David Waranch (00:23):

Hey everyone. David Waranch here. Welcome again to the authentic dad podcast. We inspire fathers on to have more connection, aliveness, presence in their life with themselves children, partners, but not just for dads, lots of women listen. And I appreciate all the women who have reached out. Give me feedback who are listening. Its for you too, even though it’s called the authentic dad podcast, women can still listen. Anyway, I got Dr. Oviedo today. He’s a psychiatrist. He specializes in addiction and this conversation is very important. We talk about opioid addiction, addiction in general, and most importantly, how to talk to your kids about drugs, about addiction. Something I remember vividly when I was a kid, how they tried to do in the eighties, you know, with those commercials with them, you know, with the egg in the frying pan, we talked about that a little bit.

David Waranch (01:15):

I don’t know how effective or not effective it was, but he gives us tips. Dr. Oviedo, about how to do that to today in the modern world, please reach out to me for the coach.com. If you are FU R T H U R coach.com, I do a free 30 minute phone consultation. I’m on Instagram, Facebook for their coaching F U R T H U R. Hope wherever you are, you’re safe and well and healthy. And I thank you all so much for your support and I’ll see you on the other side.

New Speaker (01:47):

So I’m here with Dr Oviedo, and he completed medical school at the University of Buffalo school of medicine in 2007. He’s a university of Maryland trained psychiatrist who is triple boarded in adult child and adolescent and addiction psychiatry. He currently serves as a medical director for addiction treatment at both Catholic charities of Baltimore and mat clinics or mat clinics. He has continued on faculty at the university of Maryland school of medicine as a clinical assistant professor in the department of child and adolescent psychiatry. Dr. Oviedo is on the public policy committee of the Maryland society of addiction medicine, and has been involved in several advocacy efforts related to mental health and addiction treatment. Thank you very much for joining me on this podcast. Thanks for having me. That is a, quite a biography of my friend. Very, very impressive.

Dr. Enrique Oviedo (02:46):

Yeah. So I you know, my kind of, I always knew I wanted to be a doctor and I always liked working with kids and during medical school I hadn’t planned to be a psychiatrist, but that’s just kinda what I fell in love with. And it was kind of only natural that I became a child psychiatrist. So I finished that fellowship in 2012 and went right out into practice and I plan to just, just be a child psychiatrist for 40 50 years, see kids all day every day. And what I found was even as a child psychiatrist, you end up seeing some adults, right. And so picture me in Baltimore, which sometimes gets labeled as the heroin capital of the world and seeing mostly kids, but I’m also seeing adults in the mix and I’m seeing way more addiction than I, than I planned alcohol cocaine, people trying to stop smoking and especially opioid addiction

David Waranch (04:08):

In the adults or the kids, or both

Dr. Enrique Oviedo (04:11):

In the adults, primarily in the adults. Yeah. You know, certainly in the teens, the 16, 17, 18 year olds here, you know, almost as expected, you know, experimenting with cigarettes and alcohol and marijuana, but the you know, harder drugs, so to speak the heroin cocaine benzodiazepines I was seeing much more of that in the adults than that, than I planned. And I quickly realized unless I know how to treat addiction, I’m not going to be a very good psychiatrist working in Baltimore city. So after about only one year in practice, I I decided to go back to training at the university of Maryland. I, I did the addiction psychiatry fellowship for a year returned to practice. And for the past five years I’ve been working to roll out integrated mental health treatment so that we’re doing both psychiatry and substance use disorder treatment. So somebody can just come to one place and get both both treatments if needed.

David Waranch (05:29):

And you still are seeing children and adults, correct? Yeah, no, it’s really interesting. Cause you you’re, you’re treating kids and then the adults come in and imagine it’s like, Oh, I see how this problem formed because your mom or your dad has this problem. And it’s like this whole system and you felt like you really needed that extra knowledge or toolbox to do what want it to do what I mean, addiction is a word that everybody’s very familiar with. Could we just define it? Sure. Cause it’s, you know, I think sometimes it’s helpful to know like what, what are we talking about from a psych, from a psychiatrist point of view, what do you consider addiction?

Dr. Enrique Oviedo (06:13):

So the, the core, the core element of addiction is the loss of control where somebody starts using a substance impulsively and compulsively, despite it causing impairment in their, their work, their family, their relationships, their physical health that the, the cravings and the desire to use this is so powerful that despite not wanting to use any more, that person has lost control, you know, the brakes are off so to speak and they continue to use despite negative life consequences. Okay.

David Waranch (07:03):

Right. The classic can stop and not only can stop, keep doing it despite, you know, job loss divorce, DUI any, any type, you know, I’m a lawyer, so legal problems I guess, any number of things, and what you’re talking about is substance abuse or addictions. There are behavioral addictions as well, like let’s say gambling, sex things like that is, is, would you consider that in the same category?

Dr. Enrique Oviedo (07:41):

Great question. So gambling or problem gambling is actually categorized with all the other addictions of various substances where the research done with gambling has shown that the same brain changes that are seen with somebody who’s addicted to gambling are also seeing with people addicted to alcohol, opiates, benzos. So gambling is lumped in with all the substances of abuse. There are other behavioral addictions sex pornography, internet gaming, and at least preliminarily the brains don’t match the other ones that I just mentioned. And so they’re, they’re kind of being studied, you know, separately, and there’s a lot of research being done, but they, they are different as far as the physiologic brain changes that happen compared to gambling, opiates, alcohol, nicotine.

David Waranch (08:49):

Yeah. But I would imagine, and then it sounds like more research needs to be done, but behaviorally some people with those things, Hey, they can’t stop. They’re doing it despite negative consequences in their life and so on and so forth. What do you say? I hear this sometimes where someone who let’s say as an alcoholic or as a drug addict and we hear a lot, well, they have a disease and then there’s other people who say, that’s not a disease. You know, I ha I have a disease. I have this medical problem. Do you consider it as a psychology psychiatrist, addiction to disease?

Dr. Enrique Oviedo (09:27):

Yes. So, you know, a lot of research has been done in the past 15, 20 years. And we, now we have a much deeper understanding of the genetics of addiction. So, you know, the number right now that’s quoted as about, is about 60% of people who are addicted to any particular substance that, that you can link the cause of that addiction developing it. It was in their genetics, they were predisposed to genetics. And for anyone who know somebody struggling with alcohol say it’s probably a safe bet that other people in their family also have addiction to alcohol and that it’s this kind of generational problem. And so that’s where, you know, a lot of times people with addiction, they gave, they they’re, they’re told, you know, this is just a lack of willpower. It’s just a, it’s a spiritual failing. It’s a moral deficit where, whereas I think of it as, you know, through no fault of their own, this person was genetically loaded to develop this disease.

Dr. Enrique Oviedo (10:41):

And, you know, their genes lit up and activated when exposed to alcohol and kind of the disease process took off on them. You know, we have all these advanced,ukind of brain scan tests now, MRIs and FMR rise and, and people struggling with addiction. We can see the reward circuits, the circuits going to the prefrontal cortex, which is in charge of judgment and planning and the circuits going to the hippocampus, which is in charge of memory. Th th they are altered. Uso between the genetics that we understand a lot better and what we’re seeing on, you know, brain imaging, it’s, it’s, it’s very clear that physiologic changes are happening, and this is a disease like any other disease.

David Waranch (11:34):

Yeah, no, it’s incredible. As an attorney, you, once in a while, you’ll get, somebody will call my office and they’ll need help with this or that. And we’ll look up, let’s say their background and they’ll have like 10 things on there and a telltale sign that there’s an addiction problem is let’s say three or four or theft. There’s a lot of thefts on their record. And like I said, did you have a substance abuse problem? Yes, I did. And it just, I can just that idea of this part of your brain with judgment besides probably needing money and,uvarious other things to support the addiction. I can totally imagine. Cause they’ll say, you know, as a different person than the whole thing was a blur, I didn’t even know what I was doing. And just that idea of this part of your brain, you said, particularly with judgment, I guess just isn’t isn’t working. Right.

Dr. Enrique Oviedo (12:28):

Absolutely. And people, you know, you mentioned theft, you know, people with addiction, they get, they get stuck in this cycle of being intoxicated on the substance. And then you know, especially as the disease progresses, they go from intoxication to withdrawal of that substance and then the withdrawal leaves to drug seeking behavior. So when somebody is in the depths of heroin withdrawal, which is described as, you know, one of the worst feelings, a human can feel, you know, a picture the very having the flu influenza and the very worst flu sickness you’ve ever had, you know, picture that day in and day out, people will do anything to to get out of that withdrawal state.

David Waranch (13:23):

Right now. It’s like this it’s just cycle the withdrawal and the withdrawal is so painful. Then they have to seek the drug to stop the withdraw it’s like around and around. We go let’s get a little more specific. So someone like you, highly trained addiction psychiatrist, and I know opioids is a big problem later. Maybe we can get into the Pandora’s box of, of medical marijuana and all of that. Where do you start? If someone comes in clear, they’re really struggling, let’s say from some type of opioid addiction, what’s, what’s the first step

Dr. Enrique Oviedo (14:02):

You’re going to treat them. Yeah. So a little bit of background. So we right now in the U S we have 2.1 million people with an opioid use disorder. We’ve got about a 50,000 fatal overdoses from exclusively opiates. A year 50,000 people died of just pure opioid overdose. I

David Waranch (14:26):

Had no idea it was that I had Sarah

Dr. Enrique Oviedo (14:29):

There’s. If you add up all fatal overdoses, it comes up to 70,000. And most of those, an opiate is also involved, but 50,000 a year, just, just purely from opiate overdoses and only seven, only about 17% of people have access and seek care. So it’s, you know, it’s the biggest problem we’re facing is still access to care.

David Waranch (14:57):

Huge problem, not enough support, hence I guess the name opioid crisis.

Dr. Enrique Oviedo (15:02):

So so it’s very hard for a consumer, somebody struggling with opiates to kind of, to know where to go, because you’ll have some people who will say, well, just get into narcotics anonymous and go to some groups and get a sponsor. Or a lot of people will try to go into their primary care doctor. Yeah. And, you know, some primary care doctors are comfortable treating opioid use disorder, many are not. And th they’re just, there aren’t enough. Addictionologists around to, to, to treat this problem. And that’s where there’s been this big push to ask pediatricians, internists, family medicine docs, you know, to say, you know, we in large part, the medical community created this monster with, with the over-prescription of opiates in the nineties. And it’s really an all hands on deck solution that, that we need. Okay.

David Waranch (16:04):

And everybody’s going to be able to a have insurance be able to, if they don’t have insurance or even if they do afford someone as highly trained and specialized gosh, a lot of people probably don’t have a primary care physician. And it was a really basic question, but what are some, we say, opiates, give me some exam opioids. What are some examples of like the most common ones that, that are prescribed and that people are becoming addicted to, or like, what is an opiate opiate?

Dr. Enrique Oviedo (16:32):

Sure. So we have, we have pharmaceutical opiates. So those are medicines like Percocet, Vicodin, Oxycontin, morphine. And then we have illicit opiates, like heroin, and more, more recently they’ve been mixing in a synthetic opiate called fentanyl, scrambling it into the heroin. And fentanyl is far, far more potent than heroin is. And, and even now sometimes when people go to buy heroin off the street, there’s no heroin in it. It’s just pure illicitly made fentanyl that that’s most of it’s coming over from China. And so the, the heroin of the eighties and nineties, yeah, it is, is what’s on the street today. It it’s nothing like it is so much more potent and addictive than, than it was

David Waranch (17:35):

Like, like completely synthetic from a completely something. It doesn’t come from the poppy plant or anything like that.

Dr. Enrique Oviedo (17:42):

We’re talking to a chemist and a lab mix chemicals and coming up with the most potent opiate they can

David Waranch (17:51):

And terrifying. So, and you’re saying that version a lot, this is synthetic on occasion and in Baltimore and your practice or things of that. Yeah.

Dr. Enrique Oviedo (18:02):

So in, in Baltimore, essentially almost a hundred percent of the heroin on the street is, is either pure fentanyl or a scramble of, of heroin fentanyl. It is, it is really, really hard to find pure heroin. And it’s rare that on your, in drug screening, we’ll find heroin without the fentanyl. And it’s the fentanyl, that’s the reason why the overdose numbers keep going up and up and up is heroin of the past. Wouldn’t necessarily strong enough to make somebody fatally overdose, but the fentanyl on the street now, even with experienced heroin users all it takes is a batch of heroin with fentanyl. That’s a little bit more potent than, than, than what they’re used to. And, and, and somebody dies

David Waranch (18:54):

How let’s say someone does have access to someone like you. How do we treat them?

Dr. Enrique Oviedo (19:01):

So with, with opioid use disorder specifically, there are three three medication options. One is methadone, right? I’ve heard of that. And methadone has been around since the seventies and the whole methadone clinic infrastructure was developed for all the troops returning from Vietnam, who, who got addicted to heroin while they were serving over there. So it it’s been methadone essentially since the Vietnam era. And then in the early two thousands there was a medicine that came to market called buprenorphine buprenorphine, which most people know it as Suboxone. Yup. I’ve heard of that. So the advantage of the advantages of Suboxone is that any doctor can prescribe it. It can be prescribed out of, out of any medical office. So a pediatrician, an internist, a psychiatrist can prescribe Suboxone or buprenorphine as opposed to, you know, with methadone clinics. There’s only one reason why you go to a methadone clinic it’s to go get methadone. And so confidentiality, there were some issues with confidentiality and because of all the stigma, a lot of people wouldn’t seek treatment because they thought they would be outed by going to a methadone clinic. Whereas with Suboxone, somebody can come to go, go to any medical professional and be treated and no one knows why you’re there. It’s completely essential. And then the third one, an injectable medicine called Vivitrol, that’s a once a month injection. It is a, which distinguishes it from Suboxone and methadone. And that that’s, that’s the third option.

David Waranch (20:56):

So you obviously would as a practitioner prescribe something like that medically and medicinally. And would you recommend, let’s say a psychotherapy or because I imagine there’s that physical component, but then the, what maybe got someone to try it or use it in the first place. Sometimes I see addiction as like the symptom of, let’s say depression, anxiety, trauma, and sort of that underlying thing that maybe got them on the path to begin with. Do you deal with that as well as a psychiatrist? Or is that something and say, go see the psychologist or the psychotherapist in combination with what you’re doing.

Dr. Enrique Oviedo (21:36):

Yeah. So as, as both an addictionologist and a psychiatrist, you know, so I’m looking to see, is, is there any kind of self-medication component here? Is there any underlying mood disorders, like bipolar disorder or depression or anxiety or PTSD? And then kind of based on what I find, you know, I, I help triage that person to, are they going to benefit from a therapist to do some individual therapy? Do they need some family therapy? Cause all of their family relationships are strained. Do they need a, there’s a services service called PRP that helps people, you know, all the things like getting an ID and applying for social services and getting help with sorting out all their legal issues and working on housing and you know, maybe going back to school, seeking employment you know, th there are a lot of pieces that need to be picked up and put back together when somebody is in early recovery.

David Waranch (22:52):

I mean, as you’re explaining this, it just doesn’t Dawn on me, but it just strikes me how complicated this really is because you have a person, they have an addiction and obviously their, their, their body physically is addicted to that. And there’s withdrawal and there’s medications, but then there’s so much more, maybe they lost their job, they need social services. Maybe they have an underlying psychiatric problem, bipolar depression. A lot of it could be their environment where they’re, where they’re living, where they grew up their genetics. And it’s just so complicated, especially if you don’t have the time, the resources or go to somebody like who knows what they’re doing, you know, cause I’m sure there are many primary care physicians that really qualified to handle all of the complexities of this. So it’s, it’s unbelievable. And so that, that’s why you think, I think you’re a double threat because you have the psychiatry, the child psychology background, you have the addiction specialist. It’s incredible,

Dr. Enrique Oviedo (24:04):

You know, there’s that saying that, you know, it takes a village to raise a child, you know, it, it, it takes a village to help somebody recover from, from addiction. And, you know, we, I listed all those things, but, you know, the list keeps going. You know, the people with addictions tend to have,uyou know, many, many medical co-morbidities and people who are injection drug users,uyou know, a percentage of ’em have, or will acquire HIV or hepatitis C or, you know, they’re not taking care of their, their diabetes or their blood pressure. They stopped seeing the dentist. So they start developing, you know,udental abscesses, you know, that the list keeps, yeah,

David Waranch (24:50):

It was this compounding problem, like one thing after the other. And I would imagine once they get into recovery, it takes years. And there’s probably some relapse be surprised if there wasn’t. And it’s a lifetime process of maintaining your sobriety. I mean, it’s, it’s heavy duty. I would like to shift gears slightly. This is called the authentic dad podcast, as you know, and probably you, I don’t know, I grew up in the eighties. Right. And in the eighties, they would have that. I remember this commercial, this is your brain, is your brain on drugs. Right. They would put the the egg in the pan and it would sizzle. And when I was in school, we would have the police officer come and talk to us about drugs, like the dare program. I think they called it and all these commercials, I think it was during, during Reagan. And I’m wondering, like, what would you say to fathers to, how do we talk to our kids about this? I mean, you know, obviously I’m saying don’t do drugs, you know, it’s horrible, it’s bad for you. It can cause a lot of problems, but do you have any specific strategies to talk about our children before they get to try something that puts them on some path like this?

Dr. Enrique Oviedo (26:07):

I think, you know, I, I, I remember those commercials too, and I think we’ve learned it, it, it doesn’t help to S sensationalize things, you know, our, our, our kids are smart. And, you know, for example, you know, take, take an average team, has a friend who tries marijuana for the first time as a pleasant experience and nothing bad happened. You know, that they’re going to think about that experience and say, well, everything these adults have told me is just nonsense, have no idea what they’re talking about. So so I think not, not sensationalizing, I, I think so, so we know, we know several things are protective against drug experimentation, drug use. So you know, kids, kids having a lot of structure and being involved in activities, sports and clubs, or, you know, religious groups, you know, so keeping them busy supervision.

Dr. Enrique Oviedo (27:12):

So you know, setting reasonable curfews for your, you know, teenage kids and kind of knowing where they are. And if they’re going to knowing the parents or the friend’s house, they’re, they’re going to you know, just, we know kids who achieve you know, academically who are high achievers and who are supported in their academics are, are less likely to use an experiment. But, but I think even maybe more importantly than all of that is just, just having that open line of communication. And, you know, I, I know people are vaping and jeweling and that’s the new thing. And I, and I want us to be able to talk about that. You know, I know you know, the, the medicinal cannabis is being diverted and it’s very easy for teens to get that. And if, if you have questions about it or have used, let, let’s just talk about it, you know, I’m not going to be mad. I would much rather us just talk about the pros and cons and what ifs and, you know, let’s so I think just being honest and open with,

David Waranch (28:31):

I love that, you know, being present, you know, not, not in sort of like a S a CIA way, like where are you going? Who are you hanging out with paying attention, not making the conversation taboo. I think you said something CSH sensationalizing, it like this big dramatic, you know, because I’m remembering a friend I was growing up with his father would make the biggest deal about smoking marijuana, which I think we should talk about next. But to the point, like, if you ever do that, you know, it’s, it’s going to be, you know, God only knows what does it turns out. The father was always stoned, you know, like, and of course the kid would happen. He grew up and he became the, became the same, the same problem. And I think it was really interesting. Maybe if you would have said talk to him, like you’re saying, and here here’s the, here’s the pluses, here’s the minuses. Here’s what I’m concerned about. Build trust with build presence whatever, maybe had a different outcome, but probably there’s no magic bullet or no answer. I would, I was really just curious to like, does, you know, the eighties, they, they, they did sensationalize it. And as there’s like a new model for how we can do it there’s commercials in retrospective kind of

Dr. Enrique Oviedo (29:50):

Funny. And, you know, we, we know with teenagers, we know developmentally they’re they’re thrill seekers, and they all have that, you know, Superman complex, and a lot of times, whatever you tell them to do, they’re going to look to do the opposite to, you know, the, that rebelling against authority, quality of, of teenagers. So that’s what I think, just talking about it openly and honestly, is better than the don’t do drugs. Drugs are bad approach. The one other thing I wanted to plug in was many kids have their first exposure to opiates and benzos like Xanax yep. Through the the medication bottles of their parents or grandparents that are left in the medicine cabinet.

David Waranch (30:39):

Oh yeah, yeah. Great. Grandma got a surgery and she’s got some leftover axes or something. Right.

Dr. Enrique Oviedo (30:44):

Right. The, the, you know, the typical story is somebody goes in for a surgery, gets 90, oxies uses two, and the bottle stays in the medicine cabinet, just in case people, you know, it’s not always easy to dispose of medications or people just worry that, well, if I’m in pain, at some point in the future, these might come in handy. Sure. And so many teenagers had their first exposure from old medicines in the medicine cabinet. And that’s where I’ll tell dads out there. Yeah. Buy a $15 lockbox on Amazon and all controlled substances, you know, keep, keep them locked up.

David Waranch (31:25):

It’s such a great point. And so interesting. Cause I think some people are like, I’ll just lock the liquor cabinet up and I’m like, well, that’s good, but that’s not the one you really want to worry about. I don’t think as much. That’s a really good point. Thanks for bringing. Yeah. Cause I think there’s probably half, not half, but a good percentage of people out there who have like old stuff lying around from their whatever surgery or even pregnancy. And then they tried to gave my wife some or dental procedures. She had a C-section yeah. Dental procedure. Well, I guess that’s a problem, right. They’re just giving, which is a good segue. Cause they’re, they’re prescribing this for everything. It has been said to me, by a psychiatrist that he would rather people do smoke weed because then do opioids. And his opinion was we had this sort of philosophical discussion that marijuana is a medicine that we need more research. And my observation as we, you and I spoke about is that if you feel like with marijuana, you have like the advocates who are like this cures cancer, this is the greatest thing ever. And then, and maybe I’m simplifying a little bit and then some people think this causes psychosis stay away from it. And of course, many States it’s completely legal there’s medical marijuana, but it still seems like a very, not to get too deep into it. Hot topic. So what does the psychiatrist say? The addiction psychiatrist say about weed.

Dr. Enrique Oviedo (32:52):

Gosh, where to start. So here’s what we know that the, that the developing brain, the brain does not the rain has the brain hasn’t reached full maturation till about age 25 or 26. So yes, didn’t realize it was that old. Wow. Yes. So I, I’ll kind of separate out marijuana for adolescents, young adults and marijuana for people with fully developed brains.

David Waranch (33:22):

Right. So, so let’s talk about fully developed brains and assume that a 12 year old or 16 year old should probably stay away from

Dr. Enrique Oviedo (33:33):

So th there’s there’s good research about the benefits of, of cannabis for for some conditions. So there are some, there are certain seizure disorders that respond well. And it’s helped people people with neuropathic pain or certain types of nerve pain people with HIV AIDS who are struggling with wasting syndrome and are losing a lot of weight and don’t have an appetite or people undergoing chemotherapy for cancer or spasticity associated with multiple sclerosis. So there’s really good research for, for certain conditions. I I’m even struggling to from there, where do I go? So for many conditions, especially mental health, there is not a lot of good research to suggest it improves outcomes. The caveat there is for a very long time up until just recently, it’s been really hard to do good quality research. You know, there, there’s only really, if there’s like one farm somewhere in Kentucky that has the one DEA license to grow cannabis for, for medical research. And the research just hasn’t been done. And we know, we know cannabis has like, you know, 300 or so psychoactive components and we really only know about THC and CBD cannabidiol. And then there’s a 200 other plus, you know, components of it that we just, we just have such little resources.

David Waranch (35:29):

So they’re really complicated substance with all of these. Yeah. It sounds like there’s not a lot of research done in the United States because federally it’s illegal, but I, they’re probably doing, I think in Israel and some other countries, of course they’re doing it, but, but, but here not allowed. Right.

Dr. Enrique Oviedo (35:44):

Right. So Israel you know, D does seem to be leading the way. And I, I, I feel like the, there there is a sea change happening and academic centers who up until recently wanted no part in, in cannabis research are now more open to what you, you know, when your comment about I’d rather have my patient on cannabis as opposed to opiates. You know, I, I guess I would answer that with, you know, why does it have to be one or the other? So, so we could have a whole podcast on, on patient management and, you know, the average patient struggling with pain who comes to me, you know, I’ll take a history and that they really haven’t maximized the non-opiate analgesics like ibuprofen and acetaminophen and approximation. And they’re not in physical therapy, they’re not doing Aqua therapy. They’re not getting individual therapy just to deal with the psychological effects of, of chronic pain.

Dr. Enrique Oviedo (36:59):

They’re often not dealing with the medical comorbidities, whether it’s you know, obesity or, or, you know, oftentimes they they’re like way overdue for, for a new MRI or getting in to see, you know, a specialist. And so oftentimes people start using opiates to just because they’re, they’re stuck. They don’t have the resources, the money, the transportation, just the wherewithal to get to the right people. And that’s, that’s a story I’ve heard, you know, over and over is they just got stuck. They couldn’t deal with the pain anymore. And that’s when the opiate prescriptions started, you know, unfortunately, you know, in Maryland and everywhere in the country, you know, you you know, in the nineties and two thousands, these opiate pill mills popped up and people know where to go to, to, to be guaranteed a script prescription for opiates. And you had the M J co, which is the kind of accrediting body for medical facilities, pushing that pain as the fifth vital sign.

Dr. Enrique Oviedo (38:10):

And doctors were put under a lot of pressure to get those subjective pain scores down. And it was just kind of this perfect storm for many, many people getting hooked on opiates and not really maximizing all the other interventions that we know help pain. So, you know you know, do I think cannabis can be part of pain management plan? Absolutely. we know that addiction rates for cannabis are lower than addiction rates for opiates. Yeah. People don’t overdose, people don’t die on, on, on cannabis. So it’s, I don’t think it has to be one or the other. I think they, I think opiates do have a place in pain management and I think cannabis can have a place in pain management.

David Waranch (39:02):

Yeah. It probably simplified an extremely complex question. This was sort of an off the cuff anecdotal conversation from, from a psychiatrist, but I always sort of grabbed onto that is I think he said something. Yeah, I’d rather him do it we’d than that. But very big question. I’m going to put you on the spot before we end, because this seems very important work and also really challenging work. Right? Like, so what, what, like drives you to do this? Like, what do you like for you? Like what what’s, when you think about this? Like yeah. Like what drives you, you know, Y Y Y tree heroin addict, heroin problems in Baltimore and don’t do something else.

Dr. Enrique Oviedo (39:42):

So addiction treatment never had a home for a very long time. It was really a N N a and the methadone clinic system. But, you know, mainstream medicine really saw it as this. Isn’t our problem. This isn’t, this isn’t part of traditional medicine and psychiatrists for the longest time, but say, well, if you’re, if you have an addiction, you’re not even, you’re not even a candidate for psychiatric treatment, you know, take care of your addiction and come back and see me when you’re, when you’re living. So, Oh yeah. Oh my gosh. You know, maybe up until five, you know, that’s a change in the last five, 10 years up until recently, psycho mainstream psychiatry would say people with addiction don’t benefit from psychiatric medicines or psychotherapy every addiction first and then come back.

David Waranch (40:36):

So they go to the, go to the 12th step in the clinic and come back, come back later. Right.

Dr. Enrique Oviedo (40:42):

And outcomes for people struggling with addiction have just been so poor for so long. And, and I, I saw it and, and I just said, I, I can’t watch people die. And we know when people are able to consolidate their health care medical, psychiatric addiction, if people can get everything under one roof outcomes are going to be better. And I just said that there’s no reason why psychiatrists can’t treat addiction. And, and, and, and it makes, you know, we, we were trained to talk to people with trauma and, and all kinds of mental conditions. What, why can’t we talk to people about their addiction? That that’s, what we’re trained to do is to talk to people about really hard stuff. And it just made sense that psychiatrist, where were we, we were trained to do this. We should be doing this. And I, that, that’s what drives me is I just, I, I, I, I couldn’t bear the thought of people dying unnecessarily when, when the, the effective treatments are just right there in front of us. It, it’s just a matter of people not having the access. And, and we, we need to provide that access.

David Waranch (42:03):

That is very beautiful. I think your patients are lucky to have you, I could, we just met today, but I can feel your compassion and your passion for this. And thank you for doing the work that you do. Is there anything else that people should know that we maybe missed before we wrap up?

Dr. Enrique Oviedo (42:19):

Yeah. I would say if you or someone, you know, is struggling with addiction you know, reach out for help. Tell, tell your primary care doctor, tell your therapist. If you have one, this is not something you need to be ashamed about. There is effective treatment out there for behavioral addictions, for opiates, for alcohol, for, for smoking. You know, the first step is just asking for help. And there are a lot of, there’s a lot of help out there. And if the first person you reach out to may not be able to help you, but I’m sure they know someone who is so just get the help that you need. And don’t be ashamed of it.

David Waranch (43:04):

Shame is a big factor, cause there’s so much judgment out there. And it’s so nice. I can feel your nonjudgmental vibes talking to you. So if people need a prescription, where can they find you? That was a joke. Wait, wait, wait, wait. Do you want to throw out a website or an email or anything like that? You don’t.

Dr. Enrique Oviedo (43:25):

Yeah. So SAMHSA spelled S a M H S a as a provider database for anyone who’s struggling with opiates and they’ll link you to providers who who prescribed Suboxone

David Waranch (43:46):

S a M S H n.com,

Dr. Enrique Oviedo (43:49):

S a M H S a S a.com H S a. Got it. Yup. So I would say that website, plus your, your primary care provider those are probably the best two ways to get, to get linked to treatment.

David Waranch (44:04):

Well, Dr. Oviedo, thank you very, very much. It is a real pleasure and I think very important hope people get a lot out of this. I know they will. I did. There was so many fascinating things. I had no idea psychiatrists when treating addiction until what, five years ago. Anyway,

Dr. Enrique Oviedo (44:22):

Until just recently. Yeah. We’ll have

David Waranch (44:24):

To have you back so we can, we can get into the pain management or the weed a little more. I know there’s like 10, each of those topics are like 10 podcasts or something. Sure. Yeah. Happy to be here. This was great. Thank you for having me have a great one. You too see you habit, Dr. And Rick Oviedo. Thank you so much for your time. Really enjoyed it. Super passionate. I can tell that he is about the work he does. It’s important work. And I’m so glad I was able to talk to him. I mean, he’s a friend of a friend. My friend introduced me to him, never met him before really enjoyed meeting him and talking to him. And I hope you all got something out of that, particularly the part where we talk about kids and you know how to talk to them about these things. And that’s it for this episode. Thank you so much. Again, hope you’re well and healthy and safe. And please consider giving us a five-star review. Subscribing telling someone about this take care.