Episode 125: Addiction Knows No Boundaries

Speaker 1:

You're listening to your practice made perfect support, protection and advice for practicing medical professionals. Brought to you by SVMIC.

J Baugh:

Welcome back to our podcast Your Practice Made Perfect. On today's episode, we're going to revisit prior conversations with a similar theme, addiction. Specifically opioid addiction. Since the start of the COVID 19 pandemic, our country has seen a definite increase in opioid addiction and overdose. And that's a big reason we think this topic is so important to revisit. We're going to take you through these personal and heartfelt conversations one more time today, in hopes this can help us all better recognize and understand addiction, especially for those working in the healthcare arena. Joining us today to narrate today's podcast is SVMIC's Katie Musacchio. Katie, welcome. It's so nice to have you.

Katie Musacchio:

Thanks for having me, J. I look forward to walking you all through this topic today. So without further ado, let's get started.

Speaker 4:

As we all know, the opioid overdose deaths have quadrupled over the past decade. This is a major issue in the nation and Tennessee, as well as a lot of their Southeastern and Appalachian states have been hit particularly hard with us.

Katie Musacchio:

In 2018, we sat down with two doctors who have struggled with opioid addictions, Dr. Bob and Dr. Steven Lloyd. We're going to take a look back at both of their stories. So let's begin at the start of Dr. Bob's journey with addiction.

Dr. Bob:

I took a stand at a walk-in clinic, it was a year of transition. After being at the walk-in clinic for a few months, the nurse who I very much love was a good fellow, said, "Hey, we're cleaning out the sample closet. We've got a sample carton of cough syrup. Do you want it?" And I said, "Not really." He said, "We're going to throw it away." I said, "Okay." He said, "You sure you don't want to take it home? You might want to need it for later." I said, "What the hell, I'll take it home." It was M-End or M-Clear, I'm not sure it had either two and a half or five milligrams of hydrocodone per teaspoon. And I took it home, there were nine one and a half ounce bottles, and I put them in my closet and totally forgot about them.

Dr. Bob:

And they stayed in my closet about three months until low and behold, I had a cough. I took the bottle out and a teaspoon and I made... No, I didn't do that at all. I took the bottle out and took a big slurp from it, because I had a cough. And in about 20 to 30 minutes, a feeling came over me that was so great. It was a true sense of euphoria that all is good. I'm happy. I have energy. I have focus and nothing can go wrong.

Dr. Bob:

I knew it from that moment that was something I absolutely loved. And that started what I call a 15 year love affair. And that 15 years is marked by five years of sporadic use. Another five years of fairly regular use, nearly daily, but certain lines I would never cross. And then the last five years is, I have to have this drug or I will die. And it all started from having cough syrup available to me for six months, three at the office, three at home. And I actually took it as directed and people like me get those effects from those kind of medicines.

Katie Musacchio:

So Dr. Bob went on to describe in greater detail what he calls his 15 year love affair, which you can hear in the full episode of confessions of a recovering addict. Later on that year, we also sat down with Dr. Steven Lloyd. Here's a refresh on his story.

Dr. Stephen Loyd:

I was driving home from work one day and I pulled up there in a red light on market street in Johnson city, right in front of Colonel Steve's liquor store. I reached over to my glove compartment and flipped the glove compartment open. And I still don't know what I was looking for. And there was some old norcos in there, hydrocodone that I had from a dental visit months before. And you go to the dentist and they do a procedure, and then they load you up with opioids leaving, because they don't want you to call back. And I didn't take them, it didn't hurt. So I took them in the glove compartment, and I remember looking over there and seeing it and thinking, "My patients take these things all the time." And so I took one out of the package. It was a little sample and broke it in half.

Dr. Stephen Loyd:

So that's two and a half milligrams of hydrocodone. Threw it in my mouth. And at the time I was living out in Boones Creeks, it was about 10 minutes away, maybe. And by the time I got home, I felt like I'd found a cure for my anxiety and depression. It was really the most amazing thing. And just that short amount of time. And within three years, I was using the equivalent of 500 milligrams of oxycodone a day. If you want to put that in hydrocodone terms, they're pretty similar. In Vicodin, that'd be a hundred Vicodin pills a day.

Speaker 7:

That's really dangerous. It's a wonder you're even here. That's a tremendous amount of narcotics.

Dr. Stephen Loyd:

It really is. For the longest time as it got towards the end, because this all happened over about a three year time period, three and a half years. As I got towards the end, I was so scared to count. But I knew, I knew if I got a bottle of 90 in the morning, then it was gone by the end of the day. So I knew it was over 90. The feeling there is so helpless and the things that happened, and it was just a thousand stories you look back on and sometimes cringe and almost cry. But I'll tell you one in particular, I love coaching baseball. I'm a baseball guy.

Speaker 7:

I love baseball.

Dr. Stephen Loyd:

I ran into some kids I coached this past weekend and, they're all in professional baseball now. And I've got one of my performer players is a pitcher for the Detroit Tigers. And so I had some really good players. My buddies told me I should have won more games. But we were playing in the State Little League Tournament in 2003. Nothing I would rather do than hang out with these little boys. We had so much fun, but I was addicted to pills. And we're getting ready to play in the state finals against Lexington, Tennessee. State Little League finals, Johnson city, we made it to the finals and I had the best player in the state, Daniel. I was out in the outfield, messing around with the kids before the game. And I dropped my little pill carrier. The top of it came off and I realized as we were walking into the duck out that I didn't have them.

Dr. Stephen Loyd:

And so the kids are in there, getting excited, we're getting ready to play in the state championship game. And I'm out in the outfield, digging around through the grass, looking for pills. The kids don't know that. They know about me, I've been very open with this, but that's a moment that I haven't talked about very much. That really impacts me a lot. Now looking back on it, because what a special time, what a special time with those kids. We lost. We finished runner up mainly because I'm not a very good manager. And I just think of how sad that was. I forgot about everything else at that moment.

Dr. Stephen Loyd:

And it's one of the things that... I've been on a quest for really the last 13 years to try to figure that out, how does that happen? And I actually know how it happens. The reward center of our brain, which is responsible for basically our drive to live, is a part of our brain that's hijacked by opioids or any drugs, as a matter of fact, but particularly opioids. And so literally if you're cravings for these drugs are 10 times stronger than a normal person's cravings are for food when they're hungry. So when you start to look at it in that perspective, if you don't have the drug, what will you do to get it?

Katie Musacchio:

Both of these well-respected doctors struggled with opioid addiction for a long time before they received treatment. Interestingly enough, both doctors worked with the Tennessee Medical Foundation while they were receiving their treatment to help them get back on their feet. Next, we're going to listen to their experiences before, during and after treatment. Let's take it back to Dr. Bob's story.

Dr. Bob:

The way it worked is I had a lot of friends around here. I write you a prescription, you go to the pharmacy, you pay cash, you bring me half back.

Speaker 7:

Oh, okay.

Dr. Bob:

We'll do it again next month. Which is a little unusual for an ER doctor to do that. It went from one or two prescriptions every other month to three prescriptions a month. And the second five years was probably five to 10 prescriptions a month. And in the final five years was anywhere between 20 and 25 prescriptions a month with high dose narcotics and lots of numbers of them.

Speaker 7:

And it was that agreement of, "Go get it. You get half, I get half."

Dr. Bob:

Right.

Speaker 7:

And it's really starting to grow. What happened that got you at a point that your medical license was in trouble? What was that event?

Dr. Bob:

Before I actually answer that question, I will answer it. The strangest thing is in writing these prescriptions from the very get go. From the early part, I always knew that I would be caught.

Speaker 7:

Really?

Dr. Bob:

Always knew. I was just waiting, "Is it this one? Is it the next one? Is it the one before?"

Speaker 7:

So you didn't see yourself necessarily as 10 feet tall and Bulletproof, you expected to be caught?

Dr. Bob:

I expected to be caught. I know that pharmacies have to report twice a month every controlled substance that comes into their pharmacy. And I was amazed at some pharmacist is not looking at this saying, "What is this guy writing these people all these prescriptions for?" But it never happened. And in fact, the event that actually put my medical license and my career and all at jeopardy was, a friend of mine, one of the guys from the very early get go went to junior high school, et cetera, et cetera, couldn't make contact with me. I was out of town. He went and wrote his own prescription. He got busted by it. And when the drug task force asked him about it, they pulled out basically a laundry list where all these prescriptions come to you, to your wife, to your son, to your father, to your mother.

Dr. Bob:

And of course I was writing them in their name. He was getting them filled in the same story. And when he told them that I had written them, they didn't believe him. They said that they knew me, and there was no way I would do that. They didn't know me. And that was the first shot. And then they started going to these pharmacy records, starting putting on all this together. And went around to 20 or 30 people that had been writing scripts to. And I was the very last one. And they showed up on my door, July 1st 2011. And they wanted medical records of which I had none. Obviously. They had two drug task force detectives and the medical board's investigator. And at that point I turned in a resignation letter to my partners to let them know. They refused to take.

Dr. Bob:

And I told them, "It doesn't matter whether you refused, it's going to happen." And then within a week or so, they were showing up the hospital looking for medical records. And then at that point, the chief of staff called me and advised that I get in touch with Roland Gray, who was the medical director of Tennessee medical foundation at that point. And I did. And luckily Roland was in town. And Mike Todd, who's the assistant director, both great people, I love these people. And I love the Tennessee Medical Foundation for what all they do for people like me. They met with me. And I think they're so used to having people, "Somebody else's fault." Or "I didn't do it." Or "I didn't have that big a problem."

Speaker 7:

Playing the blame game.

Dr. Bob:

Playing the blame game. I was done. I had had it.

Speaker 7:

You had hit your rock bottom again.

Dr. Bob:

I had hit my rock bottom. I was so deep that my prayers to God were, "Lord, strike me suddenly sober or don't let me wake up." And when I woke up, I was mad at God for not doing his job. Would I have killed myself? Absolutely. I had a nice life insurance plan. I'm sure there's a suicide writer on it. And there's many a night when I got off work at one or two in the morning that I went up to the Natchez Trace Bridge and tried to figure out how I could drive my vehicle off the bridge to make it look like an accident. I'm not afraid of dying. I'm afraid of being maimed and leaving people, somebody within that shape. But I didn't know about recovery. I didn't know, to be honest and just go seek help. I was so worried about everybody knowing. And obviously because of that, I got a much worse consequence. And I was just scared. Just scared. I couldn't live with the dope and I couldn't live without the dope. And I just saw no way out, no way whatsoever.

Katie Musacchio:

Later on that year, we sat down with Dr. Steven Lloyd. Let's take a listen to how his journey unravels. The moment he decided to receive treatment and what drove him there.

Dr. Stephen Loyd:

I was taking my son down to meet my dad. My dad's an outdoor guy, loves to hike and all that. And my son was nine at the time. And so took him down to Jonesborough to meet my dad to go hiking. And I used to carry my pills in the drink holder in my truck. Right out in the open. Right there. Hundreds of them. And so I took Heath down to meet dad, and I met him in the grocery store and he walked around the front of my truck. And to this day, even when I'm telling you this right now, I could have sworn I saw my dad walking away with Heath. "Steve, we're going to take hiking. I'll bring him back to the house tomorrow. So I saw him walk away. I reached over, I had 10 milligram Percocets in my drink holder.

Dr. Stephen Loyd:

I took 15 of them. That's 150 milligrams right in my mouth. That's 150 milligrams of Percocet like that. And soon as I got them swallowed, didn't take some to swallow 15 of them at once. I turned around and my dad was standing right there. Right at my window. And he looked at me and he said, "Steve?" He said, "Did you just take a handful of pills?" You know what my answer was? "No." I didn't do what you just saw me do. That was my mindset. And he shook his head and said, "All right." He said, "All right." He said, "Be careful going home." I said, "Okay, dad." So next day when I was coming home from work, I ran in the corner. My house was up on the hill and I saw my dad's truck in the driveway of my house.

Dr. Stephen Loyd:

I knew what he was there for. I knew before I ever pulled up in the driveway and I pulled up in the driveway and he's standing there and he say, "Steve." He said, "We need to go see your sister." My parents had gotten divorced about 10 years before. And me and my sister were estranged. I hadn't talked to her. And I said, "I don't want to go see her." He said, "Yeah." He said, "Let's go." So we got in the truck and we headed down the road and we get out to the interstate and he looks over at me, he says, "Steve." He said, "Do you have a drug problem?" I said, "No, dad, I ain't got a drug problem." I said, "I'm tired. I'm working multiple shifts, multiple hospitals. And I'm young. I'm trying to get my practice established."`

Dr. Stephen Loyd:

And he said, "All right." We drove another couple of miles up the road and he put his hand over on my knee. And he had a little tear in his eye and he said, "Steve." He said, "You got a drug problem." And [inaudible 00:13:39] just broke down. I was the guy out in the middle of the ocean, drowning and somebody drives by or comes by in a boat and throws you a life ring. And that's what dad did. And I looked at him and I started crying. I said, "Yeah, dad, I do." And I said, "I'm going to lose everything." I said, "I'm going to lose my medical license. I'm going to lose my house. I'm going to lose my family. I'm going to lose my courage." And he shook his head and he said, "Yeah." He said, "But none of that stuff is going to do you any good if you're dead."

Dr. Stephen Loyd:

And I haven't really been able to figure out to comeback for that one yet. So we got over to my sister's office and she's there. She's the one who actually told him, she thought I had a problem. She saw me at Walmart or somewhere and said, "That's not my brother anymore." And so she started-

Speaker 8:

She could see it. Yeah.

Dr. Stephen Loyd:

And by the way, she have a great relationship today. So ironically, it brought that relationship back full circle. But she got on the computer and said... Basically just Googled drug addicted doctors in Tennessee. What pops up? But something called the Tennessee Medical Foundation. She said, "Have you ever heard of it?" I said, "Nope." I said, "There's a guy here in Johnson city who is the branch of it up here. He's named Jack Woodside, a family medicine physician."

Dr. Stephen Loyd:

And actually at my school, I work with Jack. I knew him. And so I called Jack and he said, "Yeah, come see me." I can went and saw him the next morning, and I told him everything. And he said, "Yes, Steve." He said, "You're going to need help. You're going to need treatment." And so he put me in contact with the TMF, they gave me a list of places I could go. And there was one in Nashville called the Center for Professional Excellence, CPE. And it was at grasmere. And I love Chip Dod to death. Chip saved my life. But I tell Chip, I said, "I didn't really research you very much, buddy. You were in Nashville. My best friend lives in Nashville. And my wife is going to kick me out of the house. I know it. So at least I have a place to go when I get out."

Dr. Stephen Loyd:

So, that's how I pick CPE. And so the next day I was on the road from the Tri-Cities down to Nashville. I still had pills in my pocket. I still took pills all the way down. A matter of fact, the last pills that I ever had, I walked to the corner of the parking lot at CPE. And at the time the gorillas were just on the other side of the fence and I tossed the lord tab over there to the gorillas. I hope I didn't hurt them.

Speaker 8:

I was going to say that did the zookeepers thank you for that.

Dr. Stephen Loyd:

Yeah. That's if you see some withdrawing gorillas down there, it was me. But I walked in CPE and they took a look at me and said, "You need to go to a Vanderbilt for detox." And so I spent five and a half days at the Vanderbilt Institute for treatment addiction. I want to say something about that. There were 24 people on my service, including me. At the end of that five days, I was the only one of the 24 that got to go to treatment. The rest of those kids went back to the street. And I think about that every day. There's not a day goes by that doesn't cross my mind in one form or another.

Dr. Stephen Loyd:

And these are great kids. They're young. They're kids. The little girl who was next to me is from Mount Julie. She was 19. I just won't forget them. But I got that help there at Vanderbilt then went to CPE. And the very first night I got out of CPE, they had a doctor's meeting for impaired physicians at Baptist Hospital downtown.

Dr. Stephen Loyd:

It was in July 13th. And it was hot. And I had on a sweatshirt and I walked in and I met a guy named Roland Gray. He came up to me, he knew I was going to be there. He put his arms around me and he said, "Steve." He said, "You're going to be okay." And that night, those guys and women in that room, I went around and they told how they got there. And I'm sitting there drug addicted, coming off, freezing to death. And I hear one guy who is the chief of orthopedic surgery at his hospital. Another guy that's moved into hospital administration, and he's the CEO of his hospital. Roland gray, who was a pediatrician who is now the medical director for the Tennessee Medical Foundation. And it went like that all the way around the room. And for an hour, I felt better.

Dr. Stephen Loyd:

I was sitting there thinking, "These guys lives don't appear to be over and they've done some pretty bad stuff. And some of them done stuff worse than me." And I started to get some hope. So if you're out there right now and somebody like this, first of all, get involved. I see people all the time, "It's none of my business." It's absolutely your business, they're going to die. And I don't want to go to their funeral. Get involved. The second thing is, call the Tennessee Medical Foundation. Now Roland has since retired, but we have a new medical director, Mike Barron, who is every bit Roland Gray.

Speaker 8:

He's a great guy.

Dr. Stephen Loyd:

He is. Mike is kind compassionate. He is incredibly nonjudgmental. I really couldn't think of anything that Mike wouldn't help me with now. So our physicians in the state need to realize this resources here. And the weird thing is I'm a proud member. I've been a member of the TMF for 13 years now. And I'm very proud of that. When I go to get credentialed at a hospital or I took a job that I have now, he says, "Have you ever had an issue with drugs or alcohol?" And I write, yes. Please contact Roland Gray.

Dr. Stephen Loyd:

I have never even gotten a whisper back about that because I have maintained what I was supposed to do in my program with urine drug screening. I completed my five year contract. I signed a lifetime contract after that, because if I relapse, I hope I get caught early. I don't want to die. And my life has done nothing but climb up. So for the people out there right now who are still like that, you don't have to keep living like that. It's a horrible existence. Do I struggle now? Heck yeah. I've emotionally relapsed about 10 million times in the last week, but I have picked up. And I've been given tools and I've been given resources and the friends I have are all friends I met through the TMF.

Katie Musacchio:

Addiction signs are out there. Dr. Blake, a pain physician out of Chattanooga, Tennessee spoke with us in may of 2019 on opioid use risks, along with ways to recognize abuse versus misuse. Let's take a look back at this conversation.

Dr. Rett Blake:

There are some ways to screen for the risk of addiction. And there are some ways to screen for the risk of abuse and misuse. But you're right, it is difficult for physicians to identify that. When we look at whether or not physicians are good at screening for the potential for abuse, there was one study that says that when we just use the "eyeball method" of is my patient at high risk for opioid abuse, the physicians were wrong about 95% of the time.

Dr. Rett Blake:

Now that was just one study. Most of the studies say that we're wrong about 50% of the time. And that's not an implication of physicians not caring or not doing what they should be doing. It's just that's an extraordinarily difficult task to look at a patient and identify whether someone is at high risk for abuse of an opioid or any other medication. It's a tough thing to do.

Dr. Rett Blake:

There's often a lot to that story and opioids have the potential to cause euphoria in some people. They don't cause euphoria in all people. Most people, they take opioids and it makes them feel nauseated that it helps their pain, but they don't like the way it makes them feel. But in some patients, they take an opioid and it makes them feel great, buzzed or high. And so people take it for the same reason that they would use any other recreational drug, whether that's marijuana or cocaine or alcohol, so it can cause a euphoric effect.

Dr. Rett Blake:

And so if you're taking a medication that was prescribed for pain, but instead you're taking it because you like the euphoria that it causes, that's abuse as opposed to misuse. So it's the reason that you're taking it. If you are abusing a medication and you like the euphoric effect of it than you are obviously much more likely to develop an addiction.

Katie Musacchio:

Addiction can affect anyone. Through the stories told today by Dr. Bob and Dr. Lloyd, as well as the conversation on abuse versus misuse we heard with Dr. Blake, we can see the many ways that this disease can manifest. We're so thankful to have had the opportunity to speak with these doctors. Before I pass it back to J, our host, I would just like to share that I've enjoyed narrating this episode and having the opportunity to share again, these stories of addiction and recovery. We truly appreciate the perspective and personal stories that Dr. Blake, Dr. Lloyd and Dr. Bob have shared with us today. I would also like to add that while in Tennessee, our State Physician Health Program is the Tennessee Medical Foundation. Your state likely has its own physician health program. And as Dr. Bob and Dr. Lloyd both have shared, it is absolutely worth reaching out. We will link the TMF in our show notes, but please do look up your own state's physician health program if you need to.

J Baugh:

And this wraps up today's episode, we hope that revisiting these personal stories of pain and eventual rehabilitation has helped us shed some light on opioid addiction in the healthcare world. Thank you, Katie, for taking us through these important conversations. This is such an important topic to revisit. You did a wonderful job walking us through. Thank you listeners for tuning in to today's show. If this topic is of interest to you and you would like to listen to the original episodes, we have linked to those episodes in the show notes.