Richard Hession, CEO of BlueCrest Recovery Center talks with special guests Dr. John Kakowski and Mark Bonanni about Suboxone.

Transcript

Richie Hession

So, we’re here. Mark, welcome back. This is our third podcast. We’ve done one on the Emma Semler case, which got a lot of feedback because I’m still sad over the whole thing. We did kind of an easier one on interventions, important, but easier and a little shorter. This one we’ve kind of been … I didn’t want to lead out with this one because it’s probably going to be kind of brutal.

Richie Hession

But we’re going to do … Today’s podcast is going to be about, really it centers on Suboxone, it’s about medication-assisted treatment, but we’re not really looking to cover the pros and cons of medicated-assisted treatment. Mark and I really want to talk about the cons of Suboxone usage, but we’re going to talk about that aspect of medication-assisted treatment as the two main … and John … let me tell you who I’m here with.

Richie Hession

So, I’m Richie Hession. This thing can be found, this podcast, apparently I have to tell this every time, is available on the major streaming platforms, iTunes, Spotify, SoundCloud, and YouTube. Richie H, The Other Side, or something like that, whatever we’re called. The Other Side with Richie H. I want to tell you who we’re here with. I’m Richie H, and then we’ve got Mark Bonanni, and Mark is an Outreach Coordinator at BlueCrest. And then we’ve got Dr. John Kakowski. John is … I can tell everybody who you actually are, right?

Dr. John Kakowski

Of course, yeah.

Richie Hession

John is a formerly licensed pharmacist who, let’s be honest, John, you had some problems-

Dr. John Kakowski

Yes.

Richie Hession

And he kind of lost-

Mark Bonanni

That’s an understatement.

Richie Hession

He might have lost his license a little bit.

Dr. John Kakowski

Just a little bit.

Richie Hession

But now he’s recovered for some years. And, again, a separate topic conversation, but a really good program that they did put into place, you were the first person that actually entered into that program, and thank God for these programs in the state of New Jersey because any normal … “normal” person … people who, outside the understanding of the addiction world, would look at somebody like John, who got caught up in addiction, crossed a line, was sneaking meds out of his whatever, out of the CVS or wherever the hell he worked, and they would say, “Off with his head,” and that’s all …

Richie Hession

John’s a rockstar and cares more about these people than any pharmacist or even medical professional, personally that I’ve met and sat down with, and has done a total 180, his life is astounding. He’s a supervisor and he runs Cornerstone Sober Residences, and he’s about to get, hopefully, if the board’s watching, he more than deserves getting his license back, way more than deserves it, and he’s on the path to getting that. And John is super smart, and he’s very well-educated, and he understands addiction, understands medication-assisted treatment unbelievably well. We’re lucky to have you sitting in, talking on the podcast. And if any of the stuff that I just said you want cut it out, we can cut it out for you later.

Dr. John Kakowski

No.

Richie Hession

We wear it all, we just throw it all out there, man, it is what it is. So, yeah, we’re going to talk about Suboxone, mainly. And subs, Mark and I have a big thing. You know what, we’re going to be streaming consciousness is what we always are, we’re going to jump around topic to topic around subs. But we get infuriated, right, because Suboxone is not a curative, neither is Vivitrol, there is no medication that can cure you of addiction that I’ve ever heard of, that I’m unaware of. Science may one day accomplish this, but-

Mark Bonanni

Hasn’t done so yet.

Richie Hession

Hasn’t done so yet. So-

Mark Bonanni

[crosstalk 00:03:33].

Richie Hession

There are good tools that they’ve come up with, right, and so medication-assisted treatment as a tool. And even the guys … We had watched some of the clips from when you went to that with the Attorney General and they had … there’s panels everywhere now, all the politicians want to talk about it, and everyone comes up and all of a sudden a lot of people become semi-experts on addiction treatment, apparently. Some people seem to be under the illusion, in my opinion and my personal experience it’s an illusion that Suboxone is some curative. I mean certainly if you’re into harm reduction, Suboxone is definitely a curative of sorts, right? I mean crime statistics can go down, and it keeps people … it’s the old methadone experiment revisited, right? I mean wouldn’t you say?

Mark Bonanni

Yeah, 100%. And the thing that I disagree most with all of it, and might as well put this out in the beginning, is that not that it doesn’t have its place in treatment of addictions for opiate addiction, but that … and I see it repeatedly said in article after article after article that it is the gold standard of treatment. That’s my problem. The problem isn’t that it’s used, because it’s got its use cases in all forms, even sometimes maintenance, I think we can agree, for a certain population. But now that we’re pushing it as the gold standard, the go-to, the thing that’s going to solve the opioid epidemic-

Richie Hession

And they’re trying to, and they’re also, by the way, marijuana now all of a sudden is supposedly-

Mark Bonanni

In this state-

Richie Hession

It’s totally insane that marijuana is going to help cure opiate addiction is … I can’t even imagine people say that out loud, it’s astounding to me, but we’re not … I’m going to try and stay away from the marijuana, we’re going to have a whole separate podcast on the marijuana thing. But not only, yeah, gold standard, true, they want to incorporate it where they want to try and force treatment facilities of all ilk to mandatory that you have medication-assisted treatment. Now, if you tell me “mandatory,” we’re big proponents at our place, we do Vivitrol, it’s a good tool. It’s not curative, but it’s a great tool-

Mark Bonanni

Early recovery tool.

Richie Hession

John, why is Vivitrol a great early recovery tool?

Dr. John Kakowski

Vivitrol is great because the fact that you can use it, number one, it’s very easy to use for somebody who is off opiates. You can start them off on a tablet, you can work with insurances, they’ll pay for it, there’s more acceptance of it today. The thing with Vivitrol is also that it decreases cravings. So, if you look at the studies that are associated with it, it can decrease cravings, which is very, very high, usually in early recovery, usually in 1 to 3 months, 1 to 6 months. And, basically, if somebody tries to use while they’re on Vivitrol, it will block it. So, there is-

Richie Hession

So, it’s a blocker?

Dr. John Kakowski

It’s a complete antagonist.

Richie Hession

So, if a heroin addict gets a Vivitrol shot, when they’re leaving rehab is the most ideal time to give it to them, right. Typically, the process that we, as I understand it is-

Mark Bonanni

Or jail.

Richie Hession

Or jail. Well, and we’re going to talk about that. But, typically, for us, we’ll give somebody … they’ll go on naltrexone for a few days to a week to make sure that they don’t have any adverse reaction to it; also, you have to have your liver levels checked, right, because it also passes through the liver. You understand this better than I do, but we have to make sure that their liver can accept that type of a shot and that it will process appropriately. Once we see that after the first few days, now, if this is done right by each of the treatment facilities, if you’re a proponent of Vivitrol, you’ll prepare them for their graduation and when they’re going to leave, and then you’ll give them the naltrexone, and then they’ll get their shot, and then they go out into the world. And, basically, for 28 days?

Dr. John Kakowski

Yes.

Richie Hession

For 28 days, they can’t get high. They can go buy heroin and they can shoot it, intravenously, it won’t get them high. Then they can do another shot, and it’s still not going to get it-

Mark Bonanni

Tried it, didn’t work.

Dr. John Kakowski

And that’s an important point because what’s the biggest thing, right … So, we have some other medications that are used for, let’s say, for alcoholism, one of them is Antabuse. If you take this Antabuse, if you drink you’ll throw up, right, so there’s this negative conditioning-

Mark Bonanni

Violently ill.

Dr. John Kakowski

Violently ill. With Vivitrol, once you get the shot, you’re covered for 28 days. So, you talk about med compliance, med compliance is very important because if you’re giving a pill, you have to talk something daily, but it’s ingrained in your head, “If I don’t take this pill, I can get high.” At least with the Vivitrol, you have now a more positive med compliance with it.

Richie Hession

Yeah, for 27 days.

Dr. John Kakowski

Right.

Richie Hession

And let’s call that what it is, right? If I’m an addict and I’m not … See, this is where everyone is in agreement, or at least from what they say when I hear all the panels and all the different experts talking about it and all the politicians are talking about it. One thing they do throw in is that it’s not just the medication-assisted treatment you give, you also need the accompanying psychosocial service.

Dr. John Kakowski

Yes.

Richie Hession

And they all say that, and they’re 100% correct. And the truth is, you know, Vivitrol parents, I’ll tell this to parents, if any of them are watching the podcast, if you think that just getting your kid a Vivitrol shot and they’re good, you know, go back to college and live your life normal-

Dr. John Kakowski

No.

Richie Hession

What happens is on day 23, I’m making this up, they start thinking, “I got the shot set up on the 27th day, or the 28th day, but, you know, maybe …” now, again, I’ll throw this out there, as well, really you should set the shot up on the third week, it should be day 21 or 22, that way if anything happens where you can’t get there, the doctor can’t be there, there’s an issue with the train system or a power outage. If you leave it to the 27th day and they can’t go for three more days, guess what, that’s a window where they can actually be getting high and it will no longer be blocking.

Richie Hession

So, we try and do it a little earlier, just in case, because it can bridge, like it doesn’t have to be exactly, and you can do it a week earlier. But then they start thinking on day 23 about “Maybe I won’t go get that shot,” and once that … That’s why the other, the actual treatment work that you have to do to get yourself and your mind to shift so you can be taken beyond where you are in that urge or that thought to go do the thing that you know is going to destroy everything for you, which is what people don’t understand about addiction, like, “Why would anybody do that?” They can’t not do it.

Richie Hession

And the mind kicks in, and they start thinking and they minimize, and they start thinking, “This time it’s going to be different. I don’t need these shots.” And on day 27, they cancel the appointment, and on day 28 or day 29 they’re out there and they’re getting high all over again. Vivitrol is not a curative, but, for those 27 days, that gives them 27 days where they know they’re not going to be able to get high anyway, “Let’s do some work.” Psychosocial services, that’s where the other 12-Step work, or the counseling work, or whatever it is that you’re doing to try and get recovered, you’ve got 27 days that you’ll be all right.

Dr. John Kakowski

And I just want to highlight-

Mark Bonanni

For opiates.

Richie Hession

For opiates.

Dr. John Kakowski

For opiates.

Richie Hession

We’ll go there in a second.

Dr. John Kakowski

I want to highlight that, too, because if you look at basically how the opioid epidemic is being sensationalized in the media, all we hear about is addiction, addiction, addiction, there’s not mental health piece, right. So, that also comes with the counseling, where addiction and mental health counseling or treatment or whatever has to come hand-in-hand. So, we’re very focused on addiction treatment, even in the prison systems and the jails, but the mental health system isn’t great, it’s not good at all, we’re just focusing on the addiction piece.

Dr. John Kakowski

Now, it’s great if we can have people, if they’re receiving Vivitrol and they’re going to treatment, simultaneously get that mental health, as Richie had mentioned, Vivitrol is by no means a curative, it is just a tool of many tools in a toolbox. And this is not something that you just give and, boom, you’re cured, and that’s it. It’s an ongoing process, and it’s an ongoing process with you might need medication for mental health, if there’s depression, anxiety, bipolar disorder, you know, what is the real reason why somebody is using, specifically opiates or whatever the case is. And having Vivitrol in that toolbox is great, but it’s also not a monotherapy-

Richie Hession

No, you have to get down to causes and conditions-

Dr. John Kakowski

Absolutely.

Richie Hession

Bottom line, what’s underneath. And then the caveat to it, which is what Mark was alluding to, which is so true, is it’s not a curative in other ways because we know, we see it happen all the time, people get Vivitrol and they can’t get high on heroin, so guess what they do?

Mark Bonanni

Smoke crack.

Richie Hession

Crack cocaine. They just get high on coke, or they get crack, or they smoke pot, or they drink, it’s not a blocker for any of that. There’s an argument that you can get Vivitrol and it’ll actually also help control your cravings for alcohol and for other things. And whether that’s true, I don’t know, but I can tell you that we see people that, when they’re on Vivitrol, they go and they start doing other drugs.

Mark Bonanni

I’ve been on naltrexone before, and I’ve drank, and I’ve smoked crack, I’ve done all that stuff-

Richie Hession

I wanted you on this podcast, Mark, because in case, now, John, I don’t know if you know Mark’s story, and Mark gets mad, Mark’s like, “I never did that,” and I remember it different from back when he was a kid, but-

Mark Bonanni

I did not dig it out.

Richie Hession

When he was 20, he got those blockers, you know how you have that … they used to have the surgery, where they inserted the … and John took a-

Mark Bonanni

Pre-Vivitrol.

Richie Hession

He took a kitchen knife at his mom’s house and tried to dig and pull the-

Dr. John Kakowski

That’s very common. People take the implants out, I mean-

Mark Bonanni

I had the implant, four of them.

Richie Hession

Removing your own implants, that’s insane. He had four different implants done. Mark’s been there, done that, done it all, when it comes to … So, we talked about Vivitrol a little bit, which I wanted to because I’m a big proponent of Vivitrol as a tool, that’s how we use it, while we do the other work that can actually help you to recover from alcoholism and addiction.

Richie Hession

Now we move on to the main thing, which is Suboxone. I’ll start off by telling just an interesting story, and it just shows our mindset of it. Mark and I were on … and this is one thing that you always like to say, and it’s so true, and so I bring it up all the time. You’re out … and so we were on some … We were at one of the events, of the addiction symposiums or wherever we were at, and we were walking around, we were engaging and talking to people, and we started talking to some doctor.

Richie Hession

And this guy was a big proponent for Suboxone. He was telling Mark, and he and Mark and I are talking to him, nice guy, he was very well-educated, and he was like, “Suboxone’s not a drug. Suboxone,” and he goes into Mark and I all the benefits of the Suboxone, and longterm usage, and whatever. And so Mark was like, “I’m sorry, did you say that Suboxone’s not a drug?” And the guy’s like, “Well, I mean it doesn’t get you high,” and Mark said, “Really? It doesn’t get you high? I’m guessing you’ve never taken Suboxone before.”

Richie Hession

And the guy’s like, “Well, no, I’ve never taken.” Mark said, “Well, I would posit to you,” you didn’t say it that way, that’s what I would have said, but you basically said to him, “Well, I’ll tell you that if you took just one milligram strip of Suboxone, and I gave it to you now and you ate it, within 20 minutes you’d fall on the floor, you wouldn’t be able to get up or move, you’d be wasted beyond belief, probably couldn’t even talk, and you’d be high for 12 hours.”

Mark Bonanni

Itching, scratching, throwing up.

Richie Hession

Itching, scratching, maybe even throw up the way you would on heroin. That’s not a drug, and it doesn’t get you high? It makes no sense. But a lot of the guys that are out there talking about it, they don’t know, they have no idea, they don’t know what it is that these folks are on. If a regular person, or somebody who’s, what do you call it, heroin naïve or opiate naïve, takes one of those, it’s you’re lights out, man, you’re high as a kite.

Mark Bonanni

Yeah, for a milligram, I think I’ve read 30 milligrams of oxycodone is equivalent to 1 milligram of Suboxone.

Richie Hession

Would you agree?

Dr. John Kakowski

It’s a very strong drug, I mean just by nature.

Mark Bonanni

Super potent opiate.

Dr. John Kakowski

Yeah. I mean just think about it this way: if somebody is on opioids, and let’s say they’re high, and they’re going in to get Suboxone, they have to be in withdrawal to get that Suboxone, and the reason is is because Suboxone is so strong, it actually goes into the receptor-

Mark Bonanni

Yeah, it’s a binder, it’s stronger.

Dr. John Kakowski

Yeah, it kicks off the existing opioid. Now, while it kicks off that existing opioid, what is happening is that the patient is in withdrawal because the receptors are clear. It takes a little bit of time for the Suboxone to shimmy its way in there.

Mark Bonanni

And it doesn’t fit the puzzle perfectly, so it’s not a full agonist, so it’s not-

Dr. John Kakowski

Yeah, it’s a mixed agonist and antagonist. And by agonist, it basically will activate and get you high, and antagonist meaning that it will basically block other opiates and displace other opiates, so that’s where the mix nature of Suboxone comes in of being an agonist and antagonist.

Richie Hession

Again, outside of the treatment industry, there’s so many aspects of this and who uses subs and longterm, like I get the need for longterm, and that’s why I say this whole thing is stream of consciousness because everything leads to something else. In the end of the day, these are … John was at a … they have so many of these drug panels now, and opioid conferences, and symposiums. We’re at one of them, and I go, and John’s there, and John does all the stuff, he’s in McGreevey’s Reentry Program for prisoners coming back out of prison, which we’re going to talk about in a second, as well.

Richie Hession

So, John had these things, and I’m looking at it, and you see … and I’m not going to mention the politician’s name, but they were one of the local politicians, a New Jersey guy, and he was up there and he was touting these unbelievable benefits of Suboxone, how it’s a curative, and of course they love it in and of itself and so do all the sheriffs, and I get it, it’s not lost on me, I see the benefit for crime reduction because you do, you see crime reduction, you see harm reduction overall, and people’s big thing is, “Well, he went back to work, and now he’s showing up for his kids and picking them up from school.”

Richie Hession

And, yeah, I guess that’s good if that’s as best as you think the guy’s ever going to be, while it lasts, until he goes back out and he gets high again. But, anyway, we’re at these symposiums, and you hear these politicians and they’re touting these unbelievable benefits. And then you look and you see all the signs all over, and you see in this amazing lunch, a beautiful, beautiful conference that they put on with this great food. And then you see the little fine print, “Paid for by such-and-such” pharmaceutical company that is a maker of Suboxone. I mean, come on, guys, are you kidding me or what?

Richie Hession

And they’re out there, it’s like an ad campaign. Mark and I were just reading The Associated Press, some lady, the author was Lauran Neergaard, and it was their Health and Science Department, and they basically put out this piece, and I’m paraphrasing, and you can go look it up or whatever, and I’m not calling anybody out on anything particular, but it’s just this particular article said something to the effect of that subs and methadone are really just very weak opioids, and she kind of marginalized what they are-

Mark Bonanni

I’ll show you.

Richie Hession

Yeah, he can show the article.

Dr. John Kakowski

That’s insane.

Mark Bonanni

Weak opioids.

Richie Hession

This comes from The Associated Press Health and Science Department, and they’re literally saying this, it’s almost like a big campaign. Now, and we all know what’s going on, right, and I love their studies, the studies they’re doing, “We’re doing studies.” And one lady, John, who you actually like, what’s her name, Nora what?

Mark Bonanni

[Nora Volkow 00:17:29], she’s the national drug czar, essentially, in the United States, right?

Richie Hession

I’ll tell you now, she’s amazing-

Mark Bonanni

She’s doing studies-

Richie Hession

I’ve read a lot of her stuff, she’s astounding, and she does a lot of these studies, and what was the study that she was … She was positing that-

Mark Bonanni

They’re going to do a study on successful longer-term MAT, specifically on Suboxone maintenance, and how they’re brain is repairing, because we know that opiates and opiate abuse changes the wiring of the brain and brain chemicals and all that stuff. So, they’re thinking, the theory is that people stabilized on longterm Suboxone, that their brain is going to repair itself. I don’t really understand-

Richie Hession

But you said it’s going to literally repair the pleasure of-

Mark Bonanni

The pleasure pathways.

Richie Hession

The pleasure pathways is what she’s intimating-

Mark Bonanni

That somehow-

Richie Hession

Now, again, I can’t-

Mark Bonanni

And that’s why they were saying here-

Richie Hession

She’s a rockstar.

Mark Bonanni

[crosstalk 00:18:17] the line is-

Richie Hession

The lady, Nora, is a rockstar, she knows more than I’ll ever know about the science behind any of this, and all three of us put together-

Mark Bonanni

Yeah, she’s a doctor.

Richie Hession

Man, she’s an amazing doctor, and she’s really very helpful of the addiction community, it’s just an interesting … and I’m not suggesting that Nora is funded by a drug company, she’s in this game for real. And if there is a way to show that it would actually, I’m open-minded. The problem is-

Mark Bonanni

Let’s see it.

Richie Hession

There’s the science versus what we see. I’m a yo-yo, right, like we see-

Mark Bonanni

Absolutely.

Richie Hession

What I’m talking is kitchen-table logic, I see what I see every day, dealing with this stuff for 22 years, not in a scientific capacity, but dealing with addicts, and watching the reality of what happens versus what some of their hypotheses are.

Mark Bonanni

Believing what I see. Believing what I see on a day to day, year over year basis.

Richie Hession

And we know people who have been on longterm Suboxone maintenance, and how many people have we had to come into our rehab, where we get the call where the drug that they’re looking to get off of is Suboxone? And they’re hooked on it-

Mark Bonanni

Too many.

Richie Hession

And they don’t want to live on it anymore, and they want to get off it.

Mark Bonanni

They can’t get off.

Richie Hession

The withdrawal is insane. If you’ve ever … If you know anything about heroin withdrawal, and you know better than most, heroin withdrawal, how many times did you withdrawal on heroin, even in jail, on the floor of a jail, you hear the story all the time, because they don’t have it and they’re puking and shitting everywhere, and everyone else who’s in the cell with you, they hate your guts because you’re-

Mark Bonanni

Hot, cold, sweating-

Richie Hession

For five days, you’re a mess-

Mark Bonanni

Don’t sleep for a month.

Richie Hession

Oh my God. But that’s heroin.

Mark Bonanni

Or oxycodone, right.

Richie Hession

Or oxycodone. But now you look at subs, the half-life of subs, right,-

Dr. John Kakowski

The half-life is insane, and even with methadone, too.

Mark Bonanni

What is it, 42, 72 hours, or something like that?

Dr. John Kakowski

It could be 24 to 36, and depending on the patient that’s on it, depending on their system, but it could be about a day, so you’re looking at withdrawal, heroins could be 4 to 7 very intense days, but Suboxone, they say, “It’s weaker,” it’s still intense, but it’s for much-

Mark Bonanni

It’s less intense, but for-

Richie Hession

Longer periods-

Dr. John Kakowski

It’s still intense, but it’s much longer.

Richie Hession

Longer periods of time.

Mark Bonanni

I know people that didn’t feel right for six months.

Dr. John Kakowski

Absolutely.

Richie Hession

And keep in mind, when people first come in, one of the things that keeps them from seeking treatment in the first place is they don’t want to be sick. They know what that’s going to look like, and they do not want to walk down that road. They know how it makes you feel. Subs are even worse, it’s very hard to come off of subs once you’re on it. Again, it leads into, and, again, we can in so many paths, but we’re talking about the pharmaceutical companies, and how the pharmaceutical companies are … there was just a lawsuit settled, $1.4 billion settlement. Right, $1.4 billion?

Mark Bonanni

$1.4 billion. The largest ever, so far.

Richie Hession

And what was the nature of the suit?

Mark Bonanni

False and misleading marketing practices. Basically … And it also-

Richie Hession

That it’s not addictive.

Mark Bonanni

Procreating an army of marketers to get out and to get more doctors to write more prescriptions, that it’s not addictive, that it’s not abusable, and it’s not divertable. What I tell people all the time-

Richie Hession

And their ad campaign is successful. They’ll pay the $1.4 billion, they’re going to make a lot more than that on the backend, first of all-

Mark Bonanni

Of course-

Richie Hession

And second of all, it’s-

Mark Bonanni

They paid that $1.4 billion without even blinking an eye.

Richie Hession

They’ll take-

Mark Bonanni

They’ve done enough to-

Richie Hession

Yeah, absolutely.

Mark Bonanni

They’ve done enough to already get the masses to believe that this is the solution, so every level of government and doctors-

Richie Hession

They all believe it.

Mark Bonanni

And healthcare, they all think that this is the answer, and they’re all willing to write it and prescribe it.

Richie Hession

Absolutely.

Mark Bonanni

Then you got doctors that are making a business out of it, charging 250 to their clients once a month. It’s 160 clients, I think is the law, right, they can only treat 160 people, so it’s 200 bucks to 250 for the appointment every month, they have to come back to go to their legal drug dealer in a lab coat. That’s 40, 50,000 a month for that doctor that runs it. I mean there’s just, like you said, so many directions to go.

Richie Hession

No question. But now I’m also going to point out that subs aren’t all negative and evil, either. Now there’s a couple of different things that I would put out there for positives on Suboxone, right, because I’m not going to ignore the possible benefit because if it was used as a tool, it can be used helpfully as a tool, like in the detox process.

Mark Bonanni

Miracle-

Richie Hession

Sometimes when people are-

Mark Bonanni

Miracle drug in detox.

Richie Hession

They go, in detox, a miracle drug. And then people who are longer-term users, sometimes out of detox they still need help with withdrawal management, and so they’ll go on subs where they’ll come out of detox and their last is a 2 milligram, maybe for a couple more weeks they need to do 1, 1, 1, half, half, half, and they’ll work them down off of it so it kind of helps with the withdrawal-

Mark Bonanni

But, again, so let’s stop right there. So, now we’ve got a person with substance use disorder, or addiction, I don’t really love the new substance use disorder term, that’s just for me, whose got a problem, displays a problem with chemicals. And we’re going to send them home with a highly addictive and, counter to what that article says, a strong opiate, and we’re going to expect them to follow protocol. The nature of the disease of addiction is “I cannot follow protocol.”

Richie Hession

Yeah, and the reason we do that is because the insurance company will not pay more than 7 days, that’s the most you’re going to get, usually it’s 5 for the heroin addicts, 7 for alcohol, but the insurance company is not going to pay to have someone … this is an issue, by the way-

Mark Bonanni

“Listen, you’ve had a drug problem for 20 years, take this script home and take it as directed.”

Richie Hession

As directed, yeah.

Dr. John Kakowski

[crosstalk 00:23:25]. No, no, it’s insane.

Mark Bonanni

And it doesn’t even … none of it makes sense.

Dr. John Kakowski

Right.

Mark Bonanni

When we talk about the marketing, the $1.4 billion, only my experience is all I can talk about, that it’s not abusable. So, nine years ago, I’m addicted to heroin, and I get on the internet, and I buy Suboxone on the street, and I’m going to kick it on my own. And I’m reading stuff on the internet, I tell this story a lot of times to a lot of different people, too, I’m like, “I’m wondering if you can inject this stuff.” And so I go on these chats-

Richie Hession

It’s a normal thing to do, considering, I wonder, I wonder if I could do that.

Mark Bonanni

But that’s what I wanted to do, right, and so everybody says if you inject this stuff, I mean it’s got naloxone, it’s 2 milligrams naloxone, 8 milligrams of buprenorphine, in each strip, and the 2 milligrams of the naloxone is there so you cannot snort or shoot the stuff. But I’m like … So, I go on a drug forum online, you can find a wealth of bad information on there, but I’m reading this stuff, and people are saying you can snort it, you can inject it, and nothing will happen.

Mark Bonanni

So, here you have the drug company side saying you can’t do it and it’s going to kick you into immediate withdrawals, which I’d been in precipitated withdrawals before, they are the worst. And I’m like, “Well, that’s what they’re saying. But these guys on the internet chat forum are saying I can shoot it. You know what, I’m going to roll the dice,” because that’s how nuts I am. And so I shoot it, nothing happens. But I don’t get dope sick, and I feel a little better. And I got a problem with needles, just like a got a problem with heroin, and now I’m shooting suboxone. Then I’m sniffing suboxone.

Mark Bonanni

And so the whole idea, like what they don’t talk about is even that little 2 milligrams of naloxone they put in there is also a lie; naloxone is the same stuff as Vivitrol, if you don’t know that. And so they put that in there to make it … initially, I think the idea was that was the part that makes it not abusable. What they don’t tell you is, just like it’s a stronger binder to the opiate receptors in the brain buprenorphine is than heroin, buprenorphine is stronger than even naloxone.

Mark Bonanni

So, it has no effect; it’s in there, it does literally nothing. So, the naloxone that’s supposed to make it not abusable has no chance; the buprenorphine outcompetes for the receptors and keeps even the naloxone off the receptors, so it’s like … and they’re out there pushing stuff … I mean it’s crazy.

Dr. John Kakowski

Yeah, I mean that’s something we definitely learned about in school, and the naloxone, which is the same crap, it’s in Narcan, will counteract the abuse potential for snorting or injecting. But ever since I’ve been working in treatment, I hear stories of it, and I don’t hear people saying, “I was in withdrawal from shooting that suboxone,” they continue to repeat it, so, just from my own knowledge, I’m like, “Well, what the heck is going on here?”

Mark Bonanni

Well, I did it.

Dr. John Kakowski

Yeah, I know, that’s what I mean. So, it’s odd because from … and I’m telling you, I went through school for six years, and we studied, obviously, poisons-

Mark Bonanni

Little weird, wouldn’t you say?

Dr. John Kakowski

It’s a little strange, it’s a little weird. And you’re completely correct in saying that buprenorphine can displace pretty much any opioid, it’s very, very powerful. So, it’s a little odd.

Mark Bonanni

I knew a guy-

Dr. John Kakowski

It’s kind of like a public common factor.

Richie Hession

Did we go off … I don’t remember … to finish the story about the doctor, but he was pissed when you first told him “If you took one of those, you’d fall on the floor-

Mark Bonanni

I think it was in Cape Cod.

Richie Hession

And you would be high as a kite.” Yeah, it was up in Cape Cod.

Mark Bonanni

I vaguely remember it.

Richie Hession

And he was kind of put-off a little bit by Mark’s commentary.

Mark Bonanni

Well, I mean the symposium we went to, with all the dignitaries from the state and law enforcement, when they were doing the whole conference, and I looked around, I’m like, “There’s not a guy in this room who’s ever taken this stuff.” How can you be an expert on the stuff without talking about the people that have taken it? I don’t know, see, I’m a non-trusting person, so I don’t-

Richie Hession

There was a movie line in one of the Jason Bourne movies, where he looks at the lady, Pamela Landy, and says, “Lady, you talk about this stuff like you read it in a book.” And that’s exactly what you’re talking about, right, they’re talking about this stuff like they read it in a book. And the reality of it is a lot different-

Mark Bonanni

Based on bad info, right.

Richie Hession

There you go, bad info, bad intel. And then there’s the reality of what it’s intended to do and what benefits there could be, and how it actually shows up on the street, because an addict is going to take and manipulate and turn around and twist. Let’s talk about the reality of what they actually do with their scripts for subs when they get them, right. Like, everybody knows what it is. They’ll leave, and they’ll be given their subscription for subs, maybe they take them a couple few days. Subs have a value; like, in prison, that’s how you get high.

Mark Bonanni

Listen-

Richie Hession

Subs are what you get high on, they cost … how much was it, 10 bucks a strip or something like that, inside of prison?

Mark Bonanni

When it’s out of prison, it’s probably 50. On the street-

Richie Hession

It might even be higher.

Mark Bonanni

It’s 10 to 20.

Richie Hession

Ten to 20 on the street, there you go.

Mark Bonanni

I’m in a Suboxone doctor’s office, and they don’t know that I’m there because I’m friends with the doctor and I know the people and I’m not there to get subs, and so the kid starts volunteering information to me, he’s like, “Well, I just come here to get my subs. To be honest with you, dude, I don’t really take them anymore. I haven’t really taken them in years, but they’re worth 20 a strip on the street in Paterson.”

Richie Hession

Right, so they get them filled, and then they go sell them and they get money for heroin.

Dr. John Kakowski

That’s so common.

Richie Hession

And they go get high on heroin.

Mark Bonanni

Right, and I’m like, “Really, dude?”

Dr. John Kakowski

And that’s one of the down falls of that, the fact that you can have somebody who is struggling with addiction, especially early, and get a whole month’s supply of the stuff, and then-

Richie Hession

Which, by the way, it happens a lot.

Dr. John Kakowski

It happens a lot.

Richie Hession

Hey, insurance company, guess what, the drug bankers are saying that this is a cure-all, and look how much of it they’re selling. Well, a lot of the kids are actually just taking it, and your money that’s being paid for that prescription is actually being … they’re using it to buy heroin in the end because they’re selling it out onto the street, and it’s just a whole cottage industry that’s taking place inside the addiction [crosstalk 00:28:49].

Mark Bonanni

It’s an insane drug, from my personal guinea pigging myself experience. Like I was telling you earlier, the amount that people get prescribed, 16, 24, 32 milligrams-

Richie Hession

That’s another thing.

Dr. John Kakowski

That’s insane, yeah.

Mark Bonanni

I’ve had pretty monstrous dope habits, and I felt fine on the first 4 milligrams. Did I feel great? No, but I’m coming off of heroin, I’m not supposed to be feel great. And the crazy thing about it is they’re over-prescribing this stuff, and you can taper down on your own, because I did that, too, pretty quickly, with zero discomfort. You stable on 4, you can go to 2 milligrams two days later-

Richie Hession

Let’s not marginalize that. Let’s not undersell that at all. I mean, I promised [inaudible 00:29:28], I’ll try not to curse on the thing, but I would say to the doctors that are out there, you know, what the fuck? Like, are you kidding me? So, they have to go to some, what, is it a 2 day class, to get the special DEAX license, to be able to-

Mark Bonanni

10 hour, 12 hour-

Dr. John Kakowski

It’s not difficult.

Richie Hession

10 hours of training. I mean if they want to be able to write and to be a drug dealer, and they want to be able to write Suboxone. Now not all Suboxone doctors are like that, and some of them … you know, Suboxone, in and of itself, it should be done in only in conjunction with treatment is really what it should be because, in and of itself, it’s not going to be effective anyway. But you’ve got kids that are going in there, and we know, we talk to these people; for us, this isn’t theory, this is practical reality, and we have dealt with it over and over, it’s anecdotal-

Mark Bonanni

It’s every day.

Richie Hession

It is anecdotal in so far as I don’t personally have a million experiences, but all the experience we do have, it’s not just coincidental-

Mark Bonanni

Yeah, and we’re not doctors.

Richie Hession

That these kids are going in, and they’re on maybe a three-bag-a-day habit, not three-bundle-a-day, but-

Mark Bonanni

Even 30.

Richie Hession

Three-bag-a-day habit, even 30, but I’m talking about the kids that are the lower line, they were taking pills, they get into heroin, they get scared, they come in to detox, or they go see their family doctor-

Mark Bonanni

If they’re taking two 30 milligram blues a day.

Richie Hession

Right, there you go. All right, let’s call it that, they’re taking two 30’s a day, that’s a … again, we don’t know who’s watching the podcast, two 30 milligram blues of-

Mark Bonanni

Oxycodone.

Richie Hession

Of oxycodone, one in the morning and one at night, you pretty much stay numb for a good part of the day because you haven’t built up the tolerance-

Mark Bonanni

And you will withdrawal. You will have withdrawal.

Richie Hession

Yeah, no question, you’ll have withdrawal. And now they don’t want to go to rehab, they don’t want to go to detox, because this isn’t just what happens; parents, if you’re watching this, of course they don’t want to go to rehab and detox.

Mark Bonanni

Yeah, nobody wants to.

Richie Hession

And, of course, unfortunately-

Mark Bonanni

Nobody wants to go to detox.

Richie Hession

But, unfortunately, a lot of the parents don’t want them to either because they’re not drug addicts, they just happen to get into a bad thing, they go see a doctor, and the doctor says, “Oh, no problem, we can write you a script for Suboxone, and we’ll help you get off of that.” And they write them a prescription for 16 milligrams of Suboxone, 16 milligrams, the kid was taking two 30’s a day.

Mark Bonanni

And literally 2 would hold [crosstalk 00:31:31].

Richie Hession

Two milligrams would have been just fine, and he’s getting 16 milligrams. Now the kid is starting to foster a real drug habit because Suboxone, 16 milligrams, taken over the long term, that kid is screwed, when he ever tries to come off of that, oh my God.

Mark Bonanni

Yeah, and he’s high as a kite from the rip, too. He’s high-

Richie Hession

No, he just upped himself. So, the curative, he was like, “Wow, I should’ve done this a long time ago. Sure, Mom, I’ll go back to that doctor again tomorrow, absolutely,” until that doesn’t work anymore, either.

Mark Bonanni

Well, it’ll wear off after a period of time because your tolerance will go up and you won’t feel high, you won’t feel high. That’s the other thing I-

Richie Hession

Which is the misconception, and that’s their argument, they’re like, “They don’t get high on Suboxone.”

Mark Bonanni

And then the question is, “Okay, do you want your surgeon being on 16 milligrams of Suboxone when he perform heart surgery? Do you want your pilot in the plane on 16 milligrams of Suboxone?”

Richie Hession

It’s a good question. And when your answer is “Absolutely not,” why is it okay for my son?

Mark Bonanni

Or anybody else.

Dr. John Kakowski

It’s an interesting point because when you go back to that and you look at that, you’re giving somebody 16 milligrams of Suboxone. If they want to fall back on what their old drug was, so if it was one 30 in the morning, one 30 at night, that’s not going to cut it-

Mark Bonanni

They’re going to get a lot more.

Dr. John Kakowski

So now they’re-

Mark Bonanni

Wouldn’t even touch it.

Dr. John Kakowski

Yeah, they’re going to be at more of a risk for overdose and for experimentation for other things. So, if you’re not dosing it right, that’s extremely problematic. So, you have a person who wants to take five, “I need five now. Let me try six. Let me try seven.” So, you’re fostering, like Richie had said, a much, much worse addiction, and that’s something where people can actually overdose accidentally from.

Mark Bonanni

And we should probably talk about … like, what is the reason for this? Like, nowhere in the history of treating addiction and alcoholism has the protocol for treating it been giving them more of the same drugs and alcohol with an … you never tell an alcoholic, “Just drink two airplane bottles of vodka a day for the rest of your life,” they would never do that, they would never say, “Here’s a rock of crack, but this-

Richie Hession

Well, then let’s call what it is. Let me … I’ll be devil’s advocate, I’ll play the other side for a second. The argument can be made, and it is, I believe it is a strong argument, it wouldn’t work with alcohol, but, with subs, from the research and from what they see happening, a lot of the heroin addicts, at first, when they first come in and they start taking Suboxone, their desire to go out and get heroin is reduced-

Dr. John Kakowski

Correct.

Richie Hession

Many of them do stay away from it for periods of time, the ones that are able to … usually it’s because they have some support network that gives them the drugs every day and they do have that mindset of “I really don’t want to be a heroin addict anymore,” and they’re taking it as prescribed, they actually do go back to work, they actually do take the kids to the park again.

Richie Hession

They’re not out selling their paychecks and going out and buying; they’re getting prescriptions, they’re following the prescription the way if you had cancer or any other drug, and they said, “Okay, you’ve got to take one of these a day,” and now they start growing their hair back, and you start seeing them come back to life. Now, what kind of life? That’s the ultimate question from us because we see-

Mark Bonanni

Maybe they’re good lives. But we’re not going to get calls from those people. I’m not going to run into those people. I’m going to run into the ones that are dying and using other drugs, or dying to get off-

Richie Hession

Agree, but we can’t ignore the fact that we cannot say … see, that’s the real issue here, I guess. I mean this is even part of the reason of having one of these conversations, it really does get you thinking. And that’s the issue, it’s not a panacea, there is no cure-all. Addiction strikes different people in different ways, and some people are able to maintain and moderate in these ways, and other people absolutely cannot. When it comes to the people who can do that and go back to work, unfortunately, I’ve talked to them, as well.

Richie Hession

And here’s the real problem, and this is one of the things that … I mean this is close to home for me, this is what hits at the heart. So, I’m a recovery guy, I will concede the fact that some people, and I hate to do this, and I won’t be the one to say who it is, I won’t do it, and I’ll tell you why, but I’ll concede the fact that there are people who probably should be on longterm Suboxone.

Mark Bonanni

Yeah, right.

Richie Hession

Maybe forever. Maybe that’s the best that they’re ever going to hope to get and be. And make no mistake, they may be back in their kids’ lives, and, again, this is not something we read in a book, right, I mean you’ve been on it, and we talk to thousands of kids, like I know what they go through, like we deal with it in the trenches every day. They may go back to work, and they may get their relationship with their kids, but they’re in a fog. When you’re on those levels of Suboxone for longterm, you may not feel high, but, behind the scenes, you’re on a drug that if anybody else was taking it, you’d be laid out on the floor.

Richie Hession

So now you’re taking this maintenance and you’re taking this very powerful drug every day so you can go to work, the connectivity you have with other human beings, the passion that lights up people’s lives, the ability to connect interpersonally is diminished hugely. Yeah, you can do the basic stuff, like shower and go to work and pay your bills, and I guess that’s good, it’s great for the government who’s looking for crime reduction and who wants the people to stop running around and being drug addicts on the street. But in the end, is that the end goal? It can’t be, for me, I’m a recovery guy, I believe that you can have a different experience using those things as tools-

Mark Bonanni

A different life, yeah.

Richie Hession

Where if you do some real recovery work, you can be taken beyond where you are. You can recover in a way that is astounding, where you don’t need any drugs. That’s what recovery is. In the outside recovery community, I, personally, when it comes to the 12-Step work that I do on the side, I won’t … from me, if somebody’s on Suboxone, I can’t even … like, doing 12-Step work when you’re on Suboxone is … it doesn’t mean I’m right, it’s just, from me, I won’t do it-

Mark Bonanni

Yeah, me neither.

Richie Hession

Because you’re still getting high every day, I mean there’s no … to us, we [crosstalk 00:37:08] we understand it.

Mark Bonanni

[crosstalk 00:37:09] experience both my own and everyone that I’ve seen is it hadn’t worked for them. They tried it and it didn’t work, it inevitably always got high at some point, or picked back up whatever their original drug of choice was. That’s what I’ve seen. I’m not saying it can’t be-

Richie Hession

Over and over and over again.

Mark Bonanni

Everyone, I’m not so close-minded to think people that … there’s just so many different things that I can’t be close-minded to thinking maybe for a lot of people, they have a different experience. But what I’ve seen is the experiences of myself and everyone, not just … everyone I’ve seen, didn’t work for them.

Richie Hession

Yeah, and, again, over and over and over-

Mark Bonanni

And they ended up back.

Richie Hession

Hundreds and hundreds and hundreds, and even thousands of cases that you’re talking about, in practical terms from what we see.

Mark Bonanni

And I have a theory. I have a theory on this.

Richie Hession

Hold on, Mark has a fucking theory. This is exciting.

Mark Bonanni

You have to be … I think for even those that are successful, whatever that looks like … Nailed it.

Richie Hession

I have a feeling this theory is going to elicit that response, and I don’t think-

Mark Bonanni

But the people that do well on Suboxone, you have to be incredibly motivated to do well on Suboxone or abstinence-based recovery. But the difference is-

Dr. John Kakowski

Yes, that’s a great point.

Mark Bonanni

After a few months in on abstinence-based recovery, you don’t have to kick another drug. You’re going to … Most people aren’t going to resign to taking this stuff for the rest of their lives. They’re going to have to face the withdrawal at some point. But I think the motivation level has to be the exact same. Like, I don’t even think … I think you’re wrong.

Mark Bonanni

My experience was that being on Suboxone, as far as during my times taking it, did not cut down my cravings, it did not make me want to use real drugs any less. It didn’t. It just made me not get sick. And I think if you ask a lot of people on Suboxone, I don’t think it cuts their cravings. That’s just not been my experience or anyone that I know. They’re just doing it for outside reasons, they’re not really looking to get sober yet. I mean that’s been [crosstalk 00:39:05]-

Richie Hession

Again, is it possible that for some people it cuts down cravings, whereas for other people it doesn’t cut down cravings?

Dr. John Kakowski

Absolutely. But that all comes with-

Richie Hession

That’s all part of the campaign that the drug companies are putting out there, “There’s also a bunch of side benefits, like it cuts down your cravings-

Mark Bonanni

By the way, cutting down cravings, even with naloxone or with Vivitrol, I wanted to get high more than ever on … I just couldn’t. So, I didn’t crave … I mean I craved heroin, I just knew that I couldn’t do it, so let’s drink instead.

Dr. John Kakowski

Suboxone’s the thing that, you know, you’re giving it every month, and something like that really has to have intense dose monitoring, so a one-size-fits-all is not the model here. And, of course, it can maybe just feed the beast just a little bit to keep him off your back, but you still have that underlying mental obsession that’s going on that it’s not really going to treat at all.

Mark Bonanni

Right, which we kind of glazed over-

Dr. John Kakowski

Absolutely.

Richie Hession

Well, and that’s getting down to causes and conditions, rather than just the physical aspects of desire versus withdrawal. But I’m still not clear on … So, what exactly is your theory? I mean it didn’t even sound like a theory, it sounds like just what it is. But I’m … Restate your theory.

Mark Bonanni

A theory, because I’m not a doctor, I don’t have studies, but my theory is that you have to be just as equally motivated for abstinence-based recovery as you do to be successful on Suboxone-based recovery.

Richie Hession

Okay. I mean-

Mark Bonanni

So, why are we pushing-

Richie Hession

I’ll just concede that to you.

Mark Bonanni

But why push medication-assisted treatment as the cure to, really, at the end of the day, the person has to be just as equally motivated for both sides-

Richie Hession

Again, I’ll play the other side of it, there is a reason. When they’re not motivated, at least on the medication-assisted treatment-

Mark Bonanni

But then here’s the thing-

Richie Hession

At least on the medication-assisted treatment, they may get to a point where they become motivated, but they’re still not out there getting high and maybe overdosing and dying on heroin. So you can’t pretend it doesn’t play a fucking role, because it does play a role.

Mark Bonanni

Okay, agree-

Richie Hession

And I can’t believe I’m taking the other side of the argument, but it’s true.

Mark Bonanni

[crosstalk 00:40:51] the other side, but then why is it not always pushing Vivitrol, which at least gives 28 days? Because if you don’t want it … If you’re on Suboxone maintenance and you want to get high tomorrow, you don’t take the pill and you get high tomorrow. And it doesn’t protect you past a day.

Richie Hession

I’m with you.

Dr. John Kakowski

And the reason why Vivitrol, they’re not pushing it as much, obviously, it’s just because of the pounds and pounds of data they have, I mean the initial thing was methadone, and like Richie had said, the only thing really that it has extreme value in, right, or not the only thing, but something that it has extreme value in is the reentry population.

Dr. John Kakowski

So, as Richie had alluded to, it’s somebody who’s been struggling their whole life, they can’t get sober at all, so they’re putting them on MAT, methadone, and, as of presently, Suboxone, as well, you’re getting more studies with that, just so they can go about their lives, so they’re not going outside to rob a store or commit crimes. And, also-

Mark Bonanni

But if that’s what the prisoner wants to do, they’re going to stop taking the stuff and go do it.

Dr. John Kakowski

I know, but-

Mark Bonanni

Why is that making it so different-

Richie Hession

But it just increases their chances, though, Mark, that’s the thing, it’s a percentage thing; not all of them, some are compulsory, they do it, but if they’re given some of this kind of help, the argument we’d make: it’s just a percentage game. Instead of 80% running out and doing that, you’re right, maybe 60% of them, but maybe that other 20 are people we can save-

Dr. John Kakowski

It’s a positive [crosstalk 00:42:07]-

Richie Hession

That’s the argument.

Dr. John Kakowski

[crosstalk 00:42:08].

Richie Hession

They do have statistics to back that up-

Mark Bonanni

And in that case-

Dr. John Kakowski

It’s not only MAT-

Mark Bonanni

Then it makes sense.

Dr. John Kakowski

It’s not only just solely MAT. So, if you look at Rhode Island, for instance, what they’re doing, Rhode Island was giving MAT, mostly methadone and Suboxone, but sometimes Vivitrol, for prisoners that were being released. It wasn’t a soft hand-off, they set up all these Centers of Excellence, so there was a followup with care. So, they would give the methadone as they’re leaving, follow them up, they would have a doctor’s appointment right to go to, right away, as soon as they got out. And they did see a reduction in overdose deaths. From that end, that’s great because you’re decreasing-

Mark Bonanni

In what time period?

Dr. John Kakowski

For a half-year period. It was statistically significant. I mean it was … I thought it was a lot less, but I actually just-

Richie Hession

Six months is six months, right.

Dr. John Kakowski

Yeah, it was actually statistically significant, so you can kind of look-

Mark Bonanni

Yeah, it’s a lot harder to overdose when you’re taking-

Dr. John Kakowski

Of course, but, again-

Mark Bonanni

[crosstalk 00:42:59].

Dr. John Kakowski

Of course. Of course, absolutely. But it becomes … I think the main point of the argument is, you know, if MAT is available, and it’s legal, and it’s FDA-approved, or whatever the case, when do you start it, when is the prime period to start it?

Richie Hession

So, hold on. If you name me the drug czar, let’s say I was named drug czar and I got to make the ultimate decision in the United States, this is how we’re using this drug, forget about the insurance companies, the pharmaceutical companies, who’s making money, how it’s supposed to all work, your opinion on it, my opinion on it, all have valid arguments to make some much less valuable than others, in my practical opinion, but whatever. \

Richie Hession

If I’m the drug czar, this is what I’m … and, again, you guys can each play drug czar for a second, but, for me, when people go into detox, they have good detox protocols, for all drugs, in place now, we work at a lot of detoxes, they’ve got that down pretty well, they can take all the chemicals safely out of your body. If Suboxone is used as part of that protocol in a lot of the detoxes, that’s fine. That’s what you’ll use it for.

Richie Hession

And then depending on the level of your addiction, how much you’ve used, how long you’ve used it, whatever, I’ll allow you to be on Suboxone, on a wean, on a taper, for an extended period of time, for another two weeks or three weeks, so maybe you actually leave detox on four because you really needed to take 16 … I don’t know that anybody ever needs to take 16 … but 8, you leave detox on 4, we let you go to 2, to 1, to half, to quarter, and then eventually you get down to zero. When you’re getting to the point where you’re down to zero, we have the naltrexone pills as that three-day buffer because I don’t believe you can take Vivitrol while you still are-

Dr. John Kakowski

No, you got to have-

Richie Hession

Right on the sub.

Dr. John Kakowski

Seven to 14 days.

Richie Hession

Seven to 14 days-

Dr. John Kakowski

With Suboxone longer because a lower half-life.

Richie Hession

But can you take the naltrexone pills at-

Dr. John Kakowski

No, no, no, you cannot-

Richie Hession

So, you can’t take anything?

Dr. John Kakowski

You can’t take anything, no. You’re going to have a gap, [crosstalk 00:44:45]-

Richie Hession

So, herein lies the issue and problem, right. And so it’s going to have to be done then to be really effective, this is all going to have to be done in a rehab setting.

Dr. John Kakowski

Yes.

Richie Hession

Like, there’s no other way. Letting them do it out on the street,[inaudible 00:44:58] serious problem of the mind that’s going to take them back to it, and we know the nature of addiction, especially in this type of addiction, would have to be in a rehab setting, which means 28-day stays are out the fucking window because they’re not effective anyway; most people need to be there 45 days, two months, maybe even a little longer, depending on the nature of their problem and the kind of treatment that’s actually being employed.

Richie Hession

But now that 14-day period takes place in the detox. Now they’re safe, protected, they’ve been weaned off, the 14 days go by, so they’re able to take the naltrexone pill to make sure that they’re okay to take Vivitrol. And now we know they don’t have an adverse reaction, now you start planning what their aftercare is going to look like; again, being the drug czar, I’m going to say you can’t go back home, you can’t go in an apartment, I want you to go into some type of supportive housing with the professionals that you’re kind of given freedom, go back out and work, but you’re still living with sober people, there’s a degree of structure in place where a sober living home, something to that effect, for a period of time, while you’re on your Vivitrol.

Richie Hession

While you’re doing all that, it’s assumed, as I’m having this conversation, during all of this, you should be engaging in recovery activity, right, because you need to have an experience, and you’ve got to have that internal shift where you’ve got to be able to find a way, or somebody’s got to help you to find that path, where you have a shift, where you no longer want to go back to use that stuff anymore. Now that’s the big … How does that happen?

Mark Bonanni

Well-

Richie Hession

We know what we believe, but we-

Mark Bonanni

We glazed over it earlier, that even MAT, in all forms, treats the body, and we believe that it’s a mind-body-spirit thing, and really the problem is it’s a mental disorder-

Richie Hession

That’s it, and there’s no pill you’re going to give that’s going to make that go away. Period.

Mark Bonanni

None. It hasn’t done it yet, it’s not going to do it now.

Richie Hession

Right. So you’re talking about just one-third of the thing, and it’s important, and the physical aspects of it do need to be dealt with-

Mark Bonanni

Huge.

Richie Hession

But in the end, that, in and of itself, is not going to solve the opioid crisis.

Mark Bonanni

Yeah, ask any person who’s had a problem with drugs or alcohol, legit, if just getting sober and stopping kept them stopped.

Richie Hession

Yeah, of course, it just doesn’t work that way, unfortunately. So, if we could, and I want to go back to it, and it brings us back to, and my point earlier, that I made, which, and I still stand by it, I do see the … when we talk about who should be on, I alluded to some people probably would just benefit from being on longterm subs. They might be constitutionally incapable of grasping and developing a manner of living, which recovery might require; maybe some people, for various reasons, just not going to get it, they won’t … I’m not going to be the one to decide who gets it and who doesn’t-

Mark Bonanni

Yeah, who makes the decision, what’s the criteria?

Richie Hession

I can’t make that decision. Dude, I want to believe that everyone has a shot at a rockstar lifestyle.

Mark Bonanni

I’ve literally met people that have been to detox 105 times and now have years of abstinence recovery. Literally, 105 times. I thought I went a lot.

Richie Hession

Most people would have given up on you. What you went through, in your life, they would have given up, written you off. You’re a rockstar. So, don’t tell me, like I’ve met people that I’ve literally … and I hate to admit this, but I’ll be completely honest, I’ve met people in my recovery life, in 22 years, I’ve met a bunch of people that, after spending a little time with them, I’ve said to myself, “No shot. Zero chance.”

Dr. John Kakowski

I think we all have.

Richie Hession

“This kid will inevitably end up either dead or in prison for a long period of time.” I’m not going to turn my back on the guy. On the outside of this, I’ve tried to help people in recovery lifestyle ways, but I’m saying to myself the whole time, “Zero chance.” One of those kids I’m thinking of, particularly, right now, and you know who it is, [Mark Q. 00:48:30] is astounding, I mean that kid is beyond rockstar, and I would have written him off many, many years ago, and he is amazing.

Richie Hession

So, there are examples of that. Who am I to decide, who is anybody, who’s the government, who’s an insurance company to decide that I’m going to write this kid off? I can’t be the one to do it, I won’t be. I’m not saying that there’s not people that wouldn’t benefit from literally being on longterm Suboxone-

Mark Bonanni

And now it brings into something else that I can’t stand, that I’ve seen change with what we all do in this industry. Like, what happened to the “Your best thinking got you here”? What happened to your-best-thinking-got-you-here mentality to now it seems to be there’s this shift of asking the person, in day three of detox, “What do you think you need for recovery?”

Mark Bonanni

I mean, what happened? When did that change take place? And if you offer me Suboxone in detox, I’m taking it, every time, especially if a guy in lab coat, who I typically would trust, is telling me that this is your answer, I’m like, “Okay, done.” It’s mind-blowing stuff. It gets me so angry.

Dr. John Kakowski

Yeah, I agree with what both of you are saying. I think that, also, you know, there’s a major problem, also, with MAT that is not really talked about, is-

Mark Bonanni

We can reduce a lot of harm by telling people they shouldn’t use drugs.

Dr. John Kakowski

Of course.

Richie Hession

Nancy Reagan did that back in the 80s and it didn’t work.

Mark Bonanni

Did it?

Richie Hession

Just Say No.

Mark Bonanni

I know, but at least there was something. What’s the-

Richie Hession

Yeah, [inaudible 00:50:01].

Mark Bonanni

What is anybody doing today? I mean now it’s been a little different in the past year or so, because of the opioid epidemic, but what’s the national level of … what’s the fighting cry? There is no tagline. There’s no-

Richie Hession

Fair enough. You know what-

Mark Bonanni

Like, if this stuff’s going to change [crosstalk 00:50:17] … sorry I keep cutting you off, John.

Dr. John Kakowski

No, no, no, it’s fine. It’s a good discussion.

Richie Hession

It’s not the same … It’s weird you say that, and it just came up into my mind, and, again, we’re going to wrap it up soon because, listen, we could go on and on and on-

Mark Bonanni

For hours.

Dr. John Kakowski

Yeah, it’s a huge topic.

Richie Hession

Yeah, it’s a huge topic.

Mark Bonanni

Joe Rogan does four-hour ones, we can …

Richie Hession

But I’ll tell you that, it’s weird, because I was sitting talk to my 10-year-olds, my twins, last night, and we were just sitting around and chatting, and I said something to them, and I just said it out of the blue and I don’t know why, and it speaks in a weird way to what you’re talking about, which is where we are as a society, as a country, as families, right, prevention, this kind of thing. And one of the things that I said to them, out of the blue, I just was sitting there, and, how old are you? You’re in your early 40s right?

Mark Bonanni

41.

Richie Hession

And how old are you?

Dr. John Kakowski

33.

Richie Hession

Yeah, you’re a child. Kevin, how old are you, bro? 33. So, you two might not know, but you might, but you might remember it from when you were a wee lad. You ever remember this, “It’s 10:00 P.M.-

Dr. John Kakowski

Do you know where your children are?

Mark Bonanni

Do you know where your children are?

Richie Hession

Do you know where your children are?” And I said that out loud in front of my kids, and they both looked at me and said, “Dad, what are you talking about?” And I said, “Well, back when Daddy was a kid, they used to … the TV, at 10:00, before the news, would go, “It’s 10:00 P.M.”” and they were like, “Well, why did they do that?” I said, “That’s a good question. I think they did it just to remind families like, “Hey, you’ve got some kids out there, do you know what they’re doing and where they’re at and what they’re up to? You may want to go to the front-

Mark Bonanni

The frying pan.

Dr. John Kakowski

The frying pan.

Richie Hession

Yeah.

Mark Bonanni

Brain on drugs commercials. The one I always saw growing up, which I think is still poignant today, which was “I never wanted to be a junkie when I grew up,” that’s what they said on the thing. It was a commercial of a track star in high school, and it kind of morphed into running from the cops and being tackled. And I was like, I didn’t … my goal was not to end up-

Richie Hession

2:00 in the morning, I’m in my apartment, and I’m wasted, geeked out, fucking three 8-balls deep with a bottle of Jack, and I’m sitting on my couch like this, and all of a sudden the commercial comes on, and I have the TV on, and I hear, “Are you high right now?” And I’m like, “What?”

Dr. John Kakowski

Oh my God, I would have lost my mind.

Richie Hession

You know what I mean? “You’re sitting right now in your living room,” and I’m like, “Oh my God.” That’s brutal. And I’ll take that even one step further. You’re like, “Holy shit,” you turn the TV off, of course. Now you go to the bathroom, and I go, and I’m looking in the mirror in my bathroom, and I’m bringing this up only because this is what we’re dealing with. When I say “we,” I mean we, as a society, the people, and the well-intentioned, not all bad-intentioned, well-intentioned politicians, people trying to get a handle on this opioid crisis, all these kids that are dying.

Richie Hession

But what we’re dealing with is that my whole life had gone to shit, I’m sitting in my brother’s apartment, he’s away working on the tug boats for weeks at a time, I’m done, my parents threw me out, no one would have me in, I dropped out of college, all my friends have gone on to graduate and go to school and get married, and everyone’s living real life, but I’m an addict. And I’m sitting there wasted, alone, at 2:00 in the morning. I get out of the bathroom and I look in the mirror, and I see me with black fucking eyes, not having slept for three days, I’m like this.

Richie Hession

And I’m looking at myself in the mirror, and the thought … when you’re an addict and you’re in it, I’d love to be able to say that I looked and I had this moment of clarity where I was like, “I can’t live like this anymore.” I looked at myself, and the way I processed was just kind of like, “Well, you know, this is me. I’m an addict, what are you going to do? This is what it is, and I’ve got to do it as best I can, and go on as long as possible.” It didn’t occur … Like, a normal person looks at that and goes “What are you doing? What are you thinking about?” “What do you mean? You know what I mean, like what’s the problem? I’ve still got some left.” That’s crazy, but that’s the reality. But do you write me off? Like, am I somebody to be written off, like I can’t … again-

Mark Bonanni

No, but you would have went into rehab as an alcoholic and a cocaine user, and they would have said-

Richie Hession

Which is what I did. I did detox that way.

Mark Bonanni

“We can only suggest to you abstinence. Oh, but, John, you’re using opiates, we have a pill for you.”

Richie Hession

Right, yeah, yeah.

Mark Bonanni

Still. And that’s another thing that kind of blows my mind today.

Richie Hession

Absolutely.

Dr. John Kakowski

Right, right, right.

Richie Hession

So, all right, do you guys want to leave off with any last minute kind of something to think about, something to consider, or final thought, a shout-out to somebody if you can’t think of anything cerebral to say?

Mark Bonanni

Hi, Mom.

Richie Hession

Yeah, say hi to your mom, that’s cool.

Mark Bonanni

She will share, and she will watch this.

Richie Hession

I’m sure she will.

Dr. John Kakowski

Just a heads-up, I guess, to the federal courts and everything that they had done for me. And they did it right.

Richie Hession

Oh, wait, before you give your final, we cut him off more than anything, but make us think when you talk, that’s one of the things-

Dr. John Kakowski

I don’t know if that’s good.

Richie Hession

One of the things we never did talk about, and it’s worth extending this thing for just a minute or two, as you’re giving a shout-out to the fucking federal court system, but I will say this, one of the things that is outlandish, and I’m speaking to the federal and state court systems, and I’m asking you guys: what the fuck are you thinking about?

Richie Hession

We know kids that are in jail, abstinent for a year, in prison, about to get released, and as part of the release program, you know what they give them? 16 milligrams of Suboxone so they don’t get high on heroin when they leave. That’s insane. Whoever came up with that rule, you are a moron. That is … You got him wasted high on … Mark, if you haven’t taken anything for a year, and they give you a 16 … how high are you the day that you’re ready to leave from prison?

Mark Bonanni

2.

Richie Hession

And this is going on. We have kids that come in with us that they’re in the court systems, they’re mandating that they take this shit.

Mark Bonanni

The counter is that the amount of overdoses the day, or within the week of leaving prison, are extremely high.

Richie Hession

And that’s why-

Mark Bonanni

But, still-

Richie Hession

That’s why they’re doing it. But, again-

Mark Bonanni

Vivitrol-

Richie Hession

But then … Okay, fine, Vivitrol is a much better answer because you can give them all the Vivitrol shot, and you won’t have those overdoses within three days of leaving prison, it’ll at least be 27. And if you’re going to do it right, give them the Vivitrol and then give them a followup for a second Vivitrol shot so they at least have the opportunity. But by giving them the Suboxone, you’re just basically … it’s just total nonsense-

Mark Bonanni

Restarting the whole [crosstalk 00:56:05]-

Richie Hession

You’re restarting the process for them again. Because if I’m clean a year now, and you’re forcing me to take that high, and wasted high, the day before I leave prison, you’re not doing anybody any fucking favors. Really?

Dr. John Kakowski

There was an interesting article that just came out, about three days ago, about somebody in Rikers Island who said, “You can either be in jail, or you can take your addiction medicine,” and the guy was like, “I don’t want to take anything,” and he was in jail for six months. So, you’ve got to read this article if you … I’m not going to go into the depths of it, but read-

Richie Hession

Well, tell them, where is the article? People like to read this stuff. Where do you find it?

Dr. John Kakowski

I don’t know the website-

Richie Hession

You know the name of the article, or what it’s called?

Dr. John Kakowski

Yeah, it’s-

Richie Hession

What would be the keywords?

Dr. John Kakowski

It was-

Richie Hession

Rikers Island?

Dr. John Kakowski

Yeah, it said Rikers Island prisoner either takes medicine or stays in jail, or forced to stay in jail, that’s what the-

Richie Hession

Google that, I’ll do it when we go back up and I’ll check it out-

Dr. John Kakowski

Yeah, Google that, it’s a very interesting article, and it kind of piggy-backs into that, where … you know, Rikers Island, they have a very long-standing, long-running methadone program-

Mark Bonanni

Yeah, many, 30, 40 years.

Dr. John Kakowski

Yeah, very, very long. This gentleman didn’t want to take any MAT, and he was left behind bars, which I think is just insane to even do that to somebody.

Richie Hession

The person who came up with that role-

Mark Bonanni

It was an either/or?

Richie Hession

We have a special button for that-

Dr. John Kakowski

Yeah, you’re fired.

Richie Hession

That’s old Uncle Don.

Mark Bonanni

Does that thing translate?

Richie Hession

Yeah, I don’t know. All right, so, we were signing off, you wanted to give a shout-out to the federal government, apparently.

Dr. John Kakowski

Well, the federal courts, yeah, because the program that they had put into place, I think they finally came to their senses, you know, with the mandatory minimums of the 80s, and the draconian sentences, if you had a little bit of crack you were going to prison for years and years and years-

Richie Hession

Well, they may want to talk to the people in Pennsylvania about Emma Semler-

Dr. John Kakowski

I know. No, no, yeah, that’s crazy-

Richie Hession

Just throwing that out, we covered that already. Wow, 21 years for giving your friend drugs. Insane.

Dr. John Kakowski

I know, that’s insane. So, but the court program that they had set up really encompassed everything. If they had people on MAT, they worked with them. This is not just an addiction issue or a substance issue, it’s a whole issue, from social services, to mental health, as I had mentioned before, education, these are things that often set people up for failure if they haven’t obtained, which they generally don’t. Just working in reentry, I had people behind bars for years. They’d come to our office with literally a bag of shoes-

Mark Bonanni

Yeah, nothing.

Dr. John Kakowski

Nothing, and I’m like, “Okay, where’s your ID?” He’s like, “I don’t have an ID.” “Okay, do you have a birth certificate?” “Nope.” Literally, just a faceless person, and now we have to … it’s no wonder why recidivism is so high, it’s not only just because of the drug abuse-

Mark Bonanni

Yeah, what are they supposed to do?

Dr. John Kakowski

Of course. So, I mean, the way the federal court, the Pretrial [inaudible 00:58:30] Program sort of molded their program, and it helped out with all of those things, which is what needs to happen, it’s not just “MAT, see you later. MAT, okay, don’t come back,” or whatever it is. You have to treat everything, everything, everything, it’s a whole comprehensive issue-

Richie Hession

And, by the way, the reason that this is such a huge topic and we’re in a national state of emergency, and this is sad to say, but human nature’s human nature, and people are people, and it is what it is. Back in the day, this conversation would have been about this person in society, which is people in prison, prisoners, chronic criminals, and this whole conversation would be taking place over here, and maybe the mainstream wouldn’t even “Oh, that’s interesting.”

Richie Hession

But now heroin has broken through the vale of that and gone throughout all society, these are the best, the rich, the poor, cultural barriers, there are no barriers to heroin addiction, and it’s now gone the full gambit, so that’s why this is a national conversation, even a global conversation now, because this isn’t just about that, you’re talking about one slice of an overall … that’s the reality.

Dr. John Kakowski

Right. I want to also say this. There’s an old advertisement from 1996, Purdue Pharma, and they’re like, “Oxycontin,” when it came out, “Oxycontin, it’s going to save lives, and here are eight testimonials,” and it’s all these business people, they’re like, “Yeah, I had a chronic back problem,” and on the bottom it says the name, like, “Joe Shmoe,” and it says how many milligrams of Oxycontin they’re taking, some of them are on 80 milligrams a day, and I’m like, “That’s insane.”

Richie Hession

No wonder why they seem so happy doing the commercial.

Dr. John Kakowski

Yeah, they’re sitting behind the desk and they’re like, “Yeah, I can go to work every day, my back feels great.” You follow those people, all right, literally there’s-

Mark Bonanni

It’s like the faces of meth.

Dr. John Kakowski

There’s a documentary. Two of them died, one person had a Master’s level degree, she’s homeless on the streets now, and she’s like, “It just went out of control.” And even more recently, there was a drug called Subsys, right, which was a fentanyl sublingual spray. And there was a whole thing on American Greed about it-

Mark Bonanni

Wasn’t it nasal? Yeah, those guys got-

Dr. John Kakowski

Yeah, there’s nasal, but there’s also … this was sublingual. So, there was two doctors that were paid off by the drug company, and there was a woman who had just gotten surgery and she was prescribed Subsys, which is insane because you have to be opioid-tolerant for that thing, that’s for cancer patients. Patients that can’t swallow or can’t move, you can help them open their mouth and spray a little bit under their tongue, that way they have indignity when they’re dying and stuff like that. A woman that just had surgery was now using this thing multiple times a day, and she didn’t even understand withdrawal, she had no education. So, it’s also the other facet where we’re giving these drugs and we’re not educating patients, really a lot of it is motivated by greed, which is disgusting. Seriously, if you get a chance-

Mark Bonanni

All of it.

Dr. John Kakowski

Check out the Purdue Pharma, they have them on YouTube, and it’s a nice little documentary, and then you follow those lives later on, all destroyed, and it’s so sad, man, it’s terrible.

Richie Hession

All right, I’m going to leave it like this, and I want just one final thought, as we go out, and it’s a weird way to end it, but I want to end it because I know that we’re going to get … first of all, you can get this podcast on the major streaming platforms: iTunes, Spotify, SoundCloud, and YouTube. And I want to say that when people go and they start commenting on everything, because we get a lot of comment back and forth, and this one, listen, this is a hot topic, a hot-button topic, because people feel very passionate about it. If you think Suboxone is a curative and it is good for longterm, well, you’re just wrong.

Richie Hession

But there are people who will come, and they’ll talk about how, invariably, even though we’re not really talking … we’ve made mention to the need for painkillers and Oxycontin and this and Percs, and how it starts there. There’s always people who come onto our thing, no matter what the topic is, saying, “Some of us need longterm pain medications,”-

Mark Bonanni

Agreed.

Richie Hession

It’s ridiculous. We agree with you, we’re not saying that this is for … we’re talking about drug addicts and drug addiction. And if you’re somebody sitting home, and when you hear this, you’re thinking, “This is ridiculous,” and you’re getting defensive, my sponsor used to tell me, “If somebody says something that makes you angry, you may want to take a look at what they’re saying,” just saying. Because if you’re getting that defensive about it, we’re really not talking about you, if you’re taking it for legit reasons, longterm for pain management-

Mark Bonanni

Or successful on it. I want to see those.

Richie Hession

Me, too.

Dr. John Kakowski

But they’re not longterm pain options anyway, they’re-

Richie Hession

Well, there you go. And that’s what … We’re not going to go there.

Dr. John Kakowski

I agree, but we’re not going to go there, yeah.

Mark Bonanni

I’m just talking about people doing well on Suboxone, period.

Richie Hession

I said that as an aside, but I also want to say to the people that are on longer-term subs that are watching this, that are doing well-

Mark Bonanni

Please comment.

Richie Hession

Good for you. I’m glad. We love-

Dr. John Kakowski

Absolutely.

Richie Hession

I’m here for the addict, we have your back 1,000%. If it’s working well for you, I would posit and give the consideration of well for you in what way, like what do you consider well? If you would have asked me when I first came in to get sober, “Okay, describe yourself in five years, where would you want to be?” I would have undersold myself by just a gargantuan, Herculean undersell of what actually happened in my life.

Richie Hession

So, my question is, I’m glad that you’re not getting high, and I’m glad it’s working for you, and you got your family back and your kids back, and that’s what I hope for you, I mean I really do, I mean we want to see people get well and convalesce and to experience life and to get through to the other side. And so our thing to you is: if it is working for you, then that’s awesome, I’m not saying that no one should be on it, if you we’re listening to what we were saying here today, we’re not saying that by any stretch, we’re just not going to be the ones to say, “You’re never going to make it in an abstinent-based, where you can actually have life come back, on fire, rockstar again, and you’re going to have to take this longterm drug,” we’re not going to be the ones to say it. But for those that it is working for, listen, anything’s better than the way we used to live-

Mark Bonanni

And speak up, please.

Dr. John Kakowski

No, I agree, absolutely.

Richie Hession

Yeah, and we want to hear from you, too.

Mark Bonanni

I’d like to see some positive testimonials.

Richie Hession

Yeah, absolutely.

Dr. John Kakowski

Yeah, yeah, yeah.

Richie Hession

Because we don’t see a lot of it.

Mark Bonanni

Not studies by the drug companies.

Richie Hession

Absolutely.

Mark Bonanni

They obviously can’t be trusted.

Dr. John Kakowski

Yeah, I agree with that.

Richie Hession

All right, so, John, thank you.

Dr. John Kakowski

Thank you. Thank you for having me.

Richie Hession

And, Mark, thank you.

Mark Bonanni

Thank you.

Richie Hession

It wasn’t as crazy as I thought it was going to be, I thought it was going to be kind of … sometimes we can get a little vicious and crazy with it. Next time we have one of these, maybe if we get people who have comment back, we’ll get a proponent for it to come in here, and we’ll just duke it out with somebody.

Dr. John Kakowski

I think it’s a great idea.

Mark Bonanni

Do it in a ring.

Dr. John Kakowski

There you go.

Richie Hession

All right, well, check us next time. Thank you.

Dr. John Kakowski

Thank you.

Richie Hession

So, we’re here. Mark, welcome back. This is our third podcast. We’ve done one on the Emma Semler case, which got a lot of feedback because I’m still sad over the whole thing. We did kind of an easier one on interventions, important, but easier and a little shorter. This one we’ve kind of been … I didn’t want to lead out with this one because it’s probably going to be kind of brutal.

Richie Hession

But we’re going to do … Today’s podcast is going to be about, really it centers on Suboxone, it’s about medication-assisted treatment, but we’re not really looking to cover the pros and cons of medicated-assisted treatment. Mark and I really want to talk about the cons of Suboxone usage, but we’re going to talk about that aspect of medication-assisted treatment as the two main … and John … let me tell you who I’m here with.

Richie Hession

So, I’m Richie Hession. This thing can be found, this podcast, apparently I have to tell this every time, is available on the major streaming platforms, iTunes, Spotify, SoundCloud, and YouTube. Richie H, The Other Side, or something like that, whatever we’re called. The Other Side with Richie H. I want to tell you who we’re here with. I’m Richie H, and then we’ve got Mark Bonanni, and Mark is an Outreach Coordinator at BlueCrest. And then we’ve got Dr. John Kakowski. John is … I can tell everybody who you actually are, right?

Dr. John Kakowski

Of course, yeah.

Richie Hession

John is a formerly licensed pharmacist who, let’s be honest, John, you had some problems-

Dr. John Kakowski

Yes.

Richie Hession

And he kind of lost-

Mark Bonanni

That’s an understatement.

Richie Hession

He might have lost his license a little bit.

Dr. John Kakowski

Just a little bit.

Richie Hession

But now he’s recovered for some years. And, again, a separate topic conversation, but a really good program that they did put into place, you were the first person that actually entered into that program, and thank God for these programs in the state of New Jersey because any normal … “normal” person … people who, outside the understanding of the addiction world, would look at somebody like John, who got caught up in addiction, crossed a line, was sneaking meds out of his whatever, out of the CVS or wherever the hell he worked, and they would say, “Off with his head,” and that’s all …

Richie Hession

John’s a rockstar and cares more about these people than any pharmacist or even medical professional, personally that I’ve met and sat down with, and has done a total 180, his life is astounding. He’s a supervisor and he runs Cornerstone Sober Residences, and he’s about to get, hopefully, if the board’s watching, he more than deserves getting his license back, way more than deserves it, and he’s on the path to getting that. And John is super smart, and he’s very well-educated, and he understands addiction, understands medication-assisted treatment unbelievably well. We’re lucky to have you sitting in, talking on the podcast. And if any of the stuff that I just said you want cut it out, we can cut it out for you later.

Dr. John Kakowski

No.

Richie Hession

We wear it all, we just throw it all out there, man, it is what it is. So, yeah, we’re going to talk about Suboxone, mainly. And subs, Mark and I have a big thing. You know what, we’re going to be streaming consciousness is what we always are, we’re going to jump around topic to topic around subs. But we get infuriated, right, because Suboxone is not a curative, neither is Vivitrol, there is no medication that can cure you of addiction that I’ve ever heard of, that I’m unaware of. Science may one day accomplish this, but-

Mark Bonanni

Hasn’t done so yet.

Richie Hession

Hasn’t done so yet. So-

Mark Bonanni

[crosstalk 00:03:33].

Richie Hession

There are good tools that they’ve come up with, right, and so medication-assisted treatment as a tool. And even the guys … We had watched some of the clips from when you went to that with the Attorney General and they had … there’s panels everywhere now, all the politicians want to talk about it, and everyone comes up and all of a sudden a lot of people become semi-experts on addiction treatment, apparently. Some people seem to be under the illusion, in my opinion and my personal experience it’s an illusion that Suboxone is some curative. I mean certainly if you’re into harm reduction, Suboxone is definitely a curative of sorts, right? I mean crime statistics can go down, and it keeps people … it’s the old methadone experiment revisited, right? I mean wouldn’t you say?

Mark Bonanni

Yeah, 100%. And the thing that I disagree most with all of it, and might as well put this out in the beginning, is that not that it doesn’t have its place in treatment of addictions for opiate addiction, but that … and I see it repeatedly said in article after article after article that it is the gold standard of treatment. That’s my problem. The problem isn’t that it’s used, because it’s got its use cases in all forms, even sometimes maintenance, I think we can agree, for a certain population. But now that we’re pushing it as the gold standard, the go-to, the thing that’s going to solve the opioid epidemic-

Richie Hession

And they’re trying to, and they’re also, by the way, marijuana now all of a sudden is supposedly-

Mark Bonanni

In this state-

Richie Hession

It’s totally insane that marijuana is going to help cure opiate addiction is … I can’t even imagine people say that out loud, it’s astounding to me, but we’re not … I’m going to try and stay away from the marijuana, we’re going to have a whole separate podcast on the marijuana thing. But not only, yeah, gold standard, true, they want to incorporate it where they want to try and force treatment facilities of all ilk to mandatory that you have medication-assisted treatment. Now, if you tell me “mandatory,” we’re big proponents at our place, we do Vivitrol, it’s a good tool. It’s not curative, but it’s a great tool-

Mark Bonanni

Early recovery tool.

Richie Hession

John, why is Vivitrol a great early recovery tool?

Dr. John Kakowski

Vivitrol is great because the fact that you can use it, number one, it’s very easy to use for somebody who is off opiates. You can start them off on a tablet, you can work with insurances, they’ll pay for it, there’s more acceptance of it today. The thing with Vivitrol is also that it decreases cravings. So, if you look at the studies that are associated with it, it can decrease cravings, which is very, very high, usually in early recovery, usually in 1 to 3 months, 1 to 6 months. And, basically, if somebody tries to use while they’re on Vivitrol, it will block it. So, there is-

Richie Hession

So, it’s a blocker?

Dr. John Kakowski

It’s a complete antagonist.

Richie Hession

So, if a heroin addict gets a Vivitrol shot, when they’re leaving rehab is the most ideal time to give it to them, right. Typically, the process that we, as I understand it is-

Mark Bonanni

Or jail.

Richie Hession

Or jail. Well, and we’re going to talk about that. But, typically, for us, we’ll give somebody … they’ll go on naltrexone for a few days to a week to make sure that they don’t have any adverse reaction to it; also, you have to have your liver levels checked, right, because it also passes through the liver. You understand this better than I do, but we have to make sure that their liver can accept that type of a shot and that it will process appropriately. Once we see that after the first few days, now, if this is done right by each of the treatment facilities, if you’re a proponent of Vivitrol, you’ll prepare them for their graduation and when they’re going to leave, and then you’ll give them the naltrexone, and then they’ll get their shot, and then they go out into the world. And, basically, for 28 days?

Dr. John Kakowski

Yes.

Richie Hession

For 28 days, they can’t get high. They can go buy heroin and they can shoot it, intravenously, it won’t get them high. Then they can do another shot, and it’s still not going to get it-

Mark Bonanni

Tried it, didn’t work.

Dr. John Kakowski

And that’s an important point because what’s the biggest thing, right … So, we have some other medications that are used for, let’s say, for alcoholism, one of them is Antabuse. If you take this Antabuse, if you drink you’ll throw up, right, so there’s this negative conditioning-

Mark Bonanni

Violently ill.

Dr. John Kakowski

Violently ill. With Vivitrol, once you get the shot, you’re covered for 28 days. So, you talk about med compliance, med compliance is very important because if you’re giving a pill, you have to talk something daily, but it’s ingrained in your head, “If I don’t take this pill, I can get high.” At least with the Vivitrol, you have now a more positive med compliance with it.

Richie Hession

Yeah, for 27 days.

Dr. John Kakowski

Right.

Richie Hession

And let’s call that what it is, right? If I’m an addict and I’m not … See, this is where everyone is in agreement, or at least from what they say when I hear all the panels and all the different experts talking about it and all the politicians are talking about it. One thing they do throw in is that it’s not just the medication-assisted treatment you give, you also need the accompanying psychosocial service.

Dr. John Kakowski

Yes.

Richie Hession

And they all say that, and they’re 100% correct. And the truth is, you know, Vivitrol parents, I’ll tell this to parents, if any of them are watching the podcast, if you think that just getting your kid a Vivitrol shot and they’re good, you know, go back to college and live your life normal-

Dr. John Kakowski

No.

Richie Hession

What happens is on day 23, I’m making this up, they start thinking, “I got the shot set up on the 27th day, or the 28th day, but, you know, maybe …” now, again, I’ll throw this out there, as well, really you should set the shot up on the third week, it should be day 21 or 22, that way if anything happens where you can’t get there, the doctor can’t be there, there’s an issue with the train system or a power outage. If you leave it to the 27th day and they can’t go for three more days, guess what, that’s a window where they can actually be getting high and it will no longer be blocking.

Richie Hession

So, we try and do it a little earlier, just in case, because it can bridge, like it doesn’t have to be exactly, and you can do it a week earlier. But then they start thinking on day 23 about “Maybe I won’t go get that shot,” and once that … That’s why the other, the actual treatment work that you have to do to get yourself and your mind to shift so you can be taken beyond where you are in that urge or that thought to go do the thing that you know is going to destroy everything for you, which is what people don’t understand about addiction, like, “Why would anybody do that?” They can’t not do it.

Richie Hession

And the mind kicks in, and they start thinking and they minimize, and they start thinking, “This time it’s going to be different. I don’t need these shots.” And on day 27, they cancel the appointment, and on day 28 or day 29 they’re out there and they’re getting high all over again. Vivitrol is not a curative, but, for those 27 days, that gives them 27 days where they know they’re not going to be able to get high anyway, “Let’s do some work.” Psychosocial services, that’s where the other 12-Step work, or the counseling work, or whatever it is that you’re doing to try and get recovered, you’ve got 27 days that you’ll be all right.

Dr. John Kakowski

And I just want to highlight-

Mark Bonanni

For opiates.

Richie Hession

For opiates.

Dr. John Kakowski

For opiates.

Richie Hession

We’ll go there in a second.

Dr. John Kakowski

I want to highlight that, too, because if you look at basically how the opioid epidemic is being sensationalized in the media, all we hear about is addiction, addiction, addiction, there’s not mental health piece, right. So, that also comes with the counseling, where addiction and mental health counseling or treatment or whatever has to come hand-in-hand. So, we’re very focused on addiction treatment, even in the prison systems and the jails, but the mental health system isn’t great, it’s not good at all, we’re just focusing on the addiction piece.

Dr. John Kakowski

Now, it’s great if we can have people, if they’re receiving Vivitrol and they’re going to treatment, simultaneously get that mental health, as Richie had mentioned, Vivitrol is by no means a curative, it is just a tool of many tools in a toolbox. And this is not something that you just give and, boom, you’re cured, and that’s it. It’s an ongoing process, and it’s an ongoing process with you might need medication for mental health, if there’s depression, anxiety, bipolar disorder, you know, what is the real reason why somebody is using, specifically opiates or whatever the case is. And having Vivitrol in that toolbox is great, but it’s also not a monotherapy-

Richie Hession

No, you have to get down to causes and conditions-

Dr. John Kakowski

Absolutely.

Richie Hession

Bottom line, what’s underneath. And then the caveat to it, which is what Mark was alluding to, which is so true, is it’s not a curative in other ways because we know, we see it happen all the time, people get Vivitrol and they can’t get high on heroin, so guess what they do?

Mark Bonanni

Smoke crack.

Richie Hession

Crack cocaine. They just get high on coke, or they get crack, or they smoke pot, or they drink, it’s not a blocker for any of that. There’s an argument that you can get Vivitrol and it’ll actually also help control your cravings for alcohol and for other things. And whether that’s true, I don’t know, but I can tell you that we see people that, when they’re on Vivitrol, they go and they start doing other drugs.

Mark Bonanni

I’ve been on naltrexone before, and I’ve drank, and I’ve smoked crack, I’ve done all that stuff-

Richie Hession

I wanted you on this podcast, Mark, because in case, now, John, I don’t know if you know Mark’s story, and Mark gets mad, Mark’s like, “I never did that,” and I remember it different from back when he was a kid, but-

Mark Bonanni

I did not dig it out.

Richie Hession

When he was 20, he got those blockers, you know how you have that … they used to have the surgery, where they inserted the … and John took a-

Mark Bonanni

Pre-Vivitrol.

Richie Hession

He took a kitchen knife at his mom’s house and tried to dig and pull the-

Dr. John Kakowski

That’s very common. People take the implants out, I mean-

Mark Bonanni

I had the implant, four of them.

Richie Hession

Removing your own implants, that’s insane. He had four different implants done. Mark’s been there, done that, done it all, when it comes to … So, we talked about Vivitrol a little bit, which I wanted to because I’m a big proponent of Vivitrol as a tool, that’s how we use it, while we do the other work that can actually help you to recover from alcoholism and addiction.

Richie Hession

Now we move on to the main thing, which is Suboxone. I’ll start off by telling just an interesting story, and it just shows our mindset of it. Mark and I were on … and this is one thing that you always like to say, and it’s so true, and so I bring it up all the time. You’re out … and so we were on some … We were at one of the events, of the addiction symposiums or wherever we were at, and we were walking around, we were engaging and talking to people, and we started talking to some doctor.

Richie Hession

And this guy was a big proponent for Suboxone. He was telling Mark, and he and Mark and I are talking to him, nice guy, he was very well-educated, and he was like, “Suboxone’s not a drug. Suboxone,” and he goes into Mark and I all the benefits of the Suboxone, and longterm usage, and whatever. And so Mark was like, “I’m sorry, did you say that Suboxone’s not a drug?” And the guy’s like, “Well, I mean it doesn’t get you high,” and Mark said, “Really? It doesn’t get you high? I’m guessing you’ve never taken Suboxone before.”

Richie Hession

And the guy’s like, “Well, no, I’ve never taken.” Mark said, “Well, I would posit to you,” you didn’t say it that way, that’s what I would have said, but you basically said to him, “Well, I’ll tell you that if you took just one milligram strip of Suboxone, and I gave it to you now and you ate it, within 20 minutes you’d fall on the floor, you wouldn’t be able to get up or move, you’d be wasted beyond belief, probably couldn’t even talk, and you’d be high for 12 hours.”

Mark Bonanni

Itching, scratching, throwing up.

Richie Hession

Itching, scratching, maybe even throw up the way you would on heroin. That’s not a drug, and it doesn’t get you high? It makes no sense. But a lot of the guys that are out there talking about it, they don’t know, they have no idea, they don’t know what it is that these folks are on. If a regular person, or somebody who’s, what do you call it, heroin naïve or opiate naïve, takes one of those, it’s you’re lights out, man, you’re high as a kite.

Mark Bonanni

Yeah, for a milligram, I think I’ve read 30 milligrams of oxycodone is equivalent to 1 milligram of Suboxone.

Richie Hession

Would you agree?

Dr. John Kakowski

It’s a very strong drug, I mean just by nature.

Mark Bonanni

Super potent opiate.

Dr. John Kakowski

Yeah. I mean just think about it this way: if somebody is on opioids, and let’s say they’re high, and they’re going in to get Suboxone, they have to be in withdrawal to get that Suboxone, and the reason is is because Suboxone is so strong, it actually goes into the receptor-

Mark Bonanni

Yeah, it’s a binder, it’s stronger.

Dr. John Kakowski

Yeah, it kicks off the existing opioid. Now, while it kicks off that existing opioid, what is happening is that the patient is in withdrawal because the receptors are clear. It takes a little bit of time for the Suboxone to shimmy its way in there.

Mark Bonanni

And it doesn’t fit the puzzle perfectly, so it’s not a full agonist, so it’s not-

Dr. John Kakowski

Yeah, it’s a mixed agonist and antagonist. And by agonist, it basically will activate and get you high, and antagonist meaning that it will basically block other opiates and displace other opiates, so that’s where the mix nature of Suboxone comes in of being an agonist and antagonist.

Richie Hession

Again, outside of the treatment industry, there’s so many aspects of this and who uses subs and longterm, like I get the need for longterm, and that’s why I say this whole thing is stream of consciousness because everything leads to something else. In the end of the day, these are … John was at a … they have so many of these drug panels now, and opioid conferences, and symposiums. We’re at one of them, and I go, and John’s there, and John does all the stuff, he’s in McGreevey’s Reentry Program for prisoners coming back out of prison, which we’re going to talk about in a second, as well.

Richie Hession

So, John had these things, and I’m looking at it, and you see … and I’m not going to mention the politician’s name, but they were one of the local politicians, a New Jersey guy, and he was up there and he was touting these unbelievable benefits of Suboxone, how it’s a curative, and of course they love it in and of itself and so do all the sheriffs, and I get it, it’s not lost on me, I see the benefit for crime reduction because you do, you see crime reduction, you see harm reduction overall, and people’s big thing is, “Well, he went back to work, and now he’s showing up for his kids and picking them up from school.”

Richie Hession

And, yeah, I guess that’s good if that’s as best as you think the guy’s ever going to be, while it lasts, until he goes back out and he gets high again. But, anyway, we’re at these symposiums, and you hear these politicians and they’re touting these unbelievable benefits. And then you look and you see all the signs all over, and you see in this amazing lunch, a beautiful, beautiful conference that they put on with this great food. And then you see the little fine print, “Paid for by such-and-such” pharmaceutical company that is a maker of Suboxone. I mean, come on, guys, are you kidding me or what?

Richie Hession

And they’re out there, it’s like an ad campaign. Mark and I were just reading The Associated Press, some lady, the author was Lauran Neergaard, and it was their Health and Science Department, and they basically put out this piece, and I’m paraphrasing, and you can go look it up or whatever, and I’m not calling anybody out on anything particular, but it’s just this particular article said something to the effect of that subs and methadone are really just very weak opioids, and she kind of marginalized what they are-

Mark Bonanni

I’ll show you.

Richie Hession

Yeah, he can show the article.

Dr. John Kakowski

That’s insane.

Mark Bonanni

Weak opioids.

Richie Hession

This comes from The Associated Press Health and Science Department, and they’re literally saying this, it’s almost like a big campaign. Now, and we all know what’s going on, right, and I love their studies, the studies they’re doing, “We’re doing studies.” And one lady, John, who you actually like, what’s her name, Nora what?

Mark Bonanni

[Nora Volkow 00:17:29], she’s the national drug czar, essentially, in the United States, right?

Richie Hession

I’ll tell you now, she’s amazing-

Mark Bonanni

She’s doing studies-

Richie Hession

I’ve read a lot of her stuff, she’s astounding, and she does a lot of these studies, and what was the study that she was … She was positing that-

Mark Bonanni

They’re going to do a study on successful longer-term MAT, specifically on Suboxone maintenance, and how they’re brain is repairing, because we know that opiates and opiate abuse changes the wiring of the brain and brain chemicals and all that stuff. So, they’re thinking, the theory is that people stabilized on longterm Suboxone, that their brain is going to repair itself. I don’t really understand-

Richie Hession

But you said it’s going to literally repair the pleasure of-

Mark Bonanni

The pleasure pathways.

Richie Hession

The pleasure pathways is what she’s intimating-

Mark Bonanni

That somehow-

Richie Hession

Now, again, I can’t-

Mark Bonanni

And that’s why they were saying here-

Richie Hession

She’s a rockstar.

Mark Bonanni

[crosstalk 00:18:17] the line is-

Richie Hession

The lady, Nora, is a rockstar, she knows more than I’ll ever know about the science behind any of this, and all three of us put together-

Mark Bonanni

Yeah, she’s a doctor.

Richie Hession

Man, she’s an amazing doctor, and she’s really very helpful of the addiction community, it’s just an interesting … and I’m not suggesting that Nora is funded by a drug company, she’s in this game for real. And if there is a way to show that it would actually, I’m open-minded. The problem is-

Mark Bonanni

Let’s see it.

Richie Hession

There’s the science versus what we see. I’m a yo-yo, right, like we see-

Mark Bonanni

Absolutely.

Richie Hession

What I’m talking is kitchen-table logic, I see what I see every day, dealing with this stuff for 22 years, not in a scientific capacity, but dealing with addicts, and watching the reality of what happens versus what some of their hypotheses are.

Mark Bonanni

Believing what I see. Believing what I see on a day to day, year over year basis.

Richie Hession

And we know people who have been on longterm Suboxone maintenance, and how many people have we had to come into our rehab, where we get the call where the drug that they’re looking to get off of is Suboxone? And they’re hooked on it-

Mark Bonanni

Too many.

Richie Hession

And they don’t want to live on it anymore, and they want to get off it.

Mark Bonanni

They can’t get off.

Richie Hession

The withdrawal is insane. If you’ve ever … If you know anything about heroin withdrawal, and you know better than most, heroin withdrawal, how many times did you withdrawal on heroin, even in jail, on the floor of a jail, you hear the story all the time, because they don’t have it and they’re puking and shitting everywhere, and everyone else who’s in the cell with you, they hate your guts because you’re-

Mark Bonanni

Hot, cold, sweating-

Richie Hession

For five days, you’re a mess-

Mark Bonanni

Don’t sleep for a month.

Richie Hession

Oh my God. But that’s heroin.

Mark Bonanni

Or oxycodone, right.

Richie Hession

Or oxycodone. But now you look at subs, the half-life of subs, right,-

Dr. John Kakowski

The half-life is insane, and even with methadone, too.

Mark Bonanni

What is it, 42, 72 hours, or something like that?

Dr. John Kakowski

It could be 24 to 36, and depending on the patient that’s on it, depending on their system, but it could be about a day, so you’re looking at withdrawal, heroins could be 4 to 7 very intense days, but Suboxone, they say, “It’s weaker,” it’s still intense, but it’s for much-

Mark Bonanni

It’s less intense, but for-

Richie Hession

Longer periods-

Dr. John Kakowski

It’s still intense, but it’s much longer.

Richie Hession

Longer periods of time.

Mark Bonanni

I know people that didn’t feel right for six months.

Dr. John Kakowski

Absolutely.

Richie Hession

And keep in mind, when people first come in, one of the things that keeps them from seeking treatment in the first place is they don’t want to be sick. They know what that’s going to look like, and they do not want to walk down that road. They know how it makes you feel. Subs are even worse, it’s very hard to come off of subs once you’re on it. Again, it leads into, and, again, we can in so many paths, but we’re talking about the pharmaceutical companies, and how the pharmaceutical companies are … there was just a lawsuit settled, $1.4 billion settlement. Right, $1.4 billion?

Mark Bonanni

$1.4 billion. The largest ever, so far.

Richie Hession

And what was the nature of the suit?

Mark Bonanni

False and misleading marketing practices. Basically … And it also-

Richie Hession

That it’s not addictive.

Mark Bonanni

Procreating an army of marketers to get out and to get more doctors to write more prescriptions, that it’s not addictive, that it’s not abusable, and it’s not divertable. What I tell people all the time-

Richie Hession

And their ad campaign is successful. They’ll pay the $1.4 billion, they’re going to make a lot more than that on the backend, first of all-

Mark Bonanni

Of course-

Richie Hession

And second of all, it’s-

Mark Bonanni

They paid that $1.4 billion without even blinking an eye.

Richie Hession

They’ll take-

Mark Bonanni

They’ve done enough to-

Richie Hession

Yeah, absolutely.

Mark Bonanni

They’ve done enough to already get the masses to believe that this is the solution, so every level of government and doctors-

Richie Hession

They all believe it.

Mark Bonanni

And healthcare, they all think that this is the answer, and they’re all willing to write it and prescribe it.

Richie Hession

Absolutely.

Mark Bonanni

Then you got doctors that are making a business out of it, charging 250 to their clients once a month. It’s 160 clients, I think is the law, right, they can only treat 160 people, so it’s 200 bucks to 250 for the appointment every month, they have to come back to go to their legal drug dealer in a lab coat. That’s 40, 50,000 a month for that doctor that runs it. I mean there’s just, like you said, so many directions to go.

Richie Hession

No question. But now I’m also going to point out that subs aren’t all negative and evil, either. Now there’s a couple of different things that I would put out there for positives on Suboxone, right, because I’m not going to ignore the possible benefit because if it was used as a tool, it can be used helpfully as a tool, like in the detox process.

Mark Bonanni

Miracle-

Richie Hession

Sometimes when people are-

Mark Bonanni

Miracle drug in detox.

Richie Hession

They go, in detox, a miracle drug. And then people who are longer-term users, sometimes out of detox they still need help with withdrawal management, and so they’ll go on subs where they’ll come out of detox and their last is a 2 milligram, maybe for a couple more weeks they need to do 1, 1, 1, half, half, half, and they’ll work them down off of it so it kind of helps with the withdrawal-

Mark Bonanni

But, again, so let’s stop right there. So, now we’ve got a person with substance use disorder, or addiction, I don’t really love the new substance use disorder term, that’s just for me, whose got a problem, displays a problem with chemicals. And we’re going to send them home with a highly addictive and, counter to what that article says, a strong opiate, and we’re going to expect them to follow protocol. The nature of the disease of addiction is “I cannot follow protocol.”

Richie Hession

Yeah, and the reason we do that is because the insurance company will not pay more than 7 days, that’s the most you’re going to get, usually it’s 5 for the heroin addicts, 7 for alcohol, but the insurance company is not going to pay to have someone … this is an issue, by the way-

Mark Bonanni

“Listen, you’ve had a drug problem for 20 years, take this script home and take it as directed.”

Richie Hession

As directed, yeah.

Dr. John Kakowski

[crosstalk 00:23:25]. No, no, it’s insane.

Mark Bonanni

And it doesn’t even … none of it makes sense.

Dr. John Kakowski

Right.

Mark Bonanni

When we talk about the marketing, the $1.4 billion, only my experience is all I can talk about, that it’s not abusable. So, nine years ago, I’m addicted to heroin, and I get on the internet, and I buy Suboxone on the street, and I’m going to kick it on my own. And I’m reading stuff on the internet, I tell this story a lot of times to a lot of different people, too, I’m like, “I’m wondering if you can inject this stuff.” And so I go on these chats-

Richie Hession

It’s a normal thing to do, considering, I wonder, I wonder if I could do that.

Mark Bonanni

But that’s what I wanted to do, right, and so everybody says if you inject this stuff, I mean it’s got naloxone, it’s 2 milligrams naloxone, 8 milligrams of buprenorphine, in each strip, and the 2 milligrams of the naloxone is there so you cannot snort or shoot the stuff. But I’m like … So, I go on a drug forum online, you can find a wealth of bad information on there, but I’m reading this stuff, and people are saying you can snort it, you can inject it, and nothing will happen.

Mark Bonanni

So, here you have the drug company side saying you can’t do it and it’s going to kick you into immediate withdrawals, which I’d been in precipitated withdrawals before, they are the worst. And I’m like, “Well, that’s what they’re saying. But these guys on the internet chat forum are saying I can shoot it. You know what, I’m going to roll the dice,” because that’s how nuts I am. And so I shoot it, nothing happens. But I don’t get dope sick, and I feel a little better. And I got a problem with needles, just like a got a problem with heroin, and now I’m shooting suboxone. Then I’m sniffing suboxone.

Mark Bonanni

And so the whole idea, like what they don’t talk about is even that little 2 milligrams of naloxone they put in there is also a lie; naloxone is the same stuff as Vivitrol, if you don’t know that. And so they put that in there to make it … initially, I think the idea was that was the part that makes it not abusable. What they don’t tell you is, just like it’s a stronger binder to the opiate receptors in the brain buprenorphine is than heroin, buprenorphine is stronger than even naloxone.

Mark Bonanni

So, it has no effect; it’s in there, it does literally nothing. So, the naloxone that’s supposed to make it not abusable has no chance; the buprenorphine outcompetes for the receptors and keeps even the naloxone off the receptors, so it’s like … and they’re out there pushing stuff … I mean it’s crazy.

Dr. John Kakowski

Yeah, I mean that’s something we definitely learned about in school, and the naloxone, which is the same crap, it’s in Narcan, will counteract the abuse potential for snorting or injecting. But ever since I’ve been working in treatment, I hear stories of it, and I don’t hear people saying, “I was in withdrawal from shooting that suboxone,” they continue to repeat it, so, just from my own knowledge, I’m like, “Well, what the heck is going on here?”

Mark Bonanni

Well, I did it.

Dr. John Kakowski

Yeah, I know, that’s what I mean. So, it’s odd because from … and I’m telling you, I went through school for six years, and we studied, obviously, poisons-

Mark Bonanni

Little weird, wouldn’t you say?

Dr. John Kakowski

It’s a little strange, it’s a little weird. And you’re completely correct in saying that buprenorphine can displace pretty much any opioid, it’s very, very powerful. So, it’s a little odd.

Mark Bonanni

I knew a guy-

Dr. John Kakowski

It’s kind of like a public common factor.

Richie Hession

Did we go off … I don’t remember … to finish the story about the doctor, but he was pissed when you first told him “If you took one of those, you’d fall on the floor-

Mark Bonanni

I think it was in Cape Cod.

Richie Hession

And you would be high as a kite.” Yeah, it was up in Cape Cod.

Mark Bonanni

I vaguely remember it.

Richie Hession

And he was kind of put-off a little bit by Mark’s commentary.

Mark Bonanni

Well, I mean the symposium we went to, with all the dignitaries from the state and law enforcement, when they were doing the whole conference, and I looked around, I’m like, “There’s not a guy in this room who’s ever taken this stuff.” How can you be an expert on the stuff without talking about the people that have taken it? I don’t know, see, I’m a non-trusting person, so I don’t-

Richie Hession

There was a movie line in one of the Jason Bourne movies, where he looks at the lady, Pamela Landy, and says, “Lady, you talk about this stuff like you read it in a book.” And that’s exactly what you’re talking about, right, they’re talking about this stuff like they read it in a book. And the reality of it is a lot different-

Mark Bonanni

Based on bad info, right.

Richie Hession

There you go, bad info, bad intel. And then there’s the reality of what it’s intended to do and what benefits there could be, and how it actually shows up on the street, because an addict is going to take and manipulate and turn around and twist. Let’s talk about the reality of what they actually do with their scripts for subs when they get them, right. Like, everybody knows what it is. They’ll leave, and they’ll be given their subscription for subs, maybe they take them a couple few days. Subs have a value; like, in prison, that’s how you get high.

Mark Bonanni

Listen-

Richie Hession

Subs are what you get high on, they cost … how much was it, 10 bucks a strip or something like that, inside of prison?

Mark Bonanni

When it’s out of prison, it’s probably 50. On the street-

Richie Hession

It might even be higher.

Mark Bonanni

It’s 10 to 20.

Richie Hession

Ten to 20 on the street, there you go.

Mark Bonanni

I’m in a Suboxone doctor’s office, and they don’t know that I’m there because I’m friends with the doctor and I know the people and I’m not there to get subs, and so the kid starts volunteering information to me, he’s like, “Well, I just come here to get my subs. To be honest with you, dude, I don’t really take them anymore. I haven’t really taken them in years, but they’re worth 20 a strip on the street in Paterson.”

Richie Hession

Right, so they get them filled, and then they go sell them and they get money for heroin.

Dr. John Kakowski

That’s so common.

Richie Hession

And they go get high on heroin.

Mark Bonanni

Right, and I’m like, “Really, dude?”

Dr. John Kakowski

And that’s one of the down falls of that, the fact that you can have somebody who is struggling with addiction, especially early, and get a whole month’s supply of the stuff, and then-

Richie Hession

Which, by the way, it happens a lot.

Dr. John Kakowski

It happens a lot.

Richie Hession

Hey, insurance company, guess what, the drug bankers are saying that this is a cure-all, and look how much of it they’re selling. Well, a lot of the kids are actually just taking it, and your money that’s being paid for that prescription is actually being … they’re using it to buy heroin in the end because they’re selling it out onto the street, and it’s just a whole cottage industry that’s taking place inside the addiction [crosstalk 00:28:49].

Mark Bonanni

It’s an insane drug, from my personal guinea pigging myself experience. Like I was telling you earlier, the amount that people get prescribed, 16, 24, 32 milligrams-

Richie Hession

That’s another thing.

Dr. John Kakowski

That’s insane, yeah.

Mark Bonanni

I’ve had pretty monstrous dope habits, and I felt fine on the first 4 milligrams. Did I feel great? No, but I’m coming off of heroin, I’m not supposed to be feel great. And the crazy thing about it is they’re over-prescribing this stuff, and you can taper down on your own, because I did that, too, pretty quickly, with zero discomfort. You stable on 4, you can go to 2 milligrams two days later-

Richie Hession

Let’s not marginalize that. Let’s not undersell that at all. I mean, I promised [inaudible 00:29:28], I’ll try not to curse on the thing, but I would say to the doctors that are out there, you know, what the fuck? Like, are you kidding me? So, they have to go to some, what, is it a 2 day class, to get the special DEAX license, to be able to-

Mark Bonanni

10 hour, 12 hour-

Dr. John Kakowski

It’s not difficult.

Richie Hession

10 hours of training. I mean if they want to be able to write and to be a drug dealer, and they want to be able to write Suboxone. Now not all Suboxone doctors are like that, and some of them … you know, Suboxone, in and of itself, it should be done in only in conjunction with treatment is really what it should be because, in and of itself, it’s not going to be effective anyway. But you’ve got kids that are going in there, and we know, we talk to these people; for us, this isn’t theory, this is practical reality, and we have dealt with it over and over, it’s anecdotal-

Mark Bonanni

It’s every day.

Richie Hession

It is anecdotal in so far as I don’t personally have a million experiences, but all the experience we do have, it’s not just coincidental-

Mark Bonanni

Yeah, and we’re not doctors.

Richie Hession

That these kids are going in, and they’re on maybe a three-bag-a-day habit, not three-bundle-a-day, but-

Mark Bonanni

Even 30.

Richie Hession

Three-bag-a-day habit, even 30, but I’m talking about the kids that are the lower line, they were taking pills, they get into heroin, they get scared, they come in to detox, or they go see their family doctor-

Mark Bonanni

If they’re taking two 30 milligram blues a day.

Richie Hession

Right, there you go. All right, let’s call it that, they’re taking two 30’s a day, that’s a … again, we don’t know who’s watching the podcast, two 30 milligram blues of-

Mark Bonanni

Oxycodone.

Richie Hession

Of oxycodone, one in the morning and one at night, you pretty much stay numb for a good part of the day because you haven’t built up the tolerance-

Mark Bonanni

And you will withdrawal. You will have withdrawal.

Richie Hession

Yeah, no question, you’ll have withdrawal. And now they don’t want to go to rehab, they don’t want to go to detox, because this isn’t just what happens; parents, if you’re watching this, of course they don’t want to go to rehab and detox.

Mark Bonanni

Yeah, nobody wants to.

Richie Hession

And, of course, unfortunately-

Mark Bonanni

Nobody wants to go to detox.

Richie Hession

But, unfortunately, a lot of the parents don’t want them to either because they’re not drug addicts, they just happen to get into a bad thing, they go see a doctor, and the doctor says, “Oh, no problem, we can write you a script for Suboxone, and we’ll help you get off of that.” And they write them a prescription for 16 milligrams of Suboxone, 16 milligrams, the kid was taking two 30’s a day.

Mark Bonanni

And literally 2 would hold [crosstalk 00:31:31].

Richie Hession

Two milligrams would have been just fine, and he’s getting 16 milligrams. Now the kid is starting to foster a real drug habit because Suboxone, 16 milligrams, taken over the long term, that kid is screwed, when he ever tries to come off of that, oh my God.

Mark Bonanni

Yeah, and he’s high as a kite from the rip, too. He’s high-

Richie Hession

No, he just upped himself. So, the curative, he was like, “Wow, I should’ve done this a long time ago. Sure, Mom, I’ll go back to that doctor again tomorrow, absolutely,” until that doesn’t work anymore, either.

Mark Bonanni

Well, it’ll wear off after a period of time because your tolerance will go up and you won’t feel high, you won’t feel high. That’s the other thing I-

Richie Hession

Which is the misconception, and that’s their argument, they’re like, “They don’t get high on Suboxone.”

Mark Bonanni

And then the question is, “Okay, do you want your surgeon being on 16 milligrams of Suboxone when he perform heart surgery? Do you want your pilot in the plane on 16 milligrams of Suboxone?”

Richie Hession

It’s a good question. And when your answer is “Absolutely not,” why is it okay for my son?

Mark Bonanni

Or anybody else.

Dr. John Kakowski

It’s an interesting point because when you go back to that and you look at that, you’re giving somebody 16 milligrams of Suboxone. If they want to fall back on what their old drug was, so if it was one 30 in the morning, one 30 at night, that’s not going to cut it-

Mark Bonanni

They’re going to get a lot more.

Dr. John Kakowski

So now they’re-

Mark Bonanni

Wouldn’t even touch it.

Dr. John Kakowski

Yeah, they’re going to be at more of a risk for overdose and for experimentation for other things. So, if you’re not dosing it right, that’s extremely problematic. So, you have a person who wants to take five, “I need five now. Let me try six. Let me try seven.” So, you’re fostering, like Richie had said, a much, much worse addiction, and that’s something where people can actually overdose accidentally from.

Mark Bonanni

And we should probably talk about … like, what is the reason for this? Like, nowhere in the history of treating addiction and alcoholism has the protocol for treating it been giving them more of the same drugs and alcohol with an … you never tell an alcoholic, “Just drink two airplane bottles of vodka a day for the rest of your life,” they would never do that, they would never say, “Here’s a rock of crack, but this-

Richie Hession

Well, then let’s call what it is. Let me … I’ll be devil’s advocate, I’ll play the other side for a second. The argument can be made, and it is, I believe it is a strong argument, it wouldn’t work with alcohol, but, with subs, from the research and from what they see happening, a lot of the heroin addicts, at first, when they first come in and they start taking Suboxone, their desire to go out and get heroin is reduced-

Dr. John Kakowski

Correct.

Richie Hession

Many of them do stay away from it for periods of time, the ones that are able to … usually it’s because they have some support network that gives them the drugs every day and they do have that mindset of “I really don’t want to be a heroin addict anymore,” and they’re taking it as prescribed, they actually do go back to work, they actually do take the kids to the park again.

Richie Hession

They’re not out selling their paychecks and going out and buying; they’re getting prescriptions, they’re following the prescription the way if you had cancer or any other drug, and they said, “Okay, you’ve got to take one of these a day,” and now they start growing their hair back, and you start seeing them come back to life. Now, what kind of life? That’s the ultimate question from us because we see-

Mark Bonanni

Maybe they’re good lives. But we’re not going to get calls from those people. I’m not going to run into those people. I’m going to run into the ones that are dying and using other drugs, or dying to get off-

Richie Hession

Agree, but we can’t ignore the fact that we cannot say … see, that’s the real issue here, I guess. I mean this is even part of the reason of having one of these conversations, it really does get you thinking. And that’s the issue, it’s not a panacea, there is no cure-all. Addiction strikes different people in different ways, and some people are able to maintain and moderate in these ways, and other people absolutely cannot. When it comes to the people who can do that and go back to work, unfortunately, I’ve talked to them, as well.

Richie Hession

And here’s the real problem, and this is one of the things that … I mean this is close to home for me, this is what hits at the heart. So, I’m a recovery guy, I will concede the fact that some people, and I hate to do this, and I won’t be the one to say who it is, I won’t do it, and I’ll tell you why, but I’ll concede the fact that there are people who probably should be on longterm Suboxone.

Mark Bonanni

Yeah, right.

Richie Hession

Maybe forever. Maybe that’s the best that they’re ever going to hope to get and be. And make no mistake, they may be back in their kids’ lives, and, again, this is not something we read in a book, right, I mean you’ve been on it, and we talk to thousands of kids, like I know what they go through, like we deal with it in the trenches every day. They may go back to work, and they may get their relationship with their kids, but they’re in a fog. When you’re on those levels of Suboxone for longterm, you may not feel high, but, behind the scenes, you’re on a drug that if anybody else was taking it, you’d be laid out on the floor.

Richie Hession

So now you’re taking this maintenance and you’re taking this very powerful drug every day so you can go to work, the connectivity you have with other human beings, the passion that lights up people’s lives, the ability to connect interpersonally is diminished hugely. Yeah, you can do the basic stuff, like shower and go to work and pay your bills, and I guess that’s good, it’s great for the government who’s looking for crime reduction and who wants the people to stop running around and being drug addicts on the street. But in the end, is that the end goal? It can’t be, for me, I’m a recovery guy, I believe that you can have a different experience using those things as tools-

Mark Bonanni

A different life, yeah.

Richie Hession

Where if you do some real recovery work, you can be taken beyond where you are. You can recover in a way that is astounding, where you don’t need any drugs. That’s what recovery is. In the outside recovery community, I, personally, when it comes to the 12-Step work that I do on the side, I won’t … from me, if somebody’s on Suboxone, I can’t even … like, doing 12-Step work when you’re on Suboxone is … it doesn’t mean I’m right, it’s just, from me, I won’t do it-

Mark Bonanni

Yeah, me neither.

Richie Hession

Because you’re still getting high every day, I mean there’s no … to us, we [crosstalk 00:37:08] we understand it.

Mark Bonanni

[crosstalk 00:37:09] experience both my own and everyone that I’ve seen is it hadn’t worked for them. They tried it and it didn’t work, it inevitably always got high at some point, or picked back up whatever their original drug of choice was. That’s what I’ve seen. I’m not saying it can’t be-

Richie Hession

Over and over and over again.

Mark Bonanni

Everyone, I’m not so close-minded to think people that … there’s just so many different things that I can’t be close-minded to thinking maybe for a lot of people, they have a different experience. But what I’ve seen is the experiences of myself and everyone, not just … everyone I’ve seen, didn’t work for them.

Richie Hession

Yeah, and, again, over and over and over-

Mark Bonanni

And they ended up back.

Richie Hession

Hundreds and hundreds and hundreds, and even thousands of cases that you’re talking about, in practical terms from what we see.

Mark Bonanni

And I have a theory. I have a theory on this.

Richie Hession

Hold on, Mark has a fucking theory. This is exciting.

Mark Bonanni

You have to be … I think for even those that are successful, whatever that looks like … Nailed it.

Richie Hession

I have a feeling this theory is going to elicit that response, and I don’t think-

Mark Bonanni

But the people that do well on Suboxone, you have to be incredibly motivated to do well on Suboxone or abstinence-based recovery. But the difference is-

Dr. John Kakowski

Yes, that’s a great point.

Mark Bonanni

After a few months in on abstinence-based recovery, you don’t have to kick another drug. You’re going to … Most people aren’t going to resign to taking this stuff for the rest of their lives. They’re going to have to face the withdrawal at some point. But I think the motivation level has to be the exact same. Like, I don’t even think … I think you’re wrong.

Mark Bonanni

My experience was that being on Suboxone, as far as during my times taking it, did not cut down my cravings, it did not make me want to use real drugs any less. It didn’t. It just made me not get sick. And I think if you ask a lot of people on Suboxone, I don’t think it cuts their cravings. That’s just not been my experience or anyone that I know. They’re just doing it for outside reasons, they’re not really looking to get sober yet. I mean that’s been [crosstalk 00:39:05]-

Richie Hession

Again, is it possible that for some people it cuts down cravings, whereas for other people it doesn’t cut down cravings?

Dr. John Kakowski

Absolutely. But that all comes with-

Richie Hession

That’s all part of the campaign that the drug companies are putting out there, “There’s also a bunch of side benefits, like it cuts down your cravings-

Mark Bonanni

By the way, cutting down cravings, even with naloxone or with Vivitrol, I wanted to get high more than ever on … I just couldn’t. So, I didn’t crave … I mean I craved heroin, I just knew that I couldn’t do it, so let’s drink instead.

Dr. John Kakowski

Suboxone’s the thing that, you know, you’re giving it every month, and something like that really has to have intense dose monitoring, so a one-size-fits-all is not the model here. And, of course, it can maybe just feed the beast just a little bit to keep him off your back, but you still have that underlying mental obsession that’s going on that it’s not really going to treat at all.

Mark Bonanni

Right, which we kind of glazed over-

Dr. John Kakowski

Absolutely.

Richie Hession

Well, and that’s getting down to causes and conditions, rather than just the physical aspects of desire versus withdrawal. But I’m still not clear on … So, what exactly is your theory? I mean it didn’t even sound like a theory, it sounds like just what it is. But I’m … Restate your theory.

Mark Bonanni

A theory, because I’m not a doctor, I don’t have studies, but my theory is that you have to be just as equally motivated for abstinence-based recovery as you do to be successful on Suboxone-based recovery.

Richie Hession

Okay. I mean-

Mark Bonanni

So, why are we pushing-

Richie Hession

I’ll just concede that to you.

Mark Bonanni

But why push medication-assisted treatment as the cure to, really, at the end of the day, the person has to be just as equally motivated for both sides-

Richie Hession

Again, I’ll play the other side of it, there is a reason. When they’re not motivated, at least on the medication-assisted treatment-

Mark Bonanni

But then here’s the thing-

Richie Hession

At least on the medication-assisted treatment, they may get to a point where they become motivated, but they’re still not out there getting high and maybe overdosing and dying on heroin. So you can’t pretend it doesn’t play a fucking role, because it does play a role.

Mark Bonanni

Okay, agree-

Richie Hession

And I can’t believe I’m taking the other side of the argument, but it’s true.

Mark Bonanni

[crosstalk 00:40:51] the other side, but then why is it not always pushing Vivitrol, which at least gives 28 days? Because if you don’t want it … If you’re on Suboxone maintenance and you want to get high tomorrow, you don’t take the pill and you get high tomorrow. And it doesn’t protect you past a day.

Richie Hession

I’m with you.

Dr. John Kakowski

And the reason why Vivitrol, they’re not pushing it as much, obviously, it’s just because of the pounds and pounds of data they have, I mean the initial thing was methadone, and like Richie had said, the only thing really that it has extreme value in, right, or not the only thing, but something that it has extreme value in is the reentry population.

Dr. John Kakowski

So, as Richie had alluded to, it’s somebody who’s been struggling their whole life, they can’t get sober at all, so they’re putting them on MAT, methadone, and, as of presently, Suboxone, as well, you’re getting more studies with that, just so they can go about their lives, so they’re not going outside to rob a store or commit crimes. And, also-

Mark Bonanni

But if that’s what the prisoner wants to do, they’re going to stop taking the stuff and go do it.

Dr. John Kakowski

I know, but-

Mark Bonanni

Why is that making it so different-

Richie Hession

But it just increases their chances, though, Mark, that’s the thing, it’s a percentage thing; not all of them, some are compulsory, they do it, but if they’re given some of this kind of help, the argument we’d make: it’s just a percentage game. Instead of 80% running out and doing that, you’re right, maybe 60% of them, but maybe that other 20 are people we can save-

Dr. John Kakowski

It’s a positive [crosstalk 00:42:07]-

Richie Hession

That’s the argument.

Dr. John Kakowski

[crosstalk 00:42:08].

Richie Hession

They do have statistics to back that up-

Mark Bonanni

And in that case-

Dr. John Kakowski

It’s not only MAT-

Mark Bonanni

Then it makes sense.

Dr. John Kakowski

It’s not only just solely MAT. So, if you look at Rhode Island, for instance, what they’re doing, Rhode Island was giving MAT, mostly methadone and Suboxone, but sometimes Vivitrol, for prisoners that were being released. It wasn’t a soft hand-off, they set up all these Centers of Excellence, so there was a followup with care. So, they would give the methadone as they’re leaving, follow them up, they would have a doctor’s appointment right to go to, right away, as soon as they got out. And they did see a reduction in overdose deaths. From that end, that’s great because you’re decreasing-

Mark Bonanni

In what time period?

Dr. John Kakowski

For a half-year period. It was statistically significant. I mean it was … I thought it was a lot less, but I actually just-

Richie Hession

Six months is six months, right.

Dr. John Kakowski

Yeah, it was actually statistically significant, so you can kind of look-

Mark Bonanni

Yeah, it’s a lot harder to overdose when you’re taking-

Dr. John Kakowski

Of course, but, again-

Mark Bonanni

[crosstalk 00:42:59].

Dr. John Kakowski

Of course. Of course, absolutely. But it becomes … I think the main point of the argument is, you know, if MAT is available, and it’s legal, and it’s FDA-approved, or whatever the case, when do you start it, when is the prime period to start it?

Richie Hession

So, hold on. If you name me the drug czar, let’s say I was named drug czar and I got to make the ultimate decision in the United States, this is how we’re using this drug, forget about the insurance companies, the pharmaceutical companies, who’s making money, how it’s supposed to all work, your opinion on it, my opinion on it, all have valid arguments to make some much less valuable than others, in my practical opinion, but whatever. \

Richie Hession

If I’m the drug czar, this is what I’m … and, again, you guys can each play drug czar for a second, but, for me, when people go into detox, they have good detox protocols, for all drugs, in place now, we work at a lot of detoxes, they’ve got that down pretty well, they can take all the chemicals safely out of your body. If Suboxone is used as part of that protocol in a lot of the detoxes, that’s fine. That’s what you’ll use it for.

Richie Hession

And then depending on the level of your addiction, how much you’ve used, how long you’ve used it, whatever, I’ll allow you to be on Suboxone, on a wean, on a taper, for an extended period of time, for another two weeks or three weeks, so maybe you actually leave detox on four because you really needed to take 16 … I don’t know that anybody ever needs to take 16 … but 8, you leave detox on 4, we let you go to 2, to 1, to half, to quarter, and then eventually you get down to zero. When you’re getting to the point where you’re down to zero, we have the naltrexone pills as that three-day buffer because I don’t believe you can take Vivitrol while you still are-

Dr. John Kakowski

No, you got to have-

Richie Hession

Right on the sub.

Dr. John Kakowski

Seven to 14 days.

Richie Hession

Seven to 14 days-

Dr. John Kakowski

With Suboxone longer because a lower half-life.

Richie Hession

But can you take the naltrexone pills at-

Dr. John Kakowski

No, no, no, you cannot-

Richie Hession

So, you can’t take anything?

Dr. John Kakowski

You can’t take anything, no. You’re going to have a gap, [crosstalk 00:44:45]-

Richie Hession

So, herein lies the issue and problem, right. And so it’s going to have to be done then to be really effective, this is all going to have to be done in a rehab setting.

Dr. John Kakowski

Yes.

Richie Hession

Like, there’s no other way. Letting them do it out on the street,[inaudible 00:44:58] serious problem of the mind that’s going to take them back to it, and we know the nature of addiction, especially in this type of addiction, would have to be in a rehab setting, which means 28-day stays are out the fucking window because they’re not effective anyway; most people need to be there 45 days, two months, maybe even a little longer, depending on the nature of their problem and the kind of treatment that’s actually being employed.

Richie Hession

But now that 14-day period takes place in the detox. Now they’re safe, protected, they’ve been weaned off, the 14 days go by, so they’re able to take the naltrexone pill to make sure that they’re okay to take Vivitrol. And now we know they don’t have an adverse reaction, now you start planning what their aftercare is going to look like; again, being the drug czar, I’m going to say you can’t go back home, you can’t go in an apartment, I want you to go into some type of supportive housing with the professionals that you’re kind of given freedom, go back out and work, but you’re still living with sober people, there’s a degree of structure in place where a sober living home, something to that effect, for a period of time, while you’re on your Vivitrol.

Richie Hession

While you’re doing all that, it’s assumed, as I’m having this conversation, during all of this, you should be engaging in recovery activity, right, because you need to have an experience, and you’ve got to have that internal shift where you’ve got to be able to find a way, or somebody’s got to help you to find that path, where you have a shift, where you no longer want to go back to use that stuff anymore. Now that’s the big … How does that happen?

Mark Bonanni

Well-

Richie Hession

We know what we believe, but we-

Mark Bonanni

We glazed over it earlier, that even MAT, in all forms, treats the body, and we believe that it’s a mind-body-spirit thing, and really the problem is it’s a mental disorder-

Richie Hession

That’s it, and there’s no pill you’re going to give that’s going to make that go away. Period.

Mark Bonanni

None. It hasn’t done it yet, it’s not going to do it now.

Richie Hession

Right. So you’re talking about just one-third of the thing, and it’s important, and the physical aspects of it do need to be dealt with-

Mark Bonanni

Huge.

Richie Hession

But in the end, that, in and of itself, is not going to solve the opioid crisis.

Mark Bonanni

Yeah, ask any person who’s had a problem with drugs or alcohol, legit, if just getting sober and stopping kept them stopped.

Richie Hession

Yeah, of course, it just doesn’t work that way, unfortunately. So, if we could, and I want to go back to it, and it brings us back to, and my point earlier, that I made, which, and I still stand by it, I do see the … when we talk about who should be on, I alluded to some people probably would just benefit from being on longterm subs. They might be constitutionally incapable of grasping and developing a manner of living, which recovery might require; maybe some people, for various reasons, just not going to get it, they won’t … I’m not going to be the one to decide who gets it and who doesn’t-

Mark Bonanni

Yeah, who makes the decision, what’s the criteria?

Richie Hession

I can’t make that decision. Dude, I want to believe that everyone has a shot at a rockstar lifestyle.

Mark Bonanni

I’ve literally met people that have been to detox 105 times and now have years of abstinence recovery. Literally, 105 times. I thought I went a lot.

Richie Hession

Most people would have given up on you. What you went through, in your life, they would have given up, written you off. You’re a rockstar. So, don’t tell me, like I’ve met people that I’ve literally … and I hate to admit this, but I’ll be completely honest, I’ve met people in my recovery life, in 22 years, I’ve met a bunch of people that, after spending a little time with them, I’ve said to myself, “No shot. Zero chance.”

Dr. John Kakowski

I think we all have.

Richie Hession

“This kid will inevitably end up either dead or in prison for a long period of time.” I’m not going to turn my back on the guy. On the outside of this, I’ve tried to help people in recovery lifestyle ways, but I’m saying to myself the whole time, “Zero chance.” One of those kids I’m thinking of, particularly, right now, and you know who it is, [Mark Q. 00:48:30] is astounding, I mean that kid is beyond rockstar, and I would have written him off many, many years ago, and he is amazing.

Richie Hession

So, there are examples of that. Who am I to decide, who is anybody, who’s the government, who’s an insurance company to decide that I’m going to write this kid off? I can’t be the one to do it, I won’t be. I’m not saying that there’s not people that wouldn’t benefit from literally being on longterm Suboxone-

Mark Bonanni

And now it brings into something else that I can’t stand, that I’ve seen change with what we all do in this industry. Like, what happened to the “Your best thinking got you here”? What happened to your-best-thinking-got-you-here mentality to now it seems to be there’s this shift of asking the person, in day three of detox, “What do you think you need for recovery?”

Mark Bonanni

I mean, what happened? When did that change take place? And if you offer me Suboxone in detox, I’m taking it, every time, especially if a guy in lab coat, who I typically would trust, is telling me that this is your answer, I’m like, “Okay, done.” It’s mind-blowing stuff. It gets me so angry.

Dr. John Kakowski

Yeah, I agree with what both of you are saying. I think that, also, you know, there’s a major problem, also, with MAT that is not really talked about, is-

Mark Bonanni

We can reduce a lot of harm by telling people they shouldn’t use drugs.

Dr. John Kakowski

Of course.

Richie Hession

Nancy Reagan did that back in the 80s and it didn’t work.

Mark Bonanni

Did it?

Richie Hession

Just Say No.

Mark Bonanni

I know, but at least there was something. What’s the-

Richie Hession

Yeah, [inaudible 00:50:01].

Mark Bonanni

What is anybody doing today? I mean now it’s been a little different in the past year or so, because of the opioid epidemic, but what’s the national level of … what’s the fighting cry? There is no tagline. There’s no-

Richie Hession

Fair enough. You know what-

Mark Bonanni

Like, if this stuff’s going to change [crosstalk 00:50:17] … sorry I keep cutting you off, John.

Dr. John Kakowski

No, no, no, it’s fine. It’s a good discussion.

Richie Hession

It’s not the same … It’s weird you say that, and it just came up into my mind, and, again, we’re going to wrap it up soon because, listen, we could go on and on and on-

Mark Bonanni

For hours.

Dr. John Kakowski

Yeah, it’s a huge topic.

Richie Hession

Yeah, it’s a huge topic.

Mark Bonanni

Joe Rogan does four-hour ones, we can …

Richie Hession

But I’ll tell you that, it’s weird, because I was sitting talk to my 10-year-olds, my twins, last night, and we were just sitting around and chatting, and I said something to them, and I just said it out of the blue and I don’t know why, and it speaks in a weird way to what you’re talking about, which is where we are as a society, as a country, as families, right, prevention, this kind of thing. And one of the things that I said to them, out of the blue, I just was sitting there, and, how old are you? You’re in your early 40s right?

Mark Bonanni

41.

Richie Hession

And how old are you?

Dr. John Kakowski

33.

Richie Hession

Yeah, you’re a child. Kevin, how old are you, bro? 33. So, you two might not know, but you might, but you might remember it from when you were a wee lad. You ever remember this, “It’s 10:00 P.M.-

Dr. John Kakowski

Do you know where your children are?

Mark Bonanni

Do you know where your children are?

Richie Hession

Do you know where your children are?” And I said that out loud in front of my kids, and they both looked at me and said, “Dad, what are you talking about?” And I said, “Well, back when Daddy was a kid, they used to … the TV, at 10:00, before the news, would go, “It’s 10:00 P.M.”” and they were like, “Well, why did they do that?” I said, “That’s a good question. I think they did it just to remind families like, “Hey, you’ve got some kids out there, do you know what they’re doing and where they’re at and what they’re up to? You may want to go to the front-

Mark Bonanni

The frying pan.

Dr. John Kakowski

The frying pan.

Richie Hession

Yeah.

Mark Bonanni

Brain on drugs commercials. The one I always saw growing up, which I think is still poignant today, which was “I never wanted to be a junkie when I grew up,” that’s what they said on the thing. It was a commercial of a track star in high school, and it kind of morphed into running from the cops and being tackled. And I was like, I didn’t … my goal was not to end up-

Richie Hession

2:00 in the morning, I’m in my apartment, and I’m wasted, geeked out, fucking three 8-balls deep with a bottle of Jack, and I’m sitting on my couch like this, and all of a sudden the commercial comes on, and I have the TV on, and I hear, “Are you high right now?” And I’m like, “What?”

Dr. John Kakowski

Oh my God, I would have lost my mind.

Richie Hession

You know what I mean? “You’re sitting right now in your living room,” and I’m like, “Oh my God.” That’s brutal. And I’ll take that even one step further. You’re like, “Holy shit,” you turn the TV off, of course. Now you go to the bathroom, and I go, and I’m looking in the mirror in my bathroom, and I’m bringing this up only because this is what we’re dealing with. When I say “we,” I mean we, as a society, the people, and the well-intentioned, not all bad-intentioned, well-intentioned politicians, people trying to get a handle on this opioid crisis, all these kids that are dying.

Richie Hession

But what we’re dealing with is that my whole life had gone to shit, I’m sitting in my brother’s apartment, he’s away working on the tug boats for weeks at a time, I’m done, my parents threw me out, no one would have me in, I dropped out of college, all my friends have gone on to graduate and go to school and get married, and everyone’s living real life, but I’m an addict. And I’m sitting there wasted, alone, at 2:00 in the morning. I get out of the bathroom and I look in the mirror, and I see me with black fucking eyes, not having slept for three days, I’m like this.

Richie Hession

And I’m looking at myself in the mirror, and the thought … when you’re an addict and you’re in it, I’d love to be able to say that I looked and I had this moment of clarity where I was like, “I can’t live like this anymore.” I looked at myself, and the way I processed was just kind of like, “Well, you know, this is me. I’m an addict, what are you going to do? This is what it is, and I’ve got to do it as best I can, and go on as long as possible.” It didn’t occur … Like, a normal person looks at that and goes “What are you doing? What are you thinking about?” “What do you mean? You know what I mean, like what’s the problem? I’ve still got some left.” That’s crazy, but that’s the reality. But do you write me off? Like, am I somebody to be written off, like I can’t … again-

Mark Bonanni

No, but you would have went into rehab as an alcoholic and a cocaine user, and they would have said-

Richie Hession

Which is what I did. I did detox that way.

Mark Bonanni

“We can only suggest to you abstinence. Oh, but, John, you’re using opiates, we have a pill for you.”

Richie Hession

Right, yeah, yeah.

Mark Bonanni

Still. And that’s another thing that kind of blows my mind today.

Richie Hession

Absolutely.

Dr. John Kakowski

Right, right, right.

Richie Hession

So, all right, do you guys want to leave off with any last minute kind of something to think about, something to consider, or final thought, a shout-out to somebody if you can’t think of anything cerebral to say?

Mark Bonanni

Hi, Mom.

Richie Hession

Yeah, say hi to your mom, that’s cool.

Mark Bonanni

She will share, and she will watch this.

Richie Hession

I’m sure she will.

Dr. John Kakowski

Just a heads-up, I guess, to the federal courts and everything that they had done for me. And they did it right.

Richie Hession

Oh, wait, before you give your final, we cut him off more than anything, but make us think when you talk, that’s one of the things-

Dr. John Kakowski

I don’t know if that’s good.

Richie Hession

One of the things we never did talk about, and it’s worth extending this thing for just a minute or two, as you’re giving a shout-out to the fucking federal court system, but I will say this, one of the things that is outlandish, and I’m speaking to the federal and state court systems, and I’m asking you guys: what the fuck are you thinking about?

Richie Hession

We know kids that are in jail, abstinent for a year, in prison, about to get released, and as part of the release program, you know what they give them? 16 milligrams of Suboxone so they don’t get high on heroin when they leave. That’s insane. Whoever came up with that rule, you are a moron. That is … You got him wasted high on … Mark, if you haven’t taken anything for a year, and they give you a 16 … how high are you the day that you’re ready to leave from prison?

Mark Bonanni

2.

Richie Hession

And this is going on. We have kids that come in with us that they’re in the court systems, they’re mandating that they take this shit.

Mark Bonanni

The counter is that the amount of overdoses the day, or within the week of leaving prison, are extremely high.

Richie Hession

And that’s why-

Mark Bonanni

But, still-

Richie Hession

That’s why they’re doing it. But, again-

Mark Bonanni

Vivitrol-

Richie Hession

But then … Okay, fine, Vivitrol is a much better answer because you can give them all the Vivitrol shot, and you won’t have those overdoses within three days of leaving prison, it’ll at least be 27. And if you’re going to do it right, give them the Vivitrol and then give them a followup for a second Vivitrol shot so they at least have the opportunity. But by giving them the Suboxone, you’re just basically … it’s just total nonsense-

Mark Bonanni

Restarting the whole [crosstalk 00:56:05]-

Richie Hession

You’re restarting the process for them again. Because if I’m clean a year now, and you’re forcing me to take that high, and wasted high, the day before I leave prison, you’re not doing anybody any fucking favors. Really?

Dr. John Kakowski

There was an interesting article that just came out, about three days ago, about somebody in Rikers Island who said, “You can either be in jail, or you can take your addiction medicine,” and the guy was like, “I don’t want to take anything,” and he was in jail for six months. So, you’ve got to read this article if you … I’m not going to go into the depths of it, but read-

Richie Hession

Well, tell them, where is the article? People like to read this stuff. Where do you find it?

Dr. John Kakowski

I don’t know the website-

Richie Hession

You know the name of the article, or what it’s called?

Dr. John Kakowski

Yeah, it’s-

Richie Hession

What would be the keywords?

Dr. John Kakowski

It was-

Richie Hession

Rikers Island?

Dr. John Kakowski

Yeah, it said Rikers Island prisoner either takes medicine or stays in jail, or forced to stay in jail, that’s what the-

Richie Hession

Google that, I’ll do it when we go back up and I’ll check it out-

Dr. John Kakowski

Yeah, Google that, it’s a very interesting article, and it kind of piggy-backs into that, where … you know, Rikers Island, they have a very long-standing, long-running methadone program-

Mark Bonanni

Yeah, many, 30, 40 years.

Dr. John Kakowski

Yeah, very, very long. This gentleman didn’t want to take any MAT, and he was left behind bars, which I think is just insane to even do that to somebody.

Richie Hession

The person who came up with that role-

Mark Bonanni

It was an either/or?

Richie Hession

We have a special button for that-

Dr. John Kakowski

Yeah, you’re fired.

Richie Hession

That’s old Uncle Don.

Mark Bonanni

Does that thing translate?

Richie Hession

Yeah, I don’t know. All right, so, we were signing off, you wanted to give a shout-out to the federal government, apparently.

Dr. John Kakowski

Well, the federal courts, yeah, because the program that they had put into place, I think they finally came to their senses, you know, with the mandatory minimums of the 80s, and the draconian sentences, if you had a little bit of crack you were going to prison for years and years and years-

Richie Hession

Well, they may want to talk to the people in Pennsylvania about Emma Semler-

Dr. John Kakowski

I know. No, no, yeah, that’s crazy-

Richie Hession

Just throwing that out, we covered that already. Wow, 21 years for giving your friend drugs. Insane.

Dr. John Kakowski

I know, that’s insane. So, but the court program that they had set up really encompassed everything. If they had people on MAT, they worked with them. This is not just an addiction issue or a substance issue, it’s a whole issue, from social services, to mental health, as I had mentioned before, education, these are things that often set people up for failure if they haven’t obtained, which they generally don’t. Just working in reentry, I had people behind bars for years. They’d come to our office with literally a bag of shoes-

Mark Bonanni

Yeah, nothing.

Dr. John Kakowski

Nothing, and I’m like, “Okay, where’s your ID?” He’s like, “I don’t have an ID.” “Okay, do you have a birth certificate?” “Nope.” Literally, just a faceless person, and now we have to … it’s no wonder why recidivism is so high, it’s not only just because of the drug abuse-

Mark Bonanni

Yeah, what are they supposed to do?

Dr. John Kakowski

Of course. So, I mean, the way the federal court, the Pretrial [inaudible 00:58:30] Program sort of molded their program, and it helped out with all of those things, which is what needs to happen, it’s not just “MAT, see you later. MAT, okay, don’t come back,” or whatever it is. You have to treat everything, everything, everything, it’s a whole comprehensive issue-

Richie Hession

And, by the way, the reason that this is such a huge topic and we’re in a national state of emergency, and this is sad to say, but human nature’s human nature, and people are people, and it is what it is. Back in the day, this conversation would have been about this person in society, which is people in prison, prisoners, chronic criminals, and this whole conversation would be taking place over here, and maybe the mainstream wouldn’t even “Oh, that’s interesting.”

Richie Hession

But now heroin has broken through the vale of that and gone throughout all society, these are the best, the rich, the poor, cultural barriers, there are no barriers to heroin addiction, and it’s now gone the full gambit, so that’s why this is a national conversation, even a global conversation now, because this isn’t just about that, you’re talking about one slice of an overall … that’s the reality.

Dr. John Kakowski

Right. I want to also say this. There’s an old advertisement from 1996, Purdue Pharma, and they’re like, “Oxycontin,” when it came out, “Oxycontin, it’s going to save lives, and here are eight testimonials,” and it’s all these business people, they’re like, “Yeah, I had a chronic back problem,” and on the bottom it says the name, like, “Joe Shmoe,” and it says how many milligrams of Oxycontin they’re taking, some of them are on 80 milligrams a day, and I’m like, “That’s insane.”

Richie Hession

No wonder why they seem so happy doing the commercial.

Dr. John Kakowski

Yeah, they’re sitting behind the desk and they’re like, “Yeah, I can go to work every day, my back feels great.” You follow those people, all right, literally there’s-

Mark Bonanni

It’s like the faces of meth.

Dr. John Kakowski

There’s a documentary. Two of them died, one person had a Master’s level degree, she’s homeless on the streets now, and she’s like, “It just went out of control.” And even more recently, there was a drug called Subsys, right, which was a fentanyl sublingual spray. And there was a whole thing on American Greed about it-

Mark Bonanni

Wasn’t it nasal? Yeah, those guys got-

Dr. John Kakowski

Yeah, there’s nasal, but there’s also … this was sublingual. So, there was two doctors that were paid off by the drug company, and there was a woman who had just gotten surgery and she was prescribed Subsys, which is insane because you have to be opioid-tolerant for that thing, that’s for cancer patients. Patients that can’t swallow or can’t move, you can help them open their mouth and spray a little bit under their tongue, that way they have indignity when they’re dying and stuff like that. A woman that just had surgery was now using this thing multiple times a day, and she didn’t even understand withdrawal, she had no education. So, it’s also the other facet where we’re giving these drugs and we’re not educating patients, really a lot of it is motivated by greed, which is disgusting. Seriously, if you get a chance-

Mark Bonanni

All of it.

Dr. John Kakowski

Check out the Purdue Pharma, they have them on YouTube, and it’s a nice little documentary, and then you follow those lives later on, all destroyed, and it’s so sad, man, it’s terrible.

Richie Hession

All right, I’m going to leave it like this, and I want just one final thought, as we go out, and it’s a weird way to end it, but I want to end it because I know that we’re going to get … first of all, you can get this podcast on the major streaming platforms: iTunes, Spotify, SoundCloud, and YouTube. And I want to say that when people go and they start commenting on everything, because we get a lot of comment back and forth, and this one, listen, this is a hot topic, a hot-button topic, because people feel very passionate about it. If you think Suboxone is a curative and it is good for longterm, well, you’re just wrong.

Richie Hession

But there are people who will come, and they’ll talk about how, invariably, even though we’re not really talking … we’ve made mention to the need for painkillers and Oxycontin and this and Percs, and how it starts there. There’s always people who come onto our thing, no matter what the topic is, saying, “Some of us need longterm pain medications,”-

Mark Bonanni

Agreed.

Richie Hession

It’s ridiculous. We agree with you, we’re not saying that this is for … we’re talking about drug addicts and drug addiction. And if you’re somebody sitting home, and when you hear this, you’re thinking, “This is ridiculous,” and you’re getting defensive, my sponsor used to tell me, “If somebody says something that makes you angry, you may want to take a look at what they’re saying,” just saying. Because if you’re getting that defensive about it, we’re really not talking about you, if you’re taking it for legit reasons, longterm for pain management-

Mark Bonanni

Or successful on it. I want to see those.

Richie Hession

Me, too.

Dr. John Kakowski

But they’re not longterm pain options anyway, they’re-

Richie Hession

Well, there you go. And that’s what … We’re not going to go there.

Dr. John Kakowski

I agree, but we’re not going to go there, yeah.

Mark Bonanni

I’m just talking about people doing well on Suboxone, period.

Richie Hession

I said that as an aside, but I also want to say to the people that are on longer-term subs that are watching this, that are doing well-

Mark Bonanni

Please comment.

Richie Hession

Good for you. I’m glad. We love-

Dr. John Kakowski

Absolutely.

Richie Hession

I’m here for the addict, we have your back 1,000%. If it’s working well for you, I would posit and give the consideration of well for you in what way, like what do you consider well? If you would have asked me when I first came in to get sober, “Okay, describe yourself in five years, where would you want to be?” I would have undersold myself by just a gargantuan, Herculean undersell of what actually happened in my life.

Richie Hession

So, my question is, I’m glad that you’re not getting high, and I’m glad it’s working for you, and you got your family back and your kids back, and that’s what I hope for you, I mean I really do, I mean we want to see people get well and convalesce and to experience life and to get through to the other side. And so our thing to you is: if it is working for you, then that’s awesome, I’m not saying that no one should be on it, if you we’re listening to what we were saying here today, we’re not saying that by any stretch, we’re just not going to be the ones to say, “You’re never going to make it in an abstinent-based, where you can actually have life come back, on fire, rockstar again, and you’re going to have to take this longterm drug,” we’re not going to be the ones to say it. But for those that it is working for, listen, anything’s better than the way we used to live-

Mark Bonanni

And speak up, please.

Dr. John Kakowski

No, I agree, absolutely.

Richie Hession

Yeah, and we want to hear from you, too.

Mark Bonanni

I’d like to see some positive testimonials.

Richie Hession

Yeah, absolutely.

Dr. John Kakowski

Yeah, yeah, yeah.

Richie Hession

Because we don’t see a lot of it.

Mark Bonanni

Not studies by the drug companies.

Richie Hession

Absolutely.

Mark Bonanni

They obviously can’t be trusted.

Dr. John Kakowski

Yeah, I agree with that.

Richie Hession

All right, so, John, thank you.

Dr. John Kakowski

Thank you. Thank you for having me.

Richie Hession

And, Mark, thank you.

Mark Bonanni

Thank you.

Richie Hession

It wasn’t as crazy as I thought it was going to be, I thought it was going to be kind of … sometimes we can get a little vicious and crazy with it. Next time we have one of these, maybe if we get people who have comment back, we’ll get a proponent for it to come in here, and we’ll just duke it out with somebody.

Dr. John Kakowski

I think it’s a great idea.

Mark Bonanni

Do it in a ring.

Dr. John Kakowski

There you go.

Richie Hession

All right, well, check us next time. Thank you.

Dr. John Kakowski

Thank you.

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