Episode 63: Dr. Russell Surasky, Managing Opioid Addiction
In this episode, Karen speaks with Dr. Russell Surasky, a leading opioid addiction specialist and currently the only board certified physician in both neurology and addictions treatment in the United States, about managing opioid addiction.
Dr. Russell Surasky, FAAN, ABAM, ABPM, is a triple board certified neurologist. He is the only physician in the U.S. with this combination of credentials. He serves as the chief physician and consultant to multiple addiction centers on Long Island. His private practice, Recovery Revolution, is located in Great Neck, New York. Additionally Dr. Surasky is a national speaker on the topic of opiate and alcohol addiction.
Intro Voices 00:04
Where do I go? It only happened once. I think I was singled out. The phone calls began about one month ago. What is hazing? Something happened to me when I was younger. I'm worried about my safety. He said he was sorry. Can someone help me? Where can I get help? Can someone help me? This is You Matter, a podcast for the NYU community developed by the Department of Public Safety.
Karen Ortman 00:36
Hi, everyone, and welcome back to You Matter, a podcast created to teach, inspire and motivate members of the NYU community who have been victimized in some form or fashion and to identify resources both on and off campus that can help. I am your host Karen Ortman, Associate Vice President of Campus Safety Operations at the Department of Public Safety, and a retired law enforcement professional. Today I welcome Dr. Russell Surasky. Dr. Surasky a leading opioid addiction specialist who is currently the only board certified physician in both neurology and addictions treatment in the United States, Dr. Surasky, welcome to You Matter.
Dr. Russell Surasky 01:17
Thank you so much for having me. It's a pleasure to be here.
Karen Ortman 01:21
So you're a leading opioid addiction specialist. Tell me how your journey began with your interest in this specialty, and sort of how it evolved into what it is today for you?
Dr. Russell Surasky 01:35
Sure, I'll try to give you a relatively abridged version. After I finished my training at Northwell in neurology, I went into pain medicine practice. It was really at the height of the opiate epidemic, I mean, we're still very much very in it, but it was really when it was starting to be acknowledged by the medical community that, wait a minute, we have a crisis looming here.
Karen Ortman 02:06
What year was that, if you wouldn't mind?
Dr. Russell Surasky 02:08
I graduated from residency in 2013 and I went right into practice. Basically, what I was seeing was a lot of patients that were coming in were simply being shuffled from doctor to doctor, all physically dependent, or addicted, which there's a difference. I think we should get into that if we have time, but either physically dependent and/or addicted to these opiate pain medications. Essentially, we're enslaved to them by the nature of how they affect the brain. So, they're being passed from doctor to doctor for refills of these medications and oftentimes for multiple reasons, this leads to a tremendously devastating cascade of events in somebody's life. I was seeing this happen with my patients, then I was seeing it happen to loved ones and close friends, and they were getting quite caught up in the system. I realized that, despite all the training I had, and the years of medical school, residency, everything else, I wasn't so well equipped to handle the situation. When I looked around at my colleagues, neither were they, so I said, I gotta go back, I gotta go train with the best, I gotta go figure out. How do we help get people out of what's almost always a life and death situation? We are, not as a community, understanding this problem correctly, and therefore, we're not coming up with the right solutions. That's how I went into it, and since then, I've never looked back.
Karen Ortman 03:38
So when that thought came to your mind, did you already have a direction in which to go, or was it something that you had to talk to other colleagues about and, kind of, figure out what that roadmap should look like to become the expert that you are?
Dr. Russell Surasky 03:55
Yeah, well, interestingly enough, right at that time, there still wasn't a specific board certification for doctors to be specialists in the field of Addiction Medicine, which is mind blowing, because we have the need, and the amount of the population who is so desperate for help. We have 180 people now, especially with the lockdowns, dying from just opiates - let's put alcohol and other drugs to the side - just opiate drugs a day in this country. Yet, the field of Addiction Medicine is brand new as a field of medicine. When I started doing research and said, I want to try to learn from the best and see what the newest technology is, the latest studies, the best treatments, where we can go from here, it was right when this new specialty was forming officially. I ran to that and I got board certified in Addiction Medicine separately from my neurology.
Karen Ortman 04:25
Wow. And, you remain the only board certified physician in the country with a certification in neurology and addictions treatment.
Dr. Russell Surasky 05:09
Karen Ortman 05:10
Dr. Russell Surasky 05:13
Again, I think it comes down to the fact that the recognition of the epidemic really didn't reach critical threshold for doctors to decide, hey, this is a specialty unto itself and we have a suffering public that really need us, and it really lagged behind the need. That's where we find ourselves now.
Karen Ortman 05:38
How does addiction intersect with mental health?
Dr. Russell Surasky 05:42
Okay, that's a great question. There's a lot to unpack there. We know that certain mental health conditions such as, certain anxiety disorders, or bipolar disorder, or schizophrenia, can certainly be significant risk factors that predispose somebody to being susceptible to developing addiction. We know that oftentimes, when somebody is coming in for help with an addiction, you have to be very diligent in assessing if there's also an underlying mental health problem, because you need to treat both in order to help the person really get to a place where they can be well, not just with sobriety, but mental health. If you don't treat their mental health, it will act as a trigger for them to keep relapsing back to drugs. It's often comorbid, together, but not always. Essentially, if you develop an addiction to a drug, whether it's a pill or alcohol, what that means is that you have an inherent susceptibility in your brain, a specific region of the brain, which we've identified. Now, through advanced neurological imaging, we have functional MRIs, we can see the area of the brain that gets hijacked by these drugs. In certain people, it's not just about the drug, it's about your individual brain and how they mix. If you have seen that when you that when you take a particular drug that you develop cravings, and obsessions, and you want to keep using that drug despite the fact that you know rationally it's not good for you, but you continue to obsess and think and spend time trying to find and use that drug, that speaks to a loss of control, and that is addiction. That means that that switch has gone off, the drug has hijacked that person's brain stem area for the brain to now fight with itself, and reorganize its priorities of life so that drugs now become as important to the survival center of the brain as things like food and water and procreation. With that kind of drive, the brain then goes at it with your rational brain each day and says, we need to get it today. And the rational brain says, yes, but look at the problems we're having from the drugs. At the end of the day, the brainstem wins and says, alright, we'll just get it today and tomorrow we'll stop. That's what happens. That's the cycle until, God forbid, death, jail, or institutions.
Karen Ortman 08:13
Can you see the area of the brain that is susceptible to addiction prior to developing the addiction?
Dr. Russell Surasky 08:21
Wouldn't that be incredible. We're not there yet. It's a good question though, right? Yeah. I hope that we are moving in that direction. There are some studies out now which are trying to map the genes because we know that there's a genetic susceptibility. It's a mix between, like most things in medicine, a combination of your genetic susceptibility, and then what you're exposed to environmentally. For example, you can have a very strong genetics towards addiction. You could have one or two drinks of alcohol, and the switch of addiction goes off and that's it. In other people, they may have some tendency, but the circumstances in their life would have led them to maybe drinking into their 20s and 30s, then all of a sudden, it's enough, with that small genetic tendency, but enough exposure from the environment with a switch can go off. The overwhelming point here that I want everyone listening to know is that addiction is not a moral failing. That's sort of the the old school thinking that you're just not mentally strong enough, you're weak. You know... Why don't you just stop? ...why don't you just stop, looking at all the things going on around you, you must have come from a bad family or...
Karen Ortman 09:41
Dr. Russell Surasky 09:42
...you're weak, right. What we've learned really is it's a neurological issue. The reason that one person can have half a glass of wine and put it down and not think twice about it and forget they even poured it, and somebody else through hard work, and counseling, and maybe even medicine for years, going to meetings, and gets their way to 5, 10 years of sobriety; if they have one drink of alcohol, it goes off the rails. That's not because that person has been morals and the other one doesn't, it's because the chemical cascade that happens in their brain is different than in the other person, the hijacking is different.
Karen Ortman 10:21
That's so important for you to say. This is another one of those subjects, addiction, that is spoken of quietly in corners never to the person affected, maybe about the person who is affected. There's a lot of shame associated with it, but what you're saying is that addiction affects the brain.
Dr. Russell Surasky 10:47
Addiction is a neurological brain condition. It's like if you have an epilepsy or bipolar disorder, or migraines; it's a susceptibility that when a particular substance combines with your brain it can hijack a particular area, which then sets off the addiction switch. It's about the drug and the person.
Karen Ortman 11:11
So is it fair to say that the addicted brain is essentially rewired...
Dr. Russell Surasky 11:19
Karen Ortman 11:19
...after the onset of addiction?
Dr. Russell Surasky 11:23
Yes, we know it is actually, and that's why addiction is now defined as a chronic relapsing brain disease; meaning that you should expect the condition to have chronic ramifications over a person's lifetime. Relapsing is typically part of that process. Now, I say that and that sounds very discouraging, however, we have developed, through our understanding the neurology of this, we've under we've developed new tools, new medicines, safe medicines, that can help restore to a large degree those changes in the brain along with a counseling program. We're working on two different parts of the brain, and if we have time we can get into that, but essentially, we need to heal the part of the brain that got hijacked by the drugs that's on a subconscious level and drives the cravings, and the counseling works on the thinking part of the brain, which is how you're going to live your life and making sure to be stay away from the triggers, the people, the places, the things, and the medicines are calming down the other area of the brain so they're not fighting with each other. Although it is defined as a chronic relapsing condition, I have seen many countless people who have faced the most severe of consequences in their life and I've turned it all around, and I've been sober for decades now.
Karen Ortman 12:47
So in effect, was their brain rewired?
Dr. Russell Surasky 12:52
Karen Ortman 12:53
Dr. Russell Surasky 12:54
...let me let me sort of finalize that by saying, when I say rewired, what that means is that if the person's experiences have shown them that when they take that drug or that drink, things go sideways on them. It's never one. One is never enough, they plan to have one, but it's always becomes 3, 4, 5, 6. They always face negative consequences when they try to convince themselves, maybe this time I can control it. If they if the universe teaches them, through the school of hard knocks, that okay, you keep trying this and look at the outcome, this is not for you. Once that sets in, once you see that will never change because that is how your brain is structured, and how that drug interacts with your brain, it will be that way till the end of time. That doesn't mean you're destined to keep relapsing, what it means is, if you think you're going to use the drug and control it, that will never happen. Do you follow what I'm saying there? The wiring has changed, such that you can't have this recreationally on a Monday and everything will be fine. It's not going to happen that way, so it's changed now to that.
Karen Ortman 14:11
Okay, fair enough. Do you know the statistics as it pertains to addiction today? Earlier you said 180 people a day die from the opioid epidemic.
Dr. Russell Surasky 14:26
We were at about 150 a day, but with the lockdowns, the shutdowns, the removal of healthy coping skills, the removal of the 12 step meetings, all of the healthy structure that people in recovery use as medicine for themselves were taken away. The isolation, and all these problems that we know about, we're at 180 people that die a day from opiate overdoses. As far as alcohol, we are at one in five people in this country that meet the criteria for an alcohol addiction, or what we call alcohol use disorder in medical terms.
Karen Ortman 15:08
With respect to alcohol, is there a minimum standard for men and women on a daily basis regarding alcohol consumption?
Dr. Russell Surasky 15:20
Yes. There's a couple of different forms of alcohol addiction, right? There's binge drinking, which is someone you might think of as a weekend warrior. They can go the whole week and not drink without a problem, but when they have one drink on the weekend, they drink till they blackout. They can sometimes keep what appears, from the outside, to be a relatively functional, alcoholic type of life. Inevitably, it doesn't work and problems ensue, so that is still alcoholism or alcohol addiction. In terms of if you're a male and you're drinking five drinks or more in a sitting in a day, or you are a woman and drinking four drinks or more, that is considered to be indicative of a problem. If that's generally what you do, then you fall into the criteria that this person very likely has an addictive problem.
Karen Ortman 16:31
Do you differentiate between having four, five cans of beer, as opposed to five martinis?
Dr. Russell Surasky 16:42
Let me break it down, because I think I can simplify. If you actually look up there's about 12 criteria that the DSM, the Diagnostic Statistical Manual of the psychiatry standard, uses for diagnosing a substance use disorder. It's about 12 criteria, and if you have three or so criteria, it's considered mild. If you have a few more points, then it's considered moderate. The higher scale, you're considered severe. But, what does that mean? What it really means is, if you want to know if someone has an addiction, all you have to listen for is, are you seeing a lack of control, that is addiction. If you see somebody, every time they say they're gonna have one drink, it's not one drink, or if they're hiding their drinking, people without addiction don't hide their drinking, or if they constantly try to cut down and never seem to be able to. All the addictive behaviors are really showing that there's a loss of control. The recognition is a problem, but yet the person can't get it under control, and that's really where you know that there's an addiction even if you didn't memorize all the criteria in the manual. If you hear that the person is losing control, having bad things happen to them, and yet can't stop, they have an addiction.
Karen Ortman 18:08
What role would you say physicians prescribing opioids play in the epidemic that we know exists today?
Dr. Russell Surasky 18:19
Physicians played a tremendous role in getting us to where we are, but there are other players that are part of that. Primarily, I don't know if we want to name names, but there was a major pharmaceutical company who's been in the news lately, due to lawsuits. They realized and idea. Now, opiate pain medications were initially used for hospice care and they were used for a few days after surgical procedures, they were not meant for everyday aches and pains. Along came this idea from a pharmaceutical company, a major pharmaceutical company, that said, if we can convince physicians that they're helping their patients with their pain, and that it's really not addictive, if their patients genuinely have pain, which wasn't based on any evidence by the way, but they said, if we can spin that narrative to physicians that it's safe and it will help their patients then we can turn this into a very profitable drug. They took the drug Oxycontin and they sent out their salesforce into doctors’ offices in droves to convince doctors that this particular form of a drug opiate pain medication, Oxycontin, would not be addictive if the person had genuine pain. This is not true. It's completely proven that it wasn't based on any science. It was just a company motto, and doctors bought this hook, line, and sinker and they gave their patients opiates for every day, common aches and pains; everything from arthritis to ankle sprains, or back pain to headaches, things they were not intended for. I think most doctors had good meaning, they want to help their patients. In other words, they prescribed opiates maybe too much, because like they prescribe antibiotics too much, they just want to help their patients. You also have a fraction of doctors who have realized that, hey, these patients are getting addicted to these drugs and they're never gonna leave my practice, I can build this practice to the moon if I just keep handing these things out and they need me because they're addicted and then withdraw. They're basically drug dealers with white coats on. It's a small fraction of physicians, and many of them have been reined in or have gone to prison, but they're responsible for the deaths of a lot of people the way I view it, so they did play a role, but so did the pharmaceutical company.
Karen Ortman 20:57
Sure. And, there's big money involved.
Dr. Russell Surasky 21:00
Big money. Oxycontin, that medicine has brought in the most money of any pain medicine today, I think it was over $3 billion for that one medicine.
Karen Ortman 21:11
Dr. Russell Surasky 21:12
That company has since filed bankruptcy...
Karen Ortman 21:15
Dr. Russell Surasky 21:15
...because of the lawsuits. Again, even though we're not naming names, it is in headlines right now that not just people have suffered, but states. States within our country have collectively sued this pharmaceutical company in a class action lawsuit. Numerous states have sued because of the devastation of the opioid epidemic and what that's done to their state, to their resources, to their funding, to everything that they need now to take care of the people that are stuck in this place.
Karen Ortman 21:46
It's terrible. Can you talk about the difference between a physical dependence and addiction?
Dr. Russell Surasky 21:55
This is such a great question, I'm glad you're asking. These terms are even confused amongst specialists. Physical dependency simply means that if you're taking a drug, or a medicine of any kind, and then you stop it, that you'll have withdrawal symptoms that are specific to that drug's withdrawal symptoms; that does not equal addiction. That can happen with even non-abusive medications, you can be taking a blood pressure medication, and as your body adapts to it, if you suddenly stop it, you can have a withdrawal syndrome from that. Physical dependency just simply means that your body has undergone some adaptation to the drug or medicine you're taking, and if you stop it you have withdrawal symptoms. Addiction is a specific behavioral pattern in which somebody compulsively thinks about a drug, and compulsively spends time finding and using that drug despite the fact that, rationally, their world is crumbling around them because of that drug. For example, if everybody in this building that we're in were to take opiate drugs for three months and then we stopped it, we would all be physically dependent, we would all go through the same withdrawal process, but only a small percentage of us then, by statistics I mean, after going through all that detox would after that, obsessively think about it and want it again, and pursue it again despite the fact that it would cause problems. You see, addiction is much more than just having a physical dependency. Somebody could be on opiate pain medications for a little while for an unnecessary condition and be weaned off them, it doesn't mean that they're going to develop addiction.
Karen Ortman 23:46
When we talk about that person who's gone through withdrawal, after taking three months’ worth of opiates, and that person after withdrawing, still wants to consume, what is it about that feeling as a result of taking that drug? What is so appealing about the effects on that person, if you know, if you can even describe?
Dr. Russell Surasky 24:31
Well, what I can tell you is that the how an individual feels when they take a particular drug is not the same from person to person. Again, it has to do with, not just the drug, it's about your brain. In some people, if you take 100 people off the street and you expose them say to alcohol, maybe 75% of them roughly, this is an estimate right, it will light up a particular area of their brain, 20/30%, a pleasure center in their brain that's on a subconscious level. That's kind of why most people like to have a drink or two, but in some people, to no fault of their own, that drug will actually light up this limbic system, this area in the brainstem, not 30%, but 50/60/70%. That area of the brain uses that degree of how much something affects and triggers it to try to understand what we call salience, or what's important in life, what am I supposed to be caring about, what am I supposed to be motivated to do every day. For example, what's hardwired is things like food and procreation, those things we don't have to remember, that's on autopilot. Where the addiction comes in is, in some people drugs get entry to hijack that area, and now they are on par with things like food, and sex drive and these types of things. That area then starts bombarding that person's thinking brain with compulsions to want to keep going. In some people that doesn't happen.
Karen Ortman 26:11
When that brain is hijacked, once again, by an addiction, and let's presume the person is free of that addiction for several months, but there's something in their brain telling them they want to consume those drugs, the alcohol. Is there a way, from a physician standpoint, to sort of intercept that dialogue in the brain to not go down that road again?
Dr. Russell Surasky 26:44
There is, and that comes from us first understanding what's going on in the brain. Out of that, we've developed some medicine to help people. Counseling and therapy is important, but that only works on the rational part of our brain, which is in the frontal area, but when you have a limbic area, this is the brainstem very deep inside the brain that gets hijacked by drugs, and it's on fire looking for that drug. If someone were to send them to counseling, the counseling is just sort of bouncing around their thinking brain while the other area, which is extremely powerful is screaming, I can't wait to get out of this counseling session to get a drink. You've got to calm that area down before counseling, it's very important, but you got to calm the limbic area down first, because it's way too powerful, and then counseling can help the person change the way they're living. We have medicines now that if you treat people with addiction with these medicines, they go to that area of the brain, they help heal it, they help them calm down, and it stops yelling and fighting with that person about the cravings.
Karen Ortman 27:52
Interesting. So how long have these medications been available to those who are addicted?
Dr. Russell Surasky 28:01
We've had a couple of them around. It started out for opiate addiction, and it's different depending on the drug that you happen to have an addiction to, because it works on different receptors. For opiate addiction, the medicine that's been around for decades is methadone. Methadone comes with its own set of positives and negatives, then that transitions to Suboxone. Now, both of these drugs are opiate based drugs, but they're safer than what people are using on the street. They take it like a medicine every day and they can live their life in a normal fashion, essentially, without them putting needles in their arms to inject heroin or getting pills on the street that have fentanyl. It basically helps them get back to a more stable life. However, more recently, we've developed an entirely different treatment and that's called Vivitrol. Vivitrol is a major breakthrough, and this is what a lot of people are not aware of, Vivitrol is not an opiate. It is not an addictive drug or drug to cause dependency, and it works for both alcohol and opiates because both drugs take hold of the same limbic area of the brain, that's what we've learned. What Vivitrol does, briefly, it's once a month, it's a shot of a medicine that's not addictive, it doesn't cause any dependency at all, it goes directly to that back area of the brain, and it just helps it heal faster, and return back to his normal number of receptors. It stops the cravings dramatically, as much as a Suboxone or Methadone, and further, as a safety feature it acts as a complete blockade. If that person, for any reason, were to use that drug, opiates or alcohol, it's not going to allow it to enter the brain. It's going to stop someone from overdosing, it's going to stop them from getting high, they don't get sick from it. Essentially, not only does it reduce the cravings, but it's also protective. Now, the medicine is not meant to be forever, it's meant to be a go along with a program, and after six months to a year based on the individual, the medicine can be discontinued. It's not a lifelong sentence. When you stop Vivitrol you don't have to wean or taper, it just stops.
Karen Ortman 30:16
Can you explain the relationship between opioids, heroin, and fentanyl?
Dr. Russell Surasky 30:22
Sure, so opiates are a category of medicines that are pain relieving medicines and their called opiates because they attach to what's called opiate receptors, we all have them naturally our body uses them, that's where our natural endorphins go to, so we call these drugs opiates. Now, Heroin, the real name of heroin is something called Diacetyl Morphine, and that is what heroin is. It's a potent opiate. There's many different opiates, but this is a potent opiate. This is not one that is prescribed, there are many that are prescribed, but this is not one of them. Fentanyl is a synthetic opiate that has recently been in the news a lot because it's been flooding the streets across our country. It comes from outside our country, but has been flooding all the streets in our country. It's extremely potent, much more potent than heroin so it makes the risk of an overdose far higher. Sometimes there's Fentanyl in the heroin that they're using, or in fact, some people are just using pure fentanyl in place of heroin based on whatever the dealer has that given day. It's very cheap to produce, and it's all over the place, and it's accounting for a big skyrocketing of the overdose deaths that we're seeing right now.
Karen Ortman 31:57
When something is mixed with Fentanyl, Heroin for example, but other substances can be mixed, is it not known to the user the Fentanyl is in there?
Dr. Russell Surasky 32:09
Usually not, however, I will tell you that, unfortunately, certain drug dealers it's known that is what they have, and people when they're not well, and they're in or mired in addiction, their brains not well, they will seek out dealers who have Fentanyl. You might say, well, why would they want to seek out something that could kill them? The thinking is really, I won't die, I'll just get very high from this medication. I'll be okay. I can handle it, and unfortunately, that's not what happens.
Karen Ortman 32:46
And that is the appeal, correct? The user who's in their state of addiction is seeking out the best high, even if it killed somebody that they know who is also a user. They they're looking for that, correct?
Dr. Russell Surasky 33:04
Yeah, unfortunately, yes.
Karen Ortman 33:07
Is there a difference between an opiate and opioid?
Dr. Russell Surasky 33:11
Yes, there is. They're very commonly confused. It's, for all intents and purposes for what we're discussing, we use them interchangeably, but opiates refer to more more of the natural state of opiates that you can find, things like Morphine and Codeine, from poppy seeds, things that are naturally produced in nature. The opioids, there's some synthetic involvement, meaning somebody gets a hold of the morphine, the coding, and they do a synthetic process to it in which they turn it into either a prescription drug or some other, opiate drug. They manipulate it.
Karen Ortman 34:01
Is there any useful purpose for heroin?
Dr. Russell Surasky 34:07
No. Heroin right now is still considered a level one controlled substance which means that there's no recognized medical use under any circumstances. It doesn't have any advantages over helping anyone with anything over prescription opiates should you need them? It only leads to severe problems, including death.
Karen Ortman 34:32
Do you think that anybody who is prescribed an opiate should at least be aware of the addictive properties of consuming an opiate?
Dr. Russell Surasky 34:51
I'll go a step further and say I think that it's extremely negligent. If a clinician prescribes a medication like that knowing the risk that they're putting that person in, sometimes the benefit outweighs the risk in certain cases where opiates are necessary, but always the clinician should be educating heavily the patient about the risks of the medication, which are many, especially if they stay on them for a while. I think not to do so is just tremendous negligence.
Karen Ortman 35:24
So that brings me to my next question, what are the checks and balances, if any, associated with doctors who may over prescribe, or maybe not prescribe with the instructions required for opiates?
Dr. Russell Surasky 35:46
The checks and balances unfortunately, aren't there. That's the sad fact. I think what happens is that certain clinicians, who clearly stand out by their prescribing patterns, are seen and noticed by the DEA and certain pharmacists. One of the things that happened more recently was they passed laws that made pharmacies responsible for detecting suspicious or prescribing behavior that look to be out of sync with normal prescribing behavior. Because they added liability onto the pharmacies, now you're seeing big chain pharmacies set their own rules, and calling doctors back in saying, are you sure about this? Do you think this is the right thing, doctor? A lot of doctors get upset by that, and they say, well, I'm the doctor. In truth, they when they see high doses of opiate prescriptions being given to people and their meter goes up, I think it's a small check and balance. They also have a way, if they feel like, despite their discussions with the prescriber, if they continue to see behavior like that, they can report it to the DEA as being suspicious, and then the DEA can then check it out.
Karen Ortman 37:06
What does the future of addiction look like? In your view, in terms of treatment of addicted persons?
Dr. Russell Surasky 37:15
I think I'm very optimistic. I believe that this field is advancing quickly. Right now it's a little bit of the Wild West out there when you're looking for help. there are 10s of 1000s of treatment centers to choose from, often someone doesn't know which way to turn, where to go. Insurance coverage is challenging oftentimes to go to into a rehab, or detox, or to find a private doctor. There's very few addiction specialists. It's very fragmented right now. There's a big push from multiple angles to try to consolidate this, and make the systems more efficient and accessible. For example, I'm part of a telehealth platform now where we help people in more rural areas with drug addiction who just would not have access to see doctors that are able to help them with what they're dealing with. Telehealth is going to help bridge that gap. Also, the awareness of the public about addiction, helping educate the public, helping to also explain that there are certain laws. For example, there's a Good Samaritan Law that says that if you are using drugs with someone else, and that person should have an overdose and you need to call for help, they will come and help that person and no one will get charged with a crime. Does everyone know that know that? No, and why don't they know that? There’s not enough education, there's not enough programs and teaching, I think, at the school level it should start. I'm very optimistic from what I see on the inside. It's a multi-pronged approach that will get us there, but I believe we're going to get there. Finally, I do think something has to be done to try to stop the flooding of American streets with Fentanyl from other countries. I've said that before, and some of the feedback is, well, true, but drugs will always be around. I say well, yes, but Fentanyl is so lethal that we have people that are 16, 17 years old, who don't have addiction, trying a drug for the first time. They don't get a chance to go to detox, or rehab, or learn about it. It's taking people's lives at such young ages. None of that Fentanyl is comes from the United States, it comes from overseas, mostly China and Mexico, it comes through those areas and we need to keep doing more and more to try to protect our borders from those drugs entering into our country. I agree, most of the progress has to be made on the treatment side, because we'll never stop all the drugs, but something needs to be done
Karen Ortman 40:15
Based upon the clients that you see, is there a typical user out there?
Dr. Russell Surasky 40:27
In terms of opiate addiction, I think this is one of the most misunderstood concepts in people's minds. A lot of people think of an opiate addict as someone who is living under a bridge, and it couldn't be further from the truth. The typical person right now, demographically, that's using opiates recreationally or addicted to opiates is a 22 or 23-year-old kid, a young adult from the suburbs.
Karen Ortman 41:01
I bet a lot of people don't know that.
Dr. Russell Surasky 41:02
No. Look, before COVID, the opiate addiction and the crisis was already deemed an absolute emergency. Trump deemed an emergency in this country and it sort of got, not lost, but certainly, it got pushed to the side as we dealt with this pandemic which actually made the other one worse. Because of all the lockdowns and the overdoses, we're seeing a 40% increase in overdoses just in the tristate area during these lock downs, not because of the virus, but because of the lock downs, unfortunately. That's a major issue here.
Karen Ortman 41:42
Is there anything that I haven't asked you today that you would like to add at this moment?
Dr. Russell Surasky 41:52
Just that I want to reiterate. You certainly asked a lot of comprehensive questions, and I think we answered everything that I think the audience needs to hear about this. I would say that there is tremendous, tremendous hope for the future. It doesn't matter if your friend, or family member, or you even are struggling, or how bad you feel you're struggling, or how many rehabs you've gone to, or how much you're using. As long as you are still here, alive, then you can turn it around. We have tremendous tools that we didn't have before. You absolutely should be reaching out for help right away, because every time somebody uses, particularly with Fentanyl right now, every day is a life and death decision. 180 people dying a day, none of those people are thinking I want to kill myself today, they're just saying, let me get high one more day and that was it for them. Don't let that be you. Don't become a statistic. If you're still alive, you have your whole life ahead of you and we can change things. I see it every day.
Karen Ortman 43:00
I thank you so much, because your expertise is fascinating. The information that you present needs to be heard. I'm so thrilled and honored that you agreed to talk to me today, and share all this information with our audience. Thank you so much.
Dr. Russell Surasky 43:25
Thank you so much for having me on. I think the more we help spread this message, the more will help our suffering society.
Karen Ortman 43:31
I agree. Thank you to my guests Dr. Surasky and to all of our listeners for joining us for today's episode of You Matter if any information presented was triggering or disturbing, please feel free to contact the Wellness Exchange at 212-443-9999 or NYU's Department of Public Safety and their Victim Services Unit at 212-998-2222. Please share, like, and subscribe to You Matter on Apple Podcasts, Google Play, Tune in or Spotify.