Episode #187
Ep. 185 - A Prescription for Disaster.
Summary: On this episode, Jared Miller and Dr. Terry Sellers discuss the complicated reality of medication management in addiction recovery, with a focus on the dangerous rise of gabapentin or Lyrica co-prescribed with opioids. They talk about how these combinations can increase the risk of overdose and relapse, and the need for informed prescribing and patient education. Main Topics: The medical uses and history of gabapentin How gabapentin interacts with mu-opiate receptors and its potential for abuse Trends in opioid prescriptions and co-prescription of gabapentin The dangers of combining gabapentin with opioids and benzodiazepines The impact of long-term opioid use on age and dependency The importance of intention when using medications in recovery Addressing the role of physicians and prescribers in addiction management Strategies for responsible medication use and moral inventories in recovery The significance of community and support in mental health and substance recovery Chapters: 00:00 - Introduction and overview of episode focus on prescription medications in recovery 02:00 - Discussing the emotional and physical effects of sleep medication 02:59 - The background and initial FDA approval of gabapentin for nerve pain 04:53 - Trends in detox and treatment centers' approaches and resources 05:23 - Gender-specific treatment approaches and their significance 06:21 - Rise-up supplements for brain health and their benefits 07:42 - The importance of fueling the brain and supplementing nutrition 09:28 - Personal reflections on playing golf and gratitude for recovery milestones 10:24 - The impact of sports and competition on mental health 11:17 - Updates on personal life, family, and upcoming plans 12:42 - New treatment centers and mental health initiatives 14:03 - The rise in mental health issues and co-occurring disorders in recovery 14:54 - The risks of psychotic episodes in treatment groups 15:25 - Medication misuse and the importance of trust in treatment 16:21 - Why active psychosis should exclude someone from substance abuse treatment 17:19 - Pharmacology of gabapentin, including receptor activity 17:49 - FDA-approved uses of gabapentin and its off-label misuse 19:44 - Dosage recommendations and the pharmacological ceiling of gabapentin 20:12 - Data on decreasing opioid prescriptions and increasing co-prescriptions with gabapentin 22:03 - The risks of co-prescribing opioids and gabapentin 23:29 - Analysis of prescription trends and their implications for relapse 24:22 - Dangerous interactions between gabapentin and opioids 25:41 - The rising co-prescription rates and overdose concerns 26:10 - The dangerous combination of gabapentin and opioids leading to respiratory depression 27:40 - The physical and psychological dependency concerns with prescribed opioids 29:07 - Responsible use and the importance of dosing within FDA guidelines 30:28 - The role of doctor responsibility and prescribing practices 32:49 - How social and medical systems may contribute to medication misuse 33:46 - Recognizing therapeutic intent versus misuse 35:40 - The importance of self-awareness and a moral inventory 36:38 - Managing pain responsibly and the risk of hyperalgesia 38:36 - The consequences of long-term opioid use and the increased risk with age 39:46 - The importance of community and proper prescribing in preventing overdose 41:10 - The clinical significance of prescription length and dependency risk 43:01 - The myth of hooks in opiates and the realities of dependence 44:58 - Dependency statistics and the impact on older adults 46:52 - The dangers of combining benzodiazepines and opioids 48:14 - The global age trend and the rising average age of prescription users 50:26 - The importance of moral inventory and intentional medication use 52:20 - The influence of stimulant medications like Adderall 55:41 - Summary of gabapentin's danger and misuse in recovery 56:08 - Encouragement to empower oneself through knowledge and accountability 58:16 - Physician responsibilities and the importance of medical oversight 59:44 - The cultural shift and the need for better medical education on addiction 61:12 - Personal stories emphasizing the importance of prescriber accountability 62:37 - The role of self-awareness, honesty, and spiritual inventory in recovery 64:02 - Balancing medication use with intention and responsibility 65:23 - Final thoughts on responsible medication management and community support 66:22 - The sobering reality of deterioration due to substance use 68:42 - Closing remarks, trusted resources, and importance of ongoing support.
