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Interview With Dr. Drew

Aired October 10, 2003 - 15:35   ET


MILES O'BRIEN, CNN ANCHOR: Joining us on the line from New York to talk a little more about the drug and the beating its addiction and the problem of the addiction is Dr. Drew Pinsky. Dr. Drew, good to have you with us.

O'BRIEN: They call it "Hillbilly Heroin" in some parts of the country. This OxyContin is a real problem. Just give us a sense though, from your perspective as somebody who deals with people who are addicted to these kinds of things, how big an uphill battle does Rush Limbaugh face right now?

PINSKY: Well we're really talking about opiate addiction. And it doesn't matter if you're taking OxyContin, Vicodin, Lortab, heroin or codeine. It's all the same disease and it has basically the same biology.

It is the form of addiction with the highest recidivism. The biology, the biological grips of the disease is profound. The withdrawal is miserable and painful. And it takes a long time to recover. Treatments are drawn out. They need to stay engaged in intensive, highly structured treatment.

In my opinion, it's unrealistic to expect somebody to get significant recovery or a high probability of success from opiate addiction without three to six months of intensive treatment. The 30 days is really just getting things started.

O'BRIEN: Thirty days, then, would be...


PINSKY: Just getting going. It is a time consuming, intensive, painful, miserable disease, with a high recidivism and it takes a lot of work to get over it.

I think we should wish him well. Who wants this disease? It's the disease that people get -- comes upon them often accidentally. These are common medication that are prescribed. If on a you have a history of alcoholism or addiction in your family and you're prescribed that for a period of time, eventually that switch gets thrown in this disease and you're off to the races.

O'BRIEN: Dr. Drew, is it a physical addiction, a mental addiction or a little bit of both? PINSKY: Addiction is addiction is addiction. You can either stop or you cannot. And when you cannot, we know a ton about that biology. There's an activation of the Measel-Limbrick (ph) reward system in the genetically-prone individual that alters permanently the motivational priorities of the brain.

It is literally a hijacking of the survival system whereby the brain begins confusing the actuality of survival with the chemical message of the drug. So people with this disease -- that's why they die of it. They will literally die to get the drug, do anything to get the drug without really consciously realizing this is what's behind the behaviors.

O'BRIEN: So then, I guess what you're implying, if somebody is genetically predisposed towards this addiction, are there people who are genetically unable to become addicted to such things?

PINSKY: You can make anybody human dependent on these drugs, but to actually induce the disease of addiction when you cannot stop using even when you want to that's a genetic disorder. And that requires intensive, intensive treatment, when particularly when the drug of choice is an opiate.

My actual concern for Rush, there's a lot of controversy in my field about how to treat opiate addicts because it is such a profoundly powerful disease that's there's a school of thought we shouldn't even try to treat them. We should just put people on methadone or buphrenorphine or one of these replacement chemicals and just call it a life, just put them on chronic replacement.

I don't think somebody like -- a high-level, high-functioning professional would take that option. I hope to hell he doesn't.

O'BRIEN: All right, now, let me ask you this. In theory, then, methadone would work in this case...


PINSKY: Absolutely. Methadone would be an option for cases like this, but that's committing to somebody to really, in my opinion, chronic disease.

I suspect this will -- this coming forward with his disease will create some dialogue about what kinds of treatments are appropriate. I think -- I've seen miracle recoveries. I've seen people become better than they ever knew they could be after having suffered this disease. And I have no doubt that he could achieve the same.

I think putting him on methadone, which is a very difficult drug to stop using, would be a travesty.

O'BRIEN: And, Dr. Drew. I want you to stay with us. I've one final question for this first segment we're going to do with you. A person who is addicted this way, how are they able to function? Rush Limbaugh has been conducting a nationwide radio program all throughout this. PINSKY: It's an interesting question. And people, when he started -- we started hearing rumors about this, people started asking me that question.

And opiates are an interesting form of addiction. Most opiate addicts function well for a long period of time before the house of cards falls. One of my favorites patients was a heroin addict who ran a radio station. Was this woman who was well-kept and well-pressed out.

But she would save one little vein there by her thumb and she'd go in the bathroom four times a day, and did that for years before it started to escalate.

It's a progressive disease and when it progresses, the house of cards falls. And that's the way it is with most opiate addicts. The disease, because it has a progressive nature, they can't go back to the way it was.

O'BRIEN: So perhaps, then, and this is a bit of supposition here, this investigation might have saved him from something more serious?

PINSKY: Oh, listen. The legal system, the criminal system saves people's lives. People that are opiate addicted, that's sometimes all that ever gets them to make a change. It is a disease that eventually leads to death. And if somebody doesn't intervene in some way, it's horrible.

O'BRIEN: All right, Dr. Drew, these are sobering, if you will, comments. I appreciate if you could stay on the line with us as we continue our coverage here we'd appreciate it -- Kyra.

KYRA PHILLIPS, CNN ANCHOR: If you're just tuning in, you may remember just barely a week after news reports surfaced linking talk radio icon Rush Limbaugh to the Florida probe of black market pain killers, Rush has now come forward on his radio show issuing this statement that, in fact, he is an addict. We want to listen to another part of that statement. A little bit more emotional than we previously aired.


RUSH LIMBAUGH, TALK RADIO HOST: I'm not a victim, and I'm not going to portray myself as a victim. I'm not going to allow anyone to portray myself as a victim. I take full responsibility for this problem.

At the present time, the authorities are conducting an investigation. I have been asked to limit my public comments until this investigation is complete. So I am only going to say that the stories you've read, the stories you've heard contain inaccuracies and distortions. And I'm going to clear those up when I am finally free to speak about them.

Now, I've mentioned this over the course of this past week and I want to do it again. I deeply appreciate the overwhelming support that you have expressed to me, extended to me. It has -- it literally has sustained me. But it doesn't fool me. It is what it is. I take it for what it is and I appreciate it more than I will ever be able to express to you.

But now, I want to ask for your prayers. Because when this is all over with, I look forward -- and actually, it's never going to be all over with. That's something I know. But nevertheless, I look forward to resuming our excursions into broadcast excellence together again soon as possible.


PHILLIPS: Well, Dr. Drew, I guess step one, no longer in denial and taking full responsibility for his actions?

PINSKY: (UNINTELLIGIBLE) much responsibility, because he didn't ask for this disease and it's going to be a long and painful process for him. But the fact that he is willing to be as honest as he possibly can is a very positive prognostic sign.

O'BRIEN: Dr. Drew, let's talk a little bit about the scourge of OxyContin. And I don't want to put you too much on the spot because I doubt you have the stats handy, but we've been talking about this being an emerging, growing problem, something you've witnessed. Can you give us a sense of how big a problem it is nationwide?

PINSKY: I don't think I can in any kind of a meaningful way other than to tell you that it is exceedingly common. Vicodin, hydrocodone, this has been a long standing problem for those of us who work in the field of addiction. OxyContin is basically just a way of giving a more powerful, high dose of the chemical -- the same kind of opiate chemicals.

And as long as we keep finding stronger chemicals with higher binding affinity (UNINTELLIGIBLE) receptor in the brain with different pharmacology, my patients will find ways to use these things to induce more serious forms of their disease.

O'BRIEN: You know there has been some criticism of the company that makes this, Purdue Pharma.

PINSKY: It's a mistake to blame the product, because it's an excellent product that is -- if you're a cancer patient, you're thanking God it's available.

The problem really is that we don't screen for people with this disease. There's a lot of controversy in medicine about how to deal with pain, and deal with people that are taking opiates. We need a greater ability to identify people with the disease and refer them for treatment.

And frankly, there's another problem too is that there are no resources available to treat people with this disease. It's very difficult to get insurance companies and to find access to ways to treat people. The disease it takes a long time to treat. PHILLIPS: Thirty days. He says he's checking in for 30 days.

PINSKY: That's just the beginning.

PHILLIPS: It seems like that's just not enough. That can't be enough.

PINSKY: I don't mean to be promoting something I've written here, but I wrote a book called "Crack" where I chronicle -- I run a treatment center in Pasadena, California. If you're interested in what it looks like from a caretaker point of view, I chronicle several addicts through their early recovery process. What the withdrawal, what treatment is about.

And treatment is basically getting them out of the biological grips, which is something we can do -- all of us that run treatment centers can do quite safely and fairly readily. And then engaging them in 12-step process of recovery.

It turns out so far we've not found anything that really succeeds as well as 12-step in helping people deal with this disease. That's a time consuming process. It literally is a rewiring of the brain regulatory systems. Emotional regulation needs to be sort of rebuilt in the folks so they can exist without the outside resources to help them manage their pain.

O'BRIEN: You've referred to this earlier, the recidivism rate or the rate of failure in attempts to break oneself of this is very high.

PINSKY: Opiates, specially, very high.

O'BRIEN: When you say the brain is being rewired, there's not a way to wire it back easily?

PINSKY: No. I've always said if I could just take an opiate addict and hold them in a room for 30 days and let them out -- or really 90 days and let them out after 90 days, they would be much more workable in terms of the treatment process.

The first step is to keep them be abstinent from these substances so the brain mechanisms themselves can heal. There's literally a sort of a settling down of this process. Then we engage them in an emotional dialogue with other of their peers that helps them, again, slowly, in a experience by experience basis, rewire some of these mechanisms that allows their brain to integrate better.

That's the best -- it's a complex process and that's about the simplest way to explain to it you. But the first thing is really getting off the drug and letting the biology settle down.



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