4: Was it Painful?

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[0:33] Stephanie Wittels Wachs: If you are just joining us for the first time, welcome, hello, we are happy to have you. I promise that this episode will make the most sense if you start listening from Episode 1. That is my advice to you today and every week. But let’s also talk about tomorrow.

[0:52] Stephanie Wittels Wachs: Tomorrow, Lemonada Media launches the trailer for our second original podcast series, As Me with Sinéad. I promise you will want to listen to the incredible advocate, educator, TED talker, around-around badass Sinead Burke as she talks to all sorts of extraordinary people about what it’s like to live in their body and mind. Like, what is really going on with this person? That is the good stuff. So, if you want to hear the good stuff, subscribe now to hear it first. OK, here is the show.


[1:41] Stephanie Wittels Wachs: My mom runs a support group in Houston for people who have lost their loved ones to overdoses. We heard from a few of these people in our last episode. When I went one night this summer, several people described in detail the day their person died. And even though I’ve been there, I admit that it was painful, and a little uncomfortable, to listen to these stories. All of this is to say – this episode we’re going to talk about death, like, really, really talk about it. With medical people. And if that’s not something that you want to or feel like you should hear about, I get that and hope to see you again next week. 

[2:29] Stephanie Wittels Wachs:
OK, if you’re still here: back to the support group. So there was this dad who described the night his 25 year old son Jonathan died. He and his wife were asleep. Jonathan had gone out to see some friends and say his goodbyes. Because he was moving to Seattle the next day.


[2:53] Jonathan’s dad: She hears him come in about midnight. Thank God he’s home.


[2:57] Stephanie Wittels Wachs: ‘She’ being his mom. 


[2:59] Jonathan’s dad: And so he’s got a flight 11 o’clock.


[3:04] Jonathan’s mom: Early. 


[3:05] Jonathan’s dad: So we generally are up at around 5 a.m. because we have dogs we take out before going to work. She gets up. The light’s on in his room. Ah, he’s up early. She doesn’t hear anything. The light’s on in the bathroom. The door’s closed. And she’s like, yeah, that kid, he just wastes electricity. She opens the door and he’s dead on the floor. So she runs in and she says ‘Jonathan’s gone’ and I’m like, ‘he didn’t come home?’ ‘No, I think he’s dead.’ I get up. And run into the bathroom and I see a belt around his arm, a syringe on the counter. And I went to shake him. And I was like, ‘why are you so cold?’ I didn’t understand. I said he, you know, he is cold as the floor. And I kind of roll him a little bit. He’s kind of seized up and he’s blue. Call 911 and they’re like ‘start CPR’ and I’m like, ‘I don’t think — I don’t think it’s gonna do anything.’ And then she says, ‘are you refusing to start CPR?’ I said ‘he’s a little stiff.’ The firemen come, the police come. The firemen just looked at him, they’re shaking their heads. There’s nothing they can do. And then the medical examiner is coming and it’s just — your brain is not believing what your eyes are showing you. 


[4:46] Stephanie Wittels Wachs: As I’m sitting in the meeting, listening to him tell this horrible story, I couldn’t help but think about Stefano. The similarities between their endings — where they died, how they died, the moment their bodies were found. Stefano’s wife, Paige, got home from work around 10:30 p.m. Her shift had been long. She was ready to go to sleep. But there was something nagging at her. She hadn’t heard from Stefano, her husband, all day. She’d texted him a few times. No response. And the first thing she saw when she opened her front door was her cat, Crystal. And when she got to the bathroom door, it was just as Jonathan’s mom had described. She pushed hard on the bathroom door, but it wouldn’t budge. Stefano had collapsed against it. Like Jonathan, Stefano was stiff. The operator instructed her to start CPR on her dead husband — same thing that happened when Jonathan’s parents called. Like, can you imagine that? And once they got to the scene, the first responders knew immediately that he was dead. No breath. No signs of life. So cold. Just like Jonathan.


[6:26] Stephanie Wittels Wachs: On October 24th, there were a total of 11 Narcotic Related Incidents, or NRIs, logged into Boston’s database. Of those 11 calls, Stefano was the only one who died. Which really fucking sucks. Since he died, his sister Jess has asked herself so many unanswered — and unanswerable — questions: like, when did he die? How long was he dead? How long was he alone? Did he know he was dying? And, from personal experience, lemme tell you — this list is very, VERY long. This is just the tip of the iceberg. But nearly two years later, there’s one question that still keeps her up at night: was it painful?


[7:27] Dr. Jay Pereira: I would say, number one, not painful —


[7:29] Stephanie Wittels Wachs: That’s Dr. Jay. And if it’s not obvious, he and that great accent are originally from Rhode Island. But these days, he works in an emergency room in Minneapolis. 


[7:40] Dr. Jay Pereira: When people are dying, this is how we help them die sometimes in a non-painful way is by giving them things like morphine. And so it’s absolutely not a painful way to die. And the way that people die is exact same — every time, it’s just that they just don’t breathe enough. You get that decrease drive to breathe and you just stop breathing. And then, you know, you don’t get the oxygen you need and then you have an arrest. But of all the ways I’ve seen people pass, this is not a painful way at all. This is the least painful way.


[8:25] Stephanie Wittels Wachs: OK. Not painful. That’s good, right? Let’s say, yes, that is categorically good. He went peacefully. Which is what everyone wants when all is said and done. But what happened to Stefano? Physiologically? To his body? Like, why and how did it stop living?


[8:57] Dr. Jay Pereira: The fentanyl is the primary driver of the overdose.


[9:01] Stephanie Wittels Wachs: Of Stef’s overdose. 


[9:02] Dr. Jay Pereira: That’s what’s going to end up having the biggest effect on decreasing your drive to breathe. So the end result is always the same. You have a decreased drive to breathe, so you don’t breathe or you don’t breathe enough, then you don’t get enough oxygen and then subsequently your organs start to fail — specifically, your heart. You go into cardiac arrest, and then you die. 


[9:33] Stephanie Wittels Wachs: But those other 10 people? They survived. Any number of things could have happened between being logged as a Narcotic Related Incident and not dying, but I imagine that someone called 911, that the paramedics arrived, and that someone was able to save them. I’m Stephanie Wittels Wachs, and this is Last Day. 


[10:01] Karen Host: Clinically I oversee every paramedic and EMT that works here. So every call that goes on within the company eventually rolls up to me from a clinical standpoint. 


[10:14] Stephanie Wittels Wachs: That’s Karen Host. She’s the director of all kinds of things at Cataldo Ambulance, a private ambulance service based in Massachusetts, where Stef lived. But before Karen became the boss, she was a paramedic. Since she started as a paramedic, nearly 30 years ago, Karen has been watching the number of drug overdoses go up and up and up in the neighborhoods she serves.


[10:40] Karen Host: Overdoses were not as common as they are now. I would say we do probably about 450 calls a day, and there’s a large percentage of those calls that are overdoses. Most of them are opioid overdoses. They are now broadening in terms of who is being affected, as well. So it’s all genders, all ages, socio-economically — there’s no boundaries anymore. And there used to be 


[11:12] Stephanie Wittels Wachs: To reiterate: every type of human person on the planet has the capacity to develop a substance use disorder and be the subject of one of these 911 calls. And if you’ve ever watched an episode of Law & Order, you know what this call sounds like — one person is desperately screaming into a phone, while someone else is passed out in the other room. And that’s what we remember, because it’s so emotionally heightened and dramatic. But what about the other voice on the line? The Karen in the situation. What happens when someone like Stefano’s wife calls 911 for help, panicked, to report that he’s overdosed? Find out when we come back.


[14:10] Stephanie Wittels Wachs: We’re back. This is Last Day, and we’re talking about what happens when a person needs medical attention and dials 911. In many cases, they are scared, frazzled, unsure of what to do. And an operator picks up — someone cool, calm and collected, like our guest Karen. And then what?  


[14:33] Karen Host: At that point we go through a series of questions to determine what’s wrong with the patient, if we can to find their location. Part of what we do with them is give directions over the phone if there’s someone who’s there with them who can help them, or even to the patient themselves if they’ve dialed 911 to try to help them help themselves. 


[14:54] Stephanie Wittels Wachs: So they’re coaching the person who’s called to be a first responder by proxy until the actual EMTs show up. 


[15:01] Karen Host: lf we’re talking to the person who’s overdosed, or if they’re talking to us, that’s great because that means they’re still conscious and they’re still alive and they were able to make a phone call. And we can talk to them about either — do you have Narcan? Do you have your own Narcan that you can administer, if it’s an overdose?


[15:16] Stephanie Wittels Wachs: Narcan is that nasal spray Paige mentioned in our second episode. She gave it to Stefano several times. It helps revive people who are overdosing. 


[15:27] Karen Host: If there’s someone who’s there with them and, you know, depending on the condition of the patient, we’ll talk them through administering the Narcan. We’ll help you. We’ll walk you through administering it because it can be frightening for someone who has never done it before. What we hope happens is that they slowly start to be able to breathe again and slowly come back. Because what can happen if Narcan is administered too quickly and too aggressively is that they’ll wake up very quickly and they’ll be vomiting everywhere and they can choke on that. And it turns into a different kind of emergency. But the idea is to get them to wake up slowly, start breathing on their own again, be able to support their airway, not choke and then slowly come back into you know being conscious and able to care for themselves again. It only lasts for so long though, which is one of the things that we see at times is people think, OK, I gave Narcan and they’re fine now so I don’t need to go to the hospital. That’s always a problem for us. 


[16:28] Karen Host: And if the patient isn’t breathing, you know, then we’ll talk to them about how to do CPR. We’ll walk them through every step of that. We stay on the line with them until help arrives, and then care is transferred over to the responding crews. At that point in time when the crews get there, scene safety is key for everyone making sure that everyone’s safe as they go into to help.


[16:50] Stephanie Wittels Wachs: And once the paramedics get there, there can be a lot of other things to care for. Not just the patient.


[16:58] Karen Host: That’s why we like to have police there. We like to have another unit there, if possible, as well. You know, make sure doors are open, we want to be able to get to you. Make sure the dog’s away so there’s nothing that’s going to impede us from getting to you. And oftentimes we, you know, I’ve been on scenes where there’s evidence of children. And so we make a really good attempt to search the whole house, because you never know where they’re going to be. There have been times when we’ve gone to scenes and there’s no police officers available and we’ve had to have a second unit come to transfer the child.


[17:30] Stephanie Wittels Wachs: Ugh. The child. This is the kind of thing that makes a deep and permanent impression in a little brain that’s still forming all its little brain pathways. That then turn into big adult pathways. We’ll be digging into the effects of this epidemic on children in a few episodes. It’s affecting schools. It’s affecting foster care. It’s overwhelming the system in a variety of ways and it’s impossible to ignore. So this is important to note: One person’s overdose doesn’t JUST impact that one person. It ripples out and affects lots of people in a variety of ways. And I’m not saying this to shame anyone. I’m saying it because it’s yet another reason not to look away, to not ignore the problem because you think it’s happening in someone else’s backyard. What these paramedics see on the ground every single day, day in and day out, affects their work in lots of ways.


[18:40] Karen Host: it definitely takes its toll. 


[18:42] Stephanie Wittels Wachs: Emotionally. It takes its toll emotionally. 


[18:47] Karen Host: I think that there are a lot of folks who sometimes will go for the same patient three or four or five times a day. And I think that that’s — it’s frustrating for our crews at times because, you know, they just see this cycle.


[19:501] Stephanie Wittels Wachs: I’m sorry. In case you missed that, Karen just said that the paramedics she works with sometimes treat the same patient five times in one day. So, the same person is overdosing five times in a single 24-hour period.


[19:19] Karen Host: They do everything they can for them. They wake them back up. They get them to the hospital and then they walk back out. And oftentimes once they’re alert and oriented they can refuse treatment. So they can get to the doors of the hospital and just walk right back out again. And just go and do it again and again. And unfortunately, that does take its toll. We see our crews in some of these areas who do get frustrated with that a lot.  


[19:44] Stephanie Wittels Wachs: It’s easy to understand the sheer frustration of bringing the same person back from the edge of death five times in one day, which, in theory, seems like something that would be met with some semblance of gratitude, but what makes it worse is that this isn’t always the case. And a large part of that is that being revived with Narcan after an overdose sorta sucks. Like yes, you are alive, but it’s physically miserable. Karen’s had folks on her team assaulted by patients. Like physically assaulted. Some people wake up angry because they just spent their last dollar on this high and you just ruined it for them. And part of her job is to make sure that her crews don’t burn out, that they can continue to do their jobs effectively. 


[20:37] Karen Host: Well, we try to help them with the idea that this is a disease, it’s not a life choice. And sometimes we switch them out of the city for a little while, you know. We have cities that definitely have more drug overdoses than others. We just have to be really aware. And, you know, people self-report that they’ve they’ve kind of built up some stress to these type of calls, or a partner may call and say, you know, ‘I’m kind of worried about someone. I’ve seen their compassion level drop’ and things like that. So that’s when we know it’s time to intervene, and pull them out, get them someone to talk to, something like that. 


[21:21] Stephanie Wittels Wachs: Trained medical professionals understand, probably better than anyone, that addiction isn’t a choice. That a person who’s struggling with it isn’t inherently “bad.” They get that this is a disease of the brain. But they’re still human beings. They still feel complex emotions, and sometimes, it’s hard to shut those off. Things get to them. And even they can get overwhelmed by the opioid crisis. 


[21:54] Dr. Jay Pereira: You just feel so frustrated. And it just feels like what am I even doing, you know? It’s almost like you’re like you’re driving in your car and you, as a doctor, are one swipe of the windshield wiper. You know, like you clear the rain off for, like, one brief moment. And then it’s the rain down on the windshield again. And it just is a really crazy, roller coaster experience that you have with somebody. 


[22:34] Stephanie Wittels Wachs: When we come back, we’ll talk to Dr. Jay about saving someone’s life, the immediate aftermath, and the absolute mind-fuck of prescribing opioids for pain in the midst of saving — and losing — so many lives because of opioids. Stick with us. 


[25:02] Stephanie Wittels Wachs: We’re back. I’m Stephanie Wittels Wachs, and this is Last Day. I wonder what happened to the other 10 Narcotic Related Incidents. The ones logged in the database along with Stefano the day his death was reported. Are they still alive? If so, are they still using? Are they okay? Are they happy? Whatever the case, it worked out for them that day, at least. First responders responded, those patients were likely brought to local emergency rooms, where doctors treated them, and, in some cases, helped save their lives.


[25:52] Dr. Jay Pereira: Overdoses look a certain way. There’s certain things that we look at, for example, we look at their level of consciousness. We look at their pupils. We look at this — we feel the skin. We look at the vital signs and based on those things we can make an educated guess as to what drug they’re overdosing on. And sometimes it’s a mix of multiple drugs, which makes it more difficult to diagnose. I’m never able to really tell for sure what they overdosed on unless subsequently they have a complete turnaround in the E.R. and they tell me what they took. 


[26:28] Stephanie Wittels Wachs: Dr. Jay has tons of training and experience, but he’s not a machine. He’s a real person with a range of complex emotions. In many cases, it’s those emotions that make him so good at his job. But it’s also what makes working with people who struggle with opioid use disorder so taxing. It’s what makes resuscitating someone laying on the gurney in front of him, barely breathing, feel like a roller coaster of adrenaline, exhilaration, and sheer frustration. 


[27:08] Dr. Jay Pereira: So this is one of the most dramatic events that comes through the E.R. because when something overdoses on opioid and they stop breathing, or they’re not breathing sufficiently, they basically are on the very verge of death. They look absolutely terrible. And generally they’re brought in by a friend, or just dropped at the door, and immediately rushed back into the E.R. And there’s a scramble to, one, help them breathe and, two, get them the antidote which is naloxone. 


[27:48] Stephanie Wittels Wachs: FYI: Naloxone is the same thing as the Narcan Karen was talking about before the break. Narcan is the brand name for Naloxone.


[27:57] Dr. Jay Pereira: And what’s incredible is that when you give the drug naloxone it almost immediately takes effect. And so you have somebody who goes from on the verge of dying —  pale, slow pulse, very low oxygen level, completely unresponsive — to very much awake and alive. And I can’t think of anything in medicine that is as dramatic in terms of its turnaround, and how quickly it turns around from one extreme to the other. And you have this situation where somebody has a near-death experience and then they’re alive. And you kind of have this assumption that when somebody has an experience like that, that it would have an impact, you know? And they would be really thankful for being alive and kind of reflect, have a hard reflection on what got them to that point.

[29:11] Dr. Jay Pereira: But it doesn’t happen like that. There’s very often anger. An immediate request to leave, which is just — you’re just so taken aback by that. It’s just not what you would expect to see. You’re kind of hoping to have this really impactful interaction with the person and talk to them about what just happened. ‘Oh my gosh, you were almost dead. And now you’re alive.’ You know, like, ‘what can we do to stop this from happening again?’ And that conversation almost never happens. And I oftentimes have to really try to convince people to even stay. 


[30:02] Stephanie Wittels Wachs: Dr. Jay isn’t just trying to get them to stay so he can slide some fancy brochures across the table and talk to them about long term recovery. He’s trying to get ahead of the very real and present danger that comes on as the naloxone wears off. 


[30:18] Dr. Jay Pereira: The half-life — it doesn’t last as long as the drug that they’re taking, usually. And so the fear is always that when the antidote wears off, then the drug that they were taking starts to kick in again, and they could have the same thing — find themselves in the same exact situation where they’re not breathing. And so I’m always trying to convince people to stay so I can watch them and monitor them long enough so that I feel comfortable that they’re safe, and they’re not going to end up right back in that same situation once the antidote wears off. And it’s a struggle to get people to stay. It’s just, you know, ‘I want out of here.’ And you get the sinking feeling that they’re going to go back out and use again. 


[31:03] Stephanie Wittels Wachs: This sinking feeling seems like a totally normal response to trying to fight this big, powerful monster that keeps growing stronger and stronger. Like I keep imagining that plant from the Little Shop of Horrors that is just screaming, ‘feed me. Seymour. feed me.’ You know that movie? That’s what I keep thinking about. 


[31:32] Stephanie Wittels Wachs: Jay is fully aware of the nature of opioids. How powerful they are. How they make people do things that are so counterintuitive. I mean, let’s be honest, they get a pretty bad fucking rap. And justifiably so! It’s why we’re doing this entire podcast. But it’s important to note that in some cases, from a medical perspective, these drugs can be useful. For people suffering with acute pain, or chronic pain, or those who are recovering from surgeries (hello, two C-sections right here) – these medications can and do offer real relief. 


[32:15] Dr. Jay Pereira: But I also see people who are kind of unwittingly stumbling towards addiction in those scenarios where they don’t really understand, or no one’s really talked to them about how to taper off of that, and the importance of that. I see people who rely on the medication for chronic pain who are under contract with other doctors. Sometimes breaking contracts, coming to me requesting additional pain medication, and then, you know, that leads to difficult conversations with people about that. 


[32:55] Stephanie Wittels Wachs: When Dr. Jay talks about a patient being under contract, what he means is that a patient will typically sign a contract with a doctor when they have chronic pain and are being prescribed opioid medication. It basically is an agreement between the doctor and the patient whereby the patient receives a certain number of pills per month from the doctor to treat his or her chronic pain. The patient has to agree in writing not to seek opioid medication from any other provider for any reason other than, like, for a true E.R. sort of emergency, like a broken leg or something. It’s a way for doctors to treat chronic pain with opioids while making sure the patient is not doctor shopping or E.R.-hopping or something like that. 


[33:48] Dr. Jay Pereira: I have colleagues who have become addicted to opioids, who have basically lost their career because of that.


[34:00] Stephanie Wittels Wachs: Yep, colleagues. As in doctors. Nurses. Healthcare professional-type humans. They’re susceptible, too. 


[34:09] Dr. Jay Pereira: I’ve had my DEA number stolen and my signature forged and had multiple prescriptions for oxycodone. Large quantity written. And I had to call all the pharmacies and, you know, have them call me anytime as a prescription for an opioid came to them with my name on it. And I had to interact with police officers, and so I had that whole experience. And then I’ve had people come to the E.R., you know, who are dying from an overdose that need immediate attention. So it’s like coming at me from all sides. It’s all around.


[35:01] Stephanie Wittels Wachs: It’s a lot. Basically, every day he’s trying to protect his professional integrity — and let’s face it, his sanity — in the face of doctor shopping and prescription forging and relentless resuscitating. But it’s ALSO his job to treat people who come into the E.R. with valid complaints of pain. So yes, if you’re sitting there thinking that prescribing opioids in the midst of an opioid crisis is an insanely complex issue for medical professionals, you would be correct. 


[35:38] Dr. Jay Pereira: What I always tell people is if you have severe pain and, you know, the acute setting from an injury, or from a surgery, then you probably will need some of the opiate medication to control your pain so it doesn’t get to the severe level. Because once it gets to that severe level, then it’s very difficult to control. But what I also tell them is — because what happens is often that the prescription is written to be taken every four to six hours as needed. And so a lot of times people just they look at the prescription and they say, OK, every four to six hours. Well, I’m having pain so that I’m going to take two of these. But their pain may not be severe, you know, might not warrant or need that level of pain control. You might be able to take a Tylenol at that point, or Motrin. And then you don’t have to take it every four to six hours. And then if you have severe pain that needs controlled in these acute situations, then you could take an oxycodone or whatever that is prescribed. A lot of times I tell people that you might only need it before you go to bed. You can’t keep taking it every four hours for days and days because that’s where you can get into a real dangerous situation.


[36:57] Dr. Jay Pereira: We have a database now where we can look up any patient who we are considering prescribing opioids to and see what they’ve been prescribed in the past. So it’s really helpful just to kind of track how much people are getting and to make sure that you’re being you’re not contributing to an addiction problem. I’ve had a lot of situations where I’ve consulted with the database and then I went back and talked to the patient about their history of opioid prescriptions and use and had really frank conversations about addiction. And trying to offer my assistance in that way. So that’s one major thing that’s been really helpful because prior to that, without the database, in the past we didn’t really have any way of knowing.


[37:48] Stephanie Wittels Wachs: OK, so this database he’s referring to — and this is going to be a dense four-word phrase, so get your brain ready — is a prescription drug monitoring program, or a PDMP. They track controlled substance prescriptions at a state level — so basically, any time your doc prescribes you a medication that’s classified as “controlled,” whether it’s morphine or ADHD medication, that prescription gets tracked from your doctor’s office to the pharmacy window, and that info is available to insurance providers, licensure boards, and law enforcement. These digital systems have been rolling out over the last decade or so, and their impact has been dramatic, which is to say, they’ve made it way fucking harder to get prescription opioids. And that’s the goal. Many healthcare professionals are relieved to have this tool in place. 


[38:42] Dr. Jay Pereira: No one likes to be lied to, you know, and feel like they’re being manipulated. And so I think that sours the relationship. Both the individual relationships that you have with with particular patients, but also just your relationship as a provider to the population in general who are addicted to opioids. Because you had this kind of bad taste in your mouth about the whole situation and you feel like you’re being manipulated, and you’re being lied to and it’s frustrating. 


[39:23] Stephanie Wittels Wachs: Being lied to, especially by someone you’re trying to help, is definitely not cool, but these drug monitoring programs are just another example of what makes trying to beat this thing so hard. Remember the plant from Little Shop of Horrors? It’s still hungry. It never stops wanting to eat. And here’s some science: studies have shown that tracking controlled substances has had a real impact on reducing prescription opioid use and lowering the rates of prescription opioid overdoses. And that is a good thing! But, in the short term at least, it also It looks like there has been a corresponding increase in heroin and fentanyl deaths. Making one form of opioids less accessible doesn’t magically make people uninterested in using them. It just makes them more desperate. Both Stefano and Harris started out on Oxycontin and then eventually moved to heroin because it got too expensive and too hard to come by. So, you know, it sucks. Because this database is a really good idea. It makes so much sense on paper. But with a problem this massive, this pervasive, there is no magic bullet. And I really, really, really wish that there was. It would be so much easier. But no. Nope. We are going to need a multiplatform, fully-funded, comprehensive approach if we ever stand a chance of beating this motherfucking man-eating plant — that is a metaphor. and whatever strategy we do employ, it can’t just be efficient, it has to be rooted in empathy. 


[41:23] Dr. Jay Pereira: Everyone has their struggles and this is a problem that you basically cannot help yourself with. You need other people to help you. It’s too big, you know, it’s too powerful, the addiction. And it’s not shameful, you know, it just part of life. People make mistakes and this is one of those things where you can kind of stumble into this and once you have the problem it’s very difficult to get rid of it. 


[42:03] Stephanie Wittels Wachs: So what happens when someone you love stumbles into this very difficult problem and you want to help? You want to solve, you want to intervene, you want to fix, you want to DO SOMETHING. You’ve seen Intervention. You’ve watched Dr. Phil. You’re ready to slap on your armor of tough love and take down that dragon, or the plant if you want to continue with that line of metaphoring. Your heart is in the right place. But you’re in for it. 


[42:38] Dr. Nzinga Harrison: It’s interesting when you see a person in a severe withdrawal syndrome. Like it is literally impossible as a human to see another human in that much pain and not want to do something. Like you’ll even find yourself thinking, ‘is there something I can give you to make this pain go away,’ right? And then you develop the empathy for what it must be like to be inside that pain. And for so many individuals that have an opioid use disorder, there is a point at which it is no longer about intoxication, right? It is about not being able to survive the pain of that withdrawal syndrome.


[43:19] Stephanie Wittels Wachs: Next week. Detox and intervention. 


[43:31] Stephanie Wittels Wachs: Last Day is a production of Lemonada Media. It’s produced by Justine Daum. Jessica Cordova Kramer is our Executive Producer. Jackie Danziger is our consulting producer. Kegan Zema is our technical director. And our music is by Hannis Brown. Special thanks to Kat Aaron for her help this season and to Westwood One, our ad sales and distribution partner. You can find us online @lemonadamedia. That’s Lemonada like L-E-M-O-N-A-D-A. If you liked what you heard today, don’t be shy, tell your family and friends to listen and subscribe, rate and review us on Apple, Spotify, Stitcher, or wherever you get your podcasts. And check out our show notes for a deeper dive into what you’ve heard today and how to connect with the Last Day Community. I’m Stephanie Wittels Wachs. See you next week.

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