On the Frontlines of America’s Opioid Epidemic: Dr. Arun Gupta’s Breakthrough Solutions Ep. 78

If a person who's addicted can get hold of this book is not going to do anything for that person. This book is for a common man, a common woman, a parent, and then the policy makers, the insurance companies, and the media.

Welcome to FASCINATING ENTREPRENEURS. How do people end up becoming an entrepreneur? How do they scale and grow their businesses? How do they plan for profit? Are they in it for life? Are they building to exit these and a myriad of other topic? We'll be discussed to pull back the veil on the wizardry of successful and FASCINATING ENTREPRENEURS. My book RELENLTESS is now available. Everywhere books can be bought online, including Amazon and BarnesAndNoble.com. Try your local indie bookstore too. And if they don't have it, they can order it. Just ask them, the reviews are streaming in and I'm so thankful for the positive feedback, as well as hearing from people that my memoir has impacted them positively. It is not enough to be resilient. You have to be relentless. You can go to the relentless book.com for more information. Thank you so much. Today's episode is just a little bit different than normal. I'm interviewing Dr. Arun Gupta. Who's a solo primary care physician and has been for 35 years. Doctors don't often refer to themselves as an entrepreneur, but if you have your own practice, that's exactly what you are. He's an addiction doctor for the past 16 years. He's the author of the highly acclaimed new book, the preventable epidemic, a frontline doctor's experience and recommendations to resolve America's opioid crisis. It's a best seller on both wall street journal and USA today's lists. And he has been treating addiction patients for years and has firsthand experience with the devastation and heartbreak cause to their families. He also has a passion for stopping the opioid crisis that is claiming so many lives in our country.

The medical profession and the business has gone down tremendously over the last two, three decades. As the MBS have gone into the medical business for 1 million doctors, the 5 million MBS that control that business. So the private practitioners are a dying commodity today. They're curing us down, cornering us in every way, and we're barely survive.

Oh, wow.

Golden days are gone, you know, 20, 30 years ago for physicians.

So what support team do you have running your business today?

I am really in a bad shape. All my trained staff last year, quit for hospital jobs. One went to nursing school and another went to a dental job, which is even better than medical job. So I am not in a very good shape, right now.

Wow. So you are a physician, a doctor who is also an entrepreneur, and you don't have actually the support that you probably need to run your business, but you have all the accreditation and skills and talent to do what you're put on this earth to do. It's an interesting position to be put in currently.

Yeah, it's a very difficult position. So because of my book, we created a foundation called Resolve America Opioid Epidemic Foundation. So I do have a board and some people are IT, but they do not help me with day to day functioning, but they advise me around this topic of my book and the foundation.

Right. So let's talk about your specialty in addiction treatment, very interesting. How did you stumble upon this specialty?

I was not destined to get into the field of either psychiatry or treating them mind problems, but what happened is from 1995 to 2006, I was appointed as a local jail physician, that two jails in here in town. And for 11 years, I took care of those people in addition to working in my office hospital and the nursing home settings. And I seen lot more sickness and misery in the jail as I was relieved of that responsibility. I had more free time. And I started looking into why do we have this problem and what can be done about it? And I became a member of American society of addiction. I was primarily bothered why the death rates are going up and why people are looking into getting drugs. And so I learned a lot from American Society of Addiction Medicine, and that's how I got into this space.

I think a lot of people just in general, whether listening to this podcast or not has some experience with a family member or a loved one or someone that they're close to that has an addiction where whether it's known or not, especially in the opioid crisis. I know I have had family members who are reliant upon oxycodone or morphine. My question would be why are doctors continuing to allow them to be filled?

Well, it's not doctors. So doctors have no training in treating pain on a long term basis, nor do they have any training, even in America to treat addictions. So 25 years ago when Oxycontin and stuff exploded, the federal government put pressure on the doctors and said, you cannot undertreat patient's pain, or you could get sued. So in the fear of getting litigated, the physicians started writing pain pills. The drug companies came to the doctors and said, "Hey, my product is the best." So with no training, it's just like trying to fly a plane without knowing how to ladder. That's exactly the same situation, both for the doctor and for the patient. So that's what created this big mess on top of it. Thousands of new regulations that have been passed to curb the pills and the pill mills and restrict doctors from getting writing too many narcotics has made life difficult for access to care and patients to get access from the doctors and the necessary medications.

Do you think we are at the beginning, middle or end of the challenge of figuring this out?

Well, I do not think anybody is trying to figure it out. What happened is in 2017, CDC said two things that first time the overdose death rate went to 70,000 and it was slowly increasing from 16,099 by 10%-15%. So first time it dies 70,000. The second thing it said. 700,000 people have died in the previous 18 years from drug overdose. So I was faced with a question from a senior administrator from the, from our community. And she said, doc, "When is all this going to end?" And I was like, I don't have a good answer. And she said, "What do you mean?" I said, when everybody dies. She looked at me, I looked at her and I said, I got to do something to figure out what's going on. So with next three, four years of my own research, the problems I faced taking care of these people, I was then advised that I should write a book of a good message. So even after the book came out and, you know, Mike Alden and other people helped me out to promote the book and has done good at the, what you call box office or whatever But the media and the policy makers do not want to talk about it. They keep on saying it's, it's getting worse. Let's do something out of the box. Thinking my book provides all the path that's possible to be. They don't want to talk about it.

Okay. So let's talk about the book it's called The Preventable Epidemic.

Yes.

The frontline doctor's experience and recommendations to resolve America's opioid crisis. So who is your target audience? Who do you want to buy the book? And what do you hope to achieve? With the publication of this book.

My only goal is that I cannot understand that it is normal or okay. For 300 young Americans, healthy Americans to die every day. My only success is to see that the curve bends down and these young people don't have to die as a physician. My vocation is to keep people healthy and alive as soon as possible. So the policies have been made in a way that it restricts access to care and we cannot provide care without the fear of our own license and life. So that's my main goal. Who's the book for, I have struggled with the answer. I'll give you different answers. I've given it to you. I've said it's for everybody I've been told. No book is for everybody. It's for males. It's females 20 years old, 40 years old, 30 to 50 years old. So I could tell you if a person who's addicted can get hold of this book, is not going to do anything for that person. This book is for a common man. A common woman, a parent, a relative, a family member, a policeman, a doctor, a nurse, anybody who is in working in this space and then the policy makers, the insurance companies and the media. So I was recently invited to do a presentation at a rotary international annual meeting in Houston two weeks ago. On June 6th, I did a presentation for, at a breakout session. I am a Rotarian. And I've been asking Rotary Club, Rotary International to take this up as a challenge, but they had a thinking that once they can eradicate polio only. Then they will take up some big project. So three years ago I was almost there, but then COVID happened and social happened. So they divided all their attention there. Now with my book coming out, they invited me to come there and speak. And I think I may be closer now than I was three years ago to encourage rotor international, to take up as a project. The problem is the problems are very unique in America. Because of the legislations and all the policies that have been created. So it's very unique. Rotary International is an international organization. They do things at a global level. So we made a north America chapter. And so let's see where it goes.

And so can you walk me and the listeners through a couple of the points of the book that you think might be most impactful for us to hear now?

I was faced this question. What are the problems that we have in this country? So the first problem is enforcement. A law and order approach has not worked for a hundred years. So in 1913 a innocent narcotic tax act was started to control the trade of illegal drugs around the world. It said a lot of things, and it said addiction is a moral failing and could not be treated even though the Supreme court said in 1962, that it is wrong and it is treatable and it's a chronic condition that attitude has not changed from the government to the policy makers, to the licensing and regulation and insurance companies. The second problem is stigma towards the disease. So the stigma is preventing people to get access. Where is the stigma coming from? First is coming from the Harrison narcotic act. Secondly, there is no education in American medical schools. All these years we heard was "Zelle colleague is a junkie." It's a druggie take care of the overdose, or don't let them die. They're gonna go home and do the same stuff. And so there is no treatment available. Then there is stigma towards treatment. There, a lot of forces in this country that say you can substitute one drug for another drug, even though it's treat. And then I find doing this addiction medicine for the last 16 years. There's lot of stigma towards people in treatment. So I have saved hundreds and hundreds of lives year after year, month after month. But these people are, the grandparents may not know their work may not know their kids may not know, but they're alive and well, they Excel in their work and they're the nicest human beings. So those are the things that have to change. And the third problem, the government created. There's a treatment arm called Suboxone AR Buprenorphine. I do not know, you know, that 85% of my patients do well on this treatment, but they criminalized this in 2005 because some of it was on the street. CDC said 41 million people with substance use disorder are at risk only 2.4 million are in treatment. That means 39 million have no access to care. CDC also sets people, wait, listed for treatment, have very high mortality. So then they put this Devion control plan on the treatment arm that they never put on the Oxycontins and the morphine and the Opanas and the street dogs are not killing people left and right. I mean the death, it went up from 200 a day to 300. So those are the main problems that I see. And then another 500 new regulations that we passed in the last 20 years to curb the pills on the pill mills. And that makes doctors life difficult. For example, 1000 doctors have been shut down in this country because they were trying to comply with the regulations and then the government comes and finds out. You're doing too much in excess are not necessary. At the same time, we are letting the drug addicted people with criminal behavior off the hook. So at one end, we are letting these criminals off the hook to get in treatment. And then we are getting doctors into, get out of work and, and have face legal challenges. So the laws are not workable. They're not practical.

Have you ever thought that you should write a book that you should write the story of your life to help other people learn from your experience? Please go to MemoirSherpa.com and learn how I can help you write, figure out your publishing path and market your story, your Memoir, to a best seller status. Are you going up to Capitol Hill and lobbying for this kind of thing? Is that part of your journey?

Right now I'm a single voice, lobbying is not allowed. So all we could do is educate and advocate. I had forces in Washington. I hired people, but the policy makers, the government officials also Senate, they cannot do anything. I recently found out because I'm relatively new in this country, not very political, but the democratic party listens to bookings foundation and the Republican party listens to the heritage foundation. So two months ago, bookings foundation, after millions of dollars of research presented a document of the government on how to solve the upgrade crisis. I was sent that document it's based on studies from 2006 to 2014 data. That data is totally irrelevant. So if that kind of research. Is being provided to the government. Government is only going to make decisions based on what is said. So even though I had people trying to contact, I could talk to some staffers, but I could never reach the main politicians. Because they do not know what to do, even though I know my state representatives and stuff, I've given them a books that I've tried to ship more books to Washington, but it's not easy to get into that space.

Do you have a band of other physicians that are along the likes of your mindset that you're pooling resources with?

So only 1% of the physicians in this country know little bit about addiction medicine, and none of them are talking what I'm talking. So I'm a one man army and there is nobody behind me other than my close friends.

And are these physicians opposed to your thinking or just not able to take the time or maybe they don't want to take the time to consider your stance and your approach?

The physicians are very busy. If they have food on the table and the bills are paid, they generally don't care and they're afraid of bad consequences could happen. So everybody does their own work and go home. And, but if you look at the review on the books, you know, there may be a dozen and a half. Physicians have written very strongly about my position. Do physicians have time to read the book? Answer is not, do they have a desire to maybe. If people are not affected themselves, they may not be interested in doing that. And it's so easy to overlook. Like I said, I was in a Houston meeting, we there for three day status and then Monday, June four to sixth, and we had a booth for a addiction prevention or reaction group, and people will just pass by not wanting to talk to us, but if we stop them and say, "Hi, I'm-" so, and so "How are you Joan?" And tell us stories about all the bad things that have happened in the family and, and neighborhood and friends but then they still had, before we started the conversation, they had no interest in that. So like you said, a lot of people,-

You think that that's the stigma?

That is that's the stigma. Yeah.

Yeah. Wow. So you decided to write a book. Let's talk about the book writing process. Did you write it completely on your own? Did you have editors or coaches? How did you approach that?

So once the bug was put into my head that I should write a book, I just started typing, one, I type one finger. And after hours work during lunch, before work in the morning, I'll have an idea. I'll research. I'll think I tapped about a thousand pages. I have no clear idea where it's going to go. And I knew that it was not workable. So I spent six months trying to find somebody to clean up my mess. And luckily I got a guy. Chris Manning is a English teacher in Lansing, Michigan. And so we were supposed to finish it up in six months, then COVID happened. And then he had four kids at home trying to teach on a new platform from home that doesn't work. So it took like a year and a half, 20 months. And towards the end he was burnt out and he says, "I can't do it last year anymore." And I ended up writing four new chapters because I knew without these four, two new chapters, the story is not complete because the major players in this situation, so no big publishers would, I couldn't reach anybody. So I was suggested to do a self-publishing. He recommended a company called Book Launchers, and they gave me a course, the course gave. Four weeks to clean up the act. And we did whatever. And then I went through more editors through them and then the process was moving very slow. Now I'm talking from April of last year to September of last year. So I have physician friends, I have professional people who want to read and edit and then suggest me things. The book launches are doing something. And my physician, friends and other professional people in my social circle are writing up at the same time and they can see each other. So this company got scared and said, we help you till here we are now going to take you to the finish line. You're gotta find somebody else.

Yes. So book launchers said that.

Book launches told me that. Yes, so I said, fine. I struggled for a month. I started having some board people on my board for the foundation. They helped me with dealing with the social media and book companies. And, you know, who's gonna make a cover what design, this and that stuff. And so we through another recommendation, somebody locally suggested a Lady Palm five and six and she was busy, but she said since she got recommended by so and so I'll look into it. So we said, she'll read in November and pass it on. And then we edit it a little bit more. And we went to the finish line and we published on February 14th.

Congratulations. I know how much work it is and how much money it is and how much focus. And it's challenging. I published my book in March 22nd and wow. I didn't realize how much it would take out of me, but it was a great journey as well. So, but it's good that you've got this information out here. How are people reacting to it that have read it? Are people pushing it away? Are they saying this isn't right? Or are pharma companies that produce some of these drugs upset? Is there any backlash?

No, I do not have backlash, but I have room for a lot of backlash because I questioned everybody that has made inappropriate wrong decisions. It could be the go of Michigan. It could be AMA, it could be licensing and regulation. It could be the regulations made by the federal government and the state government. So I questioned everybody in a nice way. So I know I could be even Purdue Pharma could come and get me. I mean, there are things in there that, for example, so Purdue Pharma is known for Oxycontin. They're not known publicly for Dilaudid. Dilaudid is the same medication is also made of Purdue Pharmaceutical. So what they did is they promoted in the hospital setting in the emergency room setting to give patients IV Dilaudid, and then the patients will come out and say, "Hey doc, we need something as strong as Dilaudid for our pain control." Look, the hospital gave it to us. You gotta give it to us or we gonna Sue you. So that is a missing link against Purdue, which I wrote in the book. Mm. So a lot of people can come and get me. I'll give you an example. I was, uh, referred to a board member of AMA. Two months ago and sky was-

American medical association?

Association.

Yeah.

Member of the board. Yes and he says, "Hey doc, I will position. And I will read the book and I'll get back with you." Listen, this's a chapter on AMA. This guy never called me back you know, the Michigan attorney journal came to my town two months ago to talk about how to disperse this drug money that they got from drug companies and stuff. 34 million were to state of Michigan. So I gave her a book as a chapter, the Neurontin, and they gave APEN and they made it to schedule five drug in Michigan and made it very, very difficult for us to write patients, to get it very useful drug the federal government, doesn't say it's a narcotic. So it made life difficult for everybody. It did not reduce the overdose death,-

Which drug was this?

It's called Neurontin or Gabapentin.

I know someone on Gabapentin and it was not a good situation for him, but everyone reacts differently to.

Yeah, I had 90% of our patients were on Gabapentin, so we had to start cutting down, do drug testing, do routine office drug test as a test for Gabapentin. So we have to send out for a $1,500 test to see if the drug is there or not. I mean, it's unnecessary, what we call an academic field controversial or kneejerk reactions-

right

by the policy makers.

Well, I would just like to say on behalf of the human condition, thank you for putting your time and your effort and your expertise into something that people are ignoring or just letting flow down the river. It's clear that there's a time and need for it, not just now but long ago. And you are sort of a pioneer. In the fight against it. So before we end the interview, is there anything else you wanna talk about that we didn't touch upon?

So you were asking about how's the reaction with the public? Have you heard of a series called The Pharmacist?

No.

It came on Netflix two and a half years ago. Okay. It's a pharmacist guy. His name is Dan Schneider. His son got killed in a drug bad deal. In 1999, he became very concerned and he started videoing doctors and pharmacies, and all the paraphernalia went to the FBI hundreds and hundreds of time made all the recordings. So I had seen the serial before COVID happened. And my book came out and some newspaper interviews came and he sent me a message. This is Danny Schneider contact. I that name didn't ring a bell at that time, but I said, okay, I should call it. So I did, we talked for an hour at the end. He was not very happy with my position because it was today different than what his position was 20 years ago. But he read the book and he sent me a two page message and said, I understand your viewpoint. And he is in touch with lot of high end people like Beth Macy who wrote the sealed book for a that was on Hulu, the a Doc Sick.

I've heard of that.

And the guy who produced Danny Strong, he produced that movie serial, 8 part serial. So these kind of people are on my list of people that I talked to. I talked to Danny Schneider. Another lady that recently approached me is Dr. Susan Harrick. Her son died last year from the struggle with injuries and pain and addiction. And I had done an interview on Emily's Hope and she was invited to speak there and she heard my interview. And, so she's writing a book called Slow Dance With The Devil. But she's got connection at a financial level and the movie business. So she's looking to convert that into a movie and they ask me if I would help them advise on their project. So things are happening at a good level. I'm making connections and good people are connecting and together we will do something meaningful. It's gonna take more time, but that's all I can say. This is my project that I think is the biggest humanitarian and peace project. And I think the social groups, the media, the policy makers, doctors, and the insurance companies all need to get together with one mind and looking in one direction to solve this problem. And I've outlined that in my book very well. I did have two, three regrets that I was finishing the project that I may want to share one. I wanted to finish this book before COVID. But the book wouldn't have turned out to be this good.

Right.

So it, but at that time, 200 people were dying today. 300 people are dying. So I do feel some burden on my chest. If the book would've come out earlier, we would've started this dialogue earlier. Maybe things would not be this bad. The second problem I did not pay attention to is the young kids that are left behind of the parents who are either incapacitated or dead. What's going to happen to them. That question was asked to me at Christmas and what I find now, I'm trying to find now that is going to explode in the next few years. The third thing that I had the study in my research is called the link between misconceptions of opioid use disorder and current policies. It was a research done by UUs U Penn in Pittsburgh. Over two years, time came out in twenty nineteen, a hundred and six people participated it. And they said a lot of good things that were not right or what was wrong. And that was my other regret that that study did not make it into my book.

For more information, go to the show notes where you're listening to this podcast. Wanna know more about me go to my website, OfficialNatashaMiller.com. Thank you so much for listening. I hope you loved the show. If you did, please subscribe also, if you haven't done so yet, please leave a review where you're listening to this podcast now. I'm Natasha Miller and you've been listening to FASCINATING ENTREPRENUERS.