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:

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.