AUGUSTA, Ga. (WJBF) – The Means Report’s Mental health matters because you matter series continues as we turn our attention to addiction. The truth about addictions, what are they? The fact is what you perceive to be an addiction might not be or vice versa. We’re gonna get some clarification on that from an expert who’s been kind enough to join us. Also the treatment that’s out there for addiction. How can we make you and those you love better and healthier once again.
Brad Means: Dr. Lelan Byrd has been kind enough to join us. He’s from the Medical College of Georgia at Augusta University. He’s a professor. He specializes in addiction medicine and we just are so grateful, not only to have you here, Doctor, but just for what you do for those who need help. Thanks for that.
Dr. Lelan Byrd: Well, thank you for having me, giving me the opportunity to talk about something that’s so prevalent out there and needs to be talked about. So thanks for doing this.
Brad Means: You’re right, it’s everywhere. And I was driving over here today trying to figure out what addiction is. And I thought, oh, well, addiction is, what it boils down to is something that you do too much, that you do in excess. Is that accurate?
Dr. Lelan Byrd: Yeah. I mean, that’s accurate, but it’s really loss of control over whatever it is that you’re addicted to. Whether it’s a behavioral addiction or whether it’s a substance issue, namely what we’re seeing so much of and I’m overwhelmed with, here in our area, particularly all over the nation, is the opioid addiction.
Brad Means: Yeah.
Dr. Lelan Byrd: And what you hear so much of and that’s what we’re confronted with on a daily basis. Really, we’re trying to save lives with people that, as you turn on any television you wanna look at, you see people dying of the opioid overdose.
Brad Means: So are addiction and dependence the same thing? Are they close?
Dr. Lelan Byrd: They are close. Addiction, we really have 11 criteria that we go through when we’re diagnosing a substance use disorder of some sort, whether it be alcohol, whether it be marijuana, whether it be tranquilizers. And those criteria, we used to call ’em, we used to call alcoholism. Now we are more gentle in how we term that. We call alcohol use disorder, mild, moderate, or severe based on those criteria that we use to evaluate it. Pretty much every family, every person out there has either a friend or a family member or an associate that they may have concerns that has a substance issue that they’re dealing with. We all do. And we’re the ones that will evaluate the severity of that problem. If it’s causing trouble at work, if it’s causing trouble with family, with interpersonal relationships, that’s where we’re called on to to assess it and to intervene when we think it’s necessary.
Brad Means: How do these people get to you? Is it their family members dragging them in? Do they come voluntarily? Or is it-
Dr. Lelan Byrd: Many times. Of course here, it’s different. I came out of private practice and out of private practice coming to the medical school, most of my patients would either be coming out of recovery or out of the hospital that were referred to my office. Here at the Medical College, of course, I’m involved in the in patient care and the consult. So they’ll come either out of the hospital. Sometimes, most of the time they come voluntarily. Many times, families, it’s a family disease. And many times families will call the office and say, “Look, I’m worried about my son,” “I’m worried about my husband,” “I’m worried about my wife,” and they’ll get an appointment for us to evaluate it.
Brad Means: Walk me through the opioid addiction. Because, you know, it seems that you have a medical procedure, you take a pill, it makes the pain go away and you’re good. How do you go from that to addiction? Is it, because, honestly, when I take, you know, hydrocodone, or OxyContin, or something like that after, my last time was a dental procedure. It didn’t make me feel high. It made my tooth stop hurting for the duration of the prescription. And I don’t, where’s the addiction come from?
Dr. Lelan Byrd: Fascinating question. I mean, the opioid epidemic, which you, I’m a retired surgeon and I can’t tell you the number of patients that I took care of, either with a kidney stone or some surgical procedure that we would prescribe a medicine like you’re alluding to, hydrocodone, hydromorphone. And back in the early 90s what we would do somebody came in with a kidney stone that was gonna pass it, you’d write ’em a prescription for Percocet or hydrocodone and give ’em 30. And they’d tell ’em to drink a lot of fluids and they would pass the stone. It would alleviate the pain so that they could take care of it as an outpatient. A significant percentage of those patients, as much as 30% of ’em that we put on that medication, after they passed the stone would come back to us requesting more of the medicine. Now that euphoric effect that you did not get, many patients love that euphoric effect of an opiate.
Brad Means: So it’s a high they feel!
Dr. Lelan Byrd: It’s a high, absolutely.
Brad Means: Okay.
Dr. Lelan Byrd: And they would come wanting more of that medication. Now they’ve passed their stone and their pain is gone but they wanted more of this.
Brad Means: Okay.
Dr. Lelan Byrd: And what we’re starting to see is that we can now, hopefully, some of the research and some of the fascinating stuff that I’m involved with that it’s going on from Penn State University, is that we hopefully will be able to identify those people. That subset of patients that are fixing to have a surgical procedure, that you can identify may have a problem with opioids down the road. That you can predict the ones that are gonna get that euphoric effect and that are gonna want it. What you asked what happens with these patients. Whether it’s a car accident and they get opioids from the emergency room when they’re evaluated there. They go home, they take it, they like it. Next thing they come back and a doctor won’t prescribe it. So what do you think happens? They go right to the street
Brad Means: Yeah.
Dr. Lelan Byrd: and get it. It’s so easy to do. And we have some in the hospital right now with that very scenario.
Brad Means: Let’s go back to your patient profile. Do you see all ages or does addiction kick in at a certain age?
Dr. Lelan Byrd: That’s a great question. But I would see it in private practice, surprisingly. This was coming out of my fellowship in my addiction training. I never thought that you would see child and adolescent addiction as much as I did.
Brad Means: Yeah.
Dr. Lelan Byrd: My practice was in Roswell, Georgia. And in a lot of the high-end high schools that were there, Marist, Cambridge High School, you would think there’s not gonna be an addiction problem. I was overwhelmed with that age group of patients that were involved in it. Where you would think that they would be immune from it, no, I mean, we would see it over and over. I mean, the earliest I’ve had patients that came to me in private practice was age 14.
Brad Means: 14? Was it drinking mainly?
Dr. Lelan Byrd: You know, we talk about gateway drugs and almost invariably it’ll start with marijuana. Marijuana is different than it was back when I was in the early 70s and 60s.
Brad Means: Sure.
Dr. Lelan Byrd: The marijuana that’s out there now, that THC content of marijuana nowadays, street marijuana, is totally different. Back in the day, early 80s, even the THC content would be four, 5%. Now it approaches 80 and 90%. And that’s a different drug altogether. That’s a hallucinogenic drug. So we would see patients that gateway drug of cannabis, that they start using very quickly escalates in that group to where they’re looking for some mind altering substance.
Brad Means: Is there a gene for addiction? We’ve heard you’ll be tested and find out. Okay, I’m on the path to be addicted to cocaine. I better never touch it.
Dr. Lelan Byrd: Yes.
Brad Means: Is that possible?
Dr. Lelan Byrd: Let’s just take alcohol. We talk about the gene for alcohol in terms of are we able to predict who, with drinking at an early age, is gonna become an alcoholic or have alcohol use disorder, severe. 50% of it we look at and say it’s genetic. The other 50% would be environmental, social, whatever, but there’s a huge DNA component. There’s a huge DNA component, genetic component to all addictions. And we’re starting to unmask that. That’s where the science is headed and that’s one of the exciting things that we’re doing in it.
Brad Means: I wanna ask you one quick question then I wanna transition into the treatments that are out there, but I know that you have experience with athletics, not only as an athlete yourself but also as a coach. Do you see addiction and abuse in the world of sports? And if so, why? Is it just one person does it and then the peer pressure makes it spread?
Dr. Lelan Byrd: Another great question, but yes. Now we wonder what our kids are doing.
Brad Means: Oh my goodness.
Dr. Lelan Byrd: Yeah. It used to be back in the 70s when I was very active in professional sports. Stimulants were the performance enhancing drug, early 70s, I mean, it was not unusual for cocaine and we didn’t test athletes back at that time.
Brad Means: Right, no testing.
Dr. Lelan Byrd: If you had enough money, you’d buy cocaine. And that was very prevalent. And did it enhance performance? Well, there though, if you would look at some of those teams in the early 70s and see where they were, we called it being in the jar. In the jar meant you’re taking amphetamines,
Brad Means: Yeah.
Dr. Lelan Byrd: your greenies, green dextroamphetamine, that was the popular drug. As time went on, that completely changed to where steroids became something and anybody that’s followed sports knows Barry Bonds and what he looked like early in his career and what he looked like toward the end of his career, and what those particular drugs did, performance enhancing drugs, which are steroids and testosterone which is used, beta hCG and human chorionic gonadotropin that they’re able to get. Very expensive, but very difficult to detect. But yeah, they’re a prominent problem in sports.
Brad Means: So for somebody who’s watching and they’re apprehensive about taking that first step, what’s treatment look like and how soon can you break the need for that substance or that behavior?
Dr. Lelan Byrd: Of course, it depends on what substance. But of course early intervention is the best. The lethal drug that we deal with on a daily basis now are the opioids. And with the influx of fentanyl that’s coming really out of Mexico,
Brad Means: Yeah.
Dr. Lelan Byrd: people that are buying street drugs now, the laced street drugs, the Xanax, the street lingo for drugs, almost 100% of the time are laced with fentanyl and that’s a frightening thing.
Brad Means: Terrifying.
Dr. Lelan Byrd: But that’s what we’re seeing. And treating that and having an intervention, we have patients in the hospital right now. There are three of ’em that have come in that have overdosed with fentanyl that have been resuscitated with Narcan, and now we’re taking care of ’em and getting them detoxed. The detox is just, that’s kind of the easy part. That’s the introduction to recovery.
Brad Means: What do you do with those after you get ’em detoxed in terms of saving their life? Is it more behavior therapy at that point?
Dr. Lelan Byrd: We do have new medications out which we call ’em MAT therapy, medically-assisted therapy, which are drugs that really replace the opioid with a substance that diminishes the cravings that they will have for the opioid. And we run a clinic here now at the Medical College that we’re seeing more and more of those patients. But you can take, for example, the patients I was talking about that came in with fentanyl overdose. Now they’re gonna go into withdrawal. And at a certain point of withdrawal when they have the shakes, and the tremors, and the muscle pains, and the sweats, and they’re miserable being in there withdrawing from the opioid, we can give ’em that medication, we call it Suboxone or buprenorphine. And right before your eyes, I mean, within 30 minutes if you give them this dose when they’re in active or moderate withdrawal, their symptoms dissipate.
Brad Means: Wow.
Dr. Lelan Byrd: Of course, once you can get ’em in that kind of therapy or that kind of treatment, their life can turn around but it gives ’em a chance. Just like the name says, medically-assisted therapy.
Brad Means: Yeah.
Dr. Lelan Byrd: It’s helping them to get through.
Brad Means: >My last question, and it’s just a personal one. How must it feel to you to take somebody, so many people, from their darkest hour, many of whom may be watching right now and give them a new lease on life? It’s gotta be awesome.
Dr. Lelan Byrd: It really is. Dr. Vaughn asked me, Vaughn McCall, our chairman, asked me that when I was looking at this job. What is it like to be in recovery? I did kidney transplants here at the Medical College for a number of years. And when we would sew that kidney into somebody and it would literally, on the operating table, it start making urine. And we’d see ’em back. This is a patient that have been on hemodialysis or getting their complete blood volume filtered three times a week. So having to go to a hemodialysis center. Well when you transplant them, their life changes. I mean, literally overnight to where they don’t have to go, that’s what recovery, that’s the closest thing in medicine that I’ve seen to recovery in my life in the addiction medicine. if you get somebody in true recovery, like I said, detox is a first step, but if you can get somebody, whether it’s alcohol, opiates, stimulants, tranquilizers, if you get ’em in recovery their life changes. And that’s exciting. That’s a fun thing to do ’cause literally you’re saving that person’s life.
Brad Means: Oh, you are saving so many lives, Dr. Byrd, and everybody who works over there at MCG. Thank you all for what you do and thanks for the input today. It was invaluable.
Dr. Lelan Byrd: Well, thank you. As again, thanks for letting us talk about addiction. And more people know about it and that we can help somebody, the better we’re gonna be.
Brad Means: Absolutely. Thank you for that.