Nicole Lamberson on Benzo Tapers, Dependence, and Physician Desensitization

Dr. Mark Leeds [00:00] Hi, Nicole. How are you?

Nicole Lamberson [00:01] Good. How are you?

Dr. Mark Leeds [00:03] Good. Good, thanks. So this is our second attempt. We recorded this already, and unfortunately, it’s completely my fault. I messed up. I pushed the wrong button and didn’t record. But I right away took a bunch of notes on everything we talked about.

Nicole Lamberson [00:20] Oh, good. All right. Maybe we’ll do a better job this time. Let’s see.

Dr. Mark Leeds [00:27] Yeah. So, Nicole Lamberson, you are in charge of the BIC, Benzodiazepine Information Coalition. And yeah, for anyone who doesn’t know what that is, tell us about what exactly the BIC does.

Nicole Lamberson [00:43] Yeah, so it’s a 501c3 nonprofit in the United States that was founded in the summer of 2016 by actually injured patients who were injured by benzodiazepines. And they brought on medical professionals and other professionals like therapists to form a medical board for the nonprofit essentially to raise awareness and educate about the adverse effects of benzodiazepines specifically when taken as prescribed. So we don’t do a lot around benzodiazepine misuse abuse and addiction just mostly around the prescribed physical dependence problem yeah

Dr. Mark Leeds [01:37] And if you go to the home page I believe it has the percentages of and one of them that really stands out is what the chance of a person being addicted is and I think it’s a tiny percent like is it one percent or less than one percent

Nicole Lamberson [01:51] Yeah. So that study was done by the national survey on drug use and health. I think, well, they took the results from that survey. It was like a 2015, 2016 survey, and it was a hundred thousand adults, 18 and up. And among U.S. Adults, they determined 12.5% used benzos, but only 1.5% who were benzo users had a use disorder or addiction. So basically the summary of that study is that while benzodiazepine use is high, use disorders or true addiction is actually pretty rare. And I don’t think that’s something that a lot of medical professionals appreciate or understand. You know, they hear about benzos causing withdrawal or even the word withdrawal sort of sparks the idea of addiction or substance use disorder in people’s heads. But what we find most people are missing is that they just don’t understand the difference between prescribed physical dependence and addiction or substance use disorder. And that withdrawal does not equal addict or addicted by definition. You can have a withdrawal syndrome just by way of taking the drugs on a daily basis exactly as prescribed by your physician. So we get tons of reports all the time from patients who are struggling to get off their benzodiazepines and they are panicked because their doctor suddenly, you know, kind of freaks out on them and says, oh, if you’re having trouble stopping, I’m going to stop prescribing the drug for you because you are addicted or having a substance use disorder issue. And that’s the wrong thing to do. People in that position need repeat prescriptions of benzos in many different forms, you know, smaller doses, liquids in order to do a really long outpatient deprescribing protocol, like a taper at home, essentially to get off safely. So yeah that’s why we differentiate I mean that’s been one of our like main projects at bic is to really try to define the language so that misunderstanding and in language is really understood so that patients stop being harmed by that yeah yeah yeah

Dr. Mark Leeds [04:32] Doctors really don’t know a lot about addiction from their training and that’s something that in the addiction treatment world they talk about that it’s one of the biggest problems that we have is addiction and we know which is clear with all the news about fentanyl it’s a major problem and it’s something that if anything doctors might get you know an hour or two of lectures in medical school there’s very little coverage of addiction and one important thing about learning about addiction and I think a lot of people who are addiction specialists don’t understand this even is to know when something is not addiction. Something might look like addiction to your average person, but it’s not. And so when doctors don’t understand something and they don’t know about it, they fall back on what they think they know probably from their regular life. I mean, I don’t know, maybe what they see on TV, what their family and friends and upbringing has taught them. And they see someone in that physical state of withdrawal, shivering, shaking, upset, anxious, agitated, saying, you know, please help me. I need something right now. If you just give me that pill, I’ll probably feel better. That looks like addiction, and it’s not addiction always. It depends. And there’s things that cause addiction and physical dependence. There’s things that cause only physical dependence. And there’s things that have more addiction and less physical dependence. And also, I think it’s confusing because benzodiazepines are intoxicating. If a person takes too much, they might look like they’re drunk. And alcohol is addicting. Alcohol has physical dependence and addiction. So I can see that a doctor or family members might say, well, it kind of looks like, you know, and to even confuse it further, people in the addiction world might say, well, benzos are like alcohol on a pill. I think I’ve heard that for more than once. And they’re really not. They don’t have that addictive component. They can be intoxicating. They can be misused and abused by people, but they don’t call addiction. It’s hard to define. It’s not, there’s a lot of different definitions for addiction. But one easy way you can say, one easy way to look at it is a person who is addicted to a prescription medication is probably going to use it all up in a very short time. If someone’s addicted to their opioid prescription, the whole bottle will probably be gone in less than a week. People that take their benzodiazepines as directed, they still have their bottle full. They still have their medication left appropriately because they take it as directed. If a person can take their medication as directed and not keep taking extra, they’re probably not addicted. In some cases, even if they take a little bit too much, it still doesn’t necessarily mean that it’s an addiction. But it’s really important because when people confuse addiction dependence, when they think that if a family member, family members think that their loved one is addicted, they send them to the wrong places. They’re like, you need to go to rehab. We need to get you off this stuff. You need to be detoxed quickly, which, you know, is completely the wrong way to treat benzodependence.

Nicole Lamberson [07:45] Yeah. I mean, it can be catastrophic. That’s what happened to me. I went to a detox center because I didn’t know how to get off of this stuff. And nobody told me that, oh, what you have is a physical dependence and not an addiction other than my father, who’s an anesthesiologist kind of figured it out and sent me these articles while I was in this rehab center being accused of being an addict. But like, like you said, I showed up there with a whole bottle of Klonopin and like all my polypharmacy and was like, I just want to get off of this stuff, you know, and they didn’t know the difference. And, it makes me think of that old saying, like, when all you have is a hammer, everything looks like a nail, right? So anybody who walks through the door of a rehab center, like all they have is this hammer. So you’re going to be a nail, you’re going to be an addict, because they don’t, they don’t know anything different. They don’t know how to treat any differently, or the place isn’t set up for what I needed, which was outpatient tapering. So they subjected me to, you know, 12 step stuff, which was totally irrelevant to my situation and ripped me rapidly off of all of the drugs that they deemed quote unquote addictive, even though I hadn’t been misusing or abusing them at all and put me in a severe, severe withdrawal syndrome that horribly damaged my nervous system for years. I mean, it was a very, very protracted syndrome. And that to give you some perspective that happened on October 10th of 2010 and it is 2024. And I still have symptoms of nervous system injury from being detoxed in that manner. So yeah, I mean, you can steal years and years of life and health from somebody by subjecting them to the wrong treatment. So that’s why we advocate around the language so much so that people really understand the concept. The other thing that you touched on, I mean, I wonder, have you worked with both patients in your practice, people who are truly just physically dependent to benzos and maybe somebody who actually had a benzodiazepine addiction by, you know, that could have been diagnosed as such or like met the criteria. I’ve worked with both. And to me, it is like just blatantly obvious, like the difference in people. The people who are purely physically dependent actually sometimes you are some of the work with them is trying to slow them down in coming off of the medication because they are they want it out of their body they’re begging you please please can I taper faster can I and that is not typical addict behavior you know so to me I just I can’t believe that people can’t like see the differences in people but maybe it’s because they aren’t working with people like with an open mind when these patients come in, you know, and knowing what they’re looking for. If you don’t know what you’re looking for, you can’t accurately diagnose it. So.

Dr. Mark Leeds [11:05] Yeah. It’s, benzodiazepine dependence is very, it’s very different from what, and I don’t even know that the rehabs are even handling things like alcohol and, you know, opioids. I mean, for a long time, they were mishandling opioid addiction and dependence also, because opioids cause both addiction and dependence. Because we have, you know, for the last 20-something years, and even further back if you count methadone, but, you know, we’ve had suboxone or buprenorphine for the opioid patients, and the rehabs were all very resistant. You know, they said, if anything, we’re going to use it for a one or two-week detox, but nobody should be on this medication long-term. But buprenorphine, which is Suboxone allows us to do long-term tapers off of opioids, similar to benzodiazepines. We can take one to three years. We can take a long period of time and let the person really get used to a gradual taper and stabilize. And these rehabs, exactly, they have that one hammer that really doesn’t work very well on anything. And everything is a nail, and they just don’t want to hear anything different. I mean, we have like a whole Home Depot full of all kinds of different tools, and they’re like, you know, we’re happy with our hammer and it’s really not good. And the success rate is something,

Nicole Lamberson [12:21] I mean, I don’t know. I watch, I don’t know if you’ve seen the documentary, like, I think it’s called the business of recovery. Have you seen that one? It’s pretty sad. Like they say that the rates of success are like 5% or something like that of those places.

Dr. Mark Leeds [12:38] Yeah. And I think, I think that’s true. And I think it’s also similar to the spontaneous success rate of people that would just get better anyway without any help. Because there are always a certain number of people that, even with addiction, there’s people that grow out of it. They get tired of it. They realize on their own. And not everybody. I mean, no one should feel bad if they can’t get in that state of just saying, okay, I’m done with it. But that does happen. There’s a percentage of people that are addicted. And they’re just like, you know, okay, I’ve had enough cocaine. I’m kind of tired of it, like losing everything in my life. I’m done with it. They would probably have gotten better anyway. When you go to just for example, if someone goes to an AA meeting or an NA meeting, Alcoholics Anonymous, and they see all these people that have all these years of success, like people raising their hands saying I’ve got 30 years sober, 20 years sober. Those are the few people that for whatever reason it works for them. Maybe they like to sit in a room and talk. For whatever reason, But you don’t see the thousands and thousands of people that came and went and found some other solution or maybe nothing worked for them. So it’s a selection bias. It’s, you know, that we only see the success rates. And, you know, rehabs will point to that. They’ll say, oh, look, you know, look at all these people that have had great success. I think even with, which is interesting with the opioids, there’s a lot of people on opioids that are only physically dependent, not addicted. And I think a lot of those people think they’re addicted or they thought they were addicted years ago and maybe they got in recovery and they got over their physical dependence and maybe there never really was an addiction. And so that would look like a success rate in an addiction treatment. So, yeah, I think there’s a lot of confusion with that.

Nicole Lamberson [14:29] Or they don’t follow up. Like I left that horrible place free of the drugs they deemed addictive. But I never went back there to tell them like, Hey, you imploded my nervous system. And I actually had to go back on benzos by a psychiatrist who knew what she was doing. You know, they don’t know when you leave because a lot of people figure it out after the fact, and they’re not going to report back to this rehab place because what, I mean, that place can’t do anything for you so you just move on and find treatment that makes sense essentially so maybe they have next to my name you know oh we got her off well you didn’t you actually destroyed my nervous system yeah so yeah

Dr. Mark Leeds [15:20] It’s true that if they count their success rate is that you walk out the door not taking benzodiazepines and they would count you as a success and they really they harmed you this iatrogenic harm you know medically induced harm they were complicit and damaging your nervous system for many years and you know and they’re also if you know if someone’s looking for help and they go on google and search for how do I get off the benzodiazepines the top search results are all going to be rehab or detox facilities like places that are going to do that. I mean, look, I guess Google is now like they, for a long time now, they usually put like the official like SAMHSA government thing at the top of, you know, that these advertisers don’t get to come out above that. But I didn’t even know if that organization, I don’t know, I don’t know if SAMHSA, I think it’s SMA, whatever it is, SHA, that, you know, the organization that deals with part of what they deal with is addiction. But I don’t even know if they differentiate, you know and would help someone in that in that situation for all I know they maybe they just send them to rehab but yeah it’s difficult I mean are there so are there like a lot of experts or science like that people can look to learn more about like you know how this works like why tapering has to be done very gradually

Nicole Lamberson [16:43] I mean they’re you know the ashton manual was kind of like the old school, you know, like landmark document that existed since the nineties. When she had a clinic over in the UK where she worked with patients to withdraw them slowly. And then she wrote the manual based on her experience with those patients. So that’s kind of the first document that exists that explains this. Although she didn’t go into the difference in language, you know, the difference between physical dependence and addiction in that document. And I think she used addiction language incorrectly in that document. So now we have, as of this year, the Maudsley deprescribing guidelines that were just released. And that the authors of that are Mark Horowitz, who’s a psychiatrist in training in the UK, and Dr. David Taylor, who I believe is a psychopharmacologist, who’s well known in the UK for his work. And Maudsley is a very respected textbook in the UK. The textbooks by Maudsley prior to this one are all called Maudsley prescribing guidelines. So it’s all for psychiatrists and doctors about how to prescribe psychiatric meds. So the latest one is the deprescribing, Maudsley deprescribing guidelines. It’s the first of its kind, and it’s incredibly detailed and thorough because Mark, who is one of the co-authors, is a psychiatrist in training, but he’s also a patient. And I’ve heard him say he considers himself a patient first because of what happened to him trying to withdraw from psychiatric medications, including benzos and sleeping pills that he was on. And so he’s written an incredibly thorough textbook about all the different ways that people are tapering these drugs at home on their own. And he had contributors to the book. I helped with the benzo section. Dr. Christy Huff, who’s passed away, but was our medical director at BIC also helped. Any I think he has in there you know gabapentin z drugs benzodiazepines antidepressants everything that needs to be tapered slowly at home on an outpatient basis so this can be bought and you can take it to your physician if you’re a patient out there and you find yourself in this physical dependent state and having trouble withdrawing you can educate yourself with it but you can also take it to your doctor or PA or nurse practitioner and use it as a tool to sort of convince them like, Hey, this is a well-respected textbook with all the information that we need to safely get me off of this stuff at home in the way that it’s supposed to be done. So that doesn’t mean you’re guaranteed to have still an open-minded clinician who’s going to read it and listen to you, but at least it’s sort of a tool in your toolkit to try to be better understood and taken seriously when you walk in there.

Dr. Mark Leeds [20:09] Yeah, and that’s a good point. That kind of reminds me of, I remember hearing in a lecture that if you have a, if someone has a legal problem, they’re going to a lawyer that, you know, your lawyer is going to handle your case. And the truth is that you need an expert witness or an advocate. And they say that you’re your own best expert witness.

Nicole Lamberson [20:32] Oh, sorry, I’m just declining a call there.

Dr. Mark Leeds [20:33] That you can’t expect a lawyer to handle your issue. You need to be your own expert witness. You need to get deep in the case and review everything and act like you’re your own lawyer and learn everything and kind of put it together and package it up in a way that can be easily understood and say, this is what my real case is here, that, you know, you do need the professional, but you need to be your own best advocate and really educate yourself. And it’s not just true for working with a lawyer, it’s true for working with a doctor. If you go to see a doctor that only has 15 minutes to see you and they’re in a hurry and they’ve got 50 people on the schedule for that day, if you walk in and say, I need to taper, I need you to prescribe me this liquid compound and I’m going to take a little bit less on a regular basis and follow this tapering schedule, that might work. Or they might say, like, where’d you get this from? On Google? And then they say, like, you can’t go to Dr. Google. Listen to me. And then the next thing you do, if you bring in this book and say, here’s this deprescribing guide written by scientists and experts in the field. And this is real science. This is a real medical textbook. And if you say, I’ve read it through for you because I know you don’t have time to read it and I’ve put together a plan and this is going to work and just you know if you want to read the book you can you know having that authority and also having done some of the work and you know that can I think that can go a long way like you know that we really need to be our best advocates or even to have somebody with us you know to bring somebody to an appointment that can also can stand up for you know maybe a spouse or a parent or a family member you know somebody you know it helps if you have somebody that has some medical knowledge and, you know, they can, you know, but to, you know, not to fight the doctor, but to say like, you know, I know you’re in a hurry and that you don’t know a lot about this maybe, which is understandable because they, you know, nobody teaches this stuff. It’s anti-Big Pharma, which unfortunately the medical education system has, Big Pharma is so deeply entrenched. That’s probably a big reason why there’s no science about this stuff or not much science. Of course, in the UK, things are different, but definitely in the US, our medical education system is so infiltrated by these drug companies that have no intention of anybody ever getting off of these drugs. But, you know, yeah, so if a patient can go being their best advocate, maybe bring somebody with them to advocate for them, and they have also this medical book that, you know, has all the information in it, and you’ve also put together a plan. Yeah, I mean, I think people can possibly in a lot of cases make things work with their primary care doctor or their family doctor.

Nicole Lamberson [23:15] Yeah, totally. I mean, one of the number one emails we get is, you know, at Benzoinfo Coalition, we have a doctor’s list that has physicians, you’re on there, who are willing to help people taper benzodiazepines. But we have above the list is a huge disclaimer that says just because somebody is on this list does not mean that they’re super educated on proper benzodiazepine tapering. Like at best, what you’re probably going to get is a collaborative physician, PA nurse practitioner, who’s willing to prescribe you the drug, but they may not know all of the tips and tricks and things in the Maudsley book or in the online forums that you can learn for yourself. And so people will write us and say, well, I went to this doctor and they didn’t like design me a micro taper. And it’s like, well, they’re probably not going to, you’re going to have to figure that out yourself with a coach who knows how to do that. Or, in some of the groups, you know, you can read and in the Maudsley book you can read. So yeah, it’s unfortunate that you have to like dive deep into a textbook and learn how to save yourself from this situation, but it’s just reality. Unfortunately, with the landscape of our, you know, this gap in like medical knowledge that currently exists, it’s, you’re just going to have to do that unless you are one of the rare few that is incredibly lucky that, you know, comes across you, Dr. Leeds, or lives in the state where you’re licensed, or, you know, maybe Josef Witt-Doerring in the few states that he’s licensed in. I mean, there’s a handful of physicians who are like top of this field and could, could manage a taper for you in that way. But most of them are not going to have any idea. And so you’re going to have to be the one who drives, you know, this, and then your physician or prescribers, just kind of like your, your co-pilot essentially along for the ride. And maybe they learn from you know, I’ve had tons learn from me and then they can take it forward to their next patients, you know, and do better next time. But yeah, you may just be getting somebody who has no idea what they’re doing and they’re kind of relying on you to tell them what you want to do. In other cases, we’ve even had patients who had to lie in order to save themselves and say, the drug is working really well for me. I’d like to keep taking it because they feared if they mentioned that they were trying to withdraw, that the patient would try to take over. I mean, the doctor would try to take over. And that happens all the time. I don’t know why. I don’t know if it’s an ego thing with physicians or a control thing or what, but as soon as you mentioned taper, they start saying to patients like, Oh, all right, well, you can do it in a month, cut it in half, cut it in half again and you’ll be done. And when the patient says no, then they’re like, well, that’s how we’re doing it. And so some people are just terrified to even bring it up in the first place because they kind of know the vibe of their doctor. They don’t feel like they’re going to be collaborative. So they just pretend like the drug is working great. And then they go home and read Maudsley themselves or hire a taper coach or something and devise a plan. And then they just do it on their own behind the scenes. And then once they’re off the drug, they just like never go back to the doctor, you know? So that’s the least ideal way. Obviously we’d like everybody to have somebody monitoring them who cares about them and wants to know that they’re okay. And who’s like on board with the plan. But again, that’s not reality in all cases. So yeah.

Dr. Mark Leeds [27:08] Yeah. Yeah. I think that’s part of medical education that, and I don’t know if it’s intentional or not, but that it works out that way that, you know, desensitizing the doctors, kind of dehumanizing them. And it starts with things like, you know, for example, they have a lab where you have to learn how to do surgery. I don’t know if they do this anymore, but you have to do surgery on dogs. And we had that lab and I had this idea that I thought like if we’re successful if we save our dog we do all the surgical procedures we have to do and our dog survives you know he’s going to get to go you know live on a dog farm or something and retire somewhere like he survived because we did our job well I didn’t realize none of the dogs make it whether they survive the surgery or not in fact this is maybe I shouldn’t say this is horrible they there was this barbecue smell one day and someone told me that’s the dogs being what do they call it you know when they

Nicole Lamberson [28:06] Incinerated or whatever

Dr. Mark Leeds [28:07] Yeah yeah yeah it’s really horrible and there’s you know I know there’s people that have like protested that and apparently if you refuse to do the dog lab you’re risking your your medical education and some people believe that kind of a thing is not really to help teach you surgical technique it’s part of that process of you know cause I guess suppressing your emotion or compassion fatigue that you know that I mean you know I the thing with cadavers they could probably teach people anatomy without having dead people I mean I don’t know maybe it maybe it’s helpful I have some pretty clear memories of that gross anatomy lab but I think

Nicole Lamberson [28:47] Yeah yeah

Dr. Mark Leeds [28:49] Yeah I mean if any I mean actually a lot lots of them I mean one thing is you know remembering what the tendons look like like wow that almost looks like artificial at those arm tendons and you know just but yeah that’s between you know but even worse going beyond that just the way residencies are of these long shifts of 48 hours or whatever you know which are supposed to be limited but they’re not and you just the things that you see and the things you have to deal with and the people who are superior to tell you that you just have to do this or do that and not really feel anything and you know doctors just come out of medical school and out of residency not really connecting, not having empathy for their patients. And it’s just, I can kind of see how that, you know, that you just kind of, they might look down on a patient or not see them as a human being the same way. And, you know, when a person says, you know, I want to get off of this medication and now you have a doctor who’s been through all of that and they only, and now they’re working in a place where they have to see 50 people a day or even 30 people a day, which is still a lot. That all you’re thinking, and I’ve worked in a place like that, when you walk in the room, all you’re thinking is, how can I get out of here? Because I have so many more people to see before lunchtime. And I have a bunch of charts I have to call people back and all this stuff to do. And then the person gives you this big problem. It’s like, oh, I can refer them somewhere. I can order some labs and put off talking to them until next time. You have all these ways of dealing with it. But people in this situation need help. And on top of that, you have these drug reps coming in the office, taking up time. And these drug companies, they really have no intention of people coming off of medication. And it’s so easy to get put on a like a Prozac prescription or even even benzos. You know, I can’t sleep. Well, here’s some Restoril, which is a benzo, and that’ll help you sleep. It’s only meant to be taken for two weeks. But when you come back and tell me how great it worked, here’s another prescription. I think a lot of benzo dependence happens that way, that it’s easier just to write the prescription again and just keep it going. And people really do feel better with it in the short term.

Nicole Lamberson [30:53] Yeah, I mean, there is a physician, his name is Sami Timimi. He’s like a child psychiatrist in the UK. And he said once, like, he doesn’t even like short term prescriptions because he says that they open the door essentially for long term ones. And I think that’s true. It’s like what you say, somebody maybe intended for something to be short term, but then when it worked, the next doctor is like, oh, you got that? We’ll just keep refilling it, you know, or the same one. You come back and they forget that they intended for it to be only two weeks and they prescribe it longer because the patient says it worked. Or like what you said, just the problems like sort of baked into the way that our medical system here is in the U.S., like corporate medicine. And I worked in it too before I got sick. And it was like, even the place that I worked for would send us reports at the end of the month. Like your average time with a patient was this many minutes. Your goal is to shrink it down to this, you know, or your dictation was too long and everything was about just compacting it in to shorter amounts of time and like, hurry up, hurry up. And they’re monitoring you know, about how fast you are. So how can you provide good medical care? You know and then a complex case like oh I’m physically dependent on three psychiatric meds at the same time and I need like this taper plan written out for me and all of this like it just there’s no time for it you know yeah

Dr. Mark Leeds [32:23] I saw someone post something on Twitter that was interesting I don’t think and it just it never occurred to me but it makes perfect sense something I don’t remember the exact wording of it but something about that you’ll never be taken seriously as a credible person ever again once you’re on psych meds and you know it kind of and it kind of makes sense if you think about it imagine that someone is like a say a witness in a court case and then they bring it up like oh well you’re on prozac or you’re on xanax or Klonopin are you sure that we could you know like now it brings up endowed into their testimony and doctors may see it the same way like like if you start complaining about stuff like well you’re you’re hysterical you know you’re making it up I mean you’re imagining it’s in your head because you’re look you’re on this stuff already that affects your brain and whatever I mean it kind of makes sense like and people should probably be aware of that as well you know […] And that’s just, you know, one thing, I mean, all, all these drugs, psychiatric drugs and antipsychotics and, things that cross the blood brain barrier and affect the brain chemistry in ways that we don’t And all of these things, if you look at the FDA approved literature, they all start with, we don’t really know how it works, but here’s how we think it works. And it’s just crazy of what doctors unknowingly are doing to people being pushed by the big pharma people. And yeah, these drug groups come in with these colorful pamphlets of like, you know, look how safe and good this is. And it’s going to help them with this and initiate comparisons, you know, and the things that I think also are designed to make the doctor feel kind of dumb. So you really like you start thinking like, wow, I don’t I don’t know what that look at those P’s and Q numbers or whatever these statistical numbers that I never really learned that well. And they’re comparing all these drugs and using terms I don’t even know on this person who’s not even a doctor knows a step better than me. I mean, of course, they’ve been training very well on that one very specific thing of comparing their drug to a couple other ones and a couple of studies that they know very well. And, you know, before you know it, they’ve convinced you that the best thing I can do is get this patient on this drug. And then they give you samples so you can like get free samples out say oh look I happen to have a colorful little pack of them here and I probably have enough to give you like more the next time you come in until they run out and then we have to give you a prescription

Nicole Lamberson [35:10] Yeah and then that prescription will be so expensive because it’s still on patent which is why the drug rep is here promoting the drug in the first place because they can get a lot lot of money from it because it’s not generic, you know, but all of the, all of the problems that are just, you know, in our American medical culture that, you know, creates these nightmares for people that I think a lot of people who go in are just unsuspecting patients. Like they blindly trust their doctors to know. That’s how I felt. I mean, I had just finished PA school when I started psychiatric medications. And I think because I was fresh out of training by a bunch of doctors and I really wanted to believe that like I had chosen a profession that was to help people that everything I taught had been taught in school was true, you know, and I was raised by a physician. And so I had that sort of in me already, like looking up to my father and thinking like doctors exact cures, they help people all the time. And so I didn’t even have harm like on my radar at all. Such a naive, you know, stance, but that’s really how I felt and thought like, if a doctor says it must be so and all they can do is help you and now I realize that medical errors the third leading cause of death in the United States and I was just so naive yeah so

Dr. Mark Leeds [36:51] That could be a big part of it for doctors also that imposter syndrome where you feel like you don’t really and I think a lot of us feel like you know we just feel like we don’t really know enough and we’re not as good as everybody else and you know and I think that you know the Big Pharma I think really preys on that you know and also that but yeah like so when you go into you know being a resident and then a doctor early on you just want to keep up with everybody and do what everybody else is doing and you know and when you see like a doctor shouting at someone who’s in withdrawal saying you know you addict you’re going to rehab and we’re going to put you in the psych ward and ship you out or whatever, however they say it. You’re like, oh, that’s how you do it. So when I see one of those cases, I’ll know what to do on my, you know, send them to rehab. That’s how you handle that kind of case. You know, maybe make a note in your little pocketbook that you keep with you of notes of what to do. But yeah, in a lot of cases, you know, nobody’s really questioning any of this stuff. But this is completely, I mean, as real as anything, that people, these drugs, these psych drugs, benzodiazepines, antidepressants, can be very, very damaging to people and cause very long-term damage. And they have to be, people have to be taken off of them very carefully and gradually, and everybody’s different. I mean, that’s important. Also, patient-led tapers or patient responsive tapers where you don’t like to say, here’s your plan and we’re sticking with it. And don’t think that you’re going to deviate from the plan. Sometimes a person is not ready to make that next reduction and they need a little bit of time. Sometimes you have to reinstate. So everybody has to be looked at as an individual case. And in some cases, people have to work with their doctor or, I mean, to bring up also the idea of a tapering coach, somebody who’s not a doctor, but someone who has a lot of experience in this, who’s done it themselves and has worked with other people and knows how to be and can be that advocate, you know, like we’re talking about bringing somebody with you know, maybe someone doesn’t have an advocate and they don’t, they can’t be their own advocate or they don’t feel comfortable being their own. And they could call you, they could email you and ask for help.

Nicole Lamberson [39:08] Yeah. I mean, some people just honestly, like they, the math overwhelms them or just the idea of like using a syringe, like they really need somebody to sit down and take an hour with them and kind of design a taper and then show them how to use the syringe and like what all the markings mean. And I mean, you can simplify it as much as if the person designing the taper knows the math that the person doing it, who maybe has cognitive impairment because they’re on, you know, three psych meds or something, they can just break it down very simply and say, okay, you’re doing a micro taper and the math works out where you can come down by, you know, one tick mark on this syringe every day. And you don’t even have to do the math or think about the math. And like you said, too, the tapers kind of have to be individualized. It’s not like you can write one that’s like a recipe and send somebody with it and say, follow this and you’ll be fine. Because maybe the rate that you started somebody at for the first six months or something works really well. And then they get halfway down in dose and that same rate doesn’t serve them anymore. And it has to be slowed back because the current dose is much smaller now. So it helps to have somebody who, you know, you can touch base with once in a while and say like, okay, how would we rework this now if I need to slow it down or that kind of thing. And then you can take that plan to your doctor and say, hey, I’m a really easy patient. I’m not going to take up a ton of your time today. You know, here’s my plan. It’s been working great. I just need to slow down a little bit. I need a refill on my compounded liquid and I’ll be out of your hair, you know? So yeah, that kind of thing. But yeah

Dr. Mark Leeds [40:55] Yeah doctors are who are willing to work with you I mean it also does help to be you know like say the doctor doesn’t know how to how to write the prescription you know for the for the compound I mean to even say that you know I talked to the compound farmers they I found this great place they’re certified and whatever they’re a really good compound pharmacy you can look them up if you want and here and they sent me a thing of here’s how you write the prescription you know that they can just copy that right up and just fax it to this number and it’ll be handled which is not that difficult to do

Nicole Lamberson [41:26] Yeah and yeah compounding pharmacies are great too really good resources so if you think about it they’re filling all of these scripts for people who are using the compounded method anyways some people call the local compounding pharmacies in their area and say, what doctors are writing compounded benzodiazepine prescriptions? And then you get their names and you figure if they’re writing for them, they’re probably doing taper. So you can call that guy, you know, and see if he’s taking new patients. So you can kind of work backwards. Yeah. And see, you just have to know what you’re doing and where to look, you know, to try to get help with this. So.

Dr. Mark Leeds [42:06] Yeah. Yeah. That’s a really good idea that the compound pharmacies would know. And there’s a, actually I’m going to look it up. Just to make sure that the piece for finding

Nicole Lamberson [42:17] A RX one, you mean?

Dr. Mark Leeds [42:20] Oh, yeah, that’s it. Yeah. Yeah. What is that? There’s that organization. If you Google them, you can find like the best compound pharmacies.

Nicole Lamberson [42:26] Yeah. It’s called PCC a RX and they monitor and, certify compounding pharmacies and they even have a link with like a little box that you can put your zip code in and do like a 10 or 20 or 30 mile radius and they’ll tell you all of the certified pharmacies around you that you can you know reach out to yeah

Dr. Mark Leeds [42:50] Yeah I have the compound pharmacies that I like to work with but I did that and found out that if I needed them there’s actually a bunch of local ones I mean they’re everywhere so there’s

Nicole Lamberson [43:01] Even ones who work like I use for some of the people that I work with Dr. Witt-Doerring’s practice, there’s one in New York that ships to tons of states as well. So if you’re like in some rural place that doesn’t have a compounding pharmacy, you can have one mail you your medication as well.

Dr. Mark Leeds [43:25] Yeah, that’s true. If the pharmacy has a license in your state, it’s as if they were there. Like we use one in North Carolina, they have a Florida license and it works just like, as if they were in Florida, we send a prescription, they send it to us and it doesn’t matter that they’re not physically located here.

Nicole Lamberson [43:41] Yeah, exactly. So, yeah, I mean, that’s where having a doctor like you who knows all this stuff, you know, or a coach who’s been in the trenches working with people, like these are the tips and tricks and things that you need to know in order to, if you’re, you know, using a compounding pharmacy, they also know like what, concentrations they can make for you. If they’re, if they’re making a liquid, like the smallest amount per milliliter they can make, or if you’re doing compounded capsules and you’re going down from one to the next, in dose, they can tell you, all right, here’s with precision, the size of reduction that we can get. That’s the smallest, you know, if we’re doing it for you, weighing it on a scale. So big, you know, resources just in talking to a compounding pharmacist. Yeah.

Dr. Mark Leeds [44:32] Yeah, definitely. Yeah. And now in the book that you’re talking about that deprescribing guide, they also have, we talked about this before that there’s even instructions for people that for whatever reason might not have access to that. But, you know, say in the case of a person that goes to their doctor and the doctor is willing to keep giving them a prescription, just say for Klonopin. And they’re like, here’s your Klonopin prescription. And maybe the patient knows if I say anything, they’re going to label me as an addict or something and refuse to give me the prescription anymore. And they just have to, they’re not going to be able to get the compound prescription. And so I think you told me that book does talk about ways to do it on your own if you really have to not that I’m recommending that at all but if a person had to that like these a lot of these tablets are very soluble and whole milk

Nicole Lamberson [45:27] People use whole milk for Klonopin and valium all the time and it works great yeah and they use it I mean they use whole milk too for other things because milk is sort of it’s more viscous than water so even if you’re using a drug that isn’t water soluble for example you would be getting like a suspension because it’s you know it’s like the snow globe thing if you can picture a snow globe if it’s just water in there and the flakes and you shake it the flakes are going to probably fall pretty quickly in water. But if you put something thicker in there, like maybe water mixed with sugar, you know, they will stay up longer. And so that’s what people are trying to accomplish with using milk instead of water. Sometimes, sometimes people even buy their own like Ora Plus and Ora Sweet and make their own suspensions at home. But a lot of people, you know, will just take Klonopin and put it in whole milk or Valium and put it in whole milk, and they’ll do their own at-home liquid emulsion is what it is called when you do that. And there’s citations in that Maudsley book for why milk works for those two benzos specifically. Like someone actually had done a study that shows that milk would be a good liquid to use. That’s for Valium.

Dr. Mark Leeds [46:47] What was the other one? Klonopin. Yeah.

Nicole Lamberson [46:51] And then some people dilute the manufacturer liquids down as well with more water because some of them are very potent and you don’t want them so potent you want them more diluted so that you can make smaller cuts and so people will get like valium liquid for example comes in one to one which is a pretty good ratio but if you wanted it more dilute you know people just add more water and maybe they make it one to 20 or one to you know, 50, whatever they want it to be essentially. And then they kind of micro taper, changing it in that way. So yeah, that book tells you all of those methods as well. And maybe it helps to show your doctor that if that’s the method that you’re going to try, because, a lot of doctors will get weirded out about that. If you tell them you’re at home and you’re like mixing up your Klonopin with whole milk, they’re probably going to look at you like you’re crazy or what are you doing? That’s so dangerous. Or, you know, you’re some drug addict, obviously, because you’re making like a milk drug concoction, you know, but it really is a way that is a means to an end to successfully gently peel yourself off of these drugs, you know? So,

Dr. Mark Leeds [48:10] Yeah, I would imagine with the milk taper, you’d have to, you’d be also restricted by the expiration date of the milk that you wouldn’t want to mix like a large batch of it all at once probably.

Nicole Lamberson [48:21] Yeah. People do it every single day for their dose. Yeah. They don’t store or anything like that typically when they do that. Yeah.

Dr. Mark Leeds [48:29] Yeah. I mean, I think it’s great that there’s resources for people at all levels. I mean, not everybody has, has access to, you know, wherever they happen to live, you know, that not everybody has access to a doctor that’s going to help them through this. So there’s, you know, it’s good that everybody has, can, can get the information they need. You know,

Nicole Lamberson [48:53] I think compounding is expensive, you know, it’s not cheap to get your drugs compounded, especially if you’re using pure, like pure powder versus the compound or just crushing up tablets for you pure powder is like you know 70 to 200 per like month of liquid it’s very expensive yeah

Dr. Mark Leeds [49:14] Yeah and benzodiazepines tend to be very inexpensive I mean unfortunately the generic tablets can vary in their potency because they don’t they’re not always exactly what you think they’re getting you know they can vary by whatever 20 25 but you know at least there’s a lot of resources that people can, whatever situation they’re in, they can figure out something, some way to do the taper.

Nicole Lamberson [49:39] Yeah. Yep, exactly. And even if all you just have is water, you know, people are doing water titrations all the time. And maybe it’s not the most ideal because of that, again, that snow globe thing, but it doesn’t mean that people aren’t successful using water titration all the time. They are, you know, if you just come in the groups and have a look around, you’ll see. And my opinion is, it doesn’t matter how you get off of this stuff. If it works for you, then it works. Like, it’s a means to an end. And that’s, that’s, you know, you found a method that works. And congratulations, now you’re finally off of this drug that you wanted to be rid of, you know, so.

Dr. Mark Leeds [50:22] Yeah. Yeah, speaking of that, there’s lots of different, you know, people want to always know, like, you know, what can help them along with just, you know, the tapering so that they’re doing the tapering, they’re doing gradual reductions of their medication. And then, you know, what else can they do? Of course, eating healthy exercise, you know, eating less refined foods and less sugar, that’s all good. You know, we talked about that of even like a ketogenic diet being helpful in some cases. And, you know, then also, as far as supplements, that’s a difficult, that’s kind of a complicated of thing because some people will have really terrible reactions to certain supplements and some people will have a lot of relief from them depending on the supplement. You know, for example, like I’ve had some patients do well with that L-theanine, you know, which helps them to relax and get to sleep and focus and, you know, has like various benefits, but some people might have a bad reaction to it. Same thing with other things like the antihistamines and some people might do great with them you know like what does that the antihistamine for anxiety that helps some people

Nicole Lamberson [51:27] Vistaril you mean yeah

Dr. Mark Leeds [51:29] Vistaril yeah so that for some people that in fact some people have had experience where it might be they might have a terrible reaction to it they’re like oh you know how can you even think to recommend that to me but it does help some people you know and the same thing with probably like magnesium and it’s different kinds of magnesium Some are better than others and some might be helpful and that might, some people might have a reaction. So say, you know, everybody’s different. You know, you always, you have to be careful, maybe try a little bit of something. And if it doesn’t work, if it, you know, don’t do it again. And, you know, but that doesn’t mean it’s not going to help somebody else.

Nicole Lamberson [52:05] Yeah, that’s true. I mean, we have a list at benzoinfo.com of all of the things that people have written into us over the years saying like, this caused me a horrible adverse reaction. Probably because when people are in withdrawal from psychiatric medications, their nervous system is destabilized in some way to where they don’t respond to other agents in the same way as they would if they were a healthy volunteer. Here. But we don’t know. I mean, we really don’t know why people are having these chemical sensitivities, but we know that it happens at least anecdotally. We have tons of reports of things, even people tolerated when they were well, they don’t tolerate now that they’re in psych med withdrawal. And so, yeah, all you can do is kind of mitigate risk, which is, you know, start low. If you’re going to try something and tiny little doses and kind of test it out and see, You can look around at anecdote and see, well, are a ton of people having problems with this? If so, it’s probably more risky. You can look at kind of the suspected mechanism of action of the thing, even although with supplements, it’s hard because they’re not as studied really in some instances. But if it if it messes with GABA and dopamine and serotonin, it might cause you issues because that’s the system that you’re kind of trying to heal or that’s damaged when you’re in psychiatric drug withdrawal. And then as with anything in medicine, it’s a risk benefit analysis. I mean, I ask people who ask me that question all the time. You have to say, like, how bad is the thing that I’m having that I’m trying to take something for? Can I live with it? Or is it worth the risk of introducing something that I’m hoping would help, but I don’t have any evidence that it’s going to? And it could make me worse. Can I deal with being worse? You know, and then you have to make that hard decision of if you want to try something. In general, I’ve not heard a ton of success stories from people introducing a supplement and saying like, it healed my withdrawal, you know, if anything, you kind of like mask or give minor kind of relief. And so like, if you’re expecting a magic bullet, it’s, it probably doesn’t exist. You know, you may get something that kind of gives you a little relief or allows you to keep going. But ultimately I tell people the best tool you have to control the severity of suffering in most cases is the rate and speed of your taper, you know, and finding out this information before you make big mistakes. Like that is kind of our challenge at BIC and everywhere else doing this work is how do we reach people before they start tapering their drug with bad information? Cause that’s when people get injured and really, really sick. If we could catch everybody right before they make that catastrophic mistake of listening to their doctor who says, cut it in half. And then, you know, cause once you’ve injured the nervous system, sometimes it doesn’t like reinstating the drug doesn’t fix it people are kind of left with symptoms that they you know have to live with essentially until the nervous system heals so but I don’t know not crack the code on how to catch those people first you know that’s usually how people even figure out they have a problem with the drug and physical dependence is they make some big mistake and then they’re like oh my gosh what is this you know so yeah

Dr. Mark Leeds [55:56] Yeah sometimes when you know do like if I do a consultation with someone you know someone like you know because we do like like these paid consultations where someone is kind of like like a patient visit but it’s not a medical business just to like share information and I sometimes feel like you know I hope I can give them something useful I hope I can give them their money’s worth you know I don’t want to like talk to someone and maybe not really give them anything useful. Like I’m, you know, so, but I do my best try. And, but when you, when you can tell someone, if they say like, I was thinking about going to a rehab or a two week detox, I’m like, Oh, okay. I can give your money’s worth right now. Yeah. Please do not do that.

Nicole Lamberson [56:35] Yeah. Yeah. That’s worth, you know, so much. Cause the rehab is going to rob you of thousands and thousands of dollars. You know, those places are not cheap. And then all of the fallout, I mean, I’ve never sat down because it would probably be too depressing, but like added up what that decision cost me as far as like, you know, the amount of money I would have been making every year if I was healthy enough to work and like investing in a home to have a mortgage almost paid off and all of these things that you could add up over time because I was sick for, you know, I was out of work for since from 2010 until, you know, only recently did I start working again from, from the injury just because I made the decision to go to a detox center. So it can be a huge cost to people financially and socially. I mean, you, people can lose everything, everything.

Dr. Mark Leeds [57:34] Yeah yeah so yeah so some great advice we can give people right now if you’re listening right now don’t go to rehab or detox you know get get that book that deep with is it mosley how do you spell that

Nicole Lamberson [57:46] Maudsley, M-A-U-D-S-L-E-Y, deprescribing guidelines and it’s on amazon probably wherever books are sold I think but just google it and you’ll find it’s purple yeah yeah

Dr. Mark Leeds [58:00] Yeah and if you want to even save that you know for if you don’t want to spend any money go to benzo info is it benzo info.com

Nicole Lamberson [58:07] Yeah

Dr. Mark Leeds [58:08] And or google the ashton manual and the first thing that comes up will be the pdf that’s free offered by benzo info.com and you can get this incredible great resource you know it’s almost like the bible you know it’s not perfect you know it’s not just like no bible is perfect but you know it’s but it has if you read it like I every time I read did I find something new? I’m like, Oh, she really didn’t say, you know, people will say like, well, Ashton didn’t do it the right way. And I’ll go back and read it. I’m like, well, she never really said the things that you’re all saying. She said, you know, it wasn’t a one size fits all, you know, she didn’t say you have to do it this way. It’s a guideline. It’s something that you can use. And it was, you know, it’s a, it’s a major incredible first piece of work, you know, based on decades of research of hundreds and hundreds of patients that, you know, without it, that’s the foundation really for everything. And that’s what got me into this originally. You know, I’ve been doing addiction treatment for a long time. And people start, I started hearing Ashton Manual. Like, have you heard of the Ashton Manual? And I’m like, no, but I’m going to go look it up now. And, you know, just sometimes just like that, hearing the words, you know, the right person hears it and they go look it up and like, wow, this is like a whole world I didn’t even know about.

Nicole Lamberson [59:25] Yeah, exactly. Well, thanks for being one of the doctors who is willing, you know, because most of them say, where’d you find that online? I’m not going to read that, you know, but yeah, here she is. Some credible psychopharmacologist in the UK who’s put this beautiful manual together to try to guide clinicians on how to help their patients. But you’re right the most important sentence in that manual a lot of people ignore which is this is only a guideline like it’s not meant to be followed as a strict recipe it needs to be tailored to each individual patient etc but that’s the problem with guidelines I mean there’s a there’s a guy I don’t remember his name but like his whole focus in all of his work is like the problems with guideline based medicine, you know, because that’s what doctors want to do is like follow a guideline sort of to a T and they’re so problematic. I mean, I’m figuring that out now I’m on the committee, working with the ASAM. So that’s the American society of addiction medicine, who they just got $2 million in grant money from the FDA to come up with deprescribing guidelines for benzodiazepines. And they have a patient panel, which I’m part of, and then they have an expert panel. And they’ve just given us the first cut, if you will, of what their guidelines are going to be. And all of us on the patient panel are like, go back to the drawing board. Like, this is not it, you know, because we know doctors are going to read this stuff and they’re just going to follow it like without long explanations of things underneath of it. I mean, some of them were just dangerous, like, well, if somebody is having too hard of a time, then they can go to an inpatient center. And we’re like, no, they can’t. I mean, that, you know, so they’re trying to put things in that we are like so opposed to. So anybody listening, pay attention because soon, I think like June or July, this summer, sort of the first draft from the ASAM is going to come out. And what they do is they make it public and then it’s open to public commentary. So anybody kind of vested in this topic who wants to have your say, you’re going to have like 30 days or something to go leave, you know, points underneath of it of all the things that you are opposed to. And then we hope that they take some of the feedback and actually incorporate it and come up with, I mean, I’m not super hopeful. I’m trying to, you know, hope that we get something that’s decent. I’m not expecting it to be perfect, like something that I would write or you would write, Mark. But I don’t think we can hope for perfect in this. We can just try to influence it as much as possible, you know. But these are going to be the official guidelines that are probably going to be followed. You know, so.

Dr. Mark Leeds [1:02:33] And just so people know who ASAM, who they are, they credential doctors, you know, a doctor who’s board certified in addiction medicine may have been credentialed by that organization. But they also advocate 12-step facilitation as being a evidence-based therapy for addiction. Not not the 12-step group itself so if you go to aa there’s no way that there can be nobody can really do a study to show that aa is a evidence-based medicine because it’s a group you go and you do the 12 steps which involve believing in a higher power and praying to have defects removed or whatever you know I’m not probably not saying it precisely but yeah

Nicole Lamberson [1:03:15] Surrendering and all of that right yeah how do you measure that so

Dr. Mark Leeds [1:03:19] Imagine a medical organization that credentials doctors to allow them to be board certified that advocates prayer as being a medical therapy. You know, I’m sick. I have a medical problem wrong with me. Pray that you’re broken. You have defects of character. Something doesn’t feel right about that. So that I take it with a grain of salt, whatever they come up with. And it’s unfortunate that 2 million didn’t go to Benzo Info to BIC to do this work.

Nicole Lamberson [1:03:46] Yeah. I mean, the existing nonprofits in this space that work on this. I mean, there’s two of us, it’s us, BIC, and then there’s another one, the Alliance for Benzo Best Practices. But when we saw sort of the requirements to get the 2 million in order to make this thing happen, it was like way too much and tiny little grassroots organizations could have managed on our own, you know, to meet the criteria of what they were looking for. And so unfortunately a big kind of mainstream organization, like you’re talking about with major problems is the one who was awarded the money. And now we’re just the patient panel that, you know, I don’t know how much they’re just kind of blowing smoke and pretending like they care what we think, because they have to sort of check that box and say, yep, we had a patient panel, you know, but I don’t know. I mean, they have admitted that they did like a huge literature search and that the literature is like completely lacking as far as benzos and how to effectively get people off of them. So, I mean, at least we know that and they’re admitting that, but what are they going to come up with the final recommendations is what is kind of yet to be seen. So keep your eyes out. I mean, BIC will be advertising it all over when it’s ready for public commentary. And we hope that like, they’ll just be bombarded with the same message over and over again, if they have a very potentially damaging recommendation, like send somebody to an inpatient facility, you know?

Dr. Mark Leeds [1:05:28] Yeah. Yeah. Which I can see that maybe being a part of it, that, you know, there’s always that thing where people want to cover for themselves of saying, you know, I’m not going to take any chances. I’m just going to refer you to inpatient, to the psych ward, to the, you know, which can be very harmful to people. So yeah, it’s, this is a real thing, but we have a lot of big forces against us. Big pharma, you know, like we’re saying in the addiction treatment community, the rehab industry, the, how, Alcoholics Anonymous and the 12 steps are very entrenched in that. And it’s just not, there’s just a lot of, major big forces of things working against getting this information out. And, but it is a real thing. And other kinds, sometimes we have to look at what’s going on in other countries, for alcohol treatment. There’s a Canadian organization. I think it’s the Canadian Alcohol Use Disorder Society, and they have incredible information about medications that can be used for alcohol harm reduction, getting people off of alcohol. And that information is just not readily available in the U.S. And they’re not they’re not that far away. I mean, you know, just apparently everybody, 90 percent of the population of Canada lives along the border. So they’re practically almost here anyway. But they’re so advanced in some of this addiction stuff. But we have too many of these forces in our country that are working against suppressing or not making that kind of information readily available. And like you said, a lot of great work is coming out of the UK. I think they see benzodiazepines a lot different than we do. And so you have Dr. Mark Horowitz working there. We had Dr. Ashton. And, you know, there’s just so much. So sometimes we have to look to these, you know, advanced countries, you know, that have that are maybe more advanced than us and in a lot of ways. And, you know, to get the best information.

Nicole Lamberson [1:07:24] Yeah, it’s true. It’s kind of mind blowing, isn’t it? Like what you’re saying, it’s just literally like across the pond or across this border. And it’s so different. It’s like how it’s the same chemical and we’re all human beings, but you over there recognize the harm. And we over here still are like in the dark ages and not understanding. It’s crazy to me, but it’s true. Yeah. Yeah. Yeah. Dr. Horowitz says all the time, like you, U.S. People are crazy. Like when he looks at our numbers of benzo prescribing, you know, compared to what they do in the UK, he’s like, it is wild over there in the U.S. And I’m like, yeah. So I think universal healthcare helps a lot too. And I’m sure I’ll get comments about, you know, some political thing or whatever. Obviously there’s good things and bad things about all things when you’re making an argument. So I’m not advocating for one thing or another, but it’s easier when you have a healthcare system regulated by the government or whatever to say, okay, you can only prescribe benzos for two weeks. And then that’s the rule. And everybody has to follow it because that’s, you know, like the NHS can make the rules. Whereas in the US, you know, you just sort of standard of care is using things off label and whatever. And even in different states, the rules vary. I mean, I think in Tennessee, gabapentin is a scheduled drug, but in another state, it’s not. So it’s kind of the wildest over here in the US.

Dr. Mark Leeds [1:09:00] Oh, yeah. I mean, just, you know, your health care system is broken when hospitals are successfully suing patients because they can’t pay for their hospital bills. It’s one thing to send them to a collection agency, but it actually happened to me. They actually got to experience that during early in COVID. The process server coming to service with papers of being sued by our local county hospital for missing, not paying a bill on time. And the guy just kept knocking. I finally called my own health care lawyer. I said, what do I do about this? He said, it’s not something we deal with, but he said, I actually went through the same thing myself. You just got to pay the lawyer and they’ll go away. Oh, my gosh. But that was a relatively affordable bill. I could afford to pay it. But there’s people that are being sued by hospitals for bills that there’s no way that they can afford to pay. And they’re being taken to court and sued successfully by the hospitals that they went to for medical care.

Nicole Lamberson [1:09:54] Yeah. Well, welcome to America. I don’t know. Yeah, it’s just we it’s broken over here. Our whole system is broken in so many ways. And unfortunately, it’s the patient that suffers most of the time from that, you know.

Dr. Mark Leeds [1:10:11] Yeah, definitely something. Yeah, something’s got to change with that. But yeah, Nicole, thank you again. Thank you for this incredible conversation.

Nicole Lamberson [1:10:19] Yeah. Thanks for having me. Talk soon. Bye, everybody. Thanks for listening. Yeah. Bye. Thank you.