#26 – Dr. Ken Starr
Dr. Ken Starr is an authority in the field of Addiction Medicine and Wellness. Since founding his clinic in 2012 after the overdose death of his brother, he has been committed to helping patients achieve lasting sobriety and improve the quality of their lives. Dr. Starr utilizes medications, supplements, traditional and non-traditional therapies that help people overcome chemical dependency and live the lives they know are possible. His current areas of interest include advancing drug and alcohol detox methods, facilitating long term recovery, IV nutritional programs for optimal health, and Men’s health programs.
Dr. Starr’s passion about NAD therapy has enabled the clinic to become the most experienced provider of NAD treatments on the West Coast. He has introduced nutritional IV Infusions into the practice so all patients can affordably and comfortably work towards their wellness goals.
Dr. Starr is board certified in both Addiction Medicine and Emergency Medicine. He takes a personal and compassionate interest in each of his patients and is easily available for patients and their families at all times.
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Episode Transcript
Ashley Loeb Blassingame:
Hello beautiful people. Welcome to the Courage to Change Recovery Podcast. My name is Ashley Loeb Blassingame and I am your host. Today, we are talking to Dr. Ken Starr. Dr. Starr is an authority in the field of addiction medicine, and wellness. Since founding his clinic in 2002 after the overdose of his brother, he has been committed to helping patients achieve lasting sobriety and improve the quality of their lives. Dr. Starr utilizes medications, supplements, traditional and nontraditional therapies that help people overcome chemical dependency and live the lives they know are possible.
Ashley Loeb Blassingame:
His current areas of interest include advancing drug and alcohol detox methods, facilitating long term recovery, IV nutritional programs for optimal health and men’s health programs. Dr. Starr’s passion about NAD therapy has enabled the clinic to become the most experienced provider of NAD treatments on the West Coast. He has introduced nutritional IV infusions to the practice so all patients can affordably and comfortably work towards their wellness goals. Dr. Starr is board certified in addiction medicine and emergency medicine. He takes a personal and compassionate interest in each of his patients and is easily available for patients and their families at all time.
Ashley Loeb Blassingame:
Dr. Starr is also the medical director for Lion Rock Recovery, and he has a wonderful YouTube channel that you can find and subscribe to where he makes videos answering all sorts of questions about ways to treat addiction, and particularly different types of medical treatment and bio hacking addiction recovery. Please see his YouTube channel, Ken Starr, with two R’s. K-E-N S-T-A-R-R M-D, for more information. And I hope you enjoy this awesome episode that dives into addiction medicine and wellness. And any questions that you have, Dr. Starr would be happy to answer. Please see his contact information in the show notes.
Ashley Loeb Blassingame:
All right episode 26, let’s do this. [music 00:02:16].
Ashley Loeb Blassingame:
Ken Starr, welcome to The Courage Change, a recovery podcast.
Dr. Ken Starr:
Thank you for having me.
Ashley Loeb Blassingame:
So, you are Lion Rock Recovery’s medical director. You have been with us, how long has it? It feels like [crosstalk 00:02:38]-
Dr. Ken Starr:
Oh, since maybe 2013? 2014?
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
Something like that.
Ashley Loeb Blassingame:
A good amount of time.
Dr. Ken Starr:
Maybe sooner. Maybe, 2012?
Ashley Loeb Blassingame:
We don’t know what your [inaudible 00:02:53]. Well, awesome. So, can you give us a little bit of background about your… Give us a little bit of your resume, your professional background?
Dr. Ken Starr:
Yeah, sure. Thanks Ashley. Well, I am the current medical director for Lion Rock, and that is a funny story how that came to be because I had a counselor who was working for me, who was also working for Lion Rock when it first got started.
Ashley Loeb Blassingame:
That’s right.
Dr. Ken Starr:
Then, Larry, his name is Larry. Then, Larry, I think Peter [inaudible 00:03:19] had said, “Hey, we need a medical director.” And then, Larry was like, “Well, I just know this guy.” And then, they called me in like, yeah, sure. So, that was it. So, it was pretty unofficial.
Dr. Ken Starr:
But yeah, so I basically, I’m from El Paso, Texas. And I did my undergraduate at University of Colorado of Boulder. I went back to Texas for medical school. And did emergency medicine, studied emergency medicine and practiced. So, the first 10 years of my career was definitely emergency medicine and EMS, and I lived and practiced in Eugene, Oregon where I was really involved in just EMS and pre-hospital care and administration. I was a medical director for a lot of fire districts and critical care transport companies. In fact, Reach, an air ambulance service, which is out of, I think, Santa Rosa. I was the Oregon medical director for Reach.
Dr. Ken Starr:
So, and then when we moved to California around 2010 I was with a group, an AR group, and just kind of started to get into addiction medicine a little bit, which is a whole different story. And, have transitioned to addiction medicine in the last, I guess, the last eight years now. I still do emergency medicine part time, but less and less every year.
Ashley Loeb Blassingame:
Oh, part time emergency medicine?
Dr. Ken Starr:
Part time.
Ashley Loeb Blassingame:
Moonlighting? Just as a hobby?
Dr. Ken Starr:
Yeah, just like one shift… Maybe like anywhere from two to four shifts a month.
Ashley Loeb Blassingame:
Okay. Okay.
Dr. Ken Starr:
I did [inaudible 00:04:33], that’s all.
Ashley Loeb Blassingame:
It’s pretty part time. That’s good. Keep it fresh. So, are you one of those people who wanted to go to medical school since you were a kid, like knew what you were going to do?
Dr. Ken Starr:
No, I wanted to be a fireman when I was a kid, for sure. Then, in college, no, in high school I took a biology class. That just blew me away. I had a great teacher, like AP Biology and was super interested in that. Then, when I started college I think I applied to the University of Colorado, and I applied into the business school and didn’t get in. Then, got into molecular biology and loved molecular biology and that was my degree. And I thought I wanted to do molecular biology the first couple years. Then, I took an EMT class and then, I worked as an EMT and I loved that. Then, I got a job in the ER and then, I got a job in an ambulance. Then, I was bringing patients to the hospital and talking to ER docs. I was like, “I want that job.”
Dr. Ken Starr:
So, then, I went to medical school. But once I started medical school I knew I wanted to do emergency medicine.
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
For sure [crosstalk 00:05:26]-
Ashley Loeb Blassingame:
What do you like about it?
Dr. Ken Starr:
Oh, I like the variety. I like the shift work. I like being part of a team. I like the intensity.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
At times, I like the intensity. And I’m really… I’m a good memorizer and ER is good for just memorization. Like, if this, do that. If this, do that.
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
You know that game you had when you were a little kid and it was a big hopscotch board, and you lifted up a cover. It would be an apple, and then, you lifted up another cover and it would be like-
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
… a jellybean.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
And then, you flip another cover and it was… You had to remember where the two apples where.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
That’s all emergency medicine is. It’s like remembering, like what’d you do for this? Do that.
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
So, I just liked emergency medicine. I love pre-hospital care, and I love paramedic education, and EMS development. So, I love it. I thought it was great, but actually, and I probably would still do it, but then when I moved to California those opportunities just kind of dried up. And the reason is because in Oregon every single department had its own medical director. And in California every county has a medical director.
Ashley Loeb Blassingame:
Oh wow. Okay. So, not as many jobs.
Dr. Ken Starr:
Yeah. So, all I had like 12 agencies that I was the medical director for, and then it moved down [inaudible 00:06:35] to this building, there’s just one county medical director, period. So, it just kind of changed. And then, I kind of got a little bit burnt out on EMS and then, I started addiction.
Ashley Loeb Blassingame:
So, did you know any addict… Where did you grow… You grew up in El Paso. In El Paso, growing up, did you know any addicts or alcoholics? And if so, what did you think about that? What were your perceptions about addiction growing up?
Dr. Ken Starr:
That’s a great question. You know, I didn’t first… Well, first hand, I mean my parents didn’t have any substance abuse problems, but in that [inaudible 00:07:09], actually when they grew up in the 80s. My brother, so I had a brother named Sander, who was a year older than me. I was born in ’69. He was born in ’68. Anyway, so when we went through high school, say seventh, eighth grade, it was very popular in Texas. Everybody was drinking, everyone was smoking pot.
Dr. Ken Starr:
And of course, I did that too. But he started to get edgier and edgier and got really into punk rock, and got really, you know smoking cigarettes and just drinking a lot. And then by, say ninth or 10th grade, he was a totally different group of people than I was. So, even though my friends were partying a little bit. We were in band, and we were doing well in school. And then he just kind of started to hang out with a very alternative group, that punk rock, skating.
Dr. Ken Starr:
Then, so my brother was the first person who had a substance abuse problem. So, he started using heroin in high school.
Ashley Loeb Blassingame:
So, okay. Let’s back up just a little bit. Were you, you know a lot of the time we don’t know. We get a lot of information about addicts and alcoholics through the media, particularly I’m sure in the 80s that this is a choice that people make. They’re bad. They’re lazy. They’re hedonistic. All these things, right? And then, most of us come into contact with someone we love who ends up suffering as a result of alcoholism, addiction. And get a better understanding of what’s going on, that it doesn’t quite fit this bad person mold we thought.
Ashley Loeb Blassingame:
With your brother, it sounds like you guys were really close. If you had perceptions about addiction and drug use, how did your brother going in that direction affect what you believed and what were your thoughts about that? Did it change your belief system?
Dr. Ken Starr:
You know, I didn’t fully understand addiction and change my belief system until I started practicing addiction medicine.
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
So, even though my brother was suffering, as he suffered more we just became less in contact.
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
So, the last 10 years, I mean I would hear from his once a year. I might see him every couple years. So, we weren’t close. And I still probably held on to those descriptors that you described where drug addicts really just need to get their life together. It’s all self induced, and making bad choices.
Dr. Ken Starr:
And I didn’t learn any better in my medical school training. I didn’t learn any better in my emergency medicine training. And until I started taking care of substance abuse patients, and then started really getting interested in it, and then reading about it. And then, reading the people who wrote this book. Then, getting involved in programming and getting involved in medications. I’m embarrassed to say that I was board certified in addiction medicine before I really understood addiction.
Ashley Loeb Blassingame:
That-
Dr. Ken Starr:
[crosstalk 00:09:58] that’s pretty late to the party.
Ashley Loeb Blassingame:
No, I really appreciate you saying that. I really appreciate you saying that, more than you know, because I’m in an MBA program at John’s Hopkins for health care management. And all of my peers are doctors, and a couple of them are pain management specialist, and different specialties. And I am horrified with… I mean, truly, particularly the pain management ones, I really, really… I can not believe the lack of training or talking about this topic. And as someone who is in recovery and has gone through that, and we have so much information, which we’ll get into, about alcoholism and addiction is a brain disease. It feels crazy to me that that isn’t taught. That this… I mean, these people are brilliant. It’s not an intelligence issue, it’s an information issue.
Ashley Loeb Blassingame:
So, I really appreciate you saying that because I think that, because I see it, I see that to be the case. Is like, a lot of people, until they have extensive knowledge and experience with the population, they truly don’t understand. And, a lot of the time they think they do.
Dr. Ken Starr:
And doctors are the worst actually, because they don’t understand addiction at all.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
I mean, look at the whole buprenorphine waiver, right? The government gives out this data 2000 waiver to get people certified, and doctors don’t even want to do it. I mean, they don’t have enough people signing up, which thank goodness that’s changed and we’ll probably talk about that, and they’re extending it out to mid levelers, and physician’s assistants. And they’re decreasing the patient number limit. They’re trying to increase access and increase access, but doctors are not… Are the worst.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
I mean, trying to teach a doctor new things is horrible.
Ashley Loeb Blassingame:
Yeah, I won’t say that, but I’ll let you say it.
Dr. Ken Starr:
And the emergency medicine doctors, now I’m trying to educate. I play, one of my hats is I try to educate emergency medicine physicians because I wear both those hats into initiating medications as a treatment in the ERs and into the jails and so forth. So, there’s a lot of reluctance in ER docs, and I’ve been in that tribe for 20 years, and I know. It’s, look, this is not the place to come. This is not what we do here, but we need to rethink that because most patients in the ER are not there for a true medical emergency. You have to do what’s right.
Dr. Ken Starr:
So, yeah. Addiction, doctors don’t get it.
Ashley Loeb Blassingame:
What happened that made you shift away from emergency medicine?
Dr. Ken Starr:
Well, a couple things. We had moved to California, my wife and I and our son had moved to California in 2010. I gave up a great job. I loved Oregon. I came crying and kicking and screaming. I did not want to move but I said I would. Then, I started with an ER group in [inaudible 00:12:50] that I loved the guys individually. I liked everyone in the group individually, but just business wise I didn’t really fit in. I didn’t like the business model. I didn’t like how they were running the group.
Dr. Ken Starr:
Then, I just kind of just got a little burnt out, right? I had already been doing this for, I don’t know, 12 years or 11 years or something. And, then my brother overdosed and died. So, then, I don’t know if it was just that, but something changed and I just had like, “Where are we sending people? Who in town is taking care of drug and alcohol patients? No one.” Right? What are we doing about this? Where am I going to send people? And the ER has just been like, “Okay, here’s some medicines. Good luck. Oh, you’re in withdrawal. Okay, well here’s some medicine that could be helpful. Good luck.” You know, not ever knowing the other side of that, which was like none of those patients did well with that plan.
Dr. Ken Starr:
So, one of my best friends is an addiction psychiatrist in Portland. And he had been doing some Suboxone, and most ER docs and most docs in general, it was like, “Well, what’s that? How do you do it?” So he says, “Okay, that’s all you have to do. Just start doing this.” So, I thought, you know what? I just felt this compelled, it was this compelling thing. It was like, “I have to do this.”
Dr. Ken Starr:
And it was never even really a conscious decision. I just basically, there was a primary care doctor down the street from my house, and I just went to him. I didn’t even know him well. I’m like, “Can I rent maybe your office, maybe a couple hours a week?” He’s like, “Yeah, sure.” So, then I just put out advertisements. I got my waiver, did my training. I put out advertisements, this is probably back in 2011. I said, “Okay, Suboxone. Suboxone prescriptions available, opioid detox, whatever.”
Dr. Ken Starr:
And I felt comfortable doing that just because in emergency medicine we’ve been taking care of drug and alcohol patients for so many years.
Ashley Loeb Blassingame:
Oh yeah.
Dr. Ken Starr:
So, it’s really just honestly fake it til you make it. And I had people come in and I was like, “Okay, let’s take good care of you.” It was just a small shop, and then after about a year or so I had a very chance encounter with a lady named Juliana Beckett, who was in recovery and had a lot of experience with groups. She had been in treatment, treatment coordinator and a counselor. She was like, “Oh, let’s team up, and you can start doing groups. And you can start doing alcohol patients.” And I was like, “Yeah, sure.”
Dr. Ken Starr:
So, then we teamed up, got a little bit bigger office. She was in charge of programming and groups. Then, I just did more medication treatment, and then took on alcohol patients, and took on other substance abuse and just read what I could and learned what I could. I enjoyed it. I really enjoyed it, and I was just nonjudgmental, very approachable, easy going, take really good care of people.
Dr. Ken Starr:
Then, we just built and built it and built it. Then, I guess fast forward now, seven years later, and we’re CARFA credited, we’re state licensed. We have a 4,000 square foot facility. We’re the biggest, probably the largest private provider of substance abuse in three counties, right?
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
I mean, biggest between LA and San Francisco, we’re probably the biggest shop in town. So, I love it. It’s great. I don’t know. I guess it just so happened, I don’t know. I guess it was just an occurrence of the timing was right.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
Because I got into this right before the opioid epidemic really became national [crosstalk 00:15:56]-
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
There’s a lot of national attention.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
So, as there was more and more resources and attention being shifted to the opioid epidemic, all of a sudden I was already teed up. Like, “Okay, I’m the guy in town. I’m board certified in addiction medicine.” So, that was really lucky and I just, I don’t know, I just love doing it, take great care of people and I think that’s really the recipe, right? Is just take good care of people and be passionate about what you do, and do the right thing.
Dr. Ken Starr:
And well, I guess we’ve expanded services since then, of course. So, we do more than drug and alcohol now, but that’s what happened. It was just meeting people where they are. There wasn’t any resources. Before me, patients had to either go to the county to get drug and alcohol, which they would only get if they weren’t Meta Cal or SIN Cal. Or they had to go away to a private residential program. I mean, there was no real out patient medication treatment.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
Yeah.
Ashley Loeb Blassingame:
So, I want to touch on a couple things. I want to talk about some of the cool stuff that you’re doing, alternative, different alter… I’m super into that, and interested in all the alternative things you’re doing. And I also want to talk to you because I think it’d be interesting to people listening.
Ashley Loeb Blassingame:
I want to talk to you about some of the beliefs that people in recovery, or people in the recovery field, have about medication assisted treatment. And I want to ask you some questions that usually come up behind the backs of the medication assistive treatment doctors, and see if we can get some clarity because I think whenever I learn more, if I’m trying to understand, when I’m in judgment I’m not understanding. So, I want to work on some of that.
Ashley Loeb Blassingame:
But talk to us a little bit about some of the stuff that you’re doing. So, you’re doing Suboxone. You have NAD ketamine program, sounds awesome. What kind of stuff do you guys do?
Dr. Ken Starr:
Well, the first thing we started doing was NAD. So, going back, and for people who don’t know what that is, NAD is Nicotinamide Adenosine Dinucleotide, and it’s basically a natural co-enzyme that’s in every mitochondrial cell of your body. And it’s really sort of the fuel for energy production of your nervous system, and of your cellular being is NAD. And of course, I always learned NAD is just like your ATP cycle, your pyruvate cycle. To make ATP you need NAD.
Dr. Ken Starr:
But it turns out that NAD is this very powerful modulator for over 400 known processes from immune system to sleep, to anti aging, to oxygenated stress to protecting telomeres. I mean, all these other things.
Ashley Loeb Blassingame:
Why aren’t we all taking this?
Dr. Ken Starr:
Well, we should. We should all be taking NAD and it’s blowing up. I was going to say that. When we first started, our only indication was for substance abuse, but now over half of our patients are just wellness. But in any event, the story with NAD is, and I’ll try to make it short, but I had a patient. One of my opioid patients was, he said, “I’m going to go do this brain restoration therapy.” And of course, I was very skeptical. I was like, “Yeah, okay. Whatever. What is that? Like, oh fairy dust on your head or something?”
Dr. Ken Starr:
And he came back, I saw him a month later and he was fine. He was great. He was detoxed, he felt great, didn’t have any cravings. And he got my attention. I’m like, okay, where did you go? Now what is it called? So, he told me about this NAD program, and I basically kind of called somebody and then, called somebody and had to wiggle my way into Dick Madiay’s program, and Dick Madiay runs Springfield Wellness Center in Springfield, Louisiana. He’s sort of the, kind of the father of NAD in this country in terms of refining it, and administering it.
Dr. Ken Starr:
And I went and trained with him, and sure enough, I mean, I had had several years of experience now detoxing patients. And then, what I saw in that clinic blew me away. I mean, if you give IV NAD it alleviates withdrawal and craving. It really does.
Ashley Loeb Blassingame:
Immediate? So, just-
Dr. Ken Starr:
Yeah, immediately.
Ashley Loeb Blassingame:
So, I’m coming in. I am detoxing. You hook me up to this IV and that goes away?
Dr. Ken Starr:
It significantly improves.
Ashley Loeb Blassingame:
Wow.
Dr. Ken Starr:
It significantly improves. And, I’m not exaggerating but you know, we were detoxing patients off high levels of methadone, high levels of opioids with very minimal withdrawal symptoms with NAD. And after a period of, say, week, 10 days, they’re walking out feeling great. So, it blew me away. I remember flying back on the plane thinking, “I’m going to change the face of addiction treatment nationally with this. This is incredible.”
Dr. Ken Starr:
So, we started our NAD program in around 20… I think that was like 2013 or 2014. Then, of course we’ve been doing it since. Anyway, we started doing NAD, it’s been very popular. We can talk more about that, but then because I had nurses here doing IV infusions of NAD I had one of my nurses, who just so happens a really wonderful lady who passed away last year. But she was very experienced with just IV nutritional therapy. Like, why aren’t you giving vitamins? Why aren’t you giving amino acids? Why aren’t you giving glutathione? Why aren’t you doing-
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
[crosstalk 00:20:59] vitamin C? Why aren’t you doing… And I was like, “What’s that? What do you do?” So, she turned me on to that. I learned all about that field. I studied with Virginia Osborn. I’ve been hanging around with the gurus of IV nutritional medicine for the last six years.
Dr. Ken Starr:
So, of course we started an infusion program and then, found out, wow, if I give my detoxers these common amino acids it helps a lot. If I give my alcoholic patients high doses of these B vitamins and other things, it helps a lot. They’re feeling so much better so much faster. So, it really took off.
Dr. Ken Starr:
So, then we kind of got known as this very unique clinic that’s doing natural alternative medicine with traditional medicine because I’m still giving benzos or anti [inaudible 00:21:43] standard of care meds. And in fact, NAD has gotten a little bit of bad attention lately because it’s gotten so popular, now everyone can just do NAD and people are going into detox at these natural pathic centers who know nothing about substance abuse or withdrawal.
Ashley Loeb Blassingame:
Oh.
Dr. Ken Starr:
And having medical complications because they don’t know how to handle detox withdrawal with or without NAD. So, anyway, then because we were already doing infusions and then, we started our ketamine program I think last year. And ketamine has been a game changer as well. So, now we do all these sorts of really amazing things.
Ashley Loeb Blassingame:
So, I am a novice in this area. Ketamine, to me, is just a good night with some friends. So, what [crosstalk 00:22:26] are you guys doing with it that we missed out on?
Dr. Ken Starr:
Well you’re right. Yeah, well so ketamine is used medically now for a number of mental health problems, and specifically treatment resistant depression. So, ketamine is profoundly effective for treatment resistant depression. What does that mean? Someone who’s depressed, who’s been on one or more antidepressants, they haven’t worked that well. I mean, don’t forget that only about 30% of people respond to oral antidepressants. I mean, most people don’t get better with them, despite some people do, that’s great.
Dr. Ken Starr:
So, ketamine, which has been used since the 60s as an anesthetic was found maybe, I don’t know, 15 years ago, 20 years ago, to be an antidepressant. People would wake up from their ketamine induced anesthesia and they wouldn’t be depressed. So, as you know, because these ketamine clinics are popping up everywhere, that ketamine is a very powerful tool. So, and not only treatment resistant depression but it’s very useful for certain types of pain syndromes. It’s very helpful for certain types of pain syndromes that are centrally mediated like Fibromyalgia, Reflex Sympathetic Dystrophy, complex regional pain syndrome, neuro pathic pain. It’s very helpful.
Dr. Ken Starr:
And other mental health problems like anxiety, PTSD all can get significantly improved with ketamine. So, we started our ketamine program. But you know what? Ketamine also alleviates opioid withdrawal. And ketamine also helps re regulate alcohol impulsivity. So, we’re using it now for our drug and alcohol patients because it re-frames their now adaptive decision making by this central reset.
Ashley Loeb Blassingame:
So, tell me, okay two questions about that. The first question is, what is the program? You give it to them once, and then they’re better for life? They have to take it weekly? What is the ketamine and how is it administered?
Dr. Ken Starr:
Yeah, so the ketamine is IV. We use it IV. We follow the kind of main National Institute of Mental Health protocol, which is about six infusions. So, our protocol specifically actually is six infusions over two or three weeks. So, that’s two to three infusions a week for two or three weeks, to total six. It’s an escalating dose of ketamine that’s basically weight based initially that goes up every time. Some of the more research, some of the most… Correct, some of the most recent research shows that only about 30% of people, at best, get a response with that first infusion. The same with the second and the third.
Dr. Ken Starr:
In fact, commonly we’ll see people get worse with the second and the third. I don’t know why. And then, by the fifth and sixth we have close to an 80% response rate, a significantly improved response rate.
Ashley Loeb Blassingame:
And this is a self report depression response?
Dr. Ken Starr:
Right. This is self reported, but we’ll use like a PHQ9. We’ll use something called the nude monitor, where people can check in.
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
Then, the answer is… So, the first question is yeah, it’s called induction. We try to do six infusions over a period of two or three weeks. Then, the question is, did it work? How well it worked? And how long is it going to last? Most people will need a booster anywhere from one to three months later. And you’re right, it does wear off. It’s not a permanent solution.
Ashley Loeb Blassingame:
Okay, okay.
Dr. Ken Starr:
No. Although, it can be a permanent solution for some people because it does stimulate what’s called axonal growth and nerve cell growth. It’s actually, you can see MRI pictures of how ketamine makes these new dendritic spines on your nerve cells to reach out.
Ashley Loeb Blassingame:
Wow.
Dr. Ken Starr:
But some people get a longer term benefit, but honestly it buys you time.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
So, it’s buying you time to maybe try a different medication. It’s buying you time to do more programming or therapy. I met with a group in San Francisco that’s doing ketamine assisted therapy, where even just during the ketamine infusion you can process, you can get to a deeper layer. Now, we’re using sub dissociated doses. So, to go back to your original question.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
When people are abusing recreational ketamine, most of them are in this K-hole. They’re out to lunch, right?
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
Well, there was a continuum. So, at very low doses it’s sort of just relaxing, and more calming and so forth. And as you get higher and higher and higher up you can get obviously general anesthesia. So, all the doses that we use, people are awake, they’re alert, they’re responsive.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
They’re not… I’m not going to say it’s not enjoyable, but they’re not totally tripping out.
Ashley Loeb Blassingame:
Yeah, yeah. Now, does insurance cover it?
Dr. Ken Starr:
No. So, insurance does not cover ketamine. Some infusion centers have learned how to bill insurance and it turns out what they’re doing is they’re just billing for like an extended office visit, they’re billing for an IV infusion, they’re billing for cardiac monitoring. They’re billing an injection fee, but there’s no code for ketamine because ketamine is not FDA approved to use for this.
Dr. Ken Starr:
But last March, S-Ketamine, or Spravato came out, which is a commercially available nasal spray. And really, what that’s about is that ketamine is generic. It’s been around too long that nobody can make money on it. I mean, a bottle of ketamine is like $8. So, big business, big pharma, you know how can we make money on this? So, they took the ETH in [inaudible 00:27:25], sort of half the molecule, and they studied it, did some trials and said, “Oh, we can just use this nasal spray.”
Dr. Ken Starr:
Of course, up to now, we’ve just been compounding our own nasal spray. Taking regular ketamine and putting it in nasal spray and there you go. But, again, no big pharma is going to make money on that. So, anyway they came out with a proprietary product called S-Ketamine or Spravato. And now, that got FDA approved and that has a lot of strict prescribing requirements around it. For example, the patient never even touches it. It’s administered in the doctor’s office. That medicine has to stay in the doctor’s office, the patient has to be observed for two hours, all those patients were studied on an antidepressant. And it’s supposed to just buy them time.
Dr. Ken Starr:
I haven’t used it yet, despite submitting over a dozen verification and benefits and trying to get it, just because their roll out was so bad. Patient’s copay is too high, or there’s no pharmacy to send it to us, or blah, blah, blah. But the best studies show that it either is not that effective, or may be a little effective but certainly not as good as ketamine. So, my preference is do an infusion of ketamine, right? You do this [inaudible 00:28:30] see if they get better. If that works, and they get some traction with it, then lets get them on Spravato or nasal spray or a lozenge or something else to maintain them. And if it doesn’t work, or if they didn’t get a big response from it I wouldn’t bother with S-Ketamine nasal spray.
Peter Loeb:
Hi, I’m Peter Loeb, CEO and Co-founder of Lion Rock Recovery. We’re proud to sponsor The Courage to Change and I hope you find that it’s an inspiration. I was inspired to start Lion Rock after my sister lost her own struggle with drugs and alcohol back in 2010. Because we provide care online by live video, Lion Rock clients can get help from the privacy of home. We offer flexible schedules that fit our clients’ busy lives. And of course, we’re licensed and accredited and we accept most private health insurance.
Peter Loeb:
You can find out more about us at LionRockRecovery.com or call us for a free consultation, no commitment, at 800-258-6550. Thank you.
Ashley Loeb Blassingame:
So, let’s talk a little bit about Suboxone. So, Suboxone in the recovery field, what we call medication assisted treatment, MAT, is mostly Suboxone at this point. Is that accurate?
Dr. Ken Starr:
Yeah, the term mostly refers to Suboxone [crosstalk 00:29:48]-
Ashley Loeb Blassingame:
Refers to that.
Dr. Ken Starr:
Yeah, it also refers to Vivitrol, Naltrexone.
Ashley Loeb Blassingame:
Right, right, right.
Dr. Ken Starr:
And other FDA approved medications.
Ashley Loeb Blassingame:
From my perspective, one of the things, you know I was a heroin addict. And in my day we had a bottle of Buprenex. So, we would use that in between, and so some of this stuff was… It was a little bit different but it was around. And I wonder, I have to wonder, about people who are on Suboxone long term. And I know it’s probably a really uneducated stance, for lack of a better term. But, for me, I’m so grateful that I was able to get off opioids and not be on them again.
Ashley Loeb Blassingame:
And I know a lot of people who were put on Suboxone long term, and they struggle so hard to get completely off of it. I think it seems to be an amazing tool for detox. Can you talk about what is it, what is the value and the controversy around are we just using this to get people addicted to another opiate, to get them on something else? Can you straighten some of those ideas out?
Dr. Ken Starr:
Well, I think if somebody has an idea of what they decide it is I don’t think I’m going to switch, change their mind, but Buprenorphine is a life saving tool. So, we use a lot of Buprenorphine. I guess the conversation is, say an opiate dependent patient comes into the office.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
I can tell you that of all those patients who say to me, “I don’t want to do Suboxone, I don’t want to do methadone. Just detox me. So, just give me a med for detox.”
Ashley Loeb Blassingame:
Yeah, yeah.
Dr. Ken Starr:
Here’s my spill. I can do that if I want. If you want to do that I will do that. I can prescribe… There’s a half a dozen medicines that are phenomenal for opiate withdrawal, right? Gabapentin, Hydroxyzine, Tizanidine, Clonidine, Lofexidine. We can do that. Let’s do it your way if you want, okay? Let’s give you detox meds. I can tell you that 99% of the time I’ve tried that over the last 10 years, it doesn’t work.
Ashley Loeb Blassingame:
The detox meds don’t work?
Dr. Ken Starr:
They don’t work. Those patients don’t stay clean.
Ashley Loeb Blassingame:
Oh, they don’t stay clean long enough.
Dr. Ken Starr:
They don’t stay clean. Oh no, the medicines help.
Ashley Loeb Blassingame:
Yeah, okay, okay. I was like, they don’t work?
Dr. Ken Starr:
But you’re not targeting that chemistry that’s been hijacked, right? So, here’s the thing. I mean, I have no intention, and I tell patients this day one, I have no intention for you to be on Suboxone long term, okay? It is a tool, okay? But here’s a tool that a young mother or a professional or somebody comes in who’s addicted to opiates. I can say, okay, I can detox you with NAD. I mean, we can do a 10 day NAD detox if you want to do that, because I really feel like that alleviates your withdrawal or alleviate your craving and that’ll give you a headstart. So, that’s absolutely on the menu.
Dr. Ken Starr:
But the thing about Buprenorphine is that it meets people where they are. They can immediately feel good, they feel okay. We get traction of that neuro chemistry. Here’s the way I like to say, it took them years and years and years for that neuro biology and that neuro chemistry to get hijacked and changed. Since that, it’s way up here now for them to feel normal, okay?
Dr. Ken Starr:
When you’re in an airplane at 40,000 feet you don’t feel any different than you do on ground. I mean, they need to be at 40,000 feet now to feel normal, okay? So, the thing with Buprenorphine is I can get that traction, I can get control, they can feel good and what’s good about Buprenorphine, and I’ll try to explain this better, is that you’re not just trading Gin for Whiskey.
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
You’re not. You’re not. Buprenorphine has a lot of properties that make it safer, that make it easier to taper off of then traditional opiates. So, the role of Buprenorphine is within 24 hours I can put somebody on the medicine and boom, they feel good. They can get their life back, they can go to work. They can start being honest, they can participate in a program of recovery. They can start to rebuild relationships, they’re not sick. They can participate meaningfully in activities, and when it’s prescribed correctly, and a lot of people don’t do it that way, but when it’s prescribed correctly those doses go down, and down, and down slowly over time. And we can get people off.
Dr. Ken Starr:
And just for comparison, say a standard dose of Suboxone might be eight to 16 milligrams of Buprenorphine and somebody comes into a program. I try to get people down to 0.125 milligrams when they’re done. And at that point, they’re just walking away from it. I mean, so it’s part of a program. It does require a plan. It does require an exit strategy.
Dr. Ken Starr:
Now, do I have people that do it their own way, and just do we just use detox, do we use Suboxone for detox, say a one or two week program? Yes. Absolutely. If we can. Do I have people who have been on Buprenorphine for 10 years? Yes. So, not that I say, “You have to be on this for the rest of your life.” It’s because they say, “You know what? I have never felt this good. I feel normal. My life is perfect. I’m not depressed. I’m not anxious. I’m not lying. I’m not cheating. I’m not stealing. I’m not shooting up. Don’t make me come off this.”
Dr. Ken Starr:
So, everybody’s unique. Everybody has a different philosophy. I’ve been a medical director for residential programs where we did just have two, three week tapers and that works for some people. But you don’t-
Ashley Loeb Blassingame:
But you found that it wasn’t sufficient, is that-
Dr. Ken Starr:
I would say, I mean, the relapse is definitely higher if you detox somebody off of Suboxone. Because look, they didn’t get the way they are in two or three weeks. So, my preferred way of prescribing Suboxone, just because I’m going to get lots of questions and emails about this. My preferred way is just get on the lowest amount you feel okay. And when you’re rock solid stable, your mood’s good, you’re not craving, you’re not relapsing, your energy is good, your sleep’s good, then just go down a tick. And that changes depending on the dose you’re on. That’s probably beyond the scope of this.
Dr. Ken Starr:
But if you’re on 16 milligrams, let’s go to 14 milligrams. And because Buprenorphine, again it’s only partially activating at that opiate receptor, and it’s very long acting. We’re talking about a 37 hour half life. So, when you tell somebody to go down from 16 to 14, that’s easy. They do fine with it, okay? When you have someone go from 14 to 12, that’s easy. And you warn them, “Look, you’re going to have a week you’re going to feel a little irritable. You’re going to feel a little anxious. It’s going to go away. You’re going to be fine.”
Dr. Ken Starr:
Then, so it’s not a fast program, but it allows somebody to get stable on the medicine and gradually taper off. Now, I’m not going to say that Suboxone withdrawal isn’t legit. I mean, it’s horrible. If you’re on 16 milligrams a day and you stock cold turkey you’re going to be sick as snot. But it has a role. It just has a role. And I’m sensitive, everyone comes in differently, everyone’s got a different biology, everybody’s got a different genetic makeup. I have people who can do two or three weeks of Suboxone and come off of it and they do terrific. So, let’s give them that chance, I’m fine with that. But a lot of people don’t. A lot of people need a longer term program.
Dr. Ken Starr:
Some of it might be reward deficiency syndrome. How many people are on anti… How many people are on Prozac 20 years later?
Ashley Loeb Blassingame:
Oh, for sure. For sure. I mean-
Dr. Ken Starr:
I mean, really. It’s like, okay-
Ashley Loeb Blassingame:
The logic is questionable.
Dr. Ken Starr:
Right. So, it’s like have you ever been on these studies on Prozac? 20, 30 years out. I mean it was never designed for that, right? I mean, the best studies I know showed that a year out, people who were off antidepressants did better. So, I mean, there’s no timeframe. And the other thing is, don’t forget that opiates are better antidepressants than antidepressants. Opiates are better mood stabilizers than mood stabilizers. So, I mean, opiates have all these properties. They’re not just pain medicines, which is why they’re so addicting, right?
Dr. Ken Starr:
I mean, it’s not just a pain medicine. They make everything better for the right person, right? If you’re vulnerable, if you have that-
Ashley Loeb Blassingame:
Yes, yes they do.
Dr. Ken Starr:
They make everything better. So, if somebody needs a low level, two milligrams, a milligram of Buprenorphine-
Ashley Loeb Blassingame:
Expect for digestion.
Dr. Ken Starr:
Yeah, well that’s true. They don’t make me poop better, that’s for sure.
Ashley Loeb Blassingame:
Or at all.
Dr. Ken Starr:
Yeah. So, if somebody needs a low level of Buprenorphine to feel normal, I mean I’m not going to tell them you have to get off this medicine-
Ashley Loeb Blassingame:
No, no totally. I mean, that makes sense.
Dr. Ken Starr:
But just know that that’s not my intention. And I tell patients day one, “Look, nothing will make me happier than to see you get stable, get down on your dose and get the hell out of here. I don’t want to see you every month, forever. I don’t. I want you to be done with this.” So, it’s really patient driven and it’s patient centered. And that’s the difference, it’s patient centered. So, I support the dose reductions. I guide them. I say, “Okay, if you’re on six milligrams, let’s try four. If you’re on four, let’s try three and a half.” I mean, I just… Here’s your homework, when you’re ready for it, here’s your homework. If you’re going to stop cold turkey four milligrams that’s not what I’m recommending.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
It doesn’t go well.
Ashley Loeb Blassingame:
I’ve learned a bit about Naltrexone, which sounds like a miracle drug. Can you tell us a little bit about that, and maybe some stories about what you’ve seen with it too?
Dr. Ken Starr:
Yeah, well Naltrexone is an opiate receptor blocker. Naltrexone refers to the oral kill, but there’s a long acting shot of Naltrexone called Vivitrol. Now, Vivitrol is approved for both alcohol use disorder and opiate use disorder. And I’ll explain how it works. For opiates it’s real straight forward, right, it’s a blocker. So, once somebody has detoxed off of opiates you can give them a shot in the ass of Vivitrol, which is a month long blocker. That’s basically actually a 30 day insurance policy because once that’s in their butt, for 30 days they are not going to get high. They can do whatever they want, they’re blocked. It’s an opiate blocker.
Ashley Loeb Blassingame:
So, that means that if they were to take a shot of heroin they would feel zip?
Dr. Ken Starr:
Yep, once… Not five seconds after the shot, but several hours later once it takes some effect. It’s actually a chemical compound that absorbs moisture then, peaks about 14 days and then, gradually goes down. But yeah, once that’s in them it’s a 28 day insurance policy. So, for somebody, say, who’s detoxed and they do… The idea is you do that shot for six months, or nine months or a year.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
And give them some clean time, right? Because they’re going to challenge it. They’re going to test it, but they’re going to realize, wow that really wasn’t worth it. It didn’t do anything. So, that’s how it’s used for opiate use disorder.
Dr. Ken Starr:
For alcohol use disorder, interestingly, it’s used because the final common pathway for people to feel really good on alcohol is also dopamine and receptor, opiate receptor mediated. So, what that means is when you give an alcoholic Vivitrol or Naltrexone, it blocks the reinforcing and rewarding aspects of alcohol. So, it doesn’t effect intoxication. It doesn’t make them sick like Anavuse, but what it does, the way I like to explain it, it just doesn’t give them that really super feel good. So, what happens is, the way it’s best explained to me by patients, is they’ll pour the second and not finish it.
Dr. Ken Starr:
And the way to think about it is like if you’re not going to get… Because we all have a subconscious relationship with alcohol. And if you’re an alcoholic, that feel good, relax, it gets fun, I’m checking out, I deserve this. This is how I cope, this is my special place. That is big and powerful and overwhelming. And what’s really small and minimized at is this is poison, it’s making me depressed, it’s making me anxious, it’s making me fat, I’m socially isolating. I’m compromising my relationships. I’m doing shitty at work. We don’t think about that. We just think like, “Hey, this is good.”
Dr. Ken Starr:
So, when you have Vivitrol in your system you don’t think… All of a sudden you don’t really feel good.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
I mean, you don’t really get that feel, feel super, really good feeling. And you’re just going to get fat and depressed, and drunk. If I’m just going to get fat and depressed I don’t want it. So, one of the mantras that I tell my alcohol patients who are struggling, it’s like, “Okay, every time you take this drink. You can drink. Okay, Ashley you can go drink, but before every drink I want you to say… When you drink I want you to say I want to be fat, tired and depressed.” [crosstalk 00:41:23] No, I want… Okay, as you drink you’re saying to yourself, “I want to be fat and tired and depressed. That’s what I’m doing to my… That’s what I’m nourishing myself with.”
Dr. Ken Starr:
And that mantra is really the truth. Not the truth as, oh I deserve this. I’m a professional. I’m successful, and I reward myself by drinking a bottle of wine because I’m awesome. So, Vivitrol kind of helps you make that decision.
Ashley Loeb Blassingame:
Okay, okay.
Dr. Ken Starr:
So, Vivitrol and Naltrexone are both used for opiates and alcohol.
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
Anyway, and in summary, I love Vivitrol for my early opiate recovery. Say we’ve detoxed somebody with or without Buprenorphine, with or without NAD. We’ve detoxed them. I’d love for them to get that shot in the butt for 30 says because I want them to do it for three months, for six months, for nine months because I know that their recovery is going strong. So, it’s just an insurance policy. And you don’t have to do it but I like it, and as a parent I would love if my-
Ashley Loeb Blassingame:
Oh yeah, oh yeah.
Dr. Ken Starr:
… my son [crosstalk 00:42:17].
Ashley Loeb Blassingame:
I have seen that Naltrexone was being used for binge eating disorder and food cravings. Is that something that you see?
Dr. Ken Starr:
Yeah, we here at the clinic don’t really treat process addiction so much. We don’t specifically have eating disorders, but there is a medication called [inaudible 00:42:35] has Naltrexone in it, and I think it’s Wellbutrin. So, it’s an antidepressant that has a stimulate as an appetite suppressant property, and it has Naltrexone. So, the idea with that is it’s going to decrease the rewarding and, what’s the word? The rewarding affects of eating.
Dr. Ken Starr:
So, if somebody who has a binge eating disorder, also gets a dopamine surge with eating. So, the idea is you could use Naltrexone and it would reduce the reinforcing and rewarding affects of eating as well. So, yeah, you could try Naltrexone. I know it’s used for that. We also even tried for marijuana use because we don’t really have a lot of drugs for that. So, our marijuana patients, we’ll try putting them on Naltrexone and there’s some early data that says it might be helpful. So, anything that’s reinforcing or rewarding might be blunted with Naltrexone. So, it doesn’t block all the opiate receptors. Don’t forget, there’s a lot of opiate receptors but it blocks the one that’s the most commonly used in substance abuse.
Dr. Ken Starr:
So, the question is, well I’m not going to get joy when I worked out or go to the gym. I’m not going to get joy when I pick up my grandchild if I’m on Naltrexone. I don’t think that’s the case.
Ashley Loeb Blassingame:
Oh okay.
Dr. Ken Starr:
It doesn’t just block everything that’s good in your life.
Ashley Loeb Blassingame:
So, what did you learn that made you change, you know you said when I became board certified in addiction, right? That was when you had this new understanding. Was there anything that you remember? What did you learn that really cemented for you that this was a medical problem?
Dr. Ken Starr:
It’s sad that I didn’t really fully appreciate the complexities of addiction when my own brother was suffering from it. And I really solved that problem just by distancing myself from him.
Ashley Loeb Blassingame:
Yeah. Yeah.
Dr. Ken Starr:
I think understanding that most people with some addiction have trauma history, emotional loss. So, I always refer back to that [inaudible 00:44:30] quote, “You don’t ask why people have addiction. You ask why they have pain.”
Ashley Loeb Blassingame:
Yeah, yeah.
Dr. Ken Starr:
And the reason it’s a medical diagnosis, because a medical condition has a predictable time course.
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
Like asthma, hypertension, diabetes. They’re medical problems because we know that untreated diabetes causes this, this, and this. Well, I can tell you untreated heroin addiction causes this, this, this. It’s going to result in overdose, or incarceration, or death. I mean, it’s a very predictable course too, right? You’re going to lose your job, you’re going to lose your house. You’re going to lose your family. It’s no different, and there’s a medical treatment. So, there’s relapse in hypertension. There’s relapses in obesity management.
Dr. Ken Starr:
So, I think that the medical nature becomes clear as a physician treating addiction, but it still doesn’t help you understand addiction patients unless you understand addiction. So, that for me I think came late but, I have a sincere love of the field now.
Ashley Loeb Blassingame:
So, you think that learning about how the brain responds, learning about how the brain rewires and all of that, even that… Did any of that change?
Dr. Ken Starr:
Well, the neuro biology of addiction is interesting, but I think that it is a medical problem and I think that there are some medical solutions. But as you mentioned, MAT is not medication as treatment. It’s medication associated treatment, right? Or medicated assisted treatment.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
So, people show up, “Look, we can get you feeling better with X or Y or Z but you have to do the work of recovery. You have to understand why you’re chemically copping and why you’re doing this. And what is going on underneath this?” So, that is the disease of addiction. And that’s why it’s a medical disease because it’s treatable and it has a progressive destructive nature. And I see it every day with my alcohol patients and my opiate patients, right? If you’re a drinker, I can tell you that it plays out for the same way every single time for everybody. Right? Relationships, job problems, DUI, worsen social isolation, doing less things with your friends. I mean, there’s not that many people with a really hard core alcohol problem who are doing great at work, who have great friends, who are out hiking, who are in great physical shape, who are meeting all their goals, who are running marathons. It’s like, you don’t. Maybe you did.
Dr. Ken Starr:
And I always ask, what do you do for fun? And they all say things they used to do for fun, but you’re not doing anything. You’re not doing anything for fun now if you have a substance abuse disorder, anything because your using is a full time job. Or you can’t wait to go home to drink after work. Or you’re just looking for… I mean, heroin addiction is nonstop circle, right? It’s like all your time [crosstalk 00:47:33], “Who can I call? Who’s going to answer the phone? Can I go out of town this weekend? [crosstalk 00:47:33].” It just nonstop.
Ashley Loeb Blassingame:
It totally, it’s not even fun. You’re not even getting high, you’re just getting to that 40,000 feet kind of deal. It’s like, it really becomes a survival situation.
Dr. Ken Starr:
Right, and so that’s the role of Buprenorphine too, is that now you can stabilize somebody, like I think, I don’t know where I read some book that if that vase is full of just using. Like if your whole life is just using, if you can get somebody stabilized medically, and then you can start filling that vase up, or that life up with community and relationships, and job responsibilities and gratefulness, and other things. People have less desire for drugs, and this has been shown, as you know, in studies with injection U Centers in Europe, right? You can tell people, “You can come here, use every day, free heroin. You can come every day. Just safe injection zone. You shoot up here. It’s free. It’s supervised.” And you know what? Almost all those patients, like 90% of those patients over five years aren’t there anymore.
Dr. Ken Starr:
Because once the structure is provided and they’re not suffering, trying to figure out how they’re going to lie, cheat, steal, vandalize, or whatever, all of a sudden now they’re holding jobs, now they’re going to work. Now they have good relationships. And as that fills up, they use less and less and less and less. So, that’s the role of medication assisted treatment, and that’s the role… That’s the, you know anyway. That’s kind of one of the stigmas. It’s like you’ve got to provide people a way out. I can’t take care of somebody who has an active substance use disorder, and put him in a program and say, “Oh, you just need counseling.”
Ashley Loeb Blassingame:
Right. Right.
Dr. Ken Starr:
No, they’re going to totally unravel, right?
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
That’s the role of medication. That’s the role of Buprenorphine. It’s like, “Ah, we can get him stable on something, feeling good. We can taper that down while we do some programming.”
Ashley Loeb Blassingame:
You do some really cool work in the jails. Tell us about that.
Dr. Ken Starr:
Well, there’s been really a… Unfortunately there’s been a national outcry the last couple years about the standard of care of addiction treatment in prison, in jails.
Ashley Loeb Blassingame:
Which is laughable, right, because that’s most of the population?
Dr. Ken Starr:
Right, right. So, all these people end up jail. A lot of them end up jail. But if you go up until recently, and probably still in most places, if you go into a jail in this country and say your stable on methadone, or you’re stable on Buprenorphine or you’re just a heroin user, you’re going to detox. They’re going to death their treatments, they’re just going to detox you. There’s protocols for detox. Well, that doesn’t always go well. Then, there have been some bad outcomes, and I think there was a federal… There was, I think, it was a federal case out of somewhere in the Northwest. I should know more about it, but a judge ordered that you can’t… This is a medical disease and you can’t withhold medication.
Dr. Ken Starr:
So, there’s a big role now with jails initiating MAT. And that might mean, look, if somebody comes into jail and their on Suboxone and they have a provider and they test positive for it, why wouldn’t you continue it? But if somebody comes in on methadone, they’ve been stable on it, why wouldn’t you continue it? Or better yet, people who come in with a heroin use disorder, you know heroin, who do detox in jail. They’re getting shots of Vivitrol now before they leave because that’s what happened to my brother. He was in jail for nine months or 10 months. His tolerance went down. He got out of jail in Texas, went to a sober living, used heroin, overdosed and died.
Dr. Ken Starr:
So, if he would have gotten a Vivitrol shot that would have been an opportunity to set him up for his next Vivitrol shot, you know? Or his next-
Ashley Loeb Blassingame:
Let me ask a question about that. So, if he had gotten a Vivitrol shot, or anyone gets a Vivitrol shot, and they use to try to test that theory. Isn’t the amount of opiates in the system enough to repress the respiratory system, even though you’re not getting high?
Dr. Ken Starr:
No, because you’re blocked. I mean, the Vivitrol blocks those new opiate receptors.
Ashley Loeb Blassingame:
Oh, so because it’s blocked, it can’t do whatever the rest of it does to your-
Dr. Ken Starr:
Nothing, right. Now, assuming there’s a level in your system, right? So, at the very beginning of treatment if you get a shot, and use a couple hours later, use an hour later.
Ashley Loeb Blassingame:
Yeah, yeah.
Dr. Ken Starr:
This happened to one of my patients, unfortunately. Or if you use it at 31 days and the level is down, then it is going to be effected but it’s a blocker. So, if you take somebody who has no history of opiate use at all, right? Then, you give them Vivitrol it doesn’t do anything, it has no effect. But if you can give it to somebody as part of a treatment program it might give them a month. Now sure, if he would have gotten the Vivitrol shot, waited a month and then used, then he probably still would have overdosed and died.
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
That’s true, but while that had a therapeutic level in his blood, he would have been-
Ashley Loeb Blassingame:
You would survive it, okay. Okay. Yeah, I mean it definitely sounds like-
Dr. Ken Starr:
So, there’s more medication assisted treatment now happening in county jails, which is good.
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
It’s just more humane treatment, it’s more appropriate treatment.
Ashley Loeb Blassingame:
What do you think about the addiction… I mean, so we have the opioid crisis, however alcohol is still so killing so many people. And so many people are going to jail. That’s where a lot of people with addiction end up. Do you have thoughts on what we should be doing in terms of treatment, or ways that we can incarcerate fewer people as a result of addiction and help them? Do you have broader views on how we can get out of this?
Dr. Ken Starr:
Well, fortunately a lot of cities and counties have learned that you can’t arrest your way out of addiction. And I know some cities like Seattle, and some, I think it was some city in Rhode Island were very progressive in that when people are arrested for substance abuse issues like DUI or public intoxication, or paraphernalia or possession. They’re putting them in treatment. They’re not putting them in jail.
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
So, yeah, I think it’s great and better late than never. I mean, yeah, we’ve incarcerated something, some ungodly number of patients, right? And for substance abuse problems. So, yeah, no, treatment is what people need. They don’t need incarceration because I can tell you, because they come out and then they relapse.
Ashley Loeb Blassingame:
Because they have the same tools they went in with.
Dr. Ken Starr:
Yeah, or they come out better drug addicts, or they come out-
Ashley Loeb Blassingame:
Right.
Dr. Ken Starr:
Yeah, it’s not, incarceration is not an effective solution for substance use. So, I think that counties and states and provinces are all getting that memo, and it’s cheaper too.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
It’s cheaper to put them in treatment than it is to put them in jail. So, yeah. No, it’s great. It’s great. I mean, we have a deferred judgment program here in [inaudible 00:53:56] County where if people are arrested for substance use problems they get treatment. They don’t go to jail. They get a treatment offered to them, or they have to prove some sort of participation in treatment and they can get it off their record. So, it’s good. It’s good, and again, it’s late but I think it’s a necessary thing.
Dr. Ken Starr:
So, I’m glad that the incarceration system is changing.
Ashley Loeb Blassingame:
Yeah, yeah, me too. So, can you tell us a little bit about where your clinic is, where people can find you, more information?
Dr. Ken Starr:
Well sure. I am the medical director for Lion Rock, which is awesome. But [crosstalk 00:54:29]-
Ashley Loeb Blassingame:
I know how to find you.
Dr. Ken Starr:
You know how to find me by email, but Lion Rock is not a medication dispensing institution.
Ashley Loeb Blassingame:
Correct.
Dr. Ken Starr:
So, it’s really been more educational and administrative. So, Y Clinic is in Royal Grande, California. So, we’re just a few minutes outside of San Lesa [inaudible 00:54:46] in the central coast. We’re halfway between LA and San Francisco. The website is just KenStarrMD.com with two R’s. KenStarrMD.com. Our supplement store, so we create a lot of supplements. It’s called Clean, which is great. So, we’ve created basically all the supplements that are used in recovery, and detox, and post acute withdrawal. We’ve kind of just decided these what’s the best so we made our own supplement line.
Dr. Ken Starr:
And there’s a link from the website, but there’s also out store, our web store is called GetCleanSupplements.com, GetCleanSupplements.com. So, that’s how you can find me. You can email me from the website, or you can email me at Ken@KenStarrMD.com. And yeah, we have a YouTube channel. So I want everyone to subscribe to my YouTube channel because I only have like 180 subscribers. And you can just check KenStarrMD.com-
Ashley Loeb Blassingame:
Ooh, what are you doing on your YouTube channel?
Dr. Ken Starr:
We have all sorts of videos and educational videos, and what’s the difference between this and that, and how to get off methadone, and here’s what you need to know about Suboxone.
Ashley Loeb Blassingame:
Oh. That’s awesome.
Dr. Ken Starr:
Just educational things. It’s just Ken Starr MD on YouTube.
Ashley Loeb Blassingame:
Ken Starr-
Dr. Ken Starr:
Ken Starr.
Ashley Loeb Blassingame:
With two R’s, MD.
Dr. Ken Starr:
Two R’s.
Ashley Loeb Blassingame:
On YouTube.
Dr. Ken Starr:
On YouTube. So, I want everyone to subscribe because-
Ashley Loeb Blassingame:
Everyone go and subscribe to Ken Starr MD on YouTube and check out.
Dr. Ken Starr:
And our clinicians have actually started to post things for recovery, our counselors have started to answer questions.
Ashley Loeb Blassingame:
That’s really cool.
Dr. Ken Starr:
So, and anytime people want us to make a video, like I’ll just get an email saying, “Hey, can you talk about this?” So, I’ll just give my thoughts on-
Ashley Loeb Blassingame:
Okay.
Dr. Ken Starr:
… Kratom, like if somebody wants to know about Kratom. So, I created a five minute video on Kratom. Or somebody wants to know about a new drug for detox, called Lofexidine. So, I wrote a blog and created a video on Lofexidine. So, just trying to answer people’s questions and there’s just so much misinformation about MAT, about Suboxone, about treatment, about Vivitrol. So, it’s just great to provide education and to answer questions and to be featured on wonderful podcast like this that really help people learn more about the disease of addiction. And I love the podcast. I listened to a few of them. So, I’ve really enjoyed it. You do such a good job. I’m honored to be on it, honored.
Ashley Loeb Blassingame:
Thank you. Thank you. Yeah, it’s really fun to do and really… You’re probably the same way where we hear all these amazing tremendous stories of people overcoming and getting better under insane circumstances or traumas or whatever. So, we have this wealth of knowledge but most people don’t get that. So, I love that I can hear these stories and dispense them so that other people can hear all the amazing stories, and meet all the amazing people that I’ve met through this process.
Dr. Ken Starr:
Yeah, there’s so many good resources online now. I teamed up with Matt Finch, with Opiate Recovery Addiction Support. He’s got a great website. He’s got 10,000 followers. He’s always making videos, and YouTube videos, and writing books for people. There’s just so much good information. But we really try to simplify and add value to medication assisted treatment, what it is, what it’s not. Who it’s for? Who can benefit? And dispel a lot of myths about medications, how people access medications.
Dr. Ken Starr:
And some people, there’s lots of people who come in who don’t get on any medications. But, it’s just important to educate, even counselors and physicians. A lot of our people who send me… In fact, later this afternoon I have a pediatrician coming to the office to tour the office to see what we do to help with substance abuse because she is tasked out with managing a juvenile hall. She got recruited and now, she’s like, “I need to do Suboxone, and I don’t know how.” So, she wants to come here to learn how to do it.
Dr. Ken Starr:
We were out at American Society of Ketamine Physicians Meeting two weekends ago in Denver. And then people seeing that I’m using Ketamine to detox people and they’re blown away, like, “Oh, I guess it makes sense.” So, we’re combining NAD with Ketamine, which is really revolutionary. Talk about minimizing withdrawal. So, I’m really passionate about bio hacking recovery. Especially bio hacking detox.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
I love taking really challenging, frustrated patients, who’ve tried detoxing off everything and bring him in the clinic for a couple weeks and seeing what we can do. We can put on a bridge device. We can give him Ketamine. We can try NAD. We can try little net, homeopathic doses of Buprenorphine if we need to. So, it’s really rewarding to see people feel better and detox, and get their lives back. And again, everyone’s got a different story, right? I mean, you’ve got to meet people where they are. So, some people are on Suboxone, some people can do it without. It’s great. Whatever people need, it’s just figuring it out and then, providing solutions.
Ashley Loeb Blassingame:
Do you ever detox people off of medications, like Efexer, or difficult psychiatric meds that people have been on because I know that’s something that I see, where people are on that.
Dr. Ken Starr:
That’s a great question. I get calls about that. I have people counting grains out of their antidepressant capsules.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
Usually, the answer is usually I don’t. Usually I have some psychiatrist friends who can transition them to a different medication. But the answer is, we have and we do it, but we usually use NAD. So, those are our NAD patients, right? So, we’ll use NAD for opiates and alcohol, but we’ll use it for antidepressants as well.
Ashley Loeb Blassingame:
Okay, okay.
Dr. Ken Starr:
Yeah.
Ashley Loeb Blassingame:
Yeah, awesome. Well, I am so grateful for your time, and also, hope that some day you will get the chance to educate lots of other physicians about how to treat this, and from a place of reputability.
Dr. Ken Starr:
Yeah, right.
Ashley Loeb Blassingame:
Because I think that’s really important, is the next piece of this is disseminating and getting physicians and people in places where they’re seeing this to believe that we can, A, bio hack, and B, that it’s a real thing.
Dr. Ken Starr:
Yeah, it’s a real thing and it’s not cookie cutter, right?
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
It’s not like, oh, you can just take this. You need five units of insulin. Oh, you need 10 units of insulin. And there’s people who don’t need Suboxone. There’s people who need to do things differently in their lives, or people who just need tools.
Ashley Loeb Blassingame:
Yeah.
Dr. Ken Starr:
They need tools. That’s why I’m the only medical provider in my clinic. I’ve got a whole team of clinicians, and therapist and counselors and nutritionist, and office staff and nursing. And I mean, the medicine is the easy part, honestly.
Ashley Loeb Blassingame:
Oh, I totally agree.
Dr. Ken Starr:
Yeah. Yeah, medicine is the easy part. I can sit down and talk to people but it’s my counseling. We have groups. We have evening groups. We have day groups. We have individual therapy. And that’s what I love to see is people who put the effort in. And if people put as much work into their recovery as they did into using they would do great. They would have great outcomes.
Ashley Loeb Blassingame:
Yeah, that’s what I was always told. Awesome. Well, thank you so much for your time, Ken.
Dr. Ken Starr:
Thanks Ashley.
Ashley Loeb Blassingame:
And we’ll get everybody to subscribe to your YouTube channel.
Dr. Ken Starr:
Okay, you first.
Ashley Loeb Blassingame:
Okay, I will.
Dr. Ken Starr:
All right.
Ashley Loeb Blassingame:
All right, bye.
Dr. Ken Starr:
Thanks for having me.
Ashley Loeb Blassingame:
Thank you.
Ashley Loeb Blassingame:
The Courage to Change, a Recovery Podcast would like to thank our sponsor, Lion Rock Recovery for their support. Lion Rock Recovery provides online substance abuse counseling where you can get help from the privacy of your own home. For more information visit www.LionRockRecovery.com/podcast. Subscribe and join our podcast community to hear amazing stories of courage and transformation. We are so grateful to our listeners and hope that you will engage with us. Please email us comments, questions, anything you want to share with us, how this podcast has affected you. Our email address is podcast@LionRockRecovery.com. We want to hear from you.