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Dr. Russell Surasky: “Where there is no vision, the people perish”

We are facing an opiate epidemic in this country, with about 150 people dying each day from opiate overdoses. We are all now just one degree of separation from someone who is addicted to opiates. If you yourself are not dealing with this issue, then it is likely that someone close to you is. There […]

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We are facing an opiate epidemic in this country, with about 150 people dying each day from opiate overdoses. We are all now just one degree of separation from someone who is addicted to opiates. If you yourself are not dealing with this issue, then it is likely that someone close to you is. There are very few afflictions in this world that can brutally destroy a life the way opiate addiction does. Half of the counties in the United States do not have a single addiction specialist. In the field of neurology, we have learned an enormous amount about how opiates hijack the brain and how we can help individuals escape what is almost always a life and death situation. It is imperative that physicians do everything they can to help better educate the public about addiction and help save the lives of those who are currently addicted.


As a part of our series about “Heroes of Addiction Crisis” I had the pleasure of interviewing Dr. Russell Surasky.

Dr. Russell Surasky, FAAN, ABAM, ABPM, is a triple board-certified neurologist. He is board certified in neurology by the American Board of Psychiatry & Neurology and in addiction medicine by the American Board of Addiction Medicine and the American Board of Preventative Medicine. He is the only physician in the United States with these credentials.


Thank you so much for doing this with us! Can you tell us a bit of your backstory? Is there a particular story, or incident, that inspired you to get involved in your work with opioid and drug addiction?

We are facing an opiate epidemic in this country, with about 150 people dying each day from opiate overdoses. We are all now just one degree of separation from someone who is addicted to opiates. If you yourself are not dealing with this issue, then it is likely that someone close to you is. There are very few afflictions in this world that can brutally destroy a life the way opiate addiction does. Half of the counties in the United States do not have a single addiction specialist. In the field of neurology, we have learned an enormous amount about how opiates hijack the brain and how we can help individuals escape what is almost always a life and death situation. It is imperative that physicians do everything they can to help better educate the public about addiction and help save the lives of those who are currently addicted.

Can you explain what brought us to this place? Where did this epidemic come from?

By the time you end your morning shower the opiate epidemic will take a life. Everyday 125 families feel the crushing defeat of losing a loved one to the fight against addiction. Annually, over 50,000 people will lose their lives; more than car accidents and gun related deaths combined.

Purdue Pharmaceutical company was the major driving force of this drug epidemic. Purdue Pharma, a privately held pharmaceutical company, made a pain-reliever called Oxycontin in the mid 1990’s. Purdue marketers realized early on that if they could get doctors to prescribe this opiate not just for cancer-related pain but rather for everyday aches and pains, the company’s profits would skyrocket. They did this by creating a massive, fraudulent campaign in which they downplayed the addiction risk of Oxycontin. Purdue’s representatives told doctors that if their patients had pain and did not have a history of addiction, these drugs would not cause them to become addicted. Oxycontin then became the most profitable pain medication every made. Purdue made 32 billion dollars from this one drug. Addiction rates soared and along with it came untold suffering and death.

There are many Prescription opiate drugs including but not limited to (Vicodin/hydrocodone, Percocet/Oxycodone, Dilaudid/hydromorphone). Three out of four heroin users actually began their tragic path with a prescription opiate drug from their doctor.

Can you describe how your work is making an impact battling this epidemic?

The disease of addiction, or SUD, is the most widely misunderstood condition in all of health care. Few conditions on earth are as destructive, horrific, dire and terminal as addiction — particularly opiate addiction. I have made it my life’s purpose to educate the public and fellow medical professionals, about the truth of addiction. There has been a significant leap forward in our understanding of how the brain becomes hijacked by these drugs and how these neurological changes trap individuals into a life of addiction. Out of this new understanding has come advanced neurological medications which can help alleviate needless suffering and save countless lives. Most of the public is only aware of treatments such as Methadone or Buprenorphine/naloxone (Suboxone) to treat opiate addiction. There is, however, a newer, non-opiate based, non-habit forming, phenomenally successful treatment called Vivitrol. To understand how Vivitrol works differently than Suboxone or Methadone, we must first understand what is occurring inside the brain of someone who has developed addiction.

Addiction is a brain disease. Essentially it is a tale of 2 brain centers: our rational brain and our limbic system. The limbic system controls basic survival needs such as eating, drinking, and mating. It functions outside conscious control. It is the most powerful driver of human behavior, and no messages from our rational brain can restrain it. The use of opioids (pain relieving medications) hijack the limbic system. These drugs bind directly to receptors, rewiring the brain. This reorders the brain’s survival priorities so that opioid drugs become the primary motivator in life.

Suboxone and Methadone appear to be useful in reducing overdoses, but both are extremely addictive. With Suboxone and Methadone, the brain does not have a chance to return to the normal number of opiate receptors, so the individual continues to rely on opiates to live. The emotional centers of the brain are not allowed to reset. The mind continues to create memories in the presence of an opiate. Physical dependency to opiates continues, so if the Methadone or Suboxone are discontinued the individual will experience horrendous withdrawal symptoms — often leading to relapse. It will require specialized medical care to detox from these medicines.

I have had extraordinary success with the treatment program I developed, which centers around the medication, Vivitrol. Vivitrol is a once-monthly injection that reduces cravings for opiate drugs. In contrast to Suboxone and Methadone, Vivitrol is not an opiate, it is not addictive, and it does not cause physical dependence. Also, if a patient taking Vivitrol were to use opiates they would not feel high nor get sick; simply nothing would occur. This has been shown to be enough of a deterrent to some patients

Without sharing real names, can you tell us a story about a particular individual who was impacted by your initiative?

Between private practice, directing the multi-center outpatient addiction program Bridge Back to Life and as a national speaker for the medication Vivitrol — I am incredibly fortunate to see miracle recoveries every day. I can offer true hope to the previously hopeless and I can shepherd them through the fire of withdrawal. I have made it possible for patients who were injecting 20 to 30 bags of heroin each day, to be completely drug-free, and go on to live productive lives. It is an impossible task to pick a single story about a single individual’s recovery — a testament to just how many people are being saved. No matter how bad the situation may appear, there is now a new hope — and everyone can recover.

Can you share something about your work that makes you most proud? Is there a particular story or incident that you found most uplifting?

I meet people every day who come to me utterly hopeless. They have tried “everything” to get better but have continued to relapse and continued to lose everything in their lives that ever mattered to them. They have come to believe that there is nothing anyone can do to help and there is no light at the end of the tunnel. Often, they have lived through multiple overdoses, but still cannot stop using opiates. Many are suicidal. Many times, their loving family members are with them and they often feel hopeless as well. They have watched as their loved one has gone from detox to rehab and back, to no avail. The most rewarding part of my work is the ability to definitively give the suffering individual and their families hope again — something they thought was utterly lost. But it is never hopeless! It does not matter how many detox/rehab programs, relapses or overdoses have occurred. We understand exactly how drugs such as opiates hijack the brain and from this understanding, we have new treatments and renewed hope for every individual.

Can you share three things that the community and society can do to help you address the root of this problem? Can you give some examples?

The language we use to describe people suffering from addiction is important. It influences how we frame issues and solutions — whether an individual should be punished or treated, whether we afford them the full measure of human dignity or condemn them to cower in guilt and shame. The stigma of addiction has serious repercussions for an individual’s likelihood of recovery. Apprehension about social ostracism, anxiety about how they will be received by the medical community, and fear of legal consequences keep many from seeking help.

The term “addict” has overwhelmingly negative connotations to most people. We don’t refer to people with mental and physical impairments as crazies or cripples. We don’t define sick people by their illness. You wouldn’t say “my best friend, the epileptic” or “my best friend, the leukemic”. Yet most people don’t think twice before labeling someone struggling with a substance use disorder an “addict” — dismissively defining an individual’s entire identity and humanity with a single word. This is why language is so important — people are people first and their challenge is just one factor of their life.

We must separate the illness from the individual who suffers from it. We must erase the tinge of character flaws and immorality from addictive disorders and restore dignity and humanity to the people who struggle to overcome them. Being careful about the language we use is an important step toward that end.

If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?

1. The federal government must do everything in its power to shut down the influx of heroin/fentanyl into this country. Almost all heroin/fentanyl in the U.S. is grown/manufactured in other countries. These drugs pour across our border every day. Reducing the flooding of these drugs into our communities can help stem the tide.

2. The federal and/or state governments must continue to make it illegal for insurance companies to require prior authorization for medication assisted treatment. While some progress has been made in this area, more needs to be done. It is not uncommon to have patients overdose and die while they are waiting for life saving medications to get “authorized” by their insurance company.

3. Patients in opiate withdrawal are often turned away from hospital emergency rooms. It has been incorrectly taught to doctors and insurance companies that opiate withdrawal is akin to a “bad flu” and is not “life-threatening” or dangerous. The fact of the matter is that opiate withdrawal is horrendous. If that patient leaves and seeks to self-medicate their awful symptoms by using more opiates, they can certainly die. Withdrawal symptoms impact all major bodily systems. These symptoms include severe and unrelenting pain, intractable vomiting and diarrhea, body shakes, severe insomnia, and intense drug cravings — often for many days. Some individuals become suicidal during the withdrawal process. At least 90% of patients will be unable to tolerate the withdrawal symptoms after just a couple of days and then relapse right back to using heroin/fentanyl again. This is a life and death issue every single time, for every single person. Emergency room physicians and insurance companies must improve their training and protocols on how to treat individuals with opiate withdrawal/addiction so that they can stop needless suffering and death.

Do you have hope that one day this leading cause of death can be defeated?

Yes, I am certain that we can dramatically reduce the number of people dying from addiction. A small number of experts in this field now have the understanding and tools required to fight the epidemic, but that does not immediately translate into the public getting the help it needs. Unfortunately, there are significant challenges which delay or stop the dissemination of this information to the public as well as to most physicians. The federal and local government, insurance companies and physicians need to be congruent in their intentions and actions. Right now, we have a sick and suffering public, yet less than 0.1% of patients have access to the care that could save them. It is my life’s purpose to accelerate these changes.

How do you define “Leadership?” Can you explain what you mean or give an example?

Most people think that we have great leaders and visionaries running the world. The truth is that we do not elect leaders, we elect followers. We put the person who represents the majority viewpoint into office, and they in turn follow where everyone else is going. You cannot lead as long as you think the way the rest of the community does. They are not leaders, they are followers. When it comes to the issue of addiction, we are living in the land of the blind. Our community at large believes addiction is simply a moral failing. We must elect visionaries with new ideas and who forge new paths forward out of the darkness of ignorance. Many of our “leaders” have the eyesight of an eagle but the vision of a clam.

If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

With an epidemic of this magnitude, we need to initiate a massive influential campaign in order to make a dramatic leap forward in the public’s understanding of addiction and the treatments that are available.

Information campaigns delivered by social influencers have proven to be the fastest way to disseminate information across the globe. Today, this is done over the Internet — primarily through social media, which continues to show the staggering power it has, to instantaneously disseminate information worldwide. We continue to witness how celebrities posting information with hashtags can educate and empower the globe literally within minutes.

Let us all start using the hashtag #recoveryrevolution

Can you please give us your favorite “Life Lesson Quote?” Can you share how that was relevant to you in your life?

Proverbs 29:18 — Where there is no vision, the people perish.

I have a vision, a “definite major purpose” for my life: Giving, loving, and serving out of my own abundance. To help all individuals regardless of their condition or their ability to pay. To continue to love for the sake of loving and give for the sake of giving. Regardless of your education and degrees, if you do not have pure intent, your results in helping people won’t be nearly as good.

The first and most critical step in helping someone to heal is offering them hope. Hope is essential to someone’s recovery. As a doctor or counselor, you absolutely must be able to inspire hope in the individual. If you as a clinician are not genuinely inspired, you cannot transmit the gift of hope to someone who is sick and suffering with addiction.

Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. 🙂

Russell Brand continues to be very outspoken about his recovery journey. He speaks globally, has written books and currently has a podcast called “Under the Skin.” If you pay close attention to his energy and words, you will hear someone who is not just successfully navigating sobriety but an individual who has made it his life’s mission to help people suffering with addiction.

Russell Brand often emphasizes the critical importance of 12 step meetings and how this is the single most important factor in his recovery. My clinical experience as a neurologist and addiction medicine specialist confirms what Russell Brand has been saying.

We have made staggering leaps forward in our understanding of the brain changes that occur in someone who has developed addiction. We also have new life-saving medications that can help shatter the chains of addiction and help set the sick and suffering free. However, medication for addiction, no matter how effective, should always go along with a counseling and/or self-help program.

Whenever I teach physicians and scientists about the importance of 12 step meetings, I am often asked this question: ‘As a neurologist, why do you believe that 12 step meetings can help patients? They are not scientific.’ Not only is there an enormous amount of misinformation about 12 step meetings in the public’s eye, it is also unfortunately misunderstood by most doctors.

The medications we use to treat addiction, whether it be Buprenorphine, Methadone, Vivitrol, etc., all primarily effect the limbic system of the brain. Remember, the limbic system of the brain does not function on a conscious level yet is the most powerful driver of human behavior. Drugs such as alcohol or opiates hijack this specific area of the brain and change the wiring. Once the wiring is changed, the brain now prioritizes using that drug more than other more important drives of our life. The impulse to keep using the drug overwhelms the rational, logical part of the brain and the individual continues to use the drugs until they either die or land in jail.

So, while medications treat the limbic system and successfully end drug cravings and withdrawal symptoms, 12 step programs and drug counseling work on the thinking/logical part of the brain. Once the withdrawal and cravings are gone, the individual needs to learn how to live life without the use of drugs. Combining 12 step programs along with medication has been shown to be the most effective treatment method for individuals suffering with substance use disorder.

12 step programs also provide structure and support, both critically important for people recovering from addiction. The opportunity to connect with others facing a similar challenge and the bonds that develop through shared experiences, are a vital aspect of the recovery process and have lasting benefits. One of the most important bonds forged is with a sponsor, someone who has maintained sobriety for an extended period of time, who helps the new member navigate the “step work” and offers their experience, strength and hope in difficult moments. The “step-work” is the backbone of 12 step programs and is critical to staying sober. It helps individuals spiritually and mentally evolve to live their best lives. As far as I am concerned, step-work should be required practice for all people.

Russell Brand, because of his celebrity status, could have a tremendous impact on the world’s understanding of addiction.

How can our readers follow you on social media?

Instagram @russellsuraskymd

www.drsurasky.com

This was very meaningful, thank you so much!

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