Transcription of Pain, Addiction & Prevention #242
Lisa: Today, it is my great pleasure to talk with one of my colleagues at Central Maine Medical Center. This is Dr. David Salko, who is the Chief of Family Medicine at Central Maine Medical Center, the Medical Director of the Freeport Nursing Home, and also, the Coastal Primary Care Lead Provider. He and his wife Jen have four children and they live in Brunswick. You and I have known each other a long time, Dave.
Dave: Yes. I was pleased you said colleagues. You were one of my mentors.
Lisa: That’s a strong word, at least with one of your teachers at Maine Medical Center at the Family Practice Residency Program. My dad also is one of your teachers.
Dave: Your dad was a great guy. He’s the reason we selected the residency that we went to.
Lisa: They do a good job up there.
Dave: Yeah.
Lisa: You also have a family history of family medicine. You actually spent time practicing with your father in Pennsylvania.
Dave: After I completed my residency in Maine, I had the opportunity to work with my father. We did that for three years. I think it was really more like another fellowship. We’re doing hospitals. We were doing nursing homes. The only thing we didn’t do is deliver babies. I got exposure to a lot of medicine, and in I’ll call it an older way of caring that the practice of medicine is changed, that you don’t necessarily get the deep relationships that might have been there before. People selected their provider, their physician, their doctor to stay with them for the rest of their life. They didn’t move. Communities stayed the same and they relied on that person. I grew up in that. I was trained in it and I got to go back and work in it. That probably set me off to the direction that I am now in family medicine and why I love it as much as I do.
Lisa: You’ve been up in Topsham as a provider for how long now?
Dave: I think we’re going on seven years, seventh/eighth year. I came back to Maine in 2007 before our third child was born. We had a goal to have them all born in the state of Maine. The girls were born while we were in residency and then we had to high-tail it back to the state with my wife pregnant so we could have the third and fourth in the state. James was born 2007 and we moved just before that.
Lisa: You and wife your, Jen, both have a really strong commitment, both to family and to health. Jen actually does health coaching.
Dave: Yep. I think it’s around us. It’s something we use to help raise the kids with because we want them to have a good sense of their own health and their bodies. It’s something that we try to live. I think when you adopt something like that, the practice what you preach idea, it doesn’t so much feel like work as it feels like you’re helping other people, you’re coaching them along, you’re giving them information only so that they could improve themselves in a way.
Lisa: When I left private practice, I think I’ve told you this before, one of the reasons that I chose to go with Central Maine Medical Center and the practices in Topsham-Brunswick was because you were practicing there and you and I had interacted when you were a resident and I was a teacher. You always have this very caring way about you with patients, but also very intelligent. That’s a really important mixture in family medicine. I think family medicine is harder than people think.
Dave: It is. I think one of the statements I made recently, one of the talks or education sessions I gave was you have to listen to the music, not just the lyrics. I think it does take a special breed of person to listen to what the patient is saying, but also to watch them observe them and to understanding of the situation to really supply what they need. What they need may not be what they’re asking for and it really takes a relationship that you have to set up fairly quickly and a bond of trust with the patient that can then be very therapeutic for them. If they trust you, and you’re giving them good information, they can get better over time.
Lisa: This leads to something that I know you have an interest in or at least you’re willing to discuss.
Dave: Willingness, interest, sure. They all apply.
Lisa: Yeah. That is the issue of pain and addiction and medication for those issues. This has become an increasing problem over the course of, I think, both of our medical careers. It’s something that not every doctor feels completely comfortable with.
Dave: You know, I think everybody has a different, almost a sub-specialty within what they do, what they feel comfortable with, what they don’t. I always loved family medicine because of its breadth. There’s a lot of things that you need to know a little bit about. It might have been your dad who told me that. In being able to receive patients on any plane or any level that they come in with or any problem, you’ve got to at least know where to start.
As far as pain management and the use of opiates or other pain management things, that really has been evolving. It’s changed a lot since medical school. Pain was the fifth vital sign. It was we had to treat pain. We had to stop pain. There were pain scales. There were ratings on ERs, whether or not they controlled people’s pain. That was a very real thing that everybody had to step up to. People were given medicines the second they arrived in the emergency room so they weren’t in any pain. Pain was viewed as a bad thing. It really is a symptom just like a heart rate or anything else.
As we learn to live with it, from acute to chronic pain, that’s where a lot of things shifted. People did not want to live in pain. That’s reasonable and understandable, but as family physicians, we had to figure out a way to help people live healthy and live well, despite their chronic conditions, not just to bury them aside with a medicine that they can take to forget about it.
As we progress, I mean, nationwide, statewide, we know there’s an opiate problem. We know there’s an epidemic. We see the, not just the use, but the abuse of controlled prescription drugs just increasing astronomically. If we don’t educate the public, if we don’t educate our patients, if we don’t pay attention to that, it is going to get worse. That’s where I think a lot of the shift has been, both with state, national government, to kind of shift over the control there and shift over how we treat pain, how we deal with pain, and how we look at chronic pain as a diagnosis.
Lisa: There’s a lot of interplay between pain and emotional issues, between pain and depression, or pain and anxiety. Then it becomes complicated because there’s a whole other set of treatments for emotional issues. Sometimes you don’t know which has come first, the pain or the depression, for example.
Dave: That’s true. That’s where I’ll go back to that, “listen to the music rather than the lyrics.” Somebody can come in, tell you, “I’m in pain, I’m in pain, I’m in pain,” and really what they’re screaming out is that they’re depressed. That there’s something else about their life that they’re not happy with.
Now I think we’ve developed more of a broad approach where patients that will come and see me and talk about their pain, it’s very easy to say the statement like, “Well, we have a multidisciplinary approach now. Your pain is about more than just what you’re feeling for physical pain. We need to know that your life has taken on a new trajectory since that car accident twenty years ago or whatever happened that changed how your life has been going and we need to pay attention to that.”
The majority of people now are at least offered, if not go, for some co-counseling in the world of chronic pain. There’s specific psychologists and therapists that are developed around just dealing with living with chronic pain. That’s helped a lot, in a way. I think individual patients have been able to understand their pain, understand their bodies reaction to it, and then be able to make better choices as to how they’re treating it.
Lisa: I think the most complicated thing for many health care providers is that some of the medicines that we are using are physiologically addictive. You have your benzodiazepines that we’re using for anxiety, for example. Or you have your opiates that you’re using for pain. We, as health care providers, know that this addiction is possible. It’s a dependence. It’s not a judgment that I’m making that someone is addicted. It is a physiologic dependence upon these medications. How do you balance the need of the patient with something that maybe is, in the long term, is not the best medication for them?
Dave: I think you said it well right there. It’s really about letting the patient know that. That this may not be the best long-term solution. A lot more of what we do now, especially around controlled medications, is informed consent. “You’re going to take this. I’d like you to take it for two-three weeks. Yes, your body is going to get used to it. There may be some side effects when you stop it.” Helping people understand what their body is feeling and translating those feelings, physical or otherwise, into, “This is really an effect from the medicine.” When they understand that, I think they’re much more willing to be able to use or not use specific medicines.
It’s always a question of time. How much time do you have with a patient? How much time does it take to educate them through that? Some people that I see have come to me on those medicines and they’ve been on them for twenty years, longer. You really have to start somewhere. I think that’s where I sort of have this willingness to start wherever the patient is and make some progress in their health care by educating them, by telling them what they’re using, how it’s being used. We use a lot more handouts now. We can have a lot more resources, good internet resources. Things like that. Even specialists that people can go to that aren’t right there just to write another prescription. They’re there to figure out the mechanism of the pain and how people can get better.
I do often have that conversation with people of dependency versus addiction and tell them that, “Physically your body is dependent on this. Just like coffee, just like nicotine,” just like any other substance that they might understand and make a comparison. “Say you have three cups of coffee everyday and you stop drinking. What happens?” Everybody can recognize they get a headache from withdrawal.
Same things with their medicines. If they miss a dose, especially with an opiate, withdrawal can set in within 12, 24 hours. You can get body aches, physically feel tired, nausea, vomiting, diarrhea. There can be a lot of effects depending on the dose, but they can come really quickly. If people don’t recognize them for what they are, they might end up with a different outcome.
Lisa: Sleep is also really big when it comes to both pain and depression and actually anxiety. When people over the long term, for whatever reason, because they’re in pain or because they’re anxious, they’re not getting enough sleep, then it just becomes a vicious cycle. Unfortunately, some of the medications that we use for sleep also have been proven, over the long term, to not be that healthy for patients. It’s so delicate.
Dave: It is. A lot of the medicines, they have an effect and they also carry on side effects. One of the assessments that we’ll do for opiates, let’s say, and there’s a lot more screening and risk tools available to kind of evaluate people and have that conversation with what this med might do. People just want sleep, but the majority of your sleep meds just initiate sleep. They don’t actually prolong it or help it or make it more restful, refreshing. “Sleep is a habit,” I tell patients. I also tell them sleep is good medicine. If you can do that well, if you can set that habit well, you can start your day better. Your pain’s going to be better. A lot of different things. I think that’s a symptom of life, maybe, that your sleep becomes poor and then you’re days will follow with difficulty, you know?
Lisa: When I think about sleep medication, I think about the patients who often will tell me that even on the prescribed dose, the next day they feel hungover. It’s less likely that they can actually perform the jobs that they’re doing. I even worry a little bit about them driving. So often, what we’re told that we should prescribe as doctors is far more than what most people need. It’s something that we can really do on a fairly short-term basis just to break whatever cycle that is until they get into a better pattern.
Dave: That’s it exactly. To get into a better habit and they may need a trigger for awhile to reset that habit. What I’ve noticed over time, though, is we will often pull out the sledgehammer when we might need just a finer tool. Alternative medicine does provide us a lot of windows of opportunity. Acupuncture, aromatherapy, these might seem more subtle. Massage therapy. Things like that that could help institute a better cycle of sleep for people, a better restful state. Meditation. Those are all very, very, very powerful, but they take time. They take time for people to learn them. They take time for people to use them as a routine.
All those alternative things would apply as well to the management of pain. Everybody has an individual or subjective experience with pain, but we also have the ability with our mind to control how we feel in certain situations. Based on how we’ve lived, that’s the track record that’s set before us. That can be changed, it can be worked with, it can be altered. It’s just about creating a new loop, a new habit, a new experience.
Lisa: I find it really very encouraging that there are three of us in the Brunswick area who are physicians. You and Dr. Cindy Dechenes and myself, we all practice acupuncture and each of us have been doing acupuncture for a number of years. Having that kind of creeping into the medical mainstream, it makes me feel good because now we’re offering people something that might actually help their lives in a bigger way with, “Let’s just deal with the symptom.”
Dave: You know, ten or fifteen or twenty years ago, it might have been odd to even suggest acupuncture to a patient. Now it is more mainstream. We know how many people are using alternative medicines and alternative treatments. They do provide good relief and they do provide, I’ll say, individual success, even if there’s not some gigantic, ten-thousand-person study that says it’s going to work. We’ve seen a lot of individual success with that. It’s always good to offer people more options, more opportunities. If you limit yourself to one or two choices, you’re very unlikely to be successful over time with patients and that’s where the relationship with medicine goes. Somebody can come and see you and if you only have two options for headache, you’re going to be out pretty quick. You have to continue to go back and redefine the problem, redefine what successes they had, what failures they’ve had, and try to come up with new solutions.
I think the challenge of family medicine now is to integrate more of that, is to integrate more of the lifestyle, the things we hear about functional medicine, the things that we know about alternative treatments into people’s lives so they can have those good skills and have those good, I’ll call them self-adapting skills to be able to manage their problems.
Lisa: We’ve been talking about acupuncture, but there are also doctors who for a long time have been practicing what’s called osteopathic manipulative medicine, or manual medicine, in addition to chiropractors who are doing the same sort of manipulative medicine and often bringing together something like acupuncture with something like OMT or OMM manipulative medicine can be really life-changing, I think, for patients.
Dave: You’re right. When somebody has the opportunity or has a successful acupuncture, even OMT session, and they feel, even if it’s for a moment or a few days or a few weeks that their pain is more manageable or better, or that they’re able to do some of the things that they didn’t used to be able to do, or they can successfully do their job, take care of their kids, manage their life, that’s way more powerful than any pill will ever be. It’s not something they have to think about how to cope with. People who take a pill or something, it’s that moment they look for it to wipe everything away.
Whereas, if you’ve taught them a skill with meditation or they’ve been able to have OMT and some manual muscle therapies, they go, “Wow, I can do some of this myself.” They can actually correct some of the malalignments and the other problems that they’ve been carrying for years. They can be very useful for actually getting to the base of their problem, I think.
Lisa: Another, too, kind of foundational thing is that you and I both incorporate into our practices are discussion of diet and discussion of exercise. Because exercise, if you can get past an acute-pain flair, exercise over the long-term actually has been shown to be helpful for chronic pain issues for things like fibromyalgia.
Diet is also important. You referred to functional medicine and this is a very specific way of looking at nutrition in the life of a patient. We know that there are inflammatory foods that set off most patients and then, in addition, some people are sensitive to foods. Say citrus or wheat or dairy. How much do you bring this into your practice?
Dave: I think over a time as you develop a relationship with a patient, you’re going to be able to offer them a lot. I often think day one of the first person that comes in and I diagnose with diabetes, I think, “Wow, we can add five medicines today and sixteen quality goals to your list. We have all these things we have to do right now,” but it’s really a journey. Lifestyle definitely has to be part of their journey no matter what medication or medical problem they have, whether it’s pain, sleep, or something else.
That investment of what they can do, when they have control of the change, a lot of what we do now with motivational interviewing is to get people to seek out what it is they have control over, what it is they can change, little changes that they’ve noticed and help them build on them. Find those little bright spots where they say, “You know what? Last night I didn’t hurt.” “Why didn’t you hurt?” “Well, I didn’t eat all those French fries.” You know? I it can be as simple as that, but you can build off that and start to find any little lifestyle thing that you can pick up on.
I’ve had certainly patients come in and I really have not a great idea as to what’s going on, but I will always often tell them something along this line now and say, “There’s always a foundation of what we can do, okay? Good sleep, good nutrition, some exercise, and eliminate any real negative habits like smoking or alcohol.” Those are the fastest five things I can tell somebody that they can start with and it doesn’t matter what their problem is. You’re going to be able to impact the outcome based on their investment and their involvement in finding solutions through those means.
Lisa: I would add in something that’s not as quick, obviously, but that I think is also very important and part of the reason why I went into family medicine, I suspect you as well, and that is the importance of good relationships and understanding that if your primary relationship has some difficulties, that that’s actually going to impact your mood, your pain level, your ability to sleep. It’s a little bit harder to work through that sometimes.
Dave: It’s true. I think you need a good relationship with the patient. You need a good rapport with them for them to start to develop that trust in you to tell you those things. I think I’ve seen that a number of times over my career that someone will come in with a major life medical problem and you find out six months ago they went through a divorce or they had to move or they lost a job, some other big, stressful thing, and that will push them. It will push their body in a direction so that connection between their spirit or emotional state or mental state and their physical health is real.
It’s something that when they recognize it, I think they can make amendments to and they can change things, but it leads us in a way. If we can protect those relationships and we can nourish those relationships, they’ll come back and help us when we have a physical ailment to be able to support our bodies and support us staying in a realm of good health.
Lisa: One thing that I have thought a lot about, and probably because I have children like you, is the things that we offer to our children when they are younger to help them integrate with their lives as they get older. Some children do fine. Some children cope well with the world around them. Other children, maybe they have sensory issues or maybe they have some attention-deficit issues. This has become an increasing issue, autism, the autism spectrum. It’s an interesting and complicated thing that family doctors and pediatricians and other health care providers are dealing with.
Dave: Right. What kids have available now just in electronics, it may be a way for them to cope. It may be a way for them to have a nice tool. A lot of them have, I guess, a double edge to them. Is this something that is supporting the child or is this something that’s taking away?
Their ability to cope, too, I think a lot of times comes from those relationships that you mentioned. How good is their relationship with their care giver, family member, Mom, Dad, whoever’s around, siblings? They learn support from that. They learn how to be strong through difficult situations. They learn a lot of things from those relationships growing up and those are patterns. We know that we can track adverse childhood events now and say the more adverse childhood events that exist for a kid, the more difficulties they’ll have when they become grown up and to identify those and to get them to help and support, to get the emotional state settled, then they will be more successful.
Lisa: Dave, how can people find out about the work that you do at Central Maine Medical Center and your practice in Topsham?
Dave: Okay, they can call the office, I suppose. We have websites. I think there’s a Facebook site for Topsham Family Medicine. The office number is 798-6200. We are accepting new patients. We love working in that area. I love the job that I have and I really do enjoy the relationships I have with a lot of colleagues and people that I can share patient successes with and also to see people get healthier from a system base of care and a team base approach to care, rather than just an individual or a one-time prescription.
Lisa: We’ve been speaking with Dr. David Salko, who is the Chief of Family Medicine at Central Maine Medical Center and so much more. He and his wife, Jen, have four children and they live in Brunswick. Thank you so much for coming in today and thank you for being the person who brought me back into family medicine up in the mid-coast region.
Dave: I would just say thanks for the opportunity. Thanks for joining us.
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Lisa: Today I have with me a good friend of mine and also someone that I profiled previously in the Wellness column for Maine Magazine. I believe that was in June of 2015. This is Jim Godbout, who is the owner of Jim Godbout Plumbing and Heating, Incorporated. He is also the Co-Chair of the Red Ribbon Committee of the Biddeford-Saco Rotary Club. It’s great to have you here again.
Jim: Morning, Lisa.
Lisa: You are here today because you’ve been working on something that you touched upon the last time you were in on the radio show and that is drugs. Drugs specifically in your area, but really all over the state and what you’re seeing as a business person and what you’re seeing as a long-time resident of the Biddeford-Saco area. Tell me about that.
Jim: Well, I’ve seen over many years of my life the cultural change that’s been taking place and the acceptance of drugs, and the use of drugs, and the misuse of drugs and substances. It really has taken me back. I’ve watched many people die in my life or friends or acquaintances over the years; a total of forty-two to date. Some have been my age, some have been children that I coached in my son’s age in youth football or in hockey. It’s really hard for me to accept that, that we allow this to take place.
Back in 2015, I approached my Rotary Club, which I’ve been very active in many years and I challenged the group that we make a change to the culture that we currently are in. We’re seeing people dying from opiate abuse on a regular basis. We see the acceptance of alcohol and marijuana, which are typical gateways to heavier use of drugs. Our group developed a focus group with the entire Rotary Club, about fifty individuals. We had monthly meetings for about three or four months and determined that out of that focus group to develop education as our main goal, to provide and encourage healthy, thriving communities through education. We felt it would be our best role to make change in our area. We’re currently trying to develop this in the Biddeford-Saco and Old Orchard Beach area. We’re starting out small. We’d like to replicate this for other communities throughout the state and possibly throughout the United States and maybe further.
The reason I went to Rotary, they are people who are very knowledgeable in my club. They’re a very diverse group of people. They’re people who get things done. I recognized this a long time ago. When they accept a task, these people really drive to make sure we get to an end goal.
The challenge took place back in the fall. Our group has been implemented as a standing committee with the Rotary Club of Biddeford-Saco, which is a big deal because it will be sustainable forever is my goal. With that, we’ve actually started the education process, we felt, was the most needed is to let’s get the children, the school children from high school and junior high. We’ve interviewed law enforcement, social workers, health care workers all over our community and recognize that maybe the best change we could really do as a Rotary group and the focus that we could make is to educate our students in the schools. We directly went to the top to make this change. It’s hard for municipalities and school districts to change curriculums because they’re mandated by the federal government and by the state government to teach specific things. There didn’t seem to be any room to do drug education in the classroom or to take any time to do that.
As a businessman, I’ve seen over many years we’re losing our workforce at an alarming rate. We don’t have job-ready students coming out of school or college, for that matter. I attribute some of that to the addiction issues and substance issues or substance misuse issues. Our Rotary group, I think, is going to be the tell-tale source of hoping to make change. If we can get everybody to bite on, we can do something.
I talked about going to the top. We actually met with the school administrators. That would be the superintendents, the principals, the people that make decisions. Of all three communities that we’re currently in, that’s Saco-Biddeford, Old Orchard, and Thornton Academy, which is private high school, they all recognized the problem obviously and they’re all open-arms about having the Rotary Club help them implement the curriculum change and education process within their prospective school systems.
Needless to say, that’s a pretty big task to do. The Rotary Club, the doers that we are, we got many meetings together with them, some very long. Very frustrating for me because I’m the kind of person that likes things done quickly. I’m the motivator, so to speak, to make decisions. We got together with the prospective school districts and their players from social workers, school resource, principals, and such, for long meetings and we’ve developed a series of events that are actually going to start to take place this coming April. In a very short time, we were able to put something together using our Red Ribbon Committee’s model and that is to develop healthy, thriving communities with the purpose of reducing substance and illegal drug use in our communities.
Lisa: As a child of the 80’s, I was around while we were talking about drug use and Nancy Reagan and “Just Say No”. Obviously, I’m not a child anymore. I’m a doctor and I see that drug use, actually use of both legal and illegal drugs, has really continued to grow. I’m wondering if you’re surprised by the fact that you are creating this committee to deal with drug use in the state that you’ve grown up in. Did you think you would see this happening when you were younger?
Jim: If I dial back to, let’s call it 1979, late 70’s and early 80’s, absolutely not. I could not see myself doing this today because I was part of that whole culture. As recently as a few weeks ago, I had a good friend of mine who I thought may have been number forty-three actually get on with me on Facebook and talk to me through Facebook, which has been a pretty good tool for actually getting the word out for what we’re doing. Pretty good.
Came back to me, this is thirty-five-plus years later that this individual comes back and tells me about his story of why he’s still here today, that I challenged him back in the early 80’s to get out of the drug culture. He got into the Marines. He was heavily into cocaine at that time. He was destined for number forty-three, to tell you the truth. He would have been one of my friends that would have died. I was so excited to hear how well he’s done with his life. The challenge took him into the service for many years as a career and now he’s back here and he’s an advocate for speaking about the misuse of different substances today.
To answer your question, those years were pretty scary when you think about it. I think of the acceptance of marijuana and alcohol back then were very, very accepted at that time and most of the people that I knew led into cocaine or barbiturates; then, that was the driver. These people did not live an entire life. I talk about that high number of people that I lost and known over the years. Many of them died from terrible accidents that may have been attributed to overdoses, to cardiac failure from the drug use. As you know, marijuana increases your heart rate, I think, ten times or five times its normal rate. Cocaine does the same thing. It makes your heart expand. A lot of these people died from health issues attributed to the drug use or alcohol abuse at the same time.
What scary to me today is to see the marijuana push in this area. It’s a little bit disturbing to me, or it’s very disturbing to me because the potency of the marijuana is a bit more stronger than it used to be. There are a lot of known carcinogens using/smoking marijuana. There’s a lot of things attributed to marijuana that I don’t think the typical user understands. They say, “Well, if we make it as a drug that’s accepted on a regular basis like alcohol,” that marijuana stays in your system for three days. The THC stays in your system for seventy-two hours. Where are they going to work? You can’t drive machinery. You can’t do a lot of things. Again, we’re going to diminish our workforce if we go to legalization.
It also, I think, is a huge gateway to stronger drugs. I really do as I watch many of my friends over the years do this. I’m in hopes that our Red Ribbon Committee, along with a huge community support throughout our area and the state and throughout the United States, if we could all come together to join forces, I think as a whole, we can make a difference in our culture today.
Lisa: How are we going to do things differently now when it comes to education considering we were trying to do some of this educational stuff back in the “Just Say No” era? How are we shifting our focus so that people can become more aware and, especially kids, don’t just kind of stop listening after awhile?
Jim: That’s a great question because that was a huge topic of our discussions with the school administrators and teachers. Our focus group came up with what we feel is the strongest. If you recall, there was a program called DARE, who was mostly funded by, I believe, the Knights of Columbus and their group for many, many years, and driven by adult mentors for the most part. They felt that that didn’t really work that well and that’s kind of why the program went away.
Our focus group now has looked at in a variety of different ways. One being specific is peer mentoring, is develop peer mentoring. They feel that’s the most influential piece that students could bite onto. Peer-to-peer mentoring and health and driving healthy lifestyles within the school systems, with peers we feel is the best way.
However, this is not going to be the only way we attack this. We have people from addiction, rehab facilities that have been in recovery for some time are going to be speaking to tell their experiences. There are many good speakers in southern Maine that do a great job of telling their stories and they come from a wide array of demographics. Everybody thinks that it comes from the poor or from the very rich. It’s from everywhere. Every demographic group out there has issues with substance use and misuse.
We’re going to have recovery people. We’re going to have law enforcement. Law enforcement has been a big advocate for teaching. They feel that education is going to be the number one way to make change as well, so we’ve had great support from law enforcement throughout the state. We’re working also with the University of New England and some of the professors over there. Professor Ed Bilsky is a good friend. He is working on the physiological piece of it so that children understand and adults understand what it does to the brain and the irreversible things it does to your brain.
They’ve been a huge, huge supporter of a coalition process that we’re also working on. The Red Ribbon’s got a lot of different things, but we’re also working on a coalition with police, clergy, health care workers as such, three municipalities as well. It’s not just working the school system. We’re working with another collaborative group as well. University of New England has been a huge proponent of making this happen. It’s a lot of pieces of the puzzle when you think about it, really. That’s what it really takes to make a change.
Lisa: Yeah, I’m thinking about say alcohol. Alcohol is a legal substance. Also, marijuana, which is currently legal for some uses. There are prescription medications which are legal if you are prescribed them for pain and for anxiety and other issues. It’s an interesting and slippery slope because, for some people, you can have a drink with dinner or a couple of drinks with dinner and it’s fine, and for some people, their brain chemistry is such or maybe their genetics is such that they really can’t. Some people just really can’t ever have anything, even if it’s legal because it is, for them, a gateway.
I also think about the patients that I treat who use medical marijuana or who are on controlled substances, are on pain medication. Some of them really need the medications and some of them are really dependent upon the medication. They’re using them very well. Others of them, I feel like they’ve been maybe started on something and probably decades before I even saw them and basically they’re in maintenance phase. If they don’t get them, they go into withdrawal and then we can’t actually control their pain or their anxiety. Talk to me about that, the fact that many of the things we have access to are things that are legal.
Jim: Yeah. That’s a huge problem because if you look at a lot of the current people in addiction, or opiate addiction especially, they led from prescription drugs, which are legal drugs. They started with that and they’re readily accessible, unfortunately.
I personally try to stay away from them. I had a back surgery a few years ago. I think I told you. I like alternative. Maybe I have a higher tolerance to pain, I’m not sure, but I didn’t take any kind of oxycodones or OxyContins during that time. I have a lot of other physical attributes, but I like the alternative piece from massage to physical activity to acupuncture to just a good mental sound being, too. I guess part of that mental sound being is connections and I think if people have healthy connections in their lives, too, the substance misuse of prescriptions or alcohol tend to be less of an issue if you have those connections.
I think connections with people can make a difference, too. That’s part of the cultural change that I see. The connections Maine Home and Design, Maine Radio does is incredible. I think those are good, healthy connections and I hope that all our communities bite onto that because I think that is a big piece.
Alcohol is really accepted heavily in our society. It’s nothing for me. I, for one, I drink alcohol. I drink wine. Hopefully I don’t overdo it, but I think about the people that are in recovery from alcohol abuse and things. It’s always on my mind. When I see a lot of people getting into heavy alcohol use, I think it’s very important to talk to them about that because there are signals that you don’t come back from and sometimes it leads to greater problems socially and with your families and other things.
Lisa: Yeah, I agree with you. I think it is important to talk to people and I also having been the person who’s talked to some of these people, both in my personal life and my professional life, it’s sometimes really hard to be that person because when you say, “I’m really concerned about you and I see that this is really impacting your life,” most situations, as the messenger, you end up kind of being attacked. It makes people very defensive and they can’t hear it as I care about you as a friend or I care about you as a patient. This seems like it’s really impacting you negatively. Most people, they kind of defend the status quo.
Jim: I totally agree with that because I’ve had friends with alcohol issues and I tend to try to listen or to try and change the conversation or have open conversation about healthy lifestyles that can maybe make their lives a little better. There’s usually a reason for many of these people in my own perspective of it. There’s a reason people drink heavily or take drugs as an escape from maybe their current mental being that they’re in. They may have some job issues, some family issues. I can’t speak on all of them, but I think it’s important to have that connection and to listen to people that have these issues.
Part of our Red Ribbon thing, I’ll go back to that again, is we’re developing mentors within our group to be directly speaking with some students, whether it be about life skills, which we can really teach a lot about because we have bankers, insurance people, we have people in the health care industry. All can have an important role in keeping these people focused, these students focused to the next level.
Lisa: I’m remembering back to my conversation with you the last time you were on the radio show and when you were talking about the drug issue. You were talking about how it impacted your own company and your own workforce and people’s ability to come in and get the job done and even your ability to hire people who could do the work for you. There was more of an edge. There was more of an anger and maybe more of a frustration. What I’m getting from you now is the fact that even if you don’t have the answers, at least you’re working on it. At least there’s a plan in place. At least there’s something that you have been in conversation with others about that makes you feel more empowered as a citizen and as a business owner.
Jim: I agree. I’ll tell you one of the big reasons I’ve gone from anger to open-minded discussions with the public and with anybody I can find, Andy Greif, who’s our co-chair with this, is a very good friend who has a social background. He runs a community bike center benefit who’s mentoring children everyday. I’ve learned an awful lot about how to handle people with Andy. He’s a special guy. He’s toned me down a little bit in regards to, “Put the hammer down,” type Jim attitude that’s not always the answer.
I’ve learned a lot from Andy and he’d be a great person to actually interview here because he’s a special person. He really is. He does a lot with young children that may not have a home life to have a role model for. He provides that services through his community bike center. He’s my co-chair on the Red Ribbon. He’s a very fitting person for that.
Lisa: I like that suggestion. It sounds like maybe he will be a future guest. I do like your comment about the connections because what I have seen, having now been a doctor for twenty years, is that it doesn’t really matter whether you have a lot of money or not much money, or whether you live in an upscale, suburban Maine community, or whether you live in a former mill town, which may also be upscale, but you know. It doesn’t really seem to matter as much because if there is some disconnect, if you don’t feel like for whatever reason you can talk to people about your concerns, whether they’re school or whether they’re money problems or whether they’re emotional issues, if you don’t have that outlet, I think you’re right that it is so tempting to just try to escape. I think that’s hard. I think that’s a hard question that we have to answer is why are people feeling so alienated.
Jim: I agree. Part of it, I think, is the electronic age, to tell you the truth. It really drives me crazy when I go out to dinner and I watch a couple sitting there and they both have their iPhones on the table. My wife and I go, “What kind of conversation’s going on there? I hope they’re texting each other at least.” There is some disconnect with people today and I think we need to bring that connection back.
I love the movement in Biddeford. That’s a really interesting thing that’s happening down there with the arts people, with the mayor, Alan Casavant, and Doug Sanford and the mill complex down there. There’s a real sense of community down there. You have some thriving restaurants. You have some people in the art world that are doing some fantastic things. We have Engine driving some wonderful business programs down there. There’s some really great young entrepreneurs down there. Delilah’s doing a good thing with the Heart of Biddeford. I really like the excitement and how they’re building community. They’re bringing people together and they’re just like you said. They’re from all different demographics, I mean, from the very poor to the very rich. Everybody’s involved.
We recently had a fundraiser that’s called, ironically enough it’s a wine and beer tasting, but of course we get good following from that from my Rotary group, but we did it at the North Dam mill complex. We didn’t label it Red Ribbon, by-the-way. It was a fundraiser we do on an annual basis. It was wonderful to see 350 odd people come to this together and socialize and interact as a community. There was no heavy drinking of any sort. It was a wine tasting. It was a wonderful event and a real sense of community and I commend our rotary club for putting on such a beautiful event and bringing our towns together.
Lisa: You know, that’s an important point. I think that we talk about substance abuse and misuse, but there are some people who have their glass of wine because they just enjoy it. It just makes them feel happy. It’s a social experience. That is the other side of it. I think to hit everybody with the big hammer and say, “Nobody should ever drink anything ever,” I think that comes across as being really judgmental sometimes.
Jim: I would agree and that’s why our mission statement says, “misuse of substances,” because substances are allowed and misuse is probably the term that’s most fitting for that. I, for one, love a nice glass of red wine with my dinner at night. I call it heart-healthy wine. It’s beautiful eating with me wife. I agree. That’s part of our vision. Our mission statement was to describe illegal substances and legal substances misused because there is a tolerance and an acceptance and it’s not going to go away. I think we’ll all enjoy that glass of wine or whatever it might be.
Lisa: Well, and I have to say it bothers me because now that I’ve seen the marijuana being legalized and I’ve also seen what long-term use can lead to having had people that I’ve known for forty years that have heavily used pot and it does have more of an impact than I think we initially thought. It actually bothers me a lot to see it portrayed in television and movies as being something that’s okay. It’s such a strange place to be where we know so much and yet there’s still so much that we don’t know. Just the use of some of these substances and putting them out there in the media as being okay, I worry about that.
Jim: Yeah, it’s almost a joke to people. They just don’t really recognize the potency and the problems that are associated with using that. One thing I always think about, if it’s such a great drug, why aren’t the major pharmaceutical companies jumping on board to manufacture this as a prescribed drug in the field? That’s never been talked about. It’s always being done in a barn or a farm that’s being developed by somebody who wants to be an entrepreneur and grow weed.
I’m a huge proponent of THC use for adolescents and babies that have seizure disorders. I think it’s a huge benefit to them. I have no idea how it’s manufactured, but I just know it really works well and I’m really happy that these families have a resource to go to. However, the medical card for smoking marijuana on a regular basis, I’m just not totally sold on that. I just don’t see it. I’ve seen too much negative from it more than positive. I really don’t think it’s the future of our country is to continue this.
Lisa: You’re speaking as someone who had seizures, so you actually know this very well yourself. I kind of agree with you. This is me personally. This is not me representing the entirety of the medical community, this is just my own personal feeling about the medical marijuana card, that I just don’t know that we have quite figured out how to manage this in a systemic way yet. It doesn’t mean that people don’t need it. It just means that we don’t know how to incorporate it very well yet.
Jim: Yeah, we’re not utilizing it properly at this point. I see there’s a dispensary in Biddeford and I look at there are some people, and maybe I’m profiling them, but they look like they actually could use that medical marijuana. Then there are others, I’m not so sure they’re even close to being needed for that. I think it’s just been a part of their life for their entire life and that’s why they use it.
Lisa: That’s hard to tell because sometimes just looking at somebody from the outside, you don’t really know.
Jim: Profiling, which I shouldn’t do.
Lisa: I mean, I think we all do it. Jim, how can people find out about the Red Ribbon Committee of the Biddeford-Saco Rotary Club?
Jim: Well, you’re going to hear more and more about it. It’s a very grassroots organization, like I said. We just became a standing committee beginning of this year. I developed a Facebook page, a take-off of mine, that’s going to provide information on a regular basis, I hope. It’s tough for me to find the time sometimes, running a business and trying to do this as well as the other things I do in the community. I do a lot of things as well.
I’m trying to promote healthy choices, teach people about certain things. There are a lot of resources out there, so I hope to be posting them at different times and talking about our upcoming events through the school systems and through the local coalition. Our Rotary Club is very active in this. Our Rotary Benefits Soccer Rotary page will actually have more about this as well, our website and our Facebook page about that.
We will be doing a major fundraiser to try to drive this. In the early stage of this, we recognize that we need a major cash flow to try to get these schools … Schools needs money to do these type of programs. Whether it be speakers and videos, information, it all takes money and that’s where the Rotary really comes in strong because we have the way to create the resources to help these municipalities and their school systems. In a very short time, we raised about $20,000. We haven’t reached outside of our organization yet.
Just in my local community in Kinney Shores, which it’s a small community of ninety beach homes, which is very few people living there in the winter time, we had a dinner party and we raised almost $10,000 in my neighborhood just by reaching out and discussing the issues of drugs. It was a huge take-off.
We hope to implement a fundraising campaign along with our April 25 kickoff at the same time so that we keep this a sustained committee and a sustained programming in our schools. We really want to model this so it will be there for future generations to use and to hopefully expand in our Rotary network. We’re a small group of Biddeford, Saco, and Orchard, and then there are other districts within our state, and then there are other districts throughout the United States. We hope to model this so it can be utilized for other areas to really take a step forward and make change in the community.
Lisa: We’ve been speaking with Jim Godbout, who’s the owner of Jim Godbout Plumbing and Heating, Incorporated. He is also the Co-Chair of the Red Ribbon Committee of the Biddeford-Saco Rotary Club. Thanks for coming back in again to speak with me today.
Jim: Thanks, Lisa.
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This is Dr. Lisa Belisle. I hope that you have enjoyed our “Pain, Addiction, and Prevention” show. Thank you for allowing me to be a part of your day. May you have a bountiful life.
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