Episode Transcript
Pod Jonathan Naltrexone
Deb: Welcome back to the Alcohol Tipping Point Podcast. I am your host, Deb Masner. I am a registered nurse health coach and AFBA that's a new abbreviation. We've started calling ourselves AFBA because it stands for alcohol free Badass. And so I invite y'all to start using that term if you want.
I have on the show today Jonathan Hunt Glassman. He is the founder and CEO of, Oar Health, which is a company that offers telehealth addiction treatment, and they specialize in using Naltrexone for alcohol use disorder. So I think this was really good timing. I was telling Jonathan before we started recording.
I'm noticing that more and more of the people I work with are using Naltrexone and it's just becoming more common to help people, either if they're wanting to quit drinking or reduce drinking. So we are gonna talk about Naltrexone today, so welcome to the show, Jonathan.
Jonathan: Thank you. Thank you for having me.
Deb: Well, tell us a little bit about who you are and what you do, where you're at, all that good stuff.
Jonathan: Yeah, absolutely. I am the founder and CEO of, OaR Health as you said, our mission is to help people drink less or quit by providing. Convenient, private, affordable access to tools that they can use to take that first step towards recovery and wellbeing, which can sometimes be both the hardest and the most important and the main tool that we're focused on, on providing pupil with is access to safe, effective medication that can help them drink less.
Specifically naltrexone, we've been doing that at or since the beginning of 2020. And over that time served over 10,000 members and helped them take that first.
Deb: Wow. That's fantastic. So let's talk about Naltrexone first of all. Like what is it? How does it
Jonathan: work? Sure. So it is a the most important things to know are that it's a safe, effective FDA approved medication that's used to treat alcohol use disorder.
The, the way that it works is it helps. Cool off some of the reward pathways that alcohol can activate in the brain, and thereby it works both in the short term and the long term. To disrupt some of the feedback loops that can contribute to excessive drinking. So in the short run that first second drink if you do drink doesn't feel as exciting, as pleasurable, as rewarding.
That's where it was most helpful to me personally. I'm an Naltrexone user and I used to. Hit this point of no return where that third or fourth drink made me want an eighth, the ninth, the 10th, and that was the only thing I could, I could fixate on. Naltrexone helped to disrupt that runaway train in the longer run of taking it over a period of weeks and months.
It can also help to reduce cravings days. That one drinks at all days of heavy drinking. Relapse to alcohol dependence. And as you mentioned, it is something that you can start even if you are still drinking on a regular basis and is appropriate for people who are pursuing a goal of moderation as well as those who are pursuing a goal of sobriety.
The last important thing to, to know about nal Tre. Is that it's dramatically under prescribed, relative to the appropriateness of its use. So among people who had alcohol use disorder in the last year, about one or 2% get an Naltrexone prescription, which is part of the gap we're trying to fill. And, and why do
Deb: you think that is?
Jonathan: There's plenty of blame to go around, but I'll give you three big reasons. One is Naltrexone has been around and been manufactured generically since before direct to consumer pharmaceutical advertising was a thing, meaning there is no particular pharma company that has an economic incentive. To make it a household name like Prozac or Viagra.
Number two, the level of training that physicians and other healthcare professionals get on treating addiction really falls short of what's necessary given how prevalent these conditions are in our world. And so there are a lot of clinicians who don't feel competent or comfortable treating addiction in their offices and using all of the tools.
All the evidence-based tools that are at their disposal. And so they may not prescribe even when a patient presents with a case of a u d that would be amenable to pharmacotherapy. And then lastly, there's still a little bit of kind of a culturally received notion in pockets that taking medication to treat an addiction is the easy way out, or replacing one drug with another.
And I don't think that's a valid criticism when it comes to a drug like Naltrexone that's not subject to abuse, doesn't have the potential to get addicted to. But it may be a barrier for some.
Deb: Yeah. Thank you for going over those and just, I mean, you're so right, like they're. There is not enough training in addiction or alcohol use disorder or, or even time there.
There now we just kind of run clinics like machines and just get people in and out and so it's good. That we have this tool, and I like how you said it's a tool. It can be another tool in your toolbox. So like you said, whether you're wanting to quit drinking or cut back on drinking. Let me ask you, what made you decide, you know, to get involved in oar health and like what, what's your background with drinking?
Jonathan: Sure. So I really view or as the coming together of kind of some of my professional history and my personal history with alcohol. Professionally, I worked in healthcare my whole career as a product manager, a a strategy consultant, but. Probably more relevantly. I struggled with alcohol use pretty much my entire adult life.
So what started as binge drinking in high school and college became a pattern of frequently drinking to blackout in my twenties. That's where I really started to have that. Pattern of use where I just lost control around that third or fourth drink. And then as I saw some of my peers start to put excessive alcohol use in the rear view mirror as they grew up a little, shall we say, the opposite was happening for me.
In addition to those one night binges, I was having multi-day binges over the course of a long weekend or a vacation. And as I've tried to sober up from those and return to my life, my job started for the first time to experience some of the symptoms of withdrawal both psychological and, and physiological.
So things were pretty rough for quite a while. Mm-hmm. .
Deb: And then what, where are you at now with, you know, you, I know that when we first started talking, you know, for you, you're able to take Naltrexone and still drink occasionally. Is that right?
Jonathan: Yeah, that's correct. So, you know, over those , 10 or 15 years of struggle, it was, it was no secret to me that I had a drinking problem.
So I sought treatment in a lot of the places that first come to mind. primary care psychotherapy. The emergency department and pretty much always heard the same thing, which was, you need to stop drinking and start going to meetings, and I gave that a shot. But it, it just didn't click with me.
What was much more of a turning point was having the, the good fortune to connect with a physician who had some experience treating addiction in his panel, and he did two things that felt very new. One was support my goal of moderation. And then the second was suggest prescription medication, as you said, kind of as one tool in the toolkit.
And you know, his, it was a short visit, but it was a meaningful visit. It wasn't a factory visit, you know, he took in the information I was giving him, he listened when I said, I feel addicted to alcohol, but I'm not ready to quit. And I had as much trepidation about the second half of that statement as the.
But he kind of took it in without judgment and worked within the constraints I was giving him including suggesting naltrexone as something that fit with where I was at that moment. And then I've had very positive results with the medication. Of course, pupil's responses to it very, but very quickly.
Once I actually started taking it, it, it sat on my shelf for about 30 days, but once I actually started taking it I could still enjoy a first. But then started to notice big differences on the second drink, where often I wouldn't finish it because it just wasn't that exciting to me. And so for the first time in my life, had experiences like.
Walking away from a a half finished drink. And so that has been the right recipe for me, along with a few behavior changes in that I find I've found that I'm able to enjoy a glass of wine with dinner, a beer at a baseball game, and not get into that danger zone of being on the, the runaway path to blacking out and all the negative behaviors that come along with that.
Deb: Sure. So how does one typically take Naltrexone?
Jonathan: So it's available in, in two formulations firstly. So there is an injectable version which you need to see a healthcare professional to get the injection either in a doctor's office or in some states of pharmacy. The good part about that is it lasts for 30 days.
Bad part about that is not everyone wants to get a shot in their. The, the more common formulation in what we're able to do, given that we're a telemedicine company, is prescribe the tablet form so it. You know, small, yellow or white tablet that is, can be taken in one of two ways. So if you kind of read the FDA label, what it says is take daily.
And that's what many of us do, including me. Just make it part of your morning routine. Take it with dinner if it's causing any sort of tummy troubles so that you've got, got a good base. And then there are others who take it in a more targeted fashion meaning they either take it before they're going to drink only or when they're going into high risk situations.
And one form of that target. Bucket is something called the Sinclair Method where there are folks who take it about an hour before they plan to drink. And what many of them report is that over time that helps them get down to having no desire to drink. They call that pharmacological extinction.
And so there, there are some, some options in terms of one, one, how one takes it, but the, the general idea. Set a routine, stick with it, make a mindful plan to drink less. I don't wanna represent it as a silver bullet. And then monitor response. And if, if things are going well, keep at it. If they're not, there are some options in terms of increasing dosage or changing administration schedule.
And there are of course also options of layering on other helpful things like a coach like a support group. As you said, it's one tool in the toolkit.
Deb: Yeah. Yeah. I, I will say I years ago I had reached out to one of my friends who's a psychiatric nurse practitioner and was telling her about my drinking, and she prescribed me naltrexone and just my own experience with it.
Like at first I felt like, okay, this is helping. But then I just kinda, I, I was not consistent. I would take it like you were mentioning, the as needed method, like okay, before I go out, before whatever the weekend. And so I, I just share it just to let people know, like, People, like, a lot of more people take it than you realize, even though it is under prescribed and it's something to try.
If it works for you, then that's wonderful. I have some people I work with, like I was saying, that are taking it now daily and it's, it's really helping them as well. But they're also using the other tools, the coaching, the group programs and whatnot. Yeah. So I just want to get that out there. I just don't, like you said, there is a stigma to taking medication.
You know, I also take antidepressants. Mm-hmm. I, you know, like people take medication for their cholesterol or for diabetes management or whatnot. So I'm just like grateful that we do have these options and it is newer, like in this whole field of treating alcohol. And the other thing that I was thinking about too was, you're right, most people don't get to a point, you know, they, they start to become aware that drinking is causing them problems, but they, it's, it's really hard to go from.
Being aware that it's causing you problems and then just being like, Oh, I'm done. And to make that decision. And so that is a whole process and a lot of people do want to moderate. You said like, is it the silver bullet or the silver bullet or whatever, like it's not a magic pill. It's gonna help you and encourage you to try it, but who do you think this would not be helpful
Jonathan: for?
Hmm. You know, I think it would, the only folks I would kind of steer away from, from Naltrexone are those who. I have an understanding of their relationship with alcohol and what they think will help them. That doesn't include medication. One of our kind of fundamental principles at, at, or is that we wanna empower our members with the tools that they, that will help them.
And we think most folks have pretty sophisticated understandings of their relationship with alcohol. And so perhaps as they reflect, Other change journeys they've gone through. Perhaps relative to a health issue. You know, if they I think both of the analogies that you brought up using antidepressants or anti-anxiety medications for mental health concern, statins for high cholesterol.
Are both great examples and of how medication in combination with lifestyle changes, with other forms of support, like working with a dietician or with a therapist can, can be helpful. But they, you know, every person is gonna bring their own strengths, capabilities, resiliencies and theories of change.
To drinking less or quitting. And there's definitely a, a group of people who kind of have the, the belief that the, the change is gonna be more meaningful and lasting if they do it without help from medication. And I think that's okay. You know, so those would be the only folks I'd, I'd counsel away from it or those who take a look at it, think about it and say, I don't think this is gonna.
Deb: Yeah, I, I'm glad you brought that up because one of the things I wanted to ask you was like, what is the controversy? What are some of the misconceptions or, you know, when it comes to medication management and drinking and like, what are you seeing out
Jonathan: there? Yeah, I think you know, I'll give, I think there are two, both of which we've touched on a little bit, and they're kind of at opposite ends of the spectrum.
I think one, you know, misconception is that using medication as part of a journey to recovery and wellbeing is taking the easy way out or replacing one. With another just as we wouldn't criticize somebody who's using antidepressants alongside seeing a therapist or somebody who's taking statins as well as changing elements of their diet and exercise routine.
I don't think. It makes a lot of sense to take this tool away from someone or to look down on someone who's taking the step of connecting with a prescriber and learning about a, a tool like medication At the opposite end of the spectrum, you sometimes hear Naltrexone described as a magic pill and you know, that may be a limited number of individuals experience.
I would never wanna diminish someone's authentic experience, and I think there are folks who, you know, start taking the pill and never look. But it's also important to know that that's not typical. What's more typical is that it is. Effective and helpful, but more effective and helpful if used in combination with other things, like a mindful plan to drink less like layering on other types of support.
For example, we have members who take Naltrexone and go to aa. And that's a great combination for them. There are others who, as they take Naltrexone, find that as naltrexone is kind of pushing down on the pleasure from alcohol, there's room to engage with or reengage with other natural healthy sources of pleasure.
So their compliment to Naltrexone is more time with their children, more movement in their, in their. Picking back up a hobby or a social relationship that atrophied a bit during the, the days when they were most dependent on, on alcohol. So that's certainly how I've thought of it in my life, is it's a tool in the toolkit.
Don't neglect it or throw it out just off the bat because of kind of an outdated saying. But don't expect it to do all the work either.
Deb: Yeah. What are some considerations if you are on it? What are some things to be aware of, like as far as side effects or interactions with other drugs or?
Anything you can think of?
Jonathan: Sure. So the big watch out is that it is not appropriate for anyone who is taking opioid based painkillers or using illicit opioids. And the reason for that is naltrexone was actually. Initially developed as a treatment for opioid use disorder. And so it can, and it is an opioid antagonist and so it can trigger withdrawal from any opioid based medications or drugs that one is dependent on.
Beyond that, there, there are some other much less commonly use medications that it has interaction with. So your physician and your pharmacist should definitely do a medication interaction test severe. Kidney or, or liver issues could be a contraindication. Again, discuss those with your healthcare provider.
Assuming none of those kind of contraindications are, are triggered side effects are probably the other thing to. Be concerned about and to manage as medications go. There's a fairly benign side effect profile. The most common issues are nausea and other variants of tummy troubles to, to use a little bit of euphemism.
The good news about those is they tend to dissipate within a few weeks of use as your body gets accustomed to taking the medication. And one thing that. It's certainly appropriate to do in the early days is to titrate up. So to start with half a pill, which is 25 milligrams. Then maybe move up to taking 25 in the morning and 25 in the evening, a split dose, so you're getting a full dose, but not all at once.
Then graduate to 50 experiment with taking with a meal. Does that help? There, there are all sorts of, And then, and then just using kind of over the counter remedies if you know, Pink Bi myth, that, that sort of thing to address anything that that does come up. Yeah. And,
Deb: and thank you for sharing about the opioids.
And I have an acquaintance who, he was in a really serious car crash and he broke his back and he was on Naltrexone. But. What was happening was they were giving him pain meds and they weren't effective. And so in some of my research I had read that part of the recommendation is to carry a, a card that you are taking naltrexone.
For that very reason. Would you agree? Yeah.
Jonathan: That, that's right. Whether it's a card or now you can do health alerts on your smartphone or, you know, and you know, tell anyone who's, you know, a spouse or anyone who might be consulted on your medical care if you're incapacitated, that you're taking naltrexone, some way to communicate that.
Because there are plenty of painkillers out there that are not opioid based. But if you can give your healthcare provider. An indication that you're on naltrexone, even one they can access if you're not able to speak to them. That way they can move to a non-opioid based pain killer first and not you know, waste time and have you in unnecessary pain administering an opioid based one that's blocked by the Naltrexone.
Kind of adjunctive to this is if. If you end up needing surgery of some sort you know good to discuss with your surgeon that you're on Naltrexone. One of the good things about Naltrexone and it not being addictive is You can take a break from it without having withdrawal symptoms. So often what folks end up being advised by their surgeon is, Yeah, just stop the Naltrexone a few days before you come in for surgery.
We'll give you some pain meds. Once you're through those, you can get, get back on it. So it's not rarely like a huge, you know, problem. But definitely something to to discuss if you're in a situation where you need pain killers.
Deb: Yeah, I mean obviously that was an extreme situation, but I was like, Oh, you know, like That's a good point.
I mean, wow. So how can someone get naltrexone.
Jonathan: Yeah, so one of the good things about Naltrexone is any licensed prescriber can prescribe naltrexone if medically appropriate. So if you are struggling with alcohol issues and have a primary care provider or other healthcare professional that you see regularly would definitely encourage.
You two discuss it with them. That's how I, I found Naltrexone was through my primary care practice. However, as we've not everyone has a primary care provider, first of all, and as we've discussed, not all healthcare professionals are as up to speed on naltrexone as they should be. We have a lot of members who.
Tried with their primary care provider and essentially been brushed off, which is unfortunate. The good news is that there are Folks filling the gap. And so we like to think of ourselves as one of those. So folks can come to Aura Health and, you know, take a assessment and connect with a clinician who's licensed in their state.
We operate in 27 states right now, and then the, something called the c3 foundation serves as a bit of a, a clearing house for inform. About Naltrexone and they list us and other web based as well as in person prescribers of, of naltrexone in all 50 states and in a lot of countries around the world.
Deb: Oh, that's good cuz I know we have some international listeners too who will be curious. Is it prescribed typically throughout the world then, or do you know what that's
Jonathan: like? As far as I know you know, I know there are definitely folks who, that's one of the good parts about it having been around so long.
I know there are definitely folks who prescribe it in the uk, Canada, Australia. I'm, I'm less familiar with other countries, but you know, it's been FDA approved in the US since the overall, since the eighties for al alcohol, since the nineties. So it's, it's had a while to get distributed. Good.
Deb: Good. Yeah. I mean, I know that it's been a game changer in the treatment of alcohol use disorder. I mean, you say the nineties like, but that wasn't that long ago. It's true.
Jonathan: Sometimes, sometimes, you know, we ask, you know, why is it the some, you know, more, you know, sometimes one might ask why isn't, you know, step four of the 12 steps.
Investigating medication options? Well, the answer is these. Op modern medicine didn't have a lot to offer in terms of addiction treatment for a long time. As you say, for most of humans recorded history with alcohol and other addictive substances, there weren't good medications. So it's no.
Failing of aa, that that's not step four, they were doing the best they possibly could with the tools, information, and resources available. And so I view kind of the development and of, of naltrexone and other safe effective medications as like a hopeful addition to the range of, of tools that are available to people, not a substitute or, you know, the only.
Deb: Yeah. Well, what else would you want someone who's listening to this podcast to know?
Jonathan: I think the one other thing that I would say is that often transformational change, and I feel like I've had a transformational change in my relationship with alcohol. Finally feeling like I have control over. Rather than the other way around, finding that less alcohol creates more room for everything else in life that's important.
Often those big changes start with one small, simple step. You know, for me it was taking medication for someone else. It might be going to a first meeting for someone else, it might be reaching out to a coach or a counselor or a loved one. Sometimes there's a little hindsight bias when five years or 10 years later, where we look back and we say, I changed everything in my life.
But that rarely happens in one day. . Normally it's, it's one step. Maybe it's. Removing some of the, the triggers around your house and buying one of those zero ABB beverages that's on the market now and putting it in the front of the refrigerator. Maybe it's planning one sober activity. For, for this weekend, maybe it's calling one friend that you've fallen a bit out of touch with, but would be happy to hear from you.
Who's, you know, who when you get together with the, the interaction doesn't revolve around alcohol. You know, the majority of people who struggle from alcohol use disorder do recover. But it is very hard to predict and advance what specific treatment. Or what specific behavior change is going to unlock the lock for any one of us.
And so that can be confounding, but I think it's ultimately hopeful. And the takeaway is do something.
Deb: Yeah. Thank you for sharing that. I, I just wanna add to that, like, if, if you're like changing your relationship with alcohol, good for you. Like that's amazing. And you know, something I've said is like, if someone goes from 26 drinks a month to three drinks a month, that's something that should be applauded and not shamed down to zero, right?
If you are drinking less, if you are practicing not drinking, Good for you. Like it. Maybe you're taking a break, Maybe you're ready to take a break forever. Maybe not. And that's okay. Like I just really give yourself credit for addressing this and changing your drinking and looking into new tools and.
Thank you, Jonathan, for the work that you do. And talking about Naltrexone, How can someone find you and find or health
Jonathan: so you can find or health or health.com. And we're on Instagram and, and Twitter as well. And personally, I'm on Twitter at just at J H G, which are my initials.
Deb: J h g. How'd you get such a little
Jonathan: I that, you know that's what comes, that comes from being an early adopter. I think I was on Twitter in like oh 8, 0 9, back in the early days. . I love
Deb: it. Well, thank you so much again for coming on the show and talking about this important topic and giving someone another tool in their toolbox.
Jonathan: Thank you for having me, Deb.
Really appreciate the opportu.
And we'll end it there.
Deb: Awesome. Thank you. I think that's gonna be so helpful. I'm glad you guys are doing so well and have so many members.
Jonathan: Yeah. It's been, it's been,
Deb: Wow. That's a lot of growth
Jonathan: and it's, it's, yeah, we've grown pretty quickly. We, we think we're about maybe 4% of the national Naltrexone market.
Oh my gosh. Yeah. Which is, you know, small market. But yeah, growing and that's, and we hope to like we're in 27 states right now, but we should be close to national by the end of the year.
Deb: Oh good. That's what I was gonna ask. So you just need a provider in each state,
Jonathan: a provider network, and then there's some like requirements for how the visit is conducted that kind of, we're putting a few technology upgrades in place, but, mm.
Deb: Yeah. Well, very cool. Let me know how I can support you and your mission. Likewise.
Jonathan: Okay. This, this was, this was really great. Really fun.
Deb: Good, good. Okay. So like I said, I will email, Reach out when the episode airs and Awesome.
Jonathan: We'll share it on a, on a good all our channels for
Deb: sure. Yay. Okay. Well, have a wonderful day.
Thank you. You
Jonathan: too. Have a nice, Enjoy your nice weather, . Yeah, yeah, yeah. I'll try and enjoy for both of us. . No good.
Deb: Okay. Bye.
Jonathan: Bye. Bye.
