Hi, I'm Faried Banimahd MD, an addiction specialist and former Clinical Professor of Emergency Medicine at UC Irvine & UCLA/Kern. Ask Me Anything!

1. What is your position on Gabor Mate's work and his general attitude regarding addiction as a symptom of trauma?

2. Do you see policies treating addiction as a flaw of character to be productive? If not, what are some talking points / facts / stats that could help counter this worldview and possibly enact policy change?

3. What are some successful approaches for treatment of addiction long term?

1.I am a categorical fan of Gabor Mate and pretty much in line with his approach and paradigm.

2/3. Flaw of character is a tragic deeply American approached fueld by many social and cultural roots. Talking points and data and succesful approaches? Please see the Portugal model, amongst others. I believe that addiction can be couched in a social context and the root of it is existential angst stemming from human isolation caused mainly from a capitalistic corporate approach to our lives.

I believe that addiction can be couched in a social context and the root of it is existential angst stemming from human isolation caused mainly from a capitalistic corporate approach to our lives.

That's potent. Please elaborate if you have the time!

Existential Angst: Where do I begin? Some short years ago I was proud to have gotten one of my young patients, BW age 21, to a reasonably safe place. He had been in over 30 programs and in meth psychosis when he got to us. 2 years later he was a different young man. The last year with us his insurance had even cut off. But he was now ready to go. Now what? How do I guide him towards continued recovery? What society was I to send him back into? What healthy society that I did not believe in was I supposed to advise him to adjust into? What tools did he have after 8 years of meth, heroin, benzos, and ETOH and more importantly, tools for what? Go get a job at 7-11 for 12 dollars an hour and be a good corporate citizen? You will barely sustain. No health insurance. Share an apartment with 3 others barely surviving with no end in sight! You will have no retirement, no hope for a better future for your children, and impending environmental catastrophe for icing on the cake!
Should I send him back to the broken home he came from? Should I tell him to spend endless mind-numbing hours on social media and continue to mistake this vacuous mind flattening engagement as real human engagement? Should I tell him to mistakenly get a bullshit certificate and call it education and push him into a debt he will never repay? Should he hyper-consume, watch staged reality TV, consume ubiquitous porn that destroys his sense of human connection even worse than social media? Should he watch the endless meaningless streams without a narrative on Twitter, spend hundreds to watch gladiators on UFC, or put his vote in for meaningless caricature candidates that will have no impact on the improvement of his life? Wait, should I send him to the local mega-church that has nothing to do with the Abrahamic tradition but deeply wrapped up with everything I am telling him to run from? Maniacal and false sense of hope, magical thinking, cognitive dissonance, and eventually bigotry and hate?

It looked to me that I was sending him into what I thought caused his addiction in the first place. Addicts: too sensitive for their own good. They smell the bullshit and hopelessness of it all and run into the warm fuzzy embrace that seems to them, the last haven of honesty. They are rebels in protest but chose the wrong tool. Then, they wake up and see this crap was bought and paid for just like the rest of it.

This is existential angst. In short anyway! This is what I am fighting.

Hope this helps.

Wow. I’ve never seen someone who wasn’t an addict describe the reason why I use so perfectly. It’s encouraging to see that there are some people in this world who understand, at least at some level.

My drug of choice is heroin and I absolutely love the moment I enter that warm blissful state of euphoria where I can simply just exist, and I don’t have to worry about the fact that I’m almost 25 and haven’t done anything meaningful with my life, or that I’m barely surviving financially and unless something unlikely happens, I’ll probably have to live like this for the rest of my life. Or that my mother has no retirement money saved up and I won’t be able to help her because I can barely help myself, despite the fact that she is such a good hearted woman and doesn’t deserve to live in poverty, especially after the hard life she’s already endured, or the fact that none of this matters in the long run and my existence on earth is simply long stretches of suffering with brief moments of “happiness” sprinkled in, if you can call it that.

Anyway, Dr. Banimahd, you mentioned that this is what you are fighting. How are you doing so, and what can you recommend to those of us that suffer from this existential angst in order to try and combat it?

I am sorry to say I don’t have a concrete answer. I educate whoever listens, I never turn most patients away, and I treat each as a unique human being trying to get them to see how important they are. I fight wherever the opportunity presents itself. But, in the end I will probably lose. You do the right thing not to win, but because it is right. Maybe we will make a dent:

Hope has two beautiful daughters: anger at the way things are and courage to try and change them

St Augustine

Stay angry and courageous kid

Well, what’s your stance on inpatient rehab programs?

For example, I’m still covered under my mothers insurance and could go to a 30 day inpatient program right now, but I have done so in the past with pretty shit results.

So I can either go to rehab and possibly lose my job (shitty little medical diagnostic tech gig), or try to get on suboxone and do it on my own.

You could do both. Depends on your use pattern and intensity of use. Find agood reputable program please but first make sure someone evaluates you and puts you in the right level of care.

You're a fucking awesome person and need to keep talking. A lot. Talk this talk all day long and you will do a lot of good!

Thank you for the kind words.

This is all I want to talk about. I will get back to you shortly on this.

I see this every day, I am in Northern Ireland where the legacy of "The Troubles" has left generations of people addicted to alcohol and drugs of many types, just so they can get through the day.

I am very familiar. Thank you.

Recovering opiate addict here.

Regarding 1 - zero past trauma in my life. The fact is, opiates just feel good. But deeper down I was emotionally stunted, and that was a big reason it spiraled. That’s how I coped.

I was in a fraternity in college, and I know a ton of people who binge drank like there’s no tomorrow on a regular basis. Of them, none are alcoholics today.

Of the 8 or so I used opiates with: 1 is dead, 1 is still active and has struggles with it, 4 are sober and turned things around, and the other 2-3 just never had issues. That’s a batting average of over .500.

Opiates are a monster.

Curious how your still know all 100+ people well enough to know they're not alcoholics. It can be a hidden addiction because it's possible to be a functioning alcoholic.

this is a very good point!

Thank you for the comment. Opiates are indeed a monster.

Is there such as thing as an addictive personality?

There always seemd to be something that I am "addicted" to. By that I mean both good and bad things. Hobbies, drugs, phone screen time etc

Yes, I believe so. I believe we all have "the potential for addiction" and many of us manifest that propensity in different avenues. Much of it is hidden. I believe the root of it is an unhealthy community and social structure that we occupy.

Are people addicted to sugar in the same way people get addicted to drugs? If so what strategies to break sugar addiction?

Yes. Absolutely. In fact, The most basic sugars are the most addicting. Looking at WHO statistics, they cause more mayhem across the planet than almost any other thing. The American corporate structure fueled by greed and the need for profits is a large culprit. Addiction is everywhere.

I usually advise patients to taper. Also, just the fact that I engage with them regarding quantity and the health consequences seems to have a therapeutic effect. Not very different than some of what I do with the classical substances of abuse.

Here’s my question. Are you planning to answer any questions?

Absolutely. I am getting to bed now though. I spent all afternoon answering questions today in various subreddits and at the pace this is going, I will probably be spending all day tomorrow (and more) responding.

I will get to all your questions tomorrow. If you want to check out the questions/answers from today, check out these posts: https://www.reddit.com/user/drbanimahd/posts/

Maybe submit the thread when you actually plan to answer posts?

Omg, hahaha. Do what he said. Look at his user page and his comments. It looks like he made an AMA post in many various subreddits with this exact same post, and so he has been answering questions from all of the subs at once, therefore splitting his time and attention in a way where it looks like he isn't answering many questions. I've never seen this approach. This is pretty funny.

Dr. B's assistant here.

We originally made posts on various subreddits to just announce the AMA and increase awareness but people started asking questions and Dr. B decided to respond to them anyway. Then we started getting more questions until we decided it prudent to make this thread early to consolidate and not have 10+ posts of questions.

Our sincere apologies for creating this post early and Dr. B being unavailable to answer, but I promise we will get to all your questions first thing in the AM (PST)!

What was the most counter-intuitive thing you've learned during your career? What common mistakes do people make when dealing with their addiction? Like things they think are for positive change but are more likely hindering

I find all of my immediate society counter-intuitive. The whole infrastructure of the individual and community is geared toward "magical thinking" as Chris Hedges says. Addiction is just a stereotyped manifestation of that same phenomenon.

The most common mistake that I find is that an attempt at self-management and use of other toxic pharmacotherapy often obtained illicitly but sometimes not. The biggest mistake that people make is thinking that they can outsmart addiction. The failure rate is 100%.

What is your position on the legalization of marijuana?
Can marijuana be used legitimately as an aid for quitting opiates or alcohol?

1. In general, I fully advocate the decriminalization but not legalization, of all drugs. The evidence is clear as daylight with the ideas of harm reduction and chronic disease model, as well as a humane, nurturing social milieu. In terms of marijuana legalization, it will go down the same road as everything else does in our corporate, capitalistic political economy. Overused and abused.
2. There is absolutely no evidence for this. The only reason that this idea even floats is marketing and our political economy that alluded to above.

Is gaming addiction(or addiction to social media, sometimes I feel anxious if I havent checked reddit for a few hours) real? Is it caused by some chemical changes in your body(like nicotine in cigarette) or is it mostly psychological? What is the best way to treat it?

Yes. It is always accompanied by chemical and even synaptic structural changes. The WHO added gaming disorders to its classification of diseases in 2018. The current treatment of choice seems to be CBT (Cognitive Behavioral Therapy). There is a lot of research in this area at this time. Be aware, more and more data is coming out in regards to mechanisms used by social media websites such Facebook, Instagram, to mimic the same mechanisms used in casinos/slot machines, which trigger salient behavior response. This is the classic definition of addiction. I hope that helps

After decades of drug use into one's 30s since teenage years, is it possible for my brain to go back to ever being normal ?

I believe so. Experts in brain/cognitive development have done wonderful work in the plasticity of the brain, well into old age.

What can you say about methods of treating food addictions? There’s no way of quitting food “cold turkey”, since people still need to eat. It doesn’t work like drugs or alcohol where you eventually just stay away from the stuff.

Cognitive Behavioral Therapy (especially in an inpatient treatment setting) is a great addition to many eating disorder treatment plans. Re-training your brain to not rely on food as psychological comfort & main source of dopamine, not viewing food as a reward but rather as a function of life.

I second this!

what is your opinion on the statement "you can get addicted to anything"?

is it even true?

​

also - what is an addiction most people have that they may look over?

1. In the appropriate context, I would have to say yes. Remember, part of the formal definition of addiction is that the use consumes the spaces in your life and your time to a pathological extent. I suspect that in a pathological society such as ours, much of this can be hidden. For example, we are a geared hyperconsumer society that others would find insane.
2. There are many. Work, food, sugars, and social media, shopping, social media--to name a few.

I hope you can see this and can answer.

What is the best way to provide the best evidence that you are NOT addicted? I am a pain patients whose mads were cancelled by a reckless GP who didn't even check my medical history (and I know this because they hadn't arrived to their office yet and I have been really suffering.

Like thousands of other pain patients, I've NEVER abused my medication but no matter how matter of fact and pragmatic you are and how much you know and how many medical records you bring and copies of scans and other tests, the doctors these days have non-falsifiable conformation bias that pegs all pain patients as drug abusers/addicts even though there is plenty of evidence that pain patients have been scapegoated by the system and those that abuse meds are a tiny minority, under 5%, yet this cull is causing strokes, heart attacks and other pain comorbid health issues and many MANY suicides. (Kind of rhetorical question here, why isn't suicide in the pain patient population taken as seriously as in other populations of medical conditions?)

I even considered going to an addiction specialist to try and disprove addiction behaviors (ie not seeking illicit drugs for non-medical reason, and for some reason I don't have a detox effect when I cease even quite high doses of opiates/opioids even though I'm been on them some time, so I don't get sick- but then I realized that if I had an addiction center in my charts, that is as far as the skeptical doctors would read when checking my history and they would assume the worst. Funny story about that, I told a doctor I didn't detox when stopped opiates and all she heard was "detox" and assumed I'd been to a detox center somewhere. they really ONLY hear what they want to hear.

Please can you help us? The unjust accusation is unethical, inhumane and it's a violation of basic human rights, but it is getting worse and many people are losing quality of life completely and dying

I am cross posting in r/ChronicPain

Thank you :)

Here is the thread I made:
https://www.reddit.com/r/ChronicPain/comments/du9jlb/ama_addiction_specialist_in_raskreddit_asking/

Your comment resonates deeply with me. It is actually worthy of a discussion and I could not do justice to it with a brief answer. The problem is we are a deeply reactionary society versus one that seeks answers through critical thought, rationality, and evidence. You have to realize that the indications for opiate prescriptions have changed to a narrow spectrum of patients. The only quick answer that I can give you is that you need to find a doctor and get evaluated, and get on suboxone for pain management versus addiction. Please take this with a grain of salt (not medical advice). Best of luck in a hostile environment. On my end, I will continue to educate professionals and the public alike.

Thank you for the work you do. I'm from an Appalachian state, and I was wondering if, and if so, how, your approach would change in a highly populated, relatively prosperous urban area vs a rural, economically underdeveloped area?

In general, I tailor my care to every individual patient. This includes not only the depth and breadth of their substance abuse but all of the psychological and socioeconomic factors involved. I believe this is critical. In my own practice, I have a few very high-end executives, while at the same time, I treat homeless 19-year-olds. For each one, I try to apply the tools and resources at my disposal to fit their needs.

What should chronic pain patients do in ERs to allow doctors to believe we are not addicts but are people in a lot of pain for some reason?

I am hoping negative attitudes and perceptions for both chronic pain patients and addicts are slowly changing. Having many years in the emergency department, I do understand where you are coming from. I think the key is for all of us to continue educating the medical community. I am working towards that end by lecturing at the medical school and giving medical doctors education classes whenever I am invited. There is no quick, easy solution.

There's a research study in the British Journal of Sports Medicine that concludes refined sugar acts on our brains in the same ways as cocaine.

Does this match up with your experience in addiction medicine? Do you think food abuse is a form of substance abuse? Thank you!

Absolutely, and the data has been clear on this for years. I responded to a similar sugars question above. Keep in mind, let us separate the simple sugars and their addictive properties versus general food addiction as an addictive behavioral pattern. There is a lot more data with the sugars and it seems that I can safely say it works exactly the same way as the hardcore substances of abuse.

What is your take on programs such as AA/NA?

No comment.

EDIT: In general, if what you are doing is working in a meaningful way--which means healthy, sustained, and long-term recovery, then more power to you.

What’s your view on current established treatments in psychedelic therapy, such as ibogaine, LSD, psilocybin etc, to address addiction?

I think the research going on is fantastic. I think it was disrupted many years ago for unfounded policy reasons. Beyond addiction, I believe there could be a lot of benefits, once the research is established, ie PTSD.

Came here to hear about his knowledge/understanding/current research on ibogaine treatment!

Also would be curious to see how microdosing (ie sub-threshhold dosages) of cubensis/psilocybin mushrooms affects addiction in the medical literature (if any research is out there)

Very little strong research that I can find to say anything with gravity regarding Ibogaine or microdosing. What I can say is that hallucinogenics, in general, may have great potential therapeutic benefit for a lot of mental health issues. The research seems to be very promising and I would be a strong advocate once we sift through the data with some clarity.

Hi there doctor. 2nd year med student here. I am involved in addiction treatment research as it relates to medical students outlooks and views on patients with addiction disorders, specifically OUD. My research involves providing MAT training to medical students during rotations, and a separate cohort during 1st/2nd year and seeing how it impacts students views. We have promising results that show there are improved views and outlooks on patients with OUD.

However, another area of research I’m involved in is naloxone treatment research. We’ve recently found a decrease in positive outlooks from medical students in their third and fourth year when compared to first and second. We believe it may have to do with witnessing overdoses and actually being involved in the treatment of patients with OUD

My question is this - have you noticed a shift of viewpoint in recent years on how both doctors and medical students view patients with OUD while being treated, and if so, how can we minimize negative viewpoints and preconceived opinions and beliefs before they are engrained regarding patients with OUD? Thanks for reading

Fantastic! I do some of the same work with the University of California, Irvine medical students. Let's link up and discuss further. Call my medical office and leave your contact information! Would love to chat.

949-347-8721

Where are we at with treatments for methamphetamine addiction? I’m a GP and this is a fairly big problem in my area.

Unfortunately, we are not anywhere solid based on validated clinical evidence. Different people seem to try different methods, including prescription stimulants, antipsychotics, antidepressants, etc. I personally use my own interpretation applying harm reduction at the individual clinical level. I have patients come in weekly and we do a frequency and amount inventory for the last week. We make it a very nonjudgmental interaction. I do some motivational interviewing. I assess the potential need for any pharmacotherapy. We make goals for the following week. I continue this until I get results. And introduce medication when I feel the time is appropriate. I do not have any data but I am happy with my own results. I hope this helps.

Crisis clinician that constantly sees SUD cases.

What is your opinion on your old colleague Dr. Emeran Mayer's work with the mind gut connection? Specifically looking at the connections between curcumin derived from turmeric and the role it has with mitochondrial growth. With this in mind, could this prevent cell death or possibly repair damaged cells in the brain from methamphetamine use/abuse?

I have peripheral and superficial knowledge. My guess is that it is too reductionist in it's approach and alot more research needs to be done to have a meaninful clinical impact. Couch this in my notion that we have quite a bit of understanding of what addiction is and how to treat it. We just need to quickly revamp much of our society:)

​

Hope that helps

What are your thoughts regarding the impact that a broad legalization of all drugs would have on drug use and addiction?

I believe in decriminalization but not legalization as well as the following:

-Education for all

-Universal healthcare, treatment and education for addiction

-Dissipation of the prison industrial complex, medical-industrial complex, military-industrial complex

-Co-ops but not corporations

Imparting with each individual in our society with human rights, dignity, and empowerment for their self-worth

I would be out of business and no more addicts to treat. I hope that helps

Why hasn't he actually answered anything? So frustrating.

I apologize. I am new on this and my team navigating just left. We answered a lot today. Tomorrow morning we will answer all day. Thank you for your patience.

I have several friends that have been severely impacted by addiction so this hits close to home for me. Thank you for your work.

Two questions:

Given the emerging research around the Dormant Mode Network, have you researched the potential impact of psilocybin and/or LSD on breaking down the network?

Also, is Ibogaine, in your opinion a plausible course of treatment?

I am not very familiar with the clinical utility of the work. I am very hopeful about the research being conducted on hallucinogens in general.

As far as Ibogaine, I feel that robust research just needs to be done and there may be potential there. But, at this time, it seems to be more hype and gimmick as well as have potential negative health consequences.

Has the academic and research community come any closer to understanding what drives the craving that seems to accompany addiction?

Yes. The neurobiology and anatomy of craving are relatively well understood. Dr. George Koob, head of the NIAAA, has spent his life in laying out, conceptualizing, and describing these pathways.

What would, in your estimation, be the ideal ecosystem of programs and laws to end the epidemic of opioid abuse?

1. Decriminalization but not legalization of all drugs
2. Education for all
3. Universal healthcare, treatment and education for addiction
4. Dissipation of the prison industrial complex, medical-industrial complex, military-industrial complex
5. Co-ops but not corporations
6. Imparting each individual in our society with human rights, dignity, and empowerment for their self-worth, growth and development as an autonomous living entity

Apparently addiction "runs in the family" according to a DNA test. I'm wondering what this actually means.

Also, do addicts have any permanent changes to their brain due to prolonged use depending on the drug?

1. Nothing and everything. Nature vs nurture is very misunderstood and often interpreted wrong. It does not help when it is fueled by marketing and for-profit companies ie genetic testing companies. In a short answer, think of genetics as nothing more than a PREDISPOSITION or PROPENSITY towards addiction. One has to understand the spectrum from the physical to the environmental, what that means, and how it really plays out.
2. There are definitely changes in synaptic architecture and biochemistry. "Permanent," I disagree. I feel strongly that neurodevelopment research at the bench and bedside is quite strong in showing that neuroadaptations can occur into old age. This is critical because the traditional thinking has been that the elderly can not learn or make cognitive and behavioral modifications, in a sense.

I'm a little confused as to why addiction is considered a disease, can you shed some light?

"Addiction is a complex disease of the brain and body that involves compulsive use of one or more substances despite serious health and social consequences. Addiction disrupts regions of the brain that are responsible for reward, motivation, learning, judgment and memory."

"Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioral, environmental and biological factors. Genetic risks factors account for about half of the likelihood that an individual will develop addiction.

Addiction involves changes in the functioning of the brain and body. These changes may be brought on by risky substance use or may pre-exist.  

The consequences of untreated addiction often include other physical and mental health disorders that require medical attention. If left untreated over time, addiction becomes more severe, disabling and life threatening."

Nice answer.

I would only add this: Since we have defined it as a disease, and we claim that, at least for opiate addiction, and we have pharmacotherapy, we can measure the outcomes for improvement. Keep in mind that a disease is a complex construct that does have environmental influences. For example, diabetes has different outcomes given your environment, and not just your physical makeup. What you eat, what you can afford, what family and cultural habits are, what your society promotes as healthy or unhealthy, etc. In this same light, addiction is a disease but with a lot more complexity and environmental abstractions.

What are your thoughts regarding - and direct experience treating those affected by - the recent surge in the manufacture, availability, and use of of RCs, “designer“ synthetic drugs, and analogues?

I feel like cannabinoid and opioid analogues get the most news coverage, but my specific interest is about your experiences with benzo analogues and your views on long vs. short tapers, among other aspects of treatment, and the potential for permanent brain injury.

Thank you for doing this AMA!

1. Benzo analogues. I have had scary experiences with them as people have overdosed buying this stuff on the internet. This problem is compounded by the fact that drug manufacturer labs (namely in China) tweak the chemical structure of a substance to bypass legal restrictions. These entirely new compounds, wholely untested, should not be consumed, and yet they are used and abused. The benzo analogues especially come to mind, particularly with the spread of pressed benzos.
2. Benzo taper. I do not believe the approach in this country is clinically correct or humane. Part of the reason is that the payment structure for rehabilitation programs and office visits essentially rules the correct approach out. The correct approach is a long, highly monitored, continued engagement taper depending on your age, comorbidities, amount, and length of use. This is what the international literature dictates and this is what I try to do. Often times, I get no reimbursement but I am rewarded with successful outcomes. I hope this helps.

Can you offer any advice on how to improve care coordination and patient engagement for substance use disorder patients?

I am currently a part of a team developing an opioid treatment database to be deployed within my state. The system's overall goal will be to improve coordination of treatment between programs/providers and better connect patients with resources within their community. As you know, many times these patients are transient, homeless, or otherwise difficult to contact once they leave an outpatient or inpatient treatment program.

Thank you for the work you do and for advocating for MAT.

1. Look into Hub and Spoke model.
2. Either in spirit or letter, implement a harm reduction mentality and a chronic disease model approach.
3. Get rid of as much paperwork and bureaucracy as possible.
4. Utilize law enforcement as an advocate for treatment versus punishment

I hope this helps. If you would like to speak more specifically, call my office and we can set something up. I can also connect you to some of my colleagues at the university.

949-347-8721

Have you noticed any difference in the drugs of choice between patients in Laguna and those at KCMC? It's certainly a different demographic.

It has been a few years since I have been at Kern. But, at that time, it was a wide variety of PCP, spice, methamphetamines and benzos. In OC, I see a lot of meth, benzos, and heroin.

Hi! Banimahd! I'm fairly fresh but my first clinical job were at a university addiction in patient setting. I have the following questions:

1: One of the most frequent "medical dilemmas" brought up in medical ethics talks is what to do in the case of a drug addict (I know we say substance use disorder but it's not how other docs term it) or a former drug addict that is in the hospital for a somatic reason. A surgery or injury or something. Now the dilemma the treating doctor is facing is do I increase the opiats when the patient claims to be in pain or do I then risk to either support a ongoing addiction or spiral someone back into previus addiction. I would always advice to give the medication because my logic is that if the patient already is addicted the hospital morphine is way better than street drugs and if they are not the safest way to push them back into addiction is to leave them in pain so they go back to the streets for painkillers.

Now, do you agree with me or do you have another view? Is there relevant research for this predicament?

2: How do we find the balance where we can still use benzos to treat the patients that truly need it (not talking about treating withdrawls but other indications) but not risk making people addicted?

3: What are your thoughts on pregabalin? It seems its use is increasing and people sure hate tapering down.

Thanks!

1. I agree with you 100%. Keep in mind the hyperalgesic effect of opiate use, so they might be more in pain than the average patient. This is harm reduction. This is humane and the benefits outweigh the risks.
2. Close monitoring, continued engagement, and the lowest dose possible.
3. I don't have any thoughts on pregabalin at this time but I do have thoughts on gabapentin. It is a substance of abuse, especially in the younger generations.

Have you studied addiction to social media or technology? If so, what can you say you've found out about these addictions?

I am starting to vigorously. It is horrifying. In fact, I just heard a fantastic lecture from a researcher at UCSF. There is also some NSA data I came across once. Can I leave it all at that. It is simply very concerning.

Good morning everyone! I did not expect so many questions! Blown away. Since you guys have asked so many questions, I'm going to start early and get answering now. It is 8:02AM PST

have you ever seen an addict truly recover or at least never relapse? or is it true what they say you’re an addict forever?

Recovery for me means certain psychosocial metrics that show that you are embedded in your enviroment in a healthy productive way, for a sustained period of time. I do not like to use the term "Addict" or "Alcoholic for life" because that does not determine who they are any more than a person's disability defines who they are. I like to think of it as sustained remission of a chronic issue and that is what we aim for. Vigilance is important for exacerbation of the issue. That is how I like to put it.

What are your views on Kratom?

Please view my posts in the /r/rquittingkratom subreddit. Great discussions yesterday

What is your opinion on safe injection sites? My local community recently added one and it has been very polarizing.

1. What community? Where do you live?
2. I am a categorical fan. It saves lives and any argument otherwise is prejudiced, cognitive dissonance, and magical thinking. This is harm reduction at the core, with more evidence than I can cite here. If you want to see something interesting w/ regards to this topic, keep an eye on Orange County news in the next couple of months :)