America in Pain. Why no one cares…! Claudia Merandi, President, Don’t Punish Pain Rally and The Doctor/Patient Forum & Beth Dost, RN

John Malanca 0:00
Welcome back everybody. This is John Malanca. With united patients group be informed and be well, we have two special guests today we have Claudia Marandi, as well as Beth Dost, who you’ve seen on our show a few times. She’s been a friend of the United patient group, a friend of Corinne and I and we’ve done a lot together so thanks for being on and we’re gonna be talking about pain and this is a big subject not only here in the US but around the globe and we have two specialists The first one is Claudia Marandi she I won’t mention your name, Claudia How about that, but she’s the founder of the national don’t punish pain rally organization. Claudia, a retired court reporter self published author is from East Providence, Rhode Island. As a person living living with severe Crohn’s disease since a child she witnessed firsthand the challenges a person with pain encounters when trying to obtain adequate pain management claudian 2017 created a don’t punish pain rally organization Focusing on organizing pod excuse me protest rallies throughout the country for people with pain who could no longer access pain management due to the 2016 CDC opioid prescription guidelines. She started with five members today there’s 1000 members, congratulations for that across the country. There’s chapters in Canada, Australia as well as the UK. And today Claudia works with doctors throughout the country who have been targeted unfairly by governmental agencies and medical boards. She can be reached at see Marandi the number one at Cox dotnet and I’ll give I’ll put all that information in there as well. And then you’ve also authored a few books, Dotty on the potty but Claudia Marandi and krones the other seaward Crohn’s disease court reporting you custody battles. Welcome Claudia and also do best intro Beth dos. She is an RN, a senior healthcare consultant who is a first nurse to stand for the humanitarian use of medical marijuana in 2012 and master’s juices. She is the clinical director of the Massachusetts patient advocacy Alliance MPa, which promoted the medical marijuana bill. Beth, a former oncology ICU er homecare and hospice executive currently advocates publicly for safe access to cannabis for those who suffer and have been marginalized. She’s been featured locally and on numerous national broadcast mediums. She expanded her advocacy work focusing on cannabis therapeutics, educating, educating and policy creation while raising awareness of the embedment of pain patients who rely on prescribed opioids and the attack on the doctors who care for them. In 2000, Beth was diagnosed with three chronic pain conditions, thus joining the approximately 50 million Americans who chronically suffer since 2008. She’s been treated by 13 physicians for intractable pain, one of only about 17 million intractable pain sufferers are experiences of being stigmatized. And decriminalized against in her quest for adequate pain control has galvanized the resolve to help. And she speaks openly about the state of suffering in America. Beth was awarded the Ernst and Young Entrepreneur of the Year in healthcare, and is a member of their entire alumni group. Whoo. That was a lot to take in. Ladies and gentlemen, how are you doing? Both? Yeah.

Claudia Merandi 3:23
Hi, john. Thanks for having me.

John Malanca 3:25
Thanks for having being on the show here, ladies. And let’s talk about pain. And so you you both have experienced pain with your patients but for yourself. And let’s talk about what’s going on in the us right now. You know, because a lot of doctors are under the, I guess the microscope of how many prescriptions they can write, and what their their I guess what the government has from it. What just happened last week was a friend of mine brothers Just passed away. Because his, his doctors stopped writing narcotics or excuse me opioids for his pain. And he went to the street and led to

Claudia Merandi 4:12
his dying.

John Malanca 4:13
And so right. It’s sad because the family’s like, he was an addict. He wasn’t a homeless gentleman. I mean, you have this image of an attic of a homeless person in the alley, stealing felon, etc, etc, etc. and the outcome could have been solved could have been helped. And so can you talk about what you have been experiencing Claudia, which brought you into this into this industry, I guess, and why are you kidding why you’re the voice for millions and millions of people?

Claudia Merandi 4:41
Right? So I lived in a hospital for about 10 years on and off. I raise my children from there. I ran my business from there fought a custody battle. I have severe Crohn’s disease. And I’ve had it since I was about four or five years old. I think probably seven years. ago, I started to hear the term drug seeker. And I live in the smallest state in the country. And whenever I was at the hospital, which was every, usually every two weeks, I would get admitted, I always had an advocate with me, my mom, and she looked at me, she says, Oh my gosh, she’s like, you need to have legislation regarding this because you’re treated like a criminal. So that’s what I did. I went on social media 2017 and I said, I’m going to organize a national protest for pain patients. I started with five members, there’s over 10,000. And the response has been, like so sad because there’s millions that don’t know about us and we need to bring awareness. Just a brief synopsis. Why are we here? So we have anti opioid Crusaders in the country. One is Andrew kolodny. And there They’re not even pain management doctors and they’ve created this organization called prop and prop helped create those 2016 CDC guidelines in secret from the FDA. They approached the FDA and the FDA said no way we’re not going to put any arbitrary limit on how much pain medication a person needs, but the CDC did. So once those CDC guidelines went into effect. Many states actually turned them into laws regulations, and they were grossly misapplied misinterpreted, and they were really intended for primary care physicians, but there was so much confusion. And with the confusion came the DEA targeting doctors because it was just a great way to you know, latch on to low hanging fruit, and instead of the DEA focusing on the real culprit, heroin, illicit fentanyl. They went after Pain Management physicians. Fast forward four years later, thousands of suicides thousands more of legitimate pain patients who hit the street and a desperate attempt to live a pain free life. And the sad thing about this is we have, I think 9000 deaths associated with overdoses. But when a doctor loses a patient, the government has taken it upon themselves to call it an overdose. So if somebody has a heart attack, and they have an opiate in their system, it’s going down as an overdose because that’s revenue. So anti opioid Crusaders have essentially created that the opioid crisis because we’re now driving up our overdose rates and prescribing is at an all time low since 2011. And overdosing is at an all time high. So pain patients have Become collateral damage. By the time doctors find me they’re broken. They’ve been targeted by the, you know, the unscrupulous DEA. When they they’ll usually plead because their doctors, not lawyers, they were afraid. And the DEA, you know, breaks down the doctors door in the clinic terrorizes these doctors. They’re robbed of their medical license their DEA certificate, they can no longer prescribe. The patients become collateral damage. The Attorney General’s make money, seizing their assets. And there’s one message right now. And the anti opioid Crusaders are just pushing for our country to be an opioid free country unless the person

Unknown Speaker 8:53
can take buprenorphine, Suboxone and it’s just a disgusting vile attack on the pain patient. My patients, they’re elderly, they have rare disease. They have advanced stage cancer, my veterans don’t have limbs and the cruelest form that’s been brought to the country because of those 2016 CDC guidelines, which I’m confident will be rewritten, hopefully in a better light. Patients have been forced to choose their benzodiazepine, or their opiates. And you can absolutely take both safely. The reason we’re here is because of hateful anti opioid Crusaders. I’m a mom to two teenagers. So I’m all too familiar with what I don’t want my child to do. And of course, I would never want my child to get their hands on opiates, but they’re, they’re going to be informed on the issue. All of this work that we poured into the fake opioid crisis, our overdose rates are sky high, and we ain’t seen nothing yet. Because over the next six months post COVID, it’s going to get more Worse

John Malanca 10:01
you think with pain and also you know my fear with a lot of a lot of patients that I’ve spoken to on a regular basis that are in the midst of COVID depression seeking in and they’re talking to their doctors about it you know other medications for that as well and that which is another type of pain you know you have pain of going down the rabbit hole of grief is another one too. So, Beth your pain patient or just your pain advocate I should say in you’ve been on the show quite a few times talking about pain and so can you add to that because you work with a lot of pain patients and I love what you’re talking about Claudia, I didn’t realize that you work with the doctors and you really fight for the doctors to stand up for them because a lot of times doctors don’t have time one but also, you know, know what to do with the next step and when you get threatened that your that your medical license is going to be yanked I mean that’s that’s a that’s that’s it. That’s major threats.

Unknown Speaker 11:02
JOHN, we have doctors in prison. 40 years. We have doctors in prison 20 years. I just want to add one thing, john if I could before Beth speaks, because I’m going through menopause and I don’t want to lose this train of thought.

Unknown Speaker 11:15
I wanted to speak as long as you want.

Unknown Speaker 11:19
I just want to take john through the life of a pain patient because Beth is going through this right now. There’s the life of a pain patient. First, you have to find a doctor who is willing to prescribe you have about a 30% chance in our country today of finding a doctor who’s going to prescribe now most patients white knuckle it driving to their pain management visit because they’re not sure is this the day I get caught off. When you get to your pain management visit you’re going to see but you’ll be seen by a random anesthesiologist one time and then you’ll be seeing by a nurse practitioner or a PA who doesn’t know your history. You’re going to be subjected to a urine drug screen in that urine drug screen if they ever find cannabis in your system. You’re booted, no THC, no CBD some pain, pain management facilities will not allow you to take melatonin, no kratom nothing that’s plant based is accepted. If you fail your urine drug screen, you’re booted, you’ll never get back in and it’s your tarnished. If you’re fortunate to find a doctor, you have zero problems with your urine drug screens which are 70% prone to human error. When you drive to the pharmacy, you have a 50 50% chance that the pharmacist is going to fill or not fill. The reason they may not fill Is it because it’s above the 90 daily morphine equivalent. Because the CDC and they’re not infinite wisdom put an arbitrary limit on how much pain medication a person should receive. Why Once again, that goes back to Andrew kolodny and malenky. All of the anti opiate opioid Crusaders whose one goal and they’ve been very successful because they’ve been bhusal The country is to. They attack pain patients in an effort to heal their pain of a loss. Once you get to the pharmacy, your pharmacist will say, Yes, I’m filling. No, I’m not filling. But this is probably one of the grossest things that’s happening to patients is the pharmacist will tell you, you need to fill another script. Well, what do you mean I only need one script to be filled. No, no. The DEA says wait a minute hose the DEA because if you’re an elderly person, you know who the DEA is, but the pharmacists will say you need to fill not one but three non opioid script scripts. So now you’re going to have unused scripts. littered around your house, which is dangerous, right? What if somebody gets their hands on those scripts, you’re going to incur maybe six $700 extra monthly. But these are desperate people. My veterans don’t have limbs, and this is what they’re being subjected to. Now, if your pharmacist will agree to fill it, don’t worry, chances are your insurance carrier will not cover opiates. This all goes back to those grossly misapplied misinterpreted CDC guidelines that were created with the help of anti opioid zealots who are making hundreds of thousands millions of dollars by promoting Suboxone, buprenorphine, it’s all about the money at the end of the day. We’ve had 9000 overdoses a year since 1999. But yet in 2017, we had 488,000 alcohol related accidents. We have innovation dosing problem, but it ain’t from swallowing pain pills. It’s from illicit fentanyl and heroin. But I just wanted to take you through the joyous life of a pain patient.

John Malanca 15:10
You brought back some memories. What Chris and I went through, you know, ever we spent a day down in Stanford University at the oncologist Friday afternoon. Normally an hour ride it was two and a half hours because we got other 532 we’re in bumper to bumper and shoes and so much pain. We get back home, I go to our CVS pharmacy, and they would not. We sat there for good two hours because they wouldn’t feel it because she had already had a I think it was five milligram narcotic that was already prescribed. They said no, it’s not the 30 days I I just sat there and it’s like, my wife needs us and I pleaded with the pharmacist tears in my eyes. After going through we went through and I said You know, she needs this and they ended up filling it, but it took me area and I and I went back after she passed. I went back and shared just thank you for listening to me and not and and I guess thinking outside the box or going around the law if you want to say sorry, Beth, you’re still here right

Unknown Speaker 16:21
here. There’s a slice of hope after 19 months of working with lawyers, we are filing a class action lawsuit against large chain pharmacies in my home state of Rhode Island. This insanity will stop. This is referred to as the pain patient genocide. Those CDC guidelines specified these CDC guidelines will not affect cancer patients or sickle cell. They affect everybody now, only the privileged receive pain medication. It’s disgusting. It’s the most abrasive disgusting attack on the disabled community, the most vulnerable community in the country, and it’s going to stop. And I’ll tell you what if I have to run for Congress in two years, I’ll run because I’m, I’m going to start snagging up people’s seats at this point, because I’m in Rhode Island. So I can just go knocking on doors at this point. It’s going to stop

John Malanca 17:19
the smoke the smallest state in the union. Is that is that? That is

Unknown Speaker 17:23
the biggest little state in the union. Yeah, yeah.

John Malanca 17:27
Invest. Sorry, I know you’re here.

Unknown Speaker 17:33
What Claudia said about the pain patient experience, rinse and repeat. Because it’s every 30 days. It’s not go there. You see your doctor annually, and then you get your scripts renewed? Oh, no, no one calls you to renew and opia No one calls, but they’ll call you ad nauseum to renew like, Listen, you know, my father was luck. It was integral to your high blood pressure. But no one. So it’s every 30 days pain patients go through this rounds again. And these patients can have years worth of long standing history of very good compliance and good pain relief. And now all of a sudden, they’re living in terror as their physicians are forced tapering them down off their opiates, which is simple.

John Malanca 18:23
Well, if you mentioned living in terror, but you know, I worked with patients that like you said, Claudia 50% of the time they’re driving down there, are they going to fill it but they’re not going to fill it? Or they’ll say you know, you have your your your script that will say for 30 pills, and they in the pharmacist receives a pill that we need to lower mountain so the doctor has a 29 and they said no, we meant 10 not 29 when we say fewer and so what’s happening right now, with with what you’re going through, I know you’re doing a lot are you working with your local State governments. What can you recommend for patients that are going through this that are watching the show right now?

Unknown Speaker 19:07
So I have legislation that’s passed the House unanimously. This basically stating chronic intractable pain patients need opiates. And I’m, you know, my version of my bill has been carried into, I think six or seven other states. And that was the goal when I created this legislation. But not everybody lives in the smallest state. So it’s hard to get down to your state house, but nobody was willing to cover the plight of the pain patient. Because of those hateful anti opioid Crusaders. They’ll say, Well, the reason that they’re you know, they’re in pain is because they’re hooked on their their drugs so that the anti opioid Crusader such as Prop, you know, they’ve not only exposed people who have lost loved ones, they’ll use them as pawns to attack pain patients. What you can do is first join the Facebook page don’t punish pain rally. We protest again on October 7. And constantly hound your federal senators, all federal senators are aware of the issue. Now your local representatives, some of them, you know, they sell cars during the day and they practice medicine at nighttime. They don’t know this is happening unless they were affected. I think what I had going for me as I started to advocate for local lawmakers, not everybody. Well, nobody does. I’m the only person in the country who does what I do. I take people to pain management. I accompany them to the pharmacy, and I can tell you what, when I’m in the room, the nurse practitioner or the PA or the doctor always seem to take on a different tone when I’m in the room. Don’t get me wrong. I mean, I wouldn’t be prescribing in this day and age because Your the medical board keeps track of every pill that is dispense. What the medical boards do is they print out the highest prescribers and then they hand it off to the DEA. And that’s how these raids start. So the DEA, knocks on the doctor’s door terrorizes the patients, they’re in Swat gear, weapons drawn, and the patients, they’re like, Oh, my God, what what’s happening and the doctors, sometimes the doctors will usually know this is going to happen because they’ll get alerted from a pharmacy. But the two tools that were created to protect the doctor are actually used against the doctor and one is those urine drug screens and the other is the pdmp. It’s going to take a while to ever eliminate those because

John Malanca 21:53
it’s embarrassing for the doctors. When Chris and I were battling her cancer. We went To an ER doctor up here in the Bay Area recommended American doctors been down in Mexico for last 18 years. And they said, I think you should go down and I said, Come on, I’m not gonna be that husband that takes his wife down to Mexico. And we did it. And I would do it again. And he was just tired of constantly getting rated, spending all this time in court and winning and winning. Emmys. You know what, forget this. I’m moving down there. And if the Americans want to come down when we went down to his clinic, professional, clean, and you had patients from all over the world, not only South America, Asians, Europeans, Americans, US athletes, you know, on his wall, I mean, he was a clean, he was just tired of doing this. You made a point earlier about lawmakers don’t know unless they’re, they’re affected. It’s the same thing the cannabis industry, you know, cancer will unfortunately will affect us all. Some way if it’s, God forbid us a loved one a spouse, you know it will and, and, you know, I don’t hope no one has to be in that position but it’s I don’t want to say it’s life but, you know, paint cannabis with Corrine did not work with her pain. And that was all and that was wrong. That really bummed me and her out because like, God, we’ve been advocates and I share with pain patients everywhere all the time on our show is I don’t want people to think cannabis is the golden pill, the golden ticket that will help and I never have to use the word cure that that is that will help everything. And it worked with her father, my father in law, but it didn’t work with her in regards to pain or attacking her cancer cells. You know, she didn’t want pain pills because it didn’t make her feel good. So what do you say for patients? Let’s take the other side. So what if you have the doctor or the or there’s other advocacy advocates See groups that have lost a loved one with with pain pills and say, you know, banned all opioids, it’s bad, bad, bad. And you must get that.

Unknown Speaker 24:12
You know, actually, I don’t, because I’m, I think an educated person who lost a loved one to an overdose. Chances are their loved one struggles with addiction. Let’s face it, if you’re an addict, you’re probably predisposed to addiction. And I’m sure there was not all the time because some people just get hooked on pain pills. And that’s just the way it is. But we find and research will prove over and over and over again, if there was an underlying condition with addiction. It started when they were younger, and a lot of senators. A lot of my Southern senators believe that cannabis is the gateway drug. I don’t buy that. I think if you’re predisposed to addiction, you’re going to struggle with a food addiction and out alcohol addiction and opioid addiction, a sex addiction. What? Learn more about that’s okay. But it’s, um, it’s it’s not. It’s not common to meet somebody and when they say, Oh my gosh, my son took one Vicodin and he went right to the street and he got his hands on heroin. Yeah, that doesn’t happen, you know and the fact that these anti opioid Crusaders, they they profit off of people who lost loved ones to addiction and addiction tears the family apart. It is a debilitating illness, but so is Crohn’s disease.

John Malanca 25:38
So it’s what you went through as well. Let’s talk about what what is your definition definition of pain management or bethlen? How about you what what’s your definition of pain management and we’ve talked about this of pain management and the importance of a pharmaceutical but also important to have combination. Can you talk about the benefits Combining cannabis with a pharmaceutical a pain payment.

Unknown Speaker 26:07
Well, so we always talk about combining pharmaceuticals with cannabis and usually in the hope that people can wean themselves down a little bit off their pain medication. Usually it’s an opiate. However, as Claudia just stated, and you stated, john, and I’ve stated multiple times, we’ve been to conferences where we have seen the isolates. They’ve been able to isolate the various components of the planet, and it really does not show any action against severe chronic intractable, hot cannabis can have, especially depending on people, their endocannabinoid system, the receptor Phil when they take plant based cannabis to enhance their and flush their endocannabinoid system with identity receptors, they can have a feeling of overall wellness. And they can also have better sleep. And so people like that. people that enjoy getting mildly intoxicated, and that it makes them feel good, that can also help their experience of pain. But as audio said, if you’re getting kicked out, if you take opiates and cannabis and then and cannabis is when it shows up in your urine screen, and then you can’t get your opiates anymore. You’re not going to be very happy because that cannabis is not going to take care of your pain. But when it does, there is nothing like an opiate to take care of chronic supports and fear and often intractable pain. And this is not just chronic pain patients that we’re talking about. We are seeing the spillover now into post surgical patients. We’re seeing the spillover into post accident patients in my family, but the family members had an accident, a lot of damage to his face. And he was sent home with four or five milligrams that lasted him through about I want to say maybe 10 hours, because

John Malanca 28:20
that’s not a lot is what you’re saying

Unknown Speaker 28:21
or is very small five milligrams is very small and not every opiate is created equal. So the gold standard opiate care, an opiate, if you were to look at opiates, the gold standard is more. So they are that’s why it’s morphing. That’s why the CDC guidelines are 100 morphine milligram equivalents, then everything else is can be put up against the efficacy of morphine. So I lauded and fentanyl are stronger than morphine. Very clean, metabolized without with very little metabolites. People get very good pain relief from the fentanyl is dispensed in micrograms, like a thousandth of a gram, like, like smaller than a hundredth of a milligram. They’re very, very small doses. And you’ll see here people will take 25 micron 10 like patches, and then put them on an area that has fat, and it’s a slow release of fentanyl. And then they’re also prescribed if their doctor is skilled at pain medication, which we’ll see doctors are they’ve gotten in trouble. They’re often prescribed a breakthrough. And a lot of times that’s oxy Cotto, which is pure Percocet. Oxycontin is a slow release Percocet and what addicts like to do with oxycottons chew it, because then they get that full on 12 hour effect very quickly. And that’s what happened. But one of the things that we talked about in the change, okay used to be the fifth vital sign. And that’s because in multiple studies, people that didn’t have a voice, especially hospitalized patients that had experienced extreme pain, all conditions are certainly People that didn’t have a voice, including children were under medicated for pain against their peers that could express that they were having pain. And so, if you look at then the phenols the dialogue added the morphine, then you have typically the oxy cotton, Percocet, mocha Damn, that just means that it’s a combination therapy one as Tylenol one as aspirin. And then you look at the vitamins, they’re sort of like, oh, and they have vitamins like profund. One has motor and one has Tylenol. And then, like the colons kind of come down below that people are quoting has a great, great action against coughing. So it suppresses coughs. That’s why it’s in cough medicine. So people are coughing, it’s out now they have to cover their brains out. You know, they’re they have a respiratory virus going around the country. And if you get you can’t get relief from that so you’re up all night. I don’t know how that’s good for you. People get headaches and fever. Yep, coding could be described and used to always be imposter ups and I can remember having old cough syrups because so few people with pain actually become addicted to opiates that most people just self you’ve all you’ve all heard the stories about. The kids have gotten four wisdom teeth pulled, by the way that can be if they’re impacted that’s a big surgery in your mouth to get sent home with typically by get in and they might have taken a maybe they take for two days. And then they say, you know what, I don’t really like the way this feels anymore and then you’ve got it. So when they call back unused opiates, the government called them back they said grab it take back day six, wasn’t it 6000 tons of was like a massive amount of opiates was 6000 pounds or times nationwide, people turn them into their most so obviously, most people take their opiates responsible response. But there’s a pathophysiology to pain. So short term as acute. If it goes into a chronic, more than three months, if it lasts for and we’ll get on that, and it lasts more than six months, you’re probably going to be in pain for the rest of your life, you’re probably going to be in pain because the body gets very smart and pain, where does pain occur in the brain, that’s where the receptors are. And so if you were to touch a hot stove, get that get full of the hot nose and pull your hand away because that whole signal goes up through the great horn of the spinal cord up to your brain perceive it full. Now, if you’re constantly bombarded with pain, chronic pain, consequence, consequence constant. The body gets really smart. It’s sort of like laying down the highway on a very high traffic freeway. And so the body starts laying down more receptors to receive the pain. Because you’re overwhelming the brain. So that’s always been the goal is to cut off the reception of thing. You’ll see a pain patient that’s totally incapacitated. They take the right dose of an opiate within an hour, they can get up into longer. It’s as long as they don’t have any other physical. I have invisible pink, so people don’t know I have it. And so as I tell Claudia, she has invisible thing you wouldn’t know Connie had been unless she told me so there are a lot of people walking around that we don’t see that we don’t know have chronic pain. And so they’re I always say they’re great pretenders all. And if we look at, which is what I said, if we look at Primo Levy, who will was a Holocaust survivor and poet and just an exemplary man, wrote that if we know that there is pain, if we know that there is suffering, and we do nothing to alleviate it, we ourselves become mentors in this country. It’s a guest the World Cup organization, even against it’s more common to allow people to suffer like this and yet it goes on every day in a civilized country in very specific ways. Pharmacists have been empowered, and they have they override the physician and the physician is being disempowered. And I just heard a report that in 10 years, I don’t have any interest. Yeah. physician.

John Malanca 34:27
You being a hospice nurse and talking about pain and end of life, I mean, they’re okay with that. Take as much as you want more and more and more, and I personally think that human euthanizing,

Unknown Speaker 34:39
actually they’re not anymore. That’s part of that’s also an issue. Yes, they’re starting to have trouble getting opiates for hospice pain. So this is not just it’s going to affect everybody. So and when I was with quiet had the privilege of being with Claudia in front of the road, One legislature. And in particular, we had a patient there that suffers from severe, very rare Ll Sandler’s, which she is supplicate they can dislocate them very loosely so they can dislocate. They can roll over their shoulders, extremely painful. So when she got up and she described her life and she said that she had to say, in pain medication because she had been tapered to take so she could testify. Yeah, all the legislators were like this because they just don’t know. You know, one of these things you don’t really know until it happens to you. But this is something that you

John Malanca 35:42
know, so Claudia you You know, I’ve worked with a father actually, that was talking about into life with his son and he was denied cannabis in the hospital and so in his any last four weeks with the sun had eight weeks and they finally allowed him to use cannabis but he’s doing something called Ryan’s lawn is for determinate terminally ill allowed to use cannabis in hospitals, you know, to defeat that pain, but like you he went to our Senate and legislator and had unanimous unanimous both sides of the aisle that said, You’re right. Let’s do it. And then our governor Gavin Newsome write it. And then when it stuck because Gavin was he wanted the cannabis vote. He got the cannabis vote. He’s well, but so is that is that

Unknown Speaker 36:34
shysters john, they’re shysters. At the end of the day, they’re politicians. Cannabis needs to be legal. Period. End of story. We’re having the same issue with kratom kratom has not only helped addicts get off of heroin, but it’s also been a lifesaver for pain patients. But we need to have The Safe cranium act so people know they’re getting creative from, you know, a safe vendor and I don’t use kratom but I’m support. If it works for you, then you should be able to access it. But the the narrow mindedness of some of these senators they really believe it’s the they’re thinking of cannabis is just so warped where they still think it’s an evil drug and I don’t use cannabis. I you know, I tried some of the oils, but it may be a little loopy and I have to fit a lot of hours in my day. But the fact that my pain patients can’t use cannabis, in combination with their opioids is is lunacy because it’s all it’s the Controlled Substances Act that needs to be done away with the Controlled Substances Act was created. To stop the drug deals to, you know, for the cartel, but now it’s used in the doctor’s office. And it was just it’s low hanging fruit and the government. They’re just so desperate to spread the false narrative. But I think that’s what our government does is they they create this false narrative and the media jumps on board. And it becomes a real nightmare for both cannabis users and opioid users and creative users. It’s just a shame. What we do have going for us and this is just a sliver of Hope is the AMA on June 18. put out a press release stating the AMA urges the CDC to revise opioid prescribing guidelines. And Jama also put out a piece saying you know what, prescribing is down yet people are still overdosing. So those are two real powerful pieces. Without having to burden your lawmaker, because I’m really not impressed with most lawmakers and I sit down with and sometimes I just don’t even have the patience because they’ve just they’ve been polluted by the media. And you know, Senator Whitehouse

Unknown Speaker 39:20
she’s a doctor. So there you go. It’s true. I mean, Charlie Baker was very instrumental in the opiate.

Unknown Speaker 39:27
Oh, God. Yeah, yeah. And because he works in tandem with Brandeis University, and Charlie Baker gets millions of dollars in federal grants from the makers of Suboxone from buprenorphine, and how much money are, you know, are the senators getting from pharmaceutical companies? How much are they donating to their campaign funds? So we’re just in a time where you don’t know what to believe what’s really sad is that if you’re on a ventilator in North Carolina, line with COVID there’s a good chance your doctor will not keep you comfortable with opioid opiates because they’re afraid there’s going to be an issue with dependency. We don’t know what posts COVID brings, we don’t know if scarring on the lungs is going to be an issue. What about this part of the community? Are they going to be able to receive medication? No, because the DEA implemented, manufacturers must make 30 40% less. We came into 2020 40% less opioids in the country and we urged our senators, please don’t do this. If we have a catastrophic event. My senator laughed at me. He said, what kind of a catastrophic event will we have? There you go wearing a catastrophic event? And he said, Well, we could always get medication from Massachusetts or Connecticut, huh? We’re all out of luck because the DEA ordered manufacture anxious to stop making to slow down. And the only reason we were able to get that IV medication made is because 12 organizations, I think the American Cancer Society, they’re really they’re big proponents. They said, Look, we need more opiates, these people need to be sedated, or they’re going to pull out there. They’re breathing too. And it’s just one out of four people, you’re going to get cancer, you’re not going to get pain medication. So it’s just it’s a fight. And we just we need the pain patients to get out there and protest. And that’s really all I can other than being in everybody’s state.

John Malanca 41:41
Yeah. Is this that what’s happening in Rhode Island? Pretty much what’s happening in in across our nation. I mean, it’s the same laws out here. I mean, thank goodness, I’m not in any pain. And so I mean, it could

Unknown Speaker 41:52
it could, it’s actually, California has one of the best pain patient Bill of Rights in the country. But California In Medical Board, probably the most unscrupulous Medical Board following Louisiana. They just target prescribers, period. They don’t care if you’re an oncologist or rheumatologists or neurologist they’re going after you. But it’s the same all 50 states have been equally attacked and I do have patients that go to Guadalajara for for medication. I mean, what a country. Look, welcome to America, you know, you can work but you can’t, you can’t get your pain treated. And if you do you got to pick your benzo or your pain medication, which is more important, you know, not having debilitating anxiety or having the vikan that you need for your nerve pain.

John Malanca 42:43
You mentioned sorry, you mentioned benzo and can you give a definition of Have you said benzos or pain medication? Can you give a definition of benzos

Unknown Speaker 42:54
I’ll let best take that one because she’s the nurse

John Malanca 42:56
yeah and why and why they help with pain. We This is There’s so many names in the pharmaceutical industry and and I’m not, I’m not involved with that. I mean, I thank goodness I, I’m not in any pain.

Unknown Speaker 43:09
Yes. And that is people that are not everything should be grateful because you take that for granted. I know you don’t all but people take it for granted and they can’t imagine it because it’s one of those things. You know, it’s kind of akin to when I first got pregnant with my first daughter, I thought, holy cow, because this always happened to someone else. And then it happened to me. And so I was

Unknown Speaker 43:35
I got pregnant. Yeah. And I thought, wow, this is really good. This is a big deal. Now I’m

Unknown Speaker 43:43
gonna you know, it was a big deal, but it was like the type that always happens to someone else for chronic pain, or intensely painful diseases. Everyone thinks always happens to someone else, or you’re always born with it. I’m here to tell you that. It can happen to anyone. Anyone can ask Have an accident have their backs have located and now they’re in spinal pain for the rest of their life. They can’t walk, they have a walker, anyone can come down with physical diseases anyone can there have developed this, there’s all sorts of painful diseases that people have that really are incompatible with living. And yet, relief can just be a proper appropriate dose of opiates away. And the reason why there’s such a low rate of addiction there’s a difference between addiction and dependence. dependence is when you need a medication to get through your day. So people are dependent on their antihypertensives people are dependent on insulin, and insulin can be abused. People are dependent on all sorts of different medications in order to keep them in a state of health and get them through the day. Some people have chronic pain or dependent on dosing of opiates and that gets them through their day and then work under pressure. And no one needs to know. But now they can’t get their medication and now they’re crippled and now they’re in bed. So dependency. Typical chronic pain or severe pain patient does not get a euphoria from their pain medication. But it just made that very clear they do not fornia However, they may get a feeling of wellness, because now they can move and they can get up and move around and they’re not in crippling pain. Because pain tends to bring on more pain, as I described tends to bring on more pain. This is an addict is someone that drug seeks without need, and it’s illegal. So they’re not taking legally prescribed drugs. They’re taking drugs that they bought or sold off the street. And that is typically the influx from China and from down south, across the border of opiates, heroin, very cheap, and fentanyl, synthetic and illicit fentanyl. And so those are what’s causing the overdoses because they decrease, decrease the respiratory centers, and then you stop breathing. And that’s why not can is the big, hot button topic because Narcan reverses that in person. So when I worked in the ICU, you had somebody that was ventilator dependent and you wanted them to be Wyatt, you paralyze them, paralyze them with a drug popat at the time, you would paralyze them. Whenever you paralyze someone, they would get morphine and Valium. And so there are advantages. So they get pain medication, and they get some sort of anti anxiety. Because if they were to wake up and they can’t move, and you’re breathing for them that can, you know, they can be very impacted on that. But you don’t know it because they can’t talk because they’re intubated. So you just so what we would do is anytime patient started to move typically their eyelids, they would need to be re paralyzed again, you need to continue to have that and so that, I mean, the type of care that goes on in the intensive care unit is beyond comprehension. If you have not worked in an intensive care unit, you can’t really it’s kind of like the type of thing you can’t really understand it unless you are there seeing it, or you’re there working in that environment or the ER, what doctors have latitude. I mean, the doctors are the top of the food chain, and the things that we are going after our physicians at a very time for just writing prescriptions for appropriate opioid therapy. At a very time we’re also calling upon them to find a cure for COVID or a buy or a vaccine is a to me so hypocritical that on the one hand, the government’s handcuffing them literally and figuratively, but on the other hand, they’re looking to them for answers for this horrible disease that we have, that we’re all dealing with this pandemic is preposterous. And so I wanted to make sure that we knew and I also want to say what I always talk about is nobody realizes that when they had to change Talking about Oh, it’s been flooded with pain pills since like 2012. Well, also, the use of hospice exploded during that time, people realize they had a Medicare benefit they had paid into Medicare, they could die at home and they could die comfortably. And those are called comfort beds. And to the extent that people want to be comfortable, that’s the hospices job is to follow what their their wishes are, when they’re admitted. So those things happen kind of in tandem with this whole issue that has gotten totally out of control.

John Malanca 48:34
So, you mentioned out of it as well. So if you can get given a brief definition on benzos, opioids as well as do they fall into the same category? Well, so

Unknown Speaker 48:45
opiates are really they hang on the on the pain receptors in the brain where the benzos they add events, decrease anxiety, sometimes they can be used for medication, but they can also be used for But sometimes chronic pain also gives people anxiety, or anxiety alone is torturous to people and Claudia had I believe a physician psychologist that all his patients were taken off a lot. He lost his patience. They were taken off their sedatives or their or their benzodiazepines, and there’s a chance that they can seize. If they go for a long time. You know, you have to ease off these type of medications. But what do you ease off to back to your anxiety that promoted you generally prompted that first request for a script, but they can also be used for muscle relaxants. And people a lot of people that are in chronic pain are very tight. So they can be for muscle relaxants. They can be used for anxiety. They can believe us to enhance sleep, and all the things that they’ve been used for for years and years and years. One thing might enhance each other, but they certainly don’t. I don’t hear many patients that are having any problems.

John Malanca 50:10
Like Like when you mentioned benzos for anxiety and so what what is that like? Again I’m not

Unknown Speaker 50:18
familiar Xanax and then like Valium to like Lorazepam, diazepam. Those are a little bit of a different class but they’re also very powerful muscle relaxers very powerful anti anxiety, assists but people will build up a tolerance to them. That’s one of the criticisms if people can build up a tolerance and so their dose goes up. But that’s all within the physicians scope of practice is that they see these patients and they adjust accordingly. And if they see their patients taking too big of a dose, they have a conversation with the patient. It’s not about the government jumping into this relationship. Telling and arresting physicians and then pain patients are left. Next thing you know, they’re going through withdrawal and their pain is skyrocketing and they are left with nowhere to go. So wherever they go, what do they do?

John Malanca 51:16
is out of man, good for pain relief.

Unknown Speaker 51:19
It can be it can be benzos and muscle relaxers, sometimes sometimes a benzo pair with like mo trend or even like buffered aspirin or something can just do it for some patients for maybe a dose but long term pain we’re talking about chronic intractable pain here. That’s not gonna work for you. You might just be taking it to for something else or to maybe enhance but one of the things I do see about cannabis is that I think cannabis for many people and experience change For some of the benzos, because they do have that guy that does have that relaxing sedating can, you know, depending on the type of cannabis and the ratios that you take. So I think that that’s a very realistic opportunity. But I agree with Claudia, whatever the patient needs to take, especially if it’s plant based and has been used for thousands of years like freedom should be allowed to be taken by any us anybody in the United States to mitigate their symptoms. It’s it’s,

John Malanca 52:34
what do you say for the doctors are the people anti opioids saying, because you always hear these pharmaceutical ads and cringe I did an ad side by side ad with Lyrica, Lyrica versus Canada.

Unknown Speaker 52:48
Oh, doctors love their Lyrica, john.

John Malanca 52:52
And you see, you see these side effects. And so what do you say about that when you see the cibic suicide But they always play them with some beautiful music. So you’re kind of mesmerized with the pictures on the screen at the same time with the music and not hearing them say, you know, you could have suicidal effects or liver damage, or you know everything.

Unknown Speaker 53:17
That’s Um, can I answer this one? Yeah.

Unknown Speaker 53:21
A lot of the patients, when they go to pain management centers, they’re subjected to unnecessary painful steroid injections, blocks ablations these patients have already been down that road. They’re also subjected to gobbles of Gabba Penton neurons, anti depressants, and then they’re offered Suboxone. So what do we have we have anti depressed Suboxone is walking throughout the country. Those drugs are not indicated to treat pain. There’s zero evidence based studies that say the gap, you know, nerve pain. gabapentin is effective. But antidepressants. I mean, this is another form of insanity but the anti opioid Crusaders, they’ll say, Well, you’ve got Gabba Penton, you have injections. What more do you need, unless you want to take our drug you for nerfing and it’s all it’s always following the money. The way I explain this to a lay person is if you’re really depressed, and you go to your psychiatrist and you say, I am so depressed, your psychiatrist is going to say we’re going to up your dose. But if you’re in pain and you tell your pain doctor, I’m in pain. Your doctors like up can’t help you CDC CDC, I can only give you a certain amount of medication. Same with you know, listener If you’re having high blood pressure, I can’t get my blood pressure controls wrong. We’re going to up your dose we’re going to add some medications. That’s that’s not an option with narcotics with opioids is you get what you get, and you don’t get upset. And if you do, we’re going to boot you from the clinic, period, end of sentence. And the we the Human Rights Watch actually did an investigation about this. And that report also fell on deaf ears, but I think it was too soon in, you know, when this all happened two years ago, but now, more people are contacting their senators. They’re like, enough is enough. I need to access medication. How will this change first off having a celebrity bring awareness like Annie Lennox did, and she just said, this is brutal. people with chronic pain can’t get medication. We need a celebrity but we really need 10 or 12 senators. on a federal level, go before Congress and say this is an issue. People with pain can no longer receive medication. And we were sold a, you know, a fake bill of goods when it came to the overdosing crisis if prescribing is at an all time low. Why are people still overdosing because we never had a prescription pain medication issue. And when the DA this makes me laugh, I laugh every time I say it when the DEA did their bring your medication. if everybody’s gobbling up pain pills like tic tac, why is there any medication to turn in? Because there isn’t medication to turn in. It was never a crisis. We’ve never had an opioid pill problem. But I’ll tell you what, your kid if they think they’re getting a Xanax from their friend, they’ve got about a 75% chance of overdosing, because it’s gonna be it’s gonna have the illicit fentanyl in it because these drug dealers, they are creating Have they actually stamp their product? Kids can go online and say this I got a great high from this. Give this drug dealer business. This is we’ve actually spiked the overdosing crisis. Maybe that’s what was supposed to happen. Maybe this has been a plan. I don’t want to sound like some crazy conspiracy theorist, but you got to wonder what’s going on on Capitol Hill. What it is,

John Malanca 57:30
you mentioned kids and I heard I don’t I don’t have children. But you have about one john, he have to Queenie

Unknown Speaker 57:39
but what are some older man? What about this

John Malanca 57:43
stuff that we’re hearing right now where the kids are going in into into parents cabinets, getting pills and they put it almost like a Russian roulette. They put the pills into anything and people are pulling them out not knowing what they’re taking. They’re just taking

Unknown Speaker 57:56
a wire the kit let’s figure let’s address this wire. The kids Doing this we live in a very sad world, right? Everybody is self medicating with alcohol with too many antidepressants. With you know too much weed. I don’t want my kids get smoking weed. I’m a mom when you’re 18 you want to smoke weed Have at it. But you’re a healthy person. You don’t need to be you know, taking pills and smoking weed and drinking when you’re an adult. You make that decision under my roof. No can doozy Not going to happen here? But why are we self medicating? Because we live in a really sad place right now. let’s address the reason for addiction. And we’re always going to go back to predisposition. You know my niece, my sister was adopted. My siblings were adopted, and my brother in law overdosed, but we raised my niece knowing you can’t drink you can’t smoke. Because your dad was an addict, let’s have this discussion with our kids at home to hopefully slow down the overdosing, but the anti opioid Crusaders will have you believe this is all happening because of pill Mills. Look, of course, there were some bad apples, right? Doctors were over prescribing that fifth vital sign probably helped out a little with that, but it did not cause the opioid crisis. But when you see the media 60 minutes, have, you know, interviewing doctors, this doctor prescribed 750,000 pills. How many patients did he have? Was he the only pain management center that comes out to four pills a day for 3000 patients?

Unknown Speaker 59:46
Okay.

Unknown Speaker 59:48
What So what? But the other shocking thing john overdoses are going down as overdoses, you can have a heart attack but if you have an opiate in your system, it’s great. Going down as an overdose, and that’s how the doctors are getting tagged. And that’s how those malicious medical boards who by the way have qualified immunity. That’s wrong. They’re not God. The DEA has qualified immunity. They’re not God, oh, my god anyway, removed qualified immunity. And you won’t be seeing doctors raid, you won’t see those rates happen because before a DEA goes barreling in with a gun hell to the doctor, he’s gonna think or she’s gonna think, oh, maybe I shouldn’t do this. I could lose my home. That’s, that’s another thing that needs to be addressed. There’s a lot of things that need to be addressed.

John Malanca 1:00:38
It is a big problem. Thanks for doing what you do. So for the patients that don’t have access to this, their doctors are afraid to write the prescriptions to help these patients. Are there any good substitutes, some substitutes for benzos and opioids

Unknown Speaker 1:00:59
now No, no,

Unknown Speaker 1:01:01
no, my patients are very, very sick. That’s why

Unknown Speaker 1:01:05
because there actually are no, these are very specific, very, very old, old, well used, well understood. prescribe medications that have been used for years and years and years and years. We know how they work there, they understand it, there’s really no substitute and I can tell you just springboarding off the Lyrica. One of the reasons why antidepressants were used and became all the rage is because they want obviously not to use opiates. But in particularly the age population, they were depressed and when it took their depression, their medication LBL started out with Ella Bell, they found that they had a side effect that it seemed to lift peripheral thing. But that’s so now all of a sudden you have an antidepressant well goes into the presence of enormous side effects, especially if you’re not depressed isn’t working on depression, it’s working on pain and if there was you’re being used. So, for every antidepressant that I was prescribed, I was allergic to. So so many, many, many pain patients that take long term opioid therapies actually have been through the mill with other modalities and

Unknown Speaker 1:02:22
well that’s, that’s that’s really that’s how I got started on the antidepressants.

John Malanca 1:02:27
So you mentioned that does it work for everyone? Like cannabis doesn’t work for everyone and so is it sometimes trial and error when it comes to these pharmaceuticals, Claudia?

Unknown Speaker 1:02:38
I think if you take an opiate and you’re not in pain, it worked. And that’s pretty much how it goes. You know, a lot of people take a pain pill and say, oh, that made me You know, my mom something about the generation my mom’s 84 and she fell down the stairs broke her back for a connection broken Things I didn’t know could be broken. But that woman was horribly sick when they try to give her pain medication. And it was the decision of myself and my mom’s, you know, and I, I handled her pain with acetaminophen and ibuprofen. And I did her physical therapy. And I took care of her, because I don’t you know, she didn’t react the same way. I reacted to pain medication in the hospital. But, you know, health care should be individualized. It’s between the doctor and the patient, not the doctor, the patient, the attorney general, the DEA and the medical board. And that’s what we that’s what we have to re instill. I have a nonprofit, the doctor patient form, and that’s how we’re able to help people myself and a retired doctor, we’ll get on the phone, and we’ll say okay, let’s start from the beginning. Do you ever primary care physician? Probably not because If you’re a chronic pain patient, most primary care physicians will not even take you as a patient. So it’s another attack. Um, but, you know, we just want to be sure patients have had the proper workup, what’s their diagnosis, and if we can help them, we will and if you can manage your pain without a narcotic, great, but it’s, you know, when you’re a veteran and you fight and you go to war for us and you have a like in an arm blown off, why should you have to fight for your pain medication and your benzodiazepine? Why is this an issue this should not even be a conversation um, you know, it’s an I was on the Dr. Drew show when we spoke about this, but if you’re an anti opioid zealot, it’s, you know, you’re a zealot. And I think for a lot of these anti opioid Crusaders, started off as a cause for them, because they lost a loved one. But their cause has stoked the pain patient genocide. And it’s like a knot, like how much pain Are you going to bring to another community in an effort to heal your pain?

John Malanca 1:05:20
Well, if they don’t know it until they’re until they’re truly effective, like I said, if it’s it with them or someone in their circle, before we get off it, I receive a lot of emails from a lot of these companies from up in Canada that will send you even or all these pills online. Is that what this is, you know, what a lot of people are doing now because they’re they’re one fearful that they’re not me that their doctors not going to prescribe the medication. Now you can’t get a doctor to prescribe or these companies safe or is it scary? I mean, I mean, are they is it just a pill that has a stamp on it? Is there any way? I mean, are these real companies that are doing these

Unknown Speaker 1:06:00
Don’t think you can get opiates at all. And and just so that you know, what also is very interesting. Walmart will not give anybody a discount that are RX on any opiate that they choose to fill with a legal prescription. They will

Unknown Speaker 1:06:19
cut you down

Unknown Speaker 1:06:20
the pharmacists has been empowered to reduce the amount of opiates that you can get at a single fill. And they’ve been over a physician, a physician’s prescription, which actually has always been a felony because they’re practicing medicine. So now you have pharmacists that are stepping in, and they’re refusing to fill a physician’s order. So there are there are all sorts of ways that pain patients are shaming because of something that happened to them, that for the most part B had nothing they had the misfortune of having this happen to them and there are many Many, many ways they’re embarrassed. I had a very dear friend who died of cancer. And he had been in the hero, a hero in firefighting. And he was having a lot of pain and it was the first time he ever had to fill his oxycodone. And he said he was fairest, and fairest. Because he felt they commented on it. There are now times you have to actually put down in your prescription what the ICD 10 code is, while you’re in pain, so that everybody in the pharmacy can understand all of the diseases that cause you pain, for some reason, because they’re tracking you. But this gentleman, not only was he facing his end of his life as a young man, but he was so humiliated by what he went through in the pharmacy. And he came to me and said, You have no idea. I mean, I I felt like I had to say Everybody I answer because they all looked at me like I was a drug addict. And I never took a drug in my life. So that’s the type of stories that we hear. And it’s heartbreaking. And there’s nothing to be done. Once you’ve watched your doctor, and once you’ve lost your prescriptions, guess what? You’re gonna detox off here. And then you are going to be in a raging thing. And that’s when people kill themselves. And you’re on your own that shad.

John Malanca 1:08:28
Claudia, you mentioned, you know, offline about a class action lawsuit. Are you interested in getting into that right now? Is that a topic? You don’t want to talk about it?

Unknown Speaker 1:08:37
Oh, no, I don’t mind. So yeah. My partner Dr. Feldman reached out to an attorney in West Virginia. Ironically, this attorney also was the plaintiff’s attorney in the Big Tobacco lawsuit years ago, his family, and there’s no I think, four, maybe five law firms on board and they’re suing CVS. I interview a doctor every few weeks on my podcast. And I interviewed a pharmacist the other night. And he said it’s despicable. He said, No, nobody should be doing that. But it’s Walgreens internal policy, which is about this big right? To tell a patient. It’s their policy to not fill it. So if you say, Why won’t you fill it? They’ll say, well, it’s our policy. And you’ll say, Well, can I see the policy? They’ll say, we can’t show you the policy because it’s our policy. But is it legal? Isn’t that that’s tampering with a controlled substance script. And it took us a year to really educate these attorneys about it because they didn’t know about it. But I think the class action lawsuit will put this issue on the map. Sadly, this country responds to only litigation. When you have the pants suit off of you, that’s when a light bulb is going to go on. And same with the doctors while I support providers and I work with them. I’ll be the first to take a bad one out. And if you’re pumping my patient with injections they don’t need and all this other medication while you’re dangling a small daily script over their head, you’re gonna lose your license, because these are all wrong things I represent the underdog I don’t like to see people being attacked and belittled and that’s why this is you know, everybody has a cause. This is my cause.

John Malanca 1:10:45
Well, thank you for that Claudia and thank you Beth as well and can on closing words do you want to add anything that you’re doing right now besides his class after the last few but your website how they find how they can find you and what you’re doing. Not only in Rhode Island, but nationwide and worldwide.

Unknown Speaker 1:11:06
Right? So the best thing for a patient to do is join the Facebook page, don’t punish pain rally, start organizing your protest October 7, send the link to the AMA. The ama just put out that very powerful statement. send that to your lawmakers, call up scheduled meetings with your local people. Those people want those seats, make them work for those seats, make them earn it. And hopefully 60 minutes we’ll pick up our side of this. It’s it’s a lot of work. We need national media. So we just encourage people stay on top of it, get on Twitter, be active and if they need help, they can find me at the doctor patient forum.

John Malanca 1:11:51
Great and Beth, you want to add to that?

Unknown Speaker 1:11:54
What Claudia said

John Malanca 1:11:56
what Claudia Ladies, I can’t thank you enough for being on and sharing this and Claudia and Beth is anything that that I can do or united patients group can do. We’re a patient advocate as well. And there’s a lot of times when patients come to us, I wrap them away from Canvas, you know, I say, you know, I’ve seen higher success rates with this versus this. And it kind of surprises them because they say what you’re you’re a cannabis company yet, but my number one goal is being a health advocate. And what I’ve seen success in as well and like you taking the stance and this is this is the passion that Chris and I started, you know, cannabis was not our lifestyle, but we were kind of adopted and I won’t say forced in this industry, but I’ve seen this work and I’ve seen other things work and so again, you know, that’s, that’s who makes me but that’s, that’s why we do what we do. So, Claudia Marandi, thank you so much for being on Beth das. Thank you so much for being on Your support over the years as well. And we will see both soon. This is John Malanca with the United patient group being formed and we will talk to you then bye bye