Jay Joshi: Episode 1177

Transcript

[0:00:52] HA: My next guest has one simple question when it comes to the political and clinical chaos of the opioid epidemic and that is, “Is anyone protecting the patients?” Welcome to the Author Hour Podcast. I’m your host Hussein Al-Baiaty and I’m joined by author Dr. Jay Joshi, who is here to talk about his new book, Burden of Pain: A Physician’s Journey through the Opioid Epidemic. Let’s flip through it. Hello friends and welcome back to Author Hour. I’m here with a special guest. My man, Dr. Jay Joshi. Jay, how are you doing my friend? Good to have you on the show.

[0:01:30] Jay Joshi: Thank you, sir. I’m doing well, how are you doing?

[0:01:33] HA: I’m doing well man, thank you for coming on the Author Hour. I know you just launched an amazing book, Burden of Pain, and man, I got to tell you, now I’ll just tell you before we got on here that, you know, I was telling my wife last night that this book is a little hard to put down. I just wanted to keep going into the story and kind of really, in a way, watch you do the good fight, which I really want to talk about in the book. Before we get into the book, of course, I really want to share with our audience a little bit about you, your personal background, perhaps where you grew up, maybe a person that inspired you or an event that inspired you to be on the path that you are on today. I’d love to hear a little bit about that.

[0:02:10] Jay Joshi: Well, thank you. So as mentioned, my name is Dr. Joshi. I am a physician by training. I practice outpatient primary care in Northwest Indiana and I live in the Chicago suburbs. So it’s one of those kind of New York, New Jersey kind of things where people go across the state on a daily basis. I got the impetus to write this book, really, based on my lived experiences. I was the first primary care practice in Northwest Indiana to implement telepsychiatry for patients in the primary care setting that had be a real help complications and comorbidities and I was also one of the first physicians in the last five years to be targeted by the DEA and it was an interesting juxtaposition because NPR featured my practice just days before the DEA came and targeted me.

[0:02:58] HA: Wow.

[0:03:00] Jay Joshi: I thought about writing this book when I started to realize that this was starting to become very serious and that they were looking at this as though I were behaving as a criminal conducting drug dealing transactions when I was providing medications for my patients and that really triggered a cognitive dissonance in me because, for the longest time I almost felt that I was doing right for the patients and my patients felt, I was doing right for them. But here we had the DEA coming in, making its own interpretation, taking their own actions, and in many ways, destroying the fabric of the patient-physician relationship. So to go to your original question about, “Who really inspired me” I would have to say, it’s folks like Nelson Mandela, Mahatma Gandhi, who through the perils that they went through, drew the inspiration to write about it. I think, when I was going through everything that I was going, there was a massive propaganda campaign. I mean, just Google me and you’ll still see some of these crazy articles about me, apparently, imitating somebody, apparently writing all these crazy opioids but when I realized I could write, that’s when I found my voice and it actually gave me courage to stand up to what was going on because I was able to write.

[0:04:20] HA: That’s beautiful man, I love that. I mean, I know you're going through some things and I’ve gone through a lot of things, we’ll get into it a little bit more, but I love, you know, what I meant by saying, that’s beautiful is that you found the courage.

[0:04:33] Jay Joshi: Thank you.

[0:04:33] HA: In writing, I always feel like you know, for me, it was art. You know, I always found, that’s where I found my voice. You know, whether it be through graphics and truly when I found writing that I was not afraid of it anymore. It was another way to express myself, I too found some liberation in that space too, man. So I’m glad you’re able to kind of take your story and then of course, be inspired by the greats that lead us from the inside out, you know what I mean? I feel like those greats when you hear their stories, you’re just emotionally changed and it’s like, whatever you're doing at the time and moment you realize like man, they are telling me right now if they could do it, you too can stand up and you know, at least, bring your voice, bring your vision, bring your idea and not allow someone else to speak for you, right? Especially and put you in a negative light, that is not acceptable, right?

[0:05:27] Jay Joshi: Exactly.

[0:05:28] HA: So I appreciate your courage man, I want to share a little bit more with our audience about sort of, the beginnings of your practice, and your work with your patients was really, you know, it spawns from a place of really wanting to help. It spawns from a place that you see this epidemic happen all around us. Like I said earlier, you know, I lived in Oregon, and man, it was exponential it felt like in the last five years, unfortunately, in so many ways. But I know you feel this pain, you know, all over the world man, and especially in your community and we all know what you know, drugs do in our communities. However, there are people who actually need these things for all kinds of reasons and that’s not for me to say, you’re obviously the doctor. Can you tell me a little bit more about your practice?

[0:06:12] Jay Joshi: Certainly. One of the first things as a physician you have to realize is that is not your position to judge a patient.

[0:06:18] HA: Sure.

[0:06:19] Jay Joshi: It’s your responsibility to treat him or her to the best ability possible. So when somebody presents with chronic pain are acute pain following a work-related injury as is common in Northwest Indiana, you follow the CDC guidelines for what is appropriate care. That could include medications like Tylenol, it can include certain non-steroidal medications that help with inflammation but it can also include opioids. In fact, opioids are considered one of the most cost-effective forms of treatment for chronic pain and other forms of pain that do not have a neurological component and before the opioid epidemic and now as we call it, the overdose crisis, really change your perception on these medications, they were considered frontline therapy for many patients. What I would focus on is really, the relationship with the patients. Yes, if they had certain conditions, I would prescribe opioid medications but I would not simply provide the medication and leave it at that, which is why I incorporated telepsychiatry into my practice because if I were to prescribe these medications, I would also want to follow up with them. It is a balance between trusting a patient and verifying that trust and that’s a fabric of a strong patient-physician relationship. A patient X presents with a chronic condition, physician Y treats that chronic condition. Anything beyond that is outside of the realm of what should be considered a proper patient-physician encounter. The situation that I found myself in is that you have this third-party entity, the DEA, looking at prescription medications as though they were drugs, as though the clinical encounter was a drug transaction. So they’re not focused on the underlying pathophysiology, the underlying disease state. They’re not focused on what socioeconomic constraints the patient is facing as he or she has to work in pain because their union dissolved and now, they’re independent contractors. That doesn’t matter to the DEA. What matters to the DEA is that you wrote an opioid to that patient, you committed a crime and it sounds almost bizarre when I phrase it that way. But really, that’s the genesis of the disconnect between the medical world and the legal world. In the medical world, you look at the patient holistically and provide medications as part of the ongoing relationship. In the legal world, they’re simply focused on, “Did you prescribe a certain medication and did you provide the legal documentation to justify that prescription?” It should be that those two align. But when you have these different interpretations of what level of legal oversight constitutes the appropriate transaction, you find yourself at odds with what would be considered good medical care and I’ll give you a great example of this. The urine drug screen. You know how much a urine drug screen cost if you don’t have insurance?

[0:09:25] HA: No idea.

[0:09:27] Jay Joshi: Yeah, you wouldn’t believe it. It’s in the hundreds, 400, USD 800.

[0:09:33] HA: For a pee test? That’s crazy. I was just like, you pee on a test and it tells you some stuff that – or like a little strip and it just – but I mean, I don’t know, what am I talking about? That’s insanity. Yeah, I didn’t realize it was so expensive.

[0:09:46] Jay Joshi: So Google it. Google the cost of a urine drug screen, it’s unreal. So if I have a patient who, let’s say, lost her job and is now in transit working as an independent contractor, she has a shoulder injury, she can’t take time off because she’s the breadwinner but she can’t afford surgery because she’s not going to get paid for her rehab time. If she loses her Medicaid because she’s no longer working and serving as independent contractor, am I to deny her continuity of care? Am I to deny her, her medications because she can’t afford a urine drug screen?

[0:10:24] HA: Right.

[0:10:25] Jay Joshi: So now the question becomes, how much do the legal oversight, a urine drug screen, checking the prescribed database, ordering imaging studies, outweigh the patient-physician relationship itself? Now, I get it, there should be certain oversights. Like, every time a patient would come into my practice. I would check their prescription database to make sure that they’re not doctor-shopped, meaning, going to multiple physicians and asking the same medications.

[0:10:51] HA: I see.

[0:10:51] Jay Joshi: That’s easy, that’s free of charge. Anything that then subsequently requires a cost or a clinical barrier to accessing care for the patient, that must be weighed relative to what is good for the patient, and the moment those legal oversights overwhelm what is good for the patient, you are seeing a disconnect between the legal and clinical worlds.

[0:11:13] HA: That is really powerful man. I mean, I don’t realize that you know, when I think the DEA and I feel like most of us out in the world who are just regular old peeps that really aren’t in the legal or the medical world, which I feel like has always been, I don’t know, I feel like there’s always been tension there of course. Like in most industries, but I always thought the DEA was more like, you know, drugs that weren’t going through the medical world per se but I guess I can see the line in where it’s blurry but I thought that was like your right as a doctor, as a physician. You’re obviously, you’ve worked really hard, you’ve practiced at this thing. You understand your patient, what they may or may not need and you have sort of, in a way, the law backing you up to help with those things but it sounds like that’s not obviously the case and it sounds like physicians and doctors out there are you know, obviously, fighting this battle, trying to figure out where this line is. So in your opinion, what are some of the most important steps that could be taken and addressed? You know, I know you talk about this a lot, the root causes of addiction and prevent future sort of epidemics because I feel like, you know, we can fight about the legal stuff all day and we can fight about the medical stuff, it sounds like in the world, right? But the root causes are really, what’s impacting your patients and that’s, those are the people that eventually got to this level of work and to serve, right? So how do we take these important steps man?

[0:12:43] Jay Joshi: That’s a great question and I want to break it down into three points because you talked about some very important things. You first talk about the DEA’s role inside and outside of healthcare, you talked about what protections physicians have, and you talked about the root causes of addiction. Let me go one by one because I think those are all three critical points to address.

[0:13:03] HA: Beautiful.

[0:13:04] Jay Joshi: So true, the DEA is nominally understood to be the government agency that prevents drug transactions, whether it’s street-level drug dealing or whether that’s cross-the-border or international drug trading but they also have a role in healthcare. They oversee the prescribing of certain controlled substances. These can be prescription opioids, they can be prescription benzodiazepines, which are commonly used for anxiety and they can also oversee opioid abuse medications like Suboxone and methadone. What the DEA does is that they schedule these drugs according to risk. So schedule one are illegal drugs, not permissible to be prescribed in any capacity, schedule two have the highest addictive potential, and schedule five has the lowest addictive potential. Opioids, like Norco, Percocet, what have you are schedule two medications, and what the DEA does is that it monitors the number of schedule two, three, four, and five prescriptions that are being written and its current strategy is to examine, and I’m using that word nicely, examine physicians who may have higher prescribing schedules and then determine whether there are some sort of illegality or lack of legal oversight to justify going after that physician. I think the DEA does have a role and should remain active in healthcare but they should focus on principles of harm reduction where the physician has the latitude to make the clinical decision, what is good and what is bad for the patient based on his or her clinical discernment and that’s where we get into the laws that protect physicians and I’m very passionate about this because I wrote a supreme court brief for a case involving a physician. It was the first physician case in decades that addressed this very matter of good faith. Can a physician, if acting in good faith, be legally protected against the actions of the DEA? And when I was indicted, I did not have that good faith provision, believe it or not. As a physician, I did not have the right to defend my actions clinically as saying they were in the best interest for the patient and that I was acting in good faith. Fortunately, in 2022, I was what is known as an Amicus party, meaning, a third-party advocate for the physician, Dr. Ruan and Dr. Couch and Dr. Khan, now established legally in the courts, federal courts that if a physician is acting in good faith, he or she cannot be prosecuted by the DEA, DOJ for prescribing outside his scope of medicine under the controlled substance act, which is the same statute that effectively all drug dealers at a federal level are target against and I think that’s very important because it transitions to your third point along the root cause analysis of addiction. Addiction really is a series of clinical decisions and actions that culminate into patterns of behavior, patterns of thought that create dependencies and addictions and I think it’s very important to make that distinction because if a patient has a dependency, as a physician, it is your responsibility to still care for that patient but to identify what dependency the patient has developed and that requires honest conversation, a trusting relationship. Now, if a patient has transgressed into the world of addiction, where he or she is behaving in ways that are harmful to society, then the clinical encounter has been violated because the patient is no longer acting within the sanctity of the patient-physician relationship and so when you start to look at the root causes of addiction, let’s start to focus on why are we, in the healthcare community, have failed to identify patients who are dependent and treat them properly? And it starts with destigmatizing patient care for those who have substance use dependencies. They are patients with chronic diseases just like any other chronic disease, whether that’s hypertension, diabetes. You would not, as a physician, stigmatize a diabetic for not taking his or her medications because they can’t afford it or not taking his or her diet seriously because he went to his niece’s birthday party and ate an extra slice of cake. You wouldn’t tell that patient, “You know what? I can’t see you anymore. I’m legally at risk”. No, you would help that patient. You would explain to them, what are the pros and cons of that decision, of that action, and work to find solutions. You would potentially create an app, create a reminder system, something that can provide some level of interface, whether digital or analog, to help that patient. Let’s do that for those that have substance use dependencies and when we start to destigmatize patients who have developed dependencies but genuinely want help or patients with chronic pain that genuinely want help that may not be able to function properly without certain medications, we have to realize that they are patients. They are not to be ostracized and eliminated from the medical community and the root cause of addiction really forms through that stigmatization by ostracizing those individuals. Now, then once we start to realize that we need to implement principles of harm reduction, helping those patients while mitigating against societal risk that those patients could, those societal risk those patients could be, then we’re at a point where we found a balance between protecting the patient and maintaining some degree of regulatory oversight and my hope is that by writing this book that I can help the DEA and other policymakers in the legal world understand that good legal policy begins by de-stigmatizing patients who have substance dependencies or maybe in the verge of developing addictions and truly want help clinically.

[0:19:47] HA: Yeah man, that’s so powerful. I mean, you’re so deep in this world of where you’re trying to I feel like not only advocate for the patients but create an avenue where both parties can work together in really helping one another in a place where the overall sort of I feel like the byproduct of all of this work could be the health and wellbeing of the patients because really that’s what it comes down to is that there’s no reason to create criminals, right? And most, let’s be real, just because I’m addicted to something because of X, Y, or Z and this is my life, these are the things that I am going through, I am also not a criminal. I’m just heavily dependent on this thing and I feel like, you know, there’s a level of this idea of criminality behind it, especially in pop culture, right? There’s so much stigmatization like you refer to, I think that’s really powerful. What advice would you give to other healthcare professionals who are working to balance this need to manage pain with risk associated with opioid use?

[0:20:51] Jay Joshi: I’ll answer that by referencing a passage in part one of my book.

[0:20:55] HA: Yeah.

[0:20:56] Jay Joshi: Where I say, “An addict through proper clinical care can become a patient with substance use dependency just as much as a patient with substance use dependency can become an addict if they are left outside of the healthcare system.” I think what we need to do is create an opportunity for patients with conditions that we stigmatize with their substance use dependency, opioid use dependency, chronic pain to be a part of the healthcare system and have their voices heard. I think what you are starting to see in this broader narrative is that many of the restrictive policies led by the DEA have really harmed patients with chronic pain and patients with substance use dependency and access to care is a fundamental right in healthcare and regardless of the medical condition that you have, you cannot deny a patient access to healthcare. Now, once they have access then it’s incumbent on both the patient and the physician to implement the right solutions and so the advice I would have to answer your question directly, to physicians and my colleagues in the healthcare world with level providers and otherwise would be to implement healthcare strategies that go beyond just providing a certain medication and providing holistic approach to understanding the patient. Look, healthcare at the end of the day is an experience, right? That’s why we say the art and science of medicine. We can’t forget about that art, we focus so much on the data, the lab, right? But the art is a relationship. It is a form of engagement and when you study addiction, depression, at its fundamental cause, they are behavioral patterns that emerge that the patient then struggles to cope with and then develop certain patterns as a result. We wouldn’t ostracize the hypertensive patient who can’t control her stress and therefore, has these hypertensive spikes. Why are we ostracizing a patient with substance use dependency? I stress these analogies deliberately because I want people to start looking at substance use dependencies and addictions as a form of chronic disease and we’re starting to see that narrative change for chronic pain patients. We need that to change for patients with substance use dependencies as well and I want to touch on one key point here, when I talk to policymakers that have this, you know, Nixonian-Reagan type of mindset on drug use, the whole “yes they know” often what happens is they will say, “I understand the importance of harm reduction” so they will acknowledge the importance of a clinical approach to patients with substance dependency and harm reduction as a means of treating those patients. But what they will come back to say is, “If we were to decriminalize or provide some level of safety net for this type of behavior, there will still be a black market. There will still be people undercutting legally available medications whether it’s through the patient encounter or over-the-counter medications” and my response to them is that you’re looking at this economically. You need to look at this clinically and you need to look at it in terms of patient behavior with all its beauty, all its complexity. I am going to throw a controversial word out there, all its irrationality and I don’t say that to disrespect patients. I say that to say, patients like you and I behave in ways that are counterintuitive that may not be in our best interests but we develop habits, we develop tendencies, we develop patterns and it’s incumbent on us to create frameworks that incorporate principles of behavioral economics to study patients in the real-life setting because that is a form of healthcare. Understanding how the patient behaves is just as effective, if not more effective, than treating the patient properly within the what, 10 to 15 minutes of the patient encounter? I mean, how many hours in a day does a patient live through, right? Everybody has 24 hours, if you are seeing a patient every three months, how much time are you spending outside of the clinical encounter as a patient versus how much time are you spending in the clinical encounter. We’ve got to start understanding that when you’re going to treat addiction and dependency, it’s outside of the traditional bounds of healthcare. It’s requiring a more comprehensive approach to patient care and understanding the experience that patients are going through.

[0:25:38] HA: Yeah, so powerful man. I mean, I feel like you know, it’s one of those things that journey is windy because there’s so much unmeet attention and I feel like if there’s more awareness, more understanding, and like you said, you know this idea of how we approach what crisis and drugs and things like that from perspectives of those 60s, 70s, 80s even, you know it’s just not rational. We’re in 2023 and we need to approach these things in a way that actually brings in your voice and brings in voices that are advocates for how to try to deal with these differently and move forward in a way that is both helpful and can help communities and help, of course, the patients, which is what we’re ultimately after. Can you talk a little bit, maybe give a lesson or two that you’ve learned from your journey that you believe could help those who are of course struggling with the addiction or perhaps caring for their loved ones who are struggling with that?

[0:26:37] Jay Joshi: Yeah, I want to give a direct response to that and I also want to give a more philosophical response to that. I will start by looking at the pandemic. COVID-19 made apparent things that are always present in healthcare, just exacerbated. That’s why when we saw decreasing access to care, we saw overdoses rising and what happens is when you remove patients from the healthcare system, you’re not changing their existing behavior, you are simply making it more risky. That’s why we’re starting to see all these fentanyl analogs but their crazy names and their crazy level of potencies leading to ever-increasing rates of overdoses. It’s not that these patients are deliberately seeking a high, it’s that they have no avenue to address their dependencies and their addictions, so they’re forced to go through more and more risky means of getting certain potencies in order to satisfy their dependencies, their addictions. If we instead provide a means for them to address their conditions without judging them, without moralizing them but simply treating them as patients, then we’d be in a much better situation. These current models of rehab, you know these outpatient rehabilitation facilities, these inpatient rehabilitation facilities, they’re a revolving door of patients coming in and out because they don’t get that we have to focus on harm reduction. Instead, it’s, “Okay, well a patient overdosed” they agree to go to rehab, they’re clean for XYZ days, they go back out into the real world and they relapse. Well, why did that happen? Well, they resume the original patterns of behavior once they left the rehabilitation facility and you know, you can always talk about the financial correlate and kind of say that people may not have the best of intentions and these addiction rehab facilities. But I think a more productive conversation would focus around understanding that these models don’t help the behavioral patterns of patients with dependencies, with addictions. Instead, try to focus more on what are the patterns that are leading patients to behave a certain way because when you start to see those behavioral patterns, you will see the same patterns emerging within a town, within a district, within a state. People behave in very intelligent ways, it’s that the systems we’ve created incentivize irrational behaviors. So oftentimes, when you see patients overdosing, is not that they’re becoming self-destructive, it’s that they’re behaving in the way that they perceive to be the best way possible given the societal constraints that they find themselves in or the societal constraints that they are willing to put themselves into. I think that is a very important point to understand that addiction and dependency require treatment as any other chronic disease would, where you don’t go from one extreme to the other where patient addict is kicked out of the house and then patient X goes into a rehabilitation facility. Find that medium, find the balance in harm reduction that helps to address the underlying causes for that type of behavior while recognizing in the intro, there may be a certain need to take that medication. To take that illicit substance in a safe controlled manner as you work to taper yourself off and from a philosophical standpoint, you start to see these tendencies in all aspects of healthcare, whether that’s abortion, vaping, opioids, and I really try to make it clear that these fundamental tendencies in healthcare are pervasive throughout. When you look at the issues of abortion, effectively we’ve simplified a very complex procedure and a very complex decision that a patient makes to go through an abortion into a simple rubric of weeks, where in ten weeks and after it’s illegal and ten weeks and before, it’s illegal but we don’t understand that. It is much more complicated than that. There is so many factors that weigh into a patient’s decision to get an abortion and not get an abortion to even be in that position in the first place to even make that decision. The same thing goes with addiction, right? Addiction doesn’t begin at the overdose, it ends at the overdose. Addiction begins through a series of decisions and events surrounding that person’s life that turns that person toward a certain pathway where he or she is making decisions that again, he or she feels is in the best interest of what circumstances he or she finds himself in. I think what we need to be cognizant of is that tendencies in healthcare repeat themselves at an individual level, at a societal level and until we start to focus on these tendencies and recognize them as they start to appear, we’re going to continue to see the same problems and as we see with the overdose crisis, we’re going to see a worsening of the problems. The DEA and legislators seem hell-bent on restricting access to care when it comes to certain opioid medications or certain opioid abuse medications. That’s going to lead to increasing overdoses and I think you are starting to see the legalization of marijuana creep into more and more red states because they are starting to realize that restricting certain behavior is not going to prevent it, it’s going to make it more risky. So let’s start with marijuana, let’s decriminalize marijuana, and see what happens. Now, let’s, in a few years, decriminalize or de-stigmatize other substances. I think you are starting to see the start of a trend to go away from this “just say no” mindset to more of a nuanced balanced approach understanding individual patient behavior within a broader construct.

[0:32:55] HA: Yeah, it’s so powerful. You know, it’s interesting your perspective is so deep and you’re obviously very passionate about this work because it is on that intersection of medical and legal and I’m glad you are doing this fight man because we need people like you that could really advocate for the patient in a way that’s helpful and healthy but also understand community and a broader scale, how these things can impact this not only now but of course, down the line and where those lines can be drawn. I think considering your perspective and others that again advocate for the patient’s health, it’s so powerful. So I got to ask you, I mean, writing a book is not an easy feat. We wrote this book with very much intending to help the narrative progress in a positive way but I got to ask you, what is the most, like would you say your favorite part of pulling this book together? What did you learn from that journey in and of itself?

[0:33:48] Jay Joshi: You know, I’ll tell you it’s such an amazing experience, just the art of rewriting, really. I think the biggest thing I learned is that find a good editorial team. Find a set of folks that believe in your vision that will work with you to edit and revise the book in a way where you see your voice magnified. As a writer and as somebody who writes op-eds and provides editorialized content, I feel like I’m a good writer. But I think you want somebody to challenge your writing so that the tendencies that appear, certain writing structures that may not be optimal for your voice gets corrected and you know, as we spoke before this, Scribe Media has been amazing and really helping with your – refine my voice and that journey of refining the content, going through the proofreading, the QA, incorporating the graphs, it was an amazing experience. Man, I have to tell you that I truly enjoyed it.

[0:34:50] HA: That’s awesome, man. I love that, I’m so glad you’re able to come to Scribe, and really put this pen to paper and make sure that it’s something fully own of course, and engage with in a way that can really pull the best sort of golden gems out of you and you know, I agree with that challenging part because you know, we are in a way our own writers. You know, we’re all on our own voice and all those kinds of things. But it’s until that voice is sort of exposed to someone that can in an analytical way, in a very helpful coaching manner can challenge it or help you grow it or understand it more and I think the writing process I think for me personally, it helped me understand my own wisdom. It helped me understand my own story and knowledge and why the heck am I in my own fight, you know what I mean?

[0:35:32] Jay Joshi: Exactly.

[0:35:32] HA: I’m glad that was something that you have felt as well. Well, Dr. Jay, it’s been an absolute pleasure having you on today, man. Again, your passion and you’re on a mission to really help individuals, I just appreciate that about your work. The book is titled, Burden of Pain: A Physician’s Journey through the Opioid Epidemic. So besides checking out the book, where can people find you and connect with you, sir?

[0:35:55] Jay Joshi: Well, I write predominantly on my blog, Daily Remedy, that’s daily-remedy.com. I have a few blurbs here and there, on Kevin MD, The Healthcare Blog but really, the best way to get a hold of me is to reach out via email and I have no problem answering cold call emails. In fact, I welcome them. So if you’re interested in implementing any of the solutions I discuss in my book or if you feel that my book may be important for somebody to read, please get a hold of me. I can be reached at jayjoshi45@gmail.com, and please, don’t hesitate to provide any sort of feedback engagement that you feel is important.

[0:35:55] HA: I love that, thank you so much Dr. Jay. Man, again, it’s a pleasure having you today. Congrats again on the book and I know it’s going to go out there and make a great impact on the world, so thanks again.

[0:36:52] Jay Joshi: Thank you, sir. I appreciate it.

[0:36:55] HA: Thank you all so much for joining us for this episode of Author Hour. You can find Burden of Pain: A Physician’s Journey through the Opioid Epidemic, right now on Amazon. For more Author Hour episodes, subscribe to this podcast on your favorite subscription service. Thanks for joining us, we’ll see you next time. Same place, different author.