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Why Substance Use Looks Different After 65

lundi 24 novembre 2025 • Durée 35:44

The most dangerous phrase in senior health might be “I’ve always handled it fine.” We dive into how aging reshapes the risks of alcohol, benzodiazepines, opioids, nicotine, and today’s ultra‑potent cannabis—and why familiar habits can turn hazardous after 65. Drawing on frontline cases and recent research, we unpack the baby boomer lived experience, from “mother’s little helper” to daily cocktail hours in senior communities, then connect it to the biology of aging: slower metabolism, reduced kidney and liver function, impaired balance, and sharper sensitivity to side effects.

You’ll hear why DSM‑5 criteria still apply but require age‑aware interpretation, what “code cannabis” looks like in the ER when edibles or high‑THC products masquerade as stroke, and how subtle red flags—poor sleep, irritability, shakiness, forgetfulness, falls—signal a brewing problem. We get practical about safer detox for older adults, the reality of kindling with alcohol withdrawal, and the medication decisions that matter: when to taper sedatives, how to avoid dangerous interactions, and why nutrition and B‑vitamins can’t be an afterthought. Two real-world cases ground the lessons—titrating decades‑long benzodiazepine and Z‑drug use while reducing fall risk, and using naltrexone strategically for late‑onset alcohol use without tipping a patient into instability.

If you care for an older adult—or you are one—this conversation offers clear steps to lower risk and raise quality of life: rethink sleep meds, reduce alcohol use, check cannabis potency, simplify regimens, and choose therapy and support groups that fit your season of life. Subscribe, share this with a friend or colleague, and leave a review with your biggest takeaway so we can keep building smart, stigma‑free care for older adults.

To contact Dr. Grover: ammadeeasy@fastmail.com

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A Bariatric Surgeon Schools Me On Food Addiction and Weight Loss Surgery

lundi 17 novembre 2025 • Durée 01:08:30

Food isn’t just fuel and obesity isn’t just willpower. We sat down with bariatric surgeon Dr. Mark Vierra to unpack what weight-loss surgery really changes, why genetics and hormones can overpower the best intentions, and how a careful program decides who needs a scalpel and who needs a different plan. From GLP‑1 surges and ghrelin drops to PYY’s “brake,” we walk through how surgery reshapes appetite signals and why even modest weight loss can dramatically improve diabetes and cardiovascular risk.

The conversation goes beyond the operating room. Dr. Vierra explains why five of six referrals don’t get surgery, how he and his partner analyze food diaries, depression, and daily constraints, and when medications like bupropion or GLP‑1s make more sense. We explore binge patterns, the messy reality of predicting who will do well after weight loss surgery, and the tough calls around patients who’ve been told their BMI is destiny when their labs and function say otherwise. The story shifts sharply when we talk alcohol: after gastric bypass, blood alcohol rises faster and stays higher, which raises the risk of alcohol use disorder over time. We share practical ways to screen motives for drinking, plan safeguards with families, and use craving meds thoughtfully.

What ties it all together is respect for biology and the person in front of us. Genetics like MC4R variants and syndromes such as Prader–Willi can drive lifelong hyperphagia; ultra‑processed foods and liquid calories amplify the problem; stigma keeps people from care. We push for a different bias—against soda and engineered foods, not against people—and for care that follows patients long after the incisions heal. If you want a grounded, humane guide to obesity treatment, this conversation delivers clarity without blame.

If this resonated, follow the show, share it with a friend, and leave a review so others can find it. Your support helps us keep building informed, stigma‑free conversations about health.

To contact Dr. Grover: ammadeeasy@fastmail.com

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Stigma 2: Stigma Hurts, Compassion Heals

lundi 15 septembre 2025 • Durée 43:00

This episode is the second episode of a four part series on stigma.

This episode is done in collaboration with Central Coast Overdose Prevention (CCODP) and was made possible by California Overdose Prevention Network Accelerator funding from the Public Health Institute's Center for Health Leadership and Impact.

In this episode, Gabrielle shares her powerful journey from fentanyl addiction to recovery, highlighting the unexpected moment of compassion from a correctional officer that changed everything. Her story reveals how respect and dignity can transform recovery outcomes, while exploring the deep impact of self-stigma and family support.

She shares her experience:

• Hitting rock bottom on Christmas Eve 2022 after stealing her mother's car during active fentanyl addiction
• Experiencing six overdoses, with each one bringing her closer to death
• Finding transformation through a year-long program at Teen Challenge
• Encountering a correctional officer who showed unexpected compassion and dignity
• Battling intense self-stigma despite having family who never gave up on her
• Receiving an ultimatum from her pregnant sister that became a powerful motivator
• Learning that recovery meant becoming a different person, not just the same person without drugs
• Moving from shame about her addiction to being open about her recovery journey
• Finding ways to help others by showing kindness and treating "humans like humans"
• Building a life she couldn't have imagined three years ago, working six days a week and helping with her sister's child

If you or someone you know is struggling with addiction, remember you don't have to do it alone. There are many avenues to recovery, and compassion can make all the difference.

To Contact Dr. Grover: ammadeeasy@fastmail.com

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Episode 47 - What is Kratom?

mercredi 22 mars 2023 • Durée 22:40

How much do you know about Kratom? Who takes it and why? How does Kratom withdrawal present and how do you treat it? And what do you do in the case of a Kratom overdose? In this episode we do an evidence based review on Kratom to answer all of these questions and more.

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Episode 46 - Treating Alcohol Use Disorder with Topiramate

vendredi 10 mars 2023 • Durée 25:54

Have you had a patient ask you about using Topiramate to treat their alcohol use disorder? Or maybe you've heard a colleague talk about it, but don't know much about it? In this episode we review the use of the medication topiramate in treating alcohol use disorder. Spoiler alert! This may be practice changing!

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Episode 45 - Cannabinoid Hyperemesis Syndrome

lundi 27 février 2023 • Durée 26:46

How often do you see patients who regularly use cannabis who get recurrent abdominal pain, nausea, and vomiting? It seems like this comes up at least every other shift in the Emergency Department. In this episode we review all aspects of Cannabinoid Hyperemesis Syndrome, from pathophysiology, to diagnosis, to treatment.

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Episode 44 - What is the risk of fentanyl exposure to first responders and what do we do about it?

vendredi 10 février 2023 • Durée 39:02

Have you heard reports of first responders having overdoses on fentanyl after just touching it? Do you actually know how well fentanyl is absorbed through the skin? What PPE should first responders use if they know they are going to be exposed to fentanyl? In this episode we do a mega deep dive to find out what is the risk of fentanyl exposure to first responders and what can we do to mitigate that risk?

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Episode 43 - Cannabis Toxicity and "Greening Out"

jeudi 19 janvier 2023 • Durée 24:44

How familiar are you with cannabis toxicity? Do you know the symptoms of a cannabis overdose? If your patient told you that she "greened out" last night, would you know what she was talking about? In this episode we do an evidence-based review of cannabis toxicity, including what it means to "green out"

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Episode 42 - Delirium Tremens

vendredi 6 janvier 2023 • Durée 22:17

Pink Elephants anyone? In this episode we review Delirium Tremens, also know as alcohol withdrawal delirium. It's not too common, but it makes people impressively sick when it develops. Listen in for an evidence based review of the diagnosis and treatment of delirium tremens.

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Episode 41 - How does microdosing buprenorphine work?

mercredi 28 décembre 2022 • Durée 29:31

Have you heard about microdosing buprenorphine? Have your patients asked you if it's an option for them? In this episode we do a deep dive on the topic of microdosing buprenorphine...including how it might be the best option for patients using illicit fentanyl to start bupe without experiencing precipitated withdrawal.

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