Joey Wahler (Host): It remains a major problem in the United States. So, we're discussing drug addiction. Our guest is Dan Burkybile. He's a Pharmacy Director for Kirby Medical Center. This is the Kirby Connections Healthcare Podcast where we help you nourish your wellness journey with Kirby Medical Center. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dan. Welcome.

Dan Burkybile, PharmD: Hey, thanks, Joey. Second time back. So, I guess I did okay the first time. So, thanks for having me.

Host: Absolutely. You obviously passed the stringent screening process. And so, we're on to phase 2 indeed.

Dan Burkybile, PharmD: There you go.

Host: So first, congratulations on that. And we rightfully hear, of course, so much about drug addiction. As a pharmacist, in a nutshell, how would you sum up just how bad drug addiction is right now from your experience here in this country?

Dan Burkybile, PharmD: Historically, I got out in '08, which was kind of the tail end of the opioid crisis. So, the way I look at it, you've had an opioid crisis. After that, it kind of converted to heroin. And then now, it's the fentanyl. So, the more potent, the easier it is to make, the more likely it is for that drug to be smuggled or used or abused. So, Fentanyl is kind of the one that's on the forefront of my mind right now. But I've kind of gone through the gamut through my years as a pharmacist.

Host: Gotcha. And so, when we talk about fentanyl, how would you illustrate just how bad an issue that continues to be?

Dan Burkybile, PharmD: I was looking at statistics, it was about 78,000 deaths accounted for in 2024. It's about 50,000 the next year, so it's gone down a little bit. But I'm just hearing stories anecdotally of in prison they smuggle fentanyl because it's so small you can put it on a piece of paper and smuggle it around. I've heard of track meets that they're passing around fentanyl brownies. So, the ease of it makes it a little tougher to deal with. So, that's my concern, I guess.

Host: Interesting. So it's not just the potency, but the ease with which it's acquired. That's a great point. Historically speaking as a society, if you will, how did we get here, Dan? Why has addiction spiraled so out of control? I'm sure there are many reasons. What would you mainly point to here?

Dan Burkybile, PharmD: So, I read a really good book, Johann Hari, it's called Chasing the Scream. And he's a journalist and kind of investigated this. His thesis was addiction, It's a lack of connection. So when you're lonely, you go to drugs is kind of his theory. So, there was a study with mice that you put them in a cage with morphine and water. They kill themselves 95% of the time. But you put them in a rat cage, he called it a rat park where you've got other animals to interact with. You've got toys to play with that mice, that rat never killed itself with overdose and morphine. So, he was making that study and just saying it's about connection and connecting people so you don't get lonely and don't go to drugs.

I think there's more to that, but I think there's a lot to what he had. So, It was a great book to really get mind thinking of, like, "Okay, as a society, loneliness is probably a big problem.

Host: Interesting. You've got little else to focus on. That exacerbates the problem. How about the term drug controls? What's meant by that for those unfamiliar? And generally speaking, what's been their effectiveness And the ramifications of their use?

Dan Burkybile, PharmD: So Johann, in that book, the first third of it's dedicated to the drug controls. And I remember I was a kid in the '80s, so it's the D.A.R.E. Programs D.A.R.E. To Say No To Drugs. So, we've come a long way to where if you've got an addict, we typically would catch them in the act and then throw them into jail. Where now we're kind of treating them more medically, so that the law enforcement, we've kind of accepted it hasn't worked for very well. So, I think that's been good for society to kind of accept that and change. I'm in U of I territory here. They did a study and they basically found the D.A.R.E. Program wasn't effective. So, I think we've come a long way in that sense. So, I'm pleased to see that change in direction.

Host: And that leads me very nicely, Dan, into my next question. Namely, what's been learned about the science behind drug dependency? How can pharmacists like yourself use that knowledge to become better patient advocates? Like when you find out, for instance, that we all kind of looked up to those D.A.R.E. officers as kids, felt safe, felt secure around them, and I'm sure learned a lot of valuable information. But you say when it came to addiction, not so effective. How can you use information like that?

Dan Burkybile, PharmD: So, I mean, when mom and dad tell you to do something, your first reaction is to kind of say no. So, I think that was kind of the thing. It's like we're telling you to do this, and you just have that instinct of like, "I don't always want to be told what to do. So, from a pharmacist's perspective, I get into the chemistry. And it gets a little nerdy, but there's a great physician out in the West coast, Corey Waller, and he looks at how drugs affect your dopamine.

So, he says to live you need water, food, and dopamine. And that dopamine is the main driver in life. So, Joey, you're on a Monday, you got to come into work. You're okay, but you're at like 50 nanograms per deciliter. If you're having a bad day, you might be in the 30s, 40s, you're going to call in sick. We were talking earlier if the Jersey Devils make a good playoff run with Jack Hughes. And you get you score this huge interview with Jack Hughes, your dopamine level's going to be up in the hundreds. You just have this kind of high of like, "Yes, This is going super well."

So, the problem is what happens when you introduce drugs, marijuana, alcohol, you get kind of above this natural high. And that's why we feel good. We get a buzz when we have a beer. We get up in that maybe 200 nanogram per deciliter range. But now, we add your opioids, you get methamphetamine—that's one of the worst ones—you're in the 1100, you're in the thousand range, it's totally not natural for your dopamine level. So now, your body stops producing dopamine when you start introducing all these drugs consistently. And so now, that normal person where you and me are in, you know, 40s on a Monday, they're struggling, they're in the 15s, and they're just struggling to get out of bed. They want to seek drugs. So now, the chemistry behind that is going to drive their behavior.

So now, you're going to see the drug seeking, you're going to see all the bad behavior that come with that. So, understanding that dynamic I think helps me as a pharmacist and hopefully physicians and other healthcare providers kind of understand where people are coming from.

Host: Gotcha. So, what are the latest addiction treatment options? Obviously, different things have been tried through trial and error really for generations now. And how effective are they? What's considered to be most effective today. And I would imagine, am I right, Dan, that what may be considered effective today, like the D.A.R.E. Program that you mentioned, perhaps next year, not so much, right? It's, kind of a moving target to some degree, right?

Dan Burkybile, PharmD: Yeah. So in state of Illinois, marijuana's legal here, and you can buy it. But it's kind of controlled. It's certified. There's not a Black Market. So in theory, that makes it a little safer. But as far as us going to treating addiction, buprenorphine, suboxone is what you hear. So, that allows us to treat a patient to get their dopamine levels back to normal so they don't have that drug-seeking behavior. So, that's the big one. There's a couple different formulations to get that. But that's the first thing we'll look at. And obviously, Johann Hari, he's going to want that social worker to come in and help you find whatever else is causing you to, want to seek drugs.

so I think there's definitely a social work aspect to it also.

Joey Wahler (Host): When you talk about marijuana And the legalization of it in many states now, any sense in your case? Community on what impact that's had on addiction.

Dan Burkybile, PharmD: So, we have a strong mental health center and they, do kind of studies and they ask people that, As a coach for high school soccer, I, tell my kids like, This is not going to give you peak performance by any means. so I don't know that I've seen. A huge effect, making it different.

But, uh, you're seeing in the grocery stores now, I think you can get alcohol with THC in it. you're seeing at the gas stations, you can get kind of, they call it, gas station crack, where it's like this crem that hits some of the opioid receptors. So, I think these, some of these people that are looking for that stuff are going to find it no matter what.

so I don't know that it's changed the dynamic. You just. is ever changing. So it's kinda hard to say, but.

Joey Wahler (Host): Understood. Couple of other things for you. You mentioned you're a youth sports coach, And so when you're around young kids these days, being a coach but also a pharmacist and involved in trying to, in your own way, help fight the addiction problem. Are you able to get a message across effectively these days with young people having so many places where they can get information?

Dan Burkybile, PharmD: My big thing as a coach is to, Turn things that don't go your way into something good, you have a bad loss. What can we learn from it? How do we move on? so I guess that's my principle message is, when things don't go your way. Let's find solutions, let's find answers. so kind of my segue into pharmacy is, if you've got somebody in your family struggling or you're seeing somebody.

Let, just let people know to get them the help they need. Let's actually learn from this. Let's grow from it. don't be ashamed of it. Like that was kind of the D.A.R.E. Program where I'm going to get thrown in jail. well now it's not so much that it's let's get you the help you need at rather than actually punishing you.

'cause you do need the help.

Joey Wahler (Host): Absolutely, and it seems like oftentimes, as you well know, being a coach in sports, sometimes the most important lessons you teach aren't necessarily about particular things like drugs, but they're just good overall messages that apply to sports and hopefully through osmosis can be applied to other things like drug addiction or preventing it right.

Dan Burkybile, PharmD: Absolutely. And that, the great thing about sports. you have a good time, you learn from it, but, those life lessons. That go that you know you really cherish. So yeah, absolutely.

Joey Wahler (Host): No question. And in summary here, what's your main message, Dan, for those joining us about drug addiction in general? we've covered a lot of ground here. There's so much more that could be covered of course. But I guess what I'm wondering mainly is what can people. Do about it, if anything, the average person, and at least how can they avoid falling victim themselves, most importantly.

Dan Burkybile, PharmD: Yeah, so I think understanding the chemistry behind that, don't expose yourself to methamphetamine, 'cause that's going to mess with your body. And then it leads to that cascade of just having. Problem. So, that's obviously easiest, but if you are in that scenario, we have people, they show up in our ed, we treat them, And then that we refer them to our, Dr. Mondan here. and I work with Dr. Mondan on, on finding solutions patient's. So we do a good job just kind of completing that circle here. so whether it's, going to the ed, it's telling. your local church or wherever it is, start that cascade of getting help and, it's out there.

You just got to ask for it sometimes.

Joey Wahler (Host): Great advice indeed. Well, folks. Trust. We're now more familiar with the perils of drug addiction And what can be done about it these days. Dan, an important topic to say the very least. Thanks so much again.

Dan Burkybile, PharmD: Thanks, joy. Talk to you later.

Joey Wahler (Host): Absolutely. And for more information, please do visit kirby rx.org. If you found this podcast helpful, please do share it on your social media and thanks so much again for being part of the Kirby Connections Health Podcast.