Since their introduction, opioids have been an effective tool in pain management for many. Unfortunately, they have also been the path to powerful addiction for others. According to the Centers for Disease Control and Prevention, 130 Americans die every day from an opioid overdose. Dr. Chris Jenson, a former ER doctor who spent time with the CDC and is now an educator, joins the podcast to discuss the opioid epidemic as a situation that could potentially affect any one of us.

Transcript

Brian: Hello and thank you for downloading another episode of Your Life, Simplified. As you know, if you’ve been listening to this show, it’s all about improving and simplifying people’s lives through education, so we try and educate you by bringing on experts in a variety of different topics.

On this episode, we’re going to discuss the opioid epidemic because of the impact it’s having on families across the country. And we know it’s a really complex issue because it’s medicine, it’s a necessary pain reliever. But having said that, the opioid crisis is costing the U.S. economy over $500 billion a year, every year. In the United States, over 2 million people are addicted to it, and on average, 115 people die every day from overdose. So, it doesn’t matter if you’re someone from the inner city or from the wealthy suburbs, a teenager or a baby boomer, it does not discriminate. It’s an issue that continues to grow and the more educated that we can all become at the topic, the better we can help navigate these issues with friends and loved ones or someone that might be dealing with this.

So, today I’m excited to have an expert with us on the subject. His name is Dr. Chris Jensen. Chris, welcome to the show.

Chris: Thank you so much for having me.

Brian: So, Chris, just a little bit about your background. You’re an expert in this field. You spent 13 years as an emergency room doctor, you spent time with the CDC, and now you’re in education, right?

Chris: Yes. It’s kind of a funny path, but those are the areas that I frequented in life. And it’s a nice perspective to grab when you’re looking at the opioid crisis, because it is inherently a science-driven topic. But it is making a profound impact on society, and it’s one that we really all need to look at the facts and gather what’s going on. And there’s no way to tackle this until you really get your mind around it.

Brian: So Chris, I shared a couple of quick stats, but can you give us some background on what this looks like?

Chris: Sure. Well, first of all, a lot of people don’t realize the extent of this epidemic, and the media has jumped on board recently, but this has been a problem that’s been brewing for some time. It is actually as bad as it is portrayed to be. It’s a problem, as you mentioned, that involves 50 States, every county in America and local municipalities everywhere. As you said, it doesn’t discriminate, and everyone’s involved. There’s literally no spot in the United States that has immunity from opioids. And of course it is lethal. Approximately 115 to 130 Americans a day succumb to unintentional opioid overdose. And those are the reportable cases. We have no idea what goes on out there that doesn’t make it to the hospital or the law enforcement agency.

And I honestly can’t imagine the numbers of users each day that come close to a terminal event. And so to really wrap your mind around this, you’ve got to go back to when it started, around 1999. And at that time, there was a big emphasis in health care to do a better job addressing pain in patients. And there were a lot of valid reasons for that. The perception was that health care providers were not adequately treating it. And so, at that point in time, the Joint Commission on Accreditation of Healthcare Organizations, also known as JCAHO, put forward some really good directives to take care of the patient, and they were looking to improve the quality of care when it came to pain management. Specifically, JCAHO had three guidelines they wanted providers to consider.

One, they wanted a reliable, consistent method to assess pain in patients, whether that was outpatient or inpatient. Second, the hospital needed to reassess and respond to the patient’s pain. So, it wasn’t a one-time deal. You know, you’re in the hospital for a little while, you’re in the ER for five hours. How are we doing with your pain management? Where is this going? What’s our trajectory? And then finally the hospital either treats the patient’s pain effectively or refers the patient for professional help, such as an anesthesiologist or pain specialist, as an outpatient basis. And that was the intent of those guidelines. And they were released around 2001.

However, those guidelines probably didn’t fall into the practice that JCAHO and Medicare and other regulatory agencies were hoping for. Because here’s the reality of how they sometimes got applied. A lot of people would claim in health care that really pain became the fifth vital sign, there now became too much focus on it. People might also say that they thought the pain assessments had to apply to every patient who walked in the door. A lot of clinical practitioners also felt that you had to treat the pain aggressively until their perspective score of zero through 10 was a zero. And the fear was that, if pain wasn’t treated properly, that a hospital could lose accreditation or that there could be financial implications. Now, I’m not saying that every health care provider in America felt that way, but that’s kind of a gestalt that a lot of practitioners felt was being recommended. And so instead of finger pointing and blaming an individual or an organization, all I can tell you is around 1999, 2000 this desire to treat pain more aggressively started. And we think, we don’t know for sure, but we think that’s why we started seeing an increase in the amount of pain prescriptions, specifically opioids at that point in time.

We’ll get into it later, but we saw a dramatic increase in the number of opioid prescriptions right around 2000, and that has continued to rise persistently through 2017. In 2018-2019, data is still being finalized, but that may have been the start of it all. And so now you find yourself in United States with a great deal of opioid prescriptions out there in the community and suddenly access to opioids became quite prevalent.

Brian: So, Chris, those stats are really interesting. The one that sticks out to me is, not only the emphasis that people put on pain management, but you know, that whole threshold of, how do you measure pain, and the doctors generally say it’s one through 10, with 10 being the worst. How do you feel? It’s all relative, right?

Chris: Yes, it is. It’s hard to quantify something scientifically that’s your own personal perspective and impression. And I think the intent behind the rules was to make sure we’re taking good care of patients. But I think in medicine, we possibly lost the forest for the trees, and the profession became obsessed about a number and driving pain scores down to zero aggressively. And I’m not trying to suggest that every practitioner did this, but there became a little bit of an obsession of pain management.

Brian: Well, you take the patient out of pain, they’re going to be a happier patient, right? And then if it was the worst-case scenario, all of a sudden, you’re not giving them enough medication. They’re in a whole lot of pain. And then you potentially have some sort of liability, or we live in a litigious society and things of that nature, right?

Chris: Absolutely. And you know, not only is it the ethically and humane thing to do to treat someone’s pain, but it affects the business perspective of the hospital. You know, these patients are wonderful people who need help, but from an administrative point of view, or from a hospital point of view, they’re also clients, and you want them to be happy.

Brian: That’s a great point.

Chris: So you know, Brian, if you look at the gestalt from 1999 to 2016, a drug overdose resulted in 632,000 reportable deaths from that time period. And over 351,000 of those were attributed to opioids.

Brian: Wow.

Chris: And that was a massive spike that we’d never seen before.

Brian: What does the crisis look like in America? I mean, are there certain common threads or patterns that you see where folks struggle?

Chris: In many ways, the surge in opioid use does not match the typical patterns of drug abuse that law enforcement and health care used to see.

Typically, if you think about drugs of abuse, you might think of it being potentially an area of poverty or perhaps an inner city location or something along those lines. It often involves the young. And if you look at the breakdown of opioid deaths, the CDC published a really good morbidity and mortality weekly report in 2016, and I’m just going to jump to the facts. What they found is that the most prevalent user who has access to opioids is typically between the age of 30 and 55. They’re often Caucasian, they’re usually male, and they’re most likely from South or Western States. This is not what we’re used to seeing. There are a lot of theories as to why that is, and although we’ll never definitively know, one of the leading theories is, these are the people who have access to health care. These are the people who can gain prescriptions.

So not everyone walks into the doctor to become an opioid addict, that’s not how it happens. But they’re being prescribed these meds, and what we find is that when they get access to them, they accidentally go down this road and become dependent upon opioids.

Brian: So let me ask you a question. As a doctor, you’ve given a prescription out and within 30 days, the individual should be off of these. Maybe I have had some sort of procedure and, after those 30 days, I called the doctor’s office and I say, “Hey, I’m still in a lot of pain here. I need more meds.” I mean do they just write the script from that conversation or is there further analysis that needs to be done?

Chris: No, there are a lot more stricter guidelines in place, and I’m glad you brought that up. There are things being done at this point in time to try and change how we approach pain management and certainly over the phone prescriptions, things like that, which, lacking re-evaluation, are not a good way to go. And I think health care providers realize that now. Rather, we’re trying to set up more of a dynamic, continuous relationship with the patient as he or she is recovering. And making the individual check in with office visits and seeing that individual in person and setting realistic goals. Instead of talking in vague generalities, really the center for disease control and other regulatory agencies are encouraging physicians, and those who deal with opioids, to do three things. First of all, be more judicious and thoughtful about prescribing. Opioids should never be first line therapy for pain management. You also have to sit down and have a nice conversation with the patient and say, “Look, I’m probably not going to make you pain-free, but here’s my realistic goals, and we’re going to use these medicines in conjunction with non-narcotic medicines that are also effective in certain ways. We’ll kind of create a treatment plan, and then being smart about it, using immediate-release opioids that are not as chronic or long-acting and using the lowest effective dose. And I’m not going to lie, that’s a lot more work and effort on the health care provider, but it’s the right thing for the patient to have those conversations. Then the second is, preventing opioid disorder. Pharmaceutical companies have jumped in, and they’re trying to alter their formularies so that physicians can even write some of these higher-dose, longer-acting opioids that put people more at risk. That’s called formulary management. We’re educating providers. We find that, mostly it’s general practitioners who are writing the greatest number of scripts, innocently enough, and they’re not as trained in pain management, per se, as an anesthesiologist or perhaps an ER doctor or surgeon who is a little more versed than them.

However, they’re just as educated, and they’re doing a much better job in recent years of monitoring those scripts. And then, something that you and I have talked about, not all states do a good job regulating narcotic prescriptions. Not all states, believe it or not, have drug prescription monitoring programs.

Brian: Which just blows me away.

Chris: It does me as well, and you can imagine that if a prescription were issued, let’s say in a situation with a city that’s on a border between two States, I’ll pick Kansas city, which I’m familiar with. Missouri doesn’t really have the same monitoring programs that Kansas does. And it’s conceivably possible, if someone wanted to be deliberately fraudulent, to fill that script in both States, with the left hand not knowing what the right is doing.

Brian: Do you know why that is? Why would a state like Missouri not want that? Are there costs associated with that, is there just administrative red tape and things of that nature and why would they not want that in place for their citizens in that sense?

Chris: As far as the details of the Missouri government, I’m certainly not an expert, so I’m going to dodge that question. I am not sure, but what I can tell you is, there’s a lot of federal pressure for not only for states to get monitoring programs in place, but to also link and talk with each other and they are making some good headway in this area in a sense.

Brian: So Chris, it’s really interesting to hear what the manufacturer of the drug companies are coming out with some of the less lethal forms of pain management. In your experience, and we’re talking obviously all about Western medicine here, have you seen any non-Western medicine be used or leveraged as part of the healing process in different types of procedures? Or is it just we’re just not there yet?

Chris: You know, my experience with that is mainly limited to patient encounter and a little bit anecdotal. But yes, there are patients who are unfortunately dealing with terminal cancer and have a lot of pain needs. Some of their therapy is traditional pill-based medicine or Western medicine, and others pursue acupuncture and a variety of alternative choices. And you know, it’s really to each their own. As you mentioned earlier in the podcast, pain is a subjective.

And so these nontraditional therapies for a lot of patients that are very effective and certainly can be pursued. And if they work, that’s great. It reduces the need for other pain management solutions and would inherently reduce the opioids someone needs access to.

Brian: Yes, absolutely. And obviously, less addictive, causing less pain, things of that nature. Going back to the doctor’s Hippocratic oath, right?

Chris: Absolutely. Do no harm.

Brian: So this is interesting to hear that we’re beginning to incorporate both Western medicine and non-Western medicine, but I think we all realize in this country, the way a lot of us deal with pain is through pills and those types of things. And so, when I think about the crisis that we’re talking about, there are probably a couple of different ways in which people get hooked and do whatever they need to do to make sure that they’re receiving this type of pain medication.

And so generally they get it after a procedure, but once they do get hooked, and they can’t get any more from their doctor, is that when they go to the black market and start buying it on the street? What does that look like? What’s the split between those who get their medicine from the doctor versus those who are getting them on the street?

Chris: You ask a very smart question. And it’s interesting, because there’s a very distinct timeline that has brought the opioid crisis into three unique phases. So, I mentioned the fact that there was a rise in prescription starting in 1999. And you know what? That rise was so profound between 1999 in 2016 that opioid prescriptions quadrupled. And so what I want to get out there is that there are a lot of scripts. Now, what we saw around 2010 was a very sad statistic.

There was a dramatic rise in heroin, and heroin became a significant overdose death again. And we believe that what was going on is, between 1999-2010, we started cracking down on health care providers and becoming very stringent and restrictive in many ways and doing some good education, limiting the number of prescriptions. So, now you can imagine a scenario where, let’s say I go for an innocent dental procedure and, appropriately from my dentist, get prescribed some pain meds, and I take them the way that I’m supposed to. But now I’m finding that I really feel like I need these opioids, and I ask for refills. And maybe when I’m truthful with myself, my tooth pain is pretty much resolved. But the dentist is trying to do the right thing and providing me with a humane treatment plan, and then the dentist tells me, “You know what, Chris, you really should be over this pain by now. I don’t feel comfortable writing your for another script.”

But now I’m addicted, so what am I going to do? And I could try and pursue a prescription from another means. My brain is now chemically reliant on this drug. It’s not a sign of weakness. It’s a physiological dependence.

Brian: And that’s what I think a lot of people get confused about. This isn’t just something that I really want at this point. It’s something I really need, right?

Chris: Absolutely. You bring up an excellent point. Opioids are a great pain management solution, because they block a lot of the pain fibers coming up through your spinal cord to your brain. And that means that your brain doesn’t encompass or feel the same significant amount of pain, which is good. But the downside is that’s not the only place they bind. They also bind to areas of the brain that trigger dopamine release. And dopamine is the neurotransmitter we studied a lot, and it happens to be associated with pleasure.

So these chemicals release this pleasurable response, and presumably when you take the pill, you get that dopamine rush, and you get that pleasurable response. And frankly anyone would want to continue feeling that way. When the drug wears off, you lose the response. There are also some changes within the brain itself where you literally become more dependent at the receptors and those nerve cells, you become more dependent on a higher drug dose. And so not only do we see people sadly needing this medicine physiologically to continue, but they need even higher amounts. And that’s where things get very dangerous.

Brian: You bet.

Chris: So, the reality is, if I’m stuck in that situation where I’m now physiologically addicted, and I can no longer gain legitimate prescriptions, I’m going to go get it from other options and that likely would be from a drug dealer. It starts very innocently, maybe you know a friend that has access to X, Y, Z, and you try to acquire it. Now you’ve got that phone number in your speed dial. And so that was the second rise. We saw a rise in heroin around 2010. It gets a little worse, because heroin itself is fairly addictive. It’s very similar to opioids, but there’s a more powerful addiction out there, and it’s semi-synthetic opioids known as fentanyl. And what we saw was drug distributors and cartels got wise, and they decided to mix in fentanyl with some of the heroin they’re distributing. So that although the high or rush really didn’t change, the physiologic dependence increased significantly. So what they did really was prey on someone’s current addiction and make it more profound. So we saw fentanyl rise shortly after 2010, and you can imagine how that spirals out of control. I start just taking some pills for an innocent procedure.

I can’t get off the pills, and I’m buying heroin now. They’ve tampered with my heroin, my addiction is really tremendous at this point, because you’re not dealing with an honest group of people, and things just go out of control and that becomes all I can think about in my day now.

Brian: It just takes control of your entire life. And I think from the outside looking in, it’s sort of need versus want. I don’t think a lot of us can understand exactly what that looks like and how fast that can take place.

Brian: Thanks again for downloading this episode of Your Life, Simplified, which is produced by Mariner. We are here to serve as your advocate. We help people chart a course to reach their personal and financial goals so that they may have greater peace of mind that may lead to a more fulfilled life. We do this by always putting our clients first. So as you listen to this podcast and have questions about your own financial situation or would simply like a second opinion or even if you have an idea for a future podcast, please go ahead and email us at: [email protected]. If you found the information on this podcast valuable, please go ahead and share it with friend or family member who you think might benefit from this information. And please don’t forget to subscribe to this podcast so you don’t miss an episode. Thanks for listening. And now back to the episode.

Brian: So in the spirit of somebody actually getting hooked, many of us are taking these medications when we need to, appropriately. But if I were to go in for a procedure today because something happens, of course I don’t want to be one of those numbers. So how at risk am I? I mean, what is going through in the back of my head is, I’m going to do everything I can to not to take these and that’s probably not the right idea. But how fast can somebody get hooked on this?

Chris: That is a point that shocked a lot of prescribers. The CDC came out with some good data in 2016 and what they focused on was the number of prescriptions and chances of getting hooked and then just number of days that you’re taking this script. So, it’s not surprising to someone that, if I get multiple refills for opioids, and I take them over an extended period of time, that my chance of getting dependent on opioids is quite high.

What I think shocked a lot of medical providers was this one. If I write what I previously thought was a very simplistic, straightforward and small prescription of opioids for five days, I’m actually giving that patient about a 10% to 12% probability of being dependent on opioids at one year.

Brian: It seems really high.

Chris: It does to me, yes. I think it was a shocker for us and that forced a lot of health care providers to really take a step back and think and say, “Okay, opioids aren’t necessarily a bad thing, but I want to be a lot more cautious and conservative about how I prescribe them.” Infusing other pain medicines that are non-narcotic based right out of the gate and using opioids for breakthrough pain in a shorter duration is really the way to go. Because you know, if I don’t know, maybe you had a bad fracture, and because you’re traveling across the United States, and you’re going to be back to a primary care doctor, and I write you for 10 days, and maybe that turns into 15 days, and now you’ve got about a 32% chance of being dependent at the end of one year.

So we were very shocked and surprised when the CDC published this, to see that there is quite a significant dependence with a rather short duration. The figure that humbled me the most was that, at five days, I’m giving someone about a 10% chance that they might be dependent at the end of one year. And that really changed my practice style.

Brian: I’m sure it would as it would for many, I would think.

Chris: Yes, and to your point, I’m not sure a lot of patients are aware of that and that kind of changes the spirit of the game. You know, I think patients and doctors are more willing to work together like, “Hey, I may not be able to make you pain free, but I want to make this tolerable for you, and we’re going to try some non-opioid meds, and you can have a small dose of these for breakthroughs if you need, but here’s why I’m restricting them for you.”

Brian: Then maybe just inserting some sort of pain management person into the mix. Is there someone who is in between sort of the doctor and the patient as it relates to those sorts of things?

Chris: The answer to that is, it depends. Some hospitals are more streamlined and have follow-up procedures that have all different ways of interacting with the patient. But the general school of thought is, no matter what your situation is medically, whether you’re practicing in an urban setting or a rural setting with maybe less funding and bandwidth, you’re looking to make contact with the patient more frequently instead of it being a one-and-done process where a procedure occurs, I hand you a prescription and say, “Hey Brian, good luck.” It needs to be a more constant interaction, not just about refills, but rather, how’s your pain doing? And if I call you up in a day two, and you say it’s actually pretty tolerable. Great. Then let’s get you off opioids today.

Brian: Yes, I just think back about, I’ve had both my knees scoped, and I’ve had my shoulder done, and I’ve been given the pain medication and so forth. I don’t think I ever got a follow-up call from either of the doctors whom I worked with, so I find this interesting.

Chris: Yes, absolutely, and I don’t want to be a hypocrite either. In the emergency department, I can tell you I did a poor job of that, following up with patients. And we were blessed at some of the ERs where I practiced, that we had nurse managers follow up with patients who had acute trauma or things that required opioids and would try and steer them in that direction. And that’s a really great initiative that hospitals are making. And that’s kind of been an ad hoc thing, but it needs to become more streamlined and more regulated.

Brian: Absolutely. So obviously the bandwidth of this problem is enormous. What is the current plan to address the crisis in the United States?

Chris: We’re still fact gathering, so in many ways, we’re being asked to build the ship as we sail it. But the three biggest prongs have come out. We talked about improving opioid prescription and that really falls on health care providers and the medical system. And the quick and dirty of that is, you know, we’re trying to make sure that opioids are used judiciously, that they’re not first-line therapies, that there’s communication with the patient about realistic goals and that there is realistic interaction that involves reassessment and getting them off of them as fast as they can. Also informing the patients, just making sure they understand that this is a highly addictive drug and it can go south in a hurry and this is why we’re going to schedule your pain management with some non-narcotics and try and get you off the opioid part of it as fast as possible. It’s not a perfect solution to your pain but it’s a safe solution and that’s going to be important.

And, at a higher level, preventing opioid disorder to begin with. So that’s education to the public like we’re doing today and trying to give people access to information so they understand the problem and the scope of the problem and can be proactive with their health care providers. That’s education to health care providers and practitioners who don’t traditionally write for opioids and maybe are less-versed in understanding the doses they should select, the specific pill they should select. And frankly, some physicians were irritated by it, but I think pharmaceutical companies did a good thing by removing certain choices off the market, because they were inherently dangerous. And then also creating treatment of opioid disorder. When someone realizes they’ve got a situation with opioids, it’s not just a quit by willpower. As we talked about, they’re chemically addicted. So, providing medication-assisted treatment is really the most effective way, along with psychological support, because this deals with a whole host of emotions. An addiction disorder isn’t just a simple chemical thing. It’s also changes their personality and outlook on life and trying to support them in that regard. And so we’re trying to tackle it in many different ways.

Brian: That makes a lot of sense, especially your last point. It’s a problem. You need a holistic solution, because it impacts so many different areas of the brain and what that looks like.

Chris: Absolutely. I completely agree.

Brian: So it sounds like there are steps taking place to maybe reduce the issue and the crisis, but from your perspective, how are we doing and where are we today? Because we spent the majority of the show educating, talking about how bad this issue is. Are we making progress?

Chris: I don’t think we’re making progress at the rate that we want to. We’re not where we want to be at this time, but we do see some positive things. In 2017, the number of overdose deaths involving opioids, particularly prescription, as well as illegal, was six times higher than it was in 1999, but what I can tell you is the number of opioid prescriptions has declined pretty significantly from 2012 to 2017, and it has fallen to a rate of prescription that’s the lowest it’s been in more than 10 years. And so we do see health care providers responding to the education they’re getting. We do see more judicious use of pain meds. We do see better partnerships between patient and health care provider and a greater understanding. What we’ve got is that issue of the increase in heroin and addictive non-synthetic opioids, such as fentanyl-infused. And we’ve got people who have acquired this addiction over the last 10 to 15 years that we’re trying to get off of it.

And so I think we are limiting new potential patients. We’re trying to make sure we don’t draw anyone else into this crisis. But healing the folks who are already addicted, that’s something that we’re actively trying to work on and improve.

Brian: With the folks who are already addicted, obviously, rehab comes up quite a bit. Do you have any stats on rehabilitation and whether that’s successful or not? I know people will talk about how they went from one facility to another or they relapsed or how incredibly expensive it is and there’s only a limited amount of people who can join those facilities. Do you have any thoughts on that?

Chris: Yes. All those things you said are true. It is expensive and it varies state to state, and it varies whether you have insurance or you don’t.

Chris: So there are a lot of variables in play. What I can tell you is, it goes back to the holistic approach, and if an individual can receive medication-assisted therapy to provide them with a drug that mimics opioid but is less addictive. There’s less of a high or rush, and it slowly brings them down, along with as much emotional support as they can get. Now, if that’s a licensed therapist, there’s an advantage to that. But family and friends can offer some input as well. The big thing is, if you’re trying to get someone to sail their way through an addiction and come out the other side okay, you can’t expect them to do it by themselves. It requires a great deal of support from health care providers and folks who are adept at dealing with addiction disorders.

Brian: So Chris, if someone listening knows someone or has a loved one or a friend who is dealing with this now, what are some of the first steps that they can take to help that individual?

Chris: I’m going to assume that that someone is probably not in health care to begin with. So I think the first thing that I would realistically do is sit down with that individual and have a difficult talk and it can’t be something that’s aggressive. It can just be, “I’m worried about you. I’ve noticed the following things, and I’m concerned about this. Do you think I’m right?” I would ask questions. Often folks deny. They don’t want to admit this, it’s very embarrassing. It’s a setback in their job and social life. But the key element is, offer help with no judgment. And once you’ve done that, as the person helping out, need to put in the legwork and the effort to get them to a health care provider who can counsel them.

And you know, there are many ways you can do that, depending on your state. You can reference clinics, organization’s, hotlines for opioid addiction. And honestly, if you have nowhere else to turn, I would honestly think about taking them to the ER. It’s a reasonable place if you can’t figure something else to queue them through a social work process to get them where they need to be.

Brian: I know that we work with a lot of different families across the country and this is, as you mentioned earlier, it’s an epidemic. It hits families with no boundaries, if you will. And we’ve had conversations with clients about this very issue and, even as wealth advisors, we’ve been able to help guide people down the right path, putting them in touch with the right professionals. I guess because the issue is so big, there’s so much out there, at least for help, so I appreciate those thoughts.

Chris: Absolutely. I appreciate you having the opportunity to chat with you today.

Brian: Chris, thanks again for joining us on the show today. Topics like these are very difficult to talk about, especially if it’s a friend or another loved one. Emotionally it becomes very difficult to talk to somebody who’s dealing with an addiction. But the better educated we are, the better prepared we can all be. Chris, before we let you go, I’m going to ask you the same question we ask all of our guests, and that is what is the worst financial decision you’ve ever made?

Chris: You’re going to actually love my answer, seeing as how you spend a lot of your time at Mariner, but educated as a physician and thinking falsely that I was a smart guy, I thought I could manage my finances on my own. It took me until my mid- to late 30s to turn to a financial advisor, and they looked at the mess that I created and they’re like, “Oh man, we need to help you.” So, I can honestly say, with no prejudice whatsoever, that I probably should have interjected a financial advisor earlier in my life.

Brian: Well said, and we’ll leave it at that. But Chris, thanks again for your expertise, passion and your time today.

Chris: Thank you. It was a pleasure.

Brian: So everyone, thanks for listening to the show today. If you have questions, ideas, comments for the show, please go ahead and email them in at [email protected]. Thanks again.

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