Dr. JoAnn Yanez, Executive Director of the Association of Accredited Naturopathic Medical Colleges (right), joins KCAAs “On the Brink” host, Erin Brinker (left) and Tobin Brinker (middle) to discuss the opioid crisis and naturopathic approaches to pain management.

Full Transcript of Interview Below.

The importance of naturopathic doctor licensure
Opioid crisis
Naturopathic approaches to pain management
And much more…..

Erin: Welcome back, I’m Erin Brinker.

Tobin: And I’m Tobin Brinker.

Erin: And we are “On the Brink,” the morning show on KCAA AM 1050 FM 106.5 and FM 102.3 and we welcome back regular guest here on the show, Dr. JoAnn Yanez. She is the executive director of the Association of Accredited Naturopathic Medical Colleges and is a naturopathic doctor herself. And as the AANMC executive director, she oversees research, advocacy efforts, and the joint academic endeavors of the accredited colleges of naturopathic medicine. Additionally, she helps spread awareness of naturopathic medicine as a viable and satisfying career path.

Prior to joining the AANMC, Dr. Yanez was head of government relations for the New York Association of Naturopathic Physicians. She increased recognition of the importance of licensure in the state, and effectively garnered support of legislators and senior government officials. During her tenure with the NYANP, Dr. Yanez was invited to participate in a think tank on childhood obesity sponsored by MIT, Harvard, and Columbia universities. During the summer of ’09 she found herself, quote, “On the hill working with congressional members and elected women on the Affordable Care Act,” so Dr. Yanez, welcome back to the show.

Dr. Yanez: Thank you so much! Good morning.

Erin: So first of all, since accreditation is part of your life’s work, there’s been a landmark in the state of Massachusetts.

Dr. Yanez: Actually, so I’m glad you bring up Massachusetts. The legislature, the House and the State Senate for Massachusetts passed a bill to license naturopathic medicine. However, it is sitting on the desk of the governor, and he’s got to sign it. So we’re asking folks right now, if you know Governor Charlie Baker, to give him a call and tell him you support licensing and signing that law.

Erin: And there’s no down-side to this. I mean, the licensure means that there’s going to be standards for people who call themselves naturopathic doctors because there are accredited schools and there are unaccredited schools. And we’re talking about medicine.

Dr. Yanez: There are, yeah.

Erin: You’re talking about medicine. You want to make sure that people who hang a shingle out actually know what they’re doing.

Dr. Yanez: Yes. You know, states, Erin, that don’t have the licensing laws, you could go and print out a certificate on your computer and hang it up on the wall and call yourself an ND, and there’s no board to ascertain whether your credentials are appropriate or not.

Erin: Wow. Let that sink in for a minute. Wow.

Dr. Yanez: Yes, it’s a little scary.

Erin: It really is.

Dr. Yanez: There have been documented cases of patient harm as a result and even patient death as a result of folks who’ve gone to the online courses and so, you know. I’m sure there’s plenty of room for folks to do self learning, but don’t hold yourself out to be a licensed practitioner if you’re doing so.

Erin: Right. Get the degree first and become licensed, or graduate from accredited school, and then the self learning should be ongoing for the rest of your life. I mean, that’s what professionals do.

Dr. Yanez: Yes.

Erin: You continue to educate yourself about whatever your field of study is. So, nationally, one of the biggest issues at the moment is addiction to opiates and other pain medications. And you had a column on the AANMC website, a post about this. And can we talk about this issue?

Dr. Yanez: It is something that really is so important right now. 21.5 million adults are battling substance abuse disorder, according to the National Survey on Drug Use and Health. This is a problem that has been tackling our young, our old, it does not discriminate against age, socioeconomic status, race, gender, sexual orientation. Addiction does not discriminate. And I really think, I’ve been thinking a lot about this issue over the last number of years, and looking at it from a historical perspective.

There was something really interesting that happened about 20-ish years ago. Patients were not being treated appropriately for pain. Pain was one of those things where, you know, “just suck it up, deal with it,” it really wasn’t something that was assessed much. And so there was a bit national initiative to make pain, quote unquote, “fifth vital sign.” And what that meant was that nurses, doctors, assessed patients for pain. So they ask you on a scale of one to five, rate your pain. Tell us what’s going on. And folks did. So they talked about their pain.

Well, the unintended consequence of that, I don’t want to say a problem, but the unintended consequence of that is, in the medical model, if you diagnose a symptom, you have to address it. You can’t just leave it unaddressed. And so what happened was folks started identifying this fifth vital sign of pain, and identifying folks who were complaining of pain, and then subsequently the approach to manage the pain was often a strong pharmaceutical opiate.

What has, kind of downstream, happened as a result, is we’ve got folks with lots of pills in their home and those pills either would be used by them or would have the temptation of being used by somebody else in the home. And we have just seen this problem blow up. Heroin use is back up again. There are so many issues with prescription drug addiction and leading to other things, to overdose deaths. And it is such a huge problem, Erin.

I think that, in my world, in the naturopathic approach to care, symptoms are a sign of the body’s call for help. And so, when we see a patient who is in pain, we’re not going to ignore that pain, but we’re going to look to the root cause of the pain. Rather than just giving something temporarily to deal with the pain, that may happen depending on the severity, but we’re always going to look at that underlying cause. Why do you have pain? What is the root of this pain for you? And address the root so that the pain goes away.

So the issue with only giving a pharmaceutical for pain is you’re not addressing the root cause. You’re just addressing the symptom, and so that root cause is going to still be there and so is the pain. Does that make sense?

Erin: It does, it does. And I know that I’ve known people who, they may have surgery, or they may have an accident, and they’re given the strongest medicine that they can be given. So, they have an accident, they have a surgery to fix whatever they broke, and they end up with Oxycontin going home or maybe they were given Fentanyl or something else that’s equally strong. Then an addiction develops, when perhaps they could have been given something a little less potent and it would have met their needs.

Dr. Yanez: You know, a couple weeks ago, I actually had an elective surgery. And I experienced exactly that. I am so fortunate to have my naturopathic background, and also 39 hours of childbirth under my belt as well, to understand my body’s approach to pain, how to manage it, how to handle it with the least amount of meds on board.

So I go into this procedure, and they wheel me into the OR, and the first thing that they wanted to do was, “Okay, well, we’ll put you under and we’ll give you all of this and this and this.” And I said, “Well, do we have to?” And they said, “No.” And I said, “Well, then let’s not. Let’s do as little as possible. If at some point during the procedure I’m really uncomfortable, I’ll let you know and we can go stronger.” So, that was the approach, and I had the procedure, and I talked to the doctors and the anesthesiologists and the staff and the nurses all throughout the procedure and told stories, and the time passed and before I knew it we were out.

So, you know, it was really interesting. And then I get into the waiting room, or the recovery room rather, and the nurse is commenting, she’s like, “You’re doing great.” I’m like, “Well, I didn’t have pain meds, so.” She’s like, “Well, I guess we can get you out of here.” So I was out of the hospital and home within 20 minutes.

Erin: Wow!

Dr. Yanez: Whereas it would have been a two to three hour, watching me to come out of the anesthesia, had I gone through the full round. And then of course, when I’m getting ready to leave the hospital, the doctor hands my husband a prescription for very strong pain meds. And he’s a physician, I’m a naturopath, and he looked at me, and he said, “We’re not filling this.” And they said, “That’s cool.”

So for us, we have a young child, we don’t want those meds hanging around in the house. For myself, I was thinking from a safety issue, I can always fill it if I really need to. I had some ibuprofen at home. I had my acupuncture needles and my other therapies. And the first day or two I was uncomfortable but not so uncomfortable that I needed to take an opiate.

Erin: So what do we do? As a nation, we are facing this huge problem with opiate addiction and overdoses. Our son lived in, for a year he lived in West Virginia, which is ground zero for opioid addiction. It’s awful there how many overdoses happen. And young people it’s happening to as well as old, like you said, it doesn’t discriminate. So what policies can we implement? We don’t want to deny people who are in real pain the medicine that they need, but the other side is you don’t want to overmedicate either. So what do you do?

Dr. Yanez: Well, my approach is we have to empower patients. We have become a culture where – and again, I agree with you, we don’t want people to suffer unnecessarily – but we’ve become a culture where no one should be uncomfortable at all ever.

Erin: That’s true.

Dr. Yanez: Whether it’s socially uncomfortable or physically uncomfortable or emotionally uncomfortable, we’re a culture that has become uncomfortable with being uncomfortable.

Erin: That’s so true.

Dr. Yanez: I really think that we should empower people to know how strong their bodies are. To know how to address issues. When they were doing the needle stick on me and trying to get blood, I had a nurse at first who was not doing such a great job, and she was having to fish around to get the IV started. And it was uncomfortable, but you know, at the end of the day I knew it was a needle, it wasn’t that big of a deal. It wasn’t going to kill me. And it was just a little uncomfortable, so what did I do? I breathed. And the nurse was like, “Oh, you’re doing a great job.” I’m like, “What am I going to do?” It’s uncomfortable, it’s going to pass. And I think that we need to empower people to know and to have faith in their bodies that they have the ability to better control their stress response, better control their emotions, their anxiety.

So my take on this, Erin, from a policy perspective is we’ve got to start with kids. We have to empower children with the coping skills that they need to deal with the uncomfortable times in life. It starts when they’re young. So when they’re up at night because they’re scared of the monsters under their bed, how we help them handle that, how we help them feel safe and empowered in those dark moments when they’re not feeling safe and empowered, is going to stay with them for their life. So that is where I think we need to start, both in parents and in educators, to really help children understand how to cope with skill.

So much of what I saw when I practiced medicine with folks struggling with addiction was, it was often a self-medication for coping. There was something that was painful in their life that they were trying to deal with and numb, they didn’t know how to deal with it better. So they turned to alcohol, they turned to drugs, they turned to sex, they turned to gambling, they turned to some sort of thing that was addictive and raised those dopamine levels in their brain to make them feel better. So if we give people the tools to empower themselves, to know that they can, A) identify that they’re uncomfortable and why, and then B) deal with it, they’re hopefully not going to have to turn to that substance to make them feel better.

Erin: Well, and I think that we need to let our kids get bumped and bruised and fall off the jungle gym, and ride their bikes and just figure out that you can survive the bumps and bruises that life gives you.

Dr. Yanez: Yes. Within safe parameters.

Erin: Of course.

Dr. Yanez: My son is four and I put the helmet on him even though I never wore a helmet once when I was a child. I do put the helmet on him when he goes out on his scooter. But yes, I do agree. We need to teach kids the coping skills. Fall down, dust off, get up, you know? As long as there’s no major blood coming out from anywhere, you’re going to be okay. And really empower people. You know, the “everyone gets a trophy” thing, I was recently watching a YouTube podcast on this, and it’s really fascinating. They were summarizing some research, some literature, that when folks are all treated so special, it devalues the folks who truly earn the degree, the award. And then the folks that didn’t really earn the reward and just got the participation award feel worse about themselves because they know at the end of the day that they really didn’t do anything to deserve it.

Erin: It’s true.

Dr. Yanez: And so I think we’re doing a disservice to our fellow human beings by not teaching them the coping skills to deal with losing, to deal with pain, to deal with those uncomfortable moments. So that’s where, if you’re talking policy, I would love to see more education happening with very young children, to teach them nutrition skills, to teach them healthy communication, to teach them stress and coping management skills.

Erin: I agree. And with that we are completely out of time. So let people know how they can follow you and find you.

Dr. Yanez: Awesome! Thank you so much. We are at aanmc.org, that’s the Association of Accredited Naturopathic Medical Colleges, representing the seven accredited schools across North America.

Erin: Wonderful, well Dr. JoAnn Yanez, thank you so much for joining us. And real quick, we’re going to be starting a new segment with you that I’m very, very excited about on human rights. We’re looking forward to that. We’ll be announcing the dates. I don’t have it in front of me and we’re completely out of time. But I am looking forward to that.

Dr. Yanez: Thank you so much. Have a great day, folks!

Erin: Thank you, you too. So I’m Erin Brinker.

Tobin: And I’m Tobin Brinker.

Erin: And we are “On the Brink,” the morning show on KCAA AM 1050 FM 106.5 and FM 102.3. We’ll be right back.