The Saving Dose

John Hsu & William Pedranti
  • 5.0 (4)
  • Medicine

The podcast for those building the future of healthcare. A clinician, a healthcare attorney, and a behavioral health executive on what's actually working in addiction, adherence, and the capital reshaping both.75% of patients do not take medications as prescribed. 125,000 Americans die from it every year. $528 billion in preventable costs trace directly to a gap the healthcare system has known about for decades and never closed: what happens after the prescription is written. The Saving Dose is a podcast about that gap, the space between the clinic visit and the outcome, between the evidence-based treatment and the patient who never receives it, between the innovation that works and the reimbursement system that decides whether anyone can afford to deliver it. Hosted by Dr. John Hsu, and William Pedranti, the show brings together a behavioral health revenue strategist, an addiction medicine physician, and a biotech entrepreneur to go inside the clinical, operational, and commercial realities of addiction recovery, medication adherence, opioid use disorder (OUD), and behavioral health. Three different vantage points on the same broken system. Honest about what fails, specific about why, and direct about what a real fix requires. Topics include: addiction, addiction recovery, MOUD and MAT clinic operations, medication-assisted treatment adherence, behavioral health reimbursement, opioid use disorder treatment, payer contracting, DEA compliance, FFS-to-value-based care transitions, and the patient adherence gap in controlled substance prescribing. The Saving Dose is for investors evaluating the addiction recovery and behavioral health infrastructure market. For clinic operators and executives running opioid treatment programs, MOUD practices, and behavioral health facilities. For clinicians in addiction medicine and pain management. For payers and administrators navigating the cost and risk of behavioral health coverage. New episodes every two weeks. Available on Spotify, Apple Podcasts, YouTube, and wherever you listen.058171

  1. 1d ago

    Addiction, Stigma, and the Treatment Gap| The Saving Dose Ep. 17 Ft. Dr. Michael Genovese

    In this episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Dr. Michael Genovese, a board-certified psychiatrist and attorney whose rare dual training gives him an unusually clear view of both the clinical and legal dimensions of behavioral health. As Chief Medical Officer of Behavioral Health at Access Telecare, he leads the nation’s largest acute specialty telemedicine platform, helping hospitals deliver psychiatric and addiction care where it’s needed most. He previously served as Chief Medical Officer at Acadia Healthcare, the largest standalone behavioral health provider in the United States, and brings more than two decades of hands-on experience as an addiction specialist. He is a longtime advocate for first responders and attorneys in recovery, and recently joined the boards of the National Eating Disorders Association and Banyan Treatment Centers. This conversation covers the clinical and legal realities that shape how addiction is treated in America and why nearly two-thirds of people who need treatment for substance use disorders never receive it. Dr. Genovese and the hosts examine how stigma distorts clinical decision-making, what the medical community still gets wrong about opioid use disorder, and why treating the whole patient, not just the disorder, is the only approach that holds. 00:00 Introduction 02:01 Dr. Genovese’s path from law to medicine 05:46 Why psychiatry captured a doctor trained for cardiology 08:23 From one patient at a time to a facility of people 10:16 How telemedicine reaches patients no specialist could otherwise see 12:01 How a law degree changes the way a doctor practices medicine 16:14 What doctors still get wrong about addiction and stigma 18:58 When stigma becomes malpractice: cases where bias caused harm 22:41 The CDC’s 90 MME guideline and what it actually did to patients 23:48 Telehealth for opioid use disorder: better or worse? 26:10 Only 15 to 20 percent of OUD patients get treatment, and we know how to change that 28:20 First responders, the FBI National Academy, and the stigma that runs deepest 31:16 Veterans, VR treatment, and 44 deaths a day 37:31 Is buprenorphine trading one addiction for another? 38:41 Why psychosocial support cannot be separated from medication 40:11 Multidisciplinary pain treatment and why it collapsed 41:02 What it will actually take to solve the opioid crisis 43:37 Ignorance is not an excuse: 5,000 addictionologists for 48 million people 46:12 One legal or regulatory change to unlock mental health and addiction care About the Hosts John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch. William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit. About the Guest Dr. Michael Genovese is a board-certified psychiatrist and attorney serving as Chief Medical Officer of Behavioral Health at Access Telecare, the nation’s largest acute specialty telemedicine platform. He previously served as Chief Medical Officer at Acadia Healthcare, the largest standalone behavioral health provider in the United States. With more than two decades of experience as an addiction specialist, he is a longtime advocate for first responders and attorneys in recovery. He recently joined the boards of the National Eating Disorders Association and Banyan Treatment Centers. Website: thesavingdose.com This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions. If you or someone you know is struggling with substance use disorder, contact SAMHSA’s National Helpline at 1-800-662-4357. Free, confidential, 24/7. #AddictionMedicine #BehavioralHealth #TheSavingDose #OpioidCrisis #SubstanceUseDisorder #Psychiatry #Telemedicine #AddictionRecovery #Stigma #OpioidUseDIsorder #MOUD #MentalHealth #FirstResponders #HealthcarePodcast #StigmaKills #BrainHealth #PublicHealth #RecoveryPodcast #AccessTelecare #PsychiatryPodcast

  2. Oct 20

    The Politics of Addiction | The Saving Dose Ep. 16 ft. Andrew Kessler

    In the sixteenth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Andrew D. Kessler, JD, founder and principal of Slingshot Solutions LLC, a Washington, DC behavioral health policy consulting firm with more than two decades of experience navigating Congress, the White House Office of National Drug Control Policy, SAMHSA, and NIDA on behalf of treatment providers, advocacy organizations, and professional associations. Andrew has written legislation and report language passed by both the House and Senate, presented before the Scientific Management Review Board, the College on Problems of Drug Dependence, and the National Conference on Addictive Disorders, and is a frequent contributor to Politico, The Hill, and Alcohol and Drug Abuse Weekly. He is one of the few people in this space who understands both what advocates need and why Capitol Hill consistently fails to deliver it, and he says so plainly. 00:00 Introduction 02:34 Andrew’s path from Capitol Hill intern to DC policy specialist 07:53 Why Slingshot Solutions has nothing to do with David and Goliath 10:02 The fourth decade of the opioid epidemic and the gap between suffering and policy 11:06 Why stigma is still the number one obstacle on Capitol Hill 13:00 Addiction as a brain disease: what society still does not understand 14:25 How Hollywood shapes what policymakers think treatment looks like 17:44 The $4 trillion problem and why 85% of people with OUD never get treatment 24:20 The three-legged stool: prevention, treatment, and recovery 26:07 Reducing overdose deaths by more than 50% is possible, so why aren’t we 29:38 The workforce crisis: retention, not recruitment, is the problem 31:53 Why Medicaid reimbursement for SUD has never recovered from the 1960s 35:40 The $57 billion opioid litigation settlement and what actually happened to it 43:12 If the president gave you one year and full backing: Andrew’s three moves 51:47 Homelessness, addiction, and what the current administration is actually saying 54:38 Robert F. Kennedy Jr., 14 years of heroin addiction, and zero days homeless 57:56 A vision without funding is a hallucination: how Andrew holds the White House accountable 1:00:46 What Slingshot Solutions does and how to reach Andrew About the Hosts John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch.  William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit.  About the Guest Andrew D. Kessler, JD is the founder and principal of Slingshot Solutions LLC, a Washington, DC consulting firm specializing in behavioral health policy. With more than 20 years of experience in substance use disorder policy, he has written legislation and report language passed by both the House and Senate, collaborated with congressional offices, the White House ONDCP, NIDA, and SAMHSA, and represented organizations including the International Certification and Reciprocity Consortium, the California Consortium of Addiction Programs and Professionals, and Faces and Voices of Recovery. He is a frequent contributor to Politico, The Hill, and Alcohol and Drug Abuse Weekly, and speaks nationally on substance use policy and advocacy. He speaks in a personal capacity. Website: thesavingdose.com This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions. If you or someone you know is struggling with substance use disorder, contact SAMHSA’s National Helpline at 1-800-662-4357. Free, confidential, 24/7. #OpioidPolicy #AddictionRecovery #BehavioralHealth #TheSavingDose #DrugPolicy #SubstanceUseDisorder #ONDCP #SAMHSA #NIDA #OpioidCrisis #HarmReduction #MOUD #MedicaidPolicy #AddictionMedicine #PublicHealth #RecoveryPodcast #StigmaKills #HealthcarePodcast #SlinghotSolutions #OpioidSettlement

  3. Oct 13

    Inside Hospital Drug Diversion | The Saving Dose Ep. 15 ft. Terry Vidals

    Terri Vidals has spent more than 35 years in pharmacy, with the last 15 focused on a problem most healthcare institutions prefer not to discuss: drug diversion by their own staff. She founded RExpert Solutions to help hospitals assess where their diversion vulnerabilities actually are and build programs that close them. She hosts the Drug Diversion Insights Podcast. She knows what the automated dispensing machines catch, what they miss, and what happens to patients when a clinician replaces fentanyl with saline. In this conversation with Dr. John Hsu and William Pedranti, Terri walks through the mechanics of diversion at the point of care, the accountability frameworks that protect patients without destroying careers, and why the home monitoring environment remains a blind spot no current system addresses. Chapters: [[00:00]] Introduction and Terri’s background [[10:46]] What happens when the vial has been tampered [[15:41]] The home monitoring black hole: no visibility after the cabinet [[19:00]] Diversion rates among healthcare professionals: 10 to 20 percent [[25:00]] Accountability vs. compassion: remove from bedside, investigate fully [[32:00]] The false accusation: when reporting gets used as a weapon [[38:00]] MOUD access and the 75% who cannot get medication [[43:44]] What Terri would mandate at every hospital in the country [[49:11]] Closing Connect with Terri Vidals: LinkedIn: https://www.linkedin.com/in/terri-vidals About The Saving Dose: The Saving Dose is a podcast about what it actually takes to close the gap between the medication adherence crisis and the patients who need care. Hosted by Dr. John Hsu, an anesthesiologist and pain management physician with 25 years of experience, and William Pedranti, a healthcare attorney and biotech operator who has taken companies from founding through FDA approval and commercial exit. New episodes every Tuesday. Subscribe on Spotify, Apple Podcasts, and YouTube.

  4. Oct 6

    What the UK Got Right About Addiction | The Saving Dose Ep. 14 Ft. Mark Gilman

    Mark Gilman has worked inside the opioid crisis from every angle for more than 40 years: as a researcher, a policy architect, a commissioner, a clinician, and a patient. He designed the Through the Gate program for NHS England, which put medication-assisted treatment inside prisons and continued it through release. He helped build the harm reduction infrastructure that prevented the UK's HIV response from becoming a second catastrophe. He started self-medicating at 12 after his father's death, spent years navigating addiction before going to university, and built a career dedicated to fixing the systems that had failed him. In this conversation with Dr. John Hsu, Mark makes the case that the United States already has the evidence it needs. The question is whether it will use it. What they cover: The UK's 1981 brown powder heroin epidemic and why unemployment, displacement, and loss of identity drove addiction rates more than drug availabilityWhy policing a drug market is like standing on a balloon: push it down in one place, it pops up somewhere else, because the markets are demand-ledHow harm reduction began as a peer-led self-help movement with no government support and became national policy when Margaret Thatcher's government decided HIV was a greater threat than drug misuseThe abstinence-without-medication success rate: 2 to 7 percentWhy people are 129 times more likely to die in the two weeks after prison release in the US, and 25 times more likely in the UK, and what the Through the Gate program does to close that windowThe Retox concept: stabilizing people on MOUD inside prison so medication continues seamlessly from the prison gate into the communityHeroin-assisted therapy and the Basel model: patients in Switzerland can choose between injectable diamorphine, a nasal spray, or a 200mg tablet, and early observations show a shift toward the tablet because what people actually want is jobs, homes, and friendsThe subset of patients, less than 10%, with severe trauma histories for whom buprenorphine doesn't work because greater cognitive clarity brings the trauma backStigma inside the recovery community itself, including 12-step fundamentalists who tell people taking ADHD medication that they've relapsed, and why Mark argues that internal cultural stigma causes more damage than state stigmaVietnam veterans: 25% of soldiers became heroin addicts during the war; 85 to 90% simply stopped when they came home to jobs, homes, and a sense of purposeThe biopsychosocial model and the case for adding a fourth dimension: spiritual, meaning a sense of meaning and purpose, not religion specificallyChapters: [00:00] Introduction and Mark's background [01:01] Self-medicating at 12 after his father's death [01:42] University, two degrees, and entering the field [02:09] The six elements of OUD: research, policy, practice, commissioning, providers, and patient [03:22] The UK's 1981 brown powder heroin epidemic [05:26] Pain, unemployment, and displacement as the drivers of addiction [06:48] Why policing drug markets is like standing on a balloon [08:52] Harm reduction as a peer-led self-help movement [10:07] How Thatcher's Conservative government pragmatically backed harm reduction [13:36] Recovery requires more than medication: jobs, friends, and houses [15:30] The abstinence-without-medication success rate: 2 to 7% [17:59] The history of diamorphine prescribing in the UK since 1926 [19:59] Buprenorphine and the subset it doesn't serve [21:11] Heroin-assisted therapy and the Basel model [23:05] Stigma from OUD's history as a moral or criminal failing [24:31] NIMBY: why clinics end up on the wrong side of town [25:02] Stigma inside recovery communities: ADHD medication and 12-step fundamentalism [27:01] Four decades of the US opioid epidemic and the case for looking outward [28:43] Prison, recidivism, and the 75% three-month return rate [31:22] The two-week death window after prison release: 25x in the UK, 129x in the US [32:32] Through the Gate: seamless handover at the prison gate [33:04] The two pathways in prison: abstinence-based or MOUD stabilization [36:01] Why short sentences create a revolving door of detoxification and death [39:08] The growing crisis of meaning and ketamine among young people [40:00] Vietnam veterans: most stopped using when they came home to a life [42:27] Dignity, the diversion concern, and the Basel diamorphine tablet options [46:21] The final question: what would you change from your early career? [47:27] The biopsychosocial model and the case for a fourth dimension: spiritual [48:15] John's patient who found meaning in a peer support group at a church [49:51] Closing Connect with Mark Gilman: LinkedIn: https://www.linkedin.com/in/mark-gilman-0597012b/ About The Saving Dose: The Saving Dose is a podcast about what it actually takes to close the gap between the medication adherence crisis and the patients who need care. Hosted by Dr. John Hsu, an anesthesiologist and pain management physician with 25 years of experience, and William Pedranti, a healthcare attorney and biotech operator who has taken companies from founding through FDA approval and commercial exit. New episodes every Tuesday. Subscribe on Spotify, Apple Podcasts, and YouTube. The Saving Dose is produced by iPill Adherence Tech Services. All content is for educational and informational purposes only and does not constitute medical advice.

  5. Sep 29

    How Stigma Keeps People from Getting Help | The Saving Dose Ep. 13 Ft. Melissa Shackleford

    Melissa Shackleford has been in addiction recovery for 37 years. She got sober as a college freshman, went on to spend a decade as SVP of Marketing at Hazelden Betty Ford, and built a career at the intersection of healthcare marketing and behavioral health. She is a TEDx speaker, Amazon #1 bestselling author of Harnessing Purpose, and founder of Shackleford Strategies. In this conversation with Dr. John Hsu and William Pedranti, Melissa breaks down why stigma is not just a cultural problem but a clinical one. She's seen it from both sides: as a person in long-term recovery and as the marketing executive who had to fight to remove stigmatizing language from Hazelden's own outreach materials. What they cover: Why the language we use determines whether someone seeks help or disappearsThe person-first language shift and why it matters beyond addictionThe Gallup and Shatterproof stigma studies and what the data reveals about how little has changedWhy doctors call OUD patients "difficult" when no one says that about diabetics who won't follow their dietThe buprenorphine shame problem inside 12-step recovery communitiesMedicaid's 8-to-9-month wait for OUD treatment and who loses their life in that windowWhy pharmacies refusing to stock MOUD medications is a form of stigma with real body countsWhat Hazelden Betty Ford got right about messaging: lead with hope, not shockJohn's La Joya house: giving six bedrooms to a sober living facility because no neighborhood wants treatment next doorThe one change Melissa asks every doctor, pharmacist, and family member to makeChapters: 00:00 Introduction and Melissa's background 02:30 Getting sober at 18: what that looked like 05:00 Why person-first language is not political, it's medical 08:00 The parking lot pill count story (and what it says about how we treat patients) 10:00 Stigma inside the recovery community: buprenorphine and 12-step 15:30 MAT stigma and the barriers it creates 17:00 Medicaid pays 80% of OUD treatment, then makes patients wait 9 months 18:40 John's sober living house and the "not in my backyard" problem 20:00 Why OUD patients are labeled "difficult" when no chronic condition patient is 22:00 Long-term MAT: the three schools of thought 24:00 How the drug supply changed: from prescription opioids to fentanyl-laced everything 25:00 Treating the body and the mind: why medication alone is not recovery 26:00 MAT and the work requirement trap: losing Medicaid means losing medication 28:00 Pharmacies that refuse to stock MOUD medications 28:44 These medications reduce overdose-related death by more than 50% 31:00 OUD providers keeping secret lists of pharmacies that will fill prescriptions 32:00 Trust as the currency of healthcare 33:00 Hazelden's messaging strategy: pull out stigmatizing imagery entirely 35:00 People call treatment centers on the worst day of their life 37:00 The one thing to change: use person-first language 40:00 Addiction is not a choice, it's not a moral failing 41:00 Cancer has pink ribbons. Why does addiction still carry shame? 43:00 About Shackleford Strategies and how to connect with Melissa 44:10 Closing Connect with Melissa Shackleford: LinkedIn: linkedin.com/in/melissashackleford Website:  https://melissaforsshackelford.com/ About The Saving Dose: The Saving Dose is a podcast about what it actually takes to close the gap between the medication adherence crisis and the patients who need care. Hosted by Dr. John Hsu, an anesthesiologist and pain management physician with 25 years of experience, and William Pedranti, a healthcare attorney and biotech operator who has taken companies from founding through FDA approval and commercial exit. New episodes every Tuesday. Subscribe on Spotify, Apple Podcasts, and YouTube. The Saving Dose is produced by iPill Adherence Tech Services. All content is for educational and informational purposes only and does not constitute medical advice.

  6. Sep 22

    The Drug That Can Make Pain Worse | The Saving Dose Ep. 12 Ft. Prof. Patrice Forget

    In the twelfth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Professor Patrice Forget, a Belgian anesthesiologist and pain researcher now based in the United Kingdom. With more than 250 peer-reviewed publications, Professor Forget chairs the PANDOS research group (Pain and Opioids After Surgery) at the European Society of Anesthesiology and Intensive Care, serves as a board member and honorary treasurer of the European Pain Federation, and is deputy editor-in-chief of the European Journal of Anesthesiology. His work bridges clinical practice, large-scale epidemiology, and policy at the intersection of post-operative pain management, opioid use, and long-term outcomes. This episode goes further into the clinical science of opioids than any conversation The Saving Dose has had. Professor Forget challenges assumptions that have shaped prescribing practice for decades, including the idea that more opioids during surgery means less pain after it. 00:00 Introduction 02:06 Professor Forget's background and path from Brussels to the UK 04:00 How fentanyl was developed in Belgium and what it was originally designed to do 07:15 Opioid-induced hyperalgesia: what it is and why it matters 10:00 The Liverpool technique and the history of balanced anesthesia 12:00 Why large doses of opioids can increase pain sensitivity rather than reduce it 16:00 The preemptive analgesia theory and why the data rejected it 20:00 How not all patients respond to opioids the same way 24:00 What European post-surgical data shows about long-term opioid outcomes 28:00 The gap between what research shows and what policy assumes 32:00 Opioid stewardship and responsible prescribing in a post-crisis environment 38:00 John on cardiac anesthesia and the clinical reality of high-dose opioid use 44:00 What the field still does not know and where research is heading 50:00 What better perioperative pain management could mean for addiction prevention About the Hosts John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch.  William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit.  About the Guest Professor Patrice Forget is a Belgian anesthesiologist and pain researcher based in the United Kingdom. He chairs the PANDOS (Pain and Opioids After Surgery) research group at the European Society of Anesthesiology and Intensive Care and serves as a board member and honorary treasurer of the European Pain Federation. He is deputy editor-in-chief of the European Journal of Anesthesiology and a past president of the Belgian Pain Society. He has authored more than 250 peer-reviewed publications on perioperative epidemiology, clinical pharmacology, and opioid stewardship. Website: thesavingdose.com This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions. If you or someone you know is struggling with substance use disorder, contact SAMHSA's National Helpline at 1-800-662-4357. Free, confidential, 24/7. #ChronicPain #OpioidCrisis #PainManagement #AddictionRecovery #TheSavingDose #OpioidInducedHyperalgesia #Anesthesiology #PeroperativeCare #OpioidStewardship #SurgicalPain #PainMedicine #Buprenorphine #SubstanceUseDisorder #HealthcarePodcast #EuropeanPainFederation #PANDOS #OpioidPolicy #AddictionMedicine #ChronicPainManagement #PublicHealth

  7. Sep 15

    Inside the White House Drug Policy Office | The Saving Dose Ep. 11 feat. Rob Kent

    In the eleventh episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Rob Kent, former General Counsel at the White House Office of National Drug Control Policy under the Biden administration and a 30-year veteran of New York state government drug policy. He now runs Kent Strategic Advisors, working with treatment providers, advocacy groups, and think tanks to navigate regulators and insurance companies. Rob is one of the few people in this conversation who has been inside the machinery of federal drug policy and is now free to say exactly what he thinks about how it works and where it fails. This episode is the most policy-focused conversation The Saving Dose has had, and it does not pull punches. This episode covers the X-waiver elimination and why removing the barrier did not move prescribing numbers the way anyone hoped, why harm reduction is still the third rail of drug policy, what the Biden administration actually accomplished in its first 18 months before reelection politics took over, why the opioid settlement billions are being misspent in ways Rob believes are worse than the tobacco settlement errors, and what it looks like when an insurance company tells you a person who barricaded themselves in a hotel room and drank the entire minibar did not meet the criteria for inpatient care. 00:00 Introduction and Rob Kent's background 02:06 Growing up in Syracuse, 30 years in New York state government, White House ONDCP 04:00 What the Office of National Drug Control Policy actually does 05:32 What the Biden administration focused on: harm reduction, X-waiver, jails and prisons 06:49 The biggest challenges: Congress, stigma, and the politics of harm reduction 08:33 Why the first 18 months are the window and what happened after 10:11 The X-waiver: what it was, why it mattered, and what eliminating it did and did not do 12:54 Why removing the barrier was not enough without incentivizing prescribers 14:44 John on the X-waiver limiting him to 25 patients and killing the business model 16:23 Telehealth and buprenorphine: how COVID blew the door open and what the DEA is doing now 18:36 Why too many policymakers still believe addiction is a choice 20:03 Proving it works versus winning hearts and minds: Rob's policy approach 20:40 OUD as a lifelong condition: why policy needs to treat it like high blood pressure 26:00 Medicaid work requirements and what they mean for people in recovery 28:47 The opioid settlement billions: why Rob believes the money is being wasted 30:16 The death rate dropped 37% after CDC loosened prescribing restrictions in 2022 31:14 Opioid dependency versus opioid use disorder: two diseases, one stigma 33:06 What the Biden CMS guidance on Medicaid in jails actually did 34:41 Why guards are the happiest people when MAT is offered in correctional facilities 36:33 New York's seven-day acute supply law and what happened when a pain clinic was shut down overnight 38:01 How policy swings from one extreme to the other instead of legislating in the middle 38:29 John on the 1999 pain as a fifth vital sign movement and what it started 42:01 How the Joint Commission and reimbursement incentives built the opioid crisis systemwide 43:29 Physicians stopping opioid prescribing entirely out of fear of monitoring 44:19 Tylenol and Motrin after a total knee replacement: John on the prescribing overcorrection 49:34 Insurance clawbacks: John receives a bill for a patient who died six years after treatment 50:17 Rob on insurance companies and where the money in the system actually goes 51:04 Kent Strategic Advisors: what Rob does now and who he works with 54:05 The insurance company that said a person who barricaded themselves in a hotel room did not need inpatient care 55:15 William's experience attending an addiction recovery meeting and why everyone should go About the Hosts John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch. Connect with John: https://www.linkedin.com/in/john-hsu-md-300a8b2a/ William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit. Connect with William: https://www.linkedin.com/in/williampedranti/ Kendra Allen is the CRO of iPill with 20 years in behavioral health revenue strategy, payer contracting, and regulatory navigation. She founded and exited a national healthcare consulting firm. Connect with Kendra: https://www.linkedin.com/in/kendra-allen-cro/ About the Guest Rob Kent is a former attorney and government official with 30 years of experience in New York state drug policy and addiction recovery. He served as General Counsel at the White House Office of National Drug Control Policy under the Biden administration, where he worked on the X-waiver elimination, harm reduction policy, and expanding MAT access in jails and prisons. He now runs Kent Strategic Advisors, working with treatment providers, advocacy groups, and think tanks on drug policy, insurance disputes, and regulatory navigation. He speaks in a personal capacity. Website: thesavingdose.com This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions. If you or someone you know is struggling with substance use disorder, contact SAMHSA's National Helpline at 1-800-662-4357. Free, confidential, 24/7. #OpioidPolicy #AddictionRecovery #OpioidUseDisorder #BehavioralHealth #TheSavingDose #HealthcarePodcast #DrugPolicy #HarmReduction #MOUD #Buprenorphine #OpioidSettlement #PublicHealth #AddictionMedicine #SubstanceUseDisorder #WhiteHouse #ONDCP #MedicaidPolicy #CriminalJusticeReform #OpioidCrisis #RecoveryPodcast

  8. Sep 8

    What Actually Happens After Rehab | The Saving Dose Ep. 10 ft Frank Galimidi

    In the tenth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Frank Galimidi, CEO of Sunview Wellness in West Palm Beach, Florida, a veteran clinical leader with 23 years in addiction treatment and substance use disorder who entered the field himself in recovery at 22 years old. Frank runs one of the most honest extended outpatient programs in the country. Average length of stay at Sunview Wellness is 130 days. He believes the addiction treatment industry has made enormous scientific progress and almost none of it has moved the relapse needle, and he is direct about why: short-term treatment, insurance-driven discharge, and a cultural belief that stabilization equals recovery are producing a predictable failure rate that the industry keeps misreading as patient noncompliance. This episode covers why 40 to 60% of OUD patients relapse within 90 days of leaving residential treatment, what consequence fade is and why it hits hardest at exactly the moment insurance companies decide to cut patients off, why Frank scholars patients out of his own pocket rather than discharge them mid-treatment cycle, and the one line that stopped William cold: connection is the opposite of addiction. You cannot connect with a pill and you cannot connect with artificial intelligence. 00:00 Introduction and Frank's background 02:08 23 years in addiction treatment: from Phoenix House Brooklyn to CEO 04:27 Why the relapse rate has not moved despite decades of scientific progress 06:13 Counselor burnout, workforce collapse, and who is leaving the field 08:35 Holistic OUD treatment: why medication without therapy is not enough 12:09 What AMA blocking is and why patients leave treatment before it works 13:07 Consequence fade: why patients stop doing what is working at 90 days 15:30 Why Frank's average length of stay is 130 days and what that changes 16:34 The statistics: 27% relapse the day of discharge, 90% within a year 19:00 In vivo treatment: doing recovery in real life, not inside a facility 26:00 Insurance companies cutting patients at exactly the wrong moment 32:00 Frank scholarships patients to finish treatment when insurance pulls out 35:00 Medicaid, work requirements, and the socioeconomic reality of OUD 38:00 Why Europe is trialing an oral heroin pill and what that means for harm reduction 38:53 OUD as a chronic condition: why John compares it to cancer surveillance 41:40 Longer duration, decreasing intensity: what the research actually supports 42:02 What the perfect OUD treatment center looks like 43:03 Detox alone without step-down care is setting patients up to fail 45:28 The future of addiction treatment if the therapist workforce keeps shrinking 46:05 Connection is the opposite of addiction 47:49 Your addiction is constantly telling you you're okay 49:15 Closing and how to find Sunview Wellness About the Hosts John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch. Connect with John: https://www.linkedin.com/in/john-hsu-md-300a8b2a/ William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit. Connect with William: https://www.linkedin.com/in/williampedranti/ About the Guest Frank Galimidi is the CEO of Sunview Wellness, an extended outpatient addiction treatment program based in West Palm Beach, Florida. He has 23 years of experience in substance use disorder and mental health treatment, beginning at Phoenix House in Brooklyn at age 22. He has held senior executive roles at Sunset House and the Meadows Counseling Center and is a recognized expert in program development, clinical frameworks, and continuum of care. He speaks from both professional expertise and personal experience in recovery. Website: thesavingdose.com This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions. If you or someone you know is struggling with substance use disorder, contact SAMHSA's National Helpline at 1-800-662-4357. Free, confidential, 24/7. #OpioidUseDisorder #AddictionRecovery #BehavioralHealth #TheSavingDose #HealthcarePodcast #AddictionTreatment #SubstanceUseDisorder #MOUD #RehabReality #PatientRetention #MentalHealth #RecoveryPodcast #OpioidCrisis #AddictionMedicine #SoberLiving #ContinuumOfCare #PublicHealth #OutpatientTreatment

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5
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4 Ratings

About

The podcast for those building the future of healthcare. A clinician, a healthcare attorney, and a behavioral health executive on what's actually working in addiction, adherence, and the capital reshaping both.75% of patients do not take medications as prescribed. 125,000 Americans die from it every year. $528 billion in preventable costs trace directly to a gap the healthcare system has known about for decades and never closed: what happens after the prescription is written. The Saving Dose is a podcast about that gap, the space between the clinic visit and the outcome, between the evidence-based treatment and the patient who never receives it, between the innovation that works and the reimbursement system that decides whether anyone can afford to deliver it. Hosted by Dr. John Hsu, and William Pedranti, the show brings together a behavioral health revenue strategist, an addiction medicine physician, and a biotech entrepreneur to go inside the clinical, operational, and commercial realities of addiction recovery, medication adherence, opioid use disorder (OUD), and behavioral health. Three different vantage points on the same broken system. Honest about what fails, specific about why, and direct about what a real fix requires. Topics include: addiction, addiction recovery, MOUD and MAT clinic operations, medication-assisted treatment adherence, behavioral health reimbursement, opioid use disorder treatment, payer contracting, DEA compliance, FFS-to-value-based care transitions, and the patient adherence gap in controlled substance prescribing. The Saving Dose is for investors evaluating the addiction recovery and behavioral health infrastructure market. For clinic operators and executives running opioid treatment programs, MOUD practices, and behavioral health facilities. For clinicians in addiction medicine and pain management. For payers and administrators navigating the cost and risk of behavioral health coverage. New episodes every two weeks. Available on Spotify, Apple Podcasts, YouTube, and wherever you listen.058171

Information

  • Creator
    John Hsu & William Pedranti
  • Years Active
    2026
  • Episodes
    17
  • Rating
    Clean
  • Copyright
    © 2026 The Saving Dose
  • Show Website
    The Saving Dose

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