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Episode 32: One Physician’s FDA-Award-Winning Answer To The Opioid Crisis w. Dr. John Hsu

Jan 20, 2020

This Episode

Interview w/ Dr. John Hsu

You Will Learn

 You will learn:
– The reason Anesthesiologist have the highest rate of addiction within the medical society.
– The idea behind the iPill, and why it will change lives.
– The reason not only doctors, but patients need to be educated about acute pain and how to treat it.
– How the opioid crisis personally affected Dr. Hsu
 
 
 

Resources & Links

In this episode, Justin sits down with Dr. John Hsu to talk about the opioid crisis in America, and the contributing factors that have grown it to the size that it is today. After 28 years of clinical practice in pain and anesthesia, John has been working a product to help fight against one of the root causes of the opioid problems, the diversion of prescribed drugs.

Justin: [00:48] Hello and welcome to episode 32 of the anesthesia success podcast. I’m really excited to be joined today by Dr. John Hsu. John is an anesthesiologist and pain management physician who after almost three decades of clinical experience is now working on a novel invention to be able to combat the opioid crisis. And in addition to John’s clinical experience, he has a lot of business acumen and he’s shared a little bit about some real estate endeavors and other things and healthcare policy. And I’m really looking forward to today’s conversation. So John, thanks for joining us today.
Dr. Hsu [01:20] Thank you for having me.
Justin: [01:22] So to start us off, John, why don’t you just give us a little bit of context for your current clinical, well, I think your, I should say maybe prior clinical practice and what you’re up to right now as far as the uphill. Sure.
Dr. Hsu [01:34] I was a anesthesiologist doing acute pain and was doing chronic pain on the side. I had been doing chronic pain for 28 years, acute anesthesia for 28 years and had been following the opioid crisis over the number of the same number of years. The problem with the opiod crisis is that it isn’t getting better and it’s getting worse. Government policy has changed things. The limit of opioid access has caused the push towards heroin and fentanyl. And so as I’m reaching the sunset of my career, I’ve decided to put my hat in to try to solve the problem.
Justin: [02:19] And I know that you mentioned there is, this is something that hits close to home for you as well with, with regards to a opioid overdose specifically. So can you talk a little bit about the, sort of, the personal context for your mission in, in this in this journey? Sure.
Dr. Hsu [02:35] Anesthesiologists have the highest rate of addiction within the medical society. So I had a colleague who eventually passed away from fentanyl overdoses and that made me a little leery of fentanyl. We had other colleagues who were addicted to fentanyl and then the whole issue became, well, if doctors and nurses are getting addicted, why don’t we use the technology to try to prevent some of that? So Omnicell and Pyxis came out with their devices to prevent doctors from diverting opioids. And that has really dropped the number of physician overdoses. Patient overdoses to less than $800 800 people per year in 60 to 150 hospitals in the U S so we know that’s cure storage of opioids is very, very important.
Justin: [03:38] And I know there’s, in addition to, you know, your personal story, there’s other, we’ll call them a systemic factors that have contributed to over the last year is just the explosion of opioid prescription. So can you share a little bit about sort of your perspective on the broader context in terms of prescribing and insurance? And you know, we mentioned the fifth vital sign.
Dr. Hsu [03:59] Wow. You’ve opened up a Pandora’s box at that point about 20 years ago, a joint commission on hospital accreditation organization, J co they basically came out with a mandate saying that no patients should have pain postoperatively. They said that the pain is a fifth vital sign. Well that in addition to the Purdue issue that promoted the fact that opioids are not addicted. Well, those are two fallacies that I’d like to address right away. We’ve known for years that opioids are addictive. We look at the opium crisis and the opium Wars in the 1830s 1850s then we look at, you know, Caesar was using poppy seeds for heroin. So we notice a very old problem. Yeah. Yes. And also it’s always been a scheduled drug. Opioids are schedule three, schedule two and in ninth in the year 2017 I believe hydrocodone was changed from schedule three to schedule two.
Dr. Hsu [05:15] So basically the bottom line is that opioids are addictive and they were misrepresented as not being addicted. Doctors were put being put in jail for not prescribing opioids to take care of patients. Pain. Really? Doctors were losing their license. I did not know that. That’s mean. That’s crazy. Well, it’s, it’s, it’s, you know, it’s, it’s not common sense. You know, the doctor, patient relationship has gotten so distant and what’s in the middle government policy, other people who didn’t go to medical school, who are trying to tell me how to practice medicine. So that’s the fifth vital sign problem. We had uncontrolled access to controlled substances. So more and more people were getting drugs. It was then that more people found that they were overdosing and dying. So in the last 20 years, we’ve had double digit increases in the opioid overdose deaths with limited opioid access.
Dr. Hsu [06:24] So we know that limiting opioids isn’t the solution. People have talked about Narcan as being the solution, but that’s where people are already overdosed. And then Suboxone, that’s where people are already addicted. They’re very helpful. They’re needed. But what’s been ignored is prevention. How do we prevent people from being dependent then addicted, then abuse abusers than addicts. Yup. Yup. Go ahead. The fifth vital sign was the start. And people will say that that’s not the start, it’s the doctor’s fault. But we were mandated and as a whole, doctors do what they’re told. We don’t want to go to jail. We don’t want to lose our license. Government says this. So we’re good rule followers.
Justin: [07:17] Yeah. So enter your solution. So talk a little bit about your transition. You know, you’ve obviously observed this clinically over the last almost three decades. And then talk a little bit about the Genesis of your idea to create a product to start to help address this issue.
Dr. Hsu [07:34] So Omnicell and Pyxis devices hold opioids in the hospital. There are class one FDA registered product. They prevent people from just taking 10 pills and taking those opioids and giving them to their friends and family. So I began to look at what happens at home in the hospital. [66:250] hospitals was only about 800 people who die when you use a child resistant cap that prevents kids from opening it. But kids are smarter, they can open them now. And once you open that, you have access to all pills. It could be 90 pills. Yeah. But that doesn’t prevent adults from opening cause they can open it and if they open it, they get access to pills. So my
Dr. Hsu [08:26] Concept was the root of the problem is lack of controlled access and diversion. So I was at the bank one day and I was thinking about my colleague who died and I was thinking, well what happens if we have an ATM at home for opioids? My friend wouldn’t have died. So I started to put together some ideas. I’m a computer Deek. I have several issues within medical devices. Yeah. I love tampering. And then I love thinking outside the box over the last 20 years as people have thought about opioid crisis, they thought, Oh, it’s just because there’s too many opioids. Well, a knee jerk reaction is to just limit opioids. Well, that hasn’t worked out because the evidence has shown that limiting opioids causes people to go to heroin and fentanyl. And if they can’t get those drugs, which are easier and cheaper, they commit suicide. Yeah. So over the last three years consecutive the life expense, the life expectancy has dropped the last three consecutive years because of this problem.
Justin: [09:44] And I think that bears repeating. So just to what you, what you just said is that because of the way that the, the problem is being approached from a policy standpoint, which is like shut off the source of opioids. What’s happening is that people who are in pain, who need who legitimately need acute pain relief, are unable to get the drugs that for a long time had been used to treat that and as a result are driven to harder drugs and sometimes even to suicide.
Dr. Hsu [10:13] Absolutely. And depending on the swung the other way, you break a hip, you break a femur, they’re saying, Oh, just take Tylenol. Oh, just take Motrin for a maximum of a week. We’re only going to give you opioids for three days. Well, what happens if you’re still hurting? Yeah. Are we supposed to allow our pain, allow our patients to be in pain? That’s not why I became a doctor. I became a doctor to treat pain. That’s my specialty.
Justin: [10:40] Yeah, absolutely. And, and this one actually hits close to close to home for me. I actually, I had a an injury in my neck in July where I was doing a kettlebell workout and I had a, what’s called a clay shovelers fracture. Yeah. Which is the spinus process of the [inaudible] snaps off. And it was, I was like, 10 out of 10 woke up one morning and I couldn’t even stand up. It fell on the ground. My wife was on call, had to call an Uber to go to the emergency room. And I got there and I couldn’t move. And it was like getting stabbed in the back and they gave me a couple Tylenols and a muscle relaxer. And I, you know, again, I’m not a doctor, so I don’t know if that was within the, the scope of what was, if I would’ve been somebody who could have been prescribed something to actually help.
Justin: [11:29] But I remember those being, having the effectiveness of tic-tacs and me just wanting to die and thinking, you know, if this was a few years ago, I probably, perhaps I could’ve gotten something that in this acute with this acute issue, you know, I’m not I, I’ve, I don’t think I’ve ever even taken any painkillers or anything, even including post-surgical this would have, this would have helped. And I was majorly suffering. And I’m imagining people who have a more severe version of what I went, not being able to get a certain types of drugs because of policy and taking that decision out of the hands of the doctor and I just, that’s just, again, I’m not a doctor, but that doesn’t sound like a good idea to me.
Dr. Hsu [12:07] It isn’t. It’s like taking out the steering wheel of a car and I’m sitting in the driver’s seat. Yeah, and it’s really difficult because then I’ll have family members, I’ll have nurses, I have other doctors telling me that you should give him something now you can’t just use Tylenol or the other because of the current situation. I’ll have nurses telling me, don’t give anything stronger than an opioid. Don’t give anything stronger than Motrin. Don’t give anything stronger than Tylenol. Pretty soon these young doctors who are being trained aren’t going to be as empathic, sympathetic towards patients in pain. They’re just going to say grin and bear it.
Justin: [12:46] Yeah. Yeah, and honestly, in reality, I would imagine the answer is somewhere in between. Right? Because pain is, it sounds like what you just described with the advent of pain as the fifth vital sign, like we don’t need to ask somebody every 15 minutes if they hurt and if they say, well yeah, I’m somewhere more than a two on a scale of one to 10 then we should treat that like that probably isn’t the right answer, but conversely, maybe a little bit more latitude for physicians who are trained to treat that stuff is in order.
Dr. Hsu [13:17] Well, you know when you talk about the doctor patient relationship, we’ve only talked about the doctor so far. Now we need to talk about the patient. Yeah. We need to educate patients that acute pain that you had needs some sort of strong pain medicine and then when you don’t have pain, you need to not take opioids because you don’t have pain. You shouldn’t take opioids. 68% of the people in the United States takes take opioids appropriately. 32% do not. They take it because they can’t sleep. They’re depressed. They want to feel better. They want to get high. That’s the problem, right? It’s a huge percentage. It is one, basically one third of people take opioids inappropriately. Your situation that you just described is an appropriate use of an opioid and then when you don’t have pain, most people, what stopped their opioids? Yeah, there is one thing I want to bring up at this point. There’s a cultural difference. The United States is the only country, well the United States and Canada now the only countries that have a huge opioid problem. And it stems back to the fifth vital sign. If you look at Germany, you look at China, those people are afraid of opioids. So they will tolerate the pain. But if they have pain, they get education. Doctors educate patients about the risks and complications. Yeah.
Justin: [14:50] Yeah. Cause I can tell you for my own self, I was
Dr. Hsu [14:52] On the couch for two days and then it was up and I was fine. And I think, you know, I, and I made it right. I’m, I’m still alive and I, I was, I had a 0% danger of opioid addiction cause I literally didn’t take any, cause I couldn’t get them. But had I had a couple of days where I could have taken something to alleviate my acute pain, I definitely would have taken it and definitely would have been happier. But absolutely in the big picture, you know, I, I, I’m sympathetic I guess all sides cause as that ER doc who, you know, I don’t know if they putting their license on the line to like give me a script for something based on the diagnosis that they perceived. Like I’m, I’m sympathetic to that. But it was frustrating for me as the patient and I [inaudible] to give you another piece of information, you know, it’s like getting a speeding ticket. You get one, you wait a few years, you’re going to speed again.
Justin: [15:42] Yeah.
Dr. Hsu [15:42] Right. But what happens if we treat opioid complications appropriately? You know, we take opioids, we treat nausea, vomiting, we treat constipation, we treat itching. We don’t treat respiratory depression. There’s a company called [inaudible] pharma. It has added a respiratory stimulant that sits alongside of the opioid, which means that it causes a functional antagonism. You get pain relief, but you don’t block the new receptor and you give the respiratory stimulant, so you prevent the side effect of the respiratory stimulant. If you take too many, you become very anxious and you don’t want to take those drugs again. Wow,
Justin: [16:31] That’s genius. So sorry, go ahead.
Dr. Hsu [16:37] I would hope that as people think about this, you say it’s genius, but to try to get the medical establishment to change a little bit is very difficult. We’ve been doing the same thing for the last 20 years, getting the same result. I think outside the box and you know, to get the medical establishment to change is very different.
Justin: [16:59] I know that there’s a statistic we started on the past in this show where the lag time between someone conclusively proving something in a, in a rigorous peer reviewed white paper and the time in which that conclusion is implemented systemically is something like 17 years now. I think that that’s probably a shrinking number as technology helps to accelerate implementation for things, but that goes to show that institutional change is hard. Systemic change is hard and it’s certainly, this is an uphill battle it seems, which, which I want to pivot a little bit and talk about how you’re contributing to this. So you had this, this ATM realization while you’re at the bank. Talk a little bit about what trends, like what was the, you know, you went home and maybe got out like a piece of paper and started jotting down some ideas. How did this, how did this evolve over time for you?
Dr. Hsu [17:45] Well, I just thought if a thousand people, less than thousand people die in the hospitals because of a smart safe in the hospital. What, why don’t have that at home. We have a travel resistant cap, you know, my two year old grandkid can open it, so why don’t we have something at home that’s just as good. And then the FDA started talking about it. Then I put in a application for a contest. So we won the 2018 FDA innovation challenge for the prevention and treatment of opioid use disorder.
Justin: [18:22] Awesome. Tell, tell me a little bit about that, that that competition. How’d you find out about it?
Dr. Hsu [18:29] Actually I’ve been on LinkedIn and somebody from LinkedIn told me, you have a great idea. You should apply for something we’re applying to. And it just so happened it was two days away. Wow. I fit, filled out the application. And then one day I get a phone call and it was from a number in Washington, D C I answer the phone and honestly, it sounded like a spam call. Yeah. So I actually hung up and then they called again and they said, we want to speak to dr Sue. This is the FDA. And I got really quiet because I thought I had done something wrong. Oh, wow. And then they said, are you sitting down? And I said, no, I’m, I’m not, but how can I help you? Because I’m a practicing physician and I’m an anesthesiologist. There’s an opioid crisis. Is there something I can help you with? And then they notified me and then I was in shock for a little while because they were, I’m the only startup there. I’m, my company was going up against billion dollar companies. Wow.
Justin: [19:54] So talk a little bit about the product and the design and how you came up with all that.
Dr. Hsu [20:00] All right. So I, you know, being a physician and being, having a lot of experiences, I put everything together from all my experiences since I write in a go. I write in flutter for mobile apps. I had an idea of using a mobile app to control an ATM for the home device. So I have a device that uses the mobile app that connects to a device that dispenses opioids. So it’s like a car fog that opens the door to a car only your father can open your car. And then if I have a clock, it only the, your fog can open your car at the prescribed timeframe so you can’t take more drugs than prescribed. Then I thought, okay, well if my daughter wants to use my car, she’s going to steal my fog, take my car and go do whatever she wants.
Dr. Hsu [21:06] But what happens if I take that fog and make it two point authentication? So you have a fingerprint on an app and you have a personal code. Only the person that has that app that’s registered can all can access those drugs. Then the next thing I thought of, well, if my daughter can get into the car just grabbing my fob, then what I should do is destroy the pills in the dispenser. So my dispenser, our dispenser can actually destroy the pills with a da approved substance to destroy the pills. If it’s tampered with and at 90 days it’ll destroy the pills automatically because of there. There’s a timer when I’m trying to avoid is the fact that 42 to 71% of postoperative opioids go unused, which means that 3.3 billion pills, not million billion pills enter the communities per year. That’s why the study that came out of Boston medical center this year talks about only 1.3% of the people who overdose on opioids have an opioid prescription. Hmm. Most of the opioids are actually diverted.
Justin: [22:27] Wow. So there’s a, it sounds like this is a, a two component system. There’s an app on your, on your phone. I guess, right. And then there’s a, the dispenser, the box. Describe like how did you, how did you consume or do you have an engineering background or you have friends who are, and how did you think like materials and construction and how does it work if you, if you’re at Liberty to, I understand that maybe a little bit specific for something that’s still in D in process. What we’re actually patented so I can discuss. Oh, great. Okay. So so here’s what, here’s the question that I’m thinking is what if I take, you know, you talked about the fog, maybe I don’t need the fog. What if I want to take the box out back with a hammer and try to get the stuff inside? Describe in that circumstance, what happens.
Dr. Hsu [23:12] There’s a small electrical current that surrounds the box, kind of like star Wars. I love star Wars, I love star Trek. So you know that phase around stun people talk about there’s a little current that goes through the box and on the inside. And if that current is broken, it’s short circuits and that short circuit creates an UPC current that causes a switch to open that floods the pill container with liquids that destroys the pills. Okay. Wow. Even if you try to break the device and any box can be broken into, the pills are destroyed when you get into it within 30 seconds.
Justin: [23:57] Wow. Okay. That’s, that’s really, that’s really cool. So how, how talk about the process of like constructing, constructing the design and everything like that.
Dr. Hsu [24:07] Well, I have AutoCAD on my computer, so I’ve, I’m a programmer. I had a com, I had a company that did a physician practice management software with revenue cycle management software and also a PAX unit. So I put that together. We took off the shelf software from the U S government called open Vista and changed it and we were selling it to physicians. Okay. So I was looking at the software that can, so I understand software and then the hardware part came because I was tinkering. A long, long time ago, I was a contractor and I had to build a safe room for somebody who wanted a safe room. And so I started thinking, how do I make a safe room for these opioids? So that’s kind of the idea of where that came from.
Justin: [25:04] Okay. Wow. Cool. Talk a little bit about intellectual property. I know that in, in patenting a design, there’s, there’s a lot of, I recently had, I’ve, I’ve been involved with my own attorney to try to have conversations around some trademark stuff for my company. And it’s been probably a very simple version of what you’re having to navigate with regards to like technology and product patents and making sure it’s all the IP is, is well defended. Talk about how do you find somebody to help you with that stuff and what was that process like?
Dr. Hsu [25:45] It’s nice to have friends. Yeah. You know, it starts off with, I bootstrapped this company. I put $[500:000] of my own money into this company because it just seems like with the opioid litigation, people don’t want to invest in a company that’s going to try to prevent the opioid overdose epidemic.

Speaker 5: [26:06] [Inaudible]
Dr. Hsu [26:06] People just don’t want it to. Then they look at me, then they look, then they say you are so scatterbrained because you do so much that we don’t feel comfortable with you focusing on one product. We find that you are not what we’re looking for in a CEO. You know? And I pushed back a little bit by saying that, you know, I have three children. I don’t love one children less than the other. I love all three kids. So I have a couple of different projects. So I’m using all my experiences as physician, as a programmer, as a medical device engineer from hobby. I don’t have a degree. Yeah, I’m putting them all together. And so it’s really a difficult situation. I’ve been through NIH grants, I’ve been through and they have not given me a grant. They have basically told me, your commercialization project is not what we’re thinking or we’re not what we like. Hm. We think that the big problem is fentanyl and heroin and my thinking is
Dr. Hsu [27:22] Am I talking too the night at NIH or am I talking to S DEA? Yeah, right. Because if you’re going to study fentanyl and heroin, then you should understand that 80 to 90% of the heroin and fentanyl users started out by abusing opioids in their youth. So if you’re thinking about that, then perhaps you think about what I’m thinking about prevention, going to the youth, going to the youth and explaining that, Hey, you know, if you have pain, take your opioids as directed. Don’t try to use them to get high. Don’t try to take if one pill hurt, if one pill helps you with pain, don’t take two pills to make you feel better. Take it as directed by your physician. Did you know that it’s actually a federal offense to take more pills than directed by physician? I did not know that. Well, everyone breaks the law. Everyone speeds. It sounds like a difficult to enforce rule. It is and we have, it’s a difficult thing, but with the iPill you can only take pills as directed.
Justin: [28:40] Right. So did you consider at all, and I’m curious, you know, with regards to like a time release kind of function having it, you know, maybe spit out a pill every 12 hours or 24 hours or whatever rather than doing the biometric thing. And how did you come to like the design that you had sort of landed on?
Dr. Hsu [28:59] Well, let me back up for one thing. I don’t, I didn’t answer your IP question. Oh yeah. Okay. You’re right. So really the issue is, you know, I have a lot of friends. I have a really good friend. His company is called [inaudible] and he understands IP. He was a former U S PTO patent office reviewer and he got my pan in within a year, which is unheard of. Wow. Awesome. My company’s two years old and we’ve gotten a patent. We’ve gotten an FDA innovation win. We’ve gotten a breakthrough product designation and now we’re going to Hartford, Connecticut to work with the insurance to figure out a financial model for reimbursement. Okay. So the IPA was very fortunate in getting a good firm who can push it through in a market that is created with, I would say between 400 and [700:000] people would die from opiod overdoses. There’s a market need. The IP is there. It was searched out. I actually, I’ll tell you a funny story. As soon as I got my patent, I started getting phone calls in the middle of the night. You stole my idea. I was thinking about it. Hmm. But you know, Hey, I’m not about my idea, your idea, my more about, Hey, then let’s work together. This, this concept, this, this problem is bigger than you or me. I need all the help I can get. The more people that can help me prevent opioid addiction, the better we can save
Dr. Hsu [30:50] The young generation. If we prevent the opioid crisis, more young people are dying. And one of the, the, the reason why I know young, more young people who are dying is because, you know, there’s more open heart transplants, there’s more kidney transplants, there’s more liver transplants because they’re from young people who died from opioid overdoses.
Justin: [31:17] So John, talk a little bit about, from an insurance standpoint, you mentioned you’re going to Hartford the insurance capital of the world. Talk about how, you know, how much does it cost to produce one of these, and how much does it cost an insurance company or, you know, once you, how much are you projecting and, and how is the, how does this compare to the cost of, you know, the, the opioid problem and, and what’s the sort of the value prop there economically.
Dr. Hsu [31:41] Sure. I, three D printed the case, the inside. I thought you’re going to laugh at this. I bought the stuff to make the inside on Amazon and I thank you Jeff Bezos. Yeah. my Ardwino chipset bought for a dollar 90. The BLE chip I bought for, I bought two of them for a dollar 30. And I bought a servo motor for about $3 and 24 cents. I put it together and I wrote this software and use my fingerprint personal code and then started working. Wow. I put everything on solid works for three D printing and hired someone to D printed and it works. So the box is very inexpensive to make at high volume. I can make it cheaper. I’ve actually have a mutual understanding with NL con, which is an offshoot of Foxconn, which makes the IPL, sorry, which makes the iPhone and they’re gonna make the I pill dispenser. Okay. I can make one to 2 million of these a day and the cost is going to go down even more. Wow.
Justin: [33:10] You can make one to 2 million of your units per day once you scale this up, you’re saying.
Dr. Hsu [33:15] Right. Wow. Okay. Because what I want to do is have an insurance mandate. So all opioids can be dispensed with the IPL dispenser. If an insurance mandate comes through, maybe we have a federal mandate. You know, the I, the a child resistant cap was designed by doctor Henri [inaudible] in 1967 from in Canada, less than a penny a piece, but it doesn’t work anymore. In 1970, the U S government made it a federal mandate to protect children. So I’m trying to follow that situation. The opioid crisis has cost the U S economy, $635 billion. If I decrease opioid usage by 10% I can save $335 million. I can increase quality of care, treat patients in pain who actually have pain. Yeah. Debt patients with chronic pain to prevent their drugs from being stolen. And I can prevent unused opioids from entering the PR, the cities and communities to be diverted. Yeah. You know, 10% of 3 billion, 3.3 billion pills, that’s 330 million opioid pills that can be destroyed and not use to have people overdose on them.
Justin: [34:45] Yeah, it sounds, I mean, it sounds like an absolute no brainer. So talk a little bit about the cost of system, you know, like when when somebody, I saw some of the charts in your the pitch deck, which I reviewed that was talking about the cost of like you know, ER visits for overdoses or other like system costs pertaining to opioids. Talk about how the cost of the IPL dispenser compares to other systemic costs in the current environment.
Dr. Hsu [35:17] Sure. let’s just say the for the sake of demonstration, the IPL is 50 to $60. Okay. because I have to have district distribution costs, I have licensing costs and so forth. Yeah. The ER visit for a person who’s overdose is [12:000]. If per visit, if you have to be in the hospital, it’s [28:000]. If you go to inpatient rehab, it’s [128:000]. For insurance companies. Ed can cost anywhere from 14 to $[16:000] extra per year per subscriber. Just opioid dependency just for the medications alone. So from a standpoint of cost, if you’re a parent and you have three kids like I do, I would rather pay $50 than $[12:000] for my kid to go to the ER. It’s just a matter of economics.
Justin: [36:19] Yeah. And if you take that inpatient rehab number of 120 K plus, and that’s something that people go back to again and again and again. In many cases it’s easy to see that number. Getting into the seven figures.
Dr. Hsu [36:32] Did you know that most people who are addicts actually relapse? Relapse is 90% so let’s say we present to parents and we say to them, let’s use this device to prevent your child from getting dependent on opioids and finding your stash of drugs so that they won’t become addicts at $50 yeah. You know, most patients would probably do it if they don’t, when I’m trying to do now is go to a health and human services to get a Hicks fix code, a health common procedure, coding system to make the device reimbursable. You know, I have to consider patient economics as well. So if I get this to be reimbursed, maybe the government can help. Maybe insurance companies could help. You know, employers now are, are really looking at how to prevent their employees from getting addicted and getting dependent on opioids. So this situation could be a win, win, win, win for everyone. No kidding. Kids may not be a dependent. Parents save money. Hospitals save money. Politicians could say they solve the problem and insurance companies could save money, $50 for the IPL verses 14 to $[16:000]. It could improve profits for them. Our, our, our our economy save 635 billion from treatment of opioid addiction and loss of worker productivity. Yeah.
Justin: [38:28] Awesome. So tell me what’s next for your company and how are you going to sort of take this from its current state to continue to pursue a
Dr. Hsu [38:36] Broad adoption? Well, we need to do a pilot study, so we’re going to register the device with the FDA and do a pilot study at Rutgers dental school. As most people are unaware, dentists have a second highest prescriber opioids in there in the country. There’s 935 physicians, [935:000] physicians. There’s only about [5:000] pain physicians. Interesting to note. The U S dentists prescribed 37 times more opioids than the British dentists. Wow. So we’re going to start with doing a study at Rutgers dental school. After that, we’re hopefully going to roll out the iPill through the dental society. After that, we want to go to a clinical research organizations and a addiction treatment centers because we can try to make addiction treatment an outpatient setting instead of an inpatient setting.
Dr. Hsu [39:45] Right. Then after that, we hope to have a insurance mandate than a federal mandate. One of the issues that we have for the future is the class two version of the IPO. The class two version involves remote patient monitoring, remote physician access, cognitive behavioral therapy, and then data collection so that we can collect the data for all these situations to try to predict who is at high risk for addiction and then we can take all that information as big data and manage the population as a whole. This is a nationwide problem. We can take all that data. We can population manage to try to prevent people and the population from being addicts. Yeah, that’s, that sounds really exciting. One of the biggest issues that most people have criticized the IPL class two is the biosensor. We have a sensor that fits on the skin at the chest that monitors respiratory depression.
Dr. Hsu [41:03] It’s done three different ways to decrease false positive errors. If you’re taking an opioid but you also drink and you take pot and you take heroin and fentanyl, those other drugs will combine with the opioids in the IPL dispenser and cause death. You look at most of the celebrities, they have a cocktail of drugs that they take that decrease respiration, so I need to prevent the other opioids from effecting the opioids in the box. If it does, my opioids are protected and the patient can be protected because the app can call nine one one alert people to bring in Narcan to save that person’s life.
Justin: [41:53] Wow, that’s, that’s amazing.
Justin: [41:57] Really exciting to think about the possibilities
Dr. Hsu [42:01] I think the possibilities are there. I need help. I need people to come in. I, I would like to have a start, a super PAC to help people who can think about these things outside the box. If all the doctors in the country came together and said, Hey look, this makes sense. Let’s form a super, super pack of physicians because people blame doctors for causing the opioid crisis. Let’s let physicians come up with a solution so that we can act like physicians and bring our patients back to this doctor patient relationship situation.
Justin: [42:40] Absolutely. So for all our listeners out there if you want to learn more about the pill dispenser, we’re going to post links in the show notes. We’ll also post some contact information for John there. If you want to reach out to him, if you have any good ideas, if you want to get involved, if you want to be able to support this this new business in some way, maybe you want to invest I’m sure he would be interested in having that conversation with you. I’m sure there’s people listening, John, that are thinking, I th that are really struck with the sort of the arc that you’ve taken career-wise to be, you know, clinically involved for a long time and then observing things that you want to change and then starting a business to be able to attack a specific problem, which in this case it’s the, the opioid crisis. Can you talk a little bit about what kind of wisdom you would want to share or advice for somebody who has a business idea or has is seeing a problem? Maybe it’s a big problem that they want to work towards solving and they’re currently a full time practicing physician. How do you begin to make that transition to what, what kinds of things should they be aware of? Or what kind of questions should they be asking right now?
Dr. Hsu [43:49] Well, let me tell you a story. This is the best example of how I can do it. When the fifth vital sign came out, people were talking about how I was doing multimodal pain therapy 20 years ago. People said, well, you know, why don’t you just use an opioid? It’s pennies. You’re using all these different anti depressants anti-seizure drugs. No one’s doing it. And people took pot shots at me. They said, are you practicing Chinese medicine?
Dr. Hsu [44:23] And I had to bring papers into committees to show that these papers are from Americans. Fast forward 20 years, CMS now says that multimodal pain therapy is a measure of quality of anesthesiologist. Yeah. So dance to your question, read a lot, don’t sleep very much and have a lot of enthusiasm for other things because just being a doctor is not enough. Yeah. You have to know finance. You have, you know, EMR is something that is, is impacted our, our medical practice. And it’s been shown not to be better, but just costly. But you’ve got to know about computers, you’ve got to know about business, you got to know about estate planning, you got to know about a lot of different things.
Justin: [45:24] Yeah, that’s a lot. And I’m sure you know, and one of the things you referenced this in the areas where you don’t have specific technical expertise, like the IP for example. Having people that you can go to that you can trust, that are on your team, that want to pull in the same direction, that want to work on the same project at the same business, and to be able to borrow their expertise and their intellectual horsepower to be able to you know, work on whatever you’re, you’re building together. It sounds like that’s an important piece of the puzzle as well.
Dr. Hsu [45:50] It is. My wife’s father was in practice for almost 65 years as a general surgeon. Whoa. He had no interest other outside of medicine. So when he retired, when he retired he had a medical mishap. And when he retired, he had nothing to do. When I retire, I want to get a new lease on life. Yeah. You know, people talk about being reborn. I want to be reborn.
Justin: [46:26] Yeah, that makes perfect sense. And honestly, as you were describing all of your endeavors, I was thinking John is a Renaissance man. And it’s ironic because Renaissance, that’s rebirth, right? That’s what that word means. So
Dr. Hsu [46:38] And to make it even more interesting as being a Renaissance, you know, and this part we can whether we add it in or not, but I actually got baptized in the river Jordan about a year and a half ago. After that, everything with the iPill has been positive hug. And I sorta think that God is using me as an instrument to help his people in the world too, dealing with those, this opioid crisis. And that’s given me a lot of comfort and it’s given me a lot of help because it’s just seems like I’m, I’m one person trying to change the,
Justin: [47:30] And the one person that’s standing behind me has gone. Hmm. Excellent. Well, thank you for sharing that and Dr. John Hsu, it’s been a pleasure speaking with you today on the anesthesia success podcast.

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