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

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

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.