Dan Wagner: [00:00:13] Well, thank you all so much for joining us. My name is Dan Wagner. I'm the chief commercial officer here at Spark Biomedical. And today I am honored. And it's a pleasure to be joined by Dr. Joel Hansen. Dr. Joel Hansen, welcome to the Spark podcast.

Dr. Joel Hansen: [00:00:31] Thank you. Glad to be here.

Dan Wagner: [00:00:32] So glad to have the conversation with you because you're doing some really interesting work out in Utah. So can you start by telling our audience and ourselves a little bit about your clinical background and what you're doing currently?

Dr. Joel Hansen: [00:00:47] You bet. Yeah. So I'm a psychiatrist and board certified addiction specialist and also a background in internal medicine. I work with a program called Altium Health, and we focus on addiction treatment, outpatient addiction treatment, also mental health. We have a group of. Medical practitioners and therapists. So we do everything outpatient related to addiction and mental health groups, individual medical management, and we’re involved in newer, newer methods, newer ways of trying to address people's issues. One of the one of our main fairly unique services is outpatient ambulatory detox. So we manage alcohol and various other substances. Opioids detox much like a hospital would do, but we do it out of the office.

Dan Wagner: [00:01:53] Interesting. And so on that topic. Dr. Hansen So what are some of the advantages to your patients in looking at ambulatory detox as opposed to hospitalization?

Dr. Joel Hansen: [00:02:05] There's always been an issue of access to care for a lot of people. Some insurances, most insurances now are hesitating to cover opioid detox on an inpatient basis. Some people with alcohol don't perhaps don't have quite the severity to go inpatient. Other people, frankly, just don't go get the detox done because they're hesitant to do it in a hospital. Another is some people get lost to services in that step between they might go to hospital detox and then they're referred for treatment and they don't follow follow up for whatever reason. So there's that stepdown issue.

Dan Wagner: [00:02:50] So so offering the outpatient or ambulatory detox is more of a response to the community and kind of meeting the patients where they're at in their journey.

Dr. Joel Hansen: [00:03:01] Yes. And in terms of insurance reimbursement, they you know, it's a lot less expensive to do. Sure. To cover an outpatient detox compared to an inpatient detox. So we do have the interest of insurance companies in terms of what we're doing.

Dan Wagner: [00:03:19] That's smart. I mean, we have to always Economics 101 is management of scarce resources, right?

Dr. Joel Hansen: [00:03:25] Yeah, yeah, yeah. Well, we know that of every 100 people who need substance abuse treatment, only ten are getting it. So there's a big gap out there. And so we're trying to try to do our best to figure out where we can help with those gaps.

Dan Wagner: [00:03:45] Absolutely. Dr. Hanson I think that's a big reason that I was so attracted to have this discussion today, because we look at traditional methods and we're only capturing that 10% of folks who raise their hand and are looking for help. Some of that is based on methods. If the prerequisite is always to go in patient, that's going to be a self selecting cohort. Right? So very interesting the work you're doing at Altium and looking at the outpatient cohort of patients who are looking at that in addition to outpatient. What other methodologies are you offering as far as the acute detox component and that initial foray into substance use disorder programing?

Dr. Joel Hansen: [00:04:31] Well, yeah, there are some in terms of basic interventions that we're offering as they come in for detox, we're also offering intravenous fluids with supplements in the fluids. And most of these folks are. You know, haven't been taking good care of themselves, understandably, and they're dehydrated and malnourished. The other thing we're able to do is traditional formal detox is mostly for sedative type drugs like alcohol and opioids. But with the methods we're using, we're also able to help people with their detoxes from stimulants, methamphetamine, cocaine, even even cannabis, or even some of the club drugs or street drugs. So we can help them, even though there's not typically been a formal detox protocol for those folks. And of course, we're entering into some newer modalities that we can talk about, where we've started working with NAD+ intravenous supplements, and we can certainly talk about that.

Dan Wagner: [00:05:42] Sure. Sure. Yeah. We're seeing, I think, across the rehabilitation kind of landscape. And we look at both inpatient and outpatient. We are seeing a lot more intravenous use, whether it be just IV fluids administered or other components like NAD+. I'm curious, how are you how are you looking at that within your practice and what is NAD+ for our audience and for our laypeople, I think would be it'd be good to discuss that a little further. What is NAD+?

Dr. Joel Hansen: [00:06:12] Sure. Sure. Well, and I think we know in general that, you know, substance abuse and mental health treatment is still very much in the pioneering stages that most of the treatments, unfortunately, still have a fairly low success rate in terms of adequately helping people to get off drugs and stay off drugs. So we are always interested in finding things that that seem to be working because there haven't been that many innovations, you know, for 50 years or so in in those kinds of treatments. So one of those that seems really hopeful is this NAD+. So NAD+, basically, there's a long name for it, but it's basically a metabolite of vitamin B3 of niacin. So it's a chemical that actually has a lot of purposes. It's involved in basically all of our cells in terms of metabolism, in terms of cleaning up waste products, cleaning up oxidants. People tend to be familiar with antioxidants. It's one of those what it what it seems to be doing. To benefit people with addiction issues. The earlier research on it had to do with other forms of nerve damage. You know, with addictions that we've damaged our brains, there's clear evidence of brain damage with long term substance use. But the earlier studies with NAD+ have focused on dementias like Alzheimer's and NAD+.

Dr. Joel Hansen: [00:08:08] NAD+ is one of those substances that helps clean up the nervous system. It helps calm down the inflammatory response. So they showed some definite healing of neurons using NAD+ infusions for people with Alzheimer's. So that research is distinct and definite and successful. And now there have been some studies that have gone through. Phase one, Phase two, phase three trials in terms of using it. Using NAD+ officially in 80 plus, which is the the positively charged version. For those of us that understand what that means for detox, for helping in detox situations, and I can talk about the protocol itself, but basically when this NAD+ is added to a detox protocol, then. What they're finding is that the healing process happens much more quickly and it tends to be lower acting. So if you add if you do, for instance, a. Now, the studies mainly had to do the most the most typical studies were a ten, actually a ten day treatment process. I'm not sure it has to be ten days, but these studies were ten day processes with need infusions. And interestingly, the the actual symptoms of withdrawal resolved considerably more quickly with with that component. But there were also other benefits people were having experiencing much more quickly increased clarity of thought.

Dan Wagner: [00:10:08] I was going to ask you. So things like brain fog and kind of that that cognitive kind of difference as you're getting sober, as you're going through detox, that's accelerating it, then?

Dr. Joel Hansen: [00:10:22] Yes. The interesting thing is that it seems to persist. That's what we're used to calling that. I mean, there's the acute withdrawal brain fog, but then there's the what we're commonly calling post-acute withdrawal, brain fog, which can go on for months, and it appears that the NAD+ treatments significantly decreases all of that.

Dan Wagner: [00:10:49] That's so interesting, because I know I've seen with families especially like so as families recovery advocates are along for the journey, sometimes it can be really big news to hear about how long the recovery process is, you know, not just chemical sobriety, which is one thing, but then the recovery process to, I'll say, 100% return of cognitive function for the patient or for the individual. And I think it's so fascinating that you're keying in on this NAD+ plus component. If you can accelerate that at all for that individual, but also their family, I think that's so impactful to the community.

Dr. Joel Hansen: [00:11:29] Yes. We're like I said, I mean, we're so used to having to tell people that, well, no, you're stuck with this issue for months, you know, But maybe not. Maybe not necessarily. Well, and the other advantages are obviously, it's nice to not have foggy thinking, but most of these people, hopefully all of them are entering into treatment of some sort, relapse prevention treatment, whether it's residential or day treatment or intensive outpatient or I mean, it's the detox is helpful, but the therapy is where the money is, right?

Dan Wagner: [00:12:06] That's where the progress for the individual really takes off. Yeah.

Dr. Joel Hansen: [00:12:09] Well, and so for the therapists and for the patient, you know, if the thoughts are clearer, more quickly, then that improves. You know, therapy outcome. So it's a big and it decreases relapse risk. And I mean, the post-acute withdrawal, cognitive symptoms are a significant contributor to to people returning to their substance use. Sure. Sure. Yeah. It's a big deal. So the NAD+ also, I should say, it regenerates nerve function also in the physical symptoms, so in physical system, so people report, they feel generally more healthy. They feel more physically strong. If they had muscle aches, if they had deconditioning, those kinds of things seem to be reversing more quickly as well. So they feel physically and cognitively improved much more quickly than we were seeing with without that type of a treatment. So it's got that advantage as well. Mean, as we know an awful lot most people with addictions have also are debilitated. Certainly a lot of people with opioid use have, for instance, chronic pain issues and muscle aches, post-acute withdrawal, muscle aches. And so those seem to be healing up more quickly with the NAD+ treatments as well.

Dan Wagner: [00:13:48] Wow. That's fascinating. Such interesting new tools that are available and it's great to see them being put in place.

Dr. Joel Hansen: [00:13:56] In terms of mental health and substance abuse. We focused mainly for quite a while on basic neurotransmitters, dopamine, norepinephrine, serotonin, and that's great, but that's really very basic. I mean, there we know a lot more now about antioxidants and about the inflammatory process and how that plays into all this. And so. We're getting much more sophisticated with our knowledge of the chemistry, the brain chemistry, the neuronal chemistry, chemistry. And I could talk a little bit about how the NAD+ the process looks like.

Dan Wagner: [00:14:33] Sure, we have. What does that look like to a patient coming into, say, your practice?

Dr. Joel Hansen: [00:14:37] Yes. For now, we're following the original research protocol so that we're staying within what's. You know what? What we know something about and what works. So it's a it's a ten day process. It's fairly involved, but it does help. It expedites everything like we've been talking about. So it's a you can't infuse NAD+ very quickly because people just don't tolerate it. So it's actually about a seven hour IV infusion for ten days and they. The last gentleman we did, he basically just brought in his we have a separate room and he basically it was his work office. He worked. Well, he was getting an infusion. He was doing his job.

Dan Wagner: [00:15:28] And that's awesome.

Dr. Joel Hansen: [00:15:29] That worked out fine for him.

Dan Wagner: [00:15:32] Yeah.

Dr. Joel Hansen: [00:15:33] And, you know, we provide some meals and whatever else we can do to help them to pass the time. But so about a seven hour infusion of the NAD+ intravenous infusion along with. So in the actual IV bag is the NAD+ measured out per the person's weight. There are some definite concentrations that you're shooting for. And typically we will add other detox related supplements that you would normally use for A detox. B, some. B vitamins. Yep. Some magnesium. Typical things that need to be replenished with with a detoxification. It's monitored, of course, by myself, by the medical staff in terms of vitals. In terms of tolerating the heavy flow, the usual.

Dan Wagner: [00:16:37] It's pretty neat, though, that your patient can come in and continue to possibly continue, you know, their job or their day to day function through the IV treatment. That's a pretty phenomenal opportunity.

Dr. Joel Hansen: [00:16:51] Well, yes, If you're asking somebody to be there all day for ten days, it's a. You know, it's a chunk of time.

Dan Wagner: [00:17:02] It is. It is. I think I've comparative to the options of inpatient or full admission. Right. And like, you kind of don't get to participate and normal life function when you when you've gone down that pathway. The fact that your facility is offering a different opportunity, continue up like that, that function in society. But also, I could imagine if one has dependents at home or things like that, you can still manage your daily obligations while also choosing a pathway to to possibly get well, long term.

Dr. Joel Hansen: [00:17:38] Yes. And that's what they're saying. They're saying that just that investment, you know, brings them back to full function much more quickly. And, you know, like we talked about these folks, you want to they want to get going with the therapy and so at our center, we also have our therapists. So we are able to start with the therapy sessions while they're getting the treatments as well. So the therapists will come in to the to the infusion room and they'll start in with their counseling while they're in with us.

Dan Wagner: [00:18:16] So that's smart. That's smart. I mean, I think that when the spark of hope is there, right. And one is motivated to begin working and doing the work, that's when you need to move. So that's so great that you have that flexibility within your program to offer that. That's great.

Dr. Joel Hansen: [00:18:33] Yes. Thank you. Yeah. That's another in terms of access to care. That's been another area that's a challenge is when people are moving from detox into therapy. To have it all in one location like that is pretty ideal. And that's definitely the direction that programs are trying to go so that they're not spreading out their treatment through having their medical done through one office and then their therapists or some other setting. The warm handoff and minimal, minimal opportunities for things falling through the cracks.

Dan Wagner: [00:19:15] That's great. Well, and recently yourself and Altium made a very significant investment in kind of bringing it together more under one roof. Correct. You've moved to a new facility.

Dr. Joel Hansen: [00:19:28] Thank you. Yes. And we're still we're still unloading some of the boxes. But yes, we had our medical services in the next building over from our therapy for a while. So, yeah, we just moved three weeks ago to a larger space where we're all under the same roof with the therapists. So a lot better interaction. The patients are just moving from one door to a couple of doors down between the medical and the therapists.

Dan Wagner: [00:20:08] That's awesome.

Dr. Joel Hansen: [00:20:09] The people that are in intensive treatments like the day treatment or the intensive outpatient there, the medical staff gets to connect with them more, more freely and frequently. And of course, we get to interact with the therapists. It's it's a nice way to be able to just kind of. Chat about particular patient when you know. If something comes up, we just walk down the hall and talk to each other.

Dan Wagner: [00:20:37] So I've got to imagine that has positive impacts to the patient journey being all under one roof. So that's awesome. So as you think of it and kind of as you're continuing to expand Dr. Hansen and the Altium team and what you're building under one roof, what do you see as hopefully the future of what you're building within the West Jordan and the Salt Lake community? What do you see? What's next.

Dr. Joel Hansen: [00:21:05] For you? So good question. Where we're adding other modalities? On the psychiatric end and also adding the intravenous ketamine for refractory depression and folks struggling with suicidal thoughts. We would like to eventually add also the trans magnetic stimulation, transcranial magnetic stimulation, basically using all of these newer modalities. That seems to be quite helpful and are helping where some of our more conventional treatments are falling short. So there's that. We are adding more on the mental health end as well. Our original focus was the addiction, and that will remain remain our main thrust. But there's a big need for the mental health end of services as well..

Dan Wagner: [00:22:06] Great.

Dr. Joel Hansen: [00:22:07] We'll be developing a full spectrum of therapies, including day treatments and [aiops] for mental health specific issues. And by the way, the some of the other modalities we're using for addiction work. They're very likely going to be helpful for mental health issues as well. And. We have some grants, some federal grants we're working with.

Dan Wagner: [00:22:36] Where? Congrats. Thank you. That's big to expand not just within the community locally, but to see that type of expansion supported federally. I think that's really important.

Dr. Joel Hansen: [00:22:48] Thank you. Yeah, I think it's encouraging to know that the government is trying to help us advance these kinds of projects. And we anticipate we have one grant already in place that helps basically expand services. We're applying for another, that we will we believe we will be awarded. It has to do with, for instance, comparing the usual services for detox with services with need and of course, the Sparrow apparatus.

Dan Wagner: [00:23:33] Yeah. So looking at trends irregular. Excellent. Now that's normal. So looking at that and that will be interesting as we continue to expand out in adding services to to meet the community, you know, solutions like NAD+ plus the Sparrow therapy system, Neurostimulation. I mean, I think you're building a really big toolbox with a lot of tools in it, and I think that's phenomenal. I mean, compared comparative to 50 or 60 years ago within the addiction medicine space and the world is continuing to evolve. And I think it's great to see that leadership Doctor Hanson from yourself, but also from Altium, to be able to offer those various tools out to the patient base. That's huge.

Dr. Joel Hansen: [00:24:25] Yes. Thank you. And it's more rewarding for us, too, to know that we're working on. Trying to make improvements on something that's historically been a real tough nut to crack.

Dan Wagner: [00:24:39] Absolutely. Absolutely. And that's going to provide a ton of hope. Because I think we look at substance use disorder and we look at the addiction landscape. I mean, hope is paramount. You see the restoration of people's lives, not just saving lives, but true restoration of lives. That's what it's all about. And as you add those tools to the toolbox, as you expanding your just even just the square footage and the availability of the facility to serve the community, I think that's awesome.

Dr. Joel Hansen: [00:25:13] Thank you.

Dan Wagner: [00:25:14] Dr. Hanson, I want to wrap up and just say thank you for sharing some of this additional knowledge, knowledge that I certainly didn't have before I came to this discussion with you and hopefully that we can share with the community so that for loved ones, for those who are suffering with substance use disorder, but also just our community writ large so we can know more about this disease state, some of the solutions that are possibly in front of us, as well as some of the great providers like yourself. Dr. Hansen, so thank you for all that you do.

Dr. Joel Hansen: [00:25:45] Glad to do it and thank you.

Dan Wagner: [00:25:46] Awesome. Well, have a great day and we'll talk soon.

Dr. Joel Hansen: [00:25:50] All right. Thank you.

Dan Wagner: [00:25:52] Goodbye. Thanks, Dr. Hansen.