Dopey 550: The Anesthesiologist Who Shot Adrenaline and Fentanyl, Dr. Jason Giles, Hitler, Freud, Halsted, Addiction Recovery
Dopey Nation Emails and Voicemails! Dopeycon News! Dopeycon themesong challenge! Santa Monica/Culver City; father a quart-a-day gin drinker; mother deeply codependent; father later sober ~35 years but “dry/angry.” Teen: ska/mod (Specials, Selecter, Untouchables, Madness), Vespa rides, alcohol/weed/amphetamines. Berkeley & Free Clinic Chose Berkeley (also accepted to MIT); Berkeley Free Clinic mentorship; lineage to Haight-Ashbury Free Clinic (David Smith; bands funded care). Purpose & “hero’s journey” framing; service as “primary purpose.” Anesthesia / pain medicine Charmed by physiology-in-real-time and the human connection (esp. parents in pediatric cases). Basics: take away pain & anxiety/memory (e.g., fentanyl, Versed); use relaxants; manage airway/complications. Favorite contrast: from tiny trigger-finger release to replacing the aortic arch. Fentanyl descent (1999) Diverted via paper logs; carried 2 mL for a month before first sterile IV use; loved the warm/relief/confidence. Waited ~6 weeks, used again; escalated to “after work only,” leading to daytime withdrawal and concealment (long gown to hide arms/weight/sweat). Experimented separately with other drawer drugs (e.g., propofol, pentothal; hates ketamine → “crumpled cellophane” feel). Sufentanil even more potent but dangerously narrow window. Intervention & recovery Chairman’s page about missing fentanyl; offered help, not punishment; referenced prior resident death. Bathtub cold-turkey detox; called a sober doctor; went to an AA meeting of doctors; felt less alone; kept going; “ultimate challenge is handling success.” Treatment feedback groups taught honest feeling-language and service; newfound congruence. Finished residency (board made it 2 years), married, child, then shift to treatment medicine in Malibu; “fish met water.” Substances & side topics Adrenaline/epinephrine: synthetic now; shooting it feels “weird/anxious.” Hitler: amphetamines + opiates (references Blitzed); late-stage junkie logic/psychosis frame. Halsted: cocaine mapping nerves → heroin maintenance, long IM use with periodic retreats; even “stable” heroin isn’t smooth. Crowley: “infinite supply” idea discussed; brain adapts—no stable bliss. Benzos vs. opiates Opiate withdrawal: nausea/diarrhea/sweats/chills/aches/runny nose/goosebumps unique to opiates. Benzo withdrawal: anxiety/fear, same feeling benzos treat → especially hard; seizures risk (Dave shares lived seizures). Memory / benzos / awareness Benzos disrupt hippocampal consolidation, but recall can still occur (e.g., intraoperative awareness with strong stimuli). Kratom Opiate-like activity; ~1/3 minimal withdrawal, ~1/3 rough as fentanyl, rest in-between (his experience). Often uses Suboxone to transition; prefers to wait/see which group before MOUD. Suboxone vs. abstinence MOUD prevents death/harms; some should stay indefinitely; for most: “cast/training wheels” until life is rebuilt + real recovery connections in place. Fentanyl now Overall OD deaths have ticked down recently from the peak, but fentanyl involvement is sky-high; he says he’s seen fentanyl in other drugs, counterfeit Percocet common; heroin is rare now. Economics: opium supply changes; fentanyl is cheap; heroin cachet remains among some.
Dopey: On the Dark Comedy of Drug Addiction
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Show Notes
This Week on Dopey! We are joined by Oro Recovery Medical Director - Dr. Jason Giles! We also read old comments and hear from a few dopes in the dopey nation. Then Dave interviews Dr. Giles—twice board-certified in addiction medicine (via ABAM then ABPM), previously board-certified in anesthesiology and pain medicine, and a recovering opioid addict. He grew up in Santa Monica with a severely alcoholic father, fell into the second-wave ska/mod scene (Vespa, sharkskin suits, amphetamines), dropped out of high school, then clawed his way through community college to Berkeley, volunteering at the Berkeley Free Clinic and falling in love with medicine.
He explains anesthesia’s demands (no pain, no memory; muscle relaxants; airway control), the human connection of pediatric anesthesia, and the hope-work of pain management. In 1999, curiosity and stress led him to divert fentanyl: he edited paper records, carried a 2 mL syringe for a month, then IV-used with sterile technique. After a six-week gap he used again, convincing himself he could “handle it.” Use escalated to daily “after work,” leaving him in daytime withdrawal. The department chair paged him about missing fentanyl; instead of punishment, he offered help and a path into California’s 5-year diversion program (treatment, meetings, testing). Giles detoxed cold turkey, went to AA (first meeting mostly doctors), found he wasn’t unique, and built long-term sobriety (nearly 26 years by his telling), learning service and vulnerability through treatment feedback groups.
With sobriety he finished residency, married, had a son, worked in cardiac anesthesia and pain, and then moved into addiction treatment (Malibu), where his science and lived experience met the work. He and Dave range widely: purpose/mission as a recovery engine; Bill W., boomerangs and ants; truth-serum myths; Halsted (cocaine→heroin), Freud letters, Hitler’s amphetamines/opioids (book Blitzed), kratom (mixed withdrawal profiles), benzos vs. opiates (benzo withdrawal = fear), intraoperative awareness & memory, Suboxone vs. abstinence (cast/training-wheels framing), fentanyl’s dominance (counterfeit pills; heroin now rare), and whether fentanyl appears in non-opioid street drugs (he says he’s seen it). ALL THAT AND MUCH MORE ON A BRAND NEW EPISODE OF THAT GOD OLD DOPEY SHOW!
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