Hello and welcome back to Ackrak. I'm Jed Walpaw and I am thrilled to have a fabulous guest for a fabulous topic today.

We are going to talk about buprenorphins, something that is just really on everyone's minds these days.

And I have with me, Dr. Tom Hickey.

Tom earned his medical degree from Harvard Medical School and completed anesthesia residency at Brigham and Women's Hospital.

He joined the Yale faculty in 2015, and he's a full-time staff at the West Haven VA hospital. He's board certified in both anesthesiology and addiction medicine, and his research interest focus on the overlap between addiction and acute pain management. So he is really the perfect person to have this discussion, and I'm thrilled to have him here. Tom, thanks so much for coming on the show. Delighted to be with you. So I read a little bit there, but tell us a little more about you. How did you get where you are? What does your career look like? And how did you get interested in buprenorphine? Yeah, great question. So I think anybody who is co-resident with me at the Brigham, shout out to the Brigham, probably knows I had kind of a natural affinity for pain management. And I always had this feeling like, well, there's got to be a better way to handle these patients with chronic pain with chronic opioids. So I feel like we just keep screwing this off every time. Like an ambulatory case becomes like a five-day painful admission. We've all been there. And there's no easy way to do it. But I think there was an inclination. And when I got to my current job at Yale and in the

Connecticut VA health care system, and these are my views, by the way, not the governments.

It was actually a case cancellation. So something we all lived through if we've been in practice

over, say, a decade or so. And it was a case cancellation because a patient who's on

buprenorphin for opioid use disorder.

So most of us think Suboxone, which is the buprenorphine naloxone combination product.

And the guy had woken up that day, like every day, taking his 16 or 24 milligrams of buprenorphin and came in for his elective hip surgery, which he'd look forward to for months, probably.

A lot of planning went to it. And the anesthesiologist, very reasonably at the time, said, sorry, sir, really can't do it because we were too dang nervous about your pain management. So that was then, right? This was probably about eight years ago. And that was, by the way, what we learned at the Brigham when I graduated in 2015. It was just the best practice. And more background on that later, I think, I'm sure we'll get into it. But at that point, the surgeon said to me, listen, Tom, like, I don't care what we do with this drug, but what we're doing ain't working, right? It just ain't working for anybody. So I partnered with an addiction psychiatrist, and honestly, I don't even know if I knew there was such a thing as addiction psychiatrists at the time.

And together we partnered and developed a perioperative management strategy to try to really formalize our approach to these patients.

So that got me interested in addiction medicine.

And lo and behold, there was this pathway to addiction medicine through the ABPM, a practice pathway.

And you just have to justify you practice addiction medicine.

And I would put it to the anesthesia audience.

Every day you think about a careful anesthetic plan for your patient, really you're practicing some addiction medicine.

And the more I learned about buprenorphine in particular, the more interest that I became, in particular, getting to know what I think is largely forgotten literature for acute pain management, I thought, man, it was a good option in the 70s, good option in the 80s, good option in the 90s, and it's a good option in 2026. So that's kind of the story, Jed. Very cool. Yeah, and I'll tell I think, so my sister-in-law, shout out, Judy, runs an addiction medicine fellowship. And it's really just a fascinating field and incredibly applicable these days. And she gets applicants from all different fields. And so if folks are interested, I think that's a really neat thing to think about as a way to take your career. So let's talk about buprenorphine specifically. Give me a little background

on it. Tell me about the drug. Where did it come from? Obviously, it's been around a while, but I think

it's maybe entering people's minds in a way it hasn't before. What makes it unique? That's a great

question, too. And I would recommend to the readers, ask Google right now for a speech that a British chemist gave.

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