Dr. Starr is an authority in the field of addiction medicine and wellness. After his brother overdosed 10 years ago , he opened his clinic in 2002, and has been committed to helping patients achieve lasting sobriety and improve the quality of their lives. In episode 26 of The Courage to Change: A Recovery Podcast, Dr. Starr shares how he utilizes a combination of medications, supplements, traditional and nontraditional therapies to help people overcome chemical dependency. You can listen to the interview in its entirety here

The following is presented as personal opinion of Dr. Starr and not Lionrock Recovery. This blog is not designed to, and does not provide medical advice. All content available through this blog is for general informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. 

Dr. Starr grew up in El Paso, Texas in the 80s with his brother, Sander, who was one year older than him. He recalls growing up during a time when, “everybody was drinking, everyone was smoking pot.” By ninth grade his brother was hanging out with an edgier crowd, smoking cigarettes and drinking often, while Dr. Starr’s friends partied sometimes, but were doing well in school. There was a stark contrast between the two, he recalls, “my brother had a substance abuse problem, he started using heroin in high school.” 

The last 10 years of his brother’s life, Dr. Starr would hear from him once a year, “even though my brother was suffering, as he suffered more, we just became less in contact.” He didn’t fully understand addiction and change his belief system until he started practicing addiction medicine. “I’m embarrassed to say that I was board certified in addiction medicine before I really understood addiction,” reveals Dr. Starr.

Dr. Starr went back to Texas for medical school where he studied and practiced emergency medicine for 10 years. He then moved and started practicing in Eugene, Oregon where his career focused on emergency medicine and Emergency Medical Service (EMS). 

In 2010, Dr. Starr moved to California, where he transitioned from emergency medicine to addiction medicine. “I just got a little burnt out, I had been doing this for 11 years and then my brother overdosed and died,” recalls Dr. Starr. At that point, he was left with many unanswered questions, “who in town is taking care of drug and alcohol patients? What are we doing about this?”

A New Approach

Dr. Starr’s good friend, an addiction psychiatrist, had the answers he was looking for. He was using Suboxone with some of his patients and Dr. Starr felt compelled to start implementing this into his community. In 2011 he rented a small office space, did his training and started advertising, “Suboxone prescriptions available, opioid detox.” It was a small shop and after a year he teamed up with a treatment coordinator and started to grow his clinic. Fast forward seven years and Dr. Starr’s office and patient panel had grown immensely, “we’re probably the largest private provider of substance abuse in three counties.” 

NAD

Dr. Starr started implementing new treatments into his clinic, including Nicotinamide Adenosine Dinucleotide, or NAD for short. NAD is a natural co-enzyme in every mitochondrial cell of our bodies, Dr Starr explains, “it’s really the fuel for energy production of your nervous system, and of your cellular being.” NAD is a powerful modulator for over 400 known processes. This powerful drug has the ability to alleviate withdrawal and craving, immediately. Dr. Starr shares, “I’m not exaggerating, we were detoxing patients off high levels of methadone, high levels of opioids, with very minimal withdrawal symptoms with NAD.” 

Shortly after implementing NAD, Dr. Starr started an infusion program and discovered giving common amino acids helps tremendously. “If I give my alcoholic patients high doses of B vitamins and other things, they’re feeling so much better, so much faster.” Dr. Starr quickly became known as a unique clinic doing natural alternative medicine combined with traditional medicine. 

Because they were already doing infusions, Dr. Starr started a Ketamine program. Ketamine is used medically for a number of mental health problems, specifically treatment-resistant depression. Ketamine is used for certain pain syndromes, anxiety, PTSD and other mental health problems. But, the real benefit in Dr. Starr’s clinic is that Ketamine alleviates opioid withdrawal and helps re-regulate alcohol impulsivity. Ketamine is administered in clinic through IV and typically requires six infusions over a period of two to three weeks. Dr. Starr says, “by the fifth or sixth infusion we have close to an 80% response rate.” Ketamine at high levels is general anesthesia, but at a very low dose is calming and relaxing. Dr. Starr said, “[with] all the doses that we use people are awake, they’re alert and they’re responsive.”

Suboxone

Dr. Starr believes, “Suboxone is a lifesaving tool,” he adds, “it meets people where they are, and they can immediately feel good.” Suboxone has properties that make it safer to taper off of than traditional opioids. For Dr. Starr, the goal when prescribing Suboxone is that the dose continues to taper down and it not be used long-term. 

Naltrexone

Naltrexone is an opiate receptor blocker. Naltrexone refers to the oral pill, but there is a long acting shot of Naltrexone; Vivitrol. Vivitrol is approved for both alcohol use disorder and opiate use disorder. Dr. Starr explains, “once somebody has detoxed off opiates you can give them a shot of Vivitrol, which is a month-long blocker. For 30 days they are not going to get high.” When an alcoholic uses Vivitrol, it blocks the reinforcing and rewarding aspects of alcohol, “it just doesn’t give them really super feel good,” Dr. Starr says. He loves using Vivitrol for early opiate recovery.

Addiction

Starr believes the neurobiology of addiction is a medical problem and that there are medical solutions, “it’s a medical disease because it’s treatable and it has a progressive destructive nature.” Looking back Dr. Starr says, “It’s sad that I didn’t really fully appreciate the complexities of addiction when my own brother was suffering from it, and I really solved that problem just by distancing myself from him.” Dr. Starr believes most people with some addiction have a trauma history or emotional loss. He said he always refers back to, “you don’t ask why people have addiction, you ask why they have pain.” 

Quotes have been edited for clarity.