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The Saving Dose

The Saving Dose

著者： John Hsu & William Pedranti
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The podcast for those building the future of healthcare. A clinician, a healthcare attorney, and a behavioral health executive on what's actually working in addiction, adherence, and the capital reshaping both.


75% of patients do not take medications as prescribed. 125,000 Americans die from it every year. $528 billion in preventable costs trace directly to a gap the healthcare system has known about for decades and never closed: what happens after the prescription is written.

The Saving Dose is a podcast about that gap, the space between the clinic visit and the outcome, between the evidence-based treatment and the patient who never receives it, between the innovation that works and the reimbursement system that decides whether anyone can afford to deliver it.

Hosted by Kendra Allen, Dr. John Hsu, and William Pedranti, the show brings together a behavioral health revenue strategist, an addiction medicine physician, and a biotech entrepreneur to go inside the clinical, operational, and commercial realities of addiction recovery, medication adherence, opioid use disorder (OUD), and behavioral health. Three different vantage points on the same broken system. Honest about what fails, specific about why, and direct about what a real fix requires.

Topics include: MOUD and MAT clinic operations, medication-assisted treatment adherence, behavioral health reimbursement, opioid use disorder treatment, payer contracting, DEA compliance, FFS-to-value-based care transitions, and the patient adherence gap in controlled substance prescribing.

The Saving Dose is for investors evaluating the addiction recovery and behavioral health infrastructure market. For clinic operators and executives running opioid treatment programs, MOUD practices, and behavioral health facilities. For clinicians in addiction medicine and pain management. For payers and administrators navigating the cost and risk of behavioral health coverage.

New episodes every two weeks. Available on Spotify, Apple Podcasts, YouTube, and wherever you listen.

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© 2026 The Saving Dose 個人ファイナンス 経済学 衛生・健康的な生活 身体的病い・疾患
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  • How Stigma Keeps People from Getting Help | The Saving Dose Ep. 13 Ft. Melissa Shackleford

    How Stigma Keeps People from Getting Help | The Saving Dose Ep. 13 Ft. Melissa Shackleford
    2026/09/29

    Melissa Shackleford has been in addiction recovery for 37 years. She got sober as a college freshman, went on to spend a decade as SVP of Marketing at Hazelden Betty Ford, and built a career at the intersection of healthcare marketing and behavioral health. She is a TEDx speaker, Amazon #1 bestselling author of Harnessing Purpose, and founder of Shackleford Strategies.

    In this conversation with Dr. John Hsu and William Pedranti, Melissa breaks down why stigma is not just a cultural problem but a clinical one. She's seen it from both sides: as a person in long-term recovery and as the marketing executive who had to fight to remove stigmatizing language from Hazelden's own outreach materials.

    What they cover:

    • Why the language we use determines whether someone seeks help or disappears
    • The person-first language shift and why it matters beyond addiction
    • The Gallup and Shatterproof stigma studies and what the data reveals about how little has changed
    • Why doctors call OUD patients "difficult" when no one says that about diabetics who won't follow their diet
    • The buprenorphine shame problem inside 12-step recovery communities
    • Medicaid's 8-to-9-month wait for OUD treatment and who loses their life in that window
    • Why pharmacies refusing to stock MOUD medications is a form of stigma with real body counts
    • What Hazelden Betty Ford got right about messaging: lead with hope, not shock
    • John's La Joya house: giving six bedrooms to a sober living facility because no neighborhood wants treatment next door
    • The one change Melissa asks every doctor, pharmacist, and family member to make

    Chapters:
    00:00 Introduction and Melissa's background
    02:30 Getting sober at 18: what that looked like
    05:00 Why person-first language is not political, it's medical
    08:00 The parking lot pill count story (and what it says about how we treat patients)
    10:00 Stigma inside the recovery community: buprenorphine and 12-step
    15:30 MAT stigma and the barriers it creates
    17:00 Medicaid pays 80% of OUD treatment, then makes patients wait 9 months
    18:40 John's sober living house and the "not in my backyard" problem
    20:00 Why OUD patients are labeled "difficult" when no chronic condition patient is
    22:00 Long-term MAT: the three schools of thought
    24:00 How the drug supply changed: from prescription opioids to fentanyl-laced everything
    25:00 Treating the body and the mind: why medication alone is not recovery
    26:00 MAT and the work requirement trap: losing Medicaid means losing medication
    28:00 Pharmacies that refuse to stock MOUD medications
    28:44 These medications reduce overdose-related death by more than 50%
    31:00 OUD providers keeping secret lists of pharmacies that will fill prescriptions
    32:00 Trust as the currency of healthcare
    33:00 Hazelden's messaging strategy: pull out stigmatizing imagery entirely
    35:00 People call treatment centers on the worst day of their life
    37:00 The one thing to change: use person-first language
    40:00 Addiction is not a choice, it's not a moral failing
    41:00 Cancer has pink ribbons. Why does addiction still carry shame?
    43:00 About Shackleford Strategies and how to connect with Melissa
    44:10 Closing

    Connect with Melissa Shackleford:
    LinkedIn: linkedin.com/in/melissashackleford
    Website: https://melissaforsshackelford.com/

    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.

    The Saving Dose is produced by iPill Adherence Tech Services. All content is for educational and informational purposes only and does not constitute medical advice.
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    45 分
  • The Drug That Can Make Pain Worse | The Saving Dose Ep. 12 Ft. Prof. Patrice Forget

    The Drug That Can Make Pain Worse | The Saving Dose Ep. 12 Ft. Prof. Patrice Forget
    2026/09/22

    In the twelfth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Professor Patrice Forget, a Belgian anesthesiologist and pain researcher now based in the United Kingdom. With more than 250 peer-reviewed publications, Professor Forget chairs the PANDOS research group (Pain and Opioids After Surgery) at the European Society of Anesthesiology and Intensive Care, serves as a board member and honorary treasurer of the European Pain Federation, and is deputy editor-in-chief of the European Journal of Anesthesiology. His work bridges clinical practice, large-scale epidemiology, and policy at the intersection of post-operative pain management, opioid use, and long-term outcomes.

    This episode goes further into the clinical science of opioids than any conversation The Saving Dose has had. Professor Forget challenges assumptions that have shaped prescribing practice for decades, including the idea that more opioids during surgery means less pain after it.

    00:00 Introduction
    02:06 Professor Forget's background and path from Brussels to the UK
    04:00 How fentanyl was developed in Belgium and what it was originally designed to do
    07:15 Opioid-induced hyperalgesia: what it is and why it matters
    10:00 The Liverpool technique and the history of balanced anesthesia
    12:00 Why large doses of opioids can increase pain sensitivity rather than reduce it
    16:00 The preemptive analgesia theory and why the data rejected it
    20:00 How not all patients respond to opioids the same way
    24:00 What European post-surgical data shows about long-term opioid outcomes
    28:00 The gap between what research shows and what policy assumes
    32:00 Opioid stewardship and responsible prescribing in a post-crisis environment
    38:00 John on cardiac anesthesia and the clinical reality of high-dose opioid use
    44:00 What the field still does not know and where research is heading
    50:00 What better perioperative pain management could mean for addiction prevention

    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

    Professor Patrice Forget is a Belgian anesthesiologist and pain researcher based in the United Kingdom. He chairs the PANDOS (Pain and Opioids After Surgery) research group at the European Society of Anesthesiology and Intensive Care and serves as a board member and honorary treasurer of the European Pain Federation. He is deputy editor-in-chief of the European Journal of Anesthesiology and a past president of the Belgian Pain Society. He has authored more than 250 peer-reviewed publications on perioperative epidemiology, clinical pharmacology, and opioid stewardship.

    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.

    #ChronicPain #OpioidCrisis #PainManagement #AddictionRecovery #TheSavingDose #OpioidInducedHyperalgesia #Anesthesiology #PeroperativeCare #OpioidStewardship #SurgicalPain #PainMedicine #Buprenorphine #SubstanceUseDisorder #HealthcarePodcast #EuropeanPainFederation #PANDOS #OpioidPolicy #AddictionMedicine #ChronicPainManagement #PublicHealth
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    44 分
  • Inside the White House Drug Policy Office | The Saving Dose Ep. 11 feat. Rob Kent

    Inside the White House Drug Policy Office | The Saving Dose Ep. 11 feat. Rob Kent
    2026/09/15
    In the eleventh episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Rob Kent, former General Counsel at the White House Office of National Drug Control Policy under the Biden administration and a 30-year veteran of New York state government drug policy. He now runs Kent Strategic Advisors, working with treatment providers, advocacy groups, and think tanks to navigate regulators and insurance companies.Rob is one of the few people in this conversation who has been inside the machinery of federal drug policy and is now free to say exactly what he thinks about how it works and where it fails. This episode is the most policy-focused conversation The Saving Dose has had, and it does not pull punches.This episode covers the X-waiver elimination and why removing the barrier did not move prescribing numbers the way anyone hoped, why harm reduction is still the third rail of drug policy, what the Biden administration actually accomplished in its first 18 months before reelection politics took over, why the opioid settlement billions are being misspent in ways Rob believes are worse than the tobacco settlement errors, and what it looks like when an insurance company tells you a person who barricaded themselves in a hotel room and drank the entire minibar did not meet the criteria for inpatient care.00:00 Introduction and Rob Kent's background02:06 Growing up in Syracuse, 30 years in New York state government, White House ONDCP04:00 What the Office of National Drug Control Policy actually does05:32 What the Biden administration focused on: harm reduction, X-waiver, jails and prisons06:49 The biggest challenges: Congress, stigma, and the politics of harm reduction08:33 Why the first 18 months are the window and what happened after10:11 The X-waiver: what it was, why it mattered, and what eliminating it did and did not do12:54 Why removing the barrier was not enough without incentivizing prescribers14:44 John on the X-waiver limiting him to 25 patients and killing the business model16:23 Telehealth and buprenorphine: how COVID blew the door open and what the DEA is doing now18:36 Why too many policymakers still believe addiction is a choice20:03 Proving it works versus winning hearts and minds: Rob's policy approach20:40 OUD as a lifelong condition: why policy needs to treat it like high blood pressure26:00 Medicaid work requirements and what they mean for people in recovery28:47 The opioid settlement billions: why Rob believes the money is being wasted30:16 The death rate dropped 37% after CDC loosened prescribing restrictions in 202231:14 Opioid dependency versus opioid use disorder: two diseases, one stigma33:06 What the Biden CMS guidance on Medicaid in jails actually did34:41 Why guards are the happiest people when MAT is offered in correctional facilities36:33 New York's seven-day acute supply law and what happened when a pain clinic was shut down overnight38:01 How policy swings from one extreme to the other instead of legislating in the middle38:29 John on the 1999 pain as a fifth vital sign movement and what it started42:01 How the Joint Commission and reimbursement incentives built the opioid crisis systemwide43:29 Physicians stopping opioid prescribing entirely out of fear of monitoring44:19 Tylenol and Motrin after a total knee replacement: John on the prescribing overcorrection49:34 Insurance clawbacks: John receives a bill for a patient who died six years after treatment50:17 Rob on insurance companies and where the money in the system actually goes51:04 Kent Strategic Advisors: what Rob does now and who he works with54:05 The insurance company that said a person who barricaded themselves in a hotel room did not need inpatient care55:15 William's experience attending an addiction recovery meeting and why everyone should goAbout the HostsJohn 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. Connect with John: https://www.linkedin.com/in/john-hsu-md-300a8b2a/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. Connect with William: https://www.linkedin.com/in/williampedranti/Kendra Allen is the CRO of iPill with 20 years in behavioral health revenue strategy, payer contracting, and regulatory navigation. She founded and exited a national healthcare consulting firm. Connect with Kendra: https://www.linkedin.com/in/kendra-allen-cro/About the GuestRob Kent is a former attorney and government official with 30 years of experience in New York state drug policy and addiction recovery. He served as General Counsel at the White House Office of National Drug Control Policy under the Biden administration, where he worked on the X-waiver elimination, harm reduction policy, and expanding...
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    53 分
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