LDN Video Interviews and Presentations (Low Dose Naltrexone) LDN Research Trust

Radio Show interviews, and Presentations from the LDN 2013, 2014, 2016, 2017, 2018 and 2019 Conferences

They are also on our Vimeo Channel and YouTube Channel

Type of Video

Sunita Shares her Multiple Conditions and How LDN has Helped

Sunita from the United States who takes LDN for fibromyalgia depression dry eye and dry mouth, her journey start end of 2013 living in a house with mold. She has Thyroid issues, Sjogrn's syndrome and LDN changed her life.

Erin Panian, PharmD, BCPS - LDN Radio Show November 2023 (LDN; low dose naltrexone)

Have you always wanted to be a pharmacist?

I wanted to be a doctor first and foremost but when I got into college, I did an internship in the ER and figured out quickly that I tend to pass out when there's blood. It wasn't the right path for me.
A non-hands-on approach would be a little bit better. My mom was a pharmacist and I shadowed her a few times. I thought it was neat, the knowledge of medications and what they were doing and I thought it was a fun field to get into. So, that's when I went to pharmacy school. I had a compounding rotation in my sixth year of pharmacy school. I just thought it was so fun. It's something new every day.
We get to figure out problems. Helping somebody figure something out was a lot of fun for me. To this day, it's still something I enjoy the most about the job. We always get the patients who have trouble finding help anywhere else, we're always able to try and help them. It's a very rewarding and fun job. I've been doing it now for 17 years.
Could you explain to our listeners what it is you do in pharmacy school and how many years? I know you said in your sixth year I believe seven isn't it now?
When I went to school it was six years, it's seven now. Each school is a little bit different. When I went to a pharmacy school you could start from day one and just finish, whereas a lot of other places have you do like a pre-pharm program. You might do two or four years in pre-pharm and then actually enter pharmacy school for three or four years. Mine was six years and then I did a residency training afterwards. That was at the VA. I switched over to compounding but did some more residency training after school. Some people do a year or two. I did one year and then I just entered straight into compounding from there.

What kind of things do you learn in pharmacy school? Walk us through it so we can understand what training a pharmacist has to have to become a compounding pharmacist.

It's not a lot of compounding. You get a class on compounding. One class out of those six or seven years and you learn the basics. I think the pharmacy school here has a couple of newer machines and technology that we use currently, but back when I went to school it was all very antiquated in terms of what they taught you for compounding because they didn't teach you much. It was still using an old ointment slab, a very sort of old-school Pharmacy. I always talk about compounding being an old-school Pharmacy, but with new inventions and fancier machines to help us make it more accurate, and a little faster. A lot of pharmacy school is going through all these other medications that you would see anywhere, whether it be at the hospital, Walgreens, or CVS. It’s going through different medical conditions and learning about those, learning how the drugs work for those conditions, learning how the drugs work in the body and how they break down and get to the different tissue levels. It doesn't prepare you fully for compounding.

I always say when somebody comes to work for us it's about 75% on-the-job training because with compounding there's a lot of stuff out there that people haven't done before. A lot of what I depend on is kind of a network of compounders that you can communicate with.
I'm part of a list of Compounders from across the world and people would send an email out to everybody:” I have a patient that needs this, I can't find any data on it. What have people done? “
You kind of take your background information of conditions and different disease states, then you take your information of the drugs that you're able to utilize or the bulk chemical powders that you're able to get. Through that information, sometimes you have to figure out a unique way to give the medication to the patient or a unique dosage. It's a lot of on-the-job training and it's one of those jobs that the longer you do it the better you are. You've done a lot more. As experience goes along you get used to some of the questions, a little bit faster at being able to figure out some of the problems.

What about drug interactions? I mean that must be part of your course.

It definitely is, and it's one of the trickier parts, to be honest. As a cash-only pharmacy, we do have to make sure to take a good medication history with the patients. With people that bill Insurance, a lot of times insurance does that drug utilization review and that interaction review for you automatically. So, when you bill the insurance company it will see even if the patient didn't get that drug at your pharmacy, it will see they got it at another pharmacy and it will alert you to the fact that it's going to interact. Here, we don't have that because we're cash only and we don't bill insurance on that, but we're able to take a thorough medication history of the patients and there's a lot of stuff that are your common interactors that will interact with a lot of drugs. So, anytime we see that we always make sure to be even more thorough and make sure that they give us everything they're on so we know to be able to check through those interactions and make sure it's not something that's not going to work out for the patient.
In your pharmacy, just go through the different options that a patient can have for LDN.
Our most common form is tablets because a lot of times patients are going to begin on a lower dose and then work up. Tablets make it very convenient because you can split them in half. I even have some patients that split them in quarters. Therefore, they can start with one tablet or a half tablet and then increase up as gradually as they need to, to reach their target dose. I do find the tablets are the easiest and they are the most common with us. We also do capsules. The only downfall with that is you can't split them. You're kind of stuck with doing one or two or three multiples or something like that.
We can make different liquids. Liquids are nice in terms of being able to dose them because with liquids the options are endless. If you have a 1 milligram per 1 milliliter, you could use 1 mil to get the 1 milligram dose. If you wanted to start at 0.1 milligrams, you'd only have to use 0.1 ml. If you wanted to go up to a target dose of 4.5 then you could go up to 4.5 MLS. You could do all your doses with just one liquid. The only downfall is the taste. It's not the worst-tasting medicine. It's not the best-tasting medicine. Everybody is different in their palatability tolerances. You've got excipients. If somebody is sensitive to the excipients. Storage it's not as convenient. Some of them are room temperature but still just keeping a liquid around can also be a little messy. If you spill some it can be sticky. A lot of times people just prefer taking a tablet or a capsule over a liquid. We've also done cream, so any sort of topical. We can do gels and creams.
There is an LDN eyedrop. That is something we were looking into providing to patients. Being an eye drop, it comes with a little more stringent rules and testing. We do have a sterile room that we can make it in. It's about getting the formula down and getting the testing done on it and getting that out to patients. Suppositories. I mean LDN I've seen done in almost every single dosage form we have available. We've done a sublingual, something that you can dissolve underneath your tongue. Some patients get some GI side effects from Naltrexone so the sublingual dosing under the tongue is a good way to help mitigate those side effects.

What about fillers that you use in your preparations?

Our most common filler is cellulose. We do have some patients that are allergic to cellulose and from there if they need something else done, we work with them. Generally, if just a lone script comes across, we're going to default to cellulose unless the doctor or the patient has alerted us that the patient needs to be worked with and they don't want a cellulose filler. Many times, we'll work with the patient and see what they want or need. Whether it be with a capsule, the possibilities are pretty much endless. We can choose something of their liking.
Probably the second most common filler would be rice flour. We see that a lot, but we can also do tapioca. I've done inulin before, crushed salt, arrowroot, all sorts of different fillers, oat flour, the possibilities are endless with capsules. Fillers for liquids get a little trickier. Naltrexone is water soluble so theoretically you can just put the Naltrexone in water and dispense it to the patient. However, when it's just in water without a preservative, it can only be good for 14 days and it has to be refrigerated. Not only do they have to get it refilled every 14 days, but they have to pay for it every 14 days. That can get a little cost-prohibitive, considering a lot of times we're dispensing up to three months for a patient and not just 14 days at a time.
Fillers for non-water liquids. We can do oil, if they're tolerant of different oils. Again, we just come across different palatability and tolerances. Some people just don't like that oil feel. Another liquid's available that has data on it and it's a little bit better mouth feel, but it does have different excipients in it that people may not be able to tolerate.
So, there are lots of different options that we can work with patients to try to figure out what's going to work best with them.
We want them to get the advantage of the medicine without reacting to the excipients. We want to make sure that they're going to get the advantage of the medication.

What disease states would you say your patients are using LDN for?

The most common we see is any sort of autoimmune disease and that can kind of run the gamut. We have some doctors that if their patient has any sort of autoimmune condition, Low Dose Naltrexone is one of the first lines for them. GI diseases, so anything from all sorts of colitis to Crohn's, IBS, IBD. We see a lot of Naltrexone for that. Restless leg syndrome is another common one.
Fertility. We see a lot in women's health and we have some doctors that will prescribe it for patients having trouble conceiving or having trouble keeping pregnancies, or having a lot of miscarriages.
Depression. We see it from some different psychiatrists around town. Those are probably the most common ones that we see and then you'll have random ones thrown out there because it can be used for so many different things. Pain is another one. We see it a lot for anything from fibromyalgia to nerve pain, to CRPS (chronic regional pain syndrome).
We do see it a lot for pain too. I think those are the main things. That doesn't encompass everything it can be used for.
When you talk to patients, what do you tell them about LDN and the expectations? Some people are so desperate to find an answer, they want it to work on day one.
Oh, I know. I feel so bad for them when I tell them it's probably not going to be day one, this can take several weeks to work. You know it is working, it's not just a Band-Aid, it's helping to work in the underlying mechanisms with inflammation and modulating the immune system. I have had some patients call me after one day and they're like:” This stuff is miraculous!” but that is not the norm.
Normally it's going to take a little bit to work and some patients get frustrated, because like you said, they're so ready to have an answer and they want to feel better and they've already been through so many other things. Generally, I always tell patients to give it a good three-month trial at their full dose. Don't just give the one milligram a shot for two weeks, make sure to work up if you're able to tolerate it. Make sure to work up and then give it a good shot at the full dose. I tell them it's not going to work for everybody but it is a great option that we've seen change lives. It's not expensive, and the side effects are minimal and mild, generally. I always tell them it's worth a shot. Especially with some of these patients that have just been through the gamut of doctors and treatments. Many of them do give it a shot.
We see it very successful in a lot of patients and then I have some patients that will stop it just to say, “Oh I think I can come off of it now.” Once they are off it for a while they are like:” Oh no I can't, I need that back. I feel much better on it.” It kind of helps confirm and reaffirm to them that it is actually helping them. Well, I've been taking LDN nearly 20 years and people are worried about the long-term effect of taking LDN, but LDN generally is in your system for like four hours. So, every day you're getting like a 20-hour break.

What do you say to people when they ask you how long can you take LDN?

It's been studied in Low Doses now for probably about 40 years. I always tell them that we do have data over 40 years now and that it's still not showing any long-term adverse effects. The benefits of it should outweigh any potential effects. I can't even really think of any long-term effects that they've seen from patients being on it for a long time. You may get side effects at the beginning. Whenever you're on it you might have some of those as you're working up, however, generally, I'm not seeing any and I don't think there's any data out there on the long term that there is any harm to taking it long term. after 40 years of studies. I always refer them to the LDN Research Trust because it kind of shows all the different studies that have been done. They love that source because a lot of my patients want to look this up, they haven't heard of it before. So they'll see the studies for themselves and see what’s all being done and see no adverse effects of it. It helps give them a little peace of mind also. I think that does help. They are also used to, here in America, all those commercials on TV and these drugs that come up and all the side effects are like death and brain tumors. We haven't seen any of that with this over 40-plus year study. You can feel a little better with that also.

Well, being English, when I come to America, you have a lot of commercials on your stations and there's a really nice advert promoting some drug. Then very quickly at the end they're saying:” Possible side effects could be heart attack, stroke, cancers.”

I know it's terrible, possible death! You think:” Why would anybody, after such a lovely advert that makes you think you’re to feel so much better, add that you could die?
I know. I know. People just remember that jingle or something that was at the beginning.

With LDN, when you said that you could potentially have some side effects while you're titrating up when you first start, what do you tell people those side effects could possibly be?

I see vivid dreams the most. A lot of times I warn them about the vivid dreams right off the bat and a lot of times the doctors have done that warning too. It seems to be the most common one that the doctors warn them about, too. We have seen that it works as well in the morning, so a lot of doctors will just proactively write for it in the morning rather than having a patient take it at bedtime. It does work on those endorphins that come at night so it does make sense that the dreams would be more vivid because those endorphins are coming out then. I tell them that's the most common.
The majority that I see might be dizziness, jitteriness, constipation, or diarrhea. General stomach upset is one is one of the main ones. I tell them it's fairly mild if they do experience it, give it a couple of days before they increase their dose. Hopefully, those side effects will kind of disappear. If they don't and if they're up at a dose like three to four milligrams, that might be the dose they stay on. We don't have everybody that gets up to the target dose of the 4.5 but that may just be something they have to do lower than that. I’ve seen a couple of people with anxiety, but I don't see that as much. The vivid dreams that come out probably more than anything but usually that can be mitigated by taking it in the morning.
I never had vivid dreams, but some say these dreams are so fantastic they don't want them to end.
I have had a couple of people that enjoy them so well. I'm sure that your body gets used to it and the vivid dreams stop anyway. Good if you can enjoy it while you can. I can't really remember dreaming. I can probably remember one dream every three years. I'm sure I dream but I just can't remember.

Could you tell us what you think is the most common dose when somebody is stabilized on LDN?

Four point five (4.5) is the most common we see. Many of our patients can get up to 4.5. It is by far the most common that we do. The one milligram and the 4.5 are probably the two most common doses that we do. The one milligram is for when they're just starting to work up and they need that smaller dose to be able to tailor their work up. We do have a majority of patients who tolerate and can stay on the 4.5. The two to the four milligrams anywhere in there, whether it be 2, 2.5, 3, 3.5, 4. We do have some patients that stay on there and they're probably all about the same, to be honest. It seems like our majority of patients are at 4.5 and then after that, it's anywhere from two to four, and those are all about the same in terms of quantities and where patients are stable. So, 4.5 is generally the most common.

Now there are a few doctors that prescribe a higher dose than 4.5. Do any of your doctors do that?

They do, but not as much. I do see it occasionally, like a 4.5 twice daily. Every once in a while, we do have some doctors that will go up to a five or a six. I do see the five or the six in some doctors and patients feel they're so close on the 4.5, they have faith that five or that six is going to really push them to feel they're optimal. When they get put on the five or the six, they find it works better for them so they do stay on that. So, we do see that occasionally. I don't know that there's much data on going above 4.5 but we do see every once in a while, for patients or doctors who think that extra little push will help.

Christian Stella, PharmD, ABAAHP, FAAMM - LDN For Depression - 2022 Conference (LDN; low dose naltrexone)

Elizabeth Livengood, NMD - Major Depressive Disorder - 2020 Conference; Bahamas (LDN, low dose naltrexone)

Linda Elsegood: Today we're joined by pharmacist Dr Dawn Ipsen who's the owner of two pharmacies in Washington state. Kuslers Pharmacy and Clark Pharmacy. Could you tell us what it was that inspired you to become a pharmacist?

Dawn Ipsen: I knew early on as a high schooler that I wanted to have a doctorate degree in something and was sort of a little bit torn between pharmacy and optometry and with long heartfelt discussions and soul-searching I became a pharmacist and very early on in my career not only was I trending towards being a pharmacist but I had an opportunity to intern at a compounding pharmacy and just absolutely completely fell in love. It was the art and the science and the way of being able to help individual patients in manner of which no other pharmacist in my area was able to do so, of providing very personalized therapies. I was able to really listen to patient needs and work with their doctors, to formulate the exact therapeutic tool that they needed to improve their quality of life. That is really what has driven me in my career.

Linda Elsegood: When did you open your first pharmacy?

Dawn Ipsen: I had been a pharmacy compounding lab manager for about 10 years for the Kusler family. When they were ready to go do other things in their life I was given the opportunity to purchase Kusler's Compounding Pharmacy. It had been a pharmacy I had worked at as a staff member for 10 years and took over as the owner and I've now owned that pharmacy for almost 10 years. In January it will be 10 years. That was my first pharmacy.

I was doing all my good work up at my Snohomish Pharmacy and suddenly had a random phone call on a Friday afternoon in which the Clark family was looking for a new owner for their pharmacy. They were ready to retire and go do other things as well. I've also owned Clark's compounding pharmacy down in Bellevue Washington for six years. I've been an owner for almost 10 years total and have had multiple locations now for about six years. We service not only the entire state of Washington but we also work within nine other states as well. Our boundaries go quite deep and it's a really great way to help all types of patients all over the nation.

Linda Elsegood: What would you say is the most popular form of LDN that you use the most?

Dawn Ipsen: I would say primarily we use the most customized strengths of capsule formulations of low dose naltrexone (LDN). It gives patients really great consistency yet opportunity to get the doses titrated in appropriately where they need it to be. What's really great about how we approach our making of capsules is we use hypoallergenic fillers. We're also able to work specifically with patients who have sensitivities. We can customize what that filler might be and I think that's really what sets our pharmacies apart and why doctors and patients choose to work with us.

We are experts in autoimmune and chronic inflammatory diseases and therefore we're very used to working with patients where the normal just isn't what they need and isn't what's best for them. We can customize that to be appropriate for them. Along with capsules of course, we are able to do transdermals. That's really popular in pediatrics, especially for patients with an autism spectrum disorder. We are able to make flavored liquid tinctures of it so patients are able to use various small doses to titrate up doses. We also make sublinguals. I would say capsules are pretty popular for us.

Linda Elsegood: What kind of fillers are you asked to use?

Dawn Ipsen: Most of the time I will steer a patient towards microcrystalline cellulose (which is a tree based cellulose). It is very hypoallergenic for a lot of patients. However, some patients know they have tree allergies and those patients primarily prefer rice flour. I do have a couple of patients, but very very rare that actually do better on lactose filler. They tend to not be my autoimmune patients. They tend to be patients in the chronic pain spectrum area.

We have also worked with other fillers, like tapioca flour. We can be very customized into our approach of how patients need it. I've got one patient that comes to mind that loves magnesium as their filler and that's very relaxing for their muscles. I've also seen probiotics being used. There is not one right answer to how we do things. We are that pharmacy that is able to have a conversation with a patient. We talk about what their needs are and customize it based on that approach.

Linda Elsegood: From the prescribers that you work with, do you have many consultants that you fill scripts for?

Dawn Ipsen: We definitely do. What's also kind of a little side thing that I do. I've always been very passionate about teaching. I'm on faculty at University of Washington School of Pharmacy and also Bastyr University which is one of the top naturopathic doctor schools in the nation. I teach there during summer quarter. I teach nationally to providers continuing ed-based content that is often LDN in nature or ties into LDN. Especially with autoimmune and chronic pain and chronic inflammatory conditions. We consult a lot with doctors. I probably work with three or four hundred functional med type providers on any monthly basis even on being able to customize therapies for their patients. We are really big in the post COVID syndrome arena of helping patients that are really struggling and LDN. We're finding it pairing quite nicely in that condition as it's very inflammatory based.

We work quite heavily within the MCAS arena for patients who have a lot of mast cell instability and need other therapies. LDN is one of the tools that is used quite frequently by those types of providers and for those specific kinds of patients.

Linda Elsegood: Do you work with any pain specialists, dermatologists, rheumatologists, gastroenterologists?

Dawn Ipsen: We do. Honestly, I'm quite proud of our little Seattle area of Washington because we do have MDs that are pain specialists that are now really turning towards using LDN in their toolbox of things they have available for patients. They're getting quite savvy at it. They're doing a really great job. It is super exciting. I have some dermatologists. I consult a lot with my functional med providers that are seeing dermatology conditions like psoriasis. I have an email I need to work with a doctor on after this to help them with this patient with a psoriasis case. We are seeing it in the GI world as well for Crohn's and irritable bowel disorder. Those chronic inflammatory conditions. I would say the MD pain specialists are really turning around over here. Obviously with the opiate crisis that has occurred in our nation I think most doctors of any type of credentialing or medical training or experience are quite interested in what LDN is doing for their communities and what opportunities it affords for patients who are trying to make sure they aren’t addicted to opiates but yet have something to improve quality of life and their day-to-day living. Low dose naltrexone (LDN) has been an amazing tool for that.

Linda Elsegood: I'm always excited to meet different LDN prescribers and nurse practitioners who are providing lots of scripts. When you get an MD or a DO that is prescribing LDN and it is completely out of their comfort zone, I always think yes, you know we've got another one on board. We're making it right. We're getting it. MDs are already working outside of the box. That is normal for them to look into LDN it's not normal for MDs to look at LDN but as you know I've interviewed so many people and so many MDs when they have a patient that they can't help and fix their issues. They've tried everything and they feel as if they've failed this patient and then they try LDN. Once they have had amazing results with the first person it's then so easy for them to look into prescribing not only for other patients with that condition but for any autoimmune disease, chronic pain, mental health, etc. I mean it's really amazing and this is where people like yourself come into play. The hand-holding with doctors because a lot of them haven't got time to do the homework. They're very busy and they need somebody to tell them exactly what it is, how to prescribe it, what to look for, what to do and have somebody on hand to say, like you said, I've got a patient with psoriasis. What do I do? Can you help me? That is the way to get more doctors involved is the pharmacist doing the hand holding.

Dawn Ipsen: There is a local psychiatrist in our area that works with younger adults with substance abuse disorders and teenagers that are having a lot of trouble with mental health. I had an opportunity to get him thinking about LDN and his patient population. I love when I get to reconnect with him every few months because he just raves He finally has a tool that actually does something. He felt the antidepressants and all these other things were not really fixing any of the issues or fixing the symptomatology. We still have the same abuse issues, we still have the same addiction issues and we still have the same levels of depression and suicide risk. But with LDN he's finding that he's actually causing positive change in his patient population and that's the only thing he really changed within his practice.

We're really affecting the health of our community in a very positive manner with something that's really safe and low risk and not expensive. It doesn't get any better than that. It's the best compliment I could ever have.

Linda Elsegood: It's really nice when patients take all their information to the doctor. Once you've got a doctor really hooked on prescribing LDN they can change the lives of hundreds of patients. Dr Phil Boyle uses LDN in his fertility clinic He also uses it in women's health for things like endometriosis, polycystic ovary, painful periods, heavy periods. Right across the board he uses LDN. He gets patients coming to see him with women's health problems who also have Hashimoto's or long COVID etc.

Dawn Ipsen: I refer to his work all the time. I get questions a lot from local providers such as we have somebody who wants to become pregnant or they did become pregnant and they're on LDN and they want to know what the standard of care is and can we continue, and what's the risk and benefit are. It is so great to have providers like him out there that have been doing this work for so long that we can very confidently share those case experiences and history of using the medication long term for those patients.

Linda Elsegood: There have been so many of our members who were skeptical about using LDN during pregnancy. Doctor Boyle is always very generous with his time. I will send him details and he will answer the patient and share his experience. You know we used it once up until birth rather and breastfeeding, etc. We have those people who have done two or three pregnancies using LDN who are happy to talk to other people. This is my experience with 20 years as the charity next year, which is totally amazing, but I’ve found that word of mouth and with the education it is just spreading.

Dawn Ipsen: Linda, you've done an amazing job with the LDN Research Trust and I thank you for that. You have made the Research Trust, its website, resources and its books into a trusted referral point that I can use with our doctors and our patients who are wanting that next level of information beyond what I'm able to say to them. They want to go see those studies themselves. They want to go read the book themselves and I know that without a doubt I can send them to your resources for them to receive complete in-depth and correct information. Thank you, Linda. You're doing amazing things and this is all because of you.

Linda Elsegood: How can people contact you?

Dawn Ipsen: We have two locations in Washington State. We have Kusler's Compounding Pharmacy in Snohomish Washington and the website there is www.Kuslers.com; and then we have Clarks Compounding Pharmacy in Bellevue Washington. That website is www.clarkspharmacywa.com. The WA stands for Washington. We are happy to help patients all over and talk with doctors that need guidance and assistance in learning more. I love being an educator and I love being here to support my community.

Linda Elsegood: Any questions or comments you may have please email me Linda linda@ldnrt.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time stay safe and keep well.

Today we're joined by pharmacist Dr Dawn Ipsen who's the owner of two pharmacies in Washington State, Kuslers Pharmacy and Clark Pharmacy. Could you tell us what it was that inspired you to become a pharmacist?

I knew early on as a high schooler that I wanted to have a doctorate degree in something and was sort of a little bit torn between pharmacy and optometry and with long heartfelt discussions and soul-searching I became a pharmacist and very early on in my career not only was I trending towards being a pharmacist but I had an opportunity to intern at a compounding pharmacy and just absolutely completely fell in love. It was the art and the science and the way of being able to help individual patients in manner of which no other pharmacist in my area was able to do so, of providing very personalized therapies. I was able to really listen to patient needs and work with their doctors, to formulate the exact therapeutic tool that they needed to improve their quality of life. That is really what has driven me in my career.

When did you open your first pharmacy?

I had been a pharmacy compounding lab manager for about 10 years for the Kusler family. When they were ready to go do other things in their life I was given the opportunity to purchase Kusler's Compounding Pharmacy. It had been a pharmacy I had worked at as a staff member for 10 years and took over as the owner and I've now owned that pharmacy for almost 10 years. In January it will be 10 years. That was my first pharmacy. I was doing all my good work up at my Snohomish Pharmacy and suddenly had a random phone call on a Friday afternoon in which the Clark family was looking for a new owner for their pharmacy. They were ready to retire and go do other things as well. I've also owned Clark's Compounding Pharmacy down in Bellevue Washington for six years. I've been an owner for almost 10 years total and have had multiple locations now for about six years. We service not only the entire state of Washington but we also work within nine other states as well. Our boundaries go quite deep and it's a really great way to help all types of patients all over the nation.

What would you say is the most popular form of LDN that you use the most?

I would say primarily we use the most customized strengths of capsule formulations of low dose naltrexone (LDN). It gives patients really great consistency yet opportunity to get the doses titrated in appropriately where they need it to be. What's really great about how we approach our making of capsules: we use hypoallergenic fillers. We're also able to work specifically with patients who have sensitivities. We can customize what that filler might be and I think that's really what sets our pharmacies apart and why doctors and patients choose to work with us. We are experts in autoimmune and chronic inflammatory diseases and therefore we're very used to working with patients where the normal just isn't what they need and isn't what's best for them. We can customize that to be appropriate for them. Along with capsules of course, we are able to do transdermals. That's really popular in pediatrics, especially for patients with an autism spectrum disorder. We are able to make flavored liquid tinctures of it so patients are able to use various small doses to titrate up doses. We also make sublinguals. I would say capsules are pretty popular for us.

What kind of fillers are you asked to use?

Most of the time I will steer a patient towards microcrystalline cellulose (which is a tree-based cellulose). It is very hypoallergenic for a lot of patients. However, some patients know they have tree allergies and those patients primarily prefer rice flour. I do have a couple of patients, but very very rare, that actually do better on lactose filler. They tend to not be my autoimmune patients. They tend to be patients in the chronic pain spectrum area. We have also worked with other fillers, like tapioca flour. We can be very customized into our approach of how patients need it. I've got one patient that comes to mind that loves magnesium as their filler and that's very relaxing for their muscles. I've also seen probiotics being used. There is not one right answer to how we do things. We are that pharmacy that is able to have a conversation with a patient. We talk about what their needs are and customize it based on that approach.

From the prescribers that you work with, do you have many consultants that you fill scripts for?

We definitely do. That's also kind of a little side thing that I do. I've always been very passionate about teaching. I'm on faculty at University of Washington School of Pharmacy and also Bastyr University, which is one of the top naturopathic doctor schools in the nation. I teach there during summer quarter. I teach nationally to providers continuing ed-based content that is often LDN in nature, or ties into LDN. Especially with autoimmune and chronic pain and chronic inflammatory conditions. We consult a lot with doctors. I probably work with three or four hundred functional med type providers on any monthly basis, even on being able to customize therapies for their patients. We are really big in the post-COVID syndrome arena of helping patients that are really struggling and LDN. We're finding it pairing quite nicely in that condition as it's very inflammatory based. We work quite heavily within the MCAS arena for patients who have a lot of mast cell instability and need other therapies. LDN is one of the tools that is used quite frequently by those types of providers and for those specific kinds of patients.

Do you work with any pain specialists, dermatologists, rheumatologists, gastroenterologists?

We do. Honestly, I’m quite proud of our little Seattle area of Washington because we do have MDs that are pain specialists that are now really turning towards using LDN in their toolbox of things they have available for patients. They're getting quite savvy at it. They're doing a really great job. It is super exciting. I have some dermatologists. I consult a lot with my functional med providers that are seeing dermatology conditions like psoriasis. I have an email I need to work with a doctor on after this to help them with this patient with a psoriasis case. We are seeing it in the GI world as well for Crohn's and irritable bowel disorder. Those chronic inflammatory conditions. I would say the MD pain specialists are really turning around over here. Obviously with the opiate crisis that has occurred in our nation I think most doctors of any type of credentialing or medical training or experience are quite interested in what LDN is doing for their communities and what opportunities it affords for patients who are trying to make sure they aren’t addicted to opiates but yet have something to improve quality of life and their day-to-day living. Low dose naltrexone has been an amazing tool for that.

I'm always excited to meet different LDN prescribers and nurse practitioners who are providing lots of scripts. When you get an MD or a DO that is prescribing LDN and it is completely out of their comfort zone, I always think yes, you know we've got another one on board. We're making it right. We're getting it. MDs are already working outside of the box. That is normal for them to look into LDN; it's not normal for MDs to look at LDN but as you know, I've interviewed so many people and so many MDs when they have a patient that they can't help, and fix their issues. They've tried everything and they feel as if they've failed this patient, and then they try LDN. Once they have had amazing results with the first person it's then so easy for them to look into prescribing, not only for other patients with that condition but for any autoimmune disease, chronic pain, mental health, etc.

I mean it's really amazing and this is where people like yourself come into play. The hand-holding with doctors because a lot of them haven't got time to do the homework. They're very busy and they need somebody to tell them exactly what it is, how to prescribe it, what to look for, what to do and have somebody on hand to say, like you said, I've got a patient with psoriasis. What do I do? Can you help me? That is the way to get more doctors involved is the pharmacist doing the hand holding.

There is a local psychiatrist in our area that works with younger adults with substance abuse disorders and teenagers that are having a lot of trouble with mental health. I had an opportunity to get him thinking about LDN and his patient population. I love when I get to reconnect with him every few months because he just raves He finally has a tool that actually does something. He felt the antidepressants and all these other things were not really fixing any of the issues or fixing the symptomatology. We still have the same abuse issues, we still have the same addiction issues and we still have the same levels of depression and suicide risk. But with LDN he's finding that he's actually causing positive change in his patient population, and that's the only thing he really changed within his practice. We're really affecting the health of our community in a very positive manner with something that's really safe and low risk and not expensive. It doesn't get any better than that. It's the best compliment I could ever have.

It's really nice when patients take all their information to the doctor. Once you've got a doctor really hooked on prescribing LDN they can change the lives of hundreds of patients. Dr Phil Boyle uses LDN in his fertility clinic. He also uses it in women's health for things like endometriosis, polycystic ovary, painful periods, heavy periods. Right across the board he uses LDN. He gets patients coming to see him with women's health problems who also have Hashimoto's or long COVID etc. I refer to his work all the time. He gets questions a lot from local providers such as we have somebody who wants to become pregnant, or they did become pregnant and they're on LDN and they want to know what the standard of care is and can we continue, and what's the risk and benefit are. It is so great to have providers like him out there that have been doing this work for so long that we can very confidently share those case experiences and history of using the medication long term for those patients.

There have been so many of our members who were skeptical about using LDN during pregnancy. Doctor Boyle is always very generous with his time. I will send him details and he will answer the patient and share his experience. You know we used it once up until birth rather and breastfeeding, etc. We have those people who have done two or three pregnancies using LDN who are happy to talk to other people. This is my experience with 20 years as the charity next year, which is totally amazing, but I’ve found that word of mouth and with the education it is just spreading.

Linda, you've done an amazing job with the LDN Research Trust and I thank you for that. You have made the Research Trust, its website, resources and its books into a trusted referral point that I can use with our doctors and our patients who are wanting that next level of information beyond what I'm able to say to them. They want to go see those studies themselves. They want to go read the book themselves and I know that without a doubt I can send them to your resources for them to receive complete in-depth and correct information. Thank you Linda. You're doing amazing things and this is all because of you.

How can people contact you?

We have two locations in Washington State. We have Kusler's Compounding Pharmacy in Snohomish Washington and the website there is www.Kuslers.com; and then we have Clarks Compounding Pharmacy in Bellevue Washington. That website is www.clarkspharmacywa.com. The WA stands for Washington. We are happy to help patients all over and talk with doctors that need guidance and assistance in learning more. I love being an educator and I love being here to support my community.