LDN Video Interviews and Presentations

 

Leslea Knisel, BSN, RN-BC, CHPN, CDP Feb 2020 Pain Seminar Welcome Address (LDN, low dose naltrexone)

 

 

Pain Specialist Dr Asher Goldstein Feb 2020 Pain Seminar (LDN, low dose naltrexone)

 

 

Jo - England: Behçet's Disease and Multiple Sclerosis (LDN; low dose naltrexone)

 

 

John Herr, RPh of Town and Country Compounding Pharmacy Talks about the Many Forms of Low Dose Naltrexone and more

 

 

Linda Bluestein, MD - MCAS Documentary Fundraiser; August 2023 (LDN; low dose naltrexone)

 

 

Tania Dempsey, MD - MCAS Documentary Fundraiser; August 2023 (LDN; low dose naltrexone)

 

 

Madi Wend - MCAS Documentary Fundraiser; August 2023 (LDN; low dose naltrexone)

 

 

Leonard Weinstock, MD - MCAS Documentary Fundraiser (LDN; low dose naltrexone)

 

 

Linda Elsegood: Welcome to the LDN Radio show brought to you by the LDN Research Trust. I'm your host Linda Elsegood. Today we're joined by pharmacist Mark Filosi from Family Care Compounding Pharmacy in Florida. Thank you for joining us today, Mark. We'd like to find out more about who is Mark Filosi. 

Mark Filosi: I grew up in pharmacy. My very first job was in a pharmacy when I was 14 years old. I began compounding even back then. This is before computerization, typing on a manual typewriter, filling capsules, one at a time on a torsion balance on Saturdays in support of compounding. Fast forwarding to 2023 where we've got really a state-of-the-art very high-tech pharmacy this is very very different. 

Linda Elsegood: So are you the manager? The owner? What's your role? 

Mark Filosi: I own two pharmacies. I own Family Care Compounding. I also own Live and Learn Pharmacy. I've done a brief stint as a PCAP ACHC Surveyor or accreditation and compounding both sterile and non-sterile. I also sit on the board of directors for the Alliance for Pharmacy Compounding. It's really the only advocacy group that I know of in the United States in support of what we do and allows us to be able to compound things like low dose naltrexone and bioidentical hormones. I'm a preceptor for four different universities in America. I'm a career coach for young pharmacists. I also teach educational programs for continuing education for pharmacists through the parent company that's sponsoring me on Medisca and LP3 Network. I'm a senior facilitator for them. I've worked teaching sterile and non-sterile, advanced non-sterile business for pharmacists for the last 15 years. 

I've taken on a very new role on basically off the bench now as a pharmacist, even though I still work in my stores. I'm a success partner with Medisca Pharmacy Compounding Coaching Services. That is something that's very new. When my son was younger, I was a Boy Scout leader for him and horseback riding with my daughter and all kinds of fun stuff with my wife. Now we have a a lot of hobbies and projects. 

Linda Elsegood: You are a very busy man obviously. Please tell us about your pharmacies. 

Mark Filosi: We've been in business for 27 years. I started way back when there really wasn't much support for compounding pharmacies, back when there was just a publication called the Secundum Artem. 

I would learn everything then that Mark Erickson talked about in that particular publication. I learned how to compound a progesterone suppository. Then I would go out land market that one thing to physicians and practitioners in Florida. I became so impassioned with that that I wanted to learn more. I've taken flagship programs from Medisca Sterile Compounding, non-sterile and I've really expanded the scope of what we do to the point where I would say compounding has really eclipsed all the other things that I do in pharmacy, but I've probably done just about everything you could think of as a pharmacist. My most passionate and exciting thing that I do at my pharmacy is non-sterile compounding. I just love it. 

Linda Elsegood: What forms do you compound LDN into? 

Mark Filosi: Right now we compound rapid dissolve tablets, trochees, which are just basically lozenges that you dissolve in your mouth. Capsules of course are probably our number one, but one of the exciting things that you might not know about is something called Nova film from Medisca. It can bypass down the hatch, into the stomach, then to the liver, then to the blood, then to the biological side of action. We've got a new product called Nova film which is sublingual but the unique thing about it is it's also mucoadhesive so it gives your body much more opportunity for absorption in the tiny blood vessels inside your mouth. It is similar to a Listerine strip or some of the commercial products that are like that right now. The mucosal lining is kind of a moving target. There's a turnover rate with it and this really makes it bind to that and we're really looking forward to using low dose naltrexone in that type of delivery system. It is very novel, very unique. 

Linda Elsegood: Do you make low dose naltrexone (LDN) in a nasal spray? 

Mark Filosi: It's my feeling and the feeling that the folks that support me at Medisca and LP3 that that should probably start as a sterile compounded preparation as it doesn't have direct access to the body like an injection or intramuscular, but it's still something that you wouldn't want to introduce a pathogen into somebody's body. I don't really focus on sterile compounding anymore. That's not something that I do. 

Linda Elsegood: You mentioned two pharmacies. Are they run very similar? 

Mark Filosi: Yes they are. Live and Learn Pharmacy, a pharmacy I just purchased a few months ago, was nothing but compounding, and my pharmacy was a hybrid of just about everything; DNA, retail and of course compounding.

Linda Elsegood: What kind of doctors do you deal with in Florida? I know West Coast is mainly naturopathic doctors. Do you have MDs and DOs and physician assistants, etc. 

Mark Filosi: NDs would not be the primary here because they don't have prescriptive authority in Florida. It is interesting, I could take a prescription from an ND in California because they do legally have prescriptive authority and the right to prescribe low dose naltrexone in California, so if one called to here I could fill it, but an ND in Florida, I would not be able to. It is very interesting but I would say the primary prescribers that I see here in Florida would be MDs and probably nurse practitioners. Especially because nurse practitioners here in Florida can be autonomous. They can open up their own practices and this is really kind of a niche market that's very well supported with nurse practitioners. It's something that's really within their power to do that. 

Linda Elsegood: We find that there are many nurse practitioners who seem to have more time to spend with patients than a doctor. 

Mark Filosi: Although I've got some really wonderful prescribing MDs I will say that in my experience nurse practitioners do give you more of their time and because of that it can be a very powerful experience for a lot of people 

Linda Elsegood: Now in Scotland, and we're going to start having them in England – Pharmacy Consultant Prescribers. Something so new in Scotland, I think they had it before COVID. It will mean you can go to your doctor or your pharmacist with minor things. In Scotland they could prescribe LDN as well. In England I think it's going to be minor things to begin with. Do you have that already in place? 

Mark Filosi: It depends on the state because each state is run like a small country. We have different rules within the state versus Federal law standards and guidelines. In Florida we've got two programs. We've got something called Test To Treat where a pharmacist could do a CLIA approved test and then from that we would be able to prescribe certain limited things like you're describing in Scotland. We also have something called a Collaborative Practice Model where we could create a collaborative practice agreement with a practitioner and then prescribe things within that agreement. I would think that prescribing LDN could be one of those collaborative things that we could do moving forward. 

Linda Elsegood: It is really exciting. 

Mark Filosi: I am excited for that and I think that the world has recognized that pharmacists have a great place within healthcare and that we should be recognized as practitioners and we're probably one of the best suited professions, and that we would be able to prescribe because we know the drug. 

Linda Elsegood: Doctors only do a certain amount of drug interactions because that's not their wheel house that's yours. It's the pharmacy, that's the nurse, prescribers are like doctors to a point you know. Why wouldn't you have a pharmacist prescribing like you have a nurse prescriber? I don’t see what the difference is. 

Mark Filosi: That's very true and it's funny that the lobbying groups and the association surrounding nurses and doctors are strong but historically those types of groups surrounding pharmacists have been weak. We haven't been a cohesive body. That's one of the reasons why I sit on the board of directors for APC is to give that voice 

Linda Elsegood: Because in England there's a crisis that we are short of medical professionals, doctors, nurses, etc and I'm sure it must be similar to the US. It would be so much easier for patients who have access to medical care if all those pharmacists that were ready and willing and able to become prescribers. Surely that would take a lot of pressure off your health system. 

Mark Filosi: Yeah, and I think that it's a partnership with those people. It's not like we're taking power away from a practitioner. We're sharing the process. I think we make them more effective. If a physician only has five or ten minutes to meet with a patient we can work behind the scenes and write suggested prescriptions. We can measure outcomes with prescribers and patients and it's that triad. It's the relationship between a pharmacist, a patient and a practitioner that really rounds out that whole process. 

Linda Elsegood: It is all for the good of the patient. 

Mark Filosi: Of course, it works best if you have that kind of time. That's something that APC, an independent group, they have a new product called Outcomes MD. It is a platform available to both pharmacists and providers. It interfaces with electronic healthcare records and they have a very new platform specific to naltrexone that I can text a survey to my patient. Once they receive their prescription it will establish a baseline of symptoms with that patient associated with naltrexone and then I can start to measure and monitor outcomes. The measures are to prove that it's either working or if there's some sort of gap in therapy, or is there something that I can go back and now recognize because the beauty of compounding is it something that we can modulate, fix and make better, because it's personalized medicine.

Linda Elsegood: It is always good to start with a baseline. For people sitting in that survey initially before they take the first pill, capsule, whatever it may be, you then got the baseline which makes such a big difference. 

Mark Filosi: I would say to the pharmacist in the United States that might hear this that the data that's being collected by Outcomes MD will become redacted and shared back to the Alliance for Pharmacy Compounding. This is something that we can show evidence to the FDA that compounding is valid and that the works of pharmacy are true. We've been doing this as a privilege for thousands of years. With a stroke of a pen the Federal regulatory bodies could take that away from us. I think it's important if we want to preserve really valuable and powerful things like LDN and BHRT and all those things that go with it then we have to be proactive. 

Linda Elsegood: I believe you are quite big in the hormone community. 

Mark Filosi: With the community of everything that's possible within non-sterile compounding and sterile compounding. Yes, I've got a new role. In addition to being a facilitator for educational programs I also teach. I have been teaching compounding for 15 years. I've been advocating for colleges of pharmacy and so on. When you take a program like that then people don't know what to do on Monday morning after the program, after they get home. They've taken a course, they've gone to college but they still need somebody to hold their hand through the process and Medisca, now the parent company, the global leader in compounding, really has allowed me to open this channel and I become what's called a success partner. I have two other people that are working with me. I've got another coach that's working as a coach and remote patient monitoring and clinical services. I have another coach that's specializing in pharmacy operations, CEO mindset leadership. When somebody wants to open the niche market of non-sterile compounding or maybe they already are a fantastic non-sterile compounder but they want to open the niche market of LDN I can walk them through that process and really this whole team would guide them on that effort. Something that's very new and this is what we're going to kind of splash at the LDN conference.

Linda Elsegood: Third party testing is very important and pharmacists hold that in very high regard because as a pharmacist you can say there is definitely 4.5 milligrams in my capsule.

Mark Filosi: You know I have what I affectionately call pharmacists that behave more like bartenders. They're dabblers in non-sterile compounding. Then I have pharmacists that are truly professional, personalized compounding pharmacists and they're very different. It's different than just crushing a 50 milligram tablet and dividing it in some way to make a capsule or some other preparation. If you used an FDA grade, USP grade, active pharmaceutical ingredient from somebody like Medisca and you learn how to manipulate that. 

If I have five milligrams of Naltrexone, and 50 milligrams of Naltrexone it is very difficult for somebody to weigh that precisely. You have to learn how to weigh the unweighable. You need to learn how to do mixtures that if I was making a capsule, even if every one of my capsules the finished product weighed exactly 300 milligrams but the finished powders in there. If I make a hundred capsules at a time, if they all just by chance weigh 300 milligrams, my theoretical weight, how would I really know 4.5 milligrams or 1.5 milligrams on the titration was really in those capsules? That predicates itself on homogeneity and content uniformity when we make that mixture powder blend to start with. We would need devices like the Mazerustar, that's an inverse planetary mixer. We would need testing facilities to confirm and validate repeatedly that when I make a mixture in service of making a 1.5 milligram capsule or a 3 or 4.5 or what have you that I do have a homogeneous blend. When I make those capsules and they weigh the correct amount the finished preparation is correct. I believe that all pharmacists should operate by the family rule. If I was making that for my mom, I was making that for my wife, if it's not good enough to dispense to any of those people then I shouldn't be doing this. If you're just dropping a tablet into a glass of water, are you thinking about the fact that naltrexone is the salt of a strong acid and it could be either more dissociated or less dissociated in the presence of an acid or a base. It could undergo hydrolysis in water. It's not stable. What happens if a lot of the excipient ingredients have grabbed onto that drug and it's at the bottom of the glass and you're supposed to drink one tenth of this glass to give you the five milligrams which is going to be nearly impossible. At the beginning of that glass maybe you get a light dose, at the bottom of the glass maybe get a heavy dose and you're looking at a narrow therapeutic index drug where we're telling people that 1.5 milligrams in increments is what you need to do. If we're giving people instructions that are that precise. If we're doing very low low dose naltrexone, an ultra low dose naltrexone how is that possible without this committed validated process? 

Linda Elsegood: Please share your website so that people can go and find out more. 

Mark Filosi: Yes uh I would tell them to go on to Medisca.com and they can look at pharmacy success partners. They can look at our services. They can look at formulation development. We have everything. Really a need from LP3 education it's a one stop shop really to get somebody up to speed and able to do something like this. Which really is something that you really need to pay close attention to. If you don't do it right we can cause patient harm instead of patient good. I think that if you really want to do things correctly you want to work with somebody like this company Medisca. 

Linda Elsegood: Any questions or comments you may have please email me Linda@ldnrt.org. I look forward to hearing from you. 

 

 

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.