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The Saving Dose

The Saving Dose

Di: 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 Disturbo fisico e malattia Economia Finanza personale Igiene e vita sana
Episodi
  • The Politics of Addiction | The Saving Dose Ep. 16 ft. Andrew Kessler

    The Politics of Addiction | The Saving Dose Ep. 16 ft. Andrew Kessler
    Oct 20 2026

    In the sixteenth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Andrew D. Kessler, JD, founder and principal of Slingshot Solutions LLC, a Washington, DC behavioral health policy consulting firm with more than two decades of experience navigating Congress, the White House Office of National Drug Control Policy, SAMHSA, and NIDA on behalf of treatment providers, advocacy organizations, and professional associations.

    Andrew has written legislation and report language passed by both the House and Senate, presented before the Scientific Management Review Board, the College on Problems of Drug Dependence, and the National Conference on Addictive Disorders, and is a frequent contributor to Politico, The Hill, and Alcohol and Drug Abuse Weekly. He is one of the few people in this space who understands both what advocates need and why Capitol Hill consistently fails to deliver it, and he says so plainly.

    00:00 Introduction
    02:34 Andrew’s path from Capitol Hill intern to DC policy specialist
    07:53 Why Slingshot Solutions has nothing to do with David and Goliath
    10:02 The fourth decade of the opioid epidemic and the gap between suffering and policy
    11:06 Why stigma is still the number one obstacle on Capitol Hill
    13:00 Addiction as a brain disease: what society still does not understand
    14:25 How Hollywood shapes what policymakers think treatment looks like
    17:44 The $4 trillion problem and why 85% of people with OUD never get treatment
    24:20 The three-legged stool: prevention, treatment, and recovery
    26:07 Reducing overdose deaths by more than 50% is possible, so why aren’t we
    29:38 The workforce crisis: retention, not recruitment, is the problem
    31:53 Why Medicaid reimbursement for SUD has never recovered from the 1960s
    35:40 The $57 billion opioid litigation settlement and what actually happened to it
    43:12 If the president gave you one year and full backing: Andrew’s three moves
    51:47 Homelessness, addiction, and what the current administration is actually saying
    54:38 Robert F. Kennedy Jr., 14 years of heroin addiction, and zero days homeless
    57:56 A vision without funding is a hallucination: how Andrew holds the White House accountable
    1:00:46 What Slingshot Solutions does and how to reach Andrew

    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

    Andrew D. Kessler, JD is the founder and principal of Slingshot Solutions LLC, a Washington, DC consulting firm specializing in behavioral health policy. With more than 20 years of experience in substance use disorder policy, he has written legislation and report language passed by both the House and Senate, collaborated with congressional offices, the White House ONDCP, NIDA, and SAMHSA, and represented organizations including the International Certification and Reciprocity Consortium, the California Consortium of Addiction Programs and Professionals, and Faces and Voices of Recovery. He is a frequent contributor to Politico, The Hill, and Alcohol and Drug Abuse Weekly, and speaks nationally on substance use policy and advocacy. He speaks in a personal capacity.

    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.

    #OpioidPolicy #AddictionRecovery #BehavioralHealth #TheSavingDose #DrugPolicy #SubstanceUseDisorder #ONDCP #SAMHSA #NIDA #OpioidCrisis #HarmReduction #MOUD #MedicaidPolicy #AddictionMedicine #PublicHealth #RecoveryPodcast #StigmaKills #HealthcarePodcast #SlinghotSolutions #OpioidSettlement
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    1 ora e 6 min
  • Inside Hospital Drug Diversion | The Saving Dose Ep. 15 ft. Terry Vidals

    Inside Hospital Drug Diversion | The Saving Dose Ep. 15 ft. Terry Vidals
    Oct 13 2026

    Terri Vidals has spent more than 35 years in pharmacy, with the last 15 focused on a problem most healthcare institutions prefer not to discuss: drug diversion by their own staff. She founded RExpert Solutions to help hospitals assess where their diversion vulnerabilities actually are and build programs that close them. She hosts the Drug Diversion Insights Podcast. She knows what the automated dispensing machines catch, what they miss, and what happens to patients when a clinician replaces fentanyl with saline.

    In this conversation with Dr. John Hsu and William Pedranti, Terri walks through the mechanics of diversion at the point of care, the accountability frameworks that protect patients without destroying careers, and why the home monitoring environment remains a blind spot no current system addresses.

    Chapters:
    [[00:00]] Introduction and Terri’s background
    [[10:46]] What happens when the vial has been tampered
    [[15:41]] The home monitoring black hole: no visibility after the cabinet
    [[19:00]] Diversion rates among healthcare professionals: 10 to 20 percent
    [[25:00]] Accountability vs. compassion: remove from bedside, investigate fully
    [[32:00]] The false accusation: when reporting gets used as a weapon
    [[38:00]] MOUD access and the 75% who cannot get medication
    [[43:44]] What Terri would mandate at every hospital in the country
    [[49:11]] Closing

    Connect with Terri Vidals:
    LinkedIn: https://www.linkedin.com/in/terri-vidals

    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.
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    51 min
  • What the UK Got Right About Addiction | The Saving Dose Ep. 14 Ft. Mark Gilman

    What the UK Got Right About Addiction | The Saving Dose Ep. 14 Ft. Mark Gilman
    Oct 6 2026
    Mark Gilman has worked inside the opioid crisis from every angle for more than 40 years: as a researcher, a policy architect, a commissioner, a clinician, and a patient. He designed the Through the Gate program for NHS England, which put medication-assisted treatment inside prisons and continued it through release. He helped build the harm reduction infrastructure that prevented the UK's HIV response from becoming a second catastrophe. He started self-medicating at 12 after his father's death, spent years navigating addiction before going to university, and built a career dedicated to fixing the systems that had failed him.In this conversation with Dr. John Hsu, Mark makes the case that the United States already has the evidence it needs. The question is whether it will use it.What they cover:The UK's 1981 brown powder heroin epidemic and why unemployment, displacement, and loss of identity drove addiction rates more than drug availabilityWhy policing a drug market is like standing on a balloon: push it down in one place, it pops up somewhere else, because the markets are demand-ledHow harm reduction began as a peer-led self-help movement with no government support and became national policy when Margaret Thatcher's government decided HIV was a greater threat than drug misuseThe abstinence-without-medication success rate: 2 to 7 percentWhy people are 129 times more likely to die in the two weeks after prison release in the US, and 25 times more likely in the UK, and what the Through the Gate program does to close that windowThe Retox concept: stabilizing people on MOUD inside prison so medication continues seamlessly from the prison gate into the communityHeroin-assisted therapy and the Basel model: patients in Switzerland can choose between injectable diamorphine, a nasal spray, or a 200mg tablet, and early observations show a shift toward the tablet because what people actually want is jobs, homes, and friendsThe subset of patients, less than 10%, with severe trauma histories for whom buprenorphine doesn't work because greater cognitive clarity brings the trauma backStigma inside the recovery community itself, including 12-step fundamentalists who tell people taking ADHD medication that they've relapsed, and why Mark argues that internal cultural stigma causes more damage than state stigmaVietnam veterans: 25% of soldiers became heroin addicts during the war; 85 to 90% simply stopped when they came home to jobs, homes, and a sense of purposeThe biopsychosocial model and the case for adding a fourth dimension: spiritual, meaning a sense of meaning and purpose, not religion specificallyChapters:[00:00] Introduction and Mark's background[01:01] Self-medicating at 12 after his father's death[01:42] University, two degrees, and entering the field[02:09] The six elements of OUD: research, policy, practice, commissioning, providers, and patient[03:22] The UK's 1981 brown powder heroin epidemic[05:26] Pain, unemployment, and displacement as the drivers of addiction[06:48] Why policing drug markets is like standing on a balloon[08:52] Harm reduction as a peer-led self-help movement[10:07] How Thatcher's Conservative government pragmatically backed harm reduction[13:36] Recovery requires more than medication: jobs, friends, and houses[15:30] The abstinence-without-medication success rate: 2 to 7%[17:59] The history of diamorphine prescribing in the UK since 1926[19:59] Buprenorphine and the subset it doesn't serve[21:11] Heroin-assisted therapy and the Basel model[23:05] Stigma from OUD's history as a moral or criminal failing[24:31] NIMBY: why clinics end up on the wrong side of town[25:02] Stigma inside recovery communities: ADHD medication and 12-step fundamentalism[27:01] Four decades of the US opioid epidemic and the case for looking outward[28:43] Prison, recidivism, and the 75% three-month return rate[31:22] The two-week death window after prison release: 25x in the UK, 129x in the US[32:32] Through the Gate: seamless handover at the prison gate[33:04] The two pathways in prison: abstinence-based or MOUD stabilization[36:01] Why short sentences create a revolving door of detoxification and death[39:08] The growing crisis of meaning and ketamine among young people[40:00] Vietnam veterans: most stopped using when they came home to a life[42:27] Dignity, the diversion concern, and the Basel diamorphine tablet options[46:21] The final question: what would you change from your early career?[47:27] The biopsychosocial model and the case for a fourth dimension: spiritual[48:15] John's patient who found meaning in a peer support group at a church[49:51] ClosingConnect with Mark Gilman:LinkedIn: https://www.linkedin.com/in/mark-gilman-0597012b/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, ...
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    52 min
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