>> WELCOME TO ANOTHER SESSION OF
THE 23RD YEAR OF A COURSE CALLED
DEMYSTIFYING MEDICINE.
I'M WIN ARIAS, A SENIOR
SCIENTIST EMERITUS, AND WE ARE
PRESENTING THIS FROM THE
NATIONATIONAL INSTITUTES OF HEAN
BETHESDA, MARYLAND.
THE PURPOSE OF THIS COURSE FROM
ITS VERY BEGINNING WAS TO BRIDGE
THE EXCITING DEVELOPMENTS IN
BIOLOGICAL, ENGINEERING, AND
COMPUTER SCIENCES WITH MEDICINE
AND PUBLIC HEALTH.
IT IS REALLY A COURSE IN BRIDGE
BUILDING.
THE INTENT IS TO EXCITE OUR VERY
HETEROGENEOUS AUDIENCE INTO
OPPORTUNITIES FOR NEW IDEAS AND
RESEARCH IN ADVANCING MAJOR
PROBLEMS IN THE BASIC SCIENCE
AND PARTICULARLY IN ITS LINKS TO
HUMAN DISEASE.
SO THE COURSE IS HELD ON
TUESDAYS FROM 4:00 TO 6:00 P.M.
FROM JANUARY TO MAY.
YOU CAN WATCH IT ON THE
VIDEOCAST LINK SHOWN ON THIS
SLIDE.
FOR THOSE WHO WISH CME CREDIT,
TODAY THE CODE IS 52101.
AND MOST IMPORTANTLY, WE URGE
YOU NO MATTER WHERE YOU ARE TO
SUBMIT QUESTIONS DURING THE
PRESENTATIONS TODAY, AND YOU DO
THAT BY CLICKING ON YOUR "SEND
LIVE FEEDBACK" ON YOUR VIDEOCAST
DISPLAY.
THE SPEAKERS WILL TALK FIRST,
AND THEN WE WILL HAVE AN
EXTENSIVE Q & A AND DISCUSSION
IN WHICH YOUR QUESTIONS AND
OTHERS WILL OCCUPY THE REST OF
OUR TIME UNTIL 6:00 P.M.
I CALL TO YOUR ATTENTION THAT
ALL PREVIOUS SESSIONS FROM THE
VERY BEGINNING ARE ARCHIVED AND
ARE ACCESSIBLE IN THE LINK SHOWN
ON THIS SLIDE.
IT'S THE
VIDEOCAST.NIH.GOV/PASTEVENTS, ET
CETERA.
IF YOU HAVE ANY ADDITIONAL
INFORMATION, YOU CAN CONTACT US,
WE'LL BE DELIGHTED TO RESPOND.
NOW THERE ARE TWO SYMBOLS OF
THIS COURSE, THE ONE ON THE
LOWER RIGHT ON THIS SLIDE IS A
SILO.
AND IN A WAY, THAT REPRESENTS
THE EXTENSIVE INFORMATION THAT
IS KNOWN, BUT UNFORTUNATELY IN
DIFFERENT HEADS.
SO THE PURPOSE OF THIS COURSE IS
TO BE MORE LIKE THE UPPER IMAGE,
WHICH IS THE BROOKLYN BRIDGE.
AND TO BRIDGE DISCIPLINES THAT
VERY OFTEN DON'T COMMUNICATE
WITH ONE ANOTHER ABOUT THESE
MAJOR ISSUES THAT ARE THE
SUBJECT OF THE OVERALL COURSE.
AND AS ALWAYS, WE ARE LIKE THE
TWO INDIVIDUALS ON THE CATWALK
HERE OF THE BROOKLYN BRIDGE.
REPRESENTING TWO DIFFERENT
ASPECTS OF A MAJOR HEALTH AND
SCIENCE PROBLEM.
VERY FREQUENTLY, WE BEGIN BY
HAVING A LIVE PATIENT DESCRIBE
THEIR ILLNESS, AND THEN A
FURTHER DISCUSSION AND
PRESENTATION BY TWO SPEAKERS.
THE CME CODE CREDIT IS 52101 AND
THE TEXT CODE IS 844-980-1555.
THERE ARE NO DISCLOSURES BY OUR
SPEAKERS.
NOW, THINK FOR A MOMENT.
HAVE YOU EVER HEARD OF THE
FOLLOWING, AND YOU CAN READ THAT
LONG LIST OF SOMEWHAT EXOTIC
NAMES.
IF YOU ARE, YOU ARE FAMILIAR
WITH THE STREET NAMES FOR
FENTANYL.
WHICH IS PRESENTING AND HAS
PRESENTED FOR SOME TIME NOW A
MAJOR CHALLENGE IN TERMS OF DRUG
ADDICTION, SUICIDE, AND EVER
SEEMINGLY INCREASING EPIDEMIC,
AND MAY -- I'M NOT SURE ABOUT
THIS, ACTUALLY BE A PANDEMIC.
AND THESE ARE THE NAMES THAT ARE
USED IN THE STREET TO SELL
FENTANYL, OFTEN TO PEOPLE WHO
MAY NOT EVEN SUSPECT THAT
THEY'RE GETTING IT.
I'M SURE WE'LL HEAR ABOUT THAT
IN TODAY'S DISCUSSION.
SO I WONDER ABOUT THINGS LIKE IS
THERE ONLY ONE FENTANYL?
ARE THERE MORE DANGEROUS
DERIVATIVES?
AND ARE THERE EVEN MORE THAT CAN
BE MADE?
AND HOW IS FENTANYL HIGHLY
ADDICTIVE?
I WONDER, SHOULD IT EVER BE
PRESCRIBED -- IT IS FOR PAIN,
AND I BELIEVE IT IS APPROVED BY
THE FDA.
CAN ONE BE TAKING FENTANYL
WITHOUT EVEN KNOWING IT?
AND HAS FENTANYL REPLACED HEROIN
IN ADDICTION?
THERE ARE MANY, MANY QUESTIONS
OF THIS TYPE, AND THESE ARE JUST
THE FEW THAT POPPED IN MY MIND,
AND MORE RELATED TO THE
DISCUSSIONS TODAY ARE THE TWO AT
THE BOTTOM OF THIS SLIDE.
HOW IS THE FENTANYL EPIDEMIC
BEING CONFRONTED BY PUBLIC
HEALTH AND BY RESEARCH LEADERS?
AND MOST IMPORTANTLY, HOW DOES
ONE RECOVER FROM ADDICTION IF IT
IS A BRAIN DISEASE?
TODAY'S SPEAKERS HAVE
EXTRAORDINARY EXPERIENCE IN BOTH
OF THESE TWO AREAS.
OUR FIRST SPEAKER IS NORA
VOLKOW, WHO RECEIVED HER
MEDICAL DEGREE FROM THE NATIONAL
UNIVERSITY OF MEXICO, A
PSYCHIATRIC RESIDENCY AT
NEW YORK UNIVERSITY, AND THEN
SPENT A LONG AND PRODUCTIVE
CAREER AT THE BROOKHAVEN
NATIONAL LABORATORY, WHERE SHE
WAS THE DIRECTOR OF NUCLEAR
MEDICINE AND CHAIRMAN OF
MEDICINE, AND ALSO A PROFESSOR
OF PSYCHIATRY AND ASSOCIATE DEAN
AT THE STATE UNIVERSITY OF
NEW YORK MEDICAL SCHOOL AT STONY
BROOK.
AND IT WAS DURING THIS TIME THAT
SHE BEGAN TO APPLY AND EXTEND
THE USE OF SOPHISTICATED BRAIN
IMAGING TO STUDY MORE OF THE
BASIC ASPECTS OF WHAT ADDICTION
IS AND HOW IT OCCURS.
AND IN 2003, SHE BECAME DIRECTOR
OF THE NATIONAL INSTITUTE ON
DRUG ABUSE, NIDA.
NIDA IS THE LARGEST, I BELIEVE,
GLOBAL FUNDER OF RESEARCH,
DEALING WITH DRUG ADDICTION AND
USE.
HER CAREER IS BASED TO A GREAT
EXTENT UPON THE APPLICATION OF
BRAIN IMAGING, AND THE
DEFINITION OF DRUG ADDICTION AS
A BRAIN DISORDER AND NOT SOME
FLAW IN INDIVIDUALS' CHARACTERS.
FOR HER OUTSTANDING WORK, SHE'S
RECEIVED INNURABLE AWARDS AND
PRIZES, ONE FOR OUTSTANDING
GOVERNMENT SERVICE.
SHE'S A MEMBER OF THE NATIONAL
ACADEMY OF MEDICINE, ASSOCIATION
OF AMERICAN PHYSICIANS, THE
FRENCH INSTITUTE OF HEALTH AND
MANY OTHERS.
I NOTE THAT ACTUALLY MANY OF OUR
LEADING MAGAZINES HAVE
IDENTIFIED NORA WITH LEADERSHIP
BEING SAID TO BE AMONG THE TOP
HUNDRED PEOPLE WHO SHAPED OUR
WORLD, THE 100 MOST POWERFUL
WOMEN, AND LEADERS WHO'VE
CHANGED HEALTHCARE.
SHE'S PLAYED A CRITICAL ROLE IN
THE NATION'S RESPONSE TO THE
FENTANYL EPIDEMIC.
AND TODAY, SHE IS GOING TO
DISCUSS FENTANYL AND OTHER DRUG
ADDICTIONS IN TERMS OF THE
CURRENT CHALLENGES AS TO WHAT IS
BEING DONE IN RESEARCH AND ITS
APPLICATION TO HEALTH POLICY.
NOW OTHER SE OUR SECOND SPEAKERS
MEGHANN PERRY.
USUALLY IN THIS COURSE, THE
PATIENT SPEAKS FIRST.
BUT IN THIS CASE, IT SEEMED
APPROPRIATE TO HAVE MEGHANN
FOLLOW.
MEGHANN HAS STRUGGLED WITH
SUBSTANCE ADDICTION, MENTAL
HEALTH CHALLENGES,
INCARCERATION, HOMELESSNESS,
TRAUMA AND LOSS.
IN RESPONSE TO THIS, SHE'S
BECOME THE FOUNDER OF THE
MEGHANN PERRY GROUP, WHICH
CREATES NOVEL LEARNING AND
PERFORMANCE EXPERIENCES THAT
BLEND THEATER, STORYTELLING AND
RECOVERING COACHING, ALL
DESIGNED TO HELP PEOPLE AVOID
AND ESCAPE FROM SUBSTANCE
ADDICTION.
IN LEARNING HOW TO MOVE BEYOND
SURVIVING TO ACTUALLY
PROSPERING, SHE INSPIRES OTHERS
TO OVERCOME THEIR CHALLENGES.
AND WE ARE VERY GRATEFUL TO HER
FOR TAKING PART IN TODAY'S
EVENT.
SO OUR FIRST SPEAKER IS
DR. VOLKOW.
NORA?
>> THANK YOU, WIN, VERY, VERY
MUCH FOR THAT KIND INTRODUCTION,
BUT MORE PORPLY IMPORTANTLY FOG
AN OPPORTUNITY TO PRESENT
MEGHANN AND I SIDE BY SIDE WITH
PERSPECTIVES THAT DO IN A WAY
EXACTLY WHAT YOU'RE SAYING,
BRIDGING UP DIFFERENT WORLDS
THAT ARE NECESSARY TO BRING
TOGETHER IN ORDER TO ADDRESS THE
PROBLEMS THAT WE'RE DEALING
WITH, WHICH IN THIS CASE IS THE
OVERDOSE CRISIS.
AND I ALSO THOUGHT ABOUT IT, I
LOVE THE SLIDES, SO MY
PRESENTATION IS GOING TO FOLLOW
VERY MUCH THAT METAPHOR THAT YOU
HAVE IN THOSE TWO SLIDES, ONE OF
THEM WITH THE SILOS, WHERE ALL
OF THE KNOWLEDGE IS CONTAINED,
BUT YOU ALSO HAVE THE -- BY THE
SIDE AND IF YOU DON'T TAKE
ADVANTAGE OF THAT KNOWLEDGE,
THAT WILL NOT PROLIFERATE THE
WAY IT IS.
SO I THINK THAT IN A WAY, HAVING
GONE THROUGH THE COVID
EXPERIENCE AND THE SENSE THAT
ACTUALLY OF COURSE SCIENCE GIVES
US TOOLS THAT ARE
EXTRAORDINARILY POWERFUL AND CAN
ULTIMATELY ABSOLUTELY HAVE THE
POTENTIAL TO ADDRESS THE PROB
PROBLEMS, THE REALITY IS HOW WE
IMPLEMENT AND PROVIDE THEM IS
FUNDAMENTAL FOR THE LIKELIHOOD
THAT THEY WILL SUCCEED.
THIS IS ALSO VERY TRUE IN THE
CASE OF THE SCIENCE OF ADDICTION
AS IT RELATES TO ADDRESSING THE
OVERDOSE CRISIS.
WE CAN HAVE KNOWLEDGE THAT
PERTAINS DIRECTLY TO SOLUTIONS
THAT ARE VERY ABLE TO CONTROL
AND PREVENT PEOPLE FROM DYING.
BUT IF THESE SOLUTIONS ARE NOT
DEPLOYED AND WE DO NOT ADDRESS
THE CHALLENGES THAT EXIST FOR
THEIR DEPLOYMENT, THEN WE WON'T
ACHIEVE OUR GOALS, WHICH IN THIS
CASE IS, OF COURSE, PROTECT THE
LIVES OF SO MANY PEOPLE THAT ARE
DYING, MANY OF THEM AT A YOUNG
AGE.
AND NONE OF THEM SHOULD HAVE
DIED TO START WITH.
SO IT IS -- IT FORCES US AT NIDA
TO REALIZE THAT WE NEED TO
FIGURE OUT HOW TO USE SCIENCE AS
A STRATEGY TO CHANGE THAT
PARADIGM TO NOT JUST DEVELOP A
SCIENTIFIC SOLUTION AND
UNDERSTAND IT, BUT USE SCIENCE
TO MAXIMIZE BRINGING TO THOSE
THAT NEED IT, AND THAT'S THE
WHOLE WHAT I'M GOING TO BE
FOCUSING ON, HOW WE ARE MOVING
THAT AT NIDA TO TRY TO ADDRESS
THE OVERDOSE CRISIS.
SO LET ME SHARE MY SCREEN, HOLD
ONE MOMENT.
SHARE, SHARE, SHARE, THERE IT
IS, AND I WILL NEED YOU TO TELL
ME IF I'M OKAY OR I'M NOT OKAY.
AND LET ME SEE NOW.
CAN YOU ALL SEE IT?
>> YES.
VERY NICE.
>> OKAY.
THE SCIENCE IN THE WHOLE FIELD
OF WHAT IS IT THAT HAPPENS IN
THE BRAIN OF A PERSON THAT'S
ADDICTED TO THEADZ LEM TO THEIR
ABILITY TO -- THE STRONG URGES
THAT LEADS THEM TO HAVE THESE
STRONG URGES TO START WITH AT
THE EXPENSE OF MANY OTHER
BEHAVIORS, THAT NEGATIVE
EMOTIONAL STATE THAT THEY HAVE
TO STRUGGLE WITH WHEN THEY ARE
NOT UNDER THE EFFECTS OF THE
DRUGS, ALL OF THEM, WE NOW HAVE
UNDERSTANDING ABOUT WHAT ARE THE
NEUROBIOLOGICAL SUBSTRATES
UNDERLYING THOSE CHANGES IN
THEIR EMOTIONS, THEIR BEHAVIORS
AND THEIR PERCEPTIONS AND
CHOICES.
AND I'M NOT GOING TO GO INTO IT
BECAUSE I WANT TO DWELL INTO HOW
CAN WE USE THIS KNOWLEDGE AS I
SAID TO ADVANCE OUR
UNDERSTANDING OF HOW TO ADDRESS
THE CRISIS.
WHAT I DO WANT TO SAY JUST
ACTUALLY BECAUSE I DO THINK IT
IS IMPORTANT IS THAT AT THE
BEGINNING WHEN RESEARCHERS WERE
TRYING TO INVESTIGATE WHY IS IT
THAT DRUGS PRODUCE ADDICTION, IT
WAS WELL RECOGNIZED THAT THE
ABILITY OF DRUGS TO INCREASE
DOPAMINE TO ACTIVATE DOPE MA
DOPAMINERGIC CIRCUITS WAS WHAT
DROVE THE APPEAL TO START USING
THEM.
IT WAS NOT REALLY UNDERSTOOD HOW
THAT DOPAMINE SYSTEM ULTIMATELY
LED TO THE LOSS OF CONTROL AND
COMPULSIVE PATTERN OF USE.
AND THERE WERE -- CERTAINLY AT
THE BEGINNING IT WAS VERY MUCH
THE HYPOTHESIS THAT THE
PATHOLOGY ON THE BRAIN OF
ADDICTION, OF PEOPLE ADDICTED,
WAS LOCALIZED IN THE REWIRED
BRAIN CENTERS, REWIRED BRAIN
REGIONS.
AND WE HAVE COME TO REALIZE MANY
YEARS LATER, OF COURSE, THAT
FIRST OF ALL, THAT NO SINGLE
FUNCTION IN THE BRAIN IS
LOCALIZED TO ANY ONE BRAIN
REGION.
INHIBITION.
THAT THE WAY THE BRAIN WORKS IS
ACTUALLY BY NETWORKS, BY
CONNECTIVITY.
THOSE BRIDGES THAT WIN WAS SHO
SHOWING, IMAGINE THEM AT THE
MAXIMAL COMPLEXITY.
SO THE BRAIN DOES REQUIRE THIS
CONSTANT COMMUNICATION BETWEEN
REGIONS THAT TEND TO CONFIGURE
IN PATTERNS, AND IN PATTERNS
THAT, FOR EXAMPLE, MAY EMERGE IN
LANGUAGE.
THERE ARE MULTIPLE REGIONS THAT
FORM A LANGUAGE NETWORK.
BUT THOSE REGIONS IN THE
LANGUAGE NETWORK THAT THEN CAN
CONNECT WITH OTHER NETWORKS.
SO THERE IS A DYNAMIC
CONFIGURATION.
AND WE NOW KNOW THAT THIS IS THE
SAME SITUATION WITH ADDICTION,
THAT IT'S NOT ONE BRAIN REGION
AT ALL, BUT THAT THERE ARE SOME
VERY SPECIFIC CRUCIAL NETWORKS
THAT GET INVOLVED AND THAT ARE
MODIFIED BY THE USE OF DRUGS IN
PEOPLE THAT BECOME ADDICTED.
INCLUDING THE REWIRED NETWORKS.
BUT ALSO, FUNDAMENTAL, IN
HELPING US UNDERSTAND MANY
PATTERNS OF ADDICTION, IS THE
NETWORK THAT CONTROLS EXECUTIVE
FUNCTION.
AND THAT HAS AS A CENTRAL HUB
PREFRONTAL REGIONS OF THE BRAIN.
BUT IT IS FUNDAMENTAL, THAT HUB
FOR EXECUTIVE FUNCTION, FOR
ACTUALLY ENABLING US TO --
INCLUDING INHIBITORY CONTROL
WHEN WE WANT TO DO SOMETHING,
BUT IT'S ALSO THE AREA, THE
CENTER, THE NETWORK THAT ALLOWS
US TO DO JUDGMENTS, DECISIONS,
CARRYING THEM THROUGH, AND IT'S
ALSO THE NETWORK THAT IS
INVOLVED IN ASSIGNING VALUE TO
ACTIONS, AND IN THAT PROCESS,
BASICALLY LINKS WITH OUR REWARD
SYSTEMS.
AND ALSO THE OTHER THIRD VERY
IMPORTANT NETWORK IS THAT ONE
THAT IS HERE IN RED, WHICH IS
THE NETWORK THAT IS INVOLVED IN
EMOTIONS BUT ALSO THAT IS
RESPONSIBLE FOR MAKING US FEEL
LOUSY AND IRRITABLE AND ANXIOUS,
AND THAT NETWORK IS ANTITHETICAL
TO ANYTHING THAT ONE WOULD THINK
OF POSITIVE IS CRUCIAL FOR
SURVIVAL.
IT'S A NETWORK THAT'S ACTIVATED,
FOR EXAMPLE, BY PAIN, AND PAIN,
OF COURSE, IS A VERY IMPORTANT
PHYSIOLOGICAL -- IT EXISTS FOR A
VERY IMPORTANT PHYSIOLOGICAL
REASON.
SO OUR UNDERSTANDING, JUST
SUFFICE IT TO SAY, IS THAT
ADDICTION, THE PERSONS THAT ARE
ADDICTED, HAVE DISRUPTIONS IN
MULTIPLE NETWORKS AND THREE KEY
NETWORKS THAT ACTUALLY ARE
CRUCIAL FOR EVERYDAY LIFE, AND
EXTREMELY IMPORTANT FOR SOCIAL
INTERACTIONS.
AND THROUGH THAT DELINEATION OF
THOSE CHANGES AND OUR
UNDERSTANDING OF HOW THOSE
CHANGES TRANSLATES IN CHANGES IN
BEHAVIORS AND SYMPTOMS, WE HAVE
COME TO CONCEPTUALIZE AS WIN WAS
MENTIONING OF ADDICTION AS A
DISEASE OF THE BRAIN.
AND WE'VE ALSO CONCEPTUALIZED IT
AS A CHRONIC DISEASE, A
RELAPSING DISEASE.
IT'S CHRONIC BECAUSE THERE ARE
CHANGES IN THE BRAIN IN THESE
NETWORKS ARE LONG LASTING, AND
THEY WILL NOT DISAPPEAR ONCE A
PERSON STOPS TAKING THE DRUG.
AND THIS IS CLINICALLY RELEVANT
BECAUSE IT MEANS THAT THE PERSON
THAT GOES INTO TREATMENT WILL
HAVE TO STAY IN TREATMENT FOR A
LONG PERIOD OF TIME.
BUT THIS IS NOT DIFFERENT FROM
THE WAY THAT WE DEAL IN THE
HEALTHCARE SYSTEM OF OTHER
CHRONIC CONDITIONS.
SO IF YOU'RE DIAGNOSED WITH
CANCER, YOU GO TO TREATMENT, AND
THAT WILL REQUIRE THAT YOU HAVE
A LONG FOLLOW-UP.
AND WITH TIME, AS YOU
ACTUALLY -- THERE IS A REDUCTION
IN THE PROBABILITY THAT THE
TUMOR MAY RETURN, YOU CAN
ACTUALLY MAKE THOSE
INTERVENTIONS LESS INTENSE.
THE SAME THING WITH ADDICTION.
AS A PERSON STARTS TO
RESTRUCTURE THEIR LIVES, THE
RISK OF RELAPSE BECOMES LESS
FREQUENT.
AND THERE IS A POINT AND A LEVEL
WHEN THEY RESTRUCTURE THEIR LIFE
THAT ONE BASICALLY -- THEY MAY
STILL BE AT THE CERTAIN
VULNERABILITY, BUT THE INTENSITY
OF THE NEED FOR TREATMENT GOES
DOWN.
SO WHAT IT HAS, IT HAS
DEFINITELY LED TO THE CONCEPT OF
ADDICTION AS A DISEASE OF THE
BRAIN, BUT WE ENCOUNTER A LOT OF
CONTROVERSY ON THIS AND A LOT OF
PEOPLE HAVE BEEN VERY, VERY
ANGRY WITH IT, BECAUSE THEY SAY
BY IMPLICATING ADDICTION AS A
DISEASE OF THE BRAIN, YOU ARE
REMOVING OFF ALL OF THE
EXTREMELY IMPORTANT SOCIAL,
ENVIRONMENTAL, CULTURAL,
ECONOMIC ASPECTS THAT LIE BEHIND
IT.
AND THEY ARE THE ONES THAT ARE
DRIVING THE ADDICTION.
AND IT'S ABSOLUTELY CORRECT.
THE ENVIRONMENT IS FUNDAMENTAL
AND YOU SEE THAT SORT OF
MULTIPLE FACTOR COMPONENT THAT
DETERMINES ADDICTION.
ENVIRONMENTS ARE CRUCIAL AND
FUNDAMENTAL.
BUT IT DOESN'T NEGATE THAT THE
ENVIRONMENT, THE FACT THAT THE
ENVIRONMENTS PLAY SUCH AN
IMPORTANT CONSEQUENTIAL ROLE IN
DRUG-TAKING AND IN THE RISK OF
ADDICTION THAT IT'S NOT
PRODUCING A DISEASE.
AND I THINK THIS IS VERY CLEAR
BUT WE DON'T QUESTION IT WHEN IT
COMES TO SOMETHING LIKE
DIABETES.
WHERE YOU CAN ACTUALLY SAY,
CERTAINLY ENVIRONMENTS AND
BEHAVIORS AND THE BEHAVIORS THAT
ARE DRIVEN BY WHAT YOU HAVE IN
YOUR ENVIRONMENT TO EAT OR NOT
TO EAT ACTUALLY ARE GOING TO BE
MAKING YOU VULNERABLE TO
DIABETES.
AND YET NO ONE WILL QUESTION
DIABETES AS A DISEASE.
SO IN THAT RESPECT, DRUG
ADDICTION DOES HAVE AN
EXTRAORDINARILY IMPORTANT
COMPONENT FROM THE ENVIRONMENT.
UNLIKE OTHER DISEASES AND
CONDITIONS, INCLUDING DIABETES,
THERE ARE ALSO EXTREMELY
IMPORTANT FACTORS THAT RELATE TO
GENETICS AND, TOO, BUT PERHAPS
TO EVEN A GREATER EXTENT IN
ADDICTION THAN FOR OTHER
CONDITIONS, THAT DEVELOPMENTAL
BIOLOGICAL PROCESS BY WHICH OUR
BRAIN GOES FROM FETAL
DEVELOPMENT INTO ADULTHOOD.
AND THAT PROCESS WHICH FOR THE
BRAIN TAKES A LONG PERIOD OF
TIME, MORE THAN TWO DECADES,
ACTUALLY MAKES THE WHOLE PROCESS
OF EXPOSURE TO DRUGS AND
VULNERABILITY PERIODS EXTREMELY
IMPORTANT.
IN TERMS OF IDENTIFYING PERIODS
WHERE THE BRAIN WILL BE VERY
SENSITIVE TO EFFECTS OF AN
ADVERSE ENVIRONMENT, AND ALSO
VERY SENSITIVE TO THE EFFECTS OF
DRUGS.
PRODUCING MUCH FASTER CHANGES
THAT CAN THEN MAKE THAT PERSON
GO MUCH MORE EASILY INTO
ESCALATING DRUG-TAKING AND IN
THE CHANGES IN THE NETWORKS THAT
I WAS JUST DESCRIBING THAT
ULTIMATELY PRODUCE THE ADDICTION
PHENOTYPE.
WHICH IS AT THAT STATE IN WHICH
THE INDIVIDUAL, DESPITE HIM OR
HER COGNITIVELY AND CONSCIOUSLY
NOT WANTING TO TAKE DRUGS
ANYMORE, IT'S BY THEIR REALIZING
THAT EVEN IF THEY STOP TAKING
DRUGS, THEY MAY LOSE THEIR
LIVES.
THEY CANNOT STOP IT.
AND THAT IS VERY DIFFICULT TO
UNDERSTAND FROM SOMEONE THAT HAS
NOT HAD A SIMILAR EXPERIENCE.
BUT IT IS ACTUALLY AKIN TO
DISRUPTION ON THE BASIC
FUNDAMENTAL CAPACITY THAT WE
HAVE TO ACTUALLY CONTROL OUR
DECISIONS, MOTIVATIONS AND
ACTIONS.
SO THAT IS -- VERY MUCH DAMAGE
BY USE OF DRUGS.
I PUT IT LIKE THIS BECAUSE AN
IMPORTANT QUESTION -- AND IT
RELATES TO THE QUESTION OF WIN
THAT HE WAS SAYING, SHOULD WE NO
LONGER PRESCRIBE FENTANYL
BECAUSE IT'S A VERY POTENT
ANALGESIC, IT'S ALSO A
MEDICATION USED EXTENSIVELY FOR
ANESTHESIA, AND IT HAS VERY GOOD
PHARMACOLOGICAL PROPERTIES.
SO IN -- USED OUTSIDE THE
CONTEXT, IT CAN DEFINITELY HAVE
HIGHLY ADDICTIVE EFFECTS.
SO IS THE ASPECT OF ALSO, TOO,
NOT EVERYBODY THAT GETS EXPOSED
TO THESE DRUGS BECOMES ADDICTED,
AND THESE OCCUR TYPICALLY WITH
PEOPLE THAT CAN DRINK SOCIALLY
FOR DECADES AND NEVER BECOME
ALCOHOLICS.
OR IF YOU HAVE SIMILARLY PEOPLE
THAT CAN BE BINGING COCAINE ON A
WEEKLY BASIS AND NEVER BECOME --
THEY NEVER DEVELOP A COCAINE USE
DISORDER.
SO THERE ARE DIFFERENCES IN
VULNERABILITY, AND THAT ASPECT
OF THE DIFFERENCES IN
VULNERABILITY, THAT RESEARCH HAS
BEEN GOING ON IN TERMS OF
UNDERSTANDING WHICH GENES
INCREASE THE RISK FOR ADDICTION,
BECAUSE WE KNOW ADDICTION RUNS
IN FAMILIES, AND WHY DO THEY DO
THAT?
AND THAT, OF COURSE, IS AN
EXTREMELY IMPORTANT AREA OF
RESEARCH THAT HELPS US
PARTICULARLY IN THE DEVELOPMENT
OF COMPLETELY NOVEL
THERAPEUTICS.
SO WITHIN THIS BACKGROUND OF
RECOGNIZING THAT WE HAVE TO
UNDERSTAND ADDICTION IN ITS
COMPLEXITY AND HOW IMPORTANT THE
ENVIRONMENT IS, AND AS WELL AS
RECOGNIZING THE IMPORTANCE OF
GENETICS, WE HAVE TO SEE HOW
THIS KNOWLEDGE CAN BE USED AND
EMPLOYED IN MY BRAIN OVERALL TO
ADDRESS ADDICTION BUT RIGHT NOW
EXTREMELY URGENTLY TO ADDRESS
THE EPIDEMIC OF THE OVERDOSE
CRISIS THAT WIN WAS MENTIONING.
LET ME START BY ASKING THE
QUESTION HOW BAD IT IS.
WELL, THIS IS DATA FROM A GRAPH
THAT SHOWS DATA UP TO 2022, BUT
THE LATEST DATA THAT WE HAVE AS
OF OCTOBER 2023 HAS ACTUALLY
SHOWN THAT NUMBERS ARE HIGHER
THAN WHAT YOU SEE THERE.
IT'S MORE THAN 110,000 PEOPLE
THAT DIED IN ONE YEAR, THAT WAS
FOR OCTOBER 2023.
BUT REGARDLESS, IT GIVES YOU AN
IDEA OF THE MAGNITUDE OF THE
PROBLEM THAT WE HAVE IN OUR
HANDS.
THESE DEATHS, AND YOU CAN
OBSERVE THEM IN TERMS OF THE
YEAR AT WHICH THEY ARE
HAPPENING, STARTED MORE THAN TWO
DECADES AGO WHEN THEY WERE
INITIATED BY THE
OVERPRESCRIPTION OF PAIN
MEDICATIONS THAT CONTAIN
OPIOIDS.
THE OXYCONTINS, THE
HYDROCODONES, THE VICODIN.
ALL OF THEM BECAME WILDLY
PRESCRIBED BY PHYSICIANS WHO
BASICALLY BECAME OVERCONFIDENT
AND BASICALLY BELIEVED WHAT WAS
PUBLISHING IN SOME OF THE TOP
JOURNALS AT THE TIME THAT IF YOU
HAVE PAIN, YOU'RE NOT GOING TO
BECOME ADDICTED TO YOUR PAIN
MEDICATIONS, TO YOUR OPIOIDS,
AND THEREFORE OVERPRESCRIBE THEM
EVEN FOR CONDITIONS THAT DID NOT
MERIT IT.
OVERPRESCRIPTION OF THESE
MEDICATIONS FACILITATED THEIR
DIVERSION, BECAUSE OPIOIDS ARE
HIGHLY REWARDING.
AND THEY HAVE A VALUE IN THE
BLACK MARKET.
BUT ALSO IT MADE PEOPLE THAT
WERE USING THEM FOR THEIR PAIN
BECOME ADDICTED.
AND THAT NOTION THAT PAIN
PROTECTION IS NOT CORRECT AND
BASICALLY THIS HAS BASICALLY
BEEN CLARIFIED AS SUCH.
BUT -- AND IT TOOK ACTUALLY MORE
THAN A DECADE FOR REALLY THE
SYSTEM TO REALIZE HOW BAD IT
WAS.
AND I GUESS IT WAS IN 2010 THAT
THEY REALIZED HOW MANY PEOPLE
WERE DYING JUST FROM OVERDOSES
FROM PAIN MEDICATIONS, AND THAT
RESULTED IN GUIDELINES THAT
MODIFIED AND MADE PRESCRIPTION
MUCH SAFER.
THAT HAS ACTUALLY, IN FACT,
HELPED VERY MUCH, AND WE NOW
SEE, FOR EXAMPLE, THAT THE
NUMBER OF DEATHS FROM OPIOID
ANALGESICS WHICH IS IN THIS
CATEGORY, NATURAL AND SIN THEY
TICS IN BLUE, IN SKY BLUE, HAVE
BASICALLY LEVELED OFF.
BUT THIS HAS NOT RESULTED IN A
REDUCTION IN DEATHS.
IN FACT, THE DEATHS HAVE JUST
BEEN ESCALATING AND ESCALATING.
FIRST HEROIN TOOK OFF IN BROWN,
AND THEN HEROIN NOW GOES DOWN.
SO WHEN WE ASK THE QUESTION WHAT
HAS HAPPENED WITH HEROIN, RIGHT
NOW IN MANY PLACES IN THE UNITED
STATES, WHAT IS BEING SOLD AS
HEROIN DOES NOT CONTAIN HEROIN.
IT IS BASICALLY FENTANYL MIXED
WITH OTHER PRODUCTS.
AND YOU CAN SEE THESE, I MEAN,
TREATMENT PROGRAMS THAT ARE
ACTUALLY OBTAINING URINES TO
MONITOR THE USE OF DRUGS IN
THEIR PATIENTS, PATIENTS THAT
COME IN DESCRIBING THEMSELVES AS
HEROIN USE.
, THEIR URINE DOES NOT
CONTAIN HEROIN, IT CONTAINS
FENTANYL, AND IT IS REALLY
FENTANYL WHICH IS THE SYNTHETIC
OPIOID, FENTANYL.
I SPEAK ABOUT FENTANYL BUT IT'S
ALSO SOME OF ITS ANALOGS OR
FENTANYL, ALL OF THEM CONTRIBUTE
TO THESE OVERDOSE MORTALITY.
FENTANYL ITSELF IS THE MOST
FREQUENT, AND IT IS ESTIMATED IN
THE LAST -- LATEST NUMBERS FROM
THE CDC THAT 67% OF ALL OVERDOSE
DEATHS IN 2023, 67%, WERE FROM
FENTANYL.
BY ITSELF OR IN COMBINATION WITH
OTHER DRUGS.
AND THESE ALSO EXPLAINS WHY
WE'RE SEEING THESE VERY
SIGNIFICANT RISE IN OVERDOSES
FROM METHAMPHETAMINE, AND FROM
COCAINE.
YES, COCAINE AND METHAMPHETAMINE
IN THE UNITED STATES HAS
INCREASED BUT THE MAG TE MAGNITF
INCREASE OR THE NUMBER OF PEOPLE
USING THIS DRUG HAS NOT
INCREASED AT THE SAME PROPORTION
THAT WE'RE SEEING THE MORTALITY.
WHAT HAS HAPPENED IS THAT THE
DEALERS RECOGNIZING HOW MUCH
PROFIT THEY CAN GET FROM SELLING
FENTANYL AS OPPOSED TO, FOR
EXAMPLE, SPECIFICALLY SELLING
COCAINE, THAT REQUIRES
CULTIVATION AND BRINGING UP
THESE BIG VOLUMES OF COCAINE
THROUGH THE BORDER, CAN BE
DILUTED BY ADDING FENTANYL, AND
YOU STILL HAVE A VERY POTENT
PRODUCT THAT THE PERSON WILL BE
VERY REWARDING AND ADDICTIVE.
METHAMPHETAMINE, WHICH IS A
SYNTHETIC DRUG, IT'S EASIER TO
MANUFACTURE, YOU DON'T NEED ALL
THE PROCEDURES AND COMPLEXITY OF
COCAINE, BUT NONETHELESS, IT'S
ACTUALLY INCREASINGLY BEING
MIXED WITH FENTANYL.
AND WE NOW KNOW THAT OF THE
DEATHS OF COCAINE, MORE THAN 75%
CONTAIN FENTANYL AND
METHAMPHETAMINE, MORE THAN 65%
CONTAIN FENTANYL.
THIS IS THE REALITY WHERE WE
FIND OURSELVES.
FENTANYL AT THE CENTER OF THE
OVERDOSES, BUT MORE AND MORE
PEOPLE ARE DYING WITH DRUG
COMBINATIONS.
AND TO YOUR QUESTION, WIN, ARE
THERE PEOPLE THAT ARE DYING
WITHOUT KNOWING THEY ARE
CONSUMING FENTANYL?
ABSOLUTELY.
AND THIS IS PARTICULARLY
PROBLEMATIC, FOR EXAMPLE, FOR
PEOPLE THAT HAVE COCAINE
ADDICTION OR METHAMPHETAMINE
ADDICTION BY A PRODUCT THAT
CONTAINS FENTANYL BECAUSE THEY
HAVE NO TOLERANCE.
SO THEY ARE EVEN MORE VULNERABLE
TO THE RESPIRATORY DEPRESSANT
EFFECTS OF FENTANYL THAN SOMEONE
THAT HAS OPIOID ADDICTION.
SO THESE ARE THE ACTUAL NUMBERS
FOR 2023, OCTOBER 23, AND THIS
IS 110,000, AND IT JUST -- WHAT
IS DIFFERENT FROM THE OTHER
SLIDES IS ONE YEAR MORE UP TO
DATE, BUT IMPORTANTLY, IT TELLS
YOU THAT COMPARISON FROM THE
YEAR BEFORE.
AND SO OVERALL, THERE'S BEEN A
1.1% INCREASE.
IT'S NOT A LARGE INCREASE, BUT
WE'VE BEEN STRUGGLING AND AT
EXTREMELY HIGH LEVELS OF
MORTALITY AND WE HAVE NOT BEEN
ABLE TO BRING THESE NUMBERS DOWN
OVERALL.
SOME OF THE CAUSES OF DEATHS ARE
GOING DOWN.
31% REDUCTION IN HEROIN FROM THE
YEAR BEFORE.
14% ON PRESCRIPTION OPIOID
MEDICATIONS.
METHADONE ALSO SHOWS -- I MEAN,
METHADONE DOES NOT SHOW A
DECREASE BUT IT BASICALLY IS A
ZERO NET GAIN.
IT'S VERY, VERY LOW, THE
CONTRIBUTION OF METHADONE TO
OVERDOSES.
FENTANYL, COCAINE,
METHAMPHETAMINE, THOSE CONTINUE
TO RISE AND THAT'S ACTUALLY ONE
OF THE ISSUES AND CHALLENGES
WHEN I SAY, OKAY, HOW DO WE
TACKLE THAT PROBLEM?
BECAUSE IT IS TELLING US
SOMETHING -- WHAT IT'S TELLING
US, IF ALL OF THE INTERVENTIONS
THAT WE'RE DOING ACROSS MANY
AGENCIES OBVIOUSLY HAVE BEEN
INSUFFICIENT.
AND IN MY BRAIN, THAT'S WHAT WE
DO DAY TO ON, DO SCIENCE FOR, TO
TRY TO UNDERSTAND AND IDENTIFY
WHERE THE INSUFFICIENT ISSUES
ARE, WHERE ARE THE GAP AREAS AND
HOW TO ADDRESS THEM.
SPECIFICALLY, YES, WE'RE SEEING
MORE AND MORE DRUG COMBINATIONS.
AT THE ESSENCE, THERE IS
FENTANYL.
AND WE DO HAVE MEDICATIONS THAT
ARE VERY EFFECTIVE FOR
ADDRESSING OPIOID ADDICTION, AND
FOR PREVENTING PEOPLE FROM
OVERDOSING, AND WE HAVE
MEDICATIONS THAT ARE VERY
EFFECTIVE IN REVERSING AN
OVERDOSE FROM OPIOIDS, PROVIDED
YOU ADMINISTER THE DRUG RAPIDLY.
THESE ARE METHADONE,
BUPRENORPHINE, AND NALTREXONE
FOR TREATMENT OF OPIOID USE
DISORDERS, AND IF A PERSON IS
TREATED ON SUSTAINING TREATMENT,
YOU CAN DRAMATICALLY REDUCE
THEIR RISK OF OVERDOSES.
IN THE CASE OF NALOXONE, THIS IS
AN OPIOID -- AN OVERDOSE
REVERSAL MEDICATION THAT IF YOU
ADMINISTER IT RAPIDLY AND
PROMPTLY AT THE CORRECT DOSE,
YOU WILL SAVE THE PERSON.
EVEN IF THEY OVERDOSED WITH
FENTANYL, EVEN IF THEY OVERDOSED
WITH CA CARFENTANYL WHICH IS AN
EVEN MORE POTENT SYNTHETIC THAN
FENTANYL.
THE TRICK IS TO ADMINISTER IT AS
SOON AS POSSIBLE, AND AT THE
CORRECT DOSES.
AND AGAIN, TO MONITOR THE
PATIENT SO IF THEY -- YOU CAN
GIVE THE NALOXONE AGAIN.
HOW EFFECTIVE OF ALL THE
INTERVENTIONS WE HAVE, WHICH MAY
NOT BE MANY BUT THEY ARE VERY
EFFECTIVE, SO WE CAN WORK WITH
THAT.
WE CAN WORK WITH THAT SORT OF
CLEARLY IN DISCUSSING THE
STRATEGY OF OUR GOVERNMENT TO
BASICALLY EXPAND AS MUCH AS
POSSIBLE ACCESS TO MEDICATIONS
FOR OPIOID USE DISORDER AND
EXPAND ACCESS TO THE REVERSAL
DRUG NALOXONE.
AND NOW THERE'S ANOTHER ONE,
NALTREXONE, THAT CAN BE ALSO
USED FOR REVERSING OVERDOSES.
SO THIS IS THE FIGURE THAT WAS
PUBLISHED IN 2022 THAT
ILLUSTRATES VERY NICELY WHY
MEDICATIONS FOR OPIOID USE
DISORDER ARE SO IMPORTANT TO
ADDRESS THE CRISIS.
WHAT THIS FIGURE IS TELLING US
IS THAT REDUCTION, THE PERCENT
REDUCTION IN OVERDOSES, IN THIS
CASE THE STUDY WAS DONE IN
PREGNANT WOMEN THAT HAD AN
OPIOID USE DISORDER.
AND THEY WERE MEASURING THE
REDUCTION VERSUS THOSE THAT WERE
NOT IN TREATMENT, AND ON
BUPRENORPHINE AND THEY
BASICALLY -- THESE WERE
OVERDOSES THAT WERE NON-FATAL.
AND WHAT THEY SHOW IS THAT EVEN
IF THEY WERE ONLY COVERED FOR 10
WEEKS, THAT ACTUALLY
SIGNIFICANTLY REDUCED THEIR
LIKELIHOOD OF OVERDOSING DURING
THAT PERIOD.
BUT IF THEY TOOK IT OVER THE --
YOU HAVE TO GIVE THE PERSON THE
MEDICATION AND THE PERSON HAS TO
STAY ON THE MEDICATION.
SO WHAT IS OUR REALITY AS A
COUNTRY, AS WE ALL RECOGNIZE
THIS IS PROBABLY THE MOST
POWERFUL INTERVENTION THAT WE
HAVE FOR PREVENTING PEOPLE FROM
OVERDOSES THAT HAVE AN OPIOID
USE DISORDER, THAT WE REFER TO
AS OPIOID ADDICTION, OPIOID
DISORDER.
WHAT'S VERY TRAGIC, THIS IS DATA
RECENTLY PUBLISHED BUT FROM
INFORMATION THAT WENT UP TO
2021, AND FROM ESTIMATES, MORE
CURRENT ONES, THIS HAS NOT
CHANGED VERY MUCH.
FOR PEOPLE TO HAVE AN OPIOID USE
DISORDER, THAT IS TO SAY, AND
IT'S ESTIMATED AT 2.5 MILLION,
THIS IS NOT NOT A VERY PRECISE
AND ACCURATE NUMBER.
MANY FEEL THAT THIS IS AN
UNDERESTIMATION AND WE BELIEVE
THAT IT IS AN UNDERESTIMATION,
BUT LET'S BE CONSERVATIVE AND
SAY THAT, YES, THERE ARE
2.5 MILLION PEOPLE THAT ARE
ADDICTED TO OPIOIDS.
OF THOSE, IT WAS ESTIMATED THAT
ONLY 36% RECEIVED ANY TYPE OF
TREATMENT.
ANY TYPE OF TREATMENT DOES NOT
MEAN QUALITY TREATMENT OR
EVIDENCE-BASED TREATMENT.
ANY TYPE OF TREATMENT.
AND OF THE 2.5 MILLION PEOPLE,
ONLY 22% RECEIVED MEDICATIONS
FOR OPIOID USE DISORDER, WHICH
IS THE RECOMMENDED TREATMENT,
WHICH IS THE EVIDENCE-BASED
INTERVENTION THAT HELPS THE
PERSON, PREVENTS THEM FROM
OVERDOSING BUT ALSO HELPS THEM
IN THE PROCESS OF RECOVERY.
AND DESPITE THIS EFFICACY, YOU
SEE HOW POORLY THE PENETRATION
OF THESE INTERVENTIONS INTO
PEOPLE THAT WOULD BENEFIT FROM
THEM, THAT COULD SAVE THEIR
LIVES.
SO FROM THE PERSPECTIVE OF
SCIENCE, WHAT IS IT THAT WE CAN
DO TO CHANGE THIS LANDSCAPE?
BECAUSE YES, THE MEDICATIONS --
I'D LOVE TO HAVE MORE
MEDICATIONS.
BUT MEANWHILE, THE MEDICATIONS
THAT ARE OUT THERE ARE NOT BEING
DEPLOYED, SO HOW DO WE USE
SCIENCE TO DO THIS?
SO AMIDST THE OVERDOSE CRISIS,
AND WE'RE PRIORITIZING IT
BECAUSE WHEN YOU ARE LOSING ONE
PERSON FROM AN OVERDOSE EVERY
5 MINUTES, EVERY FIVE MINUTES,
YOU DON'T HAVE LUXURY OF TIME.
YOU NEED TO ACTUALLY ADDRESS
INTERVENTIONS THAT ARE GOING TO
CHANGE THINGS NOW TO PROTECT
THEM WHILE IN PARALLEL, OF
COURSE, CONTINUE TO DO SCIENCE
THAT CAN LEAD TO TRANSFORMATIVE
APPROACHES THAT WILL NULLIFY THE
WAY WE DO THINGS INTO THE
FUTURE, BUT RIGHT NOW, PEOPLE
ARE DYING.
SO THIS IS WHERE ONE OF OUR
PRIORITIES IN THE OVERDOSE
CRISIS HAS BEEN TO EXPAND WHAT
WE CALL IMPLEMENTATION RESEARCH.
THE WAY THAT I VIEW THIS ABOUT
IMPLEMENTATION RESEARCH AND THE
WAY IT GOES INTO MY BRAIN IS, WE
CAN BECOME VERY THEORETICAL AND
DESIGN A SORT OF PLAN, WE NEED
TO -- AND THIS IS CLEAR, WE NEED
TO EXPAND.
WHEN PEOPLE WERE LOOKING AT THE
TREATMENT PROGRAMS THAT ARE
CURRENTLY AVAILABLE FOR PEOPLE
WITH ADDICTIONS, THEY CAME BACK
AND THEY SAID, YOU KNOW, WE HAVE
INADEQUADEQUATE TREATMENTS IN OR
COUNTRY.
BUT THE ISSUE TO ME THAT'S VERY
DISTURBING TO ME AND DISTURBS MY
BRAIN IS WHY DO WE AS A
HEALTHCARE COMMUNITY AND
SPEAKING OF PUBLIC HEALTH,
CONCEIVE OF TREATMENTS OUTSIDE
THE HEALTHCARE SYSTEM?
WE DON'T DO THAT FOR ANY OTHER
CONDITIONS, AND I SEE THIS AS
SUCH A HORRIBLE MISSED
OPPORTUNITY.
WHY?
BECAUSE EVEN THOUGH IT MAY NOT
BE AS EXTENSIVE AS WE WOULD WANT
IN CERTAIN AREAS OF THE COUNTRY,
LIKE IN RURAL AREAS, WE KNOW THE
HEALTHCARE STRUCTURE IS QUITE
POWERFUL, AND IF WE CAN
PENETRATE THAT HEALTHCARE
SYSTEM, THEN WE CAN USE IT FOR
THE SCREENING AND TREAT M OF
INDIVIDUALS THAT HAVE AN OPIOID
ADDICTION AND TO MONITOR THAT.
AND WE DON'T NEED TO -- AND IF
IT'S SEVERE ENOUGH OR REQUIRES
SPECIALIZED TREATMENT, THEN WE
SEND THEM TO THE SPECIALIZED
TREATMENT PROGRAM.
BUT WE USE EXACTLY WHAT WE'RE
USING THE REST OF MEDICINE, RELY
ON MODELS THAT EXIST AND BECOME
AVAILABLE AS OUR MAIN WAY OF
ADDRESSING THE PAST NEE VAST NEE
POPULATION.
SO WE HAVE TAKEN ADVANTAGE OF
NIDA'S CLINICAL TRIALS NETWORK,
WHICH IS ACTUALLY 17 NODES
ACROSS THE UNITED STATES THAT
ARE ALSO LIKE THE BRAIN DYNAMIC,
MOVING AND LINKING WITH
PARTNERSHIPS AND DEPENDING ON
THE PROJECTS THAT RUTH BADER
GINSBURG DEPLOYED.
AND WE HAVE PRIORITIZED PROJECTS
THAT ACTUALLY DEVELOP MODELS
THAT DOCUMENT HOW INVOLVEMENT OF
HEALTHCARE ITSELF ON DIFFERENT
SPECIALTIES AND WAYS CAN
SIGNIFICANTLY IMPACT THE ABILITY
TO TREAT PEOPLE WITH OPIOID USE
DISORDER AND HELP THEM ACHIEVE
RECOVERY AND PREVENT THEM FROM
OVERDOSING.
SO THROUGH THAT CLINICAL TRIAL
NETWORKS, FOR EXAMPLE, THEY
CHANGE AND THEY'VE MODIFIED THE
WILLINGNESS OF MANY HEALTHCARE
SYSTEMS TO ACTUALLY NOW NOT JUST
HAVE SPECIAL CLINICIANS IN
ADDICTIONS, BUT ALSO
IMPORTANTLY, ENGAGE SOME OF THE
DEPARTMENTS THAT IN THE PAST
WERE NOT AT ALL ENGAGED IN
TREATMENT OF THESE PATIENTS.
FOR EXAMPLE, ONE OF THE MOST
EXCITING ADVANCEMENTS IN
IMPLEMENTATION HAS BEEN CHANGING
THE WAY THAT EMERGENCY
DEPARTMENTS NOW IN THE COUNTRY
ARE NOW VERY PROACTIVELY
SCREENING AND INITIATING
TREATMENT WITH MEDICATIONS FOR
OPIOID USE DISORDER IN THE
EMERGENCY DEPARTMENT ITSELF.
THE CLINICAL TRIALS NETWORK DID
A STUDY THAT ACTUALLY SHOWED
THAT INDEED, RESULTED IN MUCH
BETTER OUTCOMES.
SIMILARLY, CLINICAL TRIALS
NETWORK IS BASICALLY DOING A
STUDY THAT HAS SHOWN THAT
PRIMARY CARE PHYSICIANS AND
SCREENING FOR OPIOID USE
TREATMENT RESULTS IN SIMILAR --
OBTAINED BY SPECIALIZED CENTERS.
WITH OTHER INFECTIONS AND
DISEASES WHICH FOR WHICH PEOPLE
WITH OPIOID USE DISORDER ARE --
ALSO SIGNIFICANTLY NOT JUST IN
THE OPIOID USE DISORDER BUT ALSO
IN THE -- EMERGE OUT OF THIS
IMPLEMENTATION RESEARCH OF THE
CTN HUB AND SPOKE MODELS THAT
BASICALLY AWAY.
WITH SIMILAR OUTCOMES.
MOBILE DELIVERY OF MEDICATIONS.
CHANGING, USING INNOVATION,
OPENING IT UP AND SAYING HOW DO
WE USE HEALTH SYSTEMS TO DO
THIS.
AND IT'S ACTUALLY QUITE
REMARKABLE TO SEE THE
TRANSFORMATION THAT HAS HAPPENED
OVER THE PAST DECADE.
THE SECOND AREA THAT WE'VE
TARGETED ARE THE STRUCTURE THAT
EXISTED IN OUR COUNTRY TO EXPAND
ACCESS TO TREATMENT IS THE
JUSTICE SETTING.
BECAUSE ONE IN FOUR PEOPLE WHO
HAVE DIED OF OVERDOSES HAD PRIOR
YEAR JUSTICE INVOLVEMENT.
WHICH MEANS THAT IF SOMEONE HAD
INITIATED THE TREATMENT, THEY
HAVE NOT DIED -- THEY MAY HAVE
NOT OVERDOSED AT ALL.
THERE'S A PILOT STUDY THAT WAS
DONE, BUT THEY INITIATED
TREATMENT OF EVERY SINGLE PERSON
IN THE JAIL OR PRISON AND HAD AN
OPIOID USE DISORDER AND THEY
MONITORED THE OUTCOMES.
WHAT H THEY SHOWED WAS PEOPLE TT
HAD AN OPIOID USE DISORDER THAT
WERE IN THE JUSTICE SYSTEM, THIS
REDUCED THEIR DEATHS BY 70%.
IN THE POPULATION AT LARGE, SO
THIS ONE TO FOUR PEOPLE, THE
EFFECT FOR THAT -- WAS 30%
REDUCTION IN OVERDOSE DEATHS.
SO USING DATA, SPECIFICALLY
JUSTIFY -- SO WE CREATED -- JUST
LIKE WE HAD THE CLINICAL TRIAL
NETWORK, WE CREATED A -- THAT WE
HAVE NOT ENGAGED YET,
PREDOMINANTLY HAVE BEEN WORKING
WITH JAILS AND INDIVIDUALS ARE
ON FEDERAL JUSTICE SYSTEM AND
BASED ON THAT AND THAT
PARTNERSHIP AND THAT RECOGNITION
DATA THAT'S EMERGING SHOWED
BETTER OUTCOMES WHEN PEOPLE ARE
ACTUALLY PROVIDED WITH TREATMENT
OR WITH MEDICATIONS WHILE IN
JAIL, BEFORE THEY LEAVE JAIL
SIGNIFICANTLY IMPROVE -- THAT
THEY WILL SUSTAIN TREATMENT,
SIGNIFICANTLY REDUCES CHANCES OF
DYING AND CAN REDUCE THEIR RISK
OF REINCARCERATION.
SO THIS STARTS TO CHANGE THE
CULTURE THAT HAS BEEN PUNITIVE
IN RECOGNIZING ALSO THIS IS WHAT
WE WANT TO TAKE INTO THE FUTURE
AND WE WANT TO TAKE IT INTO
MODELS THAT CAN INTERVENE
INSTEAD OF PUTTING PEOPLE IN
JAIL.
SO ACTUALLY GO TO AN EXPERIENCE
THAT COULD BASICALLY INCREASE AT
THE END OF THE DAY --
SIGNIFICANTLY -- FOR SUBSTANCE
USE DISORDER -- THE CONDITION.
HOW AN IMPACT -- THE OUTCOMES
AND IT'S BASICALLY I DON'T HAVE
SUFFICIENT DATA OR OTHER RIGHT
NOW FOR LOOKING AT JAILS
THEMSELVES AND THE WILLINGNESS
TO PROVIDE MEDICATIONS FOR
OPIOID USE DISORDER THAT
SEPARATES, WE'RE WANTING -- IN
2022, THAT CLEARLY SHOW HOW
WE'RE SIGNIFICANTLY INCREASING
IN A RELATIVELY SHORT PERIOD
JAILS AND PRISONS TO PROVIDE
MEDICATIONS FOR INDIVIDUALS THAT
HAVE OPIOID USE DISORDER.
SO IT HAS, AGAIN, JUST LIKE WITH
THE HEALTHCARE SYSTEM -- TO SEE
HOW YOU CAN CHANGE CULTURE
PROVIDING -- AND PROVIDING THE
INFORMATION THAT THEY CAN
ACTUALLY LET THEM TO EMBRACE
THEM AND CONTINUE.
AND THEN THE OTHER
IMPLEMENTATION PROJECT THAT WE
HAVE PRIORITIZE IS ONE THAT WAS
ALSO EXTREMELY AMBITIOUS, THAT
BASICALLY WAS LAUNCHED IN 2018,
WHEN WE WERE SAYING OKAY, WHAT
CAN WE DO.
WE KNOW THAT IF WE INVOLVE THE
HEALTHCARE SYSTEM INTO TREATMENT
WE WOULD PROVIDE NALOXONE TO
REVERSE OVERDOSES.
WE KNOW THAT WHEN WE TRANSITION
TO NOT HAVING MEDICATIONS WHEN
THEY ARE NOT NECESSARY AND
PRESCRIBE THEM WHEN THEY ARE
NEEDED THAT WE CAN SIGNIFICANTLY
REDUCE OVERDOSES.
FOR THAT TO HAPPEN, WE NEED TO
CREATE THOSE BRIDGES THAT WHEN
SPEAKING ABOUT -- WE NEED TO
HELP -- WE NEED THE STATES TO
WORK WITH ACTUALLY THESE OTHER
GROUPS.
WE NEED THE COMMUNITY TO --
USING THE NEED FOR UNDERSTANDING
AND ENGAGEMENT TO PARTNER WITH
ORGANIZATIONS AND STRUCTURES
WITH THE STATES THAT HAVE SOME
OF THE HIGHEST MORTALITY, AND WE
DO HAVE A DEMONSTRATION PROJECT
OF WHAT HAPPENS WHEN BRIDGES ARE
BUILT.
AND YOU GET THAT INTERVENTION,
THE BASIS -- IN THAT PROJECT, IT
ACTUALLY -- THAT ALSO FRANCIS
WAS DIRECTOR AND WE HAVE TO BE
BOLD, WE HAVE TO COME UP WITH AN
OUTCOME THAT IS ACTUALLY REALLY
TO INSPIRE EVERYONE, I FEEL VERY
NERVOUS TO SAY THAT THIS WILL
REDUCE OVERDOSE DEATHS BY ANY
SUCH NUMBER BUT SO FINALLY, WE
SAID WE'RE GOING TO DECREASE 40%
MORTALITY.
AND I SAID I DON'T WANT TO DO IT
BECAUSE I DON'T KNOW WHAT'S
GOING TO HAPPEN.
I WAS VERY -- THAT WE WOULD
START TO SEE EMERGENCE OF
METHAMPHETAMINE, WHICH HAPPENED.
BUT I DID NOT HAVED IN WHAT
WOULD HAPPEN WAS THE COVID
PANDEMIC AND THAT BASICALLY WAS
COMPLETELY DISRUPTIVE.
BUT THE STUDIES WENT ON AND THE
STUDIES WILL BE PUBLISHED SOON,
I'M NOT ALLOWED TO ACTUALLY
COMMENT ON THEM, ALTHOUGH I'M
SHOWING SOME RESULTS THAT SHOW
THAT BASICALLY ONE OF THE
INTERVENTIONS WHICH WAS TO
EXPAND THE ACCESS OF NALOXONE,
AND IN BLUE YOU HAVE THE CONTROL
COMMUNITIES AND IN RED -- THE
ACTION COMMUNITY, THE ONES THAT
ARE DOUBLE BLIND, WE DID THAT
INTERVENTION, 18 MONTHS LATER,
DURING -- THAT WAS 18 MONTHS,
BUT THEN WE HAVE THE CONTROL,
THE COMMUNITY RECEIVED THE
INTERVENTIONS AND THE -- YOU CAN
SEE MUCH -- DELIVERY OF
NALOXONE.
SO IT WORKED THAT WAY AND NOW
THE COMMUNITIES THAT WERE --
CONTROLS ARE RECEIVING THE
INTERVENTIONS, SO THAT WE
BASICALLY DON'T COME IN IN ONE
OF THE CRITICISMS IN THE
COMMUNITY AND THEN DISAPPEAR, SO
WE BASICALLY FEEL THE -- WE HAVE
TO THESE COMMUNITIES TO HAVE
PARTICIPATED.
BUT THIS IMPLEMENTATION, WE HA
HAVE -- ARE THERE OTHER VENUES
THAT WE NEED TO TACKLE IN ORDER
TO TACKLE THE OVERDOSE CRISIS,
AND REQUIRE THAT WE, OF COURSE,
UNDERSTAND WHY FENTANYL IS SO
DANGEROUS.
AND YOU ALL HAVE BEEN READING IN
THE NEWSPAPERS THE QUOTE THAT
SAID -- IT'S AN EXTREMELY POTENT
DRUG, IT'S EASY TO MANUFACTURE,
AND THE -- MOSTLY COME FROM
CHINA, THEN THEY GO TO MEXICO,
WHERE THESE AND THEN TO THE UND
STATES.
THIS IS 50 TIMES MORE POTENT.
POTENCY MEANS YOU NEED MUCH,
MUCH, MUCH TINIER DOSE TO KILL
YOU, SO HIGHLY, JAI ALAI HIGHLY
ADDICTIVE.
IT'S EASY TO MANUFACTURE, IT'S
NOT VERY -- AND FOR THEM IT'S AT
LEAST -- MORE MONEY THAT THEY
SELL.
AND IT'S ADDICTIVE.
SO WHAT IS -- THAT 2 MG CAN KILL
YOU.
IT'S NOT AN EXAGGERATION.
SOMETIMES -- HAS TO LOSE
CREDIBILITY TO EQUALIZE DRUGS AS
ALL BAD OR ALL GOOD.
WHEN PEOPLE BUY THEM IN THE
STREETS, FIRST OF ALL THEY GO
AND BUY HEROIN WHICH IS REALLY
FENTANYL, AS I SAY, TO --
THERE'S NO -- WHAT QUANTITY OR
BATCH HAS, IT'S BASICALLY NOT --
ONE OF THE WAYS WHICH ALSO HAS
MADE THE SITUATION EVEN MORE
ALARMING, DURING THE COVID
PANDEMIC, THE AMOUNT OF FENTANYL
THAT CAME IN TO THE COUNTRY
INCREASED SIGNIFICANTLY, AND HAS
CONTINUED TO INCREASE.
-- IN ILLICITLY MANUFACTURED
FIELDS, FIELDS, FOR EXAMPLE, CAN
BE SLEEP OR FOR -- AND THEY LOOK
IDENTICAL TO THE ONES THAT YOU
BASICALLY BUY IN THE PHARMACY.
AND THEY ARE -- LESS EXPENSIVE.
WHAT'S HAPPENING IS THAT PEOPLE
FOR EXAMPLE THAT BUY MEDICATION
WHERE THEIR DOCTORS GIVE THEM,
THEY HAVE PAIN AND THEY NEED A
PAIN MEDICATION, OR TEENAGERS
THAT -- ONE OF THE THINGS THEY
DO, THEY DO -- THEY LIKE --
MIXED IN WITH ALCOHOL, GET ONE
OF THEIR PILLS AND IT CONTAINS
FENTANYL, ONE DOSE WILL VERY,
VERY LIKELY KILL THEM, AND THIS
IS WHAT YOU HEAR FROM PARENTS
WHO HAVE LOST THEIR CHILD BY
JUST THE ONE DOSE.
BUT IN OLDER PEOPLE THAT GO OUT
THERE AND THEY TAKE ONE TO THEM,
SO THIS IS A WAY THAT FENTANYL
IS COMING INTO THE COUNTRY THAT
ACTUALLY HAS MADE DEMOGRAPHIC OF
OUR POPULATION WHEN THEY'RE
ABOUT TO OVERDOSE.
ANOTHER ASPECT ABOUT THE
FENTANYL DANGERS IS NOT JUST
THAT IT'S MORE POTENT THAN --
IT'S ALSO MORE -- AND THAT WHAT
THAT MEANS IS THAT IT GETS INTO
THE BRAIN MUCH -- THAN HEROIN.
AND WHY THAT'S IMPORTANT, IT CAN
INTERRUPT RESPIRATION.
AND YOU HEARD THE SAYING IN
ORDER FOR NALOXONE TO BE
EFFECTIVE, YOU HAVE TO
ADMINISTER IT -- SO WHAT IT
MEANS BECAUSE IT GETS INTO THE
BRAIN SO, SO FAST, YOU HAVE A
MUCH SHORTER WINDOW AT WHICH YOU
CAN GIVE NALOXONE -- AND THAT OF
COURSE IS HARDER TO ACHEE.
-- THEY TEND
TO -- SYNDROME, AND WHAT IT
BASICALLY INTERFERES YOUR
ABILITY TO EXPAND YOUR --
MUSCLES SO YOU CANNOT EXPAND,
INSPIRE AND EXPIRE.
SO IT'S NOT JUST DEPRESSING --
BUT INTERFERING WITH YOUR
ABILITY TO INHALE OXYGEN.
SO THESE ACTUALLY ARE EVEN MORE
LETHAL.
FOR US IN THE TREATMENT FIELD,
PEOPLE OUT THERE WHO BELIEVE --
MOST PEOPLE -- MANY DO KNOW THAT
IT'S LIKELY THAT THEY ARE NOT --
FENTANYL, IS THAT FENTANYL
POTENCY GENERATES A MUCH EVEN
STRONGER PHYSICAL DEPENDENCE
THAN WHAT YOU HAVE WITH
SOMETHING LIKE HEROIN.
AND AS A RESULT OF THAT,
MEDICATIONS THAT WE USE FOR
OPIOID USE DISORDER OR EVEN
METHADONE, AND NOT TO SAY
NALTREXONE, THAT'S EXTREMELY --
THAT HAVE THE STRONG PHYSICAL
DEPENDENCE, MUCH HARDER WITH
MEDICATIONS IN OPIOID USE
DISORDER WHEN PEOPLE -- AND
PROTOCOLS -- ACTUALLY -- TO DO
IT, WE REQUIRE, WHICH IS WHAT A
LOT OF PEOPLE BELIEVE THE DOS
DOSES -- WITHDRAWAL AND THE
CRAVING.
AND THAT IS THE THING WITH
OVERDOSES, YOU CAN REVERSE THEM
BUT YOU MAY NEED MULTIPLE DOSES
OF NALOXONE.
SO YOU GO IN AND YOU SEE IN THE
STREET SOMETIMES WHAT HAPPENS,
THE PERSON IS REVERTED, THEY
DON'T WANT TO GO TO THE
EMERGENCY DEPARTMENT, AND THEN
90 MINUTES -- THEY STOP
BREATHING AGAIN, NALOXONE IS NO
LONGER AND THEY DIE.
SO YOU NEED TO HAVE A PROCESS
THAT'S MUCH MORE URGENT.
YOU SHOULD HAVE IT FOR ANY
PERSON THAT OVERDOSES BUT IT'S
MUCH MORE THAN WITH FENTANYL.
AND WITH ALL OF THESE ISSUES
SORT OF TOO --
>> EXCUSE ME, I'M SORRY,
DR. VOLKOW, I DIDN'T MEAN TO
INTERRUPT, BUT --
>> IT IS CLEAR THAT, YES, WE
HAVE MEDICATIONS THAT ARE
VERY -- WE DEFINITELY NEED MORE.
WE NEED MORE -- WHAT HAPPENS
WHEN SOMEONE IS METHAMPHETAMINE
AND FENTANYL, NALOXONE WOULD
REVERT FENTANYL BUT THE METH AM-
BASICALLY -- LIKE LEHIGH POX IK.
LIKELY
LIKLIKELY HYPOXIC.
WE NEED TREATMENT FOR
MEDICATIONS CLOSE TO 40,
SOMETIMES 50% OF THEM STOP AT
SIX MONTHS.
WHAT IS ACTUALLY -- WHAT IS IT
THAT WE CAN DO TO IMPROVE THAT
RETENTION?
OTHER ALTERNATIVES THAT CAN BE
USED BY THEMSELVES ORALLY --
WITH THESE MEDICATIONS TO HELP
RETAIN PEOPLE IN TREATMENT.
AND EXTREMELY -- ACTUALLY UNBEE
UNBEKNOWNST TO THEM -- OR SOME
OF THEM SEEK THEM OUT AND THAT
WOULD ACTUALLY REQUIRE WE SHIFT
OUR PARADIGM ON TREATMENT SO --
AND THIS IS SOMETHING THAT WE'VE
BEEN DOING FOR A LONG TIME
BUT -- TO DEVELOP TREATMENTS FOR
NOT SPECIFIC -- BUT FOR
ADDICTION PHENOTYPE AND THERE'S
ENOUGH EVIDENCE, SCIENTIFICALLY
FROM -- ACTUALLY ETHICS THAT
INDICATE THAT THIS IS ETHICALLY
SOUND.
THESE ARE SOME EXAMPLES --
>> EXCUSE ME, DR. VOLKOW?
DR. VOLKOW?
>> FROM SORT OF -- -- WANT TO GO
INTO AN OVERDOSE TO SOUND AN
ALARM, THAT ACTUALLY RELEASE
NALOXONE TO THIS THAT I'M
HIGHLIGHTING BECAUSE I THINK
IT'S SUCH AN EXCITING AREA OF
RESEARCH, WHICH AS WE KNOW THE
NETWORKS AFFECTED IN ADDICTION
AND WE HAVE TOOLS TO STRENGTHEN
THOSE NETWORKS OR GIVE A DOSE
THAT ARE ACTUALLY -- WE'LL
BASICALLY BE ABLE TO MODIFY THE
WAY THAT WE TREAT SUBSTANCE USE
DISORDERS OR OTHER MENTAL
DISEASES IN WAYS THAT CURRENTLY
ARE BEING REALIZED AS WE IMPROVE
NEUROMODULATION AND TOOLS --
ADDICTION BUT IT HAS ALSO BEEN
APPROVED FOR DEPRESSION AND
THERE'S ONGOING WORK -- AND
YOU'VE ALSO HEARD IN TERMS OF
THERAPEUTICS AND OTHER AREA OF
GREAT INTEREST HAVE BEEN THIS --
RECEPTORS LIKE -- THAT ARE
SHOWING EVIDENCE THAT PEOPLE
THAT ARE BEING GIVEN THESE
MEDICATIONS FOR DIABETES --
INTERESTING DRUGS.
WE'VE ALSO HEARD A LOT OF VERY
INTERESTING SCIENCE.
-- POTENTIAL UTILIZATION OF --
TO EXCITE THE WAY THAT OUR BRAIN
LEARNS SO THAT WE CAN BASICALLY
RECOVER FROM DISRUPTED LEARNING
PROCESS IN ADDICTION SO ALL OF
THESE ARE FASCINATING AREA OF
RESEARCH THAT WILL GIVE US
MANY -- MEANWHILE, WE ALSO HAVE
TO KEEP OUR EYES ON THE BALL.
HOW FENTANYL IS RECENTLY BEING
COMBINED WITH PAIN AND -- BUT
WE'RE ALSO SAYING THAT
INCREASINGLY COMBINED WITH
DRUGS -- LIKE THIS ONE RIGHT
NOW, CREATING A LOT OF CONCERNS
AND NOT EVEN ADDICTIVE, THEY ARE
NOT WORKING.
SILENCING THE MEDICATION AND --
AGONIST IS THAT -- MEDICINE.
WE HAVE DRUGS THAT ARE SIMILAR
TO XYLAZINE USED FOR ANESTHESIA.
IT'S NOT ADDICTIVE.
BUT PEOPLE STARTED TO -- AND
JUST HAS BEEN GROWING AND
GROWING AND GROWING, BUT IT'S
BASICALLY THAT WE'RE SEEING --
FENTANYL WITH THESE DRUGS,
XYLAZINE, AND THEN THERE WAS A
CONCERN ABOUT THE MIXTURE OF
XYLAZINE WITH FENTANYL CAN
ACTUALLY HAVE -- CONSEQUENCES.
XYLAZINE BY ITSELF PRODUCES --
REDUCES OXYGEN -- SO -- AND
HYPOXIA BY ITSELF FROM XYLAZINE
IS AS BAD AS THAT FROM FENTANYL,
BUT IT LASTS LONGER.
AND COMBINED WITH FENTANYL, IT
CAN ACTUALLY EXPAND THE DURATION
OF FENTANYL ACTIONS.
SO THIS IS NOW A BIG CHALLENGE.
WE DON'T KNOW HOW TO TREAT IT
AND THERE IS ENORMOUS CONCERN
THAT FENTANYL WHEN MIXED WITH
XYLAZINE JUST -- THE PICTURE
BECAUSE THERE IS WITHDRAWAL FROM
FENTANYL, THERE IS ALSO
PHYSICAL -- FROM XYLAZINE AND
ALSO ASSOCIATED WITH REALLY
THESE HORRIBLE WOUNDS THAT HAS
BEEN ONE OF THE THING --
EVERYONE THAT SOMETHING
MALIGNANT WAS GOING IN THE --
SUPPLY.
THESE WOUNDS GROW VERY, VERY
RAPIDLY AND THEY BASICALLY DON'T
NECESSARILY -- WHERE THE PERSON
IS INJECTING.
SOP IT -- IT'S REALLY COMPLETELY
UNDERSTOOD WHY IS IT BEING USED
IN THE MARKET, IT JUST ACTS AS A
FILLER BUT PRODUCING -- BUT IT'S
A CHALLENGE, SO HOW DO WE TREAT
THIS.
AND -- OVERDOSES FROM FENTANYL
THAT CONTAIN XYLAZINE IN THE
UNITED STATES IN 2022 IS 12%, SO
IT'S VERY SIGNIFICANT.
I HIGHLIGHT THIS BECAUSE WE'RE
SEEING IT CHANGING.
OBVIOUSLY A KEY ELEMENT OF THIS
REALLY MATRIX -- WE HAVE TO KEEP
OUR EYES ON IS THE NEED TO
OBTAIN THE DATA.
WE CANNOT -- INTERVENE.
SO FOR EXAMPLE -- ACTUALLY
BEFORE IT WAS USED FOR COVID,
THE USE OF WASTEWATER, WE HAVE
BEEN USING WASTEWATER FOR
DECADES, IT WAS VERY
TRANSFORMATIVE FOR DETECTION OF
SUBSTANCES -- SENSITIVITY, SO I
THINK THAT -- I JUST WANT TO
FINISH HERE BY SAYING THAT AS WE
GO ALONG, WE ALSO HAVE TO
REALIZE THAT PATHOLOGY, THAT
VULNERABILITY OF PEOPLE HAS GO
GONE -- DISORDERS -- WE SEE
CHILDREN DYING FROM FENTANYL AND
WE SEE OTHER PEOPLE DYING ALSO
FROM -- SO WHAT CAME FROM THE
PERSPECTIVE OF PRIORITY IS THAT
AS WE LOOK INTO THE FUTURE, IT'S
CLEAR THAT -- INTERVENTION HAS
THE OVERDOSE CRISIS, THAT YES,
WE NEED TO DO TREATMENT, THAT WE
NEED TO DO HARM REDUCTION
PRACTICES, ALSO DEVELOP THE
RESEARCH OF THE WAY OF
IMPLEMENTING -- SO THAT PEOPLE
CAN STAY ALIVE.
FOR IT IS FUNDAMENTAL AND
CRUCIAL THAT WE ESTABLISH
INTERVENTIONS THAT THAT CAN
PREVENT PEOPLE -- WHO ARE TAKING
THEM TO ESCALATE TO MORE SEVERE
DRUG USE.
AND WITH THAT, I AM GOING TO END
MY PRESENTATION AND I'M GOING TO
STOP SHARING MY SLIDES.
>> THANK YOU, THA THANK YOU VERY
MUCH, NORA.
NOW, MEGHANN?
IT'S UP TO YOU.
>> WIN, YOU ARE MUTED.
>> I'M MUTED?
>> ALL GOOD.
WE CAN HEAR EVERYBODY.
>> MEGHANN?
>> YES, THANK YOU.
THANK YOU, DR. VOLKOW.
IT WAS EXCELLENT TO HEAR YOU.
SO I'M HERE BOTH AS A
PROFESSIONAL.
MEGHANN PERRY GROUP, WE DO
EDUCATION PRIMARILY,
STORYTELLING AND SPEAKING, AND
I'M ALSO HERE AS A PERSON WHO
HAS EXPERIENCED THIS EPIDEMIC
AND CHALLENGING SUBSTANCE USE
FIRSTHAND.
I'M A PERSON WHO HAS EXPERIENCED
PROBLEMATIC SUBSTANCE USE.
I HAVE SINCE RESOLVED MY
RELATIONSHIP WITH THE SUBSTANCES
THAT COST ME THE GREATEST AND
CAUSED THE MOST CHAOS AND HARM,
BUT I WILL STILL ADMIT THAT MY
RELATIONSHIP WITH TWO SUBSTABSES
STANCES OR MAYBE THREE THINGS
AND THAT'S SUGAR, CAFFEINE AND
WORKING TOO MUCH.
BUT I WANT TO SHARE A LITTLE BIT
ABOUT MY OWN EXPERIENCE AS WELL
AS SOME OF MY EXPERIENCE WORKING
IN THIS FIELD.
I AT 15 YEARS OLD DEVELOPED SOME
MENTAL HEALTH CHALLENGES,
DEPRESSION, ANXIETY, OBSESSIVE
COMPULSIVE DISORDER.
I HAD NO IDEA WHAT THOSE WERE AT
THE TIME.
NOBODY ELSE SEEMED TO RECOGNIZE
THOSE EITHER.
AND I FIRST TURNED TO FOOD AND I
TURNED TO SUBSTANCES LIKE
ALCOHOL, CANNABIS, AND I FOUND
THAT THEY MADE IT TOLERABLE TO
BE ME.
I WAS HAVING A REALLY HARD TIME
JUST SORT OF EXISTING IN THE
BODY AND MIND THAT IS MEGHANN,
AND SUBSTANCES REALLY HELPED ME
BE ABLE TO NAVIGATE LIFE.
THAT SUBSTANCE USE PROGRESSED.
THE LAST PHOTO THAT YOU SEE HERE
IS MY COLLEGE GRADUATION.
I TURNED 22, AND 3 WEEKS LATER,
I GRADUATED FROM COLLEGE, AND
THREE WEEKS AFTER THAT, I GOT
MARRIED, AND SIX WEEKS AFTER
THAT, I WENT INTO DETOX FOR THE
FIRST TIME.
SO IN THAT PICTURE THAT YOU SEE
THERE, I DID USE HEROIN ON MY
WAY TO MY COLLEGE GRADUATION
BECAUSE I HAD DEVELOPED A
DEPENDENCY, AN ADDICTION TO IT
BY THAT POINT IN MY LIFE.
AND THAT STARTED A LONG CYCLE OF
USING WHAT WAS AVAILABLE BACK
THEN.
SO THAT WAS 1995, AND WE REALLY
JUST HAD A FEW THINGS, A FEW
TOOLS IN OUR DISPOSAL AT THAT
TIME.
THERE WAS ACUTE INPATIENT CARE
LIKE DETOX, REHAB, THERE WAS
12-STEP FELLOWSHIP, BOTH OF
THOSE WERE BASED IN ABSTINENCE
AND THERE WAS METHADONE.
THERE WAS NOT EVEN BUPRENORPHINE
AT THAT POINT.
IT WASN'T UNTIL 1999 THAT I WAS
IN CLINICAL TRIALS RECEIVING
BUPRENORPHINE BOTH IN ENGLAND
AND THEN WHEN I MOVED BACK HERE
IN MASSACHUSETTS.
SO WE DIDN'T HAVE ACCESS TO
NALOXONE OR MOST OF THE TOOLS
THAT WE TAKE FOR GRANTED TODAY.
SO I CYCLED THROUGH MANY
DIFFERENT PROGRAMS AND MANY
DIFFERENT ATTEMPTS BUT THEY WERE
REALLY ALL THE SAME COUPLE OF
TOOLS.
WHEN I WAS 28, I FOUND MYSELF
INCARCERATED FIVE MONTHS
PREGNANT.
I WAS USING MEDICATION FOR
OPIOID USE DISORDER, I WAS ON ME
METHADONE.
I WAS NOT USING -- IT WAS HEROIN
AT THAT TIME, BUT I WAS
INCARCERATED FOR $40 WORTH OF
HEROIN THAT I SOLD TO MY HEROIN
DEALER AND THEN SPENT A GOOD
PART OF MY PREGNANCY
INCARCERATED.
AND I REMEMBER VERY CLEARLY THAT
EVERY DAY THEY HAD TO LOCK DOWN
THE WHOLE WOMEN'S UNIT FOR A
NURSE TO BRING MY METHADONE TO
ME, AND I REMEMBER REALLY,
REALLY WELL THAT THERE WAS A
LOUD BUZZ THAT MEANT THAT
SOMEBODY WAS BEING LET ON TO THE
UNIT, AND THE NURSE WOULD COME
AND SHE WAS ALWAYS VERY WELL
DRESSED AND WELL PUT TOGETHER,
SHE HAD A LITTLE WHITE BOTTLE OF
METHADONE IN HER HAND.
AND MY DOOR WOULD POP OPEN, THE
BOLT WOULD SLIDE OPEN AND I
WOULD STEP OUT ON TO THIS METAL
WALKWAY THAT WAS SORT OF WHAT WE
CALLED A GANG PLANK AND I HAD
THOSE LITTLE CANVAS SLIP-ON
SHOES WITH NO LACES.
AND EACH STEP WOULD JUST RING
OUT CLANG, CLANG, CLANG, AND I
KNEW THAT EVERY WOMAN ON THAT
UNIT WAS WATCHING ME.
AND WHEN I GOT TO THE NURSE IN
THE CENTER OF THE ROOM, SHE
DIDN'T LOOK AT MY FACE AND THE
SCABS AND SHE DIDN'T LOOK AT MY
HAIR AND HOW IT HAD NOT BEEN CUT
IN A LONG, LONG TIME, SHE DIDN'T
LOOK AT HOW SKINNY I WAS, SHE
JUST LOOKED AT THE BADGE ON MY
CHEST TO MAKE SURE THAT I WAS
THE RIGHT INMATE NUMBER BEFORE
SHE GAVE ME THAT ME METHADONE.
THAT WAS ONE OF THE MOST
DEHUMANIZING EXPERIENCES I EVER
HAD IN ALL OF MY YEARS
STRUGGLING WITH SUBSTANCE USE.
I DESPERATELY WANTED TO BE A
GOOD MOM, AND I DESPERATELY
WANTED MY DAUGHTER NOT TO START
HER LIFE THE SAME WAY.
AND THERE WAS NOTHING I COULD DO
ABOUT IT AT THAT POINT, I DID
NOT HAVE THE SUPPORTS AND
RESOURCES THAT I NEEDED TO DO
BETTER.
AFTER HAVING MY DAUGHTER, THAT'S
ME THERE WITH HER WHEN SHE WAS
AN INFANT, I WAS FORCED OFF OF
METHADONE SO I COULD PARTICIPATE
IN A DRUG COURT PROGRAM, AND IT
WAS A PART OF MY LIFE WHERE I
WAS REALLY STRUGGLING WITH THE
WITHDRAWAL FROM METHADONE OVER
TIME AS WAS MY DAUGHTER.
I WAS INCARCERATED OVER AND OVER
DURING THE FIRST 18 MONTHS OF
HER LIFE FOR THINGS LIKE LYING
AND OTHER MINOR INFRACTIONS.
I DID EVENTUALLY FINISH THAT
PROGRAM BUT I DID LOSE CUSTODY
OF HER AT 4, WHEN SHE WAS
4 YEARS OLD, AND I BEGAN TO
CYCLE AGAIN, I WAS UNHOUSED,
CYCLING OUT OF JAILS, HOMELESS
SHELTERS AND ALL OF THE SYSTEMS.
AND I KEPT BEING OFFERED THE
SAME COUPLE OF THINGS.
AND THAT KEPT NOT BEING WHAT I
NEEDED AT THAT TIME.
I DID EVENTUALLY ESTABLISH
RECOVERY AS I KNOW IT TODAY IN
2011, RIGHT BEFORE THE EPIDEMIC
THAT WE'RE IN THE MIDST OF NOW,
SORT OF STARTED TO RAMP UP.
I DO LOVE TO SHOW THAT THERE
IS -- THERE ARE HAPPY ENDINGS
AND THERE ARE MOMENTS OF HOPE IN
STORIES LIKE MINE.
THAT WAS MY LITTLE NUGGET THERE
ON THE LEFT AND THAT'S MY NUGGET
NOW.
SHE'S 22 NOW AND I GOT CUSTODY
BACK OF HER WHEN SHE WAS 10.
AND WE WERE OKAY.
SO THAT'S A VERY LITTLE SNAPSHOT
OF WHAT THE LANDSCAPE LOOKED
LIKE IN THE MID TO LATE '90S AND
THE EARLY 2,000s.
WHY I'M HERE AND WHY WE'RE
TALKING ABOUT THIS IS -- THIS
LIST OF NAMES, PEOPLE WERE DYING
AROUND ME ALL OF THE TIME IN THE
90s AND EARLY 2000s.
WHEN NOBODY WAS WATCHING AT THIS
TIME.
NOBODY WAS REALLY PAYING
ATTENTION.
SEVEN OF THE 19 NAMES ON THE
SLIDE WERE NOT OVERDOSE DEATHS,
THEY WERE THINGS LIKE
ENDOCARDITIS, AN ESOPHAGUS
RUPTURING, STROKES, ALL KINDS OF
SECONDARY REASONS WHY PEOPLE
HAVE DEATH AROUND SUBSTANCE USE.
EIGHT OF THE 12 OVERDOSES WERE
NOT FENTANYL.
SO I KNOW THAT WE ARE HERE,
WE'RE TALKING ABOUT FENTANYL AND
I JUST WANT TO PUT THIS CONTEXT
IN PLACE OF IT'S NOT JUST ABOUT
FENTANYL, FENTANYL IS JUST ONE
OF THE SUBSTANCES THAT WE'RE S
SEEING IN THE CURRENT CLIMATE
AND -- GREATER THAN OTHER
SUBSTANCES THAN WE'VE BEEN
DEALING WITH IN THE PAST BUT IT
IS A POLYSUBSTANCE CRISIS THAT
WE'RE IN, AND WE ARE SEEING
PEOPLE DYING FOR MANY DIFFERENT
REASONS RELATED TO SUBSTANCE
USE, AND SO IT'S NOT JUST ABOUT
FENTANYL.
THIS IS SOMETHING THAT'S BEEN
BUILDING FOR A LONG TIME AND DRT
CONTEXT OF HOW WE GOT HERE.
THIS IS KEALYND.
KEALYND IS AN EXAMPLE OF WHAT IS
HAPPENING MORE RECENTLY THAT
WE'RE SEEING.
I STARTED WORKING WITH KEALYND
AS A RECOVERY COACH WHEN HE WAS
21 YEARS OLD.
I MET HIM IN A CHINESE
RESTAURANT IN A TOUGH PART OF
TOWN WHERE HE WAS LIVING IN THE
DEPARTMENT OF MENTAL HEALTH
GROUP HOME.
KEALYND HAD A LOT OF THINGS THAT
WERE WORKING AGAINST HIM.
HE WAS BLACK, GAY, HE WAS
ADOPTED AFTER SEVERE SEXUAL
TRAUMA AS AN INFANT AND TODDLER.
ADOPTED INTO A JEWISH HOME WITH
A SINGLE MOM WHO WAS A
WONDERFUL, WONDERFUL WOMAN WHO
DID AMAZING WORK WITH KEALYND,
BUT HE WAS -- HE HAD PROFOUND
MENTAL HEALTH CHALLENGES,
PROFOUND TRAUMA, AND USED
SUBSTANCES TO AGAIN JUST SORT OF
TOLERATE BEING ALIVE.
IT WAS -- HE WAS AN INCREDIBLY
SENSITIVE, BRIGHT AND SHINY
HUMAN THAT FOUND IT REALLY,
REALLY HARD JUST TO EXIST, JUST
TO BE KEALYND.
KEALYND DIED AT AGE 26 FROM
METHAMPHETAMINE OVERDOSE.
AND KEALYND IS A GREAT EXAMPLE
OF WHERE WE LOSE FOLKS IN THE
GAPS IN THE SYSTEM, BECAUSE HE
WAS IN EVERY SYSTEM IMAGINABLE
AND HE ALWAYS WANTED TO GET
BETTER AND DO BETTER AND HAVE A
HIGHER QUALITY OF LIFE, BUT
THERE WERE NO SYSTEMS THAT COULD
HOLD HIM BUT WOULD HE GET KICKED
OUT OF THINGS LIKE TAKING A WALK
BECAUSE HE HAD GOTTEN SO ANGRY
THAT HE KNEW HE NEEDED TO GET A
LITTLE BIT OF SPACE.
HE WAS IN A PROGRAM -- ANOTHER
PROGRAM FOR PUNCHING A WALL
BECAUSE, AGAIN, THE MANAGING
FEELINGS AND TRYING TO LIVE
WITHOUT ANY KIND OF SUBSTANCES
WAS INCREDIBLY HARD FOR HIM, AND
HE'S AN EXAMPLE OF NOT JUST THE
GAPS IN THE SYSTEM, BUT ALSO THE
NECESSITY OF ABSTINENCE THAT WE
KIND OF ATTACH ALL OF OUR
SERVICES TO OR MANY OF OUR
SERVICES ARE BASED ON FOLKS
HAVING ABSTINENCE AND KEALYND IS
A GREAT EXAMPLE OF WHY WE NEED
TO BUILD UP OTHER SUPPORTS IN
SOME CASES BEFORE WE ASK
ABSTINENCE OF PEOPLE, SO HOLDING
THAT AS SORT OF THE HOLY GRAIL
OR ALWAYS THE DESIRED OUTCOME
REALLY LEAVES A LOT OF PEOPLE
BEHIND, AND SO NOT PREDICATING
RESOURCES OR SUPPORTS ON
ABSTINENCE IS REALLY IMPORTANT.
I WANTED TO GIVE A QUICK
CONTEXT, THESE ARE STATISTICS
FROM THE UNITED NATIONS OFFICE
ON DRUGS AND CRIME.
THERE ARE OVER 284 MILLION
PEOPLE WORLDWIDE THAT USE
SUBSTANCES AND LESS THAN
50 MILLION OF THEM ACTUALLY HAVE
A DIAGNOSABLE DISORDER.
AND THE REASON I WANT TO SHOW
THIS IS BECAUSE WE TEND TO THINK
OF SUBSTANCE USE AS ONE THING
LIKE THIS IS -- PEOPLE USE
SUBSTANCES THAT GET ADDICTED.
THEY ARE -- AND THEY DIE.
AND IT IS FAR MORE COMPLEX THAN
THAT AND AGAIN, THAT BINARY OF
LIKE ABSTINENCE OR USING I LIKE
TO TRY TO ENCOURAGE FOLKS TO
THINK ABOUT THINGS AS BEING IN A
CONTEXT.
AND SO IT'S NOT THAT BLACK AND
WHITE THAT PEOPLE USE
SUBSTANCES, SUBSTANCES ARE BAD
AND NOW THEY'RE ADDICTED AND NOW
THEY'RE WREAKING HAVOC AND
THEY'RE GOING TO DIE, THERE'S A
WHOLE MIDDLE THAT'S HAPPENING
THERE THAT OUR SYSTEMS WEREN'T
HANDLING AS DIRECTLY AND WE KNOW
THAT BECAUSE OF FENTANYL BEING
WHAT IT IS AND HOW LETHAL IT IS,
WE ARE IN CRISIS MODE AND WE
ABSOLUTELY SHOULD BE BUT I ALSO
WANT YOU TO RECOGNIZE THAT
YOU'RE ENCOUNTERING PEOPLE IN
YOUR RESEARCH AND IN YOUR
HEALTHCARE SETTINGS THAT ARE
SOMEWHERE IN THE MIDDLE.
DR. VOLKOW SPOKE TO THIS A
LITTLE BIT.
AGAIN THERE ARE GOOD REASONS WHY
PEOPLE USE SUBSTANCES.
YOU MAY LOOK AT THIS LIST AND
LOOK AT OTHER THINGS THAT YOU
ARE DOING TO SATISFY THESE NEEDS
FOR SOME OF US IT'S SUBSTANCES
FOR SOME OF YOU IT MAY BE
SOMETHING ELSE OR IT MAY BE A
SUBSTANCE, IT MAY BE ALCOHOL OR
IT MAY BE NICOTINE.
BUT HUMANS ARE WIRED FOR THESE
NEEDS.
WE'RE WIRED TO SEEK PLEASURE,
FOR CURIOSITY, FOR SOCIALIZING.
WE ARE SOCIAL SURVIVALISTS, WE
DEPEND ON EACH OTHER FOR
SURVIVAL S SO WHAT THE PEER GROP
IS DOING IS INCREDIBLY
IMPORTANT.
WE SEEK OUT NEW INFORMATION AND
NEW EXPERIENCES AND OF COURSE WE
ARE WIRED TO AVOID PAIN, BOTH
PSYCHOLOGICAL AND PHYSICAL AND
THE TRUTH IS THAT THERE ARE SOME
SUBSTANCES THAT DO A REALLY GOOD
JOB OF SATISFYING THESE THINGS.
AND AGAIN IT'S A RELATIONSHIP TO
THEM AND HOW PROBLEMATIC THAT
BECOMES AND ALSO THE
RELATIONSHIP WITH -- THAT SOME
SUBSTANCES MAY BE MORE DANGEROUS
THAN OTHERS THAT WE NEED TO JUST
HAVE IN MIND.
THERE ARE ALSO REASONS THAT --
SO WE SORT OF CRIMINALIZED
CERTAIN SURVIVAL OR COPING
MECHANISMS.
SUBSTANCE USE BEING ONE OF THEM,
WHAT THAT DOES IS IT OSTRACIZES
AND ISOLATES THOSE FOLKS WHO ARE
USING SUBSTANCES.
I WILL SHARE WITH YOU FROM
MYSELF THAT I HAD SUICIDAL
THOUGHTS AND IDEATION FOR MOST
OF MY ADOLESCENCE AND EARLY
ADULTHOOD AND I DO BELIEVE THAT
SUBSTANCES MADE IT POSSIBLE FOR
ME TO CONTINUE LIVING.
AND -- SO I HAD A REALLY GOOD
REASON AT THAT TIME TO USE
SOMETHING THAT HELPED ME FEEL A
LITTLE BIT SOOTHED OR FEEL OKAY
TO CARRY ON.
SOME FOLKS ARE USING SUBSTANCES
BECAUSE THEY ARE UNHOUSED AND
UNSAFE AT NIGHT SO THEY'LL USE A
STIMULANT TO STAY AWAKE SO THAT
THEY'RE NOT VICTIMIZED OR
ABUSED.
SOME FOLKS ARE -- HAVE --
THEY'RE IN A STREET BASED
ECONOMY, MAYBE THEY'RE DOING SEX
WORK SO THEY'RE USING SUBSTANCES
TO MAKE IT TOLERABLE TO DO THAT
SEX WORK OR TO PERFORM BETTER IN
THAT SEX WORK, SO AS YOU'RE
ENCOUNTERING PEOPLE WHO ARE
COMING TO YOU, UNDERSTANDING
THAT FOR SOME, SUBSTANCE USE IS
SURVIVAL.
IT IS A WAY, IT IS A PART OF
THEIR SURVIVAL STRATEGIES AND SO
AGAIN, UNDERSTANDING THE CONTEXT
IN WHICH PEOPLE USE CAN HELP US
IN HOW WE SUPPORT THEM AND
APPROACH THEM AND NOT JUST SORT
OF SAYING SUBSTANCE USE IS YOUR
MAIN PROBLEM AND YOU NEED TO
STOP NOW.
BECAUSE WE'VE CRIMINALIZED THESE
BEHAVIORS AND CRIMINALIZED
SUBSTANCE USE, PEOPLE TEND TO
GET ISOLATED AND OSTRACIZED AND
THAT CAN DENY THEM ACCESS TO
BASIC HUMAN NEEDS AND SUPPORTS
LIKE HOUSING, PERSONAL SAFETY,
HEALTHCARE, EMPLOYMENT, FAMILY
TIES, BEHAVIORAL HEALTHCARE, AND
SO THAT ISOLATION REALLY CAN
CONTRIBUTE TO AN OVERALL
DOWNWARD SPIRAL AND A
DISCONNECTION FROM KEY SERVICES
AND SUPPORTS AND AGAIN IT'S THIS
IDEA THAT WE HAVE TO BE SEEKING
RECOVERY IN ORDER TO -- IN ORDER
TO RECEIVE SERVICES, RIGHT?
WE HAVE TO HAVE THIS RECOVERY
READINESS, BUT IF WE'RE USING
SUBSTANCES FOR ANY NUMBER OF
REASONS AND WE'RE NOT READY OR
WE CAN'T STOP AT THAT TIME,
DENYING SERVICES IS JUST
CONTRIBUTING TO THAT PROBLEM OF
THEIR OVERALL CONTEXT THAT
THEY'RE LIVING IN.
DR. VOLKOW TALKED ABOUT WE HAVE
SOLUTIONS IN THE HEALTHCARE
SYSTEM AND WHY ARE THEY NOT
WORKING OR WHY ARE THEY NOT MORE
WIDELY USED, AND I WILL SAY THAT
THERE ARE REALLY THREE THINGS IN
MY MIND THAT ARE THE MAJOR
CONTRIBUTORS TO THAT.
ONE IS ACCESS.
SIMPLY HAVING ACCESS TO THE
SERVICES.
HEALTH INSURANCE,
TRANSPORTATION, MAYBE THE
SERVICES DON'T EVEN EXIST WHERE
YOU LIVE AT THIS TIME.
STIGMA AND DISCRIMINATION.
SO WE TALK ABOUT STIGMA A LOT
AND IN ACTION, STIGMA IS
DISCRIMINATION, SO WE ARE
TREATED DIFFERENTLY IN SYSTEMS
AND SO BECAUSE OF THAT, WE
DEVELOP A LACK OF TRUST.
SO WE ARE VERY SKEPTICAL OF A
LOT OF THE SYSTEMS THAT ARE
THERE TO CARE FOR US BECAUSE WE
HAVE NOT BEEN TREATED WELL BY
THEM IN THE PAST.
WE HAVE A LOT TO LOSE WHEN WE
COME INTO YOUR HOSPITAL OR INTO
YOUR HEALTHCARE SETTING.
YOU MAY BE REPORTING US TO
VARIOUS ENTITIES FOR VARIOUS
THINGS, AN WE CAN RISK LOSING
OUR HOUSING, OUR EMPLOYMENT,
CONNECTIONS TO SOCIAL SERVICES,
PERSONAL RELATIONSHIPS.
OUR STATUS IN OUR COMMUNITY.
AND CERTAINLY CUSTODY OF OUR
CHILDREN.
IT IS STILL ILLEGAL IN SOME
STATES FOR PREGNANT PEOPLE TO BE
ON MEDICATION FOR OPIOID USE
DISORDER AND THEY WILL BE
INCARCERATED AND REPORTED TO THE
DEPARTMENT OF CHILDREN AND
FAMILY SERVICES.
WE COU DO NOT HAVE BODILY AUTONY
IN A LOT OF CASES AND SO WE ARE
RISKING A GREAT DEAL WHEN WE
COME INTO YOUR HEALTHCARE
SETTINGS.
SOME RESEARCH HAS SHOWN -- I WAS
AT A HARM REDUCTION CONFERENCE
RECENTLY, AND A PROFESSOR WAS
PRESENTING AND SAYING THAT SOME
OF THE RESEARCH THAT SHE WAS
READING REFERRED TO DOCTORS AS
POLICE IN WHITE COATS.
AND THAT'S A REALLY, REALLY
DAMAGING DYNAMIC THAT WE DON'T
TRUST YOU AND YOU DON'T TRUST
US.
AND ANOTHER EXAMPLE OF SORT OF
THE RISKS THAT WE HAVE AS WE'RE
TRYING TO NAVIGATE ALL OF THE
CONTEXTS THAT WE'RE IN AND ALL
OF THE CHALLENGES WE FACE IS
THAT MEDICATION FOR OPIOID USE
DISORDER, A TYPICAL METHADONE
CLINIC REQUIRES THAT PEOPLE COME
IN EVERY DAY TO GET THEIR DOSE
AND IT REQUIRES TOTAL ABSTINENCE
SO THEY ARE REGULARLY TESTED FOR
SUBSTANCES IN THEIR URINE, AND
IF THEY COME UP POSITIVE FOR
CANNABIS OR ALCOHOL USE OR EVEN
IF THEY MISS A MEETING THAT
THEY'RE SUPPOSED TO BE AT AT THE
CLINIC, THEN HAVE EVERS WILL BEN
SERVICES WILL BE REMOVED, THEY
WILL BE NO LONGER ALLOWED TO
ACCESS THAT METHADONE.
AND WE KNOW THAT THE OVERDOSE
RISK IS WAY UP WHEN PEOPLE HAVE
BEEN ON OPIOID -- MEDICATION FOR
OPIOID USE DISORDER AND IT IS
REMOVED.
BUT OUR SYSTEMS ARE STILL
PREDICATED ON THIS KIND OF IDEA
OF COMPLIANCE AND RESTRICTION
AND NOT HAVING BODILY AUTONOMY.
SO WHAT HAPPENS WITH THIS LACK
OF TRUST, AND AGAIN THIS IS
RESEARCH THAT I RECENTLY FOUND,
THAT PEOPLE WHO INJECT DRUGS WHO
ARE SOME OF THE MOST STIGMATIZED
OUT OF ALL OF THE GROUPS THAT
WERE TALKING ABOUT, BECAUSE OF
THE DEHUMANIZATION AND
DISCRIMINATION TO HEALTHCARE
SETTINGS THAT THEY ACTUALLY
DELAY PRESENTING FOR HEALTHCARE.
WHICH MEANS THAT YOU ARE MY
ABSOLUTE LAST RESORT.
SO I MAY HAVE A WOUND, I MIGHT
HAVE AN ABSCESS FROM AN
INJECTION SITE BECAUSE I DIDN'T
HAVE STERILE EQUIPMENT OR AN
ENVIRONMENT WHERE I COULD HAVE
ACCESS TO CLEAN WATER TO USE,
AND THAT ABSCESS WILL GROW INTO
A MUCH LARGER INFECTION, PERHAPS
NOW I HAVE A BLOOD INFECTION,
AND SO I'M NOT PRESENTING TO YOU
UNTIL I'M ALMOST AT THE POINT
WHERE I COULD LOSE THAT LIMB.
OR IN THE CASE OF MY FRIEND ROB,
WHERE HIS ENDOCARDITIS WAS SO
BAD THAT THERE WAS NOTHING THAT
THEY COULD DO, AND HE PASSED
AWAY IN THE HOSPITAL BECAUSE HE
DID NOT WANT TO GO AND GET
TREATMENT ANY SOONER.
IT ALSO KEEPS US FROM DISCLOSING
DRUG USE, WHICH IS NOT HELPFUL
IN TERMS OF WORKING TOGETHER AND
COLLABORATING WITH A PROVIDER TO
FIGURE OUT WHAT KIND OF SUPPORTS
OR STEPS COULD BE TAKEN
DOWNPLAYING PAIN AND SEEKING
CARE ELSEWHERE.
AND THIS IS A TERM I CAME UP
WITH, I LOVE TO COME UP WITH
TERMS, BUT CONTEXT BIAS.
MAYBE IT'S A THING, I DON'T
KNOW.
I'VE NEVER HEARD ANYBODY SAY IT,
BULL I THINK ABOUT THIS IN TERMS
OF BECAUSE MANY OF US WHO --
MANY PEOPLE WHO USE DRUGS ARE
PRESENTING AS ABSOLUTE
WORST-CASE SCENARIOS WHEN WE
SHOW UP IN YOUR SYSTEMS, YOU ARE
SEEING US AT OUR ABSOLUTE LOWEST
POINT OR OUR WORST OR OUR MOST
CRITICAL OR IN OUR GREATEST
NEED.
AND YOU'RE ONLY SEEING US
PRESENTING WITH THE ABSCESS OR
THE BLOOD INFECTION OR WHATEVER
IT IS POST OVERDOSE, RIGHT?
SO YOU ONLY SEE THAT ONE ASPECT
OF US, AND YOU'RE SEEING THIS
OVER AND OVER AND OVER SO YOU'RE
THINKING SUBSTANCE USE, PEOPLE
WHO USE DRUGS, THIS IS WHAT THEY
LOOK LIKE, THIS IS -- YOU KNOW,
HOW THEY ARE, AND THIS IS HOW
THEY COME IN.
AND WHAT HAPPENS IS THAT YOU'VE
LOST SITE OF ALL OF THE REST OF
WHO WE ARE.
YOU'VE LOST SIGHT OF ALL OF THE
OTHER CHALLENGES THAT WE MAY
HAVE.
SO WHEN YOU SEE US AND YOU'RE
LIKE, I DON'T UNDERSTAND WHY YOU
CAN'T STOP USING SUBSTANCES OR
YOU AREN'T SEEING HOW MANY
BARRIERS WE ACTUALLY HAVE TO
STOPPING USING SUBSTANCES IF
THAT IS INDEED A GOAL THAT WE
HAVE AS INDIVIDUALS.
WE MAY WANT TO STOP AND OUR
LIVES ARE JUST SUCH THAT IT'S
NEARLY IMPOSSIBLE, WE DON'T HAVE
THE SUPPORTS THAT WE NEED IN
ORDER TO DO THAT.
AND SO THAT CREATES THIS BIAS
FOR A LOT OF PROVIDERS, I THINK,
IN HOW YOU SEE US.
SO I BELIEVE THERE'S A LOT OF
OPPORTUNITIES FOR BETTER
ENGAGEMENT.
I AM HERE FIRST AND FOREMOST AS
A HUMAN BEING AND I THINK THAT
IS HOW -- THE APPROACH THAT I
CAN OFFER TO YOU, TO ADD TO THE
SCIENCE AND THE MEDICINE AND ALL
OF THAT, THE FIRST THING IS JUST
TO LOOK AT US AS WHOLE PEOPLE.
UNDERSTAND ALL OF WHAT WE HAVE
GOING ON, TAKE ABSTINENCE OUT OF
THE PICTURE FOR THE MOMENT, AND
JUST DEAL WITH THE WHOLE PERSON
THAT'S SITTING IN FRONT OF YOU.
WE CAN BUILD WELLNESS IN MANY
OTHER WAYS, AND SUPPORT PEOPLE
IN DOING THINGS MORE SAFELY OR
IMPROVING THEIR QUALITY OF LIFE
IN SMALL WAYS OVER TIME.
WITHOUT HAVING TO HAVE
ABSTINENCE AS THAT FIRST PIECE.
REALLY PROMISING, AND DR. VOLKOW
TALKED ABOUT THIS, IS THE PEER
SUPPORT MODEL.
THAT IS WHAT MY -- WHAT I WORK
IN AND WHERE I DO MOST OF MY
EDUCATION.
IT'S A REALLY, REALLY SORT OF
THEORETICAL SHIFT, RIGHT?
THAT TRUST PIECE IS ABOUT A
POWER DIFFERENTIAL, YOU HAVE
MUCH GREATER POWER THAN US WHEN
WE'RE COMING IN TO YOU AS A
PATIENT.
WITH A PEER MODEL, WE'RE EQUAL.
WE ARE BASED ON MUTUAL TRUST,
WE'RE INTERESTED IN WHAT YOU
HAVE GOING WELL, AND BUILDING ON
THAT, WE'RE INTERESTED IN WHAT
CHANGES YOU WANT TO MAKE, NOT
WHAT I THINK YOU SHOULD DO.
IT PROVIDES A LEVEL OF DIGNITY,
AUTONOMY AND CHOICE THAT KEEPS
PEOPLE COMING BACK.
IT REALLY CHANGES THAT
RELATIONSHIP AND THIS MODEL
BEING INTEGRATED INTO HEALTHCARE
SETTINGS IS ONE OF THE MOST
PROMISING OPPORTUNITIES THAT WE
HAVE RIGHT NOW, AND SAMHSA,
WHICH IS THE SUBSTANCE USE AND
MENTAL HEALTH SERVICES
ADMINISTRATION, WHICH OVERSEES
SORT OF NATIONALLY ALL OUR
BEHAVIORAL HEALTH SYSTEMS, IS
REALLY PUTTING A LOT OF EMPHASIS
ON GETTING THE PEER MODEL MORE
INTEGRATED INTO HEALTHCARE
SETTINGS, AND SO AS DR. VOLKOW
WAS TALKING ABOUT, YOU KNOW,
HEALTHCARE AS WHERE THE CENTER
OF OUR APPROACH SHOULD BE, THE
PEER MODEL SHOULD BE RIGHT
THERE.
AND THEN JUST HARM REDUCTION, SO
HARM REDUCTION IS THAT MIDDLE
GROUND, RIGHT, HARM REDUCTION IS
SORT OF STANDING IN THE GAP, AND
JUST LETTING PEOPLE MAKE THEIR
OWN CHOICES, RESPECTING THEIR
AUTONOMY, UNDERSTANDING PEOPLE
HAVE REALLY GOOD REASONS TO USE
SUBSTANCES, AND THAT IT'S -- AND
WE KNOW THAT'S NEVER FORGETTING
FOR SOME FOLKS THAT'S VERY
PROBLEMATIC AND DAMAGING BUT
ALSO IT IS STILL ULTIMATELY UP
TO US TO MAKE ANY CHANGES OR
CHOOSE TO MAKE CHANGE.
AND SO HARM REDUCTION DOES NOT
FORCE OR COERCE CHANGE.
OND WHAT MAKES HARM REDUCTION SO
SUCCESSFUL IS THAT THAT RESPECT
THAT WE GIVE FOLKS, THAT MAKING
THEM FEEL WORTHY, MAKING THEM
FEE SUPPORTED AND APPRECIATED
AND VALUED AND MAKING THEM FEEL
LIKE THEY HAVE POWER IN THE
RELATIONSHIP LEADS TO BETTER
ENGAGEMENT OVER TIME AND MORE
HELP-SEEKING.
SO THERE'S MANY FORMS OF HARM
REDUCTION OUT THERE, BUT REALLY
AT ITS HEART, HARM REDUCTION IS
JUST RESPECTING THAT YOU HAVE
POWER TO MAKE YOUR OWN CHOICES
AND WE'RE JUST HERE TO HELP IF
WE WOULD LIKE YOU TO, YOU KNOW,
STAY ALIVE AND HAVE A BETTER
QUALITY OF LIFE IF THAT'S WHAT
YOU LIKE.
SO HARM REDUCTION AT ITS HEART
IS LOVE, AND I'LL LEAVE YOU KIND
OF WITH THIS ENERGY OF LOVE, AND
OF STANDING WITH US IN THE GAP.
THE BEST THING I CAN SAY YOU CAN
LEAVE HERE TODAY WITH THAT
DOESN'T TAKE SPECIAL TRAINING OR
A FELLOWSHIP OR A BUNCH OF MONEY
IS JUST TO STAND WITH US.
YOU PROBABLY CAN'T FIX ALL OUR
PROBLEMS ANYWAYS, BUT WHAT YOU
CAN DO IS EASE A LITTLE OF OUR
SUFFERING.
PERHAPS HELP US STAY A LITTLE
SAFER, PERHAPS OVER TIME THAT
LEADS TO DECREASING THE
LIKELIHOOD OF US HAVING A
PREMATURE DEATH RELATED TO OUR
RELATIONSHIP WITH SUBSTANCES,
AND PERHAPS EVEN THAT WILL SPARK
SOME HOPE OR INSPIRE US NOT TO
GIVE UP, AND MOST IMPORTANTLY,
JUST FEEL -- HELP US TO FEEL
VALUED AND WORTH SAVING, IN
THESE SYSTEMS THAT WE'RE SO
DEHUMANIZED IN, REHUMANIZING US
HAS GREAT POWER.
AND I'LL GIVE YOU A VERY QUICK
EXAMPLE OF THAT.
MY FRIEND DAVE WORKS IN HARM
REDUCTION IN THE U.K., AND ONE
OF HIS FOLKS THAT WOULD FREQUENT
HIS SERVICES WAS IN THE
HOSPITAL, SHE WAS DYING, AND HE
WENT TO VISIT HER, THERE WAS
NOBODY ELSE TO VISIT HER AT THAT
TIME, AND SHE WAS IN THE SORT OF
HOSPITAL WARD IN A CORNER BY
HERSELF AND THERE'S ALL THIS
ACTIVITY AND ALL THESE THINGS
GOING ON AROUND HER WITH OTHER
PATIENTS AND DOCTORS AND NURSES,
AND THERE'S EILEEN JUST SITTING
IN A CORNER ALONE.
AND DAVE WAS ABLE TO SIT WITH
HER AND TALK WITH HER AND PLAY
HER FAVORITE SONGS ON HIS PHONE,
AND HOLD HER HAND, AND HE STAYED
WITH HER UNTIL SHE TOOK HER
FINAL BREATH.
AND IT MEANT SHE WASN'T ALONE
WHEN SHE PASSED.
THAT IS LOVE, THAT IS HARM
REDUCTION, THAT IS STANDING WITH
US IN THE GAPS.
AND SO I HOPE THAT YOU CAN FIND
WAYS TO BRING THAT INTO YOUR
WORK AS PROVIDERS.
SO THANK YOU.
>> VERY NICE, THANK YOU.
>> THANK YOU BOTH VERY MUCH FOR
REALLY EXTRAORDINARILY
STIMULATING, INFORMATIVE AND
PASSIONATE DEDICATION TO YOUR
WORK.
WE HAVE A SERIES OF QUESTIONS,
AND IN FACT I HAVE QUITE A FEW,
SO PLEASE RESPOND, WHOEVER FEELS
IT'S APPROPRIATE, AND TRY AND
LIMIT SOMEWHAT YOUR LENGTH OF
YOUR ANSWERS.
WE'VE HAD SEVERAL QUESTIONS
ABOUT HOW THE BRAIN WORKS IN
TERMS OF HEALING.
THERE WERE QUESTIONS ABOUT IT'S
ANECDOTAL THAT THE BRAIN HEALS
ITSELF.
SO THAT'S I GUESS A POPULAR
VERSION.
IS THAT TRUE, NORA, OR -- AND
HOW LONG DOES THAT TYPE OF
PROCESS TAKE?
>> WIN, I'M HAVING TROUBLE WITH
MY SOUND.
CAN YOU HEAR ME?
>> WE CAN HEAR YOU NICE AND
CLEAR NOW.
>> SO WHAT I -- BECAUSE THE
SOUNDS GO UP AND DOWN SO I HEARD
SOMETHING ABOUT GAPS, ABOUT THE
HUMAN BRAIN THAT MAKES IT
VULNERABLE TO ADDICTION, OR IS
IT HAPPENING IN OTHER -- WAS
THAT THE QUESTION?
>> YES.
>> THE ANSWER IS NO, IT CAN'T
HAPPEN IN ANIMALS, AND WE CAN
ACTUALLY EMULATE THE SAME
PATTERNS OF COMPULSIVE DRUG USE
IN ANIMALS, AND JUST LIKE IN
HUMANS, NOT EVERY ANIMAL GOES
INTO ESCALATION.
THERE ARE CERTAIN ANIMALS THAT
HAVE HIGHER RISK THAN OTHERS.
AND JUST LIKE HUMANS, ONE OF THE
WAYS THAT WE CAN MAKE ANIMALS
ESCALATE INTO DRUG-TAKING IS
STRESS THEM.
AND ONE OF THE MAIN STRESSORS
THAT PRODUCES THERE, THIS IS IN
LINE WITH WHAT MEGHANN WAS
SPEAKING, IS ISOLATION.
SO NO, THERE'S NOTHING UNIQUE
ABOUT THE HUMAN BRAIN THAT MAKES
IT SUSCEPTIBLE TO ADDICTION, AND
IS IT ALSO UNIQUE TO THE HUMAN
BRAIN THAT MAKES IT SUSCEPTIBLE
TO STRESS AND ISOLATION.
SO THIS HAS BEEN VERY HELPFUL,
THESE ANIMAL MODELS, TO
UNDERSTAND BECAUSE IN THEM, WE
CAN STUDY IN MUCH GREATER
PRECISION THE MOLECULES AND
NETWORKS THAT ARE ENGAGING THOSE
BEHAVIORS.
>> MEGHANN, THERE ARE SEVERAL
INQUIRIES ABOUT YOUR WONDERFUL
PRESENTATION.
THEY ALL BOIL DOWN TO HOW DO I
AS AN INDIVIDUAL GET INVOLVED IN
THE PROCESS THAT YOU SO
PASSIONATELY DESCRIBED?
WHAT CAN -- THIS IS WHAT MANY
PEOPLE ASK.
WHAT CAN I DO?
YOU LIST ALL THE REQUIREMENTS IN
A WAY, THE GOALS, BUT YOU ALSO
POINTED OUT THAT SORT OF
NATIONAL PROGRAMS AND OTHERS
AREN'T THE ANSWER, AT LEAST PART
OF THE ANSWER, BUT NOT THE WHOLE
ANSWER.
SO WHAT DO YOU ADVISE PEOPLE?
WHAT COULD THEY ACTUALLY DO, ALL
OF US, TO HELP IN THIS PROCESS?
>> I'LL TRY TO BE COU CONCISE AT
THAT BECAUSE THERE ARE A LOT OF
THINGS I COULD SAY, BUT YOU
KNOW, OUR WELLNESS IS REALLY
COMMUNITY-BASED, AND SO I THINK
IT'S IMPORTANT TO LOOK AT --
THAT WE GET WELL NOT IN
ISOLATION OR NOT IN ONE SINGLE
WAY, OR, YOU KNOW, IT'S RARE
THAT, YOU KNOW, I'M GOING TO GO
TO THIS ONE THING AND IT'S GOING
TO BE MIRACULOUS AND NOW I'M
BETTER.
SO LOOKING AT WHAT ARE THE WAYS
THAT WE CAN INTEGRATE THINGS
THAT ARE -- THAT PROMOTE
WELLNESS FOR PEOPLE, REGARDLESS
OF THEIR RELATIONSHIP WITH
SUBSTANCES.
YOU KNOW, WHERE CAN WE SORT OF
PLANT ALL OF THOSE THINGS IN OUR
COMMUNITIES.
AND THE PEER BASED MODEL AND
SORT OF HARM REDUCTION CENTERS
ARE LOOKING AT THIS IDEA OF WE
NEED SAFE PLACES FOR PEOPLE TO
LAND AND TO FEEL WELCOMED.
I THINK CERTAINLY THE PEER
MODEL, IF THAT IS MORE
SPECIFICALLY WHAT PEOPLE ARE
INTERESTED IN, THERE IS SO MUCH
TRAINING AVAILABLE IF YOU WANT
TO GET TRAINED IN THE PEER
MODEL, AND I ALWAYS ENCOURAGE
PEOPLE, I DON'T CARE WHAT
DISCIPLINE OR WHAT RELATIONSHIP
YOU HAVE TO THE CHALLENGE OF
SUBSTANCE USE AND OF OVERDOSE
DEATHS.
GETTING TRAINED IN THAT PEER
MODEL WILL INFORM ALL THE REST
OF YOUR WORK AND IT WILL CHANGE
HOW YOU TREAT PEOPLE, HOW YOU
ENGAGE WITH PEOPLE, SO I THINK
THE ENGAGEMENT PIECE IS REALLY
CRITICAL OF TRYING TO LET GO OF
THOSE BIASES AND WORK AGAINST
DISCRIMINATION AND WELCOME
PEOPLE AND ENGAGE WITH THEM AS
EQUALS IS REALLY, REALLY
CRITICAL.
>> THE RECOMMENDATION IS TO BE
AWARE OF THE COMMUNITY
FACILITIES, ORGANIZATIONS AND SO
FORTH, IN YOUR PARTICULAR PART
OF THE WORLD, AND WORK WITH
THEM.
IS THAT --
>> YEAH, ABSOLUTELY.
AND I THINK EVEN JUST AS AN
EXAMPLE, THERE'S 21 MILLION
PEOPLE THAT HAVE DIAGNOSABLE
SUBSTANCE USE DISORDER, IF
THAT'S THE LANGUAGE THAT -- OR
PROBLEMATIC SUBSTANCE USE, AND
THERE'S ONLY 3,000 BOARD
CERTIFIED PHYSICIANS.
THERE'S A HUGE GAP THERE.
SO, YOU KNOW, IF YOU'RE LOOKING
FOR SOMETHING THAT'S SORT OF
MORE IN YOUR DOMAIN, RESEARCH IS
A WHOLE 'NOTHER PIECE TOO OF
JUST LITERALLY GETTING MORE
TRAINING, MORE INFORMATION, AND
KNOWING THAT A LOT OF THE WORK
THAT'S BEING DONE IS BEING DONE
JUST IN THE COMMUNITY AND NOT
INSIDE ALL OF OUR SYSTEMS.
THERE'S NO ONE NICE EASY CLEAN
ANSWER BUT START LISTENING TO
FOLKS AND ASKING QUESTIONS IN
THE COMMUNITY.
>> SO RELATED TO THAT, NORA,
THERE ARE SEVERAL QUESTIONS
ABOUT -- MAYBE YOU BOTH CAN
RESPOND.
ARE WE DEALING WITH AN EPIDEMIC
OR ARE WE DEALING WITH A
PANDEMIC?
IS THIS A DISORDER PRIMARILY OF
THE SO-CALLED DEVELOPED WORLD?
>> NO, NO, NO, ADDICTION AS SUCH
IS NOT A DISORDER OF THE FIRST
WORLD, AND YOU SEE SERIOUS
PROBLEMS OF ADDICTION IN
COUNTRIES THAT ARE IN THE WAYS
OF DEVELOPMENT ALL OVER,
INCLUDING AFRICA.
THE NATURE OF THE PROBLEM VARIES
SIGNIFICANTLY, BUT BEING POOR AS
A COUNTRY DOES NOT PROTECT YOU
IN ANY WAY.
YOU TEND TO SEE SUBSTANCES THAT
ARE MUCH MORE ACCESSIBLE, LIKE
FOR EXAMPLE, IN MEXICO AND IN
BRAZIL, YOU SEE PROBLEMS WITH
INHALANTS THAT ARE VERY, VERY
TOXIC TO THE BRAIN BECAUSE THEY
ARE ACCESSIBLE.
AND IN THE UNITED STATES, WHERE
THERE ARE MORE RESOURCES, PEOPLE
CAN PAY FOR COCAINE AND THAT
ACTUALLY HAS HELPED -- WE'RE
TARGETED BY THE DRUG DEALERS
WITH THE SENSE THAT PEOPLE WILL
HAVE RESOURCES TO BUY THEM.
I WAS ACTUALLY -- BUT LET ME --
WHAT HAS BEEN INTRIGUING TO ME
AND I'VE BEEN MONITORING IT IS
THE EPIDEMIC OF FENTANYL.
SO -- AND THAT IS THE QUESTION
BECAUSE IT'S SUCH A HIGH, HIGH
PROFITABLE DRUG, SO FOR THE
DEALERS AND SO ADDICTIVE THAT
YOU SAY, WELL, IT'S GOING TO
EXPAND INTO OTHER AREAS OF THE
WORLD.
AND WE SEE A SERIOUS PROBLEM
ALSO IN CANADA, PARTICULARLY IN
THE WEST, IN VANCOUVER, THAT IS
AS BAD AS OURS, AND WE SEE IN
VANCOUVER IN SOME OF THE CITIES
MOST AFFECTED IN THE COUNTRY,
BUT WE ALSO ARE STARTING TO SEE
IT AND IT STARTED TO BE REPORTED
IN THE BORDER TOWNS IN MEXICO.
AND -- BUT -- AND I ACTUALLY
HAVE BEEN -- I HAVE CONNECTIONS
AND COLLABORATIONS WITH PEOPLE
IN VARIOUS COUNTRIES IN THE
WORLD AND OVERALL, THERE HAVE
BEEN INSTANCES ABSOLUTELY OF
PRESENCE OF FENTANYL IN ENGLAND
IN SOME OF THE NORTHERN EUROPEAN
COUNTRIES, BUT IT'S MUCH MORE
RESTRICTIVE.
AND WHERE WILL IT GO, I DO NOT
KNOW.
I THINK THAT THESE MARKETS ARE
DRIVEN BY PROFITS, AND IF WE
SATURATE, IF THEY SATURATE THE
MARKET IN THE UNITED STATES,
THEN I AM AFRAID WE'LL START TO
SEE IT IN OTHER COUNTRIES.
BUT AS OF NOW, IT IS PRETOM
PREDOMINANTLY CONCENTRATED IN
NORTH AMERICA, FOR FENTANYL.
BUT AS I SAY, ADDICTIONS ARE
EVERYWHERE.
ALCOHOL, TOBACCO, HEROIN,
CANNABIS.
AND THE PREVALENCE RATES VARY BY
COUNTRIES, AND WORLD HEALTH
ORGANIZATION MONITORS
PERIODICALLY THE DIFFERENCES IN
PREVALENCE FOR THE USE OF THESE
DRUGS, AND IN GENERAL, THE
UNITED STATES TEND TO HAVE
HIGHER RATES OF DRUG USE THAN
OTHER COUNTRIES, UNITED STATES
AND CANADA.
IN GENERAL.
BUT COMING TO ALCOHOL, AND
CIGARETTES, AS YOU KNOW,
ANYTHING TEEN SMOKING HAS BEEN
GOING DOWN IN OUR COUNTRY,
WHEREAS IT'S VERY HIGH IN
COUNTRIES LIKE CHINA.
SO NO, IT'S NO PROTECTION.
IT CHANGES THE DRUGS THAT PEOPLE
ACCESS.
>> ARE THERE LESSONS THAT WE CAN
LEARN FROM WHAT'S HAPPENING IN
OTHER COUNTRIES?
>> ABSOLUTELY.
I THINK THAT IT'S VERY
IMPORTANT, BECAUSE -- I MEAN,
AND AS -- AND AGAIN, I MEAN, AS
MEGHANN WAS SPEAKING, WE HAVE
POLICIES THAT WE HAVE IN OUR
COUNTRY THAT ARE PRODUCING MORE
HARM THAN GOOD, AND BEING ABLE
TO LEARN FROM EXPERIENCES IN
OTHER COUNTRIES THAT HAVE
DISTINCT POLICIES CAN ACTUALLY
HELP US COME UP WITH
ALTERNATIVES.
THIS HAS BECOME CENTRALIZED AND
EXTREMELY CONTROVERSIAL WHEN IT
COMES, FOR EXAMPLE, WITH
CANNABIS, MARIJUANA.
MARIJUANA PRODUCES ADDICTION.
BUT IT MUCH LESS ADDICTIVE THAN
MANY OTHER DRUGS, AND IT'S LESS
TOXIC.
IT DOES NOT MEAN THAT IT DOES
NOT PRODUCE HARM.
IT ABSOLUTELY PRODUCES HARM AND
IT DOES PRODUCE ADDICTION, BUT
IF YOU COMPARE IT WITH OTHER
DRUGS, IT'S ACTUALLY MUCH LESS
DANGEROUS.
THE AND THE WAY THAT COUNTRIES
HAVE BEEN DEALING WITH MARIJUANA
HAS VARIED SIGNIFICANTLY, AND WE
KNOW ALL ALONG, FOR EXAMPLE,
THAT IN THE NETHERLANDS, WHERE
MARIJUANA IS LEGAL, YOU HAVE
SOME OF THE LOWEST RATES OF
MARIJUANA CONSUMPTION IN THAT
POPULATION.
WE KNOW THAT, FOR EXAMPLE,
PORTUGAL, WHICH ALSO LEGALIZED
ALL OF THOSE DRUGS,
SIGNIFICANTLY REDUCED THE
ADVERSE EFFECTS OF THESE DRUGS,
AND WAS ABLE TO CONTROL IT.
AND WHAT DO WE LEARN FROM IT?
I WANT TO HIGHLIGHT, IS THAT
WHEN THEY DID LEGALIZATION, THEY
DID IT WITH A PARALLEL GROWTH
AND ACCESS TO TREATMENT.
SO IT'S NOT JUST THAT YOU
LEGALIZE, BUT YOU PROVIDE THE
STRUCTURE THAT CAN HELP PEOPLE
ACTUALLY GET TO TREATMENT.
AND THAT SUPPORT SYSTEMS THAT A
PERSON REQUIRES TO THEN BE -- TO
GO TO TREATMENT AND TO ACHIEVE
RECOVERY.
AND THOSE ARE SOCIAL STRUCTURAL
SYSTEMS THAT PROTECTS THEM
AGAINST DISCRIMINATION, THAT
PROTECTS THEM AGAINST ISOLATION,
THAT GIVES THEM OPPORTUNITIES.
BECAUSE OTHERWISE, THE ONLY
CHOICE THEY MAY HAVE IS, IN
ORDER TO SURVIVE THEIR REALITY,
IS TO TAKE DRUGS.
AND I THINK VERY MUCH THAT WHOLE
NOTION OF HOW DO WE CHANGE THEIR
CONDITION SO THAT THEY DON'T
HAVE TO ESCAPE, AS MEGHANN WAS
SAYING, BUT THEY ACTUALLY CAN
CHOOSE TO RECOVER AND FLOURISH,
I THINK THAT'S WHAT WE CAN LEARN
FROM SOME OTHER COUNTRIES.
AND SOME HAVE DONE IT QUITE
WELL.
BUT WE ARE STILL QUITE FAR
BEHIND.
>> MEGHANN, WHAT IS YOUR FEELING
ABOUT THAT PROBLEM?
>> I THINK I AGREE, MANY WOULD
ARGUE THAT CRIMINALIZATION IS
ACTUALLY WHAT DRIVES MOST OF THE
HARM RELATED TO SUBSTANCE USE,
AND ONE WAY TO SORT OF LOOK AT
THE CONTEXT LIKE DR. VOLKOV WAS
JUST REFERRING TO IS THAT IT'S
ACTUALLY IF WE KIND OF DECENTER
THE SUBSTANCE ITSELF AND LOOK AT
ALL OF WHAT IS GOING ON THAT'S
DRIVING SUBSTANCE USE, THAT WE
MIGHT BE MUCH MORE EFFECTIVE IN
ADDRESSING THE HARMS THAT ARE
CAUSED BY SUBSTANCE USE, BY
PROBLEMATIC RELATIONSHIPS WITH
SUBSTANCES, AND SO, YOU KNOW, AN
EXAMPLE LI LIKE PORTUGAL WHERE Y
DECRIMINALIZED AND ADDED IN
OTHER TYPES OF SOCIAL SERVICES
IS A GREAT MODEL.
AND THE RESULTS HAVE BEEN GOOD.
AND SO IF WE CAN KIND OF -- YOU
KNOW, I KNOW WE'RE HERE -- THIS
IS ABOUT FENTANYL, AND IN MY
PERCEPTION, IT'S ABOUT A CRISIS
OF SUBSTANCE-RELATED DEATHS THAT
ARE INDICATIVE OF MUCH BIGGER
PROBLEMS THAT WE HAVE.
AND SO IF WE'RE ALWAYS
HYPERFOCUSED ON THIS SUBSTANCE
IS BAD, WE'RE MISSING SO MUCH OF
THE CONTEXT OF WHAT ACTUALLY IS
GOING ON AND IS DRIVING DEATHS.
>> THERE HAVE BEEN A WHOLE
SERIES OF QUESTIONS DEALING WITH
OTHER DRUGS, EITHER THOSE THAT
ARE ALLEGED TO BE BENEFICIAL
LIKE, FOR EXAMPLE, THE NEW
PEPTIDE WEIGHT REDUCTION
MEDICATIONS, AND TO THOSE THAT
PEOPLE HAVE ASKED WHETHER
CONCOMITANT EXPOSURE MAKES
THINGS WORSE, THINGS LIKE
ALCOHOL, MARIJUANA, OTHER, AND
KETAMINE WAS THE OTHER ONE THAT
WAS MENTIONED.
SO WE'VE GOT TWO ISSUES HERE.
ONE IS WHETHER TWO POISONS ARE
MORE DAMAGED TH SOME OF THEIR
EFFECTS.
ARE THESE ISSUES TO WORRY ABOUT?
AND ALSO ARE THERE BENEFICIAL
DRUGS BESIDES NALOXONE SUCH AS
THE REPORTS WITH THE WEIGHT
REDUCTION PILLS?
SO NORA, YOU WANT TO START WITH
THAT?
>> I WOULD SAY THAT WHETHER
COMBINATION OF DRUGS HAS HARMFUL
OR LESS HARMFUL EFFECT WILL
DEPEND SPECIFICALLY ON THE TYPE
OF COMBINATION.
FOR EXAMPLE, WE'RE SEEING VERY,
VERY FREQUENTLY -- AT LEAST 60%
OF PEOPLE THAT HAVE -- THAT ARE
IN TREATMENT PROGRAMS WITH
FENTANYL, 60% ALSO TAKE
CANNABIS, AND THE DATA SEEMS TO
AT LEAST PRIM NARELY INDICATE
WITH CONSUMPTION OF CANNABIS
ALLOWS THEM TO REDUCE THE AMOUNT
OF FENTANYL THAT THEY TAKE.
SO IN THAT RESPECT, YOU WOULD
SAY THAT IS A BENEFICIAL EFFECT,
BECAUSE FENTANYL IS SUCH A
DANGEROUS DRUG THAT ANYTHING
THAT YOU CAN DO TO REDUCE THE
DOSES THAT YOU'RE GOING TO GET
EXPOSED TO WOULD ACTUALLY HAVE A
NET BENEFICIAL EFFECT OF
PROTECTING YOU, LOWERING YOUR
RISK FOR OVERDOSE.
SO THIS IS AN EXAMPLE WHERE IT
COULD HAVE A VALUABLE EFFECT.
WHEN WE ARE DEALING WITH LIKE,
FOR EXAMPLE, COMBINATION OF
NICOTINE SMOKING AND CANNABIS
SMOKING, OVERALL THE EVIDENCE
SEAMS TO SHOW -- AND AGAIN, IT
ALSO DEPENDS ON WHAT SYSTEM YOU
ARE LOOKING AT.
IN THAT CASE, THE DATA HAVE
SHOWN THAT THE EFFECTS ON
PULMONARY FUNCTION ARE WORSE
WHEN YOU COMBINE CANNABIS
SMOKING WITH TOBACCO SMOKING
THAN EITHER OF THEM ALONE.
SO WE VERY MUCH -- ON THE TYPE
OF DRUG THAT YOU ARE -- THE
QUESTION ABOUT IS THERE -- HOW
ABOUT THE OTHER MEDICATIONS, AND
YOU WERE MENTIONING THIS --
PEPTIDE AGONIST MEDICATIONS LIKE
OWOZEMPIC OR THOSE USED TO REDUE
OBESITY, THE DATA LOOKS
EXTREMELY INTERESTING.
IN ANIMAL MODELS, FOR EXAMPLE,
RESEARCHERS HAVE SHOWN THAT
SPECIFICALLY THESE MEDICATIONS
CAN PREVENT CONSUMPTION OF
NICOTINE, COCAINE, THEY'VE ALSO
SHOWN IT FOR ALCOHOL.
THEY HAVE NOT SHOWN IT FOR
CANNABIS YET BECAUSE THEY
HAVEN'T BEEN DONE.
BUT MEANWHILE, IN RESEARCH OF
ANALYSIS OF ELECTRONIC RECORDS
WHERE YOU'RE MONITORING DATA ON
HUNDREDS OF THOUSANDS OF
PATIENTS, SO SOMETIMES MILLIONS,
ON WHAT YOU CAN SEE IS IF THOSE
PEOPLE THAT WERE PRESCRIBED
PEPTIDE MEDICATIONS FOR DIABETES
COMPARED WITH THOSE THAT WERE
PRESCRIBED OTHER ANTIDIABETIC
DRUGS, SAME THINGS FOR OBESITY,
YOU CAN SEE REDUCED UTILIZATION
OF TREATMENT, YOU CAN SEE
IMPROVED -- INDICATORS THAT SHOW
BENEFIT FOR THE SUBSTANCE USE
DISORDER.
AND YES, PEOPLE ARE REPORTING AS
I MENTIONED AT THE BEGINNING
THEIR DESIRES TO TAKE DRUGS,
ALCOHOL, TOBACCO, MARIJUANA,
SMOKING GOES DOWN WHEN THEY ARE
ON THESE MEDICATIONS.
SO WE ARE FUNDING RESEARCHERS,
THE ALCOHOL INSTITUTE IS ALSO
FUNDING RESEARCHERS TO DO
RANDOMIZED CLINICAL TRIALS
BECAUSE IT DOES HAVE THE
POTENTIAL OF GIVING US
MEDICATIONS, MEDICATIONS THAT
COULD BE VALUABLE IMPORTANTLY
NOT FOR ONE DRUG, IT'S NOT JUST
SPECIFICALLY -- WHEN YOU HAVE
METHADONE, IT TARGETS THE OPIOID
RECEPTORS, SO THOSE TREATMENTS
ARE FOR OPIOIDS.
IN THIS CASE, IT'S A TREATMENT
THAT COULD USE FOR ALCOHOL, FOR
MARIJUANA, FOR CIGARETTE
SMOKERS.
IT DOESN'T MATTER WHAT ROLE.
WHICH OF COURSE IS HIGHLY
DESIRABLE BECAUSE AS I
MENTIONED, PEOPLE ARE COMBINING
DRUGS.
SO IT'S VERY EXCITING, THAT EA
THE POSSIBILITY, THE POTENTIAL
LOOKS QUITE PROMISING.
UNTIL WE OF COURSE HAVE
RANDOMIZED CLINICAL TRIALS, WE
WON'T BE ABLE TO SAY DEFINITELY,
BUT IT DOES LOOK VERY GOOD.
>> VERY BRIEFLY, WHAT DO YOU
THINK WOULD BE THE MECHANISM OF
SUCH AN EFFECT?
>> WELL, YOU KNOW, THE REALITY
IS THAT ONE OF THE SYSTEMS --
BASICALLY JUST HIJACK THE
CIRCUITS IN OUR BRAIN THAT DRIVE
OUR MOTIVATION TO EAT.
AND AS A RESULT OF THAT, IT'S
NOT SURPRISING THAT MANY OF THE
MOLECULES THAT SIGNAL SATIETY OR
THAT SIGNAL THE HUNGER ACTUALLY
MODIFIED THE REWARDING EFFECTS
OF DRUGS.
AND IN THAT SIMPLE WAY OF
EXPLAINING THIS IS, WHEN YOU'RE
HUNGRY, THE FOOD ACQUIRES AN
ENHANCED VALUE, SALE YEN SEE
VALUE, IT'S MORE REWARDING.
THAT IS THE DOPAMINE SYSTEM.
THAT IS THE SYSTEM THAT ACTUALLY
DRUGS DIRECTLY ACTIVATE.
SO WHEN YOU ARE HUNGRY, THESE
SIGNALS THAT ACTUALLY COME FROM
PERIPHERAL AS WELL AS CENTRAL
MECHANISMS LEAD ON TO MAXIMIZE
THE ACTIVATION OF THE DOPAMINE
SYSTEM TO MOTIVATE YOU TO GO
SEEK THE FOOD.
SO, THEREFORE, NOT SURPRISED
THAT IF YOU HAVE A MECHANISM
THAT CURTAILS THAT HYPERDRIVE TO
GET THE FOOD AND TO CONTINUE TO
EAT IT, THIS IS TARGETING THAT
DOPAMINERGIC SYSTEM, NOT
SURPRISED, IT ALSO MAY TARGETING
ACTUALLY THE DRIVE TO TAKE
DRUGS, BECAUSE THAT DOPAMINE
SYSTEM IS NOT -- IT'S FOR US TO
ENSURE THAT WE CONSUME FOOD THAT
WILL KEEP US ALIVE.
SO IT'S THAT BIOLOGICAL
SUBSTRATE THAT IS SO ESSENTIAL
FOR SURVIVAL WHICH IS THE ONE
THAT DRUGS GO AFTER AND WHY THEY
CAN BE SO, SO DISRUPTIVE.
>> MEGHANN, WOULD YOU RESPOND TO
THAT, AND ALSO THERE'S A
QUESTION THAT CAME IN, HOW DO
YOU OR COMMUNITIES EVALUATE THE
SUCCESS OR FAILURE OF VARIOUS
MODALITIES THAT RINT DUED INTRO
DEAL WITH ADDICTION?
>> THANK YOU FOR THAT QUESTION.
I'M GOING TO LEAVE THE FORMER
ONE TO DR. VOLKOW.
THAT'S OUT OF MY SORT OF AREA OF
EXPERTISE.
IN TERMS OF MEASUREMENT, SO IT
IS A TRICKY THING, RIGHT, HOW DO
WE RESEARCH SOMETHING THAT'S NOT
A QUANTITATIVE OUT COME, RIGHT?
SO WHEN WE'RE LOOKING AT
INCREASED WELLNESS ACROSS THE
MULTIPLE DOMAINS OF WELLNESS,
IT'S MUCH HARDER TO MEASURE THAT
THAN, ABSTINENCE, THEY'VE
ACHIEVED ABSTINENCE FROM ALL
SUBSTANCES AND IT HAPPENED ON
THIS DAY AND THEY MAINTAINED IT
FOR THIS LONG AND OOP, THEY TOOK
AWARE -- SO WE USE SOMETHING A
LOT OF FOLKS LOOK AT THE
RECOVERY CAPITAL INDEX, OR
RECOVERY CAPITAL SCALE.
SO WE LOOK AT WELLNESS IN ALL
DIFFERENT AREAS OF LIFE.
WE KNOW THAT WELLNESS EXISTS
ACROSS PHYSICAL, ENVIRONMENTAL,
SOCIAL, SPIRITUAL FOR SOME
FOLKS, THAT YOU HAVE MEANING AND
PURPOSE.
AND SO WE CAN MEASURE QUALITY OF
LIFE IN WAYS THAT WE CAN STILL
QUANTIFY THAT, RECOVERY CAPITAL
SKILL IS A GREAT TOOL FOR DOING
THAT.
SO I THINK THAT -- I THINK
RESEARCHERS HAVE A LOT OF WORK
TO DO TO FIGURE THAT OUT, AND SO
MUCH RESEARCH IS STILL
PREDICATED ON A VERY CONCRETE
CLEAR -- BECAUSE IT'S EASIER,
RIGHT?
IT'S EASIER TO SORT OF USE THAT
STANDARD AND IT -- I DO SEE
RESEARCH EVOLVING IN ATTEMPTING
TO SORT OF MEASURE THINGS A
LITTLE BIT DIFFERENTLY NOW.
BUT WE HAVE A LOT OF WORK TO DO
IN THAT AREA AND BECAUSE -- JUST
SYSTEMS AND MONEY AND
REIMBURSEMENT AND HOW EVERYTHING
SORT OF TIED TO MEASURABLE
OUTCOMES, IT'S A LITTLE BIT --
WE'RE STILL HAVING TO KIND OF
PUSH TO SEE THINGS IN A MORE
COMPLEX WAY.
IT HARD TO MEASURE COMPLEX
THINGS.
AND THIS IS A VERY COMPLEX THI
THING.
AND I WOULD LOVE TO TAKE A
MOMENT, IF I CAN, TO TALK ABOUT
STIGMA.
AND MY WONDERFUL FRIEND
DR. HERNANDEZ SAYS YOU CAN CALL
IT STIGMA ALL DAY BUT WHAT IT IS
IS DISCRIMINATION.
AND THAT IS AT EVERY LEVEL OF
ALL OF THE SYSTEMS AND ALL OF --
IT EVEN EXISTS WITHIN US
PERSONALLY AS PEOPLE WITH
SUBSTANCE USE CHALLENGES, AND
THE POWER OF STORY AND
STORYTELLING IS REALLY -- I
MEAN, IT'S ONE OF OUR BEST
TOOLS, IT'S SO CENTRAL TO WHO WE
ARE AS HUMANS, HOW WE
COMMUNICATE, HOW WE ARE IN
RELATIONSHIP WITH ONE ANOTHER.
SO IN RESEARCH IN HEALTHCARE,
ARE YOU TRULY LISTENING TO THE
STORIES OF THE FOLKS THAT YOU'RE
ENGAGING WITH AND LEARNING FROM
THEM?
AND THINKING ABOUT HOW WE ENGAGE
IN -- IF YOU'RE INTERESTED IN
MORE ABOUT THAT, YOU CAN
CERTAINLY FIND ME.
BECAUSE IT'S ONE OF MY FAVORITE
TOPICS, AND I THINK IT'S REALLY,
REALLY IMPORTANT IN ALL OF OUR
WORK MOVING FORWARD, THAT WE
LOOK AT THAT.
>> MEGHANN, THERE HAVE BEEN
SEVERAL REQUESTS, IF YOU WOULD
PLEASE -- I THINK YOU CAN STILL
DO IT -- PUT UP YOUR LAST
POWERPOINT THAT HAS YOUR WEBSITE
AND YOUR EMAIL ADDRESS.
YEAH.
OKAY.
SO WH WHY DON'T WE LEAVE THAT U.
WE ONLY HAVE ABOUT A HALF A
MINUTE LEFT TO GO.
WELL, THERE ARE A BUNCH OF OTHER
QUESTIONS WHICH UNFORTUNATELY WE
CAN'T GET TO THEM ALL.
I WOULD JUST MENTION THAT THERE
WAS ONE QUESTION ABOUT
EVALUATING PUBLIC HEALTH
POLICIES RELATING TO RESULTS IN
PORTUGAL.
AND A RECENT ARTICLE AT LEAST IN
THE "NEW YORK TIMES" THAT
QUESTIONED THE EFFECTIVENESS OF
THAT.
SO I GUESS THIS WHOLE BUSINESS
OF WHATEVER WE DO, WHETHER IT'S
PHARMACOLOGIC OR SOA SOA SOA SOO
HAVE SOME FEEDBACK AS TO WHETHER
THESE SYSTEMS ARE HAVING THE
EFFECT THAT WE DESIRE, I
PERSONALLY THINK THIS IS
PARTICULARLY TRUE IN THE FIELD
OF EDUCATION, WHERE YOU RARELY
FIND ANY EVALUATION.
IT'S USUALLY ON TO THE NEXT
MODEL.
I THINK THAT'S A COMMON THING WE
ALL FACE.
WHAT DO YOU THINK ABOUT THAT,
MEGHANN?
OKAY.
>> I'LL PASS THAT TO DR. VOLKOW.
>> LISTEN, MEGHANN, WE WANT TO
THANK YOU ENORMOUSLY FOR SHARING
YOUR PERSONAL EXPERIENCE AND FOR
BRINGING YOUR IDEAS AND YOUR
ACTIVITIES TO OUR AWARENESS.
SOMETIMES I THINK WHERE WE ARE,
WE'RE A LITTLE BIT IN A BUBBLE,
AND WE DON'T HEAR ABOUT SUCH
THINGS.
SO MUCH THANKS TO YOU.
AND OF COURSE FOR NORA, WHO
ALWAYS EXCITES US WITH WHAT THE
CURRENT SITUATION IS, AND WHAT
THE HOPES FOR THE FUTURE ARE.
NORA, THERE WERE SEVERAL
QUESTIONS WHICH WE DIDN'T GET
TIME TO ADDRESS TO YOU, BUT ONE
OF THEM, THEY ALL DEALT ON --
WHEN YOU TALK ABOUT A VACCINE,
YOU KNOW, WHAT HAVE YOU GOT IN
MIND?
I DON'T THINK WE HAVE TIME FOR
YOU TO ANSWER THAT, BUT IT'S
INTERESTING.
WELL, MAYBE YOU QUICKLY COULD.
>> THE IDEA OF A VACCINE IS LIKE
FOR ANY OTHER VACCINE, WHICH
ACTUALLY HAVE AN ANTIBODY THAT
TRAPS THE ORGANISM, IN THIS
CASE, THAT TRAPS THE CHEMICAL IN
THE BLOOD AND DOESN'T LET IT GO
INTO THE TISSUES, THE BRAIN,
VERY IMPORTANT.
SO THAT IS THE WHOLE -- AND THE
SAME THING WITH THE USE OF
MONOCLONAL ANTIBODIES, JUST LIKE
FOR COVID.
BUT FOR DRUGS.
>> ALL RIGHT.
>> I HOPE THAT ANSWERS IT.
IT'S SORT OF LIKE VERY
STRAIGHTFORWARD.
>> WELL, ON THAT NOTE, WE HAVE
TO END, AND I WANT TO THANK YOU
ON BEHALF OF THE MANY, MANY
HUNDREDS OF PEOPLE, HERE AT NIH
AND AROUND THE WORLD, WHO NOW
AND WHEN THEY DOWNLOAD YOUR
PRESENTATIONS WILL BENEFIT AND
BE STIMULATED BY THEM.
SO THANK YOU. 3165 02:03:10,583 THANK YOU VERY MUCH.