1 00:00:05,372 --> 00:00:10,944 >> WELCOME TO ANOTHER SESSION OF 2 00:00:11,010 --> 00:00:13,279 THE 23RD YEAR OF A COURSE CALLED 3 00:00:13,346 --> 00:00:19,052 DEMYSTIFYING MEDICINE. 4 00:00:19,119 --> 00:00:23,323 I'M WIN ARIAS, A SENIOR 5 00:00:23,390 --> 00:00:24,624 SCIENTIST EMERITUS, AND WE ARE 6 00:00:24,691 --> 00:00:26,659 PRESENTING THIS FROM THE 7 00:00:26,726 --> 00:00:30,096 NATIONATIONAL INSTITUTES OF HEAN 8 00:00:30,163 --> 00:00:31,197 BETHESDA, MARYLAND. 9 00:00:31,264 --> 00:00:32,932 THE PURPOSE OF THIS COURSE FROM 10 00:00:32,999 --> 00:00:36,102 ITS VERY BEGINNING WAS TO BRIDGE 11 00:00:36,169 --> 00:00:40,473 THE EXCITING DEVELOPMENTS IN 12 00:00:40,540 --> 00:00:43,676 BIOLOGICAL, ENGINEERING, AND 13 00:00:43,743 --> 00:00:45,311 COMPUTER SCIENCES WITH MEDICINE 14 00:00:45,378 --> 00:00:46,846 AND PUBLIC HEALTH. 15 00:00:46,913 --> 00:00:49,482 IT IS REALLY A COURSE IN BRIDGE 16 00:00:49,549 --> 00:00:51,084 BUILDING. 17 00:00:51,151 --> 00:00:55,021 THE INTENT IS TO EXCITE OUR VERY 18 00:00:55,088 --> 00:00:58,525 HETEROGENEOUS AUDIENCE INTO 19 00:00:58,591 --> 00:01:03,029 OPPORTUNITIES FOR NEW IDEAS AND 20 00:01:03,096 --> 00:01:05,198 RESEARCH IN ADVANCING MAJOR 21 00:01:05,265 --> 00:01:08,735 PROBLEMS IN THE BASIC SCIENCE 22 00:01:08,802 --> 00:01:10,770 AND PARTICULARLY IN ITS LINKS TO 23 00:01:10,837 --> 00:01:13,206 HUMAN DISEASE. 24 00:01:13,273 --> 00:01:15,375 SO THE COURSE IS HELD ON 25 00:01:15,442 --> 00:01:19,078 TUESDAYS FROM 4:00 TO 6:00 P.M. 26 00:01:19,145 --> 00:01:21,614 FROM JANUARY TO MAY. 27 00:01:21,681 --> 00:01:24,117 YOU CAN WATCH IT ON THE 28 00:01:24,184 --> 00:01:26,653 VIDEOCAST LINK SHOWN ON THIS 29 00:01:26,719 --> 00:01:29,155 SLIDE. 30 00:01:29,222 --> 00:01:32,459 FOR THOSE WHO WISH CME CREDIT, 31 00:01:32,525 --> 00:01:40,099 TODAY THE CODE IS 52101. 32 00:01:40,166 --> 00:01:41,501 AND MOST IMPORTANTLY, WE URGE 33 00:01:41,568 --> 00:01:44,571 YOU NO MATTER WHERE YOU ARE TO 34 00:01:44,637 --> 00:01:47,974 SUBMIT QUESTIONS DURING THE 35 00:01:48,041 --> 00:01:50,376 PRESENTATIONS TODAY, AND YOU DO 36 00:01:50,443 --> 00:01:52,245 THAT BY CLICKING ON YOUR "SEND 37 00:01:52,312 --> 00:01:56,716 LIVE FEEDBACK" ON YOUR VIDEOCAST 38 00:01:56,783 --> 00:02:01,554 DISPLAY. 39 00:02:01,621 --> 00:02:03,289 THE SPEAKERS WILL TALK FIRST, 40 00:02:03,356 --> 00:02:06,793 AND THEN WE WILL HAVE AN 41 00:02:06,860 --> 00:02:08,761 EXTENSIVE Q & A AND DISCUSSION 42 00:02:08,828 --> 00:02:12,065 IN WHICH YOUR QUESTIONS AND 43 00:02:12,131 --> 00:02:14,000 OTHERS WILL OCCUPY THE REST OF 44 00:02:14,067 --> 00:02:19,038 OUR TIME UNTIL 6:00 P.M. 45 00:02:19,105 --> 00:02:20,573 I CALL TO YOUR ATTENTION THAT 46 00:02:20,640 --> 00:02:21,774 ALL PREVIOUS SESSIONS FROM THE 47 00:02:21,841 --> 00:02:25,912 VERY BEGINNING ARE ARCHIVED AND 48 00:02:25,979 --> 00:02:29,115 ARE ACCESSIBLE IN THE LINK SHOWN 49 00:02:29,182 --> 00:02:29,749 ON THIS SLIDE. 50 00:02:29,816 --> 00:02:34,687 IT'S THE 51 00:02:34,754 --> 00:02:35,355 VIDEOCAST.NIH.GOV/PASTEVENTS, ET 52 00:02:35,421 --> 00:02:36,756 CETERA. 53 00:02:36,823 --> 00:02:37,957 IF YOU HAVE ANY ADDITIONAL 54 00:02:38,024 --> 00:02:39,492 INFORMATION, YOU CAN CONTACT US, 55 00:02:39,559 --> 00:02:41,127 WE'LL BE DELIGHTED TO RESPOND. 56 00:02:41,194 --> 00:02:42,762 NOW THERE ARE TWO SYMBOLS OF 57 00:02:42,829 --> 00:02:44,531 THIS COURSE, THE ONE ON THE 58 00:02:44,597 --> 00:02:46,733 LOWER RIGHT ON THIS SLIDE IS A 59 00:02:46,799 --> 00:02:47,033 SILO. 60 00:02:47,100 --> 00:02:50,970 AND IN A WAY, THAT REPRESENTS 61 00:02:51,037 --> 00:02:54,140 THE EXTENSIVE INFORMATION THAT 62 00:02:54,207 --> 00:02:55,675 IS KNOWN, BUT UNFORTUNATELY IN 63 00:02:55,742 --> 00:02:58,745 DIFFERENT HEADS. 64 00:02:58,811 --> 00:03:00,046 SO THE PURPOSE OF THIS COURSE IS 65 00:03:00,113 --> 00:03:02,782 TO BE MORE LIKE THE UPPER IMAGE, 66 00:03:02,849 --> 00:03:05,084 WHICH IS THE BROOKLYN BRIDGE. 67 00:03:05,151 --> 00:03:08,154 AND TO BRIDGE DISCIPLINES THAT 68 00:03:08,221 --> 00:03:09,455 VERY OFTEN DON'T COMMUNICATE 69 00:03:09,522 --> 00:03:11,758 WITH ONE ANOTHER ABOUT THESE 70 00:03:11,824 --> 00:03:13,293 MAJOR ISSUES THAT ARE THE 71 00:03:13,359 --> 00:03:16,563 SUBJECT OF THE OVERALL COURSE. 72 00:03:16,629 --> 00:03:18,598 AND AS ALWAYS, WE ARE LIKE THE 73 00:03:18,665 --> 00:03:21,267 TWO INDIVIDUALS ON THE CATWALK 74 00:03:21,334 --> 00:03:24,437 HERE OF THE BROOKLYN BRIDGE. 75 00:03:24,504 --> 00:03:26,339 REPRESENTING TWO DIFFERENT 76 00:03:26,406 --> 00:03:29,709 ASPECTS OF A MAJOR HEALTH AND 77 00:03:29,776 --> 00:03:31,778 SCIENCE PROBLEM. 78 00:03:31,844 --> 00:03:34,714 VERY FREQUENTLY, WE BEGIN BY 79 00:03:34,781 --> 00:03:37,550 HAVING A LIVE PATIENT DESCRIBE 80 00:03:37,617 --> 00:03:40,186 THEIR ILLNESS, AND THEN A 81 00:03:40,253 --> 00:03:41,721 FURTHER DISCUSSION AND 82 00:03:41,788 --> 00:03:49,829 PRESENTATION BY TWO SPEAKERS. 83 00:03:49,896 --> 00:03:54,400 THE CME CODE CREDIT IS 52101 AND 84 00:03:54,467 --> 00:04:01,975 THE TEXT CODE IS 844-980-1555. 85 00:04:02,041 --> 00:04:04,477 THERE ARE NO DISCLOSURES BY OUR 86 00:04:04,544 --> 00:04:08,715 SPEAKERS. 87 00:04:08,781 --> 00:04:10,383 NOW, THINK FOR A MOMENT. 88 00:04:10,450 --> 00:04:13,753 HAVE YOU EVER HEARD OF THE 89 00:04:13,820 --> 00:04:16,289 FOLLOWING, AND YOU CAN READ THAT 90 00:04:16,356 --> 00:04:18,791 LONG LIST OF SOMEWHAT EXOTIC 91 00:04:18,858 --> 00:04:21,094 NAMES. 92 00:04:21,160 --> 00:04:22,729 IF YOU ARE, YOU ARE FAMILIAR 93 00:04:22,795 --> 00:04:25,465 WITH THE STREET NAMES FOR 94 00:04:25,531 --> 00:04:27,433 FENTANYL. 95 00:04:27,500 --> 00:04:29,969 WHICH IS PRESENTING AND HAS 96 00:04:30,036 --> 00:04:34,340 PRESENTED FOR SOME TIME NOW A 97 00:04:34,407 --> 00:04:41,447 MAJOR CHALLENGE IN TERMS OF DRUG 98 00:04:41,514 --> 00:04:46,586 ADDICTION, SUICIDE, AND EVER 99 00:04:46,653 --> 00:04:49,756 SEEMINGLY INCREASING EPIDEMIC, 100 00:04:49,822 --> 00:04:51,624 AND MAY -- I'M NOT SURE ABOUT 101 00:04:51,691 --> 00:04:54,594 THIS, ACTUALLY BE A PANDEMIC. 102 00:04:54,661 --> 00:04:57,730 AND THESE ARE THE NAMES THAT ARE 103 00:04:57,797 --> 00:05:02,235 USED IN THE STREET TO SELL 104 00:05:02,301 --> 00:05:03,870 FENTANYL, OFTEN TO PEOPLE WHO 105 00:05:03,936 --> 00:05:05,071 MAY NOT EVEN SUSPECT THAT 106 00:05:05,138 --> 00:05:06,072 THEY'RE GETTING IT. 107 00:05:06,139 --> 00:05:07,707 I'M SURE WE'LL HEAR ABOUT THAT 108 00:05:07,774 --> 00:05:15,682 IN TODAY'S DISCUSSION. 109 00:05:15,748 --> 00:05:17,750 SO I WONDER ABOUT THINGS LIKE IS 110 00:05:17,817 --> 00:05:19,519 THERE ONLY ONE FENTANYL? 111 00:05:19,585 --> 00:05:22,355 ARE THERE MORE DANGEROUS 112 00:05:22,422 --> 00:05:25,958 DERIVATIVES? 113 00:05:26,025 --> 00:05:27,393 AND ARE THERE EVEN MORE THAT CAN 114 00:05:27,460 --> 00:05:28,261 BE MADE? 115 00:05:28,327 --> 00:05:30,129 AND HOW IS FENTANYL HIGHLY 116 00:05:30,196 --> 00:05:33,933 ADDICTIVE? 117 00:05:34,000 --> 00:05:36,669 I WONDER, SHOULD IT EVER BE 118 00:05:36,736 --> 00:05:37,904 PRESCRIBED -- IT IS FOR PAIN, 119 00:05:37,970 --> 00:05:39,605 AND I BELIEVE IT IS APPROVED BY 120 00:05:39,672 --> 00:05:45,311 THE FDA. 121 00:05:45,378 --> 00:05:46,412 CAN ONE BE TAKING FENTANYL 122 00:05:46,479 --> 00:05:49,582 WITHOUT EVEN KNOWING IT? 123 00:05:49,649 --> 00:05:52,118 AND HAS FENTANYL REPLACED HEROIN 124 00:05:52,185 --> 00:05:54,954 IN ADDICTION? 125 00:05:55,021 --> 00:05:56,055 THERE ARE MANY, MANY QUESTIONS 126 00:05:56,122 --> 00:05:57,356 OF THIS TYPE, AND THESE ARE JUST 127 00:05:57,423 --> 00:06:01,160 THE FEW THAT POPPED IN MY MIND, 128 00:06:01,227 --> 00:06:03,763 AND MORE RELATED TO THE 129 00:06:03,830 --> 00:06:06,766 DISCUSSIONS TODAY ARE THE TWO AT 130 00:06:06,833 --> 00:06:08,601 THE BOTTOM OF THIS SLIDE. 131 00:06:08,668 --> 00:06:12,572 HOW IS THE FENTANYL EPIDEMIC 132 00:06:12,638 --> 00:06:15,641 BEING CONFRONTED BY PUBLIC 133 00:06:15,708 --> 00:06:24,083 HEALTH AND BY RESEARCH LEADERS? 134 00:06:24,150 --> 00:06:25,451 AND MOST IMPORTANTLY, HOW DOES 135 00:06:25,518 --> 00:06:28,554 ONE RECOVER FROM ADDICTION IF IT 136 00:06:28,621 --> 00:06:30,723 IS A BRAIN DISEASE? 137 00:06:30,790 --> 00:06:33,493 TODAY'S SPEAKERS HAVE 138 00:06:33,559 --> 00:06:34,761 EXTRAORDINARY EXPERIENCE IN BOTH 139 00:06:34,827 --> 00:06:38,831 OF THESE TWO AREAS. 140 00:06:38,898 --> 00:06:41,000 OUR FIRST SPEAKER IS NORA 141 00:06:41,067 --> 00:06:42,769 VOLKOW, WHO RECEIVED HER 142 00:06:42,835 --> 00:06:44,237 MEDICAL DEGREE FROM THE NATIONAL 143 00:06:44,303 --> 00:06:47,573 UNIVERSITY OF MEXICO, A 144 00:06:47,640 --> 00:06:49,542 PSYCHIATRIC RESIDENCY AT 145 00:06:49,609 --> 00:06:51,077 NEW YORK UNIVERSITY, AND THEN 146 00:06:51,144 --> 00:06:53,045 SPENT A LONG AND PRODUCTIVE 147 00:06:53,112 --> 00:06:55,348 CAREER AT THE BROOKHAVEN 148 00:06:55,414 --> 00:06:58,084 NATIONAL LABORATORY, WHERE SHE 149 00:06:58,151 --> 00:06:59,952 WAS THE DIRECTOR OF NUCLEAR 150 00:07:00,019 --> 00:07:01,888 MEDICINE AND CHAIRMAN OF 151 00:07:01,954 --> 00:07:04,223 MEDICINE, AND ALSO A PROFESSOR 152 00:07:04,290 --> 00:07:07,026 OF PSYCHIATRY AND ASSOCIATE DEAN 153 00:07:07,093 --> 00:07:08,561 AT THE STATE UNIVERSITY OF 154 00:07:08,628 --> 00:07:10,997 NEW YORK MEDICAL SCHOOL AT STONY 155 00:07:11,063 --> 00:07:11,831 BROOK. 156 00:07:11,898 --> 00:07:13,933 AND IT WAS DURING THIS TIME THAT 157 00:07:14,000 --> 00:07:18,104 SHE BEGAN TO APPLY AND EXTEND 158 00:07:18,171 --> 00:07:20,173 THE USE OF SOPHISTICATED BRAIN 159 00:07:20,239 --> 00:07:22,141 IMAGING TO STUDY MORE OF THE 160 00:07:22,208 --> 00:07:26,078 BASIC ASPECTS OF WHAT ADDICTION 161 00:07:26,145 --> 00:07:27,947 IS AND HOW IT OCCURS. 162 00:07:28,014 --> 00:07:30,616 AND IN 2003, SHE BECAME DIRECTOR 163 00:07:30,683 --> 00:07:33,286 OF THE NATIONAL INSTITUTE ON 164 00:07:33,352 --> 00:07:35,922 DRUG ABUSE, NIDA. 165 00:07:35,988 --> 00:07:41,861 NIDA IS THE LARGEST, I BELIEVE, 166 00:07:41,928 --> 00:07:43,162 GLOBAL FUNDER OF RESEARCH, 167 00:07:43,229 --> 00:07:46,098 DEALING WITH DRUG ADDICTION AND 168 00:07:46,165 --> 00:07:50,503 USE. 169 00:07:50,570 --> 00:07:52,205 HER CAREER IS BASED TO A GREAT 170 00:07:52,271 --> 00:07:53,639 EXTENT UPON THE APPLICATION OF 171 00:07:53,706 --> 00:07:56,175 BRAIN IMAGING, AND THE 172 00:07:56,242 --> 00:07:58,244 DEFINITION OF DRUG ADDICTION AS 173 00:07:58,311 --> 00:08:02,381 A BRAIN DISORDER AND NOT SOME 174 00:08:02,448 --> 00:08:05,785 FLAW IN INDIVIDUALS' CHARACTERS. 175 00:08:05,852 --> 00:08:09,755 FOR HER OUTSTANDING WORK, SHE'S 176 00:08:09,822 --> 00:08:14,760 RECEIVED INNURABLE AWARDS AND 177 00:08:14,827 --> 00:08:15,928 PRIZES, ONE FOR OUTSTANDING 178 00:08:15,995 --> 00:08:16,495 GOVERNMENT SERVICE. 179 00:08:16,562 --> 00:08:20,366 SHE'S A MEMBER OF THE NATIONAL 180 00:08:20,433 --> 00:08:22,335 ACADEMY OF MEDICINE, ASSOCIATION 181 00:08:22,401 --> 00:08:23,603 OF AMERICAN PHYSICIANS, THE 182 00:08:23,669 --> 00:08:24,537 FRENCH INSTITUTE OF HEALTH AND 183 00:08:24,604 --> 00:08:30,109 MANY OTHERS. 184 00:08:30,176 --> 00:08:31,477 I NOTE THAT ACTUALLY MANY OF OUR 185 00:08:31,544 --> 00:08:34,347 LEADING MAGAZINES HAVE 186 00:08:34,413 --> 00:08:39,118 IDENTIFIED NORA WITH LEADERSHIP 187 00:08:39,185 --> 00:08:40,653 BEING SAID TO BE AMONG THE TOP 188 00:08:40,720 --> 00:08:43,089 HUNDRED PEOPLE WHO SHAPED OUR 189 00:08:43,155 --> 00:08:46,225 WORLD, THE 100 MOST POWERFUL 190 00:08:46,292 --> 00:08:47,760 WOMEN, AND LEADERS WHO'VE 191 00:08:47,827 --> 00:08:49,862 CHANGED HEALTHCARE. 192 00:08:49,929 --> 00:08:53,499 SHE'S PLAYED A CRITICAL ROLE IN 193 00:08:53,566 --> 00:08:55,568 THE NATION'S RESPONSE TO THE 194 00:08:55,635 --> 00:08:57,069 FENTANYL EPIDEMIC. 195 00:08:57,136 --> 00:09:02,541 AND TODAY, SHE IS GOING TO 196 00:09:02,608 --> 00:09:06,145 DISCUSS FENTANYL AND OTHER DRUG 197 00:09:06,212 --> 00:09:08,447 ADDICTIONS IN TERMS OF THE 198 00:09:08,514 --> 00:09:10,549 CURRENT CHALLENGES AS TO WHAT IS 199 00:09:10,616 --> 00:09:14,453 BEING DONE IN RESEARCH AND ITS 200 00:09:14,520 --> 00:09:19,825 APPLICATION TO HEALTH POLICY. 201 00:09:19,892 --> 00:09:23,930 NOW OTHER SE OUR SECOND SPEAKERS 202 00:09:23,996 --> 00:09:24,630 MEGHANN PERRY. 203 00:09:24,697 --> 00:09:27,800 USUALLY IN THIS COURSE, THE 204 00:09:27,867 --> 00:09:29,168 PATIENT SPEAKS FIRST. 205 00:09:29,235 --> 00:09:31,437 BUT IN THIS CASE, IT SEEMED 206 00:09:31,504 --> 00:09:34,707 APPROPRIATE TO HAVE MEGHANN 207 00:09:34,774 --> 00:09:35,374 FOLLOW. 208 00:09:35,441 --> 00:09:38,411 MEGHANN HAS STRUGGLED WITH 209 00:09:38,477 --> 00:09:39,412 SUBSTANCE ADDICTION, MENTAL 210 00:09:39,478 --> 00:09:43,215 HEALTH CHALLENGES, 211 00:09:43,282 --> 00:09:44,650 INCARCERATION, HOMELESSNESS, 212 00:09:44,717 --> 00:09:47,620 TRAUMA AND LOSS. 213 00:09:47,687 --> 00:09:49,789 IN RESPONSE TO THIS, SHE'S 214 00:09:49,855 --> 00:09:52,625 BECOME THE FOUNDER OF THE 215 00:09:52,692 --> 00:09:54,827 MEGHANN PERRY GROUP, WHICH 216 00:09:54,894 --> 00:09:57,029 CREATES NOVEL LEARNING AND 217 00:09:57,096 --> 00:10:00,933 PERFORMANCE EXPERIENCES THAT 218 00:10:01,000 --> 00:10:03,035 BLEND THEATER, STORYTELLING AND 219 00:10:03,102 --> 00:10:06,839 RECOVERING COACHING, ALL 220 00:10:06,906 --> 00:10:11,243 DESIGNED TO HELP PEOPLE AVOID 221 00:10:11,310 --> 00:10:12,945 AND ESCAPE FROM SUBSTANCE 222 00:10:13,012 --> 00:10:16,482 ADDICTION. 223 00:10:16,549 --> 00:10:20,319 IN LEARNING HOW TO MOVE BEYOND 224 00:10:20,386 --> 00:10:22,588 SURVIVING TO ACTUALLY 225 00:10:22,655 --> 00:10:24,590 PROSPERING, SHE INSPIRES OTHERS 226 00:10:24,657 --> 00:10:27,626 TO OVERCOME THEIR CHALLENGES. 227 00:10:27,693 --> 00:10:31,397 AND WE ARE VERY GRATEFUL TO HER 228 00:10:31,464 --> 00:10:34,533 FOR TAKING PART IN TODAY'S 229 00:10:34,600 --> 00:10:37,136 EVENT. 230 00:10:37,203 --> 00:10:40,439 SO OUR FIRST SPEAKER IS 231 00:10:40,506 --> 00:10:42,074 DR. VOLKOW. 232 00:10:42,141 --> 00:10:42,274 NORA? 233 00:10:42,341 --> 00:10:43,909 >> THANK YOU, WIN, VERY, VERY 234 00:10:43,976 --> 00:10:46,245 MUCH FOR THAT KIND INTRODUCTION, 235 00:10:46,312 --> 00:10:50,816 BUT MORE PORPLY IMPORTANTLY FOG 236 00:10:50,883 --> 00:10:52,385 AN OPPORTUNITY TO PRESENT 237 00:10:52,451 --> 00:10:55,654 MEGHANN AND I SIDE BY SIDE WITH 238 00:10:55,721 --> 00:10:57,056 PERSPECTIVES THAT DO IN A WAY 239 00:10:57,123 --> 00:10:58,391 EXACTLY WHAT YOU'RE SAYING, 240 00:10:58,457 --> 00:10:59,358 BRIDGING UP DIFFERENT WORLDS 241 00:10:59,425 --> 00:11:01,794 THAT ARE NECESSARY TO BRING 242 00:11:01,861 --> 00:11:03,629 TOGETHER IN ORDER TO ADDRESS THE 243 00:11:03,696 --> 00:11:04,930 PROBLEMS THAT WE'RE DEALING 244 00:11:04,997 --> 00:11:06,999 WITH, WHICH IN THIS CASE IS THE 245 00:11:07,066 --> 00:11:08,768 OVERDOSE CRISIS. 246 00:11:08,834 --> 00:11:11,737 AND I ALSO THOUGHT ABOUT IT, I 247 00:11:11,804 --> 00:11:14,006 LOVE THE SLIDES, SO MY 248 00:11:14,073 --> 00:11:15,107 PRESENTATION IS GOING TO FOLLOW 249 00:11:15,174 --> 00:11:17,710 VERY MUCH THAT METAPHOR THAT YOU 250 00:11:17,777 --> 00:11:19,378 HAVE IN THOSE TWO SLIDES, ONE OF 251 00:11:19,445 --> 00:11:20,646 THEM WITH THE SILOS, WHERE ALL 252 00:11:20,713 --> 00:11:22,181 OF THE KNOWLEDGE IS CONTAINED, 253 00:11:22,248 --> 00:11:27,353 BUT YOU ALSO HAVE THE -- BY THE 254 00:11:27,420 --> 00:11:28,554 SIDE AND IF YOU DON'T TAKE 255 00:11:28,621 --> 00:11:30,089 ADVANTAGE OF THAT KNOWLEDGE, 256 00:11:30,156 --> 00:11:31,657 THAT WILL NOT PROLIFERATE THE 257 00:11:31,724 --> 00:11:31,957 WAY IT IS. 258 00:11:32,024 --> 00:11:34,493 SO I THINK THAT IN A WAY, HAVING 259 00:11:34,560 --> 00:11:35,895 GONE THROUGH THE COVID 260 00:11:35,961 --> 00:11:40,366 EXPERIENCE AND THE SENSE THAT 261 00:11:40,433 --> 00:11:41,901 ACTUALLY OF COURSE SCIENCE GIVES 262 00:11:41,967 --> 00:11:43,436 US TOOLS THAT ARE 263 00:11:43,502 --> 00:11:45,838 EXTRAORDINARILY POWERFUL AND CAN 264 00:11:45,905 --> 00:11:47,139 ULTIMATELY ABSOLUTELY HAVE THE 265 00:11:47,206 --> 00:11:50,109 POTENTIAL TO ADDRESS THE PROB 266 00:11:50,176 --> 00:11:51,410 PROBLEMS, THE REALITY IS HOW WE 267 00:11:51,477 --> 00:11:54,146 IMPLEMENT AND PROVIDE THEM IS 268 00:11:54,213 --> 00:11:55,781 FUNDAMENTAL FOR THE LIKELIHOOD 269 00:11:55,848 --> 00:11:59,318 THAT THEY WILL SUCCEED. 270 00:11:59,385 --> 00:12:01,487 THIS IS ALSO VERY TRUE IN THE 271 00:12:01,554 --> 00:12:03,022 CASE OF THE SCIENCE OF ADDICTION 272 00:12:03,089 --> 00:12:04,990 AS IT RELATES TO ADDRESSING THE 273 00:12:05,057 --> 00:12:05,658 OVERDOSE CRISIS. 274 00:12:05,724 --> 00:12:06,959 WE CAN HAVE KNOWLEDGE THAT 275 00:12:07,026 --> 00:12:08,160 PERTAINS DIRECTLY TO SOLUTIONS 276 00:12:08,227 --> 00:12:11,130 THAT ARE VERY ABLE TO CONTROL 277 00:12:11,197 --> 00:12:13,199 AND PREVENT PEOPLE FROM DYING. 278 00:12:13,265 --> 00:12:14,934 BUT IF THESE SOLUTIONS ARE NOT 279 00:12:15,000 --> 00:12:16,135 DEPLOYED AND WE DO NOT ADDRESS 280 00:12:16,202 --> 00:12:18,637 THE CHALLENGES THAT EXIST FOR 281 00:12:18,704 --> 00:12:20,406 THEIR DEPLOYMENT, THEN WE WON'T 282 00:12:20,473 --> 00:12:22,041 ACHIEVE OUR GOALS, WHICH IN THIS 283 00:12:22,108 --> 00:12:24,343 CASE IS, OF COURSE, PROTECT THE 284 00:12:24,410 --> 00:12:26,645 LIVES OF SO MANY PEOPLE THAT ARE 285 00:12:26,712 --> 00:12:28,280 DYING, MANY OF THEM AT A YOUNG 286 00:12:28,347 --> 00:12:28,681 AGE. 287 00:12:28,747 --> 00:12:29,915 AND NONE OF THEM SHOULD HAVE 288 00:12:29,982 --> 00:12:31,717 DIED TO START WITH. 289 00:12:31,784 --> 00:12:35,054 SO IT IS -- IT FORCES US AT NIDA 290 00:12:35,121 --> 00:12:37,189 TO REALIZE THAT WE NEED TO 291 00:12:37,256 --> 00:12:40,693 FIGURE OUT HOW TO USE SCIENCE AS 292 00:12:40,759 --> 00:12:45,131 A STRATEGY TO CHANGE THAT 293 00:12:45,197 --> 00:12:46,665 PARADIGM TO NOT JUST DEVELOP A 294 00:12:46,732 --> 00:12:49,068 SCIENTIFIC SOLUTION AND 295 00:12:49,135 --> 00:12:51,670 UNDERSTAND IT, BUT USE SCIENCE 296 00:12:51,737 --> 00:12:53,105 TO MAXIMIZE BRINGING TO THOSE 297 00:12:53,172 --> 00:12:57,510 THAT NEED IT, AND THAT'S THE 298 00:12:57,576 --> 00:12:59,345 WHOLE WHAT I'M GOING TO BE 299 00:12:59,411 --> 00:13:00,880 FOCUSING ON, HOW WE ARE MOVING 300 00:13:00,946 --> 00:13:03,282 THAT AT NIDA TO TRY TO ADDRESS 301 00:13:03,349 --> 00:13:05,684 THE OVERDOSE CRISIS. 302 00:13:05,751 --> 00:13:08,854 SO LET ME SHARE MY SCREEN, HOLD 303 00:13:08,921 --> 00:13:10,723 ONE MOMENT. 304 00:13:10,789 --> 00:13:11,824 SHARE, SHARE, SHARE, THERE IT 305 00:13:11,891 --> 00:13:13,792 IS, AND I WILL NEED YOU TO TELL 306 00:13:13,859 --> 00:13:16,295 ME IF I'M OKAY OR I'M NOT OKAY. 307 00:13:16,362 --> 00:13:20,065 AND LET ME SEE NOW. 308 00:13:20,132 --> 00:13:21,267 CAN YOU ALL SEE IT? 309 00:13:21,333 --> 00:13:22,868 >> YES. 310 00:13:22,935 --> 00:13:23,135 VERY NICE. 311 00:13:23,202 --> 00:13:30,776 >> OKAY. 312 00:13:30,843 --> 00:13:31,610 THE SCIENCE IN THE WHOLE FIELD 313 00:13:31,677 --> 00:13:32,878 OF WHAT IS IT THAT HAPPENS IN 314 00:13:32,945 --> 00:13:34,146 THE BRAIN OF A PERSON THAT'S 315 00:13:34,213 --> 00:13:37,216 ADDICTED TO THEADZ LEM TO THEIR 316 00:13:37,283 --> 00:13:39,084 ABILITY TO -- THE STRONG URGES 317 00:13:39,151 --> 00:13:40,152 THAT LEADS THEM TO HAVE THESE 318 00:13:40,219 --> 00:13:42,988 STRONG URGES TO START WITH AT 319 00:13:43,055 --> 00:13:45,491 THE EXPENSE OF MANY OTHER 320 00:13:45,558 --> 00:13:46,926 BEHAVIORS, THAT NEGATIVE 321 00:13:46,992 --> 00:13:48,761 EMOTIONAL STATE THAT THEY HAVE 322 00:13:48,827 --> 00:13:49,662 TO STRUGGLE WITH WHEN THEY ARE 323 00:13:49,728 --> 00:13:52,064 NOT UNDER THE EFFECTS OF THE 324 00:13:52,131 --> 00:13:55,768 DRUGS, ALL OF THEM, WE NOW HAVE 325 00:13:55,834 --> 00:13:58,504 UNDERSTANDING ABOUT WHAT ARE THE 326 00:13:58,571 --> 00:14:00,506 NEUROBIOLOGICAL SUBSTRATES 327 00:14:00,573 --> 00:14:01,640 UNDERLYING THOSE CHANGES IN 328 00:14:01,707 --> 00:14:04,009 THEIR EMOTIONS, THEIR BEHAVIORS 329 00:14:04,076 --> 00:14:06,378 AND THEIR PERCEPTIONS AND 330 00:14:06,445 --> 00:14:07,279 CHOICES. 331 00:14:07,346 --> 00:14:09,415 AND I'M NOT GOING TO GO INTO IT 332 00:14:09,481 --> 00:14:11,650 BECAUSE I WANT TO DWELL INTO HOW 333 00:14:11,717 --> 00:14:13,519 CAN WE USE THIS KNOWLEDGE AS I 334 00:14:13,586 --> 00:14:15,020 SAID TO ADVANCE OUR 335 00:14:15,087 --> 00:14:16,055 UNDERSTANDING OF HOW TO ADDRESS 336 00:14:16,121 --> 00:14:18,524 THE CRISIS. 337 00:14:18,591 --> 00:14:20,059 WHAT I DO WANT TO SAY JUST 338 00:14:20,125 --> 00:14:22,461 ACTUALLY BECAUSE I DO THINK IT 339 00:14:22,528 --> 00:14:24,230 IS IMPORTANT IS THAT AT THE 340 00:14:24,296 --> 00:14:25,431 BEGINNING WHEN RESEARCHERS WERE 341 00:14:25,497 --> 00:14:28,834 TRYING TO INVESTIGATE WHY IS IT 342 00:14:28,901 --> 00:14:30,636 THAT DRUGS PRODUCE ADDICTION, IT 343 00:14:30,703 --> 00:14:31,770 WAS WELL RECOGNIZED THAT THE 344 00:14:31,837 --> 00:14:33,305 ABILITY OF DRUGS TO INCREASE 345 00:14:33,372 --> 00:14:40,412 DOPAMINE TO ACTIVATE DOPE MA 346 00:14:40,479 --> 00:14:41,714 DOPAMINERGIC CIRCUITS WAS WHAT 347 00:14:41,780 --> 00:14:44,350 DROVE THE APPEAL TO START USING 348 00:14:44,416 --> 00:14:44,583 THEM. 349 00:14:44,650 --> 00:14:46,318 IT WAS NOT REALLY UNDERSTOOD HOW 350 00:14:46,385 --> 00:14:48,053 THAT DOPAMINE SYSTEM ULTIMATELY 351 00:14:48,120 --> 00:14:50,689 LED TO THE LOSS OF CONTROL AND 352 00:14:50,756 --> 00:14:52,825 COMPULSIVE PATTERN OF USE. 353 00:14:52,891 --> 00:14:56,161 AND THERE WERE -- CERTAINLY AT 354 00:14:56,228 --> 00:14:57,896 THE BEGINNING IT WAS VERY MUCH 355 00:14:57,963 --> 00:14:58,998 THE HYPOTHESIS THAT THE 356 00:14:59,064 --> 00:15:01,200 PATHOLOGY ON THE BRAIN OF 357 00:15:01,267 --> 00:15:02,668 ADDICTION, OF PEOPLE ADDICTED, 358 00:15:02,735 --> 00:15:04,903 WAS LOCALIZED IN THE REWIRED 359 00:15:04,970 --> 00:15:07,206 BRAIN CENTERS, REWIRED BRAIN 360 00:15:07,273 --> 00:15:07,539 REGIONS. 361 00:15:07,606 --> 00:15:10,476 AND WE HAVE COME TO REALIZE MANY 362 00:15:10,542 --> 00:15:11,343 YEARS LATER, OF COURSE, THAT 363 00:15:11,410 --> 00:15:13,445 FIRST OF ALL, THAT NO SINGLE 364 00:15:13,512 --> 00:15:14,413 FUNCTION IN THE BRAIN IS 365 00:15:14,480 --> 00:15:15,614 LOCALIZED TO ANY ONE BRAIN 366 00:15:15,681 --> 00:15:18,784 REGION. 367 00:15:18,851 --> 00:15:20,085 INHIBITION. 368 00:15:20,152 --> 00:15:21,420 THAT THE WAY THE BRAIN WORKS IS 369 00:15:21,487 --> 00:15:22,955 ACTUALLY BY NETWORKS, BY 370 00:15:23,022 --> 00:15:23,589 CONNECTIVITY. 371 00:15:23,656 --> 00:15:27,226 THOSE BRIDGES THAT WIN WAS SHO 372 00:15:27,293 --> 00:15:28,527 SHOWING, IMAGINE THEM AT THE 373 00:15:28,594 --> 00:15:29,295 MAXIMAL COMPLEXITY. 374 00:15:29,361 --> 00:15:32,998 SO THE BRAIN DOES REQUIRE THIS 375 00:15:33,065 --> 00:15:34,333 CONSTANT COMMUNICATION BETWEEN 376 00:15:34,400 --> 00:15:36,935 REGIONS THAT TEND TO CONFIGURE 377 00:15:37,002 --> 00:15:38,337 IN PATTERNS, AND IN PATTERNS 378 00:15:38,404 --> 00:15:40,572 THAT, FOR EXAMPLE, MAY EMERGE IN 379 00:15:40,639 --> 00:15:40,906 LANGUAGE. 380 00:15:40,973 --> 00:15:43,075 THERE ARE MULTIPLE REGIONS THAT 381 00:15:43,142 --> 00:15:44,576 FORM A LANGUAGE NETWORK. 382 00:15:44,643 --> 00:15:46,145 BUT THOSE REGIONS IN THE 383 00:15:46,211 --> 00:15:47,446 LANGUAGE NETWORK THAT THEN CAN 384 00:15:47,513 --> 00:15:49,315 CONNECT WITH OTHER NETWORKS. 385 00:15:49,381 --> 00:15:51,617 SO THERE IS A DYNAMIC 386 00:15:51,684 --> 00:15:51,950 CONFIGURATION. 387 00:15:52,017 --> 00:15:55,120 AND WE NOW KNOW THAT THIS IS THE 388 00:15:55,187 --> 00:15:56,322 SAME SITUATION WITH ADDICTION, 389 00:15:56,388 --> 00:15:57,856 THAT IT'S NOT ONE BRAIN REGION 390 00:15:57,923 --> 00:16:00,993 AT ALL, BUT THAT THERE ARE SOME 391 00:16:01,060 --> 00:16:02,995 VERY SPECIFIC CRUCIAL NETWORKS 392 00:16:03,062 --> 00:16:05,898 THAT GET INVOLVED AND THAT ARE 393 00:16:05,964 --> 00:16:06,799 MODIFIED BY THE USE OF DRUGS IN 394 00:16:06,865 --> 00:16:09,668 PEOPLE THAT BECOME ADDICTED. 395 00:16:09,735 --> 00:16:12,705 INCLUDING THE REWIRED NETWORKS. 396 00:16:12,771 --> 00:16:16,875 BUT ALSO, FUNDAMENTAL, IN 397 00:16:16,942 --> 00:16:18,644 HELPING US UNDERSTAND MANY 398 00:16:18,711 --> 00:16:19,745 PATTERNS OF ADDICTION, IS THE 399 00:16:19,812 --> 00:16:22,247 NETWORK THAT CONTROLS EXECUTIVE 400 00:16:22,314 --> 00:16:22,948 FUNCTION. 401 00:16:23,015 --> 00:16:26,719 AND THAT HAS AS A CENTRAL HUB 402 00:16:26,785 --> 00:16:27,820 PREFRONTAL REGIONS OF THE BRAIN. 403 00:16:27,886 --> 00:16:29,455 BUT IT IS FUNDAMENTAL, THAT HUB 404 00:16:29,521 --> 00:16:31,423 FOR EXECUTIVE FUNCTION, FOR 405 00:16:31,490 --> 00:16:34,493 ACTUALLY ENABLING US TO -- 406 00:16:34,560 --> 00:16:35,294 INCLUDING INHIBITORY CONTROL 407 00:16:35,361 --> 00:16:37,096 WHEN WE WANT TO DO SOMETHING, 408 00:16:37,162 --> 00:16:39,398 BUT IT'S ALSO THE AREA, THE 409 00:16:39,465 --> 00:16:40,699 CENTER, THE NETWORK THAT ALLOWS 410 00:16:40,766 --> 00:16:43,802 US TO DO JUDGMENTS, DECISIONS, 411 00:16:43,869 --> 00:16:45,204 CARRYING THEM THROUGH, AND IT'S 412 00:16:45,270 --> 00:16:47,172 ALSO THE NETWORK THAT IS 413 00:16:47,239 --> 00:16:51,643 INVOLVED IN ASSIGNING VALUE TO 414 00:16:51,710 --> 00:16:53,512 ACTIONS, AND IN THAT PROCESS, 415 00:16:53,579 --> 00:16:55,047 BASICALLY LINKS WITH OUR REWARD 416 00:16:55,114 --> 00:16:55,381 SYSTEMS. 417 00:16:55,447 --> 00:16:59,752 AND ALSO THE OTHER THIRD VERY 418 00:16:59,818 --> 00:17:00,452 IMPORTANT NETWORK IS THAT ONE 419 00:17:00,519 --> 00:17:02,154 THAT IS HERE IN RED, WHICH IS 420 00:17:02,221 --> 00:17:04,556 THE NETWORK THAT IS INVOLVED IN 421 00:17:04,623 --> 00:17:06,859 EMOTIONS BUT ALSO THAT IS 422 00:17:06,925 --> 00:17:09,828 RESPONSIBLE FOR MAKING US FEEL 423 00:17:09,895 --> 00:17:13,532 LOUSY AND IRRITABLE AND ANXIOUS, 424 00:17:13,599 --> 00:17:17,136 AND THAT NETWORK IS ANTITHETICAL 425 00:17:17,202 --> 00:17:19,972 TO ANYTHING THAT ONE WOULD THINK 426 00:17:20,038 --> 00:17:21,306 OF POSITIVE IS CRUCIAL FOR 427 00:17:21,373 --> 00:17:21,740 SURVIVAL. 428 00:17:21,807 --> 00:17:25,010 IT'S A NETWORK THAT'S ACTIVATED, 429 00:17:25,077 --> 00:17:26,879 FOR EXAMPLE, BY PAIN, AND PAIN, 430 00:17:26,945 --> 00:17:31,150 OF COURSE, IS A VERY IMPORTANT 431 00:17:31,216 --> 00:17:32,785 PHYSIOLOGICAL -- IT EXISTS FOR A 432 00:17:32,851 --> 00:17:33,719 VERY IMPORTANT PHYSIOLOGICAL 433 00:17:33,786 --> 00:17:34,520 REASON. 434 00:17:34,586 --> 00:17:36,388 SO OUR UNDERSTANDING, JUST 435 00:17:36,455 --> 00:17:38,257 SUFFICE IT TO SAY, IS THAT 436 00:17:38,323 --> 00:17:40,225 ADDICTION, THE PERSONS THAT ARE 437 00:17:40,292 --> 00:17:43,262 ADDICTED, HAVE DISRUPTIONS IN 438 00:17:43,328 --> 00:17:46,031 MULTIPLE NETWORKS AND THREE KEY 439 00:17:46,098 --> 00:17:46,899 NETWORKS THAT ACTUALLY ARE 440 00:17:46,965 --> 00:17:49,435 CRUCIAL FOR EVERYDAY LIFE, AND 441 00:17:49,501 --> 00:17:50,936 EXTREMELY IMPORTANT FOR SOCIAL 442 00:17:51,003 --> 00:17:56,508 INTERACTIONS. 443 00:17:56,575 --> 00:17:58,377 AND THROUGH THAT DELINEATION OF 444 00:17:58,444 --> 00:17:59,578 THOSE CHANGES AND OUR 445 00:17:59,645 --> 00:18:01,513 UNDERSTANDING OF HOW THOSE 446 00:18:01,580 --> 00:18:03,415 CHANGES TRANSLATES IN CHANGES IN 447 00:18:03,482 --> 00:18:04,616 BEHAVIORS AND SYMPTOMS, WE HAVE 448 00:18:04,683 --> 00:18:08,120 COME TO CONCEPTUALIZE AS WIN WAS 449 00:18:08,187 --> 00:18:09,188 MENTIONING OF ADDICTION AS A 450 00:18:09,254 --> 00:18:09,855 DISEASE OF THE BRAIN. 451 00:18:09,922 --> 00:18:11,790 AND WE'VE ALSO CONCEPTUALIZED IT 452 00:18:11,857 --> 00:18:13,692 AS A CHRONIC DISEASE, A 453 00:18:13,759 --> 00:18:15,227 RELAPSING DISEASE. 454 00:18:15,294 --> 00:18:16,762 IT'S CHRONIC BECAUSE THERE ARE 455 00:18:16,829 --> 00:18:19,264 CHANGES IN THE BRAIN IN THESE 456 00:18:19,331 --> 00:18:20,599 NETWORKS ARE LONG LASTING, AND 457 00:18:20,666 --> 00:18:22,768 THEY WILL NOT DISAPPEAR ONCE A 458 00:18:22,835 --> 00:18:26,839 PERSON STOPS TAKING THE DRUG. 459 00:18:26,905 --> 00:18:29,341 AND THIS IS CLINICALLY RELEVANT 460 00:18:29,408 --> 00:18:30,209 BECAUSE IT MEANS THAT THE PERSON 461 00:18:30,275 --> 00:18:31,743 THAT GOES INTO TREATMENT WILL 462 00:18:31,810 --> 00:18:33,278 HAVE TO STAY IN TREATMENT FOR A 463 00:18:33,345 --> 00:18:35,581 LONG PERIOD OF TIME. 464 00:18:35,647 --> 00:18:36,915 BUT THIS IS NOT DIFFERENT FROM 465 00:18:36,982 --> 00:18:38,417 THE WAY THAT WE DEAL IN THE 466 00:18:38,484 --> 00:18:39,284 HEALTHCARE SYSTEM OF OTHER 467 00:18:39,351 --> 00:18:40,586 CHRONIC CONDITIONS. 468 00:18:40,652 --> 00:18:42,554 SO IF YOU'RE DIAGNOSED WITH 469 00:18:42,621 --> 00:18:44,323 CANCER, YOU GO TO TREATMENT, AND 470 00:18:44,389 --> 00:18:45,791 THAT WILL REQUIRE THAT YOU HAVE 471 00:18:45,858 --> 00:18:48,026 A LONG FOLLOW-UP. 472 00:18:48,093 --> 00:18:50,762 AND WITH TIME, AS YOU 473 00:18:50,829 --> 00:18:52,531 ACTUALLY -- THERE IS A REDUCTION 474 00:18:52,598 --> 00:18:54,700 IN THE PROBABILITY THAT THE 475 00:18:54,766 --> 00:18:56,768 TUMOR MAY RETURN, YOU CAN 476 00:18:56,835 --> 00:18:59,304 ACTUALLY MAKE THOSE 477 00:18:59,371 --> 00:19:00,939 INTERVENTIONS LESS INTENSE. 478 00:19:01,006 --> 00:19:02,708 THE SAME THING WITH ADDICTION. 479 00:19:02,774 --> 00:19:04,743 AS A PERSON STARTS TO 480 00:19:04,810 --> 00:19:08,380 RESTRUCTURE THEIR LIVES, THE 481 00:19:08,447 --> 00:19:10,048 RISK OF RELAPSE BECOMES LESS 482 00:19:10,115 --> 00:19:10,716 FREQUENT. 483 00:19:10,782 --> 00:19:12,885 AND THERE IS A POINT AND A LEVEL 484 00:19:12,951 --> 00:19:15,521 WHEN THEY RESTRUCTURE THEIR LIFE 485 00:19:15,587 --> 00:19:17,456 THAT ONE BASICALLY -- THEY MAY 486 00:19:17,523 --> 00:19:19,424 STILL BE AT THE CERTAIN 487 00:19:19,491 --> 00:19:21,226 VULNERABILITY, BUT THE INTENSITY 488 00:19:21,293 --> 00:19:22,194 OF THE NEED FOR TREATMENT GOES 489 00:19:22,261 --> 00:19:24,897 DOWN. 490 00:19:24,963 --> 00:19:26,498 SO WHAT IT HAS, IT HAS 491 00:19:26,565 --> 00:19:28,200 DEFINITELY LED TO THE CONCEPT OF 492 00:19:28,267 --> 00:19:31,036 ADDICTION AS A DISEASE OF THE 493 00:19:31,103 --> 00:19:33,872 BRAIN, BUT WE ENCOUNTER A LOT OF 494 00:19:33,939 --> 00:19:34,973 CONTROVERSY ON THIS AND A LOT OF 495 00:19:35,040 --> 00:19:36,275 PEOPLE HAVE BEEN VERY, VERY 496 00:19:36,341 --> 00:19:38,577 ANGRY WITH IT, BECAUSE THEY SAY 497 00:19:38,644 --> 00:19:39,978 BY IMPLICATING ADDICTION AS A 498 00:19:40,045 --> 00:19:43,715 DISEASE OF THE BRAIN, YOU ARE 499 00:19:43,782 --> 00:19:45,450 REMOVING OFF ALL OF THE 500 00:19:45,517 --> 00:19:48,654 EXTREMELY IMPORTANT SOCIAL, 501 00:19:48,720 --> 00:19:49,721 ENVIRONMENTAL, CULTURAL, 502 00:19:49,788 --> 00:19:51,256 ECONOMIC ASPECTS THAT LIE BEHIND 503 00:19:51,323 --> 00:19:54,092 IT. 504 00:19:54,159 --> 00:19:56,628 AND THEY ARE THE ONES THAT ARE 505 00:19:56,695 --> 00:19:57,496 DRIVING THE ADDICTION. 506 00:19:57,563 --> 00:19:59,331 AND IT'S ABSOLUTELY CORRECT. 507 00:19:59,398 --> 00:20:00,666 THE ENVIRONMENT IS FUNDAMENTAL 508 00:20:00,732 --> 00:20:03,068 AND YOU SEE THAT SORT OF 509 00:20:03,135 --> 00:20:04,703 MULTIPLE FACTOR COMPONENT THAT 510 00:20:04,770 --> 00:20:07,205 DETERMINES ADDICTION. 511 00:20:07,272 --> 00:20:08,407 ENVIRONMENTS ARE CRUCIAL AND 512 00:20:08,473 --> 00:20:08,874 FUNDAMENTAL. 513 00:20:08,941 --> 00:20:10,676 BUT IT DOESN'T NEGATE THAT THE 514 00:20:10,742 --> 00:20:12,144 ENVIRONMENT, THE FACT THAT THE 515 00:20:12,210 --> 00:20:14,446 ENVIRONMENTS PLAY SUCH AN 516 00:20:14,513 --> 00:20:15,881 IMPORTANT CONSEQUENTIAL ROLE IN 517 00:20:15,948 --> 00:20:17,382 DRUG-TAKING AND IN THE RISK OF 518 00:20:17,449 --> 00:20:18,717 ADDICTION THAT IT'S NOT 519 00:20:18,784 --> 00:20:21,787 PRODUCING A DISEASE. 520 00:20:21,853 --> 00:20:23,422 AND I THINK THIS IS VERY CLEAR 521 00:20:23,488 --> 00:20:24,656 BUT WE DON'T QUESTION IT WHEN IT 522 00:20:24,723 --> 00:20:25,490 COMES TO SOMETHING LIKE 523 00:20:25,557 --> 00:20:25,824 DIABETES. 524 00:20:25,891 --> 00:20:28,126 WHERE YOU CAN ACTUALLY SAY, 525 00:20:28,193 --> 00:20:29,227 CERTAINLY ENVIRONMENTS AND 526 00:20:29,294 --> 00:20:30,963 BEHAVIORS AND THE BEHAVIORS THAT 527 00:20:31,029 --> 00:20:32,264 ARE DRIVEN BY WHAT YOU HAVE IN 528 00:20:32,331 --> 00:20:34,466 YOUR ENVIRONMENT TO EAT OR NOT 529 00:20:34,533 --> 00:20:36,101 TO EAT ACTUALLY ARE GOING TO BE 530 00:20:36,168 --> 00:20:37,736 MAKING YOU VULNERABLE TO 531 00:20:37,803 --> 00:20:38,604 DIABETES. 532 00:20:38,670 --> 00:20:41,673 AND YET NO ONE WILL QUESTION 533 00:20:41,740 --> 00:20:42,207 DIABETES AS A DISEASE. 534 00:20:42,274 --> 00:20:45,510 SO IN THAT RESPECT, DRUG 535 00:20:45,577 --> 00:20:47,679 ADDICTION DOES HAVE AN 536 00:20:47,746 --> 00:20:48,213 EXTRAORDINARILY IMPORTANT 537 00:20:48,280 --> 00:20:49,448 COMPONENT FROM THE ENVIRONMENT. 538 00:20:49,514 --> 00:20:51,750 UNLIKE OTHER DISEASES AND 539 00:20:51,817 --> 00:20:53,819 CONDITIONS, INCLUDING DIABETES, 540 00:20:53,885 --> 00:20:55,053 THERE ARE ALSO EXTREMELY 541 00:20:55,120 --> 00:20:57,089 IMPORTANT FACTORS THAT RELATE TO 542 00:20:57,155 --> 00:21:01,360 GENETICS AND, TOO, BUT PERHAPS 543 00:21:01,426 --> 00:21:02,794 TO EVEN A GREATER EXTENT IN 544 00:21:02,861 --> 00:21:04,663 ADDICTION THAN FOR OTHER 545 00:21:04,730 --> 00:21:06,798 CONDITIONS, THAT DEVELOPMENTAL 546 00:21:06,865 --> 00:21:08,800 BIOLOGICAL PROCESS BY WHICH OUR 547 00:21:08,867 --> 00:21:10,902 BRAIN GOES FROM FETAL 548 00:21:10,969 --> 00:21:12,537 DEVELOPMENT INTO ADULTHOOD. 549 00:21:12,604 --> 00:21:14,172 AND THAT PROCESS WHICH FOR THE 550 00:21:14,239 --> 00:21:16,174 BRAIN TAKES A LONG PERIOD OF 551 00:21:16,241 --> 00:21:18,644 TIME, MORE THAN TWO DECADES, 552 00:21:18,710 --> 00:21:21,613 ACTUALLY MAKES THE WHOLE PROCESS 553 00:21:21,680 --> 00:21:25,117 OF EXPOSURE TO DRUGS AND 554 00:21:25,183 --> 00:21:26,752 VULNERABILITY PERIODS EXTREMELY 555 00:21:26,818 --> 00:21:27,185 IMPORTANT. 556 00:21:27,252 --> 00:21:29,721 IN TERMS OF IDENTIFYING PERIODS 557 00:21:29,788 --> 00:21:31,890 WHERE THE BRAIN WILL BE VERY 558 00:21:31,957 --> 00:21:34,826 SENSITIVE TO EFFECTS OF AN 559 00:21:34,893 --> 00:21:36,495 ADVERSE ENVIRONMENT, AND ALSO 560 00:21:36,561 --> 00:21:37,696 VERY SENSITIVE TO THE EFFECTS OF 561 00:21:37,763 --> 00:21:39,731 DRUGS. 562 00:21:39,798 --> 00:21:41,933 PRODUCING MUCH FASTER CHANGES 563 00:21:42,000 --> 00:21:44,036 THAT CAN THEN MAKE THAT PERSON 564 00:21:44,102 --> 00:21:47,072 GO MUCH MORE EASILY INTO 565 00:21:47,139 --> 00:21:48,707 ESCALATING DRUG-TAKING AND IN 566 00:21:48,774 --> 00:21:50,108 THE CHANGES IN THE NETWORKS THAT 567 00:21:50,175 --> 00:21:52,444 I WAS JUST DESCRIBING THAT 568 00:21:52,511 --> 00:21:53,812 ULTIMATELY PRODUCE THE ADDICTION 569 00:21:53,879 --> 00:21:55,714 PHENOTYPE. 570 00:21:55,781 --> 00:21:59,017 WHICH IS AT THAT STATE IN WHICH 571 00:21:59,084 --> 00:22:00,652 THE INDIVIDUAL, DESPITE HIM OR 572 00:22:00,719 --> 00:22:02,187 HER COGNITIVELY AND CONSCIOUSLY 573 00:22:02,254 --> 00:22:05,257 NOT WANTING TO TAKE DRUGS 574 00:22:05,323 --> 00:22:07,759 ANYMORE, IT'S BY THEIR REALIZING 575 00:22:07,826 --> 00:22:12,798 THAT EVEN IF THEY STOP TAKING 576 00:22:12,864 --> 00:22:14,099 DRUGS, THEY MAY LOSE THEIR 577 00:22:14,166 --> 00:22:14,533 LIVES. 578 00:22:14,599 --> 00:22:15,534 THEY CANNOT STOP IT. 579 00:22:15,600 --> 00:22:17,369 AND THAT IS VERY DIFFICULT TO 580 00:22:17,436 --> 00:22:18,804 UNDERSTAND FROM SOMEONE THAT HAS 581 00:22:18,870 --> 00:22:21,840 NOT HAD A SIMILAR EXPERIENCE. 582 00:22:21,907 --> 00:22:27,345 BUT IT IS ACTUALLY AKIN TO 583 00:22:27,412 --> 00:22:29,081 DISRUPTION ON THE BASIC 584 00:22:29,147 --> 00:22:30,482 FUNDAMENTAL CAPACITY THAT WE 585 00:22:30,549 --> 00:22:35,220 HAVE TO ACTUALLY CONTROL OUR 586 00:22:35,287 --> 00:22:36,188 DECISIONS, MOTIVATIONS AND 587 00:22:36,254 --> 00:22:36,521 ACTIONS. 588 00:22:36,588 --> 00:22:41,893 SO THAT IS -- VERY MUCH DAMAGE 589 00:22:41,960 --> 00:22:43,195 BY USE OF DRUGS. 590 00:22:43,261 --> 00:22:44,730 I PUT IT LIKE THIS BECAUSE AN 591 00:22:44,796 --> 00:22:45,697 IMPORTANT QUESTION -- AND IT 592 00:22:45,764 --> 00:22:46,698 RELATES TO THE QUESTION OF WIN 593 00:22:46,765 --> 00:22:52,070 THAT HE WAS SAYING, SHOULD WE NO 594 00:22:52,137 --> 00:22:52,771 LONGER PRESCRIBE FENTANYL 595 00:22:52,838 --> 00:22:55,240 BECAUSE IT'S A VERY POTENT 596 00:22:55,307 --> 00:22:56,441 ANALGESIC, IT'S ALSO A 597 00:22:56,508 --> 00:22:58,844 MEDICATION USED EXTENSIVELY FOR 598 00:22:58,910 --> 00:23:00,912 ANESTHESIA, AND IT HAS VERY GOOD 599 00:23:00,979 --> 00:23:03,215 PHARMACOLOGICAL PROPERTIES. 600 00:23:03,281 --> 00:23:06,485 SO IN -- USED OUTSIDE THE 601 00:23:06,551 --> 00:23:09,454 CONTEXT, IT CAN DEFINITELY HAVE 602 00:23:09,521 --> 00:23:10,422 HIGHLY ADDICTIVE EFFECTS. 603 00:23:10,489 --> 00:23:13,492 SO IS THE ASPECT OF ALSO, TOO, 604 00:23:13,558 --> 00:23:14,993 NOT EVERYBODY THAT GETS EXPOSED 605 00:23:15,060 --> 00:23:18,764 TO THESE DRUGS BECOMES ADDICTED, 606 00:23:18,830 --> 00:23:20,832 AND THESE OCCUR TYPICALLY WITH 607 00:23:20,899 --> 00:23:22,134 PEOPLE THAT CAN DRINK SOCIALLY 608 00:23:22,200 --> 00:23:25,403 FOR DECADES AND NEVER BECOME 609 00:23:25,470 --> 00:23:25,871 ALCOHOLICS. 610 00:23:25,937 --> 00:23:28,473 OR IF YOU HAVE SIMILARLY PEOPLE 611 00:23:28,540 --> 00:23:31,977 THAT CAN BE BINGING COCAINE ON A 612 00:23:32,043 --> 00:23:35,180 WEEKLY BASIS AND NEVER BECOME -- 613 00:23:35,247 --> 00:23:36,782 THEY NEVER DEVELOP A COCAINE USE 614 00:23:36,848 --> 00:23:37,682 DISORDER. 615 00:23:37,749 --> 00:23:41,586 SO THERE ARE DIFFERENCES IN 616 00:23:41,653 --> 00:23:42,587 VULNERABILITY, AND THAT ASPECT 617 00:23:42,654 --> 00:23:48,393 OF THE DIFFERENCES IN 618 00:23:48,460 --> 00:23:49,227 VULNERABILITY, THAT RESEARCH HAS 619 00:23:49,294 --> 00:23:50,562 BEEN GOING ON IN TERMS OF 620 00:23:50,629 --> 00:23:52,531 UNDERSTANDING WHICH GENES 621 00:23:52,597 --> 00:23:54,199 INCREASE THE RISK FOR ADDICTION, 622 00:23:54,266 --> 00:23:55,267 BECAUSE WE KNOW ADDICTION RUNS 623 00:23:55,333 --> 00:23:57,135 IN FAMILIES, AND WHY DO THEY DO 624 00:23:57,202 --> 00:23:57,335 THAT? 625 00:23:57,402 --> 00:23:59,171 AND THAT, OF COURSE, IS AN 626 00:23:59,237 --> 00:24:00,872 EXTREMELY IMPORTANT AREA OF 627 00:24:00,939 --> 00:24:04,009 RESEARCH THAT HELPS US 628 00:24:04,075 --> 00:24:06,978 PARTICULARLY IN THE DEVELOPMENT 629 00:24:07,045 --> 00:24:07,746 OF COMPLETELY NOVEL 630 00:24:07,813 --> 00:24:10,248 THERAPEUTICS. 631 00:24:10,315 --> 00:24:12,350 SO WITHIN THIS BACKGROUND OF 632 00:24:12,417 --> 00:24:15,520 RECOGNIZING THAT WE HAVE TO 633 00:24:15,587 --> 00:24:16,822 UNDERSTAND ADDICTION IN ITS 634 00:24:16,888 --> 00:24:19,658 COMPLEXITY AND HOW IMPORTANT THE 635 00:24:19,724 --> 00:24:21,660 ENVIRONMENT IS, AND AS WELL AS 636 00:24:21,726 --> 00:24:23,395 RECOGNIZING THE IMPORTANCE OF 637 00:24:23,461 --> 00:24:25,030 GENETICS, WE HAVE TO SEE HOW 638 00:24:25,096 --> 00:24:27,332 THIS KNOWLEDGE CAN BE USED AND 639 00:24:27,399 --> 00:24:30,402 EMPLOYED IN MY BRAIN OVERALL TO 640 00:24:30,468 --> 00:24:32,137 ADDRESS ADDICTION BUT RIGHT NOW 641 00:24:32,204 --> 00:24:35,640 EXTREMELY URGENTLY TO ADDRESS 642 00:24:35,707 --> 00:24:37,943 THE EPIDEMIC OF THE OVERDOSE 643 00:24:38,009 --> 00:24:39,578 CRISIS THAT WIN WAS MENTIONING. 644 00:24:39,644 --> 00:24:40,679 LET ME START BY ASKING THE 645 00:24:40,745 --> 00:24:42,214 QUESTION HOW BAD IT IS. 646 00:24:42,280 --> 00:24:43,415 WELL, THIS IS DATA FROM A GRAPH 647 00:24:43,481 --> 00:24:47,419 THAT SHOWS DATA UP TO 2022, BUT 648 00:24:47,485 --> 00:24:49,120 THE LATEST DATA THAT WE HAVE AS 649 00:24:49,187 --> 00:24:51,957 OF OCTOBER 2023 HAS ACTUALLY 650 00:24:52,023 --> 00:24:53,158 SHOWN THAT NUMBERS ARE HIGHER 651 00:24:53,225 --> 00:24:55,794 THAN WHAT YOU SEE THERE. 652 00:24:55,861 --> 00:24:58,530 IT'S MORE THAN 110,000 PEOPLE 653 00:24:58,597 --> 00:25:00,498 THAT DIED IN ONE YEAR, THAT WAS 654 00:25:00,565 --> 00:25:03,969 FOR OCTOBER 2023. 655 00:25:04,035 --> 00:25:05,303 BUT REGARDLESS, IT GIVES YOU AN 656 00:25:05,370 --> 00:25:06,171 IDEA OF THE MAGNITUDE OF THE 657 00:25:06,238 --> 00:25:07,272 PROBLEM THAT WE HAVE IN OUR 658 00:25:07,339 --> 00:25:09,107 HANDS. 659 00:25:09,174 --> 00:25:10,342 THESE DEATHS, AND YOU CAN 660 00:25:10,408 --> 00:25:11,543 OBSERVE THEM IN TERMS OF THE 661 00:25:11,610 --> 00:25:14,179 YEAR AT WHICH THEY ARE 662 00:25:14,246 --> 00:25:16,014 HAPPENING, STARTED MORE THAN TWO 663 00:25:16,081 --> 00:25:18,416 DECADES AGO WHEN THEY WERE 664 00:25:18,483 --> 00:25:19,551 INITIATED BY THE 665 00:25:19,618 --> 00:25:20,619 OVERPRESCRIPTION OF PAIN 666 00:25:20,685 --> 00:25:22,454 MEDICATIONS THAT CONTAIN 667 00:25:22,520 --> 00:25:23,555 OPIOIDS. 668 00:25:23,622 --> 00:25:25,423 THE OXYCONTINS, THE 669 00:25:25,490 --> 00:25:26,524 HYDROCODONES, THE VICODIN. 670 00:25:26,591 --> 00:25:28,593 ALL OF THEM BECAME WILDLY 671 00:25:28,660 --> 00:25:31,663 PRESCRIBED BY PHYSICIANS WHO 672 00:25:31,730 --> 00:25:33,531 BASICALLY BECAME OVERCONFIDENT 673 00:25:33,598 --> 00:25:38,203 AND BASICALLY BELIEVED WHAT WAS 674 00:25:38,270 --> 00:25:39,404 PUBLISHING IN SOME OF THE TOP 675 00:25:39,471 --> 00:25:40,472 JOURNALS AT THE TIME THAT IF YOU 676 00:25:40,538 --> 00:25:42,274 HAVE PAIN, YOU'RE NOT GOING TO 677 00:25:42,340 --> 00:25:43,909 BECOME ADDICTED TO YOUR PAIN 678 00:25:43,975 --> 00:25:45,877 MEDICATIONS, TO YOUR OPIOIDS, 679 00:25:45,944 --> 00:25:46,978 AND THEREFORE OVERPRESCRIBE THEM 680 00:25:47,045 --> 00:25:47,946 EVEN FOR CONDITIONS THAT DID NOT 681 00:25:48,013 --> 00:25:50,048 MERIT IT. 682 00:25:50,115 --> 00:25:51,883 OVERPRESCRIPTION OF THESE 683 00:25:51,950 --> 00:25:53,752 MEDICATIONS FACILITATED THEIR 684 00:25:53,818 --> 00:25:55,921 DIVERSION, BECAUSE OPIOIDS ARE 685 00:25:55,987 --> 00:25:56,688 HIGHLY REWARDING. 686 00:25:56,755 --> 00:25:58,990 AND THEY HAVE A VALUE IN THE 687 00:25:59,057 --> 00:25:59,958 BLACK MARKET. 688 00:26:00,025 --> 00:26:01,626 BUT ALSO IT MADE PEOPLE THAT 689 00:26:01,693 --> 00:26:03,695 WERE USING THEM FOR THEIR PAIN 690 00:26:03,762 --> 00:26:04,996 BECOME ADDICTED. 691 00:26:05,063 --> 00:26:09,134 AND THAT NOTION THAT PAIN 692 00:26:09,200 --> 00:26:11,469 PROTECTION IS NOT CORRECT AND 693 00:26:11,536 --> 00:26:13,238 BASICALLY THIS HAS BASICALLY 694 00:26:13,305 --> 00:26:16,074 BEEN CLARIFIED AS SUCH. 695 00:26:16,141 --> 00:26:18,109 BUT -- AND IT TOOK ACTUALLY MORE 696 00:26:18,176 --> 00:26:24,382 THAN A DECADE FOR REALLY THE 697 00:26:24,449 --> 00:26:25,850 SYSTEM TO REALIZE HOW BAD IT 698 00:26:25,917 --> 00:26:26,184 WAS. 699 00:26:26,251 --> 00:26:27,619 AND I GUESS IT WAS IN 2010 THAT 700 00:26:27,686 --> 00:26:28,720 THEY REALIZED HOW MANY PEOPLE 701 00:26:28,787 --> 00:26:30,622 WERE DYING JUST FROM OVERDOSES 702 00:26:30,689 --> 00:26:33,458 FROM PAIN MEDICATIONS, AND THAT 703 00:26:33,525 --> 00:26:36,194 RESULTED IN GUIDELINES THAT 704 00:26:36,261 --> 00:26:37,829 MODIFIED AND MADE PRESCRIPTION 705 00:26:37,896 --> 00:26:38,396 MUCH SAFER. 706 00:26:38,463 --> 00:26:40,332 THAT HAS ACTUALLY, IN FACT, 707 00:26:40,398 --> 00:26:41,866 HELPED VERY MUCH, AND WE NOW 708 00:26:41,933 --> 00:26:43,635 SEE, FOR EXAMPLE, THAT THE 709 00:26:43,702 --> 00:26:48,340 NUMBER OF DEATHS FROM OPIOID 710 00:26:48,406 --> 00:26:50,942 ANALGESICS WHICH IS IN THIS 711 00:26:51,009 --> 00:26:52,577 CATEGORY, NATURAL AND SIN THEY 712 00:26:52,644 --> 00:26:55,547 TICS IN BLUE, IN SKY BLUE, HAVE 713 00:26:55,613 --> 00:26:56,314 BASICALLY LEVELED OFF. 714 00:26:56,381 --> 00:26:58,483 BUT THIS HAS NOT RESULTED IN A 715 00:26:58,550 --> 00:26:58,917 REDUCTION IN DEATHS. 716 00:26:58,984 --> 00:27:00,385 IN FACT, THE DEATHS HAVE JUST 717 00:27:00,452 --> 00:27:03,888 BEEN ESCALATING AND ESCALATING. 718 00:27:03,955 --> 00:27:06,091 FIRST HEROIN TOOK OFF IN BROWN, 719 00:27:06,157 --> 00:27:09,627 AND THEN HEROIN NOW GOES DOWN. 720 00:27:09,694 --> 00:27:10,762 SO WHEN WE ASK THE QUESTION WHAT 721 00:27:10,829 --> 00:27:12,464 HAS HAPPENED WITH HEROIN, RIGHT 722 00:27:12,530 --> 00:27:15,333 NOW IN MANY PLACES IN THE UNITED 723 00:27:15,400 --> 00:27:18,937 STATES, WHAT IS BEING SOLD AS 724 00:27:19,004 --> 00:27:20,705 HEROIN DOES NOT CONTAIN HEROIN. 725 00:27:20,772 --> 00:27:23,408 IT IS BASICALLY FENTANYL MIXED 726 00:27:23,475 --> 00:27:24,209 WITH OTHER PRODUCTS. 727 00:27:24,275 --> 00:27:26,478 AND YOU CAN SEE THESE, I MEAN, 728 00:27:26,544 --> 00:27:28,780 TREATMENT PROGRAMS THAT ARE 729 00:27:28,847 --> 00:27:30,315 ACTUALLY OBTAINING URINES TO 730 00:27:30,382 --> 00:27:33,184 MONITOR THE USE OF DRUGS IN 731 00:27:33,251 --> 00:27:34,919 THEIR PATIENTS, PATIENTS THAT 732 00:27:34,986 --> 00:27:37,322 COME IN DESCRIBING THEMSELVES AS 733 00:27:37,389 --> 00:27:40,492 HEROIN USE. 734 00:27:40,558 --> 00:27:41,693 , THEIR URINE DOES NOT 735 00:27:41,760 --> 00:27:43,561 CONTAIN HEROIN, IT CONTAINS 736 00:27:43,628 --> 00:27:44,662 FENTANYL, AND IT IS REALLY 737 00:27:44,729 --> 00:27:46,765 FENTANYL WHICH IS THE SYNTHETIC 738 00:27:46,831 --> 00:27:47,499 OPIOID, FENTANYL. 739 00:27:47,565 --> 00:27:49,234 I SPEAK ABOUT FENTANYL BUT IT'S 740 00:27:49,300 --> 00:27:54,172 ALSO SOME OF ITS ANALOGS OR 741 00:27:54,239 --> 00:27:55,540 FENTANYL, ALL OF THEM CONTRIBUTE 742 00:27:55,607 --> 00:27:57,842 TO THESE OVERDOSE MORTALITY. 743 00:27:57,909 --> 00:27:59,310 FENTANYL ITSELF IS THE MOST 744 00:27:59,377 --> 00:28:01,746 FREQUENT, AND IT IS ESTIMATED IN 745 00:28:01,813 --> 00:28:04,015 THE LAST -- LATEST NUMBERS FROM 746 00:28:04,082 --> 00:28:09,287 THE CDC THAT 67% OF ALL OVERDOSE 747 00:28:09,354 --> 00:28:13,324 DEATHS IN 2023, 67%, WERE FROM 748 00:28:13,391 --> 00:28:14,092 FENTANYL. 749 00:28:14,159 --> 00:28:15,627 BY ITSELF OR IN COMBINATION WITH 750 00:28:15,693 --> 00:28:17,062 OTHER DRUGS. 751 00:28:17,128 --> 00:28:18,897 AND THESE ALSO EXPLAINS WHY 752 00:28:18,963 --> 00:28:20,565 WE'RE SEEING THESE VERY 753 00:28:20,632 --> 00:28:22,767 SIGNIFICANT RISE IN OVERDOSES 754 00:28:22,834 --> 00:28:23,935 FROM METHAMPHETAMINE, AND FROM 755 00:28:24,002 --> 00:28:26,871 COCAINE. 756 00:28:26,938 --> 00:28:29,774 YES, COCAINE AND METHAMPHETAMINE 757 00:28:29,841 --> 00:28:31,476 IN THE UNITED STATES HAS 758 00:28:31,543 --> 00:28:35,080 INCREASED BUT THE MAG TE MAGNITF 759 00:28:35,146 --> 00:28:36,514 INCREASE OR THE NUMBER OF PEOPLE 760 00:28:36,581 --> 00:28:37,615 USING THIS DRUG HAS NOT 761 00:28:37,682 --> 00:28:38,583 INCREASED AT THE SAME PROPORTION 762 00:28:38,650 --> 00:28:40,218 THAT WE'RE SEEING THE MORTALITY. 763 00:28:40,285 --> 00:28:43,721 WHAT HAS HAPPENED IS THAT THE 764 00:28:43,788 --> 00:28:46,791 DEALERS RECOGNIZING HOW MUCH 765 00:28:46,858 --> 00:28:48,126 PROFIT THEY CAN GET FROM SELLING 766 00:28:48,193 --> 00:28:50,295 FENTANYL AS OPPOSED TO, FOR 767 00:28:50,361 --> 00:28:51,930 EXAMPLE, SPECIFICALLY SELLING 768 00:28:51,996 --> 00:28:53,832 COCAINE, THAT REQUIRES 769 00:28:53,898 --> 00:28:55,200 CULTIVATION AND BRINGING UP 770 00:28:55,266 --> 00:28:57,068 THESE BIG VOLUMES OF COCAINE 771 00:28:57,135 --> 00:28:59,737 THROUGH THE BORDER, CAN BE 772 00:28:59,804 --> 00:29:01,473 DILUTED BY ADDING FENTANYL, AND 773 00:29:01,539 --> 00:29:03,408 YOU STILL HAVE A VERY POTENT 774 00:29:03,475 --> 00:29:06,044 PRODUCT THAT THE PERSON WILL BE 775 00:29:06,111 --> 00:29:09,347 VERY REWARDING AND ADDICTIVE. 776 00:29:09,414 --> 00:29:10,748 METHAMPHETAMINE, WHICH IS A 777 00:29:10,815 --> 00:29:12,517 SYNTHETIC DRUG, IT'S EASIER TO 778 00:29:12,584 --> 00:29:13,685 MANUFACTURE, YOU DON'T NEED ALL 779 00:29:13,751 --> 00:29:17,522 THE PROCEDURES AND COMPLEXITY OF 780 00:29:17,589 --> 00:29:19,057 COCAINE, BUT NONETHELESS, IT'S 781 00:29:19,124 --> 00:29:20,358 ACTUALLY INCREASINGLY BEING 782 00:29:20,425 --> 00:29:21,893 MIXED WITH FENTANYL. 783 00:29:21,960 --> 00:29:24,796 AND WE NOW KNOW THAT OF THE 784 00:29:24,863 --> 00:29:28,600 DEATHS OF COCAINE, MORE THAN 75% 785 00:29:28,666 --> 00:29:33,705 CONTAIN FENTANYL AND 786 00:29:33,771 --> 00:29:34,906 METHAMPHETAMINE, MORE THAN 65% 787 00:29:34,973 --> 00:29:35,340 CONTAIN FENTANYL. 788 00:29:35,406 --> 00:29:36,674 THIS IS THE REALITY WHERE WE 789 00:29:36,741 --> 00:29:37,876 FIND OURSELVES. 790 00:29:37,942 --> 00:29:39,077 FENTANYL AT THE CENTER OF THE 791 00:29:39,144 --> 00:29:39,944 OVERDOSES, BUT MORE AND MORE 792 00:29:40,011 --> 00:29:42,013 PEOPLE ARE DYING WITH DRUG 793 00:29:42,080 --> 00:29:42,580 COMBINATIONS. 794 00:29:42,647 --> 00:29:44,215 AND TO YOUR QUESTION, WIN, ARE 795 00:29:44,282 --> 00:29:45,617 THERE PEOPLE THAT ARE DYING 796 00:29:45,683 --> 00:29:47,385 WITHOUT KNOWING THEY ARE 797 00:29:47,452 --> 00:29:48,686 CONSUMING FENTANYL? 798 00:29:48,753 --> 00:29:49,921 ABSOLUTELY. 799 00:29:49,988 --> 00:29:51,990 AND THIS IS PARTICULARLY 800 00:29:52,056 --> 00:29:53,525 PROBLEMATIC, FOR EXAMPLE, FOR 801 00:29:53,591 --> 00:29:54,826 PEOPLE THAT HAVE COCAINE 802 00:29:54,893 --> 00:29:57,495 ADDICTION OR METHAMPHETAMINE 803 00:29:57,562 --> 00:29:59,197 ADDICTION BY A PRODUCT THAT 804 00:29:59,264 --> 00:29:59,964 CONTAINS FENTANYL BECAUSE THEY 805 00:30:00,031 --> 00:30:00,632 HAVE NO TOLERANCE. 806 00:30:00,698 --> 00:30:02,367 SO THEY ARE EVEN MORE VULNERABLE 807 00:30:02,433 --> 00:30:04,669 TO THE RESPIRATORY DEPRESSANT 808 00:30:04,736 --> 00:30:07,739 EFFECTS OF FENTANYL THAN SOMEONE 809 00:30:07,805 --> 00:30:09,274 THAT HAS OPIOID ADDICTION. 810 00:30:09,340 --> 00:30:11,576 SO THESE ARE THE ACTUAL NUMBERS 811 00:30:11,643 --> 00:30:15,046 FOR 2023, OCTOBER 23, AND THIS 812 00:30:15,113 --> 00:30:16,481 IS 110,000, AND IT JUST -- WHAT 813 00:30:16,548 --> 00:30:17,682 IS DIFFERENT FROM THE OTHER 814 00:30:17,749 --> 00:30:19,984 SLIDES IS ONE YEAR MORE UP TO 815 00:30:20,051 --> 00:30:21,853 DATE, BUT IMPORTANTLY, IT TELLS 816 00:30:21,920 --> 00:30:22,954 YOU THAT COMPARISON FROM THE 817 00:30:23,021 --> 00:30:24,255 YEAR BEFORE. 818 00:30:24,322 --> 00:30:28,092 AND SO OVERALL, THERE'S BEEN A 819 00:30:28,159 --> 00:30:28,726 1.1% INCREASE. 820 00:30:28,793 --> 00:30:30,595 IT'S NOT A LARGE INCREASE, BUT 821 00:30:30,662 --> 00:30:33,765 WE'VE BEEN STRUGGLING AND AT 822 00:30:33,831 --> 00:30:34,766 EXTREMELY HIGH LEVELS OF 823 00:30:34,832 --> 00:30:35,733 MORTALITY AND WE HAVE NOT BEEN 824 00:30:35,800 --> 00:30:38,469 ABLE TO BRING THESE NUMBERS DOWN 825 00:30:38,536 --> 00:30:39,470 OVERALL. 826 00:30:39,537 --> 00:30:41,339 SOME OF THE CAUSES OF DEATHS ARE 827 00:30:41,406 --> 00:30:42,540 GOING DOWN. 828 00:30:42,607 --> 00:30:45,810 31% REDUCTION IN HEROIN FROM THE 829 00:30:45,877 --> 00:30:47,478 YEAR BEFORE. 830 00:30:47,545 --> 00:30:49,547 14% ON PRESCRIPTION OPIOID 831 00:30:49,614 --> 00:30:50,949 MEDICATIONS. 832 00:30:51,015 --> 00:30:53,918 METHADONE ALSO SHOWS -- I MEAN, 833 00:30:53,985 --> 00:30:55,153 METHADONE DOES NOT SHOW A 834 00:30:55,220 --> 00:30:57,355 DECREASE BUT IT BASICALLY IS A 835 00:30:57,422 --> 00:30:58,523 ZERO NET GAIN. 836 00:30:58,590 --> 00:31:00,291 IT'S VERY, VERY LOW, THE 837 00:31:00,358 --> 00:31:01,726 CONTRIBUTION OF METHADONE TO 838 00:31:01,793 --> 00:31:04,762 OVERDOSES. 839 00:31:04,829 --> 00:31:06,931 FENTANYL, COCAINE, 840 00:31:06,998 --> 00:31:07,565 METHAMPHETAMINE, THOSE CONTINUE 841 00:31:07,632 --> 00:31:09,234 TO RISE AND THAT'S ACTUALLY ONE 842 00:31:09,300 --> 00:31:10,568 OF THE ISSUES AND CHALLENGES 843 00:31:10,635 --> 00:31:12,737 WHEN I SAY, OKAY, HOW DO WE 844 00:31:12,804 --> 00:31:14,839 TACKLE THAT PROBLEM? 845 00:31:14,906 --> 00:31:18,109 BECAUSE IT IS TELLING US 846 00:31:18,176 --> 00:31:19,210 SOMETHING -- WHAT IT'S TELLING 847 00:31:19,277 --> 00:31:20,411 US, IF ALL OF THE INTERVENTIONS 848 00:31:20,478 --> 00:31:23,681 THAT WE'RE DOING ACROSS MANY 849 00:31:23,748 --> 00:31:25,350 AGENCIES OBVIOUSLY HAVE BEEN 850 00:31:25,416 --> 00:31:25,683 INSUFFICIENT. 851 00:31:25,750 --> 00:31:28,253 AND IN MY BRAIN, THAT'S WHAT WE 852 00:31:28,319 --> 00:31:29,921 DO DAY TO ON, DO SCIENCE FOR, TO 853 00:31:29,988 --> 00:31:33,758 TRY TO UNDERSTAND AND IDENTIFY 854 00:31:33,825 --> 00:31:36,160 WHERE THE INSUFFICIENT ISSUES 855 00:31:36,227 --> 00:31:37,362 ARE, WHERE ARE THE GAP AREAS AND 856 00:31:37,428 --> 00:31:39,530 HOW TO ADDRESS THEM. 857 00:31:39,597 --> 00:31:40,598 SPECIFICALLY, YES, WE'RE SEEING 858 00:31:40,665 --> 00:31:43,501 MORE AND MORE DRUG COMBINATIONS. 859 00:31:43,568 --> 00:31:44,902 AT THE ESSENCE, THERE IS 860 00:31:44,969 --> 00:31:45,303 FENTANYL. 861 00:31:45,370 --> 00:31:47,438 AND WE DO HAVE MEDICATIONS THAT 862 00:31:47,505 --> 00:31:49,407 ARE VERY EFFECTIVE FOR 863 00:31:49,474 --> 00:31:52,110 ADDRESSING OPIOID ADDICTION, AND 864 00:31:52,176 --> 00:31:54,078 FOR PREVENTING PEOPLE FROM 865 00:31:54,145 --> 00:31:55,079 OVERDOSING, AND WE HAVE 866 00:31:55,146 --> 00:31:56,414 MEDICATIONS THAT ARE VERY 867 00:31:56,481 --> 00:31:58,583 EFFECTIVE IN REVERSING AN 868 00:31:58,650 --> 00:32:00,652 OVERDOSE FROM OPIOIDS, PROVIDED 869 00:32:00,718 --> 00:32:03,154 YOU ADMINISTER THE DRUG RAPIDLY. 870 00:32:03,221 --> 00:32:05,790 THESE ARE METHADONE, 871 00:32:05,857 --> 00:32:07,225 BUPRENORPHINE, AND NALTREXONE 872 00:32:07,292 --> 00:32:09,627 FOR TREATMENT OF OPIOID USE 873 00:32:09,694 --> 00:32:11,496 DISORDERS, AND IF A PERSON IS 874 00:32:11,562 --> 00:32:12,797 TREATED ON SUSTAINING TREATMENT, 875 00:32:12,864 --> 00:32:14,232 YOU CAN DRAMATICALLY REDUCE 876 00:32:14,299 --> 00:32:16,401 THEIR RISK OF OVERDOSES. 877 00:32:16,467 --> 00:32:18,936 IN THE CASE OF NALOXONE, THIS IS 878 00:32:19,003 --> 00:32:22,173 AN OPIOID -- AN OVERDOSE 879 00:32:22,240 --> 00:32:24,409 REVERSAL MEDICATION THAT IF YOU 880 00:32:24,475 --> 00:32:26,144 ADMINISTER IT RAPIDLY AND 881 00:32:26,210 --> 00:32:28,012 PROMPTLY AT THE CORRECT DOSE, 882 00:32:28,079 --> 00:32:29,981 YOU WILL SAVE THE PERSON. 883 00:32:30,048 --> 00:32:33,151 EVEN IF THEY OVERDOSED WITH 884 00:32:33,217 --> 00:32:36,421 FENTANYL, EVEN IF THEY OVERDOSED 885 00:32:36,487 --> 00:32:39,257 WITH CA CARFENTANYL WHICH IS AN 886 00:32:39,324 --> 00:32:41,893 EVEN MORE POTENT SYNTHETIC THAN 887 00:32:41,959 --> 00:32:42,660 FENTANYL. 888 00:32:42,727 --> 00:32:43,961 THE TRICK IS TO ADMINISTER IT AS 889 00:32:44,028 --> 00:32:45,296 SOON AS POSSIBLE, AND AT THE 890 00:32:45,363 --> 00:32:47,165 CORRECT DOSES. 891 00:32:47,231 --> 00:32:48,633 AND AGAIN, TO MONITOR THE 892 00:32:48,700 --> 00:32:54,138 PATIENT SO IF THEY -- YOU CAN 893 00:32:54,205 --> 00:32:57,642 GIVE THE NALOXONE AGAIN. 894 00:32:57,709 --> 00:32:58,943 HOW EFFECTIVE OF ALL THE 895 00:32:59,010 --> 00:32:59,844 INTERVENTIONS WE HAVE, WHICH MAY 896 00:32:59,911 --> 00:33:01,379 NOT BE MANY BUT THEY ARE VERY 897 00:33:01,446 --> 00:33:02,246 EFFECTIVE, SO WE CAN WORK WITH 898 00:33:02,313 --> 00:33:02,714 THAT. 899 00:33:02,780 --> 00:33:05,650 WE CAN WORK WITH THAT SORT OF 900 00:33:05,717 --> 00:33:06,617 CLEARLY IN DISCUSSING THE 901 00:33:06,684 --> 00:33:08,820 STRATEGY OF OUR GOVERNMENT TO 902 00:33:08,886 --> 00:33:11,222 BASICALLY EXPAND AS MUCH AS 903 00:33:11,289 --> 00:33:12,323 POSSIBLE ACCESS TO MEDICATIONS 904 00:33:12,390 --> 00:33:14,826 FOR OPIOID USE DISORDER AND 905 00:33:14,892 --> 00:33:16,561 EXPAND ACCESS TO THE REVERSAL 906 00:33:16,627 --> 00:33:17,562 DRUG NALOXONE. 907 00:33:17,628 --> 00:33:19,864 AND NOW THERE'S ANOTHER ONE, 908 00:33:19,931 --> 00:33:20,832 NALTREXONE, THAT CAN BE ALSO 909 00:33:20,898 --> 00:33:22,934 USED FOR REVERSING OVERDOSES. 910 00:33:23,000 --> 00:33:25,670 SO THIS IS THE FIGURE THAT WAS 911 00:33:25,737 --> 00:33:31,676 PUBLISHED IN 2022 THAT 912 00:33:31,743 --> 00:33:33,311 ILLUSTRATES VERY NICELY WHY 913 00:33:33,378 --> 00:33:34,412 MEDICATIONS FOR OPIOID USE 914 00:33:34,479 --> 00:33:35,380 DISORDER ARE SO IMPORTANT TO 915 00:33:35,446 --> 00:33:36,180 ADDRESS THE CRISIS. 916 00:33:36,247 --> 00:33:37,415 WHAT THIS FIGURE IS TELLING US 917 00:33:37,482 --> 00:33:39,317 IS THAT REDUCTION, THE PERCENT 918 00:33:39,384 --> 00:33:42,153 REDUCTION IN OVERDOSES, IN THIS 919 00:33:42,220 --> 00:33:43,488 CASE THE STUDY WAS DONE IN 920 00:33:43,554 --> 00:33:44,689 PREGNANT WOMEN THAT HAD AN 921 00:33:44,756 --> 00:33:46,157 OPIOID USE DISORDER. 922 00:33:46,224 --> 00:33:47,892 AND THEY WERE MEASURING THE 923 00:33:47,959 --> 00:33:48,993 REDUCTION VERSUS THOSE THAT WERE 924 00:33:49,060 --> 00:33:52,597 NOT IN TREATMENT, AND ON 925 00:33:52,663 --> 00:33:53,898 BUPRENORPHINE AND THEY 926 00:33:53,965 --> 00:33:54,665 BASICALLY -- THESE WERE 927 00:33:54,732 --> 00:33:56,434 OVERDOSES THAT WERE NON-FATAL. 928 00:33:56,501 --> 00:33:58,736 AND WHAT THEY SHOW IS THAT EVEN 929 00:33:58,803 --> 00:34:01,906 IF THEY WERE ONLY COVERED FOR 10 930 00:34:01,973 --> 00:34:03,107 WEEKS, THAT ACTUALLY 931 00:34:03,174 --> 00:34:04,509 SIGNIFICANTLY REDUCED THEIR 932 00:34:04,575 --> 00:34:07,044 LIKELIHOOD OF OVERDOSING DURING 933 00:34:07,111 --> 00:34:10,415 THAT PERIOD. 934 00:34:10,481 --> 00:34:15,019 BUT IF THEY TOOK IT OVER THE -- 935 00:34:15,086 --> 00:34:17,188 YOU HAVE TO GIVE THE PERSON THE 936 00:34:17,255 --> 00:34:18,322 MEDICATION AND THE PERSON HAS TO 937 00:34:18,389 --> 00:34:19,190 STAY ON THE MEDICATION. 938 00:34:19,257 --> 00:34:23,694 SO WHAT IS OUR REALITY AS A 939 00:34:23,761 --> 00:34:24,695 COUNTRY, AS WE ALL RECOGNIZE 940 00:34:24,762 --> 00:34:26,631 THIS IS PROBABLY THE MOST 941 00:34:26,697 --> 00:34:31,669 POWERFUL INTERVENTION THAT WE 942 00:34:31,736 --> 00:34:33,838 HAVE FOR PREVENTING PEOPLE FROM 943 00:34:33,905 --> 00:34:36,040 OVERDOSES THAT HAVE AN OPIOID 944 00:34:36,107 --> 00:34:37,241 USE DISORDER, THAT WE REFER TO 945 00:34:37,308 --> 00:34:39,877 AS OPIOID ADDICTION, OPIOID 946 00:34:39,944 --> 00:34:40,745 DISORDER. 947 00:34:40,812 --> 00:34:43,481 WHAT'S VERY TRAGIC, THIS IS DATA 948 00:34:43,548 --> 00:34:45,450 RECENTLY PUBLISHED BUT FROM 949 00:34:45,516 --> 00:34:46,851 INFORMATION THAT WENT UP TO 950 00:34:46,918 --> 00:34:49,487 2021, AND FROM ESTIMATES, MORE 951 00:34:49,554 --> 00:34:51,255 CURRENT ONES, THIS HAS NOT 952 00:34:51,322 --> 00:34:54,091 CHANGED VERY MUCH. 953 00:34:54,158 --> 00:34:56,294 FOR PEOPLE TO HAVE AN OPIOID USE 954 00:34:56,360 --> 00:34:57,829 DISORDER, THAT IS TO SAY, AND 955 00:34:57,895 --> 00:35:00,031 IT'S ESTIMATED AT 2.5 MILLION, 956 00:35:00,097 --> 00:35:03,201 THIS IS NOT NOT A VERY PRECISE 957 00:35:03,267 --> 00:35:04,535 AND ACCURATE NUMBER. 958 00:35:04,602 --> 00:35:06,904 MANY FEEL THAT THIS IS AN 959 00:35:06,971 --> 00:35:07,805 UNDERESTIMATION AND WE BELIEVE 960 00:35:07,872 --> 00:35:10,208 THAT IT IS AN UNDERESTIMATION, 961 00:35:10,274 --> 00:35:11,609 BUT LET'S BE CONSERVATIVE AND 962 00:35:11,676 --> 00:35:13,911 SAY THAT, YES, THERE ARE 963 00:35:13,978 --> 00:35:14,812 2.5 MILLION PEOPLE THAT ARE 964 00:35:14,879 --> 00:35:16,647 ADDICTED TO OPIOIDS. 965 00:35:16,714 --> 00:35:19,817 OF THOSE, IT WAS ESTIMATED THAT 966 00:35:19,884 --> 00:35:22,353 ONLY 36% RECEIVED ANY TYPE OF 967 00:35:22,420 --> 00:35:22,820 TREATMENT. 968 00:35:22,887 --> 00:35:24,322 ANY TYPE OF TREATMENT DOES NOT 969 00:35:24,388 --> 00:35:25,957 MEAN QUALITY TREATMENT OR 970 00:35:26,023 --> 00:35:26,591 EVIDENCE-BASED TREATMENT. 971 00:35:26,657 --> 00:35:28,459 ANY TYPE OF TREATMENT. 972 00:35:28,526 --> 00:35:32,497 AND OF THE 2.5 MILLION PEOPLE, 973 00:35:32,563 --> 00:35:33,931 ONLY 22% RECEIVED MEDICATIONS 974 00:35:33,998 --> 00:35:36,467 FOR OPIOID USE DISORDER, WHICH 975 00:35:36,534 --> 00:35:37,869 IS THE RECOMMENDED TREATMENT, 976 00:35:37,935 --> 00:35:40,404 WHICH IS THE EVIDENCE-BASED 977 00:35:40,471 --> 00:35:42,473 INTERVENTION THAT HELPS THE 978 00:35:42,540 --> 00:35:43,474 PERSON, PREVENTS THEM FROM 979 00:35:43,541 --> 00:35:44,675 OVERDOSING BUT ALSO HELPS THEM 980 00:35:44,742 --> 00:35:47,645 IN THE PROCESS OF RECOVERY. 981 00:35:47,712 --> 00:35:51,015 AND DESPITE THIS EFFICACY, YOU 982 00:35:51,082 --> 00:35:53,518 SEE HOW POORLY THE PENETRATION 983 00:35:53,584 --> 00:35:56,287 OF THESE INTERVENTIONS INTO 984 00:35:56,354 --> 00:35:58,122 PEOPLE THAT WOULD BENEFIT FROM 985 00:35:58,189 --> 00:35:59,090 THEM, THAT COULD SAVE THEIR 986 00:35:59,156 --> 00:35:59,423 LIVES. 987 00:35:59,490 --> 00:36:00,992 SO FROM THE PERSPECTIVE OF 988 00:36:01,058 --> 00:36:03,160 SCIENCE, WHAT IS IT THAT WE CAN 989 00:36:03,227 --> 00:36:05,563 DO TO CHANGE THIS LANDSCAPE? 990 00:36:05,630 --> 00:36:07,265 BECAUSE YES, THE MEDICATIONS -- 991 00:36:07,331 --> 00:36:08,966 I'D LOVE TO HAVE MORE 992 00:36:09,033 --> 00:36:09,734 MEDICATIONS. 993 00:36:09,800 --> 00:36:11,135 BUT MEANWHILE, THE MEDICATIONS 994 00:36:11,202 --> 00:36:14,972 THAT ARE OUT THERE ARE NOT BEING 995 00:36:15,039 --> 00:36:16,841 DEPLOYED, SO HOW DO WE USE 996 00:36:16,908 --> 00:36:19,577 SCIENCE TO DO THIS? 997 00:36:19,644 --> 00:36:21,546 SO AMIDST THE OVERDOSE CRISIS, 998 00:36:21,612 --> 00:36:23,514 AND WE'RE PRIORITIZING IT 999 00:36:23,581 --> 00:36:25,249 BECAUSE WHEN YOU ARE LOSING ONE 1000 00:36:25,316 --> 00:36:27,818 PERSON FROM AN OVERDOSE EVERY 1001 00:36:27,885 --> 00:36:29,954 5 MINUTES, EVERY FIVE MINUTES, 1002 00:36:30,021 --> 00:36:31,656 YOU DON'T HAVE LUXURY OF TIME. 1003 00:36:31,722 --> 00:36:34,792 YOU NEED TO ACTUALLY ADDRESS 1004 00:36:34,859 --> 00:36:35,660 INTERVENTIONS THAT ARE GOING TO 1005 00:36:35,726 --> 00:36:37,628 CHANGE THINGS NOW TO PROTECT 1006 00:36:37,695 --> 00:36:39,530 THEM WHILE IN PARALLEL, OF 1007 00:36:39,597 --> 00:36:41,032 COURSE, CONTINUE TO DO SCIENCE 1008 00:36:41,098 --> 00:36:43,200 THAT CAN LEAD TO TRANSFORMATIVE 1009 00:36:43,267 --> 00:36:46,470 APPROACHES THAT WILL NULLIFY THE 1010 00:36:46,537 --> 00:36:47,605 WAY WE DO THINGS INTO THE 1011 00:36:47,672 --> 00:36:49,240 FUTURE, BUT RIGHT NOW, PEOPLE 1012 00:36:49,307 --> 00:36:50,007 ARE DYING. 1013 00:36:50,074 --> 00:36:52,543 SO THIS IS WHERE ONE OF OUR 1014 00:36:52,610 --> 00:36:54,178 PRIORITIES IN THE OVERDOSE 1015 00:36:54,245 --> 00:36:56,013 CRISIS HAS BEEN TO EXPAND WHAT 1016 00:36:56,080 --> 00:36:59,050 WE CALL IMPLEMENTATION RESEARCH. 1017 00:36:59,116 --> 00:37:00,918 THE WAY THAT I VIEW THIS ABOUT 1018 00:37:00,985 --> 00:37:01,686 IMPLEMENTATION RESEARCH AND THE 1019 00:37:01,752 --> 00:37:03,788 WAY IT GOES INTO MY BRAIN IS, WE 1020 00:37:03,854 --> 00:37:05,323 CAN BECOME VERY THEORETICAL AND 1021 00:37:05,389 --> 00:37:07,825 DESIGN A SORT OF PLAN, WE NEED 1022 00:37:07,892 --> 00:37:09,627 TO -- AND THIS IS CLEAR, WE NEED 1023 00:37:09,694 --> 00:37:10,161 TO EXPAND. 1024 00:37:10,227 --> 00:37:11,696 WHEN PEOPLE WERE LOOKING AT THE 1025 00:37:11,762 --> 00:37:13,331 TREATMENT PROGRAMS THAT ARE 1026 00:37:13,397 --> 00:37:14,298 CURRENTLY AVAILABLE FOR PEOPLE 1027 00:37:14,365 --> 00:37:15,733 WITH ADDICTIONS, THEY CAME BACK 1028 00:37:15,800 --> 00:37:20,104 AND THEY SAID, YOU KNOW, WE HAVE 1029 00:37:20,171 --> 00:37:24,709 INADEQUADEQUATE TREATMENTS IN OR 1030 00:37:24,775 --> 00:37:25,209 COUNTRY. 1031 00:37:25,276 --> 00:37:27,511 BUT THE ISSUE TO ME THAT'S VERY 1032 00:37:27,578 --> 00:37:29,447 DISTURBING TO ME AND DISTURBS MY 1033 00:37:29,513 --> 00:37:31,115 BRAIN IS WHY DO WE AS A 1034 00:37:31,182 --> 00:37:31,782 HEALTHCARE COMMUNITY AND 1035 00:37:31,849 --> 00:37:34,285 SPEAKING OF PUBLIC HEALTH, 1036 00:37:34,352 --> 00:37:36,387 CONCEIVE OF TREATMENTS OUTSIDE 1037 00:37:36,454 --> 00:37:37,688 THE HEALTHCARE SYSTEM? 1038 00:37:37,755 --> 00:37:41,058 WE DON'T DO THAT FOR ANY OTHER 1039 00:37:41,125 --> 00:37:44,161 CONDITIONS, AND I SEE THIS AS 1040 00:37:44,228 --> 00:37:45,363 SUCH A HORRIBLE MISSED 1041 00:37:45,429 --> 00:37:45,663 OPPORTUNITY. 1042 00:37:45,730 --> 00:37:46,797 WHY? 1043 00:37:46,864 --> 00:37:47,898 BECAUSE EVEN THOUGH IT MAY NOT 1044 00:37:47,965 --> 00:37:49,867 BE AS EXTENSIVE AS WE WOULD WANT 1045 00:37:49,934 --> 00:37:51,302 IN CERTAIN AREAS OF THE COUNTRY, 1046 00:37:51,369 --> 00:37:58,275 LIKE IN RURAL AREAS, WE KNOW THE 1047 00:37:58,342 --> 00:38:00,044 HEALTHCARE STRUCTURE IS QUITE 1048 00:38:00,111 --> 00:38:01,712 POWERFUL, AND IF WE CAN 1049 00:38:01,779 --> 00:38:02,680 PENETRATE THAT HEALTHCARE 1050 00:38:02,747 --> 00:38:03,981 SYSTEM, THEN WE CAN USE IT FOR 1051 00:38:04,048 --> 00:38:05,316 THE SCREENING AND TREAT M OF 1052 00:38:05,383 --> 00:38:07,718 INDIVIDUALS THAT HAVE AN OPIOID 1053 00:38:07,785 --> 00:38:09,053 ADDICTION AND TO MONITOR THAT. 1054 00:38:09,120 --> 00:38:11,222 AND WE DON'T NEED TO -- AND IF 1055 00:38:11,288 --> 00:38:13,424 IT'S SEVERE ENOUGH OR REQUIRES 1056 00:38:13,491 --> 00:38:14,425 SPECIALIZED TREATMENT, THEN WE 1057 00:38:14,492 --> 00:38:16,060 SEND THEM TO THE SPECIALIZED 1058 00:38:16,127 --> 00:38:18,129 TREATMENT PROGRAM. 1059 00:38:18,195 --> 00:38:20,765 BUT WE USE EXACTLY WHAT WE'RE 1060 00:38:20,831 --> 00:38:22,299 USING THE REST OF MEDICINE, RELY 1061 00:38:22,366 --> 00:38:24,168 ON MODELS THAT EXIST AND BECOME 1062 00:38:24,235 --> 00:38:27,571 AVAILABLE AS OUR MAIN WAY OF 1063 00:38:27,638 --> 00:38:30,641 ADDRESSING THE PAST NEE VAST NEE 1064 00:38:30,708 --> 00:38:31,042 POPULATION. 1065 00:38:31,108 --> 00:38:33,711 SO WE HAVE TAKEN ADVANTAGE OF 1066 00:38:33,778 --> 00:38:36,547 NIDA'S CLINICAL TRIALS NETWORK, 1067 00:38:36,614 --> 00:38:38,315 WHICH IS ACTUALLY 17 NODES 1068 00:38:38,382 --> 00:38:39,750 ACROSS THE UNITED STATES THAT 1069 00:38:39,817 --> 00:38:42,253 ARE ALSO LIKE THE BRAIN DYNAMIC, 1070 00:38:42,319 --> 00:38:44,221 MOVING AND LINKING WITH 1071 00:38:44,288 --> 00:38:45,022 PARTNERSHIPS AND DEPENDING ON 1072 00:38:45,089 --> 00:38:46,090 THE PROJECTS THAT RUTH BADER 1073 00:38:46,157 --> 00:38:46,991 GINSBURG DEPLOYED. 1074 00:38:47,058 --> 00:38:49,593 AND WE HAVE PRIORITIZED PROJECTS 1075 00:38:49,660 --> 00:38:52,263 THAT ACTUALLY DEVELOP MODELS 1076 00:38:52,329 --> 00:38:55,533 THAT DOCUMENT HOW INVOLVEMENT OF 1077 00:38:55,599 --> 00:38:57,768 HEALTHCARE ITSELF ON DIFFERENT 1078 00:38:57,835 --> 00:39:01,972 SPECIALTIES AND WAYS CAN 1079 00:39:02,039 --> 00:39:03,841 SIGNIFICANTLY IMPACT THE ABILITY 1080 00:39:03,908 --> 00:39:06,010 TO TREAT PEOPLE WITH OPIOID USE 1081 00:39:06,077 --> 00:39:08,012 DISORDER AND HELP THEM ACHIEVE 1082 00:39:08,079 --> 00:39:09,346 RECOVERY AND PREVENT THEM FROM 1083 00:39:09,413 --> 00:39:10,214 OVERDOSING. 1084 00:39:10,281 --> 00:39:12,616 SO THROUGH THAT CLINICAL TRIAL 1085 00:39:12,683 --> 00:39:14,485 NETWORKS, FOR EXAMPLE, THEY 1086 00:39:14,552 --> 00:39:16,754 CHANGE AND THEY'VE MODIFIED THE 1087 00:39:16,821 --> 00:39:17,855 WILLINGNESS OF MANY HEALTHCARE 1088 00:39:17,922 --> 00:39:21,892 SYSTEMS TO ACTUALLY NOW NOT JUST 1089 00:39:21,959 --> 00:39:24,195 HAVE SPECIAL CLINICIANS IN 1090 00:39:24,261 --> 00:39:26,697 ADDICTIONS, BUT ALSO 1091 00:39:26,764 --> 00:39:28,032 IMPORTANTLY, ENGAGE SOME OF THE 1092 00:39:28,099 --> 00:39:28,799 DEPARTMENTS THAT IN THE PAST 1093 00:39:28,866 --> 00:39:30,901 WERE NOT AT ALL ENGAGED IN 1094 00:39:30,968 --> 00:39:32,436 TREATMENT OF THESE PATIENTS. 1095 00:39:32,503 --> 00:39:37,475 FOR EXAMPLE, ONE OF THE MOST 1096 00:39:37,541 --> 00:39:40,077 EXCITING ADVANCEMENTS IN 1097 00:39:40,144 --> 00:39:40,745 IMPLEMENTATION HAS BEEN CHANGING 1098 00:39:40,811 --> 00:39:42,012 THE WAY THAT EMERGENCY 1099 00:39:42,079 --> 00:39:44,949 DEPARTMENTS NOW IN THE COUNTRY 1100 00:39:45,015 --> 00:39:47,118 ARE NOW VERY PROACTIVELY 1101 00:39:47,184 --> 00:39:48,219 SCREENING AND INITIATING 1102 00:39:48,285 --> 00:39:49,653 TREATMENT WITH MEDICATIONS FOR 1103 00:39:49,720 --> 00:39:51,622 OPIOID USE DISORDER IN THE 1104 00:39:51,689 --> 00:39:57,528 EMERGENCY DEPARTMENT ITSELF. 1105 00:39:57,595 --> 00:39:58,329 THE CLINICAL TRIALS NETWORK DID 1106 00:39:58,395 --> 00:39:59,764 A STUDY THAT ACTUALLY SHOWED 1107 00:39:59,830 --> 00:40:02,600 THAT INDEED, RESULTED IN MUCH 1108 00:40:02,666 --> 00:40:06,003 BETTER OUTCOMES. 1109 00:40:06,070 --> 00:40:07,004 SIMILARLY, CLINICAL TRIALS 1110 00:40:07,071 --> 00:40:10,074 NETWORK IS BASICALLY DOING A 1111 00:40:10,141 --> 00:40:13,444 STUDY THAT HAS SHOWN THAT 1112 00:40:13,511 --> 00:40:16,213 PRIMARY CARE PHYSICIANS AND 1113 00:40:16,280 --> 00:40:18,849 SCREENING FOR OPIOID USE 1114 00:40:18,916 --> 00:40:21,352 TREATMENT RESULTS IN SIMILAR -- 1115 00:40:21,418 --> 00:40:28,259 OBTAINED BY SPECIALIZED CENTERS. 1116 00:40:28,325 --> 00:40:30,127 WITH OTHER INFECTIONS AND 1117 00:40:30,194 --> 00:40:31,195 DISEASES WHICH FOR WHICH PEOPLE 1118 00:40:31,262 --> 00:40:36,834 WITH OPIOID USE DISORDER ARE -- 1119 00:40:36,901 --> 00:40:38,302 ALSO SIGNIFICANTLY NOT JUST IN 1120 00:40:38,369 --> 00:40:41,839 THE OPIOID USE DISORDER BUT ALSO 1121 00:40:41,906 --> 00:40:47,545 IN THE -- EMERGE OUT OF THIS 1122 00:40:47,611 --> 00:40:48,879 IMPLEMENTATION RESEARCH OF THE 1123 00:40:48,946 --> 00:40:51,615 CTN HUB AND SPOKE MODELS THAT 1124 00:40:51,682 --> 00:41:01,959 BASICALLY AWAY. 1125 00:41:23,347 --> 00:41:25,382 WITH SIMILAR OUTCOMES. 1126 00:41:25,449 --> 00:41:29,987 MOBILE DELIVERY OF MEDICATIONS. 1127 00:41:30,054 --> 00:41:31,322 CHANGING, USING INNOVATION, 1128 00:41:31,388 --> 00:41:33,190 OPENING IT UP AND SAYING HOW DO 1129 00:41:33,257 --> 00:41:34,725 WE USE HEALTH SYSTEMS TO DO 1130 00:41:34,792 --> 00:41:37,494 THIS. 1131 00:41:37,561 --> 00:41:39,530 AND IT'S ACTUALLY QUITE 1132 00:41:39,597 --> 00:41:40,764 REMARKABLE TO SEE THE 1133 00:41:40,831 --> 00:41:41,599 TRANSFORMATION THAT HAS HAPPENED 1134 00:41:41,665 --> 00:41:44,134 OVER THE PAST DECADE. 1135 00:41:44,201 --> 00:41:46,670 THE SECOND AREA THAT WE'VE 1136 00:41:46,737 --> 00:41:49,173 TARGETED ARE THE STRUCTURE THAT 1137 00:41:49,240 --> 00:41:51,709 EXISTED IN OUR COUNTRY TO EXPAND 1138 00:41:51,775 --> 00:41:54,144 ACCESS TO TREATMENT IS THE 1139 00:41:54,211 --> 00:41:58,382 JUSTICE SETTING. 1140 00:41:58,449 --> 00:42:02,219 BECAUSE ONE IN FOUR PEOPLE WHO 1141 00:42:02,286 --> 00:42:05,956 HAVE DIED OF OVERDOSES HAD PRIOR 1142 00:42:06,023 --> 00:42:07,157 YEAR JUSTICE INVOLVEMENT. 1143 00:42:07,224 --> 00:42:09,793 WHICH MEANS THAT IF SOMEONE HAD 1144 00:42:09,860 --> 00:42:14,498 INITIATED THE TREATMENT, THEY 1145 00:42:14,565 --> 00:42:15,799 HAVE NOT DIED -- THEY MAY HAVE 1146 00:42:15,866 --> 00:42:22,840 NOT OVERDOSED AT ALL. 1147 00:42:22,907 --> 00:42:25,542 THERE'S A PILOT STUDY THAT WAS 1148 00:42:25,609 --> 00:42:31,348 DONE, BUT THEY INITIATED 1149 00:42:31,415 --> 00:42:33,217 TREATMENT OF EVERY SINGLE PERSON 1150 00:42:33,284 --> 00:42:36,921 IN THE JAIL OR PRISON AND HAD AN 1151 00:42:36,987 --> 00:42:38,589 OPIOID USE DISORDER AND THEY 1152 00:42:38,656 --> 00:42:42,526 MONITORED THE OUTCOMES. 1153 00:42:42,593 --> 00:42:45,796 WHAT H THEY SHOWED WAS PEOPLE TT 1154 00:42:45,863 --> 00:42:47,865 HAD AN OPIOID USE DISORDER THAT 1155 00:42:47,932 --> 00:42:50,834 WERE IN THE JUSTICE SYSTEM, THIS 1156 00:42:50,901 --> 00:42:54,004 REDUCED THEIR DEATHS BY 70%. 1157 00:42:54,071 --> 00:42:57,074 IN THE POPULATION AT LARGE, SO 1158 00:42:57,141 --> 00:42:59,176 THIS ONE TO FOUR PEOPLE, THE 1159 00:42:59,243 --> 00:43:01,145 EFFECT FOR THAT -- WAS 30% 1160 00:43:01,211 --> 00:43:04,982 REDUCTION IN OVERDOSE DEATHS. 1161 00:43:05,049 --> 00:43:09,153 SO USING DATA, SPECIFICALLY 1162 00:43:09,219 --> 00:43:11,221 JUSTIFY -- SO WE CREATED -- JUST 1163 00:43:11,288 --> 00:43:13,090 LIKE WE HAD THE CLINICAL TRIAL 1164 00:43:13,157 --> 00:43:19,229 NETWORK, WE CREATED A -- THAT WE 1165 00:43:19,296 --> 00:43:20,764 HAVE NOT ENGAGED YET, 1166 00:43:20,831 --> 00:43:21,966 PREDOMINANTLY HAVE BEEN WORKING 1167 00:43:22,032 --> 00:43:27,571 WITH JAILS AND INDIVIDUALS ARE 1168 00:43:27,638 --> 00:43:28,906 ON FEDERAL JUSTICE SYSTEM AND 1169 00:43:28,973 --> 00:43:31,075 BASED ON THAT AND THAT 1170 00:43:31,141 --> 00:43:33,243 PARTNERSHIP AND THAT RECOGNITION 1171 00:43:33,310 --> 00:43:35,479 DATA THAT'S EMERGING SHOWED 1172 00:43:35,546 --> 00:43:36,680 BETTER OUTCOMES WHEN PEOPLE ARE 1173 00:43:36,747 --> 00:43:40,517 ACTUALLY PROVIDED WITH TREATMENT 1174 00:43:40,584 --> 00:43:42,786 OR WITH MEDICATIONS WHILE IN 1175 00:43:42,853 --> 00:43:47,524 JAIL, BEFORE THEY LEAVE JAIL 1176 00:43:47,591 --> 00:43:49,326 SIGNIFICANTLY IMPROVE -- THAT 1177 00:43:49,393 --> 00:43:51,695 THEY WILL SUSTAIN TREATMENT, 1178 00:43:51,762 --> 00:43:53,464 SIGNIFICANTLY REDUCES CHANCES OF 1179 00:43:53,530 --> 00:43:56,300 DYING AND CAN REDUCE THEIR RISK 1180 00:43:56,367 --> 00:43:57,167 OF REINCARCERATION. 1181 00:43:57,234 --> 00:43:59,003 SO THIS STARTS TO CHANGE THE 1182 00:43:59,069 --> 00:44:02,940 CULTURE THAT HAS BEEN PUNITIVE 1183 00:44:03,007 --> 00:44:04,875 IN RECOGNIZING ALSO THIS IS WHAT 1184 00:44:04,942 --> 00:44:08,979 WE WANT TO TAKE INTO THE FUTURE 1185 00:44:09,046 --> 00:44:12,049 AND WE WANT TO TAKE IT INTO 1186 00:44:12,116 --> 00:44:15,986 MODELS THAT CAN INTERVENE 1187 00:44:16,053 --> 00:44:17,421 INSTEAD OF PUTTING PEOPLE IN 1188 00:44:17,488 --> 00:44:18,088 JAIL. 1189 00:44:18,155 --> 00:44:22,593 SO ACTUALLY GO TO AN EXPERIENCE 1190 00:44:22,659 --> 00:44:23,827 THAT COULD BASICALLY INCREASE AT 1191 00:44:23,894 --> 00:44:29,800 THE END OF THE DAY -- 1192 00:44:29,867 --> 00:44:31,535 SIGNIFICANTLY -- FOR SUBSTANCE 1193 00:44:31,602 --> 00:44:34,638 USE DISORDER -- THE CONDITION. 1194 00:44:34,705 --> 00:44:37,041 HOW AN IMPACT -- THE OUTCOMES 1195 00:44:37,107 --> 00:44:39,743 AND IT'S BASICALLY I DON'T HAVE 1196 00:44:39,810 --> 00:44:42,980 SUFFICIENT DATA OR OTHER RIGHT 1197 00:44:43,047 --> 00:44:46,817 NOW FOR LOOKING AT JAILS 1198 00:44:46,884 --> 00:44:48,018 THEMSELVES AND THE WILLINGNESS 1199 00:44:48,085 --> 00:44:51,622 TO PROVIDE MEDICATIONS FOR 1200 00:44:51,688 --> 00:44:52,823 OPIOID USE DISORDER THAT 1201 00:44:52,890 --> 00:44:55,659 SEPARATES, WE'RE WANTING -- IN 1202 00:44:55,726 --> 00:44:57,661 2022, THAT CLEARLY SHOW HOW 1203 00:44:57,728 --> 00:45:02,166 WE'RE SIGNIFICANTLY INCREASING 1204 00:45:02,232 --> 00:45:04,001 IN A RELATIVELY SHORT PERIOD 1205 00:45:04,068 --> 00:45:05,669 JAILS AND PRISONS TO PROVIDE 1206 00:45:05,736 --> 00:45:07,304 MEDICATIONS FOR INDIVIDUALS THAT 1207 00:45:07,371 --> 00:45:08,972 HAVE OPIOID USE DISORDER. 1208 00:45:09,039 --> 00:45:11,041 SO IT HAS, AGAIN, JUST LIKE WITH 1209 00:45:11,108 --> 00:45:14,545 THE HEALTHCARE SYSTEM -- TO SEE 1210 00:45:14,611 --> 00:45:19,817 HOW YOU CAN CHANGE CULTURE 1211 00:45:19,883 --> 00:45:23,320 PROVIDING -- AND PROVIDING THE 1212 00:45:23,387 --> 00:45:25,055 INFORMATION THAT THEY CAN 1213 00:45:25,122 --> 00:45:27,691 ACTUALLY LET THEM TO EMBRACE 1214 00:45:27,758 --> 00:45:30,094 THEM AND CONTINUE. 1215 00:45:30,160 --> 00:45:32,096 AND THEN THE OTHER 1216 00:45:32,162 --> 00:45:33,730 IMPLEMENTATION PROJECT THAT WE 1217 00:45:33,797 --> 00:45:39,236 HAVE PRIORITIZE IS ONE THAT WAS 1218 00:45:39,303 --> 00:45:41,071 ALSO EXTREMELY AMBITIOUS, THAT 1219 00:45:41,138 --> 00:45:43,707 BASICALLY WAS LAUNCHED IN 2018, 1220 00:45:43,774 --> 00:45:46,810 WHEN WE WERE SAYING OKAY, WHAT 1221 00:45:46,877 --> 00:45:49,313 CAN WE DO. 1222 00:45:49,379 --> 00:45:53,450 WE KNOW THAT IF WE INVOLVE THE 1223 00:45:53,517 --> 00:45:55,886 HEALTHCARE SYSTEM INTO TREATMENT 1224 00:45:55,953 --> 00:45:57,654 WE WOULD PROVIDE NALOXONE TO 1225 00:45:57,721 --> 00:45:58,522 REVERSE OVERDOSES. 1226 00:45:58,589 --> 00:46:03,427 WE KNOW THAT WHEN WE TRANSITION 1227 00:46:03,494 --> 00:46:04,595 TO NOT HAVING MEDICATIONS WHEN 1228 00:46:04,661 --> 00:46:07,731 THEY ARE NOT NECESSARY AND 1229 00:46:07,798 --> 00:46:08,632 PRESCRIBE THEM WHEN THEY ARE 1230 00:46:08,699 --> 00:46:10,134 NEEDED THAT WE CAN SIGNIFICANTLY 1231 00:46:10,200 --> 00:46:13,036 REDUCE OVERDOSES. 1232 00:46:13,103 --> 00:46:17,307 FOR THAT TO HAPPEN, WE NEED TO 1233 00:46:17,374 --> 00:46:19,676 CREATE THOSE BRIDGES THAT WHEN 1234 00:46:19,743 --> 00:46:22,546 SPEAKING ABOUT -- WE NEED TO 1235 00:46:22,613 --> 00:46:23,680 HELP -- WE NEED THE STATES TO 1236 00:46:23,747 --> 00:46:27,818 WORK WITH ACTUALLY THESE OTHER 1237 00:46:27,885 --> 00:46:28,152 GROUPS. 1238 00:46:28,218 --> 00:46:33,724 WE NEED THE COMMUNITY TO -- 1239 00:46:33,790 --> 00:46:37,594 USING THE NEED FOR UNDERSTANDING 1240 00:46:37,661 --> 00:46:41,064 AND ENGAGEMENT TO PARTNER WITH 1241 00:46:41,131 --> 00:46:47,104 ORGANIZATIONS AND STRUCTURES 1242 00:46:47,171 --> 00:46:48,172 WITH THE STATES THAT HAVE SOME 1243 00:46:48,238 --> 00:46:50,941 OF THE HIGHEST MORTALITY, AND WE 1244 00:46:51,008 --> 00:46:52,042 DO HAVE A DEMONSTRATION PROJECT 1245 00:46:52,109 --> 00:46:53,343 OF WHAT HAPPENS WHEN BRIDGES ARE 1246 00:46:53,410 --> 00:46:55,112 BUILT. 1247 00:46:55,179 --> 00:46:59,082 AND YOU GET THAT INTERVENTION, 1248 00:46:59,149 --> 00:47:03,787 THE BASIS -- IN THAT PROJECT, IT 1249 00:47:03,854 --> 00:47:06,723 ACTUALLY -- THAT ALSO FRANCIS 1250 00:47:06,790 --> 00:47:08,625 WAS DIRECTOR AND WE HAVE TO BE 1251 00:47:08,692 --> 00:47:10,594 BOLD, WE HAVE TO COME UP WITH AN 1252 00:47:10,661 --> 00:47:14,198 OUTCOME THAT IS ACTUALLY REALLY 1253 00:47:14,264 --> 00:47:17,167 TO INSPIRE EVERYONE, I FEEL VERY 1254 00:47:17,234 --> 00:47:19,036 NERVOUS TO SAY THAT THIS WILL 1255 00:47:19,102 --> 00:47:20,904 REDUCE OVERDOSE DEATHS BY ANY 1256 00:47:20,971 --> 00:47:23,674 SUCH NUMBER BUT SO FINALLY, WE 1257 00:47:23,740 --> 00:47:26,610 SAID WE'RE GOING TO DECREASE 40% 1258 00:47:26,677 --> 00:47:27,144 MORTALITY. 1259 00:47:27,211 --> 00:47:28,879 AND I SAID I DON'T WANT TO DO IT 1260 00:47:28,946 --> 00:47:30,581 BECAUSE I DON'T KNOW WHAT'S 1261 00:47:30,647 --> 00:47:31,448 GOING TO HAPPEN. 1262 00:47:31,515 --> 00:47:33,617 I WAS VERY -- THAT WE WOULD 1263 00:47:33,684 --> 00:47:36,320 START TO SEE EMERGENCE OF 1264 00:47:36,386 --> 00:47:40,991 METHAMPHETAMINE, WHICH HAPPENED. 1265 00:47:41,058 --> 00:47:42,993 BUT I DID NOT HAVED IN WHAT 1266 00:47:43,060 --> 00:47:44,294 WOULD HAPPEN WAS THE COVID 1267 00:47:44,361 --> 00:47:47,264 PANDEMIC AND THAT BASICALLY WAS 1268 00:47:47,331 --> 00:47:48,298 COMPLETELY DISRUPTIVE. 1269 00:47:48,365 --> 00:47:50,100 BUT THE STUDIES WENT ON AND THE 1270 00:47:50,167 --> 00:47:51,468 STUDIES WILL BE PUBLISHED SOON, 1271 00:47:51,535 --> 00:47:52,703 I'M NOT ALLOWED TO ACTUALLY 1272 00:47:52,769 --> 00:47:56,039 COMMENT ON THEM, ALTHOUGH I'M 1273 00:47:56,106 --> 00:47:57,808 SHOWING SOME RESULTS THAT SHOW 1274 00:47:57,874 --> 00:47:59,409 THAT BASICALLY ONE OF THE 1275 00:47:59,476 --> 00:48:01,445 INTERVENTIONS WHICH WAS TO 1276 00:48:01,511 --> 00:48:04,314 EXPAND THE ACCESS OF NALOXONE, 1277 00:48:04,381 --> 00:48:07,184 AND IN BLUE YOU HAVE THE CONTROL 1278 00:48:07,251 --> 00:48:10,587 COMMUNITIES AND IN RED -- THE 1279 00:48:10,654 --> 00:48:14,625 ACTION COMMUNITY, THE ONES THAT 1280 00:48:14,691 --> 00:48:17,027 ARE DOUBLE BLIND, WE DID THAT 1281 00:48:17,094 --> 00:48:19,896 INTERVENTION, 18 MONTHS LATER, 1282 00:48:19,963 --> 00:48:21,098 DURING -- THAT WAS 18 MONTHS, 1283 00:48:21,164 --> 00:48:25,135 BUT THEN WE HAVE THE CONTROL, 1284 00:48:25,202 --> 00:48:26,703 THE COMMUNITY RECEIVED THE 1285 00:48:26,770 --> 00:48:29,439 INTERVENTIONS AND THE -- YOU CAN 1286 00:48:29,506 --> 00:48:33,610 SEE MUCH -- DELIVERY OF 1287 00:48:33,677 --> 00:48:35,345 NALOXONE. 1288 00:48:35,412 --> 00:48:37,014 SO IT WORKED THAT WAY AND NOW 1289 00:48:37,080 --> 00:48:39,082 THE COMMUNITIES THAT WERE -- 1290 00:48:39,149 --> 00:48:40,751 CONTROLS ARE RECEIVING THE 1291 00:48:40,817 --> 00:48:42,819 INTERVENTIONS, SO THAT WE 1292 00:48:42,886 --> 00:48:44,521 BASICALLY DON'T COME IN IN ONE 1293 00:48:44,588 --> 00:48:45,689 OF THE CRITICISMS IN THE 1294 00:48:45,756 --> 00:48:48,125 COMMUNITY AND THEN DISAPPEAR, SO 1295 00:48:48,191 --> 00:48:53,230 WE BASICALLY FEEL THE -- WE HAVE 1296 00:48:53,297 --> 00:48:54,965 TO THESE COMMUNITIES TO HAVE 1297 00:48:55,032 --> 00:48:57,768 PARTICIPATED. 1298 00:48:57,834 --> 00:49:03,040 BUT THIS IMPLEMENTATION, WE HA 1299 00:49:03,106 --> 00:49:04,474 HAVE -- ARE THERE OTHER VENUES 1300 00:49:04,541 --> 00:49:06,943 THAT WE NEED TO TACKLE IN ORDER 1301 00:49:07,010 --> 00:49:09,179 TO TACKLE THE OVERDOSE CRISIS, 1302 00:49:09,246 --> 00:49:12,349 AND REQUIRE THAT WE, OF COURSE, 1303 00:49:12,416 --> 00:49:13,817 UNDERSTAND WHY FENTANYL IS SO 1304 00:49:13,884 --> 00:49:15,185 DANGEROUS. 1305 00:49:15,252 --> 00:49:16,153 AND YOU ALL HAVE BEEN READING IN 1306 00:49:16,219 --> 00:49:20,857 THE NEWSPAPERS THE QUOTE THAT 1307 00:49:20,924 --> 00:49:23,593 SAID -- IT'S AN EXTREMELY POTENT 1308 00:49:23,660 --> 00:49:27,297 DRUG, IT'S EASY TO MANUFACTURE, 1309 00:49:27,364 --> 00:49:29,933 AND THE -- MOSTLY COME FROM 1310 00:49:30,000 --> 00:49:31,535 CHINA, THEN THEY GO TO MEXICO, 1311 00:49:31,601 --> 00:49:38,508 WHERE THESE AND THEN TO THE UND 1312 00:49:38,575 --> 00:49:39,076 STATES. 1313 00:49:39,142 --> 00:49:41,845 THIS IS 50 TIMES MORE POTENT. 1314 00:49:41,912 --> 00:49:43,380 POTENCY MEANS YOU NEED MUCH, 1315 00:49:43,447 --> 00:49:47,617 MUCH, MUCH TINIER DOSE TO KILL 1316 00:49:47,684 --> 00:49:57,060 YOU, SO HIGHLY, JAI ALAI HIGHLY 1317 00:49:57,127 --> 00:49:57,494 ADDICTIVE. 1318 00:49:57,561 --> 00:49:59,963 IT'S EASY TO MANUFACTURE, IT'S 1319 00:50:00,030 --> 00:50:04,668 NOT VERY -- AND FOR THEM IT'S AT 1320 00:50:04,735 --> 00:50:06,737 LEAST -- MORE MONEY THAT THEY 1321 00:50:06,803 --> 00:50:07,237 SELL. 1322 00:50:07,304 --> 00:50:09,506 AND IT'S ADDICTIVE. 1323 00:50:09,573 --> 00:50:16,646 SO WHAT IS -- THAT 2 MG CAN KILL 1324 00:50:16,713 --> 00:50:17,414 YOU. 1325 00:50:17,481 --> 00:50:20,617 IT'S NOT AN EXAGGERATION. 1326 00:50:20,684 --> 00:50:22,252 SOMETIMES -- HAS TO LOSE 1327 00:50:22,319 --> 00:50:23,553 CREDIBILITY TO EQUALIZE DRUGS AS 1328 00:50:23,620 --> 00:50:31,128 ALL BAD OR ALL GOOD. 1329 00:50:31,194 --> 00:50:32,662 WHEN PEOPLE BUY THEM IN THE 1330 00:50:32,729 --> 00:50:34,197 STREETS, FIRST OF ALL THEY GO 1331 00:50:34,264 --> 00:50:36,400 AND BUY HEROIN WHICH IS REALLY 1332 00:50:36,466 --> 00:50:43,306 FENTANYL, AS I SAY, TO -- 1333 00:50:43,373 --> 00:50:46,410 THERE'S NO -- WHAT QUANTITY OR 1334 00:50:46,476 --> 00:50:50,680 BATCH HAS, IT'S BASICALLY NOT -- 1335 00:50:50,747 --> 00:50:52,682 ONE OF THE WAYS WHICH ALSO HAS 1336 00:50:52,749 --> 00:50:55,318 MADE THE SITUATION EVEN MORE 1337 00:50:55,385 --> 00:50:57,254 ALARMING, DURING THE COVID 1338 00:50:57,320 --> 00:50:58,355 PANDEMIC, THE AMOUNT OF FENTANYL 1339 00:50:58,422 --> 00:51:00,257 THAT CAME IN TO THE COUNTRY 1340 00:51:00,323 --> 00:51:01,691 INCREASED SIGNIFICANTLY, AND HAS 1341 00:51:01,758 --> 00:51:08,565 CONTINUED TO INCREASE. 1342 00:51:08,632 --> 00:51:12,536 -- IN ILLICITLY MANUFACTURED 1343 00:51:12,602 --> 00:51:14,304 FIELDS, FIELDS, FOR EXAMPLE, CAN 1344 00:51:14,371 --> 00:51:17,040 BE SLEEP OR FOR -- AND THEY LOOK 1345 00:51:17,107 --> 00:51:19,910 IDENTICAL TO THE ONES THAT YOU 1346 00:51:19,976 --> 00:51:21,478 BASICALLY BUY IN THE PHARMACY. 1347 00:51:21,545 --> 00:51:26,183 AND THEY ARE -- LESS EXPENSIVE. 1348 00:51:26,249 --> 00:51:28,452 WHAT'S HAPPENING IS THAT PEOPLE 1349 00:51:28,518 --> 00:51:31,321 FOR EXAMPLE THAT BUY MEDICATION 1350 00:51:31,388 --> 00:51:32,556 WHERE THEIR DOCTORS GIVE THEM, 1351 00:51:32,622 --> 00:51:33,857 THEY HAVE PAIN AND THEY NEED A 1352 00:51:33,924 --> 00:51:38,228 PAIN MEDICATION, OR TEENAGERS 1353 00:51:38,295 --> 00:51:39,129 THAT -- ONE OF THE THINGS THEY 1354 00:51:39,196 --> 00:51:43,400 DO, THEY DO -- THEY LIKE -- 1355 00:51:43,467 --> 00:51:44,701 MIXED IN WITH ALCOHOL, GET ONE 1356 00:51:44,768 --> 00:51:47,804 OF THEIR PILLS AND IT CONTAINS 1357 00:51:47,871 --> 00:51:49,139 FENTANYL, ONE DOSE WILL VERY, 1358 00:51:49,206 --> 00:51:52,843 VERY LIKELY KILL THEM, AND THIS 1359 00:51:52,909 --> 00:51:54,377 IS WHAT YOU HEAR FROM PARENTS 1360 00:51:54,444 --> 00:51:57,147 WHO HAVE LOST THEIR CHILD BY 1361 00:51:57,214 --> 00:51:58,248 JUST THE ONE DOSE. 1362 00:51:58,315 --> 00:51:59,916 BUT IN OLDER PEOPLE THAT GO OUT 1363 00:51:59,983 --> 00:52:06,256 THERE AND THEY TAKE ONE TO THEM, 1364 00:52:06,323 --> 00:52:09,926 SO THIS IS A WAY THAT FENTANYL 1365 00:52:09,993 --> 00:52:12,195 IS COMING INTO THE COUNTRY THAT 1366 00:52:12,262 --> 00:52:14,064 ACTUALLY HAS MADE DEMOGRAPHIC OF 1367 00:52:14,130 --> 00:52:16,199 OUR POPULATION WHEN THEY'RE 1368 00:52:16,266 --> 00:52:17,434 ABOUT TO OVERDOSE. 1369 00:52:17,501 --> 00:52:19,169 ANOTHER ASPECT ABOUT THE 1370 00:52:19,236 --> 00:52:21,238 FENTANYL DANGERS IS NOT JUST 1371 00:52:21,304 --> 00:52:23,673 THAT IT'S MORE POTENT THAN -- 1372 00:52:23,740 --> 00:52:26,309 IT'S ALSO MORE -- AND THAT WHAT 1373 00:52:26,376 --> 00:52:29,913 THAT MEANS IS THAT IT GETS INTO 1374 00:52:29,980 --> 00:52:32,482 THE BRAIN MUCH -- THAN HEROIN. 1375 00:52:32,549 --> 00:52:34,784 AND WHY THAT'S IMPORTANT, IT CAN 1376 00:52:34,851 --> 00:52:36,553 INTERRUPT RESPIRATION. 1377 00:52:36,620 --> 00:52:39,523 AND YOU HEARD THE SAYING IN 1378 00:52:39,589 --> 00:52:41,024 ORDER FOR NALOXONE TO BE 1379 00:52:41,091 --> 00:52:42,459 EFFECTIVE, YOU HAVE TO 1380 00:52:42,526 --> 00:52:43,660 ADMINISTER IT -- SO WHAT IT 1381 00:52:43,727 --> 00:52:45,495 MEANS BECAUSE IT GETS INTO THE 1382 00:52:45,562 --> 00:52:46,763 BRAIN SO, SO FAST, YOU HAVE A 1383 00:52:46,830 --> 00:52:48,732 MUCH SHORTER WINDOW AT WHICH YOU 1384 00:52:48,798 --> 00:52:52,769 CAN GIVE NALOXONE -- AND THAT OF 1385 00:52:52,836 --> 00:53:00,677 COURSE IS HARDER TO ACHEE. 1386 00:53:00,744 --> 00:53:03,847 -- THEY TEND 1387 00:53:03,914 --> 00:53:05,715 TO -- SYNDROME, AND WHAT IT 1388 00:53:05,782 --> 00:53:06,783 BASICALLY INTERFERES YOUR 1389 00:53:06,850 --> 00:53:10,687 ABILITY TO EXPAND YOUR -- 1390 00:53:10,754 --> 00:53:12,989 MUSCLES SO YOU CANNOT EXPAND, 1391 00:53:13,056 --> 00:53:13,790 INSPIRE AND EXPIRE. 1392 00:53:13,857 --> 00:53:18,495 SO IT'S NOT JUST DEPRESSING -- 1393 00:53:18,562 --> 00:53:19,696 BUT INTERFERING WITH YOUR 1394 00:53:19,763 --> 00:53:21,464 ABILITY TO INHALE OXYGEN. 1395 00:53:21,531 --> 00:53:24,301 SO THESE ACTUALLY ARE EVEN MORE 1396 00:53:24,367 --> 00:53:26,002 LETHAL. 1397 00:53:26,069 --> 00:53:30,774 FOR US IN THE TREATMENT FIELD, 1398 00:53:30,840 --> 00:53:33,410 PEOPLE OUT THERE WHO BELIEVE -- 1399 00:53:33,476 --> 00:53:35,845 MOST PEOPLE -- MANY DO KNOW THAT 1400 00:53:35,912 --> 00:53:39,816 IT'S LIKELY THAT THEY ARE NOT -- 1401 00:53:39,883 --> 00:53:40,584 FENTANYL, IS THAT FENTANYL 1402 00:53:40,650 --> 00:53:43,720 POTENCY GENERATES A MUCH EVEN 1403 00:53:43,787 --> 00:53:45,388 STRONGER PHYSICAL DEPENDENCE 1404 00:53:45,455 --> 00:53:46,089 THAN WHAT YOU HAVE WITH 1405 00:53:46,156 --> 00:53:47,824 SOMETHING LIKE HEROIN. 1406 00:53:47,891 --> 00:53:49,659 AND AS A RESULT OF THAT, 1407 00:53:49,726 --> 00:53:51,695 MEDICATIONS THAT WE USE FOR 1408 00:53:51,761 --> 00:53:56,499 OPIOID USE DISORDER OR EVEN 1409 00:53:56,566 --> 00:53:59,002 METHADONE, AND NOT TO SAY 1410 00:53:59,069 --> 00:54:01,137 NALTREXONE, THAT'S EXTREMELY -- 1411 00:54:01,204 --> 00:54:03,306 THAT HAVE THE STRONG PHYSICAL 1412 00:54:03,373 --> 00:54:07,143 DEPENDENCE, MUCH HARDER WITH 1413 00:54:07,210 --> 00:54:08,678 MEDICATIONS IN OPIOID USE 1414 00:54:08,745 --> 00:54:13,883 DISORDER WHEN PEOPLE -- AND 1415 00:54:13,950 --> 00:54:16,186 PROTOCOLS -- ACTUALLY -- TO DO 1416 00:54:16,252 --> 00:54:18,154 IT, WE REQUIRE, WHICH IS WHAT A 1417 00:54:18,221 --> 00:54:22,058 LOT OF PEOPLE BELIEVE THE DOS 1418 00:54:22,125 --> 00:54:22,993 DOSES -- WITHDRAWAL AND THE 1419 00:54:23,059 --> 00:54:24,828 CRAVING. 1420 00:54:24,894 --> 00:54:29,432 AND THAT IS THE THING WITH 1421 00:54:29,499 --> 00:54:32,302 OVERDOSES, YOU CAN REVERSE THEM 1422 00:54:32,369 --> 00:54:34,070 BUT YOU MAY NEED MULTIPLE DOSES 1423 00:54:34,137 --> 00:54:34,604 OF NALOXONE. 1424 00:54:34,671 --> 00:54:36,873 SO YOU GO IN AND YOU SEE IN THE 1425 00:54:36,940 --> 00:54:38,942 STREET SOMETIMES WHAT HAPPENS, 1426 00:54:39,009 --> 00:54:40,577 THE PERSON IS REVERTED, THEY 1427 00:54:40,644 --> 00:54:41,578 DON'T WANT TO GO TO THE 1428 00:54:41,645 --> 00:54:46,716 EMERGENCY DEPARTMENT, AND THEN 1429 00:54:46,783 --> 00:54:48,918 90 MINUTES -- THEY STOP 1430 00:54:48,985 --> 00:54:52,422 BREATHING AGAIN, NALOXONE IS NO 1431 00:54:52,489 --> 00:54:53,223 LONGER AND THEY DIE. 1432 00:54:53,289 --> 00:54:56,993 SO YOU NEED TO HAVE A PROCESS 1433 00:54:57,060 --> 00:54:58,061 THAT'S MUCH MORE URGENT. 1434 00:54:58,128 --> 00:54:59,462 YOU SHOULD HAVE IT FOR ANY 1435 00:54:59,529 --> 00:55:01,264 PERSON THAT OVERDOSES BUT IT'S 1436 00:55:01,331 --> 00:55:04,968 MUCH MORE THAN WITH FENTANYL. 1437 00:55:05,035 --> 00:55:06,970 AND WITH ALL OF THESE ISSUES 1438 00:55:07,037 --> 00:55:08,271 SORT OF TOO -- 1439 00:55:08,338 --> 00:55:10,707 >> EXCUSE ME, I'M SORRY, 1440 00:55:10,774 --> 00:55:12,242 DR. VOLKOW, I DIDN'T MEAN TO 1441 00:55:12,308 --> 00:55:15,011 INTERRUPT, BUT -- 1442 00:55:15,078 --> 00:55:17,947 >> IT IS CLEAR THAT, YES, WE 1443 00:55:18,014 --> 00:55:20,917 HAVE MEDICATIONS THAT ARE 1444 00:55:20,984 --> 00:55:22,218 VERY -- WE DEFINITELY NEED MORE. 1445 00:55:22,285 --> 00:55:26,823 WE NEED MORE -- WHAT HAPPENS 1446 00:55:26,890 --> 00:55:28,825 WHEN SOMEONE IS METHAMPHETAMINE 1447 00:55:28,892 --> 00:55:32,996 AND FENTANYL, NALOXONE WOULD 1448 00:55:33,063 --> 00:55:41,705 REVERT FENTANYL BUT THE METH AM- 1449 00:55:41,771 --> 00:55:43,540 BASICALLY -- LIKE LEHIGH POX IK. 1450 00:55:43,606 --> 00:55:45,508 LIKELY 1451 00:55:47,177 --> 00:55:51,047 LIKLIKELY HYPOXIC. 1452 00:55:51,114 --> 00:55:52,115 WE NEED TREATMENT FOR 1453 00:55:52,182 --> 00:55:54,651 MEDICATIONS CLOSE TO 40, 1454 00:55:54,718 --> 00:55:58,054 SOMETIMES 50% OF THEM STOP AT 1455 00:55:58,121 --> 00:55:58,388 SIX MONTHS. 1456 00:55:58,455 --> 00:56:00,156 WHAT IS ACTUALLY -- WHAT IS IT 1457 00:56:00,223 --> 00:56:02,158 THAT WE CAN DO TO IMPROVE THAT 1458 00:56:02,225 --> 00:56:02,926 RETENTION? 1459 00:56:02,992 --> 00:56:06,296 OTHER ALTERNATIVES THAT CAN BE 1460 00:56:06,362 --> 00:56:08,698 USED BY THEMSELVES ORALLY -- 1461 00:56:08,765 --> 00:56:12,602 WITH THESE MEDICATIONS TO HELP 1462 00:56:12,669 --> 00:56:14,337 RETAIN PEOPLE IN TREATMENT. 1463 00:56:14,404 --> 00:56:22,245 AND EXTREMELY -- ACTUALLY UNBEE 1464 00:56:22,312 --> 00:56:26,516 UNBEKNOWNST TO THEM -- OR SOME 1465 00:56:26,583 --> 00:56:29,686 OF THEM SEEK THEM OUT AND THAT 1466 00:56:29,753 --> 00:56:31,221 WOULD ACTUALLY REQUIRE WE SHIFT 1467 00:56:31,287 --> 00:56:33,356 OUR PARADIGM ON TREATMENT SO -- 1468 00:56:33,423 --> 00:56:34,657 AND THIS IS SOMETHING THAT WE'VE 1469 00:56:34,724 --> 00:56:39,229 BEEN DOING FOR A LONG TIME 1470 00:56:39,295 --> 00:56:42,532 BUT -- TO DEVELOP TREATMENTS FOR 1471 00:56:42,599 --> 00:56:44,968 NOT SPECIFIC -- BUT FOR 1472 00:56:45,034 --> 00:56:46,836 ADDICTION PHENOTYPE AND THERE'S 1473 00:56:46,903 --> 00:56:49,906 ENOUGH EVIDENCE, SCIENTIFICALLY 1474 00:56:49,973 --> 00:56:53,443 FROM -- ACTUALLY ETHICS THAT 1475 00:56:53,510 --> 00:56:55,645 INDICATE THAT THIS IS ETHICALLY 1476 00:56:55,712 --> 00:56:57,947 SOUND. 1477 00:56:58,014 --> 00:56:59,349 THESE ARE SOME EXAMPLES -- 1478 00:56:59,415 --> 00:57:05,889 >> EXCUSE ME, DR. VOLKOW? 1479 00:57:05,955 --> 00:57:06,189 DR. VOLKOW? 1480 00:57:06,256 --> 00:57:15,698 >> FROM SORT OF -- -- WANT TO GO 1481 00:57:15,765 --> 00:57:19,636 INTO AN OVERDOSE TO SOUND AN 1482 00:57:19,702 --> 00:57:25,708 ALARM, THAT ACTUALLY RELEASE 1483 00:57:25,775 --> 00:57:27,577 NALOXONE TO THIS THAT I'M 1484 00:57:27,644 --> 00:57:28,311 HIGHLIGHTING BECAUSE I THINK 1485 00:57:28,378 --> 00:57:30,013 IT'S SUCH AN EXCITING AREA OF 1486 00:57:30,079 --> 00:57:33,449 RESEARCH, WHICH AS WE KNOW THE 1487 00:57:33,516 --> 00:57:34,417 NETWORKS AFFECTED IN ADDICTION 1488 00:57:34,484 --> 00:57:37,821 AND WE HAVE TOOLS TO STRENGTHEN 1489 00:57:37,887 --> 00:57:39,823 THOSE NETWORKS OR GIVE A DOSE 1490 00:57:39,889 --> 00:57:43,326 THAT ARE ACTUALLY -- WE'LL 1491 00:57:43,393 --> 00:57:45,295 BASICALLY BE ABLE TO MODIFY THE 1492 00:57:45,361 --> 00:57:48,498 WAY THAT WE TREAT SUBSTANCE USE 1493 00:57:48,565 --> 00:57:50,800 DISORDERS OR OTHER MENTAL 1494 00:57:50,867 --> 00:57:54,737 DISEASES IN WAYS THAT CURRENTLY 1495 00:57:54,804 --> 00:57:59,943 ARE BEING REALIZED AS WE IMPROVE 1496 00:58:00,009 --> 00:58:02,712 NEUROMODULATION AND TOOLS -- 1497 00:58:02,779 --> 00:58:04,848 ADDICTION BUT IT HAS ALSO BEEN 1498 00:58:04,914 --> 00:58:08,017 APPROVED FOR DEPRESSION AND 1499 00:58:08,084 --> 00:58:11,554 THERE'S ONGOING WORK -- AND 1500 00:58:11,621 --> 00:58:13,656 YOU'VE ALSO HEARD IN TERMS OF 1501 00:58:13,723 --> 00:58:15,525 THERAPEUTICS AND OTHER AREA OF 1502 00:58:15,592 --> 00:58:18,895 GREAT INTEREST HAVE BEEN THIS -- 1503 00:58:18,962 --> 00:58:20,530 RECEPTORS LIKE -- THAT ARE 1504 00:58:20,597 --> 00:58:23,132 SHOWING EVIDENCE THAT PEOPLE 1505 00:58:23,199 --> 00:58:25,969 THAT ARE BEING GIVEN THESE 1506 00:58:26,035 --> 00:58:29,038 MEDICATIONS FOR DIABETES -- 1507 00:58:29,105 --> 00:58:29,806 INTERESTING DRUGS. 1508 00:58:29,873 --> 00:58:32,075 WE'VE ALSO HEARD A LOT OF VERY 1509 00:58:32,141 --> 00:58:34,244 INTERESTING SCIENCE. 1510 00:58:34,310 --> 00:58:38,414 -- POTENTIAL UTILIZATION OF -- 1511 00:58:38,481 --> 00:58:40,116 TO EXCITE THE WAY THAT OUR BRAIN 1512 00:58:40,183 --> 00:58:44,153 LEARNS SO THAT WE CAN BASICALLY 1513 00:58:44,220 --> 00:58:46,689 RECOVER FROM DISRUPTED LEARNING 1514 00:58:46,756 --> 00:58:48,825 PROCESS IN ADDICTION SO ALL OF 1515 00:58:48,892 --> 00:58:50,793 THESE ARE FASCINATING AREA OF 1516 00:58:50,860 --> 00:58:54,931 RESEARCH THAT WILL GIVE US 1517 00:58:54,998 --> 00:58:56,232 MANY -- MEANWHILE, WE ALSO HAVE 1518 00:58:56,299 --> 00:59:00,136 TO KEEP OUR EYES ON THE BALL. 1519 00:59:00,203 --> 00:59:02,338 HOW FENTANYL IS RECENTLY BEING 1520 00:59:02,405 --> 00:59:04,741 COMBINED WITH PAIN AND -- BUT 1521 00:59:04,807 --> 00:59:07,644 WE'RE ALSO SAYING THAT 1522 00:59:07,710 --> 00:59:09,279 INCREASINGLY COMBINED WITH 1523 00:59:09,345 --> 00:59:10,580 DRUGS -- LIKE THIS ONE RIGHT 1524 00:59:10,647 --> 00:59:13,716 NOW, CREATING A LOT OF CONCERNS 1525 00:59:13,783 --> 00:59:15,885 AND NOT EVEN ADDICTIVE, THEY ARE 1526 00:59:15,952 --> 00:59:17,020 NOT WORKING. 1527 00:59:17,086 --> 00:59:20,390 SILENCING THE MEDICATION AND -- 1528 00:59:20,456 --> 00:59:27,864 AGONIST IS THAT -- MEDICINE. 1529 00:59:27,931 --> 00:59:29,532 WE HAVE DRUGS THAT ARE SIMILAR 1530 00:59:29,599 --> 00:59:35,204 TO XYLAZINE USED FOR ANESTHESIA. 1531 00:59:35,271 --> 00:59:38,408 IT'S NOT ADDICTIVE. 1532 00:59:38,474 --> 00:59:42,679 BUT PEOPLE STARTED TO -- AND 1533 00:59:42,745 --> 00:59:43,780 JUST HAS BEEN GROWING AND 1534 00:59:43,846 --> 00:59:45,682 GROWING AND GROWING, BUT IT'S 1535 00:59:45,748 --> 00:59:50,920 BASICALLY THAT WE'RE SEEING -- 1536 00:59:50,987 --> 00:59:53,790 FENTANYL WITH THESE DRUGS, 1537 00:59:53,856 --> 00:59:58,594 XYLAZINE, AND THEN THERE WAS A 1538 00:59:58,661 --> 01:00:00,163 CONCERN ABOUT THE MIXTURE OF 1539 01:00:00,229 --> 01:00:02,699 XYLAZINE WITH FENTANYL CAN 1540 01:00:02,765 --> 01:00:04,233 ACTUALLY HAVE -- CONSEQUENCES. 1541 01:00:04,300 --> 01:00:08,738 XYLAZINE BY ITSELF PRODUCES -- 1542 01:00:08,805 --> 01:00:14,877 REDUCES OXYGEN -- SO -- AND 1543 01:00:14,944 --> 01:00:17,080 HYPOXIA BY ITSELF FROM XYLAZINE 1544 01:00:17,146 --> 01:00:19,615 IS AS BAD AS THAT FROM FENTANYL, 1545 01:00:19,682 --> 01:00:22,151 BUT IT LASTS LONGER. 1546 01:00:22,218 --> 01:00:25,121 AND COMBINED WITH FENTANYL, IT 1547 01:00:25,188 --> 01:00:26,122 CAN ACTUALLY EXPAND THE DURATION 1548 01:00:26,189 --> 01:00:28,658 OF FENTANYL ACTIONS. 1549 01:00:28,725 --> 01:00:34,030 SO THIS IS NOW A BIG CHALLENGE. 1550 01:00:34,097 --> 01:00:35,665 WE DON'T KNOW HOW TO TREAT IT 1551 01:00:35,732 --> 01:00:37,000 AND THERE IS ENORMOUS CONCERN 1552 01:00:37,066 --> 01:00:40,603 THAT FENTANYL WHEN MIXED WITH 1553 01:00:40,670 --> 01:00:43,139 XYLAZINE JUST -- THE PICTURE 1554 01:00:43,206 --> 01:00:45,875 BECAUSE THERE IS WITHDRAWAL FROM 1555 01:00:45,942 --> 01:00:47,677 FENTANYL, THERE IS ALSO 1556 01:00:47,744 --> 01:00:50,880 PHYSICAL -- FROM XYLAZINE AND 1557 01:00:50,947 --> 01:00:55,985 ALSO ASSOCIATED WITH REALLY 1558 01:00:56,052 --> 01:00:58,287 THESE HORRIBLE WOUNDS THAT HAS 1559 01:00:58,354 --> 01:00:59,455 BEEN ONE OF THE THING -- 1560 01:00:59,522 --> 01:01:00,757 EVERYONE THAT SOMETHING 1561 01:01:00,823 --> 01:01:02,492 MALIGNANT WAS GOING IN THE -- 1562 01:01:02,558 --> 01:01:03,593 SUPPLY. 1563 01:01:03,659 --> 01:01:05,895 THESE WOUNDS GROW VERY, VERY 1564 01:01:05,962 --> 01:01:09,032 RAPIDLY AND THEY BASICALLY DON'T 1565 01:01:09,098 --> 01:01:11,100 NECESSARILY -- WHERE THE PERSON 1566 01:01:11,167 --> 01:01:13,169 IS INJECTING. 1567 01:01:13,236 --> 01:01:18,141 SOP IT -- IT'S REALLY COMPLETELY 1568 01:01:18,207 --> 01:01:19,475 UNDERSTOOD WHY IS IT BEING USED 1569 01:01:19,542 --> 01:01:25,048 IN THE MARKET, IT JUST ACTS AS A 1570 01:01:25,114 --> 01:01:28,251 FILLER BUT PRODUCING -- BUT IT'S 1571 01:01:28,317 --> 01:01:32,188 A CHALLENGE, SO HOW DO WE TREAT 1572 01:01:32,255 --> 01:01:33,756 THIS. 1573 01:01:33,823 --> 01:01:36,692 AND -- OVERDOSES FROM FENTANYL 1574 01:01:36,759 --> 01:01:37,794 THAT CONTAIN XYLAZINE IN THE 1575 01:01:37,860 --> 01:01:42,231 UNITED STATES IN 2022 IS 12%, SO 1576 01:01:42,298 --> 01:01:43,433 IT'S VERY SIGNIFICANT. 1577 01:01:43,499 --> 01:01:45,902 I HIGHLIGHT THIS BECAUSE WE'RE 1578 01:01:45,968 --> 01:01:47,203 SEEING IT CHANGING. 1579 01:01:47,270 --> 01:01:50,706 OBVIOUSLY A KEY ELEMENT OF THIS 1580 01:01:50,773 --> 01:01:51,974 REALLY MATRIX -- WE HAVE TO KEEP 1581 01:01:52,041 --> 01:01:54,477 OUR EYES ON IS THE NEED TO 1582 01:01:54,544 --> 01:01:56,779 OBTAIN THE DATA. 1583 01:01:56,846 --> 01:02:00,216 WE CANNOT -- INTERVENE. 1584 01:02:00,283 --> 01:02:03,052 SO FOR EXAMPLE -- ACTUALLY 1585 01:02:03,119 --> 01:02:05,988 BEFORE IT WAS USED FOR COVID, 1586 01:02:06,055 --> 01:02:09,459 THE USE OF WASTEWATER, WE HAVE 1587 01:02:09,525 --> 01:02:11,627 BEEN USING WASTEWATER FOR 1588 01:02:11,694 --> 01:02:12,728 DECADES, IT WAS VERY 1589 01:02:12,795 --> 01:02:15,264 TRANSFORMATIVE FOR DETECTION OF 1590 01:02:15,331 --> 01:02:19,102 SUBSTANCES -- SENSITIVITY, SO I 1591 01:02:19,168 --> 01:02:20,636 THINK THAT -- I JUST WANT TO 1592 01:02:20,703 --> 01:02:23,840 FINISH HERE BY SAYING THAT AS WE 1593 01:02:23,906 --> 01:02:26,542 GO ALONG, WE ALSO HAVE TO 1594 01:02:26,609 --> 01:02:29,479 REALIZE THAT PATHOLOGY, THAT 1595 01:02:29,545 --> 01:02:37,487 VULNERABILITY OF PEOPLE HAS GO 1596 01:02:37,553 --> 01:02:38,754 GONE -- DISORDERS -- WE SEE 1597 01:02:38,821 --> 01:02:40,156 CHILDREN DYING FROM FENTANYL AND 1598 01:02:40,223 --> 01:02:45,194 WE SEE OTHER PEOPLE DYING ALSO 1599 01:02:45,261 --> 01:02:46,562 FROM -- SO WHAT CAME FROM THE 1600 01:02:46,629 --> 01:02:48,764 PERSPECTIVE OF PRIORITY IS THAT 1601 01:02:48,831 --> 01:02:51,934 AS WE LOOK INTO THE FUTURE, IT'S 1602 01:02:52,001 --> 01:02:55,204 CLEAR THAT -- INTERVENTION HAS 1603 01:02:55,271 --> 01:02:57,140 THE OVERDOSE CRISIS, THAT YES, 1604 01:02:57,206 --> 01:02:58,674 WE NEED TO DO TREATMENT, THAT WE 1605 01:02:58,741 --> 01:03:00,576 NEED TO DO HARM REDUCTION 1606 01:03:00,643 --> 01:03:01,677 PRACTICES, ALSO DEVELOP THE 1607 01:03:01,744 --> 01:03:04,213 RESEARCH OF THE WAY OF 1608 01:03:04,280 --> 01:03:04,947 IMPLEMENTING -- SO THAT PEOPLE 1609 01:03:05,014 --> 01:03:07,183 CAN STAY ALIVE. 1610 01:03:07,250 --> 01:03:09,118 FOR IT IS FUNDAMENTAL AND 1611 01:03:09,185 --> 01:03:12,922 CRUCIAL THAT WE ESTABLISH 1612 01:03:12,989 --> 01:03:17,093 INTERVENTIONS THAT THAT CAN 1613 01:03:17,160 --> 01:03:18,928 PREVENT PEOPLE -- WHO ARE TAKING 1614 01:03:18,995 --> 01:03:20,897 THEM TO ESCALATE TO MORE SEVERE 1615 01:03:20,963 --> 01:03:21,397 DRUG USE. 1616 01:03:21,464 --> 01:03:24,033 AND WITH THAT, I AM GOING TO END 1617 01:03:24,100 --> 01:03:25,768 MY PRESENTATION AND I'M GOING TO 1618 01:03:25,835 --> 01:03:28,437 STOP SHARING MY SLIDES. 1619 01:03:28,504 --> 01:03:34,944 >> THANK YOU, THA THANK YOU VERY 1620 01:03:35,011 --> 01:03:37,079 MUCH, NORA. 1621 01:03:37,146 --> 01:03:37,413 NOW, MEGHANN? 1622 01:03:37,480 --> 01:03:39,982 IT'S UP TO YOU. 1623 01:03:40,049 --> 01:03:42,018 >> WIN, YOU ARE MUTED. 1624 01:03:42,084 --> 01:03:44,320 >> I'M MUTED? 1625 01:03:44,387 --> 01:03:45,121 >> ALL GOOD. 1626 01:03:45,188 --> 01:03:47,890 WE CAN HEAR EVERYBODY. 1627 01:03:47,957 --> 01:03:49,859 >> MEGHANN? 1628 01:03:49,926 --> 01:03:50,927 >> YES, THANK YOU. 1629 01:03:50,993 --> 01:03:52,895 THANK YOU, DR. VOLKOW. 1630 01:03:52,962 --> 01:03:56,899 IT WAS EXCELLENT TO HEAR YOU. 1631 01:03:56,966 --> 01:03:59,402 SO I'M HERE BOTH AS A 1632 01:03:59,468 --> 01:04:04,307 PROFESSIONAL. 1633 01:04:04,373 --> 01:04:05,408 MEGHANN PERRY GROUP, WE DO 1634 01:04:05,474 --> 01:04:06,542 EDUCATION PRIMARILY, 1635 01:04:06,609 --> 01:04:07,643 STORYTELLING AND SPEAKING, AND 1636 01:04:07,710 --> 01:04:09,812 I'M ALSO HERE AS A PERSON WHO 1637 01:04:09,879 --> 01:04:14,584 HAS EXPERIENCED THIS EPIDEMIC 1638 01:04:14,650 --> 01:04:17,320 AND CHALLENGING SUBSTANCE USE 1639 01:04:17,386 --> 01:04:17,587 FIRSTHAND. 1640 01:04:17,653 --> 01:04:20,723 I'M A PERSON WHO HAS EXPERIENCED 1641 01:04:20,790 --> 01:04:21,424 PROBLEMATIC SUBSTANCE USE. 1642 01:04:21,490 --> 01:04:23,392 I HAVE SINCE RESOLVED MY 1643 01:04:23,459 --> 01:04:25,928 RELATIONSHIP WITH THE SUBSTANCES 1644 01:04:25,995 --> 01:04:27,463 THAT COST ME THE GREATEST AND 1645 01:04:27,530 --> 01:04:29,165 CAUSED THE MOST CHAOS AND HARM, 1646 01:04:29,232 --> 01:04:31,567 BUT I WILL STILL ADMIT THAT MY 1647 01:04:31,634 --> 01:04:36,672 RELATIONSHIP WITH TWO SUBSTABSES 1648 01:04:36,739 --> 01:04:38,174 STANCES OR MAYBE THREE THINGS 1649 01:04:38,241 --> 01:04:39,642 AND THAT'S SUGAR, CAFFEINE AND 1650 01:04:39,709 --> 01:04:43,512 WORKING TOO MUCH. 1651 01:04:43,579 --> 01:04:44,814 BUT I WANT TO SHARE A LITTLE BIT 1652 01:04:44,880 --> 01:04:45,815 ABOUT MY OWN EXPERIENCE AS WELL 1653 01:04:45,881 --> 01:04:47,216 AS SOME OF MY EXPERIENCE WORKING 1654 01:04:47,283 --> 01:04:54,790 IN THIS FIELD. 1655 01:04:54,857 --> 01:04:58,761 I AT 15 YEARS OLD DEVELOPED SOME 1656 01:04:58,828 --> 01:05:01,631 MENTAL HEALTH CHALLENGES, 1657 01:05:01,697 --> 01:05:03,766 DEPRESSION, ANXIETY, OBSESSIVE 1658 01:05:03,833 --> 01:05:04,200 COMPULSIVE DISORDER. 1659 01:05:04,267 --> 01:05:05,301 I HAD NO IDEA WHAT THOSE WERE AT 1660 01:05:05,368 --> 01:05:05,835 THE TIME. 1661 01:05:05,901 --> 01:05:08,104 NOBODY ELSE SEEMED TO RECOGNIZE 1662 01:05:08,170 --> 01:05:12,308 THOSE EITHER. 1663 01:05:12,375 --> 01:05:13,776 AND I FIRST TURNED TO FOOD AND I 1664 01:05:13,843 --> 01:05:15,411 TURNED TO SUBSTANCES LIKE 1665 01:05:15,478 --> 01:05:18,614 ALCOHOL, CANNABIS, AND I FOUND 1666 01:05:18,681 --> 01:05:22,051 THAT THEY MADE IT TOLERABLE TO 1667 01:05:22,118 --> 01:05:23,252 BE ME. 1668 01:05:23,319 --> 01:05:25,454 I WAS HAVING A REALLY HARD TIME 1669 01:05:25,521 --> 01:05:27,590 JUST SORT OF EXISTING IN THE 1670 01:05:27,657 --> 01:05:30,426 BODY AND MIND THAT IS MEGHANN, 1671 01:05:30,493 --> 01:05:33,796 AND SUBSTANCES REALLY HELPED ME 1672 01:05:33,863 --> 01:05:37,833 BE ABLE TO NAVIGATE LIFE. 1673 01:05:37,900 --> 01:05:41,737 THAT SUBSTANCE USE PROGRESSED. 1674 01:05:41,804 --> 01:05:43,072 THE LAST PHOTO THAT YOU SEE HERE 1675 01:05:43,139 --> 01:05:44,507 IS MY COLLEGE GRADUATION. 1676 01:05:44,573 --> 01:05:48,277 I TURNED 22, AND 3 WEEKS LATER, 1677 01:05:48,344 --> 01:05:51,013 I GRADUATED FROM COLLEGE, AND 1678 01:05:51,080 --> 01:05:53,816 THREE WEEKS AFTER THAT, I GOT 1679 01:05:53,883 --> 01:05:54,583 MARRIED, AND SIX WEEKS AFTER 1680 01:05:54,650 --> 01:05:56,118 THAT, I WENT INTO DETOX FOR THE 1681 01:05:56,185 --> 01:05:57,887 FIRST TIME. 1682 01:05:57,953 --> 01:05:59,789 SO IN THAT PICTURE THAT YOU SEE 1683 01:05:59,855 --> 01:06:01,657 THERE, I DID USE HEROIN ON MY 1684 01:06:01,724 --> 01:06:02,925 WAY TO MY COLLEGE GRADUATION 1685 01:06:02,992 --> 01:06:06,562 BECAUSE I HAD DEVELOPED A 1686 01:06:06,629 --> 01:06:08,731 DEPENDENCY, AN ADDICTION TO IT 1687 01:06:08,798 --> 01:06:09,699 BY THAT POINT IN MY LIFE. 1688 01:06:09,765 --> 01:06:12,868 AND THAT STARTED A LONG CYCLE OF 1689 01:06:12,935 --> 01:06:14,337 USING WHAT WAS AVAILABLE BACK 1690 01:06:14,403 --> 01:06:14,704 THEN. 1691 01:06:14,770 --> 01:06:16,672 SO THAT WAS 1995, AND WE REALLY 1692 01:06:16,739 --> 01:06:18,974 JUST HAD A FEW THINGS, A FEW 1693 01:06:19,041 --> 01:06:21,410 TOOLS IN OUR DISPOSAL AT THAT 1694 01:06:21,477 --> 01:06:21,644 TIME. 1695 01:06:21,711 --> 01:06:24,046 THERE WAS ACUTE INPATIENT CARE 1696 01:06:24,113 --> 01:06:27,950 LIKE DETOX, REHAB, THERE WAS 1697 01:06:28,017 --> 01:06:29,251 12-STEP FELLOWSHIP, BOTH OF 1698 01:06:29,318 --> 01:06:32,421 THOSE WERE BASED IN ABSTINENCE 1699 01:06:32,488 --> 01:06:33,289 AND THERE WAS METHADONE. 1700 01:06:33,356 --> 01:06:34,957 THERE WAS NOT EVEN BUPRENORPHINE 1701 01:06:35,024 --> 01:06:35,791 AT THAT POINT. 1702 01:06:35,858 --> 01:06:39,862 IT WASN'T UNTIL 1999 THAT I WAS 1703 01:06:39,929 --> 01:06:42,765 IN CLINICAL TRIALS RECEIVING 1704 01:06:42,832 --> 01:06:43,899 BUPRENORPHINE BOTH IN ENGLAND 1705 01:06:43,966 --> 01:06:45,835 AND THEN WHEN I MOVED BACK HERE 1706 01:06:45,901 --> 01:06:46,902 IN MASSACHUSETTS. 1707 01:06:46,969 --> 01:06:51,507 SO WE DIDN'T HAVE ACCESS TO 1708 01:06:51,574 --> 01:06:54,777 NALOXONE OR MOST OF THE TOOLS 1709 01:06:54,844 --> 01:06:57,613 THAT WE TAKE FOR GRANTED TODAY. 1710 01:06:57,680 --> 01:07:02,418 SO I CYCLED THROUGH MANY 1711 01:07:02,485 --> 01:07:03,285 DIFFERENT PROGRAMS AND MANY 1712 01:07:03,352 --> 01:07:04,587 DIFFERENT ATTEMPTS BUT THEY WERE 1713 01:07:04,653 --> 01:07:05,554 REALLY ALL THE SAME COUPLE OF 1714 01:07:05,621 --> 01:07:11,260 TOOLS. 1715 01:07:11,327 --> 01:07:14,730 WHEN I WAS 28, I FOUND MYSELF 1716 01:07:14,797 --> 01:07:15,765 INCARCERATED FIVE MONTHS 1717 01:07:15,831 --> 01:07:17,199 PREGNANT. 1718 01:07:17,266 --> 01:07:20,069 I WAS USING MEDICATION FOR 1719 01:07:20,136 --> 01:07:23,305 OPIOID USE DISORDER, I WAS ON ME 1720 01:07:23,372 --> 01:07:23,572 METHADONE. 1721 01:07:23,639 --> 01:07:26,175 I WAS NOT USING -- IT WAS HEROIN 1722 01:07:26,242 --> 01:07:30,312 AT THAT TIME, BUT I WAS 1723 01:07:30,379 --> 01:07:32,148 INCARCERATED FOR $40 WORTH OF 1724 01:07:32,214 --> 01:07:34,683 HEROIN THAT I SOLD TO MY HEROIN 1725 01:07:34,750 --> 01:07:35,851 DEALER AND THEN SPENT A GOOD 1726 01:07:35,918 --> 01:07:39,121 PART OF MY PREGNANCY 1727 01:07:39,188 --> 01:07:39,522 INCARCERATED. 1728 01:07:39,588 --> 01:07:42,691 AND I REMEMBER VERY CLEARLY THAT 1729 01:07:42,758 --> 01:07:43,993 EVERY DAY THEY HAD TO LOCK DOWN 1730 01:07:44,059 --> 01:07:49,432 THE WHOLE WOMEN'S UNIT FOR A 1731 01:07:49,498 --> 01:07:51,300 NURSE TO BRING MY METHADONE TO 1732 01:07:51,367 --> 01:07:53,903 ME, AND I REMEMBER REALLY, 1733 01:07:53,969 --> 01:07:55,604 REALLY WELL THAT THERE WAS A 1734 01:07:55,671 --> 01:07:56,639 LOUD BUZZ THAT MEANT THAT 1735 01:07:56,705 --> 01:07:59,008 SOMEBODY WAS BEING LET ON TO THE 1736 01:07:59,074 --> 01:08:00,242 UNIT, AND THE NURSE WOULD COME 1737 01:08:00,309 --> 01:08:02,745 AND SHE WAS ALWAYS VERY WELL 1738 01:08:02,812 --> 01:08:04,513 DRESSED AND WELL PUT TOGETHER, 1739 01:08:04,580 --> 01:08:06,315 SHE HAD A LITTLE WHITE BOTTLE OF 1740 01:08:06,382 --> 01:08:07,616 METHADONE IN HER HAND. 1741 01:08:07,683 --> 01:08:09,785 AND MY DOOR WOULD POP OPEN, THE 1742 01:08:09,852 --> 01:08:11,754 BOLT WOULD SLIDE OPEN AND I 1743 01:08:11,821 --> 01:08:14,290 WOULD STEP OUT ON TO THIS METAL 1744 01:08:14,356 --> 01:08:15,758 WALKWAY THAT WAS SORT OF WHAT WE 1745 01:08:15,825 --> 01:08:17,860 CALLED A GANG PLANK AND I HAD 1746 01:08:17,927 --> 01:08:19,495 THOSE LITTLE CANVAS SLIP-ON 1747 01:08:19,562 --> 01:08:22,898 SHOES WITH NO LACES. 1748 01:08:22,965 --> 01:08:24,400 AND EACH STEP WOULD JUST RING 1749 01:08:24,467 --> 01:08:27,670 OUT CLANG, CLANG, CLANG, AND I 1750 01:08:27,736 --> 01:08:28,871 KNEW THAT EVERY WOMAN ON THAT 1751 01:08:28,938 --> 01:08:31,574 UNIT WAS WATCHING ME. 1752 01:08:31,640 --> 01:08:32,675 AND WHEN I GOT TO THE NURSE IN 1753 01:08:32,741 --> 01:08:35,277 THE CENTER OF THE ROOM, SHE 1754 01:08:35,344 --> 01:08:37,446 DIDN'T LOOK AT MY FACE AND THE 1755 01:08:37,513 --> 01:08:41,050 SCABS AND SHE DIDN'T LOOK AT MY 1756 01:08:41,116 --> 01:08:43,152 HAIR AND HOW IT HAD NOT BEEN CUT 1757 01:08:43,219 --> 01:08:44,854 IN A LONG, LONG TIME, SHE DIDN'T 1758 01:08:44,920 --> 01:08:46,489 LOOK AT HOW SKINNY I WAS, SHE 1759 01:08:46,555 --> 01:08:48,023 JUST LOOKED AT THE BADGE ON MY 1760 01:08:48,090 --> 01:08:48,991 CHEST TO MAKE SURE THAT I WAS 1761 01:08:49,058 --> 01:08:50,292 THE RIGHT INMATE NUMBER BEFORE 1762 01:08:50,359 --> 01:08:54,897 SHE GAVE ME THAT ME METHADONE. 1763 01:08:54,964 --> 01:08:56,499 THAT WAS ONE OF THE MOST 1764 01:08:56,565 --> 01:08:57,700 DEHUMANIZING EXPERIENCES I EVER 1765 01:08:57,766 --> 01:08:59,568 HAD IN ALL OF MY YEARS 1766 01:08:59,635 --> 01:09:04,440 STRUGGLING WITH SUBSTANCE USE. 1767 01:09:04,507 --> 01:09:05,541 I DESPERATELY WANTED TO BE A 1768 01:09:05,608 --> 01:09:06,976 GOOD MOM, AND I DESPERATELY 1769 01:09:07,042 --> 01:09:08,177 WANTED MY DAUGHTER NOT TO START 1770 01:09:08,244 --> 01:09:13,949 HER LIFE THE SAME WAY. 1771 01:09:14,016 --> 01:09:18,888 AND THERE WAS NOTHING I COULD DO 1772 01:09:18,954 --> 01:09:20,089 ABOUT IT AT THAT POINT, I DID 1773 01:09:20,155 --> 01:09:21,590 NOT HAVE THE SUPPORTS AND 1774 01:09:21,657 --> 01:09:22,791 RESOURCES THAT I NEEDED TO DO 1775 01:09:22,858 --> 01:09:28,597 BETTER. 1776 01:09:28,664 --> 01:09:29,999 AFTER HAVING MY DAUGHTER, THAT'S 1777 01:09:30,065 --> 01:09:31,600 ME THERE WITH HER WHEN SHE WAS 1778 01:09:31,667 --> 01:09:37,840 AN INFANT, I WAS FORCED OFF OF 1779 01:09:37,907 --> 01:09:39,141 METHADONE SO I COULD PARTICIPATE 1780 01:09:39,208 --> 01:09:40,409 IN A DRUG COURT PROGRAM, AND IT 1781 01:09:40,476 --> 01:09:45,281 WAS A PART OF MY LIFE WHERE I 1782 01:09:45,347 --> 01:09:46,982 WAS REALLY STRUGGLING WITH THE 1783 01:09:47,049 --> 01:09:48,050 WITHDRAWAL FROM METHADONE OVER 1784 01:09:48,117 --> 01:09:51,587 TIME AS WAS MY DAUGHTER. 1785 01:09:51,654 --> 01:09:53,422 I WAS INCARCERATED OVER AND OVER 1786 01:09:53,489 --> 01:09:55,591 DURING THE FIRST 18 MONTHS OF 1787 01:09:55,658 --> 01:09:58,527 HER LIFE FOR THINGS LIKE LYING 1788 01:09:58,594 --> 01:10:03,999 AND OTHER MINOR INFRACTIONS. 1789 01:10:04,066 --> 01:10:05,334 I DID EVENTUALLY FINISH THAT 1790 01:10:05,401 --> 01:10:07,036 PROGRAM BUT I DID LOSE CUSTODY 1791 01:10:07,102 --> 01:10:09,338 OF HER AT 4, WHEN SHE WAS 1792 01:10:09,405 --> 01:10:10,739 4 YEARS OLD, AND I BEGAN TO 1793 01:10:10,806 --> 01:10:13,776 CYCLE AGAIN, I WAS UNHOUSED, 1794 01:10:13,842 --> 01:10:17,179 CYCLING OUT OF JAILS, HOMELESS 1795 01:10:17,246 --> 01:10:19,014 SHELTERS AND ALL OF THE SYSTEMS. 1796 01:10:19,081 --> 01:10:20,215 AND I KEPT BEING OFFERED THE 1797 01:10:20,282 --> 01:10:21,951 SAME COUPLE OF THINGS. 1798 01:10:22,017 --> 01:10:23,953 AND THAT KEPT NOT BEING WHAT I 1799 01:10:24,019 --> 01:10:27,957 NEEDED AT THAT TIME. 1800 01:10:28,023 --> 01:10:30,693 I DID EVENTUALLY ESTABLISH 1801 01:10:30,759 --> 01:10:33,762 RECOVERY AS I KNOW IT TODAY IN 1802 01:10:33,829 --> 01:10:35,898 2011, RIGHT BEFORE THE EPIDEMIC 1803 01:10:35,965 --> 01:10:38,500 THAT WE'RE IN THE MIDST OF NOW, 1804 01:10:38,567 --> 01:10:41,704 SORT OF STARTED TO RAMP UP. 1805 01:10:41,770 --> 01:10:43,405 I DO LOVE TO SHOW THAT THERE 1806 01:10:43,472 --> 01:10:44,607 IS -- THERE ARE HAPPY ENDINGS 1807 01:10:44,673 --> 01:10:48,110 AND THERE ARE MOMENTS OF HOPE IN 1808 01:10:48,177 --> 01:10:48,911 STORIES LIKE MINE. 1809 01:10:48,978 --> 01:10:51,013 THAT WAS MY LITTLE NUGGET THERE 1810 01:10:51,080 --> 01:10:54,116 ON THE LEFT AND THAT'S MY NUGGET 1811 01:10:54,183 --> 01:10:57,920 NOW. 1812 01:10:57,987 --> 01:10:59,355 SHE'S 22 NOW AND I GOT CUSTODY 1813 01:10:59,421 --> 01:11:05,361 BACK OF HER WHEN SHE WAS 10. 1814 01:11:05,427 --> 01:11:09,932 AND WE WERE OKAY. 1815 01:11:09,999 --> 01:11:13,002 SO THAT'S A VERY LITTLE SNAPSHOT 1816 01:11:13,068 --> 01:11:16,038 OF WHAT THE LANDSCAPE LOOKED 1817 01:11:16,105 --> 01:11:18,941 LIKE IN THE MID TO LATE '90S AND 1818 01:11:19,008 --> 01:11:22,177 THE EARLY 2,000s. 1819 01:11:22,244 --> 01:11:23,679 WHY I'M HERE AND WHY WE'RE 1820 01:11:23,746 --> 01:11:27,282 TALKING ABOUT THIS IS -- THIS 1821 01:11:27,349 --> 01:11:30,919 LIST OF NAMES, PEOPLE WERE DYING 1822 01:11:30,986 --> 01:11:33,589 AROUND ME ALL OF THE TIME IN THE 1823 01:11:33,656 --> 01:11:36,558 90s AND EARLY 2000s. 1824 01:11:36,625 --> 01:11:38,093 WHEN NOBODY WAS WATCHING AT THIS 1825 01:11:38,160 --> 01:11:38,527 TIME. 1826 01:11:38,594 --> 01:11:39,695 NOBODY WAS REALLY PAYING 1827 01:11:39,762 --> 01:11:42,097 ATTENTION. 1828 01:11:42,164 --> 01:11:43,532 SEVEN OF THE 19 NAMES ON THE 1829 01:11:43,599 --> 01:11:45,501 SLIDE WERE NOT OVERDOSE DEATHS, 1830 01:11:45,567 --> 01:11:48,237 THEY WERE THINGS LIKE 1831 01:11:48,303 --> 01:11:53,042 ENDOCARDITIS, AN ESOPHAGUS 1832 01:11:53,108 --> 01:11:56,078 RUPTURING, STROKES, ALL KINDS OF 1833 01:11:56,145 --> 01:12:00,482 SECONDARY REASONS WHY PEOPLE 1834 01:12:00,549 --> 01:12:03,385 HAVE DEATH AROUND SUBSTANCE USE. 1835 01:12:03,452 --> 01:12:05,020 EIGHT OF THE 12 OVERDOSES WERE 1836 01:12:05,087 --> 01:12:06,121 NOT FENTANYL. 1837 01:12:06,188 --> 01:12:07,322 SO I KNOW THAT WE ARE HERE, 1838 01:12:07,389 --> 01:12:09,591 WE'RE TALKING ABOUT FENTANYL AND 1839 01:12:09,658 --> 01:12:11,126 I JUST WANT TO PUT THIS CONTEXT 1840 01:12:11,193 --> 01:12:14,063 IN PLACE OF IT'S NOT JUST ABOUT 1841 01:12:14,129 --> 01:12:15,764 FENTANYL, FENTANYL IS JUST ONE 1842 01:12:15,831 --> 01:12:19,068 OF THE SUBSTANCES THAT WE'RE S 1843 01:12:19,134 --> 01:12:22,337 SEEING IN THE CURRENT CLIMATE 1844 01:12:22,404 --> 01:12:27,142 AND -- GREATER THAN OTHER 1845 01:12:27,209 --> 01:12:27,910 SUBSTANCES THAN WE'VE BEEN 1846 01:12:27,976 --> 01:12:28,877 DEALING WITH IN THE PAST BUT IT 1847 01:12:28,944 --> 01:12:31,280 IS A POLYSUBSTANCE CRISIS THAT 1848 01:12:31,346 --> 01:12:32,715 WE'RE IN, AND WE ARE SEEING 1849 01:12:32,781 --> 01:12:34,416 PEOPLE DYING FOR MANY DIFFERENT 1850 01:12:34,483 --> 01:12:36,051 REASONS RELATED TO SUBSTANCE 1851 01:12:36,118 --> 01:12:38,587 USE, AND SO IT'S NOT JUST ABOUT 1852 01:12:38,654 --> 01:12:39,021 FENTANYL. 1853 01:12:39,088 --> 01:12:40,422 THIS IS SOMETHING THAT'S BEEN 1854 01:12:40,489 --> 01:12:43,926 BUILDING FOR A LONG TIME AND DRT 1855 01:12:43,992 --> 01:12:48,964 CONTEXT OF HOW WE GOT HERE. 1856 01:12:49,031 --> 01:12:53,902 THIS IS KEALYND. 1857 01:12:53,969 --> 01:12:55,871 KEALYND IS AN EXAMPLE OF WHAT IS 1858 01:12:55,938 --> 01:12:57,272 HAPPENING MORE RECENTLY THAT 1859 01:12:57,339 --> 01:12:58,373 WE'RE SEEING. 1860 01:12:58,440 --> 01:13:02,077 I STARTED WORKING WITH KEALYND 1861 01:13:02,144 --> 01:13:04,113 AS A RECOVERY COACH WHEN HE WAS 1862 01:13:04,179 --> 01:13:04,546 21 YEARS OLD. 1863 01:13:04,613 --> 01:13:06,115 I MET HIM IN A CHINESE 1864 01:13:06,181 --> 01:13:07,082 RESTAURANT IN A TOUGH PART OF 1865 01:13:07,149 --> 01:13:09,418 TOWN WHERE HE WAS LIVING IN THE 1866 01:13:09,485 --> 01:13:10,219 DEPARTMENT OF MENTAL HEALTH 1867 01:13:10,285 --> 01:13:14,289 GROUP HOME. 1868 01:13:14,356 --> 01:13:15,991 KEALYND HAD A LOT OF THINGS THAT 1869 01:13:16,058 --> 01:13:16,892 WERE WORKING AGAINST HIM. 1870 01:13:16,959 --> 01:13:19,394 HE WAS BLACK, GAY, HE WAS 1871 01:13:19,461 --> 01:13:20,829 ADOPTED AFTER SEVERE SEXUAL 1872 01:13:20,896 --> 01:13:23,866 TRAUMA AS AN INFANT AND TODDLER. 1873 01:13:23,932 --> 01:13:25,300 ADOPTED INTO A JEWISH HOME WITH 1874 01:13:25,367 --> 01:13:28,303 A SINGLE MOM WHO WAS A 1875 01:13:28,370 --> 01:13:29,505 WONDERFUL, WONDERFUL WOMAN WHO 1876 01:13:29,571 --> 01:13:33,776 DID AMAZING WORK WITH KEALYND, 1877 01:13:33,842 --> 01:13:37,379 BUT HE WAS -- HE HAD PROFOUND 1878 01:13:37,446 --> 01:13:39,348 MENTAL HEALTH CHALLENGES, 1879 01:13:39,414 --> 01:13:42,851 PROFOUND TRAUMA, AND USED 1880 01:13:42,918 --> 01:13:44,686 SUBSTANCES TO AGAIN JUST SORT OF 1881 01:13:44,753 --> 01:13:46,522 TOLERATE BEING ALIVE. 1882 01:13:46,588 --> 01:13:49,491 IT WAS -- HE WAS AN INCREDIBLY 1883 01:13:49,558 --> 01:13:50,926 SENSITIVE, BRIGHT AND SHINY 1884 01:13:50,993 --> 01:13:52,094 HUMAN THAT FOUND IT REALLY, 1885 01:13:52,161 --> 01:13:56,398 REALLY HARD JUST TO EXIST, JUST 1886 01:13:56,465 --> 01:14:03,806 TO BE KEALYND. 1887 01:14:03,872 --> 01:14:06,308 KEALYND DIED AT AGE 26 FROM 1888 01:14:06,375 --> 01:14:07,176 METHAMPHETAMINE OVERDOSE. 1889 01:14:07,242 --> 01:14:09,244 AND KEALYND IS A GREAT EXAMPLE 1890 01:14:09,311 --> 01:14:10,779 OF WHERE WE LOSE FOLKS IN THE 1891 01:14:10,846 --> 01:14:12,614 GAPS IN THE SYSTEM, BECAUSE HE 1892 01:14:12,681 --> 01:14:14,883 WAS IN EVERY SYSTEM IMAGINABLE 1893 01:14:14,950 --> 01:14:16,652 AND HE ALWAYS WANTED TO GET 1894 01:14:16,718 --> 01:14:19,488 BETTER AND DO BETTER AND HAVE A 1895 01:14:19,555 --> 01:14:20,989 HIGHER QUALITY OF LIFE, BUT 1896 01:14:21,056 --> 01:14:23,625 THERE WERE NO SYSTEMS THAT COULD 1897 01:14:23,692 --> 01:14:28,797 HOLD HIM BUT WOULD HE GET KICKED 1898 01:14:28,864 --> 01:14:30,399 OUT OF THINGS LIKE TAKING A WALK 1899 01:14:30,465 --> 01:14:33,268 BECAUSE HE HAD GOTTEN SO ANGRY 1900 01:14:33,335 --> 01:14:35,003 THAT HE KNEW HE NEEDED TO GET A 1901 01:14:35,070 --> 01:14:36,605 LITTLE BIT OF SPACE. 1902 01:14:36,672 --> 01:14:40,542 HE WAS IN A PROGRAM -- ANOTHER 1903 01:14:40,609 --> 01:14:42,177 PROGRAM FOR PUNCHING A WALL 1904 01:14:42,244 --> 01:14:44,847 BECAUSE, AGAIN, THE MANAGING 1905 01:14:44,913 --> 01:14:46,215 FEELINGS AND TRYING TO LIVE 1906 01:14:46,281 --> 01:14:47,749 WITHOUT ANY KIND OF SUBSTANCES 1907 01:14:47,816 --> 01:14:51,353 WAS INCREDIBLY HARD FOR HIM, AND 1908 01:14:51,420 --> 01:14:52,988 HE'S AN EXAMPLE OF NOT JUST THE 1909 01:14:53,055 --> 01:14:59,328 GAPS IN THE SYSTEM, BUT ALSO THE 1910 01:14:59,394 --> 01:15:01,163 NECESSITY OF ABSTINENCE THAT WE 1911 01:15:01,230 --> 01:15:02,364 KIND OF ATTACH ALL OF OUR 1912 01:15:02,431 --> 01:15:03,699 SERVICES TO OR MANY OF OUR 1913 01:15:03,765 --> 01:15:07,836 SERVICES ARE BASED ON FOLKS 1914 01:15:07,903 --> 01:15:11,006 HAVING ABSTINENCE AND KEALYND IS 1915 01:15:11,073 --> 01:15:12,207 A GREAT EXAMPLE OF WHY WE NEED 1916 01:15:12,274 --> 01:15:13,375 TO BUILD UP OTHER SUPPORTS IN 1917 01:15:13,442 --> 01:15:17,446 SOME CASES BEFORE WE ASK 1918 01:15:17,512 --> 01:15:18,780 ABSTINENCE OF PEOPLE, SO HOLDING 1919 01:15:18,847 --> 01:15:22,384 THAT AS SORT OF THE HOLY GRAIL 1920 01:15:22,451 --> 01:15:24,319 OR ALWAYS THE DESIRED OUTCOME 1921 01:15:24,386 --> 01:15:26,521 REALLY LEAVES A LOT OF PEOPLE 1922 01:15:26,588 --> 01:15:31,760 BEHIND, AND SO NOT PREDICATING 1923 01:15:31,827 --> 01:15:33,729 RESOURCES OR SUPPORTS ON 1924 01:15:33,795 --> 01:15:44,339 ABSTINENCE IS REALLY IMPORTANT. 1925 01:15:46,308 --> 01:15:47,509 I WANTED TO GIVE A QUICK 1926 01:15:47,576 --> 01:15:48,710 CONTEXT, THESE ARE STATISTICS 1927 01:15:48,777 --> 01:15:49,945 FROM THE UNITED NATIONS OFFICE 1928 01:15:50,012 --> 01:15:54,616 ON DRUGS AND CRIME. 1929 01:15:54,683 --> 01:15:56,985 THERE ARE OVER 284 MILLION 1930 01:15:57,052 --> 01:15:57,586 PEOPLE WORLDWIDE THAT USE 1931 01:15:57,653 --> 01:15:58,854 SUBSTANCES AND LESS THAN 1932 01:15:58,921 --> 01:15:59,855 50 MILLION OF THEM ACTUALLY HAVE 1933 01:15:59,922 --> 01:16:02,457 A DIAGNOSABLE DISORDER. 1934 01:16:02,524 --> 01:16:04,559 AND THE REASON I WANT TO SHOW 1935 01:16:04,626 --> 01:16:06,395 THIS IS BECAUSE WE TEND TO THINK 1936 01:16:06,461 --> 01:16:08,597 OF SUBSTANCE USE AS ONE THING 1937 01:16:08,664 --> 01:16:11,099 LIKE THIS IS -- PEOPLE USE 1938 01:16:11,166 --> 01:16:14,503 SUBSTANCES THAT GET ADDICTED. 1939 01:16:14,569 --> 01:16:18,774 THEY ARE -- AND THEY DIE. 1940 01:16:18,840 --> 01:16:20,108 AND IT IS FAR MORE COMPLEX THAN 1941 01:16:20,175 --> 01:16:23,578 THAT AND AGAIN, THAT BINARY OF 1942 01:16:23,645 --> 01:16:27,649 LIKE ABSTINENCE OR USING I LIKE 1943 01:16:27,716 --> 01:16:29,284 TO TRY TO ENCOURAGE FOLKS TO 1944 01:16:29,351 --> 01:16:30,686 THINK ABOUT THINGS AS BEING IN A 1945 01:16:30,752 --> 01:16:31,353 CONTEXT. 1946 01:16:31,420 --> 01:16:33,522 AND SO IT'S NOT THAT BLACK AND 1947 01:16:33,588 --> 01:16:35,057 WHITE THAT PEOPLE USE 1948 01:16:35,123 --> 01:16:35,924 SUBSTANCES, SUBSTANCES ARE BAD 1949 01:16:35,991 --> 01:16:37,793 AND NOW THEY'RE ADDICTED AND NOW 1950 01:16:37,859 --> 01:16:39,428 THEY'RE WREAKING HAVOC AND 1951 01:16:39,494 --> 01:16:41,263 THEY'RE GOING TO DIE, THERE'S A 1952 01:16:41,330 --> 01:16:42,898 WHOLE MIDDLE THAT'S HAPPENING 1953 01:16:42,965 --> 01:16:46,401 THERE THAT OUR SYSTEMS WEREN'T 1954 01:16:46,468 --> 01:16:50,238 HANDLING AS DIRECTLY AND WE KNOW 1955 01:16:50,305 --> 01:16:51,640 THAT BECAUSE OF FENTANYL BEING 1956 01:16:51,707 --> 01:16:59,081 WHAT IT IS AND HOW LETHAL IT IS, 1957 01:16:59,147 --> 01:17:01,149 WE ARE IN CRISIS MODE AND WE 1958 01:17:01,216 --> 01:17:02,217 ABSOLUTELY SHOULD BE BUT I ALSO 1959 01:17:02,284 --> 01:17:03,652 WANT YOU TO RECOGNIZE THAT 1960 01:17:03,719 --> 01:17:04,519 YOU'RE ENCOUNTERING PEOPLE IN 1961 01:17:04,586 --> 01:17:06,154 YOUR RESEARCH AND IN YOUR 1962 01:17:06,221 --> 01:17:07,589 HEALTHCARE SETTINGS THAT ARE 1963 01:17:07,656 --> 01:17:13,261 SOMEWHERE IN THE MIDDLE. 1964 01:17:13,328 --> 01:17:14,796 DR. VOLKOW SPOKE TO THIS A 1965 01:17:14,863 --> 01:17:15,564 LITTLE BIT. 1966 01:17:15,630 --> 01:17:16,965 AGAIN THERE ARE GOOD REASONS WHY 1967 01:17:17,032 --> 01:17:23,205 PEOPLE USE SUBSTANCES. 1968 01:17:23,271 --> 01:17:24,406 YOU MAY LOOK AT THIS LIST AND 1969 01:17:24,473 --> 01:17:25,273 LOOK AT OTHER THINGS THAT YOU 1970 01:17:25,340 --> 01:17:26,675 ARE DOING TO SATISFY THESE NEEDS 1971 01:17:26,742 --> 01:17:27,976 FOR SOME OF US IT'S SUBSTANCES 1972 01:17:28,043 --> 01:17:28,977 FOR SOME OF YOU IT MAY BE 1973 01:17:29,044 --> 01:17:31,513 SOMETHING ELSE OR IT MAY BE A 1974 01:17:31,580 --> 01:17:32,514 SUBSTANCE, IT MAY BE ALCOHOL OR 1975 01:17:32,581 --> 01:17:37,986 IT MAY BE NICOTINE. 1976 01:17:38,053 --> 01:17:39,621 BUT HUMANS ARE WIRED FOR THESE 1977 01:17:39,688 --> 01:17:40,155 NEEDS. 1978 01:17:40,222 --> 01:17:41,623 WE'RE WIRED TO SEEK PLEASURE, 1979 01:17:41,690 --> 01:17:44,559 FOR CURIOSITY, FOR SOCIALIZING. 1980 01:17:44,626 --> 01:17:46,795 WE ARE SOCIAL SURVIVALISTS, WE 1981 01:17:46,862 --> 01:17:48,263 DEPEND ON EACH OTHER FOR 1982 01:17:48,330 --> 01:17:50,265 SURVIVAL S SO WHAT THE PEER GROP 1983 01:17:50,332 --> 01:17:51,433 IS DOING IS INCREDIBLY 1984 01:17:51,500 --> 01:17:51,767 IMPORTANT. 1985 01:17:51,833 --> 01:17:56,671 WE SEEK OUT NEW INFORMATION AND 1986 01:17:56,738 --> 01:17:57,906 NEW EXPERIENCES AND OF COURSE WE 1987 01:17:57,973 --> 01:18:01,510 ARE WIRED TO AVOID PAIN, BOTH 1988 01:18:01,576 --> 01:18:04,446 PSYCHOLOGICAL AND PHYSICAL AND 1989 01:18:04,513 --> 01:18:06,181 THE TRUTH IS THAT THERE ARE SOME 1990 01:18:06,248 --> 01:18:07,516 SUBSTANCES THAT DO A REALLY GOOD 1991 01:18:07,582 --> 01:18:11,987 JOB OF SATISFYING THESE THINGS. 1992 01:18:12,054 --> 01:18:13,488 AND AGAIN IT'S A RELATIONSHIP TO 1993 01:18:13,555 --> 01:18:16,358 THEM AND HOW PROBLEMATIC THAT 1994 01:18:16,425 --> 01:18:18,627 BECOMES AND ALSO THE 1995 01:18:18,693 --> 01:18:21,530 RELATIONSHIP WITH -- THAT SOME 1996 01:18:21,596 --> 01:18:23,999 SUBSTANCES MAY BE MORE DANGEROUS 1997 01:18:24,066 --> 01:18:25,100 THAN OTHERS THAT WE NEED TO JUST 1998 01:18:25,167 --> 01:18:30,872 HAVE IN MIND. 1999 01:18:30,939 --> 01:18:33,842 THERE ARE ALSO REASONS THAT -- 2000 01:18:33,909 --> 01:18:35,911 SO WE SORT OF CRIMINALIZED 2001 01:18:35,977 --> 01:18:38,613 CERTAIN SURVIVAL OR COPING 2002 01:18:38,680 --> 01:18:38,914 MECHANISMS. 2003 01:18:38,980 --> 01:18:41,283 SUBSTANCE USE BEING ONE OF THEM, 2004 01:18:41,349 --> 01:18:43,785 WHAT THAT DOES IS IT OSTRACIZES 2005 01:18:43,852 --> 01:18:46,822 AND ISOLATES THOSE FOLKS WHO ARE 2006 01:18:46,888 --> 01:18:48,256 USING SUBSTANCES. 2007 01:18:48,323 --> 01:18:51,526 I WILL SHARE WITH YOU FROM 2008 01:18:51,593 --> 01:18:56,698 MYSELF THAT I HAD SUICIDAL 2009 01:18:56,765 --> 01:18:58,100 THOUGHTS AND IDEATION FOR MOST 2010 01:18:58,166 --> 01:19:01,036 OF MY ADOLESCENCE AND EARLY 2011 01:19:01,103 --> 01:19:04,973 ADULTHOOD AND I DO BELIEVE THAT 2012 01:19:05,040 --> 01:19:06,374 SUBSTANCES MADE IT POSSIBLE FOR 2013 01:19:06,441 --> 01:19:09,010 ME TO CONTINUE LIVING. 2014 01:19:09,077 --> 01:19:10,879 AND -- SO I HAD A REALLY GOOD 2015 01:19:10,946 --> 01:19:14,583 REASON AT THAT TIME TO USE 2016 01:19:14,649 --> 01:19:17,519 SOMETHING THAT HELPED ME FEEL A 2017 01:19:17,586 --> 01:19:22,124 LITTLE BIT SOOTHED OR FEEL OKAY 2018 01:19:22,190 --> 01:19:22,757 TO CARRY ON. 2019 01:19:22,824 --> 01:19:24,059 SOME FOLKS ARE USING SUBSTANCES 2020 01:19:24,126 --> 01:19:25,293 BECAUSE THEY ARE UNHOUSED AND 2021 01:19:25,360 --> 01:19:27,896 UNSAFE AT NIGHT SO THEY'LL USE A 2022 01:19:27,963 --> 01:19:29,431 STIMULANT TO STAY AWAKE SO THAT 2023 01:19:29,498 --> 01:19:31,166 THEY'RE NOT VICTIMIZED OR 2024 01:19:31,233 --> 01:19:31,600 ABUSED. 2025 01:19:31,666 --> 01:19:36,538 SOME FOLKS ARE -- HAVE -- 2026 01:19:36,605 --> 01:19:38,173 THEY'RE IN A STREET BASED 2027 01:19:38,240 --> 01:19:39,341 ECONOMY, MAYBE THEY'RE DOING SEX 2028 01:19:39,407 --> 01:19:43,945 WORK SO THEY'RE USING SUBSTANCES 2029 01:19:44,012 --> 01:19:45,480 TO MAKE IT TOLERABLE TO DO THAT 2030 01:19:45,547 --> 01:19:47,215 SEX WORK OR TO PERFORM BETTER IN 2031 01:19:47,282 --> 01:19:51,253 THAT SEX WORK, SO AS YOU'RE 2032 01:19:51,319 --> 01:19:52,053 ENCOUNTERING PEOPLE WHO ARE 2033 01:19:52,120 --> 01:19:54,856 COMING TO YOU, UNDERSTANDING 2034 01:19:54,923 --> 01:19:56,291 THAT FOR SOME, SUBSTANCE USE IS 2035 01:19:56,358 --> 01:19:56,558 SURVIVAL. 2036 01:19:56,625 --> 01:19:58,593 IT IS A WAY, IT IS A PART OF 2037 01:19:58,660 --> 01:20:02,430 THEIR SURVIVAL STRATEGIES AND SO 2038 01:20:02,497 --> 01:20:03,598 AGAIN, UNDERSTANDING THE CONTEXT 2039 01:20:03,665 --> 01:20:07,002 IN WHICH PEOPLE USE CAN HELP US 2040 01:20:07,068 --> 01:20:09,437 IN HOW WE SUPPORT THEM AND 2041 01:20:09,504 --> 01:20:13,775 APPROACH THEM AND NOT JUST SORT 2042 01:20:13,842 --> 01:20:14,876 OF SAYING SUBSTANCE USE IS YOUR 2043 01:20:14,943 --> 01:20:15,944 MAIN PROBLEM AND YOU NEED TO 2044 01:20:16,011 --> 01:20:16,711 STOP NOW. 2045 01:20:16,778 --> 01:20:18,446 BECAUSE WE'VE CRIMINALIZED THESE 2046 01:20:18,513 --> 01:20:20,015 BEHAVIORS AND CRIMINALIZED 2047 01:20:20,081 --> 01:20:22,384 SUBSTANCE USE, PEOPLE TEND TO 2048 01:20:22,450 --> 01:20:25,520 GET ISOLATED AND OSTRACIZED AND 2049 01:20:25,587 --> 01:20:28,190 THAT CAN DENY THEM ACCESS TO 2050 01:20:28,256 --> 01:20:31,159 BASIC HUMAN NEEDS AND SUPPORTS 2051 01:20:31,226 --> 01:20:33,662 LIKE HOUSING, PERSONAL SAFETY, 2052 01:20:33,728 --> 01:20:36,298 HEALTHCARE, EMPLOYMENT, FAMILY 2053 01:20:36,364 --> 01:20:38,900 TIES, BEHAVIORAL HEALTHCARE, AND 2054 01:20:38,967 --> 01:20:41,836 SO THAT ISOLATION REALLY CAN 2055 01:20:41,903 --> 01:20:44,072 CONTRIBUTE TO AN OVERALL 2056 01:20:44,139 --> 01:20:46,107 DOWNWARD SPIRAL AND A 2057 01:20:46,174 --> 01:20:47,042 DISCONNECTION FROM KEY SERVICES 2058 01:20:47,108 --> 01:20:49,844 AND SUPPORTS AND AGAIN IT'S THIS 2059 01:20:49,911 --> 01:20:52,047 IDEA THAT WE HAVE TO BE SEEKING 2060 01:20:52,113 --> 01:20:56,051 RECOVERY IN ORDER TO -- IN ORDER 2061 01:20:56,117 --> 01:20:57,485 TO RECEIVE SERVICES, RIGHT? 2062 01:20:57,552 --> 01:20:59,988 WE HAVE TO HAVE THIS RECOVERY 2063 01:21:00,055 --> 01:21:03,058 READINESS, BUT IF WE'RE USING 2064 01:21:03,124 --> 01:21:04,693 SUBSTANCES FOR ANY NUMBER OF 2065 01:21:04,759 --> 01:21:07,095 REASONS AND WE'RE NOT READY OR 2066 01:21:07,162 --> 01:21:09,931 WE CAN'T STOP AT THAT TIME, 2067 01:21:09,998 --> 01:21:12,133 DENYING SERVICES IS JUST 2068 01:21:12,200 --> 01:21:16,404 CONTRIBUTING TO THAT PROBLEM OF 2069 01:21:16,471 --> 01:21:17,772 THEIR OVERALL CONTEXT THAT 2070 01:21:17,839 --> 01:21:22,310 THEY'RE LIVING IN. 2071 01:21:22,377 --> 01:21:24,512 DR. VOLKOW TALKED ABOUT WE HAVE 2072 01:21:24,579 --> 01:21:26,915 SOLUTIONS IN THE HEALTHCARE 2073 01:21:26,982 --> 01:21:28,083 SYSTEM AND WHY ARE THEY NOT 2074 01:21:28,149 --> 01:21:29,751 WORKING OR WHY ARE THEY NOT MORE 2075 01:21:29,818 --> 01:21:31,586 WIDELY USED, AND I WILL SAY THAT 2076 01:21:31,653 --> 01:21:33,488 THERE ARE REALLY THREE THINGS IN 2077 01:21:33,555 --> 01:21:36,992 MY MIND THAT ARE THE MAJOR 2078 01:21:37,058 --> 01:21:37,525 CONTRIBUTORS TO THAT. 2079 01:21:37,592 --> 01:21:38,827 ONE IS ACCESS. 2080 01:21:38,893 --> 01:21:41,129 SIMPLY HAVING ACCESS TO THE 2081 01:21:41,196 --> 01:21:42,330 SERVICES. 2082 01:21:42,397 --> 01:21:43,531 HEALTH INSURANCE, 2083 01:21:43,598 --> 01:21:44,432 TRANSPORTATION, MAYBE THE 2084 01:21:44,499 --> 01:21:46,601 SERVICES DON'T EVEN EXIST WHERE 2085 01:21:46,668 --> 01:21:49,771 YOU LIVE AT THIS TIME. 2086 01:21:49,838 --> 01:21:52,841 STIGMA AND DISCRIMINATION. 2087 01:21:52,907 --> 01:21:55,910 SO WE TALK ABOUT STIGMA A LOT 2088 01:21:55,977 --> 01:21:59,180 AND IN ACTION, STIGMA IS 2089 01:21:59,247 --> 01:22:00,248 DISCRIMINATION, SO WE ARE 2090 01:22:00,315 --> 01:22:03,218 TREATED DIFFERENTLY IN SYSTEMS 2091 01:22:03,285 --> 01:22:05,287 AND SO BECAUSE OF THAT, WE 2092 01:22:05,353 --> 01:22:08,890 DEVELOP A LACK OF TRUST. 2093 01:22:08,957 --> 01:22:12,327 SO WE ARE VERY SKEPTICAL OF A 2094 01:22:12,394 --> 01:22:13,828 LOT OF THE SYSTEMS THAT ARE 2095 01:22:13,895 --> 01:22:15,096 THERE TO CARE FOR US BECAUSE WE 2096 01:22:15,163 --> 01:22:16,464 HAVE NOT BEEN TREATED WELL BY 2097 01:22:16,531 --> 01:22:19,301 THEM IN THE PAST. 2098 01:22:19,367 --> 01:22:21,469 WE HAVE A LOT TO LOSE WHEN WE 2099 01:22:21,536 --> 01:22:23,471 COME INTO YOUR HOSPITAL OR INTO 2100 01:22:23,538 --> 01:22:26,308 YOUR HEALTHCARE SETTING. 2101 01:22:26,374 --> 01:22:28,710 YOU MAY BE REPORTING US TO 2102 01:22:28,777 --> 01:22:33,081 VARIOUS ENTITIES FOR VARIOUS 2103 01:22:33,148 --> 01:22:35,083 THINGS, AN WE CAN RISK LOSING 2104 01:22:35,150 --> 01:22:36,251 OUR HOUSING, OUR EMPLOYMENT, 2105 01:22:36,318 --> 01:22:38,887 CONNECTIONS TO SOCIAL SERVICES, 2106 01:22:38,953 --> 01:22:40,622 PERSONAL RELATIONSHIPS. 2107 01:22:40,689 --> 01:22:41,723 OUR STATUS IN OUR COMMUNITY. 2108 01:22:41,790 --> 01:22:45,327 AND CERTAINLY CUSTODY OF OUR 2109 01:22:45,393 --> 01:22:45,593 CHILDREN. 2110 01:22:45,660 --> 01:22:50,131 IT IS STILL ILLEGAL IN SOME 2111 01:22:50,198 --> 01:22:51,299 STATES FOR PREGNANT PEOPLE TO BE 2112 01:22:51,366 --> 01:22:53,068 ON MEDICATION FOR OPIOID USE 2113 01:22:53,134 --> 01:22:55,570 DISORDER AND THEY WILL BE 2114 01:22:55,637 --> 01:22:57,739 INCARCERATED AND REPORTED TO THE 2115 01:22:57,806 --> 01:22:58,573 DEPARTMENT OF CHILDREN AND 2116 01:22:58,640 --> 01:23:01,042 FAMILY SERVICES. 2117 01:23:01,109 --> 01:23:05,447 WE COU DO NOT HAVE BODILY AUTONY 2118 01:23:05,513 --> 01:23:08,483 IN A LOT OF CASES AND SO WE ARE 2119 01:23:08,550 --> 01:23:09,784 RISKING A GREAT DEAL WHEN WE 2120 01:23:09,851 --> 01:23:10,685 COME INTO YOUR HEALTHCARE 2121 01:23:10,752 --> 01:23:11,653 SETTINGS. 2122 01:23:11,720 --> 01:23:15,590 SOME RESEARCH HAS SHOWN -- I WAS 2123 01:23:15,657 --> 01:23:18,026 AT A HARM REDUCTION CONFERENCE 2124 01:23:18,093 --> 01:23:19,527 RECENTLY, AND A PROFESSOR WAS 2125 01:23:19,594 --> 01:23:20,428 PRESENTING AND SAYING THAT SOME 2126 01:23:20,495 --> 01:23:22,597 OF THE RESEARCH THAT SHE WAS 2127 01:23:22,664 --> 01:23:25,600 READING REFERRED TO DOCTORS AS 2128 01:23:25,667 --> 01:23:28,870 POLICE IN WHITE COATS. 2129 01:23:28,937 --> 01:23:30,605 AND THAT'S A REALLY, REALLY 2130 01:23:30,672 --> 01:23:32,807 DAMAGING DYNAMIC THAT WE DON'T 2131 01:23:32,874 --> 01:23:34,542 TRUST YOU AND YOU DON'T TRUST 2132 01:23:34,609 --> 01:23:39,547 US. 2133 01:23:39,614 --> 01:23:40,815 AND ANOTHER EXAMPLE OF SORT OF 2134 01:23:40,882 --> 01:23:42,183 THE RISKS THAT WE HAVE AS WE'RE 2135 01:23:42,250 --> 01:23:43,518 TRYING TO NAVIGATE ALL OF THE 2136 01:23:43,585 --> 01:23:44,319 CONTEXTS THAT WE'RE IN AND ALL 2137 01:23:44,386 --> 01:23:46,788 OF THE CHALLENGES WE FACE IS 2138 01:23:46,855 --> 01:23:49,758 THAT MEDICATION FOR OPIOID USE 2139 01:23:49,824 --> 01:23:52,026 DISORDER, A TYPICAL METHADONE 2140 01:23:52,093 --> 01:23:53,128 CLINIC REQUIRES THAT PEOPLE COME 2141 01:23:53,194 --> 01:23:55,864 IN EVERY DAY TO GET THEIR DOSE 2142 01:23:55,930 --> 01:23:58,366 AND IT REQUIRES TOTAL ABSTINENCE 2143 01:23:58,433 --> 01:24:01,436 SO THEY ARE REGULARLY TESTED FOR 2144 01:24:01,503 --> 01:24:03,838 SUBSTANCES IN THEIR URINE, AND 2145 01:24:03,905 --> 01:24:05,940 IF THEY COME UP POSITIVE FOR 2146 01:24:06,007 --> 01:24:08,243 CANNABIS OR ALCOHOL USE OR EVEN 2147 01:24:08,309 --> 01:24:09,310 IF THEY MISS A MEETING THAT 2148 01:24:09,377 --> 01:24:11,713 THEY'RE SUPPOSED TO BE AT AT THE 2149 01:24:11,780 --> 01:24:14,682 CLINIC, THEN HAVE EVERS WILL BEN 2150 01:24:14,749 --> 01:24:15,984 SERVICES WILL BE REMOVED, THEY 2151 01:24:16,050 --> 01:24:17,218 WILL BE NO LONGER ALLOWED TO 2152 01:24:17,285 --> 01:24:18,186 ACCESS THAT METHADONE. 2153 01:24:18,253 --> 01:24:19,421 AND WE KNOW THAT THE OVERDOSE 2154 01:24:19,487 --> 01:24:22,223 RISK IS WAY UP WHEN PEOPLE HAVE 2155 01:24:22,290 --> 01:24:25,193 BEEN ON OPIOID -- MEDICATION FOR 2156 01:24:25,260 --> 01:24:27,195 OPIOID USE DISORDER AND IT IS 2157 01:24:27,262 --> 01:24:27,529 REMOVED. 2158 01:24:27,595 --> 01:24:29,397 BUT OUR SYSTEMS ARE STILL 2159 01:24:29,464 --> 01:24:34,202 PREDICATED ON THIS KIND OF IDEA 2160 01:24:34,269 --> 01:24:37,505 OF COMPLIANCE AND RESTRICTION 2161 01:24:37,572 --> 01:24:43,278 AND NOT HAVING BODILY AUTONOMY. 2162 01:24:43,344 --> 01:24:45,380 SO WHAT HAPPENS WITH THIS LACK 2163 01:24:45,447 --> 01:24:48,316 OF TRUST, AND AGAIN THIS IS 2164 01:24:48,383 --> 01:24:49,751 RESEARCH THAT I RECENTLY FOUND, 2165 01:24:49,818 --> 01:24:52,220 THAT PEOPLE WHO INJECT DRUGS WHO 2166 01:24:52,287 --> 01:24:54,122 ARE SOME OF THE MOST STIGMATIZED 2167 01:24:54,189 --> 01:24:55,390 OUT OF ALL OF THE GROUPS THAT 2168 01:24:55,457 --> 01:25:00,829 WERE TALKING ABOUT, BECAUSE OF 2169 01:25:00,895 --> 01:25:01,729 THE DEHUMANIZATION AND 2170 01:25:01,796 --> 01:25:02,597 DISCRIMINATION TO HEALTHCARE 2171 01:25:02,664 --> 01:25:03,832 SETTINGS THAT THEY ACTUALLY 2172 01:25:03,898 --> 01:25:06,100 DELAY PRESENTING FOR HEALTHCARE. 2173 01:25:06,167 --> 01:25:08,703 WHICH MEANS THAT YOU ARE MY 2174 01:25:08,770 --> 01:25:11,339 ABSOLUTE LAST RESORT. 2175 01:25:11,406 --> 01:25:13,408 SO I MAY HAVE A WOUND, I MIGHT 2176 01:25:13,475 --> 01:25:15,276 HAVE AN ABSCESS FROM AN 2177 01:25:15,343 --> 01:25:17,145 INJECTION SITE BECAUSE I DIDN'T 2178 01:25:17,212 --> 01:25:19,280 HAVE STERILE EQUIPMENT OR AN 2179 01:25:19,347 --> 01:25:20,415 ENVIRONMENT WHERE I COULD HAVE 2180 01:25:20,482 --> 01:25:24,686 ACCESS TO CLEAN WATER TO USE, 2181 01:25:24,752 --> 01:25:27,088 AND THAT ABSCESS WILL GROW INTO 2182 01:25:27,155 --> 01:25:29,157 A MUCH LARGER INFECTION, PERHAPS 2183 01:25:29,224 --> 01:25:30,925 NOW I HAVE A BLOOD INFECTION, 2184 01:25:30,992 --> 01:25:32,660 AND SO I'M NOT PRESENTING TO YOU 2185 01:25:32,727 --> 01:25:34,963 UNTIL I'M ALMOST AT THE POINT 2186 01:25:35,029 --> 01:25:37,932 WHERE I COULD LOSE THAT LIMB. 2187 01:25:37,999 --> 01:25:40,235 OR IN THE CASE OF MY FRIEND ROB, 2188 01:25:40,301 --> 01:25:41,669 WHERE HIS ENDOCARDITIS WAS SO 2189 01:25:41,736 --> 01:25:42,604 BAD THAT THERE WAS NOTHING THAT 2190 01:25:42,670 --> 01:25:45,373 THEY COULD DO, AND HE PASSED 2191 01:25:45,440 --> 01:25:48,009 AWAY IN THE HOSPITAL BECAUSE HE 2192 01:25:48,076 --> 01:25:49,644 DID NOT WANT TO GO AND GET 2193 01:25:49,711 --> 01:25:52,380 TREATMENT ANY SOONER. 2194 01:25:52,447 --> 01:25:53,882 IT ALSO KEEPS US FROM DISCLOSING 2195 01:25:53,948 --> 01:25:55,250 DRUG USE, WHICH IS NOT HELPFUL 2196 01:25:55,316 --> 01:25:59,420 IN TERMS OF WORKING TOGETHER AND 2197 01:25:59,487 --> 01:26:00,388 COLLABORATING WITH A PROVIDER TO 2198 01:26:00,455 --> 01:26:02,790 FIGURE OUT WHAT KIND OF SUPPORTS 2199 01:26:02,857 --> 01:26:05,860 OR STEPS COULD BE TAKEN 2200 01:26:05,927 --> 01:26:06,961 DOWNPLAYING PAIN AND SEEKING 2201 01:26:07,028 --> 01:26:13,968 CARE ELSEWHERE. 2202 01:26:14,035 --> 01:26:15,737 AND THIS IS A TERM I CAME UP 2203 01:26:15,803 --> 01:26:16,838 WITH, I LOVE TO COME UP WITH 2204 01:26:16,905 --> 01:26:18,273 TERMS, BUT CONTEXT BIAS. 2205 01:26:18,339 --> 01:26:19,274 MAYBE IT'S A THING, I DON'T 2206 01:26:19,340 --> 01:26:19,807 KNOW. 2207 01:26:19,874 --> 01:26:22,210 I'VE NEVER HEARD ANYBODY SAY IT, 2208 01:26:22,277 --> 01:26:26,781 BULL I THINK ABOUT THIS IN TERMS 2209 01:26:26,848 --> 01:26:29,417 OF BECAUSE MANY OF US WHO -- 2210 01:26:29,484 --> 01:26:32,253 MANY PEOPLE WHO USE DRUGS ARE 2211 01:26:32,320 --> 01:26:33,655 PRESENTING AS ABSOLUTE 2212 01:26:33,721 --> 01:26:34,455 WORST-CASE SCENARIOS WHEN WE 2213 01:26:34,522 --> 01:26:38,393 SHOW UP IN YOUR SYSTEMS, YOU ARE 2214 01:26:38,459 --> 01:26:40,962 SEEING US AT OUR ABSOLUTE LOWEST 2215 01:26:41,029 --> 01:26:43,097 POINT OR OUR WORST OR OUR MOST 2216 01:26:43,164 --> 01:26:44,299 CRITICAL OR IN OUR GREATEST 2217 01:26:44,365 --> 01:26:45,400 NEED. 2218 01:26:45,466 --> 01:26:47,168 AND YOU'RE ONLY SEEING US 2219 01:26:47,235 --> 01:26:48,169 PRESENTING WITH THE ABSCESS OR 2220 01:26:48,236 --> 01:26:49,938 THE BLOOD INFECTION OR WHATEVER 2221 01:26:50,004 --> 01:26:53,641 IT IS POST OVERDOSE, RIGHT? 2222 01:26:53,708 --> 01:26:56,344 SO YOU ONLY SEE THAT ONE ASPECT 2223 01:26:56,411 --> 01:26:57,779 OF US, AND YOU'RE SEEING THIS 2224 01:26:57,845 --> 01:26:59,981 OVER AND OVER AND OVER SO YOU'RE 2225 01:27:00,048 --> 01:27:00,882 THINKING SUBSTANCE USE, PEOPLE 2226 01:27:00,949 --> 01:27:02,150 WHO USE DRUGS, THIS IS WHAT THEY 2227 01:27:02,216 --> 01:27:05,019 LOOK LIKE, THIS IS -- YOU KNOW, 2228 01:27:05,086 --> 01:27:08,189 HOW THEY ARE, AND THIS IS HOW 2229 01:27:08,256 --> 01:27:08,957 THEY COME IN. 2230 01:27:09,023 --> 01:27:11,059 AND WHAT HAPPENS IS THAT YOU'VE 2231 01:27:11,125 --> 01:27:13,227 LOST SITE OF ALL OF THE REST OF 2232 01:27:13,294 --> 01:27:15,964 WHO WE ARE. 2233 01:27:16,030 --> 01:27:16,965 YOU'VE LOST SIGHT OF ALL OF THE 2234 01:27:17,031 --> 01:27:18,933 OTHER CHALLENGES THAT WE MAY 2235 01:27:19,000 --> 01:27:19,167 HAVE. 2236 01:27:19,233 --> 01:27:20,501 SO WHEN YOU SEE US AND YOU'RE 2237 01:27:20,568 --> 01:27:22,570 LIKE, I DON'T UNDERSTAND WHY YOU 2238 01:27:22,637 --> 01:27:25,073 CAN'T STOP USING SUBSTANCES OR 2239 01:27:25,139 --> 01:27:26,407 YOU AREN'T SEEING HOW MANY 2240 01:27:26,474 --> 01:27:29,711 BARRIERS WE ACTUALLY HAVE TO 2241 01:27:29,777 --> 01:27:31,846 STOPPING USING SUBSTANCES IF 2242 01:27:31,913 --> 01:27:37,151 THAT IS INDEED A GOAL THAT WE 2243 01:27:37,218 --> 01:27:37,785 HAVE AS INDIVIDUALS. 2244 01:27:37,852 --> 01:27:40,288 WE MAY WANT TO STOP AND OUR 2245 01:27:40,355 --> 01:27:42,390 LIVES ARE JUST SUCH THAT IT'S 2246 01:27:42,457 --> 01:27:43,491 NEARLY IMPOSSIBLE, WE DON'T HAVE 2247 01:27:43,558 --> 01:27:46,127 THE SUPPORTS THAT WE NEED IN 2248 01:27:46,194 --> 01:27:46,995 ORDER TO DO THAT. 2249 01:27:47,061 --> 01:27:50,832 AND SO THAT CREATES THIS BIAS 2250 01:27:50,898 --> 01:27:52,367 FOR A LOT OF PROVIDERS, I THINK, 2251 01:27:52,433 --> 01:28:01,476 IN HOW YOU SEE US. 2252 01:28:01,542 --> 01:28:02,777 SO I BELIEVE THERE'S A LOT OF 2253 01:28:02,844 --> 01:28:03,878 OPPORTUNITIES FOR BETTER 2254 01:28:03,945 --> 01:28:04,312 ENGAGEMENT. 2255 01:28:04,379 --> 01:28:05,947 I AM HERE FIRST AND FOREMOST AS 2256 01:28:06,014 --> 01:28:12,720 A HUMAN BEING AND I THINK THAT 2257 01:28:12,787 --> 01:28:15,023 IS HOW -- THE APPROACH THAT I 2258 01:28:15,089 --> 01:28:18,226 CAN OFFER TO YOU, TO ADD TO THE 2259 01:28:18,292 --> 01:28:20,695 SCIENCE AND THE MEDICINE AND ALL 2260 01:28:20,762 --> 01:28:22,664 OF THAT, THE FIRST THING IS JUST 2261 01:28:22,730 --> 01:28:26,067 TO LOOK AT US AS WHOLE PEOPLE. 2262 01:28:26,134 --> 01:28:27,168 UNDERSTAND ALL OF WHAT WE HAVE 2263 01:28:27,235 --> 01:28:29,804 GOING ON, TAKE ABSTINENCE OUT OF 2264 01:28:29,871 --> 01:28:31,773 THE PICTURE FOR THE MOMENT, AND 2265 01:28:31,839 --> 01:28:33,107 JUST DEAL WITH THE WHOLE PERSON 2266 01:28:33,174 --> 01:28:36,144 THAT'S SITTING IN FRONT OF YOU. 2267 01:28:36,210 --> 01:28:37,445 WE CAN BUILD WELLNESS IN MANY 2268 01:28:37,512 --> 01:28:40,648 OTHER WAYS, AND SUPPORT PEOPLE 2269 01:28:40,715 --> 01:28:43,151 IN DOING THINGS MORE SAFELY OR 2270 01:28:43,217 --> 01:28:44,018 IMPROVING THEIR QUALITY OF LIFE 2271 01:28:44,085 --> 01:28:47,321 IN SMALL WAYS OVER TIME. 2272 01:28:47,388 --> 01:28:48,723 WITHOUT HAVING TO HAVE 2273 01:28:48,790 --> 01:28:53,327 ABSTINENCE AS THAT FIRST PIECE. 2274 01:28:53,394 --> 01:28:55,296 REALLY PROMISING, AND DR. VOLKOW 2275 01:28:55,363 --> 01:28:57,265 TALKED ABOUT THIS, IS THE PEER 2276 01:28:57,331 --> 01:28:57,799 SUPPORT MODEL. 2277 01:28:57,865 --> 01:29:01,502 THAT IS WHAT MY -- WHAT I WORK 2278 01:29:01,569 --> 01:29:03,938 IN AND WHERE I DO MOST OF MY 2279 01:29:04,005 --> 01:29:05,907 EDUCATION. 2280 01:29:05,973 --> 01:29:10,378 IT'S A REALLY, REALLY SORT OF 2281 01:29:10,445 --> 01:29:12,346 THEORETICAL SHIFT, RIGHT? 2282 01:29:12,413 --> 01:29:14,682 THAT TRUST PIECE IS ABOUT A 2283 01:29:14,749 --> 01:29:16,084 POWER DIFFERENTIAL, YOU HAVE 2284 01:29:16,150 --> 01:29:17,418 MUCH GREATER POWER THAN US WHEN 2285 01:29:17,485 --> 01:29:19,487 WE'RE COMING IN TO YOU AS A 2286 01:29:19,554 --> 01:29:20,388 PATIENT. 2287 01:29:20,455 --> 01:29:23,558 WITH A PEER MODEL, WE'RE EQUAL. 2288 01:29:23,624 --> 01:29:26,194 WE ARE BASED ON MUTUAL TRUST, 2289 01:29:26,260 --> 01:29:27,161 WE'RE INTERESTED IN WHAT YOU 2290 01:29:27,228 --> 01:29:30,565 HAVE GOING WELL, AND BUILDING ON 2291 01:29:30,631 --> 01:29:31,566 THAT, WE'RE INTERESTED IN WHAT 2292 01:29:31,632 --> 01:29:32,967 CHANGES YOU WANT TO MAKE, NOT 2293 01:29:33,034 --> 01:29:36,771 WHAT I THINK YOU SHOULD DO. 2294 01:29:36,838 --> 01:29:38,639 IT PROVIDES A LEVEL OF DIGNITY, 2295 01:29:38,706 --> 01:29:40,274 AUTONOMY AND CHOICE THAT KEEPS 2296 01:29:40,341 --> 01:29:40,742 PEOPLE COMING BACK. 2297 01:29:40,808 --> 01:29:42,477 IT REALLY CHANGES THAT 2298 01:29:42,543 --> 01:29:44,345 RELATIONSHIP AND THIS MODEL 2299 01:29:44,412 --> 01:29:46,881 BEING INTEGRATED INTO HEALTHCARE 2300 01:29:46,948 --> 01:29:49,283 SETTINGS IS ONE OF THE MOST 2301 01:29:49,350 --> 01:29:52,019 PROMISING OPPORTUNITIES THAT WE 2302 01:29:52,086 --> 01:29:54,789 HAVE RIGHT NOW, AND SAMHSA, 2303 01:29:54,856 --> 01:29:56,758 WHICH IS THE SUBSTANCE USE AND 2304 01:29:56,824 --> 01:29:57,225 MENTAL HEALTH SERVICES 2305 01:29:57,291 --> 01:29:58,092 ADMINISTRATION, WHICH OVERSEES 2306 01:29:58,159 --> 01:29:59,861 SORT OF NATIONALLY ALL OUR 2307 01:29:59,927 --> 01:30:01,529 BEHAVIORAL HEALTH SYSTEMS, IS 2308 01:30:01,596 --> 01:30:03,030 REALLY PUTTING A LOT OF EMPHASIS 2309 01:30:03,097 --> 01:30:05,166 ON GETTING THE PEER MODEL MORE 2310 01:30:05,233 --> 01:30:06,701 INTEGRATED INTO HEALTHCARE 2311 01:30:06,768 --> 01:30:07,969 SETTINGS, AND SO AS DR. VOLKOW 2312 01:30:08,035 --> 01:30:10,872 WAS TALKING ABOUT, YOU KNOW, 2313 01:30:10,938 --> 01:30:12,039 HEALTHCARE AS WHERE THE CENTER 2314 01:30:12,106 --> 01:30:14,375 OF OUR APPROACH SHOULD BE, THE 2315 01:30:14,442 --> 01:30:15,143 PEER MODEL SHOULD BE RIGHT 2316 01:30:15,209 --> 01:30:17,645 THERE. 2317 01:30:17,712 --> 01:30:21,048 AND THEN JUST HARM REDUCTION, SO 2318 01:30:21,115 --> 01:30:22,250 HARM REDUCTION IS THAT MIDDLE 2319 01:30:22,316 --> 01:30:24,085 GROUND, RIGHT, HARM REDUCTION IS 2320 01:30:24,152 --> 01:30:27,455 SORT OF STANDING IN THE GAP, AND 2321 01:30:27,522 --> 01:30:29,056 JUST LETTING PEOPLE MAKE THEIR 2322 01:30:29,123 --> 01:30:31,459 OWN CHOICES, RESPECTING THEIR 2323 01:30:31,526 --> 01:30:32,160 AUTONOMY, UNDERSTANDING PEOPLE 2324 01:30:32,226 --> 01:30:34,128 HAVE REALLY GOOD REASONS TO USE 2325 01:30:34,195 --> 01:30:38,466 SUBSTANCES, AND THAT IT'S -- AND 2326 01:30:38,533 --> 01:30:42,703 WE KNOW THAT'S NEVER FORGETTING 2327 01:30:42,770 --> 01:30:44,105 FOR SOME FOLKS THAT'S VERY 2328 01:30:44,172 --> 01:30:45,206 PROBLEMATIC AND DAMAGING BUT 2329 01:30:45,273 --> 01:30:47,175 ALSO IT IS STILL ULTIMATELY UP 2330 01:30:47,241 --> 01:30:50,244 TO US TO MAKE ANY CHANGES OR 2331 01:30:50,311 --> 01:30:52,880 CHOOSE TO MAKE CHANGE. 2332 01:30:52,947 --> 01:30:55,850 AND SO HARM REDUCTION DOES NOT 2333 01:30:55,917 --> 01:30:57,952 FORCE OR COERCE CHANGE. 2334 01:30:58,019 --> 01:31:00,154 OND WHAT MAKES HARM REDUCTION SO 2335 01:31:00,221 --> 01:31:03,758 SUCCESSFUL IS THAT THAT RESPECT 2336 01:31:03,825 --> 01:31:07,562 THAT WE GIVE FOLKS, THAT MAKING 2337 01:31:07,628 --> 01:31:09,130 THEM FEEL WORTHY, MAKING THEM 2338 01:31:09,197 --> 01:31:11,098 FEE SUPPORTED AND APPRECIATED 2339 01:31:11,165 --> 01:31:14,769 AND VALUED AND MAKING THEM FEEL 2340 01:31:14,836 --> 01:31:16,103 LIKE THEY HAVE POWER IN THE 2341 01:31:16,170 --> 01:31:18,739 RELATIONSHIP LEADS TO BETTER 2342 01:31:18,806 --> 01:31:20,508 ENGAGEMENT OVER TIME AND MORE 2343 01:31:20,575 --> 01:31:20,942 HELP-SEEKING. 2344 01:31:21,008 --> 01:31:22,376 SO THERE'S MANY FORMS OF HARM 2345 01:31:22,443 --> 01:31:24,679 REDUCTION OUT THERE, BUT REALLY 2346 01:31:24,745 --> 01:31:28,783 AT ITS HEART, HARM REDUCTION IS 2347 01:31:28,850 --> 01:31:29,951 JUST RESPECTING THAT YOU HAVE 2348 01:31:30,017 --> 01:31:30,952 POWER TO MAKE YOUR OWN CHOICES 2349 01:31:31,018 --> 01:31:32,687 AND WE'RE JUST HERE TO HELP IF 2350 01:31:32,753 --> 01:31:35,223 WE WOULD LIKE YOU TO, YOU KNOW, 2351 01:31:35,289 --> 01:31:36,324 STAY ALIVE AND HAVE A BETTER 2352 01:31:36,390 --> 01:31:37,525 QUALITY OF LIFE IF THAT'S WHAT 2353 01:31:37,592 --> 01:31:44,198 YOU LIKE. 2354 01:31:44,265 --> 01:31:45,733 SO HARM REDUCTION AT ITS HEART 2355 01:31:45,800 --> 01:31:48,035 IS LOVE, AND I'LL LEAVE YOU KIND 2356 01:31:48,102 --> 01:31:52,106 OF WITH THIS ENERGY OF LOVE, AND 2357 01:31:52,173 --> 01:31:56,043 OF STANDING WITH US IN THE GAP. 2358 01:31:56,110 --> 01:31:57,445 THE BEST THING I CAN SAY YOU CAN 2359 01:31:57,511 --> 01:31:58,546 LEAVE HERE TODAY WITH THAT 2360 01:31:58,613 --> 01:32:00,648 DOESN'T TAKE SPECIAL TRAINING OR 2361 01:32:00,715 --> 01:32:04,485 A FELLOWSHIP OR A BUNCH OF MONEY 2362 01:32:04,552 --> 01:32:05,920 IS JUST TO STAND WITH US. 2363 01:32:05,987 --> 01:32:07,555 YOU PROBABLY CAN'T FIX ALL OUR 2364 01:32:07,622 --> 01:32:10,725 PROBLEMS ANYWAYS, BUT WHAT YOU 2365 01:32:10,791 --> 01:32:12,660 CAN DO IS EASE A LITTLE OF OUR 2366 01:32:12,727 --> 01:32:14,896 SUFFERING. 2367 01:32:14,962 --> 01:32:17,298 PERHAPS HELP US STAY A LITTLE 2368 01:32:17,365 --> 01:32:19,634 SAFER, PERHAPS OVER TIME THAT 2369 01:32:19,700 --> 01:32:21,068 LEADS TO DECREASING THE 2370 01:32:21,135 --> 01:32:23,004 LIKELIHOOD OF US HAVING A 2371 01:32:23,070 --> 01:32:24,538 PREMATURE DEATH RELATED TO OUR 2372 01:32:24,605 --> 01:32:26,641 RELATIONSHIP WITH SUBSTANCES, 2373 01:32:26,707 --> 01:32:28,709 AND PERHAPS EVEN THAT WILL SPARK 2374 01:32:28,776 --> 01:32:32,246 SOME HOPE OR INSPIRE US NOT TO 2375 01:32:32,313 --> 01:32:34,081 GIVE UP, AND MOST IMPORTANTLY, 2376 01:32:34,148 --> 01:32:35,950 JUST FEEL -- HELP US TO FEEL 2377 01:32:36,017 --> 01:32:38,920 VALUED AND WORTH SAVING, IN 2378 01:32:38,986 --> 01:32:40,888 THESE SYSTEMS THAT WE'RE SO 2379 01:32:40,955 --> 01:32:42,857 DEHUMANIZED IN, REHUMANIZING US 2380 01:32:42,924 --> 01:32:44,525 HAS GREAT POWER. 2381 01:32:44,592 --> 01:32:45,593 AND I'LL GIVE YOU A VERY QUICK 2382 01:32:45,660 --> 01:32:47,895 EXAMPLE OF THAT. 2383 01:32:47,962 --> 01:32:50,431 MY FRIEND DAVE WORKS IN HARM 2384 01:32:50,498 --> 01:32:52,566 REDUCTION IN THE U.K., AND ONE 2385 01:32:52,633 --> 01:32:54,402 OF HIS FOLKS THAT WOULD FREQUENT 2386 01:32:54,468 --> 01:32:57,038 HIS SERVICES WAS IN THE 2387 01:32:57,104 --> 01:33:00,741 HOSPITAL, SHE WAS DYING, AND HE 2388 01:33:00,808 --> 01:33:02,209 WENT TO VISIT HER, THERE WAS 2389 01:33:02,276 --> 01:33:04,879 NOBODY ELSE TO VISIT HER AT THAT 2390 01:33:04,946 --> 01:33:07,548 TIME, AND SHE WAS IN THE SORT OF 2391 01:33:07,615 --> 01:33:08,849 HOSPITAL WARD IN A CORNER BY 2392 01:33:08,916 --> 01:33:10,051 HERSELF AND THERE'S ALL THIS 2393 01:33:10,117 --> 01:33:11,919 ACTIVITY AND ALL THESE THINGS 2394 01:33:11,986 --> 01:33:13,688 GOING ON AROUND HER WITH OTHER 2395 01:33:13,754 --> 01:33:16,324 PATIENTS AND DOCTORS AND NURSES, 2396 01:33:16,390 --> 01:33:17,425 AND THERE'S EILEEN JUST SITTING 2397 01:33:17,491 --> 01:33:18,893 IN A CORNER ALONE. 2398 01:33:18,960 --> 01:33:21,529 AND DAVE WAS ABLE TO SIT WITH 2399 01:33:21,595 --> 01:33:23,698 HER AND TALK WITH HER AND PLAY 2400 01:33:23,764 --> 01:33:25,366 HER FAVORITE SONGS ON HIS PHONE, 2401 01:33:25,433 --> 01:33:28,769 AND HOLD HER HAND, AND HE STAYED 2402 01:33:28,836 --> 01:33:31,072 WITH HER UNTIL SHE TOOK HER 2403 01:33:31,138 --> 01:33:32,707 FINAL BREATH. 2404 01:33:32,773 --> 01:33:34,141 AND IT MEANT SHE WASN'T ALONE 2405 01:33:34,208 --> 01:33:38,012 WHEN SHE PASSED. 2406 01:33:38,079 --> 01:33:40,281 THAT IS LOVE, THAT IS HARM 2407 01:33:40,348 --> 01:33:41,482 REDUCTION, THAT IS STANDING WITH 2408 01:33:41,549 --> 01:33:43,584 US IN THE GAPS. 2409 01:33:43,651 --> 01:33:47,855 AND SO I HOPE THAT YOU CAN FIND 2410 01:33:47,922 --> 01:33:49,690 WAYS TO BRING THAT INTO YOUR 2411 01:33:49,757 --> 01:33:53,961 WORK AS PROVIDERS. 2412 01:33:54,028 --> 01:34:04,271 SO THANK YOU. 2413 01:34:10,978 --> 01:34:12,380 >> VERY NICE, THANK YOU. 2414 01:34:12,446 --> 01:34:18,919 >> THANK YOU BOTH VERY MUCH FOR 2415 01:34:18,986 --> 01:34:21,222 REALLY EXTRAORDINARILY 2416 01:34:21,288 --> 01:34:24,825 STIMULATING, INFORMATIVE AND 2417 01:34:24,892 --> 01:34:26,994 PASSIONATE DEDICATION TO YOUR 2418 01:34:27,061 --> 01:34:28,529 WORK. 2419 01:34:28,596 --> 01:34:33,134 WE HAVE A SERIES OF QUESTIONS, 2420 01:34:33,200 --> 01:34:37,004 AND IN FACT I HAVE QUITE A FEW, 2421 01:34:37,071 --> 01:34:40,174 SO PLEASE RESPOND, WHOEVER FEELS 2422 01:34:40,241 --> 01:34:44,545 IT'S APPROPRIATE, AND TRY AND 2423 01:34:44,612 --> 01:34:48,249 LIMIT SOMEWHAT YOUR LENGTH OF 2424 01:34:48,315 --> 01:34:53,054 YOUR ANSWERS. 2425 01:34:53,120 --> 01:34:54,355 WE'VE HAD SEVERAL QUESTIONS 2426 01:34:54,422 --> 01:34:58,025 ABOUT HOW THE BRAIN WORKS IN 2427 01:34:58,092 --> 01:35:01,929 TERMS OF HEALING. 2428 01:35:01,996 --> 01:35:05,866 THERE WERE QUESTIONS ABOUT IT'S 2429 01:35:05,933 --> 01:35:07,001 ANECDOTAL THAT THE BRAIN HEALS 2430 01:35:07,068 --> 01:35:10,271 ITSELF. 2431 01:35:10,337 --> 01:35:14,542 SO THAT'S I GUESS A POPULAR 2432 01:35:14,608 --> 01:35:15,609 VERSION. 2433 01:35:15,676 --> 01:35:25,719 IS THAT TRUE, NORA, OR -- AND 2434 01:35:25,786 --> 01:35:28,689 HOW LONG DOES THAT TYPE OF 2435 01:35:28,756 --> 01:35:29,857 PROCESS TAKE? 2436 01:35:29,924 --> 01:35:31,158 >> WIN, I'M HAVING TROUBLE WITH 2437 01:35:31,225 --> 01:35:31,625 MY SOUND. 2438 01:35:31,692 --> 01:35:32,460 CAN YOU HEAR ME? 2439 01:35:32,526 --> 01:35:34,495 >> WE CAN HEAR YOU NICE AND 2440 01:35:34,562 --> 01:35:35,996 CLEAR NOW. 2441 01:35:36,063 --> 01:35:40,935 >> SO WHAT I -- BECAUSE THE 2442 01:35:41,001 --> 01:35:43,671 SOUNDS GO UP AND DOWN SO I HEARD 2443 01:35:43,737 --> 01:35:44,772 SOMETHING ABOUT GAPS, ABOUT THE 2444 01:35:44,839 --> 01:35:45,973 HUMAN BRAIN THAT MAKES IT 2445 01:35:46,040 --> 01:35:48,275 VULNERABLE TO ADDICTION, OR IS 2446 01:35:48,342 --> 01:35:51,679 IT HAPPENING IN OTHER -- WAS 2447 01:35:51,745 --> 01:35:52,480 THAT THE QUESTION? 2448 01:35:52,546 --> 01:35:54,548 >> YES. 2449 01:35:54,615 --> 01:35:56,484 >> THE ANSWER IS NO, IT CAN'T 2450 01:35:56,550 --> 01:35:59,153 HAPPEN IN ANIMALS, AND WE CAN 2451 01:35:59,220 --> 01:36:02,957 ACTUALLY EMULATE THE SAME 2452 01:36:03,023 --> 01:36:07,561 PATTERNS OF COMPULSIVE DRUG USE 2453 01:36:07,628 --> 01:36:09,196 IN ANIMALS, AND JUST LIKE IN 2454 01:36:09,263 --> 01:36:11,599 HUMANS, NOT EVERY ANIMAL GOES 2455 01:36:11,665 --> 01:36:12,600 INTO ESCALATION. 2456 01:36:12,666 --> 01:36:14,335 THERE ARE CERTAIN ANIMALS THAT 2457 01:36:14,401 --> 01:36:17,304 HAVE HIGHER RISK THAN OTHERS. 2458 01:36:17,371 --> 01:36:18,939 AND JUST LIKE HUMANS, ONE OF THE 2459 01:36:19,006 --> 01:36:21,408 WAYS THAT WE CAN MAKE ANIMALS 2460 01:36:21,475 --> 01:36:23,110 ESCALATE INTO DRUG-TAKING IS 2461 01:36:23,177 --> 01:36:25,980 STRESS THEM. 2462 01:36:26,046 --> 01:36:27,047 AND ONE OF THE MAIN STRESSORS 2463 01:36:27,114 --> 01:36:28,549 THAT PRODUCES THERE, THIS IS IN 2464 01:36:28,616 --> 01:36:29,817 LINE WITH WHAT MEGHANN WAS 2465 01:36:29,884 --> 01:36:32,419 SPEAKING, IS ISOLATION. 2466 01:36:32,486 --> 01:36:34,722 SO NO, THERE'S NOTHING UNIQUE 2467 01:36:34,788 --> 01:36:37,691 ABOUT THE HUMAN BRAIN THAT MAKES 2468 01:36:37,758 --> 01:36:40,861 IT SUSCEPTIBLE TO ADDICTION, AND 2469 01:36:40,928 --> 01:36:42,730 IS IT ALSO UNIQUE TO THE HUMAN 2470 01:36:42,796 --> 01:36:45,566 BRAIN THAT MAKES IT SUSCEPTIBLE 2471 01:36:45,633 --> 01:36:46,800 TO STRESS AND ISOLATION. 2472 01:36:46,867 --> 01:36:49,637 SO THIS HAS BEEN VERY HELPFUL, 2473 01:36:49,703 --> 01:36:52,506 THESE ANIMAL MODELS, TO 2474 01:36:52,573 --> 01:36:54,241 UNDERSTAND BECAUSE IN THEM, WE 2475 01:36:54,308 --> 01:36:56,010 CAN STUDY IN MUCH GREATER 2476 01:36:56,076 --> 01:36:58,946 PRECISION THE MOLECULES AND 2477 01:36:59,013 --> 01:37:01,916 NETWORKS THAT ARE ENGAGING THOSE 2478 01:37:01,982 --> 01:37:04,118 BEHAVIORS. 2479 01:37:04,185 --> 01:37:07,154 >> MEGHANN, THERE ARE SEVERAL 2480 01:37:07,221 --> 01:37:11,892 INQUIRIES ABOUT YOUR WONDERFUL 2481 01:37:11,959 --> 01:37:12,326 PRESENTATION. 2482 01:37:12,393 --> 01:37:15,596 THEY ALL BOIL DOWN TO HOW DO I 2483 01:37:15,663 --> 01:37:25,005 AS AN INDIVIDUAL GET INVOLVED IN 2484 01:37:25,072 --> 01:37:26,440 THE PROCESS THAT YOU SO 2485 01:37:26,507 --> 01:37:29,176 PASSIONATELY DESCRIBED? 2486 01:37:29,243 --> 01:37:30,711 WHAT CAN -- THIS IS WHAT MANY 2487 01:37:30,778 --> 01:37:31,912 PEOPLE ASK. 2488 01:37:31,979 --> 01:37:33,447 WHAT CAN I DO? 2489 01:37:33,514 --> 01:37:36,650 YOU LIST ALL THE REQUIREMENTS IN 2490 01:37:36,717 --> 01:37:40,788 A WAY, THE GOALS, BUT YOU ALSO 2491 01:37:40,854 --> 01:37:44,825 POINTED OUT THAT SORT OF 2492 01:37:44,892 --> 01:37:47,661 NATIONAL PROGRAMS AND OTHERS 2493 01:37:47,728 --> 01:37:49,763 AREN'T THE ANSWER, AT LEAST PART 2494 01:37:49,830 --> 01:37:51,298 OF THE ANSWER, BUT NOT THE WHOLE 2495 01:37:51,365 --> 01:37:53,400 ANSWER. 2496 01:37:53,467 --> 01:37:55,336 SO WHAT DO YOU ADVISE PEOPLE? 2497 01:37:55,402 --> 01:37:58,339 WHAT COULD THEY ACTUALLY DO, ALL 2498 01:37:58,405 --> 01:38:04,912 OF US, TO HELP IN THIS PROCESS? 2499 01:38:04,979 --> 01:38:07,648 >> I'LL TRY TO BE COU CONCISE AT 2500 01:38:07,715 --> 01:38:08,716 THAT BECAUSE THERE ARE A LOT OF 2501 01:38:08,782 --> 01:38:10,251 THINGS I COULD SAY, BUT YOU 2502 01:38:10,317 --> 01:38:13,120 KNOW, OUR WELLNESS IS REALLY 2503 01:38:13,187 --> 01:38:14,555 COMMUNITY-BASED, AND SO I THINK 2504 01:38:14,622 --> 01:38:16,523 IT'S IMPORTANT TO LOOK AT -- 2505 01:38:16,590 --> 01:38:18,626 THAT WE GET WELL NOT IN 2506 01:38:18,692 --> 01:38:22,096 ISOLATION OR NOT IN ONE SINGLE 2507 01:38:22,162 --> 01:38:23,430 WAY, OR, YOU KNOW, IT'S RARE 2508 01:38:23,497 --> 01:38:24,798 THAT, YOU KNOW, I'M GOING TO GO 2509 01:38:24,865 --> 01:38:25,966 TO THIS ONE THING AND IT'S GOING 2510 01:38:26,033 --> 01:38:28,269 TO BE MIRACULOUS AND NOW I'M 2511 01:38:28,335 --> 01:38:28,936 BETTER. 2512 01:38:29,003 --> 01:38:30,571 SO LOOKING AT WHAT ARE THE WAYS 2513 01:38:30,638 --> 01:38:33,440 THAT WE CAN INTEGRATE THINGS 2514 01:38:33,507 --> 01:38:34,842 THAT ARE -- THAT PROMOTE 2515 01:38:34,908 --> 01:38:37,278 WELLNESS FOR PEOPLE, REGARDLESS 2516 01:38:37,344 --> 01:38:39,146 OF THEIR RELATIONSHIP WITH 2517 01:38:39,213 --> 01:38:39,613 SUBSTANCES. 2518 01:38:39,680 --> 01:38:41,148 YOU KNOW, WHERE CAN WE SORT OF 2519 01:38:41,215 --> 01:38:44,918 PLANT ALL OF THOSE THINGS IN OUR 2520 01:38:44,985 --> 01:38:45,619 COMMUNITIES. 2521 01:38:45,686 --> 01:38:49,757 AND THE PEER BASED MODEL AND 2522 01:38:49,823 --> 01:38:51,191 SORT OF HARM REDUCTION CENTERS 2523 01:38:51,258 --> 01:38:52,626 ARE LOOKING AT THIS IDEA OF WE 2524 01:38:52,693 --> 01:38:53,761 NEED SAFE PLACES FOR PEOPLE TO 2525 01:38:53,827 --> 01:38:57,731 LAND AND TO FEEL WELCOMED. 2526 01:38:57,798 --> 01:38:59,700 I THINK CERTAINLY THE PEER 2527 01:38:59,767 --> 01:39:01,568 MODEL, IF THAT IS MORE 2528 01:39:01,635 --> 01:39:02,469 SPECIFICALLY WHAT PEOPLE ARE 2529 01:39:02,536 --> 01:39:06,507 INTERESTED IN, THERE IS SO MUCH 2530 01:39:06,573 --> 01:39:07,408 TRAINING AVAILABLE IF YOU WANT 2531 01:39:07,474 --> 01:39:09,076 TO GET TRAINED IN THE PEER 2532 01:39:09,143 --> 01:39:12,146 MODEL, AND I ALWAYS ENCOURAGE 2533 01:39:12,212 --> 01:39:13,447 PEOPLE, I DON'T CARE WHAT 2534 01:39:13,514 --> 01:39:15,082 DISCIPLINE OR WHAT RELATIONSHIP 2535 01:39:15,149 --> 01:39:19,353 YOU HAVE TO THE CHALLENGE OF 2536 01:39:19,420 --> 01:39:21,889 SUBSTANCE USE AND OF OVERDOSE 2537 01:39:21,955 --> 01:39:24,091 DEATHS. 2538 01:39:24,158 --> 01:39:26,293 GETTING TRAINED IN THAT PEER 2539 01:39:26,360 --> 01:39:27,528 MODEL WILL INFORM ALL THE REST 2540 01:39:27,594 --> 01:39:28,696 OF YOUR WORK AND IT WILL CHANGE 2541 01:39:28,762 --> 01:39:30,564 HOW YOU TREAT PEOPLE, HOW YOU 2542 01:39:30,631 --> 01:39:32,099 ENGAGE WITH PEOPLE, SO I THINK 2543 01:39:32,166 --> 01:39:35,436 THE ENGAGEMENT PIECE IS REALLY 2544 01:39:35,502 --> 01:39:37,071 CRITICAL OF TRYING TO LET GO OF 2545 01:39:37,137 --> 01:39:40,774 THOSE BIASES AND WORK AGAINST 2546 01:39:40,841 --> 01:39:42,443 DISCRIMINATION AND WELCOME 2547 01:39:42,509 --> 01:39:45,612 PEOPLE AND ENGAGE WITH THEM AS 2548 01:39:45,679 --> 01:39:47,581 EQUALS IS REALLY, REALLY 2549 01:39:47,648 --> 01:39:48,615 CRITICAL. 2550 01:39:48,682 --> 01:39:50,784 >> THE RECOMMENDATION IS TO BE 2551 01:39:50,851 --> 01:39:55,389 AWARE OF THE COMMUNITY 2552 01:39:55,456 --> 01:39:57,024 FACILITIES, ORGANIZATIONS AND SO 2553 01:39:57,091 --> 01:39:58,726 FORTH, IN YOUR PARTICULAR PART 2554 01:39:58,792 --> 01:40:03,263 OF THE WORLD, AND WORK WITH 2555 01:40:03,330 --> 01:40:03,464 THEM. 2556 01:40:03,530 --> 01:40:04,031 IS THAT -- 2557 01:40:04,098 --> 01:40:05,566 >> YEAH, ABSOLUTELY. 2558 01:40:05,632 --> 01:40:08,202 AND I THINK EVEN JUST AS AN 2559 01:40:08,268 --> 01:40:08,769 EXAMPLE, THERE'S 21 MILLION 2560 01:40:08,836 --> 01:40:11,805 PEOPLE THAT HAVE DIAGNOSABLE 2561 01:40:11,872 --> 01:40:13,474 SUBSTANCE USE DISORDER, IF 2562 01:40:13,540 --> 01:40:16,677 THAT'S THE LANGUAGE THAT -- OR 2563 01:40:16,744 --> 01:40:17,444 PROBLEMATIC SUBSTANCE USE, AND 2564 01:40:17,511 --> 01:40:21,248 THERE'S ONLY 3,000 BOARD 2565 01:40:21,315 --> 01:40:22,349 CERTIFIED PHYSICIANS. 2566 01:40:22,416 --> 01:40:24,785 THERE'S A HUGE GAP THERE. 2567 01:40:24,852 --> 01:40:26,220 SO, YOU KNOW, IF YOU'RE LOOKING 2568 01:40:26,286 --> 01:40:27,187 FOR SOMETHING THAT'S SORT OF 2569 01:40:27,254 --> 01:40:28,822 MORE IN YOUR DOMAIN, RESEARCH IS 2570 01:40:28,889 --> 01:40:34,461 A WHOLE 'NOTHER PIECE TOO OF 2571 01:40:34,528 --> 01:40:35,863 JUST LITERALLY GETTING MORE 2572 01:40:35,929 --> 01:40:37,297 TRAINING, MORE INFORMATION, AND 2573 01:40:37,364 --> 01:40:39,299 KNOWING THAT A LOT OF THE WORK 2574 01:40:39,366 --> 01:40:40,601 THAT'S BEING DONE IS BEING DONE 2575 01:40:40,667 --> 01:40:41,935 JUST IN THE COMMUNITY AND NOT 2576 01:40:42,002 --> 01:40:47,207 INSIDE ALL OF OUR SYSTEMS. 2577 01:40:47,274 --> 01:40:48,709 THERE'S NO ONE NICE EASY CLEAN 2578 01:40:48,776 --> 01:40:50,344 ANSWER BUT START LISTENING TO 2579 01:40:50,411 --> 01:40:51,578 FOLKS AND ASKING QUESTIONS IN 2580 01:40:51,645 --> 01:40:53,547 THE COMMUNITY. 2581 01:40:53,614 --> 01:40:55,382 >> SO RELATED TO THAT, NORA, 2582 01:40:55,449 --> 01:40:57,818 THERE ARE SEVERAL QUESTIONS 2583 01:40:57,885 --> 01:40:59,019 ABOUT -- MAYBE YOU BOTH CAN 2584 01:40:59,086 --> 01:40:59,486 RESPOND. 2585 01:40:59,553 --> 01:41:01,221 ARE WE DEALING WITH AN EPIDEMIC 2586 01:41:01,288 --> 01:41:02,990 OR ARE WE DEALING WITH A 2587 01:41:03,056 --> 01:41:04,725 PANDEMIC? 2588 01:41:04,792 --> 01:41:07,294 IS THIS A DISORDER PRIMARILY OF 2589 01:41:07,361 --> 01:41:11,999 THE SO-CALLED DEVELOPED WORLD? 2590 01:41:12,065 --> 01:41:15,035 >> NO, NO, NO, ADDICTION AS SUCH 2591 01:41:15,102 --> 01:41:16,570 IS NOT A DISORDER OF THE FIRST 2592 01:41:16,637 --> 01:41:17,805 WORLD, AND YOU SEE SERIOUS 2593 01:41:17,871 --> 01:41:21,175 PROBLEMS OF ADDICTION IN 2594 01:41:21,241 --> 01:41:23,610 COUNTRIES THAT ARE IN THE WAYS 2595 01:41:23,677 --> 01:41:24,711 OF DEVELOPMENT ALL OVER, 2596 01:41:24,778 --> 01:41:26,914 INCLUDING AFRICA. 2597 01:41:26,980 --> 01:41:29,416 THE NATURE OF THE PROBLEM VARIES 2598 01:41:29,483 --> 01:41:31,518 SIGNIFICANTLY, BUT BEING POOR AS 2599 01:41:31,585 --> 01:41:32,820 A COUNTRY DOES NOT PROTECT YOU 2600 01:41:32,886 --> 01:41:34,354 IN ANY WAY. 2601 01:41:34,421 --> 01:41:36,657 YOU TEND TO SEE SUBSTANCES THAT 2602 01:41:36,723 --> 01:41:38,325 ARE MUCH MORE ACCESSIBLE, LIKE 2603 01:41:38,392 --> 01:41:40,527 FOR EXAMPLE, IN MEXICO AND IN 2604 01:41:40,594 --> 01:41:42,596 BRAZIL, YOU SEE PROBLEMS WITH 2605 01:41:42,663 --> 01:41:44,031 INHALANTS THAT ARE VERY, VERY 2606 01:41:44,097 --> 01:41:47,768 TOXIC TO THE BRAIN BECAUSE THEY 2607 01:41:47,835 --> 01:41:50,938 ARE ACCESSIBLE. 2608 01:41:51,004 --> 01:41:52,573 AND IN THE UNITED STATES, WHERE 2609 01:41:52,639 --> 01:41:53,707 THERE ARE MORE RESOURCES, PEOPLE 2610 01:41:53,774 --> 01:41:56,343 CAN PAY FOR COCAINE AND THAT 2611 01:41:56,410 --> 01:42:00,614 ACTUALLY HAS HELPED -- WE'RE 2612 01:42:00,681 --> 01:42:02,616 TARGETED BY THE DRUG DEALERS 2613 01:42:02,683 --> 01:42:03,817 WITH THE SENSE THAT PEOPLE WILL 2614 01:42:03,884 --> 01:42:07,087 HAVE RESOURCES TO BUY THEM. 2615 01:42:07,154 --> 01:42:10,958 I WAS ACTUALLY -- BUT LET ME -- 2616 01:42:11,024 --> 01:42:12,926 WHAT HAS BEEN INTRIGUING TO ME 2617 01:42:12,993 --> 01:42:15,562 AND I'VE BEEN MONITORING IT IS 2618 01:42:15,629 --> 01:42:17,764 THE EPIDEMIC OF FENTANYL. 2619 01:42:17,831 --> 01:42:21,768 SO -- AND THAT IS THE QUESTION 2620 01:42:21,835 --> 01:42:25,506 BECAUSE IT'S SUCH A HIGH, HIGH 2621 01:42:25,572 --> 01:42:26,974 PROFITABLE DRUG, SO FOR THE 2622 01:42:27,040 --> 01:42:28,509 DEALERS AND SO ADDICTIVE THAT 2623 01:42:28,575 --> 01:42:30,377 YOU SAY, WELL, IT'S GOING TO 2624 01:42:30,444 --> 01:42:31,578 EXPAND INTO OTHER AREAS OF THE 2625 01:42:31,645 --> 01:42:32,012 WORLD. 2626 01:42:32,079 --> 01:42:34,147 AND WE SEE A SERIOUS PROBLEM 2627 01:42:34,214 --> 01:42:36,750 ALSO IN CANADA, PARTICULARLY IN 2628 01:42:36,817 --> 01:42:39,486 THE WEST, IN VANCOUVER, THAT IS 2629 01:42:39,553 --> 01:42:42,823 AS BAD AS OURS, AND WE SEE IN 2630 01:42:42,890 --> 01:42:45,425 VANCOUVER IN SOME OF THE CITIES 2631 01:42:45,492 --> 01:42:46,560 MOST AFFECTED IN THE COUNTRY, 2632 01:42:46,627 --> 01:42:48,662 BUT WE ALSO ARE STARTING TO SEE 2633 01:42:48,729 --> 01:42:50,030 IT AND IT STARTED TO BE REPORTED 2634 01:42:50,097 --> 01:42:52,933 IN THE BORDER TOWNS IN MEXICO. 2635 01:42:53,000 --> 01:42:54,468 AND -- BUT -- AND I ACTUALLY 2636 01:42:54,535 --> 01:42:56,570 HAVE BEEN -- I HAVE CONNECTIONS 2637 01:42:56,637 --> 01:42:58,305 AND COLLABORATIONS WITH PEOPLE 2638 01:42:58,372 --> 01:43:00,207 IN VARIOUS COUNTRIES IN THE 2639 01:43:00,274 --> 01:43:01,608 WORLD AND OVERALL, THERE HAVE 2640 01:43:01,675 --> 01:43:05,045 BEEN INSTANCES ABSOLUTELY OF 2641 01:43:05,112 --> 01:43:06,580 PRESENCE OF FENTANYL IN ENGLAND 2642 01:43:06,647 --> 01:43:09,149 IN SOME OF THE NORTHERN EUROPEAN 2643 01:43:09,216 --> 01:43:11,718 COUNTRIES, BUT IT'S MUCH MORE 2644 01:43:11,785 --> 01:43:13,787 RESTRICTIVE. 2645 01:43:13,854 --> 01:43:15,689 AND WHERE WILL IT GO, I DO NOT 2646 01:43:15,756 --> 01:43:15,889 KNOW. 2647 01:43:15,956 --> 01:43:18,992 I THINK THAT THESE MARKETS ARE 2648 01:43:19,059 --> 01:43:21,929 DRIVEN BY PROFITS, AND IF WE 2649 01:43:21,995 --> 01:43:23,196 SATURATE, IF THEY SATURATE THE 2650 01:43:23,263 --> 01:43:29,202 MARKET IN THE UNITED STATES, 2651 01:43:29,269 --> 01:43:30,504 THEN I AM AFRAID WE'LL START TO 2652 01:43:30,571 --> 01:43:32,039 SEE IT IN OTHER COUNTRIES. 2653 01:43:32,105 --> 01:43:36,343 BUT AS OF NOW, IT IS PRETOM 2654 01:43:36,410 --> 01:43:38,045 PREDOMINANTLY CONCENTRATED IN 2655 01:43:38,111 --> 01:43:39,913 NORTH AMERICA, FOR FENTANYL. 2656 01:43:39,980 --> 01:43:42,282 BUT AS I SAY, ADDICTIONS ARE 2657 01:43:42,349 --> 01:43:42,716 EVERYWHERE. 2658 01:43:42,783 --> 01:43:45,686 ALCOHOL, TOBACCO, HEROIN, 2659 01:43:45,752 --> 01:43:46,386 CANNABIS. 2660 01:43:46,453 --> 01:43:50,757 AND THE PREVALENCE RATES VARY BY 2661 01:43:50,824 --> 01:43:52,392 COUNTRIES, AND WORLD HEALTH 2662 01:43:52,459 --> 01:43:54,895 ORGANIZATION MONITORS 2663 01:43:54,962 --> 01:43:57,331 PERIODICALLY THE DIFFERENCES IN 2664 01:43:57,397 --> 01:43:58,532 PREVALENCE FOR THE USE OF THESE 2665 01:43:58,599 --> 01:44:02,102 DRUGS, AND IN GENERAL, THE 2666 01:44:02,169 --> 01:44:02,936 UNITED STATES TEND TO HAVE 2667 01:44:03,003 --> 01:44:04,271 HIGHER RATES OF DRUG USE THAN 2668 01:44:04,338 --> 01:44:06,139 OTHER COUNTRIES, UNITED STATES 2669 01:44:06,206 --> 01:44:08,108 AND CANADA. 2670 01:44:08,175 --> 01:44:08,642 IN GENERAL. 2671 01:44:08,709 --> 01:44:13,814 BUT COMING TO ALCOHOL, AND 2672 01:44:13,880 --> 01:44:14,815 CIGARETTES, AS YOU KNOW, 2673 01:44:14,881 --> 01:44:15,582 ANYTHING TEEN SMOKING HAS BEEN 2674 01:44:15,649 --> 01:44:17,217 GOING DOWN IN OUR COUNTRY, 2675 01:44:17,284 --> 01:44:18,685 WHEREAS IT'S VERY HIGH IN 2676 01:44:18,752 --> 01:44:20,554 COUNTRIES LIKE CHINA. 2677 01:44:20,621 --> 01:44:23,924 SO NO, IT'S NO PROTECTION. 2678 01:44:23,991 --> 01:44:26,393 IT CHANGES THE DRUGS THAT PEOPLE 2679 01:44:26,460 --> 01:44:26,627 ACCESS. 2680 01:44:26,693 --> 01:44:28,228 >> ARE THERE LESSONS THAT WE CAN 2681 01:44:28,295 --> 01:44:30,097 LEARN FROM WHAT'S HAPPENING IN 2682 01:44:30,163 --> 01:44:33,200 OTHER COUNTRIES? 2683 01:44:33,266 --> 01:44:33,867 >> ABSOLUTELY. 2684 01:44:33,934 --> 01:44:35,736 I THINK THAT IT'S VERY 2685 01:44:35,802 --> 01:44:37,270 IMPORTANT, BECAUSE -- I MEAN, 2686 01:44:37,337 --> 01:44:42,009 AND AS -- AND AGAIN, I MEAN, AS 2687 01:44:42,075 --> 01:44:43,443 MEGHANN WAS SPEAKING, WE HAVE 2688 01:44:43,510 --> 01:44:47,147 POLICIES THAT WE HAVE IN OUR 2689 01:44:47,214 --> 01:44:49,249 COUNTRY THAT ARE PRODUCING MORE 2690 01:44:49,316 --> 01:44:50,450 HARM THAN GOOD, AND BEING ABLE 2691 01:44:50,517 --> 01:44:51,752 TO LEARN FROM EXPERIENCES IN 2692 01:44:51,818 --> 01:44:53,620 OTHER COUNTRIES THAT HAVE 2693 01:44:53,687 --> 01:44:57,491 DISTINCT POLICIES CAN ACTUALLY 2694 01:44:57,557 --> 01:44:58,825 HELP US COME UP WITH 2695 01:44:58,892 --> 01:44:59,359 ALTERNATIVES. 2696 01:44:59,426 --> 01:45:01,328 THIS HAS BECOME CENTRALIZED AND 2697 01:45:01,395 --> 01:45:02,929 EXTREMELY CONTROVERSIAL WHEN IT 2698 01:45:02,996 --> 01:45:05,198 COMES, FOR EXAMPLE, WITH 2699 01:45:05,265 --> 01:45:06,600 CANNABIS, MARIJUANA. 2700 01:45:06,667 --> 01:45:09,069 MARIJUANA PRODUCES ADDICTION. 2701 01:45:09,136 --> 01:45:10,737 BUT IT MUCH LESS ADDICTIVE THAN 2702 01:45:10,804 --> 01:45:12,806 MANY OTHER DRUGS, AND IT'S LESS 2703 01:45:12,873 --> 01:45:13,340 TOXIC. 2704 01:45:13,407 --> 01:45:15,275 IT DOES NOT MEAN THAT IT DOES 2705 01:45:15,342 --> 01:45:16,576 NOT PRODUCE HARM. 2706 01:45:16,643 --> 01:45:18,345 IT ABSOLUTELY PRODUCES HARM AND 2707 01:45:18,412 --> 01:45:20,180 IT DOES PRODUCE ADDICTION, BUT 2708 01:45:20,247 --> 01:45:21,548 IF YOU COMPARE IT WITH OTHER 2709 01:45:21,615 --> 01:45:23,417 DRUGS, IT'S ACTUALLY MUCH LESS 2710 01:45:23,483 --> 01:45:24,317 DANGEROUS. 2711 01:45:24,384 --> 01:45:28,588 THE AND THE WAY THAT COUNTRIES 2712 01:45:28,655 --> 01:45:30,023 HAVE BEEN DEALING WITH MARIJUANA 2713 01:45:30,090 --> 01:45:31,758 HAS VARIED SIGNIFICANTLY, AND WE 2714 01:45:31,825 --> 01:45:34,761 KNOW ALL ALONG, FOR EXAMPLE, 2715 01:45:34,828 --> 01:45:36,296 THAT IN THE NETHERLANDS, WHERE 2716 01:45:36,363 --> 01:45:37,264 MARIJUANA IS LEGAL, YOU HAVE 2717 01:45:37,330 --> 01:45:38,932 SOME OF THE LOWEST RATES OF 2718 01:45:38,999 --> 01:45:40,233 MARIJUANA CONSUMPTION IN THAT 2719 01:45:40,300 --> 01:45:41,802 POPULATION. 2720 01:45:41,868 --> 01:45:43,970 WE KNOW THAT, FOR EXAMPLE, 2721 01:45:44,037 --> 01:45:45,539 PORTUGAL, WHICH ALSO LEGALIZED 2722 01:45:45,605 --> 01:45:47,407 ALL OF THOSE DRUGS, 2723 01:45:47,474 --> 01:45:49,810 SIGNIFICANTLY REDUCED THE 2724 01:45:49,876 --> 01:45:52,746 ADVERSE EFFECTS OF THESE DRUGS, 2725 01:45:52,813 --> 01:45:57,217 AND WAS ABLE TO CONTROL IT. 2726 01:45:57,284 --> 01:45:58,518 AND WHAT DO WE LEARN FROM IT? 2727 01:45:58,585 --> 01:46:01,788 I WANT TO HIGHLIGHT, IS THAT 2728 01:46:01,855 --> 01:46:03,123 WHEN THEY DID LEGALIZATION, THEY 2729 01:46:03,190 --> 01:46:06,626 DID IT WITH A PARALLEL GROWTH 2730 01:46:06,693 --> 01:46:07,961 AND ACCESS TO TREATMENT. 2731 01:46:08,028 --> 01:46:09,496 SO IT'S NOT JUST THAT YOU 2732 01:46:09,563 --> 01:46:11,264 LEGALIZE, BUT YOU PROVIDE THE 2733 01:46:11,331 --> 01:46:12,466 STRUCTURE THAT CAN HELP PEOPLE 2734 01:46:12,532 --> 01:46:13,900 ACTUALLY GET TO TREATMENT. 2735 01:46:13,967 --> 01:46:17,070 AND THAT SUPPORT SYSTEMS THAT A 2736 01:46:17,137 --> 01:46:20,107 PERSON REQUIRES TO THEN BE -- TO 2737 01:46:20,173 --> 01:46:21,842 GO TO TREATMENT AND TO ACHIEVE 2738 01:46:21,908 --> 01:46:22,242 RECOVERY. 2739 01:46:22,309 --> 01:46:24,811 AND THOSE ARE SOCIAL STRUCTURAL 2740 01:46:24,878 --> 01:46:26,213 SYSTEMS THAT PROTECTS THEM 2741 01:46:26,279 --> 01:46:28,181 AGAINST DISCRIMINATION, THAT 2742 01:46:28,248 --> 01:46:29,816 PROTECTS THEM AGAINST ISOLATION, 2743 01:46:29,883 --> 01:46:32,152 THAT GIVES THEM OPPORTUNITIES. 2744 01:46:32,219 --> 01:46:34,121 BECAUSE OTHERWISE, THE ONLY 2745 01:46:34,187 --> 01:46:36,056 CHOICE THEY MAY HAVE IS, IN 2746 01:46:36,123 --> 01:46:38,291 ORDER TO SURVIVE THEIR REALITY, 2747 01:46:38,358 --> 01:46:39,359 IS TO TAKE DRUGS. 2748 01:46:39,426 --> 01:46:42,729 AND I THINK VERY MUCH THAT WHOLE 2749 01:46:42,796 --> 01:46:45,799 NOTION OF HOW DO WE CHANGE THEIR 2750 01:46:45,866 --> 01:46:46,867 CONDITION SO THAT THEY DON'T 2751 01:46:46,933 --> 01:46:49,770 HAVE TO ESCAPE, AS MEGHANN WAS 2752 01:46:49,836 --> 01:46:54,007 SAYING, BUT THEY ACTUALLY CAN 2753 01:46:54,074 --> 01:46:55,442 CHOOSE TO RECOVER AND FLOURISH, 2754 01:46:55,509 --> 01:46:57,344 I THINK THAT'S WHAT WE CAN LEARN 2755 01:46:57,410 --> 01:46:59,880 FROM SOME OTHER COUNTRIES. 2756 01:46:59,946 --> 01:47:01,615 AND SOME HAVE DONE IT QUITE 2757 01:47:01,681 --> 01:47:02,482 WELL. 2758 01:47:02,549 --> 01:47:04,684 BUT WE ARE STILL QUITE FAR 2759 01:47:04,751 --> 01:47:06,086 BEHIND. 2760 01:47:06,153 --> 01:47:07,788 >> MEGHANN, WHAT IS YOUR FEELING 2761 01:47:07,854 --> 01:47:12,492 ABOUT THAT PROBLEM? 2762 01:47:12,559 --> 01:47:15,662 >> I THINK I AGREE, MANY WOULD 2763 01:47:15,729 --> 01:47:17,564 ARGUE THAT CRIMINALIZATION IS 2764 01:47:17,631 --> 01:47:19,966 ACTUALLY WHAT DRIVES MOST OF THE 2765 01:47:20,033 --> 01:47:23,570 HARM RELATED TO SUBSTANCE USE, 2766 01:47:23,637 --> 01:47:25,939 AND ONE WAY TO SORT OF LOOK AT 2767 01:47:26,006 --> 01:47:27,574 THE CONTEXT LIKE DR. VOLKOV WAS 2768 01:47:27,641 --> 01:47:32,279 JUST REFERRING TO IS THAT IT'S 2769 01:47:32,345 --> 01:47:33,647 ACTUALLY IF WE KIND OF DECENTER 2770 01:47:33,713 --> 01:47:36,783 THE SUBSTANCE ITSELF AND LOOK AT 2771 01:47:36,850 --> 01:47:39,419 ALL OF WHAT IS GOING ON THAT'S 2772 01:47:39,486 --> 01:47:40,520 DRIVING SUBSTANCE USE, THAT WE 2773 01:47:40,587 --> 01:47:44,057 MIGHT BE MUCH MORE EFFECTIVE IN 2774 01:47:44,124 --> 01:47:46,159 ADDRESSING THE HARMS THAT ARE 2775 01:47:46,226 --> 01:47:47,694 CAUSED BY SUBSTANCE USE, BY 2776 01:47:47,761 --> 01:47:49,362 PROBLEMATIC RELATIONSHIPS WITH 2777 01:47:49,429 --> 01:47:50,997 SUBSTANCES, AND SO, YOU KNOW, AN 2778 01:47:51,064 --> 01:47:56,303 EXAMPLE LI LIKE PORTUGAL WHERE Y 2779 01:47:56,369 --> 01:47:58,271 DECRIMINALIZED AND ADDED IN 2780 01:47:58,338 --> 01:48:00,507 OTHER TYPES OF SOCIAL SERVICES 2781 01:48:00,574 --> 01:48:02,442 IS A GREAT MODEL. 2782 01:48:02,509 --> 01:48:04,544 AND THE RESULTS HAVE BEEN GOOD. 2783 01:48:04,611 --> 01:48:08,048 AND SO IF WE CAN KIND OF -- YOU 2784 01:48:08,114 --> 01:48:09,783 KNOW, I KNOW WE'RE HERE -- THIS 2785 01:48:09,850 --> 01:48:12,686 IS ABOUT FENTANYL, AND IN MY 2786 01:48:12,752 --> 01:48:16,857 PERCEPTION, IT'S ABOUT A CRISIS 2787 01:48:16,923 --> 01:48:18,825 OF SUBSTANCE-RELATED DEATHS THAT 2788 01:48:18,892 --> 01:48:20,961 ARE INDICATIVE OF MUCH BIGGER 2789 01:48:21,027 --> 01:48:21,928 PROBLEMS THAT WE HAVE. 2790 01:48:21,995 --> 01:48:23,597 AND SO IF WE'RE ALWAYS 2791 01:48:23,663 --> 01:48:24,898 HYPERFOCUSED ON THIS SUBSTANCE 2792 01:48:24,965 --> 01:48:28,134 IS BAD, WE'RE MISSING SO MUCH OF 2793 01:48:28,201 --> 01:48:30,403 THE CONTEXT OF WHAT ACTUALLY IS 2794 01:48:30,470 --> 01:48:33,707 GOING ON AND IS DRIVING DEATHS. 2795 01:48:33,773 --> 01:48:36,042 >> THERE HAVE BEEN A WHOLE 2796 01:48:36,109 --> 01:48:40,513 SERIES OF QUESTIONS DEALING WITH 2797 01:48:40,580 --> 01:48:43,683 OTHER DRUGS, EITHER THOSE THAT 2798 01:48:43,750 --> 01:48:46,019 ARE ALLEGED TO BE BENEFICIAL 2799 01:48:46,086 --> 01:48:50,390 LIKE, FOR EXAMPLE, THE NEW 2800 01:48:50,457 --> 01:48:53,260 PEPTIDE WEIGHT REDUCTION 2801 01:48:53,326 --> 01:48:54,361 MEDICATIONS, AND TO THOSE THAT 2802 01:48:54,427 --> 01:48:57,697 PEOPLE HAVE ASKED WHETHER 2803 01:48:57,764 --> 01:48:59,666 CONCOMITANT EXPOSURE MAKES 2804 01:48:59,733 --> 01:49:05,872 THINGS WORSE, THINGS LIKE 2805 01:49:05,939 --> 01:49:14,014 ALCOHOL, MARIJUANA, OTHER, AND 2806 01:49:14,080 --> 01:49:14,948 KETAMINE WAS THE OTHER ONE THAT 2807 01:49:15,015 --> 01:49:15,849 WAS MENTIONED. 2808 01:49:15,916 --> 01:49:19,352 SO WE'VE GOT TWO ISSUES HERE. 2809 01:49:19,419 --> 01:49:21,388 ONE IS WHETHER TWO POISONS ARE 2810 01:49:21,454 --> 01:49:26,860 MORE DAMAGED TH SOME OF THEIR 2811 01:49:26,927 --> 01:49:27,294 EFFECTS. 2812 01:49:27,360 --> 01:49:32,132 ARE THESE ISSUES TO WORRY ABOUT? 2813 01:49:32,198 --> 01:49:35,101 AND ALSO ARE THERE BENEFICIAL 2814 01:49:35,168 --> 01:49:38,838 DRUGS BESIDES NALOXONE SUCH AS 2815 01:49:38,905 --> 01:49:40,573 THE REPORTS WITH THE WEIGHT 2816 01:49:40,640 --> 01:49:42,375 REDUCTION PILLS? 2817 01:49:42,442 --> 01:49:45,345 SO NORA, YOU WANT TO START WITH 2818 01:49:45,412 --> 01:49:46,146 THAT? 2819 01:49:46,212 --> 01:49:49,382 >> I WOULD SAY THAT WHETHER 2820 01:49:49,449 --> 01:49:51,384 COMBINATION OF DRUGS HAS HARMFUL 2821 01:49:51,451 --> 01:49:54,888 OR LESS HARMFUL EFFECT WILL 2822 01:49:54,955 --> 01:49:56,089 DEPEND SPECIFICALLY ON THE TYPE 2823 01:49:56,156 --> 01:49:56,556 OF COMBINATION. 2824 01:49:56,623 --> 01:49:59,693 FOR EXAMPLE, WE'RE SEEING VERY, 2825 01:49:59,759 --> 01:50:01,928 VERY FREQUENTLY -- AT LEAST 60% 2826 01:50:01,995 --> 01:50:05,332 OF PEOPLE THAT HAVE -- THAT ARE 2827 01:50:05,398 --> 01:50:09,202 IN TREATMENT PROGRAMS WITH 2828 01:50:09,269 --> 01:50:12,806 FENTANYL, 60% ALSO TAKE 2829 01:50:12,872 --> 01:50:15,241 CANNABIS, AND THE DATA SEEMS TO 2830 01:50:15,308 --> 01:50:17,510 AT LEAST PRIM NARELY INDICATE 2831 01:50:17,577 --> 01:50:19,245 WITH CONSUMPTION OF CANNABIS 2832 01:50:19,312 --> 01:50:20,747 ALLOWS THEM TO REDUCE THE AMOUNT 2833 01:50:20,814 --> 01:50:21,848 OF FENTANYL THAT THEY TAKE. 2834 01:50:21,915 --> 01:50:23,016 SO IN THAT RESPECT, YOU WOULD 2835 01:50:23,083 --> 01:50:26,252 SAY THAT IS A BENEFICIAL EFFECT, 2836 01:50:26,319 --> 01:50:28,121 BECAUSE FENTANYL IS SUCH A 2837 01:50:28,188 --> 01:50:28,989 DANGEROUS DRUG THAT ANYTHING 2838 01:50:29,055 --> 01:50:31,558 THAT YOU CAN DO TO REDUCE THE 2839 01:50:31,624 --> 01:50:33,727 DOSES THAT YOU'RE GOING TO GET 2840 01:50:33,793 --> 01:50:35,829 EXPOSED TO WOULD ACTUALLY HAVE A 2841 01:50:35,895 --> 01:50:37,731 NET BENEFICIAL EFFECT OF 2842 01:50:37,797 --> 01:50:38,932 PROTECTING YOU, LOWERING YOUR 2843 01:50:38,999 --> 01:50:40,133 RISK FOR OVERDOSE. 2844 01:50:40,200 --> 01:50:43,303 SO THIS IS AN EXAMPLE WHERE IT 2845 01:50:43,370 --> 01:50:46,072 COULD HAVE A VALUABLE EFFECT. 2846 01:50:46,139 --> 01:50:48,475 WHEN WE ARE DEALING WITH LIKE, 2847 01:50:48,541 --> 01:50:49,809 FOR EXAMPLE, COMBINATION OF 2848 01:50:49,876 --> 01:50:52,379 NICOTINE SMOKING AND CANNABIS 2849 01:50:52,445 --> 01:50:53,680 SMOKING, OVERALL THE EVIDENCE 2850 01:50:53,747 --> 01:50:55,315 SEAMS TO SHOW -- AND AGAIN, IT 2851 01:50:55,382 --> 01:50:56,783 ALSO DEPENDS ON WHAT SYSTEM YOU 2852 01:50:56,850 --> 01:50:58,318 ARE LOOKING AT. 2853 01:50:58,385 --> 01:51:01,388 IN THAT CASE, THE DATA HAVE 2854 01:51:01,454 --> 01:51:04,791 SHOWN THAT THE EFFECTS ON 2855 01:51:04,858 --> 01:51:05,692 PULMONARY FUNCTION ARE WORSE 2856 01:51:05,759 --> 01:51:07,761 WHEN YOU COMBINE CANNABIS 2857 01:51:07,827 --> 01:51:09,763 SMOKING WITH TOBACCO SMOKING 2858 01:51:09,829 --> 01:51:12,265 THAN EITHER OF THEM ALONE. 2859 01:51:12,332 --> 01:51:15,402 SO WE VERY MUCH -- ON THE TYPE 2860 01:51:15,468 --> 01:51:19,406 OF DRUG THAT YOU ARE -- THE 2861 01:51:19,472 --> 01:51:21,041 QUESTION ABOUT IS THERE -- HOW 2862 01:51:21,107 --> 01:51:22,809 ABOUT THE OTHER MEDICATIONS, AND 2863 01:51:22,876 --> 01:51:26,780 YOU WERE MENTIONING THIS -- 2864 01:51:26,846 --> 01:51:28,214 PEPTIDE AGONIST MEDICATIONS LIKE 2865 01:51:28,281 --> 01:51:34,954 OWOZEMPIC OR THOSE USED TO REDUE 2866 01:51:35,021 --> 01:51:36,689 OBESITY, THE DATA LOOKS 2867 01:51:36,756 --> 01:51:37,257 EXTREMELY INTERESTING. 2868 01:51:37,323 --> 01:51:39,793 IN ANIMAL MODELS, FOR EXAMPLE, 2869 01:51:39,859 --> 01:51:42,429 RESEARCHERS HAVE SHOWN THAT 2870 01:51:42,495 --> 01:51:43,430 SPECIFICALLY THESE MEDICATIONS 2871 01:51:43,496 --> 01:51:46,699 CAN PREVENT CONSUMPTION OF 2872 01:51:46,766 --> 01:51:48,701 NICOTINE, COCAINE, THEY'VE ALSO 2873 01:51:48,768 --> 01:51:53,440 SHOWN IT FOR ALCOHOL. 2874 01:51:53,506 --> 01:51:54,507 THEY HAVE NOT SHOWN IT FOR 2875 01:51:54,574 --> 01:51:55,275 CANNABIS YET BECAUSE THEY 2876 01:51:55,341 --> 01:51:56,843 HAVEN'T BEEN DONE. 2877 01:51:56,910 --> 01:52:01,781 BUT MEANWHILE, IN RESEARCH OF 2878 01:52:01,848 --> 01:52:03,083 ANALYSIS OF ELECTRONIC RECORDS 2879 01:52:03,149 --> 01:52:05,485 WHERE YOU'RE MONITORING DATA ON 2880 01:52:05,552 --> 01:52:07,287 HUNDREDS OF THOUSANDS OF 2881 01:52:07,353 --> 01:52:09,189 PATIENTS, SO SOMETIMES MILLIONS, 2882 01:52:09,255 --> 01:52:11,791 ON WHAT YOU CAN SEE IS IF THOSE 2883 01:52:11,858 --> 01:52:15,762 PEOPLE THAT WERE PRESCRIBED 2884 01:52:15,829 --> 01:52:17,197 PEPTIDE MEDICATIONS FOR DIABETES 2885 01:52:17,263 --> 01:52:19,499 COMPARED WITH THOSE THAT WERE 2886 01:52:19,566 --> 01:52:22,502 PRESCRIBED OTHER ANTIDIABETIC 2887 01:52:22,569 --> 01:52:23,603 DRUGS, SAME THINGS FOR OBESITY, 2888 01:52:23,670 --> 01:52:26,639 YOU CAN SEE REDUCED UTILIZATION 2889 01:52:26,706 --> 01:52:30,310 OF TREATMENT, YOU CAN SEE 2890 01:52:30,376 --> 01:52:32,479 IMPROVED -- INDICATORS THAT SHOW 2891 01:52:32,545 --> 01:52:34,347 BENEFIT FOR THE SUBSTANCE USE 2892 01:52:34,414 --> 01:52:34,848 DISORDER. 2893 01:52:34,914 --> 01:52:36,683 AND YES, PEOPLE ARE REPORTING AS 2894 01:52:36,749 --> 01:52:39,652 I MENTIONED AT THE BEGINNING 2895 01:52:39,719 --> 01:52:41,654 THEIR DESIRES TO TAKE DRUGS, 2896 01:52:41,721 --> 01:52:43,556 ALCOHOL, TOBACCO, MARIJUANA, 2897 01:52:43,623 --> 01:52:44,624 SMOKING GOES DOWN WHEN THEY ARE 2898 01:52:44,691 --> 01:52:46,926 ON THESE MEDICATIONS. 2899 01:52:46,993 --> 01:52:52,132 SO WE ARE FUNDING RESEARCHERS, 2900 01:52:52,198 --> 01:52:53,333 THE ALCOHOL INSTITUTE IS ALSO 2901 01:52:53,399 --> 01:52:55,568 FUNDING RESEARCHERS TO DO 2902 01:52:55,635 --> 01:52:56,102 RANDOMIZED CLINICAL TRIALS 2903 01:52:56,169 --> 01:52:56,669 BECAUSE IT DOES HAVE THE 2904 01:52:56,736 --> 01:52:58,638 POTENTIAL OF GIVING US 2905 01:52:58,705 --> 01:52:59,606 MEDICATIONS, MEDICATIONS THAT 2906 01:52:59,672 --> 01:53:01,574 COULD BE VALUABLE IMPORTANTLY 2907 01:53:01,641 --> 01:53:05,178 NOT FOR ONE DRUG, IT'S NOT JUST 2908 01:53:05,245 --> 01:53:06,579 SPECIFICALLY -- WHEN YOU HAVE 2909 01:53:06,646 --> 01:53:08,515 METHADONE, IT TARGETS THE OPIOID 2910 01:53:08,581 --> 01:53:10,817 RECEPTORS, SO THOSE TREATMENTS 2911 01:53:10,884 --> 01:53:13,119 ARE FOR OPIOIDS. 2912 01:53:13,186 --> 01:53:14,587 IN THIS CASE, IT'S A TREATMENT 2913 01:53:14,654 --> 01:53:17,857 THAT COULD USE FOR ALCOHOL, FOR 2914 01:53:17,924 --> 01:53:18,858 MARIJUANA, FOR CIGARETTE 2915 01:53:18,925 --> 01:53:19,425 SMOKERS. 2916 01:53:19,492 --> 01:53:23,830 IT DOESN'T MATTER WHAT ROLE. 2917 01:53:23,897 --> 01:53:25,031 WHICH OF COURSE IS HIGHLY 2918 01:53:25,098 --> 01:53:26,132 DESIRABLE BECAUSE AS I 2919 01:53:26,199 --> 01:53:26,933 MENTIONED, PEOPLE ARE COMBINING 2920 01:53:27,000 --> 01:53:27,233 DRUGS. 2921 01:53:27,300 --> 01:53:29,035 SO IT'S VERY EXCITING, THAT EA 2922 01:53:29,102 --> 01:53:31,671 THE POSSIBILITY, THE POTENTIAL 2923 01:53:31,738 --> 01:53:34,474 LOOKS QUITE PROMISING. 2924 01:53:34,541 --> 01:53:37,744 UNTIL WE OF COURSE HAVE 2925 01:53:37,810 --> 01:53:38,578 RANDOMIZED CLINICAL TRIALS, WE 2926 01:53:38,645 --> 01:53:40,547 WON'T BE ABLE TO SAY DEFINITELY, 2927 01:53:40,613 --> 01:53:43,583 BUT IT DOES LOOK VERY GOOD. 2928 01:53:43,650 --> 01:53:47,620 >> VERY BRIEFLY, WHAT DO YOU 2929 01:53:47,687 --> 01:53:50,123 THINK WOULD BE THE MECHANISM OF 2930 01:53:50,190 --> 01:53:51,024 SUCH AN EFFECT? 2931 01:53:51,090 --> 01:53:54,961 >> WELL, YOU KNOW, THE REALITY 2932 01:53:55,028 --> 01:53:59,666 IS THAT ONE OF THE SYSTEMS -- 2933 01:53:59,732 --> 01:54:01,968 BASICALLY JUST HIJACK THE 2934 01:54:02,035 --> 01:54:04,270 CIRCUITS IN OUR BRAIN THAT DRIVE 2935 01:54:04,337 --> 01:54:08,174 OUR MOTIVATION TO EAT. 2936 01:54:08,241 --> 01:54:09,475 AND AS A RESULT OF THAT, IT'S 2937 01:54:09,542 --> 01:54:12,312 NOT SURPRISING THAT MANY OF THE 2938 01:54:12,378 --> 01:54:15,949 MOLECULES THAT SIGNAL SATIETY OR 2939 01:54:16,015 --> 01:54:20,587 THAT SIGNAL THE HUNGER ACTUALLY 2940 01:54:20,653 --> 01:54:22,455 MODIFIED THE REWARDING EFFECTS 2941 01:54:22,522 --> 01:54:24,424 OF DRUGS. 2942 01:54:24,490 --> 01:54:26,159 AND IN THAT SIMPLE WAY OF 2943 01:54:26,226 --> 01:54:29,295 EXPLAINING THIS IS, WHEN YOU'RE 2944 01:54:29,362 --> 01:54:32,332 HUNGRY, THE FOOD ACQUIRES AN 2945 01:54:32,398 --> 01:54:36,069 ENHANCED VALUE, SALE YEN SEE 2946 01:54:36,135 --> 01:54:37,003 VALUE, IT'S MORE REWARDING. 2947 01:54:37,070 --> 01:54:38,204 THAT IS THE DOPAMINE SYSTEM. 2948 01:54:38,271 --> 01:54:40,873 THAT IS THE SYSTEM THAT ACTUALLY 2949 01:54:40,940 --> 01:54:41,975 DRUGS DIRECTLY ACTIVATE. 2950 01:54:42,041 --> 01:54:44,377 SO WHEN YOU ARE HUNGRY, THESE 2951 01:54:44,444 --> 01:54:46,479 SIGNALS THAT ACTUALLY COME FROM 2952 01:54:46,546 --> 01:54:48,881 PERIPHERAL AS WELL AS CENTRAL 2953 01:54:48,948 --> 01:54:51,451 MECHANISMS LEAD ON TO MAXIMIZE 2954 01:54:51,517 --> 01:54:53,519 THE ACTIVATION OF THE DOPAMINE 2955 01:54:53,586 --> 01:54:55,388 SYSTEM TO MOTIVATE YOU TO GO 2956 01:54:55,455 --> 01:54:58,958 SEEK THE FOOD. 2957 01:54:59,025 --> 01:55:00,460 SO, THEREFORE, NOT SURPRISED 2958 01:55:00,526 --> 01:55:02,996 THAT IF YOU HAVE A MECHANISM 2959 01:55:03,062 --> 01:55:05,932 THAT CURTAILS THAT HYPERDRIVE TO 2960 01:55:05,999 --> 01:55:07,300 GET THE FOOD AND TO CONTINUE TO 2961 01:55:07,367 --> 01:55:11,771 EAT IT, THIS IS TARGETING THAT 2962 01:55:11,838 --> 01:55:13,673 DOPAMINERGIC SYSTEM, NOT 2963 01:55:13,740 --> 01:55:15,375 SURPRISED, IT ALSO MAY TARGETING 2964 01:55:15,441 --> 01:55:17,777 ACTUALLY THE DRIVE TO TAKE 2965 01:55:17,844 --> 01:55:21,180 DRUGS, BECAUSE THAT DOPAMINE 2966 01:55:21,247 --> 01:55:24,083 SYSTEM IS NOT -- IT'S FOR US TO 2967 01:55:24,150 --> 01:55:25,718 ENSURE THAT WE CONSUME FOOD THAT 2968 01:55:25,785 --> 01:55:27,787 WILL KEEP US ALIVE. 2969 01:55:27,854 --> 01:55:33,593 SO IT'S THAT BIOLOGICAL 2970 01:55:33,660 --> 01:55:34,994 SUBSTRATE THAT IS SO ESSENTIAL 2971 01:55:35,061 --> 01:55:36,329 FOR SURVIVAL WHICH IS THE ONE 2972 01:55:36,396 --> 01:55:38,031 THAT DRUGS GO AFTER AND WHY THEY 2973 01:55:38,097 --> 01:55:40,466 CAN BE SO, SO DISRUPTIVE. 2974 01:55:40,533 --> 01:55:43,670 >> MEGHANN, WOULD YOU RESPOND TO 2975 01:55:43,736 --> 01:55:45,538 THAT, AND ALSO THERE'S A 2976 01:55:45,605 --> 01:55:52,645 QUESTION THAT CAME IN, HOW DO 2977 01:55:52,712 --> 01:55:56,316 YOU OR COMMUNITIES EVALUATE THE 2978 01:55:56,382 --> 01:56:00,820 SUCCESS OR FAILURE OF VARIOUS 2979 01:56:00,887 --> 01:56:04,057 MODALITIES THAT RINT DUED INTRO 2980 01:56:04,123 --> 01:56:05,892 DEAL WITH ADDICTION? 2981 01:56:05,958 --> 01:56:06,993 >> THANK YOU FOR THAT QUESTION. 2982 01:56:07,060 --> 01:56:10,563 I'M GOING TO LEAVE THE FORMER 2983 01:56:10,630 --> 01:56:12,832 ONE TO DR. VOLKOW. 2984 01:56:12,899 --> 01:56:14,267 THAT'S OUT OF MY SORT OF AREA OF 2985 01:56:14,334 --> 01:56:16,336 EXPERTISE. 2986 01:56:16,402 --> 01:56:18,771 IN TERMS OF MEASUREMENT, SO IT 2987 01:56:18,838 --> 01:56:20,773 IS A TRICKY THING, RIGHT, HOW DO 2988 01:56:20,840 --> 01:56:23,943 WE RESEARCH SOMETHING THAT'S NOT 2989 01:56:24,010 --> 01:56:25,311 A QUANTITATIVE OUT COME, RIGHT? 2990 01:56:25,378 --> 01:56:26,646 SO WHEN WE'RE LOOKING AT 2991 01:56:26,713 --> 01:56:30,450 INCREASED WELLNESS ACROSS THE 2992 01:56:30,516 --> 01:56:32,251 MULTIPLE DOMAINS OF WELLNESS, 2993 01:56:32,318 --> 01:56:36,089 IT'S MUCH HARDER TO MEASURE THAT 2994 01:56:36,155 --> 01:56:38,057 THAN, ABSTINENCE, THEY'VE 2995 01:56:38,124 --> 01:56:39,225 ACHIEVED ABSTINENCE FROM ALL 2996 01:56:39,292 --> 01:56:40,426 SUBSTANCES AND IT HAPPENED ON 2997 01:56:40,493 --> 01:56:41,728 THIS DAY AND THEY MAINTAINED IT 2998 01:56:41,794 --> 01:56:45,264 FOR THIS LONG AND OOP, THEY TOOK 2999 01:56:45,331 --> 01:56:46,599 AWARE -- SO WE USE SOMETHING A 3000 01:56:46,666 --> 01:56:49,335 LOT OF FOLKS LOOK AT THE 3001 01:56:49,402 --> 01:56:53,005 RECOVERY CAPITAL INDEX, OR 3002 01:56:53,072 --> 01:56:53,506 RECOVERY CAPITAL SCALE. 3003 01:56:53,573 --> 01:56:55,208 SO WE LOOK AT WELLNESS IN ALL 3004 01:56:55,274 --> 01:56:56,609 DIFFERENT AREAS OF LIFE. 3005 01:56:56,676 --> 01:56:58,911 WE KNOW THAT WELLNESS EXISTS 3006 01:56:58,978 --> 01:57:02,949 ACROSS PHYSICAL, ENVIRONMENTAL, 3007 01:57:03,015 --> 01:57:05,318 SOCIAL, SPIRITUAL FOR SOME 3008 01:57:05,385 --> 01:57:07,854 FOLKS, THAT YOU HAVE MEANING AND 3009 01:57:07,920 --> 01:57:08,521 PURPOSE. 3010 01:57:08,588 --> 01:57:10,556 AND SO WE CAN MEASURE QUALITY OF 3011 01:57:10,623 --> 01:57:14,494 LIFE IN WAYS THAT WE CAN STILL 3012 01:57:14,560 --> 01:57:16,162 QUANTIFY THAT, RECOVERY CAPITAL 3013 01:57:16,229 --> 01:57:17,196 SKILL IS A GREAT TOOL FOR DOING 3014 01:57:17,263 --> 01:57:19,065 THAT. 3015 01:57:19,132 --> 01:57:21,701 SO I THINK THAT -- I THINK 3016 01:57:21,768 --> 01:57:22,969 RESEARCHERS HAVE A LOT OF WORK 3017 01:57:23,035 --> 01:57:27,673 TO DO TO FIGURE THAT OUT, AND SO 3018 01:57:27,740 --> 01:57:28,875 MUCH RESEARCH IS STILL 3019 01:57:28,941 --> 01:57:31,244 PREDICATED ON A VERY CONCRETE 3020 01:57:31,310 --> 01:57:32,111 CLEAR -- BECAUSE IT'S EASIER, 3021 01:57:32,178 --> 01:57:32,545 RIGHT? 3022 01:57:32,612 --> 01:57:35,381 IT'S EASIER TO SORT OF USE THAT 3023 01:57:35,448 --> 01:57:38,284 STANDARD AND IT -- I DO SEE 3024 01:57:38,351 --> 01:57:41,788 RESEARCH EVOLVING IN ATTEMPTING 3025 01:57:41,854 --> 01:57:43,089 TO SORT OF MEASURE THINGS A 3026 01:57:43,156 --> 01:57:46,125 LITTLE BIT DIFFERENTLY NOW. 3027 01:57:46,192 --> 01:57:47,560 BUT WE HAVE A LOT OF WORK TO DO 3028 01:57:47,627 --> 01:57:51,697 IN THAT AREA AND BECAUSE -- JUST 3029 01:57:51,764 --> 01:57:53,399 SYSTEMS AND MONEY AND 3030 01:57:53,466 --> 01:57:54,700 REIMBURSEMENT AND HOW EVERYTHING 3031 01:57:54,767 --> 01:57:57,770 SORT OF TIED TO MEASURABLE 3032 01:57:57,837 --> 01:57:59,205 OUTCOMES, IT'S A LITTLE BIT -- 3033 01:57:59,272 --> 01:58:01,007 WE'RE STILL HAVING TO KIND OF 3034 01:58:01,073 --> 01:58:02,975 PUSH TO SEE THINGS IN A MORE 3035 01:58:03,042 --> 01:58:03,643 COMPLEX WAY. 3036 01:58:03,709 --> 01:58:04,977 IT HARD TO MEASURE COMPLEX 3037 01:58:05,044 --> 01:58:06,712 THINGS. 3038 01:58:06,779 --> 01:58:09,782 AND THIS IS A VERY COMPLEX THI 3039 01:58:09,849 --> 01:58:10,049 THING. 3040 01:58:10,116 --> 01:58:11,384 AND I WOULD LOVE TO TAKE A 3041 01:58:11,451 --> 01:58:15,655 MOMENT, IF I CAN, TO TALK ABOUT 3042 01:58:15,721 --> 01:58:16,222 STIGMA. 3043 01:58:16,289 --> 01:58:20,026 AND MY WONDERFUL FRIEND 3044 01:58:20,092 --> 01:58:20,993 DR. HERNANDEZ SAYS YOU CAN CALL 3045 01:58:21,060 --> 01:58:22,728 IT STIGMA ALL DAY BUT WHAT IT IS 3046 01:58:22,795 --> 01:58:23,496 IS DISCRIMINATION. 3047 01:58:23,563 --> 01:58:26,065 AND THAT IS AT EVERY LEVEL OF 3048 01:58:26,132 --> 01:58:30,870 ALL OF THE SYSTEMS AND ALL OF -- 3049 01:58:30,937 --> 01:58:32,672 IT EVEN EXISTS WITHIN US 3050 01:58:32,738 --> 01:58:34,006 PERSONALLY AS PEOPLE WITH 3051 01:58:34,073 --> 01:58:36,642 SUBSTANCE USE CHALLENGES, AND 3052 01:58:36,709 --> 01:58:40,146 THE POWER OF STORY AND 3053 01:58:40,213 --> 01:58:41,848 STORYTELLING IS REALLY -- I 3054 01:58:41,914 --> 01:58:43,483 MEAN, IT'S ONE OF OUR BEST 3055 01:58:43,549 --> 01:58:45,885 TOOLS, IT'S SO CENTRAL TO WHO WE 3056 01:58:45,952 --> 01:58:47,820 ARE AS HUMANS, HOW WE 3057 01:58:47,887 --> 01:58:49,222 COMMUNICATE, HOW WE ARE IN 3058 01:58:49,288 --> 01:58:54,694 RELATIONSHIP WITH ONE ANOTHER. 3059 01:58:54,760 --> 01:58:57,196 SO IN RESEARCH IN HEALTHCARE, 3060 01:58:57,263 --> 01:58:58,698 ARE YOU TRULY LISTENING TO THE 3061 01:58:58,764 --> 01:58:59,799 STORIES OF THE FOLKS THAT YOU'RE 3062 01:58:59,866 --> 01:59:03,603 ENGAGING WITH AND LEARNING FROM 3063 01:59:03,669 --> 01:59:03,803 THEM? 3064 01:59:03,870 --> 01:59:05,872 AND THINKING ABOUT HOW WE ENGAGE 3065 01:59:05,938 --> 01:59:07,406 IN -- IF YOU'RE INTERESTED IN 3066 01:59:07,473 --> 01:59:11,110 MORE ABOUT THAT, YOU CAN 3067 01:59:11,177 --> 01:59:14,013 CERTAINLY FIND ME. 3068 01:59:14,080 --> 01:59:15,248 BECAUSE IT'S ONE OF MY FAVORITE 3069 01:59:15,314 --> 01:59:16,682 TOPICS, AND I THINK IT'S REALLY, 3070 01:59:16,749 --> 01:59:17,550 REALLY IMPORTANT IN ALL OF OUR 3071 01:59:17,617 --> 01:59:21,787 WORK MOVING FORWARD, THAT WE 3072 01:59:21,854 --> 01:59:23,456 LOOK AT THAT. 3073 01:59:23,523 --> 01:59:27,059 >> MEGHANN, THERE HAVE BEEN 3074 01:59:27,126 --> 01:59:28,861 SEVERAL REQUESTS, IF YOU WOULD 3075 01:59:28,928 --> 01:59:30,062 PLEASE -- I THINK YOU CAN STILL 3076 01:59:30,129 --> 01:59:34,901 DO IT -- PUT UP YOUR LAST 3077 01:59:34,967 --> 01:59:38,070 POWERPOINT THAT HAS YOUR WEBSITE 3078 01:59:38,137 --> 01:59:44,577 AND YOUR EMAIL ADDRESS. 3079 01:59:44,644 --> 01:59:45,578 YEAH. 3080 01:59:45,645 --> 01:59:46,345 OKAY. 3081 01:59:46,412 --> 01:59:49,248 SO WH WHY DON'T WE LEAVE THAT U. 3082 01:59:49,315 --> 01:59:52,218 WE ONLY HAVE ABOUT A HALF A 3083 01:59:52,285 --> 01:59:54,620 MINUTE LEFT TO GO. 3084 01:59:54,687 --> 01:59:56,355 WELL, THERE ARE A BUNCH OF OTHER 3085 01:59:56,422 --> 01:59:58,324 QUESTIONS WHICH UNFORTUNATELY WE 3086 01:59:58,391 --> 02:00:00,927 CAN'T GET TO THEM ALL. 3087 02:00:00,993 --> 02:00:04,530 I WOULD JUST MENTION THAT THERE 3088 02:00:04,597 --> 02:00:07,900 WAS ONE QUESTION ABOUT 3089 02:00:07,967 --> 02:00:08,901 EVALUATING PUBLIC HEALTH 3090 02:00:08,968 --> 02:00:12,171 POLICIES RELATING TO RESULTS IN 3091 02:00:12,238 --> 02:00:13,706 PORTUGAL. 3092 02:00:13,773 --> 02:00:15,741 AND A RECENT ARTICLE AT LEAST IN 3093 02:00:15,808 --> 02:00:18,277 THE "NEW YORK TIMES" THAT 3094 02:00:18,344 --> 02:00:20,246 QUESTIONED THE EFFECTIVENESS OF 3095 02:00:20,313 --> 02:00:20,680 THAT. 3096 02:00:20,746 --> 02:00:24,951 SO I GUESS THIS WHOLE BUSINESS 3097 02:00:25,017 --> 02:00:28,087 OF WHATEVER WE DO, WHETHER IT'S 3098 02:00:28,154 --> 02:00:39,231 PHARMACOLOGIC OR SOA SOA SOA SOO 3099 02:00:39,298 --> 02:00:40,666 HAVE SOME FEEDBACK AS TO WHETHER 3100 02:00:40,733 --> 02:00:41,834 THESE SYSTEMS ARE HAVING THE 3101 02:00:41,901 --> 02:00:45,104 EFFECT THAT WE DESIRE, I 3102 02:00:45,171 --> 02:00:45,871 PERSONALLY THINK THIS IS 3103 02:00:45,938 --> 02:00:48,074 PARTICULARLY TRUE IN THE FIELD 3104 02:00:48,140 --> 02:00:51,110 OF EDUCATION, WHERE YOU RARELY 3105 02:00:51,177 --> 02:00:53,079 FIND ANY EVALUATION. 3106 02:00:53,145 --> 02:00:55,681 IT'S USUALLY ON TO THE NEXT 3107 02:00:55,748 --> 02:01:00,419 MODEL. 3108 02:01:00,486 --> 02:01:01,821 I THINK THAT'S A COMMON THING WE 3109 02:01:01,887 --> 02:01:02,221 ALL FACE. 3110 02:01:02,288 --> 02:01:03,522 WHAT DO YOU THINK ABOUT THAT, 3111 02:01:03,589 --> 02:01:11,731 MEGHANN? 3112 02:01:11,797 --> 02:01:11,931 OKAY. 3113 02:01:11,998 --> 02:01:19,505 >> I'LL PASS THAT TO DR. VOLKOW. 3114 02:01:19,572 --> 02:01:22,208 >> LISTEN, MEGHANN, WE WANT TO 3115 02:01:22,274 --> 02:01:24,510 THANK YOU ENORMOUSLY FOR SHARING 3116 02:01:24,577 --> 02:01:27,113 YOUR PERSONAL EXPERIENCE AND FOR 3117 02:01:27,179 --> 02:01:30,049 BRINGING YOUR IDEAS AND YOUR 3118 02:01:30,116 --> 02:01:34,086 ACTIVITIES TO OUR AWARENESS. 3119 02:01:34,153 --> 02:01:35,721 SOMETIMES I THINK WHERE WE ARE, 3120 02:01:35,788 --> 02:01:38,090 WE'RE A LITTLE BIT IN A BUBBLE, 3121 02:01:38,157 --> 02:01:39,725 AND WE DON'T HEAR ABOUT SUCH 3122 02:01:39,792 --> 02:01:40,826 THINGS. 3123 02:01:40,893 --> 02:01:43,029 SO MUCH THANKS TO YOU. 3124 02:01:43,095 --> 02:01:45,698 AND OF COURSE FOR NORA, WHO 3125 02:01:45,765 --> 02:01:50,736 ALWAYS EXCITES US WITH WHAT THE 3126 02:01:50,803 --> 02:01:53,139 CURRENT SITUATION IS, AND WHAT 3127 02:01:53,205 --> 02:01:55,841 THE HOPES FOR THE FUTURE ARE. 3128 02:01:55,908 --> 02:01:56,809 NORA, THERE WERE SEVERAL 3129 02:01:56,876 --> 02:01:58,344 QUESTIONS WHICH WE DIDN'T GET 3130 02:01:58,411 --> 02:02:00,479 TIME TO ADDRESS TO YOU, BUT ONE 3131 02:02:00,546 --> 02:02:02,982 OF THEM, THEY ALL DEALT ON -- 3132 02:02:03,049 --> 02:02:05,017 WHEN YOU TALK ABOUT A VACCINE, 3133 02:02:05,084 --> 02:02:09,355 YOU KNOW, WHAT HAVE YOU GOT IN 3134 02:02:09,422 --> 02:02:10,456 MIND? 3135 02:02:10,523 --> 02:02:12,024 I DON'T THINK WE HAVE TIME FOR 3136 02:02:12,091 --> 02:02:15,761 YOU TO ANSWER THAT, BUT IT'S 3137 02:02:15,828 --> 02:02:16,495 INTERESTING. 3138 02:02:16,562 --> 02:02:19,398 WELL, MAYBE YOU QUICKLY COULD. 3139 02:02:19,465 --> 02:02:21,300 >> THE IDEA OF A VACCINE IS LIKE 3140 02:02:21,367 --> 02:02:23,169 FOR ANY OTHER VACCINE, WHICH 3141 02:02:23,235 --> 02:02:26,005 ACTUALLY HAVE AN ANTIBODY THAT 3142 02:02:26,072 --> 02:02:27,740 TRAPS THE ORGANISM, IN THIS 3143 02:02:27,807 --> 02:02:30,076 CASE, THAT TRAPS THE CHEMICAL IN 3144 02:02:30,142 --> 02:02:32,478 THE BLOOD AND DOESN'T LET IT GO 3145 02:02:32,545 --> 02:02:35,448 INTO THE TISSUES, THE BRAIN, 3146 02:02:35,514 --> 02:02:35,981 VERY IMPORTANT. 3147 02:02:36,048 --> 02:02:37,950 SO THAT IS THE WHOLE -- AND THE 3148 02:02:38,017 --> 02:02:40,453 SAME THING WITH THE USE OF 3149 02:02:40,519 --> 02:02:42,621 MONOCLONAL ANTIBODIES, JUST LIKE 3150 02:02:42,688 --> 02:02:44,056 FOR COVID. 3151 02:02:44,123 --> 02:02:47,460 BUT FOR DRUGS. 3152 02:02:47,526 --> 02:02:48,461 >> ALL RIGHT. 3153 02:02:48,527 --> 02:02:50,029 >> I HOPE THAT ANSWERS IT. 3154 02:02:50,096 --> 02:02:51,097 IT'S SORT OF LIKE VERY 3155 02:02:51,163 --> 02:02:51,797 STRAIGHTFORWARD. 3156 02:02:51,864 --> 02:02:54,166 >> WELL, ON THAT NOTE, WE HAVE 3157 02:02:54,233 --> 02:02:58,738 TO END, AND I WANT TO THANK YOU 3158 02:02:58,804 --> 02:03:01,240 ON BEHALF OF THE MANY, MANY 3159 02:03:01,307 --> 02:03:03,642 HUNDREDS OF PEOPLE, HERE AT NIH 3160 02:03:03,709 --> 02:03:05,711 AND AROUND THE WORLD, WHO NOW 3161 02:03:05,778 --> 02:03:06,912 AND WHEN THEY DOWNLOAD YOUR 3162 02:03:06,979 --> 02:03:08,881 PRESENTATIONS WILL BENEFIT AND 3163 02:03:08,948 --> 02:03:09,882 BE STIMULATED BY THEM. 3164 02:03:09,949 --> 02:03:10,516 SO THANK YOU. 3165 02:03:10,583 THANK YOU VERY MUCH.