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>>WELCOME TO THIS MEETING OF

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HEAL, HELPING TO END ADDICTION

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LONG-TERM INITIATIVES, MULTIDOSE

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PLINARY WORKING GROUP MEETING.

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I THINK SOME OF THE WORKING

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GROUP MEMBERS AND MEMBERS OF THE

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KEY NOTE COMMITTEE ARE

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CONTINUING TO JOIN US.

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SINCE IT'S NOW 11:00, I WILL

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TURN IT OVER TO THE DIRECTOR

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LARRY TABAK.

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>> THANK YOU EVERYBODY, IT'S--

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SINCE MARCH OF 2019, VERY

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SHORTLY AFTER THE HEAL

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INITIATIVE WAS LAUNCHED AND THE

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GROUP HAS REALLILY BEEN

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INSTRUMENTAL IN GUIDING THE

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RESEARCH OR THIS AMBITIOUS AND

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FRANKLY UNPRECEDENTED EFFORT TO

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HELP STEM THE NATION'S OPIOID

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CRISIS.

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SINCE THE GROUP LAST MET IN

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SEPTEMBER, WE HAVE REACHED AN

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UNIMAGINABLE MILESTONE, IN THE

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12 MONTH PERIOD, BEGINNING IN

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MAY 2020, OVER 100,000 OVERDOSE

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DEATHS.

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HAS OCCURRED AGAINST THE BACK

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DROP OF THE COVID-19 PANDEMIC

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AND THE CONCOMITANT RISE OF

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PREVALENCE IN FENTANYL IN THE

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ILLICIT DRUG SUPPLY AND THESE 2

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FACTORS IN THE RISE AND

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POLYSUBSTANCE USE, THAT HAVE

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MADE EFFORTS TO STEM THE OPIOID

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CRISIS EVEN MORE CHALLENGE AND

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AND EVEN MORE DEVASTATING TO

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COMMITTEES IN EVERY CORNER OF

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THE NATION.

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AS YOU KNOW NIH IS PUTTING

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FUNDING BEHINDS TO FIND NEW

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APPROACHES TO BETTER PREVENT AND

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TREAT OPIOID USE DISORDER AND

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OVERDOSE, AND ENHANCE PAIN

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MANAGEMENT.

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FOLLOWING THE GUIDANCE AT THE

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SEPTEMBER 21 MEETING, THE HEAL

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INITIATIVE, HAS RELEASED THE

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STRIKING NUMBER OF NEW FUNDING

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ANNOUNCEMENTS IN NEW AREAS OF

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THE RESEARCH THAT ADDRESS THIS

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CHANGING LANDSCAPE OF THE OPIOID

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CRISIS IN THE COMPLEXITY OF

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CONCEPTS AND PROGRAMS AS WELL AS

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LIMITATIONS OF CURRENT DATA

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COLLECTION THAT HINDER OUR

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ABILITY TO REALLY SEE WHAT'S

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GOING ON IN COMMUNITIES IN THE

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U.S.

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WE ARE CERTAINLY LOOKING FORWARD

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TO YOUR GUIDANCE OVER THE NEXT 2

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DAYS.

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TO INSURE NIH IS USING ALL

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RESOURCES TO MOST EFFECTIVELY

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SUPPORT THE BEST SCIENCE THAT

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WILL HELP TURN THE TIDE IN THE

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OPIOID CRISIS WHILE ALSO

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PREPARING FOR WHAT WE HOPE ARE

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SIGNIFICANT INCREASES TO THE

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HEAL BUDGET BY CONGRESS FOR THIS

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FISCAL YEAR.

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OBVIOUSLY TO THAT, WE HAVE TO

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STAY TUNED.

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WE NEED YOUR THOUGHTFUL ADVICE

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AND GUIDANCE TO MAKE SURE THAT

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THE RESEARCH WE CONTINUE TO

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INVEST IN, IS POSING THE RIGHT

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QUESTIONS AND ADDRESSING THE

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MOST PRESSING NEEDS AND

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CONCERNS, SO WE WANT TO THANK

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YOU FOR JOINING US FOR THESE 2

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DAYS AND WE CERTAINLY LOOK

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FORWARD TO A PRODUCTIVE

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DISCUSSIONS ABOUT HOW WE CAN

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BUILD UPON THE PROGRESS MADE

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THUS FAR, BUT HOW WE MIGHT

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INTENSIFY OUR EFFORTS GOING

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FORWARD TO MEET THESE FORMIDABLE

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CHALLENGES.

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LET ME THANK THE EXECUTIVE

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MEMBERS OF THE HEAL COMMITTEE

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WHO PUT FORWARD FOR APPROVAL

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WHAT THEY BELIEVE TO BE THE MOST

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MERITORIOUS SCIENCE.

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I WOULD LIKE TO GIVE A SHOUT OUT

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IN PARTICULAR TO STAFF LED BY

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REBECCA BAKER AND THE 6 WORKING

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GROUPS WHO REALLY PUT IN AN

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EXTRAORDINARY EFFORT TO GETITOUS

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THIS POINT.

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I THINK MOST OF YOU UNDERSTAND

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THAT THESE ARE EFFORTS OVER AND

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ABOVE YOU KNOW THEIR NORMAL

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DUTIES IN THEIR HOME INSTITUTES

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AND CENTERS.

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I WOULD ALSO BE REMISS FIELD

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FUNCTIONS DIDN'T ACKNOWLEDGE THE

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WORK OF THE SCIENTIFIC TEAMS AND

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THE PROGRAM OFFICERS WHO

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COLLECTIVELY WORK TO GET 40 AND

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COUNTING, FUNDING OPPORTUNITY

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ANNOUNCEMENTS PUBLISHED SINCE

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THE LAST MEETING, THE MBWG AND

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THIS IS REALLY ASTONISHING AND

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THEIR DEDICATION TO HEAL IS TO

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BE COMMENDED.

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I THINK WE NEED TO DO A QUICK

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ROLL CALL TO CAPTURE WHO'S WITH

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US TODAY.

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SO IF I MAY, ERIN IF I CAN TURN

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IT TO YOU TO DO THE ROLE CALL,

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PLEASE?

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>> CERTAINLY.

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I'M HAPPY TO.

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I WILL GO DOWN THE LIST OF THE

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MULTIDISCIPLINARY GROUP MEMBERS

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THAT I SEE.

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SO CAN YOU JUST DO A QUICK CHECK

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TO MAKE SURE YOUR VIDEO WORKS

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AND SAY HELLO TO THE GROUP.

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SO START ON TOP HERE, SO I SEE

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DR. ANDRIEA JONES, DO YOU WANT

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TO SAY HELLO.

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>> HI, GOOD MORNINGS, THANKS FOR

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HAVING ME. 

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>> GREAT.

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>> HELLO. 

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>> DR. WISNER.

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>> I'M VERY SORRY, I'M HERE I

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JUST DIDN'T UNMUTE. 

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>> PERFECT.

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HELLO.

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UPON.

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>> DR. [INDISCERNIBLE]

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>> YES, GOOD MORNING.

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>> HELLO.

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DR. SMITH.

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>> HEY, WALLY SMITH HERE.

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>> GOOD TO SEE YOU, DR. JARREAU?

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>> GOOD MORNING ALL, GOOD TO SEE

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YOU ALL.

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>> DR. BOSSBAUM.

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>> GOOD MORNING EVERYONE.

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>> HELLO, THANKS FOR JOINING,

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DR. HARRIS.

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>> GOOD MORNING EVERYONE.

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>> I ALSO SEE DR. DEBARN.

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>> GOOD MORNING NICE TO SEE

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EVERYBODY.

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AND I THINK I CAUGHT EVERYONE ON

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THIS LIST BUT IF I MISSED YOU,

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PLEASE FEEL FREE TO OPEN UP YOUR

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CAMERA AND  SAY HELLO. 

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>> HI, CHRIS HERE, GOOD MORNING.

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>> HELLO, GOOD MORNING.

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>> CONNIE WISENER SAYING HI.

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>> WE SEE YOU THANKS, CONNIE.

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DID EMPLOY.

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>> LET ME JUST REAL QUICKLY THEN

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GO THROUGH THE LIST OF THE HEAL

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EXECUTIVE COMMITTEE MEMBERS I

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SEE AS WELL.

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YOU CAN SAY HELLO BUT LET ME

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JUST RUN THROUGH WHO I SEE.

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SO I SEE DR. KOROSHETKRYSTEN

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ANDERSON.

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>> DR. RUNNER, DR. CRISWELL, AND

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I BELIEVE THAT IS THE LIST

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JOINING US RIGHT NOW ALTHOUGH

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MULTIPLE OTHER MEMBERS WILL BE

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COMING IN OUT OF THE MEETING.

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>> AND I THINK DR. LANGEVIN,

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TOO.

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>> THANK YOU SO MUCH, AGAIN, AND

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WELCOME EVERYBODY.

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LET'S GO QUICKLY THROUGH THE RUN

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OF SHOW, IN A BIT YOU WILL HEAR

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FROM DR. BAKER ABOUT THE HEAL

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PORTFOLIO AND PROGRAMS AND I

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HOPE YOU WILL FIND THAT TO BE

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VERY INTERESTING.

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AND THIS WILL BE FOLLOWED BY A

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DISCUSSION PERIOD WHERE WE HOPE

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YOU WILL REFLECT ON WHAT YOU'VE

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HEARD ABOUT THE PORTFOLIO.

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THEN YOU WILL HEAR FROM

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DR. NORA VOLKOW, DIRECTOR OF

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NIDA, AND DR. WALTER KOROSHETZ,

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FROM NINDS, EMERGING ISSUES IN

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OPIOID CRISIS, FOLLOWED BY

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DISCUSSION, AGAIN, THE EMSIS IS

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WE WANT TO HEAR FEEDBACK FROM

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YOU.

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THERE WILL BE A BREAK AT 12:30

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AND THEN AT 12:45, THERE WILL BE

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A RETURN FOR THE CLOSED SESSION

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TO DISCUSS NEW RESEARCH CONCEPTS

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FOR THE UPCOMING FISCAL YEAR

209
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THAT STARTS ON OCTOBER 1st.

210
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SO THAT'S THE 2023 BUDGET AND OF

211
00:08:55,160 --> 00:08:57,240
COURSE, WE ARE AWARE THAT WE ARE

212
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STILL ADJUDICATING WHAT WE HOPE

213
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WILL BE A BUDGET FOR 2022.

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00:09:02,440 --> 00:09:05,720
BUT THIS IS--THIS IS THE WAY

215
00:09:05,720 --> 00:09:06,040
THINGS WORK.

216
00:09:06,040 --> 00:09:08,880
AND YOU WILL ALSO HEAR

217
00:09:08,880 --> 00:09:11,720
ADDITIONAL UPDATES FROM REBECCA

218
00:09:11,720 --> 00:09:13,200
ABOUT HEAL EFFORTS TO BUILD AND

219
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ENHANCE THE RESEARCH WORKFORCE

220
00:09:15,640 --> 00:09:17,680
AND PROGRESS TO DATE IN THE

221
00:09:17,680 --> 00:09:23,240
DEVELOPMENT OF THE HEAL DATA

222
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PLATFORM AND SHE WILL ALSO LET

223
00:09:25,160 --> 00:09:27,760
YOU KNOW ABOUT THE UPCOMING HEAL

224
00:09:27,760 --> 00:09:29,040
INVESTIGATOR MEETING WHICH WILL

225
00:09:29,040 --> 00:09:34,320
BE TAKING PLACE VIRTUALLY ON

226
00:09:34,320 --> 00:09:35,080
OCTOBER 11th AND 12th.

227
00:09:35,080 --> 00:09:39,040
SO JUST TO CONCLUDE, TO GET US

228
00:09:39,040 --> 00:09:42,680
OFF TO THE ESSENCE OF THE

229
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PROGRAM, I WANT TO AGAIN THANK

230
00:09:43,720 --> 00:09:45,120
YOU ALL FOR YOUR WILLINGNESS TO

231
00:09:45,120 --> 00:09:48,000
BE HERE TODAY, TO GIVE US THE

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TYPE OF ADVICE THAT WE REALLY

233
00:09:51,440 --> 00:09:53,680
NEED TO DEPEND UPON AS WE SEEK

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TO BUILD AREAS THAT ARE REALLY

235
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READY FOR PROGRESS AND OF

236
00:09:58,600 --> 00:10:01,760
COURSE, THE SAME TIME

237
00:10:01,760 --> 00:10:03,920
AGGRESSIVELY RESPOND TO AN EVER

238
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EVOLVING CRISIS WITH THE GOAL OF

239
00:10:05,920 --> 00:10:09,040
COURSE, THE SHARED GOAL OF

240
00:10:09,040 --> 00:10:11,120
REVERSING THE DISTURBING AND

241
00:10:11,120 --> 00:10:12,760
QUITE TRAGIC TRENDS THAT WE ARE

242
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SEEING.

243
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SO THANK YOU AND I WILL TURN IT

244
00:10:15,480 --> 00:10:18,640
OVER TO DR. REBECCA BAKER WHO IS

245
00:10:18,640 --> 00:10:22,240
THE DIRECTOR OF THE NIH HEAL

246
00:10:22,240 --> 00:10:22,920
INITIATIVE.

247
00:10:22,920 --> 00:10:23,840
REBECCA?

248
00:10:23,840 --> 00:10:25,160
>> THANK YOU DR. TABAK, AND

249
00:10:25,160 --> 00:10:27,040
THANK YOU EVERYONE FOR COMING

250
00:10:27,040 --> 00:10:29,320
AND JOINING US TODAY, BOTH THOSE

251
00:10:29,320 --> 00:10:31,080
WHO WE JUST WENT THROUGH YOUR

252
00:10:31,080 --> 00:10:35,120
NAMES ON THE EXECUTIVE COMMITTEE

253
00:10:35,120 --> 00:10:36,360
AND MULTIDISCIPLINARY WORKING

254
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GROUP AND ALSO THOSE OF YOU WHO

255
00:10:38,520 --> 00:10:40,240
ARE WATCHING THE VIDEOCAST, VERY

256
00:10:40,240 --> 00:10:42,120
PLEASED TO SHARE WITH YOU SOME

257
00:10:42,120 --> 00:10:43,640
OF THE PROGRESS, THE HEAL

258
00:10:43,640 --> 00:10:46,160
INITIATIVE HAS MADE OVER THE

259
00:10:46,160 --> 00:10:47,160
PAST YEAR.

260
00:10:47,160 --> 00:10:48,320
THIS SPRING MEETING IS OFTEN

261
00:10:48,320 --> 00:10:51,120
WHEN WE LOOK BACK AND REFLECT ON

262
00:10:51,120 --> 00:10:51,920
WHAT WE'VE DONE.

263
00:10:51,920 --> 00:10:56,160
I WILL SAY, THIS NOW MARKS 2

264
00:10:56,160 --> 00:10:59,360
YEARS SINCE WE'VE BEEN DOING

265
00:10:59,360 --> 00:11:00,520
THIS INITIALLY AND EVEN THOUGH

266
00:11:00,520 --> 00:11:02,880
WE HAVE NOT BEEN TOGETHER, THE

267
00:11:02,880 --> 00:11:04,600
COLLECTIVE TEAMS IN THE HILL

268
00:11:04,600 --> 00:11:10,120
COMMUNITY HAVE DONE A TREMENDOUS

269
00:11:10,120 --> 00:11:12,160
AMOUNT OF WORK VERY PROUD OF THE

270
00:11:12,160 --> 00:11:13,000
ACTIVITIES AND ACCOMPLISHMENTS

271
00:11:13,000 --> 00:11:14,920
AND I WILL TRY TO RUN THROUGH

272
00:11:14,920 --> 00:11:15,880
THEM QUICKLY BUT YOU WILL HEAR

273
00:11:15,880 --> 00:11:17,560
ABOUT THEM IN MORE DETAIL AS THE

274
00:11:17,560 --> 00:11:18,640
MEETING GOES ON FROM THE CO

275
00:11:18,640 --> 00:11:20,480
CHAIRS OF THE HEAL SCIENTIFIC

276
00:11:20,480 --> 00:11:20,840
TEAMS.

277
00:11:20,840 --> 00:11:35,680
SO NEXT SLIDE, PLEASE.

278
00:11:35,680 --> 00:11:36,760
--OVERDOSE CONTINUES TO

279
00:11:36,760 --> 00:11:41,600
DEVASTATE COMMUNITIES ACROSS THE

280
00:11:41,600 --> 00:11:41,960
COUNTRY.

281
00:11:41,960 --> 00:11:43,840
IT HAS NOT GONE AWAY DURING

282
00:11:43,840 --> 00:11:45,280
COVID, IT HAS ACTUALLY GOTTEN

283
00:11:45,280 --> 00:11:46,400
WORSE DESPITE OUR RESEARCH AND

284
00:11:46,400 --> 00:11:47,480
POLICY EFFORTS.

285
00:11:47,480 --> 00:11:51,040
THERE WAS A 20% IN CREASE IN

286
00:11:51,040 --> 00:11:53,040
FATAL DRUG OVERDOSES, THAT'S ALL

287
00:11:53,040 --> 00:11:54,560
DRUG OVERDOSES IN THE LAST 12

288
00:11:54,560 --> 00:11:59,040
MONTH PERIOD FOR WHICH WE HAVE

289
00:11:59,040 --> 00:12:00,240
GOOD DATA AND THOSE THAT ARE

290
00:12:00,240 --> 00:12:02,640
LIVES THAT ARE IMPORTANT TO US

291
00:12:02,640 --> 00:12:04,200
AND THOSE ARE DEATH THAT ARE

292
00:12:04,200 --> 00:12:07,000
PREVENTIBLE AND YET WE ARE

293
00:12:07,000 --> 00:12:08,640
STRUGGLING TO USE OUR RESEARCH

294
00:12:08,640 --> 00:12:10,600
AND OUR COMMUNITIES TO PULL

295
00:12:10,600 --> 00:12:13,760
TOGETHER AND PREVENT THESE

296
00:12:13,760 --> 00:12:14,080
DEATHS.

297
00:12:14,080 --> 00:12:17,200
AS YOU HEARD FROM DR. TABAK,

298
00:12:17,200 --> 00:12:18,320
THERE ARE POWERFUL TRENDS THAT

299
00:12:18,320 --> 00:12:20,760
ARE DRIVING OVERDOSE AND USE

300
00:12:20,760 --> 00:12:21,920
PATTERNS IN THE UNITED STATES

301
00:12:21,920 --> 00:12:24,720
INCLUDING THE RISE OF SYNTHETIC

302
00:12:24,720 --> 00:12:25,640
OPIOIDS LIKE FENTANYL AND THE

303
00:12:25,640 --> 00:12:29,760
USE OF MORE THAN 1 SUBSTANCE.

304
00:12:29,760 --> 00:12:31,680
INCLUDING BUT NOT LIMITED TO

305
00:12:31,680 --> 00:12:32,080
OPIOIDS.

306
00:12:32,080 --> 00:12:33,600
THE MAJORITY OF THESE OVERDOSE

307
00:12:33,600 --> 00:12:34,600
DEATHS ARE ASSOCIATED WITH

308
00:12:34,600 --> 00:12:37,040
OPIOIDS BUT NOT ALL OF THEM AND

309
00:12:37,040 --> 00:12:40,440
RISE IN THE USE OF STIMULANTS IS

310
00:12:40,440 --> 00:12:42,760
PUTTING A LOT MORE PEOPLE AT

311
00:12:42,760 --> 00:12:42,960
RISK.

312
00:12:42,960 --> 00:12:44,200
AND THEN, IT'S ALSO IMPORTANT TO

313
00:12:44,200 --> 00:12:45,160
ACKNOWLEDGE THAT THE DEATHS ARE

314
00:12:45,160 --> 00:12:48,120
JUST THE TIP OF THE ICEBERG.

315
00:12:48,120 --> 00:12:50,280
WE HAVE A LOT OF AMERICANS WHO

316
00:12:50,280 --> 00:12:52,920
MISUSE OPIOIDS OR HAVE AN OPIOID

317
00:12:52,920 --> 00:12:55,680
USE DISORDER WHO DO NOT HAVE

318
00:12:55,680 --> 00:12:57,240
ACCESS TO HIGH QUALITY CARE AND

319
00:12:57,240 --> 00:12:57,960
DON'T HAVE TREATMENTS AVAILABLE

320
00:12:57,960 --> 00:13:01,040
THAT WORK FOR THEM.

321
00:13:01,040 --> 00:13:02,680
AND COLLECTIVELY, THIS IS

322
00:13:02,680 --> 00:13:04,400
DRIVING US TO LOOK AT WHAT WE

323
00:13:04,400 --> 00:13:08,080
CAN DO AS RESEARCH COMMUNITY AND

324
00:13:08,080 --> 00:13:10,400
PULL TOGETHER A REALLY ROBUST

325
00:13:10,400 --> 00:13:11,400
AND DIVERSE PORTFOLIO OF EFFORTS

326
00:13:11,400 --> 00:13:13,720
TO ADDRESS THIS CRISIS.

327
00:13:13,720 --> 00:13:17,800
AND WE WOULD NOT BE ABLE TO

328
00:13:17,800 --> 00:13:19,960
PROVIDE LASTING AND DURABLE

329
00:13:19,960 --> 00:13:21,440
SOLUTIONS TO THE NATIONAL OPIOID

330
00:13:21,440 --> 00:13:24,160
CRISIS IF WE WERE NOT ABLE

331
00:13:24,160 --> 00:13:25,200
TO--IF WE ARE NOT ABLE TO

332
00:13:25,200 --> 00:13:27,240
ADDRESS THE NEEDS OF THE

333
00:13:27,240 --> 00:13:30,360
MILLIONS OF AMERICANS WHO

334
00:13:30,360 --> 00:13:30,880
EXPERIENCE PAIN.

335
00:13:30,880 --> 00:13:33,560
SO THE NEXT SLIDE SHOWS, JUST

336
00:13:33,560 --> 00:13:37,360
HOW MANY AMERICANS THIS IS,

337
00:13:37,360 --> 00:13:38,760
50 MILLION AMERICAN ADULTS

338
00:13:38,760 --> 00:13:40,240
EXPERIENCE CHRONIC PAIN, ABOUT

339
00:13:40,240 --> 00:13:43,320
HALF OF THEM EXPERIENCE SEVERE

340
00:13:43,320 --> 00:13:46,040
PAIN EVERY DAY.

341
00:13:46,040 --> 00:13:46,640
20 MILLION HAVE SUCH CHRONIC

342
00:13:46,640 --> 00:13:48,480
PAIN THAT THEY'RE NOT ABLE TO

343
00:13:48,480 --> 00:13:52,440
CARRY OUT FUNCTIONS THAT GIVE

344
00:13:52,440 --> 00:13:53,240
THEIR LIFE MEANING AND AND WE

345
00:13:53,240 --> 00:13:56,040
HAVE ALL OF THESE--WE HAVE

346
00:13:56,040 --> 00:13:56,840
LIMITED THERAPEUTIC OPTIONS FOR

347
00:13:56,840 --> 00:14:00,240
PEOPLE WITH PAIN AND SO, THESE

348
00:14:00,240 --> 00:14:03,160
PATIENTS ARE EXPOSED TO RISKS

349
00:14:03,160 --> 00:14:04,800
ASSOCIATED WITH OPIOIDS AND FACE

350
00:14:04,800 --> 00:14:09,120
CHALLENGES TO OBTAINING HIGH

351
00:14:09,120 --> 00:14:09,840
QUALITY EFFECTIVE

352
00:14:09,840 --> 00:14:10,320
MULTIDISCIPLINARY PAIN

353
00:14:10,320 --> 00:14:11,440
MANAGEMENT THAT THEY NEED.

354
00:14:11,440 --> 00:14:25,200
SO IN THE NEXT SLIDE ... WE

355
00:14:25,200 --> 00:14:27,040
STARTED THE HEAL INITIATIVE,

356
00:14:27,040 --> 00:14:28,560
HELPING TO END ADDICTION

357
00:14:28,560 --> 00:14:30,040
LONG-TERM, LIKE THE CRISIS IS

358
00:14:30,040 --> 00:14:32,240
LARGE IN SCOPE AND SCALE.

359
00:14:32,240 --> 00:14:34,800
WE'VE NOW SPENT OVER 2 BILLION

360
00:14:34,800 --> 00:14:36,080
DOLLARS IN RESEARCH ACROSS 600

361
00:14:36,080 --> 00:14:39,720
DIFFERENT PROJECTINGS, LARGE

362
00:14:39,720 --> 00:14:46,760
NUMBER OF NEWLY LAUNCHED

363
00:14:46,760 --> 00:14:48,120
PROGRAMS ACROSS ALL 50 STATES

364
00:14:48,120 --> 00:14:50,320
AND A LARGE NUMBER OF FUNDING

365
00:14:50,320 --> 00:14:51,520
OPPORTUNITY ANNOUNCEMENT VS COME

366
00:14:51,520 --> 00:14:54,920
THROUGH TARGETING SPECIFIC AREAS

367
00:14:54,920 --> 00:14:56,600
OF NEED FOR RESEARCH TO ADDRESS

368
00:14:56,600 --> 00:14:58,040
THE CRISIS, 30 OF THESE ARE NOW

369
00:14:58,040 --> 00:14:59,520
OPEN, SO IF YOU ARE TUNING IN

370
00:14:59,520 --> 00:15:00,800
AND YOU'RE INTERESTED IN BEING

371
00:15:00,800 --> 00:15:02,800
PART OF HEAL, PLEASE GO TO OUR

372
00:15:02,800 --> 00:15:05,000
WEBSITE AND SEE THE OPEN FUNDING

373
00:15:05,000 --> 00:15:05,680
OPPORTUNITIES AND LOOK FOR

374
00:15:05,680 --> 00:15:08,320
SOMETHING THAT MIGHT BE A MATCH

375
00:15:08,320 --> 00:15:10,040
FOR YOU BECAUSE THE NUMBER OF

376
00:15:10,040 --> 00:15:11,440
DIFFERENT TYPES OF RESEARCH THAT

377
00:15:11,440 --> 00:15:13,640
WE ARE FUNDING IS EXTREMELY

378
00:15:13,640 --> 00:15:16,720
LARGE AND IT'S BROAD.

379
00:15:16,720 --> 00:15:19,600
SO WE REFLECTING THE COMPLEXITY

380
00:15:19,600 --> 00:15:21,200
OF THE CRISIS, WE HAVE

381
00:15:21,200 --> 00:15:22,440
PREVENTION RESEARCH, WE HAVE

382
00:15:22,440 --> 00:15:23,120
BASIC AND TRANSLATIONAL SCIENCE

383
00:15:23,120 --> 00:15:25,800
TRYING TO COME UP WITH NEW

384
00:15:25,800 --> 00:15:26,240
THERAPEUTIC OPTIONS.

385
00:15:26,240 --> 00:15:29,480
A LARGE NUMBER OF CLINICAL

386
00:15:29,480 --> 00:15:30,040
TRIALS, TESTING SPECIFIC

387
00:15:30,040 --> 00:15:32,400
INTERVENTIONS FOR PAIN AND

388
00:15:32,400 --> 00:15:33,440
ADDICTION AND SPECIFIC

389
00:15:33,440 --> 00:15:35,520
POPULATIONS AND IN SPECIFIC

390
00:15:35,520 --> 00:15:36,360
SETTINGS, TRYING TO INFORM THE

391
00:15:36,360 --> 00:15:38,800
BEST TREATMENT FOR THE

392
00:15:38,800 --> 00:15:40,640
POPULATIONS WE SERVE.

393
00:15:40,640 --> 00:15:42,880
AND THEN LASTLY, A FOCUS ON

394
00:15:42,880 --> 00:15:43,400
IMPLEMENTATION SCIENCE.

395
00:15:43,400 --> 00:15:45,640
HOW DO WE TAKE THE

396
00:15:45,640 --> 00:15:46,480
EVIDENCE-BASED INTERVENTIONS AND

397
00:15:46,480 --> 00:15:49,120
KNOWLEDGE THAT WE HAVE AND

398
00:15:49,120 --> 00:15:50,200
CONVERT THAT INTO TREATMENTS AND

399
00:15:50,200 --> 00:15:52,320
APPROACHES THAT WORK FOR PEOPLE.

400
00:15:52,320 --> 00:15:55,440
SO HERE ON YOUR RIGHT IS THE

401
00:15:55,440 --> 00:15:58,040
DIAGRAM OF THE DIFFERENT

402
00:15:58,040 --> 00:15:59,360
RESEARCH FOCUS AREAS WITHIN

403
00:15:59,360 --> 00:15:59,600
HEAL.

404
00:15:59,600 --> 00:16:02,000
THIS WILL BE OUR MAP FOR TODAY.

405
00:16:02,000 --> 00:16:03,640
YOU WILL HEAR FROM THE

406
00:16:03,640 --> 00:16:05,960
LEADERSHIP OF EACH OF THE

407
00:16:05,960 --> 00:16:06,720
SCIENTIFIC TEAMS REFLECTING

408
00:16:06,720 --> 00:16:08,200
THESE RESEARCH FOCUS AREAS BUT

409
00:16:08,200 --> 00:16:11,040
BEFORE THAT, I WILL GO THROUGH

410
00:16:11,040 --> 00:16:14,280
EACH 1 AND BRIEFLY DESCRIBE NOT

411
00:16:14,280 --> 00:16:15,720
ONLY WHAT RESEARCH IS TAKING ON,

412
00:16:15,720 --> 00:16:18,640
BUT ALSO SOME OF THE NEW

413
00:16:18,640 --> 00:16:20,280
DIRECTIONS THAT WE'VE LAUNCHED

414
00:16:20,280 --> 00:16:23,240
IN THE PAST YEAR OR 2 AS WE'VE

415
00:16:23,240 --> 00:16:25,080
BEEN SO INCREDIBLY ACTIVE.

416
00:16:25,080 --> 00:16:26,920
SO NEXT SLIDE, PLEASE.

417
00:16:26,920 --> 00:16:28,680
THE FIRST AREA OF RESEARCH FOCUS

418
00:16:28,680 --> 00:16:31,200
IS PRECLINICAL AND TRANSLATIONAL

419
00:16:31,200 --> 00:16:32,240
RESEARCH IN PAIN MANAGEMENT.

420
00:16:32,240 --> 00:16:35,040
THIS IS OUR EFFORT TO COME UP

421
00:16:35,040 --> 00:16:37,600
WITH NEW TARGETS, NEW

422
00:16:37,600 --> 00:16:39,440
THERAPEUTIC OPTIONS, NEW DEVICES

423
00:16:39,440 --> 00:16:40,840
AND APPROACHES FOR MANAGING PAIN

424
00:16:40,840 --> 00:16:45,080
THAT ARE NOT ADDICTIVE.

425
00:16:45,080 --> 00:16:47,080
SO THIS INCORPORATES A NUMBER OF

426
00:16:47,080 --> 00:16:47,680
DIFFERENT REALLY INNOVATIVE

427
00:16:47,680 --> 00:16:50,360
STUDIES THAT ARE BEGINNING TO

428
00:16:50,360 --> 00:16:53,160
BEAR FRUIT INCLUDING PATENTS AND

429
00:16:53,160 --> 00:16:55,000
INDs FOR NOVEL CANDIDATES TO

430
00:16:55,000 --> 00:16:57,040
TREAT CHRONIC PAIN BUT ALSO A

431
00:16:57,040 --> 00:16:58,720
LOT OF RESEARCH PROGRESS IN THE

432
00:16:58,720 --> 00:17:02,800
MODELS AND SYSTEMS WE CAN USE TO

433
00:17:02,800 --> 00:17:03,920
AS A COLLECTIVE ADVANCE

434
00:17:03,920 --> 00:17:07,440
THERAPEUTIC OPTIONS THROUGH THE

435
00:17:07,440 --> 00:17:08,080
PIPELINE.

436
00:17:08,080 --> 00:17:11,600
I'M REALLY WORKING TO INCREASE

437
00:17:11,600 --> 00:17:14,320
TEAM BASED RESEARCH, SO THAT

438
00:17:14,320 --> 00:17:15,640
INNOVATIVE AND PROMISING

439
00:17:15,640 --> 00:17:17,320
CANDIDATES DON'T GET LOST FROM 1

440
00:17:17,320 --> 00:17:17,800
SET TO THE NEXT.

441
00:17:17,800 --> 00:17:25,840
AND THE NEXT SLIDE.

442
00:17:25,840 --> 00:17:28,240
YOU CAN SEE SOME OF THE ADVANCES

443
00:17:28,240 --> 00:17:29,240
IN THIS WORKING SPACE, THE

444
00:17:29,240 --> 00:17:31,000
WORKING GROUP GAVE A LOT OF

445
00:17:31,000 --> 00:17:35,360
FEEDBACK THAT LED TO A NEW AND

446
00:17:35,360 --> 00:17:36,160
EXPANDED ANALGESIC THERAPEUTIC

447
00:17:36,160 --> 00:17:40,640
DEVELOPMENT PROGRAM, BOTH

448
00:17:40,640 --> 00:17:42,400
PLANNING STUDIES AND MORE LARGE

449
00:17:42,400 --> 00:17:45,080
SCALE PHASED ASHES WARDS TO

450
00:17:45,080 --> 00:17:46,600
ADVANCE THERAPEUTIC OPTIONS FOR

451
00:17:46,600 --> 00:17:47,680
TREATING PAIN AND THEN PLANNED

452
00:17:47,680 --> 00:17:49,800
FOR THIS COMING YEAR, FY22 AND

453
00:17:49,800 --> 00:17:51,240
I'M ALSO THINKING OF A FISCAL

454
00:17:51,240 --> 00:17:54,360
YEAR HERE, WHEN IT SAYS 22,

455
00:17:54,360 --> 00:17:58,080
INCREASED RESEARCH IN DEVICES TO

456
00:17:58,080 --> 00:18:01,200
TREAT PATIENT, WAYS TO STUDY AND

457
00:18:01,200 --> 00:18:03,400
UNDERSTAND PAIN, NOT IN ANIMAL

458
00:18:03,400 --> 00:18:05,680
MODELS BUT IN HUMAN GENES

459
00:18:05,680 --> 00:18:06,000
THEMSELVES.

460
00:18:06,000 --> 00:18:07,040
A FOCUS ON JOINTS THROUGH THE

461
00:18:07,040 --> 00:18:08,640
REJOIN PROGRAM AND A NUMBER OF

462
00:18:08,640 --> 00:18:10,840
AWARDS FOR EARLY STAGE

463
00:18:10,840 --> 00:18:11,840
INVESTIGATORS AND INNOVATIVE

464
00:18:11,840 --> 00:18:14,960
APPROACHES INCLUDING THE HEAL

465
00:18:14,960 --> 00:18:15,360
INNOVATOR AWARDS.

466
00:18:15,360 --> 00:18:16,640
I WILL NOW MOVE TO CLINICAL

467
00:18:16,640 --> 00:18:21,880
RESEARCH AND PAIN MANAGEMENT.

468
00:18:21,880 --> 00:18:24,160
NEXT SLIDE.

469
00:18:24,160 --> 00:18:26,120
WHERE OUR SCIENTIFIC EXPERTS

470
00:18:26,120 --> 00:18:29,400
SEEK TO PROVIDE INFORMATION TO

471
00:18:29,400 --> 00:18:31,040
CLINICIANS AND PATIENTS AND

472
00:18:31,040 --> 00:18:32,240
CAREGIVERS ABOUT WHAT THERAPIES

473
00:18:32,240 --> 00:18:34,440
AND TREATMENT APPROACHES WORK

474
00:18:34,440 --> 00:18:35,680
BEST FOR SPECIFIC PAIN

475
00:18:35,680 --> 00:18:38,400
CONDITIONS AND IN SPECIFIC

476
00:18:38,400 --> 00:18:38,720
SETTINGS.

477
00:18:38,720 --> 00:18:41,800
THERE'S A LARGE NUMBER OF

478
00:18:41,800 --> 00:18:43,680
CLINICAL TRIALS UNDERWAY IN THIS

479
00:18:43,680 --> 00:18:45,560
AREA OF RESEARCH FOCUS.

480
00:18:45,560 --> 00:18:46,720
SOME FOCUSED ON SPECIFIC PAIN

481
00:18:46,720 --> 00:18:50,920
CONDITIONS FOR WHICH WE KNOW WE

482
00:18:50,920 --> 00:18:53,240
MIGHT PUT A LOT OF PEOPLE AT

483
00:18:53,240 --> 00:18:56,480
RISK FOR OPIOIDS SUCH AS

484
00:18:56,480 --> 00:18:57,680
MUSCULOSKELETAL PAIN CONDITIONS,

485
00:18:57,680 --> 00:19:00,640
CHRONIC LOW BACK PAIN BUT ALSO

486
00:19:00,640 --> 00:19:01,680
PROGRAMS THAT ARE PRETTY

487
00:19:01,680 --> 00:19:03,600
AGNOSTIC TO THE PAIN CONDITION

488
00:19:03,600 --> 00:19:06,240
BUT ARE LOOKING TO COMPARE 1

489
00:19:06,240 --> 00:19:07,240
TREATMENT VERSUS ANOTHER OR

490
00:19:07,240 --> 00:19:09,040
INTEGRATE INTO HEALTHCARE

491
00:19:09,040 --> 00:19:09,800
SYSTEMS, EVIDENCE-BASED

492
00:19:09,800 --> 00:19:12,320
TREATMENTS FOR A SPECIFIC PAIN

493
00:19:12,320 --> 00:19:12,640
CONDITIONS.

494
00:19:12,640 --> 00:19:15,520
ALL OF THESE ARE USING A CORE

495
00:19:15,520 --> 00:19:17,200
SET OF COMMON DATA ELEMENTS SO

496
00:19:17,200 --> 00:19:19,240
THAT RESEARCH CAN BE COMPARED

497
00:19:19,240 --> 00:19:19,880
ACROSS THE DIFFERENT PROGRAMS

498
00:19:19,880 --> 00:19:24,720
AND IN THE NEXT SLIDE CAN SEE

499
00:19:24,720 --> 00:19:26,040
WE'RE ALSO REALLY TRYING TO

500
00:19:26,040 --> 00:19:27,600
FECUS ON AREAS WHERE ADDITIONAL

501
00:19:27,600 --> 00:19:29,320
WORK IS NEEDED SO THE EMPOWER

502
00:19:29,320 --> 00:19:32,040
PROGRAM OF WHICH I'M REALLY

503
00:19:32,040 --> 00:19:33,360
PROUD AND WHICH WAS LAUNCHED

504
00:19:33,360 --> 00:19:37,640
WITH A LOT OF INPUT FROM THIS

505
00:19:37,640 --> 00:19:38,600
MULTIDISCIPLINARY WORKING GROUP

506
00:19:38,600 --> 00:19:40,320
SEEKS TO ADDRESS CHRONIC PAIN

507
00:19:40,320 --> 00:19:41,760
AMONG PEOPLE WITH OPIOID USE

508
00:19:41,760 --> 00:19:44,200
DISORDER OR A HISTORY OF OPIOID

509
00:19:44,200 --> 00:19:46,080
USE DISORDER FOR WHOM OPIOIDS

510
00:19:46,080 --> 00:19:48,120
ARE REALLY NOT GOOD CANDIDATES

511
00:19:48,120 --> 00:19:49,240
FOR PAIN MANAGEMENT AND THEN

512
00:19:49,240 --> 00:19:51,640
ALSO A REALLY SIGNIFICANT EFFORT

513
00:19:51,640 --> 00:19:53,640
TO FOCUS ON HEALTH EQUITY AND

514
00:19:53,640 --> 00:19:54,400
HEALTH DISPARITIES WHICH REALLY

515
00:19:54,400 --> 00:19:56,800
KEEP A LOT OF PEOPLE FROM

516
00:19:56,800 --> 00:19:58,640
ACCESSING HIGH QUALITY PAIN CARE

517
00:19:58,640 --> 00:20:00,040
THAT THEY NEED.

518
00:20:00,040 --> 00:20:03,160
AND THAT INCLUDES EFFORTS TO

519
00:20:03,160 --> 00:20:04,880
ADDRESS BIAS, STIGMA AND OTHER

520
00:20:04,880 --> 00:20:06,640
BARRIERS TO HIGH QUALITY PAIN

521
00:20:06,640 --> 00:20:07,000
CARE.

522
00:20:07,000 --> 00:20:11,120
>> LOOKING FORWARD, WE HAVE

523
00:20:11,120 --> 00:20:12,720
ADDITIONAL BIOMARKERS EFFORTS IN

524
00:20:12,720 --> 00:20:17,280
THE PLANNING STAGES AS WELL AS

525
00:20:17,280 --> 00:20:18,880
EFFORTS TO ENHANCE THE PAIN

526
00:20:18,880 --> 00:20:20,560
RESEARCH WORKFORCE AND A LOT OF

527
00:20:20,560 --> 00:20:22,040
DIFFERENT DIMENSIONS AND ALSO

528
00:20:22,040 --> 00:20:24,040
START USING SOME OF THE DATA

529
00:20:24,040 --> 00:20:28,040
TOOLS THAT WE HAVE TO LOOK OVER

530
00:20:28,040 --> 00:20:30,280
EXISTING DATA SETS AND COME UP

531
00:20:30,280 --> 00:20:31,840
WITH NEW INSIGHTS AND NEW

532
00:20:31,840 --> 00:20:33,640
SCIENTIFIC SOLUTIONS FOR

533
00:20:33,640 --> 00:20:35,880
UNDERSTANDING AND TREATING PAIN.

534
00:20:35,880 --> 00:20:37,600
SO THOSE ARE THE 2 AREAS OF

535
00:20:37,600 --> 00:20:40,200
RESEARCH FOCUS ON THE ENHANCING

536
00:20:40,200 --> 00:20:42,240
PAIN MANAGEMENT SIDE, I WILL NOW

537
00:20:42,240 --> 00:20:44,280
MOVE TO RESEARCH TO IMPROVE

538
00:20:44,280 --> 00:20:45,640
TREATMENTS AND PREVENTION

539
00:20:45,640 --> 00:20:48,480
STRATEGIES FOR OPIOID USE AND

540
00:20:48,480 --> 00:20:49,240
ADDICTION.

541
00:20:49,240 --> 00:20:52,880
IN THE PREVENTION SPACE, THIS IS

542
00:20:52,880 --> 00:20:56,880
SO IMPORTANT TO NOT WAIT UNTIL A

543
00:20:56,880 --> 00:20:59,120
PERSON HAS A CLINICAL OPIOID USE

544
00:20:59,120 --> 00:21:01,520
DISORDER BUT TO INTERVENE AND

545
00:21:01,520 --> 00:21:02,840
PREVENT THE DEVELOPMENT OF

546
00:21:02,840 --> 00:21:05,960
OPIOID USE AND ADDICTION, WE DO

547
00:21:05,960 --> 00:21:09,040
THAT BY FOCUSING ON CERTAIN AT

548
00:21:09,040 --> 00:21:10,640
RISK GROUPS LIKE YOUNG ADULGTS

549
00:21:10,640 --> 00:21:14,200
AND PEOPLE IN POPULATIONS LIKE

550
00:21:14,200 --> 00:21:21,240
AMERICAN INDIAN AND ALASKA INN

551
00:21:21,240 --> 00:21:23,080
NATIVES ALSO USING TOOLS AND ALL

552
00:21:23,080 --> 00:21:24,400
OF THEA SPECTS THAT CONTRIBUTE

553
00:21:24,400 --> 00:21:28,440
TO A PERSON'S SLEEP DISORDER

554
00:21:28,440 --> 00:21:32,240
INCLUDING SLEEP, CIRCADIAN

555
00:21:32,240 --> 00:21:33,640
RHYTHM AND MENTAL HEALTH

556
00:21:33,640 --> 00:21:34,040
CONDITIONS.

557
00:21:34,040 --> 00:21:36,240
>> OT NEXT SLIDE, CAN YOU SEE

558
00:21:36,240 --> 00:21:40,320
MANY AREAS OF NEW RESEARCH LED

559
00:21:40,320 --> 00:21:41,840
BY THIS SCIENTIFIC TEAM.

560
00:21:41,840 --> 00:21:44,160
SO SERVICE DELIVERY

561
00:21:44,160 --> 00:21:47,000
INTERVENTIONS FOR OPIOID USE

562
00:21:47,000 --> 00:21:48,040
DISORDER AND MENTAL HEALTH

563
00:21:48,040 --> 00:21:49,040
CONDITIONS, ESPECIALLY THOSE

564
00:21:49,040 --> 00:21:50,360
THAT FOCUS ON PRIMARY CARE.

565
00:21:50,360 --> 00:21:56,280
AND THEN A NUMBER OF UPON

566
00:21:56,280 --> 00:21:58,560
STUDIES ARE INCLUDED FOR 2022

567
00:21:58,560 --> 00:22:00,160
INCLUDING WAYS FOR POLYSUBSTANCE

568
00:22:00,160 --> 00:22:02,760
USE, WAYS TO BETTER SCREEN

569
00:22:02,760 --> 00:22:04,880
INDIVIDUALS FOR OPIOID USE

570
00:22:04,880 --> 00:22:06,640
DISORDER AND WAYS TO INTERVENE

571
00:22:06,640 --> 00:22:08,280
ON SOCIAL DETERMINANTS OF HEALTH

572
00:22:08,280 --> 00:22:12,240
TO PREVENT OPILOT PROJECTIE USE

573
00:22:12,240 --> 00:22:16,240
PROGRESSION AND PREVENT MISUSE

574
00:22:16,240 --> 00:22:16,640
FOR OPIOID DISORDER.

575
00:22:16,640 --> 00:22:18,720
SO AS YOU CAN SEE A REALLY NEW

576
00:22:18,720 --> 00:22:20,680
SET OF ROBUST PLANS ARE UNDERWAY

577
00:22:20,680 --> 00:22:21,200
IN THIS SPACE.

578
00:22:21,200 --> 00:22:24,400
IN THE NEXT SLIDE, WE ADDRESS

579
00:22:24,400 --> 00:22:26,840
THE NEED OF THE MANY, MANY

580
00:22:26,840 --> 00:22:29,240
PEOPLE WITH OPOID USE DISORDER

581
00:22:29,240 --> 00:22:30,400
WHO NEVER RECEIVE APPROPRIATE

582
00:22:30,400 --> 00:22:32,160
TREATMENT FOR THEIR CONDITION.

583
00:22:32,160 --> 00:22:33,440
IT'S REALLY A MINORITY OF

584
00:22:33,440 --> 00:22:35,160
PATIENT WHO IS RECEIVE

585
00:22:35,160 --> 00:22:37,200
APPROPRIATE TREATMENT AND SO, WE

586
00:22:37,200 --> 00:22:40,640
SEEK TO TAKE THE EVIDENCE-BASED

587
00:22:40,640 --> 00:22:42,040
INTERVENTIONS AND PREVENTION

588
00:22:42,040 --> 00:22:43,440
STRATEGIES THAT WE HAVE AND PUT

589
00:22:43,440 --> 00:22:46,040
THEM INTO THE HANDS OF PEOPLE

590
00:22:46,040 --> 00:22:47,880
AND SETTINGS WHERE PEOPLE WITH

591
00:22:47,880 --> 00:22:52,320
ADDICTION COME SEEKING HELP, SO

592
00:22:52,320 --> 00:22:53,880
THAT CAN BE A COMMUNITY SETTING,

593
00:22:53,880 --> 00:22:55,640
PRIMARY CARE SETTING AND A LOT

594
00:22:55,640 --> 00:22:57,640
OF TERRIFIC PROGRESS HAS BEEN

595
00:22:57,640 --> 00:22:59,840
UNDERWAY IN THESE GROUPS

596
00:22:59,840 --> 00:23:02,560
ESPECIALLY IN SPECIFIC DOMAINS

597
00:23:02,560 --> 00:23:05,600
LIKE EDUCATING PEOPLE FOR THE

598
00:23:05,600 --> 00:23:07,240
USE OF NOLOXONE FOR OVERDOSE AND

599
00:23:07,240 --> 00:23:09,920
LOOKING AT THESE COMMUNITIES AND

600
00:23:09,920 --> 00:23:10,640
SPECIFIC STAKEHOLDERS, SPECIFIC

601
00:23:10,640 --> 00:23:13,760
PLACES WHERE THEY CAN WILL IT

602
00:23:13,760 --> 00:23:15,280
US, HERE'S WHAT WE NEED, HERE'S

603
00:23:15,280 --> 00:23:16,480
INFORMATION THAT'S GOING TO MAKE

604
00:23:16,480 --> 00:23:19,000
A CHANGE FOR US AND FOR THE

605
00:23:19,000 --> 00:23:20,440
PEOPLE WE SERVE AND WORKING IN

606
00:23:20,440 --> 00:23:22,040
PARTNERSHIP TO DO SO.

607
00:23:22,040 --> 00:23:23,840
AND IN THE NEXT SLIDE, YOU SEE

608
00:23:23,840 --> 00:23:27,440
SOME OF THE DIRECTIONS WE'RE

609
00:23:27,440 --> 00:23:33,080
MOVING INCLUDING AN ADDITIONAL

610
00:23:33,080 --> 00:23:34,920
INVESTMENT AND INVESTMENT

611
00:23:34,920 --> 00:23:36,240
RECOVERY RESEARCH, WAYS TO

612
00:23:36,240 --> 00:23:37,200
UNDERSTAND HARM REDUCTION

613
00:23:37,200 --> 00:23:39,320
STRATEGIES BOTH HOW THEY MIGHT

614
00:23:39,320 --> 00:23:41,320
AFFECT BEHAVIOR CHANGE AND ALSO

615
00:23:41,320 --> 00:23:42,000
OPPORTUNITIES FOR INNOVATION AND

616
00:23:42,000 --> 00:23:45,240
THEN A NUMBER OF DATA FOCUSED

617
00:23:45,240 --> 00:23:48,240
EFFORTS SEEKING TO GIVE OUR

618
00:23:48,240 --> 00:23:49,360
STAKEHOLDERS THE DATA THEY NEED

619
00:23:49,360 --> 00:23:50,800
AND PROVIDING THEM WITH

620
00:23:50,800 --> 00:23:52,320
INFRASTRUCTURE AND TOOLS TO

621
00:23:52,320 --> 00:23:53,440
ADOPT THE RESEARCH FINDINGS THAT

622
00:23:53,440 --> 00:23:55,160
COME OUT OF THE HEAL INITIATIVE

623
00:23:55,160 --> 00:23:58,800
AND THAT MIGHT EVEN BE AVAILABLE

624
00:23:58,800 --> 00:24:02,040
TO THEM IN THEIR LOCAL

625
00:24:02,040 --> 00:24:02,320
COMMUNITIES.

626
00:24:02,320 --> 00:24:03,920
>> SO THAT'S THE AREA OF

627
00:24:03,920 --> 00:24:05,080
IMPLEMENTATION SCIENCE WHERE WE

628
00:24:05,080 --> 00:24:07,080
SEEK TO TRANSLATE THE RESEARCH

629
00:24:07,080 --> 00:24:13,240
INTO PRACTICE, AND IN THE NEXT

630
00:24:13,240 --> 00:24:14,880
SLIDE, THE NOVEL THERAPEUTIC

631
00:24:14,880 --> 00:24:17,240
OPTIONS AREA OF RESEARCH FOCUS

632
00:24:17,240 --> 00:24:19,000
SEEKS TO ADDRESS THE NEEDS OF

633
00:24:19,000 --> 00:24:20,400
PEOPLE WHO DO RECEIVE SOME KIND

634
00:24:20,400 --> 00:24:22,440
OF TREATMENT FOR OPIOID USE

635
00:24:22,440 --> 00:24:24,080
DISORDER BUT WHO ARE NOT ABLE TO

636
00:24:24,080 --> 00:24:27,040
STAY ON IT LONG ENOUGH TO

637
00:24:27,040 --> 00:24:30,240
ACHIEVE LONG-TERM RECOVERY OR

638
00:24:30,240 --> 00:24:33,440
OTHER MINORITY. 

639
00:24:33,440 --> 00:24:35,840
SO FOR THIS GROUP WE'RE POSTING

640
00:24:35,840 --> 00:24:37,840
THE QUESTION WELL WHAT

641
00:24:37,840 --> 00:24:38,520
ADDITIONAL THERAPEUTIC OPTIONS

642
00:24:38,520 --> 00:24:40,280
MIGHT MAKE IT EASIER FOR A

643
00:24:40,280 --> 00:24:41,440
PERSON TO STAY ON TREATMENT AND

644
00:24:41,440 --> 00:24:43,200
MAKE IT MORE LIKELY FOR A PERSON

645
00:24:43,200 --> 00:24:48,280
TO ENTER LONG-TERM RECOVERY AND

646
00:24:48,280 --> 00:24:50,400
SO THAT IS ENCOMPASSES A LARGE

647
00:24:50,400 --> 00:24:51,680
NUMBER OF THERAPEUTIC PROGRAMS,

648
00:24:51,680 --> 00:24:54,280
BOTH APPROACHES TO MAKE LONGER

649
00:24:54,280 --> 00:24:56,000
LASTING OR MORE USER FRIENDLY

650
00:24:56,000 --> 00:24:57,600
VERSION OF THE MEDICATIONS AND

651
00:24:57,600 --> 00:24:59,480
THERAPEUTIC TREATMENTS WE

652
00:24:59,480 --> 00:25:04,280
ALREADY HAVE AND THAT EFFORT HAS

653
00:25:04,280 --> 00:25:07,000
LED TO OVER 20 I&  Ds SINCE

654
00:25:07,000 --> 00:25:09,800
HEAL IPT GREATER LAUNCHED BUT

655
00:25:09,800 --> 00:25:10,480
ALSO NEW INVOCABULARYIVATIVE

656
00:25:10,480 --> 00:25:10,800
APPROACHES.

657
00:25:10,800 --> 00:25:13,120
NEW WAYS OF THINKING ABOUT

658
00:25:13,120 --> 00:25:15,320
ADDICTION AND HOW IT'S TREATED

659
00:25:15,320 --> 00:25:17,280
SO INCORPORATING SLEEP OUTCOMES

660
00:25:17,280 --> 00:25:19,480
AND OTHER MECHANISMS OF TREATING

661
00:25:19,480 --> 00:25:22,440
OPIOID USE DISORDER AND ALSO

662
00:25:22,440 --> 00:25:23,040
MODALITIES INCLUDING THE FIRST

663
00:25:23,040 --> 00:25:26,400
HUMAN STUDY OF A VACCINE FOR

664
00:25:26,400 --> 00:25:26,640
OPIOIDS.

665
00:25:26,640 --> 00:25:28,280
AND SOME DEVICES AS WELL.

666
00:25:28,280 --> 00:25:30,560
SO IN THE NEXT SLIDE, YOU CAN

667
00:25:30,560 --> 00:25:35,760
SEE HOW THIS RESEARCH IS MOVING

668
00:25:35,760 --> 00:25:39,600
INTO UNDERSTANDING MEDICATIONS

669
00:25:39,600 --> 00:25:40,240
AND THERAPEUTIC TREATMENTS FOR

670
00:25:40,240 --> 00:25:41,760
POLYSUBSTANCE USE AND INCLUDING

671
00:25:41,760 --> 00:25:44,000
THE USE OF STIMULANTS AND THAT

672
00:25:44,000 --> 00:25:47,080
INCLUDES NOT JUST PHARMA CO

673
00:25:47,080 --> 00:25:47,640
THERAPIES FOR OPIOID USE

674
00:25:47,640 --> 00:25:50,640
DISORDER BUT ALSO TO REVERSE

675
00:25:50,640 --> 00:25:54,240
OVERDOSE AND ALSO SOME DIGITAL

676
00:25:54,240 --> 00:25:55,280
THERAPEUTICS RECOGNIZING THAT

677
00:25:55,280 --> 00:25:57,040
ESPECIALLY IN THESE VIRTUAL

678
00:25:57,040 --> 00:25:58,800
DAYS, FOLKS ARE ON THEIR PHONES

679
00:25:58,800 --> 00:26:00,440
AND THERE MAY BE MODALITIES THAT

680
00:26:00,440 --> 00:26:03,680
WE HAVE NOT TESTED THAT COULD BE

681
00:26:03,680 --> 00:26:05,320
EFFECTIVE FOR TREATING OPIOID

682
00:26:05,320 --> 00:26:06,960
USE DISORDER IN THE CONTEXT OF

683
00:26:06,960 --> 00:26:11,040
THE USE OF OTHER SUBSTANCES AS

684
00:26:11,040 --> 00:26:11,240
WELL.

685
00:26:11,240 --> 00:26:14,120
>> NOW IN THE LAST AREA OF

686
00:26:14,120 --> 00:26:16,000
RESEARCH FOCUS, WE KNOW THAT

687
00:26:16,000 --> 00:26:16,680
OPIOID USE DOESN'T JUST AFFECT

688
00:26:16,680 --> 00:26:20,640
THE PERSON WHO USES IT, IT

689
00:26:20,640 --> 00:26:21,360
AFFECTS THEIR FAMILIES AND

690
00:26:21,360 --> 00:26:22,000
COMMUNITIES.

691
00:26:22,000 --> 00:26:24,120
AND FOR INSTANTS THERE CAN BE

692
00:26:24,120 --> 00:26:25,240
EXTREME CONSEQUENCES OF BEING

693
00:26:25,240 --> 00:26:28,440
EXPOSED TO OPIOIDS DURING A

694
00:26:28,440 --> 00:26:29,600
MOTHER'S PREGNANCY SO 2 PROGRAMS

695
00:26:29,600 --> 00:26:31,720
WITHIN THE HEAL INITIATIVE, THE

696
00:26:31,720 --> 00:26:33,560
ACT NOW ADVANCING CLINICAL

697
00:26:33,560 --> 00:26:35,640
TRIALS IN NEONATAL O, PILOT

698
00:26:35,640 --> 00:26:36,240
PROJECTOID WITHDRAWAL PROGRAM

699
00:26:36,240 --> 00:26:38,080
SEEKS TO UNDERSTAND HOW TO BEST

700
00:26:38,080 --> 00:26:40,320
TREAT THESE INFANTS, AND THEN

701
00:26:40,320 --> 00:26:43,280
THE HEALTHY BRAIN AND CHILD

702
00:26:43,280 --> 00:26:44,840
DEVELOPMENT STUDY OR HBCD, SEEKS

703
00:26:44,840 --> 00:26:46,440
TO UNDERSTAND WHAT THE

704
00:26:46,440 --> 00:26:48,760
CONSEQUENCES ARE FOR THESE

705
00:26:48,760 --> 00:26:50,200
EXPOSURES OVER THE LONG-TERM,

706
00:26:50,200 --> 00:26:51,240
TAKING INTO CONSIDERATION ALL

707
00:26:51,240 --> 00:26:54,120
THE OTHER ENVIRONMENTAL AND

708
00:26:54,120 --> 00:26:57,200
OTHER CONTRIBUTORS TO A CHILD'S

709
00:26:57,200 --> 00:26:59,160
BRAIN AND OVERALL DEVELOPMENT.

710
00:26:59,160 --> 00:27:04,040
SO IN THE NEXT SLIDE, CAN YOU

711
00:27:04,040 --> 00:27:05,600
SEE HOW WE--I'M VERY PROUD TO

712
00:27:05,600 --> 00:27:07,920
SAYEE LAUNCHED THE HEALTHY BRAIN

713
00:27:07,920 --> 00:27:09,640
AND CHILD DEVELOPMENT STUDY IN

714
00:27:09,640 --> 00:27:13,240
2021 AND ARE NOW IN THE PLANNING

715
00:27:13,240 --> 00:27:14,520
STAGES FOR COMPARATIVE

716
00:27:14,520 --> 00:27:15,320
EFFECTIVENESS TRIAL,

717
00:27:15,320 --> 00:27:18,360
UNDERSTANDING THE BEST WAY TO

718
00:27:18,360 --> 00:27:20,000
TREAT INFANTS WITH ANALYSIS, AND

719
00:27:20,000 --> 00:27:26,840
HAVE SOME WAYS OF ENHANCING AND

720
00:27:26,840 --> 00:27:29,400
STRENGTHENING THOSE PROGRAMS

721
00:27:29,400 --> 00:27:30,640
THROUGH SOME NAVIGATOR SUPPORT

722
00:27:30,640 --> 00:27:31,040
UNDERWAY AS WELL.

723
00:27:31,040 --> 00:27:34,000
SO THAT IS IT FOR THE AREAS OF

724
00:27:34,000 --> 00:27:36,360
THE 6 RESEARCH FOCUS AREAS BUT

725
00:27:36,360 --> 00:27:39,640
THERE ARE SOME CROSS CUTTING

726
00:27:39,640 --> 00:27:40,920
ELEMENTS THAT REALLY EFFECT ALL

727
00:27:40,920 --> 00:27:41,440
OF OUR RESEARCH.

728
00:27:41,440 --> 00:27:44,840
THE FIRST IS THE NEED TO

729
00:27:44,840 --> 00:27:47,280
INTEGRATE THE STRENGTHENS AND

730
00:27:47,280 --> 00:27:48,320
CAPABILITIES OF UNDERSTANDINGS

731
00:27:48,320 --> 00:27:50,640
OF PAIN AND OPIOID USE DISORDER

732
00:27:50,640 --> 00:27:52,240
RESEARCH THAT HAS BEEN A THEME

733
00:27:52,240 --> 00:27:54,000
THAT WE'VE HEARD FROM YOU SINCE

734
00:27:54,000 --> 00:27:55,240
WE FIRST STARTED AND HAS REALLY

735
00:27:55,240 --> 00:27:59,240
COME OUT OF OUR RESEARCH

736
00:27:59,240 --> 00:28:00,840
COMMUNITIES AND STAKEHOLDERS AS

737
00:28:00,840 --> 00:28:01,200
WELL.

738
00:28:01,200 --> 00:28:04,120
ACROSS ALL OF THIS RESEARCH, WE

739
00:28:04,120 --> 00:28:06,800
CONTINUE TO PRESS TO ENHANCE

740
00:28:06,800 --> 00:28:09,200
HEALTH EQUITY TO INCREASE THE

741
00:28:09,200 --> 00:28:10,480
DIVERSITY OF THE RESEARCH

742
00:28:10,480 --> 00:28:13,040
PARTICIPANTS INVOLVED IN OUR

743
00:28:13,040 --> 00:28:14,160
STUDIES AND TO UNDERSTAND WHAT

744
00:28:14,160 --> 00:28:18,880
RESEARCH CAN DO TO ADDRESS THESE

745
00:28:18,880 --> 00:28:19,200
INIQUITIES.

746
00:28:19,200 --> 00:28:20,880
PART OF THAT INVOLVES THE

747
00:28:20,880 --> 00:28:22,960
PARTNERSHIP WITH PEOPLE'S LIVED

748
00:28:22,960 --> 00:28:23,240
EXPERIENCE.

749
00:28:23,240 --> 00:28:26,240
WE'VE NOW BEEN ABLE TO STAND UP

750
00:28:26,240 --> 00:28:27,880
A GROUP OF INDIVIDUALS WITH

751
00:28:27,880 --> 00:28:29,640
LIVED EXPERIENCE AND PAIN AND

752
00:28:29,640 --> 00:28:31,160
ADDICTION WHO ADVISE THE HEAL

753
00:28:31,160 --> 00:28:34,640
INITIATIVE AND ALSO WORK WITH

754
00:28:34,640 --> 00:28:35,800
THE SCIENTISTS ON THE INDIVIDUAL

755
00:28:35,800 --> 00:28:37,160
HEAL PROGRAMS AND I WILL TELL

756
00:28:37,160 --> 00:28:40,320
YOU MORE ABOUT THAT LATER IN

757
00:28:40,320 --> 00:28:43,520
THE--LATER IN TODAY'S MEETING.

758
00:28:43,520 --> 00:28:45,400
A REAL NEED FOR DISSEMINATION

759
00:28:45,400 --> 00:28:48,240
AND SHARING OF RESEARCH FINDINGS

760
00:28:48,240 --> 00:28:50,040
WITH THE SCIENTIFIC COMMUNITY

761
00:28:50,040 --> 00:28:53,880
BUT ALSO BEYOND TO OUR DIFFERENT

762
00:28:53,880 --> 00:28:56,880
STAKEHOLDER POLICY MAKER, AND

763
00:28:56,880 --> 00:28:58,240
PATIENT AND CAREGIVER PARTNERS

764
00:28:58,240 --> 00:29:01,280
AND I'M ALSO GOING TO NEED TO

765
00:29:01,280 --> 00:29:03,920
ADAPT TO THE HISTORIC COVID

766
00:29:03,920 --> 00:29:04,200
PANDEMIC.

767
00:29:04,200 --> 00:29:06,320
OUR SCIENTIST VS REALLY MADE

768
00:29:06,320 --> 00:29:07,600
SIGNIFICANT CHANGES TO THEIR

769
00:29:07,600 --> 00:29:09,360
STUDIES IN ORDER TO CONTINUE TO

770
00:29:09,360 --> 00:29:11,760
CARRY THEM OUT AND NOT SPEND

771
00:29:11,760 --> 00:29:12,680
ACROSS THE BOARD, ALTHOUGH

772
00:29:12,680 --> 00:29:15,080
DIFFERENT IN EACH AREA OF

773
00:29:15,080 --> 00:29:15,640
RESEARCH FOCUS.

774
00:29:15,640 --> 00:29:18,720
YOU CAN LEARN MORE ABOUT SOME OF

775
00:29:18,720 --> 00:29:20,400
THE AREAS OF PROGRESS IN THE

776
00:29:20,400 --> 00:29:22,400
HEAL INITIATIVE THROUGH OUR

777
00:29:22,400 --> 00:29:22,720
ANNUAL REPORT.

778
00:29:22,720 --> 00:29:24,120
WE HAVE 1 THAT CAME OUT LAST

779
00:29:24,120 --> 00:29:27,320
YEAR AND A NEW 1 IS EXPECTED TO

780
00:29:27,320 --> 00:29:28,320
COME OUT SOON.

781
00:29:28,320 --> 00:29:33,440
SO, NEXT, SLIDE, PLEASE.

782
00:29:33,440 --> 00:29:35,400
I'LL NOW MOVE ON TO A SUMMARY OF

783
00:29:35,400 --> 00:29:37,040
OUR CURRENT ACTIVITY AND FUTURE

784
00:29:37,040 --> 00:29:38,120
DIRECTION, SETTING US UP FOR THE

785
00:29:38,120 --> 00:29:42,720
REST OF TODAY'S MEETING.

786
00:29:42,720 --> 00:29:44,200
NEXT SLIDE.

787
00:29:44,200 --> 00:29:47,040
AS DR. TABAK, ALLUDED, WE DO NOT

788
00:29:47,040 --> 00:29:48,800
HAVE AN APPROPRIATION FOR THE

789
00:29:48,800 --> 00:29:50,680
FISCAL YEAR 2022, THAT'S WHEREY

790
00:29:50,680 --> 00:29:53,520
WOO ARE RIGHT NOW.

791
00:29:53,520 --> 00:29:55,760
SO WE'RE FORTUNATE IN THAT THE

792
00:29:55,760 --> 00:29:57,440
PRESIDENT REQUESTED A

793
00:29:57,440 --> 00:29:59,640
SUBSTANTIAL INCREASE IN THE

794
00:29:59,640 --> 00:30:01,280
BUDGET FOR THE HEAL INITIATIVE,

795
00:30:01,280 --> 00:30:04,240
A 50% INCREASE THAT IS ACTUALLY

796
00:30:04,240 --> 00:30:08,160
PART OF A LARGER AND ACROSS THE

797
00:30:08,160 --> 00:30:09,800
NIH PROPOSED INCREASE BUT WE DO

798
00:30:09,800 --> 00:30:11,440
NOT YET HAVE A BILL PASSED BY

799
00:30:11,440 --> 00:30:14,560
CONGRESS SO WHAT WE'VE BEEN

800
00:30:14,560 --> 00:30:15,720
DOING IS PLANNING, THE MANY

801
00:30:15,720 --> 00:30:20,240
DIFFERENT WAYS THAT WE COULD USE

802
00:30:20,240 --> 00:30:21,960
THOSE RESOURCES TO STRENGTHEN

803
00:30:21,960 --> 00:30:23,800
THE RESEARCH EFFORTS WE HAVE

804
00:30:23,800 --> 00:30:25,240
UNDERWAY IN THE INITIATIVE AND

805
00:30:25,240 --> 00:30:27,160
BUILD INTO AREAS OF URGENT NEED,

806
00:30:27,160 --> 00:30:30,480
AND WE ARE NOW BEGINNING TO

807
00:30:30,480 --> 00:30:33,400
CONDUCT A SIMILAR UPON ANALYSIS

808
00:30:33,400 --> 00:30:36,240
AND PLANNING PROCESS FOR FY2023

809
00:30:36,240 --> 00:30:37,880
AND THAT WILL BE A LOT OF WHAT

810
00:30:37,880 --> 00:30:39,720
WE ASKED THE GROUP TO GIVE US

811
00:30:39,720 --> 00:30:42,200
ADVICE ON IN THE NEXT 2 DAYS.

812
00:30:42,200 --> 00:30:44,720
WHAT ARE THE GREATEST AREAS OF

813
00:30:44,720 --> 00:30:46,840
OPPORTUNITY FOR THE COMING YEAR,

814
00:30:46,840 --> 00:30:48,760
TAKING INTO CONSIDERATION ALL

815
00:30:48,760 --> 00:30:49,840
THAT WE'VE FUNDED, ALREADY AND

816
00:30:49,840 --> 00:30:53,160
ALL THAT WE'VE PLANNED FOR THIS

817
00:30:53,160 --> 00:30:55,160
YEAR.

818
00:30:55,160 --> 00:31:00,200
SO, NEXT SLIDE, PLEASE.

819
00:31:00,200 --> 00:31:02,960
THIS IS A COLLECTION OF THE MANY

820
00:31:02,960 --> 00:31:06,720
RESEARCH EFFORTS, I SAID THAT

821
00:31:06,720 --> 00:31:10,240
THERE WERE OVER 40 I THINK THAT

822
00:31:10,240 --> 00:31:11,040
WERE LAUNCHED IN 2022.

823
00:31:11,040 --> 00:31:16,600
MANY OF THESE ALIGN WITH THE HHS

824
00:31:16,600 --> 00:31:17,440
OVERDOSE PREVENTION STRATEGY

825
00:31:17,440 --> 00:31:19,240
THAT FOCUSES ON PREVENTION,

826
00:31:19,240 --> 00:31:21,480
TREATMENT, HOME REDUCTION AND

827
00:31:21,480 --> 00:31:25,120
RECOVERY SUPPORT SERVICES. 

828
00:31:25,120 --> 00:31:27,280
SO HEAL HAS MADE AND OUR

829
00:31:27,280 --> 00:31:28,360
SCIENTIFIC TEAMS HAVE WORKED

830
00:31:28,360 --> 00:31:32,560
HARD TO MAKE SURE THAT THE

831
00:31:32,560 --> 00:31:34,560
RESEARCH WE SUPPORT ALIGNS WITH

832
00:31:34,560 --> 00:31:37,640
AND ADVANCES THE DEPARTMENT'S

833
00:31:37,640 --> 00:31:40,840
GOALS IN PREVENTING OVERDOSE AND

834
00:31:40,840 --> 00:31:42,000
OVERDOSE STAFF, AND YOU WILL SEE

835
00:31:42,000 --> 00:31:44,000
THE TEAMS REFLECT ON EACH OF

836
00:31:44,000 --> 00:31:44,840
THESE NEW PRIORITIES, AND

837
00:31:44,840 --> 00:31:45,680
RESEARCH PROGRAMS OVER THE

838
00:31:45,680 --> 00:31:52,080
COURSE OF THE 2 DAY MEETING.

839
00:31:52,080 --> 00:31:52,600
NEXT SLIDE.

840
00:31:52,600 --> 00:31:53,880
AND HEARING SOME OF THE AREAS

841
00:31:53,880 --> 00:31:58,240
YOU WILL HEAR MORE ABOUT FOR

842
00:31:58,240 --> 00:31:59,520
FY2023, SOME SIMILAR BUT A LOT

843
00:31:59,520 --> 00:32:04,240
OF NEW DOMAIN AREAS THAT WERE

844
00:32:04,240 --> 00:32:08,040
WORKING TO ADDRESS AND THEN, IN

845
00:32:08,040 --> 00:32:10,440
THE NEXT SLIDE, I SAY THANK YOU

846
00:32:10,440 --> 00:32:13,240
TO THE MANY PARTNERS THAT WE

847
00:32:13,240 --> 00:32:15,520
HAVE ACROSS THE HEAL INITIATIVE

848
00:32:15,520 --> 00:32:18,280
AT NIH, FIRST, THE SCIENTIFIC

849
00:32:18,280 --> 00:32:19,560
TEAMS, WE HAVE 6 SCIENTIFIC

850
00:32:19,560 --> 00:32:23,160
TEAMS EACH WITH 2 CO-CHAIRS,

851
00:32:23,160 --> 00:32:24,800
TOGETHER THESE TEAMS REPRESENT

852
00:32:24,800 --> 00:32:28,320
ALL OF OUR 200 NIH PROGRAM

853
00:32:28,320 --> 00:32:28,520
STAFF.

854
00:32:28,520 --> 00:32:30,760
TWENTY OF THE INSTITUTES CENTERS

855
00:32:30,760 --> 00:32:36,640
AND OFFICES AT NIH ARE REALLY

856
00:32:36,640 --> 00:32:38,360
BROAD COLLECTION OF EXPERTISE

857
00:32:38,360 --> 00:32:40,440
AND KNOWLEDGE TO RAPIDLY CONVERT

858
00:32:40,440 --> 00:32:42,680
THE GOOD IDEAS, COMING FROM YOU

859
00:32:42,680 --> 00:32:48,080
ALL AND OUR BROADER COMMUNITY

860
00:32:48,080 --> 00:32:49,320
INTO DISCREET RESEARCH

861
00:32:49,320 --> 00:32:50,800
OPPORTUNITIES AND PROGRAMS FOR

862
00:32:50,800 --> 00:32:51,360
THE HEAL INITIATIVE.

863
00:32:51,360 --> 00:32:57,840
AND THEN OF COURSE, IN THE NEXT

864
00:32:57,840 --> 00:32:58,960
SLIDE, THE HEAL EXECUTIVE

865
00:32:58,960 --> 00:32:59,640
COMMITTEE, THANK YOU VERY MUCH

866
00:32:59,640 --> 00:33:01,720
FOR YOUR LEADERSHIP AND FOR YOUR

867
00:33:01,720 --> 00:33:03,440
COLLECTIVE GUIDANCE AND GOOD

868
00:33:03,440 --> 00:33:05,240
IDEAS FOR RESEARCH TO BE CARRIED

869
00:33:05,240 --> 00:33:06,440
OUT THROUGH THE INITIATIVE.

870
00:33:06,440 --> 00:33:09,440
SO WITH THAT, I WILL PAUSE AND

871
00:33:09,440 --> 00:33:12,040
ASK IF THERE ARE ANY QUESTIONS

872
00:33:12,040 --> 00:33:14,360
OR WE CAN START A DISCUSSION.

873
00:33:14,360 --> 00:33:28,080
YOU CAN GO TO THE NEXT SLIDE. 

874
00:33:28,080 --> 00:33:28,960
THANK YOU.

875
00:33:28,960 --> 00:33:31,360
>> I DID HAVE 1 QUICK QUESTION,

876
00:33:31,360 --> 00:33:32,280
THIS IS LYNN.

877
00:33:32,280 --> 00:33:34,480
I AM JUST CURIOUS, WHEN YOU

878
00:33:34,480 --> 00:33:36,080
WERE--WHEN YOU WERE GOING

879
00:33:36,080 --> 00:33:40,040
THROUGH SOME OF THE LARGER SCALE

880
00:33:40,040 --> 00:33:42,960
SUBINITIATIVES AMONG THE

881
00:33:42,960 --> 00:33:43,800
CLINICAL TRIALS, I KNOW THAT

882
00:33:43,800 --> 00:33:46,440
PRISM AND THE PAIN ERN, HAVE

883
00:33:46,440 --> 00:33:51,000
CONTINUED TO PUT OUT

884
00:33:51,000 --> 00:33:53,200
ANNOUNCEMENTS AND YOU KNOW

885
00:33:53,200 --> 00:33:54,920
THEY'RE AN ONGOING ENTERPRISE,

886
00:33:54,920 --> 00:33:55,200
RIGHT?

887
00:33:55,200 --> 00:33:56,720
IT'S AN INFRASTRUCTURE THAT'S

888
00:33:56,720 --> 00:33:58,480
BEEN WONDERFUL AND HELPED AND

889
00:33:58,480 --> 00:33:59,520
SUPPORTED THOSE PROJECTS IS THE

890
00:33:59,520 --> 00:34:02,720
SAME THING EXPECT WIDE EMPOWER?

891
00:34:02,720 --> 00:34:04,280
I WAS JUST CURIOUS, THE WAY IT

892
00:34:04,280 --> 00:34:06,240
WAS PUT UP THERE, I WAS THINKING

893
00:34:06,240 --> 00:34:07,720
IT'S MORE OF A 1 TIME INITIATIVE

894
00:34:07,720 --> 00:34:09,200
BUT IS THAT EXPECTED TO CONTINUE

895
00:34:09,200 --> 00:34:11,720
ON IN A SIMILAR SORT OF FASHION.

896
00:34:11,720 --> 00:34:12,760
>> GREAT, QUESTION.

897
00:34:12,760 --> 00:34:13,040
THANKS LYNN.

898
00:34:13,040 --> 00:34:15,120
IT'S NICE TO SEE YOU.

899
00:34:15,120 --> 00:34:18,920
SO, 1 OF THE SPECIAL THINGS

900
00:34:18,920 --> 00:34:21,800
ABOUT BOTH THE PRISM PROGRAM

901
00:34:21,800 --> 00:34:22,400
WHICH LEVERAGES THE

902
00:34:22,400 --> 00:34:27,120
INFRASTRUCTURE OF THE NIH

903
00:34:27,120 --> 00:34:27,680
HEALTHCARE RESEARCH SYSTEMS

904
00:34:27,680 --> 00:34:30,280
COLLAB RATORSKPE BAKUGAN

905
00:34:30,280 --> 00:34:32,240
EFFECTIVENESS RESEARCH NETWORK

906
00:34:32,240 --> 00:34:35,000
WHICH LEVERAGES THE STRENGTHS OF

907
00:34:35,000 --> 00:34:37,360
THE CTSA, AND THE TRIALS

908
00:34:37,360 --> 00:34:39,960
INNOVATION NETWORKS AT NCATS IS

909
00:34:39,960 --> 00:34:41,800
THAT THEY HAVE THIS BASE AND SO

910
00:34:41,800 --> 00:34:43,440
WE CAN CONTINUE TO LAYER ON NEW

911
00:34:43,440 --> 00:34:44,760
TRIAL, NEW TRIAL, WE CAN SAY,

912
00:34:44,760 --> 00:34:47,320
OKAY, WELL WE HAVE A LOT AND

913
00:34:47,320 --> 00:34:48,840
THERE'S SOME THAT WOULD STILL

914
00:34:48,840 --> 00:34:51,600
LIKE TO UNDERSTAND

915
00:34:51,600 --> 00:34:52,840
PHARMAICOLOGICAL TREATMENT OR

916
00:34:52,840 --> 00:34:53,800
PEDIATRIC PAIN MANAGEMENT AND

917
00:34:53,800 --> 00:34:56,240
THEN WE CAN ADD TRIALS THROUGH

918
00:34:56,240 --> 00:35:00,040
THAT NETWORK, OR 1 OF THOSE

919
00:35:00,040 --> 00:35:00,720
NETWORKS AS APPROPRIATE.

920
00:35:00,720 --> 00:35:04,600
FOR THE OTHER PROGRAMS, IT'S

921
00:35:04,600 --> 00:35:06,360
KIND OF A DIFFERENT STRUCTURE.

922
00:35:06,360 --> 00:35:11,760
SO NOTHING REALLY PRECLUDES US

923
00:35:11,760 --> 00:35:16,240
FROM ADAPTING OR ADDING NEW

924
00:35:16,240 --> 00:35:18,640
PROGRAMS TO THOSE EXISTING

925
00:35:18,640 --> 00:35:20,400
NETWORKS BUT I THINK IT WOULDN'T

926
00:35:20,400 --> 00:35:23,840
BE QUITE AS EASY AS JUST KIND OF

927
00:35:23,840 --> 00:35:24,840
LAUNCHING 1 ADDITIONAL TRIAL.

928
00:35:24,840 --> 00:35:27,880
AND SO, WHAT I THINK A LOT OF

929
00:35:27,880 --> 00:35:29,000
THE GROUPS LEADING THOSE

930
00:35:29,000 --> 00:35:31,240
PROGRAMS, ARE THINKING AS WELL,

931
00:35:31,240 --> 00:35:33,640
THEY WERE LAUNCHED IN 2019, THEY

932
00:35:33,640 --> 00:35:35,720
HAVE A COUPLE YEARS UNTIL A LOT

933
00:35:35,720 --> 00:35:37,240
OF THE TRIALS THAT LAUNCHED AT

934
00:35:37,240 --> 00:35:39,200
THAT TIME BEGIN TO SUN SET AND

935
00:35:39,200 --> 00:35:41,840
PERHAPS WHEN THAT TIME COMES,

936
00:35:41,840 --> 00:35:44,240
THERE WILL BE A MOMENT TO THINK,

937
00:35:44,240 --> 00:35:45,840
WELL, WHAT HAVE WE LEARNED?

938
00:35:45,840 --> 00:35:48,360
WHAT DO WE STILL NEED TO LEARN

939
00:35:48,360 --> 00:35:50,320
AND TO WHAT DEGREE DOES A

940
00:35:50,320 --> 00:35:54,160
CONTINUATION OF THIS PROGRAM OR,

941
00:35:54,160 --> 00:35:57,240
YOU KNOW PERHAPS A MORE

942
00:35:57,240 --> 00:35:59,920
STREAMLINED EXTENSION OF A

943
00:35:59,920 --> 00:36:01,480
PROGRAM WOULD MAKE SENSE.

944
00:36:01,480 --> 00:36:04,120
AND FOR EMPOWER, I WOULD BE

945
00:36:04,120 --> 00:36:06,280
INTERESTED TO HEAR--FOR EMPOWER

946
00:36:06,280 --> 00:36:07,040
SPECIFICALLY I WOULD BE

947
00:36:07,040 --> 00:36:10,440
INTERESTED TO HEAR WHAT NORA AND

948
00:36:10,440 --> 00:36:12,040
WALTER WOULD SAY ABOUT HOW

949
00:36:12,040 --> 00:36:12,680
THEY'RE THINKING ABOUT THE

950
00:36:12,680 --> 00:36:13,880
FUTURE OF THAT PROGRAM BUT THEN

951
00:36:13,880 --> 00:36:15,520
ALL THE MEMBERS OF THE EXECUTIVE

952
00:36:15,520 --> 00:36:16,880
COMMITTEE FEEL FREE TO JUMP IN

953
00:36:16,880 --> 00:36:18,440
BECAUSE YOU HAVE PROGRAMS IN

954
00:36:18,440 --> 00:36:30,600
YOUR ICs THAT ARE RELEVANT AS

955
00:36:30,600 --> 00:36:31,160
WELL.

956
00:36:31,160 --> 00:36:32,280
>> YEAH, THIS IS WALTER, I THINK

957
00:36:32,280 --> 00:36:36,480
IT'S JUST KIND OF KICKING OFF

958
00:36:36,480 --> 00:36:37,840
NOW AND LAUNCHING.

959
00:36:37,840 --> 00:36:41,400
CERTAINLY, IF WE FIND THAT YOU

960
00:36:41,400 --> 00:36:43,320
KNOW IT'S A SUCCESSFUL PROGRAM,

961
00:36:43,320 --> 00:36:46,600
THEN I THINK WOO CAN CERTAINLY

962
00:36:46,600 --> 00:36:50,080
ADD ON TO IT, OVERTIME.

963
00:36:50,080 --> 00:36:52,080
I SUSPECT, YOU KNOW IT'S A BIG

964
00:36:52,080 --> 00:36:52,320
PROBLEM.

965
00:36:52,320 --> 00:36:54,240
IT'S NOT GOING TO BE SOLVED

966
00:36:54,240 --> 00:36:56,840
ACROSS THE COUNTRY IN A SHORT

967
00:36:56,840 --> 00:36:57,240
TIME FRAME.

968
00:36:57,240 --> 00:36:59,560
SO THE GOAL IS GOING TO BE A

969
00:36:59,560 --> 00:37:01,640
LONG-TERM GOAL, WE WILL CONTINUE

970
00:37:01,640 --> 00:37:04,960
TO WORK ON AND HOPEFULLY THE

971
00:37:04,960 --> 00:37:06,120
EMPOWER GROUP AS THEY START

972
00:37:06,120 --> 00:37:10,800
WORKING WILL BE A FORCE THAT WE

973
00:37:10,800 --> 00:37:11,920
CAN CONTINUOUSLY INVEST IN TO

974
00:37:11,920 --> 00:37:15,400
GET THE WORK DONE, NOW NORIA DO

975
00:37:15,400 --> 00:37:17,360
HAVE YOU ANYTHING TO ADD?

976
00:37:17,360 --> 00:37:18,480
>> NO, I THINK THAT YOU

977
00:37:18,480 --> 00:37:19,880
BASICALLY, THE PLAN THAT IS A

978
00:37:19,880 --> 00:37:21,320
STEP PLAN AND WE WILL LEARN

979
00:37:21,320 --> 00:37:29,640
BASED ON THE RESULTS FOR US HAS

980
00:37:29,640 --> 00:37:31,040
BEEN IN THE CLINICAL TRIAL

981
00:37:31,040 --> 00:37:32,440
NETWORK, IT HAS BEEN WORKED FOR

982
00:37:32,440 --> 00:37:35,480
MANY, MANY YEARS AND ENABLED US

983
00:37:35,480 --> 00:37:37,680
TO WORK FAIRLY RAPIDLY BUT OF

984
00:37:37,680 --> 00:37:39,960
COURSE WE'RE CONSTRAINED BY NOW,

985
00:37:39,960 --> 00:37:41,840
THE RECRUITMENT OF PATIENTS, BUT

986
00:37:41,840 --> 00:37:43,360
WE ALSO WANT THE CLINICAL TRIAL

987
00:37:43,360 --> 00:37:45,840
NETWORK THAT HAS THE DIVERSITY

988
00:37:45,840 --> 00:37:47,840
AND FLEXIBILITY TO CHANGE AND

989
00:37:47,840 --> 00:37:49,920
ACCOMMODATE AND IN THAT CONTEXT

990
00:37:49,920 --> 00:37:51,480
WE'RE VERY, VERY EXCITED AND

991
00:37:51,480 --> 00:37:54,240
SEEING OPPORTUNITIES WHERE WE

992
00:37:54,240 --> 00:37:55,120
CAN BRING APPROXIMATE SOME OF

993
00:37:55,120 --> 00:37:56,800
THE CLINICAL TRIALS THAT ARE

994
00:37:56,800 --> 00:37:58,840
BEING DONE ON PAIN TO PATIENTS

995
00:37:58,840 --> 00:38:01,080
WITH SUBSTANCE USE DISORDERS

996
00:38:01,080 --> 00:38:02,960
BECAUSE THE CO MORBIDITY IS SO

997
00:38:02,960 --> 00:38:03,160
HIGH.

998
00:38:03,160 --> 00:38:05,040
SO INDEED, I THINK THAT THE

999
00:38:05,040 --> 00:38:07,760
BUILDING UP OF THE EMPOWER WILL

1000
00:38:07,760 --> 00:38:09,400
ALLOW US TO DO THINGS THAT

1001
00:38:09,400 --> 00:38:13,360
OTHERWISE WOULD NOT BE POSSIBLE.

1002
00:38:13,360 --> 00:38:15,760
UPON --SO, THANKS.

1003
00:38:15,760 --> 00:38:16,800
DR. VOLKOW, I BELIEVE YOU ARE

1004
00:38:16,800 --> 00:38:18,680
FIRST UP.

1005
00:38:18,680 --> 00:38:19,320
>> YES, IT'S SURPRISED ME

1006
00:38:19,320 --> 00:38:23,080
BECAUSE I THINK IT WAS STILL

1007
00:38:23,080 --> 00:38:28,640
2:00 BUT I MAY HAVE LOOKED

1008
00:38:28,640 --> 00:38:28,840
AGAIN.

1009
00:38:28,840 --> 00:38:30,000
AS ALWAYS IT'S A PRIVILEGE TO BE

1010
00:38:30,000 --> 00:38:32,080
HERE WHERE WE ARE AND GIVE YOU

1011
00:38:32,080 --> 00:38:34,320
AN UPDATE AND THE ISSUES OF THE

1012
00:38:34,320 --> 00:38:40,080
OVERDOSE CRISES THAT WE'RE

1013
00:38:40,080 --> 00:38:41,280
LIVING THAT WAS ALSO TALKED

1014
00:38:41,280 --> 00:38:44,840
ABOUT IN THE INTRODUCTION, AS

1015
00:38:44,840 --> 00:38:46,360
DR. TABAK, AND THESE HAVE GOTTEN

1016
00:38:46,360 --> 00:38:47,800
WORSE AND WE SEE THIS IN THE

1017
00:38:47,800 --> 00:38:48,280
NUMBERS.

1018
00:38:48,280 --> 00:38:50,560
SO I WILL SHARE THE SCREEN TO

1019
00:38:50,560 --> 00:38:51,440
IDENTIFY TOUGH ISSUES I WANT YOU

1020
00:38:51,440 --> 00:38:53,520
TO BE AWARE BECAUSE OF COURSE,

1021
00:38:53,520 --> 00:38:56,040
THEY COULD BENEFIT FROM FURTHER

1022
00:38:56,040 --> 00:38:56,520
RESEARCH.

1023
00:38:56,520 --> 00:38:57,880
LET ME GET WHICH 1 OF THESE IS

1024
00:38:57,880 --> 00:39:00,960
IT AND I NEED TO KNOW SOMEONE TO

1025
00:39:00,960 --> 00:39:07,840
TELL ME, IF YOU CAN SEE MY

1026
00:39:07,840 --> 00:39:33,280
PRESENTATION FOR 1 SECOND----SO

1027
00:39:33,280 --> 00:39:34,960
THIS IS THE DAT ATHE LATEST DATA

1028
00:39:34,960 --> 00:39:38,760
THAT WE HAVE WHICH IS FROM 2021,

1029
00:39:38,760 --> 00:39:42,000
THE 12 MONTHS THAT END ON

1030
00:39:42,000 --> 00:39:42,920
SEPTEMBER 30, 2021 AND YOU CAN

1031
00:39:42,920 --> 00:39:45,720
SEE IN THAT AREA THERE WAS 68%

1032
00:39:45,720 --> 00:39:46,200
OF INCREASES.

1033
00:39:46,200 --> 00:39:49,080
IN LOOKING AT THE DATA, I MEAN

1034
00:39:49,080 --> 00:39:49,920
THERE ARE--THERE IS INFORMATION

1035
00:39:49,920 --> 00:39:54,400
THAT IS VERY VALUABLE FOR US TO

1036
00:39:54,400 --> 00:39:55,960
QUANDER UPON BECAUSE IT'S

1037
00:39:55,960 --> 00:39:58,480
TELLING US SORT OF A CERTAIN

1038
00:39:58,480 --> 00:39:59,120
PERSPECTIVE OF WHAT'S HAPPENING

1039
00:39:59,120 --> 00:40:02,560
OR WHAT IS HAPPENING IN THE PAST

1040
00:40:02,560 --> 00:40:03,800
FIRST OF ALL HEROIN IS GOING

1041
00:40:03,800 --> 00:40:04,920
DOWN WHICH IS AGAIN, SOMETHING

1042
00:40:04,920 --> 00:40:12,040
WE HAVE STARTED TO SEE IN THE

1043
00:40:12,040 --> 00:40:13,920
PAST 5 YEARS, WITH HEROIN AND

1044
00:40:13,920 --> 00:40:15,520
FENTANYL, THIS IS GOING DOWN.

1045
00:40:15,520 --> 00:40:17,080
VERY IMPORTANTLY THIS COLUMN

1046
00:40:17,080 --> 00:40:19,720
HERE OF NATURAL AND

1047
00:40:19,720 --> 00:40:23,320
SEMISYNTHETIC WHICH REFLECTS

1048
00:40:23,320 --> 00:40:24,280
PRESCRIPTION ON OPIOIDS,

1049
00:40:24,280 --> 00:40:25,840
BASICALLY VERY STABLE AND THAT

1050
00:40:25,840 --> 00:40:28,680
REFLECTS WHAT ALSO WE HAVE BEEN

1051
00:40:28,680 --> 00:40:29,960
SEEING THAT THE RELATIVE

1052
00:40:29,960 --> 00:40:34,040
CONTRIBUTION OF OVERDOSES FROM

1053
00:40:34,040 --> 00:40:35,120
PRESCRIPTION OPIOIDS HAS COME

1054
00:40:35,120 --> 00:40:36,960
DOWN FROM BEING 1 OF THE MAIN

1055
00:40:36,960 --> 00:40:38,880
CONTRIBUTIONS FOR OVERDOSE

1056
00:40:38,880 --> 00:40:44,680
DEATHS, EARLY IN THE EPIDEMIC TO

1057
00:40:44,680 --> 00:40:45,800
NOW BEING BASICALLY 1 OF THE

1058
00:40:45,800 --> 00:40:47,560
COMPONENTS AND NOT THE MOST

1059
00:40:47,560 --> 00:40:47,880
IMPORTANT 1.

1060
00:40:47,880 --> 00:40:51,520
I ALSO WANT YOU TO LOOK AT

1061
00:40:51,520 --> 00:40:53,160
METHADONE BECAUSE WITH THE

1062
00:40:53,160 --> 00:40:54,200
CHANGES IN METHADONE PRACTICES,

1063
00:40:54,200 --> 00:40:56,280
1 OF THE CONCERNS WAS THAT AS

1064
00:40:56,280 --> 00:40:58,400
PEOPLE ARE ALLOWED TO TAKE HOME

1065
00:40:58,400 --> 00:41:00,480
METHADONE, MUCH MORE FREELY FROM

1066
00:41:00,480 --> 00:41:02,440
THE METHADONE CLINICS THERE WAS

1067
00:41:02,440 --> 00:41:03,960
CONCERN THAT THIS WOULD BE

1068
00:41:03,960 --> 00:41:05,560
OPIOID DIVERSION AND THEN

1069
00:41:05,560 --> 00:41:05,880
OVERDOSES.

1070
00:41:05,880 --> 00:41:07,680
WE NOW HAVE DATA TO SHOW AS THE

1071
00:41:07,680 --> 00:41:09,880
EVIDENCE FROM HERE, THAT THIS IS

1072
00:41:09,880 --> 00:41:10,640
NOT THE CASE.

1073
00:41:10,640 --> 00:41:13,480
WE HAVE NOT SEEN AN INCREASE IN

1074
00:41:13,480 --> 00:41:15,520
OVERDOSE DEATHS WITH METHADONE

1075
00:41:15,520 --> 00:41:19,320
WHICH WOULD HAVE BASICALLY

1076
00:41:19,320 --> 00:41:21,320
INDICATED THAT THE PRACTICES

1077
00:41:21,320 --> 00:41:22,600
HAVE EXACERBATED THE PROBLEM, IT

1078
00:41:22,600 --> 00:41:24,120
DOES NOT APPEAR TO BE THE CASE.

1079
00:41:24,120 --> 00:41:26,360
ON THE 1 HAND WE ARE SEEING THAT

1080
00:41:26,360 --> 00:41:29,960
MANY PATIENTS HAVE BENEFITED

1081
00:41:29,960 --> 00:41:30,880
FROM THIS FLEXIBILITIES.

1082
00:41:30,880 --> 00:41:32,680
ON THE OTHER HAND, YOU WILL SEE

1083
00:41:32,680 --> 00:41:33,840
WHAT WE HAVE BEEN COMMENTING

1084
00:41:33,840 --> 00:41:36,720
UPON THAT IS DRIVING THE

1085
00:41:36,720 --> 00:41:39,120
OVERDOSE DEATHS, FENTANYL, 26%

1086
00:41:39,120 --> 00:41:40,800
OF THAT INCREASE IN FENTANYL

1087
00:41:40,800 --> 00:41:43,280
OVERDOSE DEATHS AT LEVELS THAT

1088
00:41:43,280 --> 00:41:47,560
WERE ALREADY VERY, VERY HIGH.

1089
00:41:47,560 --> 00:41:48,520
AND THE OTHER EXTREMELY

1090
00:41:48,520 --> 00:41:50,040
IMPORTANT CULPRIT THAT WE HAD

1091
00:41:50,040 --> 00:41:55,160
BASICALLY JUST GONE UP AS

1092
00:41:55,160 --> 00:41:56,040
STEEPLY AS FENTANYL IS

1093
00:41:56,040 --> 00:41:56,400
METHAMPHETAMINE.

1094
00:41:56,400 --> 00:42:00,320
AND THAT IS INCREASINGLY

1095
00:42:00,320 --> 00:42:01,720
ACCOUNTING FOR OVERDOSE

1096
00:42:01,720 --> 00:42:04,720
MORTALITY AND WHAT IS RELEVANT

1097
00:42:04,720 --> 00:42:06,200
THAT THE PARTICULARS OF THE DRUG

1098
00:42:06,200 --> 00:42:07,640
AFFECT GROUPS DIFFERENTLY AND WE

1099
00:42:07,640 --> 00:42:12,360
NEED TO GET THAT DATA, MUCH MORE

1100
00:42:12,360 --> 00:42:12,680
ACCURATELY.

1101
00:42:12,680 --> 00:42:14,680
SO, LAST TIME WE LOOKED, I SAID

1102
00:42:14,680 --> 00:42:16,280
WE NEED DATA THAT IS MORE

1103
00:42:16,280 --> 00:42:17,960
TIMELY, THIS IS 6 MOCKS OLD, BUT

1104
00:42:17,960 --> 00:42:20,080
WE ALSO NEED TO UNDERSTAND THE

1105
00:42:20,080 --> 00:42:21,480
SPECIFICS OF THIS DATA SETS.

1106
00:42:21,480 --> 00:42:25,480
SO, WHAT DO I MEAN BY THIS?

1107
00:42:25,480 --> 00:42:28,720
FIRST OF ALL WE KNOW THAT THE

1108
00:42:28,720 --> 00:42:29,880
EPIDEMIC HAS BEEN CHANGING QUITE

1109
00:42:29,880 --> 00:42:32,000
DRAMATIC LOAMACYY IN TERMS OF

1110
00:42:32,000 --> 00:42:33,960
GEOGRAPHIC PRESENTATION, IN

1111
00:42:33,960 --> 00:42:38,960
TERMS OF ETHNICITY, RACIAL

1112
00:42:38,960 --> 00:42:40,080
GROUPS URBANNIVERSEUS RURAL AND

1113
00:42:40,080 --> 00:42:42,680
WHAT YOU SEE HERE IS YES,

1114
00:42:42,680 --> 00:42:44,800
PREDOMINANCE INITIALLY OF SORT

1115
00:42:44,800 --> 00:42:47,560
OF IN THE WHITES, THE WHITES

1116
00:42:47,560 --> 00:42:49,480
WERE THE 1S BASICALLY MOSTLY

1117
00:42:49,480 --> 00:42:50,480
AFFECTED OTHER THAN AMERICAN

1118
00:42:50,480 --> 00:42:53,720
INDIANS THAT HAVE HAD AN

1119
00:42:53,720 --> 00:42:56,480
OVERREPRESENTATION OF OVERDOSE

1120
00:42:56,480 --> 00:42:56,680
DEATHS.

1121
00:42:56,680 --> 00:42:57,680
THIS DOES NOT NECESSARILY

1122
00:42:57,680 --> 00:43:00,320
CAPTURE BUT THE NUMBERS HERE ARE

1123
00:43:00,320 --> 00:43:01,240
SISMGLE, CLEAR AND POINT TO

1124
00:43:01,240 --> 00:43:06,360
ACTUALLY SOME OF THESE ISSUES.

1125
00:43:06,360 --> 00:43:08,680
THIS REPRESENTS THE RATES OF

1126
00:43:08,680 --> 00:43:09,080
POPULATION DEATHS.

1127
00:43:09,080 --> 00:43:10,040
LOOK AT THE AMERICAN IBDIAN

1128
00:43:10,040 --> 00:43:13,080
NUMBERS AND CAN YOU SEE HOW THE

1129
00:43:13,080 --> 00:43:14,280
BLACK, FROM OVERDOSES ACTUALLY

1130
00:43:14,280 --> 00:43:16,720
HAVE BEEN GOING UP

1131
00:43:16,720 --> 00:43:17,080
SIGNIFICANTLY.

1132
00:43:17,080 --> 00:43:19,920
SO NOW WE HAVE UNACCEPTABLE

1133
00:43:19,920 --> 00:43:21,840
NUMBERS AS IT RELATES TO DEATHS

1134
00:43:21,840 --> 00:43:27,040
FROM AMERICAN INDIAN, ALASKA

1135
00:43:27,040 --> 00:43:27,640
NATIVE, IT'S 41.9 PER HUNDRED

1136
00:43:27,640 --> 00:43:27,920
THOUSAND.

1137
00:43:27,920 --> 00:43:32,680
I MEAN THIS IS A HUGE NUMBER.

1138
00:43:32,680 --> 00:43:34,280
SIMILARLY FOR BLACK IS 35.4 EVEN

1139
00:43:34,280 --> 00:43:35,680
THOUGH THOSE NUMBERS WERE

1140
00:43:35,680 --> 00:43:37,520
RELATIVELY LOW AT THE EMERGENCE

1141
00:43:37,520 --> 00:43:39,880
OF THE EPIDEMIC, WHICH IS REALLY

1142
00:43:39,880 --> 00:43:40,760
INDICATING THERE IS A CHANGE IN

1143
00:43:40,760 --> 00:43:44,240
THE WAY THAT THE OVERDOSE THAT'S

1144
00:43:44,240 --> 00:43:44,480
HAPPENING.

1145
00:43:44,480 --> 00:43:46,760
I ALSO WANT YOU TO--I WILL ALSO

1146
00:43:46,760 --> 00:43:48,200
FOCUS ON ANOTHER POPULATION

1147
00:43:48,200 --> 00:43:49,680
BECAUSE IT'S SOMETHING THAT WE

1148
00:43:49,680 --> 00:43:51,440
HAVE NOT PAID ATTENTION

1149
00:43:51,440 --> 00:43:52,480
INITIALLY SINCE IT WAS NOT A

1150
00:43:52,480 --> 00:44:00,720
POPULATION THAT WAS AFFECTED. 

1151
00:44:00,720 --> 00:44:03,000
THIS WAS ASIANS AND HISPANICS.

1152
00:44:03,000 --> 00:44:07,880
SO STILL, THE HIGHEST MORTALITY

1153
00:44:07,880 --> 00:44:09,440
OF OTHERS IN INDIVIDUALS THAT

1154
00:44:09,440 --> 00:44:11,000
ARE 24-54 YEARS OF AGE,

1155
00:44:11,000 --> 00:44:13,240
INTERESTINGLY THE MORTALITY FROM

1156
00:44:13,240 --> 00:44:15,840
OVERDOSES IN OUR LESSONS WAS

1157
00:44:15,840 --> 00:44:17,560
CERTAINLY INITIALLY WAS VERY,

1158
00:44:17,560 --> 00:44:19,080
VERY LOW AND AS A RESULT OF THAT

1159
00:44:19,080 --> 00:44:20,520
WE HAVE NOT BEEN TRACKING IT,

1160
00:44:20,520 --> 00:44:21,880
AND PARTICULARLY BECAUSE IN OUR

1161
00:44:21,880 --> 00:44:26,400
LESSONS WE HAVE SEEN SOME OF THE

1162
00:44:26,400 --> 00:44:27,520
LOWEST LEVELS EVER OF

1163
00:44:27,520 --> 00:44:29,120
COMSUMPTION OF HEROIN AND WE

1164
00:44:29,120 --> 00:44:31,320
HAVE SEEN A VERY DRAMATIC

1165
00:44:31,320 --> 00:44:32,200
REDUCTION IN THE ORGANIZATION

1166
00:44:32,200 --> 00:44:34,280
AND THAT MEANS USE OF

1167
00:44:34,280 --> 00:44:34,760
PRESCRIPTION OPIOIDS.

1168
00:44:34,760 --> 00:44:38,120
BUT LOOK AT THIS DATA THAT SHOWS

1169
00:44:38,120 --> 00:44:40,560
OVERALL DRUG OVERDOSES AND THEN

1170
00:44:40,560 --> 00:44:42,960
IDENTIFIED WITHIN THOSE DRUG OR

1171
00:44:42,960 --> 00:44:44,680
OTHER DRUG OVERDOSES, THE 1S

1172
00:44:44,680 --> 00:44:48,560
THAT ARE AREYALATED TO FENTANYL

1173
00:44:48,560 --> 00:44:48,920
FROM 2015-2020.

1174
00:44:48,920 --> 00:44:51,800
AND YOU CAN SEE WHY THIS IS A

1175
00:44:51,800 --> 00:44:55,480
MAJOR AREA OF CONCERN.

1176
00:44:55,480 --> 00:44:58,680
ALL OF US ARE IN IT, WE'VE SEEN

1177
00:44:58,680 --> 00:45:01,480
CLOSE TO A 5-FOLD INCREASE IN

1178
00:45:01,480 --> 00:45:02,880
DEATHS IN TEENAGERS, THIS IS

1179
00:45:02,880 --> 00:45:04,880
12-20 YEARS OF AGE, IN 5 YEARS

1180
00:45:04,880 --> 00:45:08,680
AND IT IS DRIVEN BY FENTANYL.

1181
00:45:08,680 --> 00:45:11,080
AND THIS IS NOT EXPLAINED BY THE

1182
00:45:11,080 --> 00:45:13,280
RATE OF DRUG USE WHICH WE

1183
00:45:13,280 --> 00:45:14,080
MONITOR THROUGH MONITORING IN

1184
00:45:14,080 --> 00:45:16,960
THE FUTURE WHICH HAS BEEN

1185
00:45:16,960 --> 00:45:18,880
ACTUALLY QUITE STABLE ACROSS ALL

1186
00:45:18,880 --> 00:45:21,480
OF THESE YEARS AND ACTUALLY IF

1187
00:45:21,480 --> 00:45:24,240
ANYTHING, HAS SIGNIFICANTLY

1188
00:45:24,240 --> 00:45:27,080
REDUCED AMONG TEENAGERS DURING

1189
00:45:27,080 --> 00:45:28,080
THE COVID PANDEMIC SO THE

1190
00:45:28,080 --> 00:45:30,920
QUESTION IS WHAT'S DRIVING THESE

1191
00:45:30,920 --> 00:45:31,200
OVERDOSES.

1192
00:45:31,200 --> 00:45:32,720
SO IF THEY ARE NOT TAKING HEROIN

1193
00:45:32,720 --> 00:45:36,680
AND THEY ARE NOT TAKING

1194
00:45:36,680 --> 00:45:39,720
FENTANYL, BY THE EXAMPLE, THE

1195
00:45:39,720 --> 00:45:43,320
RATE OF--HEROIN USE IN 12 GRADE

1196
00:45:43,320 --> 00:45:48,000
WHICH HAS THE HIGHEST RATE, IS

1197
00:45:48,000 --> 00:45:49,400
MORE THAN 5 PERCENT, IT'S VERY

1198
00:45:49,400 --> 00:45:51,520
LOW AND I AM SHOWING YOU THE

1199
00:45:51,520 --> 00:45:52,680
NUMBERS FOR 12 GRADER WHICH IS

1200
00:45:52,680 --> 00:45:54,680
HAVE THE HIGHEST RATE OF USE,

1201
00:45:54,680 --> 00:45:56,880
FOR 2021 THAT INDICATES IN

1202
00:45:56,880 --> 00:45:58,320
GRANTS WHAT ARE THE DRUGS THAT

1203
00:45:58,320 --> 00:45:59,880
ARE FAVORED BY TEENAGERS AND WE

1204
00:45:59,880 --> 00:46:00,760
NEED TO UNDERSTAND THESE BECAUSE

1205
00:46:00,760 --> 00:46:02,960
IF WE WANT TO PREVENT THE

1206
00:46:02,960 --> 00:46:06,880
OVERDOSES, WE HAVE TO UNDERSTAND

1207
00:46:06,880 --> 00:46:09,080
WHAT'S DRIVING IT.

1208
00:46:09,080 --> 00:46:10,280
IT'S INTERESTING AND I'M MARKING

1209
00:46:10,280 --> 00:46:12,760
IT IN DIFFERENT COLORS AND WE'VE

1210
00:46:12,760 --> 00:46:15,480
KNOWN ALL ALONG THAT TEENAGERS

1211
00:46:15,480 --> 00:46:18,160
DO FAVOR PRESCRIPTION PILLS,

1212
00:46:18,160 --> 00:46:23,880
THESE CAN BE TRAINK QUILLIZERS

1213
00:46:23,880 --> 00:46:25,160
LIKE BENZOs, AMPHETAMINES AND

1214
00:46:25,160 --> 00:46:29,720
THEY ALSO FAVOR OPIOIDS, COUGH

1215
00:46:29,720 --> 00:46:33,520
MEDICINE, OTHER THAN HEROIN, OR

1216
00:46:33,520 --> 00:46:35,160
VICODIN ISSUE BUT THESE AS I

1217
00:46:35,160 --> 00:46:39,680
MENTIONED THESE HAVE BEEN GOING

1218
00:46:39,680 --> 00:46:41,680
DOWN. 

1219
00:46:41,680 --> 00:46:45,960
RIGHT NOW IT'S .9%, BUT IT'S

1220
00:46:45,960 --> 00:46:47,440
STILL GOING DOWN, THERE ARE

1221
00:46:47,440 --> 00:46:49,520
STILL 1 OF THE FAVORITE DRUGS OF

1222
00:46:49,520 --> 00:46:50,720
ABUSE.

1223
00:46:50,720 --> 00:46:51,600
NOW IN IS RELEVANT BECAUSE IN

1224
00:46:51,600 --> 00:46:53,480
THE MEAN TIME WHAT WE HAVE SEEN

1225
00:46:53,480 --> 00:46:57,680
IS A SIGNIFICANT INCREASE IN THE

1226
00:46:57,680 --> 00:46:59,760
NUMBER OF COUNTERFEIT PILLS THAT

1227
00:46:59,760 --> 00:47:01,680
ARE ACTUALLY BEING FOUND TO

1228
00:47:01,680 --> 00:47:02,080
CONTAIN FENTANYL.

1229
00:47:02,080 --> 00:47:05,760
AND I WAS TESTIFYING IN CONGRESS

1230
00:47:05,760 --> 00:47:08,760
WITH DEA AND THIS WAS SOMETHING

1231
00:47:08,760 --> 00:47:10,360
THAT ACTUALLY CAPTURE THE

1232
00:47:10,360 --> 00:47:12,080
MOMENT, DEA AND LAW ENFORCEMENT

1233
00:47:12,080 --> 00:47:14,360
PARTNERS HAVE SEIZED MORE THAN

1234
00:47:14,360 --> 00:47:17,320
50 MILLION FAKE PILLS, THIS IS

1235
00:47:17,320 --> 00:47:18,600
DECEMBER 2021, AND AMOUNT THAT

1236
00:47:18,600 --> 00:47:22,360
HAS CONTINUED TO RISE

1237
00:47:22,360 --> 00:47:23,440
DRAMATICALLY.

1238
00:47:23,440 --> 00:47:24,360
30 MILLION OF THESE FAKE PILLS,

1239
00:47:24,360 --> 00:47:28,680
AT LEAST 2/3RDS OF THEM WERE

1240
00:47:28,680 --> 00:47:35,760
LACED WITH FENTANYL,  4 IN 10

1241
00:47:35,760 --> 00:47:37,280
CONTAIN A LEATHAL FENTANYL DOSE.

1242
00:47:37,280 --> 00:47:40,200
SO 1 THING THAT MAY BE COUNTING

1243
00:47:40,200 --> 00:47:41,600
FOR THE OVERDOSE, MORTALITY

1244
00:47:41,600 --> 00:47:42,280
COULD BE COUNTERFEIT PILLS THAT

1245
00:47:42,280 --> 00:47:46,320
ARE 1 OF THE THINGS THAT ARE

1246
00:47:46,320 --> 00:47:48,440
BASICALLY RAISED THAT DRAWS

1247
00:47:48,440 --> 00:47:50,280
FAVOR BY TEENAGERS.

1248
00:47:50,280 --> 00:47:52,280
THEY ARE NOT PERCEPTIVE TO THEM,

1249
00:47:52,280 --> 00:47:54,160
THEY ARE MISUSING THEM AND 1

1250
00:47:54,160 --> 00:47:58,400
SINGLE EXPOSURE CAN RESULT IN IT

1251
00:47:58,400 --> 00:47:58,600
DEATH.

1252
00:47:58,600 --> 00:47:59,720
BUT OTHER ISSUES THAT WE NEED TO

1253
00:47:59,720 --> 00:48:02,080
PAY ATTENTION TO IS THAT WE ARE

1254
00:48:02,080 --> 00:48:03,360
FOCUSING ON FENTANYL BUT THERE

1255
00:48:03,360 --> 00:48:06,960
HAS BEEN AN INCREASE IN REPORTS

1256
00:48:06,960 --> 00:48:08,680
OF OTHER SYNTHETIC OPIOIDS THAT

1257
00:48:08,680 --> 00:48:11,400
ARE ALSO EXTREMELY POTENT AS

1258
00:48:11,400 --> 00:48:18,680
POTENT OR MORE THAN FENTANYL.

1259
00:48:18,680 --> 00:48:19,920
PARTICULARLY NOTABLE IS

1260
00:48:19,920 --> 00:48:21,040
[INDISCERNIBLE] THAT WAS

1261
00:48:21,040 --> 00:48:24,760
REPORTED FOR THE FIRST TIME IN

1262
00:48:24,760 --> 00:48:28,040
CANADA IN 1919 AND ACCOUNTED FOR

1263
00:48:28,040 --> 00:48:30,040
MORE THAN 200 OVERDOSE DEATHS

1264
00:48:30,040 --> 00:48:32,080
AND AUGUST 2020 BECAUSE OF THE

1265
00:48:32,080 --> 00:48:35,160
NUMBERS IT WAS STILL A SCHEDULE

1266
00:48:35,160 --> 00:48:35,280
1.

1267
00:48:35,280 --> 00:48:39,040
IT IS LISTED AS AN ANNUAL

1268
00:48:39,040 --> 00:48:41,480
EMERGING 

1269
00:48:41,480 --> 00:48:44,480
EMERGING THREAT REPORTS AND

1270
00:48:44,480 --> 00:48:45,680
THERE ARE OTHER NITAZINES THAT

1271
00:48:45,680 --> 00:48:47,080
ARE USED IN THE MARKET, IT'S

1272
00:48:47,080 --> 00:48:48,400
PROBLEMATIC BECAUSE IT IS NOT

1273
00:48:48,400 --> 00:48:51,480
DETECTED BY MOST TESTS.

1274
00:48:51,480 --> 00:48:55,040
AND ACTUALLY IS NOT NECESSARILY

1275
00:48:55,040 --> 00:48:58,880
EVALUATED IN  POSTMORTEM DEATHS.

1276
00:48:58,880 --> 00:49:00,600
SO THIS IS BRINGING IT FORWARD

1277
00:49:00,600 --> 00:49:01,400
BECAUSE IT IDENTIFIES THE NEED

1278
00:49:01,400 --> 00:49:04,400
TO HAVE WAYS OF MEASURING THE

1279
00:49:04,400 --> 00:49:06,560
EMERGENCE OF A THERAPY ENTHETIC

1280
00:49:06,560 --> 00:49:08,800
OPIOIDS THAT ARE GOING TO BE

1281
00:49:08,800 --> 00:49:11,400
PROLIFERATING AND WITHOUT THE

1282
00:49:11,400 --> 00:49:15,760
PROPER KNOWLEDGE, MAY RESULT IN

1283
00:49:15,760 --> 00:49:19,200
THE TREATMENT.

1284
00:49:19,200 --> 00:49:20,560
SO AS A RESULT OF THESE, AND

1285
00:49:20,560 --> 00:49:22,680
BASED ON THE DATA I AM SHOWING,

1286
00:49:22,680 --> 00:49:25,360
SORT OF LOOKING AT WHERE WE ARE,

1287
00:49:25,360 --> 00:49:27,600
I WANT TO IDENTIFY 4 KEY GAP

1288
00:49:27,600 --> 00:49:32,280
AREAAS THAT WE NEED TO ADDRESS

1289
00:49:32,280 --> 00:49:33,960
TO KEEP OVERICOSES,--TO PREVENT

1290
00:49:33,960 --> 00:49:34,240
OVERDOSES.

1291
00:49:34,240 --> 00:49:35,160
APART FROM THE 1S THAT ARE

1292
00:49:35,160 --> 00:49:37,040
ALREADY BEING LOOKED AFTER, WE

1293
00:49:37,040 --> 00:49:38,520
NEED MORE TIMELY DATA.

1294
00:49:38,520 --> 00:49:41,320
THERE'S NO 2 WAYS AROUND IT.

1295
00:49:41,320 --> 00:49:42,680
RESPONDING 6 MONTHS LATER

1296
00:49:42,680 --> 00:49:43,680
BASICALLY MEANS THAT A LOT OF

1297
00:49:43,680 --> 00:49:46,800
PEOPLE HAVE DIED IN THE MEAN

1298
00:49:46,800 --> 00:49:47,680
TIME.

1299
00:49:47,680 --> 00:49:53,440
WE NEED EXPANDED DRUG TESTING

1300
00:49:53,440 --> 00:49:54,000
CAPABILITIES.

1301
00:49:54,000 --> 00:49:55,640
AND THIS SHOULD INCLUDE

1302
00:49:55,640 --> 00:49:58,280
MONITORING FOR THE USE OF DRUGS,

1303
00:49:58,280 --> 00:49:59,560
OTHERWISE, THEY WILL NOT BE IN

1304
00:49:59,560 --> 00:50:01,920
THE RADAR OF DRUGS THAT ARE IT

1305
00:50:01,920 --> 00:50:02,960
ACTUALLY ACCOUNTABLE FOR THOSE

1306
00:50:02,960 --> 00:50:04,480
OF INDIVIDUALS AND A TARGET THAT

1307
00:50:04,480 --> 00:50:06,680
INTERVENTIONS MAY NOT BE AS

1308
00:50:06,680 --> 00:50:06,960
EFFECTIVE.

1309
00:50:06,960 --> 00:50:11,680
IN THE AREA OF PREVENTION, WE

1310
00:50:11,680 --> 00:50:12,520
DEFINITELY NEED TO EXPAND

1311
00:50:12,520 --> 00:50:16,440
PREVENTION EFFORTS TO ADDRESS

1312
00:50:16,440 --> 00:50:17,800
RISKS FROM EXPOSURE FROM

1313
00:50:17,800 --> 00:50:20,680
FENTANYL CONTAMINATED DRUGS AND

1314
00:50:20,680 --> 00:50:25,680
THAT COULD INCLUDE

1315
00:50:25,680 --> 00:50:26,600
BENZODIAZPINES AND STIMULATION

1316
00:50:26,600 --> 00:50:31,080
MEDICATIONS THAT ARE BASICALLY

1317
00:50:31,080 --> 00:50:32,720
ILLICITLY MANUFACTURED.

1318
00:50:32,720 --> 00:50:35,480
AND THIS INCLUDES ADOLESCENTS

1319
00:50:35,480 --> 00:50:38,880
AND INDIVIDUALS IN THE

1320
00:50:38,880 --> 00:50:39,320
PRE-ADDICTION STAGE.

1321
00:50:39,320 --> 00:50:43,280
AS WE ADDRESS ADDICTION, WE NEED

1322
00:50:43,280 --> 00:50:44,680
TO ACTUALLY UNDERSTAND THAT WE

1323
00:50:44,680 --> 00:50:49,920
HAVE TO, APPLY MODELS THAT ARE

1324
00:50:49,920 --> 00:50:54,200
SIMILAR TO THOSE THAT ARE

1325
00:50:54,200 --> 00:50:57,360
PREDIABETES IN ORDER TO TREAT

1326
00:50:57,360 --> 00:50:57,840
ESCALATION.

1327
00:50:57,840 --> 00:50:59,720
AND FOR TREATMENT, WE NEED TO

1328
00:50:59,720 --> 00:51:00,880
IMPROVE ACCESS, QUALITY AND

1329
00:51:00,880 --> 00:51:01,120
RETENTION.

1330
00:51:01,120 --> 00:51:02,400
AND WITH THAT I WANT TO THANK

1331
00:51:02,400 --> 00:51:05,640
YOU FOR ALL OF YOUR EFFORTS AND

1332
00:51:05,640 --> 00:51:13,280
I TURN  TURNOVER MICROPHONE TO
WALTER.

1333
00:51:13,280 --> 00:51:16,680
>> THANK YOU VERY MUCH, NORA.

1334
00:51:16,680 --> 00:51:35,920
>> I WILL STOP SHARING.

1335
00:51:35,920 --> 00:51:37,120
>> WALTER, WE HAVE YOUR SLIDES,

1336
00:51:37,120 --> 00:51:38,480
SO YOU DON'T NEED TO SHARE IF

1337
00:51:38,480 --> 00:51:39,600
YOU DON'T WANT TO.

1338
00:51:39,600 --> 00:51:50,280
>> YOU HAVE MY SLIDES?

1339
00:51:50,280 --> 00:51:52,680
>> SO I WILL TALK ABOUT THE PAIN

1340
00:51:52,680 --> 00:51:54,200
PICTURE FROM THE BIG VIEW AND

1341
00:51:54,200 --> 00:51:56,480
JUST TO START OUT BY SAYING THAT

1342
00:51:56,480 --> 00:51:57,360
OPPOSE TO THE SUBSTANCE ABUSE

1343
00:51:57,360 --> 00:51:59,600
PROBLEM, WE DON'T HAVE AN

1344
00:51:59,600 --> 00:52:02,720
INSTITUTE THAT'S DEVOTED TO PAIN

1345
00:52:02,720 --> 00:52:04,600
BUT WE BASICALLY HAVE LIKE A

1346
00:52:04,600 --> 00:52:06,120
NATO EQUIVALENT WHICH IS A WHOLE

1347
00:52:06,120 --> 00:52:09,600
BUNCH OF INSTITUTES THAT HAVE

1348
00:52:09,600 --> 00:52:11,480
GOTTEN TOGETHER AND THE HEAL

1349
00:52:11,480 --> 00:52:12,680
INITIATIVE HAS REALLY MADE SUCH

1350
00:52:12,680 --> 00:52:14,840
A DIFFERENCE IN BRINGING US

1351
00:52:14,840 --> 00:52:18,360
TOGETHER TO DO SOME REALLY

1352
00:52:18,360 --> 00:52:19,520
AMBITIOUS PROJECTS THAT WE COULD

1353
00:52:19,520 --> 00:52:23,280
NEVER HAVE DONE ON OUR OWN AND

1354
00:52:23,280 --> 00:52:28,000
SO HATS OFF TO NCATS AND JOHNNY

1355
00:52:28,000 --> 00:52:30,560
[INDISCERNIBLE], AND NIAMS, AND

1356
00:52:30,560 --> 00:52:35,640
LINDSAY CRISWELL, AND LYNN

1357
00:52:35,640 --> 00:52:40,560
LANGEVIN, AND NIDCR, RENA

1358
00:52:40,560 --> 00:52:42,920
DESOUZA, AND WORKING WITH NINDS

1359
00:52:42,920 --> 00:52:47,240
CONSISTENTLY ON THE PAIN SIDE OF

1360
00:52:47,240 --> 00:52:47,440
HEAL.

1361
00:52:47,440 --> 00:52:52,680
AND SO, YOU KNOW WHAT--WHY

1362
00:52:52,680 --> 00:52:55,040
INSTITUTES HAVE ALL FUNDING AND

1363
00:52:55,040 --> 00:52:56,760
HELPED WITH OUR OANS INSTITUTES

1364
00:52:56,760 --> 00:52:59,560
BUT HEAL ALLOWED US TO DO THINGS

1365
00:52:59,560 --> 00:53:01,200
THAT CUT ACROSS ALL INSTITUTES

1366
00:53:01,200 --> 00:53:03,040
AND NOT THINGS WE COULD HAVE

1367
00:53:03,040 --> 00:53:04,280
DONE PREVIOUSLY ON OUR OWN.

1368
00:53:04,280 --> 00:53:07,000
I SAY, I THINK OF THE GOAL OF

1369
00:53:07,000 --> 00:53:12,080
HEAL AS 3 FOLD.

1370
00:53:12,080 --> 00:53:15,280
AND AS YOU CAN SEE HERE ON THE

1371
00:53:15,280 --> 00:53:18,840
RIGHT, WHEN WE STARTED OFF WITH

1372
00:53:18,840 --> 00:53:20,400
HEAL, PRESCRIPTION OPIOIDS WERE

1373
00:53:20,400 --> 00:53:23,320
THE LEADING CAUSE OF OPIOID

1374
00:53:23,320 --> 00:53:28,000
DEATHS THAT WAS SURPASSED VERY

1375
00:53:28,000 --> 00:53:30,760
UNFORTUNATELY BY THE SYNTHETIC

1376
00:53:30,760 --> 00:53:31,960
OPIOIDS BUT PRIMARILY FENTANYL

1377
00:53:31,960 --> 00:53:34,120
AS NORA WAS TELLING AND THERE

1378
00:53:34,120 --> 00:53:35,800
HAS BEEN SOMEWHAT OF A DROP IN

1379
00:53:35,800 --> 00:53:37,760
THE DEATHS DUE TO PRESCRIPTION

1380
00:53:37,760 --> 00:53:38,720
OPIOIDS BI IT'S STILL BASICALLY

1381
00:53:38,720 --> 00:53:45,280
THE WILL  SAME AS HEROIN AND THE

1382
00:53:45,280 --> 00:53:45,960
OTHER CONTRIBUTORS HERE.

1383
00:53:45,960 --> 00:53:47,760
SO IT'S STILL A SUBSTANTIAL

1384
00:53:47,760 --> 00:53:49,560
PROBLEM IN THE U.S. AND IT IS

1385
00:53:49,560 --> 00:53:51,160
WHAT FUELED THE PROGRAM TO BEGIN

1386
00:53:51,160 --> 00:53:54,880
WITH AND SO HOW DO WE--HOW DO WE

1387
00:53:54,880 --> 00:53:57,360
SOLVE THIS KIND OF DUAL PROBLEM,

1388
00:53:57,360 --> 00:54:00,520
OPIOID TESTS AND THEN THE REALLY

1389
00:54:00,520 --> 00:54:04,480
POOR TREATMENT OF PAIN, AND THE

1390
00:54:04,480 --> 00:54:06,000
NATIONAL HEALTH STATISTICS ARE

1391
00:54:06,000 --> 00:54:08,440
THAT 1 IN 20 PEOPLE IN THE

1392
00:54:08,440 --> 00:54:10,720
ADULTS IN THE U.S. REPORT THAT

1393
00:54:10,720 --> 00:54:12,720
THEY HAVE PAIN ALMOST EITHER

1394
00:54:12,720 --> 00:54:15,080
EVERYDAY OR ALMOST EVERY DAY AND

1395
00:54:15,080 --> 00:54:18,440
A GOOD PROPORTION OF THEM, THE

1396
00:54:18,440 --> 00:54:19,800
PAIN ABOUT 40-50% OF THOSE

1397
00:54:19,800 --> 00:54:23,040
PEOPLE, THE PAIN IS IMPAIRING

1398
00:54:23,040 --> 00:54:23,720
THEIR FUNCTION.

1399
00:54:23,720 --> 00:54:24,880
SO PAIN IS WITH US.

1400
00:54:24,880 --> 00:54:28,040
IT'S BEEN WITH US THROUGHOUT OUR

1401
00:54:28,040 --> 00:54:30,160
HISTORY AND OPIOIDS

1402
00:54:30,160 --> 00:54:32,480
UNFORTUNATELY HAVE BEEN WITH US

1403
00:54:32,480 --> 00:54:33,200
THROUGHOUT OUR HISTORY AND

1404
00:54:33,200 --> 00:54:34,800
ALTHOUGH THEY CAN BE QUITE

1405
00:54:34,800 --> 00:54:35,760
EFFECTIVE AND ACUTE PAIN,

1406
00:54:35,760 --> 00:54:39,480
THEY'RE NOT VERY EFFECTIVE IN

1407
00:54:39,480 --> 00:54:44,000
CHRONIC PAIN AND THEY RUN THIS

1408
00:54:44,000 --> 00:54:45,480
BIG RISK OF HOOKING PEOPLE TO

1409
00:54:45,480 --> 00:54:47,280
THE POINT WHERE THEY BECOME

1410
00:54:47,280 --> 00:54:48,680
ADDICTED AND POTENTIALLY DIE

1411
00:54:48,680 --> 00:54:50,080
FROM THEIR ADDICTION.

1412
00:54:50,080 --> 00:54:54,400
SO, THE L IN HEAL IS

1413
00:54:54,400 --> 00:54:55,280
REALLY--STANDS FOR LONG-TERM AND

1414
00:54:55,280 --> 00:54:59,080
I THINK IF WE'RE GOING TO SOLVE

1415
00:54:59,080 --> 00:55:00,280
THIS PROBLEM, LONG-TERM, WE

1416
00:55:00,280 --> 00:55:02,080
REALLY NEED BETTER NONADDICTIVE

1417
00:55:02,080 --> 00:55:09,160
DRUGS TO MANAGE PAIN.

1418
00:55:09,160 --> 00:55:11,400
AND THAT'S A MAJOR FOCUS OF THE

1419
00:55:11,400 --> 00:55:16,880
HEAL INITIATIVE AND IT'S TO

1420
00:55:16,880 --> 00:55:17,600
STIMULATE THE COMMERCIALIZATION

1421
00:55:17,600 --> 00:55:19,200
OF PRODUCTS THAT COME OUT OF THE

1422
00:55:19,200 --> 00:55:21,720
SCIENCE THAT WE ARE ALL DOING

1423
00:55:21,720 --> 00:55:26,080
HERE AT NIH, IN THE PAIN SPACE.

1424
00:55:26,080 --> 00:55:28,280
SO ALTHOUGH LARGE PHARMA IS

1425
00:55:28,280 --> 00:55:29,400
MOSTLY ABANDONED THE DEVELOPMENT

1426
00:55:29,400 --> 00:55:31,920
OF NEW THERAPIES, THERE ARE

1427
00:55:31,920 --> 00:55:33,000
BIOTECH COMPANIES WE CAN WORK

1428
00:55:33,000 --> 00:55:35,000
WITH AND HOPEFULLY THOSE WILL BE

1429
00:55:35,000 --> 00:55:38,360
MOVED INTO BIG PHARMA AT SOME

1430
00:55:38,360 --> 00:55:38,560
POINT.

1431
00:55:38,560 --> 00:55:41,640
PAIN SCIENCES HAVE DEFINITELY

1432
00:55:41,640 --> 00:55:44,160
MADE STUDY ADVANCES PRODUCING A

1433
00:55:44,160 --> 00:55:47,640
PLETHORA OF TARGETS FOR NEW

1434
00:55:47,640 --> 00:55:48,120
NONADDICTIVE THERAPIES.

1435
00:55:48,120 --> 00:55:50,880
SO A BIG PORTION OF THE HEAL

1436
00:55:50,880 --> 00:55:53,680
INITIATIVE IS IT DEVELOPED NEW

1437
00:55:53,680 --> 00:55:55,280
THERAPIES THAT COULD HELP THE

1438
00:55:55,280 --> 00:55:56,480
TREATMENT OF CONDITIONS THAT CUT

1439
00:55:56,480 --> 00:55:58,280
ACROSS MANY OF OUR INSTITUTES.

1440
00:55:58,280 --> 00:56:00,640
AND IN THE SHORT-TERM, I THINK

1441
00:56:00,640 --> 00:56:02,680
WE CAN ALSO HELP BY COLLECTING

1442
00:56:02,680 --> 00:56:05,760
THE KIND OF EVIDENCE THAT WILL

1443
00:56:05,760 --> 00:56:06,840
PROVIDE PATIENTS AND PHYSICIANS

1444
00:56:06,840 --> 00:56:09,360
ON WHAT IS THE BEST WAY TO

1445
00:56:09,360 --> 00:56:10,760
MANAGE THEIR DIFFERENT PAIN

1446
00:56:10,760 --> 00:56:13,160
CONDITIONS AND THE BEST WAY

1447
00:56:13,160 --> 00:56:15,360
BEING DEFINED AS THOSE THAT GET

1448
00:56:15,360 --> 00:56:17,480
THEM TO THE HIGHEST FUNCTIONAL

1449
00:56:17,480 --> 00:56:19,480
LEVEL AND CERTAINLY OPIOID

1450
00:56:19,480 --> 00:56:22,280
OVERUSE WILL BE A NEGATIVE DRAW

1451
00:56:22,280 --> 00:56:23,320
ON THAT, SO AGAIN, THE

1452
00:56:23,320 --> 00:56:26,200
APPROPRIATE USE OF OPIOIDS IS

1453
00:56:26,200 --> 00:56:28,720
IMPORTANT TO UNDERSTAND BUT ALSO

1454
00:56:28,720 --> 00:56:32,800
WHAT ARE THE OPTIONS AND WHAT

1455
00:56:32,800 --> 00:56:34,560
ARE THE RISKS AND THEN,

1456
00:56:34,560 --> 00:56:36,280
PARTICULARLY IN THE CHRONIC PAIN

1457
00:56:36,280 --> 00:56:37,680
SPACE, WHERE, YOU HAVE VERY

1458
00:56:37,680 --> 00:56:42,760
LITTLE IN THE WAY OF EFFECTIVE

1459
00:56:42,760 --> 00:56:43,200
TREATMENTS.

1460
00:56:43,200 --> 00:56:47,080
WE REALLY NEED TO PUSH ON THAT

1461
00:56:47,080 --> 00:56:53,400
FROM THE SCIENCE STANDPOINT.

1462
00:56:53,400 --> 00:56:53,880
NEXT SLIDE.

1463
00:56:53,880 --> 00:56:56,120
ON THE NEXT SLIDE, YOU SEE KIND

1464
00:56:56,120 --> 00:57:01,520
OF ACROSS THE BOARD HOW HEAL

1465
00:57:01,520 --> 00:57:08,000
STANDS UP IN THESE DIFFERENT

1466
00:57:08,000 --> 00:57:09,760
AREAS SO THE BOTTOM OF THE SLIDE

1467
00:57:09,760 --> 00:57:10,680
IS NOT SHOWING.

1468
00:57:10,680 --> 00:57:11,080
>> THERE IT IS.

1469
00:57:11,080 --> 00:57:12,560
SO MOST OF THE DISCOVERY WORK IS

1470
00:57:12,560 --> 00:57:13,720
ACTUALLY DONE IN THE INSTITUTES

1471
00:57:13,720 --> 00:57:16,080
BUT WE HAVE A PROGRAM IN

1472
00:57:16,080 --> 00:57:17,960
CHRONIC, THE COMMON FUND

1473
00:57:17,960 --> 00:57:28,760
PROGRAM, TO LOOK AT THE RICK

1474
00:57:28,760 --> 00:57:30,080
FACTORS THERE AND DISCUSS THE

1475
00:57:30,080 --> 00:57:32,400
PROGRAMS GOING ON THERE.

1476
00:57:32,400 --> 00:57:34,880
WE HAVE 2 PROJECTS GOING ON IN

1477
00:57:34,880 --> 00:57:36,440
THE POST SURGICAL CHRONIC PAIN.

1478
00:57:36,440 --> 00:57:41,720
WE HAVE SOME REALLY NOVEL

1479
00:57:41,720 --> 00:57:42,560
PROGRAM TO DISCOVER

1480
00:57:42,560 --> 00:57:43,280
FUNCTION--DISCOVER NEW TARGETS

1481
00:57:43,280 --> 00:57:44,680
FROM THE FUNCTION WILL

1482
00:57:44,680 --> 00:57:48,080
EVALUATION OF THE HUMAN PAIN

1483
00:57:48,080 --> 00:57:49,200
GENES IN CELLS AND THIS IS

1484
00:57:49,200 --> 00:57:52,560
TISSUES THAT HAVE TAKEN AND

1485
00:57:52,560 --> 00:57:53,360
TISSUES THAT CAN ACTUALLY BE

1486
00:57:53,360 --> 00:57:57,080
INVESTIGATED AND YOU CAN

1487
00:57:57,080 --> 00:57:59,480
ACTUALLY RECORD FROM THE ROOT

1488
00:57:59,480 --> 00:58:02,440
GANGLION CELLS AND ISSUES TAKEN

1489
00:58:02,440 --> 00:58:03,680
FROM HUMAN AT THE TIME OF

1490
00:58:03,680 --> 00:58:04,880
SURGERY AND I WILL MENTION SOME

1491
00:58:04,880 --> 00:58:08,720
OF THESE KIND OF INTERESTING

1492
00:58:08,720 --> 00:58:14,480
DISCOVERIES AS WE GO ALONG.

1493
00:58:14,480 --> 00:58:17,680
THE ISSUE IN TERMS OF MOVING

1494
00:58:17,680 --> 00:58:20,440
THINGS FROM DISCOVERY TO THERAPY

1495
00:58:20,440 --> 00:58:23,720
IS IN THIS VALIDATION SPACE.

1496
00:58:23,720 --> 00:58:25,520
SO, THERE ARE A PLETHORA OF

1497
00:58:25,520 --> 00:58:26,680
TARGETS ISSUES THE QUESTION IS

1498
00:58:26,680 --> 00:58:28,120
HOW MANY WERE REALLY GOOD

1499
00:58:28,120 --> 00:58:30,760
TARGETS AND THAT'S THE ISSUE OF

1500
00:58:30,760 --> 00:58:32,480
VALIDATION UNDERSTANDING THE

1501
00:58:32,480 --> 00:58:34,240
ROBUSTNESS OF THE EFFECT OF

1502
00:58:34,240 --> 00:58:36,320
TARGETING A PARTICULAR RECEPTOR,

1503
00:58:36,320 --> 00:58:40,000
SAY FOR INSTANCE, SO THAT'S THE

1504
00:58:40,000 --> 00:58:44,160
KIND OF WORK THAT IS NOT THE

1505
00:58:44,160 --> 00:58:45,880
SAME AND DISCOVERY STUFF THAT

1506
00:58:45,880 --> 00:58:47,560
NIH HAS BEEN REALLY STRONG IN

1507
00:58:47,560 --> 00:58:50,080
BUT IT'S THAT NEXT STEP TO

1508
00:58:50,080 --> 00:58:52,440
VALIDATE THESE TARGETS, IT'S A

1509
00:58:52,440 --> 00:58:54,840
LITTLE MORE WROTE BUT WITHOUT

1510
00:58:54,840 --> 00:58:57,480
THAT, THE PROGRESS TO GET

1511
00:58:57,480 --> 00:58:58,000
THERAPIES IS STYMIED.

1512
00:58:58,000 --> 00:59:02,200
WE HAVE ALSO A COUPLE OF

1513
00:59:02,200 --> 00:59:02,480
RESOURCES.

1514
00:59:02,480 --> 00:59:05,920
WE HAVE A PRECLINICAL SCREENING

1515
00:59:05,920 --> 00:59:07,680
PLATFORM, RUN BY PSYCHOGENICS

1516
00:59:07,680 --> 00:59:09,200
WITH MANY DIFFERENT AIM MODELS

1517
00:59:09,200 --> 00:59:11,080
THAT PEOPLE CAN BRING THEIR

1518
00:59:11,080 --> 00:59:16,080
ASSETS IN TO HAVE THEM TESTED

1519
00:59:16,080 --> 00:59:19,680
AND THIS IS EEP TO ACADEMICS OR

1520
00:59:19,680 --> 00:59:20,640
INDUSTRY FOLKS.

1521
00:59:20,640 --> 00:59:22,480
NCATS HAS A REALLY STRONG

1522
00:59:22,480 --> 00:59:25,040
PROGRAM IN PURSUING TARGETS AND

1523
00:59:25,040 --> 00:59:29,080
CELL-BASED ASSAYS WITH KIND OF

1524
00:59:29,080 --> 00:59:29,640
THE TECHNOLOGIES THAT ARE

1525
00:59:29,640 --> 00:59:32,920
AVAILABLE IN A LOT OF FORM

1526
00:59:32,920 --> 00:59:34,400
SUITICAL COMPANIES NOW THESE ARE

1527
00:59:34,400 --> 00:59:37,000
AVAILABLE TO OUR ACADEMIC

1528
00:59:37,000 --> 00:59:37,640
INVESTIGATORS AS WELL.

1529
00:59:37,640 --> 00:59:39,560
AND WE HAVE A NUMBER OF PROGRAMS

1530
00:59:39,560 --> 00:59:40,720
TO BRING NOVEL THERAPIES TO THE

1531
00:59:40,720 --> 00:59:42,720
POINT WHERE THEY CAN GET AN IND

1532
00:59:42,720 --> 00:59:44,640
FROM THE FDA AND POTENTIALLY GO

1533
00:59:44,640 --> 00:59:49,200
INTO PATIENTS AND HOPEFULLY IN

1534
00:59:49,200 --> 00:59:51,960
THAT PROCESS, THOSE THERAPIES

1535
00:59:51,960 --> 00:59:54,360
DERISK TO HELP THEM MOVE THEM

1536
00:59:54,360 --> 01:00:00,320
INTO THOSE NEW PHASE 3 TRIALS,

1537
01:00:00,320 --> 01:00:04,480
LOOKING AT DEVICE PAIN RELIEF

1538
01:00:04,480 --> 01:00:05,840
WORKS BUT IT'S NOT CLEAR HOW.

1539
01:00:05,840 --> 01:00:07,160
BUT THIS COULD BE SOMETHING THAT

1540
01:00:07,160 --> 01:00:10,320
COULD REALLY IMPROVE THE

1541
01:00:10,320 --> 01:00:14,240
DEVELOPMENT OF BETTER DEVICE,

1542
01:00:14,240 --> 01:00:15,360
STIMULATION OF AFFECTING

1543
01:00:15,360 --> 01:00:17,160
NEUROCIRCUITS TO REDUCE PAIN.

1544
01:00:17,160 --> 01:00:24,280
THE LACK OF BIOMARKERS HAS BEEN

1545
01:00:24,280 --> 01:00:25,560
A CRITICAL DEFICIT IN MOVING

1546
01:00:25,560 --> 01:00:27,400
THERAPIES FROM THE CLINICAL TO

1547
01:00:27,400 --> 01:00:28,280
THE PRECLINICAL SPACE.

1548
01:00:28,280 --> 01:00:32,720
COMPANIES HAVE FOUND THAT THE IN

1549
01:00:32,720 --> 01:00:34,120
THE ANIMAL MODELS ARE NOW

1550
01:00:34,120 --> 01:00:35,200
PREDICTING WHAT HAPPENS WHEN YOU

1551
01:00:35,200 --> 01:00:38,320
GO INTO THE CLINIC AND IT'S THIS

1552
01:00:38,320 --> 01:00:40,480
LACK OF BIOMARKERS OF TARGET

1553
01:00:40,480 --> 01:00:41,360
ENGAGEMENT AND PROOF OF

1554
01:00:41,360 --> 01:00:43,720
PRINCIPLE THAT WE'RE HOPING TO

1555
01:00:43,720 --> 01:00:45,520
BUILD IN THE HEAL PROGRAM AND

1556
01:00:45,520 --> 01:00:47,640
THESE COULD POTENTIALLY, YOU

1557
01:00:47,640 --> 01:00:49,480
KNOW IF THEY'RE--IF THEY'RE THEY

1558
01:00:49,480 --> 01:00:51,080
WORK THEY COULD CUT ACROSS A

1559
01:00:51,080 --> 01:00:52,600
WHOLE BUNCH OF PAIN CONDITIONS,

1560
01:00:52,600 --> 01:00:56,080
SO IF IT'S A BIOMARKER OF SAY

1561
01:00:56,080 --> 01:00:57,720
INFLAMMATORY PAIN, SO WE COULD

1562
01:00:57,720 --> 01:00:59,560
HAVE BREAK THROUGHS IN THE

1563
01:00:59,560 --> 01:01:04,080
BIOMARKERS SPACE THAT COULD

1564
01:01:04,080 --> 01:01:06,480
REALLY MOVE THE THERAPEUTIC

1565
01:01:06,480 --> 01:01:06,960
DEVELOPMENT FORWARD.

1566
01:01:06,960 --> 01:01:10,280
WE'RE MAKING BIG EFFORTS IN

1567
01:01:10,280 --> 01:01:11,520
MUSCULOSKELETAL PAIN TO DEVELOP

1568
01:01:11,520 --> 01:01:14,680
BI ON O MARKERS IN THE

1569
01:01:14,680 --> 01:01:16,440
BACK--BIOMARKERS IN THE BACK

1570
01:01:16,440 --> 01:01:17,720
PAIN CONSORTIUM, FOR THE

1571
01:01:17,720 --> 01:01:19,160
PHENOTYPE, UNDERSTAND THE

1572
01:01:19,160 --> 01:01:19,720
MECHANISMS BEHIND DIFFERENT

1573
01:01:19,720 --> 01:01:22,080
TYPES OF BACK PAIN, BACK PAIN

1574
01:01:22,080 --> 01:01:23,080
BEING THE LARNLEST CAUSE OF

1575
01:01:23,080 --> 01:01:25,240
DISABILITY IN THE UNITED STATES.

1576
01:01:25,240 --> 01:01:29,000
YOU ALSO HAVE NETWORK, PHASE 2

1577
01:01:29,000 --> 01:01:32,880
NETWORK TO TEST NEW THERAPIES

1578
01:01:32,880 --> 01:01:34,720
AND ACTUALLY HAVE 3 BIOTECH

1579
01:01:34,720 --> 01:01:38,840
COMPANIES, PRODUCTS NOW BEING

1580
01:01:38,840 --> 01:01:40,680
TESTED IN THE [INDISCERNIBLE] WE

1581
01:01:40,680 --> 01:01:42,840
HAVE THE EFFECTIVENESS NETWORK

1582
01:01:42,840 --> 01:01:43,480
FOR COMPARATIVE EFFECTIVENESS

1583
01:01:43,480 --> 01:01:44,800
RESEARCH TO GIVE INFORMATION

1584
01:01:44,800 --> 01:01:49,120
BACK TO PHYSICIANS AND PATIENTS

1585
01:01:49,120 --> 01:01:50,360
ON BEST TREATMENTS, HEMODIALYSIS

1586
01:01:50,360 --> 01:01:51,240
PAIN PROGRAM AND THE PRISON

1587
01:01:51,240 --> 01:01:55,080
PROGRAM KLF-TWO WAS MENTIONED

1588
01:01:55,080 --> 01:01:55,680
WHICH IS PRAGMATIC TRIALS,

1589
01:01:55,680 --> 01:01:59,840
PARTICULARLY IN THE HEALTHCARE

1590
01:01:59,840 --> 01:02:04,480
SYSTEM AND HEAVILY NOW ON THE

1591
01:02:04,480 --> 01:02:05,280
NONPHARMAICOLOGICAL TREATMENTS

1592
01:02:05,280 --> 01:02:05,640
OF PAIN.

1593
01:02:05,640 --> 01:02:10,640
SO THAT'S HOW IT LOOKS IN THE

1594
01:02:10,640 --> 01:02:10,920
BIG PICTURE.

1595
01:02:10,920 --> 01:02:11,240
NEXT SLIDE.

1596
01:02:11,240 --> 01:02:12,760
I JUST WANT TO SAY LOOKING

1597
01:02:12,760 --> 01:02:18,400
FORWARD, A COUPLE OF THINGS THAT

1598
01:02:18,400 --> 01:02:19,920
WE ARE LOOKING FORWARD TO WORK

1599
01:02:19,920 --> 01:02:21,280
ON, HEALTH EQUITY AND THAT'S

1600
01:02:21,280 --> 01:02:22,720
REALLY ESSENTIAL TO THE NEW

1601
01:02:22,720 --> 01:02:24,120
INITTIAIVE ITS WE'RE PUTTING

1602
01:02:24,120 --> 01:02:24,360
FORWARD.

1603
01:02:24,360 --> 01:02:28,080
HOW DO WE DO RESEARCH TO

1604
01:02:28,080 --> 01:02:29,720
IDENTIFY INIQUITIES AND HOW

1605
01:02:29,720 --> 01:02:32,240
PEOPLE ARE TREATED FOR THEIR

1606
01:02:32,240 --> 01:02:36,400
PAIN AND THEN WHAT CAN WE DO TO

1607
01:02:36,400 --> 01:02:39,680
ATTENUATE THOSE OR OBLIT RATE

1608
01:02:39,680 --> 01:02:40,320
THEM.

1609
01:02:40,320 --> 01:02:43,680
IN THE PAIN SPACE, THERE HASN'T

1610
01:02:43,680 --> 01:02:47,720
BEEN A TREMENDOUS EFFORT IN

1611
01:02:47,720 --> 01:02:50,360
DEVELOPING A WORKFORCE THAT'S

1612
01:02:50,360 --> 01:02:51,760
CLINICAL AND WORKFORCE WORKING

1613
01:02:51,760 --> 01:02:53,400
ON DEVELOPING NEW PAIN THERAPIES

1614
01:02:53,400 --> 01:02:55,120
OR TESTING NEW PAIN THERAPIES,

1615
01:02:55,120 --> 01:02:57,080
SO I'M TRYING TO GET

1616
01:02:57,080 --> 01:03:00,480
PARTICULARLY A CLINICAL

1617
01:03:00,480 --> 01:03:02,040
INVESTIGATORS INTO THIS AREA IS

1618
01:03:02,040 --> 01:03:02,960
CRITICALLY IMPORTANT FOR US AND

1619
01:03:02,960 --> 01:03:06,880
WE WILL BE SUCCESSFUL DOWN THE

1620
01:03:06,880 --> 01:03:07,080
LINE.

1621
01:03:07,080 --> 01:03:10,440
DATA INTEGRATION, YOU WILL HEAR

1622
01:03:10,440 --> 01:03:14,560
ABOUT LATER ON, AND THEN, ALSO

1623
01:03:14,560 --> 01:03:15,800
MENTIONED WITH EMPOWER WE'RE

1624
01:03:15,800 --> 01:03:16,680
GETTING INTO A VERY TOUGH

1625
01:03:16,680 --> 01:03:19,360
PROBLEM IS HOW DO YOU MANAGE

1626
01:03:19,360 --> 01:03:23,400
PAIN IN PEOPLE WHO ARE USING

1627
01:03:23,400 --> 01:03:25,760
OPIOIDS, SOMETHING THAT MANY

1628
01:03:25,760 --> 01:03:26,400
PHYSICIANS JUST WON'T EVEN TRY

1629
01:03:26,400 --> 01:03:28,480
TO DO AND YOU KNOW THAT REALLY

1630
01:03:28,480 --> 01:03:31,360
LEAVES PEOPLE WITHOUT OPTIONS,

1631
01:03:31,360 --> 01:03:32,480
EXCEPT FOR THEIR OPIOIDS WHEN

1632
01:03:32,480 --> 01:03:34,000
THEY HAVE PAIN AND THAT CAN

1633
01:03:34,000 --> 01:03:38,080
CERTAINLY HAVE A BAD OUTCOME.

1634
01:03:38,080 --> 01:03:40,200
AND WE VERY MUCH, AGAIN, WOULD

1635
01:03:40,200 --> 01:03:41,720
LIKE TO REDOUBLE OUR EFFORTS TO

1636
01:03:41,720 --> 01:03:44,600
DO RESEARCH THAT WILL INFORM THE

1637
01:03:44,600 --> 01:03:45,680
PRIMARY CARE PHYSICIANS AND

1638
01:03:45,680 --> 01:03:47,320
HEALTHCARE SYSTEMS WHERE

1639
01:03:47,320 --> 01:03:49,440
PATIENTS ARE GOING TO PRESENT

1640
01:03:49,440 --> 01:03:54,040
WITH THEIR PAIN AND TO DEVELOP

1641
01:03:54,040 --> 01:03:55,640
INTEGRATED SYSTEMS TO SUPPORT

1642
01:03:55,640 --> 01:03:56,760
THE PRIMARY CARE PHYSICIANS AND

1643
01:03:56,760 --> 01:03:58,080
THEIR CARE OF PATIENTS WITH

1644
01:03:58,080 --> 01:04:01,240
PAIN, THE SAME PEOPLE EVERY 15

1645
01:04:01,240 --> 01:04:03,200
MINUTES, THEY WILL REALLY NEED

1646
01:04:03,200 --> 01:04:04,560
SUPPORT FOR A COMPLICATED

1647
01:04:04,560 --> 01:04:05,760
PATIENT WITH CHRONIC PAIN AND

1648
01:04:05,760 --> 01:04:07,160
HOW TO BUILD THOSE SUPPORTS IN

1649
01:04:07,160 --> 01:04:08,960
IT, IS SOMETHING THAT WE'RE REAL

1650
01:04:08,960 --> 01:04:12,240
INTERESTED IN DOING.

1651
01:04:12,240 --> 01:04:12,720
NEXT SLIDE.

1652
01:04:12,720 --> 01:04:14,280
AND JUST WANTED TO MENTION A

1653
01:04:14,280 --> 01:04:17,760
COUPLE THINGS, IN TERMS OF THE

1654
01:04:17,760 --> 01:04:20,280
SCIENCE, THE SCIENCE OF PAIN,

1655
01:04:20,280 --> 01:04:21,200
IT'S ALWAYS BEEN, YOU KNOW

1656
01:04:21,200 --> 01:04:24,280
REALLY INTERESTING TO ME, AND

1657
01:04:24,280 --> 01:04:26,360
IT'S EXPANDED OVER THE YEARS,

1658
01:04:26,360 --> 01:04:30,840
AND JUST TO SAY THAT, YOU KNOW

1659
01:04:30,840 --> 01:04:32,840
THAT THE--NOBEL PRIZE WAS GIVEN

1660
01:04:32,840 --> 01:04:35,720
TO 2 PAIN SCIENTISTS FOR THE

1661
01:04:35,720 --> 01:04:44,160
DISCOVERY AND THE 3D STRUCTURE

1662
01:04:44,160 --> 01:04:45,080
OF PAIN, TEMPERATURE RECEPTORS

1663
01:04:45,080 --> 01:04:47,080
AND THIS IS JUST THE BEGINNING

1664
01:04:47,080 --> 01:04:49,560
SO THERE IS NOW 3D STRUCTURES

1665
01:04:49,560 --> 01:04:55,760
FOR MANY OF THE RECEPTORS THAT 1

1666
01:04:55,760 --> 01:04:56,480
COULD INSILIC O DEVELOP DRUGS

1667
01:04:56,480 --> 01:04:58,880
THAT ARE GOING TO BE MORE

1668
01:04:58,880 --> 01:05:00,640
SPECIFIC AND POTENT THAN THE 1S

1669
01:05:00,640 --> 01:05:01,680
WE HAVE NOW WORKING RIGHT ON THE

1670
01:05:01,680 --> 01:05:04,720
PAIN SYSTEM WHICH IS NOT

1671
01:05:04,720 --> 01:05:05,760
EXPECTED TO BE ADDICTIVE.

1672
01:05:05,760 --> 01:05:09,320
THEN ALSO THE WINNERS OF THE BIG

1673
01:05:09,320 --> 01:05:10,840
BRAIN PRIZE IN 2021 WERE A GROUP

1674
01:05:10,840 --> 01:05:13,600
THAT WORKED ON CGRP AS THE

1675
01:05:13,600 --> 01:05:16,080
DRIVER OF SOME PEOPLE'S MIGRAINE

1676
01:05:16,080 --> 01:05:23,560
WHICH HAS NOW LED TO A

1677
01:05:23,560 --> 01:05:26,160
COMMERCIALIZATION OF MULTIPLE

1678
01:05:26,160 --> 01:05:26,960
ANTIGPR PRODUCTS FOR MIGRATION,

1679
01:05:26,960 --> 01:05:31,480
SO IT'S AN EXAMPLE OF, I

1680
01:05:31,480 --> 01:05:35,720
REMEMBER BACK DR. MIKE AT

1681
01:05:35,720 --> 01:05:37,480
MOSKOWITZ, IT WAS A 30 YEAR

1682
01:05:37,480 --> 01:05:38,640
EFFORT BUT PERSISTENCE HELPS.

1683
01:05:38,640 --> 01:05:38,960
NEXT SLIDE.

1684
01:05:38,960 --> 01:05:42,520
AND THEN JUST TO SAY THAT IN

1685
01:05:42,520 --> 01:05:48,080
THIS SPACE OF TRYING TO, YOU

1686
01:05:48,080 --> 01:05:49,200
KNOW--TO MONITOR AND MODULATE

1687
01:05:49,200 --> 01:05:54,280
CIRCUITS AND PAIN IT CLEARLY A

1688
01:05:54,280 --> 01:05:57,040
PROTOTYPICAL CIRCUIT DISORDER IS

1689
01:05:57,040 --> 01:05:59,080
NOT A PATHOLOGY IN GENERAL, IT'S

1690
01:05:59,080 --> 01:06:00,800
AN ABNORMAL CIRCUIT THAT'S BEEN

1691
01:06:00,800 --> 01:06:02,800
SET UP BY A AN EXPERIENCE OR

1692
01:06:02,800 --> 01:06:04,880
STIMULUS AND THE BRAIN

1693
01:06:04,880 --> 01:06:06,920
INITIATIVE IS DEVELOPING NEW

1694
01:06:06,920 --> 01:06:10,600
TOOLS TO ALLOW US TO INVESTIGATE

1695
01:06:10,600 --> 01:06:11,680
CIRCUITS AND THEY'RE GENERIC AND

1696
01:06:11,680 --> 01:06:13,560
CAN BE I THINK POWERFULLY

1697
01:06:13,560 --> 01:06:16,080
EMPLOYED TO THE PAIN SIDE OF

1698
01:06:16,080 --> 01:06:16,320
THINGS.

1699
01:06:16,320 --> 01:06:19,240
SO NEXT SLIDE, THIS IS JUST AN

1700
01:06:19,240 --> 01:06:20,400
EXAMPLE IN NATURE, A LARGE

1701
01:06:20,400 --> 01:06:24,080
AMOUNT OF WORK WAS PUBLISHED IN

1702
01:06:24,080 --> 01:06:25,760
OCTOBER, LOOKING AT WHAT WE CALL

1703
01:06:25,760 --> 01:06:28,560
THE CELL CENSUS OF THE DIFFERENT

1704
01:06:28,560 --> 01:06:33,840
TYPES OF CELLS IN THE BRAIN. 

1705
01:06:33,840 --> 01:06:36,240
THIS WAS ENABLED BY BY NEW

1706
01:06:36,240 --> 01:06:36,840
GENOMIC HIGH THROUGH PUT STUDIES

1707
01:06:36,840 --> 01:06:40,840
THAT YOU CAN LOOK AT THE

1708
01:06:40,840 --> 01:06:42,840
TRANSCRIPT OHM IN THE CELL

1709
01:06:42,840 --> 01:06:46,120
CYTOPLASM OR YOU CAN LOOK AT A

1710
01:06:46,120 --> 01:06:47,000
DNA METHYLATION IN THE NUCLEUS

1711
01:06:47,000 --> 01:06:51,680
AND YOU CAN THEN CLASSIFY CELLS,

1712
01:06:51,680 --> 01:06:54,320
YOU CAN IDENTIFY CELL SPECIFIC

1713
01:06:54,320 --> 01:06:59,800
ENHANCERS, THAT CAN THEN BE USED

1714
01:06:59,800 --> 01:07:01,840
TO DELIVER ARTIFICIAL GENES THAT

1715
01:07:01,840 --> 01:07:03,280
CAN THEN ACTIVATE OR DEACTIVATE

1716
01:07:03,280 --> 01:07:06,800
SPECIFICALLY THOSE CELL TYPES.

1717
01:07:06,800 --> 01:07:07,880
YOU COULD EVEN PATCH CLAMP THE

1718
01:07:07,880 --> 01:07:10,280
CELLS AND LOOK AT THEIR

1719
01:07:10,280 --> 01:07:11,960
ELECTROPHYSIOLOGICAL PROPERTIES

1720
01:07:11,960 --> 01:07:14,880
AND YOU COULD ALSO INJECT THE

1721
01:07:14,880 --> 01:07:17,400
TRACERS EITHER GENETICALLY OR

1722
01:07:17,400 --> 01:07:20,600
PHYSICALLY INTO THESE CELLS TO

1723
01:07:20,600 --> 01:07:23,840
LOOK AT THEIR CONNECTIONS.

1724
01:07:23,840 --> 01:07:24,280
NEXT SLIDE.

1725
01:07:24,280 --> 01:07:25,160
FOR THE FIRST EFFORT THAT WAS

1726
01:07:25,160 --> 01:07:27,680
DONE IN THE MOTOR CORTEX, AND

1727
01:07:27,680 --> 01:07:32,480
THEY LOOKED AT HUMAN, NONHUMAN

1728
01:07:32,480 --> 01:07:34,440
PRIMATE AND MOUSE AND THE--YOU

1729
01:07:34,440 --> 01:07:37,960
KNOW LOOKING ACROSS SPECIES,

1730
01:07:37,960 --> 01:07:39,480
WHAT YOU FIND--NEXT SLIDE--IS

1731
01:07:39,480 --> 01:07:44,400
THAT THE CELL TYPES ARE ACTUALLY

1732
01:07:44,400 --> 01:07:48,680
PRETTY WELL CONSERVED BUT THE

1733
01:07:48,680 --> 01:07:49,960
ACTUAL TRANSCRIPT OHM IN THOSE

1734
01:07:49,960 --> 01:07:51,040
DIFFERENT CELL TYPES DIFFER.

1735
01:07:51,040 --> 01:07:54,640
SO YOU HAVE THE SAME CELL TYPES

1736
01:07:54,640 --> 01:07:56,400
BUT THEY'RE USING DIFFERENT

1737
01:07:56,400 --> 01:07:59,440
LEVERS AND MACHINERY THAT MAKES

1738
01:07:59,440 --> 01:08:01,640
THE DIFFERENCE BETWEEN THE BIG

1739
01:08:01,640 --> 01:08:03,560
DIFFERENCE BETWEEN THE MOUSE,

1740
01:08:03,560 --> 01:08:04,760
THE NONHUMAN PRIMATE AND THEN

1741
01:08:04,760 --> 01:08:08,320
LESS OF A CHANGE BETWEEN THE

1742
01:08:08,320 --> 01:08:11,280
NONHUMAN PRIMATE AND HUMANS.

1743
01:08:11,280 --> 01:08:12,400
NEXT SLIDE.

1744
01:08:12,400 --> 01:08:14,280
AND THIS IS REALLY IMPORTANT IN

1745
01:08:14,280 --> 01:08:16,480
UNDERSTANDING, YOU KNOW HOW WE

1746
01:08:16,480 --> 01:08:22,040
MOVE IN PAIN BECAUSE THERE ARE

1747
01:08:22,040 --> 01:08:22,680
CERTAIN--CERTAIN CHARACTERISTICS

1748
01:08:22,680 --> 01:08:24,720
OF THE MOUSE CELLS THAT ARE NOT

1749
01:08:24,720 --> 01:08:30,480
IN THE HUMAN IS VICE VERSA, SO

1750
01:08:30,480 --> 01:08:32,400
AVENUES OF WHERE YOU--THERAPIES

1751
01:08:32,400 --> 01:08:34,120
LOOK GREAT IN THE MOUSE AND NOT

1752
01:08:34,120 --> 01:08:35,960
IN THE HUMAN POTENTIALLY COULD

1753
01:08:35,960 --> 01:08:39,720
HAVE EXPLANATIONS IN THESE

1754
01:08:39,720 --> 01:08:40,680
DIFFERENCES.

1755
01:08:40,680 --> 01:08:41,160
NEXT SLIDE.

1756
01:08:41,160 --> 01:08:44,480
THESE TECHNIQUES ARE ALREADY

1757
01:08:44,480 --> 01:08:45,240
BEING APPLIED TO PAIN.

1758
01:08:45,240 --> 01:08:48,160
AND SO THIS IS A RECENT PAPER

1759
01:08:48,160 --> 01:08:55,680
OUT OF TED PRICE'S LAB LOOKING

1760
01:08:55,680 --> 01:09:00,720
AT GANGLION CELLS AND LOOKING AT

1761
01:09:00,720 --> 01:09:01,840
TRANSCRIPT OMES AND IDENTIFYING

1762
01:09:01,840 --> 01:09:04,080
WHOLE CELL TYPES OF IN THE

1763
01:09:04,080 --> 01:09:05,480
DORSAL ROOT GANGLION AND LOOKING

1764
01:09:05,480 --> 01:09:07,880
AT DIFFERENCES BETWEEN THE HUMAN

1765
01:09:07,880 --> 01:09:11,040
AND MOUSE AND THEN DIFFERENCES

1766
01:09:11,040 --> 01:09:13,040
BETWEEN MALES  MALES AND
FEMALES,

1767
01:09:13,040 --> 01:09:14,480
ANOTHER FACT WE HAVE TO DEAL

1768
01:09:14,480 --> 01:09:15,720
WITH AND MALES AND FEMALES

1769
01:09:15,720 --> 01:09:16,880
RESPOND TO PAIN AND HAVE

1770
01:09:16,880 --> 01:09:21,080
DIFFERENT RESPONSE TO PAIN

1771
01:09:21,080 --> 01:09:22,440
THERAPIES.

1772
01:09:22,440 --> 01:09:23,480
AND THEY ALSO WITH THIS

1773
01:09:23,480 --> 01:09:29,160
TECHNIQUE WERE ABLE TO IDENTIFY

1774
01:09:29,160 --> 01:09:30,800
WHOLE SERIES, HUNDREDS ACTUALLY

1775
01:09:30,800 --> 01:09:32,240
OF WHAT'S CALLED THE

1776
01:09:32,240 --> 01:09:35,280
UNDERSTUDIED DRUGGABLE GENOME SO

1777
01:09:35,280 --> 01:09:37,480
POTENTIAL CELL SPECIFIC PROTEINS

1778
01:09:37,480 --> 01:09:43,360
THAT MIGHT BE TARGETS FOR PAIN

1779
01:09:43,360 --> 01:09:44,840
THERAPIES.

1780
01:09:44,840 --> 01:09:45,520
NEXT SLIDE.

1781
01:09:45,520 --> 01:09:47,040
SO THE QUESTION IS, WHAT COULD

1782
01:09:47,040 --> 01:09:50,240
THIS LOOK LIKE DOWN THE ROAD?

1783
01:09:50,240 --> 01:09:54,840
I THINK THE ABILITY TO LOOK AT

1784
01:09:54,840 --> 01:09:58,920
THESE SIGNALING PATHWAYS ISSUES

1785
01:09:58,920 --> 01:10:01,240
SUCH AS THE ANTIPD1 TREATMENT,

1786
01:10:01,240 --> 01:10:03,160
YOU KNOW LOOKING AT OPENING UP

1787
01:10:03,160 --> 01:10:05,120
THE INFLAMMATORY RESPONSE TO

1788
01:10:05,120 --> 01:10:10,560
TUMORS, TURNS OUT THAT THAT'S

1789
01:10:10,560 --> 01:10:13,200
ALSO ACTIVE IN RECEPTION OF

1790
01:10:13,200 --> 01:10:13,720
DORSAL GANGLION CELLS.

1791
01:10:13,720 --> 01:10:15,640
PEOPLE HAVE BEEN ABLE TO

1792
01:10:15,640 --> 01:10:17,640
IDENTIFY IN THE AMYGDALA REGIONS

1793
01:10:17,640 --> 01:10:19,200
OF THE BRAIN THAT ARE

1794
01:10:19,200 --> 01:10:22,680
RESPONSIBLE FOR THE

1795
01:10:22,680 --> 01:10:24,600
UNPLEASANTNESS OF PAIN, BRINGING

1796
01:10:24,600 --> 01:10:25,600
TO THE IDEA--BRINGS UP THE IDEA

1797
01:10:25,600 --> 01:10:28,200
THAT YOU MIGHT BE ABLE TO TURN

1798
01:10:28,200 --> 01:10:29,720
OFF THE CENTER AND YOU WOULD

1799
01:10:29,720 --> 01:10:32,400
STILL BE ABLE TO DETECT A

1800
01:10:32,400 --> 01:10:33,880
PAINFUL STIMULUS, SO HOT COVERY,

1801
01:10:33,880 --> 01:10:35,960
YOU WOULD NOT SIP THE HOT COFFEE

1802
01:10:35,960 --> 01:10:38,480
BECAUSE YOU KNOW IT'S HOT BUT

1803
01:10:38,480 --> 01:10:39,640
YOU WOULDN'T HAVE THAT

1804
01:10:39,640 --> 01:10:40,520
UNPLEASANTNESS THAT IS

1805
01:10:40,520 --> 01:10:42,320
RESPONSIBLE FOR THE SUFFERING

1806
01:10:42,320 --> 01:10:43,280
DUE TO PAIN.

1807
01:10:43,280 --> 01:10:44,680
REALLY POWERFUL IDEA THERE.

1808
01:10:44,680 --> 01:10:51,960
BUT THERE IS CLEARLY CIRCUITS

1809
01:10:51,960 --> 01:10:53,600
THAT CONNECT THE NOSE-SUSCEPT

1810
01:10:53,600 --> 01:10:54,800
EPTOR WITH THE NEGATIVE VALENCE

1811
01:10:54,800 --> 01:11:00,360
OF PAIN THAT WE MIGHT BE ABLE TO

1812
01:11:00,360 --> 01:11:01,520
MANIPULATE WITH CHEMICALS,

1813
01:11:01,520 --> 01:11:03,400
DREADS, THE DREAD TECHNOLOGIES

1814
01:11:03,400 --> 01:11:05,680
ALLOW YOU TO POTENTIALLY TURN ON

1815
01:11:05,680 --> 01:11:08,000
OR TURN OFF PARTICULAR CELL

1816
01:11:08,000 --> 01:11:13,480
TYPES BASED ON THEIR

1817
01:11:13,480 --> 01:11:14,480
CELL-SPECIFIC ENHANCERS.

1818
01:11:14,480 --> 01:11:19,680
AND THERE'S OORLGT EXAMPLE

1819
01:11:19,680 --> 01:11:20,880
LOOKING AT THE DORSAL ROOT

1820
01:11:20,880 --> 01:11:22,200
GANGLION I MENTIONED EARLIER

1821
01:11:22,200 --> 01:11:24,840
TAKEN FROM HUMANS AND THEY ARE

1822
01:11:24,840 --> 01:11:26,120
ELECTRICALLY ACTIVE AND YOU CAN

1823
01:11:26,120 --> 01:11:27,880
STUDY THEM AND YOU WHAT WE FOUND

1824
01:11:27,880 --> 01:11:30,680
WAS IF YOU LOOK AT THE DORSAL

1825
01:11:30,680 --> 01:11:33,080
ROOT GANGLION CELLS FROM A

1826
01:11:33,080 --> 01:11:34,160
NORMAL SIDE DERMA TELOMERE WITH

1827
01:11:34,160 --> 01:11:36,160
NO PAIN, THE CELLS ARE

1828
01:11:36,160 --> 01:11:37,520
COMPLETELY I SILENT BUT LOOKING

1829
01:11:37,520 --> 01:11:39,080
AT THE SIDE WHERE THERE IS PAIN

1830
01:11:39,080 --> 01:11:40,280
DUE TO THAT ON THE CELLS ARE

1831
01:11:40,280 --> 01:11:42,480
FIRING ALL THE TIME.

1832
01:11:42,480 --> 01:11:43,480
SO THEY HAVE ACTUAL, THIS IS

1833
01:11:43,480 --> 01:11:46,680
PROJECTION 

1834
01:11:46,680 --> 01:11:47,320
SPONTANEOUS ACTIVITY, YOU HAVE

1835
01:11:47,320 --> 01:11:49,760
PAIN ON THAT SIDE, YOUR

1836
01:11:49,760 --> 01:11:51,880
SPONTANEOUS ACTIVITY IS WAY UP,

1837
01:11:51,880 --> 01:11:53,600
AND SIMILARLY IF YOU HAD

1838
01:11:53,600 --> 01:11:55,520
COMPRESSION OF THAT NERVE ROOT,

1839
01:11:55,520 --> 01:11:56,880
THAT'S THE USUAL COURSE OF MAIN,

1840
01:11:56,880 --> 01:11:57,800
YOUR PROJECTION NEURONS OR PIONS

1841
01:11:57,800 --> 01:12:00,240
TIANYLIOUS ACTIVITY IS WAY UP.

1842
01:12:00,240 --> 01:12:02,840
SO, IT MAY BE SIMPLISTIC TO

1843
01:12:02,840 --> 01:12:05,080
THINK THAT SOMETHING THAT

1844
01:12:05,080 --> 01:12:05,920
DEPRESSES THE SPONTANEOUS

1845
01:12:05,920 --> 01:12:09,320
ACTIVITY IN THE DRG CELLS MIGHT

1846
01:12:09,320 --> 01:12:14,680
RELIEVE PAIN IN PEOPLE WITH ROOT

1847
01:12:14,680 --> 01:12:16,680
COMPRESSION.

1848
01:12:16,680 --> 01:12:19,640
SO AS I MENTIONED LOTS OF

1849
01:12:19,640 --> 01:12:21,880
TARGETS TO PURSUE AND THE HEAL

1850
01:12:21,880 --> 01:12:23,360
INITIATIVE ALLOWS US TO KIND OF

1851
01:12:23,360 --> 01:12:28,360
MOVE ALL THESE THINGS FORWARD TO

1852
01:12:28,360 --> 01:12:30,440
THE POINT WHERE PHARMACEUTICAL

1853
01:12:30,440 --> 01:12:32,080
COMPANIES, BIOTECHS CAN SEE THE

1854
01:12:32,080 --> 01:12:34,200
LOW RISK IN MOVING THEM FORWARD

1855
01:12:34,200 --> 01:12:36,440
IN THE POTENTIAL HIGH GAIN OF

1856
01:12:36,440 --> 01:12:37,680
MOVING THESE ADVANCES FORWARD

1857
01:12:37,680 --> 01:12:41,280
AND THAT'S WHAT I HOPE THE HEAL

1858
01:12:41,280 --> 01:12:42,760
INITIATIVE CAN BE SUCCESSFUL AT

1859
01:12:42,760 --> 01:12:45,320
WITHIN THE NEXT COUPLE OF YEARS.

1860
01:12:45,320 --> 01:12:46,800
SO I THINK THAT WAS MY LAST

1861
01:12:46,800 --> 01:12:49,200
SLIDE, I WANT TO THANK YOU FOR

1862
01:12:49,200 --> 01:12:50,360
ATTENTION AND I'M HAPPY TO

1863
01:12:50,360 --> 01:12:55,520
ANSWER ANY QUESTIONS OR TAKE ANY

1864
01:12:55,520 --> 01:12:56,000
ADVICE.

1865
01:12:56,000 --> 01:12:57,400
>> YEAH, WE CAN NOW OPEN IT UP

1866
01:12:57,400 --> 01:12:59,280
TO QUESTIONS FROM ANY ASPECTS OF

1867
01:12:59,280 --> 01:13:02,000
THE PRESENTATIONS YOU HEARD SO

1868
01:13:02,000 --> 01:13:02,480
FAR.

1869
01:13:02,480 --> 01:13:11,640
THANK YOU WALTER, THANK YOU

1870
01:13:11,640 --> 01:13:12,520
NORA.

1871
01:13:12,520 --> 01:13:15,040
>> HEY WALTER THIS IS WALLY

1872
01:13:15,040 --> 01:13:15,240
SMITH.

1873
01:13:15,240 --> 01:13:16,800
FASCINATING COUPLE OF SLIDES

1874
01:13:16,800 --> 01:13:17,480
THERE.

1875
01:13:17,480 --> 01:13:20,760
AND AS CLINICIANS WE

1876
01:13:20,760 --> 01:13:24,400
ANECDOTEALLY SEE SOME OF THESE

1877
01:13:24,400 --> 01:13:25,320
EXPRESSIONS AND DON'T KNOW WHAT

1878
01:13:25,320 --> 01:13:28,440
TO DO WITH THEM AND I WONDERED

1879
01:13:28,440 --> 01:13:32,160
IF YOU SAW ROOM FOR TEAMS OF

1880
01:13:32,160 --> 01:13:34,880
BASIC SCIENTISTS AND CLINICIANS

1881
01:13:34,880 --> 01:13:37,600
TO TEAM UP AND HOW THEY MIGHT

1882
01:13:37,600 --> 01:13:40,320
TEAM UP TO TRY TO BRING THE

1883
01:13:40,320 --> 01:13:42,800
CLINICAL COROLATES OF SOME OF

1884
01:13:42,800 --> 01:13:44,480
THOSE ELECTRICAL RESPONSES THAT

1885
01:13:44,480 --> 01:13:46,680
YOU JUST NOTED BETWEEN FOR

1886
01:13:46,680 --> 01:13:52,400
EXAMPLE, THE AMYGDALA AND THE

1887
01:13:52,400 --> 01:13:53,000
NOSE RECEPTORS?

1888
01:13:53,000 --> 01:13:54,000
>> REALLY GOOD QUESTION, BECAUSE

1889
01:13:54,000 --> 01:13:56,680
I THINK--IS THAT A CONCEPT WE'RE

1890
01:13:56,680 --> 01:13:58,920
PRESENTING TOMORROW?

1891
01:13:58,920 --> 01:14:02,960
I THINK IT IS.

1892
01:14:02,960 --> 01:14:04,200
BUT YOU'RE RIGHT, WE HAVE A LOT

1893
01:14:04,200 --> 01:14:05,760
OF THINGS GOING ON, BUT YOU'RE

1894
01:14:05,760 --> 01:14:06,600
RIGHT, WE'RE THINKING THAT WE

1895
01:14:06,600 --> 01:14:09,680
NEED TO BUILD THIS CLINICAL

1896
01:14:09,680 --> 01:14:11,840
WORKFORCE AND IT'S GOT TO BE

1897
01:14:11,840 --> 01:14:12,680
INTEGRATED WITH THE BASIC

1898
01:14:12,680 --> 01:14:15,520
SCIENCE AND THE BASIC SCIENCE IS

1899
01:14:15,520 --> 01:14:17,000
ACTUALLY QUITE STRONG.

1900
01:14:17,000 --> 01:14:20,680
IT'S--I MEAN, I'VE BEEN

1901
01:14:20,680 --> 01:14:25,120
IMPRESSED, I'M SURE A L HAS SEEN

1902
01:14:25,120 --> 01:14:26,480
JUST TREMENDOUS CHANGES OVER HIS

1903
01:14:26,480 --> 01:14:27,600
CAREER.

1904
01:14:27,600 --> 01:14:29,000
SO OUR PROPOSAL IS TO BUILD

1905
01:14:29,000 --> 01:14:31,280
THESE CENTERS THAT ARE GOING TO

1906
01:14:31,280 --> 01:14:34,600
FUSE THE CLINICAL AND THE BASIC

1907
01:14:34,600 --> 01:14:36,440
RESEARCHERS TOGETHER AND THEN

1908
01:14:36,440 --> 01:14:38,720
BUILD THAT WORKFORCE WHICH I

1909
01:14:38,720 --> 01:14:40,280
THINK IS--THAT'S THE SECRET FOR

1910
01:14:40,280 --> 01:14:42,280
SUCCESS IS TO BUILD THAT

1911
01:14:42,280 --> 01:14:44,520
INTEGRATIVE WORKFORCE BETWEEN

1912
01:14:44,520 --> 01:14:48,240
THE CLINICAL AND THE BASIC

1913
01:14:48,240 --> 01:14:48,480
SCIENTIST.

1914
01:14:48,480 --> 01:14:52,400
THAT'S 1 OF THE INITIATIVES WE

1915
01:14:52,400 --> 01:14:54,360
HAVE PLANNED.

1916
01:14:54,360 --> 01:14:58,120
I'M TRYING TO GET NORA TO THINK

1917
01:14:58,120 --> 01:14:59,360
ABOUT STIMULATION, TOO, BRAIN

1918
01:14:59,360 --> 01:15:01,920
STIMULATION AS A TREATMENT FOR

1919
01:15:01,920 --> 01:15:02,200
ADDICTION.

1920
01:15:02,200 --> 01:15:04,000
>> YEAH, THERE ARE SEVERAL

1921
01:15:04,000 --> 01:15:07,000
TRIALS GOING ON AND

1922
01:15:07,000 --> 01:15:08,800
METHODOLOGIES FROM ACTUALLY

1923
01:15:08,800 --> 01:15:10,200
NONINVASIVE WITH EMS OR DIRECT

1924
01:15:10,200 --> 01:15:13,840
CURRENT STIMULATION OR EVEN

1925
01:15:13,840 --> 01:15:14,840
PERIPHERAL NERVE STIMULATION TO

1926
01:15:14,840 --> 01:15:17,520
INVASIVE 1S WHERE YOU PUT THE

1927
01:15:17,520 --> 01:15:19,360
ELECTRODES, AND MOST OF THE WORK

1928
01:15:19,360 --> 01:15:20,680
ACTUALLY HAS BEEN WITH THE

1929
01:15:20,680 --> 01:15:24,360
ELECTRODES THAT ARE PLACED IN

1930
01:15:24,360 --> 01:15:26,360
THE NUCLEUS CIRCUMFERENCE AND

1931
01:15:26,360 --> 01:15:27,960
THE TRIALS IN THE UNITED STATES

1932
01:15:27,960 --> 01:15:31,840
HAVE BEEN RELATIVELY SMALL BUT

1933
01:15:31,840 --> 01:15:36,440
LOOK ACTUALLY QUITE INTERESTING.

1934
01:15:36,440 --> 01:15:37,640
WRASSE'REWHEREAS THERE'S ALSO

1935
01:15:37,640 --> 01:15:39,360
BEEN WORK IN OTHER COUNTRIES SO

1936
01:15:39,360 --> 01:15:44,960
THIS IS AN AREA OF VERY, VERY

1937
01:15:44,960 --> 01:15:45,320
ACTIVE RESEARCH.

1938
01:15:45,320 --> 01:15:46,800
>> BECAUSE ADDICTION IS ANOTHER

1939
01:15:46,800 --> 01:15:47,200
CIRCUIT DISORDER.

1940
01:15:47,200 --> 01:15:48,920
>> OF COURSE AND I THINK THAT

1941
01:15:48,920 --> 01:15:51,360
BASICALLY YOU'RE GOING TO FIND

1942
01:15:51,360 --> 01:15:53,320
THAT THEY ARE STRIPPED BECAUSE

1943
01:15:53,320 --> 01:15:56,200
THE BRAIN IS SUCH A COMPLEX

1944
01:15:56,200 --> 01:15:58,720
CIRCUIT OF CIRCUITS THAT THE

1945
01:15:58,720 --> 01:16:00,480
ISSUE IS IDENTIFYING HUBS THAT

1946
01:16:00,480 --> 01:16:03,680
BY MANIPULATING CAN HAVE A DOWN

1947
01:16:03,680 --> 01:16:05,040
STREAM EFFECT AND OBVIOUSLY IN

1948
01:16:05,040 --> 01:16:08,080
THE PAIN FIELD AS YOU HAVE BEEN

1949
01:16:08,080 --> 01:16:12,200
SHOWING, THE AMYGDALA IS

1950
01:16:12,200 --> 01:16:15,600
FUNDAMENTAL ACTUALLY IN

1951
01:16:15,600 --> 01:16:16,200
DETERMINING THE SEVERITY AND

1952
01:16:16,200 --> 01:16:18,800
PHYSICAL ABILITY TO ADAPT TO IT.

1953
01:16:18,800 --> 01:16:22,480
INTERESTINGLY ARE, THE AMYGDALA

1954
01:16:22,480 --> 01:16:23,400
ALSO NEGATIVELY INFLUENCES

1955
01:16:23,400 --> 01:16:27,480
OUTCOMES IN ADDICTION AND ENSTED

1956
01:16:27,480 --> 01:16:34,880
IN SUCH OTHER WAYS THERE IS A CO

1957
01:16:34,880 --> 01:16:36,600
MORBIDITY BETWEEN ADDICTION AND

1958
01:16:36,600 --> 01:16:38,080
PAIN AND A NEUROCIRCUITRY THAT

1959
01:16:38,080 --> 01:16:40,720
CAN BE ENGAGE INDEED BOTH OF

1960
01:16:40,720 --> 01:16:41,320
THESE CONDITIONS BECAUSE MOST

1961
01:16:41,320 --> 01:16:43,200
PEOPLE THAT ARE ADDICTED AND

1962
01:16:43,200 --> 01:16:44,280
TAKE DRUGS ARE NOT TAKING THEM

1963
01:16:44,280 --> 01:16:46,960
BECAUSE THEY HAVE THE CHOICE

1964
01:16:46,960 --> 01:16:47,360
THEY FEEL PRESSURE.

1965
01:16:47,360 --> 01:16:50,520
THEY TAKE IT BECAUSE THEY'RE

1966
01:16:50,520 --> 01:16:59,800
TRYING TO ESCAPE A --ACHIEVE A

1967
01:16:59,800 --> 01:17:01,360
VERY EUPHORIC STATE.

1968
01:17:01,360 --> 01:17:03,520
>> THIS IS ERIC GARLAND AND THIS

1969
01:17:03,520 --> 01:17:04,800
LAST SERIES OF COMMENTS MADE ME

1970
01:17:04,800 --> 01:17:05,920
WANT TO CHANGE MY COMMENT ABOUT

1971
01:17:05,920 --> 01:17:07,320
THE POINT YOU RAISED WALTER

1972
01:17:07,320 --> 01:17:09,960
ABOUT THE FACT THAT WE KNOW THAT

1973
01:17:09,960 --> 01:17:12,240
OPIOIDS DO NOT SEEM TO BE

1974
01:17:12,240 --> 01:17:20,000
PARTICULARLY EFFECTIVE FOR

1975
01:17:20,000 --> 01:17:23,840
CHRONIC PAIN AND YET THIS IS A

1976
01:17:23,840 --> 01:17:24,920
HIGHLY POLITICIZED AND DIVISIVE

1977
01:17:24,920 --> 01:17:27,360
ISSUE AND THERE ARE MANY

1978
01:17:27,360 --> 01:17:29,320
PATIENTS WHO THINK THEY NEED

1979
01:17:29,320 --> 01:17:30,200
THESE MEDICINES TO ALLEVIATE

1980
01:17:30,200 --> 01:17:32,080
THEIR PAIN AND WE KNOW THAT IN

1981
01:17:32,080 --> 01:17:34,200
THEIR CONSTRICTION OF THE OPIOID

1982
01:17:34,200 --> 01:17:35,120
PRESCRIBING IN THE WAKE OF THE

1983
01:17:35,120 --> 01:17:37,200
CRISIS THERE WAS AN INCREASE IN

1984
01:17:37,200 --> 01:17:42,920
SUICIDE AMONG THESE PATIENTS.

1985
01:17:42,920 --> 01:17:45,200
BUT I WONDER ABOUT YOUR THOUGHTS

1986
01:17:45,200 --> 01:17:48,280
HERE, WHAT DO WE DO ABOUT THIS

1987
01:17:48,280 --> 01:17:50,000
DISCONNECT BETWEEN THE EFFICACY

1988
01:17:50,000 --> 01:17:54,320
DATA AND THEN THE POLITICAL AND

1989
01:17:54,320 --> 01:17:56,280
SOCIAL CONCERN OF PATIENT WHO IS

1990
01:17:56,280 --> 01:17:59,760
HAVE THIS UNRELIEVED SUFFERING

1991
01:17:59,760 --> 01:18:01,600
WHICH MAY WELL RELATE TO THE

1992
01:18:01,600 --> 01:18:02,200
AMYGDALA RESPONSE THAT WE'VE

1993
01:18:02,200 --> 01:18:04,000
BEEN TALKING ABOUT BECAUSE WE

1994
01:18:04,000 --> 01:18:07,000
KNOW THAT OPIOIDS ACTUALLY

1995
01:18:07,000 --> 01:18:08,200
MODULATE FUNCTION IN THE

1996
01:18:08,200 --> 01:18:09,000
EMOTIONAL CIRCUITRY OF THE

1997
01:18:09,000 --> 01:18:09,520
BRAIN.

1998
01:18:09,520 --> 01:18:11,880
SO WHETHER OR NOT THEY'RE

1999
01:18:11,880 --> 01:18:17,200
ALLEVIATING THE PHYSICAL PAIN,

2000
01:18:17,200 --> 01:18:18,160
THE NOSE-SUSCEPTIVE CHRONIC

2001
01:18:18,160 --> 01:18:20,360
PROCESSING OF PAIN, THEY BE

2002
01:18:20,360 --> 01:18:21,200
ALLEVIATING SUFFERING IN THESE

2003
01:18:21,200 --> 01:18:23,320
PATIENTS SO WHAT DO WE DO ABOUT

2004
01:18:23,320 --> 01:18:26,200
THE DISCONNECT AT A SOCIAL LEVEL

2005
01:18:26,200 --> 01:18:28,360
AND ALSO, I THINK THE HEAL

2006
01:18:28,360 --> 01:18:31,000
INITIATIVE CAN BRING TO BEAR

2007
01:18:31,000 --> 01:18:32,800
FORCES TO ADDRESS THIS EMOTIONAL

2008
01:18:32,800 --> 01:18:38,720
SUFFERING THAT COMES ALONG WITH

2009
01:18:38,720 --> 01:18:38,920
PAIN?

2010
01:18:38,920 --> 01:18:40,680
>> I THINK IT WOULD BE GREAT TO

2011
01:18:40,680 --> 01:18:43,200
HEAR WHAT OTHERS SAY.

2012
01:18:43,200 --> 01:18:47,640
I WOULD--I THINK YOUR COMMENTS

2013
01:18:47,640 --> 01:18:52,480
ARE RIGHT ON BUT THE WAY I THINK

2014
01:18:52,480 --> 01:18:55,480
IS THAT THERE'S A PREVENTATIVE

2015
01:18:55,480 --> 01:18:56,040
TYPE OF APPROACH.

2016
01:18:56,040 --> 01:19:00,600
SO HOW DO YOU MANAGE CHRONIC

2017
01:19:00,600 --> 01:19:01,800
PAIN KNOWING THAT CHRONIC

2018
01:19:01,800 --> 01:19:03,680
OPIOIDS ARE NOT GOING TO BE

2019
01:19:03,680 --> 01:19:04,200
EFFECTIVE.

2020
01:19:04,200 --> 01:19:04,560
THAT'S 1 SET.

2021
01:19:04,560 --> 01:19:06,800
I THINK THE OTHER SET IS PEOPLE

2022
01:19:06,800 --> 01:19:09,040
WHO HAVE GONE TO THE DOCTORS AND

2023
01:19:09,040 --> 01:19:11,800
THEY SAID, I JUST CAN'T STAND IT

2024
01:19:11,800 --> 01:19:12,960
ANYMORE, IT'S WORSE THAN EVER

2025
01:19:12,960 --> 01:19:14,360
AND I NEED SOMETHING AND THEY

2026
01:19:14,360 --> 01:19:16,680
GET OPIOIDS AND THEY COME BACK

2027
01:19:16,680 --> 01:19:19,560
AND THEY SAY, MY PAIN IS

2028
01:19:19,560 --> 01:19:20,880
TERRIBLE, CAN I GET MORE OPIOIDS

2029
01:19:20,880 --> 01:19:24,600
AND THEY COME BACK, MY PAIN IS

2030
01:19:24,600 --> 01:19:25,960
TERRIBLE AND BUT NOW, I CAN'T

2031
01:19:25,960 --> 01:19:27,360
GET OFF THE OPIOIDS, FIELD

2032
01:19:27,360 --> 01:19:29,000
FUNCTIONS COME DOWN OFF THE

2033
01:19:29,000 --> 01:19:31,720
OPIOIDS, NOW THE PAIN GETS WORSE

2034
01:19:31,720 --> 01:19:35,600
SO I THINK THAT THAT--THIS

2035
01:19:35,600 --> 01:19:36,960
PROGRAM WE HAVE NOW START LOOK

2036
01:19:36,960 --> 01:19:40,280
BEING AT HOW YOU MANAGE PAIN IN

2037
01:19:40,280 --> 01:19:45,000
PEOPLE WHO ARE ON OPIOIDS, THIS

2038
01:19:45,000 --> 01:19:46,680
HAS TO BE CUSTOMIZED TO THE

2039
01:19:46,680 --> 01:19:48,120
POINTS THAT YOU MADE AND IN

2040
01:19:48,120 --> 01:19:50,400
TERMS OF POLITICS WE JUST HAVE

2041
01:19:50,400 --> 01:19:53,360
TO OBJECTIFY THE ISSUE, THE

2042
01:19:53,360 --> 01:19:54,880
ISSUE IS HOW DO YOU GET THE

2043
01:19:54,880 --> 01:19:57,600
PATIENT TO THE HIGHEST

2044
01:19:57,600 --> 01:19:59,520
FUNCTIONAL LEVEL PERIOD AND

2045
01:19:59,520 --> 01:20:02,120
IF--YOU KNOW IF IN SOME PEOPLE,

2046
01:20:02,120 --> 01:20:06,560
IT MAY MEAN THAT THEY NEED TO

2047
01:20:06,560 --> 01:20:08,040
CONTINUE ON OPIOIDS.

2048
01:20:08,040 --> 01:20:09,640
AND THERE ARE SOME PEOPLE WHERE

2049
01:20:09,640 --> 01:20:12,600
THE OPIOIDS, YOU KNOW MAY HELP

2050
01:20:12,600 --> 01:20:16,800
THEM IN TERMS OF THE PAIN AS

2051
01:20:16,800 --> 01:20:17,000
WELL.

2052
01:20:17,000 --> 01:20:20,200
SO I THINK THAT'S SPACE WHERE

2053
01:20:20,200 --> 01:20:23,320
IT'S THE MOST CHALLENGING TO GO

2054
01:20:23,320 --> 01:20:24,600
INTO, BUT I THINK THAT'S WHERE

2055
01:20:24,600 --> 01:20:27,600
WE'RE GOING NOW WITH THESE NEW

2056
01:20:27,600 --> 01:20:27,880
PROGRAMS.

2057
01:20:27,880 --> 01:20:29,480
>> YEAH, AND I KNOW YEAR JUST

2058
01:20:29,480 --> 01:20:31,440
GOING TO COMMENT ON THAT THAT

2059
01:20:31,440 --> 01:20:34,040
CERTAINLY THERE IS A NEW

2060
01:20:34,040 --> 01:20:35,080
INITIATIVE, THE EMPOWER

2061
01:20:35,080 --> 01:20:36,360
INITIATIVE THAT WILL BASICALLY

2062
01:20:36,360 --> 01:20:37,880
DWELL ON THIS VERY CHALLENGING

2063
01:20:37,880 --> 01:20:40,320
PROBLEM OF PEOPLE THAT ACTUALLY

2064
01:20:40,320 --> 01:20:41,600
HAVE CHRONIC PAIN AND AT THE

2065
01:20:41,600 --> 01:20:45,800
SAME TIME ARE ADDICTED TO THE

2066
01:20:45,800 --> 01:20:47,440
OPIOIDS, HOW DO YOU PROPERLY

2067
01:20:47,440 --> 01:20:49,360
MANAGE THEM BECAUSE THE OPIOIDS

2068
01:20:49,360 --> 01:20:52,200
MAY BE IN SOME INSTANCES, THE

2069
01:20:52,200 --> 01:20:54,040
ONLY INTERVENTION THAT RELIEVES

2070
01:20:54,040 --> 01:20:56,320
THEIR PAIN AND AT THE SAME TIME

2071
01:20:56,320 --> 01:20:58,760
IT IS ACTUALLY CAN LEAD TO LOSS

2072
01:20:58,760 --> 01:20:59,040
OF CONTROL.

2073
01:20:59,040 --> 01:21:01,760
SO THEY THERE ARE WAYS THAT 1

2074
01:21:01,760 --> 01:21:02,880
CAN ACTUALLY, THAT CLINICIANS

2075
01:21:02,880 --> 01:21:04,800
HAVE BEEN DEALING WITH THIS

2076
01:21:04,800 --> 01:21:06,640
ISSUE, BUT IT'S A SPACE THAT

2077
01:21:06,640 --> 01:21:09,640
OVERALL IN TERMS OF RESEARCH HAS

2078
01:21:09,640 --> 01:21:11,520
BEEN VERY POORLY INVESTIGATED.

2079
01:21:11,520 --> 01:21:16,000
BUT I THINK YOU WILL HEAR LATER

2080
01:21:16,000 --> 01:21:24,960
ON ABOUT EMPOWER INITIATIVE.

2081
01:21:24,960 --> 01:21:25,600
>> ALLAN?

2082
01:21:25,600 --> 01:21:27,240
>> NORA THANK YOU FOR EVEN

2083
01:21:27,240 --> 01:21:30,160
HINTING THAT THERE ARE SOME

2084
01:21:30,160 --> 01:21:31,000
PEASHTS WHO DO RESPOND

2085
01:21:31,000 --> 01:21:32,320
POSITIVELY AND I WE WANT TO BE

2086
01:21:32,320 --> 01:21:36,200
CAREFUL TO MAKE THE GENERAL

2087
01:21:36,200 --> 01:21:44,000
ASSUMPTIONS THAT OPIATES DON'T

2088
01:21:44,000 --> 01:21:46,800
WORK, AND FOR CANCER PATIENTS,

2089
01:21:46,800 --> 01:21:48,120
PARTICULARLY WITH CANCER PAIN,

2090
01:21:48,120 --> 01:21:50,080
YOU DO NOT WANT TO TAKE AWAY

2091
01:21:50,080 --> 01:21:51,480
THEIR OPIOIDS, AND TO ASSUME

2092
01:21:51,480 --> 01:21:53,360
THAT EVERYBODY'S THE SAME IS A

2093
01:21:53,360 --> 01:21:53,800
BIG MISTAKE.

2094
01:21:53,800 --> 01:21:56,200
WE NEED TO UNDERSTAND THE

2095
01:21:56,200 --> 01:21:57,640
GENETICS OF THE INDIVIDUALS,

2096
01:21:57,640 --> 01:22:00,400
QUESTIONS OF TOLERANCE, SOME

2097
01:22:00,400 --> 01:22:01,240
PATIENTS BECOME TOLERANT, OTHER

2098
01:22:01,240 --> 01:22:03,240
PATIENTS STAY ON THE SAME DOSE

2099
01:22:03,240 --> 01:22:04,280
AND WE DON'T KNOW ENOUGH ABOUT

2100
01:22:04,280 --> 01:22:06,160
SOME OF THESE MECHANISMS, BUT I

2101
01:22:06,160 --> 01:22:08,720
THINK TO JUST MAKE THE GENERAL

2102
01:22:08,720 --> 01:22:09,800
ASSUMPTION, THROW AWAY THE

2103
01:22:09,800 --> 01:22:12,840
OPIOIDS AND COME UP WITH

2104
01:22:12,840 --> 01:22:15,000
SOMETHING ELSE, THAT'S PROBABLY

2105
01:22:15,000 --> 01:22:15,600
LITERALLY THROWING THE

2106
01:22:15,600 --> 01:22:17,880
PROVERBIAL BABY OUT WITH THE

2107
01:22:17,880 --> 01:22:20,200
BATH WATER.

2108
01:22:20,200 --> 01:22:20,920
>> ALLAN, THANKS FOR MAKING THAT

2109
01:22:20,920 --> 01:22:22,200
POINT BECAUSE THE REALITY IS

2110
01:22:22,200 --> 01:22:23,680
THERE ARE SOME PEOPLE THAT HAVE

2111
01:22:23,680 --> 01:22:26,400
TRIED EVERYTHING AND THE OPIOID

2112
01:22:26,400 --> 01:22:28,000
MEDICATIONS IS THE ONLY THING

2113
01:22:28,000 --> 01:22:29,760
THAT IMPROVES THEIR PAIN AND

2114
01:22:29,760 --> 01:22:31,120
WITHOUT IT THEY ARE VERY HIGH

2115
01:22:31,120 --> 01:22:32,200
RISK OF SUICIDE, SO I THINK THAT

2116
01:22:32,200 --> 01:22:34,280
THE NOTION IS WE LIKE TO

2117
01:22:34,280 --> 01:22:36,400
POLARIZE THINGS AND SAY EITHER

2118
01:22:36,400 --> 01:22:39,600
THEY ACTUALLY BECAME VERY OPEN

2119
01:22:39,600 --> 01:22:41,000
IN HOW WE OVERPRESCRIBED BUT ON

2120
01:22:41,000 --> 01:22:42,520
THE OTHER 1 WE CAN INSERT

2121
01:22:42,520 --> 01:22:45,800
INSTANCES WHERE THEY CAN BE USED

2122
01:22:45,800 --> 01:22:48,080
IN A SAFE WAY THAT CAN HELP THE

2123
01:22:48,080 --> 01:22:49,600
PATIENTS AND SO, I GUESS THE

2124
01:22:49,600 --> 01:22:50,880
PART OF THAT RESEARCH THAT WE'RE

2125
01:22:50,880 --> 01:22:53,520
AIMING TO DO IS UNDERSTANDING

2126
01:22:53,520 --> 01:22:56,160
UNDER WHAT CONDITIONS AND FOR

2127
01:22:56,160 --> 01:22:58,600
WHOM OPIOID MEDICATIONS MAY HAVE

2128
01:22:58,600 --> 01:22:59,960
A VALUE MANAGEMENT OF CHRONIC

2129
01:22:59,960 --> 01:23:02,000
PAIN FOR A WHILE AS PART OF A

2130
01:23:02,000 --> 01:23:03,160
MULTIPRONGED APPROACH THAT IS

2131
01:23:03,160 --> 01:23:07,600
NOT JUST RELYING ON THE OPIOID

2132
01:23:07,600 --> 01:23:08,680
BY ITSELF.

2133
01:23:08,680 --> 01:23:10,800
AND THE EXPECTATIONS, ACTUALLY

2134
01:23:10,800 --> 01:23:12,400
TRAINING PEOPLE OF WHAT

2135
01:23:12,400 --> 01:23:13,840
EXPECTATIONS THEY SHOULD HAVE

2136
01:23:13,840 --> 01:23:15,000
REGUARDING WHAT THE OPIOID

2137
01:23:15,000 --> 01:23:16,200
MEDICATION SHOULD DO FOR THEM,

2138
01:23:16,200 --> 01:23:18,880
SO I AGREE WITH YOU AND I AM

2139
01:23:18,880 --> 01:23:20,000
CONCERNED THAT JUST THE PENDULUM

2140
01:23:20,000 --> 01:23:21,360
GOING BACK AND FORTH IS NOT THE

2141
01:23:21,360 --> 01:23:23,320
RIGHT WAY TO ADDRESSING THE

2142
01:23:23,320 --> 01:23:25,200
BASICALLY WHAT THE DATA IS

2143
01:23:25,200 --> 01:23:34,760
SHOWING US TO OPTIMALLY HELP

2144
01:23:34,760 --> 01:23:35,000
PATIENTS.

2145
01:23:35,000 --> 01:23:36,200
>> I WOULD ONLY ADD NORA AND

2146
01:23:36,200 --> 01:23:37,640
WALTER THAT WHEN WE STARTED, I

2147
01:23:37,640 --> 01:23:39,200
THINK THERE WAS A SENSE THAT WE

2148
01:23:39,200 --> 01:23:42,000
REALLY DIDN'T WANT TO BE

2149
01:23:42,000 --> 01:23:43,480
STUDYING OPIOIDS, WE WANTED TO

2150
01:23:43,480 --> 01:23:47,640
BE SUPPORTING RESEARCH TO

2151
01:23:47,640 --> 01:23:48,480
PROVIDE ALTERNATIVES,

2152
01:23:48,480 --> 01:23:49,080
PHARMAICOLOGICAL ALTERNATIVES

2153
01:23:49,080 --> 01:23:51,640
AND COMING FROM THE PINE LINE

2154
01:23:51,640 --> 01:23:52,160
AND NONPHARMAICOLOGICAL

2155
01:23:52,160 --> 01:23:53,880
ALTERNATIVES AND I THINK AS WE

2156
01:23:53,880 --> 01:23:56,800
HAVE MATURED AS AN INITIATIVE,

2157
01:23:56,800 --> 01:23:58,840
WE'VE NOW BEEN ABLE TO TAKE ON

2158
01:23:58,840 --> 01:24:00,440
SOME OF THESE MORE COMPLEX

2159
01:24:00,440 --> 01:24:00,720
QUESTIONS.

2160
01:24:00,720 --> 01:24:03,520
WHAT HAPPENS WHEN SOMEONE IS ON

2161
01:24:03,520 --> 01:24:06,240
HIGHER DOSE OPIOIDS, WHAT FORMS

2162
01:24:06,240 --> 01:24:08,560
OF TREATMENT FOR A GIVEN PATIENT

2163
01:24:08,560 --> 01:24:10,520
OR A PATIENT WITH A GIVEN

2164
01:24:10,520 --> 01:24:10,760
HISTORY.

2165
01:24:10,760 --> 01:24:13,200
SO I THINK YOU WILL SEE SOME OF

2166
01:24:13,200 --> 01:24:13,920
THE RECENT INVESTMENTS IN HEAL

2167
01:24:13,920 --> 01:24:17,240
AND THEN SOME OF THE DISCUSSIONS

2168
01:24:17,240 --> 01:24:18,920
WE'RE HAVING CONSIDERING FUTURE

2169
01:24:18,920 --> 01:24:20,240
INVESTMENTS TO REALLY START TO

2170
01:24:20,240 --> 01:24:25,480
MOVE INTO THIS SPACE AND EMPOWER

2171
01:24:25,480 --> 01:24:26,840
IS 1 EXCELLENT EXAMPLE THAT

2172
01:24:26,840 --> 01:24:28,000
THERE ARE OTHER IDEAS OUT THERE

2173
01:24:28,000 --> 01:24:29,600
TO GET INTO THIS MIDDLE SPACE

2174
01:24:29,600 --> 01:24:32,240
THAT WE WEREN'T ABLE TO TACKLE

2175
01:24:32,240 --> 01:24:34,440
RIGHT AWAY.

2176
01:24:34,440 --> 01:24:35,800
>> YEAH, NO, I HAPPY YOU BRING

2177
01:24:35,800 --> 01:24:38,440
THIS UP BECAUSE ALSO THE OTHER

2178
01:24:38,440 --> 01:24:40,200
ISSUE IS THAT NOT ALL OPIOID

2179
01:24:40,200 --> 01:24:41,520
AGANIST DRUGS THAT ARE THE SAME

2180
01:24:41,520 --> 01:24:43,800
AND THERE ARE SOME OPIOID

2181
01:24:43,800 --> 01:24:45,000
AGANIST THAT HAVE ADVANTAGES

2182
01:24:45,000 --> 01:24:48,200
THAT MAY HAVE MECHANISM OF

2183
01:24:48,200 --> 01:24:48,880
ACTION MAY OFFER PROTECTION

2184
01:24:48,880 --> 01:24:51,600
AGAINST ADDICTION AND MAY ENABLE

2185
01:24:51,600 --> 01:24:53,840
TO PROPERLY MANAGE PAIN AND

2186
01:24:53,840 --> 01:24:56,040
THERE IS ONGOING RESEARCH IN

2187
01:24:56,040 --> 01:24:58,000
MULTIPLE INSTITUTES AND IN THE

2188
01:24:58,000 --> 01:25:00,720
FIELD TOO AS PART OF THE HEAL OF

2189
01:25:00,720 --> 01:25:04,000
ALTERNATIVE OPIOIDS THAT MAY

2190
01:25:04,000 --> 01:25:06,040
HAVE ANALGESIC EFFECTS AND HAVE

2191
01:25:06,040 --> 01:25:10,680
MUCH LESS LIABILITY FOR

2192
01:25:10,680 --> 01:25:11,720
ADDICTION. 

2193
01:25:11,720 --> 01:25:14,600
SO THAT IS--SORT OF AN YIR THAT

2194
01:25:14,600 --> 01:25:16,000
WE SHOULD NOT NEGLECT BECAUSE

2195
01:25:16,000 --> 01:25:17,200
OBVIOUSLY THESE ARE THINGS THAT

2196
01:25:17,200 --> 01:25:19,720
MAY PROVIDE US WITH SOLUTIONS IN

2197
01:25:19,720 --> 01:25:23,240
A SHORTER TIME PERIOD THAN

2198
01:25:23,240 --> 01:25:24,560
COMPLETELY DIFFERENT MOLECULES

2199
01:25:24,560 --> 01:25:25,280
TO HELP [INDISCERNIBLE].

2200
01:25:25,280 --> 01:25:26,440
WHICH IS OF COURSE WHERE WE WANT

2201
01:25:26,440 --> 01:25:31,360
TO GO BUT IN THE MEAN TIME WITH

2202
01:25:31,360 --> 01:25:32,240
EXPERIMENTING WITH WAYS FOR

2203
01:25:32,240 --> 01:25:33,680
OAPPROXIMATE PILOT PROJECTOID

2204
01:25:33,680 --> 01:25:36,280
DRUGS OR DIFFERENT

2205
01:25:36,280 --> 01:25:37,880
PHARMAICOLOGICAL STUDIES IN A

2206
01:25:37,880 --> 01:25:39,400
SAFE BENEFICIAL WAY THAT'S GOOD

2207
01:25:39,400 --> 01:25:42,600
FOR PATIENTS. 

2208
01:25:42,600 --> 01:25:44,120
>> HI, THIS IS WALLY I WOULD

2209
01:25:44,120 --> 01:25:46,240
LIKE TO GET ON THE RECORD FROM

2210
01:25:46,240 --> 01:25:49,480
WALTER, A STATEMENT REPEATED AND

2211
01:25:49,480 --> 01:25:50,520
THEN AN EXPLANATION FOR THE

2212
01:25:50,520 --> 01:25:54,000
STATEMENT WHICH I AGREE WITH: 

2213
01:25:54,000 --> 01:25:57,800
LARGE PHARMA HAS IN GENERAL

2214
01:25:57,800 --> 01:26:00,200
ABANDONED THERAPIES FOR PAIN IN

2215
01:26:00,200 --> 01:26:01,800
THE LAST 20-30 YEARS.

2216
01:26:01,800 --> 01:26:02,680
I HEARD YOU SAY THAT.

2217
01:26:02,680 --> 01:26:03,880
I WOULD LIKE YOU TO REPEAT THAT

2218
01:26:03,880 --> 01:26:10,800
AND TELL ME WHAT YOU THINK IS

2219
01:26:10,800 --> 01:26:11,200
DRIVING IT?

2220
01:26:11,200 --> 01:26:14,600
>> OTHERS ON THE CALL MIGHT KNOW

2221
01:26:14,600 --> 01:26:17,040
BETTER BUT THEY THINK WHEN WE

2222
01:26:17,040 --> 01:26:20,200
INITIALLY STARTED THE HEAL

2223
01:26:20,200 --> 01:26:23,440
INITIATIVE, WE BROUGHT BIG

2224
01:26:23,440 --> 01:26:26,760
PHARMA TO THE TABLE AND THEY

2225
01:26:26,760 --> 01:26:28,640
TOLD US DIRECTLY THAT THEY

2226
01:26:28,640 --> 01:26:30,800
WERE--HAD CLOSED DOWN WITH THE

2227
01:26:30,800 --> 01:26:32,600
EXCEPTION OF LILLY, I THINK

2228
01:26:32,600 --> 01:26:34,240
LILLY IS THE 1 EXCEPTION THAT I

2229
01:26:34,240 --> 01:26:36,000
KNOW IT THAT THEY CLOSED DOWN

2230
01:26:36,000 --> 01:26:37,440
PAIN PROGRAMS AND WERE NOT

2231
01:26:37,440 --> 01:26:39,000
REALLY CONSIDERING OPENING THEM

2232
01:26:39,000 --> 01:26:43,520
UP AGAIN.

2233
01:26:43,520 --> 01:26:46,120
AND THE REASONS ARE PROBABLY

2234
01:26:46,120 --> 01:26:47,600
COMPLEX, BUT THE MAIN REASONS

2235
01:26:47,600 --> 01:26:50,600
WERE FAILURE OF GOING FROM THE

2236
01:26:50,600 --> 01:26:57,000
ANIMAL MODELS INTO THE HUMAN

2237
01:26:57,000 --> 01:26:58,360
CONDITION, HIGH EXPECTATION ON

2238
01:26:58,360 --> 01:27:00,600
BEHALF OF THE FDA, THAT THESE

2239
01:27:00,600 --> 01:27:04,000
THINGS WOULD HAVE TO BE VERY

2240
01:27:04,000 --> 01:27:06,160
SAFE BECAUSE AS WE MENTIONED IF

2241
01:27:06,160 --> 01:27:09,000
1 IN 20 PEOPLE IN THE U.S. HAVE

2242
01:27:09,000 --> 01:27:13,000
PAIN, 1 IN 20 PEOPLE ARE TAKING

2243
01:27:13,000 --> 01:27:13,600
MEDICINE, THAT'S TREMENDOUS

2244
01:27:13,600 --> 01:27:16,240
SAFETY ISSUE AND IT HAS TO BE

2245
01:27:16,240 --> 01:27:19,720
SAFE AND THEY WERE CERTAINLY

2246
01:27:19,720 --> 01:27:22,760
BURNT BY SOME OF THE

2247
01:27:22,760 --> 01:27:24,360
NONSTEROIDALS THAT WERE FOUND TO

2248
01:27:24,360 --> 01:27:27,640
HAVE CARDIAC EFFECTS AND HAD TO

2249
01:27:27,640 --> 01:27:31,880
COME OFF THE MARKET.

2250
01:27:31,880 --> 01:27:33,400
AND I THINK THOSE--I MEAN YOU

2251
01:27:33,400 --> 01:27:34,680
COULD MAKE A LOT OF MONEY,

2252
01:27:34,680 --> 01:27:36,360
THEREYA NO QUESTION IF YOU HAVE

2253
01:27:36,360 --> 01:27:37,920
A MORE EFFECTIVE PAIN MEDICINE,

2254
01:27:37,920 --> 01:27:41,560
SO IT'S NOT--THE MARKET IS THERE

2255
01:27:41,560 --> 01:27:44,160
BUT THE SUCCESS RATES OF GOING

2256
01:27:44,160 --> 01:27:45,360
OUT AND GETTING SOMETHING

2257
01:27:45,360 --> 01:27:49,920
APPROVED AND THEN KEEPING IT

2258
01:27:49,920 --> 01:27:51,240
APPROVED SO BIAX WAS APPROVED

2259
01:27:51,240 --> 01:27:53,480
AND THEN IT WAS TAKEN OFF, SO

2260
01:27:53,480 --> 01:27:55,200
THOSE ARE THE MAIN THINGS AND

2261
01:27:55,200 --> 01:27:58,160
YOU KNOW WHAT I'VE SEEN IN

2262
01:27:58,160 --> 01:28:01,600
INDUSTRY IS THAT WHEN YOU HAVE A

2263
01:28:01,600 --> 01:28:03,480
BUNCH OF FAILURES, THEN THE

2264
01:28:03,480 --> 01:28:04,920
WHOLE FIELD HAS A BLACK MARK ON

2265
01:28:04,920 --> 01:28:06,360
IT AND IT'S REALLY HARD TO GET

2266
01:28:06,360 --> 01:28:08,920
THAT BLACK MARK OFF YOUR BACK.

2267
01:28:08,920 --> 01:28:10,560
CERTAINLY IN STROKE, I COULD

2268
01:28:10,560 --> 01:28:12,200
TELL YOU THE SAME THING HAPPENS

2269
01:28:12,200 --> 01:28:16,280
TO STROKE IN THE LATE 1990S,

2270
01:28:16,280 --> 01:28:17,760
2000S. 

2271
01:28:17,760 --> 01:28:19,360
THERE ARE NO PHARMA SUITICAL

2272
01:28:19,360 --> 01:28:20,120
COMPANIES INTERESTED IN STROKE

2273
01:28:20,120 --> 01:28:22,200
EVEN THOUGH IT'S THE THIRD

2274
01:28:22,200 --> 01:28:24,600
LEADING CAUSE OF DEATH.

2275
01:28:24,600 --> 01:28:26,480
ANYWAY, ALLAN, PROBABLY CAN--

2276
01:28:26,480 --> 01:28:32,120
>> YEAH, SO I THINK THE NOTION

2277
01:28:32,120 --> 01:28:33,280
THAT PHARMA LOST INTEREST IS

2278
01:28:33,280 --> 01:28:34,480
SOMETHING THAT WAS RELATIVELY

2279
01:28:34,480 --> 01:28:36,360
QUITE A FEW YEARS AGO NOW AND

2280
01:28:36,360 --> 01:28:39,000
THEY'RE SLOWLY COMING BACK.

2281
01:28:39,000 --> 01:28:40,520
NOVARTIS CERTAINLY IS INVESTING

2282
01:28:40,520 --> 01:28:44,360
AND FOLLOWING UP EITHER IN THEIR

2283
01:28:44,360 --> 01:28:46,680
OWN LABS OR INVESTING QUITE

2284
01:28:46,680 --> 01:28:47,960
HEAVILY IN SMALL COMPANIES.

2285
01:28:47,960 --> 01:28:52,400
REMEMBER THAT LILLY AND PFIZER

2286
01:28:52,400 --> 01:28:54,360
HAD--THEY REALLY HAD WONDERFUL

2287
01:28:54,360 --> 01:28:56,760
RESULTS WITH ANTIBODIES TO NERVE

2288
01:28:56,760 --> 01:28:57,480
GROWTH FACTOR, UNFORTUNATELY,

2289
01:28:57,480 --> 01:29:01,520
THERE WERE SOME SIDE EFFECTS

2290
01:29:01,520 --> 01:29:04,200
THAT THE FDA SAID THEY WOULD NOT

2291
01:29:04,200 --> 01:29:05,800
APPROVE THE DRUG.

2292
01:29:05,800 --> 01:29:07,080
PFIZER AND LILLY ARE NEEDLESS TO

2293
01:29:07,080 --> 01:29:08,920
SAY UNHAPPY AND MAY BE APPEALING

2294
01:29:08,920 --> 01:29:11,320
BUT THE POINT IS THAT THEY--THIS

2295
01:29:11,320 --> 01:29:15,520
WAS A MAJOR INVESTMENT BY

2296
01:29:15,520 --> 01:29:15,760
PHARMA.

2297
01:29:15,760 --> 01:29:18,120
IT IS TRUE THEY BACKED OFF

2298
01:29:18,120 --> 01:29:20,280
BECAUSE OF FAILURES, ISSUES OF

2299
01:29:20,280 --> 01:29:22,520
TRANSLATION FROM THE PRECLINICAL

2300
01:29:22,520 --> 01:29:22,760
STUDIES.

2301
01:29:22,760 --> 01:29:27,200
PAIN IS A TOUGH 1 IN THAT

2302
01:29:27,200 --> 01:29:29,200
PATIENTS DO RESPOND TO PLACEBOS

2303
01:29:29,200 --> 01:29:30,960
AND IT'S GOT TO BE BETTER THAN A

2304
01:29:30,960 --> 01:29:33,360
PLACEBO SO THAT I CANS THE

2305
01:29:33,360 --> 01:29:34,560
CHALLENGE--SO THEY SAID LET'S

2306
01:29:34,560 --> 01:29:35,600
PUT OUR MONEY SOMEWHERE ELSE BUT

2307
01:29:35,600 --> 01:29:38,040
I THINK THAT'S CHANGING AND

2308
01:29:38,040 --> 01:29:40,040
THEY'RE COMING BACK I REMAIN

2309
01:29:40,040 --> 01:29:41,120
OPTIMISTIC THAT THEY'RE--THAT

2310
01:29:41,120 --> 01:29:46,600
THEY WILL STAY IN THE FIELD.

2311
01:29:46,600 --> 01:29:47,160
>> OKAY.

2312
01:29:47,160 --> 01:29:48,920
>> IT'S NOT A LARGE PHARMA BUT

2313
01:29:48,920 --> 01:29:51,560
WE HAVE WITNESSED THROUGH HEAL,

2314
01:29:51,560 --> 01:29:53,240
A REALLY INCREDIBLE BLOSSOMING

2315
01:29:53,240 --> 01:29:55,200
OF SMALL BUSINESSES WITH IDEAS.

2316
01:29:55,200 --> 01:29:56,920
MAYBE EARLIER IN THE PIPELINE,

2317
01:29:56,920 --> 01:29:58,040
BUT IDEAS FOR TREATING PAIN AND

2318
01:29:58,040 --> 01:29:59,640
ADDICTION AND I'VE BEEN REALLY

2319
01:29:59,640 --> 01:30:02,520
IMPRESSED JUST OVER THE PAST

2320
01:30:02,520 --> 01:30:04,800
YEAR OR 2, HOW MANY DIFFERENT

2321
01:30:04,800 --> 01:30:06,360
TYPES OF HIGH QUALITY

2322
01:30:06,360 --> 01:30:09,680
APPLICATIONS WE RECEIVE FROM THE

2323
01:30:09,680 --> 01:30:10,080
SMALL BUSINESSES.

2324
01:30:10,080 --> 01:30:13,800
SO I ECHO ALAN'S HOPEFULNESS

2325
01:30:13,800 --> 01:30:14,440
ALTHOUGH IT'S NOT--IT'S STILL

2326
01:30:14,440 --> 01:30:16,600
NOT LILLY AND PFIZER.

2327
01:30:16,600 --> 01:30:22,600
BOB, HAVE YOU A QUESTION?

2328
01:30:22,600 --> 01:30:24,760
>> YEAH, I WAS GOING TO SAY SOME

2329
01:30:24,760 --> 01:30:25,760
OF WHAT ALAN JUST SAID BUT I

2330
01:30:25,760 --> 01:30:30,680
WOULD LIKE TO ADD TO THAT, BACK

2331
01:30:30,680 --> 01:30:34,760
TO WALTER'S COMMENT ABOUT THE

2332
01:30:34,760 --> 01:30:36,240
CONCERNS OF ANY POTENTIAL RISKS

2333
01:30:36,240 --> 01:30:37,320
LIKE THE HIGH BAR FOR SAFETY

2334
01:30:37,320 --> 01:30:38,520
BECAUSE OF A VERY LARGE NUMBER

2335
01:30:38,520 --> 01:30:41,800
OF PATIENTS AND I THINK 1 THING

2336
01:30:41,800 --> 01:30:43,920
THAT WE AS A SOCIETY NEED TO

2337
01:30:43,920 --> 01:30:49,600
REALLY BE MINDFUL OF IS THE RISK

2338
01:30:49,600 --> 01:30:51,720
OF PROVIDING NOTHING BECAUSE WE

2339
01:30:51,720 --> 01:30:53,200
SEE WHAT HAPPENS WITH THE SAFETY

2340
01:30:53,200 --> 01:30:53,760
BAR THAT WE HAVE.

2341
01:30:53,760 --> 01:30:56,200
I MEAN WE HAVE MANY DRUGS ON THE

2342
01:30:56,200 --> 01:30:58,360
MARKET THAT ARE SHOWN TO BE VERY

2343
01:30:58,360 --> 01:30:58,640
DANGEROUS.

2344
01:30:58,640 --> 01:31:00,600
THEY'RE STILL ON THE MARKET

2345
01:31:00,600 --> 01:31:02,520
BECAUSE THEY DO PROVIDE PAIN

2346
01:31:02,520 --> 01:31:02,760
RELIEF.

2347
01:31:02,760 --> 01:31:04,600
SO THE SAFETY BAR SHOULD BE

2348
01:31:04,600 --> 01:31:06,360
SAFER THAT OPIOIDS AND THAT WILL

2349
01:31:06,360 --> 01:31:09,440
DECREASE RISKS THAT WILL PROVIDE

2350
01:31:09,440 --> 01:31:12,760
HARM REDUCTION, OBVIOUSLY

2351
01:31:12,760 --> 01:31:14,600
THERE'S POTENTIAL ADICKAL RISKS

2352
01:31:14,600 --> 01:31:16,440
WITH ANY NEW MEDICATION THAT BUT

2353
01:31:16,440 --> 01:31:18,760
CONVERSATION NEEDS TO BE

2354
01:31:18,760 --> 01:31:22,360
RETHOUGHT IN TERMS OF HOW THE

2355
01:31:22,360 --> 01:31:23,200
FDA IS ACCOMPLISHING THIS SAFETY

2356
01:31:23,200 --> 01:31:25,200
BAR BECAUSE IF WE CAN MOVE

2357
01:31:25,200 --> 01:31:27,000
PEOPLE AWAY FROM NEEDING OPIOIDS

2358
01:31:27,000 --> 01:31:28,440
AT ALL, THAT HORSE IS OUT OF THE

2359
01:31:28,440 --> 01:31:30,520
BARN, WE KNOW THAT BUT I THINK

2360
01:31:30,520 --> 01:31:31,600
THAT'S A VERY IMPORTANT CONCEPT

2361
01:31:31,600 --> 01:31:35,200
FOR THIS GROUP AND FOR ALL OF US

2362
01:31:35,200 --> 01:31:35,800
TO KEEP IN MIND.

2363
01:31:35,800 --> 01:31:37,920
>> AND THE STRATEGY WE HAVE

2364
01:31:37,920 --> 01:31:40,440
TAKEN WITH AFTER DISCUSSION WITH

2365
01:31:40,440 --> 01:31:44,520
THE FDA, IS TO GO AFTER PAIN

2366
01:31:44,520 --> 01:31:47,160
CONDITIONS THAT, YOU KNOW ARE

2367
01:31:47,160 --> 01:31:49,800
MORE CONFINED AND WHICH HAVE

2368
01:31:49,800 --> 01:31:51,280
POOR TREATMENTS AVAILABLE AND

2369
01:31:51,280 --> 01:31:52,680
THERE, YOU KNOW IF IT'S

2370
01:31:52,680 --> 01:31:55,600
CONDITION X AND THERE'S

2371
01:31:55,600 --> 01:31:57,640
NOTHING--THEN THEY CAN--THEN THE

2372
01:31:57,640 --> 01:31:59,680
BAR CAN COME DOWN BECAUSE IT HAS

2373
01:31:59,680 --> 01:32:02,320
TO BE A BALANCE BETWEEN THE

2374
01:32:02,320 --> 01:32:03,720
SUFFERING AND THE RISK.

2375
01:32:03,720 --> 01:32:06,360
I THINK THE FDA IS MOST

2376
01:32:06,360 --> 01:32:07,320
CONCERNED IF IT'S GOING TO BE

2377
01:32:07,320 --> 01:32:10,040
SPLG THAT EVERYBODY IN THE

2378
01:32:10,040 --> 01:32:11,200
COUNTRY WILL TAKE.

2379
01:32:11,200 --> 01:32:15,600
SO OUR STRATEGY IS TO GO AFTER,

2380
01:32:15,600 --> 01:32:18,880
YOU KNOW SPECIFIC DISORDERS AND

2381
01:32:18,880 --> 01:32:22,480
NOT OVERGENERALIZE IT FOR US ON

2382
01:32:22,480 --> 01:32:24,000
EVERYTHING AT THIS POINT IN

2383
01:32:24,000 --> 01:32:24,400
TIME.

2384
01:32:24,400 --> 01:32:25,240
>> KRISTIN?

2385
01:32:25,240 --> 01:32:26,360
>> YEAH, I TOTALLY UNDERSTAND

2386
01:32:26,360 --> 01:32:27,120
THAT PERSPECTIVE WALTER BUT I

2387
01:32:27,120 --> 01:32:29,480
ALSO WORRY AND I KNOW YOU AND I

2388
01:32:29,480 --> 01:32:30,720
AND OTHERS TALKED ABOUT THIS A

2389
01:32:30,720 --> 01:32:34,360
LOT IS THAT WE HAVE DOZENS, YOU

2390
01:32:34,360 --> 01:32:37,040
KNOW, MANY MORE THAN DOZENS PAIN

2391
01:32:37,040 --> 01:32:38,680
CONDITIONS AND IS IT REALLY

2392
01:32:38,680 --> 01:32:41,320
FEASIBLE TO GO AFTER THEM 1 BY 1

2393
01:32:41,320 --> 01:32:43,520
BY 1 AND HOW LONG IS THAT GOING

2394
01:32:43,520 --> 01:32:45,600
TO TAKE BEFORE WE'RE ACTUALLY

2395
01:32:45,600 --> 01:32:49,320
ABLE TO DEVELOP THERAPIES THAT

2396
01:32:49,320 --> 01:32:52,200
CAN HELP PEOPLE WITH ALL OF

2397
01:32:52,200 --> 01:32:52,880
THESE DESPERATE PAIN CONDITIONS

2398
01:32:52,880 --> 01:32:56,800
OR DO YOU TAKE THE APPROACH FROM

2399
01:32:56,800 --> 01:32:58,960
A MORE MECHANISTIC PERSPECTIVES

2400
01:32:58,960 --> 01:32:59,520
WHERE WE DEVELOP THERAPIES

2401
01:32:59,520 --> 01:33:01,280
BECAUSE WE KNOW THERE'S

2402
01:33:01,280 --> 01:33:02,960
DIFFERENT PHENOTYPES WITHIN EACH

2403
01:33:02,960 --> 01:33:05,360
PAIN CONDITION, THAT RANGE IN

2404
01:33:05,360 --> 01:33:09,400
SYMPTOMS AND SIGNS AS WELL AS

2405
01:33:09,400 --> 01:33:09,680
SEVERITY.

2406
01:33:09,680 --> 01:33:11,120
AND I KNOW WE'RE THINKING ABOUT

2407
01:33:11,120 --> 01:33:13,000
THIS AND FUNDING STUDIES IN THE

2408
01:33:13,000 --> 01:33:14,600
BASIC SCIENCE APPROACH TO LOOK

2409
01:33:14,600 --> 01:33:15,440
AT MECHANISMS, RIGHT?

2410
01:33:15,440 --> 01:33:17,200
THAT'S KIND OF THE HOLY GRAIL OF

2411
01:33:17,200 --> 01:33:18,200
PAIN RESEARCH BUT I JUST WONDER

2412
01:33:18,200 --> 01:33:19,640
WHAT YOU THINK ABOUT THAT TYPE

2413
01:33:19,640 --> 01:33:20,200
OF APPROACH.

2414
01:33:20,200 --> 01:33:21,280
IS IT REALLY FEASIBLE THAT WE'RE

2415
01:33:21,280 --> 01:33:24,960
GOING TO BE ABLE TO DEVELOP

2416
01:33:24,960 --> 01:33:27,360
THERAPIES, THAT ARE REALLY GOING

2417
01:33:27,360 --> 01:33:29,240
TO TARGET THIS HUGE PERCENTAGE

2418
01:33:29,240 --> 01:33:31,200
OF PEOPLE IN AMERICA ACROSS THE

2419
01:33:31,200 --> 01:33:32,600
WORLD BUT HAVE CHRONIC PAIN IF

2420
01:33:32,600 --> 01:33:40,000
WE ONLY GO CONDITION BY

2421
01:33:40,000 --> 01:33:40,240
CONDITION.

2422
01:33:40,240 --> 01:33:43,200
>> DEFINITELY WOULD TAKE A LOT

2423
01:33:43,200 --> 01:33:44,800
LONGER.

2424
01:33:44,800 --> 01:33:46,880
IT'S THE GENERALIZATION. 

2425
01:33:46,880 --> 01:33:48,360
SO YOU COULD ENVISION, YOU KNOW

2426
01:33:48,360 --> 01:33:55,520
IF WE HAVE THE PROGRAM NOW IN

2427
01:33:55,520 --> 01:33:59,360
ARTHRITIS WHERE WE'RE BLOCKING

2428
01:33:59,360 --> 01:34:00,520
PARTICULARLY LYMPHOCYTE ENTERING

2429
01:34:00,520 --> 01:34:03,320
THE JOINT SPACE AND THE DRUG

2430
01:34:03,320 --> 01:34:04,240
WOULD PREVENT THAT.

2431
01:34:04,240 --> 01:34:09,000
SO THAT'S A SPECIFIC CONDITION

2432
01:34:09,000 --> 01:34:12,640
BUT IF IT WORKED THERE, WE WOULD

2433
01:34:12,640 --> 01:34:18,080
SUSPECT IT MIGHT WORK IN OTHER

2434
01:34:18,080 --> 01:34:18,320
JOINTS.

2435
01:34:18,320 --> 01:34:19,840
SO WOO GO FROM KNEE TO OTHER

2436
01:34:19,840 --> 01:34:22,480
JOINTS BUT IT WOULD BE A

2437
01:34:22,480 --> 01:34:23,360
RATIONAL JUMP FROM 1 CONDITION

2438
01:34:23,360 --> 01:34:24,040
TO ANOTHER.

2439
01:34:24,040 --> 01:34:27,720
IF YOU GO VERY CENTRAL, THE

2440
01:34:27,720 --> 01:34:28,760
CENTRAL NERVOUS SYSTEM, THEN,

2441
01:34:28,760 --> 01:34:30,200
YOU KNOW YOU SHUT OFF THE

2442
01:34:30,200 --> 01:34:37,160
SUFFERING DUE TO PAIN NO MATTER

2443
01:34:37,160 --> 01:34:40,560
WHAT IT IS, AND THAT YOU KNOW IF

2444
01:34:40,560 --> 01:34:41,680
IT'S AN INVASIVE PROCEDURE, TELL

2445
01:34:41,680 --> 01:34:43,240
BE A SMALL POPULATION BECAUSE

2446
01:34:43,240 --> 01:34:44,560
TELL ONLY BE THOSE WITH THE

2447
01:34:44,560 --> 01:34:48,320
WORST TYPE OF PAIN, BUT IT WOULD

2448
01:34:48,320 --> 01:34:51,200
BE A MAJOR ADVANCE IF WE COULD

2449
01:34:51,200 --> 01:34:53,560
DO THAT FOR PEOPLE WHO ARE

2450
01:34:53,560 --> 01:34:55,800
REALLY DESPERATE.

2451
01:34:55,800 --> 01:35:01,000
SO I THINK, YEAH, THE MAGIC

2452
01:35:01,000 --> 01:35:05,800
BULLET IDEA, I'M NOT TOO

2453
01:35:05,800 --> 01:35:06,760
ENTHUSIASTIC THAT THAT'S GOING

2454
01:35:06,760 --> 01:35:07,600
TO BE HELPFUL.

2455
01:35:07,600 --> 01:35:09,600
I THINK THAT'S WHAT OPIOIDS ARE.

2456
01:35:09,600 --> 01:35:14,960
BUT THAT'S JUST MY OPINION.

2457
01:35:14,960 --> 01:35:16,120
>> NO, I AGREE, I AGREE.

2458
01:35:16,120 --> 01:35:17,880
I THINK THE IDEA IS THAT WE

2459
01:35:17,880 --> 01:35:19,920
CONTINUE TO DEVELOP MECHANISM

2460
01:35:19,920 --> 01:35:21,000
BASED TARGETED THERAPIES FOR

2461
01:35:21,000 --> 01:35:21,800
INDIVIDUAL CONDITIONS LIKE THE

2462
01:35:21,800 --> 01:35:24,240
EXAMPLE YOU JUST GAVE AND AS THE

2463
01:35:24,240 --> 01:35:27,440
BASIC SCIENCE CONTINUES TO

2464
01:35:27,440 --> 01:35:29,360
PROGRESS AND WE SEE THERE ARE

2465
01:35:29,360 --> 01:35:30,640
GROUPS OF PATIENTS WITHIN

2466
01:35:30,640 --> 01:35:31,920
CONDITIONS THAT HAVE SIMILAR

2467
01:35:31,920 --> 01:35:33,160
MECHANISMS ACROSS CONDITIONS

2468
01:35:33,160 --> 01:35:34,360
THAT THOSE THERAPIES ACTUALLY

2469
01:35:34,360 --> 01:35:37,520
CAN BE APPLIED, YOU KNOW TO

2470
01:35:37,520 --> 01:35:39,320
OTHER POPULATIONS, I DON'T THINK

2471
01:35:39,320 --> 01:35:40,600
THERE'S MUCH INCENTIVE FOR

2472
01:35:40,600 --> 01:35:41,680
PHARMA TO THEN REPEAT ALL THOSE

2473
01:35:41,680 --> 01:35:43,920
STUDIES IN ANOTHER POPULATION,

2474
01:35:43,920 --> 01:35:45,800
THEY JUST RELY THAT IT WILL BE

2475
01:35:45,800 --> 01:35:47,200
USE TD OFF-LABEL BUT I JUST, YOU

2476
01:35:47,200 --> 01:35:51,240
KNOW I UNDERSTAND THE ISSUES AND

2477
01:35:51,240 --> 01:35:52,640
PERSPECTIVES, I APPRECIATE YOUR

2478
01:35:52,640 --> 01:35:53,520
PERSPECTIVE ON THAT IT JUST

2479
01:35:53,520 --> 01:35:57,840
MAKES ME THINK IS THIS A

2480
01:35:57,840 --> 01:35:59,080
REALISTIC AND PRAGMATIC APPROACH

2481
01:35:59,080 --> 01:36:01,800
THAT WILL GO 1 CONDITION, 1

2482
01:36:01,800 --> 01:36:03,680
CONDITION, SO HOPEFULLY AS A

2483
01:36:03,680 --> 01:36:06,400
THERAPEUTICS ADVANCE AND WE

2484
01:36:06,400 --> 01:36:07,000
UNDERSTAND MECHANISMS BETTER

2485
01:36:07,000 --> 01:36:09,800
LIKE WE SAID WE CAN USE MULTIPLE

2486
01:36:09,800 --> 01:36:11,000
TARGETED THERAPY ACROSS

2487
01:36:11,000 --> 01:36:17,800
DIFFERENT CONDITIONS OR

2488
01:36:17,800 --> 01:36:18,280
SUBPOPULATIONS WITHIN

2489
01:36:18,280 --> 01:36:18,600
CONDITIONS.

2490
01:36:18,600 --> 01:36:20,000
>> WE'RE A LITTLE BIT OVERTIME

2491
01:36:20,000 --> 01:36:22,240
IN THAT WE'RE SUPPOSED TO TAKE A

2492
01:36:22,240 --> 01:36:24,320
15 MINUTE BREAK BEFORE WE

2493
01:36:24,320 --> 01:36:25,560
COMMENCE DISCUSSION OF CONCEPTS

2494
01:36:25,560 --> 01:36:29,160
IN THE CLOSED SESSION AT 12:45.

2495
01:36:29,160 --> 01:36:31,440
SO--SO THAT WE CAN RETAIN A

2496
01:36:31,440 --> 01:36:33,000
SHORT BREAK FOR FOLKS TO GET UP

2497
01:36:33,000 --> 01:36:35,680
AND WALK AROUND BEFORE WE START

2498
01:36:35,680 --> 01:36:37,080
THAT SECTION, ALLAN AND NORA DO

2499
01:36:37,080 --> 01:36:39,440
HAVE YOU KIND OF CLOSING WORDS

2500
01:36:39,440 --> 01:36:40,640
IF ARE THIS DISCUSSION.

2501
01:36:40,640 --> 01:36:42,800
>> YEAH, MY QUESTION HAD TO DO

2502
01:36:42,800 --> 01:36:45,080
WITH THE NOTION OF SINCE WE HAVE

2503
01:36:45,080 --> 01:36:45,920
THE EXPERTS HERE, I AM HEARING

2504
01:36:45,920 --> 01:36:48,560
WHAT YOU ARE SAYING AND I

2505
01:36:48,560 --> 01:36:50,360
BASICALLY WRESTLE WITH IT WITH

2506
01:36:50,360 --> 01:36:51,520
THE URGENCY OF GETTING TREATMENT

2507
01:36:51,520 --> 01:36:53,160
AND THE RECOGNITION THAT MORE

2508
01:36:53,160 --> 01:36:56,520
AND MORE IS BIOTECH, AND NOT BIG

2509
01:36:56,520 --> 01:36:58,040
PHARMA WHICH IS SOMETHING WE'VE

2510
01:36:58,040 --> 01:36:59,320
SEEN WITH MEDICATIONS GOING INTO

2511
01:36:59,320 --> 01:37:01,800
THE CLINIC AND WHAT MORE COULD

2512
01:37:01,800 --> 01:37:03,920
WE PLAY WITHIN THE HEAL TO

2513
01:37:03,920 --> 01:37:07,000
ACTUALLY ACCELERATE THE

2514
01:37:07,000 --> 01:37:07,600
DEVELOPMENT OF THOSE BIOTECHS?

2515
01:37:07,600 --> 01:37:12,520
AND WE HAVE BEEN APPLYING THESE

2516
01:37:12,520 --> 01:37:14,720
IN THE DRUG ABUSE FIELD IN

2517
01:37:14,720 --> 01:37:15,680
GENERATING AND TRAINING

2518
01:37:15,680 --> 01:37:17,120
RESEARCHERS AND PARTNER BE WITH

2519
01:37:17,120 --> 01:37:22,800
VENTURE CAPITAL SO THAT NOW WE

2520
01:37:22,800 --> 01:37:24,320
HAVE FIELD OF BIOTECH THAT CAN

2521
01:37:24,320 --> 01:37:25,920
APPROACH THE PROBLEM OF

2522
01:37:25,920 --> 01:37:26,560
SUBSIDIARY STANCE DISORDERS AND

2523
01:37:26,560 --> 01:37:28,840
IT STRIKES ME THAT THIS APPROACH

2524
01:37:28,840 --> 01:37:29,680
COULD BE EXTRAORDINARILY

2525
01:37:29,680 --> 01:37:32,480
VALUABLE FOR PAIN, SO IF WE

2526
01:37:32,480 --> 01:37:35,320
EXPAND THE CAPABILITIES FROM

2527
01:37:35,320 --> 01:37:37,280
BIOTECH, WE COULD PROBABLY

2528
01:37:37,280 --> 01:37:38,920
ACCELERATE THE DEVELOPMENT OF

2529
01:37:38,920 --> 01:37:39,880
NEW THERAPEUTICS FOR PAIN AND

2530
01:37:39,880 --> 01:37:43,600
I'M PUTTING IT IN THE STABLE AS

2531
01:37:43,600 --> 01:37:44,360
A SUGGESTION OF POTENTIALLY

2532
01:37:44,360 --> 01:37:49,280
SOMETHING THAT WE COULD USE

2533
01:37:49,280 --> 01:37:50,160
SCALE MONEY FOR.

2534
01:37:50,160 --> 01:37:51,600
>> THANK YOU NORA, I THINK WE

2535
01:37:51,600 --> 01:37:55,200
HAVE GOOD IDEAS COMING YOUR WAY

2536
01:37:55,200 --> 01:37:59,480
TOWARD THAT GOAL.

2537
01:37:59,480 --> 01:38:00,760
ALLAN, CLOSING THOUGHTS?

2538
01:38:00,760 --> 01:38:03,200
>> NOW, OBVIOUSLY WE NEED TO

2539
01:38:03,200 --> 01:38:04,360
PUSH WITH THE PHARMAICOLOGICAL

2540
01:38:04,360 --> 01:38:07,600
APPROACHES BUT LET'S NOT FORGET

2541
01:38:07,600 --> 01:38:11,000
THE NONPHARMAICOLOGICAL, RIGHT? 

2542
01:38:11,000 --> 01:38:15,160
THAT CAN NOT ONLY SORT OF HAVE

2543
01:38:15,160 --> 01:38:16,640
AN EFFECT ON NOSE-SUSCEPTION BUT

2544
01:38:16,640 --> 01:38:20,800
ALSO ON THE COMPLEXIVE FORM OF

2545
01:38:20,800 --> 01:38:21,760
PAIN AND SUFFERING IN ALL OF

2546
01:38:21,760 --> 01:38:21,960
THIS.

2547
01:38:21,960 --> 01:38:23,560
SO I THINK THIS IS A GREAT

2548
01:38:23,560 --> 01:38:24,480
DISCUSSION, I REALLY WANT TO

2549
01:38:24,480 --> 01:38:26,440
MAKE SURE THAT WE KEEP IN MIND

2550
01:38:26,440 --> 01:38:28,200
THAT THIS ALL HAS TO BE DONE IN

2551
01:38:28,200 --> 01:38:29,080
THE CONTEXT OF PUSHING AS HARD

2552
01:38:29,080 --> 01:38:31,440
AS WE CAN ON THE

2553
01:38:31,440 --> 01:38:34,760
NONPHARMAICOLOGICAL ASPECTS AS

2554
01:38:34,760 --> 01:38:35,760
WELL.

2555
01:38:35,760 --> 01:38:36,800
>> THANK YOU, HELENE, SO WITH

2556
01:38:36,800 --> 01:38:39,000
THEY WILL CLOSE THE OPEN PORTION

2557
01:38:39,000 --> 01:38:40,960
OF THE HEAL MULTIDISCIPLINARY

2558
01:38:40,960 --> 01:38:44,120
WORKING GROUP FOR MARCH, 2022

2559
01:38:44,120 --> 01:38:45,800
MEETING, THANK YOU VERY MUCH FOR

2560
01:38:45,800 --> 01:38:47,320
THOSE WHO TUNED IN WE WILL TAKE

2561
01:38:47,320 --> 01:38:50,560
A SHORT BREAK, SHORT BREAK,

2562
01:38:50,560 --> 01:38:54,640
RECONVENE AT 12:45 P.M. EASTERN

2563
01:38:54,640 --> 01:38:56,400
TIME AND BEGIN DISCUSSING SOME

2564
01:38:56,400 --> 01:38:58,280
OF THE FUTURE LOOKING IDEAS FOR

2565
01:38:58,280 --> 01:38:58,600
HEAL RESEARCH.

2566
01:38:58,600 --> 01:40:36,320
THANK YOU VERY