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>> HELLO EVERYBODY.  I
WANT TO 

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WELCOME YOU TO THE THE HEAL 

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MULTI-DISCIPLINARY WORKING 

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GROUP MEETING.  THE HEAL 2.0 

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MULTIDISCIPLINARY WORKING 

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GROUP. I AM SUSAN WEISS, 

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FILLING IN TODAY FOR AMY ADAMS 

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AT THE DESIGNATED FEDERAL 

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OFFICIAL FOR THIS.

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IN MY OTHER JOB I AM THE 

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DIRECTOR OF THE DIVISION OF 

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EXTRAMURAL RESEARCH AT NIDA.  

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FIRST OF ALL I WANT TO THANK 

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WENDY WOULD AND -- FOR DOING 

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THE PREPARATORY WORK TO GET US 

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TO THIS POINT. WENT IN 

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PARTICULAR FOR PREPPING ME AND 

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TALK ME THROUGH EVERYTHING THAT 

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IS GOING TO HAPPEN TODAY.  I 

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THINK WE HAVE MOST OF THE 

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COUNCILMEMBERS HERE, MOST OF 

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THE WORKING WORK MEMBERS HERE. 

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IS THAT CORRECT MINDY?

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>> YES. 

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>> DR. WEISS:I THINK WE
CAN 

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BEGIN. I WILL TURN IT OVER TO 

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THAT DR. VOLKOW. 

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>> DR. VOLKOW: HELLO
EVERYONE'S 

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HOPEFULLY WE CAN GET AN ISSUES 

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TO WHERE WE ARE PERTINENT TO 

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THE CRISIS.  ONE THAT IS 

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CHANGING CONSTANTLY. IN VERY 

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MANY TIMES AND PREDICTABLE 

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WAYS.  

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IN MY PRESENTATION TODAY I'M 

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GOING TO HIGHLIGHT SOME OF THE 

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AREAS WHERE THERE HAVE BEEN 

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MAJOR CHANGES, BUT ALSO UPDATE 

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YOU IN SPECIFIC PROGRAMS WHERE 

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WE HAVE STARTED TO SEE RESULTS. 

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 HAVING SAID THAT, I AM NOT 

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GOING TO SHARE MY SCREEN. I 

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NEED TO KNOW IF YOU CAN SEE IT. 

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CAN YOU SEE IT?

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>> YES. 

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>> YEP. 

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>> DR. VOLKOW:NICE.  SO I
WILL 

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START WITH THE NUMBERS AND 

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THESE ARE THE LATEST NUMBERS 

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THAT WE HAVE FROM CDC.  

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ACTUALLY REPORT UNTIL OCTOBER 

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23, THE DATA FOR THE 12 MONTHS 

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THAT PRECEDE THAT. 110,640 

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PEOPLE DIED FROM OVERDOSE IN 

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THE 12 MONTH AND THAT 

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CORRESPONDED TO A 1.10% 

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INCREASE FROM WHAT IT WAS A 

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YEAR BEFORE.  IF YOU LOOK AT IT 

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IT IS SIGNIFICANTLY SMALLER 

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CHANGE THAT WE WERE SEEING 

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DURING THE COVID PANDEMIC.  THE 

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FIRST YEAR WAS 30% INCREASE, 

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SECOND-YEAR 15% INCREASES IN, 

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THEY HAVE BEEN SLOWLY TRENDING 

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DOWNWARD.  BUT UNFORTUNATELY WE 

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ARE STILL SEEING UPTICS IN 

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OVERDOSE DEATHS.

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IF YOU LOOK AT GRANULARITY 

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WITHIN GROUPS, SOME OF THE 

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GROUPS WHERE WE ARE STARTING TO 

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 DETECT INCREASES IN OVERDOSE 

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MORTALITY. AND OTHERS WHERE WE 

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SEE STEEP INCREASES; 

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UNDERSTANDING THE PARAMETERS 

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THAT ALWAYS HIGHLIGHT, WE NEED 

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TO LOOK ALL THE DATA AND THIS 

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COLUMN HERE SHOWS A VERY 

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DRAMATIC REDUCTION, GOING ON 

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FOR MANY YEARS IN THE OVERDOSES 

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THAT RESULT FROM HEROIN. 31% 

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FROM ONE YEAR TO THE OTHER. 

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ALSO THIS IS THE CATEGORY WHERE 

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YOU HAVE OPIOID PAIN 

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MEDICATIONS, AND THEY HAVE ALSO 

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BEEN GOING DOWN, NOT AS 

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DRAMATICALLY AS HEROIN, BUT 

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SIGNIFICANTLY SO.  

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THIS IS METHADONE FOR PRACTICAL 

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PURPOSES, NO CHANGES. THE ONES 

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THAT WE DO SEE INCREASES OUR 

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FENTANYL, COCAINE AND 

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METHAMPHETAMINES. AND IF YOU 

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JUST LOOK AT THE NUMBERS, IT IS 

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70% WE KNOW OF ALL OF THE 

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OVERDOSES ARE FROM FENTANYL. 

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AND THESE OVERDOSES, COCAINE IN 

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MED AND METHAMPHETAMINES, 

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67,000 MANY OF THEM CORRESPOND 

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TO CO-ADMINISTRATION ON BOTH 

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THE STIMULANT DRUG WITH 

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FENTANYL. THESE NUMBERS 

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CONTINUE TO RISE IN SOME YEARS 

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THERE HIGHER THAN OTHERS, BUT 

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THERE SIGNIFICANTLY TRENDING 

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UPWARD. 

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WHAT WE KNOW RIGHT NOW, FOR 

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WHICH WE DON'T REALLY NEED TO 

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DO NORMAL RESEARCH, IS THAT THE 

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MEDICATIONS FOR OPIOID USE 

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DISORDER, WHETHER METHADONE OR 

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NALTREXONE -- SIGNIFICANTLY 

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REDUCE THE LIKELIHOOD OF 

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RELAPSE AND OVERDOSING. 

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OBVIOUSLY THAT IS A KNOWN FACT  

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THAT WAS BASICALLY REPORTED BY 

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THE NATIONAL ACADEMY OF 

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SCIENCES IN MEDICINE, 

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DOCUMENTING THAT THIS IS THE 

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MOST POWERFUL TOOL THAT WE 

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HAVE.  ALONGSIDE OF COURSE 

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NALOXONE, THE OVERDOSE REVERSAL 

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AGENT AND NOT SURPRISING IT IS 

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BEEN TO EXPAND ACCESS TO 

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NALOXONE, AS WELL AS EXPANDING 

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TREATMENT WITH MEDICATIONS FOR 

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THOSE WITH A OPIOID USE 

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DISORDER AND HOW WE ARE DOING 

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IN BOTH OF THESE ENDEAVORS DATA 

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SHOWS THAT DEFINITELY I DON'T 

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HAVE THE GRAPH, BUT FROM 

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ACTIVIA  WE HAVE SEEN A 

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SIGNIFICANT RISE IN 

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PRESCRIPTIONS NALOXONE. ONE 

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THINGS TO DISTRIBUTE NALOXONE; 

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AND THE OTHER IS GETTING IT 

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INTO THE RIGHT HANDS, AND THAT 

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IS WHY WE ARE CORRECTLY 

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RESEARCHING AND TRYING TO 

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DETERMINE IF IT IS OPTIMALLY 

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BEING DISTRIBUTED.

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WHEN IT COMES TO MEDICATIONS, 

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ACTUALLY WE KNOW THAT 

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UNFORTUNATELY WE ARE DOING 

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VERY, VERY POORLY IN PROVIDING 

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THESE MEDICATIONS FOR PEOPLE 

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WITH AN OPIOID USE DISORDER WHO 

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WOULD SIGNIFICANT BENEFIT FROM 

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THEM. 

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LATEST ANALYSIS BUT WAS 

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RECENTLY ACTUALLY DOCUMENTED 

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THAT ONLY 22% OF PEOPLE WITH AN 

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OPIOID USE DISORDER RECEIVED 

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THESE MEDICATIONS EVEN THOUGH 

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RIGHT NOW WE KNOW THAT THE USE 

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OF OPIOIDS IS EXTREME THE 

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DANGEROUS. AND THAT MORTALITY 

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RISKS ARE VERY HIGH. 

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AND SO IT IS UNCLEAR-- I MEAN I 

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DON'T WANT TO SAY UNCLEAR, BUT 

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OBVIOUSLY THERE ARE MULTIPLE 

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FACTORS THAT DRIVE THE VERY LOW 

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PENETRATION OF MEDICATIONS FOR 

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OPIOID USE DISORDER.  THAT 

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COULD PROBABLY BE THE MOST 

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POWERFUL TOOL THAT WE HAVE FOR 

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PREVENTING OVERDOSES, ALONGSIDE 

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NALOXONE. 

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THAT IS WHY ONE OF THE TOP, TOP 

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PRIORITIES HAS BEEN TO ACTUALLY 

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TAKE OF THE HELPER SYSTEM, 

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BECAUSE IT REPRESENTS THE MOST 

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IMPACTFUL INFRA STRUCTURE THAT 

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WE HAVE IN OUR COUNTRY TO 

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PREVENT SUBSTANCE USE 

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DISORDERS.  IT GOES WITHOUT 

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SAYING WE CANNOT CONTINUE TO BE 

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RELYING ON SPECIALIZED 

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TREATMENT PROGRAMS FOR 

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ADDRESSING THE OVERDOSE CRISIS 

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THEY ARE INSUFFICIENT AND IT 

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DOESN'T MEAN THAT THOSE 

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PROGRAMS IMPROPERLY PREPARED TO 

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DO THE ACTUAL EVIDENCE-BASED 

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INTERVENTIONS IN SOME OF THOSE 

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PROGRAMS. THEY DON'T 

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NECESSARILY ADMINISTER ADVANCED 

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RATIONS.

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TO THE CLINICAL TRIAL NETWORK, 

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WE WANT TO ACCELERATE WITH 

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FUNDING FROM HEAL.   IT HAS 

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ENABLED US TO EXPAND THE 

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PROJECT THAT ACTUALLY CREATE 

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EVIDENCE THAT SHOWS THAT 

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INVOLVEMENT OF DIFFERENT 

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MEDICAL SPECIALTIES HAS ENABLED 

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US TO EXPAND THAT CAPABILITIES, 

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TO BE ABLE TO SCREEN AND 

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PROVIDE MEDICATIONS FOR OPIOID 

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USE DISORDER AND ACTUALLY 

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SUPPORT THEM AND THOSE 

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INTERVENTIONS, IN THE HELPER 

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SYSTEM, RESULTED IN GOOD 

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OUTCOMES AS THOSE SPECIALIZING 

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IN TREATMENT THAT OFFER 

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MEDICATIONS FOR OPIOID USE 

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DISORDER. 

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FOR NETWORK PROJECTS, THE MOST 

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IMPACTFUL HAS BEEN THE 

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DOCUMENTATION INITIATED 

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MEDICATIONS FOR OPIOID USE 

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DISORDER IN THE EMERGENCY 

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DEPARTMENT, AND THESE MODELS 

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ARE NOW BEING IMPLEMENTED IN 

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MULTIPLE SITES ACROSS THE 

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UNITED STATES.

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SECOND ONE, VERY IMPACTFUL WAS 

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INVOLVED IN THE PRIMARY CARE, 

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AND SCREENING. WHY? BECAUSE 

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THAT IS THE MOST EXTENSIVE 

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NETWORK AVAILABLE AND IT DOES 

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SHOW THAT PRIMARY CARE 

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PHYSICIANS ARE ABLE TO PROVIDE 

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SUCCESSFUL FOLLOW-UP AND 

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MANAGEMENT OF THESE PATIENTS. 

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A THIRD MODEL HAS BEEN THE 

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INTEGRATION OF INFECTIOUS 

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DISEASE DOCTORS WITH CARE FOR 

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MEDICATIONS FOR OPIOID USE 

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DISORDERS, AND THESE INTEGRATED 

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PROGRAMS HAVE SHOWN THAT 

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SIGNIFICANT BENEFICIAL EFFECTS 

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FOR ENSURING THAT PATIENTS ARE 

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STAYING ON MEDICATIONS FOR 

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OPIOID USE DISORDERS ALSO HAVE 

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SHOWN THAT THEY HAVE IMPROVE 

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THE OUTCOMES FOR INFECTIOUS 

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DISEASE-- IN THIS CASE HIV. 

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THERE ARE OTHER MODELS THAT 

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RELY ON ALTERNATIVES.  SPOKE 

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AND HUB MODELS PERMIT NETWORKS 

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THAT ARE CENTRALIZING IN THE 

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AREA OF SPECIALTY, WHERE A 

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DOCTOR MAY HAVE A SPECIALTY FOR 

244
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TREATMENT OF SUBSTANCE USE 

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DISORDER THAT THEN PROVIDES 

246
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THAT SUPPORT FOR FARAWAY SITES 

247
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THAT ARE ABLE TO PRESCRIBE 

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THOSE MEDICATIONS. 

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ALTERNATIVE METHODS LIKE 

250
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PHARMACY DELIVERY OF MOUD 

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LARGELY POTENTIALLY, THEY WERE 

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IMPLEMENTED AT THE LEVEL THEY 

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SHOULD. THEY WOULD LARGELY 

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EXPAND ACCESS TO MEDICATIONS TO 

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MANY PEOPLE, AND FACILITATE THE 

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RETENTION.  BECAUSE PHARMACIES 

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TEND TO BE CLOSER TO WHERE 

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PEOPLE LIVE. 

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MOBILE DELIVERY FOR OPIOID USE 

260
00:10:00,615 --> 00:10:02,683
DISORDER DISORDER HAS BEEN 

261
00:10:02,683 --> 00:10:03,251
ANOTHER INNOVATION THAT IS 

262
00:10:03,251 --> 00:10:03,885
BROUGHT TREATMENT TO DIFFICULT 

263
00:10:03,885 --> 00:10:04,685
TO REACH COMMUNITIES, RURAL 

264
00:10:04,685 --> 00:10:05,753
AREAS WERE EVEN A PHARMACY MAY 

265
00:10:05,753 --> 00:10:08,122
NOT BE SO CLOSE BY. 

266
00:10:08,122 --> 00:10:12,226
AND FINALLY LIKE MANY AREAS OF 

267
00:10:12,226 --> 00:10:12,860
MEDICINE, ACCESS TO TELEHEALTH 

268
00:10:12,860 --> 00:10:15,596
HAS EXPANDED OUR CAPABILITY FOR 

269
00:10:15,596 --> 00:10:16,230
PROVIDING TREATMENT AND SUPPORT 

270
00:10:16,230 --> 00:10:20,401
FOR PEOPLE WITH OPIOID USE 

271
00:10:20,401 --> 00:10:23,171
DISORDERS.

272
00:10:23,171 --> 00:10:24,839
AND THE CHANGES THAT ARE DONE 

273
00:10:24,839 --> 00:10:28,676
COINCIDENT WITH THE COVID 

274
00:10:28,676 --> 00:10:29,243
PANDEMIC MADE IT EASIER TO 

275
00:10:29,243 --> 00:10:29,911
PRESCRIBE MEDICATIONS FOR 

276
00:10:29,911 --> 00:10:32,213
OPIOID USE DISORDERS VIA 

277
00:10:32,213 --> 00:10:35,616
TELEHEALTH. 

278
00:10:35,616 --> 00:10:37,618
A SECOND PRIORITY FOR US HAS 

279
00:10:37,618 --> 00:10:41,222
BEEN THE JUSTICE SETTING, I 

280
00:10:41,222 --> 00:10:42,557
WOULD SAY IT IS THE HIGHEST 

281
00:10:42,557 --> 00:10:43,157
IMPACT INFRASTRUCTURE WE HAVE 

282
00:10:43,157 --> 00:10:44,492
IN OUR COUNTRY TO BE ABLE TO 

283
00:10:44,492 --> 00:10:45,326
SCREEN AND PROVIDE FOR 

284
00:10:45,326 --> 00:10:46,761
TREATMENT OF INDIVIDUALS WITH 

285
00:10:46,761 --> 00:10:50,531
AN OPIOID USE DISORDER.  HOW 

286
00:10:50,531 --> 00:10:52,467
CONSEQUENTIAL IS THE JUSTICE 

287
00:10:52,467 --> 00:10:52,834
SYSTEM?

288
00:10:52,834 --> 00:10:53,434
WELL IF YOU TAKE THESE NUMBERS 

289
00:10:53,434 --> 00:10:58,873
HERE, THE STATISTICS, ONE IN 4, 

290
00:10:58,873 --> 00:10:59,474
25%, OF PEOPLE THAT HAVE DIED 

291
00:10:59,474 --> 00:11:02,510
FROM AN OVERDOSE HAD A PRIOR 

292
00:11:02,510 --> 00:11:06,481
YEAR JUSTICE INVOLVEMENT. 25%. 

293
00:11:06,481 --> 00:11:08,082
THIS WAS AN OPPORTUNITY SUCH 

294
00:11:08,082 --> 00:11:10,418
THAT IF THERE HAD BEEN THE 

295
00:11:10,418 --> 00:11:12,787
ABILITY TO PROVIDE THEM WITH 

296
00:11:12,787 --> 00:11:13,387
TREATMENT, THOSE INDIVIDUALS 

297
00:11:13,387 --> 00:11:15,423
MAY HAVE NOT DIED. IN THIS 

298
00:11:15,423 --> 00:11:19,126
PAPER THAT ACTUALLY WAS DONE IN 

299
00:11:19,126 --> 00:11:20,394
RHODE ISLAND, WHERE THE 

300
00:11:20,394 --> 00:11:21,796
IMPLEMENTED TREATMENT, ALL OF 

301
00:11:21,796 --> 00:11:25,433
THEM, THREE MEDICATIONS, IN 

302
00:11:25,433 --> 00:11:26,968
JAIL, SYSTEMATICALLY SHOWED 

303
00:11:26,968 --> 00:11:31,005
THAT THEY REDUCED MORTALITY BY 

304
00:11:31,005 --> 00:11:32,440
70% WHEN PEOPLE WERE RELEASED 

305
00:11:32,440 --> 00:11:33,808
AFTER ONE YEAR AFTER THEY WERE 

306
00:11:33,808 --> 00:11:36,477
RELEASED INTO THE COMMUNITIES. 

307
00:11:36,477 --> 00:11:40,214
AND THE EFFECT OF THAT IN THE 

308
00:11:40,214 --> 00:11:40,748
STATE WAS 31% DECREASE IN 

309
00:11:40,748 --> 00:11:41,782
MORTALITY IN RHODE ISLAND FROM 

310
00:11:41,782 --> 00:11:44,218
THAT INTERVENTION. 

311
00:11:44,218 --> 00:11:46,787
SO THIS IS WHY ONE OF OUR TOP, 

312
00:11:46,787 --> 00:11:48,022
TOP PRIORITIES IS BEEN THE 

313
00:11:48,022 --> 00:11:48,656
JUSTICE COMMUNITY OPIOID 

314
00:11:48,656 --> 00:11:51,425
INNOVATION NETWORK INITIATED IN 

315
00:11:51,425 --> 00:11:54,795
2019.  AND HAS BEEN GOING ON 

316
00:11:54,795 --> 00:11:57,131
NOW FOR SIX YEARS. AND WE ARE 

317
00:11:57,131 --> 00:11:57,698
GOING TO BE HEARING DETAILS 

318
00:11:57,698 --> 00:12:01,469
FROM THAT FROM TISHA WILEY 

319
00:12:01,469 --> 00:12:04,705
LATER ON. BUT I DO WANT TO NOTE 

320
00:12:04,705 --> 00:12:05,273
SOMETHING THAT CAPTURED MY 

321
00:12:05,273 --> 00:12:06,307
ATTENTION. 

322
00:12:06,307 --> 00:12:10,044
WHEN YOU LOOK AT THE SURVEYS OF 

323
00:12:10,044 --> 00:12:11,279
JAILS THAT WERE ABLE TO PROVIDE 

324
00:12:11,279 --> 00:12:13,748
MEDICATIONS AVAILABLE, THIS IS 

325
00:12:13,748 --> 00:12:15,016
A SURVEY THAT WAS DONE ON 2019. 

326
00:12:15,016 --> 00:12:16,417
 THIS IS THE SURVEY DONE THREE 

327
00:12:16,417 --> 00:12:20,488
YEARS LATER.  YOU CAN SEE-- NOT 

328
00:12:20,488 --> 00:12:21,756
THE SAME SURVEY, SO YOU CANNOT 

329
00:12:21,756 --> 00:12:24,325
DO A DIRECT COMPARISON-- BUT IT 

330
00:12:24,325 --> 00:12:25,927
IS NOTABLE THAT THERE APPEARS 

331
00:12:25,927 --> 00:12:27,828
TO BE A MUCH LARGER NUMBER OR 

332
00:12:27,828 --> 00:12:32,400
SYSTEMS THAT ARE ACTUALLY JAILS 

333
00:12:32,400 --> 00:12:36,704
PROVIDING MEDICATION. AND THAT 

334
00:12:36,704 --> 00:12:37,338
HAS BEEN CORROBORATED BY OTHER 

335
00:12:37,338 --> 00:12:37,972
PUBLICATIONS BOTH IN JAILS AND 

336
00:12:37,972 --> 00:12:44,245
PRISONS. 

337
00:12:44,245 --> 00:12:44,812
THESE NUMBERS BASICALLY DOES 

338
00:12:44,812 --> 00:12:45,413
NOT LOOK LIKE IT HAS CHANGED 

339
00:12:45,413 --> 00:12:46,747
VERY MUCH.  I DON'T KNOW THAT 

340
00:12:46,747 --> 00:12:49,150
WE CAN SAY NOTHING ABOUT IT. 

341
00:12:49,150 --> 00:12:50,918
BUT IT DOES PUSH US TO THE FACT 

342
00:12:50,918 --> 00:12:52,286
THAT PEOPLE THAT COME IN 

343
00:12:52,286 --> 00:12:53,254
ALREADY WITH MEDICATIONS FOR 

344
00:12:53,254 --> 00:12:57,058
OPIOID USE DISORDER, A 

345
00:12:57,058 --> 00:13:00,828
SIGNIFICANT PORTION AS OF 2022, 

346
00:13:00,828 --> 00:13:01,462
WERE NOT CONTINUING TO RECEIVE 

347
00:13:01,462 --> 00:13:02,063
THEM ONCE THEY GET INTO THE 

348
00:13:02,063 --> 00:13:04,999
JAIL.  THIS IS IN JAILS. 

349
00:13:04,999 --> 00:13:08,202
NOW, LET ME GO TO THE NEXT 

350
00:13:08,202 --> 00:13:11,706
THERAPY AND POLITICIAN PROBLEM. 

351
00:13:11,706 --> 00:13:14,475
 HEALTHCARE JUSTICE AND HEALING 

352
00:13:14,475 --> 00:13:22,216
COMMUNITY STORIES. I WOULD SAY 

353
00:13:22,216 --> 00:13:24,619
WE DECIDED WE WOULD SAY, LET'S 

354
00:13:24,619 --> 00:13:26,587
BE AMBITIOUS. LET'S CREATE A 

355
00:13:26,587 --> 00:13:28,923
PROJECT THAT BRINGS TOGETHER 

356
00:13:28,923 --> 00:13:31,225
ALL OF THE EVIDENCE-BASED, AND 

357
00:13:31,225 --> 00:13:35,663
DOCUMENT AND DEMONSTRATE HOW 

358
00:13:35,663 --> 00:13:36,631
TAKING ADVANTAGE OF THE 

359
00:13:36,631 --> 00:13:43,437
EVIDENCE-BASED INTERVENTIONS IN 

360
00:13:43,437 --> 00:13:44,038
SITES,  AND COMMUNITIES THAT 

361
00:13:44,038 --> 00:13:44,672
HAVE SOME OF THE HIGHEST RATES 

362
00:13:44,672 --> 00:13:46,140
OF OVERDOSES IN THE COUNTRY CAN 

363
00:13:46,140 --> 00:13:46,741
ACTUALLY SIGNIFICANTLY REDUCE 

364
00:13:46,741 --> 00:13:48,175
OVERDOSE MORTALITY. AND THAT IS 

365
00:13:48,175 --> 00:13:48,709
HOW THE HEALING COMMUNITY 

366
00:13:48,709 --> 00:13:50,277
STARTED. 

367
00:13:50,277 --> 00:13:52,346
IT STARTED WITH FUNDING IN 2019 

368
00:13:52,346 --> 00:13:55,483
TO THE 4 DIFFERENT STATES, 

369
00:13:55,483 --> 00:13:58,753
KENTUCKY, OHIO, MASSACHUSETTS 

370
00:13:58,753 --> 00:14:02,523
AND NEW YORK. 66 COMMUNITIES, 

371
00:14:02,523 --> 00:14:05,426
67, MAY INVOLVE RURAL AND URBAN 

372
00:14:05,426 --> 00:14:07,662
AREAS. 

373
00:14:07,662 --> 00:14:10,498
AGAIN SELECTED FOR THEIR HIGH 

374
00:14:10,498 --> 00:14:14,635
RATE OF OVERDOSE MORTALITY.

375
00:14:14,635 --> 00:14:18,205
AND THE INTERVENTION WAS TO 

376
00:14:18,205 --> 00:14:19,273
ACTUALLY IN EACH COMMUNITY, TO 

377
00:14:19,273 --> 00:14:22,877
QUANTIFY THE CHALLENGES AND THE 

378
00:14:22,877 --> 00:14:26,480
INFRASTRUCTURE THAT EXISTED IN 

379
00:14:26,480 --> 00:14:29,650
THAT COMMUNITY. AND TO USE THAT 

380
00:14:29,650 --> 00:14:32,286
DATA TO ACTUALLY MONITOR 

381
00:14:32,286 --> 00:14:32,887
INTERVENTIONS. AND TO BRING 

382
00:14:32,887 --> 00:14:37,525
TOGETHER JUSTICE, HEALTH CARE 

383
00:14:37,525 --> 00:14:38,025
AND THE STATES AND THE 

384
00:14:38,025 --> 00:14:38,659
COMMUNITIES IN ORDER TO DEPLOY 

385
00:14:38,659 --> 00:14:40,728
THE INTERVENTIONS. IT IS AN 

386
00:14:40,728 --> 00:14:42,229
INTEGRATED MODEL OF CARE OF 

387
00:14:42,229 --> 00:14:42,830
DEPLOYING THE EVIDENCE-BASED 

388
00:14:42,830 --> 00:14:47,201
INTERVENTIONS. 

389
00:14:47,201 --> 00:14:47,802
THE MAIN INTERVENTIONS FROM THE 

390
00:14:47,802 --> 00:14:49,170
MEDICAL PERSPECTIVE WAS 

391
00:14:49,170 --> 00:14:52,239
INCREASED NALOXONE IS DIVISION 

392
00:14:52,239 --> 00:14:58,879
AND ACCESS UTILIZATION OF MOUD 

393
00:14:58,879 --> 00:15:00,614
AND DECREASE HIGH-RISK OPIOID 

394
00:15:00,614 --> 00:15:01,682
PRESCRIBING. THE RESULTS HAVE 

395
00:15:01,682 --> 00:15:02,216
NOT YET BEEN PUBLISHED SO 

396
00:15:02,216 --> 00:15:04,351
PLEASE KEEP IT CONFIDENTIAL.  

397
00:15:04,351 --> 00:15:06,954
THIS CANNOT BE DISTRIBUTED. THE 

398
00:15:06,954 --> 00:15:07,588
PAPER HOPEFULLY WILL BE COMING 

399
00:15:07,588 --> 00:15:09,023
SOON. 

400
00:15:09,023 --> 00:15:12,426
SO WHAT DID WE OBSERVE? THESE 

401
00:15:12,426 --> 00:15:12,993
ARE THE RESULTS. THE MAIN 

402
00:15:12,993 --> 00:15:16,630
OUTCOME WAS REDUCTION IN 

403
00:15:16,630 --> 00:15:18,799
OVERDOSE MORTALITY. AND THIS IS 

404
00:15:18,799 --> 00:15:23,637
THE DATA. IT IS COMPARING WAVE 

405
00:15:23,637 --> 00:15:32,012
1 AND WAVE 2.  IMPLEMENTATION 

406
00:15:32,012 --> 00:15:32,546
OF THE HEALING COMMUNITY 

407
00:15:32,546 --> 00:15:33,180
INTERVENTION AND DURING THE 12 

408
00:15:33,180 --> 00:15:33,814
MONTH PERIOD, AND COMPARING TO 

409
00:15:33,814 --> 00:15:38,586
THE WAVE 2 WHO DID NOT GET THE 

410
00:15:38,586 --> 00:15:39,220
INTERVENTION JUST TREATMENT IN 

411
00:15:39,220 --> 00:15:41,322
THOSE COMMUNITIES. 

412
00:15:41,322 --> 00:15:41,889
THIS IS THE RATE OF MORTALITY 

413
00:15:41,889 --> 00:15:47,394
PER 100,000 FOUR WAVE 1 THAT 

414
00:15:47,394 --> 00:15:47,995
RECEIVE THE INTERVENTION AND 

415
00:15:47,995 --> 00:15:51,465
WAVE 2 THAT DID NOT. YOU CAN 

416
00:15:51,465 --> 00:15:52,633
SEE A REDUCTION IS NOT 

417
00:15:52,633 --> 00:15:55,836
SIGNIFICANT. 9% REDUCTION. WE 

418
00:15:55,836 --> 00:16:01,041
BASICALLY HAD WANTED  THE IDEA 

419
00:16:01,041 --> 00:16:01,642
THEORETICALLY TO EXPECT A 40% 

420
00:16:01,642 --> 00:16:02,109
REDUCTION IN OVERDOSE 

421
00:16:02,109 --> 00:16:03,677
MORTALITY.  AND WE OBSERVED A 

422
00:16:03,677 --> 00:16:05,579
9%.

423
00:16:05,579 --> 00:16:08,816
AND WHAT IS INTERESTING IS 

424
00:16:08,816 --> 00:16:09,450
THAT, THESE ARE THE THINGS THAT 

425
00:16:09,450 --> 00:16:10,751
ARE INTERESTING ABOUT IT. THE 

426
00:16:10,751 --> 00:16:12,653
DIFFERENCE IN SUCCESS OF THE 

427
00:16:12,653 --> 00:16:13,187
INTERVENTIONS BETWEEN THE 

428
00:16:13,187 --> 00:16:17,558
STATES. AND IT IS NOTABLE THAT 

429
00:16:17,558 --> 00:16:18,058
KENTUCKY DID NOT SEE A 

430
00:16:18,058 --> 00:16:19,059
DIFFERENCE BETWEEN WAVE 1 AND 

431
00:16:19,059 --> 00:16:22,696
2.  WE CAN DISCUSS IF YOU HAVE 

432
00:16:22,696 --> 00:16:25,800
QUESTIONS WHY THAT MIGHT BE SO. 

433
00:16:25,800 --> 00:16:26,433
 WHEREAS IN THE OTHER ONES YOU 

434
00:16:26,433 --> 00:16:27,835
CAN CONSISTENTLY SEE IT.

435
00:16:27,835 --> 00:16:32,540
WHAT IS ALSO NOTABLE, NOT THE 

436
00:16:32,540 --> 00:16:34,475
MAIN OUTCOME BUT INTRIGUING, IS 

437
00:16:34,475 --> 00:16:35,543
THAT WHAT WE DID SEE A 

438
00:16:35,543 --> 00:16:36,143
SIGNIFICANT REDUCTION IN ONE 

439
00:16:36,143 --> 00:16:36,911
YEAR WAS IN TERMS OF TOTALITY 

440
00:16:36,911 --> 00:16:39,980
ASSOCIATE WITH 

441
00:16:39,980 --> 00:16:40,781
PSYCHOSTIMULANTS, WITH 

442
00:16:40,781 --> 00:16:42,917
FENTANYL. THIS IS WAVE 1 AND 

443
00:16:42,917 --> 00:16:45,753
WAVE 2. 

444
00:16:45,753 --> 00:16:46,787
NOTE ALSO THAT THE RATE OF 

445
00:16:46,787 --> 00:16:48,722
MORTALITY AS EXPECTED IS MUCH 

446
00:16:48,722 --> 00:16:51,058
LOWER FOR PSYCHOSTIMULANTS 

447
00:16:51,058 --> 00:16:53,794
OVERALL THEN WITH THESE FOUR 

448
00:16:53,794 --> 00:16:57,298
OPIOIDS. THAT REPRESENT THE 

449
00:16:57,298 --> 00:16:59,400
REALLY PREDOMINANCE OF 

450
00:16:59,400 --> 00:17:01,769
OVERDOSES LINKED WITH OPIOIDS 

451
00:17:01,769 --> 00:17:03,938
DIRECTLY. 

452
00:17:03,938 --> 00:17:04,839
SO WHAT ARE THE CONCLUSIONS 

453
00:17:04,839 --> 00:17:08,075
FROM THE HEALING COMMUNITY 

454
00:17:08,075 --> 00:17:08,576
STUDY? YES THERE WAS A 

455
00:17:08,576 --> 00:17:12,680
REDUCTION IN OPIOID OVERDOSE 

456
00:17:12,680 --> 00:17:16,317
DEATHS, BUT NOT STATISTICALLY 

457
00:17:16,317 --> 00:17:16,917
SIGNIFICANT. THERE WAS A 37% 

458
00:17:16,917 --> 00:17:18,385
REDUCTION ON OVERDOSE DEATHS 

459
00:17:18,385 --> 00:17:19,920
FROM OPIOIDS AND 

460
00:17:19,920 --> 00:17:20,521
PSYCHOSTIMULANTS, OTHER THAN 

461
00:17:20,521 --> 00:17:23,157
COCAINE. THIS WAS SIGNIFICANT.

462
00:17:23,157 --> 00:17:26,393
IN TOTAL THERE WERE 525 

463
00:17:26,393 --> 00:17:28,796
OVERDOSE DEATHS THAT WERE 

464
00:17:28,796 --> 00:17:32,166
OBVIATED, AVERTED IN WAVE 1 

465
00:17:32,166 --> 00:17:35,135
WHEN COMPARED TO WAVE 2. 

466
00:17:35,135 --> 00:17:36,804
YES WE WANTED 40% REDUCTION IN 

467
00:17:36,804 --> 00:17:45,546
OVERDOSES. HOPING THAT WE HAD 

468
00:17:45,546 --> 00:17:46,180
TENTATIVELY ESTABLISHED WITH NO 

469
00:17:46,180 --> 00:17:48,215
PRECEDENCE ABOUT WHY THAT 

470
00:17:48,215 --> 00:17:48,782
NUMBER, BUT TO HAVE A BOLD 

471
00:17:48,782 --> 00:17:51,185
STATEMENT. AT THAT TIME, ONE OF 

472
00:17:51,185 --> 00:17:56,423
THE REASONS WHY WE DID NOT WANT 

473
00:17:56,423 --> 00:17:58,292
STOP 40% OR ANY OTHER NUMBER, 

474
00:17:58,292 --> 00:17:58,959
WAS THAT WE WERE STARTING TO 

475
00:17:58,959 --> 00:18:09,403
SEE THERE WAS A RISE IN  

476
00:18:12,873 --> 00:18:13,307
METHAMPHETAMINE USE THE 

477
00:18:13,307 --> 00:18:15,643
COMMUNITY.  AND THOSE 

478
00:18:15,643 --> 00:18:16,143
INTERVENTIONS THEY WERE 

479
00:18:16,143 --> 00:18:16,677
TARGETED SPECIFICALLY FOR 

480
00:18:16,677 --> 00:18:18,579
OPIOID USE DISORDER MAY BE MUCH 

481
00:18:18,579 --> 00:18:21,115
LESS EFFECTIVE. 

482
00:18:21,115 --> 00:18:24,018
WE DO NOT KNOW OR ANYBODY KNOWS 

483
00:18:24,018 --> 00:18:26,987
WAS THAT WE IMPLEMENTED THE 

484
00:18:26,987 --> 00:18:34,061
HEALING COMMUNITY STUDIES, 

485
00:18:34,061 --> 00:18:34,695
COVID EMERGE IN OUR COUNTRY AND 

486
00:18:34,695 --> 00:18:36,931
THAT LED TO ABSOLUTE CLOSURES 

487
00:18:36,931 --> 00:18:37,498
OF THE HEALTHCARE SYSTEMS, 

488
00:18:37,498 --> 00:18:38,132
SUPPORT SYSTEMS FOR PEOPLE WHO 

489
00:18:38,132 --> 00:18:39,733
WERE RECEIVING TREATMENT 

490
00:18:39,733 --> 00:18:40,334
PARTICULARLY IN THE SUBSTANCE 

491
00:18:40,334 --> 00:18:42,603
USE DISORDER.

492
00:18:42,603 --> 00:18:43,637
ALSO RESULTED BECAUSE OF THAT 

493
00:18:43,637 --> 00:18:51,779
IN CHANGES IN THE PROVISION OF 

494
00:18:51,779 --> 00:18:52,413
METHADONE, TAKE-HOME METHADONE, 

495
00:18:52,413 --> 00:18:52,880
AND FACILITATION AND 

496
00:18:52,880 --> 00:19:03,390
IMPLEMENTATION OF PENOPHRIN. 

497
00:19:10,464 --> 00:19:10,998
ALSO DURING THAT PERIOD THERE 

498
00:19:10,998 --> 00:19:11,532
WAS A MASSIVE INCREASE OF 

499
00:19:11,532 --> 00:19:13,867
FENTANYL IN OUR COUNTRY. AND 

500
00:19:13,867 --> 00:19:14,401
THE ILLICIT MARKET BECAME 

501
00:19:14,401 --> 00:19:18,205
INCREASINGLY MORE UNPREDICTABLE 

502
00:19:18,205 --> 00:19:22,309
VIS-à-VIS THE COMBINATIONS. 

503
00:19:22,309 --> 00:19:26,914
SO, WE DELAYED THAT.  ONE OF 

504
00:19:26,914 --> 00:19:27,514
THE REASONS WHY THESE RESULTS 

505
00:19:27,514 --> 00:19:28,115
MAY NOT HAVE BEEN SIGNIFICANT 

506
00:19:28,115 --> 00:19:29,049
WAS CERTAINLY ALL OF THE 

507
00:19:29,049 --> 00:19:30,584
DISTURBANCE REDUCED BY EITHER 

508
00:19:30,584 --> 00:19:33,854
THE COVID PANDEMIC AND VERY 

509
00:19:33,854 --> 00:19:34,455
IMPORTANTLY THE EXPANSION OF 

510
00:19:34,455 --> 00:19:37,191
FENTANYL. 

511
00:19:37,191 --> 00:19:39,393
A QUESTION TO ASK IS, DURING 

512
00:19:39,393 --> 00:19:40,027
THE PERIOD OF IMPLEMENTATION OF 

513
00:19:40,027 --> 00:19:45,366
EVERYTHING DONE, ONE YEAR AND A 

514
00:19:45,366 --> 00:19:48,402
HALF, WAS IT SUFFICIENT? DO WE 

515
00:19:48,402 --> 00:19:49,403
NEED A LONGER PERIOD OF TIME? 

516
00:19:49,403 --> 00:19:54,274
THAT IS POSSIBLE. IT IS A 

517
00:19:54,274 --> 00:19:54,808
HYPOTHESIS THAT MAY HAVE 

518
00:19:54,808 --> 00:19:57,444
ACTUALLY CONTRIBUTED. 

519
00:19:57,444 --> 00:20:00,781
FROM MY PERSPECTIVE OF WHAT THE 

520
00:20:00,781 --> 00:20:01,382
ANALYSIS OF WHAT I'VE SEEN IN 

521
00:20:01,382 --> 00:20:02,483
OTHER PARTS OF THE COUNTRY, 

522
00:20:02,483 --> 00:20:03,851
CERTAINLY THE EXPANDED USE OF 

523
00:20:03,851 --> 00:20:06,887
FENTANYL IN COMBINATION WITH 

524
00:20:06,887 --> 00:20:07,454
BASICALLY ALMOST ANY OTHER 

525
00:20:07,454 --> 00:20:08,922
ILLICIT DRUG, HAS MADE THE 

526
00:20:08,922 --> 00:20:12,426
PROBLEM VERY, VERY COMPLEX. AND 

527
00:20:12,426 --> 00:20:20,000
IT IS NOT JUST EVEN DRUGS.NOW 

528
00:20:20,000 --> 00:20:20,634
WE ARE SEEING ALSO ALL SORTS OF 

529
00:20:20,634 --> 00:20:21,268
OTHER TOXIC SUBSTANCES THAT MAY 

530
00:20:21,268 --> 00:20:21,668
BE MIXED.

531
00:20:21,668 --> 00:20:24,605
THIS IS AN EXAMPLE.  CERTAINLY 

532
00:20:24,605 --> 00:20:25,973
WE HAVE SEEN INCREASES STARTING 

533
00:20:25,973 --> 00:20:29,777
REALLY IN 2020 WITH THE COVID 

534
00:20:29,777 --> 00:20:30,377
PANDEMIC ARISE IN A NUMBER OF 

535
00:20:30,377 --> 00:20:32,546
OVERDOSE DEATHS THAT CONTAIN 

536
00:20:32,546 --> 00:20:35,549
ACTUALLY -- AND IN THE UNITED 

537
00:20:35,549 --> 00:20:38,419
STATES IF YOU LOOK RIGHT NOW,  

538
00:20:38,419 --> 00:20:40,754
IS APPROXIMATELY 12% OF THE 

539
00:20:40,754 --> 00:20:42,322
OVERDOSE DEATHS IN OUR COUNTRY 

540
00:20:42,322 --> 00:20:43,290
FROM FENTANYL CONTAINING 

541
00:20:43,290 --> 00:20:46,427
XYLAZINE. 

542
00:20:46,427 --> 00:20:53,567
XYLAZINE WHEN COMBINED WITH 

543
00:20:53,567 --> 00:20:54,134
FENTANYL, LO AND BEHOLD AND 

544
00:20:54,134 --> 00:20:58,505
THIS IS A STUDY NOT ONLY DOSES 

545
00:20:58,505 --> 00:21:05,112
OF XYLAZINE, 100-FOD INCREASE 

546
00:21:05,112 --> 00:21:12,586
FOR ILLICIT DOSE OF FENTANYL. 

547
00:21:12,586 --> 00:21:13,120
XYLAZINE DECREASES BLOOD 

548
00:21:13,120 --> 00:21:18,625
PRESSURE AND PRODUCES 

549
00:21:18,625 --> 00:21:19,259
HYPOGLYCEMIA. WE SEE THE RISE. 

550
00:21:19,259 --> 00:21:21,962
NOT THAT WE ARE TO UNDERSTAND 

551
00:21:21,962 --> 00:21:24,064
THE RESEARCH, BUT WHY  HAVE 

552
00:21:24,064 --> 00:21:26,400
THEY BEEN MIXING XYLAZINE WITH 

553
00:21:26,400 --> 00:21:28,702
FENTANYL?

554
00:21:28,702 --> 00:21:29,303
WE KNOW FROM ANIMAL STUDIES AND 

555
00:21:29,303 --> 00:21:31,605
FROM WHAT PEOPLE ARE SAYING, 

556
00:21:31,605 --> 00:21:32,239
NUMBER ONE IN ANIMAL STUDIES IT 

557
00:21:32,239 --> 00:21:33,874
BASICALLY PROLONGS THE DURATION 

558
00:21:33,874 --> 00:21:36,643
OF THE EFFECTS OF FENTANYL. 

559
00:21:36,643 --> 00:21:37,144
WHICH PATIENTS TEND TO 

560
00:21:37,144 --> 00:21:38,145
CORROBORATE.

561
00:21:38,145 --> 00:21:43,517
THE OTHER THING THAT PATIENTS 

562
00:21:43,517 --> 00:21:44,017
ARE TELLING US IS THAT 

563
00:21:44,017 --> 00:21:44,985
BASICALLY THE CULMINATION 

564
00:21:44,985 --> 00:21:45,519
REDUCES THE EMERGENCE OF 

565
00:21:45,519 --> 00:21:47,154
WITHDRAWAL SYMPTOMS.  NOT 

566
00:21:47,154 --> 00:21:50,858
SURPRISING SINCE IT IS A ...

567
00:21:50,858 --> 00:21:52,493
SO THE CLINICAL TRIAL NETWORK 

568
00:21:52,493 --> 00:21:55,596
HAS BEEN AT WORK TRYING TO 

569
00:21:55,596 --> 00:21:57,131
IDENTIFY PRACTICES. AND ALSO 

570
00:21:57,131 --> 00:22:01,969
RESEARCH GAP  AREAS THAT NEED 

571
00:22:01,969 --> 00:22:02,569
TO BE TO HELP CLINICIANS ALL 

572
00:22:02,569 --> 00:22:04,471
OVER THE UNITED STATES TO 

573
00:22:04,471 --> 00:22:06,406
ADDRESS HOW DO YOU TREAT 

574
00:22:06,406 --> 00:22:06,974
SOMEONE  THAT COMES WITH AN 

575
00:22:06,974 --> 00:22:08,408
OVERDOSE FROM FENTANYL, 

576
00:22:08,408 --> 00:22:10,277
XYLAZINE? AND MORE RETURNEES TO 

577
00:22:10,277 --> 00:22:12,579
BE DONE. 

578
00:22:12,579 --> 00:22:15,716
XYLAZINE BY ITSELF CAN PRODUCE 

579
00:22:15,716 --> 00:22:16,350
PHYSICAL DEPENDENCE. WHICH CAN 

580
00:22:16,350 --> 00:22:20,521
RESULT IN WITHDRAWALS. AND THAT 

581
00:22:20,521 --> 00:22:21,355
CAN EXACERBATE THE ABILITY TO 

582
00:22:21,355 --> 00:22:24,725
KEEP PEOPLE TREATED. ALSO IF 

583
00:22:24,725 --> 00:22:25,359
ASSOCIATED WITH MANIFESTATIONS 

584
00:22:25,359 --> 00:22:26,493
PRESENTED IN THE PAST. 

585
00:22:26,493 --> 00:22:27,895
WE NEED TO EXPAND THE 

586
00:22:27,895 --> 00:22:31,999
SURVEILLANCE OF XYLAZINE AND 

587
00:22:31,999 --> 00:22:32,533
ITS DETECTION IN CLINICAL 

588
00:22:32,533 --> 00:22:36,537
STUDIES. 

589
00:22:36,537 --> 00:22:42,743
THE EMERGENCE OF THESE PATTERNS 

590
00:22:42,743 --> 00:22:46,713
OF COMBINED DRUG USE AND 

591
00:22:46,713 --> 00:22:47,314
OVERDOSE, IN OUR PIPELINE FOR 

592
00:22:47,314 --> 00:22:49,850
THE DEVELOPMENT FOR NOVEL 

593
00:22:49,850 --> 00:22:50,484
THERAPEUTICS, WE HAVE TO EXPAND 

594
00:22:50,484 --> 00:22:51,051
THE SCOPE OF WHAT WE WERE 

595
00:22:51,051 --> 00:22:52,986
AIMING TO DO.  INITIALLY IT WAS 

596
00:22:52,986 --> 00:22:54,121
OF COURSE TO ADDRESS THE ISSUE 

597
00:22:54,121 --> 00:22:56,356
OF OVERDOSES FROM OPIOIDS IN 

598
00:22:56,356 --> 00:22:57,124
INDIVIDUALS WITH OPIOID USE 

599
00:22:57,124 --> 00:23:00,827
DISORDERS.  THAT IS NOT 

600
00:23:00,827 --> 00:23:02,262
SUFFICIENT. YOU HAVE HEARD ME 

601
00:23:02,262 --> 00:23:03,330
SAY THAT MANY TIMES.

602
00:23:03,330 --> 00:23:04,665
WE ALSO NEED TO ADDRESS 

603
00:23:04,665 --> 00:23:06,833
WHATEVER DIFFICULTIES IN NOT 

604
00:23:06,833 --> 00:23:11,271
JUST ADDRESSING AN OVERDOSE 

605
00:23:11,271 --> 00:23:11,838
THAT CONTAINS FENTANYL AND 

606
00:23:11,838 --> 00:23:14,508
COCAINE OR METHAMPHETAMINE? BUT 

607
00:23:14,508 --> 00:23:16,610
ALSO HOW DO YOU ADDRESS THE 

608
00:23:16,610 --> 00:23:17,211
DIFFICULTY ON KEEPING SOMEONE 

609
00:23:17,211 --> 00:23:18,178
ON TREATMENT, FOR MEDICATIONS 

610
00:23:18,178 --> 00:23:20,514
FOR OPIOID USE DISORDER WHO MAY 

611
00:23:20,514 --> 00:23:26,119
ALSO HAVE A COCAINE OR A 

612
00:23:26,119 --> 00:23:29,089
META-FENTANYL USE DISORDER? AND 

613
00:23:29,089 --> 00:23:30,224
SO THE CHALLENGES OF WORKING 

614
00:23:30,224 --> 00:23:31,692
WITH HAVING TO DEAL WITH PEOPLE 

615
00:23:31,692 --> 00:23:42,202
THAT ARE TAKING ... WHEN THEY 

616
00:23:45,172 --> 00:23:45,739
THINK YOU'RE TAKING HEROIN THEY 

617
00:23:45,739 --> 00:23:46,373
ARE TAKEN FENTANYL, WHICH MAKE 

618
00:23:46,373 --> 00:23:49,009
DEPENDENCE MUCH WORSE. 

619
00:23:49,009 --> 00:23:50,644
HOW DO WE ENSURE THAT THEIR 

620
00:23:50,644 --> 00:23:54,848
PROPERLY MANAGED? AND IN OUR 

621
00:23:54,848 --> 00:23:56,617
MEDICATIONS, IT IS VERY CLEAR 

622
00:23:56,617 --> 00:24:00,220
IN OUR BRAINS, THAT WE NEED TO 

623
00:24:00,220 --> 00:24:05,092
MOVE MORE AND MORE TO TARGET 

624
00:24:05,092 --> 00:24:05,859
SUBSTANCES, AS OPPOSED TO JUST 

625
00:24:05,859 --> 00:24:08,262
TARGETING OPIOID USE DISORDERS 

626
00:24:08,262 --> 00:24:12,432
BY THEMSELVES.  RIGHT NOW, IF 

627
00:24:12,432 --> 00:24:13,567
YOU LOOK AT IT IN TERMS OF 

628
00:24:13,567 --> 00:24:20,741
PATTERNS, THE FREQUENCY OF 

629
00:24:20,741 --> 00:24:21,375
CO-ABUSE IS SEEN IN MORE THAN 

630
00:24:21,375 --> 00:24:28,181
60% OF URINE THAT COMES IN FROM 

631
00:24:28,181 --> 00:24:28,815
PATIENTS ARE GOING TO TREATMENT 

632
00:24:28,815 --> 00:24:29,416
INDICATED THAT MORE THAN 60% 

633
00:24:29,416 --> 00:24:31,785
ARE COMBINING DRUGS. 

634
00:24:31,785 --> 00:24:34,554
AND FOR THE FINAL ADVOCATE, I 

635
00:24:34,554 --> 00:24:35,188
WANTED TO SAY AND HIGHLIGHT. WE 

636
00:24:35,188 --> 00:24:39,793
SPOKE ABOUT THAT 1.5% INCREASE, 

637
00:24:39,793 --> 00:24:40,427
BUT I TOLD YOU THAT IS NOT THE 

638
00:24:40,427 --> 00:24:42,095
CASE FOR SOME GROUPS.  AND YOU 

639
00:24:42,095 --> 00:24:44,097
HAVE SEEN ME PRESENT THESE.  

640
00:24:44,097 --> 00:24:46,300
THIS IS AN UPDATE, AMERICAN 

641
00:24:46,300 --> 00:24:50,437
INDIAN ALASKA NATIVES, 64.4% 

642
00:24:50,437 --> 00:24:51,171
PER HUNDRED PERCENT POPULATION 

643
00:24:51,171 --> 00:24:54,608
DEATH RATE.  DOUBLE THAT OF THE 

644
00:24:54,608 --> 00:24:56,910
REST OF THE UNITED STATES. ALSO 

645
00:24:56,910 --> 00:24:59,279
IN BLACK COMMUNITIES, THE 

646
00:24:59,279 --> 00:25:01,014
OVERDOSE RATES ARE VERY HIGH.  

647
00:25:01,014 --> 00:25:02,115
AND THAT IS WHY WE ACTUALLY CAN 

648
00:25:02,115 --> 00:25:07,054
SEE THAT OF THE NATIVE COLLECT 

649
00:25:07,054 --> 00:25:07,621
RESEARCH EFFORT TO ENHANCE 

650
00:25:07,621 --> 00:25:13,660
WELLNESS LED BY DR. -- AND 

651
00:25:13,660 --> 00:25:17,264
OVERDOSE OF SUBSTANCE USE FOR 

652
00:25:17,264 --> 00:25:17,864
PAIN, AND THE MAIN GOAL IS TO 

653
00:25:17,864 --> 00:25:20,100
BUILD THE INFRASTRUCTURE TO 

654
00:25:20,100 --> 00:25:22,402
ALLOW TRIBAL COMMUNITIES, 

655
00:25:22,402 --> 00:25:24,671
NATIVE AMERICAN RESEARCHERS, TO 

656
00:25:24,671 --> 00:25:31,511
BE INVOLVED IN THE PURSUIT OF 

657
00:25:31,511 --> 00:25:32,546
SOLUTIONS THAT THEY CAN TAKE 

658
00:25:32,546 --> 00:25:35,349
ADVANTAGE OF THE TRADITION  OF 

659
00:25:35,349 --> 00:25:35,949
MEDICINE AS WELL AS A STRONG 

660
00:25:35,949 --> 00:25:38,185
SOCIAL SUPPORT SYSTEMS. 

661
00:25:38,185 --> 00:25:42,823
THE N CREW REQUEST REPLICATION 

662
00:25:42,823 --> 00:25:46,993
REPORTED IN JUNE 2023, RECEIVED 

663
00:25:46,993 --> 00:25:47,594
THE APPLICATIONS IN NOVEMBER 

664
00:25:47,594 --> 00:25:51,231
2024. AND ON FEBRUARY 24.  WE 

665
00:25:51,231 --> 00:25:52,366
EXPECT FUNDING OF THE AWARD IN 

666
00:25:52,366 --> 00:25:57,137
JUNE 2024. AND DOCTOR -- WILL 

667
00:25:57,137 --> 00:25:57,738
BE GIVING YOU AN UPDATE WHEN 

668
00:25:57,738 --> 00:25:58,605
THAT IS DONE. 

669
00:25:58,605 --> 00:26:03,610
WHERE ARE WE? CERTAINLY WHERE 

670
00:26:03,610 --> 00:26:05,412
WE'RE, I WOULD SORT OF SAFER 

671
00:26:05,412 --> 00:26:07,414
RESEARCH, FOR THE PERSPECTIVE, 

672
00:26:07,414 --> 00:26:10,283
THERE IS A LOT OF GAP AREAS.  

673
00:26:10,283 --> 00:26:18,692
WHAT ARE THE CONSEQUENCES OF 

674
00:26:18,692 --> 00:26:19,292
FENTANYL AND SUBSTANCE ABUSE? 

675
00:26:19,292 --> 00:26:20,660
WE DO UNDERSTAND AND PROPERLY. 

676
00:26:20,660 --> 00:26:23,130
INCLUDING THE INITIATION AND 

677
00:26:23,130 --> 00:26:24,765
RETENTION. WHAT ARE THE 

678
00:26:24,765 --> 00:26:25,332
CONSEQUENCES OF OVERDOSES? 

679
00:26:25,332 --> 00:26:27,834
SEVERELY HYPOGLYCEMIC. HOW DOES 

680
00:26:27,834 --> 00:26:29,736
THAT AFFECT THE BRAIN?

681
00:26:29,736 --> 00:26:30,337
ULTIMATELY THESE OVERDOSES ARE 

682
00:26:30,337 --> 00:26:34,608
REPEATED. SO HOW DOES THAT 

683
00:26:34,608 --> 00:26:36,576
IMPAIR THE ABILITY OF AN 

684
00:26:36,576 --> 00:26:37,210
INDIVIDUAL TO RECOVER? AND THAT 

685
00:26:37,210 --> 00:26:40,180
PERTAINS EXACTLY TO WHAT ARE 

686
00:26:40,180 --> 00:26:40,714
THE LONG-TERM OUTCOMES OF 

687
00:26:40,714 --> 00:26:43,116
SOMEONE THAT SUFFERS WITH 

688
00:26:43,116 --> 00:26:43,950
DIFFERENT TRAJECTORIES FOR 

689
00:26:43,950 --> 00:26:48,155
OPIOID USE DISORDER? WITH OR 

690
00:26:48,155 --> 00:26:50,190
WITHOUT OVERDOSES. WITH OR 

691
00:26:50,190 --> 00:26:52,626
WITHOUT ACTUALLY MIXTURE WITH 

692
00:26:52,626 --> 00:26:54,161
STIMULANTS. WE HAVE LIMITED 

693
00:26:54,161 --> 00:26:55,695
INFORMATION. 

694
00:26:55,695 --> 00:26:59,065
WE NEED TO CONTINUE TO EXPAND 

695
00:26:59,065 --> 00:27:00,734
RESEARCH ON HARD-TO-REACH, 

696
00:27:00,734 --> 00:27:02,102
UNDERSERVED POPULATIONS. I 

697
00:27:02,102 --> 00:27:03,437
SPOKE ABOUT THE AMERICAN 

698
00:27:03,437 --> 00:27:08,442
INDIANS, AND ALASKA NATIVES. I 

699
00:27:08,442 --> 00:27:09,075
ALSO MENTIONED MORTALITY RATES 

700
00:27:09,075 --> 00:27:10,143
IN BLACK AMERICA CONTINUE TO 

701
00:27:10,143 --> 00:27:12,579
INCREASE AT A MUCH HIGHER RATE 

702
00:27:12,579 --> 00:27:13,713
THAN WHITE AMERICA IN RURAL 

703
00:27:13,713 --> 00:27:18,485
AREAS. AMONG THE HOMELESS.  THE 

704
00:27:18,485 --> 00:27:19,119
HOMELESS HAVE THE HIGHEST RATES 

705
00:27:19,119 --> 00:27:19,719
OF MORTALITY AMONG ANY OTHER 

706
00:27:19,719 --> 00:27:21,721
GROUP.  

707
00:27:21,721 --> 00:27:23,590
CERTAINLY PREGNANT WOMEN WERE 

708
00:27:23,590 --> 00:27:24,157
THE OVERDOSE MORTALITY HAS 

709
00:27:24,157 --> 00:27:24,624
CONTINUED TO INCREASE 

710
00:27:24,624 --> 00:27:28,628
SIGNIFICANTLY.  IT IS OBVIOUS-- 

711
00:27:28,628 --> 00:27:31,398
AND I ACTUALLY AM LOOKING AT 

712
00:27:31,398 --> 00:27:32,732
THIS, THESE CONDITIONS DO NOT 

713
00:27:32,732 --> 00:27:35,368
OCCUR IN ISOLATION. SUBSTANCE 

714
00:27:35,368 --> 00:27:36,770
USE DISORDER IN GENERAL WITH 

715
00:27:36,770 --> 00:27:41,374
OPIOID USE DISORDER HAS A HIGH 

716
00:27:41,374 --> 00:27:43,510
COMORBIDITY WITH PAIN AND WITH 

717
00:27:43,510 --> 00:27:45,412
PSYCHIATRIC OTHER DISORDERS. 

718
00:27:45,412 --> 00:27:52,052
IN TERMS OF SUICIDE, OPIOID USE 

719
00:27:52,052 --> 00:27:52,619
DISORDER  AND SUBSTANCE USE 

720
00:27:52,619 --> 00:27:53,220
DISORDER ACCOUNTS FOR 25% OF 

721
00:27:53,220 --> 00:27:55,889
PEOPLE WHO DIED FROM SUICIDE. 

722
00:27:55,889 --> 00:27:57,657
WE NEED NOVEL HARM REDUCTION 

723
00:27:57,657 --> 00:27:59,392
APPROACHES.  WHAT WE WANT 

724
00:27:59,392 --> 00:28:00,660
EVERYBODY TO GO TO TREATMENT, 

725
00:28:00,660 --> 00:28:02,462
ENERGY RECOVERY, MANY PEOPLE 

726
00:28:02,462 --> 00:28:03,797
ARE DYING AND ARE NOT READY TO 

727
00:28:03,797 --> 00:28:05,098
GO TO TREATMENT.  WE NEED TO 

728
00:28:05,098 --> 00:28:07,400
KEEP THEM ALIVE.

729
00:28:07,400 --> 00:28:08,001
WE NEED TO CONTINUE TO MONITOR 

730
00:28:08,001 --> 00:28:12,672
THE CHANGING LANDSCAPE. IT IS 

731
00:28:12,672 --> 00:28:14,541
SURPRISING TO HEAR WHAT STATES 

732
00:28:14,541 --> 00:28:15,909
ARE STARTING TO REPORT 

733
00:28:15,909 --> 00:28:16,510
VIS-à-VIS WHAT TYPE OF DRUGS 

734
00:28:16,510 --> 00:28:17,611
ARE BEING COMBINED WITH 

735
00:28:17,611 --> 00:28:20,847
FENTANYL. 

736
00:28:20,847 --> 00:28:21,481
AND IT IS ACTUALLY THE 

737
00:28:21,481 --> 00:28:24,618
RECOGNITION TOO THAT PREVENTION 

738
00:28:24,618 --> 00:28:26,553
IS A KEY COMPONENT OF WHAT WE 

739
00:28:26,553 --> 00:28:29,890
ARE DOING. AND WHY WE HAVE 

740
00:28:29,890 --> 00:28:32,659
CERTAINLY ALWAYS PRIORITIZED 

741
00:28:32,659 --> 00:28:33,260
PREVENTION AMONG ADOLESCENTS 

742
00:28:33,260 --> 00:28:34,728
AND YOUNG ADULTS, WHO HAVE THE 

743
00:28:34,728 --> 00:28:37,230
HIGHEST RISK FOR DRUG USE, IN 

744
00:28:37,230 --> 00:28:38,331
THIS CASE PREVENTION HAS TO BE 

745
00:28:38,331 --> 00:28:44,905
EXPANDED ACROSS THE WHOLE 

746
00:28:44,905 --> 00:28:45,539
LIFESPAN. WHAT WE ARE SEEING IS 

747
00:28:45,539 --> 00:28:50,043
RISES OF OVERDOSE MORTALITY 

748
00:28:50,043 --> 00:28:53,680
AMONG PEOPLE OVER 65 YEARS, AND 

749
00:28:53,680 --> 00:28:54,314
YOU HAVE SEEN THE PRESENT DATA 

750
00:28:54,314 --> 00:28:54,848
ON RISING MORTALITY AMONG 

751
00:28:54,848 --> 00:28:56,316
TEENAGERS. 

752
00:28:56,316 --> 00:28:56,917
AND HEALTH DISPARITIES AND THE 

753
00:28:56,917 --> 00:29:01,955
INCREASED RISK OF BOTH AMERICAN 

754
00:29:01,955 --> 00:29:02,589
INDIANS, ALASKA NATIVES, BLACK 

755
00:29:02,589 --> 00:29:04,658
AMERICANS, AND THE HOMELESS ARE 

756
00:29:04,658 --> 00:29:05,225
THE SOCIAL DETERMINANTS OF 

757
00:29:05,225 --> 00:29:08,828
HEALTH. AND THE UNDERSTANDING 

758
00:29:08,828 --> 00:29:10,830
AND DEVELOPING MODELS BASED ON 

759
00:29:10,830 --> 00:29:12,599
RESEARCH AND EVIDENCE THAT 

760
00:29:12,599 --> 00:29:13,199
DOCUMENTS THE BENEFITS IS THE 

761
00:29:13,199 --> 00:29:15,435
WAY THAT WE HAVE A CHANCE TO 

762
00:29:15,435 --> 00:29:18,038
ACTUALLY INFORM POLICIES, AND 

763
00:29:18,038 --> 00:29:27,280
HOPEFULLY PUSH FOR POLICIES 

764
00:29:27,280 --> 00:29:27,881
THAT WILL BE ABLE TO BENEFIT 

765
00:29:27,881 --> 00:29:28,481
EVERYONE IN A MORE ACCREDITED 

766
00:29:28,481 --> 00:29:29,716
FASHION. 

767
00:29:29,716 --> 00:29:30,317
WITHOUT I WANT TO THANK YOU FOR 

768
00:29:30,317 --> 00:29:31,017
YOUR ATTENTION. I AM GOING TO 

769
00:29:31,017 --> 00:29:37,057
STOP SHARING. 

770
00:29:37,057 --> 00:29:40,694
>> DR. WEISS: OKAY. WALTER
YOU 

771
00:29:40,694 --> 00:29:42,629
ARE UP NEXT. 

772
00:29:42,629 --> 00:29:44,531
>> DR. KOROSHETZ: THANK
YOU 

773
00:29:44,531 --> 00:29:46,032
VERY MUCH. I AM GOING TO TALK A 

774
00:29:46,032 --> 00:29:47,434
LITTLE BIT ABOUT THE WORK THAT 

775
00:29:47,434 --> 00:29:50,236
HEAL HAS BEEN DOING IN PAIN.  

776
00:29:50,236 --> 00:29:53,306
TRYING TO REDUCE THE SUFFERING 

777
00:29:53,306 --> 00:29:55,575
DUE TO PAIN. AND PREVENT 

778
00:29:55,575 --> 00:30:01,348
ADDICTION. AND JUST TO STRESS 

779
00:30:01,348 --> 00:30:06,486
AS I ALWAYS DO THAT THE "L" IN 

780
00:30:06,486 --> 00:30:08,455
HEAL STANDS FOR LONG-TERM, 

781
00:30:08,455 --> 00:30:09,089
HELPING TO END ADDITION OF THE 

782
00:30:09,089 --> 00:30:17,797
LONG-TERM. THE IDEA IS THAT 

783
00:30:17,797 --> 00:30:18,398
ONLY BY DEVELOPING EFFECTIVE, 

784
00:30:18,398 --> 00:30:19,032
NONADDICTIVE THERAPIES FOR PAIN 

785
00:30:19,032 --> 00:30:19,699
THAT WE ARE GOING TO BE 

786
00:30:19,699 --> 00:30:26,640
SUCCESSFUL OVER THE LONG TERM. 

787
00:30:26,640 --> 00:30:27,240
LET'S TALK A LOT OF THE PROCESS 

788
00:30:27,240 --> 00:30:27,807
BECAUSE WE ARE GOING TO BE 

789
00:30:27,807 --> 00:30:34,247
SEEING SOMEBODY DELIBERATIONS 

790
00:30:34,247 --> 00:30:34,781
FROM THIS PROCESS.

791
00:30:34,781 --> 00:30:37,717
AS MENTIONED PREVIOUSLY, THE 

792
00:30:37,717 --> 00:30:38,385
HEAL GOVERNANCE IS NOW A LITTLE 

793
00:30:38,385 --> 00:30:41,421
BIT DIFFERENT.  ACTUALLY -- AND 

794
00:30:41,421 --> 00:30:44,724
MYSELF OVERSEE THE HEAL PROGRAM 

795
00:30:44,724 --> 00:30:47,527
AND KEEP IT FOCUSED ON THE 

796
00:30:47,527 --> 00:30:51,097
CRISIS THAT NORA JUST TALKED TO 

797
00:30:51,097 --> 00:30:54,000
US ABOUT.  THE PAIN PROGRAM 

798
00:30:54,000 --> 00:30:55,368
SIDE OF IT IS A LITTLE BIT 

799
00:30:55,368 --> 00:30:58,905
DIFFERENT.  BECAUSE THERE IS NO 

800
00:30:58,905 --> 00:31:00,940
INSTITUTE FOR PAIN, LIKE THERE 

801
00:31:00,940 --> 00:31:04,678
IS FOR DRUG ABUSE. AND SO,  WE 

802
00:31:04,678 --> 00:31:07,547
ARE KIND OF INTERESTED IN DOING 

803
00:31:07,547 --> 00:31:11,051
THINGS ON THE PAIN SIDE THAT 

804
00:31:11,051 --> 00:31:11,685
NIDA IS BEEN DOING FOR DECADES 

805
00:31:11,685 --> 00:31:14,754
ON THE OPIOID OVERUSE DISORDER 

806
00:31:14,754 --> 00:31:17,190
SIDE. AND WE WORK TOGETHER VERY 

807
00:31:17,190 --> 00:31:20,093
WELL ON THESE CROSSCUTTING 

808
00:31:20,093 --> 00:31:20,694
PROGRAMS LOOKING AT PAIN IN 

809
00:31:20,694 --> 00:31:25,999
PEOPLE WITH OPIOID USE DISORDER 

810
00:31:25,999 --> 00:31:26,766
OR PEOPLE BEING TREATED FOR 

811
00:31:26,766 --> 00:31:30,570
PAIN. TRAINING PROGRAMS AND SO 

812
00:31:30,570 --> 00:31:31,171
FORTH AND WE WILL TALK ABOUT 

813
00:31:31,171 --> 00:31:31,671
SOME OF THOSE.

814
00:31:31,671 --> 00:31:34,207
WE HAVE ABOUT 14 DIFFERENT 

815
00:31:34,207 --> 00:31:37,911
INSTITUTE NOW INVOLVED IN THE 

816
00:31:37,911 --> 00:31:48,455
PAIN SECTION OF THE HELPING TO 

817
00:31:49,756 --> 00:31:53,059
END ADDICTION LONG-TERM.

818
00:31:53,059 --> 00:31:58,031
WE HAVE THREE IC DIRECTORS 

819
00:31:58,031 --> 00:32:00,767
MYSELF, -- -- AND YOU HEAR 

820
00:32:00,767 --> 00:32:05,939
ABOUT THEM FROM HELEN IN A BABY 

821
00:32:05,939 --> 00:32:07,640
WE ARE BASICALLY OVERSEEING THE 

822
00:32:07,640 --> 00:32:09,209
WEEK TO WEEK, MONTH-TO-MONTH 

823
00:32:09,209 --> 00:32:11,411
ACTIVITIES OF THE HEAL PAIN 

824
00:32:11,411 --> 00:32:13,413
SIDE. 

825
00:32:13,413 --> 00:32:18,818
WILL BRING ALL DECISIONAL 

826
00:32:18,818 --> 00:32:21,588
ACTIONS TO THE IC DIRECTORS, 

827
00:32:21,588 --> 00:32:24,924
THE 14 IC DIRECTOR THAT HAVE 

828
00:32:24,924 --> 00:32:26,459
COME TOGETHER ONCE A MONTH TO 

829
00:32:26,459 --> 00:32:27,527
DISCUSS THE PAIN PROGRAM. NEXT 

830
00:32:27,527 --> 00:32:29,329
SLIDE.

831
00:32:29,329 --> 00:32:34,167
AND THEN EVERY THREE MONTHS OR 

832
00:32:34,167 --> 00:32:39,205
SO WE MEET TOGETHER WITH NIADR 

833
00:32:39,205 --> 00:32:40,607
AND THE OTHER ENTITIES INVOLVED 

834
00:32:40,607 --> 00:32:46,146
IN THE OPIOID OVERUSE MEETING. 

835
00:32:46,146 --> 00:32:50,216
THIS GOVERNS WHAT WE DO. WE 

836
00:32:50,216 --> 00:32:50,817
WILL TALK A LITTLE ABOUT THE 

837
00:32:50,817 --> 00:32:52,252
STRATEGIC PLAN GOING FORWARD. 

838
00:32:52,252 --> 00:32:53,453
AND THIS ALSO IS KIND OF THE 

839
00:32:53,453 --> 00:32:55,622
GOVERNING PRINCIPLE FOR THAT.  

840
00:32:55,622 --> 00:32:58,591
SO BASICALLY IT STATES THAT 

841
00:32:58,591 --> 00:33:00,760
HEAL PAIN RESEARCH AIMS TO 

842
00:33:00,760 --> 00:33:02,929
REDUCE PAIN AND THE RISK OF 

843
00:33:02,929 --> 00:33:04,631
OPIOID USE DISORDER BY 

844
00:33:04,631 --> 00:33:07,066
DEVELOPING SAFE AND EFFECTIVE 

845
00:33:07,066 --> 00:33:07,667
PAIN TREATMENT AND PREVENTION 

846
00:33:07,667 --> 00:33:08,268
STRATEGIES TO IMPROVE QUALITY 

847
00:33:08,268 --> 00:33:08,868
OF LIFE FOR ALL PEOPLE. NEXT 

848
00:33:08,868 --> 00:33:18,978
SLIDE.

849
00:33:21,114 --> 00:33:24,717
THE WORK THE WAY IT IS 

850
00:33:24,717 --> 00:33:25,285
DIVIDED-- THERE ARE SO MANY 

851
00:33:25,285 --> 00:33:25,852
PEOPLE LIKE HUNDRED PEOPLE 

852
00:33:25,852 --> 00:33:26,519
ACROSS THE INSTITUTE WORKING ON 

853
00:33:26,519 --> 00:33:30,056
THE HEAL PAIN SIDE NOW, ALL OF 

854
00:33:30,056 --> 00:33:35,595
THE INSTITUTE HAVE EQUITIES AND 

855
00:33:35,595 --> 00:33:36,129
PAIN. THEY MAY HAVE PAIN 

856
00:33:36,129 --> 00:33:40,099
PHYSICIANS IN THE PORTFOLIO. 

857
00:33:40,099 --> 00:33:44,304
AND SO THEIR VALUED INPUT IN 

858
00:33:44,304 --> 00:33:47,240
HEAL IS NOT TO BE UNDERSTATED.

859
00:33:47,240 --> 00:33:47,807
WE HAVE WORKING GROUPS, WHICH 

860
00:33:47,807 --> 00:33:48,708
ARE PROGRAM DIRECTORS, WHO WORK 

861
00:33:48,708 --> 00:33:49,576
ON THE VARIOUS PROGRAMS IN 

862
00:33:49,576 --> 00:33:53,546
HEAL.  NOT ONLY IN MANAGING THE 

863
00:33:53,546 --> 00:33:55,548
ONES THAT HAVE BEEN FUNDING BUT 

864
00:33:55,548 --> 00:33:58,651
IN DEVELOPING PLANS FOR NEW 

865
00:33:58,651 --> 00:34:02,922
PROGRAMS TO COME INTO HEAL. 

866
00:34:02,922 --> 00:34:05,525
AND THE WORKGROUPS FOCUS ON 

867
00:34:05,525 --> 00:34:07,260
COLLABORATION ACROSS THE 

868
00:34:07,260 --> 00:34:09,262
INSTITUTE, DO INITIATIVE 

869
00:34:09,262 --> 00:34:13,199
DEVELOPMENT, FUNDING PLAN 

870
00:34:13,199 --> 00:34:14,467
DEVELOPMENT, IN-DEPTH 

871
00:34:14,467 --> 00:34:15,802
SCIENTIFIC DISRUPTIONS, PROGRAM 

872
00:34:15,802 --> 00:34:16,903
UPDATES AND FEEDBACK, AND 

873
00:34:16,903 --> 00:34:18,137
DISSEMINATION OF INFORMATION. 

874
00:34:18,137 --> 00:34:19,405
THERE ARE FOUR OF THEM. WE USED 

875
00:34:19,405 --> 00:34:24,577
TO HAVE TWO, JUST CLINICAL AND 

876
00:34:24,577 --> 00:34:25,011
PRECLINICAL.

877
00:34:25,011 --> 00:34:25,612
WE HAVE ONE THAT IS DEVOTED TO 

878
00:34:25,612 --> 00:34:27,146
TRAINING. ONE THAT IS DEVOTED 

879
00:34:27,146 --> 00:34:29,382
TO CLINICAL CARE. AND CLINICAL 

880
00:34:29,382 --> 00:34:32,952
TRIALS. THINGS LIKE ADVANCING 

881
00:34:32,952 --> 00:34:38,324
HEALTH EQUITY IN PAIN.  WE HAVE 

882
00:34:38,324 --> 00:34:42,061
A GROUP THAT IS LOOKING AT 

883
00:34:42,061 --> 00:34:42,662
TRANSLATIONAL DEVELOPMENT AND 

884
00:34:42,662 --> 00:34:43,730
NONADDICTIVE THERAPEUTICS FOR 

885
00:34:43,730 --> 00:34:44,063
PAIN.

886
00:34:44,063 --> 00:34:48,001
AND THEN WE HAVE A GROUP THAT 

887
00:34:48,001 --> 00:34:48,468
WORKS ON WHAT WE CALL 

888
00:34:48,468 --> 00:34:49,836
"INTEGRATED PAIN MECHANISMS." 

889
00:34:49,836 --> 00:34:51,304
THESE ARE PROJECTS THAT THEY 

890
00:34:51,304 --> 00:34:56,643
INVOLVE THE PAIN SYSTEM. BUT 

891
00:34:56,643 --> 00:34:57,176
THEY CUT ACROSS MULTIPLE 

892
00:34:57,176 --> 00:35:01,881
INSTITUTE.  AND THEY ARE 

893
00:35:01,881 --> 00:35:02,515
PROJECTS THAT NO ONE INSTITUTE 

894
00:35:02,515 --> 00:35:03,583
COULD DO ON THEIR OWN.

895
00:35:03,583 --> 00:35:04,651
WE HAVE A NUMBER OF THESE NOW. 

896
00:35:04,651 --> 00:35:08,621
FOR INSTANCE, REJOIN, LOOKING 

897
00:35:08,621 --> 00:35:11,224
AT THE INNOVATION OF THE WHOLE 

898
00:35:11,224 --> 00:35:20,600
JOINT AND NOT JUST -- BUT ALSO 

899
00:35:20,600 --> 00:35:23,803
MUSCLE AND LIGAMENTS. THESE 

900
00:35:23,803 --> 00:35:24,370
KINDS OF PROGRAMS WILL FALL 

901
00:35:24,370 --> 00:35:25,805
INTO THIS GROUP.

902
00:35:25,805 --> 00:35:26,506
AND THEY ARE DIFFERENTIATED 

903
00:35:26,506 --> 00:35:30,610
FROM THE WORK THAT WILL BE DONE 

904
00:35:30,610 --> 00:35:33,479
IN AN INSTITUTE BECAUSE THE 

905
00:35:33,479 --> 00:35:39,819
PROBLEM IS TOO BIG FOR ONE 

906
00:35:39,819 --> 00:35:40,620
INSTITUTE. IT CUTS ACROSS 

907
00:35:40,620 --> 00:35:46,092
MULTIPLE INSTITUTE. NEXT SLIDE.

908
00:35:46,092 --> 00:35:50,430
YOU CAN SEE HOW THE PAIN PLANS 

909
00:35:50,430 --> 00:35:50,997
PROCESS OCCURS AND YOU WILL 

910
00:35:50,997 --> 00:35:51,564
HEAR THE PAIN PLANS IN THE 

911
00:35:51,564 --> 00:35:52,398
CLOSED SESSION. AS I MENTIONED 

912
00:35:52,398 --> 00:35:53,800
IN THE SCIENTIFIC WORKGROUPS, 

913
00:35:53,800 --> 00:35:55,268
THE OTHER FOLKS WHO HAVE 

914
00:35:55,268 --> 00:36:00,606
GENERATED THE IDEAS. THEY ARE 

915
00:36:00,606 --> 00:36:07,180
ON THE NOTICE OF FUNDING 

916
00:36:07,180 --> 00:36:07,780
ANNOUNCEMENTS, AND THEY LOOK 

917
00:36:07,780 --> 00:36:08,381
AND PARTICIPATE AND LISTEN TO 

918
00:36:08,381 --> 00:36:09,849
THE REVIEWS.  AND MAKE 

919
00:36:09,849 --> 00:36:10,450
DECISIONS ON WHAT THEY THINK 

920
00:36:10,450 --> 00:36:11,517
SHOULD BE FUNDED.

921
00:36:11,517 --> 00:36:14,120
THEN THAT GROUP BRINGS THEIR 

922
00:36:14,120 --> 00:36:16,589
PLANS TO WHAT WE CALL THE HEAL 

923
00:36:16,589 --> 00:36:19,425
PAIN STEERING COMMITTEE.  A 

924
00:36:19,425 --> 00:36:21,227
GROUP OF ABOUT 14 PROGRAM 

925
00:36:21,227 --> 00:36:24,597
DIRECTORS FROM ACROSS THE 

926
00:36:24,597 --> 00:36:25,932
INSTITUTES. AND THEY HAVE BEEN 

927
00:36:25,932 --> 00:36:29,869
REALLY FANTASTIC.  THEY 

928
00:36:29,869 --> 00:36:32,538
EVALUATE THE FUNDING PLANS, OR 

929
00:36:32,538 --> 00:36:33,172
THE INITIATIVES. AND THEY GIVE 

930
00:36:33,172 --> 00:36:34,307
THEIR INPUT THEN TO THE HEAL 

931
00:36:34,307 --> 00:36:37,577
PAIN IC DIRECTORS THAT DO THE 

932
00:36:37,577 --> 00:36:38,745
ACTUAL VOTING. 

933
00:36:38,745 --> 00:36:41,347
IN THIS CASE, WE DID BECAUSE OF 

934
00:36:41,347 --> 00:36:44,617
THE TIMING, WE HAD OUR IC 

935
00:36:44,617 --> 00:36:46,552
DIRECTORS MEETING LAST WEEK. 

936
00:36:46,552 --> 00:36:47,186
THE HOPE WOULD BE THAT WE COULD 

937
00:36:47,186 --> 00:36:50,823
BRING THEM TO MDWG TO GET 

938
00:36:50,823 --> 00:36:51,657
FURTHER INPUT AND THEN GO BACK 

939
00:36:51,657 --> 00:36:54,694
TO THE IC DIRECTOR HERE AND THE 

940
00:36:54,694 --> 00:36:57,797
MDWG IS COMING AFTER THE IC 

941
00:36:57,797 --> 00:36:58,431
DIRECTORS BUT WE WILL BE TAKING 

942
00:36:58,431 --> 00:36:59,732
THEIR INPUT AND RUNNING IT 

943
00:36:59,732 --> 00:37:02,201
THROUGH THE IC DIRECTORS FOR 

944
00:37:02,201 --> 00:37:04,170
ANY DIFFERENCES THAT COME UP IN 

945
00:37:04,170 --> 00:37:05,571
TODAY'S DISCUSSION. 

946
00:37:05,571 --> 00:37:12,378
AND THEN,  FOR ALL OF NIH'S 

947
00:37:12,378 --> 00:37:13,012
PROCESSES, FUNDING PLANS HAD TO 

948
00:37:13,012 --> 00:37:16,215
BE APPROVED BY A COUNCIL.  AND 

949
00:37:16,215 --> 00:37:16,849
SO DEPENDING ON THE CONTENT OF 

950
00:37:16,849 --> 00:37:20,787
THE SCIENCE, AND THE DIFFERENT 

951
00:37:20,787 --> 00:37:22,822
GRANT FUNDING PLANS, IT WILL GO 

952
00:37:22,822 --> 00:37:24,557
TO ONE OF THE COUNCILS THAT ARE 

953
00:37:24,557 --> 00:37:26,626
INVOLVED IN HEAL. 

954
00:37:26,626 --> 00:37:29,462
THAT IS KIND OF HOW IT WORKS. 

955
00:37:29,462 --> 00:37:29,962
IT IS DEFINITELY A VERY 

956
00:37:29,962 --> 00:37:31,130
DELIBERATE PROCESS. MULTIPLE 

957
00:37:31,130 --> 00:37:33,433
DIFFERENT STEPS. WE FEEL IT 

958
00:37:33,433 --> 00:37:34,767
GIVES US A REALLY GOOD PRODUCT. 

959
00:37:34,767 --> 00:37:37,737
AT THE END. PARTICULARLY WHEN 

960
00:37:37,737 --> 00:37:40,606
WE ARE ABLE TO GET YOUR INPUT. 

961
00:37:40,606 --> 00:37:41,774
SO THANKS IN ADVANCE FOR THAT. 

962
00:37:41,774 --> 00:37:47,346
NEXT SLIDE.

963
00:37:47,346 --> 00:37:48,614
THIS IS A PICTURE OF THE BUDGET 

964
00:37:48,614 --> 00:37:51,184
AVAILABLE FOR THE HEAL 

965
00:37:51,184 --> 00:37:53,586
INITIATIVE ON THE PAIN SIDE.  

966
00:37:53,586 --> 00:37:56,489
AS YOU PROBABLY KNOW, THE 

967
00:37:56,489 --> 00:38:00,359
FUNDING FROM CONGRESS ON HEAL, 

968
00:38:00,359 --> 00:38:10,436
IT COMES TO NINDS AND TO NIDA. 

969
00:38:10,436 --> 00:38:11,771
NIDS YOU SEE NICAEA ABOUT 285 

970
00:38:11,771 --> 00:38:15,174
LINEAR. I THINK NIDA IS UPWARDS 

971
00:38:15,174 --> 00:38:25,651
OF 355, I MIGHT HAVE TO BE 

972
00:38:26,886 --> 00:38:27,353
CORRECT ABOUT. THIS SLIDE 

973
00:38:27,353 --> 00:38:29,455
BASICALLY SHOWS WHERE THE FUNDS 

974
00:38:29,455 --> 00:38:33,059
HAVE ALREADY BEEN COMMITTED TO 

975
00:38:33,059 --> 00:38:35,728
PRECLINICAL IN THE DARK BLUE, 

976
00:38:35,728 --> 00:38:37,029
TO CLINICAL PROJECTS IN THE 

977
00:38:37,029 --> 00:38:42,902
LIGHT BLUE. TO THE FY24 

978
00:38:42,902 --> 00:38:43,503
PROPOSED BUDGETS HERE IN THIS 

979
00:38:43,503 --> 00:38:47,473
CORRUGATED BLUE. FY25 PROPOSED 

980
00:38:47,473 --> 00:38:52,044
CONCEPTS IN THE RED.  AND THEN, 

981
00:38:52,044 --> 00:38:55,915
THE PURPLE ARE CROSSCUTTING 

982
00:38:55,915 --> 00:38:58,184
PROJECTS THAT ARE FUNDED BY 

983
00:38:58,184 --> 00:39:03,222
BOTH THE NIDA FUNDS AND THE 

984
00:39:03,222 --> 00:39:07,994
NIDS FUNDS.  AND THERE ARE 

985
00:39:07,994 --> 00:39:12,598
CAMPS, IN WHAT WE CALL RMS TO 

986
00:39:12,598 --> 00:39:13,900
RUN THE PROGRAM.

987
00:39:13,900 --> 00:39:14,467
AND IN THE BUBBLE YOU SEE THE 

988
00:39:14,467 --> 00:39:17,069
AMOUNT OF FUNDS THAT ARE 

989
00:39:17,069 --> 00:39:18,271
AVAILABLE, THAT HAVE NOT BEEN 

990
00:39:18,271 --> 00:39:20,740
ASSIGNED AS OF YET. 

991
00:39:20,740 --> 00:39:23,142
AND SO THE KEY POINT INVOLVED 

992
00:39:23,142 --> 00:39:26,179
HERE, IS THAT WE ARE THINKING 

993
00:39:26,179 --> 00:39:27,480
WE ARE GOING TO DROP DOWN TO 

994
00:39:27,480 --> 00:39:29,482
ABOUT 3 MILLION DOLLARS IN 

995
00:39:29,482 --> 00:39:34,086
2026.  BASED OFF THE ASSUMPTION 

996
00:39:34,086 --> 00:39:36,756
THAT WE WILL GET FIVE BUDGETS 

997
00:39:36,756 --> 00:39:38,024
GOING FORWARD. WHICH IS PRETTY 

998
00:39:38,024 --> 00:39:43,296
CLOSE TO TWO, BUT THIS YEAR 

999
00:39:43,296 --> 00:39:44,497
AGAIN WE DID GET A $5 MILLION 

1000
00:39:44,497 --> 00:39:44,897
INCREASE.

1001
00:39:44,897 --> 00:39:49,535
AND SO WITH THAT, NEXT SLIDE, 

1002
00:39:49,535 --> 00:39:52,205
WHAT WE DECIDED TO DO IS TO NOT 

1003
00:39:52,205 --> 00:39:55,374
PUT OUT INITIATIVES,  NEW 

1004
00:39:55,374 --> 00:39:57,543
INITIATIVES FOR FY26, BECAUSE 

1005
00:39:57,543 --> 00:39:59,178
WE DON'T HAVE $3 MILLION IN 

1006
00:39:59,178 --> 00:40:04,083
FY26.  AND ACTUALLY HOLD A NEW 

1007
00:40:04,083 --> 00:40:08,754
INITIATIVE DEVELOPMENT FOR 

1008
00:40:08,754 --> 00:40:09,355
FY27, WHEN WE HAVE MORE MONEY 

1009
00:40:09,355 --> 00:40:12,258
FOR THE PAIN PROGRAM. AND ALSO 

1010
00:40:12,258 --> 00:40:12,892
AS YOU WERE HERE, WE WILL HAVE 

1011
00:40:12,892 --> 00:40:14,360
A STRATEGIC PLAN WHICH WILL BE 

1012
00:40:14,360 --> 00:40:17,296
REALLY GREAT IN TERMS OF A 

1013
00:40:17,296 --> 00:40:17,897
ROADMAP OF WHAT WE SHOULD BE 

1014
00:40:17,897 --> 00:40:21,200
DOING. 

1015
00:40:21,200 --> 00:40:23,002
WHAT WE HAVE WORKED ON IN THE 

1016
00:40:23,002 --> 00:40:27,506
LAST YEAR IS A PLAN TO DEVELOP 

1017
00:40:27,506 --> 00:40:32,645
A PROGRAM WITH AN INTRAMURAL 

1018
00:40:32,645 --> 00:40:34,580
NIH, AGAIN MULTIPLE INSTITUTES 

1019
00:40:34,580 --> 00:40:37,750
INVOLVED. WITH THE IDEA THAT  

1020
00:40:37,750 --> 00:40:38,384
THERE ARE SOME THINGS THAT CAN 

1021
00:40:38,384 --> 00:40:40,086
BE DONE IN THE INTRAMURAL 

1022
00:40:40,086 --> 00:40:42,054
PROGRAM UNIQUELY ADVANTAGEOUS 

1023
00:40:42,054 --> 00:40:46,459
TO DO IT THERE.  WE WILL BE 

1024
00:40:46,459 --> 00:40:47,093
LOOKING FOR PROJECTS COMING OUT 

1025
00:40:47,093 --> 00:40:49,161
OF THE INTRAMURAL PROGRAM THAT 

1026
00:40:49,161 --> 00:40:49,662
WILL BE REVIEWED BY THE 

1027
00:40:49,662 --> 00:40:57,603
STEERING COMMITTEE.  AND 

1028
00:40:57,603 --> 00:40:58,137
PREPARED FOR THE PROGRESS 

1029
00:40:58,137 --> 00:40:58,738
COMING IN FROM THE EXTRAMURAL 

1030
00:40:58,738 --> 00:41:00,606
SPACE. BUT WE HAVE NOT UP UNTIL 

1031
00:41:00,606 --> 00:41:01,874
NOW DEVOTED ANY FUNDS IN THE 

1032
00:41:01,874 --> 00:41:02,441
EXTRAMURAL PROGRAM, AND WE 

1033
00:41:02,441 --> 00:41:06,312
THINK THE HEAL CAN REALLY 

1034
00:41:06,312 --> 00:41:11,183
ADVANCE THAT BY DOING SO. 

1035
00:41:11,183 --> 00:41:11,651
AND I MENTIONED THE NEW 

1036
00:41:11,651 --> 00:41:12,251
SCIENTIFIC WORKGROUPS THAT WE 

1037
00:41:12,251 --> 00:41:17,356
PUT TOGETHER ALREADY.  WE'RE 

1038
00:41:17,356 --> 00:41:17,923
GOING TO HEAR A LAYER ABOUT 

1039
00:41:17,923 --> 00:41:20,026
THIS FANTASTIC PROGRAM THAT 

1040
00:41:20,026 --> 00:41:25,398
KATHY -- THE NATIVE AMERICAN 

1041
00:41:25,398 --> 00:41:28,934
PROGRAM TO ENHANCE WELLNESS BY 

1042
00:41:28,934 --> 00:41:32,305
REDUCING  OPIOID OVERUSE 

1043
00:41:32,305 --> 00:41:32,872
DISORDER, AND REDUCE THOSE 

1044
00:41:32,872 --> 00:41:35,341
DEATHS.  AND ALSO TO IMPROVE 

1045
00:41:35,341 --> 00:41:37,777
THE MANAGEMENT OF PAIN.  

1046
00:41:37,777 --> 00:41:38,377
BECAUSE I THINK THEY ARE VERY 

1047
00:41:38,377 --> 00:41:40,780
INTEGRALLY TIED.  IT IS GOING 

1048
00:41:40,780 --> 00:41:42,648
TO BE CHALLENGING. BUT KATHY 

1049
00:41:42,648 --> 00:41:45,217
HAS DONE A FANTASTIC JOB. AND 

1050
00:41:45,217 --> 00:41:47,420
YOU WILL HEAR MORE ABOUT IT 

1051
00:41:47,420 --> 00:41:47,753
LATER.

1052
00:41:47,753 --> 00:41:49,722
SO WE ARE REALLY VERY 

1053
00:41:49,722 --> 00:41:51,857
ENTHUSIASTIC ABOUT WORKING WITH 

1054
00:41:51,857 --> 00:41:55,561
NIDA TO BUILD IN PROGRAMS FOR 

1055
00:41:55,561 --> 00:41:59,365
BETTER PAIN MANAGEMENT IN 

1056
00:41:59,365 --> 00:42:02,201
TRIBAL NATIONS. NEXT SLIDE.

1057
00:42:02,201 --> 00:42:04,737
THIS IS A SLIDE TO TALK ABOUT 

1058
00:42:04,737 --> 00:42:08,240
WHAT HEAL HAS BEEN DOING.  WE 

1059
00:42:08,240 --> 00:42:10,509
HAVE A LOT OF CLINICAL TRIALS. 

1060
00:42:10,509 --> 00:42:12,278
AND MANY OF THEM ARE GOING TO 

1061
00:42:12,278 --> 00:42:12,912
BE COMING TO A CLOSURE PRETTY 

1062
00:42:12,912 --> 00:42:19,251
SOON. SO WE WILL START GETTING 

1063
00:42:19,251 --> 00:42:19,885
SOME REALLY INTERESTING RESULTS 

1064
00:42:19,885 --> 00:42:22,855
OUT OF THEM. AND YOU CAN SEE 

1065
00:42:22,855 --> 00:42:23,489
THE CONDITIONS TARGETED IN THE 

1066
00:42:23,489 --> 00:42:25,191
CLINICAL TRIALS. THE DIFFERENT 

1067
00:42:25,191 --> 00:42:28,127
TYPES OF TRIALS.  AND,  SO WE 

1068
00:42:28,127 --> 00:42:38,637
ARE LOOKING AT -- HEALTH NEW 

1069
00:42:41,273 --> 00:42:41,807
PROGRAM FOR TREATING CHILDREN 

1070
00:42:41,807 --> 00:42:42,375
WITH BOTH ACUTE AND CHRONIC 

1071
00:42:42,375 --> 00:42:44,276
PAIN.  WE HAVE THE PRISON 

1072
00:42:44,276 --> 00:42:44,844
NETWORK THAT YOU WILL HEAR 

1073
00:42:44,844 --> 00:42:48,681
ABOUT FROM HELEN SHORTLY ABOUT 

1074
00:42:48,681 --> 00:42:51,550
THE PRAGMATIC TRIAL THEY ARE 

1075
00:42:51,550 --> 00:42:52,385
DOING WITH APPROVED PAIN CARE. 

1076
00:42:52,385 --> 00:42:54,153
NEXT SLIDE.

1077
00:42:54,153 --> 00:42:56,555
NEXT SLIDE.

1078
00:42:56,555 --> 00:42:59,191
AND THE INTRAMURAL PROGRAM I 

1079
00:42:59,191 --> 00:43:02,661
MENTIONED ALREADY. THE GOAL IS 

1080
00:43:02,661 --> 00:43:05,464
TO ENTERTAIN AND SOLICIT 

1081
00:43:05,464 --> 00:43:06,932
PROPOSALS THAT COULD THEN GET 

1082
00:43:06,932 --> 00:43:08,701
REVIEWED, FURTHERING THOSE THAT 

1083
00:43:08,701 --> 00:43:09,835
ARE FURTHERING THE MISSION OF 

1084
00:43:09,835 --> 00:43:16,075
THE HELPING TO END ADDICTION 

1085
00:43:16,075 --> 00:43:19,011
LONG-TERM INITITIVE AND WE HAVE 

1086
00:43:19,011 --> 00:43:20,546
SIGNIFICANT PROGRAM THROUGH THE 

1087
00:43:20,546 --> 00:43:22,114
NATIONAL CENTER FOR ADVANCING 

1088
00:43:22,114 --> 00:43:28,487
THE TRANSITIONAL SCIENCES OR 

1089
00:43:28,487 --> 00:43:29,121
NCATS FOR DEVELOPING DRUGS AND 

1090
00:43:29,121 --> 00:43:29,655
HUMAN CELL BASED TESTING 

1091
00:43:29,655 --> 00:43:30,956
PLATFORMS. NEXT SLIDE.

1092
00:43:30,956 --> 00:43:35,661
TO TALK A LITTLE ABOUT THE HEAL 

1093
00:43:35,661 --> 00:43:36,295
PAIN THERAPEUTIC SIDE OF THINGS 

1094
00:43:36,295 --> 00:43:37,163
WE TALKED ABOUT CLINICAL 

1095
00:43:37,163 --> 00:43:38,063
TRIALS, AND WE HAVE DEFINITELY 

1096
00:43:38,063 --> 00:43:40,633
SOME SUCCESSES HERE. WE HAVE 

1097
00:43:40,633 --> 00:43:43,135
FIVE INVESTIGATIONAL DEVICE 

1098
00:43:43,135 --> 00:43:47,306
EXEMPTIONS FROM THE FDA TO GO 

1099
00:43:47,306 --> 00:43:49,341
INTO PEOPLE WITH DEVICES FOR 

1100
00:43:49,341 --> 00:43:51,710
PAIN, COMING OUT OF THE DEVICE 

1101
00:43:51,710 --> 00:43:56,649
PROGRAM. WE HAVE TWO INPS THAT 

1102
00:43:56,649 --> 00:44:04,256
HAVE COME OUT OF THE 12 

1103
00:44:04,256 --> 00:44:07,626
MOLECULE GROUPS, AND WE HAVE 

1104
00:44:07,626 --> 00:44:08,260
APPLIED THEM TO TEST ASSET FOR 

1105
00:44:08,260 --> 00:44:10,396
MANY COMPANIES AND ACADEMICS 

1106
00:44:10,396 --> 00:44:11,130
FOR THEIR EFFECTIVENESS IN 

1107
00:44:11,130 --> 00:44:12,364
MULTIPLE DIFFERENT ... FOR 

1108
00:44:12,364 --> 00:44:16,902
PAIN.  LOOKING SO FAR AT 40 

1109
00:44:16,902 --> 00:44:20,506
ASSETS. AND AS I MENTIONED 

1110
00:44:20,506 --> 00:44:24,210
NCATS, VERY ACTIVE IN 14 DRUG 

1111
00:44:24,210 --> 00:44:24,777
DISCOVERY PROJECTS AND THEY 

1112
00:44:24,777 --> 00:44:26,145
HAVE A COMPOUND LIBRARY THAT 

1113
00:44:26,145 --> 00:44:26,712
CAN BE SCREENED AGAINST THE 

1114
00:44:26,712 --> 00:44:29,048
RELEVANT ASSAY TO UNDERSTAND 

1115
00:44:29,048 --> 00:44:30,316
WHICH OF THOSE MIGHT BE 

1116
00:44:30,316 --> 00:44:34,487
VALUABLE IN DEVELOPING A NEW, 

1117
00:44:34,487 --> 00:44:36,856
NONADDICTIVE PAIN TREATMENT. 

1118
00:44:36,856 --> 00:44:39,191
NEXT SLIDE.

1119
00:44:39,191 --> 00:44:43,963
AND, WE WE TALKED IN THE PAST 

1120
00:44:43,963 --> 00:44:47,533
ABOUT HOW THE INDUSTRY IS KIND 

1121
00:44:47,533 --> 00:44:51,437
OF LEFT PAIN BECAUSE OF ALL THE 

1122
00:44:51,437 --> 00:44:51,971
FAILURES AND THERE IS ONE 

1123
00:44:51,971 --> 00:44:56,542
RECENT REPORT COMING UP WITH 

1124
00:44:56,542 --> 00:44:57,176
COMPANY, NOT A PUBLISHED PAPER 

1125
00:44:57,176 --> 00:44:57,776
YET THE COMPANY REPORTED THAT 

1126
00:44:57,776 --> 00:45:01,347
THEY ARE NOW 1.8 INHIBITOR, 

1127
00:45:01,347 --> 00:45:06,318
BASICALLY IN THE POSTOPERATIVE 

1128
00:45:06,318 --> 00:45:06,919
SCENARIOS, WAS ABLE TO MATCH 

1129
00:45:06,919 --> 00:45:10,356
THE EFFECTIVENESS OF 

1130
00:45:10,356 --> 00:45:11,790
COMBINATION OF I THINK IT WAS 

1131
00:45:11,790 --> 00:45:17,062
VICODIN AND TYLENOL-- OXYCODONE 

1132
00:45:17,062 --> 00:45:22,234
AND TYLENOL. 

1133
00:45:22,234 --> 00:45:23,869
SO, I GUESS THE MESSAGE HERE IS 

1134
00:45:23,869 --> 00:45:24,803
THAT, THERE IS A TARGET HERE 

1135
00:45:24,803 --> 00:45:26,772
THAT DOES NOT INVOLVE THE 

1136
00:45:26,772 --> 00:45:28,741
OPIOID SYSTEM.  IT IS NOT 

1137
00:45:28,741 --> 00:45:31,644
ADDICTIVE. IT PERFORMS AS WELL 

1138
00:45:31,644 --> 00:45:38,617
IS ONE OF THE MOST MORE COMMON 

1139
00:45:38,617 --> 00:45:40,786
OPIOIDS GIVEN FOR POST 

1140
00:45:40,786 --> 00:45:41,287
OPERATIVE PAIN.

1141
00:45:41,287 --> 00:45:42,187
THIS COMPANY ALSO I THINK 

1142
00:45:42,187 --> 00:45:46,358
LICENSED ONE OF THE NAV 1.7S 

1143
00:45:46,358 --> 00:45:47,526
THAT WE FUNDED EARLIER. BUT 

1144
00:45:47,526 --> 00:45:52,164
THIS IS A NAV 1.8. WE WILL SEE 

1145
00:45:52,164 --> 00:45:55,334
WHAT HAPPENS THERE. BUT SOME 

1146
00:45:55,334 --> 00:45:55,935
PROGRESS IN THE FIELD WHICH I 

1147
00:45:55,935 --> 00:45:56,535
THINK WILL HOPEFULLY OPEN UP 

1148
00:45:56,535 --> 00:45:57,770
MORE AND MORE. NEXT SLIDE.

1149
00:45:57,770 --> 00:46:06,912
AND, I'M GOING TO HAND OFF TO 

1150
00:46:06,912 --> 00:46:08,280
JACKIE WARD, TO TALK ABOUT THE 

1151
00:46:08,280 --> 00:46:10,583
STRATEGIC PLAN.  THANK YOU ALL 

1152
00:46:10,583 --> 00:46:12,551
FOR YOUR PARTICIPATION IN THIS. 

1153
00:46:12,551 --> 00:46:13,152
 YOU ARE GOING TO BE HEARING 

1154
00:46:13,152 --> 00:46:14,787
FROM US. REALLY IMPORTANT THAT 

1155
00:46:14,787 --> 00:46:17,423
WE DO A REALLY GOOD JOB HERE. 

1156
00:46:17,423 --> 00:46:18,290
WE ARE REALLY LUCKY TO HAVE 

1157
00:46:18,290 --> 00:46:19,191
JACKIE. 

1158
00:46:19,191 --> 00:46:27,600
JACKIE IS A SENIOR ADVISOR HERE 

1159
00:46:27,600 --> 00:46:28,233
AT NINDS IN THE OFFICE OF PAIN 

1160
00:46:28,233 --> 00:46:30,903
POLICY AND PLANNING. PRIOR TO 

1161
00:46:30,903 --> 00:46:32,972
THAT JACKIE WAS MY CHIEF OF 

1162
00:46:32,972 --> 00:46:33,606
STAFF, AND THEN SHE LEFT FOR A 

1163
00:46:33,606 --> 00:46:35,474
DEMOTION AT THE WHITE HOUSE. 

1164
00:46:35,474 --> 00:46:37,042
SHE WENT TO THE WHITE HOUSE. 

1165
00:46:37,042 --> 00:46:40,613
RECENTLY CAME BACK. WE ARE 

1166
00:46:40,613 --> 00:46:41,747
REALLY HAPPY, THAT SHE IS GOING 

1167
00:46:41,747 --> 00:46:42,481
TO DO A GREAT JOB OF LEADING 

1168
00:46:42,481 --> 00:46:45,250
THIS GROUP.  AND I WANT TO TURN 

1169
00:46:45,250 --> 00:46:48,120
THAT OVER TO JACKIE. 

1170
00:46:48,120 --> 00:46:53,859
>> DR. WARD: THANKS
WALTER. SO 

1171
00:46:53,859 --> 00:46:55,761
I SEE MYSELF ON THE SCREEN.  I 

1172
00:46:55,761 --> 00:46:57,730
HOPE EVERYONE CAN HEAR ME OKAY. 

1173
00:46:57,730 --> 00:47:00,432
SO I WANT TO SAY THAT WE ARE 

1174
00:47:00,432 --> 00:47:08,340
BASICALLY GOING TO TALK RIGHT 

1175
00:47:08,340 --> 00:47:08,941
NOW ABOUT THE DEEP DIVE INTO 

1176
00:47:08,941 --> 00:47:09,441
THE PAIN SIDE TWO DIGIT 

1177
00:47:09,441 --> 00:47:10,075
PLANNING FOR THE PAIN SIDE AND 

1178
00:47:10,075 --> 00:47:10,643
THEY WILL COME BACK TO TALK 

1179
00:47:10,643 --> 00:47:11,143
ABOUT THE CROSSCUTTING 

1180
00:47:11,143 --> 00:47:12,478
STRATEGIC PLAN. BUT AS WALTERS 

1181
00:47:12,478 --> 00:47:14,580
SAID IN HIS TALK, WE ARE IN THE 

1182
00:47:14,580 --> 00:47:25,124
SIX YEAR OF FUNDING FOR HEAL.  

1183
00:47:25,557 --> 00:47:26,125
A LOT OF THE EARLY AWARDS THAT 

1184
00:47:26,125 --> 00:47:27,826
WERE GIVEN OUT IN THE FIRST 

1185
00:47:27,826 --> 00:47:28,360
YEAR, STARTING TO REPORT 

1186
00:47:28,360 --> 00:47:29,728
RESULTS OF LOOKING TO THE 

1187
00:47:29,728 --> 00:47:30,596
FUTURE TO FIGURE OUT WHAT THE 

1188
00:47:30,596 --> 00:47:31,130
BEST OPPORTUNITIES ARE TO 

1189
00:47:31,130 --> 00:47:34,933
SUPPORT THE MISSION OF HEAL 

1190
00:47:34,933 --> 00:47:36,835
PAIN THAT WALTER TALKED ABOUT, 

1191
00:47:36,835 --> 00:47:37,336
BY DEVELOPING RESEARCH 

1192
00:47:37,336 --> 00:47:37,970
PRIORITIES THAT WILL GUIDE THIS 

1193
00:47:37,970 --> 00:47:41,106
NEXT PHASE OF THE HEAL PAIN 

1194
00:47:41,106 --> 00:47:41,573
PROGRAMS AND FUNDING 

1195
00:47:41,573 --> 00:47:44,843
OPPORTUNITIES. 

1196
00:47:44,843 --> 00:47:45,377
I DO WANT TO SAY THAT SINCE 

1197
00:47:45,377 --> 00:47:47,346
PAIN RESEARCH AT NIH EXTENDS 

1198
00:47:47,346 --> 00:47:50,916
WHAT IS SUPPORTED BY HEAL, WE 

1199
00:47:50,916 --> 00:47:52,384
ARE HOPING THAT THE STRATEGIC 

1200
00:47:52,384 --> 00:47:52,918
PLANNING PROCESS WILL BE 

1201
00:47:52,918 --> 00:47:53,419
INFORMED BY THE BROADER 

1202
00:47:53,419 --> 00:47:56,755
LANDSCAPE OF IC-SUPPORTED 

1203
00:47:56,755 --> 00:47:58,490
RESEARCH. THAT IS AN IMPORTANT 

1204
00:47:58,490 --> 00:47:59,124
COMPONENT WE ARE THINKING ABOUT 

1205
00:47:59,124 --> 00:47:59,525
AS WELL. 

1206
00:47:59,525 --> 00:48:03,562
AND THESE NIH-WIDE STRATEGIC 

1207
00:48:03,562 --> 00:48:05,798
RESEARCH PRIORITIES FOR HEAL 

1208
00:48:05,798 --> 00:48:10,602
PAIN, WILL BE ULTIMATELY PAIRED 

1209
00:48:10,602 --> 00:48:14,406
WITH NIDA STRATEGIC PLAN THAT 

1210
00:48:14,406 --> 00:48:15,040
ADDRESSES PRIORITIES FOR OPIOID 

1211
00:48:15,040 --> 00:48:15,908
USE DISORDER AND OVERDOSE, THAT 

1212
00:48:15,908 --> 00:48:16,475
WILL SUBSEQUENTLY GUIDE THE 

1213
00:48:16,475 --> 00:48:19,011
DEVELOPMENT OF THE CROSSCUTTING 

1214
00:48:19,011 --> 00:48:20,546
HEAL STRATEGIC PLAN THAT WILL 

1215
00:48:20,546 --> 00:48:25,818
BE DEVELOPING IN PARALLEL. TO 

1216
00:48:25,818 --> 00:48:26,452
DIVE INTO THE PAIN SIDE LITTLE 

1217
00:48:26,452 --> 00:48:29,021
BIT.

1218
00:48:29,021 --> 00:48:29,621
WE WANT TO MAKE SURE THAT THESE 

1219
00:48:29,621 --> 00:48:31,623
PRIORITIES REFLECT THE THOUGHTS 

1220
00:48:31,623 --> 00:48:32,257
OF THE EXTERNAL SIGNS COMMITTEE 

1221
00:48:32,257 --> 00:48:32,825
AND THE COMMUNITY OF PEOPLE 

1222
00:48:32,825 --> 00:48:33,425
WITH LIVED EXPERIENCE OF THE 

1223
00:48:33,425 --> 00:48:36,195
GENERAL PUBLIC.  SO WE ARE 

1224
00:48:36,195 --> 00:48:36,695
ACTUALLY STANDING UP AN 

1225
00:48:36,695 --> 00:48:38,397
EXTERNAL COMMITTEE TO GUIDE AND 

1226
00:48:38,397 --> 00:48:39,865
OVERSEE THIS PROCESS.  AND I AM 

1227
00:48:39,865 --> 00:48:42,501
HAPPY TO ANNOUNCE THAT YOUR 

1228
00:48:42,501 --> 00:48:52,344
FELLOW MDWG MEMBER ROB GERAU 

1229
00:48:52,344 --> 00:48:52,878
HAS AGREED TO CHAIR THIS 

1230
00:48:52,878 --> 00:48:59,485
COMMITTEE WITH KATHLEEN SLUKA.  

1231
00:48:59,485 --> 00:49:00,652
ROB IS A DIRECTOR OF THE 

1232
00:49:00,652 --> 00:49:01,220
WASHINGTON UNIVERSITY PAIN 

1233
00:49:01,220 --> 00:49:01,820
CENTER AND SERVES AS A DOCTOR 

1234
00:49:01,820 --> 00:49:08,060
SEYMOUR AND ROSE T. BROWN BY 

1235
00:49:08,060 --> 00:49:08,527
CAREFUL RESEARCH IN 

1236
00:49:08,527 --> 00:49:09,695
ANESTHESIOLOGY AT THE 

1237
00:49:09,695 --> 00:49:13,132
WASHINGTON UNIVERSITY ST. 

1238
00:49:13,132 --> 00:49:13,699
LOUIS, WORKING TO DETERMINE 

1239
00:49:13,699 --> 00:49:14,199
CELLULAR AND MOLECULAR 

1240
00:49:14,199 --> 00:49:24,676
MECHANISMS INVOLVED IN THE  

1241
00:49:28,413 --> 00:49:28,914
DEVELOPMENT OF CHRONIC PAIN 

1242
00:49:28,914 --> 00:49:29,515
CONDITIONS WITH AN EYE TO THE 

1243
00:49:29,515 --> 00:49:30,115
DEVELOPMENT OF NEW APPROACHES 

1244
00:49:30,115 --> 00:49:30,616
FOR THE PREVENTION AND 

1245
00:49:30,616 --> 00:49:31,250
MANAGEMENT OF CHRONIC PAIN AND 

1246
00:49:31,250 --> 00:49:31,784
ITS COMORBIDITIES.  AND 

1247
00:49:31,784 --> 00:49:32,251
RECEIVED AN AWARD FOR 

1248
00:49:32,251 --> 00:49:34,286
OUTSTANDING MENTORSHIP IN 2020. 

1249
00:49:34,286 --> 00:49:37,222
KATHLEEN SLUKA IS A PROFESSOR 

1250
00:49:37,222 --> 00:49:37,723
OF PHYSICAL THERAPY AND 

1251
00:49:37,723 --> 00:49:38,190
REHABILITATION AT THE 

1252
00:49:38,190 --> 00:49:40,726
UNIVERSITY OF IOWA CARVER 

1253
00:49:40,726 --> 00:49:41,460
COLLEGE OF MEDICINE. HER WORK 

1254
00:49:41,460 --> 00:49:44,530
FOCUSES ON THE PERIPHERAL AND 

1255
00:49:44,530 --> 00:49:45,297
CENTRAL MECHANISMS OF CHRONIC 

1256
00:49:45,297 --> 00:49:48,600
MUSCULOSKELETAL PAIN AND 

1257
00:49:48,600 --> 00:49:49,201
NONPHARMACOLOGICAL TREATMENT 

1258
00:49:49,201 --> 00:49:49,835
FOR CHRONIC PAIN. SHE IS THE PI 

1259
00:49:49,835 --> 00:49:53,305
OF A NUMBER OF NIH AND HEAL 

1260
00:49:53,305 --> 00:49:56,942
AWARDS INCLUDING AS PI  OF THE 

1261
00:49:56,942 --> 00:49:57,576
CLINICAL COORDINATOR ENCOUNTER 

1262
00:49:57,576 --> 00:49:58,177
FOR THE ACUTE TO CHRONIC PAIN 

1263
00:49:58,177 --> 00:50:00,345
SIGNATURE PROGRAM AND ALSO AS A 

1264
00:50:00,345 --> 00:50:07,519
CO-PI OF THE IOWA T-32  PROGRAM 

1265
00:50:07,519 --> 00:50:08,153
ON PAIN RESEARCH AND RECIPIENT 

1266
00:50:08,153 --> 00:50:14,026
OF THE HEAL 2020 AWARD. 

1267
00:50:14,026 --> 00:50:14,626
LOOKING FORWARD TO WORKING WITH 

1268
00:50:14,626 --> 00:50:15,260
THEM AND ALSO WANT TO POINT OUT 

1269
00:50:15,260 --> 00:50:16,428
THE PRIMARY CHARGE OF THIS 

1270
00:50:16,428 --> 00:50:18,664
GROUP THAT THEY WILL BE 

1271
00:50:18,664 --> 00:50:22,134
COCHAIRING IS TO PROPOSE AND 

1272
00:50:22,134 --> 00:50:22,701
PRIORITIZE FUTURE STRATEGIC 

1273
00:50:22,701 --> 00:50:23,268
RESEARCH PRIORITIES FOR THE 

1274
00:50:23,268 --> 00:50:23,902
NEXT PHASE OF PAIN RESEARCH TO 

1275
00:50:23,902 --> 00:50:26,338
ADVANCE THE HEAL MISSION. 

1276
00:50:26,338 --> 00:50:27,072
AND WE WILL BE ALSO BE ASKING 

1277
00:50:27,072 --> 00:50:30,876
THEM TO ASSESS THE PROGRESS 

1278
00:50:30,876 --> 00:50:31,443
HEAL HAS MADE TO DATE, AND 

1279
00:50:31,443 --> 00:50:33,679
IDENTIFY GAPS IN THE CURRENT OR 

1280
00:50:33,679 --> 00:50:35,547
PAST HEAL PAIN RESEARCH 

1281
00:50:35,547 --> 00:50:36,748
PORTFOLIO AND RECOMMENDING 

1282
00:50:36,748 --> 00:50:37,316
BETTER WAYS TO ACHIEVE THE 

1283
00:50:37,316 --> 00:50:42,020
GOALS OF HEAL.   AS WELL AS 

1284
00:50:42,020 --> 00:50:42,621
SUGGESTING NEW OPPORTUNITIES 

1285
00:50:42,621 --> 00:50:43,055
WHETHER THROUGH NEW 

1286
00:50:43,055 --> 00:50:44,189
PARTNERSHIPS OR TECHNOLOGIES OR 

1287
00:50:44,189 --> 00:50:44,790
BREAKING DEVELOPMENTS IN THE 

1288
00:50:44,790 --> 00:50:49,494
SCIENCE. NEXT SLIDE.

1289
00:50:49,494 --> 00:50:51,063
AS FAR AS THE TIMELINE GOES, 

1290
00:50:51,063 --> 00:50:51,663
THIS IS WHAT WE ARE THINKING 

1291
00:50:51,663 --> 00:50:55,934
RIGHT NOW.   AS I SAID, WE ARE 

1292
00:50:55,934 --> 00:50:56,535
REALLY INTERESTED IN ENGAGING 

1293
00:50:56,535 --> 00:51:05,978
THE SCIENTIFIC COMMUNITY, BUT 

1294
00:51:05,978 --> 00:51:06,478
ALSO PEOPLE WOULD LIVED 

1295
00:51:06,478 --> 00:51:07,045
EXPERIENCE AND THE GENERAL 

1296
00:51:07,045 --> 00:51:08,280
PUBLIC AND SO WE ARE WORKING 

1297
00:51:08,280 --> 00:51:12,651
WITH NIDA TO GET PUBLIC INPUT. 

1298
00:51:12,651 --> 00:51:13,218
WE ARE IN THIS TIME PERIOD OF 

1299
00:51:13,218 --> 00:51:14,519
APRIL AND MAY FOR WE APPOINTED 

1300
00:51:14,519 --> 00:51:19,291
THE COCHAIRS FOR THE HEAL PAIN 

1301
00:51:19,291 --> 00:51:19,791
STRATEGIC PLANNING AND 

1302
00:51:19,791 --> 00:51:20,525
EXECUTIVE COMMITTEE AND WORKING 

1303
00:51:20,525 --> 00:51:24,263
ON IDENTIFYING ADDITIONAL 

1304
00:51:24,263 --> 00:51:24,863
COMMITTEE MEMBERS. AND THEIR 

1305
00:51:24,863 --> 00:51:25,464
FIRST TASK IS TO THINK ABOUT 

1306
00:51:25,464 --> 00:51:28,000
THE WAY WE WANT TO ORGANIZE THE 

1307
00:51:28,000 --> 00:51:28,500
SCRIPT AROUND DIFFERENT 

1308
00:51:28,500 --> 00:51:30,102
SCIENTIFIC FOCUS AREAS. THAT IS 

1309
00:51:30,102 --> 00:51:32,337
HAPPENING NOW THROUGH JUNE.  

1310
00:51:32,337 --> 00:51:32,871
AND SUBCOMMITTEES WILL BE 

1311
00:51:32,871 --> 00:51:34,072
FORMED AROUND THOSE DIFFERENT 

1312
00:51:34,072 --> 00:51:37,976
FOCUS AREAS.  AND THAT IS 

1313
00:51:37,976 --> 00:51:38,610
REALLY WHERE A LOT OF THE WORK 

1314
00:51:38,610 --> 00:51:40,345
WILL BE DONE, THE DOSE OF 

1315
00:51:40,345 --> 00:51:42,748
COMMIT WILL BE TASKED WITH 

1316
00:51:42,748 --> 00:51:43,315
FURTHER ENGAGEMENT THROUGH 

1317
00:51:43,315 --> 00:51:43,882
LISTENING SESSIONS, MAY BE 

1318
00:51:43,882 --> 00:51:46,685
ADDITIONAL RFIS AND SOME OTHER 

1319
00:51:46,685 --> 00:51:50,555
SORT OF MORE IN-DEPTH MEETINGS 

1320
00:51:50,555 --> 00:51:53,191
TO GET AT RESEARCH PRIORITIES. 

1321
00:51:53,191 --> 00:51:53,792
AND LATER THIS YEAR BEGINNING 

1322
00:51:53,792 --> 00:51:54,493
NEXT YEAR WE WILL GO THROUGH 

1323
00:51:54,493 --> 00:51:56,395
THE PROCESS OF PRIORITIZING 

1324
00:51:56,395 --> 00:51:57,062
WHAT THOSE RESEARCH TOPICS WILL 

1325
00:51:57,062 --> 00:51:59,531
BE FOR THE NEXT PHASE OF HEAL 

1326
00:51:59,531 --> 00:52:03,235
PAIN.  AND THOSE WILL BE 

1327
00:52:03,235 --> 00:52:12,077
FORMALLY PRESENTED TO THE NINDS 

1328
00:52:12,077 --> 00:52:12,678
ADVISORY COUNCIL FOR APPROVAL 

1329
00:52:12,678 --> 00:52:13,312
AND I DID WANT TO MENTION THAT 

1330
00:52:13,312 --> 00:52:14,680
THE SCOPE OF THIS GROUP AND THE 

1331
00:52:14,680 --> 00:52:18,817
STRATEGIC PLAN CROSS ACROSS ALL 

1332
00:52:18,817 --> 00:52:22,688
THE ICS, BUT WE'RE INTERESTED 

1333
00:52:22,688 --> 00:52:23,155
IN ENSURING THAT THIS 

1334
00:52:23,155 --> 00:52:24,623
COLLABORATIVE AS POSSIBLE 

1335
00:52:24,623 --> 00:52:25,123
ACROSS ALL OF THE OTHER 

1336
00:52:25,123 --> 00:52:25,691
INSTITUTES AND CENTERS AND 

1337
00:52:25,691 --> 00:52:28,226
WITHIN HEAL PAIN. 

1338
00:52:28,226 --> 00:52:28,827
ALONG THE WAY WE WILL WORK WITH 

1339
00:52:28,827 --> 00:52:32,597
OUR COLLEAGUES AT NIDA TO 

1340
00:52:32,597 --> 00:52:36,835
DEVELOP A CROSSCUTTING 

1341
00:52:36,835 --> 00:52:38,036
STRATEGIC PLAN. AND DEVELOPING 

1342
00:52:38,036 --> 00:52:38,670
A TIMELINE AND I WILL CLOSE BY 

1343
00:52:38,670 --> 00:52:40,672
SAYING THAT WE ARE REALLY AS 

1344
00:52:40,672 --> 00:52:42,541
WALTERS SAID, WITH THESE BUDGET 

1345
00:52:42,541 --> 00:52:48,680
WE ARE LOOKING AHEAD TO FY 27 

1346
00:52:48,680 --> 00:52:56,922
WHEN THE BUDGET LOOSENS UP A 

1347
00:52:56,922 --> 00:52:57,522
LITTLE BIT FOR THE PROJECT TO 

1348
00:52:57,522 --> 00:52:58,090
COME TO A CLOSE, AIMING TO 

1349
00:52:58,090 --> 00:52:58,657
ENSURE THE PROJECT PLANNING 

1350
00:52:58,657 --> 00:52:59,324
INFORMS WHAT DOES FY 27 FUNDING 

1351
00:52:59,324 --> 00:52:59,958
OPPORTUNITIES WILL LOOK LIKE. I 

1352
00:52:59,958 --> 00:53:01,860
WILL STOP THERE.  THAT MIGHT BE 

1353
00:53:01,860 --> 00:53:03,729
THE END OF THE DISCUSSION. I 

1354
00:53:03,729 --> 00:53:04,329
DON'T KNOW IF WALTER HAS ANY 

1355
00:53:04,329 --> 00:53:06,131
ADDITIONAL SLIDES. 

1356
00:53:06,131 --> 00:53:09,401
>> DR. WEISS: THANKS VERY
MUCH. 

1357
00:53:09,401 --> 00:53:10,569
 I THINK WE ARE OPEN NOW FOR 

1358
00:53:10,569 --> 00:53:13,438
THE DISCUSSION ABOUT LAURA AND 

1359
00:53:13,438 --> 00:53:13,872
WALTER AND JACKIE'S 

1360
00:53:13,872 --> 00:53:14,940
PRESENTATION. WE HAVE ABOUT 20 

1361
00:53:14,940 --> 00:53:25,450
MINUTES.  I WILL UNMUTE YOU. 

1362
00:53:34,993 --> 00:53:37,863
>> DR. VOLKOW: THERE DOES
NOT 

1363
00:53:37,863 --> 00:53:38,797
SEEM TO BE ANY QUESTIONS. 

1364
00:53:38,797 --> 00:53:40,899
WALTER? 

1365
00:53:40,899 --> 00:53:44,002
>> DR. KOROSHETZ: NORA,
HERE IS 

1366
00:53:44,002 --> 00:53:46,338
A HARD ONE. IF YOU HAD TO DO IT 

1367
00:53:46,338 --> 00:53:48,774
ALL OVER AGAIN, WHAT WOULD YOU 

1368
00:53:48,774 --> 00:53:49,708
DO DIFFERENTLY?

1369
00:53:49,708 --> 00:53:53,512
>> DR. VOLKOW: I CERTAINLY

1370
00:53:53,512 --> 00:53:57,349
WOULD'VE LIKED TO TAKE 

1371
00:53:57,349 --> 00:53:59,718
ADVANTAGE FROM MORE OBJECTIVE 

1372
00:53:59,718 --> 00:54:02,587
WAYS OF MONITORING THE DRUGS IN 

1373
00:54:02,587 --> 00:54:05,290
THE COMMUNITIES. I THINK THAT 

1374
00:54:05,290 --> 00:54:06,758
IT TOOK US A WHILE TO REALLY 

1375
00:54:06,758 --> 00:54:12,664
UNDERSTAND THAT.  AND IF WE 

1376
00:54:12,664 --> 00:54:14,900
HAVE THE TOOLS IN PARTICULAR, 

1377
00:54:14,900 --> 00:54:18,403
WASTEWATER, DEPLOYING THAT. ONE 

1378
00:54:18,403 --> 00:54:18,970
OF THE THINGS THAT I ALWAYS 

1379
00:54:18,970 --> 00:54:20,939
FELT VERY FRUSTRATED WITH THE 

1380
00:54:20,939 --> 00:54:23,241
INABILITY TO DEPLOY THE 

1381
00:54:23,241 --> 00:54:23,809
WASTEWATER WITH THE HEALING 

1382
00:54:23,809 --> 00:54:26,478
COMMUNITIES STUDIES.  THAT 

1383
00:54:26,478 --> 00:54:27,079
WOULD HAVE GIVEN US A BROADER 

1384
00:54:27,079 --> 00:54:27,946
PERSPECTIVE ON THE ONE HAND OF 

1385
00:54:27,946 --> 00:54:31,583
WHAT DRUGS WERE THERE.  BUT 

1386
00:54:31,583 --> 00:54:34,119
ALSO HOW EFFECTIVE IS OUR 

1387
00:54:34,119 --> 00:54:36,588
IMPLEMENTATION FOR TREATMENT.  

1388
00:54:36,588 --> 00:54:40,659
SO IS THERE NALOXONE IN THE 

1389
00:54:40,659 --> 00:54:42,661
WASTEWATER? OR ARE WE 

1390
00:54:42,661 --> 00:54:44,696
DISTRIBUTE IN IT, AND NEVER BE 

1391
00:54:44,696 --> 00:54:54,406
USED?

1392
00:54:54,406 --> 00:54:55,006
SO A SECOND ONE WALTER, THIS IS 

1393
00:54:55,006 --> 00:54:55,574
SOMETHING THAT WOULD BECOME 

1394
00:54:55,574 --> 00:54:56,808
MORE CENTRALIZED, WE SHOULD 

1395
00:54:56,808 --> 00:54:57,909
HAVE FROM THE BEGINNING ENGAGED 

1396
00:54:57,909 --> 00:55:00,612
WITH MORE ACTIVE PARTICIPANTS.  

1397
00:55:00,612 --> 00:55:01,113
PEOPLE THAT HAVE LIVED 

1398
00:55:01,113 --> 00:55:02,814
EXPERIENCE IN TREATMENT. BUT 

1399
00:55:02,814 --> 00:55:09,287
PEOPLE THAT WERE STRUGGLING IN 

1400
00:55:09,287 --> 00:55:09,821
THEIR-- EITHER THE USE OF 

1401
00:55:09,821 --> 00:55:10,355
SUBSTANCES, THAT ARE NOT 

1402
00:55:10,355 --> 00:55:10,856
INTERESTED ONGOING TO 

1403
00:55:10,856 --> 00:55:14,626
TREATMENT.  LISTENING TO THEM. 

1404
00:55:14,626 --> 00:55:15,260
THAT WAS NOT SOMETHING WITH IT 

1405
00:55:15,260 --> 00:55:18,263
UNTIL VERY RECENTLY. 

1406
00:55:18,263 --> 00:55:26,037
I ALSO THINK IF WE HAD A 

1407
00:55:26,037 --> 00:55:30,308
RETROSPECTIVE ON UNDERSTANDING 

1408
00:55:30,308 --> 00:55:33,812
TEENAGERS EXPOSED TO 

1409
00:55:33,812 --> 00:55:34,412
PSYCHOTHERAPEUTIC, WOULD HAVE 

1410
00:55:34,412 --> 00:55:35,614
ENABLED US TO DEPLOY PREVENTION 

1411
00:55:35,614 --> 00:55:36,815
INTERVENTION, THAT WERE 

1412
00:55:36,815 --> 00:55:40,418
TAILORED TOWARDS THIS RISK. 

1413
00:55:40,418 --> 00:55:42,087
AND CERTAINLY ALL OF THE WORK 

1414
00:55:42,087 --> 00:55:43,588
ON THE UNDERREPRESENTED GROUPS 

1415
00:55:43,588 --> 00:55:46,758
HAS EMERGED MORE RECENTLY.  FOR 

1416
00:55:46,758 --> 00:55:47,392
EXAMPLE THE SORT OF RECOGNITION 

1417
00:55:47,392 --> 00:55:50,529
ON NATIVE AMERICANS, AND BLACK 

1418
00:55:50,529 --> 00:55:51,396
AMERICANS, THAT WE NEED TO HAVE 

1419
00:55:51,396 --> 00:55:51,963
TAILORED INTERVENTIONS FOR 

1420
00:55:51,963 --> 00:55:55,333
THEM.  WE HAVE VERY LITTLE FOR 

1421
00:55:55,333 --> 00:55:56,535
ADOLESCENTS, IN TERMS OF 

1422
00:55:56,535 --> 00:55:59,237
TREATMENT. THERE IS A HUGE GAP 

1423
00:55:59,237 --> 00:56:01,039
AREA WE TO ADVANCE IT.

1424
00:56:01,039 --> 00:56:01,907
SO THESE ARE OVERALL LESSONS 

1425
00:56:01,907 --> 00:56:05,377
LEARNED FROM HAVING SEEN THE 

1426
00:56:05,377 --> 00:56:10,282
EPIDEMIC EMERGE. I WISH I HAD 

1427
00:56:10,282 --> 00:56:10,882
IT AT THE BEGINNING, WHEN WE 

1428
00:56:10,882 --> 00:56:12,584
WERE MAKING THE DECISIONS.

1429
00:56:12,584 --> 00:56:17,355
I STAND BY THE WHOLE DECISION 

1430
00:56:17,355 --> 00:56:17,789
STRUCTURE TO INVEST 

1431
00:56:17,789 --> 00:56:21,560
IMPLEMENTATION IN HEALTH CARE, 

1432
00:56:21,560 --> 00:56:23,061
IN JUSTICE SETTINGS, AND IN 

1433
00:56:23,061 --> 00:56:29,701
COMMUNITIES.  AND AT THE SAME 

1434
00:56:29,701 --> 00:56:32,370
TIME, INVEST IN THERAPEUTICS.  

1435
00:56:32,370 --> 00:56:34,206
OTHERWISE WE WILL ALWAYS BE 

1436
00:56:34,206 --> 00:56:36,274
FINDING THOSE INDIVIDUALS THEY 

1437
00:56:36,274 --> 00:56:36,908
DON'T RESPOND TO THE 

1438
00:56:36,908 --> 00:56:37,475
MEDICATIONS, OR STOP TAKING 

1439
00:56:37,475 --> 00:56:40,679
THEM. 

1440
00:56:40,679 --> 00:56:42,414
IN MY LAST SLIDE, I DID 

1441
00:56:42,414 --> 00:56:44,015
IDENTIFY THE AREAS WHERE WE 

1442
00:56:44,015 --> 00:56:49,988
HAVE THE KNOWLEDGE RIGHT NOW.  

1443
00:56:49,988 --> 00:56:50,622
WE NEED TO STRENGTHEN THAT. SO 

1444
00:56:50,622 --> 00:56:51,256
I HOPE WALTER THAT ANSWER YOUR 

1445
00:56:51,256 --> 00:56:54,059
QUESTION. 

1446
00:56:54,059 --> 00:56:55,126
>> THANKS LAURA. 

1447
00:56:55,126 --> 00:56:58,563
>> DR. VOLKOW: I'M GOING
TO ASK 

1448
00:56:58,563 --> 00:56:59,164
YOUR QUESTION BECAUSE I DON'T 

1449
00:56:59,164 --> 00:57:00,332
SEE ANY OTHER QUESTIONS. 

1450
00:57:00,332 --> 00:57:02,634
IN TERMS OF-- YOU HAVE BEEN SO 

1451
00:57:02,634 --> 00:57:04,903
INVOLVED.  YOU'VE ACTUALLY 

1452
00:57:04,903 --> 00:57:07,706
SPOKEN SO VERY MUCH IN TERMS OF 

1453
00:57:07,706 --> 00:57:13,011
THE NEUROBIOLOGICAL-- I'M GOING 

1454
00:57:13,011 --> 00:57:13,645
TO SHUT UP. I SEE OTHER PEOPLE 

1455
00:57:13,645 --> 00:57:14,246
RAISING THEIR HANDS. I WOULD 

1456
00:57:14,246 --> 00:57:18,450
RATHER LISTEN TO THEM. ELISEO 

1457
00:57:18,450 --> 00:57:20,986
PLEASE. 

1458
00:57:20,986 --> 00:57:22,587
>> I JOINED A BIT LATE. 
AND 

1459
00:57:22,587 --> 00:57:25,924
MISSED THE FIRST PART NORA. 

1460
00:57:25,924 --> 00:57:26,491
REFLECTING ON WHAT HAS BEEN 

1461
00:57:26,491 --> 00:57:28,460
GOING ON IN THE SPACE OF 

1462
00:57:28,460 --> 00:57:37,235
TRANSFORMATIVE ANALYSIS, I AM A 

1463
00:57:37,235 --> 00:57:38,103
UCSF PRIMARY CARE DOCTOR, HOW 

1464
00:57:38,103 --> 00:57:38,703
THINGS HAVE SHIFTED, AND THE 

1465
00:57:38,703 --> 00:57:41,673
LATEST ONE.  AND WHETHER HEAL 

1466
00:57:41,673 --> 00:57:45,677
IN ALL ITS ASPECTS NEEDS TO 

1467
00:57:45,677 --> 00:57:46,511
SORT OF ADAPTER THAT AND HOW 

1468
00:57:46,511 --> 00:57:50,048
NIMBLE CAN WE BE? THAT WAS ONE 

1469
00:57:50,048 --> 00:57:53,151
THOUGHT. 

1470
00:57:53,151 --> 00:57:56,688
PRESCRIBING OF OPIOIDS IN THE 

1471
00:57:56,688 --> 00:57:57,322
CLINICAL SETTING HAS DEFINITELY 

1472
00:57:57,322 --> 00:57:59,491
BEEN IMPACTED BY THIS AWARENESS 

1473
00:57:59,491 --> 00:58:01,293
BEFORE HEAL. NOT TO THE POINT 

1474
00:58:01,293 --> 00:58:04,996
WHERE WE WANT PEOPLE HURT 

1475
00:58:04,996 --> 00:58:05,597
BECAUSE THEY ARE NOT GETTING 

1476
00:58:05,597 --> 00:58:11,303
SUFFICIENT PAIN MEDICINE, WHEN 

1477
00:58:11,303 --> 00:58:11,903
THEY HAVE CONDITIONS THAT ARE 

1478
00:58:11,903 --> 00:58:12,504
NOT MANAGEABLE. AND WE STILL 

1479
00:58:12,504 --> 00:58:16,141
HAVE NOT -- I'VE NEVER SEEN 

1480
00:58:16,141 --> 00:58:20,679
THAT CHRONIC OPIOIDS ARE GOOD 

1481
00:58:20,679 --> 00:58:22,480
FOR CHRONIC PAIN, IN TERMS OF 

1482
00:58:22,480 --> 00:58:24,316
COMPARISON TO OTHER THERAPIES.  

1483
00:58:24,316 --> 00:58:26,251
BUT IN A TRIAL BASIS. 

1484
00:58:26,251 --> 00:58:30,622
BUT THEN, N CREW IS EXCITING.  

1485
00:58:30,622 --> 00:58:31,990
EVERYTHING I'VE SEEN. WHAT 

1486
00:58:31,990 --> 00:58:36,728
ABOUT AN N CREW FOR AFRICAN 

1487
00:58:36,728 --> 00:58:43,501
AMERICAN COMMUNITIES? THEY 

1488
00:58:43,501 --> 00:58:46,471
COULD BE IN A PILOT PROSPECT.  

1489
00:58:46,471 --> 00:58:47,572
PERHAPS AREAS THAT COULD BE 

1490
00:58:47,572 --> 00:58:48,206
HIGHEST AFFECTED. COULD BE THE 

1491
00:58:48,206 --> 00:58:50,742
DISTRICT OF COLUMBIA.  WE HAVE 

1492
00:58:50,742 --> 00:58:56,247
A PROGRAM AT MHMD, 13" PCUS ARE 

1493
00:58:56,247 --> 00:59:04,589
PART OF IT, INCLUDING HOWARD. 

1494
00:59:04,589 --> 00:59:05,223
IT IS A THOUGHT OUT THERE WITH 

1495
00:59:05,223 --> 00:59:06,691
LIMITED FUNDS. IN THE NEXT 

1496
00:59:06,691 --> 00:59:07,325
COUPLE OF YEARS TO THINK ABOUT 

1497
00:59:07,325 --> 00:59:11,529
THAT. 

1498
00:59:11,529 --> 00:59:15,500
>> DR. VOLKOW: YOU CANNOT 

1499
00:59:15,500 --> 00:59:16,968
IGNORE WHAT IS HAPPENING IN 

1500
00:59:16,968 --> 00:59:22,907
BLACK COMMUNITIES. I DO LIKE 

1501
00:59:22,907 --> 00:59:23,541
VERY MUCH THE ISSUE OF A PILOT 

1502
00:59:23,541 --> 00:59:24,609
PROGRAM. AND WE HAVE BEEN 

1503
00:59:24,609 --> 00:59:25,243
DISCUSSING THIS IN THE INTERNAL 

1504
00:59:25,243 --> 00:59:27,078
PROGRAM IN ULTIMO BECAUSE THERE 

1505
00:59:27,078 --> 00:59:27,846
IS A BLACK COMMUNITY 

1506
00:59:27,846 --> 00:59:28,313
PREDOMINANTLY. IT IS 

1507
00:59:28,313 --> 00:59:30,382
DEVASTATING OVER THERE.  IT 

1508
00:59:30,382 --> 00:59:31,583
COULD ENABLE US TO DO A 

1509
00:59:31,583 --> 00:59:32,784
DEPLOYMENT THAT FOCUSES 

1510
00:59:32,784 --> 00:59:39,124
SPECIFICALLY IN OUR BACKYARD.  

1511
00:59:39,124 --> 00:59:39,524
SO,  THERE IS THE 

1512
00:59:39,524 --> 00:59:40,725
INFRASTRUCTURE TO DO IT.

1513
00:59:40,725 --> 00:59:41,626
IN THE DISTRICT OF COLUMBIA, 

1514
00:59:41,626 --> 00:59:46,798
THE TREATMENT IS NOT AS 

1515
00:59:46,798 --> 00:59:48,666
EXPENSIVE AS BALTIMORE. BUT WE 

1516
00:59:48,666 --> 00:59:49,467
CAN DISCUSS THIS AS A SEPARATE 

1517
00:59:49,467 --> 00:59:58,510
IDEA. 

1518
00:59:58,510 --> 00:59:59,077
>> I WAS AT A MEETING
MONDAY 

1519
00:59:59,077 --> 00:59:59,677
MORNING, WE DEFINITELY SHOULD 

1520
00:59:59,677 --> 01:00:00,278
TALK FURTHER BECAUSE I THINK 

1521
01:00:00,278 --> 01:00:00,979
THERE'S OPPORTUNITY THERE. 

1522
01:00:00,979 --> 01:00:02,881
>> DR. VOLKOW: GREAT 

1523
01:00:02,881 --> 01:00:05,617
SUGGESTIONS. 

1524
01:00:05,617 --> 01:00:07,018
>> THANKS FOR THE
PRESENTATION. 

1525
01:00:07,018 --> 01:00:07,485
WERE INTERESTING AND 

1526
01:00:07,485 --> 01:00:10,155
ILLUMINATING.  MY QUESTION IS 

1527
01:00:10,155 --> 01:00:10,588
ABOUT THE ISSUE OF 

1528
01:00:10,588 --> 01:00:13,057
ENVIRONMENTAL JUSTICE.  SO, AT 

1529
01:00:13,057 --> 01:00:17,595
LEAST THE IC DIRECTORS KNOW 

1530
01:00:17,595 --> 01:00:18,229
THAT ENVIRONMENTAL JUSTICE IS A 

1531
01:00:18,229 --> 01:00:19,798
MAJOR AREA OF FOCUS FOR 

1532
01:00:19,798 --> 01:00:27,772
SECRETARY BECERRA AND OTHER 

1533
01:00:27,772 --> 01:00:28,406
PARTS OF THE US GOVERNMENT. BUT 

1534
01:00:28,406 --> 01:00:31,810
A LOT OF US IN ENVIRONMENTAL 

1535
01:00:31,810 --> 01:00:32,377
JUSTICE HAVE TRADITIONALLY 

1536
01:00:32,377 --> 01:00:33,011
FOCUSED AND POPULATIONS EXPOSED 

1537
01:00:33,011 --> 01:00:34,012
TO AIR POLLUTION AND TOXIC 

1538
01:00:34,012 --> 01:00:35,780
CHEMICALS IN VARIOUS THINGS.  

1539
01:00:35,780 --> 01:00:38,316
BUT THE SAME COMMUNITIES-- 

1540
01:00:38,316 --> 01:00:40,452
THOSE ENVIRONMENTAL JUSTICE 

1541
01:00:40,452 --> 01:00:41,052
COMMUNITIES-- ARE EXACTLY THE 

1542
01:00:41,052 --> 01:00:41,686
ONES THAT YOU WERE HIGHLIGHTING 

1543
01:00:41,686 --> 01:00:42,287
IN YOUR PRESENTATION. IS THAT 

1544
01:00:42,287 --> 01:00:48,359
CORRECT? IS ENVIRONMENTAL 

1545
01:00:48,359 --> 01:00:48,927
JUSTICE, IS THE DEFINITION 

1546
01:00:48,927 --> 01:00:50,695
FUNDAMENTALLY INCLUDE OPIOID 

1547
01:00:50,695 --> 01:00:59,571
USE DISORDERS? IF NOT WE SHOULD 

1548
01:00:59,571 --> 01:01:01,072
BE EXPANDING THE DEFINITION OF 

1549
01:01:01,072 --> 01:01:02,006
ENVIRONMENTAL JUSTICE. 

1550
01:01:02,006 --> 01:01:03,608
>> DR. VOLKOW: THAT IS A
GOOD 

1551
01:01:03,608 --> 01:01:06,377
POINT.  I WOULD NOT FEEL 

1552
01:01:06,377 --> 01:01:08,580
COMFORTABLE DETERMINING-- NOT 

1553
01:01:08,580 --> 01:01:09,647
TO MY KNOWLEDGE. I DON'T THINK 

1554
01:01:09,647 --> 01:01:11,416
IT IS INCLUDED THERE.  BUT IT 

1555
01:01:11,416 --> 01:01:14,319
DOES REFLECT.  NOT SURPRISING.  

1556
01:01:14,319 --> 01:01:16,454
PEOPLE THAT ARE VULNERABLE THEY 

1557
01:01:16,454 --> 01:01:20,291
DON'T HAVE A WAY OUT, THERE ARE 

1558
01:01:20,291 --> 01:01:24,596
IN DESPAIR, ALL COME TOGETHER. 

1559
01:01:24,596 --> 01:01:26,664
NOT SURPRISING. PEOPLE FEEL 

1560
01:01:26,664 --> 01:01:27,365
COMPLETELY ABANDONED BY THE 

1561
01:01:27,365 --> 01:01:27,966
SYSTEM ARE THE ONES THAT ARE 

1562
01:01:27,966 --> 01:01:32,036
VULNERABLE.  AND THAT IS WHERE 

1563
01:01:32,036 --> 01:01:32,670
THEY ALSO GET-- THEY DON'T HAVE 

1564
01:01:32,670 --> 01:01:33,605
THE MEANS TO ENSURE THAT THEY 

1565
01:01:33,605 --> 01:01:36,674
HAVE AN ENVIRONMENT THAT IS 

1566
01:01:36,674 --> 01:01:38,676
HEALTHY. I WOULD WELCOME THE 

1567
01:01:38,676 --> 01:01:39,244
OPPORTUNITY, BECAUSE AGAIN 

1568
01:01:39,244 --> 01:01:42,447
THESE ARE ISSUES THAT PEOPLE IN 

1569
01:01:42,447 --> 01:01:44,449
NATIVE LANDS HAVE TO DEAL WITH. 

1570
01:01:44,449 --> 01:01:48,753
THAT LEADS THEM TO DISTRESS, 

1571
01:01:48,753 --> 01:01:51,856
AND HOPELESSNESS. THIS ASPECT 

1572
01:01:51,856 --> 01:01:53,558
OF ENVIRONMENTAL TOXIC 

1573
01:01:53,558 --> 01:01:55,260
EXPOSURES ARE DRIVING FURTHER 

1574
01:01:55,260 --> 01:01:58,096
THE DISPARITIES. I WOULD BE 

1575
01:01:58,096 --> 01:01:58,596
VERY INTERESTED IN ALSO 

1576
01:01:58,596 --> 01:02:01,099
LISTENING TO OTHERS.  BECAUSE 

1577
01:02:01,099 --> 01:02:02,634
SOMETIMES IF YOU ADD MORE 

1578
01:02:02,634 --> 01:02:04,702
THINGS INTO CONCEPTS, IT CAN 

1579
01:02:04,702 --> 01:02:10,208
GET DILUTED.LET'S DISCUSS IT. 

1580
01:02:10,208 --> 01:02:11,643
IT IS A GOOD POINT, RELATED 

1581
01:02:11,643 --> 01:02:13,311
OBVIOUSLY.  WE WILL FOLLOW UP 

1582
01:02:13,311 --> 01:02:17,882
ON THAT. 

1583
01:02:17,882 --> 01:02:20,218
>> WE CAN FOLLOW UP. AND I
WILL 

1584
01:02:20,218 --> 01:02:23,755
HAVE TREVOR ARCHER LEADING THE 

1585
01:02:23,755 --> 01:02:29,627
NIH-WIDE INITIATIVE. I SEE 

1586
01:02:29,627 --> 01:02:30,261
THESE THINGS SO INTERCONNECTED. 

1587
01:02:30,261 --> 01:02:31,863
SOME OF THE ENVIRONMENTAL 

1588
01:02:31,863 --> 01:02:32,697
JUSTICE COMMUNITIES WERE LIVING 

1589
01:02:32,697 --> 01:02:35,099
IN TOXIC ENVIRONMENTS. THE 

1590
01:02:35,099 --> 01:02:37,468
HELPLESSNESS MAY LEAD THEM TO 

1591
01:02:37,468 --> 01:02:41,306
OPIOID USE DISORDERS.  AND IT 

1592
01:02:41,306 --> 01:02:42,740
EXACERBATES THE PROBLEM. 

1593
01:02:42,740 --> 01:02:51,783
>> DR. VOLKOW: ABSOLUTELY,
YES. 

1594
01:02:51,783 --> 01:02:52,317
>> GREAT PRESENTATION,
VERY 

1595
01:02:52,317 --> 01:02:54,852
WELL DONE.

1596
01:02:54,852 --> 01:03:00,124
>> I KEEP SAYING THIS --
WE DO 

1597
01:03:00,124 --> 01:03:00,758
THE SIGNS AND SOMEHOW WE CAN'T 

1598
01:03:00,758 --> 01:03:01,793
GET THE SIGNS TO LOOK FORWARD. 

1599
01:03:01,793 --> 01:03:05,863
I THINK ACTUALLY, THE NEW 

1600
01:03:05,863 --> 01:03:08,199
SURVEY, NATIONAL SURVEY ON 

1601
01:03:08,199 --> 01:03:08,800
HEALTH, IS ONLY 18% OF PEOPLE 

1602
01:03:08,800 --> 01:03:12,136
THAT ARE GETTING -- -- ALWAYS 

1603
01:03:12,136 --> 01:03:13,438
TRYING TO LOOK FOR OTHER WAYS 

1604
01:03:13,438 --> 01:03:16,274
THAT WE CAN ENFORCE IT THROUGH 

1605
01:03:16,274 --> 01:03:18,543
SOME QUALITY MEASURE STUFF.  I 

1606
01:03:18,543 --> 01:03:22,547
KNOW WE DO THAT IN STL 

1607
01:03:22,547 --> 01:03:26,584
ELEVATION-- THAT IS REALLY DONE 

1608
01:03:26,584 --> 01:03:29,420
THROUGH MEDICARE.  HOW WE DO 

1609
01:03:29,420 --> 01:03:31,189
THAT THROUGH MEDICAID, OR HOW 

1610
01:03:31,189 --> 01:03:33,291
WE DO THAT SOME OTHER WAYS, 

1611
01:03:33,291 --> 01:03:34,726
IT'S JUST WORTH NOTING. LIKE 

1612
01:03:34,726 --> 01:03:38,596
THE JAILS AND PRISONS.  THERE 

1613
01:03:38,596 --> 01:03:40,164
MUST BE A WAY TO MAKE PRISONS-- 

1614
01:03:40,164 --> 01:03:42,967
I MEAN AT LEAST IN THE FEDERAL 

1615
01:03:42,967 --> 01:03:45,637
SYSTEM, HOW DO WE MAKE THEM 

1616
01:03:45,637 --> 01:03:48,706
GIVE OUT MEDICATION? I DON'T 

1617
01:03:48,706 --> 01:03:50,575
KNOW THAT. I AM PUTTING IT OUT 

1618
01:03:50,575 --> 01:03:53,378
THERE. AND WHAT ADVOCACY 

1619
01:03:53,378 --> 01:03:54,979
GROUPS, OR WHAT OTHER THINGS WE 

1620
01:03:54,979 --> 01:03:55,580
COULD BE DOING TO MAKE THOSE 

1621
01:03:55,580 --> 01:03:57,815
THINGS HAPPEN. 

1622
01:03:57,815 --> 01:04:04,922
BECAUSE I AM AT A LOSS. I GIVE 

1623
01:04:04,922 --> 01:04:05,556
A LOT OF TALKS. WE GET A LOT OF 

1624
01:04:05,556 --> 01:04:06,290
MONEY FROM YOU THANK YOU BUT MY 

1625
01:04:06,290 --> 01:04:06,924
DOING THE TALKING DOES NOT DO 

1626
01:04:06,924 --> 01:04:09,694
ANYTHING.  IS REALLY MORE ABOUT 

1627
01:04:09,694 --> 01:04:11,262
PUTTING THINGS IN PRACTICE, 

1628
01:04:11,262 --> 01:04:11,996
WHICH WE HAVE TRIED A LOT TO 

1629
01:04:11,996 --> 01:04:16,401
DO. WE HAVE OUR EHRS NOW 

1630
01:04:16,401 --> 01:04:17,335
ADOPTING CERTAIN CLINICAL 

1631
01:04:17,335 --> 01:04:20,371
PATHWAYS FOR DOING THAT IN EDS. 

1632
01:04:20,371 --> 01:04:26,344
I THINK WE ARE GETTING CLOSER. 

1633
01:04:26,344 --> 01:04:26,844
BUT,  I'M JUST KIND OF 

1634
01:04:26,844 --> 01:04:27,478
WONDERING, HOW WE COULD-- THAT 

1635
01:04:27,478 --> 01:04:28,713
IS MY FIRST QUESTION-- HOW WE 

1636
01:04:28,713 --> 01:04:30,081
CAN DO THESE QUALITY MEASURES 

1637
01:04:30,081 --> 01:04:32,850
OR THESE ADVOCACY THINGS THAT 

1638
01:04:32,850 --> 01:04:37,021
WE COULD DO TO MAKE IT BETTER.

1639
01:04:37,021 --> 01:04:37,588
THE ONLY OTHER THING I WANTED 

1640
01:04:37,588 --> 01:04:38,723
TO COMMENT, HEALING 

1641
01:04:38,723 --> 01:04:40,825
COMMUNITIES, NOT BE DISTRAUGHT 

1642
01:04:40,825 --> 01:04:42,727
ABOUT THAT. BECAUSE LOOKING AT 

1643
01:04:42,727 --> 01:04:49,934
THE OVERWHELMING AMOUNT OF 

1644
01:04:49,934 --> 01:04:50,568
OVERDOSE, LUCKILY OVERDOSES ARE 

1645
01:04:50,568 --> 01:04:51,636
NOT ESCALATING, NOT GETTING 

1646
01:04:51,636 --> 01:04:55,239
BETTER, BUT NOT HORRIBLY 

1647
01:04:55,239 --> 01:04:55,840
ESCALATING. AND THERE IS ONLY 

1648
01:04:55,840 --> 01:04:59,210
SO WE CAN DO ABOUT NALOXONE 

1649
01:04:59,210 --> 01:04:59,811
THAT IS AVAILABLE BUT WHEN WE 

1650
01:04:59,811 --> 01:05:02,647
TALK ABOUT PATIENTS IN OUR 

1651
01:05:02,647 --> 01:05:03,347
STUDIES ABOUT NONFATAL 

1652
01:05:03,347 --> 01:05:03,881
OVERDOSES, WE REALLY ARE 

1653
01:05:03,881 --> 01:05:04,415
PREVENTING MANY NONFATAL 

1654
01:05:04,415 --> 01:05:06,718
OVERDOSES.  I JUST WANTED TO 

1655
01:05:06,718 --> 01:05:07,752
KNOW, DON'T TAKE THAT TO HEART 

1656
01:05:07,752 --> 01:05:15,626
THAT IT IS NOT BEING DONE.  

1657
01:05:15,626 --> 01:05:16,260
BECAUSE THE AMOUNT OF NONFATAL 

1658
01:05:16,260 --> 01:05:16,828
OVERDOSES THAT WE KNOW ARE 

1659
01:05:16,828 --> 01:05:17,929
OCCURRING ARE ESCALATING. IT IS 

1660
01:05:17,929 --> 01:05:18,496
HARD TO FIND THE DATA SINCE 

1661
01:05:18,496 --> 01:05:20,631
THEY DON'T COME TO THE ED OR 

1662
01:05:20,631 --> 01:05:21,766
WHATEVER. IT IS REALLY BY 

1663
01:05:21,766 --> 01:05:24,802
TALKING TO PEOPLE, AND ASKING 

1664
01:05:24,802 --> 01:05:25,436
ABOUT IT. ANYWAY THOSE ARE MY 

1665
01:05:25,436 --> 01:05:26,838
TWO COMMENTS. 

1666
01:05:26,838 --> 01:05:28,706
>> DR. VOLKOW: THOSE ARE
VERY 

1667
01:05:28,706 --> 01:05:29,807
GOOD COMMENTS INTO THE LAST 

1668
01:05:29,807 --> 01:05:36,614
ONE, ONE OF THE THINGS WE 

1669
01:05:36,614 --> 01:05:37,915
STARTED IS A PILOT PROJECT TWO 

1670
01:05:37,915 --> 01:05:40,318
DIFFERENT PIS, AND OBTAIN 

1671
01:05:40,318 --> 01:05:42,887
WASTEWATER AND LOOK AT NALOXONE 

1672
01:05:42,887 --> 01:05:45,056
TO SEE IF WE SEE CHANGES. AND 

1673
01:05:45,056 --> 01:05:46,924
SEE THAT CORRELATE TO THE 

1674
01:05:46,924 --> 01:05:49,827
PRESCRIPTION OF NALOXONE. 

1675
01:05:49,827 --> 01:05:57,001
AS I SAID, THE DIVISION OF 

1676
01:05:57,001 --> 01:05:57,502
NALOXONE HAS INCREASED 

1677
01:05:57,502 --> 01:05:58,136
SIGNIFICANTLY. BUT WE KNOW HOW 

1678
01:05:58,136 --> 01:06:01,973
MUCH WAS DEPLOYED. THE OTHER 

1679
01:06:01,973 --> 01:06:02,607
ONE THAT RELATES ULTIMATELY IS 

1680
01:06:02,607 --> 01:06:04,776
HOW DO WE ENSURE THAT 

1681
01:06:04,776 --> 01:06:07,578
EVIDENCE-BASED IS IMPLEMENTED? 

1682
01:06:07,578 --> 01:06:08,146
WHY ARE WE STILL STRUGGLING 

1683
01:06:08,146 --> 01:06:09,881
WITH SUCH A TERRIBLE GAP? AND 

1684
01:06:09,881 --> 01:06:10,448
AGAIN THERE IS NOT JUST ONE 

1685
01:06:10,448 --> 01:06:12,350
ANSWER TO THAT. BUT ONE HAS TO 

1686
01:06:12,350 --> 01:06:15,086
LOOK AT WHICH ARE THE TRACTABLE 

1687
01:06:15,086 --> 01:06:16,788
ONES WHERE WE CAN INTERVENE.  

1688
01:06:16,788 --> 01:06:17,688
AND CERTAINLY ONE OF THE 

1689
01:06:17,688 --> 01:06:20,758
ASPECTS THAT MAKES CLINICIANS 

1690
01:06:20,758 --> 01:06:23,961
NOT BE WILLING TO PRESCRIBE OR 

1691
01:06:23,961 --> 01:06:34,305
EVEN SCREAM PEOPLE FOR OPIOID 

1692
01:06:34,305 --> 01:06:34,872
USE DISORDER IS A LEVEL OF 

1693
01:06:34,872 --> 01:06:35,406
REIMBURSEMENT THEY GET IS 

1694
01:06:35,406 --> 01:06:37,375
INADEQUATE FOR THEM. THEY WOULD 

1695
01:06:37,375 --> 01:06:37,975
MAKE MUCH MORE MONEY TREATING 

1696
01:06:37,975 --> 01:06:39,577
OTHER CONDITIONS.

1697
01:06:39,577 --> 01:06:40,144
THE OTHER ASPECT OF IT IS NOT 

1698
01:06:40,144 --> 01:06:44,715
STRAIGHTFORWARD. EVEN THOUGH 

1699
01:06:44,715 --> 01:06:48,386
THERE IS A LAW THAT THAT SHOULD 

1700
01:06:48,386 --> 01:06:48,820
NOT DISCRIMINATE IN 

1701
01:06:48,820 --> 01:06:50,588
REIMBURSEMENT FOR MEDICATION OR 

1702
01:06:50,588 --> 01:06:51,088
TREATMENT, THAT IS NOT 

1703
01:06:51,088 --> 01:06:52,223
NECESSARILY AT ALL DEPLOYED. SO 

1704
01:06:52,223 --> 01:06:55,526
THE AMOUNT OF-- YOU CAN GET THE 

1705
01:06:55,526 --> 01:06:59,864
INSURANCE TO PAY FOR 

1706
01:06:59,864 --> 01:07:03,234
BUPRENORPHINE. BUT IF YOU WANT 

1707
01:07:03,234 --> 01:07:03,868
TO DO AN EXTENDED RELEASE, GOOD 

1708
01:07:03,868 --> 01:07:06,637
LUCK WITH IT.  THERE ALWAYS 

1709
01:07:06,637 --> 01:07:07,605
ECONOMIC BARRIERS THAT DO NOT 

1710
01:07:07,605 --> 01:07:09,640
INCENTIVIZE CLINICIANS TO DO 

1711
01:07:09,640 --> 01:07:11,242
THE PROPER THING.

1712
01:07:11,242 --> 01:07:12,677
HOW DO WE TACKLE THAT? 

1713
01:07:12,677 --> 01:07:18,115
CERTAINLY I DO-- WE HAVE TO 

1714
01:07:18,115 --> 01:07:20,551
SPEAK WITH PEOPLE THAT ARE 

1715
01:07:20,551 --> 01:07:21,152
ACTUALLY AT HIGHER GOVERNMENT 

1716
01:07:21,152 --> 01:07:22,587
LEVELS THAT ARE RESPONSIBLE FOR 

1717
01:07:22,587 --> 01:07:23,020
DEFINING WHAT THOSE 

1718
01:07:23,020 --> 01:07:25,389
REIMBURSEMENTS ARE.  BUT WE 

1719
01:07:25,389 --> 01:07:31,229
ALSO NEED TO ACTUALLY SHOW DATA 

1720
01:07:31,229 --> 01:07:34,298
THAT YOU CAN IN THE HELPER 

1721
01:07:34,298 --> 01:07:36,500
SYSTEM SIGNIFICANTLY IMPROVE 

1722
01:07:36,500 --> 01:07:37,134
OUTCOMES AND SAVE MONEY IF YOU 

1723
01:07:37,134 --> 01:07:37,768
IMPLEMENT THEM IN A SYSTEMATIC 

1724
01:07:37,768 --> 01:07:44,308
WAY.  AND ARPA-H TO THE HEROES 

1725
01:07:44,308 --> 01:07:44,942
PROGRAM, IS LAUNCHING THIS-- WE 

1726
01:07:44,942 --> 01:07:51,582
ARE DISCUSSING IT-- THEY ARE 

1727
01:07:51,582 --> 01:07:52,183
GOING TO GIVE THE PRIZE FOR A 

1728
01:07:52,183 --> 01:07:57,054
HEALTHCARE SYSTEM ABLE TO SHOW 

1729
01:07:57,054 --> 01:07:57,655
INTERVENTIONS AND REDUCE THE 

1730
01:07:57,655 --> 01:07:58,256
COSTS AND IN MY BRAIN IF YOU 

1731
01:07:58,256 --> 01:08:01,893
SYSTEMATICALLY PROVIDE 

1732
01:08:01,893 --> 01:08:02,426
MEDICATIONS TO EMERGENCY 

1733
01:08:02,426 --> 01:08:03,027
DEPARTMENTS FOR TREATMENT YOU 

1734
01:08:03,027 --> 01:08:04,929
WILL REDUCE THE NUMBER OF 

1735
01:08:04,929 --> 01:08:05,563
HOSPITALIZATIONS AND EMERGENCY 

1736
01:08:05,563 --> 01:08:08,065
DEPARTMENT USE.  YOU CAN 

1737
01:08:08,065 --> 01:08:10,468
DOCUMENT IT. 

1738
01:08:10,468 --> 01:08:12,570
THERE ARE MULTIPLE THINGS IN 

1739
01:08:12,570 --> 01:08:17,108
TERMS OF CREATING DATA, THAT 

1740
01:08:17,108 --> 01:08:26,951
HOPEFULLY CAN INFORM POLICY AND 

1741
01:08:26,951 --> 01:08:27,551
INCENTIVIZE THE HELPER SYSTEM 

1742
01:08:27,551 --> 01:08:28,185
TO DO THE RIGHT THING AND THAT 

1743
01:08:28,185 --> 01:08:32,256
IS WHERE WE STAND RIGHT NOW. 

1744
01:08:32,256 --> 01:08:32,823
>> JUST BE CAREFUL ABOUT
THE 

1745
01:08:32,823 --> 01:08:33,424
REPEAT VISITING WHICH I FIGHT 

1746
01:08:33,424 --> 01:08:34,725
WITH ALL THE TIME. AS YOU 

1747
01:08:34,725 --> 01:08:35,359
MENTIONED IN ONE OF YOUR SLIDES 

1748
01:08:35,359 --> 01:08:38,296
ABOUT THE SOCIAL DETERMINANTS 

1749
01:08:38,296 --> 01:08:45,169
OF HEALTH, OUR PATIENTS ARE ALL 

1750
01:08:45,169 --> 01:08:48,205
UNHOUSED OR HAVE UNSTABLE 

1751
01:08:48,205 --> 01:08:50,975
HOUSING. THE ENTIRE SYSTEM IS 

1752
01:08:50,975 --> 01:08:51,676
BROKEN SO INDIVIDUAL WILL ONLY 

1753
01:08:51,676 --> 01:08:56,747
USE THE ED IS THE ONLY SOURCE 

1754
01:08:56,747 --> 01:09:01,285
OF CARE. SO THE REPEAT, 

1755
01:09:01,285 --> 01:09:01,786
ELIMINATE THE AROUND OF 

1756
01:09:01,786 --> 01:09:02,353
SUBSTANCE USE DISORDER, FOR 

1757
01:09:02,353 --> 01:09:06,557
WHATEVER ELSE THEY NEED TO DO.  

1758
01:09:06,557 --> 01:09:07,124
IT IS JUST A CAUTION TO BE 

1759
01:09:07,124 --> 01:09:08,559
CAREFUL ABOUT IT.

1760
01:09:08,559 --> 01:09:09,160
AND ONE POSITIVE NOTE WITH THE 

1761
01:09:09,160 --> 01:09:12,830
SEVEN DAY EJECTABLE, WE HAVE 

1762
01:09:12,830 --> 01:09:14,165
MANY PEOPLE IN OUR STUDY, MANY 

1763
01:09:14,165 --> 01:09:15,933
SITE IN OUR STUDY INCLUDING NEW 

1764
01:09:15,933 --> 01:09:19,470
HAVEN, GRADY, UNIVERSITY OF 

1765
01:09:19,470 --> 01:09:20,805
PENNSYLVANIA, ALL HAVE AGREED 

1766
01:09:20,805 --> 01:09:25,376
TO PUT THE 7-DAY EJECTABLE IN 

1767
01:09:25,376 --> 01:09:28,512
THEIR ED FORMULA. WE ARE MOVING 

1768
01:09:28,512 --> 01:09:31,649
TOWARDS THAT. WE NEED A POINT 

1769
01:09:31,649 --> 01:09:33,985
TO REDUCE. WE HAVE BEEN ABLE TO 

1770
01:09:33,985 --> 01:09:34,685
GET THAT FAR. 

1771
01:09:34,685 --> 01:09:36,420
>> DR. VOLKOW: THAT IS
GREAT 

1772
01:09:36,420 --> 01:09:39,690
NEWS.  ERIC?

1773
01:09:39,690 --> 01:09:43,694
>> THANK YOU NORA FOR THE 

1774
01:09:43,694 --> 01:09:44,261
EXCELLENT TALKING THANK YOU 

1775
01:09:44,261 --> 01:09:44,996
WALTER AS WELL. JUST REFLECTING 

1776
01:09:44,996 --> 01:09:48,632
ON THE HEALING COMMUNITIES 

1777
01:09:48,632 --> 01:09:52,503
STUDY RESULTS, I CANNOT HELP 

1778
01:09:52,503 --> 01:09:54,572
BUT FEEL A LITTLE SAD TO SEE 

1779
01:09:54,572 --> 01:09:55,072
THAT. AND ALSO I REALLY 

1780
01:09:55,072 --> 01:10:02,780
APPRECIATED YOUR ANALYSIS OF 

1781
01:10:02,780 --> 01:10:03,381
WHY THE RESULTS WERE THE WAY 

1782
01:10:03,381 --> 01:10:05,549
THEY WERE.

1783
01:10:05,549 --> 01:10:07,051
I WONDER IF THIS IS ALSO A 

1784
01:10:07,051 --> 01:10:08,019
FUNCTION OF HISTORY IN THE 

1785
01:10:08,019 --> 01:10:08,552
SENSE THAT THE STUDY WAS 

1786
01:10:08,552 --> 01:10:09,153
LAUNCHED AT THE BEGINNING OF 

1787
01:10:09,153 --> 01:10:11,922
THE NIH HEAL INITIATIVE.  BUT 

1788
01:10:11,922 --> 01:10:12,723
NOW WE HAVE HAD MANY YEARS OF 

1789
01:10:12,723 --> 01:10:14,692
INNOVATIONS AND DISCOVERIES 

1790
01:10:14,692 --> 01:10:17,028
FROM THE NIH HEAL INITIATIVE 

1791
01:10:17,028 --> 01:10:24,402
NOVEL THERAPEUTICS, NOVEL 

1792
01:10:24,402 --> 01:10:24,835
MEDICATIONS, NOVEL 

1793
01:10:24,835 --> 01:10:25,369
PSYCHOTHERAPEUTIC 

1794
01:10:25,369 --> 01:10:26,771
INTERVENTIONS. I'M HOPING THAT 

1795
01:10:26,771 --> 01:10:29,607
THERE WILL BE A HEALING 

1796
01:10:29,607 --> 01:10:31,876
COMMUNITIES TOO AT SOME POINT 

1797
01:10:31,876 --> 01:10:33,310
TO TAKE THE MOST EFFICACIOUS 

1798
01:10:33,310 --> 01:10:33,944
MEDICATIONS DEVELOPED OVER THE 

1799
01:10:33,944 --> 01:10:36,547
COURSE OF THE NIH HEAL 

1800
01:10:36,547 --> 01:10:37,181
INITIATIVE AND TESTAMENT AGAIN 

1801
01:10:37,181 --> 01:10:39,617
IN THIS LARGE-SCALE 

1802
01:10:39,617 --> 01:10:40,684
IMPLEMENTATION KIND OF WAY IN 

1803
01:10:40,684 --> 01:10:42,853
THE COMMUNITY. BECAUSE WHAT WE 

1804
01:10:42,853 --> 01:10:46,157
DID IN THE HEALING COMMUNITIES 

1805
01:10:46,157 --> 01:10:48,559
STUDY IS TO TEST TO THE BEST OF 

1806
01:10:48,559 --> 01:10:49,160
OUR KNOWLEDGE IN TERMS OF HOW 

1807
01:10:49,160 --> 01:10:49,994
TO HELP THIS PROBLEM AT THAT 

1808
01:10:49,994 --> 01:10:50,728
POINT. HOPEFULLY WE HAVE 

1809
01:10:50,728 --> 01:10:54,031
EVOLVED THAT NOW, OVER THE 

1810
01:10:54,031 --> 01:10:54,632
COURSE OF THE PAST FIVE YEARS 

1811
01:10:54,632 --> 01:10:54,999
OR SO. 

1812
01:10:54,999 --> 01:11:00,971
>> DR. VOLKOW: WELL ERIC,
A LOT 

1813
01:11:00,971 --> 01:11:01,572
OF THE KNOWLEDGE WAS THERE. I 

1814
01:11:01,572 --> 01:11:04,108
FEEL WE HAVE COME A LONG WAY 

1815
01:11:04,108 --> 01:11:04,742
WITH INFORMATIVE INFORMATION ON 

1816
01:11:04,742 --> 01:11:05,342
HOW TO ACTUALLY TREAT PEOPLE 

1817
01:11:05,342 --> 01:11:06,911
WITH AN OPIOID USE DISORDERS, 

1818
01:11:06,911 --> 01:11:10,581
OR HOW TO DISTRIBUTE NALOXONE, 

1819
01:11:10,581 --> 01:11:11,182
AND THE FACT WE NEED TO HAVE 

1820
01:11:11,182 --> 01:11:17,588
BETTER PRACTICES FOR PAIN. I 

1821
01:11:17,588 --> 01:11:20,591
THINK THAT THE CHALLENGE 

1822
01:11:20,591 --> 01:11:29,600
OBVIOUSLY IS HOW TO WORK IN A 

1823
01:11:29,600 --> 01:11:32,103
COHESIVE INTEGRATED FASHION.  

1824
01:11:32,103 --> 01:11:32,703
AND HOW TO FORM COALITIONS A 

1825
01:11:32,703 --> 01:11:35,306
COMMENT TO THE COMMUNITY AND BE 

1826
01:11:35,306 --> 01:11:37,308
MORE EFFECTIVE. LESSONS LEARNED.

1827
01:11:37,308 --> 01:11:37,842
THE LESSONS LEARNED IS NOW 

1828
01:11:37,842 --> 01:11:41,178
BEING IMPLEMENTED ON WAVE 2.  

1829
01:11:41,178 --> 01:11:42,413
WE ARE NOW PROVIDING ALL OF THE 

1830
01:11:42,413 --> 01:11:46,417
INTERVENTIONS TO WAVE 2.  WE 

1831
01:11:46,417 --> 01:11:48,352
WILL SEE HOW THE OVERDOSE 

1832
01:11:48,352 --> 01:11:49,753
MORTALITY COMPARED TO THE YEAR 

1833
01:11:49,753 --> 01:11:50,387
BEFORE WITH THIS IMPLEMENTATION 

1834
01:11:50,387 --> 01:11:52,623
THAT IS ACTUALLY GOING TO BE 

1835
01:11:52,623 --> 01:11:55,025
EXPEDITED. BECAUSE WE ARE 

1836
01:11:55,025 --> 01:11:56,660
OBVIATING SOME OF THE INITIAL, 

1837
01:11:56,660 --> 01:11:58,229
SLOW STEPS THAT WERE TAKEN. I 

1838
01:11:58,229 --> 01:12:00,898
THINK THAT WE WILL NOT HAVE THE 

1839
01:12:00,898 --> 01:12:01,532
COVID PANDEMIC WHICH WAS 

1840
01:12:01,532 --> 01:12:04,869
BASICALLY A TREMENDOUS 

1841
01:12:04,869 --> 01:12:05,903
CHALLENGE. AND WHAT IS 

1842
01:12:05,903 --> 01:12:07,471
SURPRISING IS THAT DESPITE THE 

1843
01:12:07,471 --> 01:12:10,007
COVID PANDEMIC-- AND REMEMBER 

1844
01:12:10,007 --> 01:12:12,643
THE FIRST 18 MONTHS, EVERYTHING 

1845
01:12:12,643 --> 01:12:14,178
SHUT DOWN. PEOPLE COULDN'T GO 

1846
01:12:14,178 --> 01:12:16,347
INTO THE JAIL SYSTEMS. WE DON'T 

1847
01:12:16,347 --> 01:12:19,483
HAVE THAT. BUT WE LEARNED A LOT 

1848
01:12:19,483 --> 01:12:20,951
ABOUT HOW TO ADJUST, AND DO 

1849
01:12:20,951 --> 01:12:22,887
RESEARCH. 

1850
01:12:22,887 --> 01:12:26,290
SO WE WANT TO TAKE ABSOLUTELY 

1851
01:12:26,290 --> 01:12:27,992
THE ESSENCE OF WHAT HAS COME, 

1852
01:12:27,992 --> 01:12:31,862
THAT WE HAVE LEARNED FROM THE  

1853
01:12:31,862 --> 01:12:32,463
HEALING COMMUNITY STUDIES AND 

1854
01:12:32,463 --> 01:12:37,902
TRANSLATE IT IN A WAY THAT CAN 

1855
01:12:37,902 --> 01:12:39,270
BE TRANSLATED TO OTHER 

1856
01:12:39,270 --> 01:12:39,904
COMMUNITIES. AND THAT IS A WAY 

1857
01:12:39,904 --> 01:12:41,172
WHERE WE CAN SEE THE HEALING 

1858
01:12:41,172 --> 01:12:45,309
STUDY GO TO 2.0.  HOW DO WE 

1859
01:12:45,309 --> 01:12:47,711
EXPAND AND TRANSLATE WHAT IS 

1860
01:12:47,711 --> 01:12:50,347
USEFUL? AND WHAT WE LEARN FROM? 

1861
01:12:50,347 --> 01:12:50,948
AS WELL AS OTHER THINGS THAT 

1862
01:12:50,948 --> 01:12:52,283
MAY HAPPEN IN BETWEEN. 

1863
01:12:52,283 --> 01:12:55,653
>> THANK YOU. I THINK
THERE HAS 

1864
01:12:55,653 --> 01:12:56,921
TO BE NOVELTY AND INNOVATION 

1865
01:12:56,921 --> 01:12:57,555
THAT IS BEEN GENERATED FOR THE 

1866
01:12:57,555 --> 01:12:59,590
REST OF THE HEAL INITIATIVE 

1867
01:12:59,590 --> 01:13:00,991
THAT CAN REALLY BE INTEGRATED 

1868
01:13:00,991 --> 01:13:06,330
INTO HEALING COMMUNITIES 2.0 TO 

1869
01:13:06,330 --> 01:13:07,298
INCREASE THE EFFICACY OF THE 

1870
01:13:07,298 --> 01:13:08,265
INITIATIVE. THANK YOU. 

1871
01:13:08,265 --> 01:13:12,236
>> DR. VOLKOW: I THINK ED
HAD 

1872
01:13:12,236 --> 01:13:14,305
HIS HAND UP?

1873
01:13:14,305 --> 01:13:16,373
>> THANK YOU NORA. 
FOLLOWING 

1874
01:13:16,373 --> 01:13:22,479
UP ON GAIL'S POINTS ABOUT 

1875
01:13:22,479 --> 01:13:24,848
EMERGENCY INTERVENTIONS, AND 

1876
01:13:24,848 --> 01:13:26,884
YOUR RESPONSE ANTICIPATED MY 

1877
01:13:26,884 --> 01:13:29,086
QUESTION. BUT I REALLY LIKED 

1878
01:13:29,086 --> 01:13:35,659
THE ANALOGY BETWEEN THE ST 

1879
01:13:35,659 --> 01:13:36,260
ELEVATION AND THE RESPONSE IN 

1880
01:13:36,260 --> 01:13:36,894
THE EMERGENCY ROOM AND HOW THAT 

1881
01:13:36,894 --> 01:13:40,197
HAS BEEN INCENTIVIZED.  AND THE 

1882
01:13:40,197 --> 01:13:40,798
RESPONSE TO PATIENTS WITH AN 

1883
01:13:40,798 --> 01:13:46,270
OVERDOSE OR OPIOID USE DISORDER 

1884
01:13:46,270 --> 01:13:48,939
THAT COMES TO THE EMERGENCY 

1885
01:13:48,939 --> 01:13:50,975
ROOM. HOSPITALS GET PAID A LOT 

1886
01:13:50,975 --> 01:13:51,609
OF MONEY TO INTERVENE WITH THE 

1887
01:13:51,609 --> 01:13:53,210
PATIENT UP TO THE CATH LAB PUT 

1888
01:13:53,210 --> 01:13:57,648
IN STINTS, ETC., THAT IS REALLY 

1889
01:13:57,648 --> 01:13:59,550
REIMBURSED VERY WELL.

1890
01:13:59,550 --> 01:14:00,150
I WONDER IF IT IS WORTH NEEDING 

1891
01:14:00,150 --> 01:14:05,322
ABOUT STUDIES THAT LOOK AT THE 

1892
01:14:05,322 --> 01:14:12,796
VARIED REIMBURSEMENT. TO SEE 

1893
01:14:12,796 --> 01:14:13,397
WHETHER VARYING REIMBURSEMENT 

1894
01:14:13,397 --> 01:14:15,532
FOR THESE ACUTE INTERVENTIONS 

1895
01:14:15,532 --> 01:14:16,100
THAT WE KNOW CAN MAKE A BIG 

1896
01:14:16,100 --> 01:14:20,571
DIFFERENCE ENSURE EFFECTIVENESS 

1897
01:14:20,571 --> 01:14:21,171
AND CROSS EFFECTIVENESS DOWN 

1898
01:14:21,171 --> 01:14:21,872
THE LINE.

1899
01:14:21,872 --> 01:14:22,473
ONE OTHER THING THAT STRUCK ME 

1900
01:14:22,473 --> 01:14:29,380
ABOUT THE HEALING COMMUNITY 

1901
01:14:29,380 --> 01:14:29,947
STUDIES, A LOT OF THE MONEY 

1902
01:14:29,947 --> 01:14:30,581
WENT INTO RESEARCH OF ONE KIND 

1903
01:14:30,581 --> 01:14:32,116
OR ANOTHER.  SOME MONEY WENT 

1904
01:14:32,116 --> 01:14:35,653
INTO THE COMMUNITIES. BUT THE 

1905
01:14:35,653 --> 01:14:36,620
FUNNY THAT WENT INTO THE 

1906
01:14:36,620 --> 01:14:37,721
COMMUNITIES TO AUGMENT 

1907
01:14:37,721 --> 01:14:39,156
TREATMENT SERVICES AND SO FORTH 

1908
01:14:39,156 --> 01:14:42,359
WAS LIMITED. I WONDER ABOUT THE 

1909
01:14:42,359 --> 01:14:45,996
IDEA OF STARTING REIMBURSEMENT 

1910
01:14:45,996 --> 01:14:49,033
AS AN INTERVENTION IN THE 

1911
01:14:49,033 --> 01:14:50,901
COMMUNITY. OR HEALTH CENTER 

1912
01:14:50,901 --> 01:14:52,936
LEVEL. WOULD MORE PEOPLE GET 

1913
01:14:52,936 --> 01:15:00,944
INVOLVED IN THIS? AND WOULD 

1914
01:15:00,944 --> 01:15:02,346
MOUD, MEDICATION AND 

1915
01:15:02,346 --> 01:15:02,880
EVIDENCE-BASED PRACTICES 

1916
01:15:02,880 --> 01:15:04,048
DISSEMINATE FASTER IF YOU GOT 

1917
01:15:04,048 --> 01:15:04,615
PAID MORE TO DO IT?

1918
01:15:04,615 --> 01:15:06,517
>> DR. VOLKOW: I THINK IT
IS A 

1919
01:15:06,517 --> 01:15:14,591
GREAT IDEA.  I AM THINKING HOW 

1920
01:15:14,591 --> 01:15:15,326
TO DEPLOY SUCH A STUDY. IT IS A 

1921
01:15:15,326 --> 01:15:19,430
GOOD IDEA. 

1922
01:15:19,430 --> 01:15:21,632
>> I THINK WE SHOULD MOVE
ON.  

1923
01:15:21,632 --> 01:15:24,435
WE ARE JUST ABOUT ON-TIME.  

1924
01:15:24,435 --> 01:15:30,307
THANK YOU ALL. AND WALTER, DO 

1925
01:15:30,307 --> 01:15:32,643
YOU WANT TO INTRODUCE ELAINE? 

1926
01:15:32,643 --> 01:15:33,210
SHE IS HAVING SOME INTERNET 

1927
01:15:33,210 --> 01:15:33,877
ISSUES AND WE HAVE TO WORK IT 

1928
01:15:33,877 --> 01:15:35,112
OUT WITH HER. 

1929
01:15:35,112 --> 01:15:36,914
>> DR. KOROSHETZ: LOOKS
GREAT 

1930
01:15:36,914 --> 01:15:45,356
RIGHT NOW.ELAINE IS THE 

1931
01:15:45,356 --> 01:15:45,989
DIRECTOR OF NATIONAL CENTER FOR 

1932
01:15:45,989 --> 01:15:46,623
INTEGRATED CENTER FOR COMMUNITY 

1933
01:15:46,623 --> 01:15:47,324
HEALTH. SHE SPENT HER CAREER 

1934
01:15:47,324 --> 01:15:48,826
STUDYING PAIN AND NONADDICTIVE 

1935
01:15:48,826 --> 01:15:52,062
THERAPEUTICS FOR PAIN.  SHE HAS 

1936
01:15:52,062 --> 01:15:54,665
BEEN AS I MENTIONED ONE OF THE 

1937
01:15:54,665 --> 01:15:59,370
CO-DIRECTORS OF THE ICD GROUP 

1938
01:15:59,370 --> 01:16:03,006
FOR HEAL PAIN.  AND SHE WILL 

1939
01:16:03,006 --> 01:16:04,141
TALK TO US TODAY ABOUT THE 

1940
01:16:04,141 --> 01:16:05,809
PRAGMATIC TRIAL PROGRAM AT 

1941
01:16:05,809 --> 01:16:10,748
HEAL. 

1942
01:16:10,748 --> 01:16:12,783
HELEN?

1943
01:16:12,783 --> 01:16:18,122
>> DR. LANGEVIN: THANK YOU

1944
01:16:18,122 --> 01:16:18,722
AGAIN WALTER AND MY INTERNET 

1945
01:16:18,722 --> 01:16:19,990
HAS BEEN A LITTLE BIT SLIPPERY. 

1946
01:16:19,990 --> 01:16:20,557
IF I HAVE A PROBLEM I WILL 

1947
01:16:20,557 --> 01:16:29,767
SWITCH TO A DIFFERENT MODE. CAN 

1948
01:16:29,767 --> 01:16:31,702
I HAVE MY SLIDES UP PLEASE?

1949
01:16:31,702 --> 01:16:33,437
I APPRECIATE THE OPPORTUNITY TO 

1950
01:16:33,437 --> 01:16:34,571
TALK ABOUT TWO PROGRAMS THAT 

1951
01:16:34,571 --> 01:16:37,141
ARE NOT ACTUALLY HEAL PROGRAMS 

1952
01:16:37,141 --> 01:16:40,144
BUT THAT DO INTERFACE WITH HEAL 

1953
01:16:40,144 --> 01:16:42,346
IN A MUTUALLY BENEFICIAL WAY. 

1954
01:16:42,346 --> 01:16:44,882
ONE IS THE PRAGMATIC TRIAL 

1955
01:16:44,882 --> 01:16:50,654
COLLABORATORY OR PCPC AND THE 

1956
01:16:50,654 --> 01:16:54,291
OTHER IS THE NIH PAIN 

1957
01:16:54,291 --> 01:17:04,768
MANAGEMENT COLLABORATORY OR 

1958
01:17:09,173 --> 01:17:09,706
PMC, THE ACRONYMS ARE SIMILAR 

1959
01:17:09,706 --> 01:17:10,340
AND SOMETIMES THE PROGRAMS GET 

1960
01:17:10,340 --> 01:17:10,941
CONFUSED. I HOPE YOU WILL SEE 

1961
01:17:10,941 --> 01:17:11,575
HOW IMPORTANT THEY ARE FOR THE 

1962
01:17:11,575 --> 01:17:13,110
HEALING INITIATIVE. NEXT SLIDE.

1963
01:17:13,110 --> 01:17:15,379
I WILL START WITH THE 

1964
01:17:15,379 --> 01:17:23,887
MOTIVATION FOR WHY DO WE NEED 

1965
01:17:23,887 --> 01:17:24,521
COLLABORATORY TYPE OF RESEARCH 

1966
01:17:24,521 --> 01:17:27,758
PROGRAMS? THAT HELP US ADDRESS 

1967
01:17:27,758 --> 01:17:29,693
VERY, VERY IMPORTANT PROBLEM 

1968
01:17:29,693 --> 01:17:32,029
WHICH HAS COME UP MANY TIMES IN 

1969
01:17:32,029 --> 01:17:32,629
THE DISCUSSIONS THAT WE HAVE 

1970
01:17:32,629 --> 01:17:36,667
HAD HERE AT THE MDWG. AND WERE 

1971
01:17:36,667 --> 01:17:43,173
RAISED A SECOND AGO GY GAIL, 

1972
01:17:43,173 --> 01:17:43,774
AND ALSO MENTIONED BY NORA IN 

1973
01:17:43,774 --> 01:17:44,975
HER PRESENTATION.

1974
01:17:44,975 --> 01:17:49,079
THERE IS A HUGE PROBLEM IN HOW 

1975
01:17:49,079 --> 01:17:49,646
RESEARCH THAT IS HAPPENING, 

1976
01:17:49,646 --> 01:17:53,750
THAT IS SUCCESSFUL, ETC., HOW 

1977
01:17:53,750 --> 01:17:58,889
THE IMPLEMENTATION AND THE 

1978
01:17:58,889 --> 01:17:59,389
UPTAKE  OF THE RESEARCH 

1979
01:17:59,389 --> 01:18:00,390
FINDINGS INTO ACTUAL PATIENT 

1980
01:18:00,390 --> 01:18:00,724
CARE?

1981
01:18:00,724 --> 01:18:01,692
IT IS A DISCONCERTING NUMBER. 

1982
01:18:01,692 --> 01:18:04,995
IT TAKES 17 YEARS FOR RESEARCH 

1983
01:18:04,995 --> 01:18:10,901
TO BE APPLIED TO CLINICAL 

1984
01:18:10,901 --> 01:18:12,803
THERAPY. NOT ONLY DOES IT TAKE 

1985
01:18:12,803 --> 01:18:16,640
TIME BUT 14% OF RESEARCH, BY 

1986
01:18:16,640 --> 01:18:17,741
SOME ESTIMATES, HAS ACTUALLY 

1987
01:18:17,741 --> 01:18:18,308
APPLIED TO PATIENT CARE AND 

1988
01:18:18,308 --> 01:18:25,082
ONLY 18% OF PRACTITIONERS 

1989
01:18:25,082 --> 01:18:25,549
REPORT REGULARLY USE 

1990
01:18:25,549 --> 01:18:26,149
EVIDENCE-BASED PRACTICE. THIS 

1991
01:18:26,149 --> 01:18:28,652
IS A PROBLEM.

1992
01:18:28,652 --> 01:18:32,589
HOW DO WE CLOSE THIS GAP? HOW 

1993
01:18:32,589 --> 01:18:41,698
DO WE ADDRESS THIS? THIS IS 

1994
01:18:41,698 --> 01:18:42,266
WHAT THE TWO COLLABORATORY 

1995
01:18:42,266 --> 01:18:42,866
PROGRAMS GO TALK ABOUT ARE IN 

1996
01:18:42,866 --> 01:18:43,567
RESPONSE TO THIS.  HOW DO WE 

1997
01:18:43,567 --> 01:18:47,204
PUT TOGETHER A STRUCTURE THAT 

1998
01:18:47,204 --> 01:18:49,273
WILL STRENGTHEN CAPACITY TO 

1999
01:18:49,273 --> 01:18:51,708
REALLY TRANSLATE RESEARCH INTO 

2000
01:18:51,708 --> 01:18:59,082
CARE? NEXT SLIDE.

2001
01:18:59,082 --> 01:19:04,354
SO, STARTING WITH BOTH OF THESE 

2002
01:19:04,354 --> 01:19:05,956
PROGRAMS INVOLVE PREGNANT 

2003
01:19:05,956 --> 01:19:12,195
TRIALS. IN ONE QUICK WORD ABOUT 

2004
01:19:12,195 --> 01:19:22,706
WHAT A PRAGMATIC TRIAL IS. AN 

2005
01:19:24,675 --> 01:19:25,242
EXPLANATORY TRIAL, THE ONES WE 

2006
01:19:25,242 --> 01:19:25,809
ARE MOSTLY USED TO, ARE TO 

2007
01:19:25,809 --> 01:19:26,376
DETERMINE THE EFFECT OF AN 

2008
01:19:26,376 --> 01:19:27,010
INTERVENTION COMPARED WITH THE 

2009
01:19:27,010 --> 01:19:30,347
PLACEBO CONTROL FOR EXAMPLE.  

2010
01:19:30,347 --> 01:19:30,981
THESE ARE USUALLY TESTED UNDER 

2011
01:19:30,981 --> 01:19:32,683
IDEAL CIRCUMSTANCES. USUALLY IN 

2012
01:19:32,683 --> 01:19:34,284
THE RESEARCH SETTING. AND THE 

2013
01:19:34,284 --> 01:19:35,452
PATIENT POPULATIONS CAREFULLY 

2014
01:19:35,452 --> 01:19:37,454
SELECTED TO MINIMIZE 

2015
01:19:37,454 --> 01:19:40,757
CONFOUNDERS, ETC. A TYPE OF 

2016
01:19:40,757 --> 01:19:43,527
CONTROL.

2017
01:19:43,527 --> 01:19:45,062
IN CONTRAST, A PRAGMATIC TRIAL 

2018
01:19:45,062 --> 01:19:46,563
IS A TRIAL THAT ADDRESSES A 

2019
01:19:46,563 --> 01:19:48,632
DIFFERENT KIND OF QUESTION. NOT 

2020
01:19:48,632 --> 01:19:50,901
SO MUCH DOES THE INTERVENTION 

2021
01:19:50,901 --> 01:19:58,241
WORK. BUT WHAT HAPPENS WHEN 

2022
01:19:58,241 --> 01:19:58,709
THIS INTERVENTION IS 

2023
01:19:58,709 --> 01:19:59,743
IMPLEMENTED FOR EXAMPLE IN 

2024
01:19:59,743 --> 01:20:00,277
HEALTHCARE? WHAT ARE ITS 

2025
01:20:00,277 --> 01:20:06,283
EFFECTS? WHAT ARE THE VARIOUS 

2026
01:20:06,283 --> 01:20:07,784
FACTORS THAT WILL INFLUENCE THE 

2027
01:20:07,784 --> 01:20:08,385
EFFECTIVENESS OF THIS 

2028
01:20:08,385 --> 01:20:16,793
INTERVENTION? NEXT SLIDE.

2029
01:20:16,793 --> 01:20:18,462
SO, THERE ARE DIFFERENT 

2030
01:20:18,462 --> 01:20:20,397
CHARACTERISTICS. WE CALL HIM 

2031
01:20:20,397 --> 01:20:20,964
THE FIVE RS OF THE CLINICAL 

2032
01:20:20,964 --> 01:20:22,332
TRIALS.  FIRST OF ALL THEY HAVE 

2033
01:20:22,332 --> 01:20:24,968
TO ASK A QUESTION THAT IS 

2034
01:20:24,968 --> 01:20:28,739
RELEVANT TO PATIENT CARE, IN A 

2035
01:20:28,739 --> 01:20:31,041
VERY PRACTICAL WAY. THE TRIAL 

2036
01:20:31,041 --> 01:20:34,311
ITSELF NEED TO BE PRACTICED IN 

2037
01:20:34,311 --> 01:20:36,647
WHAT WE CALL A REAL-WORLD 

2038
01:20:36,647 --> 01:20:37,147
SETTING. NOT A RESEARCH 

2039
01:20:37,147 --> 01:20:37,914
ENVIRONMENT, BUT AN ACTUAL 

2040
01:20:37,914 --> 01:20:39,149
PLACE LIKE A CLINIC OR 

2041
01:20:39,149 --> 01:20:41,418
HOSPITAL, ETC., WHERE 

2042
01:20:41,418 --> 01:20:42,819
HEALTHCARE IS BEING PRACTICED.

2043
01:20:42,819 --> 01:20:45,622
THE POPULATION THAT IS TESTED 

2044
01:20:45,622 --> 01:20:48,692
NEED TO BE REPRESENTATIVE OF 

2045
01:20:48,692 --> 01:20:50,894
THE RELEVANT POPULATION, 

2046
01:20:50,894 --> 01:20:55,298
INCLUDING REPRESENTATION OF 

2047
01:20:55,298 --> 01:20:55,866
VARIOUS DIFFERENT CIRCLES. 

2048
01:20:55,866 --> 01:20:59,369
RACIAL, ETHNIC GROUPS, 

2049
01:20:59,369 --> 01:21:01,338
SEX/GENDER, ETC.

2050
01:21:01,338 --> 01:21:03,440
IMPORTANTLY THE DATA COLLECTION 

2051
01:21:03,440 --> 01:21:06,410
NEEDS TO BE REALLY KIND OF PART 

2052
01:21:06,410 --> 01:21:08,945
AND PARCEL OF CARE.  ONE 

2053
01:21:08,945 --> 01:21:12,349
EXAMPLE OF THAT IS TO DIRECTLY 

2054
01:21:12,349 --> 01:21:15,786
USE HEALTH RECORDS FOR EXAMPLE 

2055
01:21:15,786 --> 01:21:22,426
TO USE AS COLLECTIVELY ARE 

2056
01:21:22,426 --> 01:21:24,494
GENERATED BY THE PRACTITIONERS 

2057
01:21:24,494 --> 01:21:25,128
THEMSELVES. AND FINALLY IT HAS 

2058
01:21:25,128 --> 01:21:26,630
TO BE RIGOROUS. THIS IS REALLY 

2059
01:21:26,630 --> 01:21:30,701
IMPORTANT.

2060
01:21:30,701 --> 01:21:32,536
SOMETIMES PRAGMATIC TRIALS GET 

2061
01:21:32,536 --> 01:21:33,136
REPETITION OF BEING RESEARCH 

2062
01:21:33,136 --> 01:21:37,207
DONE IN AN UNCONTROLLED WAY. 

2063
01:21:37,207 --> 01:21:38,575
THE COULD NOT BE FURTHEST FROM 

2064
01:21:38,575 --> 01:21:40,644
THE TRUTH. THE WAY OF 

2065
01:21:40,644 --> 01:21:41,778
PERFORMING PRAGMATIC TRIAL IN A 

2066
01:21:41,778 --> 01:21:44,614
GROUP IS TO RANDOMIZE.  

2067
01:21:44,614 --> 01:21:47,284
SECONDLY,  REALLY LOOK AT 

2068
01:21:47,284 --> 01:21:47,884
CONFOUNDERS. LOOK AT ALL THE 

2069
01:21:47,884 --> 01:21:49,119
FACTORS THAT COULD BE AFFECTING 

2070
01:21:49,119 --> 01:21:50,787
THE RESULTS BESIDES CLINICAL 

2071
01:21:50,787 --> 01:21:53,290
QUESTIONS BEING ASKED. 

2072
01:21:53,290 --> 01:21:53,790
SO THE ART OF DOING THESE 

2073
01:21:53,790 --> 01:21:54,491
TRIALS IS TO DO THEM IN A 

2074
01:21:54,491 --> 01:21:57,461
RIGOROUS WAY.  WHERE WE ENTER 

2075
01:21:57,461 --> 01:21:58,261
THE PRAGMATIC TRIALS. NEXT 

2076
01:21:58,261 --> 01:22:08,371
SLIDE.

2077
01:22:14,945 --> 01:22:15,479
SO, WHY ARE IS A PRAGMATIC 

2078
01:22:15,479 --> 01:22:16,613
TRIAL COLLABORATIV?  WHAT IS 

2079
01:22:16,613 --> 01:22:18,115
MEANT TO DO. REALLY TO CREATE 

2080
01:22:18,115 --> 01:22:19,149
AND PARTICIPATE IN WHAT WE CALL 

2081
01:22:19,149 --> 01:22:20,550
LEARNING HEALTHCARE SYSTEM. 

2082
01:22:20,550 --> 01:22:28,725
WHAT IS THAT?

2083
01:22:28,725 --> 01:22:29,259
THIS IS REALLY A HEALTHCARE 

2084
01:22:29,259 --> 01:22:29,793
SYSTEM THAT UTILIZES, IS 

2085
01:22:29,793 --> 01:22:31,461
ACTIVELY ENGAGED IN PERFORMING 

2086
01:22:31,461 --> 01:22:33,730
AND USHERING AND INTERPRETING 

2087
01:22:33,730 --> 01:22:35,932
RESULTS OF EMBEDDED, 

2088
01:22:35,932 --> 01:22:38,735
LARGE-SCALE STUDIES THAT 

2089
01:22:38,735 --> 01:22:40,237
ACTUALLY ENGAGE WITH THE 

2090
01:22:40,237 --> 01:22:40,704
HEALTHCARE SYSTEM AND 

2091
01:22:40,704 --> 01:22:41,471
HEALTHCARE DELIVERY 

2092
01:22:41,471 --> 01:22:47,644
ORGANIZATIONS THEMSELVES.  SUCH 

2093
01:22:47,644 --> 01:22:48,245
THAT THERE ARE PARTNERS. THE 

2094
01:22:48,245 --> 01:22:51,081
HEALTHCARE SYSTEM IS IN 

2095
01:22:51,081 --> 01:22:51,715
PARTNERSHIP WITH THE DESIGN OF 

2096
01:22:51,715 --> 01:22:52,315
THE STUDY, IN CONDUCTING THE 

2097
01:22:52,315 --> 01:22:55,185
STUDY, AND GATHERING AND 

2098
01:22:55,185 --> 01:22:56,887
INTERPRETING THE RESULTS. AND 

2099
01:22:56,887 --> 01:23:05,595
FINALLY, (AUDIO LOST)

2100
01:23:05,595 --> 01:23:08,832
>> YEAH, SHE SAID SHE WAS
GOING 

2101
01:23:08,832 --> 01:23:10,934
TO CALL IN, IF SHE HAD TROUBLE. 

2102
01:23:10,934 --> 01:23:17,307
>> (NO AUDIO)

2103
01:23:17,307 --> 01:23:19,109
>> MY BE IN BUILDING 31,
WHERE 

2104
01:23:19,109 --> 01:23:23,180
I AM HAVING TROUBLE TOO. 

2105
01:23:23,180 --> 01:23:23,713
>> ... WITH NO RELEVANCE
TO 

2106
01:23:23,713 --> 01:23:25,515
CONTINUE THE CYCLE. HOW TO USE 

2107
01:23:25,515 --> 01:23:26,983
SOMETHING LIKE THIS SUCH AS 

2108
01:23:26,983 --> 01:23:27,584
HEALTHCARE CAN IMPROVE AS A 

2109
01:23:27,584 --> 01:23:29,853
RESULT? 

2110
01:23:29,853 --> 01:23:34,057
>> HELEN? MAYBE YOU SHOULD
SHUT 

2111
01:23:34,057 --> 01:23:34,624
OFF YOUR VIDEO NOW. WE JUST 

2112
01:23:34,624 --> 01:23:37,027
LOST YOU A SECOND AGO. 

2113
01:23:37,027 --> 01:23:38,628
>> IS IT BETTER?

2114
01:23:38,628 --> 01:23:42,399
>> YEAH. 

2115
01:23:42,399 --> 01:23:45,135
>> GO BACK A SLIDE? WHERE
DID 

2116
01:23:45,135 --> 01:23:47,804
YOU LOSE ME?

2117
01:23:47,804 --> 01:23:50,240
>> YOU CAN START WITH THIS
ONE. 

2118
01:23:50,240 --> 01:23:52,809
>> WITH THIS ONE? THE
LEARNING 

2119
01:23:52,809 --> 01:23:54,110
HEALTHCARE SYSTEM. I WILL SAY 

2120
01:23:54,110 --> 01:23:57,013
THAT AGAIN QUICKLY.  SO THE 

2121
01:23:57,013 --> 01:23:58,048
IDEA OF A LEARNING HEALTHCARE 

2122
01:23:58,048 --> 01:24:08,491
SYSTEM IS WHERE PRAGMATIC 

2123
01:24:10,660 --> 01:24:11,228
TRIALS ACTUALLY PERFORM IN THE 

2124
01:24:11,228 --> 01:24:11,862
CONTEXT OF THE HEALTHCARE SUCH 

2125
01:24:11,862 --> 01:24:12,462
THAT THE RESULTS OF THE STUDY 

2126
01:24:12,462 --> 01:24:17,400
ARE IMPLEMENTED BY THE 

2127
01:24:17,400 --> 01:24:18,034
HEALTHCARE SYSTEM FORMING SORT 

2128
01:24:18,034 --> 01:24:18,835
OF THE LEARNING CYCLE OF 

2129
01:24:18,835 --> 01:24:20,337
LEARNING AND FINALLY GENERATING 

2130
01:24:20,337 --> 01:24:22,439
MORE CLINICAL QUESTIONS. 

2131
01:24:22,439 --> 01:24:24,441
THE IMPORTANT THING TO ACHIEVE 

2132
01:24:24,441 --> 01:24:25,008
THAT IS THAT THE HEALTHCARE 

2133
01:24:25,008 --> 01:24:26,409
SYSTEM NEEDS TO BE A PARTNER IN 

2134
01:24:26,409 --> 01:24:30,447
THE RESEARCH.  SUCH THAT THE 

2135
01:24:30,447 --> 01:24:31,014
RESEARCH QUESTIONS THAT ARE 

2136
01:24:31,014 --> 01:24:31,548
ASKED ARE QUESTIONS THAT 

2137
01:24:31,548 --> 01:24:34,351
ACTUALLY MATTER TO THE PEOPLE 

2138
01:24:34,351 --> 01:24:37,087
WHO ARE PERFORMING THE CARE.  

2139
01:24:37,087 --> 01:24:37,721
SUCH THAT THEY ARE INVESTED IN 

2140
01:24:37,721 --> 01:24:48,231
THE RESULTS. AND, (AUDIO LOST)

2141
01:24:49,266 --> 01:24:49,866
>> IT MIGHT BE BETTER TO
SWITCH 

2142
01:24:49,866 --> 01:25:00,110
TO THE PHONE. 

2143
01:25:09,152 --> 01:25:13,089
>> LET ME SENS HER A CHAT.

2144
01:25:13,089 --> 01:25:15,358
>> I'M SWITCHING TO A
DIFFERENT 

2145
01:25:15,358 --> 01:25:15,926
SYSTEM. HOW ABOUT NOW? ANY 

2146
01:25:15,926 --> 01:25:17,227
BETTER? 

2147
01:25:17,227 --> 01:25:20,397
>> SO FAR. 

2148
01:25:20,397 --> 01:25:23,333
>> SO, DID YOU HEAR WHAT I
SAID 

2149
01:25:23,333 --> 01:25:24,634
ABOUT THE LEARNING HEALTHCARE 

2150
01:25:24,634 --> 01:25:29,272
SYSTEM?

2151
01:25:29,272 --> 01:25:33,209
>> I THINK SO. 

2152
01:25:33,209 --> 01:25:38,949
>> GETTING A CYCLE WHERE
WE ASK 

2153
01:25:38,949 --> 01:25:39,582
RESEARCH QUESTIONS ARE RELEVANT 

2154
01:25:39,582 --> 01:25:42,452
TO THE HEALTHCARE SYSTEM, AND 

2155
01:25:42,452 --> 01:25:42,986
THE HEALTHCARE SYSTEM IS 

2156
01:25:42,986 --> 01:25:44,854
INVESTED IN THE RESULTS OF THE 

2157
01:25:44,854 --> 01:25:45,422
STUDY, AND IN IMPLEMENTING 

2158
01:25:45,422 --> 01:25:46,523
THESE RESULTS IN THE CONTEXT OF 

2159
01:25:46,523 --> 01:25:49,826
THEIR CARE. WHICH CREATES A 

2160
01:25:49,826 --> 01:25:51,795
LEARNING CYCLE. 

2161
01:25:51,795 --> 01:25:53,797
STILL OKAY? STILL HEARING ME?

2162
01:25:53,797 --> 01:25:55,131
>> YES. 

2163
01:25:55,131 --> 01:26:05,342
>> NEXT SLIDE. 

2164
01:26:12,382 --> 01:26:12,916
ESSENTIALLY, THE PRAGMATIC 

2165
01:26:12,916 --> 01:26:14,651
TRIAL COLLABORATIVE, I'VE BEEN 

2166
01:26:14,651 --> 01:26:20,023
AT NIH SINCE 2012, THIS WAS A 

2167
01:26:20,023 --> 01:26:20,557
STUDY, A PROGRAM THAT WAS 

2168
01:26:20,557 --> 01:26:22,892
INITIALLY STARTED BY THE NIH 

2169
01:26:22,892 --> 01:26:25,595
COMMON FUND.  IT HAS BEEN GOING 

2170
01:26:25,595 --> 01:26:35,405
ON EVER SINCE. 

2171
01:26:35,405 --> 01:26:36,006
INITIALLY, THE FUNDING FOR THE 

2172
01:26:36,006 --> 01:26:40,210
COMMON FUND, PROGRAM OUT OF THE 

2173
01:26:40,210 --> 01:26:44,214
NIH'S DIRECTORS OFFICE WAS VERY 

2174
01:26:44,214 --> 01:26:44,814
ACCESSIBLE IN THE TRANSITION 

2175
01:26:44,814 --> 01:26:48,752
FROM A COMMON FUND TO SUPPORT 

2176
01:26:48,752 --> 01:26:50,520
FROM THE NIH INSTITUTES AND 

2177
01:26:50,520 --> 01:26:52,822
CENTERS.  RECENTLY INTEGRATED 

2178
01:26:52,822 --> 01:26:56,926
WITH THE NIH HEAL INITIATIVE 

2179
01:26:56,926 --> 01:27:00,630
WHICH I WILL TELL YOU ABOUT.  

2180
01:27:00,630 --> 01:27:04,667
AND ALSO HAS SPAWNED DIFFERENT 

2181
01:27:04,667 --> 01:27:05,268
OTHER INITIATIVES AROUND THE 

2182
01:27:05,268 --> 01:27:08,204
SAME KIND OF THEME. ONE OF THEM 

2183
01:27:08,204 --> 01:27:09,939
BEING THE PAIN MANAGEMENT 

2184
01:27:09,939 --> 01:27:10,507
COLLABORATORY, AND ALSO THE 

2185
01:27:10,507 --> 01:27:13,910
IMPACT OF COLLABORATORY -- 

2186
01:27:13,910 --> 01:27:24,454
ISSUES AROUND AGING. NEXT SLIDE.

2187
01:27:26,623 --> 01:27:27,757
AN IMPORTANT PART OF THE 

2188
01:27:27,757 --> 01:27:33,029
PRAGMATIC TRIAL'S 

2189
01:27:33,029 --> 01:27:33,663
COLLABORATORY, IS IT PROVIDES A 

2190
01:27:33,663 --> 01:27:35,231
WEALTH AND EXPERTISE IN VERY 

2191
01:27:35,231 --> 01:27:37,467
IMPORTANT AREAS INCLUDING 

2192
01:27:37,467 --> 01:27:39,903
BIOSTATISTICS AND STUDY DESIGN, 

2193
01:27:39,903 --> 01:27:43,173
ETHICS, ELECTRONIC HEALTH 

2194
01:27:43,173 --> 01:27:44,874
RECORDS, HEALTHCARE SYSTEMS 

2195
01:27:44,874 --> 01:27:46,943
INTERACTIONS, AS WELL AS HEALTH 

2196
01:27:46,943 --> 01:27:47,577
EQUITY. AND ALSO IMPLEMENTATION 

2197
01:27:47,577 --> 01:27:50,613
OF SCIENCE.  AND SO THERE ARE 

2198
01:27:50,613 --> 01:27:53,817
IN ADDITION TO THIS, THERE ARE 

2199
01:27:53,817 --> 01:27:55,351
WORKING GROUPS THAT HAVE HELPED 

2200
01:27:55,351 --> 01:27:57,454
THE INVESTIGATORS TO DESIGN THE 

2201
01:27:57,454 --> 01:27:58,588
STUDIES AND TO RUN THEM, ETC., 

2202
01:27:58,588 --> 01:28:05,695
AND TO MAKE SURE THAT THE STUDY 

2203
01:28:05,695 --> 01:28:06,729
HAS THE OUTCOME THAT IS MOST 

2204
01:28:06,729 --> 01:28:11,468
POSITIVELY USEFUL. NEXT SLIDE.

2205
01:28:11,468 --> 01:28:14,070
SO JUST TO GIVE YOU A SENSE OF 

2206
01:28:14,070 --> 01:28:15,472
THE VAST NUMBER OF PARTNERS 

2207
01:28:15,472 --> 01:28:19,776
THAT THE COLLABORATORY HAS NOW 

2208
01:28:19,776 --> 01:28:21,411
BEEN WORKING WITH OVERALL THESE 

2209
01:28:21,411 --> 01:28:25,148
YEARS. THERE'S BEEN 32 

2210
01:28:25,148 --> 01:28:26,483
PRAGMATIC TRIALS INVOLVING 13 

2211
01:28:26,483 --> 01:28:29,619
DIFFERENT NIH INSTITUTES AND 

2212
01:28:29,619 --> 01:28:32,489
CENTERS YOU CAN SEE OVER 1000 

2213
01:28:32,489 --> 01:28:33,022
CLINICAL SITES, ALMOST A 

2214
01:28:33,022 --> 01:28:36,126
MILLION PARTICIPANTS. AND VERY 

2215
01:28:36,126 --> 01:28:37,060
IMPRESSIVE SUCCESS IN TERMS OF 

2216
01:28:37,060 --> 01:28:39,295
PUBLICATIONS, DISSEMINATIONS, 

2217
01:28:39,295 --> 01:28:40,763
ETC., IN A VERY SUCCESSFUL 

2218
01:28:40,763 --> 01:28:43,166
GRAND ROUNDS SERIES THAT IS 

2219
01:28:43,166 --> 01:28:48,571
WELL ATTENDED.  AS WELL AS A 

2220
01:28:48,571 --> 01:28:49,205
WEBSITE THAT HAS WHAT IS CALLED 

2221
01:28:49,205 --> 01:28:52,642
A LIVING TEXTBOOK FOR PEOPLE 

2222
01:28:52,642 --> 01:28:55,245
CONSTANTLY ARE UPDATED ON BEST 

2223
01:28:55,245 --> 01:28:56,312
PRACTICES, AND THEIR USEFUL 

2224
01:28:56,312 --> 01:28:58,715
INFORMATION ALL CONDUCTING 

2225
01:28:58,715 --> 01:29:02,719
PRAGMATIC TRIALS. NEXT SLIDE.

2226
01:29:02,719 --> 01:29:05,121
THIS SHOWS YOU WHAT KIND OF 

2227
01:29:05,121 --> 01:29:08,091
MOSAIC OF ALL THE TRIALS THAT 

2228
01:29:08,091 --> 01:29:17,333
HAVE BEEN FUNDED SO FAR BY THE 

2229
01:29:17,333 --> 01:29:18,902
COLLABORATORY. IN YELLOW IS A 

2230
01:29:18,902 --> 01:29:19,869
SHOW OF THE STUDIES ARE NOW 

2231
01:29:19,869 --> 01:29:26,075
PART OF HEAL.  ALSO AS IN 

2232
01:29:26,075 --> 01:29:26,676
GREEN. THOSE ARE OUTLINED IN 

2233
01:29:26,676 --> 01:29:27,744
YELLOW ARE PART OF A HEAL 

2234
01:29:27,744 --> 01:29:33,950
PROGRAM CALLED PRISM, PRAGMATIC 

2235
01:29:33,950 --> 01:29:35,318
AND IMPLICATIONS STUDIES THE 

2236
01:29:35,318 --> 01:29:37,921
MANAGEMENT OF PAIN TO REDUCE 

2237
01:29:37,921 --> 01:29:40,623
OPIOID PRESCRIBING. ALL 

2238
01:29:40,623 --> 01:29:43,526
PRAGMATIC STUDIES, THE 

2239
01:29:43,526 --> 01:29:44,427
PRAGMATIC MODEL OF SELLING 

2240
01:29:44,427 --> 01:29:45,828
ABOUT. AND THEY UTILIZE THE 

2241
01:29:45,828 --> 01:29:49,799
PRAGMATIC TRIALS COLLABORATORY 

2242
01:29:49,799 --> 01:29:52,535
COORDINATING CENTER. AND THAT 

2243
01:29:52,535 --> 01:29:54,737
IS HOW THEY ARE CONNECTED TO 

2244
01:29:54,737 --> 01:29:55,872
THE PRAGMATIC TRIALS 

2245
01:29:55,872 --> 01:29:59,609
COLLABORATORY. 

2246
01:29:59,609 --> 01:30:02,245
AND THE STUDIES GREENER STUDIES 

2247
01:30:02,245 --> 01:30:04,147
THERE ARE ABOUT RURAL PAIN 

2248
01:30:04,147 --> 01:30:04,781
MANAGEMENT. AND THESE ARE AGAIN 

2249
01:30:04,781 --> 01:30:07,784
PRAGMATIC STUDIES THAT ARE 

2250
01:30:07,784 --> 01:30:10,286
CONNECTED TO THE PRAGMATIC 

2251
01:30:10,286 --> 01:30:12,555
TRIALS COLLABORATORY.  NEXT 

2252
01:30:12,555 --> 01:30:14,991
SLIDE.

2253
01:30:14,991 --> 01:30:16,259
THIS SLIDE SHOWS YOU WHAT TYPES 

2254
01:30:16,259 --> 01:30:18,695
OF STUDIES THESE ARE.  YOU CAN 

2255
01:30:18,695 --> 01:30:21,264
SEE THE ONE AT THE TOP. THERE 

2256
01:30:21,264 --> 01:30:22,599
ARE SEVEN STUDIES THAT ARE PART 

2257
01:30:22,599 --> 01:30:26,636
OF THE PRISM PROGRAM AND THREE 

2258
01:30:26,636 --> 01:30:28,771
IN PAIN MANAGEMENT. DISCOVER A 

2259
01:30:28,771 --> 01:30:32,642
RANGE OF NONPHARMACOLOGICAL 

2260
01:30:32,642 --> 01:30:35,745
STUDIES, RANGING FROM 

2261
01:30:35,745 --> 01:30:37,747
ACUPUNCTURE TO TRANSCUTANEOUS 

2262
01:30:37,747 --> 01:30:41,784
NERVE STIMULATION, GUIDED 

2263
01:30:41,784 --> 01:30:43,186
RELAXATION; THERE IS 

2264
01:30:43,186 --> 01:30:44,854
MINDFULNESS. AS WELL AS A 

2265
01:30:44,854 --> 01:30:49,659
VARIETY OF MANAGEMENT  MODELS 

2266
01:30:49,659 --> 01:30:59,636
IN THE RURAL CARE STUDIES. I 

2267
01:30:59,636 --> 01:31:00,270
WANT TO HIGHLIGHT THE ONE AT TO 

2268
01:31:00,270 --> 01:31:00,837
1 OF THE TOP. THE PRAGMATIC 

2269
01:31:00,837 --> 01:31:01,504
TRIAL OF ACUPUNCTURE. THE STUDY 

2270
01:31:01,504 --> 01:31:02,138
WAS DONE IN COLLABORATION WITH 

2271
01:31:02,138 --> 01:31:06,509
CMS.  THE STUDY IS TIED TO 

2272
01:31:06,509 --> 01:31:08,978
COVERAGE DETERMINATION. SO WHAT 

2273
01:31:08,978 --> 01:31:11,714
I WAS DISCUSSING EARLIER ABOUT 

2274
01:31:11,714 --> 01:31:12,148
STUDYING HEALTHCARE 

2275
01:31:12,148 --> 01:31:12,815
REIMBURSEMENT PATTERNS IS VERY 

2276
01:31:12,815 --> 01:31:15,551
RELEVANT HERE.  SO YOU CAN SEE 

2277
01:31:15,551 --> 01:31:20,890
THAT THE CMS HAS COMMITTED TO 

2278
01:31:20,890 --> 01:31:22,425
UTILIZING THE RESOURCES OF THE 

2279
01:31:22,425 --> 01:31:22,925
STUDY IN ORDER TO MAKE 

2280
01:31:22,925 --> 01:31:23,559
DECISIONS ABOUT COVERAGE. NEXT 

2281
01:31:23,559 --> 01:31:27,563
SLIDE.

2282
01:31:27,563 --> 01:31:30,066
THIS IS TO SHOW YOU HOW THE 

2283
01:31:30,066 --> 01:31:32,935
STUDIES ARE PROGRESSING. YOU 

2284
01:31:32,935 --> 01:31:34,604
CAN SEE THAT DESPITE SOME 

2285
01:31:34,604 --> 01:31:38,141
CHALLENGES DURING THE PANDEMIC, 

2286
01:31:38,141 --> 01:31:40,476
MANY OF THE STUDIES ARE NOW-- 

2287
01:31:40,476 --> 01:31:44,147
YOU SEE THE TOP SEVEN-- THREE 

2288
01:31:44,147 --> 01:31:44,781
OF THE SEVEN HAVE MET THEIR 

2289
01:31:44,781 --> 01:31:47,150
ENROLLMENT TARGETS. AND THE 

2290
01:31:47,150 --> 01:31:50,720
OTHER ONES ARE ON TRACK, THEY 

2291
01:31:50,720 --> 01:31:51,354
ARE CATCHING UP PRETTY QUICKLY 

2292
01:31:51,354 --> 01:31:52,955
AFTER A SLOWDOWN IN ENROLLMENT 

2293
01:31:52,955 --> 01:31:55,858
DURING THE PANDEMIC. BUT NOW, 

2294
01:31:55,858 --> 01:31:57,627
THEY ARE DOING QUITE WELL.

2295
01:31:57,627 --> 01:32:02,365
THE BOTTOM THREE ARE STILL IN 

2296
01:32:02,365 --> 01:32:02,999
THE PILOT PHASE, THE ONE IN THE 

2297
01:32:02,999 --> 01:32:07,804
RURAL PAIN PROGRAM. NEXT SLIDE.

2298
01:32:07,804 --> 01:32:09,305
I PRESUME YOU'RE STILL HEARING 

2299
01:32:09,305 --> 01:32:15,445
ME. RIGHT? THIS SHOWS YOU A 

2300
01:32:15,445 --> 01:32:17,146
TIMELINE, JUST TO SHOW YOU HOW 

2301
01:32:17,146 --> 01:32:22,018
THIS IS GOING ON SINCE 2019, 

2302
01:32:22,018 --> 01:32:27,623
WHEN THE HEAL INITIATIVE 

2303
01:32:27,623 --> 01:32:28,224
STARTED TO FUND STUDIES THAT 

2304
01:32:28,224 --> 01:32:30,259
UTILIZED THE PRAGMATIC TRIALS 

2305
01:32:30,259 --> 01:32:32,362
COLLABORATORY. FOUR FUNDED IN 

2306
01:32:32,362 --> 01:32:37,433
2019. TWO IN 2020. AND THE RULE 

2307
01:32:37,433 --> 01:32:38,034
PAIN MANAGEMENT STUDIES WERE 

2308
01:32:38,034 --> 01:32:44,807
ADDED IN 23 AND 24. WE 

2309
01:32:44,807 --> 01:32:45,975
ANTICIPATE THE COORDINATED PAIN 

2310
01:32:45,975 --> 01:32:47,677
CARE PROGRAM WILL ADD 3-4 

2311
01:32:47,677 --> 01:32:49,979
TRIALS ANTICIPATED FOR 2025.  

2312
01:32:49,979 --> 01:32:53,316
AND THEN, AS WE KEEP GOING, 

2313
01:32:53,316 --> 01:32:54,283
ADDITIONAL TRIALS CAN BE ADDED 

2314
01:32:54,283 --> 01:32:59,021
TO ADDRESS HEAL PRIORITIES AND 

2315
01:32:59,021 --> 01:33:01,524
GAP. 

2316
01:33:01,524 --> 01:33:02,992
NOTHING ABOUT THE MODELS WE 

2317
01:33:02,992 --> 01:33:04,660
ESTABLISHED A STRUCTURE THAT IS 

2318
01:33:04,660 --> 01:33:05,094
QUITE EASY. ALMOST 

2319
01:33:05,094 --> 01:33:07,263
PLUG-AND-PLAY. EACH TRIAL THAT 

2320
01:33:07,263 --> 01:33:08,398
WAS TO UTILIZE THE PRAGMATIC 

2321
01:33:08,398 --> 01:33:14,270
TRIALS COLLABORATORY 

2322
01:33:14,270 --> 01:33:14,837
COORDINATING CENTER CAN PAY 

2323
01:33:14,837 --> 01:33:21,411
RELATIVELY MODEST ANNUAL SUM OF 

2324
01:33:21,411 --> 01:33:22,412
MONEY TO UTILIZE THE 

2325
01:33:22,412 --> 01:33:23,646
COORDINATING CENTER. THAT IS 

2326
01:33:23,646 --> 01:33:24,247
EASY TO DO, AND IT GOES QUITE 

2327
01:33:24,247 --> 01:33:28,084
WELL.  NEXT SLIDE.

2328
01:33:28,084 --> 01:33:30,920
SO, I WANT TO NOW SHIFT GEARS A 

2329
01:33:30,920 --> 01:33:32,655
LITTLE BIT TO TALK ABOUT THE 

2330
01:33:32,655 --> 01:33:34,891
PAIN MANAGEMENT COOPERATIVE. 

2331
01:33:34,891 --> 01:33:35,591
THIS IS A DIFFERENT 

2332
01:33:35,591 --> 01:33:40,696
COLLABORATORY THAT IS IN THE 

2333
01:33:40,696 --> 01:33:43,099
MILITARY. IT IS A COLLABORATION 

2334
01:33:43,099 --> 01:33:50,339
BETWEEN NIH, DEPARTMENT OF 

2335
01:33:50,339 --> 01:33:52,442
DEFENSE, IN THE VETERANS 

2336
01:33:52,442 --> 01:33:53,009
ADMINISTRATION, TO TEST THE 

2337
01:33:53,009 --> 01:33:53,609
IMPLEMENTATION AND EVALUATION 

2338
01:33:53,609 --> 01:34:00,316
OF NONPHARMACOLOGICAL 

2339
01:34:00,316 --> 01:34:00,950
APPROACHES TO THE MANAGEMENT OF 

2340
01:34:00,950 --> 01:34:01,584
PAIN FUNDED IN 2017. IT NOW HAS 

2341
01:34:01,584 --> 01:34:02,652
INCLUDED PRIMARY TRIALS, SOME 

2342
01:34:02,652 --> 01:34:06,522
FUNDED BY NIH, OTHERS BY DOD 

2343
01:34:06,522 --> 01:34:08,124
AND OTHERS BY THE VA.  THIS IS 

2344
01:34:08,124 --> 01:34:11,060
BEEN VERY SUCCESSFUL.  IN FACT 

2345
01:34:11,060 --> 01:34:21,471
FOR FY 23, AND OMNIBUS 

2346
01:34:22,605 --> 01:34:23,806
APPROPRIATIONS BILL INCLUDED A 

2347
01:34:23,806 --> 01:34:24,407
CONGRESSIONAL RECOGNITION TO 

2348
01:34:24,407 --> 01:34:25,475
EXPAND ON THIS PROGRAM.  NEXT 

2349
01:34:25,475 --> 01:34:26,943
SLIDE.

2350
01:34:26,943 --> 01:34:33,049
SO, WHY THIS COLLABORATION? 

2351
01:34:33,049 --> 01:34:42,625
WELL IT HAS BEEN CLEAR THAT 

2352
01:34:42,625 --> 01:34:43,259
SERVICE MEMBERS OR VETERANS AND 

2353
01:34:43,259 --> 01:34:43,726
ACTIVE DUTY MEMBERS, 

2354
01:34:43,726 --> 01:34:44,360
DISPROPORTIONATELY SUFFER FROM 

2355
01:34:44,360 --> 01:34:47,163
PAIN. WE KNOW THAT 29% OF 

2356
01:34:47,163 --> 01:34:49,765
ACTIVE-DUTY SERVICE MEMBERS AND 

2357
01:34:49,765 --> 01:34:50,666
32% OF VETERANS HAVE CHRONIC 

2358
01:34:50,666 --> 01:34:52,668
PAIN. MANY OF THEM ARE AT HIGH 

2359
01:34:52,668 --> 01:34:56,072
RISK. MANY OF THEM OVERLAPPING 

2360
01:34:56,072 --> 01:34:58,307
WITH PTSD, TRAUMATIC BRAIN 

2361
01:34:58,307 --> 01:35:00,443
INJURY, AND DEPRESSION AND EVEN 

2362
01:35:00,443 --> 01:35:02,979
SUICIDE RISK. THIS IS A VERY 

2363
01:35:02,979 --> 01:35:04,714
VULNERABLE POPULATION THAT -- 

2364
01:35:04,714 --> 01:35:07,483
AND IT'S ALSO VERY UNIQUE 

2365
01:35:07,483 --> 01:35:10,987
SETTING. IT IS VERY INTERESTING 

2366
01:35:10,987 --> 01:35:11,521
FROM THE POINT OF VIEW OF 

2367
01:35:11,521 --> 01:35:16,092
RESEARCH. BECAUSE THIS IS AN 

2368
01:35:16,092 --> 01:35:18,094
INTEGRATED STUDY OF THE 

2369
01:35:18,094 --> 01:35:19,362
MILITARY THAT USES A SINGLE 

2370
01:35:19,362 --> 01:35:21,731
ELECTRONIC HEALTH RECORD SYSTEM.

2371
01:35:21,731 --> 01:35:23,833
 SO THE OPPORTUNITIES FOR DOING 

2372
01:35:23,833 --> 01:35:24,667
RESEARCH WHERE DATA CAN BE 

2373
01:35:24,667 --> 01:35:27,036
SHARED IS VERY, VERY GOOD. VERY 

2374
01:35:27,036 --> 01:35:29,672
HIGH.  WE HAVE BEEN TAKING FULL 

2375
01:35:29,672 --> 01:35:31,240
ADVANTAGE OF THIS. 

2376
01:35:31,240 --> 01:35:33,809
YOU CAN SEE THE EXTENT OF THIS. 

2377
01:35:33,809 --> 01:35:36,112
9 MILLION ENROLLED VETERANS 

2378
01:35:36,112 --> 01:35:39,582
EACH YEAR AS WELL AS OVER 9 

2379
01:35:39,582 --> 01:35:40,216
MILLION SERVICE MEMBERS WHO ARE 

2380
01:35:40,216 --> 01:35:43,986
BENEFICIARIES. NEXT SLIDE.

2381
01:35:43,986 --> 01:35:52,628
AND, SO ... THE ACCOMPLISHMENTS 

2382
01:35:52,628 --> 01:35:53,763
SO FAR IS THAT WE HAVE 

2383
01:35:53,763 --> 01:35:54,797
DEMONSTRATED THAT WE CAN DO 

2384
01:35:54,797 --> 01:35:56,499
RESEARCH THAT IS COORDINATED, 

2385
01:35:56,499 --> 01:35:58,534
THAT IS PRAGMATIC, THAT 

2386
01:35:58,534 --> 01:36:03,205
FULFILLS ALL OF THE GOALS OF 

2387
01:36:03,205 --> 01:36:04,707
PRAGMATIC TRIALS IN THIS 

2388
01:36:04,707 --> 01:36:06,909
SETTING. THAT WE CAN DO 

2389
01:36:06,909 --> 01:36:07,510
HARMONIZATION OF KEY OUTCOMES 

2390
01:36:07,510 --> 01:36:10,746
ACROSS STUDIES TO SUPPORT 

2391
01:36:10,746 --> 01:36:12,048
FUTURE, LARGE-SCALE 

2392
01:36:12,048 --> 01:36:14,717
META-ANALYSIS. AND ALSO THAT WE 

2393
01:36:14,717 --> 01:36:18,387
WERE ABLE TO WORK THROUGH THE 

2394
01:36:18,387 --> 01:36:22,625
CVOID-19 CHALLENGES, AND THE 

2395
01:36:22,625 --> 01:36:23,192
PUBLICATION RECORD HAS BEEN 

2396
01:36:23,192 --> 01:36:23,793
WITNESSING A LOT OF SUCCESS. 

2397
01:36:23,793 --> 01:36:29,198
NEXT SLIDE.

2398
01:36:29,198 --> 01:36:31,167
JUST A QUICK TIMELINE TO SHOW 

2399
01:36:31,167 --> 01:36:33,302
YOU HOW THIS HAS EVOLVED. 2017 

2400
01:36:33,302 --> 01:36:36,606
WAS THE BEGINNING. HEAL  

2401
01:36:36,606 --> 01:36:40,142
ACTUALLY SUPPLEMENTED TO START 

2402
01:36:40,142 --> 01:36:44,714
THIS. SINCE THEN THE PMC TRIAL 

2403
01:36:44,714 --> 01:36:46,015
HAS CONTINUED ON ITS OWN 

2404
01:36:46,015 --> 01:36:48,618
FUNDING, VARIETY OF TRIALS. AND 

2405
01:36:48,618 --> 01:36:50,119
JUST RECENTLY, WE CAN SEE IN FY 

2406
01:36:50,119 --> 01:36:56,659
24 HEAL HAS NOW  CO-FUNDED  A 

2407
01:36:56,659 --> 01:37:00,363
PORTION OF THE COORDINATING 

2408
01:37:00,363 --> 01:37:00,997
CENTER, AND WE ANTICIPATE THAT 

2409
01:37:00,997 --> 01:37:03,399
THERE WILL BE TRIALS FROM HEAL 

2410
01:37:03,399 --> 01:37:05,267
THAT WILL NOT GRAFT ON TO THE 

2411
01:37:05,267 --> 01:37:11,474
STRUCTURE. 

2412
01:37:11,474 --> 01:37:12,642
ONE QUESTION THAT SOMETIMES 

2413
01:37:12,642 --> 01:37:14,577
GETS ASKED. WHY IS THERE A 

2414
01:37:14,577 --> 01:37:15,177
SEPARATE COORDINATING CENTER 

2415
01:37:15,177 --> 01:37:17,446
FOR THE PRIMARY TRIALS 

2416
01:37:17,446 --> 01:37:19,615
COLLABORATORY AND FOR THE PAIN 

2417
01:37:19,615 --> 01:37:22,585
MANAGEMENT COLLABORATORY?

2418
01:37:22,585 --> 01:37:23,119
THE REASON FOR THAT IS THE 

2419
01:37:23,119 --> 01:37:24,420
ENVIRONMENT IS DIFFERENT. THE 

2420
01:37:24,420 --> 01:37:27,056
EXPERTISE NEEDED TO MANAGE 

2421
01:37:27,056 --> 01:37:30,926
THOSE STUDIES IS-- THE MILITARY 

2422
01:37:30,926 --> 01:37:31,427
ENVIRONMENT IS A WHOLE 

2423
01:37:31,427 --> 01:37:33,763
DIFFERENT ANIMAL FROM THE 

2424
01:37:33,763 --> 01:37:36,232
CIVILIAN HEALTHCARE SYSTEMS. 

2425
01:37:36,232 --> 01:37:37,933
AND SO THIS IS WHY WE NEED A 

2426
01:37:37,933 --> 01:37:44,607
SEPARATE COLLABORATORY, NOT 

2427
01:37:44,607 --> 01:37:48,177
THAT THE GOALS ARE ALL THAT IS 

2428
01:37:48,177 --> 01:37:48,778
SIMILAR. IT IS JUST THAT THE 

2429
01:37:48,778 --> 01:37:49,412
ENVIRONMENT IS VERY DIFFERENT. 

2430
01:37:49,412 --> 01:37:50,012
AND REALLY WANTS A SEPARATE 

2431
01:37:50,012 --> 01:37:54,884
INFRASTRUCTURE.  NEXT SLIDE.

2432
01:37:54,884 --> 01:37:56,852
SO WHAT ABOUT FUTURE DIRECTIONS?

2433
01:37:56,852 --> 01:38:00,723
 WE THINK THAT BOTH PROGRAMS 

2434
01:38:00,723 --> 01:38:02,658
CAN BE SUCCESSFULLY USED IN 

2435
01:38:02,658 --> 01:38:06,662
TRIALS FOR HEAL PRIORITIES LIKE 

2436
01:38:06,662 --> 01:38:10,599
PREVENTION OF PAIN. AND WHOLE 

2437
01:38:10,599 --> 01:38:11,200
PERSON PAIN MANAGEMENT, WHICH 

2438
01:38:11,200 --> 01:38:11,801
IS A BIG FOCUS, ESPECIALLY AT 

2439
01:38:11,801 --> 01:38:13,502
THE VA. AS WELL AS THE OVERLAP 

2440
01:38:13,502 --> 01:38:15,404
OF ADDICTION AND PAIN.  SO WE 

2441
01:38:15,404 --> 01:38:16,806
ARE VERY EXCITED TO REALLY 

2442
01:38:16,806 --> 01:38:19,241
LEVERAGE THESE TWO VERY 

2443
01:38:19,241 --> 01:38:21,343
SUCCESSFUL PROGRAMS FOR THE 

2444
01:38:21,343 --> 01:38:24,680
HEAL INITIATIVE. AND WE REALLY 

2445
01:38:24,680 --> 01:38:26,315
LOOK FORWARD TO CONTINUING THIS 

2446
01:38:26,315 --> 01:38:28,417
REALLY FRUITFUL COLLABORATION. 

2447
01:38:28,417 --> 01:38:29,018
SO THANK YOU VERY MUCH FOR YOUR 

2448
01:38:29,018 --> 01:38:30,352
ATTENTION. HAPPY TO ANSWER ANY 

2449
01:38:30,352 --> 01:38:40,563
QUESTIONS. 

2450
01:38:50,339 --> 01:38:52,608
NOT HEARING ANYTHING. 

2451
01:38:52,608 --> 01:38:58,948
>> DR. WEISS: THERE IS A
HAND 

2452
01:38:58,948 --> 01:39:01,650
RAISED. LYNN?

2453
01:39:01,650 --> 01:39:02,752
>> THANK YOU FOR GREAT 

2454
01:39:02,752 --> 01:39:04,887
PRESENTATION. I HAVE A VERY IN 

2455
01:39:04,887 --> 01:39:06,522
THE WEEDS QUESTION FOR YOU. YOU 

2456
01:39:06,522 --> 01:39:12,161
MENTIONED THAT THERE IS A 

2457
01:39:12,161 --> 01:39:12,628
COORDINATED PAIN CARE 

2458
01:39:12,628 --> 01:39:13,763
INITIATIVE THAT IS FUNDED BY 

2459
01:39:13,763 --> 01:39:18,634
HEAL EMBEDDED WITHIN PRISM. I 

2460
01:39:18,634 --> 01:39:19,201
WONDER IF YOU CAN SAY MORE 

2461
01:39:19,201 --> 01:39:21,704
ABOUT THAT. SOME OF THE 

2462
01:39:21,704 --> 01:39:22,671
ANTICIPATED TRIALS THAT WILL BE 

2463
01:39:22,671 --> 01:39:24,940
FUNDED IN THE NEAR RUN.  MAYBE 

2464
01:39:24,940 --> 01:39:27,810
I MISSED THAT. I WAS INTERESTED 

2465
01:39:27,810 --> 01:39:31,247
IN HEARING MORE. 

2466
01:39:31,247 --> 01:39:31,847
>> THE COORDINATED PAIN
CARE IS 

2467
01:39:31,847 --> 01:39:38,854
NOT PART OF PRISM> IT IS A 

2468
01:39:38,854 --> 01:39:40,756
SEPARATE INITIATIVE. THAT 

2469
01:39:40,756 --> 01:39:44,226
FOCUSES ON THESE INTEGRATED 

2470
01:39:44,226 --> 01:39:45,661
PAIN MANAGEMENT VERY 

2471
01:39:45,661 --> 01:39:47,797
SPECIFICALLY. WHEREAS PRISM IS 

2472
01:39:47,797 --> 01:39:56,138
NOT  100% -- LET'S PUT IT THIS 

2473
01:39:56,138 --> 01:39:56,505
WAY, THESE ARE 

2474
01:39:56,505 --> 01:40:01,443
MULTIDISCIPLINARY TEAMS. IT CAN 

2475
01:40:01,443 --> 01:40:02,044
BE. BUT THE COORDINATING PAIN 

2476
01:40:02,044 --> 01:40:02,611
CARE IS REALLY SPECIFICALLY 

2477
01:40:02,611 --> 01:40:04,814
TARGETING THIS. THERE'S A LOT 

2478
01:40:04,814 --> 01:40:10,953
OF, YOU KNOW, SIMILARITIES. BUT 

2479
01:40:10,953 --> 01:40:11,554
THERE SOMETHING VERY SPECIFIC 

2480
01:40:11,554 --> 01:40:12,688
ABOUT THAT INITIATIVE ABOUT 

2481
01:40:12,688 --> 01:40:15,124
COORDINATED PAIN CARE. 

2482
01:40:15,124 --> 01:40:16,992
>> THANKS FOR CLARIFYING. 

2483
01:40:16,992 --> 01:40:20,062
>> YEAH, THE -- GOAL IS
WITH 

2484
01:40:20,062 --> 01:40:24,233
THAT ONE ALSO IS TO HAVE IT 

2485
01:40:24,233 --> 01:40:29,238
PILOTED IN HEALTHCARE SYSTEMS 

2486
01:40:29,238 --> 01:40:33,209
THAT COULD ADOPT IT, SHOULD IT 

2487
01:40:33,209 --> 01:40:36,145
SHOW BENEFIT. 

2488
01:40:36,145 --> 01:40:36,712
>> AND THIS IS WHAT WE
THINK 

2489
01:40:36,712 --> 01:40:37,379
THE COLLABORATIVE WOULD BE SO 

2490
01:40:37,379 --> 01:40:39,748
HELPFUL IN HELPING IT TO BE 

2491
01:40:39,748 --> 01:40:49,191
SUCCESSFUL. 

2492
01:40:49,191 --> 01:40:51,961
>> ERIC? 

2493
01:40:51,961 --> 01:40:52,962
>> THANK YOU HELEN FOR 

2494
01:40:52,962 --> 01:40:55,631
REPRESENTATION. I WAS CURIOUS 

2495
01:40:55,631 --> 01:40:56,198
ABOUT THE COLLABORATORY AND 

2496
01:40:56,198 --> 01:40:57,099
WHETHER THE LARGER SIZE 

2497
01:40:57,099 --> 01:40:59,702
COMMUNITY IS AWARE OF THIS 

2498
01:40:59,702 --> 01:41:03,205
RESOURCE. HOW THEY ACCESS IT? A 

2499
01:41:03,205 --> 01:41:03,839
RESOURCE POTENTIALLY AVAILABLE 

2500
01:41:03,839 --> 01:41:04,874
FOR TRIALS THEY ARE PROPOSING? 

2501
01:41:04,874 --> 01:41:11,480
IS THAT WIDELY KNOWN? IF NOT 

2502
01:41:11,480 --> 01:41:12,681
HOW CAN WE GET THE WORD OUT TO 

2503
01:41:12,681 --> 01:41:13,315
OTHER PAIN RESEARCHERS AND 

2504
01:41:13,315 --> 01:41:14,450
INTEGRATED HEALTH RESEARCHERS 

2505
01:41:14,450 --> 01:41:21,290
CAN ACCESS THIS RESOURCE?

2506
01:41:21,290 --> 01:41:24,627
>> DR. LANGEVIN: THIS IS
SUCH A 

2507
01:41:24,627 --> 01:41:26,962
GREAT QUESTION.

2508
01:41:26,962 --> 01:41:28,697
HOW CAN PEOPLE GET MORE AWARE 

2509
01:41:28,697 --> 01:41:30,499
OF THIS? IT USED TO BE THE 

2510
01:41:30,499 --> 01:41:32,968
BEST-KEPT SECRET AT NIH. IT IS 

2511
01:41:32,968 --> 01:41:37,840
REALLY A RESOURCE. WE HAVE BEEN 

2512
01:41:37,840 --> 01:41:38,407
TRYING EVERYTHING INCLUDING 

2513
01:41:38,407 --> 01:41:40,743
THIS PRESENTATION TODAY TO 

2514
01:41:40,743 --> 01:41:41,277
REALLY SPREAD THE WORD TO 

2515
01:41:41,277 --> 01:41:41,911
PEOPLE UNDERSTAND THEY CAN USE 

2516
01:41:41,911 --> 01:41:43,379
IT. 

2517
01:41:43,379 --> 01:41:46,148
NOW, HOW DO YOU ACCESS IT? FOR 

2518
01:41:46,148 --> 01:41:47,149
EXAMPLE, ONE WAY WE CAN ACCESS 

2519
01:41:47,149 --> 01:41:49,618
IT USED TO BE THAT WE WOULD 

2520
01:41:49,618 --> 01:41:53,022
ISSUE RFAS.  THAT WOULD 

2521
01:41:53,022 --> 01:41:55,624
SPECIFICALLY FOR STUDIES THAT 

2522
01:41:55,624 --> 01:41:58,494
WOULD THEN UTILIZE THE 

2523
01:41:58,494 --> 01:42:00,963
COORDINATING CENTER.

2524
01:42:00,963 --> 01:42:02,164
NOW WHAT WE ARE DOING THAT IS 

2525
01:42:02,164 --> 01:42:02,731
EVEN EASIER, YOU DON'T EVEN 

2526
01:42:02,731 --> 01:42:08,470
HAVE TO RESPOND TO AN RFA.  

2527
01:42:08,470 --> 01:42:09,038
ANYBODY THAT HAS PROPOSED A 

2528
01:42:09,038 --> 01:42:10,205
STUDY WHERE THEY THINK IT MIGHT 

2529
01:42:10,205 --> 01:42:11,540
BE A GOOD FIT FOR UTILIZING THE 

2530
01:42:11,540 --> 01:42:16,111
COORDINATING CENTER, DISCUSS IT 

2531
01:42:16,111 --> 01:42:16,745
WITH THE PROGRAM STAFF AND WHAT 

2532
01:42:16,745 --> 01:42:17,379
THEY WILL DO IS THEY WILL MAKE 

2533
01:42:17,379 --> 01:42:18,814
THE LEAP TO THE COLLABORATORY.  

2534
01:42:18,814 --> 01:42:23,585
VICE VERSA. PROGRAM STAFF AND 

2535
01:42:23,585 --> 01:42:24,219
NIH STAFF CAN IDENTIFY STUDIES 

2536
01:42:24,219 --> 01:42:26,255
EVEN AFTER THEY ARE FUNDED. OH, 

2537
01:42:26,255 --> 01:42:27,189
THIS MIGHT BE A GOOD FIT FOR 

2538
01:42:27,189 --> 01:42:28,857
THE COLLABORATORY. AND THEY CAN 

2539
01:42:28,857 --> 01:42:31,794
INITIATE THE LINK. 

2540
01:42:31,794 --> 01:42:33,629
IT IS ACTUALLY VERY EASY. WE 

2541
01:42:33,629 --> 01:42:36,231
CALL IT PLUG-AND-PLAY. IT IS 

2542
01:42:36,231 --> 01:42:38,834
QUITE EASY. SOME PEOPLE 

2543
01:42:38,834 --> 01:42:40,602
SOMETIMES GET CONFUSED. THEY 

2544
01:42:40,602 --> 01:42:44,340
THINK THAT THE COLLABORATORY IS 

2545
01:42:44,340 --> 01:42:54,883
ITS HAS ITS OWN CLINICAL TRIAL 

2546
01:42:55,417 --> 01:42:55,985
NETWORK. IT DOESN'T. IT IS ONLY 

2547
01:42:55,985 --> 01:42:58,454
A RESOURCE.  ONE WAY TO 

2548
01:42:58,454 --> 01:43:00,622
UNDERSTAND IT IS TO VISIT THE 

2549
01:43:00,622 --> 01:43:02,691
WEBSITE. THE BEST WAY TO 

2550
01:43:02,691 --> 01:43:03,625
REMEMBER WHAT THE WEBSITE IS, 

2551
01:43:03,625 --> 01:43:07,096
IF YOU TYPE "REINVENTING 

2552
01:43:07,096 --> 01:43:08,430
CLINICAL TRIALS." YOU WILL GET 

2553
01:43:08,430 --> 01:43:12,368
THERE. 

2554
01:43:12,368 --> 01:43:16,005
AND, THE WEBSITE HAS ALL THE 

2555
01:43:16,005 --> 01:43:16,505
DETAILS, ABOUT ALL THE 

2556
01:43:16,505 --> 01:43:19,808
RESOURCES THAT ARE AVAILABLE TO 

2557
01:43:19,808 --> 01:43:20,442
ANYBODY WHO WANTS TO VISIT THE 

2558
01:43:20,442 --> 01:43:29,284
WEBSITE. FIRST OF ALL. AND ALSO 

2559
01:43:29,284 --> 01:43:29,885
SPECIFICALLY TO INVESTIGATORS 

2560
01:43:29,885 --> 01:43:31,186
WHOSE STUDIES ARE CONNECTED TO 

2561
01:43:31,186 --> 01:43:33,088
THE COLLABORATORY.  IT IS TRULY 

2562
01:43:33,088 --> 01:43:35,224
EXCELLENT. CANNOT RECOMMEND IT 

2563
01:43:35,224 --> 01:43:36,525
ENOUGH. 

2564
01:43:36,525 --> 01:43:40,562
>> THANK YOU SO MUCH. 

2565
01:43:40,562 --> 01:43:46,835
>> AND DR. LANGEVIN, I
HAVE A 

2566
01:43:46,835 --> 01:43:48,337
QUESTION. GREAT RESOURCE. MY 

2567
01:43:48,337 --> 01:43:53,042
UNDERSTANDING IS IN VA 

2568
01:43:53,042 --> 01:43:55,411
HOSPITALS, DOCTORS CANNOT 

2569
01:43:55,411 --> 01:43:57,446
PRESCRIBE MARIJUANA. BUT AT THE 

2570
01:43:57,446 --> 01:44:00,682
SAME TIME, WE KNOW THAT ONE OF 

2571
01:44:00,682 --> 01:44:07,890
THE MAIN USES OF MARIJUANA, AND 

2572
01:44:07,890 --> 01:44:08,490
PARTICULARLY IN VETERANS, IS 

2573
01:44:08,490 --> 01:44:11,760
OBVIOUS. FOR PAIN. IS IT BEING 

2574
01:44:11,760 --> 01:44:16,532
RECORDED? IS A VIABLE? IS IT 

2575
01:44:16,532 --> 01:44:17,266
BEING FOLLOWED UP?

2576
01:44:17,266 --> 01:44:19,635
>> DR. LANGEVIN: WELL I
DON'T 

2577
01:44:19,635 --> 01:44:22,037
KNOW THE ANSWER TO THIS.  I 

2578
01:44:22,037 --> 01:44:22,671
WOULD BE INTERESTED TO KNOW THE 

2579
01:44:22,671 --> 01:44:24,306
ANSWER MYSELF. I DON'T KNOW. 

2580
01:44:24,306 --> 01:44:28,143
GOOD QUESTION. DAVID--  I DON'T 

2581
01:44:28,143 --> 01:44:30,345
KNOW IF DAVID IS ARTICLE.  HE 

2582
01:44:30,345 --> 01:44:31,914
MIGHT KNOW. 

2583
01:44:31,914 --> 01:44:33,649
>> IT IS A GREAT QUESTION.
IT 

2584
01:44:33,649 --> 01:44:34,716
IS SOMETHING WE SHOULD EXPLORE. 

2585
01:44:34,716 --> 01:44:38,087
IN THEORY THE EHR SHOULD HAVE 

2586
01:44:38,087 --> 01:44:39,488
SOME RECOMMENDATION. BUT YOU 

2587
01:44:39,488 --> 01:44:44,626
ARE RIGHT. UNDER FEDERAL LAW, 

2588
01:44:44,626 --> 01:44:45,260
PHYSICIANS CANNOT PRESCRIBE IT, 

2589
01:44:45,260 --> 01:44:45,861
BUT THEY MAY BE CAPTURING IT. 

2590
01:44:45,861 --> 01:44:53,836
AND I KNOW NCR IS DOING A LARGE 

2591
01:44:53,836 --> 01:44:54,403
MULTISTATE STUDY LOOKING AT 

2592
01:44:54,403 --> 01:44:55,270
CANCER PATIENTS'USE OF 

2593
01:44:55,270 --> 01:45:00,609
CANNABIS, FOR REASONS OF DRUG 

2594
01:45:00,609 --> 01:45:01,143
INTERACTIONS AMONG CANCER 

2595
01:45:01,143 --> 01:45:02,177
PATIENTS. GREAT QUESTION FOR 

2596
01:45:02,177 --> 01:45:02,811
THE VA. WE COULD FOLLOW-UP AND 

2597
01:45:02,811 --> 01:45:03,979
GET YOU AN ANSWER. 

2598
01:45:03,979 --> 01:45:07,749
>> THANK YOU DAVID. 

2599
01:45:07,749 --> 01:45:14,723
>> NORA? SORRY. >>
NOW IT IS MY 

2600
01:45:14,723 --> 01:45:20,696
TURN TO INTRODUCE ACTUALLY THE 

2601
01:45:20,696 --> 01:45:25,434
NEXT SPEAKER. ONE SECOND. I 

2602
01:45:25,434 --> 01:45:26,568
HAVE ALL OF MY SCREENS. 

2603
01:45:26,568 --> 01:45:32,307
I'M INTRODUCING TISHA WILEY, 

2604
01:45:32,307 --> 01:45:32,941
THE PLEASURE TO INTRODUCE HER. 

2605
01:45:32,941 --> 01:45:41,350
SHE IS THE LEAD PERSON ON J 

2606
01:45:41,350 --> 01:45:41,950
COINT, WITH HER TEAM SHE HAS 

2607
01:45:41,950 --> 01:45:42,551
MADE IT POSSIBLE TO SERVE AS 

2608
01:45:42,551 --> 01:45:44,119
THE BRANCH CHIEF OF NATIONAL 

2609
01:45:44,119 --> 01:45:49,024
INSTITUTES -- OF NATIONAL 

2610
01:45:49,024 --> 01:45:54,863
INSTITUTES (CORRECTION) NIDA 

2611
01:45:54,863 --> 01:45:55,864
DIVISION OF EPIDEMIOLOGY. AND 

2612
01:45:55,864 --> 01:46:00,035
THIS INCLUDES NIDA JUSTICE 

2613
01:46:00,035 --> 01:46:00,736
COMMUNITY AND THE OPIOID 

2614
01:46:00,736 --> 01:46:05,941
INNOVATION NETWORK, THE JCOIN.  

2615
01:46:05,941 --> 01:46:06,542
AND BEFORE THAT SHE SERVICES 

2616
01:46:06,542 --> 01:46:14,049
SCIENCE OFFICER IN JUSTICE 

2617
01:46:14,049 --> 01:46:14,583
INITIATIVES INCLUDING THE 

2618
01:46:14,583 --> 01:46:15,217
JUVENILE JUSTICE TRANSLATIONAL 

2619
01:46:15,217 --> 01:46:15,851
INTERVENTION FOR ADOLESCENTS IN 

2620
01:46:15,851 --> 01:46:16,385
THE LEGAL SYSTEMS, IN THE 

2621
01:46:16,385 --> 01:46:18,420
CRIMINAL JUSTICE PROGRAM 

2622
01:46:18,420 --> 01:46:19,288
TREATMENT STUDIES COOPERATIVE 

2623
01:46:19,288 --> 01:46:20,622
RESEARCH PROGRAMS.  DURING HER 

2624
01:46:20,622 --> 01:46:26,929
TIME AT NATIONAL INSTITUTES OF 

2625
01:46:26,929 --> 01:46:32,668
HEALTH AND NIDA, SHE HAS 

2626
01:46:32,668 --> 01:46:36,772
DEVELOPED IMPLEMENTATION 

2627
01:46:36,772 --> 01:46:37,306
STUDIES AMONG MULTIMEDIA 

2628
01:46:37,306 --> 01:46:37,906
MEASUREMENTS AMONG OTHERS. IT 

2629
01:46:37,906 --> 01:46:41,510
IS A PLEASURE TO INTRODUCE HER. 

2630
01:46:41,510 --> 01:46:42,644
DR. WILEY?

2631
01:46:42,644 --> 01:46:53,088
>> DR. WILEY: CAN I SHARE
MY 

2632
01:47:06,668 --> 01:47:12,374
SCREEN SO I CAN GO THROUGH...

2633
01:47:12,374 --> 01:47:13,909
ARE USING THE RIGHT VERSION? 

2634
01:47:13,909 --> 01:47:15,010
GOOD NOW?

2635
01:47:15,010 --> 01:47:16,912
>> NO. 

2636
01:47:16,912 --> 01:47:20,616
>> TISHA: HOLD ON.  STOP 

2637
01:47:20,616 --> 01:47:24,253
SHARING. LET ME TRY AGAIN. I AM 

2638
01:47:24,253 --> 01:47:25,320
ALREADY IN PRESENTATION MODE, 

2639
01:47:25,320 --> 01:47:28,824
THAT WAS PROBABLY THE PROBLEM. 

2640
01:47:28,824 --> 01:47:39,001
AND SHARE ...

2641
01:47:40,402 --> 01:47:41,603
NOW?

2642
01:47:41,603 --> 01:47:42,638
>> YES. 

2643
01:47:42,638 --> 01:47:44,640
>> TISHA: THANK YOU AND
SORRY 

2644
01:47:44,640 --> 01:47:48,143
FOR THAT.  THANK YOU FOR THE 

2645
01:47:48,143 --> 01:47:48,777
KIND INTRODUCTION, AND FOR THE 

2646
01:47:48,777 --> 01:47:49,378
OPPORTUNITY TO TALK TO Y'ALL 

2647
01:47:49,378 --> 01:47:51,246
AGAIN ABOUT JCOIN AND THE WORK 

2648
01:47:51,246 --> 01:48:01,757
WE ARE DOING SO NORA A LATE A 

2649
01:48:02,591 --> 01:48:03,125
LOT OF THE LOGIC OF THIS AND 

2650
01:48:03,125 --> 01:48:03,692
WANT TO START WITH WHY THE 

2651
01:48:03,692 --> 01:48:04,259
JUSTICE SYSTEM. AND YOU ALL 

2652
01:48:04,259 --> 01:48:04,893
KNOW THE NUMBERS, WHILE WE ARE 

2653
01:48:04,893 --> 01:48:07,929
IN THE VIRTUAL ROOM TODAY. TO 

2654
01:48:07,929 --> 01:48:08,497
ME PEOPLE ARE LOSING THEIR 

2655
01:48:08,497 --> 01:48:10,132
LIVES TO OVERDOSES. WE HAVE TO 

2656
01:48:10,132 --> 01:48:10,632
FIGURE OUT THE WAYS TO 

2657
01:48:10,632 --> 01:48:12,200
INTERVENE AND THE BEST WAYS TO 

2658
01:48:12,200 --> 01:48:15,203
INTERVENE IN REALLY THE JUSTICE 

2659
01:48:15,203 --> 01:48:15,737
SYSTEM REPRESENT SUCH AN 

2660
01:48:15,737 --> 01:48:17,272
IMPORTANT OPPORTUNITY WE CAN 

2661
01:48:17,272 --> 01:48:19,374
MAKE A DIFFERENCE. 

2662
01:48:19,374 --> 01:48:19,841
WE KNOW PEOPLE WHO WERE 

2663
01:48:19,841 --> 01:48:23,145
TOUCHING THE JUSTICE SYSTEM ARE 

2664
01:48:23,145 --> 01:48:23,779
DISPROPORTIONATELY REPRESENTED 

2665
01:48:23,779 --> 01:48:25,080
AMONG THE PEOPLE LOSING THEIR 

2666
01:48:25,080 --> 01:48:26,682
LIVES AND CAN BE OFTEN THEIR 

2667
01:48:26,682 --> 01:48:29,451
USE OF SUBSTANCES BRINGING THEM 

2668
01:48:29,451 --> 01:48:33,121
INTO THE SYSTEM FOR MANY YEARS 

2669
01:48:33,121 --> 01:48:33,722
WHEN PEOPLE DO GO INTO JAILS 

2670
01:48:33,722 --> 01:48:34,890
AND PRISONS AND THEY GO BACK 

2671
01:48:34,890 --> 01:48:37,025
INTO THE COMMUNITY THAT IS A 

2672
01:48:37,025 --> 01:48:37,659
PERIOD WHERE THEY ARE REALLY AT 

2673
01:48:37,659 --> 01:48:40,062
RISK FOR RELAPSE AND FOUR FATAL 

2674
01:48:40,062 --> 01:48:44,900
OVERDOSES.  PARTICULARLY AS THE 

2675
01:48:44,900 --> 01:48:47,936
DRUG SUPPLY HAS GOTTEN MORE AND 

2676
01:48:47,936 --> 01:48:48,603
MORE TALKING OVER TIME AND THE 

2677
01:48:48,603 --> 01:48:50,072
STUDY IN RHODE ISLAND, REALLY 

2678
01:48:50,072 --> 01:48:51,840
AMONG THE LEADERS IN THE 

2679
01:48:51,840 --> 01:48:54,142
COUNTRY TRYING TO EMBRACE 

2680
01:48:54,142 --> 01:48:54,776
MEDICATIONS BEING DELIVERED IN 

2681
01:48:54,776 --> 01:48:56,611
JAILS AND PRISONS.  AND THEY 

2682
01:48:56,611 --> 01:49:00,215
WERE ABLE  TO SEE GREAT SUCCESS 

2683
01:49:00,215 --> 01:49:00,716
WITH THAT APPROACH AND 

2684
01:49:00,716 --> 01:49:01,550
PROJECTED THAT HE COULD REALLY 

2685
01:49:01,550 --> 01:49:04,653
MAKE A SUBSTANTIAL REDUCTION IN 

2686
01:49:04,653 --> 01:49:06,722
OVERDOSE DEATHS. THIS POINT TO 

2687
01:49:06,722 --> 01:49:08,623
THE JUSTICE SYSTEM AND IN 

2688
01:49:08,623 --> 01:49:09,124
PARTICULAR JAILS IS AN 

2689
01:49:09,124 --> 01:49:10,692
IMPORTANT PLACE TO INTERVENE 

2690
01:49:10,692 --> 01:49:16,498
BUT IS REALLY NOT ENOUGH TO 

2691
01:49:16,498 --> 01:49:17,099
JUST THINK ABOUT JAIL OR THE 

2692
01:49:17,099 --> 01:49:17,666
CRIMINAL JUSTICE SYSTEM IN 

2693
01:49:17,666 --> 01:49:19,401
ISOLATION. 

2694
01:49:19,401 --> 01:49:19,901
IS REALLY WHAT HAPPENS IS 

2695
01:49:19,901 --> 01:49:21,269
PEOPLE RETURNED BACK, TO THE 

2696
01:49:21,269 --> 01:49:21,837
COMMUNITIES AND THE WAY THE 

2697
01:49:21,837 --> 01:49:27,042
ACCESS CARE AND ROAD POINTS, 

2698
01:49:27,042 --> 01:49:27,609
AND THE IMPORTANCE OF CROSS 

2699
01:49:27,609 --> 01:49:31,646
SECTOR PARTNERSHIPS, THAT 

2700
01:49:31,646 --> 01:49:32,381
INTERVENE IN MULTIPLE SYSTEMS.

2701
01:49:32,381 --> 01:49:32,948
THIS PICTURE HERE IS ACTUALLY 

2702
01:49:32,948 --> 01:49:33,582
FROM ONE OF OUR STUDIES THAT WE 

2703
01:49:33,582 --> 01:49:42,257
FUNDED THROUGH JCOIN OUT OF THE 

2704
01:49:42,257 --> 01:49:42,758
CHESTNUT RESEARCH HUB, 

2705
01:49:42,758 --> 01:49:43,325
NAVIGATORS IN THE COMMUNITY 

2706
01:49:43,325 --> 01:49:43,892
DOING THE OUTREACH THEY DO 

2707
01:49:43,892 --> 01:49:44,726
EVERY DAY. 

2708
01:49:44,726 --> 01:49:45,193
EVEN AS PEOPLE GO INTO 

2709
01:49:45,193 --> 01:49:48,196
TREATMENT SYSTEMS, LOTS OF 

2710
01:49:48,196 --> 01:49:48,830
CHALLENGES WITHIN THE TREATMENT 

2711
01:49:48,830 --> 01:49:50,565
SYSTEMS GENERALLY.  THOSE WHO 

2712
01:49:50,565 --> 01:49:52,334
HAVE TOUCHED THE JUSTICE SYSTEM 

2713
01:49:52,334 --> 01:49:52,934
OR EVEN AT A DISADVANTAGE IN 

2714
01:49:52,934 --> 01:49:55,804
THAT RESPECT. THIS IS A STUDY 

2715
01:49:55,804 --> 01:49:57,038
FROM JUST BEFORE WE WERE 

2716
01:49:57,038 --> 01:50:00,842
LAUNCHING JCOIN SHOWING THAT 

2717
01:50:00,842 --> 01:50:01,476
ONLY 5% OF PEOPLE REFERRED INTO 

2718
01:50:01,476 --> 01:50:03,011
THE TREATMENT SYSTEM HAD BEEN 

2719
01:50:03,011 --> 01:50:13,522
GIVEN ACCESS TO METHADONE AND 

2720
01:50:31,606 --> 01:50:32,107
BUPRENORPHINE. AND GETTING 

2721
01:50:32,107 --> 01:50:33,475
ACCESS TO THOSE MEDICATIONS. 

2722
01:50:33,475 --> 01:50:34,109
AND HOUSECLEANING INTERVENTIONS 

2723
01:50:34,109 --> 01:50:39,347
TO BE LAUNCHED JCOIN 1.0 IN 

2724
01:50:39,347 --> 01:50:39,981
2018, ONE OF THE FIRST PROGRAMS 

2725
01:50:39,981 --> 01:50:42,851
WE WERE ABLE TO GET FUNDING OUT 

2726
01:50:42,851 --> 01:50:50,459
AND WERE ABLE TO DO SOUTHERLY 

2727
01:50:50,459 --> 01:50:50,992
SUPPLEMENTS TO GET EARLY 

2728
01:50:50,992 --> 01:50:51,626
SUPPLEMENTS AND LAUNCH PROJECT 

2729
01:50:51,626 --> 01:50:52,260
QUICKLY AND IN 2019. AND LIKE 

2730
01:50:52,260 --> 01:50:54,796
MANY PROGRAMS WE WERE AFFECTED 

2731
01:50:54,796 --> 01:50:55,397
BY COVID SO A LOT OF CLINICAL 

2732
01:50:55,397 --> 01:50:56,765
TRIALS ARE GOING TO STAY IN THE 

2733
01:50:56,765 --> 01:50:58,934
FIELD A LITTLE BIT LONGER. BUT 

2734
01:50:58,934 --> 01:50:59,534
BY 2025 WE SHOULD HAVE ALL OF 

2735
01:50:59,534 --> 01:51:03,738
THE JCOIN 1.0 PROJECT LAUNCHED. 

2736
01:51:03,738 --> 01:51:04,806
CONCURRENTLY WITH INPUT AND 

2737
01:51:04,806 --> 01:51:11,580
SUPPORT FROM HEAL AND NIDA, 

2738
01:51:11,580 --> 01:51:12,214
LEADERSHIP-- WE HAVE BEEN GIVEN 

2739
01:51:12,214 --> 01:51:12,814
PERMISSION TO LAUNCH A SECOND 

2740
01:51:12,814 --> 01:51:22,791
ITERATION OF JCOIN TO BUILD ON 

2741
01:51:22,791 --> 01:51:23,358
OUR SUCCESSES ALL GIVE YOU 

2742
01:51:23,358 --> 01:51:24,626
LITTLE BIT MORE DETAIL LATER 

2743
01:51:24,626 --> 01:51:25,227
ON. ABOUT WHERE WE ARE AT IN 

2744
01:51:25,227 --> 01:51:25,861
TERMS OF THAT LUNCH. THAT WILL 

2745
01:51:25,861 --> 01:51:28,330
CARRY US INTO 2030.

2746
01:51:28,330 --> 01:51:30,699
AN END IS VENN DIAGRAM CAPTURES 

2747
01:51:30,699 --> 01:51:33,902
THE ESSENCE OF ONE OF HER CORE 

2748
01:51:33,902 --> 01:51:34,536
PHILOSOPHIES, DATA SECTION WHAT 

2749
01:51:34,536 --> 01:51:35,937
HAPPENS WITH JUSTICE PARTNERS-- 

2750
01:51:35,937 --> 01:51:37,873
JAILS, PRISONS ARE COMMITTED TO 

2751
01:51:37,873 --> 01:51:38,507
CORRECTIONS-- AND THE COMMITTED 

2752
01:51:38,507 --> 01:51:39,875
PARTNERS WHICH CAN INCLUDE THE 

2753
01:51:39,875 --> 01:51:46,548
HIPAA HEALTH PROVIDER, CCBHCS, 

2754
01:51:46,548 --> 01:51:48,583
AND WHAT RESEARCHERS CAN BRING 

2755
01:51:48,583 --> 01:51:49,150
AND HOW WE CAN BUILD THOSE 

2756
01:51:49,150 --> 01:51:49,584
PARTNERSHIPS AT THE 

2757
01:51:49,584 --> 01:51:51,086
INTERSECTION OF THAT VENN 

2758
01:51:51,086 --> 01:51:53,555
DIAGRAM. 

2759
01:51:53,555 --> 01:51:54,122
ONE OF THE THINGS THAT REALLY 

2760
01:51:54,122 --> 01:51:55,657
IS THE FOUNDATION OF HOW WE 

2761
01:51:55,657 --> 01:51:57,692
APPROACH JCOIN WAS STUDYING A 

2762
01:51:57,692 --> 01:52:00,729
VISION -- WE MOVE THROUGH THIS 

2763
01:52:00,729 --> 01:52:02,030
AND ON THE SURFACE IT IS A 

2764
01:52:02,030 --> 01:52:05,133
SIMPLE VISION.  THE IDEA THAT 

2765
01:52:05,133 --> 01:52:05,767
EVERY PERSON WHO IS INVOLVED IN 

2766
01:52:05,767 --> 01:52:09,304
THE JUSTICE VISION THAT HAS A 

2767
01:52:09,304 --> 01:52:12,474
SUBSTANCE ABUSE DISORDER SHOULD 

2768
01:52:12,474 --> 01:52:15,176
HAVE ACCESS TO EFFECTIVE 

2769
01:52:15,176 --> 01:52:15,810
TREATMENT, IN JAIL PRISON OR IN 

2770
01:52:15,810 --> 01:52:18,647
THE COMMUNITY.

2771
01:52:18,647 --> 01:52:19,247
AND THERE ARE FIVE PILLARS HOW 

2772
01:52:19,247 --> 01:52:19,848
TO APPROACH THIS VISION. THIS 

2773
01:52:19,848 --> 01:52:20,482
IS NOT A FIVE-YEAR VISION. THIS 

2774
01:52:20,482 --> 01:52:22,784
IS A 20+ YEAR VISION OF WHERE 

2775
01:52:22,784 --> 01:52:28,323
WE ARE TRYING TO GO. BUT THIS 

2776
01:52:28,323 --> 01:52:28,957
WILL GIVE YOU A SENSE OF HOW WE 

2777
01:52:28,957 --> 01:52:30,825
ARE APPROACHING THIS, AND 

2778
01:52:30,825 --> 01:52:33,361
EVERYTHING TRACKS BACK TO ONE 

2779
01:52:33,361 --> 01:52:35,330
OF THESE FIVE PILLARS BECAUSE 

2780
01:52:35,330 --> 01:52:38,133
WE ARE NIH FIRST AND FOREMOST 

2781
01:52:38,133 --> 01:52:38,733
WE ARE FOCUSED ON RESEARCHING 

2782
01:52:38,733 --> 01:52:40,268
HOW TO ENERVATE EVIDENCE ABOUT 

2783
01:52:40,268 --> 01:52:40,835
WHAT WORKS IN THE STUDY BUT 

2784
01:52:40,835 --> 01:52:41,436
ALSO HOW DO WE TAKE WHAT WE 

2785
01:52:41,436 --> 01:52:44,306
KNOW TO WORK AND BUILD EVIDENCE 

2786
01:52:44,306 --> 01:52:47,475
OF HOW TO GET IT INTO PRACTICE. 

2787
01:52:47,475 --> 01:52:48,076
 EXACTLY THE POINT THAT GAIL 

2788
01:52:48,076 --> 01:52:48,710
WAS MAKING EARLIER. 

2789
01:52:48,710 --> 01:52:52,948
AND SPEAKING TO THE VENN 

2790
01:52:52,948 --> 01:52:54,316
DIAGRAM I SHOWED YOU ON THE 

2791
01:52:54,316 --> 01:52:54,883
LAST SLIDE, WITH EITHER THE 

2792
01:52:54,883 --> 01:53:00,956
HEART OF THIS IS BUILDING 

2793
01:53:00,956 --> 01:53:01,423
COLLABORATIONS AT THE 

2794
01:53:01,423 --> 01:53:01,957
INTERSECTION OF THAT VENN 

2795
01:53:01,957 --> 01:53:02,591
DIAGRAM, BUILDING THIS NATIONAL 

2796
01:53:02,591 --> 01:53:04,693
COLLABORATIVE NETWORK OF 

2797
01:53:04,693 --> 01:53:05,560
PRACTITIONERS WORKING TOGETHER 

2798
01:53:05,560 --> 01:53:06,061
WITH RESEARCHERS AT THE 

2799
01:53:06,061 --> 01:53:06,761
INTERSECTION OF JUSTICE AND 

2800
01:53:06,761 --> 01:53:11,900
COMMUNITY SERVICE STUDIES. 

2801
01:53:11,900 --> 01:53:12,500
ALSO FOCUSING HERE ON BECOMING 

2802
01:53:12,500 --> 01:53:13,134
A GO TO RESOURCE FOR THE FIELD, 

2803
01:53:13,134 --> 01:53:14,502
MAKING SURE THAT OUR 

2804
01:53:14,502 --> 01:53:15,136
DISSEMINATION PATHWAYS ARE NOT 

2805
01:53:15,136 --> 01:53:19,507
JUST GENERAL ARTICLES, REALLY 

2806
01:53:19,507 --> 01:53:20,041
THINKING ABOUT HOW WE ARE 

2807
01:53:20,041 --> 01:53:20,609
BUILDING THAT TRANSLATIONAL 

2808
01:53:20,609 --> 01:53:21,843
PIPELINE IN REAL TIME,AND 

2809
01:53:21,843 --> 01:53:22,444
PUSHING THINGS OUT AS QUICKLY 

2810
01:53:22,444 --> 01:53:23,912
AS WE CAN. 

2811
01:53:23,912 --> 01:53:26,247
WE ALSO HAVE A LOT OF EMPHASIS 

2812
01:53:26,247 --> 01:53:27,549
ON CAPACITY BUILDING IN TWO 

2813
01:53:27,549 --> 01:53:35,256
RESPECTS.  IN THE FIRST RESPECT 

2814
01:53:35,256 --> 01:53:35,857
IT'S ABOUT CAPACITY, BUILDING 

2815
01:53:35,857 --> 01:53:36,791
CAPACITY FOR RESEARCHERS TO 

2816
01:53:36,791 --> 01:53:38,193
KNOW HOW TO DO THIS RESEARCH, 

2817
01:53:38,193 --> 01:53:38,627
HOW TO NAVIGATE THE 

2818
01:53:38,627 --> 01:53:42,797
COMPLEXITIES.  BUT ALSO FOR THE 

2819
01:53:42,797 --> 01:53:43,431
PRACTITIONERS, UNDERSTAND WHERE 

2820
01:53:43,431 --> 01:53:46,601
TO FIND THE RESEARCH AND HOW TO 

2821
01:53:46,601 --> 01:53:47,102
INTERPRET IT AND HOW TO 

2822
01:53:47,102 --> 01:53:50,105
PARTICIPATE IN IT AS WELL.  SO 

2823
01:53:50,105 --> 01:53:50,705
WE HAVE BEEN TRYING TO BUILD 

2824
01:53:50,705 --> 01:53:54,209
BOTH ASPECTS OF CAPACITY. AND 

2825
01:53:54,209 --> 01:53:54,843
THE IDEA IS THAT IF WE CAN PULL 

2826
01:53:54,843 --> 01:54:00,815
THIS TOGETHER WE CAN ADDRESS 

2827
01:54:00,815 --> 01:54:11,259
THAT CHASM THAT HELEN WAS 

2828
01:54:13,828 --> 01:54:14,329
TALKING ABOUT AND SPEEDING 

2829
01:54:14,329 --> 01:54:14,896
SOLUTIONS TO SCIENCE AROUND 

2830
01:54:14,896 --> 01:54:16,264
THIS PARTICULAR AREA.

2831
01:54:16,264 --> 01:54:18,667
THERE WERE 13 RESEARCH HUBS, 

2832
01:54:18,667 --> 01:54:19,134
BUILDING LARGE-SCALE 

2833
01:54:19,134 --> 01:54:22,337
MULTI-CLINICAL TRIALS.  SEVEN 

2834
01:54:22,337 --> 01:54:22,937
ARE SPECIFICALLY FOCUSING ON 

2835
01:54:22,937 --> 01:54:26,441
LINKAGE INTERVENTIONS. WHAT 

2836
01:54:26,441 --> 01:54:27,042
HAPPENS IS PEOPLE TRANSITION 

2837
01:54:27,042 --> 01:54:27,609
FROM JAILS AND PRISONS BACK 

2838
01:54:27,609 --> 01:54:31,212
INTO THE COMMUNITY? TO FOCUSING 

2839
01:54:31,212 --> 01:54:32,614
ON STATEWIDE POLICY ROLLOUT IN 

2840
01:54:32,614 --> 01:54:34,115
MASSACHUSETTS. THIS WAS PRIOR 

2841
01:54:34,115 --> 01:54:36,151
TO JCOIN, REQUIRING ALL THREE 

2842
01:54:36,151 --> 01:54:40,822
FORMS OF MEDICATION FOR OPIOID 

2843
01:54:40,822 --> 01:54:41,456
USE DISORDER, TO BE PROVIDED BY 

2844
01:54:41,456 --> 01:54:45,026
JOE'S IN THAT STATE. AND WE HAD 

2845
01:54:45,026 --> 01:54:45,660
A TIME PERIOD TO ROLL THAT OUT, 

2846
01:54:45,660 --> 01:54:46,728
AND WE WERE ABLE TO PARTNER 

2847
01:54:46,728 --> 01:54:47,295
WITH THEM. AND IN NEW YORK 

2848
01:54:47,295 --> 01:54:48,029
THERE WAS A SIMILAR THING, 

2849
01:54:48,029 --> 01:54:56,104
CALLED THE OPIOID COURT MODEL. 

2850
01:54:56,104 --> 01:54:56,705
 AND WE WERE DOING STUDIES OF 

2851
01:54:56,705 --> 01:55:00,742
HIGH COMPARATIVES TRIALS 

2852
01:55:00,742 --> 01:55:03,178
ESPECIALLY LONG-ACTING 

2853
01:55:03,178 --> 01:55:03,745
NALOXONE, AND IN ONE TRIAL 

2854
01:55:03,745 --> 01:55:04,245
WOULD LONG-ACTING FROM 

2855
01:55:04,245 --> 01:55:09,350
RELATIONS OF -- STUDY AND ALSO 

2856
01:55:09,350 --> 01:55:09,884
FOR SUPPLICATE, AND ALSO 

2857
01:55:09,884 --> 01:55:11,186
COMPARISONS WITH 

2858
01:55:11,186 --> 01:55:14,255
NON-EXPONENTIAL METHODS.  WE 

2859
01:55:14,255 --> 01:55:14,856
ARE EXCITED ABOUT WHAT WE'RE 

2860
01:55:14,856 --> 01:55:17,325
FINDING FROM THOSE. 

2861
01:55:17,325 --> 01:55:17,892
AND TWO OF HER STUDIES WE ARE 

2862
01:55:17,892 --> 01:55:18,693
LOOKING AT ORGANIZATIONAL 

2863
01:55:18,693 --> 01:55:20,462
IMPLEMENTATION STRATEGIES.  HOW 

2864
01:55:20,462 --> 01:55:22,964
DO YOU GET THIS INTO PRACTICE?

2865
01:55:22,964 --> 01:55:26,134
ONE OF OUR GOALS WITH JCOIN, 

2866
01:55:26,134 --> 01:55:28,670
WHEN YOU LOOK AT THE LITERATURE 

2867
01:55:28,670 --> 01:55:29,904
THAT HAS BEEN PUBLISHED UP TO 

2868
01:55:29,904 --> 01:55:31,673
2018, A LOT OF THE STUDIES WERE 

2869
01:55:31,673 --> 01:55:35,143
REALLY HAPPENING IN NORTHEAST, 

2870
01:55:35,143 --> 01:55:35,710
IF YOU WENT OUT AND TALK TO 

2871
01:55:35,710 --> 01:55:46,221
PEOPLE IN THE COMMUNITY WOULD 

2872
01:55:50,825 --> 01:55:51,359
HEAR LOTS OF RUMBLINGS ABOUT 

2873
01:55:51,359 --> 01:55:51,993
HOW THAT WASN'T APPLICABLE. AND 

2874
01:55:51,993 --> 01:55:52,627
HOW THOSE COMMUNITIES WERE 

2875
01:55:52,627 --> 01:55:53,261
DIFFERENT. ONE THING WOULD MADE 

2876
01:55:53,261 --> 01:55:53,795
A CONCERTED EFFORT IN 140 

2877
01:55:53,795 --> 01:55:56,431
COUNTRIES, 38 STATES AND 

2878
01:55:56,431 --> 01:56:02,437
HOPEFULLY IN 2.0 WE WILL BUILD 

2879
01:56:02,437 --> 01:56:03,004
THAT NATIONAL FOOTPRINT AND 

2880
01:56:03,004 --> 01:56:03,505
ENROLLED NEARLY 23,000 

2881
01:56:03,505 --> 01:56:05,206
PARTICIPANTS IN CLINICAL 

2882
01:56:05,206 --> 01:56:05,807
TRIALS, LITTLE BIT OF AN OLD 

2883
01:56:05,807 --> 01:56:07,642
NUMBER. WE PROBABLY CLEARED 

2884
01:56:07,642 --> 01:56:08,209
23,000 PARTICIPANTS AT THIS 

2885
01:56:08,209 --> 01:56:09,611
POINT. 

2886
01:56:09,611 --> 01:56:10,178
AND WE SUPPORTED THE WORK OF 

2887
01:56:10,178 --> 01:56:14,182
THESE RESEARCH HUBS TO SUPPORT 

2888
01:56:14,182 --> 01:56:17,185
CENTERS. ON METHODOLOGY AND 

2889
01:56:17,185 --> 01:56:17,819
ADVANCING RESOURCE CENTER WHICH 

2890
01:56:17,819 --> 01:56:18,987
IS BEEN BUILDING THE RESOURCES 

2891
01:56:18,987 --> 01:56:20,488
TO SUPPORT COMMON DATA 

2892
01:56:20,488 --> 01:56:24,159
INFRASTRUCTURE.  SUPPORTING  

2893
01:56:24,159 --> 01:56:27,896
COLLABORATIONS ACROSS THE 

2894
01:56:27,896 --> 01:56:28,429
STUDIES; COORDINATION AND 

2895
01:56:28,429 --> 01:56:30,799
TRANSLATION CENTER FOCUS MORE 

2896
01:56:30,799 --> 01:56:31,432
ON THE DAY-TO-DAY COORDINATION, 

2897
01:56:31,432 --> 01:56:32,500
AND THE TRANSLATION AND 

2898
01:56:32,500 --> 01:56:33,168
DISSEMINATION PEAS AND BUILDING 

2899
01:56:33,168 --> 01:56:36,638
A DATA AND TRANSLATIONAL 

2900
01:56:36,638 --> 01:56:37,672
PRODUCTS. DOES NOT ENCOMPASS 

2901
01:56:37,672 --> 01:56:44,779
THE WHOLE OF JCOIN. THIS IS A 

2902
01:56:44,779 --> 01:56:46,281
NETWORK REGION RESEARCH, 

2903
01:56:46,281 --> 01:56:48,483
EMBEDDED IN MANY PLACES AND WE 

2904
01:56:48,483 --> 01:56:49,050
HAVE 55 ADDITIONAL RESEARCH 

2905
01:56:49,050 --> 01:56:49,984
PROTOCOLS INCLUDE NATIONAL 

2906
01:56:49,984 --> 01:56:57,659
SURVEYS AND PILOTS AND 

2907
01:56:57,659 --> 01:56:58,293
MODELING, AND MAPPING STUDIES, 

2908
01:56:58,293 --> 01:56:58,893
DIVERSITY SUPPLEMENTS, SMALL 

2909
01:56:58,893 --> 01:56:59,394
GRANT PROGRAMS, LOTS OF 

2910
01:56:59,394 --> 01:57:00,895
RESEARCH BUILT INTO THE NETWORK 

2911
01:57:00,895 --> 01:57:01,496
IN LOTS OF DIFFERENT WAYS IN 

2912
01:57:01,496 --> 01:57:02,330
THE IDEA THAT ALL OF THESE 

2913
01:57:02,330 --> 01:57:02,897
PIECES ARE COMPLEMENTARY TO 

2914
01:57:02,897 --> 01:57:05,066
EACH OTHER. 

2915
01:57:05,066 --> 01:57:06,134
JUST GIVING YOU KIND OF A QUICK 

2916
01:57:06,134 --> 01:57:09,704
VISUAL. THIS REPEATS A LITTLE 

2917
01:57:09,704 --> 01:57:10,305
BIT OF WHAT I WAS SHOWING YOU 

2918
01:57:10,305 --> 01:57:13,675
IN TERMS OF THE 88 RESEARCH 

2919
01:57:13,675 --> 01:57:14,309
PROTOCOLS IN THE 13 LARGE-SCALE 

2920
01:57:14,309 --> 01:57:16,377
CLINICAL TRIALS. WHAT I WANT TO 

2921
01:57:16,377 --> 01:57:16,945
HIGHLIGHT HERE IS THE COLOR 

2922
01:57:16,945 --> 01:57:18,246
CODING. WHAT YOU SEE IN ORANGE, 

2923
01:57:18,246 --> 01:57:25,019
THESE ARE ALL JAIL STUDIES. WE 

2924
01:57:25,019 --> 01:57:25,620
ARE PRIMARILY A JAIL FOCUSED 

2925
01:57:25,620 --> 01:57:26,821
NETWORK AT LEAST IN 1.0 WE 

2926
01:57:26,821 --> 01:57:35,597
WERE.  BECAUSE PEOPLE GO PRETTY 

2927
01:57:35,597 --> 01:57:36,231
THREE JAIL THE AVERAGE STAY IS 

2928
01:57:36,231 --> 01:57:38,766
LESS THAN A WEEK. SO THESE ARE 

2929
01:57:38,766 --> 01:57:39,934
PEOPLE COMING IN AND OUT, VERY 

2930
01:57:39,934 --> 01:57:41,202
VULNERABLE BUT ALSO MORE 

2931
01:57:41,202 --> 01:57:43,204
FOCUSED ON PROBATION AND 

2932
01:57:43,204 --> 01:57:46,875
PAROLE. AND JUVENILE JUSTICE. 

2933
01:57:46,875 --> 01:57:48,710
THAT GIVES YOU A SENSE OF WHAT 

2934
01:57:48,710 --> 01:57:49,344
KINDS, WHAT PARTS OF THE SYSTEM 

2935
01:57:49,344 --> 01:57:50,078
WE HAVE BEEN FOCUSED IN, IN 

2936
01:57:50,078 --> 01:57:54,015
THIS FIRST PHASE OF JCOIN. 

2937
01:57:54,015 --> 01:57:56,184
I WILL TURN NOW TO SORT OF TALK 

2938
01:57:56,184 --> 01:57:56,918
ABOUT HOW THE RESEARCH AND 

2939
01:57:56,918 --> 01:58:00,121
CAPACITY BUILDING THAT WE DO 

2940
01:58:00,121 --> 01:58:03,424
REALLY SYNERGIZES US AND WORKS 

2941
01:58:03,424 --> 01:58:06,728
TOGETHER TO TRY TO PUSH US 

2942
01:58:06,728 --> 01:58:08,496
TOWARDS BUILDING THIS RESEARCH 

2943
01:58:08,496 --> 01:58:08,997
PRACTICE. THE RESEARCH 

2944
01:58:08,997 --> 01:58:10,098
PROTOCOLS. 

2945
01:58:10,098 --> 01:58:11,666
CLINICAL TRIALS, NONE OF THEM 

2946
01:58:11,666 --> 01:58:14,202
ARE COMPLETE.  MANY OF THEM ARE 

2947
01:58:14,202 --> 01:58:15,536
COMPLETE BUT NONE OF THEM HAVE 

2948
01:58:15,536 --> 01:58:16,838
PUBLISHED THEIR MAIN FINDINGS 

2949
01:58:16,838 --> 01:58:18,640
YET. AND EVEN WITHOUT THOSE 

2950
01:58:18,640 --> 01:58:21,376
STUDIES BEING COMPLETE, WE HAVE 

2951
01:58:21,376 --> 01:58:24,646
165 PUBLICATIONS AND THE NUMBER 

2952
01:58:24,646 --> 01:58:25,280
GROWS ALMOST EVERY DAY AT THIS 

2953
01:58:25,280 --> 01:58:29,884
POINT.  A FEW MONTHS AGO I 

2954
01:58:29,884 --> 01:58:30,785
PLUGGED ALL APPLICATIONS IN AND 

2955
01:58:30,785 --> 01:58:34,722
CALCULATING WHAT THE NIH OFFICE 

2956
01:58:34,722 --> 01:58:36,758
OF RESEARCH BECAUSE THE 

2957
01:58:36,758 --> 01:58:45,566
CITATION RELEVANT ISSUE AND GOT 

2958
01:58:45,566 --> 01:58:51,439
A 2.41. AND SO THE PAPER IS 

2959
01:58:51,439 --> 01:58:52,073
CITED AS OFTEN AS IN THE FIELD 

2960
01:58:52,073 --> 01:58:52,674
AND I SHOW YOU THAT THESE ARE 

2961
01:58:52,674 --> 01:58:53,508
PAPERS THAT ARE ALREADY 

2962
01:58:53,508 --> 01:58:54,142
INFLUENTIAL, EVEN THOUGH WE ARE 

2963
01:58:54,142 --> 01:58:54,776
ALREADY AT THE EARLY STAGES OF 

2964
01:58:54,776 --> 01:58:55,410
PUBLICATIONS COMING OUT OF THE 

2965
01:58:55,410 --> 01:58:57,745
NETWORK. 

2966
01:58:57,745 --> 01:58:58,346
THE OTHER THING THAT IS REALLY 

2967
01:58:58,346 --> 01:58:59,480
INTERESTING AND IMPORTANT ABOUT 

2968
01:58:59,480 --> 01:59:00,782
OUR PUBLICATIONS IS THAT THE 

2969
01:59:00,782 --> 01:59:01,849
NETWORK STRUCTURE HAS ALLOWED 

2970
01:59:01,849 --> 01:59:04,085
COLLABORATIONS ACROSS DIFFERENT 

2971
01:59:04,085 --> 01:59:08,323
TEAMS, ACROSS DIFFERENT PEOPLE  

2972
01:59:08,323 --> 01:59:08,957
THAT WORK TOGETHER AND WE BEEN 

2973
01:59:08,957 --> 01:59:10,591
ABLE TO ANALYZE AND DEMONSTRATE 

2974
01:59:10,591 --> 01:59:11,192
THAT USING THIS NET STRATEGY 

2975
01:59:11,192 --> 01:59:12,860
HAS REALLY INCREASED AND BUILT 

2976
01:59:12,860 --> 01:59:14,395
RELATIONSHIPS WHICH I THINK 

2977
01:59:14,395 --> 01:59:15,129
IMPROVES THE QUALITY OF THE 

2978
01:59:15,129 --> 01:59:17,899
SCIENCE. 

2979
01:59:17,899 --> 01:59:18,499
ONE THING THAT IS A LITTLE BIT 

2980
01:59:18,499 --> 01:59:19,867
DIFFERENT ABOUT WHAT WE DID, 

2981
01:59:19,867 --> 01:59:21,202
THAT I THINK HAS BEEN REALLY 

2982
01:59:21,202 --> 01:59:26,374
INTERESTING AND HAS HAD A GREAT 

2983
01:59:26,374 --> 01:59:27,008
PAYOFF, IS REBUILT THE IDEA OF 

2984
01:59:27,008 --> 01:59:27,642
RAPID INNOVATION GRANTS. GRANTS 

2985
01:59:27,642 --> 01:59:34,115
ADMINISTRATIVE BY THE 

2986
01:59:34,115 --> 01:59:34,716
COORDINATION AND TRANSLATION 

2987
01:59:34,716 --> 01:59:35,383
CENTER, BUILT ALONG THE SAME 

2988
01:59:35,383 --> 01:59:44,926
STRUCTURE AS TRADITIONAL NIH 

2989
01:59:44,926 --> 01:59:45,526
GRANTS BUT THEY GET REVIEWED 

2990
01:59:45,526 --> 01:59:46,060
FASTER DECISIONS ARE MADE 

2991
01:59:46,060 --> 01:59:46,661
WITHIN THREE MONTHS OF THEIR 

2992
01:59:46,661 --> 01:59:48,596
RELATIVELY SMALL AWARDS. 

2993
01:59:48,596 --> 01:59:49,130
AND WE NEEDED A VERSION OF 

2994
01:59:49,130 --> 01:59:49,764
APPLICATION ACCESSIBLE EVEN FOR 

2995
01:59:49,764 --> 01:59:50,398
PRACTITIONERS THAT DID NOT HAVE 

2996
01:59:50,398 --> 01:59:50,798
ALL THE NECESSARY 

2997
01:59:50,798 --> 01:59:51,399
INFRASTRUCTURE TO APPLY TO A 

2998
01:59:51,399 --> 01:59:53,501
TYPICAL NIH GRANT. WE HAVE SEEN 

2999
01:59:53,501 --> 01:59:59,073
JUST REALLY-- WE HAVE GOTTEN 

3000
01:59:59,073 --> 02:00:01,109
DIRECT AWARDS TO PARTNERS, TO 

3001
02:00:01,109 --> 02:00:03,878
EARLY STAGE INVESTIGATORS. WE 

3002
02:00:03,878 --> 02:00:04,512
HAVE SEEN PUBLICATIONS COME OUT 

3003
02:00:04,512 --> 02:00:10,084
OF THESE. I THINK THIS HAS BEEN 

3004
02:00:10,084 --> 02:00:14,355
AN IMPORTANT TOOL FOR SEEDING  

3005
02:00:14,355 --> 02:00:14,922
THE FIELDS AND LEARNING NEW 

3006
02:00:14,922 --> 02:00:18,626
THINGS AND LEARNING FASTER, 

3007
02:00:18,626 --> 02:00:19,193
TAKING SMALL RISKS THAT ARE 

3008
02:00:19,193 --> 02:00:19,894
PAID OFF IN A LOT OF WAYS THAT 

3009
02:00:19,894 --> 02:00:21,796
WE COULD NOT HAVE ANTICIPATED.  

3010
02:00:21,796 --> 02:00:22,430
THIS IS BEEN A REALLY VALUABLE 

3011
02:00:22,430 --> 02:00:25,600
TOOL FOR US. 

3012
02:00:25,600 --> 02:00:26,067
I ALSO TALKED ABOUT OUR 

3013
02:00:26,067 --> 02:00:26,601
CAPACITY BUILDING AND OUR 

3014
02:00:26,601 --> 02:00:32,874
TRAINING PROGRAM. WE FOUND 71 

3015
02:00:32,874 --> 02:00:33,508
PEOPLE TO GO THROUGH THE EARLY 

3016
02:00:33,508 --> 02:00:34,142
PROGRAM, FOCUSING ON MENTORING. 

3017
02:00:34,142 --> 02:00:36,310
TWO TRACKS.  ONE FOCUSING ON 

3018
02:00:36,310 --> 02:00:36,844
ACADEMICS, PEOPLE WHO ARE 

3019
02:00:36,844 --> 02:00:40,848
GETTING READY TO LAUNCH AND NIH 

3020
02:00:40,848 --> 02:00:41,449
GROUP AND THE OTHER TRACTORS 

3021
02:00:41,449 --> 02:00:46,721
EARLY-STAGE FOLKS AS WELL AS 

3022
02:00:46,721 --> 02:00:47,321
PRACTITIONERS ANYTHING IT IS 

3023
02:00:47,321 --> 02:00:48,656
BEEN REALLY INTERESTING TO SEE 

3024
02:00:48,656 --> 02:00:49,257
HOW THIS IS WORK BY BRINGING 

3025
02:00:49,257 --> 02:00:49,824
THEM TOGETHER IN A PROGRAM 

3026
02:00:49,824 --> 02:00:50,458
TOGETHER BECAUSE THEIR BUILDING 

3027
02:00:50,458 --> 02:00:51,092
RELATIONSHIPS THAT I THINK WILL 

3028
02:00:51,092 --> 02:00:53,361
PAY OFF IN THE FUTURE. 

3029
02:00:53,361 --> 02:00:54,395
AND THEN WE GOT A DIVERSE SET 

3030
02:00:54,395 --> 02:00:56,531
OF OTHER THINGS. MORE THAN 50 

3031
02:00:56,531 --> 02:01:01,769
COURSES AND PODCASTS THAT HAD 

3032
02:01:01,769 --> 02:01:05,840
ALMOST 15,000 DOWNLOADS, 

3033
02:01:05,840 --> 02:01:06,474
NEWSLETTERS AND WEBINAR AND ONE 

3034
02:01:06,474 --> 02:01:07,075
OTHER UNIQUE PIECE I WANT TO 

3035
02:01:07,075 --> 02:01:10,478
HIGHLIGHT -- IF EVERYONE COULD 

3036
02:01:10,478 --> 02:01:14,782
MUTE THEMSELVES -- ONE OTHER 

3037
02:01:14,782 --> 02:01:16,851
UNIQUE PIECE, WE WERE ABLE TO 

3038
02:01:16,851 --> 02:01:20,688
ESTABLISH A MEMORANDUM OF 

3039
02:01:20,688 --> 02:01:21,322
UNDERSTANDING WITH OUR PARTNERS 

3040
02:01:21,322 --> 02:01:22,457
AND COLLEAGUES OVER AT THE 

3041
02:01:22,457 --> 02:01:23,624
BUREAU OF JUSTICE TO PAIR UP 

3042
02:01:23,624 --> 02:01:26,394
WHAT WE DO WITH THEIR WORK. BJA 

3043
02:01:26,394 --> 02:01:30,798
LIKE CENSUS SINCE A LOT OF 

3044
02:01:30,798 --> 02:01:31,365
MONEY OUT TO THE FIELD. AND 

3045
02:01:31,365 --> 02:01:34,702
WERE ABLE TO BRIDGE THE KIND OF 

3046
02:01:34,702 --> 02:01:35,303
WORK  WE DO WITH WHAT THEY DO 

3047
02:01:35,303 --> 02:01:35,870
BY CREATING A PIPELINE FOR 

3048
02:01:35,870 --> 02:01:36,437
PEOPLE OUT IN THE FIELD WHO 

3049
02:01:36,437 --> 02:01:39,140
WANTED TO UNDERSTAND WHAT 

3050
02:01:39,140 --> 02:01:46,214
MEASURE TO DO. OR I AM TRAINED 

3051
02:01:46,214 --> 02:01:46,814
IN A PROGRAM AND I DON'T KNOW 

3052
02:01:46,814 --> 02:01:48,483
WHERE TO START IN TERMS OF 

3053
02:01:48,483 --> 02:01:51,486
DESIGNING AN EVALUATION. HOW 

3054
02:01:51,486 --> 02:01:54,755
CAN I DO THAT? WHO CAN HELP ME?

3055
02:01:54,755 --> 02:02:01,095
AND THE RAPID INNOVATION GRANTS 

3056
02:02:01,095 --> 02:02:01,662
AND THE ON-DEMAND TECHNICAL 

3057
02:02:01,662 --> 02:02:02,263
ASSISTANCE ALL WORK TOGETHER 

3058
02:02:02,263 --> 02:02:02,897
VERY SYNERGISTICALLY, AND THIS 

3059
02:02:02,897 --> 02:02:09,670
IS BEEN A LITTLE BIT OF THE 

3060
02:02:09,670 --> 02:02:10,304
THINGS THAT HAVE WORKED BETTER 

3061
02:02:10,304 --> 02:02:13,207
THAN EVEN WE HOPED WOULD WORK.

3062
02:02:13,207 --> 02:02:14,775
I WANT TO SHOW YOU THE FACE OF 

3063
02:02:14,775 --> 02:02:15,343
THE LEAD INVESTIGATORS. THE 

3064
02:02:15,343 --> 02:02:15,910
FACES OF THE FUTURE OF THE 

3065
02:02:15,910 --> 02:02:22,049
FIELD.  THIS HAS ALSO HELPED US 

3066
02:02:22,049 --> 02:02:22,650
DIVERSIFY THE NETWORK AND IS 

3067
02:02:22,650 --> 02:02:23,885
GOING TO LEAD TO BETTER 

3068
02:02:23,885 --> 02:02:26,587
RESEARCH IS REMOVE, BECAUSE WE 

3069
02:02:26,587 --> 02:02:27,221
HAVE A DIVERSITY OF BACKGROUNDS 

3070
02:02:27,221 --> 02:02:29,490
AND PERSPECTIVES.  AND THESE 

3071
02:02:29,490 --> 02:02:30,758
ARE PEOPLE WHO HAVE PERFORMED 

3072
02:02:30,758 --> 02:02:36,230
IN THE NETWORK.  THIS HAS BEEN 

3073
02:02:36,230 --> 02:02:36,831
A REALLY NICE FEATURE OF THE 

3074
02:02:36,831 --> 02:02:37,899
NETWORK.

3075
02:02:37,899 --> 02:02:38,432
ONLY TAKE A FEW MINUTES AND 

3076
02:02:38,432 --> 02:02:40,868
WALK YOU THROUGH AN EXAMPLE OF 

3077
02:02:40,868 --> 02:02:42,603
HOW WE TAKE A PARTICULAR 

3078
02:02:42,603 --> 02:02:43,204
FINDING AND WORKING TRANSLATE 

3079
02:02:43,204 --> 02:02:44,839
IN THAT BACK OUT INTO THE FIELD 

3080
02:02:44,839 --> 02:02:47,408
AS QUICKLY AS POSSIBLE.  THIS 

3081
02:02:47,408 --> 02:02:48,176
IS A PAPER THAT WAS PUBLISHED 

3082
02:02:48,176 --> 02:02:50,211
OUT OF THE MASSACHUSETTS JCOIN 

3083
02:02:50,211 --> 02:02:54,715
HARM. THE ISSUE THAT IT TACKLES 

3084
02:02:54,715 --> 02:02:55,316
IS A VERY COMMON CONCERN THAT 

3085
02:02:55,316 --> 02:02:57,618
WE HEAR FROM OUR JAIL PARTNERS 

3086
02:02:57,618 --> 02:03:08,162
ABOUT OFFERING BUPRENOFRIN  IN 

3087
02:03:08,496 --> 02:03:09,063
THEIR STUDIES AND ANYTHING THAT 

3088
02:03:09,063 --> 02:03:09,697
GETS DIVERTED IN THE JAIL STUDY 

3089
02:03:09,697 --> 02:03:14,602
CREATE SAFETY AND SECURITY 

3090
02:03:14,602 --> 02:03:15,169
ISSUES. SO AS PART OF THIS 

3091
02:03:15,169 --> 02:03:15,803
EFFORT TO ALSO FUND MEDICATION 

3092
02:03:15,803 --> 02:03:16,704
IN THE JAILS, THE RESEARCHERS 

3093
02:03:16,704 --> 02:03:18,806
WENT IN AND EQUALITY WORK TO 

3094
02:03:18,806 --> 02:03:22,677
UNDERSTAND WHAT THE CONDITIONS 

3095
02:03:22,677 --> 02:03:23,311
WERE FROM THE STAFF PERSPECTIVE 

3096
02:03:23,311 --> 02:03:26,247
AND HOW THEY OFTEN HAPPENED.  

3097
02:03:26,247 --> 02:03:26,847
THEIR CONCLUSION WAS THAT IT 

3098
02:03:26,847 --> 02:03:27,315
WAS BOTH UNCOMMON AND 

3099
02:03:27,315 --> 02:03:30,184
PREVENTABLE.

3100
02:03:30,184 --> 02:03:30,751
IN THE PAPER THEY LAYOUT SOME 

3101
02:03:30,751 --> 02:03:32,687
OF THE STRATEGIES THAT THE 

3102
02:03:32,687 --> 02:03:43,164
JAILS IN MASSACHUSETTS HAVE 

3103
02:03:53,140 --> 02:03:53,641
USED TO REALLY ADDRESS THE 

3104
02:03:53,641 --> 02:03:54,242
CONCERNS AROUND DIVERSION. WE 

3105
02:03:54,242 --> 02:03:57,044
PUT A SUMMARY OF THE NEWSLETTER 

3106
02:03:57,044 --> 02:03:57,945
AND HAD WERE NOT WITH GOING 

3107
02:03:57,945 --> 02:03:58,579
OVER THE RESULTS OF THE FUNDING 

3108
02:03:58,579 --> 02:04:01,916
AND A LITTLE BIT MORE UNUSUAL, 

3109
02:04:01,916 --> 02:04:02,516
THE PODCAST THAT HAS QUITE A 

3110
02:04:02,516 --> 02:04:03,150
FEW SUBSCRIBERS SO THERE IS A 

3111
02:04:03,150 --> 02:04:04,819
PODCAST TO TALK WITH 

3112
02:04:04,819 --> 02:04:08,189
INVESTIGATORS, A SHORT SNIPPET. 

3113
02:04:08,189 --> 02:04:13,628
WE ALSO CREATED INFOGRAPHICS, 

3114
02:04:13,628 --> 02:04:14,128
LAYING OUT WHAT THE KEY 

3115
02:04:14,128 --> 02:04:14,762
STRATEGIES WERE FOR PREVENTING 

3116
02:04:14,762 --> 02:04:15,363
AND ADDRESSING DIVERSION, AS 

3117
02:04:15,363 --> 02:04:16,597
WELL AS SOCIAL MEDIA PUSHES 

3118
02:04:16,597 --> 02:04:17,164
WITH DIFFERENT ELEMENTS OF 

3119
02:04:17,164 --> 02:04:18,566
THAT. 

3120
02:04:18,566 --> 02:04:20,334
THIS HAS BEEN QUITE SUCCESSFUL. 

3121
02:04:20,334 --> 02:04:20,968
I ACTUALLY HAD A CONVERSATION 

3122
02:04:20,968 --> 02:04:24,739
WITH ED HANES (PHONETIC) WHO IS 

3123
02:04:24,739 --> 02:04:30,878
THE SUPERINTENDENT IN ONE OF 

3124
02:04:30,878 --> 02:04:31,512
THESE JAILS. ONE OF THE THINGS 

3125
02:04:31,512 --> 02:04:37,585
HE SHARED WITH ME IS THAT HE 

3126
02:04:37,585 --> 02:04:38,152
FOUND AS A PARTNER FOR THIS 

3127
02:04:38,152 --> 02:04:38,786
RESEARCHERS, HE FOUND IT SUPER 

3128
02:04:38,786 --> 02:04:39,353
VALUABLE. AS OTHERS IN THE 

3129
02:04:39,353 --> 02:04:39,987
COUNTRY HAVE LOOKED TO HIM AND 

3130
02:04:39,987 --> 02:04:40,554
HIS TEAM AND WHAT THEY HAVE 

3131
02:04:40,554 --> 02:04:41,656
BEEN DOING HAVING ALL THESE 

3132
02:04:41,656 --> 02:04:42,256
RESOURCES IS SOMETHING HE CAN 

3133
02:04:42,256 --> 02:04:44,959
REFER HIS PEERS TO. SOMETHING 

3134
02:04:44,959 --> 02:04:48,129
HE HAS FOUND VERY VALUABLE IN 

3135
02:04:48,129 --> 02:04:48,729
TERMS OF BEING ABLE TO MANAGE 

3136
02:04:48,729 --> 02:04:49,363
THE INTEREST AND HELP 

3137
02:04:49,363 --> 02:04:49,964
COLLEAGUES WHO ARE INTERESTED 

3138
02:04:49,964 --> 02:04:51,232
IN LEARNING FROM WHAT THEY HAVE 

3139
02:04:51,232 --> 02:04:53,401
DONE. 

3140
02:04:53,401 --> 02:04:55,836
I WANT TO GIVE YOU ONE MORE 

3141
02:04:55,836 --> 02:04:58,706
EXAMPLE ABOUT THIS TRANSLATION 

3142
02:04:58,706 --> 02:05:00,708
PIPELINE. STILL USING 

3143
02:05:00,708 --> 02:05:01,409
MASSACHUSETTS AS AN EXAMPLE.

3144
02:05:01,409 --> 02:05:02,877
THIS ONE IS A PARTNERSHIP THAT 

3145
02:05:02,877 --> 02:05:05,513
EVOLVED FROM THE ECONOMICS TEAM 

3146
02:05:05,513 --> 02:05:06,914
WORKING ACROSS THESE DIFFERENT 

3147
02:05:06,914 --> 02:05:08,416
STUDIES, AND THE STAFF AT 

3148
02:05:08,416 --> 02:05:10,751
DIFFERENT JAILS. THIS IS A 

3149
02:05:10,751 --> 02:05:12,620
PAPER TALKING ABOUT DESCRIBING 

3150
02:05:12,620 --> 02:05:14,922
WHAT THEY CALLED "BUDGET IMPACT 

3151
02:05:14,922 --> 02:05:17,658
TOOL." HERE ONE OF THE KEY 

3152
02:05:17,658 --> 02:05:19,327
QUESTIONS FOR THE JAILS AS THEY 

3153
02:05:19,327 --> 02:05:21,429
WERE PUSHING TO INCORPORATE 

3154
02:05:21,429 --> 02:05:25,066
METHADONE, WAS SHOULD WE SET UP 

3155
02:05:25,066 --> 02:05:29,103
AN OTP WITHIN OUR OWN JAIL? 

3156
02:05:29,103 --> 02:05:30,071
SHOULD WE CONTRACT OUT WITH 

3157
02:05:30,071 --> 02:05:30,705
ANOTHER SERVICE? SHOULD WE WORK 

3158
02:05:30,705 --> 02:05:34,442
OUT SOME SORT OF GUEST DOSING, 

3159
02:05:34,442 --> 02:05:37,144
COMMUNITY OTP? THOSE ARE 

3160
02:05:37,144 --> 02:05:39,280
DECISIONS THAT DEPEND AROUND 

3161
02:05:39,280 --> 02:05:39,814
THE CONFIGURATION OF THE 

3162
02:05:39,814 --> 02:05:42,983
PREPARATION BEING SERVED IN THE 

3163
02:05:42,983 --> 02:05:43,517
FACILITY, AS WELL AS THE 

3164
02:05:43,517 --> 02:05:45,886
COMMUNITY FACTORS. AND SO THIS 

3165
02:05:45,886 --> 02:05:47,755
PAPER REPORTED ON THAT BUDGET 

3166
02:05:47,755 --> 02:05:48,356
IMPACT WILL THAT REFLECTED ON 

3167
02:05:48,356 --> 02:05:48,923
THE LESSONS LEARNED IN 

3168
02:05:48,923 --> 02:05:52,960
MASSACHUSETTS. 

3169
02:05:52,960 --> 02:05:53,561
BUT I'M HIDING HERE IN THE RED 

3170
02:05:53,561 --> 02:05:55,062
SQUARE FOR YOU, IS THAT AN 

3171
02:05:55,062 --> 02:05:56,163
UNUSUAL FEATURE IS THAT THE 

3172
02:05:56,163 --> 02:05:56,764
CO-AUTHORS OF THE PAPER 

3173
02:05:56,764 --> 02:05:59,233
INCLUDED SHERIFF-- THE SHERIFF 

3174
02:05:59,233 --> 02:05:59,700
OF MIDDLESEX COUNTY-- 

3175
02:05:59,700 --> 02:06:03,204
(INDISCERNIBLE) WHO WAS BUDGET 

3176
02:06:03,204 --> 02:06:11,345
DIRECTOR OF THE MIDDLESEX 

3177
02:06:11,345 --> 02:06:14,048
COUNTY JAIL, AND THE -- HOUSE 

3178
02:06:14,048 --> 02:06:17,184
OF CORRECTIONS AND ED HANES THE 

3179
02:06:17,184 --> 02:06:19,153
SUPERINTENDENT IN THE FRANKLIN 

3180
02:06:19,153 --> 02:06:24,959
COUNTY JAIL. THESE PARTNERS 

3181
02:06:24,959 --> 02:06:25,593
CO-AUTHORING ON THE PAPER WHICH 

3182
02:06:25,593 --> 02:06:26,594
WAS BOTH THE FOUNDATION THAT WE 

3183
02:06:26,594 --> 02:06:30,765
FOCUS FROM THE BEGINNING OF 

3184
02:06:30,765 --> 02:06:34,902
JCOIN, CLOSE COLLABORATIVE 

3185
02:06:34,902 --> 02:06:35,536
RELATIONSHIPS TO TURN THE TOOL 

3186
02:06:35,536 --> 02:06:36,103
INTO A DOWNLOADABLE, EXCEL 

3187
02:06:36,103 --> 02:06:36,837
SPREADSHEET THAT OTHERS COULD 

3188
02:06:36,837 --> 02:06:37,138
USE.

3189
02:06:37,138 --> 02:06:40,107
DID A WEBINAR AGAIN. BUT IN 

3190
02:06:40,107 --> 02:06:42,710
TERMS OF RAPID TRANSLATION TO 

3191
02:06:42,710 --> 02:06:43,344
PRACTICE, WE WERE ABLE TO SHARE 

3192
02:06:43,344 --> 02:06:44,578
THIS CLOSELY WITH OUR 

3193
02:06:44,578 --> 02:06:45,079
COLLEAGUES, OUR FEDERAL 

3194
02:06:45,079 --> 02:06:49,283
COLLEAGUES.  AND JUST A FEW 

3195
02:06:49,283 --> 02:06:50,818
MONTHS AFTER THE PAPER WAS 

3196
02:06:50,818 --> 02:06:51,952
PUBLISHED, THAT TEAM CAME IN 

3197
02:06:51,952 --> 02:06:52,520
AND DID A WHOLE SESSION FOR 

3198
02:06:52,520 --> 02:06:54,722
TEAMS THAT HAD COME IN FROM 

3199
02:06:54,722 --> 02:06:56,590
AROUND THE COUNTRY TO HELP THEM 

3200
02:06:56,590 --> 02:06:57,725
UNDERSTAND WHAT THIS TOOL WAS, 

3201
02:06:57,725 --> 02:07:00,394
HOW TO USE IT, AND SUPPORT THE 

3202
02:07:00,394 --> 02:07:02,296
USE OF TEAMS BEING BROUGHT UP 

3203
02:07:02,296 --> 02:07:04,732
BY SAMSAH AS PART OF THE 

3204
02:07:04,732 --> 02:07:07,468
ACADEMY STRATEGY.  AND WE USED 

3205
02:07:07,468 --> 02:07:07,968
TO TECHNICAL ASSISTANCE 

3206
02:07:07,968 --> 02:07:08,936
COMPONENT TO PROVIDE SUPPORT. 

3207
02:07:08,936 --> 02:07:11,472
I KNOW I'M RUNNING OUT OF TIME. 

3208
02:07:11,472 --> 02:07:12,106
 I WANTED TO GIVE YOU A LITTLE 

3209
02:07:12,106 --> 02:07:14,074
BIT OF A PREVIEW OF HOW WE ARE 

3210
02:07:14,074 --> 02:07:14,909
GOING TO TRANSLATE THESE 

3211
02:07:14,909 --> 02:07:15,643
LESSONS LEARNED INTO A SECOND 

3212
02:07:15,643 --> 02:07:19,413
PHASE OF JCOIN. AND WE WANT TO 

3213
02:07:19,413 --> 02:07:21,148
KEEP OUR MOMENTUM.

3214
02:07:21,148 --> 02:07:24,852
SO BACK LAST FALL, WE 

3215
02:07:24,852 --> 02:07:25,419
ADVERTISED TO CONTINUE THE 

3216
02:07:25,419 --> 02:07:26,020
INFRASTRUCTURE THAT HAS BEEN 

3217
02:07:26,020 --> 02:07:27,421
PROVIDED BY OUR COORDINATION 

3218
02:07:27,421 --> 02:07:32,126
AND TRANSLATION CENTER AND THE 

3219
02:07:32,126 --> 02:07:32,660
ADVANCED METHODOLOGY AND 

3220
02:07:32,660 --> 02:07:35,429
RESEARCH CENTER.  WE SHOULD BE 

3221
02:07:35,429 --> 02:07:36,030
MAKING AN ANNOUNCEMENT ABOUT 

3222
02:07:36,030 --> 02:07:38,599
THOSE AWARDS VERY SOON, NOT 

3223
02:07:38,599 --> 02:07:39,133
QUITE YET BUT VERY SOON. 

3224
02:07:39,133 --> 02:07:39,800
MEANWHILE WE ALSO PUBLISHED OUR 

3225
02:07:39,800 --> 02:07:42,903
INTENT TO CONTINUE JCOIN, THAT 

3226
02:07:42,903 --> 02:07:45,906
WE WILL BE REALLY SEEING THIS 

3227
02:07:45,906 --> 02:07:48,642
VERY SOON, AND OUR NEXT PHASE 

3228
02:07:48,642 --> 02:07:51,512
OF RESEARCH HUBS. WE BEEN 

3229
02:07:51,512 --> 02:07:52,146
SHARING THAT IN SOME PEOPLE CAN 

3230
02:07:52,146 --> 02:07:54,515
ANTICIPATE THAT IS COMING.

3231
02:07:54,515 --> 02:07:55,082
AND AMONG THE THINGS THAT ARE 

3232
02:07:55,082 --> 02:07:57,284
COVERED IN THAT, IS THE IDEA OF 

3233
02:07:57,284 --> 02:07:57,885
WANTING TO MOVE EARLY ON THE 

3234
02:07:57,885 --> 02:08:01,755
CONTINUUM.  SHOW YOU SOMETHING 

3235
02:08:01,755 --> 02:08:02,790
THAT IS OFTEN REFERENCES THE 

3236
02:08:02,790 --> 02:08:05,626
INTERCEPT MODEL. AND TO ADJUST 

3237
02:08:05,626 --> 02:08:06,260
THE WAY OF THINKING HOW PEOPLE 

3238
02:08:06,260 --> 02:08:06,794
MOVED TO THE SYSTEM FROM 

3239
02:08:06,794 --> 02:08:07,294
INITIAL LAW ENFORCEMENT 

3240
02:08:07,294 --> 02:08:08,829
CONTACT, TO WHAT HAPPENS AFTER 

3241
02:08:08,829 --> 02:08:18,472
THEY GET ARRESTED, TO COURTS, 

3242
02:08:18,472 --> 02:08:19,106
JAILS AND PRISONS AND TO RETURN 

3243
02:08:19,106 --> 02:08:19,740
TO THE COMMUNITY. WHEN YOU LOOK 

3244
02:08:19,740 --> 02:08:20,708
AT WHAT WE HAVE DONE WE HAVE 

3245
02:08:20,708 --> 02:08:24,011
FOCUSED ON THE 4-5 INTERCEPT 

3246
02:08:24,011 --> 02:08:25,246
TRAJECTORY AND WE SEE A LOT OF 

3247
02:08:25,246 --> 02:08:27,681
OPPORTUNITIES FOR ADDITIONAL 

3248
02:08:27,681 --> 02:08:28,249
RESEARCH BUT WE ARE AT THE 

3249
02:08:28,249 --> 02:08:30,050
EARLY STAGES, BUT KEEPING 

3250
02:08:30,050 --> 02:08:30,618
PEOPLE OUT OF THE SYSTEM AS 

3251
02:08:30,618 --> 02:08:32,419
MUCH AS WE CAN. 

3252
02:08:32,419 --> 02:08:33,020
ONE OF THE OTHER BIG CHANGES WE 

3253
02:08:33,020 --> 02:08:34,522
HOPE TO MAKE, THAT WE WILL BE 

3254
02:08:34,522 --> 02:08:35,189
MAKING IN THE SECOND PHASE, IS 

3255
02:08:35,189 --> 02:08:39,360
CONVERTING THE "O" FROM OPIOID 

3256
02:08:39,360 --> 02:08:48,736
TO OVERDOSE. NOT JUST OPIOIDS, 

3257
02:08:48,736 --> 02:08:51,205
PEOPLE ARE DYING FROM OTHER 

3258
02:08:51,205 --> 02:08:51,805
THINGS, DOUBLING DOWN ON THE 

3259
02:08:51,805 --> 02:08:54,241
IDEA OF BRINGING IN THE 

3260
02:08:54,241 --> 02:08:55,809
PERSPECTIVE OF PEOPLE WE LIVED 

3261
02:08:55,809 --> 02:08:56,377
EXPERIENCE. AND CONTINUE TO 

3262
02:08:56,377 --> 02:08:56,944
RAMP UP THE SCALE OF THINGS 

3263
02:08:56,944 --> 02:09:00,180
THAT WORKED. LOTS AND LOTS OF 

3264
02:09:00,180 --> 02:09:00,814
REALLY, REALLY IMPORTANT POLICY 

3265
02:09:00,814 --> 02:09:02,850
CHANGES HAPPENING RIGHT NOW.  I 

3266
02:09:02,850 --> 02:09:08,322
THINK THAT NORA SHARED EARLIER 

3267
02:09:08,322 --> 02:09:08,889
DATA ABOUT THE SURVEY WERE 

3268
02:09:08,889 --> 02:09:09,657
COMPARED TO 2018 WITH NOT KNOW 

3269
02:09:09,657 --> 02:09:12,560
WHAT IMPLEMENTATION OF MOUDS IN 

3270
02:09:12,560 --> 02:09:14,795
JAILS LOOK LIKE. WE THOUGHT IT 

3271
02:09:14,795 --> 02:09:16,230
WAS RARE. THERE HAVE BEEN A LOT 

3272
02:09:16,230 --> 02:09:20,601
OF CHANGES. THE JCOIN CHANGES 

3273
02:09:20,601 --> 02:09:22,269
HAVE BEEN INCORPORATED INTO WAS 

3274
02:09:22,269 --> 02:09:24,605
COMING OUT OF THE BUREAU OF 

3275
02:09:24,605 --> 02:09:25,573
JUSTICE STATISTICS, STARTING TO 

3276
02:09:25,573 --> 02:09:26,206
MAKE CHANGES IN LOTS OF POLICY 

3277
02:09:26,206 --> 02:09:26,840
CHANGES. THEY ARE PUSHING THAT 

3278
02:09:26,840 --> 02:09:29,410
DIRECTION. 

3279
02:09:29,410 --> 02:09:31,612
YOU ASKED THE QUESTION EARLIER. 

3280
02:09:31,612 --> 02:09:32,146
LOTS AND LOTS OF STUFF IS 

3281
02:09:32,146 --> 02:09:34,248
HAPPENING.  A LOT OF MOVEMENT 

3282
02:09:34,248 --> 02:09:35,716
IS IN THE SPACE AND WE ARE 

3283
02:09:35,716 --> 02:09:37,851
SEEING EXAMPLES WHERE CMS IS 

3284
02:09:37,851 --> 02:09:39,587
NOW OFFERING STATES TO APPLY TO 

3285
02:09:39,587 --> 02:09:42,623
BE ABLE TO PAY FOR SERVICES 

3286
02:09:42,623 --> 02:09:43,190
BEFORE PEOPLE RETURN TO THE 

3287
02:09:43,190 --> 02:09:45,726
COMMUNITY.  HOPEFULLY WILL BE 

3288
02:09:45,726 --> 02:09:48,662
ABLE TO UNDERSTAND. AND 

3289
02:09:48,662 --> 02:09:49,897
SIGNIFICANT CHANGES WITH SOME 

3290
02:09:49,897 --> 02:09:58,939
OF THE ROLES THAT SAMSAH HAS 

3291
02:09:58,939 --> 02:09:59,540
ABOUT METHADONE AND HOW IT IS 

3292
02:09:59,540 --> 02:10:00,808
BEING DELIVERED LOTS OF POLICY 

3293
02:10:00,808 --> 02:10:03,777
CHANGES THAT I THINK ARE ON THE 

3294
02:10:03,777 --> 02:10:04,378
HORIZON. WHERE WE SEE IMPACTS 

3295
02:10:04,378 --> 02:10:07,314
ON THE SYSTEM MOVING FORWARD. 

3296
02:10:07,314 --> 02:10:07,881
WILL ALSO THINK WE NEED MORE 

3297
02:10:07,881 --> 02:10:11,919
WORK ON DISORDERS, AND LOTS OF 

3298
02:10:11,919 --> 02:10:14,922
ISSUES AROUND TECHNOLOGY AND 

3299
02:10:14,922 --> 02:10:16,790
SPECIAL POPULATIONS LIKE WOMEN, 

3300
02:10:16,790 --> 02:10:17,958
ADOLESCENTS AND TRIBAL. I WANT 

3301
02:10:17,958 --> 02:10:18,592
TO LEAVE TIME FOR QUESTIONS. WE 

3302
02:10:18,592 --> 02:10:23,697
ARE RUNNING A LITTLE BIT LATE. 

3303
02:10:23,697 --> 02:10:24,598
I WANT TO STOP THERE. I THANK 

3304
02:10:24,598 --> 02:10:26,767
MY TEAM AND THE RESEARCHERS, IN 

3305
02:10:26,767 --> 02:10:27,901
THE PARTICIPANTS IN THE TRIAL. 

3306
02:10:27,901 --> 02:10:28,535
AND I WELCOME ANY QUESTIONS YOU 

3307
02:10:28,535 --> 02:10:30,504
HAVE.  AND IF YOU WANT TO SEE 

3308
02:10:30,504 --> 02:10:31,672
ANY OF THOSE RESOURCES, THE 

3309
02:10:31,672 --> 02:10:34,708
JCOIN CTC WEBSITE IS EVERYTHING 

3310
02:10:34,708 --> 02:10:39,046
I REFERENCED. THE COURSES IN 

3311
02:10:39,046 --> 02:10:42,983
THE PODCASTS, AND EVERYTHING 

3312
02:10:42,983 --> 02:10:43,484
ALSO THANK YOU FOR THE 

3313
02:10:43,484 --> 02:10:44,918
OPPORTUNITY TO SHARE. 

3314
02:10:44,918 --> 02:10:47,354
>> DR. VOLKOW: THANK YOU
FOR 

3315
02:10:47,354 --> 02:10:51,358
THE EXCELLENT PRESENTATION.  I 

3316
02:10:51,358 --> 02:10:51,959
KNOW WE ARE RUNNING A LITTLE 

3317
02:10:51,959 --> 02:10:52,793
BIT LATE BUT CAN WE ASK 

3318
02:10:52,793 --> 02:10:53,460
QUESTIONS? 

3319
02:10:53,460 --> 02:11:00,668
>> DR. WEISS: YEAH WHY
DON'T WE 

3320
02:11:00,668 --> 02:11:04,104
TAKE FIVE MINUTES FOR QUESTIONS.

3321
02:11:04,104 --> 02:11:04,638
 I ALSO HATE TO CUT THESE 

3322
02:11:04,638 --> 02:11:07,508
THINGS OFF ALSO. 

3323
02:11:07,508 --> 02:11:10,878
>> HI.  THANK YOU SO MUCH
FOR 

3324
02:11:10,878 --> 02:11:13,781
YOUR REPRESENTATION. I AM 

3325
02:11:13,781 --> 02:11:16,483
WONDERING, IN YOUR DISCUSSIONS 

3326
02:11:16,483 --> 02:11:17,117
AND LOOKING AT THE FUTURE WHERE 

3327
02:11:17,117 --> 02:11:19,186
YOU ARE WITH PARTNERING WITH 

3328
02:11:19,186 --> 02:11:29,697
HOUSING AUTHORITIES? A LOT OF 

3329
02:11:36,437 --> 02:11:37,004
THIS POPULATION IS UNHOUSED, OR 

3330
02:11:37,004 --> 02:11:37,638
HOUSING IS UNSTABLE, DIFFICULT 

3331
02:11:37,638 --> 02:11:40,441
TO GET TREATMENT. 

3332
02:11:40,441 --> 02:11:41,008
>> I AGREE WITH YOU
ENTIRELY. 

3333
02:11:41,008 --> 02:11:41,542
THIS IS SUCH AN IMPORTANT 

3334
02:11:41,542 --> 02:11:43,310
PIECE.  I HAVE NOT REACHED OUT 

3335
02:11:43,310 --> 02:11:46,146
TO HUD. BUT I WOULD SAY THAT 

3336
02:11:46,146 --> 02:11:52,653
DOOR IS WIDE OPEN.  HALFWAY 

3337
02:11:52,653 --> 02:11:53,220
HOUSING IS PART OF WHAT IS 

3338
02:11:53,220 --> 02:11:54,121
OFTEN ON THE CONTINUUM OF CARE, 

3339
02:11:54,121 --> 02:11:55,055
PEOPLE RETURNING TO THEIR 

3340
02:11:55,055 --> 02:11:57,491
COMMUNITY. YEAH, THAT IS KIND 

3341
02:11:57,491 --> 02:11:58,859
OF EXAMPLE SOMETHING THAT THE 

3342
02:11:58,859 --> 02:12:02,262
DOOR IS WIDE OPEN, PART OF THE 

3343
02:12:02,262 --> 02:12:02,896
SOCIAL DETERMINANTS OF HEALTH. 

3344
02:12:02,896 --> 02:12:05,265
SO SUPER IMPORTANT. ABSOLUTELY 

3345
02:12:05,265 --> 02:12:06,366
WOULD WELCOME WITH OPEN ARMS 

3346
02:12:06,366 --> 02:12:07,634
ANYONE WHO WANTED TO EXPLORE 

3347
02:12:07,634 --> 02:12:10,671
THE POSSIBILITY. 

3348
02:12:10,671 --> 02:12:12,506
>> AND I THINK THE OTHER
PIECE 

3349
02:12:12,506 --> 02:12:15,342
IS, VOCATIONAL RETRAINING. 

3350
02:12:15,342 --> 02:12:17,611
BECAUSE IF YOU DON'T HAVE A 

3351
02:12:17,611 --> 02:12:18,245
JOB, OBVIOUSLY YOU CAN'T AFFORD 

3352
02:12:18,245 --> 02:12:21,014
HOUSING. RIGHT? SO THOSE THINGS 

3353
02:12:21,014 --> 02:12:22,716
GO HAND-IN-HAND. AND SO THOSE 

3354
02:12:22,716 --> 02:12:26,954
ARE THE TWO MAJOR ASSET YOU CAN 

3355
02:12:26,954 --> 02:12:27,521
ADD TO THE FUTURE PLANNING 

3356
02:12:27,521 --> 02:12:28,122
PERHAPS. 

3357
02:12:28,122 --> 02:12:32,993
>> TISHA: I WILL SAY TO
YOU I 

3358
02:12:32,993 --> 02:12:33,627
THINK THAT IS SOMETHING WE HOPE 

3359
02:12:33,627 --> 02:12:34,228
IN THE COMPONENTS THAT WE ARE 

3360
02:12:34,228 --> 02:12:41,835
PLANNING AROUND ... REALLY  

3361
02:12:41,835 --> 02:12:42,402
INCREASING OUR EFFORTS FOR 

3362
02:12:42,402 --> 02:12:43,003
LISTENING TO THE PERSPECTIVES 

3363
02:12:43,003 --> 02:12:43,937
OF PEOPLE WE LIVED EXPERIENCE, 

3364
02:12:43,937 --> 02:12:46,507
THAT IS WHAT WOULD HELP THEM. 

3365
02:12:46,507 --> 02:12:48,041
WHAT DO THEY NEED? HOW DO YOU 

3366
02:12:48,041 --> 02:12:48,609
SUPPORT THAT? BECAUSE I DO 

3367
02:12:48,609 --> 02:12:53,547
THINK THAT IF YOU GO BACK TO 

3368
02:12:53,547 --> 02:12:54,148
MASLOW HIERARCHY OF NEED, IF 

3369
02:12:54,148 --> 02:12:56,617
SOMEONE RETURNS TO THEIR HOME 

3370
02:12:56,617 --> 02:12:59,052
AND ALL THEY HAVE -- THEY GO 

3371
02:12:59,052 --> 02:13:00,854
HOME TO ALMOST NOTHING. RIGHT? 

3372
02:13:00,854 --> 02:13:04,258
THEY MAY BE DISCONNECTED. THEY 

3373
02:13:04,258 --> 02:13:04,792
MAY NOT BE FOCUSED ON THE 

3374
02:13:04,792 --> 02:13:09,062
CARDIOVASCULAR HEALTH.  OR EVEN 

3375
02:13:09,062 --> 02:13:09,696
THEIR SUBSTANCE USE DISORDER IF 

3376
02:13:09,696 --> 02:13:11,465
THEY DON'T HAVE A PLACE TO 

3377
02:13:11,465 --> 02:13:12,533
LIVE, OR WAYS TO SUPPORT 

3378
02:13:12,533 --> 02:13:14,835
THEMSELVES. ABSOLUTELY. 

3379
02:13:14,835 --> 02:13:20,040
>> THANK YOU. 

3380
02:13:20,040 --> 02:13:24,711
>> DR. VOLKOW: TISHA,  ONE

3381
02:13:24,711 --> 02:13:27,214
QUESTION. DO WE HAVE GOOD DATA 

3382
02:13:27,214 --> 02:13:27,848
IN TERMS OF LONG-TERM OUTCOMES? 

3383
02:13:27,848 --> 02:13:28,982
WE KNOW THAT THERE AT HIGHER 

3384
02:13:28,982 --> 02:13:31,919
RISK OF DYING. HAVE THERE BEEN 

3385
02:13:31,919 --> 02:13:33,253
RECENT ESTIMATES ABOUT WHAT 

3386
02:13:33,253 --> 02:13:35,956
HAPPENS THAT IS IN JAIL OR 

3387
02:13:35,956 --> 02:13:36,857
PRISON WITH A SUBSTANCE USE 

3388
02:13:36,857 --> 02:13:38,559
DISORDER? WHAT IS YOUR LIFE 

3389
02:13:38,559 --> 02:13:39,893
EXPECTANCY? 

3390
02:13:39,893 --> 02:13:43,297
>> TISHA: LIFE EXPECTANCY,

3391
02:13:43,297 --> 02:13:49,336
DON'T KNOW THE ANSWER. BUT I AM 

3392
02:13:49,336 --> 02:13:49,903
CERTAIN IT IS DRAMATICALLY 

3393
02:13:49,903 --> 02:13:50,804
DECREASED RELATIVE TO OTHER 

3394
02:13:50,804 --> 02:13:51,338
POPULATIONS, FOR A WHOLE 

3395
02:13:51,338 --> 02:13:53,507
VARIETY OF REASONS. INCLUDING 

3396
02:13:53,507 --> 02:13:54,875
NOT JUST SUBSTANCE USE, BUT IN 

3397
02:13:54,875 --> 02:13:57,544
GENERAL PEOPLE WHO ARE -- AND 

3398
02:13:57,544 --> 02:14:00,147
OFTEN PEOPLE THINK OF THIS AS 

3399
02:14:00,147 --> 02:14:04,518
AN INVITED THING. BUT PEOPLE 

3400
02:14:04,518 --> 02:14:07,421
WHO ARE INCARCERATED HAVE WORSE 

3401
02:14:07,421 --> 02:14:12,826
OUTCOMES IN ALMOST EVERY 

3402
02:14:12,826 --> 02:14:13,360
DIMENSION, CARDIOVASCULAR 

3403
02:14:13,360 --> 02:14:15,095
HEALTH, THERE IS INFECTIONS 

3404
02:14:15,095 --> 02:14:16,797
DISEASES, LOT OF CHRONIC 

3405
02:14:16,797 --> 02:14:19,700
DISEASES. A POPULATION THAT IN 

3406
02:14:19,700 --> 02:14:20,334
TURN STRUGGLES WITH HOUSING AND 

3407
02:14:20,334 --> 02:14:24,705
ALL KINDS OF THINGS SO LIFE 

3408
02:14:24,705 --> 02:14:27,975
EXPECTANCY RELATIVE TO OTHER 

3409
02:14:27,975 --> 02:14:28,575
POPULATIONS-- I WILL SEE IF I 

3410
02:14:28,575 --> 02:14:29,209
CAN FIND ANY THAT THIS IS ABOUT 

3411
02:14:29,209 --> 02:14:29,843
THE IMPACT OF INCARCERATION ON 

3412
02:14:29,843 --> 02:14:31,178
LIFE EXPECTANCY. BUT I CAN 

3413
02:14:31,178 --> 02:14:32,613
GUARANTEE YOU, IT IS NOT GOOD. 

3414
02:14:32,613 --> 02:14:34,982
>> DR. VOLKOW: YOU HAVE
YOUR 

3415
02:14:34,982 --> 02:14:37,517
HAND RAISED RICK. 

3416
02:14:37,517 --> 02:14:40,320
>> TISHA DON'T FORGET
ABOUT 

3417
02:14:40,320 --> 02:14:44,591
THOSE CLASSIC EXPOSURES. THAT 

3418
02:14:44,591 --> 02:14:45,225
ARE COINCIDENT WITH THESE 

3419
02:14:45,225 --> 02:14:48,428
ENVIRONMENTS. IT IS A VERY 

3420
02:14:48,428 --> 02:14:49,630
CHALLENGING LIFESTYLE. 

3421
02:14:49,630 --> 02:14:53,600
>> TISHA: I WILL ACTUALLY 

3422
02:14:53,600 --> 02:14:54,201
MENTION, JUST TWO WEEKS AGO I 

3423
02:14:54,201 --> 02:14:57,104
WAS AT THE ACADEMIC AND 

3424
02:14:57,104 --> 02:14:57,604
CORRECTIONAL HEALTHCARE 

3425
02:14:57,604 --> 02:15:00,073
CONSORTIUM, ONE OF THE BIG 

3426
02:15:00,073 --> 02:15:00,641
MEETINGS IN THE SPACE THAT 

3427
02:15:00,641 --> 02:15:01,141
TRIES TO LEARN WHAT THE 

3428
02:15:01,141 --> 02:15:06,380
ACADEMIC AND COMMUNITY PARTNER 

3429
02:15:06,380 --> 02:15:08,515
PERSPECTIVES, AND THE WHOLE 

3430
02:15:08,515 --> 02:15:10,083
THEME OF THE CONFERENCE WAS 

3431
02:15:10,083 --> 02:15:18,025
ENVIRONMENTAL JUSTICE. THAT WAS 

3432
02:15:18,025 --> 02:15:18,592
ONE OF THE KEY THEMES. THE 

3433
02:15:18,592 --> 02:15:20,594
MEETING WAS HOSTED IN ARIZONA, 

3434
02:15:20,594 --> 02:15:22,195
FOCUSING ON HEAT, AND CROSSROAD 

3435
02:15:22,195 --> 02:15:23,664
FACILITIES OFTEN HAVE POOR 

3436
02:15:23,664 --> 02:15:25,666
INFRASTRUCTURE. THEY WERE AMONG 

3437
02:15:25,666 --> 02:15:26,733
THE HARDEST HIT FACILITIES 

3438
02:15:26,733 --> 02:15:28,235
DURING COVID BECAUSE OF THE 

3439
02:15:28,235 --> 02:15:29,202
LACK OF INFRASTRUCTURE.  

3440
02:15:29,202 --> 02:15:33,607
ABSOLUTELY. 

3441
02:15:33,607 --> 02:15:36,243
>> SO, THIS PROCESS GOES 

3442
02:15:36,243 --> 02:15:36,877
HAND-IN-HAND WITH SOME MANY OF 

3443
02:15:36,877 --> 02:15:40,113
THESE THINGS. NORA, I DON'T 

3444
02:15:40,113 --> 02:15:40,781
KNOW THE REST OF YOU, WE HAD A 

3445
02:15:40,781 --> 02:15:44,685
MEETING WITH SECRETARY BECERRA. 

3446
02:15:44,685 --> 02:15:45,218
 HE WAS TALKING ABOUT THE 

3447
02:15:45,218 --> 02:15:47,087
COMPLICATIONS OF MANY 

3448
02:15:47,087 --> 02:15:49,056
FARMWORKERS IN CENTRAL 

3449
02:15:49,056 --> 02:15:52,859
CALIFORNIA.  THE IMPACTS OF 

3450
02:15:52,859 --> 02:15:56,964
CLIMATE CHANGE, AND INCREASED 

3451
02:15:56,964 --> 02:16:00,867
HEAT, IN THE CONTEXT OF THESE, 

3452
02:16:00,867 --> 02:16:01,501
PEOPLE ARE EASING SOME OF THEIR 

3453
02:16:01,501 --> 02:16:03,203
PAIN WITH ILLICIT DRUG USE. IT 

3454
02:16:03,203 --> 02:16:04,571
IS REALLY A COMPLICATED 

3455
02:16:04,571 --> 02:16:08,909
FORMULA. NOT SURPRISED IF THE 

3456
02:16:08,909 --> 02:16:10,210
LIFESPANS ARE MARKEDLY REDUCED 

3457
02:16:10,210 --> 02:16:13,413
IN THESE INDIVIDUALS. 

3458
02:16:13,413 --> 02:16:20,754
>> DR. VOLKOW: ABSOLUTELY,

3459
02:16:20,754 --> 02:16:23,390
TISHA IS CORRECT. IT WILL BE 

3460
02:16:23,390 --> 02:16:23,957
INTERESTING TO SEE HOW MUCH 

3461
02:16:23,957 --> 02:16:29,496
LOWER. IT IS AN ISSUE THAT BY 

3462
02:16:29,496 --> 02:16:30,097
SPEAKING ABOUT IT PEOPLE CAN 

3463
02:16:30,097 --> 02:16:33,700
START TO REACT. WE ARE SPENDING 

3464
02:16:33,700 --> 02:16:34,234
MINUTES OF DOLLARS IN THE 

3465
02:16:34,234 --> 02:16:34,768
CRIMINAL SYSTEM, AND THE 

3466
02:16:34,768 --> 02:16:35,369
OUTCOMES ARE CLEARLY NEGATIVE 

3467
02:16:35,369 --> 02:16:36,636
FOR PEOPLE WHO END UP THERE AND 

3468
02:16:36,636 --> 02:16:43,510
THEIR FAMILIES.  BECAUSE 

3469
02:16:43,510 --> 02:16:44,077
OBVIOUSLY THE CHILDREN HAVE 

3470
02:16:44,077 --> 02:16:45,612
MUCH WORSE OUTCOMES. SOCIAL 

3471
02:16:45,612 --> 02:16:47,514
DISPARITIES AT THE EXTREME. 

3472
02:16:47,514 --> 02:16:48,482
BUT THANKS FOR A FANTASTIC 

3473
02:16:48,482 --> 02:16:50,851
PRESENTATION TISHA.  AND I WILL 

3474
02:16:50,851 --> 02:16:53,487
TURN IT BACK TO YOU SUSAN, TO 

3475
02:16:53,487 --> 02:16:54,087
GUIDE US TO THE NEXT PART OF 

3476
02:16:54,087 --> 02:16:54,554
THE MEETING. 

3477
02:16:54,554 --> 02:16:56,923
>> DR. WEISS: SO WE HAVE A

3478
02:16:56,923 --> 02:16:58,025
BREAK RIGHT NOW WHICH GOES 

3479
02:16:58,025 --> 02:17:00,694
UNTIL 2:25. WHY DON'T WE MAKE 

3480
02:17:00,694 --> 02:17:04,097
IT UNTIL 2:30 PM, SO WE HAVE 15 

3481
02:17:04,097 --> 02:17:04,731
MINUTES AND THEN WILL START THE 

3482
02:17:04,731 --> 02:17:07,367
CLOSE SESSION THEN.  SEE YOU 

3483
02:17:07,367 --> 02:17:10,037
BACK YOUR 2:30 PM. IS THERE A 

3484
02:17:10,037 --> 02:17:15,475
SEPARATE SIGN IN FOR THIS?

3485
02:17:15,475 --> 02:17:25,585
>> [BREAK]