1 00:00:05,520 --> 00:00:08,240 IT IS MY DISTINCT PLEASURE TO 2 00:00:08,240 --> 00:00:11,600 WELCOME YOU TO TODAY'S MEETING 3 00:00:11,600 --> 00:00:15,080 OF THE "HEAL," HELPING TO END 4 00:00:15,080 --> 00:00:17,200 ADDICTION LONG TERM 5 00:00:17,200 --> 00:00:18,040 MULTI-DISCIPLINARY WORKING GROUP 6 00:00:18,040 --> 00:00:18,680 MEETING. 7 00:00:18,680 --> 00:00:20,680 SO, TODAY IS THE FIRST OF A 8 00:00:20,680 --> 00:00:21,520 TWO-DAY MEETING, THIS FIRST 9 00:00:21,520 --> 00:00:26,000 PORTION OF THE MEETING WILL BE 10 00:00:26,000 --> 00:00:27,200 MADE LIVE THROUGH NIH VIDEOCAST, 11 00:00:27,200 --> 00:00:29,760 SO PLEASE BE AWARE THAT YOUR 12 00:00:29,760 --> 00:00:32,680 COMMENTS WILL BE SEEN BY FOLKS 13 00:00:32,680 --> 00:00:35,480 TUNING IN, THE MEETING WILL ALSO 14 00:00:35,480 --> 00:00:37,720 BE RECORDED. 15 00:00:37,720 --> 00:00:40,640 SO WE HAVE A REALLY WONDERFUL 16 00:00:40,640 --> 00:00:41,840 SET OF PROGRAMS MOVING FORWARD 17 00:00:41,840 --> 00:00:43,640 THROUGH THE INITIATIVE THAT YOU 18 00:00:43,640 --> 00:00:47,240 WILL HEAR ABOUT TODAY. 19 00:00:47,240 --> 00:00:49,200 AND WE WILL START WITH SOME 20 00:00:49,200 --> 00:00:54,320 WORDS OF WELCOME FROM MYSELF AND 21 00:00:54,320 --> 00:00:55,720 THEN INTRODUCTIONS AND ROLL CALL 22 00:00:55,720 --> 00:01:00,360 OF THE M OF MULTI-DISCIPLINARY 23 00:01:00,360 --> 00:01:02,360 WORKING GROUP MEMBERS AND "HEAL" 24 00:01:02,360 --> 00:01:03,560 EXECUTIVE COMMITTEE JOINING 25 00:01:03,560 --> 00:01:05,920 TODAY AND WE'LL HEAR FROM 26 00:01:05,920 --> 00:01:07,280 DOCTORS NORA VOLKOW AND WALTER 27 00:01:07,280 --> 00:01:08,560 KOROSHETZ ABOUT CURRENT TOPICS 28 00:01:08,560 --> 00:01:10,560 IN HEAL INITIATIVE TO SHARE WITH 29 00:01:10,560 --> 00:01:12,200 THE BROADER GROUP. 30 00:01:12,200 --> 00:01:14,440 SO, WITH THOSE WORDS OF WELCOME, 31 00:01:14,440 --> 00:01:16,480 THANK YOU, EVERYONE, FOR MAKING 32 00:01:16,480 --> 00:01:20,080 TIME IN YOUR BUSY AUGUST FOR 33 00:01:20,080 --> 00:01:21,880 JOINING US, AND CONTRIBUTING TO 34 00:01:21,880 --> 00:01:23,640 THIS COLLABORATIVE EFFORT. 35 00:01:23,640 --> 00:01:26,480 I'LL TURN IT OVER TO ERIN 36 00:01:26,480 --> 00:01:28,520 SPANIOL TO GO THROUGH ROLL. 37 00:01:28,520 --> 00:01:30,960 >> RECORDING IN PROGRESS. 38 00:01:30,960 --> 00:01:31,880 >> HELLO, GOOD MORNING, 39 00:01:31,880 --> 00:01:32,120 EVERYONE. 40 00:01:32,120 --> 00:01:34,880 I'M GOING DOWN THE LIST TO START 41 00:01:34,880 --> 00:01:37,360 WITH MDWG MEMBERS I SEE. 42 00:01:37,360 --> 00:01:39,280 SO I DO SEE DR. JONES, CAN YOU 43 00:01:39,280 --> 00:01:43,000 PLEASE TURN ON YOUR CAMERA AND 44 00:01:43,000 --> 00:01:43,800 SAY HI? 45 00:01:43,800 --> 00:01:46,960 >> GOOD MORNING, OR GOOD 46 00:01:46,960 --> 00:01:47,640 AFTERNOON. 47 00:01:47,640 --> 00:01:48,680 >> GOOD MORNING. 48 00:01:48,680 --> 00:01:50,680 OKAY. 49 00:01:50,680 --> 00:01:53,360 DR. NUNES, YOU'RE NEXT. 50 00:01:53,360 --> 00:01:53,880 >> GOOD MORNING. 51 00:01:53,880 --> 00:01:56,920 >> GREAT, WE CAN HEAR YOU, GOOD 52 00:01:56,920 --> 00:01:57,160 MORNING. 53 00:01:57,160 --> 00:01:58,840 DR. GARLAND, GLAD YOU MADE IT 54 00:01:58,840 --> 00:01:59,000 IN. 55 00:01:59,000 --> 00:02:02,680 DO YOU WANT TO TURN ON YOUR 56 00:02:02,680 --> 00:02:03,800 CAMERA? 57 00:02:03,800 --> 00:02:05,160 >> GOOD TO SEE EVERYONE. 58 00:02:05,160 --> 00:02:07,520 HOPEFULLY YOU CAN SEE ME. 59 00:02:07,520 --> 00:02:08,280 >> YES, WE CAN. 60 00:02:08,280 --> 00:02:11,440 WE CAN HEAR YOU GREAT. 61 00:02:11,440 --> 00:02:14,120 DR. JERNIGAN? 62 00:02:14,120 --> 00:02:16,320 >> GOOD MORNING, EVERYBODY. 63 00:02:16,320 --> 00:02:16,760 >> GOOD MORNING. 64 00:02:16,760 --> 00:02:18,960 ALL RIGHT. 65 00:02:18,960 --> 00:02:21,720 I SEE DR. KUNTZ. 66 00:02:21,720 --> 00:02:22,160 >> GOOD MORNING. 67 00:02:22,160 --> 00:02:28,560 >> HELLO, GOOD TO SEE YOU. 68 00:02:28,560 --> 00:02:29,880 DR. PAICE, YOU'RE NEXT. 69 00:02:29,880 --> 00:02:31,840 >> GOOD MORNING. 70 00:02:31,840 --> 00:02:35,520 >> ALL RIGHT. 71 00:02:35,520 --> 00:02:39,640 AND THEN DR. HENRY? 72 00:02:39,640 --> 00:02:40,520 >> YES, GOOD MORNING. 73 00:02:40,520 --> 00:02:42,720 >> WE CAN HEAR AND SEE YOU. 74 00:02:42,720 --> 00:02:47,840 AND I THINK A FEW OTHER PEOPLE 75 00:02:47,840 --> 00:02:48,400 POPPED ON WHILE -- 76 00:02:48,400 --> 00:02:51,800 >> THIS IS LYNN DEBAR, THANK YOU 77 00:02:51,800 --> 00:02:53,720 FOR FIXING MY LINK, I'M ON. 78 00:02:53,720 --> 00:02:55,600 >> GOOD, GLAD TO SEE YOU ON. 79 00:02:55,600 --> 00:02:57,920 SORRY TO THOSE WHO HAD SOME 80 00:02:57,920 --> 00:02:58,960 TROUBLE JOINING THIS MORNING BUT 81 00:02:58,960 --> 00:03:01,160 GLAD TO SEE YOU. 82 00:03:01,160 --> 00:03:02,600 ANY OTHER MDWG MEMBERS THAT 83 00:03:02,600 --> 00:03:06,760 POPPED ON THAT I MISSED? 84 00:03:06,760 --> 00:03:07,120 ALL RIGHT. 85 00:03:07,120 --> 00:03:08,320 SOME OTHERS WILL BE JOINING A 86 00:03:08,320 --> 00:03:11,200 LITTLE BIT LATER IN THE MEETING. 87 00:03:11,200 --> 00:03:12,920 IN ADDITION TO THE MDWG MEMBERS 88 00:03:12,920 --> 00:03:15,840 WE HAVE MEMBERS OF OUR EXECUTIVE 89 00:03:15,840 --> 00:03:18,120 COMMITTEE ON. 90 00:03:18,120 --> 00:03:19,840 DR. KOROSHETZ, SAY HELLO. 91 00:03:19,840 --> 00:03:20,200 >> HI, FOLKS. 92 00:03:20,200 --> 00:03:23,720 GOOD TO BE HERE TODAY. 93 00:03:23,720 --> 00:03:27,840 >> THANKS, WALTER. 94 00:03:27,840 --> 00:03:29,520 DR. VOLKOW. 95 00:03:29,520 --> 00:03:30,120 >> GOOD MORNING, WELCOME. 96 00:03:30,120 --> 00:03:31,040 >> GOOD MORNING. 97 00:03:31,040 --> 00:03:33,520 GOING THROUGH THE LIST, THERE 98 00:03:33,520 --> 00:03:35,680 ARE A FEW EXECUTIVE COMMITTEE 99 00:03:35,680 --> 00:03:37,400 MEMBERS THAT WILL BE JOINING 100 00:03:37,400 --> 00:03:38,640 LATER ESPECIALLY WHEN SOME 101 00:03:38,640 --> 00:03:41,920 FUNDING PLANS WILL BE DISCUSSED, 102 00:03:41,920 --> 00:03:45,440 BUT IN ADDITION TO THOSE 103 00:03:45,440 --> 00:03:47,120 ATTENDING LATER THERE ARE SOME 104 00:03:47,120 --> 00:03:49,400 DELEGATES THEY HAVE ASKED TO 105 00:03:49,400 --> 00:03:53,240 JOIN FOR THEM. 106 00:03:53,240 --> 00:03:57,520 SO CHRISTINE COLVIS, DO YOU WANT 107 00:03:57,520 --> 00:03:58,280 TO SAY HELLO? 108 00:03:58,280 --> 00:04:01,880 SHE MIGHT HAVE JUST POPPED OFF. 109 00:04:01,880 --> 00:04:03,840 DR. ATKINSON IS ON. 110 00:04:03,840 --> 00:04:07,080 >> HELLO, EVERYBODY. 111 00:04:07,080 --> 00:04:14,160 THANK YOU FOR ATTENDING. 112 00:04:14,160 --> 00:04:18,960 >> DR. ELJEE JUST JOINED, HE ON 113 00:04:18,960 --> 00:04:20,440 BEHALF OF DR. KOO, THAT'S 114 00:04:20,440 --> 00:04:21,800 EVERYONE I SEE, IF THERE ARE 115 00:04:21,800 --> 00:04:24,800 OTHER DELEGATES THAT BO LIKE -- 116 00:04:24,800 --> 00:04:27,920 WOULD LIKE TO SAY HELLO, IF I 117 00:04:27,920 --> 00:04:34,640 MISSED YOU, PLEASE DO SO NOW. 118 00:04:34,640 --> 00:04:35,960 >> ALLAN BASEBAUAM AS JOINED. 119 00:04:35,960 --> 00:04:36,560 >> HI, EVERYONE. 120 00:04:36,560 --> 00:04:40,080 GOOD TO SEE YOU. 121 00:04:40,080 --> 00:04:41,560 >> HI THERE. 122 00:04:41,560 --> 00:04:44,880 >> HEY, ALLAN. 123 00:04:44,880 --> 00:04:45,280 >> ALL RIGHT. 124 00:04:45,280 --> 00:04:46,800 WELL, IN ADDITION TO THE 125 00:04:46,800 --> 00:04:48,040 EXECUTIVE COMMITTEE MEMBERS, 126 00:04:48,040 --> 00:04:49,320 THEIR DELEGATES, THERE'S ALSO 127 00:04:49,320 --> 00:04:50,920 MEMBERS OF OUR CO-CHAIR 128 00:04:50,920 --> 00:04:52,800 COMMITTEE, LEADERS OF THE 129 00:04:52,800 --> 00:04:53,720 SCIENTIFIC TEAMS. 130 00:04:53,720 --> 00:04:55,560 SO IF YOU ALL WANT TO SAY A 131 00:04:55,560 --> 00:04:56,760 QUICK HELLO, AND THEN THAT'S 132 00:04:56,760 --> 00:05:00,640 PRETTY MUCH OUR LIST FOR THIS 133 00:05:00,640 --> 00:05:04,000 MORNING. 134 00:05:04,000 --> 00:05:06,440 >> GOOD MORNING, EVERYONE. 135 00:05:06,440 --> 00:05:11,520 THANKS FOR JOINING TODAY. 136 00:05:11,520 --> 00:05:13,800 137 00:05:13,800 --> 00:05:16,520 >> GOOD MORNING, EVERYBODY. 138 00:05:16,520 --> 00:05:19,560 139 00:05:19,560 --> 00:05:20,000 >> EXCELLENT. 140 00:05:20,000 --> 00:05:21,640 THANK YOU. 141 00:05:21,640 --> 00:05:24,120 I'M VERY EXCITED, AS YOU WILL 142 00:05:24,120 --> 00:05:25,520 SEE OVER THE COURSE OF THE 143 00:05:25,520 --> 00:05:27,560 TWO-DAY MEETING IN FRONT OF US 144 00:05:27,560 --> 00:05:31,040 WE HAVE A LOT OF NEW RESEARCH TO 145 00:05:31,040 --> 00:05:32,920 TELL YOU ABOUT, AND PROPOSALS TO 146 00:05:32,920 --> 00:05:35,560 SHARE, BUT BEFORE WE GET STARTED 147 00:05:35,560 --> 00:05:39,360 I'D LIKE TO SITUATE US IN OUR 148 00:05:39,360 --> 00:05:43,600 MISSION, AND OUR AREA OF 149 00:05:43,600 --> 00:05:44,240 COLLECTIVE ACTION, SCIENTIFIC 150 00:05:44,240 --> 00:05:46,040 SOLUTIONS TO THE NATIONAL CRISIS 151 00:05:46,040 --> 00:05:48,680 OF OPIOID MISUSE AND PAIN WITH 152 00:05:48,680 --> 00:05:50,080 TWO PRESENTATIONS. 153 00:05:50,080 --> 00:05:51,520 FIRST FROM DR. NORA VOLKOW, 154 00:05:51,520 --> 00:05:55,240 DIRECTOR OF THE NATIONAL 155 00:05:55,240 --> 00:05:58,400 INSTITUTE ON -- ACTUALLY, NORA, 156 00:05:58,400 --> 00:06:01,160 GO AHEAD. 157 00:06:01,160 --> 00:06:02,560 EVERYONE KNOWS NORA. 158 00:06:02,560 --> 00:06:08,280 NIDA DIRECTOR, DR. NORA VOLKOW. 159 00:06:08,280 --> 00:06:08,960 >> HELLO. 160 00:06:08,960 --> 00:06:10,600 I THOUGHT YOU WERE GOING TO 161 00:06:10,600 --> 00:06:11,440 CHALLENGE ME, ARE YOU NOT 162 00:06:11,440 --> 00:06:13,000 CHANGING THE NAME OF THE 163 00:06:13,000 --> 00:06:14,280 INSTITUTE? 164 00:06:14,280 --> 00:06:14,440 YES. 165 00:06:14,440 --> 00:06:15,000 >> NO, YOU HAVE, RIGHT? 166 00:06:15,000 --> 00:06:16,280 >> NOT YET. 167 00:06:16,280 --> 00:06:17,920 WE HAVE TO GET APPROVAL 168 00:06:17,920 --> 00:06:19,840 OFFICIALLY. 169 00:06:19,840 --> 00:06:20,880 I'M NOT ALLOWED TO OFFICIALLY 170 00:06:20,880 --> 00:06:23,000 STATE IN THE FUTURE WE MAY 171 00:06:23,000 --> 00:06:25,360 BECOME THE NATIONAL INSTITUTE ON 172 00:06:25,360 --> 00:06:26,360 DRUGS AND ADDICTION, UNTIL THEN 173 00:06:26,360 --> 00:06:28,920 I HAVE TO SAY WE'RE THE NATIONAL 174 00:06:28,920 --> 00:06:29,920 INSTITUTE ON DRUG ABUSE. 175 00:06:29,920 --> 00:06:35,360 WE'RE TRYING TO GET RID OF THAT 176 00:06:35,360 --> 00:06:36,600 "ABUSE" WORD. 177 00:06:36,600 --> 00:06:37,760 >> FEARLESS LEADER, PLEASE TAKE 178 00:06:37,760 --> 00:06:39,480 US AWAY. 179 00:06:39,480 --> 00:06:41,040 >> OKAY, THANKS A LOT FOR 180 00:06:41,040 --> 00:06:42,960 INTRODUCING ALL OF US AND IT'S A 181 00:06:42,960 --> 00:06:44,480 PLEASURE TO BE HERE. 182 00:06:44,480 --> 00:06:45,800 I'M GOING TO BE DOING TODAY, 183 00:06:45,800 --> 00:06:47,240 JUST GIVE YOU IN TEN MINUTES AN 184 00:06:47,240 --> 00:06:49,680 UPDATE OF SOME OF THE ISSUES 185 00:06:49,680 --> 00:06:51,560 THAT PERTAIN TO THE OPIOID 186 00:06:51,560 --> 00:06:54,640 CRISIS AND WHICH WE NOW REFER TO 187 00:06:54,640 --> 00:06:56,680 AS THE OVERDOSE CRISIS, BECAUSE 188 00:06:56,680 --> 00:07:02,920 OBVIOUSLY THEY ARE DRIVING SOME 189 00:07:02,920 --> 00:07:05,720 OF WHAT WE NEED TO TARGET OUR 190 00:07:05,720 --> 00:07:06,160 RESEARCH. 191 00:07:06,160 --> 00:07:07,360 IF IT'S OKAY, REBECCA, CAN I 192 00:07:07,360 --> 00:07:08,800 SHARE MY SCREENS OR DO YOU WANT 193 00:07:08,800 --> 00:07:10,600 TO DO IT OVER THERE? 194 00:07:10,600 --> 00:07:11,640 >> I THINK WE HAVE YOUR SLIDES 195 00:07:11,640 --> 00:07:14,200 BUT IF YOU WOULD LIKE TO SHARE 196 00:07:14,200 --> 00:07:15,840 AND ARE PREPARED TO DO SO, 197 00:07:15,840 --> 00:07:19,160 PLEASE GO AHEAD. 198 00:07:19,160 --> 00:07:21,040 >> I'D LOVE TO SHARE, SO WHY 199 00:07:21,040 --> 00:07:22,280 DON'T I SHARE. 200 00:07:22,280 --> 00:07:26,240 LET ME SEE. 201 00:07:26,240 --> 00:07:28,600 OKAY. 202 00:07:28,600 --> 00:07:29,400 I'M GOING TO NEED TO JUST -- 203 00:07:29,400 --> 00:07:34,000 JUST TELL ME, DO YOU SEE IT? 204 00:07:34,000 --> 00:07:34,640 >> YES. 205 00:07:34,640 --> 00:07:35,320 >> OKAY, GOOD. 206 00:07:35,320 --> 00:07:36,800 SO, FIRST I WANT TO GO OVER 207 00:07:36,800 --> 00:07:39,840 WHERE WE ARE IN TERMS OF THE 208 00:07:39,840 --> 00:07:40,440 NUMBERS. 209 00:07:40,440 --> 00:07:43,040 AS YOU KNOW, THE COVID PANDEMIC 210 00:07:43,040 --> 00:07:43,640 HAS ACTUALLY SIGNIFICANTLY 211 00:07:43,640 --> 00:07:44,720 INCREASED THE NUMBER OF PEOPLE 212 00:07:44,720 --> 00:07:47,480 THAT HAVE DIED FROM OVERDOSES 213 00:07:47,480 --> 00:07:49,240 ACROSS THE UNITED STATES. 214 00:07:49,240 --> 00:07:51,640 THE LARGEST INCREASES WERE 215 00:07:51,640 --> 00:07:54,360 OBSERVED ON 2020 BUT THEY HAVE 216 00:07:54,360 --> 00:07:56,040 CONTINUED AND ARE BASICALLY 217 00:07:56,040 --> 00:07:57,120 INCREASING OVER BASELINE VERY, 218 00:07:57,120 --> 00:07:58,160 VERY HIGH RATES. 219 00:07:58,160 --> 00:08:02,560 SO, THIS IS THE LATEST DATA FROM 220 00:08:02,560 --> 00:08:04,160 CDC, AS OF FEBRUARY 2022, FOR 221 00:08:04,160 --> 00:08:05,960 THE 12 MONTHS THAT PRECEDED THAT 222 00:08:05,960 --> 00:08:10,480 PERIOD IN WHICH THERE WERE 223 00:08:10,480 --> 00:08:12,880 RECORDED 108,642 OVERDOSE 224 00:08:12,880 --> 00:08:13,440 DEATHS. 225 00:08:13,440 --> 00:08:15,400 AND THAT CLOSE TO 12% INCREASE 226 00:08:15,400 --> 00:08:19,200 FROM THE VERY, VERY HIGH NUMBERS 227 00:08:19,200 --> 00:08:20,160 WE ALREADY HAD FROM 2021. 228 00:08:20,160 --> 00:08:22,640 AS I'VE DONE IN THE PAST, I WANT 229 00:08:22,640 --> 00:08:24,480 YOU TO PAY ATTENTION TO DATA IN 230 00:08:24,480 --> 00:08:26,760 FRONT OF YOU BECAUSE, AGAIN, IT 231 00:08:26,760 --> 00:08:30,320 GIVES US PERSPECTIVE ABOUT HOW 232 00:08:30,320 --> 00:08:33,160 RAPIDLY THIS OVERDOSE CRISIS IS 233 00:08:33,160 --> 00:08:35,960 CHANGING, WHICH WE ACTUALLY NEED 234 00:08:35,960 --> 00:08:36,240 TO TARGET. 235 00:08:36,240 --> 00:08:38,520 FIRST OF ALL, WE'RE SEEING A 236 00:08:38,520 --> 00:08:40,480 CONTINUOUS DECREASE IN THE 237 00:08:40,480 --> 00:08:42,880 OVERDOSE DEATHS FROM HEROIN. 238 00:08:42,880 --> 00:08:45,280 WE'RE ALSO SEEING DECREASES IN 239 00:08:45,280 --> 00:08:48,880 OVERDOSE DEATHS ASSOCIATED WITH 240 00:08:48,880 --> 00:08:49,360 PRESCRIPTION OPIOIDS. 241 00:08:49,360 --> 00:08:50,800 IMPORTANTLY, I WANT YOU TO PAY 242 00:08:50,800 --> 00:08:53,280 ATTENTION, WE'RE SEEING 243 00:08:53,280 --> 00:08:54,280 DECREASES IN OVERDOSE DEATHS 244 00:08:54,280 --> 00:08:56,640 ASSOCIATED WITH METHADONE. 245 00:08:56,640 --> 00:08:57,920 I'LL COME BACK TO WHY THIS IS 246 00:08:57,920 --> 00:08:58,360 RELEVANT. 247 00:08:58,360 --> 00:09:01,000 ON THE OTHER HAND, WE'RE SEEING 248 00:09:01,000 --> 00:09:02,920 SIGNIFICANT INCREASES IN 249 00:09:02,920 --> 00:09:03,920 OVERDOSE MORTALITY, BOTH FROM 250 00:09:03,920 --> 00:09:06,560 SYNTHETIC OPIOIDS AS WELL AS 251 00:09:06,560 --> 00:09:07,960 STIMULANT DRUGS, THOSE ARE THE 252 00:09:07,960 --> 00:09:10,760 ONES DRIVING THE VERY HIGH RATES 253 00:09:10,760 --> 00:09:16,400 OF MORTALITY DURING THE COVID 254 00:09:16,400 --> 00:09:17,800 PANDEMIC, PREDOMINANTLY 255 00:09:17,800 --> 00:09:18,040 FENTANYL. 256 00:09:18,040 --> 00:09:21,080 YOU MAY SAY NUMBERS ARE HIGHER 257 00:09:21,080 --> 00:09:21,880 FOR COCAINE AND AMPHETAMINE 258 00:09:21,880 --> 00:09:24,400 OVERALL, WE HAVE TO CONSIDER IN 259 00:09:24,400 --> 00:09:27,400 ABSOLUTE TERMS THE NUMBERS ARE 260 00:09:27,400 --> 00:09:31,240 MUCH HIGHER FOR FENTANYL AND 261 00:09:31,240 --> 00:09:34,400 OVERDOSE DEATHS, 60 TO 75% OF 262 00:09:34,400 --> 00:09:36,960 THEM, ARE ASSOCIATED WITH 263 00:09:36,960 --> 00:09:38,680 COMBINATION WITH FENTANYL. 264 00:09:38,680 --> 00:09:41,720 HOW BAD IS THE EFFECT OF THE 265 00:09:41,720 --> 00:09:43,160 COVID PANDEMIC? 266 00:09:43,160 --> 00:09:45,600 I THINK IT IS IMPORTANT BECAUSE 267 00:09:45,600 --> 00:09:46,800 IT'S GUIDING US TOWARD SOME 268 00:09:46,800 --> 00:09:49,520 ISSUES AND CHALLENGES THAT WE'RE 269 00:09:49,520 --> 00:09:50,280 FACING. 270 00:09:50,280 --> 00:09:54,800 THIS IS DATA THAT IDENTIFIES IN 271 00:09:54,800 --> 00:09:58,120 DIFFERENT COLORS THE NUMBER OF 272 00:09:58,120 --> 00:10:00,080 OVERDOES DEATHS BEFORE THE 273 00:10:00,080 --> 00:10:03,000 PANDEMIC IN BLUES, DURING THE 274 00:10:03,000 --> 00:10:04,960 PANDEMIC IN PURPLES AND REDS. 275 00:10:04,960 --> 00:10:07,200 FOR DIFFERENT RATES AND 276 00:10:07,200 --> 00:10:08,920 ETHNICITY GROUPS, DIVIDED BY MEN 277 00:10:08,920 --> 00:10:11,600 IN THE LEFT, AND WOMEN ON THE 278 00:10:11,600 --> 00:10:15,400 RIGHT, DIVIDED BY GROUPS. 279 00:10:15,400 --> 00:10:18,800 AND THIS IS THE GROUP, 19 TO 64 280 00:10:18,800 --> 00:10:20,600 YEARS OF AGE, HIGHEST RATES OF 281 00:10:20,600 --> 00:10:21,400 MORTALITY. 282 00:10:21,400 --> 00:10:22,680 IN FACT THE OVERDOSE MORTALITY 283 00:10:22,680 --> 00:10:24,600 ACCOUNTS FOR GREATER NUMBER OF 284 00:10:24,600 --> 00:10:25,240 DEATHS FROM COVID. 285 00:10:25,240 --> 00:10:27,920 IF YOU LOOK AT IT, IT'S CLEAR 286 00:10:27,920 --> 00:10:29,880 THAT MALES OVERALL HAVE HIGHER 287 00:10:29,880 --> 00:10:31,040 RATES THAN FEMALES. 288 00:10:31,040 --> 00:10:33,720 WE ALSO SEE HIGHER RATES OF 289 00:10:33,720 --> 00:10:36,640 DEATH AMONG 35 TO 64 THAN 15 TO 290 00:10:36,640 --> 00:10:39,400 34 BUT THERE ARE NOTABLE CHANGES 291 00:10:39,400 --> 00:10:40,640 HAPPENING VERY, VERY RAPIDLY 292 00:10:40,640 --> 00:10:42,280 DURING THE COVID PANDEMIC, AND 293 00:10:42,280 --> 00:10:47,120 THAT IS THE VERY HIGH RATE OF 294 00:10:47,120 --> 00:10:48,960 OVERDOSES THAT WE'RE OBSERVING 295 00:10:48,960 --> 00:10:50,600 IN GROUPS OF VULNERABLE RACE AND 296 00:10:50,600 --> 00:10:52,680 ETHNIC GROUPS, ONE OF THEM IS 297 00:10:52,680 --> 00:10:56,080 BLACK AMERICA, AND YOU CAN SEE 298 00:10:56,080 --> 00:10:58,200 THAT SIGNIFICANT RISE IN BLACK 299 00:10:58,200 --> 00:11:00,440 AMERICANS, AND SIGNIFICANT RISE 300 00:11:00,440 --> 00:11:06,080 IN AMERICAN AND ALASKA NATIVES, 301 00:11:06,080 --> 00:11:07,680 THE TWO GROUPS, IN RATE OF 302 00:11:07,680 --> 00:11:10,320 OVERDOSE DEATHS HAVE THE HIGHEST 303 00:11:10,320 --> 00:11:11,280 MORTALITY OVERALL BY FAR. 304 00:11:11,280 --> 00:11:13,200 IF YOU LOOK AT WOMEN, I THINK IT 305 00:11:13,200 --> 00:11:15,760 IS IMPORTANT THAT WE LOOK AT THE 306 00:11:15,760 --> 00:11:17,520 GROUPS, BECAUSE OTHERWISE THEY 307 00:11:17,520 --> 00:11:21,320 GET LOST, THE WHOLE AVERAGING, 308 00:11:21,320 --> 00:11:24,040 LOOK AT WOMEN THAT ARE AMERICAN 309 00:11:24,040 --> 00:11:26,760 INDIAN AND ALASKA NATIVES, HAVE 310 00:11:26,760 --> 00:11:28,120 BY FAR THE HIGHEST RATES OF ANY 311 00:11:28,120 --> 00:11:29,200 OTHER GROUP. 312 00:11:29,200 --> 00:11:31,760 SO THIS DATA IS TELLING US AMONG 313 00:11:31,760 --> 00:11:35,160 THE MOST VULNERABLE FOR OVERDOSE 314 00:11:35,160 --> 00:11:37,960 ARE BLACK AND AMERICAN INDIAN 315 00:11:37,960 --> 00:11:39,480 GROUPS, PARTICULARLY MEN, AND 316 00:11:39,480 --> 00:11:41,160 FOR WOMEN, AMERICAN INDIAN AND 317 00:11:41,160 --> 00:11:42,600 ALASKA NATIVES. 318 00:11:42,600 --> 00:11:45,120 AND THIS WAS NOT THE CASE, 319 00:11:45,120 --> 00:11:45,880 SEARCH NOT FOR BLACK AMERICANS, 320 00:11:45,880 --> 00:11:49,800 AT THE BEGINNING OF THE OVERDOSE 321 00:11:49,800 --> 00:11:50,600 CRISIS. 322 00:11:50,600 --> 00:11:51,560 IT'S ALSO IMPORTANT LOOKING AT 323 00:11:51,560 --> 00:11:54,080 THIS NEW DATA THAT WE UNDERSTAND 324 00:11:54,080 --> 00:11:56,160 AND ASK THE QUESTION WHAT IS 325 00:11:56,160 --> 00:11:58,080 DRIVING THESE OVERDOSES IN THESE 326 00:11:58,080 --> 00:11:59,360 UNDERREPRESENTED GROUPS? 327 00:11:59,360 --> 00:12:01,200 THIS DATA FROM THE CDC INDICATES 328 00:12:01,200 --> 00:12:04,160 THAT ONE OF THE FACTORS THAT IS 329 00:12:04,160 --> 00:12:05,800 ACCOUNTING FOR INCREASING 330 00:12:05,800 --> 00:12:07,440 MORTALITY, THAT WE OBSERVED 331 00:12:07,440 --> 00:12:09,400 DURING THE COVID, IS VERY MUCH 332 00:12:09,400 --> 00:12:12,360 DRIVEN IN PART BY INCOME 333 00:12:12,360 --> 00:12:15,720 INEQUALITY, AND THIS IS EVIDENT 334 00:12:15,720 --> 00:12:17,320 IN BLACK, HIGH INCOME 335 00:12:17,320 --> 00:12:21,120 INEQUALITY, MUCH HIGHER RATES 336 00:12:21,120 --> 00:12:22,320 AMONG COMMUNITIES WITH LOW 337 00:12:22,320 --> 00:12:23,600 INCOME, LOW INCOME THAN THOSE 338 00:12:23,600 --> 00:12:25,360 WITH HIGHER INCOMES, IN BLACK, 339 00:12:25,360 --> 00:12:26,520 WHITE, HISPANIC. 340 00:12:26,520 --> 00:12:29,000 IT IS NOTABLE THIS IS NOT 341 00:12:29,000 --> 00:12:31,680 OBSERVED IN AMERICAN INDIAN AND 342 00:12:31,680 --> 00:12:33,000 ALASKA NATIVES, BEGS THE 343 00:12:33,000 --> 00:12:37,720 QUESTION WHAT IS GOING ON THAT 344 00:12:37,720 --> 00:12:39,440 ACTUALLY WHAT OTHER FACTORS ARE 345 00:12:39,440 --> 00:12:42,240 DRIVING THESE VERY HIGH RATES OF 346 00:12:42,240 --> 00:12:44,040 OVERDOES DEATH IT'S IN THESE 347 00:12:44,040 --> 00:12:44,520 GROUPS. 348 00:12:44,520 --> 00:12:47,880 NUMBERS ARE QUITE CHILLING. 349 00:12:47,880 --> 00:12:51,400 OVERDOSE DEATHS INCREASED BY 44% 350 00:12:51,400 --> 00:12:53,520 IN ONE YEAR AMONG BLACKS, 39% 351 00:12:53,520 --> 00:12:57,320 AMONG AMERICAN INDIANS AND 352 00:12:57,320 --> 00:13:00,720 ALASKA NATIVES, DATA IN 2020. 353 00:13:00,720 --> 00:13:01,880 DATA GOES INTO ACTUALLY 354 00:13:01,880 --> 00:13:02,800 IMPORTANT INFORMATION RELEVANT 355 00:13:02,800 --> 00:13:04,600 FOR SOME OF THE DISCUSSIONS THAT 356 00:13:04,600 --> 00:13:06,840 WE'RE GOING TO HAVE TODAY. 357 00:13:06,840 --> 00:13:08,200 WE KNOW THAT THE MAIN STRATEGIES 358 00:13:08,200 --> 00:13:12,800 THAT WE HAVE FOR ADDRESSING THE 359 00:13:12,800 --> 00:13:14,440 OVERDOSE CRISIS ARE EXPANDING 360 00:13:14,440 --> 00:13:15,840 ACCESS TO TREATMENT, MEDICATIONS 361 00:13:15,840 --> 00:13:17,640 FOR OPIOID USE DISORDER, 362 00:13:17,640 --> 00:13:20,280 EXPANDING ACCESS TO NALOXONE. 363 00:13:20,280 --> 00:13:21,720 THESE INVESTIGATORS LOOKED AT 364 00:13:21,720 --> 00:13:24,480 PERCENTAGE OF THOSE PEOPLE THAT 365 00:13:24,480 --> 00:13:26,240 HAVE AN OVERDOSE FATALITY THAT 366 00:13:26,240 --> 00:13:27,760 HAD DIED AND LOOKED AT THE 367 00:13:27,760 --> 00:13:30,320 PERCENTAGE THAT HAD EVIDENCE OF 368 00:13:30,320 --> 00:13:31,360 TREATMENT FOR SUBSTANCE USE 369 00:13:31,360 --> 00:13:33,080 DISORDER OF ANY TYPE, AND 370 00:13:33,080 --> 00:13:34,800 WHETHER THEY HAD BEEN 371 00:13:34,800 --> 00:13:35,760 ADMINISTERED NALOXONE. 372 00:13:35,760 --> 00:13:38,880 WHAT YOU CAN SEE IS THAT LESS 373 00:13:38,880 --> 00:13:40,400 THAN 16 OVERALL OF THESE 374 00:13:40,400 --> 00:13:41,360 INDIVIDUALS HAD RECEIVED 375 00:13:41,360 --> 00:13:41,840 TREATMENT. 376 00:13:41,840 --> 00:13:44,320 EVEN THOUGH WE KNOW AND WE 377 00:13:44,320 --> 00:13:46,360 RECOGNIZE THAT THIS IS CRUCIAL, 378 00:13:46,360 --> 00:13:47,840 PROBABLY THE MOST POWERFUL TOOL 379 00:13:47,840 --> 00:13:52,280 WE HAVE, TO OVERCOME THE 380 00:13:52,280 --> 00:13:53,600 OVERDOSE CRISIS, ONLY A SMALL 381 00:13:53,600 --> 00:13:56,720 PERCENTAGE IS GETTING IT. 382 00:13:56,720 --> 00:13:57,880 SIMILARLY, I WAS SURPRISED TO 383 00:13:57,880 --> 00:14:01,320 SEE SO LOW NUMBERS OF NALOXONE 384 00:14:01,320 --> 00:14:02,720 ADMINISTRATION BECAUSE WE HAVE 385 00:14:02,720 --> 00:14:04,080 BASICALLY IDENTIFIED THESE AS 386 00:14:04,080 --> 00:14:07,960 ONE OF THE MOST IMPORTANT 387 00:14:07,960 --> 00:14:08,880 INTERVENTIONS, EXPANDING ACCESS 388 00:14:08,880 --> 00:14:12,080 TO NALOXONE, ONLY 20% OR LESS OF 389 00:14:12,080 --> 00:14:13,640 INDIVIDUALS HAD ACCESS TO 390 00:14:13,640 --> 00:14:13,920 NALOXONE. 391 00:14:13,920 --> 00:14:16,800 AND I ALSO PUT THESE DATA HERE 392 00:14:16,800 --> 00:14:18,960 BECAUSE I THINK THEY ARE 393 00:14:18,960 --> 00:14:20,360 RELEVANT FOR OUR DISCUSSIONS, 394 00:14:20,360 --> 00:14:22,120 AND THIS WAS RELATED TO THE 395 00:14:22,120 --> 00:14:24,520 NUMBER OF INDIVIDUALS THAT 396 00:14:24,520 --> 00:14:25,880 RECEIVED PAIN TREATMENT. 397 00:14:25,880 --> 00:14:28,280 OVERALL, IT'S LESS THAN 10%, 398 00:14:28,280 --> 00:14:29,120 WHICH INDICATES THAT THE 399 00:14:29,120 --> 00:14:31,000 MAJORITY OF THESE INDIVIDUALS 400 00:14:31,000 --> 00:14:34,920 THAT ARE DYING FROM OVERDOSES 401 00:14:34,920 --> 00:14:38,120 ARE NOT BEING DRIVEN, PROBABLY 402 00:14:38,120 --> 00:14:39,760 ACTUALLY IMPORTANTLY, BY 403 00:14:39,760 --> 00:14:41,440 PRESCRIPTION OPIOID MEDICATIONS 404 00:14:41,440 --> 00:14:43,160 BY THEIR PROVIDERS. 405 00:14:43,160 --> 00:14:45,000 BUT THOSE IDENTIFIED ACTUALLY 406 00:14:45,000 --> 00:14:47,800 10% IS NOT A NEGLIGIBLE AMOUNT 407 00:14:47,800 --> 00:14:49,760 IN TERMS OF INDIVIDUALS THAT ARE 408 00:14:49,760 --> 00:14:53,520 SUFFERING FROM PAIN CONDITIONS 409 00:14:53,520 --> 00:14:54,480 THAT REQUIRE TREATMENT. 410 00:14:54,480 --> 00:14:56,360 AN IMPORTANT QUESTION THAT 411 00:14:56,360 --> 00:14:57,520 ACTUALLY AS ONE IS ADDRESSING 412 00:14:57,520 --> 00:14:59,720 THE ISSUE OF IF WE ARE NOT 413 00:14:59,720 --> 00:15:02,280 PROVIDING MEDICATIONS FOR OPIOID 414 00:15:02,280 --> 00:15:03,600 USE DISORDER, HOW BIG OF A GAP 415 00:15:03,600 --> 00:15:06,160 DO WE HAVE, HOW MANY PEOPLE ARE 416 00:15:06,160 --> 00:15:07,320 NOT RECEIVING TREATMENT. 417 00:15:07,320 --> 00:15:10,280 IN ORDER TO GET THAT NUMBER AT 418 00:15:10,280 --> 00:15:11,520 THAT NUMBER WE HAVE BASICALLY 419 00:15:11,520 --> 00:15:14,240 MANY OF US BEEN STRUGGLING TO 420 00:15:14,240 --> 00:15:16,880 TRY TO IDENTIFY THE VERY 421 00:15:16,880 --> 00:15:18,080 IMPORTANT INDICATOR, HOW MANY 422 00:15:18,080 --> 00:15:19,600 AMERICANS SUFFERING FROM AN 423 00:15:19,600 --> 00:15:22,600 OPIOID USE DISORDER, BECAUSE THE 424 00:15:22,600 --> 00:15:25,080 DATA JUST DOES NOT MAKE SENSE. 425 00:15:25,080 --> 00:15:26,960 OVERALL, FOR EXAMPLE, THE DATA 426 00:15:26,960 --> 00:15:29,720 FROM SAMHSA, ONE OF THE MAIN 427 00:15:29,720 --> 00:15:32,120 SURVEYS, HAS BEEN INDICATED THAT 428 00:15:32,120 --> 00:15:32,680 APPROXIMATELY 2.2 MILLION 429 00:15:32,680 --> 00:15:35,040 INDIVIDUALS SUFFER FROM AN 430 00:15:35,040 --> 00:15:36,080 OPIOID USE DISORDER. 431 00:15:36,080 --> 00:15:37,360 IF YOU FOLLOW THAT, AND WE KNOW 432 00:15:37,360 --> 00:15:38,960 MORE THAN A MILLION INDIVIDUALS 433 00:15:38,960 --> 00:15:41,160 ARE BEING GIVEN MEDICATIONS FOR 434 00:15:41,160 --> 00:15:43,160 OPIOID USE DISORDER, THIS WILL 435 00:15:43,160 --> 00:15:45,000 IMPLY CLOSE TO 50% OF PEOPLE ARE 436 00:15:45,000 --> 00:15:45,760 RECEIVING TREATMENT. 437 00:15:45,760 --> 00:15:48,640 BUT THAT'S NOT WHAT WE ARE 438 00:15:48,640 --> 00:15:49,880 OBSERVING. 439 00:15:49,880 --> 00:15:50,600 SO RESEARCHERS HAVE NOW 440 00:15:50,600 --> 00:15:51,920 BASICALLY DONE ANALYSIS TO TRY 441 00:15:51,920 --> 00:15:53,640 TO GET A BETTER ESTIMATE OF WHAT 442 00:15:53,640 --> 00:15:55,400 IS THE REAL NUMBER OF 443 00:15:55,400 --> 00:15:57,400 INDIVIDUALS WITH OPIOID USE 444 00:15:57,400 --> 00:15:57,640 DISORDER. 445 00:15:57,640 --> 00:15:59,560 AND THE ESTIMATES ARE GOING 446 00:15:59,560 --> 00:16:01,520 BETWEEN 7.6 MILLION TO 10 447 00:16:01,520 --> 00:16:04,360 MILLION INDIVIDUALS WITH OPIOID 448 00:16:04,360 --> 00:16:07,000 USE DISORDER DISPENDING ON 449 00:16:07,000 --> 00:16:07,960 METHODOLOGY YOU USE, WHICH 450 00:16:07,960 --> 00:16:08,880 BASICALLY BRINGS DOWN THE NUMBER 451 00:16:08,880 --> 00:16:10,160 OF PEOPLE THAT WOULD BENEFIT 452 00:16:10,160 --> 00:16:13,120 FROM A MEDICATION OF OPIOID USE 453 00:16:13,120 --> 00:16:17,600 DISORDER THAT ARE RECEIVING IT 454 00:16:17,600 --> 00:16:18,800 TO 13.4% BASEDDED ON THIS 455 00:16:18,800 --> 00:16:20,360 ESTIMATE HIGHLIGHTING ONE OF THE 456 00:16:20,360 --> 00:16:22,160 MAIN CHALLENGES WE HAVE IS TO 457 00:16:22,160 --> 00:16:23,560 EXPAND ACCESS TO MEDICATION FOR 458 00:16:23,560 --> 00:16:25,400 OPIOID USE DISORDER FOR THOSE 459 00:16:25,400 --> 00:16:26,680 WHO NEED IT. 460 00:16:26,680 --> 00:16:28,200 AND THIS IS WHERE I COME BACK 461 00:16:28,200 --> 00:16:29,560 WITH THE SLIDE I SAID I WAS 462 00:16:29,560 --> 00:16:31,320 GOING TO BE TOUCHING BEFORE. 463 00:16:31,320 --> 00:16:33,840 WE HAVE SEEN A REDUCTION IN 464 00:16:33,840 --> 00:16:36,200 METHADONE OVERDOSE DEATHS, AND 465 00:16:36,200 --> 00:16:40,480 THIS HAPPENED AT THE TIME 466 00:16:40,480 --> 00:16:41,680 METHADONE RESTRICTION WENT DOWN, 467 00:16:41,680 --> 00:16:43,280 SO OPIOID TREATMENT PROGRAMS 468 00:16:43,280 --> 00:16:46,120 WERE ABLE TO PROVIDE WITH 469 00:16:46,120 --> 00:16:46,760 TAKEHOME METHADONE FOR 470 00:16:46,760 --> 00:16:48,520 INDIVIDUALS THAT IN THE PAST 471 00:16:48,520 --> 00:16:51,080 WOULD HAVE NOT DONE SO. 472 00:16:51,080 --> 00:16:52,880 THEY CAN BRING UP TO FOUR WEEKS 473 00:16:52,880 --> 00:16:54,760 OF MEDICATION, THIS LED TO A LOT 474 00:16:54,760 --> 00:16:57,000 OF CONCERN THAT WOULD RESULT IN 475 00:16:57,000 --> 00:16:58,360 AN INCREASE IN METHADONE 476 00:16:58,360 --> 00:16:59,000 OVERDOSE DEATHS. 477 00:16:59,000 --> 00:17:01,400 THIS DID NOT HAPPEN. 478 00:17:01,400 --> 00:17:08,120 AND THIS IS DATA FROM JANUARY 20 479 00:17:08,120 --> 00:17:10,000 SHOWING PERCENTAGE OF OVERDOSES 480 00:17:10,000 --> 00:17:10,920 FROM METHADONE AND THIS IS AT 481 00:17:10,920 --> 00:17:14,680 THE TIME THAT WE HAVE THE COVID 482 00:17:14,680 --> 00:17:16,160 PANDEMIC RESTRICTIONS, YOU SEE 483 00:17:16,160 --> 00:17:17,800 INCREASE OVERALL, BUT YOU CAN 484 00:17:17,800 --> 00:17:20,440 SEE OVERALL THE NUMBER OF 485 00:17:20,440 --> 00:17:22,160 METHADONE OVERDOSE DEATHS HAS 486 00:17:22,160 --> 00:17:22,800 DECREASED. 487 00:17:22,800 --> 00:17:26,280 WHAT ARE THE IMPLICATIONS? 488 00:17:26,280 --> 00:17:27,080 IMPLICATIONS ARE THAT RELAXATION 489 00:17:27,080 --> 00:17:29,720 OF THESE POLICIES TO BRING HOME 490 00:17:29,720 --> 00:17:30,880 METHADONE MADE IT FEASIBLE FOR 491 00:17:30,880 --> 00:17:32,200 MANY PATIENTS TO ACCESS THE 492 00:17:32,200 --> 00:17:33,960 TREATMENT AND MUCH EASIER TO 493 00:17:33,960 --> 00:17:36,560 STAY IN TREATMENT AND WAS NOT 494 00:17:36,560 --> 00:17:37,840 ASSOCIATED WITH OVERDOSE DEATHS. 495 00:17:37,840 --> 00:17:39,240 THIS HAS LED TO A LOT OF 496 00:17:39,240 --> 00:17:41,280 DISCUSSION AS IT RELATES TO 497 00:17:41,280 --> 00:17:44,600 CONCEPT SHOULD THESE CHANGES BE 498 00:17:44,600 --> 00:17:45,680 MADE PERMANENT? 499 00:17:45,680 --> 00:17:47,080 SIMILAR FINDINGS ARE REPORTING 500 00:17:47,080 --> 00:17:51,520 NO EVIDENCE OF INCREASES IN 501 00:17:51,520 --> 00:17:53,760 BUPRENORPHINE OVERDOSE DEATHS, 502 00:17:53,760 --> 00:17:55,560 DESPITE RELAXATION OF SUCH 503 00:17:55,560 --> 00:17:56,360 MEASURES. 504 00:17:56,360 --> 00:17:58,440 IN FACT FOR METHADONE THE NUMBER 505 00:17:58,440 --> 00:17:59,800 OF OVERDOES DEATHS FROM 506 00:17:59,800 --> 00:18:02,200 BUPRENORPHINE IS GOING DOWN. 507 00:18:02,200 --> 00:18:03,720 SO WHAT'S GOING ON? 508 00:18:03,720 --> 00:18:06,320 WHAT IS DRIVING MANY OF THESE 509 00:18:06,320 --> 00:18:08,320 INCREASES DESPITE ACTUALLY 510 00:18:08,320 --> 00:18:09,760 NUMBER ONE WE'RE NOT PROVIDING 511 00:18:09,760 --> 00:18:10,400 SUFFICIENT MEDICATION TREATMENT 512 00:18:10,400 --> 00:18:11,800 FOR THOSE THAT NEED IT. 513 00:18:11,800 --> 00:18:16,200 NUMBER TWO, WE'RE NOT PROVIDING 514 00:18:16,200 --> 00:18:17,880 SUFFICIENT NALOXONE DOSES 515 00:18:17,880 --> 00:18:18,200 NECESSARY. 516 00:18:18,200 --> 00:18:21,600 AND WE'RE FIGHTING AN ILLICIT 517 00:18:21,600 --> 00:18:23,480 MARKET MAKING IT MORE 518 00:18:23,480 --> 00:18:24,080 CHALLENGING. 519 00:18:24,080 --> 00:18:29,360 I HIGHLIGHT THE SLIDE THAT SHOWS 520 00:18:29,360 --> 00:18:30,440 ELICITLY MANUFACTURED PILLS THAT 521 00:18:30,440 --> 00:18:32,760 CONTAIN FENTANYL WILL YOU ARE 522 00:18:32,760 --> 00:18:35,800 DISGUISED AS OTHER PRESCRIPTION 523 00:18:35,800 --> 00:18:45,840 DRUGS. 524 00:18:45,840 --> 00:18:48,400 SUCH AS ADDERALL, BENZENE 525 00:18:48,400 --> 00:18:56,280 PRODUCTS SUCH AS ATIVAN, 526 00:18:56,280 --> 00:19:00,680 INCREASED INCREASED, AT PRICES 527 00:19:00,680 --> 00:19:04,440 MUCH LOWER THAN THOSE OF 528 00:19:04,440 --> 00:19:05,160 BASICALLY PRESCRIPTION DRUGS 529 00:19:05,160 --> 00:19:11,280 THAT MAKE IT INTO THE ILLICIT 530 00:19:11,280 --> 00:19:11,520 MARKET. 531 00:19:11,520 --> 00:19:13,240 THIS HAS PUT PEOPLE AT RISK OF 532 00:19:13,240 --> 00:19:15,640 BUYING THEM SUCH AS TEENAGERS, 533 00:19:15,640 --> 00:19:16,960 FOR EXAMPLE, WE'RE OBSERVING 534 00:19:16,960 --> 00:19:19,720 SIGNIFICANT INCREASES FOR THE 535 00:19:19,720 --> 00:19:21,720 FIRST TIME IN OVERDOSES FROM 536 00:19:21,720 --> 00:19:24,440 FENNEL AMONG ADOLESCENTS, THE 537 00:19:24,440 --> 00:19:30,320 RISING OVERDOSE DEATHS FROM 538 00:19:30,320 --> 00:19:32,480 FENTANYL, LIKELY TO BE DRIVEN BY 539 00:19:32,480 --> 00:19:34,080 INCREASES IN ILLICIT MARKET OF 540 00:19:34,080 --> 00:19:35,080 PRESCRIPTION DRUGS THAT CONTAIN 541 00:19:35,080 --> 00:19:37,200 FENTANYL. 542 00:19:37,200 --> 00:19:38,200 SO THEY ARE GETTING OVERDOSE 543 00:19:38,200 --> 00:19:40,320 WITHOUT REALIZING THEY ARE 544 00:19:40,320 --> 00:19:41,080 CONSUMING FENTANYL. 545 00:19:41,080 --> 00:19:42,720 SO WHEN WE TAKE THIS 546 00:19:42,720 --> 00:19:44,560 INFORMATION, AND WE PUT IT IN 547 00:19:44,560 --> 00:19:46,960 FRONT OF US IN TERMS OF 548 00:19:46,960 --> 00:19:48,000 CHALLENGES AND OPPORTUNITIES WE 549 00:19:48,000 --> 00:19:49,720 HAVE FROM RESEARCH, WHAT ARE 550 00:19:49,720 --> 00:19:52,320 SOME OF THE ISSUES? 551 00:19:52,320 --> 00:19:54,720 CLEARLY WE CANNOT STOP IN ANY 552 00:19:54,720 --> 00:19:55,880 WAY TO ACTUALLY ADVANCING 553 00:19:55,880 --> 00:19:57,440 RESEARCH ON BETTER TREATMENT FOR 554 00:19:57,440 --> 00:19:59,440 PEOPLE THAT SUFFER FROM PAIN. 555 00:19:59,440 --> 00:19:59,760 IT'S CRUCIAL. 556 00:19:59,760 --> 00:20:02,720 IF NOT, THEY WILL GO INTO THE 557 00:20:02,720 --> 00:20:03,600 ILLICIT DRUG MARKETS AND BECOME 558 00:20:03,600 --> 00:20:07,560 AGAIN A MAJOR TARGET FOR 559 00:20:07,560 --> 00:20:08,440 OVERDOSE DEATHS. 560 00:20:08,440 --> 00:20:10,520 WE NEED TO CONTINUE TO PROVIDE 561 00:20:10,520 --> 00:20:11,960 TREATMENT FOR OPIOID USE 562 00:20:11,960 --> 00:20:12,440 DISORDER. 563 00:20:12,440 --> 00:20:13,720 IT IS CRUCIAL. 564 00:20:13,720 --> 00:20:15,080 WE NEED TO DEVELOP MODELS THAT 565 00:20:15,080 --> 00:20:18,080 WILL ENABLE US TO DO THAT IN A 566 00:20:18,080 --> 00:20:19,160 SUSTAINABLE FASHION. 567 00:20:19,160 --> 00:20:20,640 BUT WE ALSO NEED TO BASICALLY 568 00:20:20,640 --> 00:20:23,120 RECOGNIZE THAT WE'RE GOING TO 569 00:20:23,120 --> 00:20:24,080 NEED TO TAILOR THOSE 570 00:20:24,080 --> 00:20:25,000 INTERVENTIONS FOR GROUPS THAT 571 00:20:25,000 --> 00:20:27,400 OTHERWISE ARE NOT GOING TO BE 572 00:20:27,400 --> 00:20:29,400 SEEKING THEM SUCH AS WE'VE SEEN 573 00:20:29,400 --> 00:20:32,480 FOR AMERICAN INDIANS AND ALASKA 574 00:20:32,480 --> 00:20:32,720 NATIVES. 575 00:20:32,720 --> 00:20:34,480 OR FOR BLACK AMERICANS. 576 00:20:34,480 --> 00:20:36,600 WE ALSO NEED TO EMPHASIZE THE 577 00:20:36,600 --> 00:20:38,920 IMPORTANCE OF TREATING OTHER 578 00:20:38,920 --> 00:20:41,520 SUBSTANCE USE DISORDERS APART 579 00:20:41,520 --> 00:20:45,240 FROM OPIOIDS BECAUSE THESE ARE 580 00:20:45,240 --> 00:20:47,120 CURRENTLY STIMULANT DRUGS ARE 581 00:20:47,120 --> 00:20:48,600 BASICALLY VERY FREQUENTLY 582 00:20:48,600 --> 00:20:49,400 CONTAMINATED WITH FENTANYL, 583 00:20:49,400 --> 00:20:51,000 PUTTING THESE INDIVIDUALS AT 584 00:20:51,000 --> 00:20:52,000 RISK FOR OVERDOSES. 585 00:20:52,000 --> 00:20:55,400 AND WE NOW DO NEED TO CONSIDER 586 00:20:55,400 --> 00:20:57,800 THAT INDIVIDUALS THAT MAY BE 587 00:20:57,800 --> 00:20:58,920 OCCASIONAL DRUG USERS, THE 588 00:20:58,920 --> 00:21:01,240 TEENAGER, THE OLDER PERSON 589 00:21:01,240 --> 00:21:02,360 SEEKING DRUGS, MEDICATIONS WHEN 590 00:21:02,360 --> 00:21:04,000 THEY ARE PHYSICIANS ARE NOT 591 00:21:04,000 --> 00:21:05,600 PRESCRIBING THEM IN THE ILLICIT 592 00:21:05,600 --> 00:21:08,440 MARKET IS NOW A TARGET SO WE 593 00:21:08,440 --> 00:21:10,640 NEED TO VAMP OUT PREVENTION 594 00:21:10,640 --> 00:21:11,120 EFFORTS FOR TARGETING 595 00:21:11,120 --> 00:21:13,160 INDIVIDUALS THAT MAY BE MISUSING 596 00:21:13,160 --> 00:21:13,720 DRUGS. 597 00:21:13,720 --> 00:21:18,280 AND WE ALSO NEED TO ACTUALLY 598 00:21:18,280 --> 00:21:21,120 KEEP ON FIGURING OUT BETTER WAYS 599 00:21:21,120 --> 00:21:23,280 TO OBTAIN MORE TIMELY DATA 600 00:21:23,280 --> 00:21:24,680 RELATED TO OVERDOSES, ALL OF THE 601 00:21:24,680 --> 00:21:26,920 DATA THAT I SHOWED YOU ARE AT 602 00:21:26,920 --> 00:21:29,000 LEAST SIX MONTHS OLD, AND THINGS 603 00:21:29,000 --> 00:21:30,720 ARE HAPPENING RIGHT NOW. 604 00:21:30,720 --> 00:21:32,640 THINGS ARE ACTUALLY CHANGING 605 00:21:32,640 --> 00:21:34,040 QUITE ABRUPTLY, INCLUDING THE 606 00:21:34,040 --> 00:21:36,240 EMERGENCE OF NEW DRUGS AND 607 00:21:36,240 --> 00:21:38,200 RECOGNITION THAT MORE AND MORE 608 00:21:38,200 --> 00:21:40,320 PEOPLE WITH OVERDOSES HAVE 609 00:21:40,320 --> 00:21:40,760 MULTIPLE DRUGS. 610 00:21:40,760 --> 00:21:42,480 WHAT ARE SOME OF THE DRUGS THAT 611 00:21:42,480 --> 00:21:49,480 HAVE CAUGHT THE ATTENTION OF THE 612 00:21:49,480 --> 00:21:49,680 MEDIA? 613 00:21:49,680 --> 00:21:52,480 GABAPENTIN HAS REALLY NOT BEEN 614 00:21:52,480 --> 00:21:54,160 IN OUR RADAR, AND USED FOR 615 00:21:54,160 --> 00:21:56,160 TREATMENT OF PAIN. 616 00:21:56,160 --> 00:22:00,640 SO WE'RE SEEING 10% IN OVERDOSE 617 00:22:00,640 --> 00:22:01,720 DEATHS WITH OPIOIDS CONTAIN 618 00:22:01,720 --> 00:22:02,000 GABAPENTIN. 619 00:22:02,000 --> 00:22:04,640 THE QUESTION IS IS THIS 620 00:22:04,640 --> 00:22:07,120 ILLICITLY PROCURED OR PART OF 621 00:22:07,120 --> 00:22:08,720 MEDICATIONS THAT HAVE BEEN 622 00:22:08,720 --> 00:22:09,880 PRESCRIBED TO INDIVIDUALS? 623 00:22:09,880 --> 00:22:12,240 WE NEED TO DEVELOP ANTIDOTES 624 00:22:12,240 --> 00:22:16,680 THAT ADDRESS THE CHALLENGES OF 625 00:22:16,680 --> 00:22:18,480 OVERDOSES THAT ARE ASSOCIATED 626 00:22:18,480 --> 00:22:20,520 THAT MIGHT NOT BE AS RESPONSIVE 627 00:22:20,520 --> 00:22:21,120 TO NALOXONE. 628 00:22:21,120 --> 00:22:22,720 AND WITH THAT I WANT TO THANK 629 00:22:22,720 --> 00:22:24,920 YOU FOR YOUR ATTENTION, AND I 630 00:22:24,920 --> 00:22:27,360 THINK AS WE TURN BACK THE SCREEN 631 00:22:27,360 --> 00:22:32,160 TO REBECCA SO THAT SHE CAN HELP 632 00:22:32,160 --> 00:22:35,160 US INTRODUCE DR. WALTER 633 00:22:35,160 --> 00:22:35,920 KOROSHETZ. 634 00:22:35,920 --> 00:22:38,520 >> WE HAVE A TIME DEDICATED FOR 635 00:22:38,520 --> 00:22:40,880 DISCUSSION AFTER THIS NEXT TALK, 636 00:22:40,880 --> 00:22:44,200 SO I'LL TURN IT DIRECTLY OVER TO 637 00:22:44,200 --> 00:22:45,880 DR. WALTER KOROSHETZ, DIRECTOR 638 00:22:45,880 --> 00:22:48,080 OF THE NATIONAL INSTITUTE ON 639 00:22:48,080 --> 00:22:49,480 NEUROLOGICAL DISORDERS AND 640 00:22:49,480 --> 00:22:49,720 STROKE. 641 00:22:49,720 --> 00:22:50,480 WELCOME, WALTER. 642 00:22:50,480 --> 00:22:51,440 THANK YOU. 643 00:22:51,440 --> 00:22:53,840 >> THANK YOU VERY MUCH. 644 00:22:53,840 --> 00:22:57,560 AND YES, WE WANTED TO TALK TODAY 645 00:22:57,560 --> 00:23:00,080 ABOUT A PROJECT REBECCA AND I 646 00:23:00,080 --> 00:23:04,960 HAVE BEEN ENGAGED IN. 647 00:23:04,960 --> 00:23:06,800 REVISITING THE PUBLIC/PRIVATE 648 00:23:06,800 --> 00:23:10,400 PARTNERSHIP WITH BIG PHARMA. 649 00:23:10,400 --> 00:23:14,120 DR. COLLINS' IDEA WAS A 650 00:23:14,120 --> 00:23:16,560 COLLABORATIVE BETWEEN BIG PHARMA 651 00:23:16,560 --> 00:23:18,840 AND NIH DEVELOPING NON-ADDICTIVE 652 00:23:18,840 --> 00:23:23,240 PAIN MEDICATIONS, AND FOR 653 00:23:23,240 --> 00:23:26,160 VARIOUS REASONS BIG PHARMA HAS 654 00:23:26,160 --> 00:23:27,480 NOT BEEN HEAVILY INVOLVED, MOST 655 00:23:27,480 --> 00:23:30,520 OF OUR GRANTEES ARE IN THE 656 00:23:30,520 --> 00:23:33,240 BIOTECH SPACE, MOST OF BIG 657 00:23:33,240 --> 00:23:38,040 PHARMA HAS ACTUALLY LEFT THE 658 00:23:38,040 --> 00:23:39,720 PAIN RESEARCH SPACE, PAIN 659 00:23:39,720 --> 00:23:40,320 DEVELOPMENT SPACE, ELY LILLY 660 00:23:40,320 --> 00:23:44,520 BEING ONE OF THE EXCEPTIONS. 661 00:23:44,520 --> 00:23:46,760 AND SO BUT FOR US WE HAVE 662 00:23:46,760 --> 00:23:48,400 NUMEROUS PROGRAMS WHICH WE'LL 663 00:23:48,400 --> 00:23:51,000 TALK ABOUT THAT ARE ALL AIMED AT 664 00:23:51,000 --> 00:23:53,520 DE-RISKING THE DEVELOPMENT OF 665 00:23:53,520 --> 00:23:54,520 NON-ADDICTIVE PAIN THERAPIES AND 666 00:23:54,520 --> 00:23:57,560 AT SOME POINT FOR THIS TO BE 667 00:23:57,560 --> 00:23:59,000 SUCCESSFUL WE THINK THAT BIG 668 00:23:59,000 --> 00:24:04,120 PHARMA HAS TO BE ABLE TO SEE THE 669 00:24:04,120 --> 00:24:06,560 ADVANTAGES OF TAKING SOMETHING 670 00:24:06,560 --> 00:24:07,960 ON AND MOVING IT TO PATIENTS, 671 00:24:07,960 --> 00:24:10,160 BECAUSE THAT'S REALLY THE ONLY 672 00:24:10,160 --> 00:24:11,160 WAY WITH THESE MEDICINES ARE 673 00:24:11,160 --> 00:24:12,880 REALLY GOING TO GET OUT TO 674 00:24:12,880 --> 00:24:13,120 PEOPLE. 675 00:24:13,120 --> 00:24:14,440 SO THINKING OF THE BIG PICTURE 676 00:24:14,440 --> 00:24:17,600 WE THOUGHT IT WAS WORTH 677 00:24:17,600 --> 00:24:18,200 REVISITING THIS ISSUE, GIVING 678 00:24:18,200 --> 00:24:20,520 WHAT IS GOING TO BE THE ROLE OF 679 00:24:20,520 --> 00:24:25,400 BIG PHARMA, HOW CAN WE IMPROVE 680 00:24:25,400 --> 00:24:26,840 OUR COMMUNICATIONS THERE TO 681 00:24:26,840 --> 00:24:29,480 ENABLE THERAPIES TO EVENTUALLY 682 00:24:29,480 --> 00:24:31,400 MOVE OUT INTO THE COMMERCIAL 683 00:24:31,400 --> 00:24:31,960 SPACE. 684 00:24:31,960 --> 00:24:32,520 NEXT SLIDE. 685 00:24:32,520 --> 00:24:36,120 SO, WHAT WE DID IS TALKED TO ONE 686 00:24:36,120 --> 00:24:40,640 OF THE MULTI-DISCIPLINARY 687 00:24:40,640 --> 00:24:47,880 WORKING GROUP PEOPLE, KEN 688 00:24:47,880 --> 00:24:50,600 VERBER, HE RAN THE PROGRAM FOR 689 00:24:50,600 --> 00:24:51,760 PFIZER LILLY WHICH HAD A LOT 690 00:24:51,760 --> 00:24:54,920 GOING FOR IT IN TERMS OF PAIN, 691 00:24:54,920 --> 00:24:56,680 BUT BECAUSE OF SAFETY ISSUES IT 692 00:24:56,680 --> 00:25:00,760 WAS NOT APPROVED BY THE FDA, AND 693 00:25:00,760 --> 00:25:04,880 PFIZER AND LILLY HAVE ABANDONED 694 00:25:04,880 --> 00:25:05,800 THAT PROGRAM. 695 00:25:05,800 --> 00:25:08,640 KEN HAD LOTS OF IDEAS, ALL GOOD 696 00:25:08,640 --> 00:25:09,400 IDEAS. 697 00:25:09,400 --> 00:25:11,680 NOT ALL WE CAN DO, BUT ALL GOOD 698 00:25:11,680 --> 00:25:12,000 IDEAS. 699 00:25:12,000 --> 00:25:13,760 AND ONE OF THEM WAS, HE SAID, 700 00:25:13,760 --> 00:25:16,520 WELL, MOST OF THE BIG PHARMA IS 701 00:25:16,520 --> 00:25:17,760 REALLY OUT OF PAIN SO YOU'RE NOT 702 00:25:17,760 --> 00:25:21,360 GOING TO BE ABLE TO FIND PEOPLE 703 00:25:21,360 --> 00:25:24,520 THERE TO TALK SPECIFICALLY, YOU 704 00:25:24,520 --> 00:25:26,680 KNOW, ABOUT PAIN, EXCEPT IF YOU 705 00:25:26,680 --> 00:25:29,360 GO TOWARDS KIND OF THE NEUROLOGY 706 00:25:29,360 --> 00:25:30,320 PROGRAMS WHERE, YOU KNOW, IF 707 00:25:30,320 --> 00:25:32,360 PAIN IS GOING TO COME BACK IT 708 00:25:32,360 --> 00:25:35,120 MIGHT BE THROUGH THE NEUROLOGY 709 00:25:35,120 --> 00:25:35,800 PROGRAM. 710 00:25:35,800 --> 00:25:41,120 SO HAVING A NUMBER OF CONTACTS 711 00:25:41,120 --> 00:25:44,600 OF NEUROLOGISTS AND BIG PHARMA, 712 00:25:44,600 --> 00:25:47,160 WE SET UP A SERIES OF ONE-ON-ONE 713 00:25:47,160 --> 00:25:47,800 CONVERSATIONS, WE'RE GOING TO 714 00:25:47,800 --> 00:25:51,000 TALK TO YOU A LITTLE BIT ABOUT 715 00:25:51,000 --> 00:25:55,960 WHAT THEY SAID, NOT GOING TO 716 00:25:55,960 --> 00:25:56,720 REALLY -- TRY HARD NOT TO 717 00:25:56,720 --> 00:25:58,720 QUALITY WHAT WE AGREE WITH OR 718 00:25:58,720 --> 00:26:00,760 NOT BUT THIS IS KIND OF A 719 00:26:00,760 --> 00:26:02,400 REPORT-OUT. 720 00:26:02,400 --> 00:26:03,400 WE INCLUDED BILL SCHMIDT, HE 721 00:26:03,400 --> 00:26:06,640 WORKS WITH A LOT OF THE BIOTECH 722 00:26:06,640 --> 00:26:08,040 COMPANIES AND CLIFFORD WOOLF WHO 723 00:26:08,040 --> 00:26:11,360 IS ALSO ON THE "HEAL" 724 00:26:11,360 --> 00:26:14,000 PARTNERSHIP COMMITTEE ACADEMICS. 725 00:26:14,000 --> 00:26:15,440 NEXT SLIDE. 726 00:26:15,440 --> 00:26:17,920 SO, JUST TO REVIEW, I CAN'T GO 727 00:26:17,920 --> 00:26:21,560 INTO ALL THE DETAILS, WE HAVE 728 00:26:21,560 --> 00:26:23,120 REALLY SUBSTANTIAL INNOVATIVE 729 00:26:23,120 --> 00:26:25,960 PROGRAMS TO MOVE, TO IDENTIFY 730 00:26:25,960 --> 00:26:27,000 NEW TARGETS FOR PAIN 731 00:26:27,000 --> 00:26:30,600 THERAPEUTICS AND THEN TO TRY AND 732 00:26:30,600 --> 00:26:34,240 MOVE THESE ALONG, ALONG THE 733 00:26:34,240 --> 00:26:35,480 PATHWAY TO GOING INTO PATIENTS 734 00:26:35,480 --> 00:26:39,160 IN CLINICAL TRIALS. 735 00:26:39,160 --> 00:26:42,320 SO, THIS IS THE NCATS HEAL 736 00:26:42,320 --> 00:26:43,640 PORTFOLIO, AND THEY FOCUS NOT 737 00:26:43,640 --> 00:26:46,120 JUST ON PAIN BUT OPIOID USE AS 738 00:26:46,120 --> 00:26:46,680 WELL. 739 00:26:46,680 --> 00:26:50,320 BUT YOU CAN SEE THEY HAVE A 740 00:26:50,320 --> 00:26:52,280 WHOLE HOST OF DIFFERENT PROGRAMS 741 00:26:52,280 --> 00:26:55,600 AND THEY FOCUS HEAVILY ON THESE 742 00:26:55,600 --> 00:27:00,520 ASSAYS, TISSUE CHIP MODELS, 743 00:27:00,520 --> 00:27:01,960 iPSC-DERIVED NEURONS, AND IN 744 00:27:01,960 --> 00:27:03,480 IDENTIFYING TARGETS AND THEN 745 00:27:03,480 --> 00:27:08,040 PURSUING THEM ALONG THE PATHWAY 746 00:27:08,040 --> 00:27:09,560 TOWARDS PRE-CLINICAL -- TOWARDS 747 00:27:09,560 --> 00:27:14,280 CLINICAL DEVELOPMENT. 748 00:27:14,280 --> 00:27:15,000 NEXT SLIDE. 749 00:27:15,000 --> 00:27:16,920 AND IF YOU PUT THEM ALL TOGETHER 750 00:27:16,920 --> 00:27:18,880 WITH THE OTHER PAIN PROGRAMS, 751 00:27:18,880 --> 00:27:26,120 YOU CAN SEE NCATS DOWN HERE, THE 752 00:27:26,120 --> 00:27:28,480 SCREENING LIBRARY, TISSUE CHIPS, 753 00:27:28,480 --> 00:27:31,080 CELLS, GETTING TO ACADEMICS, TO 754 00:27:31,080 --> 00:27:32,240 VALIDATE THEIR TARGETS, EARLY 755 00:27:32,240 --> 00:27:35,200 STAGE VALIDATION OF THINGS THAT 756 00:27:35,200 --> 00:27:38,800 LOOK PROMISING FROM, YOU KNOW, 757 00:27:38,800 --> 00:27:39,640 THE INSTITUTE-FUNDED SCIENCE, 758 00:27:39,640 --> 00:27:41,240 WHICH OFTEN, YOU KNOW, DOESN'T 759 00:27:41,240 --> 00:27:44,720 WANT TO FUND A LOT OF THE MORE 760 00:27:44,720 --> 00:27:47,800 BORING VALIDATION STUFF, BUT 761 00:27:47,800 --> 00:27:50,080 CRITICALLY IMPORTANT BECAUSE WE 762 00:27:50,080 --> 00:27:53,040 DON'T HAVE A -- WE DON'T HAVE 763 00:27:53,040 --> 00:27:57,400 ANY SHORTAGE OF TARGETS IN PAIN. 764 00:27:57,400 --> 00:27:59,160 THE PRE-CLINICAL PAIN SPACE IS 765 00:27:59,160 --> 00:28:00,360 JUST EXPLODED WITH TARGETS. 766 00:28:00,360 --> 00:28:02,760 THE ISSUE IS WHICH ONES CAN BE 767 00:28:02,760 --> 00:28:04,400 VALIDATED ROBUST ENOUGH TO MOVE 768 00:28:04,400 --> 00:28:04,760 FORWARD. 769 00:28:04,760 --> 00:28:07,960 SO THERE WE HAVE EARLY PLANNING 770 00:28:07,960 --> 00:28:11,200 STUDIES FOR ANALGESIC 771 00:28:11,200 --> 00:28:11,720 DEVELOPMENT. 772 00:28:11,720 --> 00:28:12,320 INITIAL TRANSLATIONAL EFFORT 773 00:28:12,320 --> 00:28:14,360 GRANTS, TO TRY AND GET PEOPLE 774 00:28:14,360 --> 00:28:19,880 INTO A PAIN THERAPEUTIC PROGRAM 775 00:28:19,880 --> 00:28:22,600 THAT WOULD MOVE A LEAD COMPOUND 776 00:28:22,600 --> 00:28:24,000 TO AN IND WITHIN ABOUT FIVE 777 00:28:24,000 --> 00:28:26,720 YEARS, SO THAT'S KIND OF OUR 778 00:28:26,720 --> 00:28:28,920 SIGNATURE PROGRAM WE'RE TRYING 779 00:28:28,920 --> 00:28:30,120 TO GET MOVING INTO. 780 00:28:30,120 --> 00:28:32,760 AND THEN WE ALSO HAVE THINGS TO 781 00:28:32,760 --> 00:28:34,600 AID THE INDUSTRY, PARTICULARLY 782 00:28:34,600 --> 00:28:37,240 PRE-CLINICAL SCREENING PLATFORM 783 00:28:37,240 --> 00:28:38,680 FOR PAIN, WHERE PSYCHOGENICS HAS 784 00:28:38,680 --> 00:28:41,640 A HOST OF PAIN MODELS THAT ARE 785 00:28:41,640 --> 00:28:44,440 SET UP, WELL VALIDATED, AND ANY 786 00:28:44,440 --> 00:28:46,160 ACADEMIC OR SMALL BIOTECH FOLKS 787 00:28:46,160 --> 00:28:48,080 COULD COME IN WITH ASSETS AND 788 00:28:48,080 --> 00:28:52,000 TEST THEM IN THESE MODELS. 789 00:28:52,000 --> 00:28:53,640 AND WE ALSO ARE FUNDING QUITE A 790 00:28:53,640 --> 00:28:55,720 BIT OF SMALL BUSINESS GRANTS IN 791 00:28:55,720 --> 00:28:56,920 THE PAIN SPACE. 792 00:28:56,920 --> 00:28:59,560 I WOULD SAY THAT THE QUALITY OF 793 00:28:59,560 --> 00:29:02,400 THOSE GRANTS HAS REALLY JUMPED 794 00:29:02,400 --> 00:29:04,360 TO ANOTHER LEVEL SINCE HEAL HAS 795 00:29:04,360 --> 00:29:07,000 STARTED, SO WE ARE LOOKING FOR 796 00:29:07,000 --> 00:29:08,960 ACTIVITY IN THAT SPACE, IN TERMS 797 00:29:08,960 --> 00:29:11,360 OF BRINGING THINGS UP THAT MIGHT 798 00:29:11,360 --> 00:29:14,560 BE DE-RISKED ENOUGH TO BE TAKEN 799 00:29:14,560 --> 00:29:16,960 UP BY PHARMA. 800 00:29:16,960 --> 00:29:23,080 WE HAVE THIS NEW PROGRAM TO 801 00:29:23,080 --> 00:29:24,440 REALLY FOCUS ON TISSUE RELATED 802 00:29:24,440 --> 00:29:31,480 TO PAIN THAT'S COMING FROM 803 00:29:31,480 --> 00:29:33,720 HUMANS, DRG, SPINAL CORD, AND 804 00:29:33,720 --> 00:29:35,400 PERIPHERAL NERVE EVEN, TO KIND 805 00:29:35,400 --> 00:29:37,000 OF GET AT ONE OF THE POINTS 806 00:29:37,000 --> 00:29:40,560 YOU'LL HEAR LATER ABOUT MOVING 807 00:29:40,560 --> 00:29:42,760 FOR TOWARDS THE HUMAN 808 00:29:42,760 --> 00:29:45,560 EXPERIMENTAL PARADIGMS. 809 00:29:45,560 --> 00:29:46,320 NEXT SLIDE. 810 00:29:46,320 --> 00:29:48,080 SO, THE BIG QUESTION IS WHAT 811 00:29:48,080 --> 00:29:51,400 WOULD IT TAKE FOR BIG PHARMA TO 812 00:29:51,400 --> 00:29:53,560 ACQUIRE NOVEL PAIN THERAPEUTIC? 813 00:29:53,560 --> 00:29:54,800 I MENTION BIG PHARMA IS PRETTY 814 00:29:54,800 --> 00:29:56,200 MUCH OUT OF BUSINESS, TRUTH OF 815 00:29:56,200 --> 00:29:57,920 THE MATTER IS ALL THE COMPANIES 816 00:29:57,920 --> 00:30:02,240 WE TALK TO DO NOT HAVE ACTIVE 817 00:30:02,240 --> 00:30:04,280 PAIN THERAPEUTIC PROGRAMS RIGHT 818 00:30:04,280 --> 00:30:04,920 NOW. 819 00:30:04,920 --> 00:30:07,720 AT LEAST AT ANY KIND OF MODERATE 820 00:30:07,720 --> 00:30:08,920 STAGE. 821 00:30:08,920 --> 00:30:10,320 SO, THE QUESTION IS WHAT WOULD 822 00:30:10,320 --> 00:30:14,160 IT TAKE FOR THEIR COMPANY TO 823 00:30:14,160 --> 00:30:15,720 COME BACK INTO PAIN, AND 824 00:30:15,720 --> 00:30:17,080 BASICALLY THE TAKEHOME POINT IS 825 00:30:17,080 --> 00:30:22,120 FOR CAN COMPANY TO COME BACK, 826 00:30:22,120 --> 00:30:25,680 THEY NEED PHASE 2 DATA PEOPLE. 827 00:30:25,680 --> 00:30:28,600 SO THERE'S A REAL SHADOW AROUND 828 00:30:28,600 --> 00:30:30,440 PAIN AND DRUG DEVELOPMENT, AND 829 00:30:30,440 --> 00:30:31,640 SO MOST THE COMPANIES SHY AWAY 830 00:30:31,640 --> 00:30:33,960 FROM, YOU KNOW, JUST HEARING 831 00:30:33,960 --> 00:30:35,600 ABOUT SOMETHING THAT'S RELATED 832 00:30:35,600 --> 00:30:36,440 TO PAIN. 833 00:30:36,440 --> 00:30:39,640 SO WHAT IT WOULD TAKE NOW IS 834 00:30:39,640 --> 00:30:43,000 ACTUALLY DATA OF SOME EFFICACY 835 00:30:43,000 --> 00:30:44,520 IN HUMANS WITH A PARTICULAR PAIN 836 00:30:44,520 --> 00:30:46,560 CONDITION IS KIND OF THE 837 00:30:46,560 --> 00:30:47,600 TAKEHOME POINT. 838 00:30:47,600 --> 00:30:50,720 AND OF COURSE WE ARE -- WE DO 839 00:30:50,720 --> 00:30:53,760 HAVE EPPIC NET, SET UP TO 840 00:30:53,760 --> 00:30:58,800 BASICALLY DO JUST THAT, AND 841 00:30:58,800 --> 00:31:00,840 BECAUSE THERE'S SO FEW OTHER 842 00:31:00,840 --> 00:31:02,880 AVENUES TO DO THESE CLINICAL 843 00:31:02,880 --> 00:31:04,600 TRIALS EPPIC NET BECOMES MORE 844 00:31:04,600 --> 00:31:05,360 AND MORE IMPORTANT. 845 00:31:05,360 --> 00:31:07,680 WE WERE TOLD THE ONLY THING THAT 846 00:31:07,680 --> 00:31:10,960 REALLY LOOKS A LITTLE BIT BY 847 00:31:10,960 --> 00:31:13,960 EPPIC-NET IS THE CRO IN BELGIUM, 848 00:31:13,960 --> 00:31:15,440 OTHERWISE WE'RE ALMOST THE ONLY 849 00:31:15,440 --> 00:31:18,720 SHOW IN TOWN IN DOING HIGH 850 00:31:18,720 --> 00:31:21,720 QUALITY PAIN RESEARCH IN PHASE 2 851 00:31:21,720 --> 00:31:22,560 PEOPLE. 852 00:31:22,560 --> 00:31:27,280 THE OTHER THING IS THAT THE 853 00:31:27,280 --> 00:31:29,000 INDUSTRY HAS A VERY NEGATIVE 854 00:31:29,000 --> 00:31:30,720 ASSESSMENT OF HOW ANIMAL MODELS 855 00:31:30,720 --> 00:31:32,800 PREDICT HOW AN ASSET IS GOING TO 856 00:31:32,800 --> 00:31:35,280 BEHAVE IN HUMAN PAIN CONDITIONS, 857 00:31:35,280 --> 00:31:37,520 AND AGAIN I'M NOT GOING TO SAY 858 00:31:37,520 --> 00:31:43,640 THAT THAT'S TRUE OR FALSE, BUT 859 00:31:43,640 --> 00:31:45,000 THAT IS THEIR STATEMENT. 860 00:31:45,000 --> 00:31:46,080 OF COURSE, WHEN ANYTHING FAILS 861 00:31:46,080 --> 00:31:49,760 YOU TRY AND LOOK AND SEE WHAT 862 00:31:49,760 --> 00:31:51,560 THE PROBLEM IS. 863 00:31:51,560 --> 00:31:55,800 I WOULD SAY THAT PROBABLY MORE 864 00:31:55,800 --> 00:31:57,440 THAN ONE THING BUT LET'S GO ON. 865 00:31:57,440 --> 00:31:59,120 SO THE OTHER THING THEY MENTION 866 00:31:59,120 --> 00:32:01,960 THEY WANT TO SEE EVIDENCE OF 867 00:32:01,960 --> 00:32:03,600 TARGET ENGAGEMENT AT AN EARLY 868 00:32:03,600 --> 00:32:06,240 STAGE, SO DON'T WANT TO GO IN 869 00:32:06,240 --> 00:32:08,720 WITH A DRUG AND INTO LIKE A 870 00:32:08,720 --> 00:32:09,400 BLACK BOX SITUATION. 871 00:32:09,400 --> 00:32:11,600 THEY WANT TO KNOW THEIR DRUG IS 872 00:32:11,600 --> 00:32:13,680 HITTING A TARGET IN EARLY STAGE 873 00:32:13,680 --> 00:32:14,440 OF DEVELOPMENT. 874 00:32:14,440 --> 00:32:16,880 TOXICITY IS A REALLY BIG PROBLEM 875 00:32:16,880 --> 00:32:19,360 FOR PAIN MEDICINES, AND THAT'S 876 00:32:19,360 --> 00:32:22,880 PRETTY MUCH WHAT DROPPED NGF 877 00:32:22,880 --> 00:32:27,640 OFF, VIOXX ISSUE, A COUPLE OTHER 878 00:32:27,640 --> 00:32:29,280 THINGS WE HEARD ABOUT, THINGS 879 00:32:29,280 --> 00:32:32,400 THAT MOVED FAR ALONG ONLY TO 880 00:32:32,400 --> 00:32:33,600 FINE LIVER TOXICITY, AUTONOMIC 881 00:32:33,600 --> 00:32:35,800 SIDE EFFECTS, AND RECALL RIGHT 882 00:32:35,800 --> 00:32:38,080 FROM THE BEGINNING DISCUSSIONS 883 00:32:38,080 --> 00:32:40,640 WITH THE FDA, WHEN THERE'S A 884 00:32:40,640 --> 00:32:43,320 DRUG THAT'S FOR PAIN, WHICH IS, 885 00:32:43,320 --> 00:32:44,640 YOU KNOW, EXPERIENCED BY PRETTY 886 00:32:44,640 --> 00:32:45,600 MUCH ANYBODY IN THE COUNTRY, 887 00:32:45,600 --> 00:32:48,680 THEY ARE GOING TO HAVE A HIGH 888 00:32:48,680 --> 00:32:49,880 BAR FOR SAFETY. 889 00:32:49,880 --> 00:32:54,400 OUR PARADIGM HAS BEEN TO MOVE 890 00:32:54,400 --> 00:32:57,320 INTO MORE NICHE AREAS WHERE 891 00:32:57,320 --> 00:33:01,440 THERE'S A DEFINED CONDITION, AND 892 00:33:01,440 --> 00:33:03,320 WE DEVELOP TREATMENTS FOR THE 893 00:33:03,320 --> 00:33:04,560 DEFINED CONDITION WHERE THERE'S 894 00:33:04,560 --> 00:33:06,600 NO CURRENT TREATMENT SO RATIO OF 895 00:33:06,600 --> 00:33:09,600 RISK TO BENEFIT COULD BE 896 00:33:09,600 --> 00:33:11,800 SUBSTANTIALLY DIFFERENT, IN THAT 897 00:33:11,800 --> 00:33:14,880 CASE IN OUR DISCUSSIONS WITH THE 898 00:33:14,880 --> 00:33:15,240 FDA. 899 00:33:15,240 --> 00:33:17,360 AND THEN THE USUAL THING THEY 900 00:33:17,360 --> 00:33:19,400 WANT TO DIFFERENTIATE THEIR 901 00:33:19,400 --> 00:33:20,600 ASSETS FROM TREATMENTS THAT ARE 902 00:33:20,600 --> 00:33:22,680 ALREADY ON THE MARKET, SO THEY 903 00:33:22,680 --> 00:33:28,520 ACTUALLY GET REIMBURSED. 904 00:33:28,520 --> 00:33:31,560 NEXT SLIDE. 905 00:33:31,560 --> 00:33:32,520 SO, MIKE AZARI PRESENTED IN 906 00:33:32,520 --> 00:33:34,920 CLEAR FASHION WHAT HE CALLS 907 00:33:34,920 --> 00:33:36,160 THREE Rs, RIGHT HYPOTHESIS 908 00:33:36,160 --> 00:33:37,160 BASED ON PRE-CLINICAL DATA, WHAT 909 00:33:37,160 --> 00:33:39,320 IS KNOWN ABOUT THE TARGET. 910 00:33:39,320 --> 00:33:42,160 THE RIGHT POPULATION IS A 911 00:33:42,160 --> 00:33:42,880 GROWING DEPENDENCY ON REALLY 912 00:33:42,880 --> 00:33:45,720 WANTING TO GO INTO VERY 913 00:33:45,720 --> 00:33:47,120 WELL-DEFINED PATIENT GROUPS THAT 914 00:33:47,120 --> 00:33:48,320 SHOULD RESPOND TO AN 915 00:33:48,320 --> 00:33:52,160 INTERVENTION THAT ENGAGES THE 916 00:33:52,160 --> 00:33:53,640 BIOLOGICAL TARGET, SO MOVING 917 00:33:53,640 --> 00:33:57,760 INTO KIND OF A NICHE AREA FIRST 918 00:33:57,760 --> 00:33:59,720 IS SOMETHING THAT'S MORE 919 00:33:59,720 --> 00:34:01,680 ATTRACTIVE, IF THAT NICHE AREA 920 00:34:01,680 --> 00:34:05,520 CAN BE WELL DEFINED AS HAVING 921 00:34:05,520 --> 00:34:07,160 PAIN, A PARTICULAR TYPE OF PAIN 922 00:34:07,160 --> 00:34:09,160 THAT WOULD RESPOND TO THE TARGET 923 00:34:09,160 --> 00:34:11,760 YOU'RE TALKING ABOUT. 924 00:34:11,760 --> 00:34:12,880 THE RIGHT DOSE, REALLY 925 00:34:12,880 --> 00:34:13,840 IMPORTANT. 926 00:34:13,840 --> 00:34:16,920 AND THE RIGHT OUTCOME MEASURE. 927 00:34:16,920 --> 00:34:23,000 SO, AGAIN, A LOT OF ANXIETY 928 00:34:23,000 --> 00:34:25,120 ABOUT THE LIKERT SCALE FOR PAIN 929 00:34:25,120 --> 00:34:27,240 THAT WE'RE PRETTY MUCH RELIANT 930 00:34:27,240 --> 00:34:29,120 UPON, AND PEOPLE HAVE BROUGHT UP 931 00:34:29,120 --> 00:34:30,480 POTENTIAL FOR DIGITAL OUTCOMES 932 00:34:30,480 --> 00:34:33,000 THAT COULD BENEFIT PAIN STUDIES, 933 00:34:33,000 --> 00:34:35,640 AT LEAST AT SOME EARLY STAGE, 934 00:34:35,640 --> 00:34:36,440 ALTHOUGH CLEARLY THE PATIENT'S 935 00:34:36,440 --> 00:34:37,600 EXPERIENCE OF PAIN IS WHAT'S 936 00:34:37,600 --> 00:34:43,800 GOING TO DRIVE THINGS IN THE EN. 937 00:34:43,800 --> 00:34:44,720 NEXT SLIDE. 938 00:34:44,720 --> 00:34:45,480 OKAY. 939 00:34:45,480 --> 00:34:47,480 SO, WHAT DO THEY NEED FROM NIH? 940 00:34:47,480 --> 00:34:48,920 WELL, IT GOES BACK TO THE 941 00:34:48,920 --> 00:34:49,480 MODELS. 942 00:34:49,480 --> 00:34:51,800 THEY WANT MODELS THAT CAN BETTER 943 00:34:51,800 --> 00:34:53,680 PREDICT EFFICACY IN HUMANS. 944 00:34:53,680 --> 00:34:56,480 THAT'S WHAT DRUG COMPANIES DO. 945 00:34:56,480 --> 00:34:58,240 THE MORE ROBUST THE MODEL, THE 946 00:34:58,240 --> 00:35:00,880 CLOSER THEY ARE TO HUMAN 947 00:35:00,880 --> 00:35:03,360 CONDITION, THE BETTER. 948 00:35:03,360 --> 00:35:09,120 SO MOVING MORE TOWARDS KIND OF 949 00:35:09,120 --> 00:35:11,040 HUMAN CELLS, THE PRECISION -- 950 00:35:11,040 --> 00:35:12,760 HUMAN PRECISION MODELS WE'RE 951 00:35:12,760 --> 00:35:17,720 WORKING ON, THE PSPP MODEL IS 952 00:35:17,720 --> 00:35:20,160 EXTREMELY VALUABLE PARTICULARLY 953 00:35:20,160 --> 00:35:21,120 FOR BIOPHARMA PEOPLE THAT DON'T 954 00:35:21,120 --> 00:35:22,960 HAVE ACCESS TO THOSE MODELS. 955 00:35:22,960 --> 00:35:25,720 BIG PHARMA PEOPLE CAN GET THOSE 956 00:35:25,720 --> 00:35:26,800 MODELS GOING AND THEY USED TO 957 00:35:26,800 --> 00:35:29,400 HAVE THEM IN THEIR COMPANIES. 958 00:35:29,400 --> 00:35:33,320 THEY DID SAY THEY ARE NOT HOT ON 959 00:35:33,320 --> 00:35:34,520 THOSE MODELS, THEY WANT NEW 960 00:35:34,520 --> 00:35:37,680 MODELS, AND THEY REALLY WANT 961 00:35:37,680 --> 00:35:39,320 MODELS, YOU KNOW, THAT WILL 962 00:35:39,320 --> 00:35:40,880 PREDICT A DRUG EFFECT IN THE 963 00:35:40,880 --> 00:35:42,520 HUMAN PAIN CONDITION. 964 00:35:42,520 --> 00:35:46,960 AND SO WORKING ON DEVELOPING 965 00:35:46,960 --> 00:35:48,200 BETTER MODELS THAT MORE REFLECT 966 00:35:48,200 --> 00:35:50,080 THE HUMAN CONDITION MAY BE 967 00:35:50,080 --> 00:35:51,160 SOMETHING THAT "HEAL" SHOULD 968 00:35:51,160 --> 00:35:54,400 MAYBE PUT MORE EFFORT INTO. 969 00:35:54,400 --> 00:35:55,120 BIOMARKERS THAT IDENTIFY 970 00:35:55,120 --> 00:35:57,600 POPULATION LIKELY TO BENEFIT 971 00:35:57,600 --> 00:36:00,200 FROM A DRUG, THAT GOES BACK TO 972 00:36:00,200 --> 00:36:03,440 PICKING THE AREA IN PAIN, THE 973 00:36:03,440 --> 00:36:05,640 PAIN CONDITION THAT YOUR DRUG IS 974 00:36:05,640 --> 00:36:07,720 BEST ABLE TO SHOW BENEFIT IN AND 975 00:36:07,720 --> 00:36:09,480 BE ABLE TO IDENTIFY THAT 976 00:36:09,480 --> 00:36:11,800 POPULATION WITH SOME TYPE OF 977 00:36:11,800 --> 00:36:13,040 BIOMARKER OF INTEREST. 978 00:36:13,040 --> 00:36:19,680 ALSO BIOMARKERS TIED TO EFFICACY 979 00:36:19,680 --> 00:36:21,360 WOULD BE INCREDIBLY IMPORTANT 980 00:36:21,360 --> 00:36:24,880 AND WAYS IN WHICH THE PLACEBO 981 00:36:24,880 --> 00:36:27,280 EFFECT CAN BE BETTER SUBTRACTED 982 00:36:27,280 --> 00:36:31,760 OUT IN PAIN TRIALS TO 983 00:36:31,760 --> 00:36:34,280 DISTINGUISH TARGET ENGAGEMENT 984 00:36:34,280 --> 00:36:35,720 EFFECTS. 985 00:36:35,720 --> 00:36:36,920 SOME PEOPLE TALKED ABOUT 986 00:36:36,920 --> 00:36:38,040 PHENOTYPIC SCREENING FOR NOVEL 987 00:36:38,040 --> 00:36:39,760 TREATMENT, NOT NECESSARILY GOING 988 00:36:39,760 --> 00:36:44,600 AFTER A TARGET BUT GOING AFTER A 989 00:36:44,600 --> 00:36:46,360 PARTICULAR ASSAY AND SCREENING 990 00:36:46,360 --> 00:36:48,720 LARGE NUMBER OF COMPOUNDS TO SEE 991 00:36:48,720 --> 00:36:51,960 IF THE PHENOTYPE YOU WANT, AND I 992 00:36:51,960 --> 00:36:56,840 THINK MOSTLY THINKING OF iPS 993 00:36:56,840 --> 00:36:58,080 CELLS, CAN BE REPLICATED BY ONE 994 00:36:58,080 --> 00:37:02,240 OF THE COMPOUNDS IN A LARGE 995 00:37:02,240 --> 00:37:06,320 SCREEN, ALMOST THINKING OF A 996 00:37:06,320 --> 00:37:08,160 DARPA-LIKE PROGRAM ON A LARGE 997 00:37:08,160 --> 00:37:13,440 SCALE THAT WOULD DO THAT AND 998 00:37:13,440 --> 00:37:14,280 THEN BRING THINGS THROUGH THE 999 00:37:14,280 --> 00:37:16,080 DIFFERENT STAGES IN ONE PIECE AS 1000 00:37:16,080 --> 00:37:17,680 POSED TO MULTIPLE GRANTS WE 1001 00:37:17,680 --> 00:37:18,400 HAVE. 1002 00:37:18,400 --> 00:37:19,400 SOME PEOPLE TALKED ABOUT BASKET 1003 00:37:19,400 --> 00:37:22,640 TRIALS, IF A COMPANY HAS AN 1004 00:37:22,640 --> 00:37:24,320 AGENT THEY THINK IS GOOD FOR 1005 00:37:24,320 --> 00:37:27,360 PAIN THEY MAY NOT WANT TO PUT 1006 00:37:27,360 --> 00:37:30,160 ALL THEIR EGGS IN ONE BASKET, 1007 00:37:30,160 --> 00:37:31,720 QUOTE/UNQUOTE, BUT HAVE ABILITY 1008 00:37:31,720 --> 00:37:34,400 TO TEST ACROSS DIFFERENT PAIN 1009 00:37:34,400 --> 00:37:35,120 CONDITIONS, BASKET TRIALS. 1010 00:37:35,120 --> 00:37:37,720 WE HAVEN'T REALLY GONE INTO THAT 1011 00:37:37,720 --> 00:37:38,720 SPACE. 1012 00:37:38,720 --> 00:37:43,080 WE HAVE INSTEAD PLATFORM TRIALS, 1013 00:37:43,080 --> 00:37:45,440 WE HAVE DIABETIC NEUROPATHY 1014 00:37:45,440 --> 00:37:48,240 PLATFORM THAT WE CAN TEST 1015 00:37:48,240 --> 00:37:50,080 MULTIPLE AGENTS ON DIABETIC 1016 00:37:50,080 --> 00:37:52,040 NEUROPATHY, THIS WOULD BE THE 1017 00:37:52,040 --> 00:37:54,800 KIND OF OPPOSITE OF THAT WHERE 1018 00:37:54,800 --> 00:37:57,880 YOU TEST A DRUG IN MULTIPLE PAIN 1019 00:37:57,880 --> 00:37:58,920 CONDITIONS, YEAH, MAY NOT BE 1020 00:37:58,920 --> 00:38:02,560 SOMETHING WE CAN DO RIGHT AWAY. 1021 00:38:02,560 --> 00:38:04,960 WE NEED MORE EXPERIENCE IN 1022 00:38:04,960 --> 00:38:05,920 MULTIPLE PAIN CONDITIONS AND 1023 00:38:05,920 --> 00:38:08,720 EPPIC NET TO DO THAT. 1024 00:38:08,720 --> 00:38:10,560 NEXT SLIDE PLEASE. 1025 00:38:10,560 --> 00:38:15,360 IN TERMS OF THEN BIG PHARMA 1026 00:38:15,360 --> 00:38:16,560 WORKING WITH NIH-FUNDED CLINICAL 1027 00:38:16,560 --> 00:38:17,880 TRIAL CONSORTIA, SO THAT 1028 00:38:17,880 --> 00:38:19,720 QUESTION WE ALSO POSED TO THEM, 1029 00:38:19,720 --> 00:38:22,160 AND SOME COMPANIES HAVE HAD A 1030 00:38:22,160 --> 00:38:24,280 EXPERIENCE PARTICULARLY IN 1031 00:38:24,280 --> 00:38:24,840 ALZHEIMER'S, WORKING WITH 1032 00:38:24,840 --> 00:38:26,960 ACADEMIC CONSORTIA THROUGH THE 1033 00:38:26,960 --> 00:38:28,280 NATIONAL INSTITUTE OF AGING. 1034 00:38:28,280 --> 00:38:31,120 AND THE ISSUES AS YOU MIGHT 1035 00:38:31,120 --> 00:38:32,760 IMAGINE, YOU KNOW, THE COMPANIES 1036 00:38:32,760 --> 00:38:35,200 FEEL THAT THERE MAY BE LESS 1037 00:38:35,200 --> 00:38:40,240 CONTROL THAN THEY HAVE WORKING 1038 00:38:40,240 --> 00:38:43,560 DIRECTLY WITH A CRO, WORRIED 1039 00:38:43,560 --> 00:38:45,240 POTENTIALLY REASONABLY SO THAT 1040 00:38:45,240 --> 00:38:47,240 ACADEMIC CONSORTIA MAY NOT MEET 1041 00:38:47,240 --> 00:38:49,080 THE SAME CRITICAL TIMELINES A 1042 00:38:49,080 --> 00:38:53,680 CRO WOULD, AND IT REQUIRES MORE 1043 00:38:53,680 --> 00:38:54,720 HARMONIZATION OF CONTRACTING, 1044 00:38:54,720 --> 00:38:58,880 NEED FOR CLEAR DELINEATION OF 1045 00:38:58,880 --> 00:39:00,560 ROLES, AND SO BIG PHARMA IS 1046 00:39:00,560 --> 00:39:02,880 LOOKING TO SEE WHAT EPPIC NET 1047 00:39:02,880 --> 00:39:03,520 DOES. 1048 00:39:03,520 --> 00:39:05,480 WE CERTAINLY HAVE SEEN THAT A 1049 00:39:05,480 --> 00:39:06,760 LOT OF THESE BARRIERS HAVE 1050 00:39:06,760 --> 00:39:11,560 SLOWED DOWN THE ACTUAL MOVEMENT 1051 00:39:11,560 --> 00:39:13,640 INTO THE CLINICAL TRIAL, EVEN IN 1052 00:39:13,640 --> 00:39:15,880 EPPIC NET. 1053 00:39:15,880 --> 00:39:17,400 STILL CONCERN ABOUT REACH 1054 00:39:17,400 --> 00:39:18,920 THROUGH, WHERE IN THE GOVERNMENT 1055 00:39:18,920 --> 00:39:21,320 MONEY IS INVOLVED IN DEVELOPMENT 1056 00:39:21,320 --> 00:39:24,200 THAT SOMEHOW WHICH I CAN'T 1057 00:39:24,200 --> 00:39:25,480 IMAGINE HAPPENING BUT THERE IS 1058 00:39:25,480 --> 00:39:27,160 CONCERN FROM I GUESS THE LAWYERS 1059 00:39:27,160 --> 00:39:32,080 THAT THE NIH COULD POTENTIALLY 1060 00:39:32,080 --> 00:39:35,920 TAKE SOME KIND OF ACTION IN 1061 00:39:35,920 --> 00:39:36,840 TERMS OF THE DEVELOPMENT. 1062 00:39:36,840 --> 00:39:40,280 AND I THINK THAT WAS IT. 1063 00:39:40,280 --> 00:39:41,160 NEXT SLIDE. 1064 00:39:41,160 --> 00:39:43,920 I THINK WE'RE AT THE END. 1065 00:39:43,920 --> 00:39:44,200 YEAH. 1066 00:39:44,200 --> 00:39:46,440 NO, NO, NEXT SLIDE IS SOMETHING 1067 00:39:46,440 --> 00:39:48,200 TO CONSIDER. 1068 00:39:48,200 --> 00:39:50,640 SO I GUESS THE ISSUE IS HOW TO 1069 00:39:50,640 --> 00:39:52,280 MOVE FORWARD, SO A COUPLE THINGS 1070 00:39:52,280 --> 00:39:53,240 CAME TO MIND. 1071 00:39:53,240 --> 00:39:55,600 ONE IS THAT TALKING TO FOLKS, 1072 00:39:55,600 --> 00:39:56,680 THE HEAL TRANSLATIONAL PROGRAMS, 1073 00:39:56,680 --> 00:39:58,120 ALTHOUGH THEY MAY KNOW SOMETHING 1074 00:39:58,120 --> 00:39:59,360 ABOUT THE BIG TOPIC, THEY DON'T 1075 00:39:59,360 --> 00:40:02,080 REALLY KNOW THE DETAILS OF WHAT 1076 00:40:02,080 --> 00:40:02,600 WE'RE DOING. 1077 00:40:02,600 --> 00:40:05,360 AND SO THERE MIGHT BE A NEED TO 1078 00:40:05,360 --> 00:40:08,000 SHOWCASE WHAT HEAL IS FUNDING IN 1079 00:40:08,000 --> 00:40:10,080 THE SMALL BIOTECH AND ACADEMIA, 1080 00:40:10,080 --> 00:40:12,400 SHOW THE INNOVATION THAT'S IN 1081 00:40:12,400 --> 00:40:14,560 THE HEAL PROGRAM, VARIOUS 1082 00:40:14,560 --> 00:40:15,560 PROGRAMS, GET INPUT FROM BIG 1083 00:40:15,560 --> 00:40:16,760 PHARMA ON, YOU KNOW, WHAT THEY 1084 00:40:16,760 --> 00:40:20,800 LIKE, WHAT THEY DON'T LIKE, 1085 00:40:20,800 --> 00:40:21,680 WHAT'S MISSING. 1086 00:40:21,680 --> 00:40:24,800 AND THEY MAY, YOU KNOW, ALTHOUGH 1087 00:40:24,800 --> 00:40:26,000 THEY WOULDN'T SPEND A LOT OF 1088 00:40:26,000 --> 00:40:28,080 TIME WITH A SINGLE COMPANY WHO 1089 00:40:28,080 --> 00:40:29,760 HAS A PAIN ASSET, THEY MIGHT BE 1090 00:40:29,760 --> 00:40:33,040 MORE INTERESTED IN COMING TO 1091 00:40:33,040 --> 00:40:35,480 SOMETHING NIH PUTS OUT WITH 15 1092 00:40:35,480 --> 00:40:42,840 OR 20 BIOTECHS WITH PAIN ASSETS 1093 00:40:42,840 --> 00:40:43,280 WE'VE BEEN FUNDING. 1094 00:40:43,280 --> 00:40:45,920 I DON'T KNOW WHAT HAPPENED THIS 1095 00:40:45,920 --> 00:40:48,440 WEEK EXACTLY, BUT BIOTECH 1096 00:40:48,440 --> 00:40:49,760 INVESTMENTS DROPPED OFF A CLIFF, 1097 00:40:49,760 --> 00:40:51,160 STARTING ABOUT SIX MONTHS AGO, 1098 00:40:51,160 --> 00:40:56,000 AND SO A NUMBER OF THE BIOTECHS 1099 00:40:56,000 --> 00:40:59,480 ARE HAVING TROUBLE RIGHT NOW 1100 00:40:59,480 --> 00:41:00,160 FINANCIALLY. 1101 00:41:00,160 --> 00:41:02,640 THERE ARE POTENTIAL OTHER THINGS 1102 00:41:02,640 --> 00:41:05,040 WE COULD DO WITH BIG PHARMA, 1103 00:41:05,040 --> 00:41:05,720 EXPLORE JOINT PROGRAMS FOR 1104 00:41:05,720 --> 00:41:09,920 TRAINING, WE'RE IN THE CLINICAL 1105 00:41:09,920 --> 00:41:10,840 TRIAL NETWORKS, CENTERS, THE 1106 00:41:10,840 --> 00:41:13,440 PAIN CENTERS THAT WE FUND HERE 1107 00:41:13,440 --> 00:41:13,920 AT "HEAL." 1108 00:41:13,920 --> 00:41:16,480 SO THOSE ARE A COUPLE IDEAS THAT 1109 00:41:16,480 --> 00:41:18,720 CAME OUT FOR GOING FORWARD FROM 1110 00:41:18,720 --> 00:41:19,680 THESE CONVERSATIONS. 1111 00:41:19,680 --> 00:41:23,920 I THINK THAT'S THE LAST SLIDE. 1112 00:41:23,920 --> 00:41:24,360 LET ME CHECK. 1113 00:41:24,360 --> 00:41:26,680 AND SO WITH THAT, YEAH, I WONDER 1114 00:41:26,680 --> 00:41:29,280 BEFORE WE GO INTO GENERAL 1115 00:41:29,280 --> 00:41:30,440 DISCUSSION, REBECCA, DO YOU WANT 1116 00:41:30,440 --> 00:41:34,440 TO SAY ANYTHING IN ADDITION TO 1117 00:41:34,440 --> 00:41:35,200 WHAT WAS JUST PRESENTED? 1118 00:41:35,200 --> 00:41:38,600 YOU WERE THERE FOR EACH OF THESE 1119 00:41:38,600 --> 00:41:39,040 TALKS. 1120 00:41:39,040 --> 00:41:40,280 >> OH, YES. 1121 00:41:40,280 --> 00:41:43,800 I WOULD ONLY ADD, WALTER, THAT 1122 00:41:43,800 --> 00:41:46,920 THIS IS IMPORTANT BECAUSE WE AT 1123 00:41:46,920 --> 00:41:48,160 NIH CANNOT COMMERCIALIZE THE 1124 00:41:48,160 --> 00:41:50,520 THERAPEUTICS COMING OUT OF OUR 1125 00:41:50,520 --> 00:41:50,920 PROGRAM. 1126 00:41:50,920 --> 00:41:53,640 SO WE KNOW THAT PEOPLE IN PAIN 1127 00:41:53,640 --> 00:41:54,960 NEED ADDITIONAL OPTIONS. 1128 00:41:54,960 --> 00:41:57,320 AND WE KNOW NIH RESEARCH ALONE 1129 00:41:57,320 --> 00:41:59,960 IS NOT GOING TO BE SUFFICIENT AS 1130 00:41:59,960 --> 00:42:03,360 NORA WOULD FRAME IT, TO BRING US 1131 00:42:03,360 --> 00:42:07,080 THOSE THERAPEUTIC CANDIDATES. 1132 00:42:07,080 --> 00:42:11,640 SO, HOW CAN WE BEST EQUIP OUR 1133 00:42:11,640 --> 00:42:13,680 RESEARCHERS TO ESTABLISH THOSE 1134 00:42:13,680 --> 00:42:15,680 COLLABORATIONS AND FUNCTIONAL 1135 00:42:15,680 --> 00:42:16,800 RELATIONSHIPS WITH THE COMPANIES 1136 00:42:16,800 --> 00:42:21,360 SUCH THAT ARE LIKE THE FRUIT OF 1137 00:42:21,360 --> 00:42:23,040 OUR COLLECTIVE BROUGHT TO 1138 00:42:23,040 --> 00:42:23,560 PATIENTS. 1139 00:42:23,560 --> 00:42:24,920 BUT YOU CAPTURED THE DISCUSSION 1140 00:42:24,920 --> 00:42:25,200 PERFECTLY. 1141 00:42:25,200 --> 00:42:27,400 I WOULDN'T REALLY ADD ANYTHING 1142 00:42:27,400 --> 00:42:28,400 ELSE. 1143 00:42:28,400 --> 00:42:32,120 I WOULD LOVE TO HEAR THOUGHTS 1144 00:42:32,120 --> 00:42:35,960 AND REACTIONS AND FEEDBACK FROM 1145 00:42:35,960 --> 00:42:38,800 THESE -- ON THESE TWO VERY BROAD 1146 00:42:38,800 --> 00:42:40,040 PRESENTATIONS FROM THE MDWG SO 1147 00:42:40,040 --> 00:42:41,560 I'LL OPEN IT UP. 1148 00:42:41,560 --> 00:42:43,720 THANK YOU, WALTER. 1149 00:42:43,720 --> 00:42:49,680 THANK YOU, NORA. 1150 00:42:49,680 --> 00:42:53,000 1151 00:42:53,000 --> 00:42:53,560 >> NED HERE. 1152 00:42:53,560 --> 00:42:55,720 CAN YOU HEAR ME? 1153 00:42:55,720 --> 00:42:56,880 >> YES. 1154 00:42:56,880 --> 00:42:57,280 >> GOOD MORNING. 1155 00:42:57,280 --> 00:42:58,880 >> YEAH, A COUPLE THOUGHTS. 1156 00:42:58,880 --> 00:43:02,480 I NOTICED IN TERMS OF THE BIG 1157 00:43:02,480 --> 00:43:04,240 PHARMA HESITATION, ONE OF THE 1158 00:43:04,240 --> 00:43:08,920 POINTS IS TIMELINES AND 1159 00:43:08,920 --> 00:43:09,400 CONTRACTING. 1160 00:43:09,400 --> 00:43:10,920 AND CONTRACTING MULTI-SITE 1161 00:43:10,920 --> 00:43:14,120 TRIALS PARTICULARLY BY NIH IS 1162 00:43:14,120 --> 00:43:14,840 VERY CUMBERSOME. 1163 00:43:14,840 --> 00:43:19,760 I DON'T KNOW HOW TO FIX THAT. 1164 00:43:19,760 --> 00:43:20,520 TWO ISSUES. 1165 00:43:20,520 --> 00:43:22,480 ONE, CONTRACTING AND 1166 00:43:22,480 --> 00:43:23,120 SUBCONTRACTING IS VERY 1167 00:43:23,120 --> 00:43:26,200 CUMBERSOME, ALSO IT'S HARD TO 1168 00:43:26,200 --> 00:43:27,880 PAY FOR PERFORMANCE WITH, YOU 1169 00:43:27,880 --> 00:43:30,040 KNOW, AN NIH STUDY, WHICH IS OF 1170 00:43:30,040 --> 00:43:31,360 COURSE EXACTLY HOW PHARMA 1171 00:43:31,360 --> 00:43:32,920 STUDIES WORK. 1172 00:43:32,920 --> 00:43:37,520 IN OTHER WORDS, A SITE GETS PAID 1173 00:43:37,520 --> 00:43:38,360 WHEN IT RECRUITS, AND WHEREAS 1174 00:43:38,360 --> 00:43:41,040 WITH NIH YOU HAVE TO GIVE A SITE 1175 00:43:41,040 --> 00:43:45,920 MONEY AND HOPE THEY RECRUIT. 1176 00:43:45,920 --> 00:43:47,560 WHICH IS NOT AS STRONG AN 1177 00:43:47,560 --> 00:43:48,000 INCENTIVE. 1178 00:43:48,000 --> 00:43:50,440 I HAVE NO IDEA HOW TO FIX THAT 1179 00:43:50,440 --> 00:43:52,080 BUT JUST PUT THAT OUT THERE, 1180 00:43:52,080 --> 00:43:53,720 SOMETHING TO TRY TO THINK ABOUT. 1181 00:43:53,720 --> 00:43:59,280 AND THEN JUST IN TERMS OF, NORA, 1182 00:43:59,280 --> 00:44:00,920 THANK YOU FOR THE GREAT SUMMARY, 1183 00:44:00,920 --> 00:44:03,080 WHERE WE ARE. 1184 00:44:03,080 --> 00:44:04,200 I JUST WANTED TO EMPHASIZE 1185 00:44:04,200 --> 00:44:05,840 THERE'S THE TREATMENT GAP AND 1186 00:44:05,840 --> 00:44:07,800 THEN THERE'S THE PROBLEM OF 1187 00:44:07,800 --> 00:44:10,880 DROPOUT FROM TREATMENT ONCE 1188 00:44:10,880 --> 00:44:13,680 PEOPLE ENGAGE, WHICH IS ALSO A 1189 00:44:13,680 --> 00:44:16,600 BIG PROBLEM, PARTICULARLY WITH 1190 00:44:16,600 --> 00:44:19,440 BUPRENORPHINE AND NALOXONE. 1191 00:44:19,440 --> 00:44:23,240 SO I WOULD JUST ALSO KEEP THAT 1192 00:44:23,240 --> 00:44:25,640 UP ON THE RADAR SCREEN, AS WELL 1193 00:44:25,640 --> 00:44:29,760 AS WHAT -- WHY DON'T PEOPLE WITH 1194 00:44:29,760 --> 00:44:30,800 OPIOID USE DISORDER SEEK 1195 00:44:30,800 --> 00:44:32,920 TREATMENT, THAT'S AN IMPORTANT 1196 00:44:32,920 --> 00:44:33,720 QUESTION TO ANSWER. 1197 00:44:33,720 --> 00:44:37,360 ANYWAY, THANK YOU GUYS. 1198 00:44:37,360 --> 00:44:37,880 >> THANK YOU. 1199 00:44:37,880 --> 00:44:39,600 I THINK THOSE ARE GREAT POINTS. 1200 00:44:39,600 --> 00:44:42,760 WE CAN KEEP MOVING THROUGH THE 1201 00:44:42,760 --> 00:44:43,360 LIST. 1202 00:44:43,360 --> 00:44:43,760 WALLY SMITH. 1203 00:44:43,760 --> 00:44:46,560 >> COULD I JUST SAY ONE THING? 1204 00:44:46,560 --> 00:44:48,080 >> GO AHEAD, WALTER. 1205 00:44:48,080 --> 00:44:49,200 >> IN TERMS OF CONTRACTING, 1206 00:44:49,200 --> 00:44:50,280 YOU'RE ABSOLUTELY RIGHT. 1207 00:44:50,280 --> 00:44:52,800 WHAT WE TRY TO DO IS SET THE 1208 00:44:52,800 --> 00:44:54,680 NETWORK UP AND HAVE THEM DO ALL 1209 00:44:54,680 --> 00:44:56,760 THE CONTRACTS AND HAVE A SYSTEM 1210 00:44:56,760 --> 00:44:58,200 SO WHEN THE NEXT -- IT TAKES A 1211 00:44:58,200 --> 00:44:59,960 LONG TIME TO GET THE FIRST ONE, 1212 00:44:59,960 --> 00:45:05,640 BUT THE HOPE IS SYSTEMS PUT 1213 00:45:05,640 --> 00:45:06,840 TOGETHER MASTER AGREEMENT 1214 00:45:06,840 --> 00:45:07,880 BETWEEN SITES, THE NEXT ONE IS 1215 00:45:07,880 --> 00:45:08,640 MUCH EASIER. 1216 00:45:08,640 --> 00:45:14,160 WHAT WE LEARNED IN EPPIC-NET 1217 00:45:14,160 --> 00:45:15,240 DEALING WITH SMALL BIOTECHS THEY 1218 00:45:15,240 --> 00:45:16,440 SOMETIMES HAVE A DIFFERENT 1219 00:45:16,440 --> 00:45:19,480 AGENDA AND MAY DRAG THEIR FEET 1220 00:45:19,480 --> 00:45:21,800 FOR REASONS THAT ARE NOT 1221 00:45:21,800 --> 00:45:23,960 OBVIOUS, SO BUT ANYWAY, THAT'S 1222 00:45:23,960 --> 00:45:27,960 THE POINT WE GO ABOUT. 1223 00:45:27,960 --> 00:45:29,880 WE DO GIVE INFRASTRUCTURE, TO 1224 00:45:29,880 --> 00:45:31,880 BUILD THE INFRASTRUCTURE WITH 1225 00:45:31,880 --> 00:45:35,320 MONEY, BUT SITES GETS PAID FOR 1226 00:45:35,320 --> 00:45:36,520 ENROLLEE, SO PAYMENT GOES TO 1227 00:45:36,520 --> 00:45:39,040 SITES, THAT DOES DEPEND ON WHAT 1228 00:45:39,040 --> 00:45:43,600 THEY ENROLL. 1229 00:45:43,600 --> 00:45:48,160 >> THANK YOU, WALTER. 1230 00:45:48,160 --> 00:45:48,960 WALLY SMITH, WELCOME. 1231 00:45:48,960 --> 00:45:50,200 >> I YIELD TO SHARON WHO HAD HER 1232 00:45:50,200 --> 00:45:51,200 HAND UP. 1233 00:45:51,200 --> 00:45:53,800 >> I'M SORRY, GO AHEAD, SHARON. 1234 00:45:53,800 --> 00:45:55,320 >> THANK YOU, NORA, FOR YOUR 1235 00:45:55,320 --> 00:45:56,000 PRESENTATION. 1236 00:45:56,000 --> 00:45:57,720 IN THE DATA YOU PRESENTED, 1237 00:45:57,720 --> 00:45:59,640 INVESTIGATORS HAD A CHANCE TO 1238 00:45:59,640 --> 00:46:01,720 DIG DOWN DEEPER AND FIGURE OUT 1239 00:46:01,720 --> 00:46:04,600 SOME OF THE SYSTEMATIC REASONS 1240 00:46:04,600 --> 00:46:07,320 WHY THERE ISN'T ACCESS TO CARE, 1241 00:46:07,320 --> 00:46:09,440 OTHER THAN ACCESSIBILITY. 1242 00:46:09,440 --> 00:46:11,680 THE TREATMENT DRUG. 1243 00:46:11,680 --> 00:46:12,680 IF CLINICS AND ADMINISTRATORS 1244 00:46:12,680 --> 00:46:14,120 DON'T HAVE ACCESS TO THAT 1245 00:46:14,120 --> 00:46:16,040 INFORMATION, THEY CAN'T CHANGE 1246 00:46:16,040 --> 00:46:19,320 THE SYSTEM. 1247 00:46:19,320 --> 00:46:21,480 >> YEAH, NO, AND I THINK THAT 1248 00:46:21,480 --> 00:46:23,480 YOUR QUESTION, IT DIDN'T COME UP 1249 00:46:23,480 --> 00:46:25,560 CLEAR, BECAUSE THE SOUND WAS 1250 00:46:25,560 --> 00:46:25,800 MUFFLED. 1251 00:46:25,800 --> 00:46:27,800 IF I UNDERSTAND IT CORRECTLY, 1252 00:46:27,800 --> 00:46:29,880 YOU WERE ASKING ME WHAT ACCOUNTS 1253 00:46:29,880 --> 00:46:32,400 FOR THE GAP IN TREATMENT AND 1254 00:46:32,400 --> 00:46:33,600 ACCESS TO TREATMENT, IS THAT 1255 00:46:33,600 --> 00:46:34,680 CORRECT? 1256 00:46:34,680 --> 00:46:35,400 >> THAT IS CORRECT. 1257 00:46:35,400 --> 00:46:39,440 HAS ANY OF THOSE INVESTIGATORS 1258 00:46:39,440 --> 00:46:40,520 LOOKED AT IT SYSTEMATICALLY SO 1259 00:46:40,520 --> 00:46:42,480 THE INFORMATION CAN BE SENT BACK 1260 00:46:42,480 --> 00:46:44,080 TO CLINICIANS AND OTHER -- YOU 1261 00:46:44,080 --> 00:46:46,040 KNOW, THE PROVIDERS. 1262 00:46:46,040 --> 00:46:47,320 >> YEAH, NO, AND THAT SPECIFIC 1263 00:46:47,320 --> 00:46:48,320 QUESTION IS CRUCIAL. 1264 00:46:48,320 --> 00:46:52,520 IT HAS TO BE OBVIOUSLY FROM THE 1265 00:46:52,520 --> 00:46:54,440 DATA I PRESENTED REGIONALLY 1266 00:46:54,440 --> 00:46:55,120 SPECIFIC. 1267 00:46:55,120 --> 00:46:57,800 AND THAT INFORMATION CURRENTLY 1268 00:46:57,800 --> 00:46:59,040 IS NOT AVAILABLE WIDESPREAD 1269 00:46:59,040 --> 00:46:59,720 APART FROM IT. 1270 00:46:59,720 --> 00:47:03,400 I THINK THAT I DO WANT TO 1271 00:47:03,400 --> 00:47:05,000 ABSOLUTELY RECOGNIZE THE POINT 1272 00:47:05,000 --> 00:47:07,480 THAT ED WAS MAKING THAT ONE OF 1273 00:47:07,480 --> 00:47:09,960 THE BIG CHALLENGES THAT WE HAVE 1274 00:47:09,960 --> 00:47:12,600 IS NOT JUST GIVING TREATMENT TO 1275 00:47:12,600 --> 00:47:15,440 PEOPLE BUT RETAINING THEM IN 1276 00:47:15,440 --> 00:47:15,680 TREATMENT. 1277 00:47:15,680 --> 00:47:18,120 SO YOU INITIATE AND THE PERSON 1278 00:47:18,120 --> 00:47:19,560 STOPS, THEN THAT BASICALLY PUTS 1279 00:47:19,560 --> 00:47:23,120 THEM AGAIN AT VERY HIGH RISK OF 1280 00:47:23,120 --> 00:47:23,400 OVERDOSE. 1281 00:47:23,400 --> 00:47:25,080 ANOTHER COMPONENT THAT WE NEED 1282 00:47:25,080 --> 00:47:28,040 TO WORK ON TO TARGET AND HE 1283 00:47:28,040 --> 00:47:29,960 MENTIONED IT, ABSOLUTELY THAT IS 1284 00:47:29,960 --> 00:47:31,840 CORRECT, MANY PEOPLE THAT SUFFER 1285 00:47:31,840 --> 00:47:34,480 FROM AN OPIOID USE DISORDER DO 1286 00:47:34,480 --> 00:47:38,680 NOT REACH OUT TO TREATMENT. 1287 00:47:38,680 --> 00:47:42,120 AND THAT ELEMENT WHICH HAS BEEN 1288 00:47:42,120 --> 00:47:43,080 SPOKEN ABOUT BUT ALSO IN TERMS 1289 00:47:43,080 --> 00:47:45,480 OF WHY IS IT THAT PEOPLE DON'T 1290 00:47:45,480 --> 00:47:46,680 REACH OUT TO TREATMENT, ONE OF 1291 00:47:46,680 --> 00:47:48,120 THEM IS STIGMA. 1292 00:47:48,120 --> 00:47:51,320 A KEY COMPONENT IS STIGMA. 1293 00:47:51,320 --> 00:47:54,320 AND THE OTHER ONE THAT IS 1294 00:47:54,320 --> 00:47:56,440 RELEVANT IS THE ACCESSIBILITY OF 1295 00:47:56,440 --> 00:47:58,080 THAT TREATMENT AND IN THE PAST 1296 00:47:58,080 --> 00:48:00,720 WE HAVE BEEN VERY RESTRICTIVE 1297 00:48:00,720 --> 00:48:03,480 WITH THE OPIOID TREATMENT 1298 00:48:03,480 --> 00:48:03,760 PROGRAMS. 1299 00:48:03,760 --> 00:48:05,880 BUPRENORPHINE HAS MADE IT MORE 1300 00:48:05,880 --> 00:48:09,360 FLEXIBLE BUT WE'RE ALSO SEEING 1301 00:48:09,360 --> 00:48:12,640 THAT ACCESS TO BUPRENORPHINE IS 1302 00:48:12,640 --> 00:48:14,480 HINDERED TO CERTAIN GROUPS LIKE 1303 00:48:14,480 --> 00:48:16,880 BLACK AMERICANS, AND THIS IS IN 1304 00:48:16,880 --> 00:48:17,480 FACT RELATED TO ANOTHER 1305 00:48:17,480 --> 00:48:19,680 COMPONENT THAT NEEDS TO BE 1306 00:48:19,680 --> 00:48:20,680 ADDRESSED, WHICH IS 1307 00:48:20,680 --> 00:48:21,720 REIMBURSEMENT. 1308 00:48:21,720 --> 00:48:23,800 SO WE'VE GONE OUT INTO THE 1309 00:48:23,800 --> 00:48:25,760 COMMUNITIES TO TRY TO UNDERSTAND 1310 00:48:25,760 --> 00:48:30,320 WHY NOT MORE PHYSICIANS THAT ARE 1311 00:48:30,320 --> 00:48:31,040 WAITING TO PRESCRIBE 1312 00:48:31,040 --> 00:48:33,240 BUPRENORPHINE NOT DOING IT. 1313 00:48:33,240 --> 00:48:34,600 THEY SAID BECAUSE REIMBURSEMENT 1314 00:48:34,600 --> 00:48:35,880 IS INSUFFICIENT. 1315 00:48:35,880 --> 00:48:36,960 SO THERE ARE MULTIPLE FACTORS 1316 00:48:36,960 --> 00:48:39,320 THAT ARE CONTRIBUTING TO THAT 1317 00:48:39,320 --> 00:48:42,000 GAP THAT ACTUALLY NEED TO BE 1318 00:48:42,000 --> 00:48:42,360 ADDRESSED. 1319 00:48:42,360 --> 00:48:45,880 AND CRUCIAL IS THAT ISSUE OF 1320 00:48:45,880 --> 00:48:47,240 STIGMA BECAUSE IF PEOPLE DO NOT 1321 00:48:47,240 --> 00:48:48,880 FEEL THAT THEY ARE GOING TO BE 1322 00:48:48,880 --> 00:48:50,800 TREATED PROPERLY, THEY ARE NOT 1323 00:48:50,800 --> 00:48:51,920 GOING TO ACCESS TREATMENT. 1324 00:48:51,920 --> 00:48:55,480 SO THAT IS A KEY COMPONENT. 1325 00:48:55,480 --> 00:48:59,480 >> MAYBE WE CAN THINK ABOUT HOW 1326 00:48:59,480 --> 00:49:01,720 TO INCENTIVIZE INVESTIGATORS TO 1327 00:49:01,720 --> 00:49:04,840 FIND WAYS TO ADDRESS THOSE 1328 00:49:04,840 --> 00:49:06,600 ISSUES, YEAH, YEAH, GOING 1329 00:49:06,600 --> 00:49:07,120 FORWARD. 1330 00:49:07,120 --> 00:49:09,560 >> AND THAT INCLUDES HOW DO WE 1331 00:49:09,560 --> 00:49:13,480 BRING FORWARD INFORMATION TO 1332 00:49:13,480 --> 00:49:14,480 ACTUALLY SHIFT THE REIMBURSEMENT 1333 00:49:14,480 --> 00:49:19,080 MODEL BECAUSE THAT'S AN ISSUE. 1334 00:49:19,080 --> 00:49:20,280 REIMBURSEMENT FOR SUBSTANCE USE 1335 00:49:20,280 --> 00:49:22,000 DISORDER IS MUCH LOWER THAN 1336 00:49:22,000 --> 00:49:31,080 OTHER MEDICAL CONDITIONS. 1337 00:49:31,080 --> 00:49:31,440 >> YES. 1338 00:49:31,440 --> 00:49:32,240 THANK YOU. 1339 00:49:32,240 --> 00:49:34,760 >> I DID NOT SEE THE LINE, THE 1340 00:49:34,760 --> 00:49:35,400 QUEUE. 1341 00:49:35,400 --> 00:49:38,800 I'M GOING BACK TO YOU, DR. WALLY 1342 00:49:38,800 --> 00:49:40,000 SMITH, AND LET YOU WEIGH IN. 1343 00:49:40,000 --> 00:49:41,000 >> GOOD MORNING. 1344 00:49:41,000 --> 00:49:42,560 I AGREE WITH EVERYTHING THAT'S 1345 00:49:42,560 --> 00:49:42,960 BEEN SAID. 1346 00:49:42,960 --> 00:49:49,080 WANTED TO PICK UP ON WALTER AND 1347 00:49:49,080 --> 00:49:51,400 ED'S COMMENTS. 1348 00:49:51,400 --> 00:49:55,120 TO MY WAY OF THINKING, THE ROLE 1349 00:49:55,120 --> 00:50:01,920 THE NIH HAS TO PLAY IS TO FIND 1350 00:50:01,920 --> 00:50:02,840 POTENTIALLY COMMERCIALLY VIABLE 1351 00:50:02,840 --> 00:50:07,120 COMPOUNDS AND ONLY GET THEM TO A 1352 00:50:07,120 --> 00:50:07,320 POINT. 1353 00:50:07,320 --> 00:50:10,280 WE DON'T WANT TO BE DOING PHASE 1354 00:50:10,280 --> 00:50:12,000 3 TRIALS. 1355 00:50:12,000 --> 00:50:13,320 MAYBE NOT EVEN PHASE 2. 1356 00:50:13,320 --> 00:50:15,360 I WONDER. 1357 00:50:15,360 --> 00:50:17,680 BECAUSE I DON'T THINK WE, NIH, 1358 00:50:17,680 --> 00:50:19,560 CAN DO THAT EFFICIENTLY AND I 1359 00:50:19,560 --> 00:50:24,480 DON'T THINK WE HAVE A SUFFICIENT 1360 00:50:24,480 --> 00:50:25,280 PROFIT MOTIVE. 1361 00:50:25,280 --> 00:50:27,480 FROM INDUSTRY'S POINT OF VIEW IF 1362 00:50:27,480 --> 00:50:28,960 THEY DON'T SEE PROFIT POTENTIAL 1363 00:50:28,960 --> 00:50:32,440 OF A GIVEN COMPOUND, THEY WON'T 1364 00:50:32,440 --> 00:50:34,520 DO THE PHASE 2 OR PHASE 3 TRIAL 1365 00:50:34,520 --> 00:50:37,640 BECAUSE IT'S NOT IN THEIR 1366 00:50:37,640 --> 00:50:39,920 INVESTORS' BEST INTEREST. 1367 00:50:39,920 --> 00:50:47,840 SO, THE NEXUS IS TO FIND THE 1368 00:50:47,840 --> 00:50:48,960 SWEET SPOT, SOMETHING SALIENT TO 1369 00:50:48,960 --> 00:50:50,560 A PATIENT ENOUGH THEY WILL NOT 1370 00:50:50,560 --> 00:50:53,000 USE OPIOIDS AND USE THAT PRODUCT 1371 00:50:53,000 --> 00:50:55,240 INSTEAD, OR IT WILL RELIEVE 1372 00:50:55,240 --> 00:50:57,280 THEIR PAIN SUFFICIENTLY, 1373 00:50:57,280 --> 00:51:03,160 SPEAKING ON BOTH SIDES OF THE 1374 00:51:03,160 --> 00:51:04,200 TWIN HEAL MISSION, AND IF 1375 00:51:04,200 --> 00:51:06,200 THERE'S ENOUGH OF A PROFIT 1376 00:51:06,200 --> 00:51:08,720 MOTIVE IN IT FOR IT, FOR 1377 00:51:08,720 --> 00:51:09,480 INDUSTRY, I.E. SOMEBODY'S GOING 1378 00:51:09,480 --> 00:51:14,920 TO PAY FOR IT, THERE'S A LOT OF 1379 00:51:14,920 --> 00:51:15,520 FOLKS, YOU KNOW, ACCESSIBILITY, 1380 00:51:15,520 --> 00:51:16,320 ALL OF THOSE THINGS. 1381 00:51:16,320 --> 00:51:20,320 I KNOW THAT'S A TALL ORDER BUT 1382 00:51:20,320 --> 00:51:25,360 I'M SUGGESTING WE SHOOT WITH A 1383 00:51:25,360 --> 00:51:28,160 PRECISION RIFLE AFTER SHOOTING 1384 00:51:28,160 --> 00:51:31,600 WITH A SHOTGUN TO IDENTIFY THOSE 1385 00:51:31,600 --> 00:51:33,000 POTENTIAL TARGETS. 1386 00:51:33,000 --> 00:51:35,240 WE FIND JUST THOSE FEW, AND THEN 1387 00:51:35,240 --> 00:51:38,360 WE GO HARD AND FAST TO TRY TO 1388 00:51:38,360 --> 00:51:39,480 FIND COMPANIES, AND SAY, HEY, 1389 00:51:39,480 --> 00:51:41,400 THERE'S MONEY IN THIS FOR YOU, 1390 00:51:41,400 --> 00:51:42,560 LET'S BE HONEST, THERE'S MONEY 1391 00:51:42,560 --> 00:51:45,240 IN THIS FOR YOU AND TO PATIENTS, 1392 00:51:45,240 --> 00:51:48,120 HEY, THERE'S BENEFIT IN THIS FOR 1393 00:51:48,120 --> 00:51:48,320 YOU. 1394 00:51:48,320 --> 00:51:51,520 I FEEL THAT IF WE CAN SORT OF 1395 00:51:51,520 --> 00:51:57,520 SAY THAT TO OURSELVES AND NOT BE 1396 00:51:57,520 --> 00:52:00,440 IN THE BUSINESS OF WASTING 1397 00:52:00,440 --> 00:52:03,200 BUCKSHOT OR AIMING AT WRONG 1398 00:52:03,200 --> 00:52:04,200 TARGETS WITH PRECISION RIFLES 1399 00:52:04,200 --> 00:52:08,720 THAT WOULD BE GOOD. 1400 00:52:08,720 --> 00:52:11,080 >> YEAH, PERFECTLY SAID. 1401 00:52:11,080 --> 00:52:12,560 >> THANK YOU. 1402 00:52:12,560 --> 00:52:12,920 OKAY. 1403 00:52:12,920 --> 00:52:16,160 I NOW HAVE THE LIST IN ORDER. 1404 00:52:16,160 --> 00:52:17,720 NEXT IS GAIL. 1405 00:52:17,720 --> 00:52:19,480 GO AHEAD, GAIL. 1406 00:52:19,480 --> 00:52:20,400 >> THANK YOU. 1407 00:52:20,400 --> 00:52:23,960 I HAD A COUPLE COMMENTS. 1408 00:52:23,960 --> 00:52:25,440 ONE WAS ON THE DIFFERENT 1409 00:52:25,440 --> 00:52:27,160 CHALLENGES THAT WE HAVE FOR THE 1410 00:52:27,160 --> 00:52:30,360 GAP AND BESIDES ALL THAT WAS 1411 00:52:30,360 --> 00:52:31,560 MENTIONED THE STIGMA, LOGISTICS, 1412 00:52:31,560 --> 00:52:34,520 WE HAVE TO REMEMBER THAT NUMBER 1413 00:52:34,520 --> 00:52:35,600 ONE MANY OF THESE INDIVIDUALS 1414 00:52:35,600 --> 00:52:38,080 WE'RE SEEING AT LEAST IN THE 1415 00:52:38,080 --> 00:52:38,760 EMERGENCY DEPARTMENT, MORE THAN 1416 00:52:38,760 --> 00:52:40,400 50% OF THEM I WOULD SAY MUCH 1417 00:52:40,400 --> 00:52:44,120 HIGHER BUT IT'S AT LEAST THAT IN 1418 00:52:44,120 --> 00:52:46,840 OUR TRIALS ON HOMELESS, UNSTABLE 1419 00:52:46,840 --> 00:52:47,480 HOUSING. 1420 00:52:47,480 --> 00:52:48,080 WE'RE EXPECTING TO INITIATE 1421 00:52:48,080 --> 00:52:49,720 SOMEONE AND THEN THEY HAVE TO GO 1422 00:52:49,720 --> 00:52:51,240 SOMEWHERE ALL THE TIME, THEY 1423 00:52:51,240 --> 00:52:52,680 HAVE TO GET THERE. 1424 00:52:52,680 --> 00:52:55,160 IT'S NOT WORKING. 1425 00:52:55,160 --> 00:52:56,920 SO, WE NEED LONG-ACTING 1426 00:52:56,920 --> 00:52:58,120 MEDICATIONS, AND WE HAVE SOME 1427 00:52:58,120 --> 00:52:59,640 GREAT PROMISING THINGS THAT WE 1428 00:52:59,640 --> 00:53:02,920 COULD PROBABLY DO THOSE IN THE 1429 00:53:02,920 --> 00:53:03,480 E.D. 1430 00:53:03,480 --> 00:53:07,400 THOUGH I CANNOT FOR LOTS OF 1431 00:53:07,400 --> 00:53:09,200 REASONS GIVE A LONG-ACTING BUPE 1432 00:53:09,200 --> 00:53:13,800 FORMULATION TRYING TO GET TO MY 1433 00:53:13,800 --> 00:53:15,480 COMMITTEES NEXT MONTH TO SOMEHOW 1434 00:53:15,480 --> 00:53:17,560 GET IT IN THE HOSPITAL. 1435 00:53:17,560 --> 00:53:19,240 I DESPERATELY -- YOU CAN'T 1436 00:53:19,240 --> 00:53:20,240 BELIEVE THAT SHENANIGANS I'M 1437 00:53:20,240 --> 00:53:22,880 GOING THROUGH WITH A PATIENT, I 1438 00:53:22,880 --> 00:53:23,680 TRANSITIONED YESTERDAY, A 1439 00:53:23,680 --> 00:53:25,720 NIGHTMARE FOR 24 HOURS, I CAN'T 1440 00:53:25,720 --> 00:53:27,520 GET THE LONG ACTING. 1441 00:53:27,520 --> 00:53:29,040 I HAVE TO SOMEHOW GET HIM A CAP 1442 00:53:29,040 --> 00:53:30,840 AND GET HIM TO A COMMUNITY SITE 1443 00:53:30,840 --> 00:53:33,520 AND ORDER THROUGH THE MEDICAID. 1444 00:53:33,520 --> 00:53:33,920 IT'S UNBELIEVABLE. 1445 00:53:33,920 --> 00:53:35,800 I'M ABOUT TO CARRY HIM MYSELF 1446 00:53:35,800 --> 00:53:36,840 OVER THERE. 1447 00:53:36,840 --> 00:53:40,080 SO, THOSE ARE THE LOGISTICS BUT 1448 00:53:40,080 --> 00:53:41,840 THE LONG-ACTING PREPARATIONS ARE 1449 00:53:41,840 --> 00:53:45,920 REALLY EXCITING AS IN THE OTHER 1450 00:53:45,920 --> 00:53:48,080 DOSES WHICH I'VE DONE TO SORT 1451 00:53:48,080 --> 00:53:51,280 OF -- THE SCIENCE OF THE REALLY 1452 00:53:51,280 --> 00:53:52,880 HIGH DOSE OF BUPE BUT 1453 00:53:52,880 --> 00:53:54,080 HOMELESSNESS IS IMPORTANT SO 1454 00:53:54,080 --> 00:53:56,160 UNLESS WE CAN CAPTURE BETTER 1455 00:53:56,160 --> 00:53:57,480 WAYS OF ENGAGING THESE 1456 00:53:57,480 --> 00:53:59,440 INDIVIDUALS WE'RE NOT GOING TO 1457 00:53:59,440 --> 00:54:00,440 GET ANYWHERE. 1458 00:54:00,440 --> 00:54:03,440 THE OTHER THING I JUST WANTED TO 1459 00:54:03,440 --> 00:54:05,720 SAY ABOUT THE FUNDING THE SITES 1460 00:54:05,720 --> 00:54:10,560 THOUGH I HAVE DONE BOTH. 1461 00:54:10,560 --> 00:54:12,520 I HAVE WORKED WITH THYRIN WHO 1462 00:54:12,520 --> 00:54:13,720 GIVES A SMALL AMOUNT OF MONEY 1463 00:54:13,720 --> 00:54:16,480 AND A TRIAL I'M DOING WITH MANY 1464 00:54:16,480 --> 00:54:19,520 E.D.s FUNDED BY THE CTN, AND I 1465 00:54:19,520 --> 00:54:21,640 WOULD TELL YOU THAT JUST GIVING 1466 00:54:21,640 --> 00:54:22,920 LITTLE BITS AMOUNT OF MONEY YOU 1467 00:54:22,920 --> 00:54:24,840 DON'T GET THE RIGHT PEOPLE IN 1468 00:54:24,840 --> 00:54:28,400 THIS STUDY. 1469 00:54:28,400 --> 00:54:29,040 WE CHERRY-PICK PEOPLE, YOU HAVE 1470 00:54:29,040 --> 00:54:34,960 SO ALSO MONEY IT INTO. 1471 00:54:34,960 --> 00:54:36,720 SO LITTLE MONEY INTO IT. 1472 00:54:36,720 --> 00:54:39,040 I DON'T HAVE MONEY TO KEEP 1473 00:54:39,040 --> 00:54:40,440 PEOPLE THERE ALL THE TIME 1474 00:54:40,440 --> 00:54:45,360 WHEREAS IF I CAN PROVIDE MORE 1475 00:54:45,360 --> 00:54:46,360 RESOURCES, TO A CENTER. 1476 00:54:46,360 --> 00:54:49,960 AND THE OTHER HAND I'VE HAD TO 1477 00:54:49,960 --> 00:54:52,040 LET SEVERAL CENTERS GO BECAUSE 1478 00:54:52,040 --> 00:54:53,880 THEY DIDN'T SAY YOU HAVE TO HAVE 1479 00:54:53,880 --> 00:54:56,160 SOME SET IN THE BEGINNING WHAT 1480 00:54:56,160 --> 00:54:57,440 YOUR EXPECTATIONS ARE, AND IF 1481 00:54:57,440 --> 00:54:58,520 YOU CAN'T MEET THOSE 1482 00:54:58,520 --> 00:54:59,280 EXPECTATIONS THEN YOU'RE NOT 1483 00:54:59,280 --> 00:55:00,880 GOING TO BE ABLE TO CONTINUE ON. 1484 00:55:00,880 --> 00:55:03,480 WE'RE GOING TO HAVE TO PHASE YOU 1485 00:55:03,480 --> 00:55:04,680 OUT FAIRLY QUICKLY. 1486 00:55:04,680 --> 00:55:06,160 BUT IT'S PROBABLY A COMBINATION 1487 00:55:06,160 --> 00:55:07,520 OF THOSE THINGS THAT WORK THE 1488 00:55:07,520 --> 00:55:08,280 BEST. 1489 00:55:08,280 --> 00:55:12,480 AND THEN IN TERMS OF COMPANIES, 1490 00:55:12,480 --> 00:55:14,680 I DON'T KNOW HOW MUCH I CAN SAY 1491 00:55:14,680 --> 00:55:18,160 BUT SOME ONE OF YOU PUT ME IN 1492 00:55:18,160 --> 00:55:20,200 TOUCH WITH CLAIRE THERAPEUTICS, 1493 00:55:20,200 --> 00:55:22,400 I'M WORKING WITH A NEW DRUG 1494 00:55:22,400 --> 00:55:23,840 PREPARATION, AND I THINK IT 1495 00:55:23,840 --> 00:55:27,000 WOULD WORK VERY WELL TO HAVE THE 1496 00:55:27,000 --> 00:55:27,840 COMPANY WITH INVESTIGATORS 1497 00:55:27,840 --> 00:55:29,880 BECAUSE WHEN THE BASIC SCIENCE, 1498 00:55:29,880 --> 00:55:31,840 AND THEY ARE DOING SOME BASIC 1499 00:55:31,840 --> 00:55:34,280 SCIENCE, I GOT THEM IN AT YALE, 1500 00:55:34,280 --> 00:55:37,640 WHEN THIS DOES POTENTIALLY GO TO 1501 00:55:37,640 --> 00:55:38,920 HUMAN TRIALS I THINK IT WOULD BE 1502 00:55:38,920 --> 00:55:40,680 GREAT TO PARTNER WITH THEM 1503 00:55:40,680 --> 00:55:42,440 BECAUSE I HAD THE PEOPLE WHO 1504 00:55:42,440 --> 00:55:43,880 WOULD DO IT. 1505 00:55:43,880 --> 00:55:45,320 AND I'M NOT SURE EVERYONE WANTS 1506 00:55:45,320 --> 00:55:47,600 TO DO IT FOR A PHARMACEUTICAL 1507 00:55:47,600 --> 00:55:49,680 COMPANY BUT WOULD VERY MUCH LIKE 1508 00:55:49,680 --> 00:55:54,800 TO DO IT UNDER A MORE OF AN 1509 00:55:54,800 --> 00:55:55,400 ACADEMIC/GOVERNMENT SETTING AS 1510 00:55:55,400 --> 00:55:59,560 WELL LIKE NIH TO GET INDIVIDUALS 1511 00:55:59,560 --> 00:56:01,040 WHO REALLY ARE COMMITTED TO TAKE 1512 00:56:01,040 --> 00:56:02,240 THE TRIAL TO FRUITION. 1513 00:56:02,240 --> 00:56:03,720 SO ANYWAY, THAT'S IT. 1514 00:56:03,720 --> 00:56:12,480 THANK YOU ALL. 1515 00:56:12,480 --> 00:56:13,360 >> GAIL, I THANK YOU FOR 1516 00:56:13,360 --> 00:56:14,480 BRINGING UP THE ISSUE HOW 1517 00:56:14,480 --> 00:56:16,080 DIFFICULT IT IS TO GET EXTENDED 1518 00:56:16,080 --> 00:56:17,320 RELEASE BUPRENORPHINE AND WHY DO 1519 00:56:17,320 --> 00:56:20,800 I WANT TO HIGHLIGHT THIS IS THAT 1520 00:56:20,800 --> 00:56:22,360 THERE IS EVIDENCE, DEFINITIVELY 1521 00:56:22,360 --> 00:56:24,560 FROM DATA COMING FROM THE 1522 00:56:24,560 --> 00:56:26,960 JUSTICE SETTING THAT EXTENDED 1523 00:56:26,960 --> 00:56:31,360 RELEASE FORMULATION 1524 00:56:31,360 --> 00:56:32,880 SIGNIFICANTLY IMPROVES OUTCOMES, 1525 00:56:32,880 --> 00:56:33,840 IMMEDIATE RELEASE BUPRENORPHINE, 1526 00:56:33,840 --> 00:56:35,600 AND YET THESE TREATMENTS ARE NOT 1527 00:56:35,600 --> 00:56:36,160 BEING USED. 1528 00:56:36,160 --> 00:56:39,280 SO MY QUESTION FOR ALL OF YOU TO 1529 00:56:39,280 --> 00:56:41,440 THINK ABOUT, WHEN WE SPEAK ABOUT 1530 00:56:41,440 --> 00:56:42,520 TRANSLATION WE USUALLY THINK 1531 00:56:42,520 --> 00:56:44,000 ABOUT WE HAVE A PRE-CLINICAL 1532 00:56:44,000 --> 00:56:44,920 FINDINGS, HOW DO WE TRANSLATE 1533 00:56:44,920 --> 00:56:46,200 INTO A PRODUCT. 1534 00:56:46,200 --> 00:56:48,680 I ALSO THINK IN TERMS OF 1535 00:56:48,680 --> 00:56:52,560 TRANSLATION, AS RELATES TO 1536 00:56:52,560 --> 00:56:54,400 ULTIMATELY THE DATA THAT WE'RE 1537 00:56:54,400 --> 00:56:57,720 GARNERING HOW DO WE TRANSLATE 1538 00:56:57,720 --> 00:56:58,760 THAT INFORMATION JUST LIKE JUST 1539 00:56:58,760 --> 00:57:02,200 PRESENTED INTO A POLICY THAT WE 1540 00:57:02,200 --> 00:57:05,400 WILL PROVIDE SUPPORT FOR 1541 00:57:05,400 --> 00:57:06,960 REIMBURSEMENT BECAUSE OTHERWISE 1542 00:57:06,960 --> 00:57:07,840 IT'S EXTRAORDINARILY 1543 00:57:07,840 --> 00:57:08,360 FRUSTRATING. 1544 00:57:08,360 --> 00:57:09,440 WE DEVELOP TREATMENTS MORE 1545 00:57:09,440 --> 00:57:13,160 EFFECTIVE AND YET THE COST 1546 00:57:13,160 --> 00:57:14,600 BASICALLY PRECLUDES THEIR 1547 00:57:14,600 --> 00:57:14,960 IMPLEMENTATION. 1548 00:57:14,960 --> 00:57:17,320 THE COSTS ARE SET UP BY POLICIES 1549 00:57:17,320 --> 00:57:18,760 THAT ARE DETERMINING HOW MUCH 1550 00:57:18,760 --> 00:57:19,680 YOU GET REIMBURSED. 1551 00:57:19,680 --> 00:57:22,640 SO I THINK THAT THIS IS 1552 00:57:22,640 --> 00:57:23,800 SOMETHING THAT WE WILL PULL OUR 1553 00:57:23,800 --> 00:57:27,520 HEADS TOGETHER. 1554 00:57:27,520 --> 00:57:29,840 I DON'T KNOW, DR. CARLOS AT 1555 00:57:29,840 --> 00:57:31,920 NIDA, HAS BEEN ACTIVE IN THIS 1556 00:57:31,920 --> 00:57:34,360 TARGETED TYPE OF RESEARCH 1557 00:57:34,360 --> 00:57:35,760 GETTING KNOWLEDGE TO ADVANCE 1558 00:57:35,760 --> 00:57:35,960 THAT. 1559 00:57:35,960 --> 00:57:39,480 I AGREE WITH YOU, GAIL, AND IT'S 1560 00:57:39,480 --> 00:57:40,840 REALLY UNFORTUNATE. 1561 00:57:40,840 --> 00:57:41,840 >> THANK YOU, NORA. 1562 00:57:41,840 --> 00:57:47,920 I'M GOING TO TURN NOW TO LYNN 1563 00:57:47,920 --> 00:57:49,400 DEBAR. 1564 00:57:49,400 --> 00:57:50,240 >> I HAD A FEW PIGGYBACK 1565 00:57:50,240 --> 00:57:54,920 COMMENTS AND THEN A QUESTION FOR 1566 00:57:54,920 --> 00:57:55,440 NORA. 1567 00:57:55,440 --> 00:57:58,640 MY COMMENTS WERE GOING BACK TO 1568 00:57:58,640 --> 00:58:00,000 WALTER'S PRESENTATION, I WAS 1569 00:58:00,000 --> 00:58:03,680 STRUCK BY ONE OF THE COMMENTS 1570 00:58:03,680 --> 00:58:05,040 ABOUT THE DISSATISFACTION WITH 1571 00:58:05,040 --> 00:58:07,360 LIKERT SCALES AS REALLY OUR 1572 00:58:07,360 --> 00:58:09,600 PRIMARY OUTCOME THAT WE'VE BEEN 1573 00:58:09,600 --> 00:58:12,560 ABLE TO USE FOR PAIN. 1574 00:58:12,560 --> 00:58:13,800 AND JUST -- THIS MAY BE 1575 00:58:13,800 --> 00:58:17,000 PROVOCATIVE BUT IN THE CHRONIC 1576 00:58:17,000 --> 00:58:20,720 PAIN SPACE THAT REALLY 1577 00:58:20,720 --> 00:58:22,680 PRIORITIZING FUNCTIONING MIGHT 1578 00:58:22,680 --> 00:58:24,280 BE REALLY IMPORTANT, PHYSICAL, 1579 00:58:24,280 --> 00:58:28,560 EMOTIONAL, SOCIAL FUNCTIONING 1580 00:58:28,560 --> 00:58:29,560 BECAUSE THOSE ARE THE -- YOU 1581 00:58:29,560 --> 00:58:31,640 KNOW, I THINK WHAT'S MOST 1582 00:58:31,640 --> 00:58:33,520 IMPORTANT THERE. 1583 00:58:33,520 --> 00:58:36,920 AND SOMETIMES I THINK THE ACUTE 1584 00:58:36,920 --> 00:58:38,480 PAIN MODEL GETS MIXED IN IN A 1585 00:58:38,480 --> 00:58:40,200 WAY THAT'S A LITTLE BIT 1586 00:58:40,200 --> 00:58:41,320 UNFORTUNATE. 1587 00:58:41,320 --> 00:58:44,320 I WANTED TO COMMENT ON WHAT GAIL 1588 00:58:44,320 --> 00:58:47,840 WAS JUST TALKING ABOUT, AND THAT 1589 00:58:47,840 --> 00:58:52,960 SHARON BROUGHT UP, ABOUT WHY NOT 1590 00:58:52,960 --> 00:58:55,120 MORE MEDICATION FOR OUD, WHERE 1591 00:58:55,120 --> 00:58:56,600 ARE SOME GAPS THERE. 1592 00:58:56,600 --> 00:58:58,880 AND ALL OF THAT MADE SENSE. 1593 00:58:58,880 --> 00:59:00,720 I REALLY AGREE, COULDN'T AGREE 1594 00:59:00,720 --> 00:59:01,000 MORE. 1595 00:59:01,000 --> 00:59:05,240 I THINK THE OTHER THING WE WOULD 1596 00:59:05,240 --> 00:59:07,200 BE WELL SERVED TO REALLY PAY 1597 00:59:07,200 --> 00:59:09,200 SOME ATTENTION TO IS TO 1598 00:59:09,200 --> 00:59:10,040 RECOGNIZE BECAUSE OF THE STIGMA 1599 00:59:10,040 --> 00:59:11,920 AND BECAUSE OF A NUMBER OF OTHER 1600 00:59:11,920 --> 00:59:15,000 THINGS THAT PEOPLE ARE OFTEN NOT 1601 00:59:15,000 --> 00:59:16,440 AT AN ACTIONABLE POINT IN TIME 1602 00:59:16,440 --> 00:59:19,000 SO WHEN PEOPLE ARE APPROACHED 1603 00:59:19,000 --> 00:59:22,240 CAN WE BUILD INTO OUR DESIGN 1604 00:59:22,240 --> 00:59:23,080 SOMETHING WHERE THAT ENGAGEMENT 1605 00:59:23,080 --> 00:59:25,360 PROCESS IS REALLY PART OF WHAT 1606 00:59:25,360 --> 00:59:25,720 WE'RE STUDYING? 1607 00:59:25,720 --> 00:59:28,080 AND A LOT OF TIMES WITH CLINICAL 1608 00:59:28,080 --> 00:59:30,960 TRIALS WE'RE TRYING -- WE HAVE A 1609 00:59:30,960 --> 00:59:32,520 NARROW WINDOW GETTING PEOPLE IN. 1610 00:59:32,520 --> 00:59:34,280 WE SORT OF LOSE THAT 1611 00:59:34,280 --> 00:59:36,280 OPPORTUNITY, BUT THAT AS A 1612 00:59:36,280 --> 00:59:38,440 TARGET IN ITSELF, IT WRAPS 1613 00:59:38,440 --> 00:59:40,960 AROUND HOW WE CAN GET DATA ABOUT 1614 00:59:40,960 --> 00:59:43,680 WHO THOSE FOLKS ARE AND I KNOW 1615 00:59:43,680 --> 00:59:45,560 THERE'S LOTS OF INTERESTING AND 1616 00:59:45,560 --> 00:59:46,360 REALLY INNOVATIVE WAYS THAT 1617 00:59:46,360 --> 00:59:48,360 WE'RE GOING TO TALK ABOUT TODAY 1618 00:59:48,360 --> 00:59:51,480 ABOUT USING DATA, BUT HOW CAN WE 1619 00:59:51,480 --> 00:59:53,480 IDENTIFY THOSE POPULATIONS, AND 1620 00:59:53,480 --> 00:59:56,560 THEN MY COMMENT, MY QUESTION FOR 1621 00:59:56,560 --> 01:00:00,960 NORA, THAT I WAS STRUCK BY, IN 1622 01:00:00,960 --> 01:00:03,040 YOUR PRESENTATION, THE REALLY 1623 01:00:03,040 --> 01:00:04,440 QUICK EVOLUTION IN SOME OF THE 1624 01:00:04,440 --> 01:00:07,080 STREET DRUGS, AND ONE OF THE 1625 01:00:07,080 --> 01:00:09,360 IMPLICATIONS IN TERMS OF HOW WE 1626 01:00:09,360 --> 01:00:10,800 RESPOND AND WHAT VARIOUS ISSUES 1627 01:00:10,800 --> 01:00:12,520 ARE, AND I JUST WONDERED IF YOU 1628 01:00:12,520 --> 01:00:15,760 COULD COMMENT A LITTLE BIT ON 1629 01:00:15,760 --> 01:00:16,960 SOMETHING THAT I CERTAINLY HAVE 1630 01:00:16,960 --> 01:00:18,960 BEEN HEARING A LOT ABOUT LATELY 1631 01:00:18,960 --> 01:00:29,320 WHICH IS THE SHIFT IN 1632 01:00:29,680 --> 01:00:30,480 METHAMPHETAMINE WITH P2P AND 1633 01:00:30,480 --> 01:00:35,400 FOLKS SAY THIS IS SHOWING UP 1634 01:00:35,400 --> 01:00:36,080 DIFFERENTLY, MORE HARD-TO-MANAGE 1635 01:00:36,080 --> 01:00:40,520 BEHAVIOR, PLACES LIKE OREGON HAD 1636 01:00:40,520 --> 01:00:41,920 TO CLOSE THEIR -- YOU KNOW, 1637 01:00:41,920 --> 01:00:43,840 WHERE THEY WERE TRYING TO HELP 1638 01:00:43,840 --> 01:00:44,720 PEOPLE DETOX BECAUSE PEOPLE, 1639 01:00:44,720 --> 01:00:47,920 THERE WAS SO MUCH DANGER IN THAT 1640 01:00:47,920 --> 01:00:48,160 PROCESS. 1641 01:00:48,160 --> 01:00:49,960 IT HASN'T -- YOU KNOW, IT'S 1642 01:00:49,960 --> 01:00:51,120 FLOODED MENTAL HEALTH SYSTEMS. 1643 01:00:51,120 --> 01:00:54,840 I JUST WOULD BE CURIOUS, IS THAT 1644 01:00:54,840 --> 01:00:57,320 URBAN MYTH OR IS THERE REALLY A 1645 01:00:57,320 --> 01:01:00,280 DIFFERENCE IN THIS KIND OF RATE 1646 01:01:00,280 --> 01:01:02,960 OF ACUTE PSYCHOSIS AND OTHER 1647 01:01:02,960 --> 01:01:06,120 THINGS THAT MIGHT MERIT, YOU 1648 01:01:06,120 --> 01:01:06,920 KNOW, JUST SOMEWHAT DIFFERENT 1649 01:01:06,920 --> 01:01:09,320 KIND OF WAY OF RESPONDING TO IT 1650 01:01:09,320 --> 01:01:11,000 OVER TIME OR TRYING TO DEAL WITH 1651 01:01:11,000 --> 01:01:14,600 SORT OF ACUTE ISSUES AS WELL AS 1652 01:01:14,600 --> 01:01:16,120 WHAT THAT MEANS LONGITUDINALLY. 1653 01:01:16,120 --> 01:01:17,920 >> YEAH, NO, LYNN, THANKS FOR 1654 01:01:17,920 --> 01:01:19,280 BRINGING THIS ISSUE UP. 1655 01:01:19,280 --> 01:01:23,120 I WISH I COULD TELL YOU THERE'S 1656 01:01:23,120 --> 01:01:24,600 EVIDENCE IN INDICATES THE 1657 01:01:24,600 --> 01:01:28,520 SYNTHESIS PROCESS JUST FOR 1658 01:01:28,520 --> 01:01:30,120 METHAMPHETAMINE IS RESPONSIBLE 1659 01:01:30,120 --> 01:01:35,720 FOR INCREASED REPORTS OF MORE 1660 01:01:35,720 --> 01:01:36,680 PSYCHOSIS, BUT THERE'S NO DATA. 1661 01:01:36,680 --> 01:01:39,080 THAT DOESN'T MEAN IT DOESN'T 1662 01:01:39,080 --> 01:01:39,440 EXIST. 1663 01:01:39,440 --> 01:01:43,680 ARE THERE METABOLITES NOT 1664 01:01:43,680 --> 01:01:45,280 PRESENT WHEN METHAMPHETAMINE IS 1665 01:01:45,280 --> 01:01:49,520 NOT SYNTHESIZED WITH THE P2P 1666 01:01:49,520 --> 01:01:50,120 PROCESS, SOMETHING RESEARCHERS 1667 01:01:50,120 --> 01:01:52,280 SHOULD BE LOOKING AT. 1668 01:01:52,280 --> 01:01:53,560 YOU'RE PUTTING IT INTO MY RADAR 1669 01:01:53,560 --> 01:01:55,880 BECAUSE I DO THINK IT'S 1670 01:01:55,880 --> 01:01:57,560 IMPORTANT THAT WE UNDERSTAND THE 1671 01:01:57,560 --> 01:02:04,200 CHARACTERISTICS OF THE 1672 01:02:04,200 --> 01:02:05,720 METHAMPHETAMINE PROBLEMS. 1673 01:02:05,720 --> 01:02:08,520 IT'S LINKED WITH HIGHER TOXICITY 1674 01:02:08,520 --> 01:02:09,520 OVERALL, ANOTHER REASON TO TRY 1675 01:02:09,520 --> 01:02:13,080 TO UNDERSTAND IT BETTER BECAUSE 1676 01:02:13,080 --> 01:02:15,480 THIS CAN BE UTILIZED IN OUR 1677 01:02:15,480 --> 01:02:15,880 EDUCATION MATERIALS. 1678 01:02:15,880 --> 01:02:17,440 THANKS FOR BRINGING THAT UP. 1679 01:02:17,440 --> 01:02:19,320 I WISH I HAD DATA TO TELL YOU 1680 01:02:19,320 --> 01:02:20,720 THIS IS THE EVIDENCE. 1681 01:02:20,720 --> 01:02:24,960 NO, BUT WE CAN LOOK INTO IT. 1682 01:02:24,960 --> 01:02:25,560 >> THANKS. 1683 01:02:25,560 --> 01:02:25,880 >> GREAT. 1684 01:02:25,880 --> 01:02:27,960 WE'RE GOING TO TALK ABOUT A LOT. 1685 01:02:27,960 --> 01:02:29,720 THANK YOU FOR ALLUDING TO SOME 1686 01:02:29,720 --> 01:02:31,360 FUTURE TOPICS OF DISCUSSION, 1687 01:02:31,360 --> 01:02:32,240 LYNN, BECAUSE WE'RE GOING TO GET 1688 01:02:32,240 --> 01:02:34,440 TO A LOT OF THESE LATER IN 1689 01:02:34,440 --> 01:02:38,360 TODAY'S MEETING. 1690 01:02:38,360 --> 01:02:43,840 TWO MORE COMMENTS IN OPEN 1691 01:02:43,840 --> 01:02:45,840 SESSION, HENDREÉ JONES, YOU'RE 1692 01:02:45,840 --> 01:02:46,720 NEXT. 1693 01:02:46,720 --> 01:02:48,080 >> I JUST WANTED TO HIGHLIGHT 1694 01:02:48,080 --> 01:02:50,680 THAT WHEN WE TALK ABOUT STIGMA, 1695 01:02:50,680 --> 01:02:52,680 THAT IS OFTEN LIKE THE 1696 01:02:52,680 --> 01:02:54,080 STEREOTYPE ATTITUDE, THE BELIEF, 1697 01:02:54,080 --> 01:02:58,920 IF WE COULD INCLUED TALKING 1698 01:02:58,920 --> 01:03:01,040 ABOUT DISCRIMINATION, ACTIONS 1699 01:03:01,040 --> 01:03:03,520 AND BEHAVIORS THAT RESULT FROM 1700 01:03:03,520 --> 01:03:05,240 STIGMA, PAIR THOSE TOGETHER, 1701 01:03:05,240 --> 01:03:07,120 THAT'S IMPORTANT. 1702 01:03:07,120 --> 01:03:09,760 MY QUESTION FOR NORA IS I WAS 1703 01:03:09,760 --> 01:03:12,160 STRUCK BY THE AMERICAN INDIAN 1704 01:03:12,160 --> 01:03:13,840 AND ALASKA NATIVE DATA YOU 1705 01:03:13,840 --> 01:03:16,280 PRESENTED PARTICULARLY FOR 1706 01:03:16,280 --> 01:03:17,000 WOMEN. 1707 01:03:17,000 --> 01:03:18,480 I WAS WONDERING IF WE KNOW 1708 01:03:18,480 --> 01:03:20,600 ANYBODY IS THIS HAPPENING ACROSS 1709 01:03:20,600 --> 01:03:23,280 EVERY COMMUNITY OR ARE THERE 1710 01:03:23,280 --> 01:03:24,080 COMMUNITIES THAT ARE PROTECTED, 1711 01:03:24,080 --> 01:03:27,520 WHERE WE'VE NOT SEEN THE 1712 01:03:27,520 --> 01:03:28,840 INCREASES IN OVERDOSES, AND DO 1713 01:03:28,840 --> 01:03:29,920 WE KNOW ANYTHING ABOUT THOSE 1714 01:03:29,920 --> 01:03:31,920 COMMUNITIES AND CAN WE LEARN 1715 01:03:31,920 --> 01:03:33,640 SOMETHING FROM THOSE PROTECTIVE 1716 01:03:33,640 --> 01:03:37,400 FACTORS THAT WE COULD APPLY TO 1717 01:03:37,400 --> 01:03:40,360 THE OTHER COMMUNITIES? 1718 01:03:40,360 --> 01:03:46,840 >> NO, HENDREE, WE NEED TO 1719 01:03:46,840 --> 01:03:49,440 ADDRESS DISCRIMINATION TO HELP 1720 01:03:49,440 --> 01:03:50,320 US TARGET INTERVENTIONS, AS TO 1721 01:03:50,320 --> 01:03:56,160 THE QUESTION OF THE DATA, IS IT 1722 01:03:56,160 --> 01:03:56,720 HOMOGENOUS OR HETEROGENEOUS 1723 01:03:56,720 --> 01:03:58,440 AMONG AMERICAN INDIAN AND ALASKA 1724 01:03:58,440 --> 01:04:01,080 NATIVE POPULATIONS LIKING TO BE 1725 01:04:01,080 --> 01:04:04,320 HETEROGENEOUS BUT SPECIFICS 1726 01:04:04,320 --> 01:04:07,120 ABOUT WHAT GROUPS MAY BE 1727 01:04:07,120 --> 01:04:09,160 RESILIENT WE DO NOT HAVE, AND 1728 01:04:09,160 --> 01:04:10,720 I'VE SPOKEN WITH SOME OF THE 1729 01:04:10,720 --> 01:04:12,160 TRIBES, FOR EXAMPLE, AND THIS IS 1730 01:04:12,160 --> 01:04:13,680 ONE OF THE REASONS. 1731 01:04:13,680 --> 01:04:16,120 THEY THEMSELVES DO NOT KNOW 1732 01:04:16,120 --> 01:04:17,400 EXACTLY THE MAGNITUDE OF THE 1733 01:04:17,400 --> 01:04:18,520 PROBLEM, OTHER THAN THEY 1734 01:04:18,520 --> 01:04:20,360 RECOGNIZE THAT IT IS INCREASING 1735 01:04:20,360 --> 01:04:23,360 AND THAT IT'S CONSIDERED BY SOME 1736 01:04:23,360 --> 01:04:25,960 THE NUMBER ONE CHALLENGE THAT 1737 01:04:25,960 --> 01:04:29,280 THEY HAVE, OVERDOSE, AND THIS IS 1738 01:04:29,280 --> 01:04:30,080 ACTUALLY GOES OVER SUICIDES 1739 01:04:30,080 --> 01:04:31,640 WHICH ARE ALSO HIGHER IN SOME OF 1740 01:04:31,640 --> 01:04:33,480 THESE COMMUNITIES. 1741 01:04:33,480 --> 01:04:35,240 SO ONE OF THE TARGETED AREAS 1742 01:04:35,240 --> 01:04:38,560 THAT WE IDENTIFY IS TO TRY TO 1743 01:04:38,560 --> 01:04:41,160 GET SURVEYS INTO AMERICAN 1744 01:04:41,160 --> 01:04:43,800 INDIANS AND ALASKA NATIVES 1745 01:04:43,800 --> 01:04:45,760 INCLUSIVE OF TRIBES, TO GET A 1746 01:04:45,760 --> 01:04:48,800 PERSPECTIVE OF THE MAGNITUDE OF 1747 01:04:48,800 --> 01:04:50,440 THE PROBLEM, DEMOGRAPHICS OF 1748 01:04:50,440 --> 01:04:51,800 THOSE GROUPS, AND THE CONDITIONS 1749 01:04:51,800 --> 01:04:53,720 THEY LEAD ON. 1750 01:04:53,720 --> 01:04:55,440 THAT'S WHY I COMMENTED, I WAS 1751 01:04:55,440 --> 01:04:58,840 SURPRISED THE CDC DATA DOES NOT 1752 01:04:58,840 --> 01:05:01,040 SHOW A DEPRIVATION IN THE 1753 01:05:01,040 --> 01:05:05,560 SUCCESS ARE AMERICAN INDIANS AND 1754 01:05:05,560 --> 01:05:07,680 ALASKA NATIVES, IT'S HIGH ACROSS 1755 01:05:07,680 --> 01:05:08,480 ALL. 1756 01:05:08,480 --> 01:05:10,000 ADDRESSING THE QUESTION OF 1757 01:05:10,000 --> 01:05:10,720 HETEROGENEITY COULD PROVIDE A 1758 01:05:10,720 --> 01:05:12,720 GLIMPSE PERHAPS ON WHAT ARE 1759 01:05:12,720 --> 01:05:14,360 FACTORS WE COULD USE TO PROVIDE 1760 01:05:14,360 --> 01:05:17,240 RESILIENCE AND WHAT WE NEED TO 1761 01:05:17,240 --> 01:05:18,360 TACKLE TO MINIMIZE VERY HIGH 1762 01:05:18,360 --> 01:05:19,640 RISK, AND I'M GLAD YOU'RE 1763 01:05:19,640 --> 01:05:21,400 BRINGING UP FOR WOMEN BECAUSE 1764 01:05:21,400 --> 01:05:22,800 THAT'S ANOTHER AREA WE NEED TO 1765 01:05:22,800 --> 01:05:24,640 FOCUS VERY MUCH, WHAT ARE THE 1766 01:05:24,640 --> 01:05:26,880 UNIQUE NEEDS TO PROTECT WOMEN 1767 01:05:26,880 --> 01:05:29,840 FROM OVERDOSES. 1768 01:05:29,840 --> 01:05:32,960 1769 01:05:32,960 --> 01:05:36,720 >> YEAH, THANK YOU. 1770 01:05:36,720 --> 01:05:37,560 WE DID CONSULT WITH TRIBAL 1771 01:05:37,560 --> 01:05:38,360 COMMUNITIES. 1772 01:05:38,360 --> 01:05:40,680 WE HAVE A FORMAL PROCESS FOR 1773 01:05:40,680 --> 01:05:43,120 DOING THIS, AND "HEAL" LED A 1774 01:05:43,120 --> 01:05:49,360 CONSULTATION PROCESS IN THE 1775 01:05:49,360 --> 01:05:52,840 SPRING AND RECENTLY RELEASED OUR 1776 01:05:52,840 --> 01:05:53,960 REPORT ON WHICH OPPORTUNITIES TO 1777 01:05:53,960 --> 01:05:54,720 PURSUE BASED ON THAT. 1778 01:05:54,720 --> 01:05:56,000 THERE ARE A LOT OF GAPS IN THE 1779 01:05:56,000 --> 01:05:57,800 DATA, A LOT OF AREAS OF NEED. 1780 01:05:57,800 --> 01:06:03,480 THERE'S A LOT TO DO THERE. 1781 01:06:03,480 --> 01:06:04,560 AND THEN DR. ERIC GARLAND, 1782 01:06:04,560 --> 01:06:06,480 YOU'RE LAST IN LINED AMONG THOSE 1783 01:06:06,480 --> 01:06:08,280 WITH RAISED HANDS. 1784 01:06:08,280 --> 01:06:08,760 GO AHEAD. 1785 01:06:08,760 --> 01:06:10,960 >> THANK YOU SO MUCH. 1786 01:06:10,960 --> 01:06:14,000 I WANTED TO PICK UP ON THIS 1787 01:06:14,000 --> 01:06:17,720 POINT ABOUT TRANSLATION. 1788 01:06:17,720 --> 01:06:18,080 TRANSLATION GAP. 1789 01:06:18,080 --> 01:06:21,520 ALSO BRING FOCUS TO THE AREA OF 1790 01:06:21,520 --> 01:06:26,240 BEHAVIORAL THERAPIES. 1791 01:06:26,240 --> 01:06:27,240 SO DISPARITIES NORA IDENTIFIED 1792 01:06:27,240 --> 01:06:31,120 IN THE COMPELLING TALK SPEAK TO 1793 01:06:31,120 --> 01:06:32,400 LACK OF QUALITY EVIDENCE-BASED 1794 01:06:32,400 --> 01:06:33,440 TREATMENT IN UNDERSERVED 1795 01:06:33,440 --> 01:06:35,000 COMMUNITIES AND THAT I THINK 1796 01:06:35,000 --> 01:06:37,720 REALLY POINTS TO THE SEVERE 1797 01:06:37,720 --> 01:06:39,840 TRANSLATION GAP FROM RESEARCH TO 1798 01:06:39,840 --> 01:06:41,720 PRACTICE, IN MANY UNDERSERVED 1799 01:06:41,720 --> 01:06:46,280 COMMUNITIES TREATMENT AS USUAL 1800 01:06:46,280 --> 01:06:47,360 INVOLVES UNTESTED AND SUBOPTIMAL 1801 01:06:47,360 --> 01:06:49,000 TYPES OF COUNSELING THAT DON'T 1802 01:06:49,000 --> 01:06:50,360 WORK, DON'T ADD MUCH. 1803 01:06:50,360 --> 01:06:52,120 BUT WE'VE SPENT A LOT OF MONEY 1804 01:06:52,120 --> 01:06:55,760 THROUGH "HEAL" AND NIH TO 1805 01:06:55,760 --> 01:06:56,640 DEVELOP EVIDENCE-BASED 1806 01:06:56,640 --> 01:06:57,560 PSYCHOSOCIAL INTERVENTIONS LIKE 1807 01:06:57,560 --> 01:07:01,960 VARIOUS NOVEL FORMS OF COGNITIVE 1808 01:07:01,960 --> 01:07:02,600 BEHAVIORAL THERAPY, MINDFULNESS 1809 01:07:02,600 --> 01:07:04,000 BASED INTERVENTION, ET CETERA. 1810 01:07:04,000 --> 01:07:05,920 WE NEED TO ATTEMPT MOVING THESE 1811 01:07:05,920 --> 01:07:08,080 INTO THE REAL WORLD. 1812 01:07:08,080 --> 01:07:10,240 WHAT MECHANISMS EXIST TO HELP 1813 01:07:10,240 --> 01:07:12,320 INVESTIGATORS WHO DEVELOPED 1814 01:07:12,320 --> 01:07:13,440 NOVEL EVIDENCE-BASED 1815 01:07:13,440 --> 01:07:14,440 INTERVENTIONS MOVE THOSE 1816 01:07:14,440 --> 01:07:15,480 INTERVENTIONS INTO THESE 1817 01:07:15,480 --> 01:07:17,040 COMMUNITIES THAT REALLY NEED 1818 01:07:17,040 --> 01:07:17,240 THEM. 1819 01:07:17,240 --> 01:07:19,480 HOW DO WE INCREASE THE UPTAKE OF 1820 01:07:19,480 --> 01:07:20,440 THESE INTERVENTIONS? 1821 01:07:20,440 --> 01:07:22,760 DO WE NEED TO THINK ABOUT 1822 01:07:22,760 --> 01:07:26,120 TRAINING GRANTS TO COMMUNITY 1823 01:07:26,120 --> 01:07:27,440 AGENCIES TO MOTIVATE THEM TO 1824 01:07:27,440 --> 01:07:29,520 BECOME TRAINED AND TO BE ABLE TO 1825 01:07:29,520 --> 01:07:30,880 IMPLEMENT THESE PRACTICES WITH 1826 01:07:30,880 --> 01:07:32,200 HIGH DEGREE OF FIDELITY? 1827 01:07:32,200 --> 01:07:33,880 I DON'T KNOW THE ANSWER HERE BUT 1828 01:07:33,880 --> 01:07:37,360 I DO KNOW THAT TO MAKE THIS HEAL 1829 01:07:37,360 --> 01:07:38,840 FUNDING IMPACTFUL WE NEED A 1830 01:07:38,840 --> 01:07:41,720 MECHANISM THAT CAN HELP 1831 01:07:41,720 --> 01:07:42,480 TRANSLATE THESE RESEARCH-PROVEN 1832 01:07:42,480 --> 01:07:43,440 TREATMENTS INTO REAL WORLD 1833 01:07:43,440 --> 01:07:46,120 CLINICAL PRACTICE. 1834 01:07:46,120 --> 01:07:49,040 >> YEAH, NO, I AGREE A ONE 1835 01:07:49,040 --> 01:07:51,120 PERCENT, ERIC, AND WOULD ADDED 1836 01:07:51,120 --> 01:07:52,240 OTHER NOTION IT'S IMPORTANT WE 1837 01:07:52,240 --> 01:07:53,920 ALSO ENSURE THEY ARE SUSTAINABLE 1838 01:07:53,920 --> 01:07:57,720 BECAUSE THE ISSUE BEING MANY 1839 01:07:57,720 --> 01:07:58,760 TREATMENTS MIGHT BE PROVIDED FOR 1840 01:07:58,760 --> 01:08:04,560 A SHORT PERIOD OF TIME, WE 1841 01:08:04,560 --> 01:08:05,240 RECOGNIZE TREATMENT, LONG-TERM 1842 01:08:05,240 --> 01:08:07,360 TREATMENT IS ASSOCIATED WITH 1843 01:08:07,360 --> 01:08:08,160 BEST OUTCOMES. 1844 01:08:08,160 --> 01:08:09,800 SO THERE'S THE NEED TO ACTUALLY 1845 01:08:09,800 --> 01:08:12,200 TAILOR IT TO THE COMMUNITY, 1846 01:08:12,200 --> 01:08:13,200 NUMBER ONE, ABSOLUTELY BECAUSE 1847 01:08:13,200 --> 01:08:14,840 OTHERWISE IT MAY NOT BE 1848 01:08:14,840 --> 01:08:15,200 ACCEPTABLE. 1849 01:08:15,200 --> 01:08:17,040 I THINK THAT THE OTHER ISSUE 1850 01:08:17,040 --> 01:08:19,440 THAT IT IS AN OPPORTUNITY THAT 1851 01:08:19,440 --> 01:08:22,640 WE CURRENTLY HAVE IS WITH USE OF 1852 01:08:22,640 --> 01:08:23,880 APPLICATIONS WE CAN GET ACCESS 1853 01:08:23,880 --> 01:08:28,320 TO SOME OF THE BEHAVIORAL 1854 01:08:28,320 --> 01:08:29,920 TREATMENTS LIKE CONTINGENCY 1855 01:08:29,920 --> 01:08:30,840 MANAGEMENTS WAYS MUCH WIDESPREAD 1856 01:08:30,840 --> 01:08:33,080 THAN WE COULD IN THE PAST. 1857 01:08:33,080 --> 01:08:35,240 IN THAT RESPECT, THE GOOD NEWS 1858 01:08:35,240 --> 01:08:36,160 IS THAT NOW CONTINGENCY 1859 01:08:36,160 --> 01:08:37,560 MANAGEMENT IS GOING TO BE ABLE 1860 01:08:37,560 --> 01:08:39,760 TO INCREASE THE AMOUNT OF MONEY 1861 01:08:39,760 --> 01:08:44,600 THAT IS AUTHORIZED TO BE GIVEN 1862 01:08:44,600 --> 01:08:47,560 FROM $75 A YEAR TO $750, WILL 1863 01:08:47,560 --> 01:08:48,920 ALSO ENHANCE ITS EFFECTIVENESS. 1864 01:08:48,920 --> 01:08:49,960 BUT, YEAH, WE NEED TO LOOK INTO 1865 01:08:49,960 --> 01:08:55,880 IT AND LOOK INTO IT IN TERMS OF 1866 01:08:55,880 --> 01:08:56,480 PERSONALIZING THAT BEHAVIORAL 1867 01:08:56,480 --> 01:08:57,040 INTERVENTION. 1868 01:08:57,040 --> 01:09:00,800 >> THIS IS A TERRIFIC WAY TO 1869 01:09:00,800 --> 01:09:01,120 END. 1870 01:09:01,120 --> 01:09:04,200 WE HAVE OVER THE COURSE OF THE 1871 01:09:04,200 --> 01:09:06,520 NEXT TWO DAYS A LOT OF 1872 01:09:06,520 --> 01:09:07,520 ADDITIONAL RESEARCH THAT WE'RE 1873 01:09:07,520 --> 01:09:09,000 PLANNING FOR THE COMING YEAR AND 1874 01:09:09,000 --> 01:09:12,160 WE'LL ASK FOR YOUR INPUT ON THAT 1875 01:09:12,160 --> 01:09:13,480 WILL BE DISCUSSED IN CLOSED 1876 01:09:13,480 --> 01:09:15,800 SESSION, AND MANY PROJECTS WILL 1877 01:09:15,800 --> 01:09:17,800 SEEK TO TACKLE SOME OF THE 1878 01:09:17,800 --> 01:09:19,400 CHALLENGES WE JUST DISCUSSED BUT 1879 01:09:19,400 --> 01:09:23,560 THANK YOU TO EVERYONE FOR YOUR 1880 01:09:23,560 --> 01:09:25,040 THOUGHTS AND COMMENTS. 1881 01:09:25,040 --> 01:09:26,240 THIS ENDS THE OPEN SESSION OF 1882 01:09:26,240 --> 00:00:00,000 TODAY'S MEETING.