Transcripts For CSPAN Surgeon General Speaks On Opioid Epidemic 20240714

Good afternoon. Im the executive Vice President and chief Program Officer here at the Pew Charitable trust. I am delighted to join you in welcoming our very special guest, vice admiral jerome m. Adams. The 20th Surgeon General of the United States. No other publichealth speaker Leader Speaks with the knowledge and expertise and moral authority that comes with being Surgeon General. And thats why when dr. Adams speaks, americans listen. Behavior changes and lives are saved. And in the very best tradition of previous Surgeon Generals who educated the american people, rallied the health care community, and changed the culture surrounding tobacco, hiv, nutrition, and other Public Health challenges, dr. Adams is now leading the fight against the epidemic of opioid misuse. Opioid overdoses were responsible for nearly 48,000 deaths in 2017 and 2 Million People in the United States suffer from opioid use disorder, which we know is a chronic debilitating brain condition. Pew is also working to make progress on the Opioid Crisis. Our Substance Use prevention and Treatment Initiative encourages states to expand access to medication assisted treatment, which has proven to be the most effective therapy for opioid use disorder. To achieve this goal, were providing Technical Assistance to states and localities, but we also serve as a convener for experts to share their research, separate fact from fiction, and explore ways to make treatment for widely available. Thats why dr. Adams is with us today. Hes made combatting the Opioid Crisis a major priority, including expanding access to treatment, educating the public that addiction is not a personal failing, and ending the stigma that too often keeps people from seeking treatment. In 2015, dr. Adams used his credibility as indianas Health Commissioner to successfully advise thengovernor mike pence to sign legislation allowing counties to establish Needle Exchange programs to reduce the spread of infectious diseases. And hes been willing to share his own familys personal story with addiction. In doing so, dr. Adams is changing the conversation around opioids, bringing this condition out of the shadows and into the mainstream of how we prevent and treat chronic illness and helping to promote healthy communities. Dr. Adams is also using his role as Surgeon General to expand the the importance of expanding access to oral health, including highlighting what Oral Health Providers can do to combat the Opioid Epidemic. And were especially pleased that a pew staffer was invited to write on work force issues on the upcoming Surgeon Generals report. Now its my very great pleasure to introduce jerome m. Adams, Surgeon General of the United States. [applause] dr. Adams thank you so much for the kind introduction and i appreciate the opportunity to speak to the folks here today about what is a critically important topic. I get introduced in any number of different ways. Folks talk about my md or my mph, but to steal an analogy from the Vice President or a saying from the Vice President , those arent the most important letters to me. The most important letters to me in my background are d. A. D. Im a father of a 15, a 13, and a 9yearold. Its funny, sue. You said when the Surgeon General talks, people listen. I only wish that was the case at home. [laughter] but jokes aside, it is critically important that we think about our children and our future. For the third year in a row, Life Expectancy in the u. S. Is going down. I stand before you as the first generation of parents in the last half century who as of right now cant look their kids in the eye and say youre going to live a longer life than im going to live. And that is not a future i want to leave for my children. I hope its a future that you all agree we shouldnt be leaving for the children of the United States and of the planet. And in many cases, its due to these depths of despair. Suicides, folks misusing alcohol, and the Opioid Epidemic. So again, really glad to be here today. I want to level set with you because many folks dont know what the Surgeon General is or does. So first of all, im not the attorney general. I know there are lots of reporters here. I dont want the questions that you all are going to be giving to that guy. Surgeon general, not attorney general. And im also neither a surgeon nor a general. Im actually an anesthesiologist, and i still practice part time. I was at walter reed just last week. I think its critically important we try as much as we can to continue to be hands on, to get to those grassroots levels. I was in a thoracotomy. They cut open a mans chest and we were providing anesthesiology for that thoracotomy. This is something folks never believed could be done without using opioids. We didnt opioidspearing anesthetic on this gentleman. He woke up, was wide awake, smiling, said are we done, and its just amazing because its one thing to stand up here and say we should be doing opioidsparing techniques and to say that there are alternatives that are better an opioids in many cases for pain, but its another thing to actually say i just did it on thursday, i know its true, i know what can be done. I also mentioned im not a general. Im a vice admiral in the United States Public Health Service Commission corps. Its why we wear this uniform. Very, very proud to wear this uniform. Interestingly enough, were one of the seven uniformed services. Were actually older than air force. The Public Health Service Started through an act passed by president john adams, the second president of the United States, no relation that i know of. But passed by [laughter] dr. Adams passed by president john adams. You know whats interesting is we wear Navy Uniforms because we inspected ships as they came into port. We were there to make sure diseases, like measles, didnt get into our country. And i never thought that as the 20th Surgeon General, id still be dealing with the same diseases that the first Surgeon General of the United States had to deal with over 150 years ago. But i think it reflects in many cases a failure on our part to engage with folks. And i know were here to talk about opioids, bing its but i think it is important to dig into measles a little bit because this is a case where everyone out there, whether you agree or disagree, really just wants to do what they feel is best for their kids, for their family, for their own personal health. And i think it illustrates the fact that we need to do a better job of showing people that we care so they care what we know. People have lost faith in our governmental systems and our Health Care Systems and our scientific expertise. Its because we like to stand within hospitals and within clinics, and we dont get out into the communities. We dont show people that were there to listen and to lift you up versus standing in front of them and waving our papers from prestigious journals and saying that we know better than you and that youre an idiot if you dont listen to me. So going back to the Opioid Epidemic, i think we have to do that same thing in regards to the Opioid Epidemic. We know the science, and we need to lead with the science. As a nations doctor, ive pledged to promote health, prevent disease, and lead with the science, but weve also got to remember that people need to know that you care before they care what you know. And the key to solving the Opioid Epidemic is going to be showing people we care about them. Then that opens the door to talk about all the other things we know are important. I want to back into how im prioritizing the Opioid Epidemic and let you know what im working on. One of the challenges of being Surgeon General is that every day theres five, ten people who want to meet with me and make their top priority my top priority. Theyre all worthy causes, but theres just one of me, and there are literally hundreds of different priorities out there that folks want me to lift up. One of the things ive done as Surgeon General is try to pick crosscutting priorities that allow us to lift up multiple areas. One of the things im working on is a report on Community Health and economic prosperity, making the case that communities that invest in health see dividends not just from a health point of view, but from an economic jobity point of view growth, wage growth they see , decreased absenteeism. They see Lower Health Care costs. The number two cost for most fortune 500 companies right now in this country is health care. Quite frankly, the out of control Health Care Costs in our country are hurting our ability to be economically competitive. But we know that company that go companies that go to healthy cities actually do better. Just down the street from us, theres a small little startup. You all may have heard of it, called amazon. Well, amazon put their Second Headquarters in crystal city, virginia. Whats interesting and what people dont talk about is crystal city, virginia, is surrounded by four of u. S. News and World Reports healthiest cities in the entire United States. Why is that . Because Companies Move where they can find a healthy, a productive, an educated work force. And young people, educated people want to move to cities with complete streets, with clean air laws, with many of those social determinants of health that we know about intact so they can raise healthy and productive families. So i want folks to understand that when we invest in health, its not just about making an individual healthier. Its about making a Community Healthier. And when you make a Community Healthier, you see benefits across the board. Because the number one issue people vote on, black or white, democrat or republican, rural or urban, consistently is jobs and the economy. Folks dont vote on health. I wish they did. But they dont. Some of you may call me out and say, well, health care is one of the top reasons that folks vote. Well, that is true, but even in the last election, health care wasnt the number one. It was still jobs and the economy. And even health care, i would argue, isnt the same as voting on health. Folks are voting for health care because one in every five dollars our economy generates is going to pay for health care expenses, and so it is still an economic reason. Theyre largely voting for health care. They cant pay their mortgage. They cant make the car payments. They cant put money into their 401 k or their kids college accounts because so much of it is going to pay for health care. So we want people to lift up health. Weve got to frame what were talking about in a way that relates to them. Its why i travelled across the country with secretary acosta from the department of labor. What we see as a Health Crisis in regards to the Opioid Epidemic, he sees as a work force crisis. We now have over a million unfilled jobs in this country. More people more unfilled jobs than there are people who are looking for work because so many folks have checked out of the work force due to our nations poor health. So its why its critical that we all lean into in and bring all partners into the equation, especially, especially the Business Community and our employers. The second issue that im working on is health and national security, raising the awareness of the link between our Nations Health and its national security. Over the years, the number two issue people vote on is usually safety and security. Shocking stat for you. Seven out of ten of our 18 to 24yearolds in this country are ineligible for military service. Seven out of ten of our young people cant serve, are unfit to serve in our military because they cant pass the physical, cant meet the educational requirements, or have a criminal background requirement. Record. That number is probably inching closer to eight out of ten because of the Opioid Epidemic. Because were losing so many folks in regards to the Opioid Epidemic. So our nations poor health, our our communities poor health, and chronic disease 20 or 30 down the roads. An unhealthy country. We have to help everyone understand that when we invest in helping communities we are investing in our national security. We go to congress sent back for nichols and dimes. When the military says they need a new airplane or tank they get a blank check. Investing in our Health Care Communities is just as important because that will lift up our nations security just as significantly. In the words of the great al lawson for my tyson, everyone has a plan until they get punched in the mouth. Epidemic, and i also think this is a opportunity , folks dont vote on health. Sometimes they do. Blip. Measles you see a head of the local college the superintendent of schools, the sheriff, the local faith based leader. I can get a room of people to talk about it. But if we look at this as a higher to turn out, this will pass. I was in seattle and now they methorried about a epidemic. We need to help folks understand the causes of substance misuse across the board. If we do that we will solve not but the Opioid Epidemic solve many other problems that exist out there. Trauma, untreated Mental Health issues that cause substance issues, it they increase your chance for ink incarceration. They increase your chance for cardiovascular disease and diet 80s. Diabetes. Tos is an opportunity prevent this from happening in the future. That, we have to walk the talk in terms of partnership. And reach break down out to the folks who have not then at the table before. My motto is that her health through partnerships. We need to look at business, leaders if weaith will solve some of these complex problems. Some of you heard my story. Just my baby brother philip is in court prison right now because of this. He suffered from untreated mental issues and tended to self medicate. Pursue us tobacco, alcohol, marijuana and one day at a party someone gave him a pill. 80 of people who use here and went either got started with a prescription opiate. That rapidly led to hear when severalhe stalled hundred dollars to support his addiction and got a 10 year prison sentence. I tell his story with his permission for a couple of reasons. Time whatsall the the biggest killer out there, tobacco, sugary drinks, and obesity . Is of the biggest killers stigma. Stigma keeps people in the shadows, it keeps people from asking for help and keeps people like my brother from recognizing they even have a problem. A dont even admit we have problem. Stigma keeps families from coming forward and asking for help. The more we share our stories it works. There is no us when it comes to the Opioid Epidemic. My family managed to raise a Surgeon General of the United States. They did ok. I want my kid to be a Surgeon General one day when they grow up but those same parents produce my brother who is now in jail with untreated still Substance Abuse disorder. If it can happen to my family it can happen to any family. Another face of what it looks like, would you come appear i want to give audrey a shout out. She is a friend of mine and her mom is a very good friend of mine. Alternate lost her brother to an opioid overdose. Said as it was, she and her mother and their family not to determine not to let her loss he in vain. As my momted out wanted other moms to have access to naloxone. ,he yelled at him and she said why is the there a law and why cant laypersons why cant we carry naloxone. Aarons law is no pass in indiana that allows people to go to a pharmacy and get naloxone. It turned into an education state that over the it helps to identify kids that are going to be high risk so they are aware that i might be sore susceptible to an addiction than the kid sitting next to me in class. It also helps to raise awareness of both about opiates. Previously programs were just about alcohol and marijuana. In sixthroughd 10th grade or less. It has grown all across the nation and it has been cool to see the Amazing Things my mother has done. I wanted audrey to come appear, please give her a round of applause. You look at audrey. She went to academy and indiana, one of the top private. Chools in the entire world there are people who come from outside the United States to go to call for academy. You look at us and we dont look like the familys you think of when you think of addiction. We are the faces of addiction right here before you. What recovery looks like. It is important to understand audrey, thank you for coming up here and sharing where family has done. [applause] indiana, i have also been on the other side of the Opioid Epidemic. As state Health Commissioner in responsei oversaw the to the largest ever outbreak of hiv related to injection drugs. I often get asked, how do we stem the tide of hiv and that community . Health entities were critically important. When i tell people is the people who we most needed to get that Syringe Service program approved where the local pastors. The local business leaders. The local sheriff. We had to get into those communities and get the high in by in. By going down there, not sitting in indianapolis and saying i know better than you. But by sitting down with the sheriff and asking him what his concerns were and showing him how we could work together. We were able to get a Syringe Service approved, get the town to accept it and stem the tide of hiv. Hink read what the science there are many folks out there ,ho like to criticize me criticize the Vice President and they say we moved to slow. Do you know what would have happened . Gone down there and use my authority to force that community . The local Law Enforcement officers would have set up a perimeter around the Syringe Service program. We never would have had any success and hiv with still be spread throughout the community. We have to understand that we have to get into these communities and earn the trust and likely sometimes we have to be willing to compromise a little bit or go a little slow so that we can manage the equation. I am proud not only what scott county did, and that was critical because it was a conservative, all white town in middle america. All over the midwest and all over the country Syringe Service programs open up. Federal rules change and regard to funding for Syringe Service programs. That happened to his we went in and we listened it to the community and we worked with the community and earn their trust. I think it is important that we remember that. Look atwe also need to what is going on in terms of success in this country. I put up the first Surgeon Generals advisory and motivated by the work that Justin Phillips raising awareness. There is a person dying of an half areerdose and dying in a home environment. They are dying in bathrooms and bedrooms and garages. An ambulance that can get to minutes, wend 46 will not turn around this epidemic unless more appealing people are willing to carry naloxone. Racial hand if you carry naloxone everywhere you go. Three hands. Hands. D to 20 or 30 it is more likely that someone will come in this building and say there is an overdose happening. Even here where i am preaching where. Choir we are not we have seen naloxone describing go up over 400 and 50 in that time. Thousands of lives are being saved. I want to tell you a little bit more about what we are doing in my office to help stem the tide of the opioid adamic epidemic. We are working with Health Care Professionals by encouraging people to use rhesus resources. It is important that we decrease opioid describing because we still prescribed 90 of the opioids. That is still the case even though we have decreased prescribing by 22 . Of usearted as a crisis of pain. We also have to measure what we are substituting act in twos to treat pain. We need to remember our history. Surgeon generals have been fighting tobacco use. I have journals where there are doctors smoking cigarettes and saying nine out of 10 doctors prefer camels and they recommended them to women for pms,orts of ailments, for anxiety and for depression, smoke a cigarette. Once upon a time we were told that cigarettes were safe. They were natural. They were good for whatever ails you. Do clean up tried that mess. 20 or 30 years ago when i was in thatal school we were told opioids were safe and effective and good for what ever else you and if a doctor prescribes that they wont hurt you now we are leaning up that mess cleaning up that mess. We are hearing the same rhetoric in terms of marijuana, natural, safe, good for what is shoot and it will not hurt you if a doctor recommends it. It is important that we understand that this is a different product than when what folks think about. Marijuana 10 years ago had Single Digits thc. Now you have strains at 2025 thc. Getting 8095 percent thc delivery. Drinkingrence between a glass of wine and a bottle of grain alcohol. Impact,about the communities and california where one out of five pregnant women are reporting using marijuana during pregnancy. Fetus tothe developing the high concentrations of thc. In communities that have legalized marijuana even for medicinal purposes that the attitudes about marijuana have gone down and obtaining i am worried about the impact on the youth in our communities. That we areed repeating history all over again. It is important that we look not just again at the Opioid Epidemic but such stick substance issues and the negative effect that we see over and over again when we accept before the science had weighed in and normalize it in society and thence then the next 20 or 30 years. How to properly and safely store and dispose of Prescription Medications. We think of drug dealers as bad people. First drug dealers are your dont be so once first life daily. There are dangers of keeping unused medication around the house. , veryo talk about stigma important that we work to lower stigma. And make naloxone more available. Anyone from law and for smith here . Law enforcement here . No hands raise. Choir. Up speaking to the the number one Mental Health our jails and prison systems. They didnt go to medical School Number onelso our Substance Abuse providers. We will not solve this problem if we dont get in touch with these people and bring them into the conversation. Then in florida and colorado and california over the weekend and i heard a lot about passion fatigue about among our Public Safety officers. Times, folks are saying Surgeon General what are you doing to get that compassion back . I am working with them to try to help them understand that naloxone is the first step to getting someone into the pathway of recovery. We have to step up. They are getting frustrated because i have talked to drug dealers. Two best places for drug dealer she will hand out, the er parking lot, we send them right back into the street. We have to do a better job for a Public Safety officers and the people for Substance Use disorder and making sure more people are willing to get treatment and get on these medications before they go to theparking lot and go into drug dealers arms. We have to do our part. Seeing thefrustrated same thing over and over again. They are not bad people, they are just frustrated. There is a different and better way. Its not just one thing, it is the whole gamut of services that we need to provide. I want to close, but i do want to mention another article of information. Remember this guy c everett coop . Tomorrow is Natural National hiv testing day. Stigma, isis of crisis of fear where everyone was pointing figures. He wanted everyone to understand the role they can play in responding. He set a pamphlet out calling understanding and spirit. We put out a digital postcard and my postcard list of five steps that every american should be thinking about to respond to the opioid response. Works if every single one of you all, racial hand if you have a social media account. Every single one of you that racial hand should be taking a picture of that and sharing it right now on your social media channels. If you dont have a social media account you can go to surgeon and post it in your offices, in your homes and school. We all have a role to play to respond to the Opioid Epidemic. Problems is we tell all the bad stories out there but we dont do enough of a good job of telling the good stories, the stories that it is important fallenioid abuse has 4. 4 . There is more medication assisted treatment. Go, mileslong way to to go before we sleep but we have made progress and we want to share their stories of hope so that people dont get compassion fatigue and that they understand that they are not doing the same thing but not receiving any positive results. There are people out there who are recovering and go on out there being recovery coaches. I want to close by challenging you to make a new friend today. There are no Law Enforcement folks in this room. Are there any people from the Faith Based Community in the room . We have to do a better job of reaching out, inviting people to todayect table but make a new friend and a new partner because that is the only way we will turn this around. Walk the talk particularly about naloxone. Its a great way to potentially save a life and start a conversation. In the communities that have turned around the overdose rates the ones that have turned things around are the ones that first saturated the communities with naloxone. You cant get people in recovery if they are dead. Cant talk about recovery if someone is dead. The first step is keeping them alive and then connecting them to care. Put an end to stigma. You can go to crisis next door. Gov. Many folks have shared their stories because thats how we turn around this horrible crisis that we are and. About programsk for individuals, think about policy change and sustainability. Handld love to go out and naloxone to every single individual out there but i cant do that. To helpt on an advisory the country understand naloxone. Make naloxone more available and affordable to people in the communities. Think about project echo that in wirralatment areas. Put policy changes in place that will help us turned the tide. Share our best practices. When i gotrated around the country and hear people trying to recreate the wheel over and over again because they dont know that or one towncity over already did this. Practices, publish your results in journals even if it is not working, it is helpful for people to know that we tried this so that we dont repeat mistakes. I want to challenge you to be the innovators the educators, the communicators, and where necessary the educators that will push us towards a have healthier tomorrow. Thank you for the opportunity to join you today. Applause] here, there is also an injectable version. These are the two takehome version spirit put it in the nostril and you press. Thats how easy it is to save a life. If you dont have naloxone and if youre not caring like some go to your local pharmacy and ask. Talk to some of the folks in this room. They are plenty of nonprofits out there that will make naloxone for free. What i can to make it available to you. Thank you. [applause] i think we have time for a few questions. Andy fisher, i am the pr guy and i am always interested in the success that we had with , how yound seatbelts get people to change behaviors . What kinds of things you can do to do that and how you get people to have more knowledge about their health. Found to dou successfully that will do that . I think what we need to do is normalize good behaviors denormalized bad behaviors. Stigma works in multiple directions. Looking at tobacco there is a statement towards combust smoking combustible cigarettes. That to what is going on with ecigarettes a are cool. We need to do a better job of normalizing behavior but having people understand and looked down upon with negative behaviors. Our give you an example. When i try to do is always stay positive and lift up people who are doing the right thing. When we go out to the schools, when it comes to vaccines i always point out that 93 of parents out there are vaccinated. When we talked about ecigarettes we talk about the usingho are not ecigarettes and help normalize them. Lets lift up our Public Safety officers and First Responders who are carrying naloxone and share their stories of success. Chief, tell us about your use of naloxone. When he gets a and tells a story about how he saved someones life, and he is back with his family, thats how you change behaviors. It is by sharing stories. Every time i share the story of my brother, someone comes up to me afterwards and says, my family is going through this also an until today i havent had the courage to share this to you. There was the young lady who would do it never ever would expect to have been a person with a history of Substance Abuse. Professional, sharply dressed and she came up to me after i gave a talk over the a problem withd, i had substance misuse a while ago. Thank you for sharing your brothers story. I am always ashamed to talk about it. Hearing you tell your story makes me feel like maybe i am not such a bad person. ,hat is what we need to do fight stigma by sharing stories and lifting up good behaviors. Surgeon general, i actually used to work for the Chiefs Office of the metropolitan police department. I was on the street as well by that time. I am on my career transition to congress and the private sector. The Citizens Academy each year, from our city and district. I was part of that, too. Focusedelt there more to ask people what Law Enforcement is, but based on your description i think something has to be changed, because i still work closely with them as a community partner. Is there anything they can add to train our citizens to learn more about how important the Opioid Crisis is . That is a great question. It goes back to the interplay between Public Safety and Public Health. I think we have to do a better job of helping folks understand, that a healthier community is a safer community. I want to tell you a quick story not related to the Opioid Epidemic, but drives home the point. I was at the mayors conference and i had mayor de blasio on one side and the mayor from South Carolina on the other in a room full of mayors. It drives home a point. Thee are two mayors with two most walkable cities in the United States. I asked this room full of mayors, 50 mayors, how many ran lower hemoglobin a 1c by 50 . That is how you measure diabetes. If you have a Walkable Community that is how you lower diabetes. Not one mayor raise their hand. In many cases we talk about the only measure health outcomes, but then we try to talk to folks who are being measured on different variables. There proud of the fact that we handed out thousands of needles. Measuredff is actually by how many needles he gets off the streets, not on the streets. We are talking about hiv and hepatitis cases averted. As much as the sheriff may care about that, he is more worried about weekends and overcrowded prisons. We have to go to their table to find out what motivates them, and help them understand that a Syringe Service program with connection to support services keeps syringes off the streets, gets people into care to keep the jails from being overcrowded, lowers recidivism rates. Once we become better partners, the concept of leadership by meeting the needs of others. Once we do that we will see there is lots of overlap in the things we are focused on. We will see that they are more willing to say tell me about this health thing, help me understand it. Safety folks are talking about social determinants of health. How can we get People Housing . You put someone on the streets after you discharge them from jail and you wonder why they commit another crime. They have no place to go, they have to steal to support their habit, the after breakin somewhere to get food and shelter. If you gave them permanent supportive housing, they would be much less likely to use substances, less likely to commit crime. We have to sit down together and find out where those commonalities occur. Humble us being more ourselves and not expecting people to do what we want them to do show them how they can achieve their goals. Thank you. My question is a twopart question. Patient i a pediatric had surgery. It was, i guess, not simple, but i was out in four days. It was invasive. The doctor insisted that i go home with opioids. My parents were like, no, you really dont need them. The doctors wanted, insisted, that we take them. Doctors orou combat get messages to doctors to say, please listen to the patient if they dont need it. He can take advil. Messages tou get parents to say please hold onto your pill bottles and make sure you know where they are . Questions. We just had Prescription Drug take back a. Sheriff leaned into this, people across the country have leaned into this. We have it twice a year. I wish every day could be Prescription Drug take back day. We are helping them understand the best ways to dispose of prescription medication. That is a message that people are slowly starting to understand. It is slowly starting to get traction. Dont leave your Prescription Medications around. I challenge all of you in the room to go home and go through your medicine cabinet tonight and see how many unused medications you have lying around and get rid of them. It is important and we all have a role to play. That is one of the points on my digital postcard. Changing attitudes in hospitals, prescribing is down 22 . We are going in the right direction, but still massively overprescribing. The dental community prescribes the lions share of opioids to young people. They are starting to do the right thing. We didnt get here overnight. It took 20 or 30 years. We wont undo it overnight. Patients, you have the right to say i dont want that. I hear you. My wife had surgery for melanoma about a year ago. Major surgery. They cut into her thigh and stomach and did a deep dissection. No one believed that the surgery could be done with little to no opioids. I am an anesthesiologist and the Surgeon General of the United States. We crafted a plan. Folks were shocked. They said she did better than anyone theyd ever seen with the surgery. Opioids dont treat pain in the majority of cases. They mask pain. They make you sleepy so you dont notice the pain. They also have terrible side effects which make it harder for patients to get out of the hospital, harder to participate in physical therapy. I dont want folks to be hurt. It is not an either or. There are folks that do benefit from opioids, but we need to change the culture in the public so that patients understand that they work better than opioid heavy anesthetics, and this is what i want from your my loved one. They are changing the culture within the community. At ucs why i gave arounds davis on monday. Grand rounds in the last two weeks at Rush University at cleveland click, the university, chicago. Generalthere as surgeon speaking directly to provider saying that there is a better way and we need to get on board quickly because we shouldnt be the first drug dealer for folks out there. One more question. What about asking chains like cvs or walgreens . Likeat about asking chains cvs or walgreens to take drugs back . Many do have drug take backs. The challenge with takeback sites is there is a federal rule for where you can have a takeback sites for a bin full of opioids. Opioids sell for 1 and milligram. You could have a bin full of tens or thousands of dollars of opioids. Numberana we were the two behind california for pharmacy robberies. That is the danger. We need to promote better takeback. Disposal bags are great way to get rid of opioids. You put them in the bag, they instantly become unusable and you dont have to worry about bringing them into a pharmacy. Police stations are having take tax. Fire stations. I am encouraging more medical clinics. Thinkyour surgery i that it should be standard that after your surgery you bring your medications back in and you sit down with your doctor and say, did you finish your and biotic or your opioids . If not, what is the plan for getting rid of them . Can we take one more . She had her hand up for a while. Absolutely. [indiscernible] that is a great question. Medicinalne means no properties. Impliesher schedule that it has medicinal properties. Physician, as a person with a degree in biochemistry, as a person who chaired the committee at my hospital for the last decade. There is no such thing as medical marijuana. What why mean . Over 100 is has different components. Some have medicinal potential and value. Approvedwo fda medicines derived from marijuana. It has different substances, some of which can be dangerous. There are no other medications yourdoctors say grow it in backyard, crumble it up, cook it into a brownie or smoke it. That is my prescription to you. We need to have a more nuanced and Public Health Oriented Approach to marijuana in this country. We need to push for more research. That is one thing i am passionate about. I want communities to have information to make informed choices. I dont think blanket normalization of marijuana usage and acceptance across the board of marijuana as opposed to derivatives of marijuana as appropriate medicines for folks will get us into a place from a Public Health putting view that provides a clear net and if it down the road. We have to understand there are many different elements. There is adult use of marijuana, medicinal use of marijuana which, again, we need to make sure we are deriving the components, risk, benefit, and disease and then public justice issues. I am concerned as a black man with two young boys that black men are four times more likely to be arrested for marijuana than white men. You have a liquor store and a smoke shop on every corner in every black community. I dont know. I dont believe that adding a Marijuana Dispensary to that equation is going to be something that will provide a net social justice benefit further down the road. We need to think a little more about how we have intelligence social justice policies that address the underlying bias that causes people of color to be disproportionately arrested and not think that legalization and normalization will have a benefit. From a Public Health point of view, i think any doctor, any pharmacist, any scientist say we dont do this for any other medication. We need to make sure we have the research so that we can have an informed conversation about marijuana from a Public Health point of view. I will be going after work to get my naloxone. I expect you all to do the same. Your fabulous presentation. Thank you all. [applause] we need to get our obligatory selfie. [laughter] i want to get one with the audience in the background. Fantastic. [applause] cspan is live in chicago waiting for todays session of the Rainbow Push Coalition convention to get underway. Senators Elizabeth Warren and Amy Klobuchar and representative tulsa gabbard are expected to speak. Yesterday former Vice President joe biden spoke at the fiveday convention. While we wait, here are his remarks. [applause] judge greg mathis. [applause]