Addiction recovery research. Tors ago, i kept trying convince dr. Clark that the best way to have any research was to people and track people. He was the director. You suggested my attitude was a bit of republican conservatism and not very american. However, today as years of past, i have a thing on my wrist called a fitbit that keeps track of every step i take. Lotsk at people and i see of piercings and other things. Me that at some point we need to really become a tracking mechanism for people who do research so people will if youactly what happens move into an oxford house, get involved in the democracy of a house, learn the kind of selfreliance and selfrespect that comes from oxford house. You will probably stay clean and sober forever. Having said all that, this session has some wonderful clark, will dr. Compton, john kelly. The energyo be in and Commerce Committee back in the day. Let me turn it over to the moderator. Keep this panel going. [applause] my name is john kelly. Minute of you saw me on the last talk. Im a researcher and clinician from mass general hospital. Im very happy to be here. I am the moderator. Feell chime in when i appropriate. Weve got such an expert panel here. I am honored to be with all of these fantastic experts in the field of addiction. What i thought we would do to in many ways, i think thats what we want to get, what is on your mind. To find that what we need to do more research on. Suggested to the panel to begin with is for each member to come up and talk for five to seven minutes. Are, give onehey newsworthy tidbits on research and addiction and once new. Start . Unteers to has volunteered. Thank you. Good morning everybody. On the deck to the director of the National Institute on drug abuse. Da. S known as ni research in terms of drug abuse and drug addiction. We explore how drugs affect the brain. We look at how recovery is reflected in rain recovery itself. Weve done a lot of research about how oxford house has affected lives. Show and the work to helped demonstrate how effective oxford house can be in supporting lives. Thats really what this is about. How do people turn their lives around and change their lives in the long haul. About,where research is what can we do to help people exit these conditions. I have a couple of things to share with you after those introductory remarks. I want to remind us that oxford house is about housing. Housing is essential to recovery. I was struck when our director visited Treatment Centers in baltimore recently. In the discussions with people in treatment, they run up how difficult it was to recover without stable housing that provided support for their changing lives. Most people end up going back to the communities where they came from, where the same problems exist for them. Oxford house provides a respite from that. Relations, to those having a place to live is not a given for many people who are early in recovery. Housing is essential to the recovery process. Its something we know from you and much of our research. Crisis,ss the opioid thats been the focus of my attention for more than a few years. We have at extra funding to do Additional Research in this area. We see recovery as key to the issue. We are doing work on how to engage Recovery Support personnel. About our doctors to ask using substances, which are you using. Just the doctor or the nurses or the Health Care Practitioners doing that. Is the model we are trying to study. How can we help people make that transition. People show up in health care, they are also quite ready for that condition. Pierce support can make a difference. We also know that helping people and to recovery when they have overdosed is a key challenge. Way that in my naive when you overdose and we rescue you, we have a medication that saves peoples lives may have overdosed, people would want recovery at that moment. They would want to enter treatment because they nearly died. Thinking i have andn up, now im with withdrawal. I want to get high. The next day, there is an opportunity to reach out to them. We are figuring out can we use pierce support to reach out the next eight or the day after, when people may be ready and willing to hear the message about the value of recovery in the opportunity to turn their lives around. Thats number two. The third is a specific Research Study i read about recently. It looked at what happens longterm when you start people on medication. We did a study to look at can we use this to help people who are recovering from prescription opioid addiction . Short wasnt as good as longterm. We did some longterm followup. How are people doing . Recoverye still in four years later . The number one protector is those on medication. That didnt shock me. Can be very helpful to people who are struggling with opioid addiction. What was important in the study was the number two predictor, engagement in recovery programs. These things were not mutually exclusive. Mean that medicare supports some. The combination of the two was essential. They added to one another. Together, wese two can have a bigger impact. That is super important for the field. The last thing i want to leave you with is i needed help. I have identified a couple of key questions that are important for recovery research. Use pierce support to help people who have recently. There are can narcan devices . Even if its not for the people tothe house, you are going see people in the community. You will run into people who need their lives saved. I cant do Recovery Support on a deceased person. We can when people have their lives saved. I would love to hear your ideas for Research Ideas we can help support. Fund people like dr. Kelly and others who do Research Across the country. That will turn to you for observations. Thank you very much. [applause] thanks. Is thing i forgot to mention dr. Jerome adams, the Surgeon General, will be joining us around 10 30 a. M. We can look forward to that. When he comes in, we will have introduction and talk a little bit in the same way. Who wants to go next . Thanks. Good morning. I am in rhode island. I have a private practice there on addictions. What i would like to focus on is the importance of recovery. The important thing within recovery is its not useful unless you are alive to experience it. The number one leading cause of death among patients in recovery is smoking. Nobody thinks of that. Meetingsme to these thinking we are being successful when i can get into the hotel without coming through a smoke cloud. If we are going to get to the point where you can experience recovery for as long as you possibly can, we are going to address smoking. Weve got to start looking at that as a key issue. We need to look at the number one leading cause of mortality. We are in the middle of what the New York Times addresses as the Opioid Crisis. People last0,000 year as a result of opioids. Smoking500,000 due to last year. Weve lost about 500,000 people year each year for the past 15 years. Its not news. Because its not news, the same thing happens here after year, we are having this experience where 747s people crash every day around this and the news is about the small crash taking place across town. Thats the leading story. Weve got to focus on the 747s. Apologies to boeing for the example. Thekey is to look at where deaths are taking place. Number two, behind cigarette smoking, behind vaping, behind esmoking, is alcohol, the second leading cause of death for folks with addictive disease. Opioids are way in the background. Ist we need to focus on tobacco and alcohol. I cannot say that enough, because that is the key to solving the problem of the mortality rate that we have associated with addictive disease. Having said that, since you all expect me to Say Something about opiates, lets Say Something about it. The rate of death among people with opioid use disorder is about 15 times higher than it is in the general population, meaning that i have an expectation among folks coming into my office who have opioid use disorder that they are going to die pretty quickly. What can i do to stop that, or at least slow it down . My expectation is that individuals with opioid use disorder if i have 100 patients , and all i do is say hi and smile and send them to 12 step meetings, about five of them are going to die every year. Of every hundred, i am going to lose five per year if i only use psychotherapy plus 12 step. If i add medication to that, i save four people per year out of those hundred, because the number of deaths goes from five per hundred to one per hundred on medication, whether it is or methadone. For either one of those, i save four out of 100 people per year. Then comes the question, and here is the new research. The question is, how long do we keep them on medication . The answer, forever. This is an antihypertensive for people with hypertensive disease. This is insulin for people with diabetes. Dont come off it, because if you do, even years later, the mortality rate rises from one per hundred to about 1. 7 per hundred. I almost double the death rate by taking some money off methadone. There is no point in taking them off unless the only reason is, i dont want to be on it anymore. That is a terrible reason. I do not want to be on it anymore. I dont want to be on an antihypertensive anymore, and my diabetic patients do not want to be on insulin anymore. Tough. Suck it up and keep taking the medication, because that is going to make it less likely that you die. Thats a good reason in my book. The bottom line for this is, take the medication and do Everything Else you need to have a good recovery. Quit smoking would be number one. Number two, go to aa or na meetings. Work in the program. Do the steps. Talk to everybody else in the room. But the key to all this is to take care of yourself. The ways of doing that are the same as they are for everybody. If you have a chronic disease, take the medication that is the right one for your chronic disease state. If your chronic diseases state involves a certain way of thinking, then work that through on a daily basis. Focus on it. Everybody here in this room is doing that second piece. Do the first piece, take care of yourself, in addition to taking care of yourself spiritually. Thank you. [applause] thanks, stu. And kevin, you volunteered next . Thanks. [applause] kevin thank you all so much. My name is kevin sabet. I was a senior policy advisor in the Obama Administration for two and a half years. There that, for a time in Bush Administration when it was ok to be bipartisan. I hope we can bring those days back. I miss those days a lot. I also want to commend you all for being here, because one of my mentors, bob dupont, talks about the Oxford House Program and 12 steps also as a modern miracle. It may not be popular on twitter. If you are on twitter and look what people say about 12step programs, it is not very popular. But there has been this very insidious thing that i call a false dichotomy between 12 steps and medication assisted treatment, as if they are completely incompatible. We know there are many paths to recovery. We know they are compatible. We want to have a large enough tent to keep people alive and bring everyone in the fold. But you all are the living examples of why us people appear, and it is an honor to be appear with the giants of the field, i am humbled to be up here, although it looks more panel. Manel than a we will change that time. We have some great women who can be appear. People like dr. Eden evans, on and on. I want to go further with this idea of a false dichotomy, because where i am coming from, coming off what stu just said, i cant believe we look around at the addiction for profit industry that, sadly, our country is so good at doing. We look at the alcohol industry. 90,000 People Killed a year. Every dollar in alcohol tax costs us almost 20 in social costs. More people in the criminal Justice System today for thanol related offenses marijuana and all the other Illegal Drugs combined. Alcohol taxes are a fifth of what they were during the korean war because we have a massive industry with lobbyists that have more money than oxford house or other recovery groups, and are laughing all the way to the bank. We look at another one of our favorite industries, the opioid industry. The sacklers have generously said they would give 10 billion to get people off their backs for oxycontin and the mess from Purdue Pharma and the opioid industry. That industry, dont worry, they are still making a ton of money, even after the Johnson Johnson lawsuit. 40,000 people dead a year alone from that addiction for profit business. Then we look at the biggest one, which is by far the biggest one, the 747. We look at the tobacco industry. 450,000 people dead a year for the past 50 years, an industry that lied to the American People for almost a century, that said in 1999 that tobacco was not addictive. They said that in 1999. Not 18 99, 1999. Tobacco did not kill many people until 50 or 100 years ago. That is when the lung cancer incidents happened. When big tobacco took over, went before it was an occasional thing used in a pipe, did not have all the additives. They took a plant, tobacco, that had been used for thousands of years by many cultures. It was kind of an irritant, but not killing the amount of people it does today worldwide. Big tobacco took that and turned it the deadliest weapon mankind has ever produced. I look around and wake up and look at the one that is about to be the fourth one, our friend marijuana. Thats right. Thats what i am concerned about. I founded a group called sam, smart approaches to marijuana, with former congressman patrick kennedy, not because i thought marijuana was killing more people than tobacco, but because there was kind of no one else doing it. I saw a couple of years ago that the addiction for profit industry was starting up again for marijuana, taking what is called just a plant by the way, poison ivy is just a plant too. Do not think that just a plant is ok. A lot of plants, you do not want to ingest including hemlock and a lot of other things. But we see the marijuana plant being used for a long time, but now we see an industry around it. We see an industry hes right. Kevin thank you, Surgeon General. Jerome adams. Lets thank him for his leadership. [applause] kevin i am going to shut up in a minute, because we are here to see jerome adams. I want to talk about the great work he did yesterday, which was the most difficult policy development from the Surgeon Generals office in my lifetime. Since 1982, and what happened yesterday was historic. I want to finish this thread and introduce the Surgeon General. An industry that took a plant and is basically now modifying it to its benefit, that relies on addiction for profit, like tobacco, alcohol, and pharmaceuticals. What happens when an industry takes over something is that more people die. More people are dying from tobacco and alcohol than heroin, not because they are more harmful than heroin one to one. If you had a gun to your head and were given a vial of heroin or a cigarette, i would probably pick the cigarette. But to society, tobacco is much more harmful because it kills 10 times as many people, costs 10 times as much money in social costs. When an industry takes over and produces what we see the Marijuana Industry is producing today, 99 concentrate, 77 gummy bears, we think that is for the occasional adult user . We have heard that story before. We heard it with the candy cigarettes. We heard it before with the alcopops. We heard it before with the formulated opioids that were supposed to be for people with very severe pain, but in reality the average person was getting 350 pills every time they went to the pharmacy . We have heard this before because this is what we call the addiction for profit industry. So i do not people to go to prison for marijuana. Let me be clear. I do not to saddle someone with a criminal record because they made a mistake and could not hire a good lawyer, and because of the color of their skin, they got caught up in the criminal Justice System, but to tell me that the answer to that systemic, big problem is to commercialize a new substance of which, by the way, the research we talk about when we talk about the harms of marijuana, psychosis, schizophrenia, reduction in iq, that is done on marijuana that was 10 or less potent. We are only beginning to find out what the 99 potent stuff actually does. When i look at Society Today and see there are 10 times more daily users of marijuana in this country among americans 12 and older, 9 million today, 900,000 in 1992, i see a new industry that is laughing all the way to the bank, pretending to be social justice advocates while in reality the big secret is the pot industry is basically 99 white, rich, coming from corporate america, trying to get rich again. I ask you all to look into who is behind the Marijuana Industry. You do the research yourself. You are going to find familiar players, people like phillip morris. You are going to find the largest alcohol industry conglomerate, constellation brands, involved. Youre going to find them involved because this is their new product line. It may not be cool to talk about marijuana right now in the midst of the Opioid Crisis and the midst of stimulants, which is a huge issue. In our country, every time we have had an Opioid Crisis, it has been followed by a stimulant crisis. You look at the numbers with methamphetamine and cocaine around the country, and it is scary. It looks like the Opioid Crisis in the early 2000s, when we were getting the precursors. I am very worried about the stimulants. But lets not take our eye off this benign plant that is not a plant, that has been genetically bred to be a lot more harmful. I will leave you with this. I had someone the other day tell me marijuana was not addictive. I asked them how they knew that. Why do you think marijuana as not addictive . The 16yearold said, i know marijuana is not addictive because i use it every single day. [laughter] kevin that is the misinformation we are led with. I want to introduce the Surgeon General, and i want to thank general adams for the leadership that he and his department of hhs and secretary a czar did yesterday by talking by issuing the first Surgeon General advisory on marijuana since 1982, to warn americans, especially pregnant women and young people, but really all americans, that this is a growing problem. We may not have the industry influence and the lobbyists, but we have truth, history. In the long arc of history, they are going to say, what were they thinking, pot gummy bears . What were they thinking, 99 potency . Like i say to my parents, smoking on airplanes, what were you thinking . Smoking in the hospital, what were you thinking . Doctors smoking. Doctors selling it. Doctors advertising it, what was your generation, the baby boomers, what in the world were you thinking . Our kids and grandkids are going to say the same thing to us. Surgeon general . [applause] mr. Adams good morning, everyone. Thank you for giving me the opportunity to come in and address all of you. I cant tell you how honored i am to be in front of each and every one of you. I am going to tell you why i am honored, but first, i have to tell you, kevin gave me a promotion. I am neither a surgeon nor a general. I am an anesthesiologist trained in acute and chronic pain management. 25 years ago in middle school in medical school, they told me opioids were nonaddictive and safe. They told me i was bad if i did not prescribe them. So i have lived through this. I have seen this evolve over the years. As kevin mentioned, i dont want to see this same play all over again when it comes to other dangerous substances. I am also not a general. I am a vice admiral in the United States Public Service mission corps. [applause] mr. Adams thank you. Rolling stone yesterday identified me as the attorney general. I am not the attorney general either. If youll have questions for him, please do not give them to me. Surgeon general, not attorney general. But my most important accolade is not my m. D. , my mph, my vice admiral, it is dad. I am a database 15, a 13, and a nineyearold. [applause] dr. Adams thank you for that. For the third year in a row, Life Expectancy is going down. Raise your hand if you have schoolage kids. We represent the first generation of parents in 50 years who cannot look their kids in the eye right now and say, you are going to live a longer life than what i am going to live. One of the biggest reasons for that, suicide has now popped into the top 10 in terms of causes of death. Overdoses, as you all know, are a leading cause of death. These deaths of despair, in many cases, start with a common pathway, unrecognized, untreated trauma, Mental Health issues that are again unrecognized and untreated and then lead into selfmedication, with an array of products. It could be alcohol, nicotine, marijuana, an array of products, but then it ultimately leads to people who are not getting the help they need to deal with their Substance Abuse disorders. I want to say first of all, congratulations to each of you in this audience in recovery. Raise your hand if you are in recovery. [cheers and applause] dr. Adams raise your hand in recovery and leave it up. Raise your hand if you smoked pot while you were under the age of 25. Hold on. Im sorry, ive got to do this. Put your hands down. Ive got to get this on tape. [laughter] dr. Adams i am Surgeon General jerome adams, and i am here with a recovery audience, and i am going to ask the unanswered question. Raise your hand if you are in recovery. Now keep your hand up or raise your hand if you smoked marijuana before the age of 25. See how many hands stayed up . Almost every single one. It is critically important that we know marijuana has a unique impact on the developing brain. A can prime your brain for addition to other substances it can prime your brain for addiction to other substances. Thank you all for that. [applause] dr. Adams so, my personal twitter account is jeromeadamsmd. I get more real on my personal account. In a tweet this morning, i was describing my week. On tuesday, my son called me from the bathroom and said, dad, somebody is trying to sell me marijuana, what do i do . Thats tuesday. Wednesday, my brother went to court for crimes related to his drug use, trying to get into recovery. His pathway started with unrecognized Mental Health issues that he self medicated with marijuana and then went to a party and someone gave him a pill, and that rapidly led to heroin usage. That was tuesday and wednesday. Thursday, i released a Surgeon Generals advisory saying pregnant women and young people should not use marijuana, and everyone said i was fear mongering. [applause] dr. Adams but this is my lived experience in addition to where the science is taking us. I want you to understand this is not fear mongering. I hope that whatever your feelings are on marijuana and adult usage, and ive got some strong feelings about that too from a Public Health point of view, but i hope we can all agree that no young person, no pregnant woman, should be using marijuana. [applause] dr. Adams that is really what my advisory is all about. Kevin mentioned this, and wilson too. Here he is the expert in this. In 1985, strains of marijuana worse of marijuana were tested at around 4 thc. Just so everyone is on the same page, thc is the component of marijuana that causes euphoria, intoxication, and most of the documented harmful effects including addiction. 4 in 1995. In 2014, the strains were up to 14 , three times as strong. That was in 2014. The average dispensary now is putting out marijuana in the 20 range of thc, five times more potent than the strains people think of when they think of marijuana. As i said yesterday, folks were talking about it on gma, on cnn, npr i said this yesterday, this aint your mamas marijuana. [laughter] dr. Adams we are talking 5 stronger thc content. 25 in the platform. And you look at oils, waxes, shatter, people vaping this, and they can get 75 , 80 , 90 thc delivery to the brain. This is like the difference between me saying i am ok with you having a 12 ounce light beer or a glass of wine to go to sleep, and me saying i am ok with you tricking a pint of vodka to go to sleep. That is the difference in potency. It is important that we recognize we are talking about a fundamentally different product that is particularly dangerous to the developing brain. Again, i dont want to take up too much time other than to tell you all, my brother, my uncle, many people in my family are walking the same path you all have walked and you are walking right now. I am not some government talking head spouting reefer madness. I am talking about my lived experience, my familys lived experience. Im talking about a father whose kids are genetically at risk for addiction. Im talking about things i would want any other parent to know if they wanted to protect their children. And asking you to help me again, regardless of how you feel about adult use, to help me spread the word that no pregnant woman and no young person should be using this, especially potent marijuana that is out there. Their future is too valuable. Youth use,t when they are more likely to drop out of high school, we have seen iq decline. That Emergency Department admissions have gone up for adolescents for overdoses of marijuana, for psychosis, it increases your chance of schizophrenia, and it increases social consequences. I dont want to get too far off the tangent on social justice, but ive been around the country and many folks are patting themselves on the back for driving down adult arrest rates and not noticing the fact that youth arrest rates are going up. In every state, marijuana is still illegal under 18. We are not solving social justice issues, we are shifting social justice issues. We are seeing the disparity play out among young people. If you have racist policies and bias, you will still have racist policies and bias after you legalize. They are shipping them down to 17 and 15 16 and 15yearolds. We have to deal with the underlying root causes of discrimination when it comes to addressing social justice issues. In every minority community, community of color across the United States, we already have a liquor store and a smoke show. I do see how adding a Marijuana Dispensary will help solve the problems those communities face. So please, for young people and pregnant women, help me spread the message and know that as Surgeon General of the United States, you have no bigger advocate in washington, d. C. Than me for what you do each and every day and i am praying my brother gets into one of the recovery houses that you all health you all help lift up. We know theres not enough recovery out there. [applause] dr. Adams thank you. I ask you pray for him and my family and keep doing what you are doing. There is not enough treatment, there is not enough recovery out there. We know this, and i am leaning into this issue. For anyone who thinks i am taking my eye off the price, i am widening my aperture and seeing the big picture. We need to stop using a rifle and pick off one part of the problem and have it pop up in another place. The big picture starts with prevention and educating people on the importance of diagnosing and treating Mental Health issues. It leads into a discussion about all of the different pathways that people end up needing treatment. And it involves getting people into treatment and making sure there is access to naloxone because you cant get people treatment if they are dead. Making sure we continue to talk about naloxone. It goes into making sure that treatment is effective and evidencebased and that medication assistance is available to more people. Then it leads into recovery. You are not magically fixed after 30 days of treatment. We have to help people understand recovery is a lifetime. And it is a lifestyle. It requires support. And we need to make sure people can transition successfully from using to treatment to a lifetime of recovery and social supports they need to get back and become productive and successful members of society and of their families again. Thank you for letting me riff a little bit. I hope you are patient with me and understand i am passionate about this. I hope you can feel it and understand i am not up here just spouting off because i want to demonize you all or hurt peoples access to marijuana. I am here talking because i have lived it, i have seen it and i , want people to learn from your mistakes and your successes. I want people to stop stigmatizing people with Substance Use disorder no matter what their substance of choice is. And i want us to make sure our kids have the best chance at a successful future. Thanks again. [applause] thank you so much, Surgeon General. Great to see you. Thank you for coming. We have two more speakers. And then we will open it up for questions so get your questions ready. Someone got the short straw. Being after dr. Adams. I just want to say how much i appreciate the Surgeon General and to point out that when he put out an advisory on naloxone encouraging people to carry naloxone, it had a big impact on naloxone and on overdoses. His use of the position has been really remarkable for Public Health. I dont know if this is going to work, hold on. Can you see anything . There we go. Ok. My name is Josh Sharfstein from johns hopkins. I am a professor there. Im so appreciative of the chance to be here with you all and i have such a deep respect about what you do every day helping so many other people in the midst of this crisis. Im going to talk about the new research on opioid addiction. The good news and the bad news. Sixgoing to briefly mention studies that were published in the last year i thought you might be interested in. Let me also say that at johns hopkins, we have a special program called the American Health initiative where we give full scholarships plus 10,000 for people who want to get a masters of Public Health degree in the field of addiction and violence and a few other fields. If any of you are interested, you should go to American Healths website. All of the information is there as well as email addresses about how you can find out about requirements. You do not have to move to baltimore. You can do it from where you are. If anybody here is interested, we would love to have people involved. Jhu. Edu. Rican health were going to talk about three studies on treatment and three studies on harm reduction. The first one on treatment was published in september 2019. It is not yet september. 19 but they released the study early. The study by researchers at our school and elsewhere shows that when people with opioid addiction were taking morphine, helptaking it, it not only them for opioid addiction but improve care for other illnesses they had including seizures, illnesses, and other as we have talked about, people ,ie of many conditions including chronic illnesses actually having good treatment , helps them with other illnesses and they are less likely to die of seizures and depression. Then there is bad news, which is a study out of West Virginia shows that fewer than one in 10 people who had a nonfatal overdose of opioid actually got treated with this, so 90 plus are not getting this. I am a pediatrician but my wife is an addiction medicine doctor. When we were in medical school, i thought my girlfriend is a saint, shes going to take care of patients and all of her patients are going to die. I thought it was hopeless. I thought as a pediatrician i be i would be getting all kinds of presence from my patience because i be such a great pediatrician. Fastforward and i guess i wasnt that good of a pediatrician. My wife supports them in treatment and recovery to take people from the brink of death and homelessness and hiv. She helps them get into treatment. So many of her patients do so well on medication, not on medication. You come to our house around the holidays and they are so appreciative of what she has done. She gives so much back to them. So few people have access to that kind of treatment in the u. S. And that is not good news. Why is it so few people can get access to medication . Another study came out about the news Media Coverage about medication and how it is wrong. More frequently, it sends the message that methadone is a form of addiction and it is not a form of addiction. Addiction requires use despite harmful consequences. It means someones life is falling away from them. When people are in treatment, even with medication, they are getting their life back, reconnecting with their family, living independently, doing what they want to do with their life. They are not in the throes of addiction, they are in recovery and remission. That misunderstanding is prevalent in the news media and keeps a lot of people from getting care that could save their lives. Quickly, three new studies on harm reduction. All of these were published in the last 12 months. Naloxone, we have heard about naloxone, it can save so many lives. A recent study in pennsylvania was published that shows that more than half of the pharmacies in pennsylvania did not carry naloxone at all. Not only that, only 64 of pharmacists knew there was a Standing Order where people could just go in and get naloxone. A third of them didnt even know how to dispense them. That is a huge risk even how important it is to have rescue medicine around if people are using drugs. We still need to get the word out even to pharmacies about naloxone. Here is some more bad news. Syringe Exchange Programs are effective in reducing hiv and helping people get into treatment. That is the good news. Recently there is a trend for syringe Exchange Programs to start medications and transition people into recovery and that has been very successful for places like burlington, vermont. But other places are shutting down syringe Exchange Programs mostly because of misinformation. They are doing it in a way that is very stigmatizing to the people who are using it. One program in charleston, was virginia, there was a Research Study that found when they closed the Syringe Exchange, people shared syringe is more syringes more and they were likely to get more hiv testing. One participant says i have been tested four times this year and i know a couple of people who have hiv and im afraid i am going to contract it. They had no way to get safe needles. These individuals using drugs often want to stop and they are trying to find a pathway to success. Keeping them alive and healthy until he can do that, until they can make a connection with a peer is critical. When a Syringe Exchange program is shut down, that puts more people in harms way. Lastly, fentanyl is killing americans more than any other opioid and increasingly contaminating cocaine and methamphetamine so people are dying of fentanyl without knowing it is in the drugs they are using. There is research to suggest that if you help people test the drugs, they are very interested in knowing whether it contains fentanyl. Having the testing strips an opportunity to make a connection and a step on the path to getting treatment and recovery. 90 of people who use drugs intravenously were interested in testing, and the greatest interest was in people who themselves had overdosed or witnessed an overdose. People are really interested in what they can do to keep alive until they can get into effective treatment. Those are my six updates and im looking forward to the rest of the panel, thank you. [applause] last but not least, we have dr. Westley clark. [applause] dr. Clark thank you, is a pleasure to be here. This is i think my 15th oxford house session. [applause] dr. Clark i want to talk less about research per se and more about Substance Abuse confidentiality. Before i start, i want you all to repeat after me 263. 263. Dr. Clark i will explain that shortly. I want to thank the women in the audience, especially the ones concerned about the use of marijuana. Data shows that pregnant women, once they know they are pregnant, they stop marijuana substantially. 2018, by the second trimester, it drops to 2. 3 percent, and the third trimester, 1. 7 . The Public Health message is getting through to woman and of course it should be zero, that the data shows that the Public Health message is getting through and women listen. I do know about the men, but the women listen. [laughter] dr. Clark key issues. You heard speakers repeat over and over again about the importance of treatment. One of the things that encourages people to get in treatment is the ability to have your treatment records subject to your decision as to who gets it. That is changing. For the first time in the history of the federal rules that protect you, the federal government wants to change that. Last week, they released two rules, one to liberalize the people who have access. I call this 263, for the first time it is saying if you commit a serious crime including violence and child abuse and Drug Trafficking, the court can issue an order to go through your records. Historically, its as if you have committed a Violent Crime and child abuse, the court can go through your records. Now they want to add Drug Trafficking. They dont define what that is. Has anyone here ever sold or bought marijuana or opioids or any other Illegal Drugs . [laughter] dr. Clark by and large a lot of you were involved in Drug Trafficking. You should be able to go to treatment and say i want to stop Drug Trafficking because i need to clean up my act. For the first time, the government is saying, we want to know who you are. Not only do we want to know who you are, we want to know who your providers are, and who your friends and relatives are. We want to know if you have committed a serious crime or trafficking at or from a Substance Abuse treatment program. These are proposed rulemakings and you have 30 days to respond to that. Hhs believes reverting to the previous language is necessary to deter Drug Trafficking. The key issue is, if we want to encourage people to go to treatment, what we should do is allow them to go to treatment and talk about the things that caused them to have a Substance Abuse problem. Associated with this change there is legislation, and to a company that legislation, i have a letter from 22 state attorneys general that are in favor of substantially changing it. Does anybody know what a state attorney generals job is . What is it . Prosecution. When they want to get into your personal records, what do you think their purpose is . My job is to prosecute offenders, it is illegal to use drugs, that makes you an offender, so i want to be able to find that information out. When your personal information becomes subject to disclosure to anybody and every buddy, they can find that information out. A miranda warning that says the rule against selfincrimination anything you can and say will be used against you. We are discouraging people to go from professional treatment and to go some place like oxford house, which is a good thing. [applause] dr. Clark i encourage you to understand my five minutes are up but the most important thing is to be aware that we are moving away from the war on drugs to the war on patients. And that i find objectionable. If you want to do with the epidemic of drugs, we have to deal with the people, allow people to go into treatment and feel comfortable and safe. Again, oxford house does that. Oxford house is more than just housing, it is recovery. I would like to stress that. I know you mentioned it is important for housing, but the larger issue is it facilitates recovery, and it uses the proximity of people who are interested in recovery to achieve that. It gives them a safe place to be there. Back to the federal rules. The federal rules you should be aware of are 263. Can i hear you say that . 263 dr. Clark make sure you tell people not to support 263. [applause] excellent. Thank you to all of the Panel Members for that brief synopsis. We have got about 15 minutes left. We have a floor microphone here for your questions. Please come up and ask a question. If you want to address the question to one of the Panel Members, just say, or you can address it to everyone on the panel. Hello, i am charles, a person in recovery. My question is about methadone and other drugs. I was given this inside an inpatient detox, and on my way out, i was offered it to go to the Doctors Clinic and he would continue to write me this prescription. My question about this is, why is this not considered addiction for profit . Its the same pharmaceutical companies that are making this [applause] my personal addiction, and the young man i smoked marijuana and did cocaine. I got into a car accident and a group of doctors said you need this, it overprescribed oxycontin, which led to a heroin addiction. It nearly killed me. I have been sober over two years now. [applause] because of the 12 steps through Alcoholics Anonymous and the Recovery Support system i have at oxford house, i declined the offer to go Doctors Clinic and take this. I know that medically assisted treatment is a big deal right now in oxford house, but right now i see a group of doctors once again telling me you need this. It can be done without that and i dont understand why we are pushing this and not saying were going to do this for x amount of time and work with sponsors and do these things, instead of saying for the rest of your life we will keep you on this product. Because it is expensive. When mr. Kelly spoke earlier, he said without this, we are saving 10,000 a person, millions of dollars a person. And when mr. Surgeon general spoke, he said 30 years ago they told me opiates were ok and now they are telling me they are bad. How do we know that 30 years from now something is not going to stand up there and say they told me [applause] they told me methadone was ok, and now it is not. Thank you for your question. [applause] i think its a great question. It boils down to strength of recovery. No listen up. If you have an impressively good recovery and you are working the program and doing the 12 steps and doing commitments and participating actively, that can be the means to the end, the means to the recovery. Every person is an individual. We have to look at each person individually. We have to consider each persons situation individually. But if you look at the general population, everybody with addictive disease you know as well as i do, how many of them are as committed as all of you are . There are a good portion of them if not the majority who are not as committed, who are not participating every day, who come into my office and when i say to them, are you going to the program, working the program, doing the steps . They tell me, all that does is make me want to use. Or they tell me, i am going to the meetings, when really what they mean is that they are across the street and they looked over and there was a meeting going on. Or they sat in back, they arrived late and left early, they never talked to anyone or raised their hand or participated. These are the people coming into my office and they represent the majority of folks trying to get into recovery. So when i am working with them and i look at the general statistics, which we are applying to the whole group, and the statistics tell me that their chances of living are going to double over everybody else if they stay on the medication, im going to promote medication in general. But that doesnt mean im not going to look at an individual and say my god, youre working a good program and you are perfect to taper this medication off. That is fine. But for the general individual out there, where you went to the Detox Program and they try to answer you immediately into Outpatient Care with medication assisted treatment, i think that is a pretty fair way to start. I think it is a pretty fair way to continue for the majority of folks out there. Not to say that applies to each of you individually but it is saying in general the statistics bear that out. [applause] i think weve got about five minutes left. My name is william. I am from oregon. Anybody here have a vape . Hold it up. I want to see. I want to ask your opinion on vaping. Because nicotine kills people, so smoking is terrible. I got off smoking but i vape now. I wanted to hear your opinion on this. Im going to answer this from a research perspective. We havent learned enough about vaping. Each device you carry is different from one another. Does the device she carries work the same as yours i dont know. , there is almost no regulation of these products. Were trying to increase the research on these understand who on these to understand who they can benefit, because certainly helping somebody quit burned tobacco is a good thing. If the only way you can do that is through a vaporizing device, that seems a fair tradeoff, but we dont have enough research to know who it will help, who it wont help. Are flavorings good for you . Probably some of them not so good, i dont want red pepper flavoring inhaled in my lungs and im not sure that gummy bear or orange flavor are so great for teenagers. There are a lot of things we need to learn. Safer than smoking at this point . It is looking like a steamed product, which is safer from a burned product, but it is a complicated issue. Some people use it as a crutch to keep smoking longer term. Thank you. Thank you for the question. A few minutes left. My name is luke and i am from kansas. I am an addict in recovery. I was an Opiate Addict for 4. 5 years and almost of my life. And it almost took my life. My question is for the gentleman on the far right. Have you yourself ever personally taken methadone . No . How can you push a substance that has a chemical dependency with it despite if a person works the program, that drug will create a chemical dependency, i know firsthand. The question is first of all, let me back up. I dont prescribe methadone but i will answer the question. All of these substances that we talk about in here, marijuana, cocaine, methadone, vicodin, percocet, all of them, carry with them a physiological dependence possibility. If i take them a regular basis each day and suddenly stop i will experience withdrawal. If i take it each day, i will find gradually over the course of the first few weeks that if i am taking the same dose, the effects of the drug radically gradually diminished to some point where they end up at a baseline. That is typical. Remember that what we are doing is we are providing suboxone or methadone i will probably say this to your surprise we are replacing one drug with another. I am not surprised. But remember that what we are doing, all of us, when you start addictive Substance Use, you are starting it because you are treating an underlying condition. The discomfort you had originally that led you to find that these drugs made you feel better. For everybody out there who used heroin and got hooked, there were some people who did not get hooked. What differentiates those people . The people who got hooked had addictive disease but they had that before they used the drug. So when we are giving suboxone or methadone, we are giving a drug to treat the underlying disease, the addictive disease, and we are doing it with a medication that is less likely to cause harm and is less likely to lead to more mortality than to morbidity and mortality than the drugs the person had previously chosen to use to treat how they felt. [applause] thank you for the question. One more question. Hi, i am chelsea from texas. My mom was in a bad car accident and she was low income so she got medicaid and her doctors prescribed her vicodin. Toward the end of her life, doctors and medicaid did not want to fund or pay for her vicodin, so eventually she resorted to heroin. What are we going to do when medicaid stopped paying for vicodin or oxycodone for people who are in severe pain . And you dont have to answer this question. I wasnt able to get into treatment until cps got into my life. If you ask for help from doctors, will they report you to cps . Would you get punished for asking for help . Indeed, you do. And thats one of the problems. In six states, the moment you are pregnant, any Substance Use makes you reportable. It discourages pregnant women from going into treatment. This is part of the problem. People are using treatment as a way to identify people who use and that is not a good thing. This is also a lot of these questions but especially this last one, thank you where we need your voices here in washington, d. C. And your state capitals. This maybe controversial, dont take it the wrong way, you need to stop being anonymous. [applause] i dont mean that you need to out your fellow meeting members when youre in public, when you go to the bakery. Im not talking about that. Im talking about your voices collectively. Because all the things were talking about here, most of the things we brought up, the great things that dr. Clarke and others have brought up, these are underlying issues that lawmakers have no clue about. I have worked for both parties and they have no clue. There are dealing with 100 other issues, staffers dont have a lot of time in less it is on the front page of the local paper. They could not care less unless it is a Campaign Issue they have to run on. They are not experts and you are and the people on this panel are. We need your voices out there, you need to write your legislators and show up in their offices. Right now the impression is that half of Congress Things that legislators and show up in their thinks that most people dont need health care and medicaid provided, that Addiction Treatment maybe should be involved, it took our country 150 years to realize the brain was a natural part of the body. In other words, health care was not just physical health care, but things going on up here. It took a long time because we were anonymous about it. We need your voices. Thank you. [applause] we are out of time, but i want to honor these last questions. Could you please just ask your question, we can answer, but we can think about those questions as well. I am an addict of 20 years. I got clean without any treatment. Its not a question, but do you guys really reach out in the field to talk to the people out there . Marijuana gets talked about. I heard marijuana described as a horrible thing when ive heard it treated cancer. The only difference between the two is you guys dont control the Marijuana Industry but you do control the [indiscernible] industry. Thats the difference i see. Thank you for the comment. When it comes to the Mental Health issues, ive noticed a growing number of people that were being misdiagnosed, and mostly as bipolar, and they are given Prescription Medications that make them at the beginning crazier than they were in the first place. And then once they become accustomed to the medication, they appear normal to us. How do we change that in reduce that and reduce the number of misdiagnosis and increase the educational part through parenting and our School Systems so that people know not to look for the things that are wrong but to help change them . Thank you for the question. I am an alcoholic. I first raised my hand after dr. Compton had spoken and im going to thank him for his remarks. But then i was going to remark that i had heard him use the word drug and opioid and numerous other words in that category ever so many times. And opioids had never once threatened my and i think i can speak for mr. Malloy as well, bourbon whiskey threatened our lives. And it was never mentioned i might be answering my question is it because there is an iaa niaa ande there is your institute does strict we focus on drugs . If not, why was there not a remark about alcohol . Thank you. Last one. I am calling. I am colleen. I think that oxford houses in general are a great opportunity to educate and i dont know why we dont have people that come and teach us how to use naloxone, to make sure its not expired, to make sure we have enough and get everyone certified to use it. I think that would be really beneficial. I also think i havent received a survey being here and i hear a lot of statistics about drug addicts and alcohol abusers. I am one of those people and i have never signed up for a survey or handed an Anonymous Survey and we have 1700 people right here. Why dont we have a survey asking us the same questions so we can be part of the statistics we hear every time we come to these things . [applause] thank you so much. Thank you for all the questions and thank you for coming. Lets thank the panel also. Have a great conference. [applause] good afternoon, i am a person and longterm recovery. I hail from the great state of hawaii. [applause] oxford house is alive and well and strong on the island of oahu. Ive been with oxford house since 1992 and employed since 1993. It is no small task to be up here. We would like to welcome our panelists. Starting with dan from oxford house, state coordinator from oklahoma. [applause] curtis taylor, oxford house alumni from north carolina. Michael, oxford house alumni, outreach in florida. [applause] jason wilson, oxford house resident and reentry coordinator, north carolina. Jesse. What did i say . Jesse. And ann cleveland, oxford house alumni. [applause] over three qer
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