Including video and differing points of view. Information is on the website, student can start work. Cap next, a look at the Opioid Epidemic in Substance AbuseRecovery Efforts we hear from general doctor jerome along with medical doctors and drug addiction researchers. Posted by oxford house which relies on housing for people recovering from addiction. We are about to get into the next session. Get to your seats. This is our panel on addiction, what to do. In just a second, i will read exactly as he wrote it. Its newsworthy. Get the latest information about the Addiction Recovery research. Years ago, i kept trying to convince doctor clark that the best way to have any kind of research is to put in a year end track people as they come in. Doctor clark was using, his suggestion my attitude was our republican conservatism and not very american. [laughter] however, today, as years have passed, i have a thing on my wrist called a fitbit that takes track of every step i take, i look at people at this convention and i see thoughts of things, everywhere else, it seems to me at some. Mark, we need to really become a tracking mechanism for folks who do research so people will know exactly what happened if you move in, get involved in the democracy, learn the kind of selfreliance and selfrespect that comes from this. Will probably stay clean and sober forever. Having said all that, this session has some wonderful experts. Used to be in the energy and Commerce Committee way back in the days that i was up there. He was called waxman. [laughter] week republicans is to figure out how we will change when they want. We never succeeded very much. Fortunately, he was responsible in helping us in expansion because of the antidrug abuse act in 1988. With fact, let me turn it over to the moderator and john kelly, keep this panel going. [applause] thank you. My name is john kelly. Many of you probably saw me on the last talk. Im a researcher and inclination from the hospital and medical school in boston. Im happy to be here. Paul tasked me with the moderator rock this morning. I will chime in as well when i feel appropriate. Weve got such an expert, to be up here on the stage with all these fantastic experts. What i thought we would do to begin with, i want to get your questions, i think in many ways thats what we all want to get, what is on your mind. I want to make sure we leave enough time. Many of your thoughts and questions about whats going on and what we need more research on. The pressing issues you are facing. What i have suggested to the panel to begin with is for each panel member to come up and talk seven minutes, tell you who they are and give one or two new newsworthy tidbits on research and addiction. Any volunteers to start . Thank you, wilson. [applause] good morning. On the deputy director. We are the folks who do all sorts of Research Related to drug abuse and addiction. Rather want to explore how drugs affect the brain and perhaps the most relevant to this group, will affect recovery is reflected in brain recovery itself. Weve done a lot of research to look at how oxford has impacted lives of so many people, funded work by colleagues to show how effective it can be in supporting peoples lives and allowing them to enter recovery for the longterm. Thats really what this is all about. Partly help not just save lives but turned their lives around and change their lives in the local . Thats what we all hope and thats what our research is about. While preventing them from we can do to help people exit these devastating conditions. I have just a couple of things to check this morning after those introductory remarks. First, i want to remind us that its all about housing and housing is essential to recovery. I was struck when art director visited a series of treatment programs recently and in discussions with the people in treatment, one of the issues they brought up was how difficult it was to recover without stable housing that provided support where they are changing their lives. Most people end up going back to the communities where they came from within same risks and problems exist for them. Oxford house can provide a respite for that in turn your life around in a safe environment. In addition to this practical issue, just having a place to live is not a given for many people early in recovery beginning to make that transition. Housing is essential to the recovery process. Its something we know from all of you and much of our research. To address the upgrade crisis, that has been the focus in the last more than a few years, we had extra funding and support to do Additional Research in this area recently. We seek recovery report is key. Artery engaged Recovery Support personnel in screening and brief intervention . Want our primary care doctors to ask, are you accusing . What substance are you using . If you have a problem, how can i get you into treatment . Is not just that doctors or nurses or Health Practitioners doing that, its when they engage with the Recovery Support that is the most prominent. Better the models we are trying to study. How can we help people think that transition . People who show up in healthcare, the often white are not ready yet. The support can make a difference in moving along in the introductory. No helping people enter recovery when they overdosed is a key challenge. I kind of thought in my naive way when you overdosed and went we rescued you because we are so grateful to have a medication that can save peoples lives, when they have overdosed, that people would want recovery at that moment. They would want to enter treatment because they nearly died. Turns out most people in that setting are mostly thinking, have woken up, now im in withdrawal, i want to go back and get high. The next day, there may be an opportunity to reach out to them. Thats what our researchers are doing now. Can we use. Support to reach up the next day or the day after when people make be ready and willing to hear the message about the value of recovery and opportunity to turn their lives around for programs like these . So thats number two, engaging in recovery at the Research Enterprise in the upgrade crisis right now. The third is a specific Research Study that i read about that looked at what happens longterm when we start people on medication. We did a study not too long ago look at can we use this to help people who are recovering from prescription opioid addiction . The answer was yes, the shortterm wasnt as good as longterm but they did longterm followup four years later. How are they doing . Or predicts people being obstinate and stopping in recovery for years later . The number one predictor was those still on medications. That didnt shock me. I know medication can be very helpful for people struggling with opioid use and addiction. What was really important was the number two predictor, engagement in 12 separate recovery programs. It turned out to be mutually exclusive. Doesnt mean the medication helps him promote the combination of the tube was essential. They added to one another, they didnt defeat one another but by adding them together, we have a bigger impact. I think that lesson is super important and its ignored by way too many. The last thing, i need your help. I identified a couple of key questions i think are important through recovery research, can we use. Support and engaging pc people in the Healthcare System . Can we use. Support to help people who have recently had an overdose . I bet there are a lot of questions you have that need to be answered. Either narcan devices in these houses . I see a bunch of nodding heads and im really pleased. You will know a lot of people in the community. You will run into people who need their lives saved. I cant do Recovery Management and support on this people. But we can when people have their lives saved. We have the opportunity to turn their lives around. I would like to hear your ideas for research support. We find people to do research all across the country and we want your ideas. Not sure whether im allowed to take questions, will definitely turn to you for observations. Thank you so much. [applause] thank you. One thing i forgot to mention, doctor adams, the general will join us around 10 30 a. M. So we can look forward to that. I should be about 30 minutes. When he comes in, well have him give a five to seven minute introduction and talk a bit in the same way. Who wants to go next . [applause] good morning. Im in rhode island, i have a private practice there in addiction. What i would like to focus on is the importance of recovery. The important things within recovery is that its not useful unless you are alive to experience it. The number one leading cause of death among patients in recove recovery, nobody thinks about. Ill come to these meetings thinking we are being successful when i can get into the hotel without coming through cloud of smoke and vapor. Which at this time, i cant do. So if you are going to captiva point where you can experience recovery for as long as you possibly can, we will address smoking and weve got to start looking at that as being a key issue among folks in recovery without talking about heroin or cocaine or marijuana look at the number one leading cause of mortality. We are here in the middle of the newspapers addresses being the opioid crisis. Some are between 70 and 80 feeding 80000 people lost last year. We lost 500,000 duke to smoking last year. Weve lost about 500,000 people a year due to smoking each year for the past five ten 15 years. So its not news. Because its not news, the same things happening here year after year, we are essentially having this experience where 747 crashing all around us and the news is about the small car crash taking place across town. That is the leading story. We have to focus on the 740 sevens. Apologies to boeing for the example. The key here is to look at where the deaths are actually taking place. Number two, behind cigarette smoking and sleeping and eating smoking, alcohol. Still the second leading cause of death among folks with addictive disease. Opioids are way in the background. What we need to focus on still is tobacco and alcohol. I cannot say that enough because that is the key to solving the problem of the mortality rate we have with addictive disease. Having said that, since you expect me to Say Something about opioids, lets Say Something about it. 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, 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 an individual with opioid use disorder, if i have 100 patients in all i do is say hi and smile at them and send them off to meetings about five of them will die every year. Of every 100, i will lose five figure if i only use psychotherapy plus 12 step. If i add medication to that, i save for people figure out of those 100. The number of deaths caused 51 51021 and 100. For either one, i save four out of 100 people a year. Then comes the question with new research, the question is, how long do we keep them on medication . The answer, forever. This is an anti hypertensive for people with hyper intensive disease. Insulin for people with diabetes. If you come off it even years later, the mortality rate rises from 100 to about 1. 7 and hundred. Almost double the death rate by taking somebody off morphine or methadone. Theres no point in taking them off unless the only reason for wanting to come off is, i dont want to be on it anymore. Thats a terrible reason. I dont want to be on it anymore, i dont want to be on antihypertensive anymore diabetics dont want to be on insulin anymore. Tough. Keep taking it. That will make it less likely that you die. Thats a pretty good reason in my book. Bottom line, take the medication and then do Everything Else you need to do to have a good recovery. Quit smoking would be number one. Number two, go to aa or na meetings. Work the program and do the steps. The key to all of this is to take care of your self. The ways of doing that are the same as they are for everybody. If you have a chronic disease, take the medication from and if youre chronic Disease State involves as it does here, 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 your self. In addition to taking care of yourself spiritually. Thank you. [applause] and kevin. [applause] thank you. As a senior policy advisor in the Obama Administration for two and a half years in National Drug policy and before that, the bush ministration. When it was okay to be bipartisan, which i hope we can bring those dates back. I miss those days. I also want to commend you for being here because one of my mentors talks about the program and 12 steps also as a modern miracle. It may not be popular on twitter, if you look at what people say about 12 step programs. Its not very popular but theres been this insidious thing about between 12 steps and medication treatment as if they are completely incompatible. We know there are many paths to recovery and they are compatible. We want to have a large enough tent to keep people alive and bring everyone in. But that you are all the living example of why people appear, its an honor to be up here with giant, im humbled to be up here. It looks more like a mantle panel. Well change that next time. We have some great women. We want to incorporate those for next time. I want to go further with us idea, from where i am coming from and it comes off of what stu just said, i cant believe we look around, at the addiction forprofit industry that sadly our country is so good at doing. Look at the alcohol industry, 90000 People Killed year, every dollar in our crawl tax cost us almost 20 more people in the criminal Justice System today for alcohol related marijuana and all other Illegal Drugs combined. Are we having fun yet . Yet, alcohol taxes or were they were during the korean war. They have a massive industry with great lobbyists have a lot more money than oxford house or other recovery groups and lasting all the way to the bank. In our other favorite industry, the opioid industry. They have said they would give i get 10 billion, which is probably a tenth or 100 of their wealth to get people off their backs with oxycontin industry. But that industry, dont worry, they are still making a ton of money even after lawsuits. We are 50, 40000 people that i get from opioids alone. Then we look at the biggest one, 747, the tobacco industry. 4,150,000 people dead a year for the past 50 years, industry that allied to the American People for almost a century that said in 1999 that tobacco was not addictive. Not 1899, 1999. If you look at the history, tobacco didnt kill people until about 100 years ago. Thats when cancer happened, when big tobacco took over when before it was kind of an occasional thing, didnt have all the additives in it. Tomato plant used thousands of years and it was kind of an irritate but it wasnt killing people. They turned into the deadliest weapon that mankind has ever produced. I look around and wake up and look at the one thats about to be a fourth one. Our friend, marijuana. Rights . [laughter] we look at, thats what i am concerned about. I found a big group called smart approaches to marijuana 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 this addiction forprofit industry starting up again for marijuana, taking a plant, poison ivy is just a plant, to so dont think just a plant means its okay. There are a lot of plans you dont want to ingest. But we see a marijuana plant being used for a long time but now we see in industry around you are right. Thank you. Lets thank him actually, for his leadership. [applause] i will shut up in a minute, i could go on all day. I do want to talk about the great work he did yesterday which was the most significant policy development marijuana from a Surgeon Generals office in my lifetime about 38 years, two or three years. 1982 and what happened yesterday was historic. I want to finish this and then i will introduce the general. An industry that took a plant and is now modifying it to its benefit that relies on addiction forprofit is like the industries we just talked about, tobacco, alcohol and pharmaceuticals. What happens when industry takes over something, more people die. More people are dying from tobacco and alcohol and heroin, not because tobacco is more harmful to one, if you have a gun to your head and you are given a cigarette for herriman, i would smoke a cigarette if i had to choose. But society, much more harmful than heroin. It kills ten times as many people in a social cost, when an industry takes is over and what we see them producing today, 99 concentrate. 70 concentrated, gummy bears and chocolates and cookies, sodas, think thats the occasional adult user. Weve heard that before. What we call the addiction forprofit industry. We do live, i do not want people to go to prison for marijuana. Let me be very clear. I dont want to sell someone with a criminal record for making a mistake and they couldnt hire a good lawyer and because of the color of the skin they got caught up in the criminal Justice System. But you tell me the answer to that systemic, big problem is to commercialize a new substance of which by the way the research that we talk about when you wek about the harms of marijuana, psychosis, Mental Illness comes schizophrenic and reduction in iq, thats done a that was 10 or less potent. We are only beginning to find out what the 99 potent stuff actually does. When i look in Society Today at the sea there are ten times more daily users of marijuana in this country, among americans 12 and older, there are 9 million today. There were 900,000 in 1992. I see a new industry that is laughing all the way to the bank and pretend to be social justice advocates while in reality you know the big secret is the pot industry basically 99 white, rich, come in from Corporate America trying to get rich again. I ask all you to look into who is behind a one industry. You do the research yourself. You will find some similar player. Youll people like philip morris. Youll find the largest alcohol industry conglomerate Constellation Brands brand andk you will find that all involved because this is the new product line. It may be declasse. May not be cool to talk about marijuana in this at all. Crisis in the midst of stimulants is a huge issue coming back now. And our country every time without all. Crisis we have been followed by a stable prices. Look at nose with methamphetamine and with cocaine around the country and its scary. Its looking like with the altered crisis looked like in the early 2000 when were getting the precursor. Im very worried about the statements as well. Lets not take our eye off this benign plant that is not a plant that is been genetically bred to be a lot more harmful. Ill leave you with this. Id so tell me the other day that marijuana wasnt addictived and asked them how they knew that. How do you think of white think theyre one is . 60 muehl, said im a one is not addictive because i use it every single day. [laughing] so folks, that is the misinformation that will lead with. I want to introduce the Surgeon General, and i want to thank general adams for the leadership that he and the department of hhs, secretary azar did yesterday by issuing annual talk about it, the first Surgeon General advisory on marijuana since 1982 to warn americans especially pregnant women and young people around all americans that this is a growing problem and we may not have industry influence and the lobbyists, which they have tons of, but we have truth. With history in the long arc of history they will say what were they thinking . Pot gummy bears. What were they thinking . 99 potency. Just like i say to my parents, smoking on airplanes, what were you thinking . Spoke at the hospitals, what were you thinking . Doctor smoking, doctor selling it, advertising it. What was your generation, the baby boomers, what in a world where you thinking . Our kids and grandkids are going to say the same thing to us. Surgeon general. [applause] will come good morning, everyone. Good morning. Thank you so much for giving me the opportunity to come in and address all of you. I cant tell you how honored i am to be a in front of each and everyone of you and going to tell a little bit why im honored but first i got to tell you, kevin gave me a promotion. Im neither a surgeon nora general. Im actually an anesthesiologist train in acute and chronic pain management. 25 years ago when i was in medical school they told me opioids were nonaddictive. He told me they were safe they told me i was a bad doctor if i didnt prescribe them. So i have lived through this. I have seen this evolved over the years, and as kevin mentioned, i dont want us to the same all over again when comes other dangerous substance. Im not a surgeon. Im an anesthesiologist. Im also not a general. On a vice admiral in the unita States Public Health Service commission force. [applause] thank you. Thank you. And Rolling Stone yesterday identified me as the attorney general. Im not the attorney general either. If you all of questions for him, lees did not give them to me. Please do not give them to me. Surgeon general, not attorney general. I most important accolade isnt my md, my miles per hour, my vice admiral. Its vad. Im a dad of the 15, 13 and nineyearoldyearold or any of you who grew up [applause] thank you for that. Because for the third year in a row Life Expectancy is going down. To put another way to , raise yr hand if you school age kids. Those of you who raise your hands can we represent the first generation of parents in 50 years who cant look the kids in the eye right now and say youre going to live a longer life than what im going to live. One of the biggest reasons for that, suicide is now popped into the top ten in terms of causes of death. Overdoses, as you all know, is a leading cause of death. Death of disparate many cases start with a common pathway. Unrecognized, untreated, trauma, Mental Health issues that are again unrecognized and untreated, that they leading to selfmedication with an array of products. Remember, it could alcohol, nicotine, marijuana, it could be an array of products, but ultimately then leads to people who are not getting the help they need to do with the Substance Abuse disorders colleges have first of all congratulation to each and everyone of you in this audience was recovery. Raise your hand if you are in recovery. [cheers and applause] now, i also want to ask you to raise your hand if youre in recovery and leave it up. Ill ask you, raise your hand if you smoke pot while you under the age of 25. Hold on, hold on. Im sorry, ive got to do this. Put your hands down. Ive got to get this on tape. Ive got to get this on tape. Im Surgeon General jerome at us and im here with her covert id is ongoing as the audience a question. Racial hand in recovery. Now keep your hand up a raise your hand if you smoke marijuana before the age of 25. See how many hands stayed up . Almost every single one. It is critically important that we know that marijuana has unique impacts on the developing brain. It can prime your brain to addiction to other substances and it is a common component of many folks pathway to Substance Use disorder. Thank you all for that. [applause] so my personal twitter account is at jerome adams md. I tweaked this morning, i actually was describing my week. 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, untreated Mental Health issues that he self medicate with marijuana and then went to a party and someone gave him a pill, and that would rapidly lead to heroin uses. That was tuesday and wednesday. Thursday i i released a Surgeon Generals advisory saying that pregnant women and young people should not be using marijuana. And edward said said i was fear mongering. [applause] but this is my lived experience in addition to where the signs is taking as to how much to understand this is not fear mongering. I hope whatever your feelings are on marijuana and adult usage, and i got some stringfield about that 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] that is really what might advisory is all about. Kevin mentioned this, and wilson is up here. Hes the expert in this. But marijuana from 1995, strains of marijuana tested were about 4 thc. Im speaking to a crowd that is very educated but just everyone is on the same page. Thc is a component of marijuana that causes euphoria, intoxication and causes most of the document harmful effects including addiction. 4 in 1995. In 2014 the strains that were tested were up to 14 , three times a start. The average dispensary now is putting out marijuana thats in the 20 range tac. So five times more potent than the strains people think of when you think of marijuana. As i said yesterday, im still waiting for the means to come up a folks at talkback, talking been on gma, on good morning america, on cnn, npr. I said this yesterday, this aint your mom is marijuana. Watauga 25 stronger thc content or 5 stronger, 25 in the plant form. If you look at oils, waxes, shatter, look at people vaping this and they can get 75, 80, 90 cici delivered to their brains. This is like the difference between missing im okay with you having a 12ounce light beer or glass of wine to go to sleep, and you think im okay with you drinking a pint of vodka every night to go to sleep. Thats the difference in potency. We have to understand as were having a conversation about marijuana use, that we recognize were talking about a fundamentally different product that is particularly changes to the developing brain. Again i do want to take too much time other than to tell you all, my brother, my uncle, many people in my family are walking the same path that you all have walked and that youre walking right now. Im not some government talking head who was spouting reefer madness over and over again. Talking about my lived experience, my families lived experience. Im talking about a father whose kids genetically because of my family are at risk for addiction. Im talking about the things i would want any other pair to know if they wanted to protect their children. Im asking you all to help me. Again, regardless of how you feel about adult use, to help me spread the word that no pregnant woman, no young person should be using this, especially potent marijuana that is out there because our youth, their future is too valuable. It is too valuable. We know when youth use their more likely to drop out of high school, that theyve seen eye to declines in youth use especially correlated with higher thc content. The Emergency Department admissions have gone up for adolescents for overdoses of marijuana, for psychosis. We know it increases your chance of schizophrenia and we know it increases social consequences. I dont want to get too far off the tangent on social justice, but i been around the country and in many communities we are seeing folks are patting themselves on the back for driving down adult arrest rates but not paying attention to the fact that youth arrest rates are going up because marijuana use has been normalized. And in every state it is illegal if youre under the age of 18 to possess marijuana. We are not solving social justice issues. Where shifting social justice issues. We are still saying and play out among young people. If you have racist policies, if you bias, you are so kind of racist policies and bias even after you legalize. Its just shifting them down the 16 and c15 from older people. We have to do with the underlying root causes of this commission when it comes to addressing social justice issues. In every minority community, community of color across the United States weve got a liquor store and a smoke shop. I personally dont see how adding a Marijuana Dispensary is going to help solve the problems that those communities face. So please, for young people and for pregnant women, help me spread this message and know that as Surgeon General of the United States, you have no bigger advocate in washington, d. C. Then me for what you do each and every day, and im praying that my brother gets into one of the recovery houses that you all help lift up. We know theres not enough recovery [applause] thank you. I ask that you pray for him and my family, and keep doing what youre doing. There is not enough treatment. Theres not enough recovery out there. We know this and im leaning into this issue. For anyone who thinks im taking my eye off the prize, no. Im whiting my aperture and seeing the big picture. We need to stop using a rifle and picking off one part of the problem and watching it crop up in another place to where to look at the big picture and it starts with prevention and it leads into educating people about the importance of diagnosing and treating Mental Health issues. And it leads into a a discussin about all the different pathways that people end up needing treatment. And then it involves eating people into treatment and making sure theres access to the locks up because you cant get someone into treatment if they are dead. We need to make sure we continue to talk about naloxone and then it goes into making sure that treatment is effective and evidencebased evidencebased and medicationassisted treatment is available to more people. Then it leads into recovery because you are not magically fix after 30 days of treatment. Weve got help people understand that recovery is a lifetime, it is a lifetime and it is a lifestyle. It requires support, and that we need to make sure people can transition successfully from using to treatment to a lifetime of recovery and having the social support that they need to be able to get back and become productive and successful members of society and of their families again. So thank you for letting me with a little bit. I hope you all were patient with me and understand im passionate about these issues. I hope you can hear. I hope you can feel it. I hope you understand im not up here just spouting off because i want, because i want to demonize you or because i want to hurt peoples access to marijuana. Im here talking because ive lived it. Ive seen it and i want people to learn from your mistakes. I want people to learn from your successes. I want people to stop stigmatizing people with Substance Use disorder, no matter what the substance of choice is. And i want us to make sure our kids have the best chance at a successful future. So thanks again. [applause] thank you so much, Surgeon General. Thank you for coming. Weve got two more speakers. We will have josh up next and then west and i think well opened up to questions from you all. Get your questions ready. All right. Someone got the short straw. To speak 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 had a big impact on overdoses. His use of the position has been really remarkable for Public Health. My name is i dont know if this is going to work, hold on. There we go. So my name is josh sharkskin. Im from Johns Hopkins. Good to see you. Im a professor there. I am so appreciative of the chance to be here with you all and such deep respect for what you do every day to not only help yourself a really to help so many other people in the midst of this crisis. Im going to talk about new research on the opioid addiction. The good news and the bad news. Im going to talk, im going to very briefly mention six studies have been published in the last year i thought you might be interested. Let me just also say that at Johns Hopkins with a special program called the American Health initiative will we get full scholarships plus 10,000 for people who want to study and get a masters of Public Health degree in the field of addiction and violence, and a few other fields. But if any of your interested you should go to American Health and all the information is there as well as email addresses for how you can find out about the requirements and that sort of thing. You do not have two moved to baltimore. You can do from where you are. If anybody is interested we love to people interested in oxford house study at Johns Hopkins. Real quick, were going to do about three studies in treatment and three studies on harm reduction. First one on treatment was published in september 2019. It is not yet september 2019, but they released the study early. This study by some researchers at our school, and elsewhere, showed that when people were taking, people with opioid addiction were taking buprenorphine earning that on health and for all. Addiction but it actually improved care for other illnesses that they have including seizures, depression and other illnesses. So that as we talked about the fact that people with addiction diet many conditions, including chronic illnesses, actually having to treatment helps them with those other illnesses and their less likely to die seizures, depression and other illnesses. But then there some bad news, which is a study out of West Virginia showed that fewer than one in ten people who had a nonfatal overdose of opioid actually got treated with buprenorphine. Fewer than one in ten. So 90 plus people are not getting medication that actually reduce the risk of death by 50 or more. Im not an addiction medical doctor. Im a pediatrician or my wife is an addiction medical doctor. When we were in middle school i thought she was going to be, like i said why, microphone, shes like a saint. She is going to take care of patient and all the patients are going to die. In fact, i thought it was hopeless. I thought was hopeless and about as a pediatrician i would be getting all kinds of presents for my patients. You, because i be such a great nutrition. Fastforward and pair turkey busy to give presents to the pediatrician, why wasnt that good of a pediatrician. [laughing] my wife supports people in treatment and recovery. She treats people from the brink of death and from homelessness, from hiv. She helps them get into treatment come counseling ever patients do so well on medications, not on medications. You come to our house, the holidays and theyre so appreciative of what shes done, kiki is so much back to them. Shes on call for them all the time. And yet so few people have access to that kind of treatment around the country so that is a recent finding here what is it that so few people are able to get medications . Another study just came out about the news Media Coverage of medication and how often it is wrong. Its often wrong because it fails to say that their useful, that they reduce death by huge amounts, that they reduce the chance of dying from chronic illness. And it also more frequently since a message that being on buprenorphine or methadone safety is a form of addiction. And it is not a form of addiction. Addiction requires use despite harmful consequences. In someones life is falling away from them. But when people are in treatment even with medication theyre getting their life back. Theyre reconnecting with their family. Theyre living independently. Theyre living and with the want in their life. They are not in the throes of addiction. Here in recovery and remission. Thats the misunderstanding, very prevalent in the news media keeps a lot of people from getting care that could save their lives. Three new studies on harm reduction. All the studies were published in the last 12 months. This is about naloxone. You put about how naloxone, Surgeon General, narcan consistently lies but the recent study in pennsylvania published that showed more than half of the pharmacies in pennsylvania did not carry naloxone at all. And not only that, only 64 of pharmacists knew that there was a Standing Order where people could just go in and get naloxone. So a third of them didnt even know how to dispense it. That is a huge risk, given how important it is to have a rescue medicine around if people using drugs. We still need to get the word out, even the pharmacies about naloxone. Heres some more bad news. Syringe Exchange Programs are effective in reducing hiv and actually helping people get into treatment. Thats the good news part of the story. Recently theres a trend for syringe Exchange Programs to start medication to help transition people writing discovery, and that is been very successful for places like burlington, vermont, but other places are shutting down syringe Exchange Programs largely because of misinformation. They are doing it in a way that is very stigmatizing to the people are using it. In one program and charleston, West Virginia, there was a Research Study that found when you close the Syringe Exchange people started sharing syringes more and actually were much more likely get hiv testing which greatly increases the risk of hiv outbreak. This is what one of the female participants said. So what about contacting hiv, ive been tested four times this you find a couple of people that have hiv. Im afraid im going to contract it. They had no way to get safe needles. These individuals who are using drugs often want to stop, and theyre trying to find a pathway to success. Keeping them alive and healthy until they can do that, until they can make a connection with a peer, thats critical. Unfortunately, a Syringe Service program shut down, people put more in harms way. Last one i will just mention briefly, maybe a bit of good news, in the face of the fentanyl epidemic. Fentanyl as a last line that is killing so many americans, more than any other opioid now. Its increasingly contaminating cocaine and methamphetamine the people are dying of fentanyl without even knowing its in the drugs theyre using. There is research that suggests if you help people test the drugs, they are very interested in knowing whether they contained fentanyl. They may take steps to protect themselves. Theres also research that having those testing strips is an opportunity to make a connection with someone. Even the active straight to test their own drugs is a step on the path to getting to treatment and recovery. 90 of people who use drugs intravenously or interest 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 theyre able to get into effective treatment. So those are my six updates, and im looking forward to the rest of the panel. Thanks. [applause] terrific. Thanks so much. Last but not least we have doctor westley clark. [applause] thank you. Its a pleasure to be here. This is i think my 15th oxford house session, and its always [applause] i want to talk about, less about research and more about Substance Abuse confident jelly. But before i start i want you all to repeat after me. 263. 263. 263. 263. And ill explain that shortly. But i also want to thank the women in the audience, particularly those who are concerned about the use of marijuana. The data show that pregnant women, once they know that they are pregnant, stop using marijuana substantially. In 2018 2018 the prevalence of marijuana use in the first trimester was 10. 5 . By the second trimester and drop to 2. 3 . The third trimester, 1. 7 . So the public of message is getting through to women. It should be zero, but the data to show the Public Health message is getting through, and women listen. I dont know about the men, but women listen. [laughing] 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. Thats 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 the overall the liberalize the people who can access to information, and two of what i call 263 because it is section 263 but section 263 is for the first time it is saying if you commit a serious crime that includes violence and child abuse and Drug Trafficking, the court can issue an order to go through your records. Historically, it says if you commit a Violent Crime and child abuse, the court can issue a record. Now they want to include Drug Trafficking. They dont define what Drug Trafficking is. So the question is, anybody here ever bought and sold marijuana or opiates or any other Illegal Drugs . Im not [laughing] so by and large a number of you were involved in Drug Trafficking. So you should be able to go to treatment as a look, i want to step Drug Trafficking because i need to clean up my act. Well, for the first time the company is saying, well, we want to know who you are. That only two we to know who you are, we want to know who your providers are and your friends and relatives are. We want to know if you have committed a serious crime, Drug Trafficking, at or from a Substance Abuse treatment program. These are notices of proposed will make you send your to respond to that. It just believes reverting to the previous language is necessary to reduce antitumor Drug Trafficking. So the key issue is that 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 a Substance Abuse disorder. Associate with a change of part two that is legislation, and to company that legislation i have a letter from 20 states attorneys general who favor getting rid of that substantial gender. As in by what a state attorney generals job is . [inaudible] what is it . Prosecution. When they want to get into your personal records, what do you think their purpose is . [inaudible] my job is to prosecute offenders. Its illegal to use drugs. That makes you an offender. So i want to be able to find that information out. Now, when your personal information becomes subject to disclosure to anybody and everybody, they can find that information out. So the miranda warning says, its the rule against selfincrimination. Anything you cant answer will be used against you. If you want people to go to treatment what we are doing is discouraging people from going to professional treatment, encouraging them to go to oxford house, which is a good thing. [applause] to the extent buprenorphine is helpful, we are changing the rules, and i encourage you to understand that bipeds are up but most important thing is to be aware that we are moving away from the war on drugs to a war on patients. And that i find objectionable. If we want to deal with the epidemic of drugs, we have to deal with the people, with allow people to go into treatment and feel comfortable and safe. Again, oxford house does that. Oxford house is more than just housing. Its recovery. I think i would like to stress that. I know you mentioned that its important for housing and i agree with you, but its the larger issue of oxford house is it facilitates recovery. And it uses the proximity of people who are interested in recovery to achieve that and it gives them a a safe place to be there. So back to the federal rules, the federal rules that you should be aware of is 263. Can i hear you say that . 263. To make sure you tell people not to support 263. Thanks. [applause] thank you. Thanks much, dr. Clark. Thank you all the Panel Members for the little brief synopsis from everybody. Now weve got about 15 minutes left. We have a floor mic year for your questions. These come up and ask the question. If youd like to just go to the mic so we can hear it, thank you. If you want to address the question to one of the panels, to say what anil member, of the way you can dress it to everybody on the panel. Hello. Im a person in recovery. My question is about suboxone, methadone. I was given this inside of an inpatient detox. And on my way out i was offered it to go to the Doctors Clinic and for a fee he would continue to write me this prescription. You know, my question about this is, why is it is not considered addiction for profit . Its the same pharmaceutical companies that are making this [applause] and my personal addiction, as a young man i smoked marijuana and did cocaine. I got into a car wreck, and a group of doctors said you need this, and overprescribed me oxycontin, which led to a heroin addiction which nearly killed me. Ive been sober for a for a lit over two years now, but [applause] because of the 12 steps through alcohol anonymous and the Recovery Support system that have at oxford house, i declined the offer to go to this Doctors Clinic and take this. I know that medicallyassisted treatment is a a big deal right now we can oxford house, but right now what i see is a group of doctors once again telling me you need this. And it can be done without that, and a dont understand why we are pushing this and we are not saying were going to this for x amount of time and we are going to work with some sponsors and were going to do these things, instead of saying for the rest of your life were going to keep you on this product. Because its expensive and when mr. Kelly spoke earlier, he said without this we are saving 10,000 a person. Were. Were saving millions of dollars a person. When mr. Surgeon general spoke up, he said 30 years ago they told me opiates were okay. Another tony they are bad. How do we know 30 30 years frow somebody suckled to stand up there and say, hey, they told me [cheers and applause] hey, they told me methadone was okay, suboxone was okay, and now its not. Thank you for your question. [applause] i think its a quick question. I think its a great question, and it boils down to strength of recovery. If you have no. [booing] listen up, listen up. If you have an oppressively good recovery and you are working the program and are doing the 12 steps and youre doing commitments and your participating actively, then that can be the means to the end. That can be the means to the recovery. Every person is an individual. We have to look at each person individually, and we have to consider each persons situation individually. But if you look at the general population, if you look at everybody with addictive disease, you guys know as well as i do. Hobby of them are as committed as all of you are . Theres a good portion of them, if not the majority, who are not as committed, or 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 . Tell me, all that does is make me want to use. You know, all i do, or they tell me im going to meetings when really what they mean is they