Transcripts For CSPAN3 Opioid Epidemic 20170907

Epidemic, hosted by the oxford house, this is about an hour and 15 minutes. Back in 1971, this postage stamp came out. This is a path we have been down before. The whole question about drug abuse and issues that resolve around opioids. Today were going through the Opioid Crisis, facts and experiences, but what we need to remember, one of the keys to remember is that in the midst of this Opioid Crisis, in the midst of the numbers of individuals who are dying as a direct result of their use of opioids, we have to keep in mind that this still represents a comparative drop in the bucket. 50,000 lives lost last year due to opioids, no small number. However, we have to compare that to the 80,000 lives lost due to alcohol and the 500,000 lives lost due to cigarette smoking. Remember, the number one leading cause of death in people with addictive disease and recovery is smoking related illness. So the major issue for us to deal with remains tobacco. The second most significant issue for us to deal with remains alcohol. The Media Attention to the Opioid Crisis is wonderful because it brings attention to addictive disease as a whole, but remember whats happening is that there are roughly thr three 747s per day crashing, and the media is focused on the car crash, all right . We need every chance we get to ensure that we are also paying attention to the 747s full of people. And that we dont just look at the car crash. All right. Coming back to the 50,000 lives lost due to opioids, lets figure out where that comes from and basically weve got a panel today, weve all got about 15 minutes, 10 minutes or so. Im going to try to take as little of that as possible, but i want to set the stage. The Opioid Crisis arose if you will out of roughly a perfect storm. Three things went wrong. The first thing that went wrong is that doctors who remember for many years were reluctant to prescribe opiates because they didnt want to see people get in trouble from them, but doctors were told by largely pharmaceutical industry hey, there are these new long acting pharmaceuticals, long acting opiates that would work well to treat your patients with pain. Now never mind the fact that theres never been any literature to indicate that opioids provide adequate treatment for patients with noncancer related chronic pain. They dont work. Theres no literature out there that says they do. However, the initial reaction that most people will have to receiving an opiate is oh, that makes me feel better. Surprised . No. So when people feel that way they come back and ask for more. The doctor says oh, good, its working. When they come back and ask for more, if they are turned down, the patient is dissatisfied which leads to part two of the perfect storm. At the same time as the availability of long acting opioids started, we had physicians and medical facilities being told that the way they would do well, the way they would be certified, the way they would get a gold star is by making sure that patients were satisfied. Well, the patient came back in, said doc, the 30 vicodin worked well, i would like 30 more, and you tell the patient no, im sorry, you already had a month supply of vicodin, were not giving you any more, do you think the patient is satisfied . No. So the patient would leave a black mark instead of a gold star. That wasnt going to be any good. Years past we ended up with thousands of individuals taking opiates for a condition for which opioids are not indicated. Suddenly people realized this is a problem. We need to stop that. Doctors were reeducated. Programs that were giving out opioids like m and ms were closed down. What happened to all those individuals who were taking opiates every day who could no longer get them from their favorite family physician . Well, they left and they went to the street. When they went to the street, what they found, this is part three of the perfect storm, is that over the past bunch of years the United States has turned from importing marijuana to exporting marijuana because we grow apparently good marijuana. Because we grow good marijuana and because marijuana is increasingly accepted in the United States, we have an abundance of the plant, and we now send our marijuana across the boarders instead of bringing it in. The department of justice pointed out well, these folks who sold us the marijuana, they need other centers of profit now. And in order to accomplish that, they sent us cheap heroin at the exact time that our patients could no longer obtain prescription narcotics from the pill mills they used to go to for their opioids. They go to the street, theres cheap, pure heroin. Unfortunately sometimes laced with fentanyl to give you an even better feeling if you dont die. All right. So these were the three steps that brought us to the point where were at now. So as weve been educating the Clinical Community and we have seen a drop in the number of people getting prescriptions for opiates, we have seen an equal if not greater increase in use of street opioids like heroin. So were not even close to stopping this crisis yet and i dont think well i dont think well be at the point of stopping the crisis until the country recognizings that addictive disease is addictive disease. You cant be a country that embraces marijuana and encourages the use of a drug that gives you Better Living through chemistry at the same time as you have a crisis of adick tiff disease thats killing tens of thousands of people a year. And a crisis of alcohol and tobacco use thats killing hundreds of thousands of people a year. You cant in that context say but we still love addictive drugs, therefore lets make them legal. Doesnt make sense. So lets go ahead with our panel. Weve got a great panel for you today. Weve got dr. Wilson compton, the deputy director, dr. Wellcy clark, we have marty walker, the oxford house outreach coordinator, lori holtzclaw, flow stein and john major the researcher and Clinical Psychology professor at truman college. I look forward to hearing from your panel today and i apologize that they all have only about ten minutes a piece. But like i said, we will try and cram in all of that information for you today. Well turn quickly to dr. Compton. [ applause ] thank you. Its a pleasure to be here. And ive been a fan of oxford house for many many years. I lived in st. Louis up until the early 2000s and we had a new oxford house in my neighborhood back in the early 90s. And they were having trouble. The neighbors were trying to kick them out using illegal reason because they said there were too many different unrelated people in the house. Turns out thats discriminatory. You cant discriminate against people in recovery. I hads the pleasure of being one of the neighbors and a little bit of an expert in the field in some of the court cases and i was so pleased that they succeeded and have been a successful home in the Central West End in st. Louis, or were for a number of years. Thats my personal connection to oxford house. As well as a clinician i referred a lot of people and saw them turn their lives around because of the long term support. I think thats one of the themes thats important for all of addiction is that weve had this fantasy that if we treat people for a month, treat people for a couple of weeks theyll be cured, theyll be fixed, theyll be changed. Those treatment programs and that process can be a wonderful beginning to turn a life around. But turning a life around is a long term process. And it takes months to years for people to reenter society, to reorganize their daily activities for the memories to begin to fade so theyre not quite so powerful, for the cravings and urgings to be minimize and frankly for normal social activities to take the place of all of those problems for work and family and loving relationships to take the place of the way drugs occupied so much mental space. Thats why oxford house plays such a key role in long term recovery and i dont think weve tauxd about that so much in terms of the Opioid Crisis. How we need to Pay Attention to long term Recovery Supports and oxford house being a key part of that process to really address the underlying issue related to the Opioid Crisis, which is addiction in so many people. Now thats really just my main point and if thats all you remember i said, that would be fine. At the National Institute on drug abuse, our job is to bring science to address the Health Problems related to addiction. So how can science be the solutions related to the Opioid Crisis. Some of this relates to bringing information about it. So, you know, we certainly know that it has played a major role in overdose deaths. That of course is whats drawn all of the attention, is the phenomenal and destructive power of opioids in our communities in terms of how many people its been killing. Weve noticed that its been killing people in different parts of the country than are used to having drug problems. Its been in rural and suburban areas disproportionately. Thats part of the reason its generated so much attention. Its population that thought well, addiction is somebody elses issue and now theyre seeing its their own communities issue in ways that are visible and unfortunate. Deaths are the number one reason that its drawn attention. But its also infectious disease. We saw an outbreak of hiv in Southern Indiana completely driven by injection of ooh pan that. And it was reformulated to make it harder to snort. Turns out that was a mistake. It pushed people to inject it. It doesnt last long so people inject frequently. This was also a part of the country that had absolutely no Public Health infrastructure. So you had nobody bringing messages of safety and bringing messages of recovery and support and treatment to that community. So the result was that we had first hepatitis c, of course spread by sharing of infected injection equipment an an hiv outbreak where 4 of that community was eventually infected by hiv. Not just of a High Risk Group but of the entire community. Its really quite astounding. You have deaths, we have infections. To add further to the complexity is not just opioids, its the combination of opioids with other sedatives. Things like ben do die as peens. Its the combination with sedative agents. Thats an all too common medical combination so some of my colleagues are helping to fuel this by supplying both the opioids and the sedatives that help cause this. Its all neonatal absence syndrome. Thats a fancy way of saying that babies are exposed inutero. I visited charleston, west virginia, the hospitals there, one in ten babies that means every day they were seeing babies who were suffering from Opioid Withdrawal when they were first born. Fortunately we have reasonable treatments and way to help the babies but its an indication that not only the baby may have some difficulty but the family needs help. And weve been paying a lot of attention to the babies but what can we do to the moms and turn their lives around and have the recovery that you have found and seek. Okay. Thats enough about some of the background. What are we trying to do about this. I would love to say we have the solution. Unfortunately the data dont suggest that. The data suggests that the number of people dying from overdose continues to increase. First it was the prescription pills, i would suggest by economic. The power of profits. We saw illegal marketing practices by a Pharmaceutical Company that engaged in egregious marketing practices to promote the products so it meant that so many millions of people were exposed to them and misusing them and a number of them become addicted and having these deadly outcomes. The other economics are for heroin. Heroin is a remarkable product. When i lived in st. Louis and working in the addiction field in the 90s, we didnt have much of a heroin problem in st. Louis. Thats not true in the last 15 years. I think that because so many people were already taking the pills and misusing them, there was a recognition that theres an untapped market for a cheaper readily available opioid that could be sold on the street and thats what heroin represents. A cheaper readily available. So its now in cities like st. Louis that didnt used to have a problem and rural and suburban communities that didnt have it either. Fentanyl has had two lives. We saw it as an outbreak in did 2000s, deaths in chicago and philadelphia, a couple of other areas, all bought about one site that manufactured fentanyl illegally. When that site was closed down, the outbreak pretty much disappeared. Didnt completely disappear but for the most part. There are tens of thousands as far as im informed companies that manufacture fentanyl in china. It was legal to manufacture fentanyl up until early march. Fortunately their state department and others have been helping to change that so we can get some cooperation to reduce the flow. But it doesnt vn reduced yet and weve got a ways to go. Fentanyl is 50 times more potent than heroin. One gram, a tiny amount of fentanyl is like 50 grams of heroin. That means it can be shipped in the mail, it can be shipped in commercial carriers naps a fancy way of saying fedex, dhl and the other not Postal Service but the other ways you ship packages across the borders. Its shipped directly to the states or shipped to canada and mexico. The wall street journal, you know, theyre all about business, reminded us that this is a business. The raw products cause about 1,000 of fentanyl can be sold on the streets in the u. S. For about a million dollars. Thats a pretty big profit margin and it motivates a lot of behavior. I think as much as we can focus on the supply, we better do something to help people enter recovery so theres less of a demand for the products. I want to end by emphasizing that our department of health and Human Services in the federal government under dr. Prices leadership has laid out five main priorities. New approaches to pain. The key driver was excess prescribing of opioids. Cant we do a better job of not using opioids to treat pain. Yes we can. The second approach will be improving prevention, treatment and recovery services. So what can we do to focus on to be addictive process itself aneliminating it. The third will be can we save lives more ready by providing the lock zone, narcan, the antidote. I wonder how many oxford houses have narcan in their facilities. I hope that all of you do. Its not that your residents will necessarily have a problem, although it might happen. But youre going to know people that do. Youll have friends that have an overdose and having this life saving medication ready available is a key part of saving lives so that people can then make those gradual steps towards recovery. The fourth area is to improve our data. We talk about how many deaths we have in the u. S. From the overdose. My latest data from 2015. Where are we . This is now september of 2017. Dont you think we could have numbers from 2016 by now . Dont you think we could know more about this . Well, wed like to speed up that process. And im pleased to see that research is being supported. Im thrilled with the treatments we have. Im thrilled with the Recovery Support services that we have. We need more of them. We need to know how to implement them as efficienty and effectively as possible but we also need better treatments. Im kind of pleased with the medications that we have for treating heroin, fentanyl and opioid orders. We have medications that can be helpful but they dont help everybody. Many people fail who have on the medications, cant we do a better job. Thats what i hope ore research into the basic mechanisms, what explains these conditions and how we can treat them better will lead us to transformations so we dont have to see so many tens of thousands of people dying every year. Thanks very much. [ applause ] thank you, dr. Compton. Well move directly on to dr. Clark. [ applause ] thank you, pleasure to be here again at oxford house. Its ban long time. Last year. I appreciate this audience and were going to be talking about again later. I dont have any slides but i have slides later. So both dr. Getlo and dr. Compton addressed a host of issues associated with the epidemic weve been discussing. I would like to take a slightly different perspective. I want to point out there is an issue called the social deter innocence of health. Theres also the issue of how do we adequately treat pain. And dont compton made reference to that. But thats a large issue because indeed it affects peoples desire to use opioids. And we brought in with the epidemic a host of new individuals who previously were not using opioids. We have to keep in mind, as dr. Compton pointed out, we have 69. 9 Million People who are bing drinkers within 55 Million People who are cigarette smoker, 4. 3 Million People who misuse pain relievers. Not the Largest Group of individuals. So dr. Getlos point wu well ta was well taken. We have to deal with the fact that our society embraces the use of psychoactive substances. How it should be administered, thats another matter. With regard to Prescription Drugs, we have, according to the House Hold Survey of data from 2015, i agree with dr. Compton that its outdated data but ostensibly within the next two weeks well hear of 2016 data. There were 97 million past pain users but only 12. 8 of those admitted to past year misuse. So we have to deal with this issue anybody here ever have any pain . Anybody here want to enjoy that pain . So unless youre into s and m there are people, im a psychiatrist. We meet all sorts of individuals. Dont want to dismiss theird syd sinkcies. Were not going to deal with this issue. I know dr. Comptons institute, nih, has a working group thats trying to come up with nonpsychoactive substances that will help treat pain, developing strategie strategies. I know the cdc has come up with guidelines to treat pain. But the fact of the matter is we dont know how to treat chronic noncancer related pain adequately. People say well take motrin. Well motrin hurts you if you take too much of it. They say take tylenol. Ale asecetaminophen hurts you i you take too much of it. Im not a proponent of the oops yoids. I cant stand the things. But i am also not a proponent of people suffering. There seems to be a mistrust and a distrust of consumers. The pill mills, those werent responsible consumers. You just show up and say i got a pain in my pinkie and they give you all of the pills in the world. Thats not a responsible consumer. Thats not a responsible prescriber. There is mistrust and distrust of the consumer. And my fear is that we go from one end of the pendulum to the other end and we single out the consumer as the bad guy. We have Prescription Drug monitoring programs. We have people wanting to have access. They want to put you on registries. They want access to your information. They want all they can get and your phone is already doing half of that with your gps. But they want all that they can get from you. And so vilifying the consumer is not a solution to this problem. We have people who are explo exploiting the vulnerable, the business misery. Dr. Compton made reference to indiana. And it was a matter of opioids and a matter of ben do die as peeps. But it was also a matter of methamphetamine. I looked at the jail records in this community. Who is being arrested for what. That information is public. A bunch of folks were being arrested for methamphetamine. Know, they werent just snorting the meth amphetamine and injecting the heroin. You mow how you do that to be the combo . You inject the combo. So the fact is when we start focusing on one substance alone, as dr. Getlo was pointing out, we ignore the larger issue, back to the social determine nance of health. If theyre being abused psychologically, if they have no solutions then they tend to use whatever makes them feel better. We need solutions and im going to turn to some the themes that surface from oxford house because i see in oxford house some of the solutions. You may have seen from your materials over the years themes like accountability, responsibility, integrity, honesty, community, support, respect. These are things that make for a good doctorpatient relationship, a Good Community relationship. If we can deal with those things, employers who are mindful and respectful of employees, not let me see if i can get the next 26 hours out of you. When you look at mine workers and look at the pain they dont have cancer pain but theyre crunched over for long years and they come out and all theyve got is pain and then were surprised that they use opioids. How did that happen . Factory worker. Anybody ever work at a factory . I worked in a factory when i was in college. A one of the relief people. After eight hours my mind was numb. I was only doing it twice a week. I asked myself could i do this every day of the week. Basically what they were interested in was the assembly line, not me. So my point to you is that oxford house offers some solutions. Wilson, there are some solutions. The solutions in the principles of oxford house, accountability and responsibility. The patient needs to be responsible. The patient needs to be accountable. But so does the doctor with so does the hospital, so do the drug company. The system needs to be accountable. Honesty. The doctors need to tell the patients about this. [ applause ] support. If you need physical therapy, you should be able to get physical therapy because that was one of the other problems. They were giving out pills instead of alternative solutions. The alternative Solutions Cost 100 and the pill costs 5. See, what do you think the Insurance Company is going to do . Right. So im going to wind up with the notion of gratitude because the principles of oxford house function well if our Larger Community adopts those principles. That way when someone is quote backsliding and, as dr. Compton pointed out, you could have it in your facilities. People do crash and burn. This is not a perfect disease and the efforts are not also flawless. But if youve got an environment where people get support and people have opportunities and people know that if they follow the basic tenants, they have recovery on the horizon, then i think we can deal with chronic pain, if we have an Honest Society that recognizes that we put people in grueling environments and they need relief but they dont necessarily need to be drugged for relief. So your principles should be incorporated in the larger theme of what were going to do. Theres not another pill necessarily. Not another big brother Surveillance System necessarily. But a society that treats each other with respect and with dignity, that holds people to accountability and responsibility and that diffuses to every participant in the society then we have our solution. Thank you. [ applause ] dr. Major. [ applause ] good morning. How are you all doing. Morning. Got some bad news for you. I have a power point. So it might take a second or two to put it up there on the screen. I dont have a prompter so im going to be looking over here i think when i present. Lets see. Yeah. So im john major with harry s. Truman college. Part of the city colleges of chicago. And i wish i had my glasses. I didnt know i was going to have a prompter. Im going to be squinting a lot, looking at my notes. Bear with me. When i think of what constitute a crisis, several things come to mind. What are the prevalence rates. I like to go into the detail of the data discussed with dr. Clark and dr. Compton. This comes from the data from the National Survey on drug use and health. This was data presented about one year ago today reflecting 2015 data. Ive got a bunch of slides. Im not going to be terribly technical. Bear with me and ill try to get through this as quick as i can. Theres a lot of drug use going on and its comprehensive report from the survey that classify psychotherapeutic drugs into four categories. Prescription drugs that are painkiller, analgesics, things that make us not feel the pain, we have tranquilizers, things that calm us down, stimulants are and the sedative is typically used to help us go to sleep. If you look at the chart there, its surprising. Almost 45 of people in the United States are estimated for using these drugs. And you might be thinking, oh my gosh, this is an epidemic. Maybe they dont use the drugs like some of the people today. They actually throw away the drugs or give them back to the pharmacy when theyre done. They take them as prescribed. I think the issue here is misuse of Prescription Drugs. Now the numbers get smaller but still significant. 7 of folks are estimated for misusing their Prescription Drugs. Those frequently misused Prescription Drug in that category, pain relievers are analgesics and it doesnt get any better. When you look at people who use other drugs, alcohol included, tobacco, stimulants. Folk who use heroin have a High Frequency of misusing Prescription Drugs. Can you guess which of the four categories they tend to misuse more . Painkillers, right, analgesics at the same rate. Theres a lot of drug use going on. In terms of meeting diagnostic criteria for an opioid use disorder, you can see the bar charts. At the top is alcohol. Yeah, we have a big problem with smoking and drinking. But today we eesh talkire talk opioids. You see a sliver, 0. 6. Why are we talking about heroin. Thats a small number. That translate to 566,000 people. But what is even more alarming, three times the rate more for other opioids and thats something im going to be focusing on today. Theres all kinds of opioid use. We seem to really focus a lot on heroin. A lot of it is going on with other prescription opioid use thats being misused. This bar chart shows initiated drug use. These days people might be initiating or starting or expeermenting with Prescription Drugs. Painkillers. That explains the prevalence of the use of the drugs. I would like to introduce some dau that produced a couple of years ago, one of the most respected researchers gave testimony to the United States senate focusing on americas addiction to heroin and prescriptive drugs. She presented compelling and scary data. This chart shows the increase in Prescription Drugs that have been assigned in the last 20 years or so. And folks, thats in the millions. Now i dont have any glasses on, i cant see that far so i think its 74 million prescriptions who assigned in 91 and 12 years later its nearly tripled. You can see a red and a green line there corresponding to specific opioid drugs that were prescribed. So this is a very serious problem. This graph here seems a little complicated but its pretty simple. From the period of 2009 to about 2011, a threeyear period, they showed trends of drug use across four opioids. I think one category is other opioids, ox continuen, hydro hydrocodoane and then heroin. This is the percentage of people who reported that they used these opioids to get high in the past 30 days. On the far left youll see 10 of people who were surveyed said yeah, i used heroin to get high in the last 30 days and then it gets to be 50 or more report that theyre using Prescription Drugs. Now you see there are changes when you go from the left to the right. Were talking about trends of drug use. Dr. Vocow says, and i quote, the emergence of chemical tolerance perhaps combined in a smaller number of cases with difficulty in obtaining the medications illegally made some instances explain the tra sigs to abuse of heroin, which is cheaper and in some communities easier to obtain that Prescription Drugs. Thats a concern among a lot of researches. Theyre getting ahold of the Prescription Drugs. Its hard to come by, theyre expensive. Lets go into the communities and get the dope because its cheaper. But when i read this, something stuck out to me. First, look at this line. Chemical tolerance toward prescribed opioids. Have you ever once heard anybody talk about the chemical tolerance toward heroin . Other things that speak out to me, things like perhaps in a smaller number of cases. In other words, the doctor is very smart. Shes a researcher. We have to be very careful when we interpret data. We have to be cautious and use conservative language but she make as point that these things are leading to a transition of abuse. And ive come across a couple of studies where the data suggests that people are using Prescription Drugs, therefore it needs them to using heroin and then they typically overdose. When i look at the numbers on the graph, it shows changes over time. In other words, trends. But nowhere in this report that i came across did it make reference to the changes as being significant. And thats very important. In research, when we talk about statistics, we find something thats significant, that means that its due to something other than chance. Its not a chance occurrence. Oftentimes we make the attribution it has something to do with our variable or whatever it is that were looking at. At least when i look at this chart, this to me shows normal trends across time. That theres no rhyme or reason for the changes of frequencies. Now ive highlighted and probably from where youre sitting it might be difficult to see, two sets of data points that kind of suggest that support the notion of a switch from Prescription Drugs to heroin. If you look at the turquoise colored graph toward the bottom, you see from one time point there is a slight increase in heroin use. And that corresponds to the other lines above it, decreases in opioids. And you see that in the second highlighted column to the right. And the idea is people are increasing their heroin use because theyre getting less access or theyre decreasing their use of Prescription Drugs. That is pretty interesting. Now, the doctor also says, and if you read this on the website that heroin abuse like prescription opioid abuse is dangerous both because of the drugs addictiveness and the high risk of overdosing. Thats great. She cease saying Prescription Drug abuse and heroin abuse are both dangerous, both highly addict tif. But then we read in the case of heroin now, i include the emphasis here on the slide. The danger is compounded by the lack of control over the purity of the drug injected and its possible contamination with other drugs. Thats true. We know in recent years theyre mixing the dope with fentanyl. People are dropping left and right. Its horrible. But when i read this and lets say im a u. S. Senator and maybe im not adept at look in research stuff. I want to walk away with the idea that heroin is worse for you, the danger is even more. But what about the dangers of prescription opioids . That doesnt really seem to ring very loud to me when i Read Research articles. And i think this is something that we, as researchers, need to do. Dr. Clark talked about accountability. I think researchers are a little behind the curve. But i think were going to continue being accountable for showing the dangers of this epidemic or this crisis that we have. Now i would like to draw your attention over to that graph. Ill get rid of it very quickly. You can see that there are at least seven points to look at where you can draw conclusions. Now, the only basis i can see that supports a claim of a switch from Prescription Drug use to heroin are those two that i just showed you. But yo can take a look at other sets, like these two. It shows when people increase their heroin use theyre also increasing their prescription opioid use. And there are three data points that show the opposite effect. You could actually draw the conclusion that the Prescription Drugs are plentiful and because of that im going to reduce my heroin use. So us researchers have to be careful in interpreting these data points. Now if you look to the screen again, look at the gold line. Essentially it shows an increase in heroin overdoses by 50 in a tenyear period. That is alarming. We definitely have a problem. So im sorry, i dont have amy glasses. So in conclusion, you know, you could read that were seeing an increase in the number of people who are dying from overdoses predominantly from the prescribe analgesi analgesics. Were coming around starting to see it. It appear to be associated with a growing number in and diversion from the legal market. Indeed prescription opioids like other prescribed medications do present health risks but theyre also clinical allies. Clinical allies . Thats interesting. One thing in the testimony is the fact that over 13,000 people died from opioid drugs, prescription opioid drugs but its not considered an overdose. Its referred to as an unintentional death. If you die by here wioin you han overdose. You die from opioids, its an unintentional death. And now these drugs are clinical allies. And we have to be very careful. I think theres something do it because one of the first charts i showed you, a lot of people are using these drugs and they dont have a problem. Theyre not you know that 7 of people who misuse them and develop an opioid use disorder. But even if we go with that and we know more prescriptions are going out and more people have access to it, you might make the argument that this might be the gateway that maybe overtime people are going to become more addicted to this stuff. What about people in 12step recovery. Its interesting about giving them Prescription Drugs for any reason because we know they tend to misuse prescribed drugs. Right . But people i know this is where the experience comes in for this, you know, facts and experience. I know a lot of people in 12step recovery and their pain is real and some researchers say hey Pain Management not just for nonaddict tif populations but its also important for people who have opioid use disorder or other types of addictive disorders. And it kind of bothers me that i know some people, they would drug seek, oh, im in pain. How are we going to distinguish what is legit and what is not. What disturbs me these days, my friends in 12step recovery go see their doctor, im a recovery addict, i cant use anything thats going to alter my mood and their physicians are telling them this is nonnarcotic. This is nonadick tiff. This is just a muscle relaxant. And they tell me, john, i felt like i was high. I dont know if i relapse, what the heck. These physicians need to be careful. Not just read the pamphlets that say this is nonnarcotic when it can trigger a craving process for people in recovery. So let me talk very briefly about diversion. Diversion is the act of sharing, selling or illicitly using substances. This isnt just mere misuse of prescribed drugs. Were talking about maybe getting drugs in the black market, selling them. Not just using them against doctors orders. Now three drugs in particular have become of interest to researches. Medication assisted drugs. Drugs used to help people get off opioids. One recent study found people using methadone, those who are using so boxen for twice as likely to engage in die version practices. Another study found that theres an increase risk of overdose among people engaged in diversion practices. Thats kind of cool. Its not like its lethal overdose. Its a nonlethal overdose. Its like playing russian roulette without spinning the chamber. But perhaps one of the most disturbing reports i read found that people who engage in diversion practices, medication treatments, they feel this is a positive thing. The vast majority of the people in the study say they were morally right to do so and they could do so without getting detected. Lastly, i know im running out of time. I thought i had 15 minute and i prepared for that. Ill try to wrap up as soon as i can. This chart came out at Johns Hopkins University School of Public Health. Just recently came out. Theres two lines. A broken line, the bottom line showing trends in lethal yofr doses due to methadone. The top line lethal overdoses in relation to prescribed medications but theyre not really defined what prescribe medications were talking about. This is very alarming. Because we go from the bottom line in terms of methadone overdoses 1999, 784 deaths and by 2014 it goes up to 3400. Now some people will say about 2007, 2008 there were regulations implemented to regulate methadone to decrease the rate of overdoses due to methadone and some researchers are saying were showing decreases in the death rates of methadone in a short, maybe two or threeyear period theres some truth to that. But when you look over a course of 15 years, go from 784 to 3400. Thats like getting a sixinch dagger in somebodys back, pulling it out one inch, leaving it in there saying hey, we made a difference. [ applause ] now when it comes to the other prescribe opioids, its off the hook. Were talking about i cant read the numbers from there. Could somebody read that for me . 14,838 over a 14year period. Its only a 300 increase, its not a 400 like the methadone. But the numbers are very high. If you look at the highlighted 2010, thats the same level if not a little higher than 2014. And those rates are very comparable with what the doctor presented. Theres a lot of consistency across researches looking at this epidemic. So if you look at the numbers from this report from 2014 you see a lot of deaths due to opioids. You know, not just the heroin, you know, methadone, thats a medication assisted treatment. Its used for some paint management but its a lot more as medication assisted treatment. You add up the numbers. Now were looking at 18,000 people dying from opioids. This just 2014. If you take heroin out of the equation, thats a huge number. So a lot more people are dying not from heroin but by prescribe opioid medications. Then one more study and im almost done here. One year later here are the rates. Im going to show you the rates of heroin overdoses and prescription opioids not including methadone. Heroin went up by 25 in one year. That is very alarming. And by over 30 for prescription opioids. So this is whats going on. This is what the numbers tell us. But when we turn on the tv or we go to people magazine, its the heroin crisis. Theres no mention of how people are dropping like flies due to prescribe opioids, not just for pain but for those to treat opioid use disorders. We dont know anything about the death rates. Were just finding that out about methadone. Now a good friend of mine, andy chapman, i met him this week and i explained what i was presenting. The first thing out of this persons mind hes not an academic. Hes a normal person like most of us in here. First thing out of his mind is john, you guys have the data. Why arent you reporting the death rates about people on these prescribe drugs . Well that remains to be seen. So in conclusion, you know, theres a gator access to and greater use of opioids particularly prescribe opioid medications. Medications used to treat this problem with being misused, being diverted. Death rates continue to increase. But we continue to promote these medications. Now, you know, im not a real doctor. Im just a ph. D. I tell my students i play one in the classroom. But many my crowd we adhere to a certain ethics code, code of ethics and its pretty similar across all professions theres a thing called, lets do good but we need to cup that with another. Do no harm. So even if i went along with the idea that medication assisted therapies are really beneficial and im not a believer i wanted to be a believer. I think some circumstances it can work. But when you institutionalize it just goes awry. But for the sake of argument these things do provide benefit, we must embrace it with not doing harm. I dont think theres a risk of harm. I know theres a harm. The numbers dont lie. People are dying from the medications we prescribe them. Like weve been saying since the 80s, silence equals death. We need that talk about this and the researches need to be accountable about how the medication assisted treatments not only show risk but show death, show harm. And if we have that we might be in a better position. Lastly, in the 90s might have taken Dietary Supplements and then the fda said this could cause harm. But the harm it might have caused pales in comparison to the harm we know is going on with the use of prescription medications. So thats all i have. Thank you for the indulgence. Good morning, everybody. My name is lori holtzclaw. Im the regional manager for oxford houses in louisiana and mississippi. So i am not a doctor. For a researcher. But what im im going to speak to you about today is my experience. Dr. Clark mentioned something about, you know, we need a solution. And what i believe is that the solution starts right here with everybody in this room. [ applause ] so, you know, theres a little quote, a saying, be the change that you want to see in the world. And that is what i strive to do every day, is i strive to be the change that i want to see in the world of the people that i love the most, which is, you know, alcoholics and addicts. People trying so hard to change their life. So i am an addict. I am an opioid addict. I was addicted to prescription medication, oxycontin, heroin, anything like that. And then i also have been on medically assisted treatment which did not work for me. Im not saying it does not work for everybody, it just did not work for me. My addiction brought me to homelessness and incarceration. And, you know, i lost everything. As everyone knows in this room, it brought me to incomprehensible demoralization. And i was unable to make decisions. I couldnt put two thoughts together. My first seven months of recovery, sobriety, i spent in jail. And then when i got out of jail i was very fortunate to move into an oxford house. So one of the things that i have learned over the last ten years is to be open minded to different forms of recovery and thats where a lot of the change is coming in. So theres all types of different 12step recovery is not the only recovery out there. Theres all types of different recovery out there. One of the things i want to focus on today is for us as, you know, as individuals and as a whole to focus on other ways and paths to recovery. They have this new thing called refuge recovery. Has anyone heard of that . All right. And then they have smart recovery, which is also a newer form of recovery. They have the 12step programs, they have faithbased programs and then of course they have the medically assisted treatment. So all of those different, you know, those are just some of them. Theres probably more of them out there. Those have just some exam. S of them. All of those different torms of recovery can lead to the same results and thats abstinence from opioids, abstinence from infete means, any drug or substance thats out there. So, you know, another thing i want to you know, i want to speak to you guys as individuals. Like give yourself the time at oxford house. I lived in oxford house for seven years. I know thats a really long time. But i know me. You know what i mean . And you know you. And you know that its going to take more than three, six, nine, one year of recovery for you to change and stay sober for the rest of your life. I took that time for me. And it was important. You know, i made sure they was stable and that i didnt i wasnt moving in with somebody that i could make everything work for myself. Thats one of the biggest things that we focus on in oxford house is, you know, being self supporting. Thats not just for your oxford house. Thats for you as an individual to be self supporting and self sustaining and not depend on the system to take care of you and having the food stamps. Those things are there to help you as tools. And then, you know, im going to close with this. The other part of is giving back. And one of the biggest ways that i gave back before i started working for oxford house i did it for service work was opening houses. That is one of the most rewarding things you can do is provide six, eight, ten, 12 beds for people that need it. You know, we have 110 houses in the state of louisiana and we have 20 in mississippi and those are the houses that im directly the regional manager over. Whoop whoop [ applause ] and we dont have a lot of staff down there. So we truly depend on the people that live in the houses to open these houses, to make sure they get all of the furniture anstuff like that. But it gives you a sense of purpose. And we have to have a sense of purpose to stay sober. We cant just you know, we cant just work all of the time, we cant flail around and not have something thats going to give us a sense that were changing the world. So, you nknow, i just you know, i want you all to take this back to your houses and to the chapters and stuff like that. You know, you can make a difference in the Opioid Crisis today. You can be an example to your best friend thats still out there, your sister, your mother, your child. You know, all of these people. Everybody is different. Everybodys family members are different. But i know that we can be an example of what recovery looks like. And all that comes from within and being the change that you want to see in the world. So thank you. [ applause ] how yall doing . Whats up, family . Hey, lets do a lot of people poured their heart out up here. Lets just do me a favor. Part of the thing would be cool if you did is just take just do one thing. Just take ten seconds. Take a deep breath. Take a deep breath, let that thing out and be grateful. You know. [ applause ] be grateful that we made it. Because all them graphs and stuff, that gets me depressed, you know. Id like to see a graph on you, you know . You are everybody in this room is 100 successful today, 100 . [ applause ] 100 . Hey, everybody, you know the little thing i dont know why im saying this. The little thing on the pill bottle that says alcohol may intensify this effect, do yot operate machinery. But anyway, ill get past that. What was kind of chilling, it was chilling me up here because as we were talking about a perfect storm, you know, a perfect storm, what created the perfect storm of opioid disaster is whats going on. And its not just opioids. Alcohol has been a disaster for thousands of years. But opioid, you know, the World Population the population of the world this is simple math. It doubles every 25 years. You know, th25 years ago we had 3. 7 billion people. Now weve got 7point better buy some real estate. But the worlds population doubles which mean the problems double. Thats scary. I was sitting here looking a lot of you everybody here has put together a lot of work to get here. A lot of people have put together a lot of work to put this on. For 42 years ox fort house has put together a lot of work to make sure that everybody here has a house to go to, a safe place. Theres a system of operations. Theres been untold volunteers, chapter housing services, house president s, house secretary, all of that for 42 years im thinking it just kind of dawns on me. Weve been creating the perfect storm to combat this. This is the perfect storm to move forward. That self run, self financed democratically run system of operations thats catching everybodys attention. This is the perfect storm. This is one of the greatest solutions on the planet today and youre a part of that. Please give yourself a round of applause for that. [ applause ] its kind of mindboggling. One of the reasons that i got you know, i could qualify myself. You see these beautiful cities. Importantla portland, oregon is a beautiful city. Anybody here from oregon . I ran those streets in portland, oregon when i was coherent. Portland, oregon changes after about 10 p. M. Its a different city. Its a different city that most people dont see. All of the things that are going on, theres a lot. And i saw a little bit when we had our World Convention there. You know, going down the beautiful parks and things. Well if you look in the corners, if you look in the shadows, its there, you know, and it comes out after 10 p. M. , you know. Its a whole different world. So its always been there. And i guess theres a famous saying when the teacher or when the student is ready the teacher will appear. Theres also good recovery in portland, oregon. Weve all been in the shadows and things like that. Its always been there. The Opioid Crisis. Up was a product of the op joid cris Opioid Crisis. Alcohol may intensify this effect. I pruz a product of that the entire 80s. Many jails and institutions. I was and probably quite a few of my family here mhas been the ones that they gave up on. How cool is that that we were the hardest cases and were here together working together, common purpose. Thats amazing. I would love to see a graph on that. But theres the anonymity factor and things like that. Thats great. But the cool thing about oxford house is that were different in that we motivate were not only we hold each other accountable. You know. They were talking about the first one said you need somebody whos the house manager. You give an addict or alcoholic some authority over you guys. You know . You ever had a piece of that . Thats a mess. We do this. We vote excruciatingly democrat. We vote who comes in and we can vote who goes out. To motivate the motivation and support of oxford house has been unparalleled, you know. Yes, we have accountability. We have some consequence. If you dont pay your rent, you might not live here. But the power of the group has been exponential in my recovery. By the grace of god if march makes it and i make it there, 20 years. Freakin 20 years. Just sounds weird even saying it, you know. Im 20 years off that crap. And thats what it is, too. Were the kind of people me and lori were just kind of giggling about that. We might get in trouble later. We were giggling. Were the kind of people, somebody says, man, johnny, johnny odd, you know, he got that dope from, you know placco. Wheres he at . We got to go to his house. It aint going to happen to me. Its the disease that we have. We immediately want to know where the hell placco is. Thats freakin craziness. One foot in the grave constantly. Everybody is giggling because they know exactly what im talking about. Yeah. And what ive learn has been the most valuable thing in my recovery is i should never ever say anywhemore i got this. I aint got nothing. I aint got nothing. What i say now is we got this. We got this right . Were going to do this together. Okay . Ill end with this. Ill shut up. Dont have graphs and stuff like that. I am so grateful every time my butt wakes up in the morning im not in jail. I got a license with my picture on it, you know. I got a credit card with my name on it. Its awesome. [ cheers applause ] but what i found and i see it a lot. People move in, they want its kind of like smoking cigarettes. You talk to people that smoke. You go out there and people are smoking cigarettes. Man, i wish i could quit. If i could do it over, i would. They want to quit, they dont want that. But its so familiar that they keep going and going. I smoked for 32 years, camel filters. You think they would buy me a hat . Hell no, you know. Thats a lot of freakin money, man. And so moving into oxford house, moving in with our family, we do this together. I look at you now, im looking at you. Im looking at the perfect storm. Perfect storm. And we the only way were going to move forward when you give a person the option to either succeed or die, youre probably going to succeed. If those are the only two options. In 1519 i got a story. I got a story. In 1519 cortez took his soldiers over to the yucatan peninsula to get to rape, pillage and plunder. And the soldiers were like you know, they were like, i dont know. Thats a long ocean ride from tired, were tired. Hes like, get off the ship and burn your boat, burn your freaking boat. You aint got an option. You have no back doors. The only way were going to do this together is if we all burn our boats. Weve got no other options. We dont have a back door. Weve got to move forward and weve got to do it together. Thats what i got for you, man. Thank god youre here. We have flo stein going up and were going a couple of minutes over. I want to take a minute to point out, weve been talking about two things. The importance of recognizing that our strength lies in one another and the perfect storm. Of course, we had the perfect storm. That was last week down in houston. I do want all of us to keep in mind the fact that our folks down there in houston, our peers in houston dont have the ability right now to rely on their group the way they have been, right. Their access to their peers, their access to their group, their access to methadone or whatever theyre taking, all has been cut off for many of them. So our hearts and thoughts go out to all of our peers in houston. We will open our doors to them so we can help them out the best we can. Hi, you guys. I am everything i was going to do, and thats what we do. We will take it from there. I want to thank all of you for inviting me today, and those of you who did because i feel this is my personal withdrawal program. I just retired one month ago from 30 years in my job. And you were so nice to invite me back and want me to keep going even though im no longer the Substance Abuse director. But what is great about this panel is these are all of the people who are part of the solution. When dr. Clark, i think almost 15 years ago he called me up and said, there is a spike in methadone deaths, a lot happening along the Appalachian Mountains and youre one of those that better get up there. There were medical banners, health people, Substance Abuse treatment people to try to figure out what was going on. It was just the beginning of the tip of this iceberg. So a lot of us have been trying to work on figuring this problem out for quite a while. It is a very big problem. Theyre not going to take our and my state would not be anywhere without the help, and it takes the integration of medical leadership into what we were doing because it was gone for a while, and now we have physicians and other Health Practitioners are really helping us. So im proud to say that i just checked with Kathleen Kathleen lives in North Carolina, but we dont care. We want her and were keeping her. We have 239 houses as of today. That means weve started we started building those houses the day paul was talking about the requirement grant, the block grant. We are one of the states that still has evolving fund. I have to say we keep adding money to it, but thats okay. That means were opening more and more houses. I want to talk about how oxford house is part of the solution, particularly in our state and i hope it will be true in other states. Like kathleen and tony on our advisory council, curtis was actually appointed by our secretary to our opioid study task force. So he was representing not only oxford house but the voice of recovery, and actually worked a lot on the opioid stigma, and the stigma happens to be trying to talk to providers. So thats a particular problem of our field where we have a lot of different beliefs and we hold them very strongly, but we do have to learn to work together. So i really appreciate what oxford house has done, particularly in the last two years with like leadership at the state level on all of our groups. So the justice was the appointee of the group curtis is on now, our attorney general has taken it up. A big deal for states to try to figure out how to improve the health of their citizens. And our governor, Governor Cooper is now on the president s opioid task force. So were really going to be working hard to implement some of our strategic plans. I like what paul malloy said this morning. One thing thats really important about organizations, and oxford house is one of those important organizations, is you have to have a story. There has to be a saga. There has to be a leader, and everybody has to repeat that story over and over again, because thats how you build the momentum. I think oxford house is one of those great organizations. I have to say what oxford house has done in North Carolina to respond to needs in our state. We have homes for women and children, homes for reentry, homes for veterans. Our newest homes are recovery homes on College Campuses and we are looking forward to oxford house being continuing to be part of the solution on the Opioid Crisis, and it is an issue with medication and oxford house and i think you all are working on it. I know your position is that the house decides for itself what the state needs to do or know or your referring agencies, which houses can accept somebody like that, which ones cant, and what are you doing to improve your education, to be watching for those signs and symptoms. There are overdoses in houses. Weve had a number of those this last year in North Carolina. Were making the objective to leave. I read a story last week, while increasing our amount of syphilis in places where it had been thought to have been completely completely eradicated but it is from the needle sharing behavior. A lot of challenges for you all in houses, not to mention as we have medication treatment, a new current provider that might be out there, people that dont know about, you know, some primary care clinics to talk about oxford house. They dont think about peoples housing. Usually they should. Housing has to be everybodys issue, shelter for a meaningful life. Thats a new group for you to talk to. I want to introduce rob morrison who is right there. Raise your hand, rob. He is the executive director of the oxford authority. 30 years ago i was the Public Policy chair but now im nothing. Im nothing. But im glad rob is here because when i was asked to do this talk the first person i called was rob. What is our most recent report on what all of the states are doing to respond to this opioid issue . And they have reports and thats what they track and thats what they provide assistance with. So between nasda, providing direct handson assistance to the states to implement something which you have to help us do, theres a lot of money out there that was put out that congress provided through the act. It is almost too much money to be absorbed quickly so we need a lot of ideas. It will be a terrible happening if money gets out there and nothing changes, nothing changes on the ground, more people are being arrested than ever, which is one of our inhouse Typical Solutions for this kind of problem. We have to make it work and we need you to work with us like our oxford house in North Carolina does to make it happen. All of these others that im not going to talk about, but i do want to say that you are the solution. What you all said is true. Oxford house in new orleans or i was in texas, i forget where i was, i thought i had never seen this many people totally in one place in my life and it was a tiny little group. I look at you now. So congratulations. Thank you so much to our panel today. Thank you all for coming to see us. I will see you guys this afternoon. Tonight on cspan3 a Senate Hearing on the Childrens Health insurance program. Then a house hearing looks at ways to improve efficiency at the Environmental Protection agency. Later, a discussion about the strategic and Economic Alliance between the u. S. And south korea. Funding for the Childrens Health insurance program, known as chip, expires at the end of this month. At the Senate Finance committee hearing, several advocates for the federal program urged congress to reauthorize chip. Senator orrin hatch chairs this twohour hearing