Please say thanks. Before we begin, please silence all of your devices. We hope you are following us on social media today and if you are, please use theev hash tag gbf. At the end if you can fill out a survey in the back of the tent or online will be entered to win a 100 visa gift card. Doctor sederer will be signing books after the panel, so copies of the addiction solution are available in the politics and prose book tent just around the corner there. A quick word about buying books. This is a free event but it does help the festival if you purchase books from the speakers. Not only does it think the olfestival possible, but it also supports i politics and prose which is a wonderful independent bookstore in the dc area. So if you can buy the book, please do. Okay, so doctor Lloyd Sederer is an adjunct professor at the Public Health and contribute a writer for u. S. News world report and chief medical officer for the state office of Mental Health and is a monthly regularh on xm tell me everything. He was given an award for excellence by the American Psychiatric association which in 2009 recognized him as the psychiatrice administrator of te year. The new book the addiction solution treating opioids and other drugs which w is what we will be discussing today. Please help me in welcoming doctor sederer. [applause]. In both of those rules it is my job if you will, to look at how ill health and fatalities are occurring throughout the nation over the years i have covered opioids and cannabis and amphetamine and synthetic marijuana and i just saw the problem worsening when in fact we had a lot of solutions we were not using and thats what prompted me to write the book. I felt that i needed to say that we can get out of this epidemic. You mentioned what is the one piece of advice that you could give . You said it would be to avoid those experiences that lead people down the path through addiction. Can you give some examples of that quick. This is the Public Health and for loan voucher those experiences are that Young Children have that are three or five or six that are abused or neglected or multiple foster homes her parents in prison or homes with domestic violence. These accumulate so there is a score of how many Adverse Childhood Experiences. Four or more almost always predictsy by the time they are all teenager they will have a variety of Mental Health problems and will obese or diabetes, smoke and teenage pregnancy. So one of the interventions that could make a difference is to intervene and help families do better when children are exposed to these circumstances and prevent the problems that are inescapable to them. You think that word require somebody testing them so outside the Healthcare System who should be on the lookout . As it teachers or any adult . Were the gatekeepers quick. In my state i introduced variety of screening techniques for Substance Abuse and addiction starting the march to acquire pediatric family practices and schools to screen for these Adverse Childhood Experiences. We are all socialized to a screen if you go to a doctor you get a number. You get your pulls you get your Blood Pressure and lipid levels and sugar levels and we are all socialized to think what is normal or what is not normal. So if you quantify a problem it gets attention and its more likely people will attend to wet. To it so then to screen for this and link those families to services in the community which admittedly were very sparse but they dont build them until the demand occurs. That is my view. At do you find that pediatricians are more receptive . Or is that one more thing quick. Thats different. Pediatricians recognize thesepe problems and have published white papers supporting the importance of Adverse Childhood Experiences but not the screening because they feel that its not good servicesdo that could be troubled for doctor to identify a problem and not solve it but schools are phobic by the for identifying problems because their resources are even moreou limited. Talking about programs that is the Gold Standard but yet the success rate is incrediblyy low. Went out of ten are one out of 20 but given those results why does it remain the Gold Standard quick. Attendance at aa meetings have not increased in about 40 hayears. Maybe some of that is a reflection of the inaccessibility to be everywhere but also a few people respond to these recovery programs they are a good thing but they are not sufficient and thats the one thing i tried to message to you people and to the book that you need to combine interventions with a complex problem. Is just as true with Heart Disease one medication is not enough so you have to combine recovery with therapy and Family Support and you get it much more likely somebody gets better. Is there a type of person that is more receptive . Because it is anonymous and its hard to track people in these programs but you can appreciate that those who believe that spirituality is recognized with a spiritual presence and a higher power will make a difference, they are much more apt to respond to aa or gambling anonymous. Also being religious. Yes. I see myself as a spiritual person who does not follow a religion but spiritual to me means that we do think there is a higher power and a sense of connectedness and continuity and thats closer to what spiritual means and thats closer to what spiritual means talked about the most thai faceted approach of what you pointed out is that standard universality. Can you explain what that is and what it looks like quick. Yes. Imagine a mother who comes to her pediatrician bringing her child with the ear ache. It is repeatedly and he asks questions and pretty soon he uncovers the mother is a smoker and smoking is associated with ear infections. So the doctor starts to be rate the mother. Dont you know that smoking is related probably causing your child earaches . Now the mother is squirming and cannot wait to get out of the office. That is an example of not doing motivational interviewing. What it is about is getting on the side of the mother to understand. You are a single mom there must be a lot of stress. I see that you smoke. How is that helpful to you . So when do you smoke . Why do you smoke . So the doctor sides with the person to recognize that tobacco or opioid or cannabis use is serving a person. That is the premise it may not be good but its the best that someone has so that is getting behind in appreciating that somebody is doing something that seems disruptive but it is useful to them. When you do that, that is how they begin to feel more trustworthy. Its not that its so helpful to me. Does that give you a sense . Rhe it does. I read the book. And that the doctor is planting a seed hoping they will act on that how do you quantify thehe success of motivational interviewing . Or versus if you are just planting that seed . Thats a very good question its hard to do research on programs interventions and for them to use this approach because there is no funding for this and its hard to track where it makes a difference where it may be somebody else but experiments on exponentially but it makes a difference and it goes back many years and first used with addiction and variety of behavioral problemss like eating too much or sedentary lifestyle or to get on the other side of problem behavior. You say counterintuitively there is Promising Research like Psychedelic Drugs like lsd people would be surprised to hear that. What isde it that makes them useful . Its a drug that is very much like lsd you can think of it as a softer form and comes from mushrooms and sometimes a call the magic mushrooms. We have some good treatments but we dont have as many effective treatments as we would like and then we have interventions where you do the same thing twice and it turns the course of somebodys life. And this causes a psychedelic trip that lasts about six hours and when done under safe circumstances first with people who were terminally ill and were in a crisis over 500 people having given them under these conditions without one bad reaction. They are in a protective environment, and 80 percent of those individuals went from being an extreme distress to reconciling themselves with the circumstances withs, their own death. I dont know how many of you have had trips whether i dont know how many of you have had trips whether or belladonna you have that restored sense of wonder to be one of the universe that you are not dying but continuing one trip, maximum of two is lasting without experience. So now there are studies underway to see if it is as effective as well of obsessive compulsive disorder. And there are reasons for that but because we understand what happens in the brain when somebody goes on a trip. Is the potential use the psychedelics greater or is there still a stigma . Some people think that im on a trip myself to be suggesting but i am not suggesting that you go to hopkins this afternoon to find the source or to your local drug dealer. But i am saying that a good ight good idea for the general public to be open that addiction is a tough problem and maybe to some people but this will actually turn their mind away from addiction to a different kind of life. It is feared or stigmatized but i wouldnt be surprised if more people began to say this is something. Have any of your own patients benefit from that kind of therapy . No. I have several hundred thousand patients every year thats how many are served by my agency in new york state into my knowledge i havent prescribed it for any of them i i dont know i only know what has been done for research conditions. You talk about how often they go handinhand but they are separate conditions with two separate problems and you advocate for good Mental Health care along with addiction care but if you had to pick two areas how realistic is it people that need that health care will get it . Ro what i have learned from patients and families they ndve to go to two different places for different care with two different conditions they may not go to any or only one that has led to more and more efforts to provide onestop shopping. You can be cared for your diabetes and depression and cannabis addiction narcotic pill addiction all in the same pace that is principally in primary care. If they go to a psychiatrist there are far fewer onestop shopping is where they try to develop in terms of services. Is that wholesale primary care doctors . It isnt simple and not onesizefitsall but also a moving target. How do they i become equipped . It is easier to spot it because we have the screening just like the value for your sugar very reliable questionnaires for substance problems. So when those are introduced the Standard Operating Procedure you fill out a simple questionnaire. But then that requires a change in practice but that can beost done. Most general practices need the presence of the addiction counselor. Because these are tough conditions and did rural areas it is even harder to bring in a Mental Health specialist. And then we will see that Problem Solved over the years ahead which is called telehealth which is a protected form of skype or face time. And then todo speak with someone with expertise. Especially in rural area areas, because there is lack of facilities the addict goes to the emergency room because they have no reason to keep athem what they need is but they dont have one but what happens is one of those communities so what do they do to fill the gap to get more facilities . What the local clinic or hospital . Most of those inspirational communities that there are high rates of Overdose Deaths families who have lost a brother or sister the families came together or not only to support themselves but to be a channel for people to link them literally by hand to services and then second our Police Departments that stop arresting or charging people with drugs. And the authority of the Police Department to determine if they charge somebody but but those now say if you show up and you have a drug problem we will not press charges but with all those families that are affected will help you get care. Literally at that time. Not tomorrow. Those that have yet to explode. Because those really work. So to dovetail on that. Where drugs are illegal or decriminalized is the incidence of the negative behavior crime related or drugrelated crimes in hiv or all that goes down but then you say you are not an advocate for legalizing drugs acrossan the board, even marijuana. I am an advocate for decriminalization which is not incarcerating people with the disease because addiction is a disease. Also incarcerating them with addiction means it will fall disproportionately. So incarceration is not a solution for those who are users. S. This deal or you prostitute yourself or you deal drugs. Decriminalizationud and treatment for dealers who are users. The more substance is available in a community the more it will be used. The more accessible it is whether tobacco or alcohol or t opioids, the more it will be used. And with cannabis now there is a number of states that his legalized Recreational Marijuana and i have cover orthat story and then say we still havent figured out how to do this. We are not making w as much money as we thought. And with that enforcement because there is still a cartel and there is homegrown stuff. They havent figured it out. For those like cannabis we have to know a lot more and we dont have Much Research on this because it is a schedule one drug. So we dont know the potency or mixture of the plant is useful or for what more dangerous for others. There is such limited information. How much time with legalized marijuana . And there is such a march by how manyeg states to legalize and there is a lot going on in terms of driving under the influence accessed by teenagers and the whole financialal aspect. And then to go ahead in a much more informed way. So you are not judge mental. Even right addiction prior to the brain is not toward those of a humanity. Go thats pretty good. [laughter] you are a good writer. You should write a book. [laughter] you wrote that. Did those that turned to compassion versus judgment. Everybody knows somebody that nis but its not a crime. Because so many families, almostow somebody knows somebody who has an addiction. And to seize the tragedy of that has started to realize they have a big Public Health problem with the disease that has gone unchecked. And the answer is not more Law Enforcement but prevention and treatment. Another heartbreaking example is a poster child how things can go wrong. Is billie holiday. Tell people her story and how that illustrates every bad thing that could happen. I am a big fan of billieig holiday, then shes one of the greatest blues singers in this countrys history. She grew up not far from here in baltimore she grew up on the streets. Her mother was a prostitute. Live in the life of a child of a prostitute but when she was ten she was raped but then the local police took her to be a prostitute and arrested her and she spent one year in juvenile corrections. She wandered around and followed her mother to harlem her mother worked in a brothel. She was 14 and had no home and her mother would not take her in so she began to prostitute herself. After a while she was arrested as a prostitute. Went to some institutions and Rikers Island and when she got out she only had one goal which was to get as far away from her interior experience of abuse and rape in incarceration and she turned to alcoholn and heroin and use those for the rest of her life. She is an example of Adverse Childhood Experiences in spades. And she died at 44 in a hospital from cirrhosis. She is an example whose life and trauma put her on a path on the addiction that she could not escape. Its a miracle so many other who have lives like hers escape addiction. So what is the difference with the opioid and epidemic . Why the disparity . Crackhead had to do with neighborhoods of poverty are neighborhoods of color just like caroline in the past. Used to be a problem of the innercity poor and people of color. And with those crack mothers and crack babies but but it never got the appreciation that this is an addiction or disease. And mostly that they are doing this to themselves in some respects with a darwinian approach. We have tenan minutes left does anybody have questions . Image and Adverse Childhood Experiences but thats something that has been going on for humanitys existence but what is different from the narrative that those that say lack of economicrt opportunity, cheap access coming from mexico with the heroine and oversubscription one prescription of opioids from doctors. And how those issues compared to what you have seen . Thank you for bringing up which is a considerable overlap. What you arer describing is the social determinants of Mental Health of poverty and loss of job or loss of opportunity and then those are Vulnerable People with that deep the vulnerable population was social despair. So if they try because they have injured themselves, arthr themselves, arthritis, chronic pain, they discover they are transported away that they have never known before. Not only their physical pain but psychic pain. So there is so with the ability of the substance that affected at taking people away from their. Uffering so a number of comments have said the large npharmaceutical companies played a role in the opioid addiction. What are your thoughts on that . That is certainly the case and that goes back 20 years to the late nineties and one company inom particular called Perdue Pharmaceuticals was the manufacture of oxycontin they had a drug that was used for terminal lille pain and suddenly they began to market it for any kind of pain. They use false reports to say nobody gets addicted. So they had a huge workforce of drug detailers to say here is what your patients need it is safe. They dont have to suffer anymore. An far my has always played an Important Role in terms of promoting the drug and in this case, the opioids and theres only two countries on earth that allow direct to consumer rdvertising thats what you see when you watch tv or listen to the radio. United states and new zealand. The reason it is so popular is if we are exposed to a drug that offers a solution mother for pain, erectile dysfunctio dysfunction, diabetes, it was much more apt to go to a doctor. When you ask can i get this . Most are decent people and want to make their patient happy. These are slippery slopes and this company settle the suit for a bad advertise 600 million a few years ago but thats b the pittance compared to what they made over the years. I have a point to make and a question but as far as Marijuana Legalization and decriminalization of marijuana but the point to see how things go and taking time to determineak but i feel like people have been using it for a long time. Maybe not legallyal but its fair to say its at least as alcohol ifs not safer. People dont die from blood poisoning or overdoses. I think some of the issues with decriminalization versus legalization is that people can still lose their jobs. It stays in your system for so long so there are challenges. What are your thoughts to that . And also have if you heard of and your thoughts on that . Cannabis is not good for the developing brain. While her brains are under construction into our twenties through a process by which with the neural fibers when it is under construction its very vulnerable to thc which is the active ingredient which more powerful today than it was when i was smoking pot in college. Was very strong when a youth brain is exposed to that than that can interfere with the normal development of the brain and for the youth who has an underlying Mental Illness running in the family , they have to unleash that. That is another reason to be careful not just decriminalization but legalization because when it is more available it will get in the hands of kids. None of these have controlled access and it cost them a lot of money to prevent kids from buying this stuff. Its a complicated problem. It safe for a lot of people and it works for a lot of people. But with anothers Psychedelic Drug with very limited use as far as i understand it in this country. So if we are breaking the addiction cycle . Doesff that have a purpose or are they treating that as a problem . This is called medication assisted treatment and we have had it since the sixties with methadone which is the alternative to heroine. Its a way by which they dont use dirty needles to pay for their habit and since 2002 we had another medication similar to methadone but safer called suboxone and for some people it is a way to detoxify but others it is a maintenance drug like methadone but its very hard to overdose on it which means it doesnt stop breathing. But its hard to get off of. No solution is perfect but for some people this is lifesaving. We want to give an example because you mentioned Emergency Rooms with contact with the hospitals but Emergency Rooms are aware people are taken during an overdose. They are given the antidote to the opioid called narcan. What it does is it helps him breathing again but it puts them into immediate isthdrawal. Its not deadly but extremely uncomfortable and then have to go to the emergency room. Then the first thing they want to do was get a fix because they feel so horrible. So now some Emergency Rooms do the practice of give the medication but a few days of that to somebody who takes the overdose because they know that person is likely to be back in three days so its a lifesaving measure but that then they know they will come back. This is another innovation and it is one that should be carefully considered because it is not easy to get off but it is lifesaving. I had a chance to interview a few Homeless People and they said whether coming from big pharma is that a better way or to be more costeffective. I have had a lot as well. In new york city those who are homeless or poor but gave through to, spice. It is really cheap but these drugs many now they come to the Emergency Rooms and the latest concoctions are very sedating so they go into a coma. But i see this effort to medicate themselves to feel some relief from the pain and enhopelessness that they experience. Is that what you experience . Can you shed light on micro dosing . Yes. It is smile on small doses of lsd 10 micrograms taken every few days instead of 150 for a trip. Doesnt cause the hallucinatory state but it has become pretty popular and it is the alternative to adderall and ritalin in creative and financial communities where performanceta is everything. And there is word out that this enables you to be more creativ creative, it oergizes you and to think outofthebox. It probably does but its not easy to w get and you dont know what you get when you buy it. Micro dosing. One woman who is a writer and attorney, former federal attorney and that is even after having no remedy i will take those micro doses. I have some friends i grew up with that passed away as a result so it seems when soldiers came back from vietnam many came back hooked on heroin. But then they were offered morphine at clinics so then they moved to methadone than that was too oppressive. So do you think now this is the better alternative or do you think it could be justified . Bracket is good questions. It depends but it is a popular story so how many soldiers in combat are we using quick switch is cheap i pulled on potency theres two questions of actual use brings the addiction home 20 percent wereg using it three to seven days a week. But he also predicted it wouldnt ring the same rate because his theory was sometimes drug use is a way to cope with the environment you are in. One soldier described that using when was something pretty important but then we will be worried is not supported at home. So they did but not to the normal population. Most of the years we try to find a less toxic and destructive substances with that progression that you describe to go from heroine to methadone they are all safer but none of them are safe or has a life without being under the influence to some extent. So that is why i say keep out and i because for some people is a difference between living or not. What are one or two policies you would like to see the president where Congress Make to address the problem . I have no hope for this administration to do the right thing thats one reason i read thee book. Many states are now trying to do the right thing of prevention and treatment but it takes a huge amount of federal money and you can think of the hiv aids epidemic as a type of uprising around a Public Health crisis. And a tremendous amount of money was mobilized for then hivaids or treatment. But the amount of money that has been mobilized by the Trump Administration is a pittance but if you think of what is spent on emergency services, disability, file destruction, incarceration but i have no hope at all for the Trump Administration. It is a Public Health emergency putting 50 billion behind it. So i dont have hope until that administration has changed or congress to be changed for there to be enough resources to make a differencef. On that depressing note. [laughter] families and communities are making differences. We are out of time. Thank you for coming. [applause] it is great to be with you and thank you for all your effort. What an incredible four years you spent on fentanyl ink so lets dive right in. My interest is in this is that my company in new hampshire, i