October 20, 2023 • 49 mins
In this episode of "The Middle with Jeremy Hobson," we look at America's opioid crisis - and what solutions are working across the nation. Jeremy is joined by Dr. Nora Volkow, director of the National Institute on Drug Abuse, and Beth Macy, author and executive producer of Dopesick, a book and now a TV series on Hulu. Her latest book is Raising Lazarus. The Middle's house DJ Tolliver joins as well, plus callers from around the country.
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Speaker 1 (00:05):
Welcome to the Middle I'm Jeremy Hobson along with Tolliver.
Speaker 2 (00:08):
Hi.
Speaker 3 (00:08):
Tolliver, Hey, how's it going.
Speaker 4 (00:10):
Jeremy. Hey, I just want to let our listeners know
I had a show last night and a recording session,
so if I hit puberty during the show.
Speaker 5 (00:17):
That's where that is.
Speaker 3 (00:18):
Okay.
Speaker 1 (00:19):
Well, it's good to have you here tonight, and we
also welcome the listeners across the state of Wyoming on
Wyoming Public Media to the show. And what a week
of news it has been. President Biden was in Israel,
the war there continues, huge protests around the Middle East,
concerned about a worsening humanitarian situation in Gaza, and just
(00:39):
heartbreaking interviews with family members of the Israeli hostages. Now,
last week on the show, the war was our topic
and we got many more calls than we could get
on the air. Here are just a few of them.
Speaker 6 (00:51):
Oh my name is Tom.
Speaker 5 (00:52):
I'm calling from clear Water, Florida.
Speaker 6 (00:54):
Hi.
Speaker 5 (00:54):
My name is Justin Stewart.
Speaker 7 (00:55):
I'm calling from Houston, Texas.
Speaker 8 (00:57):
Hi.
Speaker 9 (00:57):
My name is Alie.
Speaker 7 (00:58):
I'm in Hi.
Speaker 10 (01:00):
Jeremy, this is from Pittsburgh. How the hell is Israel
supposed to try to make peace with neighbors who want
Israel to not exist.
Speaker 8 (01:12):
Why it's okay to call from US terists when they
kill children and civilians, and it's not okay to call
Israel the same.
Speaker 5 (01:20):
I am a staunch conservative.
Speaker 11 (01:22):
I am not pro Israel, I am not pro Palestine.
Speaker 7 (01:25):
But I want to know why is this happening?
Speaker 6 (01:27):
What is the root?
Speaker 5 (01:28):
Why is this even a thing.
Speaker 8 (01:31):
We hear one It's like last past Away was killed,
but it's twenty people of Placinias.
Speaker 7 (01:36):
I'm being killed.
Speaker 8 (01:37):
Nobody cares about that and never standard to the wall
Placinians leaves in the biggesty world of a puism. Why
can't you leave some piecee d A problems coming from.
Speaker 1 (01:51):
Well, we could have easily done another show about what's
going on in the Middle East, and maybe we'll we
will need to do that next week. But there is
a topic that often gets pushed side by other news,
even though it is killing hundreds of Americans every day
and will likely kill a record number of Americans this year.
That would be the opioid crisis. And what we want
(02:11):
to know from you this hour is what solutions are
working in your community when it comes to dealing with
the opioid crisis, which has been going on for many years. Tolliver,
can you give them our phone number please?
Speaker 4 (02:24):
Yes, it's eight four four four Middle. That's eight four
four four six four three three five three. You can
also write to a set listen to the Middle dot
com and you can find our social media handles there
as well.
Speaker 1 (02:35):
And before we take calls, let's meet our panel. Joining
us from Roanoke, Virginia Beth Maacy, author of the book
Dope Sic, which has been adapted into a Hulu series.
She has a new book out called Raising Lazarus, Hope, Justice,
and the Future of America's overdose crisis.
Speaker 3 (02:48):
Beth Macy, Welcome, thanks.
Speaker 12 (02:51):
For having me, appreciate it.
Speaker 3 (02:53):
It's great to have you.
Speaker 1 (02:54):
And we're also joined from Phoenix by doctor Nora Volkov,
director of the National Institute on Drug Abuse. That's a
federal agency that funds scientific research on the health aspects
of drug use and addiction. Doctor Volcoff, welcome to you.
Speaker 13 (03:07):
Thanks very much, Jeremy, and thanks for having me well.
Speaker 1 (03:11):
And I want to before we get to our callers,
ask each of you a question. In doctor Volkov, let
me just ask you if you could define the opioid
crisis right now. It's been going on for many years,
but what is it in the United States in twenty
twenty three.
Speaker 13 (03:26):
Well, we see a crisis that actually has reached the
highest levels in terms of mortality that.
Speaker 5 (03:32):
We have ever seen.
Speaker 13 (03:34):
Is also a much more complex crisis than it was
two decades ago because though we now see that the
main cause of driving the mortality is fentanil, which is
a synthetic opio we are more frequently seeing it combined
with other drugs like cocaine or metaphetamine or sila sin.
So this has made the control of the crisis so
(03:56):
much more harder because people that want to take cocaine
may not be seeking fentanil, may end up with a.
Speaker 5 (04:03):
Drug that contains a mixture.
Speaker 13 (04:05):
So we have seen that diversification of the people that
actually across all demographics that actually where we're seeing overdoses
from fentanyl or drow combinations.
Speaker 1 (04:17):
And when you talk about people who they want to
do cocaine or methamphetamine and then there's fentanyl mixed in,
does that then lead to an accidental overdose or does
that get them addicted to fentanyl?
Speaker 5 (04:31):
Well, it can happen both ways.
Speaker 13 (04:33):
It can lead to someone without knowing that they become
physically dependent to the opioid and they don't realize why
they feel so uncomfortable when they are not taking their cocaine,
and then that may lead them to just look at
products that have fentanil. Eventually that could result in an
overdose or there. When someone is not seeking fentanil doesn't
(04:56):
know that they're taking it, they don't have the tolerance
that usually someone that's taking opious whether it's heroin or
prescription or opiate medications have, so they have higher risk
of dying from it.
Speaker 5 (05:06):
So in this respect, some use that term that people are.
Speaker 13 (05:10):
Dying because they are being poisoned by consuming a substance
that they didn't know they had. But the reality is
it's an overdose driven in many instances by fentanil and
by the exacerbated letality when these drugs are combined. So
you have hiri risk when you have stimulants with fentanyl,
(05:30):
or alcohol with fentannil, or benzodiazepines with fentanyl.
Speaker 1 (05:35):
Beth Masie, you've been covering the opioid crisis for years.
Speaker 3 (05:37):
How would you define it right now?
Speaker 12 (05:40):
I would say doctor Volkov nailed it. I would also
point out the fact that, you know, I think we
lost for the first time. We lost over a thousand teenagers.
And these weren't people who were addicted per se. They
were experimenting like many teenagers do, and instead of taking
a xenax, they bought off the street, it was actually
a fatanyel. So the drugs are just getting more dangerous,
(06:04):
and until we start to make the treatments easier to
access than the dope, we're going to continue to see
an increase in overdose deaths.
Speaker 1 (06:15):
Let's get to a call. We're getting a few that
are coming in right now. I'm going to go to John,
who's on the line from Boulder, Colorado. John, go ahead,
welcome to the middle.
Speaker 6 (06:26):
Hey, thank you very much for having me in the middle.
M'ch appreciate it. Yeah, I actually agree with at what
she said. At the same time, I would feel like
our schools are not doing enough. I think our parents
are more scared about this and not talking to kids
about it enough. I have two teenage daughters, and I
obviously have a very open door policy with them, being
a former addict and alcoholic myself going through it ten
(06:49):
years sober, but The one thing that really kind of
scares me is I still see a doctor about this
and he has runs a clinic where he's giving out
maybe two winored durines to check for drug that they're
on and he hasn't seen heroin in over two years.
All his urines are all fentanyl. That st shows you
how bad it is in Denver. So I don't think
we're doing enough. Obviously, not a stone is a very
(07:11):
big step, but I think people really have to understand
the consequences of what withdraw does, how much you screw
up your life, the shame. It's not enough that's being
brought out that an attic has to kind of go
through it to understand it. And I think overall there's
needs to be more than has to happen on the
school level, but also on the whole level as well
too well.
Speaker 1 (07:30):
And actually I read that it takes the average opioid
addicted person eight years and five to six treatment attempts
to achieve one year of sobriety. John, Since you say
you're a former addict yourself and congratulations on being sober
for ten years, what was there something that you would
(07:50):
counsel other people on how to do that how to
do what you did?
Speaker 6 (07:54):
Yeah, people have to do it their way, you know.
I mean being in the rooms really kind of brought
up a lot of like war story is that really
kind of hurt me. It made me feel more shame.
Uh So I kind of did it myself. And I
you know, I tapered off this the box one, which
is worse than getting off heroin. And then I take
subbloicated a couple of times and I finally forgot about
it and it finally went away. But overall, you know,
(08:15):
from switching one drug to another, it doesn't work really well.
Uh you need to switch your lifestyle around. And that's
that's something I've done. But you know, lost one hundred
pounds since I quit using drugs and swim every single day.
And overall, I gotta tell you what, I've never had
a better relationship with my kids after beating heroin and
and and overall, that's that's that's what to live for.
(08:35):
And and and then I missed out on a lot
and there's a lot of shame there too, So I'm
still getting over that part. It doesn't go away very
very very easily.
Speaker 1 (08:43):
So yeah, well, John, thank you so much for your call.
Really appreciate it, doctor Volkov as you listen uh there
to John your thoughts.
Speaker 13 (08:53):
Yeah, I basically I first of all, I think it's
I want to thank John for sharing with us this experience,
because we don't hear enough of success stories of people
that have been able to overcome their addiction and completely
go back to having a very fulfilling life, which is
what I basically heard expressing certainly one that he has
(09:15):
feel proud about and speaking about his own family. I
think that the message that we need to understand is
that addiction instead is an opiod addiction that can be treated,
and that people recovery and can lead normal lives. The
aspect about it right now that we also need to
(09:35):
emphasize is that the illicit drug supplies is extremely dangerous
because of the contamination of anannil.
Speaker 5 (09:42):
So as a result of that, your likelihood of.
Speaker 13 (09:44):
Dying if you take these drugs is much higher than
what it was one decade ago. And in this respect,
for example, medications that we use for treating people with
opio due disorder actually not just allowed to decrease the
craving and desire for the drug and to cont roll
that we draw, but they protect you from dying from
an overdose. So they are very very useful medications and
(10:07):
we should make them available. And so the extent to
which then that we build will help that person rebuild
their life. And at one point, and we're starting this
is to help us understand when the person can be
tapered from those medications. Currently, we recommend long term treatment
with the use of norphin, metadon or vv trol as
(10:31):
basically the most effective way to address the craving that
we draw and to prevent from overdoses.
Speaker 1 (10:38):
And I want, I want to get more into some
of the things you just spoke about, including in the
lock zone and other ways that we can deal with
situations where people are dealing with overdoses. In a few moments,
and we've got many more calls coming in, but I
want to bring another thing up, Tolliver. You know, when
you look at polling on this issue, there is a
(11:00):
morning console pull that finds Americans most often blame Mexican
drug cartels for this crisis, followed by the users themselves.
Speaker 4 (11:10):
Yeah and Jeremy. There've also been so many lawsuits against
the drug companies, including Perdue Pharma, maker of oxyconton, and
you can probably see why when you hear this clip
from an internal Purdue marketing video from the nineteen nineties.
Speaker 14 (11:21):
Once you've found the right doctor and have told him
or her about your pain, don't be afraid to take
what they give you. Often it will be an opioid medication.
Some patients may be afraid of taking opioids because they're
perceived as too strong or addictive, but that is far
from actual fact. Less than one percent of patients taking
(11:44):
opioids actually become addicted.
Speaker 1 (11:47):
Wow, it sounds like the tobacco executives on Capitol Hill
those many years ago saying that nicotine was not addictive.
Stay with us more than Middle coming right up. This
is the Middle. I'm Jeremy Hobson. If you're just tuning
in the Middle as a national call in show, we're
focused on elevating voices from the middle geographically, politically, and philosophically,
(12:07):
or maybe you just want to meet in the middle.
My guest this hour doctor Nora Volkov, director of the
National Institute on Drug Abuse, and Beth Macy, author and
executive producer of Dope Sic, a book and now TV
series on Hulu. Her latest book is raising Lazarus and
we are talking about America's opioid crisis. We want to
hear from you. Have you been affected, what solutions are
(12:27):
working in your community? Tolliver, what's that number again?
Speaker 4 (12:30):
It's eight four four four Middle That is eight four
four four six four three three five three.
Speaker 1 (12:36):
Give us a call and let's get back to the phones.
Cody is joining us from Las Vegas. Cody, go ahead,
welcome to the Middle.
Speaker 15 (12:44):
Hi, thank you. I'm listening to here on KMPR, our
local station. I'm a nurse and a paramedic. When we
have big festivals like we do here in Las Vegas
and Nevada in general, the state and the public health
agencies providing a lock slon overdose kits on a no prescription,
just here, take it, here's how to use it, and
(13:05):
they provide free, no questions asked drug testing at major
festivals through the health departments, just to get the fentanel
out of there. What are the barriers to this being
a more universal action on the part of public health
and or communities in general. And thank you for your time.
Speaker 3 (13:22):
Thank you, Cody.
Speaker 1 (13:23):
Great question, Beth Macy, what about that? What are the
barriers to getting fentanyl test strips and the lock zone
more widely available, And is that do you think a
solution that could really make a difference.
Speaker 12 (13:35):
I think it could make a huge difference. And no,
lock zone is free in many states over the counter anyway,
the fentanyl test strips are largely distributed by health departments
in a more on the ground method by harm reduction groups.
And I love harm reduction because not only are they
(13:57):
handing out fentanyl test strips, clean use supplies, clean needles,
but there are also people who go to harm reduction
groups are five times more likely to eventually enter treatment
because people who are using drugs need to build back
those little threads of trust. And when you see that
(14:18):
start to happen, you start to bring in this forty
percent of American drug users who say they don't want
to stop using, who don't think they can get better.
And as a caller earlier mentioned people can get better,
Doctor Volcolm mentioned that we still are treating this as
not the disease that it is, and folks in active
(14:40):
use don't think they can get better, and Americans have
they also have a lot of skepticism about that. And
so first we've got to build up some hope with
this right, we've got to start to work on that
eighty seven percent treatment gap.
Speaker 1 (14:55):
Well, what do you mean we are not treating this
as the disease that it is.
Speaker 12 (15:00):
Well, I would say largely systematically, looking at everything, courts, cops, healthcare,
harm reduction, We're still treating it as a criminal action.
We're not treating it like a disease. The number one
a tool that the government uses is still incarceration, and
that's from a historic war on drugs that was racist
(15:23):
by design, that goes right back to Nixon trying to
shore up Southern votes and disproportionately incarcerate black and brown people.
We have all grown up thinking that people who use
drugs are moral failures and criminals, and most jails don't
offer treatment. They certainly many don't offer evidence based treatment
(15:44):
or medication assisted treatment. That's a real problem because when
you get out of jail, you're forty times more likely
to if you use again, to overdose and die because
you've been opioid nai.
Speaker 1 (15:57):
Let's go to another called Joyce is with us from Nashville, Tennessee.
Speaker 16 (16:01):
Hi, Joyce, welcome, Hi very and thank you and thank
you for taking my call and thank you for doing
this program.
Speaker 1 (16:10):
Go ahead, what's your what's your what's your experience with
opioids or do you is there a solution that you've
found that that could work in helping deal with the
crisis nationwide.
Speaker 16 (16:21):
Okay, I just want to say up front, you know,
like one, I am not a recovered person, and I
you know, I have other addictions, but not drugs, and
I don't want gold points for that. I've just done
it my way. I'm straight out in New York and
I've been in Nashville since nineteen seventy nine. So I
(16:41):
say all that. I started the first needle exchange program
with a minister and another Ron Crowder, who is a superstar.
So I'm not far into the work that we what
we're talking about tonight, but quickly though, everything that's been
said is absolutely correct in terms of black and brown
(17:05):
people are infected and affected by this disease right now,
and I call it people are being poisoned because of
the fetanyl. We talked about the teenagers. What's not being done?
The Health Department is really doing an outstanding job. I
work for a Harry. I am eighty one years old.
(17:26):
They hired me because I know the streets of Nashville,
and it's not politically correct, but like here, I am
doing this. But the issue of not in my backyard.
The pieces that are missing is things like what's going
on in New York. With one point, they have a
site which I understand and I may be incorrect on
(17:48):
this one. It's not funded by the city or the state.
They write grants like everything else that's being done even
here in Nashville, like everything is grant. There's no budget
for anything there is. Again, the Health Department does the
testing of the drugs. They have knock on.
Speaker 17 (18:07):
That's being right.
Speaker 16 (18:08):
Even now you can't you cannot get it over the
counter because well you can, but will bring CBS.
Speaker 15 (18:15):
It's fifty dollars.
Speaker 16 (18:17):
It's not free. You know. You can't go in and
say I need you know, and I want that to
be heard, or at least that's what it is here.
Speaker 1 (18:24):
Well, and Joyce, let me just stand by because let
me ask about that narcan uh doctor Volkov she said
it's about fifty dollars. I think it's fifty dollars for
two actually, but is that really how much of a
solution is that, because don't you have to be in
the right place at the right time with narcan in
order to in order for it to work. Well, you
(18:46):
know what, if somebody has an overdose and they're nowhere
near somebody with narcan, then.
Speaker 13 (18:50):
You cannot give them. You won't be able to revive them.
I mean that the challenge with the narcane is that
they dis are very effective medication, but you need to
and is there rapidly and adequate doses and so the issue.
That's why what was commented by the priy or as
a person that called was that making it widely accessible
(19:13):
for people at no cost is the ideal solution because otherwise,
while many people may be able to pay fifty dollars
for two doses of narcain, those that needed the most,
those that are in the highest vulnerable populations, fifty dollars
may make the difference or not of having it available
or not. So the notion of over the counter and
(19:38):
narcaine or naloxon made by approved by the FDA was
important because it gets success more access and it also
sends the message that this is such a safe medications
that the FDA approved that to be sold over the
counter alongside your dental supplies or your soap, so it
is it's felt as safe as that, but there have
(19:59):
been concerns that the price may be at the trent
that may limit its access for those that needed the most.
And we also have to ask ourselves the question, when
we're distributing narcan and a looxon, are we distributing a
sufficiently high doses such that the people that need it
(20:20):
will be able to use it. You don't want to
be in a situation that there's not enough sufficient narcin
to properly revert someone overdose and who has overdose. And
this is particularly urgent with fentanil because what we're hearing
and what researchers are documenting that when people overdose with fentanil,
(20:42):
they may need more than one dose of naloxon, they
may need two or three.
Speaker 5 (20:47):
So if you don't have sufficient doses.
Speaker 13 (20:49):
You may not be able to properly recover that person
and save them from time. So, yes, we want to
make it widely available but also accessible, that is to
say that people can afford it.
Speaker 1 (21:04):
You know, we we brought up fentanyls so much in
this program, I think we should we should say that
a lot of it is coming across the border. Fentanyl
seizures at the Mexico US border increased one hundred and
sixty four percent from twenty twenty to twenty twenty two.
In this year, twenty one and forty six pounds have
(21:24):
already surpassed what came in last year. Beth Macy, you know,
there are many people that, as we said earlier, a
lot of people blame Mexican drug cartells for this problem.
How much of the fentanyl problem is because it's coming
in from other countries.
Speaker 12 (21:44):
Well, the supply is obviously a huge part of the problem.
But if we simply cut it off, which a is
impossible without ruining, shutting down the border, and messing up
the economy, we still have this huge demand for drug use.
(22:05):
We have seven million people with opioid use disorder. According
to the latest numbers I read out of a study
in Science last year. It was four times more than
what was previously known. And until we begin offering treatments
at the scale to match the crisis, we're gonna still
have that demand. And you have folks going for xylazine,
(22:26):
which is a veterinarian tranquilizer. Now people are going to
figure out other ways to not be dope sick, and
so we've really got to work on making the treatments
easier to get than the dope.
Speaker 1 (22:41):
Let's go to another called Joshua is joining us from Chicago. Joshua,
welcome to the middle Go.
Speaker 9 (22:46):
Ahead, Hi guys, thank you, and no thanks for taking
my call. So ready with Joshua and from Chicago. And
I'm going to kind of come at this at a
little bit different angle and a side of the fence.
I'm a disabled veteran. I've been disabled for twenty three years.
(23:06):
They had three tours to erect three nine to eleven.
I was shot three times and my left leife from
the knee down that was blown off. I suffer pain.
And I'm going to tell you the biggest culprit in
the beginning of this was our government was the VA themselves.
(23:28):
They sent me to a pay management doctor and the
doctor wanted to give me twelve NORCO a day, eight BC,
a profen and a fentantyl patch. And I looked at
him and I said, are you out of your mind?
Speaker 6 (23:42):
Now?
Speaker 9 (23:42):
You're gonna kill me. And I've seen too many of
my friends in the same situation that sat in the
corner for thirty days drewing from their mouth because they
were sold loaded up with the opioides. And I'm going
to tell you that. You know, so there's a difference
between want in need. I think in addiction, you you
(24:03):
want want, want. But then on the other side of
the fence, people like me who who rely on the
medication and and need it to to have a better
quality of life. We're affected because of of the big
opioid crisis, and everybody points a finger at it, and
doctors are so scared to treat patients in that that
(24:27):
what's happening is patients that have have have been on
a program and everything are cut off and they go
to the streets and minory in Chicago. It's not the opioids,
it's them. It's people who get cut off of the
medications and they go to the streets and the next
thing you know, they're they're they're they need something. So
(24:50):
they're getting uh it's vent and dollar something synsotic and
and folks, don't get me wrong here, and I'm not
going to say this so education. Nobody really talks about education.
I have a great doctor, now I have a pain
management contract with her. I am your ine tested every month,
(25:12):
and you know where I'm at. No all noois. They
can track you through a system, so they know if
I'm doctor Hoppy.
Speaker 1 (25:24):
Let me let me, let me take your call to
our to our guests, and first of all, thank you
for your service as well, and thank you for calling
in doctor Volkoff. We actually got a couple of voicemails
on this issue of people who say, look, I actually
do need the pain medication and the fact that doctors
are afraid to prescribe it now because of the opioid
crisis is making it more difficult for me to get it.
Speaker 13 (25:47):
Yeah, and it couldn't injury it, just like your caller said,
because if they have very severe pain and very intense
I mean pain is a very aversive state, then your
brain wants to get out of it. So people then
may choose to go and buy illicit substances as a
means to control their pain, and that may put them
at much higher risks of dying from overdoses. So we
(26:12):
need to realize that pain initiated these over those crisis
and the way that it initiated in many ways reflected
how neglected it has been as a field in medicine.
We haven't invested sufficient resources to understand actually the different
types of pain that exists. We do not know how
(26:34):
to properly treat it. We don't get educated properly on
management of pain, and we don't have many alternative medicines.
We do have some analgastics, but some of these analgatics
don't work for chronic severe conditions of pain. And there
hasn't been sufficient investment by an industry on the medications
(26:55):
that can actually be safe for managing pain. And when
there are alternative treatments for pain, there are more costly,
so insurances don't pay them. So there are more any
structural issues that exist that have perpetuated at first originated
these over those crisis, as was pointed earlier in the program,
(27:16):
but also that continue to make pain a major challenge
and cornering people that have no alternatives. When there are
opiod medications in cases where it was offering some relief,
they cannot get access to them because physicians are so
don't want to.
Speaker 5 (27:32):
Prescribe them anymore.
Speaker 13 (27:34):
So we are a country that is so very polarized.
It's either we become over complacent and give opioid medications
to anyone or we don't. We basically say no, we don't,
We're not going to give them, when in reality we
need to understand how to properly utilize them and how
to help patients that are suffering from pain lead productive lives.
Speaker 5 (27:57):
Even if it does, it means and this is something.
Speaker 13 (28:00):
That we're changing, that they may have to learn to
live with some level of pain, but despite but they
can achieve things that in their life, they can leave
their life so that we minimize negative effects. And as
an area of research, we see the responsibility that we
have certainly at the nih of advancing the science so
(28:23):
that we can provide better treatments for people that need them,
because pain is not a rare condition. I mean it's
a very very common, frequent presentation and if not treated properly,
can lead to actually very devastating outcomes such as suicide
or overdoses.
Speaker 1 (28:42):
We're also hearing from people who have written in via email.
You can go to our website Listen to the Middle
dot com to do that. We're also on social media
in most places at Listen to the Middle. Buffy in
New Orleans asks, we know people are going to use drugs,
so why help them not die, get hurt, or get
(29:02):
sick again. You can reach out at listen to themiddle
dot com, you know, tolliver and we're waiting for more calls.
We've got some more calls on the line. We're going
to get to them in a few moments. But this
opioid crisis, as we've said, has been going on for
many years. It is not a Republican crisis, and it
is not a Democratic crisis.
Speaker 3 (29:23):
Yeah.
Speaker 4 (29:24):
Absolutely, And in fact, both Republican and Democratic presidents have
you know, promised to solve the crisis over the last
couple decades. Check this out.
Speaker 2 (29:31):
It's important to recognize that today we are saying more
people killed because of opioid overdose than traffic accidents.
Speaker 18 (29:42):
In the last Congress, both parties came together to pass
unprecedented legislation to confront the opioid crisis.
Speaker 19 (29:53):
Addiction touches families in every community in red states and
blue states, across all races, creeds. The crisis is national,
but the struggle is personal, deeply personal.
Speaker 1 (30:06):
And given the current trajectory, President Biden is probably not
going to be the last president to talk about the
opioid crisis. Stay with us more than middle coming right up.
This is the Middle. I'm Jeremy Hobson. We're talking about
finding solutions to America's opioid crisis. My guests are doctor
Nora Volkov, who is director of the National Institute on
(30:27):
Drug Abuse, and Beth Macy, author of Dope Sick and
the new book Raising Lazarus, Hope, Justice, and the Future
of America's opioid Crisis. Our number is eight four four
four Middle. That's eight four four four six four three
three five three, or you can reach out at listen
to Themiddle dot com. Let's go to another call. Jennifer
is joining us from Minneapolis. Jennifer, Welcome to the Middle.
Speaker 11 (30:51):
Thank you very much.
Speaker 3 (30:54):
We'll go ahead, just.
Speaker 6 (30:57):
Go for I'm waiting to uh.
Speaker 11 (31:01):
Make a plain reservation to go back to Philadelphia. On
June twenty fourth, my son was shot in the head
buying ventana on the street in Philadelphia. He's been in
he's been in another treatment. I've been waiting for a
shoot to drop and for some odd reason like him
getting shot in the shoulder was like the biggest blessing
(31:22):
because he's tried to break this addiction. He's been through
treatment three times and he just goes back, he's lived
on the streets, he's homeless, he's been various things. He
went to a very prestigious prep school on the East
Coast and six of his classmates are gone out of
(31:44):
a very small number of people from a very privileged class.
And that alone says that this thing is not it's everywhere,
it's it's it's it's not somebody else's problem.
Speaker 1 (32:01):
And do you see do you see anything that is
that that may be a light at the end of
the tunnel for him, for you as you navigate.
Speaker 11 (32:12):
I think, like I said, this odd thing that I mean,
he gets shot, right, he didn't get shot directly in
the head, It went through his shoulder, grazed his head,
caused a brain bleed. So he's been without a cranium
for six months. So he's in the hospital. He's in
the ICU and traumatic brain injury unit, and he would
(32:33):
it saved his life. And he woke up and I
was like, he just got a resa. But he's on
the box zone and reading about that. It's like another issue, right,
we need to help people who are addicted to this
drug at every level, on a community level. We can't
(32:55):
ostracize them. We can't say they aren't criminals. My son
is not a criminal. I he's not. It's just it's
it's it's portrayed as this thing that is on the
other side of somebody else's spends, you know, right, And
I don't Jennifer anything.
Speaker 1 (33:17):
Thank you so much for for that call, and you know,
the best of luck as you as you help your
son through this.
Speaker 3 (33:25):
I really appreciate you calling in.
Speaker 6 (33:27):
Uh.
Speaker 1 (33:28):
I want to go to both of our guests on this,
but doctor Volkov, you you've you've gained notoriety for talking
about the benefit of not treating this as not not
looking for punishment but rather for treatment when you deal
with people who are addicted.
Speaker 13 (33:46):
Yeah, and I think that. I mean, what is clear
is that criminalizing a person because they take drugs or
because they are addicted, it basically not just continues to
stigmatize them, but it also makes them much less likely
to want to go and seek help. And this in
turn is something that leads them to have lower self esteem,
(34:09):
to stigmatize themselves and make them so much more vulnerable
to actually try to take drugs to escape. So it
isolates them and so absolutely, I the science shows that
when someone is addicted that they don't control the urges
that they have the need. And I was listening to
(34:29):
a color earlier that said, the differences between one thing
I needing and one thing drugs may emerge at the
beginning when someone experiments, but once they become addicted, it's
not that they want a drugs. They need them, and
their body perceives it as an instinctual need of food
or water or even air in order to be able
(34:50):
to breed, so it's not a criminal behavior.
Speaker 5 (34:54):
Is the transformation.
Speaker 13 (34:55):
That has happened in the brain of a person that
now has this instinctive, artificial need for drugs that are
perceived as necessary for survival. And this is why it
becomes such a powerful motivating drive for the person that's addicted,
and that's why we conceptualize it in the process that
the person needs to be treated in order to be
(35:18):
able to control those strong urges to take the drugs
and to also help them control that withdrawal that leads
them otherwise to take drugs and suboxone. Gubernorphin is a
medication that is very useful to help people achieve this goal,
to stabilize them and with time this allows them to
(35:41):
get back into their everyday life and eventually recover. So
because that's a message that I think is crucial that
we keep on doing. Number One, addiction to opios can
be treated and you can recover.
Speaker 12 (35:56):
That Maysie, Yeah, I mean that was hartly why it
was so important for us with this Hulu show to
show how hard it is for people to access treatments
like suboxone. You see an A list actor like Michael
Keaton struggle to get on a method, stigmatized right and left,
struggled then to get on suboxone when that becomes available,
(36:20):
and then eventually becoming a helper in his community. This
is straight out of the pages of my nonfiction book,
straight from the storyline of doctor Steve Boyd in rural Tennessee,
who who became a leader in providing addiction care. If
we could change the thinking that doctor Valcov talks about,
(36:41):
and we could begin to treat addiction as a disease, when,
for instance, people are coming into the ed for emergency
room for an overdose and rather than just fix whatever
they're in there for narcan or maybe correcting on abscess,
actually connect them to support services, connect them to pupen orphine, clinics.
(37:04):
I mean, we know we have years of research showing
that works. And similarly with jails, when people begin to
get treated and so that at the moment of release,
which is so critical, such a time when they're much
more likely to overdose and die, we see them get
a warm handoff to appear and to the next place
to stay, connections to housing, connections to care. I mean,
(37:28):
it makes all the difference in the world.
Speaker 1 (37:31):
Let's go to another call that has come in. Raphael
is joining us from draper Utah. Raphael, welcome to the
middle go ahead.
Speaker 5 (37:42):
Hey.
Speaker 7 (37:42):
Yeah, So from my experience, those drugs have not provided
the escape that you guys are suggesting, because they are
just as addictive and withdrawals are very rough when you
(38:03):
come off of deep in North Green and suboxone and
all those other drugs as replacements. But my main question
is all the billions of dollars that are coming from
like Johnson and Johnson that produce family. It's a Sackler family.
(38:24):
While Mari cvs like all them, like where is that
money going? Like there are all these communities and lives
that are just ruined, and like are they saying any
of that? Like like where is it going. There's billions
of dollars just floating out.
Speaker 3 (38:40):
There, Beth may see.
Speaker 12 (38:44):
Yeah, well, the problem is that every state has a
different plan for how they're going to use the money.
And we've already seen some early reporting from Kaiser Family
Foundation showing that, you know, some of that money is
going to same old, same old drug war cops, cops, cars,
and more jailing. When we know that simply doesn't work.
(39:06):
We need to make the treatments easier to access, whether
that is in walk in centers. Huntington, West Virginia, which
had twenty six overdoses in one day, now has walk
in centers where people can come in and get connected
to care. I feel like every health department should be
offering harm reduction services and connections to care.
Speaker 1 (39:29):
Let's go to another called. Jeff is joining us from Boise, Idaho. Jeff,
Welcome to the middle.
Speaker 17 (39:35):
Hey, Jamaine, thank you, thanks for calling.
Speaker 3 (39:39):
Go ahead.
Speaker 17 (39:41):
Yeah, so great topic. It's just this is a god thing.
I'm actually on my way to treatment as we speak.
Speaker 5 (39:49):
Wow.
Speaker 17 (39:49):
And I'm an an alcoholic addict and it is a
disease and I'm glad they finally acknowledged that that made
it easier for me to it's easier for the swallow,
so speak. So I actually overdose on set mall two
days ago. I tried it because it was available and
(40:13):
I was going to withdrawals. I've been taking Kreative, which
is a legal plant that comes out of Indonesia, but
it hits the opioid receptors and you don't go to withdraws.
And I've been on it for years. And I ran
out and I started going to withdraws and I tried
the set mall and sure enough, within minutes, you know,
I was done. And luckily they had the narcamp there
(40:36):
I think it's called, and they gave me two doses
of that. It took two doses, you guys nailed earlier.
If there was only windows, I would be dead. And yeah,
I died. So I got up and I'm like, okay,
I'm done. I'm going to treatment. So I've been. I've
been to treatment twice. This time was in Utah. It
(40:57):
was a very very nice place, I mean top of
the line, thirty thousand dollars a month. I was there
for three months and I didn't want to leave. It
was amazing. But when I got out, what shock me
was the afterchair. There was none. They said, okay, right,
your exit plan, you know your aftercare plan, and this
(41:20):
is what you're going to do. Where it was all
a tie in the sky and there was nothing there.
They said, go to meetings, good luck. So I relapsed
within ninety days. So I went back to another treatment center,
same deal, no aftercare. And it's a problem. The aftercare is,
in my opinion, is one of the most important aspects.
(41:42):
But this time I'm doing something different. I'm going through
the Wilderness program. I'm going to be at the wilderness
for fifty sixty days and there are some components in
aspects of addition to it, but I'm not going through
the same old treatment traditional rag I did before.
Speaker 3 (41:59):
Because app yeah, let me ask you.
Speaker 1 (42:02):
Let me take that to our guests. Thank you, Jeff,
I really appreciated, and good luck. Good luck in the
wilderness and trying to get a handle on this doctor Volkov,
what about that that that if you can find the
treatment that maybe it doesn't doesn't go on long enough
to actually do what it's supposed to do.
Speaker 13 (42:22):
I mean, this color has just his finger on the
falls of one of the main problems that we have
in the treatment programs in for a substantious disorder in
our country that there's no continuity of care. I mean,
addiction is a chronic disease and it requires treatment for
a very long time period, just like with hypertension antiabetes.
(42:42):
So this notion that you go to a three month
program and you're going to be able once you live
there to go back to a normal life without need
and urges and craving is basically magical thinking. And the
problem that we're observing is that many of these in
patient programs that actually are very very nice, and while
(43:04):
you are there it seems to be working, don't have
the referral system that will ensure that once you live
that that intense service, that intense treatment, you will have
someone that monitors your care as you proceed. And in fact,
for example, what the stoys have shown is that the
(43:26):
best outcomes occur in those that have been sustained for
treatment for five years. Initially is more intense, and as
you go through time that frequency and the intensity or
the intervention goes down and not very similar to what
you see with cancer, of course, I mean at the beginning,
you undergo treatment and then they are checking you up
(43:48):
every few weeks or months, and then they get paste
off until there's a point that says, you know, you
just achieve recovery. The same situation happens with addiction, but
we don't have the structure nor we have the ways
of overseeing that the treatments are providing the support that
(44:09):
a person will need throughout the chronic state until they
achieve recovery. So continuity of care is crucial for success,
and we need these need to be addressed in a
more systematic way in the treatment programs we offer in
our country.
Speaker 1 (44:27):
You know, we have heard from so many people with
personal stories this hour about getting help, getting treatment. Beth Macy,
I'm sure there are a lot of people who have
family members, who have friends who are not at that
point yet, who may be using maybe you know, taking
opioids in a way that they shouldn't be for their
(44:49):
own health, and they have not admitted that they it
is something that they need to get treatment for at
this point.
Speaker 12 (44:57):
Right, the latest study when I turned raising Lazarus in
twenty seventeen, one third of American families were in experienced
strife because of this issue. Just now, a recent survey
it's now two thirds of American families are impacted by this,
and yet you know, our treatment rates, our overdose rates
(45:19):
aren't getting any better, and it is so so hard
for family members to deal with I mean, I have
gotten close to so many families that have struggled with this,
and there just isn't an easy answer other than continuing
to connect folks to care. You know a woman I
(45:42):
followed for DOSIC who ended up dying after two and
a half years of addiction. You know, her mother said, well,
if she just hits rock bottom, then she'll snap out
of it. And you know she now says, you know,
rock bottom had a basement, and the basement had a trapdoor.
So we all got to do our research so that
we begin to shift the way we culturally think of
(46:06):
this and start to think of it as a disease
not just a moral failing.
Speaker 1 (46:14):
Just before we wrap up this hour, Tolliver, I know
we've been getting some comments online. Maybe there's somebody with
a question that we can get to.
Speaker 4 (46:22):
Yeah, I absolutely love this question. Casey asks, does the
criminalization of drugs and Portugal work? Is that a blueprint
for us? Do you know what I mean?
Speaker 3 (46:30):
Doctor Volkov?
Speaker 1 (46:31):
Is there any answer to that is another person had
written in about the same thing.
Speaker 3 (46:34):
What about decriminalizing things?
Speaker 13 (46:37):
Yeah, and I think that it is a very interesting proposition.
And I think then when we speak about the criminalizing droves,
we need to understand that there are different ways of
decriminalizing it. And since you asked about Portugal, one of
the things that Portugal did is just not just.
Speaker 5 (46:53):
That the criminalization of trugs.
Speaker 13 (46:54):
So you don't end up in jail if if they
find you with drugs. But what they did was they
provide treatment that a person needs. So they find drugs
on you, you go to treatment. And when we do
other other other states are the criminalizing drugs or other countries,
they don't necessarily provide a treatment that is necessary to
(47:14):
provide the support to a person.
Speaker 5 (47:16):
So just saying we're.
Speaker 13 (47:17):
Going to the criminalize and not provide support that we
all counterbal as the entry of drugs that risk associated
with them could actually result in negative consequences. On the
other hand, if you decriminalize the drugs and you provide
support and education. And one of the things that we
haven't spoken at all doing the program is the notion
(47:39):
of prevention. How do we protect people, how do we
bring build resilience so that people don't get addicted to it,
and that is something else that has to be assigned
with the criminalizing.
Speaker 1 (47:51):
Well, you can reach out for more at Listen to
the Middle dot com. You can also leave us a
message at eight four four four six four three three
five three. I want to thank my guest doctor Norvolkov,
director of the National Institute on Drug Abuse, and Beth Maacy,
author and executive producer of Dope Sic, a book now
at TV series on Hulu, and her latest book, Raising Lazarus.
Speaker 3 (48:11):
Thanks to both of you for joining.
Speaker 12 (48:12):
Us, Thank you for having us, Thanks a lot.
Speaker 1 (48:17):
And join us next week, same time, same place, Tolliver,
what is our topic for next week's show?
Speaker 4 (48:22):
Well, this might sound familiar to Jeremy because it was
supposed to be our topic last week but got bunked.
The topic is are our political leaders too old?
Speaker 3 (48:31):
Okay?
Speaker 1 (48:31):
And that means President Biden, former President Trump, Mitch McConnell,
on and on. We're not picking on any one candidate again.
We're at eight four four four Middle. You can leave
a voicemail there or call in live next week, or
go to Listen to the Middle dot com. And while
you're there, you can sign up for our weekly newsletter.
The Middle is brought to you by LONGNOK Media, produced
by Joanne Jennings, John Barth, Harrison Patino, Danny Alexander, and
(48:52):
Charlie Little. Our technical director is Jason Croft. Thanks this
week to WUNC and Chapel Hill, North Carolina, to our
partners at Illinois Public MEANT, Nashville Public Radio, iHeartMedia, and
all the stations that are making it possible for people
across the country to listen to the Middle. I'm Jeremy Hobson.
Talk to you next week.
Welcome to the Middle I'm Jeremy Hobson along with Tolliver.
Speaker 2 (00:08):
Hi.
Speaker 3 (00:08):
Tolliver, Hey, how's it going.
Speaker 4 (00:10):
Jeremy. Hey, I just want to let our listeners know
I had a show last night and a recording session,
so if I hit puberty during the show.
Speaker 5 (00:17):
That's where that is.
Speaker 3 (00:18):
Okay.
Speaker 1 (00:19):
Well, it's good to have you here tonight, and we
also welcome the listeners across the state of Wyoming on
Wyoming Public Media to the show. And what a week
of news it has been. President Biden was in Israel,
the war there continues, huge protests around the Middle East,
concerned about a worsening humanitarian situation in Gaza, and just
(00:39):
heartbreaking interviews with family members of the Israeli hostages. Now,
last week on the show, the war was our topic
and we got many more calls than we could get
on the air. Here are just a few of them.
Speaker 6 (00:51):
Oh my name is Tom.
Speaker 5 (00:52):
I'm calling from clear Water, Florida.
Speaker 6 (00:54):
Hi.
Speaker 5 (00:54):
My name is Justin Stewart.
Speaker 7 (00:55):
I'm calling from Houston, Texas.
Speaker 8 (00:57):
Hi.
Speaker 9 (00:57):
My name is Alie.
Speaker 7 (00:58):
I'm in Hi.
Speaker 10 (01:00):
Jeremy, this is from Pittsburgh. How the hell is Israel
supposed to try to make peace with neighbors who want
Israel to not exist.
Speaker 8 (01:12):
Why it's okay to call from US terists when they
kill children and civilians, and it's not okay to call
Israel the same.
Speaker 5 (01:20):
I am a staunch conservative.
Speaker 11 (01:22):
I am not pro Israel, I am not pro Palestine.
Speaker 7 (01:25):
But I want to know why is this happening?
Speaker 6 (01:27):
What is the root?
Speaker 5 (01:28):
Why is this even a thing.
Speaker 8 (01:31):
We hear one It's like last past Away was killed,
but it's twenty people of Placinias.
Speaker 7 (01:36):
I'm being killed.
Speaker 8 (01:37):
Nobody cares about that and never standard to the wall
Placinians leaves in the biggesty world of a puism. Why
can't you leave some piecee d A problems coming from.
Speaker 1 (01:51):
Well, we could have easily done another show about what's
going on in the Middle East, and maybe we'll we
will need to do that next week. But there is
a topic that often gets pushed side by other news,
even though it is killing hundreds of Americans every day
and will likely kill a record number of Americans this year.
That would be the opioid crisis. And what we want
(02:11):
to know from you this hour is what solutions are
working in your community when it comes to dealing with
the opioid crisis, which has been going on for many years. Tolliver,
can you give them our phone number please?
Speaker 4 (02:24):
Yes, it's eight four four four Middle. That's eight four
four four six four three three five three. You can
also write to a set listen to the Middle dot
com and you can find our social media handles there
as well.
Speaker 1 (02:35):
And before we take calls, let's meet our panel. Joining
us from Roanoke, Virginia Beth Maacy, author of the book
Dope Sic, which has been adapted into a Hulu series.
She has a new book out called Raising Lazarus, Hope, Justice,
and the Future of America's overdose crisis.
Speaker 3 (02:48):
Beth Macy, Welcome, thanks.
Speaker 12 (02:51):
For having me, appreciate it.
Speaker 3 (02:53):
It's great to have you.
Speaker 1 (02:54):
And we're also joined from Phoenix by doctor Nora Volkov,
director of the National Institute on Drug Abuse. That's a
federal agency that funds scientific research on the health aspects
of drug use and addiction. Doctor Volcoff, welcome to you.
Speaker 13 (03:07):
Thanks very much, Jeremy, and thanks for having me well.
Speaker 1 (03:11):
And I want to before we get to our callers,
ask each of you a question. In doctor Volkov, let
me just ask you if you could define the opioid
crisis right now. It's been going on for many years,
but what is it in the United States in twenty
twenty three.
Speaker 13 (03:26):
Well, we see a crisis that actually has reached the
highest levels in terms of mortality that.
Speaker 5 (03:32):
We have ever seen.
Speaker 13 (03:34):
Is also a much more complex crisis than it was
two decades ago because though we now see that the
main cause of driving the mortality is fentanil, which is
a synthetic opio we are more frequently seeing it combined
with other drugs like cocaine or metaphetamine or sila sin.
So this has made the control of the crisis so
(03:56):
much more harder because people that want to take cocaine
may not be seeking fentanil, may end up with a.
Speaker 5 (04:03):
Drug that contains a mixture.
Speaker 13 (04:05):
So we have seen that diversification of the people that
actually across all demographics that actually where we're seeing overdoses
from fentanyl or drow combinations.
Speaker 1 (04:17):
And when you talk about people who they want to
do cocaine or methamphetamine and then there's fentanyl mixed in,
does that then lead to an accidental overdose or does
that get them addicted to fentanyl?
Speaker 5 (04:31):
Well, it can happen both ways.
Speaker 13 (04:33):
It can lead to someone without knowing that they become
physically dependent to the opioid and they don't realize why
they feel so uncomfortable when they are not taking their cocaine,
and then that may lead them to just look at
products that have fentanil. Eventually that could result in an
overdose or there. When someone is not seeking fentanil doesn't
(04:56):
know that they're taking it, they don't have the tolerance
that usually someone that's taking opious whether it's heroin or
prescription or opiate medications have, so they have higher risk
of dying from it.
Speaker 5 (05:06):
So in this respect, some use that term that people are.
Speaker 13 (05:10):
Dying because they are being poisoned by consuming a substance
that they didn't know they had. But the reality is
it's an overdose driven in many instances by fentanil and
by the exacerbated letality when these drugs are combined. So
you have hiri risk when you have stimulants with fentanyl,
(05:30):
or alcohol with fentannil, or benzodiazepines with fentanyl.
Speaker 1 (05:35):
Beth Masie, you've been covering the opioid crisis for years.
Speaker 3 (05:37):
How would you define it right now?
Speaker 12 (05:40):
I would say doctor Volkov nailed it. I would also
point out the fact that, you know, I think we
lost for the first time. We lost over a thousand teenagers.
And these weren't people who were addicted per se. They
were experimenting like many teenagers do, and instead of taking
a xenax, they bought off the street, it was actually
a fatanyel. So the drugs are just getting more dangerous,
(06:04):
and until we start to make the treatments easier to
access than the dope, we're going to continue to see
an increase in overdose deaths.
Speaker 1 (06:15):
Let's get to a call. We're getting a few that
are coming in right now. I'm going to go to John,
who's on the line from Boulder, Colorado. John, go ahead,
welcome to the middle.
Speaker 6 (06:26):
Hey, thank you very much for having me in the middle.
M'ch appreciate it. Yeah, I actually agree with at what
she said. At the same time, I would feel like
our schools are not doing enough. I think our parents
are more scared about this and not talking to kids
about it enough. I have two teenage daughters, and I
obviously have a very open door policy with them, being
a former addict and alcoholic myself going through it ten
(06:49):
years sober, but The one thing that really kind of
scares me is I still see a doctor about this
and he has runs a clinic where he's giving out
maybe two winored durines to check for drug that they're
on and he hasn't seen heroin in over two years.
All his urines are all fentanyl. That st shows you
how bad it is in Denver. So I don't think
we're doing enough. Obviously, not a stone is a very
(07:11):
big step, but I think people really have to understand
the consequences of what withdraw does, how much you screw
up your life, the shame. It's not enough that's being
brought out that an attic has to kind of go
through it to understand it. And I think overall there's
needs to be more than has to happen on the
school level, but also on the whole level as well
too well.
Speaker 1 (07:30):
And actually I read that it takes the average opioid
addicted person eight years and five to six treatment attempts
to achieve one year of sobriety. John, Since you say
you're a former addict yourself and congratulations on being sober
for ten years, what was there something that you would
(07:50):
counsel other people on how to do that how to
do what you did?
Speaker 6 (07:54):
Yeah, people have to do it their way, you know.
I mean being in the rooms really kind of brought
up a lot of like war story is that really
kind of hurt me. It made me feel more shame.
Uh So I kind of did it myself. And I
you know, I tapered off this the box one, which
is worse than getting off heroin. And then I take
subbloicated a couple of times and I finally forgot about
it and it finally went away. But overall, you know,
(08:15):
from switching one drug to another, it doesn't work really well.
Uh you need to switch your lifestyle around. And that's
that's something I've done. But you know, lost one hundred
pounds since I quit using drugs and swim every single day.
And overall, I gotta tell you what, I've never had
a better relationship with my kids after beating heroin and
and and overall, that's that's that's what to live for.
(08:35):
And and and then I missed out on a lot
and there's a lot of shame there too, So I'm
still getting over that part. It doesn't go away very
very very easily.
Speaker 1 (08:43):
So yeah, well, John, thank you so much for your call.
Really appreciate it, doctor Volkov as you listen uh there
to John your thoughts.
Speaker 13 (08:53):
Yeah, I basically I first of all, I think it's
I want to thank John for sharing with us this experience,
because we don't hear enough of success stories of people
that have been able to overcome their addiction and completely
go back to having a very fulfilling life, which is
what I basically heard expressing certainly one that he has
(09:15):
feel proud about and speaking about his own family. I
think that the message that we need to understand is
that addiction instead is an opiod addiction that can be treated,
and that people recovery and can lead normal lives. The
aspect about it right now that we also need to
(09:35):
emphasize is that the illicit drug supplies is extremely dangerous
because of the contamination of anannil.
Speaker 5 (09:42):
So as a result of that, your likelihood of.
Speaker 13 (09:44):
Dying if you take these drugs is much higher than
what it was one decade ago. And in this respect,
for example, medications that we use for treating people with
opio due disorder actually not just allowed to decrease the
craving and desire for the drug and to cont roll
that we draw, but they protect you from dying from
an overdose. So they are very very useful medications and
(10:07):
we should make them available. And so the extent to
which then that we build will help that person rebuild
their life. And at one point, and we're starting this
is to help us understand when the person can be
tapered from those medications. Currently, we recommend long term treatment
with the use of norphin, metadon or vv trol as
(10:31):
basically the most effective way to address the craving that
we draw and to prevent from overdoses.
Speaker 1 (10:38):
And I want, I want to get more into some
of the things you just spoke about, including in the
lock zone and other ways that we can deal with
situations where people are dealing with overdoses. In a few moments,
and we've got many more calls coming in, but I
want to bring another thing up, Tolliver. You know, when
you look at polling on this issue, there is a
(11:00):
morning console pull that finds Americans most often blame Mexican
drug cartels for this crisis, followed by the users themselves.
Speaker 4 (11:10):
Yeah and Jeremy. There've also been so many lawsuits against
the drug companies, including Perdue Pharma, maker of oxyconton, and
you can probably see why when you hear this clip
from an internal Purdue marketing video from the nineteen nineties.
Speaker 14 (11:21):
Once you've found the right doctor and have told him
or her about your pain, don't be afraid to take
what they give you. Often it will be an opioid medication.
Some patients may be afraid of taking opioids because they're
perceived as too strong or addictive, but that is far
from actual fact. Less than one percent of patients taking
(11:44):
opioids actually become addicted.
Speaker 1 (11:47):
Wow, it sounds like the tobacco executives on Capitol Hill
those many years ago saying that nicotine was not addictive.
Stay with us more than Middle coming right up. This
is the Middle. I'm Jeremy Hobson. If you're just tuning
in the Middle as a national call in show, we're
focused on elevating voices from the middle geographically, politically, and philosophically,
(12:07):
or maybe you just want to meet in the middle.
My guest this hour doctor Nora Volkov, director of the
National Institute on Drug Abuse, and Beth Macy, author and
executive producer of Dope Sic, a book and now TV
series on Hulu. Her latest book is raising Lazarus and
we are talking about America's opioid crisis. We want to
hear from you. Have you been affected, what solutions are
(12:27):
working in your community? Tolliver, what's that number again?
Speaker 4 (12:30):
It's eight four four four Middle That is eight four
four four six four three three five three.
Speaker 1 (12:36):
Give us a call and let's get back to the phones.
Cody is joining us from Las Vegas. Cody, go ahead,
welcome to the Middle.
Speaker 15 (12:44):
Hi, thank you. I'm listening to here on KMPR, our
local station. I'm a nurse and a paramedic. When we
have big festivals like we do here in Las Vegas
and Nevada in general, the state and the public health
agencies providing a lock slon overdose kits on a no prescription,
just here, take it, here's how to use it, and
(13:05):
they provide free, no questions asked drug testing at major
festivals through the health departments, just to get the fentanel
out of there. What are the barriers to this being
a more universal action on the part of public health
and or communities in general. And thank you for your time.
Speaker 3 (13:22):
Thank you, Cody.
Speaker 1 (13:23):
Great question, Beth Macy, what about that? What are the
barriers to getting fentanyl test strips and the lock zone
more widely available, And is that do you think a
solution that could really make a difference.
Speaker 12 (13:35):
I think it could make a huge difference. And no,
lock zone is free in many states over the counter anyway,
the fentanyl test strips are largely distributed by health departments
in a more on the ground method by harm reduction groups.
And I love harm reduction because not only are they
(13:57):
handing out fentanyl test strips, clean use supplies, clean needles,
but there are also people who go to harm reduction
groups are five times more likely to eventually enter treatment
because people who are using drugs need to build back
those little threads of trust. And when you see that
(14:18):
start to happen, you start to bring in this forty
percent of American drug users who say they don't want
to stop using, who don't think they can get better.
And as a caller earlier mentioned people can get better,
Doctor Volcolm mentioned that we still are treating this as
not the disease that it is, and folks in active
(14:40):
use don't think they can get better, and Americans have
they also have a lot of skepticism about that. And
so first we've got to build up some hope with
this right, we've got to start to work on that
eighty seven percent treatment gap.
Speaker 1 (14:55):
Well, what do you mean we are not treating this
as the disease that it is.
Speaker 12 (15:00):
Well, I would say largely systematically, looking at everything, courts, cops, healthcare,
harm reduction, We're still treating it as a criminal action.
We're not treating it like a disease. The number one
a tool that the government uses is still incarceration, and
that's from a historic war on drugs that was racist
(15:23):
by design, that goes right back to Nixon trying to
shore up Southern votes and disproportionately incarcerate black and brown people.
We have all grown up thinking that people who use
drugs are moral failures and criminals, and most jails don't
offer treatment. They certainly many don't offer evidence based treatment
(15:44):
or medication assisted treatment. That's a real problem because when
you get out of jail, you're forty times more likely
to if you use again, to overdose and die because
you've been opioid nai.
Speaker 1 (15:57):
Let's go to another called Joyce is with us from Nashville, Tennessee.
Speaker 16 (16:01):
Hi, Joyce, welcome, Hi very and thank you and thank
you for taking my call and thank you for doing
this program.
Speaker 1 (16:10):
Go ahead, what's your what's your what's your experience with
opioids or do you is there a solution that you've
found that that could work in helping deal with the
crisis nationwide.
Speaker 16 (16:21):
Okay, I just want to say up front, you know,
like one, I am not a recovered person, and I
you know, I have other addictions, but not drugs, and
I don't want gold points for that. I've just done
it my way. I'm straight out in New York and
I've been in Nashville since nineteen seventy nine. So I
(16:41):
say all that. I started the first needle exchange program
with a minister and another Ron Crowder, who is a superstar.
So I'm not far into the work that we what
we're talking about tonight, but quickly though, everything that's been
said is absolutely correct in terms of black and brown
(17:05):
people are infected and affected by this disease right now,
and I call it people are being poisoned because of
the fetanyl. We talked about the teenagers. What's not being done?
The Health Department is really doing an outstanding job. I
work for a Harry. I am eighty one years old.
(17:26):
They hired me because I know the streets of Nashville,
and it's not politically correct, but like here, I am
doing this. But the issue of not in my backyard.
The pieces that are missing is things like what's going
on in New York. With one point, they have a
site which I understand and I may be incorrect on
(17:48):
this one. It's not funded by the city or the state.
They write grants like everything else that's being done even
here in Nashville, like everything is grant. There's no budget
for anything there is. Again, the Health Department does the
testing of the drugs. They have knock on.
Speaker 17 (18:07):
That's being right.
Speaker 16 (18:08):
Even now you can't you cannot get it over the
counter because well you can, but will bring CBS.
Speaker 15 (18:15):
It's fifty dollars.
Speaker 16 (18:17):
It's not free. You know. You can't go in and
say I need you know, and I want that to
be heard, or at least that's what it is here.
Speaker 1 (18:24):
Well, and Joyce, let me just stand by because let
me ask about that narcan uh doctor Volkov she said
it's about fifty dollars. I think it's fifty dollars for
two actually, but is that really how much of a
solution is that, because don't you have to be in
the right place at the right time with narcan in
order to in order for it to work. Well, you
(18:46):
know what, if somebody has an overdose and they're nowhere
near somebody with narcan, then.
Speaker 13 (18:50):
You cannot give them. You won't be able to revive them.
I mean that the challenge with the narcane is that
they dis are very effective medication, but you need to
and is there rapidly and adequate doses and so the issue.
That's why what was commented by the priy or as
a person that called was that making it widely accessible
(19:13):
for people at no cost is the ideal solution because otherwise,
while many people may be able to pay fifty dollars
for two doses of narcain, those that needed the most,
those that are in the highest vulnerable populations, fifty dollars
may make the difference or not of having it available
or not. So the notion of over the counter and
(19:38):
narcaine or naloxon made by approved by the FDA was
important because it gets success more access and it also
sends the message that this is such a safe medications
that the FDA approved that to be sold over the
counter alongside your dental supplies or your soap, so it
is it's felt as safe as that, but there have
(19:59):
been concerns that the price may be at the trent
that may limit its access for those that needed the most.
And we also have to ask ourselves the question, when
we're distributing narcan and a looxon, are we distributing a
sufficiently high doses such that the people that need it
(20:20):
will be able to use it. You don't want to
be in a situation that there's not enough sufficient narcin
to properly revert someone overdose and who has overdose. And
this is particularly urgent with fentanil because what we're hearing
and what researchers are documenting that when people overdose with fentanil,
(20:42):
they may need more than one dose of naloxon, they
may need two or three.
Speaker 5 (20:47):
So if you don't have sufficient doses.
Speaker 13 (20:49):
You may not be able to properly recover that person
and save them from time. So, yes, we want to
make it widely available but also accessible, that is to
say that people can afford it.
Speaker 1 (21:04):
You know, we we brought up fentanyls so much in
this program, I think we should we should say that
a lot of it is coming across the border. Fentanyl
seizures at the Mexico US border increased one hundred and
sixty four percent from twenty twenty to twenty twenty two.
In this year, twenty one and forty six pounds have
(21:24):
already surpassed what came in last year. Beth Macy, you know,
there are many people that, as we said earlier, a
lot of people blame Mexican drug cartells for this problem.
How much of the fentanyl problem is because it's coming
in from other countries.
Speaker 12 (21:44):
Well, the supply is obviously a huge part of the problem.
But if we simply cut it off, which a is
impossible without ruining, shutting down the border, and messing up
the economy, we still have this huge demand for drug use.
(22:05):
We have seven million people with opioid use disorder. According
to the latest numbers I read out of a study
in Science last year. It was four times more than
what was previously known. And until we begin offering treatments
at the scale to match the crisis, we're gonna still
have that demand. And you have folks going for xylazine,
(22:26):
which is a veterinarian tranquilizer. Now people are going to
figure out other ways to not be dope sick, and
so we've really got to work on making the treatments
easier to get than the dope.
Speaker 1 (22:41):
Let's go to another called Joshua is joining us from Chicago. Joshua,
welcome to the middle Go.
Speaker 9 (22:46):
Ahead, Hi guys, thank you, and no thanks for taking
my call. So ready with Joshua and from Chicago. And
I'm going to kind of come at this at a
little bit different angle and a side of the fence.
I'm a disabled veteran. I've been disabled for twenty three years.
(23:06):
They had three tours to erect three nine to eleven.
I was shot three times and my left leife from
the knee down that was blown off. I suffer pain.
And I'm going to tell you the biggest culprit in
the beginning of this was our government was the VA themselves.
(23:28):
They sent me to a pay management doctor and the
doctor wanted to give me twelve NORCO a day, eight BC,
a profen and a fentantyl patch. And I looked at
him and I said, are you out of your mind?
Speaker 6 (23:42):
Now?
Speaker 9 (23:42):
You're gonna kill me. And I've seen too many of
my friends in the same situation that sat in the
corner for thirty days drewing from their mouth because they
were sold loaded up with the opioides. And I'm going
to tell you that. You know, so there's a difference
between want in need. I think in addiction, you you
(24:03):
want want, want. But then on the other side of
the fence, people like me who who rely on the
medication and and need it to to have a better
quality of life. We're affected because of of the big
opioid crisis, and everybody points a finger at it, and
doctors are so scared to treat patients in that that
(24:27):
what's happening is patients that have have have been on
a program and everything are cut off and they go
to the streets and minory in Chicago. It's not the opioids,
it's them. It's people who get cut off of the
medications and they go to the streets and the next
thing you know, they're they're they're they need something. So
(24:50):
they're getting uh it's vent and dollar something synsotic and
and folks, don't get me wrong here, and I'm not
going to say this so education. Nobody really talks about education.
I have a great doctor, now I have a pain
management contract with her. I am your ine tested every month,
(25:12):
and you know where I'm at. No all noois. They
can track you through a system, so they know if
I'm doctor Hoppy.
Speaker 1 (25:24):
Let me let me, let me take your call to
our to our guests, and first of all, thank you
for your service as well, and thank you for calling
in doctor Volkoff. We actually got a couple of voicemails
on this issue of people who say, look, I actually
do need the pain medication and the fact that doctors
are afraid to prescribe it now because of the opioid
crisis is making it more difficult for me to get it.
Speaker 13 (25:47):
Yeah, and it couldn't injury it, just like your caller said,
because if they have very severe pain and very intense
I mean pain is a very aversive state, then your
brain wants to get out of it. So people then
may choose to go and buy illicit substances as a
means to control their pain, and that may put them
at much higher risks of dying from overdoses. So we
(26:12):
need to realize that pain initiated these over those crisis
and the way that it initiated in many ways reflected
how neglected it has been as a field in medicine.
We haven't invested sufficient resources to understand actually the different
types of pain that exists. We do not know how
(26:34):
to properly treat it. We don't get educated properly on
management of pain, and we don't have many alternative medicines.
We do have some analgastics, but some of these analgatics
don't work for chronic severe conditions of pain. And there
hasn't been sufficient investment by an industry on the medications
(26:55):
that can actually be safe for managing pain. And when
there are alternative treatments for pain, there are more costly,
so insurances don't pay them. So there are more any
structural issues that exist that have perpetuated at first originated
these over those crisis, as was pointed earlier in the program,
(27:16):
but also that continue to make pain a major challenge
and cornering people that have no alternatives. When there are
opiod medications in cases where it was offering some relief,
they cannot get access to them because physicians are so
don't want to.
Speaker 5 (27:32):
Prescribe them anymore.
Speaker 13 (27:34):
So we are a country that is so very polarized.
It's either we become over complacent and give opioid medications
to anyone or we don't. We basically say no, we don't,
We're not going to give them, when in reality we
need to understand how to properly utilize them and how
to help patients that are suffering from pain lead productive lives.
Speaker 5 (27:57):
Even if it does, it means and this is something.
Speaker 13 (28:00):
That we're changing, that they may have to learn to
live with some level of pain, but despite but they
can achieve things that in their life, they can leave
their life so that we minimize negative effects. And as
an area of research, we see the responsibility that we
have certainly at the nih of advancing the science so
(28:23):
that we can provide better treatments for people that need them,
because pain is not a rare condition. I mean it's
a very very common, frequent presentation and if not treated properly,
can lead to actually very devastating outcomes such as suicide
or overdoses.
Speaker 1 (28:42):
We're also hearing from people who have written in via email.
You can go to our website Listen to the Middle
dot com to do that. We're also on social media
in most places at Listen to the Middle. Buffy in
New Orleans asks, we know people are going to use drugs,
so why help them not die, get hurt, or get
(29:02):
sick again. You can reach out at listen to themiddle
dot com, you know, tolliver and we're waiting for more calls.
We've got some more calls on the line. We're going
to get to them in a few moments. But this
opioid crisis, as we've said, has been going on for
many years. It is not a Republican crisis, and it
is not a Democratic crisis.
Speaker 3 (29:23):
Yeah.
Speaker 4 (29:24):
Absolutely, And in fact, both Republican and Democratic presidents have
you know, promised to solve the crisis over the last
couple decades. Check this out.
Speaker 2 (29:31):
It's important to recognize that today we are saying more
people killed because of opioid overdose than traffic accidents.
Speaker 18 (29:42):
In the last Congress, both parties came together to pass
unprecedented legislation to confront the opioid crisis.
Speaker 19 (29:53):
Addiction touches families in every community in red states and
blue states, across all races, creeds. The crisis is national,
but the struggle is personal, deeply personal.
Speaker 1 (30:06):
And given the current trajectory, President Biden is probably not
going to be the last president to talk about the
opioid crisis. Stay with us more than middle coming right up.
This is the Middle. I'm Jeremy Hobson. We're talking about
finding solutions to America's opioid crisis. My guests are doctor
Nora Volkov, who is director of the National Institute on
(30:27):
Drug Abuse, and Beth Macy, author of Dope Sick and
the new book Raising Lazarus, Hope, Justice, and the Future
of America's opioid Crisis. Our number is eight four four
four Middle. That's eight four four four six four three
three five three, or you can reach out at listen
to Themiddle dot com. Let's go to another call. Jennifer
is joining us from Minneapolis. Jennifer, Welcome to the Middle.
Speaker 11 (30:51):
Thank you very much.
Speaker 3 (30:54):
We'll go ahead, just.
Speaker 6 (30:57):
Go for I'm waiting to uh.
Speaker 11 (31:01):
Make a plain reservation to go back to Philadelphia. On
June twenty fourth, my son was shot in the head
buying ventana on the street in Philadelphia. He's been in
he's been in another treatment. I've been waiting for a
shoot to drop and for some odd reason like him
getting shot in the shoulder was like the biggest blessing
(31:22):
because he's tried to break this addiction. He's been through
treatment three times and he just goes back, he's lived
on the streets, he's homeless, he's been various things. He
went to a very prestigious prep school on the East
Coast and six of his classmates are gone out of
(31:44):
a very small number of people from a very privileged class.
And that alone says that this thing is not it's everywhere,
it's it's it's it's not somebody else's problem.
Speaker 1 (32:01):
And do you see do you see anything that is
that that may be a light at the end of
the tunnel for him, for you as you navigate.
Speaker 11 (32:12):
I think, like I said, this odd thing that I mean,
he gets shot, right, he didn't get shot directly in
the head, It went through his shoulder, grazed his head,
caused a brain bleed. So he's been without a cranium
for six months. So he's in the hospital. He's in
the ICU and traumatic brain injury unit, and he would
(32:33):
it saved his life. And he woke up and I
was like, he just got a resa. But he's on
the box zone and reading about that. It's like another issue, right,
we need to help people who are addicted to this
drug at every level, on a community level. We can't
(32:55):
ostracize them. We can't say they aren't criminals. My son
is not a criminal. I he's not. It's just it's
it's it's portrayed as this thing that is on the
other side of somebody else's spends, you know, right, And
I don't Jennifer anything.
Speaker 1 (33:17):
Thank you so much for for that call, and you know,
the best of luck as you as you help your
son through this.
Speaker 3 (33:25):
I really appreciate you calling in.
Speaker 6 (33:27):
Uh.
Speaker 1 (33:28):
I want to go to both of our guests on this,
but doctor Volkov, you you've you've gained notoriety for talking
about the benefit of not treating this as not not
looking for punishment but rather for treatment when you deal
with people who are addicted.
Speaker 13 (33:46):
Yeah, and I think that. I mean, what is clear
is that criminalizing a person because they take drugs or
because they are addicted, it basically not just continues to
stigmatize them, but it also makes them much less likely
to want to go and seek help. And this in
turn is something that leads them to have lower self esteem,
(34:09):
to stigmatize themselves and make them so much more vulnerable
to actually try to take drugs to escape. So it
isolates them and so absolutely, I the science shows that
when someone is addicted that they don't control the urges
that they have the need. And I was listening to
(34:29):
a color earlier that said, the differences between one thing
I needing and one thing drugs may emerge at the
beginning when someone experiments, but once they become addicted, it's
not that they want a drugs. They need them, and
their body perceives it as an instinctual need of food
or water or even air in order to be able
(34:50):
to breed, so it's not a criminal behavior.
Speaker 5 (34:54):
Is the transformation.
Speaker 13 (34:55):
That has happened in the brain of a person that
now has this instinctive, artificial need for drugs that are
perceived as necessary for survival. And this is why it
becomes such a powerful motivating drive for the person that's addicted,
and that's why we conceptualize it in the process that
the person needs to be treated in order to be
(35:18):
able to control those strong urges to take the drugs
and to also help them control that withdrawal that leads
them otherwise to take drugs and suboxone. Gubernorphin is a
medication that is very useful to help people achieve this goal,
to stabilize them and with time this allows them to
(35:41):
get back into their everyday life and eventually recover. So
because that's a message that I think is crucial that
we keep on doing. Number One, addiction to opios can
be treated and you can recover.
Speaker 12 (35:56):
That Maysie, Yeah, I mean that was hartly why it
was so important for us with this Hulu show to
show how hard it is for people to access treatments
like suboxone. You see an A list actor like Michael
Keaton struggle to get on a method, stigmatized right and left,
struggled then to get on suboxone when that becomes available,
(36:20):
and then eventually becoming a helper in his community. This
is straight out of the pages of my nonfiction book,
straight from the storyline of doctor Steve Boyd in rural Tennessee,
who who became a leader in providing addiction care. If
we could change the thinking that doctor Valcov talks about,
(36:41):
and we could begin to treat addiction as a disease, when,
for instance, people are coming into the ed for emergency
room for an overdose and rather than just fix whatever
they're in there for narcan or maybe correcting on abscess,
actually connect them to support services, connect them to pupen orphine, clinics.
(37:04):
I mean, we know we have years of research showing
that works. And similarly with jails, when people begin to
get treated and so that at the moment of release,
which is so critical, such a time when they're much
more likely to overdose and die, we see them get
a warm handoff to appear and to the next place
to stay, connections to housing, connections to care. I mean,
(37:28):
it makes all the difference in the world.
Speaker 1 (37:31):
Let's go to another call that has come in. Raphael
is joining us from draper Utah. Raphael, welcome to the
middle go ahead.
Speaker 5 (37:42):
Hey.
Speaker 7 (37:42):
Yeah, So from my experience, those drugs have not provided
the escape that you guys are suggesting, because they are
just as addictive and withdrawals are very rough when you
(38:03):
come off of deep in North Green and suboxone and
all those other drugs as replacements. But my main question
is all the billions of dollars that are coming from
like Johnson and Johnson that produce family. It's a Sackler family.
(38:24):
While Mari cvs like all them, like where is that
money going? Like there are all these communities and lives
that are just ruined, and like are they saying any
of that? Like like where is it going. There's billions
of dollars just floating out.
Speaker 3 (38:40):
There, Beth may see.
Speaker 12 (38:44):
Yeah, well, the problem is that every state has a
different plan for how they're going to use the money.
And we've already seen some early reporting from Kaiser Family
Foundation showing that, you know, some of that money is
going to same old, same old drug war cops, cops, cars,
and more jailing. When we know that simply doesn't work.
(39:06):
We need to make the treatments easier to access, whether
that is in walk in centers. Huntington, West Virginia, which
had twenty six overdoses in one day, now has walk
in centers where people can come in and get connected
to care. I feel like every health department should be
offering harm reduction services and connections to care.
Speaker 1 (39:29):
Let's go to another called. Jeff is joining us from Boise, Idaho. Jeff,
Welcome to the middle.
Speaker 17 (39:35):
Hey, Jamaine, thank you, thanks for calling.
Speaker 3 (39:39):
Go ahead.
Speaker 17 (39:41):
Yeah, so great topic. It's just this is a god thing.
I'm actually on my way to treatment as we speak.
Speaker 5 (39:49):
Wow.
Speaker 17 (39:49):
And I'm an an alcoholic addict and it is a
disease and I'm glad they finally acknowledged that that made
it easier for me to it's easier for the swallow,
so speak. So I actually overdose on set mall two
days ago. I tried it because it was available and
(40:13):
I was going to withdrawals. I've been taking Kreative, which
is a legal plant that comes out of Indonesia, but
it hits the opioid receptors and you don't go to withdraws.
And I've been on it for years. And I ran
out and I started going to withdraws and I tried
the set mall and sure enough, within minutes, you know,
I was done. And luckily they had the narcamp there
(40:36):
I think it's called, and they gave me two doses
of that. It took two doses, you guys nailed earlier.
If there was only windows, I would be dead. And yeah,
I died. So I got up and I'm like, okay,
I'm done. I'm going to treatment. So I've been. I've
been to treatment twice. This time was in Utah. It
(40:57):
was a very very nice place, I mean top of
the line, thirty thousand dollars a month. I was there
for three months and I didn't want to leave. It
was amazing. But when I got out, what shock me
was the afterchair. There was none. They said, okay, right,
your exit plan, you know your aftercare plan, and this
(41:20):
is what you're going to do. Where it was all
a tie in the sky and there was nothing there.
They said, go to meetings, good luck. So I relapsed
within ninety days. So I went back to another treatment center,
same deal, no aftercare. And it's a problem. The aftercare is,
in my opinion, is one of the most important aspects.
(41:42):
But this time I'm doing something different. I'm going through
the Wilderness program. I'm going to be at the wilderness
for fifty sixty days and there are some components in
aspects of addition to it, but I'm not going through
the same old treatment traditional rag I did before.
Speaker 3 (41:59):
Because app yeah, let me ask you.
Speaker 1 (42:02):
Let me take that to our guests. Thank you, Jeff,
I really appreciated, and good luck. Good luck in the
wilderness and trying to get a handle on this doctor Volkov,
what about that that that if you can find the
treatment that maybe it doesn't doesn't go on long enough
to actually do what it's supposed to do.
Speaker 13 (42:22):
I mean, this color has just his finger on the
falls of one of the main problems that we have
in the treatment programs in for a substantious disorder in
our country that there's no continuity of care. I mean,
addiction is a chronic disease and it requires treatment for
a very long time period, just like with hypertension antiabetes.
(42:42):
So this notion that you go to a three month
program and you're going to be able once you live
there to go back to a normal life without need
and urges and craving is basically magical thinking. And the
problem that we're observing is that many of these in
patient programs that actually are very very nice, and while
(43:04):
you are there it seems to be working, don't have
the referral system that will ensure that once you live
that that intense service, that intense treatment, you will have
someone that monitors your care as you proceed. And in fact,
for example, what the stoys have shown is that the
(43:26):
best outcomes occur in those that have been sustained for
treatment for five years. Initially is more intense, and as
you go through time that frequency and the intensity or
the intervention goes down and not very similar to what
you see with cancer, of course, I mean at the beginning,
you undergo treatment and then they are checking you up
(43:48):
every few weeks or months, and then they get paste
off until there's a point that says, you know, you
just achieve recovery. The same situation happens with addiction, but
we don't have the structure nor we have the ways
of overseeing that the treatments are providing the support that
(44:09):
a person will need throughout the chronic state until they
achieve recovery. So continuity of care is crucial for success,
and we need these need to be addressed in a
more systematic way in the treatment programs we offer in
our country.
Speaker 1 (44:27):
You know, we have heard from so many people with
personal stories this hour about getting help, getting treatment. Beth Macy,
I'm sure there are a lot of people who have
family members, who have friends who are not at that
point yet, who may be using maybe you know, taking
opioids in a way that they shouldn't be for their
(44:49):
own health, and they have not admitted that they it
is something that they need to get treatment for at
this point.
Speaker 12 (44:57):
Right, the latest study when I turned raising Lazarus in
twenty seventeen, one third of American families were in experienced
strife because of this issue. Just now, a recent survey
it's now two thirds of American families are impacted by this,
and yet you know, our treatment rates, our overdose rates
(45:19):
aren't getting any better, and it is so so hard
for family members to deal with I mean, I have
gotten close to so many families that have struggled with this,
and there just isn't an easy answer other than continuing
to connect folks to care. You know a woman I
(45:42):
followed for DOSIC who ended up dying after two and
a half years of addiction. You know, her mother said, well,
if she just hits rock bottom, then she'll snap out
of it. And you know she now says, you know,
rock bottom had a basement, and the basement had a trapdoor.
So we all got to do our research so that
we begin to shift the way we culturally think of
(46:06):
this and start to think of it as a disease
not just a moral failing.
Speaker 1 (46:14):
Just before we wrap up this hour, Tolliver, I know
we've been getting some comments online. Maybe there's somebody with
a question that we can get to.
Speaker 4 (46:22):
Yeah, I absolutely love this question. Casey asks, does the
criminalization of drugs and Portugal work? Is that a blueprint
for us? Do you know what I mean?
Speaker 3 (46:30):
Doctor Volkov?
Speaker 1 (46:31):
Is there any answer to that is another person had
written in about the same thing.
Speaker 3 (46:34):
What about decriminalizing things?
Speaker 13 (46:37):
Yeah, and I think that it is a very interesting proposition.
And I think then when we speak about the criminalizing droves,
we need to understand that there are different ways of
decriminalizing it. And since you asked about Portugal, one of
the things that Portugal did is just not just.
Speaker 5 (46:53):
That the criminalization of trugs.
Speaker 13 (46:54):
So you don't end up in jail if if they
find you with drugs. But what they did was they
provide treatment that a person needs. So they find drugs
on you, you go to treatment. And when we do
other other other states are the criminalizing drugs or other countries,
they don't necessarily provide a treatment that is necessary to
(47:14):
provide the support to a person.
Speaker 5 (47:16):
So just saying we're.
Speaker 13 (47:17):
Going to the criminalize and not provide support that we
all counterbal as the entry of drugs that risk associated
with them could actually result in negative consequences. On the
other hand, if you decriminalize the drugs and you provide
support and education. And one of the things that we
haven't spoken at all doing the program is the notion
(47:39):
of prevention. How do we protect people, how do we
bring build resilience so that people don't get addicted to it,
and that is something else that has to be assigned
with the criminalizing.
Speaker 1 (47:51):
Well, you can reach out for more at Listen to
the Middle dot com. You can also leave us a
message at eight four four four six four three three
five three. I want to thank my guest doctor Norvolkov,
director of the National Institute on Drug Abuse, and Beth Maacy,
author and executive producer of Dope Sic, a book now
at TV series on Hulu, and her latest book, Raising Lazarus.
Speaker 3 (48:11):
Thanks to both of you for joining.
Speaker 12 (48:12):
Us, Thank you for having us, Thanks a lot.
Speaker 1 (48:17):
And join us next week, same time, same place, Tolliver,
what is our topic for next week's show?
Speaker 4 (48:22):
Well, this might sound familiar to Jeremy because it was
supposed to be our topic last week but got bunked.
The topic is are our political leaders too old?
Speaker 3 (48:31):
Okay?
Speaker 1 (48:31):
And that means President Biden, former President Trump, Mitch McConnell,
on and on. We're not picking on any one candidate again.
We're at eight four four four Middle. You can leave
a voicemail there or call in live next week, or
go to Listen to the Middle dot com. And while
you're there, you can sign up for our weekly newsletter.
The Middle is brought to you by LONGNOK Media, produced
by Joanne Jennings, John Barth, Harrison Patino, Danny Alexander, and
(48:52):
Charlie Little. Our technical director is Jason Croft. Thanks this
week to WUNC and Chapel Hill, North Carolina, to our
partners at Illinois Public MEANT, Nashville Public Radio, iHeartMedia, and
all the stations that are making it possible for people
across the country to listen to the Middle. I'm Jeremy Hobson.
Talk to you next week.
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