Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Yes or no?
Do you believe nicotine is notaddictive?
Speaker 2 (00:02):
I believe nicotine is
not addictive.
Yes, Congressman, cigarettesand nicotine clearly do not meet
the classic definitions ofaddiction.
I don't believe that nicotinefor our products are addictive.
I believe nicotine is notaddictive.
I believe that nicotine is notaddictive.
Speaker 1 (00:17):
Hi everyone.
This is Luke Niferatos.
I am your host of the DrugReport podcast brought to you by
SAM Smart Approaches toMarijuana, which you can find at
learnaboutsamorg, as well asFDPS, the Foundation for Drug
Policy Solutions, which you canfind at gooddrugpolicyorg.
Great to have you all.
We are back from a whirlwindtour.
The last several weeks we werein Vienna, austria, at the UN,
(00:40):
meeting with member statestalking about drug policy
globally and treaties andagreements across countries to
schedule the various substancesthat are out there.
So learned a lot, made a lot ofprogress.
It was very interesting heretoday to join me in kind of a
discussion of kind of what'sgoing on here in the United
States as it relates to our drugpolicy strategy is our
president and CEO, dr KevinSabet.
(01:01):
Hey, kevin, hello, how are youGood?
Glad to have you back on.
So yeah, there's obviously alot of people are asking
questions and we heard this alot at the UN this last week
which is kind of what is goingon with American drug control
strategy, when we look at NIH,when we look at SAMHSA and the
various cuts that are happening.
So what are you hearing andwhat are you kind of thinking?
Speaker 2 (01:21):
Well, I just,
obviously I don't think we
really know, I don't thinkanybody knows, I don't think the
administration knows.
They're still kind of, I think,figuring out their posture on
drug policy.
It's interesting for an issuethat polls so highly in terms of
interest, and mainly because ofthe fentanyl issue.
You know, it's interesting howthere really hasn't been a lot
(01:43):
since the inauguration on this.
You know, when we were inVienna, you know it's
interesting how there reallyhasn't been a lot since the
inauguration on this Um, youknow, when we were in Vienna, of
course the uh there were.
There was a U S delegation, asthere always is, but you know,
as opposed to 35 people, it wasdown to about eight or nine uh,
very, very different than thepast.
The side event also that theAmericans did uh was a was a
video film that was a couple ofyears old, very different than
(02:05):
what they would have done in thepast.
So you know, because themeeting is usually a time to
showcase and, you know, sort ofshow off what you're doing, and
I think they couldn't really dothat because they're still
figuring out what they're doing.
So NIH, I think, is the sameway.
We've seen layoffs at SAMHSA.
There is a new senior advisorcoming on that we know about and
(02:27):
you know we just I guess therewas this interview in Stat News
I'm sure you saw it with Dr NoraVolkow, the director of NIDA.
Speaker 1 (02:37):
Yeah.
So I kind of talked to us alittle bit about what you saw
there.
She was asked about RFK, shewas asked about kind of the
strategy for treating the drugcrisis and addiction crisis and
kind of where the opioid crisisstands.
She talked a little bit aboutwhat she saw as the solution.
What it was kind of startedthis decline that we've seen
over the last two years inopioid crisis, opioid overdose
deaths.
So it was a wide ranginginterview and you know some
(03:01):
little interesting nuggets inthere.
So talk to me about what jumpedout at you in that interview.
Speaker 2 (03:06):
Yeah, I think there
were a couple of things.
I mean, obviously I think Norais great.
I've been able to have alongstanding friendship with her
and relationship as colleagueswhen I served both times in the
last two administrations that Iserved in she was director of
NIDA.
She's really the Teflon womanwhen it comes to NIH, no matter
(03:26):
the president or the issue.
She's there saying veryintelligent things and really
working hard to make sure thatUS research stays on top of
things.
You know, as people knowprobably, but in case some don't
, you know the US funds 85% ofthe world's research and that
comes out of NIDA and that'ssignificant.
So 85% of the world's drugresearch coming from one
Institute.
(03:46):
It's a, it's a big, it's a verybig deal and her position,
especially in our field, is avery big deal.
So, um, you know, uh, uh, uh, Ithink that you know, try it's,
it's tricky to navigate, kind ofthis new administration because
, again, we're just, you know,everyone's kind of learning,
still learning about what we'regoing to.
Um, you know what we're goingto see.
(04:06):
I think that what struck me alittle bit was, uh, you know it,
it, uh, you know, and I getthat this happens in the media
and interviewers, uh, you know,tend to want to like pull out
juicy bits.
But you know, we've heard BobbyKennedy talk about, uh, how he
supports medication for opioiduse disorder, but he also
(04:27):
realizes that he says that thegold standard that was his term,
the gold standard is 12 steprecovery and that's where he
comes from, so obviously he seesit firsthand.
And I think, you know, I thinkDr Volkow was a little bit
critical of this idea that if itworked for somebody it must
work for everybody and that youknow, um, it doesn't really.
And she was talking about howit doesn't really work for
everybody, um, and she's rightthat not everybody responds the
(04:49):
same way to things.
Of course.
I mean there, we, you know, wesay that there are, um, you know
, different pathways to recovery, as we say, and so you know
there's, there are, she saidshe's met many people that have
um, said they don't like thephilosophy of 12 step because it
doesn't speak to them and andwhatnot.
And you know, and there aresome 12 step you know, you know
(05:12):
routes where people think that'sincompatible with medications.
I don't think that, by the way,but there are there, there are
people that think that and Ithink that you know she was
critical of it, I, you know, I.
I think it's just important tosay that 12-step programs have
been thoroughly researched andKeith Humphreys talks about this
(05:34):
.
I think he did a actually acouple of years ago during COVID
time he did an evaluation ofalmost three dozen studies in
the work of over 150 scientists140 scientists dozen studies and
the work of over 150 scientists140 scientists and found that
it was the most effective, moreeffective than just sort of
traditional psychotherapy andalso lowered healthcare costs.
Now, of course, again, thatdoesn't mean that it's
(05:55):
incompatible with medications.
I think every path is different.
But you know, she did kind ofpoke a little bit at that and it
could have just been maybewords slightly out of context, I
don't know, but that was alittle interesting tidbit there,
because I do think that thisadministration, given Bobby's
background, will lean on 12-stepprograms, a particular
(06:26):
intervention going throughCochrane, which is what Keith
who's, of course, is at Stanfordand people from Harvard Medical
School did, and also theEuropean, what used to be called
the European Monitoring Centerfor Drugs and Drug Addiction.
Those groups basically cametogether and researched this and
said that yeah, this is reallyworking, and so I think that's
important.
Speaker 1 (06:42):
I think it's a little
bit, I think she's.
You know, and we all love DrVolkow.
She does a great, great workand so we've.
We've had her at Sam dowebinars with us and speak at
our summit.
So we're definitely big fans.
But I will, uh, a lightcritique I will say is I do
think some of her comments werea little behind the times.
Yeah, I think you know there'sbeen this prevailing trend of
extreme harm reduction uh, theperson who's in active addiction
(07:04):
, they know best what's for them.
That's been kind of theprevailing thought really since
2020, since Oregon did theirinsane Measure 110.
That now has been repealed.
And I think, looking at thestatus of drug policy today, we
just had the news of SanFrancisco's mayor rolling back
their extreme harm reductionprograms, saying we're no longer
going to subsidize drug use andaddiction.
(07:25):
We're no longer going toprovide all the paraphernalia
and tools for someone to stayaddicted on the streets and you
know that doesn't work anymore.
And in fact there there is areturn, not just in San
Francisco, but not just inOregon, but nationally.
There's a return to what Ithink we're all realizing is the
common sense bedrock principleof responsibility and
(07:46):
accountability.
Accountability has to be in themix, and that is what, to me,
really embodies what the 12-stepprogram is, which is this idea
that you have to haveaccountability, whether the
accountability is to God, tohigher power, to your community,
whatever that accountability is, you have to have it in order
to stay out of addiction.
And so I do think she's alittle behind the times in terms
of some of these old messagesthat now have been disproven and
(08:08):
really widely rejected by thepublic, and so I do think we're
going to see a return to hey,accountability is actually a
universal principle.
Now, that doesn't mean that12-step works for 100% of people
, but I do think it's tenets,given that it stood the test of
time.
It's a timeless program thatrelies on universal concepts of
accountability that work, Ithink, everywhere.
Speaker 2 (08:29):
Yeah, no, it's true.
I think the accountability isreally important and you know
obviously 12 steps, that it waslike punishment or something if
you relapse, but there isaccountability to other people,
you know, which obviously wewould hope would be in all the
pathways, and I think theaccountability is important.
We see that with the physicianhealth programs which I was able
(08:54):
to speak there a couple ofmonths or two ago in San Diego
to the Western Doctors inRecovery.
These are 300 doctors inrecovery and what worked for
them and I think we talked aboutit the last time, but what
worked for them was the factthat they did have
accountability and they did do12-step.
They also did medication.
So it really is about differentpathways.
I just hope we're not throwingthe baby out with the bathwater
(09:14):
because there are medicationsnow and saying that 12-step
don't work, because again,everybody does follow that
different path, a different path, and I think it's important to
realize that.
Speaker 1 (09:24):
Definitely so.
Another part of that interviewwas they talked a little bit
about the decrease in opioidoverdose deaths, which we're all
thankful for, and they askedher you know some of the reasons
why she thinks that is, and shementions naloxone.
So maybe talk a little bitabout what you see is you know
the causes and kind of what youthought about her answer.
Speaker 2 (09:41):
No, I mean, look, I
think we have expanded naloxone.
It's more normalized.
I would love to see studiesthat talk about rather than just
kind of us assume that we'veexpanded it because we talk
about it a lot just actuallywhat the utilization?
I do think the utilizationwould be up.
That would be my hypothesis forany study.
But it'd be great to see somenumbers.
Maybe they're out there and Idon't know about it.
It's very possible.
(10:07):
I think that she talks abouteducation of the public in terms
of people realizing how bad itis.
That, and I definitely agreethat's a lot of it.
This is what you know the greatlate david mustos would say was
talking about.
You know how we learn about adrug's harmfulness, often after
many people have.
You know many people die fromit or are about to die, uh, or,
or close to dying, and then wewe do kind of forget that so it
does come back.
That's his warning.
(10:28):
But I think with fentanyl we'rein the cycle of.
You know, a lot of people havelearned that this is out there
and every people know what thatis, and they probably know what
it is more than they even knowwhat methamphetamine is, which
is remarkable because weobviously had a big
methamphetamine problem, whichwe still do in Western US and in
various places 20, 30 years ago, which we still do in Western
US and in various places 20, 30years ago.
(10:49):
So I do think that that is alot of it.
I also think that, you know, wehave, I do think that some of
this and she doesn't reallymention that, but maybe a little
bit is that you know well, shedoes talk about it actually at
(11:10):
the end, I believe.
But basically this idea thatthe most vulnerable people,
vulnerable people, have alreadydied, and I do think that's a
lot of it.
I think that that is a hugepart of it.
The people that were going torisk and take fentanyl.
Unfortunately, many of themhave succumbed to it.
So I think that's a huge.
Speaker 1 (11:23):
So there's a there's
a bunch of factors.
I think she's right about them.
I think it's she lays it outwell, but I do think education
is a big part of it, yeah, so Ithink you know we'll obviously
need to see a lot more researchon that, but kind of looking
into the reasons for why we'veseen these overdoses go down, I
do think, like you mentioned, alot of people know how deadly
fentanyl is and I think that youknow having that healthy and
(11:45):
you know, fact-based fear ofdrug use I do think helps drive
down people's willingness toexperiment with drugs and to use
these, to use drugs moreheavily at a very minimum.
So I do think that it doesalways come back to making sure
folks are educated about therisks and how risky drug use is.
Today is much more risky thanit ever was before and it's
(12:05):
always been risky, and so I dothink that that that uh piece of
this is something that I'mhoping to see come out more as
well.
Um, to kind of learn about someof these different causes.
Speaker 2 (12:16):
Yep, no, I completely
agree.
Speaker 1 (12:18):
That's great.
Well, Kevin, thank you forjoining us.
I don't know if you have anyother thoughts or anything else
you wanted to share.
Speaker 2 (12:21):
No, I think that's
great.
Speaker 1 (12:29):
Okay, that's great,
okay, awesome, good, great, well
, um, to all of our listeners,thank you, as always, for
listening.
Thank you for supporting ourpodcast, please.