1 00:00:00,280 --> 00:00:07,760 Speaker 1: Hi, I'm Ethan Nadalman, and this is Psychoactive, a production 2 00:00:07,800 --> 00:00:11,600 Speaker 1: of I Heart Radio and Protozoa Pictures. Psychoactive is the 3 00:00:11,640 --> 00:00:15,040 Speaker 1: show where we talk about all things drugs. But any 4 00:00:15,120 --> 00:00:18,760 Speaker 1: views expressed here do not represent those of iHeart Media, 5 00:00:18,920 --> 00:00:23,480 Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, heed, as 6 00:00:23,520 --> 00:00:26,400 Speaker 1: an inveterate contrarian, I can tell you they may not 7 00:00:26,560 --> 00:00:30,760 Speaker 1: even represent my own. And nothing contained in this show 8 00:00:30,840 --> 00:00:33,680 Speaker 1: should be used as medical advice or encouragement to use 9 00:00:33,800 --> 00:00:45,400 Speaker 1: any type of drug. Hello, Psychoactive listeners. Um, Today We're 10 00:00:45,400 --> 00:00:49,160 Speaker 1: gonna talk about an issue, uh that I've long been 11 00:00:49,200 --> 00:00:52,519 Speaker 1: fascinated by, but it's becoming ever more important, and it's 12 00:00:52,560 --> 00:00:55,800 Speaker 1: the issue that has to deal with the under treatment 13 00:00:56,120 --> 00:01:00,240 Speaker 1: of pain, and especially chronic pain, and especially in Amerror Ka. 14 00:01:00,680 --> 00:01:03,240 Speaker 1: I mean, we've all familiar with the overdose crisis and 15 00:01:03,360 --> 00:01:06,920 Speaker 1: the over pushing and prescribing of opiois by the pharmaceutical 16 00:01:06,959 --> 00:01:10,120 Speaker 1: companies and now the problems with overdose connected with fentinel 17 00:01:10,200 --> 00:01:12,960 Speaker 1: and other drugs like that. But there's been a flip 18 00:01:13,000 --> 00:01:14,959 Speaker 1: side to this thing, which is that opiois have been 19 00:01:15,000 --> 00:01:17,600 Speaker 1: around for a very long time, thousands of years in fact, 20 00:01:18,400 --> 00:01:21,680 Speaker 1: for treating pain and the medication of pain is one 21 00:01:21,720 --> 00:01:25,280 Speaker 1: that has gone through all sorts of changes and waves 22 00:01:25,440 --> 00:01:29,240 Speaker 1: over the past years and decades and even centuries. Now 23 00:01:29,280 --> 00:01:33,800 Speaker 1: my guest today is Kate Nicholson. Kate is I mean, 24 00:01:33,800 --> 00:01:36,959 Speaker 1: a brilliant lawyer, graduated Harvard Law School many years ago, 25 00:01:37,160 --> 00:01:39,880 Speaker 1: worked in the Justice Department Civil Rights Division for a 26 00:01:39,920 --> 00:01:42,399 Speaker 1: couple of decades. But the reason I'm having her on 27 00:01:42,520 --> 00:01:46,200 Speaker 1: now is because she recently started an organization called the 28 00:01:46,319 --> 00:01:51,720 Speaker 1: National Pain Advocacy Center, specifically devoted to advancing the healthy 29 00:01:51,800 --> 00:01:55,120 Speaker 1: human rights of people in pain. So, Kate, thank you 30 00:01:55,200 --> 00:01:57,400 Speaker 1: so much for being my guest today. I'm delighted to 31 00:01:57,440 --> 00:02:00,560 Speaker 1: have you on, and uh, let's get started. Delighted to 32 00:02:00,600 --> 00:02:04,040 Speaker 1: be here. Your work dealing with people with disabilities influenced 33 00:02:04,040 --> 00:02:07,080 Speaker 1: some of your thinking on this, but perhaps even more 34 00:02:07,160 --> 00:02:11,680 Speaker 1: so was your own personal experience with really terrible pain 35 00:02:11,840 --> 00:02:15,400 Speaker 1: for really long period of time. So just tell me 36 00:02:15,520 --> 00:02:18,280 Speaker 1: a little more about what that was like and what 37 00:02:18,360 --> 00:02:22,160 Speaker 1: you learned through the process. When my pain began, I 38 00:02:22,200 --> 00:02:26,360 Speaker 1: was already working as a civil rights attorney in the U. 39 00:02:26,440 --> 00:02:30,359 Speaker 1: S Department of Justice, doing primarily health related civil rights law. 40 00:02:31,080 --> 00:02:35,560 Speaker 1: So Sunday afternoon in August, I sat down to get 41 00:02:35,560 --> 00:02:39,320 Speaker 1: to work like I always did, and after about thirty minutes, 42 00:02:39,360 --> 00:02:43,280 Speaker 1: my back started to burn really badly. I felt a 43 00:02:43,280 --> 00:02:48,200 Speaker 1: little like acid was eating my spine, and pretty quickly 44 00:02:48,360 --> 00:02:52,639 Speaker 1: the pain intensified and a lot of the muscles in 45 00:02:52,680 --> 00:02:56,320 Speaker 1: my body seized up on me and I ended up 46 00:02:56,480 --> 00:02:58,880 Speaker 1: in a face plan on the floor of my office. 47 00:02:59,639 --> 00:03:03,360 Speaker 1: It turned out that I had had a surgery and 48 00:03:03,480 --> 00:03:05,960 Speaker 1: a doctor had severed a part of the nerve plexus 49 00:03:06,000 --> 00:03:09,400 Speaker 1: leading into my spinal cord, and the consequences only appeared 50 00:03:09,400 --> 00:03:13,040 Speaker 1: when the nerves began to regenerate, scarring it adhesouldn't sort 51 00:03:13,040 --> 00:03:15,960 Speaker 1: of embedded informed and caused a lot of problems for me, 52 00:03:16,320 --> 00:03:19,640 Speaker 1: and so, like many chronic pain patients, I entered a 53 00:03:19,680 --> 00:03:23,519 Speaker 1: real slog through the health care system for about three years. 54 00:03:23,800 --> 00:03:25,800 Speaker 1: There was a lot of inflammation in my spine and 55 00:03:25,840 --> 00:03:29,480 Speaker 1: so they thought maybe it was this rare arthritic disorder. 56 00:03:29,720 --> 00:03:33,480 Speaker 1: I had abnormal nerve conduction studies, which isn't so surprising 57 00:03:33,520 --> 00:03:37,000 Speaker 1: since I had, you know, difficulty walking, but they thought 58 00:03:37,040 --> 00:03:40,280 Speaker 1: maybe I had m S. So um, it took a 59 00:03:40,320 --> 00:03:43,920 Speaker 1: long time to get to the bottom of what was 60 00:03:44,000 --> 00:03:47,640 Speaker 1: going on. Meanwhile, you're working throughout this period. Mostly I was. 61 00:03:47,760 --> 00:03:51,760 Speaker 1: I took a few leaves of absence UM because I 62 00:03:51,760 --> 00:03:55,200 Speaker 1: was also being treated throughout this this time UM and 63 00:03:55,440 --> 00:04:00,240 Speaker 1: I tried gosh about thirty seven different kinds of treat 64 00:04:00,000 --> 00:04:03,880 Speaker 1: and some of them were integrated, things like biofeedback and 65 00:04:04,000 --> 00:04:06,920 Speaker 1: self hypnosis. And I tried a lot of different kinds 66 00:04:06,920 --> 00:04:12,040 Speaker 1: of medication, though not opioids, initially, physical therapy, massage, you know, 67 00:04:12,640 --> 00:04:15,200 Speaker 1: just a host of different things. I did have a 68 00:04:15,200 --> 00:04:19,159 Speaker 1: surgery where they tried to go in and separate the 69 00:04:19,200 --> 00:04:22,360 Speaker 1: scarring um, but it was not successful. And so when 70 00:04:22,360 --> 00:04:24,400 Speaker 1: did you start relying on opioids to make it? Was? 71 00:04:24,480 --> 00:04:26,920 Speaker 1: It was that day. It was a really depressing day 72 00:04:26,920 --> 00:04:30,440 Speaker 1: in my life because I went to the doctor. It 73 00:04:30,600 --> 00:04:33,200 Speaker 1: was at this point I'm so disabled that my husband 74 00:04:33,240 --> 00:04:36,360 Speaker 1: was literally having to carry me everywhere, was carrying me 75 00:04:36,400 --> 00:04:39,560 Speaker 1: into the doctor's office. We've had this very hopeful surgery 76 00:04:39,600 --> 00:04:42,719 Speaker 1: that we've been sort of thinking would would address things. 77 00:04:42,920 --> 00:04:47,599 Speaker 1: And it was that day that the doctors basically uh said, 78 00:04:47,760 --> 00:04:49,600 Speaker 1: there will be no cure. Things are not going to 79 00:04:49,720 --> 00:04:52,600 Speaker 1: get better, They're probably gonna get worse. We've tried everything, 80 00:04:52,760 --> 00:04:55,000 Speaker 1: you know, we've tried nerve blocks, we've tried every medication 81 00:04:55,440 --> 00:04:57,680 Speaker 1: and it's not working, and so now we think you 82 00:04:57,720 --> 00:05:01,000 Speaker 1: really need to try prescription opioids. And I had avoided 83 00:05:01,040 --> 00:05:04,720 Speaker 1: them up to that point because I was afraid of them. 84 00:05:04,839 --> 00:05:07,240 Speaker 1: I had read things and was worried about addiction. I 85 00:05:07,279 --> 00:05:09,520 Speaker 1: was afraid that I would become, you know, sort of 86 00:05:09,520 --> 00:05:13,960 Speaker 1: fuzzy and unable to to think, because my only experience 87 00:05:14,000 --> 00:05:16,520 Speaker 1: with taking opioids in the past had been post surgically. 88 00:05:17,000 --> 00:05:18,880 Speaker 1: But it turned out that that none of that was 89 00:05:18,920 --> 00:05:22,480 Speaker 1: really the case. That once I did start them, I 90 00:05:22,560 --> 00:05:25,360 Speaker 1: really improved. I wasn't foggy, I was I was in 91 00:05:25,440 --> 00:05:28,040 Speaker 1: less pain and able to work better and to think better. 92 00:05:28,200 --> 00:05:30,600 Speaker 1: And so they were really enormously helpful to me. Which ones, 93 00:05:30,640 --> 00:05:33,960 Speaker 1: what are you using? We ended up with methodone. Probably 94 00:05:34,040 --> 00:05:36,960 Speaker 1: my doctor's positive. That's because the way it's formulated in 95 00:05:37,000 --> 00:05:40,080 Speaker 1: the US, it also has an agent that helps with 96 00:05:40,600 --> 00:05:43,680 Speaker 1: certain neurological conditions or neuropathic pain. So you get into 97 00:05:43,680 --> 00:05:45,479 Speaker 1: the opioids, you're still doing with the pain. Now the 98 00:05:45,520 --> 00:05:48,560 Speaker 1: opioids are helping, the methodons helping you're able to work. 99 00:05:48,920 --> 00:05:51,080 Speaker 1: And then I just sort of continued my life I 100 00:05:51,120 --> 00:05:54,360 Speaker 1: mean I I still was very limited, so I had 101 00:05:54,400 --> 00:05:57,719 Speaker 1: to argue cases locally lying in a reclining folding lawn chair, 102 00:05:57,960 --> 00:06:02,680 Speaker 1: and overseas litigation across the country using video teleconferencing, which 103 00:06:02,760 --> 00:06:05,520 Speaker 1: was brand new in the early nineties, at least for 104 00:06:05,520 --> 00:06:07,200 Speaker 1: for the kinds of work that I was doing. So 105 00:06:07,240 --> 00:06:10,440 Speaker 1: I remained limited my mobility, but I was able to 106 00:06:10,480 --> 00:06:15,680 Speaker 1: continue to work and function despite those difficult circumstances. And so, 107 00:06:15,720 --> 00:06:20,000 Speaker 1: what's the connection between your being prescribed opioids, successfully deal 108 00:06:20,080 --> 00:06:23,880 Speaker 1: with your pain and UH would then emerge? This is 109 00:06:23,920 --> 00:06:27,840 Speaker 1: this massive over prescribing of opioids. How does your personal 110 00:06:27,839 --> 00:06:30,040 Speaker 1: story fit into the bigger picture of what's going on 111 00:06:30,160 --> 00:06:32,480 Speaker 1: in the in the country. Well, in a couple of ways. 112 00:06:32,480 --> 00:06:36,520 Speaker 1: I mean, first of all, um, there was a liberalization 113 00:06:37,120 --> 00:06:40,640 Speaker 1: prescribing sort of starting in the eighties. In the early nineties, 114 00:06:41,080 --> 00:06:45,479 Speaker 1: there was a recognition that pain was undertreated, and that 115 00:06:45,720 --> 00:06:47,920 Speaker 1: is true, that remains true. Pain is the number one 116 00:06:47,960 --> 00:06:52,119 Speaker 1: cause of disability both globally. In the US, daily pain 117 00:06:52,160 --> 00:06:57,680 Speaker 1: affects some fifty million Americans and profoundly impactful pain like 118 00:06:57,760 --> 00:07:00,880 Speaker 1: mind some twenty millions. So it is still a very 119 00:07:00,960 --> 00:07:04,440 Speaker 1: serious problem. But that genuine concern was in some ways 120 00:07:04,480 --> 00:07:10,640 Speaker 1: sort of hijacked by pharmaceutical malfeasance and the promotion of 121 00:07:10,680 --> 00:07:13,560 Speaker 1: the idea that if you had pain, you couldn't become 122 00:07:13,920 --> 00:07:17,320 Speaker 1: addicted to these medications, the understatement of the risks, and 123 00:07:17,320 --> 00:07:21,200 Speaker 1: and there were and really the risks are relatively low, 124 00:07:21,480 --> 00:07:24,920 Speaker 1: but it's still a small but significant group of people 125 00:07:24,960 --> 00:07:27,200 Speaker 1: who were harmed. Right, So that was the connection. But 126 00:07:27,240 --> 00:07:30,040 Speaker 1: also the other connection with me is that I didn't 127 00:07:30,080 --> 00:07:33,720 Speaker 1: have cancer pain, so it is quite possible that I 128 00:07:33,720 --> 00:07:37,360 Speaker 1: would never have been offered opioids, even after trying thirty 129 00:07:37,360 --> 00:07:39,960 Speaker 1: seven different kinds of treatment over three years. Because when 130 00:07:40,000 --> 00:07:43,000 Speaker 1: the Big CEA is involved, doctors are ready to prescribe opioids, 131 00:07:43,040 --> 00:07:45,640 Speaker 1: but if it's something else, even back then, they would 132 00:07:45,640 --> 00:07:48,360 Speaker 1: be leery of this sort of thing. I remember when 133 00:07:48,400 --> 00:07:52,280 Speaker 1: the late nineties mid nineties when Perdue Pharma, you know, 134 00:07:52,320 --> 00:07:55,840 Speaker 1: the now infamous pharmaceutical comely owned by the Sackler family, 135 00:07:56,360 --> 00:07:59,360 Speaker 1: came up with oxycontent and it initially appeared to be 136 00:07:59,440 --> 00:08:02,920 Speaker 1: virtually racle drug, right that people dealing with serious pain, 137 00:08:03,000 --> 00:08:05,800 Speaker 1: we're finding great relief from this thing, and it seemed 138 00:08:05,840 --> 00:08:09,840 Speaker 1: like a very positive development. Um But obviously things, and 139 00:08:09,840 --> 00:08:12,320 Speaker 1: it may have been true for many people. UM, Yet 140 00:08:12,360 --> 00:08:14,720 Speaker 1: at the same time we then see them beginning to 141 00:08:14,760 --> 00:08:18,040 Speaker 1: promote these drugs much more aggressively to all sorts of people. 142 00:08:18,400 --> 00:08:20,440 Speaker 1: UM And what's your take about what happened with that 143 00:08:20,960 --> 00:08:24,040 Speaker 1: with a Perduce farm in the other companies. The theory 144 00:08:24,160 --> 00:08:28,160 Speaker 1: behind oxycoton is that if you have pain that lasts, 145 00:08:28,560 --> 00:08:32,080 Speaker 1: you know, all the time, that taking a pill that's 146 00:08:32,080 --> 00:08:34,800 Speaker 1: going to spike and then wear off every few hours 147 00:08:34,880 --> 00:08:37,080 Speaker 1: might not be as effective as something that's going to 148 00:08:37,160 --> 00:08:40,240 Speaker 1: have a slow, extended release through a period of time. 149 00:08:40,600 --> 00:08:43,480 Speaker 1: UM and Oxyconton was marketed to do that. It wasn't 150 00:08:43,760 --> 00:08:45,960 Speaker 1: as effective as it was marketed to be in terms 151 00:08:45,960 --> 00:08:47,920 Speaker 1: of how long the range lasted, and there were some 152 00:08:47,960 --> 00:08:51,280 Speaker 1: problems with it. But I think the bigger issue with 153 00:08:51,320 --> 00:08:55,840 Speaker 1: oxyconton was in the way it was marketed, the understatement 154 00:08:55,880 --> 00:09:00,120 Speaker 1: of the risks and um the larger availability of it, 155 00:09:00,679 --> 00:09:03,680 Speaker 1: and pitching to a lot of doctors and medical professionals 156 00:09:03,720 --> 00:09:06,320 Speaker 1: who really are not very trained in dealing with pain, 157 00:09:06,480 --> 00:09:09,040 Speaker 1: right right. Again, That's that's the other problem. And I 158 00:09:09,160 --> 00:09:13,480 Speaker 1: sort of have this under acknowledge condition pain partly because 159 00:09:13,520 --> 00:09:15,840 Speaker 1: it's ubiquitous, because we all have pain at some level, 160 00:09:15,880 --> 00:09:19,520 Speaker 1: but most people don't really understand that. Well. Acute pain 161 00:09:19,960 --> 00:09:23,199 Speaker 1: is adaptive and normal, and people who have a genetic 162 00:09:23,200 --> 00:09:25,920 Speaker 1: condition that makes them not able to feel pain will 163 00:09:26,080 --> 00:09:29,120 Speaker 1: not live very long. So it's necessary that we experience 164 00:09:29,160 --> 00:09:31,640 Speaker 1: pain to teach us to rest or seek medical care. 165 00:09:32,120 --> 00:09:35,080 Speaker 1: Chronic pain is something very different. It's often described by 166 00:09:35,120 --> 00:09:38,240 Speaker 1: experts as a disease because it actually isn't adaptive. It 167 00:09:38,600 --> 00:09:42,480 Speaker 1: damages the body, affecting almost every organ system, and that's 168 00:09:42,480 --> 00:09:45,200 Speaker 1: why it requires treatment. And I'm just thinking, you know, 169 00:09:45,200 --> 00:09:48,160 Speaker 1: because also people talk about real pain or unreal pain, 170 00:09:48,280 --> 00:09:51,679 Speaker 1: or physical pain versus emotional pain, or or how it's 171 00:09:51,720 --> 00:09:54,280 Speaker 1: all mixed up, or pain exists in the brain, or 172 00:09:54,559 --> 00:09:58,440 Speaker 1: you know, different cultures experience pain differently. What's you're thinking 173 00:09:58,440 --> 00:10:01,400 Speaker 1: about this reality of pain? Well, I think it's all real, 174 00:10:01,640 --> 00:10:04,319 Speaker 1: whether it's physical or emotional pain, right, I don't I 175 00:10:04,600 --> 00:10:07,440 Speaker 1: think it's all real. I think there are spectrums, Like 176 00:10:07,480 --> 00:10:09,400 Speaker 1: I said, the difference between sort of the kind of 177 00:10:09,400 --> 00:10:11,880 Speaker 1: pain that everyone experiences in a small pain and having 178 00:10:11,920 --> 00:10:14,679 Speaker 1: intractable pain that's more like a disease, just as there's 179 00:10:14,679 --> 00:10:19,600 Speaker 1: a difference between people feeling sad and people having intractable depression. 180 00:10:19,880 --> 00:10:22,800 Speaker 1: I think there are there are spectrums in many illnesses, 181 00:10:22,880 --> 00:10:24,480 Speaker 1: and it is in the brain. It is experience in 182 00:10:24,480 --> 00:10:26,400 Speaker 1: the brain, but a lot of our body operates from 183 00:10:26,400 --> 00:10:29,760 Speaker 1: our brain. Um So that's that's, you know, sort of 184 00:10:29,800 --> 00:10:34,920 Speaker 1: a funny Cartesian idea of the division between mind and 185 00:10:34,960 --> 00:10:39,240 Speaker 1: body that that just isn't biologically accurate. The thing that 186 00:10:39,520 --> 00:10:43,040 Speaker 1: is true about the connection between emotions and pain is 187 00:10:43,080 --> 00:10:45,360 Speaker 1: that the way pain works is it's a you know, 188 00:10:45,440 --> 00:10:48,440 Speaker 1: a noxious signal. But if we didn't have an emotional 189 00:10:48,480 --> 00:10:51,960 Speaker 1: response to it, we wouldn't react to that signal. And 190 00:10:52,000 --> 00:10:56,480 Speaker 1: so there is a connection between how we experience pain 191 00:10:56,520 --> 00:11:00,160 Speaker 1: and the emotional experience of pain. So I think it's 192 00:11:00,160 --> 00:11:04,760 Speaker 1: it's a spectrum. But um so you lived with this 193 00:11:04,840 --> 00:11:07,280 Speaker 1: pain in a very serious way for what almost twenty years, 194 00:11:07,320 --> 00:11:11,200 Speaker 1: So you had this relatively successful surgery that moderated quite 195 00:11:11,240 --> 00:11:13,200 Speaker 1: a bit. That's true. I mean it was a little 196 00:11:13,240 --> 00:11:15,920 Speaker 1: more complicated than that. Um. I was using a medical 197 00:11:15,960 --> 00:11:19,160 Speaker 1: device that has advanced a lot, called a spinal stimulator 198 00:11:19,200 --> 00:11:22,760 Speaker 1: that was starting to improve things for me a little bit. 199 00:11:23,040 --> 00:11:25,720 Speaker 1: And then I had the surgery on the spinal cord 200 00:11:25,920 --> 00:11:31,199 Speaker 1: issue UM and moved to Colorado, was starting to learn 201 00:11:31,240 --> 00:11:36,240 Speaker 1: to walk again and was really improving. UM. And that's 202 00:11:36,280 --> 00:11:39,680 Speaker 1: what brought me into this current conversation because I was finally, 203 00:11:39,720 --> 00:11:43,120 Speaker 1: after you know, almost two decades of trying to trying 204 00:11:43,120 --> 00:11:46,160 Speaker 1: to get a better quality of life, that possibility was 205 00:11:46,720 --> 00:11:49,920 Speaker 1: really in front of me. And I was rehabilitating and 206 00:11:49,960 --> 00:11:53,400 Speaker 1: learning to walk again and going down on the medication. 207 00:11:54,000 --> 00:11:57,360 Speaker 1: And I went into my doctor's office one day, UM, 208 00:11:57,440 --> 00:12:00,480 Speaker 1: and she said, I'm not going to prescribe opioids anymore 209 00:12:00,800 --> 00:12:03,680 Speaker 1: to any of my patients, and you won't find anyone 210 00:12:03,720 --> 00:12:06,160 Speaker 1: else in the area who's willing to either. And this 211 00:12:06,200 --> 00:12:10,920 Speaker 1: was and what had happened is that a local clinician 212 00:12:11,640 --> 00:12:14,760 Speaker 1: who was well respected had fallen under d e a 213 00:12:14,880 --> 00:12:18,480 Speaker 1: investigation for opia prescribing, and that really just sent shock 214 00:12:18,559 --> 00:12:22,240 Speaker 1: waves through the whole medical community locally. And this was 215 00:12:22,280 --> 00:12:24,439 Speaker 1: coming at a time and prescribing in America started to 216 00:12:24,520 --> 00:12:28,000 Speaker 1: drop in there was a growing awareness UM and pushed 217 00:12:28,040 --> 00:12:29,920 Speaker 1: back in the press. I was worried. I said, well, 218 00:12:29,960 --> 00:12:31,839 Speaker 1: can't you at least give me a taper plan? Because 219 00:12:31,840 --> 00:12:34,520 Speaker 1: I knew that people who take opioids long term become 220 00:12:34,760 --> 00:12:38,680 Speaker 1: physically dependent on them, which is different from being addicted it. 221 00:12:38,679 --> 00:12:43,000 Speaker 1: It lacks the sort of compulsive use, but it's dangerous 222 00:12:43,040 --> 00:12:49,080 Speaker 1: to stop the medication abruptly, and she just wasn't willing 223 00:12:49,160 --> 00:12:52,800 Speaker 1: to help me. It's luckily I had a prior treatment 224 00:12:52,840 --> 00:12:55,600 Speaker 1: team in d C where I lived before, and I 225 00:12:55,640 --> 00:12:57,880 Speaker 1: was able to go back there and they gave me 226 00:12:57,920 --> 00:13:00,440 Speaker 1: a taper plan, and um, I was to get off 227 00:13:00,440 --> 00:13:02,120 Speaker 1: of them, and as I said, I was already improving, 228 00:13:02,160 --> 00:13:06,360 Speaker 1: and so it didn't cause any major problems in my 229 00:13:06,920 --> 00:13:10,280 Speaker 1: personal condition, but it did let me see what was 230 00:13:10,320 --> 00:13:13,760 Speaker 1: coming in the environment. So now you're able to live 231 00:13:13,800 --> 00:13:16,760 Speaker 1: a life where you have occasional pain and the opioids 232 00:13:16,840 --> 00:13:19,560 Speaker 1: or what. I still have continual pain, but it's it's 233 00:13:19,600 --> 00:13:21,880 Speaker 1: at a very low level. It's not nearly as severe. 234 00:13:22,360 --> 00:13:25,960 Speaker 1: Um it doesn't limit my activities very much, and I 235 00:13:25,960 --> 00:13:28,240 Speaker 1: don't require use of any medications anymore. I do use 236 00:13:28,280 --> 00:13:31,840 Speaker 1: a lot of complimentary and adjunctive techniques, and I started 237 00:13:31,880 --> 00:13:35,280 Speaker 1: meditating very early on when I had pain, and using 238 00:13:35,320 --> 00:13:38,680 Speaker 1: mindfulness techniques. But yeah, I no longer require use of 239 00:13:38,920 --> 00:13:42,199 Speaker 1: prescribed opioids. So it instigated you to get into this 240 00:13:42,360 --> 00:13:44,920 Speaker 1: issue as an advocate. Was that experience of having a 241 00:13:45,000 --> 00:13:47,320 Speaker 1: doctor I want to cut you off the opioids right 242 00:13:47,360 --> 00:13:49,880 Speaker 1: away like that. I mean, you must have been furious 243 00:13:49,920 --> 00:13:52,040 Speaker 1: exactly what I was mostly scared. I mean, I've been 244 00:13:52,080 --> 00:13:55,520 Speaker 1: working so hard to get better and and I thought 245 00:13:55,679 --> 00:13:58,200 Speaker 1: everything was gonna, you know, collapse in front of me. 246 00:13:58,240 --> 00:14:00,480 Speaker 1: And I had been hearing through the DISAPL the rights 247 00:14:00,520 --> 00:14:02,840 Speaker 1: community about more and more people being cut off of 248 00:14:02,880 --> 00:14:05,559 Speaker 1: their pain medication. So I got up and did a 249 00:14:05,640 --> 00:14:08,800 Speaker 1: ted X talk and started advocating about you know, the 250 00:14:08,840 --> 00:14:13,160 Speaker 1: appropriate use of opioids and people being denied care. And 251 00:14:13,200 --> 00:14:16,600 Speaker 1: I was also interested in that because of some of 252 00:14:16,640 --> 00:14:19,440 Speaker 1: my previous work. As I mentioned to you, I was 253 00:14:19,480 --> 00:14:22,240 Speaker 1: a health related civil rights attorney, and some of my 254 00:14:22,320 --> 00:14:25,760 Speaker 1: early cases were in the HIV and AIDS crisis. And 255 00:14:25,840 --> 00:14:28,880 Speaker 1: what we saw was that in these public health crises, 256 00:14:29,040 --> 00:14:31,560 Speaker 1: the people were trying to help often become stigmatized and 257 00:14:31,560 --> 00:14:34,480 Speaker 1: then denied care. And so one of my big cases 258 00:14:35,000 --> 00:14:38,240 Speaker 1: was this case called Bragdon versus Abbott, which was about 259 00:14:38,280 --> 00:14:41,600 Speaker 1: whether someone even with asymptomatic HIV could have access to 260 00:14:41,840 --> 00:14:44,280 Speaker 1: basic dental care. And we had to win that right 261 00:14:44,320 --> 00:14:46,200 Speaker 1: all the way in the U. S. Supreme Court. So 262 00:14:46,760 --> 00:14:50,640 Speaker 1: it is a phenomenon of the I think public health crisis, 263 00:14:50,720 --> 00:14:54,960 Speaker 1: that people often become stigmatized, and that that those stigmas 264 00:14:55,000 --> 00:14:58,000 Speaker 1: can result in discrimination and barriers to healthcare. And so 265 00:14:58,200 --> 00:15:01,400 Speaker 1: having had that professional experience and then the personal experience, 266 00:15:01,440 --> 00:15:04,320 Speaker 1: it seemed important for me to be able to get 267 00:15:04,360 --> 00:15:07,720 Speaker 1: up and talk about it. And people were sadly going 268 00:15:07,720 --> 00:15:11,000 Speaker 1: to take me seriously because I was someone who used 269 00:15:11,000 --> 00:15:13,280 Speaker 1: them for many years, got off of them with no trouble, 270 00:15:13,600 --> 00:15:16,200 Speaker 1: and was not using them anymore. And did you find 271 00:15:16,240 --> 00:15:19,840 Speaker 1: that there was already a substantial advocacy world of people 272 00:15:20,120 --> 00:15:23,560 Speaker 1: trying to make this an issue, or were medical associations 273 00:15:23,600 --> 00:15:26,120 Speaker 1: alert to this, or the or the doctors mostly running 274 00:15:26,120 --> 00:15:28,800 Speaker 1: scared as well like your doctor had been. I think 275 00:15:28,840 --> 00:15:31,200 Speaker 1: mostly when I first stepped into it, there were a 276 00:15:31,240 --> 00:15:34,680 Speaker 1: lot of people running scared. Uh. Since that time, there's 277 00:15:34,720 --> 00:15:37,880 Speaker 1: been more advocacy, I meet, the American Medical Association has 278 00:15:37,880 --> 00:15:41,760 Speaker 1: certainly become more involved. A lot of things changed in 279 00:15:41,800 --> 00:15:44,760 Speaker 1: the conversation In the United States when the Centers for 280 00:15:44,920 --> 00:15:50,320 Speaker 1: Disease Control and Prevention issued guidance for prescribing opioids for 281 00:15:50,440 --> 00:15:53,160 Speaker 1: chronic pain um and a lot of the recommendations in 282 00:15:53,400 --> 00:15:56,920 Speaker 1: the guideline are very sensible, but a couple of the 283 00:15:56,960 --> 00:16:01,440 Speaker 1: provisions were very concrete, and they became a really weaponized 284 00:16:01,520 --> 00:16:06,200 Speaker 1: and used by law enforcement, insurers, UH, and a lot 285 00:16:06,240 --> 00:16:10,240 Speaker 1: of policy actors to limit prescribed opioids in a way 286 00:16:10,280 --> 00:16:13,720 Speaker 1: that meant that people who need them to manage serious conditions, 287 00:16:13,760 --> 00:16:17,760 Speaker 1: including cancer and sickle cell disease and multiple scurosis, had 288 00:16:17,800 --> 00:16:23,120 Speaker 1: trouble getting access at the pharmacy, and doctors either abandoned 289 00:16:23,120 --> 00:16:27,880 Speaker 1: their patients, stopped prescribing forcibly tapered people, which is a 290 00:16:27,960 --> 00:16:31,360 Speaker 1: dangerous practice that public health agencies have now come out against, 291 00:16:31,360 --> 00:16:34,960 Speaker 1: but it's still happening to people all the time. There 292 00:16:35,040 --> 00:16:38,200 Speaker 1: was a recent update to a survey done the University 293 00:16:38,200 --> 00:16:41,320 Speaker 1: of Michigan that looked at nine different states, and they 294 00:16:41,400 --> 00:16:44,680 Speaker 1: found that more than fifty percent of primary care providers 295 00:16:44,920 --> 00:16:47,400 Speaker 1: will not take on a new patient who uses opioids 296 00:16:47,440 --> 00:16:51,680 Speaker 1: to manage paint. A different survey found are reluctant to 297 00:16:51,800 --> 00:16:55,000 Speaker 1: so people are losing access not just to medication, but 298 00:16:55,080 --> 00:16:58,400 Speaker 1: to healthcare altogether. It's such another example of sort of 299 00:16:58,480 --> 00:17:04,399 Speaker 1: widespread physician fear and ignorance undermining effective treatment for people. 300 00:17:07,160 --> 00:17:21,480 Speaker 1: We'll be talking more after we hear this ad you 301 00:17:21,480 --> 00:17:24,040 Speaker 1: and I have talked briefly about. I sometimes see more 302 00:17:24,040 --> 00:17:26,600 Speaker 1: and more analogies between what's going on in this issue 303 00:17:26,600 --> 00:17:29,720 Speaker 1: of pain management and what's going on in the issue 304 00:17:29,720 --> 00:17:33,960 Speaker 1: of tobacco harm reduction, where you have these vaping devices 305 00:17:34,040 --> 00:17:36,119 Speaker 1: and heat not burn device and East cigarettes which are 306 00:17:36,119 --> 00:17:39,200 Speaker 1: actually can be quite effective in helping long term smokers 307 00:17:39,280 --> 00:17:42,679 Speaker 1: quit smoking. But because people got so freaked out about 308 00:17:42,720 --> 00:17:45,880 Speaker 1: young people, you know, using East SIGs and vaping and jeweling, 309 00:17:46,280 --> 00:17:49,359 Speaker 1: that there's massive crackdown, and you now have doctors believing 310 00:17:49,680 --> 00:17:53,840 Speaker 1: all sorts of things are absolutely false according to the 311 00:17:53,880 --> 00:17:58,760 Speaker 1: scientific evidence, and being fearful of giving correct information, are 312 00:17:58,800 --> 00:18:02,639 Speaker 1: oftentimes being more guided by inaccurate headlines than they are 313 00:18:02,640 --> 00:18:05,399 Speaker 1: by what's really going on. And people read about, you know, 314 00:18:05,440 --> 00:18:09,159 Speaker 1: the opioid overdose crisis, which is very real and very serious, 315 00:18:09,680 --> 00:18:12,359 Speaker 1: and then they think they can't prescribe opioids. And meanwhile, 316 00:18:12,359 --> 00:18:14,879 Speaker 1: I think, right, I mean early twenty years ago, fifteen 317 00:18:14,960 --> 00:18:18,159 Speaker 1: years ago, what was driving the increase in drug addiction 318 00:18:18,200 --> 00:18:20,760 Speaker 1: and over those fatalities. I think was this over aggressive 319 00:18:20,800 --> 00:18:23,439 Speaker 1: marketing by the pharmaceutical companies, by the produce pharmers in 320 00:18:23,480 --> 00:18:25,720 Speaker 1: a range of others. But for the last ten to 321 00:18:25,800 --> 00:18:29,359 Speaker 1: fifteen years. You know, pharmaceuticals opioids I think play less 322 00:18:29,359 --> 00:18:32,879 Speaker 1: and less of a role, and doctor over prescribing plays 323 00:18:32,920 --> 00:18:35,080 Speaker 1: even less of a role and more and more it 324 00:18:35,119 --> 00:18:38,639 Speaker 1: has to do with heroin or fenenal, or people getting 325 00:18:38,840 --> 00:18:41,359 Speaker 1: drugs that are legally prescribed to somebody else but now 326 00:18:41,400 --> 00:18:44,479 Speaker 1: they're getting their hands on it. Basically, that's what's going on, 327 00:18:44,640 --> 00:18:46,439 Speaker 1: right right, I mean, I think it's always been the 328 00:18:46,440 --> 00:18:48,760 Speaker 1: case if you look at the Service for Drug Use 329 00:18:48,800 --> 00:18:52,159 Speaker 1: and Health that even in the days when UH prescription 330 00:18:52,200 --> 00:18:55,840 Speaker 1: opioids were showing up in in overdose stats, if you 331 00:18:55,880 --> 00:18:58,320 Speaker 1: look at all the surveys, it looks like most people 332 00:18:58,359 --> 00:19:01,600 Speaker 1: who were using non medically or misusing them in the 333 00:19:01,640 --> 00:19:05,120 Speaker 1: greatest risk for addiction or overdose, or were not actually 334 00:19:05,200 --> 00:19:08,159 Speaker 1: the direct recipients of a prescription from a doctor. The 335 00:19:08,160 --> 00:19:11,960 Speaker 1: biggest problem even with prescribed opioids was diversion. And that 336 00:19:12,000 --> 00:19:14,919 Speaker 1: doesn't mean that some people weren't prescribed and opioid and 337 00:19:14,960 --> 00:19:17,760 Speaker 1: became addicted. That of course happened as well, but it's 338 00:19:17,760 --> 00:19:21,800 Speaker 1: a relatively small percentage of people. The bigger problem where 339 00:19:21,800 --> 00:19:26,639 Speaker 1: these leftover supplies and medicine cabinets are uh, distribution channels 340 00:19:26,760 --> 00:19:30,800 Speaker 1: in hospitals where people were able to get their hands 341 00:19:30,800 --> 00:19:34,359 Speaker 1: on prescribed opioid that wasn't given to them by a 342 00:19:34,400 --> 00:19:37,600 Speaker 1: doctor directly, but because there was liberalized prescribing, the supply 343 00:19:37,760 --> 00:19:40,119 Speaker 1: was it was so much greater. So, I mean, I 344 00:19:40,119 --> 00:19:42,640 Speaker 1: think that's certainly true. There are lots of sort of 345 00:19:42,880 --> 00:19:46,320 Speaker 1: chinks in the armor and the discussion of the addictiveness 346 00:19:46,359 --> 00:19:50,280 Speaker 1: of these medications. Neither. Director Nora Volcaw, who I think 347 00:19:50,800 --> 00:19:54,080 Speaker 1: has very little interest in understating the problem since her 348 00:19:54,200 --> 00:19:58,000 Speaker 1: job is fighting, you know, sort of against addiction UH 349 00:19:58,080 --> 00:20:02,280 Speaker 1: and misuse, says that even when they're prescribed for chronic pain, 350 00:20:02,520 --> 00:20:04,480 Speaker 1: which is sort of longer term prescribing, and so the 351 00:20:04,560 --> 00:20:07,359 Speaker 1: risks are higher um and even in groups of people 352 00:20:07,600 --> 00:20:11,080 Speaker 1: who have pre existing risk factors, whether they speaking commin 353 00:20:11,119 --> 00:20:14,359 Speaker 1: at mental health issues or prior substance huse, problematic prior 354 00:20:14,400 --> 00:20:17,879 Speaker 1: substance huose. She says that well documented studies say the 355 00:20:17,960 --> 00:20:21,280 Speaker 1: risk is less than eight percent, and often you know, 356 00:20:21,400 --> 00:20:23,879 Speaker 1: it's it's much lower than that. Now, that's still a 357 00:20:23,960 --> 00:20:27,080 Speaker 1: significant it's a small percentage, but it's a significant percentage 358 00:20:27,080 --> 00:20:29,119 Speaker 1: of right. But my understanding also is that if you 359 00:20:29,160 --> 00:20:33,960 Speaker 1: look at the people who are being prescribed opioids by 360 00:20:34,119 --> 00:20:38,879 Speaker 1: physicians for their pain. That among the people who have 361 00:20:39,040 --> 00:20:43,199 Speaker 1: never had an issue with misuse of substances before, the 362 00:20:43,320 --> 00:20:47,080 Speaker 1: likelihood that they're now going to get addicted exists, but 363 00:20:47,200 --> 00:20:49,960 Speaker 1: it's very low. It's one percent, it's less than one percent. 364 00:20:50,080 --> 00:20:53,160 Speaker 1: Whereas most of the people getting in trouble are oftentimes 365 00:20:53,240 --> 00:20:57,119 Speaker 1: people who had issues with substance abuse earlier and now 366 00:20:57,160 --> 00:21:00,240 Speaker 1: they're in a pain situation, and uh, they may be 367 00:21:00,359 --> 00:21:02,800 Speaker 1: more susceptible to getting in trouble. And of course that 368 00:21:03,200 --> 00:21:06,480 Speaker 1: people who do have pain and are prescribed to opioids 369 00:21:06,520 --> 00:21:08,000 Speaker 1: and then end up what they used to sort of too, 370 00:21:08,040 --> 00:21:11,360 Speaker 1: are probably the most vulnerable in the current environment. Well, 371 00:21:11,480 --> 00:21:14,360 Speaker 1: you know, I remember there was a doctor, his name 372 00:21:14,400 --> 00:21:16,359 Speaker 1: was Hurwitz. I think he was the subject of a 373 00:21:16,400 --> 00:21:19,679 Speaker 1: sixty minute special report, And there was a certain category 374 00:21:19,760 --> 00:21:24,000 Speaker 1: of physicians that I regard as basically among the most 375 00:21:24,080 --> 00:21:27,239 Speaker 1: courageous physicians on the face of the earth, right, And 376 00:21:27,320 --> 00:21:30,520 Speaker 1: these are physicians who were willing to deal with pain 377 00:21:30,640 --> 00:21:35,159 Speaker 1: management issues among people who were or had been addicted 378 00:21:35,200 --> 00:21:38,840 Speaker 1: to illegal drugs, because the reality is using these opioids 379 00:21:38,840 --> 00:21:41,639 Speaker 1: illegally doesn't necessarily prevent you from having pain, and you 380 00:21:41,720 --> 00:21:44,639 Speaker 1: walk into a doctor's office and the doctor's got a 381 00:21:44,680 --> 00:21:47,520 Speaker 1: hard time saying, does this person in real pain or 382 00:21:47,640 --> 00:21:49,760 Speaker 1: they just trying to scare me so that they can 383 00:21:49,760 --> 00:21:51,880 Speaker 1: get a prescription for opioids if they want to use 384 00:21:51,960 --> 00:21:55,080 Speaker 1: for their whether it's recreational, whatever you want to call it. 385 00:21:55,440 --> 00:21:58,199 Speaker 1: And the doctors willing to live on the edge in 386 00:21:58,320 --> 00:22:01,320 Speaker 1: dealing with that sort of stuff I just immense admiration for. 387 00:22:01,560 --> 00:22:04,320 Speaker 1: And they went after him with a vengeance. I remember 388 00:22:04,320 --> 00:22:07,919 Speaker 1: reading the cases, the appellate cases in his matter. I 389 00:22:07,960 --> 00:22:10,520 Speaker 1: do think that, you know, the physicians who are willing 390 00:22:10,560 --> 00:22:14,080 Speaker 1: to deal with the people who have pain and a 391 00:22:14,200 --> 00:22:17,119 Speaker 1: use disorder are very few and far between. And the 392 00:22:17,119 --> 00:22:19,840 Speaker 1: problem is, you know, it's already dangerous just to cut 393 00:22:19,880 --> 00:22:23,760 Speaker 1: someone off precipitously or forcibly taper them who has pain 394 00:22:23,800 --> 00:22:25,920 Speaker 1: and no evidence of a use disorder. There are many 395 00:22:25,960 --> 00:22:28,400 Speaker 1: studies that show it puts people in a much threefold 396 00:22:28,400 --> 00:22:31,200 Speaker 1: greater risk of overdose or death by suicide. I mean, 397 00:22:31,200 --> 00:22:33,440 Speaker 1: it's a very dangerous practice that's happening to lots of 398 00:22:33,480 --> 00:22:36,439 Speaker 1: pain patients today. But it's even more dangerous if someone 399 00:22:36,800 --> 00:22:39,520 Speaker 1: may have a use disorder right there in some ways 400 00:22:39,520 --> 00:22:42,080 Speaker 1: the most vulnerable patients. But you're right about what you 401 00:22:42,160 --> 00:22:45,360 Speaker 1: said a little while ago about what's driving the overdose 402 00:22:45,400 --> 00:22:48,800 Speaker 1: crisis at least since we started paying attention to it 403 00:22:49,240 --> 00:22:52,280 Speaker 1: in the last decade um, and that is largely a 404 00:22:52,440 --> 00:22:56,479 Speaker 1: very potent, tampered with street supply. The latest numbers from 405 00:22:56,480 --> 00:23:01,280 Speaker 1: the CDC show that it's you know, deaths orrupt related 406 00:23:01,320 --> 00:23:05,920 Speaker 1: to illicit ventnyl stimulants play an increasing role. Heroin also 407 00:23:05,920 --> 00:23:09,600 Speaker 1: plays a role. Dess related to preserved opioids are actually 408 00:23:09,880 --> 00:23:13,240 Speaker 1: down at this point, but we never saw the huge 409 00:23:13,320 --> 00:23:16,639 Speaker 1: numbers that we've seen until people were really using this 410 00:23:16,760 --> 00:23:21,400 Speaker 1: sort of dangerous street supply. A lot of policymakers now 411 00:23:21,400 --> 00:23:24,320 Speaker 1: believe that pain isn't really undertreated, that it's just a 412 00:23:24,359 --> 00:23:27,600 Speaker 1: pharmaceutical ruse. I mean, what we see is these crazy 413 00:23:27,640 --> 00:23:30,480 Speaker 1: pendulance things in this country, and what I've seen the 414 00:23:30,600 --> 00:23:33,879 Speaker 1: sacklers put in scare quotes opioid crisis to try and 415 00:23:33,920 --> 00:23:36,960 Speaker 1: pretend that it didn't exist or understate it um And 416 00:23:37,000 --> 00:23:40,840 Speaker 1: today in laws and policies, policymakers are putting undertreated pain 417 00:23:40,920 --> 00:23:43,439 Speaker 1: when they talk about the history of what happened. Also 418 00:23:43,520 --> 00:23:45,840 Speaker 1: in these quotes to say that that didn't really exist, 419 00:23:45,840 --> 00:23:48,840 Speaker 1: And so I would definitely say that, you know, pharmaceutical 420 00:23:49,320 --> 00:23:52,320 Speaker 1: companies in the Sackler family in particular, you know, hijacked 421 00:23:52,320 --> 00:23:54,959 Speaker 1: the conversation and did a lot of damage. Um. But 422 00:23:55,040 --> 00:23:57,360 Speaker 1: it's a more complicated than that, right, I mean, there 423 00:23:57,359 --> 00:24:00,359 Speaker 1: are some studies that show that drug over to deaths 424 00:24:00,359 --> 00:24:03,760 Speaker 1: have been on a steady upward trajectory since the nineteen forties, 425 00:24:03,760 --> 00:24:06,000 Speaker 1: and the drug of choice is just changed. You know. 426 00:24:06,560 --> 00:24:10,880 Speaker 1: My own view is that aggressive pharmaceutical marketing and liberal 427 00:24:10,960 --> 00:24:15,440 Speaker 1: prescribing did harm, and that the gen is a little 428 00:24:15,480 --> 00:24:17,399 Speaker 1: hard to put back in the bottle, you know, because 429 00:24:17,440 --> 00:24:21,000 Speaker 1: once you start with prohibition, you end up getting a 430 00:24:21,080 --> 00:24:24,479 Speaker 1: more dangerous supply. Yeah, I was gonna say, I just remember, 431 00:24:24,520 --> 00:24:26,760 Speaker 1: you know, years ago, maybe back in the late seventies 432 00:24:26,840 --> 00:24:29,200 Speaker 1: or eighties. Uh, there was a friend of mine, a 433 00:24:29,240 --> 00:24:32,680 Speaker 1: drug expert named Dr John Morrigan at the Cuney Medical School, 434 00:24:32,760 --> 00:24:37,000 Speaker 1: and he loved puncturing popular myths about drugs, and he 435 00:24:37,160 --> 00:24:42,320 Speaker 1: coined the term opiophobia to refer to the irrational fear 436 00:24:42,520 --> 00:24:45,480 Speaker 1: of opioids. Uh. And what he meant by this was 437 00:24:45,520 --> 00:24:48,200 Speaker 1: that you had cases of patients who would be lying 438 00:24:48,280 --> 00:24:52,520 Speaker 1: on their deathbed, dying from cancer and horrific pain, and 439 00:24:52,560 --> 00:24:55,880 Speaker 1: would be refusing opioids to manage their pain because quote 440 00:24:55,920 --> 00:24:57,960 Speaker 1: unquote they didn't want to die in addict or their 441 00:24:58,040 --> 00:25:01,679 Speaker 1: family members who were re using the pain medication, or 442 00:25:01,760 --> 00:25:04,560 Speaker 1: nurses and doctors who actually believe that stuff. And we're 443 00:25:04,560 --> 00:25:07,280 Speaker 1: allowing people to die in horrific pain because of this 444 00:25:07,320 --> 00:25:10,720 Speaker 1: pervasive opiophobia. You know, I guess in a way it 445 00:25:10,800 --> 00:25:14,520 Speaker 1: almost seems like a semi American sort of perspective that 446 00:25:14,600 --> 00:25:18,720 Speaker 1: we have a hard time finding that reasonable balance. Either 447 00:25:18,760 --> 00:25:22,359 Speaker 1: we're in a kind of super moralistic, prohibitionist mentality about 448 00:25:22,440 --> 00:25:24,600 Speaker 1: this drug or that, or on the other hand, we're 449 00:25:24,600 --> 00:25:27,960 Speaker 1: in some super capitalistic marketing. There is nothing wrong here, 450 00:25:28,400 --> 00:25:31,640 Speaker 1: and finding that middle ground is the one that becomes 451 00:25:31,680 --> 00:25:35,720 Speaker 1: such a challenge. Absolutely, the lack of nuances is extraordinary. 452 00:25:35,720 --> 00:25:38,080 Speaker 1: And even though as I said, I could see some 453 00:25:38,200 --> 00:25:41,919 Speaker 1: of this swing even in stigmatization with HIV, now that 454 00:25:41,960 --> 00:25:44,600 Speaker 1: I've sort of entered the drug policy conversation, nowhere are 455 00:25:44,600 --> 00:25:47,080 Speaker 1: there more myths, um and is there more sort of 456 00:25:47,119 --> 00:25:52,280 Speaker 1: shame and misperception than in anything related to drugs? Right, 457 00:25:52,440 --> 00:25:53,960 Speaker 1: And a lot of this has been going on in 458 00:25:53,960 --> 00:25:57,359 Speaker 1: the US for centuries, and so when they're being cautious 459 00:25:57,359 --> 00:25:59,440 Speaker 1: now in the crackdown, I mean, part of this comes 460 00:25:59,480 --> 00:26:02,920 Speaker 1: from greater wariness. Part of this comes from law enforcement 461 00:26:02,920 --> 00:26:06,080 Speaker 1: agencies beginning to go after some doctors. Some of it 462 00:26:06,160 --> 00:26:09,800 Speaker 1: comes from new state laws and regulations, things like, I mean, 463 00:26:10,000 --> 00:26:13,679 Speaker 1: how does this movement to you know, so dramatically restrict 464 00:26:14,240 --> 00:26:17,439 Speaker 1: access to opioids happen? Well, I think a lot of 465 00:26:17,480 --> 00:26:19,800 Speaker 1: it was driven by sort of the media narrative and 466 00:26:19,840 --> 00:26:22,840 Speaker 1: the way the story is told, where you had a 467 00:26:22,880 --> 00:26:26,639 Speaker 1: lot of stories about, um, you know, a teenager who 468 00:26:26,680 --> 00:26:29,360 Speaker 1: had a bum ankle uh and went to the doctor 469 00:26:29,400 --> 00:26:31,200 Speaker 1: and you know it was the high school football star 470 00:26:31,359 --> 00:26:34,960 Speaker 1: or the cheerleader and then became addicted. They were very 471 00:26:35,000 --> 00:26:39,280 Speaker 1: compelling stories. No one wants to believe that they're sending 472 00:26:39,320 --> 00:26:43,040 Speaker 1: their child to a doctor and condemning them eventually to death. Uh. 473 00:26:43,080 --> 00:26:46,960 Speaker 1: And we did have, of course, arise in overdose deaths. 474 00:26:46,960 --> 00:26:50,440 Speaker 1: Now it's interesting because MIAs Lobbits wrote a really interesting 475 00:26:50,480 --> 00:26:53,679 Speaker 1: piece for the Columbia Journalism Review, and she talked to 476 00:26:53,880 --> 00:26:57,680 Speaker 1: some folks who were keeping databases of stories, and journalists 477 00:26:57,720 --> 00:27:01,280 Speaker 1: were really just interested in that story they were looking 478 00:27:01,280 --> 00:27:04,760 Speaker 1: for people who had never had issues before, who were 479 00:27:04,800 --> 00:27:06,960 Speaker 1: not using them at a party, but who had been 480 00:27:07,000 --> 00:27:10,320 Speaker 1: prescribed in opia by a doctor, because that's a compelling victim. 481 00:27:10,600 --> 00:27:13,880 Speaker 1: And I think doctors became shamed and blamed for causing 482 00:27:14,000 --> 00:27:16,359 Speaker 1: people's teenagers to die on the streets, which just a 483 00:27:16,400 --> 00:27:21,200 Speaker 1: pretty pretty powerful message. And you know, we did let 484 00:27:21,200 --> 00:27:23,520 Speaker 1: it go on for a way too long before anybody 485 00:27:23,520 --> 00:27:26,280 Speaker 1: stepped in to do a lot about it. But you know, 486 00:27:26,320 --> 00:27:28,280 Speaker 1: one thing that also kind of piste me off about 487 00:27:28,280 --> 00:27:30,639 Speaker 1: that whole period was obviously you have these stories that 488 00:27:30,640 --> 00:27:33,960 Speaker 1: you're talking about and and doctors being careless and incautious, 489 00:27:34,280 --> 00:27:36,960 Speaker 1: but the fact of the matter was was that even 490 00:27:37,119 --> 00:27:40,600 Speaker 1: among people getting addicted in that way, you know, what 491 00:27:40,800 --> 00:27:45,520 Speaker 1: was called iatrogenically addicted by by physician prescribing huge numbers 492 00:27:45,520 --> 00:27:48,600 Speaker 1: of these fatalities were actually not taking too much of 493 00:27:48,640 --> 00:27:51,320 Speaker 1: the one drug they're being prescribed. They involved what might 494 00:27:51,320 --> 00:27:53,919 Speaker 1: be called fatal drug combinations. You know, it might have 495 00:27:53,960 --> 00:27:56,000 Speaker 1: been a football player, you know, who was injured and 496 00:27:56,080 --> 00:27:59,040 Speaker 1: was taking oxies, but he goes to a party and 497 00:27:59,080 --> 00:28:03,320 Speaker 1: gets drunk, not being aware that combining alcohol and oxyes 498 00:28:03,520 --> 00:28:05,680 Speaker 1: um is a thing that will kill you or oxyes 499 00:28:05,760 --> 00:28:10,280 Speaker 1: and benzoiazepines valiant type drugs. And meanwhile, the government and 500 00:28:10,320 --> 00:28:12,919 Speaker 1: all the sort of drug educators are reverse to putting 501 00:28:12,920 --> 00:28:17,640 Speaker 1: out the information that is really dangerous is the combination 502 00:28:17,840 --> 00:28:21,240 Speaker 1: of drugs that may feel really good if you combine 503 00:28:21,280 --> 00:28:23,320 Speaker 1: them in the right amount, but it just double that 504 00:28:23,440 --> 00:28:27,080 Speaker 1: level may stop your breathing. So, yes, doctors were to blame, 505 00:28:27,160 --> 00:28:30,280 Speaker 1: but the failure of public health authorities and government officials 506 00:28:30,320 --> 00:28:32,680 Speaker 1: and school authorities I think also played a very big 507 00:28:32,800 --> 00:28:36,639 Speaker 1: role in educating people about what were the safer or 508 00:28:36,680 --> 00:28:39,560 Speaker 1: more dangerous ways to be using these substances, whether you 509 00:28:39,640 --> 00:28:42,120 Speaker 1: already be using the medically or whether you were using 510 00:28:42,120 --> 00:28:45,400 Speaker 1: them recreationally or something in between without question, and that 511 00:28:45,440 --> 00:28:47,480 Speaker 1: continues to be a problem. I mean, these deaths were 512 00:28:47,520 --> 00:28:51,080 Speaker 1: always like what they call polypharmacy deaths, right, They usually 513 00:28:51,080 --> 00:28:54,400 Speaker 1: involved multiple drugs used in combination. One of the states 514 00:28:54,440 --> 00:28:56,520 Speaker 1: that had higher death rates found that the average number 515 00:28:56,520 --> 00:29:00,320 Speaker 1: of substances in someone's body who died was six. Right, 516 00:29:00,400 --> 00:29:04,160 Speaker 1: But the headline would read heroin death oftentimes oxy death, 517 00:29:04,240 --> 00:29:06,680 Speaker 1: and there's I mean, and the fatal drug combination thing 518 00:29:06,720 --> 00:29:08,680 Speaker 1: would either never show up in the article, maybe because 519 00:29:08,680 --> 00:29:11,080 Speaker 1: they didn't have the autopsy report as yet, or when 520 00:29:11,120 --> 00:29:12,680 Speaker 1: it did, it wasn't part of the headline because it 521 00:29:12,720 --> 00:29:15,400 Speaker 1: wasn't provocative and because talking about what was it, Polly 522 00:29:15,520 --> 00:29:18,440 Speaker 1: drug overdose doesn't make for a catchy headline in the 523 00:29:18,480 --> 00:29:21,640 Speaker 1: way that heroin or OxyContin or something like that does. 524 00:29:21,800 --> 00:29:24,479 Speaker 1: Absolutely um and in fact, all of the drugs, even 525 00:29:24,520 --> 00:29:27,360 Speaker 1: the drugs that are attributed to prescription opioids, the way 526 00:29:27,400 --> 00:29:30,480 Speaker 1: they're counted, that doesn't mean that the opioid, prescription opioid 527 00:29:30,560 --> 00:29:32,680 Speaker 1: caused death. That means that a prescription opioid was in 528 00:29:32,720 --> 00:29:35,040 Speaker 1: someone's system at the time of death. They could have 529 00:29:35,080 --> 00:29:38,800 Speaker 1: also had fentinyl, heroin, alcohol, benzo diazepine in their system 530 00:29:38,840 --> 00:29:41,640 Speaker 1: and cocaine, right, but it would still be counted as 531 00:29:41,640 --> 00:29:45,560 Speaker 1: a prescription opioid related to death. It caused this culture 532 00:29:45,560 --> 00:29:48,280 Speaker 1: of real fear, I think, and you know, not very 533 00:29:48,360 --> 00:29:51,720 Speaker 1: scientific conveyance of the problem, and that continues to be 534 00:29:51,760 --> 00:29:54,960 Speaker 1: the case. I mean, very few people talk about drug combinations, 535 00:29:55,040 --> 00:29:57,960 Speaker 1: certainly in the media. Fentinyl is now in the media 536 00:29:58,040 --> 00:30:00,000 Speaker 1: a lot, but you know, even then, they don't really 537 00:30:00,040 --> 00:30:03,239 Speaker 1: talk about the difference between illicitly produced fentyl and you know, 538 00:30:03,320 --> 00:30:06,880 Speaker 1: pharmaceutical use and and all of that. It's just sort 539 00:30:06,920 --> 00:30:10,640 Speaker 1: of you know, this the scare tactics. Yeah. I mean 540 00:30:10,680 --> 00:30:13,520 Speaker 1: what's different about the fentanyl now, of course, right, is 541 00:30:13,520 --> 00:30:15,959 Speaker 1: that fentanyl is the drug that can kill you all 542 00:30:16,000 --> 00:30:18,480 Speaker 1: by itself. I mean, it's fifty times more potent per 543 00:30:18,800 --> 00:30:21,400 Speaker 1: graham or whatever than morphine, and so that is a 544 00:30:21,440 --> 00:30:25,120 Speaker 1: real issue. But it's typically you know, being uh mixed 545 00:30:25,160 --> 00:30:27,640 Speaker 1: with other things as well, so we we can suspect 546 00:30:27,640 --> 00:30:30,120 Speaker 1: the fentanyl is the primary thing driving it, you know, 547 00:30:30,800 --> 00:30:33,480 Speaker 1: But meanwhile, hundreds of thousands of people are receiving fentanyl 548 00:30:33,640 --> 00:30:36,120 Speaker 1: post surgery and hospitals. It's one of the best drugs 549 00:30:36,120 --> 00:30:37,880 Speaker 1: you can give for that sort of thing. And the 550 00:30:37,880 --> 00:30:40,600 Speaker 1: fentanyl overdose problem in America has nothing to do with 551 00:30:40,640 --> 00:30:44,200 Speaker 1: fentinyl being diverted, right, It's fentanyl being produced illegally in China, 552 00:30:44,320 --> 00:30:47,560 Speaker 1: Mexico and being imported here in ways that are impossible 553 00:30:47,600 --> 00:30:51,600 Speaker 1: for law enforcement to stop, which is why accurate information 554 00:30:51,680 --> 00:30:53,960 Speaker 1: is all the more important. So so, so, okay, I 555 00:30:53,960 --> 00:30:56,320 Speaker 1: mean the evolution of this thing, you know, as the 556 00:30:56,400 --> 00:31:00,160 Speaker 1: crackdown mounts um on openly prescribing what are the key 557 00:31:00,280 --> 00:31:03,640 Speaker 1: ingredients to all of this? Well, I think that, as 558 00:31:03,640 --> 00:31:05,680 Speaker 1: I mentioned, I think we were caught a little as 559 00:31:05,680 --> 00:31:10,280 Speaker 1: a society flat footed. And in sixteen, the Centers for 560 00:31:10,360 --> 00:31:14,000 Speaker 1: Disease Control and Prevention in the United States issued this 561 00:31:14,200 --> 00:31:17,760 Speaker 1: guidance to try and sort of help guide doctors in 562 00:31:18,040 --> 00:31:22,840 Speaker 1: safer prescribing practices, because, as you mentioned, because pain is 563 00:31:22,840 --> 00:31:25,360 Speaker 1: sort of ignored as a as a condition and under 564 00:31:26,200 --> 00:31:30,720 Speaker 1: undertreated and underrepresented, it's also underrepresented in medical education doctors. 565 00:31:30,800 --> 00:31:33,680 Speaker 1: Even though pain is one of the top clinical complaints 566 00:31:33,760 --> 00:31:37,760 Speaker 1: in the world, very little uh in medical education addresses 567 00:31:37,800 --> 00:31:40,680 Speaker 1: the treatment of pain, at least in basic medical education. 568 00:31:40,760 --> 00:31:42,760 Speaker 1: And so the CDC stepped in and said, well, we 569 00:31:42,800 --> 00:31:45,880 Speaker 1: need to, you know, explain what the risks areta doctors 570 00:31:46,120 --> 00:31:50,680 Speaker 1: and encourage them, you know, to try other things first 571 00:31:50,720 --> 00:31:54,560 Speaker 1: to treat pain, and when they are prescribing, to prescribe 572 00:31:54,560 --> 00:31:57,440 Speaker 1: at the lowest effective dose for the shortest effective period 573 00:31:57,480 --> 00:32:00,560 Speaker 1: of time. And all of that was a sense able thing. 574 00:32:00,720 --> 00:32:03,240 Speaker 1: What happened, though, is that there were a couple of 575 00:32:03,280 --> 00:32:07,920 Speaker 1: provisions related to this problem, like the dentist who prescribe 576 00:32:07,960 --> 00:32:12,240 Speaker 1: fifty oxygotten after dental surgery. Um, the attempt to kind 577 00:32:12,240 --> 00:32:15,760 Speaker 1: of contain prescribing for acute pain, so you didn't have 578 00:32:15,840 --> 00:32:19,040 Speaker 1: a lot of people with this leftover supply in their 579 00:32:19,040 --> 00:32:22,800 Speaker 1: in their medicine chests, and the cd said CDC said 580 00:32:22,840 --> 00:32:25,520 Speaker 1: that with a lot of apute pain conditions, you're not 581 00:32:25,520 --> 00:32:28,160 Speaker 1: going to need more than a three to seven day supply. 582 00:32:28,680 --> 00:32:31,280 Speaker 1: And then then in a different provision, there was this 583 00:32:31,360 --> 00:32:34,440 Speaker 1: other problem that they identified, which was in the nineties, 584 00:32:34,480 --> 00:32:37,680 Speaker 1: there was this idea that you just titrated dose to 585 00:32:38,000 --> 00:32:41,440 Speaker 1: to palliation, so um you kept going up, and there 586 00:32:41,480 --> 00:32:42,959 Speaker 1: was as long as someone was still in pain, there 587 00:32:43,000 --> 00:32:46,880 Speaker 1: wasn't a danger in giving them increasingly higher doses. And 588 00:32:46,960 --> 00:32:49,720 Speaker 1: so there was this feeling that people were on an 589 00:32:49,840 --> 00:32:52,400 Speaker 1: unsafe level, or that we didn't want to start people 590 00:32:52,440 --> 00:32:54,640 Speaker 1: on an unsafe level because there were some studies coming 591 00:32:54,640 --> 00:32:57,480 Speaker 1: out showing that there was, you know, an elevation of 592 00:32:57,600 --> 00:33:01,400 Speaker 1: risk with an elevation of dose. The absolute risk still 593 00:33:01,520 --> 00:33:05,320 Speaker 1: isn't extraordinarily high. There was a study in North Carolina 594 00:33:05,360 --> 00:33:07,360 Speaker 1: that looked at people who'd been prescribed even at higher 595 00:33:07,400 --> 00:33:09,720 Speaker 1: doses and found that their risk of overdose was something 596 00:33:09,760 --> 00:33:13,200 Speaker 1: like point zero to two. It wasn't hugely high as 597 00:33:13,200 --> 00:33:15,360 Speaker 1: an absolute matter, but your risk definitely goes up depending 598 00:33:15,360 --> 00:33:18,280 Speaker 1: on the dosage you're prescribed, and so in that provision 599 00:33:18,320 --> 00:33:21,960 Speaker 1: they said be careful prescribing more than fifty to ninety 600 00:33:22,120 --> 00:33:25,720 Speaker 1: morphine milligram equivalence. And that's just an attempt to take 601 00:33:25,760 --> 00:33:27,920 Speaker 1: all of these different medications and put them on the 602 00:33:28,000 --> 00:33:32,160 Speaker 1: same scale. That's what they mean by equivalence. What happened is, 603 00:33:32,320 --> 00:33:36,800 Speaker 1: in the haste to address what people saw as many 604 00:33:36,840 --> 00:33:41,200 Speaker 1: people dying on the streets, state legislatures enacted strict limits 605 00:33:41,200 --> 00:33:45,440 Speaker 1: to opioid prescribing for keep prescribing. Insurance companies came in 606 00:33:45,520 --> 00:33:47,600 Speaker 1: and said they want to prove more than a certain 607 00:33:47,680 --> 00:33:51,640 Speaker 1: morphine milligram equivalent. The d e A and state medical 608 00:33:51,680 --> 00:33:56,920 Speaker 1: boards started to look at prescribing patterns through prescription drug 609 00:33:57,000 --> 00:34:02,560 Speaker 1: monitoring programs. Then doctors started getting letters, letters from police agencies, 610 00:34:02,680 --> 00:34:05,760 Speaker 1: or from medical review boards, or from d e A agents, 611 00:34:05,880 --> 00:34:11,279 Speaker 1: from medical boards, from the use attorney's offices, just you know, 612 00:34:11,600 --> 00:34:15,560 Speaker 1: different levels of law enforcement. And that's sort of the 613 00:34:15,560 --> 00:34:17,400 Speaker 1: thing had been going on. I think back in the 614 00:34:17,440 --> 00:34:20,000 Speaker 1: eighties and early nineties, right there was a period when 615 00:34:20,080 --> 00:34:23,160 Speaker 1: the d e A Office of Diversion Control and others 616 00:34:23,160 --> 00:34:25,359 Speaker 1: were sending these letters, and I guess they backed off, 617 00:34:25,400 --> 00:34:29,440 Speaker 1: maybe backed off too much and then started redoing it again. Maybe, 618 00:34:29,480 --> 00:34:32,280 Speaker 1: But in those days, we didn't have prescription drug monitory 619 00:34:32,280 --> 00:34:34,720 Speaker 1: programs in all the states. Now that information is pretty 620 00:34:34,719 --> 00:34:38,040 Speaker 1: widely available, and what's happening now is even worse. There's 621 00:34:38,120 --> 00:34:41,239 Speaker 1: sort of the companies that run these agencies come up 622 00:34:41,280 --> 00:34:43,759 Speaker 1: with what they call a knarc's care score. They have 623 00:34:43,800 --> 00:34:47,120 Speaker 1: an algorithm that tries to rate someone's risk for misuse, 624 00:34:47,280 --> 00:34:49,440 Speaker 1: and people are being denied care based on that. And 625 00:34:49,719 --> 00:34:52,160 Speaker 1: you know, dosage is one thing. Whether you have had 626 00:34:52,200 --> 00:34:55,040 Speaker 1: more than one providers is another, which can be a 627 00:34:55,040 --> 00:34:58,440 Speaker 1: proxy for doctor shopping and trying to get medication that 628 00:34:58,520 --> 00:35:00,560 Speaker 1: way to misuse. But it also it can be that 629 00:35:00,600 --> 00:35:02,480 Speaker 1: you live in a rural area and have to go 630 00:35:02,520 --> 00:35:04,879 Speaker 1: to an urban area to see a doctor, or your 631 00:35:04,920 --> 00:35:06,920 Speaker 1: doctor's practice clothes so you had to go get a 632 00:35:06,920 --> 00:35:10,280 Speaker 1: new doctor. I mean, there are lots of more innocent reasons. 633 00:35:10,520 --> 00:35:12,920 Speaker 1: There was just this huge proliferation of policies. I mean, 634 00:35:12,920 --> 00:35:15,160 Speaker 1: one study found out was something like almost five hundred 635 00:35:15,640 --> 00:35:18,560 Speaker 1: in a period of a few years, and a lot 636 00:35:18,600 --> 00:35:21,719 Speaker 1: of them are very strict and um I actually met 637 00:35:21,760 --> 00:35:24,319 Speaker 1: with this the CDC, as did some others who were 638 00:35:24,400 --> 00:35:28,200 Speaker 1: seeing problems in this area, and the CDC came out 639 00:35:28,280 --> 00:35:30,680 Speaker 1: and issued a corrective and said that was a misapplication 640 00:35:30,920 --> 00:35:35,919 Speaker 1: of its guideline. But that correction has not filtered down 641 00:35:35,920 --> 00:35:38,719 Speaker 1: to the lives of patients, and so there are a 642 00:35:38,800 --> 00:35:41,600 Speaker 1: lot of a lot of patients who are really caught 643 00:35:41,680 --> 00:35:44,000 Speaker 1: in the lurch. And I would say that, you know, 644 00:35:44,239 --> 00:35:46,520 Speaker 1: there's also this problem, of course, that it doesn't affect 645 00:35:46,560 --> 00:35:49,640 Speaker 1: everyone equally, you know, because of the way we've waged 646 00:35:49,640 --> 00:35:54,160 Speaker 1: the drug war disproportionately against communities of color, and because 647 00:35:54,200 --> 00:35:57,959 Speaker 1: of systemic racism. Even in pain treatment, there are lots 648 00:35:58,000 --> 00:36:00,960 Speaker 1: of studies that show that the pain of BIPOC folks 649 00:36:01,000 --> 00:36:04,800 Speaker 1: are rated less severe by many clinicians because of false 650 00:36:04,840 --> 00:36:09,319 Speaker 1: beliefs about biological differences that do not scientifically exists. I mean, 651 00:36:09,400 --> 00:36:11,600 Speaker 1: we have a woman in our group went into an 652 00:36:11,600 --> 00:36:14,040 Speaker 1: e er black woman and the nurse called the cops 653 00:36:14,040 --> 00:36:16,440 Speaker 1: on her just for reporting pain because they thought she 654 00:36:16,480 --> 00:36:18,960 Speaker 1: was trying to get drugs, right, right, racist beliefs that 655 00:36:19,040 --> 00:36:22,359 Speaker 1: black people don't experience pain in the same degree as 656 00:36:22,360 --> 00:36:25,120 Speaker 1: white And then you have pharmacies in black neighborhoods that 657 00:36:25,160 --> 00:36:27,560 Speaker 1: are less likely to carry opioids. I mean, it's just 658 00:36:27,840 --> 00:36:31,920 Speaker 1: it was pervasive throughout the entire system in many regards, absolutely, 659 00:36:31,920 --> 00:36:34,200 Speaker 1: and even you know, with the pharmacies that's even controlled 660 00:36:34,239 --> 00:36:37,520 Speaker 1: for for income, it's remarkable, but a lot of pharmacies 661 00:36:37,520 --> 00:36:41,520 Speaker 1: in black neighborhoods don't stock opioids. Let's take a break 662 00:36:41,520 --> 00:36:55,000 Speaker 1: here and go to an ad with Drug Policy Alliance, 663 00:36:55,000 --> 00:36:58,000 Speaker 1: and we were fighting some of the stupid policies and 664 00:36:58,080 --> 00:37:02,319 Speaker 1: stigma that people in method on maintenance confronted. And one 665 00:37:02,360 --> 00:37:04,680 Speaker 1: of the issues we we dealt with was that there was, 666 00:37:04,719 --> 00:37:08,320 Speaker 1: first of all, a less is more ideology, so doctors 667 00:37:08,320 --> 00:37:11,440 Speaker 1: were saying, well, sixty milligrams. All the scientific research showed 668 00:37:11,440 --> 00:37:13,960 Speaker 1: that closer to a hundred milligrams would be the appropriate 669 00:37:14,000 --> 00:37:17,040 Speaker 1: dose for maintenance, and that that's what you should aim for. 670 00:37:17,280 --> 00:37:19,799 Speaker 1: But the less is more ideology meant that people were 671 00:37:19,800 --> 00:37:22,479 Speaker 1: being under prescribed method on therefore it wasn't working as well. 672 00:37:22,520 --> 00:37:26,359 Speaker 1: Therefore there was an anti sentiment among patients. And the 673 00:37:26,440 --> 00:37:29,319 Speaker 1: second thing that happened, and this, you know, is that 674 00:37:29,400 --> 00:37:32,520 Speaker 1: whereas a hundred milligrams might be the appropriate dose for 675 00:37:32,560 --> 00:37:35,360 Speaker 1: the majority of people and some could deal with lower, 676 00:37:35,960 --> 00:37:38,719 Speaker 1: then you get these occasional odd balls for whom the 677 00:37:38,760 --> 00:37:41,839 Speaker 1: appropriate dose was three or four or five hundred milligrams 678 00:37:41,960 --> 00:37:43,880 Speaker 1: right just the way that they were wired. And I 679 00:37:43,880 --> 00:37:46,319 Speaker 1: imagine you have the same phenomenon happening in the pain 680 00:37:46,360 --> 00:37:49,080 Speaker 1: management area. Yeah, you definitely do. I mean you have 681 00:37:49,200 --> 00:37:54,120 Speaker 1: people who are hyper and hyper metabolizers of opioids. Lad Europe, 682 00:37:54,120 --> 00:37:56,160 Speaker 1: they actually test for that. We don't do that in 683 00:37:56,160 --> 00:37:58,319 Speaker 1: the US. And so yeah, there are people who are 684 00:37:58,320 --> 00:38:03,440 Speaker 1: going to require more. But because of this range that 685 00:38:03,520 --> 00:38:06,840 Speaker 1: was written in a guideline that was designed as recommendations 686 00:38:06,840 --> 00:38:09,960 Speaker 1: for primary care physicians and not as law policy, we 687 00:38:10,080 --> 00:38:13,560 Speaker 1: now have a rapid uptake throughout the health care system, 688 00:38:13,640 --> 00:38:16,279 Speaker 1: sort of suggesting that anybody over ninety as a risk, 689 00:38:16,480 --> 00:38:20,680 Speaker 1: and so people are being forced to lower doses. There's 690 00:38:20,719 --> 00:38:23,120 Speaker 1: one study of Medicaid patients in Vermont that showed the 691 00:38:23,160 --> 00:38:26,440 Speaker 1: average time of discontinuation was twenty four hours, which is 692 00:38:26,480 --> 00:38:28,560 Speaker 1: really dangerous, and about half of them had to be 693 00:38:28,640 --> 00:38:31,239 Speaker 1: hospitalized as a result. But even for those that are 694 00:38:31,280 --> 00:38:33,799 Speaker 1: just tapered down to ninety, it's being done in a 695 00:38:33,880 --> 00:38:36,759 Speaker 1: quick and reckless manner, and for some people they really 696 00:38:36,760 --> 00:38:39,400 Speaker 1: needed to be on those higher doses, and their quality 697 00:38:39,440 --> 00:38:43,080 Speaker 1: of life suffers. Terribly. And you know, again, the studies 698 00:38:43,120 --> 00:38:45,080 Speaker 1: showed this kind of tapering. You know, there could be 699 00:38:45,480 --> 00:38:50,040 Speaker 1: careful tapering with a lot of other adjunctive therapies thrown 700 00:38:50,080 --> 00:38:53,359 Speaker 1: in that can absolutely you know, improve the lives of 701 00:38:53,360 --> 00:38:56,160 Speaker 1: some people. But the way it's happening in the real 702 00:38:56,200 --> 00:39:00,799 Speaker 1: world is endangering people's health, distables and people. I hear 703 00:39:00,840 --> 00:39:04,600 Speaker 1: from people all the time who are acutely suicidal. I 704 00:39:04,640 --> 00:39:06,920 Speaker 1: hear from people who have lost someone to an overdose 705 00:39:07,040 --> 00:39:10,000 Speaker 1: after the pain medication was denied. I hear from people 706 00:39:10,040 --> 00:39:12,360 Speaker 1: who are now bedridden, who can no longer work, and 707 00:39:12,440 --> 00:39:16,120 Speaker 1: families who are financially devastated. It's causing a great deal 708 00:39:16,160 --> 00:39:20,560 Speaker 1: of harm. And you know, some eight to thirteen million 709 00:39:20,600 --> 00:39:25,040 Speaker 1: people use opioids to manage pain. That's a pretty big 710 00:39:25,360 --> 00:39:28,280 Speaker 1: number of people to be affected. So by and large, 711 00:39:28,360 --> 00:39:32,040 Speaker 1: this proliferation of state laws and regulations and all of 712 00:39:32,040 --> 00:39:34,000 Speaker 1: the other things around it, in terms of the shift 713 00:39:34,320 --> 00:39:38,560 Speaker 1: by physicians and by insurance companies, one could argue then 714 00:39:38,840 --> 00:39:42,719 Speaker 1: that it's done some good in terms of pushing physicians 715 00:39:42,719 --> 00:39:46,400 Speaker 1: to correct a pre existing problem with overprescribing and encouraging 716 00:39:46,440 --> 00:39:50,359 Speaker 1: them to look at alternatives opioids before they go to opioids, 717 00:39:50,360 --> 00:39:53,279 Speaker 1: but that in terms of the harm it's generating, in 718 00:39:53,400 --> 00:39:57,920 Speaker 1: terms of depriving people of access to opioids for legitimate needs, 719 00:39:57,960 --> 00:40:00,239 Speaker 1: that probably this push is doing a lot more armed 720 00:40:00,239 --> 00:40:02,960 Speaker 1: than good. When when push comes to shove, I think 721 00:40:03,000 --> 00:40:05,120 Speaker 1: it's doing both. I mean, I think that's sort of 722 00:40:05,120 --> 00:40:08,320 Speaker 1: the problem. Just like liberal prescribing. I mean, some people 723 00:40:08,640 --> 00:40:11,680 Speaker 1: who may have needed medication got it when it was 724 00:40:11,719 --> 00:40:14,600 Speaker 1: only limited to cancer, but a lot of people were 725 00:40:14,600 --> 00:40:17,040 Speaker 1: harmed as a result of liberal prescribing. And then when 726 00:40:17,040 --> 00:40:19,720 Speaker 1: you have a sort of clampdown yet it's it's helping 727 00:40:19,840 --> 00:40:22,200 Speaker 1: some people who may not be exposed who it would 728 00:40:22,200 --> 00:40:25,640 Speaker 1: have been vulnerable, but it's also hurting a whole other 729 00:40:25,719 --> 00:40:27,680 Speaker 1: group of people. You know, we just talked about the 730 00:40:27,719 --> 00:40:30,960 Speaker 1: issues around race and racism. In terms of pain management, 731 00:40:31,440 --> 00:40:34,800 Speaker 1: we've touched on the issues around class and that people 732 00:40:34,800 --> 00:40:37,319 Speaker 1: a better resources can look around as you did, right 733 00:40:37,400 --> 00:40:40,799 Speaker 1: and able to find somebody, whereas that's not the case. Um. 734 00:40:40,800 --> 00:40:42,839 Speaker 1: But then there's also a gender issue, right, I mean, 735 00:40:42,880 --> 00:40:48,399 Speaker 1: aren't women more likely to request, need or whatever pain killers? Well, yeah, 736 00:40:48,440 --> 00:40:51,080 Speaker 1: there's a huge gender issue in in the pain area. 737 00:40:51,480 --> 00:40:55,480 Speaker 1: Some studies suggest that up to of people with chronic 738 00:40:55,480 --> 00:40:59,000 Speaker 1: pain are women, or at least female identifying, and there 739 00:40:59,000 --> 00:41:02,400 Speaker 1: are studies also showing that women experience more pain, experience 740 00:41:02,440 --> 00:41:08,480 Speaker 1: pain more severely. There is some recent interesting data around 741 00:41:08,520 --> 00:41:13,920 Speaker 1: that that's sort of based in how we've traditionally had testing. 742 00:41:14,160 --> 00:41:17,560 Speaker 1: So all of our biomedical testing is done on animals, rats, 743 00:41:17,600 --> 00:41:21,160 Speaker 1: and mice. And it was only in sten that ni H, 744 00:41:21,280 --> 00:41:24,680 Speaker 1: the National Institutes of Health and United States anyway, started 745 00:41:24,719 --> 00:41:26,480 Speaker 1: to say that you needed to use more than just 746 00:41:26,719 --> 00:41:30,800 Speaker 1: male animals when you're trying to find out more about diseases. 747 00:41:30,840 --> 00:41:35,200 Speaker 1: But at least in animals, entirely different cells are involved 748 00:41:35,239 --> 00:41:39,480 Speaker 1: in what makes pain become chronic in male and female animals, 749 00:41:40,239 --> 00:41:43,480 Speaker 1: uh glial cell activation in males and T cell activation 750 00:41:44,040 --> 00:41:46,400 Speaker 1: in females, And so there may very well be a 751 00:41:46,440 --> 00:41:49,360 Speaker 1: biologic reason for this disparity. Of course, there may also 752 00:41:49,400 --> 00:41:52,320 Speaker 1: be a number of social reasons. But what we find 753 00:41:52,440 --> 00:41:54,200 Speaker 1: is I like to say that pain is sort of 754 00:41:54,200 --> 00:41:56,160 Speaker 1: a me to issue in in a similar way I 755 00:41:56,320 --> 00:41:59,200 Speaker 1: used in the hashtag pain too, because women are far 756 00:41:59,239 --> 00:42:02,400 Speaker 1: more often to missed or disbelieved. We also know that 757 00:42:02,440 --> 00:42:05,040 Speaker 1: relationships matter. You know, whether you go to a provider 758 00:42:05,080 --> 00:42:07,960 Speaker 1: who believes your pain and listens to you, just listening 759 00:42:08,000 --> 00:42:10,879 Speaker 1: to your story. Right, that could be a milierative rather 760 00:42:10,920 --> 00:42:13,680 Speaker 1: than being dismissed. That can actually be a form of treatment. 761 00:42:13,960 --> 00:42:16,080 Speaker 1: Or these studies where they show that a physician who 762 00:42:16,080 --> 00:42:18,640 Speaker 1: sits down by the bedside and touches the patient for 763 00:42:18,680 --> 00:42:20,520 Speaker 1: a few minutes and talks to them for ten minutes, 764 00:42:20,520 --> 00:42:23,279 Speaker 1: people to require less prescription drugs, get out of a 765 00:42:23,360 --> 00:42:26,560 Speaker 1: hospital fast, suffer less pain you know, goes up significantly 766 00:42:26,560 --> 00:42:30,160 Speaker 1: as a result of that simple human interaction. Right. Other 767 00:42:30,239 --> 00:42:33,200 Speaker 1: countries have fewer problems, I think, at least in sort 768 00:42:33,200 --> 00:42:35,600 Speaker 1: of Western Europe and other places. And that is they 769 00:42:35,640 --> 00:42:37,840 Speaker 1: also I think their healthcare systems are set up to 770 00:42:37,920 --> 00:42:41,000 Speaker 1: deal with pain, that they'll let people off of work 771 00:42:41,040 --> 00:42:44,000 Speaker 1: long enough to really heal from something. You know that 772 00:42:44,120 --> 00:42:46,319 Speaker 1: the incentive in this country is very much, you know, 773 00:42:46,600 --> 00:42:48,399 Speaker 1: take a pillcy you can get back to work. So yeah, 774 00:42:48,400 --> 00:42:52,280 Speaker 1: I think there are structural, interpersonal, and and belief systems 775 00:42:52,320 --> 00:42:55,839 Speaker 1: all play a role. The tough thing is that, you know, 776 00:42:55,960 --> 00:43:00,879 Speaker 1: pain responses is really individual. It's individual because pain comes 777 00:43:00,920 --> 00:43:03,960 Speaker 1: from a variety of conditions and ideologies. You know, you 778 00:43:04,000 --> 00:43:07,000 Speaker 1: may have inflammatory pain from an autoimmune disorder, you may 779 00:43:07,000 --> 00:43:10,200 Speaker 1: have neuropathic pain from a neurological problem. They're going to 780 00:43:10,239 --> 00:43:13,120 Speaker 1: be treating me to be really treated differently. They're not 781 00:43:13,160 --> 00:43:17,440 Speaker 1: the same kind of problems. So diagnosis matters a lot. Severity, 782 00:43:17,840 --> 00:43:21,480 Speaker 1: you know, is wide ranging, and so a system like 783 00:43:21,600 --> 00:43:23,680 Speaker 1: we have in the United States for for payers, for 784 00:43:23,719 --> 00:43:27,719 Speaker 1: insurers covering some things and not others, different incentives come in. 785 00:43:27,760 --> 00:43:30,200 Speaker 1: But I think we do need to expand access to 786 00:43:30,239 --> 00:43:33,160 Speaker 1: these other modes. That's what's happening sometimes is that insurers 787 00:43:33,160 --> 00:43:36,000 Speaker 1: will say, Okay, you have to do this or that, 788 00:43:36,520 --> 00:43:39,239 Speaker 1: or you have to try all of these things, and 789 00:43:39,280 --> 00:43:41,640 Speaker 1: only if you exhaust them do you get this. And 790 00:43:41,640 --> 00:43:44,120 Speaker 1: and people are also pushed into things like you know, 791 00:43:44,200 --> 00:43:48,560 Speaker 1: in more interventional things, um like nerve blocks or surgeries 792 00:43:48,680 --> 00:43:53,080 Speaker 1: or medical devices which you know also have a pharma 793 00:43:53,160 --> 00:43:56,839 Speaker 1: related potential issue. I think that maybe the next big 794 00:43:56,840 --> 00:43:58,880 Speaker 1: issue we see. And all of those things were helpful 795 00:43:58,880 --> 00:44:01,200 Speaker 1: to me, right, I had a spinal stimulator, which is 796 00:44:01,239 --> 00:44:04,120 Speaker 1: an a planet surgical device that helped me. But you're 797 00:44:04,200 --> 00:44:07,680 Speaker 1: you're sometimes seeing people being pushed into procedures that also 798 00:44:07,800 --> 00:44:10,880 Speaker 1: are more dangerous to that person than taking you know, 799 00:44:10,920 --> 00:44:13,840 Speaker 1: a prescribed opioid is I'm curious when you talk about, 800 00:44:13,880 --> 00:44:17,120 Speaker 1: you know, doctor viewers who cut you off suddenly, you know, 801 00:44:17,239 --> 00:44:21,000 Speaker 1: and you're a lawyer. Um, has any doctor ever been 802 00:44:21,160 --> 00:44:26,120 Speaker 1: successfully sued from malpractice for suddenly cutting somebody off their 803 00:44:26,120 --> 00:44:30,000 Speaker 1: opioids and having that patient die or something that's terrible happening? 804 00:44:30,160 --> 00:44:32,360 Speaker 1: You know. I haven't heard of a lawsuit. I have 805 00:44:32,440 --> 00:44:34,040 Speaker 1: heard of a lot of people, you know, having heart 806 00:44:34,040 --> 00:44:36,640 Speaker 1: attacks or things like checkcardia, you know, and then there's this, 807 00:44:37,000 --> 00:44:39,439 Speaker 1: you know, as a lawyer, their causation arguments, and people 808 00:44:39,480 --> 00:44:41,680 Speaker 1: like to poke holes and say that sort of like 809 00:44:41,760 --> 00:44:43,960 Speaker 1: what we sound the George Floyd trial, right, you know, 810 00:44:43,960 --> 00:44:45,880 Speaker 1: it was the fimal But anyway, there are lots of 811 00:44:46,520 --> 00:44:50,200 Speaker 1: attempts to muddy the waters about why someone had something 812 00:44:50,239 --> 00:44:53,239 Speaker 1: medically happened. Um, the only thing I know of that 813 00:44:53,320 --> 00:44:56,160 Speaker 1: happened is that I believe in New Hampshire, for the 814 00:44:56,200 --> 00:45:00,280 Speaker 1: first time, maybe last year, a state medical board actually 815 00:45:00,360 --> 00:45:03,200 Speaker 1: sanctioned to doctor for doing that. So most of the 816 00:45:03,239 --> 00:45:05,760 Speaker 1: letters and sanctions that go out are about you're prescribing 817 00:45:05,800 --> 00:45:08,760 Speaker 1: too much and this was you endangered this person's life. 818 00:45:09,200 --> 00:45:11,480 Speaker 1: I'd love to see a story like that get major 819 00:45:11,560 --> 00:45:14,760 Speaker 1: media attention because that's the only way to some extent, 820 00:45:14,800 --> 00:45:17,520 Speaker 1: to correct what's been going on, you know. Now, you know, 821 00:45:17,800 --> 00:45:20,720 Speaker 1: I should also just come clean in this because even 822 00:45:20,760 --> 00:45:24,680 Speaker 1: as I've been sympathetic and actually you know, devoted part 823 00:45:24,719 --> 00:45:27,640 Speaker 1: of my organization's resources to advocating for the sorts of 824 00:45:27,680 --> 00:45:30,839 Speaker 1: things that that your organization is now advocating for, I 825 00:45:30,880 --> 00:45:33,279 Speaker 1: had my own personal pain experience, you know, I mean 826 00:45:33,320 --> 00:45:35,440 Speaker 1: I had you know, when I was twenty four, I 827 00:45:35,480 --> 00:45:38,440 Speaker 1: suddenly had a terrible back pain where I couldn't stand 828 00:45:38,480 --> 00:45:40,400 Speaker 1: up straight for a few weeks, and it was terrible. 829 00:45:40,440 --> 00:45:42,359 Speaker 1: Finally got so bad and the doctor said, well, this 830 00:45:42,440 --> 00:45:45,560 Speaker 1: was in the in the mid eighties, and he said, well, 831 00:45:45,560 --> 00:45:47,960 Speaker 1: there is an intervention. It's called chemo pap pain. We 832 00:45:48,000 --> 00:45:51,440 Speaker 1: inject something into your spine and and it can work well, 833 00:45:51,680 --> 00:45:54,880 Speaker 1: but there's a one percent chance of paralysis. So I 834 00:45:54,920 --> 00:45:58,320 Speaker 1: turned down that treatment and miraculously got better. And then 835 00:45:58,520 --> 00:46:01,120 Speaker 1: when I was in my young third ease, the pain 836 00:46:01,280 --> 00:46:04,360 Speaker 1: just became overwhelming and I got m R I or 837 00:46:04,400 --> 00:46:08,160 Speaker 1: cat scan, and they diagnosed you know, herniated disks, and 838 00:46:08,280 --> 00:46:10,640 Speaker 1: I was on pain killers and this and that and 839 00:46:10,640 --> 00:46:12,640 Speaker 1: and some massage would work a little bit for an 840 00:46:12,680 --> 00:46:15,279 Speaker 1: hour or two, but not really, and a surgeon was 841 00:46:15,320 --> 00:46:18,359 Speaker 1: going to operate on me, and um, you know, under 842 00:46:18,400 --> 00:46:21,040 Speaker 1: the advice of a of a friend who was physician, 843 00:46:21,040 --> 00:46:23,279 Speaker 1: he said, don't get it. And what he suggested. I 844 00:46:23,320 --> 00:46:26,320 Speaker 1: read a book called Healing Back Pain by John Sarnol 845 00:46:26,520 --> 00:46:28,759 Speaker 1: and he was, you know, a serious physician at the 846 00:46:28,960 --> 00:46:33,120 Speaker 1: Rusk Instituted at n y U Medical Center. And his view, 847 00:46:33,239 --> 00:46:36,640 Speaker 1: in fact was that the vast majority of people who 848 00:46:36,680 --> 00:46:40,160 Speaker 1: got diagnosed with herniated disks and we're suffering lower back pain, 849 00:46:40,480 --> 00:46:43,560 Speaker 1: that in fact their pain had nothing to do with 850 00:46:43,600 --> 00:46:46,600 Speaker 1: the herniated disc right. And he had a whole theory 851 00:46:46,680 --> 00:46:49,479 Speaker 1: basically that said that when you look at m RIS 852 00:46:49,520 --> 00:46:51,640 Speaker 1: and cat scans, you see huge numbers of people with 853 00:46:51,680 --> 00:46:54,239 Speaker 1: hernia this and no pain. And conversely you have used 854 00:46:54,320 --> 00:46:56,480 Speaker 1: numbers of with pain but no herniated diss So the 855 00:46:56,520 --> 00:46:58,640 Speaker 1: notion that there was a cause of relationship between the 856 00:46:58,680 --> 00:47:01,080 Speaker 1: two didn't seem to work for a well. And his 857 00:47:01,280 --> 00:47:04,600 Speaker 1: theory was that in fact, what was going on was 858 00:47:04,680 --> 00:47:10,080 Speaker 1: that one was suffering from an underlying emotional pain, anger, frustrations, whatever, 859 00:47:10,600 --> 00:47:14,920 Speaker 1: and that the brain played a trick whereby the emotional 860 00:47:14,920 --> 00:47:18,600 Speaker 1: pain got converted into a physical pain and and and 861 00:47:18,880 --> 00:47:21,560 Speaker 1: he assumed that the method was that the brain would 862 00:47:21,560 --> 00:47:24,000 Speaker 1: curtel the flow of blood around the nerves and muscles 863 00:47:24,200 --> 00:47:26,600 Speaker 1: to that part of the body. And what the pain was, 864 00:47:26,640 --> 00:47:28,960 Speaker 1: whether it was back pain or sciatic or something else, 865 00:47:29,000 --> 00:47:32,120 Speaker 1: was to something think culturally determined, and that in the 866 00:47:32,239 --> 00:47:35,520 Speaker 1: end when that there was basically nothing wrong with my back, 867 00:47:35,920 --> 00:47:38,880 Speaker 1: and I just needed to accept this diagnosis. I needed 868 00:47:38,920 --> 00:47:42,080 Speaker 1: to get right off the opioids and the benzos, benz 869 00:47:42,080 --> 00:47:45,560 Speaker 1: andi esopines. The doctor put me on and I followed 870 00:47:45,600 --> 00:47:49,840 Speaker 1: his approach, and it worked, and it caused me to 871 00:47:49,960 --> 00:47:54,680 Speaker 1: believe that maybe a very significant number of people in 872 00:47:54,719 --> 00:47:57,439 Speaker 1: the country suffering from kind of a chronic back pain 873 00:47:57,560 --> 00:48:01,520 Speaker 1: or sciatica might have something similar. That we're living in 874 00:48:01,560 --> 00:48:04,480 Speaker 1: a culture where this type of form of pain and 875 00:48:04,520 --> 00:48:07,759 Speaker 1: disability is very culturally accepted. It's mostly it's number one 876 00:48:07,800 --> 00:48:10,520 Speaker 1: caused the misdays of work, that yes, people do have 877 00:48:10,600 --> 00:48:12,640 Speaker 1: conditions like you had, and many others have where they 878 00:48:12,719 --> 00:48:15,680 Speaker 1: have an accident or you know, other sorts of things, 879 00:48:15,680 --> 00:48:18,400 Speaker 1: but that in fact it was a type of emotional 880 00:48:18,440 --> 00:48:22,680 Speaker 1: pain being morphed into a physical pain for which opioids 881 00:48:22,760 --> 00:48:26,040 Speaker 1: um basically didn't work, and for which surgery was inappropriate. 882 00:48:26,239 --> 00:48:28,480 Speaker 1: He pointed out that people who had had surgery for 883 00:48:28,480 --> 00:48:31,880 Speaker 1: herniated disks were just as likely to suffer recurrence of 884 00:48:31,880 --> 00:48:34,640 Speaker 1: pain three years later as people who had never had 885 00:48:34,640 --> 00:48:37,360 Speaker 1: the surgery. And so it caused me to believe that 886 00:48:37,360 --> 00:48:39,320 Speaker 1: when you look at a lot of the people suffering 887 00:48:39,360 --> 00:48:42,640 Speaker 1: from these these addiction and the misuse of opioids, it 888 00:48:42,760 --> 00:48:46,040 Speaker 1: may be from certain types of pain that we believe 889 00:48:46,120 --> 00:48:49,080 Speaker 1: is physical that feels incredibly physical, because you can't believe 890 00:48:49,480 --> 00:48:51,960 Speaker 1: that that level of pain could actually just be caused 891 00:48:52,000 --> 00:48:55,440 Speaker 1: by emotional stuff. Absolutely, And I have friends who had 892 00:48:55,480 --> 00:48:57,960 Speaker 1: told me that exact same story about John Sarno's book 893 00:48:58,040 --> 00:49:00,960 Speaker 1: changing their lots. So I have I've heard that many times. 894 00:49:01,120 --> 00:49:05,400 Speaker 1: Do you think now that the pendulum is swinging back 895 00:49:05,640 --> 00:49:09,160 Speaker 1: towards a more balanced perspective, that the CDC is getting 896 00:49:09,200 --> 00:49:13,080 Speaker 1: his act together, that maybe the doctors are being to learn, 897 00:49:13,280 --> 00:49:16,520 Speaker 1: or are we still swinging in the wrong direction. I 898 00:49:16,560 --> 00:49:19,839 Speaker 1: think that we will remain opiophobic for a while. I 899 00:49:19,880 --> 00:49:23,239 Speaker 1: have seen public health agencies, including the CDC and the 900 00:49:23,320 --> 00:49:25,239 Speaker 1: f d A and the Department of Health and Human 901 00:49:25,280 --> 00:49:28,719 Speaker 1: Services come out against, for example, force tapering. I have 902 00:49:28,840 --> 00:49:33,000 Speaker 1: seen no slowing in the number of random, you know, 903 00:49:33,120 --> 00:49:36,080 Speaker 1: daily emails and phone calls I received from desperate people 904 00:49:36,120 --> 00:49:38,719 Speaker 1: all over the country. It has not filtered down to 905 00:49:38,840 --> 00:49:41,600 Speaker 1: the lives of the people that you know who are 906 00:49:41,680 --> 00:49:45,080 Speaker 1: most deeply affected. And although I do think there was 907 00:49:45,160 --> 00:49:48,759 Speaker 1: some recognition UM, Otherwise these public health agencies wouldn't have 908 00:49:48,760 --> 00:49:50,239 Speaker 1: come out and said, you know this, and this is 909 00:49:50,280 --> 00:49:52,200 Speaker 1: a problem and we're trying to you know. And the 910 00:49:52,239 --> 00:49:55,040 Speaker 1: CDC did say to policy makers, hey, you know, these 911 00:49:55,040 --> 00:49:58,399 Speaker 1: were not intended to be strict limits. The science behind 912 00:49:58,440 --> 00:50:00,919 Speaker 1: these recommendations is nowhere in the or where it would 913 00:50:00,960 --> 00:50:02,960 Speaker 1: need to be to do what you've done with it. 914 00:50:03,400 --> 00:50:06,120 Speaker 1: I still think that we will be in um an 915 00:50:06,120 --> 00:50:08,360 Speaker 1: opioid phobic period for some time. I think the general 916 00:50:08,400 --> 00:50:11,160 Speaker 1: public still thinks we are in a place where prescription 917 00:50:11,160 --> 00:50:13,840 Speaker 1: opioids and over prescribing are driving desks on the street. 918 00:50:13,880 --> 00:50:18,640 Speaker 1: Politicians still think that we are back ten years ago 919 00:50:18,880 --> 00:50:21,320 Speaker 1: and that they need to be really aggressive, and frankly, 920 00:50:21,360 --> 00:50:24,399 Speaker 1: the progressive media has no appetite for this side. They 921 00:50:24,400 --> 00:50:28,640 Speaker 1: have bought the big bad pharma, opiids, bad narratives so 922 00:50:28,760 --> 00:50:31,880 Speaker 1: completely that they do not want to touch. Do you 923 00:50:31,920 --> 00:50:36,160 Speaker 1: have any any significant allies among elected officials in Congress 924 00:50:36,280 --> 00:50:39,439 Speaker 1: or even at the gubernatorial level in places yes, um 925 00:50:39,480 --> 00:50:41,879 Speaker 1: I can not be terribly public, but there are some 926 00:50:42,080 --> 00:50:44,080 Speaker 1: who are who are allies. Some of them unfortunately are 927 00:50:44,120 --> 00:50:46,239 Speaker 1: no longer. There where allies a few years ago. But 928 00:50:46,320 --> 00:50:49,200 Speaker 1: there's no public champions on this issue, not many. There 929 00:50:49,239 --> 00:50:51,760 Speaker 1: are a couple, ironically, they intend to be the doctors 930 00:50:51,760 --> 00:50:54,680 Speaker 1: who are in the Congress who have a deeper understanding 931 00:50:54,680 --> 00:50:57,520 Speaker 1: of this um it is. It's so interesting as someone 932 00:50:57,560 --> 00:51:02,680 Speaker 1: who is politically progressive myself at you know, oftentimes it's 933 00:51:02,760 --> 00:51:06,680 Speaker 1: the more libertarian or conservative representatives that can see the 934 00:51:06,719 --> 00:51:08,560 Speaker 1: side of it. I think a lot of progressives other 935 00:51:08,560 --> 00:51:11,200 Speaker 1: they're not all just see this as a pharmaceutical ruse. 936 00:51:11,719 --> 00:51:14,600 Speaker 1: Part of my doing this program is the hope that 937 00:51:14,640 --> 00:51:18,040 Speaker 1: people will listen to this and have a more enlightened 938 00:51:18,120 --> 00:51:21,080 Speaker 1: view of drugs and drug policy and drug treatment in 939 00:51:21,120 --> 00:51:23,600 Speaker 1: their own lives right, whether it means about the drugs 940 00:51:23,680 --> 00:51:26,680 Speaker 1: they take, or about the patients they have, or about 941 00:51:26,680 --> 00:51:31,200 Speaker 1: the politicians they support. Now you started this organization, I'm 942 00:51:31,320 --> 00:51:33,640 Speaker 1: very excited about it. I know other people as well. 943 00:51:33,920 --> 00:51:36,400 Speaker 1: I mean, where do you see the places where you 944 00:51:36,400 --> 00:51:38,800 Speaker 1: think you're going to be able to make the greatest 945 00:51:38,840 --> 00:51:42,040 Speaker 1: difference in the coming years. Well, one aspect is just 946 00:51:42,280 --> 00:51:46,560 Speaker 1: bringing together I think the pain community and the sort 947 00:51:46,560 --> 00:51:49,040 Speaker 1: of drug policy and addiction communities that these communities have 948 00:51:49,160 --> 00:51:53,239 Speaker 1: been divided largely because of the stigma around drug use. 949 00:51:53,480 --> 00:51:56,600 Speaker 1: Um pain patients for the first time had the stigma 950 00:51:56,680 --> 00:51:58,960 Speaker 1: of addiction thrown their way, and so they want to 951 00:51:59,200 --> 00:52:02,680 Speaker 1: point finger and blame people who they see as misusing 952 00:52:02,719 --> 00:52:07,799 Speaker 1: medication or who become addicted. People with addiction some want 953 00:52:07,800 --> 00:52:10,080 Speaker 1: to say, hey, it's you people in pain who messed 954 00:52:10,080 --> 00:52:12,960 Speaker 1: it up. If you people hadn't been such whiners, then 955 00:52:13,600 --> 00:52:16,000 Speaker 1: evil pharma wouldn't have come in here, and we wouldn't 956 00:52:16,040 --> 00:52:18,160 Speaker 1: have all of these people dead and all of these 957 00:52:18,160 --> 00:52:20,480 Speaker 1: people addicted, and so there's a lot of finger pointing, 958 00:52:20,480 --> 00:52:22,279 Speaker 1: and so one of the things the organization does is 959 00:52:22,280 --> 00:52:24,440 Speaker 1: sort of bring those groups together. And we have a 960 00:52:24,480 --> 00:52:27,680 Speaker 1: significant community council of people with a lot of different 961 00:52:27,680 --> 00:52:29,759 Speaker 1: types of pain. We have a community council people in 962 00:52:29,800 --> 00:52:32,840 Speaker 1: recovery from addiction. We have a science and policy council 963 00:52:33,080 --> 00:52:36,440 Speaker 1: of people who are experts in drug policy and addiction 964 00:52:36,560 --> 00:52:39,640 Speaker 1: and pain management, as well as a number of health 965 00:52:39,680 --> 00:52:43,000 Speaker 1: policy and civil rights and disability rights experts and sort 966 00:52:43,000 --> 00:52:45,640 Speaker 1: of legislation. And one of the things we're trying to 967 00:52:45,680 --> 00:52:48,719 Speaker 1: do is, in addition to playing whackable and reacting and 968 00:52:48,760 --> 00:52:51,919 Speaker 1: stopping these policies, which we have been fairly successful at 969 00:52:52,000 --> 00:52:55,680 Speaker 1: at doing, is to get everyone at the table and 970 00:52:55,800 --> 00:52:57,920 Speaker 1: come up, you know, what do we need? What would 971 00:52:57,920 --> 00:53:02,960 Speaker 1: good policy, good paid policy look like that represents everyone's 972 00:53:03,000 --> 00:53:05,680 Speaker 1: needs because the problem has been that no one has 973 00:53:05,719 --> 00:53:07,799 Speaker 1: looked at this very comprehensively. I mean, we know we 974 00:53:07,840 --> 00:53:09,799 Speaker 1: need more coverage of certain things, and I've worked with 975 00:53:09,840 --> 00:53:11,680 Speaker 1: that in some issues, and I'm on a task force 976 00:53:11,719 --> 00:53:14,560 Speaker 1: for women in pain, and they're all of these silos 977 00:53:14,600 --> 00:53:18,480 Speaker 1: focusing on different subsegments of the issue. But I feel 978 00:53:18,520 --> 00:53:22,360 Speaker 1: like there's not enough coming together with a variety of 979 00:53:22,400 --> 00:53:26,080 Speaker 1: lived experiences and expertise to really tackle the big picture. 980 00:53:26,719 --> 00:53:30,799 Speaker 1: See that this is a complicated situation that requires some 981 00:53:30,840 --> 00:53:34,520 Speaker 1: complicated answers. Okay, listen, I mean, I'm just incredibly impressed 982 00:53:34,520 --> 00:53:36,719 Speaker 1: with the work that you're doing. I'm very grateful for 983 00:53:36,760 --> 00:53:40,200 Speaker 1: your taking the time to have this long conversation with me, 984 00:53:40,360 --> 00:53:43,760 Speaker 1: So thank you so much for joining me, and uh, 985 00:53:43,840 --> 00:53:46,319 Speaker 1: you know, more power and everything you're trying to accomplish 986 00:53:46,520 --> 00:53:49,839 Speaker 1: the organization that you started. Drug Policy Alliances is by 987 00:53:49,920 --> 00:53:52,839 Speaker 1: far the superstar in this arena and has been such 988 00:53:52,880 --> 00:53:55,279 Speaker 1: a great ally, um and I've learned so much from 989 00:53:55,280 --> 00:53:59,279 Speaker 1: people within that organization and community, so uh, it's just 990 00:53:59,440 --> 00:54:04,520 Speaker 1: an absolute it honor. Psychoactive is a production of I 991 00:54:04,640 --> 00:54:09,000 Speaker 1: Heart Radio and Protozoa Pictures. It's hosted by me Ethan Nadelman. 992 00:54:09,280 --> 00:54:13,160 Speaker 1: It's produced by Katcha Kumkova and Ben Kbrick. The executive 993 00:54:13,160 --> 00:54:17,400 Speaker 1: producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren 994 00:54:17,400 --> 00:54:21,600 Speaker 1: Aronovski for Protozoa Pictures, Alex Williams and Matt Frederick for 995 00:54:21,680 --> 00:54:25,480 Speaker 1: I Heart Radio and me Ethan Nadelman. Our music is 996 00:54:25,520 --> 00:54:28,920 Speaker 1: by Ari Belusian and a special thanks to Avivit Brio, 997 00:54:29,000 --> 00:54:33,520 Speaker 1: Sef Bianca Grimshaw and Robert Beatty. If you'd like to 998 00:54:33,520 --> 00:54:36,920 Speaker 1: share your own stories, comments, or ideas, please leave us 999 00:54:36,920 --> 00:54:42,000 Speaker 1: a message at eight three three seven seven nine sixty. 1000 00:54:42,800 --> 00:54:48,480 Speaker 1: That's one eight three three psycho zero. You can also 1001 00:54:48,600 --> 00:54:52,279 Speaker 1: email us as Psychoactive at Protozoa dot com or find 1002 00:54:52,320 --> 00:54:55,200 Speaker 1: me on Twitter at Ethan Nadelman. And if you couldn't 1003 00:54:55,280 --> 00:54:57,839 Speaker 1: keep track of all this. Find the information in the 1004 00:54:57,840 --> 00:54:58,440 Speaker 1: show notes.