WEBVTT - Dr. Vivek Murthy: How We Can Overcome the Opioid Crisis 0:00:01.560 --> 0:00:04.760 Like so many people across America, Hillary and I have 0:00:04.800 --> 0:00:09.040 a personal connection to the opioid epidemic. I'll never forget 0:00:09.080 --> 0:00:11.000 where I was when I heard that the son of 0:00:11.000 --> 0:00:14.440 one of my very best friends, a bright, young twenty 0:00:14.480 --> 0:00:16.200 eight year old who had worked for Hillary at the 0:00:16.239 --> 0:00:19.599 State Department and who was pursuing both an MBA and 0:00:19.680 --> 0:00:23.800 a law degree, had died in his sleep just before Christmas. 0:00:23.880 --> 0:00:28.000 And we knew him well and liked him so much, 0:00:28.760 --> 0:00:33.159 it just seemed impossible. Not long after, we learned that 0:00:33.200 --> 0:00:36.280 he died of a lethal combination of alcohol and oxy 0:00:36.320 --> 0:00:39.839 code on. Sadly, while he was the first person we 0:00:39.920 --> 0:00:43.520 knew who suffered a fatal overdose, he wasn't the last. 0:00:44.720 --> 0:00:47.000 Hillary and I now have five friends who have lost 0:00:47.040 --> 0:00:54.560 their children to this epidemic. So why am I telling 0:00:54.560 --> 0:00:58.360 you this? Because in America today, just about everyone knows 0:00:58.440 --> 0:01:01.920 someone who's died, as it was, to an overdose. Drug 0:01:01.960 --> 0:01:05.640 overdoses killed more Americans and HIV AIDS, car crashes, or 0:01:05.680 --> 0:01:09.520 gun violence. Behind every one of these statistics is a 0:01:09.560 --> 0:01:13.880 real person, someone with a real life, a real story, 0:01:14.120 --> 0:01:17.600 and real people who love them. While so much of 0:01:17.640 --> 0:01:20.400 our public health discourse over the last year has focused 0:01:20.440 --> 0:01:24.640 on the COVID nineteen pandemic. The overdose epidemic remains an 0:01:24.720 --> 0:01:29.240 urgent crisis, and the challenges of the COVID nineteen pandemic, 0:01:29.360 --> 0:01:33.560 from isolation to unemployment to the shuttering of community resources 0:01:33.560 --> 0:01:38.039 and gathering places, have had a disproportionate impact on people 0:01:38.120 --> 0:01:42.480 struggling with substance abuse disorders. We've got to find a 0:01:42.520 --> 0:01:46.640 way to turn the tide. Today's episode of Why Am 0:01:46.640 --> 0:01:48.720 I Telling You This features someone who is one of 0:01:48.720 --> 0:01:52.880 America's leading experts on the opioid and overdose epidemic, Dr 0:01:53.040 --> 0:01:56.840 Vivit Murphy. Dr Murphy served as Surgeon General of the 0:01:56.920 --> 0:02:03.160 United States from and was renominated by President Biden and 0:02:03.280 --> 0:02:09.360 reconfirmed last month. We recorded this conversation back in and 0:02:09.440 --> 0:02:13.119 I wish I could say it's no longer relevant, But unfortunately, 0:02:13.120 --> 0:02:17.839 the overdose epidemic continues to rage across America, leaving unfinished 0:02:17.880 --> 0:02:21.440 lives and broken hearts in its wake. The latest CDC 0:02:21.680 --> 0:02:26.040 data shows that overdose deaths increased by for the twelve 0:02:26.040 --> 0:02:31.119 months ending in September. Especially given that the pandemic has 0:02:31.160 --> 0:02:34.400 cut off people's access to healthcare and support systems, we 0:02:34.480 --> 0:02:37.440 need to recognize the impact it's having on people's mental 0:02:37.480 --> 0:02:44.200 health and redouble our efforts to combat this crisis. Dr 0:02:44.280 --> 0:02:47.320 Vivic Murphy, thanks for joining us. Thank you, Mr President. 0:02:47.400 --> 0:02:51.480 You did something really remarkable in first issuing the first 0:02:51.480 --> 0:02:55.600 Certain General's report ever on alcohol, drugs and health, and 0:02:55.720 --> 0:02:59.440 at the same time, more remarkably to me, you actually 0:02:59.480 --> 0:03:01.840 sent a let earn a card to two point three 0:03:01.960 --> 0:03:05.760 million doctors, nurses, dentists, and other clinicians asking them to 0:03:05.880 --> 0:03:10.079 help address the opioid epidemic. Now nobody had ever done 0:03:10.120 --> 0:03:12.640 this before. Why did you, Well, thanks for the question, 0:03:12.720 --> 0:03:16.519 Mr President, for having me joining this conversation on opioids. 0:03:16.720 --> 0:03:20.639 When I began my time in office, I remember thinking 0:03:20.680 --> 0:03:23.120 on my first day about my priorities on what they 0:03:23.120 --> 0:03:26.080 should be. But I had this instinct to spend the 0:03:26.160 --> 0:03:28.919 first few months on a listening tour, just visiting communities 0:03:28.960 --> 0:03:31.560 across the country, and the issue that kept coming up 0:03:31.560 --> 0:03:34.720 again and again and again was the issue of opioids, 0:03:34.920 --> 0:03:37.440 and so I quickly realized that that needed to be 0:03:37.520 --> 0:03:40.280 even higher on my priority list. It also dovetailed with 0:03:40.280 --> 0:03:42.880 the personal experience that I had had as a clinician. 0:03:43.240 --> 0:03:44.760 Uh you know, as a doctor, I took care of 0:03:45.080 --> 0:03:47.280 patients over the years who struggled with all kinds of 0:03:47.360 --> 0:03:51.200 chronic pain conditions, and I found myself prescribing opioids often. 0:03:52.120 --> 0:03:54.400 I also, at the same time was seeing people come 0:03:54.440 --> 0:03:59.120 in struggling with addiction to heroin, to prescription opioids, and 0:03:59.120 --> 0:04:02.480 to other all manner of substances, and I began to 0:04:02.520 --> 0:04:05.560 realize that there was a connection between the way we 0:04:05.560 --> 0:04:08.560 were as doctors prescribing these pain medicines and what was 0:04:08.600 --> 0:04:11.400 actually happening to our patients. I wish I had realized 0:04:11.400 --> 0:04:14.240 that earlier, but I, like many doctors, was taught that 0:04:14.240 --> 0:04:17.480 if we gave opioid medicines to someone who had quote 0:04:17.560 --> 0:04:20.800 unquote legitimate pain, that they would not become addicted to 0:04:20.800 --> 0:04:24.520 that substance. And why were we wrong? So coming into office, 0:04:24.520 --> 0:04:27.360 when I realized that we had, inadvertently, as a profession, 0:04:27.400 --> 0:04:30.120 contributed to the epidemic, you know, I realized that in 0:04:30.040 --> 0:04:33.320 addition to publishing the first Surgeon General's Report on the 0:04:33.360 --> 0:04:36.080 subject of addiction, we also needed to do more. We 0:04:36.279 --> 0:04:39.640 needed to call our profession to action to rectify an 0:04:39.640 --> 0:04:42.360 issue that we had helped create. And so that's why 0:04:42.400 --> 0:04:46.320 I penned a personal letter to doctors and nurse practitioners 0:04:46.320 --> 0:04:49.920 and dentists all across the country. And at the time 0:04:49.960 --> 0:04:52.680 it was you know, I did it an instinct. I 0:04:52.680 --> 0:04:55.279 didn't know quite what the reaction would be, but I 0:04:55.400 --> 0:04:58.920 was gratified to hear from many doctors and nurses over 0:04:58.960 --> 0:05:02.839 the coming months, UH that it actually changed how they practiced, 0:05:02.920 --> 0:05:06.200 how they prescribed these kind of pain medications. And I 0:05:06.240 --> 0:05:09.680 remember going to an oral surgeon actually recently to get 0:05:09.720 --> 0:05:12.440 my own wisdom tooth pulled, uh, and he told me 0:05:12.480 --> 0:05:15.520 that in addition to receiving that letter, that he had 0:05:15.560 --> 0:05:17.440 made a decision when he read it that he was 0:05:17.480 --> 0:05:21.599 going to stop prescribing percoset automatically to everyone who had 0:05:21.839 --> 0:05:24.359 wisdom teeth removed. And he gave all of them his 0:05:24.440 --> 0:05:26.680 personal cell phone number, and he braced for what he 0:05:26.720 --> 0:05:29.520 thought would be an onslaught of calls from patients saying 0:05:29.520 --> 0:05:32.320 that their pain wasn't well controlled on ibyprofen and they 0:05:32.360 --> 0:05:36.000 needed something stronger. But days went by and the calls 0:05:36.120 --> 0:05:38.960 never came, and he realized that, hey, we can actually 0:05:38.960 --> 0:05:44.800 get by treating pain safely and effectively without necessarily using opioids. 0:05:45.040 --> 0:05:47.440 I want to thank you for this. We live in 0:05:47.480 --> 0:05:50.599 an age of denial about a lot of things. When 0:05:50.680 --> 0:05:53.480 Chelsea was in high school, all our friends used to 0:05:53.520 --> 0:05:56.400 say that denial it's not just a river in Egypt 0:05:57.880 --> 0:06:01.159 and uh, And I think it takes a certain amount 0:06:01.160 --> 0:06:03.520 of courage just to say I once thought the truth 0:06:03.680 --> 0:06:06.920 was this, and I learned something and I changed. And 0:06:07.000 --> 0:06:09.320 that's what I think more and more people have to 0:06:09.320 --> 0:06:12.080 do about more and more issues, but especially this one. 0:06:12.760 --> 0:06:15.160 Let's talk about this a little bit. I think a 0:06:15.200 --> 0:06:17.120 lot of people know about the lock zone, and no, 0:06:17.240 --> 0:06:20.080 it can bring people back, but it's just the first step. 0:06:20.160 --> 0:06:24.120 So could you briefly describe what should be done to 0:06:24.320 --> 0:06:29.880 someone who's overdosed, who's injected or inhaled the lock zone 0:06:30.279 --> 0:06:33.520 and then comes back. That's the beginning, not the end 0:06:33.560 --> 0:06:36.560 of this process. So describe how that works. Well. The 0:06:36.640 --> 0:06:40.360 lockson is a really powerful medication and remarkably effective at 0:06:40.480 --> 0:06:43.800 reversing the effects of opioids. And for people who have 0:06:44.400 --> 0:06:47.440 who's breathing has been compromised by these medicines, they can 0:06:47.480 --> 0:06:50.840 reverse that and enable them to breathe again. I've administered 0:06:50.839 --> 0:06:53.159 in the locks on myself. I've seen just how rapidly 0:06:53.200 --> 0:06:55.880 it acts, so it's good that we are getting that 0:06:55.920 --> 0:06:58.839 medication to the hands at first responders and family members, 0:06:59.040 --> 0:07:01.599 but for far too many people who overdose, the treatment 0:07:01.600 --> 0:07:04.720 does stop there. And it's shocking how many people are 0:07:04.760 --> 0:07:06.719 treated with the lock zone and go right back into 0:07:06.760 --> 0:07:10.080 the community and often in fact, will get more prescriptions 0:07:10.080 --> 0:07:13.160 for opiate medications. What we really need to do is 0:07:13.200 --> 0:07:16.520 to bring those people in and connect them to treatment 0:07:16.640 --> 0:07:22.440 right away, treatment often with medication assisted therapies including methodone Bupid, 0:07:22.440 --> 0:07:25.680 Norphine UH and now trek Zone. And what we've realized 0:07:25.720 --> 0:07:28.720 now is that there should be no wrong door to treatment. 0:07:28.840 --> 0:07:33.040 So whether it's a first responder UH finding you having overdosed, 0:07:33.120 --> 0:07:35.320 let's say, in the community, whether it's somebody in the 0:07:35.360 --> 0:07:39.160 emergency room who encounters you, whether it's a somebody in 0:07:39.200 --> 0:07:41.840 your place of employment who realizes that you have a 0:07:42.000 --> 0:07:45.000 challenge with addiction. We have to find ways to create 0:07:45.080 --> 0:07:48.000 channels which people can go from where they are in 0:07:48.040 --> 0:07:51.640 their communities to getting directly connected to treatment. Right now, 0:07:51.680 --> 0:07:54.600 it's too hard for people in communities across the country. 0:07:54.600 --> 0:07:56.720 But if we can change that, and I think we 0:07:56.720 --> 0:07:59.480 can take people who need and want treatment and actually 0:07:59.480 --> 0:08:02.480 get them the life stating treatment that they deserve. I 0:08:02.520 --> 0:08:06.280 think you made a really important point. I remember a 0:08:06.280 --> 0:08:09.200 couple of summers ago, I was playing golf out on 0:08:09.200 --> 0:08:12.120 a public golf course and all these folks gathered around me. 0:08:12.160 --> 0:08:15.080 All they want to talk about was the open wood problem. 0:08:15.120 --> 0:08:17.600 And there was only one young person there. All the 0:08:17.640 --> 0:08:21.040 others walked away after about forty five minutes. He stayed 0:08:21.040 --> 0:08:23.080 behind and said, thank you. I didn't know anybody like 0:08:23.120 --> 0:08:25.520 you cared about this. I'm four days out of rehab, 0:08:26.040 --> 0:08:28.640 and he said, I'm not worried about myself. I want 0:08:28.680 --> 0:08:31.520 to live and now I know how. But he said, 0:08:31.560 --> 0:08:34.240 I think it's a terrible shame that you've got to 0:08:34.280 --> 0:08:37.640 have as much money as my family does to afford this. 0:08:37.960 --> 0:08:39.840 You've got to do something to help the people that 0:08:39.920 --> 0:08:43.840 have no money. So let's start with what the government 0:08:43.880 --> 0:08:46.680 should do, or the federal land state government, how should that? 0:08:47.160 --> 0:08:49.520 Where are we on that? Well, there's no question that 0:08:49.559 --> 0:08:52.880 when of the big barriers to treatment is the cost 0:08:53.080 --> 0:08:56.520 and the availability of these services, including the availability of 0:08:56.559 --> 0:08:59.760 trained personnel. The problem is in part of funding issue. 0:09:00.040 --> 0:09:02.840 In the last several years, we have seen Congress allocate 0:09:03.040 --> 0:09:06.680 substantial amounts of money, several billion dollars in fact, but 0:09:06.760 --> 0:09:08.960 the reality is that we need far more than a 0:09:08.960 --> 0:09:12.640 few billion dollars to expand treatment sufficiently so that everyone 0:09:12.640 --> 0:09:15.439 who needs care can get it. When we published the 0:09:15.520 --> 0:09:18.959 Certain General's Report on Alcohol, Drugs and Health in one 0:09:19.000 --> 0:09:21.120 of the things that we noted was that only one 0:09:21.160 --> 0:09:23.240 in ten people who are struggling with the substance use 0:09:23.280 --> 0:09:26.200 disorder actually getting treatment. And part of that is because 0:09:26.240 --> 0:09:29.040 people can't get treatment, and part of it also has 0:09:29.080 --> 0:09:32.680 to do with this stigma, the unfortunate stigma associated with 0:09:32.920 --> 0:09:36.440 substance use disorders, which prevents people often from seeking help. 0:09:36.840 --> 0:09:39.680 When I was traveling through Tennessee, for example, I met 0:09:39.720 --> 0:09:42.920 many people who either had loved ones who are struggling 0:09:42.920 --> 0:09:46.240 with an opiad use disorder or themselves were who refused 0:09:46.240 --> 0:09:48.080 to talk to me if there were any cameras around, 0:09:48.640 --> 0:09:50.800 And the reason was because they felt if somebody knew 0:09:51.080 --> 0:09:53.040 that they had a problem and that they needed help, 0:09:53.080 --> 0:09:55.360 that they would be ostracized not just by their neighbors, 0:09:55.679 --> 0:09:58.720 but also by their doctors. And sadly, I did meet 0:09:58.760 --> 0:10:01.240 doctors when I was in Tennessee and in other states 0:10:01.280 --> 0:10:05.520 who didn't believe what they were reading about medication assist 0:10:05.559 --> 0:10:07.760 to treatment who thought it was just another way of 0:10:07.880 --> 0:10:12.680 perpetuating a dependence on opioids, and these unfortunate misconceptions, combined 0:10:12.840 --> 0:10:16.040 with the lack of adequate funding, have combined to make 0:10:16.040 --> 0:10:18.560 it too hard for people to get treatment. We have 0:10:18.640 --> 0:10:22.280 evidence about what works. We know, for example, that medication 0:10:22.320 --> 0:10:25.120 assists to treatment with these three medications in particular method 0:10:25.120 --> 0:10:28.000 and guben orphine and now trek zone not only reduce 0:10:28.080 --> 0:10:32.479 the risk of overdose, but they also reduce crime in communities. 0:10:32.520 --> 0:10:37.360 They reduced the acquisition of needleborn infections like HIV and 0:10:37.400 --> 0:10:41.160 hepatitis c UH. They are good overall. Um, there are still, 0:10:41.240 --> 0:10:44.520 unfortunately a majority of treatment facilities in the country right 0:10:44.559 --> 0:10:48.480 now which do not offer medication assists to treatment, and 0:10:48.520 --> 0:10:52.720 that to me is uh is an unthinkable tragedy because 0:10:52.760 --> 0:10:54.240 at a time where we know what works, for the 0:10:54.280 --> 0:10:57.679 majority of treatment facilities, to not have what works and 0:10:57.720 --> 0:11:00.920 to be charging people tends of thousands of dollars for 0:11:01.040 --> 0:11:03.679 that treatment, UH is just it's just horrible, and that's 0:11:03.679 --> 0:11:06.400 something that I think we absolutely need to change. Well, 0:11:06.480 --> 0:11:09.160 let me ask you this, is it not offered because 0:11:09.600 --> 0:11:11.920 the money is not there, or because there's a stigma 0:11:11.960 --> 0:11:15.160 associated with the use of method on about for northern Well. 0:11:15.200 --> 0:11:18.079 Partially this is about payment, but only partially. So I 0:11:18.160 --> 0:11:21.400 think that once we get insurance programs of Medicaid and 0:11:21.440 --> 0:11:24.360 private insurance to fully reimburse for the full suite of 0:11:24.360 --> 0:11:28.199 medication assisted treatment UM, once we ensure that we actually 0:11:28.240 --> 0:11:31.080 have adequate personnel trained to deliver that treatment, that will 0:11:31.120 --> 0:11:33.400 help a lot. But the stigma piece that you brought 0:11:33.440 --> 0:11:35.760 up is a is a really good point because I 0:11:35.840 --> 0:11:38.600 have visited communities across the country where treatment is available, 0:11:38.640 --> 0:11:42.320 but people will not access it because they are worried 0:11:42.480 --> 0:11:44.400 that they will be looked down upon. You know, if 0:11:44.400 --> 0:11:46.360 they engage in treatment that they will doctor in fact, 0:11:46.400 --> 0:11:49.360 will look down upon them. And I visited communities that 0:11:49.440 --> 0:11:52.000 do not want to invite treatment centers in because they 0:11:52.000 --> 0:11:54.400 feel it will bring the wrong kind of people into 0:11:54.440 --> 0:11:56.720 their community and because they have been led to believe 0:11:57.200 --> 0:11:59.920 that this is uh that this treatment is just perpet 0:12:00.000 --> 0:12:03.480 awaiting opiate addiction. If you understand like what's really happening 0:12:03.480 --> 0:12:05.680 with the opia epidemic, you realize that this is not 0:12:05.760 --> 0:12:08.960 about inviting quote unquote bad people in, but the people 0:12:08.960 --> 0:12:10.800 who are struggling with opiate addiction are in all of 0:12:10.800 --> 0:12:14.959 our communities anyway, there are friends, our neighbors, often family members, 0:12:15.679 --> 0:12:18.000 and they struggle in the shadows though, unable to come 0:12:18.040 --> 0:12:21.800 forward and share their stories because the unfortunate shame associated 0:12:21.840 --> 0:12:23.719 with it. One of the things I've tried to do 0:12:23.960 --> 0:12:26.960 is to get rid of stigma by getting the whole 0:12:27.000 --> 0:12:30.600 community involved. We have this fight based initiative where we 0:12:30.679 --> 0:12:33.800 have people from all fights traditions to gather to get 0:12:34.080 --> 0:12:38.040 people to come together because everybody's congregation has got somebody 0:12:38.160 --> 0:12:41.840 in it with this problem. Education, whether it's in in 0:12:41.920 --> 0:12:45.920 school based settings grade school and colleges, or in workplaces 0:12:46.440 --> 0:12:49.600 or through faith based organizations, can be remarkably effective. The 0:12:49.640 --> 0:12:52.520 other thing that can happen in these settings is that 0:12:52.800 --> 0:12:56.800 conversations can be started to actually share the real stories 0:12:56.840 --> 0:12:59.440 of people who are struggling with addiction. This is hard 0:12:59.480 --> 0:13:02.079 to do because in an environment where you're not sure 0:13:02.679 --> 0:13:04.920 how you're going to be received. I can understand how 0:13:05.280 --> 0:13:07.480 challenging it can be for someone struggling with an opiate 0:13:07.559 --> 0:13:09.480 used disorder, for example, to come forward and say I 0:13:09.720 --> 0:13:12.120 have a problem. But what I have seen time and 0:13:12.160 --> 0:13:15.319 time again is that when people take that courageous step, 0:13:15.840 --> 0:13:20.000 people all around them respond, sometimes often silently saying oh gosh, 0:13:20.040 --> 0:13:21.480 I thought I was the only one, or I thought 0:13:21.480 --> 0:13:24.400 my family was the only one impacted, but often vocally 0:13:24.440 --> 0:13:27.400 as well, voicing their support. And I think of faith 0:13:27.600 --> 0:13:31.080 organizations as powerful partners in this regard. They convene conversations 0:13:31.120 --> 0:13:34.600 anyway on topics related to faith and life. More broadly, 0:13:35.120 --> 0:13:38.200 their ability to convene conversations where people share their real 0:13:38.280 --> 0:13:41.640 story with addiction can be extraordinarily powerful in helping to 0:13:41.679 --> 0:13:44.720 remove some of that stigma. There are times when culture 0:13:45.200 --> 0:13:48.640 trump's policy when it comes to ultimate impact, and this 0:13:48.720 --> 0:13:51.560 is a place where the culture around addiction are underlying 0:13:51.600 --> 0:13:55.280 belief around it. Uh is has to be addressed before 0:13:55.280 --> 0:13:57.679 we're fully able to address the epidemic. As much as 0:13:57.720 --> 0:13:59.719 we feel like we're reading about the opiate epidemic in 0:13:59.760 --> 0:14:01.920 the Pay Purse, there are still millions of people in 0:14:01.920 --> 0:14:05.160 our country who don't fully understand what opioids are, how 0:14:05.200 --> 0:14:09.400 to protect ourselves, you know, from combining opioids with alcohol, 0:14:09.440 --> 0:14:12.000 and how to protect ourselves when we're using opiods to 0:14:12.040 --> 0:14:14.640 begin with, when it's appropriate versus not. We still have 0:14:14.720 --> 0:14:17.600 so many people, for example, who store opioid medicines in 0:14:17.640 --> 0:14:20.200 their medicine cabinet, and it turns out the medicine cabinet 0:14:20.240 --> 0:14:22.680 is the worst place for that medicine because other people 0:14:22.680 --> 0:14:24.560 when they come and visit, can often just easily go 0:14:24.680 --> 0:14:27.240 and take those opioids. And this is actually what happens 0:14:27.480 --> 0:14:30.040 in households all across America. Do you have the sense 0:14:30.080 --> 0:14:32.200 of Congress as well into properly fund this. I mean, 0:14:32.240 --> 0:14:36.600 if there's ever been a bipartisan or a nonpartisan national epidemic, 0:14:36.720 --> 0:14:39.280 this is yes. And in it at a time where 0:14:39.280 --> 0:14:42.480 a few things seem bipartisan, this stands out as as 0:14:42.680 --> 0:14:46.840 as a rare opportunity, rare issue. I don't think though, 0:14:46.880 --> 0:14:50.960 that many in Congress have shown the appetite to fund 0:14:51.880 --> 0:14:54.280 the opiate epidemic at the level that it requires. What's 0:14:54.280 --> 0:14:56.520 happening right now with the how we're funding the opiated 0:14:56.520 --> 0:15:02.040 epidemic is we're providing oftentimes these one time grants to 0:15:02.200 --> 0:15:05.160 communities that will run out after a short period of time, 0:15:05.440 --> 0:15:06.960 and they're trying to figure out, in part, okay, we 0:15:07.000 --> 0:15:08.880 get something up and running, what's going to sustain us 0:15:08.880 --> 0:15:11.600 in years two, three, four, and five. But we're also 0:15:11.640 --> 0:15:15.280 providing that support at a mere fraction of what's needed 0:15:15.320 --> 0:15:18.240 to really turn the tide on the epidemic in those communities. 0:15:18.920 --> 0:15:21.520 I think many members of Congress, and some of them 0:15:21.560 --> 0:15:24.240 have told me this privately, they worry about the price 0:15:24.280 --> 0:15:28.080 tag on a bill that would really adequately resource the epidemic, 0:15:28.080 --> 0:15:31.000 because it would be at least ten times greater than 0:15:31.040 --> 0:15:33.240 the numbers that you're seeing out there. But I think 0:15:33.240 --> 0:15:36.000 what we have to realize is that the long term 0:15:36.040 --> 0:15:39.880 cost of not funding that is far greater. Uh And 0:15:39.880 --> 0:15:42.720 and this is why there's an urgency around this issue. 0:15:42.720 --> 0:15:46.360 It's why you know, having people like you start discussing 0:15:46.400 --> 0:15:49.280 this issue and helping raise public awareness are so important 0:15:49.320 --> 0:15:51.200 because this is one of those times where we need 0:15:51.240 --> 0:15:55.360 the public to push our policymakers not just to make 0:15:55.360 --> 0:15:58.000 an investment, but to make the right investment. But I 0:15:58.120 --> 0:16:01.000 lastly think though it's worth consider also that is in 0:16:01.040 --> 0:16:04.040 all the discussions we have on opioids, in talking about 0:16:04.080 --> 0:16:08.320 what's driving this epidemic, from you know, prescribing patterns, to 0:16:08.680 --> 0:16:13.200 pharmaceutical companies marketing these medicines irresponsibly uh to the public, 0:16:13.320 --> 0:16:15.560 to a whole host of other factors. There are also 0:16:15.600 --> 0:16:18.600 some emotional factors that are driving this epidemic as well. 0:16:18.640 --> 0:16:21.960 I was struck so often and heartbroken often when I 0:16:22.120 --> 0:16:26.760 visited communities around the country. How behind the stories of 0:16:26.840 --> 0:16:31.080 mental illness and addiction and even physical illness were often 0:16:31.120 --> 0:16:34.560 stories of deeper emotional pain that people were experiencing. Sometimes 0:16:34.600 --> 0:16:37.760 it was the pain of poverty, of discrimination. Sometimes it 0:16:37.840 --> 0:16:40.640 was a pain that came with disability um Sometimes it 0:16:40.680 --> 0:16:42.480 was a pain that came from not having a job 0:16:42.520 --> 0:16:44.760 and not being able to find a job and feeling 0:16:44.800 --> 0:16:47.280 like they were outcasts. Sometimes it was a pain of loneliness, 0:16:47.320 --> 0:16:50.480 which is extremely common, much more so than we realized. 0:16:50.800 --> 0:16:54.160 But whatever the pain source was, that deeper emotional pain 0:16:54.280 --> 0:16:57.640 was often driving people to places of despair, and it 0:16:57.720 --> 0:17:01.720 was manifesting often as disconnection from others. And I realized 0:17:01.760 --> 0:17:03.800 that if we want to address the opiate epidemic, we 0:17:03.840 --> 0:17:08.440 don't just need good treatment and counseling. We actually need community. 0:17:08.640 --> 0:17:11.360 We need connection as well. There's nobody I have met 0:17:11.440 --> 0:17:13.679 who has come through the dark tunnel of addiction and 0:17:13.680 --> 0:17:16.680 emerged on the other side who has not had somebody 0:17:16.720 --> 0:17:19.159 that they trust, who has believed in them, especially when 0:17:19.200 --> 0:17:22.840 they were not able to believe in themselves. That is 0:17:22.880 --> 0:17:25.480 why I think about the opiate epidemic is not only 0:17:25.520 --> 0:17:28.120 an illness, but as a disease of disconnection in part. 0:17:28.880 --> 0:17:30.800 And this is a place where each of us can 0:17:30.840 --> 0:17:32.960 be helpful. You don't need a medical degree or a 0:17:33.000 --> 0:17:36.159 nursing degree to be able to provide support and a 0:17:36.160 --> 0:17:39.199 listening ear to somebody who is struggling with addiction, to 0:17:39.240 --> 0:17:41.639 help them feel that they are not being judged for 0:17:41.720 --> 0:17:44.240 an illness that's not a character flaw, but that's actually 0:17:44.240 --> 0:17:46.760 a medical condition. And I will tell you that despite 0:17:46.800 --> 0:17:49.960 my training as a doctor, despite all the years that 0:17:50.240 --> 0:17:52.080 you know I put into learning how to treat in 0:17:52.160 --> 0:17:57.359 biological illnesses, that the power of a family member, of 0:17:57.480 --> 0:18:02.639 friend um building a loving, trusting relationship with someone is 0:18:02.680 --> 0:18:05.680 far greater than any medicine I could prescribe, or any 0:18:05.720 --> 0:18:08.200 treatment that I could give. And that's why I believe 0:18:08.320 --> 0:18:11.520 that in the fight against the opiate addiction, that love 0:18:11.600 --> 0:18:14.159 is in fact our most powerful medicine. It's one that 0:18:14.240 --> 0:18:16.840 anyone can dispense, and it's one that we need now 0:18:16.840 --> 0:18:20.399 more than ever. Our country was very lucky to have 0:18:20.520 --> 0:18:23.600 you as our Surgeon General, and I thank you. The 0:18:23.680 --> 0:18:25.800 only thing I'd like to say before we close to 0:18:25.840 --> 0:18:29.280 the doubters is that no progress to human life would 0:18:29.280 --> 0:18:32.400 ever be made if we never tried, because we couldn't 0:18:32.840 --> 0:18:36.560 win every time. That's someone who's lived in a family 0:18:36.640 --> 0:18:41.520 that's experienced addiction, who's what's friends bury their children. You 0:18:41.600 --> 0:18:44.840 won't win them all, but you can win a lot, 0:18:46.359 --> 0:18:50.760 and we have to try. Thank you very much, Thank you, 0:18:50.840 --> 0:19:02.560 Mr President. We'll be right back. My name is Sarah Gad. 0:19:02.720 --> 0:19:06.480 I'm a c g i U Clinton Global Initiative University alumni. 0:19:06.720 --> 0:19:09.479 It was actually the very first time I decided to 0:19:09.480 --> 0:19:13.280 share my story and my history with opioid addiction was 0:19:13.320 --> 0:19:16.199 in that discussion room at c g i U. They 0:19:16.240 --> 0:19:19.639 were just so supportive, and I realized, why have I 0:19:19.720 --> 0:19:26.159 been so secretive about this for so long? I first 0:19:26.480 --> 0:19:30.040 became addicted to opioids when I was in my third 0:19:30.160 --> 0:19:34.000 year of medical school. I ended up in a pretty 0:19:34.080 --> 0:19:38.640 horrific car accident which I remember nothing about. I woke 0:19:38.720 --> 0:19:41.920 up in a hospital room with my leg in a sling. 0:19:42.480 --> 0:19:46.919 I had undergone emergency surgery on my leg because my 0:19:47.000 --> 0:19:50.280 ankle bone literally pierced through my skin and had to 0:19:50.320 --> 0:19:53.440 be hammered and screwed back into place. So it was 0:19:53.480 --> 0:19:57.480 a pretty long, pretty painful recovery process. And during that 0:19:57.560 --> 0:20:01.440 time I was prescribed opioids like perk set An, OxyContin, 0:20:01.680 --> 0:20:04.000 and at first I was just taking them for pain. 0:20:04.400 --> 0:20:07.280 But as I was recovering, I was watching all of 0:20:07.320 --> 0:20:11.280 my classmates graduate onto their fourth year of medical school. 0:20:11.440 --> 0:20:16.320 Meanwhile I was bedridden and I was depressed. My opioid 0:20:16.520 --> 0:20:20.600 prescription pain medication was by that point they had become 0:20:20.640 --> 0:20:24.359 my only source of joy and happiness. And then maybe 0:20:24.400 --> 0:20:28.639 about a year out after my accident, my doctor sat 0:20:28.680 --> 0:20:31.679 down with me and was like, look, you cannot be 0:20:31.800 --> 0:20:34.919 in this much pain this far out. Do you have 0:20:35.160 --> 0:20:39.520 a dependency problem? And I denied it. I just didn't 0:20:39.600 --> 0:20:45.879 want to acknowledge it. Once my doctor stopped prescribing me opioids, 0:20:45.920 --> 0:20:49.120 I started going to see a bunch of other doctors 0:20:49.720 --> 0:20:52.520 and then it didn't take too long for them to 0:20:52.640 --> 0:20:55.280 figure out that I had been doctor shopping and so 0:20:55.520 --> 0:20:58.640 as a third year medical student, I was familiar with 0:20:59.040 --> 0:21:02.879 how to write prescriptions and that's what landed me in 0:21:02.960 --> 0:21:07.480 legal trouble and got me arrested. And once you're criminalized 0:21:07.480 --> 0:21:10.880 and you have a criminal record and arrest record, very 0:21:10.920 --> 0:21:15.199 difficult to reintegrate back into society in any sort of 0:21:15.320 --> 0:21:18.520 meaningful way. It was always just kind of the cycle 0:21:18.640 --> 0:21:22.120 of going to jail and detoxing cold turkey and going 0:21:22.160 --> 0:21:26.159 through the hell of physical withdrawal, getting out, trying to 0:21:26.160 --> 0:21:28.879 get my life back on track, and then relapsing and 0:21:28.920 --> 0:21:32.560 then going back to jail. And then I was incarcerated 0:21:32.600 --> 0:21:36.679 for five days, and the day that I got out, 0:21:36.920 --> 0:21:40.679 I actually ended up overdosing. It was just because my 0:21:40.800 --> 0:21:44.879 tolerance had gone down so much during that period, and 0:21:45.200 --> 0:21:48.560 I woke up in an ambulance being injected with narcan 0:21:48.960 --> 0:21:55.080 and told that I had just overdosed on opioids. The 0:21:55.160 --> 0:21:59.080 Centers for Disease Control reports that more than people died 0:21:59.160 --> 0:22:03.080 from opioid to overdoses in two thousand sixteen. Addicts need 0:22:03.160 --> 0:22:06.920 help without the fear of being stigmatized or arrested. The 0:22:06.960 --> 0:22:11.159 crisis has become so widespread that the Surgeon General is 0:22:11.280 --> 0:22:14.840 urging ordinary citizens to carry the locks on, a drug 0:22:14.880 --> 0:22:18.720 that reverses the effects of a drug overdose and saves lives. 0:22:18.840 --> 0:22:22.000 The only reason I survived was at that point we 0:22:22.080 --> 0:22:24.840 had been given the locks on. The gentleman that I 0:22:24.880 --> 0:22:29.960