1
00:00:00,280 --> 00:00:07,760
Speaker 1: Hi, I'm Ethan Nadelman, 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
00:00:15,160 --> 00:00:18,760
Speaker 1: views expressed here do not represent those of I Heeart Media,

5
00:00:18,920 --> 00:00:23,680
Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, as an

6
00:00:23,680 --> 00:00:26,840
Speaker 1: inveterate contrarian, I can tell you they may not even

7
00:00:26,920 --> 00:00:31,120
Speaker 1: represent my own and nothing contained in this show should

8
00:00:31,120 --> 00:00:34,040
Speaker 1: be used as medical advice or encouragement to use any

9
00:00:34,080 --> 00:00:46,400
Speaker 1: type of drug. Hello, Psychoactive listeners. Uh, Today's guest is

10
00:00:46,720 --> 00:00:51,199
Speaker 1: a really interesting one for me. It's Dr Nora Vocal,

11
00:00:51,520 --> 00:00:54,760
Speaker 1: who has been the head of the National Institute on

12
00:00:54,840 --> 00:00:58,440
Speaker 1: Drug Abuse in the US government since two thousand and three.

13
00:00:58,520 --> 00:01:02,680
Speaker 1: That's under four different and presidential administrations, so it's been

14
00:01:02,720 --> 00:01:08,480
Speaker 1: a remarkably long run overseeing the lead agency which provides

15
00:01:08,600 --> 00:01:11,840
Speaker 1: the majority of funding for drug research, not just in

16
00:01:11,880 --> 00:01:14,480
Speaker 1: the US, but really the majority all around the world.

17
00:01:15,280 --> 00:01:18,000
Speaker 1: Those of you who know me, you'll know I've been

18
00:01:18,080 --> 00:01:22,679
Speaker 1: highly critical of NIDA, Nationals Drug Abuse and Dr Volka

19
00:01:22,760 --> 00:01:25,559
Speaker 1: over the years, in part because I think they've so

20
00:01:25,680 --> 00:01:31,200
Speaker 1: overemphasized trying to establish that addiction is a brain disease,

21
00:01:31,360 --> 00:01:34,320
Speaker 1: and and putting a lot of research into the neuroscience

22
00:01:34,360 --> 00:01:37,000
Speaker 1: and brain imaging and all of that. And I personally

23
00:01:37,040 --> 00:01:40,200
Speaker 1: think that they should be spending dramatically more money on

24
00:01:40,280 --> 00:01:44,040
Speaker 1: things like ethnographic studies and setting things like the ways

25
00:01:44,080 --> 00:01:46,880
Speaker 1: in which people control their drug use and more research

26
00:01:46,920 --> 00:01:49,680
Speaker 1: on the benefits of drugs. Now, you should also be

27
00:01:49,760 --> 00:01:53,680
Speaker 1: aware that a few years ago Nyder receives some dedicated

28
00:01:53,680 --> 00:01:58,520
Speaker 1: funding from Congress, specifically UM to address issues involving the

29
00:01:58,600 --> 00:02:01,320
Speaker 1: drug overdose. At the demo, and those of you have

30
00:02:01,320 --> 00:02:03,680
Speaker 1: been listening carefully know that just a few episodes ago,

31
00:02:03,720 --> 00:02:08,160
Speaker 1: in episode five, we had Professor Dan Chacheroni talking about

32
00:02:09,000 --> 00:02:11,440
Speaker 1: what's going on with the overdose epidemic? Why did almost

33
00:02:11,480 --> 00:02:14,440
Speaker 1: a hundred thousand people die last year? Uh? And so

34
00:02:14,520 --> 00:02:18,080
Speaker 1: I started off the interview really by pressing uh Dr

35
00:02:18,160 --> 00:02:22,800
Speaker 1: Volcale on that question, UM, And I will admit I

36
00:02:22,840 --> 00:02:25,600
Speaker 1: was frustrated by some of her answer. She kept saying,

37
00:02:25,639 --> 00:02:28,119
Speaker 1: we need more research on this, more research on that,

38
00:02:28,520 --> 00:02:30,280
Speaker 1: you know, and of course Night has been spending more

39
00:02:30,280 --> 00:02:33,240
Speaker 1: money and anybody in the world on doing research. But

40
00:02:33,360 --> 00:02:37,480
Speaker 1: I'll tell you I was pleasantly surprised that she agreed

41
00:02:37,600 --> 00:02:40,840
Speaker 1: to be a guest on Psychoactive. Nora grew up in

42
00:02:40,919 --> 00:02:45,680
Speaker 1: Mexico City, has a fascinating family history that will get

43
00:02:45,720 --> 00:02:48,520
Speaker 1: into early in the episode. She was an outstanding medical student,

44
00:02:48,600 --> 00:02:52,600
Speaker 1: became a psychiatrist, held all sorts of influential positions, became

45
00:02:52,639 --> 00:02:54,959
Speaker 1: a real leader in the US and around the world

46
00:02:55,040 --> 00:02:58,640
Speaker 1: trying to understand addiction by looking at the brain through

47
00:02:58,800 --> 00:03:02,760
Speaker 1: neural imaging and brain scans, and has had really quite

48
00:03:02,760 --> 00:03:07,919
Speaker 1: a remarkable run. So, without further ado, here's my conversation

49
00:03:08,200 --> 00:03:15,080
Speaker 1: with Nora vocal Nora, thank you so much for joining

50
00:03:15,080 --> 00:03:18,440
Speaker 1: me today on Psychoactive. That's for having me and listen.

51
00:03:18,480 --> 00:03:21,200
Speaker 1: My job here, right, I mean here, I've led until

52
00:03:21,200 --> 00:03:24,560
Speaker 1: recently the leading drug policy reform institute, which was intensely

53
00:03:24,560 --> 00:03:28,240
Speaker 1: critical of many government policies and oftentimes of Naida's work

54
00:03:28,320 --> 00:03:30,640
Speaker 1: and priorities. But it's my job both to be the

55
00:03:30,680 --> 00:03:32,680
Speaker 1: gracious host and also to press you on a lot

56
00:03:32,680 --> 00:03:34,400
Speaker 1: of questions which have been on my mind that I'm

57
00:03:34,400 --> 00:03:36,880
Speaker 1: sure in the minds of others. But let me just

58
00:03:36,960 --> 00:03:39,080
Speaker 1: start off on a little bit of a personal thing,

59
00:03:39,240 --> 00:03:43,840
Speaker 1: which is you have this remarkably interesting background familiar background,

60
00:03:44,320 --> 00:03:46,800
Speaker 1: you know, growing up in Mexico, but growing up in

61
00:03:46,840 --> 00:03:50,720
Speaker 1: the house in which your great grandfather, the Russian revolutionary

62
00:03:51,040 --> 00:03:56,120
Speaker 1: Leon Trotsky, was murdered by Stalin's agents. And yet there's

63
00:03:56,160 --> 00:03:59,080
Speaker 1: another part of your family history involving I think your

64
00:03:59,120 --> 00:04:03,240
Speaker 1: grandfather of ears, which I understand it first sensitized you

65
00:04:03,360 --> 00:04:06,520
Speaker 1: and made you start thinking about the issues of drugs

66
00:04:06,640 --> 00:04:09,320
Speaker 1: and addiction and what you might do to address it.

67
00:04:09,360 --> 00:04:10,640
Speaker 1: And I wonder if you could just tell us a

68
00:04:10,680 --> 00:04:13,840
Speaker 1: little more about that. Yes, and and indeed, my my

69
00:04:13,880 --> 00:04:19,560
Speaker 1: story comes from two different countries. I my father came

70
00:04:19,600 --> 00:04:24,920
Speaker 1: from Russia and his grandfather was escaping from Stalin and

71
00:04:25,120 --> 00:04:28,200
Speaker 1: ultimately the only place that gave asylum to his family

72
00:04:28,400 --> 00:04:32,320
Speaker 1: was was Mexico, Whereas my mother was born in Spain

73
00:04:32,720 --> 00:04:35,760
Speaker 1: and there was the Civil War, and again Mexico was

74
00:04:35,800 --> 00:04:39,560
Speaker 1: a place that gave political asylum to all of those

75
00:04:39,600 --> 00:04:43,880
Speaker 1: refugees that were escaping Franco. So I always like to

76
00:04:43,880 --> 00:04:45,760
Speaker 1: say that I was born of the two Wars, or

77
00:04:45,760 --> 00:04:49,040
Speaker 1: the last century Russian Revolution and the Civil War, and

78
00:04:49,080 --> 00:04:51,800
Speaker 1: so that's that's how I came to be born in Mexico.

79
00:04:52,600 --> 00:04:55,240
Speaker 1: What you were saying as in terms of what led

80
00:04:55,360 --> 00:04:59,280
Speaker 1: me to think about addiction. And indeed, Um, the father

81
00:04:59,400 --> 00:05:03,000
Speaker 1: of my other unbeknownst to me as as a child,

82
00:05:03,440 --> 00:05:05,479
Speaker 1: I had never met him because he was in Spain

83
00:05:05,520 --> 00:05:09,279
Speaker 1: and I was in Mexico, had a history of alcoholism,

84
00:05:09,400 --> 00:05:12,920
Speaker 1: and when I was approximately probably six years of age,

85
00:05:13,680 --> 00:05:18,039
Speaker 1: he committed suicide because he couldn't control the strong urge

86
00:05:18,120 --> 00:05:22,080
Speaker 1: to to drink and had relapsed. So I did not

87
00:05:22,200 --> 00:05:25,560
Speaker 1: find this until later, when I was already in medical school.

88
00:05:26,040 --> 00:05:29,560
Speaker 1: But in the meantime, my favorite tone call of all times,

89
00:05:30,120 --> 00:05:35,440
Speaker 1: my mother's older brother, also had a problem with alcohol,

90
00:05:35,720 --> 00:05:39,479
Speaker 1: and to me, it was very contrasting to see the

91
00:05:39,560 --> 00:05:44,680
Speaker 1: component about what an extraordinary individual he was, how generous,

92
00:05:44,880 --> 00:05:49,360
Speaker 1: how smart, how charismatic on the one hand, and yet

93
00:05:49,720 --> 00:05:54,040
Speaker 1: when he was drinking, his personality changed so much. And

94
00:05:54,320 --> 00:05:57,480
Speaker 1: I was also intrinked about the family dynamics because nobody

95
00:05:57,520 --> 00:06:00,919
Speaker 1: wanted to speak about it was like this antic secret.

96
00:06:01,920 --> 00:06:05,960
Speaker 1: It gave me that insight that, I mean, people are

97
00:06:06,080 --> 00:06:10,520
Speaker 1: not bad because they have a problem of addiction. They

98
00:06:10,600 --> 00:06:13,080
Speaker 1: just have a problem that it's more powerful that they

99
00:06:13,080 --> 00:06:16,200
Speaker 1: can't control, and it's not that they are doing this voluntarily.

100
00:06:17,040 --> 00:06:19,760
Speaker 1: So as I went to medical school, I was also

101
00:06:19,960 --> 00:06:24,120
Speaker 1: uphold at the way that our doctors were treating addiction.

102
00:06:24,200 --> 00:06:28,200
Speaker 1: They were ignoring it, actually refusing sometimes to give treatment

103
00:06:28,200 --> 00:06:31,680
Speaker 1: to someone that have a history of addiction because they

104
00:06:31,720 --> 00:06:35,120
Speaker 1: thought that they were doing this to themselves and whatever

105
00:06:35,200 --> 00:06:38,360
Speaker 1: happened to them, they deserved it. And I saw this

106
00:06:38,680 --> 00:06:44,120
Speaker 1: even as I went after my residency training in psychiatry,

107
00:06:44,600 --> 00:06:48,599
Speaker 1: where we would admit patients that have depression with an

108
00:06:48,640 --> 00:06:52,479
Speaker 1: alcohol use disorder, and I would inquire to the attendance,

109
00:06:52,520 --> 00:06:55,800
Speaker 1: how do we address the alcohol use disorder and do

110
00:06:55,880 --> 00:06:58,920
Speaker 1: not worry about it, treat the depression and once the

111
00:06:59,000 --> 00:07:01,160
Speaker 1: person leaves the host bital, then they will deal with

112
00:07:01,200 --> 00:07:04,839
Speaker 1: their alcohol use disorder. And later on, as I became

113
00:07:04,880 --> 00:07:10,080
Speaker 1: an attendant, directly forbidden to admit patients with an addiction

114
00:07:10,160 --> 00:07:13,880
Speaker 1: into the inpatient unit of the hospital because they were

115
00:07:13,960 --> 00:07:18,080
Speaker 1: patients that misbehaved under quote. So to me, all of

116
00:07:18,120 --> 00:07:23,480
Speaker 1: these experiences were actually activating Miami Dallas, which are the

117
00:07:23,520 --> 00:07:27,880
Speaker 1: centers of emotions of the brain, because it seemed completely

118
00:07:28,080 --> 00:07:32,160
Speaker 1: counter factual with what we knew then on the pharmacology

119
00:07:32,160 --> 00:07:34,800
Speaker 1: and the neuroscience of the brain, and we knew that

120
00:07:34,880 --> 00:07:38,760
Speaker 1: we could make animals actually get compulsive in administering a

121
00:07:38,880 --> 00:07:42,320
Speaker 1: drug to the expense that they would stop eating or drinking,

122
00:07:42,360 --> 00:07:44,880
Speaker 1: and they actually j pordize their life. And so they

123
00:07:44,880 --> 00:07:50,680
Speaker 1: are very in wire wire biological circuits that make us

124
00:07:50,840 --> 00:07:53,760
Speaker 1: vulnerable to these drugs and in some people to that

125
00:07:53,840 --> 00:07:58,320
Speaker 1: complete loss of control. So that's ultimately what led me

126
00:07:58,520 --> 00:08:02,800
Speaker 1: to try to provide knowledge that could illuminate further her

127
00:08:02,960 --> 00:08:05,960
Speaker 1: calpus understand what happens in the brain of people that

128
00:08:06,040 --> 00:08:11,040
Speaker 1: lose control, with the idea that hopefully science will serve

129
00:08:11,120 --> 00:08:16,360
Speaker 1: to change policies and reduce the stigma, and basically changed

130
00:08:16,440 --> 00:08:20,920
Speaker 1: the notion of criminalizing people to that of treating and

131
00:08:21,120 --> 00:08:25,640
Speaker 1: helping people and preventing them from relapsing. Yeah, so I'm

132
00:08:25,640 --> 00:08:29,560
Speaker 1: trying to think, um, if I look at what natives

133
00:08:29,600 --> 00:08:31,920
Speaker 1: priorities have been, and I think it was true under

134
00:08:32,000 --> 00:08:35,840
Speaker 1: to some extent your predecessor listeners as well, But for you,

135
00:08:35,960 --> 00:08:38,640
Speaker 1: really it feels like the major thrust of the agency

136
00:08:38,760 --> 00:08:41,440
Speaker 1: really has been on the brain research, right and then

137
00:08:41,440 --> 00:08:44,040
Speaker 1: your imaging in that the biggest share of the resources

138
00:08:44,040 --> 00:08:47,679
Speaker 1: have gotten there, And what I have always felt has

139
00:08:47,760 --> 00:08:51,440
Speaker 1: been a sort of inadequate attention to funding the sort

140
00:08:51,679 --> 00:08:56,199
Speaker 1: of ethnographic work the deep analysis into drug using communities

141
00:08:56,240 --> 00:08:59,960
Speaker 1: and drug cultures into truly understanding what's going on there,

142
00:09:00,040 --> 00:09:02,840
Speaker 1: especially we're dealing with the overdose issue and the opioid issue.

143
00:09:03,160 --> 00:09:05,880
Speaker 1: I mean, I know you find some stuff in that area,

144
00:09:06,000 --> 00:09:10,120
Speaker 1: but it seems like it's relatively modest, very modest compared

145
00:09:10,160 --> 00:09:12,120
Speaker 1: to the work that's being done. And they were imaging

146
00:09:12,120 --> 00:09:15,040
Speaker 1: in the brain stuff, and I mean, what's the rationale

147
00:09:15,080 --> 00:09:17,240
Speaker 1: for that? Is that you believe that the brain work

148
00:09:17,320 --> 00:09:19,360
Speaker 1: is going to lead to the big breakthrough. I mean,

149
00:09:19,440 --> 00:09:21,520
Speaker 1: here we're focusing on the opioid epidemic, right, which is

150
00:09:21,559 --> 00:09:24,719
Speaker 1: now what we're approaching a hundred thousand people dying overdose

151
00:09:24,800 --> 00:09:27,840
Speaker 1: and all sorts of other ills associated with this. Why

152
00:09:27,960 --> 00:09:31,280
Speaker 1: is such a focus on that well, I mean, obviously

153
00:09:31,400 --> 00:09:34,800
Speaker 1: we are very much interested on basic neuroscience to help

154
00:09:34,880 --> 00:09:38,000
Speaker 1: us understand how it affects the brain. But we invest

155
00:09:38,080 --> 00:09:41,240
Speaker 1: much more money on research that relates to those very

156
00:09:41,280 --> 00:09:45,000
Speaker 1: important components that you discuss the issue of how socio

157
00:09:45,040 --> 00:09:52,080
Speaker 1: economical factors, cultural factors influence the vulnerability of resilience for

158
00:09:52,200 --> 00:09:56,440
Speaker 1: drug taking, and so our dollar amounts spent in research

159
00:09:56,480 --> 00:10:02,320
Speaker 1: that relates, for example, to prevention services in implementation epidemiology,

160
00:10:02,440 --> 00:10:05,640
Speaker 1: in fact, is greater than what we've spent in basic neuroscience.

161
00:10:06,200 --> 00:10:09,679
Speaker 1: We have this need in humans of polarizing things into

162
00:10:09,720 --> 00:10:14,120
Speaker 1: this or that, and ultimately that reality is that our

163
00:10:14,240 --> 00:10:18,199
Speaker 1: social systems are product of our brains interacting with one another,

164
00:10:18,400 --> 00:10:22,360
Speaker 1: and our brains are a product of our circumstances. So

165
00:10:22,400 --> 00:10:26,119
Speaker 1: the challenge in science is how do we integrate these fields.

166
00:10:26,160 --> 00:10:29,320
Speaker 1: For example, a very important story we have been doing

167
00:10:29,320 --> 00:10:33,719
Speaker 1: since twenty sixteen is a developmental study of children as

168
00:10:33,720 --> 00:10:38,000
Speaker 1: a transition into adulthood. And yez, we're studying their brains,

169
00:10:38,040 --> 00:10:42,360
Speaker 1: but yez, we're doing a very in depth phenotypic characterization

170
00:10:42,760 --> 00:10:45,520
Speaker 1: of their social environment. And as a result of these

171
00:10:45,559 --> 00:10:48,959
Speaker 1: longitude in our study, large longitude in our story, researchers

172
00:10:48,960 --> 00:10:54,000
Speaker 1: have been able to document some extremely powerful relationships between

173
00:10:54,080 --> 00:10:58,520
Speaker 1: these adverse social environments and how the brain develops. And

174
00:10:58,559 --> 00:11:02,760
Speaker 1: also important in sites on how very early owned children

175
00:11:03,400 --> 00:11:08,640
Speaker 1: as mistreating if they come from certain racial backgrounds. And

176
00:11:08,679 --> 00:11:11,559
Speaker 1: we are about to start a similar study in initiating

177
00:11:11,880 --> 00:11:15,080
Speaker 1: early in infancy to follow it up, and it will

178
00:11:15,120 --> 00:11:18,560
Speaker 1: give us some much better understanding about how our environment

179
00:11:18,600 --> 00:11:21,040
Speaker 1: influences the brain. Well, but now when I'm really getting

180
00:11:21,080 --> 00:11:23,920
Speaker 1: at those. I remember back in the seventies and eighties

181
00:11:23,960 --> 00:11:27,800
Speaker 1: there was this incredible richness of ethnographic studies going on,

182
00:11:28,000 --> 00:11:30,640
Speaker 1: and and famous ethnographers Michael Agar and others, and a

183
00:11:30,679 --> 00:11:33,600
Speaker 1: whole cohort who are really doing in depth studies. And

184
00:11:33,600 --> 00:11:36,120
Speaker 1: now I look at the questions that emerged around say,

185
00:11:36,160 --> 00:11:39,840
Speaker 1: fentonyl on the opioids, the question about how our consumers

186
00:11:39,880 --> 00:11:42,839
Speaker 1: responding when people know that fentanyels out on the street,

187
00:11:42,840 --> 00:11:44,480
Speaker 1: that they run forward to run away for it. What

188
00:11:44,559 --> 00:11:46,679
Speaker 1: sorts of precautions are they taking us to be their

189
00:11:46,720 --> 00:11:49,439
Speaker 1: own use to what exentered? The people who's selling these drugs,

190
00:11:49,440 --> 00:11:52,199
Speaker 1: the lowest level retail sellers, to what extent do they

191
00:11:52,200 --> 00:11:54,720
Speaker 1: know what's in their drugs? Are they exercising any sort

192
00:11:54,720 --> 00:11:57,760
Speaker 1: of harm reduction measures us to be their own consumers?

193
00:11:57,880 --> 00:11:59,880
Speaker 1: Right to what ex center? These drugs all being mixed,

194
00:12:00,040 --> 00:12:02,720
Speaker 1: Why is ventinyl landing up and the stimulants apply with

195
00:12:02,760 --> 00:12:06,400
Speaker 1: cocaine and methamphetamine. And there's these hosts of questions, and

196
00:12:06,480 --> 00:12:09,520
Speaker 1: it seems to me that essentially nobody has the answers.

197
00:12:09,720 --> 00:12:12,480
Speaker 1: And when I talked to, you know, the sociologist, the

198
00:12:12,520 --> 00:12:15,960
Speaker 1: ethnographers the others who are getting funded. They're saying, Ethan,

199
00:12:16,040 --> 00:12:18,439
Speaker 1: You're right, those are really important questions. But the truth

200
00:12:18,480 --> 00:12:20,520
Speaker 1: of is it, there's only a handful of us really

201
00:12:20,559 --> 00:12:24,200
Speaker 1: getting this abundance of funding to do this stuff. Isn't

202
00:12:24,200 --> 00:12:26,680
Speaker 1: a part of the job of NAIDA to be digging

203
00:12:26,880 --> 00:12:31,520
Speaker 1: deeply into what's actually going on in these active markets

204
00:12:31,679 --> 00:12:34,640
Speaker 1: right now, finding these things out, and trying to dig

205
00:12:34,679 --> 00:12:37,240
Speaker 1: into what sorts of interventions you can do with active

206
00:12:37,320 --> 00:12:40,320
Speaker 1: drug users and even low level sellers in order to

207
00:12:40,400 --> 00:12:43,560
Speaker 1: reduce the harms that are resulting from ventanyl and these

208
00:12:43,600 --> 00:12:46,319
Speaker 1: other opioids being on the street. Absolutely, we have a

209
00:12:46,440 --> 00:12:49,960
Speaker 1: responsibility to bring a light that can help address these

210
00:12:50,040 --> 00:12:53,400
Speaker 1: very challenging times. And what I can tell you I mean,

211
00:12:53,480 --> 00:12:55,520
Speaker 1: and this is in terms I mean. One of the

212
00:12:55,600 --> 00:12:59,080
Speaker 1: main drivers about why we have synthetic opio is now

213
00:12:59,160 --> 00:13:03,160
Speaker 1: widespread through the United States is because the profits for

214
00:13:03,200 --> 00:13:06,000
Speaker 1: the dealers and those that are generating these drugs are

215
00:13:06,080 --> 00:13:09,360
Speaker 1: much greater than they are for something like heroin or

216
00:13:09,440 --> 00:13:13,400
Speaker 1: many of the other drugs that require cultivation. So one

217
00:13:13,440 --> 00:13:16,720
Speaker 1: of the reasons why you see so many drugs being

218
00:13:16,800 --> 00:13:19,440
Speaker 1: laced with fentannel is that the dealers are going to

219
00:13:19,480 --> 00:13:22,960
Speaker 1: be making much more money. And we do have ethnographic

220
00:13:23,040 --> 00:13:26,440
Speaker 1: reports that actually go and speak with people on the

221
00:13:26,520 --> 00:13:30,560
Speaker 1: streets and for example in Baltimore, John heroin users maybe

222
00:13:30,559 --> 00:13:34,120
Speaker 1: in some instances seeking out fentannel, but the older ones

223
00:13:34,160 --> 00:13:37,080
Speaker 1: are actually afraid of it, but they cannot afford to

224
00:13:37,120 --> 00:13:41,520
Speaker 1: buy pure heroin because it's more expensive. Also many instances

225
00:13:41,559 --> 00:13:44,400
Speaker 1: it is very difficult to get pure heroin even if

226
00:13:44,400 --> 00:13:46,920
Speaker 1: you have the money to pay for it. So it

227
00:13:47,280 --> 00:13:51,400
Speaker 1: is a reality that unfortunately, the enormous amount of money

228
00:13:51,400 --> 00:13:56,520
Speaker 1: that can be made by selling fentannel is driving the market.

229
00:13:56,679 --> 00:13:59,400
Speaker 1: And so I mean in terms of scientific questions is

230
00:13:59,440 --> 00:14:03,960
Speaker 1: how do we counteract that negative effects and the strong

231
00:14:04,040 --> 00:14:09,840
Speaker 1: aggressive distribution of fentanyl and its contamination of the other drugs.

232
00:14:10,200 --> 00:14:14,040
Speaker 1: That's unfortunately, at an essence part of the normal challenges

233
00:14:14,080 --> 00:14:16,720
Speaker 1: that we have. But we need to understand also that

234
00:14:16,800 --> 00:14:20,360
Speaker 1: diversity of the markets and too to meet one of

235
00:14:20,400 --> 00:14:23,320
Speaker 1: the key important issues for addressing, for example, the obvious

236
00:14:23,400 --> 00:14:27,560
Speaker 1: crisis is to have more timely data, just like like

237
00:14:27,640 --> 00:14:30,520
Speaker 1: we had with COVID, Right, you see immediately you know

238
00:14:30,560 --> 00:14:33,200
Speaker 1: when you're starting to have the new variance. We don't

239
00:14:33,240 --> 00:14:36,600
Speaker 1: have that for fentanil. So if I get data, it's

240
00:14:36,640 --> 00:14:40,520
Speaker 1: at least six months later of over those mortality across

241
00:14:40,760 --> 00:14:43,440
Speaker 1: different areas of the country, and by then many people

242
00:14:43,480 --> 00:14:46,520
Speaker 1: have died. And the technology is out there that would

243
00:14:46,600 --> 00:14:49,640
Speaker 1: enable us to detect early on when we see in

244
00:14:49,640 --> 00:14:53,840
Speaker 1: a community the emergence of these very little drugs. I

245
00:14:53,920 --> 00:14:56,080
Speaker 1: know my own I just to say, my own sense

246
00:14:56,200 --> 00:14:59,040
Speaker 1: is that if you were the funding army of hnographers

247
00:14:59,120 --> 00:15:02,840
Speaker 1: going out there doing snowball research, paying drug users to

248
00:15:02,840 --> 00:15:06,120
Speaker 1: connect with other drug researchers, finding out what they're doing

249
00:15:06,160 --> 00:15:09,360
Speaker 1: around these new drugs emerging, what sorts of precautions are doing,

250
00:15:09,560 --> 00:15:12,600
Speaker 1: and even funding studies that try to enlist drug sellers,

251
00:15:12,640 --> 00:15:15,920
Speaker 1: whether they're currently incarcerated or whether they're still operating the

252
00:15:15,960 --> 00:15:19,119
Speaker 1: community to find out. Look, drug sellers don't want dead customers.

253
00:15:19,120 --> 00:15:21,880
Speaker 1: It's bad for business, right, or even trying to find

254
00:15:21,880 --> 00:15:23,160
Speaker 1: out what I mean, I don't know if you know

255
00:15:23,200 --> 00:15:26,520
Speaker 1: the answer. Why is it that cocaine and methamphetamine are

256
00:15:26,560 --> 00:15:29,120
Speaker 1: being cut now with fentanyl? I mean, are they trying

257
00:15:29,120 --> 00:15:31,120
Speaker 1: to make some form of new speedball or is it

258
00:15:31,200 --> 00:15:33,760
Speaker 1: just out of ignorance on the part of retail sellers.

259
00:15:34,320 --> 00:15:36,960
Speaker 1: Are the customers actually want that. I mean, what do

260
00:15:37,040 --> 00:15:40,360
Speaker 1: we know about that right now? What we know is

261
00:15:40,480 --> 00:15:45,000
Speaker 1: that many of the debts associated with stimulants our own

262
00:15:45,040 --> 00:15:47,840
Speaker 1: beknowns to the person that they were getting actually a

263
00:15:47,960 --> 00:15:52,040
Speaker 1: stimulant that was contaminated with fantaniel in some instances. Yes,

264
00:15:52,240 --> 00:15:54,400
Speaker 1: as you know that speed bowling was the way that

265
00:15:54,440 --> 00:15:57,720
Speaker 1: people used to want to get tired. Um, you don't

266
00:15:57,800 --> 00:16:01,640
Speaker 1: have just one reason why people maybe combining, but I

267
00:16:01,720 --> 00:16:06,000
Speaker 1: need a very important contribution is people not knowing that

268
00:16:06,040 --> 00:16:10,000
Speaker 1: they are getting fantonil, being stimulant users having no tolerance

269
00:16:10,040 --> 00:16:14,040
Speaker 1: for opious and therefore that drug combination is particularly little.

270
00:16:14,680 --> 00:16:16,640
Speaker 1: And yes, I mean I think that one of the

271
00:16:16,680 --> 00:16:18,960
Speaker 1: issues that you need to consider in terms of how

272
00:16:19,560 --> 00:16:22,960
Speaker 1: we have to make decisions. Absolutely, we need to understand

273
00:16:23,000 --> 00:16:25,680
Speaker 1: the problem in better ways, in more efficient ways, but

274
00:16:25,760 --> 00:16:28,360
Speaker 1: we also need to develop tools that will allow us

275
00:16:28,400 --> 00:16:31,080
Speaker 1: to address it. So it's not just that we are

276
00:16:31,160 --> 00:16:37,480
Speaker 1: actually have the resources just to do epidemiology and ethnography research.

277
00:16:37,560 --> 00:16:40,880
Speaker 1: We need to help develop medications. We need to develop

278
00:16:41,000 --> 00:16:44,880
Speaker 1: models that will ensure that individuals that need care will

279
00:16:44,920 --> 00:16:48,800
Speaker 1: be given care. We need to actually develop models for

280
00:16:48,960 --> 00:16:53,640
Speaker 1: prevention of relapses, for prevention into drug taking. It's not

281
00:16:53,760 --> 00:16:57,720
Speaker 1: just one thing that we can allocate all of our resources.

282
00:16:57,760 --> 00:17:00,280
Speaker 1: It is crucial that we understand the age share of

283
00:17:00,280 --> 00:17:03,160
Speaker 1: the problem. And it's also crucial in that respect that

284
00:17:03,200 --> 00:17:07,159
Speaker 1: with partner with other agencies so that we maximize the

285
00:17:07,320 --> 00:17:10,879
Speaker 1: resources and we can achieve more. And they're speaking about

286
00:17:10,920 --> 00:17:14,159
Speaker 1: something that is very very intriguing, and it's an area

287
00:17:14,280 --> 00:17:17,439
Speaker 1: that has been not thought much at and and so

288
00:17:17,480 --> 00:17:19,480
Speaker 1: I'm curious that you asked me about it, which is

289
00:17:19,520 --> 00:17:23,399
Speaker 1: the notion about the dealers. How do that dealers end

290
00:17:23,520 --> 00:17:27,080
Speaker 1: up dealing with these very dangerous strokes And that is

291
00:17:27,080 --> 00:17:31,080
Speaker 1: is something that we don't have research into that area.

292
00:17:31,359 --> 00:17:33,359
Speaker 1: It would be a great thing to solicit proposal for

293
00:17:33,560 --> 00:17:36,760
Speaker 1: because quite frankly, whether or not the lowest level retail

294
00:17:36,800 --> 00:17:39,879
Speaker 1: suppliers um actually know what's in their drugs and what

295
00:17:40,000 --> 00:17:42,800
Speaker 1: precautions they take and what's going on in that dynamic

296
00:17:43,080 --> 00:17:47,200
Speaker 1: would be fantastically valuable giving the amount of accidental overdose

297
00:17:47,240 --> 00:17:52,639
Speaker 1: that's happening right now. We'll be talking more after we

298
00:17:52,760 --> 00:18:04,040
Speaker 1: hear this add You know, I saw recently that you

299
00:18:04,080 --> 00:18:07,920
Speaker 1: wrote a piece in which you said you supported drug decriminalization,

300
00:18:08,240 --> 00:18:10,520
Speaker 1: and I know you've never been a fan of the

301
00:18:10,560 --> 00:18:13,600
Speaker 1: War on drugs. But here you've been operating in a

302
00:18:13,680 --> 00:18:19,560
Speaker 1: political context in which punitive prohibitionist policies, mass arrests, you know,

303
00:18:19,600 --> 00:18:22,040
Speaker 1: the heavily racial biases that go with all of that

304
00:18:22,240 --> 00:18:26,600
Speaker 1: has been pervasive. Now, one of the other criticisms has been,

305
00:18:26,640 --> 00:18:29,919
Speaker 1: you know, they're always looking for what's wrong with drugs,

306
00:18:29,920 --> 00:18:33,440
Speaker 1: but what about what's wrong with drug policies. I'm gonna

307
00:18:33,440 --> 00:18:35,520
Speaker 1: taking example. I'll see you write an article about all

308
00:18:35,560 --> 00:18:38,480
Speaker 1: the harmful consequences of marijuana, right, and we can agree

309
00:18:38,480 --> 00:18:41,240
Speaker 1: that one has to identify the harmful consum marijuana. But

310
00:18:41,480 --> 00:18:43,800
Speaker 1: there's nothing coming out of nightA that I'm aware of

311
00:18:43,800 --> 00:18:46,960
Speaker 1: that's looking at the harmful consequences of marijuana arrest or

312
00:18:47,000 --> 00:18:50,560
Speaker 1: marijuana related loss of employment, or even from a health context.

313
00:18:50,720 --> 00:18:53,920
Speaker 1: When you put somebody in jail for marijuana or arrest them,

314
00:18:53,960 --> 00:18:56,600
Speaker 1: restript them of the job, that has consequences for their

315
00:18:56,600 --> 00:18:59,360
Speaker 1: broader life. It also can be traumatic and cause things

316
00:18:59,440 --> 00:19:02,360
Speaker 1: that might impacked their brains in ways like that. So

317
00:19:02,480 --> 00:19:06,119
Speaker 1: what has been the resistance to this? Isn't that important?

318
00:19:06,280 --> 00:19:09,080
Speaker 1: I mean? And if not, you whop you know? And

319
00:19:09,160 --> 00:19:12,480
Speaker 1: it's crucial And I basically from day one. I've been

320
00:19:12,560 --> 00:19:15,719
Speaker 1: against criminalization of people that because they have a problem

321
00:19:15,720 --> 00:19:19,040
Speaker 1: with substantious disorders. I've been very, very vocal. We found

322
00:19:19,040 --> 00:19:23,320
Speaker 1: that research to show how negative the consequences are of

323
00:19:23,440 --> 00:19:27,439
Speaker 1: imprisonment into the brain. It actually increases the risk of

324
00:19:27,840 --> 00:19:31,960
Speaker 1: drop taking and it basically also increases right now even

325
00:19:32,000 --> 00:19:34,639
Speaker 1: more than before when it was known that risk for

326
00:19:34,840 --> 00:19:38,639
Speaker 1: overdosing and dying. A very important project that we have

327
00:19:38,720 --> 00:19:41,080
Speaker 1: been doing now for year years and now we've actually

328
00:19:41,080 --> 00:19:44,320
Speaker 1: expanded because we got extra resources, is with a criminal

329
00:19:44,400 --> 00:19:49,479
Speaker 1: justice setting exactly to provide alternative models that will ensure

330
00:19:49,960 --> 00:19:52,439
Speaker 1: that people, if for whatever reason first of all end

331
00:19:52,520 --> 00:19:55,359
Speaker 1: up in jail on prison, that they get treatment and

332
00:19:55,400 --> 00:19:59,440
Speaker 1: that they get support, and also to determine how one

333
00:19:59,600 --> 00:20:04,199
Speaker 1: can intervene to avoid that incarceration. We have funded research

334
00:20:04,280 --> 00:20:08,120
Speaker 1: showing that, as you mentioned, when you have a relative

335
00:20:08,160 --> 00:20:11,080
Speaker 1: of father and mother that ends up in jail or prison,

336
00:20:11,160 --> 00:20:13,000
Speaker 1: the risk of the child to have a substance to

337
00:20:13,080 --> 00:20:15,440
Speaker 1: use this order is much greater, and that is known

338
00:20:15,520 --> 00:20:19,439
Speaker 1: and no one is questioning it. So we've been trying

339
00:20:19,480 --> 00:20:22,240
Speaker 1: to disseminate this information. And when I am I have

340
00:20:22,359 --> 00:20:25,000
Speaker 1: to actually speak in Congress or the Senate. I bring

341
00:20:25,160 --> 00:20:28,080
Speaker 1: up this issue because I feel very very strongly, and

342
00:20:28,119 --> 00:20:29,720
Speaker 1: in fact, one of the reasons why I took this

343
00:20:29,840 --> 00:20:33,439
Speaker 1: position was because I say we can develop the science

344
00:20:33,480 --> 00:20:36,520
Speaker 1: in such a way as that that policy changes. I've

345
00:20:36,520 --> 00:20:41,159
Speaker 1: also been openly active criticizing the policy of incarcerating for

346
00:20:41,240 --> 00:20:45,720
Speaker 1: crack versus cocaine, which made absolutely no sense, and there's

347
00:20:45,760 --> 00:20:50,240
Speaker 1: record on those things. The issue comes about, I mean

348
00:20:50,359 --> 00:20:53,719
Speaker 1: that there are structural systems in such a way that

349
00:20:53,800 --> 00:20:58,919
Speaker 1: promotes certain behaviors, and science as not enough to change

350
00:20:58,920 --> 00:21:02,080
Speaker 1: those policies. So my question that I always say is

351
00:21:02,080 --> 00:21:05,600
Speaker 1: what is it that science cannot cover to change policies

352
00:21:05,880 --> 00:21:09,119
Speaker 1: that would get rid of these structural characteristics that are

353
00:21:09,200 --> 00:21:12,760
Speaker 1: leading to these inequalities. And we are very much interested,

354
00:21:12,800 --> 00:21:16,760
Speaker 1: for example, in policies. We found several researchers to identify

355
00:21:17,040 --> 00:21:21,520
Speaker 1: policies across the states as on how they are legalizing marijuana,

356
00:21:21,920 --> 00:21:24,320
Speaker 1: because as you look through the states, for example, you

357
00:21:24,400 --> 00:21:29,080
Speaker 1: see that the adverse effects of marijuana use are much

358
00:21:29,119 --> 00:21:32,240
Speaker 1: worse in some states, whereas other states that have legalized

359
00:21:32,280 --> 00:21:39,200
Speaker 1: actually have better outcomes. So understanding what policies basically protect

360
00:21:39,240 --> 00:21:43,440
Speaker 1: from negative effects and may actually lead to better outcomes,

361
00:21:43,480 --> 00:21:46,000
Speaker 1: it's crucial and we're funding it. So yes, the answer

362
00:21:46,080 --> 00:21:48,880
Speaker 1: is yes. Yeah. There's one issue I think, going back

363
00:21:48,920 --> 00:21:50,760
Speaker 1: a number of years ago, where if I pat myself

364
00:21:50,760 --> 00:21:52,800
Speaker 1: on the back, I think I was more right than

365
00:21:52,800 --> 00:21:54,760
Speaker 1: you were, which is people were saying, if you're gonna

366
00:21:54,800 --> 00:21:58,720
Speaker 1: legalize marijuana, you're gonna see this explosion in adolescent usaid

367
00:21:58,720 --> 00:22:00,840
Speaker 1: mari juana and problematic use. And I think you were

368
00:22:00,880 --> 00:22:02,840
Speaker 1: part of that group saying that. And what hit me

369
00:22:02,880 --> 00:22:04,800
Speaker 1: at the time, you know this is back six seven

370
00:22:04,880 --> 00:22:08,600
Speaker 1: years ago, was that adolescents have for fifty years always

371
00:22:08,640 --> 00:22:11,080
Speaker 1: had the best access to marijuana. Right, even as mari

372
00:22:11,119 --> 00:22:12,879
Speaker 1: wanna use among adolescents has gone up and down the

373
00:22:13,000 --> 00:22:16,520
Speaker 1: ust fifty years, the surveys that ask about access consistently

374
00:22:16,520 --> 00:22:19,000
Speaker 1: show eighty percent of high school seniors saying they have

375
00:22:19,080 --> 00:22:22,320
Speaker 1: easy access. So my sense was that marijuana use among

376
00:22:22,359 --> 00:22:25,360
Speaker 1: adolescents was not going to change much as a result,

377
00:22:25,720 --> 00:22:28,440
Speaker 1: for the simple reason that access was already so abundant,

378
00:22:28,640 --> 00:22:30,639
Speaker 1: but that where you were going to see the jump

379
00:22:30,880 --> 00:22:33,240
Speaker 1: was going to be among people our age and a

380
00:22:33,240 --> 00:22:35,800
Speaker 1: little older and a little younger people using it because

381
00:22:35,800 --> 00:22:38,560
Speaker 1: they preferred it to alcohol or pharmaceuticals. And in point

382
00:22:38,560 --> 00:22:40,159
Speaker 1: of fact, it looks like there's been a tripling or

383
00:22:40,200 --> 00:22:43,440
Speaker 1: quadrupling of marijuana use among people you know, our age

384
00:22:43,480 --> 00:22:48,280
Speaker 1: or older um, whereas the adolescents have stayed relatively constant.

385
00:22:48,480 --> 00:22:50,280
Speaker 1: And my job, I wouldn't be surprised if he jumps

386
00:22:50,280 --> 00:22:52,560
Speaker 1: in the future. Part of the other research I think

387
00:22:52,640 --> 00:22:55,960
Speaker 1: suggests that use of drugs oftentimes goes up and down

388
00:22:56,480 --> 00:22:59,560
Speaker 1: independent of what the policy is. There's a whole range

389
00:22:59,560 --> 00:23:02,200
Speaker 1: of other variables out there. And I guess when my

390
00:23:02,320 --> 00:23:05,000
Speaker 1: question now comes to you is when you write a

391
00:23:05,000 --> 00:23:08,320
Speaker 1: piece about the harms of marijuana, why not write a

392
00:23:08,320 --> 00:23:11,720
Speaker 1: piece about the benefits? What about a piece about the

393
00:23:11,760 --> 00:23:14,320
Speaker 1: controlled juice? What about one piece that looks at it all.

394
00:23:14,720 --> 00:23:17,400
Speaker 1: You know, many people were so frustrated that NITA did

395
00:23:17,440 --> 00:23:20,760
Speaker 1: not support the medical marijuana research. It took forever and

396
00:23:20,800 --> 00:23:22,520
Speaker 1: ever and ever. Or you look at the fact that

397
00:23:22,600 --> 00:23:25,440
Speaker 1: the vast majority people use marijuana don't really have a problem.

398
00:23:25,440 --> 00:23:28,240
Speaker 1: It is clearly problematic and even addictive for some, and

399
00:23:28,400 --> 00:23:30,280
Speaker 1: we have to be aware of that. But why not

400
00:23:30,400 --> 00:23:34,280
Speaker 1: have a more holistic, comprehensive approach to Let's just take

401
00:23:34,320 --> 00:23:37,119
Speaker 1: the drug marijuana as one example, yeah, no, and I

402
00:23:37,160 --> 00:23:40,000
Speaker 1: think that one of the reasons why is because the

403
00:23:40,440 --> 00:23:43,480
Speaker 1: data on the benefit from marijuana is very limited, and

404
00:23:43,560 --> 00:23:47,280
Speaker 1: it is very limited because there is limited research. And

405
00:23:47,320 --> 00:23:49,720
Speaker 1: so one of the things that I have been involved

406
00:23:49,760 --> 00:23:52,640
Speaker 1: now for more than a decade, and I must say

407
00:23:52,640 --> 00:23:55,840
Speaker 1: that I have been unsuccessful, is to stry to change

408
00:23:55,840 --> 00:23:58,800
Speaker 1: the policies that make it so very difficult for researchers

409
00:23:58,840 --> 00:24:01,960
Speaker 1: to have marijuana. So marijuana is a scalle one draw.

410
00:24:02,280 --> 00:24:04,440
Speaker 1: So if you, as a researcher want to do work

411
00:24:04,480 --> 00:24:07,600
Speaker 1: with marijuana, you have to get a d A license

412
00:24:08,000 --> 00:24:11,280
Speaker 1: and get approval from the FDA, and that takes at

413
00:24:11,359 --> 00:24:14,040
Speaker 1: least one year, and then if you change your protocol,

414
00:24:14,080 --> 00:24:16,200
Speaker 1: you have to go through the process again. So it's

415
00:24:16,240 --> 00:24:20,160
Speaker 1: extraordinary comberson and as a result of that, researchers don't

416
00:24:20,160 --> 00:24:23,439
Speaker 1: want to get into the field. That's one second. We

417
00:24:23,480 --> 00:24:27,280
Speaker 1: are also mandated, actually this is not my choice. We

418
00:24:27,359 --> 00:24:32,679
Speaker 1: are mandated to provide the marijuana for research purposes, and

419
00:24:32,760 --> 00:24:36,639
Speaker 1: so we contract these to a farm in Mississippi that

420
00:24:36,680 --> 00:24:40,560
Speaker 1: produces the marijuana. But this system is actually not ideal

421
00:24:40,760 --> 00:24:43,560
Speaker 1: because when you are testing a marijuana, say, for example,

422
00:24:43,560 --> 00:24:47,240
Speaker 1: you're interested on its potential value, for PTSD or for cancer,

423
00:24:47,280 --> 00:24:49,959
Speaker 1: for whatever you want, you are going to be working

424
00:24:50,000 --> 00:24:53,199
Speaker 1: with a particular plant, and it's unlikely that we have

425
00:24:53,320 --> 00:24:57,320
Speaker 1: such a plant, so it has hinder research. And I

426
00:24:57,320 --> 00:25:01,080
Speaker 1: think it was last week that finally that government has

427
00:25:01,200 --> 00:25:07,000
Speaker 1: identified to other producers that can provide marijuana, and if

428
00:25:07,040 --> 00:25:11,159
Speaker 1: that happens, of course that will facilitate the research into

429
00:25:11,280 --> 00:25:15,080
Speaker 1: the medical use of cannabis. I also want to comment

430
00:25:15,200 --> 00:25:19,800
Speaker 1: that neither those fund research on medical marijuana, but we

431
00:25:19,920 --> 00:25:24,479
Speaker 1: limited to potential beneficial effect for treatment of addiction, for

432
00:25:24,520 --> 00:25:28,960
Speaker 1: treatment of pain, and for treatment improving outcomes from the

433
00:25:29,000 --> 00:25:32,080
Speaker 1: individuals that may have HIV. So we limited to risk

434
00:25:32,359 --> 00:25:35,800
Speaker 1: conditions because otherwise all of our money would go into

435
00:25:35,920 --> 00:25:39,199
Speaker 1: research on medical properties of marijuana for US skimmers, for

436
00:25:39,240 --> 00:25:43,560
Speaker 1: carter aspolarisis for inflammation. We are hoping that the other

437
00:25:43,600 --> 00:25:48,000
Speaker 1: institutes will take those projects that pertains to the diseases

438
00:25:48,040 --> 00:25:50,639
Speaker 1: that they are working on. And you were right. I

439
00:25:50,800 --> 00:25:53,840
Speaker 1: was expecting that use of my juana mo cadolescens would

440
00:25:53,880 --> 00:25:56,800
Speaker 1: go up, and overall it hasn't. But what we are

441
00:25:56,840 --> 00:25:59,320
Speaker 1: starting to see, which is again important to keep an

442
00:25:59,320 --> 00:26:02,399
Speaker 1: eye on, is that regular use of marijuana appears to

443
00:26:02,440 --> 00:26:05,159
Speaker 1: be going up among other lessons, and that's that's of

444
00:26:05,200 --> 00:26:08,160
Speaker 1: course of concern. Yeah, nor you know, I so much

445
00:26:08,160 --> 00:26:11,600
Speaker 1: share your concern that with legalization that marijuana almost becoming

446
00:26:12,000 --> 00:26:14,520
Speaker 1: overly normalized in the way that people begin to sort

447
00:26:14,520 --> 00:26:16,480
Speaker 1: of lose its specialness and use it in ways that

448
00:26:16,520 --> 00:26:19,399
Speaker 1: are problematic. So we share some overlap there. But you

449
00:26:19,440 --> 00:26:22,480
Speaker 1: know you mentioned the Schedule one thing. You know, there

450
00:26:22,480 --> 00:26:24,639
Speaker 1: were lawsuits some years ago to try to get the

451
00:26:24,720 --> 00:26:28,040
Speaker 1: d A to reschedule marijuana from Schedule one to Schedule two,

452
00:26:28,080 --> 00:26:30,520
Speaker 1: and another lawsuit reguarding m d m A, And in

453
00:26:30,560 --> 00:26:33,399
Speaker 1: both cases the d AS administrative law judge ruled that

454
00:26:33,520 --> 00:26:35,880
Speaker 1: in fact, based on the evidence, it should be rescheduled.

455
00:26:36,200 --> 00:26:37,919
Speaker 1: But under U S Law, the head of the d

456
00:26:38,000 --> 00:26:41,360
Speaker 1: e A has a legal power to dismiss the recommendation

457
00:26:41,440 --> 00:26:43,560
Speaker 1: by his administrative law judge and just keep it where

458
00:26:43,600 --> 00:26:45,840
Speaker 1: it is now. I'm curious, I mean, do you think

459
00:26:45,920 --> 00:26:48,600
Speaker 1: it's appropriate for a police agency like d e A

460
00:26:48,720 --> 00:26:51,800
Speaker 1: to be control of that. Shouldn't it instead be national

461
00:26:51,800 --> 00:26:53,639
Speaker 1: in stuite of health for me to be even better

462
00:26:53,680 --> 00:26:56,639
Speaker 1: and independent body like Institute of Medicine at the National

463
00:26:56,640 --> 00:26:59,280
Speaker 1: Academies of Science. Well, I mean, I think that, in

464
00:26:59,640 --> 00:27:01,520
Speaker 1: my view, is not what I think. I mean, it's

465
00:27:01,520 --> 00:27:04,320
Speaker 1: the way that this system is organized. What I can

466
00:27:04,400 --> 00:27:08,679
Speaker 1: tell you is a very specifically explicitly describe this as

467
00:27:08,720 --> 00:27:10,720
Speaker 1: a problem in the meetings that I have at the

468
00:27:10,800 --> 00:27:15,119
Speaker 1: United Nations to state that the scandaling has made it

469
00:27:15,200 --> 00:27:19,239
Speaker 1: hard to do research, which is impedding again, investigations that

470
00:27:19,320 --> 00:27:23,440
Speaker 1: relate to the potential medical utility of cannabinoids that are

471
00:27:23,480 --> 00:27:27,360
Speaker 1: in marijuana. So I represent the science, and there are

472
00:27:27,400 --> 00:27:31,159
Speaker 1: other people that make the rules about regulations and and

473
00:27:31,200 --> 00:27:35,200
Speaker 1: that's what the missions of the agencies are. So yeah,

474
00:27:35,320 --> 00:27:37,160
Speaker 1: now I hear you, But you know, I was thinking

475
00:27:37,160 --> 00:27:40,560
Speaker 1: about this. There is only one other person I can

476
00:27:40,600 --> 00:27:43,919
Speaker 1: think of who has headed a drug related agency in

477
00:27:43,920 --> 00:27:46,480
Speaker 1: the federal government for longer than you. Right, You're the

478
00:27:46,520 --> 00:27:49,119
Speaker 1: longest at NIDA, You're the longest d e A, the

479
00:27:49,160 --> 00:27:50,560
Speaker 1: only one I can think of. It. It's not putting

480
00:27:50,560 --> 00:27:52,080
Speaker 1: you in I don't want to put you in bad company.

481
00:27:52,119 --> 00:27:54,480
Speaker 1: You're goill be Harry Anslinger, right, the guy around the

482
00:27:54,480 --> 00:27:57,439
Speaker 1: thorough Vieau of narcotics for like thirty two years or

483
00:27:57,440 --> 00:27:59,879
Speaker 1: something like that. But you are in a position of

484
00:28:00,080 --> 00:28:03,359
Speaker 1: tremendous influence by virtue of your tenure, and I have

485
00:28:03,440 --> 00:28:05,959
Speaker 1: to ask you this question, and as frankly as you

486
00:28:05,960 --> 00:28:09,240
Speaker 1: can answer it, I'd be curious. You came in under

487
00:28:09,280 --> 00:28:12,440
Speaker 1: President Bush in two thousand and three when the drugs

488
00:28:12,480 --> 00:28:16,719
Speaker 1: are John Walters was a fanatical anti drug guy. I

489
00:28:16,760 --> 00:28:19,399
Speaker 1: saw some of your testimony in front of that congressman

490
00:28:19,440 --> 00:28:22,600
Speaker 1: Mark Suitor, I mean, real drug ward nutcases, and I

491
00:28:22,600 --> 00:28:24,439
Speaker 1: admired the fact that you were telling him what the

492
00:28:24,440 --> 00:28:27,399
Speaker 1: evidence was on needle exchange. And then you go under

493
00:28:27,440 --> 00:28:30,360
Speaker 1: Obama and things open up, especially in the second term,

494
00:28:30,440 --> 00:28:33,640
Speaker 1: and then you're dealing with Trump and the first head

495
00:28:33,680 --> 00:28:36,520
Speaker 1: of Health and Human Services, your boss, I guess twice removed,

496
00:28:36,720 --> 00:28:38,760
Speaker 1: who like doesn't know his asked from his elbow about

497
00:28:38,760 --> 00:28:41,640
Speaker 1: method on and now under Biden, where things are opening

498
00:28:41,720 --> 00:28:45,720
Speaker 1: up somewhat. Can you say anything, frankly about what it's

499
00:28:45,760 --> 00:28:49,320
Speaker 1: like to deal with that political context, especially at the

500
00:28:49,360 --> 00:28:53,720
Speaker 1: federal level. Well, I've always spoken up, and I've said

501
00:28:53,760 --> 00:28:58,000
Speaker 1: it very specifically. We are an agency of science and

502
00:28:58,080 --> 00:29:00,320
Speaker 1: we need to be allowed to do science. Let the

503
00:29:00,360 --> 00:29:05,200
Speaker 1: evidence speak. The moment that our actions become politicized, we

504
00:29:05,360 --> 00:29:10,640
Speaker 1: lose any credibility. Obviously in some instances it maybe you

505
00:29:10,800 --> 00:29:14,360
Speaker 1: just have to be a little bit more diplomatic on

506
00:29:14,400 --> 00:29:16,680
Speaker 1: the way that you present these things. But I do

507
00:29:17,080 --> 00:29:20,239
Speaker 1: believe that that is our job, that's our responsibility. We

508
00:29:20,320 --> 00:29:23,320
Speaker 1: need to bring the science that can help guide decisions,

509
00:29:23,320 --> 00:29:26,000
Speaker 1: because if we don't do it, then we shouldn't be

510
00:29:26,040 --> 00:29:29,320
Speaker 1: in these positions. Well, okay, so let me repeat to

511
00:29:29,360 --> 00:29:32,520
Speaker 1: you something I've been saying since the nineties, and and

512
00:29:32,640 --> 00:29:34,640
Speaker 1: you know, please don't take offense at it, but it

513
00:29:34,720 --> 00:29:37,640
Speaker 1: was kind of my broader perspective on this thing. And

514
00:29:37,680 --> 00:29:39,560
Speaker 1: I don't think it's as true today as it was then,

515
00:29:39,600 --> 00:29:41,720
Speaker 1: but I still think there's truth to it. I would

516
00:29:41,760 --> 00:29:44,680
Speaker 1: say they're trying to do innovative drug abuse research in

517
00:29:44,680 --> 00:29:47,040
Speaker 1: the United States is a little like trying to do

518
00:29:47,080 --> 00:29:50,840
Speaker 1: innovative social science research in the old Soviet Union. That

519
00:29:51,000 --> 00:29:54,360
Speaker 1: curious researchers quickly learned that there are certain questions the

520
00:29:54,400 --> 00:29:57,400
Speaker 1: authorities don't want to have asked and certain answers they

521
00:29:57,440 --> 00:29:59,920
Speaker 1: don't want to have given. And then if you persis

522
00:30:00,000 --> 00:30:03,200
Speaker 1: often asking the wrong questions, you're giving the wrong answers. Well,

523
00:30:03,240 --> 00:30:06,360
Speaker 1: you're less likely to have your grants fundedge, you're less

524
00:30:06,360 --> 00:30:08,760
Speaker 1: likely to be asked to serve on grant review committees,

525
00:30:08,760 --> 00:30:11,640
Speaker 1: you're more likely to have your publications or things sent

526
00:30:11,720 --> 00:30:15,920
Speaker 1: to hostile reviewers. And what happens then is that many researches,

527
00:30:16,040 --> 00:30:20,720
Speaker 1: especially in the hard scientists, basically developed, you know, political blinders,

528
00:30:20,760 --> 00:30:24,880
Speaker 1: and that over time those political blinders become intellectual blinders

529
00:30:24,880 --> 00:30:27,440
Speaker 1: where they even forget to really ask some of the

530
00:30:27,440 --> 00:30:30,400
Speaker 1: most interesting questions that might happen. And so then I

531
00:30:30,440 --> 00:30:32,280
Speaker 1: asked people in the U S what does it feel like,

532
00:30:32,560 --> 00:30:35,520
Speaker 1: and they'll say, well, you know, Ethan, I'd say, we

533
00:30:35,520 --> 00:30:39,400
Speaker 1: were constantly advised by night A grant officers until maybe

534
00:30:39,400 --> 00:30:42,440
Speaker 1: around Obama's second term not to use the phrase harm

535
00:30:42,440 --> 00:30:45,880
Speaker 1: reduction and our grand proposals. Um we are even now

536
00:30:46,080 --> 00:30:49,240
Speaker 1: don't use the words control drug use and a grand proposal,

537
00:30:49,360 --> 00:30:52,160
Speaker 1: or it's just gonna say forget it. If I ask,

538
00:30:52,240 --> 00:30:55,040
Speaker 1: why isn't night OF funding research on the prescribing of

539
00:30:55,080 --> 00:30:58,880
Speaker 1: pharmaceutical heroin the way the Europeans are, or safe injection sites,

540
00:30:59,000 --> 00:31:01,640
Speaker 1: or a whole range of other things. And there don't

541
00:31:01,680 --> 00:31:04,680
Speaker 1: seem to be any good scientific reasons for not funding

542
00:31:04,680 --> 00:31:08,400
Speaker 1: that stuff. It seems to be about a political context

543
00:31:08,840 --> 00:31:12,920
Speaker 1: in which funding for this stuff is politically disapproved, and

544
00:31:12,960 --> 00:31:15,520
Speaker 1: that even if the people in your agency or yourself

545
00:31:15,520 --> 00:31:18,800
Speaker 1: approve of it, there's a realization that members of Congress,

546
00:31:18,920 --> 00:31:21,200
Speaker 1: you know, could get furious for funding things like this.

547
00:31:21,680 --> 00:31:24,040
Speaker 1: So what's your frankisty answer to all of that? My

548
00:31:24,120 --> 00:31:27,320
Speaker 1: Branco law answer to this is absolutely there were certain

549
00:31:27,440 --> 00:31:29,360
Speaker 1: terms that when you have it in the grand we

550
00:31:29,400 --> 00:31:32,440
Speaker 1: would be questioned about why we were founding science and

551
00:31:32,520 --> 00:31:35,880
Speaker 1: sort and such a subject matter. So my perspective was,

552
00:31:36,000 --> 00:31:39,840
Speaker 1: as you cannot go into an argument like that openly

553
00:31:39,960 --> 00:31:43,360
Speaker 1: when the arguments are so irrational, So you just change

554
00:31:43,480 --> 00:31:46,640
Speaker 1: that terminology is used, so you don't use carm reduction,

555
00:31:46,720 --> 00:31:48,960
Speaker 1: use other terms. I mean, again, we need to have

556
00:31:49,040 --> 00:31:51,480
Speaker 1: flexibility in our brains to accomplish what is it that

557
00:31:51,600 --> 00:31:55,360
Speaker 1: we want to accomplish. We want science that can bring

558
00:31:55,560 --> 00:31:58,520
Speaker 1: up actions that can improve It's not just because it

559
00:31:58,680 --> 00:32:02,600
Speaker 1: is academically interesting. So if I can keep on funding

560
00:32:02,640 --> 00:32:06,959
Speaker 1: things without having them come in and and removing asking

561
00:32:07,040 --> 00:32:11,240
Speaker 1: us to cut the funding by changing the terminology, what

562
00:32:11,320 --> 00:32:13,640
Speaker 1: do I lose? I mean, it is again, what battles

563
00:32:13,640 --> 00:32:15,280
Speaker 1: do you want to do? Right? I mean? And I

564
00:32:15,320 --> 00:32:20,760
Speaker 1: certainly I do navigate that they are tremendous prejudices as

565
00:32:20,800 --> 00:32:25,800
Speaker 1: still and tremendous stigmatization against addiction and its treatments. And

566
00:32:25,920 --> 00:32:30,400
Speaker 1: so my job is how within this environment and we

567
00:32:30,440 --> 00:32:34,640
Speaker 1: continue doing the work to minimize actually negative effects. Now

568
00:32:34,680 --> 00:32:37,320
Speaker 1: you're bringing something because of course I think about these things.

569
00:32:37,320 --> 00:32:40,920
Speaker 1: I mean sort of actually in terms of the Europeans

570
00:32:41,000 --> 00:32:44,840
Speaker 1: have been using high doses of morphine to treat people

571
00:32:44,920 --> 00:32:48,520
Speaker 1: that actually are not responding to other treatments of heroin

572
00:32:48,600 --> 00:32:51,400
Speaker 1: and those we've looked into that and one of the

573
00:32:51,440 --> 00:32:54,640
Speaker 1: reasons why it was not it did not make sense

574
00:32:54,680 --> 00:32:56,840
Speaker 1: for us at that time definitively on the basis of

575
00:32:56,880 --> 00:32:59,080
Speaker 1: the analysis to bring that as a treatment that could

576
00:32:59,120 --> 00:33:02,080
Speaker 1: be tested in the at that states. It was much

577
00:33:02,320 --> 00:33:06,520
Speaker 1: more consuming in resources to set up those injection sides.

578
00:33:06,560 --> 00:33:09,120
Speaker 1: And also the other problem with it is that patients

579
00:33:09,200 --> 00:33:13,080
Speaker 1: were developing arrhythmias with these guy doses of heroin, so

580
00:33:13,120 --> 00:33:16,040
Speaker 1: they were not so benign. And as it relates to

581
00:33:16,400 --> 00:33:19,920
Speaker 1: m safe injection sides, I mean, we've been not directly

582
00:33:20,000 --> 00:33:23,520
Speaker 1: funding the research on the safe injection sides, but we've

583
00:33:23,560 --> 00:33:28,560
Speaker 1: been funding the researchers that are doing that work to

584
00:33:28,840 --> 00:33:33,800
Speaker 1: understand downstream how these support systems as a community can

585
00:33:33,920 --> 00:33:36,920
Speaker 1: help people, for example, engage in treatment, how they can

586
00:33:37,000 --> 00:33:40,320
Speaker 1: prevent them from getting infected from HIV, and how they

587
00:33:40,360 --> 00:33:44,320
Speaker 1: can prevent them from overdosing and time. But let me

588
00:33:44,400 --> 00:33:46,880
Speaker 1: just ask you, I mean, just take example, the Heroin

589
00:33:46,920 --> 00:33:49,320
Speaker 1: maintenance thing, you know, back actually before your time, in

590
00:33:49,360 --> 00:33:52,000
Speaker 1: the late nineties, I pulled together a group of researchers

591
00:33:52,040 --> 00:33:54,560
Speaker 1: from the US and Canada and the Europeans who are

592
00:33:54,560 --> 00:33:57,280
Speaker 1: all interested in getting trials going on in North America.

593
00:33:57,600 --> 00:34:00,760
Speaker 1: We called it NAOMI, the North American OPI Medica Asian Initiative.

594
00:34:01,000 --> 00:34:03,520
Speaker 1: And what happened was that the Canadian leg took off

595
00:34:03,640 --> 00:34:05,280
Speaker 1: and they actually did it, and they now have it

596
00:34:05,320 --> 00:34:07,600
Speaker 1: in many cities in Canada, and you now see it

597
00:34:07,600 --> 00:34:10,600
Speaker 1: in many countries in Europe, and it is proving overwhelming successful.

598
00:34:10,600 --> 00:34:13,000
Speaker 1: It's not perfect, as you said, there are some problems resulting,

599
00:34:13,160 --> 00:34:16,000
Speaker 1: but it's reduced crime, reduced over those, reduced problems of addiction,

600
00:34:16,080 --> 00:34:18,319
Speaker 1: all this sort of stuff. But in the US, what

601
00:34:18,440 --> 00:34:20,759
Speaker 1: happened was the researchers said, Ethan, we're never going to

602
00:34:20,840 --> 00:34:23,360
Speaker 1: be able to get the funding. And even more recently,

603
00:34:23,400 --> 00:34:26,080
Speaker 1: the last meeting I had organized before I left Drug

604
00:34:26,120 --> 00:34:27,880
Speaker 1: Policy Lines four years ago it was a meeting to

605
00:34:27,880 --> 00:34:31,600
Speaker 1: bring together a younger generation of researchers, and people are saying, well,

606
00:34:31,680 --> 00:34:33,759
Speaker 1: why can't we at least give it a shot here,

607
00:34:34,080 --> 00:34:37,120
Speaker 1: or even if we don't use heroin pharmaceutical heroin, why

608
00:34:37,160 --> 00:34:39,879
Speaker 1: not use hydromorphone. You know, delouded, right, a drug that's

609
00:34:39,920 --> 00:34:42,560
Speaker 1: given out in American hospitals two hundreds of thousands of people.

610
00:34:42,960 --> 00:34:45,719
Speaker 1: We know from control double blind studies that long term

611
00:34:45,719 --> 00:34:50,200
Speaker 1: heroin attics can't tell the difference between delouded hydromorphone and heroin.

612
00:34:50,600 --> 00:34:53,640
Speaker 1: And then the public value benefit, which I mean part

613
00:34:53,640 --> 00:34:55,640
Speaker 1: of what happened in Europe was they started doing these

614
00:34:55,680 --> 00:34:59,080
Speaker 1: things and it helped transform people's understanding of heroin and

615
00:34:59,120 --> 00:35:02,160
Speaker 1: addiction that you meanize it. Rather than people being these

616
00:35:02,280 --> 00:35:05,759
Speaker 1: junkies chasing this dirty drug, people began to realize that

617
00:35:05,800 --> 00:35:08,319
Speaker 1: the drug itself was not as dangerous and it was

618
00:35:08,360 --> 00:35:10,920
Speaker 1: more the fact that it was illegal. So it seemed

619
00:35:10,960 --> 00:35:14,520
Speaker 1: that some allocation of nita's resource is something like this

620
00:35:15,000 --> 00:35:17,879
Speaker 1: would be usually advantageous. And I know when I talked

621
00:35:17,880 --> 00:35:20,040
Speaker 1: to mayors and police choose around the country, they said, hey,

622
00:35:20,239 --> 00:35:22,640
Speaker 1: as a research study, sure we won't object to it.

623
00:35:23,160 --> 00:35:25,680
Speaker 1: Why not make that a priority, especially given the issues

624
00:35:25,680 --> 00:35:28,279
Speaker 1: with sentinel now and so many people dying. Well, you

625
00:35:28,320 --> 00:35:31,040
Speaker 1: know what has made a gigantic difference, and the data

626
00:35:31,120 --> 00:35:33,080
Speaker 1: is out there, I mean, because this helps a very

627
00:35:33,120 --> 00:35:36,359
Speaker 1: restricted number of people. But what has made a magnificent

628
00:35:36,520 --> 00:35:39,960
Speaker 1: difference in terms of over those mortalities and outcomes is

629
00:35:40,000 --> 00:35:42,680
Speaker 1: what France has done with bupren orphins. So, if we

630
00:35:42,760 --> 00:35:47,239
Speaker 1: have alternative medications that actually are safer and that can

631
00:35:47,360 --> 00:35:50,880
Speaker 1: be deployed, and we're not doing that because the insurance

632
00:35:50,880 --> 00:35:54,319
Speaker 1: companies are not willing to reimburse, my focus is going

633
00:35:54,360 --> 00:35:57,440
Speaker 1: to be on how can I affect practices that are

634
00:35:57,480 --> 00:36:00,239
Speaker 1: likely to have a larger impact. And again, and it's

635
00:36:00,280 --> 00:36:02,239
Speaker 1: the issue of when you don't have all of the

636
00:36:02,320 --> 00:36:06,200
Speaker 1: resources of the world, you have to strategize which are

637
00:36:06,239 --> 00:36:08,560
Speaker 1: the ones that are going to have the largest impact.

638
00:36:08,840 --> 00:36:10,480
Speaker 1: And if you just look at the data in the

639
00:36:10,640 --> 00:36:13,640
Speaker 1: United States, the majority of people that are on treatment

640
00:36:13,680 --> 00:36:16,960
Speaker 1: for opiot disorder are on buoprinorphin. And so right now,

641
00:36:17,040 --> 00:36:22,200
Speaker 1: for example, one of our priorities is to actually expand

642
00:36:22,760 --> 00:36:27,080
Speaker 1: our basically knowledge base on clinical trials for the use

643
00:36:27,080 --> 00:36:31,040
Speaker 1: of booprenorphin on people that are being exposed to fantonil,

644
00:36:31,440 --> 00:36:34,279
Speaker 1: for which there is no clear call evidence about how

645
00:36:34,320 --> 00:36:37,719
Speaker 1: to properly treat them, what doses to use, why not

646
00:36:37,920 --> 00:36:42,120
Speaker 1: use extended formulations, how to initiate them in boopernorphin, and

647
00:36:42,200 --> 00:36:46,880
Speaker 1: also the sustainability of these practices in terms of costs.

648
00:36:46,920 --> 00:36:49,080
Speaker 1: So I see it as you know, there's not enough

649
00:36:49,160 --> 00:36:51,560
Speaker 1: money to be poured into the treatment of people with

650
00:36:51,640 --> 00:36:55,759
Speaker 1: substance use disorder, so trying to come up with models

651
00:36:55,760 --> 00:36:59,600
Speaker 1: that will ensure that the treatment will be provided it's

652
00:36:59,640 --> 00:37:02,680
Speaker 1: also key component. Let's take a break here and go

653
00:37:02,760 --> 00:37:13,880
Speaker 1: to an ad. When I was calling around, one person

654
00:37:13,920 --> 00:37:16,839
Speaker 1: who sang your praises, said that you've been very supportive

655
00:37:17,000 --> 00:37:21,200
Speaker 1: of expanding the access to method on rupernurphine behind bars, right,

656
00:37:21,400 --> 00:37:23,640
Speaker 1: You've been a big advocate that. I remember ten fifteen

657
00:37:23,680 --> 00:37:27,160
Speaker 1: years ago Drug Policy Alliance, we'll be organizing side sessions

658
00:37:27,200 --> 00:37:29,880
Speaker 1: at the annual meetings of American Correctional Association, and it

659
00:37:29,960 --> 00:37:33,239
Speaker 1: was just incredibly difficult to get correctional officials to come

660
00:37:33,239 --> 00:37:35,560
Speaker 1: along with this. And when I asked my friend what

661
00:37:35,640 --> 00:37:38,359
Speaker 1: was most significant about that, he said, you know, what

662
00:37:38,400 --> 00:37:42,000
Speaker 1: we found was that people they appreciate the opportunities you

663
00:37:42,080 --> 00:37:44,600
Speaker 1: just figure out what worked for them. For some, bruperophine

664
00:37:44,680 --> 00:37:46,799
Speaker 1: work better than method on. For others, method on work

665
00:37:46,880 --> 00:37:49,399
Speaker 1: better for some, nel trek Zone was the preferred one,

666
00:37:49,480 --> 00:37:51,600
Speaker 1: you know, for our listeners. The first two of those

667
00:37:51,680 --> 00:37:55,359
Speaker 1: drugs are basically sort of agonists, and there's like giving uh, say,

668
00:37:55,360 --> 00:37:57,839
Speaker 1: a nicotine patch to a cigarette addict, and al trek

669
00:37:57,920 --> 00:38:00,239
Speaker 1: Zone is an antagonist, which you know blocks the dealing

670
00:38:00,320 --> 00:38:02,440
Speaker 1: of these drugs. But it seems like just when we're

671
00:38:02,480 --> 00:38:05,560
Speaker 1: dealing with depression, we tried different antidepressants. When we're trying

672
00:38:05,600 --> 00:38:08,360
Speaker 1: dealing with pain management, we ideally are trying different opio

673
00:38:08,480 --> 00:38:10,879
Speaker 1: s see will work better. It does seem that when

674
00:38:10,920 --> 00:38:13,880
Speaker 1: it comes to dealing with heroin adjection and other illicit

675
00:38:14,000 --> 00:38:17,760
Speaker 1: drug opioid adjection, we should be making as many options

676
00:38:17,800 --> 00:38:20,719
Speaker 1: available as possible. I mean, I mean you basically agree

677
00:38:20,719 --> 00:38:23,439
Speaker 1: with that D percent agree And I use the same

678
00:38:23,480 --> 00:38:27,839
Speaker 1: analogiens as how many antidepressants we have, how many antibiotics

679
00:38:27,960 --> 00:38:29,799
Speaker 1: we have, and we are the only condition for we

680
00:38:29,840 --> 00:38:33,279
Speaker 1: said we have three. That's enough. In many ways, and

681
00:38:33,600 --> 00:38:37,920
Speaker 1: I perhaps shouldn't use this word. We've been very constrained

682
00:38:37,920 --> 00:38:41,000
Speaker 1: in many ways by the need to actually document that

683
00:38:41,040 --> 00:38:44,600
Speaker 1: the medications and the treatment are producing abstinence. And we've

684
00:38:44,640 --> 00:38:48,399
Speaker 1: been knowing that certain treatments, while not producing abstinence, will

685
00:38:48,480 --> 00:38:51,520
Speaker 1: improve the quality of life of people and protect them.

686
00:38:51,840 --> 00:38:54,480
Speaker 1: And so we've been trying to have a dialogue and

687
00:38:54,480 --> 00:38:57,239
Speaker 1: we've had a dialogue with the FDA. This is the

688
00:38:57,280 --> 00:39:00,640
Speaker 1: outcomes that they required to change those outcome so that

689
00:39:00,719 --> 00:39:04,560
Speaker 1: we can allow for treatments that, while not producing abstinence,

690
00:39:04,600 --> 00:39:07,160
Speaker 1: are going to be beneficial for the patients. They are

691
00:39:07,200 --> 00:39:10,400
Speaker 1: willing for us to consider this if we can provide

692
00:39:10,400 --> 00:39:13,640
Speaker 1: them evidence that this is meaningful. So we're funding researchers

693
00:39:13,680 --> 00:39:16,239
Speaker 1: to show this. And so now there is data that

694
00:39:16,320 --> 00:39:20,160
Speaker 1: we indicates, for example, that whooprint orphin or metal or

695
00:39:20,160 --> 00:39:23,320
Speaker 1: other medications, even if they don't produce abstinence, they reduce

696
00:39:23,760 --> 00:39:27,960
Speaker 1: the negative outcomes with HIV, They improve retention into anti

697
00:39:27,960 --> 00:39:31,759
Speaker 1: retroviral therapy, they decrease the likelihood of being incarcerated. So

698
00:39:32,160 --> 00:39:35,399
Speaker 1: these are meaningful consequences to that person. So we are

699
00:39:35,920 --> 00:39:41,279
Speaker 1: again negotiating towards also discussing possible medications that we may

700
00:39:41,320 --> 00:39:44,839
Speaker 1: have tested in the past that we're found nonefications because

701
00:39:44,880 --> 00:39:49,480
Speaker 1: the outcomes was impossible to reach complete abstinence a very,

702
00:39:49,600 --> 00:39:51,920
Speaker 1: very difficult work to achieve, and I think it is

703
00:39:52,480 --> 00:39:56,839
Speaker 1: different from what we demand for antidepressants or for an analgestic.

704
00:39:56,920 --> 00:39:59,920
Speaker 1: You don't demand that the pain become completely you didn

705
00:40:00,040 --> 00:40:03,080
Speaker 1: and a fifteen percent reduction, I mean, so we are

706
00:40:03,800 --> 00:40:07,880
Speaker 1: this has made the development of medications much harder. Uh so,

707
00:40:07,960 --> 00:40:10,080
Speaker 1: I mean you essentially see the dealing with this sort

708
00:40:10,120 --> 00:40:14,760
Speaker 1: of twelve step absinence only ideology has a real challenge

709
00:40:14,760 --> 00:40:16,960
Speaker 1: for you that it really gets in the way of

710
00:40:16,960 --> 00:40:20,719
Speaker 1: effective drug treatment and changing policies. Is that fair to say? Well,

711
00:40:20,760 --> 00:40:23,320
Speaker 1: what I mean, I'm not so categorical in my thinkings.

712
00:40:23,400 --> 00:40:26,520
Speaker 1: I mean, my perspective is recognizing that there is a

713
00:40:26,600 --> 00:40:30,719
Speaker 1: diversity of people and for some individuals that of Step

714
00:40:30,760 --> 00:40:34,759
Speaker 1: programs maybe um life saving, but for many others they

715
00:40:34,800 --> 00:40:38,239
Speaker 1: are not. And so in my perspective, I value that

716
00:40:38,320 --> 00:40:41,720
Speaker 1: all Step programs because I do recognize that they offer

717
00:40:42,160 --> 00:40:46,320
Speaker 1: support for people and have been able to help people recover.

718
00:40:46,440 --> 00:40:49,000
Speaker 1: So why would I be critical of that? What I

719
00:40:49,040 --> 00:40:53,239
Speaker 1: am critical of is their categorical rejection by many of them,

720
00:40:53,400 --> 00:40:56,840
Speaker 1: of the use of medications for treatment of substance use disorders.

721
00:40:57,040 --> 00:41:00,359
Speaker 1: I was actually speaking with a volunteer patient with an

722
00:41:00,360 --> 00:41:04,920
Speaker 1: opiate use disorder who is on boubernorphine and who was

723
00:41:05,160 --> 00:41:08,759
Speaker 1: very much in conflict because he wanted very much to

724
00:41:08,840 --> 00:41:11,359
Speaker 1: be part of the twelve step program, but he didn't

725
00:41:11,400 --> 00:41:14,520
Speaker 1: want to lie to them that he actually was taking

726
00:41:14,520 --> 00:41:17,320
Speaker 1: Boobern norphin and he didn't want to stop taking Boobern

727
00:41:17,400 --> 00:41:21,160
Speaker 1: rphin because he recognized that it helped him enormously. Why

728
00:41:21,040 --> 00:41:25,480
Speaker 1: I put individuals that are already with tremendous challenges in

729
00:41:25,520 --> 00:41:27,839
Speaker 1: a conflict to have to decide one versus the other?

730
00:41:28,160 --> 00:41:31,040
Speaker 1: What else it tell us that both of them can improve.

731
00:41:31,080 --> 00:41:33,800
Speaker 1: We do it for cancer, we do it for HIV,

732
00:41:33,960 --> 00:41:35,600
Speaker 1: we do it for everything. Why do we need to

733
00:41:35,640 --> 00:41:37,719
Speaker 1: have one or the other? So do you remind me?

734
00:41:37,760 --> 00:41:40,560
Speaker 1: I remember coming across a twelve step program being run

735
00:41:40,560 --> 00:41:42,600
Speaker 1: out of Bellevue Hospital years ago, which was a twelve

736
00:41:42,640 --> 00:41:44,719
Speaker 1: step program for people and that slimated it who felt

737
00:41:44,719 --> 00:41:48,359
Speaker 1: discriminated against the normal twelve step programs, like the methodology,

738
00:41:48,440 --> 00:41:50,880
Speaker 1: like the community there, but felt Tay can do it.

739
00:41:51,160 --> 00:41:52,880
Speaker 1: But now let me switch back to this thing. You know,

740
00:41:53,160 --> 00:41:56,000
Speaker 1: part of the promise, supposedly, I think of the focus

741
00:41:56,160 --> 00:41:58,680
Speaker 1: on the brain and the way you've put the resources

742
00:41:58,719 --> 00:42:01,640
Speaker 1: between the brain and addiction. Was hoped that new medications

743
00:42:01,640 --> 00:42:03,920
Speaker 1: would come out for dealing with addiction. But if we

744
00:42:03,960 --> 00:42:08,320
Speaker 1: look at the basics, right, methanon, ruper norphine, nil tracks on,

745
00:42:08,600 --> 00:42:11,480
Speaker 1: and niloxon for dealing with overdose. All four of those

746
00:42:11,560 --> 00:42:15,600
Speaker 1: drugs were patented between fifty and seventy or more years ago,

747
00:42:16,000 --> 00:42:19,840
Speaker 1: and really nothing new, really of significance has come along.

748
00:42:19,880 --> 00:42:21,680
Speaker 1: I mean, part of what was interesting about the heroin

749
00:42:21,719 --> 00:42:24,800
Speaker 1: hydromorphone stuff in Europe and some other innovations there was

750
00:42:24,840 --> 00:42:26,800
Speaker 1: at least it was another thing that worked for people

751
00:42:26,800 --> 00:42:28,760
Speaker 1: for whom method on a grouper rhine was not working.

752
00:42:29,040 --> 00:42:32,040
Speaker 1: But is there anything on the horizon, whether with opioids

753
00:42:32,160 --> 00:42:34,879
Speaker 1: or whether in dealing with the stimulants. I think you

754
00:42:34,880 --> 00:42:36,600
Speaker 1: you're out there saying the best thing we have is

755
00:42:36,800 --> 00:42:41,319
Speaker 1: contingency management, a behavioral approach rather pharmacological approach. Is there

756
00:42:41,320 --> 00:42:44,760
Speaker 1: anything promising on the horizon, the short horizon for adding

757
00:42:45,080 --> 00:42:47,799
Speaker 1: some other drug to this mix? Yeah, there is. And

758
00:42:47,840 --> 00:42:51,759
Speaker 1: I don't think that we should minimize celtic interventions because

759
00:42:51,800 --> 00:42:54,520
Speaker 1: one of the things that the neuroscience has enabled us

760
00:42:54,520 --> 00:42:58,600
Speaker 1: to do is to understand how these behavioral interventions are

761
00:42:58,719 --> 00:43:02,880
Speaker 1: affecting neurocircuits influenced by drugs, and so you can tailor

762
00:43:02,960 --> 00:43:05,160
Speaker 1: then the intervention in such a way that it will

763
00:43:05,239 --> 00:43:09,120
Speaker 1: maximize its efficacy. And in terms also the understanding of

764
00:43:09,160 --> 00:43:12,560
Speaker 1: the neurow secretry that is engaged in addiction has offered

765
00:43:12,640 --> 00:43:17,400
Speaker 1: an opportunity to start to work with a neural modulation technologies.

766
00:43:17,760 --> 00:43:20,239
Speaker 1: For example, I think it was last year that the

767
00:43:20,360 --> 00:43:24,160
Speaker 1: FDA approved the use of transparential magnetic stimulation for the

768
00:43:24,200 --> 00:43:27,640
Speaker 1: treatment of nicotine addiction. We are also taking advantage of

769
00:43:27,680 --> 00:43:31,000
Speaker 1: the peripheral system which impacts on the brain and in

770
00:43:31,000 --> 00:43:35,040
Speaker 1: in cortical regions and it modifies our sensations, and that

771
00:43:35,280 --> 00:43:40,239
Speaker 1: in turn has resulted on approval of a peripheral stimulation

772
00:43:40,320 --> 00:43:43,960
Speaker 1: device for the treatment of opiate withdrawal. I mean, the

773
00:43:44,000 --> 00:43:46,880
Speaker 1: problem of developing medications, as you know is it takes

774
00:43:46,880 --> 00:43:49,759
Speaker 1: something like twelve years from the idea until it comes out,

775
00:43:49,840 --> 00:43:52,920
Speaker 1: and the process it requires an enormous amount of money.

776
00:43:53,440 --> 00:43:56,440
Speaker 1: So what we do as an agency is try to

777
00:43:56,480 --> 00:44:00,120
Speaker 1: engage industry, whether it's big or small industry, to buy

778
00:44:00,239 --> 00:44:03,279
Speaker 1: into that product and develop it. Because it's like two

779
00:44:03,280 --> 00:44:06,440
Speaker 1: point five billion dollars to take that treatment into that clinic,

780
00:44:06,440 --> 00:44:10,240
Speaker 1: which of course will completely kill our budget for two years.

781
00:44:10,800 --> 00:44:13,080
Speaker 1: Well let me ask you, so another category of drugs,

782
00:44:13,160 --> 00:44:16,880
Speaker 1: the psychedelics psychologs research was pretty amply funded in the

783
00:44:16,920 --> 00:44:19,799
Speaker 1: fifties and sixties by the federal government, and then with

784
00:44:19,840 --> 00:44:22,400
Speaker 1: all the counterculture stuff and Timothy Leary, it was basically

785
00:44:22,400 --> 00:44:25,000
Speaker 1: obliterated in the US and much of the world. And

786
00:44:25,040 --> 00:44:27,719
Speaker 1: now it's beginning to come back. And I know, you know,

787
00:44:27,800 --> 00:44:30,440
Speaker 1: my friend Rick Doblin, who heads the Multi Distmary Associate

788
00:44:30,480 --> 00:44:32,960
Speaker 1: Psychologic Studies, has raised tens of billions of dollars of

789
00:44:33,080 --> 00:44:36,839
Speaker 1: philanthropic funds, but still there's been no government funding there

790
00:44:36,840 --> 00:44:38,759
Speaker 1: at all. And now you have this issue of four

791
00:44:38,840 --> 00:44:41,319
Speaker 1: profit players coming in, as you're saying, is sometimes needed

792
00:44:41,360 --> 00:44:44,080
Speaker 1: for drug development. But I wonder we'll be seeing something

793
00:44:44,120 --> 00:44:45,719
Speaker 1: coming out of NAIDA. I mean, I just saw that

794
00:44:45,760 --> 00:44:48,000
Speaker 1: in late May. You know, your boss Francis Collins, the

795
00:44:48,040 --> 00:44:51,040
Speaker 1: head and a Student Health, said to Congress really interesting

796
00:44:51,040 --> 00:44:54,319
Speaker 1: stuff going on with psilocybin. And National Cancer Institute just

797
00:44:54,400 --> 00:44:57,839
Speaker 1: hosted something on psychedelics and end of life care, right,

798
00:44:57,880 --> 00:44:59,920
Speaker 1: and I think National Student Mental Health another one of

799
00:45:00,000 --> 00:45:04,680
Speaker 1: your sister agencies has been holding webinar seminars about the psychedelics.

800
00:45:04,719 --> 00:45:06,960
Speaker 1: So what about National Student Rug Abuse? I mean, I

801
00:45:06,960 --> 00:45:08,600
Speaker 1: think I saw there was a couple of things maybe

802
00:45:08,600 --> 00:45:11,439
Speaker 1: about ketamine in addiction, But can we expect to see

803
00:45:11,440 --> 00:45:14,319
Speaker 1: you beginning to fund stuff on psulocybin and treatment of

804
00:45:14,320 --> 00:45:17,080
Speaker 1: addection or even or pain or things like that. Is

805
00:45:17,080 --> 00:45:19,919
Speaker 1: that on the horizon for the short term. I mean,

806
00:45:19,920 --> 00:45:24,359
Speaker 1: it was an eye opener to uncover that ketamine it's

807
00:45:24,360 --> 00:45:28,440
Speaker 1: actually has turned out to be an extremely useful intervention

808
00:45:28,600 --> 00:45:32,000
Speaker 1: for treatment resistant depression, and it is a result of

809
00:45:32,080 --> 00:45:36,080
Speaker 1: research that led to these really important advancement on the

810
00:45:36,120 --> 00:45:39,399
Speaker 1: way that we treat people with depressive disorders. So yes,

811
00:45:39,520 --> 00:45:42,280
Speaker 1: and there we have been funding research that it's ongoing,

812
00:45:42,360 --> 00:45:46,000
Speaker 1: and keptamin for opiate treatment and also keptamine for pain

813
00:45:46,160 --> 00:45:50,400
Speaker 1: also has potential for PCP. If you look at that data,

814
00:45:50,680 --> 00:45:55,719
Speaker 1: actually the evidence is strongest form showing potential benefits for depression,

815
00:45:56,160 --> 00:45:58,200
Speaker 1: and the strongest data on depression, I would say it's

816
00:45:58,239 --> 00:46:03,160
Speaker 1: on individuals that suffer from cancer terminal illnesses and they

817
00:46:03,239 --> 00:46:07,680
Speaker 1: have pretty dramatically positive results that persists that at eight months.

818
00:46:08,520 --> 00:46:11,680
Speaker 1: That is the area where there is probably the most

819
00:46:11,719 --> 00:46:14,759
Speaker 1: ongoing treatment. There is a story, there's a couple of

820
00:46:14,800 --> 00:46:18,360
Speaker 1: stories that have shown some benefit in a nicotine addiction,

821
00:46:18,440 --> 00:46:20,920
Speaker 1: but they were not blinded, so it's very difficult to

822
00:46:21,040 --> 00:46:25,480
Speaker 1: actually know the potential signal. So we are open they

823
00:46:25,520 --> 00:46:28,840
Speaker 1: have to come up with that proposal that will be

824
00:46:29,000 --> 00:46:35,640
Speaker 1: deemed meritorious and we rely on review committees to evaluate

825
00:46:36,200 --> 00:46:40,000
Speaker 1: the likelihood of success. And the data for addictions is

826
00:46:40,320 --> 00:46:42,560
Speaker 1: in terms of the evidence, it is much more limited.

827
00:46:42,880 --> 00:46:44,520
Speaker 1: But but no, I mean, let me just press you

828
00:46:44,600 --> 00:46:47,840
Speaker 1: because I mean, obviously with psilocybin there's research being privately

829
00:46:47,880 --> 00:46:50,879
Speaker 1: funded that is showing great promise. We know with ayahuasca,

830
00:46:51,120 --> 00:46:53,399
Speaker 1: lots of interesting things are emerging in terms of people

831
00:46:53,480 --> 00:46:56,840
Speaker 1: processing not just trauma but also times addiction. And you know,

832
00:46:56,880 --> 00:46:59,759
Speaker 1: there are people talking about the promise of psychedelics in

833
00:46:59,840 --> 00:47:02,319
Speaker 1: the treatment of depression and things like this. They could

834
00:47:02,360 --> 00:47:06,000
Speaker 1: revolutionize the pharmacological you know, treatment in some of these areas.

835
00:47:06,320 --> 00:47:08,520
Speaker 1: I mean, I'll tell you it wasn't long ago that

836
00:47:08,760 --> 00:47:11,560
Speaker 1: a prominent researcher who I think you know well, um,

837
00:47:11,600 --> 00:47:14,240
Speaker 1: who had done research on other drugs, you know, cocaine, nicotine,

838
00:47:14,320 --> 00:47:16,880
Speaker 1: it was getting interest in psychedelics and he was hopeful

839
00:47:16,920 --> 00:47:19,880
Speaker 1: of getting a national student drug abuse funding for research

840
00:47:19,960 --> 00:47:23,240
Speaker 1: on psilocybin, and what he ended up doing was telling

841
00:47:23,280 --> 00:47:26,520
Speaker 1: the organizers of a conference on psychedelics to disinvite me

842
00:47:27,000 --> 00:47:29,640
Speaker 1: because if he showed up at a conference where Ethan

843
00:47:29,719 --> 00:47:32,480
Speaker 1: Naedelman was talking, that would show that psychedelics is all

844
00:47:32,560 --> 00:47:36,120
Speaker 1: political and therefore he won't get funding. Now I think

845
00:47:36,200 --> 00:47:39,439
Speaker 1: he still hasn't gotten funding. But given the enthusiasm coming

846
00:47:39,480 --> 00:47:42,680
Speaker 1: out and all of the intriguing research out there, why

847
00:47:42,760 --> 00:47:45,120
Speaker 1: not go more strongly into this area? Now? I mean,

848
00:47:45,239 --> 00:47:47,960
Speaker 1: is there a fear of the political fallout or what? No,

849
00:47:48,120 --> 00:47:50,439
Speaker 1: I don't think that there is a person a fear

850
00:47:50,480 --> 00:47:52,840
Speaker 1: of the political fallout. I think that we are seeing.

851
00:47:53,400 --> 00:47:55,960
Speaker 1: I mean m d m AS is an addictive draw.

852
00:47:56,400 --> 00:48:00,200
Speaker 1: Psilocybing is not an addictive draw. And yet I mean

853
00:48:00,239 --> 00:48:02,080
Speaker 1: it's being utilized in a way that it's safe for

854
00:48:02,160 --> 00:48:05,200
Speaker 1: the treatment of people with depressions. So the notion of

855
00:48:05,320 --> 00:48:09,360
Speaker 1: when you get proposals, you are competing with other grants

856
00:48:09,520 --> 00:48:13,440
Speaker 1: in terms of likelihood of success in the proposal that

857
00:48:13,560 --> 00:48:17,000
Speaker 1: you have and likelihood of implementation, so they are the

858
00:48:17,120 --> 00:48:19,600
Speaker 1: review process is important and you cannot just come in

859
00:48:19,760 --> 00:48:22,239
Speaker 1: and with an idea without showing as you know, for

860
00:48:22,360 --> 00:48:25,920
Speaker 1: the grant, most of the ground mechanisms requires that you

861
00:48:26,000 --> 00:48:29,440
Speaker 1: do provide a background that supports the likelihood that you

862
00:48:29,480 --> 00:48:32,040
Speaker 1: will be successful. And the reason why why this is

863
00:48:32,080 --> 00:48:35,719
Speaker 1: done is again limitation of resources. So you have to

864
00:48:35,840 --> 00:48:38,839
Speaker 1: take risks, but you want to take risks that are

865
00:48:38,960 --> 00:48:42,840
Speaker 1: more likely to be successful. So Northlesia with the n

866
00:48:42,920 --> 00:48:45,200
Speaker 1: d M A, right, I mean n DMA seemed Night

867
00:48:45,239 --> 00:48:47,680
Speaker 1: have spent a lot of money trying to establish the

868
00:48:47,760 --> 00:48:50,400
Speaker 1: neurotoxicity of m d M A, and I remember there

869
00:48:50,480 --> 00:48:52,840
Speaker 1: was this sort of embarrassing thing that happened. Not it

870
00:48:52,960 --> 00:48:54,920
Speaker 1: was after you, I think, before you came in. Right,

871
00:48:54,960 --> 00:48:57,640
Speaker 1: We're Night given a big grant to researcher at Hopkins,

872
00:48:57,960 --> 00:49:01,080
Speaker 1: George Ricardi, who came out with this big study and

873
00:49:01,239 --> 00:49:04,000
Speaker 1: Science saying that all these monkeys that died from m

874
00:49:04,040 --> 00:49:05,360
Speaker 1: d M A and then it turned out lo and

875
00:49:05,400 --> 00:49:07,880
Speaker 1: behold he had given them large doses of amphetamine and

876
00:49:08,000 --> 00:49:10,960
Speaker 1: people were highly suspicious of the results even before I

877
00:49:11,000 --> 00:49:14,080
Speaker 1: got published in Science. And the day that article came out,

878
00:49:14,160 --> 00:49:17,239
Speaker 1: your predecessor Alan Lester said, got you Using m d

879
00:49:17,360 --> 00:49:19,440
Speaker 1: M A is like playing Russian roulette, which was an

880
00:49:19,480 --> 00:49:22,440
Speaker 1: incredibly irresponsible thing for a former head of NADA and

881
00:49:22,560 --> 00:49:24,839
Speaker 1: head of the American Academy Arts to Science say, now

882
00:49:24,960 --> 00:49:26,800
Speaker 1: you have the f d A, right, it's about to

883
00:49:26,920 --> 00:49:29,680
Speaker 1: proceeds in phase three trials with doing m d m

884
00:49:29,760 --> 00:49:33,520
Speaker 1: A for treating PTSD. Right, they've established the safety margins.

885
00:49:33,680 --> 00:49:37,080
Speaker 1: Right are you concerned? I mean, given all the that's

886
00:49:37,080 --> 00:49:39,400
Speaker 1: happened last fifteen twenty years and with m d m

887
00:49:39,440 --> 00:49:43,000
Speaker 1: A going through all these incredibly expensive long trials and

888
00:49:43,080 --> 00:49:45,960
Speaker 1: now the possible expansion of m DMA to treat PTSD,

889
00:49:46,120 --> 00:49:48,600
Speaker 1: do you have any concerns about that? Or you enthusiastic

890
00:49:48,640 --> 00:49:52,480
Speaker 1: about this development? I basically I support science that can

891
00:49:52,560 --> 00:49:55,200
Speaker 1: help bring new treatments. I actually was one of the

892
00:49:55,280 --> 00:49:57,640
Speaker 1: ones that was very skeptical when the paper came up

893
00:49:57,680 --> 00:50:01,600
Speaker 1: in science because we have been looking into the effects

894
00:50:01,600 --> 00:50:03,840
Speaker 1: of drugs in the brain and and and and also

895
00:50:03,920 --> 00:50:06,920
Speaker 1: the Europeans have a long history of actually studying the

896
00:50:06,920 --> 00:50:11,200
Speaker 1: effects of ecstasy and no one has reported anything like that.

897
00:50:11,520 --> 00:50:15,120
Speaker 1: And overall, the issue with with ecstasy has has had

898
00:50:15,200 --> 00:50:17,640
Speaker 1: more to do and I guess everybody what is concerning

899
00:50:18,000 --> 00:50:21,640
Speaker 1: the potential of john people using it in situations where

900
00:50:21,960 --> 00:50:24,680
Speaker 1: they are very crowded and that can result in HYPERTERMI

901
00:50:24,840 --> 00:50:28,480
Speaker 1: or there have been some debts associated with it. If again,

902
00:50:28,680 --> 00:50:30,960
Speaker 1: and it's this the history. I mean, we've learned, we

903
00:50:31,040 --> 00:50:34,319
Speaker 1: need to learn from what what the evidence is showing up.

904
00:50:34,360 --> 00:50:38,200
Speaker 1: If we can use gatamine for the treatment of severe

905
00:50:38,320 --> 00:50:41,080
Speaker 1: depression in a way that is safe, this is an

906
00:50:41,160 --> 00:50:44,440
Speaker 1: example of really that we can do. We can use

907
00:50:44,560 --> 00:50:47,879
Speaker 1: drugs that we thought were dangerous and using in ways

908
00:50:47,920 --> 00:50:52,160
Speaker 1: that are therapeutic. In fact, we use fentanyl extensively for

909
00:50:52,320 --> 00:50:55,320
Speaker 1: surgical procedures and it's a very valuable drug. So we

910
00:50:55,400 --> 00:50:59,880
Speaker 1: cannot demonize fentanyl because they elicit drug is being market

911
00:51:00,000 --> 00:51:03,799
Speaker 1: it in the streets. Because fantaniel also has a very

912
00:51:03,920 --> 00:51:07,759
Speaker 1: valuable application in medicine and can be life savings. And

913
00:51:07,880 --> 00:51:10,480
Speaker 1: the same thing with prescription opius. And this is something

914
00:51:10,560 --> 00:51:13,840
Speaker 1: that I've also been very vocal about. And so again

915
00:51:13,920 --> 00:51:16,440
Speaker 1: we polarize everything. It's either good or bad and I

916
00:51:16,920 --> 00:51:20,279
Speaker 1: and you know, my brain is why can't we not

917
00:51:20,440 --> 00:51:23,680
Speaker 1: have this and that these two things are correct. We

918
00:51:23,800 --> 00:51:26,400
Speaker 1: are over prescribing, but at the same time we are

919
00:51:26,440 --> 00:51:29,280
Speaker 1: restricting it to people that needed. They are not exclusive.

920
00:51:29,360 --> 00:51:31,080
Speaker 1: You know, one thing that worries me, right you know,

921
00:51:31,120 --> 00:51:33,800
Speaker 1: I oftentimes describe the War on drugs is being justified

922
00:51:33,840 --> 00:51:36,120
Speaker 1: in terms of being one great big child protection act.

923
00:51:36,480 --> 00:51:38,360
Speaker 1: And when you would say that politicians, why can't we

924
00:51:38,440 --> 00:51:40,719
Speaker 1: legalize marijuana for medical purposes? And they go what about

925
00:51:40,760 --> 00:51:43,239
Speaker 1: the kids? Or I remember what about needle exchange? And

926
00:51:43,280 --> 00:51:45,359
Speaker 1: the former governor of New Jersey, of Christie Whitman others

927
00:51:45,400 --> 00:51:46,719
Speaker 1: would say what about the kids, and always go what

928
00:51:46,719 --> 00:51:48,399
Speaker 1: about the kids? What about the kids? What about the kids?

929
00:51:48,680 --> 00:51:50,680
Speaker 1: And when we hear that now is on the issue

930
00:51:50,880 --> 00:51:54,279
Speaker 1: of nicotine and vaping, right, I mean, here you have

931
00:51:54,560 --> 00:51:58,719
Speaker 1: a kind of breakthrough technological innovation that has the potential

932
00:51:58,800 --> 00:52:01,600
Speaker 1: that's dramatically less staydangerous. The cigarettes and heat not burned

933
00:52:01,640 --> 00:52:05,399
Speaker 1: vaping devices are dramatically less dangerous than cigarettes. You're not safe,

934
00:52:05,440 --> 00:52:08,200
Speaker 1: but dramatically less dangerous. And then we see the rapid

935
00:52:08,280 --> 00:52:11,200
Speaker 1: uptake of jeweling among kids a few years ago. And

936
00:52:11,280 --> 00:52:15,080
Speaker 1: now it seems just like this massive miseducation campaign of

937
00:52:15,200 --> 00:52:17,600
Speaker 1: which the U. S. Government, including the Center Disease Control,

938
00:52:17,640 --> 00:52:19,960
Speaker 1: has been an ample part. I mean, you have now

939
00:52:20,080 --> 00:52:23,080
Speaker 1: a majority of Americans believing that the cigarettes are as

940
00:52:23,160 --> 00:52:26,760
Speaker 1: are more dangerous than combustible cigarettes. You have a majority

941
00:52:26,800 --> 00:52:29,080
Speaker 1: of Americans and even certain fields of medicine believing that

942
00:52:29,239 --> 00:52:32,239
Speaker 1: nicotine is what causes cancer. Rather than nicotine being the

943
00:52:32,280 --> 00:52:35,440
Speaker 1: hook that addicts people to cigarettes. You have people believing

944
00:52:35,520 --> 00:52:38,239
Speaker 1: that that whole the Valley syndrome where people were landing

945
00:52:38,280 --> 00:52:41,280
Speaker 1: up in the hospital was about nicotine e' cigarettes, whereas

946
00:52:41,320 --> 00:52:43,000
Speaker 1: we know now and in fact, there was a good

947
00:52:43,000 --> 00:52:45,480
Speaker 1: reason to believe in the beginning it was about illegally

948
00:52:45,560 --> 00:52:49,080
Speaker 1: produced tainted THHC cartridges. So the question I'm asking is

949
00:52:49,200 --> 00:52:52,080
Speaker 1: what is the responsibility what is your obligation as the

950
00:52:52,120 --> 00:52:54,920
Speaker 1: head of NAIDA to make sure that these massive public

951
00:52:55,080 --> 00:52:59,160
Speaker 1: misperceptions get corrected. This is going to be my last

952
00:52:59,320 --> 00:53:01,399
Speaker 1: answer because I do have to run to another meeting,

953
00:53:01,480 --> 00:53:03,680
Speaker 1: but it there's I mean, I cannot know not respond

954
00:53:03,680 --> 00:53:06,600
Speaker 1: to this extremely important question because it's another example about

955
00:53:06,640 --> 00:53:09,239
Speaker 1: how we swing back and forward and and the reality

956
00:53:09,560 --> 00:53:13,360
Speaker 1: is that jazz vaping of nicotine can result in people

957
00:53:13,440 --> 00:53:16,319
Speaker 1: that are naive to become addicted very rapidly and can

958
00:53:16,360 --> 00:53:18,920
Speaker 1: actually lead to toxicity because in the cartridges you can

959
00:53:18,960 --> 00:53:21,839
Speaker 1: actually concentrate high doses of nicotine that you would never

960
00:53:21,960 --> 00:53:25,239
Speaker 1: be able to smoke with combustible on the other hand,

961
00:53:25,440 --> 00:53:29,480
Speaker 1: as you say, electronic cigarettes offer an alternative delivery for

962
00:53:29,600 --> 00:53:32,480
Speaker 1: nicotine on people that cannot stop smoking, and in the

963
00:53:32,600 --> 00:53:35,400
Speaker 1: process at the European data has shown that actually they

964
00:53:35,440 --> 00:53:37,719
Speaker 1: are benefits. So one of the things that we have

965
00:53:37,880 --> 00:53:41,200
Speaker 1: been very interested on doing is funding research that will

966
00:53:41,680 --> 00:53:44,759
Speaker 1: document benefits of the use of the electronic cigarettes on

967
00:53:45,120 --> 00:53:49,680
Speaker 1: for nicotine's cessation or for alternatives for treatment. So there

968
00:53:49,840 --> 00:53:52,400
Speaker 1: is true on both of those things. I mean, although

969
00:53:52,400 --> 00:53:55,040
Speaker 1: I am impressed by the evidence coming from Ken warrener

970
00:53:55,560 --> 00:53:58,640
Speaker 1: many other people pointing out that from a public health perspective,

971
00:53:58,719 --> 00:54:02,520
Speaker 1: the net benefits for smokers and switching so exceeds any

972
00:54:02,600 --> 00:54:05,200
Speaker 1: potential risk to young people from vaping, and that the

973
00:54:05,320 --> 00:54:08,160
Speaker 1: evidence of kids starting to vaping moving into cigarettes unless

974
00:54:08,160 --> 00:54:11,160
Speaker 1: they were already engaging with two bustibles beforehand, is so

975
00:54:11,360 --> 00:54:15,480
Speaker 1: low that you have an overwhelming case for responsible public

976
00:54:15,560 --> 00:54:19,360
Speaker 1: health policy that I wish say, yes, it's so simple.

977
00:54:19,480 --> 00:54:23,239
Speaker 1: I think that I believe I'm saying it's a balancing

978
00:54:23,600 --> 00:54:25,960
Speaker 1: I see the other side of of the coin, and

979
00:54:26,080 --> 00:54:28,400
Speaker 1: I actually because I know that data on both sides,

980
00:54:28,480 --> 00:54:32,239
Speaker 1: but but that I think if we are actually ultimately

981
00:54:32,360 --> 00:54:35,160
Speaker 1: trying to understand I mean a very specific question that,

982
00:54:35,880 --> 00:54:38,279
Speaker 1: believe it or not, there's very little work. How does

983
00:54:38,400 --> 00:54:44,040
Speaker 1: nicotine exposure during brain development influence that trajectories? I mean,

984
00:54:44,280 --> 00:54:47,400
Speaker 1: what are its effects? And as you know, one of

985
00:54:47,480 --> 00:54:50,640
Speaker 1: the things that nicotine is associated with, once you've been

986
00:54:50,680 --> 00:54:53,400
Speaker 1: taking it and you stop, you have greater likelihood of

987
00:54:53,440 --> 00:54:57,040
Speaker 1: depressive symptoms of anxiety. So I have a fascination for

988
00:54:57,160 --> 00:55:01,160
Speaker 1: nicotine is another extremely interesting comp own board. It can

989
00:55:01,239 --> 00:55:04,160
Speaker 1: be very addictive. Okay, my last, my very last question

990
00:55:04,239 --> 00:55:08,000
Speaker 1: here here you've been supporting decriminalization, supporting a public health approach,

991
00:55:08,040 --> 00:55:10,680
Speaker 1: opposing the drug war. Can you envision in your life

992
00:55:10,719 --> 00:55:14,040
Speaker 1: post night to Um joining up with drug policy reform

993
00:55:14,200 --> 00:55:17,120
Speaker 1: organizations to push for policies that are more grounded in

994
00:55:17,200 --> 00:55:20,120
Speaker 1: public health and human rights and harm reduction and opposing

995
00:55:20,160 --> 00:55:24,840
Speaker 1: the punitive prohibitionist policies if they are effective. Yes, great, Okay,

996
00:55:24,920 --> 00:55:27,360
Speaker 1: I don't just like to think about problems. I'd like

997
00:55:27,520 --> 00:55:29,919
Speaker 1: to solve them. I agree, we're in the same milk

998
00:55:29,960 --> 00:55:31,840
Speaker 1: that way. Listen, Nora, thank you ever so much for

999
00:55:31,960 --> 00:55:34,239
Speaker 1: taking the time to do this. I really appreciate it

1000
00:55:34,360 --> 00:55:36,960
Speaker 1: is a very highly engaging conversation and I wish you

1001
00:55:37,040 --> 00:55:40,760
Speaker 1: the best of luck. Under this current administration. Thanks very much, guys,

1002
00:55:40,920 --> 00:55:45,359
Speaker 1: a la vista. Psychoactive is a production of I Heart

1003
00:55:45,440 --> 00:55:49,320
Speaker 1: Radio and Protozoa Pictures. It's hosted by me Ethan Edelman.

1004
00:55:49,560 --> 00:55:53,400
Speaker 1: It's produced by Katcha Kumkova and Ben Kibrick. The executive

1005
00:55:53,400 --> 00:55:57,520
Speaker 1: producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren

1006
00:55:57,560 --> 00:56:01,600
Speaker 1: Aronovski for Protozoa Pictures, Al Williams and Matt Frederick for

1007
00:56:01,680 --> 00:56:05,360
Speaker 1: I Heart Radio and me Ethan Nadelman. Our music is

1008
00:56:05,400 --> 00:56:08,919
Speaker 1: by Ari Blusian and a special thanks to a vit Brio, SF,

1009
00:56:09,280 --> 00:56:13,359
Speaker 1: Bianca Grimshaw and Robert Beatty. If you'd like to share

1010
00:56:13,400 --> 00:56:16,480
Speaker 1: your own stories, comments or ideas, please leave us a

1011
00:56:16,560 --> 00:56:22,400
Speaker 1: message at eight three three seven seven nine sixty. That's

1012
00:56:22,600 --> 00:56:28,120
Speaker 1: one eight three three psycho zero. You can also email

1013
00:56:28,239 --> 00:56:31,400
Speaker 1: us as Psychoactive at protozoa dot com or find me

1014
00:56:31,480 --> 00:56:34,400
Speaker 1: on Twitter at Ethan Nadelman. And if you couldn't keep

1015
00:56:34,400 --> 00:56:37,120
Speaker 1: track of all this, find the information in the show notes.

1016
00:56:41,280 --> 00:56:44,200
Speaker 1: Listen in next time for my conversation with Tim Ferris,

1017
00:56:44,320 --> 00:56:47,400
Speaker 1: the investor and productivity guru who has been funding research

1018
00:56:47,480 --> 00:56:49,960
Speaker 1: on psychedelics and it also has a fair number of

1019
00:56:50,040 --> 00:56:53,719
Speaker 1: experiences to share himself. Here's a bunch of college kids

1020
00:56:54,000 --> 00:56:57,400
Speaker 1: eating handfuls of mushrooms, no measurement involved to see what

1021
00:56:57,480 --> 00:57:01,680
Speaker 1: would happen. Nonetheless, I knew, just after these experiences, which

1022
00:57:01,719 --> 00:57:04,520
Speaker 1: I did once a year for a number of years,

1023
00:57:04,680 --> 00:57:09,960
Speaker 1: that there was an antidepressant after glow optimism that lasted

1024
00:57:10,000 --> 00:57:13,279
Speaker 1: for several months. Subscribe to Psychoactive now see it, don't

1025
00:57:13,280 --> 00:57:13,560
Speaker 1: miss it.