Forum on Opioids: Strategies and Solutions for Minority Communities

Forum on Opioids: Strategies and Solutions for Minority Communities


>>SO GOOD MORNING. MY NAME IS CARA JAMES AND I WANT
TO WELCOME YOU ALL TO OUR FORUM ON OPIOIDS, WHERE WE’RE TALKING
ABOUT STRATEGIES AND SOLUTIONS FOR ADDRESSING THE EPIDEMIC IN
MINORITY COMMUNITIES. I’M SO PLEASED TO BE HERE AND
WITH OUR PANELISTS AND OUR SPEAKER AND THE SURGEON GENERAL,
AS WELL AS EACH OF YOU HERE IN THE ROOM AND THE MANY OF YOU WHO
ARE JOINING US VIRTUALLY TO TALK ABOUT THIS REALLY IMPORTANT
ISSUE, PARTICULARLY IN LIGHT THAT APRIL IS NATIONAL MINORITY
HEALTH MONTH AND OUR THEME IS PARTNERING TO ACHIEVE HEALTH
EQUITY, WHICH ALSO PARALLELS THE MOTTO OF OUR KEYNOTE SPEAKER,
WHO TALKS ABOUT BETTER HEALTH THROUGH PARTNERSHIPS.
AS WE THINK ABOUT WHERE WE ARE, WE’VE SEEN THE STORIES
NATIONALLY ABOUT THE IMPACT OF THE EPIDEMIC ACROSS THE COUNTRY
WITH MORE THAN 42,000 OPIOID DEATHS OCCURRING IN 2016.
LESS SO IS THE IMPACT THAT IT’S HAVING IN RACIAL MINORITY
COMMUNITIES AND WHY WE’RE HERE TODAY TO TALK ABOUT THE IMPACT
OF THE EPIDEMIC. IN 2016, AMONG THOSE 42,000
DEATHS, 20% OF THEM OCCURRED IN PEOPLE OF COLOR.
AND WHILE THAT’S LESS THAN THE PROPORTION OF THE POPULATION WHO
IS A PERSON OF COLOR, IT’S ACTUALLY AN INCREASE IN WHAT
WE’VE SEEN OVER 2015. AND WE KNOW THAT THE EPIDEMIC IS
CHANGING, MOVING TO A LITTLE BIT MORE OF AN URBAN AREA, WHERE WE
HAVE MANY MORE DIVERSE POPULATION.
AND AS WE THINK ABOUT THIS, IT’S IMPORTANT FOR US TO THINK ABOUT
WHAT ARE THOSE SOLUTIONS. WE KNOW THAT ACROSS OUR HAD
HEALTH SPECTRUM, ONE SIZE DOESN’T FIT ALL.
AND WHEN WE THINK ABOUT WHAT THE UNIQUE CHALLENGES AND NEEDS OF
OUR COMMUNITIES OF COLOR AND HOW WE CAN ADDRESS THE EPIDEMIC,
THAT’S ONE OF THE REASONS WE’RE SO GLAD TO BE HERE TODAY TO LIFT
THAT UP, TO SHARE STORIES OF HOPE AND SOLUTIONS AND TO
BRAINSTORM WITH YOU ABOUT WHAT WE CAN DO TO ADDRESS THIS
CRISIS. WE’RE ALSO PLEASED TO BE DOING
THIS IN PARTNERSHIP WITH OUR COLLEAGUES AT SAMHSA AND THE
OFFICE OF BEHAVIORAL HEALTH EQUITY, IN PARTNERSHIP WITH US
TODAY FOR THIS IMPORTANT TOPIC. SO WITHOUT FURTHER ADO, I’M
GOING TO INTRODUCE DR. JEROME ADAMS, THE 20TH SURGEON GENERAL
OF THE UNITED STATES, AND A BOARD CERTIFIED
ANESTHESIOLOGIST. WE’RE GOING TO HEAR FROM HIM,
THEN WE’RE GOING TO MOVE INTO A DISCUSSION WITH SOME OF OUR
SPEAKERS, WHO ARE GOING TO REFLECT BOTH WHAT’S HAPPENING AT
THE CLINICAL LEVEL, PERSONAL LEVEL, AS WELL AS WHAT WE’RE
DOING IN OUR DEPARTMENTS TO FRAME THE ISSUE FOR US AND HOW
WE CAN MOVE FORWARD AND THEN ENGAGE WITH THE CONVERSATION.
WE WANT TO ENGAGE WITH YOU AS WELL, SO FOR THOSE OF YOU WHO
ARE JOINING US VIRTUALLY, WE HAVE QUESTIONS THAT YOU CAN
EMAIL US REGARDING THE CMS STUDIO AND — SORRY, THE HHS
STUDIO, THERE WAS A SLIDE A MINUTE AGO, BUT YOU CAN EMAIL
QUESTIONS TO US AND WE’LL WORK THOSE IN TO THE DISCUSSION.
SO AS I SAID, DR. JEROME ADAMS IS THE 20TH SURGEON GENERAL OF
THE UNITED STATES, AND HE’S A BOARD CERTIFIED ANESTHESIOLOGIST
WHO SERVED IN INDIANA STATE HEALTH COMMISSIONER FROM 2014
FROM 2017. DR. ADAMS IS A MARYLAND NATIVE
WITH BACHELOR’S DEGREE IN BIOCHEMISTRY AND PSYCHOLOGY FROM
THE UNIVERSITY OF MARYLAND BALTIMORE COUNTY AS WELL AS A
MASTER’S DEGREE IN PUBLIC HEALTH FROM THE UNIVERSITY OF
CALIFORNIA AT BERKLEY AND A MEDICAL DEGREE FROM INDIANA
UNIVERSITY SCHOOL OF MEDICINE. AS I MENTIONED, HIS MOTTO IS
“BETTER HEALTH THROUGH BETTER PARTNERSHIPS,” AND LOOKING
FORWARD TO TALKING TO HIM AND HEARING WHAT HE HAS TO SAY ABOUT
HOW WE CAN ADDRESS THIS EPIDEMIC IN MINORITY COMMUNITIES.
DR. ADAMS? [APPLAUSE]
>>WELL, GOOD MORNING, EVERYONE.>>GOOD MORNING.
>>ALL RIGHT. WELL, IT’S GOOD TO BE HERE
TODAY, AND I’M REALLY IMPRESSED AT THE FOLKS IN THE ROOM.
FOR THE FOLKS WITH US VIRTUALLY, WELCOME.
WHAT YOU MAY NOT REALIZE VIRTUALLY IS THAT THE FRENCH
PRESIDENT IS IN TOWN, AND JUST DROVE RIGHT BY HHS, FOLKS WHO
WERE HERE IN THIS ROOM HAD TO FIGHT THROUGH SECRET SERVICE AND
ALSO SOME OTHER SHENANIGANS TO GET HERE, REALLY A HEROIC
EFFORT. THANK YOU, DR. JAMES, FOR YOUR
KIND INTRODUCTION AND FOR YOUR LEADERSHIP, JUST REALLY
APPRECIATE HOW KIND YOU’VE BEEN TO OUR OFFICE AND THE GREAT WORK
YOU’VE DONE TO ADDRESS DISPARITIES AND EQUITY ACROSS
THE COUNTRY. THANK YOU ALL FOR TAKING THE
TIME OUT OF YOUR BUSY SCHEDULES TO JOIN US AT THIS VERY
IMPORTANT FORUM ON BEHAVIORAL HEALTH AND OPIOIDS.
I’M REALLY EXCITED FOR THE PANELISTS.
WE HAD A GREAT DISCUSSION BRIEFLY BEFORE WE CAME IN.
DRS. SMITH, COOK AND CHOO AND LEAH HILL.
I WAS JUST BLOWN AWAY IN THE SHORT A TIME I HAD WITH THEM, SO
I KNOW YOU’RE GOING TO BE REALLY, REALLY IMPRESSED WITH
THE INTERACTION THAT WE HAVE ON THE PANEL.
I SPECIFICALLY WANT TO THANK THE OFFICES OF MINORITY HEALTH FROM
BOTH CMS AND THE OVERALL OFFICE OF MINORITY HEALTH AND DR. LINN
FOR BRINGING TOGETHER SUCH A GREAT GROUP OF INDIVIDUALS.
I WAS SO GLAD TO HEAR THAT THE THEME FOR THIS YEAR’S NATIONAL
MINORITY HEALTH MONTH IS “PARTNERING FOR HEALTH EQUITY.”
AS YOU ALL KNOW AND DR. JAMES POINTED OUT, STRENGTHENING
RELATIONSHIPS IS IMPORTANT TO ME AND IS KEY TO IMPROVING HEALTH.
AND I COMMEND YOU ALL FOR EMBRACING THE IDEA, THE CONCEPT
OF BETTER HEALTH FOR BETTER PARTNERSHIPS.
I WANT TO SHARE WITH YOU TWO QUICK PERSONAL STORIES, ONE
WHICH SHOWS THE BAD AND ONE WHICH SHOWS THE GOOD IN TERMS OF
ADDRESSING DISPARITIES AND INEQUITY.
AS MANY OF YOU KNOW BY NOW, MY OWN BROTHER PHILIP IS CURRENTLY
SERVING A 10-YEAR PRISON SENTENCE ABOUT 10 MILES FROM
HERE. HE HAD UNRECOGNIZED MENTAL
HEALTH ISSUES WHEN HE WAS YOUNGER THAT TURNED INTO SELF
MEDICATION WITH ALCOHOL, TOBACCO, MARIJUANA, ONE DAY
SOMEONE GAVE HIM SOME PILLS. AND HE FOUND THAT THAT DID A
BETTER JOB AT A ANYTHING ELSE TO HELPING TO SUPPRESS SOME OF
THOSE FEELINGS OF ANXIETY AND DEPRESSION THAT HE HAD.
THAT QUICKLY TURNED INTO ADDICTION AND TO ILLICIT
SUBSTANCES. HE STOLE $200 TO SUPPORT HIS
ADDICTION AND WAS GIVEN A 10-YEAR PRISON SENTENCE.
THERE ARE SO MANY POINTS ALONG THAT PATHWAY THAT WE AS A
SOCIETY COULD HAVE INTERVENED. BUT STIGMA GOT IN THE WAY.
IF WE’RE GOING TO BE HONEST ABOUT IT, THE WAY THAT WE TREAT
MINORITIES RELATIVE TO THE REST OF SOCIETY GOT IN THE WAY.
THE LACK OF RESOURCES AND ACCESS TO THOSE RESOURCES GOT IN THE
WAY. IT REALLY IS AN EXAMPLE OF A
SYSTEM FAILURE. HIS BROTHER WAS A PHYSICIAN.
WAS THE HEAD OF THE INDIANA STATE DEPARTMENT OF HEALTH.
THE UNITED STATES SURGEON GENERAL.
AND WITH ALL THAT IN HIS FAVOR, IF WE COULDN’T PREVENT HIM FROM
GOING DOWN THAT PATHWAY, THEN IT SHOWS YOU THAT THE SYSTEM REALLY
IS FAILING US. AND SOME OF YOU HEARD ME SAY
THIS BEFORE, I DON’T SHARE HIS STORY TO TUG ON YOUR HEART
STRINGS. I SHARE HIS STORY BECAUSE FROM A
VERY PRAGMATIC POINT OF VIEW, IT COSTS BETWEEN 100 AND $200 A DAY
TO INCARCERATE SOMEONE. TIMES 365 DAYS A YEAR TIMES 10
MEANS THAT EACH AND EVERY ONE OF YOU AS A TAXPAYER IS GOING TO
CONTRIBUTE TO THE HALF A MILLION TO A MILLION DOLLARS IT’S GOING
TO COST TO INCARCERATE HIM. VERSUS HAVING INTERVENED EARLIER
AND SPENT A COUPLE HUNDRED OR EVEN A COUPLE THOUSAND DOLLARS
TO HAVE GOTTEN HIM THE TREATMENT THAT HE NEEDED.
AGAIN, I’M NOT TALKING TO YOU FROM AN EMOTIONAL STANDPOINT.
I’M SAYING IF YOU WANT MORE MONEY IN YOUR WALLET, IF YOU
WANT MORE MONEY TO BE ABLE TO SPEND ON THE THINGS THAT ARE
IMPORTANT TO YOU AND TO YOUR COMMUNITIES, WE’VE GOT TO DO A
BETTER JOB, WE’VE GOT TO CORRECT THESE SYSTEM FAILURES.
ON THE FLIP SIDE, I WANT TO SHARE WITH YOU AN EXPERIENCE I
HAD IN INDIANA. INDIANA HAS GOT — WELL, AS A
MANY OF YOU ALL KNOW, THE UNITED STATES IS AMONGST THE WORST
DEVELOPED COUNTRIES FOR INFANT MORTALITY.
INDIANA IS ONE OF THE WORST STATES WITHIN ONE OF THE WORST
COUNTRIES IN REGARDS TO INFANT MORTALITY.
AND WITHIN THAT TERRIBLE STATISTIC, THERE’S THE FACT THAT
WE HAVE DISPARITIES THAT EXIST, BLACK TO WHITE DISPARITIES.
INDIANA HAD TERRIBLE BLACK TO WHITE INFANT MORTALITY RATIOS.
AND ONE OF THE THINGS I’M MOST PROUD OF DURING MY TIME IN
INDIANA WAS BEING ABLE TO HELP DELIVER $13 MILLION TO ADDRESS
INFANT MORTALITY IN THAT STATE. HOW DID I DO IT?
I DID IT BY PARTNERING, BY GOING TO COMMUNITIES, MANY OF WHICH
WERE MOSTLY OR ALL WHITE, AND HELPING THEM UNDERSTAND THAT
ADDRESSING INEQUITY AND DISPARITY ISN’T JUST BLACK OR
WHITE ISSUE, IT ISN’T JUST ABOUT THE LANGUAGE YOU SPEAK.
IT’S ABOUT COMMUNITY PROSPERITY, IT’S ABOUT URBAN VERSUS RURAL
DISPARITY, IT’S ABOUT SHOWING EVERYONE HOW THEY FIT UNDER THE
EQUITY UMBRELLA. IF WE CAN DO THAT, THEN WE CAN
TURN AROUND THE STORY FOR MY BROTHER AND FOR SO MANY OF THE
FOLKS WHO WE’RE FIGHTING FOR. HEALTH DISPARITY IS PREVALENT
ACROSS AND WITHIN POPULATIONS. AFRICAN-AMERICAN WOMEN ARE 18
TIMES AS LIKELY TO DIE FROM HIV AND AIDS AS WHITE CHILDREN.
SUICIDE DEATH RATES FOR AMERICAN INDIAN AND ALASKAN NATIVE
ADOLESCENTS ARE 2.3 TIMES AS HIGH AS WHITE ADOLESCENTS.
ASIAN AMERICAN AND PACIFIC ISLANDERS REPRESENT HALF OF ALL
PEOPLE WITH HEPATITIS B DESPITE MAKING UP ONLY 5% OF THE
POPULATION. THESE ARE CRITICAL CHALLENGES
FOR RACIAL AND ETHNIC MINORITIES AND FOR THE NATION AT LARGE
BECAUSE AGAIN, WE’RE OVERSPENDING ON THE BACK END TO
CORRECT THOSE DISPARITIES INSTEAD OF PREEMPTIVELY
ADDRESSING THEM ON THE FRONT END.
WE’RE HERE TODAY TO TALK ABOUT OPIOIDS.
WE KNOW THAT FROM 2010 TO 2014, RATES OF HEROIN OVERDOSE
INCREASED BY 213% FOR BLACKS, 137% FOR HISPANICS AND LATINOS,
AND 236% FOR NATIVE AMERICANS. WE KNOW THAT IN THE TIME THE
WHITE OVERDOSE RATE HAS DOUBLED, IT HAS TRIPLED FOR
AFRICAN-AMERICANS. AND STIGMA AS I MENTIONED IS A
CONTRIBUTING FACTOR. BOTH FOR THE INDIVIDUAL AND FOR
THE FAMILIES AND SUPPORTS OF THOSE INDIVIDUALS.
FOR THE PHYSICIANS WHO WANT TO TREAT THOSE INDIVIDUALS.
FOR OUR PAYMENT SYSTEMS. STIGMA SEEPS INTO EVERYTHING
THAT WE DO. FOLKS OFTEN ASK ME, YOU KNOW,
ARE YOU CONCERNED THAT FOLKS ARE PAYING ATTENTION TO THE OPIOID
EPIDEMIC NOW THAT WHITE PEOPLE ARE DYING IN RURAL AMERICA?
WELL, AS I’VE SAID TO MANY AUDIENCES, WE’VE BEEN TRYING FOR
YEARS, FOR DECADES, AND SOME OF YOU FOR MOST OF YOUR LIVES TO
GET PEOPLE TO PAY ATTENTION TO BEHAVIORAL HEALTH, TO ADDICTION
AND TO THE DISPARITIES THAT EXIST.
WE NOW HAVE A TREMENDOUS OPPORTUNITY BECAUSE THE COUNTRY
IS PAYING ATTENTION. THEY’RE WILLING TO TALK ABOUT
SOCIAL DETERMINANTS, THEY’RE WILLING TO TALK ABOUT ACES.
SO WHILE WE DON’T WANT TO FORGET WHAT HAPPENED IN THE PAST, WE
WANT TO LEARN FROM WHAT HAPPENED IN THE PAST.
I WANT US TO LOOK FORWARD, I WANT US TO USE THIS OPPORTUNITY
TO HAVE THAT DISCUSSION. BECAUSE OUT OF THIS TRAGEDY THAT
IS THE NATIONAL OPIOID EPIDEMIC, THERE IS A TREMENDOUS
OPPORTUNITY IF WE CAN FOCUS ON MAKING SURE FUNDING OR PROGRAMS
ARE APPLIED IN AN EQUITABLE PROCESS.
HERE AT HHS WE’RE LEADING THE WAY AS A NATION RESPONSE TO THE
OPIOID EPIDEMIC AND ATTEMPTS TO ADDRESS DISPARITIES.
WE’RE ADDRESSING OVERPRESCRIBING, ILLICIT DRUG
SUPPLIES, INSUFFICIENT ACCESS TO EVIDENCE-BASED TREATMENT,
PRIMARY PREVENTION AND RECOVERY SUPPORT SERVICES.
IT’S IMPORTANT THAT FOLKS IN THIS ROOM KNOW THAT THERE’S A
PERSON DYING OF AN OPIOID OVERDOSE EVERY 12.5 MINUTES AND
SHOCKINGLY, THE MAJORITY OF THOSE INDIVIDUALS ARE DYING AT
HOME. THAT’S WHY I ISSUED THE FIRST
SURGEON ADVISORY IN OVER 10 YEARS EARLIER THIS MONTH,
HELPING RAISE AWARENESS ABOUT NALOXONE, A MEDICATION WHICH CAN
REVERSE THE EFFECT OF AN OPIOID OVERDOSE, AND ENCOURAGING FOLKS
TO CONSIDER CARRYING NALOXONE IF YOU OR A LOVED ONE IS AT RISK.
I WANT EVERYONE IN THE ROOM AND EVERYONE VIRTUALLY TO KNOW THAT
ANYONE CAN BE A LIFE SAVER, AND THAT ANYONE CAN USE THAT
OPPORTUNITY TO CONNECT FOLKS TO TREATMENT AND TO RECOVERY AND TO
HAVE A CONVERSATION ABOUT PREVENTION.
I WANT TO CLOSE BY STATING THAT EVERY ONE YOU HAVE IN THIS ROOM
AND EVERY ONE OF US WITH US VIRTUALLY IS SEEN AS A LEADER IN
YOUR COMMUNITY. THAT MEANS YOU HAVE NOT ONLY AN
OPPORTUNITY BUT A RESPONSIBILITY TO LEAD BY EXAMPLE.
IT IS IMPERATIVE THAT WE ALL USE OPPORTUNITIES LIKE WE HAVE TODAY
TO USE PLATFORMS TO MAXIMUM EFFECT AND THAT STARTS WITH
HUMILITY AND IT STARTS WITH SERVANT LEADERSHIP.
I LEAVE YOU TODAY WITH A FEW CHALLENGES.
A FEW CALLS TO ACTION. IF YOU OR SOMEONE YOU KNOW IS AT
RISK FOR AN OVERDOSE, CARRY AND KNOW HOW TO USE NALOXONE, AN
EASY TO USE AND LIFE SAVING MEDICATION THAT CAN REVERSE THE
EFFECTS OF OVERDOSE. SECOND, I CHALLENGE YOU TO SHARE
YOUR STORY ON CRISISNEXTDOOR.GOV.
I’VE SHARED MY STORY WITH YOU TODAY.
THERE ARE MANY FOLKS WHO HAVE SHARED THEIR STORIES ON THAT
WEBSITE AND AS LEAH AND I DISCUSSED EARLIER ARE THIS
MORNING, THE ONLY WAY WE’RE GOING TO TURN AROUND STIGMA IS
BY HELPING FOLKS SEE THAT THERE IS NO MORE “US” AND THEN BECAUSE
THAT’S WHAT STIGMA IS, WHEN YOU TAKE A GROUP OF PEOPLE AND
DIVIDE THEM INTO US AND THEM. US AND THEM IS OVER.
THIS OPIOID EPIDEMIC IS AFFECTING ALL OF US AND MORTGAGE
THAT PEOPLE CAN SEE THAT, AND THE MORE THAT PEOPLE CAN SEE
STORIES OF RECOVERY SUCH AS LEAH’S, THE MORE WE WILL BE ABLE
TO REALLY SEE ADDICTION FOR WHAT IT IS AND THAT IS A CHRONIC
DISEASE THAT CAN BE TREATED AND NOT A MORAL FAILING.
THEN FINALLY I CHALLENGE YOU TO THINK ABOUT MY STORY FROM
INDIANA ON INFANT MORTALITY. I DIDN’T GO INTO THOSE WHITE
COMMUNITIES AND SAY BLACK BABIES ARE DYING.
I SAID INFANT MORTALITY AFFECTS ALL OF US, IT AFFECTS URBAN
COMMUNITIES AND RURAL COMMUNITIES.
IT AFFECTS PEOPLE WHO ARE POOR AND PEOPLE WHO ARE RICH.
AND IF WE CAN ADDRESS INFANT MORTALITY IN A MEANINGFUL WAY,
IT WILL LIFT US ALL U WE NEED TO DO THAT WITH THE OPIOID
EPIDEMIC. THINK ABOUT HOW TO BE A MORE
EFFECTIVE COMMUNICATOR BECAUSE THE FACT IS WE KNOW WHAT TO DO,
WE’VE GOT THE EVIDENCE, WE’VE GOT TO HELP PEOPLE UNDERSTAND
THEIR ROLE IN DOING IT. IF WE DON’T RECOGNIZE THAT
REALITY, IF WE DON’T CARE THAT IN MANY CASES WE’RE IN A FOREIGN
LAND SPEAKING A FOREIGN LANGUAGE LIKE WHEN I GO TO THOSE RURAL
ALL-WHITE COMMUNITIES TO TALK ABOUT OPIOIDS OR TO TALK ABOUT
INFANT MORTALITY, THEN WE’RE NOT GOING TO GET OUR MESSAGE ACROSS
AND WE’RE GOING TO CONTINUE TO SUFFER FROM STIGMA.
MY MOTTO IS BETTER HEALTH THROUGH BETTER PARTNERSHIPS
BECAUSE NO MATTER WHAT AREA OF PUBLIC HEALTH YOU’RE PASSIONATE
ABOUT, IF YOU COMMIT TO FORGING BETTER PARTNERSHIPS, BETTER
HEALTH IS SURE TO FOLLOW. I’VE SEEN IT THROUGHOUT MY
CAREER, I’VE SEEN IT IN INDIANA, I’VE SEEN IT IN THE OPERATING
ROOM AS AN ANESTHESIOLOGIST AND AS THE UNITED STATES SURGEON
GENERAL. THANK YOU AGAIN TO THE OFFICE OF
MINORITY HEALTH AND TO ALL OF YOU FOR GATHERING SUCH A DIVERSE
GROUP OF INDIVIDUALS TO COLLABORATE WITH ONE ANOTHER.
IT’S BEEN A PLEASURE TO ADDRESS YOU ALL, AND I AM SO LOOKING
FORWARD TO THE PANEL AND I TREASURE THE OPPORTUNITY TO BE
YOUR SURGEON GENERAL AS WE TALKED ABOUT EARLIER TO BLOCK
FOR YOU GUYS SO THAT YOU CAN RUN THE BALL INTO THE END ZONE
BECAUSE WE’VE GOT AN OPPORTUNITY, WE’VE GOT A MANDATE
TO WIN THIS GAME, IF WE ALL FIGURE OUT OUR ROLES WHERE WE
CAN BE VALUABLE ON THE FIELD AND PLAY OUR PARTS.
THANK YOU SO MUCH. [APPLAUSE]
>>THANK YOU VERY MUCH, SURGEON GENERAL ADAMS, FOR THOSE VERY
INSPIRING WORDS. I THINK IT MOTIVATES ALL OF US
TO GET ON THE PLAYING FIELD AND BLOCK AND WORK WITH EACH OTHER.
GOOD MORNING. I’M LARKE HUANG, THE DIRECTOR OF
THE OFFICE OF BEHAVIORAL HEALTH EQUITY AT THE SUBSTANCE ABUSE
AND MENTAL HEALTH SERVICE ADMINISTRATION.
WE’RE VERY PLEASED TO PARTNER WITH DR. JAMES AND HER TEAM AT
THE CMS, OFFICE OF MINORITY HEALTH, ON THIS FORUM.
I HAVE THE HONOR OF INTRODUCING OUR PANELISTS TODAY ON THE ISSUE
OF OPIOIDS AND COMMUNITIES OF COLOR.
I’M GOING TO DO QUICK INTRODUCTIONS OF THEM.
YOU HAVE THEIR BIOS MORE EXTENSIVE AND A VERY IMPRESSIVE
BIOS IN YOUR PACKETS AND ONLINE. THEN I’M GOING TO ASK THEM TO
EACH COME UP. FIRST WE START WITH DR. BENJAMIN
COOK IN THE CENTER FOR MULTICULTURAL MENTALITY HEALTH
RESEARCH AND ASSISTANT PROFESSOR AT HARVARD MEDICAL SCHOOL.
HIS RESEARCH INTERESTS ARE IMPROVING METHODS FOR MEASURING
DISPARITIES AND APPLYING THESE METHODS TO UNDERSTAND MECHANISMS
UNDERLYING MENTAL HEALTH AND SUBSTANCE USE DISPARITIES.
HIS COMMENTS ARE ENTITLED OPIOIDS RESEARCH IN MINORITY
COMMUNITIES. BEN, DO YOU WANT TO COME UP?
MISS LEAH COOK IS A LONG TIME RESIDENT OF BALTIMORE CITY.
SHE GRADUATED FROM LOYOLA UNIVERSITY IN 2017 WITH HER
BACHELOR’S IN BIOLOGY, CURRENTLY A BALTIMORE CORE FELLOW WHO
STRIVES TO MAKE EQUITY AN ESSENTIAL PART OF GOVERNMENT
AGENCIES. HER EXPERTISE LIES WITHIN HER
PERSONAL STORY OF ADDICTION AND TRAUMA.
SHE USES STORYTELLING AS A WAY TO INCITE EMOTION AND CHANGE.
HER COMMENTS ARE ENTITLED “MY FAMILY STORY OF ADDICTION.”
DR. SHELLY CHOO IS SENIOR MEDICAL ADVISOR IN THE BALTIMORE
CITY HEALTH DEPARTMENT. SHE LEADS CONVENINGS WITH CITY
PHYSICIANS AROUND BEHAVIORAL AND POPULATION HEALTH INITIATIVES.
SHE PREVIOUSLY SERVED AS A SENIOR MEDICAL ADVISER AND THE
BUREAU OF MATERNAL AND CHILD HEALTH.
SHE IS BOARD CERTIFIED IN GENERAL PREVENTIVE MEDICINE AND
PUBLIC HEALTH AND SHE WILL COMMENT ON OPIOID INITIATIVES IN
BALTIMORE CITY. FINALLY, DR. KAREN SMITH IS A
CMS CLINICIAN CHAMPION AND FAMILY PHYSICIAN PRACTICING IN
THE RURAL COMMUNITY OF RAEFORD, NORTH CAROLINA, PART OF THE HOPE
COUNTY COMMUNITY FOR 26 YEARS, PROVIDING ACUTE, CHRONIC AND
PREVENTIVE CARE. MOST RECENTLY SHE HAS BEEN
PROVIDING SERVICES IN THE TREATMENT OF SUBSTANCE USE
DISORDERS, PARTICIPATING IN HEALTHCARE REFORM INITIATIVES,
AND ON-SITE EDUCATION EXPERIENCE FOR LEARNERS IN HEALTHCARE.
SHE WILL PROVIDE OBSERVATIONS FROM THE CLINIC.
SO I’M GOING TO TURN IT OVER TO OUR PANELISTS, WE’RE GOING TO
START WITH BEN AND I’M GOING TO KEEP TIME.
>>IT’S WONDERFUL TO BE HERE. THANK YOU TO DR. JAMES AND
DR. WONG FOR THE INVITATION AND FOR SETTING UP THIS EVENT.
SUCH AN IMPORTANT EVENT, YOU’VE DONE SO MUCH WORK IN RAISING
AWARENESS ON THESE ISSUES AROUND THE OPIOID CRISIS AND AROUND
RACIAL AND ETHNIC DISPARITIES IN GENERAL, BUT PARTICULARLY THIS
FOCUS ON RACIAL AND ETHNIC MINORITIES, AND OPIOID USE
DISORDER IS SUCH AN IMPORTANT ONE.
I’M GOING TO DIG INTO THE DATA BY TALKING ABOUT ALL THE DATA
WE’VE BEEN COLLECTING ON THIS EPIDEMIC AND HOW IT MIGHT BE
EVOLVING. I’M GOING TO TRY TO DO THREE
THINGS, FIRST I’D LIKE TO LOOK AT TRENDS IN MORTALITY, OPIOID
MISUSE, I WANT TO DISTINGUISH BETWEEN THOSE TWO THINGS AND DO
THAT BY RACE/ETHNICITY. I WANT TO TAKE THIS OPPORTUNITY
TO APOLOGIZE THAT WE DON’T HAVE A LOT OF DATA ON CERTAIN RACIAL
GROUPS SUCH AS AMERICAN INDIAN, NATIVE AMERICANS, WE DON’T HAVE
GREAT DATA ABOUT SUBRACIAL GROUPS, SUBETHNIC GROUPS SO I
WANT TO TAKE THIS TIME TO APOLOGIZE THAT A LOT OF WHAT
YOU’LL SEE WILL BE COMPARISONS BETWEEN NON-HISPANIC WHITES,
HISPANICS OR LATINOS AND AFRICAN-AMERICANS.
THE SECOND THING I WANT DO IS FOCUS ON ACCESS TO
MEDICATION-ASSISTED OPIOID USE DISORDER TREATMENT, WHAT DO WE
KNOW ABOUT TREATMENT, WHAT DO WE KNOW ABOUT ACCESS TO THAT
TREATMENT. THE THIRD THING WE’LL GO OVER IS
ONCE YOU DO ACCESS TREATMENT, WHAT DO THE OUTCOMES LOOK LIKE,
WHAT DOES QUALITY LOOK LIKE BY RACE/ETHNICITY?
SO I WANT TO BREAK IT INTO 1998 TO 2014 AND 2015 TO 2016.
I THINK WE’RE STARTING TO SEE THE EVOLUTION OF THE EPIDEMIC IN
THESE LAST COUPLE YEARS. THIS IS WHAT THAT EARLY PERIOD
LOOKS LIKE IN SOME SENSE, IS CAPTURED BY THIS “NEW YORK
TIMES” ARTICLE THAT SAYS DRUG OVERDOSES PROPEL RISE IN
MORTALITY RATES OF YOUNG WHITES, AND THEN THIS KIND OF SEMINAL
ARTICLE THAT CAME OUT SHOWING RISING MORBIDITY AND MORTALITY
IN MID LIFE AMONG WHITE NON-HISPANIC AMERICANS IN THE
21ST CENTURY. REALLY IT’S THIS FIGURE THAT GOT
A LOT OF ATTENTION AND THIS IS A REAL STRIKING FIGURE.
YOU CAN SEE THAT FOR EVERYONE, MORTALITY IS GETTING BETTER.
THE DEATHS PER 100,000 IS GETTING BETTER OVER TIME.
AND THAT’S IN FRANCE, GERMANY, BUT LOOK AT THAT INFLECTION
POINT FOR U.S. WHITES BETWEEN 45 AND 54 YEARS OLD.
THAT’S SOMETHING WE JUST HAVEN’T SEEN, THAT MORTALITY RATES HAVE
THAT INFLECTION POINT AROUND 1990.
IN THE LATE 1990S. SO WHAT DO WE KNOW ABOUT THAT?
WE KNOW THERE’S SOMETHING IN THAT CASE THAT THERE’S AN
INFLECTION POINT IN 1998, A LOT OF IT IS DUE TO DRUG USE,
OVERDOSE, SUICIDE, CIRRHOSIS. ALCOHOL AND OPIOID USE PLAYED A
BIG PART IN WHAT’S GOING ON WITH THAT INFLECTION POINT.
THERE ARE A NUMBER OF STUDIES THAT SHOW THIS BETWEEN PAIN,
MEDICATION PRESCRIPTION IN THE 90S WITH THESE STARK CHANGES
FOR THAT WHITE POPULATION. WE ALSO KNOW THAT AROUND THIS
TIME A LOT OF POLICIES CAME INTO EFFECT THAT TRIED TO LIMIT THE
AMOUNT OF PAIN MEDICATIONS THAT WERE IN CIRCULATION.
SO BETTER PRESCRIPTION MANAGEMENT, BETTER PHARMACY
MANAGEMENT, BETTER MONITORING OF PRIMARY CARE AND PRESCRIBERS,
AND THAT LED TO A SUBSTITUTION OF HEROIN FOR THIS GROUP OF
FOLKS THAT WERE ADDICTED TO PAIN MEDICATIONS.
ADD TO THAT SO MANY WHITES INITIATING HEROIN USE BEFORE
THAT BUT THEN YOU ADD TO THAT THE FALLING PRICE OF HEROIN
DURING THIS TIME PERIOD AND THE RISING POTENCY OF HEROIN IN THIS
TIME PERIOD. ADDING FENTANYL TO THE HEROIN
THAT’S AVAILABLE, YOU START TO SEE AVAILABILITY TO HEROIN IN
NEW AREAS. SO THAT’S KIND OF WHAT’S
TRENDING TOWARDS THE LATTER PART OF THIS PERIOD.
SO NOW WE MOVE TO 2015 AND 2016, YOU’VE SEEN THIS PAIN
MEDICATION, A LOT OF OVERDOSE, REALLY SKYROCKETING RATES, NOW
START TO ENTER RACIAL AND ETHNIC MINORITY COMMUNITIES IN 2015 AND
2016. AND THIS IS SORT OF THE NEW
CHANGE IN TREND THAT I WANTED TO BRING NOTICE TO SO IN A NUMBER
STATES RACIAL AND ETHNIC MINORITIES HAVE HIGHER OVERDOSE
RATES THAN WHITES IN MANY STATES THIS IS COMING FROM THE CDC
COMPILED BY KAISER FAMILY FOUNDATION.
YOU CAN SEE IN SOME STATES LIKE IN MISSOURI, THE BLACK RATE HAS
ACTUALLY SURPASSED THE WHITE RATE IN TERMS OF OPIOID OVERDOSE
DEATHS. AND YOU CAN SEE THAT HAPPEN IN
ABOUT 2013, AND THAT KIND OF STARK SLOPE IS SOMETHING THAT
WE’LL SEE A LOT IN THESE FIGURES BETWEEN 2015 AND 2016.
YOU START TO SEE THAT LINE ALMOST GO VERTICALLY.
NOW WE’RE TALKING ABOUT 28 PER 100,000 PEOPLE IN MISSOURI ARE
HAVING OPIOID OVERDOSE DEATHS IN THE BLACK POPULATION.
IN MASSACHUSETTS WHERE I’M FROM, WE’RE SEEING HISPANIC RATES
NEARING WHITE RATES. YOU CAN SEE AGAIN WE HAVE THOSE
KIND OF STARK INCLINES OVER THERE, AND THAT MIDDLE LINE IS
THE HISPANICS CATCHING UP TO WHITES IN MASSACHUSETTS.
SO YOU SEE THIS DISTURBING TREND OF OPIOID OVERDOSE DEATHS REALLY
INCREASING IN 2015 AND 2016 AND YOU SEE HISPANICS CATCHING UP TO
WHITES. HERE’S THAT DISTURBING TREND
AGAIN, THE SLOPE SHIFT IN THE LATER YEARS OF THESE FIGURES
ALSO. IN OHIO, THE WHITE RATE
CONTINUES TO CLIMB, YOU’RE STARTING TO SEE THE BLACK RATE
HAVE THAT SAME SLOPE IN 2015 AND 2016.
THEN I WANT TO MENTION IN THE DISTRICT OF COLUMBIA WHERE WE
ARE NOW THAT THE BLACK RATE IS THE HIGHEST IN THE COUNTRY OF
ANY RACIAL AND ETHNIC GROUP, SO AT 50 PER 100,000 PEOPLE IN THE
DISTRICT OF COLUMBIA FOR THE BLACK POPULATION.
THERE HASN’T BEEN A LOT OF DATA COLLECTED FOR WHITE, HISPANIC,
NATIVE AMERICAN AND ASIAN, BUT THAT RATE OF 50 PER 100,000 IS
AS BAD AS ANY OTHER PLACE IN THE ENTIRE COUNTRY FOR ANY RACIAL
AND ETHNIC GROUP. ALSO THE FACTOR OF THE SHIFT
THAT A LOT OF THESE DEATHS PER 100,000 HAVE BEEN MOVING INTO
URBAN AREAS. SO IN 2015 AND A 2016, YOU STILL
SEE THAT SAME TREND SHIFT UPWARDS FOR URBAN AREAS AND KIND
OF THE SCISSORS EFFECT BETWEEN URBAN AND RURAL AREAS FOR WHITES
AND BLACKS. IF WE STEP BACK AND LOOK AT
MISUSE, WE SEE FROM THE NATIONAL SURVEY ON DRUG USE AND HEALTH
ABOUT 4.7% OF WHITES IN A NATIONAL SAMPLE MISUSING
OPIOIDS. 4% OF BLACKS, 4.4% OF HISPANICS
AND ASIANS, ABOUT 2%. SO THIS IS WHERE WE’RE SEEING A
LOT OF MISUSE. IF YOU PUT THAT INTO MILLIONS OF
PEOPLE, YOU’RE TALKING ABOUT 8 MILLION WHITES IN THE U.S.,
STILL 300,000 ASIANS THAT ARE STRUGGLING WITH OPIOID USE AND
MISUSE. WE’RE STARTING TO SEE A CHANGE
IN INFLECTION POINT IN THIS EPIDEMIC OF OPIOID USE.
BLACKS — SOME OF THE EXPLANATIONS THAT PEOPLE HAVE
PUT OUT THERE IS THAT BLACKS, HISPANICS AND ASIANS RECEIVED
PAIN MEDICATIONS IN THE LATE 1990S AT LOWER RATES COMPARED
TO WHITES. PRESCRIBES LESS FOR ARE
AFRICAN-AMERICANS AND LESS FOR HISPANICS BECAUSE THEY HAD
DIFFERENT ASSESSMENTS OF THEIR PAIN LEVELS AND TREATMENT.
THERE’S BEEN SOME ARTICLES ABOUT THAT, ALSO A CONCERN THAT’S BEEN
FOUND IN SOME OF THE RESEARCH THAT SHOWS THAT CLINICIANS ARE
MORE LIKELY TO BE CONCERNED THAT MINORITIES MIGHT MISUSE OR
RESELL THE PRESCRIPTIONS SO YOU HAVE ALMOST THIS PROTECTIVE
EFFECT IN THE LATE ’90S THAT THERE JUST WASN’T AS MUCH PAIN
MEDICATION PRESCRIPTION HAPPENING IN MINORITY
COMMUNITIES. BUT NOW YOU SEE THIS OVERDOSE
RISK MOVING FROM PAIN MEDICATION MISUSE THAT’S MUCH MORE TIGHTLY
REGULATED INTO HEROIN. NOW WE’RE TALKING ABOUT HEROIN
LACED WITH FENTANYL AND CARFENTANYL AND THAT MOVE
TOWARDS URBAN HEROIN USERS IS CHANGING WHAT WE’RE SEEING ABOUT
OVERDOSE RATES IN THE U.S. AND THE DEMOGRAPHICS OF THOSE
OVERDOSES. SO THAT’S A QUICK SUMMARY OF
MORTALITY OVERDOSE AND MISUSE BY RACIAL AND ETHNIC GROUP, AND NOW
I’D LIKE TO TALK A LITTLE BIT ABOUT WHAT THE STATISTICS LOOK
LIKE FOR OPIOID USE DISORDER TREATMENT IN THE U.S. AND I’M
REALLY FOCUSED ON ACCESS HERE. SO THESE NUMBERS TO ME ARE THE
MOST STARK OF ALL OF THE NUMBERS THAT I HAVE, AND HAVE BEEN FOR A
WHILE, SO THIS IS AMONG THOSE WITH OPIOID MISUSE, HOW MANY GET
ANY SUBSTANCE USE TREATMENT AT ALL.
AND IT’S 5%, RIGHT? SO OF THOSE WHO HAVE MISUSED
OPIOIDS IN THE LAST YEAR, 4.5% OF WHITES, 4.7% OF BLACKS AND
1.7% OF HISPANICS RECEIVED ANY TREATMENT AT ALL FOR PAIN
MEDICATION AND ABUSE OF PAIN RELIEVERS.
LET’S BROADEN THAT AND SAY DID THEY GET ANY ILLICIT DRUG
TREATMENT AT ALL? NOW WE’RE IN THE 7% RANGE, 4.5%
FOR LATINOS. THIS IS A PATTERN OF SUBSTANCE
USE TREATMENT IN THE U.S. OF THOSE PEOPLE WITH SUBSTANCE
USE DISORDERS, REALLY ABOUT 10% HAD EVER RECEIVED TREATMENT.
WHAT WE’RE SEEING HERE FOR SUBSTANCE USE, FOR PAIN
RELIEVERS AND FOR HEROIN, IS THAT THOSE NUMBERS ARE EVEN
LOWER WHEN YOU HAVE LATINO COMMUNITIES HAVING EVEN LOWER
RATES STILL. WE KNOW THAT — AND THE SURGEON
GENERAL BROUGHT THIS UP TOO, THAT THERE’S THIS CONNECTION
BETWEEN SUBSTANCE ABUSE AND THE CRIMINAL JUSTICE SYSTEM.
UNFORTUNATELY THOSE WHO HAVE HAD ANY SUBSTANCE USE TREATMENT ARE
VERY LIKELY TO HAVE INTERACTED WITH THE CRIMINAL JUSTICE
SYSTEM. SO OF THOSE THAT HAD ANY
SUBSTANCE USE TREATMENT AT ALL IN THE LAST YEAR IN THIS TIME
PERIOD BETWEEN 2013 AND 2016, 60 TO 70% OF THEM HAD INTERACTIONS
WITH THE CRIMINAL JUSTICE SYSTEM.
EITHER THEY WERE ARRESTED OR BOOKED, AND THEN YOU GET DOWN TO
20 OR 30% THAT WERE ON PROBATION IN THE LAST YEAR AND THEN 5 TO
10% THAT WERE ON PAROLE OR RELEASED IN THE LAST YEAR.
I PUT THIS SLIDE UP THERE TO SHOW YOU HOW INTERCONNECTED THE
SUBSTANCE USE TREATMENT SYSTEM IS IN THIS COUNTRY WITH THE
CRIMINAL JUSTICE SYSTEM. IN SOME WAYS, YOU WILL HAVE TO
MAKE IT TO ROCK BOTTOM IN ORDER TO GET TREATMENT.
THAT SEEMS BACKWARDS THAT WE RELY ON THE CRIMINAL JUSTICE
SYSTEM TO MANDATE BECAUSE OF PROBATION, MANDATE THAT YOU GO
TO SUBSTANCE USE TREATMENT. IT TO HAVE PA A ROLE OR YOUR
RELEASE BE CONDITIONAL ON SUBSTANCE USE TREATMENT.
THE TREATMENT SHOULD HAPPEN LONG BEFORE THAT.
AND THEN I WANT TO BRING UP THIS ISSUE OF RACIAL AND ETHNIC
DISPARITIES IN MENTAL CARE ACCESS, BECAUSE OF THE
CO-MORBIDITY BETWEEN SUBSTANCE USE DISORDER AND MENTAL HEALTH
ISSUES. SO THIS IS ONE OF MANY STUDIES
THAT HAVE BEEN DONE THAT SHOW THAT WHITES ARE TWICE AS LIKELY
TO ACCESS MENTAL HEALTHCARE THAN RACIAL AND ETHNIC MINORITIES.
WE’VE DONE THIS A LOT OF DIFFERENT WAYS.
WE’VE LOOKED WITHIN DEPRESSED POPULATIONS WITH ANXIETY
DISORDER, WE’VE ADJUSTED FOR MENTAL HEALTH DISORDER, WE’VE
LOOKED AT FOLKS WITHIN PSYCHOLOGICAL DISTRESS AND YOU
SEE THIS PERSISTENT 2 TO 1 DISPARITY IN MENTAL HEALTHCARE
ACCESS. SO YOU ADD THAT TO THE SUBSTANCE
USE TREATMENT RATES THAT WE JUST SAW THAT WERE SO LOW, AND YOU
CAN SEE HOW THERE’S A REAL BUDDING PROBLEM WITH TREATMENT
OF RACIAL AND ETHNIC MINORITIES WITH SUBSTANCE USE DISORDER.
SO THAT’S THE SECOND TAKEAWAY THAT I WANT YOU TO HAVE, IS THAT
THERE’S JUST INADEQUATE TREATMENT ACCESS IN THE U.S.
THERE’S A LOT OF BARRIERS TO TREATMENT IN THE U.S., NOW THINK
ABOUT EVIDENCE BASED MEDICATION ASSISTED TREATMENT SUCH AS
NALTREXONE, THINKING ABOUT BUPRENORPHINE AS AN ADDITION TO
COGNITIVE BEHAVIORAL THERAPY AND OTHER TYPES OF THERAPY.
THE SUPPLY OF FOLKS THAT ARE LICENSED TO GIVE OUT
BUPRENORPHINE AND SOME OF THESE OTHER MEDICATIONS IS REALLY
LIMITED, AND THAT’S ESPECIALLY TRUE IN SOME STATES AND
NON-URBAN AREAS. THERE’S COST BARRIERS EVEN FOR
THOSE WHO ARE INSURED, IT’S JUST FAR TOO DIFFICULT IN THESE EARLY
STAGES OF ADDICTION TO GET ANY TREATMENT OF AT ALL.
MOTIVATIONAL INTERVIEWING, MINDFULNESS INTERVENTION, OTHER
NON-MEDICATION TREATMENT ALSO, VERY DIFFICULT TO ACCESS BECAUSE
OF STIGMA AND ALSO STRUCTURAL FACTORS THAT JUST MAKE IT
DIFFICULT TO ACCESS MENTAL HEALTH AND SUBSTANCE USE
TREATMENT. THEN WE HAVE THIS ISSUE THAT A
MAJORITY RECEIVING SUBSTANCE USE TREATMENT ARE GETTING MANDATED
TREATMENT, THEY’RE GETTING THEIR SERVICES IN MANDATED TREATMENT
PROGRAMS FOR PAROLE OR PROBATION REQUIREMENT.
LET ME MOVE QUICKLY TO WHAT HAPPENS FOR THOSE FEW THAT MAKE
IT INTO SUBSTANCE USE TREATMENT FACILITIES.
SO NOW THERE’S SOME GOOD NEWS HERE THAT IF WE’RE THINKING
ABOUT OPIOID AGONIST TREATMENTS, SOME OF THESE MEDICATIONS THAT
HAVE BEEN SHOWN TO WORK VERY WELL FOR RECOVERY WHEN THEY’RE
PAIRED WITH OTHER TYPES OF TREATMENT, WE SEE THAT
AFRICAN-AMERICANS AND HISPANICS ARE CLOSER TO 50% OR 40% OF
THOSE IN TREATMENT FACILITIES ARE GETTING THESE OPIOID AGONIST
TREATMENTS. WHITES, ONLY —
A LOT OF WORK TO BE DONE FOR EVERYTHING, BUT HERE
YOU SEE THAT AFRICAN-AMERICANS AND HISPANICS ARE MORE LIKELY TO
BE MEDICATED. NOW IF WE LOOK AT TREATMENT
COMPLETION, WHO MAKES IT OUT OF THESE PROGRAMS, COMPLETING THEIR
TREATMENT PLAN, YOU SEE BLACKS, HISPANICS, NATIVE AMERICANS WHO
HAVE HEROIN USE DISORDER ARE MUCH LESS LIKELY TO COMPLETE
THEIR TREATMENT. LESS THAN 50% OF FOLKS WHO ARE
MAKING IT INTO THESE TREATMENT CENTERS ARE COMPLETING THEIR
TREATMENT, ARE FULFILLING THEIR TREATMENT PLAN.
SO THAT’S A COUPLE OF SLIDES TO GET YOU TO THIS THIRD TAKEAWAY,
THAT THERE’S LOW QUALITY OF SPECIALTY SUBSTANCE USE
TREATMENT. IF YOU MAKE IT OVER ALL OF THOSE
HURDLES TO GET INTO TREATMENT, NOW HALF OF THEM AREN’T GOING TO
COMPLETE TREATMENT. LESS THAN HALF OF THEM ARE GOING
TO GET ANY MEDICATION ASSISTANCE WITH THEIR TREATMENT.
THAT’S STILL ABOUT 2 MILLION PEOPLE IN THE U.S. RACIAL AND
ETHNIC MINORITIES ARE 40% OF THE ADMISSIONS IN THESE PUBLICLY
FUNDED TREATMENT CENTERS SO THAT LOW QUALITY IS BEING TRANSFERRED
ON TO RACIAL AND ETHNIC MINORITIES IN THE U.S.
SO THOSE ARE THE THREE THINGS THAT I WAS TRYING TO WALK YOU
THROUGH. ONE IS THAT THERE’S SOME —
QUITE A BIT OF EVIDENCE THAT THE OPIOID EPIDEMIC IS SHIFTING,
WITH INCREASING OVERDOSE RISKS FOR BLACKS LAND TEE KNOWS AND
THIS MOVEMENT INTO HEROIN AND THE STOCKS AND SUPPLIES THAT ARE
IN URBAN AREAS. THE SECOND THING THAT I WANT TO
YOU TAKE HOME IS THERE ARE THESE EXTREMELY LOW RATES OF ACCESS TO
SUBSTANCE USE TREATMENT IN THE U.S.
LESS THAN 5%. YOU NEVER SEE SOMETHING LIKE
THIS FOR CARDIOVASCULAR CARE, YOU’D NEVER SEE SOMETHING LIKE
THIS FOR DIB. LESS THAN 10% FOR SUBSTANCE USE,
AND EVEN LOWER FOR LATINOS. THE THIRD THING I WANT YOU TO
TAKE HOME IS THAT MEDICATION ASSISTED TREATMENT WHICH HAS
BEEN PROVEN TO BE SUCCESSFUL IS STILL NOT THE NORM EVEN ONCE
THEY MAKE IT INTO SUBSTANCE USE TREATMENT FACILITIES AND
TREATMENT COMPLETION RATES ARE VERY LOW FOR RACIAL AND ETHNIC
MINORITIES. THINKING ABOUT WHERE REFORM CAN
HAPPEN THIS, IS GOING TO TAKE A PUBLIC HEALTH APPROACH, IT’S
GOING TO TAKE EFFORTS FROM OMH AND SAMHSA AND THE SURGEON
GENERAL. IN MULTIPLE PARTS OF THE
CONTINUUM, THINKING ABOUT PREVENTION, TREATMENT, HOW WE
MAINTAIN TREATMENT, IT’S GOING TO REQUIRE A PUBLIC HEALTH
APPROACH. INSURANCE REFORM ISN’T GO TO DO
AS MUCH AS WE HOPE. THE AFFORDABLE CARE ACT, WE’VE
DONE A COUPLE OF STUDIES THAT HAVE SHOWN THAT THE DEPENDENT
COVERAGE PROVISION HAS INCREASED MENTAL HEALTHCARE USE IN THE
U.S. BUT NOT INCREASE SUBSTANCE USE TREATMENT.
THE EXCHANGES IN MEDICAID EXPANSION INCREASED MENTAL
HEALTHCARE WHICH IS A GOOD THING BUT IT DIDN’T REDUCE RACIAL AND
ETHNIC DISPARITIES IN MENTAL HEALTHCARE AND DIDN’T INCREASE
ACCESS TO SUBSTANCE USE TREATMENT.
SO INSURANCE IS A GOOD FIRST STEP BUT YOU NEED STEPS AFTER
COVERAGE IN ORDER TO RECEIVE QUALITY CARE.
LET ME END WITH INDIVIDUALS IN THE THROES OF SUBSTANCE
DEPENDENCE ARE UNLIKELY TO VOLUNTARILY ENTER TREATMENT.
THIS IS A HARD THING TO GET FOLKS WHO ARE ADDICTED INTO
TREATMENT. WE HAVE TO DO MORE THAN JUST
INCREMENTAL CHANGES IN ORDER TO MAKE THIS HAPPEN.
THERE ARE SOME OTHER NICE MODELS IN SPAIN, FOR EXAMPLE, COMMUNITY
HEALTH CENTERS ARE OPEN LONG HOURS AND ON WEEKENDS, THEY HAVE
CLINICIANS READY TO DO THE INTAKE AND PROVIDE MEDICATIONS
EARLY ON AND THEY’RE MORE AVAILABLE.
HERE YOU HAVE TO GO TO A PRIMARY CARE PROVIDER, GET A REFERRAL,
AND THEN WAIT FOR THAT SPECIALTY PROVIDER WHO MAY NOT EXIST TO
PROVIDE TREATMENT FOR YOU. THAT WINDOW, THAT NARROW WINDOW
IN SOMEBODY WHO’S ADDICTED TO SUBSTANCE USE IS GOING TO CLOSE
IF YOU HAVE TO WAIT FOR THE FOLLOW-UP VISIT.
LASTLY THESE COMMUNITY-BASED HOLISTIC APPROACHES THAT ADDRESS
SOCIAL DETERMINANTS OF HEALTH HOLD A LOT OF PROMISE.
THERE’S QUITE A BIT OF WORK IN DIFFERENT PARTS OF THE COUNTRY
ON DIVERTING FOLKS WITH MENTAL HEALTH PROBLEMS INSTEAD OF
SENDING THEM TO PRISON OR JAIL, WORKING WITH THEIR MENTAL HEALTH
PROBLEMS AND THEIR ADDICTION ISSUES.
THEN COMMUNITY CARE TEAMS, REALLY A FULL COURT PRESS IS
NEEDED HERE, PSYCHOLOGISTS, PSYCHIATRISTS, SOCIAL WORKERS,
COMMUNITY HEALTH WORKERS NEED TO WORK TOGETHER IN ORDER TO
ADDRESS THE EVOLVING EPIDEMIC. THANK YOU VERY MUCH FOR YOUR
TIME AND THE OPPORTUNITY TO BE HERE.
THANK YOU. [APPLAUSE]
>>HI, EVERYONE. MY NAME IS LEAH HILL.
I’M HERE TODAY BECAUSE ADDICTION HAS AFFECTED MY FAMILY.
WHEN I WAS YOUNGER, MY FATHER, HE DIED A COUPLE WEEKS BEFORE MY
BIRTHDAY. SO I DIDN’T GET TO KNOW HIM.
AS YOU CAN SEE IT’S THE OLDER GENTLEMAN IN THE BACK.
MY BROTHER, AND ME IN THE FRONT. I DIDN’T GET TO KNOW HIS
LAUGHTER, I DIDN’T GET TO KNOW HIS SMELL, BUT ONE THING MY
FAMILY DID WAS TO MAKE SURE THAT I KNEW THAT MY FATHER LOVED ME
AND THAT HE HAD UNCONDITIONAL LOVE.
THEY SAY HE TOOK ME EVERYWHERE, THAT HE CARRIED ME LIKE A SACK
OF POTATOES UNDER HIS ARM. I DON’T THINK THAT’S THE WAY
YOU’RE SUPPOSED TO CARRY A CHILD, BUT HE LOVED ME VERY
MUCH. 18 YEARS AFTER HIS DEATH, MY
BROTHER AND A I SAT DOWN, I’M NOT SURE WHAT WE WERE TALKING
ABOUT BUT WE WERE LOOKING THROUGH THE PHOTO ALBUM AND HE
SAID LEAH, I WANT YOU TO HAVE THIS PICTURE.
OKAY, PAUL, WELL, THANK YOU. HE TOLD ME, I WANT YOU TO
LISTEN, LEAH, AND I DON’T WANT YOU TO BE UPSET.
FOR 18 YEARS, MY FAMILY HAS TOLD ME OR HAD TOLD ME THAT MY FATHER
DIED OF A HEART ATTACK. AND THAT DAY, MY BROTHER DECIDED
THAT HE WOULD BE THE ONE TO TELL ME THAT HE DIED OF AN OVERDOSE.
AND ADDICTION HAS BEEN IN MY FAMILY SINCE MY MOTHER, SHE WAS
ALSO ADDICTED TO HEROIN AS WELL. I KNEW THAT ABOUT MY MOTHER.
FOR ME, THE WHY OF HIM DYING OF AN OVERDOSE, IT WAS A SHOCK
BECAUSE THIS WAS THE PARENTS I BELIEVED THAT LOVED ME, THAT
DIDN’T CHOOSE DRUGS OVER ME AND TO KNOW THAT IT WAS TAKEN AWAY,
I WAS SO ANGRY FOR SO LONG. THAT I WASN’T ENOUGH FOR THEIR
LOVE, AND IT WAS HEARTBREAKING. MY BROTHERS AND I WERE IN AND
OUT OF HOMES THROUGHOUT OUR CHILDHOOD.
MY MOTHER WAS IN TREATMENT CENTERS, IN AND OUT.
IT’S NOT UNTIL YEARS LATER WHERE I FINALLY UNDERSTOOD THAT
ADDICTION IS A DISEASE. WHEN I START WORKING IN MENTAL
HEALTH, I FOUND FORGIVENESS. I FOUND UNDERSTANDING.
AND THAT’S WHEN I WAS ABLE TO GROW.
MY MOTHER, THIS IS MY HIGH SCHOOL GRADUATION IN 2013.
MY MOTHER TOLD ME THAT YES, SHE WAS SELFISH AND SHE MADE A
CHOICE BUT TO STOP WAS A VERY HARD CHOICE AND I CAN SAY TODAY
THAT SHE IS MY HERO BECAUSE SHE FOUGHT THROUGH TREATMENT.
SHE — WHEN SHE FAILED, SHE GOT BACK UP, AND SHE DID AGAIN AND
AGAIN. EVEN THOUGH THOSE WERE YEARS SHE
WAS NOT IN MY LIFE, THOSE WERE YEARS SHE WAS TRYING TO GET
BETTER. THERE WASN’T A LOT OF TREATMENT
CENTERS IN BALTIMORE SO I COULDN’T SEE HER BECAUSE SHE WAS
IN OTHER STATES TRYING TO SEEK HELP BECAUSE SHE WANTED TO BE
THERE FOR MY SIBLINGS AND I. AND IT WASN’T EASY, I CAN TELL
YOU, MY BROTHERS AND I, WE JUST — ABOUT THE CHILDHOOD THAT
WE HAD BECAUSE WE DIDN’T HAVE A MOTHER OR A FATHER BECAUSE
ADDICTION HAD TAKEN THEM AWAY. BUT WE UNDERSTAND THAT WE MADE
IT. I GRADUATED FROM LOYOLA
UNIVERSITY THIS YEAR, I JUST TOOK MY M CATS.
[APPLAUSE] AND IT’S THROUGH MY MOTHER’S
SACRIFICE THAT SHE WAS ABLE TO GET TREATMENT, EVEN THOUGH IT
WASN’T ACCESSIBLE, SHE FOUGHT HARD TO GET IT.
UNLIKE OTHER PEOPLE IN BALTIMORE CITY, THE ACCESS TO TREATMENT IS
VERY HARD, THE CONDITION THAT SOME CHILDREN HAVE TO LIVE IN AT
BALTIMORE CITY IS HARD, CHILDREN HAVE THE WEIGHT OF LIVING IN AN
ENVIRONMENT THAT THEY’RE SURROUNDED WITH VIE VENT, VERY
TRAUMATIC EVENTS THAT OCCUR. IT’S HARD GROWING UP IN THE
CITY, NOT HAVING THAT SUPPORT SYSTEM.
MY BROTHERS AND I WERE VERY LUCKY; OTHER CHILDREN WHO GREW
UP IN THIS ENVIRONMENT AREN’T AS LUCKY.
I RECENTLY READ THAT, MY BROTHER, HE WAS A DRUG DEALER.
IN THE DAY, MY MOTHER — MY MOTHER DID NOT PROVIDE FOR US,
AND SO MY BROTHER HAD TO BE THE PROVIDER.
HE HAD TO MAKE REALLY BAD CHOICES TO BE A PARENT TO US AND
I CANNOT SAY THAT HE WAS EVER A BAD PERSON OR SOMETHING WAS
MORALLY WRONG WITH HIM. IT WAS THE SITUATION THAT WE
WERE PUT THE IN, AND IT’S ALSO THE SITUATION THAT OTHER
CHILDREN IN BALTIMORE HAVE TO GO THROUGH.
THAT IN THE SYSTEM WE ARE CHILDREN, THEY FALL THROUGH THE
CRACKS, BECAUSE ADDICTION, IT DOESN’T JUST AFFECT THE PERSON
, IT AFFECTS EVERYONE AROUND US. SO MY BROTHER, OF COURSE HE HAD
A CHOICE, BUT SOMETIMES YOU DON’T, AND IF INADEQUATE
RESOURCES IN OUR COMMUNITIES, WHAT CHOICE CAN WE MAKE?
I’M SO PROUD OF MY BROTHER BECAUSE HE FINALLY IS GETTING
HIS GED. HE’S 35, AND I COULD NOT BE MORE
PROUD OF HIM. BECAUSE WE MADE CHOICES TO
SURVIVE, AND OTHER PEOPLE ARE MAKING THESE SAME CHOICES THAT
LIVE IN THE CITY OF BALTIMORE. IT’S EASIER TO BLAME THE
INDIVIDUAL THAN IT IS TO BLAME THE SYSTEM OF NOT PROVIDING FOR
CHILDREN, OF NOT GIVING THEM RESOURCES, OF PUTTING THEM IN A
BIND THAT THEY HAVE TO MAKE THAT DECISION AT A YOUNG AGE.
I KNOW WHY I’M HERE. I WANT TO ASK YOU WHY ARE YOU
HERE, WHY DO YOU SHOW UP? DRUGS HAVE BEEN IN THE BLACK
COMMUNITIES FOR A VERY LONG TIME NOW.
AND WE HAVE TO ASK THE REASONS WHY WE’RE HERE, WHY NOW, WHY IS
IT SO IMPORTANT NOW. BECAUSE IT WASN’T THE SAME WHEN
MY FATHER, HE DIED OF AN OVERDOSE.
UNTIL WE UNDERSTAND THE REASON WHY WE’RE HERE NOW, THEN A
CERTAIN GROUP OF PEOPLE WILL BE LESS BEHIND, THAT ADDICTION WILL
BE — CONTINUE TO BE STIGMATIZED, THAT THEY WILL BE
OF MORAL FAILING WHILE OTHERS WILL GET TREATMENT AND WILL BE
MORE ACCEPTED INTO SOCIETY. [APPLAUSE]
I WANT TO THANK YOU FOR LISTENING TO ME, I’M SORRY I
CRIED. I REALLY TRIED NOT TO.
BUT THE WOUNDS ARE — THEY’RE HEALING, AND IT’S NOT HARD TO
TALK — IT’S HARD TO TALK ABOUT MY PARENTS BECAUSE OF FEAR OF
JUDGMENT THAT PEOPLE MAY HAVE TOWARD THEM OR THE CHOICES THEY
HAD TO MAKE. MY MOTHER TOLD ME THAT SHE WAS
SELFISH AND THAT IN THE BEGINNING, THAT SHE WANTED IT
ALL, BUT IT WAS OVERWHELMING AND THAT SHE WAS SORRY THAT SHE LET
THIS TAKE OVER HER LIFE, THAT IT WAS LIKE SHE WAS IN A PRISON IN
HER OWN BODY, THAT SHE HAD GOOD INTENTIONS AND THAT SHE LOVED ME
AND MY BROTHER SO VERY MUCH, BUT IT’S SOMETHING THAT TOOK A VERY
LONG TIME TO OVERCOME, AND I’M VERY PROUD OF HER, AND I’M VERY
PROUD OF THE PEOPLE WHO HAVE BEEN THROUGH TREATMENT AND THE
PEOPLE WHO DO NOT GIVE UP, AND I’M VERY PROUD OF THE PEOPLE WHO
ARE STILL OUT IN THE STREETS OF BALTIMORE CITY, STILL TRYING TO
LIVE, AND SO THAT CHILDREN WHO HAVE PARENTS THAT HAVE SUBSTANCE
USE DISORDER, THAT IT IS A STRUGGLE IN ITS OWN TO SEE YOUR
PARENTS STRUGGLE, BUT I’M HERE TO TELL YOU THAT IT IS A DISEASE
AND TO FIND FORGIVENESS, BECAUSE AT THE END OF THE DAY, YOU’RE
HERE AND TO ALL, TRY TO MAKE A DIFFERENCE.
THANK YOU. [APPLAUSE]>>I JUST WANT TO SAY THANK YOU,
LEAH, AND ALSO I’M REALLY, REALLY LUCKY BECAUSE I GET TO
WORK WITH HER EVERY DAY. SHE’S ONE OF OUR BEHAVIORAL
HEALTH FELLOWS AND SHE IS AMAZING.
AMAZING WITH A CAPITAL A. AND ACTUALLY ALL CAPS.
SO LEAH, THANK YOU SO MUCH FOR SHARING YOUR STORY.
[APPLAUSE] WE’RE GOING TO JUMP BACK INTO
SOME NUMBERS WITH BALTIMORE CITY NOW.
AND EVEN BEFORE WE JUMP BACK INTO BALTIMORE CITY, WE’RE GOING
TO TALK ABOUT MARYLAND AND FRAMING WHAT’S HAPPENING IN THE
CITY ON A GLOBAL LEVEL AND WHAT THE CITY HEALTH DEPARTMENT IS
DOING. A LOT OF LEA H’S AMAZING WORK
YOU’VE DONE AT WELL. THIS IS THE NUMBER OF OVERDOSE
DEATHS IN MARYLAND. YOU CAN SEE FROM 2012 TO 2016
THAT THE NUMBERS HAVE INCREASED. SO IN 2012, IT WAS 799, AND IN
2016, IT WAS 2,089. NOW WE’RE GOING TO GO INTO
BALTIMORE CITY AND YOU CAN SEE THE SAME TRAJECTORY AS WELL.
IN 2011, THERE WERE 167 OVERDOSE DEATHS AND IN 2016, 694.
THE OTHER POINT I WANT TO MAKE IS THAT YOU’LL SEE THERE’S TWO
DIFFERENT COLORS. THE LIGHTER BLUE COLOR IS THE
FENTANYL DEATH SO IN 2012, WE HAD FOUR FENTANYL RELATED DEATHS
IN BALTIMORE CITY, AND IN 2016, IT WAS 419.
THE OTHER THING I WANT TO MAKE A POINT ABOUT IS THAT IN BALTIMORE
CITY, WE HAVE ABOUT 620,000 RESIDENTS, AND THESE ARE FAMILY
MEMBERS, THESE ARE AUNTS, UNCLES, YOUR NEIGHBORS AS WELL,
BUT THEN IN TERMS OF THESE NUMBERS, WE ACCOUNT FOR 10% OF
MARYLAND’S POPULATION BUT WE ACCOUNT FOR A THIRD OF THE
OVERDOSE DEATHS FOR MARYLAND. BUT I ALSO WANT TO PAINT A
DIFFERENT PICTURE AS WELL THAT BEFORE 2011, IN 2009, OVERDOSE
DEATHS WERE ACTUALLY GOING DOWN. AND AS LEAH HAD MENTIONED, THIS
IS AN EPIDEMIC THAT HAS BEEN IN THE CITY FOR YEARS NOW.
THE CITY ACTUALLY HAD BEEN TRYING TO INCREASE TREATMENT, SO
FOR THE RED LINE, YOU’LL SEE THAT THE OVERDOSE DEATHS ARE
COMING DOWN BUT YOU’LL ALSO SEE THAT THE NUMBER OF BUPRENORPHINE
PATIENTS ARE GOING UP. WITH THE INCREASE OF TREATMENT,
THE OVERDOSE DEATHS HAD GONE DOWN, BUT THAT ALL CHANGED WHEN
FENTANYL HAD COME TO BALTIMORE. RIGHT NOW COMPARED TO OTHER
METROPOLITAN COUNTIES, WHEN YOU LOOK AT THE OVERDOSE FATALITY
RATES, UNFORTUNATELY BALTIMORE CITY IS LEADING OTHER
METROPOLITAN COUNTIES. THERE ARE RURAL COUNTIES THAT
HAVE HIGHER OVERDOSE RATES BUT THEN FOR METROPOLITAN COUNTIES,
UNFORTUNATELY BALTIMORE CENTER, WE ARE AT THE EPI CENTER OF THIS
EPIDEMIC. SO WHAT DO YOU DO WHEN YOU HAVE
TWO RESIDENTS WHO ARE DYING EVERY DAY, WHAT DO YOU DO WHEN
YOU NEED TO STOP THESE NUMBERS FROM OCCURRING, WHEN YOU NEED TO
JUST SAVE YOUR FAMILY MEMBERS, YOU NEED TO DO SOMETHING.
SO FOR BALTIMORE CITY, THE NUMBER ONE STRATEGY IS HOW DO WE
PREVENT THESE OVERDOSE DEATHS FROM OCCURRING, AND AS DR. ADAMS
RELEASED YOUR ADVISORY, IT IS PROVIDING NALOXONE.
SO THERE IS FORTUNATELY AN ANTIDOTE THAT CAN REVERSE AN
OPIOID OVERDOSE AND IF IT’S ADMINISTERED, THEN SOMEONE CAN
BE WALKING AND TALKING WITHIN MINUTES AS WELL.
AND SO IN 2015, OUR HEALTH COMMISSIONER ISSUED A STANDING
ORDER THAT ALLOWS ANYONE TO OBTAIN NALOXONE FROM A PHARMACY
WITHOUT A PRESCRIPTION. IN ADDITION, THE HEALTH
DEPARTMENT HAS TRAINED OVER 35,000 RESIDENTS ON NALOXONE AND
HOW TO USE NALOXONE, AND SO LEAH IS ONE OF OUR NALOXONE TRAINERS,
AND SHE’S BEEN GOING TO THE LIBRARY, SCHOOL SOCIAL WORK,
GOING EVERYWHERE TO TRAIN EVERYONE ON NALOXONE AND YOU’VE
BEEN DOING SUCH AMAZING WORK. EVERYDAY RESIDENTS THEY HAVE
SAVED OVER 1700 LIVES. THAT’S THE NUMBER WE KNOW ABOUT
AT THE HEALTH DEPARTMENT. WE THINK THIS IS A HUGE UNDER
ESTIMATION AS WELL. I ALSO WANT TO SAY, WE DO HAVE A
LIMITED SUPPLY OF NALOXONE. WE CURRENTLY HAVE 3,400 UNITS
THAT WE HAVE RIGHT NOW, AND THAT SEEMS LIKE A LOT, BUT WE CAN
DISTRIBUTE THAT REALLY, REALLY EASILY WITHIN WEEKS.
WE DO GET PHONE CALLS EVERY DAY FROM COMMUNITY-BASED PROVIDERS,
FROM HOSPITALS, FROM NON-PROFIT ORGANIZATIONS, FROM DOCTORS’
OFFICES AS WELL, ASKING IF WE CAN PROVIDE THEM NALOXONE.
SO WE UNFORTUNATELY HAVE TO TELL THEM THAT WE HAVE A LIMITED
SUPPLY THAT WE DO RESERVE IT FOR A NEEDLE EXCHANGE — BUT THE
GOOD NEWS IS BECAUSE THERE’S A STANDING ORDER AND IF THE
PATIENT IS ON MEDICAID, THEY CAN GET THE NALOXONE FOR $1 CO-PAY.
SO ON ONE HAND, WE HAVE THESE AMAZING PARTNER ORGANIZATIONS
WHO SEE THE VALUE OF NALOXONE AND SEE HOW GREAT AND LIFE
SAVING THIS MEDICATION IS, BUT ONCE IN A WHILE, WE WILL GET A
QUESTION OF, WELL, IF WE GIVE SOMEONE NALOXONE, DOESN’T IT
MEAN THAT THAT PERSON WILL USE AGAIN?
SO WHAT WE SAY IS, WELL, IF WE DON’T SAVE THEIR LIFE TODAY, HOW
CAN WE EXPECT THEM TO GET INTO TREATMENT TOMORROW?
USUALLY THEY’LL COME BACK AND REALIZE THE VALUE OF NALOXONE.
BUT WE ALSO REALIZE THAT NALOXONE IS NOT THE SILVER
BULLET, IT IS ONE OF THE MANY ANSWERS TO THIS COMPLEX
EPIDEMIC, AND WE ALSO REALIZE THAT TREATMENT IS IMPORTANT.
SO THE SECOND PILLAR OF THE BALTIMORE CITY HEALTH DEPARTMENT
STRATEGY IS INCREASING ACCESS TO ON DEMAND TREATMENT.
AS LEAH HAD MENTIONED AND DR. COOK HAD MENTIONED AND
DR. ADAMS AS WELL THAT ADDICTION IS A DISEASE, AND WE NEED TO
TREAT IT AS SUCH AND IT’S NOT A MORAL FAILING.
TREATMENT WITH METHADONE, BUPRENORPHINE WITH COUNSELING
WORKS AND SHOWS TO DECREASE MORTALITY BY 50%.
HOWEVER, AS DR. COOK HAD MENTIONED, ONLY A FEW RECEIVE
TREATMENT. IN THE CITY, WE USE A TELEPHONE
LINE TO HELP PEOPLE GET LINKED IN TO TREATMENT.
WE HAVE A 24/7 BEHAVIORAL HEALTH LINE, IN CASE YOU’RE EVER IN
BALTIMORE CITY OR KNEW SOMEONE WHO’S IN BALTIMORE CITY, SO THIS
IS A NUMBER THAT ANY CITY RESIDENT CAN CALL IN, OUR
PROVIDERS CAN CALL IN SO THERE CAN BE A WARM HANDOFF.
THE STAFF MEMBERS OF THAT LINE WILL ACTUALLY SET UP AN
APPOINTMENT FOR THE PATIENT. WE ALSO REALIZE AS DR. ADAMS HAS
MENTIONED THAT WE NEED PARTNERSHIPS, AND PARTNERSHIPS
ARE SO EXTREMELY IMPORTANT. WE’RE CURRENTLY WORKING WITH LAW
ENFORCEMENT IN A PILOT PROGRAM CALLED THE LAW ENFORCEMENT
ASSISTED DIVERSION PROGRAM. IT’S A PROGRAM BASED OFF A
PROGRAM IN SEATTLE, WASHINGTON. SO INSTEAD OF ARRESTING SOMEONE
FOR USING DRUGS, WE PROVIDE THEM WITH INTENSIVE CASE MANAGEMENT.
THAT PROJECT MAKES A LOT OF SENSE.
JUST AS WE DON’T ARREST SOMEONE WITH CANCER EXPECTING THEY’LL
LEAVE JAIL OR PRISON THINKING THEY’LL BE CANCER-FREE, WE
SHOULDN’T DO THAT WITH ADDICTION AS WELL.
WE ALSO WORK WITH EMS AS WELL, SO CURRENTLY EMS IN BALTIMORE
CITY RELEASE APPROXIMATELY 5 TO 7,000 OVERDOSES A YEAR.
SO ABOUT HALF OF THOSE INDIVIDUALS WILL AGREE TO BE
TAKEN TO THE HOSPITAL, ABOUT HALF WON’T, SO WE’RE PARTNERING
WITH EMS TO WORK WITH PEER RECOVERY SPECIALISTS SO THEY CAN
FOLLOW UP WITH INDIVIDUALS WHO DON’T AGREE TO GO TO THE
HOSPITAL. RECENTLY IN BALTIMORE CITY, THE
STABILIZATION CENTER HAS BEEN OPENED SO THAT’S A
24/7 BEHAVIORAL HEALTH URGENT CARE OF THE SORT WHERE IF
SOMEONE IS INTOXICATED, THEY CAN BE SENT TO THE STABILIZATION
CENTER WHERE THEY CAN GET SPECIALIZED TREATMENT FOR
BEHAVIORAL HEALTH. BUT WE ALSO REALIZED THAT WE
NEED LOWER THRESHOLD INTERVENTION POINTS, SO WE ARE
WORKING WITH THE TRADITIONAL HEALTHCARE SETTING, SO WE’RE
WORKING WITH PRIMARY CARE OFFICES, WE’RE ALSO WORKING WITH
HOSPITALS. IN BALTIMORE CITY, THEY’VE BEEN
MAKING GREAT STRIDES. MANY OF THE HOSPITALS NOW ARE
DOING — THEY’RE SCREENING PROVIDING BRIEF INTERVENTIONS,
REFERRAL TO TREATMENTS. THEY ALSO HAVE PEER RECOVERY
SPECIALISTS ON SITE. SO THAT YOU HAVE THE WARM
HANDOFF, SO THAT YOU CAN ALSO ADDRESS ANY OF THE BARRIERS IN
TERMS OF GETTING SOMEONE INTO CARE, SO IF TRANSPORTATION IS AN
ISSUE, THE PEER RECOVERY SPECIALIST HELPS WITH THAT AS
WELL. THIS IS SOMETHING THAT’S NOT
DONE JUST BY OURSELVES BUT IT’S DONE WITH THE HOSPITALS, WITH
THE STATE AND WITH THE LOCAL IMPLEMENTATION GROUP ALSO CALLED
MOSAIC AS WELL. FINALLY I THINK WHAT LEAH HAD
TOUCHED UPON AS WELL IS THE STIGMA, THAT THERE IS STILL SO
MUCH STIGMA, AND AS THE HEALTH COMMISSIONER SAYS, IF SOMEONE
HAS A PEANUT ALLERGY, AS A DOCTOR YOU DON’T SAY TO THAT
PERSON, I’M NOT GOING TO PRESCRIBE YOU EPINEPHRINE
BECAUSE IF I DO, YOU’RE GOING TO EAT MORE PEANUTS.
THAT IS RIDICULOUS. UNFORTUNATELY WE HEAR THAT WITH
ADDICTION. WE HEAR THAT WITH NALOXONE AS
WELL. AND SO THE HEALTH DEPARTMENT HAS
RELEASED A BOLD DONTDIE.ORG CAMPAIGN WHERE IT TALKS ABOUT
GETTING NALOXONE SAVING A LIFE AND IT’S SOMETHING THAT EVERYONE
CAN EASILY DO. WE ALSO WORK WITH THE MAYOR’S
OFFICE AND WITH OTHER COMMUNITY ORGANIZATIONS AS WELL TO
INCREASE ACCESS TO DRUG TREATMENT.
I THINK SO IN CLOSING, UNFORTUNATELY FOR BALTIMORE
CITY, WE HAVEN’T SEEN THE PEAK OF THIS EPIDEMIC, AND WE REALLY
NEED ALL HANDS ON DECK, AND WE REALLY NEED TO RELY ON SCIENCE
AND EVIDENCE THAT TREATMENT EXISTS AND WORKS AND THIS IS NOT
A MORAL FAILING. I THINK NO ONE WHO CONTINUES
DESPITE THEIR LIFE BEING DESTROYED WOULD EVER CHOOSE
THAT. SO THIS IS A DISEASE AND WE
REALLY MUST FULLY RECOGNIZE IT. I THINK WE ALSO NEED TO CHANGE
OUR POLICIES AND REMOVE INSTITUTIONAL RACISM AS WELL.
WE KNOW THAT THE WAR ON DRUGS, THEY DON’T WORK.
AND WE KNOW THAT THIS HAS AFFECTED DISPROPORTIONATELY
COMMUNITIES OF COLOR. AND THE CONSEQUENCE OF WAR ON
DRUGS HAVE BEEN LONG-STANDING. SO WE NEED POLICIES, WE NEED
PROGRAMS AND MOST IMPORTANTLY, WE DO NEED PARTNERSHIPS AS WELL.
WE NEED PARTNERSHIPS AND WE NEED — ALL NEED TO BE STRENGTH
BASED, THEY ALL NEED TO BE BASED ON EQUITY, BASED ON SCIENCE, AND
THEN ALSO BASED ON STORIES AND STRENGTH AND ALSO ON INDIVIDUALS
WHO ARE JUST SO BRAVE IN TELLING THEIR STORIES.
I THINK EVEN WITH ALL THESE NUMBERS, WITH ALL THESE GREAT
PROGRAMS, I THINK IT’S JUST — IT’S DEPENDENT ON THE
INDIVIDUAL, AND JUST, AGAIN, THANK YOU, LEAH, FOR SHARING
YOUR AMAZING STORY. THANK YOU.
[APPLAUSE]>>GOOD MORNING.
IT IS A SHAMEFUL SITUATION WHEN ONE IS BORN IN POVERTY AND THEN
TO DIE IN POVERTY. IT IS SHAMEFUL TO HAVE NO CHOICE
IN LIFE OTHER THAN THE DAILY EXISTENCE OF KNOWING AND
ENCOUNTERING DISCRIMINATION, PREJUDICE, SEXISM AND RACISM.
AND THAT WAS SO ELOQUENTLY PRESENTED TO ME IN A LECTURE BY
A WONDERFUL LADY, DENISE RODGERS, AT RUTGERS UNIVERSITY.
THE REALITY OF INEQUALITY WITH THE ROOTS OF CONSCIOUS AND
UNCONSCIOUS BIAS IS A BEHAVIOR WHICH NOT ONLY CREATES BUT
MAINTAINS INJUSTICE, THE HUMAN SHAME IS THAT THESE INEQUITIES
OCCUR IN A COUNTRY WHICH BOASTS GREAT GLOBAL POWER AND WEALTH
YET CONTINUOUSLY, CONTINUOUSLY FALLS SHORT IN THE
RESPONSIBILITY AND ACCOUNTABILITY FOR PEOPLE
RESIDING IN OUR OWN LANDS HAD. THE GAP IN CARRIED FORWARD IN
MINORITIES WITH ADDICTION IS A MERE REFLECTION OF THE GREATER
REALITY OF RACISM, SEXISM AND DISCRIMINATION WHICH EXISTS IN
THE UNITED STATES. THE INTENT OF THIS PRESENTATION
THAT I INTEND TO DO IS TO HIGHLIGHT POTENTIALLY GREAT
SOLUTIONS WHICH WILL REDUCE MEDIOCRE IMPACT DUE TO THE NEED
OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH WHICH
INCLUDE EDUCATION, EMPLOYMENT, HOUSING, FINANCIAL STABILITY.
IT IS BOLD AND CLEAR THAT UNTIL THESE MATTERS ARE RECONCILED,
OUR COUNTRY WILL WEAR THE BADGE OF SHAME.
AND CONTINUE TO PAY THE PRICE OF HIGH COST, HIGH MORBIDITY AND
HIGH MORTALITY, BUT AS A CLAIMANT OF LEADERSHIP AND
HAVING THAT LEADERSHIP STATUS, LEADERS CAN BE PART OF THE
PROBLEM OR WE CAN BE PART OF THE SOLUTION.
TYPICALLY NOT BOTH. IT’S MY DESIRE TO BE THAT OF A
BRAZEN SOLUTION, BOLD, AND WITHOUT SHAME.
I COME JUST AS YOU DO TO RISE TO THE PURPOSE OF THIS EVENT WHICH
IS TO PREVENT STRATEGIES FROM THE MEDICAL PERSPECTIVE TOWARDS
SOLUTIONS FOR THE OPIOID CRISIS CHALLENGING THE MINORITY
COMMUNITY. I’M GOING TO MOVE FORWARD.
I’M A FAMILY PHYSICIAN OF 26 YEARS IN A RURAL COMMUNITY IN
HOPE COUNTY, RAEFORD, NORTH CAROLINA.
SO I MADE A PROMISE. JUST AS MANY OF MY COLLEAGUES
HAVE. THE AMERICAN MEDICAL
ASSOCIATION, THE AMERICAN ACADEMY OF FAMILY PHYSICIANS,
AMSTA, THERE ARE SEVERAL OTHERS THAT I’M PAYING MEMBERSHIP TO.
WE MADE A COMMITMENT, WE MADE A PROMISE, AND A IN COLLABORATIONS
ADDRESSING THE OPIOID EPIDEMIC. SO HOW ARE WE GOING TO DO THIS,
AND HOW ARE WE ASKING YOU TO ASSIST US?
THAT IS TO RAISE THE AWARENESS OF THE OPIOID USE, MISUSE AND
ABUSE IN ALL COMMUNITIES. BUT WE MUST APPLY THE CULTURAL
LENS FOR RECOGNIZING SOCIAL DETERMINANTS OF HEALTH TO
ACHIEVE EQUITY AND HEALTHCARE REALIZING THE EXISTENCE OF
SYSTEMATIC PREJUDICE, RACISM, SEXISM AND DISCRIMINATION.
BUT AS A PHYSICIAN, AN ADVISER, AS GIVER OF CARE, INFORMATION
FOR OUR PATIENTS, OUR FAMILIES, HEALTHCARE, SERVICE PROVIDERS,
COMMUNITY LEADERS, LAW ENFORCEMENT, JUDICIAL AND
LEGISLATIVE AUTHORITIES, ALL OF WHICH, ALL OF THESE INDIVIDUALS,
ALL OF THESE ORGANIZATIONS ARE DEALING WITH PEOPLE WHO ARE
DEALING WITH SUBSTANCE USE DISORDER.
BUT WE MUST REMEMBER, THIS COUNTRY HAS ALSO MADE
INITIATIVES TOWARDS ADDRESSING THE AIM OF QUALITY, ACCESS,
EFFICIENT AND COST SAVINGS BY IMPLEMENTING REALISTIC
STRATEGIES, AND WE WANT TO SHARE WHAT IT IS THAT’S WORKING IN OUR
COMMUNITIES WHETHER IT’S THAT OF BALTIMORE OR RAEFORD, NORTH
CAROLINA. SO WHAT ARE WE DOING?
THIS IS WHAT WE CONSIDER TO BE OUR HIGH IMPACT PROJECTS.
THERE ARE OTHERS, BUT THESE ARE THE ONES I’M GOING TO TALK
ABOUT. THE PRESCRIBER PREVENTIVE
INITIATIVE, BUT WE’RE TALKING ABOUT WITHOUT PUTTING ARBITRARY
QUANTITY LIMITS IN TERMS OF WHAT DOCTORS AND PRESCRIBERS ARE ABLE
TO DO. LET US MAINTAIN THE
PHYSICIAN-PATIENT RELATIONSHIP THAT, PROVIDER RELATIONSHIP, BUT
YET WE STILL MUST RECOGNIZE HOW WE ARE PRESCRIBING.
WE WANT TO HAVE INTEROPERABLE, SECURE NATIONAL DATABASE FOR
EFFECTIVE STATE PRESCRIPTION DRUG MONITORING PROGRAMS.
WHAT DOES THAT MEAN? WE WANT TO BE ABLE TO HAVE THAT
INFORMATION IN TERMS OF WHO’S RECEIVING, WHO HAS GIVEN OUT
PRESCRIPTIONS FOR THOSE SUBSTANCE AS, BUT WE NEEDED TO
GO ACROSS STATE LINES. NOT JUST IN NORTH CAROLINA.
YES, I CAN DO A MULTISTATE CHECK BUT ONLY IN THOSE STATES AROUND
ME. I NEED TO BE ABLE TO CHECK
CALIFORNIA AND EVERYWHERE ELSE TOO.
WE NEED ADEQUATE FUNDING FOR ADDICTION TREATMENT INCLUDING
COMMUNITY-BASED MEDICATION ASSISTED TREATMENT PROGRAMS.
I AM A DATA EX-WAIVERED PHYSICIAN, I DO HAVE MEDICATION
ASSISTED TREATMENT IN MY OFFICE. I’M CURRENTLY TAKING CARE OF 60
PATIENTS, AND I WOULD LIKE TO SAY, ONE AFRICAN-AMERICAN
FEMALE, ONE AFRICAN-AMERICAN MALE, AND SEVERAL NATIVE
AMERICAN INDIAN, AND THAT’S IT, OUT OF MY TOTAL OF 60.
COORDINATION OF CARE AND SERVICES OF POPULATIONS
INCLUDING THE AGED. I CAN TELL YOU, I HAVE OLDER
PEOPLE, I HAVE SENIORS OVER THE AGE OF 75 WHO ARE DEALING WITH
THIS PROBLEM. I HAVE DISABLED PEOPLE, PEOPLE
WHO HAD INJURIES THAT EITHER WAS NOT BY THEIR OWN FAULT BUT
OCCURRED. WE HAVE VETERANS.
I’M 20-MILES SOUTH OF FORT BRAGG, ONE OF OUR LARGEST
MILITARY INSTALLATIONS IN THIS COUNTRY, AND WE DO SERVE OUR
VETERANS. WE HAVE WOMEN, WE HAVE CHILDREN,
WE HAVE INCARCERATED. YET THEY ARE NOT RECEIVING
SERVICES. OR LESS THAN ADEQUATE SERVICES.
AND THEN QUITE FRANKLY, WE HAVE SOCIAL AND ECONOMICALLY
DISENFRANCHISED PEOPLE. I WORK WITH A COMMUNITY-BASED
ORGANIZATION IN FAYETTEVILLE AND I CAN TELL YOU THEY REACH OUT TO
PEOPLE UNDER THE BRIDGES. PEOPLE WHO DO NOT HAVE ZIP
CODES. SO HOW DO THEY FIT INTO OUR
DATA? BUT YOU KNOW, WE HAD TO COME UP
WITH A STRATEGY IN OUR COMMUNITY.
WE’RE JUST A LITTLE TOWN SOMEWHERE IN THE UNITED STATES
OF AMERICA. AND WHEN THE HEARTS COME
TOGETHER, WHEN ENOUGH IS ENOUGH, WE CAME TOGETHER.
WE ACTIVELY ENGAGED PARTICIPANTS WITH THE SHARED GOAL TO DECREASE
ILLNESS AND DEATH FOR ALL PEOPLE IN THE REGION.
AND WE COMMUNICATE ON THOSE ACTIVITIES, SUCH AS WE HAVE DRUG
TAKEBACK DAY. I SAW THE SIGN IN THE LOBBY AND
I’M GREATLY ENCOURAGED. WE’RE WORKING ON NEEDLE SYRINGE
EXCHANGE PROGRAMS. WE WOULD LIKE TO HAVE A DRUG
COURT IN OUR COMMUNITY, FAYETTEVILLE HAS DONE QUITE WELL
AND HAS RECEIVED RECOGNITION FOR THEIR PROGRAM.
PEER COACHING TRIALS. WE HAVE INDIVIDUALS IN OUR
COMMUNITY THAT ARE READY BUT THEY NEED TO HAVE THAT ACCESS
AND THE TRAINING NECESSARY FOR THAT.
BUT YOU KNOW, WE HAVE TO RECOGNIZE, WHAT ARE WE DEALING
WITH AND I’VE ALREADY ADDRESSED A LITTLE BIT THE CHALLENGES
RELATED TO PEOPLE, PLACES AND THINGS.
WHEN I HAVE INDIVIDUALS COME INTO MY OFFICE, THEY ALREADY
HAVE ON THEIR CELL PHONES TEXT MESSAGES AND THEY ALREADY HAVE
THE SPEED-DIAL, THEY KNOW WHERE TO GET THEIR NEXT HIT.
AND SO PEOPLE, PLACES AND THINGS, FOLKS WHO ARE ADDICTED
KNOW WHAT THAT MEANS. AND YOU NEED TO KNOW WHAT THAT
MEANS. WE NEED TO BE ABLE TO CHANGE
THOSE SITUATIONS FOR THOSE INDIVIDUALS SO THAT THOSE
PEOPLE, THOSE PLACES, THOSE THINGS ARE PEOPLE WHO CAN HELP
THEM, NOT HURT THEM. AND WE HAVE TO WORK TOGETHER TO
CREATE SOLUTIONS. IT’S A SHARED RESPONSIBILITY AND
IT’S A SHARED ACCOUNTABILITY. ALL OF US IN THIS ROOM, ALL
ACROSS THIS COUNTRY, IT’S SHARED.
WHEN WE START TO SEGMENT ANY GROUP, POPULATION OR PROFESSION
AND SAY OH, THEY WERE THE CAUSE, THEY WERE THE BLAME.
IT’S SHARED. THAT IS THE ATTITUDE AND
APPROACH WE TEND TO TAKE, SHARED.
AND WE’RE GOING TO ALSO MAKE SURE THAT WE ARE ADDRESSING THE
SOCIAL DETERMINANTS OF HEALTH BECAUSE IT’S HAVING AN IMPACT
GREATER THAN WHAT WE SEE IN OPIATE USE DISORDER, IT’S HAVING
AN IMPACT IN HEALTHCARE DELIVERY.
BUT SMALL STEPS OF CHANGE WILL LEAD TO A HEALTHIER AND HAPPIER
COMMUNITY. WE KNOW WE CAN’T MAKE A
DIFFERENCE OVERNIGHT. BUT WE KNOW IF WE CAN TAKE THAT
SMALL STEP AND START LOOKING IN THAT DIRECTION, WE WILL GET TO
WHERE WE NEED TO BE. SO HERE WE R THE DOCTOR TALKING
ABOUT DATA. WHAT DO WE DO IN TERMS OF
REACHING BEYOND HOPE, OUR NEXT STEP?
OUR LITTLE COMMUNITY GROUP IN HOPE COUNTY IS CALLED HOPE IN
HOKE. IMPLEMENTATION OF TOOLS FOR DATA
AGGREGATION, ANALYTIC, UTILIZATION, ARE WE MAKING A
DIFFERENCE? AM I MAKING A DIFFERENCE WITH
THE 60 FOLKS IN MY OFFICE? IS IT REALLY WORKING OR AM I
ACTUALLY ADDING TO THE RELAPSE AND RECIDIVISM DEATHS OCCURRING
THROUGHOUT THE COUNTRY? ARE WE MAKING A DIFFERENCE?
SO HOW DO WE DO THIS? WE ACTUALLY WANT TO MAKE SURE
THAT WE’RE EXPANDING OUR FUNDING SOURCES.
BUT APPROPRIATELY APPLYING THE FUNDING.
ARE MAKING SURE THAT MONEYS THAT WE’RE SPENDING, THAT IT’S MAKING
A DIFFERENCE. AND WELCOME NEW PARTNERS.
I HAD THE OPPORTUNITY OF MEETING ONE OF THE COMMANDERS OF THAT
LARGE INSTALLATION IN NORTH CAROLINA AND THAT PARTNER SAID
TO US, I HAVE A LOT OF DATA, AND I SAID OUR GROUP NEEDS DATA.
I SAID LET’S PUT OUR HEADS TOGETHER AND SEE WHAT WE CAN DO
TO IDENTIFY AND MAKE A DIFFERENCE.
CROSS-CULTURAL PATIENT ENGAGEMENT.
WE HAVE MULTIPLE DIFFERENT POPULATIONS THAT RESIDE IN OUR
AREA, AS MANY OF YOU DO IN THE AREAS THAT YOU LIVE IN.
AND WE NEED TO MAKE SURE THAT THE APPROACHES THAT WE APPLY
HELP EVERYONE. ON THEIR LEVEL.
BASED ON THEIR CULTURE. WE WANT TO EXPAND ACCESS TO
HEALTH AND MENTAL CARE ALLOWING EVERY PERSON TO HAVE A FAMILY
DOCTOR. I’M A LITTLE SHAKY THIS MORNING
BECAUSE I WAS SITTING IN THE EMERGENCY ROOM AT 2:00 THIS
MORNING WITH SOMEONE WHO WAS HAVING A MENTAL HEALTH CRISIS.
IF WE HAD OUR BEHAVIORAL HEALTH CO-LOCATION, WHICH WE HAVE IN
OUR OFFICE DOWN IN NORTH CAROLINA, WE DIDN’T HAVE THAT
HERE IN THE STATE OF MARYLAND IN THE LITTLE FACILITY THAT I WAS
IN, IT’S NOT A LITTLE FACILITY, BY THE WAY, IT’S A BIG ONE, BUT
WE DIDN’T HAVE THAT, AND HOW CAN WE APPLY THE CHRONIC CARE MODEL,
THE BEHAVIOR MANAGEMENT MODEL WHERE THE HEALTHCARE INDIVIDUAL
IS REACHING OUT TO THE PATIENT, MAKING SURE THEY HAVE WHAT THEY
NEED BEFORE THE CRISIS OCCURS. ENGAGE HEALTHCARE POLICY
EXPERTISE FOR MAXIMAL ADVOCACY IN MULTIPLE ARENAS.
IN MY TRAVELS, I’VE NET WITH SOME HEALTHCARE POLICY FOLKS,
PARTICULARLY DUKE UNIVERSITY INDIVIDUALS, HERE IN WASHINGTON,
HOW CAN WE ENGAGE THEM AND HELP US CREATE OUR SOLUTIONS?
YOU KNOW, ACHIEVEMENT OF SUCCESS, THE BEGINNING AND THE
END, IT REALLY STARTS WITH PASSION.
DO YOU HAVE THE PASSION FOR WHAT’S NEEDED?
ARE YOU DETERMINED TO DO WHAT’S A NECESSARY?
WE HAVE LIVES AT HAND, WE’RE LOSING PEOPLE.
AND THAT’S NOT WHAT WE’RE ABOUT. WE’RE KEEPING PEOPLE AND SAVING
PEOPLE. AND I LOOK FORWARD TO WORKING
WITH YOU AND WE DEFINITELY MUST COLLABORATE.
THANK YOU SO MUCH. [APPLAUSE]
>>I WANT TO THANK ALL OF OUR PANELISTS FOR THEIR EXCELLENT
PRESENTATIONS. CARA IS GOING TO COME UP AND
LEAD THE QUESTION AND ANSWER.>>THANK YOU SO MUCH TO EACH OF
YOU. WHAT WE TRIED TO DO IN THE STORY
WE WERE TRYING TO TELL TODAY WAS TO START WITH WHAT IS THE
PICTURE OF THE EPIDEMIC IN THE COMMUNITIES THAT WE’RE FACING,
AND TO TAKE THAT FROM THE DATA TO THE PERSONAL, AND I THINK
LEAH DID AN AMAZING JOB BRINGING THAT HOME AND YOU HOW THAT
IMPACTS REAL PEOPLE. AND THEN TO TALK ABOUT WHAT IS
IT THAT WE’RE DOING, AND IT LEADS INTO OUR CONVERSATION
ABOUT WHAT WE CAN DO AND WHERE THERE ARE SUCCESSES AND WHAT IS
IT THAT WE STILL NEED TO HAVE DONE.
AND SO WE HAVE SOME MICS THAT ARE HERE IN THE ROOM.
WE ALSO HAVE SOME QUESTIONS THAT YOU CAN SUBMIT TO QUESTIONS AT
HHS.TV AND WE’VE HEARD A NUMBER OF THINGS, AND SO I WANT TO
START WITH THE CONVERSATION AS WE WORK THE MICS AROUND, IF YOU
HAVE A QUESTION HERE IN THE ROOM, PLEASE RAISE YOUR HAND AND
WE’LL HAVE A MIC THAT COMES TO YOU.
AND SO THE CONVERSATION IS WE WANT TO START — I KIND OF WANT
TO TALK ABOUT SOMETHING THAT WAS MENTIONED BY ALL OF YOU AND
THAT’S STIGMA, SORT OF ONE OF THE QUESTIONS WE RECEIVED, I
THINK IT WAS DIRECTED A LITTLE BIT TO YOU, LEAH, IN PARTICULAR
IS, HOW DO WE ENCOURAGE MORE PEOPLE TO SHARE THEIR STORY?
DR. ADAMS TALKED ABOUT THAT. SO THAT WE’RE UNDERSTANDING AND
BEING ABLE TO LIFT THAT UP SO WE CAN HELP BREAK DOWN SOME OF
THOSE BARRIERS RELATED TO THE STIGMA BUT ALSO HELPING PEOPLE
UNDERSTAND IT IS A DISEASE. SO IF EACH OF YOU WANT TO START
AND SORT OF ANSWER THAT, MAYBE START WITH YOU, LEAH, IF YOU
HAVE A THOUGHT ABOUT HOW WE DO THAT.
>>I THINK IT’S THROUGH STORYTELLING.
I THINK WE’RE CONCERNED ABOUT THE NUMBERS BUT I THINK IT TAKES
AWAY THE PEOPLE WHO EXPERIENCE ADDICTIONS THAT PEOPLE SEE
NUMBERS BUT THEY DON’T SEE A SPACE, AND A REAL LIVE PERSON IS
GOING THROUGH THIS, PEOPLE ARE STRUGGLING, AND PEOPLE ARE
MAKING BAD DECISIONS, PEOPLE ARE FACED WITH THE STRUGGLE.
I THINK WE TAKE THAT AWAY BECAUSE WE’RE UP HERE AND
PEOPLE ARE DOWN HERE, AND WE DON’T BRING PEOPLE UP HERE, AND
SO THE PROCESS IS DEHUMANIZING OF THE SITUATION.
YOU TALK ABOUT NUMBERS, BUT TALKING ABOUT WHAT DEFINES AN
EPIDEMIC OF THIS CERTAIN AMOUNT OF PEOPLE HAVE TO DIE, BUT WHAT
ABOUT THE PEOPLE WHO ALREADY DIED, DO THEIR LIVES NOT MATTER,
DO THEIR STORIES — ARE THEIR STORIES SIGNIFICANT ENOUGH, AND
I THINK TO END THE STIGMA, WE HAVE TO CONNECT THE TOP AND THE
BOTTOM TOGETHER TO SHARE STORIES.
[APPLAUSE]>>I THINK THE LANGUAGE WE USE,
I THINK ABOUT IN MEDICINE HOW SOMETIMES WE’LL USE SUBSTANCE
ABUSE OR — INSTEAD OF SAYING A PERSON WITH SUBSTANCE USE
DISORDER, WE’LL SAY ADDICT INSTEAD, AND SO JUST THE
LANGUAGE THAT WE USE FIRST AND FOREMOST AS LEAH HAS PUT THIS,
IS AN INDIVIDUAL, IT’S A MOM, IT’S A DAD, IT’S A NEIGHBOR,
IT’S YOUR NEXT DOOR NEIGHBOR, AND SO I THINK JUST HIGHLIGHTING
THIS IS A PERSON AND ALSO THAT THIS IS A DISEASE AS WELL.
>>THIS IS SOMETHING FROM A HEALTHCARE POLICY PERSPECTIVE,
THINKING ABOUT HOSPITALS AND HEALTHCARE SYSTEMS, AND AMOUNT
OF TIME THAT PRIMARY CARE PROVIDERS AND MENTAL HEALTH
PROFESSIONALS HAVE WITH PATIENTS WITH SUBSTANCE USE DISORDER IS
SHORT, IS WAY TOO SHORT. SO IT MAKES IT THAT THE PROVIDER
HAS TO USE THEIR ASSUMPTIONS AND IN THAT SHORT AMOUNT OF TIME,
THEY’RE GOING TO MAKE A LOT OF MISTAKES BASED ON THEIR OWN
EXPERIENCE BUT MAYBE BASED ON WHERE THEY WERE RAISED AND BASED
ON THEIR ASSUMPTIONS ABOUT THE PEOPLE WHO ARE IN FRONT OF THEM.
SO IF THERE ARE WAYS TO IMPROVE THOSE ASSUMPTIONS, IMPROVE THAT
AMOUNT OF TIME, TO MAKE IT SO THAT A REAL CONSIDERATION IS
HAPPENING AS OPPOSED TO, O I KNOW WHO YOU ARE, I’M GOING TO
TREAT YOU THIS WAY, THAT KIND OF THING NEEDS TO HAPPEN, THAT KIND
OF TRAINING, THAT KIND OF SPECIALIST THAT CAN COME IN THAT
UNDERSTANDS THERE’S A HISTORY, A LONG INTERGENERATIONAL
EXPERIENCE WITH DISCRIMINATION, THAT THAT’S THERE WITH THAT
PATIENT, NOT JUST SOMEONE THAT YOU HAVE A PICTURE IN YOUR MIND
OF WHO THAT PATIENT IS.>>I WOULD LIKE TO ECHO THAT
BECAUSE WHAT WE ARE SOMEWHAT ALLUDING TO IS THAT OF
UNCONSCIOUS BIAS, AND ONCE WE LOOK WITHIN OURSELVES, AND WE
LOOK AT OUR OWN ISSUES, AND WE ALSO RECOGNIZE THAT THOSE WHO
ARE COMING IN WITH PROBLEMS PARTICULARLY FROM THE PHYSICIAN
STANDPOINT TO LOOK AT THEM AS A HUMAN, TREAT THEM AS SUCH.
AND THAT’S ONE THING THAT WE HAVE ATTEMPTED TO DO WITH
CO-LOCATION OF TREATMENT AND THERAPIES IN OUR OFFICE, WHETHER
THEY HAVE HYPERTENSION, DIABETES, WE’RE GOING TO TREAT
IT. AND IF IT’S A SUBSTANCE USE
DISORDER, WE’RE GOING TO TREAT IT.
SO THERE’S NO SPECIAL LABEL. THERE’S A PROBLEM, WE’RE GOING
TO TREAT IT.>>HI, EVERYONE.
THANK YOU SO MUCH FOR YOUR PRESENTATION.
I JUST HAD — MY NAME IS NICOLE, I WORK AT THE JUSTICE CENTER
WITH A NUMBER OF LAW ENFORCEMENT AGENCIES AROUND THE COUNTRY WHO
ARE DOING WORK IN POLICE MENTAL HEALTH COLLABORATION.
I’M HAPPY TO HEAR THAT BALTIMORE IS ADAPTING THE LEAD PROGRAM.
I JUST WANT TO GET A BETTER UNDERSTANDING OF WHAT TRAINING
IS BEING PUT IN PLACE FOR LAW ENFORCEMENT TO HAVE A BETTER
RESPONSE, AND FOR A MORE EFFECTIVE LEAD PROGRAM.
>>THAT’S A GREAT QUESTION, AND I MAY HAVE TO GET BACK TO YOU ON
THAT ONE FOR THE SPECIFIC TRAINING THAT THEY’RE
INCORPORATING. AT THE HEALTH DEPARTMENT IN
GENERAL WE’VE BEEN TRAINING EVERYONE IN TRAUMA INFORMED CARE
AS WELL, AND SO WE’VE BEEN PARTNERING WITH SAMHSA, AND WITH
THESE TRAININGS, I THINK FOR ME, IT BRINGS ME BACK TO THE
CLINICAL SETTING, MORE SO IN TERMS OF WHEN YOU HAVE A PATIENT
COME IN, SOMETIMES YOU’RE — AND I’VE BEEN THERE WHERE YOU FEEL
FRUSTRATED BUT YOU DON’T KNOW WHERE THAT PATIENT HAS BEEN,
INSTEAD OF SAYING WHAT’S WRONG WITH YOU, IT’S SORT OF ASKING
WHAT HAS HAPPENED WITH YOU. SO THE HEALTH DEPARTMENT HAS
BEEN TRAINING NOT ONLY LAW ENFORCEMENT BUT AS WELL AS
SCHOOLS, AS WELL IN TERMS OF THE CHANGING OF THE FRAMEWORK OF HOW
YOU’RE VIEWING INDIVIDUALS AND YOU’RE VIEWING THEM AS
INDIVIDUALS, INDIVIDUALS WITH EXPERIENCE AND BACKGROUND.
>>THANK YOU, I’LL FOLLOW UP WITH YOU AS WELL.
JUST WANTED TO MENTION A COUPLE OTHER INITIATIVES THAT ARE
HAPPENING HERE IN MARYLAND AND AROUND THE COUNTRY.
THERE’S — ANNE ARUNDEL COUNTY IS DOING WHERE THEY HAVE FIRE
DEPARTMENTS AND LAW ENFORCEMENT AGENCIES THAT ARE OPEN TO
INDIVIDUALS WHEN THEY’RE READY TO SAY I NEED HELP, WHICH IS
REALLY IMPORTANT. WE HAVE SOME AGENCIES AS WELL
THAT HAVE EMBEDDED CLINICIANS IN THEIR AGENCIES FOR SUBSTANCE USE
LIAISON AND ALSO PEER SUPPORT STAFF AS WELL, SO JUST THANKS TO
CONSIDER AS WE GO FORWARD.>>I MIGHT MENTION, IF IT’S
OKAY, I MIGHT MENTION TWO PROGRAMS THAT ARE HAPPENING IN
CAMBRIDGE THAT I’M INVOLVED IN. ONE IS THE SAFETY NET YOUTH
INITIATIVE, WHICH IS A DIVERSION PROGRAM FOR YOUTH INSTEAD OF
GOING INTO THE PRISON SYSTEM OR THE JAIL SYSTEM GETTING MENTAL
HEALTH TREATMENT AT CAMBRIDGE HEALTH ALLIANCE.
SO THAT’S WORTH LOOKING UP, BUT RELATED TO TRAINING, FOR ADULTS,
THERE’S KIND OF A TWO PRONGED STRATEGY AT CAMBRIDGE POLICE
DEPARTMENT. ONE IS TRAIN ALL THE OFFICERS,
ESPECIALLY THE PATROL OFFICERS ON HOW TO CALM THE TEMPERATURE,
HOW TO COOL THE TEMPERATURE WHEN THEY’RE ENCOUNTERING SOMEBODY
WHO MAY BE HAVING PSYCHOTIC EPISODE OR SOME ISSUE AT THE
INTERSECTION OF SUBSTANCE USE AND MENTAL HEALTH PROBLEMS.
AND THAT’S A 40-HOUR TRAINING, NATIONAL ALLIANCE FOR MENTAL
ILLNESS IS HELPING US THINK ABOUT WHAT THAT 40-HOUR TRAINING
IS. I THINK THERE’S A LOT TO DO ON
MAKING THAT TRAINING WORK. 40 HOURS OF POLICE OFFICERS
LISTENING TO PEOPLE TALK AT THEM IS NOT NECESSARILY HELPFUL FOR
POLICE OFFICERS. THE SECOND PRONG IS, THERE ARE
FOUR MENTAL HEALTH OFFICERS ON THE CAMBRIDGE POLICE FORCE AND
THEIR JOB IS IT FOLLOW UM WITH PEOPLE WHEN THERE’S BEEN AN
INSTANCE OR A PATROL CALL THAT’S SOMEWHAT RELATED TO MENTAL
HEALTH. THOSE ARE REAL SPECIALISTS,
THOSE ARE OFFICERS WHO ARE TRAINERS THEMSELVES AND THEY’VE
HAD NOT 40 HOURS BUT DAYS AND DAYS, ENCOUNTER, ENCOUNTERS, AND
REAL EXPERTS ABOUT HOW TO NOT ONLY BE POLICE OFFICERS AND
SECURE ARE IN MAKING SITUATIONS SAFE BUT THEN ALSO HOW TO
INTERACT WITH PEOPLE. I FEEL LIKE THAT KIND OF
SPECIALIST IS SOMETHING WE DON’T TALK ABOUT ENOUGH.
BUT ENDS UP BEING REALLY IMPORTANT IN LEAST AT CAMBRIDGE.
>>THANK YOU.>>HI, I WORK WITH A NON-PROFIT,
I’M AN AMERICORPS MEMBER. MY QUESTION IS SINCE WE HAVE A
LOT OF PEOPLE IN THE HEALTH FIELD, HOW DO YOU FEEL THAT
MOVING FROM A CULTURAL COMPETENCY VIEWPOINT TO CULTURAL
HUMILITY CAN HELP PRACTITIONERS BETTER HELP PATIENTS OF COLOR
WITH SUBSTANCE ABUSE DISORDERS?>>THERE’S A LOT OF ACTIVITY
THAT’S OCCURRING, PARTICULARLY WITH THE TRAINING AND TEACHING
OF SOCIAL DETERMINANTS OF HEALTH.
TYPICALLY IT WAS NOT PART OF OUR MEDICAL SCHOOL CURRICULUM MANY
YEARS AGO, BUT NOW IT DEFINITELY IS PART OF THAT CURRICULUM.
OUR STUDENTS ARE BEING TAUGHT, BUT THE STUDENTS, IT’S
WONDERFUL, RESIDENTS, WONDERFUL, BUT WE’RE ALSO INSTITUTING
PROGRAMS FOR OUR PRACTICING DOCTORS, OUR SEASON DOCTORS, SO
EDUCATION, IT STARTS WITH EDUCATION AND WE’RE WORKING
AGGRESSIVELY TO DO THAT.>>I ALSO WANT TO MENTION AT THE
HEALTH DEPARTMENT, I WAS ABOUT BE MORE FOR HEALTHY BABES, WE
UNDERWENT A FANTASTIC TRAINING, A 2 1/2 DAY TRAINING, PERHAPS
THE BEST TRAINING I HAVE EVER WENT TO, AND IT SORT OF MADE YOU
LOOK AT YOURSELF AND SORT OF YOUR ORGANIZATION AS WELL, AND
SORT OF WHAT OPPRESSION ARE YOU HOLDING AS WELL AND SO — AND
THAT’S SOMETHING THAT HAS CHANGED BE MORE FOR HEALTHY BABY
STRUCTURES AND LOOKED AT ITSELF AS AN INITIATIVE AS WELL, AND SO
FROM THAT COMMUNITY ADVISORY BOARD, WHERE MEMBERS ARE BEING
PAID, ALSO CHILD CARE IS PROVIDED AND TRANSPORTATION IS
GIVEN AS WELL, AND THAT’S SOMETHING THAT I WISH AS A
MEDICAL STUDENT I HAD GOTTEN THAT TRAINING AS WELL, BUT
THAT’S SOMETHING THAT PERHAPS IN THE FUTURE THERE WILL BE MORE
OPPORTUNITIES AND COLLABORATION TO HAVE THAT TRAINING OR
SOMETHING SIMILAR OF THAT SORT AS WELL.
>>THE GENTLEMAN RIGHT THERE?>>HOW ARE YOU DOING?
MY NAME IS NORMAN CLEMENT. I OWN A PHARMACY.
WE’RE IN FLORIDA. THE QUESTION I ALWAYS HAVE ABOUT
THESE OPIOID CONFERENCES IS THAT, ONE, I NEVER HEAR TWO
THINGS, WHICH OPIOID ARE CAUSING THE PROBLEMS, AND I THINK IT’S
VERY IMPORTANT, AND WHAT DO WE DO FOR TREATMENT FOR PEOPLE WITH
CHRONIC PAIN. I WANT TO TALK ABOUT DR. SMITH
AND I, YOU TALKED ABOUT THE PRESCRIPTION DRUG MONITORING
PROGRAMS THAT ARE EFFECTIVE, BUT JUST LAST WEEK, THE DEPARTMENT
OF JUSTICE OPENED UP A PROGRAM CALLED APRIS.
THIS APRIS PROGRAM ALLOWS US TO MONITOR EVERYONE.
WE’RE REQUIRED TO PUT THEIR NAME, ADDRESS, PHONE NUMBER,
DATE OF BIRTH, AND HOW THEY’RE MAKING THESE PAYMENTS, WHO’S
MAKING THE PAYMENT, WHO’S PICKING THE PRESCRIPTIONS UP FOR
THEM. AND THAT INFORMATION IS SENT TO
THE BUREAU OF JUSTICE, THE DEPARTMENT OF JUSTICE,
EVERYTHING. AND I KIND OF WONDER ABOUT THAT
IN TERMS OF — WE TALK ABOUT THIS FACEBOOK PRIVACY AND THAT
SORT OF THING, THAT WHY ARE PEOPLE’S — SINCE WHEN HAD HAVE
PHARMACIES LIKE MINE BECOME A PART OF LAW ENFORCEMENT AND
PEOPLE ARE REALIZING THAT EVERY PRESCRIPTION YOU TAKE TO A
PHARMACY IS BEING MONITORED BY THE BUREAU OF JUSTICE, WHICH IS
PART OF THE DEPARTMENT OF JUSTICE HERE IN WASHINGTON, D.C.
AND WHAT CONCERNS ME IS THAT WHEN WE TALK ABOUT PRESCRIPTION
DRUG MONITORING PROGRAMS, AND IF I’M LISTENING WITH A THIRD EAR,
IT SAYS NOTHING ABOUT THESE ARE CONTROLLED MEDICATIONS.
I MEAN, WHAT ELSE CAN YOU PUT ON THERE?
CAN YOU PUT BIRTH CONTROL PILLS ON THERE?
SO WE’RE MONITORING EVERYONE’S PRESCRIPTION, AND PEOPLE ARE
GETTING UPSET HERE ABOUT, YOU KNOW, FACEBOOK GETTING
INFORMATION. THIS INFORMATION IS GOING TO THE
POLICE DEPARTMENT. SO THAT’S MY BIGGEST CONCERN
ABOUT THAT. THE OTHER ISSUE, THE DOCTOR
TALKED ABOUT, AGAIN, WHICH OPIOIDS ARE CAUSING THE
PROBLEMS? SOMETIMES I’M WONDERING WHETHER
THEY’RE SERIOUS ABOUT THIS, BECAUSE WE HAD, FOR EXAMPLE,
THREE YEARS OR FOUR YEARS AGO THE WALGREENS COMPANY WAS FINED
$83 MILLION FOR DRUG TRAFFICKING, AND DISPENSING OF
CONTROLLED MEDICATION, OXYCODONE, METHADONE, MORPHINE,
THAT SORT OF THING, AND NO ONE GOES TO PRISON.
BUT YET ENFORCEMENT IS BROUGHT AGAINST THE LITTLE GUYS OR THOSE
SORT — AND THIS MEDICATION THAT GOT OUT IN THE STREET, THIS —
OF THE PHARMACEUTICAL GRADE, SO I THINK THAT’S IMPORTANT BECAUSE
WE’RE TALKING ABOUT — WHEN WE TALK ABOUT OPIOIDS, 82% OF WHAT
IS CAUSED, WE SEEM — IS STILL HEROIN AND FENTANYL.
AND IT SEEMS THAT IT ONLY BECAME A CRISIS WHEN SOMEBODY SAID IT
WAS A CRISIS, WHEN WHITE FOLKS — HE HATE TO BRING
THAT — WHEN WHITE FOLKS BEGAN TO DIE OF THESE — OF THE HEROIN
AND THE FENTANYL.>>I WOULD LIKE TO RESPOND.
AND I WANT TO START MY RESPONSE OFF WITH KEEPING IN MIND OUR
DESIRE FOR COLLABORATION AND KEEPING IN MIND FOR THE SHARED
ACCOUNTABILITY AND SHARED RESPONSIBILITY.
FOR THE FIRST TIME IN YEARS, WORKING EXTREMELY CLOSELY WITH
OUR PHARMACISTS, OTHER THAN CALLING YOU GUYS AND ASKING YOU
WHAT DRUG COMES IN WHAT DOSAGE, I’M ASKING A WHOLE LOT MORE
QUESTIONS. THE STOP ACT WAS A WONDERFUL
PROPOSAL AND PIECE OF INFORMATION THAT IN OUR STATE WE
ARE CERTAINLY GOING AROUND AS PART OF OUR STATE AND ACTUALLY
LECTURING TO PHYSICIANS ALL OVER SO THAT THE PHYSICIANS AND THE
PRESCRIBERS INCLUDING OUR VETERINARIANS WHO ARE ALSO
PRESCRIBING OPIATES, EVERY ONE OF THOSE PRESCRIBERS KNOW WHAT
ARE THESE DRUGS, WHAT ARE THE PROBLEMS THAT ARE ASSOCIATED
WITH IT, AND HOW CAN WE PREVENT THESE DRUGS FROM BEING MISUSED
AND ABUSED. HAVING SAID THAT, WE ALSO HAVE
TO RECOGNIZE, YES, WE DO HAVE PEOPLE WITH CHRONIC PAIN.
AND WE DO HAVE PEOPLE WITH ACUTE PAIN, BUT WE ALSO RECOGNIZE THAT
PERHAPS HOW WE WERE TREATING CHRONIC PAIN, WERE WE USING ALL
OF THE ADJUVANT THERAPIES, WERE WE LOOKING AT REALLY WHAT WAS
THE SOURCE OF THE PAIN? OR PERHAPS THAT CHRONIC PAIN
THAT WAS KEEPING SOMEONE UP AT NIGHT, WAS THAT A CASE OF
INSOMNIA OR A CASE OF PAIN? SO IT’S AN OPPORTUNITY TO GO
BACK AND LOOK AND EVALUATE WITH OUR PATIENTS.
AND HOW ARE WE ACTUALLY ADMINISTERING ACUTE PAIN
MEDICATION? WHY ARE WE GIVING OUT 20 PILLS
OR 20 DAYS’ WORTH WHEN ACTUALLY THREE DAYS MAY BE ENOUGH?
SO ALL OF THAT IS PART OF THE EDUCATION ASSOCIATED WITH THE
STOP ACT. AND EDUCATION AGAIN IS WHERE WE
ARE CERTAINLY — MOST OF OUR INFORMATION.
IN REGARD TO THE CONTROLLED SUBSTANCE REPORTING SYSTEM,
THAT’S PART OF TECHNOLOGY AND GETTING THAT INTO THE HANDS OF
THE PRESCRIBERS HAS BEEN AN ISSUE BUT IT’S WORKING AND
PEOPLE, DOCTORS AND PRESCRIBERS ARE NOW SEEING THAT THESE
MEDICATIONS ARE GOING WHERE THEY SHOULDN’T BE GOING, THEY’RE ABLE
TO IDENTIFY DIVERSION, SO YES, WE DO NEED OUR LAW ENFORCEMENT
COLLEAGUES AS PART OF THAT SOLUTION.
IT IS A SHARED RESPONSIBILITY, AND SHARED ACCOUNTABILITY.
>>I JUST WANTED TO FOLLOW U I THINK TO ADD TO THAT, THERE’S A
SWEET SPOT WHICH YOU’RE RAISING HERE WHICH WE HAVEN’T QUITE HIT.
THERE MAY BE AN OVERREGULATION OF PAIN MEDICATION, THE EXAMPLE
THAT JUMPS TO MY MIND IS AFRICAN-AMERICANS WITH SICKLE
CELL DISEASE HAVE EXTREME PAIN, AND THOSE CELLS CAN SICKLE IF
YOU DON’T REDUCE THAT PAIN. SO IT WILL GET WORSE AND THEIR
LONGEVITY WILL SUFFER. AND SO GETTING THAT SWEET SPOT
RIGHT SO YOU’RE NOT JUST SAYING WE NEED TO GET PAIN MEDICATION
OFF THE MAP AND ONLY DO OTHER THINGS, YOU’RE GOING TO MISS
THOSE FOLKS THAT HAVE PAIN AND YOU’RE GOING TO KIND OF DOUBLE
DOWN ON SOME OF THE DISCRIMINATION IN PAIN
MEDICATION PRESCRIPTION THAT WE’VE SEEN.
SO THAT MEANS THAT TO YOUR POINT, WE HAVE TO DO A GOOD JOB
ABOUT SAYING WHERE IS THE RISK FOR OPIOID OVERDOSE, WHAT
MEDICATION — I REALLY APPRECIATED DISTINGUISHING
BETWEEN A FENTANYL OVERDOSE AND OTHER KIND OF OPIOID OVERDOSE,
THAT KIND OF DATA NEEDS TO BE MADE MORE AVAILABLE.
GO AHEAD, DR. LINN.>>I JUST WANT TO SHARE MY
EXPERIENCE. I WENT TO VISIT A CITY IN WEST
VIRGINIA, ONE OF THE EPICENTER OF OUR NATION.
THEY FORMED A TEAM CALLED THE QUICK RESPONSE TEAM, FOUR OR
FIVE PEOPLE, SOCIAL WORKER, MENTAL HEALTH WORKER AND
EVERYTHING ELSE. SURPRISINGLY, THEY WERE ABLE TO
REDUCE THE OVERDOSE RATE BY 55% IN THE EARLY THREE MONTHS OF
THIS YEAR. I’M SURE YOU HAVE ALL SEEN —
THOSE OVERDOSE PEOPLE, USUALLY THEY ARE BUILDING A BRIDGE SO
NOBODY EXCEPT THOSE AT HOME — THEY DO VERY WELL, ABLE TO
RECOVER THEM FROM CONTINUING OVERDOSE.
BEFORE, PEOPLE USUALLY GET TREATMENT, GO HOME AND COME
BACK, GET TREATMENT AGAIN AND GO HOME AND DIE.
THOSE SIGNIFICANTLY REDUCE THE OVERDOSE INSTANCE.
>>WHY DON’T WE TAKE ONE QUESTION FROM THE FOLKS
VIRTUALLY THEN WE’LL COME BACK TO FOLKS IN THE ROOM HERE.
>>I HAVE A QUESTION. THANK YOU FOR EVERYONE WHO’S
SUBMITTING YOUR QUESTIONS ONLINE.
WE HEAR YOU AND WE WILL CONTINUE TO TAKE THOSE QUESTIONS ONLINE.
WE DID GET A QUESTION ABOUT WHAT CAN WE DO TO SUPPORT TRAINING IN
MEDICAL SCHOOLS SO THAT OUR YOUNG PHYSICIANS AS WELL AS
NURSES AND OTHERS PHYSICIAN ASSISTANTS CAN KNOW WHAT TO DO
IN THE COMMUNITY TO WATCH FOR POTENTIAL MISUSE AND ALSO TO
SUPPORT PAIN MANAGEMENT?>>I CAN ADDRESS THAT.
IN OUR OFFICE, FOR EXAMPLE, WE DO HAVE STUDENTS WHO COME IN AND
WE DO HAVE THE MEDICATION ASSISTED TREATMENT IN OUR
OFFICE, AND SO ACTUALLY TEACHING THE STUDENTS IN A SETTING OF
REALITY OF WHAT ACTUALLY OCCURS, IT IS A DIFFICULT TASK TO
INTEGRATE MEDICATION-ASSISTED TREATMENT IN AN OUTPATIENT
PRIMARY CARE OFFICE. BUT WE FEEL LIKE WE HAVE DONE
THIS. AND SO TEACHING THE STUDENTS AND
LETTING THE STUDENTS ACTUALLY ASSIST WITH THE PATIENT INTAKE,
ASK THE QUESTIONS, ASK THOSE QUESTIONS OF THAT INDIVIDUAL,
WHO’S GOING ON, AND WHAT BROUGHT YOU INTO OUR OFFICE, AND HOW DID
YOU START TO USE PILLS TO BEGIN WITH?
HOW DID THIS HAPPEN TO BEGIN WITH?
NOT ONLY DOES IT GIVE THE STUDENTS AN OPPORTUNITY TO LEARN
HOW TO DEVELOP A RAPPORT WITH PEOPLE WHO ARE PATIENTS, BUT IT
ALSO TEACHES THEM HOW DO WE MANAGE THIS DISORDER OR THIS
PROBLEM IN THE CLINICAL SETTING? AND SO MANY OF THE MEDICAL
SCHOOL CURRICULUMS HAVE INCORPORATED IT, BUT I WOULD SAY
THAT THE CLINICAL OUTPATIENT SETTING AS WELL AS OUR HOSPITAL
EMERGENCY ROOM SETTING, SO THE STUDENTS ARE LEARNING UNDER THE
SUPERVISION OF THOSE PHYSICIANS WHO ARE TRAINING AND LEARNING
STRATEGIES FOR MANAGEMENT.>>I AGREE THAT NEEDS TO BE
INCORPORATED INTO THE CURRICULUM AND ALSO NEEDS TO BE
INCORPORATED IN THE CLINICAL SETTING.
IN BALTIMORE CITY, MOST OUT OF THE 12 HOSPITALS, ABOUT EIGHT
OUT OF THE 12, I THINK BY NOW ARE ACTUALLY OFFERING
BUPRENORPHINE INITIATION IN THE E.D. AND THEY’RE ALSO DOING
SCREENING AS WELL, SO THEY’RE SCREENING UNIVERSALLY, SO HAVING
IT ALSO AS PART OF THE WORK FLOW SO THAT WHEN STUDENTS COME IN,
THEY REALIZE THAT TREATMENT — THAT’S THE DEFAULT, IT’S NOT THE
EXCEPTION. THAT’S REALLY IMPORTANT.
>>AT CAMBRIDGE HEALTH ALLIANCE, WE HAVE SOMETHING CALLED THE
CAMBRIDGE INTEGRATED CLERKSHIP, WHICH IS FOR THIRD YEAR MEDICAL
STUDENTS, AND A GROUP OF MEDICAL STUDENTS REALLY ARE ASSIGNED TO
ONLY A HANDFUL OF FAMILIES. AS PART OF THEIR TRAINING, THEY
LEARN ABOUT EVERYTHING THAT’S GOING ON IN THE FAMILY FOR THOSE
PATIENTS THAT HAVE MENTAL HEALTH PROBLEM OR ANOTHER TYPE OF
PROBLEM. AND THEN THEY BEGIN TO UNPEEL
ALL THE LAYERS THAT SUSTAIN THE ILLNESS IN THAT PATIENT, MAKE IT
CHRONIC, MAKE THEM — AND SEE THE FAMILIES IN THAT SITUATION.
I THINK SOMETHING LIKE THAT NEEDS TO HAPPEN MORE OFTEN IN
MEDICAL TRAINING FOR BOTH UNDERGRADUATE MEDICAL TRAINING
AS WELL AS RESIDENCY AND FELLOWSHIP.
JUST BEING ABLE TO PRESCRIBE ISN’T ENOUGH, BEING ABLE TO
PROVIDE A TREATMENT IN 15 MINUTES ISN’T ENOUGH.
YOU HAVE TO HAVE THAT ABILITY TO ASK QUESTIONS TO PEEL BACK BOTH
THOSE LAYERS. BUT THERE’S NO EXPERIENCE WITH
THAT IN MEDICAL EDUCATION, THEN IT BECOMES DIFFICULT TO DO THAT.
>>THANK YOU. I’M HERE FROM OREGON, WHICH HAS
BEEN CALLED THE WHITEST CITY — PORTLAND OREGON, WHICH HAS BEEN
CALLED THE WHITEST CITY IN THE UNITED STATES, AND AFTER THREE
YEARS OF CAMPAIGNING, THE PUBLIC HEALTH DEPARTMENT THERE HAS
FINALLY DECLARED RACISM A PUBLIC HEALTH ISSUE.
WE’RE HAPPENING THE SAME THING HAPPEN ACROSS THE NATION BECAUSE
WE ARE ACTUALLY IN THE SAME SITUATION THAT THANK YOU
DR. COOK FOR BRINGING IT UP, IT TAKES A LONG TIME WITH THESE
PATIENTS, IT TAKES A LONG TIME TO PEEL BACK THESE LAYERS AS YOU
HAVE RECOMMENDED TO DO, WITH PATIENTS, AND A PART OF MY
QUESTION IS TWOFOLD. NUMBER ONE, IF WE WERE ABLE TO
LOOK AT RACISM AS A THREAT TO PUBLIC HEALTH, DON’T YOU THINK
THAT WOULD IMPROVE THE ABILITY TO USE THIS LENS WHEN WE’RE
PRESCRIBING? AND I APPRECIATED THE
GENTLEMAN’S COMMENTS BECAUSE I HAVE TO LEAVE RIGHT NOW TO SPEAK
AT A CONGRESSIONAL HEARING ABOUT THE CHRONIC PAIN PATIENTS AND
THEIR INABILITY TO GET THE MEDICATION BECAUSE OF THIS
EPIDEMIC, WHICH HAS TARGETED PEOPLE OF COLOR
DISPROPORTIONATELY AS WE KNOW AND SICKLE CELL IS JUST A PART
OF THAT. SO I THINK THAT’S A QUESTION I
WOULD HAVE. ALSO IN THIS PROCESS, AND PSAP
IS A GREAT ORGANIZATION, STARTED ON THE WEST COAST, JUST LET ME
INTERJECT, BUT ALSO IN TRYING TO COMMUNICATE WITH OUR CDC IN
ASKING THESE QUESTIONS IN PRIMARY CARE, IT’S BEEN VERY
DIFFICULT FOR US TO GET THE RESPONSE AND GET THIS BACKING
FOR THESE KINDS OF SIMPLE ADHERENCE OF CDC’S OWN
GUIDELINES FOR THE FOUR CRITERIA THAT CONSTITUTE A THREAT TO
PUBLIC HEALTH. SO MY QUESTION IS, WHAT ROLE DO
YOU SEE IN THE POSSIBLE PROCLAMATION BY CDC THAT RACISM
IS A THREAT TO PUBLIC HEALTH, COULD WE SEE SOME IMPROVEMENT IN
THIS EXACT EPIDEMIC THAT WE’RE SEEING, AS WELL AS THE
COMPASSION THAT WE SO APPRECIATE HEARING ABOUT FROM OUR PANELISTS
FOR THOSE PATIENTS IN CHRONIC PAIN OF WHICH SICKLE CELL IS
JUST A SMALL PART. CAN YOU SPEAK TO THE
INSTITUTIONALITY THAT WE NEED TO BE LOOKING AT, THE CRITERIA, THE
PUBLIC HEALTH ISSUE THAT RACISM HAS PRESENTED IN THIS COUNTRY
FOR SO VERY LONG? CAN SOMEONE SPEAK TO THAT FOR
ME, PLEASE?>>RACISM IS AN ISSUE, AS I
STATED, RACISM, SEXISM, PREJUDICE, IT IS AN ISSUE WHICH
IS GOING TO CONTINUE TO BE A PROBLEM IN REGARD TO OUR ABILITY
TO DELIVER HEALTHCARE, AND WE HAVE TO RECOGNIZE IT AS SUCH, SO
WE RECOGNIZE IT. AND WE MOVE FORWARD AND HOW DO
WE ADDRESS IT? THAT IS WHAT WE ARE CERTAINLY
READILY DOING IN TERMS OF TEACHING OUR STUDENTS AND OUR
PRACTICING PHYSICIANS AT ALL OF OUR HEALTHCARE PROVIDERS IN
TERMS OF HOW DO YOU RECOGNIZE IT, HOW DO YOU ADDRESS IT, HOW
DO YOU NOT JUST TURN YOUR EYE OR LOOK THE OTHER WAY OR SAY I
DIDN’T HEAR IT? ADDRESS IT.
I THINK ONCE WE’RE ABLE TO DO THAT, WE’RE ABLE TO THEN PROVIDE
CARE AND BE ABLE TO ACTUALLY SEE THE OUTCOMES THAT WE’RE LOOKING
FORWARD TO. IN OUR COMMUNITY WHEN WE HAVE
THE PATIENT-CENTERED MEDICAL HOME, EVERY PERSON IN THIS
COUNTRY SHOULD HAVE A DOCTOR. EVERY PERSON IN THIS COUNTRY
SHOULD HAVE A DOCTOR. SHOULD HAVE ACCESS TO A DOCTOR.
SHOULD HAVE ACCESS TO A HEALTHCARE PROVIDER, WHETHER
IT’S A NURSE PRACTITIONER OR A P.A. WHO’S WORKING WITH A
DOCTOR. SO THE PATIENT-CENTERED MEDICAL
HOME ALLOWS THAT ENTIRE TEAM TO TAKE CARE OF THAT INDIVIDUAL.
BUT IT ALSO ALLOWS US TO HAVE CO -LOCATION WITH BEHAVIORAL
HEALTH, IT ALLOWS US TO BRING IN OUR PHARMACY, IT ALLOWS US TO
HAVE THE TOTAL COMPREHENSIVE CARE OF THAT PATIENT, AND THAT
INDIVIDUAL RECOGNIZES AND HUSBAND THE TRUST TO GO TO.
SO JUST STARTING THAT CONVERSATION AND UNDERSTANDING
HOW DOES RACISM, SEXISM, PREJUDICE AND DISCRIMINATION
HAVE AN IMPACT, HOW DO WE START THAT CONVERSATION, AND WE HAVE
STARTED THAT CONVERSATION.>>THANK YOU.
SO I’M GOING TO DO REAL QUICKLY HERE ONE ON THE WEB OR VIRTUAL
AND THEN THE GENTLEMAN RIGHT HERE WHO’S HAD HIS HAND UP FOR A
WHILE, THEN WE’RE GOING TO UNFORTUNATELY CLOSE OUT, I’M
GOING TO TURN IT BACK OVER. SO VERY QUICKLY.
>>THANK YOU. WE’RE GOING TO COLLAPSE TWO
QUESTIONS INTO ONE. ALL OF US HAVE A ROLE TO PLAY,
SO THE QUESTION IS, WHAT CAN FAITH COMMUNITIES DO BY THE
TRAININGS AND SUPPORT FOR CHURCHES AND OTHER FAITH
ORGANIZATIONS TO GET INVOLVED, AND TWO, WHERE DO FAMILIES AND
COMMUNITIES GET RESOURCES IF THEY KNOW THERE’S AN ISSUE
WITHIN THEIR FAMILY OR COMMUNITY TO BE ABLE TO ACCESS SUPPORT?
>>I’LL START THEN GIVE IT OFF TO LEAH.
I THINK IN TERMS OF FAITH COMMUNITIES, REALLY AS WHAT
DR. ADAMS PRESENTED A CHALLENGE OF EVERYONE KNOWING ABOUT
NALOXONE, KNOWING HOW TO USE IT AND HAVING IT ON HAND BECAUSE
YOU NEVER KNOW WHEN YOU’RE GOING TO BE USING IT.
THAT’S SOMETHING THAT LEAH HAS DONE A TREMENDOUS JOB OF,
TRAINING SO MANY INDIVIDUALS IN THE CITY AND THAT’S SOMETHING
THAT REALLY EVERYONE CAN DO. I DON’T KNOW IF THERE’S ANYTHING
ELSE YOU WANTED TO ADD TO THAT.>>IN REGARDS TO FAITH BASED
COMMUNITY, MY MOTHER’S RECOVERY, IT WAS SPIRITUAL TO FIND
FORGIVENESS FROM GOD, AND BREAKING THOSE BARRIERS DOWN IN
THE FAITH-BASED COMMUNITY, THAT IS NOT A MORAL FAILING THAT GOD
DOES FORGIVE AND TO OPEN UP THEIR DOORS FOR MORE PEOPLE TO
COMMUNICATE THAT TO THE PASTORS, THE PRIESTS, AND TO PROVIDE
RESOURCES, BY GETTING TRAINING IN NALOXONE AND TO HAVING
NALOXONE IN YOUR PARISH OR YOUR CHURCHES.
I THINK THAT DOES HELP TO SEND A MESSAGE THAT EVEN IF YOU DON’T
WANT TO SAY THAT YOU DO HAVE A SUBSTANCE USE DISORDER KNOWING
THAT THE PLACE THAT YOU GO TO TO PRAISE GOD OR OTHER SPIRITUAL
LEADERS, I THINK, THAT THEY ARE WITH YOU AS WELL.
>>OKAY.>>THANK YOU.
MY NAME IS ENRIQUE, I’M WITH THE NORTH CAROLINA DEPARTMENT OF
INSURANCE, AND I THINK EVERYBODY HAS A SHARE OF THIS PROBLEM.
I ALSO AM A PHYSICIAN, AND TALKING ABOUT THE MAIN TOPIC
THAT DR. COOK ADDRESSES IS DOCTORS TODAY DO NOT HAVE TIME
TO SEE THE PATIENTS WITH THE SYMPTOMS, NOT THE PROBLEM.
SO FOR THE PAST FEW YEARS, I’VE BEEN LEARNING ABOUT ALTERNATIVE
TREATMENTS FOR PAIN, AND I HAVE HELPED PEOPLE TO GET OUT OF
ADDICTIONS AND CONTROL THEIR PAIN WITH ACUPUNCTURE, MANY
OTHER, YOU KNOW, STATISTICS THAT CHOSE THAT PAIN CAN BE TREATED
DIFFERENTLY. IN 2012, I GRADUATED AS AN
INTEGRATED HEALTH COACH THAT ALSO EMPOWERS THE PERSON TO
CHANGE BAD HABITS TO GOOD HABITS.
AND ALSO WE CAN EVEN USE HYPNOSIS, CLINICAL HYPNOSIS.
HAVE YOU CONSIDERED USING THESE PROGRAMS FOR UNIVERSITIES?
INTEGRATIVE MEDICINE?>>SO AT CAMBRIDGE HEALTH
ALLIANCE, WE HAVE A CLINIC THAT IS REALLY FOCUSED ON MINDFULNESS
BASED INTERVENTIONS WHICH HAS BEEN SHOWN TO HAVE SOME
PRELIMINARY INCREASING EFFECT ON MEDICATION ASSISTED TREATMENT,
THAT THE EFFICACY IMPROVES IF YOU ALSO HAVE A MODULE OF
MINDFULNESS TRAINING. BUT YOU MENTION A NUMBER OF
OTHERS THAT SHOW A LOT OF PROMISE, AND I KNOW THERE ARE
SOME STUDIES GOING ON BUT I THINK THERE COULD BE A LOT MORE
TARGETED WORK BY FUNDERS TO SUPPORT RESEARCH THAT DOES —
THAT THOSE KIND OF ALTERNATIVE THERAPIES ALONG WITH MEDICATION
GIVEN THE PROBLEM THAT WE HAVE. I JUST WANTED TO SAY ONE MORE
THING ABOUT TIME, AND MAYBE IT’S NOT NECESSARILY I’M THE PRIMARY
CARE PROVIDER WHO HAS 15 MINUTES AND LOTS OF INSURANCE ISSUES
COMING DOWN UPON THEM TO HEAR THE STORY AND PEEL BACK ALL THE
LAYERS. BUT THERE’S GOT TO BE SOMEONE ON
THE MEDICAL CARE TEAM, AND THE FAITH BASED COMMUNITY HAS TO BE
INVOLVED IN THIS TEAM ALSO, SO WE WORK WITH THE TRANSFORMATION
CENTER WHICH IS IN ROXBURY, WHICH IS EDUCATING PEERS ON HOW
TO HELP OTHERS WITH SERIOUS MENTAL ILLNESS NAVIGATE THE
HEALTHCARE SYSTEM. ONE WOMAN’S STORY WAS THAT IT
REALLY TOOK HER 30 MINUTES TO EDUCATE HER MENTAL HEALTH
PROVIDER ABOUT ALL THE RACISM THAT SHE GREW UP WITH AND
EXPERIENCED, AND SHE STARTED HER LIFE WITH BECAUSE OF THAT
INTERGENERATIONAL CUMULATIVE EXPERIENCE OF RACISM THAT ENDED
UP IN HER HOUSE. AND THEN SHE SUFFERED TRAUMA AND
A LOT OF ISSUES GOING THROUGH HER LIFE.
SO SHE NEEDED — SHE FELT LIKE SHE NEEDED TO EXPLAIN THAT TO
HER PROVIDER FOR 30 MINUTES, SHE HAD TO COACH HER PROVIDER BEFORE
THE PROVIDER COULD THEN PROVIDE ANY TREATMENT.
THAT’S A LOT OF WORK FOR HER AND SHE HAD REALLY PUT HERSELF OUT
THERE AND TAKEN A RISK. SO THAT MAY BE ON THE PROVIDERS THAT
THEY HAVE TO BE ABLE TO UNPEEL THESE STORIES, BUT IT’S ALSO ON
THIS TEAM-BASED APPROACH OR KIND OF A FULL COURT PRESS THAT
INVOLVES THE FAITH BASED COMMUNITIES AS WELL AS SOCIAL
WORKERS AND COMMUNITY HEALTH WORKERS TO GET THAT STORY SO YOU
DON’T SPEND MORE THAN HALF OF YOUR PSYCHIATRIC VISIT TO GET
THE PHYSICIAN TO UNDERSTAND WHAT YOU’RE TALKING ABOUT.
>>THANK YOU FOR THAT, THANK YOU ALL FOR JOINING US.
I’M GOING TO TURN IT BACK OVER TO LARKE TO CLOSE US OUT AND
BEFORE I DO, I JUST WANT TO AGAIN ADD MY THANKS FOR THE
STORIES AND THE INFORMATION THAT YOU SHARED AND APOLOGIZE FOR THE
FACT THAT WE DIDN’T MAKE THIS A FOUR-HOUR OR SIX-HOUR SESSION
BECAUSE WE COULD HAVE HAD A LOT MORE DISCUSSION, BUT HOPE THAT
YOU WILL CONTINUE TO ENGAGE WITH US AS WE’RE WORKING ON OUR PATH
TO HELP EQUITY IN ADDRESSING OPIOIDS AND OTHER BEHAVIORAL
HEALTH NEEDS IN OTHER MINORITY COMMUNITIES.
>>THANKS, CARA. I ACTUALLY HAD SOME PREPARED
REMARKS TO CLOSE THIS OUT, WHICH I MAY OR MAY NOT GO TO BECAUSE
WE’RE REALLY CLOSE TO BEING OUT OF TIME AND BECAUSE THERE IS
SUCH AN INTERESTING DISCUSSION HERE.
YOUR QUESTIONS WERE TERRIFIC AND I THINK IT REALLY MAKES US THINK
ABOUT HOW DO WE DELIVER CARE, AND WHO DELIVERS THE CARE.
I THINK AS BEN WAS SAYING, THERE IS A TIME ISSUE.
AS CARA WAS SAYING, WE TRY TO INTEGRATE SO MUCH INTO OUR
OFFICE VISIT. WHO ARE THE PARTNERS AND THE
PLAYERS, WE’VE USED SO MANY SPORTS METAPHORS HERE, ON THE
FIELD, GET TO THE END ZONE. I KNOW THAT IN TERMS OF WHAT WE
REALLY DO IN HEALTHCARE DELIVERY PROBABLY ACCOUNTS FOR MAYBE 40%
OF HEALTHCARE OUTCOMES AT MOST. BUT IT’S ALL THOSE OTHER KINDS
OF FACTORS GOING ON WHICH HAVE BEEN REFERRED TO HERE AS SOCIAL
DETERMINANTS OF HEALTH, WHICH IS INCLUSIVE OF RACISM, IS
INCLUSIVE OF EXPOSURE TO VIOLENCE, EXPOSURE TO TRAUMA,
AND WHO TAKES CARE OF ALL OF THAT, WHO IS RESPONSIBLE FOR ALL
OF THAT. AND REALLY IT IS MANY COMMUNE
PROVIDERS, IT IS NOT JUST THE DOCS AND THE PEOPLE IN THE
OFFICE VISIT. AT SAMHSA, WE’VE ACTUALLY
SUPPORTED THE LEAD PROGRAM, WE FIND OUR NEWEST PARTNERS IN THIS
WORK ARE NOT JUST LAW ENFORCEMENT, BUT ARE
FIREFIGHTERS. FIREFIGHTERS ARE SAYING THAT THE
WAY THEY’RE BUILDING AND CONSTRUCTING BUILDINGS NOW,
THERE’S SO MUCH FIRE RETARDANT THAT WE’RE NOT PUTTING OUT AS
MANY FIRES SO NOW WE’RE REALLY LOOKING AT HUMAN INTERACTIONS
AND THEY ARE DOING THE NALOXONE DRUG REVERSALS.
AND THEY’RE LOOKING AT OVERDOSE REVERSALS, THEY’RE LOOKING AT
THOSE OVERDOSE OPPORTUNITIES AS WHAT THEY ARE CALLING AND ARE
TEACHING US THAT THESE ARE HOT MOMENTS.
IT’S NOT A MOMENT TO JUST GET SOMEBODY BACK ON THEIR FEET
AGAIN WITH THE INJECTION OF THE NALOXONE, BUT GETTING THEM INTO
TREATMENT, AND WE ARE PARTNERING WITH LAW ENFORCEMENT TO KEEP
PEOPLE OUT OF JAILS AND ACTUALLY OUT OF EMERGENCY DEPARTMENTS AS
WELL. BECAUSE FOR A POLICE OFFICER TO
TAKE SOMEONE TO AN EMERGENCY ROOM, THAT TAKES THEM OFF THE
STREET FOR ABOUT TWO OR THREE HOURS UNTIL THE PATIENT CAN BE
CARED FOR IN THE EMERGENCY ROOM. SO THEY’RE COMING UP WITH VERY
NEW SOLUTIONS LIKE LAZY BOY SITES OR LIVING ROOM SITES WHICH
ARE IN THE HALLWAYS OF THE EMERGENCY ROOM BUT NOT IN THE
EMERGENCY ROOM, WHERE A SOCIAL WORKER OR COMMUNITY HEALTH
WORKER OR PEER SPECIALIST CAN HELP DEESCALATE THE PERSON AND
TREAT THEM BEFORE THEY ACTUALLY GET INTO THE EMERGENCY ROOM OR
BEFORE THEY’RE CYCLED IN AND OUT OF JAILS.
I THINK THE ISSUE OF RACISM TOTALLY — VERY MUCH PENETRATES
OUR SERVICE DELIVERY SYSTEM AS WELL.
THE ISSUE OF STIGMA, I THINK WITH NO ASPERSIONS TO OUR
PHYSICIANS HERE, BUT THERE ARE STUDIES THAT HAVE SHOWN AROUND
MEN WILL TALL HEALTH ISSUES, SOMETIMES IT IS PHYSICIANS AND
THE MEDICAL PROFESSION THAT HAVE THE HIGHEST RATES OF STIGMA.
HOW OFTEN HAVE YOU HEARD PEDIATRIC CARE PROVIDERS SAYING
TO THE PARENT WHO KNOWS SOMETHING IS WRONG WITH THEIR
CHILD, HE WILL GROW OUT OF IT. YOU KNOW, NOT KNOWING HOW TO
EVEN START THE CONVERSATION. SO WE WANT TO START
CONVERSATIONS AROUND THIS OPIOID EPIDEMIC WHICH ACTUALLY IN THIS
COUNTRY HAS NOW REDUCED THE AVERAGE LIFE EXPECTANCY OF
PEOPLE IN OUR COUNTRY. IN A SHORT PERIOD OF TIME, IT
HAS DOWNGRADED OUR LIFE EXPECTANCY.
WE ALSO REALLY WANTED TO FOCUS ON IT FOR POPULATIONS OF COLOR.
WE KNOW THAT PATHWAYS TO SUBSTANCE USE, PATHWAYS TO
OPIATE USE IN PARTICULAR, ARE VERY DIFFERENT FOR DIFFERENT
POPULATIONS. AND THE INTERESTING PARADOX AT
OUR FORMER CENTER FOR SUBSTANCE ABUSE TREATMENT DIRECTOR DR. WES
CLARKE WOULD SAY, THERE’S A PARADOX FOR AFRICAN-AMERICANS.
IN A SENSE THEY WERE PROTECTED BY THE FACT THAT THEY CAN’T GET
GOOD ACCESS TO CARE AND CAN’T GET GOOD ACCESS TO PAIN CARE, SO
THEY WERE SPARED A LITTLE BIT IN THE BEGINNING OF THE OPIOID
CRISIS. BUT WE KNOW THAT IT IS
CRIMINALIZED FOR PEOPLE OF COLOR, WE KNOW THAT THE JAILS
ARE OVERWHELMED AND OVERPOPULATED WITH PEOPLE WITH
MENTAL HEALTH ISSUES AND LOW LEVEL DRUG-RELATED CRIMES THAT
WE NEED TO DO A BETTER PROCESS OF DIVERSION OR THINKING HOW DO
WE CONCEPTUALIZE IT AS CRIMINAL BEHAVIOR, WITH CERTAIN
POPULATIONS, ESPECIALLY BROWN AND BLACK POPULATIONS.
AND AS AN ADDICTION, AS A DISEASE FOR OTHER POPULATIONS.
SO THE PATHWAYS TO CRIMINALIZATION, PATHWAYS TO
JAIL, PATHWAYS TO TREATMENT REALLY VARY BY DIFFERENT DIVERSE
POPULATIONS. WE ACTUALLY NEED TO CORRECT
THAT. WE NEED TO LOOK AT UNIVERSAL
STRATEGIES THAT WORK FOR ALL POPULATIONS BUT WE ALSO NEED TO
LOOK FOR TARGETED POPULATIONS FOR SPECIFIC POPULATIONS TO
ENSURE THAT WE’RE NOT INCREASING DISPARITIES.
AS KAREN SAID, WE NEED TO LOOK AT HOW DO WE EXPAND OPTIONS FOR
MEDICATION ASSISTED TREATMENT TO LOW INCOME POPULATIONS, TO WORK
WITH COMMUNITY HEALTH CENTERS, WORK WITH FEDERALLY QUALIFIED
HEALTH CENTERS, WORK WITH COMMUNITY HEALTH WORKERS.
WE NEED TO REVISIT OUR DRUG POLICIES.
AND AS PART OF THE FEDERAL GOVERNMENT, WE’RE VERY MUCH
INVOLVED IN SOME OF THOSE DRUG POLICIES THAT COME OUT FROM OUR
DEPARTMENT AND FROM OUR DEPARTMENT OF JUSTICE.
IT REMAINS A PUBLIC HEALTH CRISIS AND IT WAS VERY
INTERESTING, I THINK SOMEONE WAS RAISING THE ISSUE OF RACISM AS A
PUBLIC HEALTH CRISIS AND AN ASSAULT ON OUR HEALTH.
I THINK WE DO HAVE EVIDENCE FOR THAT.
WE DO KNOW WE CAN LOOK AT CHRONIC STRESS BROUGHT UPON BY
MICRO-AGGRESSIONS OR DAILY PREJUDICE AND DISCRIMINATION.
THERE WAS A LARGE PIECE IN THE “NEW YORK TIMES” MAGAZINE THIS
PAST SUNDAY LOOKING AT AFRICAN-AMERICAN WOMEN OF ALL
SOCIAL CLASSES, AND WHY DO THEY HAVE SUCH A HIGH RATE OF INFANT
MORTALITY/MORBIDITY AND REALLY LOOKING AT THE CONSTANT
WEATHERING OF AN IMMUNE SYSTEM THAT HAS TO DEAL WITH DAILY
ASSAULTS. SO I WANT TO BRING THIS TO A
CLOSE BECAUSE WE CAN GO ON AND ON, AND I REALLY WANT TO THANK
OUR PARTNERS, CARA JAMES AND HER TEAM AT CMS FOR REALLY HAVING —
INITIATING THIS, ASKING US TO BE PARTNERS ON IT.
I WANT TO THANK OUR PANELISTS, WE COULD SPEND WEEKS WITH YOU
AND WE REALLY COULD HAVE YOU COME TO OUR AGENCIES AND DO A
LOT OF TEACHING FOR US AS WELL. AND THANK ALL OF YOU WHO ARE ON
THE LINE AND ALL OF YOU WHO ARE PRESENT HERE TODAY.
I WANT TO GO BACK TO LEAH’S QUESTION, SHE SAID SHE KNOWS WHY
SHE’S HERE, BUT WE NEED TO THINK ABOUT WHY ARE WE ALL HERE AND
WHAT CAN WE DO IN PARTNERSHIP TO REALLY ADDRESS THIS DEADLY
EPIDEMIC OF OPIOID MISUSE. SO THANK YOU VERY MUCH FOR
PARTICIPATING. THANK YOU FOR ALL THAT YOU’RE
GOING TO GO OUT AND DO TO ADDRESS THIS CRISIS, AND I THINK
WE ARE DONE FOR TODAY. THANK YOU.
[APPLAUSE]

Leave a Response

Your email address will not be published. Required fields are marked *