>> 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]
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