WEBVTT 00:06.306 --> 00:09.409 align:left position:10%,start line:83% size:80% >> APPRECIATE THE OPPORTUNITY TO BE HERE TO TALK TO YOU ALL ABOUT 00:09.509 --> 00:12.078 align:left position:15%,start line:83% size:75% THE OPIOID CRISIS IN WESTERN NORTH CAROLINA. 00:12.178 --> 00:15.482 align:left position:10%,start line:83% size:80% A PARTNER IN CRIME IN ALL OF THIS IS A GUY NAMED DON TEETER. 00:15.582 --> 00:18.785 align:left position:12.5%,start line:83% size:77.5% HE'S A FAMILY PHYSICIAN THAT'S BEEN WORKING FOR 30 YEARS IN 00:18.885 --> 00:21.921 align:left position:10%,start line:83% size:80% HAYWOOD COUNTY IF IN THE LAST 18 YEARS IN ADDICTIONS AND THEN 00:22.022 --> 00:26.693 align:left position:10%,start line:83% size:80% I'VE BEEN WORKING IN THIS SPACE FOR ABOUT FIVE YEARS NOW. 00:26.793 --> 00:28.828 align:left position:15%,start line:65% size:75% SO -- I HAVE NO DISCLOSURES. 00:28.928 --> 00:31.631 align:left position:10%,start line:65% size:80% THE PHARMACEUTICAL INDUSTRY IS NOT PAYING ME TO SAY THE THINGS 00:31.731 --> 00:33.733 align:left position:30%,start line:65% size:60% I'M ABOUT TO SAY. 00:33.833 --> 00:37.537 align:left position:10%,start line:89% size:80% SO JUST TO GET STARTED, 254,000. 00:37.637 --> 00:42.375 align:left position:10%,start line:83% size:80% THAT'S THE NUMBER OF PEOPLE THAT WE'VE LOST IN THE LAST TEN YEARS 00:42.475 --> 00:45.678 align:left position:25%,start line:89% size:65% TO THE OPIOID CRISIS. 00:45.779 --> 00:48.114 align:left position:12.5%,start line:83% size:77.5% SO THAT'S MORE THAN FOUR TIMES THE NUMBER OF PEOPLE THAT DIED 00:48.214 --> 00:49.716 align:left position:27.5%,start line:89% size:62.5% IN THE VIETNAM WAR. 00:49.816 --> 00:54.154 align:left position:10%,start line:83% size:80% THERE WAS A PAPER THAT JUST CAME OUT LAST YEAR AND IT SAID IF 00:54.254 --> 00:57.157 align:left position:15%,start line:83% size:75% YOU'RE UNDER 50 YEARS OLD AND YOU DIE IN THE UNITED STATES, 00:57.257 --> 01:03.196 align:left position:12.5%,start line:83% size:77.5% IT'S NOW THE NUMBER ONE REASON THAT YOU DIE. 01:03.296 --> 01:09.302 align:left position:10%,start line:83% size:80% SO GRANTED, MOST PEOPLE DIE IN THE UNITED STATES IN THEIR 50s , 01:09.402 --> 01:11.504 align:left position:20%,start line:83% size:70% 70s, 80s, 90s, IT'S RARE UNDER 50. 01:11.604 --> 01:16.509 align:left position:15%,start line:83% size:75% IF YOU DO DIE UNDER 50 IN THE UNITED STATES OPIOID ABUSE IS 01:16.609 --> 01:18.545 align:left position:15%,start line:89% size:75% THE NUMBER ONE REASON I DIE. 01:18.645 --> 01:20.547 align:left position:20%,start line:89% size:70% IT TRULY IS AN EPIDEMIC. 01:20.647 --> 01:22.449 align:left position:12.5%,start line:83% size:77.5% WE BEING THE PROVIDERS ARE THE VECTOR. 01:22.549 --> 01:24.984 align:left position:15%,start line:83% size:75% IT TOOK ABOUT 30 YEARS TO GET INTO THIS SITUATION BUT IT 01:25.085 --> 01:29.556 align:left position:15%,start line:83% size:75% REALLY WAS THE PHARMACEUTICAL INDUSTRY GIVING US A BILL OF 01:29.656 --> 01:33.860 align:left position:12.5%,start line:83% size:77.5% GOODS AND THE PROVIDERS, INCLUDING DOCS AND FAMILY DOCS 01:33.960 --> 01:35.395 align:left position:15%,start line:89% size:75% LIKE MYSELF BUYING ALL THIS. 01:35.495 --> 01:37.697 align:left position:12.5%,start line:83% size:77.5% AND WE'LL TALK ABOUT THAT IN A SECOND. 01:37.797 --> 01:39.732 align:left position:17.5%,start line:89% size:72.5% SO I AM A FAMILY PHYSICIAN. 01:39.833 --> 01:40.967 align:left position:12.5%,start line:89% size:77.5% I'VE BEEN DOING THIS 19 YEARS. 01:41.067 --> 01:43.837 align:left position:15%,start line:83% size:75% I DO IN-PATIENT WORK AND OUT- PATIENT WORK. 01:43.937 --> 01:48.274 align:left position:10%,start line:83% size:80% I SEE PREGNANT WOMEN DELIVER BAY BABIES ABOUT 30% OF MY PRACTICE 01:48.374 --> 01:49.476 align:left position:40%,start line:89% size:50% IS KIDS. 01:49.576 --> 01:51.444 align:left position:10%,start line:83% size:80% AND WHEN I WENT THROUGH RESIDENCY, AFTER MEDICAL SCHOOL, 01:51.544 --> 01:52.812 align:left position:17.5%,start line:89% size:72.5% THIS IS WHAT I WAS TAUGHT. 01:52.912 --> 01:56.349 align:left position:12.5%,start line:83% size:77.5% OH, YOU HAVE THAT PATIENT THAT HAS CHRONIC BACK PAIN. 01:56.449 --> 02:01.354 align:left position:15%,start line:83% size:75% WELL, TRY THESE THREE OR FIVE MEDICINES OR MODALITIES BUT 02:01.454 --> 02:05.592 align:left position:10%,start line:83% size:80% EVENTUALLY THAT PATIENT IS GOING TO BE ON PERCOCET AND OH, YOU 02:05.692 --> 02:08.728 align:left position:20%,start line:83% size:70% HAVE THIS PATIENT WHO HAS CHRONIC MIGRAINES. 02:08.828 --> 02:11.364 align:left position:10%,start line:83% size:80% TRY THESE TWO OR THREE MEDICINES BUT IF THAT DOESN'T WORK THAT 02:11.464 --> 02:14.234 align:left position:12.5%,start line:83% size:77.5% PATIENT IS EVENTUALLY GOING TO BE ON VICODIN. 02:14.334 --> 02:15.568 align:left position:22.5%,start line:89% size:67.5% AND THAT'S WHAT I DID. 02:15.668 --> 02:18.905 align:left position:10%,start line:83% size:80% AND THEN WHEN THEY HIRED ME ON AS FACULTY, THAT'S WHAT I TAUGHT 02:19.005 --> 02:20.440 align:left position:10%,start line:89% size:80% OTHER PEOPLE FOR A DOZEN YEARS. 02:20.540 --> 02:22.609 align:left position:10%,start line:83% size:80% THAT WAS -- THAT WAS ONE WHAT WE TAUGHT. 02:22.709 --> 02:26.112 align:left position:15%,start line:83% size:75% I'M HERE TO TELL YOU THAT THERE'S ACTUALLY NO DATA FOR 02:26.212 --> 02:29.282 align:left position:12.5%,start line:83% size:77.5% USING OPIOIDS FOR CHRONIC NON- CANCER PAIN. 02:29.382 --> 02:31.751 align:left position:12.5%,start line:83% size:77.5% THERE'S ACTUALLY NO DATA WHATSOEVER FOR WHAT WE'VE BEEN 02:31.851 --> 02:34.854 align:left position:12.5%,start line:89% size:77.5% DOING FOR THESE LAST 30 YEARS. 02:34.954 --> 02:38.391 align:left position:10%,start line:83% size:80% BUT I DO HAVE DATA IF YOU START SOMEBODY ON OPIOIDS AND IT GETS 02:38.491 --> 02:42.662 align:left position:10%,start line:83% size:80% UP TO A CERTAIN DOSE CALLED 50 MORPHINE MILI EQUIVALENTS A DAY 02:42.762 --> 02:48.001 align:left position:12.5%,start line:83% size:77.5% OR A HIGHER DOSE, YOU INCREASE FALLS, OVERDOSE AND DEATH. 02:48.101 --> 02:50.637 align:left position:15%,start line:83% size:75% SO I CAN TELL YOU THAT IT'S HARMFUL, BUT I CAN'T TELL YOU 02:50.737 --> 02:54.874 align:left position:17.5%,start line:83% size:72.5% THAT IT'S HAPPY HELPFUL FOR CHRONIC NON-CEABS PAIN. 02:54.974 --> 02:57.677 align:left position:17.5%,start line:89% size:72.5% THESE ARE OUR GOALS TODAY. 02:57.777 --> 03:00.880 align:left position:15%,start line:83% size:75% STRIVE THE THE IMPACT OF THE OPIOID CRISIS. 03:00.980 --> 03:06.719 align:left position:10%,start line:83% size:80% I KNOW YOU KNOW A LOT ABOUT IT BUT I I THINK I CAN GIVE YOU ONE 03:06.819 --> 03:08.021 align:left position:27.5%,start line:89% size:62.5% OR TWO MORE COUNTS. 03:08.121 --> 03:10.690 align:left position:10%,start line:83% size:80% FOR ALL OF YOU WORKING IN PUBLIC HEALTH OR WORKING WITH GROUPS 03:10.790 --> 03:14.394 align:left position:10%,start line:83% size:80% THAT HAVE PROVIDERS I'M GOING TO TELL AWE LITTLE BIT ABOUT THE CD 03:14.494 --> 03:17.197 align:left position:15%,start line:83% size:75% C GUIDELINES FOR ACUTE AND CHRONIC PAIN JUST SO YOU KNOW 03:17.297 --> 03:20.166 align:left position:15%,start line:83% size:75% WHAT WE'RE TEACHING THIS NEXT GENERATION OF DOCS AND WE'RE 03:20.266 --> 03:24.237 align:left position:15%,start line:83% size:75% HONESTLY HAVING TO GO OUT AND RETRAIN THE DOCS THAT WENT 03:24.337 --> 03:26.139 align:left position:10%,start line:83% size:80% THROUGH RESIDENCY YEARS AGO LIKE MYSELF. 03:26.239 --> 03:30.877 align:left position:10%,start line:83% size:80% AND THEN DESCRIBE THE -- ITS IMPACT ON OUR PATIENTS AND YOUR 03:30.977 --> 03:33.346 align:left position:20%,start line:89% size:70% ALL'S CLIENTS OUT THERE. 03:33.446 --> 03:34.681 align:left position:17.5%,start line:89% size:72.5% SO OPIOIDS IS THE BIG TERM. 03:34.781 --> 03:35.915 align:left position:30%,start line:89% size:60% IT'S ALL OF THEM. 03:36.015 --> 03:39.018 align:left position:10%,start line:83% size:80% AND OPIATES ARE IF IT COMES FROM OR DERIVED FROM THE POPPY. 03:39.118 --> 03:43.156 align:left position:10%,start line:83% size:80% AND THEN THERE'S OTHERS THAT ARE LIKE SYNTHETICS LIKE FENTANYL. 03:43.256 --> 03:45.992 align:left position:10%,start line:83% size:80% THESE ARE JUST SOME EXAMPLES UP HERE BUT I WANTED TO GO THROUGH 03:46.092 --> 03:49.862 align:left position:32.5%,start line:89% size:57.5% A FEW OF THEM. 03:49.963 --> 03:53.800 align:left position:10%,start line:83% size:80% ONE, CODEINE, SO IT'S FOR COUGH SYRUP OR 03:53.900 --> 03:55.335 align:left position:25%,start line:83% size:65% [ NO AUDIO ] NOW THE FOOD AND DRUG 03:55.435 --> 03:58.838 align:left position:10%,start line:83% size:80% ADMINISTRATION HAS COME OUT AND THEY'VE SAID WELL DON'T -- DON'T 03:58.938 --> 04:01.007 align:left position:10%,start line:83% size:80% PRESCRIBE CODEINE TO KIDS UNDER 18. 04:01.107 --> 04:05.311 align:left position:10%,start line:83% size:80% AND THEN THEY CAME OUT AND SAID WELL, DON'T PRESCRIBE CODEINE 04:05.411 --> 04:06.446 align:left position:27.5%,start line:89% size:62.5% FOR PREGNANT WOMEN? 04:06.546 --> 04:08.414 align:left position:17.5%,start line:89% size:72.5% OR IF THEIR BREAST-FEEDING. 04:08.514 --> 04:13.620 align:left position:12.5%,start line:83% size:77.5% SO NOW WHAT WE'RE TEACHING IS, DON'T PRESCRIBE CODEINE AT ALL 04:13.720 --> 04:16.222 align:left position:17.5%,start line:83% size:72.5% FOR ANYONE BECAUSE KIDS ARE GETTING AHOLD OF THIS AND 04:16.322 --> 04:17.490 align:left position:10%,start line:89% size:80% THEY'RE USING THIS TO GET HIGH. 04:17.590 --> 04:21.394 align:left position:10%,start line:83% size:80% AND THEY'RE ACTUALLY EVEN USING IT IN SCHOOL DURING THE DAY. 04:21.494 --> 04:24.297 align:left position:10%,start line:83% size:80% AND THE REASON THAT THEY CAN GET AWAY WITH IT IS THE NUMBER ONE 04:24.397 --> 04:28.501 align:left position:10%,start line:83% size:80% THING YOU LOOK LIKE WHEN YOU'RE HIGH ON OPIATES IS NORMAL. 04:28.601 --> 04:34.340 align:left position:10%,start line:83% size:80% NOW, IF YOU'VE BEEN ON OPIATES FOR A LONG TIME OR WHRA -- WHAT 04:34.440 --> 04:37.677 align:left position:10%,start line:83% size:80% HAVE YOU, YOU TEND TO HAVE SOME OF THE STIGMATA LATER. 04:37.777 --> 04:39.879 align:left position:10%,start line:83% size:80% THE KIDS THAT ARE USING THIS, IT'S REALLY HARD FOR THE PARENTS 04:39.979 --> 04:42.682 align:left position:15%,start line:83% size:75% AND THE TEACHERS HONESTLY TO PICK UP ON THIS. 04:42.782 --> 04:45.351 align:left position:12.5%,start line:83% size:77.5% YOU SEE SOME OF THE OTHER ONES UP THERE, BUT THE BIG PROBLEM 04:45.451 --> 04:50.089 align:left position:10%,start line:83% size:80% THAT WE'RE HAVING NOW IS THAT AS WE GOT INTO THIS CRISIS WITH 04:50.189 --> 04:56.362 align:left position:10%,start line:83% size:80% OPIATE PILLS, NOW WE'VE MOVED ON TO HEROINE AND WHAT THEY CALL 04:56.462 --> 04:59.265 align:left position:12.5%,start line:83% size:77.5% SYNTHETICS BUT THAT'S FENTANYL AND ITS DERIVATIVES AND WE'LL 04:59.365 --> 05:01.334 align:left position:10%,start line:83% size:80% TALK ABOUT THAT A LITTLE MORE IN A SECOND. 05:01.434 --> 05:04.671 align:left position:10%,start line:83% size:80% THE UNITED STATES IS 4.6% OF THE WORLD'S POPULATION, BUT WE 05:04.771 --> 05:10.209 align:left position:15%,start line:83% size:75% CONSUME 80% OF ALL THE OPIOID PILLS PRESCRIBED IN THE WHOLE 05:10.310 --> 05:11.878 align:left position:42.5%,start line:89% size:47.5% WORLD. 05:11.978 --> 05:13.212 align:left position:45%,start line:89% size:45% 80%. 05:13.313 --> 05:15.915 align:left position:10%,start line:83% size:80% THERE'S NO OTHER COUNTRY THAT'S EVEN CLOSE TO WHAT WE'RE DOING. 05:16.015 --> 05:19.018 align:left position:10%,start line:83% size:80% THE ONLY ONE THAT'S EVEN A FRACTION OF WHAT WE'RE DOING IS 05:19.118 --> 05:19.752 align:left position:42.5%,start line:89% size:47.5% CANADA. 05:19.852 --> 05:20.887 align:left position:17.5%,start line:89% size:72.5% I FEEL REALLY BAD FOR THEM. 05:20.987 --> 05:22.889 align:left position:10%,start line:83% size:80% THEY JUST HAVE REALLY LONGBOARD ER WITH US, I THINK 05:22.989 --> 05:26.292 align:left position:10%,start line:89% size:80% IT'S KIND OF A BLEEDOVER EFFECT. 05:26.392 --> 05:30.763 align:left position:12.5%,start line:83% size:77.5% 83% OF THE WORLD HAS NO ACCESS TO OPIATES. 05:30.863 --> 05:31.764 align:left position:30%,start line:89% size:60% THINK ABOUT THAT. 05:31.864 --> 05:35.034 align:left position:12.5%,start line:83% size:77.5% 83% OF THE WORLD HAS NO ACCESS TO OPIATES. 05:35.134 --> 05:37.737 align:left position:15%,start line:83% size:75% AND I'M GOING TO BE A LITTLE FLIPPANT HERE, BUT THEY'RE 05:37.837 --> 05:39.238 align:left position:37.5%,start line:89% size:52.5% GETTING BY. 05:39.339 --> 05:40.506 align:left position:40%,start line:89% size:50% YOU KNOW? 05:40.606 --> 05:43.910 align:left position:12.5%,start line:83% size:77.5% AND THEY'RE GETTING BY THE WAY THAT WE USED TO PRACTICE. 05:44.010 --> 05:47.380 align:left position:10%,start line:83% size:80% FOR THOSE IN THE BACK, I'M GOING TO KIND OF GO THROUGH THIS ON 05:47.480 --> 05:49.182 align:left position:22.5%,start line:89% size:67.5% THE LEFT SIDE IS 1986. 05:49.282 --> 05:50.683 align:left position:17.5%,start line:89% size:72.5% ON THE RIGHT SIDE IS 2015. 05:50.783 --> 05:52.952 align:left position:15%,start line:89% size:75% SO THIS IS A 30-YEAR PERIOD. 05:53.052 --> 05:54.954 align:left position:17.5%,start line:83% size:72.5% AND YOU CAN LOOK AT ALL THE DIFFERENT COLORS OF THE 05:55.054 --> 05:58.024 align:left position:10%,start line:83% size:80% DIFFERENT TYPES OF OPIATES, BUT REALLY THE RED LINE IS THE 05:58.124 --> 06:01.894 align:left position:10%,start line:83% size:80% ADDITIVE OR ACCUMULATION EFFECT OF ALL OF THE OPIATES THAT WE 06:01.994 --> 06:04.230 align:left position:10%,start line:83% size:80% PRESCRIBED AND DISPENSED IN THE UNITED STATES. 06:04.330 --> 06:07.500 align:left position:12.5%,start line:83% size:77.5% AND IF YOU GO OVER TO THE LEFT THEN N THE 70s AND EARLY '80S 06:07.600 --> 06:12.105 align:left position:10%,start line:83% size:80% WE WERE PRESCRIBING IN A LOW RATE THE WAY THAT WESTERN EUROPE 06:12.205 --> 06:13.439 align:left position:25%,start line:89% size:65% IS STILL PRESCRIBING. 06:13.539 --> 06:17.744 align:left position:10%,start line:83% size:80% AND REALLY, BACK IN THE '70S AND '80S, THERE WAS TWO REASONS THAT 06:17.844 --> 06:19.011 align:left position:20%,start line:89% size:70% YOU WOULD GET AN OPIATE. 06:19.112 --> 06:21.914 align:left position:10%,start line:83% size:80% IF YOU WERE IN THE LAST SIX MONTHS OF LIFE, ON HOSPICE CARE, 06:22.014 --> 06:23.416 align:left position:15%,start line:89% size:75% THEY WOULD GIVE US AN OPIATE. 06:23.516 --> 06:27.553 align:left position:10%,start line:83% size:80% AND WE HAVE VERY GOOD DATA THAT SAYS THAT IT HELPS WITH QUALITY 06:27.653 --> 06:28.855 align:left position:40%,start line:89% size:50% OF LIFE. 06:28.955 --> 06:33.459 align:left position:10%,start line:83% size:80% HELPS TO TAKE AWAY THE WANE SO YOU CAN -- PAIN SO YOU CAN SPEND 06:33.559 --> 06:35.862 align:left position:15%,start line:83% size:75% TIME WITH YOUR FAMILY BUT IT DOESN'T HELP WITH QUALITY OF 06:35.962 --> 06:38.765 align:left position:15%,start line:83% size:75% LIFE T. OTHER WAY YOU GOT AN OPIATE IS ACUTE SEVERE PAIN. 06:38.865 --> 06:41.534 align:left position:10%,start line:83% size:80% SO IF YOU'RE IN A CAR WRECK AND THE BONE IN YOUR LEG IS STICKING 06:41.634 --> 06:44.370 align:left position:15%,start line:83% size:75% OUT OF YOUR SKIN, YOU GOT AN OPIATE. 06:44.470 --> 06:48.241 align:left position:10%,start line:83% size:80% BUT THE THIS WHOLE BUSINESS OF GIVING OPIATES FOR CHRONIC NON- 06:48.341 --> 06:50.843 align:left position:17.5%,start line:83% size:72.5% CANCER PAIN JUST REALLY WASN'T HAPPENING BACK THEN. 06:50.943 --> 06:58.151 align:left position:12.5%,start line:83% size:77.5% AND THEN TWO ARTICLES CAME OUT IN THE MID '80S, AND I'M GOING 06:58.251 --> 07:01.154 align:left position:10%,start line:83% size:80% THE TALK TO YOU A LITTLE BIT ABOUT THE ARTICLE, IT WAS PICKED 07:01.254 --> 07:04.824 align:left position:12.5%,start line:83% size:77.5% UP BY THE TENS OF THOUSANDS OF DRUG REPS WHO THEN SPREAD OUT 07:04.924 --> 07:07.360 align:left position:15%,start line:83% size:75% INTO THE COUNTRY AND STARTED TALKING TO THE PROVIDERS AND 07:07.460 --> 07:11.397 align:left position:17.5%,start line:83% size:72.5% THEY SAID HEY, THERE'S THIS ARTICLE IN THE "NEW ENGLAND 07:11.497 --> 07:13.666 align:left position:10%,start line:83% size:80% JOURNAL OF MEDICINE" AND IT SAYS OPIATES ARE REALLY SAFE, LESS 07:13.766 --> 07:16.736 align:left position:10%,start line:83% size:80% THAN 1% OF PEOPLE WILL EVER GET ADDICTED AND YOU SHOULD BE USING 07:16.836 --> 07:20.807 align:left position:10%,start line:83% size:80% THESE MEDICINES FOR CHRONIC PAIN AND IF YOU LOOK, THE LINE STARTS 07:20.907 --> 07:23.976 align:left position:10%,start line:83% size:80% TO GO UP BECAUSE THEY STARTLING THE PROVIDERS THIS OVER AND OVER 07:24.076 --> 07:25.978 align:left position:32.5%,start line:89% size:57.5% AND OVER AGAIN. 07:26.078 --> 07:29.148 align:left position:15%,start line:83% size:75% INTERESTINGLY, IF YOU GO BACK AND LOOK AT THAT ARTICLE, IT 07:29.248 --> 07:34.787 align:left position:10%,start line:83% size:80% REALLY WAS IN THIS ESTEEMED JOURNAL CALLED THE "NEW ENGLAND 07:34.887 --> 07:36.823 align:left position:12.5%,start line:83% size:77.5% JOURNAL OF MEDICINE" BUT IT WASN'T A RANDOMIZED CONTROLLED 07:36.923 --> 07:41.427 align:left position:15%,start line:83% size:75% TRIAL AND DIDN'T HAVE ANY AGE MATCH CONTROLLED, WASN'T 07:41.527 --> 07:42.628 align:left position:15%,start line:89% size:75% RETROSPECTIVE OR PROSPECTIVE. 07:42.728 --> 07:44.163 align:left position:17.5%,start line:83% size:72.5% IT WAS JUST A LETTER TO THE EDITOR. 07:44.263 --> 07:48.234 align:left position:10%,start line:83% size:80% IT WAS SEVEN LINES AND THE GUY SAID HEY, I HAD SOME PATIENTS IN 07:48.334 --> 07:50.303 align:left position:35%,start line:83% size:55% THE HOSPITAL [ NO AUDIO ] 07:50.403 --> 07:52.505 align:left position:10%,start line:89% size:80% AND NONE OF THEM GOT A ADDICTED. 07:52.605 --> 07:55.441 align:left position:10%,start line:83% size:80% HE DIDN'T EVEN CALL THEM AFTER THEY LEFT THE HOSPITAL TO SEE IF 07:55.541 --> 07:59.278 align:left position:10%,start line:83% size:80% THEY WERE STILL ON OPIATES OR STILL HAVING TROUBLE WITH OPIATE 07:59.378 --> 08:00.446 align:left position:35%,start line:89% size:55% USE DISORDER. 08:00.546 --> 08:02.849 align:left position:15%,start line:83% size:75% THAT'S NOT WHAT THE PHARMACEUTICAL INDUSTRY SAID. 08:02.949 --> 08:05.284 align:left position:17.5%,start line:83% size:72.5% THEY SAID HEY, WE HAVE THIS ARTICLE IN THE "NEW ENGLAND 08:05.384 --> 08:07.386 align:left position:10%,start line:83% size:80% JOURNAL OF MEDICINE" THAT SAYS THESE MEDICINES ARE SAFE AND YOU 08:07.487 --> 08:08.621 align:left position:20%,start line:89% size:70% SHOULD START USING THEM. 08:08.721 --> 08:10.990 align:left position:12.5%,start line:83% size:77.5% SO WE START PRESCRIBING AND IT STARTS GOING UP. 08:11.090 --> 08:14.227 align:left position:15%,start line:83% size:75% THEN YOU SEE IN 1996 THERE'S THIS INFLEXION POINT, RIGHT? 08:14.327 --> 08:18.130 align:left position:10%,start line:83% size:80% AND IT STARTS GOING WAY, WAY UP AND WE START PRESCRIBING LIKE 08:18.231 --> 08:18.664 align:left position:42.5%,start line:89% size:47.5% CRAZY. 08:18.764 --> 08:19.932 align:left position:30%,start line:89% size:60% SO WHAT HAPPENED? 08:20.032 --> 08:22.568 align:left position:15%,start line:83% size:75% IN 1996 THE AMERICAN PAIN SOCIETY GOT TOGETHER AND THEY 08:22.668 --> 08:25.905 align:left position:10%,start line:83% size:80% HAD A BIG EXPERT PANEL AND THIS IS WHAT THEY SAID. 08:26.005 --> 08:29.909 align:left position:17.5%,start line:83% size:72.5% HEY, YOU PRIMARY CARE DOCS, THAT'S ME, YOU GUYS ARE ALL 08:30.009 --> 08:31.410 align:left position:25%,start line:89% size:65% DIRTY ROTTEN ROBBERS. 08:31.511 --> 08:35.314 align:left position:15%,start line:83% size:75% YOU'RE WAY UNDERTREATING PAIN AND WE HAVE SOME GREAT 08:35.414 --> 08:36.949 align:left position:20%,start line:89% size:70% MEDICATIONS TO TREAT IT. 08:37.049 --> 08:38.117 align:left position:40%,start line:89% size:50% OPIATES. 08:38.217 --> 08:44.223 align:left position:15%,start line:83% size:75% DOES ANYBODY KNOW WHAT OPIATE WAS DEBUTED IN 1996? 08:44.323 --> 08:45.491 align:left position:37.5%,start line:89% size:52.5% OXYCONTIN. 08:45.591 --> 08:48.027 align:left position:10%,start line:83% size:80% WE HAVE SOME GREAT MEDICINES LIKE OXYCONTIN AND URKD BE USING 08:48.127 --> 08:48.628 align:left position:45%,start line:89% size:45% THEM. 08:48.728 --> 08:49.595 align:left position:25%,start line:89% size:65% THEY'RE REALLY SAFE. 08:49.695 --> 08:51.297 align:left position:10%,start line:83% size:80% LESS THAN 1% OF PEOPLE EVER GET ADDICTED. 08:51.397 --> 08:54.834 align:left position:10%,start line:83% size:80% AND WE AS PRIMARY CARE DOCS SAID OH, MY GOSH, THESE ARE OUR 08:54.934 --> 08:57.870 align:left position:12.5%,start line:83% size:77.5% EXPERTS IN PAIN, CHRONIC PAIN, AND THEY'RE TELLING US WE'RE 08:57.970 --> 08:58.504 align:left position:30%,start line:89% size:60% DOING THIS WRONG. 08:58.604 --> 08:59.772 align:left position:27.5%,start line:89% size:62.5% THE GLOVES ARE OFF. 08:59.872 --> 09:06.379 align:left position:15%,start line:83% size:75% WE'RE GOING TO START TREATING PAIN LIKE THE EXPERTS SAY. 09:06.479 --> 09:10.316 align:left position:12.5%,start line:83% size:77.5% AND YOU CAN SIGH THE LINE GOES CRAZY, GOES UP. 09:10.416 --> 09:14.020 align:left position:12.5%,start line:83% size:77.5% INTERESTINGLY THAT GROUP GOT TOGETHER IN TWOZ 18 BECAUSE OF 09:14.120 --> 09:17.790 align:left position:10%,start line:83% size:80% OUR NEW ETHICS LAWS IN MEDICINE, THEY WOULD HAVE TO DISCLOSE IF 09:17.890 --> 09:20.026 align:left position:15%,start line:83% size:75% THEY WERE GETTING PAID BY THE PHARMACEUTICAL INDUSTRY AND 09:20.126 --> 09:21.160 align:left position:20%,start line:89% size:70% ALMOST ALL OF THEM WERE. 09:21.260 --> 09:23.462 align:left position:15%,start line:83% size:75% BUT THEY DIDN'T TELL US THAT BACK THEN. 09:23.563 --> 09:29.869 align:left position:15%,start line:83% size:75% SO FROM 1986 TO 2015 THIS 30- YEAR PERIOD, 600% INCREASE IN 09:29.969 --> 09:33.606 align:left position:12.5%,start line:83% size:77.5% THE NUMBER OF OPIATES THAT WE ARE PRESCRIBING AND DISPENSING 09:33.706 --> 09:36.108 align:left position:15%,start line:83% size:75% IN THE UNITED STATES WHILE NO OTHER COUNTRY IN THE WORLD IS 09:36.208 --> 09:39.412 align:left position:25%,start line:89% size:65% DOING THE SAME THING. 09:39.512 --> 09:42.415 align:left position:17.5%,start line:83% size:72.5% SO EVERYTHING WE KNOW ABOUT CHRONIC NON-CANCER PAIN AND 09:42.515 --> 09:47.119 align:left position:10%,start line:83% size:80% USING OPIATES HAS BEEN PROGRAMMED BY THE PHARMACEUTICAL 09:47.219 --> 09:47.687 align:left position:40%,start line:89% size:50% INDUSTRY. 09:47.787 --> 09:48.387 align:left position:27.5%,start line:89% size:62.5% THAT'S MY OPINION. 09:48.487 --> 09:49.922 align:left position:17.5%,start line:89% size:72.5% I DO KNOW THIS FOR A FACT. 09:50.022 --> 09:53.159 align:left position:10%,start line:83% size:80% THERE'S NO DATA THAT SAYS USING OPIATES FOR CHRONIC PAIN IS 09:53.259 --> 09:57.163 align:left position:15%,start line:83% size:75% BENEFICIAL BUT I DO HAVE DATA THAT SAYS IT'S HARMFUL. 09:57.263 --> 09:59.599 align:left position:10%,start line:83% size:80% AND THIS IS THE BEST THE PHARMACEUTICAL INDUSTRY CAN DO. 09:59.699 --> 10:02.969 align:left position:10%,start line:83% size:80% THAT IS LOT OF WORDS BUT I WANT TO READ IT FROM TO YOU. 10:03.069 --> 10:04.670 align:left position:17.5%,start line:83% size:72.5% FROM THE AMERICAN CANCER P SOCIETY. 10:04.770 --> 10:07.873 align:left position:10%,start line:83% size:80% OPEN YACHT MEDICATIONS IN THE CLASS OF MORPHINE ARE DESIGNATED 10:07.974 --> 10:11.944 align:left position:10%,start line:83% size:80% TO HAVE A LEGITIMATE MEDICAL USE THAT'S TRUE. 10:12.044 --> 10:14.747 align:left position:17.5%,start line:83% size:72.5% AND ARE INDICATED FOR THE MEDICAL MANAGEMENT OF PAIN, 10:14.847 --> 10:17.817 align:left position:10%,start line:65% size:80% ESPECIALLY IF THE PAIN IS SEVERE THAT'S TRUE AS WELL. 10:17.917 --> 10:20.453 align:left position:22.5%,start line:65% size:67.5% THE F.D.A. MAKES IT SO. 10:20.553 --> 10:24.323 align:left position:10%,start line:65% size:80% SO LOOK AT THIS NEXT LINE THOUGH ALTHOUGH THEIR USE FOR THE 10:24.423 --> 10:28.527 align:left position:12.5%,start line:83% size:77.5% RELIEF OF A VARIETY OF CHRONIC NON-CANCER PAIN CONDITIONS 10:28.628 --> 10:30.730 align:left position:25%,start line:89% size:65% CONTINUES TO EVOLVE. 10:30.830 --> 10:33.099 align:left position:27.5%,start line:89% size:62.5% WHAT DID THEY SAY? 10:33.199 --> 10:35.234 align:left position:20%,start line:89% size:70% THEY DIDN'T SAY ANYTHING. 10:35.334 --> 10:36.335 align:left position:30%,start line:89% size:60% READ THAT AGAIN. 10:36.435 --> 10:37.603 align:left position:42.5%,start line:89% size:47.5% READY? 10:37.703 --> 10:40.506 align:left position:12.5%,start line:83% size:77.5% ALTHOUGH THEIR USE FOR THE RELIEF OF A VARIETY OF CHRONIC 10:40.606 --> 10:42.508 align:left position:17.5%,start line:83% size:72.5% NON-CANCER PAIN CONDITIONS CONDITIONS TO EVOLVE AND 10:42.608 --> 10:45.378 align:left position:15%,start line:83% size:75% EVIDENCE OF EFFECTIVENESS OF THESE CONDITIONS IS DERIVED 10:45.478 --> 10:49.081 align:left position:10%,start line:83% size:80% LARGELY FROM CLINICAL EXPERIENCE SO THEY DON'T HAVE A RANDOMIZED 10:49.181 --> 10:52.618 align:left position:10%,start line:83% size:80% CONTROL TRIAL OR THEY DON'T HAVE A RETROSPECTIVE OR PROSPECTIVE 10:52.718 --> 10:53.919 align:left position:42.5%,start line:89% size:47.5% TRIAL. 10:54.020 --> 10:55.955 align:left position:10%,start line:83% size:80% WHAT THEY DO IS COME AND FIND DOCS LIKE ME AND SAY HEY, DO YOU 10:56.055 --> 10:57.657 align:left position:10%,start line:89% size:80% HAVE ANYBODY WITH LOW BACK PAIN? 10:57.757 --> 10:58.357 align:left position:37.5%,start line:89% size:52.5% I SAY YEAH. 10:58.457 --> 10:59.759 align:left position:20%,start line:89% size:70% DO YOU GIVE THEM OPIATES? 10:59.859 --> 11:00.393 align:left position:45%,start line:89% size:45% YEAH. 11:00.493 --> 11:01.560 align:left position:22.5%,start line:89% size:67.5% DO YOU THINK IT WORKS? 11:01.661 --> 11:06.966 align:left position:17.5%,start line:83% size:72.5% IF I SAY IT YES, THEY PUT A CHECK DOWN, IT WORKS. 11:07.066 --> 11:08.234 align:left position:22.5%,start line:89% size:67.5% THAT'S ALL THEY'VE GOT. 11:08.334 --> 11:10.202 align:left position:15%,start line:83% size:75% THERE SEEMS TO BE A GENERAL AGREEMENT THAT SOME PATIENTS 11:10.302 --> 11:13.339 align:left position:12.5%,start line:83% size:77.5% WITH SUCH PAIN CAN BE PROPERLY TREATED WITH OPIATE THERAPY. 11:13.439 --> 11:14.607 align:left position:37.5%,start line:89% size:52.5% THAT'S IT. 11:14.707 --> 11:16.609 align:left position:10%,start line:83% size:80% THAT'S THE BEST THE INDUSTRY HAS AND THE INDUSTRY TOLD US TWO 11:16.709 --> 11:17.843 align:left position:42.5%,start line:89% size:47.5% THINGS. 11:17.943 --> 11:19.912 align:left position:17.5%,start line:83% size:72.5% THEY TOLD US WE'RE GOING TO DECREASE PAIN AND INCREASE 11:20.012 --> 11:23.783 align:left position:10%,start line:83% size:80% FUNCTION DURING THIS TIME PERIOD THIS IS A 20-YEAR STUDY ACROSS 11:23.883 --> 11:28.220 align:left position:10%,start line:83% size:80% THE BOTTOM IS LOW BACK PAIN, MUSCULOSKELETAL PAIN, NECK PAIN 11:28.320 --> 11:31.157 align:left position:15%,start line:83% size:75% AND OSTEOARTHRITIS IS PAIN IN THE HIP OR KNEE. 11:31.257 --> 11:35.728 align:left position:10%,start line:83% size:80% SO YOU CAN SEE THAT PAIN WENT UP IN ADULTS IN THE UNITED STATES. 11:35.828 --> 11:38.998 align:left position:10%,start line:83% size:80% BUT WITH A 600% INCREASE IN OPIATES, YOU WOULD THINK THAT IT 11:39.098 --> 11:40.700 align:left position:10%,start line:83% size:80% WOULD AT LEAST STAY THE SAME OR GO DOWN. 11:40.800 --> 11:42.301 align:left position:17.5%,start line:89% size:72.5% BUT IT DIDN'T, IT WENT UP. 11:42.401 --> 11:44.837 align:left position:12.5%,start line:83% size:77.5% BUT THE SECOND THING THEY SAID IS BUT WE'RE GOING TO INCREASE 11:44.937 --> 11:46.138 align:left position:40%,start line:89% size:50% FUNCTION. 11:46.238 --> 11:48.774 align:left position:15%,start line:83% size:75% AND SO DOCS THAT I WORK WITH THAT CAN REMEMBER BACK IN THE 11:48.874 --> 11:51.644 align:left position:10%,start line:83% size:80% '80S, THEY MIGHT HAVE HAD A LITTLE BIT MORE GRAY HAIR THAN I 11:51.744 --> 11:55.314 align:left position:15%,start line:83% size:75% DO, THEY SAID THEY COULD REMEMBER DRUG REPS SAYING HEY 11:55.414 --> 11:58.751 align:left position:10%,start line:83% size:80% YOUR PATIENT THAT FELL OFF THE LADDER AND BROKE HIS BACK, DON'T 11:58.851 --> 12:00.352 align:left position:10%,start line:89% size:80% YOU WANT HIM TO GO BACK TO WORK? 12:00.453 --> 12:03.255 align:left position:10%,start line:83% size:80% AND THE DOCS P LIKE YEAH, I WANT HIM TO GO BACK TO WORK. 12:03.355 --> 12:05.758 align:left position:12.5%,start line:83% size:77.5% THEY'D SAY HEY, YOU SHOULD USE OPIATES TO HELP. 12:05.858 --> 12:09.028 align:left position:12.5%,start line:83% size:77.5% BUT DO YOU KNOW THE NUMBER OF DAYS THAT YOU NEED TO BE ON AN 12:09.128 --> 12:13.666 align:left position:15%,start line:83% size:75% OPIATE TO DOUBLE YOUR RISK OF GOING OUT ON PERMANENT 12:13.766 --> 12:14.166 align:left position:37.5%,start line:89% size:52.5% DISABILITY? 12:14.266 --> 12:14.867 align:left position:37.5%,start line:89% size:52.5% SEVEN DAYS. 12:14.967 --> 12:16.202 align:left position:37.5%,start line:89% size:52.5% THAT'S IT. 12:16.302 --> 12:18.971 align:left position:15%,start line:83% size:75% AND EVERY DAY AFTER THAT THAT YOU'RE ON AN OPIATE INCREASES 12:19.071 --> 12:21.507 align:left position:10%,start line:83% size:80% YOUR RISK EVEN MORE OF GOING OUT ON PERMANENT DISABILITY. 12:21.607 --> 12:25.411 align:left position:15%,start line:83% size:75% AND WHEN I HEARD THAT, I HAD BEEN WORKING IN THIS OPIATE 12:25.511 --> 12:29.148 align:left position:10%,start line:83% size:80% SPACE FOR ABOUT A YEAR, I HAD 12 PATIENTS THAT HAD CHRONIC PAIN 12:29.248 --> 12:33.119 align:left position:10%,start line:83% size:80% THAT I WAS WRITING OPIATES FOR THEM, EVERY THREE MONTHS I WOULD 12:33.219 --> 12:34.053 align:left position:40%,start line:89% size:50% SEE THEM. 12:34.153 --> 12:35.554 align:left position:10%,start line:83% size:80% I WENT BACK AND LOOKED AT THEIR CHARTS. 12:35.654 --> 12:38.157 align:left position:10%,start line:83% size:80% 11 OUT OF 12 OF MY PATIENTS WERE ON PERMANENT DISABILITY. 12:38.257 --> 12:40.726 align:left position:12.5%,start line:83% size:77.5% SO THE PHARMACEUTICAL INDUSTRY SAID WE'RE GOING TO DECREASE 12:40.826 --> 12:46.532 align:left position:10%,start line:83% size:80% PAIN AND INCREASE FUNCTION, BUT IT DID THE OPPOSITE. 12:46.632 --> 12:49.568 align:left position:12.5%,start line:83% size:77.5% AND IF THAT'S KIND OF LIKE NOT DAMNING ENOUGH, THIS IS THE 12:49.668 --> 12:53.906 align:left position:10%,start line:83% size:80% GREEN LINE IS ALL OF THE OPIATES PRESCRIBED -- DISPENSED BY ALL 12:54.006 --> 12:57.309 align:left position:10%,start line:83% size:80% THE PHARMACEUTICAL COMPANIES IN THE UNITED STATES, THE SECOND 12:57.409 --> 13:00.312 align:left position:15%,start line:83% size:75% LINE IS OPIATE DEATHS DURING THAT TIME FRAME. 13:00.412 --> 13:04.583 align:left position:12.5%,start line:83% size:77.5% AND THE THIRD LINE IS PEOPLE GOING INTO INPATIENT TREATMENT 13:04.683 --> 13:08.354 align:left position:10%,start line:83% size:80% FOR OPIATE USE DISORDER, THE NEW TERM FOR OPIATE ADDICTION. 13:08.454 --> 13:16.729 align:left position:12.5%,start line:83% size:77.5% TO BRING IT HOME TO NORTH CAROLINA THEN, SO THIS -- THIS 13:16.829 --> 13:20.132 align:left position:10%,start line:83% size:80% SLIDE IS FROM THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN 13:20.232 --> 13:23.269 align:left position:10%,start line:83% size:80% SERVICES AND THE TOP LINE THERE IS NUMBER OF OPIATE DEATHS FROM 13:23.369 --> 13:24.603 align:left position:42.5%,start line:89% size:47.5% PILLS. 13:24.703 --> 13:28.974 align:left position:12.5%,start line:83% size:77.5% THEN THE SECOND LINE DOWN, THE FIVE -- 7, 9, IS OPIATE DEATHS 13:29.074 --> 13:32.244 align:left position:10%,start line:83% size:80% FROM SYNTHETICS AND WE'LL JUST CALL THEM FENTANYL FROM NOW ON. 13:32.344 --> 13:35.414 align:left position:15%,start line:83% size:75% THE 538 IS OPIATE DEATHS ARE HEROINE. 13:35.514 --> 13:38.818 align:left position:12.5%,start line:83% size:77.5% SO THE STORY HERE IS THAT THIS STARTED OFF AS A PILL PROBLEM. 13:38.918 --> 13:42.188 align:left position:10%,start line:89% size:80% AND IT STILL IS A PILL PROBLEM. 13:42.288 --> 13:46.458 align:left position:17.5%,start line:83% size:72.5% BUT NOW IT'S A HEROINE AND FENTANYL PROBLEM. 13:46.559 --> 13:50.563 align:left position:15%,start line:83% size:75% WHEN WE FINALLY GET THE DATA FROM 2017A LITTLE OVER 1,500 13:50.663 --> 13:54.633 align:left position:10%,start line:83% size:80% NORTH CAROLINIANS WILL HAVE DIED FROM OPIATE DEATHS IN THE YEAR 13:54.733 --> 13:55.501 align:left position:45%,start line:89% size:45% 2017. 13:55.601 --> 13:58.237 align:left position:10%,start line:83% size:80% ON AVERAGE FOUR PEOPLE DIE EVERY DAY. 13:58.337 --> 14:01.207 align:left position:12.5%,start line:83% size:77.5% AND THIS IS HOW WE'VE GOTTEN INTO THIS PROBLEM NOW, IS THAT 14:01.307 --> 14:05.911 align:left position:10%,start line:83% size:80% WE STARTED WITH PILLS BUT NOW IT'S -- IT'S REALLY GOTTEN INTO 14:06.011 --> 14:10.216 align:left position:25%,start line:89% size:65% HEROINE AND FENTANYL. 14:10.316 --> 14:13.986 align:left position:15%,start line:83% size:75% SO THE FIRST BOTTLE THERE IS SUPPOSEDLY A GRAM OF HEROINE. 14:14.086 --> 14:19.058 align:left position:10%,start line:83% size:80% AND DEPENDING UPON A PATIENT'S OR A PERSON'S POLL RANS, IF YOU 14:19.158 --> 14:21.060 align:left position:15%,start line:83% size:75% SHOOT A GRAM YOU CAN OVERDOSE AND DIE. 14:21.160 --> 14:24.663 align:left position:12.5%,start line:83% size:77.5% BUT THE SECOND BOTTLE THERE IS FENTANYL, AND IT'S 50 TO 100 14:24.763 --> 14:27.299 align:left position:10%,start line:83% size:80% TIMES MORE POTENT THAN THE HEROINE THAT'S OUT THERE ON THE 14:27.399 --> 14:28.300 align:left position:30%,start line:89% size:60% STREET RIGHT NOW. 14:28.400 --> 14:30.169 align:left position:22.5%,start line:89% size:67.5% THAT'S JUST 50 GRAINS. 14:30.269 --> 14:32.438 align:left position:12.5%,start line:83% size:77.5% AND IF YOU SHOOT THAT, YOU CAN OVERDOSE AND DIE. 14:32.538 --> 14:35.274 align:left position:10%,start line:83% size:80% AND THEN THE LAST ONE, HAVE YOU HEARD OF THIS? 14:35.374 --> 14:37.543 align:left position:17.5%,start line:89% size:72.5% THIS CAR FENTANYL BUSINESS? 14:37.643 --> 14:40.646 align:left position:12.5%,start line:89% size:77.5% IT'S AN ELEPHANT TRANQUILIZER. 14:40.746 --> 14:44.850 align:left position:10%,start line:83% size:80% IT'S 5,000 TIMES MORE POTENT THAN THAT HEROINE THAT'S ON THE 14:44.950 --> 14:46.452 align:left position:15%,start line:83% size:75% STREET AND THERE'S JUST THREE GAINS. 14:46.552 --> 14:48.854 align:left position:12.5%,start line:83% size:77.5% THERE'S A REASON YOU CAN'T SEE MUCH IN THAT BOTTLE BECAUSE 14:48.954 --> 14:50.256 align:left position:15%,start line:83% size:75% THERE'S ONLY THREE GRAINS IN THERE. 14:50.356 --> 14:52.358 align:left position:10%,start line:83% size:80% IF YOU SHOOT THAT, YOU OVERDOSE AND DIE. 14:52.458 --> 14:56.962 align:left position:10%,start line:83% size:80% SO YOU CAN IMAGINE AS THE END USER IF THEY CUT THE CARFENTANYL 14:57.062 --> 14:59.865 align:left position:10%,start line:83% size:80% INTO THE HEROINE AND YOU SHOOT THE SAME AMOUNT OF TIME YOU DID 14:59.965 --> 15:02.701 align:left position:10%,start line:83% size:80% LAST TIME AND YOU DON'T KNOW IT, YOU DON'T KNOW WHAT'S IN IT, YOU 15:02.801 --> 15:03.702 align:left position:25%,start line:89% size:65% CAN OVERDOSE AND DIE. 15:03.802 --> 15:05.204 align:left position:15%,start line:83% size:75% AND THAT'S WHAT WE'RE FEELING OUT THERE. 15:05.304 --> 15:11.410 align:left position:10%,start line:83% size:80% WHEN YOU TALK TO THE POLICE, THE FIRE -- FOLKS IN FIRE AND THE E. 15:11.510 --> 15:14.380 align:left position:17.5%,start line:83% size:72.5% M.S. AND SAY HEY, I HEAR YOU'VE REALLY GOT A HEROINE 15:14.480 --> 15:17.283 align:left position:10%,start line:83% size:80% PROBLEM NOW, THEY'LL CORRECT YOU AND SAY IT'S A FENTANYL PROBLEM. 15:17.383 --> 15:19.818 align:left position:10%,start line:83% size:80% AND THE REASON THAT THEY'RE CUTTING THE FENTANYL IN THERE IS 15:19.919 --> 15:23.622 align:left position:15%,start line:83% size:75% BECAUSE IT'S MORE POWERFUL, PEOPLE ARE SEEKING THAT, AND 15:23.722 --> 15:24.890 align:left position:25%,start line:89% size:65% IT'S LESS EXPENSIVE. 15:24.990 --> 15:27.993 align:left position:10%,start line:83% size:80% AND IT'S BEEN LESS EXPENSIVE EVERY YEAR FOR THE LAST THREE OR 15:28.093 --> 15:31.363 align:left position:37.5%,start line:89% size:52.5% FOUR YEARS. 15:31.463 --> 15:35.734 align:left position:15%,start line:83% size:75% SO THIS IS UNINTENTIONED MEDICATION AND DRUG OVERDOSE 15:35.834 --> 15:36.602 align:left position:30%,start line:89% size:60% DEATHS BY COUNTY. 15:36.702 --> 15:38.203 align:left position:20%,start line:83% size:70% AND YOU CAN SEE THAT THE [ NO AUDIO ] 15:38.304 --> 15:41.874 align:left position:12.5%,start line:89% size:77.5% AND THE DARKER COLOR IS WORSE. 15:41.974 --> 15:44.576 align:left position:10%,start line:83% size:80% SO IF YOU KIND OF LOOK AT WESTERN NORTH CAROLINA THERE, WE 15:44.677 --> 15:50.716 align:left position:10%,start line:83% size:80% HAVE A LOT OF COUNTIES THAT HAVE THAT DARK COLOR. 15:50.816 --> 15:53.919 align:left position:15%,start line:83% size:75% [ NO AUDIO ] IN APPALACHIA, NOT JUST NORTH 15:54.019 --> 15:58.123 align:left position:10%,start line:83% size:80% CAROLINA, EASTERN TENNESSEE, WEST VIRGINIA, EASTERN OHIO, YOU 15:58.223 --> 16:05.030 align:left position:10%,start line:83% size:80% GO UP THE APPALACHIAN CHAIN EVEN UP INTO PENNSYLVANIA, AND WE 16:05.130 --> 16:08.000 align:left position:10%,start line:83% size:80% HAVE FOR THE SAME AMOUNT OF DRUG PROBLEMS, PEOPLE WITH THEIR 16:08.100 --> 16:13.405 align:left position:10%,start line:83% size:80% OPIATE USE DISORDER, WE HAVE IN APPALACHIA 55% INCREASE IN OVER 16:13.505 --> 16:15.174 align:left position:17.5%,start line:83% size:72.5% DOSE DEATHS COMPARED TO THE REST OF THE COUNTRY. 16:15.274 --> 16:18.844 align:left position:10%,start line:83% size:80% SO SOMETHING IS GOING ON HERE IN APPALACHIA. 16:18.944 --> 16:22.681 align:left position:12.5%,start line:83% size:77.5% AND THIS IS NORTH CAROLINA OPIATE OVERDOSE DEATHS -- OVER 16:22.781 --> 16:25.017 align:left position:20%,start line:83% size:70% DOSES THAT THE EMERGENCY DEPARTMENT IS SEEING. 16:25.117 --> 16:28.253 align:left position:10%,start line:83% size:80% YOU CAN SEE IT WAS KIND OF STEADY IN 2016 AND THIS IS JUST 16:28.354 --> 16:30.122 align:left position:12.5%,start line:89% size:77.5% THE DATA WE HAVE THROUGH 2017. 16:30.222 --> 16:33.525 align:left position:15%,start line:83% size:75% AND THEN IT ACTUALLY WENT UP QUITE A BIT, AND THEN NOW IT 16:33.625 --> 16:36.628 align:left position:20%,start line:89% size:70% SEEMS TO BE COMING DOWN. 16:36.729 --> 16:40.432 align:left position:10%,start line:83% size:80% INTERESTINGLY THOUGH WE THINK THERE'S MORE REVERSALS BUT WE'RE 16:40.532 --> 16:43.002 align:left position:20%,start line:83% size:70% NOT SEEING AS MUCH IN THE EMERGENCY DEPARTMENT. 16:43.102 --> 16:44.303 align:left position:25%,start line:89% size:65% SO WHAT'S HAPPENING? 16:44.403 --> 16:48.574 align:left position:12.5%,start line:83% size:77.5% BECAUSE OF A LOT OF EFFORTS OF YOU ALL, WE'RE GETTING MORE 16:48.674 --> 16:52.177 align:left position:10%,start line:83% size:80% NARCAN OUT INTO THE COMMUNITIES AND THE REVERSALS ARE ACTUALLY 16:52.277 --> 16:53.512 align:left position:22.5%,start line:89% size:67.5% HAPPENING IN THE FIELD. 16:53.612 --> 16:58.050 align:left position:10%,start line:83% size:80% SO A LOT MORE POLICE DEPARTMENTS AND FIRE DEPARTMENTS, E.M.S. ARE 16:58.150 --> 16:59.318 align:left position:35%,start line:89% size:55% CARRYING IT. 16:59.418 --> 17:04.156 align:left position:10%,start line:83% size:80% BUT ALSO THERE'S A LOT OF PEOPLE THAT ARE ALT -- AT HIGH RISK 17:04.256 --> 17:09.561 align:left position:10%,start line:83% size:80% THAT ACTUALLY HAVE NARCAN, OR THEIR LOVED ONES DO IN THE LOCK 17:09.661 --> 17:12.264 align:left position:17.5%,start line:83% size:72.5% ZONE AND ABLE TO REVERSE A PATIENT OR PERSON THAT'S 17:12.364 --> 17:13.599 align:left position:22.5%,start line:89% size:67.5% OVERDOSED IN THE FIELD. 17:13.699 --> 17:16.735 align:left position:12.5%,start line:83% size:77.5% SO WE'RE SEEING A FLATTENEDING IN THE EMERGENCY DEPARTMENT AT 17:16.835 --> 17:18.637 align:left position:10%,start line:83% size:80% THE SAME TIME WE BELIEVE THERE'S MORE AND MORE OVERDOSES THAT ARE 17:18.737 --> 17:23.308 align:left position:37.5%,start line:89% size:52.5% HAPPENING. 17:23.409 --> 17:26.445 align:left position:12.5%,start line:83% size:77.5% AND THEN FOLKS, SOMETIMES THEY TAKE THE PILLS BUT OFTENTIMES 17:26.545 --> 17:30.649 align:left position:10%,start line:83% size:80% WHEN YOU'RE IN YOUR USE DISORDER YOU'RE EITHER SNORTING OR 17:30.749 --> 17:31.917 align:left position:40%,start line:89% size:50% SHOOTING. 17:32.017 --> 17:36.989 align:left position:10%,start line:83% size:80% THERE'S A LOT OF EFFORT OUT THERE TO TRY TO HELP WITH FOLKS 17:37.089 --> 17:38.524 align:left position:20%,start line:89% size:70% THAT ARE I.V. DRUG USERS. 17:38.624 --> 17:39.925 align:left position:10%,start line:83% size:80% BUT WE ARE SEEING THE EFFECTS OF THIS. 17:40.025 --> 17:43.028 align:left position:12.5%,start line:83% size:77.5% AND SO ALL OF YOU THAT ARE OUT THERE TRYING TO HELP TO GET 17:43.128 --> 17:45.798 align:left position:10%,start line:83% size:80% CLEAN NEEDLES TO THESE FOLKS AND THEN ALSO JUST BEING THERE FOR 17:45.898 --> 17:49.001 align:left position:12.5%,start line:83% size:77.5% THE TIME THAT THEY'RE READY TO SAY I'M -- I'M READY TO DO 17:49.101 --> 17:49.701 align:left position:32.5%,start line:89% size:57.5% SOMETHING ELSE. 17:49.802 --> 17:51.103 align:left position:35%,start line:89% size:55% I WANT HELP. 17:51.203 --> 17:54.106 align:left position:15%,start line:83% size:75% I REALLY PRAISE Y'ALL AND APPRECIATE WHAT YOU'RE DOING. 17:54.206 --> 17:59.411 align:left position:12.5%,start line:89% size:77.5% BUT THIS IS WHAT WE'RE SEEING. 17:59.511 --> 18:00.712 align:left position:35%,start line:89% size:55% SO HEPATITIS. 18:00.813 --> 18:04.149 align:left position:15%,start line:83% size:75% >> CR IN NORTH CAROLINA, 500% INCREASE IN THIS SEVEN-YEAR 18:04.249 --> 18:05.317 align:left position:42.5%,start line:89% size:47.5% PERIOD. 18:05.417 --> 18:07.753 align:left position:12.5%,start line:83% size:77.5% AND HERE'S INFECTIONS THAT ARE IN THE BLOODSTREAM. 18:07.853 --> 18:11.223 align:left position:15%,start line:83% size:75% OFTENTIMES THEY CAN GET INFECTIONS FROM DIRTY NEEDLES 18:11.323 --> 18:14.460 align:left position:10%,start line:83% size:80% AND GET A PUS POCKET OR ABSCESS IN THE SKIN. 18:14.560 --> 18:16.695 align:left position:10%,start line:83% size:80% SOMETIMES THAT WILL GET INTO THE BLOODSTREAM AND THAT'S INCREASED 18:16.795 --> 18:17.996 align:left position:30%,start line:89% size:60% FOUR TIMES OVER. 18:18.097 --> 18:22.201 align:left position:10%,start line:83% size:80% AND THEN SOMETIMES THIS -- THE BACTERIA WILL GO UP TO THE HEART 18:22.301 --> 18:23.936 align:left position:15%,start line:83% size:75% AND WILL ATTACH TO THE HEART VALVES. 18:24.036 --> 18:29.875 align:left position:17.5%,start line:83% size:72.5% AND WE'VE SEEN A 13.5 TIMES INCREASE. 18:29.975 --> 18:33.078 align:left position:10%,start line:83% size:80% AND I KNOW I'M E PREACHING TO THE CHOIR, JUST TO TELL YOU THIS 18:33.178 --> 18:37.916 align:left position:10%,start line:83% size:80% PUBLIC HEALTH STORY THEN, SO IT COSTS ROUGHLY $7 FOR 100 CLEAN 18:38.016 --> 18:39.384 align:left position:40%,start line:89% size:50% NEEDLES. 18:39.485 --> 18:45.190 align:left position:12.5%,start line:83% size:77.5% AND SO -- TO REPLACE SOMEONE'S VALVE THAT'S BEEN DAMAGED TBI 18:45.290 --> 18:47.759 align:left position:10%,start line:83% size:80% BACTERIA ON THERE IS ROUGHLY $2 50,000. 18:47.860 --> 18:51.230 align:left position:12.5%,start line:83% size:77.5% SO IF WE CAN KEEP TELLING THIS STORY, AND I APPRECIATE AGAIN 18:51.330 --> 18:53.599 align:left position:10%,start line:83% size:80% ALL Y'ALL OUT THERE THAT ARE WORKING IN THIS SPACE AND TRYING 18:53.699 --> 18:57.402 align:left position:15%,start line:83% size:75% TO HELP, BUT WE HAVE TO GET CLEAN NEEDLES TO THE FOLKS TO 18:57.503 --> 19:01.540 align:left position:17.5%,start line:83% size:72.5% HELP THEM TO NOT HAVE THESE INFECTIONS. 19:01.640 --> 19:02.908 align:left position:12.5%,start line:89% size:77.5% H.I.V. IS ON THE RISE AS WELL. 19:03.008 --> 19:05.711 align:left position:10%,start line:83% size:80% TO TRY TO NOT HAVE THESE INFECTIONS AND THEN BE THERE FOR 19:05.811 --> 19:09.014 align:left position:10%,start line:83% size:80% THEM WHEN THEY'RE COMING TO EXCHANGE THEIR NEEDLES AND WHEN 19:09.114 --> 19:13.152 align:left position:10%,start line:83% size:80% THEY'RE READY TO SEEK CHANGE IN THEIR LIVES, THEN WE'RE THERE 19:13.252 --> 19:15.220 align:left position:17.5%,start line:83% size:72.5% FOR THEM, AND WE NEED TO BE DOING THAT. 19:15.320 --> 19:20.959 align:left position:10%,start line:83% size:80% AND IT'S GOT TO BE A GOOD USE OF OUR RESOURCES. 19:21.059 --> 19:25.664 align:left position:10%,start line:83% size:80% SO THEN HERE IS SOME DEMOGRAPHIC S. 19:25.764 --> 19:27.299 align:left position:12.5%,start line:83% size:77.5% IT'S URBAN AND RURAL AND WHITE AND BLACK. 19:27.399 --> 19:34.439 align:left position:10%,start line:83% size:80% THIS STARTED OFF AND THIS WAS A WHITE PHENOMENON AND 19:34.540 --> 19:35.774 align:left position:15%,start line:89% size:75% PARTICULARLY IN RURAL AREAS. 19:35.874 --> 19:39.645 align:left position:10%,start line:83% size:80% BUT IT REALLY HAS BECOME A RACE AND CLASS -- IT'S LIKE EVERYBODY 19:39.745 --> 19:40.879 align:left position:15%,start line:89% size:75% IT'S AFFECTING EVERYBODY NOW. 19:40.979 --> 19:44.049 align:left position:17.5%,start line:83% size:72.5% IT DOESN'T MATTER IF YOU'RE WHITE, BROWN, OR BLACK. 19:44.149 --> 19:46.485 align:left position:10%,start line:83% size:80% IT DOESN'T MATTER IF YOU'RE RICH OR POOR. 19:46.585 --> 19:49.454 align:left position:10%,start line:83% size:80% I ACTUALLY THINK IN MY PRACTICE, SO I DO WRITE A MEDICATION 19:49.555 --> 19:53.659 align:left position:12.5%,start line:83% size:77.5% CALLED SEBOXONE TO HELP PEOPLE STABILIZE THEIR LIVES SO THEY 19:53.759 --> 19:57.763 align:left position:12.5%,start line:83% size:77.5% CAN GET TO THEIR THERAPY, IF THEY HAVE OPIATE USE DISORDER. 19:57.863 --> 20:01.033 align:left position:10%,start line:83% size:80% BUT IT ALMOST SEEMS LIKE IF YOU HAVE MORE MONEY YOU'RE MORE 20:01.133 --> 20:03.502 align:left position:10%,start line:83% size:80% LIKELY TO BE ABLE TO BE ABLE TO BUY THESE DRUGS AND GET INTO 20:03.602 --> 20:04.670 align:left position:35%,start line:89% size:55% THIS PROBLEM. 20:04.770 --> 20:12.811 align:left position:15%,start line:83% size:75% SO IT REALLY CUTS ACROSS ALL SOCIOECONOMIC BOUNDS. 20:12.911 --> 20:15.013 align:left position:15%,start line:83% size:75% AND AGAIN, THE LAST ONE SHOWS APPALACHIA. 20:15.113 --> 20:19.384 align:left position:10%,start line:83% size:80% WE HAVE A HIGHER RATE OF DRUG OVERDOSE MORTALITY THAN THE REST 20:19.484 --> 20:20.719 align:left position:32.5%,start line:89% size:57.5% OF THE COUNTRY. 20:20.819 --> 20:25.357 align:left position:12.5%,start line:83% size:77.5% AND THEN JUST PUTTING A FEW OF THE COUNTIES OUT THERE, I KNOW 20:25.457 --> 20:28.660 align:left position:15%,start line:83% size:75% SOME OF YOU ARE FROM GRAHAM COUNTY RIGHT NOW AND THEY'RE 20:28.760 --> 20:30.963 align:left position:12.5%,start line:83% size:77.5% REALLY GETTING BROADSIDED WITH THIS. 20:31.063 --> 20:37.336 align:left position:12.5%,start line:83% size:77.5% THIS WAS DATA FROM AROUND 2011 TO 2013, I THINK. 20:37.436 --> 20:43.075 align:left position:15%,start line:83% size:75% SO SWITCHING GEARS, I WANT TO TALK A LITTLE BIT ABOUT 20:43.175 --> 20:44.009 align:left position:35%,start line:89% size:55% [INAUDIBLE]. 20:44.109 --> 20:45.377 align:left position:12.5%,start line:83% size:77.5% THERE'S ACUTE PAIN AND CHRONIC PAIN. 20:45.477 --> 20:47.045 align:left position:15%,start line:89% size:75% THIS IS ONE OF OUR PROBLEMS. 20:47.145 --> 20:49.514 align:left position:10%,start line:83% size:80% [ NO AUDIO ] GETTING INTO THE MEDICAL SCHOOLS 20:49.615 --> 20:51.083 align:left position:20%,start line:89% size:70% , NURSE PRACTITIONER, P. 20:51.183 --> 20:54.653 align:left position:10%,start line:83% size:80% A. SCHOOLS, DENTAL SCHOOLS, AND WE'RE TRYING TO TEACH THIS. 20:54.753 --> 20:58.924 align:left position:12.5%,start line:83% size:77.5% IF YOU BELIEVE CHRONIC PAIN IS JUST ACCUSE PAIN THAT LASTS A 20:59.024 --> 21:02.394 align:left position:10%,start line:83% size:80% LITTLE LONGER THEN YOU'RE GOING TO SAY OPIATES HELP IF YOUR BONE 21:02.494 --> 21:07.799 align:left position:10%,start line:83% size:80% IS STICKING OUT OF YOUR SKIN SO IT MUST HELP IN CHRONIC PAIN. 21:07.899 --> 21:11.570 align:left position:15%,start line:83% size:75% BUT CHRONIC PAIN IS A TOTALLY DIFFERENT KETTLE OF FISH AND 21:11.670 --> 21:14.373 align:left position:12.5%,start line:83% size:77.5% THAT'S WHY THOSE TWO MEDICINES DON'T WORK IN THE SAME 21:14.473 --> 21:14.973 align:left position:37.5%,start line:89% size:52.5% SITUATIONS. 21:15.073 --> 21:16.275 align:left position:27.5%,start line:89% size:62.5% HERE IS ACUTE PAIN. 21:16.375 --> 21:19.711 align:left position:10%,start line:83% size:80% YOU HAMMER YOUR TOE AND YOU HIT IT SO HARD YOU SPLIT THE SKIN 21:19.811 --> 21:20.145 align:left position:45%,start line:89% size:45% OPEN. 21:20.245 --> 21:21.079 align:left position:37.5%,start line:89% size:52.5% ALL RIGHT? 21:21.179 --> 21:22.814 align:left position:12.5%,start line:83% size:77.5% YOU'RE TO HAVE A LOT OF TISSUE INPUT. 21:22.914 --> 21:25.017 align:left position:12.5%,start line:83% size:77.5% YOU MIGHT EVEN THINK ABOUT SAY AGO BAD WORD. 21:25.117 --> 21:26.251 align:left position:25%,start line:89% size:65% I KNOW YOU WOULDN'T. 21:26.351 --> 21:28.620 align:left position:10%,start line:83% size:80% BUT THERE ARE THOUGHTS AND EMOTIONS THAT GO INTO THAT ACUTE 21:28.720 --> 21:29.154 align:left position:45%,start line:89% size:45% PAIN. 21:29.254 --> 21:30.522 align:left position:42.5%,start line:89% size:47.5% RIGHT? 21:30.622 --> 21:32.124 align:left position:15%,start line:89% size:75% AND NOW LOOK AT CHRONIC PAIN. 21:32.224 --> 21:40.299 align:left position:10%,start line:83% size:80% SO LIKE MY PATIENT, I'VE BEEN SEEING FOR ALMOST TEN YEARS AND 21:40.399 --> 21:44.536 align:left position:12.5%,start line:83% size:77.5% HE HAD THREE BACK SURGEONS AND THE SURGEON SAID I CANNOT 21:44.636 --> 21:45.537 align:left position:22.5%,start line:89% size:67.5% SURGEONIZE YOU ANYMORE. 21:45.637 --> 21:47.639 align:left position:12.5%,start line:89% size:77.5% GO SEE YOUR DOCTOR, THAT'S ME. 21:47.739 --> 21:51.043 align:left position:12.5%,start line:83% size:77.5% I'VE BEEN SEEING HIM TEN YEARS AND WRITING HIS OPIATES. 21:51.143 --> 21:54.079 align:left position:15%,start line:83% size:75% AND HE'S STILL GETTING SOME TISSUE INPUT FROM THE PAIN IN 21:54.179 --> 21:55.147 align:left position:40%,start line:89% size:50% HIS BACK. 21:55.247 --> 21:57.482 align:left position:15%,start line:83% size:75% BUT CHRONIC PAIN REWIRES THE BRAIN. 21:57.582 --> 22:01.119 align:left position:10%,start line:83% size:80% AND IF YOU HAVE CHRONIC PAIN AND YOU'RE ON OPIATES, IT REWIRES 22:01.219 --> 22:02.688 align:left position:25%,start line:89% size:65% THE BRAIN EVEN MORE. 22:02.788 --> 22:06.792 align:left position:10%,start line:83% size:80% AND SO THERE'S A LOT OF THOUGHTS AND EMOTIONS THAT ARE GOING INTO 22:06.892 --> 22:08.093 align:left position:15%,start line:89% size:75% THE PAIN THIS GENTLEMAN HAS. 22:08.193 --> 22:11.396 align:left position:12.5%,start line:83% size:77.5% AND I'M NOT SAYING IT'S ALL IN HIS HEAD, BUT IT'S ALL IN HIS 22:11.496 --> 22:14.399 align:left position:12.5%,start line:83% size:77.5% HEAD AND THAT HE REALLY IS EXPERIENCING -- IF HE SAYS I'M 22:14.499 --> 22:17.202 align:left position:15%,start line:83% size:75% HAVING 7 OUT OF 10 PAIN, IT'S THAT WAY ALL THE TIME. 22:17.302 --> 22:22.941 align:left position:12.5%,start line:83% size:77.5% HE REALLY IS EXPERIENCING IT THAT WAY BECAUSE THE BRAIN HAS 22:23.041 --> 22:25.077 align:left position:40%,start line:89% size:50% REWIRED. 22:25.177 --> 22:27.312 align:left position:10%,start line:83% size:80% BECAUSE HE'S GETTING THE OPIATES ON TOP OF IT. 22:27.412 --> 22:30.048 align:left position:10%,start line:83% size:80% SO REALLY WHAT WE'RE TRYING TO TEACH ALL THE NEW PROVIDERS THAT 22:30.148 --> 22:34.453 align:left position:10%,start line:83% size:80% ARE COMING OUT OF THEIR PROGRAMS IS THERE IS THIS NEUROPATHIC 22:34.553 --> 22:36.488 align:left position:10%,start line:83% size:80% PAIN, THERE'S OPIATE WITHDRAWAL PAIN. 22:36.588 --> 22:39.925 align:left position:15%,start line:83% size:75% SO YOU ACTUALLY CAN GET MORE PAIN FROM BEING ON OPIATES. 22:40.025 --> 22:41.560 align:left position:30%,start line:89% size:60% ISN'T THAT CRAZY? 22:41.660 --> 22:46.798 align:left position:10%,start line:83% size:80% IT'S CALLED OPIATE HYPER ALGESIA PROBABLY TAKES MONTHS TO YEARS 22:46.898 --> 22:49.234 align:left position:10%,start line:83% size:80% FOR THAT TO HAPPEN, BUT SOMETIMES WE ARE WEANING PEOPLE 22:49.334 --> 22:52.437 align:left position:10%,start line:83% size:80% DOWN ON THEIR OPIATES AND THEIR PAIN GETS BETTER AND THEY START 22:52.537 --> 22:53.605 align:left position:32.5%,start line:89% size:57.5% FEELING BETTER. 22:53.705 --> 22:56.508 align:left position:10%,start line:83% size:80% AND THEN WHAT I WAS JUST TALKING ABOUT WAS THIS CENTRAL 22:56.608 --> 22:57.776 align:left position:32.5%,start line:89% size:57.5% SENSITIZATION. 22:57.876 --> 23:01.546 align:left position:12.5%,start line:83% size:77.5% SO THEY'RE HAVING THIS CHRONIC PAIN AND THEN IF THEY GET 23:01.646 --> 23:03.615 align:left position:17.5%,start line:83% size:72.5% OPIATES ON TOP OF IT, IT'S CHANGING THEIR BRAIN. 23:03.715 --> 23:10.255 align:left position:10%,start line:83% size:80% AND THEN THERE'S ALSO THE NOASH OWE SEPTIC PAIN, YOU HAMMER YOU. 23:10.355 --> 23:14.359 align:left position:10%,start line:83% size:80% SO IN LIFE WHEN THEY LOOK AT US AS A SPECIES, IT'S DOPAMINE THAT 23:14.459 --> 23:16.161 align:left position:15%,start line:89% size:75% MAKES US DO EVERYTHING WE DO. 23:16.261 --> 23:19.164 align:left position:10%,start line:83% size:80% WHY YOU WAKE UP IN THE MORNING, YOU MAKE MONEY, EAT, DRINK, THE 23:19.264 --> 23:20.665 align:left position:15%,start line:89% size:75% WHOLE SHOOTING MATCH, RIGHT? 23:20.766 --> 23:23.835 align:left position:10%,start line:83% size:80% AND THERE'S ACTUALLY ONLY TWO THINGS THAT DUMP INTO DOPAMINE. 23:23.935 --> 23:27.539 align:left position:20%,start line:83% size:70% AND THAT'S ENDORPHINS AND OPIATES. 23:27.639 --> 23:28.840 align:left position:32.5%,start line:89% size:57.5% INTERESTINGLY. 23:28.940 --> 23:31.943 align:left position:15%,start line:83% size:75% SO WHAT HAPPENS IF YOU HAVE SOMEBODY THAT SAYS I'VE NEVER 23:32.043 --> 23:35.280 align:left position:10%,start line:83% size:80% TAKEN AN OPIATE BEFORE, AND THEY START TO TAKE AN OPIATE FOR THE 23:35.380 --> 23:36.281 align:left position:37.5%,start line:89% size:52.5% FIRST TIME? 23:36.381 --> 23:39.384 align:left position:20%,start line:83% size:70% SO WHY DO WE HAVE OPIATE RECEPTORS? 23:39.484 --> 23:42.254 align:left position:15%,start line:83% size:75% AND MOST PROVIDERS WOULD SAY IT'S TO DECREASE PAIN. 23:42.354 --> 23:44.923 align:left position:17.5%,start line:83% size:72.5% AND THAT'S TRUE, BUT THAT'S ACTUALLY THE SECOND REASON. 23:45.023 --> 23:48.527 align:left position:12.5%,start line:83% size:77.5% SO IF YOU GET INTO THE PRIMARY CARE LITERATURE ON WHY AS A 23:48.627 --> 23:51.963 align:left position:10%,start line:83% size:80% SPECIES WE HAVE OPIATE RECEPTORS , IT'S TO ACHIEVE A 23:52.063 --> 23:52.964 align:left position:30%,start line:89% size:60% SHORT-TERM GOAL. 23:53.064 --> 23:54.266 align:left position:25%,start line:89% size:65% IT'S FASCINATING NOW. 23:54.366 --> 23:56.468 align:left position:10%,start line:83% size:80% THINK ABOUT THAT WHEN I SHOW YOU EVERYTHING ELSE THAT LIGHTS UP 23:56.568 --> 24:00.705 align:left position:15%,start line:83% size:75% AS THIS PERSON IS TAKING PERCOCET SAY FOR THEIR BROKEN 24:00.806 --> 24:02.040 align:left position:42.5%,start line:89% size:47.5% ANKLE. 24:02.140 --> 24:04.743 align:left position:12.5%,start line:83% size:77.5% IT DEYESES PAIN, GREAT, THAT'S WHY I GAVE YOU THIS MEDICINE, 24:04.843 --> 24:05.777 align:left position:42.5%,start line:89% size:47.5% RIGHT? 24:05.877 --> 24:08.313 align:left position:10%,start line:83% size:80% BUT IT ALSO INCREASES MOTIVATION , IT INCREASES 24:08.413 --> 24:12.484 align:left position:15%,start line:83% size:75% CONFIDENCE, IT INCREASES THE REWARD SYSTEM, AND IT REDUCES 24:12.584 --> 24:14.486 align:left position:22.5%,start line:89% size:67.5% DEPRESSION AND ANXIETY. 24:14.586 --> 24:18.156 align:left position:10%,start line:83% size:80% IT MAY ONLY BE FOR 30 MINUTES OR AN HOUR AND A HALF, IT'S REALLY 24:18.256 --> 24:21.426 align:left position:12.5%,start line:83% size:77.5% SHORT TERM, BUT WHEN YOU FIRST START TAKING THAT, THAT CAN 24:21.526 --> 24:22.694 align:left position:30%,start line:89% size:60% HAPPEN SOMETIMES. 24:22.794 --> 24:25.831 align:left position:10%,start line:83% size:80% SO THINK ABOUT THAT PATIENT MAYBE THAT'S BEEN SEEING ME FOR 24:25.931 --> 24:28.433 align:left position:12.5%,start line:83% size:77.5% FIVE YEARS AND THEY HAVE DEPRESSION, I'VE TRIED FIVE OR 24:28.533 --> 24:31.503 align:left position:12.5%,start line:83% size:77.5% SIX DIFFERENT MEDICINES, TRIED TO GET THEM INTO THERAPY, AND 24:31.603 --> 24:34.172 align:left position:15%,start line:83% size:75% IT'S JUST NEVER GOTTEN TAKEN CARE OF. 24:34.272 --> 24:37.375 align:left position:12.5%,start line:83% size:77.5% AND THEY GO TO THE E.R. WITH A BROKEN WRIST AND THEY GET 24:37.476 --> 24:41.179 align:left position:15%,start line:83% size:75% PERCOCET AND THEY TAKE IT AND THEIR DEPRESSION TOTALLY GOES 24:41.279 --> 24:42.514 align:left position:45%,start line:89% size:45% AWAY. 24:42.614 --> 24:45.984 align:left position:12.5%,start line:83% size:77.5% DO YOU THINK THEY'RE GOING TO FINISH THAT PERCOCET RATHER -- 24:46.084 --> 24:48.353 align:left position:12.5%,start line:83% size:77.5% WHETHER IT'S 6 PILLS, 12 PILLS OR 30? 24:48.453 --> 24:49.354 align:left position:40%,start line:89% size:50% FOR SURE. 24:49.454 --> 24:51.189 align:left position:10%,start line:83% size:80% THAT'S THE BEST THEY'VE FELT IN FIVE YEARS. 24:51.289 --> 24:52.390 align:left position:20%,start line:89% size:70% THAT CAN ACTUALLY HAPPEN. 24:52.491 --> 24:54.593 align:left position:12.5%,start line:83% size:77.5% THAT INCREASES THE PLEASURE IN THE CURRENT ACTIVITY. 24:54.693 --> 24:58.296 align:left position:15%,start line:83% size:75% BUT WHAT HAPPENS IF YOU TAKE OPIATES CHRONICALLY? 24:58.396 --> 24:59.197 align:left position:45%,start line:89% size:45% OKAY? 24:59.297 --> 25:01.900 align:left position:10%,start line:83% size:80% SO AT LEAST MONTHS BUT PROBABLY YEARS. 25:02.000 --> 25:05.604 align:left position:15%,start line:83% size:75% AND SO IT DECREASES DOPAMINE PRODUCTION. 25:05.704 --> 25:06.671 align:left position:27.5%,start line:89% size:62.5% THAT'S WHY WE LIVE. 25:06.771 --> 25:08.940 align:left position:10%,start line:83% size:80% IT'S DECREASES THE NORMAL REWARD SYSTEM. 25:09.040 --> 25:12.911 align:left position:22.5%,start line:83% size:67.5% IT DOWNREGULATES OPIATE RECEPTORS AND INCREASES 25:13.011 --> 25:13.979 align:left position:37.5%,start line:89% size:52.5% ENDORPHINS. 25:14.079 --> 25:15.514 align:left position:15%,start line:83% size:75% THE ONLY TWO THINGS THAT DUMP INTO DOPAMINE. 25:15.614 --> 25:21.319 align:left position:10%,start line:83% size:80% IT DECREASES MOTIVATION AND LONG TERM IT INCREASES DEPRESSION. 25:21.419 --> 25:23.421 align:left position:32.5%,start line:89% size:57.5% GREAT MED, HUH? 25:23.522 --> 25:27.792 align:left position:10%,start line:83% size:80% SO THIS IS THE YELLOW BRICK ROAD , RIGHT, WIZARD OF OZ, AND 25:27.893 --> 25:31.663 align:left position:12.5%,start line:83% size:77.5% THEY WERE SKIPPING AND SINGING THROUGH THE POPPIES. 25:31.763 --> 25:32.163 align:left position:35%,start line:89% size:55% THAT'S RIGHT. 25:32.264 --> 25:33.465 align:left position:35%,start line:89% size:55% THAT'S RIGHT. 25:33.565 --> 25:37.335 align:left position:12.5%,start line:83% size:77.5% SO THIS IS AN ILLUSTRATION OF THE POPPIES SOMETIMES CAN MAKE 25:37.435 --> 25:40.405 align:left position:17.5%,start line:83% size:72.5% YOU FEEL REALLY GOOD AT THE BEGINNING, BUT DOES ANYBODY 25:40.505 --> 25:43.308 align:left position:10%,start line:83% size:80% REMEMBER, THEY DIDN'T QUITE MAKE IT TO THE EMERALD CITY? 25:43.408 --> 25:46.778 align:left position:20%,start line:89% size:70% THEY FELL ASLEEP, RIGHT. 25:46.878 --> 25:50.148 align:left position:10%,start line:83% size:80% AND IRONIC FORESHADOWING FOR EVERYTHING THAT'S HAPPENING WITH 25:50.248 --> 25:54.119 align:left position:10%,start line:83% size:80% THIS OPIATE CRISIS NOW IS YOU GET TOO MUCH OF THE OPIATES AND 25:54.219 --> 25:55.887 align:left position:15%,start line:89% size:75% YOU CAN FALL ASLEEP FOR SURE. 25:55.987 --> 26:00.158 align:left position:10%,start line:83% size:80% SO THIS IS THE C.D.C. GUIDELINES THAT CAME OUT MARCH OF 2016 FOR 26:00.258 --> 26:01.459 align:left position:22.5%,start line:89% size:67.5% ACUTE AND CHRONIC PAIN. 26:01.560 --> 26:04.829 align:left position:10%,start line:83% size:80% AND WE'RE GOING TO START TALKING ABOUT ACUTE PAIN FIRST. 26:04.930 --> 26:09.134 align:left position:10%,start line:83% size:80% SO THE C.D.C. CAME OUT MARCH OF 2016 AND THEY SAID TO PROVIDERS, 26:09.234 --> 26:12.804 align:left position:10%,start line:83% size:80% IF YOU'RE GOING TO PRESCRIBE OPIATES, PRESCRIBE THREE DAYS OR 26:12.904 --> 26:15.373 align:left position:12.5%,start line:83% size:77.5% LESS AND NO MORE THAN SEVEN IS RARELY NEEDED. 26:15.473 --> 26:18.577 align:left position:12.5%,start line:89% size:77.5% AND THIS WAS A RADICAL CHANGE. 26:18.677 --> 26:21.179 align:left position:12.5%,start line:83% size:77.5% NOT ONLY FOR PROVIDERS BUT FOR PATIENTS AS WELL. 26:21.279 --> 26:25.483 align:left position:15%,start line:83% size:75% BUT AGAIN, WE'RE DOING THIS TOTALLY DIFFERENT THAN OTHER 26:25.584 --> 26:26.818 align:left position:42.5%,start line:89% size:47.5% PLACES. 26:26.918 --> 26:30.555 align:left position:15%,start line:83% size:75% SO IN THE COUNTRY OF GERMANY, THEY TAKE OUT ORGANS AND WHEN 26:30.655 --> 26:35.694 align:left position:10%,start line:83% size:80% YOU LEAVE THE HOSPITAL YOU'RE ON TILE TYLENOL AND IBUPROFEN. 26:35.794 --> 26:37.729 align:left position:15%,start line:83% size:75% AND THAT JUST DOESN'T COMPUTE WITH US OVER HERE. 26:37.829 --> 26:39.531 align:left position:12.5%,start line:83% size:77.5% OF COURSE THAT'S REALLY SEVERE PAIN. 26:39.631 --> 26:42.000 align:left position:10%,start line:83% size:80% I MUST NEED PERCOCET OR VICODIN, RIGHT? 26:42.100 --> 26:43.635 align:left position:22.5%,start line:89% size:67.5% THAT'S HOW THEY DO IT. 26:43.735 --> 26:46.771 align:left position:10%,start line:83% size:80% IT'S NOT LIKE IN ONE HOSPITAL IN GERMANY T. COUNTRY OF GERMANY. 26:46.871 --> 26:50.642 align:left position:15%,start line:83% size:75% YOU GET A HYSTERECTOMY, THEY TAKE CARE OF NEW THE HOSPITAL 26:50.742 --> 26:55.246 align:left position:12.5%,start line:83% size:77.5% AND WHEN YOU GO HOME YOU'RE ON TYLENOL AND IBUPROFEN. 26:55.347 --> 26:57.916 align:left position:10%,start line:83% size:80% WE ARE TRYING TO BACK UP AND FIND OUT WHAT WE SHOULD BE DOING 26:58.016 --> 27:04.022 align:left position:10%,start line:83% size:80% IT SAYS COUNSEL YOUR PATIENTS ON SAFE STORAGE AND DISPOSAL OF 27:04.122 --> 27:05.256 align:left position:40%,start line:89% size:50% OPIOIDS. 27:05.357 --> 27:07.492 align:left position:10%,start line:83% size:80% I HAVE TO SAY PRIOR TO WREADING THAT I DISPENSED A LOT OF 27:07.592 --> 27:09.494 align:left position:10%,start line:83% size:80% VICODIN AND PERCOCET AND I NEVER DID THAT. 27:09.594 --> 27:10.729 align:left position:17.5%,start line:89% size:72.5% BUT I DO NOW AND TEACH IT. 27:10.829 --> 27:13.598 align:left position:17.5%,start line:83% size:72.5% THIS IS WHAT THE C.D.C. IS SAYING AND I APPRECIATE ALL 27:13.698 --> 27:15.600 align:left position:15%,start line:83% size:75% Y'ALL THAT ARE OUT THERE AND GETTING THESE LOCKBOXES TO 27:15.700 --> 27:20.205 align:left position:12.5%,start line:83% size:77.5% PEOPLE AND REAL LIVE -- REALLY TALKING TO THEM ABOUT IT. 27:20.305 --> 27:24.009 align:left position:10%,start line:83% size:80% BUT WE NEED TO TALK TO EVERYONE, OUR CLIENTS, PATIENTS, AND 27:24.109 --> 27:25.410 align:left position:12.5%,start line:83% size:77.5% ANYONE THAT WILL LISTEN IN OUR FAMILY. 27:25.510 --> 27:28.513 align:left position:10%,start line:83% size:80% THE C.D.C. IS SAYING IF YOU HAVE AN OPIATE YOU NEED TO HAVE IT 27:28.613 --> 27:29.681 align:left position:37.5%,start line:89% size:52.5% LOCKED UP. 27:29.781 --> 27:32.017 align:left position:10%,start line:83% size:80% AND IF YOU DON'T USE IT ALL, YOU NEED TO GET RID OF IT. 27:32.117 --> 27:34.219 align:left position:12.5%,start line:83% size:77.5% YOU NEED TO GET IT OUT OF YOUR HOUSE. 27:34.319 --> 27:35.854 align:left position:15%,start line:89% size:75% THERE'S THREE WAYS TO DO IT. 27:35.954 --> 27:38.657 align:left position:15%,start line:83% size:75% YOU CAN GOOGLE WHERE YOUR PERMANENT DROPBOX IS IN YOUR 27:38.757 --> 27:40.258 align:left position:10%,start line:83% size:80% COMMUNITY AND TAKE IT THERE AND DROP IT OFF. 27:40.358 --> 27:44.095 align:left position:10%,start line:83% size:80% IF YOU CAN'T DO THAT YOU CAN ADD COFFEE GROUNDS TO IT OR KITTY 27:44.195 --> 27:47.599 align:left position:12.5%,start line:83% size:77.5% LITTER, WATER, YOU SHAKE IT UP AND MAKE A SLURRY AND THROW IT 27:47.699 --> 27:48.099 align:left position:45%,start line:89% size:45% AWAY. 27:48.199 --> 27:49.401 align:left position:30%,start line:89% size:60% IT WILL RUIN IT. 27:49.501 --> 27:51.336 align:left position:10%,start line:83% size:80% OR IF YOU CAN'T DO ONE OF THOSE FIRST TWO, THEY SAY YOU SHOULD 27:51.436 --> 27:52.504 align:left position:40%,start line:89% size:50% FLUSH IT. 27:52.604 --> 27:55.540 align:left position:15%,start line:83% size:75% I'M JUST SAYING, FLUSHING IT FEELS NOT GOOD TO ME. 27:55.640 --> 28:00.912 align:left position:10%,start line:83% size:80% FLUSHING THIS INTO OUR, YOU KNOT SEEMS LIKE YOU SHOULD BE ABLE TO 28:01.012 --> 28:02.213 align:left position:20%,start line:89% size:70% DO ONE OF THE FIRST TWO. 28:02.313 --> 28:06.217 align:left position:10%,start line:83% size:80% IF I ONLY HAD THAT OPTION, WOULD I RATHER DO THAT THAN HAVE MY 28:06.317 --> 28:08.119 align:left position:12.5%,start line:83% size:77.5% 14-YEAR-OLD BECOME ADDICTED TO OPIATES? 28:08.219 --> 28:09.287 align:left position:25%,start line:89% size:65% YEAH, I WOULD DO IT. 28:09.387 --> 28:11.256 align:left position:12.5%,start line:83% size:77.5% BUT THIS IS WHAT THE C.D.C. IS SAYING WE SHOULD DO. 28:11.356 --> 28:16.561 align:left position:10%,start line:83% size:80% SO A STORY ABOUT THAT, ONE OF THE FOLKS I WORK WITH, SHE HAD A 28:16.661 --> 28:19.564 align:left position:10%,start line:83% size:80% SOFA DELIVERED AT HER HOUSE AND ONE OF THE GUYS DELIVERING IT 28:19.664 --> 28:21.800 align:left position:20%,start line:83% size:70% SAID HEY, CAN I USE YOUR RESTROOM? 28:21.900 --> 28:23.101 align:left position:32.5%,start line:89% size:57.5% SHE SAID YEAH. 28:23.201 --> 28:26.171 align:left position:10%,start line:83% size:80% THEN AFTER THEY LEFT SHE SAID HUH, HE SURE SPENT A LOT OF TIME 28:26.271 --> 28:27.505 align:left position:40%,start line:89% size:50% IN THERE. 28:27.605 --> 28:31.042 align:left position:12.5%,start line:83% size:77.5% SHE WENT INTO HER BATHROOM AND ALL OF HER PERCOCET WERE GONE. 28:31.142 --> 28:33.778 align:left position:10%,start line:83% size:80% AND DO YOU THINK EVERY TIME THAT HE DELIVERS A PIECE OF FURNITURE 28:33.878 --> 28:37.582 align:left position:10%,start line:83% size:80% THAT HE ASKS TO USE THE RESTROOM I BET HE DOES, DON'T YOU? 28:37.682 --> 28:42.721 align:left position:12.5%,start line:83% size:77.5% AND IF WAS -- IT WAS THAT EASY FOR THAT GUY, THINK ABOUT IT. 28:42.821 --> 28:46.458 align:left position:10%,start line:83% size:80% HOW EASY IS IT FOR OUR KIDS, OUR KIDS' FRIENDS, OUR GRANDKIDS TO 28:46.558 --> 28:47.759 align:left position:37.5%,start line:89% size:52.5% GET TO IT? 28:47.859 --> 28:51.529 align:left position:10%,start line:83% size:80% THERE ARE LITERALLY HUNDREDS OF MILLIONS OF UNUSED OPIATES IN 28:51.629 --> 28:53.364 align:left position:10%,start line:89% size:80% UNLOCKED CABINETS IN OUR HOMES. 28:53.465 --> 28:56.868 align:left position:10%,start line:83% size:80% WE GOT TO GET THEM OUT OF THERE, AND WE HAVE TO TELL OUR PATIENTS 28:56.968 --> 29:01.473 align:left position:10%,start line:83% size:80% AND CLIENTS TO DO THE SAME THING SO WHERE DID THIS COME FROM? 29:01.573 --> 29:04.442 align:left position:10%,start line:83% size:80% THE C.D.C. COMES OUT AND SAYS HEY, REALLY YOU SHOULD JUST GIVE 29:04.542 --> 29:05.677 align:left position:37.5%,start line:89% size:52.5% THREE DAYS. 29:05.777 --> 29:07.979 align:left position:12.5%,start line:83% size:77.5% BUT IF YOU HAVE TO, SEVEN DAYS BUT NOT MORE THAN SEVEN. 29:08.079 --> 29:12.884 align:left position:12.5%,start line:83% size:77.5% SO THIS IS A TEN-YEAR STUDY OF ADULTS IN THE UNITED STATES. 29:12.984 --> 29:13.618 align:left position:45%,start line:89% size:45% OKAY? 29:13.718 --> 29:14.986 align:left position:17.5%,start line:89% size:72.5% AND THEY WERE OPIATE NAIVE. 29:15.086 --> 29:19.090 align:left position:10%,start line:83% size:80% THEY HAD NEVER HAD AN OPIATE BEFORE AND THEY GET A LEGITIMATE 29:19.190 --> 29:23.128 align:left position:10%,start line:83% size:80% PRESCRIPTION FROM THEIR PROVIDER LEGITIMATE PRESCRIPTION FROM 29:23.228 --> 29:25.430 align:left position:15%,start line:83% size:75% THEIR DOCTOR FOR A LEGITIMATE REASON. 29:25.530 --> 29:27.732 align:left position:15%,start line:83% size:75% THEY SAY WHAT'S THE CHANCE YOU'RE STILL ON OPIATES AT A 29:27.832 --> 29:29.134 align:left position:20%,start line:89% size:70% YEAR AND AT THREE YEARS? 29:29.234 --> 29:30.835 align:left position:10%,start line:89% size:80% SO I JUST WANT TO SHOW YOU HERE. 29:30.935 --> 29:33.104 align:left position:15%,start line:83% size:75% IF YOU'LL FOCUS IN AT THE 30 DAYS. 29:33.204 --> 29:36.174 align:left position:17.5%,start line:83% size:72.5% SO IF YOU GOT A 30-DAY PRESCRIPTION, NEVER HAD AN 29:36.274 --> 29:39.844 align:left position:12.5%,start line:83% size:77.5% OPIATE IN YOUR LIFE, ONE YEAR LATER, 30% OF PEOPLE ARE STILL 29:39.944 --> 29:42.547 align:left position:35%,start line:89% size:55% ON AN OPIATE. 29:42.647 --> 29:47.986 align:left position:10%,start line:83% size:80% THREE YEARS LATER, 15, ALMOST 20 % OF PEOPLE ARE STILL ON AN 29:48.086 --> 29:49.287 align:left position:42.5%,start line:89% size:47.5% OPIATE. 29:49.387 --> 29:51.756 align:left position:15%,start line:83% size:75% THAT IS NOT LESS THAN 1% OF PEOPLE WHO EVER GET DEPENDENT 29:51.856 --> 29:52.757 align:left position:22.5%,start line:89% size:67.5% OSH ADDICTED TO THESE. 29:52.857 --> 29:56.094 align:left position:10%,start line:83% size:80% THESE ARE REALLY SAFE MEDICINES, IS IT? 29:56.194 --> 30:00.365 align:left position:10%,start line:83% size:80% FROM ONE 30-DAY PRESCRIPTION, 15 TO 20% OF PEOPLE THREE YEARS 30:00.465 --> 30:03.802 align:left position:10%,start line:83% size:80% LATER ARE STILL TAKING AN OPIATE NOW, THEY DIDN'T BREAK IT OUT IN 30:03.902 --> 30:05.103 align:left position:35%,start line:89% size:55% THAT DATASET. 30:05.203 --> 30:06.771 align:left position:15%,start line:83% size:75% PROBABLY THE MAJORITY OF THEM ARE STILL IN PAIN AND SEEING 30:06.871 --> 30:08.640 align:left position:15%,start line:83% size:75% THEIR PROVIDER AND GETTING A MEDICATION FOR THAT. 30:08.740 --> 30:11.109 align:left position:15%,start line:83% size:75% BUT MAYBE SOME OF THEM ARE GETTING THEM FROM FAMILY AND 30:11.209 --> 30:13.778 align:left position:10%,start line:83% size:80% FRIENDS, MAYBE SOME OF THEM ARE SLOOTING HEROINE. 30:13.878 --> 30:16.915 align:left position:10%,start line:83% size:80% THEY JUST SAID HAD YOU ON AN OPIATE ONE YEAR AND THREE YEARS 30:17.015 --> 30:19.851 align:left position:10%,start line:83% size:80% LATER AND WHERE THAT DATASET STARTS TO GO UP IS RIGHT HERE AT 30:19.951 --> 30:21.152 align:left position:37.5%,start line:89% size:52.5% THREE DAYS. 30:21.252 --> 30:22.854 align:left position:12.5%,start line:83% size:77.5% AND WHY WE IN NORTH CAROLINA PASSED THE NORTH CAROLINA STOP 30:22.954 --> 30:28.059 align:left position:10%,start line:83% size:80% ACT THAT NOW SAYS FOR ACUTE PAIN THAT YOU CAN ONLY PRESCRIBE FIVE 30:28.159 --> 30:31.763 align:left position:17.5%,start line:83% size:72.5% DAYS WORTH OR AFTER SURGERY SEVEN TO TRY TO REDUCE THE 30:31.863 --> 30:38.803 align:left position:10%,start line:83% size:80% CHANCE THAT FOLKS WILL STILL BE ON OPIATES AT A YEAR. 30:38.903 --> 30:41.706 align:left position:10%,start line:83% size:80% THEN THIS DATASET IS FROM THIS SAME STUDY WHERE THEY SAID WHAT 30:41.806 --> 30:43.007 align:left position:17.5%,start line:89% size:72.5% ABOUT THIS REFILL BUSINESS? 30:43.107 --> 30:49.214 align:left position:20%,start line:83% size:70% SO I'VE HAD THIS PATIENT I WAS 30:49.314 --> 30:52.617 align:left position:10%,start line:83% size:80% 16 YEARS OLD, BROKE MY BACK IN THREE PLACES AND MY DOCTOR GAVE 30:52.717 --> 30:55.253 align:left position:12.5%,start line:83% size:77.5% ME PERCOCET FOR A MONTH AND REFILLED IT SIX TIMES OVER THE 30:55.353 --> 30:57.889 align:left position:10%,start line:83% size:80% PHONE AND THEN SAID GO SEE YOUR REGULAR DOCTOR. 30:57.989 --> 31:00.191 align:left position:20%,start line:89% size:70% I CAN'T DO THIS ANYMORE. 31:00.291 --> 31:03.761 align:left position:10%,start line:83% size:80% AND SHE FOUND THAT SHE STARTED TO WITHDRAW AND SHE -- SHE HATED 31:03.862 --> 31:05.029 align:left position:45%,start line:89% size:45% THAT. 31:05.129 --> 31:09.767 align:left position:12.5%,start line:83% size:77.5% SO SHE STARTED BUYING PILLS AT SCHOOL AND THEN BY 20 WAS 31:09.868 --> 31:12.570 align:left position:12.5%,start line:83% size:77.5% SHOOTING HEROINE AND ROLLED IN TO SEE ME WHEN ONE OF HER 31:12.670 --> 31:15.440 align:left position:12.5%,start line:83% size:77.5% FRIENDS OVERDOSED AND DIED AND SAID I DON'T WANT TO DO THIS 31:15.540 --> 31:16.040 align:left position:40%,start line:89% size:50% ANYMORE. 31:16.140 --> 31:17.342 align:left position:25%,start line:89% size:65% I DON'T WANT TO DIE. 31:17.442 --> 31:19.811 align:left position:10%,start line:83% size:80% AND WHAT HAPPENS IF YOU GET A PRESCRIPTION AND THEN YOU REFILL 31:19.911 --> 31:21.145 align:left position:35%,start line:89% size:55% IT SIX TIMES? 31:21.246 --> 31:24.916 align:left position:10%,start line:83% size:80% WELL, THERE'S A 60% CHANCE THAT YOU'LL STILL BE ON OPIATES AT A 31:25.016 --> 31:28.820 align:left position:10%,start line:83% size:80% YEAR AND A 40% CHANCE YOU'RE STILL ON OPIATES AT THREE YEARS. 31:28.920 --> 31:32.957 align:left position:10%,start line:83% size:80% THIS IS NOT LESS THAN 1% OF THE PEOPLE. 31:33.057 --> 31:35.860 align:left position:15%,start line:83% size:75% SO FOR CHRONIC PAIN, THIS WAS VERY CONTROVERSIAL, TOO. 31:35.960 --> 31:40.265 align:left position:10%,start line:83% size:80% IT SAID IN GENERAL DO NOT PRESCRIBE OPIATES AS FIRST LINE 31:40.365 --> 31:43.534 align:left position:10%,start line:83% size:80% TREATMENT FOR KRON CHRONIC PAIN AND THEN RIGHT UNDERNEATH IT IF 31:43.635 --> 31:48.439 align:left position:10%,start line:83% size:80% YOU GO TO THE C.D.C. WEBSITE, DO NOT PRESCRIBE OPIATES FOR LOW 31:48.539 --> 31:56.114 align:left position:17.5%,start line:83% size:72.5% BACK PAIN, FINE BRO -- FIBROMYALGIA AND HEADACHES. 31:56.214 --> 31:59.183 align:left position:20%,start line:83% size:70% I HAVE DONE THAT OVER MY PRACTICE. 31:59.284 --> 32:02.086 align:left position:10%,start line:83% size:80% AND THIS IS A HARD THING TO SAY BUT I LOOK AT MY PATIENTS AND I 32:02.186 --> 32:04.055 align:left position:10%,start line:89% size:80% BELIEVE I ADDICTED SOME OF THEM. 32:04.155 --> 32:06.691 align:left position:15%,start line:83% size:75% DOCTORS WERE TRYING TO HELP PEOPLE, WE CERTAINLY WEREN'T 32:06.791 --> 32:09.594 align:left position:10%,start line:83% size:80% TRYING TO HURT THEM BUT THIS IS WHAT WE DID. 32:09.694 --> 32:11.796 align:left position:15%,start line:83% size:75% WE BOUGHT THIS BILL OF GOODS THAT THESE MEDICINES ARE SAFE 32:11.896 --> 32:20.505 align:left position:22.5%,start line:89% size:67.5% AND THEY'RE REALLY NOT. 32:20.605 --> 32:23.641 align:left position:10%,start line:83% size:80% CHRONIC PAIN, LOW BACK PAIN ON OPIATES AND THERE'S BEEN LOTS OF 32:23.741 --> 32:28.479 align:left position:12.5%,start line:83% size:77.5% STUDIES ABOUT HOW THESE FOLKS HAVE DONE AND FOUND FOUR HIGH- 32:28.579 --> 32:30.982 align:left position:15%,start line:83% size:75% QUALITY STUDIES AND DO THIS THING CALLED A META-ANALYSIS. 32:31.082 --> 32:34.385 align:left position:12.5%,start line:83% size:77.5% AND THE QUESTION IS WHAT'S THE CHANCE IF YOU HAVE CHRONIC LOW 32:34.485 --> 32:37.689 align:left position:10%,start line:83% size:80% BACK PAIN AND OPIATE YOU'LL HAVE A SUBSTANCE ABUSE DISORDER IN 32:37.789 --> 32:39.023 align:left position:32.5%,start line:89% size:57.5% YOUR LIFETIME? 32:39.123 --> 32:43.728 align:left position:10%,start line:83% size:80% LOOK AT THAT 36 TO 56% OF PEOPLE WILL HAVE A SUBSTANCE ABUSE DIS 32:43.828 --> 32:46.197 align:left position:17.5%,start line:83% size:72.5% ORDER IF THEY'RE ON OPIATES FOR CHRONIC BACK PAIN. 32:46.297 --> 32:47.732 align:left position:10%,start line:89% size:80% THAT'S NOT LESS THAN 1%, RIGHT? 32:47.832 --> 32:51.936 align:left position:10%,start line:83% size:80% AND THIS IS AN ARTICLE FROM JAMA , JUST IN 2018 AND THEY SAID 32:52.036 --> 32:55.440 align:left position:12.5%,start line:83% size:77.5% , OKAY, YOU HAVE CHRONIC BACK PAIN AND YOU'RE EITHER ON 32:55.540 --> 32:57.008 align:left position:30%,start line:89% size:60% AN OPIATE OR NOT. 32:57.108 --> 32:57.909 align:left position:32.5%,start line:89% size:57.5% HOW DO YOU DO? 32:58.009 --> 32:59.243 align:left position:10%,start line:89% size:80% AND THIS IS WHAT THEY FOUND OUT. 32:59.344 --> 33:01.946 align:left position:10%,start line:83% size:80% THERE'S NO SIGNIFICANT DIFFERENCE IN THE TWO GROUPS IN 33:02.046 --> 33:05.817 align:left position:15%,start line:83% size:75% TERMS OF THEIR PAIN RELATED FUNCTION AT 12 MONTHS BUT THE 33:05.917 --> 33:10.188 align:left position:10%,start line:83% size:80% PAIN INTENSITY WAS SIGNIFICANTLY BETTER IN THE NON-OPIATE GROUP. 33:10.288 --> 33:14.258 align:left position:10%,start line:83% size:80% SO YOU ACTUALLY FELT BETTER IF YOU WEREN'T GETTING OPIATES FOR 33:14.359 --> 33:15.493 align:left position:22.5%,start line:89% size:67.5% YOUR CHRONIC BACK PAIN. 33:15.593 --> 33:18.730 align:left position:15%,start line:83% size:75% AND THE OPIATE GROUP HAD SIGNIFICANTLY MORE MEDICATION 33:18.830 --> 33:26.537 align:left position:10%,start line:83% size:80% SIDE EFFECTS LIKE FALLS, OVER DOSE, AND DEATH IN SOME OF THEM. 33:26.637 --> 33:27.839 align:left position:30%,start line:89% size:60% WHAT ABOUT KIDS? 33:27.939 --> 33:30.675 align:left position:12.5%,start line:83% size:77.5% THE NEXT COUPLE OF SLIDES, THE STORY IS THE BRAIN UNDER 25 33:30.775 --> 33:33.378 align:left position:17.5%,start line:83% size:72.5% SHOULD NOT BE TOUCHING THIS STUFF IF AT ALL POSSIBLE. 33:33.478 --> 33:38.950 align:left position:10%,start line:83% size:80% SO THEY DID THIS STUDY, IT'S IN PEDIATRICS, IT'S AN ES SCHEME -- 33:39.050 --> 33:42.020 align:left position:17.5%,start line:83% size:72.5% ESTEEMED JOURNAL BEEN THE PEDIATRIC GRIEWBING, 2015. 33:42.120 --> 33:45.089 align:left position:10%,start line:83% size:80% AND THEY SAID WHAT'S THE CHANCE YOU'LL HAVE A SUBSTANCE ABUSE 33:45.189 --> 33:48.826 align:left position:10%,start line:83% size:80% DISORDER IN YOUR EARLY ADULTHOOD IF YOU GET ONE LEGITIMATE 33:48.926 --> 33:52.030 align:left position:10%,start line:83% size:80% PRESCRIPTION OF AN OPIATE BEFORE 12th GRADE? 33:52.130 --> 33:55.666 align:left position:17.5%,start line:83% size:72.5% WHAT THEY FOUND OUT IS IT INCREASING YOUR CHANCE 33%. 33:55.767 --> 33:59.670 align:left position:10%,start line:83% size:80% SO I DIDN'T SAY IF YOU TAKE 100 KIDS AND GIVE THEM AN OPIATE FOR 33:59.771 --> 34:01.672 align:left position:10%,start line:83% size:80% THEIR BROKEN WRIST THAT 33 WILL GET ADDICTED. 34:01.773 --> 34:03.007 align:left position:27.5%,start line:89% size:62.5% I DIDN'T SAY THAT. 34:03.107 --> 34:09.480 align:left position:10%,start line:83% size:80% BUT IF YOUR CHANCE WAS 1% OR 2% OR 6%, IT BUMPS IT 33% MORE FROM 34:09.580 --> 34:10.681 align:left position:30%,start line:89% size:60% ONE PRESCRIPTION. 34:10.782 --> 34:14.185 align:left position:10%,start line:83% size:80% AND THAT ACTUALLY REALLY CONCERNED THE RESEARCHERS A LOT. 34:14.285 --> 34:17.722 align:left position:10%,start line:83% size:80% THEY SAID WHAT ABOUT KIDS THAT HAVE A LOW CHANCE OF EVER HAVING 34:17.822 --> 34:19.157 align:left position:20%,start line:89% size:70% A SUBSTANCE USE DISORDER? 34:19.257 --> 34:25.296 align:left position:15%,start line:83% size:75% THEY DIDN'T USE ACE SCORES OR ADVERSE CHILDHOOD EXPERIENCES 34:25.396 --> 34:28.566 align:left position:17.5%,start line:89% size:72.5% BUT IT WAS SIMILAR TO THAT. 34:28.666 --> 34:34.138 align:left position:12.5%,start line:83% size:77.5% IF YOUR ACE SCORE WAS LOW, A 0 OR 1, THIS SHOULD BE SOMEBODY 34:34.238 --> 34:37.208 align:left position:10%,start line:83% size:80% WHO HAS A LOW CHANCE OF HAVING A SUBSTANCE ABUSE DISORDER IN 34:37.308 --> 34:41.679 align:left position:10%,start line:83% size:80% THEIR ADULT ONE, ONE LEGITIMATE PRESCRIPTION INCREASED THAT KIDS 34:41.779 --> 34:43.181 align:left position:32.5%,start line:89% size:57.5% ' CHANCE 300%. 34:43.281 --> 34:45.983 align:left position:10%,start line:83% size:80% IF YOU WERE A 1%, NOW YOU'RE A 3 %. 34:46.084 --> 34:49.420 align:left position:15%,start line:83% size:75% SO IF YOU'RE A 3% CHANCE, YOU NOW ARE A 9% CHANCE. 34:49.520 --> 34:52.056 align:left position:20%,start line:83% size:70% JUST FROM ONE LEGITIMATE PRESCRIPTION. 34:52.156 --> 34:53.391 align:left position:27.5%,start line:89% size:62.5% BUT THERE IS HOPE. 34:53.491 --> 34:57.462 align:left position:10%,start line:83% size:80% IVE BEEN HANGING A LOT OF CREPE AS THEY SAY HERE IN THE SOUTH SO 34:57.562 --> 34:58.763 align:left position:45%,start line:89% size:45% FAR. 34:58.863 --> 35:03.634 align:left position:10%,start line:83% size:80% BUT IF YOU TALK TO KIDS ABOUT DRUGS, 50% REDUCTION IN STARTING 35:03.734 --> 35:06.104 align:left position:20%,start line:89% size:70% AND USING ILLICIT DRUGS. 35:06.204 --> 35:07.805 align:left position:22.5%,start line:89% size:67.5% THAT'S AMAZING, RIGHT? 35:07.905 --> 35:10.508 align:left position:15%,start line:83% size:75% AND WE NEED TO BE DOING THAT, BECAUSE LOOK AT THAT TIME 35:10.608 --> 35:12.110 align:left position:25%,start line:89% size:65% STATISTIC ABOVE THAT. 35:12.210 --> 35:15.146 align:left position:15%,start line:83% size:75% 90% OF PEOPLE THAT ARE ADULTS THAT HAVE A SUBSTANCE USE 35:15.246 --> 35:18.683 align:left position:10%,start line:83% size:80% DISORDER STARTED BEFORE THE AGE OF 18. 35:18.783 --> 35:20.651 align:left position:22.5%,start line:89% size:67.5% 50% STARTED BEFORE 15. 35:20.751 --> 35:22.153 align:left position:10%,start line:89% size:80% SO WE DO NEED TO BE DOING THIS. 35:22.253 --> 35:24.989 align:left position:10%,start line:83% size:80% WE NEED TO TALK TO OUR KIDS, OUR GRANDKIDS, ANYBODY THAT WILL 35:25.089 --> 35:27.592 align:left position:12.5%,start line:83% size:77.5% LISTEN, AND WE NEED TO BE TALKING TO ALL OF OUR PATIENTS 35:27.692 --> 35:30.161 align:left position:17.5%,start line:83% size:72.5% AND TELLING THEM TO TALK TO THEIR KIDS. 35:30.261 --> 35:33.965 align:left position:10%,start line:83% size:80% 50% REDUCTION IN STARTING DRUGS OR USING DRUGS. 35:34.065 --> 35:36.834 align:left position:10%,start line:83% size:80% BUT INTERESTINGLY, SO THEN THEY GO AND TALK TO THOSE KIDS AND 35:36.934 --> 35:39.337 align:left position:12.5%,start line:83% size:77.5% THEY SAY HEY, DID SOMEONE TALK TO YOU ABOUT DRUGS? 35:39.437 --> 35:40.805 align:left position:17.5%,start line:89% size:72.5% YEAH, YOU KNOW, MY MOM DID. 35:40.905 --> 35:43.141 align:left position:12.5%,start line:83% size:77.5% AND THEY SAY WELL WHAT DID SHE SAY? 35:43.241 --> 35:49.113 align:left position:10%,start line:83% size:80% AND THEY SAY WELL, SHE TALKED TO ME ABOUT COCAINE AND METH AND 35:49.213 --> 35:50.348 align:left position:40%,start line:89% size:50% HEROINE. 35:50.448 --> 35:53.784 align:left position:10%,start line:83% size:80% ALMOST NEVER DO WE TALK TO THEM ABOUT PRESCRIPTION DRUGS. 35:53.885 --> 35:57.722 align:left position:10%,start line:83% size:80% BUT YET THAT IS THE MOST COMMON WAY THAT YOU GET TO HEROINE. 35:57.822 --> 36:00.258 align:left position:25%,start line:89% size:65% AND I GET IT, RIGHT? 36:00.358 --> 36:03.027 align:left position:15%,start line:83% size:75% SOMEBODY WITH A WHITE COAT ON WROTE THE PRESCRIPTION AND 36:03.127 --> 36:06.164 align:left position:12.5%,start line:83% size:77.5% HANDED IT TO YOU AND YOU WENT AND PICKED IT UP FROM SOMEBODY 36:06.264 --> 36:07.832 align:left position:12.5%,start line:89% size:77.5% IN A WHITE COAT AT A PHARMACY. 36:07.932 --> 36:09.367 align:left position:30%,start line:89% size:60% IT MUST BE SAFE. 36:09.467 --> 36:10.434 align:left position:35%,start line:89% size:55% BUT IT'S NOT. 36:10.535 --> 36:11.769 align:left position:42.5%,start line:89% size:47.5% RIGHT? 36:11.869 --> 36:14.105 align:left position:10%,start line:83% size:80% SO WE REALLY NEED TO TALK TO OUR KIDS ABOUT DRUGS, BUT WE NEED TO 36:14.205 --> 36:16.040 align:left position:10%,start line:83% size:80% SPECIFICALLY TALK TO THEM ABOUT PRESCRIPTION DRUGS. 36:16.140 --> 36:20.378 align:left position:10%,start line:83% size:80% NOT USING THEM OR ABUSING THEM WHEN THEY GO TO THESE PARTIES OR 36:20.478 --> 36:22.380 align:left position:20%,start line:89% size:70% BUYING THEM FROM OTHERS. 36:22.480 --> 36:28.953 align:left position:22.5%,start line:83% size:67.5% SO WHAT ARE SOME OF THE ALTERNATIVES? 36:29.053 --> 36:30.154 align:left position:32.5%,start line:89% size:57.5% WHAT CAN WE DO? 36:30.254 --> 36:37.261 align:left position:10%,start line:83% size:80% TALK ABOUT ACUTE PAIN, THERE'S A SIT MINH FIN, IBUPROFEN, 36:37.361 --> 36:38.563 align:left position:22.5%,start line:89% size:67.5% OPIATES FOR ACUTE PAIN. 36:38.663 --> 36:40.932 align:left position:15%,start line:83% size:75% YOU MIGHT GATHER I'M A LITTLE DOWN ON THEM. 36:41.032 --> 36:43.467 align:left position:12.5%,start line:83% size:77.5% THERE'S TOPICAL ACTS AND THIS REALLY DOES WORK WHEN YOU HAVE 36:43.568 --> 36:45.870 align:left position:10%,start line:83% size:80% ACUTE PAIN, ICE, HEAT, PHYSICAL THERAPY. 36:45.970 --> 36:46.304 align:left position:37.5%,start line:89% size:52.5% THEY WORK. 36:46.404 --> 36:47.071 align:left position:37.5%,start line:89% size:52.5% ALL RIGHT? 36:47.171 --> 36:48.472 align:left position:15%,start line:89% size:75% SO WHAT ARE THE SIDE EFFECTS? 36:48.573 --> 36:52.777 align:left position:10%,start line:83% size:80% YOU HAVE SOMEBODY THAT'S TAKING SOME TYLENOL AND SOMETIMES IF 36:52.877 --> 36:55.479 align:left position:22.5%,start line:83% size:67.5% YOU DON'T TAKE IT RIGHT [ NO AUDIO ] 36:55.580 --> 36:59.917 align:left position:20%,start line:83% size:70% WHAT ABOUT THESE NSAIDS, IBUPROFEN, ALEVE, MOTRIN? 37:00.017 --> 37:03.454 align:left position:10%,start line:83% size:80% WELL, IT CAN CAUSE YOU TO HAVE A LITTLE BIT OF BLEEDING IN YOUR 37:03.554 --> 37:03.955 align:left position:45%,start line:89% size:45% GUT. 37:04.055 --> 37:05.289 align:left position:30%,start line:89% size:60% THAT SOUNDS BAD. 37:05.389 --> 37:07.725 align:left position:10%,start line:83% size:80% AND IT CAN AFFECT YOUR KIDNEY IF YOU HAVE KIDNEY PROBLEMS AND IT 37:07.825 --> 37:09.527 align:left position:10%,start line:83% size:80% CAN MAKE YOUR BLOOD PRESSURE GO UP. 37:09.627 --> 37:11.362 align:left position:12.5%,start line:83% size:77.5% THOSE ALL SOUND KIND OF SCARY, RIGHT? 37:11.462 --> 37:13.898 align:left position:15%,start line:83% size:75% WHAT ARE THE SIDE EFFECTS OF OPIATES FOR TAKING THEM FOR 37:13.998 --> 37:15.166 align:left position:37.5%,start line:89% size:52.5% ACUTE PAIN? 37:15.266 --> 37:18.869 align:left position:10%,start line:83% size:80% WELL, THEY'RE MENTALLY IMPAIRING IT DELAYS RECOVERY. 37:18.970 --> 37:21.872 align:left position:10%,start line:83% size:80% AND I'M OUT THERE TRYING TO TALK TO ALL THE SURGEONS ABOUT THIS. 37:21.973 --> 37:25.543 align:left position:15%,start line:83% size:75% DOW THE SAME SUR JOB ON TWO GROUPS, ONE YOU GIVE OPIATES 37:25.643 --> 37:28.679 align:left position:10%,start line:83% size:80% WHEN THEY GO OPEN AND THE OTHERS YOU DON'T, THE ONES WHO GET THE 37:28.779 --> 37:31.782 align:left position:10%,start line:83% size:80% OPIATES, THEY HAVE DELAYED RECOVERY AND DELAY WOUND HEALING 37:31.882 --> 37:32.683 align:left position:35%,start line:89% size:55% THAT'S CRAZY. 37:32.783 --> 37:34.252 align:left position:20%,start line:83% size:70% WE DON'T KNOW WHY, BUT IT HAPPENS. 37:34.352 --> 37:38.155 align:left position:15%,start line:83% size:75% SO IT INCREASES MEDICAL COSTS WHEN YOU GIVE THEM OP YACHTS, 37:38.256 --> 37:40.725 align:left position:20%,start line:89% size:70% THE OPIATE HYPERALGESIA. 37:40.825 --> 37:44.562 align:left position:15%,start line:83% size:75% YOU CAN START DEVELOPING PAIN FROM THE MEDICINE. 37:44.662 --> 37:47.131 align:left position:10%,start line:83% size:80% IT DOUBLES YOUR CHANCE OF GOING OUT ON PERMANENT DISABILITY IN 37:47.231 --> 37:48.633 align:left position:20%,start line:89% size:70% AS LITTLE AS SEVEN DAYS. 37:48.733 --> 37:50.234 align:left position:27.5%,start line:89% size:62.5% IT INCREASES FALLS. 37:50.334 --> 37:53.571 align:left position:10%,start line:83% size:80% IT TREATS DEPRESSION SHORT TERM BUT MAKES IT WORSE LONG TERM, 37:53.671 --> 37:54.538 align:left position:42.5%,start line:89% size:47.5% RIGHT? 37:54.639 --> 37:56.073 align:left position:15%,start line:83% size:75% AND THEN THIS BRAIN CHANGING BUSINESS. 37:56.173 --> 37:57.375 align:left position:10%,start line:89% size:80% I'VE GOT TO TELL YOU ABOUT THIS. 37:57.475 --> 38:01.012 align:left position:12.5%,start line:83% size:77.5% THERE'S A SURGEON IN TEXAS, HE DOES A CERTAIN KIND OF NECK 38:01.112 --> 38:02.280 align:left position:40%,start line:89% size:50% SURGERY. 38:02.380 --> 38:05.349 align:left position:10%,start line:83% size:80% AND HIS USUAL IS YOU COME OUT OF SURGERY AND YOU GET ON I.V. 38:05.449 --> 38:08.152 align:left position:12.5%,start line:83% size:77.5% OPIATES AND YOU GET OPIATES BY MOUTH AND THEN YOU GO HOME AND 38:08.252 --> 38:11.055 align:left position:10%,start line:83% size:80% BACK THEN HE WOULD GIVE 30 DAYS OF OPIATES. 38:11.155 --> 38:14.158 align:left position:15%,start line:83% size:75% AND SO HE HAD HIS USUAL GROUP AND THEN HE HAD ANOTHER GROUP 38:14.258 --> 38:17.061 align:left position:12.5%,start line:83% size:77.5% THAT WHEN THEY WENT HOME, THEY DIDN'T GET ANY OPIATES AT ALL. 38:17.161 --> 38:20.998 align:left position:10%,start line:83% size:80% AND AT 30 DAYS HE SCANNED THEIR BRAINS AND HE COULD SEE BRAIN 38:21.098 --> 38:24.702 align:left position:12.5%,start line:83% size:77.5% CHANGES IN THE PEOPLE THAT GOT THE OP YACHTS. 38:24.802 --> 38:25.903 align:left position:35%,start line:89% size:55% - -- OPIATES. 38:26.003 --> 38:28.739 align:left position:22.5%,start line:83% size:67.5% THAT REALLY SCARED HIM, CONCERNED HIM. 38:28.839 --> 38:32.443 align:left position:10%,start line:83% size:80% HE TOOK THEM OFF THEIR OPIATES AND WAITED SIX MONTHS AND SKEIN 38:32.543 --> 38:35.913 align:left position:10%,start line:83% size:80% SCANNED THEIR BRAINS AGAIN, AND THOSE CHANGES WERE STILL THERE. 38:36.013 --> 38:39.317 align:left position:17.5%,start line:83% size:72.5% SO OPIATES CAN CAUSE BRAIN CHANGES AND SOMETIMES THOSE 38:39.417 --> 38:41.252 align:left position:15%,start line:89% size:75% BRAIN CHANGES ARE PERMANENT. 38:41.352 --> 38:45.723 align:left position:17.5%,start line:83% size:72.5% AND THEN OPIATES CAN CAUSE ADDICTION. 38:45.823 --> 38:47.024 align:left position:27.5%,start line:89% size:62.5% SO WHAT CAN WE DO? 38:47.124 --> 38:51.762 align:left position:15%,start line:83% size:75% WE CAN -- THIS IS A STUDY OF OVER 40,000 PATIENTS BUT THEY 38:51.862 --> 38:53.030 align:left position:15%,start line:89% size:75% WEREN'T HEAD-TO-HEAD STUDIES. 38:53.130 --> 38:54.265 align:left position:17.5%,start line:89% size:72.5% THEY WERE INDIVIDUAL ONES. 38:54.365 --> 38:57.168 align:left position:15%,start line:83% size:75% AND IT WAS ONE HOUR AFTER SURGERY THEY GAVE ONE OF THE 38:57.268 --> 38:58.469 align:left position:22.5%,start line:89% size:67.5% FOLLOWING MEDICATIONS. 38:58.569 --> 39:01.405 align:left position:12.5%,start line:83% size:77.5% AND IF YOU HAD A 50% REDUCTION IN YOUR PAIN, THEN THAT WAS 39:01.505 --> 39:02.973 align:left position:30%,start line:89% size:60% CONSIDERED A WIN. 39:03.074 --> 39:04.275 align:left position:22.5%,start line:89% size:67.5% PEOPLE FELT SATISFIED. 39:04.375 --> 39:07.278 align:left position:12.5%,start line:83% size:77.5% SO YOU GIVE ONE IBUPROFEN OVER THE COUNTER, 200 MILLIGRAMS. 39:07.378 --> 39:10.981 align:left position:10%,start line:83% size:80% AND 37 OUT OF ONE HIN PEOPLE, ONE HOUR AFTER SURGERY SAID I'VE 39:11.082 --> 39:14.051 align:left position:15%,start line:83% size:75% GOT 50% PAIN RELIEF FROM ONE IBUPROFEN. 39:14.151 --> 39:15.319 align:left position:27.5%,start line:89% size:62.5% THAT'S PRETTY GOOD. 39:15.419 --> 39:16.821 align:left position:27.5%,start line:89% size:62.5% TYLENOL, IT WAS 28. 39:16.921 --> 39:20.624 align:left position:15%,start line:83% size:75% THEY INCREASED -- DOUBLED THE IBUPROFEN AND GOT TO 40. 39:20.725 --> 39:24.729 align:left position:15%,start line:83% size:75% AND IBUPROFEN 600 AND 800 IT WENT UP TO ABOUT 41 OR 42. 39:24.829 --> 39:28.032 align:left position:10%,start line:83% size:80% SO IT DOESN'T GO UP MUCH MORE, BUT YOU DO START TO PICK UP THE 39:28.132 --> 39:30.601 align:left position:10%,start line:83% size:80% SIDE EFFECTS SO WE PROBABLY SHOULD STAY ON THE LOWER END OF 39:30.701 --> 39:31.335 align:left position:32.5%,start line:89% size:57.5% THE IBUPROFEN. 39:31.435 --> 39:38.142 align:left position:20%,start line:89% size:70% BUT WHAT ABOUT OXYCODONE. 39:38.242 --> 39:39.043 align:left position:25%,start line:89% size:65% 15 MILLIGRAMS, OKAY? 39:39.143 --> 39:41.278 align:left position:22.5%,start line:83% size:67.5% IT HAS F.D.A. APPROVED [ NO AUDIO ] 39:41.379 --> 39:43.180 align:left position:35%,start line:89% size:55% LOOK AT THAT. 39:43.280 --> 39:47.017 align:left position:10%,start line:83% size:80% ONLY 21 OUT OF 100 PEOPLE GOT 50 % PAIN RELIEF OR MORE. 39:47.118 --> 39:50.721 align:left position:10%,start line:83% size:80% BUT THEN THEY -- PHARMACEUTICAL INDUSTRY SAID WOW, OUR MEDICINES 39:50.821 --> 39:54.225 align:left position:12.5%,start line:83% size:77.5% NOT WORKING VERY WELL, SO THEY ADDED TILE NOT TO IT AND MADE 39:54.325 --> 39:56.527 align:left position:10%,start line:83% size:80% PERCOCET AND GOT BACK UP TO THE 37, RIGHT? 39:56.627 --> 39:59.530 align:left position:10%,start line:83% size:80% BUT WHAT HAPPENS IF YOU TOOK ONE TILE TYLENOL AND ONE IBUPROFEN, 39:59.630 --> 40:03.667 align:left position:10%,start line:83% size:80% AND THIS IS THE KEY, TOGETHER AT THE SAME TIME ONE HOUR AFTER 40:03.768 --> 40:06.904 align:left position:25%,start line:89% size:65% SURGE JI -- SURGERY? 40:07.004 --> 40:11.142 align:left position:10%,start line:83% size:80% IN 62 OUT OF 100 PEOPLE GOT 50% PAIN RELIEF. 40:11.242 --> 40:13.544 align:left position:10%,start line:83% size:80% SO DO YOU THINK THIS IS WHAT I'M TELLING MY PATIENTS TO USE? 40:13.644 --> 40:14.812 align:left position:45%,start line:89% size:45% YEAH. 40:14.912 --> 40:17.948 align:left position:10%,start line:83% size:80% IS THIS WHAT I WOULD WANT MY KID TO GET IF HE WERE INJURED OR 40:18.048 --> 40:18.349 align:left position:45%,start line:89% size:45% HURT? 40:18.449 --> 40:18.883 align:left position:40%,start line:89% size:50% FOR SURE. 40:18.983 --> 40:20.184 align:left position:30%,start line:89% size:60% FOR TWO REASONS. 40:20.284 --> 40:22.520 align:left position:10%,start line:83% size:80% ONE, IS IT WORKS THE BEST, AND THE OTHER IS IT'S NOT ADDICTIVE. 40:22.620 --> 40:25.556 align:left position:12.5%,start line:83% size:77.5% SO THIS IS WHAT WE'RE TEACHING THE NEXT GENERATION OF FOLKS. 40:25.656 --> 40:29.860 align:left position:12.5%,start line:83% size:77.5% THIS IS WHAT AGAIN THE REST OF THE WORLD IS ACTUALLY USING 40:29.960 --> 40:34.899 align:left position:30%,start line:89% size:60% INCLUDING EUROPE. 40:34.999 --> 40:38.803 align:left position:20%,start line:83% size:70% SO THEN WE HAD OUR FIRST HEAD-TO-HEAD TRIAL IN THE 40:38.903 --> 40:42.139 align:left position:10%,start line:83% size:80% EMERGENCY DEPARTMENT AND TYLENOL AND IBUPROFEN DID JUST AS GOOD 40:42.239 --> 40:43.474 align:left position:27.5%,start line:89% size:62.5% AS THE PERK E SET. 40:43.574 --> 40:46.143 align:left position:10%,start line:83% size:80% AND KIDNEY STONES, I DON'T KNOW IF ANYBODY HAS EVER HAD A KIDNEY 40:46.243 --> 40:47.445 align:left position:42.5%,start line:89% size:47.5% STONE. 40:47.545 --> 40:49.613 align:left position:10%,start line:83% size:80% IT'S SUPPOSED TO BE SOME OF THE MORE INTENSE PAIN THAT YOU CAN 40:49.713 --> 40:58.088 align:left position:10%,start line:83% size:80% ER EXPERIENCE, AND USING I.V. IN SEDZ LIKE IBUPROFEN, COUSIN IS 40:58.189 --> 41:05.629 align:left position:10%,start line:83% size:80% CALLED TORADOL, VERSE -- VERSUS AN OPIOID THEY HAD EQUAL 41:05.729 --> 41:09.400 align:left position:15%,start line:83% size:75% EFFICACY AND TREATMENT BUT OPIOID HAD MORE SIDE EFFECTS. 41:09.500 --> 41:12.236 align:left position:10%,start line:83% size:80% POSTOP PAIN, INTERESTINGLY THEY DID THIS STUDY WHERE THEY HAD 41:12.336 --> 41:14.505 align:left position:15%,start line:83% size:75% THIS MAJOR SURGERY WHERE THEY SPLIT THE PEOPLE OPEN AND CUT 41:14.605 --> 41:16.207 align:left position:17.5%,start line:89% size:72.5% OUT A PIECE OF THEIR BOWEL. 41:16.307 --> 41:17.675 align:left position:22.5%,start line:89% size:67.5% SO IT'S COLON SURGERY. 41:17.775 --> 41:18.943 align:left position:25%,start line:89% size:65% IT'S A MAJOR SURGERY. 41:19.043 --> 41:25.516 align:left position:10%,start line:83% size:80% AND USUALLY THE USUAL CARE IS IS THAT YOU COME OUT OF SURGERY 41:25.616 --> 41:28.319 align:left position:25%,start line:89% size:65% AND GET A P-C-A PUMP. 41:28.419 --> 41:32.289 align:left position:10%,start line:83% size:80% EVERY 15 MINUTES YOU CAN PUSH IT TO GET OPIATES TO HELP WITH PAIN 41:32.389 --> 41:35.993 align:left position:10%,start line:83% size:80% WHAT THEY DECIDED TO DO IS WHEN YOU COME OUT OF SURGERY THEY'RE 41:36.093 --> 41:38.596 align:left position:15%,start line:83% size:75% GOING TO TRY NOT TO GIVE YOU OPIATES AT ALL AND TRY THESE 41:38.696 --> 41:39.864 align:left position:35%,start line:89% size:55% OTHER THINGS. 41:39.964 --> 41:41.765 align:left position:15%,start line:83% size:75% ONE OF IF THINGS THEY DID IS THEY TALKED TO THE PATIENTS 41:41.866 --> 41:45.135 align:left position:10%,start line:83% size:80% BEFORE THE SURGERY FOR UP TO 30 MINUTES ABOUT WHAT THE PAIN WAS 41:45.236 --> 41:47.671 align:left position:10%,start line:83% size:80% GOING TO BE LIKE WHEN THEY WOKE UP. 41:47.771 --> 41:49.840 align:left position:35%,start line:83% size:55% AND THEY SAID [ NO AUDIO ] 41:49.940 --> 41:50.808 align:left position:25%,start line:89% size:65% HAVING MAJOR SURGERY. 41:50.908 --> 41:52.977 align:left position:10%,start line:83% size:80% WHEN YOU WAKE UP YOU'RE GOING TO HAVE PAIN. 41:53.077 --> 41:55.145 align:left position:10%,start line:83% size:80% AND WE'RE GOING TO TRY TO DO ALL THESE THINGS FOR YOU. 41:55.246 --> 41:57.815 align:left position:10%,start line:83% size:80% AND WE'LL GIVE YOU THIS KIND OF MEDICINE AND THAT KIND OF 41:57.915 --> 42:00.451 align:left position:15%,start line:83% size:75% MEDICINE AND GIVE YOU HEATING PAD. 42:00.551 --> 42:04.622 align:left position:10%,start line:83% size:80% WE'LL WALK YOU AND DO ALL THESE OTHER THINGS. 42:04.722 --> 42:07.424 align:left position:10%,start line:83% size:80% AND 50% OF THE PEOPLE WHEN THEY WOKE UP, THEY SAID HEY, THE PAIN 42:07.525 --> 42:10.628 align:left position:10%,start line:83% size:80% IS NOT AS BAD AS I WAS EXPECTING AND THINK ABOUT THAT, IF YOU'RE 42:10.728 --> 42:15.432 align:left position:12.5%,start line:83% size:77.5% THE NURSE OR THE DOCTOR TRYING TO TREAT THAT PATIENT AND THEY 42:15.533 --> 42:22.473 align:left position:10%,start line:83% size:80% THINK HEY, THIS ISN'T AS BAD AS I WAS EX -- PECTING YOU'RE IN 42:22.573 --> 42:25.910 align:left position:10%,start line:83% size:80% PRETTY GOOD SHAPE IN TRYING TO GIVE THEM TYLENOL AND A HEATING 42:26.010 --> 42:27.211 align:left position:45%,start line:89% size:45% BAD. 42:27.311 --> 42:28.646 align:left position:15%,start line:83% size:75% IF YOU'RE IN THE OTHER WING, WHICH IS MOST OF AMERICA, AND 42:28.746 --> 42:31.282 align:left position:12.5%,start line:83% size:77.5% YOU WAKE UP AND GO OH, MY GOD, THAT IS LOT OF PAIN. 42:31.382 --> 42:35.819 align:left position:10%,start line:83% size:80% DIDN'T THE DOCTOR OR NURSE TELL YOU YOU WERE GOING TO BE IN PAIN 42:35.920 --> 42:37.021 align:left position:47.5%,start line:89% size:42.5% NO. 42:37.121 --> 42:38.989 align:left position:10%,start line:83% size:80% IF YOU'RE EXPECTING 0 OUT OF 10 PAIN YOU'RE GOING TO BE 42:39.089 --> 42:40.824 align:left position:12.5%,start line:83% size:77.5% CALLING FOR THOSE OPIATES OVER AND OVER AGAIN. 42:40.925 --> 42:42.726 align:left position:10%,start line:89% size:80% THIS HAS DONE APLAYSING THINGS. 42:42.826 --> 42:46.030 align:left position:17.5%,start line:83% size:72.5% IT'S REDUCED THE AMOUNT OF OPIATES THEY'RE GIVING FOR 42:46.130 --> 42:48.465 align:left position:17.5%,start line:83% size:72.5% CERTAIN SURGERIES AND WE'RE DOING THIS AT HOSPITALS IN 42:48.566 --> 42:49.466 align:left position:22.5%,start line:89% size:67.5% WESTERN NORTH CAROLINA. 42:49.567 --> 42:51.468 align:left position:10%,start line:83% size:80% REDUCED THE NUMBER OF OPIATES BY 30%. 42:51.569 --> 42:55.940 align:left position:10%,start line:83% size:80% LOOK AT THIS, HALVED THE COMPLICATIONS, THE PATIENTS ARE 42:56.040 --> 42:59.510 align:left position:15%,start line:83% size:75% LEAVING THE HOSPITAL TWO DAYS EARLY AND SAVING $7,000 PER 42:59.610 --> 43:00.578 align:left position:40%,start line:89% size:50% SURGERY. 43:00.678 --> 43:01.912 align:left position:12.5%,start line:83% size:77.5% SO WE'VE BEEN DOING THIS WRONG FOR 30 YEARS. 43:02.012 --> 43:09.587 align:left position:10%,start line:83% size:80% BUT WE'RE TRYING TO GET BACK INTO IT AND DO IT THE RIGHT WAY. 43:09.687 --> 43:12.323 align:left position:15%,start line:83% size:75% [ NO AUDIO ] END OF LIFE, HOSPICE CARE WE 43:12.423 --> 43:15.292 align:left position:10%,start line:83% size:80% HAVE VERY GOOD DATA THAT SAYS THESE MEDICATIONS CAN BE HELPFUL 43:15.392 --> 43:20.264 align:left position:12.5%,start line:83% size:77.5% TO HELP WITH PAIN AND AT THE LAST FEW MOMENTS OF LIFE. THAT 43:20.364 --> 43:21.932 align:left position:17.5%,start line:89% size:72.5% THEY DON'T EX P TEND LIFE. 43:22.032 --> 43:25.636 align:left position:10%,start line:83% size:80% AND THEN IN ACUTE SEVERE TRAUMA FOR A SHORT PERIOD OF TIME, 43:25.736 --> 43:30.841 align:left position:10%,start line:83% size:80% PROBABLY THREE DAYS OR LESS, BUT DEFINITELY SEVEN DAYS OR LESS. 43:30.941 --> 43:33.544 align:left position:15%,start line:83% size:75% BUT THERE'S NO DATA THAT SAYS THESE MEDICATIONS ARE HELPFUL 43:33.644 --> 43:37.881 align:left position:12.5%,start line:89% size:77.5% FOR A CHRONIC NON-CANCER PAIN. 43:37.982 --> 43:41.885 align:left position:12.5%,start line:83% size:77.5% SO WHY DO PEOPLE START ABUSING OPIATES? 43:41.986 --> 43:46.090 align:left position:10%,start line:83% size:80% WELL A PERSON CAN BEGIN BY MISUSING THEM AND PROVIDERS WILL 43:46.190 --> 43:47.324 align:left position:40%,start line:89% size:50% SEE THIS. 43:47.424 --> 43:49.393 align:left position:15%,start line:83% size:75% WE'LL HAVE SOMEBODY WHO'S ON CHRONIC OPIATES AND THEIR 43:49.493 --> 43:52.663 align:left position:10%,start line:83% size:80% MEDICINE IS SUPPOSED TO LAST 30 DAYS, THAT'S WHY I WRITE IT FOR 43:52.763 --> 43:57.101 align:left position:10%,start line:83% size:80% 30 DAYS AND AT 27 DAYS THEY CALL AND SAY HEY, I'M OUT OF MY MEDS 43:57.201 --> 44:01.905 align:left position:12.5%,start line:83% size:77.5% AND THAT CAN HAPPEN EVERY ONCE IN A WHILE, THE DOG ATE IT OR 44:02.006 --> 44:05.242 align:left position:15%,start line:83% size:75% WHATEVER, THE FOLKS THAT THAT HAPPENS OVER AND OVER AGAIN. 44:05.342 --> 44:08.145 align:left position:10%,start line:83% size:80% THEY'RE MISUSING THEIR MEDICINES THEY ARE TAKING THEIR MEDICINES 44:08.245 --> 44:10.581 align:left position:12.5%,start line:83% size:77.5% FOR WHAT THEY PERCEIVE AS MORE PAIN OR OTHER REASONS. 44:10.681 --> 44:13.617 align:left position:15%,start line:83% size:75% THEY CAN USE THE MEDICINES TO COPE WITH EMOTIONAL ISSUES. 44:13.717 --> 44:18.355 align:left position:10%,start line:83% size:80% STUDY CAME OUT LAST YEAR, 16% OF THE ADULTS IN THE UNITED STATES 44:18.455 --> 44:20.924 align:left position:17.5%,start line:89% size:72.5% HAVE DEPRESSION OR ANXIETY. 44:21.025 --> 44:23.260 align:left position:10%,start line:83% size:80% I FELT WOW, THAT'S A BIG NUMBER BUT OKAY. 44:23.360 --> 44:27.097 align:left position:15%,start line:83% size:75% THEY CONSUMED 51% OF ALL THE OPIATES WE WROTE LAST YEAR. 44:27.197 --> 44:31.368 align:left position:12.5%,start line:83% size:77.5% SO MAYBE THEY ALL HAVE CHRONIC PAIN, BUT MAYBE THEY'RE USING 44:31.468 --> 44:35.105 align:left position:15%,start line:83% size:75% THE MEDICATIONS FOR OTHER REASONS, TO TRY TO HELP COPE 44:35.205 --> 44:36.440 align:left position:10%,start line:83% size:80% WITH OTHER THINGS THAT ARE GOING ON. 44:36.540 --> 44:40.310 align:left position:10%,start line:83% size:80% AND WE HAVE TO ACKNOWLEDGE THAT AS PROVIDERS AND FOLKS THAT ARE 44:40.411 --> 44:41.478 align:left position:20%,start line:89% size:70% HELPING PEOPLE OUT THERE. 44:41.578 --> 44:44.848 align:left position:10%,start line:83% size:80% AND THEN MAYBE THEY'RE EXPERIMENTING WITH THE OPIATES. 44:44.948 --> 44:46.150 align:left position:20%,start line:89% size:70% BUT WHY DO THEY CONTINUE? 44:46.250 --> 44:48.752 align:left position:10%,start line:83% size:80% SO ONCE YOU'RE ON YOUR OPIATES AND YOU'VE BEEN TAKING THEM FOR 44:48.852 --> 44:51.321 align:left position:12.5%,start line:83% size:77.5% A WHILE, WHETHER YOU'RE TAKING THEM CORRECTLY AND IT'S BEEN 44:51.422 --> 44:54.858 align:left position:10%,start line:83% size:80% YEARS OR YOU'RE STARTING TO MISUSING -- USE THEM AND YOU'RE 44:54.958 --> 44:59.897 align:left position:10%,start line:83% size:80% TAKING WAY TOO MUCH, WELL, THEY FEAR WITHDRAWAL. 44:59.997 --> 45:03.634 align:left position:10%,start line:83% size:80% THEY -- IF THEY'VE EVER BEEN, SAY, ABUSING OPIATES FOR A WHILE 45:03.734 --> 45:07.004 align:left position:15%,start line:83% size:75% AND THEN THEY RAN OUT OR THEY COULDN'T GET ANYMORE, FOR 45:07.104 --> 45:09.840 align:left position:10%,start line:83% size:80% WHATEVER REASON, THEY'VE BEEN IN WITHDRAWAL AND THEY FEAR IT. 45:09.940 --> 45:11.842 align:left position:15%,start line:83% size:75% SO WHAT DOES WITHDRAWAL FEEL LIKE? 45:11.942 --> 45:14.945 align:left position:15%,start line:83% size:75% IT REALLY FEELS LIKE THE FLU TIMES TEN. 45:15.045 --> 45:16.947 align:left position:10%,start line:83% size:80% AND THEY DON'T WANT TO BE THERE ANYMORE. 45:17.047 --> 45:19.883 align:left position:12.5%,start line:83% size:77.5% AND THE OTHER THING, THE OTHER REASON THAT THEY CONTINUE, IS 45:19.983 --> 45:22.152 align:left position:20%,start line:89% size:70% BECAUSE OF THE CRAVINGS. 45:22.252 --> 45:27.791 align:left position:10%,start line:83% size:80% AND WHEN WE FREET -- TREAT FOLKS WITH BEHAVIORAL THERAPY AND WITH 45:27.891 --> 45:30.928 align:left position:15%,start line:83% size:75% MEDICINES IF THAT'S WHAT THEY USE FOR THEIR OPIATE USE 45:31.028 --> 45:34.565 align:left position:10%,start line:83% size:80% DISORDER, WE'VE GOT TO TAKE CARE OF TWO THINGS. 45:34.665 --> 45:35.799 align:left position:10%,start line:83% size:80% THEY HAVE TO NOT FEAR WITHDRAWAL , SO THEY EITHER 45:35.899 --> 45:38.435 align:left position:15%,start line:83% size:75% HAVING TO GET THROUGH THE WITHDRAWAL PHASE AND BE DONE 45:38.535 --> 45:43.040 align:left position:10%,start line:83% size:80% WITH IT OR WE HAVE TO GIVE THEM MEDICATION SO THEY DON'T 45:43.140 --> 45:44.308 align:left position:40%,start line:89% size:50% WITHDRAW. 45:44.408 --> 45:46.343 align:left position:10%,start line:83% size:80% THE OTHER THING YOU HAVE TO TAKE CARE OF IS THE THE CAVINGS. 45:46.443 --> 45:49.146 align:left position:15%,start line:83% size:75% I'VE BEEN SITTING IN FRONT OF SOMEBODY WITH FULL-BLOWN 45:49.246 --> 45:53.550 align:left position:15%,start line:83% size:75% WITHDRAWAL AND THEIR NOSE IS RUNNING AND EYES ARE WATERING 45:53.650 --> 45:56.420 align:left position:10%,start line:83% size:80% AND THEY HAVE NAUSEA, THEIR MUSCLES HURT, THEIR JOINTS HURT, 45:56.520 --> 45:58.922 align:left position:12.5%,start line:83% size:77.5% AND I'M TRYING TO TALK TO THEM ABOUT THERAPY AND HOW I THINK 45:59.022 --> 46:03.260 align:left position:12.5%,start line:83% size:77.5% THIS IS GOING TO REALLY HELP THEM, AND IT'S REALLY HARD FOR 46:03.360 --> 46:03.627 align:left position:32.5%,start line:89% size:57.5% THEM TO ENGAGE. 46:03.727 --> 46:04.595 align:left position:42.5%,start line:89% size:47.5% RIGHT? 46:04.695 --> 46:05.863 align:left position:12.5%,start line:83% size:77.5% SO WE HAVE TO TAKE CARE OF TWO THINGS. 46:05.963 --> 46:08.398 align:left position:15%,start line:83% size:75% WE HAVE TO TAKE CARE OF THE CRAVINGS AND WE HAVE TO TAKE 46:08.499 --> 46:11.235 align:left position:10%,start line:83% size:80% CARE OF THE WITHDRAWAL SO THEY CAN DO THE THERAPY, THEY CAN GET 46:11.335 --> 46:15.906 align:left position:10%,start line:83% size:80% BACK TO WORK, IF THEIR KIDS ARE IN FOSTER CARE SO THEY CAN GET 46:16.006 --> 46:17.107 align:left position:32.5%,start line:89% size:57.5% THE KIDS BACK. 46:17.207 --> 46:21.078 align:left position:10%,start line:83% size:80% SO THERE'S REALLY JUST FOUR WAYS THAT WE TREAT OPIATE USE 46:21.178 --> 46:26.383 align:left position:12.5%,start line:83% size:77.5% DISORDER IN THE UNITED STATE% DETOX AND ASHES NENS. 46:26.483 --> 46:28.752 align:left position:10%,start line:83% size:80% IT'S THE NUMBER ONE WAY WE TREAT IT IN TUSES AND IN NORTH 46:28.852 --> 46:30.020 align:left position:40%,start line:89% size:50% CAROLINA. 46:30.120 --> 46:33.791 align:left position:10%,start line:83% size:80% AND THEN THERE'S TWO AGONIST MEDICINES, AND THEN THERE'S THIS 46:33.891 --> 46:39.062 align:left position:12.5%,start line:83% size:77.5% MEDICINE THAT'S CALL AN ANTAGONIST MEDICINE, MEL TREKS 46:39.163 --> 46:44.067 align:left position:10%,start line:83% size:80% ZONE AND YOU CAN TAKE IT BY A PILL ONCE A DAY OR AN INJECTION 46:44.168 --> 46:45.169 align:left position:35%,start line:89% size:55% ONCE A MONTH. 46:45.269 --> 46:46.503 align:left position:30%,start line:89% size:60% HERE'S THE DATA. 46:46.603 --> 46:49.606 align:left position:20%,start line:83% size:70% THESE WAVY LINES ARE HERE BECAUSE WE DON'T HAVE ANY 46:49.706 --> 46:50.808 align:left position:25%,start line:89% size:65% HEAD-TO-HEAD TRIALS. 46:50.908 --> 46:55.112 align:left position:10%,start line:83% size:80% BUT IF YOU GO THROUGH DETOX AND ABSTINENCE, WHETHER IT'S 46:55.212 --> 46:58.916 align:left position:12.5%,start line:83% size:77.5% INPATIENT 14 DAYS, 28 DAYS, 90 DAYS. 46:59.016 --> 47:02.286 align:left position:10%,start line:83% size:80% AT SIX MONTHS TO A YEAR, 90% OF PEOPLE ARE USING AGAIN. 47:02.386 --> 47:03.453 align:left position:37.5%,start line:89% size:52.5% ALL RIGHT? 47:03.554 --> 47:07.457 align:left position:10%,start line:83% size:80% BUT YOU CAN SEE WITH THE MEDICINES AND WHY THE MEDICINES 47:07.558 --> 47:11.628 align:left position:17.5%,start line:83% size:72.5% ARE NOW THE EVIDENCE-BASED ANSWER TO THE OPIATE USE 47:11.728 --> 47:12.362 align:left position:40%,start line:89% size:50% DISORDER. 47:12.462 --> 47:14.164 align:left position:15%,start line:65% size:75% SO I'M AN ALL THE ABOVE GUY. 47:14.264 --> 47:17.434 align:left position:12.5%,start line:65% size:77.5% IF SOMEBODY -- AND I -- I KNOW PEOPLE THAT HAVE BEEN THROUGH 47:17.534 --> 47:20.737 align:left position:10%,start line:65% size:80% DETOX AND THAT ARE ON ABSTINENCE NOW, AND THEY'RE DOING GREAT. 47:20.838 --> 47:24.508 align:left position:10%,start line:83% size:80% THEY SAY I'VE BEEN CLEAN AND SOBER FOR SIX MONTHS, FIVE YEARS 47:24.608 --> 47:27.578 align:left position:15%,start line:89% size:75% ONE GUY I WORK WITH 25 YEARS. 47:27.678 --> 47:28.879 align:left position:37.5%,start line:89% size:52.5% WONDERFUL. 47:28.979 --> 47:30.480 align:left position:15%,start line:83% size:75% BUT KNOW THAT NINE OUT OF TEN PEOPLE THAT GO THROUGH THOSE 47:30.581 --> 47:34.818 align:left position:10%,start line:83% size:80% PROGRAMS ARE USING AGAIN WITHIN SIX MONTHS TO A YEAR. 47:34.918 --> 47:40.123 align:left position:10%,start line:83% size:80% SO THE WORLD HEALTH ORGANIZATION SAYS USING MEDICATION ASSISTED 47:40.224 --> 47:45.329 align:left position:10%,start line:83% size:80% TREATMENT SO THAT PEOPLE CAN DO THE THERAPY, GET INTO GROUPS AND 47:45.429 --> 47:47.931 align:left position:12.5%,start line:83% size:77.5% INDIVIDUAL IS -- IS THE WAY TO GO. 47:48.031 --> 47:52.736 align:left position:10%,start line:83% size:80% AND 12 ORGANIZATIONS, FED FEDERAL -- AT THE FEDERAL LEVEL 47:52.836 --> 47:54.071 align:left position:17.5%,start line:89% size:72.5% HAVE ALL AGREED WITH THIS. 47:54.171 --> 47:56.940 align:left position:10%,start line:83% size:80% THIS IS THE -- THE NEW WAY THAT WE SHOULD BE TREATING OPIATE USE 47:57.040 --> 47:58.208 align:left position:40%,start line:89% size:50% DISORDER. 47:58.308 --> 48:00.244 align:left position:10%,start line:83% size:80% SO IF SOMEONE CAN GO THROUGH DETOX AND ABSTINENCE AND DO WELL 48:00.344 --> 48:02.579 align:left position:15%,start line:83% size:75% , GREAT F. THEY'VE GONE THROUGH IT SEVERAL TIMES AND 48:02.679 --> 48:06.617 align:left position:10%,start line:83% size:80% THEY'RE STRUGGLING AND THAT IS REALLY P -- SCARES ME BECAUSE WE 48:06.717 --> 48:10.821 align:left position:15%,start line:83% size:75% KNOW THAT THERE'S A 40 TIMES INCREASE OF OVERDOSE AND OVER 48:10.921 --> 48:15.959 align:left position:12.5%,start line:83% size:77.5% DOSE DEATH ONE MONTH AFTER GETTING OUT OF DETOX IN AND AN 48:16.059 --> 48:17.294 align:left position:12.5%,start line:83% size:77.5% ABSTINENCE PROGRAM N THE FIRST MONTH. 48:17.394 --> 48:21.131 align:left position:10%,start line:83% size:80% THEY'VE BEEN THROUGH IT A COUPLT WORKED I'M FEARFUL THEY'RE GOING 48:21.231 --> 48:23.300 align:left position:10%,start line:83% size:80% TO OVERDOSE AND DIE BEFORE THEY CAN GET THROUGH THIS AGAIN. 48:23.400 --> 48:28.505 align:left position:10%,start line:83% size:80% MAYBE THIS IS WHERE WE SHOULD GO MAYBE THEY NEED SOME MEDICATIONS 48:28.605 --> 48:33.310 align:left position:10%,start line:83% size:80% SO TREATING OPIATE USE DISORDER, IT REALLY IS A LIFE-THREATENING 48:33.410 --> 48:37.114 align:left position:10%,start line:83% size:80% ILLNESS BECAUSE OF THE CHANCE OF DEVELOPING OR LOSING YOUR 48:37.214 --> 48:41.084 align:left position:12.5%,start line:83% size:77.5% TOLERANCE AND THEN WHEN YOU RELAPSE USING AGAIN AND IF YOU 48:41.184 --> 48:47.291 align:left position:15%,start line:83% size:75% USE THE SAME AMOUNT, THEN YOU OVERDOSE OR OVERDOSE AND DIE. 48:47.391 --> 48:50.394 align:left position:10%,start line:83% size:80% SO I HOPE THAT YOU KNOW A LITTLE BIT MORE ABOUT THE OPIATE CRISIS 48:50.494 --> 48:51.828 align:left position:15%,start line:83% size:75% AND HOW IT'S AFFECTING NORTH CAROLINA. 48:51.929 --> 48:55.032 align:left position:12.5%,start line:83% size:77.5% I TALKED TO YOU A LITTLE BIT ABOUT ACUTE AND CHRONIC "LOVE, 48:55.132 --> 48:59.770 align:left position:10%,start line:83% size:80% PAIN AND THE WHOLE CRAZY THING" AND HOW WE'RE USING -- HOW WE'RY 48:59.870 --> 49:03.540 align:left position:15%,start line:83% size:75% TO THE NEXT GENERATION OF PROVIDERS IN WESTERN CAROLINA 49:03.640 --> 49:06.476 align:left position:12.5%,start line:83% size:77.5% AND RETEACHING THE DOCTORS AND PROVIDERS THAT HAVE BEEN OUT 49:06.576 --> 49:10.080 align:left position:12.5%,start line:83% size:77.5% THERE FOR 20 OR 25 YEARS ABOUT THE -- THE APPROPRIATE WAY TO 49:10.180 --> 49:11.348 align:left position:22.5%,start line:89% size:67.5% USE THESE MEDICATIONS. 49:11.448 --> 49:15.919 align:left position:15%,start line:83% size:75% AND THEN WE TALKED ABOUT THE IMPACT OF -- OF THE OPIATE 49:16.019 --> 49:19.623 align:left position:12.5%,start line:83% size:77.5% CRISIS AND OPIATE USE DISORDER ON OUR PATIENTS. 49:19.723 --> 49:21.625 align:left position:22.5%,start line:89% size:67.5% SO THANK YOU VERY MUCH. 49:21.725 --> 49:23.727 align:left position:35%,start line:89% size:55% [ APPLAUSE ]