1 00:00:06,306 --> 00:00:09,409 >> APPRECIATE THE OPPORTUNITY TO BE HERE TO TALK TO YOU ALL ABOUT 2 00:00:09,509 --> 00:00:12,078 THE OPIOID CRISIS IN WESTERN NORTH CAROLINA. 3 00:00:12,178 --> 00:00:15,482 A PARTNER IN CRIME IN ALL OF THIS IS A GUY NAMED DON TEETER. 4 00:00:15,582 --> 00:00:18,785 HE'S A FAMILY PHYSICIAN THAT'S BEEN WORKING FOR 30 YEARS IN 5 00:00:18,885 --> 00:00:21,921 HAYWOOD COUNTY IF IN THE LAST 18 YEARS IN ADDICTIONS AND THEN 6 00:00:22,022 --> 00:00:26,693 I'VE BEEN WORKING IN THIS SPACE FOR ABOUT FIVE YEARS NOW. 7 00:00:26,793 --> 00:00:28,828 SO -- I HAVE NO DISCLOSURES. 8 00:00:28,928 --> 00:00:31,631 THE PHARMACEUTICAL INDUSTRY IS NOT PAYING ME TO SAY THE THINGS 9 00:00:31,731 --> 00:00:33,733 I'M ABOUT TO SAY. 10 00:00:33,833 --> 00:00:37,537 SO JUST TO GET STARTED, 254,000. 11 00:00:37,637 --> 00:00:42,375 THAT'S THE NUMBER OF PEOPLE THAT WE'VE LOST IN THE LAST TEN YEARS 12 00:00:42,475 --> 00:00:45,678 TO THE OPIOID CRISIS. 13 00:00:45,779 --> 00:00:48,114 SO THAT'S MORE THAN FOUR TIMES THE NUMBER OF PEOPLE THAT DIED 14 00:00:48,214 --> 00:00:49,716 IN THE VIETNAM WAR. 15 00:00:49,816 --> 00:00:54,154 THERE WAS A PAPER THAT JUST CAME OUT LAST YEAR AND IT SAID IF 16 00:00:54,254 --> 00:00:57,157 YOU'RE UNDER 50 YEARS OLD AND YOU DIE IN THE UNITED STATES, 17 00:00:57,257 --> 00:01:03,196 IT'S NOW THE NUMBER ONE REASON THAT YOU DIE. 18 00:01:03,296 --> 00:01:09,302 SO GRANTED, MOST PEOPLE DIE IN THE UNITED STATES IN THEIR 50s , 19 00:01:09,402 --> 00:01:11,504 70s, 80s, 90s, IT'S RARE UNDER 50. 20 00:01:11,604 --> 00:01:16,509 IF YOU DO DIE UNDER 50 IN THE UNITED STATES OPIOID ABUSE IS 21 00:01:16,609 --> 00:01:18,545 THE NUMBER ONE REASON I DIE. 22 00:01:18,645 --> 00:01:20,547 IT TRULY IS AN EPIDEMIC. 23 00:01:20,647 --> 00:01:22,449 WE BEING THE PROVIDERS ARE THE VECTOR. 24 00:01:22,549 --> 00:01:24,984 IT TOOK ABOUT 30 YEARS TO GET INTO THIS SITUATION BUT IT 25 00:01:25,085 --> 00:01:29,556 REALLY WAS THE PHARMACEUTICAL INDUSTRY GIVING US A BILL OF 26 00:01:29,656 --> 00:01:33,860 GOODS AND THE PROVIDERS, INCLUDING DOCS AND FAMILY DOCS 27 00:01:33,960 --> 00:01:35,395 LIKE MYSELF BUYING ALL THIS. 28 00:01:35,495 --> 00:01:37,697 AND WE'LL TALK ABOUT THAT IN A SECOND. 29 00:01:37,797 --> 00:01:39,732 SO I AM A FAMILY PHYSICIAN. 30 00:01:39,833 --> 00:01:40,967 I'VE BEEN DOING THIS 19 YEARS. 31 00:01:41,067 --> 00:01:43,837 I DO IN-PATIENT WORK AND OUT- PATIENT WORK. 32 00:01:43,937 --> 00:01:48,274 I SEE PREGNANT WOMEN DELIVER BAY BABIES ABOUT 30% OF MY PRACTICE 33 00:01:48,374 --> 00:01:49,476 IS KIDS. 34 00:01:49,576 --> 00:01:51,444 AND WHEN I WENT THROUGH RESIDENCY, AFTER MEDICAL SCHOOL, 35 00:01:51,544 --> 00:01:52,812 THIS IS WHAT I WAS TAUGHT. 36 00:01:52,912 --> 00:01:56,349 OH, YOU HAVE THAT PATIENT THAT HAS CHRONIC BACK PAIN. 37 00:01:56,449 --> 00:02:01,354 WELL, TRY THESE THREE OR FIVE MEDICINES OR MODALITIES BUT 38 00:02:01,454 --> 00:02:05,592 EVENTUALLY THAT PATIENT IS GOING TO BE ON PERCOCET AND OH, YOU 39 00:02:05,692 --> 00:02:08,728 HAVE THIS PATIENT WHO HAS CHRONIC MIGRAINES. 40 00:02:08,828 --> 00:02:11,364 TRY THESE TWO OR THREE MEDICINES BUT IF THAT DOESN'T WORK THAT 41 00:02:11,464 --> 00:02:14,234 PATIENT IS EVENTUALLY GOING TO BE ON VICODIN. 42 00:02:14,334 --> 00:02:15,568 AND THAT'S WHAT I DID. 43 00:02:15,668 --> 00:02:18,905 AND THEN WHEN THEY HIRED ME ON AS FACULTY, THAT'S WHAT I TAUGHT 44 00:02:19,005 --> 00:02:20,440 OTHER PEOPLE FOR A DOZEN YEARS. 45 00:02:20,540 --> 00:02:22,609 THAT WAS -- THAT WAS ONE WHAT WE TAUGHT. 46 00:02:22,709 --> 00:02:26,112 I'M HERE TO TELL YOU THAT THERE'S ACTUALLY NO DATA FOR 47 00:02:26,212 --> 00:02:29,282 USING OPIOIDS FOR CHRONIC NON- CANCER PAIN. 48 00:02:29,382 --> 00:02:31,751 THERE'S ACTUALLY NO DATA WHATSOEVER FOR WHAT WE'VE BEEN 49 00:02:31,851 --> 00:02:34,854 DOING FOR THESE LAST 30 YEARS. 50 00:02:34,954 --> 00:02:38,391 BUT I DO HAVE DATA IF YOU START SOMEBODY ON OPIOIDS AND IT GETS 51 00:02:38,491 --> 00:02:42,662 UP TO A CERTAIN DOSE CALLED 50 MORPHINE MILI EQUIVALENTS A DAY 52 00:02:42,762 --> 00:02:48,001 OR A HIGHER DOSE, YOU INCREASE FALLS, OVERDOSE AND DEATH. 53 00:02:48,101 --> 00:02:50,637 SO I CAN TELL YOU THAT IT'S HARMFUL, BUT I CAN'T TELL YOU 54 00:02:50,737 --> 00:02:54,874 THAT IT'S HAPPY HELPFUL FOR CHRONIC NON-CEABS PAIN. 55 00:02:54,974 --> 00:02:57,677 THESE ARE OUR GOALS TODAY. 56 00:02:57,777 --> 00:03:00,880 STRIVE THE THE IMPACT OF THE OPIOID CRISIS. 57 00:03:00,980 --> 00:03:06,719 I KNOW YOU KNOW A LOT ABOUT IT BUT I I THINK I CAN GIVE YOU ONE 58 00:03:06,819 --> 00:03:08,021 OR TWO MORE COUNTS. 59 00:03:08,121 --> 00:03:10,690 FOR ALL OF YOU WORKING IN PUBLIC HEALTH OR WORKING WITH GROUPS 60 00:03:10,790 --> 00:03:14,394 THAT HAVE PROVIDERS I'M GOING TO TELL AWE LITTLE BIT ABOUT THE CD 61 00:03:14,494 --> 00:03:17,197 C GUIDELINES FOR ACUTE AND CHRONIC PAIN JUST SO YOU KNOW 62 00:03:17,297 --> 00:03:20,166 WHAT WE'RE TEACHING THIS NEXT GENERATION OF DOCS AND WE'RE 63 00:03:20,266 --> 00:03:24,237 HONESTLY HAVING TO GO OUT AND RETRAIN THE DOCS THAT WENT 64 00:03:24,337 --> 00:03:26,139 THROUGH RESIDENCY YEARS AGO LIKE MYSELF. 65 00:03:26,239 --> 00:03:30,877 AND THEN DESCRIBE THE -- ITS IMPACT ON OUR PATIENTS AND YOUR 66 00:03:30,977 --> 00:03:33,346 ALL'S CLIENTS OUT THERE. 67 00:03:33,446 --> 00:03:34,681 SO OPIOIDS IS THE BIG TERM. 68 00:03:34,781 --> 00:03:35,915 IT'S ALL OF THEM. 69 00:03:36,015 --> 00:03:39,018 AND OPIATES ARE IF IT COMES FROM OR DERIVED FROM THE POPPY. 70 00:03:39,118 --> 00:03:43,156 AND THEN THERE'S OTHERS THAT ARE LIKE SYNTHETICS LIKE FENTANYL. 71 00:03:43,256 --> 00:03:45,992 THESE ARE JUST SOME EXAMPLES UP HERE BUT I WANTED TO GO THROUGH 72 00:03:46,092 --> 00:03:49,862 A FEW OF THEM. 73 00:03:49,963 --> 00:03:53,800 ONE, CODEINE, SO IT'S FOR COUGH SYRUP OR 74 00:03:53,900 --> 00:03:55,335 [ NO AUDIO ] NOW THE FOOD AND DRUG 75 00:03:55,435 --> 00:03:58,838 ADMINISTRATION HAS COME OUT AND THEY'VE SAID WELL DON'T -- DON'T 76 00:03:58,938 --> 00:04:01,007 PRESCRIBE CODEINE TO KIDS UNDER 18. 77 00:04:01,107 --> 00:04:05,311 AND THEN THEY CAME OUT AND SAID WELL, DON'T PRESCRIBE CODEINE 78 00:04:05,411 --> 00:04:06,446 FOR PREGNANT WOMEN? 79 00:04:06,546 --> 00:04:08,414 OR IF THEIR BREAST-FEEDING. 80 00:04:08,514 --> 00:04:13,620 SO NOW WHAT WE'RE TEACHING IS, DON'T PRESCRIBE CODEINE AT ALL 81 00:04:13,720 --> 00:04:16,222 FOR ANYONE BECAUSE KIDS ARE GETTING AHOLD OF THIS AND 82 00:04:16,322 --> 00:04:17,490 THEY'RE USING THIS TO GET HIGH. 83 00:04:17,590 --> 00:04:21,394 AND THEY'RE ACTUALLY EVEN USING IT IN SCHOOL DURING THE DAY. 84 00:04:21,494 --> 00:04:24,297 AND THE REASON THAT THEY CAN GET AWAY WITH IT IS THE NUMBER ONE 85 00:04:24,397 --> 00:04:28,501 THING YOU LOOK LIKE WHEN YOU'RE HIGH ON OPIATES IS NORMAL. 86 00:04:28,601 --> 00:04:34,340 NOW, IF YOU'VE BEEN ON OPIATES FOR A LONG TIME OR WHRA -- WHAT 87 00:04:34,440 --> 00:04:37,677 HAVE YOU, YOU TEND TO HAVE SOME OF THE STIGMATA LATER. 88 00:04:37,777 --> 00:04:39,879 THE KIDS THAT ARE USING THIS, IT'S REALLY HARD FOR THE PARENTS 89 00:04:39,979 --> 00:04:42,682 AND THE TEACHERS HONESTLY TO PICK UP ON THIS. 90 00:04:42,782 --> 00:04:45,351 YOU SEE SOME OF THE OTHER ONES UP THERE, BUT THE BIG PROBLEM 91 00:04:45,451 --> 00:04:50,089 THAT WE'RE HAVING NOW IS THAT AS WE GOT INTO THIS CRISIS WITH 92 00:04:50,189 --> 00:04:56,362 OPIATE PILLS, NOW WE'VE MOVED ON TO HEROINE AND WHAT THEY CALL 93 00:04:56,462 --> 00:04:59,265 SYNTHETICS BUT THAT'S FENTANYL AND ITS DERIVATIVES AND WE'LL 94 00:04:59,365 --> 00:05:01,334 TALK ABOUT THAT A LITTLE MORE IN A SECOND. 95 00:05:01,434 --> 00:05:04,671 THE UNITED STATES IS 4.6% OF THE WORLD'S POPULATION, BUT WE 96 00:05:04,771 --> 00:05:10,209 CONSUME 80% OF ALL THE OPIOID PILLS PRESCRIBED IN THE WHOLE 97 00:05:10,310 --> 00:05:11,878 WORLD. 98 00:05:11,978 --> 00:05:13,212 80%. 99 00:05:13,313 --> 00:05:15,915 THERE'S NO OTHER COUNTRY THAT'S EVEN CLOSE TO WHAT WE'RE DOING. 100 00:05:16,015 --> 00:05:19,018 THE ONLY ONE THAT'S EVEN A FRACTION OF WHAT WE'RE DOING IS 101 00:05:19,118 --> 00:05:19,752 CANADA. 102 00:05:19,852 --> 00:05:20,887 I FEEL REALLY BAD FOR THEM. 103 00:05:20,987 --> 00:05:22,889 THEY JUST HAVE REALLY LONGBOARD ER WITH US, I THINK 104 00:05:22,989 --> 00:05:26,292 IT'S KIND OF A BLEEDOVER EFFECT. 105 00:05:26,392 --> 00:05:30,763 83% OF THE WORLD HAS NO ACCESS TO OPIATES. 106 00:05:30,863 --> 00:05:31,764 THINK ABOUT THAT. 107 00:05:31,864 --> 00:05:35,034 83% OF THE WORLD HAS NO ACCESS TO OPIATES. 108 00:05:35,134 --> 00:05:37,737 AND I'M GOING TO BE A LITTLE FLIPPANT HERE, BUT THEY'RE 109 00:05:37,837 --> 00:05:39,238 GETTING BY. 110 00:05:39,339 --> 00:05:40,506 YOU KNOW? 111 00:05:40,606 --> 00:05:43,910 AND THEY'RE GETTING BY THE WAY THAT WE USED TO PRACTICE. 112 00:05:44,010 --> 00:05:47,380 FOR THOSE IN THE BACK, I'M GOING TO KIND OF GO THROUGH THIS ON 113 00:05:47,480 --> 00:05:49,182 THE LEFT SIDE IS 1986. 114 00:05:49,282 --> 00:05:50,683 ON THE RIGHT SIDE IS 2015. 115 00:05:50,783 --> 00:05:52,952 SO THIS IS A 30-YEAR PERIOD. 116 00:05:53,052 --> 00:05:54,954 AND YOU CAN LOOK AT ALL THE DIFFERENT COLORS OF THE 117 00:05:55,054 --> 00:05:58,024 DIFFERENT TYPES OF OPIATES, BUT REALLY THE RED LINE IS THE 118 00:05:58,124 --> 00:06:01,894 ADDITIVE OR ACCUMULATION EFFECT OF ALL OF THE OPIATES THAT WE 119 00:06:01,994 --> 00:06:04,230 PRESCRIBED AND DISPENSED IN THE UNITED STATES. 120 00:06:04,330 --> 00:06:07,500 AND IF YOU GO OVER TO THE LEFT THEN N THE 70s AND EARLY '80S 121 00:06:07,600 --> 00:06:12,105 WE WERE PRESCRIBING IN A LOW RATE THE WAY THAT WESTERN EUROPE 122 00:06:12,205 --> 00:06:13,439 IS STILL PRESCRIBING. 123 00:06:13,539 --> 00:06:17,744 AND REALLY, BACK IN THE '70S AND '80S, THERE WAS TWO REASONS THAT 124 00:06:17,844 --> 00:06:19,011 YOU WOULD GET AN OPIATE. 125 00:06:19,112 --> 00:06:21,914 IF YOU WERE IN THE LAST SIX MONTHS OF LIFE, ON HOSPICE CARE, 126 00:06:22,014 --> 00:06:23,416 THEY WOULD GIVE US AN OPIATE. 127 00:06:23,516 --> 00:06:27,553 AND WE HAVE VERY GOOD DATA THAT SAYS THAT IT HELPS WITH QUALITY 128 00:06:27,653 --> 00:06:28,855 OF LIFE. 129 00:06:28,955 --> 00:06:33,459 HELPS TO TAKE AWAY THE WANE SO YOU CAN -- PAIN SO YOU CAN SPEND 130 00:06:33,559 --> 00:06:35,862 TIME WITH YOUR FAMILY BUT IT DOESN'T HELP WITH QUALITY OF 131 00:06:35,962 --> 00:06:38,765 LIFE T. OTHER WAY YOU GOT AN OPIATE IS ACUTE SEVERE PAIN. 132 00:06:38,865 --> 00:06:41,534 SO IF YOU'RE IN A CAR WRECK AND THE BONE IN YOUR LEG IS STICKING 133 00:06:41,634 --> 00:06:44,370 OUT OF YOUR SKIN, YOU GOT AN OPIATE. 134 00:06:44,470 --> 00:06:48,241 BUT THE THIS WHOLE BUSINESS OF GIVING OPIATES FOR CHRONIC NON- 135 00:06:48,341 --> 00:06:50,843 CANCER PAIN JUST REALLY WASN'T HAPPENING BACK THEN. 136 00:06:50,943 --> 00:06:58,151 AND THEN TWO ARTICLES CAME OUT IN THE MID '80S, AND I'M GOING 137 00:06:58,251 --> 00:07:01,154 THE TALK TO YOU A LITTLE BIT ABOUT THE ARTICLE, IT WAS PICKED 138 00:07:01,254 --> 00:07:04,824 UP BY THE TENS OF THOUSANDS OF DRUG REPS WHO THEN SPREAD OUT 139 00:07:04,924 --> 00:07:07,360 INTO THE COUNTRY AND STARTED TALKING TO THE PROVIDERS AND 140 00:07:07,460 --> 00:07:11,397 THEY SAID HEY, THERE'S THIS ARTICLE IN THE "NEW ENGLAND 141 00:07:11,497 --> 00:07:13,666 JOURNAL OF MEDICINE" AND IT SAYS OPIATES ARE REALLY SAFE, LESS 142 00:07:13,766 --> 00:07:16,736 THAN 1% OF PEOPLE WILL EVER GET ADDICTED AND YOU SHOULD BE USING 143 00:07:16,836 --> 00:07:20,807 THESE MEDICINES FOR CHRONIC PAIN AND IF YOU LOOK, THE LINE STARTS 144 00:07:20,907 --> 00:07:23,976 TO GO UP BECAUSE THEY STARTLING THE PROVIDERS THIS OVER AND OVER 145 00:07:24,076 --> 00:07:25,978 AND OVER AGAIN. 146 00:07:26,078 --> 00:07:29,148 INTERESTINGLY, IF YOU GO BACK AND LOOK AT THAT ARTICLE, IT 147 00:07:29,248 --> 00:07:34,787 REALLY WAS IN THIS ESTEEMED JOURNAL CALLED THE "NEW ENGLAND 148 00:07:34,887 --> 00:07:36,823 JOURNAL OF MEDICINE" BUT IT WASN'T A RANDOMIZED CONTROLLED 149 00:07:36,923 --> 00:07:41,427 TRIAL AND DIDN'T HAVE ANY AGE MATCH CONTROLLED, WASN'T 150 00:07:41,527 --> 00:07:42,628 RETROSPECTIVE OR PROSPECTIVE. 151 00:07:42,728 --> 00:07:44,163 IT WAS JUST A LETTER TO THE EDITOR. 152 00:07:44,263 --> 00:07:48,234 IT WAS SEVEN LINES AND THE GUY SAID HEY, I HAD SOME PATIENTS IN 153 00:07:48,334 --> 00:07:50,303 THE HOSPITAL [ NO AUDIO ] 154 00:07:50,403 --> 00:07:52,505 AND NONE OF THEM GOT A ADDICTED. 155 00:07:52,605 --> 00:07:55,441 HE DIDN'T EVEN CALL THEM AFTER THEY LEFT THE HOSPITAL TO SEE IF 156 00:07:55,541 --> 00:07:59,278 THEY WERE STILL ON OPIATES OR STILL HAVING TROUBLE WITH OPIATE 157 00:07:59,378 --> 00:08:00,446 USE DISORDER. 158 00:08:00,546 --> 00:08:02,849 THAT'S NOT WHAT THE PHARMACEUTICAL INDUSTRY SAID. 159 00:08:02,949 --> 00:08:05,284 THEY SAID HEY, WE HAVE THIS ARTICLE IN THE "NEW ENGLAND 160 00:08:05,384 --> 00:08:07,386 JOURNAL OF MEDICINE" THAT SAYS THESE MEDICINES ARE SAFE AND YOU 161 00:08:07,487 --> 00:08:08,621 SHOULD START USING THEM. 162 00:08:08,721 --> 00:08:10,990 SO WE START PRESCRIBING AND IT STARTS GOING UP. 163 00:08:11,090 --> 00:08:14,227 THEN YOU SEE IN 1996 THERE'S THIS INFLEXION POINT, RIGHT? 164 00:08:14,327 --> 00:08:18,130 AND IT STARTS GOING WAY, WAY UP AND WE START PRESCRIBING LIKE 165 00:08:18,231 --> 00:08:18,664 CRAZY. 166 00:08:18,764 --> 00:08:19,932 SO WHAT HAPPENED? 167 00:08:20,032 --> 00:08:22,568 IN 1996 THE AMERICAN PAIN SOCIETY GOT TOGETHER AND THEY 168 00:08:22,668 --> 00:08:25,905 HAD A BIG EXPERT PANEL AND THIS IS WHAT THEY SAID. 169 00:08:26,005 --> 00:08:29,909 HEY, YOU PRIMARY CARE DOCS, THAT'S ME, YOU GUYS ARE ALL 170 00:08:30,009 --> 00:08:31,410 DIRTY ROTTEN ROBBERS. 171 00:08:31,511 --> 00:08:35,314 YOU'RE WAY UNDERTREATING PAIN AND WE HAVE SOME GREAT 172 00:08:35,414 --> 00:08:36,949 MEDICATIONS TO TREAT IT. 173 00:08:37,049 --> 00:08:38,117 OPIATES. 174 00:08:38,217 --> 00:08:44,223 DOES ANYBODY KNOW WHAT OPIATE WAS DEBUTED IN 1996? 175 00:08:44,323 --> 00:08:45,491 OXYCONTIN. 176 00:08:45,591 --> 00:08:48,027 WE HAVE SOME GREAT MEDICINES LIKE OXYCONTIN AND URKD BE USING 177 00:08:48,127 --> 00:08:48,628 THEM. 178 00:08:48,728 --> 00:08:49,595 THEY'RE REALLY SAFE. 179 00:08:49,695 --> 00:08:51,297 LESS THAN 1% OF PEOPLE EVER GET ADDICTED. 180 00:08:51,397 --> 00:08:54,834 AND WE AS PRIMARY CARE DOCS SAID OH, MY GOSH, THESE ARE OUR 181 00:08:54,934 --> 00:08:57,870 EXPERTS IN PAIN, CHRONIC PAIN, AND THEY'RE TELLING US WE'RE 182 00:08:57,970 --> 00:08:58,504 DOING THIS WRONG. 183 00:08:58,604 --> 00:08:59,772 THE GLOVES ARE OFF. 184 00:08:59,872 --> 00:09:06,379 WE'RE GOING TO START TREATING PAIN LIKE THE EXPERTS SAY. 185 00:09:06,479 --> 00:09:10,316 AND YOU CAN SIGH THE LINE GOES CRAZY, GOES UP. 186 00:09:10,416 --> 00:09:14,020 INTERESTINGLY THAT GROUP GOT TOGETHER IN TWOZ 18 BECAUSE OF 187 00:09:14,120 --> 00:09:17,790 OUR NEW ETHICS LAWS IN MEDICINE, THEY WOULD HAVE TO DISCLOSE IF 188 00:09:17,890 --> 00:09:20,026 THEY WERE GETTING PAID BY THE PHARMACEUTICAL INDUSTRY AND 189 00:09:20,126 --> 00:09:21,160 ALMOST ALL OF THEM WERE. 190 00:09:21,260 --> 00:09:23,462 BUT THEY DIDN'T TELL US THAT BACK THEN. 191 00:09:23,563 --> 00:09:29,869 SO FROM 1986 TO 2015 THIS 30- YEAR PERIOD, 600% INCREASE IN 192 00:09:29,969 --> 00:09:33,606 THE NUMBER OF OPIATES THAT WE ARE PRESCRIBING AND DISPENSING 193 00:09:33,706 --> 00:09:36,108 IN THE UNITED STATES WHILE NO OTHER COUNTRY IN THE WORLD IS 194 00:09:36,208 --> 00:09:39,412 DOING THE SAME THING. 195 00:09:39,512 --> 00:09:42,415 SO EVERYTHING WE KNOW ABOUT CHRONIC NON-CANCER PAIN AND 196 00:09:42,515 --> 00:09:47,119 USING OPIATES HAS BEEN PROGRAMMED BY THE PHARMACEUTICAL 197 00:09:47,219 --> 00:09:47,687 INDUSTRY. 198 00:09:47,787 --> 00:09:48,387 THAT'S MY OPINION. 199 00:09:48,487 --> 00:09:49,922 I DO KNOW THIS FOR A FACT. 200 00:09:50,022 --> 00:09:53,159 THERE'S NO DATA THAT SAYS USING OPIATES FOR CHRONIC PAIN IS 201 00:09:53,259 --> 00:09:57,163 BENEFICIAL BUT I DO HAVE DATA THAT SAYS IT'S HARMFUL. 202 00:09:57,263 --> 00:09:59,599 AND THIS IS THE BEST THE PHARMACEUTICAL INDUSTRY CAN DO. 203 00:09:59,699 --> 00:10:02,969 THAT IS LOT OF WORDS BUT I WANT TO READ IT FROM TO YOU. 204 00:10:03,069 --> 00:10:04,670 FROM THE AMERICAN CANCER P SOCIETY. 205 00:10:04,770 --> 00:10:07,873 OPEN YACHT MEDICATIONS IN THE CLASS OF MORPHINE ARE DESIGNATED 206 00:10:07,974 --> 00:10:11,944 TO HAVE A LEGITIMATE MEDICAL USE THAT'S TRUE. 207 00:10:12,044 --> 00:10:14,747 AND ARE INDICATED FOR THE MEDICAL MANAGEMENT OF PAIN, 208 00:10:14,847 --> 00:10:17,817 ESPECIALLY IF THE PAIN IS SEVERE THAT'S TRUE AS WELL. 209 00:10:17,917 --> 00:10:20,453 THE F.D.A. MAKES IT SO. 210 00:10:20,553 --> 00:10:24,323 SO LOOK AT THIS NEXT LINE THOUGH ALTHOUGH THEIR USE FOR THE 211 00:10:24,423 --> 00:10:28,527 RELIEF OF A VARIETY OF CHRONIC NON-CANCER PAIN CONDITIONS 212 00:10:28,628 --> 00:10:30,730 CONTINUES TO EVOLVE. 213 00:10:30,830 --> 00:10:33,099 WHAT DID THEY SAY? 214 00:10:33,199 --> 00:10:35,234 THEY DIDN'T SAY ANYTHING. 215 00:10:35,334 --> 00:10:36,335 READ THAT AGAIN. 216 00:10:36,435 --> 00:10:37,603 READY? 217 00:10:37,703 --> 00:10:40,506 ALTHOUGH THEIR USE FOR THE RELIEF OF A VARIETY OF CHRONIC 218 00:10:40,606 --> 00:10:42,508 NON-CANCER PAIN CONDITIONS CONDITIONS TO EVOLVE AND 219 00:10:42,608 --> 00:10:45,378 EVIDENCE OF EFFECTIVENESS OF THESE CONDITIONS IS DERIVED 220 00:10:45,478 --> 00:10:49,081 LARGELY FROM CLINICAL EXPERIENCE SO THEY DON'T HAVE A RANDOMIZED 221 00:10:49,181 --> 00:10:52,618 CONTROL TRIAL OR THEY DON'T HAVE A RETROSPECTIVE OR PROSPECTIVE 222 00:10:52,718 --> 00:10:53,919 TRIAL. 223 00:10:54,020 --> 00:10:55,955 WHAT THEY DO IS COME AND FIND DOCS LIKE ME AND SAY HEY, DO YOU 224 00:10:56,055 --> 00:10:57,657 HAVE ANYBODY WITH LOW BACK PAIN? 225 00:10:57,757 --> 00:10:58,357 I SAY YEAH. 226 00:10:58,457 --> 00:10:59,759 DO YOU GIVE THEM OPIATES? 227 00:10:59,859 --> 00:11:00,393 YEAH. 228 00:11:00,493 --> 00:11:01,560 DO YOU THINK IT WORKS? 229 00:11:01,661 --> 00:11:06,966 IF I SAY IT YES, THEY PUT A CHECK DOWN, IT WORKS. 230 00:11:07,066 --> 00:11:08,234 THAT'S ALL THEY'VE GOT. 231 00:11:08,334 --> 00:11:10,202 THERE SEEMS TO BE A GENERAL AGREEMENT THAT SOME PATIENTS 232 00:11:10,302 --> 00:11:13,339 WITH SUCH PAIN CAN BE PROPERLY TREATED WITH OPIATE THERAPY. 233 00:11:13,439 --> 00:11:14,607 THAT'S IT. 234 00:11:14,707 --> 00:11:16,609 THAT'S THE BEST THE INDUSTRY HAS AND THE INDUSTRY TOLD US TWO 235 00:11:16,709 --> 00:11:17,843 THINGS. 236 00:11:17,943 --> 00:11:19,912 THEY TOLD US WE'RE GOING TO DECREASE PAIN AND INCREASE 237 00:11:20,012 --> 00:11:23,783 FUNCTION DURING THIS TIME PERIOD THIS IS A 20-YEAR STUDY ACROSS 238 00:11:23,883 --> 00:11:28,220 THE BOTTOM IS LOW BACK PAIN, MUSCULOSKELETAL PAIN, NECK PAIN 239 00:11:28,320 --> 00:11:31,157 AND OSTEOARTHRITIS IS PAIN IN THE HIP OR KNEE. 240 00:11:31,257 --> 00:11:35,728 SO YOU CAN SEE THAT PAIN WENT UP IN ADULTS IN THE UNITED STATES. 241 00:11:35,828 --> 00:11:38,998 BUT WITH A 600% INCREASE IN OPIATES, YOU WOULD THINK THAT IT 242 00:11:39,098 --> 00:11:40,700 WOULD AT LEAST STAY THE SAME OR GO DOWN. 243 00:11:40,800 --> 00:11:42,301 BUT IT DIDN'T, IT WENT UP. 244 00:11:42,401 --> 00:11:44,837 BUT THE SECOND THING THEY SAID IS BUT WE'RE GOING TO INCREASE 245 00:11:44,937 --> 00:11:46,138 FUNCTION. 246 00:11:46,238 --> 00:11:48,774 AND SO DOCS THAT I WORK WITH THAT CAN REMEMBER BACK IN THE 247 00:11:48,874 --> 00:11:51,644 '80S, THEY MIGHT HAVE HAD A LITTLE BIT MORE GRAY HAIR THAN I 248 00:11:51,744 --> 00:11:55,314 DO, THEY SAID THEY COULD REMEMBER DRUG REPS SAYING HEY 249 00:11:55,414 --> 00:11:58,751 YOUR PATIENT THAT FELL OFF THE LADDER AND BROKE HIS BACK, DON'T 250 00:11:58,851 --> 00:12:00,352 YOU WANT HIM TO GO BACK TO WORK? 251 00:12:00,453 --> 00:12:03,255 AND THE DOCS P LIKE YEAH, I WANT HIM TO GO BACK TO WORK. 252 00:12:03,355 --> 00:12:05,758 THEY'D SAY HEY, YOU SHOULD USE OPIATES TO HELP. 253 00:12:05,858 --> 00:12:09,028 BUT DO YOU KNOW THE NUMBER OF DAYS THAT YOU NEED TO BE ON AN 254 00:12:09,128 --> 00:12:13,666 OPIATE TO DOUBLE YOUR RISK OF GOING OUT ON PERMANENT 255 00:12:13,766 --> 00:12:14,166 DISABILITY? 256 00:12:14,266 --> 00:12:14,867 SEVEN DAYS. 257 00:12:14,967 --> 00:12:16,202 THAT'S IT. 258 00:12:16,302 --> 00:12:18,971 AND EVERY DAY AFTER THAT THAT YOU'RE ON AN OPIATE INCREASES 259 00:12:19,071 --> 00:12:21,507 YOUR RISK EVEN MORE OF GOING OUT ON PERMANENT DISABILITY. 260 00:12:21,607 --> 00:12:25,411 AND WHEN I HEARD THAT, I HAD BEEN WORKING IN THIS OPIATE 261 00:12:25,511 --> 00:12:29,148 SPACE FOR ABOUT A YEAR, I HAD 12 PATIENTS THAT HAD CHRONIC PAIN 262 00:12:29,248 --> 00:12:33,119 THAT I WAS WRITING OPIATES FOR THEM, EVERY THREE MONTHS I WOULD 263 00:12:33,219 --> 00:12:34,053 SEE THEM. 264 00:12:34,153 --> 00:12:35,554 I WENT BACK AND LOOKED AT THEIR CHARTS. 265 00:12:35,654 --> 00:12:38,157 11 OUT OF 12 OF MY PATIENTS WERE ON PERMANENT DISABILITY. 266 00:12:38,257 --> 00:12:40,726 SO THE PHARMACEUTICAL INDUSTRY SAID WE'RE GOING TO DECREASE 267 00:12:40,826 --> 00:12:46,532 PAIN AND INCREASE FUNCTION, BUT IT DID THE OPPOSITE. 268 00:12:46,632 --> 00:12:49,568 AND IF THAT'S KIND OF LIKE NOT DAMNING ENOUGH, THIS IS THE 269 00:12:49,668 --> 00:12:53,906 GREEN LINE IS ALL OF THE OPIATES PRESCRIBED -- DISPENSED BY ALL 270 00:12:54,006 --> 00:12:57,309 THE PHARMACEUTICAL COMPANIES IN THE UNITED STATES, THE SECOND 271 00:12:57,409 --> 00:13:00,312 LINE IS OPIATE DEATHS DURING THAT TIME FRAME. 272 00:13:00,412 --> 00:13:04,583 AND THE THIRD LINE IS PEOPLE GOING INTO INPATIENT TREATMENT 273 00:13:04,683 --> 00:13:08,354 FOR OPIATE USE DISORDER, THE NEW TERM FOR OPIATE ADDICTION. 274 00:13:08,454 --> 00:13:16,729 TO BRING IT HOME TO NORTH CAROLINA THEN, SO THIS -- THIS 275 00:13:16,829 --> 00:13:20,132 SLIDE IS FROM THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN 276 00:13:20,232 --> 00:13:23,269 SERVICES AND THE TOP LINE THERE IS NUMBER OF OPIATE DEATHS FROM 277 00:13:23,369 --> 00:13:24,603 PILLS. 278 00:13:24,703 --> 00:13:28,974 THEN THE SECOND LINE DOWN, THE FIVE -- 7, 9, IS OPIATE DEATHS 279 00:13:29,074 --> 00:13:32,244 FROM SYNTHETICS AND WE'LL JUST CALL THEM FENTANYL FROM NOW ON. 280 00:13:32,344 --> 00:13:35,414 THE 538 IS OPIATE DEATHS ARE HEROINE. 281 00:13:35,514 --> 00:13:38,818 SO THE STORY HERE IS THAT THIS STARTED OFF AS A PILL PROBLEM. 282 00:13:38,918 --> 00:13:42,188 AND IT STILL IS A PILL PROBLEM. 283 00:13:42,288 --> 00:13:46,458 BUT NOW IT'S A HEROINE AND FENTANYL PROBLEM. 284 00:13:46,559 --> 00:13:50,563 WHEN WE FINALLY GET THE DATA FROM 2017A LITTLE OVER 1,500 285 00:13:50,663 --> 00:13:54,633 NORTH CAROLINIANS WILL HAVE DIED FROM OPIATE DEATHS IN THE YEAR 286 00:13:54,733 --> 00:13:55,501 2017. 287 00:13:55,601 --> 00:13:58,237 ON AVERAGE FOUR PEOPLE DIE EVERY DAY. 288 00:13:58,337 --> 00:14:01,207 AND THIS IS HOW WE'VE GOTTEN INTO THIS PROBLEM NOW, IS THAT 289 00:14:01,307 --> 00:14:05,911 WE STARTED WITH PILLS BUT NOW IT'S -- IT'S REALLY GOTTEN INTO 290 00:14:06,011 --> 00:14:10,216 HEROINE AND FENTANYL. 291 00:14:10,316 --> 00:14:13,986 SO THE FIRST BOTTLE THERE IS SUPPOSEDLY A GRAM OF HEROINE. 292 00:14:14,086 --> 00:14:19,058 AND DEPENDING UPON A PATIENT'S OR A PERSON'S POLL RANS, IF YOU 293 00:14:19,158 --> 00:14:21,060 SHOOT A GRAM YOU CAN OVERDOSE AND DIE. 294 00:14:21,160 --> 00:14:24,663 BUT THE SECOND BOTTLE THERE IS FENTANYL, AND IT'S 50 TO 100 295 00:14:24,763 --> 00:14:27,299 TIMES MORE POTENT THAN THE HEROINE THAT'S OUT THERE ON THE 296 00:14:27,399 --> 00:14:28,300 STREET RIGHT NOW. 297 00:14:28,400 --> 00:14:30,169 THAT'S JUST 50 GRAINS. 298 00:14:30,269 --> 00:14:32,438 AND IF YOU SHOOT THAT, YOU CAN OVERDOSE AND DIE. 299 00:14:32,538 --> 00:14:35,274 AND THEN THE LAST ONE, HAVE YOU HEARD OF THIS? 300 00:14:35,374 --> 00:14:37,543 THIS CAR FENTANYL BUSINESS? 301 00:14:37,643 --> 00:14:40,646 IT'S AN ELEPHANT TRANQUILIZER. 302 00:14:40,746 --> 00:14:44,850 IT'S 5,000 TIMES MORE POTENT THAN THAT HEROINE THAT'S ON THE 303 00:14:44,950 --> 00:14:46,452 STREET AND THERE'S JUST THREE GAINS. 304 00:14:46,552 --> 00:14:48,854 THERE'S A REASON YOU CAN'T SEE MUCH IN THAT BOTTLE BECAUSE 305 00:14:48,954 --> 00:14:50,256 THERE'S ONLY THREE GRAINS IN THERE. 306 00:14:50,356 --> 00:14:52,358 IF YOU SHOOT THAT, YOU OVERDOSE AND DIE. 307 00:14:52,458 --> 00:14:56,962 SO YOU CAN IMAGINE AS THE END USER IF THEY CUT THE CARFENTANYL 308 00:14:57,062 --> 00:14:59,865 INTO THE HEROINE AND YOU SHOOT THE SAME AMOUNT OF TIME YOU DID 309 00:14:59,965 --> 00:15:02,701 LAST TIME AND YOU DON'T KNOW IT, YOU DON'T KNOW WHAT'S IN IT, YOU 310 00:15:02,801 --> 00:15:03,702 CAN OVERDOSE AND DIE. 311 00:15:03,802 --> 00:15:05,204 AND THAT'S WHAT WE'RE FEELING OUT THERE. 312 00:15:05,304 --> 00:15:11,410 WHEN YOU TALK TO THE POLICE, THE FIRE -- FOLKS IN FIRE AND THE E. 313 00:15:11,510 --> 00:15:14,380 M.S. AND SAY HEY, I HEAR YOU'VE REALLY GOT A HEROINE 314 00:15:14,480 --> 00:15:17,283 PROBLEM NOW, THEY'LL CORRECT YOU AND SAY IT'S A FENTANYL PROBLEM. 315 00:15:17,383 --> 00:15:19,818 AND THE REASON THAT THEY'RE CUTTING THE FENTANYL IN THERE IS 316 00:15:19,919 --> 00:15:23,622 BECAUSE IT'S MORE POWERFUL, PEOPLE ARE SEEKING THAT, AND 317 00:15:23,722 --> 00:15:24,890 IT'S LESS EXPENSIVE. 318 00:15:24,990 --> 00:15:27,993 AND IT'S BEEN LESS EXPENSIVE EVERY YEAR FOR THE LAST THREE OR 319 00:15:28,093 --> 00:15:31,363 FOUR YEARS. 320 00:15:31,463 --> 00:15:35,734 SO THIS IS UNINTENTIONED MEDICATION AND DRUG OVERDOSE 321 00:15:35,834 --> 00:15:36,602 DEATHS BY COUNTY. 322 00:15:36,702 --> 00:15:38,203 AND YOU CAN SEE THAT THE [ NO AUDIO ] 323 00:15:38,304 --> 00:15:41,874 AND THE DARKER COLOR IS WORSE. 324 00:15:41,974 --> 00:15:44,576 SO IF YOU KIND OF LOOK AT WESTERN NORTH CAROLINA THERE, WE 325 00:15:44,677 --> 00:15:50,716 HAVE A LOT OF COUNTIES THAT HAVE THAT DARK COLOR. 326 00:15:50,816 --> 00:15:53,919 [ NO AUDIO ] IN APPALACHIA, NOT JUST NORTH 327 00:15:54,019 --> 00:15:58,123 CAROLINA, EASTERN TENNESSEE, WEST VIRGINIA, EASTERN OHIO, YOU 328 00:15:58,223 --> 00:16:05,030 GO UP THE APPALACHIAN CHAIN EVEN UP INTO PENNSYLVANIA, AND WE 329 00:16:05,130 --> 00:16:08,000 HAVE FOR THE SAME AMOUNT OF DRUG PROBLEMS, PEOPLE WITH THEIR 330 00:16:08,100 --> 00:16:13,405 OPIATE USE DISORDER, WE HAVE IN APPALACHIA 55% INCREASE IN OVER 331 00:16:13,505 --> 00:16:15,174 DOSE DEATHS COMPARED TO THE REST OF THE COUNTRY. 332 00:16:15,274 --> 00:16:18,844 SO SOMETHING IS GOING ON HERE IN APPALACHIA. 333 00:16:18,944 --> 00:16:22,681 AND THIS IS NORTH CAROLINA OPIATE OVERDOSE DEATHS -- OVER 334 00:16:22,781 --> 00:16:25,017 DOSES THAT THE EMERGENCY DEPARTMENT IS SEEING. 335 00:16:25,117 --> 00:16:28,253 YOU CAN SEE IT WAS KIND OF STEADY IN 2016 AND THIS IS JUST 336 00:16:28,354 --> 00:16:30,122 THE DATA WE HAVE THROUGH 2017. 337 00:16:30,222 --> 00:16:33,525 AND THEN IT ACTUALLY WENT UP QUITE A BIT, AND THEN NOW IT 338 00:16:33,625 --> 00:16:36,628 SEEMS TO BE COMING DOWN. 339 00:16:36,729 --> 00:16:40,432 INTERESTINGLY THOUGH WE THINK THERE'S MORE REVERSALS BUT WE'RE 340 00:16:40,532 --> 00:16:43,002 NOT SEEING AS MUCH IN THE EMERGENCY DEPARTMENT. 341 00:16:43,102 --> 00:16:44,303 SO WHAT'S HAPPENING? 342 00:16:44,403 --> 00:16:48,574 BECAUSE OF A LOT OF EFFORTS OF YOU ALL, WE'RE GETTING MORE 343 00:16:48,674 --> 00:16:52,177 NARCAN OUT INTO THE COMMUNITIES AND THE REVERSALS ARE ACTUALLY 344 00:16:52,277 --> 00:16:53,512 HAPPENING IN THE FIELD. 345 00:16:53,612 --> 00:16:58,050 SO A LOT MORE POLICE DEPARTMENTS AND FIRE DEPARTMENTS, E.M.S. ARE 346 00:16:58,150 --> 00:16:59,318 CARRYING IT. 347 00:16:59,418 --> 00:17:04,156 BUT ALSO THERE'S A LOT OF PEOPLE THAT ARE ALT -- AT HIGH RISK 348 00:17:04,256 --> 00:17:09,561 THAT ACTUALLY HAVE NARCAN, OR THEIR LOVED ONES DO IN THE LOCK 349 00:17:09,661 --> 00:17:12,264 ZONE AND ABLE TO REVERSE A PATIENT OR PERSON THAT'S 350 00:17:12,364 --> 00:17:13,599 OVERDOSED IN THE FIELD. 351 00:17:13,699 --> 00:17:16,735 SO WE'RE SEEING A FLATTENEDING IN THE EMERGENCY DEPARTMENT AT 352 00:17:16,835 --> 00:17:18,637 THE SAME TIME WE BELIEVE THERE'S MORE AND MORE OVERDOSES THAT ARE 353 00:17:18,737 --> 00:17:23,308 HAPPENING. 354 00:17:23,409 --> 00:17:26,445 AND THEN FOLKS, SOMETIMES THEY TAKE THE PILLS BUT OFTENTIMES 355 00:17:26,545 --> 00:17:30,649 WHEN YOU'RE IN YOUR USE DISORDER YOU'RE EITHER SNORTING OR 356 00:17:30,749 --> 00:17:31,917 SHOOTING. 357 00:17:32,017 --> 00:17:36,989 THERE'S A LOT OF EFFORT OUT THERE TO TRY TO HELP WITH FOLKS 358 00:17:37,089 --> 00:17:38,524 THAT ARE I.V. DRUG USERS. 359 00:17:38,624 --> 00:17:39,925 BUT WE ARE SEEING THE EFFECTS OF THIS. 360 00:17:40,025 --> 00:17:43,028 AND SO ALL OF YOU THAT ARE OUT THERE TRYING TO HELP TO GET 361 00:17:43,128 --> 00:17:45,798 CLEAN NEEDLES TO THESE FOLKS AND THEN ALSO JUST BEING THERE FOR 362 00:17:45,898 --> 00:17:49,001 THE TIME THAT THEY'RE READY TO SAY I'M -- I'M READY TO DO 363 00:17:49,101 --> 00:17:49,701 SOMETHING ELSE. 364 00:17:49,802 --> 00:17:51,103 I WANT HELP. 365 00:17:51,203 --> 00:17:54,106 I REALLY PRAISE Y'ALL AND APPRECIATE WHAT YOU'RE DOING. 366 00:17:54,206 --> 00:17:59,411 BUT THIS IS WHAT WE'RE SEEING. 367 00:17:59,511 --> 00:18:00,712 SO HEPATITIS. 368 00:18:00,813 --> 00:18:04,149 >> CR IN NORTH CAROLINA, 500% INCREASE IN THIS SEVEN-YEAR 369 00:18:04,249 --> 00:18:05,317 PERIOD. 370 00:18:05,417 --> 00:18:07,753 AND HERE'S INFECTIONS THAT ARE IN THE BLOODSTREAM. 371 00:18:07,853 --> 00:18:11,223 OFTENTIMES THEY CAN GET INFECTIONS FROM DIRTY NEEDLES 372 00:18:11,323 --> 00:18:14,460 AND GET A PUS POCKET OR ABSCESS IN THE SKIN. 373 00:18:14,560 --> 00:18:16,695 SOMETIMES THAT WILL GET INTO THE BLOODSTREAM AND THAT'S INCREASED 374 00:18:16,795 --> 00:18:17,996 FOUR TIMES OVER. 375 00:18:18,097 --> 00:18:22,201 AND THEN SOMETIMES THIS -- THE BACTERIA WILL GO UP TO THE HEART 376 00:18:22,301 --> 00:18:23,936 AND WILL ATTACH TO THE HEART VALVES. 377 00:18:24,036 --> 00:18:29,875 AND WE'VE SEEN A 13.5 TIMES INCREASE. 378 00:18:29,975 --> 00:18:33,078 AND I KNOW I'M E PREACHING TO THE CHOIR, JUST TO TELL YOU THIS 379 00:18:33,178 --> 00:18:37,916 PUBLIC HEALTH STORY THEN, SO IT COSTS ROUGHLY $7 FOR 100 CLEAN 380 00:18:38,016 --> 00:18:39,384 NEEDLES. 381 00:18:39,485 --> 00:18:45,190 AND SO -- TO REPLACE SOMEONE'S VALVE THAT'S BEEN DAMAGED TBI 382 00:18:45,290 --> 00:18:47,759 BACTERIA ON THERE IS ROUGHLY $2 50,000. 383 00:18:47,860 --> 00:18:51,230 SO IF WE CAN KEEP TELLING THIS STORY, AND I APPRECIATE AGAIN 384 00:18:51,330 --> 00:18:53,599 ALL Y'ALL OUT THERE THAT ARE WORKING IN THIS SPACE AND TRYING 385 00:18:53,699 --> 00:18:57,402 TO HELP, BUT WE HAVE TO GET CLEAN NEEDLES TO THE FOLKS TO 386 00:18:57,503 --> 00:19:01,540 HELP THEM TO NOT HAVE THESE INFECTIONS. 387 00:19:01,640 --> 00:19:02,908 H.I.V. IS ON THE RISE AS WELL. 388 00:19:03,008 --> 00:19:05,711 TO TRY TO NOT HAVE THESE INFECTIONS AND THEN BE THERE FOR 389 00:19:05,811 --> 00:19:09,014 THEM WHEN THEY'RE COMING TO EXCHANGE THEIR NEEDLES AND WHEN 390 00:19:09,114 --> 00:19:13,152 THEY'RE READY TO SEEK CHANGE IN THEIR LIVES, THEN WE'RE THERE 391 00:19:13,252 --> 00:19:15,220 FOR THEM, AND WE NEED TO BE DOING THAT. 392 00:19:15,320 --> 00:19:20,959 AND IT'S GOT TO BE A GOOD USE OF OUR RESOURCES. 393 00:19:21,059 --> 00:19:25,664 SO THEN HERE IS SOME DEMOGRAPHIC S. 394 00:19:25,764 --> 00:19:27,299 IT'S URBAN AND RURAL AND WHITE AND BLACK. 395 00:19:27,399 --> 00:19:34,439 THIS STARTED OFF AND THIS WAS A WHITE PHENOMENON AND 396 00:19:34,540 --> 00:19:35,774 PARTICULARLY IN RURAL AREAS. 397 00:19:35,874 --> 00:19:39,645 BUT IT REALLY HAS BECOME A RACE AND CLASS -- IT'S LIKE EVERYBODY 398 00:19:39,745 --> 00:19:40,879 IT'S AFFECTING EVERYBODY NOW. 399 00:19:40,979 --> 00:19:44,049 IT DOESN'T MATTER IF YOU'RE WHITE, BROWN, OR BLACK. 400 00:19:44,149 --> 00:19:46,485 IT DOESN'T MATTER IF YOU'RE RICH OR POOR. 401 00:19:46,585 --> 00:19:49,454 I ACTUALLY THINK IN MY PRACTICE, SO I DO WRITE A MEDICATION 402 00:19:49,555 --> 00:19:53,659 CALLED SEBOXONE TO HELP PEOPLE STABILIZE THEIR LIVES SO THEY 403 00:19:53,759 --> 00:19:57,763 CAN GET TO THEIR THERAPY, IF THEY HAVE OPIATE USE DISORDER. 404 00:19:57,863 --> 00:20:01,033 BUT IT ALMOST SEEMS LIKE IF YOU HAVE MORE MONEY YOU'RE MORE 405 00:20:01,133 --> 00:20:03,502 LIKELY TO BE ABLE TO BE ABLE TO BUY THESE DRUGS AND GET INTO 406 00:20:03,602 --> 00:20:04,670 THIS PROBLEM. 407 00:20:04,770 --> 00:20:12,811 SO IT REALLY CUTS ACROSS ALL SOCIOECONOMIC BOUNDS. 408 00:20:12,911 --> 00:20:15,013 AND AGAIN, THE LAST ONE SHOWS APPALACHIA. 409 00:20:15,113 --> 00:20:19,384 WE HAVE A HIGHER RATE OF DRUG OVERDOSE MORTALITY THAN THE REST 410 00:20:19,484 --> 00:20:20,719 OF THE COUNTRY. 411 00:20:20,819 --> 00:20:25,357 AND THEN JUST PUTTING A FEW OF THE COUNTIES OUT THERE, I KNOW 412 00:20:25,457 --> 00:20:28,660 SOME OF YOU ARE FROM GRAHAM COUNTY RIGHT NOW AND THEY'RE 413 00:20:28,760 --> 00:20:30,963 REALLY GETTING BROADSIDED WITH THIS. 414 00:20:31,063 --> 00:20:37,336 THIS WAS DATA FROM AROUND 2011 TO 2013, I THINK. 415 00:20:37,436 --> 00:20:43,075 SO SWITCHING GEARS, I WANT TO TALK A LITTLE BIT ABOUT 416 00:20:43,175 --> 00:20:44,009 [INAUDIBLE]. 417 00:20:44,109 --> 00:20:45,377 THERE'S ACUTE PAIN AND CHRONIC PAIN. 418 00:20:45,477 --> 00:20:47,045 THIS IS ONE OF OUR PROBLEMS. 419 00:20:47,145 --> 00:20:49,514 [ NO AUDIO ] GETTING INTO THE MEDICAL SCHOOLS 420 00:20:49,615 --> 00:20:51,083 , NURSE PRACTITIONER, P. 421 00:20:51,183 --> 00:20:54,653 A. SCHOOLS, DENTAL SCHOOLS, AND WE'RE TRYING TO TEACH THIS. 422 00:20:54,753 --> 00:20:58,924 IF YOU BELIEVE CHRONIC PAIN IS JUST ACCUSE PAIN THAT LASTS A 423 00:20:59,024 --> 00:21:02,394 LITTLE LONGER THEN YOU'RE GOING TO SAY OPIATES HELP IF YOUR BONE 424 00:21:02,494 --> 00:21:07,799 IS STICKING OUT OF YOUR SKIN SO IT MUST HELP IN CHRONIC PAIN. 425 00:21:07,899 --> 00:21:11,570 BUT CHRONIC PAIN IS A TOTALLY DIFFERENT KETTLE OF FISH AND 426 00:21:11,670 --> 00:21:14,373 THAT'S WHY THOSE TWO MEDICINES DON'T WORK IN THE SAME 427 00:21:14,473 --> 00:21:14,973 SITUATIONS. 428 00:21:15,073 --> 00:21:16,275 HERE IS ACUTE PAIN. 429 00:21:16,375 --> 00:21:19,711 YOU HAMMER YOUR TOE AND YOU HIT IT SO HARD YOU SPLIT THE SKIN 430 00:21:19,811 --> 00:21:20,145 OPEN. 431 00:21:20,245 --> 00:21:21,079 ALL RIGHT? 432 00:21:21,179 --> 00:21:22,814 YOU'RE TO HAVE A LOT OF TISSUE INPUT. 433 00:21:22,914 --> 00:21:25,017 YOU MIGHT EVEN THINK ABOUT SAY AGO BAD WORD. 434 00:21:25,117 --> 00:21:26,251 I KNOW YOU WOULDN'T. 435 00:21:26,351 --> 00:21:28,620 BUT THERE ARE THOUGHTS AND EMOTIONS THAT GO INTO THAT ACUTE 436 00:21:28,720 --> 00:21:29,154 PAIN. 437 00:21:29,254 --> 00:21:30,522 RIGHT? 438 00:21:30,622 --> 00:21:32,124 AND NOW LOOK AT CHRONIC PAIN. 439 00:21:32,224 --> 00:21:40,299 SO LIKE MY PATIENT, I'VE BEEN SEEING FOR ALMOST TEN YEARS AND 440 00:21:40,399 --> 00:21:44,536 HE HAD THREE BACK SURGEONS AND THE SURGEON SAID I CANNOT 441 00:21:44,636 --> 00:21:45,537 SURGEONIZE YOU ANYMORE. 442 00:21:45,637 --> 00:21:47,639 GO SEE YOUR DOCTOR, THAT'S ME. 443 00:21:47,739 --> 00:21:51,043 I'VE BEEN SEEING HIM TEN YEARS AND WRITING HIS OPIATES. 444 00:21:51,143 --> 00:21:54,079 AND HE'S STILL GETTING SOME TISSUE INPUT FROM THE PAIN IN 445 00:21:54,179 --> 00:21:55,147 HIS BACK. 446 00:21:55,247 --> 00:21:57,482 BUT CHRONIC PAIN REWIRES THE BRAIN. 447 00:21:57,582 --> 00:22:01,119 AND IF YOU HAVE CHRONIC PAIN AND YOU'RE ON OPIATES, IT REWIRES 448 00:22:01,219 --> 00:22:02,688 THE BRAIN EVEN MORE. 449 00:22:02,788 --> 00:22:06,792 AND SO THERE'S A LOT OF THOUGHTS AND EMOTIONS THAT ARE GOING INTO 450 00:22:06,892 --> 00:22:08,093 THE PAIN THIS GENTLEMAN HAS. 451 00:22:08,193 --> 00:22:11,396 AND I'M NOT SAYING IT'S ALL IN HIS HEAD, BUT IT'S ALL IN HIS 452 00:22:11,496 --> 00:22:14,399 HEAD AND THAT HE REALLY IS EXPERIENCING -- IF HE SAYS I'M 453 00:22:14,499 --> 00:22:17,202 HAVING 7 OUT OF 10 PAIN, IT'S THAT WAY ALL THE TIME. 454 00:22:17,302 --> 00:22:22,941 HE REALLY IS EXPERIENCING IT THAT WAY BECAUSE THE BRAIN HAS 455 00:22:23,041 --> 00:22:25,077 REWIRED. 456 00:22:25,177 --> 00:22:27,312 BECAUSE HE'S GETTING THE OPIATES ON TOP OF IT. 457 00:22:27,412 --> 00:22:30,048 SO REALLY WHAT WE'RE TRYING TO TEACH ALL THE NEW PROVIDERS THAT 458 00:22:30,148 --> 00:22:34,453 ARE COMING OUT OF THEIR PROGRAMS IS THERE IS THIS NEUROPATHIC 459 00:22:34,553 --> 00:22:36,488 PAIN, THERE'S OPIATE WITHDRAWAL PAIN. 460 00:22:36,588 --> 00:22:39,925 SO YOU ACTUALLY CAN GET MORE PAIN FROM BEING ON OPIATES. 461 00:22:40,025 --> 00:22:41,560 ISN'T THAT CRAZY? 462 00:22:41,660 --> 00:22:46,798 IT'S CALLED OPIATE HYPER ALGESIA PROBABLY TAKES MONTHS TO YEARS 463 00:22:46,898 --> 00:22:49,234 FOR THAT TO HAPPEN, BUT SOMETIMES WE ARE WEANING PEOPLE 464 00:22:49,334 --> 00:22:52,437 DOWN ON THEIR OPIATES AND THEIR PAIN GETS BETTER AND THEY START 465 00:22:52,537 --> 00:22:53,605 FEELING BETTER. 466 00:22:53,705 --> 00:22:56,508 AND THEN WHAT I WAS JUST TALKING ABOUT WAS THIS CENTRAL 467 00:22:56,608 --> 00:22:57,776 SENSITIZATION. 468 00:22:57,876 --> 00:23:01,546 SO THEY'RE HAVING THIS CHRONIC PAIN AND THEN IF THEY GET 469 00:23:01,646 --> 00:23:03,615 OPIATES ON TOP OF IT, IT'S CHANGING THEIR BRAIN. 470 00:23:03,715 --> 00:23:10,255 AND THEN THERE'S ALSO THE NOASH OWE SEPTIC PAIN, YOU HAMMER YOU. 471 00:23:10,355 --> 00:23:14,359 SO IN LIFE WHEN THEY LOOK AT US AS A SPECIES, IT'S DOPAMINE THAT 472 00:23:14,459 --> 00:23:16,161 MAKES US DO EVERYTHING WE DO. 473 00:23:16,261 --> 00:23:19,164 WHY YOU WAKE UP IN THE MORNING, YOU MAKE MONEY, EAT, DRINK, THE 474 00:23:19,264 --> 00:23:20,665 WHOLE SHOOTING MATCH, RIGHT? 475 00:23:20,766 --> 00:23:23,835 AND THERE'S ACTUALLY ONLY TWO THINGS THAT DUMP INTO DOPAMINE. 476 00:23:23,935 --> 00:23:27,539 AND THAT'S ENDORPHINS AND OPIATES. 477 00:23:27,639 --> 00:23:28,840 INTERESTINGLY. 478 00:23:28,940 --> 00:23:31,943 SO WHAT HAPPENS IF YOU HAVE SOMEBODY THAT SAYS I'VE NEVER 479 00:23:32,043 --> 00:23:35,280 TAKEN AN OPIATE BEFORE, AND THEY START TO TAKE AN OPIATE FOR THE 480 00:23:35,380 --> 00:23:36,281 FIRST TIME? 481 00:23:36,381 --> 00:23:39,384 SO WHY DO WE HAVE OPIATE RECEPTORS? 482 00:23:39,484 --> 00:23:42,254 AND MOST PROVIDERS WOULD SAY IT'S TO DECREASE PAIN. 483 00:23:42,354 --> 00:23:44,923 AND THAT'S TRUE, BUT THAT'S ACTUALLY THE SECOND REASON. 484 00:23:45,023 --> 00:23:48,527 SO IF YOU GET INTO THE PRIMARY CARE LITERATURE ON WHY AS A 485 00:23:48,627 --> 00:23:51,963 SPECIES WE HAVE OPIATE RECEPTORS , IT'S TO ACHIEVE A 486 00:23:52,063 --> 00:23:52,964 SHORT-TERM GOAL. 487 00:23:53,064 --> 00:23:54,266 IT'S FASCINATING NOW. 488 00:23:54,366 --> 00:23:56,468 THINK ABOUT THAT WHEN I SHOW YOU EVERYTHING ELSE THAT LIGHTS UP 489 00:23:56,568 --> 00:24:00,705 AS THIS PERSON IS TAKING PERCOCET SAY FOR THEIR BROKEN 490 00:24:00,806 --> 00:24:02,040 ANKLE. 491 00:24:02,140 --> 00:24:04,743 IT DEYESES PAIN, GREAT, THAT'S WHY I GAVE YOU THIS MEDICINE, 492 00:24:04,843 --> 00:24:05,777 RIGHT? 493 00:24:05,877 --> 00:24:08,313 BUT IT ALSO INCREASES MOTIVATION , IT INCREASES 494 00:24:08,413 --> 00:24:12,484 CONFIDENCE, IT INCREASES THE REWARD SYSTEM, AND IT REDUCES 495 00:24:12,584 --> 00:24:14,486 DEPRESSION AND ANXIETY. 496 00:24:14,586 --> 00:24:18,156 IT MAY ONLY BE FOR 30 MINUTES OR AN HOUR AND A HALF, IT'S REALLY 497 00:24:18,256 --> 00:24:21,426 SHORT TERM, BUT WHEN YOU FIRST START TAKING THAT, THAT CAN 498 00:24:21,526 --> 00:24:22,694 HAPPEN SOMETIMES. 499 00:24:22,794 --> 00:24:25,831 SO THINK ABOUT THAT PATIENT MAYBE THAT'S BEEN SEEING ME FOR 500 00:24:25,931 --> 00:24:28,433 FIVE YEARS AND THEY HAVE DEPRESSION, I'VE TRIED FIVE OR 501 00:24:28,533 --> 00:24:31,503 SIX DIFFERENT MEDICINES, TRIED TO GET THEM INTO THERAPY, AND 502 00:24:31,603 --> 00:24:34,172 IT'S JUST NEVER GOTTEN TAKEN CARE OF. 503 00:24:34,272 --> 00:24:37,375 AND THEY GO TO THE E.R. WITH A BROKEN WRIST AND THEY GET 504 00:24:37,476 --> 00:24:41,179 PERCOCET AND THEY TAKE IT AND THEIR DEPRESSION TOTALLY GOES 505 00:24:41,279 --> 00:24:42,514 AWAY. 506 00:24:42,614 --> 00:24:45,984 DO YOU THINK THEY'RE GOING TO FINISH THAT PERCOCET RATHER -- 507 00:24:46,084 --> 00:24:48,353 WHETHER IT'S 6 PILLS, 12 PILLS OR 30? 508 00:24:48,453 --> 00:24:49,354 FOR SURE. 509 00:24:49,454 --> 00:24:51,189 THAT'S THE BEST THEY'VE FELT IN FIVE YEARS. 510 00:24:51,289 --> 00:24:52,390 THAT CAN ACTUALLY HAPPEN. 511 00:24:52,491 --> 00:24:54,593 THAT INCREASES THE PLEASURE IN THE CURRENT ACTIVITY. 512 00:24:54,693 --> 00:24:58,296 BUT WHAT HAPPENS IF YOU TAKE OPIATES CHRONICALLY? 513 00:24:58,396 --> 00:24:59,197 OKAY? 514 00:24:59,297 --> 00:25:01,900 SO AT LEAST MONTHS BUT PROBABLY YEARS. 515 00:25:02,000 --> 00:25:05,604 AND SO IT DECREASES DOPAMINE PRODUCTION. 516 00:25:05,704 --> 00:25:06,671 THAT'S WHY WE LIVE. 517 00:25:06,771 --> 00:25:08,940 IT'S DECREASES THE NORMAL REWARD SYSTEM. 518 00:25:09,040 --> 00:25:12,911 IT DOWNREGULATES OPIATE RECEPTORS AND INCREASES 519 00:25:13,011 --> 00:25:13,979 ENDORPHINS. 520 00:25:14,079 --> 00:25:15,514 THE ONLY TWO THINGS THAT DUMP INTO DOPAMINE. 521 00:25:15,614 --> 00:25:21,319 IT DECREASES MOTIVATION AND LONG TERM IT INCREASES DEPRESSION. 522 00:25:21,419 --> 00:25:23,421 GREAT MED, HUH? 523 00:25:23,522 --> 00:25:27,792 SO THIS IS THE YELLOW BRICK ROAD , RIGHT, WIZARD OF OZ, AND 524 00:25:27,893 --> 00:25:31,663 THEY WERE SKIPPING AND SINGING THROUGH THE POPPIES. 525 00:25:31,763 --> 00:25:32,163 THAT'S RIGHT. 526 00:25:32,264 --> 00:25:33,465 THAT'S RIGHT. 527 00:25:33,565 --> 00:25:37,335 SO THIS IS AN ILLUSTRATION OF THE POPPIES SOMETIMES CAN MAKE 528 00:25:37,435 --> 00:25:40,405 YOU FEEL REALLY GOOD AT THE BEGINNING, BUT DOES ANYBODY 529 00:25:40,505 --> 00:25:43,308 REMEMBER, THEY DIDN'T QUITE MAKE IT TO THE EMERALD CITY? 530 00:25:43,408 --> 00:25:46,778 THEY FELL ASLEEP, RIGHT. 531 00:25:46,878 --> 00:25:50,148 AND IRONIC FORESHADOWING FOR EVERYTHING THAT'S HAPPENING WITH 532 00:25:50,248 --> 00:25:54,119 THIS OPIATE CRISIS NOW IS YOU GET TOO MUCH OF THE OPIATES AND 533 00:25:54,219 --> 00:25:55,887 YOU CAN FALL ASLEEP FOR SURE. 534 00:25:55,987 --> 00:26:00,158 SO THIS IS THE C.D.C. GUIDELINES THAT CAME OUT MARCH OF 2016 FOR 535 00:26:00,258 --> 00:26:01,459 ACUTE AND CHRONIC PAIN. 536 00:26:01,560 --> 00:26:04,829 AND WE'RE GOING TO START TALKING ABOUT ACUTE PAIN FIRST. 537 00:26:04,930 --> 00:26:09,134 SO THE C.D.C. CAME OUT MARCH OF 2016 AND THEY SAID TO PROVIDERS, 538 00:26:09,234 --> 00:26:12,804 IF YOU'RE GOING TO PRESCRIBE OPIATES, PRESCRIBE THREE DAYS OR 539 00:26:12,904 --> 00:26:15,373 LESS AND NO MORE THAN SEVEN IS RARELY NEEDED. 540 00:26:15,473 --> 00:26:18,577 AND THIS WAS A RADICAL CHANGE. 541 00:26:18,677 --> 00:26:21,179 NOT ONLY FOR PROVIDERS BUT FOR PATIENTS AS WELL. 542 00:26:21,279 --> 00:26:25,483 BUT AGAIN, WE'RE DOING THIS TOTALLY DIFFERENT THAN OTHER 543 00:26:25,584 --> 00:26:26,818 PLACES. 544 00:26:26,918 --> 00:26:30,555 SO IN THE COUNTRY OF GERMANY, THEY TAKE OUT ORGANS AND WHEN 545 00:26:30,655 --> 00:26:35,694 YOU LEAVE THE HOSPITAL YOU'RE ON TILE TYLENOL AND IBUPROFEN. 546 00:26:35,794 --> 00:26:37,729 AND THAT JUST DOESN'T COMPUTE WITH US OVER HERE. 547 00:26:37,829 --> 00:26:39,531 OF COURSE THAT'S REALLY SEVERE PAIN. 548 00:26:39,631 --> 00:26:42,000 I MUST NEED PERCOCET OR VICODIN, RIGHT? 549 00:26:42,100 --> 00:26:43,635 THAT'S HOW THEY DO IT. 550 00:26:43,735 --> 00:26:46,771 IT'S NOT LIKE IN ONE HOSPITAL IN GERMANY T. COUNTRY OF GERMANY. 551 00:26:46,871 --> 00:26:50,642 YOU GET A HYSTERECTOMY, THEY TAKE CARE OF NEW THE HOSPITAL 552 00:26:50,742 --> 00:26:55,246 AND WHEN YOU GO HOME YOU'RE ON TYLENOL AND IBUPROFEN. 553 00:26:55,347 --> 00:26:57,916 WE ARE TRYING TO BACK UP AND FIND OUT WHAT WE SHOULD BE DOING 554 00:26:58,016 --> 00:27:04,022 IT SAYS COUNSEL YOUR PATIENTS ON SAFE STORAGE AND DISPOSAL OF 555 00:27:04,122 --> 00:27:05,256 OPIOIDS. 556 00:27:05,357 --> 00:27:07,492 I HAVE TO SAY PRIOR TO WREADING THAT I DISPENSED A LOT OF 557 00:27:07,592 --> 00:27:09,494 VICODIN AND PERCOCET AND I NEVER DID THAT. 558 00:27:09,594 --> 00:27:10,729 BUT I DO NOW AND TEACH IT. 559 00:27:10,829 --> 00:27:13,598 THIS IS WHAT THE C.D.C. IS SAYING AND I APPRECIATE ALL 560 00:27:13,698 --> 00:27:15,600 Y'ALL THAT ARE OUT THERE AND GETTING THESE LOCKBOXES TO 561 00:27:15,700 --> 00:27:20,205 PEOPLE AND REAL LIVE -- REALLY TALKING TO THEM ABOUT IT. 562 00:27:20,305 --> 00:27:24,009 BUT WE NEED TO TALK TO EVERYONE, OUR CLIENTS, PATIENTS, AND 563 00:27:24,109 --> 00:27:25,410 ANYONE THAT WILL LISTEN IN OUR FAMILY. 564 00:27:25,510 --> 00:27:28,513 THE C.D.C. IS SAYING IF YOU HAVE AN OPIATE YOU NEED TO HAVE IT 565 00:27:28,613 --> 00:27:29,681 LOCKED UP. 566 00:27:29,781 --> 00:27:32,017 AND IF YOU DON'T USE IT ALL, YOU NEED TO GET RID OF IT. 567 00:27:32,117 --> 00:27:34,219 YOU NEED TO GET IT OUT OF YOUR HOUSE. 568 00:27:34,319 --> 00:27:35,854 THERE'S THREE WAYS TO DO IT. 569 00:27:35,954 --> 00:27:38,657 YOU CAN GOOGLE WHERE YOUR PERMANENT DROPBOX IS IN YOUR 570 00:27:38,757 --> 00:27:40,258 COMMUNITY AND TAKE IT THERE AND DROP IT OFF. 571 00:27:40,358 --> 00:27:44,095 IF YOU CAN'T DO THAT YOU CAN ADD COFFEE GROUNDS TO IT OR KITTY 572 00:27:44,195 --> 00:27:47,599 LITTER, WATER, YOU SHAKE IT UP AND MAKE A SLURRY AND THROW IT 573 00:27:47,699 --> 00:27:48,099 AWAY. 574 00:27:48,199 --> 00:27:49,401 IT WILL RUIN IT. 575 00:27:49,501 --> 00:27:51,336 OR IF YOU CAN'T DO ONE OF THOSE FIRST TWO, THEY SAY YOU SHOULD 576 00:27:51,436 --> 00:27:52,504 FLUSH IT. 577 00:27:52,604 --> 00:27:55,540 I'M JUST SAYING, FLUSHING IT FEELS NOT GOOD TO ME. 578 00:27:55,640 --> 00:28:00,912 FLUSHING THIS INTO OUR, YOU KNOT SEEMS LIKE YOU SHOULD BE ABLE TO 579 00:28:01,012 --> 00:28:02,213 DO ONE OF THE FIRST TWO. 580 00:28:02,313 --> 00:28:06,217 IF I ONLY HAD THAT OPTION, WOULD I RATHER DO THAT THAN HAVE MY 581 00:28:06,317 --> 00:28:08,119 14-YEAR-OLD BECOME ADDICTED TO OPIATES? 582 00:28:08,219 --> 00:28:09,287 YEAH, I WOULD DO IT. 583 00:28:09,387 --> 00:28:11,256 BUT THIS IS WHAT THE C.D.C. IS SAYING WE SHOULD DO. 584 00:28:11,356 --> 00:28:16,561 SO A STORY ABOUT THAT, ONE OF THE FOLKS I WORK WITH, SHE HAD A 585 00:28:16,661 --> 00:28:19,564 SOFA DELIVERED AT HER HOUSE AND ONE OF THE GUYS DELIVERING IT 586 00:28:19,664 --> 00:28:21,800 SAID HEY, CAN I USE YOUR RESTROOM? 587 00:28:21,900 --> 00:28:23,101 SHE SAID YEAH. 588 00:28:23,201 --> 00:28:26,171 THEN AFTER THEY LEFT SHE SAID HUH, HE SURE SPENT A LOT OF TIME 589 00:28:26,271 --> 00:28:27,505 IN THERE. 590 00:28:27,605 --> 00:28:31,042 SHE WENT INTO HER BATHROOM AND ALL OF HER PERCOCET WERE GONE. 591 00:28:31,142 --> 00:28:33,778 AND DO YOU THINK EVERY TIME THAT HE DELIVERS A PIECE OF FURNITURE 592 00:28:33,878 --> 00:28:37,582 THAT HE ASKS TO USE THE RESTROOM I BET HE DOES, DON'T YOU? 593 00:28:37,682 --> 00:28:42,721 AND IF WAS -- IT WAS THAT EASY FOR THAT GUY, THINK ABOUT IT. 594 00:28:42,821 --> 00:28:46,458 HOW EASY IS IT FOR OUR KIDS, OUR KIDS' FRIENDS, OUR GRANDKIDS TO 595 00:28:46,558 --> 00:28:47,759 GET TO IT? 596 00:28:47,859 --> 00:28:51,529 THERE ARE LITERALLY HUNDREDS OF MILLIONS OF UNUSED OPIATES IN 597 00:28:51,629 --> 00:28:53,364 UNLOCKED CABINETS IN OUR HOMES. 598 00:28:53,465 --> 00:28:56,868 WE GOT TO GET THEM OUT OF THERE, AND WE HAVE TO TELL OUR PATIENTS 599 00:28:56,968 --> 00:29:01,473 AND CLIENTS TO DO THE SAME THING SO WHERE DID THIS COME FROM? 600 00:29:01,573 --> 00:29:04,442 THE C.D.C. COMES OUT AND SAYS HEY, REALLY YOU SHOULD JUST GIVE 601 00:29:04,542 --> 00:29:05,677 THREE DAYS. 602 00:29:05,777 --> 00:29:07,979 BUT IF YOU HAVE TO, SEVEN DAYS BUT NOT MORE THAN SEVEN. 603 00:29:08,079 --> 00:29:12,884 SO THIS IS A TEN-YEAR STUDY OF ADULTS IN THE UNITED STATES. 604 00:29:12,984 --> 00:29:13,618 OKAY? 605 00:29:13,718 --> 00:29:14,986 AND THEY WERE OPIATE NAIVE. 606 00:29:15,086 --> 00:29:19,090 THEY HAD NEVER HAD AN OPIATE BEFORE AND THEY GET A LEGITIMATE 607 00:29:19,190 --> 00:29:23,128 PRESCRIPTION FROM THEIR PROVIDER LEGITIMATE PRESCRIPTION FROM 608 00:29:23,228 --> 00:29:25,430 THEIR DOCTOR FOR A LEGITIMATE REASON. 609 00:29:25,530 --> 00:29:27,732 THEY SAY WHAT'S THE CHANCE YOU'RE STILL ON OPIATES AT A 610 00:29:27,832 --> 00:29:29,134 YEAR AND AT THREE YEARS? 611 00:29:29,234 --> 00:29:30,835 SO I JUST WANT TO SHOW YOU HERE. 612 00:29:30,935 --> 00:29:33,104 IF YOU'LL FOCUS IN AT THE 30 DAYS. 613 00:29:33,204 --> 00:29:36,174 SO IF YOU GOT A 30-DAY PRESCRIPTION, NEVER HAD AN 614 00:29:36,274 --> 00:29:39,844 OPIATE IN YOUR LIFE, ONE YEAR LATER, 30% OF PEOPLE ARE STILL 615 00:29:39,944 --> 00:29:42,547 ON AN OPIATE. 616 00:29:42,647 --> 00:29:47,986 THREE YEARS LATER, 15, ALMOST 20 % OF PEOPLE ARE STILL ON AN 617 00:29:48,086 --> 00:29:49,287 OPIATE. 618 00:29:49,387 --> 00:29:51,756 THAT IS NOT LESS THAN 1% OF PEOPLE WHO EVER GET DEPENDENT 619 00:29:51,856 --> 00:29:52,757 OSH ADDICTED TO THESE. 620 00:29:52,857 --> 00:29:56,094 THESE ARE REALLY SAFE MEDICINES, IS IT? 621 00:29:56,194 --> 00:30:00,365 FROM ONE 30-DAY PRESCRIPTION, 15 TO 20% OF PEOPLE THREE YEARS 622 00:30:00,465 --> 00:30:03,802 LATER ARE STILL TAKING AN OPIATE NOW, THEY DIDN'T BREAK IT OUT IN 623 00:30:03,902 --> 00:30:05,103 THAT DATASET. 624 00:30:05,203 --> 00:30:06,771 PROBABLY THE MAJORITY OF THEM ARE STILL IN PAIN AND SEEING 625 00:30:06,871 --> 00:30:08,640 THEIR PROVIDER AND GETTING A MEDICATION FOR THAT. 626 00:30:08,740 --> 00:30:11,109 BUT MAYBE SOME OF THEM ARE GETTING THEM FROM FAMILY AND 627 00:30:11,209 --> 00:30:13,778 FRIENDS, MAYBE SOME OF THEM ARE SLOOTING HEROINE. 628 00:30:13,878 --> 00:30:16,915 THEY JUST SAID HAD YOU ON AN OPIATE ONE YEAR AND THREE YEARS 629 00:30:17,015 --> 00:30:19,851 LATER AND WHERE THAT DATASET STARTS TO GO UP IS RIGHT HERE AT 630 00:30:19,951 --> 00:30:21,152 THREE DAYS. 631 00:30:21,252 --> 00:30:22,854 AND WHY WE IN NORTH CAROLINA PASSED THE NORTH CAROLINA STOP 632 00:30:22,954 --> 00:30:28,059 ACT THAT NOW SAYS FOR ACUTE PAIN THAT YOU CAN ONLY PRESCRIBE FIVE 633 00:30:28,159 --> 00:30:31,763 DAYS WORTH OR AFTER SURGERY SEVEN TO TRY TO REDUCE THE 634 00:30:31,863 --> 00:30:38,803 CHANCE THAT FOLKS WILL STILL BE ON OPIATES AT A YEAR. 635 00:30:38,903 --> 00:30:41,706 THEN THIS DATASET IS FROM THIS SAME STUDY WHERE THEY SAID WHAT 636 00:30:41,806 --> 00:30:43,007 ABOUT THIS REFILL BUSINESS? 637 00:30:43,107 --> 00:30:49,214 SO I'VE HAD THIS PATIENT I WAS 638 00:30:49,314 --> 00:30:52,617 16 YEARS OLD, BROKE MY BACK IN THREE PLACES AND MY DOCTOR GAVE 639 00:30:52,717 --> 00:30:55,253 ME PERCOCET FOR A MONTH AND REFILLED IT SIX TIMES OVER THE 640 00:30:55,353 --> 00:30:57,889 PHONE AND THEN SAID GO SEE YOUR REGULAR DOCTOR. 641 00:30:57,989 --> 00:31:00,191 I CAN'T DO THIS ANYMORE. 642 00:31:00,291 --> 00:31:03,761 AND SHE FOUND THAT SHE STARTED TO WITHDRAW AND SHE -- SHE HATED 643 00:31:03,862 --> 00:31:05,029 THAT. 644 00:31:05,129 --> 00:31:09,767 SO SHE STARTED BUYING PILLS AT SCHOOL AND THEN BY 20 WAS 645 00:31:09,868 --> 00:31:12,570 SHOOTING HEROINE AND ROLLED IN TO SEE ME WHEN ONE OF HER 646 00:31:12,670 --> 00:31:15,440 FRIENDS OVERDOSED AND DIED AND SAID I DON'T WANT TO DO THIS 647 00:31:15,540 --> 00:31:16,040 ANYMORE. 648 00:31:16,140 --> 00:31:17,342 I DON'T WANT TO DIE. 649 00:31:17,442 --> 00:31:19,811 AND WHAT HAPPENS IF YOU GET A PRESCRIPTION AND THEN YOU REFILL 650 00:31:19,911 --> 00:31:21,145 IT SIX TIMES? 651 00:31:21,246 --> 00:31:24,916 WELL, THERE'S A 60% CHANCE THAT YOU'LL STILL BE ON OPIATES AT A 652 00:31:25,016 --> 00:31:28,820 YEAR AND A 40% CHANCE YOU'RE STILL ON OPIATES AT THREE YEARS. 653 00:31:28,920 --> 00:31:32,957 THIS IS NOT LESS THAN 1% OF THE PEOPLE. 654 00:31:33,057 --> 00:31:35,860 SO FOR CHRONIC PAIN, THIS WAS VERY CONTROVERSIAL, TOO. 655 00:31:35,960 --> 00:31:40,265 IT SAID IN GENERAL DO NOT PRESCRIBE OPIATES AS FIRST LINE 656 00:31:40,365 --> 00:31:43,534 TREATMENT FOR KRON CHRONIC PAIN AND THEN RIGHT UNDERNEATH IT IF 657 00:31:43,635 --> 00:31:48,439 YOU GO TO THE C.D.C. WEBSITE, DO NOT PRESCRIBE OPIATES FOR LOW 658 00:31:48,539 --> 00:31:56,114 BACK PAIN, FINE BRO -- FIBROMYALGIA AND HEADACHES. 659 00:31:56,214 --> 00:31:59,183 I HAVE DONE THAT OVER MY PRACTICE. 660 00:31:59,284 --> 00:32:02,086 AND THIS IS A HARD THING TO SAY BUT I LOOK AT MY PATIENTS AND I 661 00:32:02,186 --> 00:32:04,055 BELIEVE I ADDICTED SOME OF THEM. 662 00:32:04,155 --> 00:32:06,691 DOCTORS WERE TRYING TO HELP PEOPLE, WE CERTAINLY WEREN'T 663 00:32:06,791 --> 00:32:09,594 TRYING TO HURT THEM BUT THIS IS WHAT WE DID. 664 00:32:09,694 --> 00:32:11,796 WE BOUGHT THIS BILL OF GOODS THAT THESE MEDICINES ARE SAFE 665 00:32:11,896 --> 00:32:20,505 AND THEY'RE REALLY NOT. 666 00:32:20,605 --> 00:32:23,641 CHRONIC PAIN, LOW BACK PAIN ON OPIATES AND THERE'S BEEN LOTS OF 667 00:32:23,741 --> 00:32:28,479 STUDIES ABOUT HOW THESE FOLKS HAVE DONE AND FOUND FOUR HIGH- 668 00:32:28,579 --> 00:32:30,982 QUALITY STUDIES AND DO THIS THING CALLED A META-ANALYSIS. 669 00:32:31,082 --> 00:32:34,385 AND THE QUESTION IS WHAT'S THE CHANCE IF YOU HAVE CHRONIC LOW 670 00:32:34,485 --> 00:32:37,689 BACK PAIN AND OPIATE YOU'LL HAVE A SUBSTANCE ABUSE DISORDER IN 671 00:32:37,789 --> 00:32:39,023 YOUR LIFETIME? 672 00:32:39,123 --> 00:32:43,728 LOOK AT THAT 36 TO 56% OF PEOPLE WILL HAVE A SUBSTANCE ABUSE DIS 673 00:32:43,828 --> 00:32:46,197 ORDER IF THEY'RE ON OPIATES FOR CHRONIC BACK PAIN. 674 00:32:46,297 --> 00:32:47,732 THAT'S NOT LESS THAN 1%, RIGHT? 675 00:32:47,832 --> 00:32:51,936 AND THIS IS AN ARTICLE FROM JAMA , JUST IN 2018 AND THEY SAID 676 00:32:52,036 --> 00:32:55,440 , OKAY, YOU HAVE CHRONIC BACK PAIN AND YOU'RE EITHER ON 677 00:32:55,540 --> 00:32:57,008 AN OPIATE OR NOT. 678 00:32:57,108 --> 00:32:57,909 HOW DO YOU DO? 679 00:32:58,009 --> 00:32:59,243 AND THIS IS WHAT THEY FOUND OUT. 680 00:32:59,344 --> 00:33:01,946 THERE'S NO SIGNIFICANT DIFFERENCE IN THE TWO GROUPS IN 681 00:33:02,046 --> 00:33:05,817 TERMS OF THEIR PAIN RELATED FUNCTION AT 12 MONTHS BUT THE 682 00:33:05,917 --> 00:33:10,188 PAIN INTENSITY WAS SIGNIFICANTLY BETTER IN THE NON-OPIATE GROUP. 683 00:33:10,288 --> 00:33:14,258 SO YOU ACTUALLY FELT BETTER IF YOU WEREN'T GETTING OPIATES FOR 684 00:33:14,359 --> 00:33:15,493 YOUR CHRONIC BACK PAIN. 685 00:33:15,593 --> 00:33:18,730 AND THE OPIATE GROUP HAD SIGNIFICANTLY MORE MEDICATION 686 00:33:18,830 --> 00:33:26,537 SIDE EFFECTS LIKE FALLS, OVER DOSE, AND DEATH IN SOME OF THEM. 687 00:33:26,637 --> 00:33:27,839 WHAT ABOUT KIDS? 688 00:33:27,939 --> 00:33:30,675 THE NEXT COUPLE OF SLIDES, THE STORY IS THE BRAIN UNDER 25 689 00:33:30,775 --> 00:33:33,378 SHOULD NOT BE TOUCHING THIS STUFF IF AT ALL POSSIBLE. 690 00:33:33,478 --> 00:33:38,950 SO THEY DID THIS STUDY, IT'S IN PEDIATRICS, IT'S AN ES SCHEME -- 691 00:33:39,050 --> 00:33:42,020 ESTEEMED JOURNAL BEEN THE PEDIATRIC GRIEWBING, 2015. 692 00:33:42,120 --> 00:33:45,089 AND THEY SAID WHAT'S THE CHANCE YOU'LL HAVE A SUBSTANCE ABUSE 693 00:33:45,189 --> 00:33:48,826 DISORDER IN YOUR EARLY ADULTHOOD IF YOU GET ONE LEGITIMATE 694 00:33:48,926 --> 00:33:52,030 PRESCRIPTION OF AN OPIATE BEFORE 12th GRADE? 695 00:33:52,130 --> 00:33:55,666 WHAT THEY FOUND OUT IS IT INCREASING YOUR CHANCE 33%. 696 00:33:55,767 --> 00:33:59,670 SO I DIDN'T SAY IF YOU TAKE 100 KIDS AND GIVE THEM AN OPIATE FOR 697 00:33:59,771 --> 00:34:01,672 THEIR BROKEN WRIST THAT 33 WILL GET ADDICTED. 698 00:34:01,773 --> 00:34:03,007 I DIDN'T SAY THAT. 699 00:34:03,107 --> 00:34:09,480 BUT IF YOUR CHANCE WAS 1% OR 2% OR 6%, IT BUMPS IT 33% MORE FROM 700 00:34:09,580 --> 00:34:10,681 ONE PRESCRIPTION. 701 00:34:10,782 --> 00:34:14,185 AND THAT ACTUALLY REALLY CONCERNED THE RESEARCHERS A LOT. 702 00:34:14,285 --> 00:34:17,722 THEY SAID WHAT ABOUT KIDS THAT HAVE A LOW CHANCE OF EVER HAVING 703 00:34:17,822 --> 00:34:19,157 A SUBSTANCE USE DISORDER? 704 00:34:19,257 --> 00:34:25,296 THEY DIDN'T USE ACE SCORES OR ADVERSE CHILDHOOD EXPERIENCES 705 00:34:25,396 --> 00:34:28,566 BUT IT WAS SIMILAR TO THAT. 706 00:34:28,666 --> 00:34:34,138 IF YOUR ACE SCORE WAS LOW, A 0 OR 1, THIS SHOULD BE SOMEBODY 707 00:34:34,238 --> 00:34:37,208 WHO HAS A LOW CHANCE OF HAVING A SUBSTANCE ABUSE DISORDER IN 708 00:34:37,308 --> 00:34:41,679 THEIR ADULT ONE, ONE LEGITIMATE PRESCRIPTION INCREASED THAT KIDS 709 00:34:41,779 --> 00:34:43,181 ' CHANCE 300%. 710 00:34:43,281 --> 00:34:45,983 IF YOU WERE A 1%, NOW YOU'RE A 3 %. 711 00:34:46,084 --> 00:34:49,420 SO IF YOU'RE A 3% CHANCE, YOU NOW ARE A 9% CHANCE. 712 00:34:49,520 --> 00:34:52,056 JUST FROM ONE LEGITIMATE PRESCRIPTION. 713 00:34:52,156 --> 00:34:53,391 BUT THERE IS HOPE. 714 00:34:53,491 --> 00:34:57,462 IVE BEEN HANGING A LOT OF CREPE AS THEY SAY HERE IN THE SOUTH SO 715 00:34:57,562 --> 00:34:58,763 FAR. 716 00:34:58,863 --> 00:35:03,634 BUT IF YOU TALK TO KIDS ABOUT DRUGS, 50% REDUCTION IN STARTING 717 00:35:03,734 --> 00:35:06,104 AND USING ILLICIT DRUGS. 718 00:35:06,204 --> 00:35:07,805 THAT'S AMAZING, RIGHT? 719 00:35:07,905 --> 00:35:10,508 AND WE NEED TO BE DOING THAT, BECAUSE LOOK AT THAT TIME 720 00:35:10,608 --> 00:35:12,110 STATISTIC ABOVE THAT. 721 00:35:12,210 --> 00:35:15,146 90% OF PEOPLE THAT ARE ADULTS THAT HAVE A SUBSTANCE USE 722 00:35:15,246 --> 00:35:18,683 DISORDER STARTED BEFORE THE AGE OF 18. 723 00:35:18,783 --> 00:35:20,651 50% STARTED BEFORE 15. 724 00:35:20,751 --> 00:35:22,153 SO WE DO NEED TO BE DOING THIS. 725 00:35:22,253 --> 00:35:24,989 WE NEED TO TALK TO OUR KIDS, OUR GRANDKIDS, ANYBODY THAT WILL 726 00:35:25,089 --> 00:35:27,592 LISTEN, AND WE NEED TO BE TALKING TO ALL OF OUR PATIENTS 727 00:35:27,692 --> 00:35:30,161 AND TELLING THEM TO TALK TO THEIR KIDS. 728 00:35:30,261 --> 00:35:33,965 50% REDUCTION IN STARTING DRUGS OR USING DRUGS. 729 00:35:34,065 --> 00:35:36,834 BUT INTERESTINGLY, SO THEN THEY GO AND TALK TO THOSE KIDS AND 730 00:35:36,934 --> 00:35:39,337 THEY SAY HEY, DID SOMEONE TALK TO YOU ABOUT DRUGS? 731 00:35:39,437 --> 00:35:40,805 YEAH, YOU KNOW, MY MOM DID. 732 00:35:40,905 --> 00:35:43,141 AND THEY SAY WELL WHAT DID SHE SAY? 733 00:35:43,241 --> 00:35:49,113 AND THEY SAY WELL, SHE TALKED TO ME ABOUT COCAINE AND METH AND 734 00:35:49,213 --> 00:35:50,348 HEROINE. 735 00:35:50,448 --> 00:35:53,784 ALMOST NEVER DO WE TALK TO THEM ABOUT PRESCRIPTION DRUGS. 736 00:35:53,885 --> 00:35:57,722 BUT YET THAT IS THE MOST COMMON WAY THAT YOU GET TO HEROINE. 737 00:35:57,822 --> 00:36:00,258 AND I GET IT, RIGHT? 738 00:36:00,358 --> 00:36:03,027 SOMEBODY WITH A WHITE COAT ON WROTE THE PRESCRIPTION AND 739 00:36:03,127 --> 00:36:06,164 HANDED IT TO YOU AND YOU WENT AND PICKED IT UP FROM SOMEBODY 740 00:36:06,264 --> 00:36:07,832 IN A WHITE COAT AT A PHARMACY. 741 00:36:07,932 --> 00:36:09,367 IT MUST BE SAFE. 742 00:36:09,467 --> 00:36:10,434 BUT IT'S NOT. 743 00:36:10,535 --> 00:36:11,769 RIGHT? 744 00:36:11,869 --> 00:36:14,105 SO WE REALLY NEED TO TALK TO OUR KIDS ABOUT DRUGS, BUT WE NEED TO 745 00:36:14,205 --> 00:36:16,040 SPECIFICALLY TALK TO THEM ABOUT PRESCRIPTION DRUGS. 746 00:36:16,140 --> 00:36:20,378 NOT USING THEM OR ABUSING THEM WHEN THEY GO TO THESE PARTIES OR 747 00:36:20,478 --> 00:36:22,380 BUYING THEM FROM OTHERS. 748 00:36:22,480 --> 00:36:28,953 SO WHAT ARE SOME OF THE ALTERNATIVES? 749 00:36:29,053 --> 00:36:30,154 WHAT CAN WE DO? 750 00:36:30,254 --> 00:36:37,261 TALK ABOUT ACUTE PAIN, THERE'S A SIT MINH FIN, IBUPROFEN, 751 00:36:37,361 --> 00:36:38,563 OPIATES FOR ACUTE PAIN. 752 00:36:38,663 --> 00:36:40,932 YOU MIGHT GATHER I'M A LITTLE DOWN ON THEM. 753 00:36:41,032 --> 00:36:43,467 THERE'S TOPICAL ACTS AND THIS REALLY DOES WORK WHEN YOU HAVE 754 00:36:43,568 --> 00:36:45,870 ACUTE PAIN, ICE, HEAT, PHYSICAL THERAPY. 755 00:36:45,970 --> 00:36:46,304 THEY WORK. 756 00:36:46,404 --> 00:36:47,071 ALL RIGHT? 757 00:36:47,171 --> 00:36:48,472 SO WHAT ARE THE SIDE EFFECTS? 758 00:36:48,573 --> 00:36:52,777 YOU HAVE SOMEBODY THAT'S TAKING SOME TYLENOL AND SOMETIMES IF 759 00:36:52,877 --> 00:36:55,479 YOU DON'T TAKE IT RIGHT [ NO AUDIO ] 760 00:36:55,580 --> 00:36:59,917 WHAT ABOUT THESE NSAIDS, IBUPROFEN, ALEVE, MOTRIN? 761 00:37:00,017 --> 00:37:03,454 WELL, IT CAN CAUSE YOU TO HAVE A LITTLE BIT OF BLEEDING IN YOUR 762 00:37:03,554 --> 00:37:03,955 GUT. 763 00:37:04,055 --> 00:37:05,289 THAT SOUNDS BAD. 764 00:37:05,389 --> 00:37:07,725 AND IT CAN AFFECT YOUR KIDNEY IF YOU HAVE KIDNEY PROBLEMS AND IT 765 00:37:07,825 --> 00:37:09,527 CAN MAKE YOUR BLOOD PRESSURE GO UP. 766 00:37:09,627 --> 00:37:11,362 THOSE ALL SOUND KIND OF SCARY, RIGHT? 767 00:37:11,462 --> 00:37:13,898 WHAT ARE THE SIDE EFFECTS OF OPIATES FOR TAKING THEM FOR 768 00:37:13,998 --> 00:37:15,166 ACUTE PAIN? 769 00:37:15,266 --> 00:37:18,869 WELL, THEY'RE MENTALLY IMPAIRING IT DELAYS RECOVERY. 770 00:37:18,970 --> 00:37:21,872 AND I'M OUT THERE TRYING TO TALK TO ALL THE SURGEONS ABOUT THIS. 771 00:37:21,973 --> 00:37:25,543 DOW THE SAME SUR JOB ON TWO GROUPS, ONE YOU GIVE OPIATES 772 00:37:25,643 --> 00:37:28,679 WHEN THEY GO OPEN AND THE OTHERS YOU DON'T, THE ONES WHO GET THE 773 00:37:28,779 --> 00:37:31,782 OPIATES, THEY HAVE DELAYED RECOVERY AND DELAY WOUND HEALING 774 00:37:31,882 --> 00:37:32,683 THAT'S CRAZY. 775 00:37:32,783 --> 00:37:34,252 WE DON'T KNOW WHY, BUT IT HAPPENS. 776 00:37:34,352 --> 00:37:38,155 SO IT INCREASES MEDICAL COSTS WHEN YOU GIVE THEM OP YACHTS, 777 00:37:38,256 --> 00:37:40,725 THE OPIATE HYPERALGESIA. 778 00:37:40,825 --> 00:37:44,562 YOU CAN START DEVELOPING PAIN FROM THE MEDICINE. 779 00:37:44,662 --> 00:37:47,131 IT DOUBLES YOUR CHANCE OF GOING OUT ON PERMANENT DISABILITY IN 780 00:37:47,231 --> 00:37:48,633 AS LITTLE AS SEVEN DAYS. 781 00:37:48,733 --> 00:37:50,234 IT INCREASES FALLS. 782 00:37:50,334 --> 00:37:53,571 IT TREATS DEPRESSION SHORT TERM BUT MAKES IT WORSE LONG TERM, 783 00:37:53,671 --> 00:37:54,538 RIGHT? 784 00:37:54,639 --> 00:37:56,073 AND THEN THIS BRAIN CHANGING BUSINESS. 785 00:37:56,173 --> 00:37:57,375 I'VE GOT TO TELL YOU ABOUT THIS. 786 00:37:57,475 --> 00:38:01,012 THERE'S A SURGEON IN TEXAS, HE DOES A CERTAIN KIND OF NECK 787 00:38:01,112 --> 00:38:02,280 SURGERY. 788 00:38:02,380 --> 00:38:05,349 AND HIS USUAL IS YOU COME OUT OF SURGERY AND YOU GET ON I.V. 789 00:38:05,449 --> 00:38:08,152 OPIATES AND YOU GET OPIATES BY MOUTH AND THEN YOU GO HOME AND 790 00:38:08,252 --> 00:38:11,055 BACK THEN HE WOULD GIVE 30 DAYS OF OPIATES. 791 00:38:11,155 --> 00:38:14,158 AND SO HE HAD HIS USUAL GROUP AND THEN HE HAD ANOTHER GROUP 792 00:38:14,258 --> 00:38:17,061 THAT WHEN THEY WENT HOME, THEY DIDN'T GET ANY OPIATES AT ALL. 793 00:38:17,161 --> 00:38:20,998 AND AT 30 DAYS HE SCANNED THEIR BRAINS AND HE COULD SEE BRAIN 794 00:38:21,098 --> 00:38:24,702 CHANGES IN THE PEOPLE THAT GOT THE OP YACHTS. 795 00:38:24,802 --> 00:38:25,903 - -- OPIATES. 796 00:38:26,003 --> 00:38:28,739 THAT REALLY SCARED HIM, CONCERNED HIM. 797 00:38:28,839 --> 00:38:32,443 HE TOOK THEM OFF THEIR OPIATES AND WAITED SIX MONTHS AND SKEIN 798 00:38:32,543 --> 00:38:35,913 SCANNED THEIR BRAINS AGAIN, AND THOSE CHANGES WERE STILL THERE. 799 00:38:36,013 --> 00:38:39,317 SO OPIATES CAN CAUSE BRAIN CHANGES AND SOMETIMES THOSE 800 00:38:39,417 --> 00:38:41,252 BRAIN CHANGES ARE PERMANENT. 801 00:38:41,352 --> 00:38:45,723 AND THEN OPIATES CAN CAUSE ADDICTION. 802 00:38:45,823 --> 00:38:47,024 SO WHAT CAN WE DO? 803 00:38:47,124 --> 00:38:51,762 WE CAN -- THIS IS A STUDY OF OVER 40,000 PATIENTS BUT THEY 804 00:38:51,862 --> 00:38:53,030 WEREN'T HEAD-TO-HEAD STUDIES. 805 00:38:53,130 --> 00:38:54,265 THEY WERE INDIVIDUAL ONES. 806 00:38:54,365 --> 00:38:57,168 AND IT WAS ONE HOUR AFTER SURGERY THEY GAVE ONE OF THE 807 00:38:57,268 --> 00:38:58,469 FOLLOWING MEDICATIONS. 808 00:38:58,569 --> 00:39:01,405 AND IF YOU HAD A 50% REDUCTION IN YOUR PAIN, THEN THAT WAS 809 00:39:01,505 --> 00:39:02,973 CONSIDERED A WIN. 810 00:39:03,074 --> 00:39:04,275 PEOPLE FELT SATISFIED. 811 00:39:04,375 --> 00:39:07,278 SO YOU GIVE ONE IBUPROFEN OVER THE COUNTER, 200 MILLIGRAMS. 812 00:39:07,378 --> 00:39:10,981 AND 37 OUT OF ONE HIN PEOPLE, ONE HOUR AFTER SURGERY SAID I'VE 813 00:39:11,082 --> 00:39:14,051 GOT 50% PAIN RELIEF FROM ONE IBUPROFEN. 814 00:39:14,151 --> 00:39:15,319 THAT'S PRETTY GOOD. 815 00:39:15,419 --> 00:39:16,821 TYLENOL, IT WAS 28. 816 00:39:16,921 --> 00:39:20,624 THEY INCREASED -- DOUBLED THE IBUPROFEN AND GOT TO 40. 817 00:39:20,725 --> 00:39:24,729 AND IBUPROFEN 600 AND 800 IT WENT UP TO ABOUT 41 OR 42. 818 00:39:24,829 --> 00:39:28,032 SO IT DOESN'T GO UP MUCH MORE, BUT YOU DO START TO PICK UP THE 819 00:39:28,132 --> 00:39:30,601 SIDE EFFECTS SO WE PROBABLY SHOULD STAY ON THE LOWER END OF 820 00:39:30,701 --> 00:39:31,335 THE IBUPROFEN. 821 00:39:31,435 --> 00:39:38,142 BUT WHAT ABOUT OXYCODONE. 822 00:39:38,242 --> 00:39:39,043 15 MILLIGRAMS, OKAY? 823 00:39:39,143 --> 00:39:41,278 IT HAS F.D.A. APPROVED [ NO AUDIO ] 824 00:39:41,379 --> 00:39:43,180 LOOK AT THAT. 825 00:39:43,280 --> 00:39:47,017 ONLY 21 OUT OF 100 PEOPLE GOT 50 % PAIN RELIEF OR MORE. 826 00:39:47,118 --> 00:39:50,721 BUT THEN THEY -- PHARMACEUTICAL INDUSTRY SAID WOW, OUR MEDICINES 827 00:39:50,821 --> 00:39:54,225 NOT WORKING VERY WELL, SO THEY ADDED TILE NOT TO IT AND MADE 828 00:39:54,325 --> 00:39:56,527 PERCOCET AND GOT BACK UP TO THE 37, RIGHT? 829 00:39:56,627 --> 00:39:59,530 BUT WHAT HAPPENS IF YOU TOOK ONE TILE TYLENOL AND ONE IBUPROFEN, 830 00:39:59,630 --> 00:40:03,667 AND THIS IS THE KEY, TOGETHER AT THE SAME TIME ONE HOUR AFTER 831 00:40:03,768 --> 00:40:06,904 SURGE JI -- SURGERY? 832 00:40:07,004 --> 00:40:11,142 IN 62 OUT OF 100 PEOPLE GOT 50% PAIN RELIEF. 833 00:40:11,242 --> 00:40:13,544 SO DO YOU THINK THIS IS WHAT I'M TELLING MY PATIENTS TO USE? 834 00:40:13,644 --> 00:40:14,812 YEAH. 835 00:40:14,912 --> 00:40:17,948 IS THIS WHAT I WOULD WANT MY KID TO GET IF HE WERE INJURED OR 836 00:40:18,048 --> 00:40:18,349 HURT? 837 00:40:18,449 --> 00:40:18,883 FOR SURE. 838 00:40:18,983 --> 00:40:20,184 FOR TWO REASONS. 839 00:40:20,284 --> 00:40:22,520 ONE, IS IT WORKS THE BEST, AND THE OTHER IS IT'S NOT ADDICTIVE. 840 00:40:22,620 --> 00:40:25,556 SO THIS IS WHAT WE'RE TEACHING THE NEXT GENERATION OF FOLKS. 841 00:40:25,656 --> 00:40:29,860 THIS IS WHAT AGAIN THE REST OF THE WORLD IS ACTUALLY USING 842 00:40:29,960 --> 00:40:34,899 INCLUDING EUROPE. 843 00:40:34,999 --> 00:40:38,803 SO THEN WE HAD OUR FIRST HEAD-TO-HEAD TRIAL IN THE 844 00:40:38,903 --> 00:40:42,139 EMERGENCY DEPARTMENT AND TYLENOL AND IBUPROFEN DID JUST AS GOOD 845 00:40:42,239 --> 00:40:43,474 AS THE PERK E SET. 846 00:40:43,574 --> 00:40:46,143 AND KIDNEY STONES, I DON'T KNOW IF ANYBODY HAS EVER HAD A KIDNEY 847 00:40:46,243 --> 00:40:47,445 STONE. 848 00:40:47,545 --> 00:40:49,613 IT'S SUPPOSED TO BE SOME OF THE MORE INTENSE PAIN THAT YOU CAN 849 00:40:49,713 --> 00:40:58,088 ER EXPERIENCE, AND USING I.V. IN SEDZ LIKE IBUPROFEN, COUSIN IS 850 00:40:58,189 --> 00:41:05,629 CALLED TORADOL, VERSE -- VERSUS AN OPIOID THEY HAD EQUAL 851 00:41:05,729 --> 00:41:09,400 EFFICACY AND TREATMENT BUT OPIOID HAD MORE SIDE EFFECTS. 852 00:41:09,500 --> 00:41:12,236 POSTOP PAIN, INTERESTINGLY THEY DID THIS STUDY WHERE THEY HAD 853 00:41:12,336 --> 00:41:14,505 THIS MAJOR SURGERY WHERE THEY SPLIT THE PEOPLE OPEN AND CUT 854 00:41:14,605 --> 00:41:16,207 OUT A PIECE OF THEIR BOWEL. 855 00:41:16,307 --> 00:41:17,675 SO IT'S COLON SURGERY. 856 00:41:17,775 --> 00:41:18,943 IT'S A MAJOR SURGERY. 857 00:41:19,043 --> 00:41:25,516 AND USUALLY THE USUAL CARE IS IS THAT YOU COME OUT OF SURGERY 858 00:41:25,616 --> 00:41:28,319 AND GET A P-C-A PUMP. 859 00:41:28,419 --> 00:41:32,289 EVERY 15 MINUTES YOU CAN PUSH IT TO GET OPIATES TO HELP WITH PAIN 860 00:41:32,389 --> 00:41:35,993 WHAT THEY DECIDED TO DO IS WHEN YOU COME OUT OF SURGERY THEY'RE 861 00:41:36,093 --> 00:41:38,596 GOING TO TRY NOT TO GIVE YOU OPIATES AT ALL AND TRY THESE 862 00:41:38,696 --> 00:41:39,864 OTHER THINGS. 863 00:41:39,964 --> 00:41:41,765 ONE OF IF THINGS THEY DID IS THEY TALKED TO THE PATIENTS 864 00:41:41,866 --> 00:41:45,135 BEFORE THE SURGERY FOR UP TO 30 MINUTES ABOUT WHAT THE PAIN WAS 865 00:41:45,236 --> 00:41:47,671 GOING TO BE LIKE WHEN THEY WOKE UP. 866 00:41:47,771 --> 00:41:49,840 AND THEY SAID [ NO AUDIO ] 867 00:41:49,940 --> 00:41:50,808 HAVING MAJOR SURGERY. 868 00:41:50,908 --> 00:41:52,977 WHEN YOU WAKE UP YOU'RE GOING TO HAVE PAIN. 869 00:41:53,077 --> 00:41:55,145 AND WE'RE GOING TO TRY TO DO ALL THESE THINGS FOR YOU. 870 00:41:55,246 --> 00:41:57,815 AND WE'LL GIVE YOU THIS KIND OF MEDICINE AND THAT KIND OF 871 00:41:57,915 --> 00:42:00,451 MEDICINE AND GIVE YOU HEATING PAD. 872 00:42:00,551 --> 00:42:04,622 WE'LL WALK YOU AND DO ALL THESE OTHER THINGS. 873 00:42:04,722 --> 00:42:07,424 AND 50% OF THE PEOPLE WHEN THEY WOKE UP, THEY SAID HEY, THE PAIN 874 00:42:07,525 --> 00:42:10,628 IS NOT AS BAD AS I WAS EXPECTING AND THINK ABOUT THAT, IF YOU'RE 875 00:42:10,728 --> 00:42:15,432 THE NURSE OR THE DOCTOR TRYING TO TREAT THAT PATIENT AND THEY 876 00:42:15,533 --> 00:42:22,473 THINK HEY, THIS ISN'T AS BAD AS I WAS EX -- PECTING YOU'RE IN 877 00:42:22,573 --> 00:42:25,910 PRETTY GOOD SHAPE IN TRYING TO GIVE THEM TYLENOL AND A HEATING 878 00:42:26,010 --> 00:42:27,211 BAD. 879 00:42:27,311 --> 00:42:28,646 IF YOU'RE IN THE OTHER WING, WHICH IS MOST OF AMERICA, AND 880 00:42:28,746 --> 00:42:31,282 YOU WAKE UP AND GO OH, MY GOD, THAT IS LOT OF PAIN. 881 00:42:31,382 --> 00:42:35,819 DIDN'T THE DOCTOR OR NURSE TELL YOU YOU WERE GOING TO BE IN PAIN 882 00:42:35,920 --> 00:42:37,021 NO. 883 00:42:37,121 --> 00:42:38,989 IF YOU'RE EXPECTING 0 OUT OF 10 PAIN YOU'RE GOING TO BE 884 00:42:39,089 --> 00:42:40,824 CALLING FOR THOSE OPIATES OVER AND OVER AGAIN. 885 00:42:40,925 --> 00:42:42,726 THIS HAS DONE APLAYSING THINGS. 886 00:42:42,826 --> 00:42:46,030 IT'S REDUCED THE AMOUNT OF OPIATES THEY'RE GIVING FOR 887 00:42:46,130 --> 00:42:48,465 CERTAIN SURGERIES AND WE'RE DOING THIS AT HOSPITALS IN 888 00:42:48,566 --> 00:42:49,466 WESTERN NORTH CAROLINA. 889 00:42:49,567 --> 00:42:51,468 REDUCED THE NUMBER OF OPIATES BY 30%. 890 00:42:51,569 --> 00:42:55,940 LOOK AT THIS, HALVED THE COMPLICATIONS, THE PATIENTS ARE 891 00:42:56,040 --> 00:42:59,510 LEAVING THE HOSPITAL TWO DAYS EARLY AND SAVING $7,000 PER 892 00:42:59,610 --> 00:43:00,578 SURGERY. 893 00:43:00,678 --> 00:43:01,912 SO WE'VE BEEN DOING THIS WRONG FOR 30 YEARS. 894 00:43:02,012 --> 00:43:09,587 BUT WE'RE TRYING TO GET BACK INTO IT AND DO IT THE RIGHT WAY. 895 00:43:09,687 --> 00:43:12,323 [ NO AUDIO ] END OF LIFE, HOSPICE CARE WE 896 00:43:12,423 --> 00:43:15,292 HAVE VERY GOOD DATA THAT SAYS THESE MEDICATIONS CAN BE HELPFUL 897 00:43:15,392 --> 00:43:20,264 TO HELP WITH PAIN AND AT THE LAST FEW MOMENTS OF LIFE. THAT 898 00:43:20,364 --> 00:43:21,932 THEY DON'T EX P TEND LIFE. 899 00:43:22,032 --> 00:43:25,636 AND THEN IN ACUTE SEVERE TRAUMA FOR A SHORT PERIOD OF TIME, 900 00:43:25,736 --> 00:43:30,841 PROBABLY THREE DAYS OR LESS, BUT DEFINITELY SEVEN DAYS OR LESS. 901 00:43:30,941 --> 00:43:33,544 BUT THERE'S NO DATA THAT SAYS THESE MEDICATIONS ARE HELPFUL 902 00:43:33,644 --> 00:43:37,881 FOR A CHRONIC NON-CANCER PAIN. 903 00:43:37,982 --> 00:43:41,885 SO WHY DO PEOPLE START ABUSING OPIATES? 904 00:43:41,986 --> 00:43:46,090 WELL A PERSON CAN BEGIN BY MISUSING THEM AND PROVIDERS WILL 905 00:43:46,190 --> 00:43:47,324 SEE THIS. 906 00:43:47,424 --> 00:43:49,393 WE'LL HAVE SOMEBODY WHO'S ON CHRONIC OPIATES AND THEIR 907 00:43:49,493 --> 00:43:52,663 MEDICINE IS SUPPOSED TO LAST 30 DAYS, THAT'S WHY I WRITE IT FOR 908 00:43:52,763 --> 00:43:57,101 30 DAYS AND AT 27 DAYS THEY CALL AND SAY HEY, I'M OUT OF MY MEDS 909 00:43:57,201 --> 00:44:01,905 AND THAT CAN HAPPEN EVERY ONCE IN A WHILE, THE DOG ATE IT OR 910 00:44:02,006 --> 00:44:05,242 WHATEVER, THE FOLKS THAT THAT HAPPENS OVER AND OVER AGAIN. 911 00:44:05,342 --> 00:44:08,145 THEY'RE MISUSING THEIR MEDICINES THEY ARE TAKING THEIR MEDICINES 912 00:44:08,245 --> 00:44:10,581 FOR WHAT THEY PERCEIVE AS MORE PAIN OR OTHER REASONS. 913 00:44:10,681 --> 00:44:13,617 THEY CAN USE THE MEDICINES TO COPE WITH EMOTIONAL ISSUES. 914 00:44:13,717 --> 00:44:18,355 STUDY CAME OUT LAST YEAR, 16% OF THE ADULTS IN THE UNITED STATES 915 00:44:18,455 --> 00:44:20,924 HAVE DEPRESSION OR ANXIETY. 916 00:44:21,025 --> 00:44:23,260 I FELT WOW, THAT'S A BIG NUMBER BUT OKAY. 917 00:44:23,360 --> 00:44:27,097 THEY CONSUMED 51% OF ALL THE OPIATES WE WROTE LAST YEAR. 918 00:44:27,197 --> 00:44:31,368 SO MAYBE THEY ALL HAVE CHRONIC PAIN, BUT MAYBE THEY'RE USING 919 00:44:31,468 --> 00:44:35,105 THE MEDICATIONS FOR OTHER REASONS, TO TRY TO HELP COPE 920 00:44:35,205 --> 00:44:36,440 WITH OTHER THINGS THAT ARE GOING ON. 921 00:44:36,540 --> 00:44:40,310 AND WE HAVE TO ACKNOWLEDGE THAT AS PROVIDERS AND FOLKS THAT ARE 922 00:44:40,411 --> 00:44:41,478 HELPING PEOPLE OUT THERE. 923 00:44:41,578 --> 00:44:44,848 AND THEN MAYBE THEY'RE EXPERIMENTING WITH THE OPIATES. 924 00:44:44,948 --> 00:44:46,150 BUT WHY DO THEY CONTINUE? 925 00:44:46,250 --> 00:44:48,752 SO ONCE YOU'RE ON YOUR OPIATES AND YOU'VE BEEN TAKING THEM FOR 926 00:44:48,852 --> 00:44:51,321 A WHILE, WHETHER YOU'RE TAKING THEM CORRECTLY AND IT'S BEEN 927 00:44:51,422 --> 00:44:54,858 YEARS OR YOU'RE STARTING TO MISUSING -- USE THEM AND YOU'RE 928 00:44:54,958 --> 00:44:59,897 TAKING WAY TOO MUCH, WELL, THEY FEAR WITHDRAWAL. 929 00:44:59,997 --> 00:45:03,634 THEY -- IF THEY'VE EVER BEEN, SAY, ABUSING OPIATES FOR A WHILE 930 00:45:03,734 --> 00:45:07,004 AND THEN THEY RAN OUT OR THEY COULDN'T GET ANYMORE, FOR 931 00:45:07,104 --> 00:45:09,840 WHATEVER REASON, THEY'VE BEEN IN WITHDRAWAL AND THEY FEAR IT. 932 00:45:09,940 --> 00:45:11,842 SO WHAT DOES WITHDRAWAL FEEL LIKE? 933 00:45:11,942 --> 00:45:14,945 IT REALLY FEELS LIKE THE FLU TIMES TEN. 934 00:45:15,045 --> 00:45:16,947 AND THEY DON'T WANT TO BE THERE ANYMORE. 935 00:45:17,047 --> 00:45:19,883 AND THE OTHER THING, THE OTHER REASON THAT THEY CONTINUE, IS 936 00:45:19,983 --> 00:45:22,152 BECAUSE OF THE CRAVINGS. 937 00:45:22,252 --> 00:45:27,791 AND WHEN WE FREET -- TREAT FOLKS WITH BEHAVIORAL THERAPY AND WITH 938 00:45:27,891 --> 00:45:30,928 MEDICINES IF THAT'S WHAT THEY USE FOR THEIR OPIATE USE 939 00:45:31,028 --> 00:45:34,565 DISORDER, WE'VE GOT TO TAKE CARE OF TWO THINGS. 940 00:45:34,665 --> 00:45:35,799 THEY HAVE TO NOT FEAR WITHDRAWAL , SO THEY EITHER 941 00:45:35,899 --> 00:45:38,435 HAVING TO GET THROUGH THE WITHDRAWAL PHASE AND BE DONE 942 00:45:38,535 --> 00:45:43,040 WITH IT OR WE HAVE TO GIVE THEM MEDICATION SO THEY DON'T 943 00:45:43,140 --> 00:45:44,308 WITHDRAW. 944 00:45:44,408 --> 00:45:46,343 THE OTHER THING YOU HAVE TO TAKE CARE OF IS THE THE CAVINGS. 945 00:45:46,443 --> 00:45:49,146 I'VE BEEN SITTING IN FRONT OF SOMEBODY WITH FULL-BLOWN 946 00:45:49,246 --> 00:45:53,550 WITHDRAWAL AND THEIR NOSE IS RUNNING AND EYES ARE WATERING 947 00:45:53,650 --> 00:45:56,420 AND THEY HAVE NAUSEA, THEIR MUSCLES HURT, THEIR JOINTS HURT, 948 00:45:56,520 --> 00:45:58,922 AND I'M TRYING TO TALK TO THEM ABOUT THERAPY AND HOW I THINK 949 00:45:59,022 --> 00:46:03,260 THIS IS GOING TO REALLY HELP THEM, AND IT'S REALLY HARD FOR 950 00:46:03,360 --> 00:46:03,627 THEM TO ENGAGE. 951 00:46:03,727 --> 00:46:04,595 RIGHT? 952 00:46:04,695 --> 00:46:05,863 SO WE HAVE TO TAKE CARE OF TWO THINGS. 953 00:46:05,963 --> 00:46:08,398 WE HAVE TO TAKE CARE OF THE CRAVINGS AND WE HAVE TO TAKE 954 00:46:08,499 --> 00:46:11,235 CARE OF THE WITHDRAWAL SO THEY CAN DO THE THERAPY, THEY CAN GET 955 00:46:11,335 --> 00:46:15,906 BACK TO WORK, IF THEIR KIDS ARE IN FOSTER CARE SO THEY CAN GET 956 00:46:16,006 --> 00:46:17,107 THE KIDS BACK. 957 00:46:17,207 --> 00:46:21,078 SO THERE'S REALLY JUST FOUR WAYS THAT WE TREAT OPIATE USE 958 00:46:21,178 --> 00:46:26,383 DISORDER IN THE UNITED STATE% DETOX AND ASHES NENS. 959 00:46:26,483 --> 00:46:28,752 IT'S THE NUMBER ONE WAY WE TREAT IT IN TUSES AND IN NORTH 960 00:46:28,852 --> 00:46:30,020 CAROLINA. 961 00:46:30,120 --> 00:46:33,791 AND THEN THERE'S TWO AGONIST MEDICINES, AND THEN THERE'S THIS 962 00:46:33,891 --> 00:46:39,062 MEDICINE THAT'S CALL AN ANTAGONIST MEDICINE, MEL TREKS 963 00:46:39,163 --> 00:46:44,067 ZONE AND YOU CAN TAKE IT BY A PILL ONCE A DAY OR AN INJECTION 964 00:46:44,168 --> 00:46:45,169 ONCE A MONTH. 965 00:46:45,269 --> 00:46:46,503 HERE'S THE DATA. 966 00:46:46,603 --> 00:46:49,606 THESE WAVY LINES ARE HERE BECAUSE WE DON'T HAVE ANY 967 00:46:49,706 --> 00:46:50,808 HEAD-TO-HEAD TRIALS. 968 00:46:50,908 --> 00:46:55,112 BUT IF YOU GO THROUGH DETOX AND ABSTINENCE, WHETHER IT'S 969 00:46:55,212 --> 00:46:58,916 INPATIENT 14 DAYS, 28 DAYS, 90 DAYS. 970 00:46:59,016 --> 00:47:02,286 AT SIX MONTHS TO A YEAR, 90% OF PEOPLE ARE USING AGAIN. 971 00:47:02,386 --> 00:47:03,453 ALL RIGHT? 972 00:47:03,554 --> 00:47:07,457 BUT YOU CAN SEE WITH THE MEDICINES AND WHY THE MEDICINES 973 00:47:07,558 --> 00:47:11,628 ARE NOW THE EVIDENCE-BASED ANSWER TO THE OPIATE USE 974 00:47:11,728 --> 00:47:12,362 DISORDER. 975 00:47:12,462 --> 00:47:14,164 SO I'M AN ALL THE ABOVE GUY. 976 00:47:14,264 --> 00:47:17,434 IF SOMEBODY -- AND I -- I KNOW PEOPLE THAT HAVE BEEN THROUGH 977 00:47:17,534 --> 00:47:20,737 DETOX AND THAT ARE ON ABSTINENCE NOW, AND THEY'RE DOING GREAT. 978 00:47:20,838 --> 00:47:24,508 THEY SAY I'VE BEEN CLEAN AND SOBER FOR SIX MONTHS, FIVE YEARS 979 00:47:24,608 --> 00:47:27,578 ONE GUY I WORK WITH 25 YEARS. 980 00:47:27,678 --> 00:47:28,879 WONDERFUL. 981 00:47:28,979 --> 00:47:30,480 BUT KNOW THAT NINE OUT OF TEN PEOPLE THAT GO THROUGH THOSE 982 00:47:30,581 --> 00:47:34,818 PROGRAMS ARE USING AGAIN WITHIN SIX MONTHS TO A YEAR. 983 00:47:34,918 --> 00:47:40,123 SO THE WORLD HEALTH ORGANIZATION SAYS USING MEDICATION ASSISTED 984 00:47:40,224 --> 00:47:45,329 TREATMENT SO THAT PEOPLE CAN DO THE THERAPY, GET INTO GROUPS AND 985 00:47:45,429 --> 00:47:47,931 INDIVIDUAL IS -- IS THE WAY TO GO. 986 00:47:48,031 --> 00:47:52,736 AND 12 ORGANIZATIONS, FED FEDERAL -- AT THE FEDERAL LEVEL 987 00:47:52,836 --> 00:47:54,071 HAVE ALL AGREED WITH THIS. 988 00:47:54,171 --> 00:47:56,940 THIS IS THE -- THE NEW WAY THAT WE SHOULD BE TREATING OPIATE USE 989 00:47:57,040 --> 00:47:58,208 DISORDER. 990 00:47:58,308 --> 00:48:00,244 SO IF SOMEONE CAN GO THROUGH DETOX AND ABSTINENCE AND DO WELL 991 00:48:00,344 --> 00:48:02,579 , GREAT F. THEY'VE GONE THROUGH IT SEVERAL TIMES AND 992 00:48:02,679 --> 00:48:06,617 THEY'RE STRUGGLING AND THAT IS REALLY P -- SCARES ME BECAUSE WE 993 00:48:06,717 --> 00:48:10,821 KNOW THAT THERE'S A 40 TIMES INCREASE OF OVERDOSE AND OVER 994 00:48:10,921 --> 00:48:15,959 DOSE DEATH ONE MONTH AFTER GETTING OUT OF DETOX IN AND AN 995 00:48:16,059 --> 00:48:17,294 ABSTINENCE PROGRAM N THE FIRST MONTH. 996 00:48:17,394 --> 00:48:21,131 THEY'VE BEEN THROUGH IT A COUPLT WORKED I'M FEARFUL THEY'RE GOING 997 00:48:21,231 --> 00:48:23,300 TO OVERDOSE AND DIE BEFORE THEY CAN GET THROUGH THIS AGAIN. 998 00:48:23,400 --> 00:48:28,505 MAYBE THIS IS WHERE WE SHOULD GO MAYBE THEY NEED SOME MEDICATIONS 999 00:48:28,605 --> 00:48:33,310 SO TREATING OPIATE USE DISORDER, IT REALLY IS A LIFE-THREATENING 1000 00:48:33,410 --> 00:48:37,114 ILLNESS BECAUSE OF THE CHANCE OF DEVELOPING OR LOSING YOUR 1001 00:48:37,214 --> 00:48:41,084 TOLERANCE AND THEN WHEN YOU RELAPSE USING AGAIN AND IF YOU 1002 00:48:41,184 --> 00:48:47,291 USE THE SAME AMOUNT, THEN YOU OVERDOSE OR OVERDOSE AND DIE. 1003 00:48:47,391 --> 00:48:50,394 SO I HOPE THAT YOU KNOW A LITTLE BIT MORE ABOUT THE OPIATE CRISIS 1004 00:48:50,494 --> 00:48:51,828 AND HOW IT'S AFFECTING NORTH CAROLINA. 1005 00:48:51,929 --> 00:48:55,032 I TALKED TO YOU A LITTLE BIT ABOUT ACUTE AND CHRONIC "LOVE, 1006 00:48:55,132 --> 00:48:59,770 PAIN AND THE WHOLE CRAZY THING" AND HOW WE'RE USING -- HOW WE'RY 1007 00:48:59,870 --> 00:49:03,540 TO THE NEXT GENERATION OF PROVIDERS IN WESTERN CAROLINA 1008 00:49:03,640 --> 00:49:06,476 AND RETEACHING THE DOCTORS AND PROVIDERS THAT HAVE BEEN OUT 1009 00:49:06,576 --> 00:49:10,080 THERE FOR 20 OR 25 YEARS ABOUT THE -- THE APPROPRIATE WAY TO 1010 00:49:10,180 --> 00:49:11,348 USE THESE MEDICATIONS. 1011 00:49:11,448 --> 00:49:15,919 AND THEN WE TALKED ABOUT THE IMPACT OF -- OF THE OPIATE 1012 00:49:16,019 --> 00:49:19,623 CRISIS AND OPIATE USE DISORDER ON OUR PATIENTS. 1013 00:49:19,723 --> 00:49:21,625 SO THANK YOU VERY MUCH. 1014 00:49:21,725 --> 00:49:23,727 [ APPLAUSE ]