>> APPRECIATE THE OPPORTUNITY TO
BE HERE TO TALK TO YOU ALL ABOUT
THE OPIOID CRISIS IN WESTERN
NORTH CAROLINA.
A PARTNER IN CRIME IN ALL OF
THIS IS A GUY NAMED DON TEETER.
HE'S A FAMILY PHYSICIAN THAT'S
BEEN WORKING FOR 30 YEARS IN
HAYWOOD COUNTY IF IN THE LAST 18
YEARS IN ADDICTIONS AND THEN
I'VE BEEN WORKING IN THIS SPACE
FOR ABOUT FIVE YEARS NOW.
SO -- I HAVE NO DISCLOSURES.
THE PHARMACEUTICAL INDUSTRY IS
NOT PAYING ME TO SAY THE THINGS
I'M ABOUT TO SAY.
SO JUST TO GET STARTED, 254,000.
THAT'S THE NUMBER OF PEOPLE THAT
WE'VE LOST IN THE LAST TEN YEARS
TO THE OPIOID CRISIS.
SO THAT'S MORE THAN FOUR TIMES
THE NUMBER OF PEOPLE THAT DIED
IN THE VIETNAM WAR.
THERE WAS A PAPER THAT JUST CAME
OUT LAST YEAR AND IT SAID IF
YOU'RE UNDER 50 YEARS OLD AND
YOU DIE IN THE UNITED STATES,
IT'S NOW THE NUMBER ONE REASON
THAT YOU DIE.
SO GRANTED, MOST PEOPLE DIE IN
THE UNITED STATES IN THEIR 50s ,
70s, 80s, 90s, IT'S RARE
UNDER 50.
IF YOU DO DIE UNDER 50 IN THE
UNITED STATES OPIOID ABUSE IS
THE NUMBER ONE REASON I DIE.
IT TRULY IS AN EPIDEMIC.
WE BEING THE PROVIDERS ARE THE
VECTOR.
IT TOOK ABOUT 30 YEARS TO GET
INTO THIS SITUATION BUT IT
REALLY WAS THE PHARMACEUTICAL
INDUSTRY GIVING US A BILL OF
GOODS AND THE PROVIDERS,
INCLUDING DOCS AND FAMILY DOCS
LIKE MYSELF BUYING ALL THIS.
AND WE'LL TALK ABOUT THAT IN A
SECOND.
SO I AM A FAMILY PHYSICIAN.
I'VE BEEN DOING THIS 19 YEARS.
I DO IN-PATIENT WORK AND OUT-
PATIENT WORK.
I SEE PREGNANT WOMEN DELIVER BAY
BABIES ABOUT 30% OF MY PRACTICE
IS KIDS.
AND WHEN I WENT THROUGH
RESIDENCY, AFTER MEDICAL SCHOOL,
THIS IS WHAT I WAS TAUGHT.
OH, YOU HAVE THAT PATIENT THAT
HAS CHRONIC BACK PAIN.
WELL, TRY THESE THREE OR FIVE
MEDICINES OR MODALITIES BUT
EVENTUALLY THAT PATIENT IS GOING
TO BE ON PERCOCET AND OH, YOU
HAVE THIS PATIENT WHO HAS
CHRONIC MIGRAINES.
TRY THESE TWO OR THREE MEDICINES
BUT IF THAT DOESN'T WORK THAT
PATIENT IS EVENTUALLY GOING TO
BE ON VICODIN.
AND THAT'S WHAT I DID.
AND THEN WHEN THEY HIRED ME ON
AS FACULTY, THAT'S WHAT I TAUGHT
OTHER PEOPLE FOR A DOZEN YEARS.
THAT WAS -- THAT WAS ONE WHAT WE
TAUGHT.
I'M HERE TO TELL YOU THAT
THERE'S ACTUALLY NO DATA FOR
USING OPIOIDS FOR CHRONIC NON-
CANCER PAIN.
THERE'S ACTUALLY NO DATA
WHATSOEVER FOR WHAT WE'VE BEEN
DOING FOR THESE LAST 30 YEARS.
BUT I DO HAVE DATA IF YOU START
SOMEBODY ON OPIOIDS AND IT GETS
UP TO A CERTAIN DOSE CALLED 50
MORPHINE MILI EQUIVALENTS A DAY
OR A HIGHER DOSE, YOU INCREASE
FALLS, OVERDOSE AND DEATH.
SO I CAN TELL YOU THAT IT'S
HARMFUL, BUT I CAN'T TELL YOU
THAT IT'S HAPPY HELPFUL FOR
CHRONIC NON-CEABS PAIN.
THESE ARE OUR GOALS TODAY.
STRIVE THE THE IMPACT OF THE
OPIOID CRISIS.
I KNOW YOU KNOW A LOT ABOUT IT
BUT I I THINK I CAN GIVE YOU ONE
OR TWO MORE COUNTS.
FOR ALL OF YOU WORKING IN PUBLIC
HEALTH OR WORKING WITH GROUPS
THAT HAVE PROVIDERS I'M GOING TO
TELL AWE LITTLE BIT ABOUT THE CD
C GUIDELINES FOR ACUTE AND
CHRONIC PAIN JUST SO YOU KNOW
WHAT WE'RE TEACHING THIS NEXT
GENERATION OF DOCS AND WE'RE
HONESTLY HAVING TO GO OUT AND
RETRAIN THE DOCS THAT WENT
THROUGH RESIDENCY YEARS AGO LIKE
MYSELF.
AND THEN DESCRIBE THE -- ITS
IMPACT ON OUR PATIENTS AND YOUR
ALL'S CLIENTS OUT THERE.
SO OPIOIDS IS THE BIG TERM.
IT'S ALL OF THEM.
AND OPIATES ARE IF IT COMES FROM
OR DERIVED FROM THE POPPY.
AND THEN THERE'S OTHERS THAT ARE
LIKE SYNTHETICS LIKE FENTANYL.
THESE ARE JUST SOME EXAMPLES UP
HERE BUT I WANTED TO GO THROUGH
A FEW OF THEM.
ONE, CODEINE, SO IT'S FOR COUGH
SYRUP OR
[ NO AUDIO ]
NOW THE FOOD AND DRUG
ADMINISTRATION HAS COME OUT AND
THEY'VE SAID WELL DON'T -- DON'T
PRESCRIBE CODEINE TO KIDS UNDER
18.
AND THEN THEY CAME OUT AND SAID
WELL, DON'T PRESCRIBE CODEINE
FOR PREGNANT WOMEN?
OR IF THEIR BREAST-FEEDING.
SO NOW WHAT WE'RE TEACHING IS,
DON'T PRESCRIBE CODEINE AT ALL
FOR ANYONE BECAUSE KIDS ARE
GETTING AHOLD OF THIS AND
THEY'RE USING THIS TO GET HIGH.
AND THEY'RE ACTUALLY EVEN USING
IT IN SCHOOL DURING THE DAY.
AND THE REASON THAT THEY CAN GET
AWAY WITH IT IS THE NUMBER ONE
THING YOU LOOK LIKE WHEN YOU'RE
HIGH ON OPIATES IS NORMAL.
NOW, IF YOU'VE BEEN ON OPIATES
FOR A LONG TIME OR WHRA -- WHAT
HAVE YOU, YOU TEND TO HAVE SOME
OF THE STIGMATA LATER.
THE KIDS THAT ARE USING THIS,
IT'S REALLY HARD FOR THE PARENTS
AND THE TEACHERS HONESTLY TO
PICK UP ON THIS.
YOU SEE SOME OF THE OTHER ONES
UP THERE, BUT THE BIG PROBLEM
THAT WE'RE HAVING NOW IS THAT AS
WE GOT INTO THIS CRISIS WITH
OPIATE PILLS, NOW WE'VE MOVED ON
TO HEROINE AND WHAT THEY CALL
SYNTHETICS BUT THAT'S FENTANYL
AND ITS DERIVATIVES AND WE'LL
TALK ABOUT THAT A LITTLE MORE IN
A SECOND.
THE UNITED STATES IS 4.6% OF THE
WORLD'S POPULATION, BUT WE
CONSUME 80% OF ALL THE OPIOID
PILLS PRESCRIBED IN THE WHOLE
WORLD.
80%.
THERE'S NO OTHER COUNTRY THAT'S
EVEN CLOSE TO WHAT WE'RE DOING.
THE ONLY ONE THAT'S EVEN A
FRACTION OF WHAT WE'RE DOING IS
CANADA.
I FEEL REALLY BAD FOR THEM.
THEY JUST HAVE REALLY LONGBOARD
ER WITH US, I THINK
IT'S KIND OF A BLEEDOVER EFFECT.
83% OF THE WORLD HAS NO ACCESS
TO OPIATES.
THINK ABOUT THAT.
83% OF THE WORLD HAS NO ACCESS
TO OPIATES.
AND I'M GOING TO BE A LITTLE
FLIPPANT HERE, BUT THEY'RE
GETTING BY.
YOU KNOW?
AND THEY'RE GETTING BY THE WAY
THAT WE USED TO PRACTICE.
FOR THOSE IN THE BACK, I'M GOING
TO KIND OF GO THROUGH THIS ON
THE LEFT SIDE IS 1986.
ON THE RIGHT SIDE IS 2015.
SO THIS IS A 30-YEAR PERIOD.
AND YOU CAN LOOK AT ALL THE
DIFFERENT COLORS OF THE
DIFFERENT TYPES OF OPIATES, BUT
REALLY THE RED LINE IS THE
ADDITIVE OR ACCUMULATION EFFECT
OF ALL OF THE OPIATES THAT WE
PRESCRIBED AND DISPENSED IN THE
UNITED STATES.
AND IF YOU GO OVER TO THE LEFT
THEN N THE 70s AND EARLY '80S
WE WERE PRESCRIBING IN A LOW
RATE THE WAY THAT WESTERN EUROPE
IS STILL PRESCRIBING.
AND REALLY, BACK IN THE '70S AND
'80S, THERE WAS TWO REASONS THAT
YOU WOULD GET AN OPIATE.
IF YOU WERE IN THE LAST SIX
MONTHS OF LIFE, ON HOSPICE CARE,
THEY WOULD GIVE US AN OPIATE.
AND WE HAVE VERY GOOD DATA THAT
SAYS THAT IT HELPS WITH QUALITY
OF LIFE.
HELPS TO TAKE AWAY THE WANE SO
YOU CAN -- PAIN SO YOU CAN SPEND
TIME WITH YOUR FAMILY BUT IT
DOESN'T HELP WITH QUALITY OF
LIFE T. OTHER WAY YOU GOT AN
OPIATE IS ACUTE SEVERE PAIN.
SO IF YOU'RE IN A CAR WRECK AND
THE BONE IN YOUR LEG IS STICKING
OUT OF YOUR SKIN, YOU GOT AN
OPIATE.
BUT THE THIS WHOLE BUSINESS OF
GIVING OPIATES FOR CHRONIC NON-
CANCER PAIN JUST REALLY
WASN'T HAPPENING BACK THEN.
AND THEN TWO ARTICLES CAME OUT
IN THE MID '80S, AND I'M GOING
THE TALK TO YOU A LITTLE BIT
ABOUT THE ARTICLE, IT WAS PICKED
UP BY THE TENS OF THOUSANDS OF
DRUG REPS WHO THEN SPREAD OUT
INTO THE COUNTRY AND STARTED
TALKING TO THE PROVIDERS AND
THEY SAID HEY, THERE'S THIS
ARTICLE IN THE "NEW ENGLAND
JOURNAL OF MEDICINE" AND IT SAYS
OPIATES ARE REALLY SAFE, LESS
THAN 1% OF PEOPLE WILL EVER GET
ADDICTED AND YOU SHOULD BE USING
THESE MEDICINES FOR CHRONIC PAIN
AND IF YOU LOOK, THE LINE STARTS
TO GO UP BECAUSE THEY STARTLING
THE PROVIDERS THIS OVER AND OVER
AND OVER AGAIN.
INTERESTINGLY, IF YOU GO BACK
AND LOOK AT THAT ARTICLE, IT
REALLY WAS IN THIS ESTEEMED
JOURNAL CALLED THE "NEW ENGLAND
JOURNAL OF MEDICINE" BUT IT
WASN'T A RANDOMIZED CONTROLLED
TRIAL AND DIDN'T HAVE ANY AGE
MATCH CONTROLLED, WASN'T
RETROSPECTIVE OR PROSPECTIVE.
IT WAS JUST A LETTER TO THE
EDITOR.
IT WAS SEVEN LINES AND THE GUY
SAID HEY, I HAD SOME PATIENTS IN
THE HOSPITAL
[ NO AUDIO ]
AND NONE OF THEM GOT A ADDICTED.
HE DIDN'T EVEN CALL THEM AFTER
THEY LEFT THE HOSPITAL TO SEE IF
THEY WERE STILL ON OPIATES OR
STILL HAVING TROUBLE WITH OPIATE
USE DISORDER.
THAT'S NOT WHAT THE
PHARMACEUTICAL INDUSTRY SAID.
THEY SAID HEY, WE HAVE THIS
ARTICLE IN THE "NEW ENGLAND
JOURNAL OF MEDICINE" THAT SAYS
THESE MEDICINES ARE SAFE AND YOU
SHOULD START USING THEM.
SO WE START PRESCRIBING AND IT
STARTS GOING UP.
THEN YOU SEE IN 1996 THERE'S
THIS INFLEXION POINT, RIGHT?
AND IT STARTS GOING WAY, WAY UP
AND WE START PRESCRIBING LIKE
CRAZY.
SO WHAT HAPPENED?
IN 1996 THE AMERICAN PAIN
SOCIETY GOT TOGETHER AND THEY
HAD A BIG EXPERT PANEL AND THIS
IS WHAT THEY SAID.
HEY, YOU PRIMARY CARE DOCS,
THAT'S ME, YOU GUYS ARE ALL
DIRTY ROTTEN ROBBERS.
YOU'RE WAY UNDERTREATING PAIN
AND WE HAVE SOME GREAT
MEDICATIONS TO TREAT IT.
OPIATES.
DOES ANYBODY KNOW WHAT OPIATE
WAS DEBUTED IN 1996?
OXYCONTIN.
WE HAVE SOME GREAT MEDICINES
LIKE OXYCONTIN AND URKD BE USING
THEM.
THEY'RE REALLY SAFE.
LESS THAN 1% OF PEOPLE EVER GET
ADDICTED.
AND WE AS PRIMARY CARE DOCS SAID
OH, MY GOSH, THESE ARE OUR
EXPERTS IN PAIN, CHRONIC PAIN,
AND THEY'RE TELLING US WE'RE
DOING THIS WRONG.
THE GLOVES ARE OFF.
WE'RE GOING TO START TREATING
PAIN LIKE THE EXPERTS SAY.
AND YOU CAN SIGH THE LINE GOES
CRAZY, GOES UP.
INTERESTINGLY THAT GROUP GOT
TOGETHER IN TWOZ 18 BECAUSE OF
OUR NEW ETHICS LAWS IN MEDICINE,
THEY WOULD HAVE TO DISCLOSE IF
THEY WERE GETTING PAID BY THE
PHARMACEUTICAL INDUSTRY AND
ALMOST ALL OF THEM WERE.
BUT THEY DIDN'T TELL US THAT
BACK THEN.
SO FROM 1986 TO 2015 THIS 30-
YEAR PERIOD, 600% INCREASE IN
THE NUMBER OF OPIATES THAT WE
ARE PRESCRIBING AND DISPENSING
IN THE UNITED STATES WHILE NO
OTHER COUNTRY IN THE WORLD IS
DOING THE SAME THING.
SO EVERYTHING WE KNOW ABOUT
CHRONIC NON-CANCER PAIN AND
USING OPIATES HAS BEEN
PROGRAMMED BY THE PHARMACEUTICAL
INDUSTRY.
THAT'S MY OPINION.
I DO KNOW THIS FOR A FACT.
THERE'S NO DATA THAT SAYS USING
OPIATES FOR CHRONIC PAIN IS
BENEFICIAL BUT I DO HAVE DATA
THAT SAYS IT'S HARMFUL.
AND THIS IS THE BEST THE
PHARMACEUTICAL INDUSTRY CAN DO.
THAT IS LOT OF WORDS BUT I WANT
TO READ IT FROM TO YOU.
FROM THE AMERICAN CANCER P
SOCIETY.
OPEN YACHT MEDICATIONS IN THE
CLASS OF MORPHINE ARE DESIGNATED
TO HAVE A LEGITIMATE MEDICAL USE
THAT'S TRUE.
AND ARE INDICATED FOR THE
MEDICAL MANAGEMENT OF PAIN,
ESPECIALLY IF THE PAIN IS SEVERE
THAT'S TRUE AS WELL.
THE F.D.A. MAKES IT SO.
SO LOOK AT THIS NEXT LINE THOUGH
ALTHOUGH THEIR USE FOR THE
RELIEF OF A VARIETY OF CHRONIC
NON-CANCER PAIN CONDITIONS
CONTINUES TO EVOLVE.
WHAT DID THEY SAY?
THEY DIDN'T SAY ANYTHING.
READ THAT AGAIN.
READY?
ALTHOUGH THEIR USE FOR THE
RELIEF OF A VARIETY OF CHRONIC
NON-CANCER PAIN CONDITIONS
CONDITIONS TO EVOLVE AND
EVIDENCE OF EFFECTIVENESS OF
THESE CONDITIONS IS DERIVED
LARGELY FROM CLINICAL EXPERIENCE
SO THEY DON'T HAVE A RANDOMIZED
CONTROL TRIAL OR THEY DON'T HAVE
A RETROSPECTIVE OR PROSPECTIVE
TRIAL.
WHAT THEY DO IS COME AND FIND
DOCS LIKE ME AND SAY HEY, DO YOU
HAVE ANYBODY WITH LOW BACK PAIN?
I SAY YEAH.
DO YOU GIVE THEM OPIATES?
YEAH.
DO YOU THINK IT WORKS?
IF I SAY IT YES, THEY PUT A
CHECK DOWN, IT WORKS.
THAT'S ALL THEY'VE GOT.
THERE SEEMS TO BE A GENERAL
AGREEMENT THAT SOME PATIENTS
WITH SUCH PAIN CAN BE PROPERLY
TREATED WITH OPIATE THERAPY.
THAT'S IT.
THAT'S THE BEST THE INDUSTRY HAS
AND THE INDUSTRY TOLD US TWO
THINGS.
THEY TOLD US WE'RE GOING TO
DECREASE PAIN AND INCREASE
FUNCTION DURING THIS TIME PERIOD
THIS IS A 20-YEAR STUDY ACROSS
THE BOTTOM IS LOW BACK PAIN,
MUSCULOSKELETAL PAIN, NECK PAIN
AND OSTEOARTHRITIS IS PAIN IN
THE HIP OR KNEE.
SO YOU CAN SEE THAT PAIN WENT UP
IN ADULTS IN THE UNITED STATES.
BUT WITH A 600% INCREASE IN
OPIATES, YOU WOULD THINK THAT IT
WOULD AT LEAST STAY THE SAME OR
GO DOWN.
BUT IT DIDN'T, IT WENT UP.
BUT THE SECOND THING THEY SAID
IS BUT WE'RE GOING TO INCREASE
FUNCTION.
AND SO DOCS THAT I WORK WITH
THAT CAN REMEMBER BACK IN THE
'80S, THEY MIGHT HAVE HAD A
LITTLE BIT MORE GRAY HAIR THAN I
DO, THEY SAID THEY COULD
REMEMBER DRUG REPS SAYING HEY
YOUR PATIENT THAT FELL OFF THE
LADDER AND BROKE HIS BACK, DON'T
YOU WANT HIM TO GO BACK TO WORK?
AND THE DOCS P LIKE YEAH, I WANT
HIM TO GO BACK TO WORK.
THEY'D SAY HEY, YOU SHOULD USE
OPIATES TO HELP.
BUT DO YOU KNOW THE NUMBER OF
DAYS THAT YOU NEED TO BE ON AN
OPIATE TO DOUBLE YOUR RISK OF
GOING OUT ON PERMANENT
DISABILITY?
SEVEN DAYS.
THAT'S IT.
AND EVERY DAY AFTER THAT THAT
YOU'RE ON AN OPIATE INCREASES
YOUR RISK EVEN MORE OF GOING OUT
ON PERMANENT DISABILITY.
AND WHEN I HEARD THAT, I HAD
BEEN WORKING IN THIS OPIATE
SPACE FOR ABOUT A YEAR, I HAD 12
PATIENTS THAT HAD CHRONIC PAIN
THAT I WAS WRITING OPIATES FOR
THEM, EVERY THREE MONTHS I WOULD
SEE THEM.
I WENT BACK AND LOOKED AT THEIR
CHARTS.
11 OUT OF 12 OF MY PATIENTS WERE
ON PERMANENT DISABILITY.
SO THE PHARMACEUTICAL INDUSTRY
SAID WE'RE GOING TO DECREASE
PAIN AND INCREASE FUNCTION, BUT
IT DID THE OPPOSITE.
AND IF THAT'S KIND OF LIKE NOT
DAMNING ENOUGH, THIS IS THE
GREEN LINE IS ALL OF THE OPIATES
PRESCRIBED -- DISPENSED BY ALL
THE PHARMACEUTICAL COMPANIES IN
THE UNITED STATES, THE SECOND
LINE IS OPIATE DEATHS DURING
THAT TIME FRAME.
AND THE THIRD LINE IS PEOPLE
GOING INTO INPATIENT TREATMENT
FOR OPIATE USE DISORDER, THE NEW
TERM FOR OPIATE ADDICTION.
TO BRING IT HOME TO NORTH
CAROLINA THEN, SO THIS -- THIS
SLIDE IS FROM THE NORTH CAROLINA
DEPARTMENT OF HEALTH AND HUMAN
SERVICES AND THE TOP LINE THERE
IS NUMBER OF OPIATE DEATHS FROM
PILLS.
THEN THE SECOND LINE DOWN, THE
FIVE -- 7, 9, IS OPIATE DEATHS
FROM SYNTHETICS AND WE'LL JUST
CALL THEM FENTANYL FROM NOW ON.
THE 538 IS OPIATE DEATHS ARE
HEROINE.
SO THE STORY HERE IS THAT THIS
STARTED OFF AS A PILL PROBLEM.
AND IT STILL IS A PILL PROBLEM.
BUT NOW IT'S A HEROINE AND
FENTANYL PROBLEM.
WHEN WE FINALLY GET THE DATA
FROM 2017A LITTLE OVER 1,500
NORTH CAROLINIANS WILL HAVE DIED
FROM OPIATE DEATHS IN THE YEAR
2017.
ON AVERAGE FOUR PEOPLE DIE EVERY
DAY.
AND THIS IS HOW WE'VE GOTTEN
INTO THIS PROBLEM NOW, IS THAT
WE STARTED WITH PILLS BUT NOW
IT'S -- IT'S REALLY GOTTEN INTO
HEROINE AND FENTANYL.
SO THE FIRST BOTTLE THERE IS
SUPPOSEDLY A GRAM OF HEROINE.
AND DEPENDING UPON A PATIENT'S
OR A PERSON'S POLL RANS, IF YOU
SHOOT A GRAM YOU CAN OVERDOSE
AND DIE.
BUT THE SECOND BOTTLE THERE IS
FENTANYL, AND IT'S 50 TO 100
TIMES MORE POTENT THAN THE
HEROINE THAT'S OUT THERE ON THE
STREET RIGHT NOW.
THAT'S JUST 50 GRAINS.
AND IF YOU SHOOT THAT, YOU CAN
OVERDOSE AND DIE.
AND THEN THE LAST ONE, HAVE YOU
HEARD OF THIS?
THIS CAR FENTANYL BUSINESS?
IT'S AN ELEPHANT TRANQUILIZER.
IT'S 5,000 TIMES MORE POTENT
THAN THAT HEROINE THAT'S ON THE
STREET AND THERE'S JUST THREE
GAINS.
THERE'S A REASON YOU CAN'T SEE
MUCH IN THAT BOTTLE BECAUSE
THERE'S ONLY THREE GRAINS IN
THERE.
IF YOU SHOOT THAT, YOU OVERDOSE
AND DIE.
SO YOU CAN IMAGINE AS THE END
USER IF THEY CUT THE CARFENTANYL
INTO THE HEROINE AND YOU SHOOT
THE SAME AMOUNT OF TIME YOU DID
LAST TIME AND YOU DON'T KNOW IT,
YOU DON'T KNOW WHAT'S IN IT, YOU
CAN OVERDOSE AND DIE.
AND THAT'S WHAT WE'RE FEELING
OUT THERE.
WHEN YOU TALK TO THE POLICE, THE
FIRE -- FOLKS IN FIRE AND THE E.
M.S. AND SAY HEY, I HEAR
YOU'VE REALLY GOT A HEROINE
PROBLEM NOW, THEY'LL CORRECT YOU
AND SAY IT'S A FENTANYL PROBLEM.
AND THE REASON THAT THEY'RE
CUTTING THE FENTANYL IN THERE IS
BECAUSE IT'S MORE POWERFUL,
PEOPLE ARE SEEKING THAT, AND
IT'S LESS EXPENSIVE.
AND IT'S BEEN LESS EXPENSIVE
EVERY YEAR FOR THE LAST THREE OR
FOUR YEARS.
SO THIS IS UNINTENTIONED
MEDICATION AND DRUG OVERDOSE
DEATHS BY COUNTY.
AND YOU CAN SEE THAT THE
[ NO AUDIO ]
AND THE DARKER COLOR IS WORSE.
SO IF YOU KIND OF LOOK AT
WESTERN NORTH CAROLINA THERE, WE
HAVE A LOT OF COUNTIES THAT HAVE
THAT DARK COLOR.
[ NO AUDIO ]
IN APPALACHIA, NOT JUST NORTH
CAROLINA, EASTERN TENNESSEE,
WEST VIRGINIA, EASTERN OHIO, YOU
GO UP THE APPALACHIAN CHAIN EVEN
UP INTO PENNSYLVANIA, AND WE
HAVE FOR THE SAME AMOUNT OF DRUG
PROBLEMS, PEOPLE WITH THEIR
OPIATE USE DISORDER, WE HAVE IN
APPALACHIA 55% INCREASE IN OVER
DOSE DEATHS COMPARED TO THE
REST OF THE COUNTRY.
SO SOMETHING IS GOING ON HERE IN
APPALACHIA.
AND THIS IS NORTH CAROLINA
OPIATE OVERDOSE DEATHS -- OVER
DOSES THAT THE EMERGENCY
DEPARTMENT IS SEEING.
YOU CAN SEE IT WAS KIND OF
STEADY IN 2016 AND THIS IS JUST
THE DATA WE HAVE THROUGH 2017.
AND THEN IT ACTUALLY WENT UP
QUITE A BIT, AND THEN NOW IT
SEEMS TO BE COMING DOWN.
INTERESTINGLY THOUGH WE THINK
THERE'S MORE REVERSALS BUT WE'RE
NOT SEEING AS MUCH IN THE
EMERGENCY DEPARTMENT.
SO WHAT'S HAPPENING?
BECAUSE OF A LOT OF EFFORTS OF
YOU ALL, WE'RE GETTING MORE
NARCAN OUT INTO THE COMMUNITIES
AND THE REVERSALS ARE ACTUALLY
HAPPENING IN THE FIELD.
SO A LOT MORE POLICE DEPARTMENTS
AND FIRE DEPARTMENTS, E.M.S. ARE
CARRYING IT.
BUT ALSO THERE'S A LOT OF PEOPLE
THAT ARE ALT -- AT HIGH RISK
THAT ACTUALLY HAVE NARCAN, OR
THEIR LOVED ONES DO IN THE LOCK
ZONE AND ABLE TO REVERSE A
PATIENT OR PERSON THAT'S
OVERDOSED IN THE FIELD.
SO WE'RE SEEING A FLATTENEDING
IN THE EMERGENCY DEPARTMENT AT
THE SAME TIME WE BELIEVE THERE'S
MORE AND MORE OVERDOSES THAT ARE
HAPPENING.
AND THEN FOLKS, SOMETIMES THEY
TAKE THE PILLS BUT OFTENTIMES
WHEN YOU'RE IN YOUR USE DISORDER
YOU'RE EITHER SNORTING OR
SHOOTING.
THERE'S A LOT OF EFFORT OUT
THERE TO TRY TO HELP WITH FOLKS
THAT ARE I.V. DRUG USERS.
BUT WE ARE SEEING THE EFFECTS OF
THIS.
AND SO ALL OF YOU THAT ARE OUT
THERE TRYING TO HELP TO GET
CLEAN NEEDLES TO THESE FOLKS AND
THEN ALSO JUST BEING THERE FOR
THE TIME THAT THEY'RE READY TO
SAY I'M -- I'M READY TO DO
SOMETHING ELSE.
I WANT HELP.
I REALLY PRAISE Y'ALL AND
APPRECIATE WHAT YOU'RE DOING.
BUT THIS IS WHAT WE'RE SEEING.
SO HEPATITIS.
>> CR IN NORTH CAROLINA, 500%
INCREASE IN THIS SEVEN-YEAR
PERIOD.
AND HERE'S INFECTIONS THAT ARE
IN THE BLOODSTREAM.
OFTENTIMES THEY CAN GET
INFECTIONS FROM DIRTY NEEDLES
AND GET A PUS POCKET OR ABSCESS
IN THE SKIN.
SOMETIMES THAT WILL GET INTO THE
BLOODSTREAM AND THAT'S INCREASED
FOUR TIMES OVER.
AND THEN SOMETIMES THIS -- THE
BACTERIA WILL GO UP TO THE HEART
AND WILL ATTACH TO THE HEART
VALVES.
AND WE'VE SEEN A 13.5 TIMES
INCREASE.
AND I KNOW I'M E PREACHING TO
THE CHOIR, JUST TO TELL YOU THIS
PUBLIC HEALTH STORY THEN, SO IT
COSTS ROUGHLY $7 FOR 100 CLEAN
NEEDLES.
AND SO -- TO REPLACE SOMEONE'S
VALVE THAT'S BEEN DAMAGED TBI
BACTERIA ON THERE IS ROUGHLY $2
50,000.
SO IF WE CAN KEEP TELLING THIS
STORY, AND I APPRECIATE AGAIN
ALL Y'ALL OUT THERE THAT ARE
WORKING IN THIS SPACE AND TRYING
TO HELP, BUT WE HAVE TO GET
CLEAN NEEDLES TO THE FOLKS TO
HELP THEM TO NOT HAVE THESE
INFECTIONS.
H.I.V. IS ON THE RISE AS WELL.
TO TRY TO NOT HAVE THESE
INFECTIONS AND THEN BE THERE FOR
THEM WHEN THEY'RE COMING TO
EXCHANGE THEIR NEEDLES AND WHEN
THEY'RE READY TO SEEK CHANGE IN
THEIR LIVES, THEN WE'RE THERE
FOR THEM, AND WE NEED TO BE
DOING THAT.
AND IT'S GOT TO BE A GOOD USE OF
OUR RESOURCES.
SO THEN HERE IS SOME DEMOGRAPHIC
S.
IT'S URBAN AND RURAL AND WHITE
AND BLACK.
THIS STARTED OFF AND THIS WAS A
WHITE PHENOMENON AND
PARTICULARLY IN RURAL AREAS.
BUT IT REALLY HAS BECOME A RACE
AND CLASS -- IT'S LIKE EVERYBODY
IT'S AFFECTING EVERYBODY NOW.
IT DOESN'T MATTER IF YOU'RE
WHITE, BROWN, OR BLACK.
IT DOESN'T MATTER IF YOU'RE RICH
OR POOR.
I ACTUALLY THINK IN MY PRACTICE,
SO I DO WRITE A MEDICATION
CALLED SEBOXONE TO HELP PEOPLE
STABILIZE THEIR LIVES SO THEY
CAN GET TO THEIR THERAPY, IF
THEY HAVE OPIATE USE DISORDER.
BUT IT ALMOST SEEMS LIKE IF YOU
HAVE MORE MONEY YOU'RE MORE
LIKELY TO BE ABLE TO BE ABLE TO
BUY THESE DRUGS AND GET INTO
THIS PROBLEM.
SO IT REALLY CUTS ACROSS ALL
SOCIOECONOMIC BOUNDS.
AND AGAIN, THE LAST ONE SHOWS
APPALACHIA.
WE HAVE A HIGHER RATE OF DRUG
OVERDOSE MORTALITY THAN THE REST
OF THE COUNTRY.
AND THEN JUST PUTTING A FEW OF
THE COUNTIES OUT THERE, I KNOW
SOME OF YOU ARE FROM GRAHAM
COUNTY RIGHT NOW AND THEY'RE
REALLY GETTING BROADSIDED WITH
THIS.
THIS WAS DATA FROM AROUND 2011
TO 2013, I THINK.
SO SWITCHING GEARS, I WANT TO
TALK A LITTLE BIT ABOUT
[INAUDIBLE].
THERE'S ACUTE PAIN AND CHRONIC
PAIN.
THIS IS ONE OF OUR PROBLEMS.
[ NO AUDIO ]
GETTING INTO THE MEDICAL SCHOOLS
, NURSE PRACTITIONER, P.
A. SCHOOLS, DENTAL SCHOOLS,
AND WE'RE TRYING TO TEACH THIS.
IF YOU BELIEVE CHRONIC PAIN IS
JUST ACCUSE PAIN THAT LASTS A
LITTLE LONGER THEN YOU'RE GOING
TO SAY OPIATES HELP IF YOUR BONE
IS STICKING OUT OF YOUR SKIN SO
IT MUST HELP IN CHRONIC PAIN.
BUT CHRONIC PAIN IS A TOTALLY
DIFFERENT KETTLE OF FISH AND
THAT'S WHY THOSE TWO MEDICINES
DON'T WORK IN THE SAME
SITUATIONS.
HERE IS ACUTE PAIN.
YOU HAMMER YOUR TOE AND YOU HIT
IT SO HARD YOU SPLIT THE SKIN
OPEN.
ALL RIGHT?
YOU'RE TO HAVE A LOT OF TISSUE
INPUT.
YOU MIGHT EVEN THINK ABOUT SAY
AGO BAD WORD.
I KNOW YOU WOULDN'T.
BUT THERE ARE THOUGHTS AND
EMOTIONS THAT GO INTO THAT ACUTE
PAIN.
RIGHT?
AND NOW LOOK AT CHRONIC PAIN.
SO LIKE MY PATIENT, I'VE BEEN
SEEING FOR ALMOST TEN YEARS AND
HE HAD THREE BACK SURGEONS AND
THE SURGEON SAID I CANNOT
SURGEONIZE YOU ANYMORE.
GO SEE YOUR DOCTOR, THAT'S ME.
I'VE BEEN SEEING HIM TEN YEARS
AND WRITING HIS OPIATES.
AND HE'S STILL GETTING SOME
TISSUE INPUT FROM THE PAIN IN
HIS BACK.
BUT CHRONIC PAIN REWIRES THE
BRAIN.
AND IF YOU HAVE CHRONIC PAIN AND
YOU'RE ON OPIATES, IT REWIRES
THE BRAIN EVEN MORE.
AND SO THERE'S A LOT OF THOUGHTS
AND EMOTIONS THAT ARE GOING INTO
THE PAIN THIS GENTLEMAN HAS.
AND I'M NOT SAYING IT'S ALL IN
HIS HEAD, BUT IT'S ALL IN HIS
HEAD AND THAT HE REALLY IS
EXPERIENCING -- IF HE SAYS I'M
HAVING 7 OUT OF 10 PAIN, IT'S
THAT WAY ALL THE TIME.
HE REALLY IS EXPERIENCING IT
THAT WAY BECAUSE THE BRAIN HAS
REWIRED.
BECAUSE HE'S GETTING THE OPIATES
ON TOP OF IT.
SO REALLY WHAT WE'RE TRYING TO
TEACH ALL THE NEW PROVIDERS THAT
ARE COMING OUT OF THEIR PROGRAMS
IS THERE IS THIS NEUROPATHIC
PAIN, THERE'S OPIATE WITHDRAWAL
PAIN.
SO YOU ACTUALLY CAN GET MORE
PAIN FROM BEING ON OPIATES.
ISN'T THAT CRAZY?
IT'S CALLED OPIATE HYPER ALGESIA
PROBABLY TAKES MONTHS TO YEARS
FOR THAT TO HAPPEN, BUT
SOMETIMES WE ARE WEANING PEOPLE
DOWN ON THEIR OPIATES AND THEIR
PAIN GETS BETTER AND THEY START
FEELING BETTER.
AND THEN WHAT I WAS JUST TALKING
ABOUT WAS THIS CENTRAL
SENSITIZATION.
SO THEY'RE HAVING THIS CHRONIC
PAIN AND THEN IF THEY GET
OPIATES ON TOP OF IT, IT'S
CHANGING THEIR BRAIN.
AND THEN THERE'S ALSO THE NOASH
OWE SEPTIC PAIN, YOU HAMMER YOU.
SO IN LIFE WHEN THEY LOOK AT US
AS A SPECIES, IT'S DOPAMINE THAT
MAKES US DO EVERYTHING WE DO.
WHY YOU WAKE UP IN THE MORNING,
YOU MAKE MONEY, EAT, DRINK, THE
WHOLE SHOOTING MATCH, RIGHT?
AND THERE'S ACTUALLY ONLY TWO
THINGS THAT DUMP INTO DOPAMINE.
AND THAT'S ENDORPHINS AND
OPIATES.
INTERESTINGLY.
SO WHAT HAPPENS IF YOU HAVE
SOMEBODY THAT SAYS I'VE NEVER
TAKEN AN OPIATE BEFORE, AND THEY
START TO TAKE AN OPIATE FOR THE
FIRST TIME?
SO WHY DO WE HAVE OPIATE
RECEPTORS?
AND MOST PROVIDERS WOULD SAY
IT'S TO DECREASE PAIN.
AND THAT'S TRUE, BUT THAT'S
ACTUALLY THE SECOND REASON.
SO IF YOU GET INTO THE PRIMARY
CARE LITERATURE ON WHY AS A
SPECIES WE HAVE OPIATE RECEPTORS
, IT'S TO ACHIEVE A
SHORT-TERM GOAL.
IT'S FASCINATING NOW.
THINK ABOUT THAT WHEN I SHOW YOU
EVERYTHING ELSE THAT LIGHTS UP
AS THIS PERSON IS TAKING
PERCOCET SAY FOR THEIR BROKEN
ANKLE.
IT DEYESES PAIN, GREAT, THAT'S
WHY I GAVE YOU THIS MEDICINE,
RIGHT?
BUT IT ALSO INCREASES MOTIVATION
, IT INCREASES
CONFIDENCE, IT INCREASES THE
REWARD SYSTEM, AND IT REDUCES
DEPRESSION AND ANXIETY.
IT MAY ONLY BE FOR 30 MINUTES OR
AN HOUR AND A HALF, IT'S REALLY
SHORT TERM, BUT WHEN YOU FIRST
START TAKING THAT, THAT CAN
HAPPEN SOMETIMES.
SO THINK ABOUT THAT PATIENT
MAYBE THAT'S BEEN SEEING ME FOR
FIVE YEARS AND THEY HAVE
DEPRESSION, I'VE TRIED FIVE OR
SIX DIFFERENT MEDICINES, TRIED
TO GET THEM INTO THERAPY, AND
IT'S JUST NEVER GOTTEN TAKEN
CARE OF.
AND THEY GO TO THE E.R. WITH A
BROKEN WRIST AND THEY GET
PERCOCET AND THEY TAKE IT AND
THEIR DEPRESSION TOTALLY GOES
AWAY.
DO YOU THINK THEY'RE GOING TO
FINISH THAT PERCOCET RATHER --
WHETHER IT'S 6 PILLS, 12 PILLS
OR 30?
FOR SURE.
THAT'S THE BEST THEY'VE FELT IN
FIVE YEARS.
THAT CAN ACTUALLY HAPPEN.
THAT INCREASES THE PLEASURE IN
THE CURRENT ACTIVITY.
BUT WHAT HAPPENS IF YOU TAKE
OPIATES CHRONICALLY?
OKAY?
SO AT LEAST MONTHS BUT PROBABLY
YEARS.
AND SO IT DECREASES DOPAMINE
PRODUCTION.
THAT'S WHY WE LIVE.
IT'S DECREASES THE NORMAL REWARD
SYSTEM.
IT DOWNREGULATES OPIATE
RECEPTORS AND INCREASES
ENDORPHINS.
THE ONLY TWO THINGS THAT DUMP
INTO DOPAMINE.
IT DECREASES MOTIVATION AND LONG
TERM IT INCREASES DEPRESSION.
GREAT MED, HUH?
SO THIS IS THE YELLOW BRICK ROAD
, RIGHT, WIZARD OF OZ, AND
THEY WERE SKIPPING AND SINGING
THROUGH THE POPPIES.
THAT'S RIGHT.
THAT'S RIGHT.
SO THIS IS AN ILLUSTRATION OF
THE POPPIES SOMETIMES CAN MAKE
YOU FEEL REALLY GOOD AT THE
BEGINNING, BUT DOES ANYBODY
REMEMBER, THEY DIDN'T QUITE MAKE
IT TO THE EMERALD CITY?
THEY FELL ASLEEP, RIGHT.
AND IRONIC FORESHADOWING FOR
EVERYTHING THAT'S HAPPENING WITH
THIS OPIATE CRISIS NOW IS YOU
GET TOO MUCH OF THE OPIATES AND
YOU CAN FALL ASLEEP FOR SURE.
SO THIS IS THE C.D.C. GUIDELINES
THAT CAME OUT MARCH OF 2016 FOR
ACUTE AND CHRONIC PAIN.
AND WE'RE GOING TO START TALKING
ABOUT ACUTE PAIN FIRST.
SO THE C.D.C. CAME OUT MARCH OF
2016 AND THEY SAID TO PROVIDERS,
IF YOU'RE GOING TO PRESCRIBE
OPIATES, PRESCRIBE THREE DAYS OR
LESS AND NO MORE THAN SEVEN IS
RARELY NEEDED.
AND THIS WAS A RADICAL CHANGE.
NOT ONLY FOR PROVIDERS BUT FOR
PATIENTS AS WELL.
BUT AGAIN, WE'RE DOING THIS
TOTALLY DIFFERENT THAN OTHER
PLACES.
SO IN THE COUNTRY OF GERMANY,
THEY TAKE OUT ORGANS AND WHEN
YOU LEAVE THE HOSPITAL YOU'RE ON
TILE TYLENOL AND IBUPROFEN.
AND THAT JUST DOESN'T COMPUTE
WITH US OVER HERE.
OF COURSE THAT'S REALLY SEVERE
PAIN.
I MUST NEED PERCOCET OR VICODIN,
RIGHT?
THAT'S HOW THEY DO IT.
IT'S NOT LIKE IN ONE HOSPITAL IN
GERMANY T. COUNTRY OF GERMANY.
YOU GET A HYSTERECTOMY, THEY
TAKE CARE OF NEW THE HOSPITAL
AND WHEN YOU GO HOME YOU'RE ON
TYLENOL AND IBUPROFEN.
WE ARE TRYING TO BACK UP AND
FIND OUT WHAT WE SHOULD BE DOING
IT SAYS COUNSEL YOUR PATIENTS ON
SAFE STORAGE AND DISPOSAL OF
OPIOIDS.
I HAVE TO SAY PRIOR TO WREADING
THAT I DISPENSED A LOT OF
VICODIN AND PERCOCET AND I NEVER
DID THAT.
BUT I DO NOW AND TEACH IT.
THIS IS WHAT THE C.D.C. IS
SAYING AND I APPRECIATE ALL
Y'ALL THAT ARE OUT THERE AND
GETTING THESE LOCKBOXES TO
PEOPLE AND REAL LIVE -- REALLY
TALKING TO THEM ABOUT IT.
BUT WE NEED TO TALK TO EVERYONE,
OUR CLIENTS, PATIENTS, AND
ANYONE THAT WILL LISTEN IN OUR
FAMILY.
THE C.D.C. IS SAYING IF YOU HAVE
AN OPIATE YOU NEED TO HAVE IT
LOCKED UP.
AND IF YOU DON'T USE IT ALL, YOU
NEED TO GET RID OF IT.
YOU NEED TO GET IT OUT OF YOUR
HOUSE.
THERE'S THREE WAYS TO DO IT.
YOU CAN GOOGLE WHERE YOUR
PERMANENT DROPBOX IS IN YOUR
COMMUNITY AND TAKE IT THERE AND
DROP IT OFF.
IF YOU CAN'T DO THAT YOU CAN ADD
COFFEE GROUNDS TO IT OR KITTY
LITTER, WATER, YOU SHAKE IT UP
AND MAKE A SLURRY AND THROW IT
AWAY.
IT WILL RUIN IT.
OR IF YOU CAN'T DO ONE OF THOSE
FIRST TWO, THEY SAY YOU SHOULD
FLUSH IT.
I'M JUST SAYING, FLUSHING IT
FEELS NOT GOOD TO ME.
FLUSHING THIS INTO OUR, YOU KNOT
SEEMS LIKE YOU SHOULD BE ABLE TO
DO ONE OF THE FIRST TWO.
IF I ONLY HAD THAT OPTION, WOULD
I RATHER DO THAT THAN HAVE MY
14-YEAR-OLD BECOME ADDICTED TO
OPIATES?
YEAH, I WOULD DO IT.
BUT THIS IS WHAT THE C.D.C. IS
SAYING WE SHOULD DO.
SO A STORY ABOUT THAT, ONE OF
THE FOLKS I WORK WITH, SHE HAD A
SOFA DELIVERED AT HER HOUSE AND
ONE OF THE GUYS DELIVERING IT
SAID HEY, CAN I USE YOUR
RESTROOM?
SHE SAID YEAH.
THEN AFTER THEY LEFT SHE SAID
HUH, HE SURE SPENT A LOT OF TIME
IN THERE.
SHE WENT INTO HER BATHROOM AND
ALL OF HER PERCOCET WERE GONE.
AND DO YOU THINK EVERY TIME THAT
HE DELIVERS A PIECE OF FURNITURE
THAT HE ASKS TO USE THE RESTROOM
I BET HE DOES, DON'T YOU?
AND IF WAS -- IT WAS THAT EASY
FOR THAT GUY, THINK ABOUT IT.
HOW EASY IS IT FOR OUR KIDS, OUR
KIDS' FRIENDS, OUR GRANDKIDS TO
GET TO IT?
THERE ARE LITERALLY HUNDREDS OF
MILLIONS OF UNUSED OPIATES IN
UNLOCKED CABINETS IN OUR HOMES.
WE GOT TO GET THEM OUT OF THERE,
AND WE HAVE TO TELL OUR PATIENTS
AND CLIENTS TO DO THE SAME THING
SO WHERE DID THIS COME FROM?
THE C.D.C. COMES OUT AND SAYS
HEY, REALLY YOU SHOULD JUST GIVE
THREE DAYS.
BUT IF YOU HAVE TO, SEVEN DAYS
BUT NOT MORE THAN SEVEN.
SO THIS IS A TEN-YEAR STUDY OF
ADULTS IN THE UNITED STATES.
OKAY?
AND THEY WERE OPIATE NAIVE.
THEY HAD NEVER HAD AN OPIATE
BEFORE AND THEY GET A LEGITIMATE
PRESCRIPTION FROM THEIR PROVIDER
LEGITIMATE PRESCRIPTION FROM
THEIR DOCTOR FOR A LEGITIMATE
REASON.
THEY SAY WHAT'S THE CHANCE
YOU'RE STILL ON OPIATES AT A
YEAR AND AT THREE YEARS?
SO I JUST WANT TO SHOW YOU HERE.
IF YOU'LL FOCUS IN AT THE 30
DAYS.
SO IF YOU GOT A 30-DAY
PRESCRIPTION, NEVER HAD AN
OPIATE IN YOUR LIFE, ONE YEAR
LATER, 30% OF PEOPLE ARE STILL
ON AN OPIATE.
THREE YEARS LATER, 15, ALMOST 20
% OF PEOPLE ARE STILL ON AN
OPIATE.
THAT IS NOT LESS THAN 1% OF
PEOPLE WHO EVER GET DEPENDENT
OSH ADDICTED TO THESE.
THESE ARE REALLY SAFE MEDICINES,
IS IT?
FROM ONE 30-DAY PRESCRIPTION, 15
TO 20% OF PEOPLE THREE YEARS
LATER ARE STILL TAKING AN OPIATE
NOW, THEY DIDN'T BREAK IT OUT IN
THAT DATASET.
PROBABLY THE MAJORITY OF THEM
ARE STILL IN PAIN AND SEEING
THEIR PROVIDER AND GETTING A
MEDICATION FOR THAT.
BUT MAYBE SOME OF THEM ARE
GETTING THEM FROM FAMILY AND
FRIENDS, MAYBE SOME OF THEM ARE
SLOOTING HEROINE.
THEY JUST SAID HAD YOU ON AN
OPIATE ONE YEAR AND THREE YEARS
LATER AND WHERE THAT DATASET
STARTS TO GO UP IS RIGHT HERE AT
THREE DAYS.
AND WHY WE IN NORTH CAROLINA
PASSED THE NORTH CAROLINA STOP
ACT THAT NOW SAYS FOR ACUTE PAIN
THAT YOU CAN ONLY PRESCRIBE FIVE
DAYS WORTH OR AFTER SURGERY
SEVEN TO TRY TO REDUCE THE
CHANCE THAT FOLKS WILL STILL BE
ON OPIATES AT A YEAR.
THEN THIS DATASET IS FROM THIS
SAME STUDY WHERE THEY SAID WHAT
ABOUT THIS REFILL BUSINESS?
SO I'VE HAD THIS PATIENT
I WAS
16 YEARS OLD, BROKE MY BACK IN
THREE PLACES AND MY DOCTOR GAVE
ME PERCOCET FOR A MONTH AND
REFILLED IT SIX TIMES OVER THE
PHONE AND THEN SAID GO SEE YOUR
REGULAR DOCTOR.
I CAN'T DO THIS ANYMORE.
AND SHE FOUND THAT SHE STARTED
TO WITHDRAW AND SHE -- SHE HATED
THAT.
SO SHE STARTED BUYING PILLS AT
SCHOOL AND THEN BY 20 WAS
SHOOTING HEROINE AND ROLLED IN
TO SEE ME WHEN ONE OF HER
FRIENDS OVERDOSED AND DIED AND
SAID I DON'T WANT TO DO THIS
ANYMORE.
I DON'T WANT TO DIE.
AND WHAT HAPPENS IF YOU GET A
PRESCRIPTION AND THEN YOU REFILL
IT SIX TIMES?
WELL, THERE'S A 60% CHANCE THAT
YOU'LL STILL BE ON OPIATES AT A
YEAR AND A 40% CHANCE YOU'RE
STILL ON OPIATES AT THREE YEARS.
THIS IS NOT LESS THAN 1% OF THE
PEOPLE.
SO FOR CHRONIC PAIN, THIS WAS
VERY CONTROVERSIAL, TOO.
IT SAID IN GENERAL DO NOT
PRESCRIBE OPIATES AS FIRST LINE
TREATMENT FOR KRON CHRONIC PAIN
AND THEN RIGHT UNDERNEATH IT IF
YOU GO TO THE C.D.C. WEBSITE,
DO NOT PRESCRIBE OPIATES FOR LOW
BACK PAIN, FINE BRO --
FIBROMYALGIA AND HEADACHES.
I HAVE DONE THAT OVER MY
PRACTICE.
AND THIS IS A HARD THING TO SAY
BUT I LOOK AT MY PATIENTS AND I
BELIEVE I ADDICTED SOME OF THEM.
DOCTORS WERE TRYING TO HELP
PEOPLE, WE CERTAINLY WEREN'T
TRYING TO HURT THEM BUT THIS IS
WHAT WE DID.
WE BOUGHT THIS BILL OF GOODS
THAT THESE MEDICINES ARE SAFE
AND THEY'RE REALLY NOT.
CHRONIC PAIN, LOW BACK PAIN ON
OPIATES AND THERE'S BEEN LOTS OF
STUDIES ABOUT HOW THESE FOLKS
HAVE DONE AND FOUND FOUR HIGH-
QUALITY STUDIES AND DO THIS
THING CALLED A META-ANALYSIS.
AND THE QUESTION IS WHAT'S THE
CHANCE IF YOU HAVE CHRONIC LOW
BACK PAIN AND OPIATE YOU'LL HAVE
A SUBSTANCE ABUSE DISORDER IN
YOUR LIFETIME?
LOOK AT THAT 36 TO 56% OF PEOPLE
WILL HAVE A SUBSTANCE ABUSE DIS
ORDER IF THEY'RE ON OPIATES
FOR CHRONIC BACK PAIN.
THAT'S NOT LESS THAN 1%, RIGHT?
AND THIS IS AN ARTICLE FROM JAMA
, JUST IN 2018 AND THEY SAID
, OKAY, YOU HAVE CHRONIC
BACK PAIN AND YOU'RE EITHER ON
AN OPIATE OR NOT.
HOW DO YOU DO?
AND THIS IS WHAT THEY FOUND OUT.
THERE'S NO SIGNIFICANT
DIFFERENCE IN THE TWO GROUPS IN
TERMS OF THEIR PAIN RELATED
FUNCTION AT 12 MONTHS BUT THE
PAIN INTENSITY WAS SIGNIFICANTLY
BETTER IN THE NON-OPIATE GROUP.
SO YOU ACTUALLY FELT BETTER IF
YOU WEREN'T GETTING OPIATES FOR
YOUR CHRONIC BACK PAIN.
AND THE OPIATE GROUP HAD
SIGNIFICANTLY MORE MEDICATION
SIDE EFFECTS LIKE FALLS, OVER
DOSE, AND DEATH IN SOME OF THEM.
WHAT ABOUT KIDS?
THE NEXT COUPLE OF SLIDES, THE
STORY IS THE BRAIN UNDER 25
SHOULD NOT BE TOUCHING THIS
STUFF IF AT ALL POSSIBLE.
SO THEY DID THIS STUDY, IT'S IN
PEDIATRICS, IT'S AN ES SCHEME --
ESTEEMED JOURNAL BEEN THE
PEDIATRIC GRIEWBING, 2015.
AND THEY SAID WHAT'S THE CHANCE
YOU'LL HAVE A SUBSTANCE ABUSE
DISORDER IN YOUR EARLY ADULTHOOD
IF YOU GET ONE LEGITIMATE
PRESCRIPTION OF AN OPIATE BEFORE
12th GRADE?
WHAT THEY FOUND OUT IS IT
INCREASING YOUR CHANCE 33%.
SO I DIDN'T SAY IF YOU TAKE 100
KIDS AND GIVE THEM AN OPIATE FOR
THEIR BROKEN WRIST THAT 33 WILL
GET ADDICTED.
I DIDN'T SAY THAT.
BUT IF YOUR CHANCE WAS 1% OR 2%
OR 6%, IT BUMPS IT 33% MORE FROM
ONE PRESCRIPTION.
AND THAT ACTUALLY REALLY
CONCERNED THE RESEARCHERS A LOT.
THEY SAID WHAT ABOUT KIDS THAT
HAVE A LOW CHANCE OF EVER HAVING
A SUBSTANCE USE DISORDER?
THEY DIDN'T USE ACE SCORES OR
ADVERSE CHILDHOOD EXPERIENCES
BUT IT WAS SIMILAR TO THAT.
IF YOUR ACE SCORE WAS LOW, A 0
OR 1, THIS SHOULD BE SOMEBODY
WHO HAS A LOW CHANCE OF HAVING A
SUBSTANCE ABUSE DISORDER IN
THEIR ADULT ONE, ONE LEGITIMATE
PRESCRIPTION INCREASED THAT KIDS
' CHANCE 300%.
IF YOU WERE A 1%, NOW YOU'RE A 3
%.
SO IF YOU'RE A 3% CHANCE, YOU
NOW ARE A 9% CHANCE.
JUST FROM ONE LEGITIMATE
PRESCRIPTION.
BUT THERE IS HOPE.
IVE BEEN HANGING A LOT OF CREPE
AS THEY SAY HERE IN THE SOUTH SO
FAR.
BUT IF YOU TALK TO KIDS ABOUT
DRUGS, 50% REDUCTION IN STARTING
AND USING ILLICIT DRUGS.
THAT'S AMAZING, RIGHT?
AND WE NEED TO BE DOING THAT,
BECAUSE LOOK AT THAT TIME
STATISTIC ABOVE THAT.
90% OF PEOPLE THAT ARE ADULTS
THAT HAVE A SUBSTANCE USE
DISORDER STARTED BEFORE THE AGE
OF 18.
50% STARTED BEFORE 15.
SO WE DO NEED TO BE DOING THIS.
WE NEED TO TALK TO OUR KIDS, OUR
GRANDKIDS, ANYBODY THAT WILL
LISTEN, AND WE NEED TO BE
TALKING TO ALL OF OUR PATIENTS
AND TELLING THEM TO TALK TO
THEIR KIDS.
50% REDUCTION IN STARTING DRUGS
OR USING DRUGS.
BUT INTERESTINGLY, SO THEN THEY
GO AND TALK TO THOSE KIDS AND
THEY SAY HEY, DID SOMEONE TALK
TO YOU ABOUT DRUGS?
YEAH, YOU KNOW, MY MOM DID.
AND THEY SAY WELL WHAT DID SHE
SAY?
AND THEY SAY WELL, SHE TALKED TO
ME ABOUT COCAINE AND METH AND
HEROINE.
ALMOST NEVER DO WE TALK TO THEM
ABOUT PRESCRIPTION DRUGS.
BUT YET THAT IS THE MOST COMMON
WAY THAT YOU GET TO HEROINE.
AND I GET IT, RIGHT?
SOMEBODY WITH A WHITE COAT ON
WROTE THE PRESCRIPTION AND
HANDED IT TO YOU AND YOU WENT
AND PICKED IT UP FROM SOMEBODY
IN A WHITE COAT AT A PHARMACY.
IT MUST BE SAFE.
BUT IT'S NOT.
RIGHT?
SO WE REALLY NEED TO TALK TO OUR
KIDS ABOUT DRUGS, BUT WE NEED TO
SPECIFICALLY TALK TO THEM ABOUT
PRESCRIPTION DRUGS.
NOT USING THEM OR ABUSING THEM
WHEN THEY GO TO THESE PARTIES OR
BUYING THEM FROM OTHERS.
SO WHAT ARE SOME OF THE
ALTERNATIVES?
WHAT CAN WE DO?
TALK ABOUT ACUTE PAIN, THERE'S A
SIT MINH FIN, IBUPROFEN,
OPIATES FOR ACUTE PAIN.
YOU MIGHT GATHER I'M A LITTLE
DOWN ON THEM.
THERE'S TOPICAL ACTS AND THIS
REALLY DOES WORK WHEN YOU HAVE
ACUTE PAIN, ICE, HEAT, PHYSICAL
THERAPY.
THEY WORK.
ALL RIGHT?
SO WHAT ARE THE SIDE EFFECTS?
YOU HAVE SOMEBODY THAT'S TAKING
SOME TYLENOL AND SOMETIMES IF
YOU DON'T TAKE IT RIGHT
[ NO AUDIO ]
WHAT ABOUT THESE NSAIDS,
IBUPROFEN, ALEVE, MOTRIN?
WELL, IT CAN CAUSE YOU TO HAVE A
LITTLE BIT OF BLEEDING IN YOUR
GUT.
THAT SOUNDS BAD.
AND IT CAN AFFECT YOUR KIDNEY IF
YOU HAVE KIDNEY PROBLEMS AND IT
CAN MAKE YOUR BLOOD PRESSURE GO
UP.
THOSE ALL SOUND KIND OF SCARY,
RIGHT?
WHAT ARE THE SIDE EFFECTS OF
OPIATES FOR TAKING THEM FOR
ACUTE PAIN?
WELL, THEY'RE MENTALLY IMPAIRING
IT DELAYS RECOVERY.
AND I'M OUT THERE TRYING TO TALK
TO ALL THE SURGEONS ABOUT THIS.
DOW THE SAME SUR JOB ON TWO
GROUPS, ONE YOU GIVE OPIATES
WHEN THEY GO OPEN AND THE OTHERS
YOU DON'T, THE ONES WHO GET THE
OPIATES, THEY HAVE DELAYED
RECOVERY AND DELAY WOUND HEALING
THAT'S CRAZY.
WE DON'T KNOW WHY, BUT IT
HAPPENS.
SO IT INCREASES MEDICAL COSTS
WHEN YOU GIVE THEM OP YACHTS,
THE OPIATE HYPERALGESIA.
YOU CAN START DEVELOPING PAIN
FROM THE MEDICINE.
IT DOUBLES YOUR CHANCE OF GOING
OUT ON PERMANENT DISABILITY IN
AS LITTLE AS SEVEN DAYS.
IT INCREASES FALLS.
IT TREATS DEPRESSION SHORT TERM
BUT MAKES IT WORSE LONG TERM,
RIGHT?
AND THEN THIS BRAIN CHANGING
BUSINESS.
I'VE GOT TO TELL YOU ABOUT THIS.
THERE'S A SURGEON IN TEXAS, HE
DOES A CERTAIN KIND OF NECK
SURGERY.
AND HIS USUAL IS YOU COME OUT OF
SURGERY AND YOU GET ON I.V.
OPIATES AND YOU GET OPIATES BY
MOUTH AND THEN YOU GO HOME AND
BACK THEN HE WOULD GIVE 30 DAYS
OF OPIATES.
AND SO HE HAD HIS USUAL GROUP
AND THEN HE HAD ANOTHER GROUP
THAT WHEN THEY WENT HOME, THEY
DIDN'T GET ANY OPIATES AT ALL.
AND AT 30 DAYS HE SCANNED THEIR
BRAINS AND HE COULD SEE BRAIN
CHANGES IN THE PEOPLE THAT GOT
THE OP YACHTS.
- -- OPIATES.
THAT REALLY SCARED HIM,
CONCERNED HIM.
HE TOOK THEM OFF THEIR OPIATES
AND WAITED SIX MONTHS AND SKEIN
SCANNED THEIR BRAINS AGAIN, AND
THOSE CHANGES WERE STILL THERE.
SO OPIATES CAN CAUSE BRAIN
CHANGES AND SOMETIMES THOSE
BRAIN CHANGES ARE PERMANENT.
AND THEN OPIATES CAN CAUSE
ADDICTION.
SO WHAT CAN WE DO?
WE CAN -- THIS IS A STUDY OF
OVER 40,000 PATIENTS BUT THEY
WEREN'T HEAD-TO-HEAD STUDIES.
THEY WERE INDIVIDUAL ONES.
AND IT WAS ONE HOUR AFTER
SURGERY THEY GAVE ONE OF THE
FOLLOWING MEDICATIONS.
AND IF YOU HAD A 50% REDUCTION
IN YOUR PAIN, THEN THAT WAS
CONSIDERED A WIN.
PEOPLE FELT SATISFIED.
SO YOU GIVE ONE IBUPROFEN OVER
THE COUNTER, 200 MILLIGRAMS.
AND 37 OUT OF ONE HIN PEOPLE,
ONE HOUR AFTER SURGERY SAID I'VE
GOT 50% PAIN RELIEF FROM ONE
IBUPROFEN.
THAT'S PRETTY GOOD.
TYLENOL, IT WAS 28.
THEY INCREASED -- DOUBLED THE
IBUPROFEN AND GOT TO 40.
AND IBUPROFEN 600 AND 800 IT
WENT UP TO ABOUT 41 OR 42.
SO IT DOESN'T GO UP MUCH MORE,
BUT YOU DO START TO PICK UP THE
SIDE EFFECTS SO WE PROBABLY
SHOULD STAY ON THE LOWER END OF
THE IBUPROFEN.
BUT WHAT ABOUT OXYCODONE.
15 MILLIGRAMS, OKAY?
IT HAS F.D.A. APPROVED
[ NO AUDIO ]
LOOK AT THAT.
ONLY 21 OUT OF 100 PEOPLE GOT 50
% PAIN RELIEF OR MORE.
BUT THEN THEY -- PHARMACEUTICAL
INDUSTRY SAID WOW, OUR MEDICINES
NOT WORKING VERY WELL, SO THEY
ADDED TILE NOT TO IT AND MADE
PERCOCET AND GOT BACK UP TO THE
37, RIGHT?
BUT WHAT HAPPENS IF YOU TOOK ONE
TILE TYLENOL AND ONE IBUPROFEN,
AND THIS IS THE KEY, TOGETHER AT
THE SAME TIME ONE HOUR AFTER
SURGE JI -- SURGERY?
IN 62 OUT OF 100 PEOPLE GOT 50%
PAIN RELIEF.
SO DO YOU THINK THIS IS WHAT I'M
TELLING MY PATIENTS TO USE?
YEAH.
IS THIS WHAT I WOULD WANT MY KID
TO GET IF HE WERE INJURED OR
HURT?
FOR SURE.
FOR TWO REASONS.
ONE, IS IT WORKS THE BEST, AND
THE OTHER IS IT'S NOT ADDICTIVE.
SO THIS IS WHAT WE'RE TEACHING
THE NEXT GENERATION OF FOLKS.
THIS IS WHAT AGAIN THE REST OF
THE WORLD IS ACTUALLY USING
INCLUDING EUROPE.
SO THEN WE HAD OUR FIRST
HEAD-TO-HEAD TRIAL IN THE
EMERGENCY DEPARTMENT AND TYLENOL
AND IBUPROFEN DID JUST AS GOOD
AS THE PERK E SET.
AND KIDNEY STONES, I DON'T KNOW
IF ANYBODY HAS EVER HAD A KIDNEY
STONE.
IT'S SUPPOSED TO BE SOME OF THE
MORE INTENSE PAIN THAT YOU CAN
ER EXPERIENCE, AND USING I.V. IN
SEDZ LIKE IBUPROFEN, COUSIN IS
CALLED TORADOL, VERSE -- VERSUS
AN OPIOID THEY HAD EQUAL
EFFICACY AND TREATMENT BUT
OPIOID HAD MORE SIDE EFFECTS.
POSTOP PAIN, INTERESTINGLY THEY
DID THIS STUDY WHERE THEY HAD
THIS MAJOR SURGERY WHERE THEY
SPLIT THE PEOPLE OPEN AND CUT
OUT A PIECE OF THEIR BOWEL.
SO IT'S COLON SURGERY.
IT'S A MAJOR SURGERY.
AND USUALLY THE USUAL CARE IS IS
THAT YOU COME OUT OF SURGERY
AND GET A P-C-A PUMP.
EVERY 15 MINUTES YOU CAN PUSH IT
TO GET OPIATES TO HELP WITH PAIN
WHAT THEY DECIDED TO DO IS WHEN
YOU COME OUT OF SURGERY THEY'RE
GOING TO TRY NOT TO GIVE YOU
OPIATES AT ALL AND TRY THESE
OTHER THINGS.
ONE OF IF THINGS THEY DID IS
THEY TALKED TO THE PATIENTS
BEFORE THE SURGERY FOR UP TO 30
MINUTES ABOUT WHAT THE PAIN WAS
GOING TO BE LIKE WHEN THEY WOKE
UP.
AND THEY SAID
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HAVING MAJOR SURGERY.
WHEN YOU WAKE UP YOU'RE GOING TO
HAVE PAIN.
AND WE'RE GOING TO TRY TO DO ALL
THESE THINGS FOR YOU.
AND WE'LL GIVE YOU THIS KIND OF
MEDICINE AND THAT KIND OF
MEDICINE AND GIVE YOU HEATING
PAD.
WE'LL WALK YOU AND DO ALL THESE
OTHER THINGS.
AND 50% OF THE PEOPLE WHEN THEY
WOKE UP, THEY SAID HEY, THE PAIN
IS NOT AS BAD AS I WAS EXPECTING
AND THINK ABOUT THAT, IF YOU'RE
THE NURSE OR THE DOCTOR TRYING
TO TREAT THAT PATIENT AND THEY
THINK HEY, THIS ISN'T AS BAD AS
I WAS EX -- PECTING YOU'RE IN
PRETTY GOOD SHAPE IN TRYING TO
GIVE THEM TYLENOL AND A HEATING
BAD.
IF YOU'RE IN THE OTHER WING,
WHICH IS MOST OF AMERICA, AND
YOU WAKE UP AND GO OH, MY GOD,
THAT IS LOT OF PAIN.
DIDN'T THE DOCTOR OR NURSE TELL
YOU YOU WERE GOING TO BE IN PAIN
NO.
IF YOU'RE EXPECTING 0 OUT OF 10
PAIN YOU'RE GOING TO BE
CALLING FOR THOSE OPIATES OVER
AND OVER AGAIN.
THIS HAS DONE APLAYSING THINGS.
IT'S REDUCED THE AMOUNT OF
OPIATES THEY'RE GIVING FOR
CERTAIN SURGERIES AND WE'RE
DOING THIS AT HOSPITALS IN
WESTERN NORTH CAROLINA.
REDUCED THE NUMBER OF OPIATES BY
30%.
LOOK AT THIS, HALVED THE
COMPLICATIONS, THE PATIENTS ARE
LEAVING THE HOSPITAL TWO DAYS
EARLY AND SAVING $7,000 PER
SURGERY.
SO WE'VE BEEN DOING THIS WRONG
FOR 30 YEARS.
BUT WE'RE TRYING TO GET BACK
INTO IT AND DO IT THE RIGHT WAY.
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END OF LIFE, HOSPICE CARE WE
HAVE VERY GOOD DATA THAT SAYS
THESE MEDICATIONS CAN BE HELPFUL
TO HELP WITH PAIN AND AT THE
LAST FEW MOMENTS OF LIFE. THAT
THEY DON'T EX P TEND LIFE.
AND THEN IN ACUTE SEVERE TRAUMA
FOR A SHORT PERIOD OF TIME,
PROBABLY THREE DAYS OR LESS, BUT
DEFINITELY SEVEN DAYS OR LESS.
BUT THERE'S NO DATA THAT SAYS
THESE MEDICATIONS ARE HELPFUL
FOR A CHRONIC NON-CANCER PAIN.
SO WHY DO PEOPLE START ABUSING
OPIATES?
WELL A PERSON CAN BEGIN BY
MISUSING THEM AND PROVIDERS WILL
SEE THIS.
WE'LL HAVE SOMEBODY WHO'S ON
CHRONIC OPIATES AND THEIR
MEDICINE IS SUPPOSED TO LAST 30
DAYS, THAT'S WHY I WRITE IT FOR
30 DAYS AND AT 27 DAYS THEY CALL
AND SAY HEY, I'M OUT OF MY MEDS
AND THAT CAN HAPPEN EVERY ONCE
IN A WHILE, THE DOG ATE IT OR
WHATEVER, THE FOLKS THAT THAT
HAPPENS OVER AND OVER AGAIN.
THEY'RE MISUSING THEIR MEDICINES
THEY ARE TAKING THEIR MEDICINES
FOR WHAT THEY PERCEIVE AS MORE
PAIN OR OTHER REASONS.
THEY CAN USE THE MEDICINES TO
COPE WITH EMOTIONAL ISSUES.
STUDY CAME OUT LAST YEAR, 16% OF
THE ADULTS IN THE UNITED STATES
HAVE DEPRESSION OR ANXIETY.
I FELT WOW, THAT'S A BIG NUMBER
BUT OKAY.
THEY CONSUMED 51% OF ALL THE
OPIATES WE WROTE LAST YEAR.
SO MAYBE THEY ALL HAVE CHRONIC
PAIN, BUT MAYBE THEY'RE USING
THE MEDICATIONS FOR OTHER
REASONS, TO TRY TO HELP COPE
WITH OTHER THINGS THAT ARE GOING
ON.
AND WE HAVE TO ACKNOWLEDGE THAT
AS PROVIDERS AND FOLKS THAT ARE
HELPING PEOPLE OUT THERE.
AND THEN MAYBE THEY'RE
EXPERIMENTING WITH THE OPIATES.
BUT WHY DO THEY CONTINUE?
SO ONCE YOU'RE ON YOUR OPIATES
AND YOU'VE BEEN TAKING THEM FOR
A WHILE, WHETHER YOU'RE TAKING
THEM CORRECTLY AND IT'S BEEN
YEARS OR YOU'RE STARTING TO
MISUSING -- USE THEM AND YOU'RE
TAKING WAY TOO MUCH, WELL, THEY
FEAR WITHDRAWAL.
THEY -- IF THEY'VE EVER BEEN,
SAY, ABUSING OPIATES FOR A WHILE
AND THEN THEY RAN OUT OR THEY
COULDN'T GET ANYMORE, FOR
WHATEVER REASON, THEY'VE BEEN IN
WITHDRAWAL AND THEY FEAR IT.
SO WHAT DOES WITHDRAWAL FEEL
LIKE?
IT REALLY FEELS LIKE THE FLU
TIMES TEN.
AND THEY DON'T WANT TO BE THERE
ANYMORE.
AND THE OTHER THING, THE OTHER
REASON THAT THEY CONTINUE, IS
BECAUSE OF THE CRAVINGS.
AND WHEN WE FREET -- TREAT FOLKS
WITH BEHAVIORAL THERAPY AND WITH
MEDICINES IF THAT'S WHAT THEY
USE FOR THEIR OPIATE USE
DISORDER, WE'VE GOT TO TAKE CARE
OF TWO THINGS.
THEY HAVE TO NOT FEAR WITHDRAWAL
, SO THEY EITHER
HAVING TO GET THROUGH THE
WITHDRAWAL PHASE AND BE DONE
WITH IT OR WE HAVE TO GIVE THEM
MEDICATION SO THEY DON'T
WITHDRAW.
THE OTHER THING YOU HAVE TO TAKE
CARE OF IS THE THE CAVINGS.
I'VE BEEN SITTING IN FRONT OF
SOMEBODY WITH FULL-BLOWN
WITHDRAWAL AND THEIR NOSE IS
RUNNING AND EYES ARE WATERING
AND THEY HAVE NAUSEA, THEIR
MUSCLES HURT, THEIR JOINTS HURT,
AND I'M TRYING TO TALK TO THEM
ABOUT THERAPY AND HOW I THINK
THIS IS GOING TO REALLY HELP
THEM, AND IT'S REALLY HARD FOR
THEM TO ENGAGE.
RIGHT?
SO WE HAVE TO TAKE CARE OF TWO
THINGS.
WE HAVE TO TAKE CARE OF THE
CRAVINGS AND WE HAVE TO TAKE
CARE OF THE WITHDRAWAL SO THEY
CAN DO THE THERAPY, THEY CAN GET
BACK TO WORK, IF THEIR KIDS ARE
IN FOSTER CARE SO THEY CAN GET
THE KIDS BACK.
SO THERE'S REALLY JUST FOUR WAYS
THAT WE TREAT OPIATE USE
DISORDER IN THE UNITED STATE%
DETOX AND ASHES NENS.
IT'S THE NUMBER ONE WAY WE TREAT
IT IN TUSES AND IN NORTH
CAROLINA.
AND THEN THERE'S TWO AGONIST
MEDICINES, AND THEN THERE'S THIS
MEDICINE THAT'S CALL AN
ANTAGONIST MEDICINE, MEL TREKS
ZONE AND YOU CAN TAKE IT BY A
PILL ONCE A DAY OR AN INJECTION
ONCE A MONTH.
HERE'S THE DATA.
THESE WAVY LINES ARE HERE
BECAUSE WE DON'T HAVE ANY
HEAD-TO-HEAD TRIALS.
BUT IF YOU GO THROUGH DETOX AND
ABSTINENCE, WHETHER IT'S
INPATIENT 14 DAYS, 28 DAYS, 90
DAYS.
AT SIX MONTHS TO A YEAR, 90% OF
PEOPLE ARE USING AGAIN.
ALL RIGHT?
BUT YOU CAN SEE WITH THE
MEDICINES AND WHY THE MEDICINES
ARE NOW THE EVIDENCE-BASED
ANSWER TO THE OPIATE USE
DISORDER.
SO I'M AN ALL THE ABOVE GUY.
IF SOMEBODY -- AND I -- I KNOW
PEOPLE THAT HAVE BEEN THROUGH
DETOX AND THAT ARE ON ABSTINENCE
NOW, AND THEY'RE DOING GREAT.
THEY SAY I'VE BEEN CLEAN AND
SOBER FOR SIX MONTHS, FIVE YEARS
ONE GUY I WORK WITH 25 YEARS.
WONDERFUL.
BUT KNOW THAT NINE OUT OF TEN
PEOPLE THAT GO THROUGH THOSE
PROGRAMS ARE USING AGAIN WITHIN
SIX MONTHS TO A YEAR.
SO THE WORLD HEALTH ORGANIZATION
SAYS USING MEDICATION ASSISTED
TREATMENT SO THAT PEOPLE CAN DO
THE THERAPY, GET INTO GROUPS AND
INDIVIDUAL IS -- IS THE WAY TO
GO.
AND 12 ORGANIZATIONS, FED
FEDERAL -- AT THE FEDERAL LEVEL
HAVE ALL AGREED WITH THIS.
THIS IS THE -- THE NEW WAY THAT
WE SHOULD BE TREATING OPIATE USE
DISORDER.
SO IF SOMEONE CAN GO THROUGH
DETOX AND ABSTINENCE AND DO WELL
, GREAT F. THEY'VE GONE
THROUGH IT SEVERAL TIMES AND
THEY'RE STRUGGLING AND THAT IS
REALLY P -- SCARES ME BECAUSE WE
KNOW THAT THERE'S A 40 TIMES
INCREASE OF OVERDOSE AND OVER
DOSE DEATH ONE MONTH AFTER
GETTING OUT OF DETOX IN AND AN
ABSTINENCE PROGRAM N THE FIRST
MONTH.
THEY'VE BEEN THROUGH IT A COUPLT
WORKED I'M FEARFUL THEY'RE GOING
TO OVERDOSE AND DIE BEFORE THEY
CAN GET THROUGH THIS AGAIN.
MAYBE THIS IS WHERE WE SHOULD GO
MAYBE THEY NEED SOME MEDICATIONS
SO TREATING OPIATE USE DISORDER,
IT REALLY IS A LIFE-THREATENING
ILLNESS BECAUSE OF THE CHANCE OF
DEVELOPING OR LOSING YOUR
TOLERANCE AND THEN WHEN YOU
RELAPSE USING AGAIN AND IF YOU
USE THE SAME AMOUNT, THEN YOU
OVERDOSE OR OVERDOSE AND DIE.
SO I HOPE THAT YOU KNOW A LITTLE
BIT MORE ABOUT THE OPIATE CRISIS
AND HOW IT'S AFFECTING NORTH
CAROLINA.
I TALKED TO YOU A LITTLE BIT
ABOUT ACUTE AND CHRONIC "LOVE,
PAIN AND THE WHOLE CRAZY THING"
AND HOW WE'RE USING -- HOW WE'RY
TO THE NEXT GENERATION OF
PROVIDERS IN WESTERN CAROLINA
AND RETEACHING THE DOCTORS AND
PROVIDERS THAT HAVE BEEN OUT
THERE FOR 20 OR 25 YEARS ABOUT
THE -- THE APPROPRIATE WAY TO
USE THESE MEDICATIONS.
AND THEN WE TALKED ABOUT THE
IMPACT OF -- OF THE OPIATE
CRISIS AND OPIATE USE DISORDER
ON OUR PATIENTS.
SO THANK YOU VERY MUCH.
[ APPLAUSE ]