Frequent MAX radio sponsored by bear progress is a human and mentioned. We look at our world and imagine how to make it better. It bear scientists, developers working with farmers to help shape the future of agriculture like farms were crops and wildlife thrive together in new digital, tools that allow farms to use less water, land and energy. It science for a better life from bear more about how there is shaping the future of agriculture. Visit crop science, dot bear dot, com. Fr radio sponsored by bear progress is a human and mentioned. We look at our world and imagine how to make it better. It bear scientists Developers, working with farmers to help shape the future of agriculture like farms were crops and wildlife thrive together in new digital tools that allow farms to use less water, land and energy it science for a better life from bear.

More about help. There is shaping the future of agriculture visit crop science, dot, bear dot, com. In our previous episode number four. Oh two, we looked at the rise of the opium epidemic. We are saying more people killed because of opium overdose than traffic accidents The tragedy seem to come out of nowhere, but in fact it had distinctive routes in the pharmaceutical industry. They really somehow fooled us into thinking that pain was a vital sign on that we needed to treat it were liberally in gum. Policy. What happened during that growth was that prices for appeals, same way down due to government subsidies and in the highly addictive feature of the medicine that had been promoted is not being addictive. I was taken five hundred milligrams of she caught in a day and so had progressed very very

quickly and I couldn't stop the opulent crisis. We learned is really a story of supply and demand. In retrospect, there's plenty of him to go round. There was in attention and which the thinking, and almost certainly some deception released greed. As result, hundreds of thousands of people have died out, families have been broken and one unintended consequence of the crew this is that many people who have legitimate need for pain management and who have never abuse those drugs now find it much harder The medicines they need, one such Certainly, I was born with severe Scully severe scolding doses he said and needed multiple surgery, starting as an eleven year old. I was on Fetnah patterns for over ten years. They allowed me to not her every minute of the day. I did not get high. I went to in clinic every month and was drug tested beer. Half ago. They stopped prescribing me because government regulations now every day

the struggle to get out of bed and be productive, so this man suggests the prescribing protocols for opiates have changed in his case, not for the better How have the new protocols affected potential opiate abuse? The fact is that, more one in five American still gets at least one opiate prescription filled or refilled per year, and dependence on precise What's an often leads to a dependence on heroin. Or synthetic fetnah, both of which are even deadlier just how, People are we talking about here? The depart health and human services. Estimates are roughly two million people in the? U S with what it calls opiate use disorder as the health care I missed Alicia Sesar modesty, no told us. Last week an entire generation has been addicted at this point, so what's to be about that its tradable we all have to over complicated.

Play Unfrequent must radio. Our second of two episodes about the opulent crisis focus today an addiction treatment, option that some people think should be universal. They can get it as part of routine care just like they might get their insulin for their diabetes or their blood pressure medicine. So is it universally embraced. That's that's probably know from stature and Gunnar productions. This is pre economics, radio broadcasts and explores the inside of everything. Here's your Stephen Governor last week, in part. One. We met Jean Marie Peronne at the University of Pennsylvania,

see medicine, physician and medical toxicologists, which means those trees, poisonings and overdoses and more recently started to do addiction. Medicine work Peronne has seen the opulent grace up close as a researcher and practitioner, so we have about a thousand or twelve hundred patients who visited our three hospitals last year and about four hundred Moreover, overdoses have you ever used opium aids of any sort. You had a couple, aids and broke my leg and broke my rest. I didn't have opiates for any those three things are you offered. In any case, I broke my leg, Canada, interesting. We, I would say right in the middle of the opium crisis and they said no, you need anything and I sent you I'm fine with Ibuprofen skiing mountain biking, but anyway, I were among yourselves, differing it myself, but I would definitely say that

I would have a super high threshold for anyone in my family. Anyone I know I mean I, I advise against it sort of across the board, because it's just easy to see that you just don't need to go there, so opioid deaths in the? U S have levelled off, maybe started declining that what are you saying here in Philadelphia? So they did decline a little bed. I think what is Orton about the national data. Is that the deaths that have declined the most are the oral pills and that's probably the result of deep. Describing a little bit of a result of prescription our monitoring programmes preventing the co prescribing of benzodiazepines with Opel. Maybe but public awareness, like I shouldn't drink when I'm taking back pain, medication.

Another potential driver of the slight decline in death is the widespread availability of nor can emergency nasal spray of the drug, Num Lock zone which can stop and overdose as its happening wherever it happening, Peronne has administered, nor can herself a few times. The most recent was writing. Subway home in Philadelphia after night out, somebody called and said it does anyone have. Nor can there's a man down, do carry our continent's. I ran five or six subway cars up. There was a man on the ground, getting. Cpr was blue. Psychotic was pulseless really on the brink of death or defined. As dead already maybe- and so we continued sepia I got my nor can out. I gave him windows and it didn't really respond and I give him another dose, and then I thought you know what we needed to do: mast Mouth, and then I thought maybe someone working still stuck in his nose and so serves scribble

no a little bit and kind of irritating a little bit more and then he took like one teeny tiny breath and over the course of the next You know ninety seconds started to wake up and then about ten minutes. Later EMS came as like you guys, just if this guy's life, you say you guys but you're, the one that came with well now, but they had started CPR. They had called someone for help. They called nine one. I mean they done so much. You know we stimulate resuscitation the hospital in this group of you know, people just got it all together We're doing all the right thing, so it was really impressive municipality, twenty five or thirty people at the if it all- and it was like this amazing. I call my Philly moment because there's like winning this, about when everyone in the streets- and everyone just had this amazing Bonn and it was, it- was incredible tears. My eyes then bring steersman as my talk about it. So that's We had a happy ending many overdose Please do not, and nor can can only do so much. It doesn't tree

The underlying addiction, the patients who come the emergency department after receiving. Our can from an overdose about six percent of them are dead at the end of one year and ten percent of them are dead at the end of two years. So there is no other medical condition that we currently treat the emergency department that has that kind of mortality. So from your perspective, I'm curious you're in your doc, and people come in for help there in a desperate state already rate there. Not typically due to say, I've thinking long and hard about my life, and I want to make her a graduated chain trade. So what can you do for them? What was the treatment? Let's say five years ago, when the problem was starting to really turn into a horror and how does the treaty different now. So that's a great question five years ago and overdose patient hopefully got some compassion and emergency department and a little bit of a conversation about why they may have overdose that day or what we can do to help them. Maybe, as of for three

so they would have been discharged with a box of nor can earn a lock zone so that if they were exposed to another over somebody can use them on them where they could use it. On a friend or or colleague, I think fast forward from there. What we realized is that giving them a kind of a crumpled piece of paper. It's a! U should stop using drugs, doesn't ring we work there in a cycle of using and fighting withdrawal every three or four hours, and so that doesn't lend itself to getting your phone out. Maybe an appointment for Monday morning to see an addiction specialist visible, model was failing and other hospitals too. We were on the front lines, Jesse patients being brought and sometimes been dropped off at the door and thrown at the emergency personnel, but skilled in off real. I am professor. Care of emergency medicine at the school of medicine. Shoes

the chief of emergency services at Yale, Newhaven, health, so low. Peronne Dinner Frio, is a practitioner and a researcher. So study and german, two thousand and fifteen was looking at different models of care for opiate use disorder JAMA the Journal of the American Medical Association and in two thousand fifteen. Your practitioners like now for your warrant having much success. Treating the many opiate attics they'd started to see. So she and her team set up a study. It included. Three hundred patients divided into three treatment groups in the first group, will try to motivate to get care and then will refer them to the centres of care that we had here at Yale error in the community. This was the standard treatment at the time. The crumpled piece of paper model, Jean Marie pruned mentioned the second group of de LA for his patience, a bit extra. They got motivational enhancement. What we call the brief.

Negotiation interview. That was a fifteen minute conversation talking about their addiction. In the circumstances it led to it, and then those people got a facilitator of Europe, not just a crumpled piece of paper, so We actually call the place ourselves and if it was at night we call them in the morning and said we were first person to you and then the third group they got off so a motivational enhancement, brief intervention, but them they were started. I'm keeping our so it's an orphan is a opiate agonists, which means it activates, the open receptor, just like heroin and oxy Codeine, Jean Marie Peronne. Again, I think everyone knows methadone and methadone. His are historically opiate in its treatment that we use for patients with a beard, use disorder and the only treatment merely had for a long time but methadone as issues methadone is dispensed.

Federal treatment programmes and the patient has the other every single day to get their dose and The protagonist methadone works by being a very long, acting opium, Lloyd and acting at the opium sceptre and in high enough doses, thoughts. The use of other opiate Agnes they ve morphine, is different. First of all, it can be pursued, from a doctor's office. So the patient doesn't, to go to a methadone clinic every day they can get. It is but of routine medical care just like they might get their insulin for their diabetes or their blood pressure, medicine and its entire to be less stigmatizing to get it as part of routine medical care. The other thing is that its apart Agnes at the opera receptor, so it doesn't continue to activate it. The way methadone does so those what we call a ceiling effect, which makes it much safer. That there isn't as much respiratory depression and there isn't much risk of opiate overdose and death. It's free hard to overdose on. It is hard, even

the child takes a pill of their adults, families, her friend and off the table that they will die from it, because it does eventually just reach that ceiling effect, so blueprint morphine, which is itself an opium seem to offer a safer and more flexible treatment for opiate addiction. But how effective it that's, what do not Riyos we're looking for in her study at Yale, and so what we found was that those patients that in the future. An group or two times more likely you be informal treatment at thirty days in one month, there was a huge proven over the two other groups in the study, so up thirty, seven percent of patients, therefore, our group were in treatment and about forty five percent in the brief prevention group and then almost eighty percent in the cuban orphan group. So there

were able to double the rate of engagement of patients who showed up for a follow up meeting when gene her own of pen, saw the Yale study she was impressed and excited and that is so critical to you know getting people into treatment and that medical and stabilizes the cycle of withdrawal that that patients are experiencing. So it's really important to not say you can come in tomorrow for your first appointment, but here's a medication, the next twelve hours be the hell. You think it's gonna be if you start on this medication now. So that sounds like a wildly useful drugged, I'm sure every hospital and Medical Board and state legislature must be in favour of, dispensing more of this antidote? Yes, that's that's! That's probably, no, I think, there's a lot of good people in theory who do want to do this and expand our treatment. I think the lagoon six of learning. How to administer. Group Norville sounds more complicated than it might be, and that is a barrier woody mean by

logistics of administering it so first in order to write a prescription for Boop and you have to get something called an Ex waiver, which means that you have to take an eight hour training programme and you you'll, find it the to get a special waiver. Does the same sort of waiver licensing process applied to prescribing medical records in the first place? It is not so I can the factory or opium use disorder with Pino oxy code, when our hydro more phone, if I wanted to- and that would be nice- regulated at. Why be extra level of regulation for Boop an it's complicated, but when we went from late sixties, when we started methadone- and you know we have people who needed treatment, but we weren't gonna, let just any doktor, prescribe it and said why methadone was restricted to these federal treatment programmes. But then, when we said well, you know in two thousand: they ve morphine became

elbow and was approved in the United States, but we weren't just can what every doktor put out a shingle and start administering Boop Morphine blueprint morphine? Is most commonly administered in a name brand drug called subject zone, which also contains no oxen Youporn morphine, was invented. By the farm affirm, Racket Ben Keyser in nineteen sixty six one of many synthetic opiates designed in the twentieth century. They were meant to treat pain but be less addictive than opium itself but, as it turned out, most of them were the directive. That is the foundational problem of the prescription. Opiate crisis in Nineteen nineties wreck it Ben Keyser recognised blueprint orphans potential for treating opiate use, disorder and spun off its blueprint, orphan division into what is now a subsidiary company called individual self years ago. Another drug company thought about getting into the pupil morphine market Purdue Farmer, which makes oxy com

when the most widely abused prescription opiates Purdue memo at the time called Blueprint morphine an attractive market, but they never did jump in today. Produce is a target of thousands of lawsuits charged with having downplayed the addictive nature of oxygen, just how influential was Purdue in the opium universe for using opiates to treat pain, why patient recently retracted. It's two main guidelines for using opiates treat pain. Why? Because the guy lines it has now been discovered were unduly influenced by opium manufacturers, including produce whose international subsidiary and yet at this moment, oxy cotton, is still legally and widely dispensed as a useful painkiller that is also easily subject to abuse. So box on, meanwhile, is much harder to abuse, but is also harder to get. What do you mean

professionals who treat opiate diction. Think of this here's, what one doktor wrote on the health affairs blog viewpoint. Orphan has the potential to be a transformative tool in healthcare practitioners, fight to reduce deaths from opiate overdose, but that the ex wavering process is onerous outdated and hampers our ability to help patients manage and recover from opulent addiction. An editorial in JAMA. Psychiatry made the same complaint and noted that, using the restrictions on pupil Orpheus in France help drive down deaths from opiate overdose there by nearly eighty percent. If extrapolated to the United States, the authors wrote this translates to more than thirty thousand your annual deaths from opiate overdoses so globally. The statistics are tremendous, a note. The evidence there do youth see the way, the requirement for Boop North

We must stop big time and, at the very least, what we're not going to do now is embrace of opium aids in the first place like we messed up big time and very least. What we're not going to do now is mess up in same direction, even though this might be a different direction. I think it lingers because of some of those concerns, but we, if we go back to two thousand, we didn't really have any kind of opium crisis in two thousand, so it was really approved. In the absence of a big sir nope you use at the time, I think not, Appealing it at this point is probably multi fact. Oral people are worried about the box soon, diversions of the same substance that we want to prescribe is also available on the street, and we acknowledge that. But it's not you on the street to get high, is used for patients to treat their own withdrawal symptoms when their unable to get other medication. So I think that's part of

there's been some resistance to taking away the ex waiver. I think it also is gonna taken if Congress, which is fairly hard to accomplish- and I think fit repealing ex waiver is an entirely gonna. U know opened the floodgates for prescribers who want to proscribe Lupin morphine there. Still some education in the end, some stigma that needs to be addressed before more, we're gonna be willing to proscribe. How would you describe the weird, Yes, sir, the paradox or whatever of the fact that Boop an orphan is so difficult to prescribe verses. I mean, if I MA, a medical resident, let's say, can prescribe oxy. Yes prescribe is different so prescribe is writing a prescription. So in order for them to order oxy cotton in the hospital, there are new requirements in for them to write a prescription for oxy cotton? They would, of course, need there d number, but in order for them to proscribe sob

some are Boop morphine. They would need to take that eight. Our training, on the other hand, if a drug is as valuable as Boop Morphine sounds, it may be, is an eight hour training program, such a big barrier a more even should not be something that we should applaud is proving the worth of being able to prescribe it. I think, there's some value to training. I think our original activism around oh periods? We thought all doctors should learn a little bit more about any opiate that they prescribe, because there is clearly a lack of education about the addictive nature of the problem. In primary care if you're gonna proscribed, Boop Buprenorphine and you need to take an eight hour training. That's ok! If you plan to treat a lot of patience, but if you're only going treat no five or six patients, just sort of his part of their other medical problems. It becomes a much bigger barrier in the. The emergency department, we had to get all of our doctors Ex wavered, just to be able to write the occasional,

Christian for somebody who has opened Eustace order. I can understand the historical evolution of this, but I cannot understand the modern response. Modern response mean modern lack of response. Modern ways of dressing, some repeal of the waiver or modifying the waiver? I see some hospital, chains and some state and local govern. Are moving in the direction that you advocate, but I see that others are moving in the opposite direction, including the state of Pennsylvania, which is kind of pinball. Can you describe that so the state Pennsylvania, despite everything we thought you know, was was moving in the right direction in the state legislature introduced a bill I would add, an additional layer to the Ex waiver, so you are already Ex wavered like myself, you have to pay for, hundred dollars a year to get an additional ex waiver licence. In order to push I've been Pennsylvania. I think that it came out of Perhaps some well intended a sense that needed to decrease the amount of people Orpheus preschool

that wasn't being as tightly administered as they might wish that bill task. The Pennsylvania state Senate Bible forty one to nine and is now in the house, but the ex wavered in training requirement and extra fees are the only things holding Buford orphan back from widespread use. If we look at residence, treatment programmes across the country, most of em oversight, ninety percent of them are still abstinence to have stepped based programmes that Stephen Lloyd, physician, Tennessee whose specializes in addiction in last week's Epps but we heard how Lloyd himself was four years addicted to prescription. Painkillers basically ought to was all day long and when I got out bed in the morning I had withdrawn during the night, so I was sweating felt Like an eighty year old man, and I was in my early thirties, Lloyd,

into a detox programme, and then a thirty day residential rehab facility, which got him turned around today, he's a medical director for a network of addiction treatment. Dinner's, I'm a big believer in medication, assisted treatment, and we know that the most effective we can do for opium. Addiction is actually medication, assisted treatment with the use of drugs like deepen, morphine methadone and now treadstone. And I've taken heat from this in the local treatment community, as well as the treatment community statewide any been nationally? Can you just Scribe, where that push back in that reluctance is coming from well and We stated that the push back comes from people in a recovery community and one of the problems with addiction. Edison is that most of the people at work and failed? Our lot of the people who work in the field had the issue themselves. That's how they get in the field looked like myself, but they were

if that the only way to get healthy is how they got healthy. So it's totally anecdotal is Lloyd, noted, most addiction treatment. Programmes, do stress, total abstinence, including twelve step programs like alcoholics, anonymous and narcotics anonymous. How successful are such programmes? That is a famously difficult question solid data are hard to come by. After all, anonymity is a feature of such programmes and there are all kinds of possum selection, biases, alcoholics, anonymous claims that seventy five percent of its participants stay sober but academic studies, but the success rate close it a ten percent raven less. That said, one Stanford study compared adequate quit with the help of a verses. Those who quit on their own and fell

a nearly doubled. The success rate Stephen Lloyd's argument is that abstinence is the chosen path for the recovery community, but that medical professionals embrace MIT medication assisted treatment throughout the World Health organization. You got an item that is the National Institute on drug abuse. Everybody who looks at this is the role of medication is paramount. It should be the cornerstone yet is so hard to get people into those programmes because of the stigma associated lot of times, it'll be from parents. I've had numerous parents, talk their kids her medication because they said to retrain one drug for another and in a few months down the road I get to call that they ve- reduced and dad, and I can't tell how heartbreaking those calls- or, if I say to you, I don't like the idea of the pharmaceutical industry being able to be the chief beneficiary of medication assisted treatment because they helped drive this problem

first place- it's a little bit like you know. I said a house on higher than I'm the hero who calls in the fire to the fire department. I don't like the optics of that. I don't like the economics of that. What do you say to that argument? I agree with your million per se it it makes me choke every time I think about it, but I don't have a better option don't have. Anything else is doing to stop my patients dying at the right to dignity. Does I can't stand it? I read somewhere recently that several years back produce farmer tried to acquire the the marketing rights to be benefiting which, just absolutely is unconscionable to me, and so I would agree with you thousand percent. I wish there was a better option, but, right now, there's not, and so I can't let my feelings get in the way of trying to help my patience and help him stay. Love could you'd described for me the underlying causes of populated Dixon. I guess what I'm looking for it if you could break it down between

physiological addiction or craving, as well as the psychological and environmental drivers. Well, I don't know how much more did you break it down you just did you know that's the classic mile psychosocial model that you just described. So that's really the three big components the developing? Any addiction in this case obiang, so you ve, got a teach it in terms of a slot machine. You know when the three whence come down on the pale on that when the money comes out, so the first seven is the bio component, that simply genetics. Do you have a family history of any addiction if you do than at? First, Evan comes down. The pale on an addiction is about sixty percent genetic for the most part. The second part is the psychology component. What can a household we raised in? Do you have a high ace score? adverse childhood experiences. Were you physically sexually recently abused. Do you have that chronic try, Maybe even lighter in your life, if you do than that? Second, seven, down on the pale on and in the third sector?

as the social component, and that's just the availability of what he is widely available and that thing is most widely available. Its alcohol and it still mostly what we see people abusing addicted to, but in an lightning in eight early Ninetys and into the two. Thousands opiates became much more widespread. You and many others call addiction generally a disease, and it sounds like the the factors may determine your likelihood, for the disease are pretty much everywhere. So. Do you see this is a different sort of disease and we typically think about with epidemiology. Let's take, it is is it. Everybody agrees on type two diabetes mellitus in nobody has a problem with type two diabetes being a disease round. I never hear any discussion about it yet, for the most part is behaviour right. Why do people get two diabetes: will they don't eat right, nay, dont, don't exercise correctly in so we treat that widely with me

creation to try to decrease the bad outcomes with diabetes. So you know, look at addiction is being much the same. If you about addiction. Addiction is a brain disease gilding off Rio again from Yale, and we know by looking at scans of the brain that even though I may be have had treatment and I'm no hunger physically dependent the man You show me something whether it's a syringe or it could be just a place that I used parts of my brain I may do a will light up, showing that I still have this craving. I still have possibility to use. If I get back in that situation, I can't pray myself out of it. I can't will myself so it doesn't matter if I call it a disease or learning disorder. It is a rewiring of the brain. The reward system in the frontal lobe interaction at the where the primary focus becomes a position of this substance, for me to be ok, and so, when

get it in those terms. It looks a lot like diabetes to me. Can you talk for a minute, a bow federal policy toward medication, assisted treatment and perhaps pupil morphine, specifically from what I've read that the policy recommendations during the Trump administration have been evolving very rapidly. If you look at it in a president, trumps first appointment to the if a department, health and human services was Doktor Tom Price. He came out early on and said. Well, you know this is simply switching one drug for another and in those of us in the addiction failed had serious anxious about that. But you have folks in the judge S right now that are giving really good direction with regards to medication, assisted treatment and making it more widely available. It is evolving quickly and I think we're to the point now that some of the stigma is being decree simply because so many people of dad instead

defining recovery is total abstinence from any medication. I wanted to find recovery in those parameters of your life. Getting better. Are you still going to jail? Do you have your kids, but you have a job. Are you a man? of the taxpaying Citizenship and United States to me Those are much more reflective of effective treatment and whether or not but he's totally absent from all drugs, because some twelve step groups, as they have to be Stephen Lloyd's philosophy, as well as that of gales and offer you and Jean Marie Peronne falls under the umbrella of what is called harm reduction. Is the idea that you, we risk not is something that must be driven to zero. In a recent episode called the truth about the vapours crisis. We talked about the battle between smoking. Abstention is speedily argued that nobody should be consuming any nicotine in any form.

And harm reduction to argue that raping, may carry risks but they're almost certainly smaller than the risks from smoking cigarettes when it comes to opiate abuse the gap between The abstention nests. Harm reduction is seems even wider. Why? What's different about opiates, it's always there. Stigmatized I dont know why, so, I think Anytime, you lessen the stigma associated with addiction, you increase, people's opportunity to step out of the shadows and ask for help after the break, how that help happens when it happens, and we talked to act in recovery, one of whom now works at the universe. Pennsylvania Hospital, helping other attics wreaked grip, you there, and if we can, on radio Stephen governor of your back

for economics, radio sponsored by Paraday hidden in each cubic, curative air or thousands of I allergens. You can't see them, but you're surround Your eyes, each nonstop you read them all day, but now Relief is just one drop away today Once daily relief contains the number one prescribed allergy, it relief ingredient, one drop, once a day, works fast and lasts all day turn europe- did. She allergy idea into a payday now available without a prescription everywhere everybody I'm Sumter and I'm an actress and most recently you can see me on ABC mixes. I this is tyrant off and I'm the boss, a cabin hearts left out loud network, and we the host of the sugar, a sweet space where we she to indulge on topics. We sometimes get left out of its face by four

about brown man. This is a place of community where we want you to feel lots of love peace and laughed aloud now's pragmatism, one that was I oh, when our hair, when I was in labour, I was like I was having a orgasm grow airs. Go now, leave you now somewhere baling, maybe you, ve not actually have an eye. This exists. We space I would like us to see ourselves and be ourselves: get ready to open up top, laugh even cry with our sweet. Should amendment the ship is out now listen on stitches apple podcast, wherever you get your pat gas, as we ve been hearing, treating opiate addiction with another opiate like Pupa Norfolk, is not the concept universally embraced, but a lot of smart and dedicated people are in

but more than just that they are changing the way attics are treated from the moment they wind up in the GDR Her team have been creating a new treatment protocol, four opiate addiction that includes pupil morphine or sub, but more than They are changing the way attics are treated from the moment they wind up in the GDR. This treatment includes what they call a warm hand. So a warm hand off is a term. Is the idea that a patient at a hospital or is going to be discharged, having already met appear or someone who's gonna, either accompany them to an appointment or they met the doktor. There clinician who will take care of them said there is a close connection between patient and the patients next step in recovery and there's another member of the warm hand off team. A pure counselor are pure cancers, are people who are in recovery themselves and who can start the dialogue right there about. You know what it would look like if they tried

education or tried to get into a treatment programmer tried to engage in key all right, then it's all about engagement. These pure councillors are on staff at the hospital they ve done, you certification, training and they ve got first hand experience as opium attics. I think there is some of the most not just dedicated, but you know people. Who have been through more than I've ever been in my super easy life I've come to the other side and who want to help other people and who are successful at helping other people, their special people, like Nicole people like Nicole. Absolutely I'm Nicola Donnell and my certified recovery specialist in emergency rooms. Pen syndicate Oh, what's your story? How'd you get to be in this position south from you things. You hear a lot of work, so my first was banned owes much was xanax. That's what I became addicted to

I went to rehab. I was twenty one. My first time I went to treatment, impatient treatment and it worked it worked for about two years and then their wise open. Wade painkillers around? So that's. You know why not right, and then Oxy cottons warrant really eyes right, the available then so is like per furred ease in opiates that were in someone's proscription that we got and then they are are expensive, so it was. Easier to get our when then what happened how'd you finally get clean. I wise tired of stalling withdraw cause. That's all I was doing in the end wise use, Why wasn't western all right? So I came to this realization that I'm going to continue to be an withdraw every single time. Until I do something about it was the withdrawals awful and nobody

to be in it, and I realized my wife was too to figure out how I was getting drugs just to stop withdrawal it's not fun in the end, not a party nobody's happy. You know you're just really try not to be sick and barely functioning you had a sister? Yes, yeah he's one gas three years younger than May Jessica, and I understand she died- of an overdose she did and it was December fourteenth of fourteen ok, and what will what were her drugs or drought heroin? And what was your relationship lake with her than we used to gather? I'm? She gave me heroin for the first time, so I was doing rational management, for seven years of my recovery, and then I lost my sister and that's I started doing outreach I needed to give her purpose and I need- it's you, maybe the person for people that gene problem we did an encounter in her active o introduced

me too, one of the people that she's been helping. Hence I Richardson, I am a restaurant manager. I am also an alcoholic and inadequate from Jersey, shore, originally new to Philadelphia. The I've been here a little over a year now. I married, I have a wife, I have a son, he just turn three situations. What's his name they, Henrik Herb, Henrik Matthew Richardson. As he likes to say on the day, we spoke Richardson I've been in recovery for ninety three days. She had come into the Ten e r, after overdosing Ban Nicole came to meet me in the hospital, but I believe it was. The physician that I saw ass If I was interested in getting help- and he said he had somebody. He knew that I could talk to an call showed up to talk to me, you overdose somewhat on, in fact, no Nicole helped. Lean, get on sub oxen, I'm still doing this box in Iraq

I take it every day this box and helps. I dont have Chris and right away that started when I went back in the second time to this box and click the recent time they up to my dose and, from TAT Day on, I haven't, had a single craving for any opiate sense with that feel like pretty awesome, pretty amazing. So how much her success. Would you a tribute to working with Nepal and Have- appear and who understands it the drug itself. And then any other third or fourth reason I mean they all play a big part. It I wouldn't want to break it into percentages, are graphs or anything like that, because for me, it's all intertwined, but you think that Nicole, without the sub oxen would do it now this box and is definitely something I needed. But if I was just doing this, oxen and nothing else. I would stop taking this box it. You know I wouldn't keep taking it. You know the drug helps the physical part,

and everything else I do helps me become a new person, the human being, which is my service oxen helps you get back the level that Nicole can work exactly right here in my cynical socks and sounds like a really good the solution least for some of the people. Some of the time rate. Can you talk about, I guess problem the barrier of being able to you. It is widely as it might oughta be used. So, from my perspective, aside from you know the axe, wavering and the medical barriers that doctors experience from our experience, Two is there is a big stigma with it in their recovery community, their recovery. Community aid nationally, has been abstinence beast, and that means nothing. No medication and no illicit drug use. Nothing. How come it's just this stick. Do you this deep seated thing? You know the tools that

Grams, there's a lot of tradition and stuff like that and there's not a lot of change, but I'm not not going like, I love the twelve steps that I love the programme, and it's done so much for me, but I don't talk about the fact that I use a box and my sponsor knows you know my close friends now, but I dont bring it up in meetings and there's different twelve set program. Obviously when one of them specifically states that Amity is not considered clean. I lay in wait before we started. Recording you told us that if a friend years just died here, just now How much you wanna say about those circumstances. It's a friend you knew for how long and how they die. I have known him since I said, going to the twelve step group that I did. I go to work out what we call our home group back in February. He was up on a year sober in

ten days he would have had a year, and he do you know this is this is how it happens. Is that people top, and then they they go back out and they think they can. Is the same amount as they were using once before in need of care anymore you're pretty much killing yourself, you go back out, not people always close to me. But I know someone that's dying every week, but I mean this one No, I was with him yesterday and we are talking in joking about the fishing trip that were going on next. We again, you know his mom wishes talking over my facebook about how proud she was the moment. It's just. It's a horrible disease, China whose Heroin probably heroin, and that now everything's fine now you're crazy. Really began with prescription pills. Then move

the heroin and now synthetic sentinel, which presents a particularly high risk of overdose. To that, there is another idea currently under consideration in Philadelphia, bra reductionist seer, Nicole again the certified recovery specialist. So we I advocate for you, no safe injection practice is than me. Exchange, but there's this safe house that raw, caring for and it's a place to go for people to safe. Not overdose, they go use drugs get tested, they have medical staff, they have peers, hopefully there to navigate them into treatment, they see my we do in the emergency room, the legal official, kind of safe drug use site that O'Donnell is describing doesn't exist yet at least not in Philadelphia or elsewhere. In the U S, though, it's been proposed in several cities, it does exist,

euro canadian cities. In the. U S, Philadelphia is at the leading edge. The safe house. Non profit is backed by many local state officials, but U S, justice, department, sued thing would be illegal to provide a facility to consume illegal drugs, even in the interests of preventing overdoses, a federal judge. Recently ruled in favour of safe house, but there will be more legal action before any such facility can open my point of advocacy for Safe House is for people like your friends that just passed because he's recovery rate. If I use I'm to die, fortunately through my yours. If you know this advocacy, I have a person I have asked perhaps I have a person that I would call if I don't want to die to make, I didn't overdose. If I used, I have that that's a safety net. Not everyone has that. So this is a place that we want people to be able to go like your friend. If he was at this place, he wouldn't have died. The opposite of a

is is not recover. The opposite addiction is community and relationship. You can't have community if you're dead, Doktor, Stephen Lloyd, again, the first thing is to keep patients alive now the longer that we keep him alive, the more that need to be able to engage them and supportive environment around really everything, and what's your point come on. I guess legal dispensaries of illegal drugs and I'm curious if there's any movement towards that in Tennessee really putting me in a position to get in trouble. I think we have to look. It is pointed out harm reduction strategies. So I think any I'm you'd lessen the stigma associated with addiction. You increase people's operate, their due to step out of the shadows and asked for help and comfort any modality that gets people to that point. the warm hand off program at you pen is still relatively new. I asked Nicole, O Donnell. The recovery specialist many patients. She will see in a given day,

In an average day, we could see up to six people, I'm Whether their impatient for a medical reason in patient in are are impatient. Drug all treatment or there are through the emergency room and of those six humming you're willing to at least have a conversation with you about medication, assisted therapy, honestly There is not many that say they don't want to talk. Whether they one things are not so different story. You now than we have a harm reduction conversation, but nobody free throws out of the room and says I want to talk about anything. So if there is one misperception about opiates about Use abuse whatever that many people like radio nerds who are gonna. Listen to this. If there's one thing they really dont know. What would you wanna tell people that every

This is order is treatable, it's not a day Santa. It's not. You know. It's a medical condition and its treatable It sounds so simple when you say that way. There's all this. I'm rotation going on around the topic now and a political community, and it's never said that simply why not because we like we're complicate things and it really need to be over complicated Eileen. Takes her medication? She engages Ngos the meetings and she's doing amazing and she's a mom to her son right, it's treatable, we don't have to overcome, located camp next time on frequent radio, Princess Superbowl. What are they going to ride over Green Bay? The sin Cisco. Forty nine were one of the best teams in NFL history with five superbowl championships, but lately they ve been terrible and

so, surrounded by controversy in chaos, so the team ownership opted for total reset nuke which new general manager, new players mindset. We chronicled this reset just before the two thousand. A teen NFL season in an episode called how to stop being a loser. Whelp, forty, nine, And now they ve got a shot at winning their sixth insuperable. How did that happen? You will find out next week on four economics: radio, pregnant with radio is produced by sticker in Dublin productions. This episode was produced by sack Le Pen's help for miles Brian or staff, also who Allison Craig low brig ribbon. Matt Picky, Daphne Chen carry Huggins and Karin Wallace

The theme song is Mr Fortune, but hitchhikers. All the other music was composed by Louis scare up. You can get for economic, Radio, on any podcast up. If you want the entire backpedal of useless teacher or go to for economics outcome, we can also find transcripts and show nuts we're on social media, and you can write to us, have radio at African Amazon com or show also please I'm any NPR station. So please check your local listings thanks for listening. Stitches.