The Opioid Addiction: Crisis in America

Good afternoon everybody! You're an amazing crowd Somebody walks up to the microphone and it gets quiet

Like you don't even have to ask, you know, "May I have your attention please?" So you're already winners today I'm very excited that we are together this afternoon because I believe it's something really special that we're doing now We can save the judgement until after this session today, but events like this are so important because they push us to think about who we are as people, what we stand for as an institution, how we must stay connected to the world and how we can learn from each other And I think you're really going to enjoy the panel today and we're extremely fortunate to have Peter Hart with us He is quite famous – he wouldn't know it because he wouldn't tell you – he is a quite famous person, a pollster

He works with NBC, The Wall Street Journal, he has managed some of the most difficult town halls So the fact that he was willing to work with us at Emory to engage in what we're calling "conversations with America" was quite remarkable I'd like to talk just for a second about these conversations with America People have asked me, "So it sounds really interesting but why are we doing this?" and I think everybody in this room I'm gonna assume – and if you disagree don't tell me now tell me later – you know it's so easy, at universities in particular, we're all smart people, all people that are thinking about what's the evidence for what we're looking at, we're all people who believe that we know how to make a case in an argument We talk a lot to each other and before we know it we forget what the rest of the world thinks

And I don't know if you ever have had this experience I recently have had to take a few trips away from Atlanta into more rural areas of Georgia, North Carolina, South Carolina, and I'm not always good at making sure that I have enough gas in my car So then I find myself at quite unusual gas stations and two things happen: I sort of listen, I'm eavesdropping to what people are talking about and I'm like "boy this is like a different planet and this is not just like a few hundred miles away" The next interesting exchange is I start to pay and I say something and people look at me as if I am a too alien because I don't sound like them at all So in all of this we reinforce the notion that that we are a part of a very complex diverse world, and that's why we're having these conversations with America, to really break through the bubble that we live in and to get a good sense of what the rest of the world thinks

You'll hear a lot more about those conversations later today as the panelists talk, as Peter sets it up And I'm really not going to say much more but I would like to highlight a few aspects One of the areas that I'm extremely proud of, for us as an Emory community, is that we are not afraid to have difficult conversations, that were not afraid to tackle sort of the impossible questions That we are also not so arrogant that we know what the answers are, but we're just willing to take a risk and challenge ourselves and thereby really advancing the world, really helping the world come up with some of the complex issues that we have As a social scientist and a public health expert, I actually have some of the people in the room know, my COO Harris here – he and I have known each other for a very long time – we have been working on addiction for quite an extensive period of time, but there's something that's different about the opioid epidemic that we currently have in the United States

And I'm not gonna take the time to give you a lecture on what I think is different about it, but some of you might have seen my recent Op-Ed piece on CNN, where you can get a sense of what I'm thinking about And one of the aspects of that, that I just can't help myself but will have to say For those of you who don't know, I grew up in the Netherlands I spent the first three decades of my life mainly in Europe and addiction is all over the world It's not something that happens only in certain places

But the approach towards people who have an issue with addiction, people who whose habits get out of hand is that you can approach it in different ways So I come from a culture and I strongly believe in a philosophy that if somebody has a problem – in this case with opioids – the last thing we should do is blame the person and turn him into a criminal – him or her into a criminal Because at the end of the day addiction is a societal problem It's a problem for all of us It's a sign that something is wrong in the world in which we live

And that means that we collectively really are responsible for not stigmatizing people, for thinking about solutions, and for having the kind of conversations that we're going to have a day So I want to thank you for your commitment to being here, to be part of this conversation, to learn from each other, and I hope that you really will enjoy it And I now invite the panel to get going and for me to get out of the way Thank you very much! [audience applauds] President Sterk, thank you very much I'm delighted to be here I've been in the public opinion field for for now over 50 years, and I've been taking the NBC Wall Street Journal poll for about 30 years now

And what we, as a society, we've made such an unbelievable advancement in so many areas Whether it be in terms of race or religion or in terms of marriage and all of the other elements, and you would say this has been remarkable But at the same time we've been doing this, what's happened is we've really become polarized as a society And it's no longer a chance that we talk to one another and that we've reached an area of consensus And so what Emory has undertaken here is the importance of beginning a conversation, the ability to be able to talk to one another to figure out how you reach a consensus

Because as you watch with the United States Congress just last week, and weekend, and week out, there is no consensus that is being built And so whether it be the issue of immigration, which we undertook in the fall, or the issue of opioids which is so important, that we're undertaking now, what this is about is having an understanding and a dialogue Last year we lost 63 thousand Americans to opioid overdose at a rate that – although there are some hopeful signs here and there – continues to increase around the country We live in a country that has six percent of the world's population We consume 96 percent of the opioid medications or opioids produced in the world

Something is particularly wrong in this country Right now about 230 million prescriptions for opioids in the US on an annual basis, enough for every single adult to have a bottle of pills around the clock for three weeks That's too much And we have decreased prescribing in the past few years, but we're at three times what we were in 1999 So when people say we've drastically reduced prescribing, no

The curve was going like this [indicates steep upward direction with hand] now it's going like this [indicates flat outward direction with hand] so there's still room to go And my concern is that we've primed the pump and so a lot of people became addicted to these prescription pills, and then have gone on to misuse or use heroin and now fentanyl, which we know is just killing people due to the potency So we really, you know, got this guideline to really change practice It's a guideline, it's not a regulation, but it's really talking about how non-opioid should be used for chronic pain first, so that people have evidence-based treatment Because that's what's about – when you look at long term evidence – for opioids for chronic pain it's not there

For acute pain, sure Chronic pain, the evidence isn't there The reason I'm here is because I'm a parent who lost a child to an accidental overdose It happened right down the street It happened Thanksgiving of 2013

Laura Hope was a senior in high school That's the new face of addiction If you , in my opinion, and it's not unlike anybody else who has family around here But part of her, she had suffered a jaw injury A broken jaw right here at Decatur High School, soccer match

She was a varsity goalie as a freshman playing against Decatur High, got a boot to the jaw While all that sounds very innocent, it happens in sports, it's an example of how it might put a young person on a path that they might not be able to get off of And in her case she was prescribed liquid Lortab As a personal long-term recovery at that time, I knew about my issues but I didn't know the ramifications of a opioid being prescribed to a person, a young person of aged 15, what it does to the brain and how much they like it so fast and they stay on it Through statistics it'll say, if you're exposed to an opioid before 21, you have 80% chance of a substance use disorder

If you make it to past 21 you've got a 80% chance of not suffering from addiction, from substance, or opioid – you know prescription turning into an addiction So those are things that I've unfortunately learned in my journey since then [audience member] I work with a program here in Georgia called Motherhood Beyond Bars and we teach prenatal classes at the Department of Corrections The vast majority of the pregnant women in the Department of Corrections are there for drug offenses or crimes related to it And to me it's probably one of the most devastating views of this crisis, to see a pregnant woman in prison attire serving time while she's pregnant and then being separated from her baby, and just the cycle that it creates in these families

[another audience member] There was a wonderful book called Pain: The Gift That Nobody Wants by Dr Bradley and Yancey, and they talk about, you know when you have leprosy pain, the lack of pain is a real problem You lose a limb But I have noticed with our patients that they don't want any pain Sometimes part of healing and part of that pain does promote healing

So I think a cultural change and a shift in how what the expectations of people are would help [another audience member] What is the rate of patients, who had legal prescriptions for opiates, that become addicted? And that's not from like family members borrowing or stealing That's patients who have been prescribed for like a surgery and then after the surgery they ended up turning to something worse or non prescribed opiates [panel answers] And what I would tell you is that we don't have great data on that And that's what the issue is

Like when we look at the incidence of new addictions in our country we can't give you that number We can tell you prevalence rates of addiction And a lot of times it depends too on how long the prescription was for and the initial strength And that's what we see is makes you more likely to get addicted Usually for somebody who's just on opioids for chronic pain, I believe the rate is less than 2% that go on to get addicted

But when you look at how many, if you've got 235 million prescriptions out there, 2%, then that number gets big So for me, this issue is epiphenomenon of so much It's epiphenomenon of our relationship to drugs in general I mean opioids are scary because they have such terrible results, but I worry how many of our students, you know, are on cocaine taking Adderall when it's not prescribed, I worry about that I worry about why are so many of Americans feeling so desperate

What that to me, this epiphenomenon of a societal illness of 21st century America, that we in a sense refuse to address by focusing on other things, which is not to say that opioids aren't as a terrible problem, but I guess to President Sterk's earlier point, if we can't see – that there are actually – this is actually a scream for help, we are going to miss the boat on so much [Peter Hart] It doesn't stop here, this is where it should start It's the beginning of a conversation, an important conversation, so give yourselves a round of applause and thank you very much for going there [audience applauds]

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