Today, Explained - How to solve the opioid crisis

Episode Date: July 31, 2018

Vox's German Lopez explains America's opioid crisis and goes looking for a solution. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Support for the program today comes from Uber. Uber is moving forward with new features designed to take the stress out of your pickup. One of them is called Pickup Notes. Another one's this thing where your phone just lights up a different color and you can hold it up and wave it so that your driver can see you. You can learn more at uber.com slash moving forward. I guess I should probably kind of tell my story a little bit. My name is Charlie. I am from South Burlington, Vermont. My mother was an alcoholic and whatever, you know, but it wasn't too bad. I played hockey and won a national championship in prep school and then went on to play Division II. Freshman year, I got injured.

I get prescribed this medication, and obviously as one self progresses, you know, you think, you know, oh, you're the man, you know, I'm an athlete. You know, I'm never going to be a drug addict. Next thing you know, you know, I'm doing heroin because I, you know, started experiencing withdrawals. That ended up sending me down a deep, dark path that led to an even deeper abyss. I left, I ended up dropping out of college. I lost everything that I'd ever worked for.

Literally was homeless, ended up going to prison. My whole time was consumed by getting the next fix. We turn now to look at America's staggering opioid epidemic. Opioids are now the biggest drug epidemic in American history. I want to talk about opioid addiction. At a time when overdose deaths have never been higher. And everyone knows someone who's been impacted. That's why we call it the crisis next door.

Herman Lopez, senior reporter at Vox, you've written about this opioid crisis for years, and I feel like we're constantly hearing about it, but when exactly did it start? So there's really three waves to this opioid crisis. The first wave is the mid-1990s when OxyContin came out. The marketing for OxyContin and the campaign that Purdue Pharma, the maker of OxyContin, really fueled this idea that opioid painkillers are the safe and effective drug.

There's no question that our best, strongest pain medicines are the opioids. These are the same drugs that have a reputation for causing addiction and other terrible things. In fact, the rate of addiction amongst pain patients who are treated by doctors is much less than 1%. Doctors bought it. They started prescribing a lot more of these opioid painkillers. And that led to this problem, not just where patients were getting these drugs and misusing it, but it also made it easier for their kids to pick up an opioid from the medicine cabinet and start misusing it or take it to a party and that kind of thing.

Death of a four-year-old boy is now being investigated as a drug overdose. The child's toxicology results are still pending, but they believe they will prove the child overdosed on either heroin or prescription painkillers. It also made it so patients had excess pills and they would sell them to the black market or to their friends. All in all, that led to this proliferation of these opioids. Then there's this second wave. During the odds, early 2010s, people who got addicted to opioids eventually transitioned to heroin.

Leveled up. Yeah. People were caught off from their painkillers. A lot of people were like, well, I'm still going to suffer withdrawal. I still want these opioids. And they went to heroin for that. Drug cartels took advantage of the situation. They saw this giant opioid problem. So they just flooded the market with heroin. And then the last wave is the one we're in right now, the one that started taking off around 2014, I would say.

A lot of this heroin is no longer really heroin. It's fentanyl and it's analogs. And these are essentially synthetic opioids or like opioids you make in a lab. These are super potent. Some of them, like carfentanil, is used as an elephant tranquilizer. Carfentanil? Yeah, carfentanil. It's called carfentanil. And in the U.S., people are dying and overdosing from the toxic opioid.

It was just like you went from being coherent and then like you just, it's like a blackout. You can look up federal agencies warning that this can be used in like chemical attacks and that sort of thing. Wow. The dangerous thing with fentanyl is that sometimes it's still advertised or sold as if it's heroin. But because fentanyl is so much more potent than heroin, if you're a drug user and you're like, I'm going to use the same dose I did last time, if you're using fentanyl, that's going to be way more potent. So your risk of overdose is just going to be way higher. And that's what we've really seen in the past few years. It's like tremendous spike in overdose

deaths because fentanyl has come in and really just completely shaken up these street markets. Tell me more about fentanyl. That's the one I hear about all the time. What does it look like? How do people actually take it? Fentanyl has been around for decades and it has been used for medical purposes in the past. It's usually used for breakthrough pain

for cancer patients. Wow. That's how strong it is. I mean, we're talking about like patients who like are already on a regimen of opioids. So they take this additional super potent opioid fentanyl for extra pain that they might feel. It seems in this case, it is actually people just making fentanyl in a lab, much like meth labs, then selling it illegally in the black market. The country's opioid problem is always spoken about as an

epidemic. How does it compare to everything else, to alcohol, to all the other drugs that people do? It's by far the worst drug overdose crisis in U.S. history in terms of deaths. To put this in perspective, HIV-AIDS at its peak killed fewer Americans than the opioid epidemic and drug overdoses now kill each year. In 2016, nearly 64,000 people died of drug overdose in the U.S. At least two-thirds of those were linked to opioids. There have been estimates put out that in the next 10 years, we can expect 500,000 people to die. And who's dying? Who is this affecting? Is it spanning communities and socioeconomic groups in America, or is it sort of more focused? For most of the opioid epidemic, it has by and large hit white Americans the hardest. That's starting to change in that there are like rising overdose deaths in black communities as

well now, but for the most part, it has hit white communities the hardest. How has that changed the conversation around opioid addiction? I mean, comparing it to crack, which mostly affected black Americans and led to mass incarceration. In the 1980s and 1990s, crack was all over the news. It was once the rich man's drug, but as crack, cocaine is cheap and abundant. And perhaps most tragically, it now threatens the future of the poor and the young. It's typically framed that Nixon started the war on drugs, but Reagan is really the one who transformed a federal system into this massive war on drugs machine.

Drugs are menacing our society. They're threatening our values and undercutting our institutions. They're killing our children. And that was all in response to crack. Our most serious problem today is cocaine, and in particular, crack. And Reagan and Bush, they were not just going against drug traffickers and drug dealers. They were going against drug users, and they were very explicit about that in their drug plans. Who's responsible? Let me tell you straight out. Everyone who uses drugs, everyone who sells drugs, and everyone who looks the other way. This tough on crime push included even Democratic politicians. So the Clinton administration passed this 1994 bill that was really focused on treating drugs and crime in a harsher, more punitive way. Gangs and drugs have taken over our streets and undermined our schools. Every day we read about somebody else who has literally gotten away with murder.

But the American people haven't forgotten the difference between right and wrong. Hillary Clinton, who supported the bill, at one point made this remark calling people super predators. They are often connected to big drug cartels. They are not just gangs of kids anymore. They are often the kinds of kids that are called super predators. No conscience, no empathy. We can talk about why they ended up that way,

but first we have to bring them to heal. I'm guessing the tone has changed for this opioid epidemic? Obama and Trump have really taken a more public health approach towards this issue in that most of the money that they've actually put towards this has generally gone to treatment and generally gone to harm reduction strategies like providing naloxone, which reverses opioid overdoses to police officers, fire departments, that kind of thing. There are some quirks with Trump. Sometimes what his administration and Congress are doing doesn't match what he is saying. Earlier this year, he talked a lot about giving the death penalty to drug dealers.

And that's definitely concerning, but it's much more public health oriented than it used to be. It's now basically a cliche to say, we can't arrest and incarcerate addiction out of people. That's something that you've heard the drug star's office under Obama repeatedly say. Not only do I think it's really inhumane, but it's ineffective and it costs us

billions upon billions of dollars to keep doing this. If you compare that to like the 80s and 90s, if somebody said we can't arrest our way out of the problem back then, they would be laughed out of the room. It would just be taken as like that's inconceivable. Of course, the criminal justice system is not only going to play our role here, they're going to take the frontline main role. How much do these very different approaches, I mean, it's literally

black and white. It's really hard to ignore that when we have a drug overdose crisis involving black Americans, we take this punitive approach. When we have a drug overdose crisis involving white Americans, we tend to take this more public health view. And there are studies out there, that show that at least in terms of how people like the general public and lawmakers view black people, they are more likely to be criminals or less innocent and so on and so forth. If you're a policymaker, you are more likely to know someone who died of a drug overdose or struggled with addiction now because a lot of these politicians tend to be white and segregated white communities and that kind of thing. If you've never seen it firsthand, it's really easy to draw a caricature in your head of what that's like. But if you see that your brother

or your best friend or your dad or mom or whatever now is struggling with addiction, that makes it personal. And you do not think, wow, my brother is suffering. I want to send him to prison. You're going to start thinking of this in a more empathetic and sympathetic way. Like, okay, how would I save my brother's life here? Right. That's essentially happened on a mass scale here. Like these lawmakers who predominantly live in white communities have seen this up close and personal, and it's made them think of the issue in a more empathetic and sympathetic way. What's the solution for America's opioid epidemic? There's a clear one, but it seems like the country doesn't want to go anywhere near it. I'm Sean Ramos from That's After the Break on Today Explained.

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It's a beautiful thing. Learn more about how Uber is moving forward at uber.com slash moving forward. Thanks. hermann lopez you've traveled the country looking at different solutions for this opioid epidemic what have you found what's the solution the main solution for opiate addiction are these medications's buprenorphine, which is also known by its brand name Suboxone. There's methadone, and then there's naltrexone. Okay. The first two in particular, buprenorphine and methadone, are the most common ways to treat opioid addiction. These are essentially medications that make you no longer have cravings and withdrawal. Yeah. And that's because they themselves are actually opioids. But the idea is that they're

safer opioids and taking on this like medically supervised regimen. And they're supported by all sorts of health organizations, the CDC, the World Health Organization, and the American Medical Association. So there's a lot of support for these medications and they're really backed by the research. But to be clear, that is sort of just like treating addiction with another lesser addiction. It is often framed that way as if it's replacing one drug with another. Yeah. But that's not the right way to look at this. So the problem with addiction is not drug use. People use alcohol all the time. They drink caffeine all the time. The thing that makes addiction a problem is when that drug use becomes compulsive and so expansive that that's all your life is about. Like it starts hurting other

aspects of your life. So you may stop showing up to work and that kind of thing. So we can take these medications, which are opioids, but they're not using these in a way that's leading to all these other problems. How does this work state to state? Are there places that have figured out how to give people these other drugs, methadone, buprenorphine, in ways that are better than others? There are states that are doing much better at this. In Vermont, they have something called the hub-and-spoke system. Generally, what this means is that it's integrated addiction treatment into the rest of the health

care system okay so the hub is the intensive care unit essentially that's where people who are they might have just overdose or really at a bad point with their addiction that they do not have a handle of their condition at all that's where they'll go and they'll be seen there daily the spoke are actually just doctor's offices that do this more long-term care. Well, they'll make sure this person is on buprenorphine. Some patients go there every week, monthly, even longer time spans just to get their buprenorphine. And that's essentially their long-term care. Okay, Vermont has this hub-and-spoke system, which is essentially normalizing addiction treatment,

integrating it into everything else. That doesn't seem that crazy. How did they come up with it? So in the 2010s, Vermont started seeing what was happening with the opioid crisis. John Brooklyn was really the architect of this program. John Brooklyn, architect of the program, but also a doctor, Dr. John Brooklyn? Yeah, John Brooklyn was really the architect of this program. John Brooklyn, architect of the program, but also a doctor, Dr. John Brooklyn. Yeah, John Brooklyn. So the original idea for The Hub and Spoke, I presented to the state of Vermont saying,

let's create these centers of excellence, addiction excellence. I mean, he really described it plainly. It's like, yeah, this is just like how we would treat any other health care problem. And I thought, OK, let's make sure we're doing this, but for addiction. If someone just had a coronary bypass and they were seen at the local French fry shop eating a double bacon cheeseburger and smoking a pack of cigarettes,

the doctor wouldn't say, hey man, I'm not taking care of you anymore. They'd be like, you have to go back to the hospital and see the cardiologist. There should have been some kind of a network that you can refer that person to to help them get stable. And to Vermont's credit, it actually saw, based on early data, drug overdose deaths drop in 2017, which is very different from the rest of the U.S. where drug overdose deaths spiked. Vermont's not the only state with an opioid addiction problem. Why aren't more places doing this?

I went into Vermont expecting to ask this question of like, okay, so what was the hardest thing about setting up this hub and spoke system? And I would expect this response of, oh, well, it costs money to set up these hubs, these spokes, and get doctors prescribing these drugs. Yeah. But that wasn't the biggest problem. The biggest problem by far was stigma. After like decades of seeing this as a criminal justice issue,

lawmakers and the public still have stigmatizing attitudes toward addiction. They don't see it as a health problem. They still see it as like a moral failure on the person's part. You don't have the understanding of the science that's universally accepted. There's still a lot of debate about whether you should or shouldn't be on medication. And so when you have that kind of debate, you're going to have

a lot of people just going to fall back and say, ah, you know, it's their choice to do this kind of thing. If you look at like major medical organizations like the American Medical Association, they will tell you that this is a health issue and you need to treat it as like a public health issue as a result. But when you're trying to tell lawmakers that after these years of like thinking, yeah, we'll respond to drug problems with prison, it can take some time to like really walk them through why that's actually not the right approach, why you should set up this healthcare system to take care of addiction. That's apparently what was the biggest hurdle in Vermont is just walking policymakers through why this is important.

And clearly it worked. So how is Vermont paying for all this now? Most of the funding for this actually comes through Medicaid because Vermont, first of all, got a waiver through the federal Medicaid program to actually help set up these hubs and spokes and that kind of thing. And then most of its patients are actually on Medicaid. How does that compare to other states? A direct comparison is New Hampshire, which is directly neighboring Vermont. It's consistently been one of the worst states in terms of drug overdose deaths. And part of the problem there is there are just large swaths of the state that do not have

accessible treatment at all. If there is a treatment clinic, it might be weeks or months of wait times before you get care. And this is really important for addiction because the time when somebody says, I want to get treatment, it's a really sensitive period. I mean, first of all, somebody has had to admit that they have a problem, which is not easy. And then second of all, they're starting to go through withdrawal and that kind of thing withdrawal is really terrible it's like imagine the worst flu mix it with like horrible anxiety yeah these people if they say i'm going to get treatment and they face these weeks or months long waiting periods and they have to go through this full withdrawal process there's a really high chance they'll relapse and once somebody relapses there's also a chance that they will just say okay i'm not going to treatment anymore president trump talks about opioid addiction all the time. Has he done anything yet?

President Trump loves to talk about this issue, but in terms of doing something significant about it, he hasn't really done much. Congress has approved more funding for the opioid epidemic, but it's just not enough money. He appointed this opioid commission in his first year, and they came back with like dozens and dozens of recommendations as to what the president could do. Trump has done at most a handful. When Trump won, I thought this was like an obvious issue that you can get bipartisan support to do something. This is something that both Democrats and Republicans seem to want to do something about. Part of the problem is the federal lawmakers just don't understand the full scope of it. They don't

understand how bad it is. They don't know how much money this will take. But it costs money to do nothing, right? The prison stints, hospital visits, whatever, we're paying for this either way. So is there a way that fixing this could make financial sense? The White House actually put out this report where they said that the opiate epidemic costs $500 billion in terms of economic output. If we're talking about like tens of billions of dollars in federal funding to take care of this issue, if we avert another $500 billion from going away, that's a massive return on investment. We have these solutions in like treatment and medications and so forth, and it's just we're not using them. We're talking about hundreds of thousands of people dying over the next decade due to opioid overdoses.

And if federal lawmakers don't do something, if state lawmakers don't do something about that, that's a lot of people dying on their watch. What ended up happening was, after my third attempt at rehab, I had decided that, okay, you know what, I'm going to try this Suboxone thing. I took it illegally off the street for a while, and I came in, I finally got my name called on the list. It was a very long list. It absolutely changed my life. I'm still very lucky. I put in a lot of work. I went from literally dying, overdosing, homeless, sleeping in the airport. Now I am lead account executive for a financial

and commercial services firm, and I have a condo, two dogs. I take care of my mother, and I pay my bills. It's crazy, man. It's absolutely crazy. And I tried multiple times. At first I thought, oh, I'm never going to be on Suboxone. I'm never going to be on it. Obviously, it's not just the Suboxone, but it gives you a crutch and it gives you some hope.

Now you're able to not be sick and have a normal, stable, emotional sense, physical sense. I think that if I did not have the Suboxone, I certainly wouldn't be here today. Uber is supporting the show today and would love for me to tell you about the new features they've got on their app. There's a bunch of them, and they're designed to make your life a little easier when you're using it. You can check them all out and see all the ways Uber is moving forward by going to uber.com slash moving forward.