Dr. Vivek Murthy: How We Can Overcome the Opioid Crisis

it just seemed impossible. Not long after, we learned that he died of a lethal combination of alcohol and oxy code on. Sadly, while he was the first person we knew who suffered a fatal overdose, he wasn't the last. Hillary and I now have five friends who have lost their children to this epidemic. So why am I telling you this? Because in America today, just about everyone knows someone who's died, as it was, to an overdose. Drug overdoses killed more Americans and HIV AIDS, car crashes, or

gun violence. Behind every one of these statistics is a real person, someone with a real life, a real story, and real people who love them. While so much of our public health discourse over the last year has focused on the COVID nineteen pandemic. The overdose epidemic remains an urgent crisis, and the challenges of the COVID nineteen pandemic, from isolation to unemployment to the shuttering of community resources and gathering places, have had a disproportionate impact on people

struggling with substance abuse disorders. We've got to find a way to turn the tide. Today's episode of Why Am I Telling You This features someone who is one of America's leading experts on the opioid and overdose epidemic, Dr Vivit Murphy. Dr Murphy served as Surgeon General of the United States from and was renominated by President Biden and

reconfirmed last month. We recorded this conversation back in and I wish I could say it's no longer relevant, But unfortunately, the overdose epidemic continues to rage across America, leaving unfinished lives and broken hearts in its wake. The latest CDC data shows that overdose deaths increased by for the twelve

months ending in September. Especially given that the pandemic has cut off people's access to healthcare and support systems, we need to recognize the impact it's having on people's mental health and redouble our efforts to combat this crisis. Dr Vivic Murphy, thanks for joining us. Thank you, Mr President.

You did something really remarkable in first issuing the first Certain General's report ever on alcohol, drugs and health, and at the same time, more remarkably to me, you actually sent a let earn a card to two point three million doctors, nurses, dentists, and other clinicians asking them to help address the opioid epidemic. Now nobody had ever done this before. Why did you, Well, thanks for the question, Mr President, for having me joining this conversation on opioids.

When I began my time in office, I remember thinking on my first day about my priorities on what they should be. But I had this instinct to spend the first few months on a listening tour, just visiting communities across the country, and the issue that kept coming up again and again and again was the issue of opioids, and so I quickly realized that that needed to be even higher on my priority list. It also dovetailed with the personal experience that I had had as a clinician.

Uh you know, as a doctor, I took care of patients over the years who struggled with all kinds of chronic pain conditions, and I found myself prescribing opioids often. I also, at the same time was seeing people come in struggling with addiction to heroin, to prescription opioids, and to other all manner of substances, and I began to realize that there was a connection between the way we were as doctors prescribing these pain medicines and what was

actually happening to our patients. I wish I had realized that earlier, but I, like many doctors, was taught that if we gave opioid medicines to someone who had quote unquote legitimate pain, that they would not become addicted to that substance. And why were we wrong? So coming into office, when I realized that we had, inadvertently, as a profession, contributed to the epidemic, you know, I realized that in addition to publishing the first Surgeon General's Report on the

subject of addiction, we also needed to do more. We needed to call our profession to action to rectify an issue that we had helped create. And so that's why I penned a personal letter to doctors and nurse practitioners and dentists all across the country. And at the time it was you know, I did it an instinct. I didn't know quite what the reaction would be, but I was gratified to hear from many doctors and nurses over the coming months, UH that it actually changed how they practiced,

how they prescribed these kind of pain medications. And I remember going to an oral surgeon actually recently to get my own wisdom tooth pulled, uh, and he told me that in addition to receiving that letter, that he had made a decision when he read it that he was going to stop prescribing percoset automatically to everyone who had

wisdom teeth removed. And he gave all of them his personal cell phone number, and he braced for what he thought would be an onslaught of calls from patients saying that their pain wasn't well controlled on ibyprofen and they needed something stronger. But days went by and the calls never came, and he realized that, hey, we can actually get by treating pain safely and effectively without necessarily using opioids. I want to thank you for this. We live in

an age of denial about a lot of things. When Chelsea was in high school, all our friends used to say that denial it's not just a river in Egypt and uh, And I think it takes a certain amount of courage just to say I once thought the truth was this, and I learned something and I changed. And that's what I think more and more people have to do about more and more issues, but especially this one.

Let's talk about this a little bit. I think a lot of people know about the lock zone, and no, it can bring people back, but it's just the first step. So could you briefly describe what should be done to someone who's overdosed, who's injected or inhaled the lock zone and then comes back. That's the beginning, not the end of this process. So describe how that works. Well. The lockson is a really powerful medication and remarkably effective at

reversing the effects of opioids. And for people who have who's breathing has been compromised by these medicines, they can reverse that and enable them to breathe again. I've administered in the locks on myself. I've seen just how rapidly it acts, so it's good that we are getting that medication to the hands at first responders and family members, but for far too many people who overdose, the treatment

does stop there. And it's shocking how many people are treated with the lock zone and go right back into the community and often in fact, will get more prescriptions for opiate medications. What we really need to do is to bring those people in and connect them to treatment right away, treatment often with medication assisted therapies including methodone Bupid, Norphine UH and now trek Zone. And what we've realized now is that there should be no wrong door to treatment.

So whether it's a first responder UH finding you having overdosed, let's say, in the community, whether it's somebody in the emergency room who encounters you, whether it's a somebody in your place of employment who realizes that you have a challenge with addiction. We have to find ways to create channels which people can go from where they are in their communities to getting directly connected to treatment. Right now, it's too hard for people in communities across the country.

But if we can change that, and I think we can take people who need and want treatment and actually get them the life stating treatment that they deserve. I think you made a really important point. I remember a couple of summers ago, I was playing golf out on a public golf course and all these folks gathered around me. All they want to talk about was the open wood problem. And there was only one young person there. All the others walked away after about forty five minutes. He stayed

behind and said, thank you. I didn't know anybody like you cared about this. I'm four days out of rehab, and he said, I'm not worried about myself. I want to live and now I know how. But he said, I think it's a terrible shame that you've got to have as much money as my family does to afford this. You've got to do something to help the people that have no money. So let's start with what the government should do, or the federal land state government, how should that?

Where are we on that? Well, there's no question that when of the big barriers to treatment is the cost and the availability of these services, including the availability of trained personnel. The problem is in part of funding issue. In the last several years, we have seen Congress allocate substantial amounts of money, several billion dollars in fact, but the reality is that we need far more than a few billion dollars to expand treatment sufficiently so that everyone

who needs care can get it. When we published the Certain General's Report on Alcohol, Drugs and Health in one of the things that we noted was that only one in ten people who are struggling with the substance use disorder actually getting treatment. And part of that is because people can't get treatment, and part of it also has to do with this stigma, the unfortunate stigma associated with substance use disorders, which prevents people often from seeking help.

When I was traveling through Tennessee, for example, I met many people who either had loved ones who are struggling with an opiad use disorder or themselves were who refused to talk to me if there were any cameras around, And the reason was because they felt if somebody knew that they had a problem and that they needed help, that they would be ostracized not just by their neighbors,

but also by their doctors. And sadly, I did meet doctors when I was in Tennessee and in other states who didn't believe what they were reading about medication assist to treatment who thought it was just another way of perpetuating a dependence on opioids, and these unfortunate misconceptions, combined with the lack of adequate funding, have combined to make it too hard for people to get treatment. We have

evidence about what works. We know, for example, that medication assists to treatment with these three medications in particular method and guben orphine and now trek zone not only reduce the risk of overdose, but they also reduce crime in communities. They reduced the acquisition of needleborn infections like HIV and

hepatitis c UH. They are good overall. Um, there are still, unfortunately a majority of treatment facilities in the country right now which do not offer medication assists to treatment, and that to me is uh is an unthinkable tragedy because at a time where we know what works, for the majority of treatment facilities, to not have what works and to be charging people tends of thousands of dollars for that treatment, UH is just it's just horrible, and that's

something that I think we absolutely need to change. Well, let me ask you this, is it not offered because the money is not there, or because there's a stigma associated with the use of method on about for northern Well.

Partially this is about payment, but only partially. So I think that once we get insurance programs of Medicaid and private insurance to fully reimburse for the full suite of medication assisted treatment UM, once we ensure that we actually have adequate personnel trained to deliver that treatment, that will

help a lot. But the stigma piece that you brought up is a is a really good point because I have visited communities across the country where treatment is available, but people will not access it because they are worried that they will be looked down upon. You know, if they engage in treatment that they will doctor in fact,

will look down upon them. And I visited communities that do not want to invite treatment centers in because they feel it will bring the wrong kind of people into their community and because they have been led to believe that this is uh that this treatment is just perpet

awaiting opiate addiction. If you understand like what's really happening with the opia epidemic, you realize that this is not about inviting quote unquote bad people in, but the people who are struggling with opiate addiction are in all of our communities anyway, there are friends, our neighbors, often family members, and they struggle in the shadows though, unable to come forward and share their stories because the unfortunate shame associated

with it. One of the things I've tried to do is to get rid of stigma by getting the whole community involved. We have this fight based initiative where we have people from all fights traditions to gather to get people to come together because everybody's congregation has got somebody in it with this problem. Education, whether it's in in school based settings grade school and colleges, or in workplaces

or through faith based organizations, can be remarkably effective. The other thing that can happen in these settings is that conversations can be started to actually share the real stories of people who are struggling with addiction. This is hard to do because in an environment where you're not sure how you're going to be received. I can understand how challenging it can be for someone struggling with an opiate used disorder, for example, to come forward and say I

have a problem. But what I have seen time and time again is that when people take that courageous step, people all around them respond, sometimes often silently saying oh gosh, I thought I was the only one, or I thought my family was the only one impacted, but often vocally as well, voicing their support. And I think of faith organizations as powerful partners in this regard. They convene conversations

anyway on topics related to faith and life. More broadly, their ability to convene conversations where people share their real story with addiction can be extraordinarily powerful in helping to remove some of that stigma. There are times when culture trump's policy when it comes to ultimate impact, and this is a place where the culture around addiction are underlying belief around it. Uh is has to be addressed before

we're fully able to address the epidemic. As much as we feel like we're reading about the opiate epidemic in the Pay Purse, there are still millions of people in our country who don't fully understand what opioids are, how to protect ourselves, you know, from combining opioids with alcohol, and how to protect ourselves when we're using opiods to

begin with, when it's appropriate versus not. We still have so many people, for example, who store opioid medicines in their medicine cabinet, and it turns out the medicine cabinet is the worst place for that medicine because other people when they come and visit, can often just easily go and take those opioids. And this is actually what happens in households all across America. Do you have the sense

of Congress as well into properly fund this. I mean, if there's ever been a bipartisan or a nonpartisan national epidemic, this is yes. And in it at a time where a few things seem bipartisan, this stands out as as as a rare opportunity, rare issue. I don't think though, that many in Congress have shown the appetite to fund

the opiate epidemic at the level that it requires. What's happening right now with the how we're funding the opiated epidemic is we're providing oftentimes these one time grants to communities that will run out after a short period of time, and they're trying to figure out, in part, okay, we get something up and running, what's going to sustain us

in years two, three, four, and five. But we're also providing that support at a mere fraction of what's needed to really turn the tide on the epidemic in those communities. I think many members of Congress, and some of them have told me this privately, they worry about the price tag on a bill that would really adequately resource the epidemic, because it would be at least ten times greater than the numbers that you're seeing out there. But I think what we have to realize is that the long term

cost of not funding that is far greater. Uh And and this is why there's an urgency around this issue. It's why you know, having people like you start discussing this issue and helping raise public awareness are so important because this is one of those times where we need the public to push our policymakers not just to make

an investment, but to make the right investment. But I lastly think though it's worth consider also that is in all the discussions we have on opioids, in talking about what's driving this epidemic, from you know, prescribing patterns, to pharmaceutical companies marketing these medicines irresponsibly uh to the public, to a whole host of other factors. There are also some emotional factors that are driving this epidemic as well. I was struck so often and heartbroken often when I

visited communities around the country. How behind the stories of mental illness and addiction and even physical illness were often stories of deeper emotional pain that people were experiencing. Sometimes it was the pain of poverty, of discrimination. Sometimes it was a pain that came with disability um Sometimes it was a pain that came from not having a job and not being able to find a job and feeling

like they were outcasts. Sometimes it was a pain of loneliness, which is extremely common, much more so than we realized. But whatever the pain source was, that deeper emotional pain was often driving people to places of despair, and it was manifesting often as disconnection from others. And I realized that if we want to address the opiate epidemic, we don't just need good treatment and counseling. We actually need community.

We need connection as well. There's nobody I have met who has come through the dark tunnel of addiction and emerged on the other side who has not had somebody that they trust, who has believed in them, especially when they were not able to believe in themselves. That is why I think about the opiate epidemic is not only an illness, but as a disease of disconnection in part. And this is a place where each of us can

be helpful. You don't need a medical degree or a nursing degree to be able to provide support and a listening ear to somebody who is struggling with addiction, to help them feel that they are not being judged for an illness that's not a character flaw, but that's actually

a medical condition. And I will tell you that despite my training as a doctor, despite all the years that you know I put into learning how to treat in biological illnesses, that the power of a family member, of friend um building a loving, trusting relationship with someone is far greater than any medicine I could prescribe, or any treatment that I could give. And that's why I believe that in the fight against the opiate addiction, that love

is in fact our most powerful medicine. It's one that anyone can dispense, and it's one that we need now more than ever. Our country was very lucky to have you as our Surgeon General, and I thank you. The only thing I'd like to say before we close to the doubters is that no progress to human life would ever be made if we never tried, because we couldn't win every time. That's someone who's lived in a family

that's experienced addiction, who's what's friends bury their children. You won't win them all, but you can win a lot, and we have to try. Thank you very much, Thank you, Mr President. We'll be right back. My name is Sarah Gad. I'm a c g i U Clinton Global Initiative University alumni. It was actually the very first time I decided to share my story and my history with opioid addiction was in that discussion room at c g i U. They were just so supportive, and I realized, why have I

been so secretive about this for so long? I first became addicted to opioids when I was in my third year of medical school. I ended up in a pretty horrific car accident which I remember nothing about. I woke up in a hospital room with my leg in a sling. I had undergone emergency surgery on my leg because my ankle bone literally pierced through my skin and had to be hammered and screwed back into place. So it was

a pretty long, pretty painful recovery process. And during that time I was prescribed opioids like perk set An, OxyContin, and at first I was just taking them for pain. But as I was recovering, I was watching all of my classmates graduate onto their fourth year of medical school. Meanwhile I was bedridden and I was depressed. My opioid prescription pain medication was by that point they had become

my only source of joy and happiness. And then maybe about a year out after my accident, my doctor sat down with me and was like, look, you cannot be in this much pain this far out. Do you have a dependency problem? And I denied it. I just didn't

want to acknowledge it. Once my doctor stopped prescribing me opioids, I started going to see a bunch of other doctors and then it didn't take too long for them to figure out that I had been doctor shopping and so as a third year medical student, I was familiar with how to write prescriptions and that's what landed me in legal trouble and got me arrested. And once you're criminalized and you have a criminal record and arrest record, very difficult to reintegrate back into society in any sort of

meaningful way. It was always just kind of the cycle of going to jail and detoxing cold turkey and going through the hell of physical withdrawal, getting out, trying to get my life back on track, and then relapsing and then going back to jail. And then I was incarcerated for five days, and the day that I got out, I actually ended up overdosing. It was just because my tolerance had gone down so much during that period, and I woke up in an ambulance being injected with narcan

and told that I had just overdosed on opioids. The Centers for Disease Control reports that more than people died from opioid to overdoses in two thousand sixteen. Addicts need help without the fear of being stigmatized or arrested. The crisis has become so widespread that the Surgeon General is urging ordinary citizens to carry the locks on, a drug that reverses the effects of a drug overdose and saves lives. The only reason I survived was at that point we

had been given the locks on. The gentleman that I was using with that his house knew how to administer it. As I said when we were talking earlier with Dr Marthy, this challenge is one that requires all hands on deck. One of the most important partners that we've had is Julie Stamper, a board member for the harm Reduction Coalition and the locks On Advocate and someone who is an indispensable force if we're ever going to turn this thing around. So, Julie,

why have you been so passionate about this for so long? First, I'll say thank you so much for having me here and and giving me a platform and for all the work the Clinton Foundation has done, because you've been there for years right along with me, and I come to the work and the passion about the work, partly unwillingly and partly proudly. Proudly because my stepfather, Jack Fishman, is credited with inventing a lock zone in the nineteen sixties, So anything that I can do to further his legacy

and a chance to talk about him. He passed a few years ago, so he's we miss him greatly. So for me to talk about in a lock zone means I get to talk about him, But I also get to talk about my brother, who died of an overdose in two thousand three, so his legacy exists as well. So for me, the unwilling part is that I had to come in to do the work because I lost my brother. But I'm proud to do the work because of my stepfather and a lock zone has saved hundreds

of thousands of lives across the world. But now we need to do more to make it because we're losing people here all the time. You cite a mission of your own endeavor? Is harm reduction? What does that mean? It actually is what it sounds like. It's harm reduction, reducing harm. We practice harm reduction every day. You get up in the morning, you brush your teeth, you're using a toothpaste that has fluoride in it. That's harm reduction. You get in your car, you put your seatbelt on,

also harm reduction. You inject drugs and have an also nearby, that's harm reduction. And even in that capacity with with substance use, if you are an ivy drug user, you're hopefully going to have access to clean syringes, sterile water, any kind of rig anything that you need to inject safely so that you're not getting infected. So anything that we can do to reduce harm for people who use drugs is key. So harm reduction is something that we

practice all the time. What role was reducing stigma and harm reduction. Stigma is one of the biggest obstacles people who use drugs face on a daily basis. We're trying to do things by even just simply changing language. So instead of referring to someone as an addict, we say someone who uses drugs. All right, it's people first language. So it's not what they do, it's who they are, right, So it's simple, it's a it's very subtle even, but what it does it actually honors that that you are

a person. You know, So, in terms of my history with my brother and his substance use, my brother was a junkie, all right. That was the word that was used talking about my brother who I grew up with. Now, all of a sudden, I'm supposed to call him a junkie, and I did because that's what I was told. And as a result of that, I lost years with my brother. He barely met my children. Right, It's devastating to consider what something, so what we think is simple stigma could

do because of this stigma attached to substance use. I lost him before I actually lost him. So stigma plays a big part in in preventing people who use drugs from getting the help that they need. A lot of the conversations that happened now. You know, we heard for years about the war on drugs, and now we know it was the wrong way to try to help the situation. You know, we we we could go back to you know, the commercial where you cracking the egg and the frying pan.

This is your brain and it is your brain on drugs. This is your brain on drugs. And we became less credible because of it, because it wasn't true in the sense that you know, when we tell our children marijuana will kill you, Uh, they look at us like we're crazy because we're not telling them the truth. And so we need to do more to tell the truth. And you know, I've said this before and and I don't know,

maybe it's controversial. The reason we're having this conversation, you and I right now is because more white people are dying right this This epidemic has impacted black and brown people in ways that we can't even fathom. And we kind of not that we ignore it, but we just kind of say, oh, well, it wasn't an issue then, but now it's an issue because all these you know, white teenagers are overdosing. So we need to recognize that that's a big component of the stigma for sure, and

and one of our biggest obstacles. And and so I I you know, I've said this before. Evolution is tremendous, right. I came a long way from thinking my brother was a junkie to now realizing no, he was a person who had some serious issues and they were compounded by his substance. Use, you, sir, have m a tremendous way, and I applaud the effort and the willingness for you to come to the place where you're at now to try to help Stay tuned for more of the conversation

after this short break. I read a study sometime in the last year that said most people who die of overdoses are in effect not alone. There's somebody in the room with them, or somebody in the next room, or somebody in the house, or if they're outside, within twenty ft of them, almost half, which means that, given the scale of this opioid epidemic, it would be better if in almost every social setting or work setting, somebody had

the locks on. What do you think we could do to change the willingness of people to tote that around everywhere? Because the more people who have it in their pocket to better off. We are, absolutely so you know we the last time you and I had a conversation, I brought you an overdose prevention kit and one of the things that I've shown people because if you if you've seen the narcan that's out now, it's a teeny tiny

little box. I mean it's like a box of altoys or tic TACs or you know, the breath mints that you're going to keep in your bag. So I I joke, but I mean it sincerely. Like if I'm going out for an evening and I have my little evening bag, I take a dose with me and it's in my bag. Because you never know where you're gonna possibly encounter someone.

The opportunity to give someone the locks on who might actually have access to someone who needs it is important, and I think we should be doing something about making sure restaurants have it. You know, any place where there is a single use bathroom is a risk because that's where someone might go to use drugs. We're now training librarians because a lot of overdoses are happening in libraries, so it's important. Oh yes, because there's always little corners

and their single use bathrooms. So yeah, no, we've got to do a whole lot to get it out there. I mean, I I have a friend who who owns a restaurant, and I was like, let me give you a kid so you can keep it behind the bar. And I know, you know Clinton Foundation along with Emergent Bio Solutions, the company that that produces narcan, making it

available for schools, universities, colleges. But maybe there should be an effort for a one time you know, for for the Starbucks location on the corner of whatever, that that that the owner can can right in and get a kit. And I you know, the conversations that I have had with people over the years who wish they had had it, that's what's sad. What have you told your children about opioids? How do you deal with it? And blessed three times over?

I have three incredible boys, a nineteen year old, a sixteen year old, and a twelve year old, and it's it's I think for me, you know, I think about the loss of my brother and them not not getting to know their uncle who was super cool and funny and a great singer and a guitar player, and and my my youngest reminds me so much of my brother

sometimes that it's heartbreaking. But so when I think about my brother's death, I think, if it's going to do anything, it's going to help save my children because we talk about Uncle Jonathan and why he's not here, and a lot of that has an impact on them. You know, when we've had conversations about when you go out into the world and you may experiment with substances, your body chemistry will likely react differently than somebody else's because you

have addiction around you. Both sides of the families have struggles with addiction, so you have to be prepared for that. So I I know I have conversations with my boys that a lot of parents aren't capable of having, aren't

willing to have. That to me is the most important right because they're the ones who were looking out for It's their future, So we have to have these conversations with them that I have a friend who shared with me that her sixteen year old son was at a party and there were children snorting Heroin sixteen and there was no n a locks on. I want to strangle somebody, because that's an easy fix. So I said to her, let me give you a kit. He could put it

in his pocket. It is small enough, no one will know. And of course the immediate responses, well, he would never do that. And it's the same message I give to my children. You're going out to a party, and my older ones takeing a locks on with you, not for you, for someone else, just in case. So we have to talk to our children. We have talked to the parents

of children. We need to get in there and we need to have real conversations because now we see you know, when I do a training, I tell people the first thing I say is you're gonna all walk out of here superheroes, because you're going to be able to save

a life. If anybody's listening to me, you should think about how much in the locks owner is in your community and who's got it, and realize that most of you with health insurance, particularly you live in open prescription cities, could get it with a very small copae and disremember, you never know when you're gonna need it. Thank you, Thank you. Why Am I telling You? This is a production of our Heart Radio, the Clinton Foundation and at

Will Media. Our executive producers are Craig Manascian and Will Malnadi. Our production team includes Mitch Bluestein, Jamison cat Sufis, Tom Galton, Sarah Harrows, and Jake Young, with production support from Tyler Scott and Oltavia Young. Original music by What White. Special thanks to John Sykes, Tina Flinois, John Davidson on hell Arena, Corey Gantley, Oscar Flores, Kevin Thurm and all our dedicated

staff and partners at the Clinton Foundation. If you have an idea of suggestion for the show, we'd love to hear it from you, so please visit Clinton Foundation dot org slash podcast to share your thoughts with us. If you like the show, tell someone else about it. You can subscribe to Who I Am I Telling You This on the I Heart Radio app, Apple podcast, or wherever you get your podcast. By listening to this podcast, you're

helping support the work of the Clinton Foundation. So thank you. Hi. I'm Chris Thrasher, and I serve as the Senior Director of Substance Use Disorders and recovery with the opiotor Sponse Network at the Clinton Foundation. According to the Centers for Disease Control and Prevention, each year we lose tens of thousands of lives to an opiate overdose in the United States, and now with COVID nineteen, this tragic and preventable epidemic

has only worsened and intensified. At the Clinton Foundation, we're working to combat this crisis head on. We invite you to learn more about our work and see how you can get involved. Please visit us at Clinton Foundation dot org. Slash Podcast