Conversations Live: Heroin Epidemic

[ Music ] >> Good evening and welcome
to Conversations Live, the Heroin Epidemic Revisited. I’m Patty Satalia. Drug overdoses in Pennsylvania
started to spike in 2011, and much of the increase
is due to heroin. Experts now say every community in Pennsylvania has
a heroin problem. Recent reports place some
of the blame on easy access to prescription pain killers,
gateway drugs for most users. Tonight, our experts will
discuss causes and solutions to this rapidly growing
epidemic. They’ll also take
your questions. Now let’s meet our guests. Senator Gene Yaw has represented
the 23rd senatorial district of Pennsylvania since 2008. He also serves as Chairman
of Board of the Directors for the Centers for
Rural Pennsylvania, which has released
multiple reports on heroin’s growing presence
throughout the Commonwealth. Dr. Philip Moore is an internist
and medical toxicologist with Associates in
Medical Toxicology. He specializes in poisoning,
overdose, and drug interactions and has experience in
outpatient and inpatient detox, as well as neutral, partial, and full agonist maintenance
therapy for drug addiction. Amanda Cope is the
administrative director for Positive Recovery Solutions, which provides controlled
medical care and case management
services to those suffering from opiate dependence. Thank you all so
much for joining us. You can join tonight’s
conversation. Our toll-free number
is 1-800-543-8242, and our email address
is [email protected] You can also Tweet your
question or comment to WPSU and use the hashtag
#WPSUconversations. I want to begin with
you, Senator Yaw. You said, “If you think there
isn’t a heroin community in your problem think again.” And in fact, as Chairman
of the Board of Directors of the Centers for
Rural Pennsylvania, you have convened two
consecutive years, hearings, statewide hearings,
on the problem. Give us an idea of
what you learned from those hearings
first, and secondly, what the scope of
the problem is. >> Well, it’s really
interesting how it got started. The Center for Rural
Pennsylvania, first of all, is a joint legislative agency
between the House and Senate. It’s bipartisan, bicameral, and the way it really
got started is one day, one of the other senators
approached me on the floor of the Senate and said,
“Can’t you use the Center for Rural Pennsylvania to bring to everybody’s attention
the nature of the problem, the heroin problem, in
rural Pennsylvania?” I mean, that’s where we
started, rural Pennsylvania, and it sounded like one
of those things, okay, it’s a good idea,
let’s look into it. We’ll have a hearing
maybe in Harrisburg. Well, the more we thought
about it, we decided just in 2014 we had four hearings
throughout the state, mainly concentrated
in the rural areas. I’ll give you just a
little bit of an example. The first hearing, we scheduled
for three hours in Williamsport. Well, it lasted five. That kind of was the precursor to say I think we may
be onto something here. >> You’ve hit a nerve here. >> We hit a nerve, and I give
credit to the Board of Directors for the Center for
Rural Pennsylvania. This is a little outside of
the way we usually operate, and they thought, they
were the ones who said, “We think that it is
a big enough problem to go ahead and do this.” So we followed up that in 2014. The primary issue or
what we were looking for is how broad
the problem was? What are we looking at here? What is it? In 2015, when we had
hearings this summer, we looked into recovery
programs, such as Amanda’s. What’s gone on out there? I hate to say this, or maybe I
should say it, that we’ve talked about it with the board, and
we intend to probably look at specific treatment
programs and what’s successful? But we’ve issued two reports, I think that the Center’s two
reports are probably the most comprehensive work that’s
been done by the state across the board to really hit at the problem at
the ground level. >> And, you know, when you look
at Pennsylvania as compared with the rest of the nation,
Pennsylvania ranks third in heroin abuse,
and I think seventh in heroin abuse overdose death. You know something
about this, Amanda. Tell us a little bit about the
population you’re working with and how Positive Recovery
Solutions is interfacing with literally hundreds, there
are hundreds of thousands of Pennsylvanians who are in
need of treatment and only one in eight are getting it. >> Yeah, when we found
out about Vivitrol, we had a representative of
the medication come in and — >> Let’s back up. What is Vivitrol? >> Yes, so Vivitrol is a
long-acting naltrexone. So what it does is it
comes in and it attaches to the opiate receptor and
essentially locks it down. Meaning that when a
patient is on Vivitrol, during that 28-day span while
the medication’s on board, they cannot successfully
abuse alcohol and opiates. It prohibits the release
of serotonin and dopamine from the brain from
taking that substance in, meaning that you don’t
get that euphoria. You don’t get the
pleasure/reward system. That’s where it works
in the brain. >> So people are coming to
you in Western Pennsylvania who were saying, “I need help.” Your Positive Recovery Solutions
is providing Vivitrol to them. So explain, what
population are you serving? What counties are you
serving, and I understand that of the 67 counties, 37 counties think
they need this sort of mobile clinic that you have. >> So we have two
physical locations. We are in Allegheny
County in Pittsburgh, and we are in Washington County,
and when we added ourselves to the Provider Locator,
meaning if somebody was looking up Vivitrol, you
can look and see where they’re a provider
that can follow you. We added ourselves to
that provider locator, and what we realized
right away was that people were traveling
sometimes four hours to come to our facilities to
receive their injection. There are not enough providers
out there that are willing to either follow this patient
population, due to the stigma, or there’s just not
enough education in the medical community
about the medication and how to provide it to the patients. >> The bottom line, Dr. Moore,
is that, as I said earlier, only one in eight
people in Pennsylvania who need addiction
treatment are getting it. Why is that the case? Many say it’s a funding problem. >> This is a complicated answer. Physicians are definitely —
they don’t have training in how to manage this population, and so because of
that, they’re afraid. They’re afraid to
manage the population. So one thing we can do
is to offer more training to physicians, as they, all
throughout their careers, you know, early on, in
the middle, and later, and then also, access
for patients to treatment facilities
or to outpatient. Definitely, there is
not enough providers and facilities for
patients to go. >> You know, speaking
of training physicians, 80% of those who present
with drug addiction, heroin in particular,
say that they began with prescription pain killers. So, education of our
physicians, Senator Yaw, certainly is important, and
I know that is something that you did address
in your hearings. >> We did, and we’re actually
looking into some legislation that would affect the mandatory
medical education, not in a way that would expand it but
just say that, you know, for your CME training, it
would require a certain amount of time addressed to either pain
management or drug addiction, and we’ve gotten a
pretty good response. We had one of our hearings at the Commonwealth
Medical College, and the people there were
even willing to, like, it should be taught
in the schools, too. That’s where we have to go. >> Well let me get back to
something I was sort of getting to a moment ago, and that
is how big this problem is. From what I’m reading,
from your report, 52,000 Pennsylvanians are
currently in treatment, but there are 760,000, at
least, some say even more, who are in need of treatment. So on one hand, we’ve had a
25% cut in the kind of funding that would provide care to them,
and the problem has quadrupled. How do you, as one of our
state representatives, feel about that? What can we do about it? >> Well, if you would have asked
me two years ago what I knew about the drug problem, it was
not much, and I agree with you. It’s something that
we need to address. Some of the things you
mentioned only peripherally. There are seven people a day die in Pennsylvania of
a drug overdose. Seven people a day, and,
you know, you do the math, that’s 2500 people a year, and the cost that’s
involved in that. It’s astronomical. This fall, there was a
report released by DEA that specifically addressed
the problems in Pennsylvania, and I’m not proud
of these numbers, but the number one county, and what it did is it
addressed deaths per thousand, overdose drug deaths. >> Is it Washington County? >> Per hundred thousand. No, it’s not. The number one is
North Hampton County. Number two, surprisingly, but it fits in with what we
started to do, Tioga County. >> Really rural areas where
you think, “Who’s using heroin in rural areas like this?” >> Number three is Schuylkill. Number four is Mercer. Number five happens to be
my home county, Lycoming, and you’ll be happy to know that
Centre County is number six. So if you look, you know, if
you drew this out on a map, it’s right down through
the center of the state, and even the Union County
is a part of that, too. So this is a very
appropriate topic when we say it affects all — >> Every county. >> Everybody. >> Every county. One in four families is
what I’m reading, as well. I want to take our first call. We have Rhonda who
is on the line. She’s calling us
from State College. Rhonda, what’s your
question, please? >> Well, I have a couple, but
the first, I guess I’d ask is where is the heroin coming from? And the other thing I’d like
to know is does today’s heroin compare in terms of potency? Is it more potent today than
it was in previous eras? >> Good question. We’ll begin with you. Senator Yaw, where is the
heroin that’s making its way to Pennsylvania coming from? And we’ll follow up
with you Dr. Moore. >> Primary source
overall is Mexico, but the Attorney General’s
Office testified at one of our hearings, and the
state’s basically divided up for where the drugs come from. I mean, the Pittsburgh
area is probably Detroit. Harrisburg is Baltimore. Williamsport for some reason — >> And before that,
Mexico, of course. >> Yeah, it’s connected to
Philadelphia, and of course, in the [inaudible] Williamsport
is New York City, but I mean, the law enforcement knows where
it comes from, and the majority of it comes in by
motor vehicle drop. >> And in terms of potency, Dr.
Moore, what’s the difference between heroin of
yesteryear and heroin today? >> That’s a great question. It is much more potent. It has increased in potency,
and the cost has decreased, and that’s what makes
it so attractive. Persons often start
with prescription, and they may have it for a
couple weeks, maybe a couple of months, and then
it’s abruptly stopped. >> The prescription. They run out of their prescribed
medicine from a physician. >> And it may just run out, and the physician hasn’t
educated the patient like we need to gradually
reduce these doses. So it may just all of a
sudden run out, and then all of the sudden, the patient feels
they have this horrible sickness of, you know, like a viral
syndrome, and I’ve heard of it also be described as run
over by a train at the same time as having like a severe cold. >> So that’s what withdraw from prescription
painkillers can be like? >> And so the patients will
often start buying the pills on the street, and it’s very,
very expensive to do that, and then they see this very
inexpensive drug, heroin, which is potent, and the
transition just happens. >> You know, 60 Minutes put
the blame, at least partially for this heroin epidemic on
the pharmaceutical industry, and pointed out that Vicodin was
the number-one most prescribed medicine in America
from 2009 to 2012. So, you know, do we need to have
a different understanding of how to treat pain, and I say that because most Americans
have some degree of back pain, and experts are now
saying exercise is going to be more effective
than a pain pill. >> Well, I mean, I think
it goes back to education and pain management,
and you know, maybe — I know the popular thing
now is that we’re pain free, and I understand that. I’ve done a sort
of classic example. Nobody wants to have
a toothache. You mention a toothache and no, but I think that pain management
is going to be the answer with education, and
we may not have to — you know, we may have to put up with a little bit more
pain than what we did. >> To get the handle on this. We go to Catherine, who is
calling us from Altoona. Catherine, what’s your
question or comment? >> Patty, first, I’d like to say
thank you for having this forum. I’m calling on behalf of the Commonwealth
Prevention Alliance, which is the statewide
organization for drug and alcohol prevention
professionals, and this past year, we created
a website called PASTOP.org, which is designed to educate
Pennsylvanians about the risks of prescription pain
killers and heroin use. On our website, we have
information for families, caregivers and individuals
seeking help and we also have free,
downloadable materials that answer questions and guide
people to the lead agencies in their counties in
Pennsylvania to find help, but first of all, we
are there to prevent, and a lot of our
information does help that aspect of the problem. >> All right, well,
thank you for your call, and as Catherine said, that
website includes information for resources in
every single county. Tell us, Amanda, a little bit about how overwhelmed
your services and how available services are
for the people who need it, and explain which
counties you’re serving. >> So currently we have,
again, the physical location in Allegheny County, the
physical location in Washington. We go via mobile unit to
Blair County in Altoona, and we go to Indiana
County, Armstrong County, and Clarion is also some of the patient population
that we service. When we formed this
pilot program in July, there were 37 counties
that reached out that said, “We want access to
your services.” Unfortunately, the
ability to move forward for those counties depends on
the budget, so on and so forth. So we’ve seen a little
bit of a delay there, but I think that things are
going to start rolling now that, you know, now that I think that there’s been some
leeway made there. But we started out with four
patients in Blair County, and I have to say we work with
the single-county authority. So that’s where a
person who is unfunded or somebody that’s looking for
treatment, they would be placed into a treatment program,
or they would be provided with referrals and resources. We contract with them, and
Judy Rosser in Blair County. Started this program
with her, and we started with four patients,
and right now, we go there on a biweekly
basis, with the mobile unit, and we are probably doing about 30 injections each
visit that we’re out there. In Indiana and Armstrong
today, we had had, I think it was 32
patients scheduled today. >> So explain how
Vivitrol works. It’s an injection, and it will
keep addicts from using alcohol and drugs, but for how long
does that injection work? >> So the injection we
give, it’s every 28 days. So we give the injection,
and during that 28-day span, they’re not able to
achieve the high. This medication is meant for
these patients to be able to engage in wraparound
services. It provides them a safety
net so that they can get busy with the work of recovery, because medication alone is
not going to solve the problem. So what we do is we pair with
behavioral health entities. The behavioral health
entities provide the drug and alcohol counseling,
which is essential to a successful road
to recovery. We provide the medical services. So during this time, it’s a
safety net for these patients. It’s a light at the end
of the tunnel for them. If you can give somebody who’s
suffering from addiction a way out and say, “Listen, these
are the steps you take. This medication, it takes
away any cravings to use. You’re not craving the drug. You’re not craving alcohol. There’s no withdrawal symptoms because it forms the
complete abstinence model.” Meaning, when you’re on
Vivitrol, you don’t have to continue to crave substances,
and it’s nonaddictive. >> And you’re speaking, to
some extent, from experience because you’re nine years
yourself in recovery from alcohol addiction. >> Yes, so I’m an alcoholic. May 6, 2006, is my
sobriety date. I was not a Vivitrol
patient, but I’m a product of long-term treatment. I did the 28 day rehab
and then followed that up with a voluntary admission into
six months of a halfway house, and it truly saved my life,
because when you are struggling with addiction, you
don’t know where to turn. You don’t know what to do,
and a lot these patients, they need a stepping stone. They need somebody to say,
“Okay, take this step.” And to create some structure and
to form a healthy support system and change your behavior
patterns and healthy coping mechanisms. >> I want to go to a phone call
in just a moment, but Dr. Moore, how important is individualized
or tailored treatment. Amanda was talking a little
bit about what her service does and the service that
she, herself, received. Is it important that addicts
receive, someone suffering from addiction, get a
specifically tailored program? >> Yes, it really is critically
important, but that process is about hearing their
story, where they’ve been, where they’ve come from,
and then from that history, then pointing them in the
right direction of where to go with therapy next. Sometimes it’s better to not
repeat history and keep going with the same therapy that
hasn’t worked in the past, and to shift it into a new
direction and try something new. So that’s the type
of unique approach that a patient really needs. >> I want to be back. Oh, go ahead Senator. >> What I’d like to say, and
this fits in with everything that Amanda and Dr.
Moore have said. This addiction that we
found out, it’s a disease. It’s a lifelong problem. It is not going to be fixed with
a 30-day period of treatment. It’s not going be fixed with a
six-month period of treatment, and what we learned in all of our hearings is what
we commonly referred to as a warm hand off. You go from one part
to the next, and it’s a community problem. >> In other words, the physician
is going to introduce you to the counselor that they
want you to work with. >> Well, we hope. Then that’s why it’s
a community problem. It affects everybody. You can’t arrest your
way out of the problem. You can’t use other drugs
to get out of the problem, and I use this example
all the time. If somebody has diabetes, you
don’t send them away for 30 days and they come back
and they’re fixed, and that’s the nature
of the problem. Diabetes is probably,
for a lot of people, it becomes a lifelong
challenge for them, and the drug addiction
is no different. >> All right, let’s
go to our next caller. Eric is calling us
from Harrisburg. Go ahead please, Eric. >> Yes, I’m wondering
why, Ms. Cope was talking about how they’re working
out of Western Pennsylvania. This question is
probably for the Senator. Why don’t we have this program
available to all the counties? I mean, particularly here
in Central Pennsylvania? I had a friend just two
weeks ago who overdosed. Is there something that can be
done in Central Pennsylvania? Can the Senator do something
to make PRS get down there? >> Well, you know, I
don’t know who’s paying for the Vivitrol program
that Amanda spoke about. One of the comments about
the Vivitrol, especially, is it’s very, very expensive. It’s somewhere between
$800 and $1000 a shot. So it is significant. There’s questions about
health care insurance. We’ve worked on those,
we tried to. I think that there’s been
more money put into drug and alcohol programs this year,
and we now have a Secretary of Drug and Alcohol,
which just came on board within the last three or four
years, something like that. So I think that it is a
problem, no question about it, that we’ve just started
to address. >> You know, Eric mentioned
having a friend overdose recently, and that brings me
to the question of naloxone, which has been saving lives
throughout the country. Can you tell us a little
bit about who’s using it and why there is some reluctance
among police departments to have it on hand, and just how
readily available it is today? >> Well, the Physician
General of Pennsylvania has put out a blanket prescription
where it can be acquired. >> It can be acquired by what? A family member,
anyone concerned? >> Family members and very
easily, and it’s something that she has supported,
but naloxone, the Pennsylvania
State Police carry it in all of their patrol cars. >> And we should say
it’s an antidote. >> It’s an antidote. >> If you are suffering
from respiratory problems from an overdose, this can
quickly turn you around. >> There’s a simple question, I
guess, that has to be answered, and that is out there that
in order to treat somebody or to save them from
a drug addiction, they have to be alive. Now we have to make that
decision, and, you know, some of the departments or
some counties, Delaware County, the district attorney in
Delaware County just took this on as a major project
and required that all of the police departments in
Delaware County carry naloxone. They’ve had, I don’t
know, somewhere 100 saves since they started
last November. >> Some people are
afraid that it’s going to create dangerous
behavior, high-risk behavior. How do you respond to that? >> Well, here’s how
I respond to that. If you’re a police
officer, you’re trained to handle dangerous behavior, and the Physician
General said most likely, when people are treated, and
Dr. Moore would be better off to describe this, but
people wake up slowly, and a lot of times,
they’re just confused. They don’t know where they are. >> But I mean, it will
encourage more people, “Hey, there’s an antidote, I’m
going to try this heroin because now someone
can save me.” >> When we did the
hearing in August, and the district attorney
from Delaware County, I asked him that
question, “Are you — you’ve saved at that
point 90-some people. How many repeat customers
have you had?” At that point, they had four. Now four out of 90
is a pretty good — I don’t know what
happened to the other ones. Maybe they got treatment. Maybe they were scared
to death or, you know, something else happened to them,
but I think it’s worthwhile, and just the cost that’s
involved in this, you know, from health care in not only
the addiction but the loss of jobs and everything else. >> Dr. Moore, you
had something to add? >> Yes, the naloxone
injections, there’s a generic and there’s also a brand name. >> Narcan. >> Narcan’s the brand
name, but there’s a company that makes an injection kit that gives you instructions
about what to do. What the next step is, and
I’ve heard that on the website for fire departments, police
departments, you can apply and get funding from the company
to get a shipment of them to get you going
with the injections. >> They would be preferable. The auto ejectors. They actually talk to you. We’ve seen them. >> And tell you step
by step what to do. >> Tell you step by step. The police departments, most
of them use the nasal spray. It’s less expensive. >> The other thing I’ve wondered
about those kits is if we need to be prescribing them. We know certain patients above
certain milligram strengths of their prescription pills
are high risk for overdose. Should we be handing
out those prescriptions with a prescription for
naloxone or the autoinjector because we know that’s such
a high-risk population? >> You have something
to add earlier, Amanda? >> Yeah, it would be
circling back a little bit. I just wanted to point out
that the medication is covered by all insurances, including
Medicare and Medicaid, and that we are an
insurance-based company. So anybody that has
Medicaid has state insurance, has commercial insurance,
would be somebody that we would be able to follow. We don’t charge our patients
cash to come and see us. We do everything through
the insurance company. >> Have you been
doing this long enough to know what your
success rate is? Because as I said earlier to
Dr. Moore it’s not uncommon for someone suffering
with addiction to be in treatment eight,
nine, 10 times, before they’re really
in recovery. >> So I did a TV program back
in October, and we had one of our patients on with us,
who is a mobile unit patient, and he has been in and out of
institutions for 20-plus years. And this is the first
time in over 20 years that he has celebrated
long-term recovery. He has been with us for going on
seven months now, and he spoke on the TV program with me that,
people want to say that, hey, you know, that people want to
say this isn’t a miracle drug, but I’m here to tell
you that it is, and so we have patients that,
if you give them a way out, the reason why they continue and
they perpetuate of the behavior and they do the same thing is
they don’t want to be sick. This is a way out. They don’t have to
live that way anymore. >> If you’re just joining
us, I’m Patty Satalia, and this is Conversations Live, The Heroin Epidemic
Revisited on WPSU. Our guests tonight are Senator
Gene Yaw, the state senator from Pennsylvania’s 23rd
District, Dr. Philip Moore, a medical toxicologist
specializing in treating drug addiction, and
Amanda Cope, a registered nurse and the administrative director
of Positive Recovery Solutions. Our telephone number
is 1-800-543-8242, and our panel is ready
to take your phone calls. If you’d prefer to email us,
our address is [email protected] And we go to our phone now. Timberlee from Altoona
is on the line. Go ahead, please, Timberlee. >> Yes, my question is,
you say how addiction and stuff can start with
prescription medications. Personally, it affects my life. I just lost my mother due
to a prescription problem, and what I would like to know
is why isn’t there a bill or something placed to where
when you’re going to the doctor, everything, really, with
your Social Security Number, why is it so easy for people,
for addicts, to go from doctor to doctor and keep
getting these medications that they overdose on, and
then eventually, you know, if they don’t get the
Narcan, they eventually die? >> That’s an excellent
question, and the reality is when you talked about the
seven people a day die from a heroin overdose,
16,000 people a year die from prescription
drug overdoses. So how would you answer
her question, Dr. Moore? >> Several states in the
country have programs for prescription drug monitoring
which allows you to see where a patient has been
filling their prescriptions. Pennsylvania, my
understanding, has been approved for this program, but it hasn’t
been fully developed yet. That’s really the key to
being able to detect patients who are doctor shopping. Now the problem with those
systems is they, if you lived on a border of a state, they might not detect
someone getting prescriptions in another state and going, you
know, going across the border. So we really have to have a
national monitoring program. >> Senator Yaw? >> We, the legislature, passed
a prescription drug monitoring program in Pennsylvania about a
year ago, and it was a follow-up to our first series of hearings about the necessity
of such a program. Unfortunately, it’s not
been fully funded yet, and my understanding,
last I heard, was that it’ll take maybe a year
to get all of the equipment set up to do that with our
program, but we have one. >> You know, the interesting
thing is, a program like yours, Amanda, Positive Recovery
Services, will leave patients with a seven-day prescription,
not a 30-day prescription, and yet insurance
companies incentivize 30-day prescriptions. That seems to me to be
something we need to change. >> So, one of the things
to consider, as well, is unfortunately, we touched
on it a little bit earlier. Pain is now considered
the fifth vital sign, and reimbursement is due
to patient satisfaction. So there’s some inner dynamics
there that aren’t correct, but it’s the reality
of our situation. So if you are being reimbursed
based on, and this is based on — and this is like at a
hospital level or whatnot, but if you’re being
reimbursed based on whether or not your patient felt that they were appropriately
taken care of, and you’re a patient that’s
coming in and claiming, you know, some sort of pain,
and they’re not being medicated for that, you can see
how that kind of flows. There’s a lot of different
moving pieces to this problem, and I think that, you know,
we need come together, as Dr. Moore suggested,
on a national level. >> You know, it’s interesting,
and I said this earlier, a number of studies have proven,
though, that exercise can be as effective if not
more effective in treating pain
than pharmaceuticals. Do you anticipate a day when
doctors are more readily going to be prescribing
exercise, Dr. Moore? >> I hope so. My patients, I’m always
encouraging every single one of them to exercise
because it’s so important for that addiction piece. A lot of them are
addicted to opioids, and exercise increases
those natural opioids, and so it is imperative to
exercise, and one of the keys to breaking that addiction. >> And we know that
tolerance, the longer you’re on a prescription, the higher
your tolerance level for it. So you need more to get
the same impact in terms of pain relief or high. You look like you were
going to add something. I’m going to go quickly
to a phone call. John is calling us from Altoona. John, you’re on the air. >> Yeah, hi, I was wondering why
nobody has ever mentioned the fact that since we
invaded Afghanistan, the opium production there
has skyrocketed to a point where it’s at record levels, and
production there is hand-in-hand with the corrupt
government that we support. The other side to that is
the money that we invest in these unnecessary wars could
be put towards not only medical needs here, but also
opportunities in low economic areas, a
lot of the Rust Belt areas, for people to have opportunities
and to have not only healthcare, but jobs and futures that
they don’t currently have, and I was wondering what
the senator thinks of that. >> Yeah, interesting
observations. Is there a link between
poverty, unemployment, and drug addiction, and — >> I think that there probably
is but, you know, I don’t mean to be flippant about it,
but, you know, what happens in Afghanistan, I don’t really
have anything to say about it. Of course, if we didn’t
spend money on other things, we would have more to spend on
this particular health problem, as with other problems. >> Yeah, it was the
second part of his comments that I thought were
particularly interesting. The opportunity, the
poverty, and the unemployment. We look at places like
Williamsport, for example, and as unemployment
rose, so did heroin use. >> I think that to some extent
that’s true, but what we found out in our studies is the heroin
problem is not specifically related to poorer. In fact, the most likely
candidate for a drug overdose in Pennsylvania is a
white middle-aged male. >> Interesting. Amanda, you had something
to add. >> I was just going
to say, I mean, from our patient population, the days of your addicts
being the people that live under the bridge,
those are long gone. These are your neighbors. These are your spouses,
your teachers, your doctors, your mailman. It affects and it touches
every aspect of our life. Looking at the patients that I
see that walk through our doors, there are people that are
well below the poverty, but there are people
that are established and that are high society and that have an addiction
and they need help. >> In fact, the way 60
Minutes put it, they said, “People like us are now using a
drug other people used to use.” >> I agree with what
Amanda said. It’s all socioeconomic groups,
all races, all ages there. It’s across the board. It can be your brother. It could be your mother. It could be your grandparents. It could be your kids, brothers,
sisters, I mean, it’s everyone. >> You’ve seen it everywhere. Go ahead, Dr. Moore. >> Yeah, I definitely
concur addiction has no boundaries anymore. One of the things I’ve
noticed is that patients with higher socioeconomic
status, it’s more difficult to get them into
treatment programs, because the funding is all for the lower socioeconomic
statuses, and so you’re often
battling insurance companies to get prior authorizations
for medications. You can battle them for
weeks, and they will come up with all kinds of
excuses why they don’t want to pay for this therapy. All the while, the
person you’re trying to help may be continuing
to use. So that should also
be another target. >> All right, we go to Caroline, who’s calling us
from State College. Go ahead please, Caroline. >> Hey Patty, it’s Caroline. >> Oh, hi, Caroline. >> My question is, and
you know my experience. How do we get these people
that need help, like my son? He wasn’t a heroin addict,
but you know the whole story. Seven times in the hospital
by my calling the police, and he’s not staying there. The doctor is releasing him. We need more help, as parents,
getting the people help that need help with the way the
laws are and the human rights, there’s not much we can do. >> Good– Was there
more to that, Caroline? >> I was going to
ask Amanda to answer, but I didn’t know
if I cut you off. >> Oh, no, that’s okay. >> Dr. Moore. >> I think I can help
answer that question. Someone can choose to
make bad decisions, but we can’t really hold them against their will unless
they’re very actively either suicidal or homicidal, and
so that’s really the problem. Someone can make bad decisions,
which clearly there are. That does happen. >> You know, the
difficult thing I think for parents is they might
get them into a program, but, you know, federal studies show
that for the best outcomes, you want a program that lasts
at least 90 days, and so often, they’re 12-week programs or
two-week program, and often, it seems to me, you’re throwing
your money down the drain. If you don’t keep
someone long enough, your chances of success
are slim. What’s your response
to that, Amanda? >> I think with Vivitrol,
specifically, they have to make a good
decision once every 28 days. >> They have to come
to your clinic. >> And that’s the case — well,
yeah, to get the injection, even if it’s not with PRS. Once every 28 days. It’s not a daily decision as to whether you’re
going to use that day. Once every 28 days. I think that it provides that
safety net for these patients. >> And how long do you have
to get that 28 day injection until you are considered, you
know able to cope on your own without the use of medication? >> So studies show that it
takes about a year for the brain to repair, to begin
normally functioning again. Literature shows that they
recommend a patient be on Vivitrol for 12 to 18 months. We go as far as to say
18 months for sure. We want to give the patient
the best possible chance to have the recovery
of the brain, to have all of those
wraparound services in place, and to change people,
places, and things, and all those other things
that come along with it. >> Dr. Moore. >> I want to ask Amanda a
question, and this is for, I guess, parents out there or
others that may have someone that they feel that
injectable naltrexone or Vivitrol is a good therapy. What would they do to
detox their loved one or themselves to be a candidate? >> So what we do, you need to
be abstinent for at least 7 to 10 days to be appropriate
for the medication. What we do in our clinic
as we provide comfort meds by prescription for
that 7 to 10 day period. So the patient comes
in to us as a consult. If they’re still actively
using, we can still help them. We would give the
medications like clonidine, like sometimes Neurontin,
sometimes trazadone, sometimes Zofran, to medicate
the symptoms of withdrawal. Once they achieve that
7 to 10 day period of complete abstinence, we then
do the naltrexone challenge test, which is the
by-mouth form of naltrexone, to make sure there isn’t an
allergy, and then we follow it up with the injection. So even if a patient
is in active addiction, they’re still appropriate
for services with us. >> And they can’t come
in and buffalo you because you will do a urine test
to determine whether they — >> Every time they come in. >> Yes. >> Every single appointment,
they’ll be urine drug screened, and the medication itself
is its own best truth serum. If they were to get the
injection while they still had a dependency on board,
they would go into what’s called
precipitated withdrawal, which is withdrawal on steroids. So it’s withdrawal exemplified,
and it’s a lot worse. So a person is not going
to willingly put themselves in that position, when withdrawal is what
the addict fears the most. So the medication, as I
said, acts as a truth serum. >> Senator Yaw. >> What both Dr. Moore
and Amanda, I mean, and this caller hit the
nail right on the head, and I could tell from
the concern in her voice that she’s had some personal
experience, but it points out the fragmented nature of the
treatment programs that we have. Amanda’s program is great, but
how do you get somebody in it? You know, and what Dr.
Moore is doing, I mean, he’s very concerned
about his patients and how he handles them, and how
does his put input get put in? What we found in all of our
studies is our system is so fragmented, and we need
somebody to put their arms around the problem, and
that’s where we came out with the community-based
answer to it. We’ve developed a program in North Carolina called Project
Lazarus that was started there. >> Right, with seven
spokes on a wheel. >> And we’ve tried to kind
of started to duplicate that with the program
in Lycoming County, and what we want to do is
provide all the services and have somebody come in and
be able to do the warm handoffs, so that they just don’t do the
Vivitrol program and then all of a sudden where do they go? And we have everybody
involved in it from the district attorney
to President Judge. We’ve got doctors, the
hospitals, colleges, we’ve got school
superintendents. >> The bottom line is there’s
a role to play for everyone. >> Everybody. And your caller, you
know, her frustration, that’s exactly what we need is
somebody, one-stop shop to go to say, “Here’s the next step. Here’s where you go. Here’s what you do.” >> Okay, you need that, and
were also looking at a state that some say, you know, we’re
in the midst of a budget impasse that is the longest in 45 years. We’ve seen funding cuts
in these health services, while at the same time,
this problem has quadrupled. So I’m sure a lot of
Pennsylvanians are thinking, “How can we possibly solve
this problem when we got other, perhaps, even bigger problems
we can’t pass the budget?” How do you respond to that? >> Education. I don’t think a lot
of people know. Really. The question was
asked of me originally. How do you get the word out, bring it to greater people’s
attention about this problem? And that’s what we’ve
tried to do. We tried to do that by
the reports, the hearings. Your program, it’s great. If people don’t know, there’s
never going to be any response to it, and the first thing the
people have to understand, too, in any community,
especially communitywide, is we have a drug problem. There are a lot of
communities in this state that they want to ignore it. Just sweep it under the table. We don’t have a drug
problem here. Because if you admit
you have a drug problem in your community,
it affects everybody. It affects your schools. You know, do people want
to go there and live? Those types of things. >> Dr. Moore — and
Jackson, I’m going to come to your phone call
in just one moment. >> There’s actually
financial information about the various
treatment programs. So they’ve compared
patients that receive, and in a methadone program
and compared them to patients in a buprenorphine or
Suboxone or Subutex or patients in naltrexone or
Vivitrol programs, and what the studies
show is that, yes, the cost of the medication, the
Vivitrol, is the most expensive, compared to methadone
and Suboxone, but all the other care
associated with it is so much more reasonable,
and so over six months, a Vivitrol program is
much more economical. It’s much — >> More cost-effective. >> Yeah, than putting someone in
a methadone or Suboxone program, and we have oftentimes these
patients are in these programs for 30 days where
they’re naturally detoxed, and they’re just released back
into society or from prisons and even the drug court systems, they’re just — and
we have this — >> And their chances of
success their are very slim. >> Yep. >> When that’s the
way they’re released. Okay, go ahead, Amanda. >> There’s a really exciting
thing happening in Blair, Armstrong, and Indiana, and they’ve started a
jail reentry program, meaning that they are starting
the patient on Vivitrol prior to release from being
incarcerated, so and then they’re
referred out to us. The same thing happens with
a patient in inpatient rehab. They get their first
injection in rehab, and then they’re
referred out to us. So it lessens the
bleed on the taxpayers. They’re not coming out
and then reoffending or having a positive urine
drug screen and ending up back in the system. If you can get them started on the medication while they’re
incarcerated, they come out. They follow up with us. They have a provider, and
they can then work on becoming that functioning
member of society again. >> And that’s what they’re
seeing with drug courts, where therapy is
part of the program. >> Yes. >> There’s a 25% recidivism rate versus the general prison
population where there’s a 75% or higher recidivism rate. So it sounds like it
does make economic sense. As promised, Jackson from New
Bloomfield, you are on the air. What your question please? >> My question is
for Nurse Amanda. How effective would this
drug be that her company uses in stopping my cravings? >> So naltrexone takes
away cravings completely. That’s what the probably
about 99% of our patient population
tells us. They report zero
cravings to use, to abuse opiates or alcohol. It’s the way that it
works in the brain. So if you’re somebody that’s
struggling with addiction, if you were to be
on the Vivitrol, I would say that you
wouldn’t have cravings at all. That’s what our patients
report to us. >> Now what do you say to
people, Dr. Moore and Amanda, to those who say we’re replacing
one addictive substance with another? I’ll begin with you, Dr. Moore. When we talk about
methadone and Suboxone and those sorts of things. You’ve heard that argument. >> Oh, sure, and when I
hear it quite frequently, and I always explain it for
a patient with methadone or Suboxone, it’s really
a risk/benefit analysis. Do you want someone receiving
a drug that’s manufactured by a pharmaceutical company
that’s highly regulated? You know exactly what it is. Or do you want someone
continuing to use a drug that you don’t know who’s
had their hands on it, what it’s been cut with? >> And we know that heroin,
bad heroin, that has been cut with something is the
reason for a number of deaths in Pennsylvania. >> Exactly. >> You had something
to add, Amanda? >> I believe, we believe, that there is a medication
that’s appropriate for every patient population. If you’re going to look
at, we have a taper program that involves Suboxone
that, with the goal for them to be completely
abstinent on Vivitrol. Obviously, Vivitrol supports
the complete abstinence, but if you’re looking at
even the change in lifestyle from somebody who’s in active
addiction to somebody who’s on Suboxone, they’re
not stealing. They’re not robbing. They’re not vandalizing. They’re not doing all of those
things to get the next one in. They’re on a prescribed
medication. So there are certainly,
you know, there’s issues with diversion with Suboxone. There’s a lot of
stigma attached to it because it has been misused,
but used in the appropriate way, it’s a good medication to bridge
somebody to complete abstinence. >> I’m going to go to a
call, but I want to get back to this idea of stigma. So remind me of that. Jane from Somerset,
you are on the air. >> I’m asking about a patient with actual chronic
pain that’s severe, but also is addicted to opioids. What you do for someone
like that? >> Dr. Moore, that’s
a tough one. >> When you’re treating
that type of patient, you can’t treat one
without the other. So if you going to treat pain, you also have to
treat addiction. You can’t isolate one. So that’s really
the key to therapy. A lot of times those
patients have problems getting into pain clinics once
there’s been a history of abuse of medications or street drugs, and it definitely,
you know, what to do? It’s definitely a challenge. >> But doing the same thing,
you know, someone who’s in chronic pain, they’re
addicted to opioids, and they’re still
in chronic pain, if you’re doing the same thing and you getting the same
results, it sounds to me like it’s time to change, and
what do you think, Dr. Moore, of something like
trying acupuncture, or as I said earlier, exercise,
and combining these things with the other treatments? >> I think anything that works. Chronic pain, just like addiction it
requires a unique approach, patient-centered. So this patient may be
different from that patient, and if acupuncture works for
one patient, that’s great. Continue it. >> All right, we go to, I hope
I pronounce your name correctly, Ching from Erie. >> Thank you. >> Hi, what’s your
question or comment, please? >> Yes, good evening,
for everybody on the — yes, good evening to everybody. >> Good evening, what’s your — >> I wanted to ask like
do you all feel as though that is a crime against humanity when these pharmaceutical
companies is getting these drugs FDA approved and not knowing
the long-term side effects? Or does anybody even care? Or is it just that they getting
paid to approve these drugs, not caring, and then this
is how these people get — >> I think what he’s getting to is something that
I said earlier. You know, between 2009 and 2012, Vicodin was the number-one
prescribed drug in America, and so I can understand
where some people are saying, “The pharmaceutical company
has some responsibility here.” What do you say to that, Amanda? >> I think that if you’re
considering what these medications were made for. I mean, we absolutely
have become a society of, “What’s your problem? Here’s a pill.” Absolutely. And it’s across the board
for everything that there is, but certain medications
were made for patients who experience horrific pain. I mean, cancer patients. People that need that medication
in order to function at all. So I don’t know that
I would find it — I would hope in my heart that a company wouldn’t create
a medication with the intention of creating an epidemic, right? But I think that, again, it
goes back there is a certain population that’s
going to be appropriate for a certain medication,
and I think that, you know — >> Well, that brings
me to this, Dr. Moore, and we only have a couple
of minutes remaining, but only about 25%
of those people who try heroin will
become addicted. Not everyone. Am I getting that right? So why does one person
become addicted and another person doesn’t? Do we know enough about that? >> It has to do with genetics, probably who you
surround yourself with. One of the common things I’ve
heard patients say is people, places, and things. Just it depends on what’s
going on around you. So there’s actually some studies
in kids who have been naïve. So not on any drugs before,
and it doesn’t take very long to get someone hooked, or, you
know, dependent on these drugs, and in as little
as nine days, 100%, in the study I’m thinking
of, were dependent on opioids in the ICUs. >> We have just a couple of
seconds remaining, and I’m going to end with you, Senator Yaw. On a legislative point
of view, what’s out there that gives you encouragement
as we go forward and try to tackle this epidemic? >> Well, I think, as I
said at the beginning, we need to learn
about the problem. We’ve already addressed
some of the things, like the Good Samaritan Bill,
naloxone, the Drug Registry. We’ve tried to do that. We need to learn about it. We’re probably going to introduce some legislation
involving drug education for doctors. Maybe in medical schools. We need some better
reporting requirements from coroners as
to where we are. We’re at the beginning of
this, and I think that, like I said before, programs
like this raises the awareness. >> All right, and on that note, unfortunately, we
are out of time. Thank you all so much
for being with us. Our guests tonight, Senator
Gene Yaw, the State Senator from Pennsylvania’s 23rd
District, Dr. Philip Moore, an internist with a Associates
in Medical Toxicology, and Amanda Cope,
a registered nurse and the administrative director
of Positive Recovery Solutions. I’m Patty Satalia. For all of us here at WPSU, thanks for joining
us and good night. [ Music ]

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