IHPI Director’s Lecture: “Better Health Through Better Partnerships” with Surgeon General Dr. Adams

– Good afternoon. I’m John Ayanian, director
of the University of Michigan Institute for Healthcare Policy and Innovation, or known as IHPI. I’d like to welcome everyone to the fourth annual
IHPI directors’ lecture, Better Health Through Better Partnerships with our special guest, Dr. Jerome Adams, the
U.S. Surgeon General. We’re pleased to see such a robust turnout and we welcome the many individuals who are joining us through our livestream, as well as those following
the conversation on Twitter with the hashtag #IHPI18. Our university-wide institute
was established in 2011 to find solutions to the
most pressing challenges facing our nation’s healthcare system. Our institute brings together
more than 500 faculty members from across the University
of Michigan’s top schools in medicine, public health,
nursing, engineering, social work, law, business,
public policy, pharmacy, dentistry, and others,
as well as more than 20 University of Michigan
research centers and programs. Our researchers collaborate
across diverse disciplines and professions, looking
for ways to evaluate and improve the quality, safety, equity, and affordability of healthcare. We focus on evidence-based innovations to transform healthcare
policy and practice, to help people live longer
and healthier lives. Today we have the great honor of welcoming U.S. Surgeon General Jerome M. Adams to the University of Michigan
to participate in our event, Better Health Through Better Partnerships, which is also Dr. Adams’
slogan for his term of office. I look forward to an engaging
conversation with him about his priorities and
goals as surgeon general and his vision for addressing
public health challenges through a wide range of partnerships. Following our initial chat,
Dr. Adams and I will be joined for a panel discussion
by Dr. Joneigh Khaldun, Director and Health Officer for the Detroit Health Department, Dr. Rebecca Cunningham,
associate vice president for Health Sciences
Research, director of the UM Injury Prevention Center, and professor of emergency medicine,
and Dr. Chad Brummett, associate professor of
anesthesiology and co-leader of the Michigan Opioid
Prescribing Engagement Network. We’ll invite audience
members to submit questions for the panel discussion
throughout this event. Those who are here in our live audience can fill out the index card
that you can find at your seat and hand it to one of our event volunteers in the blue jerseys. For our livestream audience,
you may submit your questions through our web browser or
tweet them using #IHPI18. After the panel discussion, students from the University
of Michigan School of Music, Theater, and Dance will present a special musical performance
about the opioid epidemic, a topic that has emerged as
a key priority for Dr. Adams and all of our panelists. After the performance,
we’ll adjourn to the lobby for a reception with light refreshments which all of you are welcome to attend. In addition to the members,
Dr. Adams and the members of our panel, we have some
special guests to introduce. We’ll have Dr. Kimberlydawn Wisdom, Senior Vice President for
Community Health and Equity at the Henry Ford Health System and previously serving as
Michigan’s first Surgeon General. Joining us we also have Janet Olszewski, former Director of the Michigan Department of Community Health. We have Dr. Eden Wells,
the Chief Medical Executive for the Michigan Department of Health and Human Services also joining us today. Now I’d like to welcome Nick Lyon, Director of the Michigan
Department of Health and Human Services. The state has been an
important partner to us here at the University of Michigan in guiding our priorities
for research and evaluation, including Michigan’s
expansion of Medicaid, known as the Healthy Michigan Plan, and for our collaborative efforts focused on the opioid epidemic. I’d like to invite Nick to come up and give us some welcoming remarks. (clapping) – Thank you Dr. Ayanian, and thank you for this great opportunity to welcome Surgeon General Adams here to Michigan. Today’s event, Better Health
Through Better Partnerships, is something that I certainly strive to do as the first Director of
the Michigan Department of Health and Human Services. Breaking down barriers between entities for the benefits of individuals
is part of my daily job. We think about the determinants of health and what could we do to
improve people’s lives, making sure that they have an environment where they could live
healthier and live better is a key component of what
we do in the department. You’ll have seen focus extends
to our university partners, and I wanna thank U of M and IHPI, not only for their work in ensuring that nearly 670,000 people are covered by the Healthy Michigan Plan, but also their work with the prescribing, the Opioid Prescribing Engagement Network. This is one of the key
actions that came out of the governor’s
prescription drug taskforce. I had the opportunity to serve under Lieutenant Governor Calley and chair the health
portion of that committee. Much of what we’re doing
we’re gonna talk about today involves a comprehensive approach that’s being taken on this issue. Our work here, certainly
part of it is focused on what we can do to work together, with higher education to help ensure that medical education evolves with the rapidly growing field and how to incorporate best available, evidence-based practices
to treat pain or addiction. That includes undergraduate, postgraduate, and continued
medical education. Certainly a key component is ensuring that we can get the drug-saving
treatments, Naloxone, into our emergency responders’ hands, into family members’ hands. Under leadership of Dr. Wells, we now have 54% of our pharmacies that have dispensed Naloxone. More than 1300 doses are out there, and I am sure it saved people’s lives on a very regular basis in the state. But we’ll know, we all know, through our public health leadership that if we don’t change the
environment around health, if we don’t change the environment around the stigma around addiction,
that this would continue to be a problem that will be
very difficult to overcome. I was struck by Dr. Adams’
leadership in Indiana when he was dealing with HIV epidemic in Scott County, I believe it was. And one of the things that
I remember that was said about Dr. Adams, I think
by Vice President Pence, is that what was
remarkable about Dr. Adams was he led from the front. On behalf of the state
leadership in health, on behalf of the University of Michigan, who’s been a great partner with us, we are ready to join with
you and lead from the front. Thank you, Dr. Adams. (clapping) – Thank you, Nick. Now it’s my pleasure
to officially introduce U.S. Surgeon General Jerome M. Adams. Dr. Adams received his bachelor’s degree in biochemistry and psychology from the University of Maryland Baltimore County, go Retrievers, (laughing) – [Woman] Go Retrievers. (chuckling) – We’re hyped about basketball this week. We were happy to see your
team succeed last week. So thank you. He received his Master
of Public Health degree from the University of California Burkeley and his medical degree from Indiana University School of Medicine. He’s a board certified anesthesiologist. Dr. Adams served as Indian State Health Commissioner from 2014-2017. As Health Commissioner, Dr. Adams presided over Indiana’s efforts to deal with the unprecedented HIV epidemic caused by needle sharing
among people injecting drugs. In this capacity he worked directly with the Centers for Disease Control and Prevention, state and
local health officials, and community leaders to
stem this HIV outbreak. He also helped with the successful launch of Indiana’s state based, consumer driven, approach to Medicaid expansion and he worked with the state legislature to secure more than $10 million to combat infant mortality in the high risk areas of the state. As surgeon general and vice
admiral since September 2017, Dr. Adams oversees the U.S. Public Health Service Commission Corps, which includes 6700
uniformed health officers who promote, protect, and advance the health and safety of our nation. You’re probably one of the few people in the world who served as both the vice admiral and a general. I congratulate you for that. So please join me in welcoming Dr. Adams. (clapping) So Dr. Adams, you were
the health commissioner in Indiana before being
appointed U.S. surgeon general, can you discuss how those
roles are similar and different and your roll in both of those positions? – Well that’s a great question and before I get started, again I’ll say that I really, really
was excited about UNBC being the first 16 seed to beat a one seed in the men’s tournament. I was disappointed to see them leave but University of Michigan is my new UNBC. (cheering) UM is the best college remaining. So you all are my UNBC today. But you asked me to compare and contrast being health commissioner
with being surgeon general. What’s interesting is when I was surgeon general of Indiana, or health commissioner of Indiana, I had a lot of control over
programs and over budget. I could determine, on a day to day basis, where millions of dollars
are gonna be directed and whether they’re gonna
go to infant mortality or diabetes or hypertension. That was a very unique opportunity and we were able to make
a lot of positive change in regards to health in that state. As surgeon general I don’t have as direct control over those programs. I work with many folks within the Department of Health
and Human Services who have control over programs but I have what I call the two C’s, the power to convene and
the power to communicate. I’m able to bring people together and if there’s one thing I want to come out of today, it’s
not that you all hear from me, it’s that everyone in this
audience meets someone else who they haven’t met before because I’m not gonna solve your problems here in Michigan by myself. You all are the ones that are gonna solve the problems here in Michigan and hopefully I can be
part of that solution. But that power to convene is tremendous. And then the power to communicate. To effectively and efficiently communicate the science around health
to the American people and to help you all to become
more effective communicators and I had a wonderful conversation with the students earlier about the difference between
activism and advocacy. About the overlap between
science and policy and about how to become
more effective advocates for the causes that you believe in. – Thank you. So, it would be helpful to our audience to learn more about The
Office of the Surgeon General. It’s, I think, one of
the most well established positions in the federal government. I was reading it dates
it’s origins back to 1798, – Yes
– almost as old as the country itself. What is the office responsible
for and how does it function? – One of the most well known
and least understood positions. The Office of the Surgeon General has, I like to think of as
three main sub-components. Number one, I’m the head of the United States Public Health Service, which is why I get to wear this uniform. There’s seven uniform services. Most people know about four maybe five. Army, Navy, Air Force,
Marines, Coast Guard, National Oceanic and
Atmospheric Administration, and then the United States
Public Health Service. 6500 of the best men and women dedicated to protecting and
promoting the nation’s health. Doctors, nurses, pharmacists, environmental health engineers, we were the only uniformed health service to provide medical care on the ground in Africa during the Ebola outbreak. I was in Puerto Rico and
the U.S. Virgin Islands as part of a team of 1200 people who went over there from the United States Public Health Service to respond to the public health
disaster that existed there. And it’s an incredible
honor to be able to wear that uniform and lead the
public health service. That’s one part of it
that folks see visibly but don’t always understand. I’m running a 6500 person agency on a day to day basis
and again it’s an honor and an opportunity to
positively affect health. There’s a nation’s doctor roll and that’s what people
think about and remember. When they say C. Everett Koop, or they think of David Satcher, they think of that nation’s doctor roll. And again, that’s where the convening and the communication comes in. It’s trying to effectively communicate the science around health so that every policy decision
is informed by the science. And then the final roll that I get to play is one as an advisor. And that ebbs and flows
depending on the administration but I’m very fortunate to
be able to be an advisor to the president of the United States, to the vice president
of the United States, to the secretary of
Health and Human Services, Alex Cesar, and to bring back feedback from convenings, such as
the one we’re having today. I had lunch with Alex yesterday and he said make sure
you take time to listen to what the concerns are in Michigan and bring them back to me so that we can better inform our policy. It’s tough when you’re in DC. It’s tough because it is a bubble and it’s why we’re all, as HHS advocates, employees, representatives,
out across the country. So that we can hear what’s working and hear what are challenges
in your communities. – Thank you. So you’ve been in your position for a little over six months now, what are your priorities
as surgeon general, where are you hoping to move the country through the roll you now have? – Well thank you for that David. One of the things we talked about earlier is the frustration with
playing Wack-A-Mole. And what do I mean? I could have picked a disease,
I could have picked diabetes, I could have picked high blood pressure, I could have picked stroke,
I could have picked cancer, and decided I was gonna focus on that and we could’ve moved the needle on that issue, in a meaningful way. But one of the things that
I learned in Scott County is that if we solve the opioid epidemic, the HIV outbreak that’s
going on down there, but we leave it at that, well guess what, Scott County’s also the county in Indiana that has the highest smoking rates, it’s also the county that has
the highest diabetes rates, it’s also the county that has some of the highest school dropout rates. We really wanna move upstream and that’s why my motto is better health through
better partnerships and why I’m focused on
foraging those partnerships as the primary focus of my
tenure as surgeon general. I also would like to put out
a surgeon general’s report. And surgeon general’s
reports, for those of you who aren’t familiar, are the main tools by which we make our lasting
mark as surgeons general. Surgeon general’s report on
smoking, people remember that. It’s a chance to raise
awareness about certain issues and about possible interventions. I’d like to do a surgeon general’s report on health and the economy. Number one issue people vote on, democrat or republican,
is jobs and the economy. Number two issue people vote on, democrats or republicans,
is safety and security. You know what they don’t vote one? Health. They don’t ever vote on health. Occasionally you’ll get a blip. Oh my gosh, we’re scared about Ebola and it pops up there for a little bit. Or, oh my gosh, opioid epidemic,
and we’ll talk about it for a little bit until it goes away. But it still rarely
makes into the top five, if it does make it into the top 10. And I’d argue that still in that instance, well there’s an immediate
fear that comes and goes, or we talk about health
care being up there. I don’t see health care as
being a discussion about health. It’s more a discussion
about jobs and the economy. People can’t pay their bills because they’re going bankrupt trying to pay their medical bills. And so even that is a discussion
about jobs and the economy. We know that communities that are healthier are more prosperous. We know that intuitively. We know that if you’re healthy, you’re gonna be more
likely to show up to work, you’re gonna be more productive
while you’re at work, and if you have a healthy community, with complete streets and grocery stores, and clean air, and parks, we know that the young people in this room are gonna want to move there. They’re gonna want to be part of that community and part of that work force and again, the community is
gonna be more prosperous. So I’d like to do a report
showing the connection between community health
and overall prosperity, with the hope that we can engage some new, and non-traditional partners in our fight to lift up community health. And then I’d also like to supply
a tool kit for individuals because I don’t like to
just say here’s the problem, I like to say here’s
some possible solutions. And if you haven’t had a chance to look up Blue Zones or you’re not
familiar with Blue Zones and John Buettner, go online, YouTube it, there’s a great 10 minute presentation that talks about Blue Zones and the tools that
communities can leverage to lift up their health. – Great. Thank you. So our institute here at
the University of Michigan brings together faculty and
students from across campus to try and develop better evidence that will inform policy
around important issues in health care and in public health. What would your advice be to the students in our audience here in the auditorium and watching on the web? How could they make a contribution to advancing the work
that you’re pursuing? – Well, I spoke to a small
group of students earlier, one thing I would say to you is, people say you’re the future. I don’t like that, I
don’t like that phrase. I don’t like that mindset, you’re the now. And Washington D.C.,
when I go on the hill, I always like to take students
with me because the people in congress, they want
to hear from you all. They value what you say
more than what I say. I tell folks, you know,
people roll their eyes when they see me coming,
cause I’m the no fun guy. Don’t smoke, don’t drink,
don’t eat those french fries, get out and exercise,
but they already know what I’m going to say, and they perceive me as having an agenda. The students, they know
that you all just care about making the world and your
community a better place and so number one, don’t
underestimate your ability to change the world right now. You don’t have to wait. Get involved, engage your legislators, work with thought leaders
and policy makers. You know, great example
from just very recently, who would’ve ever thought? If I’d a told you a year ago Florida would enact massive changes in the way that they
look at firearm safety, there’s lots of you all
that would’ve bet me, any amount of money,
that Florida would not be the first state to do it. But those Parkland students,
I am so incredibly proud of them, because they took a tragedy and used their voice to
facilitate a conversation. And whether you agree or disagree
with the ultimate outcome, what we don’t want to loose sight of is that they were able to use their voice and change the way we discuss things and actually get a bill passed that many people didn’t
think would be passed and that we haven’t even been able to have a meaningful discussion
about on a national level. – So before you became surgeon general, you’re an anesthesiologist by training, you were chair of the
Professional Diversity Committee for the American Society
of Anesthesiologists. What did you learn from that experience and how can we promote greater diversity in the health care professions and public health and
other related fields? – You know, what’s interesting, here’s another thing to look up. I’m giving you all lots of homework. The students are like we would’ve never came if we’d known that. (laughing) The great publication
by Robert Wood Johnson called A New Way to Talk About the Social Determinants of Health. What they did is they polled 4000 voters, not 4000 people, 4000 voters, because the great saying,
democracy is not ruled by the majority, it’s ruled by the majority who participates. And they polled them on
words such as equality, diversity, equity, and they found that those words consistently
turned off voters. Why did they turn off voters? Because when you have those conversations you automatically group
yourself into one of two groups. You’re either the oppressed
or you’re the oppressor. We need to be able to have a
conversation with individuals that shows them how they
all fit under the tent. When I was speaking
earlier with the students I said you know, talk about
people with disabilities. You know, almost all of us
know someone with a disability. Talk about veterans. We know veterans aren’t getting the care that they need and that they deserve when they come back from
serving our country. Talk about rural vs urban disparities, particularly here in Michigan. We know that those are some of the worst disparities that exist. Show everyone how they fit under the tent. Show them how diversity matters to them, instead of just expecting that continually pounding them on the head with the fact that someone
else is not doing well is going to somehow get them excited about addressing those disparities. And I believe there’s a case to be made, in almost every situation,
that diversity helps everybody. That lowering disparities helps everybody, but we need to be better
about making that case. And I’ll finish with a
quick example before they, you know, switch over to questions. Chattanooga, Tennessee, and
I gave this example earlier but I’m gonna frame it
in a very different way. Chattanooga, Tennessee had a Volkswagen plant coming to town. And they found out that the people there were so unhealthy that
they couldn’t actually find enough folks who could pass a
physical to work in the plant. So they gave them and hour on the clock to workout each and everyday. Many different lessons from this story, but engaging the business community helped their bottom line, by
making the community healthier, but guess what, Chattanooga, Tennessee also has a higher
proportion of minorities, particularly of African Americans, than the rest of the country on average. So, if we had looked at that
through an economic lens vs a disparity lens, we
could more easily engage the business sector and
show them how addressing health disparities is gonna
help their bottom line. It’s really figuring out
how to be a better partners and I told this story earlier too. You know, I’ve been married 16 years and I’m still painfully
learning the lesson that things go my way a whole lot more when I seek to meet my wife’s needs, as opposed to trying to force her, or expect her, to meet mine. I can’t force her to do anything. Her or my daughter. (chuckling) But when I try to meet their needs, they’re a whole lot nicer and
a whole lot more receptive and we’ve gotta show folks
that addressing diversity is meeting their needs,
that raising up health is meeting their needs, as
opposed to expecting them to automatically adopt
our goals and our metrics. – Great. Thank you very much Dr. Adams. I’d like to invite our panel
members to join us now upfront and as they’re coming up, I’ll
do some brief introductions. First, sitting next to Dr.
Adams, Dr. Joneigh Khaldun. She’s a graduate of the
University of Michigan, go blue, and now director and health officer for the Detroit Health Department. She’s also a practicing
emergency medicine physician at the Henry Ford Hospital. As Detroit’s chief health strategist, she executes the city’s health agenda through collaborative partnerships, evidence-based programs,
and a social justice lens focused on the resilience
and strength of Detroiters. Under Dr. Khaldun’s
leadership, Detroit launched an 18 month community health assessment, reaching health systems and public health in an effort to reduce infant mortality and unintended teen pregnancy. She’s the driving force
behind a proactive strategy to address lead poisoning in children, the restructuring of the
city’s animal welfare services, and collaborations to
tackle the opioid epidemic and violence, as public health issues. Previously, Dr. Khaldun’s
the chief medical officer for the Baltimore City Health Department, where she oversaw seven clinics and focused on robust partnerships to address the opioid epidemic. Welcome Dr. Khaldun. – Thank you for having me. (clapping) To her left, your right,
is Dr. Rebecca Cunningham. She’s the director of the CDC funded University of Michigan
Injury Prevention Center, associate vice president
for health sciences research at the University of Michigan, and professor of emergency medicine and health behavior and health education. Her research focuses on injury prevention, particularly among youth and young adults. She has experience building partnerships with state and local law enforcement to address the opioid epidemic and she helped lead the
University of Michigan’s response to the water crisis in Flint by bringing together partners from universities and community groups. Most recently she started the Firearms Safety Among
Children and Teens Consortium or FACTS, which is building capacity and research to address
firearm deaths among children. Welcome Dr. Cunningham. (clapping) – John, I’m feeling a little
outnumbered by the ER docs. Can you balance things
out for me a little bit? – I’m a primary care physician
so, I’ll try to balance it. We have, at the end of the
panel, one of your compatriots Dr. Chad Brummett, who’s
associate professor of anesthesiology here at
the University of Michigan, and by the way, a medical
school classmate of Dr. Adams. So, great to have them together here. Chad is the director of pain research and director of clinical
anesthesia research here at the University of Michigan. He also serves on the editorial boards of the Journal’s Anesthesiology and Regional and Anesthesia and Pain Medicine. His research focuses on predictors of acute and chronic postsurgical pain. He’s also the confounder and leader of the Michigan Opioid
Prescribing Engagement Network, which you heard about
from Nick Lyon earlier, also known as Michigan OPEN, which is developing a
preventive strategy approach to the opioid epidemic
in the state of Michigan through a focus acute care
prescribing in surgery, dentistry, emergency
medicine, and trauma care. So I’d like to remind
you, if you have questions for our panel, please use
the index cards at your seat and hand them to one of
our volunteers in blue or if you’re watching on the live stream, submit questions through your web browser or Tweet them through #IHPI18. So we’ll start out with
some discussion here and then we’ll begin taking your questions from the audience. Dr. Khaldun, as the health
officer for the city of Detroit and director of the
Detroit Health Department, how do you and your staff set priorities for the city’s health. – That’s a great question. Some of you may not know but
Detroit Health Department was essentially closed and
privatized several years ago really as a part of the bankruptcy and really part of
several decades actually of disinvestment in the city of Detroit. And unfortunately Detroit’s
children and families really bore the brunt
of that disinvestment. So, myself, as the health
officer of the city, I really have to go by data, right? So we go by data and also understanding and listening to the people of Detroit. And really what we’re focusing on now is focusing on
children and families. So a lot around, as you
mentioned in my introduction, infant mortality, preventing
unintended teen pregnancy, and also just making sure we can interrupt intergenerational poverty which is incredibly important
in the city of Detroit. So really focus on
data, as well as people. – Great. Thank you. So for all our panelists, I’d like to move to a topic that’s very much in
the public debate right now, that’s the opioid epidemic
and what our goals should be. I would note that half of American’s believe opioid addiction
is a major national problem but only a quarter consider
it to be a national emergency in some of the recent
polling data that we’ve seen. And only half are aware that effective, longterm treatment exists
for opioid addiction. So starting with you Dr. Brummett, how can surgeons and dentists and other acute care providers be part of the solution for the opioid crisis as we face it now? – Thanks John. So our group’s kind of
taken a different approach I think to the opioid epidemic as compared to what we’ve seen nationally. We’re really focused initially on keeping healthy people healthy and instead of talking about what to do with a chronic opioid user before surgery, which is an inherently
challenging problem, we want to take people
that are not using opioids and ensure that they don’t
go down the wrong path and that wrong path would be
becoming a new chronic user, which we’ve shown happens between 6-10% of the time after elective surgery, which would constitute millions of new opioid users each year in the U.S. and it’s really, sort
of, flooding our problem but even beyond that, we
known that surgeons, dentists, emergency room providers,
are vastly overprescribing. There’s been many reasons for which that overprescribing has happened but it’s flooding our
communities with excess pills that we know are available to our most vulnerable populations and certainly help lead
to problems as it relates to new opioid use disorder, misuse, and diversion in our community. So, we believe that surgeons
have a critical role, dentists have a critical role, emergency room physicians
have a critical role to bringing this back and starting to think about longterm prevention and having a longterm view. And we view this as part
of the bigger narrative but a part that really hasn’t
been addressed to date. – Great. Thank you
– And there’s a place where the folks in the
audience can help us too. Chad and I had this discussion earlier. There’s a role on the provider’s side but a lot of that overprescribing was meeting a demand on
the part of the public. Meeting a demand for a
pill to fix everything. Meeting a demand for opioids
as opposed to alternatives. We need to have a change in perspective. We need you all to have discussions in your communities, at
your boardroom table, at your break room table,
at your dinner tables about how dangerous
these medications can be when used improperly and the fact that in the majority of cases,
you simply don’t need them. My wisdom teeth, I got 30
Percocet, for my wisdom teeth. I didn’t take a single one. And then you know where
those 30 Percocet sat? In the medicine cabinet. Fortunately, they didn’t get diverted but that’s part of the overall problem. It’s overprescribing but it’s also this community expectation
that needs to be changed. This culture change needs to occur if we’re really going to stop the flow of opioids, both legal and
illicit, in our community. – Just a follow up, back
to you Dr. Brummett. What can we do to get
those excess opioid pills out of people’s homes and
people’s neighborhoods? That’s something that the
Michigan Opioid Prescribing Engagement Network is working on. – Yes, so Michigan OPEN and most of the hard working people
on the team are kind of in that third or fourth row. We organize a statewide opioid drive and last fall we had eight
sites throughout our state, 900 lbs of pills in a four hour period. I’m excited that we’re up to about 25 sites committed for
the April 28th drive. Four hours together and
we’re gonna leverage a bigger network through Blue Cross Blue Shield. We’re looking forward to advertising from Health and Human Services and our other partners to
get a statewide approach here and really increase our output, because we really believe that that gets pills out of the community but most importantly we
want to enhance awareness of the ills of leaving unused
pills in medicine cabinets. So even the people that
don’t attend our event, if we can just get a statewide perspective and some awareness around the ills of unused opioids, hopefully
people will then go and find everyday options, which are also available on our website, for disposal in your communities. We’ve made a map available for everyday options for disposal. – Great. Thank you. So Dr. Cunningham and Dr. Khaldun, you’re both emergency room physicians and we’ve seen recent
reports of a 30% increase in patient visits to emergency departments for opioid overdoses. How can emergency care providers, doctors, nurses, and others
play an effective roll in addressing the opioid crisis? – Sure. I think emergency
departments are critical. We’re the safety net for healthcare. We’re were people go 24/7,
us and McDonald’s we say. We’re open all night
long, we take everybody, and we see them quickly
and treat them well. But that also leaves us
with a lot of responsibility both to change our mindsets around sort of treating and streeting people. Whether that be that they came
in with Naloxone, a reversal, and now they’re being sent back out again to come back 15 hours later. What should we do in
between, what is our duty, as physicians, as public health providers to make sure that’s not a revolving door is one really important part. Our injury center, lead
by some of the folks here, in the audience, Dr. Bohnert
and Haffajee and others who have been working on
emergency department intervention. So what could we do in that critical, teachable moment while they’re there? How can we identify people who have, not only overdosed, but
those who we think are likely to overdose by risk factors
that we can identify? What should we do with them there to prevent even their first overdose? How can we get upstream,
as I hear you say. Which I think is so critically important to giving them the tools they need and getting the referrals they need so that they don’t even wind
up with that Narcan reversal, I think is one really important place. The other place emergency
departments historically have served, and continue to
serve, is in surveillance. Eventually we can count the people who overdose in the
medical examiner’s office but really counting those folks and figuring out where the
near fatal overdoses are and who is coming in to
the emergency department in hot spots and understanding that from a surveillance aspect can really then get
resources to those folks who, from a law enforcement area, to see where there’s
been a lot of overdoses, then perhaps diversion
and law enforcement needs to be better involved in that area, as well as public health resources need to be deployed to those folks
who have had one overdose or several overdose, from
a surveillance standpoint. And emergency departments are
incredibly well positioned to do that in this era of
electronic health data. We’ve been working with our
law enforcement partners as well to create a surveillance system and then working with state partners to help with methodology that
our group has been developing, Doctor Abir and others to really move that state of the art,
real time surveillance system to help our state
and other states move from data collection
that can sometimes lag, as it does everywhere in
the country, 16 months even, to really understanding what happened in our community last
week, or even yesterday, so that we can be really
real time and accurate in that right sized response. I love that Dr. Brummett. – Do you all offer
Hepatitis and HIV testing in your emergency rooms in general, or is that the exception and not the rule? – [Dr. Cunningham] So
we offer HIV testing. – Same. HIV testing. I wanted to piggy back on
what Dr. Cunningham said. I think as an emergency
physician, there are kind of three basic things you can do, just when you’re seeing a patient in front of you with an opioid
or substance use disorder. I think one thing is just,
of course like we said, talking about appropriate prescribing but also co-prescribing. We know that a lot of
overdoses are not just someone having opioid onboard, it’s
also a benzodiazepines. So not co-prescribing opioids
with things like Valium. That’s very important. If you have a patient in front of you who’s at risk of overdosing,
making sure they have Naloxone. So either prescribing it for them or for their family members or making sure they’re getting to one of our pharmacies in Michigan that has that standing order available. And then finally, there are
several emergency departments, I just had a call earlier this week to try to bring this to Detroit, there are several emergency departments where they’re actually starting people on treatment from the
emergency department. So starting Suboxone in
the appropriate patients and connecting those
warm handoffs to care. So those are three very,
I think, simple things that emergency departments can work on. – [Dr. Ayanian] Great. = And you mentioned Valium. While we have the students here, there are a surprisingly large number of folks on college campuses who are misusing Valium and misusing stimulants. Now they’re misusing stimulants to study and they misuse the Valium
to help them calm back down because they’re taking
so dang many stimulants and they’re so anxious
about there studies. But unfortunately, I spoke with
a father just two weeks ago whose son was on a college campus and got what he thought was Valium and it was actually fentanyl
and overdosed and died. So the lesson is that
you shouldn’t be taking these things period, but you
don’t know what you’re getting. It’s still baffles my mind,
I don’t understand why it’s a good marketing ploy
to give people fentanyl and to kill of your population but unfortunately, as Chad mentioned, we know that for everyone that dies off there’s many more people
who are going down that pathway each and every day. But do not take anything
that is not prescribed to you by a doctor and don’t
take it in anyway other than how it was prescribed to you because you could end up a whole lot worse than simply being addicted
and shooting up heroin further on down the road, as bad as that is. You could end up dead after
the very first time someone gives you a pill at a
party down the street or you take a pill and
try to help you stay up and study for that test. – So we’re gonna return to
the theme of our session today which is Better Health
Through Better Partnerships and really the theme of your role as surgeon general Dr. Adams. For each of our panel members, what experiences and best
practices have you learned in working with non-traditional partners, colleagues, and law
enforcement, education, business, other fields,
that often times aren’t at the table when we’re discussing health care or health issues? – [Dr. Brummett] Want to start? – [Dr. Cunningham] Sure. – Well I was again I shared
my perspective earlier that we need to be
better partners in terms of meeting them where they are and seeking to address their needs. So I’d love to hear
from the three panelist in terms of examples
that have worked out well or not worked out well for you all. – The partnership that’s
been the most, I think, interesting and fruitful for us recently in the injury center has
been the coming together with law enforcement and with specifically the high intensity drug
trafficking area folks, who came to us about a year and a half or two years ago, realizing
that this epidemic that they were not going to arrest their way out of this epidemic. That they weren’t going to fight their way out of this epidemic and that they needed to be working with folks in public health and with medicine and an
emergency medicine as well to try to partner to figure
out where the data was and then where the solutions were. We realized we had common
cause and by getting together and sharing information
in a de-identified way around sort of hot spots and methodology that we could get a lot further down the road than we could individually. This has been a shift in a lot of ways from sort of a substance
use relationship in the path with other prior interventions
with law enforcement. It’s been really nice coming together and I hear my law enforcement
colleagues say this, I think the lessons that
we learn now around opioids will help us with the next
epidemic down the road. There’s lessons that were learned during the cocaine epidemic
and the HIV epidemic and things that we’re
learning now together around the opioid epidemic,
I think may help us further down the road with, you know, firearm violence, with other
kinds of youth violence, and other infectious disease. – I see my role as
Detroit’s health director as really, not just leading
the Detroit health department, but really leading the public
health system, that includes of course the health
department, of course hospitals, but also my law enforcement
partners, nonprofits, faith-based organizations, and
so I think one good example we have recently in Detroit is
on our infant mortality work. So Detroit is about 139 square miles but unlike a lot of other large cities, there’s not a robust
transportation system. So when you talk about a lot
of the public health issues in Detroit, a lot of it
has to do with access and not only is there not a
public transportation system, but a lot of people don’t have a car or don’t have access to a car. So when I looked at what we wanted to do around infant mortality
in improving those outcomes, we said okay, what if we
could help every pregnant mom be able to get transportation to their prenatal appointments, to their prenatal education classes, and so what we said, okay,
Lyft, what can you do for us? Can you help us get our moms
to the services that they need? And so we now have a partnership
with Lyft you can get if your part of our program,
it’s called Sister Friends. You can come, get a ride, and get to your prenatal education class and your prenatal appointments. So that’s a partnership that’s kind of thinking outside the box to help improve a public health outcome. – [Dr. Ayanian] Great example – This opportunity with Michigan OPEN is lead to an endless number of new partnerships for me. IHPI has really launched. I think the ones that really
stand out are now partnering with payers, both state and private payers
partnering with the state. And then also getting involved in policy. We have a lot of new policy coming, as it relates to opioids. Some of it we kind of
helped shape a little bit but I think a lot of it
we’re now reacting to. And I think this has
been an important time for having physicians,
and certainly Rebecca and I have had a lot of opportunity to work together in this space to try help advise the implementation of these policies that are really going to change how we provide care to patients. I think I was kind of
more of a traditional nerd before then, sort of doing the NIH work, much more mechanist
stuff and this has been sort of an eye opening opportunity to really be involved in
something that’s broader, and I will say, it’s been incredible because I feel like we’re
really influencing change today. That’s really fun. – I’ll give an example, in regards to the business community
and the opioid epidemic. In Richmond, Indiana there’s
a company called Belden and they were frustrated
because they would have people apply for jobs, they would
bring them in for an initial interview, they’d bring them
in for a second interview, and then once they decided
they wanted to hire them, then they drug test them
and a significant portion of those individuals were
failing the drug test. So not only was it a work force issue but they were also just
wasting a whole lot of time bringing people all the
way through the process only for them to fail the drug test. They reached out to the
local health department, to local community organizations, and implemented a program where they come in and they offer you, and they explain what they’re doing, they offer you the drug screen right away but before you even
apply, and they tell you if you do not pass the drug screen, we will help you get connected to care. Care that they’ve coordinated
through the health department and through the local
community organizations and if you are successful in treatment, then we will hold this job for you and then you can come back
and work for the company. And so it’s made their process
a whole lot more efficient, it’s connected people to care, and the individuals that
have been successful in that program, they say,
are some of their most dedicated employees because
it lowers the stigma; it shows them somebody cares about them. Remember the opioid epidemic isn’t the problem it’s the symptom. It’s the symptom of community unwellness and the fact that these individuals, often times don’t feel like the community cares about
them, that someone loves them. For someone to say, look,
we want to get you help and then we want to have this
job here for you afterwards creates some of the most loyal
employees that you could have but it’s having the courage to form those non-traditional partnerships that allowed programs like
this to start to happen. You would never think that
you’re gonna go to Belden, to the local manufacturer to help address the opioid epidemic but they’re
changing the discussion, the dynamic in the community in a way that we can’t do as doctors, but the local business leader can completely change the conversation. We need more examples like that and I love the example
that you all brought up, hopefully something
resonates with everyone in the audience from what you’ve heard. – So another topic that’s on everyone’s mind now across the country is firearm injuries and deaths. It’s the second leading cause
of death among all children, the leading cause among
African American children. What are your thoughts on this issue? The research, what does it tell us? What more do we need to
learn about firearm safety and how to prevent injuries
related to firearms? And open that to everyone on the panel and ask you to share your thoughts. – So thank you for bringing this up. I think for so long it’s
been such a third rail that academics have even just
been afraid to talk about it which I think in and
of itself is terrifying when we think about it as
the second leading cause of death among children
altogether in the country. So this is a topic we have to find a way to talk about, one way or another. I’m very excited that the
NIH is indeed funding some research, and we recently
do have this funding to start to build capacity
around firearm research here at the University of Michigan, reaching out with partners
across the country. That conversation has to
include stakeholder groups, as you talk about, and folks from across the spectrum of views. We’re not gonna get at this problem by being polarized on either side. So we have to find some
common ground around it. I think the kids in
Parkland have helped some with the debate about that. I feel like the place
to focus, as a start, is we need less children
dying of firearm injury and I think there’s some
fundamental things we can all agree on, and that’s one we can agree on, is that something needs to
be done about firearm safety so that we have less children dying and if we can start that
sort of ground level piece and then the science and
the injury prevention person in me says, well what do we know? And we realize pretty
quickly we don’t have a lot of data about what works
and what doesn’t work because there hasn’t been any funding hardly to look at this. So, I wanted to start looking
at this about 25 years ago when I started going
into injury prevention and I and many others of that generation were
counseled aggressively that we could not do this as a career, we could not look for any answers or any science in this area,
we needed to look elsewhere. That has such down and entire
generation of researchers who might’ve been able
to provide some basic, fundamental question to things that are not actually controversial
when you talk to folks who are very enthusiastic
about Second Amendment rights. Like what is the best way to counsel parents to store guns safely? There’s some fundamental questions that we could all really
agree on around these topics if we can sit down and
talk about them together. – I don’t use the term
gun control personally. I shy away from it. I think by using that
term it allows people to push you into an us or
them binary discussion. I talk about gun safety. You know, once upon a time, car accidents where going up precipitously and then we started looking
at things like seatbelt laws and speed limits, and determining who could get a driver’s
permit or a driver’s license and when and what they
had to do to obtain it. And we didn’t call that car control. But we’re a country that
was founded by individuals who did not want to be controlled. So you loose the debate when you start off with language that makes people shut down or feel like you’re trying
to take something away from them as opposed to finding
the common ground of safety. Suicide is another opportunity
to talk about gun safety. Was talking to the health
commissioner from Washington and he said 80% of their
firearm deaths are from suicide. It presents a opportunity
to talk about, again, how can we be safer about firearm usage so that we can protect everyone’s
Second Amendment rights, as opposed to trying to
control them or take them away. And I’ll tell one quick story to set things up for you,
being from Baltimore. I went to school in Baltimore. I lived in an apartment where
the walls were this thick and where there were people all around me and where the person
in the room next to me, who I didn’t even know, owning
a gun, was a direct threat to my life, each and every day. That was a reality in
one place that I lived. I’ve also sat on my
father-in-law’s back porch on his farm in Northern Indiana and seen coyotes run across the back yard and heard articulate and understood that he perceived not having a gun, to be able to protect
his farm and his family and his livelihood, as a greater threat to his life and livelihood than I felt the availability of guns Baltimore being a threat to my livelihood. We have to understand
that the United States is a very big place and
just like all politics is local, all health is local. Again, in one place, over availability of guns is seen as a public health threat. In another place the lack of availability of guns, or some means
to protect yourself, is seen as a public health threat and while some folks may
disagree with me on that that’s how people perceive it. And we have to facilitate
these conversations on a local level and in
language that is nonthreatening or doesn’t shut down the conversation. You’re not gonna have gun legislation pass without gun owners. You’re not. So you’re gonna use language that turns them off from the start? I mean you’re gonna have a
conversation with yourself which is what we continue to do and then we don’t see any change. – Dr. Khaldun what would you add? – So I actually think that violence and gun violence is a public health issue. When you’re talking
about inner city Detroit, inner city Baltimore, you’re
talking about upstream when you’re talking about dealing with it as a public health issue. So what that means is, how
can we address the trauma, the mental health, the lack of resources in these urban communities. Okay? Well before the recent conversations around gun violence it
has been an epidemic in these urban environments
for quiet some time. So how can we think about
education, mental health and trauma when we’re
addressing gun violence, in inner cities is how I think about it. – Thank you. – So I think we’ll shift gears now and with the help of four of
our IHPI clinician scholars, Sue Anne Bell, (mumbles), Calista Harbaugh, and Beth Wallace, now bring some questions
in from the audience. Both our audience here at the auditorium and our audience online. – Thanks. This question come from Paula
Lance, from the Ford School. Several members of the
Trump administration are promoting work requirements for Medicaid and public housing. Given your interest in the relationship between the economy and
health, what is your opinion on work requirements for public services? – I’m assuming that’s directed towards me. (laughing) – Please. – You know, Michigan is one
of the states that was able to expand access to coverage
through a Medicaid waiver. Indiana, is also one of
those states that was able to expand coverage to
folks across the state through a Medicaid waiver and at the time, interestingly enough now
we’re seen as a model in Indiana, but at the time
it was very controversial. People were adamantly against it, didn’t want to go down that road. I am proud to say that we were able to work with the hospitals, work with the public health community and institute that Medicaid waiver, which in Indiana, includes a copay for people to be able to get on Medicaid or a Healthy Indiana
Plan and a disincentive for folks to utilize the ER. Also two things that folks
thought were controversial but at the end of the day we
were able to expand coverage to almost 400,000 people in the state by taking into account the
personal responsibility elements that were important to the voters and the taxpayers in that state. Now there’s a lot of
people who would disagree with where we are but
I’m a pragmatic person and at the end of the day,
I had a choice between no coverage for 400,000
people or coverage expansion in a way that that state could
accept for 400,000 people. There’re many states that did not accept a Medicaid expansion
that the Affordable Care Act offered and there are people
in those states right now who don’t have coverage. If work requirements are a
pathway for us getting there, then as a public health advocate,
what I would say to folks is make sure you’re at the table and make sure they’re applied
in a way that is equitable and that has the best
chance at being successful so that we can increase coverage, instead of again being
pushed into the binary, all or none discussion,
that either leaves people with coverage in some places, or in other places, no coverage at all. From the conversations I’ve had with folks in the administration, they
want folks to have coverage. They want it to be done in
a way that is acceptable to the voters and the policy
makers in those states. We’re very open to Medicaid waivers, particularly in the substance
use disorder treatment spectrum, and again trying
to provide flexibility for states to provide coverage
and access for individuals in a way that they see as suitable. And again, from my point of view, if I can get 400,000
people additional coverage by meeting somewhere in the middle, then I’m okay with that,
versus no coverage. – I would just add Dr.
Adams, we had a very similar experience here in Michigan,
around the same time as Indiana was expanding. Michigan, with a republican
governor, Governor Snyder, and bipartisan support in the legislature, was able to find a path of compromise whereby the state could accept
the expansion of Medicaid, Healthy Michigan Plan we call it here, with some market oriented reforms, that brought some of the
more conservative legislators along to support that
and we’re now four years, almost 5 years into the program
and we’re learning a lot. We’ve a team, a faculty
of from five schools here at the University of Michigan, working with partners at
the state Department of Health and Human Services
to understand the economic and health effects of Medicaid expansion and I think it’s something
that can continue to evolve and improve as we
learn more about how people are served, specifically on
the issue of work requirements. We’ve found in our own
work here in Michigan that about half of people with the new coverage
are actually working. About a quarter are in a
position where they’re either a student or they’re caring for a disabled or ill family member at home and probably not able to work and then roughly a quarter are receiving that Medicaid coverage but not working. Many of them are looking for work or they have significant health problems. So, I think again, we have to look for evidence and sort
of bipartisan approaches that allow people to
achieve the goal of coverage and better health care,
ultimately better health, while also doing a way that’s acceptable to voters and to legislators
as you described. – And I’m most familiar with Indiana, I know for the work requirements there, my deputy commissioner worked closely with the governor’s office to make sure that those work requirements
had sufficient exemptions for all the categories that you mentioned so that we’re not hurting anyone who doesn’t have the
ability to go out and work. Another important place
where we need more research but where there is actually
a fair amount of research, people find value in work. People who work are
healthier, so having the goal of wanting people to work is laudable, we just need to make
sure they have the tools in place in their community,
the housing supports, the child care, that allow them to be able to engage in meaningful
work, without creating an unnecessary burden on them. And that’s where the public
health approach comes into this. It’s not the work requirement,
per se, that’s an issue, that’s actually a laudable
goal, it’s how you implement it and that’s why we need everyone onboard and not being forced into
the work requirements bad or work requirements
good, binary discussion that far too many folks are having. – Thanks. We’ll take another question. – [Male Volunteer] Yes. This
comes from our online forum. The World Health Organization
issued a joint statement with the United Nations regarding
substance use disorders. Joint statement recommended
all nations to pursue public policy that
decriminalizes possession of all illicit substances. The statement cited Portugal’s success in combating the country’s opioid epidemic after decriminalization
was passed in 2001. What is your opinion in decriminalization and illicit substance possession? – I’m assuming that’s for me again. (laughing) – It’s for you. – I’m gonna tell you
all a very quick story. I was in Switzerland a couple of years ago and I was given 10 minutes,
I was on a panel like this, and they asked me, in 10 minutes, to explain the United
States health care system. (laughing) Didn’t know anything about it. Easy right? Here is what I said to them. When you look at Paris,
France and Berlin, Germany, these are two cities that
speak different languages, that during the last great world war, literally tried to obliterate
each other off the planet. If Paris had its way,
there would be no Berlin. If Berlin had its way,
there would be no Paris. Now when you look at these two places, when you look at major health issues, like universal coverage, when you look at issues
like women’s health and access to contraception and abortion, when you look at harm reduction and the way we look at drug
policies in the country, when you look at attitudes towards guns, Berlin, Germany and Paris, France, two cities that literally
tried to obliterate each other off the planet are more
aligned on those issues than Boston, Massachusetts
and Dallas, Texas. Not only are they more
aligned on those issues, they are actually geographically closer than Boston, Massachusetts
and Dallas, Texas, I Googled it. When we’re talking about U.S. policy, we always have to be careful
from a research point of view, about comparing what the
rest of the world is doing to what’s happening in the U.S. We have to understand
how different people are, culturally, how they
think in different parts of our country, and
take that into account. Now that said, I completely
understand where folks are coming from when they
talk about decriminalization. I also know that I’ve
lived in a lot of places in the United States and it doesn’t matter how you feel about it,
there’s parts of the country that that’s not gonna happen. I’m a pragmatic person,
it’s just not gonna happen. Folks aren’t there. Told folks this earlier,
in a different discussion, as much as we want science and policy, as much as we say we want
them to be one and the same, they will never be completely overlapping. If they were, we wouldn’t have cars that go over 65 miles per hour. As I said earlier to the
folks, you wouldn’t be able to drink that glass of wine or that beer when you’re watching
the Michigan game tonight, cause the surgeon general says that’s bad. (laughing) Wouldn’t be able to have chicken wings, surgeon general doesn’t like those either. Bad. Bad for you. And you know, it’s a
little bit of hyperbole but at the end of the day, science and policy will
never completely overlap. We want the science to
inform policy decisions but we’ve gotta understand that there are other variables and a complicated
multivariate policy equation and one of those variables is the culture of the community in which you’re trying
to implement that policy. And, I guess in summary I would say, the culture in which
we’re trying to implement drug policy is very different
in Boston, Massachusets versus Dallas, Texas versus Paris, France versus Berlin, Germany and
it’s part of our responsibility as folks who want to influence policy to understand that cultural difference and not just to say, well,
they’re doing it over there so we need to make it happen over here. – [Dr. Ayanian] Thank you. – [Female Volunteer 1] Dr.
Adams has already touched on this just a little bit, Dr. Cunningham began to touch on this, we’ve had several questions
that go more in depth. Health care has been
working hard to decrease the mental health stigma,
but many in this country do not have insurance coverage
to get the therapy they need. Using an emphasis, as
needed, on making sure Americans have access
to mental health care in order to solve the opioid epidemic and violence in our country, if so what are your plans to improve diagnosis, treatment, and access to care, and specifically how
can we use partnerships to impact the most vulnerable groups in settings of scarce resources? – I’m gonna punt to my partners because they’re the ones doing it on the local level. They’re the ones actually doing it and if there’s anything
that I can add then I will but I’d love to hear from you all. – So I could talk a little
bit about some innovative work that’s being done
in the injury center by Dr. Bohnert and some of the
folks at the state as well. I’m looking to get access for treatment to folks in remote areas that
may not have it otherwise, using resources here at
the University of Michigan to provide consultation for those who are in rural areas and could give, for example, medication assisted treatment to their patients but need guidance and need aid in getting
that resource out to them. So there’s a couple of innovative programs that they are able to give
that guidance remotely and have those underserved communities, where there may not be any providers who can give medication
assisted treatment, but the community needs it, and have them supported more centrally. We need more innovative models like that because, even if my colleague
over here, Dr. Brummett is completely successful
and there are no new opioid misuse cases in the next
five years after this, we still have and entire country that has giant addiction
problem with opioids and we have those people
that need to be served then, with good therapy that
exists around medication assisted treatment and decrease the stigma around the addiction for them so that we can get them back into jobs and get our workforce strong again. So we need a lot of
innovative, creative models like this one being done out of our center and with the state at the
University of Michigan and more like that. We need to increase access
to medication assisted treatment by as many
possible ways as we can think about doing it, including by
encouraging our physicians who could be prescribing Suboxone, decreasing the stigma for
them to prescribing MAT, getting them waivers,
getting them training to do it so that they
feel comfortable going out into their own communities. – I think there should be
universal access to treatment and really this kind of
no wrong door approach. I actually had a meeting
a couple of weeks ago with my police colleagues and they said, hey, you know Dr. Khaldun, we’re seeing all these people, we’re responding to 911 calls, and we reverse them
with Naloxone but then, you know, if someone
wakes up after Naloxone, they can refuse to come to
the emergency department, and they say, you know what, how about if we could
somehow connect those folks to you at the health department so you could help connect them
to services and treatment. So I think wherever the system, and I say system very broadly, is reaching families and reaching people, whether it’s the emergency department, whether it’s law enforcement, how can we really support
people wherever they are, meet them where they are,
so they can get access to the treatment that they need. – I would point to a couple of things. So Jenna Goesling is a
K funded, noted scholar who is doing work on behavior and chronic opioid use
beyond just medication assisted treatment for
opioid use disorder, really looking at how depression and opioids and chronic
opioid use interface and looking at behavioral
treatments to ween people off. And then in the broader group,
not just thinking about, there’s always managing
depression or anxiety, but Afton Hassett is doing some really innovative work around resilience and resilience interventions and think about positive affect and not only how to do
those at one on one level but looking at electronic platforms that really increase the
access and scalability of trying to enhance
resilience in our population. I think that’s a really
innovative and important way. And again, when we talk
about sort of a comprehensive approach, it can’t be
just about better managing depression or anxiety, it also has to be about enhancing
resilience and wellbeing and I know that would
resonate with you Dr. Adams. – Well you hit two of the
three things I was gonna say so I’m so glad I let you all tee it up. Access, if you haven’t
had a change to look up Project ECHO, out of New Mexico. A great program that seeks to expand care to areas where you
don’t have a specialist. We produce three addiction
psychologists a year out of Indiana University,
one of the largest medical schools in the country. We could quadruple that number
and it still not be enough. We need to arm our primary care providers, doctors, nurses, the
whole array of providers in how to provide care
and think outside the box and not think every
encounter has to be a patient with a specialist or else we’re
never gonna dig our way out. So access is one of the keys. I’m glad Chad brought up resilience. If you’re not familiar with the term adverse childhood experiences
or ACEs, look that up. Over half of adults have had at least one adverse childhood experience, a significant proportion
have had two or more. And the more ACEs you have,
the more likely you are to drink, the more
likely you are to smoke, the more likely you are to have stroke, the more likely you are to
have a teenage pregnancy, the more likely you are to be
arrested and end up in jail. And so we want to understand
what adverse childhood experiences are and how trauma
sets people down this pathway towards these negative outcomes. It’s not what’s wrong with
you, it’s what happened to you. But then, the flip side to that, as Dr. Brummett mentions, is resilience. How can we invest in programs that build resilience in communities? Because we know everyone
that had an adverse childhood experience doesn’t go on
to become an alcoholic, doesn’t go on to become
a substance misuser. How do we build resilience in communities? And there’s some great programs out there. We don’t have time to
go into them right now, but really leaning into
resilience programs. The final thing I would mention is stigma. And stigma really is hurting our ability to reach folks and also
affecting how we treat folks. And the president just
launched a new website called Crisis Nextdoor,
it’s crisisnextdoor.gov. This is a website where
individuals share their stories. I shared my story. My brother’s in state prison
in Maryland right now, due to crimes he committed
to support his addictions. He stole $200 and the judge gave him a 10 year prison sentence. We need more people sharing those stories because if it can happen
to a surgeon general of the United States, it
can happened to anyone and sharing those stories
helps lower stigma. You can go on there and share your stories and again, help normalize
mental health issues, help normalize substance use disorder, and help us overcome this problem. – We have time for one more question. – [Female Volunteer 2] This
has been touch on as well but multiple people in
the audience requested that you discuss some strategies that have helped health providers as well as policy makers,
at various levels, align multiple stakeholders
around a common goal, especially given the fiercely polarized political environment we’re currently in. – Well again, you have the power to convene, as leaders, just like I do. Bring people to the table. You have the opportunity to convene. The opioid epidemic
provides wind in our sails to have discussions about all
sorts of complicated issues. I was in Tennessee a few weeks ago, and Tennessee is the last
place you would ever expect to be a pioneer in long acting,
reversible contraception. You’re in the middle of the Bible Belt. They are leading the
nation in long acting, reservable contraception availability for people who are in jail. Why? Cause they didn’t talk about
long acting, reversible contraception as a women’s health issue. They talked about it
from the vantage point of the number of children who were being taken
away from their mothers because their mothers
are misusing substances. They talked about it
from the point of view of Tennessee leading the nation in neonatal abstinence syndrome. They used the opioid
epidemic as an opportunity to talk about other public
health interventions. And we need to do a better
job of riding the wave, if you will, that is there and having these larger conversation about community wellness, community health. The things that we all know will helps us, not only solve this epidemic
but also create a healthier, more prosperous society in the future. Other thoughts? – Couldn’t say it better. – No. (quiet chuckling) – So we’ll call that the last word. Thank you Dr. Adams. (clapping) – Can I ask a favor? I have a favor for you all. Who’s the youngest person in the audience? Anyone 18? Anyone 19? All right, all right. You have your phone? Come on down. (laughing) We need to get the
president to retweet this so we’re gonna do a
selfie with all of you all in the background because I
would love to take a picture with all of you all and
we’re gonna get a picture and we need to come up
with some sort of cheeky, not offensive, cheeky remark and tag POTUS and let him know that we’re
out here talking about the opioid epidemic, okay? – Okay. (laughing and clapping) You wanna just do it from like the podium? – We’ll do a selfie. – All right everybody. You ready? Let us see if we can get
all of you all in here. One, two, three. And then one more. One, did I get it?
– Wait, ya. – Okay. One. Oh, there we go. We got it, we got it, all right. You all are in there. Thank you very much. – I don’t know what to caption it. – I know. We need help on captions. What should we say? What should we say to POTUS? (laughing) Remember be nice. – I’m from Maryland so I don’t like, really know the best thing… – You know what, but the great thing about the convening today, is that whether you’re
liberal or conservative, whether you’re black or you’re white, we all can agree that we need to agree that we need to partner to
dig ourselves out of this hole that is the opioid epidemic. So we can say, “At University of Michigan discussing better
partnerships and,” you know… You all help me! (laughing) (crowd shouting ideas) – [Audience Memember] Join us! – Join us. You know, sharing POTUS’s vision. “@POTUS at the University of Michigan discussing partnerships – [Audience] For better health.” – For better health. – [Male Audience Member]
And don’t take pills. (crowd murmuring) – Great. – No (mumbles) – [Crowd Member] #IHPI18 (laughing) – Yes. #IHPI18 (laughing) All right we’re gonna see if
we can get him to retweet that. Put me in there too. Do @surgeongeneral (laughing) Go to mine, we’ll retweet
it, we’ll all get it going. Let’s make this thing go viral so that everyone knows
about the great work you’re all doing here and the great partnerships
you all are forging. Again, I’m convinced
John, that there is hope. We know that in Massachusetts they’ve turned around
their overdose rates. We know that in Rhode Island they’ve turned around their overdose rates and both of the health commissioners there are good friends of mine. How’d they do it? They did it with
collaboration and partnerships and you all have a great
collaboration here with IHPI. All of you all here today,
I mean it warms my heart as someone who’s suffered personally, my family is suffering
from the opioid epidemic. To see all of you here and
passionate about the issue, I’m convinced that if we really embraced better health through better partnerships we can dig ourselves out of this hole, we will dig ourselves out of this hole. We must. We’ve got to. There is no other choice. I’m the first generation of parents who’s had to look their kids in the eye, and say, you know, you might not live as long as I’m going to. The first generation where we’ve seen life expectancy go down
for two years in a row now. It’s now officially a trend I don’t want that to be
the future for my kids. I don’t want that to be
the future for your kids. Let’s do it together. (clapping) Thank you. Appreciated it. (clapping) – So Dr. Adams, in
appreciation for your vision, for your effort to come
through the snows of D.C. to join us today, for the success of your basketball team, we thank you. It’s really been great
to hear your perspective on how we can work
together for better health through better partnerships. It’s gonna take a community
wide, nation wide effort. This is a small token
of appreciation for you and recognition of your joining us today and I’ll note this is well
under the federal gift limit. – Yes. I’ll say. I appreciate that. – And to go with that,
we have one other token of appreciation, a pair of Institute for Health Care
and Policy Innovation, maize and blue, argyle socks. – Ah! I like it. I like it. Thank you. Thank you so much John. All right, who’s an Instagrammer? Which of my young folks
out there an Instagrammer? All right, get your phones ready. We’re gonna give a shout out to the basketball team too. (laughing) All right, you all let us
know when to get started. Say go. Ready? – [Instagrammer] No. – No. – All right, somebody give me the go. – [Crowd] Go. All right. John and I are here at
the University of Michigan talking about better health
through better partnerships and how we can combat the opioid epidemic but we’re also talking about
how University of Michigan is going to beat the pants off of the team that they’re playing in the
NCAA tournament later on. Go blue! – Go blue! (cheering and clapping) Thank you. We also have a token of appreciation for each of our other panelists. Dr. Khaldun
– Thank you – Know you’ll wear the maize and blue with pride.
– Yes. Thank you.
– Cunningham. – Thank you so much. – Dr. Brummett
– Ya. Thank you so much. – Thank you.
– And as we wrap up today we have one more part of the program that Dr. Brummett will introduce. Students from our School of
Music, Theater, and Dance. – You guys wanna come on down and get set up and I’ll introduce you? So if you’re heading out I
would strongly encourage you to hang out for just the next 10 minutes because you’re gonna see
something really powerful. As many of you know, we have the Precision Health Initiative here at the University of Michigan which is addressing health and wellbeing in our community leveraging
the breadth of campus. I’m proud to say that the first use case for the Precision Health
Initiative is around opioids and beyond just genetics
and precision medicine as we’ve traditionally thought about it, we’re leveraging the whole of campus and I think the ultimate
form of translation is when we translate medicine and public health problems to the arts. And I reached out to Vincent Cardinal, the chair of Musical Theater and Priscilla Lindsay the
chair of Theater and Drama this summer and said, let’s do something that gets ahead of this
and starts to speak to kids and teach kids,
critically middle schoolers, about the ills of opioids
and the challenges and the path that you can go down, such that they can, hopefully, avoid that first exposure or
that first challenge. We brought in some folks from the Families Against Narcotics,
they told their stories, to people who, probably by
their stories, should be dead, and then a couple of
parents who lost kids, and then a woman whose
daughter is constantly in and out of remission. And Peter Scattini, a
senior in musical theater from San Franciso and Jake Smith, a sophomore in musical theater major where both there and I will tell you, I’ve only seen these from
Kara Gavin’s Twitter account but I was moved, I was in a hotel room, and I was moved by these performances. And I think this shows the breadth of incredible people we have
at the University Michigan, and what we can do here to
address the opioid epidemic. There’s so much more
than medicine or policy. So with that, I’m gonna hand over. Thank you for coming. (clapping) – I’m gonna let Jake
start us off with his song but thank you for that introduction. This has been a really
interesting process for us. It was really wonderful to be able to sit with some of these affected families and just hear their stories as so that’s where these two
songs have come from is from hearing those stories
and then trying to translate that to something that other people could then hear and relate to. (piano playing) – ♪Picture frames, frame the old remains ♪ ♪of lives I forgot I knew, ♪ ♪ baseball games and missing names ♪ ♪ faces that (background noise
drowns out other sounds) ♪ ♪ Some cardboard boxes drenched ♪ ♪ (piano music drowns singing) ♪ ♪ My body’s sick, I’m shaking ♪ ♪ My mind can (murmurs) ♪ ♪ Torn (piano music drowns out singing) ♪ ♪ And my picture (piano
music drowns out singing) ♪ ♪ When she looks at me
and says you’ll be okay ♪ ♪ He smiles at me so honestly ♪ ♪ and (piano music drowns
out singing) softly say ♪ ♪ (piano music drowns out
singing) it is what’ll be ♪ ♪ clearly some problems, bad history ♪ ♪ to smiling in his dad’s old corduroy. ♪ ♪ So why do I not recognize his frame. ♪ (Piano plays) ♪ (piano music drowns out singing) ♪ ♪ You took a chance ♪ (piano music drowns out singing) ♪ You see time passes through these ♪ piano music drowns out singing) ♪ Now he looks at me
and kills me softly. ♪ ♪ He smiles at me so honestly ♪ (piano music drowns out singing) ♪ He has no idea what
he’ll become through me ♪ (piano music drowns out singing) ♪ of problems and bad history. ♪ ♪ Smiling in his dad’s old corduroy. ♪ ♪ And I buy that, I
start to hate this void ♪ ♪ inside my chest and I pull
out those old Poloroids ♪ ♪ And watch as they drape
from my hands to the floor ♪ ♪ (piano music drowns
out singing) and I feel ♪ ♪ that I need my fix or (piano
music drowns out singing) ♪ ♪ trying to (piano music
drowns out singing) ♪ ♪ scrapbooks and books
filled with scripture ♪ ♪ (piano music drowns out
singing) all on the cat ♪ ♪a small box, a small box ♪ ♪ and I lift my arms and
imagine the high as I cry ♪ ♪ in the ♪ (piano music
drowns out singing) inside. ♪ ♪ And he looks at me
asks me if I’m okay. ♪ ♪ He smiles at me so honestly as I think ♪ ♪ (piano music drowns out singing) ♪ ♪ Thank you for gathering
to honor my son. ♪ ♪ I still imagine you’re a king ♪ (piano music drowns out singing) ♪ in his dad’s corduroy. ♪ ♪ I can’t express how
much I miss my boy. ♪ ♪ And I look at him and
tears spill from eyes. ♪ ♪ My heart beats fast
and then I realize, ♪ (piano music drowns out singing) ♪ She said they’re waiting,
expecting the call. ♪ ♪ And I curse the day (piano
music drowns out singing) ♪ ♪ How that dream filled
boy became this man. ♪ ♪ And I start to
recognize that corduroy, ♪ ♪ And pray someday I’ll
be more like that boy. ♪ (piano playing) (clapping) – And then quickly before
we hit that second song, first I want to say Jake wrote
that song entirely himself and then the second song, I
want to give a little shout out to Noah Kiserman who I wrote this with. He’s one of my classmates
who couldn’t make it today but the way this song is written
is from dual perspectives. First from the son, the
person afflicted by this and then from his mother’s
perspective coming back. – I know I look like a mother. (laughing) ♪ Oh I’m going down, ♪ ♪ I’m falling apart ♪ ♪ I’m starting to drowned, ♪ ♪ I want a restart ♪ ♪ The feeling’s familiar, ♪ ♪ I’ve been here before ♪ ♪ I struggle in silence, ♪ ♪ but not anymore ♪ ♪ ’cause I found a cure, for the blues ♪ ♪ I know that Percocet,
(mumbles) or Xanax will do. ♪ ♪ They’re not hard to
find, just takes a lie. ♪ ♪ Doc there’s an ache in my back ♪ ♪ in the base of my spine ♪ ♪ And soon I’m slipping away, ♪ ♪ all at once I’m
forgetting a horrible day ♪ ♪ And all that’s upsetting,
and I’m free from the fear ♪ ♪ And I’m free from the sorrow ♪ ♪ And God’s in my hear
saying face life tomorrow ♪ ♪ But for today, ♪ ♪ I’m slipping away ♪ (piano plays) – ♪ I meet every (piano
music drowns out singing) ♪ ♪ I’d show that is me (other
sound drowns out sound) ♪ (piano music drowns out singing) ♪ if it weren’t for me
and as for the pain ♪ ♪ my day turned (mumbles) ♪ ♪ That was the start of (piano
music drowns out singing) ♪ ♪ reach you, I say ♪ ♪ I see you slipping away ♪ ♪ Can you hear me, I’m calling ♪ ♪ I’m here for the catch ♪ ♪ once your feet start to falling ♪ ♪ You’re mother is here I (piano
music drowns out singing) ♪ ♪ – I can feel myself falling ♪ ♪ I’m too weak to keep calling ♪ ♪ God the fever’s not breaking ♪ ♪ And mom I am shaking ♪ ♪ Please make it okay ♪ ♪ I’m slipping away ♪ ♪ I’m slipping away ♪ ♪ I’m slipping away ♪ (clapping) Thank you very much. (clapping) – So I want to thank you
all for coming today. I especially want to thank Dr. Adams and his staff for coordinating his visit. Getting that last flight out of D.C. last evening, which we appreciate. I want to thank the IHPI staff who planned and organized today’s event and I want to thank Peter and Jake for their moving performance and sharing that with us. So thank you very much and please join us in the reception outside. (clapping)

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