district attorney marian wright thank you for turning into this edition of middlesex up today we're going to be talking about a topic that's gained lots of attention both across our state and across the country and that is the use and abuse of one of the things that we know is that this is a disease that does not discriminate and that's why it's so important to be having these conversations to learn the signs of abuse to learn how to protect yourself and your loved ones from this epidemic and to give a sense of the issue was we were pointing that as of november eighteenth of this year troopers assigned to my office have responded to a hundred and seventy fatal overdoses across middlesex county of that one hundred  thirty of those have been confirmed as involving the use of heroin and that's a significant increase in what we've seen in prior years and that's led us to realize two things one is that the old ways we've had of dealing with these problems are not effective in dealing with this abuse and the second piece is that in order to be effective we really need to take a multi pronged approach middlesex county that's what we've been doing for a number of years now we're focusing on all fronts we're looking at education prevention intervention treatment in force meant and legislation partnering with folks bringing a different perspective who can help us to address these issues and sworn ng i'm pleased to introduce my guest dr brian o'conner on my left the president of middlesex recovery in the middle chief mike murphy of the north reading police department and finally on the end senator jason lewis the the chair of the joint committee on public health thank you all for joining us today before we start talking about some of the approaches we've developed in middlesex i think it would be helpful if i've us can learn a little bit about where you are and how your work inter about five thousand babies that merrill's wakefield hospital but the parent of an addict and over time my interest grew in addiction and about six years ago i became board certified in addiction medicine and practice ninety percent of my time in addiction medicine cheaper fee obviously for the police department a lot of the cases that we see have some roots in the addiction but you've been really a leader in some of the efforts that we've been doing to address this before people get involved with the criminal justice process in prevention and intervention so tell us a little bit about north reading the department you work with that good morning and thank you for having me money's mike murphy on the police chief in the throwing in the police chief for three years now i've been  overdose back in two thousand and six so experience support on the personal front on the professional front as well so we're we're as you said you know we're seeing this back again from in two thousand and six  and to see it back again remember it's ugly had ten times over you know it's really really is very concerning for us as a police department but but the collaboration that wasn't there ten years is there today so there is hope thank you and senator obviously in the legislature you have an opportunity to work on some of these issues so we've partnered with our office often on some legislation and also to see among your constituents the way this epidemic is affecting folks and so tell us a little bit about how you've been prioritizing that and working on it sure well good morning and great to be with you all on this panel and i want to thank you dear ryan for all of your hard work and  your leadership on the on combat ing opiate addiction and substance abuse it really as you said it there's no unfortunately easy answers and it thinks collaboration among law enforcement health care providers community  organizations and policy makers my work is both in the in the local level the district i represent which is the fifth middlesex district malden melrose stoneham reading wakefield in winchester and we have very active substance abuse coalitions in our communities working with schools working with our local law enforcement and health care providers and those are very important so i work closely with them and then at the state and the policy level i'm very pleased  have we all are rowing in the same direction so from governor baker to attorney general general healey to lawmakers i think we we're all focused on what are the solutions that we can we can put in place  and and i think we're making some really good progress there's legislation that the senate has passed already this year and the house i'm sure will be coming up with their version in early next year so i think the legislature and the governor will you know w now can you as an addiction specialist tell us a little bit about the difference between those and how they figure in this epidemic well i think to give a good explanation for that you need to start from the beginning you need to start with the poppy plant so  most or all opiates will come from some derivative from opium so if you were to take a poppy plant and take the seed pod and dry out the c pod and make a slit in it a brown liquid would come out and that brown liquid it is called opium now opium contains three main components the first component is morphine morphine is named after morpheus who is the god of dreams so we even back in one thousand years ago they knew that this substance did have some psychotropic effect or affect the mind the second is code in most patients i've heard of coding or in coding is found in protocol tunnel number three as well as in cough suppressant and the third substance is something called  is a substance that's in opium and one of its derivatives is beeping or fin which is what is found in suboxone which is a very common treatment option now those three things are called opiates because they naturally occur from opium produced first of all heroin was a missionary discovered in the late eight hundred as an alternative to morphine because they thought her would be left less addicting what you do to produce heroin is you take a morphine compound and you add to a seattle groups which are chemical compounds to it so it is something that's produced from the compound morphine now up until two thousand and four eighty of the ninety percent of morphine was produced in open opium from afghanistan but in the last ten years mexico has become a very large producer and what about that now that mill is completely synthetic now the interesting thing is when you measure how powerful a  as it changes hands it's continuously diluted down and so they will add fat milk to it to increase the potency of the heroin the problem is that the fed mills not even the distributed throughout the heroin so many times someone will think that oh i got my hair one from the same dealer i'm sure it's the same thing when actually it may contain more fat milk which is what's causing many of the overdoses now when the typical road of addiction as you've seen it includes something beginning with opioids cracked in correct and progressing through correct and how often have you ever seen anyone going backwards well it's the typical pattern when i interview patients is that i ask you know when do you from a pharmacy as opposed to heroin that comes from the field of afghanistan in mexico most patients because they start with percocet they will continue it for several years usually but eventually the cost of percocet which is about five times more expensive than heroin will cause them to and this will use heroin now when they use heroin they'll use it internees allee or what they call snorting at first and then eventually i v the potency of heroin is about three to four times more than so very rarely does someone retract back to percocet from the effect of heroin but also because the cost of purpose and chief if the prescription opiate abuse is really what we're seeing is sort of the gateway to heroin and is i'm sure you know and over the course of our careers and learned first you seen the price of heroin declined steeply so that now you can buy a bag of heroin five or six dollars on the street compared to the price of the opiates when you talk to us a little bit about over industry that you know for who are we prosecute there's hundreds more want to step in so we have that strategy but we're also working on the strategy to lessen the demand because of the demand isn't there then the supply essential to move on to something else so we continue to work with our law enforcement partners on both the federal state and local levels our officers are on several different task forces but again we do work on the prevention the treatment the referral services to combat that same problem and you've been doing a number of things in terms of collecting things right the drug drop off boxes which we find with the forfeiture money the collection of those sorts of things that we people about getting getting those drugs out of their house in the first place and that's part of the whole prevention process winning the access availability to you know not knowing just young kids but elders as wall so we do have a twenty four seven drop kids a significant amount of use of the message is getting out there the senator i know you are very involved with your communities the constituents in your community who may be experiencing these issues as well as the elected officials that are dealing with them on a municipal level but can you tell us a little bit about some of the barriers that communities are facing in dealing with these issues than well i think just how how pervasive it is and you said at the outset how substance think we understand that we need to start with education prevention very early even in our middle schools certainly in our high schools and some a lot of times with our students you know they are precursors to using opiates they start there using tobacco alcohol marijuana is very widely abused and you know that's unfortunate start some of our teenagers down that road so i think it's just making sure that we've got very strong collaboration across you know our schools our parents our local health care providers local officials you know all working to try on the prevention side because as you said at the outset this is an illness and the best way to treat the illness is to prevent people from going down this road in the first place and so i think the more we can do in that area and the more we can make sure that when somebody does need treatment that that the continuum of care is available so starting with the talks but also step down services and recovery supports we need to make sure that full spectrum of of treatment is available today we know that that's a challenge and when somebody is ready to seek treatment we can't have them waiting  n that window of opportunity can close very quickly chief traditionally those experiencing these issues associated with addiction or even their loved ones we're probably not likely to be reaching out to the police department for help and is a police chief in serving in a leadership role in the middle six chiefs of police organization what would you want people to know about the different ways that we are reacting to it as this year's was is members in this panel of opiate addiction does not discriminate as a police department we're continuing to work on breaking down the barriers of people wanting to not want to reach out to us you know we play many roles in society and foresman certainly is one of the people typically will think of us as arresting people and giving citations out but all part of our role is to improve the quality of life for everyone so it's important for us in family members that are experiencing a loved one who is addicted to reach out we have the resources to at least give referrals to get them into treatment if necessary we are collaborating with with many different names your office as well as agencies in the health care field so it's important for them to reach out we want them to feel these comfortable it's not the easiest thing because they think that they're going to get in trouble get arrested and that's not the case at all if somebody comes to the police twelve for help i don't know of a police officer that would help and you know putting them in jail is not going to help so certainly we are looking to finance that and i have as i said before i've seen on the both the professional and personal level i've seen too many lives destroyed too many families torn apart and you know we if we can somehow someway get to them at the early stages certainly we have will not get help even if they found help for them they won't go can you talk to us a little bit about what some of the physiological or mental barriers may be to getting that help well it comes on multiple levels if you think first the patient itself in order to seek help you have to admit to yourself that you have a problem and so in the many in the early stages of addiction many patients will think that well it's not the particular problem that i have that i can stop any time i want so i think the first is that the patient or the individual needs to admit to themselves that they have a problem and that can take years before the patient or the patient see me or the person would mitt that the second is the stigma associated with addiction many patients do not want to have an electronic medical record that they have addiction that they're on these medications i hear multiple stories every week of patients who end up in emergency rooms and the they're getting great care until they list the medications are on and they mention they're on suboxone or methadone and immediately their care changes so i think the stigma of addiction which is starting to get more mainstream needs to decrease for patients to access care because by accessing care you're den a find to the rest of the world that you have this problem and the third is the availability of care there are multiple levels of care that are available but many of them require that you go inpatient many require that you go daily or in the case of suboxone that you go weekly there are waiting lists for this care it's one of the few or only medical conditions where there's actually a waiting list for care and the other is the  cost of the insurance side of it many insurance companies are passing so much of the cost of care back to the patient the form of co pays and deductibles that while the care is available it may not be financially feasible for the patient now senator there's no question that this issue has gotten everyone's attention and the legislature in massachusetts has been very forward thinking and launching lots of forums i know you've been doing lots of forums and discussions in your communities how do you think that not only has raised the issue but is working to change this stigma that people attach so it's such an important point and that dr connor raised and you're raising here is the stigma that's attached to being seen as a junkie is one of the main reasons people are not coming forward in getting treatment and one of the reasons that their family members don't talk about it and they want to it's they see the shameful i've got to keep it you know under wraps and we have to change that we have to see this is you know if you have diabetes or you have heart disease you have cancer you're going to come forward and get good care and get support from your family and from the community and it needs to be viewed the same way i think we are slowly changing that i think the conversation we're having here the conversation in our communities i know our substance abuse coalitions in a local communities are doing great work in this area and i want to also give a shout out to the governor and and our department of public health which folks may not know just launched a almost a million dollar public health campaign and it's called a state without stigma with the state and stigma is m a clever play on that and that's going to be rolled out through billboards radio advertising social media and again the message is that we don't stigmatize substance abuse we understand it's not a choice it's an illness and we need to support and help people to overcome that get them into recovery and support them through that in their family so it's slowly changing but we have a lot of work still to do as part of the hospital based task forces which we've been operating in these issues that you've been an active participant and one of the things we've been doing is these mobile policy forums where we're bringing folks who are in recovery to talk about some of those things that i think is you are one of the things we hurried which was very compelling was the the way in which people are treated differently even in the emergency room when they first respond perhaps after being revived with  want to add i think the more that people out there can hear the stories of those in recovery they are very inspiring i mean every time i listen to someone in recovery and how what they went through in the end you know in so many cases near death and what they've done to fight back from that and that travel that road and in many cases you know the good all the good work that they're doing and leading a productive life now i think is i find it inspiring so i think more the more people hear that the better does that progress well treatment is a continuum of care mean there are multiple different levels of treatment and if i would to use a typical patient you'd start with detox and the most important message i want to make from that is that detox is not treatment the truck detox is an entry into treatment so i'll see patients and ask them how many detox programs they bent to and they'll go fifty sixty seventy detox programs it's not treatment but allows an opportunity for the patient to access treatment there are there are multiple different programs available throughout the state that the oldest one then and really the gold standard for the longest time was methadone methadone is a medication that you take every day and it's in the clinic based setting meaning that the methadone clinics are chartered by the federal government and typically a patient would come every day in the morning to receive their medication methadone is a dangerous medication and initially at least when someone gets on the medication it's not given the patient a take home but that you take it every day a newer medication that's out probably in the last fifteen years is called suboxone suboxone is available in the office space setting in that case you receive a prescription the prescription is filled at a pharmacy and you take that medication once a day or twice a day depending on what your needs are there are other medications out there called  a type of medication that's given in oral tablet tablet initially and then an injection once a month and that's an opiate blocker that prevents opiates from using should you relapse there are multiple settings for care as well someone may start out in a residential program the residential programs can last thirty days sixty days ninety days they may transition from that to what they call a t s s or a c s s which is a much very controlled living environment and in recovery community eventually the halfway houses sober houses and then back into the community chief just for me and we so it's perspective can you tell me how the police departments are adjusting and we allocating resources to deal with some of these issues and certainly it's a significant impact on our resources i would see crimes related to opiate addiction and also medical calls overdoses hyacinths rates so it certainly has changed our ways what we're trying to do in changing our strategies is to follow up and have some intervention after the talked to offices who administer knockin you know we don't have that ability to get them to the hospital so at that time is probably not the time for us to intervene we try to give resources to families because without their family support this you know they're going to be operating in a vacuum in for us we need to get that word out that we do have the resources at least to get them to the professional help that they need so we're changing our strategy strategies know as we all know there's no one answer to this problem so we need to continue to find solutions and work with people that are in recovery to find out what's worked best for them in try to relay that information as much we can to people that are trying to recover well senator obviously there's been a lot of it by different groups to bring legislation to you and you've been reviewing those and looking at different pieces can you tell us if you're seeing some common themes  beriah for that so that's in place already we just passed it in fact on the governor's desk is a bill that would criminalize trafficking in fentanyl we talked about how dangerous fentanyl is so that will be that will help our law enforcement in terms of prosecuting those trafficking cases and the legislation that's on the move now the senate has passed the governor has put forward his proposal the house is really focused on prevention so for example doing more screening in our schools to identify student kids that are at risk and then really working to reduce the number of excess pills that are in circulation reducing the size of prescriptions that are written giving patients more opportunity to to voluntarily cut back the size of their prescription having pharmaceutical companies take more responsibility for take back programs our police department to be doing a lot of that work already but the we think the pharmaceutical companies have a role here so really trying to take a lot of these bills that are ending up in the black market and you know and not letting that happen so there's a lso strengthening the prescription monitoring program so we can identify individuals who are at risk or prescribers who may be irresponsible and so i think we will end up with a comprehensive legislation i think early next year and that will continue to support the efforts of o be concerned about somebody they someone they work with about whether they have an issue whether what and what can they do so what are they looking for to see if there is an issue if there is wind what's the path that they should strike down well i think that an open line of communication in the family or in the social unit that the patient is in is the initial step you know i've never ever received a phone call from a parent saying i think my kid is using drugs which i'm always shocked by i get hundreds of phone calls that my son is overdosed or that i found this paraphernalia in my son's room or my daughter's room but i think that reaching out to health care providers early most addiction begins in the teenage years and so that's when children are still seeing the pediatrician so open communication with the pediatrician about what's going on with their child changes changes in their academic performance changes in their social structure new friends new activities that aren't always as wholesome or as it's different than what the patient or the child used to do i think accessing care locally i talk to patients the first thing i'm going to do is send my child to florida to a thirty day program that cost twenty thousand dollars when they're just going to return to the same environment they tell people you have to change your friends and change or your acquaintances and that's very difficult so i think having an open line of communication and starting with your primary care doctor starting with your pediatrician and eventually ending up at the addiction medicine physicians unfortunately this has been a great conversation but where the time i'd like to thank my guests today dr connor chip murphy senator lois and as we go forward we hope this