hello my name is lisa gable area and i am the co director of the belmont health collaborative one of our missions at the belmont health collaborative is to bring conversations to the community of pressing concern tonight we will explore the opioid epidemic and i'm joined by a distinguished group of gentlemen who will delve into this topic from various angles various perspectives and i'll start massachusetts and nine hundred and ninety and been twenty six thousand meetings here in massachusetts since then and i have facilitated over three thousand of these meetings great thank you all for making time out of your busy schedules to address this important conversation i guess i'd like to start with professor mcauliffe in just raise the question how did we get here not a day goes by where this topic is not covered in the news so if you could just give us a brief overview of how we got to this epidemic where it is today thanks i think it helps to start with a little treatments and this was one way to deal with people's pain it was also in patent medicines about the early part of the th century we pass some laws that  reduced the number of prescriptions dramatically and eliminated opiates from patent medicines and the problem of medical addiction which had been a major public health problem diminished to a relatively minor problem that was seen in small clinics and in pain clinics then in one thousand nine hundred and eighty there was a paper published in a new england on some acute care hospitals and addictions whether it's for tobacco or caffeine or alcohol or cocaine or opiates almost always develop patients they organize a group of people to lobby state medical boards and joint commission and a variety of other organizations and one of the things that they did is they had a program for developing pain as the th vital sign so when you go to your doctor's office and there's a little smiley face pictures of people in pain or smiling because they're not in pain that's a result of this work in any of that as a result of this the m number prescriptions began to increase at st rather gradually and then in one thousand nine hundred and ninety six there was a rapid increase and unfortunately the pain doctors and proponents did not realize that along with increase of all these prescriptions came a lot of adverse effects it came up a little later they didn't show up right away but eventually there were babies that were addicted there were overdoses it showed up in continued until two thousand and eleven and at that point efforts were made to reduce the number of prescriptions and i actually the number actually went down however just at that time  many of the newly minted prescription opioid users switched to heroin and that's where we are today we have a problem of both heroin and prescription opioids although  research suggests that prescription opioids are still used more often than heroin and the number of people who are addicted to him is probably about twice as great so that's where we were and that's where we are today and that's why we're here tonight to talk about this problem thank you so i'm going to turn to our assistant police chief here tell us a little bit about what you've seen here in belmont what trends you've seen just what what your staff is addressing so we see you know almost like any other community there is and you know a gate that keeps these kind of things up and we've seen you know we had from a time period of about twenty six months we had twenty overdoses that included six fatalities in that group that's one way we see this in our offices get to know some of the people some people have overdosed that causing the you know the high and they come off it and depending the person then has to be transported to the hospital because from where i stand what i'm told the narcan can only last so long and that person could relapse into their overdose but you know we see it that way we see we've dealt with in two thousand and thirteen we had a rash of home breaks in those individuals who were eventually caught in sudbury and they were who were people lobby to drop off you know prescription drugs no questions asked and i can't tell you how full that box gets and you know we also we also work on the enforcement end of it was you have an officer assigned to the detective assigned to the the person the people that might be selling are usually using themselves and what they do is they get the drug fronted to them and they call up three of their friends who are using drugs and they'll sell to them to make up what they what they purchase and you know it's a constant battle and you just hope that maybe by it differ interfering with the my little bit you buy somebody some time that might have not you know might have been in line to i get nervous with the with my own children and what they're exposed to thank you i do hear parents talking about the availability that there seems to have been a shift in the availability of of drugs and that the price is gone down can you speak to that phenomenon at all well i don't we don't we don't want to jinx ourselves so we don't see it really at the high school level tends to be people in their in their early the late twenty's tend to be more of the people that we interact with in town and you know just going from what i know is the percocet the prices had gone up then i think they got very difficult to get hold of and i think that's when a lot of people in in this area then made the move to heroin you know they usually snort it st and move on from there and it's it's a regional it's a regional problem i said i was talking to a couple of panelists before the show and they had i think two overdose deaths in in watertown and we had one in belmont within the same week and they were able to identify that this you know probably was the same person who was supplying these these individuals and they they think that it was being cut with think everybody's taking a different kind of angle to it and they realise that this is you know one of the one of the things you find is with you know i interviewed people in prison above what they were doing and you know in good people and they struggle took over i'm it's almost always reminds me of something out of science fiction you know that did you lose that the urge to get high again and when they're caught you know my my drug officer tells me that one of the st things they say is please don't send me to rehab you know i want it you got to get that the next time you know well it sounds like there's a multi level approach to tackling an issue is police officers we you know not in the bible police department or the other police recovery options but st i'll turn to pete thank you so much for joining us would you like to share a little bit about your story and specifically what got you to recovery and a little bit about your journey you know i just like most of the people that we're talking about here you know it's also started with prescription pain pills you know i was always a drinker and one but the once i got my hands heroin you know i'm a former i v drug use and been to countless detox programs and on probation for years and you know a lot of a lot of heartache a lot of torture and my family tortured people that loved me but you know i was afraid train there was nothing that anyone could say or do is stop me you know friends of dying next to me you know  dying while i was still out there and it didn't seem to you know to do anything when you would ask me before you know like what what got you in before we started this year what did you know what was the turning point i mean the turning point was i was finally done you know my family stopped talking to me i was and this was unable to see my niece my god daughter who you know who was the only one around at the not everyone gets a chance like i got you know and so that's you know that's why i try and take this seriously and you know i went for years with oh you know just doing my thing going to meetings you know trying to help some people in the program but up until recently you know the only reason that i really made my story public is just so that someone you know hopefully someone can see that you know you don't have to suffer  silence you know my family my brothers my parents you know all that all that hell i put them through you know the the sea now that you know i came out the other side that's all they care about you know what but but even watertown overcoming addiction you know i had gone to them and said look you know if i do this then i'm out you know i'm out there not that i was ever hiding it not that the town and my friends and families families that know me didn't know that i was clean and that i w used to do but if i come out and do this then you know this is you know this is going to be a public thing and you know just like when i was hurt and coming out of there last detox they were supporting me  so you know that's that's the reason why i made my story public and that's the reason why i say yes to mike i mean he could probably ask me anything i'd do it but but you know to come and just to let people know that look you know i'm born and raised right around the corner and you know this you know come from a respect respected family and you know two brothers who never had this issue and friends who have never had this issue and you know it can happen to anyone  for that pretty much why i'm here well thank you graduation six years tonight today wow well we're so grateful that you could share your story with us and we'll i'm sure will we'll bounce back but let's turn to mike right now and please share with us your many years of experiences yeah i guess what strikes me as very interesting is that since the beginning of the recovery movement in one thousand nine hundred and thirty five with alcoholics anonymous buildings about a one thousand people trying to stay clean and sober and live a transformed life and so what's been happening in the last thirteen half years is that since i've been there we've also had more to do with each other than happens in most of those buildings and so the the lines that have existed for a long time between up stairs down stairs have begun to get a little fuzzy and so folks in the twelve step meetings know me and i know some of them and what that's led to has been a remarkable opportunity and a great privilege from my point of view to accompany people like pete and others and not all the stories or pete story as he said not everybody makes it and so some of those some of those overdose deaths i've done the funerals for and so not every day is easy for that community and and not every day is easy for what we're trying to do if we're trying to be allies of people who are who are battling their addictions and trying to live a new life i see people one person at a time with with very different stories than this a guy and know who who once said to me he was active addiction for twenty years and he said i made a list once of five things that i would never do five things that i i knew i was doing a lot of stuff this disease was making me into some bad and want to be but there were five things i promised myself i will when i crossed off number five i went to my st meeting and he's got five years now but he said i promised myself i won't sink this low this disease won't do this to word we usually use there's great shame but there's also an amazing welcome that happens when people finally come through the the doors and command of the halls this guy and no more town who said he walked by the church years he said your parking lots always full i knew what everybody in those cars was doing in your basement but i just didn't i wasn't ready they said when i came in the st night i found there was a folding chair with my name on it that had been there for years and none of us to judge which one it is for any of us but another chance and a new start and so that's what i've encountered over these last thirteen a half years in the work that i've done as a traditional minister but then increasingly as somebody who works with with folks who are in recovery great thank you and dr kirsten could you share a little bit about smart recovery with us sure i want to start off by saying that i spent a good part of my career as a pain management consultant and people should understand that discerning who has real pain and who doesn't is very very difficult proposition and one of the real tests of the art of was prudence in some situations but is a very difficult thing to do to really be sure in any case in any objective sense what what what is really the intensity of someone's pain manufacturers who are always manufacturing something with a new twist always bringing it out saying this is unlikely to cause addiction starting way back with them or all which was supposed to be free of addictive capacity  maliciously eventually came to grief with the federal government and the justice department but really much much too late over thirty billion dollars of it has been sold and it is really a wonderful machine for addicting it was supposed to be used in certain limited circumstances and was promoted for any kind of pain and because doctors loved it as well as patients because doctors hate to be called on a saturday afternoon saying the my prescriptions out and the pain is intense and some some of you will know that that kind of a drug an opiate drug crimes are written prescriptions so you can't phone it into the pharmacy and so forth so physicians tend to overprescribe it so that they won't get into that predicament that they have to provide in a weekend or a night of something like that and then the whole communication system is complicated because unlike you know fifty years ago when a physician was pretty much on twenty four seventh's so he or she knew all the patients and they had to make a direct contact now everybody's covering for everybody else and so there's the potential there for manipulation and and  peculiarities and so forth that lead to poor communication now we have as you know universal almost universal system of being able to track prescriptions for various venue tends to show that that much of the of the malignant use of opiates is borrowing from people and stealing it from grandma's medicine cabinet and so forth and so on and so we're in a really a morass and that in that respect now in terms of getting people out of it as i say i introduced spot recovery to massachusetts in one thousand and nine the that time they were only thirteen that only twelve other programs in the country with a thirteen i never intended to get deeply involved with it because i'm an internist and i just wanted to see an option for the people who have gone to twelve step vote with their feet and i was very frustrated having people who i always pushed to try to push a twelve step program so i mean that was the only thing i knew when i was taught but there are a lot of people who just recalcitrant it was for one reason or another pushing towards the two thousand meeting mark of my recovery meetings so obviously it is available options almost all done by volunteers much like twelve steps i'd say ninety percent of the program is run by  very emphatic about this he said a doesn't have a monopoly on how to get over an addiction and he said it in the big book and he repeated it several times in the great fight and we were in the same area of interest seventy five thousand registrants on our website they can interact they go to meetings they can interact on chat room message board things like that so it's part of the modern communication and social media revolution great thank you so one question that that i've encountered in talking with people in this community is how do i know how will i know if a family member co worker teenager is struggling and i'm wondering if are there any signs that folks should be on the lookout for or is it can you help can you shed some  light on that and how we know if somebody needs some help if we need to send them to smart recovery or to the basement of the church of the neighborhood church or you know so so i wonder if any of you it's open to t know with far from the family like kind of the family unit not want to do the you know do dinner with the family not want to you know but maybe lose an interest in sports changing friends you know that all you probably got a for a reason you know and that's the way i would look at it and that's the thing for me to speak of all kids i mean i don't have any kids of my own i'll compete you know but you know if i had had experience with you know a lot of friends and a lot you know friends of the younger siblings that you know because i'm in a position now where people come to me which is still strange to me but but you know that if you have a bad feeling there's probably something going on you know it's just how you approach the subject is what's really touching because especially young kids and especially myself i was invincible and i knew i knew everything a lot better than you did you know so it's it's tough to get through  ok thank you it is there support for family members out there is well for what we have recently but i think we have a recovery it's run by a board of course it's a partnership between peers and professionals and so about five years ago we started much like twelve steps on the need for a family group so was my recovery what we call a science based program and we use a scientific program called craft community reinforcement and family training to be the basis of the crux of this program it's called family and friends as a meeting every saturday nobody forces once in a while some yeah i wasn't that big a deal i decided to go and i went i said well how long did you think about maybe going before you went oh i don't know yet so this is not an easy thing to do to walk through that door i guess it's a knowledge meant of a horrible fact and so it's a difficult thing to do but there are ways to help people do it with positive reinforcement and that's what this kind of meeting is about  ways that we are trying to be supportive allies to those who are addicted is crucial but also everybody in their circle who loves them who they love and yet who now has no idea what to do or or how to be helpful or they're worn out and they're tired and everybody has a right to all those stages of that that process but whether it's al anon or narayan or learning to cope or grasp which helps families that have lost children died of overdoses there are a lot of options out there but i think what's key is for any of us regardless of what our role is academics you know public  officials regular civilians whoever we are it's to realize that the families of people going through this are no longer somewhere else in some other zip code or some other class or some other demographic the families we're talking about are our families and the families in our workplaces the families their houses of worship the families next door and i think if nothing else comes of the recent attention given to this that's one of the most positive things that  people i think are increasingly now walker imagining this is something from somewhere else that only affects somebody that they've never met when we had an event in watertown in september that pete and some others organized for the to remember the nine people who had overdosed by that point and then within that week there were ten three hundred people came out because they realized that this was a moment for them to offer support to families that were that were  families that were just like them and when you mention the six overdoses velma and there are similar numbers in our elites and waltham and just across the board this is no longer somewhere else it's people we know of people we care about and i think we're all learning how better to support one another great thank you professor mcauliffe what have you what has changed in the last few years that you've seen as far as addressing this  just academic standpoint are you seeing in the field that medical students are being talks to trained differently what anything well let me say that in my judgment the amount of training it dictions in understanding addictions is willfully inadequate and has always been that way it's interesting that a pain management person and an addiction specialist get to see the problem of two different times the pain of outage meant person sees that when the prescriptions began the addiction person gets to see it when the problem has resulted and let's say the pain management can't really handle it anymore and they end up in the fiction recovery program and so we are as a pain management people were saying that this is a rare thing addictions people were saying this is a hidden epidemic it's a main problem and when you look at what happens when you have an enormous amount of drugs out in society you have young people who start using drugs for fifty years they would begin by using marijuana for a while there they were starting off with prescription drugs anybody with any experience knew that that was going to result in a major epidemic of prescription drug and heroin problem was it was really obvious when when kids are beginning with opiates rather than starting off with their traditional softer drugs you know that there's a problem when the number of overdose deaths is higher than the number of traffic for that fatalities in the country you know something is really different or if you turn on television and they're advertising some a drug for dealing with constipation due to opiate medication and you say to yourself what does opiate medication occur that often that they can sell drugs  dealing with the constipation that it causes that tells you that the st step in prevention for youth and for the whole society is to get the number of drugs down there too many prescriptions th writing for too much i think it's already beginning to happen but i would start right there medicine has to police itself it has to look at this problem and think more clearly about how this is going to happen when you have large number of opiates out there there are going to be overdoses there's no way to get around it and they're going to be people who get addicted and people who end up in treatment emissions and end up in emerge rooms and they have addicted babies there are a whole range of things that are going to happen because there's an enormous amount of this drug being consumed and that's what i think really needs to change and i don't really hear anybody saying you know that medical students can really do much about that i think those are policy does not need to be m he told me the story that he and his girlfriend and another couple are driving in a car they were probably drunk i didn't ask when off the road cut kicked over and spun over and they all got banged up bruised but one the hospital with a prescription for one hundred dollars oxycontin by the time this episode was over us for for these young people in their early twenty's who are hooked on heroin i mean there's nothing to do in this case you don't want to be bothered all the time but we know it and so forth so yes it's a person gets rid of them and probably doesn't even know has no idea what what kind of h about it went to my family where i know the fam assist i said just give me a dozen she's not having that bad pain she's really stoic and so for the said well gee you know you can't get this renewed over the phone so the pharmacist gave me an bias is to it's to minimize this nagging irritating demanding kind of attitude patients about getting these pain medications and th anything and then you have to chase them over the weekend to try to get something now it's going in the opposite direction overboard so they they overprescribe they give you too many pills and so i think the balance has to come back i've only been asked twice but it's been in the last six months as lisa knows my kids are in their late teens early twenty's i've had two parents ask me that had their children had their wisdom teeth and was sent home with thirty percocet on the rd so you know should i medical quality assurance it's the reason they showed just this good result with ibuprofen in these kind of post surgical cases and it's with opiates and yet this is this is what we call it a class is the conversation that parents are having with each other about pain medication for their children and what i've advised parents is to have that conversation with for scribing physician i heard of i chatted with a mom recently who whose child had a tonsillectomy and the script was for tylenol with coding and the kid was pretty miserable and she was just she had neglected to give back and gave the regular tylenol and my advice was to talk to the physician because again the balance that you gentlemen are speaking of you don't want to a five year old writhing in pain on the other hand you don't want to you know abuse thorough with dr you're old enough  could say the name because of the front page of the wall street journal but i won't institution academic institute and the length of stay for hysterectomy it was five point two days that's atrocious  i think children the five year old shouldn't they shouldn't have the medication anyway it's something a parent to control the medication and provided to the kids and even for teenagers there plenty in the literature of the chose that they divert they take their medication but they also often give it to friends and their friends misuse it or they misuse it themselves so the parents have to act exercise control over anything that has an addiction potential say well i think one of the things that seems to me it's important about this conversation that we're having here tonight but also more generally now in communities around the country is that that just the questions we ask about who to have conversations with and when what's the right time the fact is it's always the right time whether it's with the physicians whether it's with kids whether it's of the other family members whether it's with ourselves and my more depend on this than i thought i was  there's a lot that can be can be done at that stage of the process in the middle years when people are active in their addiction there's still stuff that can be done and so so there's there are groups and organizations and possibilities for that most of the people who wind up in a setting like i'm in have already lost a great deal in their lives that their families their jobs themselves and their they're really starting over and it's hard work but there's a lot that can be said and done at that stage of the process too and i think i think it's possible to be overwhelmed by this and yet i think the my own experience with it is that some of the most amazing people i've met in my life are people that we might have judged to be lost causes and i think what's remarkable is that that every day if i'm tempted to say somebody is a lost cause disproved and that's good for me to know and i'm glad that happens and i think part of what this this terrible epidemic is about is also finally forcing us to look at some of these these questions i stumbled on the figures a couple months ago that the key to combat casualties of our two longest wars iraq and afghanistan are six thousand eight hundred dead americans and the last fifteen years in massachusetts they've been six thousand seven hundred opiate related overdoses or two longest wars or opiate deaths in one state during the same fifteen years it's daunting but i think that the kinds of things we've shared here tonight also are evidence that there's something that can be done we've got examples of people who've made it and and letting that be part of our story is this really crucial  did you want to add something to the conversation oh you know i mean mike was saying you know and like you know he was this he was talking about the vigil that we had you know remember and people passed away and you know we knew or bring out some people but it just seemed like seemed like it was the right time because so many people came all and i know for a fact you know a good portion of the room had directly lost someone you know they were coming out because they wanted to be involved in you know to to see exactly what was going on i've had so many people come up to me to you know to see exactly what what we're trying to do and you know myself and wendy co founder of watertown overcome addiction you know she's she lost a brother who i have known for i knew for a long time we went to school together as kids and so she's on like kind of like on the family side  and how would the how it affects her and so it we get to be able to come out of the both ingles and you know it's not going to zero it's just like this didn't happen overnight it's not going to go away overnight it's going to take a long time but it's going to take everyone in the biggest you know the biggest hurdle a bully i believe that we face is just open up people's eyes you know they gave originally said you know the show people who really haven't been directly affected that before this is your son daughter niece nephew grandson you should get involved too you know before that happens see any problem talking to middle schools about the you know what's going on i certainly believe that we should have you know established programs in the high school not just an assembly every once in a while or whatever you know i'm not forth and you know that's one of the biggest problems is going somewhere in there getting them cleaned up for five days you know you get them on suboxone a whatever to keep them happy while they're in there and then some of the programs will send you out suboxone you take it home and then you go and sell that to your friends and you go good job you know it's like just a spin wash i know how many hundreds of people that i was in different places with that would just go in there just  a warm bed just to get fed for a few days and just to get the chaos down to a minimum for thirty four dollars days that's all they wanted and you know we had no intentions of staying clean and you know we're just program went to a sober host but then i still knew everything and i still thought i could you know have a drink and i still thought i could do that you know so i relapsed but having that ninety days and and being able to laugh again you know be able to live a normal life go to work not to you know not do all those things that i thought i had to do before i made phone calls for work or did a job or you know directed my family like all did all those things high for years and you know having that ninety days to open my eyes and realize that i could it was possible made all the difference because even when i relapse and i was still out there for another year i knew you know it was the worst year of my life after a relapse so i i knew for a fact that i that i had a chance so that was you know like like i said when they shut me down i wasn't able to see my family more i drove myself at the dogs and you know i have a need to you since i go to meetings on a regular basis and i still keep that up front so that's why that's why i continue to do what i'm doing so great thank you we're winding down our time i guess the last question i'd like to ask each of you and we have just under five minutes in the audience listening to the show there's probably someone who is suffering and there's probably a family member who was worried about that person as we flew to i guess i'm i'm wondering if you could think of what you could say to them either as a point to a beginning point perhaps forgetting on that journey or just a way to approach the person that they're concerned about just something something just to leave them with a step to take for either themselves or for the person that they're concerned about professor well i'm a strong believer in and in this particular instance the drug vivitrol which is a a long term now track so that blocks the diction unlike suboxone you can't abuse it can't sell it it's it it blocks it it only lasts for a month and you have to keep taking it for it to be successful but it does not flood the community with more drugs that's really been the problem i also am a big believer in the recovery community which is what we've been talking about tonight i like to think of it as like a immigrant community people come from another country they come to a neighborhood where people like them  other part of their ethnic group live in or supportive they learn from them about the transition out of the drug life into more conventional but they don't have to do it immediately they have like this  they can meet people who will help them and be models for them and so on and then only gradually would move into the community so i want to echo what they've been saying about having a community of people  children need to communicate with their parents and someone who face with addiction you know needs to reach out to somebody and have somebody to talk to and i think that goes a long way i think in today's society we do that less and less you know we tend to have communities of of interest that spanned across the country and don't really don't have that personal contact and i think it's important for people to communicate with one another and you know know get to know your kids really well and know your relatives really well because he said you can sometimes if you feel it it's usually a good indication that something's not right i mean i would you know i would say to anyone who's struggling i mean it doesn't have to get any worse you know  mentioned all of narcotics anonymous our dogs and i was learned to cope on all that is my recovery you know but it doesn't have to get any worse that's basically what i like to leave them with you i would just say that anybody who is  in pain watching this whether they're the ones who are addicted or it's somebody that they love contact anybody on this panel there's no bad place to start any start is a good start and there's never  an easy time to start but so was the right moment and so you're in good company they'll be people there to help you and take that st step that's the most important thing you know i'm just going to recommend the book beyond addiction but i think published two years ago it's a wonderful book in terms of explaining what addiction is and giving insight for people to want familiar with  it's pretty much up to the minute in terms of what science has brought to bear on the problem and it's written primarily for families and affiliates of people with addictions but i think it's equally applicable to people with addiction have proposition and give them hope so it's got a firm scientific background but it's spiritually very reassuring and has a lot of practical advice about how family should approach a person who they suspect of having his diction who has an addiction and doesn't admit it or who has an addiction doesn't want to do anything about it very very valuable approach so i recommend having well our time is up i would like to just thank each of you for taking time out to come in to have this conversation it's an important conversation and thank you so much for being a part of it