and this is healthy pets healthy owners today i'd like to welcome two special people who have taken time out of their bodies busy schedules to come into the studio and talk to us about a very important subject the district attorney for washing treatment program for the state for the well washington we start of the drug court in two thousand and five judge the south who saw also peter sancerre graduate runs a court right now and thank god we had a name place because that was going how they're going on probation and if they're doing well we give them instant feedback on how they're doing and if they're not doing so well he does what he can to correct that they have a whole team that works on it and it's it's a very effective program years yes and then elected is the district attorney in two thousand and twelve i was two thousand and twelve yes that's one of became so wonderful thank you and then cheryl andrews who's a executive director of the washington drug and alcohol commission i'm dry this morning  my tongue is taken to the roof of my mouth and you're also president of the pennsylvania association of county drug and alcohol ministration and the washing county opioid overdose call is and you're busy person cheryl i try to keep busy yes tell us what those things are well i am the executive director for washington drug and alcohol commission and what that is called the single county authority and what that means is we hold the contract with the state of pennsylvania to provide treatment intervention prevention services to the residents of washington county i also hold the presidency of our state wide if really it for single county authorities so there's forty seven of me across the state of pennsylvania that represents their respective counties in dealing with drug and alcohol issues in their county new work together and communicate correct yes and then  and that's more than the total number of people that died in the americans at the in the vietnam war over twenty years at the staggering number yeah the curve on this has been exponential for about the last six years it's a problem that's been going on since for at least twenty years now and that's why i tell people there's no quick answer i mean if there was a quick answer we would have done it by now as far as washington county  we had i believe forty three deaths in two thousand and eleven we had one hundred six deaths last year that were opioid related over the status of we're holding our own right now most areas of the commonwealth right now are seeing two to three times the number of deaths they had last year were pretty much where we were last year which you know we're we're taking some confidence in that hoping that that trend can continue but we have a coalition as cheryl mentioned to try to drive those numbers down our goal is to use the public safety resources the public health resources that we have available and try to completely eliminate overdose deaths  washington county so little bit of research that i've done and information i've gained over a little bit of time in the state of pennsylvania pittsburgh ranks about eighteen out of the top twenty seven cities of  drug opioid related deaths philadelphia number three of the country oddly enough they number one and then even more oddly i found was every city in ohio cleveland columbus and cincinnati ranked in the top twenty seven cities in the northeast it's been i think it's related to you know the economic distress those areas have also you're dealing with the older populations one of the things that people don't realize in our corner has been fantastic at doing autopsies doing getting toxicology and making sure that we have data that we can use to valu strategies for this epidemic is that you know this isn't just a young person's disease i mean people are dying that are in their fifty's and sixty's from overdoses you know i'm not an epidemiologist so i can't tell you what the cause is for the particular areas that you're citing or but i would imagine one of them is an older population that is using a lot of pain relief we're talking about scripted medications he writes such as  all analogues coming in from china this epidemics been kind of a moving target as originated with pharmaceuticals legitimate pharmaceuticals time release medicines such as  hundred ninety six that was crushed and then people would use it to get the high from that we went from that the powdered heroin which was coming in primarily through the cartels from  mexico now we're at the stage we're getting powdered fat and all which is coming in from china and it's various types analogues this is a pharmaceutical grade people are actually getting this are the the mail services and they're selling i n bags in the area and what you're going to see in the near future they're already seeing at some and i'll get counties counterfeit pills made from all that look like oxy cotton pills they actually use a pill press and make these pills because people feel safer taking a pill as opposed to injecting drugs into their body so it's a moving target so you have to attack it on many different fronts we attack it with the obviously from the prosecution side i have a an assistant district attorney that can bring cases in federal court or in state court when we get dealers we've done that a good bit in the last couple of years with the drug task force it's very active and it's it's a challenge to keep up with it but you were doing the best we can i just like to add to what he said back to statistics and that type of thing we're seeing a phenomenon phenomenon now across the united states where people in their late forty's to their late fifty's are overdosing and dying so we're now seeing this this age curve so to speak or this this peak in a in a middle aged individual so these are individuals who probably were legitimately prescribe medication for acute pain or chronic pain became addicted to that medication can no longer get their scripts so they have to go to the street to try to find some heroin to to avoid the withdrawal so and a prescription from a physician that medicine is pharmaceutical grade it's pure it's designed to take be taken a certain way and then this illegal illicit drugs then can be cut with anything it on the street and you don't know what you're getting the other end of this is some of these fennel analogues they're analogs they never been tested on humans we don't know what the effect of are for example carphone on which has been in the news a good that there's a look at the lincoln penny the amount of scarf and all that's necessary to kill you is about the amount that would fit on lincoln's beard on a penny and that's a very small quantity so if you have somebody mixing this stuff up that doesn't know what they're doing they all know what they're working with you can see how easily it is put too much in and then people die as a result of that so where do you think this all began well there was an excellent book you want talk about sampling honest so there's you had even mentioned the cities in ohio there's a book called dreamland and sam quinones is the author of that book and he is a freelance writer but he's an investigative writer spent a lot of time in mexico and so the real heartland of this whole conversion from prescription medication cartel was here knew that people would be needing to sustain their medications that if they couldn't get their medications then they were there to offer the heroin so that people could continue in and getting the drug so it's an excellent book it talks about the da it talks about law enforcement in and how the cartel is just able to keep one step ahead and so again i would recommend that book to you the title again which is which it's called dreamland  of this author but the other thing he talks about is the effect the politics of money in politics and that's always again there yeah yeah yeah change things they did the health care financing administration they changed their guidelines how they viewed pain as a as a sign not a symptom and how people were convinced practitioners were convinced that pain is something that was under treated and needed to be well were treated as a practice or you're inundated by by people coming to the office from pharmaceutical companies with pretty rich out scripts with your d n a number and your license number on there and  somebody comes in with this you get this is somebody comes around get this and and you're you know you're trying to help people that's what a physician does if you're in the medical profession does you know as you did as a paramedic you you want to see a good would result in something comes in the with pain dad worked for the show as my dad my dad was he spent his entire career with forms that are called industry so when you're exactly right i mean when you go in from that perspective as a professional sales rep your job is to make sure that the doctor you know so in the office you know i would have patients come in and you sort of could tell patients who had an issue you know it's not for me to judge it's for me to scrutinize a bit because my name gets on on their ultimately there's a people that are actually hooked you know but there was no way for me to check right and i had to experience one time a patient called me up on an easter sunday in terrible pain and i knew he probably had an issue because i'd seen him in the office or and he didn't deal with the problem so i think it was justified when i said i'll go in the office will will treat it he says no i can't today do it next week and i just need something for the pain and i said well let me call the pharmacy because legally you have to hand script right katic but you  and i think one of the big turning of the table was the introduction of oxy cotton and oxy cotton that particular pharmacy or that particular pharmaceutical company did a marketing campaign far before the release of oxy cotton just like what you were saying making sure doctors understood that this was a safe drug it was non addictive i mean they were giving false that are not accurate heroin but you know that pharmaceutical company actually was taken to court and they were they made thirty five billion dollars before this happened and then they were taken to court and they were paid they were fined by the  government i think it was six hundred six hundred million dollars and six hundred million dollars in then they were given no one was in jail no one got arrested they were they were given four hundred hours of community service the people that did that and they literally lied and there's another company that's doing that right now that the owner's name is kapoor or something like that he's being charged for the doing the same thing so so it places the practitioners in a bad position and it places people in about the right right now is there anything we can do about that how would a district attorney handle that well we with the way we've been addressing and obviously i think the best thing we did and cheryl drag me the table kicking and straight screaming because i've been to many meetings on this and the last thing i needed was another meeting talking about the problem and not doing anything about it but we excuse me  we teamed up last year with the university of pittsburgh school pharmacy they have a technical assistance center we formed an opioid coalition and every group you can think of is involved with this this this organization we have physicians that are involved at the hospitals the three major acute care hospitals in washington county are involved the county agencies the courts judge the south the d office the legal way it covers a whole spectrum individually of people that have lost children or loved ones due to overdoses and what we do is we actually have a strategic plan and what we want to do is work from data look at actual data and come up with evidence based solutions to address it because what we're doing prior to this was showing me years sherlyn somebody else we would say well that sounds like a good idea go do it and you'd find out well you know is a working or not you don't know it's best to work from a plan and data so that you know you're making a difference an example that's the vivitrol program we're doing in the jail and i'm going to  about that a little bit but what we found out was people were dying in the jail coming out of jail and you can read it from there for you do and sure i love what you said don't talk about don't talk about it do something about and we can wait for the state in the federal government to do it there's just too too much argument there's too much dispute over what works and how to do it will work with those folks obviously will partner with anybody  resources available so i don't have different teams so we have a treatment team we have a stigma anti stigma team we have been the laaksonen group we have  law enforcement group we have there's one more i think there's one more but one of the things i sure your viewers are well aware of that when you have any sort of abstinence or a time period where the drug is not in your system your tolerance goes down and so that basically means that if you go out and you pick up and you use that the same amount you used prior to having that abstinence period you're more likely to overdose and what we found was people being released from jail were coming out applied for a grant through the state and we're now offering treatment in the jail for identified people it's a selection process and along with that at the end of their treatment episode prior to release they're getting a shot of vivitrol and what is the and basically vivitrol is a shot that's administered every thirty days and it is a  so there's no pills there's no ability to to divert any of this medication so you're given the vivitrol upon release and you are you go to an outpatient appointment the day you are released from jail and you continue with your treatment and you continue with your vivitrol shot we're only in the early stages of the program so we don't have a lot of data yet but we are getting more and more referrals into the program and this  only available on people that have been released from jail in this type of pilot selective group so what now we can give people can get their patrol as part of their treatment go out and what would dictate how long they got treatment was their insurance provider so it could be forty five days or twenty if they're lucky that forty twenty eight days was pretty common or if you was seven i couldn't believe it seven for  addiction that's that's basically a detox so they were dying because they weren't getting effective treatment so we figured well they're in jail anyway it's not like they're real busy i mean you know they've got time on their hands and hopefully it's secure and you can get you can get them into treatment get the treatment jump started then the jail then when they get their shot they get released and they can continue with the treatment after they were evaluated for what they need so you're putting yourself in the best position to keep these people from coming back which is what i'm very much yeah my public safety standpoint keeping them from coming back to what i want as i went because one of the things that we look at you know of course a lot of these people are in jail but they're really not criminals they're they have a substance use disorder that drives them to criminality because of the fact of trying to sustain their habit so i'm very thankful and jean that he recognizes that so our focus is trying to weed out who are those people that would benefit truly from going to treatment rather than serving a sentence in the sense of only learning a criminal behavior from being in that environment because we do have another program where we we are able to release individuals to a long term treatment so they're going at a minimum of ninety days to a residential facility so you're not looking at this is punishment is rehabilitation and cure correct well that's what our system is based on israel i mean you're if we're trying to rehabilitate people you want to put them in the best position to be rehabilitated we don't do this with violent criminals if people have to have committed violent crimes know with what's going on in this county i mean sure a last one i give or this estimate but it's estimate you've got fifty five thousand people out of population two hundred thousand that have a substance use disorder in washington county we have space for about three hundred  fifty people in jail even if i wanted to incarcerate them all if they were committing crimes we couldn't do it would be cost prohibitive your money is much better spent getting them in treatment getting them engaged with people that sh hoping the spike that positive results up a little bit with that and then the trial actually causes pain when you when you get to your body when the desire to start to take the drugs doesn't it doesn't create a sense of discomfort for your body not that i'm not sure i'm aware and abuse i think there was an issue with that with it was winter yeah you can i mean there are there will certainly be people that will try or think that they can override  vivitrol that's on board but that's why i think it's so important to have the education about them the trawl prior to the shot and then continuing with the cognitive behavioral therapy so that that individual can get district attorney the tone you're a graduate of pitt right undergrad graduated master's degree from pitt as well yes and you're your j d from duke again university as an a sensitive to is that make sure that the right thing is done that justice is served and it's not a job that's based upon the number of convictions or you know how many people you can put in jail which is why this initiative with the opioid epidemic has been particularly important to me because it is kind of a marriage between public safety and public health in order to work on this we talk a lot about and charles going to talk a little bit about some of the initiatives we're doing as part of our coalition but i don't want people to lose sight of the fact that we are prosecuting drug dealers we have a drug task force is extremely active it's headed by a gentleman that was head of the vice unit for the pennsylvania state police for twenty years we have a hotline number of people have drug activity they like to report it's one eight hundred to eight one zero zero seven zero completely confidential if they see something unusual and we do in pennsylvania we lost a lot of our mandatory so when we get a mid level or higher level dealer in pennsylvania we can put him in jail for a significant period of time and the problem with that is that you can't work your way up the chain and try to get where the supply is coming from so what we do is we use jerry's ability to take things federally where they have some more severe penalties and try to rob people through that so that's something that's working out pretty well but we've taken one thousand people federally in the last year and a half which i think is at least double what i remember happening from the time i was an assistant and the office so we haven't lost sight of the prosecution side of this but we also recognize with a nonviolent person with substance use disorder putting him in jail is not necessarily the best  option because jail in that situation you could take somebody that's got a relatively minor crime and they have a significant drug use problem and it's more or less higher education once they get in there and that work with with criminals that have course passed and they do so you sort of look at it as a user and a distributor right right we try to differentiate and sometimes that can be a little murky because you and i could be using drugs at the same time and you're short it  provide to you and or you provide to me depending upon who's who's got the who happens to be flush with drugs that day those are not the people i'm looking to take federally i'm looking at the people there are the jail time because greed z only think driving it's all money that's right it's money from the pharmaceutical companies to make the hook it's money from china distribution and the illicit side of it it's money it's money from mexico that's all about money and it is all about money relevant and i'll take it one step further the reason we're seeing more funnel is also about a tenth of the price of hair when right now the stuff it's coming in from china you can acquire for a heck of a lot less than you can the that isn't such a big their issue anymore well i mean there's a trend the legalization of marijuana you know i you know i follow the law i don't i don't legislate i don't make the law  whatever the law is that's what we're going to enforce and right now in the state of pennsylvania marijuana is illegal but there is good research out there that whether that's somebody that's more likely to use it as using marijuana you know that type of bias is occurring or whether that's just an early symptom but you do see studies that indicate people to use marijuana particularly in an early age are much more likely to be addicted to heroin now whether that's marijuana per se is not addictive i guess it doesn't it doesn't trigger an addiction but it could be you can develop but dependence upon it i guess what well interesting enough our body has  sharks in the years over the ages people consume temp products right not necessarily for the high but they but they consume hemp products and rest by your body's need for for the non t h c part of the well it was it's actually a synthetic can add in a way that was developed through federal funding in the early ninety's there on a clemson university they were trying to do exactly what you said he's doing the research and everybody forgot about it but i guess a patent that and that tells you how to make it and somebody found this over in asia and europe and they started making this stuff and then end up working its way here and a lot of kids were using it because they were calling it fake marijuana and they were actually marketing that to kids them there was a takedown in two thousand and twelve by do we put two tons of this stuff in washington county we actually had it in evidence when we had a lot places that were distributed but it's still out there you can still acquire this stuff and that's that's the danger right now because with with the internet and the availability to get stuff  can you can see there's synthetic drugs coming in from everywhere and you don't the quality control measures aren't there i was just seminar in pittsburgh about two weeks ago where they have formed suitable companies talking about counterfeit pharmaceuticals that are being routed from china in through canada and being sold to pendants practitioners here in the end i yeah over the internet they think it's legitimate drugs they had sales forces that were telling  people this is short data products lucky for you i got this or we had an overstock we can save you money and was higher in medications and i'm talking about chemotherapy agents a lot of the immunotherapy drugs and it really yes i think i want to little bit further and you want to know and that's fine no it's a learning experience and there's a lot a lot going on right now i'm trying to stay abreast of it is a challenge so we do the best we can  washington county or in six last year we're proposing to be under that this year which would be phenomenal i think a lot of that's because we outfitted a lot of first responders with our can they've now to mandate treatment for people who have been reversed or nor can i think that's very much needed that's just my personal view of the coalition because you know in pairs this is a disease process i'm convinced of it impairs how you think and all you have to do is look at the newspaper and see the crimes people are committing because they're addicted and you go why why are they doing these crazy things while their frontal cortex isn't where it is they're not making good rational decisions like someone that may not be using that is and if there is that bad and there have to be reversed by police or firemen to make them start breathing again so that they don't die from a six we should be able to have some ability to get them into the treatment setting when i run into people though ask me well why are we reversing this person two three willpower that's continuum of care problem in my mind you're not getting them to where they need to be to receive the proper care that they need to address what's going to eventually kill them i mean if this proceeds to training coming up for all paramedics and first responders on how to do a warm handoff we're going to train a motivational interviewing so that when first responders are responding to an overdose call  that they have the techniques to encourage that individual either to be transported to the hospital or to agree to speak with somebody in the drug and alcohol field to engage in treatment so that's up in coming it's called community para medicine so there's you know we have compassion fatigue going on right now with our first responders because they are responding over and over and over again to the same individual so we're trying to incorporate strategies that would make a difference and that that particular strategy is one coming out of the coalition often so we need to look at it as a a community problem where the intercept points where people engaging in the system and then how do we deploy  interventions that are necessary so to start off in two thousand and fifteen we were doing a great thing and we're saving lives well now we're seeing ok we're saving lives but how do we engage them into treatment i tell you when  are central nervous system depressed right so what they actually stop your your lungs from functioning is to slow down your heartbeat you know down your blood pressure do all that stuff and that's basically why you don't suffocate and before nor can i mean and you can still use this technique but rescue breathing would keep someone alive until the paramedics arrived and could minister the no locks so now equipping not only first responders but non traditional first responders so like you said social service agencies medical physicians i mean family member family community i just want to share this story sad as it is  but we had a situation where when clients come into our office and they are accompanied by family members we train them in the use of no walks alone and provide kits to those family members and we actually had an after hours call from an emergency room and the daughter actually revived the mom with the north canon that we had provided and i'm very happy to say that this mom is still in long term treatment she's been in treatment before but again we hear if we don't have them alive we can start to talk to somebody about educate yourself and you start to learn about substance use disorders you will find that withdrawal is the very place that these individuals want to avoid at all cost  painful i've heard people explain that if their bones could just pop out of their skin that they would feel relief from the agony of the withdrawals so it's the flu times ten so take the worst flu you've ever had and multiply that by ten that is withdrawals so so we're putting them in a state where they don't want to be and then on top of that we're asking them oh by the way do you want to get help well i mean when you wake up you could have police standing around you could have the ambulance people there you could add your probation officer it's it's it's a very intimidating situation and they're full of guilt they're full of shame all they want to do is get out of that situation so what we've really tried to do is implement programs like community para medicine we have  after our first call set up with all our emergency departments in washington county we get a call with someone who may have gone into the on an overdose we send someone out we talk we engage we've been very successful at getting people from the into treatment like boom boom because we have this very short window of time to move people along that continuum and and so we're really looking at changing the way we do business ten years ago you had to call our office for an appointment you had to show up we talked about your options now my staff is all mobile interactive we're we're in the courts we're in children in youth we're in the jail we're in the hospitals were in the schools so we're meeting people where they are so that we can have a quicker it's it's something that you know it's troubling and it's something that's got and and this is all new i mean as you know like i told you before we came on i was a medic for most of those were usually de fifty you know for glucose diabetic emergencies but now well it's it's it's every day these guys are responding to these the numbers are just  off the charts in the it's going to get worse before it gets better we're twenty years in the making it's going to take this time to get through this and it's going to take everybody point to gather other things we've done medication return boxes pharmaceuticals stations have on their business hours drop them off no questions asked get that stuff out of there well you know that that central nervous depression system depression aspect of opioids actually shuts down your intestinal tract and you're unable to  you are taking opioids you will be constipated and then on the other side when you're going through withdrawal it's not so much it's your body's getting rid of the poison absolutely and it's always an yeah so so you function a bit as a social worker basically because there's big social impact here yes so what our office does is basically we are the the agency that helps people find a treatment course that would work for them and this is free to people it is yes so so it doesn't matter at this stage of the game whether you have private insurance whether you have pennsylvania medicaid whether you have no insurance we can be the office where you can begin the conversation if we're not the entity to help you will get you where you need to go so you're the people to avoid this we've set it up to that really we want no wrong door so we've done a lot of training with different social service agencies with our hospitals so that they know that we're coming they think need to call us and it's a referral to us so you're sitting in judgment absolutely and the purpose is to help this person overcome this problem absolutely and i'm going to let you know that you know we're always ask about well you know what your success rate and you know how many people get well coming through your office and that's a really hard to terminations because for some people just getting them to go to rehab is a success but what i will say is that research says the longer you can keep someone in some type of treatment coupled with therapeutic relationships the longer someone will remain abstinent or in recovery so it used to be we only had enough funding in our budget to send somebody to treatment for two weeks and we expected people to walk out of rehab and be well it's not the case so now we're looking minimally if we can keep somebody in minimally for ninety days ideally we want to see nine months of maybe intense treatment and then working down to an outpatient level maybe coupled with medication assisted treatment but the other key to this is that we follow people through the continuum of care we would send people to treatment and we would never hear of them again and now we have staff that is with that individual we have people that are actually in recovery themselves that work in our office they're called recovery specialist they're actually certified and they're peer to peer there's nothing better than someone who can relate to somebody yeah sure something in it so that absolutely we're seeing so many good results in the sense of people staying engaged in treatment because when you go it alone a lot of times you get scared you have things at home you need to tend to and this allows our staff to be engaged and help people through a continu m and yeah and one of the things i've learned from sheryl from interacting with the drug and alcohol providers is that people can get into long term recovery you want to talk a little bit about that because there's a lot of people in the united states have so we have to take what we know and then we have to individualize that to a person so that it makes sense for them and there are millions of people in long term recovery and they range from you know every their into every socio economic category out there and it is through their advocacy really that that inspires others to know that they can get clean and this has an economic effect on them on zero and it was a number heard last week after president trump talked was seventy billion dollars the piece devoted to this in treatment criminal justice destroys lives is destroys families it's a terrible thing and you know thankful for people like cheryl and jean that are doing something about it because  it's it's a serious issue very serious you know there is hope though i mean that there's a lot of initiatives having a federal one i mentioned the president and i was really heartened by his press conference and the things he said that  couple weeks ago is there quickly one area where is the washing counties that are hit a little harder good city washington run the city of washington and we seem to have a lot overdoses fortunately we have a lot in our can out there the fire appearing on the show and i want to thank all of you for watching healthy pets healthy owners remember you can hear me every saturday morning from nine to ten and twelve fifty and the answer thanks