Logo
    Search

    403. The Opioid Tragedy, Part 2: “It’s Not a Death Sentence”

    en-usJanuary 23, 2020

    Podcast Summary

    • Factors contributing to the opioid crisis in the US & the need for addiction treatmentThe opioid crisis in the US is fueled by the promotion of pain as a vital sign, government subsidies, and the risk of transitioning to deadlier drugs. Addiction is treatable, but universal acceptance of addiction treatment is lacking.

      The opioid crisis in the US is a result of various factors, including the pharmaceutical industry's promotion of pain as a vital sign and government subsidies for opioids. Dependency on prescription opioids often leads to a dependence on deadlier drugs like heroin and synthetic fentanyl. Approximately 2 million people in the US have opioid-use disorder. While prescribing protocols for opioids have changed, over 20% of Americans still get at least one prescription or refill per year. However, addiction is treatable, and some believe addiction treatment should be as routine as any other aspect of medical care. Yet, universal acceptance has been lacking.

    • One Physician's First-Hand Experience with the Opioid Crisis and the Importance of Wide-Spread Narcan Availability.Opioids are still dangerous and can cause devastating consequences. Factors such as deprescribing, prescription drug monitoring programs, public awareness efforts, and Narcan availability have contributed to declining opioid deaths. However, continued efforts are necessary to combat the opioid epidemic.

      As an emergency-medicine physician and medical toxicologist, Dr. Perrone has seen the devastating impact of the opioid crisis first-hand. Despite declining opioid deaths in the U.S., Perrone warns against the dangers of opioids and advises others to avoid them whenever possible. She attributes the decline in deaths to factors such as deprescribing, prescription drug monitoring programs, public awareness efforts, and the availability of Narcan. Perrone herself has administered Narcan to save overdose victims on several occasions. Her experiences highlight the importance of widespread Narcan availability and the need for continued efforts to combat the opioid epidemic.

    • Rethinking Support for Overdose Patients: Addressing Addiction to Save LivesOverdose patients need more than just Narcan to survive. Effective addiction treatment and ongoing support are crucial for breaking the cycle of drug use and reducing the impact of drug addiction on individuals and communities.

      Overdose patients face high mortality rates even after receiving Narcan, which highlights the need for effective addiction treatment. Emergency departments traditionally provided minimal support, but new approaches are emerging to tackle drug addiction. Patients often struggle with withdrawal and require immediate, ongoing support to break their cycle of drug use. A “crumpled piece of paper” advising them to stop using drugs isn't sufficient, and patients must have access to addiction specialists for comprehensive care. It's time to rethink the way we support overdosing patients and tackle the root cause of the problem. Only then can we hope to reduce the devastating impact of drug addiction on individuals and communities.

    • Models of Care for Opiate Use Disorder: The Study ResultsThere are three models of care for opiate use disorder: the "crumpled piece of paper" model, motivational enhancement with a facilitator referral, and motivational enhancement with brief intervention and buprenorphine. Buprenorphine is a safer alternative to methadone and can be prescribed from a doctor's office.

      The opioid crisis prompted a study on different models of care for opiate use disorder. The study included 300 patients, divided into three treatment groups. The first group received the standard treatment at the time, the 'crumpled piece of paper' model. The second group received motivational enhancement along with a facilitator referral. The third group received motivational enhancement, brief intervention, and were started on buprenorphine. Unlike methadone, buprenorphine can be prescribed from a doctor’s office, making it less stigmatizing. It's also intended to be much safer since it’s a partial agonist at the opioid receptors with a ceiling effect, which decreases the risk of opioid overdose and death, even if a child accidentally ingests it.

    • The Benefits and Barriers of Buprenorphine Treatment for Opioid AddictionBuprenorphine is a safe and effective treatment for opioid addiction, but prescribing it requires extra training and a special waiver, creating a barrier to expanding access to treatment.

      Buprenorphine, an opioid, offers a safer and more flexible treatment for opioid addiction. Patients in the buprenorphine group are two times more likely to be in formal treatment at 30 days than patients in the referral or brief-intervention group. Buprenorphine is a wildly useful drug that stabilizes the cycle of withdrawal that patients are experiencing and can double the rate of engagement of patients who showed up for a follow-up meeting. However, prescribing buprenorphine requires an extra level of regulation, including an eight-hour training program and a special waiver. This extra level of regulation does not apply to prescribing medical opioids in the first place. This is a barrier to expanding the treatment of opioid addiction.

    • The Potential Impact of Buprenorphine in Treating Opioid AddictionEasing restrictions on buprenorphine could significantly reduce deaths from opioid overdose, and it's time to reconsider the X-waiver process to make it more accessible to those who need it most.

      The prescription-opioid crisis has been perpetuated by addictive painkillers and the influence of pharmaceutical companies. Buprenorphine has been recognized as a transformative tool to treat opioid addiction, but restrictions on its dispensation have hampered its effectiveness. The X-waivering process is seen as onerous, outdated, and more focused on preventing diversion to the street than on helping patients manage and recover from opioid addiction. Yet, easing restrictions on buprenorphine in France helped reduce deaths from opioid overdose by nearly 80 percent, highlighting the potential impact in the US. While concerns about Suboxone diversion persist, it is not used to get high but to treat withdrawal symptoms. It is time to reconsider the X-waiver and make buprenorphine more accessible to those who need it most.

    • The Complexities of Prescribing Buprenorphine and the Challenges with the X-WaiverPrescribing buprenorphine is more difficult than other opioids and repealing the X-waiver won't solve all the problems. Education and stigma surrounding buprenorphine need to be addressed while modern solutions need to be improved to make it easier for doctors to prescribe.

      Prescribing buprenorphine is much harder than prescribing other opioids like OxyContin. Repealing the X-waiver won't solve the problem entirely, as some education and stigma around buprenorphine still needs to be addressed. While an eight-hour training program may prove its worth, it could pose a barrier and discouragement for some physicians who want to prescribe buprenorphine for only a few patients. Some state governments and hospital chains are moving in the right direction to address this issue, but others, like the state of Pennsylvania, are implementing additional layers to the X-waiver, making it more difficult and expensive to prescribe buprenorphine. The modern response to this problem needs to be improved.

    • Overcoming Stigma to Make Medication-Assisted Treatment Accessible for Opioid AddictionStigma attached to medication-assisted treatment (M.A.T.) for opioid addiction makes it difficult for people to access effective treatment. Overcoming this stigma is essential for successful addiction treatment.

      While buprenorphine is being held back from widespread use due to factors like X-waiver and training requirements and extra fees, the issue may also lie in the pushback from the recovery community due to their belief in total abstinence. Stephen Loyd, a physician in Tennessee who specializes in addiction, believes that medication-assisted treatment (M.A.T.) is the most effective solution for opioid addiction, as argued by organizations like the World Health Organization and the National Institute on Drug Abuse. However, the stigma attached to M.A.T. makes it difficult to get people into these programs, including parents who are worried about trading one drug for another. The success rate of traditional abstinence-based programs like Alcoholics Anonymous is hard to determine, but studies show that A.A. nearly doubles the success rate compared to addicts who quit on their own. Loyd's argument highlights the importance of M.A.T. and the need to overcome the stigma associated with it.

    • Understanding the Complex Components of Opioid AddictionOpioid addiction involves biological, psychological, and social factors, as well as genetics, adverse childhood experiences, and easy access to opioids. Pharmaceutical companies can be involved in solutions, but a comprehensive approach is needed to tackle the disease.

      Opioid addiction is a complex problem with biological, psychological, and social components. Genetics plays a role in addiction, but so do adverse childhood experiences and chronic trauma. Availability of opioids also plays a significant role in the addiction epidemic. Although the pharmaceutical industry's involvement in medication-assisted treatment is controversial due to their contribution to the problem, it remains the most effective solution for saving patients' lives. Addiction is a disease, and it can happen to anyone, regardless of their background or circumstances. To combat this epidemic, society needs to tackle addiction from all angles and provide comprehensive support to those affected.

    • Addiction as a Brain Disease: The Importance of Medication-Assisted Treatment and Harm ReductionAddiction may start as a behavioral problem, but it ultimately changes the way the brain functions. For effective treatment, a focus on improving quality of life and access to medication-assisted treatment and harm reduction services is essential.

      Addiction can be compared to Type 2 Diabetes in that it is primarily behavioral but it still rewires the brain, making it a brain disease. Medication-assisted treatment and harm reduction should be more widely available to those suffering from addiction. The focus of recovery should not be solely on total abstinence from all drugs, but on improving the individual's overall quality of life.

    • Harm Reductionist Approaches to Opioid Addiction TreatmentCombining buprenorphine and warm handoff strategy with peer counselors increases engagement with patients, reduces stigma and ensures continued support for successfully transitioning into the next phase of treatment.

      By adopting harm reductionist approaches to treatment, like using buprenorphine combined with a 'warm handoff' strategy that connects patients with peer counselors, medical professionals can increase engagement with patients and reduce the stigma that comes with addiction. The warm handoff approach ensures that patients have continued support after leaving the emergency room and can easily transition into their next phase of treatment. Peer counselors, who are in recovery themselves, provide invaluable insight into the challenges of opioid addiction, giving patients hope that they too can overcome their addiction and lead healthy lives. It’s time to shift the narrative around opioid addiction and embrace more comprehensive, compassionate solutions that work.

    • Overcoming Addiction with Compassion and UnderstandingAddiction is a difficult cycle to break, even after years of sobriety. The availability of drugs can easily re-ignite the addiction. Compassion and understanding can help addicts get on the path to recovery.

      Addiction is a vicious cycle, and getting clean requires a constant battle against withdrawal. Even after years of sobriety, the availability of opioid painkillers and other drugs can easily re-ignite the cycle. The cost of these drugs can make heroin an attractive option, despite its risks. The devastation of addiction is not limited to the individual; loved ones can also suffer from the repercussions. Losing a sibling to an overdose was a turning point for Nicole O’Donnell, and propelled her to help others struggling with addiction. With compassion and understanding, Nicole helped Eileen Richardson get on the path to recovery with Suboxone.

    • Combining Support and Suboxone for Effective Addiction TreatmentSuboxone can be an effective tool in treating addiction, but it's important to combine it with therapy and support to fully recover. Don't let stigma prevent you from seeking the best treatment for your unique path to recovery.

      Suboxone is a highly effective medication, but its use is limited by the stigma surrounding it in the recovery community. While it helps with the physical aspects of addiction, it is important to combine it with therapy and support to become a new person. The traditional abstinence-based approach in the 12-step program has made it difficult for people to accept medication-assisted treatment (M.A.T.) as a viable option, but it is important to understand that every individual's path to recovery is unique. The tragic death of Eileen's friend highlights the importance of finding the right combination of treatment and support, and not risking relapse by going back to old habits.

    • Proposal of Safe-Drug-Use Sites Amid Opioid Crisis in the US.Harm reductionists recommend safe injection practices and needle exchanges, but official safe-drug-use sites are being considered to reduce overdose risk. Safehouse nonprofit provides medical staff and peers to guide patients towards treatment. Community support is crucial in addiction recovery.

      The opioid crisis in the US has moved from prescription pills to heroin and synthetic fentanyl, resulting in a high risk of overdose. Harm reductionists advocate for safe injection practices and needle exchange, but an official safe-drug-use site that ensures people do not overdose is being proposed in several cities, including Philadelphia. The Safehouse nonprofit is leading in the U.S., providing medical staff and peers who can navigate patients into treatment in emergency cases. The US Justice Department filed a suit against this facility claiming it would be illegal to provide a facility for illegal drug use. However, the federal judge ruled in favor of Safehouse. The opposite of addiction is community and relationship. Patients need supportive environments to build this community to help keep them alive.

    • Harm Reduction Strategies for Treating Opiate Use DisorderReducing the stigma around addiction and offering warm-handoff programs with potential for medication-assisted therapy can improve treatment outcomes. Treatment for opiate use disorder is achievable and not overly complicated.

      Harm reduction strategies including lessening the stigma associated with addiction can increase opportunities for people to seek help. The warm-handoff program at UPenn sees up to six patients a day, most of whom are willing to at least have a conversation about medication-assisted therapy. Opiate use disorder is treatable and not a death sentence; it's a medical condition. However, the topic is often overcomplicated in the political community. Eileen, who takes her medication, engages, and attends meetings, is an example of someone who is doing well with treatment. We need to remember that we don't always need to overcomplicate things.

    Recent Episodes from Freakonomics Radio

    591. Signs of Progress, One Year at a Time

    591. Signs of Progress, One Year at a Time

    Every December, a British man named Tom Whitwell publishes a list of 52 things he’s learned that year. These fascinating facts reveal the spectrum of human behavior, from fraud and hypocrisy to Whitwell’s steadfast belief in progress. Should we also believe?

     

     

    Freakonomics Radio
    en-usJune 06, 2024

    EXTRA: The Opioid Tragedy — How We Got Here

    EXTRA: The Opioid Tragedy — How We Got Here

    An update of our 2020 series, in which we spoke with physicians, researchers, and addicts about the root causes of the crisis — and the tension between abstinence and harm reduction.

     

    • SOURCES:
      • Gail D’Onofrio, professor and chair of emergency medicine at the Yale School of Medicine and chief of emergency services at Yale-New Haven Health.
      • Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University.
      • Stephen Loyd, chief medical officer of Cedar Recovery and chair of the Tennessee Opioid Abatement Council.
      • Nicole O’Donnell, certified recovery specialist at the University of Pennsylvania's Center for Addiction Medicine and Policy.
      • Jeanmarie Perrone, professor of emergency medicine at the University of Pennsylvania.
      • Eileen Richardson, restaurant manager.

     

     

    Freakonomics Radio
    en-usJune 03, 2024

    590. Can $55 Billion End the Opioid Epidemic?

    590. Can $55 Billion End the Opioid Epidemic?

    Thanks to legal settlements with drug makers and distributors, states have plenty of money to boost prevention and treatment. Will it work? (Part two of a two-part series.)

     

    • SOURCES:
      • Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University.
      • Stephen Loyd, chief medical officer of Cedar Recovery and chair of the Tennessee Opioid Abatement Council.
      • Christine Minhee, founder of OpioidSettlementTracker.com.

     

     

    Freakonomics Radio
    en-usMay 30, 2024

    589. Why Has the Opioid Crisis Lasted So Long?

    589. Why Has the Opioid Crisis Lasted So Long?

    Most epidemics flare up, do their damage, and fade away. This one has been raging for almost 30 years. To find out why, it’s time to ask some uncomfortable questions. (Part one of a two-part series.)

     

    • SOURCES:
      • David Cutler, professor of economics at Harvard University.
      • Travis Donahoe, professor of health policy and management at the University of Pittsburgh.
      • Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University.
      • Stephen Loyd, chief medical officer of Cedar Recovery and chair of the Tennessee Opioid Abatement Council.

     

     

    Freakonomics Radio
    en-usMay 23, 2024

    Extra: Car Colors & Storage Units

    Extra: Car Colors & Storage Units

    Presenting two stories from The Economics of Everyday Things: Why does it seem like every car is black, white, or gray these days? And: How self-storage took over America.

     

    • SOURCES:
      • Tom Crockett, classic car enthusiast.
      • Zachary Dickens, executive vice president and chief investment officer of Extra Space Storage.
      • Mark Gutjahr, global head of design at BASF.
      • Kara Kolodziej, self-storage unit tenant.
      • Anne Mari DeCoster, self-storage consultant.
      • Nikkie Riedel, carline planning manager at Subaru of America.

     

     

    Freakonomics Radio
    en-usMay 20, 2024

    588. Confessions of a Black Conservative

    588. Confessions of a Black Conservative

    The economist and social critic Glenn Loury has led a remarkably turbulent life, both professionally and personally. In a new memoir, he has chosen to reveal just about everything. Why?

     

    • SOURCE:
      • Glenn Loury, professor of economics at Brown University and host of The Glenn Show.

     

     

    Freakonomics Radio
    en-usMay 16, 2024

    587. Should Companies Be Owned by Their Workers?

    587. Should Companies Be Owned by Their Workers?

    The employee ownership movement is growing, and one of its biggest champions is also a private equity heavyweight. Is this meaningful change, or just window dressing?

     

    • SOURCES:
      • Marjorie Kelly, distinguished senior fellow at The Democracy Collaborative.
      • Corey Rosen, founder and senior staff member of the National Center for Employee Ownership.
      • Pete Stavros, co-head of Global Private Equity at KKR.

     

     

    586. How Does the Lost World of Vienna Still Shape Our Lives?

    586. How Does the Lost World of Vienna Still Shape Our Lives?

    From politics and economics to psychology and the arts, many of the modern ideas we take for granted emerged a century ago from a single European capital. In this episode of the Freakonomics Radio Book Club, the historian Richard Cockett explores all those ideas — and how the arrival of fascism can ruin in a few years what took generations to build.

     

     

     

    Extra: Why Is 23andMe Going Under? (Update)

    Extra: Why Is 23andMe Going Under? (Update)

    Five years ago, we published an episode about the boom in home DNA testing kits, focusing on the high-flying firm 23andMe and its C.E.O. Anne Wojcicki. Their flight has been extremely bumpy since then. This update includes an additional interview with the Wall Street Journal reporter who has been investigating the firm’s collapse.

     

     

     

    585. A Social Activist in Prime Minister’s Clothing

    585. A Social Activist in Prime Minister’s Clothing

    Justin Trudeau, facing record-low approval numbers, is doubling down on his progressive agenda. But he is so upbeat (and Canada-polite) that it’s easy to miss just how radical his vision is. Can he make it work?

     

     

     

    Related Episodes

    Robert Kanter and Darren's 15 Years Clean

    Robert Kanter and Darren's 15 Years Clean

    ROBERT KANTER, THE WORLD ’S MOST RECOGNIZED INTERNATIONAL RECOVERY AND FAMILY ADVOCATE ADDRESSING THE OPIOID CRISIS, APPEARS IN THE MEDIA AROUND THE WORLD TO RAISE AWARENESS OF THE GLOBAL SURGE IN DRUG OVERDOSE FATALITIES WITH LIVE INTERVIEWS ON CTV NATIONAL TELEVISION (RADIO 89.3 FM) AND NEWSRADIO 103.9 (NEW YORK) AND IS QUOTED IN ONLINE ARTICLES ON THE NATIONAL REVIEW (U.S.A) AND THE HILL (WASHINGTON D.C.)

    Kanter’s global advocacy work encompasses a wide range of critical topics including the impact of COVID 19 on the epidemic, the Purdue Pharma class action opioid settlement, family support services legislation in the United States Congress, and the worldwide stigma of substance use disorder, which he references in an article he authored for the SHINGETSU NEWS. His heartwarming story of how he and his daughter both recovered from substance use disorder and the genesis of his advocacy work can be found in an article he authored for PARENTS.com his op-ed in the JERUSALEM POST and is featured in a live VIDEO PODCAST found on his YOUTUBE CHANNEL with his daughter. NEW YORK, March 2 3 2021 Robert Kanter, the world’s most respected international recovery and family advocate addressing the opioid epidemic, is interviewed on live television and radio, authors numerous articles and op-eds, and is quoted in digital publications around the world to raise awareness of the significant uptick in global overdose deaths. The statistics are alarming.

    Desi Lydic Celebrates Mother's Day | Alex Gibney & Sara Bareilles

    Desi Lydic Celebrates Mother's Day | Alex Gibney & Sara Bareilles

    Desi Lydic shares her pandemic-era Mother's Day wish, Alex Gibney discusses his documentary "The Crime of the Century," and Sara Bareilles talks about "Girls5Eva" and "Amidst the Chaos."

    To aid in eradicating the stigma of mental health issues in the African-American community, increasing the number of African-American therapists, combating recidivism within the prison system and providing mental health support in urban schools, please donate at https://www.dailyshow.com/BLHensonFoundation.

    Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

    See omnystudio.com/listener for privacy information.

    Introducing: Trafficked with Mariana van Zeller

    Introducing: Trafficked with Mariana van Zeller
    Today we share an episode of a new podcast series called Trafficked, hosted by National Geographic Channel’s Mariana van Zeller. The series pulls back the curtain on the people operating trafficking rings and shadow economies. In this episode, Mariana sits down with country rapper Struggle Jennings. An outlaw country rapper—and the grandson of country music legend Waylon Jennings— he once got busted for trying to purchase a big load of oxycontin in a Walmart parking lot in Memphis, Tennessee. Mariana and Jennings discuss the day he got busted, his life leading up to it, and the toll it took. This episode features some strong language and drug references, so if your kids are around, you might want to check out another one of our episodes.   The Trafficked TV series is available now on National Geographic, and new episodes air Wednesdays. If you like what you hear and want to support more content like this, please consider a National Geographic subscription. Go to natgeo.com/exploremore to subscribe today.  Learn more about your ad choices. Visit megaphone.fm/adchoices

    Ben Westhoff on Synthetic Drugs, Dive Bars, and the Evolution of Rap

    Ben Westhoff on Synthetic Drugs, Dive Bars, and the Evolution of Rap

    Ben Westhoff has written some of Tyler’s favorite books on everything from dive bars to the evolution of American rap music to how fentanyl is driving the opioid epidemic. So how does he get it done? Not from the outside in, by finding exotic experiences as he originally thought. Instead he found that it comes from the inside out: eating right, exercising, getting sleep, and journaling. Do those things, Ben says, and you’ll be in a much better position to notice the good stories happening all around you.

    He joined Tyler to discuss those many stories, including the proliferation of synthetic drugs, China’s role in the crisis, the merits of legalization versus decriminalization, why St. Louis is underrated, New Jersey hip-hop, how CDs changed rap, what’s different about Dr. Dre, whether the entourage is efficient, the social utility of dive bars, and more.

    Read a full transcript enhanced with helpful links.

    Recorded September 11th, 2019

    Other ways to connect