The Loneliness Epidemic | Surgeon General Vivek Murthy on Social Isolation

The Loneliness Epidemic | Surgeon General Vivek Murthy on Social Isolation


[ZDoggMD] For in healthcare in
particular, I think it hits a core with us. That
loneliness, social isolation, this feeling of being
detached and disconnected. We have a hugely high suicide rate. We have a huge rate of burnout. And, and how many people
really understand us? How many of us marry doctors? – Mhm. – Or nurses. Because no one
else seems to understand us. And is that because we
just haven’t codified how we connect and our
institutions haven’t helped us do this. And you say that
companies maybe the future to help us do this. What are your thoughts on this? I mean, I thought it was fascinating. [Dr. Vivek Murthy] Well, you know I think
loneliness is an incredibly important issue now. I
mean, people think hey we’re incredibly connected by technology. Everyone’s on Facebook.
People are connected via Twitter. – I’m sorry, I can’t hear
you. I’m gonna look at my comments right now. (laughing) Right? – Yeah but you know, we
have so many means of connecting through
technology, and I think there has been an assumption
sometimes that those connections can substitute
for offline connections. – Right. – And the bottom line is
they can’t. If you look at the data what you see is
that loneliness is actually been increasing at a time
when technology to connect has also been increasing. – With the so-called iGen. This younger generation
that’s coming into their teens now. We did a show on the disconnection. They have incredibly high
rates of depression, anxiety, suicide- but they’re having sex later. They’re drinking alcohol less. All these things that you and
I- our parents would have been like, (puts on accent) “Don’t, I’m so happy you’re
not doing anything, right.” (laughing) But you’re at home, on the device. – Yeah. – So, so. Please. I’ll let
you finish your thought. I interrupted you. – Yeah so the thing about
loneliness is that we’ve- There a couple things
that have been problematic in addition to the fact
that it’s been growing. Number one is we haven’t
really understood how impactful it is on our health. But we know that when you
look at the data, that there is actually a strong
association that you see between people who are lonely and
actually mortality rates. So it turns out that the
lifespan of people who are lonely tends to be shorter. And not shorter by a couple
of days or a couple of weeks. It tends to be shorter on
the same order that smoking shortens your lifespan. In fact, even greater than
the reduction in lifespan that you see in obesity. So, there is something happening
here but there’s also a clear correlation that you
see between loneliness and anxiety and depression and dementia. And you can really ask the question: Is this correlation? Is it causation? What’s actually going on? – What’s going on, yeah. – Here. And I think that’s
where we need to do more in depth research in
understanding loneliness. If you delve into the biology
of loneliness there’s a reason to believe that there
are causative mechanisms at work. – Mhm. – And if you look historically,
you know, we did evolve to be social beings. You know, thousands of years
ago if you had a network of trusted people around
you, you were more likely to have a stable food supply. You were more likely to be
protected from predators at night. – Mhm. – And over thousands of
years that need for social connection- trusted social
connection- became baked into our nervous systems. – Yeah. – Now this doesn’t mean
that we’re all extroverts. – Right. – Absolutely not. – Not at all, yeah. – But contrary, there are
many people- myself included- who tend toward the introvert side. You know, of the
introvert-extrovert scale. But all of us, whether we’re
introverts or extroverts, need some degree of
trusted social connection. We may not need a thousand friends, but we might need just one. – Right. – And this is the other point
is that loneliness is not dictated by the number
of friends you have. You know, you could have
thousands of people you consider friends. – I have six hundred and
fifty thousand friends. (laughing) Okay, buddy. And believe me I’m the
loneliest person on Earth, so. (laughing) – Well that’s why I’m here
is to hangout with you. – Thank you, thank you,
I just need one introvert to hang out with, right. – Yeah, but you know one
of the reasons I think that loneliness is also hard to
talk about- in addition to the fact that we don’t
recognize the incredible impact that it has on
health and on productivity- is that there’s actually
a stigma around loneliness as well. If you tell somebody you are lonely, what that means… – Loser. – Some people interpret
it as you’re a loser. – Right, yeah. – Some people interpret
it that you’re an outcast. What it is essentially
saying is that I’m not worthy of being loved. – Ah. – That’s what it’s saying. And I say this from a very
personal place because as a child I was very lonely. When I
was in elementary school in particular I was very close
to my Mom and Dad, still am. And I was very closer
with my sister, still am. I always knew that they were there for me. Their love was unconditional
and I knew that. But outside of that family
I didn’t have many friends in school because I was very
shy and it was hard for me to kind of reach out. And I felt lonely. The thing is, I have not
to this day told my parents about this. Because I felt ashamed. I felt that that meant that
there was something wrong with me. – Mm. – There are many people that
feel like that. And I want people to know that if you
are lonely, you are certainly not the only one. There are many people out
there who are feeling lonely. And if you aren’t feeling
lonely, there are likely people around you who are. And this is where I think we
all have to think about the role that we could play
in addressing loneliness. Again it has impacts on
our health, impacts on our productivity in the workplace,
it impacts educational performances in schools. But here’s the thing: You don’t need a medical
degree or a nursing degree to address loneliness. What
you need is a willingness to listen. You need a heart
full of compassion. A willingness to give and receive love. There are basic human
tenants that all of us have. And so the antidote to
loneliness actually lies within each of us. – You said something that
I feel you on every level. I remember being incredibly
lonely in elementary school. You know and you know, when
you have immigrant parents it’s exactly that. You don’t go to them and say, “I’m lonely” You just say, “Oh I’m fine!” You play your Ataris, you do that thing. And it actually took my
years to get to the sense where I was more than
superficially connected. And to this day I only
really have a handful of really deep friends that
unfortunately are disparate geographically, but when we
get together it’s instant the reconnection. – Mm. – It’s true. You don’t
need- and your family- you don’t need a lot more
but you need some basic level of stability and
love and someone that you can trust unconditionally
in that kind of thing. And there was something else you said, um in the article. One of the antidotes to
loneliness is you go as the lonely person and
you help somebody else. So you’re at work and you
support somebody, or you go out of your way to help somebody. That in itself can form
a connection that can ameliorate the loneliness. – Yeah, this is one of the
counterintuitive things about loneliness. Loneliness is
actually a stress state. And when you’re stressed
you tend to turn inward. – For sure. – And so the instinct that
people who are chronically lonely have is to actually
isolate themselves even further. But if you can push yourself
a bit to reach out and actually help someone
else, that actually is a mutually reaffirming experience. Not only helps the other person
and allows them to see that there are others who care
for them, and allows them to feel value. But it also reengages you
with another person in a meaningful way and reaffirms
to you that you have value to give. – Mhm. – To others, so. Helping others
is very powerful antidote to loneliness. The other thing that’s
really important though is protecting quality time
with family and friends. – Mhm. – Now, we live in a culture
where work has seeped into our evenings and our weekends
and our vacation time. – What time is it, Tom? (laughing) – It’s work time. It’s work o’clock. (laughing) – It’s work o’clock! – Case in point. But we also
have had devices purveyed every aspect of our life. (laughter) Many… (laughter) – You shut your mouth, Vivek Murthy. Former 19th US Surgeon General. You don’t tell me about my phone! – Well here’s the thing.
It’s okay to use your phone to some extent but I think
if we ask ourselves honestly the question that, Is our phone too prevalent in our life? Is it distracting us from conversations? – Mhm. – With people that we really
wanna be present with. For many of us the answer is yes. And the answer has been yes for me too. – Mhm. – You know, I came to
realize that I was um bringing my phone to the
dining table. You know, and checking messages like
when I was dining with loved ones. – Did Alice yell at you? Because my wife yells at me constantly. – Well she reminds me. In her
gentle and thoughtful way, she often does. That’s not how we want to live our life. You know there was a moment-
just to be very open with you- when we were um putting our son to bed. And you know, sometimes he
likes Alice to feed him. Alice is my wife. And sometimes he likes me to feed him. And one day when he
wanted her to feed him, she was feeding him and I was
just kind of sitting there watching them. And I
just almost unconsciously just took out my phone and
I was checking my email ’cause I was just sitting there. And she put up her hand
for for me and said, “Do you really need to do
that now, or do you just want to be fully present for his bedtime?” And I was like you’re absolutely right. You know, like this is sacred time. And so I think it’s important
for us to draw boundaries in our life for where we
are focused entirely on the people that we want to engage with. Where we take technology
out of the room or we put our phones away. Um, even… You might think
to yourself- this is where phones can be really insidious-
you might just put your phone five feet away from
you on a dining table. Like when you’re having
a meal with a friend. You know, don’t worry I’m
fully focused. But part of your mind is looking to see
if that phone lights up. If it does light up or if it
buzzes, you’re thinking hm who texted me? (laughing) – Get out of my head, Vivek
Murthy! Get out of my head. That’s exactly what I do. – It’s what all of us do.
And so that’s why I think creating a really dedicated
space- even if it’s ten minutes in a day- where
you are fully present with somebody. This is really
important to building those meaningful relationships
and a part of addressing the larger crisis we have with loneliness.

Medical industry an accomplice in opioid epidemic?

Medical industry an accomplice in opioid epidemic?


♪>>Tucker: ANOTHER INSTALLMENT TONIGHT IN OUR SERIES DRUGGED THE OPIOID EPIDEMIC IS THE WORST DRUG CRISIS IN THE HISTORY OF THIS COUNTRY, EVERY YEAR DRUG OVERDOSES KILL MORE PEOPLE IN THE ENTIRE VIETNAM WAR AND VAST MAJORITY OF THOSE ARE CAUSED BY OPIOIDS AS YOU KNOW BY NOW. TWIST PAST DRUG OVERDOSES CAUSED BY AMERICAN MEDICINE. HUGE QUANTITIES OF OPIOID PAINKILLERS ARE PRESCRIBED EVERY YEAR AND CREATED MILLIONS OF ADDICTS U NOT EVERYONE IS CONVINCED OPIOIDS IS TO BLAME. DOCTOR, THANKS FOR COMING ON, I APPRECIATE IT.>>THANKS FOR HAVING MOO, TUCKER.>>Tucker: AT THE VERY INFANT STAGES OF THE CURRENT DISASTER, THIS EPIDEMIC, YOUR ORGANIZATION, ALONG WITH ANOTHER RELEASED A STATEMENT AND I JUST WANT TO GET YOUR TAKE ON IT NOW 21 YEARS LATER. AND I’M QUOTING STUDIES INDICATE THAT THE DEVELOPMENT OF ADDICTION WHEN OPIOIDS ARE USED FOR THE RELIEF OF PAIN IS LOW. FURTHERMORE EXPERIENCE HAS SHOWN THAT KNOWN ADDICTS CAN BENEFIT FROM THE CAREFULLY JUDICIOUS USE OF OPIOID. IN LIGHT OF EVERYTHING WE HAVE SEEN OVER THE LAST 21 YEARS, WHAT DO YOU MAKE OF THAT STATEMENT.>>I THINK WE HAVE LEARNED A LOT OVER THE LAST 20 YEARS AROUND PAIN MANAGEMENT. GOING BACK TO THAT TREATMENT, IT WAS STATED THAT THE RISK FOR ADDICTION WAS LOW. I THINK OVER TIME WE HAVE SEEN THAT THERE IS A RISK FOR ADDICTION WITH PATIENTS AND STILL A PROBLEM. BUT, USING MEDICATIONS WITH THE WRONG PATIENTS, THE DEVELOPMENT ADDICTION PROBLEM OR MISUSING THE MEDICINE CAN LEAD TO ALL SORTS OF PROBLEMS. SHOWN THAT THE RISK OF ADDICTION FROM STARTING WITH PAIN SUBSTANCE ABUSE PROBLEM IS AT LEAST 10% OR LITTLE HIGHER THAN THAT IT’S LOW BUT STILL SIGNIFICANT. WE REALLY NEED TO BE CAREFUL WHO GETS THESE MID SINS AND DECIDING IF THESE ARE EFFECTIVE THERAPIES. WHAT’S IMPORTANT, TUCKER, PAIN MANAGEMENT ISN’T.>>Tucker: OF COURSE.>>OTHER OPTIONS FOR OUR PATIENTS.>>Tucker: TAKE THREE STEPS BACK PHYSICIANS ALMOST UNIVERSALLY TRUSTED BY PEOPLE OR TRAINED TO TRUST THEM. THEIR JOB IS TO HEAL US.>>RIGHT.>>Tucker: BASICALLY TELLING PEOPLE TO TAKE MORE OPIOIDS AND NOW WE HAVE TENS OF THOUSANDS OF DEAD AND WHOLE COMMUNITIES DESTROYED AND THE MIDDLE CLASS LIFE EXPECTANCY LITERALLY SHRINKING BECAUSE YOU HAVE THIS OH, SORRY, WE WERE WRONG. WOULDN’T A MORE FUNCTIONAL SOCIETY PUNISH PEOPLE WHO SAID SOMETHING LIKE THAT?>>I THINK THOUGH THE FOCUS SHOULD OBVIOUSLY BE ON HOW DO WE ASSESS WHO WHAT IS EFFECTIVE FOR THIS TREATMENT. WHAT TYPES OF TREATMENT COULD THEY BENEFIT FROM. SO MANY OTHER OPTIONS FOR PATIENTS U AND MAYBE A SMALL PERCENTAGE OF PATIENTS NEED TO BE ON OPIOIDS AS PART OF THEIR TREATMENT PLAN. I’M NOT SURE ACCUSE HOG IS WRONG OR RIGHT. TRYING TO FIGURE OUT.>>Tucker: THERE ARE ALL KINDS OF MISTAKES THAT PEOPLE MAKE AND MOST OF THEM ARE IN GOOD FAITH INDUSTRY THAT MAKES THE PRODUCT USING PHYSICIANS AND THE PUBLIC TO USE MORE OF THE PRODUCT, THEN I THINK IT’S FAIR TO SUSPECT THERE IS A FINANCIAL MOTIVATION AND I DON’T WANT TO BE A LEFTY ABOUT IT AND I DON’T WANT TO USE THE PHRASE GREED IS KILLING PEOPLE. BUT IT KIND OF LOOKS LIKE THAT A LITTLE BIT. IF YOU SEE WHAT I MEAN.>>AGAIN, I CAN’T SPEAK FOR WHAT A PHARMACEUTICAL COMPANY MIGHT DO. I WOULD HOPE THEY WOULD WORK IN THE INTEREST OF THE PATIENT. AGAIN, I REALLY THINK THE DISCUSSION SHOULD BE ON HOW DO WE ASSESS PATIENTS FOR PAIN MANAGEMENT AND UNDERSTAND WE HAVE THESE OTHER TREATMENTS FOR THOSE PATIENTS. IF THEY DO DEVELOP AN ADDICTION PROBLEM, WHAT ARE THE RESOURCES FOR THOSE PATIENTS. I THINK REALLY WE NEED TO EXPAND OUR UNDERSTANDING OF PAIN MANAGEMENT AND DEAL WITH PATIENTS ARE SUFFERING MILLIONS OF PATIENTS WITH CHRONIC PAGE. AND THEY NEED TO HAVE PAIN TREATED EFFECTIVELY. I’M NOT IMPLYING THAT THEY ALL NEED TO BE ON OPIOIDS. THERE HAS BEEN A LOT DONE TO RADIO KIND OF DECIDE AND STRATIFYING PATIENTS, DECIDING WHICH PATIENTS ARE AT RISK AND WHICH AREN’T. MONITOR PATIENTS BETTER AND HOPEFULLY THAT’S WHERE MEDICINE IS GOING AND AT LEAST THAT WILL HELP FROM THE PRESCRIPTION SIDE SEE A REDUCTION IN THE DEATHS RELATED TO OPIOID PRESCRIPTIONS.>>Tucker: HOLD ON, I WONDER WHAT YOU THOUGHT OVER THE PAST 15 YEARS WHAT THE MANUFACTURERS THOUGHT WHEN THEY SAW IT OF COURSE THEY KNOW WHERE THEIR PRODUCT GOES THEY DID SEE IT THERE WERE COUNTIES IN WEST VIRGINIA AND KENTUCKY THAT WERE GETTING BY A FACTOR OF LET’S SAY 10 MORE OPIOID DOSES THAN THEY HAD PEOPLE. WILDLY DISPROPORTIONATE TO ANY CONVENTIONAL HUMAN NEED. CLEARLY THAT’S FEEDING A ADDICTION U SOCIAL DISASTER U AND THEY DIDN’T DO ANYTHING ABOUT IT WHERE WERE YOU WHEN THAT WAS HAPPENING.>>I CAN’T SAY WHAT WAS DONE IN SMALLER COMMUNITIES. I HAVE TO SAY THAT THERE WAS IN SOME CASES DIVERSIFICATION OF MEDICINES, THERE WERE PILL MILLS, PHYSICIANS OR BAD APPLES WERE PRESCRIBING KNOWINGLY THESE MEDICINES WERE GOING TO BE ABUSED AND MISUSED. I CAN’T SUPPORT OF ANY OF THAT.>>Tucker: IT WAS YOUR GROUP TO HELP CONVINCE PHYSICIANS TO BE LOOSER IN PRESCRIPTION OF OPIOIDS. GOTTEN EXTREMELY RICH ON THE FORBES LIST BECAUSE OF IT. THEY KNEW THIS WAS HAPPENING AND DIDN’T DO ANYTHING. I DON’T UNDERSTAND WHY.>>I THINK I WOULD MAYBE CORRECT THAT AND S. THAT OUR GROUP, PAIN MEDICINE AND OTHER PAIN ASSOCIATIONS AND PHYSICIAN GROUPS, THE AMERICAN MEDICAL ASSOCIATION HAVE BEEN SUPPORTING, YOU KNOW, APPROPRIATE MANAGEMENT OF CHRONIC PAIN. AND, AGAIN, WHETHER THAT INCLUDES OPIOIDS OR NOT. OUR GOAL HAS ALWAYS BEEN TO ASSESS PATIENTS. THERE IS A NUMBER OF DIFFERENT STRATEGIES PHYSICIANS CAN USE TO, YOU KNOW, HELP MONITOR PATIENTS TO SEE IF THEY ARE TAKING THEIR MEDICINES EFFECTIVELY.>>Tucker: I GET IT. IF YOU ARE SUGGESTING THAT PEOPLE USE OPIOIDS IN WAYS THAT THEY DIDN’T BEFORE. THAT’S WHAT THE STATEMENT WE READ SUGGESTS. ISN’T IT INCUMBENT ON TO YOU SEE HOW THAT TURNS OUT. YOU SEE LIKE MASSIVE AMOUNTS OF HYDROCODONE GOING TO SOME PHARMACY IN FLORIDA OR WHEELING, WEST VIRGINIA, DON’T YOU GET ON THE PHONE WITH THE FEDERAL GOVERNMENT AND SAY WHOA, WHOA, WHOA. THERE IS SOMETHING WRONG HERE BUT NO ONE DID THAT.>>YEAH, TUCKER, I’M NOT SURE WHAT HAPPENED AT THE FEDERAL OR STATE LEVEL TO BE MORE AWARE OF THIS CRIMINAL ACTIVITY THAT WAS GOING ON AROUND THAT AGAIN, OUR FOCUS WAS REALLY AND HAS BEEN TO REALLY PUSH FOR BETTER

Opioid crisis | Pain Relievers are leading to a New Drug Injection Epidemic


Welcome students and prospective candidates and alumni I’d like to take a few moments to thank you for joining us today for this amazing learning experience and As your maphsa executive board member and also your mph online student ambassador it is my responsibility To help seek out events that represent our students interests USC Master of Public Health students are extremely interested in our nation’s opioid crisis and They desire to learn more about how to address this issue as public health professionals With the CDC’s March announcement of a national 30 percent increase in overdoses from 2002 to 2006 teen to 2017 this discussion could not be more timely It is an honor to introduce today’s hot topic speaker and educator Ricky Bluthenthal, PhD He is not only faculty in our preventive medicine department and Master of Public health program But a research expert and authority on our nation’s opioid epidemic we are very fortunate to have him as one of our professors and Please join me in welcoming this amazing guest we are sure to learn a lot from him welcome dr. Blumenthal Thank you for those kind words Why don’t we get started? So for 25 years I’ve been conducting research on Health issues related to injection drug use I began With a response to the HIV epidemic And stuck with it long enough to now be dealing with this addition this new challenge to public health For people who use drugs, which is the opioid crisis an attendant overdose death and other? Health out health ailments that are I’ll discuss more in more detail later on so let me just get started So I’ll talk about how we ended up with this prescription opiate epidemic, or crisis I’ll talk about the health consequences of it and then I’ll provide some Recommendations about how we might respond? Respond to this nationwide crisis and may just make a point that you know I started with HIV In the United States HIV really was relegated mostly to cities in large measure And I’ve obviously had an outsized impact on minimum sex with men and to a lesser extent people inject drugs, although certainly in the Northeast there was a substantial HIV epidemic among that population – part of what distinguishes the British opiate epidemic from prior crises Is that it really is impacting all of us in all kinds of different settings so rural urban suburban White black Latino Asian you know sodor no one is immune to the consequences of this and I’ll sort of I’ll begin to explain why that’s the case? So the opiate epidemic Basically has three. It’s a three-legged stool The first the first leg of the stool was a change in in medical practice related to pain in the early 90s it was widely Conceded that physicians were under treating Pain and so there was an effort Led to sort of change that so physicians became more interested in treating pain Now that created some in there sort of this idea of the as pain as a fifth vital sign And that created some unintended consequences So one of which is that pain is very subjective So we all experience it differently we could have the precisely same Injury and have widely different assessments of how much it hurts And we know there’s not a great understanding of that Another problem with pain is that? Typically when someone’s prescribed the pain medication if there’s a problem the recommendation is sort of give them more of that pain medication And in the face of these sort of new opiate medications that becomes a real problem And then finally there was a real move away from just using opiates to treat acute pain And so you might think about that if any of you had your wisdom teeth taken out you were probably given in an opiate kind of pain medication You know and they’re great for treating acute short-term pain That’s why they’re widely used in the military when people are shot or injured The but the move of them into chronic pain created a whole separate set of problems So that’s one stool pain is a fifth sign the other was new technology so pharmaceutical companies develop these long-acting opiate medication so the typical opiate medication will last four to six hours these new formulations Were advertised as lasting eight to twelve hours Which has some modest advantage in sort of taking fewer pills But I think it’s now well documented both in popular literature in the scientific literature That they’re not necessarily that long-acting and some of that just relates back to the issue of pain being a subjective Subjective kind of phenomenon Regardless there really didn’t go through the trouble of establishing that these long-acting approaches were superior to the short acting formulations The abuse potential for these medications was not established before they became widely Distributed in the fact that manufacturers claimed that they had low Abuse potential which we now obviously know it’s not true, and then of course the other pieces that when you use these medications Outside the context of either chronic or acute pain the euphoric effects are substantial so they they make you very high To put it a different way, and so they’re highly desirable as a recreational drug Then the third leg is pharmaceutical marketing now these are large multi-billion you know large companies global in nature billions and billions of dollars of annual revenue and profit so their capacity to Make sure that these medications were widely available to anyone who might possibly need them are really impressive In the case of the one of the manufacturers there was a successful effort to target physicians And they began by focusing on physicians with high rates of OB They were spending Enormous amounts of money marketing these medications to physicians and when in one case a company spent Over two hundred million dollars on that and another year they reached 90 thousand physicians in the United States Because the dis because the the distribution system is through medical care It’s sort of available in every zip code or many zip codes and then lastly this again the shift away from acute pain to chronic Which is driven. You know if you’re a pharmaceutical manufacturer their real advantage There’s a lot more people with chronic pain than acute pain and so that shift to current using these medications for chronic pain sort of created the circumstance We’re in so this chart Just shows you the massive increase in prescription opiate availability in the United States And so the way, I think about this is essentially What we’ve created a circumstance Of is that? for anyone who might misuse opiate prescription medications they probably had a chance to do so That could happen through diversion so someone in their family gets those medications Excuse me, and and don’t you doesn’t use all of them So there’s some left in the cabinet the medicine cabinet, and they begin using that way That could happen from people who have an acute or chronic pain injury who begin to misuse as a way of managing both the pain or of achieving highs, and it’s worth pointing out that the One of the challenges with these medications is if if you continue to have pain You know they will prescribe higher doses Which will facilitate this sort of process of becoming physically dependent which is sort of a unique quality of opiate medication so if you stop using them you feel very sick or unwell And then the other piece of it is that the sort of some patients Became miss users from sort of this escalation of to treating their pain The other thing is is that if you take these medications for a long time You can develop a condition called hyperalgesia Which makes you really sensitive to pain and so you’ll ease you know so you sort of a caught up in the cycle of You know you’re more You’re hypersensitive pain So you start off you had a pain problem the medications perhaps dealt with it Or didn’t deal with it you took more of it You’re now physically dependent And then you’re even more sensitive to pain so you wanna your desire to take more increases even more? So you know those are the conditions that sort of? Have emerged for us and You know as a consequence There’s obviously there’s been a response so one of those responses is the development of these abuse to turn pill formulations And what those the goals of those those medications or to not allow you to break the pill down The reason why people would break the pill down is that if you take a long-acting pill and say crush it to snort it or Liquefy it to inject it the euphoric effects are substantially greater So you you you get a uniform of a better term a better high? so we’ve had the introduction of these new pill formulations to To work against that although you know they’re not They’re available now They’re in use But they’re still the old kinds are so available There’s now prescription drug monitoring programs in most states, and what that basically is is a repository of all prescriptions given to people and what it allows physicians to do is if they have a patient in front of them for Whom an opiate medication might be indicated they can look into this prescription drug monitoring Website and determine whether the person already has outstanding medications for that so it’s a way of dealing with the issue of doctor shopping and sort of drug seeking in various medical facilities the other thing is the FDA and Cities and states have actually suits excessively to prescription opiate makers in a variety of settings But you know owing to some of the changing political dynamic United States those settlements are tended to be on the smaller side and certainly You know in the case the last case. I looked at I think a manufacturer agreed to pay West Virginia 25 million dollars But you know they’re making billions of dollars on the sell of these drugs So a twenty five million dollar fine here, are there is not going to stop them or deter them so Beginning since 2011 we’ve had this sort of substantial design Decline in opiate prescribing the president the other day indicated that he’d like to see that drop another 30% Which sounds well and good But there are some problems with sort of rapidly removing These medications from circulation now that everyone has sort of been Been exposed to them so this chart shows you Sort of this is from the National Household Survey national survey on drug use and health shows you past year initiation past year misuse and past year Disorder for prescription opiates which are in the blue and heroin which is in the in the red and? You know the key point here is that we’re sort of in a pickle now, so we’ve exposed lots of people two million people initiated prescription opiate misuse in 2016 another Almost two hundred thousand initiated heroin use we have nearly 12 million people With past year prescription opiate misuse and nearly a million heroin Mis users and then high numbers of people with opiate opiate use disorder and heroin use so one of the things that’s going to happen as we pull back the Legal the available is a little legal medications is that people will begin to move into illegal substances So we’ve seen if you just look at the last bullet a five-fold increase the number of heroin users in the last decade And the reason for that is that heroin is pharmaceutically similar to prescription opiates It’s also less expensive In illegal market so in Los Angeles for instance you can buy a what’s effectively a dose of heroin for ten dollars whereas buying a prescription medication Opiate would cost between 30 and 90 dollars sort of depending on the amount of the milligrams of opiates in the in the particular pill Heroin is now widely available in urban settings and is increasingly available in suburban and rural settings to match the market demand That’s been sort of created by these by the pharmaceutical drugs so You know these are because we’ve been out a couple reports. We don’t have great data on this, and we don’t have really good surveillance That allows us to understand Transitions between drugs so even the National Household Survey is a cross-sectional study There are relatively few local cohorts of non Injecting drug users that we can sort of follow And see how many people translate trends are transitioning from opiates to heroin or from heroin to injection. Here’s some of the data That’s available at least on that first point of movement of people from prescription misuse to heroin use so the first study saw about four percent Movement in five years Carroll sins with Carlsen’s which is the most recent study from, Ohio? Found among prescription opiates opiate users about three percent of them became heroin users and then Sarat looking at a group of Club drug users many of them were men of all sexes men saw an annual take a seven percent So the so the thing to think about though is that that translates into a real number at the population level so if there are 12 million people With prescription opiate misuse you know seven five percent of them moving into heroin use is a substantial number of people hundreds of thousands of people and so That’s going to continue to be a challenge for us moving forward So injecting heroin similar to injecting prescription opiates creates a better high There’s some forms of heroin so the heroin that’s available west of the Mississippi tends to be black tar heroin so it’s more difficult to use without injecting and We also know from the National Hospital survey that of the people who use heroin half of them injected And that compares to 13% for meth users and cocaine users, so The sort of premise is is that we have all these things happening. We have an overdose epidemic I’ll show you data on hepatitis C and HIV outbreaks There are a variety of other ailments coming with that, but we also have which has not been talked about an emerging injection drug use epidemic That’s going to have substantial public health consequences So the way, we’ve looked at this is what using low all day They’re from San Francisco, Los Angeles, and this is based on sort of two studies. I’ve conducted In the last eight or nine years One to cross-sectional study that was the first one in 2011 13, and then I have a cohort study That’s ongoing now And what we’ve tried to do is sort of bring in some I guess what I would call sociological context into understanding drug use Drug use patterns so the first one is the sort of idea of drug use generations And if you sort of survey drug use patents the United States you would see You know an evolution of people moving from away from heroin in the 60s towards cocaine and then from cocaine to crack cocaine in the 80s From crack cocaine to meth in the 90s and 2000 and then from math to this prescription opiate stuff Which is sort of in the nineteen? That really beat really took off in the 2000 so in that sort of the current place. We’re at And that’s useful to think about because that the the one of the underlying I think principles of drug drug misuse Is that if you are susceptible for drug misuse you end up using the drugs that are available at the time? and And the implication of now having this opiate Be opiate be the main problematic illicit drug Has real consequences because opiate users tend to use four years not? In decades not months and years which kind of characterised You to the crack the cocaine the crack cocaine and even to a lesser extent the methamphetamine Cohorts or people you know will start the mess around with it for a while But typically they’ll age out of it or their life circumstances will change, and they’ll move out of it Or they’ll just get get burned out we know from the earlier generation of heroin users that came out of the Vietnam War era You know those folks continued to use for 20 30 40 50 years And that’s what we’re looking at now, so we’re going to have a problem That’s going to go on for a long time so using this idea about drug use Generations, that’s helpful and sort of contextualizing the implication the change from Math to prescription opiates the other thing we do is we use this drug set and setting model Which again sort of underscores the need to look at the pharmacokinetic? attributes of the drug and how that impacts use patterns And I sort of already described that to you, and then finally life course theory is helpful and looking at How people age or don’t age out of drug use and then how they remain vulnerable And you know one of the early warning signs of the prescription opiate crisis was the fact that you saw older people requesting substitute substitute medically assisted treatment or opiate substitute treatment In Different demographic groups, and that’s you know that’s unusual typically if we’re going to misuse drugs. We will misuse them through our 20s But most folks age out of it and so when you begin seeing 40 and 50 year olds requesting treatment For methadone or buprenorphine, then you know that you’ve got a you’ve got a different you’ve changed that the life course framework of drug use in the United States All right So I’ve sort of briefly described the studies one the first ones cross-sectional the second is a cohort study were in the midst of Still collecting our six months and 12-month dated for that So the characteristics of my sample mostly male um But a little less than 15 to 2 B to 15 20 % gay lesbian or bisexual mostly white but with decent representation of Latinos and african-americans the population I see is largely homeless and You know one of the next things I’ll be working on is this big jump in the prevalence of homelessness which went from 60% in the 2011 13 kampl to 80% over 80% of the 2016-17 and then in and then we’re also seeing a basically doubling of younger people between the – the two studies Alright, so part of what I that We’ve done with this work is just begin to map on that this population of people who inject drugs actually can give us a Some a window into understanding national drug use trends, and so this slide just sort of Is my attempt to sort of match those two things so what you see is a the proportion of the sample that? report using this drug for the first time by half decades and you see we have a Heroin peak in the late 60s. That’s been replaced by a cocaine peak In the late 70s and the crack copaque coke cocaine peak in the late 80s and then map jumps up And then you see math being surpassed by prescription opiates Going into this last period of 2005 to 2009 so we so I think this this sort of makes a case for saying Yeah, it’s reasonable to use this kind of sample Using their retrospective reports to sort of understand national draw houston’s so the first question is you know what are the implications of having? prescription opiates be the sort of main illicit drug that people are using them and this shows you one of those that change so one of the implications is the move of prescription opiates from being relatively infrequent initiator of opiate use Most folks start in the eighties and so what this shows you trying to explain. It’s a little bit complicated. Is that the first? Column the pre sixties generation so this shows that About 12% of them are 15 percent of them started their opiate use with prescription medications And then most those start with heroin which was this middle one and then at the same age? And then if you just look at the first bar in each column you see it grows substantially so by the 1980s Nearly 70% of people their first opiate is the prescription drug or they’re using them in the same year? Which is a? on the far right So that’s a big. That’s a big change and part of the implication of that is you know again heroin What is not widely available although increasingly it is? Presumed opiates are everywhere and so that’s what’s sort of driving. This is that you you get the sort of generational switch and drug use patterns And this is sort of another way of representing this now. This is looking at the first drug injected And what we saw here what we see here is the top line is heroin and the bottom line is cocaine or meth And so again reflecting the surge drug use patterns the first drug injected was increasingly a speedy drugs or cocaine or meth but then as These new chords come on you see begins to go down and instead We have heroin becoming the first drug we inject and if we drew another line out From the 90s we didn’t have a lot of people in the sample who were born in the 90s But the number continues to go up So we’re going to have more heroin Injection as a consequence as a sort of follow-on from the prescription opiate crisis, so then the next thing again trying to make the point about how Opiates leading to heroin leading to injection sort of changes the injection drug use epidemiology in the country we sort of developed two measures one of them is a One of the one is sort of time to injection and that’s a broader measure Focused on one how old were you when you first used an illicit drug, and then the you first injected any drug right so That’s just one measure of time. That’s one time two injection, and then we have a second one that asks the question When you you first use any drug how long was it before you injected it? And all of this the take home for this will be Largely that the the uptake of heroin means that we’re going to end up with a lot more injection drug users moving forward So just looking again remembering that we had this change of people using more heroin injection This is the overall time to time from first use to injection by birth cohort again and You see it was pretty low for the pre sixties generation that was mostly exposed to heroin and then went up with cocaine and crack Cocaine and now it’s going down again And you know we’ll be able to look at this in my new sample, which has many more people born in the 90s But I would expect that the bars for the folks born the age cohort born in 1990s would be even shorter And then this just sort of looks at that using Multivariate regression so linear regression model with time to injection as the Dependent variable and the key thing here is we just look at the bottom two rows We see there’s a negative number with the 1970s as a referent and what this indicates is that? folks born in the 80s were significantly had significantly shorter times to injection as Compared to folks born in the 70s which sort of reinforces that point All right, so then we use for up revival analysis techniques to look at time from first used to first injection And again this sort of shows this unhappy story with heroin users median survival time is a little more than a half a year so from the first used of heroin to your first injection less than Less than a less than a year It’s over a year for speed and then much much old much much longer for the cocaine and crack cocaine And then within ten years of first use ninety-three percent of the heroin users will have injected as Compared to 78 percent for meth and 70 percent for Coke for cocaine users and then thirty percent for crack cocaine users And then last this is just a representation of data again And the point of this is just to show that a lot of that action really is in the first year so the slopes on these lines are not significantly different But what is different is the entry point so that first year of use? And seems to inevitably lead to injection for most most heroin users All right so the opiate epidemic associated a more rapid transition to injection drug use and the people using heroin Which is the drug that sort of follows on naturally from prescription opiates are going to end up injecting? All right, so one of the problems with having more injectors Is that in a way injection baguettes additional injection and so let me explain what I mean by that? So we conducted that initial study twenty eleven to thirteen was a study on how people basically asked a question how do people become injection drug users and what we found was that it is an a It’s a it’s a process. It’s a social learning process, so folks would be the stories that people told us about their pathway to injection involved exposure to injectable drugs Being around people who injected drugs an opportunity to receive instruction an injection and then actually getting assistance Injecting you know most of us don’t like getting shots. We’re needle phobic. It’s difficult to hurt yourself intentionally which injection Requires and so basically 70 to 90 percent of people who ever inject need help injecting that first time And so this sort of social learning process sort of summarizes that process so we’ve asked questions of people Like have they do they encourage others to inject drugs do the injector foot of mountain injectors do the escribe injection to non injecting? Understanding that these are potentially precursors to injection drug use for non injectors and what this shows you is that these sort of precursor behaviors are Associated with initiating people so if you’ve ever described injecting to someone you’re more likely to have initiated someone in the past 12 months We also Looked at whether you’re being asked and that sort of Is a good measure of that so that the person who currently injects is sort of involved in that social learning process And what this basically just shows is that? When you do these precursor behaviors when you inject in front of non injectors when you describe injections and non injectors or when you do both You’re going to be much more likely to be asked to initiate someone for the first time And this is sort of as a chart a figure that sort of shows that again the bottom one has ever initiated someone You know if you’re not injecting in front of non injectors. If you’re not describing it if you’re not doing both you’re very very low probability of initiating someone either in a lot of 12 months or ever which is the middle line and Then you see the thing about being a switch is the top line Okay, so one of the things that’s disturbing We know that heroin use has increased based on the national surveys the data that we’ve collected in San Francisco and Los Angeles indicates that injection both from the changes in the demographics of our sample But also in the self reports from people who currently inject It looks like there’s more initiation going on so you can see these are comparing the 2011 13 samples of 2016-2017 sample recent initiation was 7% in the order sample, it’s 13% in the in the newer one and we changed the question so the question in the newer one is for the last six months so That number if we if it was annualized it would probably be higher describing injections gone down, but injecting in front of non injectors Has gone up and that probably has something to do with the increased homelessness? And then a willingness to initiate people the future is basically equivalent so just so you know I am trying to do something about that and my current study the sort of second one is a short hour long Active listening motivational interviewing intervention with current injection drug users to sensitize them to the risk of the sort of precursor behavior and then to provide them with behavioral skills and role-playing Opportunities to sort of figure out how to get out of those situations that they find them find themselves in them Alright, so one of the consequences of all of all this that they’re they’re relatively horrific in 2015 Scott County Which has about 40,000 people in it at an outbreak of HIV and hepatitis C among their among the people inject drugs there Those 102 183 infections in a year just to give you an idea, LA County Which has 13 14 million people in it has 56 injection drug use related HIV cases in that same period of time So 40,000 people will 183 HIV infections to 56 with 13 million people there documented outbreaks of hepatitis C in, Kentucky, Tennessee, Virginia West Virginia most of those cases now because we have a clean drug supply or going to be from injecting drugs so sharing syringes or sharing cookers cotton or other drug use injection paraphernalia HIV incidence has increased among young people in non urban counties We’ve seen dramatic increases in abscesses of skin and soft-tissue infections that are often associated with Injection drug use. We’ve had these increases nationally in in North Carolina and infective in hospitalization for infective endocarditis related to drug injection We’re seeing this age cohort difference now so acute HIV kiss season acute hepatitis C Rates have increased among young adults and so the difference between the acute hepatitis E. Case of chronic as I see cases acute cases new So those are folks who’ve been affected in the last six months dramatic increases after long-standing The Pines among hall populations again that tracks with increasing evidence of more drug injection in the United States This is data from California showing the age distribution of chronic hepatitis C cases So we went from having a nice little bell curve or one hump camel to now emerging to have a two hump camel as younger people begin to increasingly become infected with hepatitis C And then you can see this is some representation if it’s darker means more hepatitis C And this sort of underscores again the you know almost global impact, or you know it’s sort of hitting everywhere So we have increases in Los Angeles Serban the quintessential urban commune in California increases in the bay area, but also increases in these sort of urban or rural areas in Northern, California Where folks are moving You know or getting getting have been exposed to prescription opiates are Misusing them through injection or perhaps transitioning to heroin if that’s available in their local communities And then we’ve all talked to there’s no law to talk about the overdose stuff So there’s a so there’s sort of two qualities of this earlier. I made the point about as we pull back prescription opiates We do run the danger of people moving to the illegal alternatives and that happens so you see this reflected in the heroin overdose deaths Beginning in 2010 how they’ve gone up dramatically and then the thing that The begin to happen in 2013 is that the heroin supply became contaminated with synthetic Synthetic opiates the main one being fentanyl, this is a problem because fentanyl is 10 to 50 times more powerful than heroin So the risk of overdose increases dramatically And that sort of it’s a sort of contamination thing, so folks don’t This may change, but at the moment for instance in Los Angeles folks aren’t buying fentanyl. They’re buying heroin But it’s been contaminated with fentanyl, and this is sort of happening throughout the country so We have out we have these HIV hepatitis C outbreaks We have the overdose crisis the contaminated drug supply Increasing drug injection and a treatment system in the 25 years. I’ve been doing this stuff that has not Increased to match the problem And so we’re poorly prepared To to deal with this, but there we do have lots of options So let me just start with the first principle which is that? We need many approaches not just one and you know as you follow this debate in the newspaper Or as you talk to local decision makers or state decision makers of your Nationals This is makers keep in mind that there isn’t one solution to this so there You know we’re going to need to sort of open the full box and take a look at all kinds of different options so this was a Cascade approach that we developed We weren’t able to test it, but we did a couple colleagues of mine Pete Davidson. Who’s at UC San Diego? Source on a scholar who now works for the LA County and Carl Castro, who runs our military health center here at USC We put this together just looking at this And it just the idea is just to highlight the different kinds of choices if you’re trying to deal with diversion You might want law, but you know lock cabinets or lockable pill boxes if you have patient driven diversion You know you might want to use peer River or referral to injection drug use if people are to drug treatment rather? If people are selling them you might want to get someone a job, so they don’t have to sell drugs and said if their self medication get them adenosine n’t provide them with overdose prevention training or naloxone And then referral to drug treatment, so there are lots of things to do I’m just going to take you through a little bit of a laundry list of what some of those things might be So we can do demand interventions to prevent Injection initiation so part of that would be making drawer treatment more widely available But there are some sort of cognitive behavioral Interventions the one that Dante’s related back in the 90s that sort of tried to arm current non injectors with information about how to About why they wouldn’t want why they why they don’t want to become injection drug users? There’s this combined structural interventions that Daniel Warp is at UC San Diego in the University of Toronto is exploring which looked at combinations of drug consumption rooms increased medically assisted treatment housing first and decriminalization of illegal drugs We can do what I’m doing with the existing population of injectors and try and move them away from facilitating an injection uptake And I’ve already described that to you the middle the middle bullet. It’s the one we’re doing which has changed the cycle Now obviously no oxygen distribution has been very important the Peer drug users and drug injectors are among the most effective respondents to overdose They know how to know what it looks like if you arm them in the hawk zone. They’ve shown over and over again They’re more than happy to use it And it probably been very effective and you know we’re sort of Collecting more and more data about this about how effective this sort of approach has been to preventing overdose deaths And then we spread first responders now Obviously from paramedics and carrying naloxone for years, but now police are increasingly carrying them carrying it as well You can see this just shows the rapid uptake now and distribution of naloxone in the country so it’s important important Development so here. I just that we use the data again from our 2011 13 sample 2016-17 so the lighter is The later one and these are broken out by City and the key thing here is just to note that You know we’ve seen increases in overdose between the two samples probably in part because of the fentanyl contamination Many people inject drugs witness overdoses, so they’ve gone up dramatically in Los Angeles, but most importantly We’ve also increased on the locks own distribution And so it went from being used four percent of the time when someone observes an overdose to almost 70 percent of the time So this shows you the power of Drugging drug users to be health interventionist in the midst of this particular crisis The same thing has happened in San Francisco services we had a little bit higher baseline of naloxone distribution but you know now 90 percent of the witnessed overdoses someone in the community is reversing that with an auction which is a tremendous help a tremendous help health benefit The other hot topic is the safe injection rooms they accomplish a variety of things So there are about a hundred in the world. No one’s ever died in one of them. I’ve visited Probably four or five of them over the years the sort of clean well-lit places to use drugs They’re very effective at perennial dosed us. They’ve been documented to provide a Great Avenue into services including substance abuse treatment and housing they obviously because people are using a loan Reduce any risk of HIV or hepatitis C transmission because the setting is clean you should see declines in the defective card ID in the endo carditis and abscesses And then finally because people aren’t using out in the community that using these facilities That reduces the socializing aspect so in fact in Switzerland They have Had safe consumption sites for many years since the 90s And if I do heroin prescribing and have seen a dramatic decline in their population of drug injectors Because the current cohort of people who use don’t use in the community They use in this facility and so they’re not in a position to socialize others into the use Of course we need to expand treatment dramatically. There are a whole set of regulatory and legal Impediments to that that we need to overcome in fact. I went to having a conversation with a pharmaceutical Maker earlier of manufacturer earlier today and learned of a new way in which we sort of prevent ourselves from making These these evidence-based treatments as widely available as they need you know for me The gold standard really has to be that we need to make legal treatments or substitutions as Readily available as the illegal drugs are and less expensive than them so right now in Los Angeles It’s a lot easier for you to get heroin than it is for you to get drug treatment And we need to change that and this just sort of underscores that point we’ve had you know there’s been great progress in improving methadone Availability and buprenorphine, but if you refer back to my earlier slide remember there are almost 2 million people last year that had prescription opiate disorder and another 600 700,000 and heroin use disorder and there are only 400,000 methadone slots similar there are only 55,000 buprenorphine slots so that that capacity is insufficient to meet the demand that we have And then this is just a little list of different things you can do and how they deal with the sort of downstream consequences of the opiate The opioid epidemic including drug injection these HIV outbreaks overdoses fentanyl a lot of things that we can do and And we need to move on it quickly you know what I’d like to see and what I would have liked have seen yesterday when the president was addressing this topic is a response like we saw for the AIDS epidemic where You know billions of dollars were put into the fight to develop new medications to provide Preventive services to make sure people have asked access to care, and we’ve made tremendous improvements in that HIV is now chronic ailment Most people certainly in developed countries receive care many people in developed countries now receive care And that’s sort of what we need to look for in terms of the prescription opiate crisis. Let me just conclude by acknowledging funding from the National Institute of drug abuse Our project officers my best friend and collaborator Alex crawl and then the community participants research assistants Students at USC who have all contributed to this work. Thank you for your attention So we’ll do questions now Yes, thank you. Dr. Blumenthal for that sharing that information We will not now try the answer your questions to submit a question Please type it into the Q&A box in the lower right hand corner of your screen and hit Send Dr. Gluten all he shared a lot of very important information with us, and he’s happy to answer any questions that you have We do have one question right now dr. Blumenthal One of our attendees asked, can you briefly describe a little bit more about the? Pharmacogenomics and the opioid epidemic and where are we with that? Probably not I’m not sure what pharmacogenetics are Okay you give me a little bit more about that. All right. I’m so sorry the Pharmacogenomics and the OPA no I don’t know what that is So tell me what that is, and then we’ll try to answer it Sorry Okay, no problem. We will move on to them to our next question Our next question is of what’s considered abuse of opioid use if an individual’s tolerance is higher than average users Yeah, I mean I think you know basically. I mean there are a couple of definitions of addiction out there You know typically it means For one of a better term I mean the search one would be sort of you know repeated use with negative consequences So you’re using so much that you can’t do the normal things that you would typically do The so you can have situations where someone is dependent on an opiate But it not be addiction and so cases like that might include folks with who are terminal cancer patients And so they’re taking it for pill for pain relief For the cancer they’re dependent on it, but it wouldn’t be considered addictive behavior Because it’s used to sort of deal with the sort of in life Moment that they’re going through you Know the issue is really What are the other things happening around you that lead to negative consequences? whether it be driving high or missing work or Selling your toaster. Oh And so here’s one so how does genes so this is the pharma Gen X? Thank you? Reidel so how does that affect a person’s response to drugs? So thank you for clarifying that? You know I do not know the answer to that question Let me just tell you what I think generically about Genetic explanations for substance abuse which is that? I’m sure that there is some contribution and we know that you know there’s some genetic markers for instance for alcohol and we know There’s some genetic Predispositions that certain populations have that make alcohol use more problematic for them those probably do exist For opiate medications as well You know I you know, I’m a sociologist the part of the problem I’m focused on more is the the other dynamics Which is that regardless of what your genetic profile is if you’ve been exposed to these drugs? And you begin to misuse them we do have relatively consistent outcomes from that And the genetic contribution to that as far as I know is not is certainly not well understood So I just keep going to the list jennifer yang Can we treat opiate abuse as a chronic disease? Well, yeah, it is a chronic disease. That’s for sure I think one of the areas that people are going to really begin focusing on is that pain is a chronic ailment And we need to come up with other ways of treating pain that don’t involve prescribing folks drugs that are highly addictive So I just keep going guys or Absolutely dr. Blumenthal Okay, and then there’s a question from Douglas about what are your thoughts on how the opiate epidemic affects state or federal? public Public health policy for treatment conditions are concerned Okay, so this is I actually learned something about this today, so let me I will try and share this with you And there are a couple of thoughts related to it, and I’ll end with the thing that I learned today Okay, so the first thing that we one of the problems that we’ve had I talked about medically assisted treatment, so that’s methadone and then buprenorphine. Those are the two main medically assisted treatments They’re highly desirable because they really are effective so people who use these medications you know their their use of illicit drugs go down substantially They’re great benefits in terms of employment and housing and social you know their ability to sort of have lives that look like they don’t have Any drug use history so they’re there they’re really powerful that way unfortunately they’ve also been heavily regulated There have been changes most recently in the legal status are none Can prescribe so for instance there was just a new directive that came out a couple of months ago from the federal government? Then now allows nurse practitioners and physician assistants to also prescribe buprenorphine So that’s a that could be very helpful moving forward Now one problem is so we have this Medicare system and Medicaid expansion so many more and we also have parity so You know substance abuse, which is a mental health illness? Should be treated the same way as a broken arm in terms of availability of treatment But there’s a thing beat that sort of happens behind the system that gets in the way of that So let me tell this so this is a new thing. I learned so there’s these things called pharmacy benefit management organizations that basically create the form of the the the farmer the farmer call the pharmacy formulary, so that’s the drugs that a provider can use to treat you know XY and Z and because of market dynamics in that system some of the best kinds of and most innovative substitution medications actually aren’t available through people’s health insurance and The example I learned us today was this drug this buprenorphine Alternative called Buena Vere Reno Vale, which is you know it’s a soft box own? So it’s a buprenorphine medication that you use as a film So it’s just like a little little piece of paper that you ingest has lower side effects, but it isn’t widely available Because the manufacturer of them hasn’t been able to get through the pharmacy benefit management companies To make it available to insurance so they’re I think one of the things that we have to look at both the state and federal Level is how do we I mean, it’s going to be crazy to say this But how do we deregulate these medications so that they can be made widely available? to UM To people that need them because there’s a there’s a bottleneck at that level as well So it’s very hard to get people into our treatment like I said It’s much easier to get heroin that is going to drug treatment, and we need to sort of change that Okay so in terms of so Sai Provost, that’s a great name ask How do we advocate for more treatments is it lack in terms of beds or funding so I think? There’s a lack you know what would have been great to hear from the president yesterday is You know here’s a pot of money for evidence-based treatment States can draw on it as rapidly as they can get patients into these kinds of evidence-based treatments So there’s a money problem, and then on the other side. There’s a regulatory problem One thing I did mention is you know folks don’t and maybe in your own communities You’ve seen this people don’t like having methadone clinics around them, so they can be hard to cite Part of the advantage of the buprenorphine medications is that they’re designed to be given out by primary care physicians So you don’t end up generating the NIMBYism piece But there are still barriers to making Buprenorphine widely available, but but yeah, we need more money we need physician attention and willingness to address this problem we need Folks to understand all the multiple barriers to drug treatment entry that they have I mean another issue That’s occurring in the population I see is that generally speaking methadone doesn’t have a great reputation among heroin users and Many people think of buprenorphine is very similar to methadone and in fact it it actually isn’t In that it’s a longer act longer acting it has much less abuse potential or diversion potential For naive people, and it doesn’t have it has what’s called respiratory ceiling effect, so It is it’s a pretty protective against overdose so you know figuring out the policy solutions that allow a Lot of these medications to be prescribed through insurances and paid for and then dealing with the sort of barriers to use Among people with with the substance use problems. It would be another thing to look at So can we abuse of treatment yes, so we need more treatment all right, let’s see Jennifer yang Yeah more integrative key care team sure that’s not but that’s not a bad idea but I do want to emphasize again what I see so if we go back to the slide where I presented the demographic characteristics of the population 80% homeless right so we need a system of care for them That’s going to make it easy for homeless people homeless chronic drug users to get the health care They need so it’s less of an issue of when they get into the system is if you integrate it That’d be great but we can’t get them into the system at all and So there’s a lot of untreated people who I know from my many years of doing this work would be happy to receive treatment We just make it really hard for them to get it and and so we really need to rethink How we provide care to this population and think about it in terms of what are the lowest? What’s the lowest? Easiest way we can make it for them to get these life-saving medications So I think I’ve the questions that have been listed are there are others I Don’t see any other dr. Blumenthal, so thank you so much for answering all of those questions for us this afternoon I want to thank you Ricky Bluthenthal, I would like to thank Dr Shubha Kumar as well as Caroline for joining us today And I’d also like to thank everyone who participated in today’s webinar If you have any additional questions, or you know as a prospective student if you think that it’s time to apply Please reach out to either myself or one of our other advisors a copy of this recording and our slide presentation This definitely concludes today’s webinar, and I want to thank you again for joining and you all have a wonderful rest of the day

We need to talk about male suicide | Steph Slack | TEDxFolkestone

We need to talk about male suicide | Steph Slack | TEDxFolkestone


Translator: Leonardo Silva
Reviewer: David DeRuwe Did you know that
by the end of this event, three men in the UK
will have died by suicide? I can still remember exactly where I was when my dad called me to tell me
that they’d found my uncle. He had taken his life, and it had taken three weeks
to find his body. Richard was 47. He was a doctor, super smart,
creative, autistic, he spoke new languages with ease,
he played and wrote music and he understood science and math
like no one else I knew. He was the kind of kid
you’d really hate at school, right? He saved people’s lives for a living, and yet, he decided to take his own. I’d like to take you back to 2010. I was at my new flat in Brighton,
having dinner with a friend, about to start my third year
of university, when my dad calls me to tell me
that they’d found my uncle. That feeling, that sinking feeling in your stomach
when your heart drops all the way down, and all you can think is, “What could I have done
to stop that from happening?” that feeling is not something
I wish anyone ever has to experience. Men are facing a crisis. How many men do you think
die by suicide each day in the UK? Have a guess. Raise your hand
if you think it’s under five. Raise your hands. Under five? Under 10? It’s 12. That’s one man every two hours. While we’re all enjoying our day, we’re going to lose 12 men
to suicide today. In my work, we talk a lot about the fact
that 76% of all suicides are male and that this silent killer is claiming
the lives of more men under 45 than anything else. And I can’t help but find myself
asking, “Why is that?” Doesn’t that trouble you? Because it troubles me. These are our brothers, fathers,
uncles, partners, sons – these are our friends, and they decide to die. I think there are some hard questions
we need to ask about male suicide. I don’t believe there’s anything wrong
with men having suicidal thoughts, but is there something wrong with how
we react to suicide being thought about? Let me explain. We’ll all die at one point
or another, right? Our bodies will fail us,
and we’ll die of disease or old age. Or we’ll have our lives taken from us,
maybe in a tragic accident. So, isn’t it perfectly normal to consider being in control
of our own death? Yes, suicide is intentional, but does that automatically make it wrong? I believe suicide is preventable, and I believe we should do
everything in our power to prevent it, but I also believe
there’s nothing inherently wrong in thinking about our own death. I’ve considered what it’s like to die. I’d like to ask you all
to close your eyes just for a minute. I promise nothing scary will happen
if you close your eyes. Now raise your hands
if you’ve ever had a really bad day that’s left you feeling
maybe stressed or upset. Okay. Keep your eyes closed
and keep your hands raised if that bad day or bad week or bad month has ever led you
to think about harming yourself or taking your own life. Thank you; put your hands down
and then open your eyes. That was about half of this room. I invite you to consider
what might be different if we didn’t see having
suicidal thoughts as wrong, and what that might mean for the men
in our lives thinking of suicide. Let’s go back to my uncle Richard. For most of his life, he experienced
what was most likely bipolar, and he’d had suicidal thoughts
on more than one occasion. In fact, six years before his death,
he attempted to take his life. The sad fact was
that Richard lived in a time where suicide wasn’t considered
something that you spoke about. It was swept under the carpet
and a cause of shame amongst families. There was something wrong with it. I mean, it was only in 1961
that we stopped making suicide a crime. Richard’s parents were medics –
an anesthetist and a nurse – and they didn’t understand suicide either. They didn’t think that it was real, and I think they were probably in denial
about what was happening with Richard. What happened to my uncle
isn’t my grandparents’ fault. Suicide is complex and rarely
attributed to any one factor. But, when I reflect
on Richard’s experience and on how we still struggle
to speak about suicide today, nothing’s really changed. We still struggle to talk about it. We label it as abnormal or unusual, and we make men wrong
for having suicidal thoughts. We say that they’re unwell,
or that they need to get better. And because we think of it this way, it stops us from being able
to talk about it, and we stay silent instead. And suicide remains
shrouded in this stigma. That stigma is only perpetuated by irresponsible
and sensationalized journalism that happens in the cases
of celebrity suicide. Just look at some of the reporting
around Anthony Bourdain’s recent death. When I was thinking about
how best to explain this point, it made me think about
sex and sex education. Stick with me, okay? (Chuckles) It’s really uncomfortable for us
to talk to kids about sex. It’s so tempting to think if we don’t talk about it,
it won’t happen, our kids won’t have sex. But we know that teenage pregnancy
and STIs are the risks if we don’t have that conversation, and we take those risks seriously. We introduced sex education into schools, and it’s now compulsory across the UK. And, I mean, it’s far from perfect, but what it has been shown to do is to improve positive attitudes
towards safe sex, to delay sex and to reduce teenage pregnancy
when used alongside other methods. With suicide, we know it’s a myth that talking about it will plant
that idea in someone’s head. And if suicide is claiming the lives
of more men under 45 than anything else, isn’t it time we just start accepting that suicidal thoughts
are something that happen, and instead start talking openly
and responsibly about it? I don’t think there’s anything wrong
with men having suicidal thoughts. But perhaps there is something wrong
with our expectations of men in society that lead them to have those thoughts. Let’s think about that. What does it mean to be masculine? What does it mean to be a man? Society tells us men should
be strong, dependable, and able to provide for their family. There’s very little research
into the reasons why men suicide, but the recent research that does exist speaks about how men’s high suicide rates
are linked to risk factors such as history
of being abused as a child, single status or relationship breakdown, and financial difficulty or unemployment. So that means that if you’re a man
and you’ve had a troubled childhood, you’re still searching for the one
or you’re worried about money, you’re at risk of suicide! How many of us know men in that situation? I mean, I’ve definitely
just described Richard, and I’ve probably described
half of millennial men in the UK. Unsurprisingly, these risk factors are linked to those
traditional notions of masculinity, of being strong, dependable,
and able to provide for your family. It seems as though when men feel
they can’t meet those expectations, they make themselves wrong for that. The research backs this up too. Just last year, there was a paper
confirming that there is a link between men feeling unable to fulfill the stereotypical
characteristics of masculinity and suicidal thoughts. Now, I imagine a lot of us in this room
don’t agree with those stereotypes, but some of us probably do,
or at least know someone who does. How many of us have been guilty of saying
“Man up!” at some point in our lives? I know I have. The conversation is starting to change. There are great campaigns
like BBC Three’s Real Men Do Cry and CALM’s L’eau de Chris, that are trying to shift those perceptions
of men and masculinity and encourage them
to be more open and vulnerable. But is it just men who are perpetuating
these outdated stereotypes of what it means to be a man and making themselves wrong for that? I don’t think so. I’d like us to consider
what our role is as women. Just last month, I was chatting
to a female friend of mine who described the guy she was dating
as “a sponge” and “too sensitive” because he opened up to her about some of the anxieties
he was facing in the relationship and how that was
making him feel vulnerable. I cannot begin to describe
the look I see on some women’s faces when I speak about how men I know
have broken down in tears in front of me. It’s somewhere between
discomfort and disdain. Men are already making themselves wrong for not living up
to these masculine ideals of being strong, dependable,
and able to provide for their families. They’re already
shaming themselves for that. But we’re compounding the problem
by making them wrong and shaming them for demonstrating
those open and vulnerable behaviors that we say we want them to show us. And we’re making them wrong for breaking out
of these rigid stereotypes and for just being fully human. To the women in the room, I’m not saying that male suicide
is our responsibility. I absolutely acknowledge that men have a huge role to play
in breaking down these stereotypes. But as a woman, I can only speak
to my experience and how I do see our role. What I’m inviting all of us to do,
regardless of our gender, is to reconsider the expectations
that we have of men in society and reconsider how we view men who have the courage
to show us their vulnerability. I’m inviting us to ask the men
in our lives how they’re really doing and if they’re struggling with anything
they haven’t told us about. And can we think about
how we respond to that? How we might choose
to empathize with their pain? Can we hold space for men
and listen to them, without trying to fix things, tell them that we love them and that it’s okay for them
to feel however they’re feeling? I’d like to tell you
about another guy I know. He’s a really good friend of mine;
I used to work with him, actually. His name’s Billy – he’s super smart, he’s genuine, authentic, kind, generous – he’s just the kind of guy
you really want to spend time with. So, imagine how I felt when Billy called me at 11:30 a.m.
on a Friday morning, three years ago, to tell that he’d spent
the night in hospital because the night before,
he’d tried to take his own life. He was 24. You’re probably thinking I felt shocked, panicked, uncomfortable. Actually, I felt honored. I felt honored that Billy felt
that he could talk to me about his suicide attempt
and how he’d been feeling. I thought back to my uncle, and I knew that I had a chance
to respond differently to Billy. I met him with compassion
and understanding, and a safe space to talk about
how he was feeling, without judgment. I didn’t make him wrong
for feeling the way that he felt or for attempting to take his life. I didn’t try to label him as suicidal
or as someone who needed to get better. I simply gave him a space
to talk about whatever he needed to. I saw what he told me
as incredibly courageous, and not something
he should ever be ashamed of. I can’t help but wonder
if this can make a difference. When I reflect on how my response
to Billy was entirely different to the response my uncle used to receive
when he spoke about suicide, I can’t help but wonder what would happen if we had different expectations
of men in society, if we had a different reaction to men who have the courage
to show us their vulnerability, and a different reaction to men
who have suicidal thoughts. Would men feel differently about suicide? I don’t have the answers, but I am inviting you
to consider the questions. Because I don’t believe there is anything
wrong with men having suicidal thoughts, but perhaps there is something wrong
with how we react to that and our expectations of men in society. So, what would happen if we all
have the courage to go home tonight and have conversations
with the men in our lives about how they’re feeling
and what they’re thinking, including their suicidal thoughts? Yeah, it’s going to be uncomfortable, I get that, but we do it with sex! Every parent dreads having
that conversation with their kids about how babies are made. But we know it’s important
to keep our kids safe, so we do it anyway,
no matter how uncomfortable we feel. I wish I could have had
a conversation with my uncle like the one I had with Billy. I wish I could have told him, “There is nothing wrong with you. There is nothing wrong with how
you’re feeling or what you’re thinking. It’s okay. I’m here to listen to whatever
you need to say or talk about because your feelings are important. You’re important, and you don’t have to do this alone.” Thank you. (Applause) (Cheers)

Deadly CYBER BULLYING Epidemic Rising Among Young Men

Deadly CYBER BULLYING Epidemic Rising Among Young Men


Most of us have been cyber bullied at one
point. But according to a new report, teenage boys
get it the worst because they spend the most time staring at a screen out of anyone else. The average amount of time teenage dudes spend
looking at screen is, on average, 8 hours a day. So obviously, increase your time staring at
a screen, and there’s more of a chance you will encounter cyber bullying. But its clear that the problem is becoming
a lot worse, in many cases, its deadly. Welcome back to IO, I’m Charlotte Dobre. Raise your hand in the comments if you’ve
been cyber bullied. U know, with that little emoji. According to a Child wise report, teenage
boys get cyber bullied the most out of any other demographic. Cyber bullying can often lead to more severe
kinds of harassment. 22 year old Ryan Woollard from Leeds says
that throughout high school, dudes he had never seen before would come up to him and
punch him. Ryan doesn’t remember much, but he does
remember being on the ground and being punched in the face. He found out later that the bullies had filmed
the encounter and posted it online. Ryan was 12 years old at the time. A 12 year old kid doesn’t know how to deal
with that kind of humiliation, so Ryan was left feeling depressed and suicidal. And Ryan’s was not an isolated case. Axe deodorant in collaborate with Ditch The
Label and Promundo, spoke to over 1 thousand men aged 18-24. At least 3 out of 5 of the men surveyed had
been physically bullied. 3 out of 5 had been called names because of
the way they look, and 3 out of 5 had gossip and rumors spread about them online. Another shocking statistic, one third of all
the men surveyed were bullied for their perceived sexuality, as in, they were bullied if they
seemed gay, even if they weren’t. But you know what, it goes both ways. To top everything off, one third of the men
admitted to bullying another man. I mean, when it happens to you, you’re more
likely to do it to other people. But its clear that not everyone can play the
victim card if they continue to be part of the problem. One thing is for certain, social media is
changing the way people are harassed. Now it doesn’t only happen at school, it
can happen at all points in the day or night. And I will also say that it happens to girls
too, not only guys. But at least with men, there could be a clear
solution. Often times men are raised to be aggressive
and manly, and they have resorted to taking out their aggression on their peers, that
they perceive to be weaker or different. Men that are taught at a young age that they
need to reinforce this idea of toxic masculinity are far more likely to be cyberbullies. Then the kids that are bullied bottle up their
emotions, and that can lead to them taking out their aggression on their peers, like
with the case of school shootings. It’s a vicious cycle, and it starts with
how parents raise their children. Lets all try to break the cycle and try to
show a little kindness. There’s some food for thought, its time
to respond to some comments, and for this video, I have chosen to feature comments that
constitute as cyber bullying. Obviously I get nice comments too, I love
you guys, but everyone gets cyber bullied, including me. Shadow Ultra – I kinda like it without Charlotte. Unfortunately Shadow Ultra, this is my job. Unless I decide to stop coming to work and
live on the street, you’re going to have to get used to me being on this channel. NHF 76 – Damn shes so simple she saying
herbs as where its pronounced erbs. Actually pronunciation depends on where you’re
from and me pronouncing things differently from you does not make me ‘simple’. Bro I write at least 4 scripts a day, you
really think I’m simple because I say HERB and not erb? Mike Smith – Love the show but sorry Charlotte,
that’s a shirt my lesbian aunt would wear. Maybe I am your lesbian aunt mike, have you
ever thought of that. The video is over, and thanks for watching. If you enjoyed this video, you’ll love this
playlist over here. Obviously make sure you give this video a
thumbs up, subscribe and turn on notifications. That’s it for me and I’ll see you in another
IO video.

Sleepy teens: A public health epidemic | Wendy Troxel | TEDxManhattanBeach

Sleepy teens: A public health epidemic | Wendy Troxel | TEDxManhattanBeach


Translator: Joanna Pietrulewicz
Reviewer: Krystian Aparta It’s six o’clock in the morning, pitch black outside. My 14-year-old son
is fast asleep in his bed, sleeping the reckless,
deep sleep of a teenager. I flip on the light and physically
shake the poor boy awake, because I know that,
like ripping off a Band-Aid, it’s better to get it over with quickly. (Laughter) I have a friend who yells “Fire!”
just to rouse her sleeping teen. And another who got so fed up that she had to dump cold water
on her son’s head just to get him out of bed. Sound brutal … but perhaps familiar? Every morning I ask myself, “How can I — knowing what I know and doing what I do for a living — be doing this to my own son?” You see, I’m a sleep researcher. (Laughter) So I know far too much about sleep and the consequences of sleep loss. I know that I’m depriving my son
of the sleep he desperately needs as a rapidly growing teenager. I also know that by waking him up hours before his natural
biological clock tells him he’s ready, I’m literally robbing him of his dreams — the type of sleep most associated
with learning, memory consolidation and emotional processing. But it’s not just my kid
that’s being deprived of sleep. Sleep deprivation among
American teenagers is an epidemic. Only about one in 10 gets
the eight to 10 hours of sleep per night recommended by sleep scientists
and pediatricians. Now, if you’re thinking to yourself, “Phew, we’re doing good,
my kid’s getting eight hours,” remember, eight hours is the minimum recommendation. You’re barely passing. Eight hours is kind of like
getting a C on your report card. There are many factors
contributing to this epidemic, but a major factor preventing teens
from getting the sleep they need is actually a matter of public policy. Not hormones, social lives or Snapchat. Across the country, many schools are starting
around 7:30am or earlier, despite the fact that major
medical organizations recommend that middle and high school
start no earlier than 8:30am. These early start policies
have a direct effect on how much — or really how little sleep
American teenagers are getting. They’re also pitting
teenagers and their parents in a fundamentally unwinnable fight
against their own bodies. Around the time of puberty, teenagers experience a delay
in their biological clock, which determines when we feel most awake
and when we feel most sleepy. This is driven in part by a shift
in the release of the hormone melatonin. Teenagers’ bodies wait to start releasing
melatonin until around 11pm, which is two hours later than what
we see in adults or younger children. This means that waking a teenager up
at 6am is the biological equivalent of waking an adult up at 4am. On the unfortunate days
when I have to wake up at 4am, I’m a zombie. Functionally useless. I can’t think straight, I’m irritable, and I probably shouldn’t be driving a car. But this is how many American
teenagers feel every single school day. In fact, many of the, shall we say, unpleasant characteristics
that we chalk up to being a teenager — moodiness, irritability,
laziness, depression — could be a product
of chronic sleep deprivation. For many teens
battling chronic sleep loss, their go-to strategy to compensate
is consuming large quantities of caffeine in the form of venti frappuccinos, or energy drinks and shots. So essentially, we’ve got an entire population
of tired but wired youth. Advocates of sleep-friendly
start times know that adolescence is a period
of dramatic brain development, particularly in the parts of the brain that are responsible for those
higher order thinking processes, including reasoning, problem-solving
and good judgment. In other words, the very type
of brain activity that’s responsible for reining in those impulsive
and often risky behaviors that are so characteristic of adolescence and that are so terrifying
to us parents of teenagers. They know that like the rest of us, when teenagers don’t
get the sleep they need, their brains, their bodies
and behaviors suffer with both immediate and lasting effects. They can’t concentrate, their attention plummets and many will even show
behavioral signs that mimic ADHD. But the consequences of teen sleep loss
go well beyond the classroom, sadly contributing to many
of the mental health problems that skyrocket during adolescence, including substance use, depression and suicide. In our work with teens
from LA Unified School District, we found that teens with sleep problems were 55 percent more likely
to have used alcohol in the past month. In another study with over
30,000 high school students, they found that
for each hour of lost sleep, there was a 38 percent increase
in feeling sad or hopeless, and a 58 percent increase
in teen suicide attempts. And if that’s not enough, teens who skip out on sleep
are at increased risk for a host of physical health problems
that plague our country, including obesity,
heart disease and diabetes. Then there’s the risk
of putting a sleep-deprived teen, with a newly minted driver’s license, behind the wheel. Studies have shown that getting five hours
or less of sleep per night is the equivalent of driving with a blood
alcohol content above the legal limit. Advocates of sleep-friendly start times, and researchers in this area, have produced tremendous science showing the tremendous benefits
of later start times. The findings are unequivocal, and as a sleep scientist, I rarely get to speak
with that kind of certainty. Teens from districts
with later start times get more sleep. To the naysayers who may think
that if schools start later, teens will just stay up later, the truth is, their bedtimes stay the same, but their wake-up times get extended, resulting in more sleep. They’re more likely to show up for school; school absences dropped
by 25 percent in one district. And they’re less likely to drop out. Not surprisingly,
they do better academically. So this has real implications
for reducing the achievement gap. Standardized test scores
in math and reading go up by two to three percentage points. That’s as powerful as reducing class sizes
by one-third fewer students, or replacing a so-so teacher
in the classroom with a truly outstanding one. Their mental and physical health improves, and even their families are happier. I mean, who wouldn’t enjoy a little
more pleasantness from our teens, and a little less crankiness? Even their communities are safer because car crash rates go down — a 70 percent reduction in one district. Given these tremendous benefits, you might think, well, this is a no-brainer, right? So why have we as a society
failed to heed this call? Often the argument against later
start times goes something like this: “Why should we delay
start times for teenagers? We need to toughen them up
so they’re ready for the real world!” But that’s like saying
to the parent of a two-year-old, “Don’t let Johnny nap, or he won’t be ready for kindergarten.” (Laughter) Delaying start times also presents
many logistical challenges. Not just for students and their families, but for communities as a whole. Updating bus routes, increased transportation costs, impact on sports, care before or after school. These are the same concerns
that come up in district after district, time and again around the country as school start times are debated. And they’re legitimate concerns, but these are problems
we have to work through. They are not valid excuses for failing to do the right thing
for our children, which is to start middle and high schools
no earlier than 8:30am. And in districts around the country, big and small, who have made this change, they found that these fears
are often unfounded and far outweighed by the tremendous
benefits for student health and performance, and our collective public safety. So tomorrow morning, when coincidentally we get
to set our clocks back by an hour and you get that delicious
extra hour of sleep, and they day seems a little longer and a little more full of hope, think about the tremendous power of sleep. And think about what a gift it would be for our children to be able
to wake up naturally, in harmony with their own biology. Thank you, and pleasant dreams. (Applause)

Square dancing helps teens deal with a  suicide epidemic in their community | Twilight Dancers

Square dancing helps teens deal with a suicide epidemic in their community | Twilight Dancers


(lively fiddle music) – I’ve played the River
Red Jig so many times, since I’ve learned it, I’ve witnessed so
many great jiggers, and that’s my preference, just to play the River
Red and see others jig to my music. – I always get a
really good feedback on what I do on behalf
of my performances. They just say “Oh it’s
just jigging Des.” (laughs) No, it’s not just jigging, it’s actually something
I grew up doing, something I love to do. (kids mumbling) (Cherish giggling) – Cherish come here,
you have to come and comb your hair too. – CrossLake Competition
is happening right now, square dancing is on Saturday. Sometimes we win, and
sometimes we don’t, but it’s all about having fun. – [Abel] Cherish and
Demi you should start going to the school! – [Girl] Did Demi already leave? – [Abel] Yep, she’s outside. – [Girl] Okay. – They’re having a floor
hockey tournament outside, or something. (upbeat fiddle music) – [Desmond] I was
dancing since I was like 5 years old man (laughs), since I was a little boy. I remember my first time, I
was in my mom’s living room, and everyone was dancing,
everyone was dancing, and one of my brothers,
he’s like “Des. and that’s when I
was like, “Why, what “are you gonna do to me, man?” He’s like, And so I tried it, it didn’t
work out well. (laughs) It was funny, and
kind of embarrassing. This is what my brother
always used to say to me, “Just because you don’t
know how to dance now “Doesn’t mean that you’ll
never know to dance “in the future.” – [Woman] Okay Aleisha
and Anisha, ready? How! Yeah, you and Demi,
you and Chloe, how! (kids giggling) – I love teaching square
dancing, honestly. Not only for future generations, but to help them, it helps, even when
you’re going through a lot in life. Not only I’m teaching
them, but I’m also teaching myself. Not just to become
a better dancer, but to also to become
a better person. – Stage is right there! – Square dancing is fun, sometimes we get our
dances from YouTube, and then we bring a little
bit of our moves in there. – I basically use
square dancing for fun, to have fun, and I can
forget about stuff. – I like learning new
steps and all that, I really like the double step, it’s the certain step
everyone knows and does. If you know how to
do the double step you can do any type of
step in square dancing, jigging, and whatever. – One time, just one time. (yelling dancing directions) Okay, one, two, three, go. – [Cherish] When
the music starts you have to tell your
team “One, two, three”, and then you start
dancing all together. To know when you’re
going to make a move, you have to say “how”. How! (laughs) (lively fiddle music) – My thoughts on how
our land was colonized, and the residential came to be, the residential school,
it’s very sad because there was so much
hidden abuse behind it, and to take away the
important identity of who we were as a people in the beginning before
this ever happened. The new generation
that we’re having, we’re having a mixture of tunes, and we’re seeing a lot
of step dancing now, into the square dancing. – Square dancing
I think was always part of the culture growing up. Old times, eh, both my
grandpas played fiddle, and they held dances
in a local hall here. They would square dance there, and have a little competition. – [Woman] How! – I think square dancing
came from white people, (laughs) I don’t know. – The colonizers did
bring us square dancing in terms of teams
and what not, eh, but there was, of course,
the First Nations People incorporated some other
moves into the dance, eh? The colonizers, they
just used their feet, not so much the body, eh? Then First Nations
incorporated their dancing into the whole body, right? That’s the influence
the First Nations had on square dancing. – I know other people
that square dance but, sometimes they don’t want to, some kids like to judge, and act how they dance. Bullying, it happens
a lot, and suicides. (slow sad music) – Everybody out there,
doesn’t matter if it’s child, going on to elder,
everybody’s in pain. “Why would they do such a thing, to take their own life?” Some people don’t even
know how to express themselves no more because, there’s barely people
out there listening. – Some people commit suicide
because they get bullied. People like to bring down
each other on social media. They like to judge,
and then tease, and everything else. – Growing up in
my community here, bullying has always
become, main thing, either you’re a part of it, or you’re the one doing it, or you’re the one
getting bullied. I’ve been a part of both sides, but I’ve learned as I grew
up not to be like that, because I was losing friends, and I was only picking sides, and I knew that was
wrong, and right away I switched up my mind,
and bullying hurts. – I kind of do like living here, and I kind of don’t. Sometimes I don’t like
staying here because of the bullying. – I don’t like
bullying just because, I lost a good friend of
mine to it, to suicide. It was really hard. (melancholic music) – I haven’t danced
last festival, and I didn’t dance
in Indian Days, due to the suicide epidemic, and what was going
on, I couldn’t do it. The most tragic thing
that happened to me in my life is losing a brother. It was very devastating. I grew up in a violent place. Couldn’t focus on school
due to getting bullied, because of the color I wear. We kind of joined that violence, but that’s the past,
a past that I probably never want to go back to, never. (upbeat jig music) (tap shoes clinking) (energetic fiddle music) – When I play I always
recognize my community. They’ve been a
big support of me, from when I first started. This is me, and if
you can accept that, I promise you,
hate me or love me, that I’m gonna be the
best person as I could be, and showing my
respect for my people, and other people of
my Native culture. Pimicikamak Cree all over. – [Kelson Voiceover] It’s
kind of different how people dance, eh? How
they make their moves. – [Keshton Voiceover]
It’s probably coming from your spirit inside, that is letting you free
of what you’re doing, it’s going with the
music, the rhythm. – [Demi Voiceover] Before I
go on stage I’ll be nervous, you know when you
get butterflies, but then you know
it’s gonna be good when you get butterflies. – [Kassidy Voiceover] Five
seconds, and the music starts, and you know when to dance,
so you just start dancing. – [Cherish Voiceover] Kind of
nervous when you get on stage, cause everybody’s
looking at you. “Okay, do I remember
the dance?”, and stuff like that. – People are dreaming
of what cars, or a nice house, or
something, you know? My dream was to dance
with my brother, to light up that stage. (shoes tapping rhythymically) (lively jig music) (audience cheers) (audience cheers) – [Host] Way to go
there, Twilight Dancers! – I’ve seen who’s shoe
that broke, I’ve seen it, But tell her, that didn’t
stop her from you guys getting the crowd
going, you guys did! – [Woman] Everyone check
their shoe right now! – That’s how you dance! (cheers) Make the crowd go wild! (lively fiddle music) – The last fewest words
my brother told me, those words that got me
going everyday in life, throughout those years. (speaks in foreign language) Which means “Never give up.” And so I took it. – [Host] Twilight Dancers. – [Host] Desmond Colombe. (melancholy music) – I do believe that there
does come a time where us youths think about our lives, and what we wanna do, and it’s then on our choice to follow those dreams and
the right steps to take. We have the opportunity,
we just have to make them happen,
and when we do get them, make sure you don’t hold back, cause you might regret it
for the rest of your life. (melancholy music) – Everybody in this
community, as we speak, is a survivor. They survived through that 2016. And through the roughest,
the roughest year, toughest. We’re hurt, we’re
damaged, we’re broken, but we’re still standing strong. That’s the important thing
about this community, no matter what happens, to each and everyone
of us out here, all I know, that every
individual in this community, is one tough warrior. (rapid jig music) (crowd cheering) (upbeat jig music)

Emotional support animals: has America’s ‘epidemic’ gone too far?

Emotional support animals: has America’s ‘epidemic’ gone too far?


Right, should I shut this before
he tries to get out? Emotional support animals, known as ESAs,
have exploded across America in recent years. With controversy never far away. Dexter the peacock, an emotional support animal, had a ticket but United wouldn’t get him on board. Every time a peacock appears in an airport
or a hamster gets flushed down the toilet, the row around their use ignites again. I’m not going to let them take my goat. ESAs are protected by law but critics
argue the system is being exploited by pet owners without genuine mental health problems. That’s just a bit of velcro, right? Now with airlines and stores across the US drawing up their own rules around animal access, has the rise of the emotional
support animal gone too far? So Wally is going to be this long. Or are the more exotic animals sensationalising and diluting a growing
solution to mental health conditions? The real epidemic is the mental health
problem in America. Joe Henney’s ESA is one such animal. Hello Joe. How you doing? A four-year-old American
alligator rescued from Disney World in 2016, months after a bigger gator had attacked
and killed a two-year-old boy. That’s about his meal size. When was the last time he ate? About three months ago. Three months? Well, he’s eaten once in three months. What did he eat? A cow? No, he just ate two chicks. Well, you’ll never gonna grow to be 15ft
without a better appetite. I really thought I would be more nervous but because he’s so calm… That’s how we started tv shows back then. Joe is no stranger to the camera, having presented his own hunting and fishing show 20 years ago on local TV. I would not recognise you. Back then, it was all about me. I was always into animals,
I loved hunting, I loved fishing. I wasn’t an emotional person back then,
I was a very selfish, ‘all for me’ type of a person. I never thought I’d ever go to heaven… You know, it didn’t take much
to push me off the edge to fight. We were walking down the street and I said:
‘I’m gonna knock out ten people with ten shots.’ the third or fourth person out
came through and I reached up and I hit him…
when I hit him, I knew the sound was different because I broke his neck. He lived but he is now today even a paraplegic What I did … I destroyed
his life, I destroyed him. Just because I was cocky. And I went into a real bad depression. I went to the doctor about it and they wanted to give me
antidepressant pills and when I took one pill and I hated how it made me feel. So I didn’t take more, I called them and said,
‘I am not taking this pill’. Stroking him is kind of addictive. While he is a little more exceptional
than most gators, he’s really super laid back, but I guess because the way we’ve
handled him, he knows when somebody needs a hug. Buddy you are cold, ain’t you? When I went to the doctors, they said, How are you getting on with depression? Wally the gator. They said, ‘are you serious?
OK, that’s better than any pill that I can give you.’ Why don’t you get Wally registered
as a support alligator? I said, are you nuts? An alligator? How’s going to register
Wally as an alligator? ‘Hey, didn’t he help you through depression?’ Yeah. ‘Well, that’s emotional support.’ He loves being petted,
he loves giving hugs. Because he’s a wild animal, it only takes
one moment where he is misbehaving and something really potentially quite
serious could happen. He literally could tear a foot off me. Yeah. People have been
bitten by service dogs. Yeah. Service dogs!
Very well-trained! Most ESAs are neither as unusual
or as placid as Wally and their presence on university campuses
has been at the frontline of the debate, with critics arguing they are nothing
more than a crutch for young people at a time when they should be outside
their comfort zone. Hello! Hi! When I registered my emotional support animals,
they said I was their first guinea pig, so I was kind of their
trial for guinea pigs… You were the guinea pig guinea pig. Do you worry at all that, because
your guinea pigs are at home that you are not pushing
yourself outside of your house enough, to battle against the anxiety issues you have? I have so much schoolwork
that I am a lot of the times in here, but what I do is, the people that I know,
I offer: ‘Hey, why don’t you come over, we can work on school work together’. It can also help them because I do have
another friend who has anxiety and she loves the guinea pigs. Is it working? I definitely think so, absolutely. If I am having a really bad day, I’ll just hold
her and her squeaks just make me smile, like things like this, it just calms you down. Hi. How’s it going? Oh, there we go. It was inevitable really, wasn’t it? Thank you, yeah. I’ve just been urinated upon
by a guinea pig… Oh, that’s fun! Would Corvo like that?
Will he be upset? OK, hi Corvo. Are you aware of the sort of controversies
around emotional support animals? There’s a lot of people that will fake
paperwork in order to have an animal with them because
there’s a lot of apartments around here that don’t allow any form of animals. I am going to need you to move, sweetie. Oh my goodness! Yeah… Oh Corvo! Me managed to find the corner. Problems like this are exactly the reason
why a lot of housing doesn’t allow animals in it. Yeah, most universities don’t want to risk it either. Damage like this seems a small
price to pay for your mental wellbeing. Yeah, it’s … I am more than willing to cover that
at the end of the semester, it was honestly a mistake. Naughty Corvo. Despite the potential for animal-related accidents, a recently opened pet-friendly dorm means even non-ESA animals have a place on the Lock Haven campus. We have three hamsters, one cat
and five rabbits. Wow, OK. If you asked me 10 years ago,
I would have been absolutely, ‘there’s no way!’ Everybody’s vying for the same group of
students to get into higher education. Anything you can do to make your college
attractive to students is going to work. Right, yeah. Do you know, I’ve not handled
a hamster for a number of years… Has anybody dropped her? What’s the greatest height she’s fallen from? As of right now, she hasn’t really fallen yet. OK, right, so the pressure is on for it not to happen. I wanted to get an emotional
support animal but then we got this pet policy. It’s basically the same thing,
it’s just less of an inconvenience to get it all sorted with the disability
services and all that stuff. Do you feel that a pet can be as good as a drug in
treating mental health problems? I think so. I mean, with me having these animals,
it makes me think about taking care of them, and I can’t take care of them if
I can’t take care of myself, so this is a more natural way of having
those happy hormones around. It’s not just in the US where ESAs are triggering debate. We’ve had newlyweds in here spending their night… Wow! In this one here. OK, I might not have this room. Is it haunted? Absolutely, yeah. In Canada, Toronto native Bill Steel ran into trouble when he relocated to a former jail in New Brunswick which he now runs as an Airbnb. I mean, they say prison’s
a bit like a hotel but this one isn’t, is it? Yeah. Although it is! It is. Princess! This is Mama. This is Deputy, Deputy goat,
and this is Princess. Hey Princess! Hey Princess! Why goats? It was always my dream,
with my son, to have goats and I got the goats. There is a need for them, which is to deal
with my depression. Part of that is obviously losing my son. He’s with me all the time, yeah. I had to make funeral arrangements
three or four times for my son… Before he died? …they said,
‘we don’t know if he’s going to make it to the next day, you have to talk to him about
where he wants to be buried.’ Where do you want to be buried, Billy? You want to be buried here,
you want to be buried there? Do you want to be cremated? Do you want to be … whatever. No parent should ever have to do that. I feel I died the day my son died. Does that thing work? You know, when people ask that,
they get an automatic drive in it, that’s my rule. Bill took me on a tour of
Dorchester, the village he now calls home but with which he has an ongoing legal dispute. They say his goats are farm animals
and as such, are banned from the village. I’ve had a lot of support in the
community for the goats, I haven’t had anybody that lives
here ever say anything bad about them. Really, nobody? Nobody, nobody ever. That’s the municipal office right there. So the problem is stemming from that office there? Right there. Which is very close to your property. It’s right in my parking lot. Have you read these documents? I agree with most of these documents.
Basically, it says, he’s got three goats. This was served to me in person
by a sheriff. Oh, right. Is this piece of paper all you feel you
need to win the court case? Yes. It says: Mr. Steele has been suffering from
resistant major depression for the past two years, his goats have been beneficial
to his mental health and I recommend that he keeps them as emotional support animals. And that’s signed by your physician. My physician, yeah. I am not giving up my goats. And I think the doctors
and the people in society are saying, hey, if it helps him, why not? same with cannabis and stuff like that, does it help? I don’t know but a lot of
people say they are better, that’s good enough for me. That’s good enough for me. Much of the anger around the explosion
of ESAs has been directed online, where multiple companies have sprung up
offering certification that critics suggest is nothing more than a
money-making scam. I travelled to Wisconsin to meet Prairie Conlan. He’s good for an emotional support dog. Clinical manager for one such company,
CertaPet. So I am going to go through the process of registering my mythical emotional support animal, So you can definitely see what it looks like. Straight away you have to give your
payment information… Just like when services are rendered, when you go to the therapist office or the doctor,
you pay right when you start. If I am trying to get my pet certified,
it’s quite easy to know which type of answer will get the response you’re after. Absolutely. You’re going to have people trying to game the system, they try to game every system. How many pets has CertaPet certified? We average about 1.2 million users per month,
less than half a percent of that actually get an emotional support animal letter. There is no doubt that emotional support
animals have exploded in recent years, some have labelled it an epidemic. Are there people making money from it? Is there something uncomfortable
about the two things there? Well, for sure. Not only is it horrible for the clients that actually need it,
it’s horrible for me when I’ve been threatened ‘we’re going to get your license,
you’re a terrible person’, I mean … terrible things. And I’ve thought, do I want
to continue to do this? And the thing is, every single time the
answer for me has come back yes. Prarie took me up to meet her horse, True, at a stables nearby. Look horses scan you,
they see what you really have and they’re reading you
because you know we have different energies. Don’t stand behind a horse,
I know that much. Can you tell me why mental health
is so important to you? I’ve always had an advocate’s heart,
I like to stand up for people that are different. You know, being an adopted kid
in a small town and then siblings of different races
that were adopted. We were always different. For me, I always
felt like I could stand up for myself. People that have mental disabilities, anxiety, depression, they can’t stand up for themselves a lot of times. We don’t need to cheat them out of an experience just by quickly getting them in and out
of an office and adding to the opioid addiction. Something as ‘silly’ as being able to sit with
your dog and take your dog on a plane. I see it change lives
everyday. That’s a pretty amazing feeling so… There may be limited scientific
evidence that animal-assisted therapy actually works. But the anecdotal
evidence is firmly in their favour. He was only that long when we got him. I want our kids to see me hold that alligator. With the stigma around mental health
finally being confronted and emotional support animals offering many people a
genuine alternative to medication, a compromise needs to be struck between
the rights of the individual, those of society as a whole
and the animals themselves. Oh my gosh. Oh, he’s just so adorable. We need something like this to give us
attention and that was huge to me. He puts a smile on your face, doesn’t he? Yes, he does.