[ music ] >> good evening and welcometo conversations live, the heroin epidemic revisited. i'm patty satalia. drug overdoses in pennsylvaniastarted to spike in 2011, and much of the increaseis due to heroin. experts now say every community in pennsylvania hasa heroin problem. recent reports place someof the blame on easy access
to prescription pain killers,gateway drugs for most users. tonight, our experts willdiscuss causes and solutions to this rapidly growingepidemic. they'll also takeyour questions. now let's meet our guests. senator gene yaw has representedthe 23rd senatorial district of pennsylvania since 2008. he also serves as chairmanof board of the directors for the centers forrural pennsylvania,
which has releasedmultiple reports on heroin's growing presencethroughout the commonwealth. dr. philip moore is an internistand medical toxicologist with associates inmedical toxicology. he specializes in poisoning,overdose, and drug interactions and has experience inoutpatient and inpatient detox, as well as neutral, partial, and full agonist maintenancetherapy for drug addiction. amanda cope is theadministrative director
for positive recovery solutions, which provides controlledmedical care and case managementservices to those suffering from opiate dependence. thank you all somuch for joining us. you can join tonight'sconversation. our toll-free numberis 1-800-543-8242, and our email addressis connect@wpsu.org. you can also tweet yourquestion or comment to wpsu
and use the hashtag#wpsuconversations. i want to begin withyou, senator yaw. you said, "if you think thereisn't a heroin community in your problem think again." and in fact, as chairmanof the board of directors of the centers forrural pennsylvania, you have convened twoconsecutive years, hearings, statewide hearings,on the problem. give us an idea ofwhat you learned
from those hearingsfirst, and secondly, what the scope ofthe problem is. >> well, it's reallyinteresting how it got started. the center for ruralpennsylvania, first of all, is a joint legislative agencybetween the house and senate. it's bipartisan, bicameral, and the way it reallygot started is one day, one of the other senatorsapproached me on the floor of the senate and said,"can't you use the center
for rural pennsylvania to bring to everybody's attentionthe nature of the problem, the heroin problem, inrural pennsylvania?" i mean, that's where westarted, rural pennsylvania, and it sounded like oneof those things, okay, it's a good idea,let's look into it. we'll have a hearingmaybe in harrisburg. well, the more we thoughtabout it, we decided just in 2014 we had four hearingsthroughout the state,
mainly concentratedin the rural areas. i'll give you just alittle bit of an example. the first hearing, we scheduledfor three hours in williamsport. well, it lasted five. that kind of was the precursor to say i think we maybe onto something here. >> you've hit a nerve here. >> we hit a nerve, and i givecredit to the board of directors for the center forrural pennsylvania.
this is a little outside ofthe way we usually operate, and they thought, theywere the ones who said, "we think that it isa big enough problem to go ahead and do this." so we followed up that in 2014. the primary issue orwhat we were looking for is how broadthe problem was? what are we looking at here? what is it?
in 2015, when we hadhearings this summer, we looked into recoveryprograms, such as amanda's. what's gone on out there? i hate to say this, or maybe ishould say it, that we've talked about it with the board, andwe intend to probably look at specific treatmentprograms and what's successful? but we've issued two reports, i think that the center's tworeports are probably the most comprehensive work that'sbeen done by the state
across the board to really hit at the problem atthe ground level. >> and, you know, when you lookat pennsylvania as compared with the rest of the nation,pennsylvania ranks third in heroin abuse,and i think seventh in heroin abuse overdose death. you know somethingabout this, amanda. tell us a little bit about thepopulation you're working with and how positive recoverysolutions is interfacing
with literally hundreds, thereare hundreds of thousands of pennsylvanians who are inneed of treatment and only one in eight are getting it. >> yeah, when we foundout about vivitrol, we had a representative ofthe medication come in and -- >> let's back up. what is vivitrol? >> yes, so vivitrol is along-acting naltrexone. so what it does is itcomes in and it attaches
to the opiate receptor andessentially locks it down. meaning that when apatient is on vivitrol, during that 28-day span whilethe medication's on board, they cannot successfullyabuse alcohol and opiates. it prohibits the releaseof serotonin and dopamine from the brain fromtaking that substance in, meaning that you don'tget that euphoria. you don't get thepleasure/reward system. that's where it worksin the brain.
>> so people are coming toyou in western pennsylvania who were saying, "i need help." your positive recovery solutionsis providing vivitrol to them. so explain, whatpopulation are you serving? what counties are youserving, and i understand that of the 67 counties, 37 counties thinkthey need this sort of mobile clinic that you have. >> so we have twophysical locations.
we are in alleghenycounty in pittsburgh, and we are in washington county,and when we added ourselves to the provider locator,meaning if somebody was looking up vivitrol, youcan look and see where they're a providerthat can follow you. we added ourselves tothat provider locator, and what we realizedright away was that people were travelingsometimes four hours to come to our facilities toreceive their injection.
there are not enough providersout there that are willing to either follow this patientpopulation, due to the stigma, or there's just notenough education in the medical communityabout the medication and how to provide it to the patients. >> the bottom line, dr. moore,is that, as i said earlier, only one in eightpeople in pennsylvania who need addictiontreatment are getting it. why is that the case?
many say it's a funding problem. >> this is a complicated answer. physicians are definitely --they don't have training in how to manage this population, and so because ofthat, they're afraid. they're afraid tomanage the population. so one thing we can dois to offer more training to physicians, as they, allthroughout their careers, you know, early on, inthe middle, and later,
and then also, accessfor patients to treatment facilitiesor to outpatient. definitely, there isnot enough providers and facilities forpatients to go. >> you know, speakingof training physicians, 80% of those who presentwith drug addiction, heroin in particular,say that they began with prescription pain killers. so, education of ourphysicians, senator yaw,
certainly is important, andi know that is something that you did addressin your hearings. >> we did, and we're actuallylooking into some legislation that would affect the mandatorymedical education, not in a way that would expand it butjust say that, you know, for your cme training, itwould require a certain amount of time addressed to either painmanagement or drug addiction, and we've gotten apretty good response. we had one of our hearings
at the commonwealthmedical college, and the people there wereeven willing to, like, it should be taughtin the schools, too. that's where we have to go. >> well let me get back tosomething i was sort of getting to a moment ago, and thatis how big this problem is. from what i'm reading,from your report, 52,000 pennsylvanians arecurrently in treatment, but there are 760,000, atleast, some say even more,
who are in need of treatment. so on one hand, we've had a25% cut in the kind of funding that would provide care to them,and the problem has quadrupled. how do you, as one of ourstate representatives, feel about that? what can we do about it? >> well, if you would have askedme two years ago what i knew about the drug problem, it wasnot much, and i agree with you. it's something thatwe need to address.
some of the things youmentioned only peripherally. there are seven people a day die in pennsylvania ofa drug overdose. seven people a day, and,you know, you do the math, that's 2500 people a year, and the cost that'sinvolved in that. it's astronomical. this fall, there was areport released by dea that specifically addressedthe problems in pennsylvania,
and i'm not proudof these numbers, but the number one county, and what it did is itaddressed deaths per thousand, overdose drug deaths. >> is it washington county? >> per hundred thousand. no, it's not. the number one isnorth hampton county. number two, surprisingly,
but it fits in with what westarted to do, tioga county. >> really rural areas whereyou think, "who's using heroin in rural areas like this?" >> number three is schuylkill. number four is mercer. number five happens to bemy home county, lycoming, and you'll be happy to know thatcentre county is number six. so if you look, you know, ifyou drew this out on a map, it's right down throughthe center of the state,
and even the union countyis a part of that, too. so this is a veryappropriate topic when we say it affects all -- >> every county. >> everybody. one in four families iswhat i'm reading, as well. i want to take our first call. we have rhonda whois on the line. she's calling usfrom state college.
rhonda, what's yourquestion, please? >> well, i have a couple, butthe first, i guess i'd ask is where is the heroin coming from? and the other thing i'd liketo know is does today's heroin compare in terms of potency? is it more potent today thanit was in previous eras? >> good question. we'll begin with you. senator yaw, where is theheroin that's making its way
to pennsylvania coming from? and we'll follow upwith you dr. moore. >> primary sourceoverall is mexico, but the attorney general'soffice testified at one of our hearings, and thestate's basically divided up for where the drugs come from. i mean, the pittsburgharea is probably detroit. harrisburg is baltimore. williamsport for some reason --
>> and before that,mexico, of course. >> yeah, it's connected tophiladelphia, and of course, in the [inaudible] williamsportis new york city, but i mean, the law enforcement knows whereit comes from, and the majority of it comes in bymotor vehicle drop. >> and in terms of potency, dr.moore, what's the difference between heroin ofyesteryear and heroin today? >> that's a great question. it is much more potent.
it has increased in potency,and the cost has decreased, and that's what makesit so attractive. persons often startwith prescription, and they may have it for acouple weeks, maybe a couple of months, and thenit's abruptly stopped. >> the prescription. they run out of their prescribedmedicine from a physician. >> and it may just run out, and the physician hasn'teducated the patient
like we need to graduallyreduce these doses. so it may just all of asudden run out, and then all of the sudden, the patient feelsthey have this horrible sickness of, you know, like a viralsyndrome, and i've heard of it also be described as runover by a train at the same time as having like a severe cold. >> so that's what withdraw from prescriptionpainkillers can be like? >> and so the patients willoften start buying the pills
on the street, and it's very,very expensive to do that, and then they see this veryinexpensive drug, heroin, which is potent, and thetransition just happens. >> you know, 60 minutes putthe blame, at least partially for this heroin epidemic onthe pharmaceutical industry, and pointed out that vicodin wasthe number-one most prescribed medicine in americafrom 2009 to 2012. so, you know, do we need to havea different understanding of how to treat pain, and i say
that because most americanshave some degree of back pain, and experts are nowsaying exercise is going to be more effectivethan a pain pill. >> well, i mean, i thinkit goes back to education and pain management,and you know, maybe -- i know the popular thingnow is that we're pain free, and i understand that. i've done a sortof classic example. nobody wants to havea toothache.
you mention a toothache and no, but i think that pain managementis going to be the answer with education, andwe may not have to -- you know, we may have to put up with a little bit morepain than what we did. >> to get the handle on this. we go to catherine, who iscalling us from altoona. catherine, what's yourquestion or comment? >> patty, first, i'd like to saythank you for having this forum.
i'm calling on behalf of the commonwealthprevention alliance, which is the statewideorganization for drug and alcohol preventionprofessionals, and this past year, we createda website called pastop.org, which is designed to educatepennsylvanians about the risks of prescription painkillers and heroin use. on our website, we haveinformation for families, caregivers and individualsseeking help
and we also have free,downloadable materials that answer questions and guidepeople to the lead agencies in their counties inpennsylvania to find help, but first of all, weare there to prevent, and a lot of ourinformation does help that aspect of the problem. >> all right, well,thank you for your call, and as catherine said, thatwebsite includes information for resources inevery single county.
tell us, amanda, a little bit about how overwhelmedyour services and how available services arefor the people who need it, and explain whichcounties you're serving. >> so currently we have,again, the physical location in allegheny county, thephysical location in washington. we go via mobile unit toblair county in altoona, and we go to indianacounty, armstrong county, and clarion is also some
of the patient populationthat we service. when we formed thispilot program in july, there were 37 countiesthat reached out that said, "we want access toyour services." unfortunately, theability to move forward for those counties depends onthe budget, so on and so forth. so we've seen a littlebit of a delay there, but i think that things aregoing to start rolling now that, you know, now that i think
that there's been someleeway made there. but we started out with fourpatients in blair county, and i have to say we work withthe single-county authority. so that's where aperson who is unfunded or somebody that's looking fortreatment, they would be placed into a treatment program,or they would be provided with referrals and resources. we contract with them, andjudy rosser in blair county. started this programwith her, and we started
with four patients,and right now, we go there on a biweeklybasis, with the mobile unit, and we are probably doing about 30 injections eachvisit that we're out there. in indiana and armstrongtoday, we had had, i think it was 32patients scheduled today. >> so explain howvivitrol works. it's an injection, and it willkeep addicts from using alcohol and drugs, but for how longdoes that injection work?
>> so the injection wegive, it's every 28 days. so we give the injection,and during that 28-day span, they're not able toachieve the high. this medication is meant forthese patients to be able to engage in wraparoundservices. it provides them a safetynet so that they can get busy with the work of recovery, because medication alone isnot going to solve the problem. so what we do is we pair withbehavioral health entities.
the behavioral healthentities provide the drug and alcohol counseling,which is essential to a successful roadto recovery. we provide the medical services. so during this time, it's asafety net for these patients. it's a light at the endof the tunnel for them. if you can give somebody who'ssuffering from addiction a way out and say, "listen, theseare the steps you take. this medication, it takesaway any cravings to use.
you're not craving the drug. you're not craving alcohol. there's no withdrawal symptoms because it forms thecomplete abstinence model." meaning, when you're onvivitrol, you don't have to continue to crave substances,and it's nonaddictive. >> and you're speaking, tosome extent, from experience because you're nine yearsyourself in recovery from alcohol addiction.
>> yes, so i'm an alcoholic. may 6, 2006, is mysobriety date. i was not a vivitrolpatient, but i'm a product of long-term treatment. i did the 28 day rehaband then followed that up with a voluntary admission intosix months of a halfway house, and it truly saved my life,because when you are struggling with addiction, youdon't know where to turn. you don't know what to do,and a lot these patients,
they need a stepping stone. they need somebody to say,"okay, take this step." and to create some structure andto form a healthy support system and change your behaviorpatterns and healthy coping mechanisms. >> i want to go to a phone callin just a moment, but dr. moore, how important is individualizedor tailored treatment. amanda was talking a littlebit about what her service does and the service thatshe, herself, received.
is it important that addictsreceive, someone suffering from addiction, get aspecifically tailored program? >> yes, it really is criticallyimportant, but that process is about hearing theirstory, where they've been, where they've come from,and then from that history, then pointing them in theright direction of where to go with therapy next. sometimes it's better to notrepeat history and keep going with the same therapy thathasn't worked in the past,
and to shift it into a newdirection and try something new. so that's the typeof unique approach that a patient really needs. >> i want to be back. oh, go ahead senator. >> what i'd like to say, andthis fits in with everything that amanda and dr.moore have said. this addiction that wefound out, it's a disease. it's a lifelong problem.
it is not going to be fixed witha 30-day period of treatment. it's not going be fixed with asix-month period of treatment, and what we learned in all of our hearings is whatwe commonly referred to as a warm hand off. you go from one partto the next, and it's a community problem. >> in other words, the physicianis going to introduce you to the counselor that theywant you to work with.
>> well, we hope. then that's why it'sa community problem. it affects everybody. you can't arrest yourway out of the problem. you can't use other drugsto get out of the problem, and i use this exampleall the time. if somebody has diabetes, youdon't send them away for 30 days and they come backand they're fixed, and that's the natureof the problem.
diabetes is probably,for a lot of people, it becomes a lifelongchallenge for them, and the drug addictionis no different. >> all right, let'sgo to our next caller. eric is calling usfrom harrisburg. go ahead please, eric. >> yes, i'm wonderingwhy, ms. cope was talking about how they're workingout of western pennsylvania. this question isprobably for the senator.
why don't we have this programavailable to all the counties? i mean, particularly herein central pennsylvania? i had a friend just twoweeks ago who overdosed. is there something that can bedone in central pennsylvania? can the senator do somethingto make prs get down there? >> well, you know, idon't know who's paying for the vivitrol programthat amanda spoke about. one of the comments aboutthe vivitrol, especially, is it's very, very expensive.
it's somewhere between$800 and $1000 a shot. so it is significant. there's questions abouthealth care insurance. we've worked on those,we tried to. i think that there's beenmore money put into drug and alcohol programs this year,and we now have a secretary of drug and alcohol,which just came on board within the last three or fouryears, something like that. so i think that it is aproblem, no question about it,
that we've just startedto address. >> you know, eric mentionedhaving a friend overdose recently, and that brings meto the question of naloxone, which has been saving livesthroughout the country. can you tell us a littlebit about who's using it and why there is some reluctanceamong police departments to have it on hand, and just howreadily available it is today? >> well, the physiciangeneral of pennsylvania has put out a blanket prescriptionwhere it can be acquired.
>> it can be acquired by what? a family member,anyone concerned? >> family members and veryeasily, and it's something that she has supported,but naloxone, the pennsylvaniastate police carry it in all of their patrol cars. >> and we should sayit's an antidote. >> it's an antidote. >> if you are sufferingfrom respiratory problems
from an overdose, this canquickly turn you around. >> there's a simple question, iguess, that has to be answered, and that is out there thatin order to treat somebody or to save them froma drug addiction, they have to be alive. now we have to make thatdecision, and, you know, some of the departments orsome counties, delaware county, the district attorney indelaware county just took this on as a major projectand required that all
of the police departments indelaware county carry naloxone. they've had, i don'tknow, somewhere 100 saves since they startedlast november. >> some people areafraid that it's going to create dangerousbehavior, high-risk behavior. how do you respond to that? >> well, here's howi respond to that. if you're a policeofficer, you're trained to handle dangerous behavior,
and the physiciangeneral said most likely, when people are treated, anddr. moore would be better off to describe this, butpeople wake up slowly, and a lot of times,they're just confused. they don't know where they are. >> but i mean, it willencourage more people, "hey, there's an antidote, i'mgoing to try this heroin because now someonecan save me." >> when we did thehearing in august,
and the district attorneyfrom delaware county, i asked him thatquestion, "are you -- you've saved at thatpoint 90-some people. how many repeat customershave you had?" at that point, they had four. now four out of 90is a pretty good -- i don't know whathappened to the other ones. maybe they got treatment. maybe they were scaredto death or, you know,
something else happened to them,but i think it's worthwhile, and just the cost that'sinvolved in this, you know, from health care in not onlythe addiction but the loss of jobs and everything else. >> dr. moore, youhad something to add? >> yes, the naloxoneinjections, there's a generic and there's also a brand name. >> narcan. >> narcan's the brandname, but there's a company
that makes an injection kit that gives you instructionsabout what to do. what the next step is, andi've heard that on the website for fire departments, policedepartments, you can apply and get funding from the companyto get a shipment of them to get you goingwith the injections. >> they would be preferable. the auto ejectors. they actually talk to you.
we've seen them. >> and tell you stepby step what to do. >> tell you step by step. the police departments, mostof them use the nasal spray. it's less expensive. >> the other thing i've wonderedabout those kits is if we need to be prescribing them. we know certain patients abovecertain milligram strengths of their prescription pillsare high risk for overdose.
should we be handingout those prescriptions with a prescription fornaloxone or the autoinjector because we know that's sucha high-risk population? >> you have somethingto add earlier, amanda? >> yeah, it would becircling back a little bit. i just wanted to point outthat the medication is covered by all insurances, includingmedicare and medicaid, and that we are aninsurance-based company. so anybody that hasmedicaid has state insurance,
has commercial insurance,would be somebody that we would be able to follow. we don't charge our patientscash to come and see us. we do everything throughthe insurance company. >> have you beendoing this long enough to know what yoursuccess rate is? because as i said earlier todr. moore it's not uncommon for someone sufferingwith addiction to be in treatment eight,nine, 10 times,
before they're reallyin recovery. >> so i did a tv program backin october, and we had one of our patients on with us,who is a mobile unit patient, and he has been in and out ofinstitutions for 20-plus years. and this is the firsttime in over 20 years that he has celebratedlong-term recovery. he has been with us for going onseven months now, and he spoke on the tv program with me that,people want to say that, hey, you know, that people want tosay this isn't a miracle drug,
but i'm here to tellyou that it is, and so we have patients that,if you give them a way out, the reason why they continue andthey perpetuate of the behavior and they do the same thing isthey don't want to be sick. this is a way out. they don't have tolive that way anymore. >> if you're just joiningus, i'm patty satalia, and this is conversations live, the heroin epidemicrevisited on wpsu.
our guests tonight are senatorgene yaw, the state senator from pennsylvania's 23rddistrict, dr. philip moore, a medical toxicologistspecializing in treating drug addiction, andamanda cope, a registered nurse and the administrative directorof positive recovery solutions. our telephone numberis 1-800-543-8242, and our panel is readyto take your phone calls. if you'd prefer to email us,our address is connect@wpsu.org. and we go to our phone now.
timberlee from altoonais on the line. go ahead, please, timberlee. >> yes, my question is,you say how addiction and stuff can start withprescription medications. personally, it affects my life. i just lost my mother dueto a prescription problem, and what i would like to knowis why isn't there a bill or something placed to wherewhen you're going to the doctor, everything, really, withyour social security number,
why is it so easy for people,for addicts, to go from doctor to doctor and keepgetting these medications that they overdose on, andthen eventually, you know, if they don't get thenarcan, they eventually die? >> that's an excellentquestion, and the reality is when you talked about theseven people a day die from a heroin overdose,16,000 people a year die from prescriptiondrug overdoses. so how would you answerher question, dr. moore?
>> several states in thecountry have programs for prescription drug monitoringwhich allows you to see where a patient has beenfilling their prescriptions. pennsylvania, myunderstanding, has been approved for this program, but it hasn'tbeen fully developed yet. that's really the key tobeing able to detect patients who are doctor shopping. now the problem with thosesystems is they, if you lived on a border of a state,
they might not detectsomeone getting prescriptions in another state and going, youknow, going across the border. so we really have to have anational monitoring program. >> senator yaw? >> we, the legislature, passeda prescription drug monitoring program in pennsylvania about ayear ago, and it was a follow-up to our first series of hearings about the necessityof such a program. unfortunately, it's notbeen fully funded yet,
and my understanding,last i heard, was that it'll take maybe a yearto get all of the equipment set up to do that with ourprogram, but we have one. >> you know, the interestingthing is, a program like yours, amanda, positive recoveryservices, will leave patients with a seven-day prescription,not a 30-day prescription, and yet insurancecompanies incentivize 30-day prescriptions. that seems to me to besomething we need to change.
>> so, one of the thingsto consider, as well, is unfortunately, we touchedon it a little bit earlier. pain is now consideredthe fifth vital sign, and reimbursement is dueto patient satisfaction. so there's some inner dynamicsthere that aren't correct, but it's the realityof our situation. so if you are being reimbursedbased on, and this is based on -- and this is like at ahospital level or whatnot, but if you're beingreimbursed based on whether
or not your patient felt that they were appropriatelytaken care of, and you're a patient that'scoming in and claiming, you know, some sort of pain,and they're not being medicated for that, you can seehow that kind of flows. there's a lot of differentmoving pieces to this problem, and i think that, you know,we need come together, as dr. moore suggested,on a national level. >> you know, it's interesting,and i said this earlier,
a number of studies have proven,though, that exercise can be as effective if notmore effective in treating painthan pharmaceuticals. do you anticipate a day whendoctors are more readily going to be prescribingexercise, dr. moore? >> i hope so. my patients, i'm alwaysencouraging every single one of them to exercisebecause it's so important for that addiction piece.
a lot of them areaddicted to opioids, and exercise increasesthose natural opioids, and so it is imperative toexercise, and one of the keys to breaking that addiction. >> and we know thattolerance, the longer you're on a prescription, the higheryour tolerance level for it. so you need more to getthe same impact in terms of pain relief or high. you look like you weregoing to add something.
i'm going to go quicklyto a phone call. john is calling us from altoona. john, you're on the air. >> yeah, hi, i was wondering whynobody has ever mentioned the fact that since weinvaded afghanistan, the opium production therehas skyrocketed to a point where it's at record levels, andproduction there is hand-in-hand with the corruptgovernment that we support. the other side to that isthe money that we invest
in these unnecessary wars couldbe put towards not only medical needs here, but alsoopportunities in low economic areas, alot of the rust belt areas, for people to have opportunitiesand to have not only healthcare, but jobs and futures thatthey don't currently have, and i was wondering whatthe senator thinks of that. >> yeah, interestingobservations. is there a link betweenpoverty, unemployment, and drug addiction, and --
>> i think that there probablyis but, you know, i don't mean to be flippant about it,but, you know, what happens in afghanistan, i don't reallyhave anything to say about it. of course, if we didn'tspend money on other things, we would have more to spend onthis particular health problem, as with other problems. >> yeah, it was thesecond part of his comments that i thought wereparticularly interesting. the opportunity, thepoverty, and the unemployment.
we look at places likewilliamsport, for example, and as unemploymentrose, so did heroin use. >> i think that to some extentthat's true, but what we found out in our studies is the heroinproblem is not specifically related to poorer. in fact, the most likelycandidate for a drug overdose in pennsylvania is awhite middle-aged male. >> interesting. amanda, you had somethingto add.
>> i was just goingto say, i mean, from our patient population, the days of your addictsbeing the people that live under the bridge,those are long gone. these are your neighbors. these are your spouses,your teachers, your doctors, your mailman. it affects and it touchesevery aspect of our life. looking at the patients that isee that walk through our doors,
there are people that arewell below the poverty, but there are peoplethat are established and that are high society and that have an addictionand they need help. >> in fact, the way 60minutes put it, they said, "people like us are now using adrug other people used to use." >> i agree with whatamanda said. it's all socioeconomic groups,all races, all ages there. it's across the board.
it can be your brother. it could be your mother. it could be your grandparents. it could be your kids, brothers,sisters, i mean, it's everyone. >> you've seen it everywhere. go ahead, dr. moore. >> yeah, i definitelyconcur addiction has no boundaries anymore. one of the things i'venoticed is that patients
with higher socioeconomicstatus, it's more difficult to get them intotreatment programs, because the funding is all for the lower socioeconomicstatuses, and so you're oftenbattling insurance companies to get prior authorizationsfor medications. you can battle them forweeks, and they will come up with all kinds ofexcuses why they don't want to pay for this therapy.
all the while, theperson you're trying to help may be continuingto use. so that should alsobe another target. >> all right, we go to caroline, who's calling usfrom state college. go ahead please, caroline. >> hey patty, it's caroline. >> oh, hi, caroline. >> my question is, andyou know my experience.
how do we get these peoplethat need help, like my son? he wasn't a heroin addict,but you know the whole story. seven times in the hospitalby my calling the police, and he's not staying there. the doctor is releasing him. we need more help, as parents,getting the people help that need help with the way thelaws are and the human rights, there's not much we can do. >> good-- was theremore to that, caroline?
>> i was going toask amanda to answer, but i didn't knowif i cut you off. >> oh, no, that's okay. >> dr. moore. >> i think i can helpanswer that question. someone can choose tomake bad decisions, but we can't really hold them against their will unlessthey're very actively either suicidal or homicidal, andso that's really the problem.
someone can make bad decisions,which clearly there are. that does happen. >> you know, thedifficult thing i think for parents is they mightget them into a program, but, you know, federal studies showthat for the best outcomes, you want a program that lastsat least 90 days, and so often, they're 12-week programs ortwo-week program, and often, it seems to me, you're throwingyour money down the drain. if you don't keepsomeone long enough,
your chances of successare slim. what's your responseto that, amanda? >> i think with vivitrol,specifically, they have to make a gooddecision once every 28 days. >> they have to cometo your clinic. >> and that's the case -- well,yeah, to get the injection, even if it's not with prs. once every 28 days. it's not a daily decision
as to whether you'regoing to use that day. i think that it provides thatsafety net for these patients. >> and how long do you haveto get that 28 day injection until you are considered, youknow able to cope on your own without the use of medication? >> so studies show that ittakes about a year for the brain to repair, to beginnormally functioning again. literature shows that theyrecommend a patient be on vivitrol for 12 to 18 months.
we go as far as to say18 months for sure. we want to give the patientthe best possible chance to have the recoveryof the brain, to have all of thosewraparound services in place, and to change people,places, and things, and all those other thingsthat come along with it. >> i want to ask amanda aquestion, and this is for, i guess, parents out there orothers that may have someone that they feel thatinjectable naltrexone
or vivitrol is a good therapy. what would they do todetox their loved one or themselves to be a candidate? >> so what we do, you need tobe abstinent for at least 7 to 10 days to be appropriatefor the medication. what we do in our clinicas we provide comfort meds by prescription forthat 7 to 10 day period. so the patient comesin to us as a consult. if they're still activelyusing, we can still help them.
we would give themedications like clonidine, like sometimes neurontin,sometimes trazadone, sometimes zofran, to medicatethe symptoms of withdrawal. once they achieve that7 to 10 day period of complete abstinence, we thendo the naltrexone challenge test, which is theby-mouth form of naltrexone, to make sure there isn't anallergy, and then we follow it up with the injection. so even if a patientis in active addiction,
they're still appropriatefor services with us. >> and they can't comein and buffalo you because you will do a urine testto determine whether they -- >> every time they come in. >> yes. >> every single appointment,they'll be urine drug screened, and the medication itselfis its own best truth serum. if they were to get theinjection while they still had a dependency on board,they would go
into what's calledprecipitated withdrawal, which is withdrawal on steroids. so it's withdrawal exemplified,and it's a lot worse. so a person is not goingto willingly put themselves in that position, when withdrawal is whatthe addict fears the most. so the medication, as isaid, acts as a truth serum. >> senator yaw. >> what both dr. mooreand amanda, i mean,
and this caller hit thenail right on the head, and i could tell fromthe concern in her voice that she's had some personalexperience, but it points out the fragmented nature of thetreatment programs that we have. amanda's program is great, buthow do you get somebody in it? you know, and what dr.moore is doing, i mean, he's very concernedabout his patients and how he handles them, and howdoes his put input get put in? what we found in all of ourstudies is our system is
so fragmented, and we needsomebody to put their arms around the problem, andthat's where we came out with the community-basedanswer to it. we've developed a program in north carolina called projectlazarus that was started there. >> right, with sevenspokes on a wheel. >> and we've tried to kindof started to duplicate that with the programin lycoming county, and what we want to do isprovide all the services
and have somebody come in andbe able to do the warm handoffs, so that they just don't do thevivitrol program and then all of a sudden where do they go? and we have everybodyinvolved in it from the district attorneyto president judge. we've got doctors, thehospitals, colleges, we've got schoolsuperintendents. >> the bottom line is there'sa role to play for everyone. and your caller, youknow, her frustration,
that's exactly what we need issomebody, one-stop shop to go to say, "here's the next step. here's where you go. here's what you do." >> okay, you need that, andwere also looking at a state that some say, you know, we'rein the midst of a budget impasse that is the longest in 45 years. we've seen funding cutsin these health services, while at the same time,this problem has quadrupled.
so i'm sure a lot ofpennsylvanians are thinking, "how can we possibly solvethis problem when we got other, perhaps, even bigger problemswe can't pass the budget?" >> education. i don't think a lotof people know. really. the question wasasked of me originally. how do you get the word out, bring it to greater people'sattention about this problem? and that's what we'vetried to do.
we tried to do that bythe reports, the hearings. your program, it's great. if people don't know, there'snever going to be any response to it, and the first thing thepeople have to understand, too, in any community,especially communitywide, is we have a drug problem. there are a lot ofcommunities in this state that they want to ignore it. just sweep it under the table.
we don't have a drugproblem here. because if you admityou have a drug problem in your community,it affects everybody. it affects your schools. you know, do people wantto go there and live? those types of things. >> dr. moore -- andjackson, i'm going to come to your phone callin just one moment. >> there's actuallyfinancial information
about the varioustreatment programs. so they've comparedpatients that receive, and in a methadone programand compared them to patients in a buprenorphine orsuboxone or subutex or patients in naltrexone orvivitrol programs, and what the studiesshow is that, yes, the cost of the medication, thevivitrol, is the most expensive, compared to methadoneand suboxone, but all the other careassociated with it is
so much more reasonable,and so over six months, a vivitrol program ismuch more economical. it's much -- >> more cost-effective. >> yeah, than putting someone ina methadone or suboxone program, and we have oftentimes thesepatients are in these programs for 30 days wherethey're naturally detoxed, and they're just released backinto society or from prisons and even the drug court systems,
they're just -- andwe have this -- >> and their chances ofsuccess their are very slim. >> yep. >> when that's theway they're released. okay, go ahead, amanda. >> there's a really excitingthing happening in blair, armstrong, and indiana, and they've started ajail reentry program, meaning that they are startingthe patient on vivitrol prior
to release from beingincarcerated, so and then they'rereferred out to us. the same thing happens witha patient in inpatient rehab. they get their firstinjection in rehab, and then they'rereferred out to us. so it lessens thebleed on the taxpayers. they're not coming outand then reoffending or having a positive urinedrug screen and ending up back in the system.
if you can get them started on the medication while they'reincarcerated, they come out. they follow up with us. they have a provider, andthey can then work on becoming that functioningmember of society again. >> and that's what they'reseeing with drug courts, where therapy ispart of the program. >> there's a 25% recidivism rate versus the general prisonpopulation where there's a 75%
or higher recidivism rate. so it sounds like itdoes make economic sense. as promised, jackson from newbloomfield, you are on the air. what your question please? >> my question isfor nurse amanda. how effective would thisdrug be that her company uses in stopping my cravings? >> so naltrexone takesaway cravings completely. that's what the probablyabout 99%
of our patient populationtells us. they report zerocravings to use, to abuse opiates or alcohol. it's the way that itworks in the brain. so if you're somebody that'sstruggling with addiction, if you were to beon the vivitrol, i would say that youwouldn't have cravings at all. that's what our patientsreport to us. >> now what do you say topeople, dr. moore and amanda,
to those who say we're replacingone addictive substance with another? i'll begin with you, dr. moore. when we talk aboutmethadone and suboxone and those sorts of things. you've heard that argument. >> oh, sure, and when ihear it quite frequently, and i always explain it fora patient with methadone or suboxone, it's reallya risk/benefit analysis.
do you want someone receivinga drug that's manufactured by a pharmaceutical companythat's highly regulated? you know exactly what it is. or do you want someonecontinuing to use a drug that you don't know who'shad their hands on it, what it's been cut with? >> and we know that heroin,bad heroin, that has been cut with something is thereason for a number of deaths in pennsylvania.
>> exactly. >> you had somethingto add, amanda? >> i believe, we believe, that there is a medicationthat's appropriate for every patient population. if you're going to lookat, we have a taper program that involves suboxonethat, with the goal for them to be completelyabstinent on vivitrol. obviously, vivitrol supportsthe complete abstinence,
but if you're looking ateven the change in lifestyle from somebody who's in activeaddiction to somebody who's on suboxone, they'renot stealing. they're not robbing. they're not vandalizing. they're not doing all of thosethings to get the next one in. they're on a prescribedmedication. so there are certainly,you know, there's issues with diversion with suboxone.
there's a lot ofstigma attached to it because it has been misused,but used in the appropriate way, it's a good medication to bridgesomebody to complete abstinence. >> i'm going to go to acall, but i want to get back to this idea of stigma. so remind me of that. jane from somerset,you are on the air. >> i'm asking about a patient with actual chronicpain that's severe,
but also is addicted to opioids. what you do for someonelike that? >> dr. moore, that'sa tough one. >> when you're treatingthat type of patient, you can't treat onewithout the other. so if you going to treat pain, you also have totreat addiction. you can't isolate one. so that's reallythe key to therapy.
a lot of times thosepatients have problems getting into pain clinics oncethere's been a history of abuse of medications or street drugs, and it definitely,you know, what to do? it's definitely a challenge. >> but doing the same thing,you know, someone who's in chronic pain, they'readdicted to opioids, and they're stillin chronic pain, if you're doing the same thing
and you getting the sameresults, it sounds to me like it's time to change, andwhat do you think, dr. moore, of something liketrying acupuncture, or as i said earlier, exercise,and combining these things with the other treatments? >> i think anything that works. chronic pain, just like addiction itrequires a unique approach, patient-centered.
so this patient may bedifferent from that patient, and if acupuncture works forone patient, that's great. continue it. >> all right, we go to, i hopei pronounce your name correctly, ching from erie. >> thank you. >> hi, what's yourquestion or comment, please? >> yes, good evening,for everybody on the -- yes, good evening to everybody.
>> good evening, what's your -- >> i wanted to ask likedo you all feel as though that is a crime against humanity when these pharmaceuticalcompanies is getting these drugs fda approved and not knowingthe long-term side effects? or does anybody even care? or is it just that they gettingpaid to approve these drugs, not caring, and then thisis how these people get -- >> i think what he's getting
to is something thati said earlier. you know, between 2009 and 2012, vicodin was the number-oneprescribed drug in america, and so i can understandwhere some people are saying, "the pharmaceutical companyhas some responsibility here." what do you say to that, amanda? >> i think that if you'reconsidering what these medications were made for. i mean, we absolutelyhave become a society of,
"what's your problem? here's a pill." absolutely. and it's across the boardfor everything that there is, but certain medicationswere made for patients who experience horrific pain. i mean, cancer patients. people that need that medicationin order to function at all. so i don't know thati would find it --
i would hope in my heart that a company wouldn't createa medication with the intention of creating an epidemic, right? but i think that, again, itgoes back there is a certain population that'sgoing to be appropriate for a certain medication,and i think that, you know -- >> well, that bringsme to this, dr. moore, and we only have a coupleof minutes remaining, but only about 25%of those people
who try heroin willbecome addicted. not everyone. am i getting that right? so why does one personbecome addicted and another person doesn't? do we know enough about that? >> it has to do with genetics, probably who yousurround yourself with. one of the common things i'veheard patients say is people,
places, and things. just it depends on what'sgoing on around you. so there's actually some studiesin kids who have been naã¯ve. so not on any drugs before,and it doesn't take very long to get someone hooked, or, youknow, dependent on these drugs, and in as littleas nine days, 100%, in the study i'm thinkingof, were dependent on opioids in the icus. >> we have just a couple ofseconds remaining, and i'm going
to end with you, senator yaw. on a legislative pointof view, what's out there that gives you encouragementas we go forward and try to tackle this epidemic? >> well, i think, as isaid at the beginning, we need to learnabout the problem. we've already addressedsome of the things, like the good samaritan bill,naloxone, the drug registry. we've tried to do that.
we need to learn about it. we're probably going to introduce some legislationinvolving drug education for doctors. maybe in medical schools. we need some betterreporting requirements from coroners asto where we are. we're at the beginning ofthis, and i think that, like i said before, programslike this raises the awareness.
>> all right, and on that note, unfortunately, weare out of time. thank you all so muchfor being with us. our guests tonight, senatorgene yaw, the state senator an internist with a associatesin medical toxicology, and amanda cope,a registered nurse for all of us here at wpsu, thanks for joiningus and good night.
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