Heroin, Methadone, Sarah Mars discussed on Forum
And you can also, of course, tweet us. Our Twitter handle is at form and Marzano party research has been talking with people really across the nation who inject drugs, would you? Learn about the motivations behind the use of drugs just generally or used to certainly drugs that have their opioid epidemic of opioids. Yes. Well, there are many different motivations for using drugs. I mean and different drugs have different effects. So the motivations for different drugs. Also, very with the opioids some people have become involved in opioid use from prescriptions for pain and have intend to other periods after they no longer able to obtain sufficient supplies of prescription drugs being a little subversive in asking this question because I wanna know what you found from your research. But also there's been a lot of. Blaming culpability put on big pharma and doctors who have been over prescribing and big pharma move and making things to accessible. Well, I think that may be an element show of the of the current Potomac. But there are also people who is starting on heroin who've never taken prescription pills and to experiencing fence, no in the heroin supply. Well, they weren't addicts to begin with the very they become addicts. Yeah. Some of them. Yes. I think unrecognised aspect of the democ is there are underlying demand. Drivers, we tend to think of this notion that of doctors pusher that the doctors over prescribed and kind of got a generation addicted to the pills, right, but who came in and what did they complain about when they came into the doctor's visit that's under studied at this point. What were the economic social psychological demand drivers of this epidemic? I think unmeasured, and if we don't address them we will morph into yet another drug epidemic after this one goes away there, maybe even a bigger elementary just people wanting perhaps a needing to avoid paying more than they did in the past. I mean here can make all these arguments about the generation before us was stronger and more able to endure pain and that gets to some silly points. But the reality is a lot of people just feel they need the pills. Are they need whatever they can take to get. Rid of the pay. It does seem to be a bit of a of an American. Conundrum about. Wanting a pill to fix this and a pill to fix that. And so on overcoming that. Of course is a is a key part to getting out of this. Let's go to our calls. I'm sorry. Sarah, Marsh, we're gonna well one point I and to make that fence, no is particularly urgent issue to address at the moment. But it's part of a long term increase in drug overdose deaths from all drugs, which has been happening since one thousand nine hundred seventy nine and climbing steadily since then so we need to look at some of the underlying causes of drug use and drug overdoses. It's a deeper level at a societal level. My father used to say it's all poison keep yourself away from poisonous best. You can really is as you said poison. But my dad used to say so as alcohol, let me get some callers on here. Aaron let's begin with you. Good morning. Good to have you. I'm wondering if there's any research yet or anything about overdose being in areas, they're free needle exchange programs, and how that affects overdoses maybe outside of your Roma research, but some thoughts or reflections. So if I understand Aaron your question correctly, it is whether the needle exchange programs which came about during the HIV crisis in the nineties as a response to death student, HIV and transmission of HIV, whether they are being helpful in the overdose crisis or perhaps even causing harm. The evidence is good that they help reduce overdose through education. Also, the provision of naloxone now the surgeon general Jerome Adams has advocated for Norwalk zone. Not only to be used by professionals. But also by family peers lovers friends of folks who use drugs and that is a step forward because no lock zone as a blocker of opiates can reverse an overdose. One can save a life. I urge all listeners to get trained and keep this medication around as if it were the sort of the mature chrome of of Michael and my generation or the aspirin in the medication cabinet, Aaron thank you for your question. Good to hear from you and LaTour next from Lisa who joins us from Oakland. Lisa you're on morning. Hi, thanks for taking my call. I wanted to stress, but what Jerry important here is not just supply and not Jeff Nawab sound, but also expanding access to treatment we have very effective treatment for opioid use disorder and these are suboxone brand name for north orpheum. Certainly methadone and California is making tremendous tries to expand access to treatment for people. So we can arrest the Sepah gummy. Yeah. Important comment. We thank you for that. And we'll get to some more of our callers right away. Her Mexico's next max, thank you for waiting. You're on the air. Hi, thank you for this important topic. My question is after any research in Centeno access or impact in Portugal, where does have been licensed around two thousand six. Thank you for that question. The the Portuguese model is definitely something. We need to examine they have been very successful. And this is this is a medium wealth country in addressing the drug problem. They're not only by sort of decriminalizing possession. But also through a social model of rehabilitation of people that develop a problem. So instead of incarceration or criminal Justice approach to the so-called drug problem. They use a social model it has been very successful. I mean to think more about that that was in Portugal talking to people about it. And they seem to really not only be behind it. But think there's been some extraordinary success. Angry. Can you talk a bit more callers in a moment about I mean, you can send us is different versions of feno. There aren't illegal. Isn't that true? That's right. Yes. And that has been something of a problem in the taking action against against different types of fennel because you can. Make something illegal, and then a new version of the drug appears on scene, and it's not illegal. And this is what happened with China? They made a number of of analogues illegal in. I think was twenty fifteen and then subsequently a whole lot of new analogs appeared and circumvented the law and here we are. Here's a tweet from ourselves says discussing methadone and methadone availability might be a great way to reach the users who are scared of all it might be ready to quit, we need to de legitimate de legitimize methadone agree. So we actually were fortunate in this idea stigmatized Simitis. Thank you stigma is our biggest barrier. We judge the people that use drugs and problematic way. When most likely the drug that spoke to them is also speaking to their genetics and those of us who may have experimented and got away with not. Having a drug problem have different genetics. And so we have to we have to destroy the problem in one way to do that is to recognize that in this epidemic. We have three good tools to treat. What we call opiate use disorder. Right. We have three medications, right? Like methadone like buprenorphine knock extended release naltrexone, okay? To use those medications to have them. Adequately funded to have insurance pay for them without preoccupation. In particularly the kiss of buprenorphine is an essential element of addressing this problem. Again, Daniel Caroni is professor of family and community medicine at UCSF. And we also have Sarah Mars in studio qualitative project director on the heroin and transition study in the department of family and community medicine at UCSF, and we have another caller. And that's you Alexandra. Good morning. Yeah. My question for the colors. I was wondering. Any opinions about if the current epidemic how to deal with the increased rate of poverty in this country. It's just I I wonder about the very San and what that might be doing that. But I think it's a very significant question, and I should mention in the next segment we're going to be talking about a new report on doing away with cutting in half alternately child poverty. It's a major plan. That's come forward out of the assembly initially Daniel. Thank you for that question. There's growing interest in looking at the demand side drivers of this triple wave crisis, which is leading us to hire a professional now, then instead of thinking that simply as a vector epidemic were doctors over prescribed to understand what are the social and economic causes of this. There have been some good economic analyses showing that economic despair is has been a predictor of opioid pill overdose deaths which then led to heroin use. Then let us and so there's a lot of interest in economic drivers is a lot of interest in social isolation. Loneliness and other issues of social cohesion that might have driven the opioid epidemic. We need to address these if we want to prevent the next drug wave that's coming right behind fence. And all this is a supply led phenomenon though. Isn't it really when we get down to basics? Yes. I would say that that we need to see the exuberant, shall we say access to opioid tells as a problem, I'm not saying that we shouldn't address it. There is ample access to heroin in this country coming from Mexico, cheap NPR. And in addition we now have a new illicit drug supply, which is China. We're getting sentinel from there. So supply is an important part as well. We're not arguing against supply as both a cause. And perhaps maybe as a response. It's just that supply reduction doesn't work very well. Historically in the evidence base. Right. So that's what we're arguing for understanding this through demand and demand reduction efforts. Will you mentioned loneliness, for example? Studies show that it's escalating it's a phenomenon that has increased in the United States, and perhaps even globally. Let me get another caller on here though. And that's Jason Jason. Join us you're on the air. Yes. Hello. My question. I think really speaks to kind of mister robot phenomenon we had a fellow who was highly functioning Rummy mallets character who was utilize eighty both opioids and suboxone simultaneously in order to. Have the effects, but then also not developed the diction? Why is there nothing? Regulation to ensure that all narcotics have the suboxone. Type medication added not to decrease their efficacy, but simply to protect the people. The patients who are using them for pay control from developing addiction. It's a Jewish filing by the whole time. It's interesting question. Thank you so much. I'm wondering if you mean the lock zone as an addition as opposed to suboxone as some the Laaksonen is the blocker. There have been cases of putting of combining the lock zone with powerful opiates in medication. So that it wouldn't be abused as crushed j- injector crushed and snorted. There's a lot of I'm hoping not transitioning too far away from your question. But there's a lot of interest that the FDA to create abuse to turn formulations. I think that we will in the next generation have a bunch of different opioid medications that are a lot different than the ones that we have now. So stay tuned for that fight over from you, sir Mars. Well, it sounds like a very interesting idea. Sure does indeed. And the research is leading us a help to more solutions. And thank you for the work you've done. Thank you for joining us this morning. Thanks for having me here. Dendritic aronie again is professor family and community medicine UCSF, and Sarah Mars is qualitative project director on the heroin and transition study in the department of family and community medicine at UCSF another segment ahead. Stay tuned for that. We're going to talk about child, poverty and family, poverty, and how to cut particularly child poverty.