Last Day Revisited: The Opioid Crisis

8: America is Insane

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[00:26] Stephanie Wittels Wachs: I am a broken record about lots of things on this show, and I am also a broken record about the fact that if you’re joining us for the first time, I think you should go back, start the series from Episode 1. I promise it will be worth it. Enjoy the show. 


[00:49] Sarah Gad: The reason why I decided to run for Congress, and why I decided to go to law school, was not because I wanted to be a lawyer, but because of my experiences in the Cook County Jail. 


[01:06] Patrick Kennedy: I do this because I feel like I was called to do it in the sense that I grew up in an alcoholic home. Everyone around me suffered from it, whether directly or indirectly. 


[01:18] Sarah Gad: I had been approached to run for Congress by that point several times, but I thought the idea was crazy because I’m 32 years old, in my third year of law school, I’ve been to jail, I am a recovering addict. I’m also Arab and come from a Muslim background. 


[01:40] Patrick Kennedy: You know, I never intended on being a champion for mental health. I never planned on it. It was not my goal in life to be a guy that was fighting against discrimination, against mental illness and addiction. I’d rather no one know that anyone in my family suffered from these illnesses. I certainly didn’t want them to know, you know, the shameful truth about my own life, which is, you know, I kind of led a double life. 


[02:05] Sarah Gad: But when I started to actually reflect on the idea, and what I could bring to the table, I thought that if not me, then who? And if not now, then when? I mean, they say insanity is doing the same thing over and over and expecting different results. And I think that by this point, it’s fair to say that America’s insane. 


[02:29] Stephanie Wittels Wachs: America really is insane. And for most of my life, that was just a thing that I would kind of casually think to myself. Like, the amount of money I pay for health insurance is insane. Or this endless cycle of school shootings is insane. But then my brother became addicted to opioids and suddenly this theoretically insane news story became our actual lives. And since we decided to make the show, Jess and I have done, I don’t know, 1, 2, 14, 20, one hundred million interviews where we tell our family stories. By which I mean we talk to strangers about our dead brothers. And sometimes I just have no fucking desire or energy to say another word about it. So why do it? Well, because you may have noticed that something has got to change. And so instead of just accepting that that’s just the way it is — America is insane. We are actively saying, no, enough is enough. Even though I didn’t choose this path willingly, it’s the path I’m on. And I’m not alone. I’m Stephanie Wattles Wachs, and this is Last Day. 


[04:06] Patrick Kennedy: By fate, I ended up being the first name on a bill that required that these illnesses of mental illness and addiction be treated like all other physical illnesses. And the reason — and the only reason — I got to be the champion of this issue in Congress is because no one else seemed to want it. I mean, no one else wanted the words ‘mental’ and ‘addiction’ kind of next to their name if they were the primary sponsor of this bill, which is what I became. And I did it only because I had a guy that I had been in drug rehab with sell his story of being in drug rehab with me to The National Enquirer saying how Patrick Kennedy was his roommate. 


[04:54] Stephanie Wittels Wachs: You know how my mom found out that Harris died? TMZ. She found out that her only son died through a trashy clickbait gossip site. Which, I mean, still makes me want to set the world on fire, because having the shittiest day of your life thrust into the spotlight for all the world to see is a nightmare. And it’s something that Congressman Patrick Kennedy has dealt with his entire life, because, well, he’s a Kennedy. Patrick served in Congress from 1995 to 2011, and his biggest accomplishment was a bill called the Mental Health Parity and Addiction Equity Act. And it basically ensures that addiction and mental health are covered like any other disease. So here’s how it came to be. In 2008, Patrick was sponsoring the House version of this bill and someone else, someone very close to him, was sponsoring the companion bill in the Senate. 


[05:51] Patrick Kennedy: So here’s the rub. My dad ended up being the sponsor on the Senate bill. 


[05:57] Stephanie Wittels Wachs: His dad was Senator Ted Kennedy. 


[06:01] Patrick Kennedy: And so what that meant was that when we passed our comprehensive Mental Health Parity and Addiction Equity Act — and we had to negotiate what was going to be the final bill, because keep in mind, the Senate had passed just the, quote, Mental Health Parity Act, which frankly wasn’t even all of mental illnesses. You know, the real negotiation would be over ‘how much of this do we really cover?’ And the real irony in all of this is that the two people who were to negotiate what was going to be guaranteed in terms of coverage for the nation had never really talked about this issue. 


[06:49] Stephanie Wittels Wachs: The two people being him and his dad. And according to Patrick, there were a number of moments between the two of them where an honest conversation about addiction would have made sense. Like when Patrick first started experimenting with drugs, or in 2006 when he checked himself back into rehab after crashing his car outside the Capitol building. But like many families, these issues were just, you know, swept under the rug. 


[07:21] Patrick Kennedy: And yet that’s normal because most families don’t want to talk about addiction in the home, mental illness in the home. And, you know, my family is no different. They didn’t want to talk about it. I grew up looking the other way. And so here we were, I’m championing the one that covers addiction and post-traumatic stress —  which, of course, affected my father, which was not covered in his bill. You know, he’d seen his brothers assassinated on TV over and over again.


[08:01] Stephanie Wittels Wachs: His dad, Ted Kennedy, was a new junior senator when in 1963, his brother John F. Kennedy was shot and killed in broad daylight for all the world to see. The following year, he was in a traumatic plane crash. And in 1968, his brother Robert was also assassinated. That is a lot of things. So Patrick grew up seeing his dad self-medicating to deal with all this PTSD while watching his mother, Joan, also struggle with alcoholism. It was many decades of undealt-with substance abuse and trauma in one family, but it was all of this stuff that ultimately informed the bill that Patrick was pushing forward.


[08:50] Patrick Kennedy: And it was just a strange coincidence of fate that I would end up saying to my dad, ‘can we pass my bill instead of your bill? Because our bill in the House covers everything. Why not do the whole thing?’ And not in so many words, but he actually at the very end — because he had just been diagnosed with glioblastoma, a brain tumor — and he couldn’t carry the fight any longer on the Senate bill. And I asked him if it were up to the House to pass the Senate bill, or the Senate to pass the House bill, I said I’d rather the Senate pass our House bill because it’s much better. Can you help me by pulling out all the stops for me? Because everybody wanted to help my dad. They loved him so much. And he said sure. So he told me to talk to his best friend in the Senate, Chris Dodd. And Chris Dodd was a member of his committee. But Chris Dodd also was chairman of the Banking Committee, and that seemed like it was an irrelevant fact. Except the week after I talked to Chris about helping me with my bill, H.R. 14 24, banks started going belly up. The economy was in a freefall and people were talking about us entering into another financial depression. 


[10:17] Patrick Kennedy: And so all of a sudden Chris Dodd was the man to know. And Chris told me, he said, ‘Patrick, I have an idea for how we can pass your H.R. 14 24.’ I said, ‘what is that, Chris?’ He said, ‘how about we write the $800 billion bailout of our nation’s banks into your bill?’ And I said, ‘really?’ He said, ‘yeah, I’m marking the bill up right now and we can write it all into your bill — the Mental Health Parity and Addiction Equity Act.’ And I said, ‘well, you can do it, go for it.’ But the only reason today we have the parity law is because Chris Dodd, chairman of the Banking Committee, wrote an $800 billion toxic asset relief program into H.R. 14 24, the Mental Health Parity and Addiction Equity Act. And I still don’t believe it. I’ve got the I’ve got the bill on my wall at home, and I still can’t believe it. 


[11:20] Stephanie Wittels Wachs: This bill is important and necessary. And it’s totally bonkers that until 2008, something like depression wasn’t considered worthy of medical coverage. But if you are a human being who has ever dealt with the quagmire of health insurance in America, you know that this bill hasn’t been a universally effective solution to the problem. In fact, it’s rarely enforced.


[11:47] Patrick Kennedy: Well, it’s still wild that the bill’s not enforced. That it’s flaunted, you know, with total disregard about observing it. You just can’t get the same access to care and you can’t depend on the same quality of care. And both of those are contingent upon the money because we’ve never paid for this. And so we’ve never been able to get enough of it available for everyone. And what we do get is not, you know, up to par, so to speak. And, you know, there’s pockets where people are doing a great job. But we’re scratching the surface on meeting the needs of those who really need help in this country. And the system is not currently anywhere near being able to meet the needs of Americans who desperately need help. 


[12:46] Stephanie Wittels Wachs: Right. So the system is essentially rigged against most Americans because the bill isn’t reinforced with proper funding, which I promise we will get into later. But what happens to people who need medical care for addiction and mental illness, people who don’t have the last name of Kennedy. What happens to them? Well, many of them go to jail. More on what happens when you are thrown in jail for having a disease when we come back. 


[15:37] Stephanie Wittels Wachs: We’re back. Remember that voice at the top of the episode who wasn’t Patrick Kennedy? Well, she is running for Congress and this is the beginning of her campaign video. 


[15:51] Sarah Gad: My parents immigrated from Egypt to the U.S. to give my sisters and I a better life. My mother wash dishes in a cafeteria. My father drove taxis. Money was tight, but they saved every penny they could for me to go to college. I’m Sarah Gad, activist and educator. A third year law student at the University of Chicago. And a former inmate at the Cook County Jail. 


[16:14] Stephanie Wittels Wachs: That may be part of the boldest political ad I have ever seen. So here’s the backstory. Sarah Gad was in her third year of medical school when she got into a serious car accident that landed her in the hospital undergoing emergency surgery. By now, you know where this is headed. She was prescribed opioids for pain, but the damage from the accident was so intense that she started missing classes and falling behind in school. And her pain meds started to feel like her only source of happiness as he became increasingly alienated and depressed. 


[16:55] Sarah Gad: The very nature of the disease is one where you lose all the volitional control over your ability to cut down on your use. And so by that point that I realized I was addicted, and I was running out of my prescriptions early, and my doctors had cut me off, it wasn’t like, OK, well, now I have to find out how to live without them. I felt like I needed them to survive. 


[17:19] Stephanie Wittels Wachs: And so she tried going to other doctors. But the prescription-tracking database we heard about in Episode 4 put an end to that real fast. 


[17:28] Sarah Gad: My way of getting them was through forging prescriptions, because that’s what I knew how to do as a medical student. So I was arrested and booked into the Cook County Jail. And I spent about two days in the holding cell because the Cook County Jail is one of the most — has one of the largest inmate populations in the country. It’s the largest single-site jail in the country. And when you’re processing in 100, 200 inmates a day, you know, you’re stuck down in booking cell for a while. And it’s you and about 20 other people all squished into a tiny cell with one sink, one toilet. Everybody’s eating their baloney sandwiches within the six by eight cell where other people are going to the bathroom. I mean, it’s just completely dehumanizing and so undignified.


[18:31] Stephanie Wittels Wachs: Not only were the physical conditions of the jail dehumanizing, but Sarah was also going through active opioid withdrawal. Under the best conditions this process fucking sucks. Remember Dr. Harrison’s description from Episode 5?


[18:48] Dr. Nzinga Harrison: It is excruciating bone pain and joint pain. It is watery eyes. It is running nose. It is nausea, vomiting, diarrhea. It’s tremor. It’s elevated blood pressure. It’s elevated heart rate. 


[19:02] Stephanie Wittels Wachs: So imagine going through that in a holding cell surrounded by strangers, baloney sandwiches and toilets. And the jail’s go-to response to this process, frankly, is medieval. 


[19:16] Sarah Gad: In jail, they call this the opioid detox cocktail. It consists of Imodium, Zofran for nausea, and ibuprofen. Those are the ingredients. Doesn’t even begin to take the edge off of the profound physical and psychological pain that accompanies physical withdrawal, especially in an environment like that. It did nothing. It was essentially useless.


[19:51] Stephanie Wittels Wachs: As if all of this wasn’t scary enough, Sarah was a nonviolent offender placed in a maximum security prison, which means she was in jail for writing a fake prescription and serving alongside women awaiting trial for murder. To say that she was vulnerable is an understatement. A warning that this next part of her story is particularly difficult to hear. 


[20:15] Sarah Gad: I was sexually assaulted on my first day, the very first morning that I was there. And I had been given this pamphlet when I was booked into the jail that said, you know, if you have been sexually harassed or assaulted in any sort of way, tell the nearest correctional officer or person in charge immediately. And so that’s what I did. I told the correctional officer thinking that the correctional officer was going to at least separate us. What ended up happening was the correctional officer actually told the inmate that I had snitched on her. And there is this saying in jails that snitches get stitches. And I learned that pretty quickly on because immediately after I had reported the sexual assault, the officer exited the pod and then the woman who had assaulted me — she was actually charged with homicide — her and three other inmates took me under the staircase where I wouldn’t be visible to the security cameras and beat me pretty severely. And the beatings just started happening on a regular basis. But at one point, I was beaten so severely, I was actually stabbed, that the jail physician ended up putting me on opioids, even though I was in there for forging a prescription for opioids. I mean, that’s how counterproductive our system is. 


[22:01] Stephanie Wittels Wachs: Honestly, this story is fucking horrific. The first time I heard it, I wept. And every time I’ve heard it since, I just get angrier and angrier. For Sarah, every minute in that facility was more traumatizing than the one before. And through all the physical and emotional pain, she kept wondering, what is the point of all of this? How much trauma could she take? How much did she deserve? Was the jail time supposed to scare her out of her addiction? Or was it supposed to rehabilitate her? Because — spoiler alert — it didn’t do a fucking thing to help her overcome the disease that landed her there in the first place. But as bad as it was in the facility, the outside presented a whole new form of cruelty. 


[22:54] Sarah Gad: It’s not like the punishment stopped when I got out of jail. It continued. It followed me. I couldn’t get a job. I couldn’t find a place to live. I couldn’t even get federal assistance. I couldn’t apply for public housing. I couldn’t even apply for federal aid to go to school. I couldn’t do anything. And in the end, I had to take the only job that was offered to me, which was at a convenience store making less than nine dollars an hour, which was not enough to even pay for rent and basic utilities. 


[23:33] Stephanie Wittels Wachs: Ladies and gentlemen, our justice system. How could this system actually help someone? It makes you think — maybe it’s not supposed to. For Sarah, the punitive measures only led to more hopelessness, more depression, which — reminder — is what jump-started her substance use in the first place. 


[23:59] Sarah Gad: Addiction is a disease just like any other disease. It’s not dissuaded by the prospect of punishment or deterrence. Like diabetes doesn’t go away if you threaten somebody with jail time if they eat sugar, like that’s not how a disease works. And by criminalizing it and creating all of these barriers and obstacles, it creates this feeling of — it’s just this overwhelming feeling of discouragement and defeat that it drives you back into using most of the time. And that’s what happened to me. I would be arrested. I would get out and try to get back on my feet and not be able to. And I would just give up relapse. And when it came time for me to be drug tested and I didn’t pass my drug tests, I’d be thrown back into jail. I had gotten arrested for the third time in July of 2015, and I was only incarcerated for five days. And then I was released and I overdosed same day that I was released. And I woke up in an ambulance being injected with Narcan and told that I had overdosed. And I was taken to the hospital and they were monitoring me and my withdrawal symptoms were just through the roof. My heart rate was consistently above 150 and my blood pressure was through the roof. I was vomiting nonstop.


[25:41] Stephanie Wittels Wachs: We’ve heard first responders explain that people brought back from the dead with Narcan aren’t exactly jumping for joy. This was exactly what happened to Sarah. She was super sick and her very first thought was, how do I get effects so I can feel better. Because, oh, by that point, she had just completely given up on the idea of long-term recovery. It just wasn’t in the cards for her. 


[26:06] Sarah Gad: But then an addiction medicine fellow stopped by my room to talk to me about a treatment program called Medication Assisted Treatment, which was becoming more recognized in the treatment community as the gold standard for treating opioid use disorder. And I was just kind of like, OK, whatever, anything to get me out of this withdrawal. 


[26:32] Stephanie Wittels Wachs: The doctor gave her Suboxone to help her feel less shitty in the short term, but also explained that she could use it long term. Also, Sarah refers to medication assisted treatment as MAT, you’ve heard others call it M-A-T. Tomato, tomahto. Don’t freak out. 


[26:49] Sarah Gad: When I started MAT, I was pleasantly surprised that — I mean, this — it was three years at this point where I had not felt normal without using drugs. And suddenly I am in a state where I don’t have cravings. I don’t have withdrawal symptoms. I’m just me. I’m extremely bored and unsatisfied because I can’t find a meaningful job. I can’t find a meaningful way to reintegrate back into society. And so you’re kind of forced to confront this reality of, OK, yes, I am now in sustained remission. I’m sober, that’s something to be proud of. But also, it’s the first time you really have to come face-to-face with the fact that your life has been destroyed because of this disease. And now that you’re out of it, your life is still destroyed. In the world of addiction we call criminalization the point of no return. 


[27:53] Stephanie Wittels Wachs: This is profound. Basically, we have tools in place now to reverse the fatal impact of an overdose. But as things stand now, you can’t really reverse the impact of criminalization.


[28:08] Sarah Gad: I couldn’t teach, I couldn’t tutor. I couldn’t be involved with anything involving patient care, even research. And it was really disheartening. And it was kind of this place of conflict where I hate my life and I so badly want to use, but I don’t have any cravings. And don’t really feel any need to use. I guess it was, in a way, more discouraging. 


[28:40] Stephanie Wittels Wachs: By luck, Sarah met a civil rights attorney in Chicago who recognized her potential. 


[28:46] Sarah Gad: And just said, hey, just why don’t you come work for me for a little bit? Just as a part-time research clerk. You can work at bad mal cases, do some administrative tasks around the office. And I knew that that was probably going to be the only chance I was given to do anything sort of in a meaningful environment. 


[29:09] Stephanie Wittels Wachs: After years of feeling bored and directionless, she got to do challenging work again, using her medical and science background to oversee forensic testing for civil rights cases. 


[29:23] Sarah Gad: I was able to contribute to the exoneration of one individual. And it was kind of a surreal experience for me because it was about two years after I had gotten out of jail for the last time. And here I was escorting somebody out of prison who was wrongfully convicted that I had helped to free.

[28:47] Stephanie Wittels Wachs: Her new boss vouched for her and her work gave her the credibility she needed to get into law school at the University of Chicago. And there she started taking advantage of every opportunity to advocate for criminal justice and drug reform.


[30:01] Sarah Gad: And this was during a time where we were being really hit hard by the opioid crisis. Synthetic opioids had been introduced into the picture at this point. 


[30:11] Stephanie Wittels Wachs: She’s talking about fentanyl. This is what killed Stefano. It was originally used as treatment in medical settings for breakthrough cancer pain. It is very intense. A little bit goes a long way and it’s cut into basically everything now. 


[30:26] Sarah Gad: I had a lot of friends and former acquaintances who were dying of opioid overdoses and I was starting to notice a pattern in which most of them were dying right after they had been discharged from a correctional facility, just like I was. 


[30:40] Stephanie Wittels Wachs: Studies show that almost two thirds of incarcerated people suffer from substance use disorders, but only about a quarter of them have access to treatment and correctional facilities. In fact, overdose is the leading cause of death for recently incarcerated people. So based on her own success with MAT, Sarah, along with most modern medical professionals, saw this as a natural solution. 


[31:05] Sarah Gad: We uniformly expand access to MAT into correctional facilities so that, I mean, even if it doesn’t keep these people in sustained remission, at least protects them when they get out so that they don’t die. I think that should be the number one goal is to keep people alive. 


[31:24] Stephanie Wittels Wachs: Sarah established a nonprofit — Addiction to Action — that’s devoted to making MAT accessible in correctional facilities. They had lots of success with this program, but they were constantly hitting these frustrating legal roadblocks, like did you know that there is a cap on how many patients a doctor can treat with MAT? And yet no limit on how many people the same doctor can prescribe opioids to? Fun! Fair. All of it makes sense. And this brings us back to Sarah’s decision to run for Congress, because like she said, if not now, when? And if not her, then who? 


[32:04] Sarah Gad: I mean, I’ve experienced the trauma of being locked in a cage. And that’s, I mean, that’s something that is not foreign to many people in my district. 


[32:19] Stephanie Wittels Wachs: Sarah just launched her campaign in mid-October. She’s already getting a lot of attention. But if you don’t live in the 1st District of Illinois and you want to vote for candidates like Sarah who also care about this issue, what should you be looking for? Because I’m not sure if you were aware, but election season is upon us. Yard signs, political ads, knocking on doors, fights at the Thanksgiving table. It is coming at us like a freight train. And if you’re listening to this podcast, I have to assume that you care about the opioid crisis. And that you’d prefer to elect leaders who care about it, too. So to that end, what should you be looking for? 


[33:02] Andy Slavitt: That’s a really interesting question for the following reason — opioid policy is one of the most popular things that a politician can run on because this is a crisis that has affected, as you know, every community. And it’s something that’s affected every family in one form or another. And because of that, it’s exceedingly popular as a politician to stand out there and say that you want to do something about this very important issue. But I will say this, that if you don’t tie your commitment to this issue to your willingness to pay for it, then we as voters ought to be able to try to see through that. 


[33:44] Stephanie Wittels Wachs: This is Andy Slavitt. He worked on healthcare in the Obama administration. And what he’s saying is that we need leaders who are willing to talk the talk AND walk the walk. In this case, walking the walk means paying for it. And according to Patrick Kennedy, we have an abysmal track record. 


[34:03] Patrick Kennedy: For people who need hospital beds, we don’t have hospital beds. For people who need treatment, we don’t have treatment. And then we bemoan the fact so many people are dying of suicide and so many people are dying of overdose. It’s just not a shocking scenario when you look at the equation. The equation is set up for this. So if you want to change the result, you got to change the equation. And that means you’ve got to appropriate the dollars, just like we did in the height of the HIV/AIDS crisis. You’ve got to follow it through, just like we would with any other public health emergency. And you got to get about solving the problem. This is not an intractable problem. We know what to do. And we’re just not doing it. And, you know, to put $6 billion — which may sound like a lot of money — into context, it’s one-fifth what we were spending on HIV/AIDS. Twenty-four billion for HIV/AIDS, six for the opioid crisis. Fifty-three thousand lives for AIDS, a hundred and twenty for the opioid and suicide crisis.


[35:14] Stephanie Wittels Wachs: Now, let’s be crystal clear. It took the U.S. way too long to meaningfully respond to the HIV and AIDS epidemic. The comparison is not meant to imply the need to approach opioids the way we totally successfully handled the height of the HIV crisis because, um, we handled it badly. But rather that there are lessons our country learned the hard way that offer a useful comparison for this latest epidemic. So, HIV was an overwhelming public health crisis, like opioid use disorder. Historically, HIV has been mired in misinformation and stigma, like opioid use disorder. People who got HIV were judged and marginalized. So are those with opioid use disorder. But the approach to treating and preventing HIV has shifted over the years. To totally oversimplify, research was funded and programs were created, and it took lots and lots and lots of money to do so. But the most striking similarity that continues to hinder progress for both HIV and addiction is that the general public still sees these diseases as the result of lifestyle choices. 


[36:31] Patrick Kennedy: The fact is, we really have less of a chance to make this happen by trying to get anti-stigma messages across, which we should be doing. But I don’t think we need to be — that’s where we put our focus. I think we put our focus in normalizing the treatment of these illnesses such that we can show people that it’s possible for us to have early intervention, dramatically drop the prevalence and incidence of these illnesses simply by practicing a very aggressive public health strategy that identifies people who are highest risk. And if we do that, people would see a big drop, I think, in the depression, suicide, overdose rates. I think we just, I mean, if we did this right. I think people would say, wow, what a difference between the time they used to ignore this and the time now when we’re really on the ball and we take great urgency at trying to address these things before they become challenges. 


[37:42] Stephanie Wittels Wachs: Andy Slavitt is also on Team Identify Things Before they Become Challenges. 


[37:47] Andy Slavitt: We should recognize that while opioids might be something that’s most recently brought our attention to the addiction crisis in America, it’s far, far deeper. Things that drive people to addictive behavior are based on a much more complex set of factors. And if we don’t have policies that invest in, say, to pick one, our mental health care system, our education system, ways of alleviating poverty, things that drive hopelessness and other things that trigger addictive behaviors, we’re really going to be just chasing the latest thing that people are addicted to. And so good policy is about investing in mental health infrastructure, mental health professionals and the kinds of treatments that we know that work. And the good news is, well, nothing works on everybody, we do know what some of the treatments are that work. And it’s important that as a country, we finance those things and pay for those things or we’ll never solve them. 


[38:44] Stephanie Wittels Wachs: And there really is only one program that exists on the federal and state level that can pay for those things. 


[38:51] Andy Slavitt: And that thing is the Medicaid program. 


[38:53] Stephanie Wittels Wachs: Ah, Medicaid. A program that is simultaneously incredibly well-known and totally misunderstood. So what is it and how does it work? In a nutshell, Medicaid serves four groups. One, moms and babies. Two, seniors. Three, people living with physical and developmental disabilities. And four, lower income and modest income Americans. 


[39:20] Andy Slavitt: And it’s equally prevalent in rural and urban areas. In many states, the vast majority of Medicaid beneficiaries are white. Seventy five percent or so in West Virginia, half of the program are people that are white people. So I say this because sadly, this is a program that all of us support. And some people don’t like to support programs unless they feel like people that look like them or that they can relate to or taken care of. And I can assure you that even if your empathy skills are not so well honed, the Medicaid program does amazing things for you and for your community. 


[39:55] Stephanie Wittels Wachs: So what does Medicaid have to do with opioids? 


[39:58] Andy Slavitt: Somewhere around a third, and maybe even more, of the medication assisted treatment programs and the recovery programs are paid for through the Medicaid program. All of these cuts to the Medicaid program that are being, I think, very much in the news over the last few years. They affect real people and real families in a pretty profound way. And, you know, when you hear a politician say, hey, we really need to do something about this opioid crisis, ask them what they’ve done, how they voted on cuts to or expansion to the Medicaid program. And if you find that they have fought for caps on the Medicaid program, then I would question their seriousness by which they want to handle the opioid crisis they claim to care so much about. 


[40:41] Stephanie Wittels Wachs: So we’ve been talking a lot about what we get wrong. Is there anything that the U.S. gets right about drug policy? If no is the answer,  that’s a totally acceptable answer. Just have to put it out there as a question.

[40:53] Andy Slavitt: Once we get it wrong enough times, and finally figured out how to get it right, we do start to do things right. There are many, many programs in states around the country that have very humane, very effective programs that they operate. I visited a number of living learning places in Oregon. There are places that are starting to buck the belief that you have to be completely sober to be moved into a residential facility. There are places that are starting to see that what you need is lifelong handholding and some group support, and a more holistic approach to the problem. There are places now that are working with people on unemployment and housing and sticking with them. And so there are some very encouraging things. And it probably took a crisis that affected people closer to home for us to say, hey, wait a minute, maybe we’ve been thinking about this incorrectly. And I hope that that’s the case.


[41:52] Stephanie Wittels Wachs: When you say people closer to home, do you mean white people? 


[41:54] Andy Slavitt: I mean white people. 


[41:58] Stephanie Wittels Wachs: Right. As you may remember from our previous episode, or from decades of history, drug use was considered recreational for white people and criminal for black people. And that influenced the insane policies we created to deal with this issue in the past. But that doesn’t mean that that has to be the way we approach things moving forward. 


[42:20] Andy Slavitt: We know how to solve these problems. This is not a disease where we lack scientific understanding. In some respects that should make us feel good. It should make us feel like there’s something out there and all we have to do is implement it. But it also lets us know we’re the only people that are getting in the way. We’re the only reason why we’re not solving these problems. And we are hopeful when this becomes something we’ll talk about. I think it’s fascinating now that in obituaries, people are no longer ashamed to talk about the cause of death, when the cause of death is something that had been a taboo for so long. 


[43:03] Stephanie Wittels Wachs: In 2017, this taboo was still very much present and the Cordova family wasn’t comfortable putting it into Stefano’s obituary. Like so many families for such a long time, it just kind of glossed over the entire ending. But now, two years later, they’re doing an entire podcast about it. And this is exactly what Andy is saying. 


[43:29] Andy Slavitt: I think that’s really a remarkable part of the turning point we may be in. And if I had to sit here and say, will we be better off ten years from now, 20 years from now? I would say those are the kind of signs, if you’re looking for hope, that should give you hope. 


[43:47] Stephanie Wittels Wachs: Should it? 


[43:52] Stephanie Wittels Wachs: Why are these kids set up for success and these kids aren’t? And there is no rhyme or reason for it. It just is what it is. And I just feel like as I was like going through all this today and trying to find the connections I just like was overwhelmed with just like,  this very intense sadness about all of this. I don’t know.


[44:22] Stephanie Wittels Wachs: In our next episode, I have a breakdown, and we talk about kids affected by the opioid crisis. 


[44:36] Stephanie Wittels Wachs: Last Day is a production of Lemonada Media. This episode was produced by Jackie Danziger. Jessica Cordova Kramer is our executive producer. Kegan Zema is our technical director. And our music is by Hannis Brown. Special thanks to Westwood One, our ad sales and distribution partner. You can find us online @Lemonadamedia. That’s Lemonada, like L-E-M-O-N-A-D-A. And if you liked what you heard today, tell your family and friends to listen and subscribe. Rate and review us on Apple, Spotify, Stitcher or wherever you get your podcasts. And check out our show notes for a deeper dive into what you’ve heard today and how to connect with the Last Day community. I’m Stephanie Wittels Wachs. See you next week.

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