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Every five minutes an American dies from an opioid or fentanyl overdose. An FDA panel is recommending Narcan be sold over the counter, which experts say would reverse more overdoses and save more lives. Andy traces the line between opioid prescriptions, heroin, fentanyl, and tranq with Scott Hadland, a pediatrician and addiction specialist at Mass General Hospital, and Sarah Laurel, who overcame her own struggle with substance use disorder to eventually found an addiction recovery nonprofit in Philadelphia. They discuss whether the problem is getting better or worse, how to reduce stigma, and where to direct opioid overdose settlement funds.

Keep up with Andy on Twitter and Post @ASlavitt.

Follow Dr. Scott Hadland and Sarah Laurel @DrScottHadland and @sarah.laurel.517.

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Check out these resources from today’s episode: 

• Learn more about the FDA panel’s recommendation to approve over-the-counter naloxone: https://www.statnews.com/2023/02/15/naloxone-otc-opioisa-fda-panel-recommends/
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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Scott Hadland, Andy Slavitt, Sarah Laurel

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Please email me, andy@lemonadamedia.com. The show today is going to focus on where we are in dealing with one of the most significant public health crisis that we’ve ever faced. And that’s all the deaths from the opioid fentanyl problem that are plaguing the country. Even after learning what we’ve learned going through, we’ve gone through we’ve had shows like dope sick and the Sacklers have been exposed, we are still losing a person every five minutes from an opioid or fentanyl death. And that we’re now expected to lose 1.2 million more people by the end of this decade. The reason that’s happening is because the problem is shifting on us. Used to be a problem with prescribing and dealing with opioid prescriptions that it became a problem of heroin, then it soon became a problem of fentanyl, which it largely is today. And the emerging threat for the future is something that is known in the street as Trank or xylazine, which is an animal tranquilizer. Because it is not an opioid. You can use test strips on it. You can even use Narcan to revive someone. And so when we’ve turned this out of the clinic, and back into the street, and as illicit drug makers have found cheaper and more potent ways of getting narcotics to people, it’s changed the whole nature of this crisis, we need to change it in a really scary way. Now, we are seeing a potential shift in policy that’s been, I think, long overdue, although we’re gonna find out in this conversation today around the use of Narcan, which is kind of a nasal prescription, which is the equivalent of naloxone. And it’s really lifesaving much in the same way that, you know, will talk on the show about things like fire extinguishers and defibrillators, and epi pens. And so undoubtedly, countless lives can be saved by a proposal like this. So I want to talk about that. But I also want to go deeper into where we sit today, with both the drugs, who’s being affected, how the addictions working, where we are with stigma, and a number of those topics. I know this is a heavy topic. It affects all of us. I know most of you have some relation or connection to people in your lives. So I think it’s an important topic, and it’s one we have to keep up to date on. And I think there have been enough changes. And it was, we felt it was time to have two great guests on Sarah Laurel, founder and executive director of an organization called Savage Sisters in Philadelphia. And they provide addiction recovery, and supportive housing. For people in Philadelphia. You’ll hear on the show, she overcame her own struggle with substance use disorder, which led to a quite interesting, challenging path for her. She’ll talk about that. And Dr. Scott Hadland is the chief of adolescent and young adult medicine at Mass General, then at Harvard Medical School. He’s a pediatrician at addiction specialists. And he was part of the hearings in the FDA advisory panel this past week. So he can give us a little bit of sense of what people are thinking about approving Narcan. And he’s terrific as well. So I think you’ll find, once again, the producers have found the most excellent experts to tackle this challenging problem. And we’re just going to let them go. Here they are. Let’s bring them in.

Andy Slavitt  04:14

Scott, Sarah, welcome to the bubble.

Sarah Laurel  04:15

Thank you.

Scott Hadland  04:16

Yeah, thanks for having me.

Andy Slavitt  04:18

Let’s start with updating our understanding of the opioid fentanyl problem as its evolved across the country, what’s changed and what hasn’t, since this crisis has evolved over the last few years. Scott, why don’t you start?

Scott Hadland  04:32

Sure. I mean, I think you said it so nicely that unfortunately, we’re at a really tragic place right now in the United States where we’re losing more than 100,000 people every year. We’ve lost more than a million people since the turn of the century and it’s really been fentanyl that has been driving this crisis in recent years. So fentanyl is a highly potent opioid it’s at least 50 times more potent than heroin. And it has been sort of cheap and expensive to bring into the country and it permeates our drug supply. It’s everywhere. It’s in counterfeit pills that are sold on the market that are made to look like oxycodone or oxycontin or Xanax medications that people want to buy to help address anxiety and other concerns like pain. And it’s also gotten into other parts of the drug supply, like cocaine, for example. And so what often happens is people not necessarily intending to use opioids get exposed to them nonetheless. And because it’s such a potent opioid it can, it can very easily lead to overdose.

Andy Slavitt  05:31

So can you delineate a little bit between these two notions of overdose versus poisoning? Because I think we’re historically used to thinking about and talking about addiction, as happening as a result of people overdosing. And yet, you’re pointing out that oftentimes, people are buying one thing thicken. It’s another, as you said, counterfeit, and they’re in effect poisoned. Do we know which is the greater challenge these days?

Scott Hadland  05:57

Well, they’re both important challenges. And people who are using opioids as part of a substance use disorder or an addiction, deserve attention and services and, and need all of our support as well. But so do people who increasingly are being exposed to fentanyl when they don’t mean to be and in my own line of work? I take care of young kids, teenagers and young adults because I’m a pediatrician who treats people who struggle with substances. And in many cases, the patients and families that I care for, are struggling with the fact that they experienced poisoning and that they don’t mean to be exposed to opioids but are exposed to fentanyl nonetheless.

Andy Slavitt  06:34

So tell us a little bit about your organization and what you’ve seen change and what you’ve seen evolve over the last few years.

Sarah Laurel  06:42

Sure. So at savage Sisters, we don’t call it an opioid epidemic anymore. It’s a public health crisis, we are not only dealing with opioids, I work with individuals who use substances all across the board. I will say that, because of prohibition, we are seeing substances. Obviously, we saw fentanyl hit the market and because of the very heavy iron law prohibition, we saw it infiltrate the supply and create a very deadly situation for anybody who uses a substance. As Scott had mentioned, individuals are unknowingly consuming fentanyl because it is being put into different substances. Now, in the city of Philadelphia, specifically, for the past three years, our supply has been adulterated with something called xylazine, which is an animal grade tranquilizer trick. It is called tranq. Dope on the street. tranq. Dope, there is no heroin left in the Philadelphia drug supply. It has fentanyl, with xylazine. And the primary substance is xylazine, talking about 24 to 52, parts of xylazine to two to three parts of fentanyl. So what we’ve noticed, and what I you know, in doing the work that I do, is that people who use substances, and when you’re at the mercy of the criminal drug market, you don’t get a warning label with what is in your substance. We advocate very strongly for safe supply, because we believe that individuals are number one unknowingly consuming fentanyl and a different supply. And number two, we are now seeing adulterants that are much more deadly and more potent, being introduced into the supply to kind of skirt around the criminal justice system.

Andy Slavitt  08:29

I want to unpack a couple things you said. But if I’m not mistaken, one of the tragic components of xylazine or this tranq. Is that because it’s an opioid things like Naloxone, Narcan, which we’ll talk about in a few moments don’t work on it as they do with fentanyl. I believe that’s one of the concerns. But you talk about I want to pick up on something you said you talked about because of the prohibition. And I want to make sure that we help our audience understand what you’re talking about. Are you saying that as regulations tightened around prescribing legal prescribing of opioids, people who were obviously physically addicted or otherwise, looking for an opioid prescription. Basically, we’re left to just to go to the illicit market?

Sarah Laurel  09:17

Yes. So we have a very informative harm reduction education training that we do, and it shows very plainly when the DEA came in and said that they were going to tighten down on the opioid prescriptions, they shut down, let’s say pill mills. Those pill mills served three to 500 individuals with legal prescriptions for opioids. Once those pill mills were shut down, Where were those three to 500 individuals who chose to go for substance that they were now chemically dependent on we saw a large number of people go to the streets for heroin. We saw a tightening up on heroin and the borders and everybody was going to crack down on heroin. The iron law prohibition came in. Then we see fentanyl hit the market, it’s much easier to traffic and much more potent. And once that happened, we saw that adulterating other substances, we saw a spike in overdose deaths. We saw heroin go down. But we saw fentanyl rise. We also saw amphetamines rise. And that was not because so many more people were using amphetamines or cocaine or methamphetamine. It is because those substances were now being adulterated with fentanyl. So we saw that kind of take place. And now specifically in Philadelphia, we saw xylazine, enter the drug supply. It’s now in Boston, West Virginia, Ohio. It’s in 32 actual states. So anytime we hyper focus on one particular substance on scheduling it, and trying to monitor it, and criminalizing it, the criminal drug market, figures out a more lethal, potent substance to adulterate the drug supply with and because we know, historically, people use substances, we are at high risk, we now have to study that substance and see what that poly substance use does to the human body, how do we respond to it, just to give you a brief idea of what xylazine is doing. No, it is not an arconic. It is an animal gray tranquilizer, and it causes ulcers on the skin that lead to infection and necrotic limbs and eventually amputation. This is not something that could have been anticipated. But when we don’t have what we’re not studying this substance, and we don’t have control over that drug market, we are at the mercy of whatever substances are put in there.

Andy Slavitt  11:28

What I hear you saying is if we focus on supply of the irritant of the moment, we’re basically just squeezing the balloon, because the other part of the balloon will hop out will be the very smart marketers of substance will find something else and that thing could end up being even more harmful.

Sarah Laurel  11:48

If that’s historically what has taken place in this country.

Andy Slavitt  11:52

Let’s take a break and come back and talk about Sarah’s own struggle with substance use disorder. Be back in a minute. Sarah, I’m wondering if you’d be willing, if you don’t mind me asking to describe your own journey. I want to give people a sense who have not experienced what a physical addiction is like and what it can do to you to tell you how it happens. And then what happens to you if you’re willing?

Sarah Laurel  12:40

Yeah, so I was a corporate executive, I got prescribed Percocet for carpal tunnel. For a couple of years that prescription ended, I went to the street that progressed, I went from pills to heroin. The end of my journey, I was homeless and addicted to substances in Kensington. And I’ve been to jail, rehab 20 times. And I pretty much had nothing going for me at that point. I went through a severe trauma, and I was in a wheelchair. And during that timeframe, I get, you know, I got metal put in my legs, learned how to walk again and then started the nonprofit from my wheelchair.

Andy Slavitt  13:23

What incredible journey over what period of time, did that happen from the time you sort of started to feel addicted to feeling like you had to go find other substances.

Sarah Laurel  13:36

I don’t think I knew I was the last one to figure out that I was addicted to substances. I found out in the hardest way because I just didn’t have it. And I was like, Oh, this is really painful. But yeah, I was the last one to realize that I had a problem. And it lasted about 10 years.

Andy Slavitt  13:53

The thing that people I think they’re hard for people to understand is how quickly and how physical an addiction can be. And I’m wondering, maybe Scott, you can pick up a little bit on what you’ve seen. I mean, clearly, when you’re working with kids and teens and adolescents, you know, these are the people that are looking to become addicted to a substance. And this dependence obviously, is creates incredible challenges. I’m wondering if you can talk about what you see as physician in terms of how physically even just beginning with basically physically how it’s affects people and then what the mental and psychological components to the dependency are?

Scott Hadland  14:29

Yeah, I mean, I work as a pediatrician. And so my practice is to take care of people between the ages of about 13 all the way up to 30. So I care for adolescents and young adults who are struggling with substance use disorders. And because I’m taking care of them during this critical age range, I actually really see the problems as they’re beginning as they escalate and as they sort of carry on into older adulthood. It actually brings me a lot of hope being able to do this work because I often find myself in the position of being able to intervene early, before someone has had decades of substance use. They have to get through it. The thing that I most commonly see in my practice is that the teens and young adults who really struggle have some of the elements of the story that we just heard from, from Sarah that she so bravely shared. You know, people are struggling with trauma, physical trauma, emotional trauma, people are often struggling with mental health conditions that have gone unaddressed for long periods of time, depression, anxiety, ADHD, and, you know, many substances actually bring temporary relief. And that’s the case with opioids. For somebody who’s experiencing physical or emotional pain, opioids, in the short term can be relieving. And so a lot of people have sort of many of these sort of elements tied up into the addiction that they live in experience. But as you use opioids more and more, your body starts to develop this physiologic dependence on them, where it becomes hard to stop using because it’s very uncomfortable to do. So we talked about, you know, somebody’s going cold turkey going cold turkey has this experience of experiencing sweat, and goosebumps and elevated blood pressure and heart rate and pain and discomfort, anxiety, these are all the things that happen if you suddenly stop using opioids, which makes it really hard to get out of the cycle of using them.

Andy Slavitt  16:14

It’s pretty much torture. One issue, of course, is you talked about you prescribe something for carpal tunnel, there are, I think, still something like 140 million annual opioid prescriptions given out in the US it’s not rising, but it’s not declining. I wonder if you learn what you know, Sarah, and as you see what your organization does, before we talk about the just the illicit market, whether or not you think that the prescribing that’s going on today is still creating some of the problem.

Sarah Laurel  16:43

So I think that a lot of individuals need pain medication and pain management. And I think that there is a very small percentage of individuals who experience substance use disorder, as opposed to individuals that don’t, I’m 100% sure that some people are still over prescribing and things like that. However, you know, at the end of the day, we should not be micromanaging pain management at this point, we should be offering more mental health resources for individuals and talking more openly about what chemical dependency can look like, can feel like what the warning signs are, and how to get yourself aligned with not only a doctor, but a mental health professional if something like that should happen.

Andy Slavitt  17:34

Right. Right. When you talk with other physicians, Scott, I’m sure the topic of prescribing and kind of how dramatic and shift there has been over the last decade didn’t have to think about pain, from the kind of burgeoning of pain management clinics, which then people begin to call pill mills. But the reality is, as Sarah talked about, chronic pain, and obviously acute pain from surgeries and things like this do require a level of management that’s hard to achieve without some sort of intervention. What do you sense is the state of thinking around prescribing there’s, there’s this new act that goes into effect in 2025, called the new opioid and against opioids, which is kind of alternative to opioids reimbursements. But I’m not quite sure what actually exists there.

Scott Hadland  18:22

Yeah, I completely agree with Sarah. There are many people who use opioids on a daily basis and are able to function very well because of them. And I think we as a medical profession have kind of three big errors that we’ve committed in the last at least two decades. But ultimately, longer than that, one, we did probably over prescribe opioids. I think that that’s been clearly demonstrated that, you know, is a phenomenon of 10 to 1520 years ago, that certainly fueled the crisis that we’re in right now, but is not a major feature of it right now. Right now. It’s really these potent opioids and other substances like xylazine, which we just heard about, that are really fueling the crisis. grave error. Number two is that starting in about the mid-20, teens, once we realized there was an opioid related overdose crisis, we cut back on our prescribing and we had many patients who were doing well on opioids were stable on them didn’t have an addiction to them. And we cut them off just because we as a medical profession felt like opioids are bad, we must stop them. And that led a lot of people to turn to the illicit drug market, as Sarah just told us, and then grave error number three for us as a medical profession is that we really need to be offering people treatment when they want treatment for addiction and our workforce, even to this day is just vastly unproven, underprepared and isn’t providing people the services that they need when they are struggling with addiction.

Andy Slavitt  19:51

Well, let’s talk about one of the things that that we can do that I think people have advocated for a long time. And that’s making Naloxone more available or in the nasal form is called Narcan, which is doesn’t require a shot, it just can be given nasally. The FDA may be about to make Narcan available over the counter. What would be the impact? Is this a good idea? Sara, do you think that’s a good idea?

Sarah Laurel  20:16

Yeah. 100% I absolutely think that it should be available over the cat. There’s zero negative impact that could have there, I can’t even come up with a reason why we wouldn’t do it. And I can’t believe that it’s 2023. And we haven’t done it yet.

Andy Slavitt  20:33

What’s the difference between that and a like a defibrillator? Right, you have a defibrillator around because people go into cardiac arrest. And you can revive them, why not have Narcan broadly available, so you can revive people who are overdosing?

Sarah Laurel  20:46

Well, the average citizen doesn’t have a defibrillator. So everybody should have Narcan in their in their medicine cabinets, because eight out of 10 overdose deaths that happen in the state of Pennsylvania happened within the home, which means people are dying in the safety of their home on the comfort of their pillow. And so we need to be able to respond, we need to recognize and respond and opioid overdose and we need to make sure that we are sharing this information widely. Having it be available over the counter is just less barriers for individuals to access it. And there is still a lot of stigma around opioid use as well as drug use. So having to go to your doctor and potentially ask for it and things like that people will feel shame, they might feel guilty, they might not feel comfortable, make it over the counter, make it easy peasy. Let them grab it and throw it in their pocket and keep it with them. It would save lives because in my opinion, every single overdose as a policy failure.

Andy Slavitt  21:38

And you’re so right, all of us know someone who we’ve lost to overdose deaths at this point in time. And you know, imagine being proximate and having the means to save their life. Maybe an epi pen is a better analogy than a defibrillator, but certainly feels like the kind of thing that saving people’s life shouldn’t be that controversial. Scott, do you agree with Sarah, what would you add?

Scott Hadland  22:07

Yeah, I completely agree. I served as a volunteer at the FDA advisory committee meeting last week to talk about the benefits of Narcan as I viewed them and agree that it should be made available to everybody. I mean, you made the comparison to a cardiac defibrillator. And Narcan is easier to use than that. And when I testified at the FDA hearing, you know, the point that I made and that so many people make is that Narcan is really something that you should think of like a fire extinguisher, something that you always want to have around you hope to never have to use it. But you’re glad you have it when you do.

Andy Slavitt  22:42

Tell us a little bit about what that dialogue was like, what were some of the counter points?

Scott Hadland  22:46

You know, actually, there weren’t a lot of strong counter points, because of Sarah just said Narcan is incredibly effective, it’s very easy to use, and there’s almost no downside whatsoever to using it. And so it becomes very difficult to make a counter argument to making a lifesaving antidote that has those properties available over the counter to everybody.

Andy Slavitt  23:08

So if over the counter Narcan is approved, let’s talk about how to get people to actually use it and afford it. Let’s do this right after the break. It sounds like from what I’m hearing from Sarah, that we need to not only approve it, but then have some very effective kind of PSA and distribution and marketing campaign so that people don’t get caught up in stigma, don’t really view this as anything other than a safety measure. And that, you know, I think we’re slowly beginning to help people understand not to blame people who have addiction challenges to suddenly we don’t blame people who have diabetes or other things. But people self-stigmatize people in the family self-stigmatize. And it feels like, we still have some work to do, in my view on messaging. Is that experience, Scott, or how do you think public attitudes have changed? And Sarah asked you the same.

Scott Hadland  24:19

Yeah, I think public attitudes are changing. I think we’re starting to view the humanity in people, you know, Sarah, and her allies in the community have long viewed the humanity and the people that they work with, and have really led the charge in changing how the public views people with addiction. And, you know, step one to saving someone who is struggling with addiction is to make sure that they’re safe. And that’s why Narcan is such an important tool because it helps keep people alive so that to the extent that somebody is ready, able and willing to accept treatment, then we’re available to provide it and we’ve kept them alive by making Narcan available. I mean, I do think it’s important to point out that having Narcan Ave Little over the counter is not going to solve every problem, particularly if, and many of us are worried about this, if when it’s over the counter, it’s very expensive, that’s going to leave a lot of people on the sidelines unable to purchase it. But it is another important avenue for people who want to have it available to be able to purchase it over the counter, in addition to some of the other ways that they currently get it now.

Andy Slavitt  25:21

They could talk to you $50 for a two pack, but there’s a lot of places that still can distribute it for free. Sarah, do you think we’re changing minds? Are you guys have you found that you have seen attitudes changed since your work has begun?

Sarah Laurel  25:33

I would like to say yes to that. I will say when I started doing this work five years ago, I assumed that the majority of my advocacy work would be to try and explain trauma informed care. And you know, and to talk about, you know, drug trends and things like that. But I quickly realized in a room full of suits that the first thing that I have to do when I enter a room is convinced this group of individuals that we are worth saving was a humbling and a hard truth to get to. And I kind of switched the way that I was approaching individuals and I had to figure out a way to get a sticky message across and figure out a way to show and humanize Well, the experience that we were having,

Andy Slavitt  26:25

what signals were people sending you to let you know that they were not even believing that people were worth saving?

Sarah Laurel  26:32

Well stigmatizing language to let’s say, I did a training at the Bar Association and some of the verbiage. One of the lawyers said, How many times should we save somebody before we just let them die? Okay, that’s terrifying. The words junkie, you know, dope fiend, the rock bottom narrative, I was invited to give a training. And when they introduced me, the slide said rock bottom. And they said with that, we want to introduce Sarah with her rock bottom story, and I was humiliated. So I very quickly saw that, unfortunately, the large majority of individuals and the people that I am working around and with EMTs police officers, first responders, that have to be convinced that my life was worth saving, that the friends that I’m advocating for like that their lives are worth saving. Because unfortunately, the stigma in this country is horrific, even when people would xylazine they’re like this zombie drug. I hate that. If you call me and asked me to do something on the zombie drug, I will not respond to it, zombies are horrifically portrayed in the American media. And so when you call my friends, zombies, you’re dehumanizing them and their experience, and you’re isolating them and stigmatizing them. And because of the substances that they use, nobody is going to come save zombies, they’re gonna come save Jean, and Sarah, and James, not a zombie.

Andy Slavitt  28:07

You know, part of what you’re telling me, of course, makes sense. And it’s sad, because it shows we haven’t made a lot of progress. And the other part of me is a little bit surprised. Because, you know, we all know so many people who can now say, Well, my daughter or my cousin or my aunt or my sister, there’s so many more personal experiences these days. That to me, you know, I tend to think people’s attitudes change when it happens to them, when they see it’s happened in their own families. And I just don’t know many people anymore, that don’t have some firsthand or secondhand experience. So we’re about to enter an interesting place in the country where major settlements with opioid manufacturers, distributors, pharmaceuticals are about, you know, they’re going to flow into pools of money that are going to be controlled largely by the states. And I’d love to just as we as we close it, we can, we’ve talked about one potential seems like no brainer solution, which is making Narcan much more broadly available. But obviously, you both said that’s not the whole problem. That’s just the baseline place to start, but it doesn’t begin to address the issue. We’ve talked about the folly of trying to address the supply problem, piece by piece. You’ve mentioned Sarah more and more mental health and wondering if you were advising the governor of Pennsylvania, if he called you and said we’re about to get a huge settlement of money to spend, which is what governors are now starting to face. What should be my priorities? How should I spend that money? Where should we go next?

Sarah Laurel  29:40

I would absolutely say trauma informed long term recovery housing, which offers mental health along with housing for individuals who are ready for that recovery journey, safe consumption sites, statewide drug testing to keep up with the drug trends. And I mean harm reduction statewide. Like that’s where The money has to go. So we will see what they do with the actual money. But I think that the substance abuse model that we’ve had hasn’t been updated in about 25 years. And I think that it needs to include that window of possibly 5-20 years of active use. Because currently, it starts at the acute withdrawal stage, and then it ends it days, which is a very unrealistic expectation to put on a human being with decades of trauma. So I think we need to include harm reduction to cover that gap of current use. And then we also need to include paths that 28 Day frame towards really stabilizing an individual and building a foundation of mental health as they recreate their lives.

Andy Slavitt  30:50

So Scott, how would you answer that question? I think one of the things that we all know, and I think Sarah is emphasizing as well as that we have just extreme shortages of available treatment, you’re obviously on the front line at helping kids and families. When you think about kind of an array of resources and resulting policy that’s going to change some of those challenges. Where would you go? Where would you point, the governors and others who are on the frontlines of solving these problems in many respects as much as you are?

Sarah Laurel  31:20

Yeah, I completely agree with Sarah, I mean, Sarah, and so many the people that she works with have lived experience and know what’s needed. And so when they tell us what’s needed, we need to listen. So I completely agree that we need to keep people safe, we need to reduce the harm of substances, we need to make sure that they get treatment and long term recovery services in a trauma informed way. So I completely agree with Sarah, I would add, we also have a duty to make sure that we are providing these services to communities of color communities that have been harder hit, socio economically, just because, you know this crisis affects everybody, but certain communities have been disproportionately affected. And as we seek to try to address this crisis, we need to make sure that we address some of these historic wrongs. I think the other thing that I would add just as a pediatrician is that there’s a lot of opportunity here for prevention. I think the old slogans of the 1980s When I was growing up, you know, things like just say no to drugs. And this is your brain on drugs, you know, Dare and programs like that have left a lot of people a little bit disenchanted that drug prevention programs for young people don’t work. But actually the truth is, we have a lot of evidence based programs, our own. Now Governor Healy, in Massachusetts, when she was attorney general, rolled out a widespread drug prevention program for middle school students in the state that was very effective. And if you look at data across the United States right now, despite everything that we just said in this conversation, fewer the teenagers than ever are using drugs and alcohol. And that’s a public health success that we don’t talk a lot about. The issue now is that the drug supply is so dangerous. So even though fewer people are struggling with substances, more people are dying, because those drugs are more dangerous when they do use them. And I think it’s really important that as we think about a national approach here, we look 10-20 years out, and we try to figure out how do we keep the young people of today from becoming the overdose statistics of tomorrow. And I think that that what that’s going to look like is a really robust mental health system, really robust trauma informed care, and then really robust addiction treatment that is rolled out as soon as somebody starts to have problems.

Andy Slavitt  33:33

As we close, you know, I was struck by Muller, before we started this interview, Sarah said, I don’t know if I could turn my phone off for an hour or words to that effect. It really got me thinking about what both of you do every day, like what an average hour is actually like for Sarah. And likewise for you, Scott. And maybe she’d close because you’re both very much on the front lines from two different angles. And you just relate what a typical day with, you know, the typical amount of successes and failures feels like in your shoes. Sarah, do you mind starting and Scott again, close this out?

Sarah Laurel  34:11

I mean, so it depends on the day. I have a lot of humans under my care that are in long term recovery. So there could be situations with advocating in the judicial system, behavioral issues and how helping somebody find employment. With the storefront. It’s very different. We respond to overdoses, we’re rocking wounds. We’re letting people come in and shower. We’re just engaging with humans, and kind of giving them a safe space to have a conversation. We also do statewide harm reduction, education and training and overdose reversal updates. So at any moment at any time. I mean, unfortunately, the nature of this business, you know, a call could be good news, but it could be tragic too. So it’s exhausting, but it’s definitely fulfilling.

Andy Slavitt  35:05

Well, thank you for the work you do, and for sharing your journey, but the incredible number of lives that you touch in Philadelphia, Scott, how about you? Tell us what a typical day can feel like?

Scott Hadland  35:17

Well, I love my job, which is why I do what I do. I work with teens and their families. And you know, as Sarah just highlighted, there are some tragic moments. I’ve lost young patients. Some of my young patients have lost their parents or brothers or sisters. And so there are absolutely tragic, and really disappointing moments in this job. But more often than not, the job brings me a lot of hope. We don’t talk about success stories enough. But there are an enormous number of teens and young adults, who I work with, who struggle, and then really experience recovery and go on to have full, happy, wonderful lives. And I do what I do, because in those moments, when I get to experience those stories, it brings a kind of joy that I really don’t think I could have in any other practice within the field of medicine.

Andy Slavitt  36:12

Well, thank you both for what you do and for sharing and coming in the bubble.

Sarah Laurel  36:16

Thank you so much.

Scott Hadland  36:17

Thank you.

Andy Slavitt  36:31

Okay, let me tell you what’s coming up. Friday, we’re going to talk about Ukraine, you just saw President Biden took a surprise trip to the country. We’re going to talk about where we stand a year after the Russian invasion. And then Monday, we’re going to talk to John Podesta. John is a longtime Washington senior person. He was one point Hillary Clinton’s campaign manager, he was Chief of Staff for Bill Clinton, and he now has an even bigger job to save the planet. He is in charge of how we implement the climate provisions in the inflation Reduction Act. And he’s coming to us for a really in depth conversation. Thank you and we’ll talk to you on Friday.

CREDITS  37:20

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.