Opioids: Hidden Dangers, New Hope

Mary Sundeen, Senior Vice President of Corporate Communications, on educating people about the use of highly efficient site-of-use drug disposal solutions, such as DisposeRx, to save lives ~ "We see far too many deaths in this country each day. We have far too many funerals. We're burying far too many young people. There are too many coffins, too many processions, too much tears and sadness. A solution exists, we just need people to know about it and become educated and become empowered to use this highly efficient system to save lives." Mary Sundeen, Senior Vice President of Corporate Communications, DisposeRx Brian Wilson: With a background in hospice care, Mary Sundeen has seen opioids used appropriately as a tool for helping those at the end of life pass peacefully and without pain. But it's the diversion and misuse of prescription drugs that moved her to action. Now as the Senior Vice President of Corporate Communications at DisposeRx, Mary has a strong message for our podcast. A message about site of use disposal the environmental impact of diverted drugs and how thinking as a society must evolve if we are to end the opioid crisis. Mary Sundeen on the Evolution of Drug Disposal Solutions Mary Sundeen: When I first joined DisposeRx I looked at this wonderfully simple elegant solution, and to me I look at this as a story of evolution. When we started with childproof caps back in 1970 that was to reduce some of the risk of accidental poisonings. We then moved along to take back days to try and harvest drugs. We then had kiosks that were used in different stores and different places. But none of those were the solution. I say that because in the presence of a decades long war on drugs, and in the presence of DEA take back days, and in the presence of kiosks, this crisis has escalated. How did we get where we are today if these things work? It's time for a new technology. The evolution of drug disposal is solutions such as Dispose RX - 100% eradication of the opportunity for drug misuse, abuse, or diversion. Brian Wilson: What is site of use? I mean i hear people say we want to take care of the problem at the site of use, but the site of use can be your home. What is Site-of-Use Drug Disposal? Mary Sundeen: Site of use is an industry term and it simply means get rid of the medication wherever it is. If you used it in your home to take care of a loved one and they passed away, get rid of it then. If you have shoulder surgery, or oral surgery and you're done with the pills, you took two of the 10 that the doctor gave you, get rid of the rest of them in your home. Wherever the pills are used is where you should get rid of them. July 1st a new law went into effect in the state of Kentucky that mandated that Hospices get rid of medication in the home at the time of the patient's death, or, actually more importantly, whenever that prescription has changed. Instead of changing from .25 milligrams to .50 and keeping the .25s, throw them out, get rid of them right away so you have fewer medications available in the home. Taking Action in the Fight Against Opioid Abuse Mary Sundeen: When I worked in Hospice, I saw the large amounts of medications in the homes of patients. Also, I've worked in the healthcare setting, in emergency rooms, and seen overdose patients come in. Those numbers are escalating. Calls to suicide hotlines are escalating. This is truly a crisis in our nation. I'm not one to sit back, nor is our founder, Dr. John Holaday, to sit back and watch such things without wanting to do something about it. The opportunity to work with this product is a fantastic one. Brian Wilson: Having been in the Hospice environment no doubt you have seen cases where at the end of someone's life the family is handed the belongings, which often include a box of medications. And, that's a problem isn't it because if they are carrying around th...

Jessica Nickel on using a holistic approach for better outcomes when treating addiction~ "When we stop playing whack-a-mole, have everyone together, and look at this as a disease space, an illness that requires us to follow the science and make advancements, and treat our patients in a more holistic way, I think we'll have better outcomes. Jessica Nickel - President and CEO of Addiction Policy Forum Jessica Nickel: We lose a 174 people a day to drug overdoses. That's like a plane crash every day. Brian Wilson: Jessica Nickel is the President and CEO of Addiction Policy Forum. From the earliest years of her life she's been impacted by drug abuse and has made it her mission to advocate for the families of those who have had the same experience. Her refreshingly candid approach to public policy and the science of addiction has put her in the spotlight - a position she hopes to use to bring families together and carve a new pathway forward on how we view addiction. We Need Access to Information to Learn to Separate the Disease of Addiction from the Person Jessica Nickel: I remember my first show and tell in kindergarten class. I went to Mrs. Dean and I wanted to talk about why people shouldn't use heroin, because my parents struggled with the heroin use disorder. My early years meant homelessness, and foster care, and hunger, and lot of instability. Then my mom went to prison as a result of her heroin use disorder when I was four. I spent some time with my maternal grandparents. Then at eight, permanently went to live with my grandparents, as my parents' health issues worsened. Because as a disease like any other disease, it gets worse over time if we don't intervene with the right healthcare interventions and the right treatment, and medications, and support. My grandma was very progressive even before we had all of our fancy brain scans and the evidence of this as being a brain disorder. She always used to tell me, "Jessica Marie, you hate that disease, but love your mama." Brian Wilson: Yeah, and that's a hard thing to do when you're that young, isn't it? Jessica Nickel: It's a hard thing for all of us to separate. Addiction is a brain disease that impacts some really important parts of your brain including your limbic system, which is our survival hard wiring. You have changed behaviors, and changed priorities. For all of us to understand how people that are close to us can feel and seem so different from the person that we know to really take that into account for some changes in the brain that can be treated and reversed is a new way of thinking about this and all of us whether it's family members, or healthcare professionals, or folks in criminal justice, we all need to have access to that information to have more empathy for the things that are happening to our patients. Brian Wilson: So then you started Addiction Policy Forum. Why? Jessica Nickel on Why She Started the Addiction Policy Forum Jessica Nickel: I felt like I was frustrated. I was frustrated for over 20 years working in this field or being involved in different ways. It felt like we were at the same yard line, like we're literally sitting at yard two with an entire field in front of us that we are not advancing down. We have a tendency to focus on one drug over the others and that's not how you should be approaching this. We need to focus on substance use disorders, not methamphetamines or opioids, or alcohol, and marijuana. We need to look at this as an illness and make sure that the systems that we put in place can respond to any addiction and to all the substances, because they change our foundations on following the science and treating this like a health condition shouldn't. So, I was frustrated about that. Frustrated that we tend to play whack-a-mole with the type of response. So, this decade its prevention is super sexy and fancy. Then it's recovery, and then it's treatment. The reality is that we need to have all of the comp...

Robert Verscharen on the DisposeRx difference in the proper disposal of unused or unwanted prescription drugs ~ "the difference between those methods and DisposeRx is . . . that this destruction happens right in the vial, the same vial that the product was dispensed with. We have a way that we think is ecologically superior. Our product doesn’t leech into the water table. Our product is easier to use than any other method. But we’re not parochial about this. We want to support any method to get that product out of the medicine cabinet" Robert Verscharen - Executive Vice President of Commercial Development, DisposeRx Brian Wilson: If asked to conjure up an image of a pharmacist most people would envision a friendly medical expert in a white lab coat answering questions about prescriptions. And while the drug stores of yesteryear may have been replaced in many areas by big chains, pharmacists themselves still hover near the top in the Gallup polling company's list of the most honest and ethical of professionals. Bob Verscharen is the Executive Vice President of Commercial Development at DisposeRx. He's also uniquely qualified to address the role of the pharmacist in the opioid crisis. Robert Verscharen: I had retired after a 40-year career in the drugstore and pharmacy arena. And when John approached me about DisposeRx, and its exciting adventure, but mostly it's really something that's needed now in the public domain. There are addictions out there that are affecting families, that are causing life loss and tragedy. And I don't want to see that continue to happen. So anything that I can do to help John to get the message out, and even reduce these tragedies by one, it's certainly a major undertaking and well worth the reward. Brian Wilson: Bob, your background is coming from a drugstore company. So what is the role of the pharmacist, in your mind, in this opioid crisis? Role of Pharmacist in Opioid Crisis Robert Verscharen: Well, the role of the pharmacist is primarily education. They have for many years fulfilled a portion of the responsibility to help control that crisis. And it's even becoming larger every day. The pharmacist is the person that ultimately deals with the patient immediately prior to the patient taking that medication home. So when the physician communicates with the pharmacist that an opioid is appropriate, the pharmacist evaluates that prescription, determines that in fact it is a legitimate prescription, uses his knowledge to make sure that the dosage is appropriate for that patient, and that the physician's directions are followed. Consults with the patient about the importance of following the physician's directions, and points out the things that that patient should know. For example, about a reaction that they might have to the medication. About an allergy that they have. Or about prescriptions that might not be appropriate to be used with an opioid product. Make no mistakes, there is a place in American medicine for opioids. There are pains that opioids will relieve. In fact, they're the most effective relief for many pains. It is when they are misused or overused, or ignored and left in medicine cabinets for any length of time inappropriately, that's what starts to cause the new addictions. It also contributes to the diversion of drugs that end up in illicit places. Brian Wilson: It would seem that the pharmacists could play a really potentially important role in educating about making sure that at the end of the cycle, when you get better, that the medicines are taken care of. New Product Life Cycle - "ends when the patient either fully consumes or appropriately disposes the medication" Robert Verscharen: Well, Brian, you're right. What we call it, it's a new product life cycle. Previously, a product was referred to ... the life cycle of a product was referred to as initiating when the manufacturer or the researcher developed the product, got FDA approval for the product,

Rick Werner on what he hopes for his late son's legacy~ "He never admitted that he had an addiction, but he was well aware that he had a mental health issue. And he would say, "I want to be an advocate for my disease." And so we're trying to do that in his honor, in his absence, but as his legacy to help people who both have mental health issues and addiction issues, and try to improve folks' lives and maybe even save some lives." Rick Werner, Co-founder James Werner Legacy Project, and his son, James Werner Brian Wilson: At just 27 years old Rick Werner's son Jamie found himself at the intersection of bipolar disorder and drug addiction. Now, Rick tells Jamie's story and speaks of the legacy he hopes will be left by his son who loved life, and died much too young. Brian Wilson: I want you to tell me about your son, Jamie. First, tell me about what kind of kid he was. Jamie Werner Rick Werner: He was 27 when he died. He was a graduate of Walt Whitman High School here in Bethesda, also a graduate of the University of Maryland, College Park. He was a huge Terp fan, as I am and as our whole family is. He was also a great high school football player. He was an all-county high school football player at Whitman. And he was also, and this continued right up until when he died, he was a football coach, an assistant football coach back at his high school. Brian Wilson: This is a young man who was very sports-minded, athletic? Rick Werner: Absolutely. Brian Wilson: Yeah? Rick Werner: He loved sports. Brian Wilson: Tell me about his personality. Rick Werner: He had an incredibly infectious personality. He was the kind of guy who when he walked into the room, he lit up the room. Let me give you sort of a funny example about that. When I would drive home from work - and this was after Jamie had moved out - I'd drive home from work - and he lived locally - and if his car was in the driveway, I knew I was gonna come home and we were gonna have a fun time. We were gonna have some drinks and he was gonna cook up an amazing dinner because he was an amateur chef and he loved to cook. And so we would sit there, and we would probably sit there for a couple of hours and he would tell stories, a huge talker, and we were gonna have a lot of fun if Jamie was there. Brian Wilson: Yeah. But there were struggles along the way. Bipolar Disorder Rick Werner: Well, I said that he was a big talker. He was diagnosed with bipolar disorder. And he would often talk a lot. He would come in and let's say I'm reading on the porch after dinner, he would come out and sit and talk to me. And I would have my book sort of out like this, and after a while I just knew I was gonna put that book down because I was not getting any more reading done. And so that was partly his personality, but partly also his bipolar disorder. Brian Wilson: So when he was up, he was talkative. Rick Werner: That's exactly right. Brian Wilson: But the downside to the bipolar disorder is there are moments when they're very, very low. Rick Werner: That's right too. Brian Wilson: Talk about that. Rick Werner: "We've learned that people who have mental health struggles very often tend to self-medicate with drugs." Rick Werner: Well, sometimes it's hard to disentangle his mental illness from his addiction, but there were many times when he was depressed and couldn't get out of bed, maybe again related to drugs too. But there were very many down times that he had where my wife in particular was trying to sort of get him going. So what we've sort of learned is that people who have mental health struggles very often tend to self-medicate with drugs. Because I think for many of them, it makes them feel "normal." They know that their mind doesn't work exactly the way other people's minds work. And when they take drugs or alcohol, it gives them that feeling like, "Hey, I'm fine. I'm just like everybody else now because I've sort of quieted my mind."

Ed Rudnic discusses how DisposeRx is designed to work~ If you can form chemical bonds, that forms a chemical mesh, you get a tighter gel, a tighter mesh, that surrounds the drug and makes it impossible in this case, for the drug to leave. In this particular case, the way we developed this, if this is added to water and it crosslinks, as the water evaporates from the system over time, that net shrinks tighter and tighter around the drug and will not allow it to leave. Ed Rudnic, PhD - Scientist, Inventor, Entrepreneur Brian Wilson: From a humble modest kitchen in Potomac, Maryland Dr. Ed Rudnic and four friends developed the chemical compounds that would one day be called DisposeRx. Dr. Rudnic joins us for a trip back to that kitchen and answers the burning question: What exactly are crosslinking copolymers? Ed Rudnic: The other co-founder of the company, John Holaday, and I were both talking about a way to improve the safety of opioids in the household, in the medicine cabinet. The DEA will tell you that 80% of heroin addicts start by medicine that was either taken from their parents or other medicine cabinets, and so to be able to inactivate and dispose of those opioids really eliminates a problem. My background is very much in developing pharmaceutical products and inventing pharmaceutical products. I have a feel on the market. I'm also going way back into my scientific training, and I've got some pretty good material science background. So I know enough about materials and how they work, and I was able to come up with a bunch of powder, if you will, that will gel and crosslink and sequester the drug very, very quickly. Brian Wilson: We've heard about crosslinking polymers. Maybe you can help us understand what that is. Ed Rudnic Explains the Concept of Crosslinking Polymers Within DisposeRx Design Ed Rudnic: Well, when you are trying to form a gel, what you're trying to do is to get things to swell, to take water and imbibe them and swell. You can only get so far with just water absorption into something. If you can form bonds, chemical bonds, that forms a mesh, a chemical mesh right there, you get a tighter gel, a tighter mesh, if you will, that surrounds the drug and makes it much, much harder, if not impossible in this case, for the drug to leave. In this particular case, the way we developed this, if this is added to water and it crosslinks, as the water evaporates from the system over time, that net shrinks tighter and tighter around the drug and will not allow it to leave- Brian Wilson: Until it's just a piece of dried up glop. Ed Rudnic: Yes. And, that glop won't leave and leach into wastewater and landfills or anything else. Opioids are incredibly dangerous, very strong medicines that have a place in medicine, but when we're talking about the abuse of them, when we're talking about people taking vials full of these things, they are potentially lethal, not just dangerous. So, this sequesters the drugs, makes it much, much, much less absorbable, much less able to even get out even if you try very soon after it gelled up. It basically keeps the drug from harming the environment or the patient. Brian Wilson: Let's set the scene. You've had a conversation in which you realize there's a problem and that you may have the knowledge to solve this problem, how to take drugs that are in the medicine cabinet that are dangerous and to make them not dangerous. So tell me a little bit about setting up in your kitchen in Potomac. Set the scene. I can't imagine what was going on and how it all looked. So take me to that day, take me to that time. DisposeRx - Initial Research, Materials and Lots of Testing Ed Rudnic: We had a pretty good idea of what we wanted to accomplish functionally from the gel. There are certain materials that will gel carefully...

Robert Bianchi, President and Chief of Scientific and Technical Affairs at the Prescription Drug Research Center, on waking up to the value of pain medications to people in severe pain and people that are at the end of life that need to have some kind of relief~ "We have to make the drugs available to them while we prevent the abuse or misuse in a social setting where it is not necessary. So we are recognizing that, to use a term, we can't arrest our way out of this dilemma. Arresting users on the street really doesn't help solve the problem. And we're finally recognizing that this is a disease that needs to be treated, just like other diseases." Robert Bianchi - President, Prescription Drug Research Center Robert Bianchi: You can't leave it up to the government to solve this problem. Brian Wilson: The Drug Enforcement Agency is the federal law enforcement entity tasked with combatting drug trafficking. The DEA has sole responsibility for pursuing illegal drug operations in the U.S. and abroad. Bob Bianchi is the President and Chief of Scientific and Technical Affairs at the Prescription Drug Research Center. Formerly with the DEA, he brings a unique perspective to the opioid crisis in America. The Changes Over Time in Federal Government's Focus Regarding Illicit Drug Use Robert Bianchi: Prior to the formation of the DEA in 1973, there were various federal agencies that patrolled the use of illicit drugs. Prior to the 60s, drug use was not considered an acceptable behavior. Most people didn't think that drug use would be acceptable in the future. But things changed. In the 60s and 70s. We saw the advent of designer drugs like LSD, DMT, PCP, sometimes called the alphabet drugs. And the federal focus on enforcing the drug laws was really directed toward marijuana and cocaine until now, when the focus changed to heroin, stimulants, amphetamines, and depressants. So, the drug landscape was changing as time went on and has now moved into the area where the abuse of prescription drugs has become, not only acceptable but extremely popular. So, when I retired from the DEA I started working with the pharmaceutical industry to try to develop new formulations that would be more difficult to abuse. And the FDA was very much in favor of that because they realized that they needed to do something, so they provided incentives to the industry to develop these new abuse deterrent formulations. So that's how I got involved in the opioid situation that we're in today. Brian Wilson: You were in a position to see the wave of this crisis coming. It is, in many ways, a perfect storm. Is it not? The U.S. Has Only 5% of the World's Population Yet Consumes 80% of the World's Supply of Pain Killers Robert Bianchi: Well yes. A number of things have come together that have created this crisis. The United States, believe it or not, consumes 80% of the world's supply of pain killers, and we only have five percent of the total world population. So there's something peculiar about our culture. And we do not tolerate the slightest discomfort. Every single day you see ads for prescription drugs that you're being encouraged to ask your doctor about, after they read the litany of side effects, including death. We are one of two countries that allow direct consumer advertising. And I think that has contributed, in part, to our chemical dependent society. We are looking for instant gratification, solutions to all our problems. That's the society that we live in in the United States. Brian Wilson: I think maybe people look at it and they go, "How dangerous can these drugs be? I see them on TV advertised every day". Leftover Pain Killers Sit in Home Medicine Cabinet and Nobody Monitors Them Robert Bianchi: Yes. That's true. And you know, they are approved by the FDA. They're prescribed by trained physicians. Friends and family use them, so how could this stuff be bad? Unfortunately,

Dennis Wiggins, DisposeRx co-founder, on the responsibility for safe and proper drug disposal~ "The environmental degradation of our water supply in the environment will last generations and it will have impact on our children and our children's children. . . As citizens, individually and collectively, we're responsible for our own actions. We must responsibly dispose of drugs and over the counter medication, not by throwing it or not by flushing it but by using a product like ours or some of the other products that are on the market." Dennis Wiggins - DisposeRx Co-Founder Brian Wilson: Addiction. Crime. Overdose and death. In the wake of the opioid crisis these are the topics you've seen splashed across the headlines all over the country. but there's another headline below the fold one that you may not hear scream from the cable outlets or see plastered on the internet websites. It's the toll that the over prescribing of prescription drugs is having on our environment. Co-founder of DisposeRx, Dennis Wiggins, sat down to discuss some surprising statistics and to talk about how dire the situation has become in this world that we all share. Dennis Wiggins on the Opioid Crisis and Contamination of Environment Due to Improper Drug Disposal Dennis Wiggins: Dr. John Holaday, founded the company and contacted several individuals. I was one of them because we had a personal contact through our children going to the same engineering school. We launched the company, and the initial focus was in terms of commercial sales to pharmaceuticals to address the opioid issues, but there's a second area, which is very important to me personally, and that is cleaning up the environment. Two of the biggest problems this country faces is the opioid crisis, and this product addresses it by removing excess product, and the second one is the contamination of the environment in the water supply. This is a visceral issue that effects the water that you drink, the water I drink, the water our children drink, the water that our grandchildren drink. We've seen from Flint, Michigan, when you destroy the water supply for the public, you literally tear the fabric of society, and this is an issue that we have to address sooner than later. It's that critical. Brian Wilson: So precious water, clean water, a passion of yours. Dennis Wiggins: Correct. Brian Wilson: Most people say, "I've got these opioids. I have to get rid of them." The quickest, easiest solution is, "I'm just going to flush them down the toilet," and that has a tremendously negative impact on our environment. Dennis Wiggins: That is absolutely correct. We have to address how we dispose of medication. It's as important as going to the doctor and obtaining a prescription for medication. For a long time, there's been no federal agency that addressed this issue. Surprisingly, in 2007, in the 21st century, the FDA said, "We should dispose of them by mixing them with coffee grinds, with saw dust, with kitty litter," and in one case, even dirt and then tossing them. The problem with that is the underlying drugs are not being addressed, and the product that Dr. Holaday and the team invented destroys that drug through crosslinking polymers and makes it safer disposal in the household trash, and the other thing, flushing it down the toilet is problem. Why? Because over time, landfills have rain, and that leeches into our ground water, and that is a serious problem. Brian Wilson: All right, so give me some statistics. Just how serious is this problem, right now? Improper Drug Disposal - Surprising Statistics Show Negative Impact on Environment Dennis Wiggins: In 2008, 48% of Americans were taking at least one prescription drug. In 2013, according to a study by the Mayo Clinic, 70% of Americans now take at least one prescription drug daily. Brian Wilson: That's, by the way, an amazing statistic. So, we've got a lot of drugs that needed proper disposing.

William Simpson on drug disposal solutions ~ "A lot of people are pulling together to try to find some things that work. The sweet spot of this will be finding a combination of solutions. There's no silver bullet here that's going to help us from an epidemic perspective. . . We need to find the solutions that work. . . DisposeRx is 10 to 30 seconds . . . " Williams Simpson, Director and President, DisposeRx William Simpson: In ten to thirty seconds I'm breaking the chain of abuse, and that's brilliant. Brian Wilson: As the Director and President of DisposeRx William Simpson is passionate about his product. He's also passionate about his team, about preventing addiction, and about educating people on the simplest ways to dispose of their medications. He sat down to share his passion and to talk about a certain kind of medication that people don't often think of as being dangerous. Brian Wilson: How did you come to be associated with this project? How and Why William Simpson Signed on With DisposeRx William Simpson I was very lucky. I got introduced to Dr. John Holiday. Met here in D.C. I was up for a different meeting, and I was told I got to meet this guy. He's got a really interesting ideas - met at a hotel - and told me a great story and an unbelievable idea of how he came up with the idea, the importance of disposal, the importance of doing it from the way that it was, and got me hooked on the idea of site of use, which is, in our opinion, the vial which the medication is dispensed. From that point, started to do research and looked at how important this topic was when you look at medication management, and you look at us as consumers of what we do and the amount of medication that's actually left in our medicine cabinets. About 40% of us have unused medication. Over 600 million prescriptions go unused a year, sitting in our medicine cabinets, so you've got about 125 million households and about 600 million vials of unused medication. Brian Wilson: Families are now coming to understand that having those drugs in the medicine cabinet is such a danger. Unused or Expired Medications Left in Medicine Cabinet can be Diverted for Misuse William Simpson It really is. From a health perspective, from a financial perspective, the value is having medicines that we're on therapy with. And with all the complications of understanding which medications we're supposed to be taking, which medications we're not supposed to be taking, you don't need to have the complexity of adding additional medications to that mix. From that perspective and the dangers of leaving medications unused, not just from a standpoint of opioids, but there's a litany of other medications that are dangerous to leave that can be diverted for misuse. Even think about things like antibiotics. If you think about becoming resistant to antibiotics, and we've all not taken our antibiotics correctly, and we all do misuse medications at times. To do this in the right way and have something when you think about medication management and how we should manage our own, having a disposal mechanism that we can use as consumers at home is very simple. Brian Wilson: The miracle of modern pharmacology is that we have these amazing drugs that can help us. When we have the right symptoms, we get the right drug, we get better. But our responsibility with that drug does not end when we start to feel better. We have another responsibility. That's to make sure it's disposed of properly. Responsibility to Manage AND Properly Dispose of Medications William Simpson Correct. I'm not a doctor, so I don't want to ever tie my doctors' hands of what they can and cannot prescribe to me. That is their practice. That is what they need to know and do.

Dr. Vanila Singh on the problem of excess medications leftover in the medicine cabinet~ "When someone has a surgery, they'll get X amount of tablets, and I think it's become clear that in many cases those are too many tablets, so they remain in the medicine cabinet, and they can be a target of folks who do suffer from addiction and start to have behaviors that make them do things that we would never expect." Dr. Vanila Singh - Chief Medical Officer for Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS) Brian Wilson: From her years practicing pain management and Anesthesiology to her current position at the Department of Health and Human Services, Dr. Vanila Singh has experienced the opioid crisis from many angles. She's a doctor, a teacher, and a policy advisor who has seen chronic pain face to face. She joins us to talk not only about the current administration's strong stance on the opioid crisis but also about how we got here. How We Got Here - The Opioid Epidemic Dr. Vanila Singh: The first wave really began with opioid prescriptions, perhaps the over-prescribing or the excess tablets. This came with different needs to one, address pain, but also not having all the treatment modalities out in the rural areas, or even the urban areas, so it really started with that first wave. Then, the second wave really was heroin use, which was available in larger quantities, used by a larger number of people, and it really actually increased over four-fold from 2010 with nearly 13,000 Americans dying from heroin in 2015. Then, the third wave, which is the wave that you hear about, is really the opioid epidemic with fentanyl, fentanyl being an agent that's 50 to 100 times more potent than morphine. It's a synthetic, you hear about it coming from overseas in our postal services. So, we are at this time noticing a significant decrease in prescribers for opioids. However, there is the challenge that remains both for the licit, the legal prescription, but also the illicit market with fentanyl and other drugs. So where we are today is we have much more of our sources from HHS and other federal government agencies and state agencies and communities aware. I would say that we're perhaps more fortified as we start to really get a grasp of this public health issue. Licit Opioids in Pain Management - From Too Much to Too Little Brian Wilson: I'm wondering about whether or not there was a time during this whole process where, because we became concerned about opioid use, perhaps we got a little too stingy, is the only word I can come up with, with the drug, so that ... In fact, there were people who needed the drug who were having trouble getting it. Have we sort of figured that out by now? Dr. Vanila Singh: Well, what you bring up is the challenge and nuances of all this, and the pendulum swings one way and then it swings the other. It's important to note opioids, like you already mentioned, can be misused and people with addiction can utilize it in a wrongful manner and tragically have overdose and even death. On the other hand, we know that it has usefulness in the surgical arena, or hip fractures, but to also moderate that with other treatment modalities. Yeah, I think that oftentimes, there's this sense of a one-size-fits-all. That is definitely not true. We know as human beings that people come with their own background, their own beliefs, and their own medical issues and conditions that make us not "Toyota Corollas", where we're treating everyone exactly the same. That has probably lent itself often to where patients aren't getting the treatment they need. So, I would just say that really a patient-centered approach is really always called for. Whenever we move away from that is when we get into trouble. Prescribing the Right Dosage Brian Wilson: How do you determine what is the right dosage, as a doctor, so that you're treating the pain but not over-medicat...

David Casarett on a solution that may help a family who is grieving after the loss of a loved one who has been in hospice ~ "This is something . . . in a hospice setting falls to family members to deal with. It's one of these things that as you're dealing with the loss of a loved one, as you're dealing with all of the other things that you have to manage after somebody dies, also being faced with the problem of getting rid of dangerous medications. That's one thing we actually could fix. We could make that better. We can't take away their grief and their sense of loss. We can't help them with all the other management and logistic issues they need to deal with, but we can, at least, help them to take care of these dangerous drugs that are sitting around in the house." David Casarett, MD, MA - Chief Medical Officer DisposeRx David Casarett: The trick for us is giving those patients exactly what they need but no more. Brian Wilson: The opioid crisis is an epidemic with many faces. To a member of the law enforcement community, opioids are dangerous substances to be managed and controlled. To the parent who's lost a child to addiction opioids are a gateway drug that can lead to a lifetime of loss and regret. But to those in pain management, opioids are necessary tools to help hurting patients at a time when little else can. Dr. David Casarett is the Chief Medical Officer at DisposeRx. As a professional with years of experience helping his patients manage pain, he brings a unique perspective to our conversation about the opioid crisis, and we start at the beginning. Downstream Effects of Increased Opioid Prescribing David Casarett: Many of us back in the '90s, early 2000s saw pain as the fifth vital sign, as a problem we had to solve, and became much more aggressive at prescribing pain medications, including opioids. Many of those prescriptions were legitimate for real needs and patients who were suffering, but some of them weren't. Gradually, the tide began to turn and there was an influx of opioids to people who didn't necessarily need them and a black market. Many of those patients, when that supply of drugs became unavailable, or less available, or more expensive turned to other forms of opioids including black tar heroin that was imported from Mexico. I wouldn't say all this started because of physicians, especially since many of those physicians like myself were really trying to do right by our patients, but I think we are seeing many of the downstream effects of increased opioid prescribing 10, 15 years ago, which we're now dealing with today. Brian Wilson: You are described to me as a palliative physician. What is that exactly? And, tell me a little bit about your credentials and what you bring to this particular story. David Casarett on Palliative Care David Casarett: Sure. So palliative care is a specialty of medicine and of nursing and social work, and other disciplines, by the way, it's not just physicians, focused on improving quality of life for patients with serious illness. We help with pain and symptom management for patients with cancer. We help with decision making under difficult circumstances for patients, say with heart failure. We provide emotional and spiritual support, meaning our team does, our nurses, our chaplains, our social workers. We really try to improve decision making and improve quality of life for patient who are going through a rough period of time, patients and their families, I should add. Brian Wilson: And often they're in hospices. What happens there at the end, let's say, of the journey? Either you get better, or in some cases, the pain management was used to support you through the end of life and now you've passed on. So what happens now to all those drugs that were prescribed? Hospice Care - Disposition of Leftover Medications David Casarett: Well, that's a good question. And just to be clear,

Becky Savage on what she says to parents when asked "What can we do? How can we make sure this doesn't happen?" ~ "It's so simple. Go home and clean out your medicine cabinets. Any expired medications that aren't needed or medications that aren't being used, get them out of your house so that they do not end up in somebody's pocket at a graduation party." Becky Savage, 525 Foundation Founder, and family Becky Savage: Our sons Nick and Jack were like many other 18 and 19 year olds. They were athletes,had a great circle of friends, and had dreams and aspirations in life. Nick had just finished is freshman year at Indiana University and Jack had just graduated high school and was heading into his first year at Ball State University. They were best friends. 2 Sons Gone, Mother Tells Opioid Story to Senate Brian Wilson: The sheer number of children being caught up in this country's opioid crisis is shocking. But let's look beyond the statistics. Each and every one of them was a child with hopes and dreams, talents and ambitions. The loss of one son or daughter can leave an indelible mark on their community, and more importantly on their families. To lose one is an absolute tragedy. Becky Savage lost two of her children to the opioid crisis. She shared her story with this podcast and explained how the tremendous loss lead to the development of a foundation dedicated to finding solutions to the opioid crisis. Brian Wilson: Becky, tell me about the 525 Foundation and what that name comes from because that tells us a lot about what you're all about. 525 Foundation Becky Savage, 525 Foundation FounderBecky Savage: Sure. Well, the 525 Foundation is a representation of our two older boys who we lost related to the opioid epidemic and crisis in our society. Five was Jack's hockey number and 25 was Nick's hockey number, so we just created a foundation to memorialize them, but also to help spread education using their story as our platform to tell people about who they were and to just raise awareness to the dangers of prescription medications and opioids when they're not taken the way they were intended. Brian Wilson: Did this start in the medicine cabinet for you at your home? Becky Savage Shares Her Tragic Story - It May Save a Child's Life Becky Savage: Yes. This did. Our two boys had gone to graduation parties, and a gentleman had brought prescription medication with him that he had taken out of somebody's medicine cabinet and was passing them out at the graduation party. Our boys decided to partake in something that they had no business participating in, and neither one of them woke up the next day. They came home. I had told both of them to be home at a decent hour and checked in with me. I was actually at home, and they went into the kitchen to make snacks, and I had went upstairs, turn my light out and went to bed. The next morning was a Sunday morning, which started out like many other Sunday mornings for me. I was doing laundry, household chores, and I was collecting laundry out of Jack's bedroom, talking to him about "It's time to get up." His dad has things that he wants the boys to help him with, and he wasn't responding, so when I went over to awaken him, he was unresponsive. I immediately grabbed my cell phone and called for 911. I remember hollering for Nick because I knew Nick was at home with friends, for their help. I picked up Jack and put him on the floor next to his bed and initiated CPR. Needless to say, that was not a morning that we would ever think would happen, and something that I would never wish on anybody. The paramedics did arrive and took over the resuscitation attempts on Jack, and I remember, everything was kind of in a fog, but I remember one of the paramedics leading the resuscitation attempts on Jack and headed downstairs. I remember hollering at him and screaming at him, like, "Why are you stopping? What are you doing? He's a fighter,

Congressman Richard Hudson on DisposeRx, an effective site-of-use method for drug disposal addressed in his recently passed bipartisan bill, the Securing Opioids and Unused Narcotics with Deliberate (SOUND) Disposal and Packaging Act (H.R. 5687), 342-13~ “I've become aware there's some great ideas out there. There's one product DisposeRx . . . they're based in my district. They've come up with this powder, that you can put in the bottle with the pills, add water, shake it up, and you got a biodegradable gel that you can't cook the drugs out of. That's a product, now a number of our retail chains are distributing for free with opioids. So, that's a great solution. I think the key is it's got to be something that's easy for the consumer to do from their home.” Congressman Richard Hudson, NC-08 Congressman Richard Hudson addresses his colleagues on the House floor: Thank you Mr. Chairman, thank you Mr. Speaker For the time. In 2018, more than two million Americans will suffer from addiction to prescription or illicit opioids. Brian Wilson: Richard Hudson is serving his third term in the United States Congress, representing North Carolina's eighth congressional district. On Capitol Hill, Hudson serves on the powerful House Energy and Commerce Committee, a position he uses to focus on reforming healthcare. In particular, Congressman Hudson is working to address the opioid crisis, in a comprehensive way. It's something he believes that legislators on both sides of the aisle can agree upon. Congressman Richard Hudson: Opioid addiction continues to take lives every day, more than 100 Americans. Touches every fabric of our society, doesn't matter where you live, how much money you make, what your personal circumstances are. We're all susceptible to this. We all know someone who's been affected. This is something that we all need to be focused on. I'm a member of the Energy and Commerce Health subcommittee. We write the healthcare laws for the country and I'm in a position to do something about it. I've been working for a number of years with my colleagues on both sides of the aisle, to try to tackle this epidemic. Brian Wilson: They say that politics is the art of the possible. What has been possible in this arena? Bipartisan Initiatives Address the Opioids Crisis Congressman Richard Hudson: Well, it's been remarkable frankly Brian, how again Republicans and Democrats have come together and made some real significant progress in tackling this issue. It's not one that was created overnight, and it's not one that we can solve overnight. There's no silver bullet. This requires education, parents, teachers and law enforcement and healthcare professionals. This requires prevention. It requires us to stop the flow of these drugs, it requires us to make sure that we don't have as many of these pills floating around in our society, and these parents need to understand the dangers of having opioids in their household, they need to know warning signs to look for. It also has to do with treatment and recovery and how are we helping folks beat the addictions, and get back into society. It's a full gamut of solutions needed, and it's a whole lot of money. Frankly, Congress has stepped up and we've appropriated a billion dollars last Congress. This Congress we appropriated $4 billion in the omnibus earlier this year, and 6.7 billion just this week, in our Department of Defense, Labor, HHS appropriations package. We're working together and we're putting real money towards this problem. Brian Wilson: We hear all the time that, you know, it's so partisan. The things aren't getting accomplished. But actually, if there was a real need Democrats and Republicans still can come together on occasion can't they? Congressman Richard Hudson: Well, we can Brian. I once had a reporter tell me, "Congressman, we don't write stories about airplanes landing." Think about that for a minute. Only the planes crashes make the news.

Ann Hamlin on her mission as Director of Training and Science for DisposeRx to change public behavior around proper drug disposal~ "There's a simple solution, and there is a convenient solution because we aren't going to change anybody's behavior unless it's absolutely simple and convenient and it doesn't make anybody have to do one or two more steps than they're already used to doing." Ann Hamlin, Director of Training and Science for DisposeRx, in studio with host Brian Wilson Ann Hamlin: We have to look at disposing of your medication like we look at wearing your seatbelt. Brian Wilson: For most Americans wearing a safety belt in the car is now second nature, but that was not always the case. In the 1960s concern about road safety and traffic fatalities prompted the U.S. government to study the effects of seatbelt usage. By 1965 every state in the union had a law requiring front seat belt usage but it took more than legislation to change the public's behavior. In fact by 1982 only 11% of drivers used seat belts but things changed. PSA Announcer: Almost 52,000 people were killed in traffic accidents last year. It's estimated that 16,000 of those people could have been saved by wearing safety belts. Brian Wilson: Powerful, sometimes shocking, occasionally even humorous commercials flooded the airwaves in a public service campaign that changed people's thinking about wearing seat belts. Commercial Voices: Vince, What are you doing? Getting out of the crash dummy business. No way I'm ending up like Charlie did. But Vince how else can we prove safety belts save lives? We can... Brian Wilson It worked. In 2016 the national highway traffic safety administration reports that the national seat belt usage rate is over 90%. Commercial Announcer: You could learn a lot from a dummy. Buckle your safety belt. Brian Wilson:I recently spoke with Ann Hamlin of DisposeRx about the opioid crisis and about how the public should view the issue of drug disposal. Hamlin's Role at DisposeRx Based on Forensic Science Career Ann Hamlin: So, I'm the Director of Science and Training at DisposeRx. and I also am over the training or the educational piece. Part of the passion of DisposeRx is to educate and change the behavior and the culture of people to understand why it's so important to properly dispose of your unused medication. Brian Wilson: Tell me about the background that you have that makes you the perfect person for that job. Ann Hamlin: Well, I worked at a crime laboratory in the state of North Carolina for 30 years. I worked my way through the ranks. In the last 10 years of my career, I was the forensic scientist manager over drug chemistry and, for a brief period of time, over toxicology as well, so I got to actually see the trends and the changes in both illicit and pharmaceutical drugs. Community Training and Education Brian Wilson: Tell me about your education efforts on behalf of DisposeRx and the curriculum that you take to families and children, I guess. Ann Hamlin: Sure. What I've done is I've developed a program that involves a number of lessons that actually teaches children about proper use of prescription medication. It's aimed at eighth graders, and there's a reason for that. There's a DARE program in our country that ends with seventh graders, so I figured, if we target eighth graders, it's a great segue from that seventh-grade class to when they go to high school to learn about the proper use of pharmaceutical medication. The last piece of the curriculum that I've developed involved the parents, and it brings the parents into the school to see projects that the kids have developed to send their message to friends and to their family about what they need to know about the proper use of pharmaceuticals, and that includes the proper disposal of unused medication.

Lisa Mortier on how, by mentioning her work with DisposeRx, she starts the "medicine cabinet" conversation with parents of her daughters' friends~ "It's easy and inexpensive. It also is a nice discussion to have with other parents. When you're trying to bring up the conversation of ... Instead of an accusatory way of, "Whoa, have you cleaned out your medicine cabinet? Are you watching your child?" For me, it's been a great way to sort of talk about, "Oh, I have this great new client. Have you heard about this product?" I never even realized that I should be cleaning out my medicine cabinet until I had that. For me, it's been a great segue into having conversations with my daughters' friends." Lisa Mortier, Capitol Hill veteran lobbyist in studio with host Brian Wilson Brian Wilson: Lisa Mortier is a Capitol Hill veteran on a mission. As a federal Lobbyist for DisposeRx she walks the corridors of power in Washington with a simple message - drug disposal is key to solving the opioid crisis. Everyday on Capitol Hill, she encourages Members of Congress to consider legislation that deals with the issue of disposal of opioids - employing her years of experience, her extensive understanding of policy matters and the heart of a mom. Lisa Mortier: We first started talking about this a little bit under the Obama administration. We had the Comprehensive Addiction and Recovery Act. . . President Obama: To combat the heroin and prescription drug epidemic that is plaguing so many of our communities. Lisa Mortier: and the 21st Century Cures Act. . . Senator Mitch McConnell: This is the product of a couple of years work, we know this is not the end of the fight but it's one heck of a beginning. Opioid Epidemic Declared a National Emergency Lisa Mortier: Starting in 2017, we did start appropriating some dollars for it, but it really didn't take effect until August of 2017 when the Trump administration declared it a national emergency, President Trump: We can be the generation that ends the opioid epidemic. We can do it. Lisa Mortier: And, That started 90 days of action. The first lady had a round table discussing opioid epidemic. First Lady Melania Trump: It's effected more than 2 million Americans nationwide. And sadly the number continues to rise. Lisa Mortier: The president appointed his very trusted advisor, Kellyanne Conway, as their health czar. Kellyanne Conway: With the Presidents leadership and the First Lady's involvement we are confident we can help those in need across this country. Lisa Mortier:The Department of Justice started cracking down on synthetic drugs entering the market. What really, I think helped push this ahead, as well as when Secretary Azar came into power as the Secretary of Health and Human Services. He declared this as one of his top pillars and priorities. Secretary Azar: Mr. President thank you so much for the confidence that you have bestowed upon me and the incredible department you have entrusted me with. Lisa Mortier: But you still need the resources, so you still needed Congress staff, and Members of Congress jumped on it because they were hearing from all their constituents. Brian Wilson: One thing I know about Washington, and it gets a bad rap in many ways, that if people back home are screaming about something, it gets the rapt attention of Members of Congress. Is that what's happening right now? Lisa Mortier: Yeah, and unfortunately, it's not just screaming, it's crying and they're seeing the pains of their constituents every day. And in this political environment where everyone is so divided and everyone is targeting certain people for their votes, unfortunately or fortunately, this issue crosses all demographics. And Members are really seeing this as something that they can do to help their constituents on an individual level and really make a difference for all these families in crisis and communities.

John Holaday on how a simple change in behavior at home can break the cycle of opioid addiction and death that begins in the home medicine cabinet. “Our passion is to both, educate and legislate. On the education side, letting people understand that they've got to change behaviors. They've got to look in their medicine cabinet and get rid of these leftover opioids. We have a product that does that called, DisposeRx. . . it changes behavior. Our solution is a site of use solution. That is, at home. You don't get in your car, you just take your drugs out of the medicine cabinet. Add . . a small amount of powder about the same amount as you'd find in a pack of sugar . . . add the water . . .shake it up in that prescription vial and within a minute or two, the drugs are dissolving and . . . become immersed in a gel from which they cannot be easily diverted or abused. And in which, they biodegrade overtime, so that they won't pollute landfills.” John Holaday, Chairman and CEO, DisposeRx in studio with host Brian Wilson John HoladayAn ounce of prevention is certainly worth a pound of cure. Brian Wilson:A scientist, an author, an inventor, an entrepreneur, and a veteran. John Holaday has seen and done a great many things. But, it's in his role as Chairman and CEO of DisposeRx where he's making perhaps his greatest impact. What follows is a conversation with a man who studied the opioid crisis from every angle, and one who is determined to change how our society views disposing of its medications. Brian Wilson: How did we get into an epidemic? Where did it all start? John Holaday: Well, there are a number of routes towards this epidemic. The one that probably is the most important is when it was decided, in about the late '90s, to put more opioids in the marketplace, under the flawed premise that opioids like OxyContin are not addictive, and that one should have a way of treating chronic pain with a drug that's less addictive. So they put OxyContin in the market. And that was from Purdue Pharma. And then as it became more widely abused, or misused, people would turn to other drugs, like heroin, because they couldn't afford it. It was a dollar a milligram. An 80 milligram OxyContin tablet, $80.00 on the street. Average problem with people who were taking up to $500.00 worth of drugs a day, couldn't afford it. Brian Wilson: Right. John Holaday: Where do they turn? They turn to heroin. For $20.00, you can get a pop of heroin; far less expensive and a better high. Brian Wilson: Alright so, are there anything inherently wrong with the idea of opioids? I mean, can they serve a legitimate purpose? John Holaday: You know, there's no better way to achieve pain relief for moderate to severe pain, having had some surgeries in the last few years, if I had not had opioids I wouldn't have been able to go through the recovery, and the physical therapy that was necessary. What about cancer pain? The people with chronic diseases like cancer, need to have pain therapy. And it's not so important they've become addicted to them. They've got to have pain relief. But there are no better drugs for the relief of moderate to severe pain than the category of opioids. Brian Wilson: The problem comes after you've completed the therapy. Now you've got an addiction that you need to be ... Treat the addiction and that you have sometimes, many leftover drugs sitting around. John Holaday: The average duration of a leftover drug in the medicine cabinet is in excess of three years. Brian Wilson: Wow. John Holaday: Although, drugs might have labels on them saying, "Please destroy after XY years." Those drugs are really good for a far longer period of time. But what we've got to do is to change those habits. We have a disruptive approach to getting rid of the medicines before they cause harm. Because 70% of the opioids addictions, overdoses and death, begin with leftover drugs in the medicine cabinet.

John Hindman on what's required of parenting today ~ "Vigilance is required, irrespective of where we are. Parents didn't just turn us out and leave us to our own devices when we were kids. It's just more vigilant parenting is required, because this is indeed very pernicious." John Hindman - Senior International & Public Affairs Advisor, Leidos Brian Wilson: In today's busy corporate culture it's easy for an email to slip through the cracks. But in the case of Leidos employee John and the company's CEO Roger Krone one email had a huge impact. But, let's back up, we will begin with a story about John's son Sean, whose life was lost to opioid addiction. Brian Wilson: John, I want you to start by telling me about your son, Sean. Tell me what kind of kid he was growing up. Sean Hindman John Hindman: Sean was a good kid. Somewhat slight of build, about 5'9". Gifted athlete, tremendous soccer player. He was a younger brother to my daughter, Allison. He was overall a quiet kid. Liked to associate with older kids, but began to get exposed to drugs, probably ... The first time we were aware of it, he was about 11 when he reported to us. He was counseled and stayed away from things until probably when he was about 13. Brian Wilson: How did it start? John Hindman: It was at somebody's house. Prescription drugs that were made available by the friends who lived at that house. That's not uncommon in our society today, unfortunately. Thus began his exposure to pills, and marijuana, and other hard drugs. And eventually, in the final years of his life, to heroin. Brian Wilson: So, this started at the age of 11. How many years did he struggle with it? Struggles with Drug Addiction John Hindman: Probably from the struggle standpoint, I would say the last decade of his life. Maybe 15 years, all together. Brian Wilson: Wow. John Hindman: In terms of in and out of usage, staying clean. But, as is often the case in situations like this, it impacts your ability to be fully employed, and it takes a toll on individuals in that regard. How Sean Lost His Struggle with Opioids Addiction John Hindman: His final days, things were going, actually, very well for him the year before he passed. He had been clean for about half a year. It was in May of 2016, he came home with a young man, was actually someone he had known from high school, and announced that this young man would be working with him in the roofing crew that he worked with for several days. My wife begged him not to engage this individual because it was clear he was high. Regrettably, within the matter of two weeks, Sean was back into using heroin again. Thus began a very precipitous decline that summer. The Friday before he passed, a friend of his had called me to ask if I had NARCAN in the house, because his sister had overdosed. And I sought out Sean, who was hard to find in those final weeks, and months, even despite his living with us. He didn't have any NARCAN, but he went and found, and got NARCAN, and went and visited this friend that Sunday. Went out with several friends, came home about 2:30 in the morning, absolutely stone sober. My wife let him in, went to bed, and when each of us got up to go to work the next morning, went to put our hands on the doorknob to tell him have a good day, because they weren't working that day. And neither of us, for some reason we stopped, and didn't go in to bother him. When my wife got home from work, she didn't hear any noise from him, she just thought that was not all that unusual, it was early afternoon. About an hour later, she texted him and got no response, and ran upstairs and found him dead. So, she attempted CPR, and called the EMTs and notified me, and I came home. Brian Wilson: We’ll be right back. [Begin Announcement] Three years ago, you fell down the stairs and ended up with a fractured ankle. OxyContin 10mg. Sometimes you need something to help you sleep,

Barry Meier on the addictive nature of opioids and narcotics ~ "The fact is that any type of opioid or narcotic, once you begin to take it, your body physically adjusts to it. It's a very natural process called tolerance, so if you're getting say a specific level of pain relief from, let's say, 40 milligrams of the drug, you're going to soon need more of the drug to get the same level of pain relief, so doctors kept having to ramp up and ramp up their patients' dosages." Barry Meier - New York Times Reporter and Author of "Pain Killer: An Empire of Deceit and the Origin of America's Opioid Epidemic" in studio with host, Brian Wilson Brian Wilson Few people have devoted as much time to studying the origins of the opioid crisis as Barry Meier. As the author of "Pain Killer: An Empire of Deceit and the Origin of America's Opioid Epidemic" Meier initially explored this as a reporter for the New York Times. His book came out in 2003. Still some 15 years later he found there was much more to the story. This led Meier to revisit his work and update more than a decade of developments in a riveting rewrite. Barry Meier: In the early going it was quite remarkable, because when I first started on the story I knew nothing about opioids; I knew nothing about pain treatment. I had done some stories about the pharmaceutical industry, and this whole story came to light with the emergence and appearance of the drug OxyContin. OxyContin was very much the seed that launched this whole opioid epidemic, and back in 2001 there was an outbreak of abuse of this new drug OxyContin. Brian Wilson Where was it coming from? Barry Meier: Well, the drug was made in Connecticut by a small company named Purdue Pharma, and marketed very aggressively by the company: Male Speaker 1: I got my life back now. Now I can enjoy every day that I live. I can really enjoy myself. Female Speaker 1: Since I've been on this new pain medication I've not missed one day of work and my boss really appreciates that. Lauren is there every day. Female Speaker 2: Life is wonderful again. I've found life again, and it's worth living now, and I'm so grateful. Barry Meier: But the abuse was turning up in places like Maine and Appalachia and very rural parts of the United States. Brian Wilson I have seen maps that suggest there is a huge problem throughout the Appalachians. Barry Meier: Well, in the early 2000s I would say that was part of the epicenter of the opioid epidemic or what was then basically an opioid crisis, and you had what we would refer to as hot spots, where you had these outbreaks of OxyContin abuse, so I remember when I was starting to report on the story you'd see local newspapers, and I mean small town newspapers in tiny little towns and cities throughout Virginia and West Virginia and Kentucky, Ohio, Western Pennsylvania, there'd be stories about scattered arrests of drug dealers or drug users, and maybe the occasional arrest of a doctor for running a so-called pill mill, essentially like a medical practice where you could come in and say, "Boy, my shoulder hurts me," or, "My back hurts me, and I heard about this drug called OxyContin. My friend told me it really works great for pain," and the doctor would write you a prescription for it. Brian Wilson Were there other ways that it was making its way into the public? Barry Meier: Essentially OxyContin was a very unique drug. It was a drug that was marketed as a long-acting pain reliever. Most traditional narcotic pain relievers last four hours. OxyContin was promoted as lasting 10-12 hours, but what was remarkable about OxyContin is that it's manufacturer, Purdue Pharma, was able to get a claim from the FDA that because it was a so-called long-acting drug it was less likely to be abused than shorter acting drugs like Percocet and Vicodin. The sales reps for this company went out to doctors, to pharmacists, to whomever, and were promoting this drug as a drug that couldn't be...

Missy Owen on why she and her husband started the Davis Direction Foundation~ “This shouldn't happen in families. And, we were bound and determined that we were going to find out how to prevent it from happening to others because people shouldn't have to go through that." Missy Owen, Co-Founder and CEO Davis Direction Foundation and her family Announcer: This is Opioids: Hidden Dangers, New Hope. Here’s Brian Wilson. Brian Wilson: The story of Missy Owen and her son, Davis, though tragic is far too common in a country that finds itself in the grip of an opioid epidemic. I spoke with Missy co-Founder and CEO of the Davis Direction Foundation about her son and discovered a unique perspective on our society's shared challenge on this issue. Brian Wilson: Tell me about your oldest son, Davis. What kind of kid was Davis? Missy Owen's son, Davis. Davis Owen Missy Owen: Davis was an amazing kid. He was a boy, boy. He was a baseball player. He was smart beyond his years. He was a gifted child all through elementary school, middle school, and high school. Everybody loved him. He was very involved in the school system. He was, as a student government person, he was a volunteer during his freshman year, a sophomore senator, a junior class president, and as the senior class president, he gave the graduation commencement speech to over 3000 people in attendance that day. Davis Owen: Dr. Daniel, amazing faculty and staff, proud parents, and fellow classmates: Congratulations to the Senior Class of 2011. We made it. Brian Wilson: This was a young man who was on a good trajectory at this point. Missy Owen: Oh, absolutely. He was hall of fame, editor of the yearbook. He had National Honor Society. He had everything in the world going for him. Brian Wilson: Well, then there came a time, however, when apparently he got into some of the drugs that were in the medicine cabinet. Can you tell me about that? Addiction Started in the Medicine Cabinet Missy Owen: Well, between high school and college, he got into a really stressful situation. It's stressful enough going from high school into college, but he just had a lot of anxiety that summer and got very stressed out, and he went to the medicine cabinet because he couldn't sleep. So, he was probably looking for something like Advil PM or Tylenol PM, and instead, because we didn't have those, instead he found an old bottle of Vicodin that said "May cause drowsiness." Because we didn't have any education really back then, back in 2012, about opioids and the devastating effects and all, he thought it was part of our medicine cabinet, it was a legally prescribed pill from the doctor, and he took it thinking that he would sleep. He did. He slept and he slept well, and he took it again the next night and the night after that, and before you know it, he became dependent on those pills. Brian Wilson: So what happened then? Struggles With Addiction Missy Owen: Well, after taking the pills for quite some time, he started buying them from the street, or taking them from other people's homes when he would be there, or sharing them with others that had some to share. One thing led to another, and after he had pawned pretty much everything that he had to pawn, he turned to heroin because it was much cheaper and much more readily available. Brian Wilson: Now, we hear this story a lot, that it starts out with "Okay, I see a pill here. It solves my short-term need," but then they become addicted to the pill, and it gets very expensive to buy more opioids on the street in pill form. Then, they turn to heroin. When did you start to detect that there was a problem? Missy Owen: Well, one morning we were headed to my hometown on Thanksgiving, and my husband went to get the shotguns because we go and shoot out there, as people in the Georgia do, and there was a BB gun in place of the shotgun that should've been there. It came to light that the shotgun had been pawned.

“Opioids: Hidden Dangers, New Hope” In October 2017, the opioid crisis was recognized as a national health emergency with opioids related overdoses and deaths claiming over 190 American lives every day. “How could this happen to my kid,” “When did this crisis start in my neighborhood?," “What is causing this epidemic to escalate to this magnitude?” are just a few questions that those most affected are asking? This 15 episode series hosted by veteran broadcaster Brian Wilson addresses the complex issues of prescription abuse head on and provides a 360 degree view of the problems surrounding the Nation’s #1 killer. In each of the 15 minute episodes, Wilson tells the story of the opioid epidemic as seen through the eyes of those directly impacted including: the siblings and parents of overdose victims, social workers, law enforcement officers, doctors who prescribe the medicines, government officials and even a writer who has been covering the story for over 20 years. “Opioids: Hidden Dangers, New Hope” is presented by DisposeRx, Inc. providing the best in class solution for site-of-use drug disposal. Radio Talk show host Brian Wilson knows first hand the devastation caused by the opioid crisis having reported on his own Nashville Mayor Megan Barry who lost a son to opioid addiction. Most Americans are unaware that 70% of new addictions begin in the home medicine cabinet. Unused, unwanted and expired medications are contributing to over 190 deaths per day. Leftover drugs remain in home medicine cabinets for an average of three years -- that’s one-thousand and ninety-five days of opportunity to contribute to a new addiction. The Center for Disease Control says nearly 72,000 overdose deaths occurred in 2017, more than the number of men and women lost during the Vietnam war, and over 42,000 of these deaths involved opioids. According to the Journal of drug abuse, 89% of consumers are looking for a safe and convenient way to dispose of these unwanted medications. DisposeRx produced this podcast series as a public service to bring information into the homes and to educate those concerned parents, teachers and pharmacists who are seeking to know more about the problem and the solution. Using DisposeRx packets to clean out your medicine cabinet breaks the cycle of drug abuse, misuse and diversion. DisposeRx is the most-tested, most convenient, at-home drug disposal solution available. Visit Disposerx.com