August 29, 2019

Episode #7: The Opioid Crisis in America – Working Together to Save Lives

The Centers for Disease Control and Prevention report that on average, nearly 130 people a day die of opioid overdoses across America, and millions more are in need of treatment. In advance of National Recovery Month, former U.S. Surgeon General Dr. Vivek Murthy and Harm Reduction Coalition Board Member and Clinton Foundation partner Julie Stampler join President Bill Clinton to discuss how we can fight this escalating crisis. This episode also features personal stories from members of the Clinton Foundation community who have overcome substance-use disorders and are now helping others recover including Mark Kinzly, who co-founded the Texas Overdose Naloxone Initiative, which helps to increase naloxone access and bring overdose awareness and trainings to the state of Texas; and Clinton Global Initiative University alumna Sarah Gad whose CGI U commitment and work focuses on increasing medication-assisted treatment for incarcerated people struggling to survive and conquer their addiction.

The Clinton Foundation has been responding to the opioid crisis since 2012 by working with partners to expand access to life-saving naloxone, engage influential faith leaders in hard-hit communities to reduce stigma, and translate research into practice with institutions such as the Johns Hopkins Bloomberg School of Public Health and Harvard Medical School.

 
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Transcript

Sarah Gad: (00:00)
My name is Sarah Gad. I’m a CGI U, Clinton Global Initiative University alumni. It was actually the very first time I decided to share my story and my history with opioid addiction was in that discussion room at CGI U. They were just so supportive and I realized, why have I been so secretive about this for so long?

Sarah Gad: (00:24)
I first became addicted to opioids when I was in my third year of medical school. I ended up in a pretty horrific car accident, which I remember nothing about. I woke up in a hospital room with my leg in a sling. I had undergone emergency surgery on my leg because my ankle bone literally pierced through my skin and had to be hammered and screwed back into place.

Sarah Gad: (00:52)
It was a pretty long, pretty painful recovery process. And during that time I was prescribed opioids like Percocet and Oxycodone, and at first I was just taking them for pain. But as I was recovering, I was watching all of my classmates graduate onto their fourth year of medical school. Meanwhile, I was bedridden and I was depressed.

Sarah Gad: (01:13)
My opioid prescription pain medication was by that point, they had become my only source of joy and happiness. And then maybe about a year out after my accident, my doctor sat down with me and was like, “Look, you cannot be in this much pain this far out. Do you have a dependency problem?”

Sarah Gad: (01:36)
And I denied it. I just didn’t want to acknowledge it. Once my doctor stopped prescribing me opioids, I started going to see a bunch of other doctors, and then it didn’t take too long for them to figure out that I had been doctor-shopping. As a third year medical student, I was familiar with how to write prescriptions and that’s what landed me in legal trouble and got me arrested.

Sarah Gad: (02:04)
And once you’re criminalized and you have a criminal record or an arrest record, very difficult to reintegrate back into society in any sort of meaningful way. It was always just kind of the cycle of going to jail, detoxing, cold turkey and going through the hell of physical withdrawal. Getting out, trying to get my life back on track and then relapsing and then going back to jail.

Sarah Gad: (02:29)
And then I was incarcerated for five days and the day that I got out I actually ended up overdosing. It was just because my tolerance had gone down so much during that period, and I woke up in an ambulance being injected with Narcan, and told that I had just overdosed on opioids.

Speaker 2: (02:54)
The centers for disease control reports that more than 40,000 people died from opioid overdoses in 2016. Addicts need help without the fear of being stigmatized or arrested. The crisis has become so widespread that the Surgeon General, is urging ordinary citizens to carry naloxone, a drug that reverses the effects of a drug overdose and saves lives.

Speaker 3: (03:18)
Only reason I survived was at that point we had been given the locks on. The gentleman that I was using with that in his house knew how to administer.

Speaker 4: (03:29)
There’s a lot of shame that comes with being an addict and I think just by recognizing that you have a disease, it doesn’t mean you can’t regain control of your own life.

Sarah Gad: (03:44)
I’ve been sober for almost four years now and the name of my CGI U project was, Addiction to Action. My project is basically devoted to helping address the opioid crisis.

President Clinton: (03:58)
Welcome to, Why Am I Telling You This? The Clinton Foundation podcast. I’ll never forget hearing just before Christmas in 2011, that the son of one of my very best friends, a bright young 28 year old who’ve worked for Hillary, at the State Department, and who was pursuing both an MBA and a law degree, had died in his sleep.

President Clinton: (04:19)
I had known him very well and liked him very much. It just seemed impossible. Not long afterward, we learned he died of a lethal combination of alcohol and oxycodone. Like so many Americans, I had now been personally touched by the opioid epidemic. Sadly, Hillary and I have five friends who’ve lost their children to overdose.

President Clinton: (04:42)
Why am I telling you this? Because in America today, just about everyone knows someone who’s died and the opioid epidemic. Drug overdoses now kill more Americans than HIV AIDS, car crashes or gun violence. Behind every one of these statistics is a real person, someone with a real life, a real story, people who really loved them.

President Clinton: (05:02)
At the Clinton Foundation, we’ve been working since 2012 to lower the price and expand access to naloxone, a miracle drug that can reverse the effects of an opioid overdose in seconds. We’re also working to do more to save lives with partners like the Johns Hopkins University School of Public Health, and with faith leaders of all traditions all across the country. We’ve got to get everybody involved. We’ve got to find a way to turn the tide and save more lives.

President Clinton: (05:41)
Today. I’m very grateful to be joined by one of America’s leading experts on the opioid issue. Former Surgeon General of the United States, Dr. Vivek Murthy. Thanks for joining us.

Dr. Vivek Murthy: (05:53)
Thank you, Mr. President.

President Clinton: (05:54)
You did something really remarkable in 2016. First issuing the first Surgeon General’s report ever on alcohol, drugs and health. And at the same time more remarkably to me, you actually sent a letter and a card to 2.3 million doctors, nurses, dentists, and other clinicians asking them to help address the opioid epidemic. Now, nobody had ever done this before. Why did you?

Dr. Vivek Murthy: (06:18)
Well, thanks for the question, Mr. President, for having me join in this conversation on opioids. When I began my time in office, I remember thinking on my first day of my priorities and what they should be, but I had this instinct to spend the first few months on a listening tour just visiting communities across the country.

Dr. Vivek Murthy: (06:36)
And the issue that kept coming up again and again and again was the issue of opioids. I quickly realized that that needed to be even higher on my priority list. It also dovetailed with the personal experience that I had as a clinician. As a doctor, I took care of patients over the years who struggled with all kinds of chronic pain conditions, and I found myself prescribing opioids often. I also at the same time was seeing people come in struggling with addiction to heroin, to prescription opioids and to other all manner of substances.

Dr. Vivek Murthy: (07:08)
And I began to realize that there was a connection between the way we were as doctors prescribing these pain medicines, and what was actually happening to our patients. I wish I had realized that earlier, but I, like many doctors was taught that if we gave opioid medicines to someone who had, “legitimate pain,” that they would not become addicted to that substance. And boy were we wrong.

Dr. Vivek Murthy: (07:30)
Coming into office when I realized that we had inadvertently as a profession contributed to the epidemic, and I realized that in addition to publishing the first Surgeon General’s Report on the subject of addiction, we also needed to do more. Well, we needed to call our profession to action to rectify an issue that we had helped to create.

Dr. Vivek Murthy: (07:48)
That’s why I penned a personal letter to doctors and nurse practitioners and dentists all across the country. And at the time I did it an instinct, I didn’t know quite what their reaction would be. But I was gratified to hear from many doctors and nurses over the coming months, that it actually changed how they practiced, how they prescribed these kinds of pain medications.

Dr. Vivek Murthy: (08:12)
And I remember going to an oral surgeon actually recently to get my own wisdom tooth pulled. And he told me that in addition to receiving that letter, that he had made a decision when he read it, that he was going to stop prescribing Percocet automatically to everyone who had wisdom teeth removed.

Dr. Vivek Murthy: (08:29)
And he gave all of them his personal cell phone number and he braced for what he thought would be an onslaught of calls from patients saying that their pain wasn’t well controlled on ibuprofen and they needed something stronger. But days went by, and the calls never came. And he realized that, “Hey, we can actually get by treating pain safely and effectively without necessarily using opioids.”

President Clinton: (08:51)
I want to thank you for this. We live in an age of denial about a lot of things. When Chelsea, was in high school, all of her friends used to say that denial is not just a river in Egypt. And I think it takes a certain amount of courage just to say, “I once thought the truth was this and I learned something and I changed.” And that’s why I think more and more people have to do about more and more issues, but especially this one.

President Clinton: (09:19)
Let’s talk about this a little bit. I think a lot of people know about naloxone, and know it can bring people back. But it’s just the first step. Could you briefly describe what should be done to someone who is overdosed, is injected or inhaled naloxone and then comes back? That’s the beginning, not the end of this process. Describe how that works.

Dr. Vivek Murthy: (09:43)
Well, naloxone is a really powerful medication and remarkably effective at reversing the effects of opioids. And for people whose breathing has been compromised by these medicines, it can reverse that and enable them to breathe again. I’ve administered naloxone myself, I’ve seen just how rapidly it acts. It’s good that we are getting that medication to the hands of first responders and family members, but far too many people who overdose, the treatment does stop there.

Dr. Vivek Murthy: (10:09)
It’s shocking how many people are treated with naloxone and go right back into the community and often in fact, will get more prescriptions for opioid medications. What we really need to do is to bring those people in and connect them to treatment right away. Treatment often with medication-assisted therapies including methadone, buprenorphine and naltrexone.

Dr. Vivek Murthy: (10:31)
What we realize now is that there should be no wrong door to treatment. Whether it’s a first responder finding you having overdosed, let’s say in the community. Whether it’s somebody in the emergency room who encounters you, or whether it’s a somebody in your place of employment who realizes that you have a challenge with addiction. We have to find ways to create channels, which people can go from where they are in their communities to getting directly connected to treatment.

Dr. Vivek Murthy: (10:57)
Right now that’s too hard for people in communities across the country. But if we can change that, and I think we can take people who need and want treatment and actually get them the lifesaving treatment that they deserve.

President Clinton: (11:08)
I think that’s a really important one. I remember a couple of summers ago I was playing golf out on a public golf course, and all these folks gathered around me. All I want to talk about was the opioid problem. And there was only one young person there, all the others walked away after about 45 minutes. He stayed behind and said, “Thank you. I didn’t know anybody like you cared about this. I’m four days out of rehab.”

President Clinton: (11:32)
And he said, “I’m not worried about myself, I want to live. And now I know how.” But he said, “I think it’s a terrible shame that you’ve got to have as much money as my family does to afford this. You got to do something to help the people that have no money.”

President Clinton: (11:48)
Let’s start with what the government should do, or the federal land state government. Where are we on that?

Dr. Vivek Murthy: (11:55)
Well, there’s no question that one of the big barriers to treatment is the cost and the availability of these services, including the availability of trained personnel. The problem is in part of funding issue. In the last several years, we have seen Congress allocate substantial amounts of money, several billion dollars in fact. But the reality is that we need far more than a few billion dollars to expand treatment sufficiently, so that everyone who needs care can get it.

Dr. Vivek Murthy: (12:21)
When we published the Surgeon General’s Report on Alcohol, Drugs and Health in 2016, one of the things that we noted was that only one in 10 people who are struggling with substance use disorder are actually getting treatment. And part of that is because people can’t get treatment. And part of it also has to do with this stigma, the unfortunate stigma associated with substance use disorders, which prevents people often from seeking help.

Dr. Vivek Murthy: (12:43)
When I was traveling through Tennessee, for example, I met many people who either had loved ones who are struggling with an opioid use disorder or themselves were, who refuse to talk to me if there were any cameras around. The reason was because they felt if somebody knew that they had a problem and that they needed help, that they would be ostracized not just by their neighbors, but also by their doctors.

Dr. Vivek Murthy: (13:04)
Sadly, I did meet doctors when I was in Tennessee and in other states who didn’t believe what they were reading about medication-assisted treatment, who thought it was just another way of perpetuating a dependence on opioids. And these unfortunate misconceptions combined with the lack of adequate funding have combined to make it too hard for people to get treatment.

Dr. Vivek Murthy: (13:24)
We have evidence about what works. We know for example, that medication-assisted treatment with these three medications in particular methadone, buprenorphine and naltrexone, not only reduce the risk of overdose, but they also reduce crime in communities. They reduce the acquisition of a needle born infections like HIV and Hepatitis C. They are good overall.

Dr. Vivek Murthy: (13:47)
There are still unfortunately a majority of treatment facilities in the country right now which do not offer medication-assisted treatment. And that to me is an unthinkable tragedy because at a time when we know what works for the majority of treatment facilities to not have what works, and to be charging people tens of thousands of dollars for that treatment is just horrible. And that’s something that I think we absolutely need to change.

President Clinton: (14:13)
Well, let me ask you this. Is it not offered because the money’s not there, or because there’s a stigma associated with the use of methadone and buprenorphine?

Dr. Vivek Murthy: (14:21)
Well, partially this is about payment, but only partially. I think that once we get insurance programs of Medicaid and private insurance to fully reimburse for the full suite of medication-assisted treatment, once we ensure that we actually have adequate personnel trained to deliver that treatment, that will help a lot.

Dr. Vivek Murthy: (14:38)
But the stigma piece that you brought up is a really good point, because I have visited communities across the country where treatment is available, but people will not access it because they are worried that there’ll be looked down upon. If engage in treatment that their doctor in fact will look down upon them.

Dr. Vivek Murthy: (14:54)
I visited communities that do not want to invite treatment centers in because they feel it will bring the wrong kind of people into their community. And because they have been led to believe that this treatment is just perpetuating opioid addiction.

Dr. Vivek Murthy: (15:08)
If you understand what’s really happening with the opioid epidemic, you realize that this is not about inviting, “Bad people in,” but the people who are struggling with opiod addiction are in all of our communities anyway. They’re our friends, our neighbors, often family members and they struggle in the shadows though, unable to come forward and share their stories because of the unfortunate shame associated with it.

President Clinton: (15:28)
One of the things I’ve tried to do is to get rid of stigma by getting the whole community involved. We have this faith-based initiative, where we have people from all faiths, traditions, gather to get people to come together because everybody’s congregation has got somebody in it with this problem.

Dr. Vivek Murthy: (15:46)
Education, whether it’s in school-based settings, grade school and colleges, or in workplaces or through faith-based organizations can be remarkably effective. The other thing though that can happen in these settings is that conversations can be started to actually share their real stories of people who are struggling with addiction.

Dr. Vivek Murthy: (16:05)
This is hard to do because in an environment where you’re not sure how you’re going to be received. I can understand how challenging it can be for someone struggling with an opioid use disorder, for example, to come forward and say, “I have a problem.”

Dr. Vivek Murthy: (16:17)
But what I have seen time and time again, is that when people take that courageous step, people all around them respond. Sometimes often silently saying, “Oh gosh, I thought I was the only one.” Or, “I thought my family was the only one impacted.” But often vocally as well, voicing their support.

Dr. Vivek Murthy: (16:33)
And I think of faith organizations as powerful partners in this regard. They convene conversations anyway on topics related to faith and life more broadly. Their ability to convene conversations where people share their real story with addiction can be extraordinarily powerful in helping to remove some of that stigma.

Dr. Vivek Murthy: (16:50)
There are times when culture trumps policy, when it comes to ultimate impact. And this is a place where the culture around addiction, our underlying belief around it, has to be addressed before we’re fully able to address the epidemic.

Dr. Vivek Murthy: (17:03)
As much as we feel like we’re reading about the opioid epidemic in the papers, there are still millions of people in our country who don’t fully understand what opioids are. How to protect ourselves from combining opioids with alcohol and how to protect ourselves when we’re using opioids to begin with, when it’s appropriate versus not.

Dr. Vivek Murthy: (17:20)
We still have so many people, for example, who store opiod medicines in their medicine cabinet. And it turns out the medicine cabinet is the worst place for that medicine, because other people when they come and visit can often just easily go and take those opioids and this is actually what happens in households all across America.

President Clinton: (17:36)
Do you have the sense of Congress is willing to properly fund this? I mean if there’s ever been a bipartisan or nonpartisan national epidemic, this is a…

Dr. Vivek Murthy: (17:44)
Yes and at a time where few things seem a by partisan, this stands out as a rare opportunity, rare issue. I don’t think though that many in Congress has shown the appetite to fund the opiate epidemic at the level that it requires. What’s happening right now with how we’re funding the opiate epidemic is we’re providing oftentimes, these one-time grants to communities that will run out after a short period of time.

Dr. Vivek Murthy: (18:11)
And they’re trying to figure out in part, “Okay, we get something up and running. What’s going to sustain us in years two, three, four and five? But we’re also providing that support at a mere fraction of what’s needed to really turn the tide on the epidemic in those communities.

Dr. Vivek Murthy: (18:25)
I think many members of Congress, and some of them have told me this privately, they worry about the price tag a on a bill that would really adequately resource the epidemic, because it would be a at least 10 times greater than the numbers that you’re seeing out there. But I think what we have to realize is that the long-term cost of not funding that is far greater.

Dr. Vivek Murthy: (18:46)
And this is why there’s an urgency around this issue. It’s why having a people like you still discussing this issue and helping raise public awareness are so important, because this is one of those times where we need the public to push our policymakers not just to make an investment, but to make the right investment.

Dr. Vivek Murthy: (19:04)
But I lastly think though, it’s worth considering also that in all the discussions we have on opioids in talking about what’s driving this epidemic. From prescribing patterns to pharmaceutical companies marketing these medicines irresponsibly to the public, to a whole host of other factors.

Dr. Vivek Murthy: (19:21)
There are also some emotional factors that are driving this epidemic as well. I was struck so often and heartbroken often when I visited communities around the country, how behind the stories of mental illness and addiction, and even physical illness were often stories of deeper emotional pain that people were experiencing.

Dr. Vivek Murthy: (19:40)
Sometimes it was the pain of poverty, of discrimination. Sometimes it was the pain that came with disability. Sometimes it was the pain that came from not having a job and not being able to find a job, and feeling like they were outcasts. Sometimes it was the pain of loneliness, which is extremely common, much more so than we realize.

Dr. Vivek Murthy: (19:57)
But whatever the pain source was, that deeper emotional pain was often driving people to places of despair, and it was manifesting a often as disconnection from others. And I realized that if we want to address the opioid epidemic, we don’t just need good treatment and counseling. We actually need community. We need connection as well.

Dr. Vivek Murthy: (20:16)
There was nobody I have met and who has come through the dark tunnel of addiction and immersion on the other side, who is not had somebody that they trust who has believed in them, especially when they were not able to believe in themselves. That is why I think about the opioid epidemic is not only an illness but as a disease of disconnection in part.

Dr. Vivek Murthy: (20:35)
And this is a place where each of us can be helpful. You don’t need a medical degree or a nursing degree to be able to provide support and a listening ear to somebody who is struggling with addiction, to help them feel that they are being judged for an illness. That’s not a character flaw, but that’s actually a medical condition.

Dr. Vivek Murthy: (20:52)And I will tell you that despite my training as a doctor, despite all the years that I have put into learning how to treat biological illnesses, that the power of a family member or friend building a loving, trusting relationship with someone is far greater than any medicine I could prescribe, or any treatment that I could give. And that’s why I believe that in the fight against the opioid addiction, that love is in fact our most powerful medicine. It’s one that anyone can dispense and it’s one that we need now more than ever.

President Clinton: (21:25)
Our country was very lucky to have you as our Surgeon General, and I thank you. The only thing I’d like to say before we close to the doubters, is that no progress in human life would ever be made if we never tried because we couldn’t win every time. As someone who’s lived in a family that’s experienced addiction, who’s watched friends bury their children, you won’t win them all. But you can win a luck, and we have to try. Thank you very much.

Dr. Vivek Murthy: (21:57)
Thank you Mr. President.

Mark Kinzly: (22:01)
My name is Mark Kinzly, co-founder of the Texas Overdose Naxolone Initiative, and a board member at the national Harm Reduction Coalition. I relapsed at a reoccurrence of my illness after almost 13 years of abstinence. If you know about this illness at all, a lot of people when they relapse they find themselves a whole lot less tolerant of the street medications, and they find themselves overdosing, and that’s what happened.

Mark Kinzly: (22:33)
The only reason I survived was at that point we had been given naloxone from the Chicago Recovery Alliance. The gentleman that I was using with at his house knew how to administer it. When I woke up that time I had a six year old son, and that’s the first thing I thought of.

Mark Kinzly: (22:52)
I have to tell you most people that I know that have this medication and administer it to someone, it’s been my case and many others that I’ve spoken with, is that when that situation happens and you have practiced with people, when the situation happens, you’re pretty calm. You know what to do, it’s a pretty simple rescue. It’s not pleasant by any means to give it to somebody, but it beats the alternative.

Mark Kinzly: (23:21)
Certainly grateful that we have it available. One of the gifts that when I got out of treatment this past time is myself and a few other people were able to start Texas Overdose Naloxone Initiative, and there’s been a lot of lives saved. With people being trained and having access to this medication, there’s still not enough of it to be out there.

Mark Kinzly: (23:43)
If we want to curb this epidemic, there’s a number of things that we have to do. One of them is to get it out to as many people in the community as we possibly can. And that looks like mass distribution, or benign medication. That’s only good for one thing, and that’s bringing people back from the dead.

President Clinton: (24:07)
As I said when we were talking earlier with Dr. Murthy, this challenge is one that requires all hands on deck. One of the most important partners that we’ve had is, Julie Stampler, a board member for the Harm Reduction Coalition, and naloxone advocate. And someone who is an indispensable force if we’re ever going to turn this thing around. Julie, why have you been so passionate about this for so long?

Julie Stampler: (24:36)
First, I’ll say thank you so much for having me here and giving me a platform, and for all the work the Clinton Foundation has done. Because you’ve been there for years, right along with me. And I come to the work and the passion about the work, partly unwillingly and partly proudly.

Julie Stampler: (24:56)
Proudly because my stepfather, Jack Fishman, is credited with inventing naloxone in the 1960s, so anything that I can do to further his legacy and a chance to talk about him, he passed a few years ago, we miss him greatly. For me to talk about naloxone means I get to talk about him.

Julie Stampler: (25:12)
But I also get to talk about my brother who died of an overdose in 2003. His legacy exists as well. For me, the unwilling part is that I had to come in to do the work because I lost my brother. But I’m proud to do the work because of my stepfather, and naloxone has saved hundreds of thousands of lives across the world, but now we need to do more to make it because we’re losing people here all the time.

President Clinton: (25:37)
You say the mission of your own endeavor is harm reduction. What does that mean?

Julie Stampler: (25:43)
It actually is what it sounds like. It’s harm reduction, reducing harm. We practice harm reduction every day. You get up in the morning, you brush your teeth, you’re using a toothpaste that has fluoride in it, that’s harm reduction. You get in your car, you put your seatbelt on, also harm reduction. You inject drugs and have naloxone nearby, that’s harm reduction.

Julie Stampler: (26:06)
And even in that capacity with substance use, if you are an IV drug user, you’re hopefully going to have access to clean syringes, sterile water, any kind of rig, anything that you need to inject safely so that you’re not getting infected. Anything that we can do to reduce harm for people who use drugs is key. Harm reduction is something that we practice all the time.

President Clinton: (26:31)
What role is reducing stigma have in harm reduction?

Julie Stampler: (26:35)
Stigma is one of the biggest obstacles people who use drugs face on a daily basis. We’re trying to do things by even just simply changing language. Instead of referring to someone as an addict, we say someone who uses drugs, right? It’s people first language. It’s not what they do, it’s who they are, right?

Julie Stampler: (27:01)
It’s simple. It’s very subtle even. But what it does, it actually honors that you are a person. In terms of my history with my brother and his substance use, my brother was a junkie. Right? That was the word that was used. Talking about my brother, who I grew up with, now all of a sudden I’m supposed to call him a junkie? And I did, because that’s what I was told. And as a result of that, I lost years with my brother.

Julie Stampler: (27:29)
He barely met my children, right? It’s devastating to consider what we think is simple stigma could do. Because of the stigma attached to substance use, I lost him, before I actually lost him. Stigma plays a big part in preventing people who use drugs from getting the help that they need.

Julie Stampler: (27:50)
A lot of the conversations that happen now, we heard for years about the war on drugs and now we know it was the wrong way to try to help the situation. We could go back to the commercial, are you cracking the egg in the frying pan? This is your brain, is your brain on drugs.

Recorded: (28:08)
This is drugs. This is your brain on drugs. Any questions?

Julie Stampler: (28:19)
We became less credible because of it, because it wasn’t true in the sense that when we tell our children, “Marijuana will kill you.” They look at us like we’re crazy because we’re not telling them the truth. We need to do more to tell the truth.

Julie Stampler: (28:39)
I’ve said this before and I don’t know it may be, it’s controversial. The reason we’re having this conversation, you and I right now, is because more white people are dying, right?

President Clinton: (28:52)
Absolutely.

Julie Stampler: (28:52)
This epidemic has impacted black and brown people in ways that we can’t even fathom. And we kind of, not that we ignore it, but we just kind of say, “Oh well, it wasn’t an issue then, but now it’s an issue because all these white teenagers are overdosing. We need to recognize that that’s a big component of the stigma for sure.

Julie Stampler: (29:16)
One of our biggest obstacles and I’ve said this before, evolution is tremendous, right? I came a long way from thinking my brother was a junkie, to now realizing no, he was a person who had some serious issues and they were compounded by his substance use.

Julie Stampler: (29:36)
You sir, have come a tremendous way, and I applaud the effort and the willingness for you to come to the place where you’re at now to try to help.

President Clinton: (29:48)
I read a study sometime in the last year that said most people who die of overdoses are in effect, not alone. There’s somebody in the room with them or somebody in the next room, or somebody in the house. Or if they’re outside within 20 feet of them, almost half. Which means that given the scale of this opioid epidemic, it would be better if in almost every social setting or work setting, somebody had naloxone.

President Clinton: (30:16)
What do you think we could do to change the willingness of people to tote that around everywhere? Because the more people who have it in their pocket, the better off we are.

Julie Stampler: (30:28)
Absolutely. The last time you and I had a conversation, I brought you an overdose prevention kit. And one of the things that I’ve shown people, because if you’ve seen the Narcan that’s out now, it’s a teeny tiny little box. I mean, it’s like a box of Altoids or Tic Tacs, the breath mints that you’re going to keep in your bag.

Julie Stampler: (30:47)
I joke, but I mean it sincerely, if I’m going out for an evening and I have my little evening bag, I take a dose with me and it’s in my bag because you never know where you’re going to possibly encounter someone. The opportunity to give someone naloxone who might actually have access to someone who needs it is important.

Julie Stampler: (31:08)
And I think we should be doing something about making sure restaurants have it. You know, any place where there is a single use bathroom is a risk because that’s where someone might go to use drugs. We’re now training librarians, because a lot of overdoses are happening in libraries. It’s important.

President Clinton: (31:27)
Really.

Julie Stampler: (31:27)
Oh yes. Because there’s always little corners and there are single use bathrooms. Yes, now we’ve got to do a whole lot to get it out there. I mean, I’ve friend who owns a restaurant and I was like, let me give you a kit so you can keep it behind the bar.

Julie Stampler: (31:42)
I know Clinton Foundation, along with Emergent BioSolutions, the company that produces Narcan, making it available for schools, universities, colleges. But maybe there should be an effort for the Starbucks location on the corner of whatever, that the owner can write in and get a kit. The conversations that I have had with people over the years who wish they had had it, that’s what’s sad.

President Clinton: (32:10)
What have you told your children about opioids, and how do you deal with it?

Julie Stampler: (32:15)
I am blessed three times over, I have three incredible boys. A 19 year old, a 16 year old and a 12 year old. For me, I think about the loss of my brother, and them not getting to know their uncle who was super cool and funny, and a great singer and a guitar player. My youngest reminds me so much of my brother sometimes that it’s heartbreaking.

Julie Stampler: (33:48)
But, when I think about my brother’s death, I think if it’s going to do anything, it’s going to help save my children. Because we talk about uncle Jonathan, and why he’s not here. And a lot of that has an impact on them. When we’ve had conversations about, “When you go out into the world and you may experiment with substances, your body chemistry will likely react differently than somebody else’s, because you have addiction around you.”

Julie Stampler: (33:13)
Both sides of the families have struggles with addiction. You have to be prepared for that. I know I have conversations with my boys that a lot of parents aren’t capable of having, aren’t willing to have. That to me is the most important, right? Because they’re the ones who were looking out for, it’s their future.

Julie Stampler: (33:31)
We have to have these conversations with them. That I have a friend who shared with me that her 16 year old son was at a party, and there were children snorting heroin. 16, and there was no naloxone? I want to strangle somebody, because that’s an easy fix.

Julie Stampler: (33:48)
I said to her, “Let me give you a kit. He could put it in his pocket, it is small enough no one will know.” And of course, the immediate response is, “Well, he would never do that.” And it’s the same message I give to my children, “You’re going out to a party,” my older ones, “Take naloxone with you. Not for you, for someone else, just in case.”

Julie Stampler: (34:09)
We have to talk to our children. We have talk to the parents of children. We need to get in there, we need to have real conversations because now we see. When I do a training, I tell people, the first thing I say is, “You’re going to all walk out of here superheroes, because you’re going to be able to save a life.”

President Clinton: (34:24)
If anybody’s listening to me, you should think about how much naloxone is in your community and who’s got it. And realize that most of you with health insurance, particularly if you live in open prescription cities could get it with a very small copay. And just remember you never know when you’re going to need it. Thank you.

Julie Stampler: (34:43)
Thank you.

President Clinton: (34:46)
Thanks for listening. For more, listen on Apple podcasts, or wherever you listen to podcasts.

Megan Affrunti: (34:52)
Hi, I’m Megan Affrunti. Here at the Clinton Foundation, I’m part of the team that’s helping to combat the opioid epidemic together with our partners we’re expanding access to naloxone, the lifesaving medicine that can reverse the effects of an opioid overdose, and engaging community leaders to help us combat the opioid epidemic.

Megan Affrunti: (35:09)
Thanks for listening to, Why Am I Telling You This? To learn more about how we’re helping people across America and around the world, head to clintonfoundation.org/podcast.