The Teen Brain and Risk Taking with Dr Ruth Potee

everybody because it’s hard I know everybody’s other things everybody really needs to be doing I there’s no doubt there’s laundering and homework and I love that the fact they’re students here I appreciate you guys being here so if anybody wants these slides I’m going to look at the dogma and say that everybody wants these slides showing here maybe we can have a sign-up email shoot Lee the outdoor where we can email up the people cuz I don’t care who takes these slides I don’t care how you use them although maybe if you care to use them it’s a crazy way so but it’s also a YouTube video there’s a little reefer that is similar to this that covers about 80% of it oh I’m going to talk too fast I’m happy to answer questions if someone is a little easier for you to catch all the questions at the end but if there’s something worried if they go oh man I have no idea just I’m just picking out the right thing and you keep with the flow so we’re going to talk about the physiology of addiction how it is that this part of the brain breaks down and I’m going with this is relatively new news this is what you see on the screen is an article from science magazine in 1997 or so I’m not that old in 1997 I was in medical school and it was being used at the time or the brainy disease and the truth is that I would argue that most people in medicine know very little about addiction do I have clinicians in the room nurses nurse practitioners pas positions I don’t know how much you guys learned about addiction during medical school residency lots I mean if you’re a psychiatrist or an addiction psychiatrist maybe but for most people we learned almost nothing about this and here’s a disease that affects 10% of Americans more than diabetes right about a bunch of diseases I’ve never seen as a doctor because that’s what you learn about Memphis will you learn about wild Eagles this is a very common illness that affects a lot of people and most of us are not equipped to take care of it a digit affects the reward center of the brain is very central elemental part of the brain that has three components the ventral tegmental area the nucleus accumbens and the prefrontal cortex this is considered the most ancient part of the brain it is the part of the brain that tells you to get up every morning find food find clean water and survive because at the point of all of us being on this planet is to survive long enough that you can pass through genetic material form that is true for every mammal like we may think we have another point on this planet but we really don’t right your ancestors did a good job with survival that’s why you’re here there’s a bunch of bodies not here because they weren’t so good at this so this is the most elemental part of the brain I think if it is the lizard brain because every living being is working on this stuff okay I survived long enough to spread my genetic material forward we’re going to spend no time talking about serotonin which governs mood and cognition and sleep we’re going to spend all of our time talking about dopamine dopamine is the neurotransmitter that gives you a sense of euphoria and reward and joy it says what you just did was really great let’s but going it has two very strong behaviors associated with it compulsiveness and perseveration and i want you to stop and think about those two behaviors incredibly helpful when it comes to surviving right a thousand years ago 200 years ago you needed to be compulsive about finding a good safe food and water right you need to curse separate about finding a mate right every night is the last thing you thought of before you might be dead the first thing you thought of when we woke up in the morning right that’s the way it’s supposed to be your ancestors were good at those behaviors apply those two behaviors to addiction they’re not so helpful the problem is part of the definition of addiction of those two behaviors and if we could pick this illness up out of this part of the brain and move it anywhere else in the day the visual cortex a hearing system and if you have an addiction we just lost our peripheral vision or something boy it would be a much easier to take care of and instead the part of the brain of impacts is this thing that is so deeply elemental to who we are through these so some of us on this planet have naturally high a built-in crevice and there’s no real way to measure this is no blood test that gets you your dopamine levels but if all of us on average are sitting in a dopamine level of 100 some of us are happy-go-lucky glass-half-full kind of folks and we maybe have dopamine levels of 105 or 106 that’s just luck sometimes genetics sometimes it’s epigenetics socialization but that’s one of there’s some of us in it don’t look that good

though skipping slide sir and we are sort of what I think of as the the Eeyore’s of slightly design make enough never goes well there there really glass half empty kind of people and I think people would say maybe their dopamine levels at the baseline alone they’re 85 and 90 most days they don’t feel just great so when you find evolutionarily speaking and a hundred years ago and a thousand years ago when you find that perfect strawberry on a June day and you’ve been starving all the way to waiting to find some fiber and some vitamin C so that you could actually improve your nutrition you find that the perfect tree in strawberry your dopamine levels will spike to a hundred and fifty because if you need to you need a little reward spice and you will return to this very healthful food that your body’s demanded if you have sex it’s consensual you have an orgasm your dopamine levels will spike to to limited it is meant it to be this way these are things we want to return to he used cocaine your dopamine levels will spike to 350 if you use any prescription opiate or heroin or dopamine illness has spiked between 500 and 900 and if you use crystal methamphetamine your dopamine levels will go between 12 and 13 hundred so those are some lovely dopant levels right and the question is why aren’t we doing that then like why is it everybody waking up every day and crystal meth because that right so I’m not going to make everybody answer but I think people might know the answer he answers not because it’s indeed there is maybe some of our answer but there’s a reason why we don’t do this so there’s three things that cover the dopamine in our body there’s the amount produced there’s the number of receptors on the other side receiving the dopamine messaging and is the number of reuptake switch is a little vacuums like suck totally out of synaptic cleft and you can impact any one of those three things to increase it or decrease it and I’m going to show you two fast strokes and just walk you through how they work of the way that cocaine works is it turns off the real taste so it turns off the vacuum so there’s nothing sucking the dopamine out of the synaptic cleft and that’s how you get yourself to a 350 the way that heroin works are all opiates work is it’s a little more complicated because it goes from you opiate receptor and then there’s a negative feedback loop that goes through gaba but at the end of the day it pops more dopamine out so i said there were three things i covered two throats and at impact two of them but we could do this with any addictive substances and we can do this with any addictive behavior some of the pathways somebody actually took the calculator a video game addiction i was like i have absolutely no idea because some of the stuff we don’t really know all the different places where it contracts in the brain and how it goes through at the end of the day almost always impulsive dopamine spike so way the brain sees this though if it’s evolutionarily speaking we have been in this form on this planet for 200,000 years the brain is Lily the adobo meat of 150 or 200 but when it starts to see levels of 350 509 at 1200 those are big numbers McGrady says holy smokes there’s something wrong here this is really – Wow there’s too much dopamine we did it down regulate we need to turn down the volume and the brains natural response to this is to stop making dopamine to care the reader for receptors receiving the information on the other side and increase the number of a key sucking the dopamine out of the synaptic cleft that’s what the brain does because it naturally it says something’s wrong I need to fix this so this down-regulation said is my baseline because I’m a happy person 105 I have that perfect strawberry or I have an orgasm my face run returns 200 afterwards with addiction that first time you have that dopamine of 900 you’ll never get a dopamine 900 again maybe you’ll get an 890 or maybe 70 it starts to descend but over time you never return to your baseline normal we never get back to it 8500 and in fact their new dopamine set level is 40 or 45 and I can tell me that it is hard to get out of bed it is hard to go to work it’s hard to pour a bowl of cereal or do anything positive in your life when they’re baseline dopamine is no 40 or 55 and I’m not talking about chasing a drug sickness or withdrawal people are desperate to feel normal again and that continued use has to do it oh my gosh I would do anything to have a day where I sat at 85 85 was awesome compared to this pit where I live so the reason why most of us in this room are not actively using crystal meth every day is not because we could explain this ahead of time but because really none of us want to go there

if everybody knew where they would end up I think most people would eat up there right but it’s not that simple I’m sorry I keep trying around it’s a question of how good my point is I don’t want to look the head that I have no idea really what’s behind me so it leads to why I think there was a broken brain right here we have this most fundamental part of the brain that’s no longer working in a normal way and one of the reasons I usually this slide is it helps remind me to say to you that things that break often get better right things heal and if I don’t actually cover it let’s talk at the end about what makes total me get better again okay because we want to talk about that so let’s talk about another disease let’s go let’s wait through how diabetes works so a nice form of health and body as a pancreas that makes insulin insulin attaches to an insulin receptor on a cell when that receptor is activated glucose gets sucked into the cell that’s what my body does I don’t have diabetes type 1 diabetes the pancreas is not functioning producing enough insulin consequently there’s nothing attached to the receptor and it’s nothing big except in type 2 diabetes the pancreas and general is working pretty well it’s usually enough insulin up until the very end it’s the receptor that’s broken and it has the same impact there’s no glucose that’s getting accepted to a cell the reason I make a point of this is that I just want to remind everybody that actually most every disease in your body has to do with an interruption in the transmission or the messaging system right we can do the same kind of slide for the way with cardiovascular disease plaques get lay down right because it’s interruption of destruction and the message systems there’s you know more or less of these very complicated cardiology enzymes that create these problems with the exception of infectious disease everything looks okay so what people arguing with me that this is not a real disease this is just people being weak-willed or they should pull themselves up by their bootstraps and get some religion and bad genetics whatever it is that people push back on me I think to myself you know I had an organ in my body my brain it’s really the most complicated organ and it again it breaks and gets better in the same ways that every other organ in our body does and my point is is that I like to remind people that most diseases look like this a breakdown or messaging system so on on the right side there’s a healthy brain and everything that you’re going to see an orange or bright yellow is helpful dopamine it is just just to remind you that it’s not me showing this stuff making it up late one night but when you look at PET scans of healthy brains versus brains of addiction you see in people who are addicted to any any drug in this picture that dopamine levels are close to zero when you go drug by drug that middle column is a control or normal columns you see lots of orange as you go down that far column to the right of people with an addiction that first drug is cocaine the next one down is meth the third one down is alcohol and the final one is heroin and I guess one of the things I like about the slightest I want you to notice that alcohol and that person addicted to alcohol is still a lot of orange there and it’s one of the reason why alcoholics and there’s a lot of us who struggle with alcohol in this country it’s one of those very quiet addictions that doesn’t enough of the public forum but a lot of us who struggle with alcohol the wheels fall off the bus fairly late we’re fairly functional alcoholics you’re still showing up at work you’re still taking care of the kids you may pass out drunk on the couch every night at 9:00 but you’re still getting by right you’re not necessarily robbing thanks for it so because it interacts with the gap assist with enough directly with dopamine people can last a longer time with alcoholism and they never walk into my office saying they need help right it’s a hard thing that she’s fine to people who are struggling with alcoholism there’s three things that predispose you to addiction not all of us get addicted I said to you 10% of eleven percent of us who struggle with addiction unites us eighty-nine percent of us won’t because who how do you know we don’t always know right sometimes there is randomness that happens but any general these are things that we can say the three things that will predispose you to have a good disease of addiction the first one is genetics a genetic predisposition which means parents or grandparents not second cousins that’s not closing right second one is early use or explosion and the final one is a history of phenomenal and some of my slides I actually then have a picture that talks about mental health because these three things actually interact with the level of mental health disorders a mood disorder depression anxiety which can also be a component of it so let’s talk about the genetic partner 50% of addiction is genetic in nature which one said one of your parents has an addiction you have a 50% chance of having to have an addiction to engineering part and medicine to find any disease that was back genetic it really does I mean people are walking around office and say I want to cancer my family and internally I actually do a little I roll where I think most cancer

is not genetic right very environmental tobacco is the number one cause of cancer right it isn’t what could happen to your mother the level of genetics of breast cancer is actually surprisingly small most prospectors arrived to novo with very original crease position there are very few diseases that having this kind of genetics ATD of has this kind of genetics in fact we often think that ATT maybe 70% and for those of us who are teachers or parents or have 80-82 yourselves you sort of look around a family tree and there’s not one person in that family I never get any head nods in this row but people don’t want to talk about right okay so profoundly genetically you know who needs to know about those genetics our kids need to know about their genetics am I telling most kids don’t know not an addiction they’ll come in I’ll see you twelve-year-old in my office and they’ll talk about cancers and other things I know because I often as a family doctor I take care of multiple generations of the family I know a lot of the stories and the kids often know – quite honestly they know that you know dad’s in jail because he is struggling with an alcohol use disorder and I talked to the parents about the fact that you know what your 12 year old needs to hear you say that right not because it’s a setup for them or not my poster is sharing private family information it is a disease it has a lot of genetic predisposition they could control that car that is just the part that gets assigned to them that they can make better decisions about postponing use in order to decrease risk for themselves so I’m a big fan of talking to your kids about a genetic risk in their family and I sat down with my kid and Dennis right now by going through everybody’s throughout the entire treatment of I should let them know about their parents of their grandparents and where they’re at risk okay early do early uses and the district attorney to cover this in a nice way but this is something that I mean would say the average pediatrician and the average family doctor people who take care of kids in the developmental stage does not know if you look at the top of this addiction is an adolescent or is a pediatric developmental disease every addiction starts during the time when the brains and development and any addiction now I’m not saying that 12 year olds of shooting heroin I’m saying that when you talk to somebody who’s really struggling with addiction you ask the question when did you start what was your drug and when did you start the easy ones of the answer is normal marijuana alcohol or tobacco and how old were you and most often the answers are I was 12 13 to 14 you know yesterday I got an 8 when I came to this talking in jail so I have 120 guys were incarcerated for their disease of addiction I asked that question you know I throw out the easies and I said who was 12 everything is in the air at 12 everything but then I start trying to get pregnant I’m kind of curious right how low does it go and I started having down 11 10 9 8 pants are dropping but there’s a lot I can do they gave me a very 87 6 when my heart breaks every number I drop down right because it makes me feel sick but I still put hands in the air at the age of 6 years old that’s a first grader and if you can imagine in your head what your first fingers look like the notion of lighting a match or stealing a cigarette or drinking alcohol but everybody starts at some point during the development training period of time in fact very good studies that specifically look at tobacco that say if you have not smoked your first cigarette by the time your for 25 26 you will never solve a cigarette right and in fact I stand here and saying it always makes you a little nervous but I always do it but that you won’t develop the disease of addiction if you haven’t started something before the age of 24 it is critical that it happens in the developing brain because if the substances that help it go off huh and we’re going to start diving in and a couple slides on sort of why this happened specifically okay so similar topic if you are 50 years old and you start drinking and drinking here is defined as tooth roots a week so that’s not a lot it’s a lot with 50 here only two decks a week starting at the age of 50 almost 40% of those kids go on to alcoholism the disease of alcohol use disorder if you wait until you’re age twenty-one seven percent when we do this overlaid on top of genetics so you take the same data and you apply whether there’s a family there’s new genetics if you can postpone use to the age of 21 it’s like the genetics get canceled out so when I say talk to your kids it’s because this is the thing they get to determine if I knew one of my parents really struggle with addiction and then I really needed to be one of those people that did you start drinking at 15 or 17 that I need to be one of those people who really has my first interaction of alcohol at 20 or 21 I actually took a lot of students who try

to make that decision they would be armed with that information because right now they know nothing and that’s that’s why I think I’ve showed this slide but this is the one that overlays the green line is it having a stronger corrective history the red line is just early use and what you see is over time those numbers start to join together right they all become low better this way so yes to a certain extent yes right because if you have aunts and uncles that you’d likely have grandparents is what I would say to you on that front if you have just one uncle anybody else not so much then I would say maybe not so but it is the case that in some no we all have these families I have families right siblings who struggle and siblings who taunted in family trees that look that way so my point meaning that if there’s a couple oxen uncles in a grandparent than I would say you guys if you’re dealing with some generations okay but if you’re talking one black sheep on everybody else’s hood then maybe not last one e to the road on your ten at the table right maybe the dictionary to Europe are not lower than ours they are not in fact the addiction rates to alcoholism in York are higher in many countries they do not have the current heroin problem that we have partly to say their reliance on prescription opiates is really low so these photos are opiate pills in the young brain or in the 20s it doesn’t happen as often but the addiction rates are just as high in to some hunch is higher so there is a study that looks at what happens have your kids drink under your roof because you’re the kind of parent thanks you know what I think it’s a great idea to actually have the kids drink what I can supervise it I don’t want them going out and riding on the road on a Friday night after homecoming I’m gonna keep them in my face I’m gonna fight whoever all the friends over right which once it’s against the law we all know that in this room but people I think are actually doing because they think it’s a good idea they actually make this benefit and there’s some benefit not having kids who are drinking on the road I don’t disagree with that right but what they do study they look at the brains of these people who’ve been exposed to alcohol the young age and what they have is a strong association between safety love of everything’s going well in my life and alcohol are connected and that’s actually not a good relationship because it was this very strong association between alcohol stating good in love I mean that kid goes off to the first frat party and for as freshmen I tell you they’re not a Hollywood friend right there’s somebody at whisper getting hauled up the back stairs in a fire so Nora Volkow I’m going to talk a little bit about her but she J had a night off she does she runs those studies looking at what it feels like to be drinking in the presence of your parents and then telling you it’s all fine is not beneficial is it anymore I’m so sorry I’m not going to make it otherwise I think so the thermo one drug of abuse in our community and this is nationwide but it’s true or not the minister here in Northampton I think it’s truly every time I know if it’s marijuana does that surprise everybody know the number – this is illicit drugs so this is not alcohol Tobacco earth earth are illegal marijuana is not jumping people the second one is stimulants and one of the I’m gonna dive in a little bit on marijuana because I think I would say a disconnect between the perception of marijuana and that a lot of adolescents have and what we think of as good research on it if they’re very of they’re a contradiction to each other and as the sense of harm has gone down with marijuana use use has gone up that happens all the time as soon as risk perceived risk goes down you just goes up it and so what you see you see nothing limits like what you see is that as the sense of harm of cigarettes has gone up cigarettes have gone down but the reverse is true for marijuana so this is the way the brain works and again anybody who watch these slides I think that she must have a sign-up sheet somewhere maybe it’s outside but if you look at the development of the brain few guys remember for those of you who are moms or dads who saw your first prenatal ultrasound and you looked at that it’s giant head inside you they thought oh my god one how is that heading out but to my massive hit because the volume of your baby’s brain is done the age of one that’s are basically your head size your brain is as big as it’s going to be so there’s things that happen earlier brain

development and there’s things that happen later and very recently in the last 25 years we move said brain development stops at the age of 12 we are very clear that brain development is not stop with the age of 12 in fact really critical things happen between the ages of 12 and 24 and that’s the answer to anybody who in the room as a student gets asked that question why does your brain done cooking it’s like 23 24 25 it’s it’s actually actually after you’re out of college so there’s three steps that happen in this this time period of adolescence and we’re going to cover some of those you can see them on this track these critical things that happen there so the grade of the average maybe twelve-year-old this is a participant representation on the left has a lot of extra turns and there are tens of billions of neurons in the brain nobody needs that many and one of the most important things that happens during adolescence is you prune the brain you start snipping back pathways that are no longer necessary this is critical and this is why our amazing teenagers push the envelope love sensation and level of physical movement and sometimes do things that you think are absolutely crazy they are exploring the world because their brains job is to figure out what does it want to keep and what does it need to get rid of it right their friends are dysfunctional they have nice normal one thing right they didn’t make me crazy they make it crazy is that huge wide range of emotion I’m the night a 14 year old who is the sweetest kid on earth and she is crazy in the same minute she’s like this right but that’s the way that teenage brains supposed to work because it is trying to sort out what needs to stay or what needs to go so that first thing that it does is synaptic refinement which I confirm is accruing so it has to get rid of about half of its connections the other thing it does is it in mine eliminates or it sheets the framing so it makes fast pathways because nation it’s like installation right it makes pathways ever moving quickly and in terms of braid that turns our brain looking like this that it could have looked like this so it’s trying to make more order of a brain that has too many neurons is not particularly ordered so I’m going to talk a little bit about marijuana because I think a lot of us don’t have great understanding and there is a good talk by a really well-known researcher at Children’s Hospital it’s next Wednesday night and now people know about that and I’m looking around at Paul dr. Susan Anderson from Children’s Hospital was speaking at Valhalla next Wednesday the 30th and I know what time it is said there okay she said I never heard her speak I just actually came back from the children’s talk on marijuana she’s supposed to be really good I think that those of you who are curious about this stuff are figuring out where you’re going to go with this ballot measure that likely will be voting on I hope you would attend that talk so one of the things I’m going to say is that the THC which is the cannabinoid that were most familiar with from marijuana the reason it has such an impact on the brain is it looks exactly the same is something called unanimity this is the natural normal endocannabinoids in a break right marijuana works in the brain as we have this receptor that is supposed to click to accept what really clips to this thing is a nice normal naturally of appearing an endocannabinoid called ananda me okay so oh I’m sorry all those purple spots are migrating are places where an androgen receptors exist so that’s a lot when you look at that perfect spots on the brain it’s the entire cortex right the cortex that outer part of the brain the slow reason but you rates on that is the part of the brain that develops last right that’s the part of the brain that our kids are making right now are 1224 of building that part and that’s where all of those some Android receptors go you see there’s only one part of the brain they don’t go they don’t go to the brain stem which is why people don’t overdose from marijuana because the brain stem is where the respiratory Center is but everywhere else boy there’s a lot of places with is really critical and no cannabinoid attached so the problem is is that THC each comes to marijuana is much more powerful than our naturally-occurring ones and it takes the place of the natural in it and and abides in the brain and it’s adapt so it has this enormous ability to really impact what the brain is doing and specifically what of this neuron naturally-occurring neurotransmitter does is it makes the decision about what gets to go and what stays it makes decisions about synaptic refining or the pruning and it makes the decisions about what gets myelinated what pathways get insulated so for those people who think that marijuana is a benign throat that is not as bad as alcohol that is naturally occurring and it’s fun which is what every teenager says to me in my office I don’t know arguing with you that I

actually don’t care what an adult does with marijuana as long as they don’t get behind a wheel of a car and actually impact anybody else’s life but I tremendously care what happens to a developing brain with marijuana because it has an enormous impact and more and more data is coming out on this and I feel like our level of knowledge of the community about the developing brain of marijuana is very low so do we do great spending to this country on marijuana no we don’t and why is that because you don’t get federal funding to study illegal drugs right that’s part of the problem and that to run a big study you need millions about so the data to this country of marijuana it states in fact if you really want on a study this country you could use some pot that’s grown in some field a federal field at Alabama that is not remotely similar to what’s actually being used at Pioneer high school right now so it’s not a new school study so most of the good studies actually come out of New Zealand in and out of Australia this is the best-known newzealand study is known as the Dunedin study and what it did is it followed people from teenagehood all the way up to the age of 35 and it followed people who started using marijuana at a young age and it looked at them 25 years later and what this is maybe show the attention showed a lot of different things but the fast one is that there was an eight point drop in IQ and a real slowing and cognition and an overall sense of my life is not going well between those two so again a study that was considered very well done that was an early exposure and what does to the brain this is the New Zealand study that is a totally distinct from this looked at just high school graduation rates for people using marijuana at the age of 13 14 and 15 and then the second one was University injuring scores for your University scores and you can see there’s a difference between these two things this is not good for cognition it’s not good for memory something for performance I had never been be promoting marijuana use in a teenager right if they have cancer and they’re dying of course right palliative care that really makes a difference of course but I think as we all know when marijuana is available in our community whether it is legal the legal and medical dispensary teenagers get it so the other thing I would say about marijuana is that whatever was being used in the 60s 70s and 80s is not today’s marijuana when you look at the THC content they’re really psychoactive substance content of today’s marijuana it is often four or five or six times more concentrated than it it used to be so on average most THC is running between 90% and 17% in most plants it used to work between 1 and 3% so even those studies that I showed you out of New Zealand in Australia went based on marijuana that was 1 to 3 percent THC I don’t know what the heck that the studies show it’s 16% who knows right but I can tell you it doesn’t feel good and the other thing I’m going to say this is to be adults in the room if I show these pictures to be I was drugged they’re like that’s marijuana like I don’t see a nice big fat growing up here what is this stuff right this is today’s marijuana teas and the concentration of these things ranged is tremendously but some of this and in fact that product in the bottom middle which some people call it ear wax because it sort of looks like that in this hash oil that gets dad the verb is dab that is that range between 70 and 80 percent THC this is the stuff where you take the actual print and before skew chain through it and this is what’s true left with is this incredibly intense product this is the stuff that explodes houses we had a not so far away house explode that was doing this the burn units in Colorado are filled with try to produce this product when you go into the medical marijuana dispensaries and the dispensaries in general Colorado people been through these okay anybody taking a trip to Colorado is it a worthwhile venture just to look it’s pretty interesting field trip okay um so you can tell what do we have we have no tell you have pop-tarts we have a honey pot of tea we have that the nerve of Nestle Crunch over there gummy bears edibles right edibles that are made with hash oil that have between 50 and 70 percent THC are being sold out I can tell you if you have HIV and AIDS cachexia are just no longer able to eat and your body’s way swimming away I guarantee you you are not popping other bears right this stuff is made and marketed to our children and we used to say that nobody has ever died of marijuana they actually used to almost be true but it’s no longer true thanks to Colorado because kids get their hands on this stuff and Here I am saying to you that you know you won’t die of a respiratory failure for marijuana but when there are five year-olds and seven now and you ingest some of these things it kills you

so we have at least two pediatric deaths of marijuana in Colorado for marijuana and again this is an industry that exists to make money there’s a great article that I asked to put up and I’m going to talk about for a second this is a workaround and I can’t remember your answers are wait again it posted somewhere okay so it’s on a Facebook page to do an internal article and I know it’s not subscription I found I found this art was so convincing what this house was about is where Big Tobacco became big marijuana so let’s talk about tobacco for a second okay so geneco is it addictive is it little later a lot a lot in fact in terms of substance is the most addictive subtypes of sugar right 94% of rats go addicted to sugar within like two days but next is nicotine nicotine is really the most addictive substance out there but her used to be that way and the eighteen hundreds like nobody smoked I mean given Native Americans like this is a native plant nobody used this stuff it wasn’t particularly addictive right but by 1950 half of this country was using cigarettes and why was that big tobacco because they intensified it they added 300 different chemicals to it they had a delivery system that drive it into this delicious cake tissue called your lungs and then dispensed it throughout her body rapidly right they were able to change the drug itself by making it more addictive right they she needs the quality of the product and they change the delivery system if you remember what I just showed you I just showed you marijuana that’s been changed in the product is the change of the delivery system and you know if we don’t know that in time and say wow legalizing tobacco was a bad idea I would argue that in the next 20 or 30 years were look back at this time in history and thinking what’s is really a good idea that haven’t yet another psychoactive substance available to our kids was that a really good thing that I voted yes to make marijuana legal I would argue strongly not this is an awesome ring so go to the Northampton Prevention Coalition Facebook page I sent them a PDF because I thought this read is so impressive when you look at what happened in Colorado I could spend all night talking about Colorado but that in City and Denver that’s the highest rate of teen marijuana use for the country right it really is the Mile High City it did not used to be this way but put dispensaries everywhere we can’t buy as a team you can’t divert out of those places all the time and for all the teenagers have entered into treatment in Denver Colorado they said they got a medical marijuana that had been diverted and had used it at least 50 times and that’s a worry for me in a town like Northampton right because I’ve been to your medical dispensary and it’s love and you cannot walk in there without an ID and your certificate it is a tight place but the minute you walk out of there with your product you can give it depending but if you want so I can tell you there’s stuff getting diverted out of your benefit this country and it will be diverted out of my medical dispensary and it ends up in the teenage brain if I can guarantee that no teenager get to the stuff on the brain development I pin but I know it doesn’t work that way okay you know what here’s a good news cigarettes cigarettes are way down with all those cigarettes if you never have lower smoking tobacco ever in the history 5.3 percent of college of high school seniors are smoking cigarettes what’s gone up though is e cigarettes did you guys have like a bake shop or head shop tobacco I know what you call it right you guys have one in town is that anybody ever talked about you been working with tips I go in these places all the time oops um isn’t that correct so what we know is when we look at the national data the 2015 that data uh exposure to nicotine cigarette smoking in the paper packets one way down but the number of our kids who are vapor from using e-cigarettes is way up and what do we think about that is that fine no big deal right because even though most of these teenagers say we’re just baking the flavored ones we’re just using watermelon bubblegum flavored today the truth is there’s no there’s no regulation of this industry right there’s no food regular ministration regulation so these products could have anything in them included picketing and we do not know and when it is this market gets shut down we’re left with a category a generation of kids who action now have a nicotine addiction which is the last thing we wanted first at the last 30 years on the public health mission to get rid of tobacco and we’re left this is that how did this happen I’ve been to schools and it eastward as many as 60 percent of high school seniors are routinely vaping at school and it’s undetectable right because it has no odor right you can fake anything you can in my high school

where my kids go to school pioneer I’m the school doctor so I always find things out but they’re leaving hemp oil right like first of all with their baking some oil into their lungs that can’t be good we see we see radiographic images that later it looks terrible but they’re doing it because they’re desperate to do anything to try to think these are not good products either should all of them are off the market they do not really help people stop smoking they maybe do some smoking but not a lot you have a question yeah so caffeine does anybody Kathleen’s addicted okay it is addictive right it needs the standard of addiction are you gonna rob a bank for your cup of coffee tomorrow Oh doesn’t have an adverse effect so we’ve done lots of studies on caffeine and interestingly it not only does not have an adverse effect on the grade but drinking five eight ounce cups of coffee a day is actually beneficial to long-term immortality you get extra years on your life I haven’t said that I know it seems crazy but caffeine addiction seems to have some health benefits it’s easy to go over writing there’s not there’s a tipping point where you get too much and we all know of people Dunkin Donuts cups look languages I’ve got these eight ounces whatever a normal sized love used to be but so there’s health benefits but it is addictive truly we crave it it often is the last thing I think of before I go to bed so I got some perseveration it’s a compulsive behavior and people can have continued use despite our minute the the thing I think about that is pregnancy so you get pregnant you’re like oh okay so and then whoever’s taking care of you says caffeine used to go to eight ounces or less instantly you’re like what right I just cities I don’t have my Dunkin Donuts much talking on their counter and I’m like that’s it you’re down to nothing is very hard for pregnant women and I can speak for myself on this one to bring it rapidly down so you know this continued use despite much I guess addictive but not bad health consequences unless you have unless that makes you sick if you do tachycardia lets you the 8-bit I mean all of us of individual differences okay so I’m gonna talk to the parents in this room so we as parents have a huge impact of whether to see and think them do and I’m going to specifically talk about alcohol here one third of us in this country 0-9 and I asked this question of almost every patient I see what’s your relationship with alcohol and when they say I would cook it off I used to go right your honor cuz I’m like oh my god I’m running behind like 12 more patients but now I say tell me why you don’t drink because there’s often a story there and sometimes they say I already love to taste one but sometimes I’ll say I don’t drink because I’m an alcoholic and I haven’t going to drink for 30 years and I think duh I need to know that nobody’s ever told me that or let’s say my mom was it rock down drunk and I don’t want to turn out like her that’s really helpful information for them for me it just acknowledges something about the genetics that I didn’t know right so I don’t escape over that question of the middle third of us drink a little bit one to two drinks a month what people will say serve a life social drinker and the final one third of us in this room who called us to be alcohol and in fact the final 10% of us drink on average eight to ten drinks a day now there you go am i oh my god it’s people like that’s not possible yeah because this is what it takes to get you through it’s one beer it is five ounces of wine or it’s one and a half ounces of hard liquor so when I ask this question and I do it really routinely than almost everybody watch the arch woman so what’s your list with alcohol I have a couple glasses of wine at night now I call you how much is in your wine glass oh I don’t know you know in the normal one of us so I want to be clear that normal wine glasses are not five ounces right your grandmother’s very old wedding set that nobody uses anymore identify that’s one plus people drink which I thought about some point they have those mason jars on the stem right your noses there’s no more autonomy market for women these days for alcohol look at these bottles of wine I could put hundreds of pictures on this one women and I’m going to amend them to be a father or offended by what I’m about to say women work really hard a lot of us work jobs we get up at 5:00 we start the winery this week before we get the dog up we go to work I come home every day and I’m like are you kidding me I didn’t work all day and the house is a mess in the kitchen the breakfast dishes could get put away nobody had to the dishwasher and it looks good been like watching TV instead of doing their homework and I have eight more hours of work and it’s response to this is glug glug glug glug and I can’t tell you now how often I am diagnosed in an alcohol use disorder in women age 25 35 42 professional women just like me who’ve developed a really unhealthy relationship about the home in fact the ratios that you should get denied until migration between men and women with alcohol use disorder now it’s 3 to 7 and this happened in the last 20 years this is a rapid shift that we’re seeing I mean I’m talking you know how many thousands of years have we had up off a long time so this is a rapid shift

that’s happening and it’s because it’s being marketed to women there’s a sense that it’s fine but I can tell you talk about the message that goes home to your kids when you walk in the door and you’re mad and you had a terminate working or yelling at them and they see a global ability right they say that the way you manage your stress and you’re busy in your an eagerness to training’s a lot of us do this behavior and I just want all of us to pause and ask yourself about your personal relationship with alcohol whether this your kids see I speak as a physician physician to have a really high rate of addiction because lives could be stressful or feel out of control it’s a lot of self medication but I have to imagine walking in the door I had a terrible day today just I’m almost tears we go walk the dog with me I hate my boss I’m thinking of quitting my work can you just go sit down with me in the other room woman and just do a 10-minute meditation because that would make me feel better what does that was the model we gauge love kids instead of drinking it cuz that’s what many of us do okay I wouldn’t die died not something that now so I feel like I’m totally off topic so we covered three two of the three things we talked about genetics and you talked about early use the probably thing I’m going to talk about in terms of who is at risk for addiction is a history of trauma and this may seem like I’m a total nub here but I hope I hope I’m going to bring you around on this subject so in 2007 a really important study came out of Kaiser in San Diego it was a big study because Kaiser is cheating you know hundreds of thousands of plate likely have millions I don’t know how many people belong to Kaiser but this is a study that surveyed 17,000 people it was done because the lead investigator was interested in why it is that people adults with massive obesity when you’re in medical school it for the medical people in the room maybe even I go ahead of this you were taught that people with massive obese in the often ended history of sexual trauma and we find that awful to be true but couldn’t we always say that this is something we created is this mythology is history no so this guy got together this study looking what he thought would be just on adult obesity it’s ten questions there are answers are yes or no and I’m going to be some of the questions cuz they’re gonna be hard to read but I want you to have a sense of what we’re talking okay and it is worth going back and looking at the study if anybody’s further interested it’s called the adverse childhood experiences study so did it parent or another adult in the household often a very awful push that slap and throw something at you ever hit you so hard that you had marks we were injured we’ve ever sexually assaulted we do often or very often feel that no one in your family loved you I thought you were important or special that your family didn’t look out for each other feel close to each other or support each other did you often or very often feel that you didn’t have enough to eat how do I wear dirty clothes and have no one to protect you your parents are too high or too drunk to take care of you or take you to the doctor if needed or your parents are separated or divorced was there anybody in your family who was incarcerated to have a family member with major mental illness ten questions yesterday so this is a mention of abuse neglect and household dysfunction and what this guy did was just think about adult abuse to being what he didn’t realize is that this study showed it was a predictor for actually every chronic disease out there if you scored a four or higher on an a score you know the Pirates who died at a higher risk of a heart attack you at a higher risk of emphysema what’s the connection there you had a higher risk of more sexual partners you very strong predisposition to addiction and a much higher risk of developing the disease of chronic pain so visiting he became something that nobody anticipated really well study really well a trend study that actually impacts the outcome of multiple chronic diseases and I have to say the CDC and many other governmental institutions are spending a huge amount of time understanding childhood trauma and what it means for all of us as adults a lot of schools are now trying to understand trauma more because kids who are suffering through trauma they don’t do well in the classroom right they look at the fear you activated this really hyper response they’re doing not only deal situations they tend to be very disconnected or actually of sometimes disassociate which is not very present or very inattentive they often have a lot of mood issues depression and anxiety they all have a bit of a disease but they don’t know that you do and we met with these kids for a TD but again we’re missing a diagnosis here because these kids would really be excellent trauma-informed treatment and most of our communities aren’t very good I’m in North Hampton what do we have here we actually have fabulous trauma and frankly say there’s anybody here from the north end of trauma Institute which is in Florence I tell them and that place is cutting edge doing all the running work but that

place is rare is what I will say so and I’m just for those of you looking to think I’m the wacky on this I just want you to imagine what happens when your body is in trauma all of us have a nice normal physiologic fight-or-flight response or be chased by a bear you either run really fast you can basal constricted you to get to your cage after two hours you’re fine you shelter down your cover right that is that adrenalin spike and then you get back to normal right that’s the way we were designed to be but if you put somebody who’s living in a household where they don’t know part where they don’t know if their mamas good that’s gonna hurt their mom but they don’t know if their little sister is safe but nor living in a household with that much stress and that much anxiety 24 hours a day 365 days a year your cortisol levels your adrenalin fight-or-flight is on all the time right and it’s on all the time for years on end and it has a huge impact on any organ development and the rest for the rest of your life this stuff is really important to get at most of us in society are not able to address it so I’m gonna skip this one I’m just gonna remind people this is actually a shout-out to our young people in the room actually most of our adolescents making ice cream decisions they really do when you look at alcohol rates it has gone down since the 1980s gone down each year statistically significant decrease cigarettes I know you covered that one I love those numbers I like nobody smoking cigarettes and our teams are making awesome decisions around that when you needed other drug use marijuana cocaine heroin pills whatever it’s been pretty flat there’s been no change in that but just a shout-out to today’s teens who actually make mostly great decisions right and in fact people kids who don’t use drugs or tobacco or alcohol define the norm it’s just that it or not the ones you care about right you’re not the ones morning talking about the dungeons and dragons being played on Friday night right it’s the kids who’s parties all night that you hear from okay so I just want a diet that everybody part thinks I’m always going to talk about opiates because it’s one of my interests I am gonna just talk a little bit about little bit so this is the region of the corner which is my local paper and every morning I get up but I reveal bitchu Aries because I know maybe the person over me but I don’t instead I video pictures because I’m a doctor a teacher of a lot of people were old and are dying and I’d like to know every morning who died last night I just need to know I have to call people you could say Hospice Philip death certificates is my Richard every morning in one morning in December 2012 I know cup and I saw this not the face but I read the story but no woman in the up above whose name is Ashley sins and her obituary read at least Andy’s age 21 died of a heroin overdose at home and I thought to myself oh my god Ashley died because I knew her and her grandmother’s who raised her and I called them to express my profound love sympathies of her loss but also to thank them for telling the truth about how she died because for years I’ve been reading these obituaries again people who died at home and thought like what is going on although often times I did that I knew why they’ve got so these grandmothers went to our local paper and said you need to tell the story of what has happened in our communities with opiate overuse and heroin use and how people are and have some people who died and the breacher recorder ran with this what was just fabulous series talking and I you know the local paper got here they’re all owned by the same company right Hampshire does that mean from recorder I don’t so company but all of these papers had cover this topic I think pretty well right and at the level of community knowledge on the subject is pretty high I think maybe not everybody lots of people know it so this is just a picture that talks about the fact that it pills around the home for creating the worst opiate worse sort of public health epidemic that this country see that the data that in looked at using opiates for non-malignant non-acute and non-cancer pain was terrible right the studies and again for the doctors and subscribers in their own pain is the fifth vital sign sounds rather really familiar and you were told this is safe no won’t get hurt but it’s not addictive discuss tamper-proof you nothing bad will happen use as much as you want I lived through this I was about from the 1990s and I prescribed because they told me it was fine to prescribe a lot of the stuff is based on a single study with 38 patients so for those of you who are researchers 38 is a small end and in this study 238 are addictive but again a notion that we put out high volumes of opiates without concern that these are actually dangerous drugs that someone will get addicted to was based on this it’s appalling like this is like a medicine at its worst at the end of my talk I show a picture

of that book at the end of my talk I show four books I think are great ways and that’s one of us so thanks for bringing that one up so again I think a kidney burger the 1990s could have drawn this graph or more you prescribe opiates the more people will get addicted to be treated for opiates and the more people will die from opiates that’s what we know now I like this line is I’m a public health person I like to think about how it is that we live and thrive and how it is that we die so when you look at this light was this really complicated in the bottom but in the little bars that go to the left these are places where we have improved mortality with fewer people had died between the years years of 2000 and 2010 so a single decade that’s pretty pretty recent and what you see there is that death by motor vehicle accidents of has decreased and why is that speed limits sit the cars in airbags seatbelts in the casino second all those things death by influenza pneumonia to prescribe yeah vaccines have done that in order to aneurysms that’s the places have the best improvement and in a way order Gators if that has decreased so much oh oh well now after this almost useless drug on that front actually smoking actually going down smoking reducing smoking improve the audience is more than you know so that’s a public health measure right I usually say it with New York skiing at expedients or people saying a stance that is not a point four percent decrease it has a very small impact even though I wanted to miss a big impact so when you look at the numbers where more people die you know we have an epidemic of Alzheimer’s and Parkinson’s do we really have an epidemic of Parkinson’s and also cold right when you’re a hundred I’m sitting here thinking I don’t know how she died right I think she’s pretty demented at the end though right you know for those of us who fell at that certificate someone you just don’t know you take some guesses and most of those diseases that have increased in the last ten years have to be the fact that none of us are ever going to die and live forever so end-stage renal disease Parkinson’s disease and Alzheimer’s and a lot because we live forever when you look at this – things have gone dramatically one is suicide and the other one is the two hundred and seventy six percent increase identify opiates the reason we like to describe is a demonstrate sort of on a public health scale this one thing that went off the chunks right really it’s hard for me and I one of the reasons I did this work as I’m a doctor who was part of the call because I’m a doctor who likes to think she’s part of the solution as well but this is it contra beautifully anything in medicine that we ever did this wrong that we ever got this wrong that harm poor people I think about it all the time right – Stevie the bottom is they’re all bad this is a big number of people that get impacted so when you look at the country that taught math anything in red is a place where there’s high rates of overdose by drugs so when you look at that top back what lights up initially is the Appalachian on that map reading what I say up arrive so people turn over I’m talking about you see that light up you see New Mexico parts of New Mexico light up on that top map a little bit of Florida stretch to light up and then five years passed and now I’m in 2004-2005 in that little map if you see a lot more already right Florida starts to light up you start to see Maine even lit up you look at the entire Southwest is lit up and then five more years passed and that bottom map is six years ago six years ago that’s like a million years ago and you see how much red is on that bottom map those red areas high incidences of that by overdose that central part of the country which is pretty rural is a fairly unattained ‘add I’m gonna skip this way cuz it’s a similar slide we skip this one and the skip this was just for time sake so one of these I’m going to say is that most of the opiates that came to New England came from Florida and that for those of us who were following the story for last 20 years we would tell I am fired like oxy Highway we just had that expression the stuff came up from Florida and that is because parada had over a thousand pain clinics they were in strip malls they way though is pill mills if you were a doctor who work there you could both write prescriptions but you could also dispense the drug so you’ve got to be like the prescriber and the pharmacist all at once it’s one of the definitions of the pillows you get to do both that’s against the law in Massachusetts it’s against the law to get everything in state so they don’t have these a tour buses go down from

Kentucky Ohio man and they say you get three three nights in Florida all paid for it nice air-conditioned bus your job is to go into the to pay clinics a day you don’t need a cane is walking in telling me of migraines are fibromyalgia they will give you your meds you hand them over to me so the tour bus operator would collect the base of mental prescriptions and then would go back to of Kentucky and Ohio and other places and sell them so these drugs are coming to us from the fine fine state of Florida and a 2010 in federal government looked at that fine state and said we will cut off all the federal funding you can no more I only might have no more education funds you need to take yourself under control injured you’re making the rest of the country terribly ill so the problem is when they shut down the vast majority of those Pillman’s and incarcerated 37 doctors for a long time for being not doctors with America medical licenses but drug dealers what are people with addiction Ohio and Kentucky who may have left and if you think of the cartels in Mexico weren’t ready for this right and that’s part of what that story tells you they were watching this happen they knew what they were station and ended with a small town ready to go because this stuff was available and it was cheap and what this slide shows you that top spot is the purity of the drug and the bottom side is the cost it got more and more pure and again she heard it cheaper it’s pretty cheap in Northampton it’s pretty cheap in Holyoke is she should buy a little town it’s more expensive the further north you go so you know right now it’s running sometimes four bucks a bag some places 350 and you made it maybe six or eight bucks a bag it’s more expensive in those green dark green areas those are regions where emergency medical workers will say my number one drug of concern is heroin what’s wrong with the southeast why should some he’s not lining up there other Prince’s the answer that is actually answer ready no not that actually not in the southeast and actually thank God Methos almond down swing partly to see if I can really dig heroin but the answers of the terms of let’s look at this one here which is those dark criminal states are states where on average everybody got last year between one and one and a half bottles of opiate prescriptions everybody in this room that one or one and a half bottles the start purposes so those are states where there’s still a tremendous amount of prescription and likely over prescription of opiates so it’s not that pain is worse than Mississippi in Arkansas right I don’t think about to the case but if you can imagine them mental snapshot of this besides when you look at the country and asked where’s hair of the Cobo it’s us right we’re red it was red otherwise red heroin is our number one problem the CDC came out with their new guidelines last week the FDA just endorsed a new guidelines and everybody knows that governor Baker just cited incredibly restricted in some ways legislation two weeks ago when those purple states start having to cut back on their opiates right when all of those one to one and a half bottles disappears every one of those purple states will become a red state and if you think and I’m going to be regionally incredibly judgmental here but if you think that Mississippi and Alabama Kentucky these other states are going to have narcan in their schools and in their patrol cars and are going to be having forums like this and they’re going to be uploading every doctor in sight to help manage addiction I don’t think that’s going to happen and I think we have the next eight to ten years with tens of thousands of heroin overdoses or beyond that in all those things like this is problem has not gotten any better in the state work we’re focusing on it tremendously but our numbers for 2015 were higher than 14 and the 2016 numbers goes far look worse than 2050 this is the great state of Massachusetts right or public health action added when we try to funnel things okay so where you are teenagers been exposed to opiates by prescription that you’re exposed to in head silhouette they get injured right they can engineer if they break the femur and they have an ACL tear cuz there’s female soccer player right those are common places wisdom teeth right it was complete come in at age eighteen seventeen whenever you get the renewal who’s had wisdom teeth or root canal this room oh yeah and how many opiates were you prescribe to shove it out 13-0 okay twelve pubs a nice number it techniques apply we need to take something every four hours oh what a day for ten days human ten okay so those parts last four to five hours so that’s a weird prescription I usually here is we would need to be here

sixty right sixty are you kidding me birdie for the person who’s got thirty can you use thirty right so that’s inexcusable that what that was on the right is your gum and you have a seventeen year old and you’ve had it sort of really you were forced to really fill it died of the second that’s lazy of it on their part right i Aramis where I call 24/7 good night and don’t think that but I said that it won’t everybody I talked to says I had my wisdom teeth in my root canal I used 0-2 for everyone that I know six one time in the back you heard somebody some guy that I used all 16 I said he did something wrong and he said I’m an addict and I said I looked at the old surgeon and you knew exactly who I was in the work I did in his little hand is hovering sort of trembling over that description path anyways were 15 and I said I’m not feeling this you say police baton if I was like okay and I did what even time motel on motive destruction Tahoe motel room under distraction done like she was fine no opiates and so what I would see you I want to be clean here if your kid is suffering your kid is you know sickle-cell disease they break their femur you know something things you’re gonna give in okay who’s gonna be any chair opiate for them you are you’re the adult I can’t tell you how often I taking out a 24 year old who says I was home alone I had my wisdom teeth out I had my full bottle and I tipped the whole thing back and I can never felt better in my entire life right and then they call the other we feel that another we phone and that kids often running so I have to be very clear if you or somebody in your house who has a developing brain and they’re you’re given an opiate for legitimate reason an adult is management medicine and you’re gonna use a lot of time on motrin and alternating fashion as long as somebody tells you that’s an okay thing to do okay so so I’m gonna skip a little bit discovery and piece of the signs and symptoms you might have at home that your kid is struggling when I take care of those 21 year olds and they come in with their parents the parents will remind me the people in this room that work reported Nicole for have your own kids brother like all this stuff is familiar like pawn slips missing money mission jewels missing silver I’m going to show you a picture here that describes some of the things and this is a nice learn to code slide that I took from them but it shows you things that parents will come back and say they found in the kids room so that first week I see that my humble kid I’m helping the parents understand the disease of addiction I look at the parent I say you both of the kids room and I need to clean down I need everything that you definitely furniture who found a room I needed have entity because I need you to finance in that room and get rid of it because there’s a little bit easy stuff and they come back with these big wide eyes and I know how to go for you and they say I found and then like I know so they’ll find hundreds or thousands of these little babies right those little babies are in mind it looks like there but little plastic bags are then the zipper sometimes were made out of wax and they fold over right but you can in the beginning you’re kind of cautious when you’re struggling with your addiction but you know halfway through or towards the end you’re just actively using at home right like you just saw and this is to get sloppy and some of the stuff I’m going to show you on the slide you know there’s anything that’s rolled up that you can snort through that dollar bill the inside of bourbon pens hills Oh be honest I don’t think pills belong in your kids River I actually don’t think I don’t want to get what I thought advil in my kids room it belongs in a central area and I think a bad headache or the terrible period Crips just let me know I just kind of want to make sure that you’re not going to overdose on Tylenol title all over this is one of the leading causes of liver failure and young people got women because they’re like I hear it’s like we did more before you know it there ten thousand milligrams a day right that’s really bad for your liver so I actually think most of our students really don’t like that you know I will find it Apollo benefit my kids remember done I’m gone you know something I want to be captain Ramirez Elmo sleeping let’s work with no sleep hygiene how’s that for you so other things that you don’t want to find in your kids room and what I say that it means you have to actually look in your kids room and I think that’s right I know clean my kids room I don’t do their laundry I don’t make their beds but I walk through my kid’s room every couple weeks and I look for things are causing the concern I find razor blades in my kid’s room and I did at one point five I’m nine to one of my kids rooms and you know whatever be some sense but it made me uncomfortable quite obviously so I remove them but a razor blade really your kids are like you know that speaking the windows I don’t think so oil any oil with birthmarks is there any

natural reason to have oil with burn marks did anybody come up no there is no reason you find for with burn marks every red fund in your head every alarm should absolutely going off at school why is there a fence for no Madeleine I don’t want any silverware my kids rooms like these are my reaction as a person who takes care of people and parents God drew all this is I think I don’t wanna I I want to know in the first six months my kid is using heroin I don’t want to find out four years later I wanted uh sooner than that so I can help them earlier filters so the common thing that people use for filters and then minutes like the key tips and those other things on the right Earth’s are either cast or but sometimes cigarette filters look like that he parents will say to me if we went to bags and bags of cotton balls or key tips and they can’t mask on anybody about cotton balls in this room I got by very often the only five years need for the holiday but if your kids are saying rattle cotton balls have been around the cotton balls again you’re buying a bag every couple weeks there’s a concern for you okay the parents will talk about later like I just didn’t know bottles of bleach or vinegar and helps clean the equipment again I know my kids are not cleaning your windows or their rooms I should have never see that disgust in their room so this is just different formulas of parents out there if you have somebody in your life that you’re worried about you should have narcan available to you I carry in my purse I have it on me all the time it could be a niece or a nephew or sister-in-law it could be somebody in your life who actually shall hide those opiates for pain but they often seem like they’re not enough there concerning to they drink with they aren’t marketing but really when you’re overdosing from an opiate you can’t self administer so you have somebody in our house who has the stuff there’s two great websites this is one of them get in a lot zone now because video is how to recognize – somebody is overdosing how was that little kid I would finish with a good what if I get narcan everybody in this room but I caused any harm you know unless you’re a chronic opiates for some reason like came then you feel that’s terrible but hopefully you would let me know that before I did it what if you’re having a seizure right now to give you Newark and what I get when I help procedure nope what is your overdose season from Pennsylvania’s appears like Valley was an annex whatever you what I help you it fixes one problem please okay but having said that is the only fix for overdose from opiates you can sit there and rescue free and call 9-1-1 and do whatever it is you’re going to do but you’re not going to get them breathing again until you administer narcan so it is available without a prescription and every Walgreens in the state it is available more and more at cbs’s of the cbss have been doing it as long they’re not as good at what they do as well really so it’s paid for by your insurance MassHealth is three bucks Michael across is ten bucks so if you have somebody who by the way they worried about if you’re a public health person if you’re the person in the earlier the uniform law enforcement back there there’s a crisis in there and people in those guys you guys have carried their control purse thank you that’s actually banks are the place to district attorney Sullivan over here he is office basically bought in our camp for every see medical worker in his districts right which is extraordinary because that is way ahead of the game and these guys on the ground rescue more people and if you’re dead they’re never gonna get to recovery if we keep you alive long enough that you really want to get recovery you think you can get better I’ve almost I’d like one more slide I think okay so these are the books in that dreamland is now known as I like that book so these are books I read they sit by my bedside table I returned to that if you think this stuff is interesting if you want to learn more again you can sign up take all these slides you can take a snapshot with your smartphone right now but in the realm of hungry ghosts is a book on overall addiction changing the stream is about to fail the drug policy and in the Western world I have to say that incarcerated people for the disease of addiction doesn’t make them any better I said we talked about it but here I have a dopamine level of 45 what is it going to take to make that person better what helps with addiction is time in recovery that is really the only thing that works the further you can get away of your use the longer the time you go the more likely you are to truly feel it and get better you will be in alcohol for somebody who’s having an opiate use disorder all the time you could relapse that the rate of relapse go down to 14 percent if you’ve been sober for three years which is 86% of the time you’d agree but if you wanted in sober for nine months to relapse rate is enormous so it’s about time and distance from the drunk and what builds dopamine in the brain human connections having friends restoring relationships with your family and your children having meaningful work

exercise in the lot giving back to society having a pet going back to school to do with regaining your life again and goats dopamine and being locked up in a cell because none of those things did you know who those people are they’re your kids and they’re your next-door neighbors and they’re going to get out someday and they’re not going to be any better than they were when they walked in and I know this and I’m a doctor for change right I know what they look like coming in I know what they look like coming out a lot ever not much better so my point there being that if I’m trying to help people really a struggle this disease I need to create a spot where they could be for fifteen months and I need to get them tons of positive things coming their way right that’s what’s going to work for our sickest people there’s lots of things that help treat addiction but I tell you it for my young people who are really struggling I need long-term sober living with lots of structure a five day detox does nothing all it does is remove the drug from their brain so you step out of a six can you could overdose and die it does nothing to promote recovery and the fact that the state really that’s all we do is we continue to fund these detox students it’s really it’s a shame and again for the great state of execution especially leading away