 I'm Jo Linda LeClair. I'm the Director of Drug Prevention Policy for Governor Scott and I oversee the Opioid Coordination Council which was established by Executive Order in January of 2017. Its mission is to improve Vermont's response to our opioid challenges which impact every community in Vermont and knows no socioeconomic barriers. Our role is to better coordinate resources by building inter and intra agency responses which better leverage resources and drive them to where they are needed most in the communities and for the people across the state of Vermont. Joining me today are Ed Baker, host of the Addiction Recovery Channel on Channel 17 in Burlington and Pat McDonald and Ben Kingsley, co-hosts and producers of Vote for Vermont Orca Media in Montpelier. The drivers of Vermont's response include prevention, intervention, treatment, recovery and enforcement and the 22-member Opioid Coordination Council includes experts on every one of these topics. Every council member believes that improving systems through collaboration can help Vermont turn this curve. Pathways to effect change include policy and program, infrastructure and investment. Vermont has many programs and collaboratives of which to be proud including Vermont's system of treatment, the hub and spoke system. We also have programs we can improve. One of the council's goals is to raise public awareness and reduce stigma and so after being on a show which was hosted by Pat and then one hosted by Ed, we got together and we started brainstorming. What would a series of topics look like? And thus we are here today. The eight segments include science of the brain and addiction, treatment, recovery, prevention, enforcement, wellness, co-occurring disorders and a final wrap-up segment of all of those we just discussed. Before we talk about each segment, I want to hear a little bit from you. Talk about yourselves and how you got here. Ed. Oh, thank you, Jolinda. First of all, I'd like to thank you and the Opioid Coordination Council's seemingly tireless efforts at crafting a solution to this opioid tragedy that we face in Vermont today. Thank you for that. I have been in the fields for over three decades. I am a licensed independent clinical social worker and I'm a licensed alcohol and drug counselor. I'm recently retired from clinical work. I do public education around addiction at this point and I host the addiction recovery channel. That's my response to the opioid tragedy, trying to do something a little extra. I'm also in a personal recovery from addiction for 34 years. It's just begun my 35th year in recovery. And I am not rare. There are people like me all over the state. We just don't see them that much because we tend to be confidential about our recoveries. But I think it's one of the points of the series today is to show that with adequate medical care, recovery support systems in place for the lifespan and the acceptance of the community that recovery is not only possible but very likely. Thanks for sharing a little bit about your life's work. Pat, how about you? I know you have a very good long history. 25 years in the private sector, 25 years in the public sector here in Vermont. I was pointed six times into exempt positions by Governor Snelling, Dean and Douglas, ran two terms at the legislature representing Berlin and Barrie City. After an unsuccessful run for the Senate, Orca, actually because I was here one day taping something for the campaign, asked me to do a show. I started vote for Vermont about two years ago. A year into it, I approached campaign for Vermont and Ben Kinsley was the executive director and we agreed to partner up and Ben became the co-host of the show. More recently, I was asked to be president of the board of directors of campaign for Vermont. Just quickly, my private sector experience included 20 years in a chemical company making pharmaceuticals, dye stuffs, plastics and additives and something else. I'm very familiar with drug interaction, used to answer all the interrogatories and the legal documents. This was sort of something I understood and I could at least pronounce the chemical. Your life experience makes you the most adept host and every one of the topics that you tackle. Ben, if you can tell us a little bit about yourself. I do a lot of work in the public policy sector. I have a consulting firm that I run that does public policy advising as well as public policy development. I am the former executive director of campaign for Vermont. I was there for a number of years as their policy development expert before kind of going out and doing my own thing for a range of clients but I've worked on subjects ranging from public education to public health as well as health insurance and kind of a whole host of issues that kind of go along with both of those subjects as they're probably the two most complicated ones and in our public policy you know world in Vermont so. Thank you. What strikes me about all three of you is that this disease addiction, it knows no party affiliation either and I think we all must embrace the fact that every one of us has to play a role in finding the pathway forward and so that leads me into the first segment. Ed, you had an incredible conversation with your guests and you focused on the science of the brain which really is foundational as we talk about all of the topics and all of the issues that impact the opioid crisis. Please share. Yes, thank you, Jolinda. It was my treat actually to interview Dr. Peter Jackson. Dr. Jackson is an adolescent psychiatrist and he is also an addiction psychiatrist. He practices at the University of Vermont Health Center. In preparation for this show I reviewed my segments last night and I watched this segment entirely and I came away from it just thinking wow you know if someone tunes in to the section on brain disease, addiction has brain disease. Not understanding what we mean when we say addiction is a brain disease and a lot of people really do not understand that, that they'll come away from their TV actually understanding without a doubt what we mean when we say addiction is a brain disease. Dr. Jackson brought to the interview a wealth of very exquisite medical training, a wealth of experience and a deep feeling of compassion for his patients that shined through the entire interview. That was what made it a treat. He elicits compassion for people with substance use disorder and I think compassion really is the way that we need to view the four pillars of Governor Scott's approach to the opioid tragedy in Vermont. Compassion underlies treatment, compassion underlies recovery support services, underlies prevention and what we're seeing today is it underlies law enforcement. Dr. Jackson presented with easy to understand clarity and compassion. Now remember I had one guest for 60 minutes so we dove deep into brain disease. We covered brain disease extensively. We looked at the stigma that is unjustly associated with substance use disorder. We looked at the risk and protective factors that are associated with brain disease. Dr. Jackson has a passion for adolescent brain development so we looked at the vulnerability of that phase of the brain development adolescence as being a major risk period for people developing addiction. We looked at adverse childhood experiences and resilience and we looked at the effective treatments available specifically for opioid use disorder today, namely the pharmacologic treatments, methadone, buprenorphine and nautrexone and Dr. Jackson had slides, colorful slides that were easy to interpret that he used to reinforce the major points that he made in his presentation. It was beautiful. In this brief clip Dr. Jackson begins his explanation of the risk factors of addiction as a brain disease. He goes over both the genetic and the environmental factors that cause one person to be more vulnerable to addiction than another. It's not about choice. It's not about moral weakness. It's not about character flaw. It's about brain disease. What do you see based in science as the causes of addiction? Sure. Yeah, so I mean that's been part of my area of interest. That's why I did a fellowship in working with kids and adolescents because understanding the causes, understanding the risk factors for addiction is something that can help us a lot as professionals, not only to be more empathic and to be less stigmatized and less biased when people come in to seek treatment, but also to educate the rest of our medical professional colleagues and understanding better some of the early risk factors. We are now starting to understand more and more through science, through imaging, taking pictures, understanding that there are many, many risk factors that contribute to the development of substance use disorders. First and foremost, genetic heritability. Just like other illnesses can run in families, substance use disorders can. The heritability, which means a rough estimate in what part of this illness do we feel like is related to your genes and what part do we feel like is related to your environment. Obviously, it's not just two categories of risk factors, but the heritability we think is about 50%. We know is about 50%. It's similar heritability to things like type 2 diabetes, prostate cancer. So nobody chooses to get prostate cancer. Nobody chooses to have that higher risk. So even just across the general public, we know that due to our genes, there's already a risk there for a lot of individuals, much higher than others. And then we look at sort of the genetic influence and we look at the environmental influence. And we're starting to see more and more through some big studies like the ACES study, ACES, that's adverse childhood experiences study, where anything that you had happened to you in your childhood as a negative experience can make you at higher risk for a substance use disorder for other mental health challenges. Ed, you've just described your segment so well, and it makes me think of photos that I have seen of the brain before addiction immediately into treatment. And then 14 months later, and what we know is that the brain heals. It does. So that leads into the importance of treatment. Yes. Vermont has a nationally recognized system of treatment, our hub and spoke model. Can you talk to us? Yes, yes, I can. And first, I want to respond to what you just said. I think every cell in a person's body is yearning for healing. The aberration is the disease we call addiction, which prevents the person from healing. Treatment is the avenue that introduces people into their pathway to recovery. In this particular segment treatment, I was privileged to be in the company of what I consider to be three leading experts in this field today in Vermont, Dr. John Brooklyn, Dr. Christopher Lacanus and Deborah Hopkins. Dr. Brooklyn is the medical director at the Howard Chittenden Hub and the Baymark St. Albans Hub, which are large treatment providers specifically for people with substance abuse disorder, more specifically opioid use disorder. Deborah Hopkins is the chief operating officer at Central Vermont Substance Abuse Services, which is a very large treatment provider in Central Vermont. All three of these people are dedicated full time to working directly with this population. Doctors Brooklyn and Lacanus medically and Deborah Hopkins more overseeing therapeutic operations of her center. Dr. Brooklyn also enjoys the distinction of being one of the major architects of the hub and spoke system in Vermont and he goes into that in depth during this episode. This is a system of health delivery specifically designed for people with opioid use disorder that works probably the best system in America for saving lives. It's being replicated in many states and it's even got international claim at this point. My guests explain deeply on medication assisted treatment, how it works. They all bring case vignettes, client examples, which are of course protected by confidentiality that convey the message that adequate, scientifically based treatment works with people with opioid use disorder. There is no doubt about it. There's no equivocation about this. The type of treatments that scientists has revealed to us today work. They also take a look at the lethality of fentanyl IMFs illicitly manufactured fentanyls and fentanyl analogs, which are the reason we have seen an incredible spike in lethality in this particular population over the past five years. From 2013 to 2018, the progression of lethality within this population has been a practically a vertical spike, which makes medication assisted treatment all the more important naloxone or knock hand naloxone hydrochloride. They also touch on that and the importance of this antidote to opioid overdose that saves so many lives in Vermont. In this brief clip, Deborah Hopkins, beautifully describes the art of engaging patients in treatment and sticking with patients in treatment. This is one this excerpt to me is just a gorgeous example of what drives these professionals in their work every day, this incredible sensitivity and compassion for their patients. Well, you know, one of the things that you said, I think you said, we hang with them, we stay tight. I like that. I think we could talk a little bit about that. Like, you know, we're people, you know, our field did abandon people in the past. We kind of punished them sometimes because of their symptomatology. What is the philosophy today? How do we see this today? How do we hang with them? How do we stay tight even when they they continue to relapse sometimes? We have to remind ourselves that is their path and not ours. It's not about outcomes for a clinic. It's not about what my version of success is. We have to stay with them in the moment that they're in and recognize that nobody is going to be as difficult to them on a relapse or doing something wrong as they're going to be themselves. And I think when I said one of the things we try to offer people is respect, that we glass over that if we are professionals and we have jobs. But if we're if we look at people on the street, when you looked at a homeless person and looks them in the eye and say hello, you can see a brightening. Our folks are expected to be put down on a regular basis. And so we start with yes, sir, no, sir. How are you today? We get to know them a little bit more as people, which helps bring their dignity up. And so that when they do have a relapse, they'll still walk through the door and know that we know them as a person and they just had a bad behavior. And I think that that is a philosophy throughout the state. I think we're seeing that that there's because first off, it's a critical mass. Everybody knows somebody who's affected by this in this community. Now that it's become less stigmatizing to talk about it. I'll admit, my son's baseball games became a family support time for me with at least three other parents who knew I worked in the field. You know what, that's the that's the good work we can do now. And and it isn't just with the people that we're serving, I think with the elevation the state has made in bringing up this issue and the stigmas around it and the preconceived notions that are false. I think it's really helped open it up to be the family, the community issue that in fact addiction is. Thank you, Ed. You have just described what sounds like a very deep and powerful conversation about all aspects of treatment. And what we know is that the first day of treatment is the first day of recovery. And so that leads us into the conversation about your guests who were on your recovery program segment. What were some of the highlights of that segment? Well, this segment was really fun. We broke it down into exactly three segments. I had four guests in three segments. We covered recovery and recovery coaching with Peter Aspen Shade. We covered sober housing with Andrew Gagnier. And we covered recovery centers, atoning point centers and some of the special programs that these places offer with Gary DeCarolis and Kelly Breyer. Peter Aspen Shade is the president of the Vermont Alliance for Mental Health and Addiction Recovery. And he's such a jewel of a person to have in this effort. Motivated with every bone in his body, really dedicated to expanding recovery coaching in Vermont. Recovery coaching is somewhere in between the psychotherapy that people will provide to people with opioid use disorder and the sponsorship that 12 step programs will provide. It's somewhere in between. It's not therapy. It's not sponsorship. It's a deep, meaningful, ongoing relationship of peer support for persons with opioid use disorder. It is invaluable. It's available free of charge in all the recovery centers in Vermont and more and more in other settings. The emergency department here in Burlington now has recovery coaches in there to intervene with people who have overdosed on opioids and develop a relationship with them at that moment, at that moment where they're motivated to accept help. It was a beautiful interview and Peter really goes into depth describing recovery coaching. Then the second segment is Andrew Garnier. Andrew Garnier is the Chief Operations Officer and one of the co-founders of Vermont's Foundation of Recovery. Andrew again is one of these people who is just a natural, a natural. He cares deeply about this population. He's set up a system. Him and his partner have set up a system of sober houses, sober living quarters for people in early recovery to live in a safe place where they don't have to worry about access to drugs, where people are supporting them and abstaining and going for support services, indispensable resource in Vermont. And then Gary DeCarolis and Kelly Brier. We talk a little bit about the system of Vermont recovery centers in Vermont. There are 12 of them where there are a wealth of different types of programs, AA, NA, nutrition, yoga, employment counseling, all kinds of support services available all week long to people searching for recovery free of charge. This is revolutionary. Kelly Brier is a person who is a recovery coach and she is developed and coordinates the new moms program, which she speaks of, a program for women with opioid use disorder who have young children that need special kinds of support to maintain their pathway to recovery. It's just a beautiful, a beautiful program. In this clip, Gary DeCarolis eloquently describes the miracle, the miracle that often occurs at recovery centers. He calls it the moment where they begin to experience hope, a sense of self and engagement with life again. So they would be allowed to come into the center and just kind of sit around and be part of the community but just feel it out until they achieve some level of comfort? Yes. In fact, many times if I, if you use the analogy of a flower that hasn't bloomed yet, people will come in, they'll find a little corner for them to sit, they'll grab a cup of coffee and sometimes they just sit literally for days and then I'll watch them over time and they make a little connection. Of course, our peer support specialists will have nudged their way into their life a little bit and then you can see the slow opening up. We have a couple recovery, I mean employment consultants and they might find their way over there too and see if they need any help with a resume or trying to deal with employment issues or housing might be another big issue on their plate. They have computers in the center that they can use for these things as well. And over time you see them open up a little bit more, a little bit more, then they might want to become a volunteer themselves after a couple months and then that's a whole cadre of people that support each other on top of all the other stuff that we got going on. And then comes the big day when they maybe venture out for that first employment interview and we've got someone there that's going to be looking forward to hearing how it went when they come back. And these things build on and build on and you can see in a good three, four, five month period of time a transformation take place. They have hope which they might not have had when they walked through the door. They have a sense of self that they might not have had when they first walked in. They might have gotten involved with our yoga program or meditation or a number of things that we offer. We have over 250 meetings a month in our center of all sorts. And so you can see they're engaging with life again. That's what happens after a period of time. The governor's opioid coordination council is spending a lot of time focused on recovery. And what we know is that wraparound supports are critical. We spend a great deal of investment in treatment. And as I said earlier, the first day of treatment is the first day of recovery. We must also invest in the wraparound recovery supports that you and your guests spent so much time talking about. It's a home, a job, and healthcare and social support. So thank you Ed. It sounds like that was a rich conversation. It was. Lastly, you produced a segment on prevention. And if you could talk a little bit about your guests and some of the takeaways from that conversation. Sure. Basically a school in community based prevention. We had Anne Gilbert, Mariah Sanderson and Christine Lloyd-Newberry. Anne Gilbert and Mariah Sanderson are involved with community level prevention. And Christine Lloyd-Newberry is primarily involved with school based prevention. Prevention is one of the keys to really turning the corner with substance use disorder or opioid use disorder. Anybody you talk to will tell you that as long as there is demand for drugs, there will be supply of drugs. You know, there can be interdiction in law enforcement and all this, you know, really important activity on that level. But as long as there's a demand, there'll be a supply. So prevention ultimately over really the next generation or two is aimed at getting at the demand, creating youngsters that grow up not only having the information that they should have about dangerous psychoactive chemicals, alcohol, tobacco, marijuana, opioids, sedatives, hallucinogens, all of them. Having the information, but also having the inner world that's equipped to help them to make healthy decisions. And this speaks a lot to the quality of early childhood development, ACEs, quality of life. This is a comprehensive view. And you'll hear that in this particular episode echoed by my guests over and over again. The importance of a comprehensive sustained effort at prevention. In this short clip, my guests share some of their inspiring views toward the value and importance of sustained prevention in our state. And this is like music to my ears. The encouraging recent research with Vermont's youth that shows unequivocally that our youth are saying that they feel they're being heard by us. I mean, there's so many things I would want to say, but I would say I would love to see Vermont think about how we can invest in prevention. So really long term, sustainable, consistent investment in prevention. We know that $1 invested in prevention saves up $18 to $20 in future costs related to incarceration and death and all the things that come as a result of substance abuse addiction. So it really does behoove us as a state to think about how we invest in prevention. And again, you can do that at a community level too. You can do that at a school district level. You can do that as a parent. What are you investing early? But you know, thinking about how we are supporting sustainable prevention efforts in our community. And the other people thing I would say is that we are seeing some progress in kids like from the youth risk behavior survey results feeling like they matter in their community. And that is a protective factor. Kids feeling like their voice matters, like they have a difference, like people are paying attention to and care about them. So as much as we can support those efforts to continue seeing that grow. Thank you. Thank you. Thank you so much. Have a couple of seconds left. Yeah. Okay. So to Mariah's point, I am hopeful that the conversations that are currently happening in our state do exactly what Mariah is suggesting and lead to a sustained prevention effort. And in my last couple of seconds, again, the, you know, knowing that students feel like their voices are heard. Kids are not a problem to be solved in our community. They are an absolute asset in our communities and making sure that we are treating them as such, giving them a voice in their schools and in their communities and a place to really belong is so, so important. And I'm hopeful that we can move in that direction. The council is also focusing a lot on youth engagement. And we know that that is key to preventing people from ever starting to try or continue to use drugs. So Pat, it's your turn. I am sure this is very hard for you, given that you are usually the host on the show. I've been keeping quiet, but I've actually loved listening to it because I've learned a lot. So that's a good thing. We've learned a lot from everyone. Yes, that's why I was trying to encourage people to look at up these videos because I think there's just so much to be learned. There is. And we are going to do a lot of marketing because we want to make sure that we do what we said in the beginning. And this is why we went down this path, increasing public awareness and reducing stigma. So the next segment was about law enforcement. And if you can talk about your guests and their takeaways. Thank you. I had Commissioner Tom Anderson, who is the Commissioner of the Vermont Department of Public Safety and right here in my studio, Chief Tony Fagos, who has been a repeat guest on our on our show, We Love Tony. And they talked, of course, about enforcement and their role. I'm going to show a clip that Commissioner Anderson, who is a co-chair of the Governor's Opioid Coordination Council, and he talked about the three law enforcement recommendations that the council made. The first was to get a better roadside test through oral fluids. Sadly, the legislature had a bill this year, but it did not pass. Two was increased resources to focus on dealers who slip between the cracks. And he will explain what that what that means and what he was talking about when he said slip between the cracks. The third, it was more drug recognition experts. We call them DREs. They are being trained to identify somebody who is impaired. Another really important thing, which I hadn't thought about, is how much our police officer's role is changing these days. They're almost quasi-social workers. And the training at the academy has changed, training in their own departments. They have to learn how to deal with somebody who's in crisis. They have to learn how to administer Narcan, how to respond when the person comes out of an overdose, usually violent. Many are violent. And also, their safety is at risk because of the violence. But also, if the drugs are exposed to the air, they could breathe them in or get absorbed from the skin because it's a form that they really have to be very careful about. And some have actually found themselves in the hospital, which is very sad. But one thing that they're doing here in Montpelier that's being taken, followed throughout the county, is something they call Project Safe Catch. And what they try to do is when an addict comes and says, I need help, they don't say, oh, you have to wait two or three days. They immediately get that individual the help they need. And if it's at night time, they bring them to the lighthouse so they can stay safely and then follow up the next day with either at the hub of the hub and spoke process. And I think that to deal with an addict where they are in that moment is critical. And so I was very pleased to hear that that's something that's being rolled out throughout the county. Sadly, Commissioner Anderson told us we lead the world. The United States leads the world in the consumption of oxycodone and prescription opioids, rather sobering comment. He talked about the fact that we lose about 64,000 people a year, two thirds of whom are dying from opioids, more than died in the Vietnam war. He's mentioned that several times. And I think we just have to be cognizant of the fact that here in Vermont, it's just another staggering comment and statistic. So we try, law enforcement has been doing all kinds of things that we've read about in the paper, limited amnesty so that people can turn in their drugs, organize exchanges where needles are replaced with new ones. And apparently we've given out almost a million syringes each year to make sure that people are safe and not transferring diseases and stuff. And they've had secure drug drop-off places all over the state and advertising that to make sure people know that if they come in, nothing will happen to them. And they can drop their drugs off and go. What I think was really important is that enforcement has been working very heavily with the medical profession. And law enforcement meets every month with doctors and medical providers because, as the commissioner said, a lot of this started because of the misdiagnosis, a mistreatment of pain. And people want to be zero free of pain. And so they were given narcotics, which the drug company said it wasn't addictive, wrong that was. And so the law enforcement is also working in very concerned about the kids, the students in school. A lot of officers have resource officers in the classroom itself. One of the things they talked about is if a family is in trouble, that a child needs somebody, an adult to turn to, whether it's the resource officer, school teacher, somebody that they can rely on that's a stable part of their life. And they're looking to see what other things they can do in schools with the kids. We have a state drug task force, who was very active around the state. That's a little slower in finding results because they start at the lowest level in the supply chain and they work their way up through the supply chain. It takes a lot of research and a lot of undercover work and a lot of investigation to really be successful. But they are making progress. And that was a very excellent discussion. And I really commend both of those gentlemen for the work that they're doing and the commitment. Could you talk specifically since this show is about law enforcement? Do you recall all the recommendations or some of them that focus on law enforcement? Yeah. And I've told people before that law enforcement to me has sort of the easy part of this equation. As difficult as it is, we have sort of the easy part of this equation. So the recommendations that the Opioid Coordination Council came out with with respect to the law enforcement was, number one, that we have a better roadside testing for drug driving. That is a real hole in Vermont's law enforcement area. So that was one that the Opioid Coordination Council supported. And that would be oral fluid testing. The second was to sort of increase law enforcement resources in the area of drug enforcement in sort of a very narrow band. And where we miss some investigations are those cases that are sort of locally driven. And they're not quite big enough. The dealers are not quite big enough to hit the radar screen of the Vermont Drug Task Force. And but there are more than kind of the local PDs can handle. So that was an area we really tried to focus on to try to get additional resources in that area. And then finally, we also were looking at increasing the number of drug recognition experts. And again, that goes back toward that goes back to roadway safety with respect to people that are driving impaired by any number of drug whether opioids or marijuana or any other type of mind altering drug. And for those that don't know, a drug recognition expert is exactly that as an expert. They've been specially trained. Well, having spent quite a bit of time with Commissioner Anderson over the last year and a half since he is co-chair of the Governor's Opioid Coordination Council, I repeatedly hear him talk about prevention. That is the way forward. Today, I was chairing the Prevention Committee of the Opioid Coordination Council. And it was law enforcement that was speaking the most clearly and eloquently about the collaboratives that must be built in order to effect change. So I think everybody in every show has said, we've all got to work together because nobody can do it alone. It's not a law enforcement problem. They were usually the ones oftentimes getting the call, but they're not the ones solving the problem. You alluded to the importance of law enforcement working with social workers. There are now models across the state of Vermont where social workers are embedded either in local police departments or in the state police barracks. Exactly. And that's very successful. There's some happening up north. St. Albans. Yes, St. Albans. And it is just the law enforcement people have said it's the best project that they've ever had so successful because they now have somebody who sees the issue a little bit differently than with the law enforcement to mind. And it's excellent. And they're finding that the stress on law enforcement can be greatly diminished as a result of having a trained mental health or licensed alcohol and drug counselor who is working side by side. And you said something important there. It's not just having someone who is a specialist in addiction treatment. It's someone who's a specialist in mental health treatment because it's not just it's not just about opiate addiction. It's also about mental health issues and broader mental health issues. And one of the things that Tony Fecos, who's the police chief here in Montpelier has done, is partnered with Washington County Mental Health Services to have some of those tag team type situations. Team two is their pilot program to partner mental health professionals with law enforcement when they're going into a situation where they suspect there may be a mental health issue at play. And I am proud to say since my lens is statewide that is happening in Rutland. It's happening in Bradelboro. It's happening in the Northeast Kingdom. So, Browington has Chief Del Pozzo and Jackie Corbine. I think there was the first incidence of someone being implanted right in the police department where they will actually go out and respond to overdoses. Absolutely. So Ben, time to bring you into this conversation. You co-hosted the wellness conversation with Pat. Talk to us a little bit about the guests as well as some of the takeaways. Well, some more people that I'm sure you're familiar with. We had Dr. Mark Levine, who's the commissioner of the Vermont Department of Health. I know you work very closely with him, as well as Dr. John Porter, who's the newly appointed pain management director at UVM Medical Center, as well as Dr. Josh Plavin, who is the chief medical officer at Blue Cross, Blue Shield of Vermont. It's a great panel. I had some great discussions. And really, the focus was on total person wellness. We talk about mental health. We talk about not just mental health but physical health, because mental health can be physical. We talked about these brain scans, MRI scans. We can actually see physical changes in the brain. It's fascinating. My wife is a year away from getting an undergrad in neuroscience. So I've seen tons of these things. But where you see physical changes in the brain from mental health disorders and substance abuse disorders. So it's not just a physical disease as well as a mental disease. And also making sure that Vermont has a nationally recognized hub and spoke program, which we mentioned earlier. But making sure that people know where they're going in that system. Because they're moving in and out. They're moving from the hub out to the spokes, sometimes back to the hub. And making sure they understand where they are in that system, who their point person is, for each of these different services that they're being provided, whether it's mental health services as well as substance abuse services. Because oftentimes, and this is one of the big things we talked about on the show, was the co-occurrence of those things. And really, I would argue that substance abuse really is a mental health disorder. It's a subset of mental health disorders. And so they're really kind of one of the same thing, although they have unique challenges within substance abuse. And they're oftentimes co-occurring. So sometimes, or most of the time, something else going on as well that needs to be addressed. Commissioner Levine said that one of the most complicated things that's a result of the opioid crisis is looking at ways to divert potentially earlier on before someone gets too far down that road. And where can we find those off points? And where can we direct that messaging? We have examples available to us, things like the campaign to end smoking, which is 20, 30 years in now, right? And it's been broadly successful. So we have models to follow. Early intervention, particularly early childhood education, are models we can follow to try to divert some of the at-risk population before they hit a point where it's a lot more difficult to bring them back. So one of the things that was interesting, there's a lot of alternative treatments available in Vermont. It's not just drugs sometimes. It's therapy sometimes. It's meditation sometimes. It's a whole host of things that you can use to address opioid issues, as well as one of the statistics they use is approximately 8,000 to 9,000 people in treatment across all kinds of different treatments, not just talking suboxone or one of those pharmacological treatments. And there could be as many as 20,000 to 30,000 in the state that have and struggle with opioid addiction. So you can kind of see if those numbers are correct, which is kind of hard to get at because it's not like people are self-reporting. At least not all people are self-reporting. But that would mean that about a third of the population that is struggling with opioids is in treatment currently. So trying to get more folks into treatment and trying to increase capacity so we can get more folks into treatment. That's an incredible number of people we have reached to take up. Yes. I think we want to celebrate that as a success. And continue to build on that success. Yes, absolutely. So here's a clip of Commissioner Levine talking about the hub and spoke system here in Vermont. It is actually a one-stop shopping, if you will. And then they sent you to a spoke because specialized so the hub is really the complex pain management center or addiction management center where you can be inducted into the use of these medications that are so helpful and helping you. But they also provide a lot of this comprehensive support around you, whether it be counseling or case management, et cetera. Because of federal prescribing regulations, hubs are the only place you can have methadone prescribed. And so methadone often requires a daily visit. Right. The hub is set up to. We have a methadone clinic and a Brufenorf clinic here in Berlin in my town. Yes. That was on the committee that created it. So anyone a methadone will be at the hub. Right, I see. Many people, though, can actually have their opioid use disorder treated as if it were another chronic medical condition in a primary care setting. We call that the spoke. So it's actually transforming the treatment of substance use problems into a chronic disease model, primary care manageable model. Most of those patients will be on buprenorphine. Yeah. And buprenorphine can be prescribed monthly. And patients will not have to visit that spoke daily. Does they even give it to take home now? Yes. Some forms. Yes. If they know you're going to respond. And that is what happens. And there's also access to all the other services that are kind of built into a bundle as we term it of care. So that works very well. And it really takes that disease and destigmatizes it. Because when you're sitting in your primary care doctor's office, we don't know if you're there for cold or diabetes or to get buprenorphine. We've actually run out of time. But when we had our buprenorphine system here, I was surprised who came to me and said, my son, my daughter. It is people that are well known in the community. Professionals, I was very amazed. They said, we want this. And they're highly functional. Folks in recovery are living full lives. So Dr. Porter, who I mentioned, is opening this pain clinic at UVM Medical Center, is going to be kind of similar to what the Brattle World Retreat is currently doing in terms of an intensive program to bring people in house. It would be another one of those hubs. Like, you know, and as we talk about how the Hubbard spoke program works and folks move in and out. And that is going to be Blue Cross, Blue Shield, recognized center of excellence, the second one in the state. So that's part of why Dr. Porter and Dr. Plavin joined us to talk about that center and opening. I think it just opened a couple months ago, I believe. And patient relapse as well is just an interesting one. One of the examples that was given is kind of like diabetes. You never fully recover. I'm sure you can speak to this better than most people can. It's never, it's over and you never have to worry about it again. Once you have a diagnosis of something that you have to work on the rest of your life or deal with the rest of your life, very similar to how more broadly recognized diabetes. You never fully recover from diabetes. It's something you have to manage. So that was interesting, I think, to kind of equate it to something that maybe people are more familiar with. I think that the state is really right behind the idea of addiction being a chronic rather than an acute disease. Yeah, absolutely. The recovery centers are proof of that. Just to speak to that very briefly, I'm in recovery for a long time and I know a lot of people in recovery for a long time. And you reach a point where if you're living a different life and you're taking care of your health and you're pursuing natural rewards and you have a full life which we're all capable of, you very rarely ever think about drugs ever. And it's just true. It's just true. If you achieve health, you very rarely are tempted to take a drug. And if you are, you have an arsenal of behaviors that you can refer to to protect yourself. So it gets easier, actually, as you get better at it, like any other life skill. Right, yeah. Well, and it's interesting because a lot of people, I have family members that have chronic diseases. And it does because you learn how to adapt to it, which I think is a fascinating parallel. And I think it also makes it more relatable to people who maybe don't know someone who's in recovery. One of the other things I think was interesting, we talked about this briefly before, kind of the genesis of this whole thing. And we talked with this group in particular about what were some of the root causes of Vermont's opioid crisis. And it's not really just Vermont's opioid crisis. It's America's opioid crisis. And one of those genesis was the Medicaid and Medicare programs back in the 90s, I believe, had listed a chronic pain level as one of the criteria for managing patients. And that was kind of adopted by the broader medical community. And of course, the most readily available pain management tool at the time were opiates, which everyone said was safe. And clearly, we know that to be not the case today. And unfortunately, before we realized that the damage was kind of done. But we're kind of left in the aftermath of that now. And doctors are very well aware that you can't treat all pain. You can't treat pain down to zero, which Pat was talking about. On the video, I kept telling them they keep asking zero to 10. Well, you've given me zero. I want zero. Raise my hand for zero. Right? And they agreed with me, the doctors. And what's acceptable is a two or three acceptable. Maybe you just had surgery. You're going to be in pain. So one of the things that we talked about was what are alternative forms of treating pain? Not just what are the alternative forms of treating opioid addiction? What are the alternative forms of treating pain that don't lead to putting someone at risk? And there's a whole bunch of things. I mean, just something as simple as massages or acupuncture or chiropractic care, physical therapy, can reduce pain, yoga, going for a walk, exercise, it goes on. So looking more holistically, and that was really kind of the root message, I think, out of the show. Beautiful. The opioid coordination council will continue to look at integrative health care, both for treatment and pain management. And that must be a priority. Having Blue Cross Blue Shield and all insurers recognize that these must be procedures and opportunities which would receive reimbursement and recognition by an insurance company. That is critical as well. And it's great to have Blue Cross Blue Shield as a part of this discussion because this is something they're very interested in. They're very active in this process. They are really pushing the envelope on this one in particular because they realize it's better for the patient and it's cost less. It will reduce the cost of the system because if you can do some of these intervention type of things, it doesn't get to the point where someone's life is really at risk. Well, Vermont has a history of wanting to lead the way and so this is going to be another example of turning this curve more quickly than we had thought. Pat, I'm leaving you to talk about the last segment which is Co-occurring Disorders. Exactly. And I had on as my guest, Sienna Fontaine, who's a licensed clinical social worker at the Howard Center. And Mary Moulton, who is the Executive Director of Washington County Mental Health Services. Another repeat guest. And Rebecca Porter, who is a licensed alcohol drug abuse counselor from the Department of Mental Health. Mary Moulton, and I'm going to show a clip about Mary talking about this, was talking about how there are no wrong doors to go into. And I just thought the whole concept of the open door, friendly, warm greeting, that whatever door an individual enters to get help, they will get help. There's no such thing as a wrong door. And I thought the way and that's what she practices at the Mental Health Services. And I think it's being picked up all over the county and hopefully all over the state. And that's where they get them to the hub and the spoke. And I thought that was just a great way to phrase it. And we have, we talked a little bit about preferred provider and designated agency. It was interesting to understand the difference of what their regulations are and how things are spelled out. Rebecca and Sienna hold dual licenses in mental health and addiction. And I think Mary has somebody in her shop. It's a very powerful to have both those licenses in one person to be able to deal with mental health and addiction at the same time and understand how they sort of merge together and of course, how to offer support. And as what Ben said before, they are treating the whole person which I just think is is such a wonderful approach. They're seeing psychological and physical and with all of the alternatives which involve physical running, exercise, they're really treating the whole person and the patients are responding to that because there's things that they enjoy doing and will help them. And I think that's one of the things that we got from this group and also from the doctors that the complementary alternatives are just rising to the top as a real treatment. Years ago, you know, oh, you're getting massages. But now it's part of the wrap around. It's part of the treatment. Well, we have so many doors that people come through Pat. So, you know, having adult and children's outpatient services and an emergency services team. Certainly people with developmental disabilities who we are also seeing an increase in by the way of using substances. Oh, really? So we're having, what we're working on in our region overall is just making sure we have no wrong door and Washington County Mental Health is one of the doors that people come through. And Mary also said that what's really upsetting her and her staff is the effect on the children. The children of the families that are in disarray and some are born with the addiction and they show up in school having come from a neglected family. I mean, they're just being neglected. So, but on a positive note, we've shared some really amazing recovery stories and they said that if a client, as you said before, has a safe place to live, adequate food, good job with support from professional help, and they get their self-confidence back, they can thrive and flourish. So they said hope is the key. It's a lifelong commitment. And, but there is hope and we have good stories to share. So I think everyone is realizing that they've got to work together as we have here to just use our resources to the best of our ability and fix it. So thank you. It was great. It was a good discussion. Thank you, Pat. You can tell that you felt uplifted while the topic is tough. There is hope. There are pathways forward. So we've just had an incredibly rich conversation. We are almost out of time, which is what happens when there's just so much to share. If each of you could take 20 seconds and give us your takeaway that was most powerful for you. I would like to refer to something both Ben and Pat said. Ben talked about 20,000 people or 30,000, between 20,000 and 30,000 people with opioid use disorder in Vermont and around 8,000 people are receiving treatment. And Pat referred to between 62 and 64,000 people per year as fatalities of opioid use disorder in America. And I just know that people with opioid use disorder are reluctant to seek treatment because of stigma. So if people viewing this series, I would urge all of you to please watch all eight segments and learn about opioid use disorder treatment and all the things that we've discussed today because the more you learn, the more you will naturally respond with compassion. And the more people who respond with compassion, the more likely it is to actually change the atmosphere. And people with opioid use disorder will then not feel reluctant. They will not feel shame. They will not feel prejudice. They'll feel acceptance and inclusion and they'll be more likely to reach out for help and will save lives. Wonderful. Pat, I don't want to necessarily repeat but I think the focus on the patient, patient-centered, including the patient being transparent, allowing them to be part of the treatment. It's not doctors sitting off in a room somewhere coming in with their great plan. You, the patient, get to weigh in and when you need help, it'll be there for you. So it's great. Thank you. And Ben. What I would end on a hopeful note, I think. You know, we talk about there being as many as 30,000 people dealing with opioid abuse disorder in Vermont, which means one out of every 20 Vermonters is affected by this. So most of our viewers probably know someone who struggles with this or a family who struggles with this. But Vermont is a leader in this. You know, we mentioned the recognition Vermont has gotten in being on the leading edge of this. We are starting to turn a corner, I think. We've got a lot of excellent people working on this. And I think there's hope that we can overcome this as a state and as a country. Agreed. Thank you all so much. What you have described beautifully is that there is a face to this disease. It is with individuals, families, and at our community door. And that is the reason why the governor made this his second executive order when he took office. I want to give a special shout out to Orca media staff here in Montpelier, particularly Zach Zorn and the staff at CCTV, Channel 17. And I also want to recognize the work of the governor's Opioid Coordination Council. This very diverse and eclectic group of people came together only a year ago and sat at a table and had to figure out how to communicate effectively with each other. Also recognizing that if we could do this at the state level, it can work very well at the community and the regional level. And we need to leverage our resources more effectively. We need to drive systems change. And I am seeing that with the state. I am seeing that with the nonprofit providers. And I'm seeing that with the private sector as everybody engages understanding we have to be all in in order to have a pathway forward. The first day of treatment is the first day of recovery. And as you said, Pat, towards the end, there is always hope for a pathway forward. By the end of August, the eight-part series can be found on Orca and CCTV, Channel 17, Public Access websites, and the Opioid Coordination Council's website under the title, Understanding Vermont's Opioid Crisis, Working Together to Create a More Resilient Community. I want to thank you, audience. I want to thank you. Thank you all. That's great. All of us. Thank you. Thank you. Thank you.