 Hi everybody. I'm Ed Baker, and it's my pleasure today to welcome you to ARC, or the Addiction Recovery Channel. ARC is a channel that's been created for people with substance use disorder. This channel is devoted to bringing you accurate information, vetted, accurate current information that pertains to the disease of addiction, recovery and treatment. It's a channel for anybody who cares about this, for anybody who may have someone in their family with substance use disorder, for alcohol counselors, drug counselors, social workers, medical providers, anybody who wants to really learn accurately about what this disease is all about and what we can do about this. It's my pleasure to be your host. I'd like to begin by calling some attention to the Step Into Action Recovery Walk that occurred this past Saturday in Burlington. I mean, this was a live example of hundreds of people walking on Church Street, showing in a very public manner that recovery works, that people with addiction recover, that they live full lives, they have purpose, they have meaning, they have self-esteem, they want to show the general public the results of treatment, recovery support services, and the support of the public in general. So I would call your attention to that. It was a very, very festive day. Along those lines, I want to introduce my guest today. Our guest today is Jason Gogan, who has himself contributed a tremendous amount to introducing and enabling people with the disease of opioid use disorder into recovery. Jason is the regional director for BART. He's been active in this field for over 20 years. He serves on boards. He's a community member. And in his own words, he's very interested in just continuing this fight, this fight for recovery. So my guest, Jason. Jason, go again. Thanks, Ed, for having me. I really appreciate it. Thank you, Jason, for being here. Absolutely. I guess what I'd like to do is begin with some current information. The FDA recently has released some research findings. And the research findings are showing that people who receive what's known as MAT, Medication Assisted Treatment for Opioid Use Disorder. In other words, they receive a medication, either buprenorphine or a methadone, that they cut the death rate, their death rate by 50%, death by all causes, is 50% less with people who are on medication-assisted treatment. And I guess my question to you, Jason, is with that kind of information about medication-assisted treatment, that the death rate for that particular population with opioid use disorder is cut by 50%, how is it that the degree of stigma against this population in our culture persists? I think that's a great question, Ed. I mean, the research is clear. MAT is what consistently works. Now, are there other alternatives? Absolutely, and I'm sure we're going to get into that a little bit more. Stigma is the hardest thing for our patient and people and employers as well that work in this field. And what I mean by that is people are judged for something that has happened to them. This is a disease. It has no barriers. It can affect anybody at any time and any place. No one usually just wakes up in the morning and says to myself, I'm going to use heroin. It doesn't start that way. Most of the time, in this day and age, it starts with prescription pills. So what I've been doing, a big purpose of what I've been doing is trying to educate the communities, trying to educate our patients, people that we work with, about reducing this stigma. I think it's because there's a lot of media coverage on MAT right now. People come into MAT, and I think MAT runs on a harm reduction model. And I know we're going to talk a little bit about that more too. But what that means is it takes time. You look at a person that's battling alcoholism, and I think the average person might relapse six or seven times throughout their life. The same is true for opioid disorder as well. So it takes time, and we work with them. And again, it's a harm reduction model. We don't expect, and we don't see accidents overnight. It doesn't happen that way, but it does happen. And we see success after success with people that follow our guidelines that we put in front of them. Stigma is the biggest thing. I think it's getting so much better in Vermont. I've been in communities and done community presentations where we've had lots of resistance. More recently, within the last year, I've been going and doing these presentations, and we get a lot more praise and people that support us. There are still people out there that have questions and challenges, but that's great. That's the only way we get better. So I think we need more people that have conquered this disease to stand up, be proud. Again, no barriers. Mailman, school teacher, nurse, your sister, your brother, the person that mows your lawn, it can affect anybody at any time. That's a great response, Jason. And it opens up just so many areas that we can move in. We had this discussion before we began the show about there's just so much information to cover. I mean, one of the interesting things that you're mentioning is this idea of relapse or recurrence of use, that sometimes people will be deeply, powerfully motivated to abstain from psychoactive chemicals. It's what they want to do most in life. But because the brain has been impaired through the course of the disease, they're actually incapable of continuing to abstain when they're put in certain situations. Maybe they'll see the drug that they used to take. Maybe someone will call them and want to sell them the drug. It could be a very innocent occurrence. But that trigger, we call it, or that cue sets a process off in the person's brain where they're motivated to reengage with that drug. And the part of the brain that makes decisions that inhibits impulses are so impaired that against their own will they'll actually have a recurrence in that self-administration of that drug. Now, when you mention alcohol and you mention someone what we call relapsing five or six times, that's one case. But when we're speaking about opioids, this is a whole different case. We have international crime organizations lacing heroin with illicitly manufactured fentanyl, 80 times more powerful than morphine. The end user on the street using these drugs does not know what he or she is getting. So one recurrence, one relapse, can be fatal. That's what we're seeing country-wide. How does that relate to MAT? Yeah, that's a great question. And again, we could go a lot of different directions here with the fentanyl and the car fentanyl and the things that are being introduced on the street that are even worse than just, I guess you could call regular heroin. So what do we do at MAT? So the medication, you know, we provide methadone. We provide buprenorphine slash suboxone. And in some cases, we do Vivitrol as well. That's just a small piece of it. We get the patient in. We have them assessed. We ask them a plethora of questions, how long they've been using, what they've been using for. And the research shows that every year a person abuses opiates, it takes the brain a year to recover. So some people, it's going to take longer than others. Again, harm reduction model. We individualize the treatment. But then it comes down to the counselor and doing therapy. The doctor makes a determination of what kind of medication they're on. And then the therapist or the counselor works with them on a weekly basis, a monthly base. Again, it's case by case. Some people want to be seen every day. Some people want to be seen once a month. And that's okay. We'll work around that with them. But we want to educate them. We want to give them and help them develop coping skills. Things they can use. So when these urges, when these opportunities come to them, they're able to say, it's okay, I'm not interested. I'm doing okay. We're just fine without that. Support. Someone they can call. And then we're really starting to look at, once we get them stable a little bit, they're not actively using or actively trying to use, we want to dive into the trauma. What happened? Why did you start this? Was it a broken leg and you were given prescription pills? And that's what led you down this path. Was it, you were raised this way and you didn't know anything, you didn't know any better. We see that a lot. It's very generational, if that's the right word. But we see families, entire families going through this. And so we try to really get at the root of it. What's causing you to do this? And then give them those skills. So when they successfully complete MAT, they're able to go out there and do this on their own. But we're always there for them regardless, if they need that support. You know, again, it's a great response and it just opens up a whole other bunch of avenues. But there's this idea of the brain healing. This is proven time and time again in research. The length of stay. The person needs to be in treatment for a good long while. Different stages of treatment, like you say. Acute. When the conditions are acute, they may need medication, they may need hospitalization. There could be residential treatment where you need to be in a protected environment where you're not going to be exposed to queues or neighbors or people with whatever drug you may be tempted to take. Outpatient therapy. You know, for weeks, sometimes for years, nutritional therapy, different types of recovery supports. In Vermont now, one of the things that I'm most proud of as a Vermonter is the network of recovery centers that we have in Vermont. It's great. Seven days a week, you know, meetings and support, recovery support services, all the time for people whose brains are suffering from impairments who need easy access to support when they're feeling weakened or when they're feeling tempted. I don't think the general public really understands that, and I think this speaks to one of the sources of stigma, that some of the belief in the general public is that addiction is a choice, like causality. It's caused by people's choice. Or the perpetuation of substance use is a choice. In other words, people have controllability. They can stop when they want, but they don't because they just don't want to stop. When people believe that, then their response is likely to be punitive. But when people see this as a disease, their response is more likely to be compassionate. Can you speak about that a little bit, about causality, about controllability? In your particular patients, people with substance use disorder, did they choose to develop addiction? Do they choose to not be in control? I think with addiction, in general, no one ever chooses addiction, regardless of what the substance may be. No one chooses that path. They might be led down that path, and before they know it, they are addicted. With a lot of our patients that we see, addiction has become something that could be either learned or known, or something that has come through prescription drugs, again, prescription drugs. That's getting better and better. What I mean by that is our primary cares, our doctors, whether it be in the emergency room, whether it be just a primary care officer, I've been educated on this, and told that these medications are addicting. You can't just stop opiate use. You can try, but to do it medically safe, you should be monitored by a doctor or have some interaction with them. What I mean by that is when you stop using opiates that you've been using consistently for a long time, you're going to have withdrawal symptoms like no other. People literally describe it as their skin, it feels like it's burning, or it's literally crawling and moving around on them. Their body aches, they sweat, they're nauseous, they can't sleep, they don't eat, they have no appetite. These things go on for days and days. To do it safely and to be monitored is the recommendation that I would have. Again, there's different kinds of treatment, and there are different paths to recovery. My answer always is if you don't agree with MAT, that's okay. Don't block a path of a patient or someone that's seeking help. Maybe someone just needs therapy with maybe some medication from a doctor. Maybe somebody... Acute detox is a big one now. We're starting to do acute detox at all of our programs right now. Acupuncture. That's right, and it's another form of acupuncture. Self-awareness, self-help, teaching people. We let our patients grow their own gardens so they can have some self-worth and this is what I did. A lot of them ended up giving it to other patients. I don't care what it is, whatever works for you, we're willing to give it a try. Go down that path. Don't be afraid to fail. Let yourself fail. Pick yourself out and fail the way you would want to fail. And then try again. Because without failure, what is success anyways? I tell our patients, I tell our staff, the people that I come into contact with, you don't have to be fearless of recovery. Just don't let fear stop you. Because it takes lots of attempts. I always say to someone, if you don't know someone that's battling opioid use disorder, you will, unfortunately. We live in a small state, we have small communities, but we have big hearts. We do. We help when we can and whatever direction that is, that's okay, as long as you're getting help. We do. And I do not think that it's peculiar to Vermont. But we do. We care so deeply about our neighbors. And we have that sense of community. And there is a groundswell of compassion occurring in Vermont right now for this particular population. And it is wonderful to be a part of it. Your point about being resilient, about not giving up, about continuing to try, I think, is invaluable. Because people with this particular disease become angry with themselves, self-hate, self-loathing, despair. This is why they need strength and acceptance and compassion from us. The hardest thing for anybody to do that's battling this disease is to pick up that phone or walk through that door for that first time and ask for help. It's the hardest thing. And that's why it's great that Vermont is heading towards a small, actually, we're there right now where we're treatment on demand. There were times where people used to call and they would get put on a waiting list. It doesn't exist right now in Vermont, it's the kudos to Vermont. The hub and spoke model that was created for Vermont is being nationally recognized. California is adopting our model for many of its counties. Other states are looking at it as well. I go to conferences and things all around the United States. And I'll go into the conferences and a lot of times after five, 10 minutes I kind of walk out, scratch on my head and saying Vermont really is the forefront. We're on the front lines here. We are making headway in this battle. And it's exciting to be a part of. But I can't help wanting to do more and want to do more. And a lot of that leads to, you know, I'm probably answering some of your questions, but the one thing that I think we really need to do is continue to educate our youth. We were seeing an increase, a big increase of people coming in with opioid use disorder at a very young age, a very young age, late teens, early 20s, and they've already been using for years. So the more education we can do, which is happening, I'm hearing some great things in the school system. Some wonderful things are happening up in the North Country of Vermont, which is very exciting. But we've got to keep doing more. I couldn't be more with you with that. That over the next few generations we will do the next few tens of years. This is going to take a while to deal with. We have one population that has addiction. Those people will need treatment, adequate treatment, medical, psychotherapeutic, and recovery supports. And we have another population that's coming up. We have children. We have to look at them differently. We have to really develop educational inputs that are age-appropriate and let kids know throughout their lifespan what's dangerous, what's not dangerous, different types of refusal skills. One of the promising areas of research right now is childhood resiliency. Childhood stress resiliency. How to get in there with a kid and help their brain to develop in a way that is likely to not respond in dysfunctional ways to exposure to stress. This is extremely important. It's also going to be expensive for our society. But I think what we've seen, I think what we've finally seen is that there's an absolute need to take care of the health of our population in ways that we have never done before. Hopefully this is a tipping point for our culture. I would certainly want to think that you would be coming back on the show because there's so much more for us to talk about. We have a few minutes left. Could we kind of direct this part of the show maybe toward harm reduction? What has it meant by harm reduction? Because I think, again, that's an area where the general public really doesn't understand what that means. Harm reduction is how we look at it is we individualize our treatment for our patients. We have a patient that comes in that's been using opiates, let's say heroin, maybe eight bags of heroin every day for the last 10 years. Our goal right now is to get them off that heroin and get them abstinent free. That's our ultimate goal. But it takes time. So maybe in two months, they're still testing positive maybe for heroin, but they're not using as much. We really encourage our patients to be open and honest with our counselors so we can adjust one, the levels of their medication. Methadone, buprenorphine are very similar in how it works is we have to find that right level where you're not craving to go get more of these opioids and you're not withdrawing. You're able to sleep at night. You're able to work and have a sustainable life. So the harm reduction is we have to get there. Let's get there. And it's different for everybody. Some people maybe after three months, maybe after three weeks will have no illicit drugs in their system. Some people might take longer. But people always ask me how long does someone have to be in an MAT program or on methadone or buprenorphine. It's different for everybody and it should be. That should never change. It should be individualized. Now I will tell you this. If I get a gentleman that's 55 years old that walks in my clinic, has been living on the street, has no families, has no doctor because he's burned all those bridges and in a year or 18 months has a job, has a roof over his head, is feeding himself, taking care of his bills, looks physically healthy. That might be as good as it gets for him, which is great. That's when we take that next step and say, okay, let's decrease your medication, let's start a taper planned and we slowly reduce that. We monitor it very closely because we don't want those cravings to come back. If we start reducing the levels of methadone or buprenorphine that they're getting and they say to us, I didn't sleep last night, I got the shakes, whatever the case may be, we might hold it right there. Let's hold it right there for a little while so you have you feeling in a couple of weeks So it seems like in a very non-judgmental way in a very medically based way you join the patient where the patient is and you begin to reduce the harm that the patient's use is doing to them. You don't look for an abrupt cure because science tells us the way the brain is organized and the way the drug affects the brain there's not going to be a quick cure. So you get in there and help the person reduce the harm that they're causing to themselves and maybe causing to society too. I think needle exchange programs are a wonderful example. Do you have any statistics on that needle exchange program? I don't personally. I hear it from Vermont Cares all the time. The statistics are great. They'll put out so many needles and they're getting 98, 99% of them back which I think is great because when a person is battling addiction and they want to use, if they don't have a clean needle they're going to use whatever they can find. So we're talking about AIDS. We're talking about hepatitis C. Hepatitis C is a big one right now. We're talking about life-threatening diseases. It's a harm reduction. Harm reduction. It's not all about the medication. I have to make that very clear. The medication will help us get them stable so they don't have those cravings or those withdrawals. But then it's about the counseling. Giving them the skills to succeed outside of our doors and in society every day. So when something does happen, an opportunity, or they feel like they're going to relapse, they know who to call, they know what to say, and sooner or later it gets engraved in there and they can rely on themselves and be strong and be a support and go to the recovery centers. That's right. The best thing that's happened in Vermont in the last couple of years has been many great things that have happened in the treatment but having journey to recovery up in Newport that was one area that didn't have one. Nice. And it's wonderful to have every county covered now. Yeah. Are we, in some ways, we're speaking about hope that this particular population either approaches or reaches a state of despair. And what they need most is hope. And where they get hope is from outside themselves. It's from you. It's from me. It's from Margaret. It's from Channel 17. It's from recovery walks. Medical doctors. Education. Exposure. That there's a possibility that they can get better. Just a short vignette on the recovery walk on Saturday. They did a call for lengths of recovery. So I've been in recovery for a long time. And, you know, so I was up there on the call for recovery. We went through 10 years, 5 years, 4 years down to months. And it struck me that the last person in the crowd was at the opposite pole from me. Was a gentleman who was my senior by a few years. And he was in recovery for 7 months. And I thought to myself, wow, you know, what I have in common with him, what we share 100% is hope. I have hope for myself. He has hope. He's borrowing from my hope that there's an agelessness for hope. When I walked on the walk, I had my walk buddy. We just kind of, you know, accidentally kind of joined forces myself in this young man who was maybe 25, 26 years old. And we told each other our stories. And he found hope in his first minutes emerging from a coma. And the coma was caused by a lethal concoction of pharmaceutical pills that he had found on the internet. And that he had taken intentionally an attempt to kill himself because of despair. And here he is walking next to me 7 months in recovery, going to a meeting every day, talking the talk using a language full of hope. And that is what it's about. We were reverberating with the general public about this hope for recovery. And I see that in you. I mean, I've always admired you. I've admired the programs that you've created in Vermont. I was telling Jason before the show that one of his treatment centers, specifically in St. John'sbury, is on Hospital Drive. And beautiful, state-of-the-art facility, big, beautiful parking lot, room, counseling offices, for people receiving medication-assisted treatment. This was not always the case. These people were kept in the shadows, even though they were receiving treatment. They suffered a double stigma, the stigma of first having addiction to opioids, and then the additional stigma of needing medication to get better. This is what's changing in our culture today because of people like Jason and thousands of other people in Vermont that are dedicated to doing something about this. I would agree, Ed. I know we've got to wrap up, but hope, you're right. We can't give up hope. We have to remember that every single day. These are human beings. They are people, just like you and I. We all make mistakes. We all battle some form of addiction, whether it means you need to have your coffee every day. You need to bite your nails. You need to have that cigarette. You've got to have it before I go to work or whatever the case may be. Sooner or later, you wake up and with the help and the support of others, hopefully, you'll beat these addictions. Opiates is a stronger one. It's a deadly one. But you can't give up hope. You have to work with the patient, meet them where they're at, help educate them and support them through this, and they will. They will get through it. So, along those lines, I hope you'll come back and join me again. Thanks, Ted. Absolutely. Thank you, Jason.