Stigma and Substance Use Disorder - the Silent Killer | December 14, 2021

February 10, 2022

Information

Gary Mendell, MBA, is the founder and CEO of Shatterproof, a national nonprofit focused on reversing the course of the addiction crisis in America. After losing his son Brian to addiction in 2011, Gary founded Shatterproof to spare other families the tragedy his had suffered. Since founding Shatterproof in 2012, Mr. Mendell has been a national leader in the addiction space creating solutions that will create more access to treatment for Opioid and Substance Use Disorders including the creation of the Shatterproof National Principles of Care to guide providers, payers, and patients to quality treatment. He advocates for state and federal policy changes, and most recently launched a national strategy and call to action to address stigma related to Opioid and Substance Use Disorders.

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To CiteDCA Citation Guide

00:30So good afternoon I'm David Fiellin
00:32and I'm director of the Yale
00:34Program in Addiction medicine.
00:36I wanted to welcome you to today's talk
00:38and are finding solutions to the opioid
00:41crisis speaker series in collaboration
00:43with the Sandgaard Foundation.
00:45We're joined today by Gary Mendell,
00:48who is the founder and CEO of
00:50Shatterproof who will speak on the topic.
00:52Stigma and substance use disorder,
00:55the silent killer.
00:57Before we get started,
00:58we just want to review a
01:00few housekeeping items
01:01on the following slides.
01:05As a reminder, you can learn more about
01:07the Yale program and addiction medicine
01:09and access the Finding solution series
01:11to the opioid crisis speaker series
01:14by visiting addictionmedicine.yale.edu.
01:17Following our program and the Sandgaard
01:20Foundation on Twitter @YaleADM
01:23or @SandgaardFnd and joining
01:26our program listserv by emailing
01:29emma.biegacki@yale.edu
01:34If you be live tweeting today's talk,
01:37be sure to tag us and include the event,
01:39hashtag, #findingsolutions
01:43and #bandtogether.
01:46To participate in today's session,
01:48use the chat box to tag US.
01:51I'm sorry, use the chat box to
01:53share comments and observations
01:55with your fellow attendees,
01:57and post your questions in the Q&A box.
02:01Finally, CME credit is available for
02:04today's event and to receive credit,
02:07please text the code
02:1030847 to the phone number in red.
02:13This information will be provided in the
02:15chat at the beginning of the session.
02:19We'd like to acknowledge the Sandgaard
02:22Foundation for assistance and support
02:24of today's talk, and I'd like to
02:26introduce you to Kyle Henderson,
02:27who's the Executive director of
02:29the Sandgaard Foundation, Kyle.
02:32Thank you so much David.
02:34Honor to be aligned with the old
02:36program and addiction medicine
02:37on this wonderful initiative.
02:39It's been incredible speaker
02:40series this year and we're ending
02:43it on a wonderful high note.
02:45Get Gary Mendell shatterproof,
02:48who's wonderful human being that's got
02:50an incredible story to share and some
02:53incredible insights as it relates to stigma.
02:55Our story starts about 25 years ago.
02:57Thomas Sandgaard founded Zynex
02:59Medical to publicly traded medically.
03:02Medical device company that
03:03helps with pain management.
03:04So we get people off of addictive.
03:07Potentially lethal painkilling
03:09drugs such as oxy etc.
03:12And that's our exclusive focus on the
03:16Sandgaard Foundation and but really what?
03:19That helps people do is get away
03:22from these addictive painkilling
03:24drugs without any side effects etc.
03:26So we've all lost people in our
03:29lives that are very close to us
03:31from this tragic epidemic.
03:33And again, this is our number
03:35one focus on the foundation side,
03:37so we've helped to distribute
03:39over half a million units.
03:40Of naloxone to recovery
03:42homes and hospitals around the
03:44country since January 1st.
03:46We've been helping with sober concerts,
03:48some funding, some films,
03:50and really broadening horizons.
03:51So if you have any ideas for
03:53the Sandgaard Foundation,
03:54please don't hesitate to reach out.
03:56I also run Thomas's investment group,
03:59so we own a football club in England
04:01so it's a little plug for that,
04:03but we do help the club with opiate
04:07related pain issues as well,
04:09so it's it's.
04:10It's very much a part of our
04:12culture on this end and we're so
04:13excited to hear from Gary today,
04:15so Gary thank you for joining us and Yale.
04:18Thank you for all your help with
04:19this wonderful speaker series.
04:22Thank you tile.
04:23So now it's my honor to introduce
04:26Gary Mendell, who's the founder and
04:29CEO of Shatterproof Shatterproof,
04:30is a national nonprofit focused
04:32on reversing the course of the
04:35addiction crisis in America.
04:36Mr Mendell received his bachelor's
04:38degree from Cornell University School
04:40of Hotel Management and his MBA with
04:43distinction from the Wharton School
04:45at the University of Pennsylvania.
04:47He founded ATI Hotels and Resorts
04:50and his former trustee and president
04:52of the Starwood Lodging Trust.
04:55It's really true that that business
04:57world experience gives him a unique
05:00perspective in running a nonprofit
05:02organization like Shatterproof
05:03since founding shatterproof in 2012.
05:06Gary has been a national leader
05:08in the addiction space,
05:09creating solutions that will create
05:11more access to treatment for
05:12opioid and substance use disorders,
05:15including the creation of the
05:17shatterproof national principles
05:18of care to guide providers,
05:20payers and patients to quality treatment.
05:24He advocates for state and
05:26federal policy changes,
05:27and most recently launched the
05:29national strategy and call to action
05:31to address stigma related to the
05:33opioid and substance use disorders
05:35that you will hear more about today.
05:38Personal note what has impressed me
05:40most about Gary and Shatterproof's
05:42work is the extent to which they have
05:44taken a laser focus on the untapped key
05:46levers of change in the field of addiction.
05:49These include evidence employers and payers
05:54quality transparent access and stigma,
05:58as you will hear today.
05:59History is how of how an outsider
06:02became an insider and decided enough
06:05was was enough and how he'd erupted,
06:07disrupted the business as usual.
06:09Model for the better.
06:11Gary,
06:12thank you for speaking
06:13with us today.
06:15David, thank you, Emma.
06:18Thank you, Tyler.
06:20Thank you for all the all the
06:23support of the Scanguard Foundation.
06:26And for this event for Yale and
06:30all of you, not only bringing.
06:33Awareness right now and attention to the
06:36addiction crisis in the United States.
06:38But also for solutions.
06:42For solutions through this
06:44speaker series finding solutions.
06:47Speaker series sponsored by Yale
06:51in the Sand Garden Foundation.
06:53And I also want to acknowledge and
06:56appreciate the Scanguard Foundation
06:57and the Hartford for all their
07:00support from for these initiatives,
07:02for shatterproof in the Yale
07:04Program in Addiction Medicine.
07:06So thank you all for having
07:08me and their support.
07:10And I'm honored to be here.
07:13I'd like to begin by telling
07:15you one story of two boys.
07:18Boys were growing up in a small
07:20town where I was raising my family.
07:22Eastern Connecticut the year is 2004.
07:26And both boys were in high school.
07:30The first Mikey was diagnosed with cancer.
07:34As you'd expect, his family was devastated.
07:38However, they were easily able to access
07:41the highest quality medical care.
07:43All based on science.
07:46Mikey's parents told their friends
07:48about what Mikey was struggling with.
07:51And I remember it like it was yesterday.
07:53Our entire town rallied
07:55behind Mikey and his family.
07:57Fear, excuse me.
08:00Pair families came to their
08:04home with cooked meals.
08:05Drove carpools and the kids in our element.
08:09Our elementary school held bake
08:11sales on the weekends for Mikey
08:13and his new charity for cancer.
08:18In the whole time Mikey was sick.
08:20He received all the love and
08:22compassion that anyone with the
08:24disease could ever ask for.
08:29Or two streets away.
08:31My son Brian was also
08:34struggling with the disease.
08:36But for Brian and our family.
08:38It was so different.
08:40Like Mikey's parents,
08:42we look for medical care for our son.
08:45But unlike Mikey's parents,
08:46we couldn't find treatment
08:48that was based on science.
08:52Unlike Mikey's parents,
08:54I didn't tell any of our friends
08:56with Brian was struggling with.
08:58To be honest. I was embarrassed.
09:02I felt ashamed as a father
09:05as a like a failure.
09:07And our community didn't rally behind us.
09:11No cook meals, no carpools.
09:14But even worse. Unlike Mikey,
09:18when he came home from treatment,
09:20he found a welcoming community with kids
09:23with bake sales to raise money for him.
09:26When Brian came home to visit.
09:29There were no bake sales.
09:31There was no welcoming community.
09:34It was just silence.
09:36The disease my son struggle
09:38with with addiction.
09:42A little bit more about my son.
09:45When he was born. He was.
09:48He was the Simon I'd always dreamed of.
09:52Always smiling, always hugging me,
09:55my little companion.
09:58And as he grew into a young boy,
10:00he did many of the things
10:02that young boys do.
10:03He used to like play in his room
10:05with his little trucks forever.
10:07Or run around the backyard
10:09chasing butterflies.
10:12And then as he grew into a teenager,
10:14he did many of the things that teenagers do.
10:17Including trying beer, wine and pot.
10:22However, for Brian,
10:23that's where things changed.
10:27His use escalated. And he needed
10:30to go to treatment where he went.
10:32In over 8 years he went to 8
10:35different treatment programs and
10:36his use escalated tragically into
10:39harder and harder drugs. Eight years,
10:42eight different treatment programs.
10:44Every treatment program was the same.
10:49Not one of them treated my son.
10:52It's with treatment protocols
10:53that were based on silence,
10:55so excuse me based on science.
10:59However, there was one difference
11:01between another difference
11:02between Mikey and Brian.
11:04When Mikey was going to treatment
11:06based on that was based on science,
11:09that's what he was battling his disease.
11:12When Brian was going to treatment.
11:15Going to treatment programs that were
11:17not following science based practices.
11:19He was also battling something else.
11:22Shame stigma.
11:26When I think back on those years.
11:29There were some good times
11:30and there were some bad.
11:31There were times that Brian wouldn't listen.
11:34But there were other times that Brian
11:36went at it with so much enthusiasm.
11:40I remember so many good times and I also
11:43remember one time I visit him I visited him
11:46in Florida at a treatment program he was at.
11:49I flew in really late the night before.
11:53And the next morning I set my alarm
11:55early early to be honest with you
11:57I I just wanted to watch him sleep.
12:00I hadn't seen him in five months.
12:03So I walked into his bedroom at
12:067:00 o'clock in the morning.
12:08And he surprised me he was already up,
12:10especially if he knew Brian.
12:11He was up 7:00 o'clock.
12:13I walked into his room,
12:14and when he heard me come in.
12:16He looked up at me with that big
12:18smile of his 'cause when I walked in.
12:20He was laying there on his bed flipping
12:22through the pages of his treatment book.
12:24He heard me looked up at me
12:26and he smiled and said, dad?
12:28Don't worry. I got this.
12:31I'm going to beat it.
12:34But addiction always doesn't work that way.
12:37On October 20th, 2011.
12:40I was waking up in the middle of
12:42the night by my cell phone, right?
12:44When I picked it up,
12:45I was told that my son had just died.
12:49He was 25 years old.
12:52And he hadn't used a substance in 13 months.
12:56Equally tragic.
12:59It wasn't just addiction that
13:01took my son's life.
13:03It was the feeling of shame.
13:05He had every morning when he opened his eyes.
13:10Of all day long.
13:12Being looked at.
13:13As the other kid who wouldn't
13:15try hard enough.
13:19It caused him to wake up that morning.
13:21Research suicide notes.
13:23Write a note of his own.
13:26Integ his own life. Alone.
13:33And ever since that day, I've continually
13:35asked myself the same question.
13:37If both boys had a disease,
13:39why the story is so vastly different?
13:43Science tells us that addiction is a disease
13:45just like any other its causes or genetic,
13:48biological and or environmental.
13:51How many most of our society disagrees?
13:55They say those with this
13:57disease have a character flaw.
13:58And they and their families.
14:01Or isolated? Judged stigmatized.
14:06And silenced.
14:09The answer to my question.
14:11Mikey was a patient.
14:13And Brian was an outcast.
14:20Two weeks later, after my bride,
14:22after my son passed away.
14:26My wife came into our bedroom
14:28and found me crying on the bed.
14:30I thanked her for having
14:32frame the serenity prayer and
14:34placing it on my night stand.
14:36And I told her that the only
14:38thing that was keeping me alive.
14:40Was reading that first sentence
14:42over and over again.
14:44God grant me the serenity to
14:47accept what I just can't change.
14:51Brian would not be coming home.
14:56However, as the weeks went on.
14:59I began to read and think
15:01about that second sentence.
15:03The courage to be able to
15:05change the things that we can.
15:10The wisdom to know the difference.
15:13And as I did so, I began
15:15to focus on 2 questions.
15:18What could I have done
15:20differently as a father?
15:22And what could be done to spare
15:23other families of the tragedy
15:25that our family had suffered?
15:29And with Brian in my heart.
15:32It took time away from my business
15:34and I traveled the country for three
15:36months in search of answers to those
15:39two questions. And as I did so.
15:42I learned so much that I hadn't
15:45learned when Brian was alive.
15:47I learned how pervasive this disease was.
15:51Over 20 million Americans with a
15:54substance use disorder. Third large,
15:57which is 1/4 of American families.
15:59Excuse me, one quarter of American
16:01families, mother, father,
16:02son or daughter were more than one.
16:07I also learned it's a third
16:08largest cause of death in this
16:10country behind heart and cancer.
16:12Third largest. And it was growing
16:16every year and no one seemed to care.
16:21I also learned that it's
16:23mostly about our children.
16:25Eight out of 10 of those addicted.
16:29Weird **** have been become addicted before.
16:31They're eight had become addicted
16:33before their 18th birthday.
16:34Not 100% but 80%.
16:38Because their brains are
16:40not fully developed and not,
16:41and those teenagers don't have the
16:44ability to protect themselves and we as
16:47a society are just letting it happen.
16:51But the next thing I learned was the worst.
16:55I wrote on a piece of paper the word tragic.
16:59When I wrote that word, I remember it
17:01like it was just like a minute ago.
17:03It was like my son had
17:06just died all over again.
17:08I learned that our federal government had
17:11provided grants of 10s of billions of dollars
17:14to researchers all all across the globe.
17:17And those researchers had successfully
17:20used that funding and created
17:22this wonderful body of knowledge.
17:24Knowledge it had proven without any
17:27doubt to randomly control trials.
17:30Be able to significantly prevent
17:31many of our loved ones from ever
17:33developing the disease of addiction.
17:38And also knowledge I had proven without any
17:41doubt also the randomly controlled trials.
17:45To be able to significantly
17:47improve outcomes for those who
17:49had developed this disease.
17:51Get all this information was sitting
17:53in peer reviewed medical journals.
17:55All the researchers knew it.
17:57And hardly any of it is being implemented.
18:01I read and learn about,
18:03learned about information that
18:05could have saved my son's life.
18:08And literally hundreds of
18:09thousands of others.
18:11It had if it had only been implemented.
18:13If I had known about it.
18:17Implemented in our healthcare system,
18:18our communities and our families.
18:22And in a businessman from a businessman,
18:24I looked at it in two ways.
18:26Work from a career in business one?
18:28How could this be?
18:30How could all this information
18:33sitting there not being used?
18:35But I also saw an opportunity.
18:39An opportunity to get this
18:41information out there and save lives.
18:45Information existed today that
18:47could start saving lives tomorrow.
18:49In all we needed to do was get
18:53it implemented. And from this.
18:56Of vision began to emerge.
19:00That our society would look this
19:02disease straight in the eye,
19:03prevent it and treat it with
19:06programs based on science.
19:09Without any shame, judgment,
19:11or stigma.
19:15And seeing this vision.
19:18I soon left my business and have
19:19dedicated the rest of my life
19:21to this cause and from this our
19:23organization shatterproof was born.
19:29As I speak to you now. I miss
19:34my son horribly. All the time.
19:40And I now know that if I had
19:43better understood this disease.
19:45He might have died, nor had uttered
19:48more potentially many others.
19:51But even worse, far worse for me.
19:57Is now better understanding shame and
20:00stigma than I did when he was alive.
20:03And thinking about what he felt.
20:06The last eight years of his life.
20:10It kills me greatly.
20:15However. In many respects many respects.
20:21I feel wonderfully blessed.
20:24I've had the opportunity meet so many
20:26wonderful people all across our country.
20:29Hundreds of thousands have now
20:30joined with us, dozens of states,
20:33hundreds of companies,
20:35and together together.
20:36We are making our vision a reality.
20:41So with that. I'd love to show you
20:45a short video that brings to life.
20:47Some of the people that have joined with us.
21:05I think we need to add the sound Emma.
21:10I apologize about that. Give me
21:11one second and I will re share it.
21:21This is why we do audio tests.
21:26Let go.
21:47While we are rightly focusing much of
21:49our nation's energy on coronavirus,
21:51this is not the only health
21:53crisis we are battling.
21:54Unfortunately, across the nation,
21:56drug overdose deaths are
21:58rising among the coronavirus.
22:00Negating much of the
22:01progress that we made over
22:02the last several
22:18Dear Brian, dear Greg, Michael honey,
22:20from the moment you were born.
22:22You were the sweetest kid.
22:24You brought us such joy and happiness.
22:26Thank you for those 29 years.
22:36We have a vision, but our society will
22:38look this disease straight in the eye,
22:41prevent it and treat it with
22:43love and empathy. And with protocols
22:46based on science.
23:12We are coming together to increase
23:13awareness and funding for the prevention,
23:15treatment and recovery of this disease.
23:17I'm repelling from my son, Paul.
23:19I'm repelling from my dad,
23:20I'm repelling from my sister-in-law.
23:24Go shatterproof.
23:27We are here for friends.
23:29We are here for family.
23:32We are here for community
23:33and we are here to bring the
23:36disease of addiction out of the
23:39darkness and into the light.
23:58My older son Brian struggled with addiction
24:00for eight years and during that time he
24:04went to 8 different treatment programs.
24:06Each one was different after Brian's death.
24:09I was haunted. What could be done to
24:13spare other families from this tragedy?
24:14Shatterproof is currently developing
24:16public databases and multiple states that,
24:19if successful, will allow the
24:21public to identify, evaluate,
24:22and compare substance use treatment programs.
24:26I would like to extend my appreciation
24:28to President Bill Clinton,
24:30Chelsea Clinton and their
24:32Health matters initiative.
24:33I'm very grateful to be here today
24:35at a critical time to talk about
24:39why we must tackle this issue.
24:41In what Congress must do
24:43to tackle this issue,
24:44we need to start treating people
24:45in this country, not jailing them.
24:47We need to give them the
24:49tools they need to recover,
24:50because every life is precious.
24:53Every life is an individual gift
24:55from God and we have to stop
24:58judging and start getting them
24:59the tools they need to get better.
25:00I don't think about this issue as a public
25:03official or as a health care guide.
25:05I think about it as a father.
25:06I've talked to people who've
25:08been in the middle of this.
25:10They're among the grittiest and
25:12gutsiest people I've ever met,
25:13and they deserve our respect
25:16and our love and our support.
25:18Let's create that world that
25:20Brian didn't see.
25:21Let's create that world for the next
25:23young man that comes along the next
25:25young woman that comes along the next family.
25:28Let's drag addiction out of
25:30the shadows into our hearts.
25:33I can't imagine a more perfect
25:36expression of humanity.
25:37Thank you.
26:07So am I. You can move right on to
26:10the next slide. That would be great.
26:13Perfect thank you. So thank you everyone.
26:17I mean I just I just feel so blessed
26:20to be side by side with so many
26:23wonderful people all across our country.
26:25Thank you. As you can see here,
26:29our work falls into three
26:30areas that we have focused on.
26:33Number one is transforming
26:34the treatment system.
26:35United States #2 is educating our
26:39families and #3 ending addiction stigma.
26:43And I'm really proud to say that our
26:46work is not only saving lives today.
26:49But we're changing the system.
26:51We're changing the way that addiction
26:53will be prevented and treated.
26:55For generations.
26:56For our children, our great grandchildren.
27:01Our great, great grandchildren.
27:04So as I mentioned,
27:06three areas related to transforming
27:08addiction treatment.
27:09We are doing several things.
27:11We are working with states to
27:13adopt A payment model that has
27:16proven to improve outcomes by 50%.
27:19We are also working with the United
27:21States Senators and Rep and House
27:24representatives for national standard
27:25for the education of healthcare
27:27provision professionals and the
27:29prevention and treatment of addiction.
27:31If signed into law.
27:34This will bring addiction treatment
27:36into our health care system finally.
27:40We have also developed our nation's
27:43first ever. National quality system.
27:45National quality measurement
27:47system for addiction treatment.
27:49In this next short video will
27:52provide you an overview of our
27:54quality measurement system Atlas.
28:01Addiction is a treatable chronic
28:04disease like diabetes or asthma
28:06and similar to other diseases.
28:08Personalized addiction treatment based
28:10on science is shown to help people
28:13manage their disease and enter recovery,
28:15but you may not know what type of
28:18treatment you need and searching for
28:20quality care can be overwhelming.
28:22When faced with misleading advertisements
28:24and other confusing information,
28:26it's hard to know who to trust
28:28and what treatment works best.
28:30The national nonprofit Shatterproof has
28:32created Atlas to help you navigate to
28:36the care that meets your specific needs.
28:38Database and transparency is the
28:41type of information that American
28:44families deserve to have,
28:47and they deserve to have it.
28:48Now.
28:48When you're ready to search,
28:50you can use Atlas to sort through addiction
28:53treatment by factors important to you,
28:55like location, services and insurance,
28:58and payment options.
29:00Experts agree that certain practices
29:02should be used when treating addiction.
29:04Atlas displays information on whether
29:07facilities offer these best practices.
29:10We also make it easy for patients
29:12to leave feedback on their
29:14experiences at the facilities.
29:16And display this information
29:18to support your care decision.
29:20As you explore options,
29:22compare up to three facilities
29:25side-by-side to help choose
29:27treatment that is best for you.
29:29Among many others,
29:30I lost three of my friends to
29:32overdose all from the same sober
29:34living in the San Fernando Valley.
29:37And now I think,
29:38what if they had some access to
29:41something like Atlas in 2014?
29:43It's not a new idea.
29:44Shatterproof is finally doing it,
29:46and they're doing it right.
29:49I imagine my departed friends,
29:52having had a universal starting point.
29:55When they might have used to
29:57pinpoint a path to true recovery,
29:59and they might still be here.
30:02We've got to stop losing people
30:04this way and we are going to
30:06stop losing people this way.
30:08And Atlas is absolutely going to help.
30:11At Shatter proof,
30:12our goal is to help you find care that
30:15best meets your needs and leads to
30:17improved health and long term recovery.
30:19We are also invested in supporting
30:21the addiction treatment system in
30:23aligning with these best practices.
30:25Ultimately, this will save lives.
30:29Atlas is the first resource of
30:31its kind to help those seeking
30:33additional addiction treatments
30:36helps them to find high quality
30:38care and appropriate care.
30:40It was launched in six states.
30:42I'm happy to say West Virginia
30:44was one of them, with the hopes
30:46expanding it to many more.
30:58Thank you, Emma. If you could just go to
30:59the next slide would be great. Thank you.
31:04So as you heard, we were launched at Atlas,
31:07launched a year and a half ago in
31:10July 2021 to 2020 in six states.
31:13Knows of the states in orange on this slide.
31:17In this slide, which prepared just weeks ago,
31:21we were expanding into
31:23five additional states,
31:24but I'm thrilled to say just in the
31:26last weeks we have two additional states.
31:30So with the 12 choose me the 13 states
31:33that are now fully funded for 2022.
31:37Atlas, where we will be available to 38%
31:41of the families in the United States.
31:44We're going from 13% this
31:46year to 38% next year.
31:50Because of the size of the States and the
31:52new states are Washington and Connecticut
31:54and I want to thank Yale for their
31:56help in bringing Atlas to Connecticut.
32:00It's just an unbelievable resource
32:01that has never existed before and
32:04we're talking to half a dozen other
32:06states right now to move into to
32:08bring it to their families as well.
32:10Next slide, please.
32:13The second area that I spoke
32:15about I mentioned three areas.
32:17Movement system.
32:18And two is getting the right
32:21information to families.
32:23That's based on science.
32:24The issue today in our society is
32:27there is so much information out there
32:29on the Internet about this disease.
32:32Some of it is based on science
32:34and some of it.
32:35A lot of it is not and it's
32:37a lot of information.
32:39So as a family member,
32:40how do you find the right information?
32:43Well, to solve this,
32:44we've done two things, number one.
32:47We have gone through all
32:49the information out there.
32:51We spent two years and hundreds of
32:53thousands of dollars doing this.
32:54And we condensed into six lessons
32:58of five minutes each.
33:01An education program for families.
33:0330 minutes, six lessons,
33:045 minutes each.
33:06You can see the topics there on
33:08on the right side of this slide.
33:10And we're distributing it through employers.
33:13And you can see some of the
33:15companies that have joined with us
33:16to provide it to their employees.
33:18That list is is we now have 50 partners.
33:20We can't fit them all on one slide.
33:22It's actually actually as of last
33:24week 60 partners that are giving
33:26it out to their their employees.
33:28We just I just also added
33:30states which are also employers.
33:32The state of Pennsylvania and the state
33:34of North Dakota for their state employees.
33:36The City of New York all 5
33:39boroughs for their employees.
33:40It's also convertible to Spanish.
33:42We're reaching over.
33:43One million families right
33:45now with this information.
33:46That's good, but it's not enough.
33:48It needs to be 10s of millions of families.
33:52We've also look at the results here
33:55on pre and post surveys of some
33:57of the people that have that have
34:01taken this educational program.
34:03And again, this is completely anonymous,
34:05but for those who took a survey
34:07in the beginning and at the end
34:10online completely anonymous,
34:11I now how to help.
34:13I know know,
34:14I now know how to help a
34:16family or excuse me,
34:18help someone addicted to drugs and
34:20alcohol pre taking the lessons 39%
34:22after taking the six lessons 80%.
34:26I feel confident I could recognize
34:28the signs of drug or alcohol
34:31addictions from 53% to 85%.
34:35This session is about stigma.
34:37Let's look at the bottom question.
34:39People who are addicted to drugs and alcohol.
34:42Are not at fault for their addiction.
34:44It went from 62% to 82%.
34:47Look at how well it's working.
34:51Next slide, please.
34:54We've also provided a lot of
34:57this information on our website
34:58in two sections in the learn
35:01section in the Find Help section.
35:03And this is reaching millions
35:05of families also.
35:06My next slide please.
35:12Actually, if we can take off slides
35:14for now, we'll come back to this.
35:19So I mentioned the two of the three areas.
35:22Transforming the addiction treatment system.
35:25In providing highly curated science
35:28based information for families.
35:31However. We can do more.
35:35And we must must do more.
35:38So I'm here today to ask for your help.
35:42Your help in what I believe.
35:44Is the most important but
35:47also difficult obstacle.
35:49That we as a society must overcome.
35:53It's the way that we
35:55think about this disease.
35:56The way we speak about it,
35:58the stigma would we attach to it?
36:02If you think about it,
36:03we don't ask people to line up in
36:06public shaming rituals who have cancer.
36:10On the sidewalk to get their chemotherapy.
36:14We don't tell someone who's a diabetic.
36:17That the very medication
36:19that can save your life.
36:21Can't be carried in on an ambulance.
36:23Or in an ambulance.
36:25We don't tell someone with heart disease.
36:28Who has not followed
36:29their treatment protocol?
36:30You must go to jail. Yeah, we do.
36:34All three of these things with those
36:36with the disease of addiction.
36:38Stigma extinguishes the very hope.
36:41And self respect that someone
36:44battling and a difficult disease.
36:47So rightly needs.
36:49And deserves.
36:53So I'd like to ask that each of you take
36:56a moment right now and think about how
36:59stigma might be affecting your thinking.
37:02Are there some of you were listening
37:05right now? Who have someone in
37:07your family is who is addicted.
37:09And because of stigma.
37:11Are you ashamed to tell others?
37:14The way I was.
37:16If so, how do you think that
37:18makes your family member feel?
37:22Are there some of you who this
37:25disease has not touched your
37:27family yet or hopefully never?
37:29And the stigma cause you to think.
37:32This could never happen
37:33to someone in my family.
37:35I'm too good a parent.
37:37In the same way that substances
37:40distort a drug user's thinking.
37:42Is it possible that stigma
37:44has distorted years?
37:48If we as a society can change the
37:50way that we think about this disease.
37:53More people will feel loved and connected.
37:57More will seek treatment.
38:01More or less will feel the shame and
38:04stigma that my son fell in so many others.
38:08Fewer will die.
38:11And fewer families will be shattered.
38:13Beyond any repair. As has mine.
38:24To better understand the depth and
38:27severity of addiction stigma because
38:29it is so important shatterproof
38:31in collaboration with the Hartford
38:34Ipsos and Indiana User University.
38:37Conduct recently conducted the
38:39largest and most comprehensive survey.
38:42Of addiction stigma ever done ever?
38:46And the data is extremely troubling.
38:5075% of the public do not believe that a
38:53person with a substance use disorder is
38:56experiencing experiencing a chronicle.
38:58Medical loans such as diabetes,
39:00arthritis or heart disease.
39:0451%. 51% or unwilling to associate
39:08with someone with a substance use
39:11disorder as their close friend,
39:13neighbor, co-worker.
39:14We're marrying into their family.
39:20But even more troubling, far troubling.
39:24People that receive evidence
39:26based treatment still experience
39:27much of this public stigma.
39:3137% of the public.
39:33Is still unwilling to associate
39:35with someone as a friend, coworker,
39:37neighbor, or marrying into their family.
39:41For someone who has received evidence
39:44based treatment and continues to
39:46receive evidence based treatment
39:48and whose symptoms have been under
39:51control for a year or longer.
39:53Think about that someone received treatment.
39:56Is doing totally fine.
39:59Hasn't had any symptoms for over a year.
40:02And more than 1/3 of the public is still
40:05unwilling to associate with that someone.
40:07As a friend, co-worker, neighbor,
40:09or marrying into their family.
40:12This is why the third segment of our
40:14work is directed ending the stigma
40:17so unjustly associated with this
40:19disease that was afflicted with it,
40:22their families,
40:22and the medications that treat it.
40:28So I'd like to share a few slides
40:30that that tell you a little
40:31bit about our work and stigma.
40:33Number one everything we do.
40:36It's the word proof,
40:38and shatter proof is based on science.
40:41So so the study stigma.
40:43We work with one of the leading
40:45consulting firms in the world.
40:49And we studied first.
40:50Can we reduce and ultimately
40:52end the stigma of addiction?
40:55And if we decided we couldn't,
40:56we'd stop our work.
40:57But if we felt we could,
40:59after a few months of work, we'd continue.
41:02After a few months we felt we
41:05could reduce it and we worked
41:06for the for an entire year.
41:08We studied 11 analogous social movements.
41:12How did our country change
41:13its views of HIV AIDS?
41:15How did our country change its views
41:17of marriage equality and all the
41:19other social issues listed there?
41:22We prioritized and read and reviewed
41:25over 100 pieces of published literature.
41:27We conducted hour and a half individuals
41:30individually with 50 experts who went
41:33through those 11 social movements.
41:36And bringing together the
41:39literature in the interviews.
41:41We put together a national strategy
41:43to to reduce the stigma of addiction.
41:48Next slide, please.
41:52Our work that we put together
41:57a national strategy involved.
41:596 sectors of our society.
42:02That we would provide.
42:04Easy to use toolkits in three areas.
42:08Educating changing language
42:11and changing policies.
42:15In one of those sectors was state the states,
42:18one of those six sectors.
42:21And and with anything you can't
42:23start and do everything all at once.
42:25We started with a state based
42:28initiative that we thought,
42:29based on the research would work,
42:31but it was a pilot we weren't sure.
42:34It involved educating.
42:37Educating with what's called
42:39contact based education.
42:41It's not about words on a piece of paper.
42:44It's not about convincing somebody with words
42:46on a piece of paper that this is a disease.
42:48Showing a picture of a brain.
42:51Now this was about stories of people
42:54who had in recovery doing well.
42:58We use social listening technology
43:00in in the state of Pennsylvania and
43:04found almost 1000 people that had
43:07been talking about their recovery
43:09from opiate addiction online.
43:11In social channels.
43:15We we cut down that list by a couple 100
43:17and we reached out to them to see who
43:19would be willing to share their stories.
43:22That took the list list a little smaller.
43:24We then had our interviews with each
43:27of them and narrowed the list to 200.
43:30And we have now collected stories,
43:31either short videos or a picture in a
43:35paragraph of 200 different individuals
43:37who live in the state of Pennsylvania.
43:40Who fall into different categories.
43:42Some white collar,
43:43some blue collar black, white, brown.
43:47Suburban urban rural and
43:51they each tell their story.
43:54And the story.
43:55Based on prompts that we have given them
43:57the story, the message that we know
44:00that we thought through research would work.
44:02Is hi I'm Johnny. I work at Walmart.
44:07I've been here 10 years.
44:09I've been promoted three times.
44:12I have a family I coach Little
44:14League on Tuesday nights.
44:15I have barbecues on Saturdays in my
44:18neighborhood for our neighbors and friends.
44:20And I'm addicted to heroin.
44:23But that's OK.
44:25My life is beautiful.
44:27My life is beautiful.
44:28I've been treated with evidence
44:30based treatment.
44:31And I'm doing great.
44:33And that changes the perception of,
44:35yes, you can work next to somebody
44:38who's been treated and doing well.
44:40You can live next to somebody they can marry,
44:42enter your family.
44:43They can be your friend.
44:45In that every story is
44:46exactly the same obviously,
44:48but that theme that they're doing well.
44:52And then we take those stories and
44:54we and we distribute them through
44:57on social media and three channels.
45:00And state in Pennsylvania we form
45:02relationships with seven with 75 to
45:0578 community based organizations and
45:08we give them the content for free.
45:10And they distribute it out
45:12through their channels.
45:13And it's not.
45:14US leading this driving this a
45:17national organization.
45:18We've formed partnerships with
45:20those community based organizations
45:22and they're part of this with us.
45:24When we hold monthly webcast
45:25where we all do this together.
45:27And they get it out through your
45:29channels and we help them teach them.
45:31Best way to get this out
45:33through their channels.
45:34And then we add a little bit of of
45:37of paid media boosting in certain
45:39geographic areas that we believe it's
45:41important to get the information out.
45:43So we're hitting everyone.
45:45We also engage with digital influencers.
45:49We engage with them and it's not someone.
45:52You know it's not someone on a celebrity
45:55who has a million followers now.
45:58This is the local pastor who
46:01has 15,000 followers and people
46:03trust in their community.
46:05It's the local Baker,
46:06the local school Superintendent,
46:07the local local Little League
46:09coach who have 10 to 55 to 15,000
46:11followers and they get it out
46:14through their channels.
46:15And then we have a state based
46:16website that gets it out.
46:19And the results are phenomenal.
46:21Better than we expected.
46:22This was a pilot,
46:23we weren't sure it was going to work.
46:25It was based on research,
46:26but we had to prove that it worked
46:28for ourselves and the state.
46:29And if you can go to the next light please,
46:31I'm thrilled to show you these
46:33results after just six months.
46:35We reached almost a quarter of the
46:3713 million people in the state.
46:39We reached 3 million people.
46:41And for those 3 million people that saw
46:44our content, look at the differences.
46:47It's addiction, opiate addiction.
46:48The state wanted to focus
46:50on opiate addiction,
46:50but we can do it all substance use disorder,
46:53or just opioids.
46:54The state wanted to start with opioids.
46:57Is opiate addiction and medical
46:58illness like other like other
47:00chronic illnesses 58% to 66%?
47:04Are medications effective 21% to 43%?
47:09Null oxone which you carry it to
47:11help save someone's life 49% to 65%.
47:15I would be willing to have a person
47:18with opiate use disorder as my neighbor.
47:2238% to 52%. It's now running.
47:26Look at these results.
47:27It's now running a year and we're scrubbing.
47:31We have the year the one year
47:33results were scrubbing them
47:34and they'll be released soon.
47:36In the coming weeks.
47:39The state of Pennsylvania is
47:41so thrilled they just extended
47:43this program for two more years.
47:45And they gave us additional money
47:47to create a new pilot in two of
47:49their hospitals to see how we can
47:51reduce stigma of professional medical
47:53professionals in the hospital.
47:54Doctors and nurses.
47:56The state of Oregon excuse me.
47:58The States of Kentucky in Colorado
48:01saw these results and we just started
48:04November 1st with this state based
48:07campaign in Kentucky and Colorado.
48:10And we're expecting to announce two
48:12other states in the next four to five weeks.
48:15The results are just too powerful.
48:17It's science based.
48:18It's work, it works.
48:19It's not about creating impressions,
48:21it's about these results.
48:27On next slide please.
48:30So if you want to learn more about this.
48:33Please feel free to reach out
48:35at shatterproof on our website.
48:36There's a contact, there's information,
48:38there's information there
48:39where you can contact someone,
48:41or if you want to learn about our
48:45stigma initiative specifically.
48:47Reach out to Matt at M.
48:49Steven koatshadowproof.org.
48:55I want to close with.
48:59Sharing that. As I mentioned earlier.
49:03My son didn't die of an overdose.
49:07He took his own life.
49:11So why? Why did someone?
49:1625 years old, physically healthy.
49:19Hadn't used a substance in 13 months.
49:21Had a great relationship
49:23with his family and friends.
49:26Why did someone with that
49:27profile take his own life?
49:32I've never had to wonder. 'cause he
49:35wrote about it in his suicide note.
49:38After telling us all how much he loved us.
49:45And about feeling so bad about the shame he
49:48had brought to our family. He wrote dad.
49:53It's about not being treated as a human.
49:57After I tried so hard to get back to normal.
50:02My son didn't see a world where as a
50:05young man he could develop a disease,
50:08get treated in our health care system.
50:11By trained professionals. Get better.
50:15And live a full and fulfilling life.
50:20Well, I'm here to ask to to
50:23ask you today to join with us.
50:26Please let everyone know
50:28that change is coming.
50:29Because it is coming. And together.
50:32We can end the stigma of addiction.
50:35We've proved that in the
50:37state of Pennsylvania,
50:38we're going to prove it in two hospitals.
50:40We're going to prove it in other states.
50:42We're going to bring it to to health
50:44care providers across the country.
50:46We're going to bring it to employers.
50:48We're going to bring it to
50:50the criminal justice system.
50:51We're going to bring it
50:52to media entertainment,
50:52and we're going to bring it to our
50:55local communities and together.
50:56We can do this shadowproof
50:58could never do it on our own.
51:01But working together we can.
51:04So thank you.
51:05And I'm really honored to be here today.
51:09And I'm thrilled to take any questions.
51:12Thank you.
51:16Thank you Gary. I wish you were here.
51:18We could give you a standing.
51:20Ovation and round of applause,
51:22but more importantly really appreciate.
51:26Your openness and willingness to Share
51:28your story and the way you've taken that
51:32story as a as a message and a impetus
51:35to to change the system so that things
51:38don't have to be the same for others
51:41as they unfortunately were for you.
51:43So thank you for for that work.
51:46We've had a couple of questions
51:48that I want to share.
51:50I think most of them have to do with
51:53making sure folks know that they'll be
51:55able to access this event afterwards.
51:58If you've registered for the for the session,
52:02then you will receive a link following the
52:05session that will allow you to access this.
52:08And please feel free to share
52:11that with your colleagues.
52:13Gary, I'm going to take the sort
52:16of the host prerogative to.
52:18To ask you about the issue
52:21that you briefly touched on,
52:22which is the stigma.
52:24In the lack of perhaps understanding
52:28and maybe the two are interrelated.
52:31Within the health care system within
52:34health care professionals and what what
52:36are the what are the options that we
52:39have about about changing that because?
52:41You know you would think if if somebody
52:43came to a health care professional,
52:45then those individuals should be poised
52:48to to provide the least stigmatized
52:52and most evidence based care.
52:55But unfortunately,
52:56that's not always the case,
52:58so thoughts on that. Sure.
53:03For the pilot again state based.
53:07Changing the way the public
53:09feels about this disease,
53:10which then pushes down to structural stigma
53:13and self stigma and medication stigma.
53:15We've proven it. We know how to do it.
53:17It's working, we're adding.
53:18We just added two more states.
53:20We're going to add others,
53:20and we're going to.
53:21We're going to get better and better
53:22as we do this related to changing
53:24the stigma in the healthcare system.
53:27We have a pilot, so it's not proven yet.
53:30That we're starting in two hospitals
53:32in the state of Pennsylvania.
53:35We're looking for funding to test it in
53:37two to five other hospitals somewhere else.
53:39So we have a large enough sample size,
53:42and we designed a pilot that has
53:46three options randomly controlled.
53:48We'll be we'll be doing things in three
53:50different ways and see what works better,
53:52or if they all work or what
53:54works better or they don't work.
53:56We're going to learn something so number one.
53:58Again, this is for health care professionals.
54:01In the hospital, nurses, doctors,
54:04etc.
54:04So one of the audience one one of that
54:07data set one of the segments of people
54:10will be served up just only just five.
54:14That education program.
54:15Another one will be served up.
54:21A stigma reduction program that
54:23was developed by Dell Medical
54:26School solely for professionals.
54:28And the third one will be served up.
54:31A connection to ECHO,
54:33which I suspect everybody listening
54:35here is familiar with ECHO it's it's.
54:38It's basically to get for professionals
54:40to get advice from other professionals
54:42in the consolidated, efficient way.
54:44We're going to be developing a
54:46program that Eco will distribute
54:48to health care professionals,
54:50so that's the three ways
54:51that we're going to do it,
54:52and we're going to learn from it.
54:55But we're also looking for funding to
54:56try it in two or three other hospitals,
54:58so we have a larger sample size,
55:00but we've already got the funding
55:01from the state of Pennsylvania.
55:02We're moving forward there.
55:05Again, kudos for developing the program,
55:07and kudos for taking a scientific approach
55:11to the evaluation of these programs.
55:13I think we all understand and agree
55:16that addressing stigma is important,
55:18but we need to be able to say we're
55:20doing it with effective strategies
55:22with the greatest return on investment.
55:25And there's.
55:26Kyle, I couldn't tell if you had a
55:28question or if I can move on to the.
55:31The audience questions.
55:34I just I just want to say what an
55:37exceptional presentation Gary.
55:39You had me tearing up a few times.
55:41I'm definitely going to be sharing
55:43and watching this one again.
55:45I just wanted to say thank
55:47you and I love how you're.
55:49You're turning your story,
55:50you know, from tragedy,
55:52to triumph and inspiring others so.
55:55It's wonderful.
55:56We're definitely going
55:56to be connecting more.
55:57Great. Thanks Kyle, and thanks
55:59to this angered foundation for
56:01all the support. Thank you. Yeah,
56:05so Alexa banista indicates that
56:08they're looking to implement
56:10justify that Lockheed Martin,
56:11hopefully early in 2022.
56:13So right here, that's that's a
56:16large manufacturer, obviously.
56:20John Hamilton has a question.
56:22John says thank you for all
56:24you're doing for the field.
56:26Johns, a local guy.
56:27In case you
56:28don't actually know John well.
56:32Thanks for joining John,
56:33and he's asking why not lean
56:37into discrimination over stigma?
56:40Is making a contrast between
56:42discrimination and stigma,
56:43and is there a is a rationale for that?
56:47Sure.
56:50We actually played with both words when we
56:53that year that we were doing this research.
56:56And we were a little worried about.
57:00Possible Chris criticism by using the
57:03word discrimination where there could
57:07be no criticism of the word stigma.
57:10Having said that, so that is why we use
57:12the word stigma versus discrimination.
57:15Having said that,
57:16we are very focused right now,
57:18and if anybody wants
57:19further information on it,
57:20please reach out to shadowproof and ask
57:21to speak to me and we'll send it to you.
57:23Or you can ask Matt Stefanko you
57:25had his email address there.
57:27We are very focused on the fact
57:30of the discrimination against.
57:32Black people right now.
57:36People who are Caucasian have 30 * 30
57:39times the probability of being prescribed
57:42Lupron orphine than those who are black.
57:44And I can go on and on with the statistics
57:47we put together statistics in in a deck,
57:49and we can. We'll be happy to send it
57:52to anybody so you can see the data.
57:54And we are very focused on what
57:56we can do to improve that.
57:59So some of the things we've done just
58:01five is now convertible to Spanish,
58:03so we have it available for that audience.
58:05Atlas is now convertible to Spanish,
58:07actually just five.
58:08We have two versions,
58:09Spanish and in English, just five right?
58:11In the website you can just click Spanish
58:14the whole the whole site turns to Spanish.
58:16We just got a grant from
58:18the state of California.
58:19When we take Atlas to California,
58:21we have a separate pot of money to
58:23go into underserved neighborhoods to
58:25make sure Atlas is being served up
58:27to those underserved neighborhoods.
58:29And we're looking at a bunch of other
58:31areas to attack this right now and again,
58:33a lot is based on funding coming
58:34in and being able to do that,
58:36but we have identified a list of
58:38things that we can do to reduce that.
58:43Thank you, that's very.
58:44That's that's wonderful and and so important.
58:47It's a real challenge,
58:48quite frankly in the field of
58:50addiction and addiction medicine to
58:52make for sure that we're creating a
58:55workforce that we flex the spectrum of
58:58individuals with with these diseases.
59:00And it's an area we've been
59:02focusing on. This
59:03we want to bring back to the previous
59:05question I forgot to mention.
59:06One thing that I wanted to
59:08mention when you mentioned about.
59:09You asked about what we're going
59:10to be doing to reduce stigma
59:12with health care prevention,
59:13and I meant 33 segmented ways of
59:15approaching it and see what works,
59:17doesn't Work etc.
59:18You know we did a survey just
59:21to give you some stats on it.
59:231 stat troubling.
59:24We partnered with the Medical Society
59:27in the state of Massachusetts and
59:30we surveyed primary care doctors
59:32in the state of Massachusetts.
59:36Why don't you treat those who are addicted?
59:39Half said because I was never
59:41taught in medical school.
59:42I don't know anything about it.
59:43Why weren't they taught medical school?
59:45Because medical schools mostly like.
59:47From him, it's not a disease.
59:49Why do we have to require it to be taught?
59:51Not all, but most.
59:54Also,
59:54the second reason they listed just
59:57below 50% was if there's an issue.
60:00I don't know.
01:00:01Therapist or behavioral health
01:00:03specialist that I can refer people to,
01:00:05why 'cause they haven't been
01:00:07taught enough in schools and
01:00:08there's not enough of them.
01:00:10You know what the third reason was?
01:00:11A quarter of primary care,
01:00:13doctors said,
01:00:14I,
01:00:14I don't want to treat people
01:00:16anybody addicted to opioids
01:00:18'cause it might hurt my practice.
01:00:20Having those people in my waiting room.
01:00:231/4
01:00:26But we're starting in Pennsylvania,
01:00:28and as we get funding,
01:00:29we'll test other hospitals.
01:00:30Our whole thing is testing
01:00:31things once at work, scale it,
01:00:33but we don't want to scale
01:00:34it and spend money scaling
01:00:35until we know that it works.
01:00:38Thank you for sharing that carrier,
01:00:39I've been. Working in that area
01:00:42for for quite some time so and
01:00:44I have heard those stories,
01:00:45I think the thing that I found
01:00:47to be most successful is patient
01:00:50success and patient experience.
01:00:52Having patients come back doing well
01:00:54is very reinforcing for the clinician
01:00:57and they come back and tell me I'm the
01:00:59best prescribe you know best physician
01:01:01they've ever had and and you know,
01:01:04I think it's really important that we
01:01:07provide trainees with the opportunity
01:01:09to see individuals who are doing well.
01:01:12In their treatment,
01:01:13not just the the the toughest cases
01:01:16that they often may see in the hospital,
01:01:18I want to make sure I I'm catching
01:01:20up on the the Q&A Rana chamois from
01:01:23Stamford asked what do you believe
01:01:25the root causes of the stigma are?
01:01:28I understand the media plays a role and
01:01:30and that's a really important point,
01:01:32but do you believe education about drugs?
01:01:35That's geared towards youth has perpetuated
01:01:37stigma towards people who use drugs
01:01:39and those who suffer with addiction.
01:01:42The answer to that last question of
01:01:45the of the broader question is yes.
01:01:49And it's how you how we talk about it,
01:01:51which I mentioned earlier.
01:01:54I learned prior to this
01:01:55research that we did in 2019.
01:01:58Shadowproof was doing it wrong.
01:02:01We were out there saying addiction is
01:02:02a disease. Addiction is a disease.
01:02:05Yes, it's important to change the
01:02:07perception that this is a disease,
01:02:09but that actually could be stigmatized.
01:02:13Would you rather be neighbors with
01:02:15someone who is not trying hard
01:02:18enough that can change like that?
01:02:20Or neighbors with someone that's got a
01:02:23chronic illness that can never change.
01:02:25It actually could make it worse.
01:02:27The right message is.
01:02:29It's a treatable disease.
01:02:31When we studied all the literature
01:02:33and all the history.
01:02:34What changed with HIV AIDS?
01:02:36It wasn't when Magic Johnson came
01:02:38out and said and said he had aids.
01:02:41No, it's when he came back two
01:02:42years later and he was sweating on
01:02:44the court with nine other guys.
01:02:46And yes, you can get into a taxi cab with me.
01:02:49You can be. You can eat dinner with me.
01:02:51I can be in your neighborhood.
01:02:52It's not going to explode on you.
01:02:54These stories of people with success
01:02:57changes the perception that someone with
01:02:59this disease is not in a back alley.
01:03:02Sticking a needle in their arm.
01:03:03That's going to break into your
01:03:05house now there's 10s of millions of
01:03:07people in this country that have been
01:03:10treated properly and are doing well.
01:03:11And that is the.
01:03:13It's a treatable disease.
01:03:15And then the other messages that's
01:03:17been proven in research is.
01:03:18Here's the barriers that I went
01:03:20through to get treated and that
01:03:22changes structural stigma policies.
01:03:24Those are the two messages
01:03:25that we're working on,
01:03:26as well as the message about medications.
01:03:29'cause there's such a
01:03:30stigma against medications,
01:03:31but also just to keep going on that question.
01:03:33If I could,
01:03:34because part of that question was the media.
01:03:37So remember I mentioned 66 sectors of
01:03:40society that we want to give content to.
01:03:44One of those is media.
01:03:47I can't tell you how many
01:03:48wonderful stories that I have read,
01:03:50written by a journalist.
01:03:52That had their heart in the right place.
01:03:55Total wrote a meaningful editorial
01:03:57or story about someone who had a
01:04:01substance use disorder or had died.
01:04:04And they met all with the best intentions.
01:04:07Writing that article,
01:04:08and they described that person
01:04:09as A at an attic or a junkie.
01:04:13That is stigmatising.
01:04:15There was a study done several years ago.
01:04:18300 health care professionals.
01:04:20150 in one room, 150 in another,
01:04:23and these are healthcare professions.
01:04:25The first group randomly controlled
01:04:27which room you were in the first group
01:04:30was told the story about John Doe.
01:04:33Who was an addict?
01:04:35The second group was told the
01:04:37exact same story about John Doe,
01:04:39who was addicted to drugs.
01:04:41But he was John Doe.
01:04:42He was Johnny.
01:04:45Then they surveyed the people when
01:04:47they got out. The first group.
01:04:49We're more likely to say by far.
01:04:53He needs to go to the criminal
01:04:55justice system. He's an addict.
01:04:57Second group was more likely
01:04:58to say get him to the health
01:05:01care system 'cause he's Johnny.
01:05:02He has a substance use disorder
01:05:04or he is addicted to drugs or he
01:05:06has diabetes or whatever it is.
01:05:07Let's get him to health care.
01:05:10So that's one of the six sectors we
01:05:13need to bring the media together.
01:05:16And just make sure that they all
01:05:18understand the right language and
01:05:19we celebrate the journalists,
01:05:21do it right and we call out the
01:05:23ones that do it wrong.
01:05:26I agree, pretty simple. Very
01:05:28important message and very impactful
01:05:31research done both with health professionals
01:05:34and with the the Community at large.
01:05:38Part time David.
01:05:39I saw a comment on there.
01:05:40I'm not sure if it turned into a question,
01:05:42but somebody said there was a comment
01:05:44I saw by a less aleska talking about.
01:05:47We need this in all corporations.
01:05:49That's also one of the six sectors, so again,
01:05:52the six sectors are corporations healthcare.
01:05:54State government could be national,
01:05:57but let's focus on states first.
01:06:00Media, entertainment,
01:06:01criminal justice system and communities.
01:06:04We just prior to COVID.
01:06:07We were going into States and
01:06:09companies as our first two.
01:06:11And then COVID disrupted.
01:06:13Going into companies,
01:06:14we have a program already
01:06:16designed to go into companies.
01:06:17Our thought is to wait till after
01:06:20employees are back at work.
01:06:21But a lot of the same methodology
01:06:23where we're using in the state of
01:06:25Pennsylvania we could use in companies.
01:06:27It's interesting.
01:06:27It's a distribution channel of getting
01:06:30out the short videos and the stories.
01:06:33Absolutely,
01:06:33it'll work.
01:06:35Well then also sends a message right
01:06:37that the company is acknowledged
01:06:39that this is not something that
01:06:41they shouldn't talk about or they
01:06:43don't talk about that by stepping
01:06:45up their modeling the type of
01:06:47behavior that we want individuals
01:06:49absolutely and we already have a list
01:06:52of policies ready for companies.
01:06:53Here's what you do with the stories.
01:06:55Here's how you here's how languages
01:06:57should never be used in any corporate.
01:07:00Communication never.
01:07:01Junkie addict, nothing.
01:07:03Not that it would be typically used anyway,
01:07:04but that's an easy lift for companies.
01:07:07We have a list of policies,
01:07:09easy lift and harder lift.
01:07:11Do the easier lifts their stuff 1st
01:07:13and aspire to do the harder lift.
01:07:16So again, trying to catch up with the chat,
01:07:18I want to acknowledge the the
01:07:20sharing that Joseph Adams has done.
01:07:22He's given us some links to NVIDIA to videos
01:07:27about people who are receiving medication.
01:07:30I happen to know a couple of the
01:07:32names Walter Ginter and Joycelyn
01:07:34Woods are really sort of the the early
01:07:37individuals in the field ten 1520 years
01:07:41ago who formed the National Alliance
01:07:44for Medication Assisted Recovery.
01:07:46Remember our and so I would encourage
01:07:47you to take a look at those videos
01:07:49and he makes the point that we rarely
01:07:51if ever see individuals who are doing
01:07:53well who are receiving medication,
01:07:55and that's that's gotta change and
01:07:59brentmoor also followed provides
01:08:01narratives from from veterans as
01:08:04he works in the VA system.
01:08:07Let's see Joseph Adams also notes
01:08:10that 70% of residential treatment
01:08:12programs do not allow offer or allow.
01:08:15Medications for opioid use disorders.
01:08:19Many of these programs are getting
01:08:21state licensing or accreditation.
01:08:23Is there something we should be
01:08:25doing and from that perspective,
01:08:27sort of from the regulatory perspective
01:08:29to address the lack of potentially
01:08:32lack of evidence based treatment at
01:08:35quote UN quote treatment facilities.
01:08:39Absolutely 100% that is,
01:08:41Atlas Atlas provides that information
01:08:44to States and states will be states
01:08:47are telling us they're going to
01:08:49start using this for licensing.
01:08:51Again, we've only been up and running
01:08:53now in six states for a year and a
01:08:56little less than a year and a half.
01:08:59But as this and now we're adding
01:09:01seven new states will be in states
01:09:04representing 4243% of the population.
01:09:08Absolutely, states are already
01:09:09telling us they're going to
01:09:10start using this for licensing.
01:09:13And then along that line to Kathleen Ward,
01:09:16Ward says thank you for sharing your work.
01:09:19She does some work evaluating
01:09:21a aissam levels of care,
01:09:25certified drug and Alcohol Assessment
01:09:27Center in Philadelphia and wonders if
01:09:30Atlas collaborates with these types of
01:09:33sites to use assessment to refer patients
01:09:35to evidence based treatment locally.
01:09:37So I think again the question is great.
01:09:40Great question.
01:09:43We first for Atlas.
01:09:45We first developed the national
01:09:47principles of care. And you know,
01:09:49coming from a background in business,
01:09:51it was very clear to me that what we
01:09:54needed was one national standard of care.
01:09:56Which unbelievably didn't exist.
01:09:58And there were dozens of practices that that
01:10:02night at National Institute of Drug Abuse
01:10:04and others and put out there Sam's etc.
01:10:07So from background in business,
01:10:08you realize you can't have dozens.
01:10:11There's no business in the world
01:10:12that bonuses any people on anybody,
01:10:14on dozens of things.
01:10:15What are the less than 10 core things
01:10:18that should be in every treatment
01:10:21program in the United States?
01:10:23Based on certain 2016 Surgeon
01:10:26General's report.
01:10:27And then we we work together with
01:10:29Pew Charitable Trust in the leading
01:10:31author of the Surgeon General's report,
01:10:33and we drafted 7 Principles of Care Plus
01:10:36one screening to get into treatment.
01:10:38And then we brought together a
01:10:42group of experts around the country
01:10:44and got consensus on this.
01:10:45So that's our national standard.
01:10:47Then we built a business plan for Atlas
01:10:50for bringing in data from three sources.
01:10:54Providers patience.
01:10:55And claims data to create the
01:10:59quality measurement system,
01:11:00and we built a business plan around that.
01:11:02To do that, we raised 5,000,000 in funding.
01:11:05We received the funding
01:11:07and we started building it.
01:11:09And when we hired a team to do
01:11:11so once that team was hired,
01:11:12we looked at the next question.
01:11:13Which exactly is the question
01:11:15that was just asked.
01:11:16You can give the best care
01:11:17in the world to someone,
01:11:18but if they're if they're better to be
01:11:20in residential and they're in outpatient,
01:11:23it's not going to work, or vice versa.
01:11:24And as we all know,
01:11:26a Sam has the gold standard of level of care,
01:11:29but it's 12 levels of care,
01:11:31so we went to a Sam and we said,
01:11:33look, we have a request.
01:11:35Your criteria for levels of care is superb.
01:11:40It's the best ever.
01:11:42It's the gold standard.
01:11:43But the problem is, it's usually usually
01:11:45not always usually given too late.
01:11:47Someone already had a treatment program,
01:11:50and if they're at a residential
01:11:52and they need outpatient,
01:11:52they're in the wrong place.
01:11:54So would you work with us in in there?
01:11:57There's because it's comprehensive.
01:11:58It needs to be delivered by
01:12:01a clinician to a patient.
01:12:03So I said,
01:12:04would you work with us and create a
01:12:07summary version of your sophisticated,
01:12:09comprehensive levels of care
01:12:12that only has two outputs?
01:12:15Outpatient or residential?
01:12:16Less than 15 minutes that a consumer
01:12:19can take confidentially on their
01:12:20own to just steer them down.
01:12:22One of two paths and then when they
01:12:25get there, they take the a Sam.
01:12:28Comprehensive assessment he said,
01:12:31hey Sam, wonderfully said yes,
01:12:33we worked on it together with
01:12:35open beds and over a year and a
01:12:38half it was developed.
01:12:39It's turned into a little bit more
01:12:41comprehensive than I had originally asked.
01:12:43That's OK.
01:12:44The science is all a Sam,
01:12:46not ours. All a Sam.
01:12:4913 questions less than 10 minutes and
01:12:53it got a little bit more sophisticated.
01:12:55It's at 2 levels of care.
01:12:56Outpatient residential.
01:12:57It was five hospitalization
01:13:00residential intensive,
01:13:01outpatient outpatient or you don't need care.
01:13:05You need an intervention.
01:13:07And a SIM added another feature which we
01:13:09had in conceptualized, which is great base.
01:13:11Once they tell you one of those five things,
01:13:14or one of the four where you need treatment,
01:13:15here's what additional services you need.
01:13:17You need medication for opiate use disorder.
01:13:19You need mental health services or you don't,
01:13:21etc. And that was completed by a
01:13:26Sam a year last June June of 2020.
01:13:29So a year and a half ago we
01:13:31we launched Atlas in July.
01:13:33A month later, when you go to Atlas.
01:13:35Now we combine the two.
01:13:37So the first thing is taking assessment.
01:13:39If you take the assessment and it
01:13:41determines you need intensive outpatient
01:13:43for opiate use disorder and then
01:13:46you search for treatment programs,
01:13:47it will only show you treatment
01:13:49programs that hit that criteria.
01:13:51If you skip that and go right to
01:13:52the search for treatment programs,
01:13:54obviously you can't filter by that
01:13:55'cause you haven't taken the assessment.
01:13:57It's completely 100% confidential
01:13:59and unlike the search feature,
01:14:01we only have data for right now
01:14:04states six states anywhere in the
01:14:06country can go onto Atlas right
01:14:09now and take the assessment.
01:14:10In its treatment atlas.org.
01:14:12It's all free.
01:14:1710 minutes completely confidential.
01:14:19All based on a sale ACM built in.
01:14:24You know, and I think I'm like,
01:14:28I'm often flipping a little bit in this,
01:14:29but you know, I think you're the story
01:14:32you tell at the beginning highlights
01:14:35this that if you have cancer.
01:14:38You know you go and ask an
01:14:40oncologist what you should do and
01:14:42and if you have cardiac disease,
01:14:43you go to a cardiologist,
01:14:45but I think for addiction.
01:14:48Often times people feel like
01:14:50everybody and their grandmother
01:14:51knows what's best for her for
01:14:53Johnny or or Jane in that situation.
01:14:55And the the extent to which we've
01:14:58been able to create this cadre
01:15:01in this algorithm that that takes
01:15:04into account what the condition is,
01:15:06the severity of the condition,
01:15:09and then work with existing strategies
01:15:11to match patients to push an
01:15:13appropriate treatment really resonates
01:15:15with with me as a clinician and.
01:15:18And reflects where the science is?
01:15:20I think so that's that's very important.
01:15:23So John Kimberly asks.
01:15:25It strikes him that shatter proof is
01:15:29close to hitting a tipping point.
01:15:32The momentum is impressive,
01:15:34and the way you are learning
01:15:37you're learning as you go is
01:15:39particularly noteworthy.
01:15:39So those are some comments from John
01:15:41Kimberly from the University of Pennsylvania.
01:15:45Well thanks Shannon,
01:15:46and I feel like we are as well.
01:15:49I I have presented to our board that.
01:15:53Let's not consider anything new right now
01:15:55for the next year or two, at a minimum.
01:15:59We could do research. We can we.
01:16:01We have information on prevention
01:16:03on our website and on justified,
01:16:05but we're not doing prevention
01:16:08programming in communities.
01:16:09Let's focus on what we have.
01:16:12Let's get Atlas in every state for
01:16:14every American that's looking for
01:16:15treatment with the assessment.
01:16:17Let's get policies changed in states related
01:16:19to how they pay for addiction treatment.
01:16:22Using the collaborative care model.
01:16:25Let's get a bill signed by the President,
01:16:27United States,
01:16:28that requires every health care professional.
01:16:31They have basic coursework in the prevention
01:16:34and treatment and recovery of addiction,
01:16:36and if we get that done then medical
01:16:38schools will accredit it and then we
01:16:41brought it all into the healthcare system.
01:16:43Let's get stigma ended.
01:16:46And once we move,
01:16:48we continue on the momentum we have
01:16:50now and we make national impact
01:16:53not 5% of the 15 points of the
01:16:55people who see it in Pennsylvania.
01:16:58By the third saw it,
01:17:00but by the end of the year.
01:17:01So that was about a five point
01:17:03of across the entire population.
01:17:04Let's get this in every state,
01:17:06not just in Pennsylvania,
01:17:07and let's get 20-30 forty point reductions,
01:17:10and then we can move on to something else.
01:17:14Terry, can I ask you to reflect a
01:17:16little bit on this issue around health
01:17:19professional training and the data
01:17:212000 and the X waiver your organization
01:17:24has made some tactical decisions
01:17:27about the legislation and legislative
01:17:31changes that I think speak to to some
01:17:33of your thoughts about this issue.
01:17:35'cause you're you're acknowledging
01:17:36that health care professionals may
01:17:38lack the expertise or the knowledge
01:17:41and the skills and the attitude.
01:17:43To treat addiction on the other hand,
01:17:46you're advocating for more
01:17:47ready access to to treatment.
01:17:49So how do we?
01:17:50How do we reconcile those
01:17:52great question? And it's a simple answer.
01:17:55And that's how we're working at politically
01:17:58with the health care professionals that
01:18:00work for congressmen and senators.
01:18:02Let's end data. 2000.
01:18:03So there's not this extra level of care that
01:18:07you need to go through liberal treatment.
01:18:10Excuse me to prescribe something
01:18:12that treats someone who's addicted.
01:18:15But let's make sure that every
01:18:17health care and replace that with.
01:18:21Required we absolutely required
01:18:23education and prevention and
01:18:25treatment recovery of addiction.
01:18:27It's unconscionable in this country today.
01:18:30That a doctor doesn't need any extra
01:18:35level of education to prescribe an opioid.
01:18:40But they go through these hurdles
01:18:42to prescribe something that will
01:18:43treat someone addicted to opioid.
01:18:45I actually don't think it was unconscionable
01:18:46when it was created back into.
01:18:48You know,
01:18:48back when the medications were created,
01:18:51I think it was probably smart to do it then,
01:18:53but not today and let's replace
01:18:56it with comprehensive education.
01:19:01OK, I think we're winding
01:19:03up two more questions.
01:19:04One is is is there a well?
01:19:06The first is?
01:19:08What's the estimated success rate?
01:19:10Of drug addiction recovery in general,
01:19:13and that's some comes from
01:19:15Gabriella Garden, Tigard Rama.
01:19:19Properly treated well,
01:19:20that's a hard question to answer because.
01:19:23It's you know there's.
01:19:25All levels of addiction.
01:19:27You know there's slight,
01:19:28you know, there's moderate.
01:19:29There's medium, there's there is
01:19:31very extensive addiction and it
01:19:33depends what you're addicted to. So.
01:19:35It's a it's a so because of that there's
01:19:38two matrices you have to put together.
01:19:40How addicted somebody is and
01:19:43what they're addicted to.
01:19:45So that's hard to answer.
01:19:46I will say generally though.
01:19:49If you're addicted to opioids.
01:19:52And you're treated and you don't
01:19:54have mental health issues and
01:19:56you're treated with medications.
01:19:59The success rate is extremely high.
01:20:03If you have mental health issues
01:20:05and you're treated product,
01:20:07depends what they are and how extensive,
01:20:09but you're treated with one
01:20:11of the six therapies that are
01:20:14on Atlas that we talk about.
01:20:16The providers offer these six 'cause
01:20:20these six are based on randomly
01:20:22controlled trials and proven to work.
01:20:25Obviously outcomes are better
01:20:26if you're treated with others.
01:20:27We don't know if they work or don't work,
01:20:29they could, which there's the
01:20:30research hasn't proven it yet.
01:20:32We're not saying they're bad,
01:20:33it's just we haven't proved they work.
01:20:35But these six on our website on
01:20:37Atlas we know work and it's been.
01:20:40It's in the Surgeon General's report.
01:20:41They're listed these are the six and
01:20:45if you're addicted to cocaine harder.
01:20:47There's no medications for it right now,
01:20:50harder.
01:20:52If you're addicted to alcohol,
01:20:54there are medications that work really well,
01:20:57but they don't,
01:20:58but they work for a smaller percent of
01:21:00the population that's addicted to alcohol.
01:21:03But for the ones that work,
01:21:04it works for it.
01:21:06They work great.
01:21:07So I know that's not a succinct answer,
01:21:09but it's the best I can give.
01:21:11Now
01:21:12it's a very important concept.
01:21:13I think for individuals to understand
01:21:15that not all substance use is the same.
01:21:18Not all substances the same,
01:21:20and that there are variety of treatment
01:21:23modalities that include counseling,
01:21:25behavioral treatments,
01:21:27medication and location of care.
01:21:29As you were addressing.
01:21:31And David, I want to
01:21:32jump in and stress again.
01:21:33I mentioned it earlier that nothing that
01:21:37shatterproof does is my opinion, nothing.
01:21:39The word proof is in shadow proof.
01:21:42It's all based on what the CDC,
01:21:45HHS SAMHSA randomly controlled
01:21:48trials Surgeon General's report.
01:21:50We're simply the implementer.
01:21:53That's it, we're getting.
01:21:55We're using basic business practices
01:21:57which are fairly intuitive.
01:21:58National National standard of care.
01:22:01Gather data,
01:22:02show which treatment programs
01:22:03are delivering quality care,
01:22:04and which ones aren't.
01:22:06Keep that information to consumers
01:22:07so they can choose treatment and then
01:22:10supply and demand takes over and the
01:22:12better quality care gets more demand
01:22:14and the whole level of care rises.
01:22:16It's it's.
01:22:17It's not rocket science, what we're doing.
01:22:20It's basic intuitive.
01:22:22The rocket science is all the researchers.
01:22:25And they have developed this content.
01:22:26We're simply following it.
01:22:30And convening bringing people together.
01:22:32We can't do this on our own.
01:22:34Its partnerships with states,
01:22:35Lockheed Martin doing just
01:22:37fine for their employees.
01:22:38The 13 states partnering with us
01:22:40without Atlas, JP Morgan Chase
01:22:42with just five on and on and on,
01:22:4460 companies and every day
01:22:45we're adding another one.
01:22:46We just added Aetna and CVS
01:22:48for all their employees.
01:22:50I mean, as this grows,
01:22:52we're just taking the science
01:22:53and getting it out there.
01:22:57That's a great model, so I'm gonna
01:22:59let Emma have the last question.
01:23:02She's wondering if there is a hope for
01:23:05a provider facing version of Atlas.
01:23:09Yeah, so I I'm curious about
01:23:13obviously Atlas does this tremendous
01:23:16tremendous work of putting knowledge
01:23:18into the hands of families and
01:23:20patients knowledge that can be really
01:23:22difficult to collate when you are,
01:23:24you know, calling this number and
01:23:26that trying to figure out where your
01:23:27loved one can go to seek treatment.
01:23:29And I'm wondering if a system like
01:23:31Atlas can be similarly useful for
01:23:34providers who are trying to have an
01:23:36understanding the treatment landscape,
01:23:38especially at that critical point.
01:23:40Between.
01:23:43Transition between residential
01:23:44and outpatient care.
01:23:46Where can I send my patient?
01:23:49Already have it in addition
01:23:51to the consumer site,
01:23:52we have 3 password protected sites,
01:23:54one for providers, one for states.
01:23:59In 114 health care health care insurance,
01:24:03so a health care insurer can use it
01:24:05to see which providers are delivering
01:24:08evidence based care and which ones aren't.
01:24:11And if they see providers that are not
01:24:12in their network that are doing well,
01:24:14they can reach out to them and see
01:24:16if they will join their network.
01:24:17Alternatively, they can see if
01:24:19there's providers in their network
01:24:21not delivering care.
01:24:22They can speak with that provider
01:24:25about following the practices
01:24:27and they can start to use it for
01:24:29for incentive payment models.
01:24:30For commercial payers states can use it.
01:24:33Where where do I see lack of
01:24:36providers in certain GF erratic areas?
01:24:38What areas of the principles of care?
01:24:41Or providers in my state not following
01:24:44versus the average of other states.
01:24:46So we don't give a state with every
01:24:48other states doing but we give him
01:24:50the average of other States and they
01:24:51can see where their providers are
01:24:53doing in relation to the average
01:24:55of the other States and we do the
01:24:57same thing with commercial payers
01:24:59and we do the exact same thing.
01:25:00We have a password protected
01:25:02site for providers,
01:25:03so every provider in those six
01:25:05states right now is soon to be 13.
01:25:06Can go on there and see exactly
01:25:08where they are in the principles of
01:25:10care and what is the state average.
01:25:12And what is the state average
01:25:14for all providers?
01:25:15If they're outpatient,
01:25:15they can just click a button and they'll
01:25:17show the average for all outpatient.
01:25:19If they're residential,
01:25:20they can click a button that will
01:25:22show the average of all residential,
01:25:23and there's loads of information there,
01:25:25and we also have three times a year.
01:25:28Trainings,
01:25:28you know,
01:25:29webcast where we invite all the
01:25:32providers in and we we.
01:25:33We basically provide a segment of
01:25:35learning for the areas that all
01:25:37providers are not doing as well.
01:25:39We also take that information and
01:25:40look at it from a policy perspective.
01:25:43You know if one state is doing
01:25:44poor in one area of the principles
01:25:47of care compared to the average
01:25:49of all the other states,
01:25:50it could be as simple as a policy change.
01:25:53It needs to be done in that state.
01:25:55Everyone always blames providers.
01:25:56This is not about bad providers.
01:25:58This is about making sure providers
01:26:00have the right resources and
01:26:02the right policies in place.
01:26:03To do their jobs so we have all
01:26:05this and anybody interested just
01:26:07reach out to just go to our website
01:26:10andshatterproof.org and ask to speak to Gary.
01:26:11I'll put you in touch with the right
01:26:13person or they can contact you,
01:26:14Emma or Dave or any way you want.
01:26:16We have all that.
01:26:17We'll do a demo of the provider sites.
01:26:20Or anything we're talking about
01:26:21today we have it all.
01:26:25Yeah, and I'll say that we
01:26:27want to always make it better.
01:26:29Any provider that goes to our site
01:26:31and says if you could add this,
01:26:33it'll help me more will add it.
01:26:36I mean, it's just here to help people.
01:26:38It's not proprietary to us.
01:26:43So Gary again, I want to say thank you
01:26:46for taking the time for sharing the
01:26:49wonderful resources that shatterproof
01:26:51and for sharing your story with us,
01:26:54and to Kyle and the Sandgaard
01:26:56Foundation for supporting this.
01:26:58We look forward to future events
01:27:01such as this in future sessions.
01:27:04Please feel free to follow us.
01:27:06You can follow SAndgaard foundation.
01:27:09You can follow shatterproof you can
01:27:10follow Gary and you can follow us at the
01:27:13Yale program and addiction medicine.
01:27:15So thank you,
01:27:16everybody really appreciate your
01:27:18attention time this afternoon and Gary.
01:27:20Thank you again for all you've
01:27:21done for the field.
01:27:22Well, thank you all as well.
01:27:24We're doing this together. Thanks.
01:27:25Everybody. Take care. Here.