►
From YouTube: Addiction Recovery Channel: Interview with Nora Volkow
Description
From Ed Baker:
Join Ed Baker and his noted guest, Dr. Nora Volkow, as they discuss the consistently accelerating velocity of drug overdose death in America. The relationship between the deadly force of stigma and the unprecedented lethality of fentanyl will be explored. Current Harm Reduction Interventions and their necessity and effectiveness during this time of public health crisis are discussed. The effectiveness and potential of Overdose Prevention Sites is investigated.
7/11/2022
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A
A
A
Dr
volkov's
work
has
been
instrumental
in
demonstrating
that
drug
addiction
is
a
brain
disorder.
This
is
a
very
big
deal.
Thank
you
doctor
for
that.
She
received
the
international
prize
from
the
french
institute
of
health
and
medical
research
for
her
pioneering
work
in
brain
imaging
and
addiction
science.
A
A
A
A
Yes,
I
want
dr
volkov.
I
wanted
to
begin
with
something
of
a
personal
nature.
You
know
it's
obvious
to
me
and
anybody
who's
been.
You
know
watching
you
and
following
your
career
that
you're
deeply
motivated
from
from
a
very
genuine
inner
place
that
that
you're
you're
energetic
you
seem
tireless,
and
you
seem
continuously
focused,
so
I'd
like
you
to
share
with
me
and
with
my
audience.
What
is
it
that
that
called
you
to
this?
What
is
it,
what
is
it
that
drives
you
some.
B
Also,
there
is
a
scientific
one
and
then
as
a
position
to
my
experience
as
as
doctor,
and
seeing
how
we
basically
completely
neglected
individuals
with
substantial
disorder
and
to
me
being
taught
medicine
in
a
way
that
made
absolutely
no
sense.
And
then,
when
I
went
into
psychiatry
this,
I
was
exposed
to
the
same
situation
where
we
were
not
taught
how
to
even
screen
for
substance
use
disorder,
at
least
so
how
to
treat
the
substance
disorder
in
the
patients
that
were
being
admitted
to
the
inpatient
psychiatric
unit,
most
of
whom
had
subconscious
disorder
problem.
B
From
the
perspective
or
from
the
perspective
perspective.
If
you
have
never
been
addicted
just
from
observation,
they
are
extremely
impossible
and,
and
so
but
scientifically.
This
is
something
that
is
amenable
for
inquiry
and
study.
And
so
I
was
fascinated
by
the
notion
of
where,
with
the
advent
of
imaging
technologists.
A
B
My
grandfather
actually
unbeknownst
to
me
until
my
mother
was
was
dying
from
cancer
and
she
told
me
the
story,
because
otherwise
it
was
a
secret
that
my
father,
claire
father,
my
grandfather
had
actually
had
a
severe
problem
of
alcoholism
and
had
gone
to
treatment
and
relapse
and,
in
the
last
relapse
enabled
to
contain
that
self-hatred
by
his
inability
to
contain
his
alcohol
drinking.
He
killed
himself,
and
this
was
something
that
was
revealed
to
me
as
a
secret
in
a
way
that
was
very,
very
devastating,
but
the
other
one,
my
uncle
my
favorite
uncle.
B
Apart
from
everything
else.
He
was
an
extraordinary
man,
but
he
also
suffered
from
alcoholism,
and
that
led
him
to
be
rejected
by
the
family
in
in
ways
that
that
I
felt
were
basically
reflected
that
stigma
that
we
have
for
addiction
and
that
notion
that
we
believe
that
the
person
is
responsible
for
their
act,
the
penalizing
attitude,
the
assignment
of
attribution
to
the
disease
process
to
the
person.
B
So
there
was
the
personal
that
I
had
lived
through
and
that
basically
did
not
make
any
any
emotional
sense
to
me
and
two
was
was
associated
with
a
very
strong
price
in
my
family
of
suffering
and
of
secrecy.
The
second,
from
the
perspective
of
science,
the
opportunity
that
we
have
to
uncover.
What
are
the
systems
that
actually
enable
us
to
have
self-determination
and
the
third
one,
which
was
the
one
as
a
physician
to
to
sort
of
figure
out?
What
is
it?
B
What
information
do
we
require
in
order
to
change
a
culture
in
the
healthcare
system
that
has
neglected
and
stigmatized
substantial
disorder,
and
this
was
particularly
important
because
by
no
time
dealing
with
it
as
a
as
a
health
condition
in
the
healthcare
system,
we
open
the
door
to
perpetuate
a
criminalization
of
people
that
take
drugs,
which
is
extraordinary,
deleterious
and
promotes
the
stigma.
So
those
are
the
personal,
the
scientific
and
the
physician,
my
professional
one
as
a
physician
reasons,
why
I
am
so
passionate
about
this
issue.
A
Yes,
a
perfect
storm
has
unleashed,
you
know
an
incredible
career
and
we're
all
indebted
to
you.
First
of
all,
I'm
sorry
to
hear,
of
course,
about
your
grandfather
and
your
uncle,
but
thank
you
for
being
frank
with
us
about
your
your
personal
life.
I
really
I
appreciate
that
you
know
so
the
three
on
three
levels.
You
became
deeply
motivated
to
pursue
an
understanding
of
addiction
and
treatment
for
addiction.
A
B
So
I
am
not
an
alcoholic,
I
don't
suffer
from
any
addiction,
but
also
I've
been
very
privileged
in
my
upbringing.
Had
I
been
born
in
a
condition
of
childhood
adverse
experiences,
I
may
have
been
at
high
risk
of
becoming
a
victim
from
those
two
factors.
So
what
is
it
that
these
predisposition
factors
are
brought
by
adverse
childhood
experiences
or
by
genetics
itself?
How
do
they
impact
these
behaviors?
B
Well,
we
know
to
start
with
that
required
system,
which
is
the
one
that
motivates
our
action
is
disrupted
by
repeated
administration
of
drugs.
We
also
know
that
if
you
are
exposed
to
stressors
that
also
disrupts
your
reward
circuitry-
and
this
is
fundamentally
modulated
by
two
operating
so
dopamine,
which
is
activated
by
drugs
with
repeated
administration,
leads
to
what
we
can
simplistically
call
tolerance.
So
you
stop
reacting
to
other
regards
that
are
less
powerful,
but
dopamine.
B
Also
modulates
our
frontal
cortex
and
the
frontal
cortex
is
what
we
need
in
order
to
make
a
decision
of
what
is
the
best
behavior
for
me
to
do
in
any
given
circumstances,
and
I
can
choose.
This
is
the
best
option
for
me
right
now
and
you
come
up
with
a
plan
to
do
it.
If
the
prefrontal
cortex
is
not
working
properly
number
one,
you
are
not
going
to
be
in
a
good
position
to
make
the
optimal
decision
of
what
should
be
the
next
choice
in
your
behaviors,
and
even
if
you
make
the
right
choice.
B
So
you
have
very
strong
urges
to
take
that
drug
and
a
very
significant
impairment
with
your
capacity
to
make
decisions
and
carry
them
through.
So
this
is
at
the
essence
of
the
symptomatology
that
we
see
in
a
person
that,
when
they
become
addicted
when
these
systems
get
disrupted,
then
you
are.
That
explains
why,
even
though
the
person
consciously
don't
want
to
take
that
drug
anymore,
they
just
cannot
stop
it.
B
So
these
are
at
the
basic
basic
essence
and,
and
the
other
aspect
that
I
do
want
to
add
in
terms
of
understanding
addiction,
because
it
certainly
helps
us.
It
was
important
in
ultimately,
what
happened
to
my
grandfather
that
he
ended
up.
Killing
himself
is
the
notion
that,
as
the
disease
process
becomes
more
and
more
and
more
severe,
you
start
to
isolate
yourself
and
you.
Actually,
you
lose
the
capacity
of
well-being.
B
Then
you
ask
me
the
last
question,
which
was
what
how
do
the
concept
of
pre-addiction
and
why
we
are
urging
this
new
new
proposal,
which
is
a
proposal
that
actually
dr
tom
mcclellan,
dr
george,
cool
and
myself
put
forth
in
a
commentary.
There
was
a
release.
I
think
it
was
released
yesterday
of
today,
but
the
idea
basically
was
born
out
of
a
sort
of
the
notion
of
again
copying
what
other
interventions
in
medicine
have
done
that
had
been
successful.
B
But
on
the
other
hand,
if
they
intervene
in
these
very
early
stages,
they
could
obviate
all
of
the
pathology
linked
with
diabetes
and
that's
why
we
basically
and
and
that
the
beauty
of
it
also
was
that
it
was
recognized
as
a
condition
pre-diabetes
with
the
advantage.
Then
you
can
put
resources
in
order
to
cover
for
that
intervention,
that's
necessary
to
improve
the
behaviors.
B
That
will
lead
you
to
interrupt
the
course
from
pre-diabetes
into
diabetes.
So
so
our
thinking
was
akin.
To
that
can
we
identify
a
condition
where
the
use
of
drugs
is
actually
harmful,
but
it
does
not
fit
the
criteria
of
a
substance
use
disorder
in
such
a
way
that
we
can
intervene
and
obviate
that
transition
into
a
more
moderate
or
more
severe
substance,
use
disorder,
with
all
of
its
associated,
devastating
consequences
and
and
and
to
the
extent
that
we
can
consolidate
that
number
one.
B
We
can
have
healthcare
providers
screening
and
then
doing
the
interventions
that
are
appropriate
and
they
should
be
reimbursed
for
it
and
to
the
extent
that
we
can
start
to
in
a
discourse
that
we
feel
open
to
speak
about
pre-addiction.
This
also
should
help
antagonize
the
stigma
that
still
permeates
for
addictions
in
general.
A
A
A
B
But
if
you
look
at
it
in
terms
of
consequences,
now
we're
seeing,
for
example,
that
a
very
significant
portion
of
people
that
are
suffering
from
overdoses
or
from
the
negative
consequences
of
drug
taking
people
that
could
fit
the
criteria
of
a
mild
substance.
Use
disorder
are
not
their
their
symptoms.
B
Don't
justify
the
administration,
for
example,
of
medications
and
so
ignore
the
administration
of
an
admission
into
an
inpatient
setting,
so
they
get
neglected
and
there
is
very
little
research
work
that
has
been
done
specifically
to
the
mass
of
consumer
disorder,
which
is
the
majority,
is
the
largest
number
of
cases.
And
it's
also
that's
the
early
stages
of
the
disease
process,
in
which
an
intervention
can
interrupt
it
and
can
save
the
person's
life,
but
again
we're
not
putting
the
resources
on
it.
B
B
So
this
is.
This
is
why
I
actually
resonated
very
much
with
that
concept
as
a
means
to
bring
attention
to
a
stage
in
the
early
stages
of
the
disease
process
of
addiction
and
that,
whereas
we
call
addiction,
the
severe
substance
disorder,
we
want
to
bring
attention
to
that
mild
substance.
Use
disorder
which,
in
the
definition
really
is
not
addiction
itself,
is
the
early
stages.
It's
the
three
addiction
basis,
yeah.
A
Thank
you
thank
you
for
that
work
and
I
think
that's
going
to
be
important,
moving
forward
into
the
future
of
health
care
for
people
who
use
drugs
in
america,
and
I
thank
you
for
that.
You
know
that.
So
what
about
the
present,
though
dr
volkov,
when
we,
when
we
look
at
the
present,
it's
overwhelming,
I
think
you
use
the
word
tsunami
and
I
think
you've
used
the
triple
wave
theory.
A
B
Both
of
those
issues
are
very
present
and
right
now
they
account
for
an
equivalent
number
of
deaths.
So,
but
they
are
very
different
in
multiple
circumstances,
and
yet
they
still
share
the
element
that
the
individuals
that
are
most
vulnerable
are
the
ones
that
are
highest
risk
of
its
most
adverse
consequences,
which
of
course,
is
there
the
the
the
issue?
B
B
Those
practices
have
not
solved
the
problem
and
in
fact
the
problem
has
gotten
worse.
We
also
need
to
embrace
the
fact
that
what
is
going
on
in
our
country
reflects
certain
social
circumstances
that
are
making
people
vulnerable
to
taking
drugs
and,
as
we
were
discussing
about
what
are
the
issues
that
lead
you
to
vulnerability.
And
yes,
we
discuss
genetics,
for
you
scared
me
very
clearly.
It
is
very
likely
that
the
reasons
how
genetics
are
basically
expressing
that
vulnerability
relates
to
the
environments
in
which
you
find
yourself,
and
I
I
didn't
say
it
just
specially.
B
That
would
be
what
I
would
say
that
the
covet
pandemic,
along
with
the
overdose
crisis,
is
forcing
us
to
look
into
in
order
to
solve
it.
I
strongly
believe
absolutely
that
it
is
solvable
that
there
are
actions
that,
if
we
implement
and
we
put
the
resources
and
we
sustain,
we
definitely
can
control
and
overcome
the
overdose
crisis,
but
we
need
to
put
the
resources
and
we
need
to
continue
to
work
together.
I
mean
here
is
not
that
me.
Damn
the
science
agency,
therefore,
I'm
going
to
tell
you
what
to
do.
B
So
the
evidence
is
down
there,
but
it's
not
being
implemented.
So
that's
to
say
why:
how
do
we
transform
that
willingness
of
putting
the
resources
that
are
necessary
to
substantiate
the
structure,
to
protect
people
from
from
drugs
and
and
if
they
do
have
a
problem
with
a
substance
use
disorder
to
help
them
protect
them
from
overdosing
and
dying
and
all
of
the
negative
consequences
and
to
help
them
achieve
recovery?
Because
recovery
is
clearly
achievable
and
that's
a
message
that
I
would
like
to
say
most
people
and
this.
B
B
That's
why
it
becomes
so
important
to
do
aggressive
interventions
just
like
when
you
have
cancer
right,
your
your
your
physician,
your
health.
Our
system
does
not
mickey
mouse
around.
It.
Just
basically
comes
up
with
a
plan
and
provides
the
resources
that
are
necessary.
We
should
be
able
to
do
the
same
thing
with
substance
use,
disorder.
A
I
mean
I,
I
couldn't
agree
with
you
more
you're,
probably
familiar
with
dr
ju
young
park
from
rhode,
island
brown,
university
she's,
written
a
paper
on
the
social
determinants
of
addiction.
More
and
more
people
are
speaking
about
this
and
that's
encouraging
to
me
because
I've
been
in
the
profession
for
a
long
time,
I'm
in
my
own
personal
recovery
since
1984..
A
A
You
know,
criminal
personality,
that
that
was
what
that
was
what
addiction
was
associated
with
so
because
of
people
like
you
and
research,
like
the
research
that
you
do
and
your
teams
do,
the
consciousness
is
slowly
raising.
But,
like
you,
I'm
frustrated
too,
because
we
know
so
much,
but
we
don't
act
a
lot
on
what
we
know
for
me
in
my
community
what's
happening
in
vermont
today,
we're
seeing
a
lot
of
people
die
from
overdose.
We've
had
the
highest
rate
in
overdose
increase
for
2019,
20
and
21..
A
Second
to
us
is
kentucky
and
then
west
virginia.
It's
very
very
sad
for
my
state.
We
lost
215
neighbors
in
2021
in
my
county
we
lost
one
vermonter
a
week,
51
vermonters
in
2021..
So
this
is
a
state
mind
you,
where
we
have
widespread
use
of
naloxone
very
behind
getting
naloxone
all
over
the
place.
We
have
incredibly
very
low
barrier
access
to
buprenorphine
medication
for
opioid
use
disorder.
A
We
have
fentanyl
strips,
we
have
safe,
syringe
programs,
we
have
wound
protection
kits.
We
have
harm
reduction
up
to
a
point,
but
even
with
everything
we
are
doing,
we
have.
We
have
recovery
centers
in
every
county,
open
seven
days
a
week,
no
charge
where
people
can
go
and
find
their
pathway
to
recovery.
We
have
very,
very
active
a
a
n
a
all
over
the
place,
but
even
with
all
this,
the
rate
of
death
is
accelerating.
A
How
do
we
reach
them?
Dr
volkov,
when
you
think
of
them,
those
are
the
ones.
In
my
view,
those
are
the
ones
that
are
dying,
a
poisoned,
unregulated
drug
supply.
That's
that's
what
they
have
access
to.
What
what
are
we?
What
are
your
thoughts
on
that?
Because
I
know
you
think
about
it
all
the
time
you
have
to
what
are
your
thoughts
on
that.
B
Yes,
I
think
about
it
all
the
time,
and
I
think
that
I
in
many
ways.
Ultimately,
we
have
certain
beliefs
and
thoughts
that
are
basically
fed
by
the
circumstances
that
we
live
and
one
of
the
aspects
that
I
think
that
you
were
alluding
that
accounts
for
why
we're
seeing
such
a
high
rise
in
mortality,
including
in
vermont,
has
to
do
with
the
fact
that
the
access
to
drug
contaminated
with
fentanyl
has
just
accelerated.
B
And
while
we
had
seen
a
very
significant
rise
of
fentanyl
since
2016,
it
was
predominantly
used
to
contaminate
feral.
And
yet
now
we
see
that
most
of
the
drugs
and
the
illicit
marker
are
contaminated
with
fentanyl,
and
these
poses
particularly
high
risk
hierarchies,
because
people
that
are
taking
obvious,
like
heroin,
have
tolerance
to
the
opioids.
So
even
if
they
take
a
very
potent
drug
like
fentanyl,
it
definitely
absolutely
can
harm
them.
But
if
you
have
no
tolerance,
you
are
certain
that
it's
going
to
harm
you
and
your
very
extraordinary
high
risk.
B
Much
much
higher
risk
of
overdosing
that,
if
you
have
some
level
of
tolerance,
so
we
are
seeing
that
the
very
dangerous
drugs
that
currently
are
out
there
in
the
illicit
drug
market
is
making
people
vulnerable
to
overdose
deaths.
That,
in
the
past
is
not
that
they
are
taking
more
drugs,
is
that
they
are
getting
exposed
to
more
lethal
drugs,
and
that
is
contributing
to
increases
in
that
all
over
the
country
and
and
very
tragically
too.
B
B
So
fentanyl
is
changing
the
game
changer
at
many
many
levels
and
we
need
to
as
a
society,
and
I
think
this
is
where
your
questions
are
coming.
How
do
we
take
that
into
consideration
when
determining
our
action
plans
to
protect
individuals?
I
mean
obviously.
Ideally,
of
course,
we
want
them
to
reach
recovery,
but
if
they
are
not
ready,
what
is
it
that
we
can
do
to
protect
them
so
that
they
don't
not
die
in
the
process
and
they
never
ever
get
a
chance
to
recover
because
they
die.
So
how
can
we
protect
them?
A
A
You
know
I
wanted
specifically,
you
mentioned
overdose
prevention
sites,
and
I
know
it's
a
controversial
subject.
I
know
there's
the
data
isn't
clear
on
it,
but
you
know
you
know
a
volkov
and
and
and
you
you
must
know
a
lot
about
it.
You
must
have
an
opinion
on
it.
Now
you
know
that
in
rhode,
island
legislation
has
been
passed.
There
are
two
sites
scheduled
to
to
open.
You
know
that
in
new
york
I
had
kailyn
c
she's
the
senior
program
director
at
onpoint
in
new
york.
A
A
The
only
data
we
have
in
america
is
from
onpoint
and
it's
looking
good
they've
reversed.
Many
overdoses
they've
had
thousands
of
uses.
They've
decreased
the
public
use
of
public
injection
the
public
disposal
of
syringes.
So
I
I
don't
think
you
have
research
on
that.
Yet,
if
you
do
share
it
with
me,
but
but
just
knowing
what
you
know
initially
about
what's
happening
in
new
york,
what
do
you
think
about
that?
Is
there
a
place
for
overdose
prevention
sites
in
america?
A
B
Well
I
anna
and
you're
asking
me
and,
and
my
perspective
I
mean
because
we
are
a
science
agency.
I
guide
my
answers
in
terms
of
data
because
my
own,
what
my
own
beliefs
on
these
things,
is
not
what
is
relevant.
What
is
becomes
relevant
is
where
is
the
data,
and
you
are
speaking
absolutely
vancouver
and
we've
been
funding
research
to
determine
the
benefits
of
the
inc
site
in
vancouver,
and
it
clearly
has
shown
that
it
is
not.
B
They
never
had
a
single
overdose
test
and
they
don't
modeling
to
estimate
that
they
basically
save
approximately
50
lives
every
single
year,
not
only
that
they
are
actually
because
it's
a
comprehensive
program.
They
are
able
to
engage
people
in
treatment
so,
and
they
also
have
shown
that
they
are
not
only
effective
in
preventing
hiv,
but
this
effect
is
so
large
that
that
actually
has
reduced
the
incidence
of
new
cases
of
hiv
in
the
whole
community
of
vancouver.
B
A
B
From
vancouver
shows
very
positive,
beneficial
effects.
There
is
data
that
has
also
emerged
from
australia,
also
showing
that
it
has
saved
an
equivalent.
They
have
seen
more
cases
it
started
to
operate.
I
think
it
was
in
2000,
so
it
is
it's
at
least
four
years
earlier
than
the
site
in
vancouver,
and
they
also
have
not
observed
a
single
case
of
an
overdose,
and
I
have
called
actually
I
called
the
vancouver
site.
B
It
was
like
three
and
a
half
months
ago
to
find
out
because
they
vancouver
has
also
a
very
serious
problem
with
fentanyl
whether
things
have
changed
with
fentanyl,
where
they
may
have
seen
overdoses
associated
with
fentanyl.
They
haven't
seen
a
single
one.
No,
no
one
that
goes
to
these
sites
has
died,
they've
seen,
overdoses,
absolutely
they've,
seen
many
overdoses,
they've
seen
many
overdoses,
but
not
a
single
phase
of
death,
and
so
in
that
respect,
you
start
to
say
well
from
the
structure
that
these
sites
are
are
placed
in
big
cities.
B
B
Or
over
those
prevention,
centers
are
all
over
the
world.
I
mean
I'm
highlighting
vancouver
and
australia,
because
that's
where
we
have
the
most
data,
but
there
are
at
least
a
hundred
sites
throughout
the
world
that
have
been
operating
now
for
many
years
and
what
I
think
is
telling
is
that
we're
seeing
more
and
more
being
developed,
and
I
think
that
it's
also
telling
that
in
canada
we
started
with
the
site
in
vancouver.
B
The
question
is
how
much
all
of
that
is
translatable
to
the
united
states,
so
we
have
been
funding
the
site
in
new
york
that
opened
up
to
try
to
evaluate
the
outcomes
and
from
what
we
are
hearing
in
new
york.
They
basically
have
been
able
to
save
several
people
that
overdose,
which
of
course,
is
what
they
are.
B
B
Evaluated
are
in
big
cities
where
you
have
a
relatively
high
throughput
of
individuals
coming
in
and
out.
If
you
build
one
of
these
places
in
a
rural
area,
you
can
start
to
see
why
it
may
not
be
optimal,
because
you
don't
have
enough
utilization
to
justify
the
cost
and
and
where
you
also
have
limited
resources
that
can
be
invested
on
something
else,
because
that's
that's
again,
when
you're
making
decisions
on
how
to
optimally
provide
the
help
that
people
need.
B
A
A
A
The
medical
system,
the
emergency
room,
the
emergency
departments,
have
been
relieved
of
like
an
incredible
amount
of
activity
in
each
overdose
in
new
york.
There's
two
detectives
assigned
to
each
case.
Each
one
of
these
cases
did
not
need
any
detectives,
so
the
cost
savings
in
terms
of
medical
hospital
stays.
A
Ambulances
and
police
work
was
was
phenomenal,
so
that's
just
in
six
months
showing
a
great
cost
saving.
So
so
that's
very
encouraging,
but
as
you're
saying
that's
that's
in
new
york
city
can
that
be
scaled
to
a
rural.
An
environment,
namely
burlington,
is
what
I'm
I'm
concerned
with
my
my
hometown
right
here
we
have
43
000
people
living
in
burlington.
A
We
did
a
study
of
overdose
fatalities
in
the
burlington
area.
We
have
a
heat
map
that
shows
they're
very
densely
concentrated
right
around
the
burlington
area
and
where
there's
a
lot
of
public
transportation,
so
we
have
a
kind
of
a
location
picked
out
where
what
would
be
optimal
for
an
overdose
prevention
site.
We
have
the
support
of
the
mayor
of
the
city
council,
the
state's
attorney,
the
attorney
general
and
and
countless
citizens.
A
They
recommend,
following
the
american
medical
association's
recommendations
and
the
american
medical
association,
recommended
that
there
be
pilot
projects,
pilot
overdose
prevention
sites
set
up
where
there
was
support
from
the
community
and
a
perceived
need
in
the
community
and
that
they
would
be
followed
in
research
to
see
if
they
work.
So,
in
my
view,
we
we
had
almost
one
vermonter
die
a
week
in
a
small
area,
burlington
or
chittenden
county.
A
In
my
view,
if
we
can
raise
the
funds,
we
should
be
allowed
to
implement
an
overdose
prevention
center,
an
overdose
prevention
site.
It
should
be
researched
and
we
should
see
whether
or
not
it
works.
I
don't
think
that
anybody
should
really
make
an
assumption
that
it
can't
be
scaled
to
any
environment,
and
I
I
don't
I
don't.
I
don't
see
how
that
could
possibly
be
true.
B
A
B
Transportation
is
so
that's
what
I
was
thinking.
I
wasn't
thinking
of
a
place
where,
on
top
of
everything
else,
you
have
a
very,
very
densely
concentrated
population
where
you
are
seeing
the
overdoses
and
that
also
you've
identified
a
site
that
is
richard.
These
are
conditions
that
lead
you
to
believe
that
you
will
sustain
the
use
of
that
facility
and
and
but
that's,
unfortunately,
not
the
circumstances
in
other
places
that
have
visited
in
the
appalachia
region,
for
example,
where
they
actually
have
difficulty
even
getting
access
to
teachers
and
to
healthcare
minimal
healthcare.
B
So
there
is,
there
are
areas
that
are
very
remote
where
this
is
that
again
they
don't.
Therefore
there.
The
question
is:
what
is
the
most
valuable
intervention?
How
do
we
provide
the
help
to
those
individuals
that
are
in
these
remote
areas?
So
we
can
protect
them
so,
but
in
what
the
way
that
you
describe
your
community,
it
seems
that
it
is
reasonable
to
predict
that
such
a
facility
could
be
justified
and
that
it
could
provide
the
benefit
that
you
are
intending
to
provide
and
you
you
should
research.
It.
A
Thank
you.
Thank
you.
We
we
are,
and
the
other
thing
I
think
you
mentioned
you've
mentioned
resources
a
number
of
times
and
you
know
believe
me.
I
have
no
idea
on
your
level
what
what
it's
like
you
know
with
the
met
with
the
limited
resources
and
the
amount
of
work
you
have
to
do.
However,
it's
kind
of
ironic,
dr
volkov,
that
that
that,
right
now,
because
of
accelerated
overdose
deaths
over
the
past
20
years,
we're
seeing
a
lot
of
money
coming
into
the
state.
A
The
opioid
wholesale
distributor
class
action
suit,
58
million
dollars,
is
coming
into
vermont
over
the
next
18
years.
The
sackler
family
there'll
probably
be
more
money
coming
in
through
that
stream.
The
biden
administration
just
passed
point
what
four
1.5
billion
dollars
like
specifically
earmarked
for
harm
reduction.
A
My
fear
is
that
this
money
will
not
be
spent
on
primarily
on
an
immediate
and
efficacious
approach
to
overdose
death,
but
it
will
get
filtered
out
to
lots
of
other
things,
because
that's
just
the
way
it
is
when
funds
become
available.
Everybody
wants
some
of
them
for
good
reasons,
but
I
see
this
right
now
this
point
in
history,
as
as
kind
of
a
perfect
storm
of
opportunity.
A
We
have
a
tsunami
of
death,
but
we
also
have
a
rising
tide
of
resources,
the
the
if
we
can
just
focus
those
resources
on
the
ones
most
at
risk.
I
think
we
can
get
through
this
point
in
history
and
then
move
on
to
some
of
the
wonderful
things
that
you've
mentioned
about
prevention
and
early
intervention
and
early
addiction,
and
you
know
intervening
earlier
in
the
process
and
saving
lives
earlier
and
saving
money
in
the
long
term.
That's
that's
just
the
way.
I
I
see
it
do
you
have
any
views
on
that.
B
Yeah
no-
and
I
wish
I
could
tell
you
yes
you're
absolutely
right.
We
let's
focus
on
these
very
severe
people
that
we
have
in
order
to
prevent
them
from
dying
and
the
reason
why
I
do
not.
I'm
basically
think
it's
not
so
simple.
Is
that
now,
as
I
was
saying
at
the
beginning,
we're
seeing
people
dying
from
overdoses
that
are
not
coming
with
a
severe
opioid
use
disorder
that
may
be
occasional
users
of
drugs,
and
that
includes
the
teenagers
that
we
are
observing.
A
B
A
B
And
yes,
indeed,
for
the
cover.
This
is
an
important,
very
important
component.
Let's
prevent
it.
So
these
aspects
are
to
me
a
lesson
on
how
to
basically
take
a
process
that
we
have
realized.
We
need
to
put
our
heads
together
in
order
to
give
the
resources
that
ensure
optimal
outcomes
and-
and
we
have
not
brought
it
anything
close
to
that
with
overdoses,
that
with
drugs
and
and
because
I
think
it
is,
they
are
not
considered
at
the
same
level
of
importance.
A
And
unfortunately,
you
know,
tragically,
this
is
true,
but
but
but
we
have
to
end
now,
have
a
few
minutes.
Thank
thanks
to
you.
People
like
you,
I
think,
of
john
kelly.
I
admire
john
kelly
tremendously
vivek
murthy.
There
are
others
who
have
really
stood
up
against
stigma
over
the
decades
and
you're
one
of
them,
and
you
know
I
just
thank
you
for
your
leadership.