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From YouTube: Drug and Alcohol Commission 10/16/2019
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B
C
B
Madam
sure
we
wanted
to
and
want
to
thank
mr.
Mohandas
commission
member
jessie
and
is
for
wanting
you
all
wanted
to
get
additional
information
and
treatment
or
addiction.
Y'all
went
through
some
naloxone
the
training
manuals,
and
now
we
wanted
to
bring
you
of
the
data
and
one
of
the
treatments
vivitrol
particular,
and
we
have
Michael
pollution
they're
going
to
introduce
and
Larry
Bush
with
one
the
company
that
makes
it
and
they
have
the
presentation,
I.
Think
as
we
move
forward,
especially
with
the
detox
and
additional
services
to
treat
addiction.
B
D
D
D
Money
we
do
not
work
with
default
for
ten
years
or
ten
years,
or
so
we
probably
know
a
lot
about
it.
I
do
one
he's
retired
psychiatrist,
who
is
who
is
interested
in
the
opiate
addiction,
even
sometimes
when
centers
of
the
opiate
addiction
crisis
and
he's
he's
here,
because
he
wants
to
be
able
to
understand
and
he's
actually
an
artist
by
trade,
now
a
painter,
and
so
he
invited
him
here
and
so.
B
B
A
F
F
Facilitate
that
conversation,
one
of
the
things
that
I
think
is
so
encouraging
for
me
as
a
individual
who
lost
his
brother
terminal
overdose
is
to
see
the
community
come
together
and
really
serve
together.
Let's
focus
on
tackling
this
issue
so
tonight
we're
going
to
talk
about
a
lot
of
three
things.
F
County
have
more
access
to
treatment,
to
be
able
to
get
screened
and
evaluated
and
to
be
placed
in
the
right
level
of
wraparound
services
and
even
on
the
right
medication
to
help
support
their
decisions
proper
to
help
so
to
protect
their
decision
to
be
abstinent
recently,
I
had
that
honor
and
you
can
tell
that
I'm
from
northeast
Texas
by
the
way
I
talk
there
I'm
just
kidding
how
many
astronauts
are
in
that
audience.
Everybody.
F
F
Out
of
the
way
from
the
UN
I
move
to
Dallas
Texas,
so
I
come
to
you
from
Dallas
via
New,
York
and
I'm
so
happy
to
be
here.
We
had
a
great
conversation
today
earlier
in
the
day,
but
early
late
last
month,
at
the
end
of
September
I
had
the
honor
of
speaking
at
unlocking
the
doors
which
is
unlocking
door
sponsors,
the
Texas
re-entry
symposium.
F
So
all
the
heavy
hitters
from
TDCJ
the
local
treatment
community
in
the
Dallas
Fort
Worth
area
had
come
out
and
they
have
a
lot
of
presentations
and
a
lot
of
talk
around
it
sheriff
Brown
from
Dallas
County,
cheap
Hall.
And
you
know,
a
lot
has
been
happening
at
Dallas
and
Fort.
Worth
they've
been
in
the
news
a
lot
right
yeah.
So
one
of
the
things
that
I'll
pass
along
to
you
is
so
you
can
get
an
idea
of
kind
of
Who.
F
I
am,
in
my
background,
I
just
celebrated
my
10
year
anniversary
with
optimist
and
I'm
happy
to
say
it's
one
of
the
proudest
of
decisions
that
I
make,
because
this
company
and
you'll
see
will
talk
a
little
bit
about
it.
Because
really,
our
hallmark
is
to
really
connect
needs
and
an
amount.
One
of
the
things
that
we
tackled
early
on
is
is
alcohol
dependence
and
we
make
long-acting
injectable
biologics
that
support
people
in
recovery
in
the
central
nervous
system
area
for
both
schizophrenia,
as
well
as
for
alcohol
and
opiate
use
disorder.
F
F
The
first
County
that
came
on
board
was
Orange
County
in
2015
and
I'll
share
with
you
why
they
did
that
they
saw
tremendous
growth
in
their
correctional
population,
and
then
they
saw
a
tremendous
growth
of
people
going
out
into
probation
and
they
were
just
overwhelmed
in
the
community
and
the
majority
of
those
people.
They
have
learned
that
they
had
become
the
addiction
and
the
mental
health
treatment
facility
for
the
county,
and
so
the
sheriff
is
here.
F
You
know
supporting
this,
and
so
what
happened
was
they
were
the
first
County
in
New
York
State
in
2015
to
put
a
reentry
program
and
open
up
access
to
vivitrol,
specifically
with
comprehensive
treatment
and
in
partnership
with
community
stakeholders,
so
that
started
the
first
conversation
and
when
I
left
in
August
to
transition
down
to
Texas
and
Oklahoma.
At
that
point
in
time
you
have
40
degrees,
reentry
programs.
Four
of
them
were
in
the
state,
the
Department
of
Corrections
focused
on
parole,
diversion
population.
F
These
were
parole,
violators
that
were
they
violated,
parole,
learn
that
they
had
a
substance
use
disorder,
so
they
would
send
them
to
a
specific
state
facility
and
those
folks
who
have
access
to
m80
and
then
comprehensive
treatment.
And
then
you
discharge
with
an
appointment.
I
had
a
treatment
provider
and-
and
there
were
39
County
reentry
program,
so
39
programs
with
the
Sheriff's
Department's
core
programs
with
the
state
of
New
York
and
in
all
of
them.
What
I
learned
is
the
gospel.
F
The
community
together
we've
got
to
gather
our
resources
and
the
folks
in
the
community
and
that's
where
we're
going
to
have
the
best
web
opening
up
more
access
to
help
more
people,
so
I'm
going
to
pass
this
along
if
you're
interested
in-
and
you
know,
I-
don't
want
to
really
talk
about
myself,
but
if
you're
interested
in
learning
a
little
bit
more
about
Who
I
am
it's
inside
of
there.
So
if
you
look
at
this
presentation
here,
I
think
I'm
a
big
statistics.
F
Guy
right
and
I
don't
know
this
presentation
talks
about
vivitrol
in
the
context
of
the
criminal
justice
system,
but
I
do
want
to
make
a
comment
before
we
get
into
the
presentation
that
somebody
doesn't
have
to
go
into
the
criminal
justice.
That's
going
to
have
access
to
this.
If
I
can't
deliver
any
message
to
you,
we
actually
we
would
prefer
that
they
avoid
that
altogether
right
and
that
we
open
up
access
to
help
them
to
divert
the
ability
having
to
Botticelli's.
F
B
I
F
Thousand
I'm,
sorry,
so
that
is
a
statistically
that's
a
large
number.
Does
everybody
have
an
idea,
so
one
thing
I'll
share
with
you
overdose.
We
know
we're
in
the
midst
of
an
epidemic.
Everybody
knows
that.
That's
why
we're
here
tonight
right
to
try
to
find
some
solutions
today
in
2015.
If
you
look
at
this
this
map
here
on
the
top
of
the
United
States,
if
there's
red,
that
shows
where
the
most
overdoses
and
you
can
see
in
2015,
if
you
look
at
this
map
and
I'll
pass
this
around
and
leave
this
for.
F
You
there's
only
a
couple
of
red
hot
spots
in
the
country
with
reporting
and
seeing
this
amazing
overdose
rate
right
and-
and
actually
this
is
data
from
1999,
but
on
25
the
time
it
gets
to
2015
you
see
the
color
all
across
the
country
is
changing
and
I.
If
we
were
to
show
your
data
from
2017
and
then
2018,
what
you're
going
to
see
is
the
entire
country
is
red.
F
Epidemic
regions,
unfortunately,
fentanyl
is
mixed
in
you
know,
and
it's
become
more
potent
and
powerful
right
and
there's
other
components
to
this
reporting
from
the
Department
of
Health
or
from
the
corner
to
where,
as
which
for
doing
a
better
job
of
tracking
all
of
those
things.
But
the
problem
is
too
many
of
our
citizens
too.
Many
of
people
are
dying
as
a
result.
Mike
and.
B
G
Calls
a
lot,
and
those
are
the
ones
that
you
know
and
then
that's
the
other
issue.
You
know
sometimes
they're
they're
classified
as
a
medical
type
of
call
and
we're
not
grasping,
though
the
correct
picture
that
it's
an
actual
overdose.
So
that's
those
are
other
gaps
across
the
nation.
They
are
probably.
F
And
then
we
put
it
in
the
context
of
people
transitioning
out
of
a
correctional
facility
or
a
detention
facility
or
a
jail
or
prison
and
then
having
access
to
treatment,
there's
even
another
that
we'll
talk
about.
Why?
All
this
is
an
important
point
and
it's
anybody
have
an
idea
of
what
the
economic
impact
of
opioid
misuse
is
and
by
the
way
this
number
is
from
2013.
F
So
take
a
guess:
I've
only
been
in
one
on
somebody
guests
actually
guessed
right,
there
was
a
total
guest,
but
they
were
pretty
much
right
on
take
it
just
just
pick
another
of
cost.
The
total
cost
of
opioid
misuse
in
the
United
States
500
million
okay.
Anybody
else
want
to
take.
You
guys
come
on
just
throw
number.
F
D
Disorders
cause
more
damage
to
society,
economically
family
and
all
the
other
substances
combined.
So
if
you
think
about
Opia
in
what
nine
billion
dollars
mark,
can
you
imagine
of
all
the
damage
we
have
to
society
economically
and
otherwise
with
all
these
sores?
And
this
is
why
moves
also
important,
because
you
taxes,
two
different
substances.
You
know
it
works
as
an
opiate
antagonist
that
blocks
us
a
receptor,
but
it
also
of
blocks
that
build
amazing
receptors
from
having
to
you
know,
taking.
I
F
I
had
a
really
good
professor,
and
it's
fully
give
us
the
answers
first
and
then
give
us
the
test
just
in
case.
Anybody
has
to
leave,
though
right
I,
like
kind
of
summarizing
it
and
then
we'll
get
into
kind
of
expanding
it
out
right.
So
the
number
for
alcohol
use
disorders
two
hundred
forty
nine
billion
dollars.
It's
amazing.
It's
amazing,
so
opening
up
access
for
people
to
treat
right,
there's
so
important.
Now
Jesse
stole
some
of
my
thunder.
We're
gonna
get
more
into
the
detail
of
them.
F
How
the
medication
word
up
seen
how
this
is
a
brain
disease,
but
I
want
to
talk
to
you
about
and
will
show
you
data.
That's
really
current
from
2017
data
comparing
head
to
head
to
so
far,
so
you
guys
can
see
you
know
it's
safety
and
effectiveness
to
that
and
by
the
way,
we're
not
here
we're
not
anti
people.
Northwood
have
enough
in
our
workflow.
Medication-Assisted
therapy
will
grow
people
having
access
to
every
tool
in
your
toolbox.
One
of
the
comments
I
said
to
dr.
F
Gonzalez
this
afternoon
is:
if
I
went
to
my
cardiologist,
and
they
said
you
know,
there's
only
one:
blood
pressure,
medicine,
we're
gonna
use
that
probably
governmental
cardiologists
so
I
think
it.
We
owe
it
to
the
citizens
of
Lorado
and
Webb
County
have
all
tools
and
availability
box
I.
Think
that's!
That's!
Morally.
The
right
thing
to
do.
F
I'll,
let
you
guys
do
something
I'll,
let
you
decide
that
so
this
is
data
from
2014
from
the
US
government
to
the
writings
of
our
report
to
the
adult
treason,
drug
courts
in
the
United
States,
and
they
talk
a
lot
about
all
the
medications
inside
of
the
millions
we
paragraph
sounds
very
small,
but
it's
very
powerful
and
I'll
pass
this
along.
So
you
can
see
it
one
of
the
things
they
talked
about.
His
studies
have
found
that
the
injectable
form
of
non
traps
or
vivitrol
can
improve
patient
adherence
to
the
medication
because
virtual
learner
does.
I
A
F
The
healthy
C
Center
in
the
movement,
where
you
see
people
what
happens
a
lot,
they
leave
treatment
before
they
get
on/off
tools
in
their
toolbox
to
really
live
a
life
right,
and
they
say
that
treatment
retention
is
particularly
important
because
it
provides
clinicians
with
sufficient
time
so
that
they
to
engage
the
patients
in
psychosocial
therapy
and
that's
why
they
can
make
learn
to
make
the
psychological
and
the
social
adjustments
that
support
a
life
without
opioids.
So
the
whole
goal
of
medication
is,
it
should
never
replace
treatment.
F
It
should
never
replace
the
good
word
that
the
counselors
are
doing
to
try
to
engage
people
to
save
their
lives,
to
give
them
new
techniques.
It
should
support
that
and
enhance
that
experience
right,
and
this
is
what
one
of
the
things
they
found
with
their
betrayal
from
the
studies.
The
other
thing
is
specific
to
criminal
justice
population,
which
we
know
is
often
a
difficult
population
to
treat
for
a
lot
of
reasons.
It
says
that.
F
A
recent
multi-site
study
of
people
on
the
legal
supervision
people
on
probation,
parole
and
drug
court
found
that
those
who
are
completing
the
treatment
program
where
they
had
received
six
monthly
injections
of
their
child
with
counseling
psychosocial
therapy
found
six
months
after
their
last
dose
so
a
year
after
started
that
there
were
significantly
fewer
positive,
urine
screens
for
hope,
healing
and
those
who
did
not
complete
treatment.
Who
didn't
receive
all
six
doses,
because
one
of
the
biggest
questions
you're
going
to
have
for
me
is
how
long
should
somebody
be
on
medication?
F
F
Be
incarcerated,
this
is
Sam,
so
the
US
government
sang
this.
This
is
I'm
just
reading
what
they
wrote.
So
how
did
you
do
something
so
I
got
any
answers
to
the
test
ran
ahead
of
time.
The
other
question
you're
gonna
have
to
me
is:
how
much
does
it
cost
and
all
of
those
things
in
what
is
the
burden
on
our
health
system?
Dr.
Shah
recently
did
a
study
where
he
compared
all
forms
of
medication,
specific
to
opioid
use,
disorder
and.
F
All
the
medications
raised
costs
to
the
health
system,
but
vivitrol
specifically
raised
at
the
least
you'll
see
buprenorphine
and
methanol
specifically
raised
at
about
the
point
of
this
study
upwards
between
40
to
50
percent
increase
to
the
health
care
system
because
of
the
utilization
and
a
part
of
that
is
the
relapse.
The
recidivism
rate
people
hitting
the
emergency
department.
Looking
for
help,
people
having
a
built
in
patient
with
vivitrol,
which
you'll
see
is
it's
a
medication.
F
F
F
We're
a
fully
integrated
global
pharmaceutical
company,
developing
products
that
make
a
meaningful
difference
in
the
way
patients
manage
their
disease
will
focus
specifically
on
the
central
nervous
system
disorder
and
if
you
want
to
get
specific
about
that,
its
schizophrenia,
opioid
use
disorder
and
alcohol
use
disorder
right
now,
so
we've
talked
a
lot
about
the
burden
on
the
just
overall
in
the
United
States,
but
in
the
criminal
justice
system.
Specifically,
what
this
slide
says
and
I'll
summarize
it
for
you-
is
1/3
of
all
people
with
heroin
use
disorders
specific
to
heroin.
F
F
One
putting
our
hospitals
out
of
business,
it's
putting
a
trans
burden
on
our
law
enforcement.
Colleagues-
and
you
know,
I-
was
just
up
in
Harris
County,
with
the
Harris
County
Sheriff's
Department,
and
one
of
the
things
that
was
remarkable
to
me
as
they
said
we
burned
through
our
entire
budget
of
narcan
and
2019
still
where
we
have
two
or
three
months.
Three
months
left
in
the
year,
yes
and
they're.
F
I
F
Wow,
this
is
not
our
first
time
at
the
rodeo
and
I
can
say
that,
because
I'm
in
Texas,
this
is
actually
incorrect,
is
probably
closer
to
700
programs
that
we've
done
in
the
United
States
and
almost
every
state
in
in
the
country.
So
a
lot
of
times
we
publish
this
stuff
and
by
the
time
it
gets
up
here
through
legal.
The
data
are
the
objects
right.
F
So
this
is
really
I
know
why
you
came
out
tonight.
It
is
to
understand
a
better.
You
probably
already
have
this
understanding
is
so
complement
a
lot
of
the
education
that
you
know
and
if
you
like
what
you
see
up
here
on
our
slide
deck,
a
lot
of
it
is
available
from
your
local
representative.
We
have
flip
charts
with
all
kinds
of
patient
educational
material
that
you
guys
can
utilize
to
continue
that
conversation,
because
if
you
don't
carry
this
message
out
into
the
community,
then
nothing's
really
going
to
change
right.
F
So
how
to
opioids
effective
brain,
because
what
we're
talking
about
is
just
like
any
chronic
disease,
the
American
Medical
Association
and
the
American
Psychiatric
Association,
and
never
define
addiction
as
a
chronic
relapsing,
brain
disease
and
I.
Think
it's
important
that
we
look
at
that
medically
because
again,
it
also
be
stigmatizing
addiction,
so
we're
gonna
talk.
The
brain
is
very
complicated
right
and
it's
amazing
how
it's
designed
like
the
motor
I,
don't
really
know,
but
them
your.
F
Are
up
here
or
back
here
or
something
you
know
why
y'all
right,
you
got
to
put
it
there
versus
putting
it
here,
because
you
think
you
know
a
lot
of
that.
Stuff
will
be
up
here
right.
Well,
we're
going
to
talk
about
it!
We're
going
to
really
simplify
the
brain
right,
we're
going
to
talk
about
two
different
regions,
the
limbic
region.
I
F
The
brain,
that's
our
pleasure
and
our
reward
system,
part
of
our
plan.
You
might
want
to
think
about
that
as
a
caveman
brain.
That's
like
the
most
basic
part
of
our
brain.
It's
it
sits
right.
On
top
of
your
spinal
cord,
the
brainstem
is
right
there
on
top
of
the
spinal
cord.
Even
if
we
live
on
the
bottom
is
somebody
and
took
out
that
prefrontal
lobe
they'd
still
be
a
breathing
human
being
that
we
need
to
eat
when
they're,
hungry,
etc.
So
that's
where
our
basic
drives,
rewards
and
pleasure.
F
Everything
you
need
to
know
about
me
is
this
I
didn't
tell
you
this
I'm
53
years
old
and
I
have
a
three-year-old
son
at
home,
so
I
think
of
low-tech
system
as
like
the
BB
prank,
because
that's
the
part
of
the
brain
that
says
I
wanna.
What
I
want
right.
So
anyone
that
has
children
and
has
you
know,
raised
any
of
the
children
at
the
age
of
pretty
nose
thing.
F
That's
it
when
a
club,
terrible
twos
and
the
terrible
breeds,
but
then
there's
another
part
of
our
time
and
that's
the
prefrontal
loafers
the
cortex,
specifically
the
prefrontal
lobe,
is
where
we
do
our
thinking
our
decision-making.
That's
the
executive
functioning
of
the
brain.
It's
important
that
we
we
talk
about
this
in
context
of
a
chronic
relapsing
brain
disease.
F
This
is
the
area
of
the
brain
you
Linda
here
is
the
area
of
the
brain
that
a
substance
fill-in-the-blank
when
a
person
becomes
physically
dependent
on
upon
that
substance.
That's
the
area,
the
brain
that
gets
taken
over
by
that
substance
and
that
area
of
the
brain
that
begins
to
send
signals
that
brief
frontal
lobe
and
tell
the
prefrontal
lobe
how
to
think
about
situation.
F
So
it
healthy
season,
counselors
and
folks
that
being
in
recovery
used
to
say
people
with
an
addiction
have
stinking
thinking
right
well.
Part
of
that
is
because
their
limbic
is
controlling
their
primitive
part
of
the
brain
is
controlling
the
prefrontal
lobe
of
their
brain
and
telling
it
how
to
think
so.
We
call
that
Olympic
hijacking
the
prefrontal
look,
so
it
kind
of
makes
sense
of
what
happens
with
meditation.
This
is
the
area
of
the
brain
that
medication
is
going
to
play.
F
F
So
hope
you
it's
occipital
if
we're
to
take
a
deeper
dive
into
that
Olympic
region.
What
we
would
see
is
an
limbic
region
has
a
bunch
of
opioid
receptors
in
there
and
there's
many
different
types
of
receptors,
but
opioids
an
alcohol
and
a
high
affinity
for
what's
called
the
MU
opioid
receptor.
You
don't
have
to
remember
it
specifically,
but
just
so
you
know,
there's
other
receptors
that
player
role
like
when
we
eat
our
favorite
food
that
might
hit
another
receptor
in
the
brain
so
specific
to
opioid
dependence
is
the
MU
interceptor
and
what
happens?
F
Is
you
have
a
natural
pharmacy?
Inside
of
your
brain,
for
example,
you're
hungry
you
eat
your
liquid
gets,
gets
an
endogenous
opioid
hooks
up
to
the
meal.
Opioid
receptor,
it
releases
a
little
bit
of
dopamine
right.
What
happens
when
somebody
uses
heroin,
oxycontin
or
a
synthetic
opioid?
Is
that
what
that
exogenous?
Hopeyou
it
comes
from
the
pain
reliever
comes
out,
gets
onto
that
new
opioid,
receptor
and
thunder
and
lightning
happens.
It's
like
a
hundred
to
a
thousand
times
more
dopamine
moving.
So
that's
kind
of
where
the
reward
system
is.
I
F
Understanding
different
types
of
medicines
there's
three
approved
medicines
by
the
FDA
to
treat
opioid
dependence.
So
we
understand
the
disease
kind
of
how
it
happens
right
where
the
hook
is.
If
you
look
at
agonist
therapy,
for
example,
methanol
that
takes
a
full
opioid
agnus
hooks
up
to
that
same
receptor
and
they
get
an
excessive
release
of
dopamine,
so
you
can
look
at
it
as
both
your
replacement
therapy
right.
Let's
talk
briefly
about
partial
agonists,
which,
for
example,
buprenorphine
what
that
will
do
is
I
get
it
I'll
hook.
F
To
that
same
me,
opioid
receptor
and
again
a
release
of
dopamine
and
there's
a
ceiling
effect.
That's
built
into
it
right.
So
that's
kind
of
the
idea
behind
right
right,
there's
no
lock
zone
as
a
part
of
it
in
case
somebody
abuses
it.
It
prevents
that
from
happening.
You
look
at
antagonist
therapy.
The
most
well-known
is
now
tracks
home,
which
is
the
active
ingredient.
That's
inside
of
the
original.
F
You
might
have
heard
it
in
an
oral
therapy
called
rabiyah
and
now
Trachsel
works
differently
and
hooks
that
well,
it
works
in
the
sense
that
it
cooks
that
same
opioid
receptor,
but
there's
no
stimulation
of
excessive
stimulation
of
dopamine.
It
actually
blocks
and
think
about
it.
As
kind
of
like
a
locking
key
is
a
nice
way
of
kind
of
explaining
it
right.
F
I'm
not
going
to
go
through
this
because
it's
it's
a
very
busy
chart,
but
it
kind
of
goes
down
the
line
here
again.
Looking
at
some
of
the
differences
between
antagonists
and
partial
address,
and
one
of
the
things
that
I
will
say
about
aunt
Agnes,
there
specifically
is
that
it
is
not
a
DEA
scheduled
medicine
and
one
of
the
key
differences
is
that,
unlike
agonist
or
partial
agonist
therapy,
it
requires
detoxification
of
front
before
starting
it.
F
F
We'll
talk
now
specifically
about
never
at
all,
and
how
is
it
good
in
segue?
Thank
you.
So
what
does
never
troll
indicated
for
an
hour?
Indications
are
FDA
indications.
That
means
that
there
has
to
be
clinical
data
behind
that
indication.
They
don't
just
give
an
indication
because
we
asked
for
it
yeah
that
the
actual
outcome,
studies
that
show
medication
improves
that
the
medication
can
do
that.
So
one
of
the
things
that
they
it's
indicated
for
is
the
treatment
of
alcohol
dependence
and
we'll
get
into
the
clinical
studies
of
how
it
works
for
the
folks.
F
Without
all
dependency,
people
should
not
be
actively
drinking
at
the
initial
time
of
the
control
administration.
It's
also
indicated
and
see,
if
only
one
of
the
three
approved
medications
to
treat
popular
companions
to
for
the
Prevention
of
relapsed,
opiate
dependence,
fine
and
I'll
do
a
detoxification,
and
that
was
based
on
the
way
the
study
investigators
designed
it
a
minimum
of
seven
days
detox,
and
it
should
be
part
of
a
comprehensive
program
that
includes
psychiatric
therapy.
So
again,
this
graphic
kind
of
just
reviews.
What
we
looked
at
for
at
antagonist
therapy.
F
Is
an
opioid
antagonist,
it
has
its
highest
affinity
for
the
mule
poit
receptor,
that's
the
receptor
that
plays
the
key
role
in
hope,
Ewing
and
alcohol
dependence
right
and
what
it
does.
Is
it
occupies
that
receptor
and
blocks
and
doggedness
opioids
from
being
able
to
get
on
to
that
receptor
and
it
markedly
attenuate
or
completely
blocks
the
subjective
effects
of
Massage
it's.
So
it's.
F
And
that's
really
important
because
show
you
the
clock
is
the
last
slide
in
them
I'll
kind
of
ask
if
there's
any
questions
and
then
we'll
get
on
to
the
data,
but
just
to
kind
of
summarize
treating
people
with
once
monthly
injection
and
counseling
is
really
the
key
to
success
here
and
Victor
12
contains
an
opioid
antagonists
that
we
talked
about
called
naltrexone.
You
know
trichomes
been
around
for
a
long
time.
F
It's
a
very
safe
and
effective,
well
study,
medicine,
but
the
way
we
formulated
it
is
in
tiny,
little
micro
strips
that
allows
us
an
individual
to
receive
a
once-a-month
dose
on
those
micro
spheres,
begin
to
dissolve
and
they
extend
the
release
of
the
naltrexone
over
a
28-day
period.
So
in
the
context
of
something
to
use
in
recovery,
that
has
a
ton
of
social
issues
that
maybe
has
to
report
to
a
probation
officer,
maybe
has
to
go
to
drug
court
or
just
has
to
show
up
for
counseling
and
go
to
a
physician
for
medication.
F
There's
a
lot
of
things
going
on
in
their
mind.
Well,
one
of
the
things
that
they
have
they
don't
have
to
worry
about
is
making
a
decision
to
take
that
medication
every
single
day
so
built
into
long-acting
injectable
is
the
fact
that
they're
automatically
compliant.
If
anybody
takes
vitamins
or
medication
world
every
single
day,
you
know
there's
some
days
when
you
miss
it
right
and
what
he
did.
F
As
soon
as
your
lover
invested
with
this
you're
covered,
the
individuals
covered
for
the
course
of
28
days
on
one
month
right.
It
is
recommended
that
taking
opioid
free
at
the
time
of
administration
and
that
recommendation
is
a
minimum
of
seven
to
ten
days,
but
will
speak
to
the
physician
specifically
about
creating
helping
them
to
do
an
induction
protocol
and
ICU.
Did
you
have
a
question?
Okay?
So
what
is
very
calm,
I?
Think
by
now
you
know
it's
a
monthly
extended
release
of
naltrexone,
specifically
380,
well
exams,
it's
only
administered
by
a
healthcare
professional.
F
So
what
that
means
is
an
individual
doesn't
walk
into
a
retail
pharmacy
and
carry
this
around
with
them.
They
have
to
go
to
their
physician's
office
to
receive
it.
It
has
no
street
value
running
it,
because
it's
not
a
narcotic,
but
it's
nice
to
know
that
them
to
report
in
to
their
doctor's
office
or
to
their
to
the
program,
that's
administering
it
and
receive
the
medication
that
gives
us
an
opportunity
to.
Yes,.
C
F
Again,
I
think
it
really
depends
where
that
person
is.
There
are
some
alcoholics
of
folks
with
alcohol
dependency
that
may
need
to
be
detox
for
Satan's
purposes,
but
to
ant.
The
short
answer
to
your
question
is
in
the
clinical
outcome
studies
which
we'll
get
into
in
a
minute
of
624
alcohol,
dependent
people,
the
majority
of
people
drank
up
and
until
their
first
dose
of.
I
F
Patron
and
it
was
very
safe
and
effective,
and
they
had
great
outcomes
for
the
group
that
decided
that
really
wanted
to
be
abstinent
and
was
seven
days
abstinent
prior
to
starting
today
they
did
even
better
okay,
so
that
makes
sense
to
me:
I
mean
I'm,
not
a
counselor,
but
it
makes
sense
to
me
that
why
would
people
that
were
abstinent
in
alcohol
studies
do
better
than
people
that
nothing
to
it
and
I?
Think
it's
just
sheer
motivation.
F
I
F
F
F
Brought
that
up,
because
one
of
the
things
I
didn't
imagine
is
all
of
these
programs
are
completely
balanced,
binary,
yeah,
so
there's
no,
nothing
that
will
force
them
to
be
the
only
the
only
thing
that
I
see
the
court
system.
If
we
well
doing
is
mandating
that
they
sanction
them
to
treatment.
You
know
what
I
mean,
but
they
don't.
They
cannot
mandate
what
medication
I
mean
I
think
we
still
live
in
the
United
States.
D
Reason
why
the
twelve
might
be
really
good
is
because
we're
gonna
get
people
that
have
to
be
detox
twelve
hours
after
they
come
in
deliver
rule
of
law.
A
process
called
Aloha
okay,
so
at
that
point
in
time
they
can
actually
get
their
Patrol
as
opposed
to
someone
that's
using
opiates.
We
may
have
to
wait
it's
a
number
of
days
right,
but
but
that'll
that
will
help
part
in
in
our.
E
When,
when
there's
a
client,
that's
referred
over
to
the
program,
a
lot
of
the
referrals
come
in
from
intake
at
the
jail
with
the
sheriff's
office.
So
what
happens
is
if
we
are
notified
that
they
are
under
the
influence
and
that's
why
they
got
picked
up.
We
request
that
they
wait
in
their
jail
cells
for
a
minimum
of
seven
days
and
throughout
those
seven
days
that
we're
trying
to
get
them
into
the
drug
court
program.
We
start
calling
up
the
doctors.
There's
a
physician,
that's
here
in
local.
That
is
aware
of
how
the
victual
works.
E
We
request
or
the
doctor
requests
labs,
because
there
are
certain
clients
that
may
not
be
as
receptive
to
the
vivitrol,
depending
on
their
certain
medical
conditions,
and
so
when
the
laboratory
results
come
in,
if
everything
seems
well,
then
the
doctor
will
go
ahead
and
prescribe
the
vivitrol
they'll
order
it,
and
then
it
gets
up
ministered
once
it
gets
administered.
Then
we
start
the
therapy
sessions,
because
we
understand
that
in
order
to
get
treated
you
have
to
have
both
in
conjunction
with.
F
F
E
The
correctional
facility
will
sometimes
do
the
court,
the
favor
of
transporting
the
individual,
while
they're
still
in
the
custody
of
the
sheriff's
office,
to
their
doctor's
appointment
and
to
get
the
labs
and
then
to
administer
the
tests.
They're,
the
I'm,
sorry,
the
medications.
Until
once
the
medication
has
been
administered,
then
they'll
come
back
to
the
court
and
then
we'll
release.
E
It's
not
something
that
you
can
force
your
clients
to
do,
because
they
to
have
to
be
receptive
to
the
medical
treatment,
and
that
is
the
office
visits
on
a
monthly
basis,
making
sure
that
those
lab
tests
are
still
coming
out
normal
and
then
making
sure
that
they
want
to
stay
clean.
So
no,
it's
it's
not
easy.
It's
not
easy.
Sometimes
we
do
lose
clients.
F
This
was
the
great
protocol
program.
I
would
hasten
to
exert
on
the
medical
piece,
but
that
would
be
a
conversation
we
have
with
the
doctor,
but
the
one
thing
the
reason
why
I
asked
you
that
is:
would
it
be
a
difference
if
it
was
if
they
were
age
we
get
on
a
dose
prior?
That's
all
I
ask:
would
that
make
it
not
necessarily
about
people
I
would
programmability
for
capturing
those
one
or
two.
A
F
F
F
F
F
It's
a
boxer
and
there
no
studies,
the
study
investigators
used
a
very
high
cutoff
on
the
liver
function
tests
and
they
digit
denied
people
to
have
active
type
C.
The
only
thing
I
amiri,
hi,
liver,
the
protocol
were
excluded,
and
so
it's
exactly
what
dr.
Gonzalez
is
saying
is
that
what
what
are
we
trying
to
do,
though,
trying
to
complain?
People
for
relapsing
and
overdose?
D
I
just
want
to
point
out
one
thing
as
your
time
level:
we
do
with
the
jails
and
drug
court
and
we
could
potentially
do
here
in
the
depot
so
any
little
sizes.
The
KDP
is
mr.
health
care.
Professional
administer
dr.
Gonzales
am
I,
not
correct
that.
If
a
doctor
who
writes
a
medical
protocol
puts
limit
roll
in
there
as
part
of
the
protocol,
a
registered
nurse
or
doctor
nursing
can
make
sure
that
shot
is
administered.
So
you
don't
have
to
have
dr.
D
F
I
got
biographies
doneness
on
the
40
and
I
would
say
one
of
the
things
that
when
people
started
at
home
that
they're
very
conservative
because
have
no
experience
with
this.
And
of
course
you
know,
people
are
afraid
of
liability.
But
now,
as
we
fast
forward
to
2019,
there's
a
lot
more
experience
with
this
particular
medication.
F
But
then
there's
the
clinical
data,
like
the
data
I
just
quoted
to
you,
where
I
mean,
let's
look
at
if
extended-release
not
far
time
was
causing
or
accentuating
the
phenomenon
of
hep-c
Rivero
problem
staff,
together
with
they
do
have
a
warning
in
our
life
that
I'll
track.
So
at
higher
doses,
can
cause
a
battle
toxicity,
but.
F
Contraindication
another
convert
all
is
always
administered
in
the
same
exact
Oh,
so
it's
not
that
it's
HCP
administered
so
that
they
cannot
administer
more
than
one
dose
at
a
time.
So
the
levels
in
their
bloodstream
are
very
consistent
and
very
constant.
There's
a
couple
of
other
bullet
points
up
here,
so
you
know
that
this
is
an
opioid
antagonist
and
you
know
what
it
opioid
antagonist
feels
right.
Who
gave
you
the
answers
for
the
test.
I
F
F
A
person
to
be
detoxed,
that's
important,
because
what
that
tells
you
again
it's
another
part
of
an
individual's
it's
a
part
of
the
disease
of
the
opioid
or
the
alcohol
dependency.
There's
a
physical
part
is
a
neuro
chemical
part,
and
there
may
be
mental
health
and
psychological
parts
to
it
as
well
right,
but
a
person
actually
has
to
detox
before
starting
this
medication
and
I
think
what
that
says
is
it's
an
indication
of
how
motivated
illness
so
I
think
that's
important,
and
it
should
be
part
of
a
comprehensive
treatment
program
under
the
prior
psychosocial
therapy.
F
It
doesn't
have
to
think,
but
all
of
the
outcomes
data,
all
the
data
that
we're
going
to
quote
includes
psychosocial,
but
remember
if
we're
talking
about
our
product
relapsing
brain
disease
without
a
treat
the
baby
brain,
we
gotta
treat
the
executive
functioning.
We
do
that
together
get
a
better
outcome.
That's
what
data
says
in
all
medications,
right.
B
Forms
I'm,
sorry
that
there's
an
organization
here,
I'm
a
who
runs
our
methadone
program
is
not
here
because
they
they've
shared
they've
got
about
two
hundred
persons
that
they
treat.
But
it's
a
revolving
door
because
folks
are
in
and
out
of
the
methadone
treatment
that
that
may
be
using
vivitrol
might
be
again.
Everybody
with
an
addiction
has
their
specific
treatment,
but,
but
certainly
vivitrol
might
be
an
alternative
for
that,
those
that
are
revolving
around
and
then
and
they
have
the
capacity
for
200,
but
they
have
a
waiting
list
of
another
hundred.
D
I
D
Something
like
that
all
I
have
to
send.
This
am
talking
where
our
doctors
are
educated
right,
so
I
do
have
an
assignment
very
late.
Everybody
has
a
doctor
again
what
a
Laurie
a
little
booklet,
take
them
to
your
doctor
and
tell
them
please
read
about
this.
Is
we
need
vivitrol
in
our
community
or
all
use
disorder
and
open
use
disorders
because
we
need
it?
I
would.
E
That's
what
I
was
going
to
say:
I,
remember
back
in
2013
or
2012
I'm,
not
exactly
sure.
There
was
a
presentation
at
the
University
here
and
we
invited
physicians
to
come
and
take
a
look
at
what
vivitrol
was
about
and
out
of
all
the
physicians
that
are
here
local.
We
only
had
a
handful
from
those
handful
of
physicians.
We'll
only
had
one
that
was
receptive
to
learning
more
about
the
veteran
and
wanting
to
help
us
out
that.
H
B
F
So
that's
what's
changed
in
that
period
of
time.
To
your
point,
it's
not
you
know
a
lot
of
tanks
number
one
it's
covered
under
Medicaid
and
there's
a
ton
of
funding,
that's
available
that
you
guys
can
get
access
to
the
local
sheriff's
departments
can
get
access
to
the
court
system
can
get
access
to
and
the
whole
goal
is
to
make
treatment
and
you
know
more
accessible,
so
more
people
can
get
access
to
the
medication
I.
D
E
D
We
have
to
get
for
them
and
make
sure
that
the
top
diagnosis
is
PTSD,
post-traumatic
stress
disorder
and
everything
flows
from
there,
including
their
addiction,
and,
if
you
have
to
advocate
for
them,
you
advocate
for
them,
because
that's
what
they
need.
You
know.
Why
would
they
be
denied
some
type
of
insurance
just
because
they
were
sexually
abusing
their
young?
It
doesn't
make
sense
right.
H
F
H
E
Remember
we
had
a
couple
of
clients
that
were
private
insured
until
their
first
month
was
free,
quote
unquote
and
then,
with
that
form
that
they
would
have
to
submit
from
the
doctor
to
alchemy
sanur
wrote
back
and
forth
and
that's
when
the
copay
or
the
partial
paid
began
or
their
treatment.
But
I
do
I
do
remember.
There
was
one
actually
visibly.
He
was
Blue
Cross
Blue
Shield
there
his
first
month
he
enough
to
pay
for
his.
H
E
H
F
Benefit
verification
and
make
sure
that
the
office
or
the
physician
knows
what
pharmacy
to
get
the
medication.
So
that's
what
glory
is
referring
to.
So
it's
helped
with
that.
The
other
thing
that
we
have
now
that
we
didn't
have
to
force
course
on.
There
are
ends
that
will
go
out
and
train
physicians.
There.
A
Microspheres,
yes,
so
that's
that
why
it's
so
expensive,
as
you
all
have
your
company
has
a
patent
on
that.
So
one
question
is:
when
does
that
co-op
patent
I
don't
know.
My
second
question
is
that
this
medication-
that's
not
in
those
Spears-
is
it
available
in
another
formulation
yeah,
so
it
can
be
used
on
a
daily
is
much.
F
F
F
D
When,
let's
say
doctor,
there's
a
tribe
that
affects
what
we
had
to
make
sure
it
was
a
good
match,
they
had
a
family
support,
because
if
you
give
it
that
client
that
somatic
they
may
take
it,
those
a
follow
it
for
a
while,
but
the
only
one
or
relapse
are
going
to
not
do
it.
So
we
have
to
find
a
faculty
member
that
was
willing
to
provide
that
medication,
so
they
could
have
happened.
So
you
have
to
find
the
right
page.
D
So
in
essence,
assignment
efficacious
I
mean
that's
what
I've
seen
so
when
I
found
out
about
bit
of
trellis,
and
while
this
is
this
is
a
winner
for
me
and
for
the
community.
You
know,
especially
as
we
were,
writing
the
first
grant
from
the
drug
court.
All
that
except
this
is
this
is
really
good
for
us
and
if
you
look
at
you
know,
we
would
get
grant.
Originally.
The
original
grant
was
three
years.
$995,000
right
and
25,000.
Larger
here
was
for
literature,
so
that
second
$5,000.
D
D
Matters
at
seventy-five
thousand.
You
had
that
five
hundred,
sixteen
thousand
so
and
I
have
the
one
point:
four
million
grant
money.
You
know
that
was
there.
It
helped
the
community
out
just
twenty
five
thousand
dollars
a
year,
those
pious
those
drug
three
days
that
those
clients
had
it
helped
us
at
my
temper.
That
was
all
the
money
we
had.
We
didn't
have
that
much
and
so
now
we're
looking
at.
How
can
we
expand
this
now?
There's
more
opportunities
in
that
we're
ten
years
ago
and
I
think
this
is
the
right
time.
F
H
I
think
just
use
us
best
resources,
because
you
know
right
down
here.
They
cover
the
whole
valley
and
even
we
have
apply
yesterday
from
the
cattle
and
the
same
problem
yeah.
This
nurse
has
clients
on
their
child
just
like
who
gives
the
shot
and
I
was
like.
You
do.
You
know
and
she's
like
I.
Do
it
I
was
like?
Oh
yes,
you
know,
that's
your
the
nerves,
you're
the
healthcare
provider
and
she
was
even
a
nurse
practitioner,
but
she
was
like
I
called
and
there's
nobody
to
be
honest.
D
Do
want
to
say
something
about
our
comida,
because
you
know
when
you're
looking
at
the
price,
a
lot
of
people
don't
know
that
we
got
many.
Many
many
free
doses
for
people
that
were
in
jail
right,
mommy,
the
first
dose
for
free,
and
so
you
know
all
for
me
is
yes,
but
they
understand.
You
know
that
this.
H
F
F
There's
a
ton
of
Samsa
also
has
funding
available
so
you're
going
to
see
in
the
governor's
office
also
as
as
making
more
funding
available
for
MIT,
so
I
think
there's
plenty
of
funding
to
go
around
to
support
treatment
and
the
support
the
ability
for
you
guys
to
access
to
medication.
And
again
it's
your
community's
decision
as
to
what
you
do
this
to
get
into
the
data
I.
Don't
know
if
we
have
time
to
if
you'd
like
to
you
can
do
that,
but
yeah
our
you
can
kind.
F
F
B
F
F
F
C
F
In
the
clinical
study
in
our
package
insert
I
think
there
is.
It's
noted
that
there
was
one
case.
B
But
to
that
to
might
because
some
of
the
overdoses
were
classified
as
suicide
overdose
and
so
again
making
the
decision
tree.
So
you
don't
overdose
or
commit
suicide,
and
so
that's
that's
the
issue
also.
That
clinicians
are
having
to
me
because
some
some
are,
the
overdoses
were
suicide,
so
we
can
prevent
the
overdose
by
treating
that
we
can
prevent
suicide
to.
H
What
most
important
is
that
it's
never
just
a
shot.
You
walk
down
the
street.
You
don't
have
relationships
with
your
counseling
working
your
program,
doing
whatever
it
is.
You
do
to
work
active
recovery
and
that
never
goes
away,
and
so
that
way,
if
you
are
getting
feelings
of
sadness
or
something
you're
talking
you're
in
community
you're,
not
isolating
where
it's,
because
it's
sometimes
take
our
brains
up
to
a
year
to
reprogram
for
addiction.
H
H
I
D
Know
and
in
reality,
I've
never
met
anyone
that
had
an
Opie
picture,
didn't
have
the
pressure,
mood,
disorder,
expression
and
so
just
like
any
other
medication
that
you're
gonna
give
you're
getting
give
an
antidepressant.
Well,
you
know:
you're
not
gonna
commit
suicide
at
the
lowest
point,
but
once
they
start
getting
the
medication
they're
getting
better.
That's
funny,
really
something
you
don't
see
now
I
have
to
do
it,
so
the
counselors
have
to
watch
it.
D
The
same
thing
was
a
blue
this,
but
there's
a
lot
because
it's
because
the
other
stuff
it
was
because
of
the
co-occurring
psychiatric
issues
that
probably
led
to
the
suicide
of
the
pair
suicide.
It
was
not.
It
was
not
basically
the
bit
of
trouble.
I
mean
it
may
have
done
the
Patrol,
but
there's
other
issues
that
we
have
to
work
at
you're
right
I
mean
if.
F
You
understood
we
go
back
to
the
disease
state
and
it's
very
basic
form
as
we
presented
it
here.
This
is
a
disease
of
the
hedonic
system,
where
the
pleasure
system
is,
you
know
attracted
to
that
particular
substance.
So
it
is
not
uncommon
and
I'm
so
glad
as
a
professional
clinician.
You
pointed
this
out
and
I
think
it
embarrasses
out
that
you
can,
if,
when
they
understand
opioid
dependence
behind
us
as
a
whole
cascade
of
neuro
chemical
effects
that
occur,
one
of
them
is
the
overproduction
of
norepinephrine.
F
So
when
you
remove
them
or
that
opioid,
then
there's
this
over
stimulation
of
more
of
the
nephron
right,
but
over
time
what
happens
is
that
begins?
That's
your
fight-or-flight
chemical
that
begins
to
calm
down,
but
it
also
unmasks
an
underlying
issue
of
chronic
depression
and
opioid
dependence,
and
you
could
probably
say
this
is
true
for
alcohol
dependence
kind
of
go
hand-in-hand,
and
that
is
because
the
person
is
so
used
to
getting
that
pleasure
from
that
opioid
of
that
particular
substance.
F
Now
you
remove
that,
but
over
time
that
changes
what's
important
inside
of
this
is,
can
you
treat
it
just
like
you
said
about
you
know?
Is
it
the
Hep
C
that's
important,
or
whether
or
not
this
person's
at
high
risk
you
know:
do
we
need
to
get
them
into
treatment?
We
can
we
can
treat
the
Hep
C
right,
so
you
can
treat
depression
very,
very
easy.
You
know
with
counseling
you've
been
treated
with
medication.
F
F
Cardiovascular
Mets,
it's
not
going
to
affect
the
safety
or
efficacy
of
those
medications.
You
can
use
vivitrol
or
you
know,
track
so
safely
and
effectively
with
those
medications,
because
it's
not
affecting
the
metabolism
of
they're
medications.
So
that's
important
to
know
so
you
can
treat
those
two
things
together.
I
think
you
mentioned
some
that's
really
important.
We
need
to
look
at
this
holistically
and
do
wraparound
services
have.
D
Really
good
wraparound
services,
you
know
the
other
thing
is
you
know,
opiate
addicts,
we
have
to
remember,
and
you
know,
I
work
with
the
clinicians
I've
supervised.
We've
worked
on
psych,
pathology
and
and
personality
disorders,
because
we
see
so
many
more
lines
and
what
I?
What
I
see
my
practice
aren't
actual
I
their
Paris
suicide
attacks
in
Paris
was
they
they
made
to
be
one.
They
want
that
attention.
D
A
lot
of
them
are
the
border
lines
that
you
see,
that
with
it,
because
they're
being
clients
and-
and
so
it's
important
as
clinicians-
that
you
all
not
only
diagnose
the
clinical
stuff
but
the
actual
personality
disorders,
so
that
you
can
do
the
right
type
of
therapeutic
milieu
that
treats
that
right,
and
so
we've
talked
about
that
in
trainings
and
different
thing
and
they're
in
different
types
of
meetings
we've
had.
But
the
reality
is
that
we're
dealing
with
a
very
we're
dealing
with
people
that
have
very
complex
issues.
D
We
deal
with
people
with
quadrant,
four
programs,
I
gather
such
disorders.
We
have
people
that
have
complex
traumas,
that
they
have
traumas
as
as
children
and
adolescents
and
as
it
builds.
We
have
people
that
have
complex
personality
disorders
that
have
four
different
clusters,
typically
cluster
being
closer
see,
and
so
those
are
the
clients
that
we've
seen
in
all
our
programs
in
the
city
of
oregano
and
our
drug
court
program.
That's
what
we
see
and
a
lot
of
them
come
from
our
heroine.
D
F
So
much
time,
I
will
show
you
this
one
piece
of
data,
because
I
think
it's
important
and
dr.
their
balance.
We've
had
out
of
it.
So
this
is
a
double-blind
placebo-controlled
study
of
two
hundred
hidden
folks.
Average
dependence
is
ten
years
as
we
spoke
about
and
all
of
these
people
were
required
to
abstain
from
opioids
for
a
minimum
of
seven
days.
F
That's
the
way
the
study,
investigators
designed
it,
and
then
they
were
referred
to
the
two
groups,
one
receiving
an
actual
injection
of
380
milligrams
of
extended-release
no
trucks
on
their
patrol
the
other
receiving
a
placebo.
Both
groups
are
getting
counseling
and
the
primary
endpoint
and
study
is
to
look
at
higher
rates
of
not
only
higher
range
of
completed
abstinence
during
the
entire
study.
But
whether
or
not
there
were
troubles
preventing
people
from
relapsing
to
opioid
dependence.
F
But
when
they
looked
at
folks
that
were
I'm
sorry
when
they
looked
at
hope,
you
only
three
weeks,
specifically
what
they
saw
was
a
significant
difference
and
when
the
FDA
looked
at
this
data,
that's
when
they
chose
to
provide
Alchemy's
or
vivitrol
specifically
with
because
they
looked
at
the
median
patient
inside
of
that
study
and
what
they
saw.
But
we'll
see
what
person
was
35
percent
hope
you
had
experienced.
35
percent
hope
you,
like
three
weeks
over
that
six
months,
but
the
liver
fell.
F
Person
was
showing
confirmed
abstinence
with
a
negative
urine
screen
of
90
percent
during
the
six
month
period.
That's
significantly
different,
but
this
there's
a
couple
of
other.
This
is
really
the
data
point
that
I
wanted
to
talk
to
you
about,
because
everyone
thinks
that,
in
order
to
reduce
cravings
for
opioid
dependent
people,
you
have
to
give
them
an
opiate,
and
actually
that's
not
true,
because
never
trouble
has
been
shown
in
this
study.
F
They
did
as
a
secondary
endpoint
look
at
cravings
specifically
and
the
way
they
looked
at
it
is
they
had
everybody
in
the
study
on
a
scale
of
1
to
100,
saying
what's
your
craving
level,
they
took
all
of
that
data
and
they
averaged
it
out,
and
you
might
not
be
able
to
see
this
in
the
back
of
the
room,
but
there's
a
dotted
line
here
that
dotted
line
represents
the
baseline.
Now,
what
I
want
you
to
to
see
this
bathroom
in
the
placebo
group,
where
they're
receiving
a
placebo
and
they're
getting
counseling
right?
F
F
The
work
that
the
counselors
do
the
treatment
providers
do
does
have
an
impact
on
a
person's
cravings
and
at
best
in
at
least
in
the
case
of
this
group
of
people,
it
can
maintain
them
at
the
same
craving
model
right
when
you
look
at
the
impact
that
their
default
environments
did
within
the
first
dose,
it
significantly
goes
down.
Second
dose
continues
to
go
down
the
third
dose.
F
It
goes
down
further
and
kind
of
troughs
off
by
the
end
of
the
study,
statistically
they're
saying,
there's
a
fifty
five
percent
difference
between
both
study
groups
in
terms
of
reported
cravings,
but
here's
what
happened.
The
study
investigators
wanted
to
find
out
by
the
way
is
highly
statistically
significant,
which
means
it
didn't
happen
by
chance,
but
they
wanted
to
find
out.
When
was
it
statistically
significant,
where
it
was
not
by
chance
that
the
person
sang
up
feeling
better
are
not
craving
as
much
versus
it
actually
was
statistically
significant?
F
What
they
found
is
that
phenomenon
happens
after
the
person
received
a
second
diligence
which
says
if
a
person
comes
out
of
a
rehab
or
a
hospital
or
a
correctional
facility
that
disclose
to
your
treatment
center
and
gets
one
dose
and
says
you
know
what
I
feel
better.
That
makes
sense.
This
became
a
setback.
I
feel
I'm,
not
craving
as
much
I'm,
not
wanting
opioids
as
much
as
I
did
before
I'm
done.
F
No,
they
really
need
another
dose
before
that's
not
happening
by
chance,
and
you
can
feel
confident
that
when
they
say
that
it's
there
chances
are
it
lines
up
with
the
study.
That's
statistically
significant,
that's
why
it's
important
to
design
a
protocol
system
that
allows
people
have
access
to
multiple
doses,
because
it's
not
just
one
dose.
That's
going
to
flip
a
switch
in
their
brain.
They
spent
a
long
time
conditioning
their
brain
to
think
a
certain
way
to
react
to
neural
chemical.
Same
way.
It's
not
going
to
change
by
just
one
dose
or
two
doses.
F
F
We
started
out
with
the
SAMSHA
piece
that
said,
it's
more
likely
that
people
stay
in
treatment
right
if
they
receive
six
monthly
injections.
Will
this
data
supports
that
the
people
in
the
river
trial
arm
stayed
in
almost
from
the
entire
study?
Is
a
180
day
study?
They
stayed
in
treatment
for
168
days
versus
the
people,
just
standing
up
with
SIBO
and
just
getting
treatment
alone.
Again.
F
All
of
these
things
are
important
more
time
in
treatment
statistically
leads
to
a
better
outcome,
makes
your
life
easy,
because
most
of
the
folks
at
tribunal
moves
into
a
treatment
program
and
their
counseling
are
going
to
occur
in
the
first
90
days
and
what
happens
in
the
first
90
days.
They
relapse
they're,
statistically
higher
incidences
of
overdoses
and
those
overdoses
could
be
fatal
so
and
this
what
I
wanted
to
point
out
that
data
for
you
to
save
you
time,
nothing,
questions
and
I
will
be
here.