Transcriber: Eunice Tan Reviewer: Rhonda Jacobs
25,000.
That's how many people will die from this in 2015.
Today, across the US, 67 people will die from it.
That's all of you sitting in the front rows here
gone.
This disease does not discriminate by race, ethnicity, cultural background,
or your opinion of Donald Trump.
(Laughter)
It affects people of all ages.
As an emergency physician,
I have treated 70-year-old grandparents and 14-year-old high schoolers.
For everyone, it all ends the same way.
Their breathing slows, then stops.
Their brain cells run out of oxygen.
Within minutes, their heart stops beating,
and they stop living.
If you think that you know who is at risk,
think again.
It could be your neighbor across the street.
It could be the person who shares your office
or your bedroom.
Some people have symptoms of the disease;
others have no telltale signs at all.
Now, what if I tell you
that there is one medication that is a complete antidote,
that it's 100% effective,
and that I can even teach you how to use it today?
Well, this is not a late-night TV pitch
to help you melt fat or enhance performance,
(Laughter)
though this drug can help to perform wonders.
And, no, I'm not a drug rep.
I don't have gizmos and pens and freebies to give away,
though I do have a message that could save your life.
In my medical training, I had a patient named Jessica.
Jessica was 26 - my age at the time.
I was an intern, a freshly minted doctor,
which meant that I had no idea what I was doing.
(Laughter)
I remember that, one time,
when Jessica brought her son in to be seen, with a fever,
she overheard me saying that I didn't know how to order Tylenol.
Then when she asked where the restroom was,
I pointed her to a supply closet.
(Laughter)
None of this inspired much confidence in my fledgling medical ability.
Over time, as I became a better doctor,
I got to know Jessica and her twin two-year-olds.
I learned that Jessica used to be a competitive swimmer.
Then she tore some discs in her back,
and her doctor prescribed painkillers -
Percocet, Vicodin, OxyContin -
all medications called "opioids" because they derive from opium.
Like so many others, Jessica became addicted to these pills.
She began going to other doctors to shop for more.
Eventually, she found a cheaper way to get the same high:
by switching to another opioid
called heroin.
Her husband, her parents, her sisters -
they all tried to get her help.
But one day, her husband found her on the ground.
She wasn't breathing.
He couldn't wake her.
The paramedics brought her to my ER,
where we worked for over an hour to resuscitate her.
We put a breathing tube down her throat to help her breathe.
We had a machine pump her heart.
But we couldn't save her.
And Jessica died.
Jessica isn't alone.
According to the Centers for Disease Control,
the number of people dying from overdose has quadrupled over the last 15 years.
In many states,
there are more people dying from overdose
than from car accidents, suicide, or homicide.
The fastest-growing demographic of people dying from overdose?
Not minorities or youth or people in inner cities,
but white, middle-aged, often suburban, women.
These statistics are all the more shocking and unacceptable
because there is one medication, naloxone, also called Narcan,
that will completely reverse the effect of an opioid overdose.
Naloxone works by attaching to the same part of the brain as opioids,
and it completely blocks those receptors.
It cannot be used to get a person high,
and if someone isn't on opioids, there's no effect on them at all.
I have given naloxone to hundreds of patients
and have seen how someone who is unresponsive,
and would otherwise die,
be walking and talking within seconds.
So if this medication is so effective,
why isn't it available to everyone everywhere?
Three reasons.
First -
there is the dangerous myth
that making naloxone available will encourage drug use.
This is not based on science but on stigma.
Would we ever say to someone whose throat is closing from an allergic reaction
that they shouldn't get epinephrine,
because it might encourage them to go out there and eat peanuts?
(Laughter)
An EpiPen saves lives.
So does naloxone,
and it should be just as readily available.
Second -
some will claim that naloxone is too difficult to use.
They will say that doctors and paramedics can learn it but not regular people.
Well, we doctors sure have a high opinion of ourselves,
(Laughter)
but this just isn't true.
In Baltimore,
we have been teaching people, "regular people," to use naloxone,
for over 10 years.
And this is so important
because if somebody is dying from an overdose,
we have minutes to save their life,
and it may be too late by the time paramedics arrive.
This is the same reason we have defibrillators available everywhere
for use by laypeople too.
Believe me, naloxone is easy to use and easy to teach.
I've taught my staff.
I've even taught people coming to the health department
looking for a job.
(Laughter)
It's a pretty weird job interview
(Laughter)
but a pretty good screening tool.
And now, if you're okay with it,
I'm going teach all of you how to use naloxone,
in 30 seconds.
You guys okay with it?
All right.
Three steps -
(Applause)
Three steps.
If you see someone who is unresponsive,
step number one is to call 911.
Even if you are a trained medical professional,
you do want backup to assist you.
Second -
take out the medication.
There are two types of naloxone that are used -
they're as equally effective as the other.
One is an intranasal version to be given in the nose,
and the other is an intramuscular version to be given in the muscle.
Naloxone, either version, should be part of everyone's medicine cabinet
and everyone's first aid kit.
Third -
you give the medication.
The intranasal version looks like this.
It comes out as a mist.
You insert this into one nostril
and squirt half into one nostril and half into the other nostril.
The intramuscular version looks like this.
It's used in the same way as an EpiPen.
So you inject this into the arm or into the thigh.
And that's it - three easy steps.
This year, we have trained nearly 5,000 Baltimoreans on using naloxone.
We do trainings in bus shelters, in markets, in court, in jails,
and on the streets.
My staff joke that pretty soon,
we'll be doing trainings in every Starbucks and every Subway:
"Would you like naloxone with that?"
(Laughter)
Recently, National Public Radio did a feature story
on Baltimore's naloxone trainings.
We received many supportive comments
but also some others, like,
"Why is public funding used to save a junkie's life?
They are a menace and a burden to society."
Someone quoted "Forrest Gump":
"Stupid is as stupid does."
Now, I know it's free speech.
A mentor once said that
"If you ever want to feel bad about yourself
and worse about humanity,
just take a look at the comments section
of any webpage."
(Laughter)
People are entitled to their own opinions,
but this is it:
this is the third reason why naloxone isn't more readily available.
Because there are many people out there
who question whether we need to save the lives of addicts at all.
Here's the reason:
addiction is a disease
just like high blood pressure, diabetes, and heart disease.
Just like any other disease, addiction can and does kill.
If people were dying of measles or Ebola in this country
at the same rate they were dying of overdose,
wouldn't we consider this to be a disease of epidemic proportions?
Isn't it time for us to base our medical decisions on science
and not stigma?
To be sure, treating overdose isn't the only solution.
Addiction treatment requires long-term medications
and psychosocial support.
And critically, we have to focus on prevention -
to stop drug trafficking
and to teach doctors more careful prescribing.
But if it's one lesson I've learned from the ER -
other than that George Clooney can do anything -
(Laughter)
it's that unless we save a life today,
there's no chance for a better tomorrow.
In Baltimore and across the country, the problems we face can seem so big.
And they are.
On April 27th,
after the death of an unarmed black man while in police custody,
the world saw my city burn.
You saw hundreds of cars destroyed,
dozens of stores looted,
pharmacies burned and closed.
It's easy to point the finger
at angry, disaffected youth who are committing violent acts.
But look just underneath the surface,
and we find deep trauma and structural poverty
that are so closely tied
to our historical policies of mass arrest and mass incarceration.
Baltimore has a population of 620,000.
Every year,
more than 73,000 arrests are made.
The most common reason for arrest is drug offense.
Many people in jail have addictions themselves,
and 8 out of 10 behind bars use illegal substances.
While African Americans are 62% of our population,
they are over 95% of juvenile arrests.
Unless we change our understanding of drugs,
our policing policies won't change,
and our inequalities will grow.
The neighborhood that Freddie Gray grew up in
has an average life expectancy that's 20 years lower
than a neighborhood just a mile away.
The unrest has many causes,
but that inequality, that disparity is fueled by violence and poverty,
which are so inextricably linked to drug use and addiction.
We cannot solve all these problems overnight.
But there is something that each and every one of us can do today.
We can speak about addiction as a disease.
Not just an individual disease,
but one that affects the family and the community.
We can recognize that addiction is not just a Baltimore problem
or an inner-city problem,
but one that affects every town and every demographic across America.
And we can learn to use naloxone
because nobody should have to die from an entirely treatable problem.
If Jessica's family had access to naloxone,
my patient could be alive today.
She would be my age,
seeing her twin boys off to school,
maybe successfully battling her addiction.
We will never have a chance to find out.
But we do have the chance to save thousands of lives
with one simple medication.
TEDxMidAtlantic, let's save a life today.
Thank you.
(Applause)