Ending the opioid crisis may seem like a hopeless or even impossible task. But authors Beth Macy and Dr. Holly Geyer are full of hope for evidence-based practices to treat opioid use disorder. They argue that everyone is touched by opioid addiction, and that we all have a role to play in combatting it.
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Dr. Denise Millstine: Welcome to the “Read.Talk.Grow.” podcast, where we explore women’s health topics through books. In the same way that books can transport us to a different time, place, or culture, “Read.Talk.Grow.” demonstrates how books can also give a new appreciation for health experiences and provide a platform from which women’s health can be discussed.
At “Read.Talk.Grow.” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives. I’m your host, Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic in Arizona, where I practice women’s health, internal medicine, and integrative medicine. I am always reading and I love discussing books with my patients, my professional colleagues, and now with you.
Today we’re going to be talking about opioids and the opioid crisis, and I’m so thrilled to introduce my two guests.
Beth Macy is a Virginia-based journalist with three decades of experience and an award-winning author of three New York Times bestselling books: “Factory Man,” “Truevine,” and “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America.” Her first book “Factory Man” won a J. Anthony Lucas Prize and “Dopesick” was shortlisted for the Carnegie Medal, won the L.A. Times Book Prize for Science and Technology, and was described as a “masterwork of narrative nonfiction” by the New York Times. “Dopesick” has now been made into a Peabody Award-winning and Emmy-winning Hulu series on which she acted as executive producer and cowriter. Her newest book, which will be the focus of our conversation today, is “Raising Lazarus, Hope, Justice and the Future of America’s Overdose Crisis,” which was published in August of 2022. Beth, welcome to the show.
Beth Macy: Thanks for having me.
Dr. Denise Millstine: Our second guest is Dr. Holly Geyer, who is an Addiction Medicine Specialist at Mayo Clinic in Arizona. Her work focuses on care of complex patients in the hospital with a focus on quality of life and the best use of non-drug interventions for treating symptoms, including pain. Dr. Geyer is active in research, patient advocacy and healthcare policy at the state and national level. She is well published in highly impactful scientific journals and book chapters. She additionally serves as a Medical Director of Mayo Clinic’s Occupational Health program in Arizona. Her forthcoming book is “Ending the Crisis: Mayo Clinic’s Guide to Opioid Addiction and Safe Opioid Use,” which is to be published in January of 2023. Holly, welcome to the show.
Dr. Holly Geyer: Thank you, Denise.
Dr. Denise Millstine: So I want to start with a quote from the introduction to “Ending the Crisis,” Holly’s upcoming book. She says, “We wrote this book because our world has been fighting the wrong battle. It is time to stop battling against opioids and fight for everyone impacted by them.” That line bowled me over, Holly. Thank you for starting with that concept.
Dr. Holly Geyer: You’re welcome, Denise. I don’t know if we could more thoroughly state the idea that as we’ve taken on the war on drugs — who’s been losing? It’s you. It’s me. It’s our kids. For the first time in my life, I took my children trick or treating a couple of weeks ago — and hidden in my back right pocket was a vial of Narcan.
Where are we at in society when we’ve degraded to that level, and how do we move away from it? That’s really what the purpose of this book was. How do we put the resources in the hands of the patients and the providers to get us out?
Dr. Denise Millstine: Well, anybody who’s read “Raising Lazarus” or who will read your book will know what Narcan is — but maybe I’ll just pause there and let you tell our listeners who aren’t familiar with it, what it was that you had in your back pocket.
Dr. Holly Geyer: Yeah. Opioids are known to cause a decrease in your respiratory rate to the point that you die. In fact, as we call it, an overdose – is actually the number one killer amongst the drug classes in America. And it’s scary. We can reverse it. We use a medication called naloxone, commonly called Narcan. Friends and families can carry this with them. It’s easy to get from most pharmacies in America without a prescription, and you deliver that. It’ll buy you up to 30 minutes of breathing time before E.M.S. or emergency services can get there. It’s a tremendous tool.
Dr. Denise Millstine: We remember the days of having to sort through our children’s candy – or actually it was when we were children and our parents had to sort through the candy. And now you’re so mindful to be thinking about everybody around you and what could be happening. Before we started recording, you were talking to Beth about the impact of her work.
Dr. Holly Geyer: It’s so true. Beth has been a titan in the field of opioid stewardship and awareness of the complications that have come from opioids. I can tell you, as I teamed up with my two managing editors for this book and we helped develop the content, we referred to the works that she’s done over and over. And Beth, I would say to you, thank you, for standing up in a world that’s likely to silence this because of the stigma associated with addiction. Call attention to it, point the fingers, honestly, where they belong in a lot of situations — and tell society: If we’re not addressing this topic, then it’s the next generation’s problem. We attributed so much of the success of our work and making these solutions tangible to the things that you had done in yours. So we appreciate you.
Beth Macy: Thank you so much for saying that. That means a lot to me.
Dr. Denise Millstine: Well, Beth, you had incredible success with “Dopesick,” not only as a book, but then also in multiple media. But your most recent book, “Raising Lazarus,” is really quite hopeful. Tell us a bit about how the book process was different for this one.
Beth Macy: Sure. When I finished “Dopesick,” or when I finished the last rewrite, I should say, it was legal, reviewed, edited, everything — the young woman whose story I had been following for two and a half years ends up murdered in Las Vegas. She had resorted to sex work in order not to be dopesick and I knew there was a chance we might lose her, I thought, from overdose. It really illuminated how hard it is for people to access care. We have an 87% treatment gap in this nation right now. That means that only 13% of folks were able to access evidence-based care in the last year. That’s an “F.” I was so despondent over losing Tess and just how many barriers that people with this treatable medical condition were facing that I didn’t want to write about it ever again.
My husband said, you should write a cookbook. Anyway, I went out across the nation talking about “Dopesick.” It was purchased to become a Hulu series. I started hearing about really innovative things. Now, they were, of course, outliers — because we still have this 87% treatment gap, but there were amazing people I found that I profile in this book.
The idea was, as I pitched the book, as this opioid litigation settlement money started to come to communities, communities need to be educated on what the best, most evidence-based ways are to spend it, because we know that the largest group of people with OUD (or opioid use disorder) don’t think they can get better. They don’t want to stop using drugs. Largely, they don’t think they can get better because they haven’t been able to access care. They have been stigmatized, stigmatized, stigmatized — every time they’ve tried to access it. What I’m doing here is writing about the heroes, the people on the ground, that are working to reach this hard-to-reach population and are helping to envelop them into systems of care.
Dr. Denise Millstine: I want to talk about that term you just used, which is, OUD – opioid use disorder. Holly, you talk about that a bit in your book as well. I think terminology is really important when we’re talking about any mental health or certainly what’s been termed “addiction.” Give us some perspective from the hospital-side, how important it is to call this opioid use disorder, versus other terminology.
Dr. Holly Geyer: Really good perspective on that, Denise. Historically, when we think about addiction, we’ve relegated it to other fields besides the medicine field. That’s a social problem. If you’re a person who works in the judicial system, it’s a criminal problem. If you’re mental health personnel, addiction is oftentimes just a mental health problem. If you’re in the spiritual or pastoral field, it’s oftentimes just a spiritual problem, or a deficit in a relationship with a higher power.
Everyone’s looked at it from their silos, but as the opioid epidemic unfolded, what we started to do is really get a better understanding of the science that bolsters addiction development. What we’ve come to realize is this is primarily a biological disorder, very similar to diabetes, to heart disease — to many of the other things that don’t carry near the weight of stigma.
What’s more important to understand, Denise, is that everyone is at risk for opioid use disorder, synonymously called addiction. It can happen to you and me. That’s why reducing the stigma is so important. The more we understand how this has biological drivers that are influenced by all these other fields that I mentioned, and manifests in those other fields, the more I realize that treatment of it includes biological treatments — those that target the body — as well as psychosocial and spiritual treatments, because all those other areas are impacted.
Dr. Denise Millstine: Beth, our audience can’t see you nodding, but I see you nodding and jotting down notes. Everything is clearly resonating.
Beth Macy: Absolutely. I mean, to go back to Tess, the spirit of Tess Henry just hovers over this entire book. The first time I interviewed her, she told me how she had been overprescribed at an urgent care center for a simple case of bronchitis — walks away with two 30-day prescriptions for opioids. She said, “What we need is urgent care for the addicted.” She didn’t know what that was, because she had never seen it or experienced that. I didn’t know what it was because I had never seen it. Now I’m starting to see it, but we’re not offering it to scale to match the scale of the crisis. That’s why I felt it was so important to really go out with these pioneers and innovators who are doing things through the context of needle exchange and harm reduction, offering low-barrier buprenorphine.
To get to your point about biological solutions, we know that buprenorphine and methadone are the gold standard treatments for this disorder, just the way insulin is for diabetes. And also, you mentioned psychosocial support — so important to this group of folks who have been so stigmatized and so on the margins. This young woman was reduced to living in a minivan with a pimp and doing sex work in order to buy her drugs, which she perceived as getting well — which was the opposite of being in excruciating withdrawal.
That’s why I called “Dopesick,” “Dopesick.” It’s an in-your-face title, but it’s what people call it, and this should be an in-your-face thing. If people can understand that at the end of your journey, you’re not doing drugs to get high, you’re doing it so as not to be dopesick. I think that really helps break the stigma.
Dr. Denise Millstine: You see a lot of people in the hospital, Holly, who are so sick from the withdrawal symptoms. For people who aren’t familiar with that, tell us what that looks like.
Dr. Holly Geyer: Oh, goodness. It’s something I wouldn’t wish on my worst enemy Denise. Beth has really highlighted the evolution of addiction, because when we start using opioids, it’s oftentimes for legitimate reasons. In fact, legitimate reasons are the number one reason people ultimately turn to more chronic use, which can occur over weeks to months. That state of chronic use is when we start seeing changes in the brain that really inhibit their ability to make decisions on their own. The brain is out of control. The drugs are in control. Because of that, use after use after use makes the body very habituated to it. When those drugs are no longer available to the body, all of a sudden you go into something called withdrawals. That can manifest in a variety of ways, but the way I’ve heard it put is — it’s the worst searing pain you’ve ever been in in your life, and it’s top to bottom. It’s uncontrolled nausea and vomiting. Your body feels like it’s crawling out of itself. It is the number one reason, Denise, that people choose not to seek treatment because they know if they’re not going to get something that reduces those withdrawals, it’s going to be the worst experience of their life. Honestly, the addiction and the cost to every other aspect of their life, including their families, their kids, their jobs — is worth it. In order to avoid this uncontrollable situation.
Beth Macy: And the cost to society when we don’t provide these evidence-based treatments is incredible. What does a typical case of endocarditis cost taxpayers? It’s in the hundreds of thousands of dollars and we’ve lost a million people since OxyContin came out in 1996 — a million. New data just showed that we were undercounting the number of folks with OUD by a factor of four. We actually have 7 million people addicted — more than that. Until we start meeting them where they are and at those junctures where they come to us, for instance, in the E.R., when somebody comes in with an overdose or an abscess, and not just putting a Band-Aid on their wound or giving them Narcan, but then treating what the real problem is,
which is that they have OUD.
Not to pick on medicine, but since we’re with these esteemed Mayo folks — 8% of doctors have been waivered to prescribe buprenorphine. Very few of those who’ve been waivered actually do it. People don’t want “those difficult people” in their waiting room. Do no harm. We have got to start going to them.
I tell the story in “Raising Lazarus” of an E.D. director, Dr. John Burton, and he’s over five hospital E.D.s in Virginia. It’s one of the largest nonprofit hospital groups in my region. When I first interviewed him in 2017, he said buprenorphine — no, that’s just treating a drug addiction with another drug. That’s not our purview. And then two years later, in one week, he got all of his docs waivered — so that 24/7, you could come into his E.D., you could get your immediate, if it was an overdose or an abscess. But then you would leave with a temporary prescription for buprenorphine, a peer coach to help you along the way — somebody you met in the hospital who’s in recovery — and an appointment to an outpatient opioid treatment for within the next week. They’ve had stunning results. And you can hear his voice changing. He’s not pessimistic about it. He’s hopeful for the first time. Now he’s going around being an evangelist for this way of practicing, because he’s like, “Everybody should do it.” One of the things I wrote about recently was how I hope that the Senate and Congress will pass the MAT Act, which would take this onerous waiver requirement away so that all doctors could prescribe these life-saving medicines, just as all doctors can prescribe OxyContin without getting a special waiver. I think that’s the low hanging fruit of this. I also think needle exchange is another big thing that we could be doing at a larger scale. What about you, Holly? What do you think are like the most important things?
Dr. Holly Geyer: Oh, I think you’ve nailed two of the biggest ones, Beth. Making access to MAT more available is a big missing link. Even in our own institution, we’ve recognized that as being an issue. And when I’ve gone to colleagues and said, “What’s your limitation? Why have you been hesitant to go forward with that?” The number one response I get back is, “I’m scared of taking a patient who was legitimately put on opioids, who now uses it for pain, but clearly has overlapping features of opioid use disorder and calling them an addict.”
One of the biggest concerns out there is that as we have patient satisfaction ratings now influencing reimbursement from the government and national scores, how will honestly identifying and treating this population impact the institution? That’s never, ever the right answer. Our patient should and will be the focus in all this, but it’s a limitation. So I would say to providers out there, the reality of addressing this is that you get a whole person out of it. By moving them into the right environment, we’re treating not just them, but their families — because the influence of addiction is never that one person. It’s everyone. I had one family member tell me once that her son struggling with addiction was worse than her son being dead — because with her son being dead, at least someone in this equation would be out of the pain.
And if we think about this deeper, there is such an opportunity, like you said, to move into that arena of patient education, which we’re trying to do with the book, and provider education at the same time.
Dr. Denise Millstine: I just want to restate how important “Raising Lazarus” is by putting it in the framework of this story. For people who are listening, who don’t understand these topics, really the way you’ve written the book, Beth, is so readable. You talk about the importance of people like us who work in a clinic or a hospital setting, but you feature people who go forward with what those with OUD need, whether it’s needle exchange or pizza, or other ways to reach the population, literally, even if that means meeting them in a — I think it’s a McDonald’s parking lot, that the book starts in.
Beth Macy: Yeah, the book starts in a McDonald’s parking lot, next to a nasty dumpster where this nurse practitioner, who is volunteering at night after he’s worked all day at his FQHC, treating addiction and HIV, mainly. He volunteers with this harm reduction group called Olive Branch. Somebody who came into one of their three needle exchanges expressed interest in getting on buprenorphine, but he works during the day and he doesn’t have the wherewithal to get to the clinic. The idea is low-threshold. They meet them where they are, literally, next to a dumpster in a McDonald’s parking lot. The guy shows up late, high, he’s crying, his broken facemask dangling from one ear at the height of COVID — and Tim talks to him.
The next morning, he’s going to prescribe low-cost buprenorphine, which he’s pre-arranged through his clinic. But he tells him two things — and these are really the two things I think are the crux of “Raising Lazarus,” and really the crux of the solution. One, he says “You can get better.” Most people think they can’t. Most Americans have written off this population. We have to have hope. We just do. Two, he says “Don’t disappear.” Even if you return to use, if you have a bad week — still, text me and I’ll meet you here next week. If your car breaks down, which often happens, text me and I’ll come to you.
That’s this idea of — We’re not going to kick you out if you have a return to use. I mean, that happened to Tess. When she finally did get access to buprenorphine, she tested positive for marijuana a month into it. And rather than increase her counseling and increase her treatment, they kicked her out, which sent her back to the streets, which ultimately led to her death.
This idea of nonjudgmental, loving care — I have this whole section that I read when I speak to medical groups. I read the section. Tim had invited me to his UHC during the day where the woman who runs the front desk is a peer recovery specialist in recovery for seven years. She could have an office in the back, but her whole job is to be the first point of contact.
I watched this woman, who it turns out, I learned later, she lives in a tent. She’s borrowed somebody’s car to get to the appointment. And this peer who is the front desk person just envelopes her in love: “Hi, honey. I’m in recovery, too. What can I do? Oh, we have a sliding scale.” It’s just nothing but love. And that woman has now been sober for eight months. She’s no longer living in a tent. She has relationships with her family again, for the first time in her whole adult life. You see over and over. Does it work the first time, always? Maybe not. As a doctor from 1926 said, “For the secret of the care of the patient is in caring for the patient.” It’s putting humanity back into our institutions.
Dr. Denise Millstine: It’s treating people with kindness and dignity, meeting them where they are, and then helping them get access to the tools that exist — but there are so many barriers for them to reach them, to actually get better. It’s so important.
Let’s talk a little bit about how dangerous the streets are now. So many people with OUD started with prescription pain medications, and for any number of reasons, have now started to use street drugs — often to prevent them from getting sick from their withdrawal. But it seems like every month, that becomes more and more dangerous. Holly, talk a little bit about what’s going on these days.
Dr. Holly Geyer: It’s scary out there, Denise. You wouldn’t find me purchasing anything off the streets these days. We’ve looked at the data and originally, before the height of the synthetic opioids, which are those that are made in clandestine labs — behind Walmart parking lots, being stored in cans by non-pharmaceutically trained individuals — we recognized that heroin was really the big drug of abuse.
And studies showed that 80% to 90% of people that moved over to heroin started with legal prescriptions from their providers for real medical indications. I don’t think we have a lot of great data on who is starting to use all of these synthetics, which really took off around 2013 to the present. But I can tell you they have emerged as the dominant and the number one cause of death associated with opioids. They’re 50 to 100 times more potent than morphine. If you take one dose to those thinking it was an oxycodone or something else you’re far more familiar with, you’re dead.
Beth Macy: Yeah, or a Xanax, or even cocaine has fentanyl in it.
Dr. Holly Geyer: You nailed it. There was a big trial in Minnesota for someone who was ordering, I believe it was some kind of a weight loss pill, right over the internet, and didn’t realize that it was fentanyl tainted. It is everywhere these days.
Beth Macy: Yeah, I was in Baltimore a couple of weeks ago giving a talk, and somebody from the public health department said that fentanyl was selling for a dollar a pill in Baltimore. One of the things I like to say is we have to make the treatments easier to access than the dope. If the dope is a dollar a pill, we have to make the treatments free.
We have to come up with a way to scale the treatments, similar to what we did at the height of HIV and AIDS. with the Ryan White Cares Act, where people who couldn’t afford antiretrovirals were given access to that. I’d really like to see the AMA and other medical leaders step into that space to advocate for that.
We still have 12 states that haven’t passed the Medicaid expansion, and that has proved to be the number one tool for getting people on buprenorphine. What do you think about that, Holly? Am I right on that?
Dr. Holly Geyer: I’ll say two things. Number one, to most of the world you’re speaking heresy. And number two, it is our answer. The reality is that when we offer people an alternative at these booths, at these sessions, where they can pick up and do things like needle exchanges — That might be our only point of contact before their next overdose. And the data shows that this works, as opposed to letting someone use needles that have been used over and over in these harsh environments where they sleep in 20 degree weather and have lost everything. When they can go to a place that they know offers a safe needle to prevent secondary consequences, like HIV and hepatitis C, and then have someone standing there saying, “Listen, this is safe and here’s naloxone or an opportunity to help reduce or reverse your overdose if it happens,” and see, here’s treatment program opportunities. Can we enroll you today? This is how we get people out of those harsh situations. And it’s just like you mentioned before — meet them where they’re at. They won’t come to us.
Beth Macy: And yet you use the word heresy, and that’s because it’s become such a political hot button. I reported in the new book that Charleston, West Virginia, has the most concerning HIV outbreak, according to the CDC, in the nation. The state legislature there has basically outlawed needs-based needle exchange. You have these warriors who are risking their freedom to deliver needles to people because they’ve decided that saving lives is more important than getting arrested.
It’s a really thorny political problem, so much of which I think the answer comes down to educating people. I would love it if I could just take every American and have them be a fly on the wall of a needle exchange because people think it’s this big, scary place, but it’s not. There’s inspirational quotes on the walls. There’s computers where people are applying for jobs, sort of like a library with some health services — signing people up for Medicaid. You see everyone there, from people wearing Trump hats to people wearing Grateful Dead T-shirts. I met a young woman who was living unhoused and she said, “Oh, I read your book, ‘Dopesick.’ But when I fell asleep at night, somebody stole it from my tent.” Just love. I don’t mean to sound like namby-pamby about it. But these aren’t bad people. If people could look at a person that they see being unhoused and living in a way that they’re judging so harshly and see that before this and often before a prescription written by a doctor, they were a person, they had a house, they had a husband, they had kids — They were just like me and you. We’re all just one accidental trip down the stairs from possibly being in that same situation.
Dr. Holly Geyer: What a good way to put it, Beth. Honestly, we’re at Mayo Clinic. We follow the evidence. If we saw that the evidence for harm reduction strategies like needle exchanges increase the rate of use, we would say no. The data shows the reverse — and we’re seeing the same thing with the stigmatization of medications like buprenorphine or methadone. I used an example in our book. If you had a major heart attack and you went to a cardiologist and that cardiologist said, “Listen, we know that your cholesterol is high, you’re in a bad situation, but here’s what we’re going to do. I’m going to give you a donut every day, but you have to take our donut. And I promise you, your chance of having another heart attack is lower.”
You’d probably go back to your family and say, “I’ve got a doctor, but he’s giving me donuts. Is this the right thing to do?” And that’s the shock value of what we’re seeing in society right now by offering the equivalent of an opioid to people with opioid use disorder. But it works. The types of opioids that we use prevent the highs and they prevent the lows. They help people live in that middle ground. And I can tell you, with chronic use of opioids, what happens is when you take an opioid and you get that surge of what we call dopamine or your happy chemical, the brain responds by having receptors accept all those chemicals. The more chronically you use those opioids, the less receptors you have, which means all of a sudden when you go to hug your kids or you play with your dog outside – the tiny little amounts of opioids you make yourself have almost no impact. That’s not how you’re going to get your pleasure. Plus, add in all the withdrawal factors.
People are scared. M18, buprenorphine, methadone – binds to those receptors and helps your body heal naturally. So it’s a great solution akin to treating someone with blood pressure problems with a blood pressure medication, or diabetes with a medicine that helps the body take in the insulin it needs. It’s a good solution that reduces problems and helps society function. Who would be against that?
Dr. Denise Millstine: I think you both have made an excellent point, though, about the need for reframing — and that’s why I’m so thrilled that these books exist, that people can start to think about it from multiple aspects instead of being stuck in the stigma, stuck in the history, stuck in their biases, which they maybe don’t even recognize they have. One of the first questions I was going to ask you guys is who does this touch?
We jumped into all things like Narcan and risk reducing strategies, but if we just backed out to that original question, it’s everybody that’s touched by OUD, whether it’s you who has the disorder or somebody you love, somebody in your community, somebody in your practice, it is everybody. Would you both agree?
Beth Macy: Absolutely. The problem is people don’t see it as their problem unless it hits them personally. We now have one third of American families — honestly, I’m surprised it isn’t higher than that — that have experienced strife in their family because of OUD. We ignore it at our own peril. Also, the costs. I think they determined we spend more than a trillion dollars a year on the downstream effects of this in lost productivity.
Dr. Holly Geyer: I agree, Beth. Its impact has been tremendous. In our book, we go into great detail to outline how each person in society plays a role in getting us out. If you’re a family member — my gosh, make the intervention. It’s not easy to do. We help talk people through how to do that. If you’re a person seeking treatment, engage that family practice provider or your internal medicine doctor. Have those harsh conversations. If you’re in the legislation arena, if you’re a mover and a shaker higher up in society — please look at the level of evidence to support your decisions. It seems scary with the sticker shock, but it can actually be your greatest solution right now. And then, of course, the funding for all of this — it’s out there. It’s smuggled covertly out of drug companies into certain initiatives, but it could have a much more blanket effect if it was used wisely, targeting those areas that would most benefit.
Beth Macy: Right. I worry about the litigation money being squandered, A.K.A. the tobacco settlement, and I worry about it just landing in the hands of police departments that believe in incarceration first, rather than diversion to treatment, when we know that works so much better. And I worry about it landing too much in abstinence-only programming. We need to be bulldogging what happens with this money. The press, you guys, we all need to be paying really careful attention because this is a once in a lifetime chance to get to turn a real problem around.
Dr. Holly Geyer: And, Beth, you’ve just made a comment there that I think is so key for our audience to know. Abstinence-only programming is a no-no for opioid use disorder. Over 90% of all people that choose abstinence-only programming will be back on the drugs within one year — if they’re alive at that time.
Beth Macy: Right. With fentanyl, we can’t guarantee this. Will you talk a little bit about the whole “Let ’em hit rock bottom” thinking? Because we’ve really shifted away from that.
Dr. Holly Geyer: I hope so. We’re still struggling with it. The concept has historically been, let people live with their consequences early. Don’t force them into situations where you believe they would benefit from treatment, but we don’t want to make any big moves. Let them hit the bottom of the barrel before they pursue treatment. I think that we could intervene so many times earlier. This is a discussion where if you’re seeing maybe a loved one who’s using opioids a bit more frequently than prescribed at home, have a meeting with that family member. Bring them to the family doctor and sit down and say, what does addiction look like? Could it be this? If we wait until rock bottom, rock bottom might be six feet, eight feet below earth. That’s not a situation that any of us are promoting.
We will say that the data does show if someone is in a position where you’ve had to kick them out of the house because the environment’s unsafe and they have hit rock bottom and they enter a criminal justice system and they get put on MATs somewhat in a forced manner, their outcomes, having been forced into a position to use MAT as opposed to going voluntarily, are almost the same. You want to avoid potential negative outcomes like medication overdoses before that ever happens.
Dr. Denise Millstine: I think one of the powerful components of “Raising Lazarus” is thinking that if we are doing a better job of treating people with OUD, we then can harness the power of the people who have lived this experience to help others to get there as well. Will you talk a little bit more about that?
Beth Macy: Sure. I call the peers my Rowdy Angels. Somebody gave me that phrase and I was like, it’s so perfect. So it’s people like Jenny Atwood’s Kris Atwood Foundation – peers who are going into the jails and working with people, and then picking them up at the moment they are released, which is when they’re 40 times more likely to overdose and die (because they’re opioid-naive at that point) and taking them to sober living or taking them to something they’ve been working on the whole time.
The book is called “Raising Lazarus” — a lot of people think it’s called that because of Narcan, which is cool too — but the reason it’s called “Raising Lazarus” is I tell the story this harm reduction group, the nation’s first queer, biracial, faith-based harm reduction group. And I meet the woman who runs it at a community meeting that gets hijacked by somebody that says, “I think when they overdose, we should let them die and take their organs.”
The whole meeting just went south, to which Reverend Michelle Mathis stands up, and she says, “Y’all, do you know the song? They will know we are Christians by our love. I’m not feeling the love here.” And what she says to get Christians to check their blindspots, because we’ve been so acculturated in drug-war thinking and thinking these people are moral failures and they’re criminals, is she tells the story of Lazarus.
Jesus raised Lazarus from the dead, but the disciples were the ones he had roll the stone. So I have a chapter on stone rollers. These are people that get rid of barriers. Then Jesus asked the disciples to bring him out and unbind them from his burial-cloths. And what Michelle says, is getting close to this issue can be scary — it can be stinky, it can be dirty — But only by getting close will you experience the miracle of raising Lazarus. I’m not a religious person, but I just thought that was such a beautiful story. You can’t dispute it. That is what the Bible teaches, to treat your neighbor as yourself.
Dr. Holly Geyer: Beth, that gave me goosebumps. I am with you. As we as society start looking at how we’re going to share this information, stories are powerful. It’s how we related to each other for thousands and thousands of years. And as much data and as clinical as I can get on this topic to my peers, the number one thing that gets them is the stories that I integrate in. This is their life when they walk out their door and hang up that white coat. This is their nephew. No one’s immune to the opioid epidemic, and I don’t know a person who hasn’t been impacted by it. So I would tell those who’ve been influenced by their own personal stories, to the point they feel confident, to relay them to others. Be bold, use it as a tool. Help the next person to share theirs.
Beth Macy: Absolutely.
Dr. Denise Millstine: I think a couple summary points for this amazing discussion are that this impacts so much of our society, that if you don’t know that your life is impacted by it, you need to look around because it definitely is if one in three families is impacted. And then an inspiration, perhaps to read both of your books, but an inspiration to figure out how to become stone rollers — how to work on the barriers and become part of the positive change and the answer.
I want to thank you both so much for coming on “Read, Talk, Grow,” and for talking about what can be a very challenging topic, and hopefully opening minds with this conversation and with your books. Thank you.
Beth Macy: Thank you so much for having us. It was an honor to be with you both.
Dr. Holly Geyer: Absolutely. Thank you, Denise.
Dr. Denise Millstine: Thank you for joining us to talk books and health today on “Read.Talk, Grow.” To continue the conversation and send comments, visit the show notes or email us at readtalkgrow@mayo.edu.
“Read.Talk.Grow.” is a production of Mayo Clinic Press. Our producer is Lisa Speckhard-Pasque and our recording engineer is Rick Andresen. The podcast is for informational purposes only and is not designed to replace a physician’s medical assessment and judgment.
Information presented is not intended as medical advice. Please contact a healthcare professional for medical assistance with specific questions pertaining to your own health if needed. Keep reading everyone.
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