Nova (1974–…): Season 45, Episode 12 - Addiction - full transcript

Discover how opioid addiction affects the brain and how evidence-based treatments are saving lives.

Are you wondering how healthy the food you are eating is? Check it -
A devastating epidemic...

We just didn't know what to do.

We just felt powerless.

A parents' worst nightmare,

to find my kid not breathing.

He was always very good

at telling us, "Mom and Dad,
everything's going to be fine,"

but it wasn't.

Addiction is ruining lives

and ending them too soon.

Overdose is the number one
cause of death

for people under 50.

We are racing against time.

We have the equivalent

of a Boeing 737 crashing
every single day.

But what causes addiction?

Individuals struggling
with addiction

are actually battling millions
of years of evolution,

because our brains are
exquisitely evolved,

to seek rewards.

It's those cravings,
the inability to stop.

A dangerous cocktail
of biology and medicine

made deadlier by a drug
100 times more potent

than morphine.

Fentanyl is super toxic.

So you get a batch that comes
on the street

that's a little bit hot,

and on those days, it's like,

bam, somebody's going down.

Bam, somebody's going down.


But can new treatments
offer hope?

We have extremely effective

that are life-saving.

This is a very treatable

The solution to this

is for us to embrace addiction
as a disease,

to bring it
within the house of medicine.

People recover from addiction.

Nobody is unreclaimable.

The only thing
that you can't recover from

is death.


on "NOVA."

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McDowell County, West Virginia,

feels like a place left behind.

Yet its miners
helped power America

when coal was king.

Back then, the largest city,

was a thriving community.

But as coal jobs vanished
by the 1990s,

the poverty rate in the county

climbed to 38%.

Then investigators found

that over a six-year period,

drug companies had flooded
the state

with 780 million
highly addictive pain pills.

West Virginia was
the perfect storm.

The whole state's dominated

by one of the hardest
and most dangerous jobs

in the world.

Most of the old timers that work
in the mines

work with pain.

And then pain pills started
flooding the community,

and people that you used to know

weren't the same people
that they used to be.

I mean, it, it just...
it ruined everything.

Jasen Edwards and
his two brothers Scott and Mark,

grew up in Sophia,
West Virginia.

The town was near
the Winding Gulf coal field.

Most of its residents
were miners,

including the Edwards family.

All three sons would struggle
with pain pills.

Jasen got his first prescription

after crushing his leg
in a mining accident.

They cut my leg off the day
after Christmas in 2008,

and I was back underground
mid-to-late February.

First day I went back to work,

I had to crawl everywhere
or ride everywhere I went,

because my stump was still
too swollen

to put my prosthetic leg on.

A man hurts his back,

if he is not back to work,
they will replace him.

And I could not have supported
my family on the disability.

Soon, a few pills a day

could no longer stop the pain.

But Jasen could easily buy more

by visiting doctors
and showing his artificial leg.

The first time I realized
that I was in trouble

is when I couldn't go to work,

because I didn't have
any pain pills.

And it wasn't because
of how bad I was hurting,

it was because of the sickness
due to detoxing.

Jasen was addicted
to a powerful opioid painkiller

called OxyContin.

Opioids like OxyContin are
chemically similar to morphine,

found in the opium
of the poppy plant.

They mimic the body's
natural pain relievers,

like endorphins,

which bind to proteins,
called receptors,

calming pain
and inducing euphoria.

Prolonged opioid use can alter
the brain

and lead to addiction,

manifested by cravings
and compulsive drug use

despite negative consequences.

As opioids were aggressively

West Virginia soon had the
highest rate of overdose deaths

in the U.S.,

alarming health commissioner
Dr. Rahul Gupta.

We were amongst the top states

prescribing pain pills
in the nation.

At the same time,

people were losing
their employment,

they were also losing
a way of life.

It spelled the perfect
conditions under which

addiction began to creep in.

At Stanford University,

psychiatrist Anna Lembke

also feared Big Pharma's
pressure on doctors

was creating an epidemic.

When she got access to
patients' prescriptions records,

her suspicions were confirmed.

Many people abusing pain pills

were getting them from doctors...
Not drug dealers.

I'll never forget when I first
looked at the drug database

for a patient of mine.

I mean,
it was just glaringly obvious

she'd been doctor shopping,

you know, 1,600 pills, I think,
in the span of a month.

And I think
it's important to know

that doctors were being sued

if they did not do everything
within their power

to address a patient's pain.

So there was a serious problem
going on here.

Lembke was also seeing
a new type of patient...

An "opioid refugee."

How's your chemistry class

It's fine.

What are you guys working on
in there?

Compounds, chemical compounds,

like iron...

Casey leads a protected life.

Her father Ken watched drugs
destroy his brothers,

so he moved his daughters
out of the city

and put them in private schools.

In her teens, Casey stayed busy
with sports.

But she began having
severe muscle cramps.

I remember one game
in particular,

all of sudden I just started
feeling really shaky

and then everything
just started hurting.

My legs and my arms
just cramped up really tight.

She fell straight to the ground
screaming in pain.

It took me and one of her
coaches to pick her up,

put her in our car,
rush her out to Children's.

They did
a million and one tests,

and then they found, you know,
an ovarian mass.

Well, an ovarian mass in a teen,
that's scary.

So then that required
more medical workup

in order to discover that
the mass was, in fact, benign,

but by then, you know,
she had a surgery,

it had been removed,

and through all of this,

she received copious opioids.

Once I left the hospital,

I noticed that I was still
having a lot of pain,

but it was nowhere near
the surgery sites

that they had operated on.

We couldn't even touch her,

she was in so much pain.

She described it as

it felt like her bones were
being ripped out of her body.

Now, the pain
she was experiencing

was opioid withdrawal pain,
but they didn't know.

So they whisk her back
to the emergency room.

"What could this possibly be?

She's got terrible pain."

And, essentially,
every single time

the solution was,
"Prescribe more opioids."

But after a while

they didn't help as much

so I started taking
way too many.

Until at one point

an emergency room doctor
realized she's addicted,

and what was his reaction?

He basically went out
and he shamed them.

And he's like,
"Your daughter's addicted.

We never want to see her here

Stunned, Ken drove home,

with no idea
of how to help his daughter.

Casey was now an opioid refugee,

battling cravings and withdrawal
on her own.

We just felt powerless.

And as a dad, I'm supposed to be
her protector,

and I just felt like I had,
I had completely let her down,


I just didn't,

I mean, I just didn't know
what, what to do anymore.

There was implicit trust.

"If this medication
were dangerous,

"they would tell me.

"As long as we take it
just as prescribed,

everything is going to be okay."

And that is totally untrue.

Casey's a great example.

Now, given her family history
of addiction,

she probably had an
underlying vulnerability, right?

But what made her addicted

was the opioids that she
received from her doctors.

Addiction runs in families,

and studies suggest

that genes play a role
in determining one's risk.

Addiction is a complex disorder,

and as a complex disorder,
there's not one addiction gene.

It's multiple genes

and multiple other factors
that interact with your genetics

that increases risk.

Over 90% of addiction cases
start before age 21,

when the brain is still forming.

For Jasen's brother Mark,

it was a time
of impulsive decisions.

I had no idea how dangerous
pain medication would be.

I never woke up any day
and said,

"Man, I want to be
an addict today."

And I asked myself,
"How did you end up here?"

And I look back
on my surroundings

and everything
that was around me.

People everywhere was,
was doing this.

It was almost like
there was nothing else in life.

As doctors prescribed
fewer pain pills,

drug cartels filled the void
by selling heroin,

an illegal opioid
cheaper than OxyContin.

Overdose deaths climbed

as heroin, long available
in inner cities,

turned up in rural communities.

In a single year,

more than 70,000 Americans died
of an overdose.

Addiction is America's
number one domestic issue today.

We have hospitals

that are overwhelmed
with people who need help.

We have a prison system
that is filled

with people
who actually need treatment.

We have judges

that are often seeing
more people with mental diseases

than a psychiatrist... or a
primary care physician like me...

Sees in a day.

The entire fabric of our society
is being destroyed,

as a result of addiction.

Addiction is often viewed
as a moral failing...

Stigmatized by words like
"clean," "dirty,"

"abuser," "addict."

But scientists now know
it's a disorder

that occurs as the brain changes
in response to drugs.

Individuals struggling
with addiction

are actually battling millions
of years of evolution,

because our brains are
exquisitely evolved

to seek rewards,

to seek reinforcement
wherever and whenever we can.

To understand
how reward shapes behavior,

Robert Malenka simulates
a famous experiment.

A mouse is attached
to a fiber optic cable

and placed in a cage
with two holes.

When the mouse explores the hole
on the right,

a flash of light sparks
a feeling of pleasure

in its brain.

At the other hole,
nothing happens.

Yep, there he goes again,
right now.

We are learning machines.

Our brains have evolved to be
exquisite reward seekers,

and that was important
for evolutionary survival.

But that came with a price...

Our susceptibility
to developing addictions.

Obsessed with that burst
of pleasure,

the mouse will probe the hole
several thousand times

over the next hour.

I mean look at this,

he's just doing nothing else.

This experiment revealed
the reward pathway in the brain,

primarily controlled
by a chemical messenger

called dopamine.

Dopamine tells your brain
to pay attention,

that whatever
it just experienced

is worth getting more of.

It's released by endorphins

or when we encounter anything
pleasurable or exciting...

Especially drugs
that can push dopamine levels

ten times higher than normal.

All drugs of abuse cause
this unnatural rise of dopamine.

And because of that,

they're among
the most powerful experiences

our brains can have.

As drugs raise dopamine levels,

they also alter the connections
between brain cells,

creating memoires of euphoria
that trigger fierce cravings.

But it's not just
about seeking pleasure.

People struggling with addiction

soon use drugs to avoid the pain
of withdrawal.

Withdrawals will make
your bones ache.

I couldn't leave the house
because I couldn't take a step

without soiling myself
from the withdrawals.

You couldn't talk to me,

I'd throw something at you
or bite your head off.

When opioids are
abruptly stopped,

stress hormones are released
at catastrophic levels.

This imbalance triggers the
opposite symptoms of opioid use,

including shaking, anxiety,
pain, and intense dysphoria.

Many times I would lay my head
on a pillow

and think, "I'm done."

I can't live like this,
I don't want to be this person."

And I would wake up
the very next day,

and I would just do more drugs.

I was powerless
over my addiction.

It consumed me, it owned me,

I was a slave to it.

This cycle of addiction,
says Dr. Corey Waller,

starts as the brain struggles
to rebalance

as drugs overwhelm it
with dopamine.

When that happens,

the body decreases
the production of dopamine,

and eventually you can't even
get enough dopamine produced

to get out of bed,

let alone produce
good relationships

and good decision-making.

To understand what happens
to dopamine,

Dr. Nora Volkow has been imaging
the brains

of people with
and without addiction

to search for changes
that occur with drug use.

We systematically were

individuals addicted
to different classes of drugs,

and we found that
a common change

across all of the different
types of drug addictions

was a reduction in the levels
of dopamine D2 receptors.

The number of receptor proteins,

seen here as red in the brains
of control subjects,

are reduced
in brains exposed to drugs.

Fewer receptors means the
brain is starving for dopamine.

Drugs interfere
with your motivational drive.

So imagine what it means

to lose the motivation to do

to just not have it.

And so anytime someone hears
the term motivation,

they should really supplant that
with dopamine.

Because without dopamine,
you don't have motivation.

And so, when we look at a person

who is in the throes
of an addictive disorder,

and say,
"They just need to motivate!"

We're telling them to somehow
magically make dopamine.

And it's not just drugs...

Gambling or eating
can also spike dopamine levels

and become addictive.

Volkow found that people
with morbid obesity

also have
fewer dopamine receptors.

Once those receptors
are going down,

you are going to have
a great difficulty

in self-regulating
the desire not to eat,

because cognitively,
your brain is fighting.

On the one hand you say,
"I, I'm obese,

I don't want to eat anymore."

And at the same time,
there is intense craving.

And if your brain is not
functioning properly,

you cannot win the game.

You are going to give in

and impulsively and compulsively
eat that food.

And drugs can unleash
even stronger cravings.

My wife at the time

went and seen her sister
for nine days,

and I spent $21,000
while she was gone...

on pain medicine.

I did lose my job,
I didn't care.

Only thing I cared about

was that magical date
on the calendar

when I went back to the doctor.

The body has a drive
for dopamine,

and that craving flips them
into survival mode.

If you understand that
this is about survival for them,

you can understand why they
steal $20 out of your wallet,

why they hock jewelry
from the house.

My habits was putting my wife
and my daughter in danger.

Finally, she just done
what any mother would do,

and they left.

Jasen attempted suicide

after his brother Scott died
of an overdose

on the outskirts of town.

For Mark Edwards,

it was a moment of reckoning
with his own addiction.

I did not want to be
that person that was broken.

And I wanted to get help,

but every place that I called
didn't have beds available.

I felt like that

if I didn't do something,

that I would end up dead.

Another drug is making
the epidemic even deadlier,

especially in Vancouver, Canada.

The city has become a gateway
for illegal fentanyl,

made in China.

Normally used for anesthesia,
fentanyl is so potent,

it's often shipped a few ounces
at a time

and later mixed
with other drugs.

Hidden in innocuous-looking

much of China's fentanyl
is headed for U.S. markets.

But it's also devastating

Fentanyl is a synthetic opiate
created in a lab.

It is super toxic.

So you'll get a batch that comes
on the street

that's a little bit hot.

And on those days, it's like,

bam, somebody's going down,
bam, somebody's going down,


Up to 50 times stronger
than heroin,

an amount of fentanyl equal
in size

to two grains of salt

will kill you.

Fentanyl's path of destruction

is closely monitored
in West Virginia

by Dr. Rahul Gupta.

Using a digital map,

Gupta follows overdoses
as they occur.

Circles stand
for non-lethal incidents.

Squares indicate fatal ones.

And a spike of deaths
in nearby states

means fentanyl-tainted drugs
may soon show up

in West Virginia.

On one day, we had
26 overdoses reported to us.

It was almost like
a communicable disease outbreak.

And here's the scariest part.

We found that of all
of those people who overdosed,

none... no one...

Was ever admitted
into a treatment facility.

But many people don't survive
at all

because opioids,
if taken in excess,

can quickly shut down breathing.


And because of the potency
of fentanyl,

the risk of a fatal overdose
is high,

no matter who you are
or where you live.

Jonathan was
a wonderful young man.

From a very early age,
compassionate, smart, loving.

Our family did go
through many moves.

We lived all over this country,

So that was, I think,
tough for Jonathan.

Jonathan Winnefeld was born
into an accomplished family.

His father James rose
through the naval ranks

to become the Vice Chairman
of the Joint Chiefs of Staff

in 2011.

By that time,
Jonathan was struggling.

At one point, he was in
five different school districts

in six years,
which is tough for a kid.

And so what became apparent
to us over time

was that Jonathan,
as great a kid as he was,

was suffering from some form
of anxiety and depression.

Jonathan was misdiagnosed

with attention deficit disorder,

and prescribed Adderall,
a powerful stimulant.

Soon, to unwind at night,
he began to drink.

To calm his anxiety,

he used Xanax,
a mild tranquilizer,

and smoked pot.

Then, he experimented
with heroin.

So we got him into counseling,

and I did what
a normal parent would do.

I took away the Xbox,

I took away his phone,
I monitored all of his moves.

In retrospect,

it was probably the worst thing
I could have done for him,

because it isolated him
even more.

And, ultimately,
he tried to take his own life.

He ended up wrapping his car
around a telephone pole.

It was at that point
when we realized

that we needed to get Jonathan
into inpatient treatment

or we were going to lose him.

I went on the internet
and searched,

and it's overwhelming.

There are so many
different places out there.

You don't know who's good,
who's bad,

who's just trying to make money.

our insurance covered nothing.

We really tried to find the best
treatment possible out there.

But, in America,
there's not a lot of support

in the mental health

and especially
in substance abuse.

The Winnefelds found a center
in Connecticut

to treat Jonathan's addiction
and anxiety.

Like some 80% of programs,

it followed the 12-step model
of Alcoholics Anonymous,

where patients admit
they are powerless over drugs,

need help from a higher power,
and commit to abstinence.

If we look
at the legacy treatments

that've been around
for 70 years,

they revolve around
going to meetings

and working
through the 12 steps,

generally doing that a lot

with self-help
and group-based therapy,

and then maintaining
that abstinence

by using that alone.

Jonathan's treatment
for 15 months

cost the Winnefelds hundreds
of thousands of dollars,

but it seemed worth it.

Our son came back to us.

We were able to have
a real conversation with him.

We saw, about a year
into his treatment,

that he regained his ambition.

Seeming confident
of his recovery,

Jonathan enrolled as a freshman
at the University of Denver.

That day we dropped him off
at his dorm,

he was excited, looking good,
fired up,

and it was one
of the best moments of my life,

seeing him doing so well.

Three days later,

their hopes were shattered.

I was not prepared to get
a phone call

saying that
my son had passed away

in his bed, in his dorm room,
from heroin and fentanyl.

Never, never,
never would have guessed that

in a million years.

With failure rates nearing 80%
to 90%,

is the abstinence-based approach
to opioid addiction

scientifically flawed?

Abstinence-based programs
really, for opioid use disorder,

are setting people up to fail
and to relapse.

And in the face of this crisis,

where we know
that every single time

that somebody uses an opioid,

they are at real risk
of overdosing and dying,

this should never be recommended
as a primary intervention.

In Morgantown, West Virginia,

Dr. James Berry also believed
abstinence-based treatment

was failing his patients
with opioid addiction.

We would get them
successfully detoxed,

get them exposed
to family therapy,

group therapy,
individual therapy,

and we'd find that
they would invariably relapse,

and they'd just be out there
on the streets using again.

Frustrated, Berry considered
using methadone,

a long-lasting opioid

that curbs cravings
from heroin and pain pills

without causing euphoria.

Methadone binds
to opioid receptors

and normalizes brain functions
altered by addiction,

including dopamine levels.

Here is your medication, sir.

Under current laws,

most patients must take it
at clinics.

Here is your medication, sir.

In 2003,
the opioid buprenorphine

became available
under the brand name Suboxone,

which could be taken at home.

Less potent than methadone,

Suboxone only partially
activates opioid receptors

to reduce cravings.

If taken as prescribed
and not misused,

both drugs cut mortality
by about half.

After a year,

40% to 90% of patients are
in recovery.

You feeling better?

Berry began giving patients

Oh, yeah, 100%.

They started doing well,

they started getting
their lives back,

they started getting
to work again.

Uh, Lawrence, how are you?


And how much time
do you got today?

I got like 260 or...

245 days!

245, okay, yeah.

Tell us what you have been doing
the last two weeks.

Work has picked up.

I'm about to buy
into my boss's business,

yeah 35%.

He's gonna let me buy in.
No kidding!

So that will be awesome for me.

So you've really showed him
what you've been able to do.

Yeah, yeah.

The main thing that makes
Suboxone so effective

is it's helping
with these cravings

that people are experiencing.

But it's so hard to break
that chain.

Patient after patient
after patient

will tell me the same story.

"Listen, Doc,

"I am not using to get high

I am just using not to be sick

What Suboxone does is

it satisfies those cravings

in a way that
they're under control.

It works so much better

on calming that demon
inside you.

If I went home,

started doing opiates again,

I was going to kill myself.

With cravings under control,

patients can take advantage
of a range of therapies

to help them cope
and rebuild their lives.

There are fantastic
psychosocial interventions

like retraining your brain,
being mindful,

learning more adaptive
coping strategies.

The night before,
I was saying...

Because it's not
just one epiphany moment.

It's a learning process.

You have to learn to be sober.

And it takes practice,
it takes trial and error.

And you've got to be ready
for the ups and downs.

One challenge, according
to psychologist Rita Goldstein,

are the changes that occur
with addiction

in the brain's
executive control center,

the prefrontal cortex.

This is the prefrontal cortex,
in the front of the brain.

And we're looking
at gray matter,

separating it
from the white matter.

So you can see,

it's actually tinted gray
in this scan.

Scans reveal
that chronic drug use

is associated
with reduced grey matter,

in the prefrontal cortex.

Those regions are essential
to make advantageous choices...

To make the right decision
at the right time.

So, the lower the gray matter,

the more the decision-making
is impaired.

You have a decrease

in the ability
to control your behavior.

Neuroscientist Yasmin Hurd

has found another way

that chronic drug use
impacts the brain.

By analyzing the brains
of overdose victims,

she's discovered
that heroin changes the activity

of key genes.

Heroin changes the way
our DNA functions.

It turns on genes
that should not be on.

And turns off genes
that should be on.

And so that imbalance changes
the brain function.

The genes most affected

regulate the brain's
key chemical messenger,

called glutamate,

which is essential for
sending signals between neurons,

making thinking, memory,
and learning possible.

It's not that addiction
completely takes away

every aspect
of your cognitive function.

In fact, you have to work
even harder.

So I think people need
to understand

that people with these disorders

are actually fighting
a very strong battle.

But is this a battle
that can be fought and won?

Opioids are still being studied,

but scans reveal

that dopamine receptors reduced
by other addictive drugs

can come back with recovery.

Rita Goldstein has seen evidence
that grey matter can increase.

The ability of the brain to heal
and to recover is amazing.

So definitely there is
a lot of hope.

The question is,

"How long does it take?"

And everyone's brain is

Yet most people don't have

to effective treatment,

especially medications
for opioid addiction.

For Dr. Corey Waller,

the problem is
that addiction is not handled

like other diseases.

If a patient comes
into an emergency department

with chest pain,

we have a pretty standard set
of approaches.

We evaluate whether or not
the heart's being injured.

We look at an E.K.G.
that tells me,

"Do they need to get
something done quickly?"

And no matter what
the answer is,

we actually have a place
for them to go.

For overdose victims,
the focus is mainly on revival.

These are patients
who are basically dead.

They're not breathing.

They are this close
to being dead forever.

Let's give the Narcan
real quick.

The drug naloxone,

sold under the brand name

can reverse an overdose

by pulling opioids off receptors
in the brain.

You all right?


And in most emergency
departments around the country,

that's the extent
of the intervention.

Check the box, sign the chart,
discharge the patient.

Unfortunately, we discharge them
back out into the wilderness,

where there is no consolidated,
appropriate care for them.

Big, deep breaths.

Although Narcan saves lives,

it can also put patients
into acute withdrawal.

Without medications
to control cravings,

many will overdose again.

Oh, my God.

This human tragedy really
is a human rights issue.

The last thing
we should be doing

is kicking people out of care.

That's when they're in crisis.

Massachusetts General Hospital

runs one of the few programs
in the U.S.

that immediately offers
overdose patients medications

to control cravings.

This is a treatable illness.

We have to have people
in that moment

who can say,
"Hey, I'm here to help you.

"Are you interested
in engaging in care?

We have Suboxone
we can start you on right away."

We're seeing people come
that day

and engage in care,

and the vast majority of them,
75% to 80%,

are returning.

What's going on here?
Did we tolerate it?

Since effective treatment
is hard to find,

the costs of the epidemic
continue to rise.

In Charleston, West Virginia,

Dr. Stefan Maxwell cares for
babies born dependent on drugs.

It's a withdrawal syndrome.

They have vomiting, diarrhea.

Frantic behavior,
they may scratch themselves.

These babies may go for many
days without sleeping

or eating.

And symptoms may last
up to three months.

I know, baby, I know.

Babies in acute withdrawal
are weaned off opioids

by giving them smaller
and smaller doses.

I just gave her a methadone
about five minutes ago.

Every 25 minutes,

somewhere in the U.S.,

a baby is born dependent
on opioids.

Many will become wards
of the state.

We have amongst the highest
number of foster children

in the nation per capita.

We're having difficulty
finding parents

and providing services.

In fact, we believe it cost

over a million dollars per child

if they're born dependent
on drugs.

Many parents with addiction
are also facing challenges

like poverty and trauma.

Trauma is an experience
that overwhelms you,

that leaves you bereft,

and with no way out.

And it can come
in many different contexts.

It can be physical, verbal,
sexual abuse,

childhood neglect.

And these problems early in life

put you at risk later in life.

Studies show experiencing
a combination

of five adverse events

can increase the risk
of addiction tenfold.

Trauma can cause long-lasting
changes in the brain,

leaving sufferers like Marie

also vulnerable to depression
and anxiety.

We had somewhat of
a decent family life, you know,

but I watched my dad beat my mom
my whole life, you know.

My dad was an alcoholic.

They finally divorced,

and me and my mom moved
out here.

And my mom kind of lost it.

That's when I started

really, just, you know,
going wild.

What you're left with as a kid,

is these heartbreaking feelings

of "I'm no good" and
"The world is a terrible place."

Somebody says to you,

"Here is something that will
make these feelings go away."

And so, people take drugs

because they can't stand
the way they feel.

After Marie had her first child,

she became addicted
to OxyContin.

Child Protective Services
took custody of her son

until she could pass
her drug tests.

For a while, things went well.

But Marie began struggling

after giving birth
to her second child.

I went home to see my first son,

you know, because I hadn't
been spending time with him.

And then I got a phone call,

and CPS said, "Get ready",

"'cause we got to meet you
in Charleston

to take your kids."

During her pregnancy,

Marie had been given methadone
for free.

But after her delivery,

she had to pay
for her treatment.

With no money or insurance,
she relapsed.

It's a reality faced
by countless people

without resources.

By that time

I owed the methadone clinic
over $600 and some, you know.

And, of course,
when you go back, you know,

they wouldn't see you no more

because I owed them
too much money.

So I couldn't,
I couldn't dose no more,

so here I am back at it again,
you know.

She needed services
that were lacking

here in rural West Virginia.

She needed those to be available
for her,

and they're not.

And that saddens me, because...

because I know...

that the mom's hearts break.

I'll never forget
that whole scene in my life.

They surrounded us with cops,

and that was not needed,
you know.

And my three-year-old said,

hold my hat while I'm gone."


they took him away.

People always want
to talk about,

"How do we stop the cycle?"

That's how we stop the cycle.

You don't stop the cycle
by pulling the baby

because mom took drugs.

We just need to see it
and treat it

like it's any other disease.

You get the mom stable,
you get baby stable,

and you go home with a family.

Back in Vancouver,

the opioid epidemic spurred
the city to take bold steps,

even before fentanyl tainted
the drug supply.

In 2003 it sanctioned the first
legal site in North America

where people could inject
illegal drugs

under medical supervision.

Called Insite,

the program provides
clean needles

to prevent the spread
of infectious diseases,

drugs to reverse overdoses,

and help accessing services,

like medically assisted

When people come to Insite,

often the first thing that
they're thinking is,

"I need a safer place to use.

"I don't want to die
in the alley.

"I'm tired of living
in, essentially,

what are Third World

So what we're doing is
we're saying,

"Come on in
to First World health care."

And in the years
since Insite's opened,

overdoses in the area
have gone down,

and our H.I.V. rate in Vancouver
has plummeted dramatically.

Insite's success bolstered
other efforts.

At the Overdose Prevention

Sarah Blythe helps people
test their drugs for fentanyl.

But that's not
the only contaminant

she's worried about.

Because we've seen everything

from cement filler to Comet
to pig de-wormer,

like, you name it,

anything that they can put
in there,

they do, and it's dangerous.

A pink stripe indicates
the presence of fentanyl.

It's now found in 88%
of illegal opioids here.

Like many longtime users,

Daniel knows
he's injecting fentanyl,

but the fear of dying

isn't as powerful
as his cravings.

He first took opioids in prison
to calm his anxiety.

There's always a fear

of something horrible
about to happen.

There's going to be somebody
getting stabbed,

a fight's going to break out.

And so when I did
that first hit,

it was the first time
I felt like I could relax

and not have to worry.

To my mind,

the most important thing

about supervised injection sites

is that it implicitly says that,

"These lives are worth saving,

these people are valuable
to us."

What's really important about it
as well

is that it's a space
of connection.

That's the space that people are
going to ask for help from.

Supervised injection sites
are illegal in the U.S.,

but in Canada,
the controversy is waning.

For 22 years, Bill Spearn
has walked the streets

of the downtown east side.

Although drugs are still here,

overdose deaths decreased 35%

after Insite opened.

Once a skeptic
of supervised injection sites,

today he's not.

Does it increase crime?

Does it encourage drug use?

Is Insite a big magnet that
attracts drug users

from all over the world?

And the answer is no,
it doesn't.

And I think that harm reduction

is something that every city
should consider,

because it keeps people alive.

It actually saves
taxpayers dollars.

The most expensive housing
that we have in this society?

Emergency rooms and jail cells.

We need to quit putting people
in those

and start putting people
in more compassionate spaces

like supervised injection sites.

Meanwhile in West Virginia,

heath commissioner
Dr. Rahul Gupta,

is also trying to reverse

the soaring number
of overdose deaths.

Today he's traveling
with a volunteer medical team

to bring free health care
to McDowell County

and take steps
to stop preventable deaths.

This is naloxone.

Because overdose fatalities here

are seven times
the national average,

Gupta and his colleagues are
trying to get naloxone,

the overdose reversal drug,

to as many people as possible.

That's how this drug works
to save your life,


But after that
you've got to get help as well.

I don't look at this
as a single epidemic.

I look at this
as multiple epidemics

coming together and evolving
in real time.

Gupta is worried

about the huge spike
in hepatitis

and the rising number
of H.I.V. cases.

Patients are offered
free testing

to see if they need treatment.

It just takes 20 minutes.

Now, I also want to talk to you
about a needle exchange,

are you okay with that?

McDowell is one
of the few counties

that allows needles to be handed
out to prevent infections.


The idea here is
to have your own set.

According to Gupta's analysis,

every dollar spent
on harm reduction

saves up to seven dollars
in medical costs

and steers people
towards treatment.

...when you do want
to get help,

whether it's counseling
or any other aspect,

we're here to help you.

The cost are really

if we continue this path,

losing over
half a trillion dollars a year

for multiple years
in our economy.

We've got to be smart
about addressing addiction.

We have to find ways

to prevent it from happening
in the first place.

As a country,

we have neglected it,

and we have stigmatized it,
and we have criminalized it,

and that has not solved
the problem.

In fact, it has made it worse.

But America's addiction crisis
is not just limited to opioids.

Each year over 80,000 people die
from excessive drinking.

Smoking is responsible
for over 400,000 deaths.

And so if we don't build
a stabilized, appropriate,

evidenced-based treatment system
for addiction,

then the reason that medicine
gets so costly every year

is because
what we're trying to do

is not intervene
on the front end,

we're trying to fix everything
that's broken on the back end.

The solution to this

is for us to embrace addiction
as a disease,

to bring it
within the house of medicine,

so that anybody struggling
with addiction

can walk into an emergency room,

or a pediatrician's office,

say, "I'm having a problem
with drugs or alcohol",

will you help me?"

And that the answer is
an enthusiastic "Yes!"

Today most people struggling
with opioid addictions

cannot access medications

or treatments proven to be

Some people recover
on their own,

but it's rare.

Jasen is one who beat the odds.

He is remarried

and delivers cars
for his brother Mark's business.

I am not the man
that I want to be,

but I'm not the man
I used to be, thank God.

I try to become better
every day.

Sometimes I fail,
sometimes I succeed.

But I keep trying.

Mark recovered after five years
of methadone treatment,

by a faith-based program.

And that love began to change me

in a way that I didn't think
would ever be possible.


Oh, good shot!

Casey is now on Suboxone

and studying to become a doctor.

Her muscle cramps have been

as fibromyalgia

and rheumatoid arthritis.

To control her symptoms,

she takes 11 other medications,

but none are opioids.


Recovery is definitely possible.

It might take years or months
or however long,

but it is possible.

Marie is on Suboxone
and getting group therapy,

paid for by Medicaid.

Today, she is going to see
her youngest son,

who lives with a foster family.

Bubby, come here.

What are you doing?

Get me in!

Come here and
give me a hug, Booga!

Mmm, I love you.

That baby means so much to me.

Now that
I'm getting it together,

I hope that as time goes by,

they'll see a difference in me,
you know.

As long as Marie is in recovery,

she can visit her children.


I want to go with you.

I wish you could go with me,

I want you to go with me,
if you only knew.

If you only knew.

People recover from addiction.

They need basic stability,
stability of relationships,

they need housing,

they need that sense of a future
that they can look forward to.

When we offer people things
like that,

they get better.

They are better.

Nobody is unreclaimable.

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