Host: Hello everybody. Welcome to Health Chatter and today's show is on the state of the opioid crisis. Unfortunately, we have to address this problem and uh it's been with us for for quite a while. We have a wonderful guest with us. We'll get to her in a minute. We have a great crew that always helps us get these shows out to you the listening audience in perfect form. Maddie Levine Wolf, who actually did the background research for us for this show and also is recording today's show. Thank you, Maddie. Aaron Collins is with us today. Deandra Howard, Matthew Campbell, and Sheridan Nygard. All these people are are responsible for the research and the marketing and the actual production of the show. So thank you to all of you. We also have Dr. Barry Baines with us, our medical advisor who has now been with us, he corrected me. He's now been with us for about a year. So that's it's it's great having you. And then of course there's Clarence, my partner in crime in this in this show. And thank you so much. It's been uh it's been a pleasure working with you Clarence as as always. Human Partnership is our sponsor. A great community Health organization. Check them out at Human Partnership.org. Check us out to Health Chatter at healthchatterpodcast.com. You will see the transcripts of the of the shows. You will see the background research of the show and also it's an opportunity for you the listening audience to chime in if you have any particular questions and we can circle back to you. So check us out again at Health Chatter podcast.com. Today, again, we're going to be looking at the state of the opioid crisis. And we have Dr. Kumi Smith, who's an associate professor in the division of Epi and Community Health at the University of Minnesota School of Public Health. She has a PhD in epidemiology from the University of North Carolina at Chapel Hill and a masters in public and international affairs, University of California. So far you've been in in North Carolina, University of California, and then she did her BA at Yale. So she was going back and forth across the country. So actually she probably got a good sense of what the country is dealing with. Studies health disparities at the intersection of infectious diseases, substance abuse and unstable housing, done work in China as well. So thank you very very much for being with us today and to talk about a subject that um unfortunately is with us and is with us for a while. And let me start out with that. You know, um certainly Clarence and I have been in the public health arena um a long time. And for as long as I can remember, as long as I can remember, we've been dealing with this issue. So, what what's going on to the point where have we made any strides at all or is this just like an ongoing chronic condition that unfortunately we're just going to have to continually address. Do you have any sense of that?
Dr. Kumi Smith: Sure, yeah, thanks for having me first of all and that's a great place to start. Uh, I think a lot of conversations about the opioid epidemic seem to start in the early 2000s. But as you point out, you know, humans have lived with substance abuse for a long, long time. We're born with opioid receptors in our brain. You know, these these uh these chemicals have been with us in human history for uh millennia. So this is not a new relationship. Um, I think the current opioid crisis though, the reason it does date back to a pretty common starting point in say the early 2000s is really the story about uh Purdue Pharma and Oxycontin. And so I think that really did kind of shift our historic relationship with opioids um into this new phase where there was, you know, company profits and corporate interests really uh heavily at play. And those interests were married with medical practice. They actually really started to shape prescribing behaviors of prescribers at large. And so that really kind of scaled out the the impact of opioid addiction into communities that had never really dealt with it in a major way. It introduced it into uh pockets of the population who really never necessarily had exposure to say black market drugs or illicit substance use. Um, so it really truly did shift the landscape of addiction in America in a major way. But what it did do is essentially bring to light a lot of things that we've struggled with as a society for a long time to more people.
Host: You know, and it's sad. It's it's sad that that we're we're dealing with it. So if you don't mind, I'm going to quote from a um, actually a journal article that you just recently published. And in the introduction, I saw just the introduction, I read the article, but the introduction starts out with something that's really sobering in in my estimation. More Americans died in 2021 from drug overdose than from vehicle accidents and firearms combined. Unlike earlier phases, the current epidemic is marked by a disproportionate impact on communities of color, which we'll get into here. And this report that you you you published investigates regional and substance abuse specific variations in racial disparities to generate possible insights into what we're doing. So hopefully we'll get into these insights. So, you know, for years and years, we used to say that motor vehicles were like the number one cause of of death. And it's just like, whoa. So, and now we're dealing with with people of color and different races. So Clarence, what do you think about all this? I mean, you you you're in this community. So what do you think? What's do you hear about this a lot?
Clarence: I actually I do and uh I'm excited Kumi that you're here. Um I as I was sitting here thinking, I mean, there's a lot of things I want to say. Uh and we talk about um you know, the the uh drug um overdoses. My question to you and this is a question for why is it affecting communities of color more than other communities?
Dr. Kumi Smith: Yeah, that is the big question, exactly. Um I mean what we can kind of say is it has always affected um marginalized and minoritized groups more. And that's sort of the logical flow that we can talk about with everything that you and your listeners know about, you know, social determinants of health and things like that. Um, substance use across racial groups and social classes has always actually been pretty even. There's no particular group that uses substances more than others. But ability to whether stressful events, um including addiction or mental health issues or anything, really is tied to our access to resources. So really it really does come back to what kinds of access to health care do folks have? How much money do they have? How much family support do they have? So that's kind of the background story as to why kind of minoritized communities including say African-American communities are going to get harder hit by um these very uh lethal um illicit drug markets right now. But when it comes to the story of um Black Americans and and Native Americans in America in general, but also especially here in Minnesota in our backyard, there is a little bit more of like a recent uh history that I think is really like illustrative for what what is kind of happening at large. Um, and so I actually teach a whole class on this and Clarence you've come and spoken with us before in it. Um, and the the main thing that we kind of unpack in this class is the fact that if we take the example of uh among Black Americans, why has been so much more lethal to Black Americans than white Americans. It actually kind of goes back to uh racialized systems of how we deliver health care, how they've played out um into the dynamics we see today.
Host: So, you know, I I've got you know, you you said something that I think's really important and that is that the way people self- identify. I know a lot of people in the health professions for whom uh what they do is not just a job, it's a vocation if you will, you know, as we used to call it. And and uh and I think that in many ways they're they're the ones that are really suffering most under this because the the well, for a variety of reasons. But I I also think the challenge with with public health uh and of things is that um the public health's mandate in this country has always been political. Um, uh from the getgo. Uh you can go back to the 19th century and and there were fights over what public health could actually do in communities and and uh there were laws passed and all this kind of stuff um uh in those days. And uh so I I think it's important to to remember that that we can't avoid dealing with the politics and you know, politics I think writ large. But um the the I think the challenge in working with um you know, and helping to get ourselves out of the current situation is really that building those relationships, you know, we call them cross sector and I mean by that that you're not just working with people in the health area, you're working with people in the business area because God knows they want healthy people working for them. Right. And they can't they don't want to see the the collapse of public health or things of that kind. So I think that's where we are and I think that's where we have to start. I think that's where we have to start. So the so the current the current administration um has been taking it a different tack for sure. And so um it has had some of the effects that that that that you mentioned and I think it's going to continue to have those effects. Now um to what extent the federal government decides to backfill those state and local health departments that are going to struggle um and may have to uh close their doors or or offer much less. I think that that's what we're going to have to keep an eye on, but I think that's that's what's going to have to happen. And and this again will not happen, this type of change will not happen without leadership. And that means both public and private sector leadership in local communities working with their state health departments and their state leaders uh to try to really make a difference in this. And I'm not just talking about for this issue. This is a broader issue of all of the diseases that you were talking about. Yeah, you know, I I was talking to a neighbor, um, who happened to go to um, the rally this this last Saturday, you know, the hands off rally, which there were thousands of of people around the country. And I happened to ask her specifically, um, what do you feel came from that? You know, it's just like, okay, everybody is, you know, upset and they have their signs and they're listening to speakers. And her comment was solidarity. It it you know, it's or call it misery loves company. And so and there's a lot of us out there that are, you know, kind of feeling miserable. And so this helps to know that, you know, there are other people that are on the same wavelength as you. And by the way, um, you know, we have to get away from this decisiveness where um, you know, you're Republican here, you're Democrat here, you're whatever. Again, the diseases don't care. Um, and and and that's and and by the way, health is an important aspect for all of us. You know, my my father used to say, if you don't have your health, you don't have anything. Um, which I think there's some truth to that. I think the Greeks actually said that, you know, 2000 plus years. Yeah, well, he probably, you know, he probably met them.
Clarence: Last words.
Host: Yeah, yeah, no. No. Thank you. I have really, uh, it it has really caused me, this conversation has really caused me to think about some things. And so I'm very much appreciate you for sharing and uh definitely appreciate you your journey and also the fact that uh I'm thinking about, you know, quite honestly, I'm thinking about organizations that are uh working with senior populations and how important it might be to talk about what you've been talking about and to see if there can be additional support for our communities. So, thank you.
Jennifer: Oh, you're very welcome.
Host: Barry, last thoughts.
Barry: Um, you know, they say the the age of the population that's increasing the most are the centenarians, people over over 100 and uh, you know, with people living longer, obviously the effects of aging uh play a role and I'm very appreciative of uh taking a topic that's that's really broad but being able to get a perspective and get it down to some of the more important things that all of us need to hear about, need to attend to, uh, and should uh, you know, be repeated over and over again uh because things are are forever changing. And I, you know, I think some of the priority things that we highlighted here today, um, again, it's just the beginning of the questions we need to ask and just be observant of and and pay attention to so that all of us can live as independently and as meaningful lives that we can. And uh, Abby, as you had highlighted the the idea of what are your goals. You got to think about what's what's important to you and that's very different from person to person, but articulating those will really help to create the kind of plan of care that you need as you age to meet your goals as well as you possibly can. And goals do change over time as well. It's not you're not locked into that. Um, and so we know that, but for the time being then let's do what we can do. So, thank you so much for um, being on our show and I appreciate it.
Host: And finally to get to to be with you face to face. Abby and I go back actually a ways but it was always
Jennifer: We've we've run in the same circles for a long time but it took us a while to to actually be in the same place at the same time. So
Host: I'm glad health chatter brought you together. Abby, thank you so much. Uh this has been wonderful. If you have any particular information that you think would be useful to put on our website, we would happily share that with with the listening audience in the transcript of the of the show. So feel free to get that get that to us. This was, um, it was really a learning experience even, you know, for me, I'm older, but you know, I I learned a lot. And so, thank you. Thank you for the service that you provide and the insights that you you gave us today. It was great having you on the show.
Jennifer: Oh, you're very welcome. It was very nice to meet you. And I actually, um, I'm giving a talk next week and I'd put together a handout about, um, sort of early signs of cognitive and functional impairment and and some, um, senior resources. So I'm happy to share that with you as well.
Host: Yeah, pop it over and we'll we'll get that out on our on our website. So thanks for being with us. For you, the listening audience, thanks for being with us today. We have great shows coming up. We have one coming up on quality improvement and quality assurance in health care. And then one that connects with this one, we're going to be doing a show on Alzheimer's coming up as well. So thanks to everybody out in the listening audience. Everybody, keep health chatting away.
