1 00:00:01,083 --> 00:00:03,518 Over the past 20 years 2 00:00:03,542 --> 00:00:07,375 more than 800,000 people have died in the United States 3 00:00:07,417 --> 00:00:09,768 due do drug overdose. 4 00:00:09,792 --> 00:00:12,934 Yes, more than all the lives lost 5 00:00:12,958 --> 00:00:15,750 in all the wars this country has fought in. 6 00:00:16,833 --> 00:00:20,417 The majority of these cases are due to opioid drugs. 7 00:00:21,917 --> 00:00:24,976 Sadly, while we're having this very conversation, 8 00:00:25,000 --> 00:00:28,476 at least one person will die from a drug overdose, 9 00:00:28,500 --> 00:00:33,393 and a child will be born experiencing severe withdrawals 10 00:00:33,417 --> 00:00:36,684 due to in utero opioid exposure. 11 00:00:36,708 --> 00:00:39,268 Only recently have some pharmaceutical companies 12 00:00:39,292 --> 00:00:42,601 been held legally responsible for the opioid crisis. 13 00:00:42,625 --> 00:00:46,184 And compared to their multibillion-dollar revenues, 14 00:00:46,208 --> 00:00:49,542 the economic penalties they're paying seem minuscule. 15 00:00:51,292 --> 00:00:53,083 So let me as a question: 16 00:00:54,208 --> 00:00:57,476 why does addiction and the stigma of addiction 17 00:00:57,500 --> 00:01:00,042 make it OK to undervalue human lives? 18 00:01:01,458 --> 00:01:04,726 Ironically, I'm often asked the opposite question. 19 00:01:04,750 --> 00:01:07,684 Why should we care about "addicts?" 20 00:01:07,708 --> 00:01:09,684 Sometimes I'm even shouted at 21 00:01:09,708 --> 00:01:13,559 by people who think that anyone who suffers from a substance use disorder 22 00:01:13,583 --> 00:01:15,101 brought it on themselves. 23 00:01:15,125 --> 00:01:16,434 They must be weak, 24 00:01:16,458 --> 00:01:17,851 they lack any moral compass 25 00:01:17,875 --> 00:01:19,833 and therefore don't deserve any help. 26 00:01:20,708 --> 00:01:24,726 But if you know anything about opioid addiction, 27 00:01:24,750 --> 00:01:28,351 you know that this population does not fit that stereotype -- 28 00:01:28,375 --> 00:01:30,875 not that any addiction every really does. 29 00:01:31,875 --> 00:01:35,143 These are mothers, fathers and grandmothers. 30 00:01:35,167 --> 00:01:37,768 They're teachers, business leaders, 31 00:01:37,792 --> 00:01:39,059 cheerleaders, athletes, 32 00:01:39,083 --> 00:01:41,101 nurses and bus drivers. 33 00:01:41,125 --> 00:01:43,458 They're your brother or sister. 34 00:01:44,292 --> 00:01:48,333 They represent every fiber in the fabric of our society. 35 00:01:50,292 --> 00:01:53,809 Yes, each person came to addiction in a different way, 36 00:01:53,833 --> 00:01:56,726 but a major cause of the current epidemic 37 00:01:56,750 --> 00:02:00,059 is that medical overprescription of opioid drugs 38 00:02:00,083 --> 00:02:02,393 for the treatment of chronic pain. 39 00:02:02,417 --> 00:02:05,559 And that is one thing that makes this epidemic different. 40 00:02:05,583 --> 00:02:09,708 This particular epidemic was caused by doctors' prescriptions. 41 00:02:11,333 --> 00:02:15,518 The cycle started when pharmaceutical companies convinced physicians 42 00:02:15,542 --> 00:02:17,833 that their patients should not feel any pain. 43 00:02:18,875 --> 00:02:20,393 Opioid makers claimed 44 00:02:20,417 --> 00:02:23,643 that their very potent drugs would not lead to addiction 45 00:02:23,667 --> 00:02:26,518 unless individuals were certain kinds of people 46 00:02:26,542 --> 00:02:28,208 from certain kinds of communities. 47 00:02:29,083 --> 00:02:30,934 Such disinformation, 48 00:02:30,958 --> 00:02:33,184 compounded with clinicians' limited education 49 00:02:33,208 --> 00:02:35,351 and public ignorance about addiction, 50 00:02:35,375 --> 00:02:37,208 is what created the epidemic. 51 00:02:38,042 --> 00:02:39,833 So that's how we got here. 52 00:02:40,875 --> 00:02:42,184 Now the question is: 53 00:02:42,208 --> 00:02:45,333 how do you treat a national opioid epidemic? 54 00:02:46,917 --> 00:02:48,226 During an epidemic, 55 00:02:48,250 --> 00:02:51,476 normally governments, clinicians and scientists are brought together 56 00:02:51,500 --> 00:02:53,184 to help the afflicted. 57 00:02:53,208 --> 00:02:56,768 They develop new and even unconventional treatment strategies 58 00:02:56,792 --> 00:02:59,458 to rapidly address the condition. 59 00:03:00,167 --> 00:03:03,351 That has not been the case for the opioid epidemic. 60 00:03:03,375 --> 00:03:05,601 However, the picture is changing. 61 00:03:05,625 --> 00:03:08,976 We're beginning to see more aggressive government actions. 62 00:03:09,000 --> 00:03:14,143 For example, the NIH recently started a new initiative called HEAL. 63 00:03:14,167 --> 00:03:17,059 HEAL stands for Helping End Addiction Long-term, 64 00:03:17,083 --> 00:03:21,476 and it's designed to accelerate research for pain management and addiction 65 00:03:21,500 --> 00:03:25,059 through funding new treatment strategies. 66 00:03:25,083 --> 00:03:28,643 The current treatment strategy for opioid addiction 67 00:03:28,667 --> 00:03:32,167 is the use of other opioids such as methadone. 68 00:03:33,292 --> 00:03:38,268 These few medications have been used during the past 50 years. 69 00:03:38,292 --> 00:03:40,893 They're considered substitution therapy -- 70 00:03:40,917 --> 00:03:43,500 basically fighting fire with fire. 71 00:03:44,708 --> 00:03:47,601 They have saved numerous lives, 72 00:03:47,625 --> 00:03:51,250 yet they're not used by many who still need them. 73 00:03:52,208 --> 00:03:53,893 Why? 74 00:03:53,917 --> 00:03:56,434 These medications are themselves addictive, 75 00:03:56,458 --> 00:04:00,143 and therefore come with many governmental regulations. 76 00:04:00,167 --> 00:04:04,208 Hundreds of thousands of people must be strictly monitored each day. 77 00:04:05,000 --> 00:04:06,851 They must find an opioid clinic -- 78 00:04:06,875 --> 00:04:08,518 often far from home -- 79 00:04:08,542 --> 00:04:10,917 take their meds and then try to make it into work. 80 00:04:11,917 --> 00:04:16,750 Obviously, that is not the most effective treatment strategy for an epidemic. 81 00:04:17,833 --> 00:04:20,542 And it raises obvious questions as well. 82 00:04:21,708 --> 00:04:24,934 For example: why is the treatment of addiction disorders different 83 00:04:24,958 --> 00:04:27,101 from other medical disorders? 84 00:04:27,125 --> 00:04:28,893 With most other medical disorders, 85 00:04:28,917 --> 00:04:32,500 a nonaddictive, prescribed medication is picked up at the pharmacy. 86 00:04:33,542 --> 00:04:37,059 Why do physicians treating their patients with a substance use disorder 87 00:04:37,083 --> 00:04:39,601 have limited treatment options? 88 00:04:39,625 --> 00:04:40,893 No one ever says 89 00:04:40,917 --> 00:04:43,393 that two to three treatments are enough for cancer, 90 00:04:43,417 --> 00:04:45,417 especially when it's not a cure. 91 00:04:47,875 --> 00:04:51,958 And that brings us to that 200 billion-dollar problem. 92 00:04:54,500 --> 00:04:58,476 Fighting fire with fire is a reasonable strategy, 93 00:04:58,500 --> 00:05:01,184 but what about using a different form of fire -- 94 00:05:01,208 --> 00:05:03,559 a safer form of fire? 95 00:05:03,583 --> 00:05:07,018 What about actually developing a nonaddictive treatment 96 00:05:07,042 --> 00:05:08,542 derived from another drug? 97 00:05:10,125 --> 00:05:11,643 That has been my journey 98 00:05:11,667 --> 00:05:15,226 towards trying to develop a treatment for opioid addiction, 99 00:05:15,250 --> 00:05:18,000 and it's taken me in some really surprising directions. 100 00:05:18,958 --> 00:05:22,226 My journey started with studying cannabis, 101 00:05:22,250 --> 00:05:25,434 the drug most people call marijuana. 102 00:05:25,458 --> 00:05:26,851 In order to understand 103 00:05:26,875 --> 00:05:30,351 how cannabis may connect to combating the opioid epidemic, 104 00:05:30,375 --> 00:05:35,059 first it helps to understand a little bit about the science behind the drug 105 00:05:35,083 --> 00:05:36,667 and the politics. 106 00:05:38,333 --> 00:05:40,309 Cannabis is a complex plant. 107 00:05:40,333 --> 00:05:43,768 It's actually made up of over 140 cannabinoids. 108 00:05:43,792 --> 00:05:46,101 Cannabinoids are active chemicals from the plant 109 00:05:46,125 --> 00:05:49,268 that binds to cannabinoid receptors in our bodies. 110 00:05:49,292 --> 00:05:53,143 The potent psychoactive cannabinoid that leads to the reward -- the high -- 111 00:05:53,167 --> 00:05:54,809 is THC, 112 00:05:54,833 --> 00:05:57,809 which we scientists call tetrahydrocannabinol. 113 00:05:57,833 --> 00:05:59,125 Pretty simple, right? 114 00:06:00,083 --> 00:06:03,250 But the politics is a lot more complicated. 115 00:06:04,333 --> 00:06:05,893 Attitudes towards cannabis 116 00:06:05,917 --> 00:06:08,893 and the amount of THC that's considered safe to consume 117 00:06:08,917 --> 00:06:11,726 have dramatically changed over the years. 118 00:06:11,750 --> 00:06:15,643 In fact, this country's had a roller-coaster relationship 119 00:06:15,667 --> 00:06:16,976 with the drug. 120 00:06:17,000 --> 00:06:20,476 Cannabis is either highly demonized or glorified. 121 00:06:20,500 --> 00:06:22,101 On the demonized side, 122 00:06:22,125 --> 00:06:25,184 cannabis was deemed a Schedule I drug by the DEA -- 123 00:06:25,208 --> 00:06:27,143 the Drug Enforcement Agency -- 124 00:06:27,167 --> 00:06:29,601 meaning that cannabis is considered 125 00:06:29,625 --> 00:06:32,893 to be a drug of the highest abuse potential 126 00:06:32,917 --> 00:06:35,208 and to have no medicinal value. 127 00:06:36,083 --> 00:06:40,518 Moreover, the Schedule I label led to the mass, biased arrest 128 00:06:40,542 --> 00:06:42,018 for the use of cannabis, 129 00:06:42,042 --> 00:06:45,059 particularly among young Black and brown men. 130 00:06:45,083 --> 00:06:46,934 However, things are changing. 131 00:06:46,958 --> 00:06:49,726 The pendulum is shifting in the opposite direction. 132 00:06:49,750 --> 00:06:55,684 Today, cannabis is legal for medical or recreational use in most states. 133 00:06:55,708 --> 00:06:58,893 And a bill is even being considered in Congress to remove cannabis 134 00:06:58,917 --> 00:07:00,792 from the list of schedule drugs. 135 00:07:01,708 --> 00:07:05,167 We've also seen a great increase in cannabis research. 136 00:07:06,125 --> 00:07:09,101 Most research studies, including some of my own, 137 00:07:09,125 --> 00:07:11,000 focus on THC. 138 00:07:11,833 --> 00:07:15,768 In fact, our animal research has shown a negative relationship 139 00:07:15,792 --> 00:07:17,833 between THC and opioid addiction. 140 00:07:19,083 --> 00:07:20,625 However, as I mentioned, 141 00:07:21,917 --> 00:07:24,726 the cannabis plant has over 100 cannabinoids. 142 00:07:24,750 --> 00:07:27,250 So THC was not the only one to study. 143 00:07:28,083 --> 00:07:30,684 In examining another cannabinoid, 144 00:07:30,708 --> 00:07:32,018 cannabidiol -- 145 00:07:32,042 --> 00:07:33,809 that is, CBD -- 146 00:07:33,833 --> 00:07:36,393 we were actually surprised to see features relevant 147 00:07:36,417 --> 00:07:40,000 to alleviating opioid addiction-related behaviors. 148 00:07:40,708 --> 00:07:43,958 So there my journey turned to CBD. 149 00:07:45,875 --> 00:07:49,434 So what's this CBD that has moved from virtual obscurity 150 00:07:49,458 --> 00:07:50,726 only a few years ago 151 00:07:50,750 --> 00:07:52,559 to everywhere in society -- 152 00:07:52,583 --> 00:07:54,018 in your coffee in the morning, 153 00:07:54,042 --> 00:07:55,518 your water at lunch 154 00:07:55,542 --> 00:07:57,125 and your beer at dinner? 155 00:07:58,625 --> 00:08:01,268 CBD comes from the cannabis plant, 156 00:08:01,292 --> 00:08:05,518 but in contrast to THC that has the high, 157 00:08:05,542 --> 00:08:08,875 CBD has no addictive properties. 158 00:08:09,792 --> 00:08:12,851 We're still trying to figure out how CBD fully works, 159 00:08:12,875 --> 00:08:15,934 but it is known that CBD alters chemicals in the brain 160 00:08:15,958 --> 00:08:19,042 that regulate emotions and anxiety. 161 00:08:20,250 --> 00:08:23,268 Interestingly, giving CBD to our animal models 162 00:08:23,292 --> 00:08:25,934 that had a history of self-administering heroin, 163 00:08:25,958 --> 00:08:28,333 reduced their heroin-seeking behavior. 164 00:08:29,250 --> 00:08:34,559 Specifically, CBD reduced heroin-seeking triggered by environmental cues 165 00:08:34,583 --> 00:08:36,875 that were previously associated with the drug. 166 00:08:37,917 --> 00:08:39,393 Let me say that again. 167 00:08:39,417 --> 00:08:44,309 CBD reduced heroin-seeking triggered by drug cues. 168 00:08:44,333 --> 00:08:45,851 This is significant, 169 00:08:45,875 --> 00:08:49,643 because craving is often triggered by the memories of the cues 170 00:08:49,667 --> 00:08:52,018 previously associated with drug use. 171 00:08:52,042 --> 00:08:55,851 And craving is a matter of life or death daily 172 00:08:55,875 --> 00:08:58,684 for people with an opioid use disorder. 173 00:08:58,708 --> 00:09:00,184 Simply put, 174 00:09:00,208 --> 00:09:02,309 craving can lead to relapse 175 00:09:02,333 --> 00:09:04,167 and death from overdose. 176 00:09:05,125 --> 00:09:08,958 So reducing craving is an important treatment strategy. 177 00:09:11,125 --> 00:09:13,643 Getting results from animal models like this 178 00:09:13,667 --> 00:09:17,018 is actually the first critical step in the FDA process 179 00:09:17,042 --> 00:09:19,250 for developing new medications. 180 00:09:20,292 --> 00:09:22,184 The next step: 181 00:09:22,208 --> 00:09:23,500 human studies. 182 00:09:24,542 --> 00:09:26,101 In our first human study, 183 00:09:26,125 --> 00:09:28,518 we demonstrated that CBD is safe, 184 00:09:28,542 --> 00:09:32,500 even though individuals taking it had also consumed a potent opioid. 185 00:09:33,458 --> 00:09:36,726 Next, to determine efficacy, 186 00:09:36,750 --> 00:09:38,226 we conducted clinical trials 187 00:09:38,250 --> 00:09:41,018 and made sure that both the study investigators 188 00:09:41,042 --> 00:09:42,684 and the study participants 189 00:09:42,708 --> 00:09:46,708 were blind to the CBD or the placebo substances. 190 00:09:47,750 --> 00:09:51,559 The results from those studies replicated the findings that we had 191 00:09:51,583 --> 00:09:53,518 in the animal experiments. 192 00:09:53,542 --> 00:09:59,434 So now we know that CBD can reduce craving triggered by environmental cues 193 00:09:59,458 --> 00:10:01,917 in human heroin users. 194 00:10:02,417 --> 00:10:04,643 What's more, our results demonstrated 195 00:10:04,667 --> 00:10:09,042 that CBD reduced anxiety associated with the drug use. 196 00:10:10,542 --> 00:10:14,893 This is also significant because anxiety is another critical factor 197 00:10:14,917 --> 00:10:16,458 that triggers craving. 198 00:10:18,208 --> 00:10:22,976 Importantly, CBD also reduced the levels of the stress hormone cortisol 199 00:10:23,000 --> 00:10:27,458 that is often elevated when addicted individuals are exposed to drug use. 200 00:10:29,375 --> 00:10:30,684 Another intriguing finding 201 00:10:30,708 --> 00:10:34,893 was the CBD continued to decrease craving and anxiety 202 00:10:34,917 --> 00:10:37,500 even a week following its final use. 203 00:10:38,167 --> 00:10:42,268 This aspect of prolonged efficacy is very beneficial 204 00:10:42,292 --> 00:10:45,476 for people taking any medication. 205 00:10:45,500 --> 00:10:48,851 So the evidence is mounting. 206 00:10:48,875 --> 00:10:53,018 CBD does show potential to reduce critical features for opioid addiction 207 00:10:53,042 --> 00:10:54,792 such as craving and anxiety. 208 00:10:56,708 --> 00:11:00,309 But we're still not at the end of the road for medication development. 209 00:11:00,333 --> 00:11:04,601 The gold standard for medicine established by the FDA 210 00:11:04,625 --> 00:11:06,583 is large, clinical trials. 211 00:11:07,708 --> 00:11:11,934 Recently, I was fortunate enough to be given that rare opportunity 212 00:11:11,958 --> 00:11:14,184 to conduct a large, clinical trial with CBD 213 00:11:14,208 --> 00:11:16,167 in people with an opioid use disorder. 214 00:11:17,167 --> 00:11:21,292 And that study is expected to continue for at least another two years. 215 00:11:21,875 --> 00:11:26,208 CBD is now being investigated for numerous medical conditions. 216 00:11:26,708 --> 00:11:28,351 Also, during the past decade, 217 00:11:28,375 --> 00:11:31,518 our society has seen an explosion of CBD. 218 00:11:31,542 --> 00:11:35,583 It's being put into drink, food, wellness and skincare products. 219 00:11:36,667 --> 00:11:38,833 They're even giving CBD to pets. 220 00:11:40,667 --> 00:11:44,375 So is CBD a wonder drug as now touted by many? 221 00:11:45,292 --> 00:11:47,059 No. 222 00:11:47,083 --> 00:11:50,143 Does it have potential medicinal benefits? 223 00:11:50,167 --> 00:11:51,518 It does. 224 00:11:51,542 --> 00:11:54,143 But the only way to get definitive information 225 00:11:54,167 --> 00:11:56,726 about CBD's full safety and efficacy 226 00:11:56,750 --> 00:11:58,792 is through large, clinical trials. 227 00:12:01,625 --> 00:12:04,976 So is it possible 228 00:12:05,000 --> 00:12:07,893 that we could actually change the game 229 00:12:07,917 --> 00:12:10,768 by taking this very familiar plant 230 00:12:10,792 --> 00:12:15,143 and developing a nonaddictive, FDA-approved medication 231 00:12:15,167 --> 00:12:17,375 for opioid use disorder? 232 00:12:19,000 --> 00:12:20,809 Absolutely. 233 00:12:20,833 --> 00:12:22,893 That is why we're working so hard right now 234 00:12:22,917 --> 00:12:24,958 to develop a solution based on CBD. 235 00:12:26,125 --> 00:12:27,417 For me, 236 00:12:28,833 --> 00:12:32,708 the potential benefits are obvious and also overwhelming. 237 00:12:33,750 --> 00:12:38,375 It means helping to give families back their mother or father. 238 00:12:39,333 --> 00:12:43,458 It means having your child graduate from high school or college. 239 00:12:44,292 --> 00:12:46,101 But most of all, 240 00:12:46,125 --> 00:12:50,934 it means helping to save many of the hundreds of thousands of lives 241 00:12:50,958 --> 00:12:53,559 that will otherwise be lost to opioids 242 00:12:53,583 --> 00:12:55,184 in the next decade. 243 00:12:55,208 --> 00:12:56,476 Thank you. 244 00:12:56,500 --> 00:12:59,125 (Applause)