#20 - Stigma, Discrimination, Recovery, and Politics - with Ryan Hampton

In this episode Stephen Hays chats with Ryan Hampton about Ryan’s personal addiction journey that has led Ryan to the forefront of our national conversation on addiction and recovery.  Ryan shares his story and talks about where we are as a country on combatting addiction, fostering recovery, and defeating stigma.  Ryan really tells it how it is, and if you are at all concerned about how the government is dealing with (or not dealing with) drugs or addiction, you will feel better when you hear that Ryan is on our side (and when you hear what he’s doing).

Ryan is a former white house staffer (Clinton Administration) and is leading the national conversation about addiction and recovery.  He is the author of the book, American Fix – Inside the Opioid Addiction Crisis and How to End it.  He’s also part of a team that released the first-ever U.S. Surgeon Generals Report on Addiction (2016) and has been called a “top social entrepreneur” by Forbes.  He’s appeared on countless broadcasts on Fox News, CNN, NPR, HLN, and in the Wall Street Journal, The Hill, Vice, HuffPost and many other publications.  He is an authoritative figure on addiction and recovery in America.

Ryan has been instrumental in getting addiction legislation drafted, and passed both in California, and at the Federal level including HR 4684, also known as “Tyler’s Law” or the “Ensuring Access to Quality Sober Living Act of 2018.”

You can connect with Ryan Hampton and learn more about his work here: Ryan Hampton’s Website, Book: American Fix, Ryan’s Twitter,

SOME OF THE THINGS WE TALKED ABOUT:

Ryan tells his story of addiction, and recovery.   Just after Thanksgiving of 2014 Ryan was in drug treatment.  It was a place he never thought he would end up.  Certainly not after being stranded and homeless on the streets of Los Angeles.  Ryan had a very promising future career in politics, he worked in the Clinton White House, then worked for the Democratic National Committee through 2003.  After a hiking accident in 2003, he was prescribed an opioid based pain killer which ultimately led him to addiction to not only pain killers bur heroin and other addictions.

Addiction journey:  From 2003 to 2014, Ryan spent years living in addiction to opioids and later heroin.  After multiple attempts at treatment, rehab, sober living, and struggling with uncertainty about what to do, he found himself homeless in Los Angeles at Thanksgiving of 2014.  Ryan spent Thanksgiving Day of 2014 on the corner of Hollywood Blvd and Highland with no food, no place to sleep, and no insurance, begging for help.  That week someone helped him and got him to a treatment center.

After treatment, he moved into a sober house, and plugged into a peer community that lifted him up when he couldn’t lift himself up.  He focused on his recovery, went to meetings every day, drove Uber, and worked odd jobs.  He was still incredibly ashamed though.  He didn’t want to talk about addiction and recovery outside of the recovery community. 

What made you start speaking out, taking action, and coming out of the shadows?  13 months into recovery, while still living in a sober living home, Ryan experienced the death of several of his friends in the recovery community.  These were people he lived with or went to treatment with.  These were people who got sober, but then relapsed, and could not get care, some of which went to hospitals and were denied care or left out on the street and died as a result.

Ryan soon started to look outside of his local recovery community to see why people were dying and why nobody cared.  This is when he started to get more involved and connect with the recovery community and recovery movement nationally.   Leveraging his former political activist roots, he started using the cause of addiction to organize people and get people registered to vote, call their congress person, etc.

Comparing the AIDS crisis to the addiction crisis: 1/3 of households in the U.S. are impacted by addiction.  This is a larger constituency than the gun lobby, the pro-life lobby, it’s larger than the LBGT community.  Why is nobody talking about it at scale?  Why have there not been changes?  We don’t need everyone to bang on their legislators’ doors but if a couple thousand people would do it, then we could see huge changes.

When the AIDS crisis was at its height, not every gay person in America got up in arms to change funding but a few thousands did.  The result was billions of dollars of investment and research in science, which led us to a point where today, AIDS is a manageable chronic disease 

How can someone go to the ER for help and not get it? Ryan explains that close to 95% of hospitals can’t treat substance use disorder in the ER.  There’s a huge stigma and bias against drug users when they walk into an ER.  ER doctors want to get “those people” out of their ERs as fast as possible.  These “dirty junkies.”  People die because of this stigma (stigma is the wrong work, it’s really discrimination).

Recently we have seen more hospitals start to have Naloxone (Narcan – an opioid antagonist) on hand.  Naloxone is a medication used to counter the effects of opioid overdose.  However, most ERs still treat SUD as “catch and release” instead of offering or facilitating access to overnight care until a stable plan can be put in place for the individual to move into recovery or sober living.

Why don’t hospitals have a plan to send people to sober houses? In a perfect world, if someone walks into an ER, overdosing, it should be the same as a heart attack.  We should not only triage but offer a continuum of care (like we do for any other medical condition).  But we treat it more as catch and release.  We would never do that with a heart attack.  There should be a warm hand off from the hospital to a peer recovery coach, community organization, sober living, etc. – there should be some sort of continuity of care (as opposed to zero).  Most of the time the ER is releasing these people onto the street after doing basically nothing, and just giving them a sheet of paper with some 800 numbers to call in the event of emergency which is totally useless to an addict in crisis mode.

What should hospitals be doing?  Look at what they are doing at Mass General.  They are taking a very disruptive, recovery informed approach.  They are making warm handoffs with “recovery coaches.”  This is taking place in Alaska, and Las Vegas as well.  We will get there nationally, but hospital ERs are drastically behind where they need to be on treating Substance Use Disorder.

How do we get the federal funding to follow the campaign rhetoric with regards to addiction and recovery?  How do we get the hospitals to get in line?

It’s important to attack the funding issue from the top down (congress, senate).  The federal government needs to provide money to the states, then the states need to have a plan in place to organize and distribute the money to the communities where it is needed. 

During the height of the AIDS crisis, there was an act passed called the “Ryan White” act.  This law really changed how we got money from the federal government into AIDS research, care, etc. at the state level.  We need something like that law for addiction.

Here are a summary of thoughts Ryan discussed on this topic:

-AIDS gets $25bn a year from the federal government
-Addiction / recovery gets $2bn a year if we are lucky

-Addiction / recovery funding should at least be on par with AIDS when you consider the size of the problem

-Funding should be at least $20 bn per year if we want to combat the problem

-The CARE act is in congress now, and it would grant $10bn in grant money to local governments and states – but it just needs to get a hearing in committee, and it isn’t happening. It’s a democrat written bill, in a democrat-controlled house, and it can’t even get a hearing. This makes you think it’s just lip service.

- Presidential candidates are laying out robust proposals on par with the $10bn a year commitment.

How do get bills like the CARE act to move beyond stalling out in committee?
There’s no outraged advocates demanding a hearing.  Therefore, we need to build civic action and civic capacity to build direct engagement and put pressure on politicians.

So, what if we pass the CARE Act?  Then what?  There’s another fight after that.  We will need internal controls to make sure money finds its way to front line services and that it just doesn’t all go to treatment centers.  As a country, when we spend money on addiction, we normally spend money on law enforcement, treatment, and interdiction/prevention.  You don’t hear much about long-term recovery supports.  You don’t hear much about peer recovery supports.  We don’t hear about harm reduction.  Harm reduction is a pathway toward recovery and saves lives.  It creates trust between the drug user and the system. 

How can individuals help? Who can help?
You don’t have to be a policy expert, doctor, scientist etc. People with ‘lived experience’ have a much more unique and valuable perspective on what needs to happen in our own communities than these “experts” who see us through the lens of data and science.  We can put names and lived experience to what is happening and impact our legislators together. Anyone who has been touched by the addiction problem should make an appointment with their state representatives, and federal representatives and tell the story of the barriers we experienced in seeking help for ourselves or for our loved ones. 

There are Organizations you can get involved with:
recoveryvoices.com
Faces and Voices of Recovery
Shatter Proof
Young People in Recovery
Google ‘Recovery Together Initiative’

The story of Tyler’s Law: Ryan was sponsoring a young man named Tyler at a sober home Ryan managed in Pasadena.  Tyler was Ryan’s first sponsee.  Tyler’s parents were paying $2,000 a month to have him live in the sober home.  Tyler came home one night and said he was using again.  The house manager let Tyler stay one more night, but Tyler had to leave the next day.  Tyler slept on a sofa in the living room, not his bed, per the house manager, and that’s where Tyler died.  The house manager came down at 6 AM to check on him.  He was blue, but still alive.  Clearly overdosing.  House manager called the owner of the sober home and had no idea what to do to help save Tyler form overdosing.  There was no Naloxone on site, nobody knew how to react.  They called 911 and he died while the EMTs were on the way.  How could a sober home charge $2,000 a month and have nobody on site with the skills to revive Tyler and no Naloxone on site? This was a preventable drug death.

The next day, the Owner told Ryan not to be upset at the sober home.  The owner blamed Tyler saying Tyler didn’t really want to get clean.  Instead of taking a baseball bat to the sober living home windows, Ryan said, “this is wrong” and he acted.  

Ryan and a couple friends in recovery went to state see their senator, state representative and their member of congress.  Ryan and his friends shared about Tyler’s story and how many community members are suffering and dying. 
 
Those conversations led to a law being passed: HR 4684 in US Congress.  Tyler’s Law.  Ensuring Access to Quality Sober Living Act of 2018

This law provided published standards on sober homes (for the first time) including requiring Naloxone on site and drug overdose reaction training for employees as well as an overdoes reaction plan.  Passed in congress unanimously.  1 vote against in the Senate.  Trump signed in late 2018.  Lives will be saved because we told this kid’s story.  We have a story to tell.  That’s the power of lived experience.  That’s how people can get involved.  

Which of the current presidential candidates are the most recovery or mental health friendly?

They are all saying a lot about it.  What they are saying and how they plan to pay for it is equally important.  They are all talking about it. 

Warren – CARE act

Sanders – Medicare for all. 

You can’t really end these crises without a massive expansion.  A total revamp of the healthcare system is needed. 

Ryan has endorsed Pete Buttigieg and his plan (an 18 page mental health plan that includes $10bn a year for addiction, a specific focus on peer work force, service, long term recovery support services, and harm reduction).

Doesn’t matter who you vote for or support.  Please get involved.  Help inform your favorite candidate and impact their policy on this topic.  One of them WILL BE president and its important that we inform all the campaigns on this topic.

What can we built privately that could help or be for profit?

Peer to peer and peer recovery support is THE way to close the recovery gap.  Even if we had treatment centers on every corner in the country, we would still have a huge treatment gap (financial barriers, insurance, cultural barriers, and other things that prevent people from getting into treatment).  We need peers, warm hand offs, expanded peer work force. 

Innovation from people with lived experiences are needed.  On-demand services are also needed.  We must figure out how to combine tech and traditional on-the-ground services together.  Private investors can play a role there.  There are many people living in parts of the country where help is not accessible with in 50 miles or more

What can we do to reduce Stigma?
We need more people to speak out.  We need to normalize this problem by increased sharing.  But stigma isn’t really the right word.  Stigma is just a nice way of saying what is really happening.  The problem is systemic discrimination and bias against people with a medical condition.

We are on the way to combatting this problem.  This is a historical problem.  The drug crisis in this country isn’t just 5 years old.  There have been decades of “wars on drugs” and “wars on people who use drugs.”

Specifically, the medical profession needs help - there is still a lot of education to be done.  Medical schools are still not providing the training necessary on addiction.  Doctors who have been around for a long time are averse to learning anything new.  It’s going to take a new generation of doctors who are wiling to learn and educate themselves to provide compassionate care to people with SUD

“War on people who use drugs” – what does that mean?

The war on drugs at its heart is a war on race, class, poverty, etc.  It’s disgusting.  We are locking people up for simple possession. These drug induced homicide laws are ridiculous (2 people using drugs, one dies, and the survivor gets a murder charge).  Decriminalization of drug use, and possession is a step in the right direction.  It will have to be taken on state by state.  It will be very hard to do this nationally. 

Should we legalize drugs? 

Ryan talks about how he is still unsure when considering all the facts right now.  It’s worked in some countries.  How will that play out in the U.S.?  Not sure.  Still weighing the pros and cons of that.  But we do need to make more of an effort on decriminalization. 

People are working hard against us.  Status Quo is public enemy number 1.  Lot of moral entrepreneurs who have planted a flag and don’t want to see change.  They want to see prevention and treatment remain the focus without looking at the other tools that we could deploy.  The fight for change is disruptive to these people. 

Connect with the Stigma Podcast in the following ways: Website, Twitter, Facebook, LinkedIn, Email

Connect with host Stephen Hays here: Stephen Hays, Twitter, LinkedIn,  What If Ventures (Mental Health Venture Fund)