TALK ABOUT THESE ALARMING TRENDS  AND HOW THE COMMUNITY CAN HELP   THE COMMUNITY OVERCOME BARRIERS THEY FACE TO  RECEIVE TREATMENT.

THAT'S NEXT ON INSIGHTS.

ALOHA AND WELCOME TO INSIGHTS ON PBS HAWAII.

I'M LAUREN DAY.

A STUDY BY RESEARCHERS AT THE  UNIVERSITY OF HAWAII AT MANOA’S CENTER ON AGING  PUBLISHED IN AUGUST OF 2024 SHOWED AN ALARMING TREND:  METHAMPHETAMINE POISONING IS THE LEADING CAUSE OF FATAL  OVERDOSE AMONG THOSE 50 AND OVER IN HAWAII.

58 PERCENT OF THE 263 DRUG RELATED DEATHS FROM JULY 2020  TO DECEMBER 2021 INVOLVED INDIVIDUALS AGED 50 TO 79 WITH  ALMOST TWO‑THIRDS OF THOSE DEATHS CAUSED BY METH AND  THOSE NUMBERS ARE ON THE RISE.

SO WHAT CAN BE DONE AT THE  STATE, COUNTY AND COMMUNITY LEVELS TO HELP OUR KUPUNA  DEALING WITH METHAMPHETAMINES AND SUBSTANCE USE DISORDER?

WE LOOK FORWARD TO YOUR PARTICIPATION IN TONIGHT'S  SHOW.

YOU CAN EMAIL OR CALL IN YOUR  QUESTIONS, AND YOU’LL FIND A LIVE STREAM OF THIS PROGRAM AT  PBSHAWAII.ORG AND THE PBS HAWAII YOUTUBE PAGE.

NOW, TO OUR GUESTS.

TREENA BECKER RECEIVED HER  PH.D.

IN ECONOMICS FROM MAASTRICHT UNIVERSITY IN THE  NETHERLANDS.

HER POSTDOCTORAL TRAINING  FOCUSES ON BIOMEDICAL RESEARCH AND SHE SPECIALIZES IN DRUG  ADDICTION RESEARCH AT THE UNIVERSITY OF HAWAII AT MANOA.

DR. MARK BAKER IS THE PRESIDENT OF THE HAWAII  CHAPTER OF THE AMERICAN COLLEGE OF EMERGENCY  PHYSICIANS.

HE IS AN EMERGENCY PHYSICIAN  AT PALI MOMI MEDICAL CENTER WHICH HE HELPED TO OPEN IN  1989.

HE FOUNDED ENDMETH, AN  ORGANIZATION DEDICATED TO THE PREVENTION OF METH USE.

JEFF NASH IS THE EXECUTIVE DIRECTOR OF HABILITAT, INC., A  LONG‑TERM ADDICTION TREATMENT AND VOCATIONAL TRAINING  PROGRAM BASED IN KANEOHE, WINDWARD OAHU.

HE STARTED WITH HABILITAT IN 1986 AND HAS FILLED MANY ROLES  INCLUDING CLINICAL DIRECTOR PRIOR TO HIS CURRENT POSITION.

MICHELE NAVARRO ISHIKI IS A LICENSED CLINICAL SOCIAL  WORKER, SUBSTANCE ABUSE COUNSELOR, AND THE FOUNDER OF  PIHA WELLNESS AND HEALING ON MAUI.

SHE WAS A FOUNDING MEMBER OF POUHANA O NA WAHINE, CREATED  TO HELP NATIVE HAWAIIAN FAMILIES ADDRESS DOMESTIC  VIOLENCE.

THANK ALL FOR   JOINING THE DISCUSSION TONIGHT.

I WANT TO START WITH YOU.

KICK START DISCUSSION.

YOU WERE  PART OF THE TEAM CONDUCTED STUDY.

BESIDES SOME OF THE THINGS I MENTIONED  IN OUR INTRODUCTION WE ARE SOME OF KEY   TAKEAWAYS THAT YOU WANT THE COMMUNITY TO KNOW?

>> I WOULD LIKE THE COMMUNITY TO UNDERSTAND AND   TO APPRECIATE THAT THERE ARE OUR KUPUNA WHO  MOST LIKELY STARTED DRUG USE AT A YOUNG AGE.

NOT JUST METHAMPHETAMINE, AND THEY HAVE BEEN  USING AND THEN IT'S AGING INTO DRUG USE AND THEN   THINGS HAVE GOT BAD FOR THEM, ESPECIALLY WITH  THE CARDIOVASCULAR SYSTEM AND NEUROLOGICALLY,   SO IT'S NOT AS IF METH DOESN'T KILL.

NOT AS IF THERE ISN'T A DRUG   OVERDOES IT COULD LEAD TO LONGLASTING  DIFFICULTIES FOR OUR KUPUNA'S HEALTH.

>>Lauren: SPEAK OF LONGLASTING SIDE EFFECTS,  YOU HAVE DEALT WITH AND HELPED INDIVIDUALS   SUFFERING FROM SUBSTANCE ABUSE, SUBSTANCE USE.

WHAT ARE SHORT TERM AND LONGTERM SIDE EFFECTS,.

>> EMERGENCY DEPARTMENT MAIN THING  HEART RELATED COMPLICATIONS IS PROBABLY   ALSO THE MOST COMMON CAUSE OF DEATH.

ALSO THINK IT'S REALLY IMPORTANT FOR   EVERYBODY TO UNDERSTAND THAT OVER DOSE RELATED TO  METHAMPHETAMINE IS NOT LIKE OPIATE OVER DOSE WHERE   YOU TAKE TOO MUCH, STOP BREATHING AND YOU DIE.

THIS IS MORE LONGTERM KIND OF PROBLEM LEADING   TO HEART NOT WORKING, YOU CAN'T  SUPPORT YOUR BLOOD PRESSURE.

YOU END UP WITH FLUID BACKING UP IN YOUR LUNGS  AND YOU DIE FROM THAT KIND OF SLOW AND PAINFUL.

>>Lauren: CURIOUS TO HEAR, BEEN  AT PALI MOMI FOR DECADES NOW.

HOW HAS THE PATIENTS THAT YOU SEE  COME IN, WHO EITHER HIGH ON METH,   HOW HAS THAT CHANGED SYMPTOMS OVER THE YEARS?

>> YOU KNOW, I THINK SYMPTOMS ARE SIMILAR OVER   THE YEARS, BUT NUMBERS HAVE GONE FROM FEW  PEOPLE WHO WOULD COME INTO THE EMERGENCY   DEPARTMENT FREQUENTLY, TO NOW, BASICALLY  TOO MANY PEOPLE TO COUNT.

PHENOMENA.

>>Lauren: YOU WORKED IN ADDITION  RECOVERY FOR A LONG TIME AS WELL.

DO YOU FEEL WE FOCUS TOO MUCH ON THE  YOUNGER POPULATION, FEEL LIKE WE TALK   ENOUGH ABOUT THE KUPUNA THAT NEED HELP AS WELL.

>> I THINK PROBABLY UNDER‑SERVED POPULATION.

SEEN UPTICK IN ADMISSIONS IN THE  LAST 3 OR 4 YEARS WITH AGE GROUP.

TREATING ABOUT 11 AT OUR FACILITY  AT IN KANEOHE AND ON AVERAGE,   TREATING ABOUT TEN PEOPLE  PER YEAR IN THAT AGE GROUP.

WE HAVE SEEN INCREASE IN  ADMITS FOR THAT AGE GROUP.

>>Lauren: FOR YOU, NUMBERS DON'T LIE, WITH WHO  YOU WORK WITH, HAVE YOU SEEN INCREASE IN METH   USERS INCREASE OVER THE YEARS?

>> ABSOLUTELY.

THERE'S TO DENYING WE ALL SEE IT.

YOU SEE IT.

SOMETIMES YOU'RE LOOKING AT FOLKS YOU  DON'T EVEN REALIZE YOU'RE SEEING IT.

THEY'RE THERE.

AND WE TALK ABOUT OUR KUPUNA.

STIGMA OF GETTING HELP AND WHEN WE TALK ABOUT  PREVENTION, HOW DO WE GET THEM INTO CARE.

A LOT OF TIMES THEY'RE TAKING CARE OF GRANDKIDS.

SOME INTERGENERATIONAL THINGS HAPPENING.

AND   SOMETIMES IT'S USED TO HELP THEM  COPE, TO HELP THEM STAY AWAKE.

MAY HAVE STARTED WITH OTHER DRUGS, ALCOHOL,  COCAINE, THEN LANDED ON METH BECAUSE IT'S   MUCH MORE AFFORDABLE LONGER LASTING HIGH.

AND IT IS SO ADDICTIVE, THAT BEFORE THEY   KNOW IT, THEY ARE USING IT MORE THAN  ONCE OR TWICE A WEEK.

USING EVERY DAY.

AND HOW DID WE HELP OUR KUPUNA?

HOW DO WE TRULY HELP OUR KUPUNA?

I'M SURE WE'LL GET TO THAT IN A LITTLE BIT.

YOU TOUCHED ON THIS.

POTENTIALLY STARTED WHEN THEY WERE  YOUNGER MAYBE THIS IS QUESTION FOR   ALL OF FOUR OF TO YOU WEIGH IN ON.

HOW DO YOU THINK THIS METHAMPHETAMINE   IS TAKING OUR ‑‑ AFFECTING OUR KUPUNA SO MUCH?

>> I THINK IT'S BECAUSE CHEAP, AFFORDABLE.

EASY TO GET AND IT WAS SOMETHING THAT WAS  PEOPLE INTRODUCED TO IT A LONG TIME AGO.

DECADES AGO.

LIKE MARK SAID,   WHEN PALI MOMI STARTED, GOES WAY BACK.

AND SO EASY ACCESS AND PEOPLE LIKE IT.

AND I THINK THAT WAS HOW THEY WERE INTRODUCED  TO IT AND THERE WAS ALSO IN OUR STUDY, DEATH   RECORDS INTERVIEW WAS FAMILY MEMBERS,  WAS THAT THE FAMILY, PERSON ALWAYS   DID METH AND THEY THOUGHT IT WAS  NORMALIZED LIKE NORMALIZED USE.

AND IT JUST BECAME A THING.

HOW IT STUCK.

>>Lauren: ANECDOTALLY, I HAVE WORKED  WITH KUPUNA WHO SAY THAT THEIR CHILDREN   ARE GROWN GRANDKIDS DON'T VISIT, HAVE  SOME FUN.

THESE ARE THINGS I'VE HEARD.

>>Lauren: THEY'VE STARTED IN LATER YEARS?

>> WELL, MIX IT WITH OTHER THINGS.

BUT THEN AGAIN, IT'S THE GO‑TO.

AGAIN, COST AND AVAILABILITY.

COCAINE USE, KIND OF NOT  AS WIDELY USED AS METH IS.

THERE'S SO MANY DIFFERENT REASONS WHY.

IT CAN BE WHAT NEIGHBORHOOD YOU'RE IN,   WHAT TOWN YOU'RE IN, WHAT ISLAND YOU'RE ON.

AS TO WHAT POPULATIONS ARE AFFECTED AND HOW   DEEPLY THEY'RE AFFECTED BY IT.

>> I DON'T MEAN IT CUT YOU OFF.

I'M CURIOUS, ANY OTHER FACTORS  THAT YOU WOULD WANT TO ADD?

>> I STARTED, I DON'T THINK THIS IS LIKE A NORMAL  THING TO DO IN THE E.R., STARTED ASKING USE,   WHO HAD A HEART FAILURE, HOW OLD THEY WERE  WHEN THEY FIRST STARTED, WAS REALLY SURPRISED.

I HAVE TALKED TO THREE ADULTS WHO  VARIED IN AGE MID 30'S TO MID FIFTIES,   WHO SAID THEY STARTED WHEN THEY WERE 13.

ONE WHAT WAS NINE YEARS OLD VERY YOUNGEST.

KIND OF GOES UP FROM THERE.

IT'S BECOME MULTIGENERATIONAL.

>> GROW UP IN HOUSEHOLD WHEN IT'S  NORMALIZED, KIND OF THING TO DO.

SAID BEFORE, VERY INEXPENSIVE.

EASIER TO ACCESS THAN MOST   OTHER SUBSTANCES OF ABUSE.

OTHER THAN ALCOHOL OF COURSE.

AND IT'S VERY, VERY ADDICTIVE.

VERY HARD TO ONCE YOU START   TAKING IT, IT'S VERY HARD TO STOP.

SO ONCE YOU'RE INTRODUCED TO IT,   KIND OF ON A PATH TO NOWHERE.

>>Lauren: HAS IT GOTTEN MORE DANGEROUS   OVER THE YEARS PHYSICIAN‑ASSISTED DEATH?

>> IT HAS.

METHAMPHETAMINE.

>> IT HAS.

GOTTEN MORE DANGEROUS BECAUSE THEY  REFINED IT MORE TO WHERE IT'S MORE   ADDICTIVE AND WE WERE TALKING EARLIER, NOW  THEY'RE PUTTING OTHER SUBSTANCES IN IT.

NOT TOO UNCOMMON TO FIND METHAMPHETAMINE WITH  FENTANYL IN IT THESE DAYS OR OTHER SUBSTANCES.

WITH FENTANYL.

SO THAT MAKES IT VERY DANGEROUS AS WELL.

>>Lauren: CAN YOU ALSO WEIGH IN, LONGTERM EFFECTS.

HOW DOES TAKING METH, HOW DOES THAT AFFECT YOUR   BRAIN, YOUR EMOTIONAL MENTAL HEALTH,  PHYSICAL HEALTH AS WELL LONGTERM?

>> GENERAL PHYSICAL HEALTH SUFFERS AND NUMBER  ONE THING WE SEE IN PEOPLE IN THE EMERGENCY   DEPARTMENT HEART RELATED PROBLEM WITH FLUID THAT  BUILDS UP IN THE LUNG, BUT PROBABLY NUMBER 2 IS  PSYCHIATRIC ILLNESS.

ANXIETY, DEPRESSION.

FEELING LIKE ONE THING IS REALLY I DON'T  KNOW IF WE UNDERSTAND, PEOPLE FEEL LIKE   THERE ARE BUGS CRAWLING OUT OF THEIR SKIN.

LOOK AT ME, POINT AT A PIECE OF LINT AND   SAY CAN YOU SEE THAT?

SO CARDIAC AND MENTAL,   ALSO TEETH AND MULTIPLE ORGAN SYSTEMS.

>>Lauren: CAN IT BE REVERSED ALL OF   THOSE SIDE EFFECTS?

TREATMENT FOR IT?

>> THERE IS UNFORTUNATELY, THERE ISN'T GOOD  TREATMENT AND THERE IS NOT A GOOD KIND OF   LIKE BANOPHEN FOR OPIATE USER CAN HELP.

THERE ISN'T PRESENTLY ANY GOOD REAL   GOOD METHAMPHETAMINE MEDICAL TREATMENT.

>> WHAT WE SEE OVER TIME IF SOMEBODY FINDS   ABSTINENCE AFTER PROLONGED PERIOD OF TIME, THEY  BEGIN TO BRAINS BEGIN TO FUNCTION NORMAL BEGIN.

PERIOD WE CALL ANADONI AFTER STOP  USING DRUGS, BRAIN DOESN'T PRODUCE   ENOUGH CHEMICALS TO FEEL GOOD ANY MORE.

SOMETIMES IT TAKE A YEAR, 18 MONTHS FOR   THAT BRAIN CHEMISTRY COME BACK  ONLINE FOR RATE IS MORE NORMAL.

TAKES A LONG TIME TO GET BACK TO NORMAL.

IN SOME CASES WE SEE IT DOES LASTING DAMAGE WHERE   THERE'S PSYCHIATRIC PROBLEMS THAT CONTINUE ON.

>> I THINK THAT NOT TO POINT OUT SPECIFICALLY   FOR KUPUNA, IS THAT THEY COULD BE SYMPTOMS LIKE  TOO MUCH METH USE LONGTERM, COULD BE MASKING,   LET ME PUT IT OTHER WAY AROUND.

MIGHT DEMENTIA NOT.

SYMPTOMS COULD BE MASKING SIDE  EFFECTS OF LONGTERM METH USE.

AMONG THE KUPUNA.

>>Lauren: COULD LEAD TO DEMENTIA.

>> THERE'S LIKE ALL OF THIS OONG SITE.

MEMORY LOSS, ANXIETY,   AND INABILITY TO DECISION‑MAKING.

ALL OF THIS, ANXIETY, MEMORY LOSS.

PEOPLE MIGHT THINK IT'S EARLY ONSET DEMENTIA,   BUT COULD EARLY BE RELATED TO  METHAMPHETAMINE USE, TOO MUCH USE.

>>Lauren: GET TO SOME OF THE VIEWER QUESTIONS.

MIKE IN EWA IS ASKING, ARE OLDER PEOPLE WHO USE   METHAMPHETAMINE BUYING FROM THE SAME  SUPPLIERS OR IS IT SO EASY TO GET,   THAT THEY CAN FIND IT ANYWHERE?

IT FEEL ANYONE TO WEIGH IN.

>> EASILY AVAILABLE EVERYWHERE.

IT DEPENDS ON THE INDIVIDUAL.

PROBABLY HAVE PREFERRED  PEOPLE THAT THEY GET IT FROM.

BUT IF WE WERE WALK DOWN THE STREET OUTSIDE THE  STUDIO HERE, THERE IS METH FOR SALE OUT THERE.

IT'S EVERYWHERE.

>> I WAS TALKING ONE PATIENT AND   ASKED HIM ABOUT THE KIND OF SAME QUESTION.

HIS ANSWER, I WON'T NAME THE COMMUNITY,   BUT IT WAS METH IS LIKE CANDY.

AND FILL IN THE BLANK.

>>Lauren: I DO WANT TO POINT TO IN THE DIRECTION  OF SPEAKING OF OUR KUPUNA, AND THAT STIGMA,   ALL THE DIFFERENT THINGS, THEY WOULD MORE  THAN LIKELY GO TO THE SAME PLACE BECAUSE THEY   DON'T WANT TOO MANY PEOPLE GOING TO DIFFERENT  PLACES AND, HOW COME AUNTY GOING OVER THERE?

HOW COME UNCLE IS GOING OVER THERE.

PROBABLY GO TO THE SAME PLACE,   SAME SUPPLIER IF YOU WILL, DEALER,.

>>Lauren: IF IT'S SO READILY AVAILABLE,   HOW IS IT GETTING IN AND WHAT IS BEING DONE  TO TRY TO LIMIT THE AMOUNT THAT'S OUT THERE?

>> THERE'S A LOT OF LAW ENFORCEMENT AND SO DEA,  HIGH INTENSITY DRUG TRACK AREA, DOING THEIR BEST,   BUT DRUG TRAFFICKING AREA, DOING THEIR BEST.

STILL EASILY AVAILABLE.

AND ONGOING BATTLE TO   TRY TO REDUCE THE SUPPLY THAT'S OUT THERE.

>> IT COMES IN EVERY WAY YOU CAN IMAGINE.

PLANES.

THROUGH THE MAIL.

ON SHIPPING CONTAINERS.

EVERY WAY YOU MIGHT IMAGINE.

>>Lauren: YOU WERE SAYING PEOPLE ARE  TRYING TO MAIL IT INTO THE STATE?

>> NOT TRYING.

THEY'RE DOING IT.

>>Lauren: REGULAR USPS BOXES, MAILING IT IN.

>> ABSOLUTELY.

>>Lauren: WAIPAHU.

RESULTS OF THE STUDY, SURPRISE  AND IF SO, WHY OR WHAT CHANGED?

WERE THE RESULTS OF THE STUDY?

>> IT WAS A SURPRISE BECAUSE US RESEARCHERS   EXPECTED IT TO BE A YOUNG PERSON PROBLEM THAT IT  WOULD BE YOUNGER PEOPLE, LESS THAN 50, THAT WAS   OUR OPERATIONAL DEFINITION WOULD BE USING A LOT OF  DRUGS, NOT JUST METHAMPHETAMINE, COULD BE OPIOIDS   AND THEN THERE WOULD DIE OF DRUG OVERDOSE.

BUT THEN IT WENT IN THE OTHER DIRECTION.

IT WAS LIKE OLDER PEOPLE.

>>Lauren: QUESTION TO YOU.

PERSON IS ASKING, ARE THESE  MOSTLY HOMELESS SENIORS?

OR ARE YOU SEEING ALL WALKS OF  LIFE DEALING WITH THIS ISSUE?

HOW ARE THEY GETTING THEIR HANDS ON THIS DRUG?

KIND OF ALREADY TOUCHED ON THAT.

>> ALL WALKS OF LIFE.

METH USE, ADDICTION.

IT DOES NOT DISCRIMINATE.

IT DOESN'T MATTER.

YOUR CLOTHES WHERE YOU WORK, WHAT NEIGHBORHOOD YOU  LIVE IN, AND WE ALL TALK ABOUT THE ON NEXT CORNER,   IT'S AT AUNTY'S HOUSE, UNCLE'S HOUSE OR  FRIENDS HOUSE OR WHATEVER CASE MAY BE,   I THINK THE QUESTIONS ARE SO, THEY'RE HARD  BECAUSE IT'S NOT A ONE SIZE FITS ALL ON WHO IS   DOING IT HOW WE'RE GOING TO COMBAT THE ISSUES.

EVERYBODY IS DOING THE BEST THAT THEY CAN WHO   HAVE THEIR HANDS ON IT.

BUT THERE'S JUST NEVER   ENOUGH PEOPLE DOING THE WORK.

>> I THINK SOMETIMES PEOPLE THINK,   THAT'S A HOMELESS PROBLEM.

>> ABSOLUTELY NOT.

>> PROFESSIONALS THAT ARE HAVING PROBLEMS WITH IT.

PEOPLE LICENSED PROFESSIONALS AND BUSINESS OWNERS.

CUT ACROSS SOCIAL CLASS.

IT'S JUST PROFESSIONALS HIDE IT BETTER.

>> I THINK THEY ALSO, I SEE PEOPLE WHO STARTED  USING IT AND ENDED UP HOMELESS, ENDED UP NOT   WORKING, ENDED UP LOSING FAMILY TIES AND I'VE HAD  OTHER FAMILY MEMBERS SAY, I'VE GOT LIKE COUSIN OUT   THERE SOMEWHERE WE DON'T KNOW WHERE HE IS.

WE DON'T KNOW IF HE'S STILL ALIVE.

>> YOU HEAR THAT WAY TOO OFTEN.

>> IS THERE SUCH A THING AS WORKING METH   ADDICT SINCE SPOKE ABOUT PROFESSIONALS.

SOMEONE WHO USES METH BUT FUNCTIONS   WELL DAY‑TO‑DAY?

THAT'S THEIR QUESTION.

MAYBE COULD YOU TOUCH ON IF THAT'S LASTING,  CAN THEY KEEP THAT UP, CERTAIN POINT WILL   THERE BE A DROP‑OFF.

>> GREAT QUESTION.

AND I WOULD REFER TO AUSTRALIAN STUDY  IN CATEGORIZATION OF METHAMPHETAMINE   USE WHERE THEY DESCRIBE SOMEBODY WHO, AT  THE VERY LOW END, WOULD NEVER PURCHASE IT.

WOULD MAYBE USE IT ONCE AT A PARTY  IF SOMEBODY OFFERED IT TO THEM.

TO MORE INTERMITTENT USE, TO MAYBE A  TRUCKER WHO NEEDS TO STAY AWAKE ALL NIGHT.

TRIES TO MINIMIZE USE.

PATIENTS WE TAKE CARE EMERGENCY   DEPARTMENT USING IT MULTIPLE TIMES THAT UP.

>>Lauren: CAN THEY KEEP THAT UP.

>> POSSIBLE SOME COULD KEEP IT UP AND USE  IT WITHOUT, BECOMING HOMELESS OR PROBABLY   STILL GET A HEART FAILURE.

HAVE OTHER COMPLICATIONS.

>>Lauren: I DON'T THINK THERE'S SUCH A  THING AS SOMEONE WHO CAN BE SUCCESSFUL.

SUCCESSFUL METH USER OR I THINK WE CAN TRY TO STAY  AWAY FROM LABELING PEOPLE BY CALLING THEM ADDICTS.

PEOPLE GET ADDICTED AND TAKES THEM  SOMEWHERE HEALTH WISE OR THEY LOSE   THEIR HOMES, THEIR CAR, FAMILIES.

THEY DO END UP ON THE STREET.

THERE IS A LOT OF FOLKS WOULD HAVE  BECOME ADDICTED WHO ARE LIVING   WITH FAMILY MEMBERS WHO ALSO MAY BE ADDICTED.

IT'S JUST A DOMINO EFFECT THAT WE TALKED ABOUT   THIS EARLIER, ABOUT WHAT WE TREATING?

WE TREATING THIS OR THAT?

TALKED ABOUT THE CHICKEN OR EGG.

STOP LOOKING AT THAT.

TREAT THE PERSON, TREAT THE FAMILY.

IF IT'S OUR KUPUNA, IT'S SAFE TO SAY   BECAUSE I'VE HEARD FOLKS 20'S AND 30'S SAY  I DON'T WANT TO USE WHAT MY PARENTS USED.

THEY'RE USING OTHER THINGS.

YOU LEAVE THE METH TO OUR KUPUNA.

>>Lauren: SARAH ASKING FOR JEFF,  IF YOU CAN TELL US HABILITAT.

ASKING WHAT THE SENIORS YOU ARE WORKING WITH IN  OUR PROGRAM REFERRED TO YOUR PROGRAM BY COURTS OR   SOME OTHER AUTHORITY OR DID THEY GO ON THEIR OWN?

>> BOTH.

BASICALLY, HABILITATE IS  LONGTERM RESIDENTIAL TREATMENT   PROGRAM WITH VOCATIONAL TRAINING ELEMENT.

OUR JOB IS TO GET PEOPLE OFF‑STREETS OR OUT   OF INCARCERATION, TREAT THEIR SUBSTANCE ABUSE  DISORDER AND PREPARE THEM WITH WHATEVER SKILLS   ARE NECESSARY TO GO BACK INTO THE COMMUNITY.

WE'RE THE LARGEST TREATMENT CENTER IN THE STATE.

WITH 150 BEDS.

WE HAVE A LOT OF PEOPLE TO TREAT.

PEOPLE COME TO US FROM VARIOUS DIFFERENT  PLACES.

SOMETIMES THEY'RE REFERRED TO   THE COURTS FROM THE PROBATION DEPARTMENT.

SOMETIMES THEY'RE REFERRED FROM OUR TREATMENT   PROGRAMS SEEKING HIGHER LEVEL OF CARE.

MAYBE THEY'RE IN A SHORT‑TERM PROGRAM.

AND IT'S DETERMINING THEY  NEED LONGTERMING PROGRAMMING.

WE GET REFERRALS FROM BOTH AND SOMETIMES WE  HAVE PEOPLE JUST WALK IN SAY, I NEED HELP.

>>Lauren: ALL OF BEDS FILLED?

CURIOUS IF WE HAVE ENOUGH BEDS.

>> THEY'RE NOT.

BY AND LARGE IN THE STATE,   DON'T HAVE ENOUGH BEDS IN MY OPINION.

WE HAVE A 150 BEDS.

WE HAVE ABOUT 120   PARTICIPANTS SO WE DO HAVE OPENINGS.

WE'RE KNOWN AS LAST RESORT.

LAST HOUSE ON THE BLOCK.

BECAUSE OUR PROGRAM IS LONG.

IT'S ARDUOUS.

AND MOST PEOPLE ARE GOING TO   TRY EASIER SHORTER TERM THINGS.

WHICH IS GOOD.

THEY CAN FIND A PATH TO SUCCESS, WITHOUT  HAVING TWO THROUGH OUR LONGTERM PROGRAM,   CERTAINLY DON'T NEED OUR LEVEL OF CARE.

>> I DO WANT TO MENTION THAT SOMETIMES   A LOT OF THE PROGRAMS, IT'S A 30,  60, IF YOU'RE LUCKY, 90 DAY PROGRAM.

WE NEED MORE.

WE NEED MORE THAN THAT.

UNFORTUNATELY INSURANCES WILL  ONLY PAY FOR SO MUCH TREATMENT.

THIS LONGTERM, IT'S HARD FOR PEOPLE  TO GO AWAY FOR A YEAR OR TWO YEARS   TO BE AWAY FROM THEIR SUPPORTS.

BUT IF THEY HAVE BEEN USING FOR   FIVE YEARS, 30, 60 DAYS IS NOT GOING TO HELP.

THEY'RE JUST COMING OUT OF THE FOG, IF YOU WILL.

>>Lauren: SINCE WE'RE TALKING ABOUT RESOURCE.

WHAT RESOURCES ARE AVAILABLE MAYBE FOR   SOMEBODY WHO IS WATCHING MAY BE  I THINK FAMILY MIGHT BE USING.

WHAT IS THE FIRST STEP TO TRY TO GET THEM HELP?

>> THEY CAN CALL, PHONE NUMBER.

GOOGLE IT.

CALLED HAWAII CARES.

AND HAWAII CARES WILL REFER, TALK TO THEM.

ALL THE SERVICES THAT WE HAVE AVAILABLE FOR   DIFFERENT TYPE OF SUBSTANCES.

NOT JUST METHAMPHETAMINE.

STIMULANT.

THERE'S ALSO OPIOIDS WHERE   THIS MEDICATION ASSISTED TREATMENT.

AND THEY CAN GET MORE INFORMATION   ABOUT HOW THEY COULD START.

IF THEY'RE READY, THEY WANT TO CHANGE.

AND I THINK THAT IS I THINK  THAT'S THE MOST IMPORTANT THING.

DO THEY WANT TO GET HELP  AND THEN YEAH.

HAWAII CARES.

>> WHAT I WOULD DO HAVING SAID THAT, I WOULD ASK.

SAY MARK, I NOTICE YOU MIGHT NEED SOME HELP.

IS THERE ANY WAY I CAN HELP YOU?

WHEN YOU'RE READY I'M HERE FOR YOU.

YOU FIND RESOURCE FOR THEM.

IF YOU YOU'RE NOT FAMILIAR WHERE TO GO, BUT REALLY   ASK YOUR LOVED ONE OR FRIEND IF THEY NEED HELP.

NOT READY, THEY'RE NOT READY BECAUSE   YOU CAN'T BE DOING ALL THE WORK.

GO YOU'RE DOING ALL THE WORK, YOU'RE   DOING ALL THE WORK AND THEY DON'T HAVE TO DO.

SO THEY'RE NOT TO GET THE HELP THEY REALLY NEED.

>>Lauren: ARE THERE RESOURCE AND MAYBE ENOUGH  RESOURCE IS NOT JUST FOR THOSE WHO ARE TRYING   TO GET OUT OF IT, BUT FOR THE SURVIVORS?

>> YOU KNOW, ADDICTION IS FAMILY ISSUE.

EVERYBODY THINKS, IT'S JUST INDIVIDUAL  THAT HAS, SUFFERING ENTIRE FAMILY SUFFERS.

THERE'S NEVER ENOUGH SUPPORT  FOR THE FOLKS WHO NEED THE HELP.

AND THERE IS THAT, THERE'S  LESS HELP FOR THE FAMILIES.

SO YOU KNOW, WE'RE IN HAWAII.

WHERE EVERYTHING IS ABOUT CONNECTION.

AND THAT WE WORK WITH NOT JUST THE PERSON  WHO SUFFERING, BUT THE ENTIRE FAMILY WHO   HAVE SUFFERED ALONGSIDE THIS INDIVIDUAL.

THEIR LOVED ONE, FRIEND.

TREAT THE WHOLE FAMILY.

SOME FAMILIES WILL SAY I'M  NOT THE ONE WITH THE PROBLEM.

YOU REALIZE WHEN YOU HAVE SOMEONE IN YOUR FAMILY  THAT HAS BEEN A ADDICTED TO SUBSTANCES THAT IT   HAS AFFECTED THE ENTIRE FAMILY.

>>Lauren: OTHER VIEWER QUESTIONS.

FEEL FREE TO WEIGH IN ANY ONE OF YOU.

WHEN SOMEONE IS OVERDOSING ON METH AND   YOU CALL AMBULANCE CAN YOU GET IN TROUBLE FOR  KNOWING ABOUT THEIR POSSESSION OF THE DRUG?

>> NO.

ABSOLUTELY NOT.

>>Lauren: WAIPAHU ASKING, IF THE FOUR OF  YOU KNOW, WHAT PERCENTAGE OF KUPUNA USING   ARE HAWAIIAN?

>>   IN THE STUDY, WE DID NOT TRACK RACE OR ETHNICITY.

BECAUSE THIS IS DIFFICULTY TOO BECAUSE WE HAVE   MANY, WITH MULTIPLE BIRACIAL, MULTIPLE  RACES DID NOT TRACK THAT IN THE DATA.

>>Lauren: FACEBOOK COMMENT, COMMENT NOT A  QUESTION, PERHAPS FOUR OF YOU CAN WEIGH ON   IT BASED OFF OF OWN EXPERIENCES WORKING WITH  BOTH SURVIVORS AND FOLKS THTAT HAVE SUBSTANCE   ABUSE DISORDER.

WE DON'T HAVE NEARLY ENOUGH  MENTAL HEALTH DETOX OR ADDICTION REHAB SERVICES   AVAILABLE HERE.

YOU CAN'T JUST QUIT.

>> THIS PERSON FROM NEIGHBOR ISLAND,   YES I WOULD AGREE.

ON OAHU, I THINK THAT WE HAVE   A LOT OF TREATMENTS SERVICES.

WE DO.

SO YEAH, WE FOR SURE, WE COULD DO WITH  MORE IN NEIGHBOR ISLANDS.

AND OF COURSE   NEIGHBOR ISLANDS THEY HAVE THEIR GEOGRAPHIC  DIFFICULTIES BECAUSE BIG ISLAND IS SO BIG.

AND SO HOW CAN WE EASILY LOCATE LOTS OF SERVICES?

THAT'S A PROBLEM THAT OAHU DOESN'T REALLY HAVE.

>>Lauren: YOU'RE FROM MAUI.

>> I'M FROM MAUI.

WE CAN NEVER, YOU KNOW, WE BUST OUR BUTTS, SORRY  I DON'T KNOW IF I SAY THAT, PUT OURSELVES OUT OF   A JOB SO WE DON'T HAVE TO DO THIS BUT WE HAVE  TO DO THIS AND WE DON'T EVER HAVE ENOUGH HELP.

OAHU IS BUSTING AT THE SEAMS  IN TERMS GETTING HELP FOR OUR   PEOPLE AND OUTER ISLANDS ARE THAT MUCH WORSE.

>> PEOPLE DO COME FROM THE OUTER ISLANDS TO OAHU   ALL THE TIME SEEKING TREATMENT.

>> UNFORTUNATE.

HISTORICAL THAT FIELD OF SOCIAL WORK,  PEOPLE PUT THEIR CHILDREN ON TRAINS   BECAUSE THEY COULDN'T CARE FOR THEM AND  HOPE THAT SOMEBODY WOULD TAKE THEM OFF.

BEING REMOVED FROM THEIR FAMILIES  AND STILL DOING THAT.

BEING REMOVED   STILL PUTTING PEOPLE AND PLANES MOVING THEM  AWAY FROM THEIR SUPPORTS AND DOESN'T WORK.

>> EVEN HERE ON OAHU, A LOT OF THE  PROGRAMS HAVE WAITING LIST IS NOT IDEAL.

SOMEONE NEEDS HELP, IT'S REALLY IMPORTANT  THAT YOU STRIKE WHILE THE IRON IS HOT.

WANT HELP, YOU NEED TO DO IT WHILE  THEY'RE MOTIVATED.

IF YOU HAVE TO   WAIT WEEKS ON WAITING LIST, IT'S BECAUSE  DEMAND FOR TREATMENT BEDS IS SO HIGH.

>> WE CAN NOTE AS WELL THAT NOT  EVERYBODY NEEDS RESIDENTIAL TREATMENT.

>> CORRECT.

>> NOT EVERYBODY NEEDS OUTPATIENT TREATMENT.

IF WE HAVE, CAN GET IT WHERE STRIKING WHEN  IT'S HOT, AND THEY'RE READY TO TALK TO SOMEONE,   COUNSELOR, THERAPIST, WE CAN START  THERE BECAUSE YOU LET THEM UNDERSTAND   THAT YOU DON'T WANT TO HAVE THIS LEAVE HOME.

IF YOU HAVE GOOD JOB, YOU DON'T WANT TO HAVE   GO TO INTENSIVE OUTPATIENT THREE TIMES A WEEK.

YOU'RE GOING TO LOSE YOUR JOB.

LET'S TRY TALK   WITH SOMEBODY WHO CAN KIND OF WALK YOU  ON THAT PATH OF RECOVERY, TRY THAT FIRST.

>>Lauren: FOUR OF YOU FEEL NEEDS TO BE DONE  IN OUR STATE TO HAVE MORE RESOURCES AND GET   MORE HELP ON THE ISLAND?

>> I THINK THAT OPIATE   SETTLEMENT FUND, STILL NOT DONE YET.

IN THE NEWSPAPERS TODAY THERE'S LIKE   ALL OF THESE OTHER CONDITIONS LIKE LAWSUIT, BUT  THERE IS FUNDING THERE AND WE HAVE OUR OPIATE   SETTLEMENT FUND AND I THINK THAT THAT COULD BE  A WAY, GREAT WAY TO HELP FUND MORE TREATMENT   SERVICES ACROSS ALL THE ISLANDS.

>> I THINK TREATMENT IS IMPORTANT.

BUT THE FOCUS I THINK WHAT I RECOGNIZED IN  WATCHING INCREASED NUMBERS OF PEOPLE USING OVER   THE YEARS, IS WE NEED TO FOCUS ON PREVENTION.

>> YES.

GETTING WORD OUT AND EDUCATION IN THE   SCHOOLS.

AND REALLY LIKE THE  COMMENT FROM THAT LAST PERSON   BECAUSE YOU CAN'T JUST SAY, GO AHEAD AND QUIT.

IT'S A LITTLE BIT LIKE THE CAMPAIGN JUST SAY NO.

JUST SAY NO DIDN'T WORK.

WHAT WE NEED TO DO IS PROVIDE   LIKE WONDERFUL ACTIVITIES, EXCITING ACTIVITIES,  GET KIDS AND FAMILIES DOING THINGS TOGETHER.

AND FOCUS ON DOING GOOD THINGS INSTEAD OF TURNING  TO SOMETHING THAT MIGHT BE EXCITING FIRST TIME   YOU USE IT, BUT KILLS YOU 20 YEARS LATER.

>> OUR PROBLEM WITH SUBSTANCE USE TREATMENT,   ONE THE PROBLEMS TREATMENT MODELS  DESIGNED AROUND THIRD‑PARTY PAYMENT.

YOU MENTIONED EARLIER, ONLY  WAS GOING TO PAY FOR 30 DAYS.

AROUND 30 DAYS WE NEED MORE TREATMENT  OPTIONS THAT WILL TREAT THE PERSON WITH   THE NEED, NEED FOR TREATMENT.

SO IF IT'S LONGER THAN 30 DAYS,   THEN THEY NEED MORE TREATMENT.

BUT THE FUNDING MODELS ARE VERY   RESTRICTIVE.

AND I AGREE WITH MARK, THAT NEED  MORE EFFORTS AND INTERVENTION AND PREVENTION.

PEOPLE NEED TO UNDERSTAND HOW DANGEROUS  IT IS AND WHAT ROAD IT LEADS DOWN.

FOLLOW WHAT MARK AND JEFF ARE SAYING ABOUT  PREVENTION, U.H.

NOW IMPLEMENTATION OF A   SCHOOL‑BASED PREVENTION CURRICULUM THAT  IS DESIGNED SPECIFICALLY FOR OUR HAWAII   SCHOOLS.

STARTED IN ROLLING OUT IN BIG ISLAND.

SO IT'S GETTING TO THE KIDS IN SCHOOL AND LIKE   IT'S A CURRICULUM AND RESIST, DON'T DO  DRUGS, DON'T INITIATE, DON'T EVEN START.

AND YEAH, IT'S FUNDED BY THE NIH AND I HOPE  THEY'LL BE GREAT SUCCESS GOING ACROSS THE ISLANDS.

>>Lauren: SPEAK OF NEED FOR  MORE EDUCATION ON THIS TOPIC.

IMPORTANT CONFERENCE COMING UP CAN YOU  TELL US WHAT'S CALLED AND WHAT IT DOES?

>> YES.

THE ORGANIZATION   THAT I PROBABLY INSPIRED AND HAVE WONDERFUL  HELP FROM A LOT OF PEOPLE, IS CALLED ENDMETH.

PREPARING FOR THIRD SUMMIT.

IT WILL BE MARCH 5, KROCK CENTER.

EWA BEACH.

THE FOCUS IS ON KIND   OF PREVENTION AND GETTING THE MESSAGE OUT AND  I THINK FIRST YEAR WE HAD 60 PEOPLE.

LAST YEAR,   TURNED AWAY PEOPLE AFTER 140 REGISTRANTS.

GOT MORE SPACE.

THIS YEAR.

AND EDUCATIONAL INFORMATION I THINK   THE MOST EXCITING SPEAKER IS GOING TO DISCUSS  WHAT HAS OCCURRED IN ICELAND WHERE ICELAND,   OVER ABOUT A TEN‑YEAR PERIOD, TOOK THEIR TEEN DRUG  AND ALCOHOL PROBLEM WAY UP THERE TO MUCH LOWER.

>>Lauren: VERY FASCINATING I WOULD LOVE  TO HEAR MORE ABOUT WHAT ICELAND IS DOING.

TYPE AFTER ATTENDANCE, STUDENTS?

OTHER PROFESSIONALS LIKE   YOU FOLKS IN DOING THE WORK?

>> ALL FOUR OF US HAVE BEEN THERE.

AND ANYBODY IN THE COMMUNITY COULD ATTEND.

THERE IS LIKE SOME INSTAGRAM AND FACEBOOK   PRESENCE FOR ENDMETH SIGN UP  WILL BE AVAILABLE ON THAT SOON.

COMBINATION OF MEDICAL PEOPLE, SOCIAL  WORKERS, HAIDA, WE HAD DISCUSSED.

>>Lauren: BACK TO SOME OF THE VIEWER QUESTIONS.

TONY IN HILO ASKING, HOW COMMON IS IT FOR PEOPLE   TO GO IN AND OUT OF TREATMENT FOR DECADES  OR EVEN LAST THAT LONG WITH EACH RELAPSE?

>> YES, NEVER GIVEN UP.

THEY CAN LAST, NOT A  BIG DEAL TO KEEP GOING IN AND OUT OF TREATMENT   BECAUSE THAT WOULD MEAN THAT THE PERSON WAS  JUST STARTED USING RETURNED TO DRUG USE,   BUT IT'S HOPED IN THIS SCENARIO, PERSON IS  USING LESS AND NOT DYING OF A DRUG OVERDOSE.

THERE IS SUCCESS.

IT CAN TAKE SOMEONE ONE TIME AND   IT MIGHT TAKE SOMEBODY ELSE TEN TIMES.

AGAIN, NOT A ONE SIZE FITS ALL.

AND YOU JUST STICK BY THEM AS MANY TIMES AS THEY,  BECAUSE WHETHER THEY'RE MANDATED BY THE COURTS,   OR BY JUDICIARY OR FAMILIES THEY'RE THERE.

THEY'RE IN TREATMENT.

THAT SHOULD GIVE THAT PERSON, NOT SHOULD, BUT  COULD GIVE THAT INDIVIDUAL AND FAMILY HOPE.

GIVES THEM A BREAK, HOPEFULLY, AND  HAVING THAT THEY SAY SOMETIMES,   HAVING THAT LIGHT GO ON AND THEY SEE A LITTLE  BIT MORE LIGHT EVERY TIME THAT THEY GO IN.

DON'T GIVE UP.

I MEAN, WHEN PEOPLE SAY   THAT THEY'RE GOING TO GO ON DIETS AND IT DOESN'T  WORK, DO WE DOG THEM BECAUSE IT'S NOT WORKING?

IT'S JUST HOW WE LOOK AT THINGS.

HAVE TO REALLY CHANGE AND SHIFT OUR PARADIGM   ON HOW WE LOOK AT PEOPLE GETTING HELP THEY NEED.

>>Lauren: ERIC IN KAILUA ASKING, HOW IS IT   POSSIBLE FOR PEOPLE TO BE ADDICTED FOR SO LONG  TO METH, WOULDN'T CONTINUAL METH USING KILL   YOU LONGER YOU BECOME A SENIOR CITIZEN?

>> I CAN SPEAK TO THAT ACTUALLY ONE OF   THE SLIDES THAT I USED IN THE LECTURES SHOWS  NUMBER OF DEATHS BY KIND OF DECADE OF LIFE.

SO METHAMPHETAMINE CHRONIC USE RARELY  KILLS PEOPLE WHEN THEY'RE IN THEIR 20'S.

SOME IN THE 30'S.

KIND OF INCREASES   IN YOUR FORTIES, FIFTIES AND SIXTIES.

THEN ACTUALLY TAPERS WAY OFF BECAUSE THEY'VE DIED.

YOU COULD ELABORATE I'M SURE.

>> SO THE DEATH RECORDS WE STUDY   IS SHOWING THAT, AND IT'S JUST PRETTY  MUCH, THIS IS STRAIN ON THE SYSTEM.

IF THEY DON'T OVER, USED TOO MUCH AND DIED  EARLIER, SO THEY KEEP GOING BUT THEN IT IS   MOST LIKELY RELATED TO HEART FAILURE  OR COULD BE NEUROLOGICAL COMPLICATION.

>>Lauren: MOST OF THE DEATHS THAT IN YOUR  STUDY WERE HEART FAILURE OR NEUROLOGICAL.

>> FIRST.

MAIN ONE.

COULD HAVE BEEN HEART ATTACK, STROKE,  ANYTHING RELATED, ANYTHING AND EVERYTHING   RELATED TO CARDIOVASCULAR.

CARDIOVASCULAR SYSTEM.

>> COULD BE COMORBIDITIES  WITH SOME OF THESE PEOPLE.

OLDER WE GET, DEVELOP OTHER DISEASE  AND METH JUST COMPOUNDS THAT.

>>Lauren: LIKE A SNOWBALL EFFECT.

>> YES.

>>Lauren: QUESTION I THINK WOULD BE  GOOD FOR ALL FOUR OF YOU TO WEIGH IN ON.

PERSON IS SAYING I KNOW SOMEONE WHO USES  METH WHO SAYS IT'S NOT AS DRAMATIC AS THEY   DEPICTED IN THE MEDIA.

SHE SAYS HELPS FOCUS.

NOT DEFENDING THIS, CAN YOU TALK ABOUT  QUOTE NORMALIZE THE USE MENTIONED?

>> THAT'S JUST AN EXCUSE.

FOCUS IS YES, STIMULANTS DO.

SO STIMULANT FAMILY INCLUDES ADDERALL, RITALIN.

IT DOES CREATE FOCUS, BUT I THINK THAT WE NEED TO   LIKE BE ABLE TO SCRATCH BEYOND THE SURFACE.

>> I WANT TO SEE THAT THEY'RE PROBABLY SELF   MEDICATEDDING.

OTHER THINGS HAPPENING.

TO SAY  IT'S NOT AS BAD AS YOU THINK IT IS, WHAT TV SAYS,   ALL THE THINGS, WAY TO SAY, I GOT IT.

I'M GOOD.

THAT IS A SIGN WHEN SOMEBODY  SAYING IT'S GOOD.

I'M GOOD.

IT'S NOT AS BAD AS YOU THINK.

MAY NOT BE NOW, BUT COULD BE LATER.

JUST KEEPING A CHECK ON YOUR FRIEND  OR FAMILY MEMBER WHOEVER THAT IS,   JUST LET THEM KNOW THAT'S NOT ABOUT WHAT THE  MEDIA OR TV OR WHAT THEY'RE SAYING.

IT'S THE   HEALTH IMPLICATIONS THAT COULD HAPPEN LONGTERM.

>> I WOULD SUGGEST THAT INDIVIDUAL IS PROBABLY IN   THE EARLIER STAGES OF DRUG USE.

SELF‑MEDICATING.

EVOLVES OVER TIME AND DOES NOTHING   BUT GET WORSE OVER TIME.

GO FROM USING TO HELP ME FOCUS,   LOSE WEIGHT, WHATEVER, EVENTUALLY BECOMES,  MAYBE THEY'RE INVOLVED IN SELLING IT.

>> IF YOU'RE FOCUSING ON SOMETHING, IT HELP  YOU FOCUS.

ARE YOU TRYING NOT TO FOCUS ON.

>> SOMETHING ELSE.

>> YES.

THAT'S A GREAT QUESTION.

>> YOU'RE USING IT TO MASK, HIDE OTHER THINGS.

YOU DON'T WANT TO THINK ABOUT.

YOU DON'T WANT TO FEEL AROUND.

AND SO YOU WANT TO FOCUS ON WORK.

>> I THINK THAT ACTUALLY TIES   IN WITH HOLLY'S QUESTION FROM THE BIG ISLAND.

REQUEST THE PANEL ADDRESS DUAL DIAGNOSIS MEANING   METH ADDICTION ALONG WITH MENTAL ILLNESS  AND HOW DUAL TREATMENT MIGHT BE FOUND?

NOT SURE IF THAT WAS WHAT WERE YOU GETTING AT  JUST NOW POTENTIALLY HIDING, TRYING TO MASK.

>> THIS WILL GO LIKE TO THE EXTREME WOULD  BE PSYCHOSIS LONGTERM METH USE, BRAIN DECAY,   COGNITIVE IMPAIRMENT, ANXIETY, PSYCHOSIS,  LEAD TO LONGTERM USE, HEAVY USE, PSYCHIATRIC.

THERE WILL BE MENTAL ILLNESS.

>> PROGRAMS IN THE STATE   THAT TREAT DUAL DIAGNOSIS.

VARIOUS VARYING LEVELS OF DUAL DIAGNOSES.

I THINK BY AND LARGE, MOST PEOPLE THAT ARE  SERIOUS IN A SERIOUS SUBSTANCE USE ISSUE PROBABLY   UNDERLYING MENTAL HEALTH ISSUES.

UNDERLYING TRAUMA.

>>Lauren: STARTED INITIAL DRUG USE.

>> BACK TO THE CHICKEN AND EGG.

WE DON'T KNOW.

>> 8, NINE TIMES OUT OF THE TEN, SOME TRAUMAS.

TRAUMA IS NOT, PEOPLE THINK THAT TRAUMA IS  SEXUAL ABUSE OR ASSAULT OR THINGS OF THAT NATURE.

BUT EVERYONE EXPERIENCES TRAUMA DIFFERENTLY.

AND SO EVERYBODY TREATS THEIR TRAUMA DIFFERENTLY.

USE SUBSTANCES DRINK ALCOHOL  OR WHATEVER THE CASE MAY BE.

BUT IT'S ALWAYS SOME UNDERLYING  TRAUMA AS DEFINED BY THE PERSON.

SO WE CANNOT CLUMP EVERYBODY  SAYING THEY HAVE TRAUMA.

EVERYBODY'S TRAUMA IS DIFFERENT.

AND DOCTOR AND YOU CAN LIKE BUMP OUR HEAD   AND WE'LL TREAT IT DIFFERENTLY.

HE'S A DOCTOR.

SO HE'LL GO SEE HIS DOCTOR FRIEND.

GET MEDICATION.

I DON'T HAVE TO TIME TO GO TO THE DOCTOR,  I WON'T TREAT MINE, SEE HIM IN A WEEK.

LUMP IS GOING DOWN AND HE'S ALL THE  THINGS AND I CAN BARELY GET OFF MY CHAIR   BECAUSE I HAVE OTHER STUFF GOING ON.

THEN I ASK HIM, HEY, HOW COME YOU'RE   GETTING SO MUCH BETTER?

I WENT TO THE DOCTOR.

I'M THINKING WELL, SHOOT, I  SHOULD GO TO THE DOCTOR TOO THEN.

THE WAY WE COPE WITH OUR TRAUMA IS DIFFERENT.

I DON'T HAVE TIME ALL THE TIME   TO GO TO THE DOCTOR.

HE WORKS WITH DOCTORS.

HE CAN TREAT.

SO HOW WE DEAL,   COPING MECHANISMS ARE VERY DIFFERENT.

THERE'S THE OTHER THING THERE.

>>Lauren: THOSE OF YOU THAT WORK WITH FACE‑TO‑FACE  WITH THOSE STRUGGLING WITH SUBSTANCE ABUSE,   DO YOU EVER SURVEY PATIENTS OR ASK  THEM WHAT LED THEM TO THIS POINT?

>> ABSOLUTELY.

ALL KINDS OF REASONS.

NOT ONE THING.

ALL OVER THE MAP.

COULD BE FAMILY INVOLVEMENT.

COULD BE DIVORCE.

LOSS OF CHILD.

ACCIDENTS SOMETIMES CAUSE SUBSTANCE ABUSE.

ALL OVER THE MAP.

ISN'T ANY ONE THING THAT LEADS TO IT.

>>Lauren: ASKING THOSE QUESTIONS, DOES THAT  HELP YOU WHEN YOU ARE SPEAKING WITH THEM OR   THEIR FAMILIES?

>> ABSOLUTELY.

BECAUSE YOU KNOW WHERE TO START.

IT'S A STARTING POINT HOW YOU'RE   GOING TO HELP TREAT THIS INDIVIDUAL.

>>Lauren: ALSO CURIOUS, WHAT DO YOU TELL   FAMILY MEMBERS OR LOVED ONES OF MAYBE HOW  THEY CAN HELP OR THE RIGHT THINGS TO SAY?

>> FIRST THING I TELL FAMILIES  IS TO GET HELP FOR THEMSELVES.

BECAUSE THAT'S THE BEST THING THAT YOU CAN  DO IS IF YOU TELL YOUR FAMILY MEMBER YOU   NEED TO BE IN TREATMENT, YOU'RE THE ONLY  ONE WITH THE PROBLEM, SO IN FAMILY SESSION   I'LL LET THEM KNOW WHAT ARE ARE YOU DOING FOR  YOURSELF BECAUSE FAMILY WHO HEALS TOGETHER,   WILL HEAL TOGETHER.

SO FOCUS ON YOURSELF.

WHILE THE INDIVIDUAL, WHILE THEIR LOVED ONE,   FRIEND, IS IN TREATMENT OR DOING WHAT THEY NEED  TO DO TO ABSTAIN THEY FOCUS ON THEMSELVES FIRST.

AND THEN YOU BRING THEM  TOGETHER BECAUSE IT'S TIMING.

TIMING IS SO IMPORTANT.

HOW YOU REALIGN FAMILY.

BECAUSE A LOT OF TIMES, IF JUST THE INDIVIDUAL  IS GETTING HELP, AND THEN THE FAMILY MEMBERS   ARE WAITING FOR THIS PERSON TO COME HOME FROM  TREATMENT, OKAY, NOW THAT YOU'RE BETTER, YOU GOT   TO GET BACK TO WORK AND START HELPING CLING THE  HOUSE AND THIS PERSON CLEANING THE HOUSE, THIS   PERSON IS JUST FRESH OUT OF TREATMENT.

JUST LEARNING HOW TO GET OUT   OF BED WITHOUT TAKING A HIT.

>> DO YOU FIND THAT FAMILIES ARE RELUCTANT   TO LOOK AT WHAT THEY NEED TO IMPROVE ON?

>> WHY SHOULD THEY?

THEY'RE NOT THE ONE WAS THE PROBLEM?

THEY'RE THE ONES WHO ARE USING.

LETTING HELPING FAMILIES TO KNOW AT  THIS POINT, IF SOMEONE IS GETTING HELP,   THAT'S NOT A PROBLEM ANY MORE.

THIS IS GIVING THEM HOPE.

THEY ARE RELUCTANT.

BUT THEN A LOT OF TIMES,   THERE'S GROUPS THAT THEY CAN GO TO  AL‑ANON AND THINGS OF THAT SORT,   BECAUSE PEOPLE LEARN TO LIVE WITH SOMEONE  WHO HAS BEEN ADDICTED TO SUBSTANCES.

LEARN HOW THEY HAVE TO COPE WHEN SOMEBODY  IS COMING DOWN OR WHEN THEY'RE HIGH OR   SO THAT'S A THERE'S A LOT OF DIFFERENT  BEHAVIORS GO WITH IT AFFECT THE FAMILY.

SO YES.

>> ANOTHER POINT TOO FOR THE LOVED ONES.

WHO ARE SEEING THEIR, THEM LIKE IN  TREATMENT OR ABOUT TO GET TREATMENT.

NOT WILLING TO GET TREATMENT.

I THINK IT'S IMPORTANT TO ALSO ACKNOWLEDGE THAT   THEY, LOVED ONE, ONE IS NOT USING DOESN'T HAVE  TO FEEL GUILTY THAT SHE COULDN'T SAVE OR HELP.

BECAUSE THERE'S ALL GUILT AS WELL.

ESPECIALLY IF THE PERSON DIES OF A DRUG OVERDOSE.

THESE ARE THE THINGS THAT I DON'T THINK WE'RE  DOING GOOD ENOUGH JOB OF UNDERSTANDING AND HELPING   THE LOVED ONES ALSO KNOWN AS SURVIVORS.

>>  >>Lauren: WE'RE TALKING NOT JUST TO YOUR  POINT, GETTING THERAPY, PROFESSIONAL HELP,   TO TALK ABOUT STRUGGLES OF BEING THAT  PERSON'S LOVED ONE, BUT THEN ALSO,   TO MICHELLE AND JEFF YOUR POINT OF EDUCATION,  HOW DO YOU BE A SUPPORTIVE FAMILY MEMBER, RIGHT?

>> DARIAN IN WAIMANALO ASKING DID THE  RESULTS OF THIS STUDY CREATE A BASELINE?

IF SO, WHAT ARE THE NEXT STEPS FOR  RESEARCHERS AND SHOULD THOSE WHO FUND   THE TREATMENT CENTERS BE PAYING MORE ATTENTION?

>> THIS BASELINE IS NOW STARTING TO POINT US   IN THE DIRECTION THAT WE NEED TO  THINK ABOUT OUR KUPUNA WHO STARTED   USING AT A YOUNG AGE AND AGING INTO IT.

WE MAY BE SEEING MORE AND MORE KUPUNA   IN TREATMENT FACILITIES SO THEY WILL NEED  ALSO LIKE CARE ASSISTANCE, WHAT WE WOULD   PROVIDE FOR OLDER PEOPLE ANY WAY.

NOW WE NEED TO ADD ON, WE NEED TO   THINK THIS THROUGH IN CARE FACILITIES OR  RETIREMENT HOMES, RETIREMENT COMMUNITIES.

NEED TO THINK ABOUT COULD THAT ALSO  BE HAPPENING SUBSTANCE USE DISORDERS.

>> ALSO THINK WE NEED TO HAVE  MORE FOCUS ON KUPUNA CARE.

MAYBE CREATING.

>> YES.

>> TREATMENT BASIS FOR THEM.

BECAUSE IT WOULD BE VERY STRANGE   TO BE IN A TREATMENT SETTING AND 60  YEARS OLD WITH A 20, 25‑YEAR‑OLD.

>> WE HAVE THAT SITUATION.

>> HAD IT BEFORE.

IT'S DIFFICULT.

AND IF THEY CAN'T DO THEIR DAILY THINGS,   IT'S VERY, THAT STIGMA, THAT EMBARRASSING.

WE WANT TO TAKE AWAY THAT SHAME.

THEY CAN BE TOGETHER.

>> BE IN THE SAME SETTING.

SO PUT MORE CARE AND FOCUS IN OUR KUPUNA THAT THEY  ARE IN A SETTING WHERE THEY CAN HEAL TOGETHER.

>> YOU THINK GOES BACK TO THE QUESTION  I ASKED JEFF, AT THE TOP OF THIS SHOW,   IF YOU FEEL LIKE WE'RE TALKING ENOUGH  ABOUT HOW METH IS AFFECTING OUR SENIORS.

SOUNDS LIKE THE ANSWER IS WE NEED TO DO  MORE OF THIS AND HAVE MORE EDUCATION.

>> ABSOLUTELY.

>> A LOT OF FOCUS HAS BEEN PUT ON FENTANYL.

WE STILL ARE HAVING MAJOR ISSUES WITH IT.

>> PREDOMINANT DRUG OF ABUSE IN HAWAII.

BY FAR.

>> I HAVEN'T SEEN IN THE EMERGENCY DEPARTMENT,   OPIATE OVER DOSE FOR PROBABLY 20 YEARS UNTIL  RECENTLY WHEN FENTANYL BECOME MORE PROMINENT.

METH RELATED DEATHS AND ILLNESS, WHEN YOU LOOK  AT THE NUMBERS, KIND OF LIKE I THINK STATEWIDE,   WE ARE PROBABLY HAVING ABOUT  TEN TIMES AS MANY METH RELATED   DEATHS PER YEAR AS OPIATE RELATED DEATHS.

>> AND YOU WERE SAYING NOW, IT'S MIXED.

TOO.

SOME PEOPLE THAT ARE DOING BOTH.

>> DOING BOTH.

YEAH.

>> OH, YEAH.

TALK WITH SOME OUTREACH   WORKERS AND THEY SAY, BECAUSE HARM REDUCTION, GIVE  PEOPLE STRIPS TO TEST IF THERE'S FENTANYL IN IT.

SOME PEOPLE ARE TESTING IT BECAUSE  THEY WANT THE FENTANYL IN THEIR METH.

>> TESTING IT NOT TO PROTECT THEMSELVES?

>> NOT TO AVOID IT BUT TO MAKE SURE IT'S THERE.

GOES BOTH WAYS.

THERE'S PEOPLE WHO   REALLY DON'T WANT FENTANYL IN THERE.

PEOPLE WHO DON'T KNOW THAT THERE IS.

THEY WANT TO KNOW THERE IS  AND DON'T WANT TO DO IT.

VERY SMALL AMOUNT OF PEOPLE WHO   WANT TO DO IT BECAUSE THERE'S FENTANYL IN IT.

>> I HOPE THERE ISN'T TAKING AS A DUMB QUESTION.

BUT WHY?

WHY ARE PEOPLE DOING THAT?

WHY DO THEY WANT BOTH FENTANYL.

>> HEAVY HIGH.

GOOD QUESTION.

ACTUALLY I'VE ASKED.

>> I'VE ASKED PATIENTS THAT BECAUSE THEY'RE ALMOST   LIKE OPPOSITES SOME WAY.

I'VE HAD VARIOUS ANSWERS.

ONE WAS, WELL, I LIKE USING OPIATES  BUT I DON'T WANT TO OVERDOSE THE METH.

KEEP ME BREATHING.

I THINK THERE'S PROBABLY   NOT A LOT OF TRUTH RELATED TO THAT.

>> I WAS GOING TO ASK IS THAT TRUE.

>> >> AND THEN OTHER PEOPLE SAY, WELL,   I KIND OF LIKE THAT UP AND DOWN FEELING.

>> YEAH.

>>Lauren: HOW LIKELY ARE CHILDREN  WHO SEE THEIR PARENTS USING METH   START ABUSING THE DRUG THEMSELVES?

>> I THINK YOU KIND OF TOUCHED ON   THIS A LITTLE BIT AGO.

>> BASED ON RESEARCH,   WITH MY COLLABORATORS AT U.H., IS WE ARE  FINDING THAT CHILDREN ARE NOT NECESSARILY   LIKE USING METH AT A YOUNG AGE.

THEY'RE INITIATING INTO MARIJUANA.

AT VERY YOUNG AGE.

FINDING THAT IN BIG ISLAND.

NORMAL BECAUSE FAMILY MEMBERS AUNTY, UNCLE,  PASSING YOU AROUND, AND SO THE KIDS ARE LIKE,   WELL, I GUESS IT'S OKAY FOR ME TO TRY SOME TOO.

>> IT'S MARIJUANA AND I THINK LIKELY PROBABLY   LATER WHEN THEY'RE OLDER, METHAMPHETAMINE.

>> NOT JUST MARIJUANA IS LACED WITH SOMETHING.

OR COMBINED MULTIPLE DRUGS.

IT'S THAT THE STARTING, GATEWAY DRUG IF YOU WILL.

>> YES.

>> NO.

FOR ME.

I'M SORRY.

GATEWAY DRUG, I THINK GATEWAY IS TRAUMA.

>> I AGREE COMPLETELY.

>> THEY START, MAY START USING MARIJUANA.

MAY START DRINKING ALCOHOL.

WANT TO TALK ABOUT A GATEWAY, SOMETHING LED TO.

IT'S TRAUMA.

TRAUMA AS DEFINED BY THE INDIVIDUAL.

I'VE KNOWN YOUNGEST AGE THAT I'VE KNOWN   SOMEONE TO USE METH IS 7 YEARS OLD.

AND IT THEY HAD OLDER SIBLINGS   DO IT.

PARENTS DID IT.

IT'S THERE, WE'RE GOING TO DO IT.

GENERATIONAL.

PREDISPOSED.

I DON'T LIKE THAT TERM, BUT IT'S LIKE YOUR EYES.

YOU HAVE BEAUTIFUL EYES BY THE WAY.

IT CAME FROM SOMEWHERE.

SO IT'S IN YOUR GENES.

SO IF ADDICTION IS IN YOUR GENES, THE LIKELIHOOD  OF YOU BECOMING A ABUSING SUBSTANCES ARE THERE.

SOME PEOPLE WHO ARE ADAMANT, NOT GOING TO DO THAT.

I DON'T WANT TO BE LIKE MY PARENTS.

I SAW TOO MUCH.

DON'T WANT TO BE LIKE MY SISTER BROTHER, WHATEVER.

IT'S THERE.

IT'S STILL THERE NEW THAT YOU WANTED   TO PICK SOMETHING UP COULD BE DANGEROUS.

TAKE OFF LIKE YOUR FAMILY MEMBER DID.

>> TREATED MULTIPLE GENERATIONS  SAME FAMILY MEMBERS.

GRANDMOTHER IN THE 80'S.

DAUGHTER IN THE 90s.

GRANDMOTHER 80s.

GRANDSON OR SON RECENTLY.

>> WE SEE IN THE JAILS AND INSTITUTIONS.

WORKED IN INSTITUTIONS, FEDERAL PRISON AND JAIL,   COMMUNITY CORRECTIONAL CENTERS,  AND THERE IS MOTHERS, DAUGHTERS,   FATHERS, SONS, GENERATIONAL WITHIN OUR SYSTEMS.

I WANTED TO SAY WAS THAT IN TERMS OF MARIJUANA,   THAT FOR YOUNGER, CHILDREN AND ADOLESCENTS,  YOUTH, IT'S TRYING TO SHIFT THE FOCUS AWAY   FROM METH IS THAT THEY ARE INITIATING AT A  YOUNGER AGE AND ALSO BECAUSE THEY'RE YOUNG.

BRAIN DEVELOPMENT.

THEY ARE AT THAT PHASE WHEN   THEY'RE STILL DEVELOPING YOUR BRAINS AND SO THEY  COULD BE HIGHER RISK OF MARIJUANA USE DISORDER.

AND THEN IT COULD HURT THEM COGNITIVELY.

SO THIS THEN LEADS TO MY NEXT POINT ON MY AGENDA.

IS RECREATIONAL MARIJUANA.

LEGISLATION IS BAD IDEA FOR CHILDREN.

EVEN THOUGH IT'S CHILDREN CAN'T  GET THEIR HAND ON MARIJUANA.

THAT IS NOT TRUE.

ABOUT PREVENTION CHILDREN.

>>Lauren: THREE MINUTES LEFT.

LAST QUESTION.

LOVE TO HEAR FROM YOU QUICKLY.

HOW  DO WE AS A COMMUNITY CREATE MORE OF   ENVIRONMENT ENCOURAGE PEOPLE TO ASK FOR HELP  AND MAYBE WHAT WOULD YOU LIKE TO SAY TO OUR   VIEWERS ENCOURAGE THEM TO SEEK HELP?

WANT TO GO FIRST, WE'LL GO AROUND.

>> IF YOU OR SOMEONE YOU KNOW IS SUFFERING, THAT  THERE IS HELP AND THE FIRST STEP THIS IN GETTING   THAT HELP IS ADMIT THERE'S A PROBLEM SOMETIMES  FAMILY MEMBERS HARD TO SAY, OH, MAN, SHAME.

BUT GET HELP FOR YOURSELF FIRST.

APPROACH YOUR FAMILY OR FRIEND AND   LET THEM KNOW HEY, I'M HERE TO HELP YOU.

>> I THINK WE NEED TO ALL HOLD HANDS   TOGETHER AS A STATE AND HELP EACH OTHER.

BECAUSE THIS IS A PROBLEM THAT  IS ONLY GOING TO GET WORSE.

UNLESS WE REALLY HELP EACH OTHER.

I THINK WE CAN BE A MODEL FOR   THE REST OF THE COUNTRY IN DOING THAT.

>> I THINK WE AS A COMMUNITY GET NEED GET   AWAY PUNITIVE APPROACH TO TREATING SUBSTANCE  USE AND TAKE A MORE ALOHA TYPE OF APPROACH.

MEDICAL ISSUE.

IT CAN BE DEALT WITH BY PROFESSIONALS.

MY ADVICE TO PEOPLE WOULD BE SEEK HELP.

SEEK TREATMENT.

IF THE FIRST TIME IT DOESN'T WORK, TRY AGAIN.

TRY AGAIN.

IT'S NOT UNCOMMON THAT SOMEBODY AS MENTIONED  BEFORE, MIGHT DO TEN STINTS IN TREATMENT.

SHORT TERM DOESN'T WORK, LOOK FOR LONGTERM.

TRY THE DIFFERENT LEVELS OF CARE AND CONTINUE   TO TRY AND GET HELP UNTIL YOU  FIND THE PEACE YOU'RE LOOKING FOR.

>>Lauren: PERHAPS NEVER TOO LATE.

>> WELL, FOR SOME IT IS BECAUSE   THEY END UP IN HER STUDY.

IT IS TOO LATE WHEN IT'S TOO LATE.

IF YOU'RE STILL ALIVE AND STILL  BREATHING YOU HAVE A CHANCE.

THERE'S LOTS, ONE THING FOR SURE, A LOT OF PEOPLE  WORKING REALLY HARD IN THIS STATE TO TRY AND HELP   PEOPLE OVERCOME THOSE CHALLENGES.

BUT YOU GOT TO WANT IT.

>>Lauren: LAST WORD TO YOU.

30 SECONDS.

WHAT WOULD YOU LIKE TO SAY.

>> I WANT TO SAY FOR PEOPLE WHO   ARE USING METH AND IT WOULD BE GREAT  IF THEY GO GET HEALTH CARE AS WELL.

CHECK ON THEIR HEARTS.

BECAUSE THEY THINK WE'RE   NOT GOING TO DIE USING METH.

BUT TAKE A LOOK AT YOUR HEART.

SEE A HEALTH CARE PROVIDER.

DON'T DIE.

>>Lauren: GOOD POINT TO END ON.

TALKED ABOUT RESOURCE.

BUT ALSO, GET HELP FOR YOUR MENTAL  HEALTH AND PHYSICAL HEALTH AS WELL.

THANK YOU FOR OF YOU BEING HERE.

DIFFICULT TOPIC.

IMPORTANT   TOPIC EDUCATE YOUR VIEWERS.

THANK YOU FOR TUNING IN AND ASKING YOUR QUESTIONS.

MAHALO TO YOU FOR JOINING US TONIGHT, AND WE THANK OUR  GUESTS, TREENA BECKER FROM THE CENTER  ON AGING AT U.H.

MANOA AND JEFF NASH, THE EXECUTIVE  DIRECTOR FROM HABILITAT, AND DR. MARK BAKER FROM  ENDMETH, AND MICHELE NAVARRO ISHIKI, SOCIAL WORKER AND  SUBSTANCE ABUSE COUNSELOR.

INSIGHTS IS OFF NEXT WEEK BUT  PLEASE JOIN US NEXT THURSDAY FOR KAKOU: HAWAII’S TOWN HALL  AS WE DISCUSS THE CHALLENGES OF ALZHEIMER’S.

WE HOPE TO HEAR FROM YOU THEN.

I’M LAUREN DAY FOR INSIGHTS ON  PBS HAWAI`I.

ALOHA!