Confronting the opioid crisis through grief
Admiral James Winnefeld explains how losing his son to an overdose pushed him to find solutions to the opioid crisis
In 2016, more Americans died from drug overdoses than the combined American combat losses in Vietnam, Iraq, and Afghanistan, the large majority of them due to opioids. And that trend shows no signs of abating.
The opioid epidemic is a frustratingly complicated public health crisis, and while there seems to be political will on both sides of the aisle to tackle it, there are few easy answers as to how to do so.
This week’s guest is no stranger to complex challenges. After a military career culminating in a tenure as Vice Chairman of the Joint Chiefs of Staff, he is very familiar with marshaling the resources necessary to overcome formidable obstacles. And so, when his son fell victim to addiction, he leapt into action, arranging for the best possible treatment he could find.
Even then, it wasn’t enough.
Now, a father’s grief for his lost son has transformed into a mission to help save other families from the same fate.
In this episode, Admiral James “Sandy” Winnefeld, a non-resident senior fellow at the Kennedy School’s Belfer Center, describes the lengths his family went to help his son Jonathan overcome addiction, what it taught him about the depth of the disease and the dearth of treatment options, and why he is now harnessing the pain of his loss to advocate for solutions to the crisis through his foundation Stop the Addiction Fatality Epidemic (SAFE.)
Each week on PolicyCast, Host Matt Cadwallader (@mattcad) explores the ways individuals make democracy work by speaking with the world’s leading experts in public policy, media, and international affairs about their experiences confronting our most pressing public problems.
Transcript
Note: This transcript was automatically generated and likely contain errors.
Matt: Just as we were speaking right before this interview started. You say you have not found a problem that is as complex as this.
Adm. Winnefeld: [00:01:46] The opioid epidemic is indeed probably the most complex public policy issue that I’ve ever dived into. The dimensions are all over the place. The the cultural problems the relatedness of the solution threads are terribly important. And if it weren’t such a tragedy in my own family it would be one of the most interesting and rewarding things I’ve ever done. Unfortunately it lives inside this background noise of sadness that we now have because we lost our son in September. We decided at that point that we could either curl up in a little ball and wish this away or based on some of the experiences we’ve had and and getting things done. People we know that sort of thing. We felt that we should try to contribute to the solution. So I’d feel terrible if I didn’t try to do something about this. And so we’ve started our foundation that’s designed to attack some of the complexity that you’re talking about. Can you tell us a little bit about your son Jonathan. Jonathan grew up in a military family. Seemed like a fairly normal kid good athlete very smart very creative younger brother had a mischievous bent to him. I’ll never forget when we got a phone call one day from his second grade teacher informing us that he had been selling school supplies to his students and lending them the money and charging them interest in order to do it. So he said I didn’t know whether to be happy or sad about that. But John was really really interesting kid a good baseball pitcher.
[00:03:16] Unfortunately he also grew up with anxiety and depression which so many young people these days have. I think that there’s a large number of teenagers in particularly who have this. You just don’t hear about it as much because there is a little stigma associated with that. And we found that John’s started to self medicate in that regard and it was that was contributed to by the fact that he was misdiagnosed as having attention deficit syndrome and was prescribed Adderall which is a methamphetamine which is probably the worst thing you want to give to somebody who has anxiety. And so John gradually grew in through alcohol. Eventually weed and then Xanax and who knows what had a series of unfortunate events that caused us to become more and more concerned. And then it culminated in a major event where we decided that he absolutely needed to go and inpatient treatment.
Matt: [00:04:07] Now of course you by virtue of your position had access to treatment options that may not have been available to others but even even then it sounds like from your experience it was difficult to find those treatment options.
Adm. Winnefeld: [00:04:21] Well two dimensions that problem. First of all when you suddenly decide that your loved one needs to go into serious inpatient treatment you suddenly become frantic. I’ve got to find a place to put this person and each addict is different. Different Dimensions of age gender how they got into addiction in the first place and what their insurance is like. So there was a frantic week there while John was detoxing where we were very lucky to find a good place in Pennsylvania to take him. The challenge was through the military health care system known as TRICARE at the time. They really did not have a grip on what this was all about. They just didn’t understand the disease of addiction and in particular what you call the DOOL or morbidity of a mental challenge anxiety depression and addiction at the same time. That has to be treated very very carefully and a very special way. And there aren’t very many places that can do that and Trecker just didn’t understand it. On top of that John was one month shy of his 18th birthday. And there are some places that only take people younger than 18 others that only take them older than 18. And you know we really didn’t have a place to take him until we were fortunate to discover this. Again this place. Very good place in Pennsylvania. Very complex. Trying to get into a treatment system. We were very fortunate in that we were able to afford this ourselves because insurance just didn’t understand it.
Matt: [00:05:45] I think I read you wrote about this in the Atlantic and you mentioned that this for the 15 months that Jonathon’s spent in this care system it cost more than four years of Harvard private colleges. Yeah it really did. Have you spoken with people who’ve been in similar positions as you yourself except for who didn’t necessarily have access to the resources that you might have.
Adm. Winnefeld: [00:06:08] Well we we are. Excuse me website went live on the 25th of November at the same time we did a CBS News interview in The Atlantic article came out. So we got to a torrent of e-mails. And I would divide those e-mails into three categories. Some people just cheering us on a lot of people willing to help. Who said I’m good at this. I want to help you. But a large number of people crying for help. I have a loved one who’s in addiction. I don’t know what to do. I don’t know where to take him or her for treatment. And so many people can’t afford this or don’t have insurance that will cover it. You find a lot of people are brought in to say 30 days of inpatient treatment or even only a week of inpatient treatment. What I tell audiences is that if you put your son or daughter into 30 days of inpatient treatment you know what it’s going to get you 30 days of sleep and that’s about it because it’s just not enough for the brain to really begin its recovery from the changes it’s undergone and the course of becoming addicted. So this is a big problem. We have a shortage of capacity for treatment in the country. We have a shortage of capability for treatment treatment centers that really understand the problem. And then of course affordability is a real issue.
Matt: [00:07:19] I believe I read that in 2017 it’s estimated that more will have died in 2017 alone from opioid overdoses than in Vietnam Afghanistan Iraq wars combined.
Adm. Winnefeld: [00:07:30] I think that’s the country you know in 2016. Around 64000 people died from overdoses. Not all of those were opioids but a substantial majority were. And that one year for the whole country is more than people who died of the Vietnam War and wounded in combat. That just indicates the true human tragedy the scale of this crisis and how terribly important it is that we as a nation invest in the capability to to treat people. Now that’s only one of the lines of operation the country needs to take on. But it’s probably the most expensive one in terms of dramatically scaling up our ability to bring people in and give them the treatment that will work in most cases.
Matt: [00:08:10] When you put Jonathan into a treatment center how confident did you feel during that time while he was undergoing treatment that there was a way out. How what was the process for you as a family.
Adm. Winnefeld: [00:08:23] Well it began with having no idea we were just desperate to put John in a place where he had a chance to stay alive. And as we know we really didn’t understand addiction until we actually got him into the treatment. And they have these parents symposiums where they literally describe to you the journey of addiction and how it really physiologically works in the brain which is you know part of public awareness raising our knowledge of that.
[00:08:51] But as we gradually began to both understand that and watch our son recover we gained a lot of confidence that you know maybe this is going to work. Now ultimately in the end it didn’t but what we really did have a lot of confidence as he got further and further into his treatment he decided to get his emergency medical technician qualification as EMT while he was very excited about that. He was more excited about that than anything I’ve ever seen him do other than maybe get on the mound and pitch a baseball. He wanted to help other people like himself. So that was very encouraging to us. He had a gap year from the University of Denver that we were fortunate enough to have and he decided as he got towards the end of his treatment that hey you know I can do this. Denver made asked him asked every incoming freshman to write an essay and the question posed in the essay was who has had the most profound influence on your life. And what Jonathan Jonathan wrote this very profound essay about an ambulance ride that he took during his EMT qualification that involved him finding himself performing CPR on a heroin addict undergoing an overdose in a McDonald’s. And that moment was very seminal for him. It caused him to realize that this guy had a family. What about my own family. And at that point he decided to dedicate himself to other people. What we didn’t know is how deeply the opioid molecule had burrowed into his brain.
[00:10:19] And even as we had rapidly gained this great confidence because he wrote this amazing essay he was just starting his relapse. And within a month he was dead.
Matt: [00:10:30] You mentioned the stigma before that is a challenge that confronts any addict who is trying to pursue recovery. But the stigma doesn’t end just with the addict themselves it also involves the family. I am curious about your your perspective on that how your your family dealt with that. How did how did that make you relate to in the past families that have dealt with this.
Adm. Winnefeld: [00:10:59] Well I I can’t blame any family for feeling ashamed for wanting us to go away to just crawl under a rock to not talk about it. I really hope hold no grudge against a family that does that. I tried to evolve personally into the kind of person who is not personally insecure about anything and who tries to turn a negative into a positive. And I think those are the two things that drove me into saying you know I’m not going to crawl under this rock I’m going to be upfront about this and maybe set an example to other people that until the country really does get over the stigma not only for the addict as you point out but the the loved ones of the addict were not going to get anywhere in this crisis. And so I’ve had a lot of people contact me and say my goodness you’re so courageous to do this and I don’t view it as being courageous at all. I just think it’s doing the right thing and standing up and owning up to it and trying to do something about it. And I’ll be honest with you we made some mistakes along the way. It was one of those things that if I only knew then what I knew now. And that’s the sadness of this thing. So one of the most important things we can do is to try to help other people know what we wish we had known earlier in Jonathan’s process and Jonathan might still be alive if we can help save other people than save one other person. All this effort will be worthwhile.
Matt: [00:12:16] Now of course one of the ways that you are doing this is through year through safe which is the stop the addiction fatality epidemic. Right. Can you tell. Tell me a little bit about that effort.
Adm. Winnefeld: [00:12:29] Sure. It started about two or three days after we lost Jonathan and we were sitting on our couch at home. Very sad. We had a lot of support from friends e-mails coming in. It’s just terribly important to get those things. Be honest with you. And we were getting e-mails that asked us should I don’t give you flowers. Is there a cause to which we can donate. And we looked at each other and said you know we’ve got an opportunity here. We were very fortunate in being able to click into an existing 501 3C organization called TAPS which is the tragedy assistance program for survivors which takes care of military families who lose a loved one whether it’s the person in uniform or just a member of the family. So we would have a donation base and we came up with a few lines of operation and decided to step out. That was in mid September when we decided to do this. It took us a month or so to formulate exactly what it is we wanted to do and just to start gather some some donations. At the same time we were riding the Atlantic article and a few other other things and it all came together on November 29th when the Atlanta girl came out CBS This Morning event we did and we got our Web developer you know can you get this thing presentable in time for us to to put this thing out. And it all came together.
[00:13:44] And so we’ve been going for about a month and a half and it’s remarkable I think what we’ve been able to get done and we’re marching off smartly in a military way on these lines of operation. Our next event is this week in Denver we’re doing something or two events one the Colorado consortium is a group of very dedicated people in Denver who are trying to take on this program we’re speaking to 600 people and the very next day we’re talking to the Colorado Hospital Association which is bringing about 300 medical professionals to talk about this.
[00:14:12] So we’ve got a lot going on. We’re hiring people. We have an executive director we have a director for national coordination and we’re bringing a number of other people on. So we’re excited about hoping to make a difference.
Matt: [00:14:25] Of course it’s early early in the effort. But have you found certain tactics that might actually make a difference in this given the complexity of it all. Are there certain things that you see is making outsized difference.
Adm. Winnefeld: [00:14:41] Well there’s very very good question. We have to do everything we can along all six lines of operation which are raising public awareness prevention efforts. Prescription medicine law enforcement medical response treatment and then family outreach within each one of those are are both critical things that have to be done and great opportunities where we can make a difference. But to your question which is a good one we’re going to probably focus a lot of our effort initially in two areas one is campuses and the other is communities. So on the campus piece it turns out and what we’ve explored over the country there’s a vast spectrum of how campuses approach this problem ranging from doing little to nothing to having very very robust programs for treatment and recovery for their students. There is a terrific organization called the Association of recovery and higher education that we hope to support that that has best practices that they can put out that sort of thing and so we’re going to work hard with within our network to work with universities and colleges to try to make sure they’re doing everything that they can for their students. I have a very good friend who’s a fellow board member of a company on which I serve who donated two and a half million dollars to Baylor University and they’ve created the bark. The Baylor Addiction Recovery Center and they even use canine therapy there but it’s efforts like that on campuses that are going to really really help in that area are much needed in the community side. There’s a terrific book out there named by a guy named Sam Quiñonez named dreamland.
[00:16:15] I recommend any book any of your listeners who are interested in this epidemic to read dreamland. He talks about the interwoven nature of the prescription medicine issues and the black tar heroin issues and how those two essentially combined to create this epidemic. Sam’s point of view is that this will be solved at the community level. And he has discovered a number of communities out there who have spontaneously just sort of said we’ve had enough. Let’s come together they bring law enforcement medical schools the whole community together to try to tackle this problem. And he’s finding that a lot of them are doing sort of the same things we’d like to scale that up go out crowdsource those. See what the best practices are see what people are doing well. Package it and then push it back out through a powerful network either the American Association of Counties or the Chamber of Commerce what have you just you know not to try to force anybody into anything but just if you’re tired of this and you want to come together as a community and do something about this here’s some best practices. So those are the two principal threats I think with keeping in mind the six lines of operation.
Matt: [00:17:19] When you look back are there things that you think could have been done differently now now that we know the scale of the problem really it’s a problem that’s ramped up considerably in the last decade or so.
Adm. Winnefeld: [00:17:31] Yeah Matt. This problem affects old and young black and white male female all walks of society rich and poor. So you’re right. No part of society is untouched by this. You specifically mentioned veterans. A lot of veterans have come home from our wars in Afghanistan and Iraq in particular with traumatic brain injury with PTSD and just physical injuries. And I think that we did in the military healthcare system tend to rely a bit much on drugs as painkillers the rest of the of the medical community was doing the same thing but maybe didn’t it wasn’t in such a concentrated part of the population let’s say. And we’re learning a lot about that. That holistic pain management is a much smarter approach. Opioids are an important part of a medical treatment system remember when they first came out they were only used for terminal cancer patients for their pain and for a variety of very nefarious reasons. Candidly that you can read all about in Sam’s book. They became much more popular for pain management and we’ve got to back away from that. Physicians need to step back and take another look at their prescription medicine practices. And that is again one of our lines of operation. It’s even more complicated than I ever thought it was in terms of database sharing training for physicians. It just goes on and on. But yes that has been our veteran population certainly a challenge.
Matt: [00:19:00] What do you tell a veteran who has come back from a theater of war who has tremendous pain maybe back issues something like that. And they know that if they get a prescription medication it will make them feel better right now. At the same time you know we we know the medical community knows now that that could very well lead to an addiction and a serious problem down the line. How do you deal with that situation.
Adm. Winnefeld: [00:19:31] Well I think there’s sort of just thinking about three categories of the type of person is the person who’s coming home and is just getting into this. And there is an opportunity there to educate them and make sure that their physicians are properly managing their pain so that there’s the minimal possible use of opioids for that pain relief and to use other techniques and other drugs as well. Then there’s the person who is has already started this and trying to do what we call titrate them down. And that is to eventually wean them off of the higher dosage of opioids and get them into a different pain regimen. And then there are the people who are fully addicted and there are a lot of those people and we need to bring them into a full fledged treatment program and recovery program. This now is a lifelong challenge for these people because the opioid Malco Berle’s itself so deeply into the brain that years later and science has proven that you can show an opioid addict a picture of paraphernalia drug paraphernalia that is flashed in front of their eyes faster than the conscious brain can detect it but the subconscious brain sees it and the endorphins begin to flow. And that person you know gets edgy and starts to feel like they need need something. So we’ve got to take care of all three people and try to prevent the person coming in from getting addicted. Take that person who’s already in the treatment regimen and try to type treat them down before they get addicted and then we have to take better care of our population.
Matt: [00:21:04] Are there policy things that can be advocated for or pursued to attack this problem.
Adm. Winnefeld: [00:21:10] Sure there are policy things across the board map that we can look at if you look into prevention programs for example the Federal Government has grants that they can give to the states to amp up their prevention programs in schools and workplaces whether it’s actual trained people going in and speaking or whether it’s helping law enforcement or even the National Guard go into places to do prevention efforts. Again one line of operation where a policy prescription would help within the law within the medical response and law enforcement piece. There is an interesting piece of legislation in Colorado right now is bipartisan legislation that is going to authorize experimentation with safe zones. Now these are something that are controversial in the U.S.. When you hear the word safe use don’t you think legalizing you think Amsterdam you think all kinds of horrid thoughts although Amsterdam very nice place. All this really is is is allowing addicts who have purchased the drug someplace else to go into an area where there’s a trained medical professional who can administer what’s called Naloxone. If they overdose and who can also offer them treatment and we’ve seen in some places like Portugal where this has been experimented with that the rate of fatal overdoses has plummeted. So let’s give it a try maybe it works in the U.S. maybe it doesn’t. But that’s another policy piece that’s that’s out there on the treatment side. There are a ton of policies that we really should look at. One is opening up Medicare Medicaid more to paying reimbursing for inpatient treatment. Another there are hundreds of these things I’m just cherry picking a few.
[00:22:53] When you look at an addict that has overdosed and has been administered naloxone to pull them out of the overdose and now they’re in a hospital setting what often happens is something called treat and street where they will you know make sure the person is doing OK and then they discharge them. Now this person’s opioid receptors have been stripped clean. They are desperate. Now they’re going through intense withdrawal. The first thing they’re going to go do is try to find another dose and they could potentially overdose again there’s a story in The New York Times just yesterday about a guy who overdosed four times in one day doing this. Well if you if you take and administer a drug called buprenorphine while that person is in the hospital for that day buprenorphine tends to take away the urges. So why not get. It costs a little bit of money but it’s a lot cheaper than bringing that person back in the same day for another drug overdose. So there are a whole host of policy prescriptions out there. The National Governors Association just came out just on January 18th with a whole list of things that governors would like the federal government to do. It’s a really interesting and powerful list. And then of course Chris Christie’s we would commission that the president asked him to form came out with some good prescriptions as well. They’re all over the place.
