a pandemic or where you have record overdose deaths but i think we are out of time now and i wanted to thank patrick and c-span2 and booktv for having us on and thank you for reading the book. keep on. >> guest: thank you. >> delighted to introduce peter canning with his new book "killing season" a paramedic's

dispatches from the frontlines of the opioid epidemic. peter canning was a paramedic in the greater hartford area since january of 1995 but his first book, paramedic on the frontlines of the pandemic. a paramedic stories of people. in 2006 peter was the author of the influential street watch. he's also a graduate of the writers workshop and attended phillip baker academy and the university of virginia and he's a tennis instructor at taxidriver meatpacker a telephone solicitor a book reviewer before he found his place as a paramedic. in addition to being of paramedic he's a coordinator at dupont health john dempsey hospital and. without further ado i biked to welcome peter canning. hi peter.

there you go. >> greetings to everybody and thanks for attending. >> thank you so much for joining us. before we get started with your presentation would you tell us a little bit about "killing season" who may not be familiar? >> "killing season" just came out and it's about my experiences at a paramedic 25 years following the opioid epidemic and during my presentation i will tell you what i started to learn in the course of my work and i wanted to give the oasis of my patients of my patience to read or so they could be changed in a way that i was changed. >> thank you so much. i'm looking forward to seeing your presentation i know the audiences as well.

go ahead and do the presentation i will be with all of you in the chat and they will welcome back to audio session during the second half of the event. >> can you see that okay? >> we can see your screen. this is a picture of city avenue in hartford where i worked. i've been a paramedic in hartford for over 25 years and this is just a picture of it. so i began as a paramedic and that's a picture of me in 1995 when i started working as a paramedic and that's me a couple of years ago.

and there at the national drug overdose deaths. you could see in 19,951,000 people were dying a year in the united states. it has skyrocketed since then. this graft only goes to 2016 words estimated 55,000 people i just read today the latest data for the 12 month period and the last august is 88,000 people in the united states died of a drug overdose. so when i began as a paramedic and i handled people who had overdose as i thought people overdosed and used drugs because they had a character flaw. i would say to them just say no or you'll end up dead or in jail. i didn't understand how people could willfully inject

themselves with the drug that could so easily kill them. i didn't understand how people could inject themselves around children. in addition to be a paramedic i'm also u.s. coordinator at the hospital so part of that job is reviewing with other paramedics. a few years back i encountered this one. what a paramedic doesn't call they do a bunch of details and write a narrative and i'll read it to you. upon arrival found the 24-year-old male in response of lying on the floor of his bedroom with his mother performing cpr on him. she states that she last saw him alive an hour ago and then found them on the floor unconscious before calling 911. she states he is has a history of heroin abuse and there is a

used needle sitting next to him. he is unresponsive with no palpable pulse and he is ethnic which means he is not breathing. what struck me about this was not that it's a thing that a mother is doing cpr and their child but that this wasn't unusual. this wasn't the first time i'd run across a narrative like this and i've been on several calls that were similar. i just began to look around and go what is happening? what has come about that these tragedies are so commonplace? so i'm looking to find out what was going on there were two stories. there's a national story and i describe it in my book but it's fairly well-known to the opioid epidemic started with the rise of prescription painkillers. the pharmaceutical companies

advertised that these pills are more addictive than a lot of doctors are well-meaning but they haven't our house looked into it as well as they should and heads prescribed these quite liberally. more and more pills were made available each year and more and more people began to die of an overdose. about 2010 what happened was there's oxycontin and what users would do is they would take the pill and strip it down the powder and they would either snort the powder or inject it so they could get a quicker feeling. the pharmaceutical companies under pressure came up with a reformulation of oxycontin so people could no longer break it down into a powder. for well-meaning thing sometimes it leads to unintended consequences.

what happened almost immediately with a rifle of the newly formulated oxycontin is people who used to use oxycontin switched to heroin. oxycontin and heroin are pretty much the same. heroin was surprisingly much more widely available and much cheaper than the pill so we saw another rise in deaths and they'll talk about this more later on we had the arrival of fentanyl a synthetic opioid that is really just devastating the country now with deaths. there's a national story but what interested me more was as a paramedic when i respond to a call where a person may not be breathing and there's evidence that they have used in the opioid some of the syndromes that go with that is they are either not breathing or diagonal breathing which is very slow.

in many cases they are completely at unresponsive so we give them at drug which most people are familiar with cold and a lot -- naloxone and it works very well. we bring them back and my job isn't over then. we take him to the hospital so i have an opportunity to talk to these patients and i had more and more people to talk to. i began to ask them how did you get involved with it and how did you end up where you are? the stories that they told me are in the genesis of this book and as i said before their story completely change the way i viewed the opioid epidemic in people who use drugs and i wanted to take their stories and share them with people so they would learn what i've learned. there are three patients that i write about in this book.

i want to take you back in time to friday night at a football game, our local high school, halftime the home team is ahead by a touchdown for the cheerleaders are out on the field and the crowd is all excited and it's a beautiful night. one cheerleader comes down and the catcher to cheers in the second leader comes down and they drop our. the father comes down from the crowd and the ambulance is called in when i get there she's lying on the ground crying, daddy, daddy my back is killing me. so we are very careful with our and put our on the board and put our on a stretcher and taken to the hospital. if father arrives and asks how is she doing, how is she doing?

a few years later there was a car accident in downtown hartford. when i get there slumped over the wheel is a young woman but it's really a minor accident. there's not a huge amount of damage to the car. as we open the door to look at our icy next to our a syringe with heroin bag with a sweetheart on it. she has rose to attend -- tattoos on both of our forearms. we give our naloxone and breathe for our until she comes around and then she goes zero coli screwed up. i just got out of rehab. i was doing so well. what happens to a lot of people is when they get out of rehab and haven't use for a while they use the same amount they used to use and it was too much for them in the overdose. somebody said to me is the first

time i slipped up but in most cases the overdose is quite common for the just ended a period where they hadn't use drugs for a while. so i'm looking at our and i start talking to our and i ask as we do in the history what other medical problems do you have? she said i broke my back cheerleading and they said the name of the town and she goes e that was me. so i asked our what had happened to our. well, she had surgery on our back. she had a difficult year and couldn't go to school and lost a lot of our friends. they gave our a fairly high amount of pain pills, our doctor did and after a year the doctor cut our off and said you don't need the money more. but she said to me i did still need them.

people develop a tolerance and it's very hard to just stop. the sickness that she felt were very expensive. it was a 30-milligram oxycodone or percocet cells for -- a milligram and that can become very expensive. one person that sold it to our our -- the thing about heroin and i'll get to this more later on in this part of the country in connecticut it's very easy to get it. you don't have to jab and needle into your elbow but she started using heroin and before long she was injecting it and your life then fell apart.

and she looked at me and she said i used to be a normal person. and i remember that. the phrase i used to be a normal person i have heard over and over from my patience. i've often wondered with our is what would have happened that night if when they threw our high into the air they had caught our and she hadn't fallen? how would the charge charge of three of our life have been different? she would have gone to the dance that night and she would then at graduation and gone on to college and perhaps an engagement, and marriage a house with a white picket fence and a family. but instead all our dreams now are going into a hole in our arm. the soldier. we get called for a person not

unresponsive and not breathing in the parking lot of what used to be a hospital but now is a rehab center. the fire department arrives before us and by the time i get there the young man is coming around and starting to breathe. we get into an ambulance and get them on a stretcher and he says to me what a i am. i was supposed to take my son trick-or-treating tonight. and look at what i've done. his plan was he a just gotten out of jail. he did 30 days for an outstanding warrant and the outstanding warrant was for -- he got caught with a broken tail pipe when he was slumped over in his car. so he got out and someone gave him one bag of our one and he had not used for a while in addition to that when he was in

jail he had actually quit for two months before that. he goes, after all it then through to almost die like this. i'm putting electrodes on his chest to monitor his heart rate and i looked and there's a star there. what is the? of the bullet hole. i asked him the story. the day after 9/11 he went over to iraq and was in a humvee accident in an ambush and suffered a brain injury. he got shot and so he ended up leaving -- he left the army with a addiction to pain pills that they had given him over a couple of months. here he is saying to me what a i am.

and i'm thinking this is a guy who the day after 9/11 went to service fight for the rest of us yet he feels today like the world views him as somebody not worthy. when we took him to the hospital i bring patients into the emergency department and we turn them over to emergency staff and he is put in a hospital bed. i always tell the nurse their story in hopes that it may get some empathy but i told them -- i told the nurse about what it happened to him and her husband was in the reserves and fought in iraq. so she went into the room with the er staff that night and said

to him thank you for your service. it was a nice way to treat him which is the way i'd like to see all people treated. there's a saying leave no one behind and that should apply to all people in our society. and there's a girl and i will write quite a bit about our and about my first met our i noticed our holding a homeless sign standing out in the rain and my partner and i carry water on hot days of marches and fruit and help people out. we drove by and i said how are you doing and she said i'm not doing well. we gave our an orange and we saw our later in the day and she said she was feeling a little bit better. i had a chance to talk to our

more and asked how did you get started doing this? she said our mom was 14 when she was born. our mom is a drug user and she gave our up and was raised by our grandmother. she said she always wanted to try heroin because she wanted to know what it was about heroin that made our mom loved heroin more than our. so at 17 she tried heroin for the first time and she said as soon as i tried it i understood my mother. so all these people you wonder what their lives would have been like if the cheerleader had been trapped or if they began man hadn't been in the army or the girl -- despite that there were still questions that i had to

understand. why in knowing how these drugs are why do people keep using them so i started asking that question and a number of them use the same analogy to describe it to me. i thought it was pretty interesting. when we do these things their brain releases endorphins that make us feel good. you eat a and oh it's delicious and a fireworks goes off in our brain. even thinking about pizza we get that good feeling of fireworks. the reason we are programmed to do these things and to take care of children is because it's an evolutionary thing to ensure our survival.

what they said is that heroin, opioids when you take those for some people usually there's one fireworks going off in their brain. the fireworks are so potent and so powerful that in time they are no longer able to endorphins are the things that matter and it becomes all about getting the opioid. what i've learned is it's not a character flaw, it's a brain disease, chronic rain disease. when you first use it get this -- where you go oh this is fantastic in another part of the brain goes i'm starting to lose feeling. maybe i should think about how i can get that feeling again and

the third part of the brain becomes completely preoccupied and it begins how can i do that? what happens with people who become evicted to opioids is the cycle goes on in their brain and eventually your. wires to reward pathways so that it's not eating food or having having are taking care of their kids. heroin is your survival now. it's very difficult for them to change that. there's a movie that i so years ago with my daughter called inside-out and there were these wonderful characters and wonderful personalities. what happens sometimes when people become evicted to heroin

is another character comes into that brain and takes over the control boards. we have to remember though matter how person acts those wonderful personalities are still in their and they are there and we can't forget about them. in the brain the pathways have been rewired. somebody who's using drugs, it's not a criminal problem. it's a medical problem. you can see the damage to their brain. it's not an invisible thing. you can see it in the same way you can mix somebody's heart or lungs and the machine and see the damage so to accept that somebody whose reward pathways have been rewired by heroin it's

like expecting somebody with copd to climb mt. everest or someone with a broken leg to run the 100-yard dash. it's very difficult, it's very hard to do. so what i started to learn about is you couldn't pay somebody to say no. it's not an easy thing to do. there's something called harm reduction which i hadn't heard of but i became a disciple of. crime reduction recognizes that people are going to use drugs and it mitigates the damages that those drugs do in hopes of keeping them alive until such time as they are able to recover. crime reduction includes a change for some i can have it clean needles of their sharing needles with someone else and using a needle over and over

again. they have no locks on so if they are somebody there would have been overdue as -- overdosing can be reversed with naloxone. save for someone to use under the eyes of someone who's watching over them. street drug testing to see what drugs they are buying. there's a wonderful organization of hartford called the greater hearts coalition in iraq about them quite at it in the book. it taught me quite a lot not just about harm reduction but about compassion. people it's not that we don't want people to be drug-free but dead people don't recover. we like to see people alive and

enough to be the thing in itself. if you can keep them alive is such a point were they can get off drugs, the people will always be on drugs. so today rather than saying just say no i hand out these pamphlets to people. five points to prevent a fatal overdose. don't use alone. if you do it in a place where you can be immediately spotted a few od. always have naloxone available. no locks on can be obtained at any pharmacy. do just a little bit at a time and don't do the whole shot. don't mix opioids with benzodiazepines. insure them that they will not report an overdose. people get very upset like how can we stop people from buying

and why are these death numbers so high, 88,000 in the last year? there are two reasons that people die. the first is our laws and stigma drives people into the shadows and they use alone with no one to give give them naloxone or call 911 if they overdose. they can die. people who die there not with a group of friends. they are hidden off in the shadows locked behind the bathroom door or under a bridge or behind a dumpster someplace. you need to not use alone and the second is a drug supply tainted by a fence on all. the problem with fentanyl is and it does that poorly mixed can

kill and even an experienced user. in connecticut along the east coast heroin comes in a powdered form and on the westco is there something called tar but in the east coast in connecticut its powder and one of the benefits of powder -- powered -- powdered heroin depending on you how you look at it you can just snorted and as i mentioned before your first introduction to heroin is not sticking a needle in your arm. heroin is also extremely cheap. you can buy six bags of hair when for the price of 130-milligram oxycodone. so heroin comes in these little bags and they have different brand names on them.

in that plastic spoon is the amount of heroin in one bag. that typically goes for four or $5 but you go into hartford and they might charge you $5. if you buy a bundle which is 10 you might pay $35 or $40 for it and if you buy it for 100 you can get it for -- a bag. a woman who has passed out of not breeding breathing we didn't know what was going on with our. people should pinpoint -- and she came around. it was cheaper for our to buy heroin thin tube by hash. many start with heroin and graduate with ivy and jackson's. here's the problem with fentanyl now. fentanyl is a white powder so

it's an indistinct ruble -- indistinguishable from white powder. it's 50 to 100 times stronger than heroin. that doesn't mean one for dollar bag of fentanyl is 50 times stronger than a bag of heroin. it means there are less active ingredients in it. imagine somebody's mixing their drugs. you have 50% heroin and you mix it with 50% cut and by cut i mean sugar baking soda or whatever looks like it and you mix it up to increase the amount that you have to sell. 1.1-gram bag of 50% pure heroin is the equivalent of a 1-gram bag of only 1% pure fentanyl.

if you are mixing things together it's a lot easier to get into the mix when it's the d50 as opposed to one out of 100 in some cases what happens is people get the fentanyl premixed. there's a bag of 10% sentinel and its mix so it's difficult for them to get a fine amount so they know they are always getting a bag with the same potency. the only problem with fentanyl as it tents to -- so what happens is you get the chocolate chip cookie syndrome. you could get it for dollar bag of heroin or fentanyl and it may not have any fentanyl and it at all or it could have the chocolate chip cookie syndrome and it words at 10% of the lethal dose and as you point out

it's so much more economically viable for the drug traffickers to use fentanyl than heroin. with heroin you have to cultivate it and bring it across the border and it's 50 to 100 times stronger but 50 to 100 times smaller and easier to use smuggle. the fact is 90% of the heroin at hartford isn't heroin at all but it's sentinel. it's just fentanyl and you can't find heroin anymore. what's also happening with fentanyl dealers are buying tesg their own pills and there is

oxycodone that is just fentanyl that's been cut. in connecticut there was a greater number of people who overdosed thinking they were taking the normal 30-milligram pill but it was filled with counterfeit samples so just to look at in connecticut its nearly skyrocketed every year. 2020 was the worst ever and fentanyl is killing people. in conclusion i want to read a passage from the book. all right so one day i was at a

community forum and one of the people there brought up the fact of the racial disparity thing and is it true that people are only paying attention to the epidemic because it's in the suburbs whereas before people didn't care about it three in and i could understand a person's bitterness. for years no one seemed to care about the addict or junkie who through their lives away. the epidemic had gained attention the suburbs and people were talking about it on behalf of their addict did sons and daughters and it's not a bad thing. their children die while the death rate seems to be improving its not happening in harvard. nationwide the epidemic has grown in the inner city.

when will the city continue to speak out on behalf of all sufferers? i'm hoping this will bring us together so we can treat everyone the same. this country and our military have a saying, leave no one behind and we have an application under the hippocratic oath. i will answer to help the sick and that commitment must -- i've treated overdose cases of all races and i found people and cars and seedy hotel rooms and the underbrush of a public park. i've dealt with overdoses and homes where a patient was found by a loved one. we will never again consider any user deserving of this. she curls up on the couch

stabbing. she found our son not breathing when she came home from a midnight shift their gaze on the floor as first responders do compressions on his chest. it isn't a stretch to think that heroin is a cause. the man on the floor was a user and they argued about it that he kept using. we worked him for 20 minutes with no response. his skin is cool and his pupils are fixed and dilated. they called the hospital to ask for -- his mom kneels over him kissing his face our tears falling on his cold skin. she cries, come with me, come

with me. do not go, do not go. my son, my love, my heart, i love you. i stand by his feet over the white sheet and my motionless. i wrote this book to bring the stories of the patients i've cared for. so the public in hopes that they would change in the same way it they have changed me. many years ago before i became a paramedic i washed -- i worked in washington for senator and one of the things he used to say the mark of a country is not how well it treats its richest people but how it treats its

most vulnerable. i think that's something we need to look to and the surgeon general and now a met -- and the demonstrations says the most fundamental obligations we have as human beings is to care for one another. thanks for listening to my presentation but i'm happy to answer any questions that you might have. >> thank you so much peter. i was a compelling and very enlightening presentation. i've a couple of questions for you and before we get into those i want to encourage our audience you can question on anything he went over in his presentation and you can go on the chat in the q&a and i will filter them for peter.

it's such a heartwrenching circumstance and the stories are so heartbreaking. one question that i have is how do you cope and how would you encourage those who have a loved one is dealing with addiction to cope because it impacts so many more people than just those who are using wouldn't you say? >> yeah. it's an very difficult situation and the thing that people have to understand and it's very sad and a lot of cases there is so little education. when i went to paramedic school we didn't learn about addiction or learn anything about mental health. you have to learn to recognize

the disease. i picked up one young man who had overdosed and because i had learned about the stuff i would explain to him how it works on the brain and this and that. he had been cast out and the one thing we all have to learn as we have to envelop these people with love and recognize that it could be us. members of our community family or loved ones who by accident ended up on the other side and we have to embrace everybody and bring them together. i've often said if one of my daughters became an addict i would rather have her chute up at the kitchen table so i could watch our rather than to find our dead two days later.

>> you talk about harm reduction which i'm sure to some people feels a bit permissive. what would you say in response that in a follow-up that i'm just going to ask now is we talk a lot about these incredibly gut-wrenching stories. did you have success stories for people that were able to recover and get back on their feet or do you not see that part of it because you're a paramedic? >> you do see that. all the time people come up to you and it didn't happen to be -- me but another paramedic told me about a pretty sitting in an ambulance and the guy came up to him and said i want to thank you but i want to thank you for what you did. i was a drug user and i overdosed several times and you guys saved me and he reaches

into his pocket and pulls out a picture in and it's picture of him holding a young child. he said my son would not be here today if not for what you guys did for me and again it's about keeping people alive and recognizing that addiction is a disease and we have to do everything we can to help people to get to a point where they can get help. we don't treat other diseases as criminal offenses and all the research shows syringe exchange can lead to much better outcomes. that would be my response. >> absolutely and i want to collect amy's comment in the chat in the feed that acknowledges other country started using -- and she hopes they will hear one day and she

wants to thank you for addressing harm reduction in order to alleviate the stigma around it. so i would love to hear a little bit about your journey one of the most strategic writing programs and working in government and campaigns. how did you end up becoming an emt, paramedic? >> i always wanted to be a writer but at the same time i worked for senator in washington and i would go back and forth working for him and going off on working job so that i could write. and then in 1988 when he ran for re-election he was upset by joe lieberman. i found that it 30 years of age i was out of work and i really

didn't know what to do. so i moved to springfield and i lived above a liquor store for the ambulances would go by at the time and i'd look out and i would wonder -- and i saw an ad for an emt and i thought maybe i'd try that. but i had caught the bug. i would work at night and ems and it became a paramedic. we were all standing around talking about what we were going to do and i said i want to become a paramedic. if i can't help people with my words o. at least try to help them with my hands.

he gave me interesting things to write about in this book, i kept a laptop with me an ambulance between calls i would try to -- understand them and i was getting so many amazing stories of the people that i met that the book came together rather easily. >> absolutely and it sounds like you're our still helping people today and hopefully this book will help breakdowns dig most around opiate use and the disease that addiction is as people read it. tell me a little bit about the last page, one of the last pages

of the book and it is a harrowing -- it hard for it. >> era when in hartford many of them have the dealer's brand on them and the dealer puts out a particular brand and people will learn that it's a particularly strong brand and i was sort of fascinated by this, the different names that they had come up with. bear street and advertising. "killing season" the name of the book comes from a brand that's out there. i do have a chapter in our about

a god upset that some of the brands they were using were kermit the frog and uggs bunny. we would play a game sometimes that anyplace they ambulance stops within 50 feet is a heroin back on the ground. if you look in there you'd say powdered sugar but for the most part the brands that are out there today tend to be. >> that such a great point about the dangers of advertising or pills that look a certain way that can be attracted to children and not just pharmaceutical or the counter or prescription pills of any drug.

what do you see is the path forward and do you think there's a path forward in your opinion with regard to addiction in terms of reducing the number of addicts? >> this is the section of the book where i go over my sort of plan. we have to end the criminal popular -- prosecution in the war on drugs and we spent so much money on the criminal side. we have to stop thinking of people who use drugs as criminals and thinking of them as medical patients. we have to have the stigma campaign. the stigma alone after 9/11 despite only a done -- stigma and the law drives people into

the shadows and i'm very much a supporter of injection sites for the safe injection sites are illegal in the united states there are places where people can go and they go in there and there's a bathroom and they can use in a bathroom. the difference between that bathroom and the bathroom down the street is we find people dead because they have been in there too long and in this bathroom after three minutes someone knocks on the door and says how are you doing in there, friend? if there's an overdose they are there to correct it. the safe injection site, you can have people using under the eyes of a health professional talk to them and can be there to help mentor them. a lot of the people working in crime reductions are great

success stories themselves and people who overcame this. i absolutely support harm reduction. these are the avenues that work in the criminal prosecution in the war on drugs people are worse off now. >> my final question for you this evening is about the changes in the brain scans that you showed during your powerpoint. in your research did you find that those were your reversible changes? >> everybody is different. there are some people who damage their brains beyond repair but it shows over time their brains have the ability to recover. if i had a longer time i could show you slides that i normally

show when i talk about this. they show a difference in time where he can see improvement in somebody's brain over time. so yes recovery is possible for some people and for other people it's not only what we want to try to do is we want to try to keep them alive. so it's a hard thing and we have to treat everybody like family and bring them in from the cold. >> as we begin to wrap up why don't you tell everyone where they can find your blog and if you have the last word that you'd like to share with the audience, the floor is yours. >> thank you. i have a blog that i've been writing for 20 years now. he can be found at -- and it can

also be found at -- but that site is having problems. i write regularly about the o.. epidemic and i write about what we are seeing out there. i joined twitter for the first time a few months ago and my book is in the bookstore here and i hope you read it or tell people about it and i hope that you read the stories in the same way that i wrote them. >> thank you so much and if you haven't purchased a copy of "killing season" will drop the link in the chats you can grab a

copy for yourself and peter thank you for joining us and talking about your incredibly moving book and sharing some of the things you've learned in your journey of education and the tools and harm reduction and one quick thing amy is asking if you weren't also an instagram? >> yes, i am. i am on their and metis great. >> it sounds like your handles are -- which is great. wonderful. for audience thank you so much for joining us this evening and peter thank you so much for coming on. >> thanks for having me.

>> i talk to people about how many businesses there around the country and most people don't have good sense of the scope thinking their millions a big businesses but it's actually the reverse. we have somewhere between 10 and 18,000 large businesses in this country and to for covid we had 30.2 million small businesses 6 billion of which had employees which accounted for half the gdp and half the employment of this country so it really is a very significant part of the economy overall and an important path for economic freedom if you think about wealth creation.

wealth creation comes with ownership. so small business enables anybody and people all over the globe who like to come here to pursue that economic freedom for wealth creation or in some cases other kind of freedoms, flexibility to do what they want or pursue a passion or whatnot and preserving that opportunity that comes along with small business and it looks like free-market capitalism and make it so critically important but i'll tell you everyone says how important businesses and we hear it from everyone. we did not have enough people --