these television companies and more including charter communications, michael. ♪♪ charter communications along with these television companies support c-span2 as a public service. >> delighted to introduce peter canning, frontlines of the opioid epidemic. peter has been a paramedic in the greater hartford area since january 1995. his first book, paramedic on the front lines of medicine details his journey for the government of connecticut to a caregiver on the city streets. a paramedic stories. peter has been the author of the influential wall street watch.

he's a graduate of the iowa writer's workshop, he attended phillips academy at the university of virginia and has worked many jobs. a taxi driver, meatpacker, line cook, telephone solicitor, book and movie reviewer and author.is before he found his direction as a paramedic. i'd like to welcome peter canning hang on, i think -- one second. there you go. >> thank you for that wonderful introduction and thank you, everybody for attending. >> before we get started with your presentation, would you tell us about "killing season" might not be familiar with? >> "killing season" is a book here, this came out and it's

about my experiences as a paramedic the last 25t years following the opioid epidemic. as i'll get through in my presentation, i started to learn things in the course of my work and i wanted to bring the voices of my patients to o the readerso they could be changed in a way that i was changed. >> thank you. i am looking forward to seeing your presentation and i know our audience is as well so peter is going to check his screen and i will be with all of you in the chat and then we will come back to audience questions during the second half of the event. >> okay, can you see that okay? >> we can see your screen. >> all right.

this is a picture of hartford where i work, and from that 25 years so i am attached to the city, this picture is particularly relevant. i began as a paramedic, that's a picture of me in 1995 when i started working as a paramedic in fact me a couple of years ago. the national drug overdose deaths. in 1995, over 10000 die a year in the united states. it has skyrocketed since then. this graph only goesst up to 206 estimates 65000 people and i read today the latest data was a

12 month period ending last august, 88000 people in the united states died of drug overdose so when i began as a paramedic and i handled people with drug overdoses, i thought people overdose because they had a character flaw. i would say to them just say no or you end up dead or in jail. i didn't understand how people could willfully inject themselves with drugs and that could easily kill them. i didn't understand how people could inject themselves with the drug in front of their own children. i am also the ems coordinator at the hospital so part of my job is reviewing forms for other paramedics a few years back, i

encountered this, when a paramedic does a call, they write a narrative describing what happened. upon arrival, a 24-year-old male unresponsive lying on the floor of his bedroom with his mother performing cpr on him. he states she last saw him alive an hour ago and found him on the floor unconscious before calling 911. she states he has a history of heroin abuse and there was a used needle sitting next to him. he's unresponsive no pulse and not breathing. what struck me about this was not that it's a horrible thing, a mother doing cpr on her child which is a horrible thing but it wasn't unusual. it wasn't the first time i have ran across this and i had been

on several calls that were similar. i began to look around and go, what is happening? what is it about these tragedies that are so commonplace? looking to find out what was going on, there were two stories. both the national story that i described in my book, the national story gone wrong. the opioid epidemic started with prescription pain pills. the pharmaceuticalls company advertised the pills weren't addictive, a lot ofe. doctors, well-meaning but probably hadn't looked into it as well as they should, tended to prescribe these quite liberally. as the members of pills, more and more pills were made available to each year, more people began to die. about 2010, there is this pill,

oxycontin and users would take the pill and scrape it down to powder and either snort the powder or they would inject it to get a stronger feeling so the pharmaceutical company under pressure, came up with a reformulation of oxycontin so they could no longer break it down into a powder, it just turns into a goo. well-meaning, sometimes that leads to unintended consequences. what happened almost immediately with this reformulated kind, people who used to do it, switch to heroin. they are chemically very much the same. heroin was much more widely available and much cheaper than the pill. we saw out of the big applies and deaths.

then weva had conventional, a synthetic opioid that is devastating the country now so there is the national story with the individual strength. when i respond to a call, a person might not be breathing, there's evidence they've used opioids, some of the symptoms, they are not breathing or they have very slow breathing, pupils pinpointed, many cases they are completely unresponsive so we give them a drug which most of us are familiar with that works very well. then we bring them back. our job isn't over they ultimately drive to the hospital so i have the opportunity to talk to them and i have more and

more people to talk to so i began to ask them, how did you get involved? how did you end up where you are?ol the stories they told me were in the genesis of this book and as i said before, their stories changed the way i viewed the opioid epidemic and people who use drugs i wanted to take their stories and share them with peoplent. i want to tell you about three of the patients i write about in the book. i'm going tobo take you back in time, a friday night football game, local high school, home team is ahead by a touchdown. cheerleaders are on the field, n the crowds are excited, it's a beautiful night. tooth cheerleaders are tossed up into the air. they are spinning with spirals way above thera crowd.

one cheerleader comes down, they catch her and the crowd cheers. the second leader comes down and they drop her and they are silent. the father comes down from the crowd, an ambulance is called. i get there, she's lying on the ground, i crying, daddy, daddy,y back is killing me. we put a collar on her neck, put her on a board and a stretcher and drive slowly to the hospital to avoid bumps. her father rise in front and she kept saying how she doing, how is she doing? two years later, i get called for a car accident downtown, car ran into a pole. i get there, slumped over the wheel is a young woman but it really a minor accident, there is not a huge amount of damage

to the car. as i opened the door to look at her, i seewi next to her syringe into heroin back that says sweetheart. there's tattoos on both forearms, she looked vaguely familiar to me. we breathe for her with a bag until she comes around. she says i screwed up, i just , i was feelingb well. what happens, they haven't used for a while and then they use again and they use the same amount they used to use. then they overdose. i used to think when somebody said to me the first time i slipped up, i used to think they were flowing me but most cases, the overdose that is quite common, they just got out of rehab. i start talking to her and what

kind of medical problems you have? she said i broke my back. i said the name of the town and she says yeah, that was me so i asked her what happened to her. she had surgery on her back, a difficult year, she didn't go to school, she lost a lot of her friends, they gave her high amount of pain pillsea then aftr a year, she says you don't need anymore. she said to me, i did need more. people develop a tolerance and an addiction to these pills, it's very hard to just stop taking them. the thickness she felt all five holes from a front but they became very expensive. pills are 30 milligrams oxycodone like percocet goes for $40 a milligram.

that booklet becomes very expensive. so the person selling these pills to her had heroin. the thing about heroin, it's powder so it's easy so they have to job a needle and she started using heroin and she was her life fell apart and she a normal person. person, i heard over and over. i often wondered, what would have happened that night they hadn't thrown her high into the

air for they had taught her how with the trajectory of her life has been? she would host monthly dance that night, she would have had a nice graduation, went on to college, had a w marriage, house with a white picket fence in the family. instead, all her dreams now going to a whole in her arms. we get called for a person unresponsive and not breathing in the parking lot of what used to be a hospital, now a rehab center. society arrives before us, by the time i get there, the person is coming around and starting to breathe. we get them into thetrer ambulae and set him on a stretcher and he says to me, what a scumbag i am. i was first to take my son trick-or-treating tonight.

now look at what i've done. he had just gotten out of jail, he did 30 days for an outstanding warrant. the warrant was for getting caught at one p time when he was slumped over in his car for some friends picked him up out of jail and as a celebration, they gave him one bag of heroin and so he thought what would one bag of heroin do to me? he had not used for a while. in addition to not using while in jail, he had actually quit for two months before that so he goes after all i've been through, i l almost died like this. so i'm putting electrodes on his chest for his heart rate and then i looked and there is a star there so i asked him his

story. the day after 9/11, he joined the army. he wanted to go to iraq, he was in a humvee accident, and ambush, he suffered a brain injury and he got shot so he ended up leaving the army with a horrible election to pain had given him with a purple heart. here he is saying to me what a scumbag i am. this is a guy who the day after 9/11, the service to fight for the rest of us yet he feels today the world views him as somebody not worthy we took him to the hospital, paramedics take patients into the er and recent

turn them over todo the emergeny staff, a nurse and putting him when i arrive at the patient on it, i always tell the nurse their story andt hope they make it empathy from them. i toldd him, i told her the nure about what happened to him in the army husband the reserves andth went to iraq into the room with the er staff that night and said to him, thank a you for yor service. it was a nice way to treat him away all people treated that way nobody behind. that should be for all of our people there was a girl, i like quite a bit about her in the

book, when i first met her, i noticed her a sign standing out in the rain and my partner and i walk around on hot days so we drove by that how are you doing? you so we saw later in the day she said she was a little better. day and i said, how did you get started doing this? she said her mom was 14 when she was born, her u mom was drunk ad gave her up, she was raised by her grandmother. she said she always wanted to try heroin because she wanted to know when it was about heroin that made her mom love heroin so

try heroin first time she said as soon as i tried it, it was my mother. all of these people live would have been my summer enlisted in the army if somebody had a normal life like that, there are questions i don't understand knowing how these, why do you think then i started asking that and number of interesting. humans are programmed to take

care of the children. when we do these things we think about we the people, think of something that delicious, firework is often our brain. think about that we get that mayor. the reason programmed to do those things and think, humans wouldn't survive as a raise if we can do these things. they said heroin, opioids, when you take them, for some people, rather than one fireworks going on in their brain is like a fourth of july fireworks are so

powerful that they are no longer able to produce things that matter all about opioids. when i learned is addiction not a character flaw, is a brain disease, chronic brain disease. the human brain is when you first get this for you, and then under the part of the brain i'm starting to think about how i will get that b feeling again. the third part of the brain becomes completely preoccupied got to get it again, how can i do that? what happens with people who are opioids, the cycle goes on in the brain and its eventually rewired in the pathway so that

it not having, it's not taking care of, getting heroin is, it's very difficult for them to change that. there's a movie years ago with my daughter called inside out in that movie, wonderful personalities andhe forth in wht happens sometimes when people become addicted to heroin is another character comes into we have to remember no matter the other wonderful personalities are still in there. they may be okay they are there. damaged brain whose pathways been rewired is a medical

problem. drug use, if somebody is using drugs, it's not a criminal problem, it's a medical problem. when you can put these people to shame and see the damage of their brain, it's not invisible, you can actually see it in the same way you a can look at somebody's heart in a machine and see the damage. so to expect that somebody whose work rewired pathways have been rewired by heroin, constantly make good decisions is akin to expecting somebody with copd to climb mount everest or someone with a broken bike to run a hundred miles -- from it's very difficult to do. so when i started to do, i started to learn, you couldn't

just say no because it's not easy to do so something else i call crime production which i had not have heard of for years, crime production recognizes people are going to use drugs and it takes steps to mitigate the damages the drugs you in hopes of keeping them alive until they are readydy for recovery. harm reduction includes needle exchange or somebody can have a needle so they are not sharing needles with someoneom else or damaging their veins by using the needle over and over. they can immediately have the overdose reserve reversed. injections were somebody can go and use, somebody who's watching over them. street drug testing to see what's in the drug they are buying.

there's a wonderful organization called greater crime production coalition. i write about it quite a bit in the book, some very good friends. it's not just about harm reduction but caring for your fellow man. a lot of people in the move use it, it's not that we don't want people to be drug free but dead people don't recover. we have to keep people alive and that's a beautiful thing in itself and some people it will keep themth alive enough to get off drugs and others will always be on drugs but at least you kept them alive and being part of their family and community. today rather than just say no, i hand out pamphlets to people, five-point two provides an overdose and make certain do not

use alone, if you do, do so in a place where you can be around someone. always have the drug available, just do a little bit at a time, don't do a whole shot, don't make opioids and benzos and call 911 immediately if you suspect something, and sure they will not be arrested if they report an overdose so i hear all this, people get very upset, how can we stop people from dying? wire the best numbers so high? 88000 in the last year. there are two reasons people die. first, they use alone. our laws and stigma drive people into the shadows. when they use alone with no one to call 911 if they overdose,

they can die. most of thest people who overdoe and die, there with, they are hidden in the shadows behind a locked bathroom door, under a bridge, behind a dumpster someplace. they need to not use alone. the second reason is blood supply tainted by fentanyl. the problem with fentanyl is if it poorly mixed. in connecticut along the east coast, a powder form. part of the west coast is black heroin, a sticky substance but it powder. one of the benefits of a popowdered heroin, it very easyo

use, you can just snort it and you don't -- introduction to heroin is not sticking a needle in your arm, just put some on your arm and breathing. heroin is extremely cheap. you can buy six bags of heroin for the price of 1 milligram of oxycodone. so they comees in little bags he and they putmo brand names on them. the amount of heroin in one bag. if that typically goes for four or $5, if you go to hartford and they think you're from the country, they might charge you $5. if youou are well known, they might charge you for. if you buy up bundle, which is

ten, you mightht get $35 or $30 for interview by 100, you can get it as low as dollars 75 cents. a woman was passed out and not breathing, we didn't know what was going on with her and so we thought we should give her narcan and shehe came around. if your teeth weren't in pain, it was cheaper to buy heroin than to buy aspirin. many users start snorting heroin and graduate to ivy injections. fentanyl is a white powder just like heroin so it's indistinguishablee from) courts mixed together, at times it's hidden. it 50 -- 100 times stronger than heroin. that doesn't mean one four-color bag of heroin is also apparent, it means there's less active ingredients.

imagine somebody mixing their drug, if you are just selling heroin, you have 50% heroin and mix it with 50% cut. by cut i mean sugar, baking soda, whatever looks like it and you mix it up to increase the amount. 1.1 grams is 50% pure heroin is equivalent of .1-gram bag of only 1% pure fentanyl. if you mix banks together, it's easier to get in the mix. 5050 as opposed to one in 100. in some cases people get fentanylxe premix there's a bag that's like 10% fentanyl and mix that but it's difficult for them to get a fine amount so we know

that each bag has the same potency. the other problem with fentanyl is you get chocolate chip cookie syndrome. you could get a pork dollar bag of heroin, a fentanyl and it might not have any fentanyl and ed at all or it could have to chocolate chip cookie syndrome parts at ten%, a lethal dose. it's so much more economically viable for drug traffickers to do fentanyl thing heroin. heroin you have to cultivate it bring it across the border, fentanyl is 50 -- 100 times stronger and smaller and easier to smuggle. right now we still talk about

heroin but the fact is 90% of the heroin is heroin at all. pretty much every bag is just fentanyl, it's very hard. you can't find heroin anymore. what's also happening with fentanyl is dealers are buying printing machines and they are making their own pills that are fake pills and there's percocet or oxycodone and it not oxycodone, it's just fentanyl. we recently had connecticut, quite a number of people overdose thinking they were taking normal pills but instead they were taking fentanyl. having overdose deaths, 2012 in

connecticut. you can see overdose deaths have skyrocketed every year, a low plateau in 2018, 2020 was the worst ever. fentanyl is worth killinggi peoe and killing them when they are using. i want to read in conclusion she here, i want to read a passage from the book. one day i was at the community forum and one of the people there brought up the fact that there are racial disparities, is it true people are only paying attention now because it's in the suburbs where before it was in the cities? people didn't care about it? i could understand their

bitterness. for years, people in the city died, nobody seemed to care, they threw their lives away with poor choices. the epidemic has gained attention, people are not talking about it and using their political power to fight on behalf of their sons and daughters is not a bad thing. for years, suburbs were silent as our children died while death rates in the suburbs seem to be improving, similar gains are not happening in hartford. nationwide epidemic is drawing more in the inner cities. suburban city continues to speak out on behalf of all suburbs. i'd like to think this crisis will bring us all together so we can treat everyone the same. there are billings in the cold need their help to find their way home. there's a saying in this country, we leave no one behind. we have an obligation with the

hippocratic oath, i will answer to help. that commitment must be overall. i treated cases of all races, i found people alone in cars, hotel rooms and underbrush. i treated overdoses and homes, rich and poor, found by a loved one on any of these calls and you will never again consider any user unworthy. she crawled on the couch sobbing, she found her son not breathing when she came home from her midnight shift. he's on the floor now, first responders to compression on his bare chest. the man has tattoos on his arms, it isn't a stretch to think heroin is the cause, he confirms this, the man on the floor was user. they argued about it everyday but he kept using.

heroin bags were onev the floorn the bathroom. we worked on him for 20 minutes with no response. pupils fixed and dilated. they called for resuscitation, frantic. we removed the heroin and defibrillator pads and place them. his mom feels over him, kicking his face, his peers falling on her old skin. she cries, come with me, come with me. you must go, he must go. my son, my love, my heart, i love you. i stand by his feet, motionless. i wrote this book, the patient's

i care for to the public in hopes that they would change tht same way it changed me. many years ago before i became a paramedic, i worked in washington when he was a senator at our governor, one thing he used to say is the mark of a country is not how i treat which people but the most vulnerable citizens. i think that is what we need. a surgeon general and the new administration, are you able to live up to the most fundamental obligation, there for one another. thank you for listening to my

presentation, i'd like to answer any questions you might have. >> thank you so much, that was compelling and enlightening presentation, i have a couple questions for you and before we get into it, i want to encourage our audience if you have questions for peter, clarification on anything he went over in his presentation, you can go ahead and put it in the chat or the q&a and i will filter it up to peter. it's a heart wrenching circumstance and the book, the stories are so heartbreaking. how do you cope and how would you encourage those with a loved one dealing with addiction to cope?

it impacts so many more people than those using, wouldn't you say? >> it's a very difficult situation and the thing people have to understand, it is that in a lot of cases, there is so little education about what addiction is about. when i wasn't paramedic school we learned about mental health. you have to learn to recognize the disease. one young man who overdosed, i sort of learned about this, ours explaining how this work on the brain, i think the one thing we have to learn as we have to

envelop these people with love and recognize it could be us, it could be members of our family or ouren community and we have o bring them together. i've often said if my daughter were to become an addict, if i found her shooting at the table next to me, i'd rather that than have her do it by herself under a bridge and somebody find her dead. >> you talk about harm reduction which i'm sure some are a bit permissive, what would you say in response to that? a follow-up i'm going to ask now, we talk a lot about incredibly wrenching stories,

did you have some success stories, some people who were able to recover and get back on their feet or dot? you not see that side because youl are a paramedic? >> you do see that all thee tim, people come up to you, this didn't happen to me but another paramedic told me he was sitting in ance ambulance and a guy came up to him and said i want to thank you for what you did for me. i was a drug user, i overdosed several times and you guys saved me and he reaches into his pocket and pulls out a picture and it's a picture of him holding a youngie child, my son would not be here today if not for what you guys did for me. it's about keeping people alive, recognizing addiction is a disease and we have to do everything we can to help people

get to where they can get help. we don't treat other diseases as criminal offenses and research shows safe injection sites, syringe exchange leads to a much better outcome. that would beso my response. >> i want to call out amy's, in the chat, she acknowledges other countries started using safety sites and hopes they will hear as well onenk day. thank you for addressing harm reduction to help alleviate stigma around it so i'd love to hear about your journey from iowa writers research workshop writing program working for government and the campaign

side, how did you become an emt? paramedic? >> i always wanted to be a writer but at the same time, i had worked for many years and i would go back and forth going off and working on a job so i the right and then 1988 when he ran for reelection, he was upset so i found 30 years of age, i was at work and i didn't know what to do. i moved up to springfield on the main street by the liquor store. amulets would go by and i would look and i would say i wonder what they are doing. i thought maybe i will try that. so i became an emt and i went

back and worked to become a governor and work for the government but i caught the bug so i still worked at night as an ems and then i became a paramedic so 1995 we had a good party and we were standing among talking about what we were going to do and i said i want to be a paramedic. if i can't help people with my words anymore, but i found my truein calling. there are interesting things to write about in this book, and between calls, i will write about the calls to try to understand them. i was hearing so many amazing stories of people i met.

it came together rather easily. >> and it sounds l like your wos are still helpful to people today. hopefully this book will continue to aid breaking down stigmas around opioid use and addiction and disease that addiction is so tell me about the last page, one of the last pages of the book, can you talk about this page in the book? >> heron at hartford crimson, the dealer. a particular brand until say

learned it's a strong brand than they buy it that way. i was always fascinated by the different t names they come up with. talking about truth in advertising we for "killing season" comes from a brand of heroin we got. inthese people are not kidding about the brands they put out. i do have a chapter in some cases, some of thehe brands, bus bunny, ms. kitty and i was upset with that because it carries you off into the park. we would play a game sometimes, any place the ambulance stopped in beautifully amulets, there was a heroin addict. k if i could pick up a bag i think

it's powdered sugar but for the most part brands out there today are more like not been opposed to the kid stuff. >> that's great about the dangers of advertising or kills that are certain way look attractive to kids, not just prescription pills but any drug, it's so risky so i do see, you think there's a path forward in regard to addiction in terms of reducing the number of addicts? >> i go over my plan. you have to edit the

prosecution, we spent so much on the criminal side. we have to stop treating people as criminals and treat them as medical patients. we have to do anti- stigma campaigns. stigma alone after 9/11, what he had done for his country, he believed he was a scumbag because he uses. i am a supporter of safe injection site. the are illegal in the united states they have done well in other countries. but there are places in one in hartford where people can go and they go in the bathroom and they can use it.

the difference between that bathroom in the bathroom down the street at mcdonald's were responsible dead, they been in there too long and after three minutes, somebody knocks on the north and if there's an overdose, they are there for safe injection site, you can have people using under the eyes of a health professional and talked about getting help and mentor them. a lot ofki people have great success stories themselves, they overcame addiction themselves so i support harm reduction, criminal prosecution. >> my final question this

evening is about the changes in brain scans you show in your powerpoint. did you find there were irreversible changes? >> everybody is different. somehe people but there are scam social overtime brains do have the ability to recover. i had a bunch of slides i normally show a difference in time you can see improvement in somebody'sov brain versus when they don't use so recovery is possible for some people. for others, it not. what we want to do is keep them alive. so it is a hard thing but we

have to treat everybody as family. >> as we begin to wrap up, want you tell everyone where they can find your blog and if you have any last words you'd like to share with tonight's audience, the floor is yours. >> think of. i have aav blog i've been writig for 20 years now. it can be found online and it can be found -- a site that's been having problems. opioid epidemic and a lot about covid we are seeing out there. on twitter i joined twitter for the first time ain few month ag, the ins and outs of it.

my book can be purchased through the bookstore here and i hope you read it or tell people about it and if you read the story in the same way that i was. >> thank you so much. if you have not already purchased a copy, drop a link in the chat one more time or stop into the bookstore and c brougha copy for yourself. thank you for joining upson about moving book, sharing some of the things you've learned along your journey of education and the tools and harm production, amy is asking if you're on instagram. >> i am on instagram. i'm trying to think -- i

think -- let me see here. i am on their. sorry, i'm a little -- describe. >> it sounds like it's consistent across the board, that's great. >> to our audience, thank you for joining us thisin evening ad thank you for p coming on. >> thank you for having me. >> thank you for the chance to talk about this subject. ♪♪ >> weekends on c-span2, intellectual satirists, american history tv documents americans for sunday, book tv brings the latest in nonfiction books and authors. ♪♪

♪♪ >> welcome to the 18th annapolis book festival. thank you to our sponsors and the donators.ou first of all, there should be i think it a green asked the question button at the bottom of your screen. we have excellent authors. feel free to write your questions as we get near the end, will answer your questions. number two, by starbucks. i have the pleasure of reading these