>> i'm delighted to introduce to discuss the new book killing season part of the opioid epidemic of paramedic in the greater hartford area

since january 1995. details his journey from speechwriter for the governor of connecticut to caregiver on the city streets of paramedic stories since 2006 the author of the ems blog street watch. graduate of thehe iowa writers workshop he has worked many jobs in his life a taxidriver meatpacker line cook and author before he found his place as a paramedic also the emf coordinator so without further ado i like to welcome peter.

>> thank you for that introduction. >> thank you for joining us but before we get started tell us about killing season for those who may not be familiar with your new book it is a book here in my experiences as a paramedic following the opioid aid epidemic out to you i started to learn things with the course of my work and i wanted to bring the voices of a patients to other readers so they could be changed in the way that i was changed in my view. >> i'mno looking forward to seeing your presentation i will be with all of you in the

chat and then we'll come back to the second half of the event. >> . >> this is a picture where i work in hartford and then there over 25 years this is a picture i particularly love this is a a picture of me in 1995 and then a couple of years ago. and national drug overdose

death it was over 10000 and has skyrocketed and since then estimating 65000 people i just read today with the 12 month period ending last august there is 88000 people in the united states died of a drug overdose. so when i began as a paramedic i thought people overdosed on use drugs had a character flaw. just say no we will end up dead. i didn't understand how people can willfully inject themselves with a drug that can so easily kill.

i didn't understand how they could injectug themselves in front of children but now in addition to being a paramedic and massimo john dempsey hospitals a part of that job so ars few years back so they do recall they fill in details i will read itt to you. upon arrival a 24 -year-old male unresponsive lying on themi floor of his bedroom. and states she last saw him alive one hour ago and then found them on the floor unconscious before calling 911. and has a history of heroin abuse and there's a needle next to him.

and was not breathing. so what struck me about this not mother doing cpr on her child but this wasn't unusual and i myself had been on several calls that were similar. i began to h look around and said what is happening? what has come about that these tragedies are so commonplace? so there were two stories. the national story and is well known the opioid epidemic started with the rise of prescription pain pills the first one —- pharmaceutical companies advertise they were not addicted doctors and well-meaning didn't look into

it as well as they should tended to push this quite liberally more pills were made available each year than more people began to die in 2010 there is a pill of oxycontin and what users would do they would take the tell and scrape into powder either start the powder so the pharmaceutical companies under pressure came up with the reformulation of oxycontin so people can no longer break it down into a powder it would go into group - - so sometimes that leads to unintended consequences what happened almost immediately with the reformed oxycontin

people who used to use it switch to heroin. chemically they are very much the same heroin was surprisingly much more widely available and much cheaper than the pills that i will talk about this more later on we had the arrival of sentinel the synthetic opioid that is devastating the country now so what interested me more was the individual stories when i respond to a call a person may not be breathing there is evidence they used in opioids either they are not reading or at allll breathing which is very slow and the pupils pinpoint and those are completely

unresponsive most are familiar with the locks on and it works very well and we bring them back. but then my job is over because i take the patient put them in the ambulance and drive them to the hospitals will have an opportunity to talk to these patients so i them how do you get involved with this or how do you end up where you are? the stories that they told me formed the genesis of this book. as i said before their stories completely change the wayd i viewed the opioid epidemic and people who use drugs and i wanted to take their stories and share it with people so they can learn. i will telle you about three of the patients i read about in the book. i will take you back in time

to friday night at a local high school the cheerleaders are on the field the crowd is excited it's a beautiful night to cheerleaders are tossed up into the air they are tight spirals comes down and the crowd cheers then the second comes down and they drop her they are silent the father comes down from the crowd and ince ambulances called she's lying on thead ground crying. we are very careful with her put her on a board and on a stretcher father rides in the front and keeps looking back how is she doing? two years later i get called

for a car accident in downtown hartford a car hits a poll. so behind the wheel is a young woman but it's a minor accident and as i opened the door to look at her a heroin bag says sweetheart with rose tattoos on both forearms and looks vaguely familiar. at really to she is until she turns around i screwed up i just got out of rehab i was doing so well. >> 's when they get out and they haven't used for a while they use the same amount that they use to use but it is too much so they overdose. so to say it's the first time i slipped up.

but that is quite common is somebody just got out of jail or rehab so they haven't. they haven't used drugs for a while. so i starter talking to her so what medical problems do you have and said they broke my back cheerleading i said the name of the town and she said yes. that was me. i asked her what had happened she had surgery on her back she couldn't go toav school she lost friends they gave her a high amount of pain pills then the doctor cut her off after one year and said you don't need it anymore and she said but i did so people develop tolerance and an addiction and

its very hard to just stop taking them so she would buy pills from a friend at school but they became very expensive oxycodone or percocet very quickly that can become very expensive so the thing about here when one —- heroin it's very easy to smith you don't have to tie a belt around your arm or jab the needle so she started to use heroin and her life fell apart. she lookedd at me and she said i used to be a normal person.

i remember that. i heard over and over so what i often wondered witht her is what would've happened that night when throwing her high into the air they caught her quick salad the trajectory of her life been different? she would've gone to the dance that night a nice graduation are on to college or and engagement over our house or a white picket fence. but instead now a hole in her arm. so we get called for a person nonresponsive and not breathing and a parking lot of what used to be a hospital now

theye rehab center the fire department arrives before us about the time i get there and now finally coming around starting to breathe we s get into the ambulance and get on the stretcher and hei says to me what a scumbag im. i was supposed to take my son trick-or-treating tonight look at what i have done. he had just gotten out of jail he did 30 days for an outstanding warrant. and one outstanding warrant he brokenght with a taillight. so some friends picked him up and as aul celebration they gave him one bag of heroin. now keep in mind he has not used for a while so over those 30 days he had quit before

that. so he goes after all i have been through to almost i like this. so i put electrodes on his chest then he flinches and there is a scar. there is a bullet hole so the day after 9/11 he went to iraq. he was in the humvee accident and suffered a brain injury. he got shot. so he ended up leaving the army with a horrible addiction to pain pills and the purple heart. so here he says to me what a scumbag im. so i think this is the get one

—- the guy the day after 9/11 went to barak but now today he feels like the world has used him as somebody not worthy so what i always do in the emergency department we turn them over to our emergency staff and then to put them in the hospital bed. i always tell the nurse their story that hopefully they can get some empathy but i told the nurse thatrm night about what had happened to him in the army her husband was in the reserves she went into the room with most of the er staff that night and said thank you for your service and that was a nice way to treat him but

then that should apply and then i learned about her in this book but when i first met her i noticed her holding a homeless andn hungry sign in the rain. my partner and i we carry water on hot days and sometimes some spare change. talking to her how are you doing and she says i'm not doing well. so i gave her some change. i gave her d in orange. and then later in the day she said she was feeling better buter then i had a chance to talk to her more and said how did you get started doing

this? she said her mom was 14 when she was born it was a drug user who gave her up for heroin and was raised by her grandmother. she was wanted to try heroin to want to know what it was about that made her mom love it mored than her 17 she tried it for the first time in his it is i tried it i understood my mother. so all of the's people that the cheerleader had not been dropped or the young man in the army or the girl the rain had a normal upbringing but despite that there were still questions i had to understand. why, knowing how horrible the

drugs are why do they keep using so i started to ask that question and then a number of them use the same analogy which i thought was interesting so humans are programmed to eat, have sex and take care of their children. and we do these things our brain releases endorphins that make us feel good. and then the fireworks goes off in the brain. then you can have the good feelings like the fireworks. the reason we are programmed to do these things to take carevo of children it is evolutionary and ensures our survival as a human race to do these things. what they said is heroin or

opioids when you take us for some people rather than one fireworks going off it's like fourth of july words fireworks it's so potent and powerful that they are no longer able to produce endorphins for what matters and it's all about getting i opioids. it is not a character flaw it is a chronic brain disease so when you first use you say this is fantastic. but then in time another part of the brain then you start to lose the feeling maybe i should think about how i get that feeling again then the third part of the brain is

completely preoccupied i have to get it again how do i do that. and now it re- words are rewind the pathways and is not taking care of their kids. it's very difficult tot. change that. and now they are living in the person's brain and then to battle back-and-forth. so what happens when people become addicted to heroin then another character comes in we

have to remember that the other personalities are still in their but we cannot forget about them. the pathways have been rewired so as somebody is using drugs it is a medical problem you can see the damage you can see it in the same way but then those pathways that are rewired by heroin to constantly make good decisions

and with those with copd to climb mount everest it's hard to do you can't just say no it's not an easy thing to do. 's another's harm reduction which i haven't heard of for years but then i became a disciple. of. harm reduction is that people are using to use drugs and takes establishes to mitigate the damage the drug does in hopes of keeping them alive until such a time they're ready for recovery. harm reduction includes needle exchange where somebody can have a clean need sol they're not sharing needle with someone else and not damaging their veins by using a needing over and over again. it's community naloxone so they

can have the overdose reveressed. it's safe injection sites where somebody can go and use under the eyes of somebody who is watching over them. street drug testing to see what in is in the drugs they're buying. a wonderful organization at hardford call the hartford harm reduction coalition, and they taught me quite lot, not just about harm reduction but about compassion and caring for your fellow man. there's a quote that people in the harm reduction movement use, it's not that we don't want people to be drug free but dead people don't recover. you have to keep people alive, and that is a beautiful thing in itself, and some people will keep them alive to such a point they can get off drugs, other people will always be on drugs, but at least you kept them alive

and living in the world. and being part of their families and communities. so today rather than saying just say no issue hand out these little pamphlets to people. five points to prevent the fatal overdose and make certain do not use alone. if you are going to use alone do so in a place where you can be spotted. always have naloxone available, when their using from a new source, do a little bit at a time. don't do the whole shot. don't mix opioids and ben sows and called 9-1-1 immediately if an overdose is suspected and assure them they will not be arrest if they report an overdose. so, i hear all these things and people get very, very upset, how can we stop people from dying? why are these death numbers so high? 88,000 in the last year. there's two reasons that people

die. the first is that they use alone. our laws and stigma drive people into the shadows. when they use alone, with no one to provide naloxone or call 9-1-1, they can die. most people who overdose and die, they're not using with a group of friends. they're hidden off in the shadows. they're in behind a locked bathroom door. under a bridge. behind the dumpster someplace. you need to not use alone. the second reason is, a drug supply tainted by fentanyl. i'll explain fentanyl in a moment. the problem with fentanyl is that any dose, if poorly mixed, can kill even an experienced user. so in connecticut, along most of the east coast, heroin comes in

a powder form and the parts of the west coast it's called black tar heroin a sticky substance but on the east coast and connecticut it's pods powder and one of the benefits of the powderhorn horn or -- heroin or the drawback, it's easy to use. you can just snort it and you don't have -- your first introduction to heroin is not sticking a needle in-under mayor arm. it's putting a little on your thumb and breathing in. heroin is extremely cheap. you can buy six bags of heroin for the price of one 30-milligram ox -- oxycodone. so the heroin comes in little bags and have different bran nameds on them. the amount of the plastic spoon is the amount of heroin in one bag. a bag goes for four or five dollars. if you go in hartford and they

think your from the country thy might charge you five dollars. if you're known you get charged four. if you buy a bundle you get $30 for it and if you buy 100 you can get is for as low as 1.7 a bag. anymore hard toronto, i had an old woman who was passed out and not breathing and we didn't know what was going on and i thought, okay, puples are pinpoints. let's give her some narcan and she came around. had just gone to the dentist and her teeth were in pain and its was cleaner to get highway hundred on the streets than to buy aspirin. many years start using heroin and then graduate to i.v. injection. so here's the problem with fentanyl now. so, fentanyl is a white powder just like the heroin is a pawed sore it's indistinguishable from white heroin and there's a heroin that is brownish but it's

hard to see. it's 50 to 100 times stronger than heroin that doesn't mean that one for a dollar bag of fentanyl is 50 times -- there's an active ingredient in it. so here -- imagine somebody is mixing their drugs, if you're just selling heroin, you have 50% heroin and you mix it with 50% cut, and by cut i mean sugar, baking soda, whatever looks like it and you mick it up to increase the amount you have to sell. 1.1 graham 50% pure heroin is equivalent of a .1-gram back of fentanyl so it's easier to get an even mix when it's 50-50 as

opposed to 1 out of 100. and in some case what happens is people get the fentanyl premixed where it's -- there's a bag that's like 10% fentanyl and they mix that with some cut but it's very difficult for them to get a fine amount so that we know that they're always getting -- each bag has the same potency. [coughing] the other problem with fentanyl is is clump sod you get the chocolate chip cookie syndrome. you could get a four dollar bag of fentanyl and might not have any fentanyl it in at all or could have the chocolates chip cookie syndrome and it's 10% and it's a lethal dote and i should point out that it is so much more economically viable for the drug traffickers to do fentanyl

than heroin. with heroin you have to cultivate it and you have to bring the stock across the border, because fentanyl is 50 to 100 times stronger it's 50 to 100 times smaller and easier to smuggle. in hart ford right now, we still talk about heroin but the fact is that 90% of the heroin in hartford isn't heroin but it's fentanyl. pretty much every bag and we test a lot of them. it's just fentanyl. it's very hard. user say to me you can't find good heroin anymore. now, what also happening with fentanyl is dealers are buying pressing machines and they are making their own pills that are fake pills, and there's the -- this is like a -- it's not percocet or oxycodone and it's

custody. s have hads quite a people overdosing thinking they're taking their normal 30-gram pill and instead it was counterfeit fentanyl. so there's a look at the overdose deaths since 2012 in connecticut. you can see the overdose death have just skyrocketed nearly every year. we had a plateau in 2018, 2020 was the worst ever and the green line this percent of edition west virginia fentanyl involved. so it's killing people when they're using alone. i want to read a -- in conclusion, i just want to read a short passage from the book. so, one day i was at a community forum and one of the people there was brought up the fact that of a racial disparate

where, it true that people are only paying attention to the epidemic now because it's in the suburbs and before it was in the cities and people didn't care. and i could understand that the person's bitterness. for years people in the cities died and no one seemed to care but the addicts and junkies who threw their lives away with for poor choices. the the panel has gained attention in the suburbs to the point that people are tacking up about it and using their political power to fight on pa of their addicted sonses and daughters is not a bad thing. noer uses the suburbs were silent as their high-died while the death rite in suburbs seems to be improving similar gains north happening in hartford. nationwide the epidemicsing growing in the inner cities. where we as a nation, suburb and city, continue to speak out on behalf of all sufferers is 0

week to think this crisis will bring us together so we can treat everyone the same. millions in the cold who need our help to find their way home. this country and our military have a situation we leave no one behind. and ems says we have an obligation to honor the oath. whatever -- i answer to help the sick. that commitment must apply to all. i have treated over those cases of all races, i have found people dead aflown carbon dark street in a seedy hotel room and the underbrush of a public park. if have treat overdoses in homes, rich and poor, where the patient was found by a loved one. go on, any of those calls and you'll never again consider any user deserving of their fate. she curls on the couch, sobbing. fund her son not breathing when he came home from their midnight shift. he is on the floor n95 mask

first department first responders do compressions. the man is lean and muscle if wisdom jailhouse tattoos on his arms, chess and next. sit isn't a stretch to think that heroin is the cause. his mother's boyfriend confirms this to us. the man on the floor was a user. they argued about it every day, the boyfriend says, but he kept using. heroin bags were retrieved from the floor in bathroom. we work on him 20 minutes without response. we call the hospital for permission to cease resuscitation. itself is granted. we remover the airway, electrodes electrodes and pads and replace them in the bag the am buie bag came. in his mom kneels over hims now, kissing his face, her tears following on his cold skin. she cry, come with me, comp with me. do do not go, do not go.

my son, my love, my heart, i love you. i stand by his feet, holding a clean white sheet. i am motionless. i wrote this book to bring the sights i've seen and the stories of the patients i cared for. to the public and hopes that it would change them in the same way they changed me. many years ago with payment a paramedic i worked in washington for governor riker when he as senator and then governor. and he used to say the mark of a country is note how well it treats its richest people but how it treats its most vulnerable citizens. and i think that's a principle we need to live up to. and the immigranty the surgeon

journal and now it's at -- are we able to live up to that most fundamental obligations we have as human beings to care for one another? so, peace to all and thank you for listening to my presentation. hope i didn't go on too along and aim happy to answer any questions you might have. >> thank you so much, peter. such a compelling and very enlightening presentation, and i have a couple of questions for you and i just -- withbe get to those i want to encourage our audience, if you have a question for peter, if you loo like characterization on his he went over in his presentation, go ahead and either put those in the chat or in the q & a and i'll filter them up to peter. i just -- it's such a heart-wrenching circumstance and

the book is -- the stories are just so heartbreaking, and one question that i have is, how do you cope and maybe how would you encourage those who have a loved one who is dealing with addiction to cope and -- because its impacts so many more people than just those who are using. wouldn't you say? >> yes. it's a very, very difficult situation, and i think that the thing that people have to understand, and it's very sad in a lot of cases is that there's so little education about what addiction is really about. when i went to paramedic school there was -- we didn't learn about addiction. we knew nothing but mental health. but in time you have to learn to recognize that this is a disease. i picked up one young man who had overdosed and dish learned

boulevard this stuff. i was complaining to him how this works on the brain and this and that and he goes, you need to talk to my parents because he had been cast out, and i think the one thing that we all have to learn is that we have to envelope these people with love and recognize it could be us. they could be in many cases are members of our family or community or loved ones who just by poor accident ended inon the other side. and we just have to embrace everybody and bring them together. i have often said if one motor vehicle daughter became an addict i would want her to shoot up at the kitchen table next to me so i could watch her rather than her shoot up under a bridge and be found dead by a stranger throw days later. >> sure. you talked but the harm reduction which i'm sure to some people feels a bet permissive.

what would you say in response to that, and a followup that i'm just going to ask now is, we talked about just these incredibly gut wrenching stories. did you have some success stories of people able to recover and get back on their feet or do you not see that side of it because as the paramedic speak aspect? >> you see at. all the time people come up to you -- this didn't happen to me but another paramedic told me about it. he was sitting in the ambulance, and a guy came up to him and said i want to thank you. i want to thank you for what you, meaning ems did for me. he goes i was a drug user, overdosed several times and you guys saved me. and then he reaches into his pocket and pulls out a picture and it's a picture of him holding a young child. my son would not be here tied if

not for what you guys did for me. there are again, it's like, it's about keeping people alive. recognizing that addiction is a disease and we have to do everything we can to help people along the way to get to a pint where they can be helped. we don't treat other diseases as criminal offenses. and all the research shows that safe injection sites, syringe exchange, they lead to much better outcomes. that would be my response. >> absolutely. just want to call out amy's comment in the chat, she also acknowledges that other countries have started using safe use sites and she hopes they will here as well one day and wants to thank you for addressing harm reduction in order to happen alleviate the stigma around it.

>> sure. >> and so i love to hear a little bit about your journey from the iowa writers workshop if one. the most prestigious writing programs and working in government. how did you become a paramedic? >> so, i also wanted to be a writer, but at the same tie i had worked for many years for riker when he was a senator in washington and i would go back and forth between working for him to going off and work on a job so i could write. and then in 1988, when he ran for re-election, he was upset by joe lieberman. so i found i had 30 years of age i was out of work, and i didn't really know what to do. so i moved up to springfield and had an apartment on the main

street above the liquor store, and the ambulances would go by and i would look at out and go i wonder what those guys are doing and i sea an ad in the paper to be an emt and i decided to try that. i became an emt and then riker ran for a governor and i went back and worked for him to become governor, and worked for him and wrote speeches for him but i had caught the bug, so i still work at night in the ems and i became a paramedic so when he left office in 1995, we had a big party, and we're all standing around and talking about what we are going to do and i said i'm going to become a paramedic, and it was like -- help people with my words anymore. i will try to help them with my hands. so i really found my true calling. i've been a paramedic in hartford ever since. the benefit to being a writer gave me interesting things to write about.

and this book just sort of after a while -- i carry a laptop with me in the ambulance so in between calls i'll write about the calls i've had to try to understand them and i was getting so many amazing stories of the people that i met, that the book just sort of came together rather easily. >> absolutely. well, it sounding lie your words are helping people today. hopefully that's book will continue to aid and breaking down stigmas around opioid use and addiction and the disease that addiction is as people read it. so, tell me a little bit about the last page -- i think it's the last page -- someone of the last pines the book, and it is the heroin bags of hartford. can you talk about that page?

>> yes. so, the heroin in hartford comes in little glassy glassine snowfalls and have the dealingers brand on them and the dealer puts at particular brand and try to hype that and people learn it's a particularly strong brand, they'll try to buy it that way. and i just -- sort of facinated by the different names they come up with. if you're talked about truth in advertising, the reaper, killing season the name of the book comes from a brand of heroin out there. people are not kidding the braineds they put out. have a chapter i got some brands they were using, kerr milted the frog, bugs bunny, miss kit kitty and i was upset because a kid its walking in a park -- these

bags are all over the ground in hartford. we play a game sometimes with my partners is that anyplace the ambulance stops within 50 feet there's a heroin bag on the ground and if a kid picks up a bag and has kerr -- kermit the frog and thinks it's powders sugar it's a horrible outcome. the brands now tend to be more with skeletons on them as opposed to kids stuff. >> that's such a great point about the dangers of advertising or pills that look a certain way that can be attractive to children. not just pharmaceutical over the counter or prescription pills nut in any drug. so risky. so, what do you see as a path forward? do you think there's a path

forward? your opinion with regards to day, in terms terms of reduce -- addiction in terms of reducing the number of addicts. >> in in book i go over my sort of plan. you have to end the criminal prosecution of the war on drugs. we spent so much money on the criminal side. we have to stop treating people whoa use drugs as criminals and treat them as medical patients. we have to fund antistigma campaigns. it's the stigma alone, as i mentioned the guy who volunteered after 9/11, despite all he had done for his country he believed his country thought he was scum bag because he was knew a drug user. stigma and draw drive people in the shadows and use alone and die. i'm a supporter of the safe injection sites. there are safe injection sites

are illegal in the united states but they have done very well in other countries but there are -- i write -- there are places and there's one in hartford where people can go and they go and there's a bathroom, and they can use in that bathroom. this difference between that bathroom and the bathroom down the street at the subway or mad mcdonald's where we find people dead and this bathroom after three minutes somebody knocks on the door and says, are how're -- how are you doing in there, friend? and if there's an overdolce they can correct it. a safe injection site you can have people using under the i'd a health professional and talk too them about getting help, can be there to help mentor them, but a lot of the people working on harm reduction are great success stories themselves. people who overcame addiction. so i do -- absolutely support

harm reduction. these are the avenues that we need to take, the criminal prosecution in the war on drugs has been very expensive and things are worse off now than when that started. >> my final question for you this evening is about the changes in the brain scans you showed during your power point. in your research did you find those were irirreversable changes. >> everybody is different. there's some people who their brain has been damaged beyond repair, but there are scans that show over time that brains have the ability to recover. if i had longer time i would -- i cut a bunch of slides normally show, where i show a difference in time where you can see the improvement in somebody's brain over time when they don't use.

so, yes, recovery is possible for some people. for other people it's not. and what we want to try to do is we want to keep them alive and not just cast them off. so, it's a hard thing, but we have to treat everybody as family and bring enemy in from the cold -- bring them in from the cold. >> thank you. as we begin to wrap up, why don't you tell everyone where they can find your blog, and if you have any last words you would like to share with tonight's audience. the floor is yours. >> sure. thank you. so i have a blog that i have been writing for, oh, probably almost 20 years now, it can be found at medicstrive.com dom or medicsdrive.com and sometimes

nothing is up there but i write regularly about the opioid epidemic and other issues. i write about covid, what we're seeing out there. i'm on twitter, just joined twitter a few months ago and still learning the ins and outs but i'm on medics drive. and my book can be purchased through the book store here, and it's -- i really hope that you read it or tell people about it. i hope that if you read the stories that you are affected by them in the same way i was. >> absolutely. su to much and to our audience if you heart already purchased a copy of "killing season" you can grab copy for yourself or the link is in the chat and thank you for joining us and taking about your incredibly moving back and sharing the things you learned along your journey

education and the tools and harm reduction and i'm just one quick thing. army is something if you're an instagram? >> yes, i am. i'm trying to think what i have dish have to look what i have -- i think maybe medics drive might be my thing here. let me see. i am on there. and -- i'm a little -- medic scribe. >> your handles or consistent. to our audience thank you for join us and thank you for coming on, peter. >> thank you for havingususe is.

>> lisa gillman, welcome to the 18th annapolis book festival, special thinks to key school cor coordinating the special and thank you no sponsor and the anonymous donor who is helping to underwrite this. a couple of reminders, there should be a grebe -- i think it's a green ask a question button at the bottom of your screen, as we proceed today with our two excellent authors, please feel free to write your question in there and as we get near the end of the session we'll be best to answer the es