Opioids are a specific class of analgesic drugs that can be found naturally occurring in the opium poppy plant. It has been documented that this drug has been used since the earliest days of civilization to treat severe acute pain and terminally ill patients. Public Health Insight’s public health professionals discuss how overprescribing opioids based on weak evidence and the subsequent efforts to correct these practices in the past created the current opioid epidemic we are now facing in North America.
Remember to follow our podcast on your podcast platform of choice and also follow us on Instagram, Twitter, Facebook, and LinkedIn. If you would like to hear more about solutions to the opioid epidemic and what has worked successfully in other countries, please let us know by direct messaging us on our social media platforms or emailing us at ThePublicHealthInsight@gmail.com
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Opioids are a specific class of analgesic drugs that can be found naturally occurring in the opium poppy plant. It has been documented that this drug has been used since the earliest days of civilization to treat severe acute pain and terminally ill patients. Public Health Insight’s public health professionals discuss how overprescribing opioids based on weak evidence and the subsequent efforts to correct these practices in the past created the current opioid epidemic we are now facing in North America.
Remember to follow our podcast on your podcast platform of choice and also follow us on Instagram, Twitter, Facebook, and LinkedIn. If you would like to hear more about solutions to the opioid epidemic and what has worked successfully in other countries, please let us know by direct messaging us on our social media platforms or emailing us at ThePublicHealthInsight@gmail.com
Icon made by Freepik from www.flaticon.com
[00:00:00] Sully: Public health is a population-based field of science focused on preventing disease and promoting health. Every week, we will be engaging in interactive discussions and analyses of the latest public health issues affecting you and your communities all around the world. This is the Public Health Insight podcast.
[00:00:24] Ben: My name is Ben and I'm here with Leshawn, Gordon, Wil, and Sully. Before we move on is important to note that the views expressed in this podcast are our own and do not represent any of the organizations we work for or affiliated with before we start, we'd like to thank our listener, Victoria Marcias from Toronto, Canada for suggesting this topic.
[00:00:43] As a reminder, if you'd like us to discuss the topic, please feel free to let us know on our various social media platforms. In this episode, we will be discussing an article published at the landset titled the "Opioid Death Crisis, Crucial Lessons for Public Health" by Benedick Fisher, Michelle Pang and Mark Tyndall.[00:01:00]
[00:01:00] The opioid crisis continues to have a devastating impact on the health and lives of Canadians across the country. Between January, 2016 and September, 2019, over 19,000 opioid related poisoning, hospitalizations, and more than 14,000 apparent opioid related deaths occurred. The article discusses three leading contributors to the opioid crisis, as well as an analysis of current public health interventions. However, it's important to establish the historical context of this crisis. So what exactly are opioids and how did we even get here?
[00:01:30] Wil: So opioids, as I understand it, there a term used to describe a broad family of drugs, and these drugs are typically prescribed for pain relief. And in Canada, typically the data suggests that one in five adults who experienced chronic pain seek healthcare and are prescribed opioids as a result and this class of drugs also have associated euphoric effects in addition to helping ease pain.
[00:01:58] Gordon: Yeah. So just to add [00:02:00] to what Wil said opioids is just basically a class of pain relievers. So, they're typically called analgesics. Everyone knows about Tylenol Advil and stuff like that.
[00:02:11] Opioids are another class of pain relievers and some examples of these opioids are oxycodone morphine and codine. In the historical context opioids are not a new discovery. Since the earliest days of civilization they've been documented to be and the traditional way of acquiring morphine was to extract it from the opium, poppy seed pods. This was used to treat severe acute pain, terminally ill patients, and patients experienced in cancer. And I think if you watch a lot of these wartime movies and on the battlefield, you see the medics and giving injections. Typically those were morphine to help them with the pain from their entries.
[00:02:53] Ben: So how exactly do opioids work in a physiological sense?
[00:02:57] Gordon: Yeah. So opioids essentially bind to [00:03:00] these receptors in your body and they're typically located on nerve cells and essentially what this does, is it blocks or dulls the transmission of a pain signal. So your experience of pain is essentially lessened. On the other end of opioids- and this is partly what makes it very dangerous, is that it stimulates the reward system of your brain to release dopamine and this is what gives it the properties and can potentially make it habit forming for people who take it over a certain period of time.
[00:03:31] Leshawn: And when we're looking at other adverse effects that comes about from taking an overdose of opioids is that these opioids can actually bind to receptors in the brain that control breathing. And if you get it in high enough doses, you could actually stop breathing as a result. And you'll starve your brain from getting oxygen and this could ultimately lead to cardiac arrest.
[00:03:51] Ben: Right, and on top of the respiratory depression, are there any long-term consequences that we should be aware of?
[00:03:57] Sully: As you use them in the long-term, you [00:04:00] would develop this kind of tolerance to them, which would require you to increase those as over time to achieve the same effect. And with that comes physical dependence. Meaning that if one day you chose to abruptly discontinue taking these drugs is going to lead to harsher withdrawal symptoms, which can lead to a lot of problems. Right now we saw from the statistics that a lot of Canadians suffer from this problem.
[00:04:26] Ben: So how did they get exposed to all these opioids? Like how did we even get here?
[00:04:31] Wil: So I believe in the mid nineties, the drug oxycodone was aggressively marketed toward healthcare providers specifically by the pharmaceuticals industry. And they marketed it as a means of pain relief and there were claims that they had less addictive properties compared to other plain pain relief drugs. This was all marketed at and told to these healthcare providers with a lack of scientific evidence [00:05:00] and, or it was around that time when we saw an increased availability of this type of drugs and as well as more accessibility for patients and individuals who are experiencing.
[00:05:12] Leshawn: Yeah, and you're talking about how these pharmaceutical companies were marketing towards healthcare providers and they would be relentless in their kind of marketing efforts. In some cases they would give like expensive gifts to these doctors. Take them on retreats and give them a whole bunch of other stuff to incentivize them to use their product.
[00:05:31] Gordon: So opioids had been around, as we discussed since the early civilization, and now the question becomes what set of events sparked the opioid epidemic that we're now observing. So in 1996 Purdue pharma, they reformulated continuous release preparation for oxycodone call Oxycontin, which as we were saying was aggressively marketed.
[00:05:54] One of the elements to why this was a problem is there is a joint commission set up that [00:06:00] also influenced hospitals. So it's not only independent prescribers in clinics and private practices. It's also in hospitals. So there were best practices set up that would encourage or gently coax doctors essentially into screening each patient for chronic pain.
[00:06:16] So in doing so they basically created a shift whereby chronic pain became a very big focus for clinicians and in doing so, they were able to then present these opioids as a solution to the problem. So that's one of the big reasons that happened as well.
[00:06:33] Leshawn: Gordon, you mentioned that more doctors and healthcare professionals started to prescribe more of these opioids in response to maybe tackling more of the pain aspect of these indicators that doctors would use. So what evidence is based on, like, how did people know that there were no addictive properties to prescribing opioids and some of the consequences?
[00:06:54] Gordon: The interesting thing about this from what we're learning or what we've learned is that there wasn't [00:07:00] any concrete evidence to suggest that unequivocally, that this was an effective strategy to treat, especially chronic pain because we've discussed, it does have uses for terminally ill patients experiencing severe acute pain and cancer patients, but there was no concrete evidence to suggest that it helped chronic pain patients to overcome some of the problems they experienced. So this was actually back in the nineties when this was being promoted.
[00:07:27] One of the arguments that used was that, and this was based on an article published in a Clinical Journal of Pain in 1996, was that only 1% of the people who were on opioids ended up becoming addicted to it. And when scientific forensics took place, identify what the source was- there was no randomized control study that came to this conclusion. And we talked about in our previous episodes, the different levels of evidence and the challenges with, people interpreting scientific evidence. But you would expect that [00:08:00] physicians, we experienced some of the highest levels of training in a profession would have been more privy to this.
[00:08:05] So it just goes to show that even clinicians can be influenced by powerful companies.
[00:08:12] Leshawn: Yeah and even with that study that you mentioned that showed that less than 1% of the individuals were. There was an observational study, first of all and second of all, they, the study was actually based on acute patients and it did not even look at more chronic pain conditions.
[00:08:29] So giving a short term prescription for opioids, you can't make a prediction or you can't translate that into how that would go into a longer term use of using opioids.
[00:08:39] Gordon: And from a policy perspective, the pharma industry has the FDA in the United States in their back pocket. Essentially there's a an act that was passed that's called the Prescription drug User Fee Act of 1992 and essentially big pharma is responsible for 50% of FDA's budget. So we can [00:09:00] see, we talked about in our gun episode, the NRA, having a lot of lobbying power. This is why the pharmaceutical industry has a lot of lobbying power and that the solution is very difficult because in public health policy is one of the most effective measures to address certain public health problems but if there is a lot of roadblocks put up to changing policy. As we see in this case, then you have a bigger problem,
[00:09:23] Ben: By 2008 non-medical prescription opioid use was found to be the fourth most prevalent form of substance abuse after alcohol, tobacco, and cannabis, which there in made it more common to misuse a prescription opioid than to use even heroin or cocaine.
[00:09:37] So we know that opioids are given on a prescription based, but what happens when the prescription is no longer available, yet you have individuals who are still dependent on the substance. What happens then?
[00:09:48] Yeah, I
[00:09:48] Leshawn: think it, it opens up other opportunities for individuals to try and look out and seek out those drugs that they're not getting anymore.
[00:09:55] And that could be through using other sources of medications or illegally obtaining [00:10:00] opioids from maybe black markets or through other venues.
[00:10:04] Wil: And I think that this is the catalyst for this whole epidemic, right? Because if you have your healthcare providers who society views as a well-trained well-respected individuals pushing this class of drugs, and then you have other individuals who are starting to take it to help them ease their pain and eventually becoming dependent on it.
[00:10:26] If we see a break in that supply chain, then they're going to end up having to find something. To address that addiction and that dependency. As we discussed earlier with opioids since they're a general class of drugs, individuals often resorting to things that not that aren't even pharmaceutical grade drugs, things like like heroin or that are that we consider as illegal drugs that are dangerous.
[00:10:51] Ben: Yeah, you brought up a great point and just to add onto that, the very aspect of accessing health care has a notion of information asymmetry to it. So what I [00:11:00] mean by that is that there is a lot of trustplaced in clinicians as a, if you're a patient in the sense that you are doing things for my best interest. So if you trust these opioids at this time, and it was marketed towards everyone as this great thing to manage pain, but later you find out that there are these vast adverse side effects and dependency, addiction, and etc, you can't no longer trust your healthcare system. So that pushes you towards more black market individuals where you can purchase the drug from, because you would assume that they're going through the same thing as you.
[00:11:30] Leshawn: Exactly and if you think about it, These healthcare providers have been prescribing some of these medication for years now. And then you have patients who have been taking these medications on a daily basis or regular basis. And for all of a sudden to see that switch and you hear the healthcare providers saying, okay, maybe we can't prescribe this to you anymore. We're going to try to ease you off it or just like cutting it cold Turkey.
[00:11:56] Gordon: Yeah. So what you're seeing, right? So you have the opioid [00:12:00] problem and then it's oh, we were wrong. Let's stop prescribing opioids, but by then, the problem had already occurred. So now what you have is you cut hundreds of thousands of people. Cold Turkey because of reforms to prescribing practices or whatever and now there is no safety net or some kind of parallel solution to help those people, knowing that it has addictive properties. So then in a way, hindsight is 2020, but the observational research is suggesting based on what these doctors were seeing, that people would still need to search out other replacements to fill that gap- and that's exactly what happened. We know from the war on drugs, there is supply and demand. When you cut the regular regulated supply chain, as bad as it was with the, the seat and everything that happened with big pharma right now, you have another underground kind of black market for drugs that is then filling that void that the cutting of prescriptions had led to in the first [00:13:00] place.
[00:13:00] Sully: So what are you saying is that we should've had an alternative.
[00:13:05] Gordon: Exactly. So you have a problem. You have something that's set off a chain of events that led to a problem, and then you ended up playing whack-a-mole that you think you fixed part of the problem and then you ended up creating another problem that is potentially even harder to control.
[00:13:20] Wil: As we discussed this relates back to what we talked about in our gun episode, when there's a problem policies were just quickly put in place to prevent that one specific aspect without considering the greater systematic effects that may have. Because if we look at the issue with the opioid epidemic right now in Canada, a study published in 2013 showed that individuals who had previous experience with opioid usage were 19 times more likely to try heroin and an additional. Also showed that within the study population, 86% of heroin users had used opioids prior to [00:14:00] trial. What I see from these two studies is that opioids itself has seeped into other areas of society and have created more and more dangers for individuals to use other forms of drugs such as heroin.
[00:14:11] Ben: Yeah and Wil that's a great point because opioids have had been shown in the literature to be a catalyst for other drug use and then Gordon, you mentioned the war on drugs. It's unfortunate because we had to deal with this issue from the realm of the pharmaceutical. But we also had to deal with this issue in the black market or the illegal substance abuse in the sense that the drug is involving there's the emergence of synthetic opioids, such as fentanyl and carfentanil, which have been shown to be 50, to a hundred times more potent than morphine. And with the example of car fence note, it's so dangerous that it's traditionally been used as a tranquilizer for large animals.
[00:14:44] Gordon: Traditionally people would move from prescribed opioids to cheaper street heroin but the problem with heroin is, and I think in the last five to 10 years, it's now what's happening now is the heroin that's [00:15:00] being sold on the street is being cut with Opioids such as fentanyl because it is cheap.
[00:15:05] It is cheaper, more potent, you can get a bigger high and it's more profits for drug manufacturers or illegal drug manufacturers and drug dealers. So what you're having now is we'll alluded to this earlier, at least, and this is still, we don't condone this in the medical and pharmaceutical setting drugs can be tested and you can ensure that it's a pharmaceutical grade and you get consistency each time.
[00:15:30] So the overdoses come in and overdoses come in when you buy street drugs and each time you buy it, it's not the same dose inside of it. So it's hard to gauge and that's why you get a lot of overdose. Just to back up a bit, opioid related deaths can be intentional and unintentional. It is hard to know the intent behind it after someone has passed, because maybe they didn't know the drug was laced with something, or they purposely did it to take their life.
[00:15:57] But the best studies show that [00:16:00] open. I think somewhere between eight and 15% of opioid related deaths were intentional. So now what this is telling you, Most people who are using opioids do not intent to overdose. So that's, and that's a problem with the unregulated illicit drug market is that there's such a wide range of inconsistencies in the product.
[00:16:24] Leshawn: Yeah it's a big problem. Cause then even in British Columbia, there was increase in the number of overdoses reported and all these overdoses were attributed to fentanyl, which was about 200 deaths that resulted in the first three months of 2016.
[00:16:38] Ben: Yeah, another aspect of fentanyl that I think is important to note is that it's odorless, it's tasteless and it's nearly undetectable and you only need a very small dosage for lethality.
[00:16:48] I believe there was an incidence in London, Ontario where phentenol was being put in envelopes within the mail and it was only a few grams, but it was enough to kill someone if someone was careless with it. So it's a [00:17:00] very dangerous and potent drug.
[00:17:03] Wil: I just wanted to add one final point relating to opioid related deaths and it's that there is the whole dying as a direct or indirect result of taking something like fentanyl or carfentanil. But another aspect of the epidemic that we need to address and recognize is that as more and more people are switching from opioids, such as Oxycontin over to heroin, this increases the likelihood of infectious diseases that they may get through using unclean new needles or sharing needles and things like that.
[00:17:38] Gordon: I'm glad you brought that up because this is where the harm reduction approach comes in or the needle exchange programs that you might've heard about and what these programs are essentially.
[00:17:49] Not to stop drug overdoses, but they're geared to prevent bloodborne diseases such as hepatitis, that people also die from and endocarditis, [00:18:00] which people also die from using dirty needles.
[00:18:02] Ben: Okay. So we talked a lot about what opioids were and how we got to this certain situation in Canada and we discussed how opioids were being laced in recreational drugs.
[00:18:13] Now it's very easy for an individual to think that recreational drugs deal with younger populations, but I wanted to ask what are the general demographics of who this crisis affects?
[00:18:24] Leshawn: Yeah. First of all, I think that when you comes to opiod overdose, it can affect anyone, whether you're rich, you're poor and raised it could affect anyone.
[00:18:32] And so what we see in the data though, is that the highest rates come from males under the age of 50. So what do you guys think are some reasons for that?
[00:18:41] Ben: We have to look at the original reason why opioids are prescribed and that's for chronic pain. So when we look at that age group, those are usually, that's usually the age group where there's a lot of comorbidities related to chronic pain. So it makes sense that opioids are being prescribed to this population group.
[00:18:57] Sully: Yeah but then what doesn't make sense [00:19:00] is we know that the age group with the greatest pass here, nonmedical use of opioids is young adults age from 18 to 25. So it brings me to the question, how did the switch from legit use of opioids to street use?
[00:19:18] How did that attract young people in the first place?
[00:19:20] Ben: I think that goes into the past of what we talked about in the sense of the historical context, where you have prescription opioid use within the medical community. As those individuals are cut off opioids, there was the development and creation of the black market.
[00:19:36] So now we still have opioid prescribing practices now, so that's a population that's affected by that, but now you have this more evolved black market that uses recreational drugs as a gateway or catalyst into opioid use. So that explains both population groups. Why you would have young adults aged 18 to 25 and while you would also have prescription opioid users on adults aged 26 or older. [00:20:00]
[00:20:00] Gordon: I want to talk about the race element for a bit. So we know from research that people of color in particular, I think this research was done for African-Americans. They were less likely to be prescribed opioids and less likely to be re- prescribed or have their opioid prescriptions refilled.
[00:20:19] So what does this mean? If a person of color is already taken. Their first refill of opioids and there they get cut off from their doctor. What we've been talking about today, people who are addicted will go and seek alternative methods to get their supply. So the way racism is even set up institutionally in the healthcare system, people of color are disproportionately more likely to go and seek street drugs because they're more likely to be cut off from their prescribers. So that's another important element we have to take into account as well and also people who have the appearance of, there's a taboo word in public health that we don't use, but I'll say it for the purpose of this.
[00:20:59] If a [00:21:00] doctor prescribers see someone that they can stereotype as a junkie. They are less likely to prescribe that person opioids. And then those persons are going to then turn to the street to get things like heroin. So institutional racism also plays a role in the vulnerable populations that are affected by the opioid crisis.
[00:21:19] Leshawn: Yeah. And you bring up a great point because you have these individuals actually trying to seek medical help and going to these hospitals and then being disregarded. So how do you think those people feel when they're disregarded by the hospital? It's going to build some medical mistrust there and they're not going to in the future.
[00:21:35] For example, if they're experiencing an overdose, the medical system, not the first place they might, may want to go.
[00:21:41] Gordon: In the Canadian context indigenous populations are some of the experienced some of the worst health outcomes because of these health disparities that exist in our health system.
[00:21:51] Wil: Yeah and the indigenous population are definitely one of the vulnerable populations who are most effected by the opioid epidemic in Canada. [00:22:00] When we look at the provinces of British Columbia and Alberta, they published reports in 2016 and 2017, and both provinces found similar findings, which were that first nations people were five times more likely than their non first nations counterparts to experience an opioid related overdose event and three times more likely to die from an opioid related overdose.
[00:22:21] So I think what stuck out to me was that the last part, where to three times more likely to die from an overdose, because for me this means that. Not having this, the necessary access to healthcare, to be able to help them in when they're experiencing that overdose or it just doesn't make sense that there's such a disparity in how their overdose being treated.
[00:22:47] Gordon: And you know why that's a great point also because we talked about opioid related overdoses are more common for non-prescription opioid use. So this could also mean that maybe. [00:23:00] They are having to rely more on the illicit drug market than healthcare providers, which is what you're saying could also be another parallel problem as well.
[00:23:10] One of the ways to treat these drug overdoses is through the use of a Naloxone kit and a Lacson kit, essentially it serves as an antidote to overcome the depress breathing problem that opioid overdoses can cause. We talked about the mechanisms for how opioid works physiologically earlier and not one of the adverse effects is that it can bind to receptors in your brain that can slow down your breathing to the point where you don't have enough oxygen and you can go into cardiac arrest.
[00:23:42] So the way this Naloxone kit or Naloxone works is that it would essentially. If administered in a reasonable period of time, it would help to prevent someone from dying of not getting oxygen.
[00:23:55] Leshawn: Yeah. So Gordon, that's a good point but do you think that using the locks on kit are more of [00:24:00] a short term solution because don't you have to also end up getting immediate medical attention and isn't this conflicting with the idea that they also have an increased avoidance in contacting medical personnel given how they're always dismissed that people that use opioids are always dismissed with the medical institution?
[00:24:18] Gordon: So we talk about in public health, wicked problems, and there's hundreds of different elements to the problem. I think Naloxone kit is a solution to one of the problems and the problem that is the solution for is it treats in a short term opioid overdoses.
[00:24:33] So the point of this intervention is to prevent opioid related deaths. So these people are often going to need when you do administer Naloxone kit, if someone, hopefully no one ever has to do it, but you should learn how to use one if you, but if you do, you're supposed to call 9 1 1 to get them emergency help as well.
[00:24:55] The health inequities and the institutional racism that [00:25:00] exists in the health system are separate issue, but I think one of the solutions to that, Leshawn, could be that hospital emergency rooms maybe could have some opioid overdose division that specifically have a health professionals that look after patients experiencing overdoses.
[00:25:17] Leshawn: And one of the interesting things is that if you're a friend of someone who uses opioids and there's an overdose situation, you might be thinking, hey, this is a, this is an awkward situation for me, because if we do call 911 on response to using the Naloxone kit, will I get in trouble for participating in that situation?
[00:25:38] But actually in Canada, there's something it's called a good Samaritan drug overdose. Which basically applies to anyone seeking emergency support during an overdose situation. And it basically protects the person who seeks up or is helping someone who's experiencing an overdose. So it protects anyone that's on the scene when help arrives.
[00:25:57] Ben: I'm glad you mentioned that this was a wicked problem [00:26:00] and how in the Luxem kits target one aspect of the problem. However, what other solutions have you guys found in literature to help the opioid crisis?
[00:26:08] Wil: So in the US they have what's called prescription monitoring programs, and these programs essentially allow pharmacists and as pharmacists to access patient prescriptions histories in order to identify if that individual seems to have suspicious use for example I would assume that if an individual came in.
[00:26:28] Regularly what very short spaces between their visits to get refills for opioids that would probably be some sort of a red flag. However in 2015, there's a survey, us physicians found that only 53% of doctors actually use these programs and 22% weren't even aware that they existed. So I think that the issue here is that it seems to be a very promising public health because it tackles a problem even further upstream then the Naloxone kits do. [00:27:00] But if healthcare providers and pharmacists and other individuals who are supposed to be monitoring and manning these programs, if they're aren't even aware that data exists, then what's the point of it, right?
[00:27:13] Gordon: It's almost as if it's in the Canadian context in my experience as a pharmacy assistant there's something called the narcotic monitoring system and I'm not sure how it works in America with physicians not being aware because in Ontario it's not a voluntary enrollment program it's mandatory.
[00:27:30] And the way it works is that it essentially tracks any prescription drug that is classified as a narcotic is flagged. So the point of it is to track healthcare providers. Prescribing practices and to check also patients filling practices. And what I mean by that is you can track the frequency at which a prescriber prescribes a particular individual and narcotic medication.
[00:27:54] As well, how many times a certain patient and what quantities of medication they're filling at [00:28:00] any given time. So this is good in terms of keeping prescribers in check, but one of the problems with this is we discuss now that there's been a transition to more of street opioids, which is a problem.
[00:28:14] And this system is not capable of catching those things. So it has its purposes to make the holding physicians accountable for their prescribing practices. But then if street drugs are now overtaking prescription medications as a problem, then this system is not privy to that information.
[00:28:33] Ben: Gordon another aspect of that worries me is that we know that systemic discrimination racism exists within the healthcare setting. If you're giving clinicians a tool that basically allows access to prescription monitoring, how can be sure that certain biases are not being reinforced with the power of such a tool?
[00:28:50] So for example, if an individual comes in and they are a person of color, and there are certain biases towards this individual that are in the realm of drug abuse, [00:29:00] how do we know that a clinician can not look at this prescription monitoring? And for whatever information or data it'd be like, Hey, they used an opioid in 2015 and then 2016 and 2017.
[00:29:13] And then just based off that information alone, decide not to give them more opioids or. Something along those lines.
[00:29:20] Gordon: Yeah, that's a good question. But I think just to go into a little bit more of how it works is what it would do is it puts up a flag for the pharmacists. So the narcotic monitoring system would say, Hey, Gordon filled a prescription in, Windsor two days for the same amount of pills. So what this is going to help me to do now is also, and I didn't sorry, I didn't touch on it earlier. It will also help you to detect fraudulent prescriptions because right now the pharmacies are having the infrastructure to be able to scan prescriptions you can then look at the prescription to see if the person like maybe copied it at home before bringing it in and then using it again somewhere else. So it helps to combat [00:30:00] acquiring prescription drugs illegally, essentially.
[00:30:02] Ben: Thank you. I was ignorant to the specifics of it. So that was a great explanation of why it's such a great strategy.
[00:30:08] Gordon: And fraudulent prescriptions are fairly common and again, the theme of this whole episode is when you have wicked problems, you have to break it down to small elements and this merely just helps to tackle one of those elements.
[00:30:23] Narrator: Remember public health is a field of inquiry and an arena for action to improve lives one population at a time. This has been the Public Health insight podcast.
[00:30:33] If you've enjoyed this episode, please drop us a and follow us on Spotify, apple podcast, Google podcast or, your podcast platform of choice. You can also send us your questions, comments, and suggestions for discussion topics at the publichealthinsight@gmail.Com. Thank you for listening, and we'll see you in the next episode.