12 Voices in 12 Hours Dr Gale Burstein

WBEN Extras
Wednesday, May 23rd
Erie County Department of Health Commissioner Doctor Gale Burstein

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Twelve voices in twelve hours this is especially community discussion and hope you like prevention on news radio 930. WPP and. Good afternoon Brian mast rusty back with you here twelve voices in twelve hours continue this. On WP yen and I'm sitting in studio with doctor Gail bursting. Erie county's health commissioner. Of course talking all day long about the OP would epidemic. Now only in Erie county but all across western new York and it though will culminate in a form tunnel on a high school that Latin. Later tonight 6 o'clock you can hear. Break here on WB Ian dale thanks so much for coming in studio taking the time to join assess things from me what number my I you know you are you know or halfway they're halfway through the list of six so on were kind of a moving along here. And sit we've covered a lot already but people are tuning in tuning out all the time so don't read your repeat something that you might have heard. I want to get started with you talking a little bit about. Something we've seen in Erie county something you talked about a little bit earlier this year Ned is a number of deaths due to overdoses. Decline which is maybe not something Nancy you would have expected. I'm looking back at this time last year when things were on the rise so much. How much of it changed is that signal to use that today who were actually happening here in Erie county in Western New York that we're seeing that number. Drop what does that tell well of course is the open you lately pleaded overdose deaths are just the tip of the iceberg is a problem I mean that's. You know the unfortunate I consequence that we're all trying to Lavoy. The good news is that we have been decreasing in our numbers of hope we are completed overdose deaths in 2017. And so we know we are going to have when you know everything is all confirmed. A lower number in 2017. And then we did in 2016. In me even be you know similar or even lower than in the numbers it 2015. When we have everything I'll confirm so. That's a very good news and our medical Examiner's office is also told me that that trend has continued in 2018 of course there. Our occasional glimpse where we seized him. You very potent drugs I'm on the market and those are our blitz mean we. Have son he's somewhere in the row out in the Marines of hundred in intend. Suspected overdose deaths so far this year. And then they seem time last year they were somewhere in the range of about a 140. So we are definitely. Intent turning down in 2018. Even compared to 2017. And we have other data to support that we are seeing a decline. In our general open UA. Problem. Mean first of all and Erie county we have access to look at our Medicaid. The number of different categories of prescriptions that are filled by Erie county for residents that tired they use Medicaid insurance. And we've seen as significant decline in the number of all the UA prescriptions that are being failed and for example hacker code zone. Has fur ever been number one prescribed drug and filled in Erie money and in the past year and a half it strapped for five. You're also looking at if you could mark for and which is medication assisted treatment to treat people struggling with OP lady diction. Those number of prescriptions have increased so we know that more people are getting to treatment we have. More treatment each season we have more health care providers that are prescribing people in our friend. We have more arm methadone clinics opening up. So we're going we're heading in a positive direction mean still one overdose death is too many. And so it is definitely that is our end goal is to try to prevent these deaths. And IE I think that looking at our our indicators. And our number of deaths were we're heading in the right direction I'm talking of. Out to a number of deaths Steve do you believe that that's because there's may be more awareness that may be more or fewer people are. Taking these drugs or is it because of something like no locks down nets at being widely spread now so many people being trained with them. All of the above me. Yeah I don't really have any deed as they can adds tease out reach program was the game change there. I think it's really the combination of our community coming together. And creating. Unusual bedfellows. For example public health has never been chummy with law enforcement. And now we are working hand in hand in various projects. For the common goal of preventing overdose deaths. More people are. Health care providers are prescribing. Less narcotic pain medication and people are aware about the risks of these men and taking less. Me have most of our first responders are trained to recognize. And OP wait overdose and Karina locks in with them to save lives. Ire. Of so we have you know so many people working together in our two meaning the dead. Have come together to address this problem and I think it's just a culmination of all the efforts of so many people working so hard on this problem. That are really Tina changing our numbers and that's very different then. This surrounding areas in New York stay eat it's very different then our surrounding states and means. We've really stand out in Western New York in me have to retrieve meted. Talk all the hard work of our community and our leadership of our company executives. What we stood out original lead because it Erie county Western New York was kind of one of these serious talking nationally that was really. Hit hard Sam talks with health experts thinking now. 56. Years ago who said that at national conferences people would say oh wow you know your from Western New York your from Erie county that's. You know count of OP Lloyd ground zero with heroin and some of these other things. How do we get to that point to where we needed this massive horse. Aunts well I first of ma I'm very skeptical that other areas were not facing the same problem. Iron medical examiner his office he's been very diligent. Eye especially with our toxicology lab into identifying. All the chickens may be awareness. Well also in a better reporting I mean we're not afraid to talk about problems that we have if it means that. They raising awareness and preventing deaths and we had been very forthcoming of aggressively investigating all possible. Overdose gases and then reporting those numbers those eight so that everybody aware of the problem that we're having we're we're not he's sticking our hands. In the sand in and running away from the problem I mean. We have been very vocal about it because. Mean we know that to address any type of public health problem means the first stresses it's an differs cast is sue. Identified a problem I mean you measure the magnitude. Try to identify who is at risk identify. The key factors that are contributing to it. And that be the is suing is we realize that. In at the end of 2015. At least had a problem because we were doubling the number of overdose death compared to 2014. He started aggressively working on his problem is I read on mark pulling cars. Meeting and task force. In the very beginning of 2016. And we hit the ground running Prejean everybody in the community together to work on his problem. Whereas other communities and meanie is starting to realize that they have a problem. And and starting to work also mean me are so fortunate that we have. And I have to say one of the best I toxicology. Labs in the country. I mean we've had been the first laps to identify east different theory is. Fentanyl monologues that are killing people and the the net debt agreed job of documenting his problem we Eric. Other health departments that may have medical Examiner's office is mean I have. As robust toxicology labs are toxicology labs colony have to send out to the task. To these. Referral labs that a charge of greet deal of money. To run those tests and so they're very discerning of who you know wit which tests they'd be sent out for why. And they don't have as the date also most counties in New York State and the United States. Do not have access to medical examiner mean they don't have a medical examiner in their Tony. And so the so most of the timeout coroner will. Determine the cause of death then. And in Pittsburgh beat a political reasons or because you know the Sam lean mean nine. Feel comfortable calling it an in. And an overdose stat. And for some of those people bitten might not be something that's on the top of their mind finreg it's a big issue at the time. Right it may not be on your radar screen these kind of things are common you know. He might think oh if they you know they don't do an autopsy toxicology lab testing making its. Be be one of the more eyes at you previously you when of the mark and coming causes of death. It eat you mention Hollande about sued the county a different officials and health officials. Identifying this problem and the fight now kind of turns to his we've heard from a lot of people throughout the day. Having other people identify the problem parents. People who are. Maybe a little more at the forefront of this dealing with that firsthand. And speaking to parents right now. What are some of the things they should be keeping in mind is their kids turn and see you know 1112 starts engaged in today at age where. You're entering whether it's a school board maybe a group of friends where. They're going to face this at some point or another. Great well. I as a pediatrician and as a parent myself I can say that. There's really he can start discussing any sensitive issues at a very young needs means he just have to make sure you -- can provide each appropriate messaging. So they kids can understand it there you know get their level of development and so. Yeah Deb very young age you can start talking about the dangers of drugs and and being careful about about you know with the eight TK and and even take your tobacco or alcohol commitment within a very dangerous effects they can have on your by the end. And I'm your school performance and he he can start giving those messages in a very simply it is very young age and then also. Un and see your child grows and becomes more sophisticated in their social network changes. You can have more sophisticated dialogue about it. Do you think that conversation might need to change that we're may be dealing with a different animal at this time around because we're used to having that you know talk about alcohol drugs with kids but. Maybe it needs to be a little bit different because this time we're talking about something that was maybe. Say originally a prescription give Cincinnati four or something that sprained ankle or and getting your wisdom teeth taken. You bring up a great point mean parents can be Greek advocates for their kids if their child say he has as sports injury or. A truth you would general procedurally it tooth extraction. And is offered a prescription for narcotic pain medication. You can say now. I am I've done it before with my child's oral surgeon he had to have and Spicer pulled her you know for braces and they wanted to give us like a week's supply of large tabs and I said an inning and have a discussion about Ibuprofen and then and so. I know I just said no and you don't have to bring those drugs in your house. And you can tops your kids that it dad died you know help them understand just because it's uphill it's prescription medication. Whether it's written for you or whether it's written for your friend and your friend once said being you know as a fever he give you some pills. And I it doesn't mean that it's safe and just to be very careful. What's what's in your body I mean kids ire you know it it isn't developmental seasons and now lessons. You know they're really interested in themselves and they're really interested in. In in their bodies in so you created. Seed use use that opportunity and say you know you want to know exactly what's going in your body and she'd be really careful about taking any pills. Unless you know it is and you know I tell you that that it's okay. Our conversation with the Erie county health commissioner doctor Gail overseeing will continue twelve voices in twelve hours here on WB EN if get a question. Feel free to send us attacks 3930. Will be taking your questions for the health commissioner. Via text message throughout the next hour after Gil bursting in with us till 1 o'clock. WB Ian is time 122012 voices in twelve hours. On WBE. And now primus rent skis here with you with your county's health commissioner doctor dale bursting. Talking well about the open you it epidemic in Erie county and western new York and exactly what is being done what has been done. It's kind of a correct things we've falling into a little bit of a spiral. I think a lot of doctors have said over the past few years with. OP Lloyds and not just heroin that we heard of originally but. Some of the medicine that was prescribed so whether the age you mentioned or tabs or hydra co don't know a lot of these popular. Painkillers that we're now learning. And maybe should have been treated a little more delicately than they were but a lot of people are wondering where the line is some and it's easy for. Must understand say. Looking at your wisdom teeth being pulled down to we really need eight X amount a week's worth of hoped you would medication for that. A lot of people those saying what it might chronic back pain what about this I've been taking this medication for a long time I don't consider myself. And addicts necessarily. What about my medication do we have to go this far. Oh what are some of the schools of thought of prescribing. This medicine now that we do know a little bit more. Right so that that's a Greek crisis and we know that many times. We is OP right medication. You narcotic painkillers that the risk can be greater than the benefits so. For an acute injuries say in sports injury or if he had and I see some I mean minor surgery or. Like it tooth extraction and debts and it's probably if you can. I used Ibuprofen in her town on its feet the pain and they have been some some degree as studies via very well done studies published in the past few years. Did demonstrate Eddie they're Ibuprofen alone or talent on loan or they're losing combination. Really controlled teen where we used to use narcotic pain medication. At testicular pain but also like you know nineteen of different joints and back and so. If we can mean that there should be the go to medication for pain you know also having a different approach. It's it's not unrealistic to expect that your pain will completely be solidly and any medication for a long period of time we know that physiologically. It's impossible for these narcotic pain medications to to work to it's a completely suppressed that pain. Over the long bond is because of the year of your body's open annoyed me sectors and the your response to Alex it's a chronic medication and that aids is it's not gonna work and so if somebody. Is prescribed a medication for pain and help pepper Shriver says okay T these tells you won't have any pain anymore and then. It's you know usually not gonna happen it's going to be some pains though bill. Return to their provider and I'll say okay well I still has some pain and for the and they get a higher garrison hired guns and I can spiral where. As if the approach is different is okay if you tape is for a short period time and your pain will decrease it won't complete legal way. And then here's some other things that you can do to help address the pain de un you know to help address how your function and really looking at the goal of functionality. Rather than pain and there are you know other nine pharma collides it tools that meet leaking news site. Acupuncture. Physical therapy he. And and crank behavioral therapy day. Had been shown to address pain it's you know it's not easy is pop an apparent. And it's in Mena we also know that it's much healthier and safer for people in the long run so even with that prescription medication. He knew people kept the risk of overdosing in the created. C take the wrong medication an anti Iran dose of forget that they took a dose earlier and then. Taking other demos so there's you know there's always the risky if somebody's been taking medication for a long period of. Time will continued talking about this twelve voices in twelve hours on WB yen but first then news update we have Tom pockets standing by. You're listening to twelve voices in twelve hours a discussion on Opie oh it's on WB yen. Twelve voices in twelve hours this is a special community discussion and hope feel like prevention on news radio 930 W. So 33 here on WBBM Brian mess around street here with fewest while voices in twelve hours continues for Frontline in studio by Erie county's health commissioner doctor Gail Ber Steen and talking about a whole host of different things because. Now twelve hours there's a reason for twelve hours because you know one hour. Simply isn't enough to its while via different topics and revolving around this issue but we've been talking a little bit about. How prescribing pain medication has changed you know what schools of thought are now. That we know a little bit more about OBO it's in their facts on the body and day you're mentioning before we had to take a break some of the things that. Parents and patients. Should know one and looking at your options if you have some sort of pain. What about those people who are already on a program of taking purse grinds. OP Lloyd painkillers. May be they're listening today and thinking while. Are there are other options for me what other options Arthur. Might work on it many times there are other options to be able this little he dialed down amendments. And at the same time. Increase other nine and from logic there apiece. And in looking at the goal of increasing functionality in practice and addressing pain. And so. Looking at talking to your health care provider about. Options is acupuncture. Or physical therapy or cognitive behavioral therapy to help. People. You know like to address like living we is simply mean. And you people doing and they can be very successful and deep crease there race and overdose. What. I'd wanna be careful on how I see this but. It sounds the way this is kind of been described of how these pain. Prescriptions have been dealt sound over the last decade or so. The we've become a bunch who was is this probably not necessarily the case right it's just that. You know it's so much better to while seemingly to take a pill it'll be so much easier to get rid of a lot of that pain. Then deal with you know a struggle of whether it's a long term physical therapy are getting better. Through another way in dealing with that I think it's kind of easy to see how. Doctors would have fallen into prescribing more and more of these medications because they do work. Right for. The limit. Date amount of time. And adjust it to be fair to prescribe errors is that. Health care that you physicians and another prescribe errors and pharmacies. We're not really told about the addictive risks of these medications that pharmaceutical companies. Similar to the tobacco companies really hated. Any information about there is a theory teenager is adverse outcomes of addiction and really. Hold press drivers that there was no risk and did you weaken and they're tired there's documentation from old commercials and and from you know old lectures that. From these. Pharmaceutical company representatives. That they are very. Adamantly claiming that there is no risk of addiction that these are very safe medications which mean I don't know was not true. So it really is a problem. For the health care community because we didn't have all the facts and so I you know again if there's a we're told it. There's a pill it's I'll leave pain it alleviates pain on determined. There's really no risk of taking it. Mean I wouldn't prescribe it and so this is being actually going for twenty years and it's changed our culture it's teens. People's expectations of of PE and now people expect having no peeking and that's really a new phenomenon. And these medications we know retailing were developed to treat like Palin for a period of care of people it. See you eight can answer and lower you know some type error and aids disease where they are suffering in Indy we're never intended regionally. T used it chronically for her for teen for. People who are expected to live for years. And so I think we have to readjust and and and our expectations of living in pain and managing pain. I mean you know everybody nobody feels like. 100%. Every day I'll day. And we have dated him go Lan and and and deal at that and sometimes you people are challenged with greater amount of pain and here's. Many opportunities that. 23. And take efforts and the they tape got in concentration. And you know it's not easy he is taking a pill but it's much safer especially for the long term I think for. Lot of people been following this story as it's developed over the years it's maybe change the way they've looked at drug addiction on even for. Some people who think that addiction is a choice you're choosing to do this. If you look at it the way that we've now kind of been told of how. Some of these painkillers will lead to heroin use it will lead to use of other drugs. You know maybe they are not making that choice because they're told to originally take this pill by a doctor. I mean I am in its there is very little counseling. Out of the risks of pain medication and the risks of overdoses and the risk of addiction. And the people believe that these tires safe medication and then all of a sudden. The feel hurt that they find that they can't stop taking it we know the overwhelming majority of people who are it become addicted to open you aids. And including those who overdosed started their journey with the prescribed medication. And the he unfortunately we've. We've become very good eight at listening to health care providers. Counseling of you have to take on your medicine even when you're feeling better yeah you can't see a stop taking your medicine. Which is really in message for antibiotics although that's changing too. And so people misunderstood that there is supposed to take this chronic this pain is pain medication even it's just for our. C in an acute injury your tooth extraction. On until the bottles fitness which really isn't true and. Even knowing some of this stuff knowing that okay will this might be addictive if you miss it. I think most people even knowing that will still look at a bottle of pills prescribed to them by a doctor and say okay. If I take what it says on the spinal I will be fine. They assume that it's safe because it was a prescription many keys and woods is not true. Every single medicine has side effects Moses time we take them because of the good side effects but. Everyman state he's in his good side effects and bad side effects and sometimes that bad side effects. Ire are more powerful then they could side effects. And people don't you know everybody has kind of a personal fable peeking get nothing bad is gonna happen today and I mean that you can does bad things happen to other people. Instill in their give men. Prescription medication in that. You even though they may have heard like oh you can become addicted to it they think they are that's not gonna happen to me that only happens to other people that are weaker. You have some other problem and it will be told he everybody's at risk. Some people are more risk than others. And so hopefully health care providers are screening for their for those risk factors before they prescribe. They're ally Dixon is is can also be hereditary traits mean and people can be mean other people are Dick can get it didn't. Alcohol. People can get addicted to other drugs besides it'll be raising addicted to gambling. And BMP ends so there is hereditary trait in so. Good question and that people should ask themselves and hopefully their health care provider asked them before they prescribed medication. Is he knew anybody in your family me. Heather had a problem is alcoholism. Or other drug addiction or addiction to gambling and NASA PC have you ever had any any type of addiction problems because you know then there and higher risk than. Other people in the population. On so there is some there are we also know they young each. Is a big risk factor for developing addiction from being exposed to pick narcotic pain medication. And the brain is not fully developed until people Arab. Well into their if their twenty's. And so it's theory during that time is theory easy to form new pathways and end up being permanent and so if a young person is exposed to. I OP UH from a prescribed medication. It's they're much more vulnerable to developing addiction and compared to somebody gets older and this has been shown in some very robust studies. There was on. Population based study that was published in pediatrics at the end of 2015. Where the I did get a population based survey and they ask young people people in their early Chinese. Have you ever used. You know a prescribed pain medication. And then also asked him about. Their current use. We know either. You know that prescribed for them or how are you know however they take it. May misuse of of OP lazy and they found that. Overall in the general population. In their lives an increased risk of people beaten knees using narcotics and and if they were giving and any. You know it narcotic pain medication during high school for a young he'll have a reasonable. Reason. It's all kind of it changed the face of this journey that you voted describe drape their changed how we look at. Addicts and stood. Heroin addiction too because I mean ten years ago eats only you picture in your mind. A heroin addict your thinking you know Johnny thunders in. Alley somewhere you know lying on the street you're not necessarily thinking suburban home. Two eyes still widen when you know you kind of paint that picture for people are people still unaware of that fact. Unfortunately. In again people think that. It's that the again their personal fable that doesn't happen to people and my community that only happens to other people. I mean we really see just as he knew grin looking at the tip of the iceberg. We see. I have a theory similar number I'm pretty much the same number of hope we I deleted overdose deaths in the suburb compared to the city. So it's unfortunately it's an equal opportunity killer. We are talking with doctor Gail bursting Erie county's health commissioner is still a little bit to go here's twelve voices in twelve hours. Continues scent coming up at 1 o'clock will be a welcoming in now recovering. And it says somebody's went through the drug court program. Andrew is his name in will be kind of talking about his journey beginning at 1 o'clock it's a conversation I don't think you wanna miss. But before that still a little bit to go with Gail bursting Erie county's health commissioner. You're taxing your questions 3930. Throughout the rest of the day will be back after this on WB yen twelve voices in twelve hours. Continuing here on WBE and looking and it's old Buick Samar in studio gas for the rest of the sour doctor Gail bursting. You re county health commissioner Indo touched on a lot of different things and I'd treatment is one of the things that so we keep coming back to you for you know what are people. Looking acts when they're. Looking for a treatments and now word shying away. From prescribing some of these OP UA meditations. And you've been talking about some of the alternatives some of the you know combining medication with other things. Right so that's primary prevention so that's you know preventing it that disease of addiction because he's teaching is a disease from happening I. They preventing people from getting exposed to something they can they can lead to that disease of addiction. So secondary prevention and is actually people already have the disease of addiction and so giving them medication and two prevents add bad outcomes of their disease. And so we know that from again and read over many years really Greek population based data. It really the the best and the long term. Evidence based treatment. For open UAE Dixon is medication is to seek treatment with either method known. Or PP nor friends easily it's available combined with no lock zone as a product called some box some people may be more familiar with it it's a pox on. And that that's a prescription medication that. And people don't they can go see a health care provider whose I'll certified to prescribes a box zone and I. Get that medications and they don't have to go to a clinic every day. It's like god they do with methadone. I think have to go to a clinic to receive directly observed therapy. There was ire of both those medications are not expensive. And we know that their cost effective and their theory effective. Because the problem is we is open you lady Dixon. Is that people have. Committee of the many many OP lately sectors and if there and the they did appropriately sectors are not happy and so the EP triggered these cravings where. And and terrible withdrawal that people feel awfully chilly they have the flu that in there their beat Philly beat you know they might tie. And so are there. There. Peep by the time someone becomes addicted to OP UH. On their they're creating medications not some not to get a high because it never get a high again. Because they've last set tyrants and they're really. Creating to escape we draw the feelings of the drop in Sydney needs something in their hope we going sectors to feel well and to be able to. You go function in society and so. And we end on either methadone. Or is to box down we chess actually isn't a true open you'll it's it's the cop partial. Oh purely silly looks like you know pioli tear a year a plea it be sectors so they're happy if they have. That that drug in them. Committee in its not a true OP or it's silly it's difficult to. Tea or you know overdose and and difficult to get high and so you're treating and that person. And we get this medication assist each he meant. And on that many times also on people would benefit from counseling. I'm now some people don't want counts and that's okay it's their without you keeping Camelot Ivan functional but ideally. It would didn't medication in the city treatment involves. Didn't the medication in and some counseling to help people. You deal with these triggers. And and new deal struggle with their their cravings and you'll be able to. Resume normal lock eyes and develop and different social networks in different behavioral patterns stick. Be able to become. You parents again until her family members again and students and and employees. And resume and return to normal society and it's not. Rich people have many people have these myths that. You're just you know substituting one addiction for another but it's really this is chronic disease and it requires chronic medication to slate. And I insulin dependent diabetes or our CO PD or hypertension mean there was require chronic medications for people to be well. And S and and so do people is OP lady Dixon. Do you think we'll ever get to. I disappoint of understanding on that though because for so many people thinking about addiction is so different from thinking about something like. Diabetes and obviously done the treatment. And they're going to pictured different in those two cases we you're describing them as some. Right I mean they're both chronic diseases so we have. More information now on means and since this is become says show widespread at the damn makes that we have done a lot of research about. Is the disease of addiction and and realized it it is just another chronic disease. I think it's similar exe like read each ivy mean people had a lot of false police about HIV that they you know transmission in treatment. And now I think dates mean mean they understand that a little bit better too so. I I I hope that. People will. A new approach. A good at populated dates in in age. Is sympathetic nine judgmental. And compassionate fashion and realize that. It's just another disease that people might struggle is often it's it's cries by taking a legitimate prescribed pain medication and that led to an end fortunate unanticipated consequence. And that's how long as you said before. A lot of this starts especially looking heroin now I I'm trying to think of the last time I heard a number on this or somebody put a number on it but. Of vast majority now with heroin users started with some sort of pill that was originally in a prescription re almost Stahl and. In over 80% have is really started by taking a prescribed medication or gentlemen. Pain medications so. It's and nobody chooses to be addicted I mean it's a terrible life and so that's why we really have to help people. Feel well again we've medication assisted treatment. And we you instead of trying to hide these clinics he should be in the center of town advertised come here feel better we can help peel. I'd just like we do and unfortunately these some chronic pain. Clinics or you know other other clinics that ire you know advertising. For patients' mean this is something that is really helping people a Greek. As part of your role health commissioner you kind of thing in the middle of all especially talking about these task force is going on in Erie county. Looking at how whether it's health care providers said different set hospital systems different doctors. How they've had to work together. On this how was that Tom was there may be you know a little bit of teeth polling at first trying to get some of these different organizations who are competitors. In the field to work together. I think. Dead when I mean we'll be presented the problem the problem in an objective manner. And showed supported by a good deed let me have from our medical Examiner's office and and from. Our first responders that were for me recording. They're on no locks on saves. I. I K can are competing hospital systems. And you colliding Catholic health had been working together on this problem. All of the competing physician networks. All the competing health plans and mean we've all come together work on this problem because we realize. It's a problem of the community and and Natchez specific view. Patient populations are where health plan members it's really. Our entire community and I've just really been it's you know so it's real and I really admire our health care community for. Owning his problem and stepping up and working together to contributing even in investing a lot of resource is including money. To address this problem. And more work to be done I'm sure for UN day everybody else to working with that says doctor Gail Versteeg Jiri county's health commissioner. She's been our in studio guest for the last hours twelve voices. In twelve hours continues now coming up a little bit. After the break we'll have of course your news set top stories coming up in just a moment but then. We'll hear from our own Tom pocket will be in studio with interest somebody wants to share they are story. Of going through recovery what addiction is like from his perspective and then new working his way through. The court system recovery and then. His way back into where he is right now I think it's a story you probably won't want to miss and that's coming up. After the news which you know will be with arm Mike banker and again it's twelve voices in twelve hours a focus on OP Lloyds if you missed any of our discussions. He can hear it hour by hour on demand it WB yen. Dot com that's the place to go Gail thank you so much for being in here last. Thinks like me are and have got again if you missed any with doctor Gail bursting of elbow on demand at WB yen. Dot com I thought you're tuning India Rush Limbaugh that's available also at WB in dot com streaming their I'm Brian has Raskind it is it's. This amounts 1 o'clock.