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Understanding The Struggle Against Opioid Addiction


A couple of years ago, the former chief medical officer at Medicaid, a man named Andrey Ostrovsky, lost his uncle. The family never knew what caused his death, and no one really talked about it. When Ostrovsky visited Florida later, he met up with his uncle's best friend.

ANDREY OSTROVSKY: He lived in town, so I used that as a chance to hook up with him for what I thought was a quick cup of coffee, and it turned into a over three-hour session where he just unloaded the details of how he and my uncle had used for many years various types of drugs. My uncle's friend was there when my uncle died, the night he died, and all of the history that my uncle's friend described, it really did help me understand how, for over a decade, he's been struggling with addiction and was never able to get help largely because of stigma.

MARTIN: When Ostrovsky found out that his uncle had died because of opioids and other drugs, he started to question a lot of things, including his career. He decided he could do more to address the opioid crisis outside of Medicaid even though he was a top official there. So last December he quit. He now runs a group that tries to focus on the broad causes of opioid addiction and treatments.

In your job at Medicaid, you had a unique vantage point on how this country is grappling with the opioid crisis. And then you've had this personal experience, this loss, losing your uncle. How would you characterize the federal government's response to the opioid epidemic?

OSTROVSKY: I think the best answer to your question is summarized by the president's State of the Union address. He spent, I believe, under a minute addressing what the federal strategies are to address the opioid use disorder crisis. He made reference to two strategies. One is stronger drug enforcement, which has some merit. And then he made a reference to a story about an officer who found a woman who was pregnant...


PRESIDENT DONALD TRUMP: Homeless woman preparing to inject heroin. When Ryan told her she was going to harm her unborn child, she began to weep. She told him she didn't know where to turn but badly wanted a safe home for her baby.

OSTROVSKY: ...And how about officer and his wife adopted the baby.


TRUMP: Ryan and Rebecca, you embody the goodness of our nation. Thank you.


OSTROVSKY: And that's it. And then he moved on to some other theme. That to me is a bit terrifying and emblematic of a lot of the policy that's coming out of the federal government right now, which is largely uninformed and incomplete. Alluding to a woman who's pregnant that has opioid use disorder and the solution being let's just take away her baby - not exactly what the evidence suggests we have as an option. There's actually great medication-assisted treatment that can empower that mom to get into recovery and not be viewed as some addict of, you know, moral failure who doesn't deserve to keep her child but rather a human that has a chronic condition that can be empowered to address and cope with that chronic condition.

MARTIN: Although the president did talk about the need for treatment. We've got a clip of him referencing that. Let's listen.


TRUMP: My administration is committed to fighting the drug epidemic and helping get treatment for those in need, for those who have been so terribly hurt. The struggle will be long, and it will be difficult, but as Americans always do, in the end, we will succeed. We will prevail.

MARTIN: Was that all encouraging for you to hear?

OSTROVSKY: My nature is to be optimistic just by virtue of what I've had to do and more importantly what my family has had to do to get us here. I think that hope is becoming more and more cautious.

MARTIN: In the beginning of our conversation, you talked about the stigma that your uncle suffered as a result of his addiction. How did that play out, I mean, in your own family? What did that look like, the stigma?

OSTROVSKY: Well, it didn't really play out in the sense that we didn't know until I had this chance conversation with his friend and all of this surfaced, and then I shared it with my family. And I certainly felt guilt that I made judgments about my uncle that in retrospect I shouldn't have made because I didn't realize that he had this chronic disease. And that...

MARTIN: Judgments like what?

OSTROVSKY: Judgments like how is it that he couldn't hold a job? How is it that he was estranged from his wife and his small child? How did he get himself into such a situation that he would be an absentee dad? Like, those are awful things to say about a dear family member that I loved. But my uncle likely had a genetic predisposition to addiction. He certainly, like the rest of my family, had massive stressors of having low socioeconomic status, at least initially, having emigrated from another country, being persecuted for being Jewish - like, lots of stuff that can accumulate and make it difficult for someone to cope and perhaps use substances.

I think even if we as a family didn't treat addiction with so much stigma and tried to reach out and help, then there's all the other barriers of, you know, the person themselves being activated enough to try to get into recovery. But we didn't even give him a shot. My family didn't even give him a shot. One, we didn't know, but we - our eyes also weren't open to thinking, oh, maybe it's addiction, maybe let's talk about it. It's just so stigmatized, and I can't bear to think that there are families today that have family members that they may actually know that there is addiction at play but are too ashamed to talk about it. And by not talking about it, people will die, and it's not worth it.

MARTIN: Andrey Ostrovsky is the CEO of Concerted Care Group. It's a comprehensive opioid addiction program in Baltimore, Md. Thanks so much for talking with us and sharing your story.

OSTROVSKY: Thanks for having me.

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