How Stigma, Social Isolation, Shaming, & Bad Policies are Fueling U.S. Addiction and Overdose Rates – Featuring Sean Fogler (Ep. 155)

Sean Fogler (00:00:00): It's interesting because I always thought I was, you know, very free when I was using like drugs and alcohol. And I think one of the things I realized in that first month was like, wow, like that was the prison. Like, this is freedom, you know? Um, and you know, which was a real, like for me, like totally kind of twisted my mind, you know? Cause I never really had that realization, you know? And when I went down there, like I wanted, I was desperate and I wanted to go to treatment and I was like, somebody telling me what to do because clearly I don't know how to live, but I like, in the back of my mind, I was like, Oh my God, this is going to be held like, like I'm never going to do drugs again. I'm never going to drink again. Come on. What are you talking? Like, that's just not possible. Like, like who does that? Um, but I did it. I'm still doing it.

Announcer (00:00:50): Thanks for tuning in to the elevation recovery podcast, your hub for addiction, recovery strategies hosted by Chris Scott and Matt.

Matt Finch (00:01:13): This is episode number one 55. I'm your host, Matt Finch. And the following quote is from a recent article written by today's featured guest, Sean Fogler. quote
I Led two lives for more than a decade. I worked as a physician, caring for the sick and suffering. I also struggled with addiction using cocaine and other drugs to manage post-traumatic stress, a consequence of surviving the nine 11 attacks on the world trade center. I loved my work, but the drugs kept me alive, managed my pain and allowed me to function. This duality showed me how people with mental illness and substance use disorders are treated by my colleagues in the health care system. I saw their judgments in their scorn and I saw how the U S drug policy was harming people right before my eyes and quote. This article is such a big hit that it was picked up as the lead front page story by the American society of addiction medicine ACM, Sean Foglar is a physician and long-term recovery and certified recovery specialist.

Matt Finch (00:02:06): He has more than 15 years of experience in the healthcare industry, working as a physician and with patients, administrators and insurance organizations, Sean is active in the recovery community and has a special interest in trauma and substance use disorders and professionals. He volunteers as a peer support specialist for lawyers, concern for lawyers, the LivWell foundation, and serves on the board of the university of Pennsylvania's project ride program and the opioid use disorder committee at Pennsylvania hospital, Sean uses his lived experience to educate and farm and improve public health policy for mental health and substance use disorders. Sean's work includes community engagement, education, writing fundraising, and expanding knowledge of substance use and harm reduction.

Matt Finch (00:03:01): Sean, welcome to the show. I'm really excited to have this talk with you. Well, Matt, thanks so much for having me. Um, yeah, my name is

Sean Fogler (00:03:09): I'm Sean Fiddler. Um, I'm a physician in longterm recovery. I've been in recovery almost six years now. Um, which is pretty amazing. Uh, one that it's been almost six years and, uh, and just to like, see like so much changes in recovery, as you probably know. Um, and the past, you know, almost six years have been really have blown my mind kind of with all the changes and the twists and turns. Um, it's been quite a journey. So yeah, my story, I mean, you know, summarize it, you know, as best I can, um, like so many stories, like there's so many details and it's long and winding. Um, but I basically, I grew up in Canada. I actually grew up in Toronto, um, and came to the U S in the mid nineties. Um, I came here for medical training and I really, I think growing up, I, I always knew I wanted to help people.

Sean Fogler (00:04:11): I didn't know what that really looked like. Um, and it just happens like that. I kinda came into medicine and I did my undergrad in anthropology, which I was always interested in people in different cultures. And, um, you know, I always had that fascination and I was actually a very good athlete, um, in high school. And then, and then into college, I got injured actually at the end of high school. Um, or it probably would have been running track, um, into college. And I think like the, the time where I really started using drugs, problematically was much, much later in my life. But if I look back, um, to when I was younger, like the way I thought about things and the way I dealt with my emotions, um, really wasn't healthy. And you know, when you're a young kid, like you can get away with a lot of stuff.

Sean Fogler (00:05:05): Um, as you become an adult, that stuff doesn't work very well. And, um, and so, you know, it kind of had that, like, I know people talk about, Oh, I had a drink and everything was fine. Or he smoked a joint and everything was fine. And I drank a little bit and I, you know, smoked a little bit of weed. Um, but I never really use drugs or alcohol problematically. Um, it might've been more of like behaviors and how I was thinking. Um, and so, you know, it kind of, it kind of just cruise through life. Um, and when I look back, I think I was really kind of numbed out and disconnected from a pretty young age. And I think that cam comes from childhood trauma. Um, and you know, which I don't talk a lot about, but, you know, I was, I guess, a really sensitive kid, you know, and that's how I dealt with things. And I, and I, you know, had different strategies like, and healthy strategies

Sean Fogler (00:05:58): Too. They were, um, you know, I played guitar and, uh, you know, it was sports and things like that. And there were ways to get out of myself that were pretty healthy when I was younger. Um, and that changed a lot, um, as I got older. So like I came to the U S in the mid nineties kind of dove into like medical training, um, ultimately like finished med school, um, in the year 2000 and I matched into a residency. Um, but it didn't go in and do the residency. I actually went and worked in New York, um, uh, right near the world trade center actually. Um, and that was from about 2000 to 2002. Um, unfortunately, you know, it, and I worked in finance actually, so it took a real turn. Um, yeah, no, I know. And, and, you know, my idea at the time was like to use my medical knowledge, um, to work in finance and look at biotech companies and look at, um, healthcare companies and be an analyst.

Sean Fogler (00:07:02): And of course I wasn't, I ended up trading stocks, um, which was pretty fast pace and stuff. And interestingly, like, like a lot of people are like, Oh, is that when you started to, you know, use problematically? And no, it wasn't actually, even though it was a real high pressure, like stressful environment, um, you know, and you know, it kind of where I, I was there working and actually didn't really like the work. Um, and I think like, I don't know, I just, you know, at the time I was confused, I was like searching for something. And it was probably was like, you know, just trying to find myself in my way. Um, and really, you know, people talk about like, geographing like moving locations, changing careers, things like that. And I think I really was doing that, um, though I didn't realize it at the time, you know, cause it never really was happy.

Sean Fogler (00:07:53): Like, um, nothing was really ever enough, you know, I never was really satisfied and I never really understood like why had this chronic like unhappiness, you know? And it's not really that I was depressed or anything, but I just was like, man, like I was always like, is this it? Um, and I think that was part of my attraction to drugs to, you know, kind of altering my mind, seeing the world in different ways. And um, I mean, it's kind of crazy, but I used to think that the most highly intelligent people were the people that were attracted to doing drugs. And that may sound crazy, but I remember like saying that and actually believing that, right, like, um, kind of changing your perspective on the world and that was just another, you know, kind of excuse to do drugs. Um, and you know, so, you know, I kind of like was just walking through life and then nine 11 happened and I was there that day.

Sean Fogler (00:08:50): I was in lower Manhattan. I was about three blocks away. Um, and that like changed everything and, you know, we could spend an hour talking about that day. Um, but it was really traumatic, much more traumatic than I gave it credit for, or really understood. Um, I do remember kind of the instant where I had left my office and the first building came down and being enveloped in that crier, in that cloud, that initial cloud that you've probably seen on TV. And I, you know, I can remember to this day, something in my mind, like switching something changed in me and maybe it was, I thought, you know, I was going to die or I don't know what it was a trauma reaction, something changed. And from that point on, I was never quite the same, you know, everything for me changed. And um, you know, I walked out of the cloud.

Sean Fogler (00:09:49): I eventually got out of the city, it took me all day. Um, you know, and, and, you know, I knew a few people that actually ended up passing away. Um, I also, you know, yeah, it was just, it was, it was, it was looking back, um, things were really, really hard and twisted and, um, but I was just, I guess I kind of put the armor up and I just kept walking. I didn't deal with it. It didn't address it. Didn't acknowledge it in any way. He didn't really get any help. Um, you know, I had never been depressed in my life, but I did, you know, go see a physician, take some antidepressants for a while that didn't work. Um, and the other thing is it wasn't really just that initial trauma, but it was, you know, after about a week or so when the exchange opened back up, I went back to work down there every day for months, you know?

Sean Fogler (00:10:49): And, uh, I lived in New Jersey and I used to take the path train under the world trade. And obviously that wasn't there anymore. So I would take the ferry every day to, and from work and the ferry, they would shut their engines off, going to work and coming home as they pass by the sight of the world trade center. So it was like going to a funeral twice a day. And then I would go through this military checkpoint and then I, you know, walk to work and, you know, the smoke and that Ash. Um, and by the end of the day, my eyes would be burning, you know, um, it was like that itself was like this prolonged trauma, you know? Um, but I just went to like, it was like business as usual, which is crazy when I look back because nothing was ordinary.

Sean Fogler: Eventually I ended up working for a firm further uptown and I went with a colleague of mine. He and I went and moved to this other company. Um, and that colleague of mine ended up killing himself or overdosing. I don't know, in the first like week I was there and I just like, man, like I gotta get outta here. And, uh, you know, I, and my, you know, my reaction was kind of like, Oh, well, I'll go back to residency. Right. So I applied for residency. I came to Philadelphia and I did a residency in anesthesia, never addressing any of this, you know, just keep moving, keep walking. Um, I mean, that was my strategy, really Bob and weave and move as fast as I can and nothing will be able to catch me. But unfortunately, as you know, like that stuff is with us, like no matter where we go, no matter what we're doing.

Sean Fogler (00:12:27): And, uh, and I dove into work and I was a really good resident. I did, you know, an internship in internal internal medicine. Um, and I was actually nominated for like a teaching award that year, which was kind of crazy. Um, and then I did an anesthesia residency, which was another three years and I finished, um, and I got a good, you know, I got a good job and I worked as an anesthesiologist for about a decade. Um, I was making a lot of money. Um, you know, I was having a lot of fun. Um, you know, at work I was always really sharp. Um, but slowly like bit by bit, um, things were falling apart, you know, I was, you know, I didn't realize it, but you know, depressed. And, uh, and like I said earlier, like just never satisfied, never happy. Um, but I could put on a good front.

Sean Fogler (00:13:24): Right. I, I like wore the mask really well. And when you have money and you're working a job like that, people look at you and they're like, Oh, this guy's, you know, he's got, you know, he's got everything going for him. He's doing great. Um, and you know, I didn't have any problems at work, so there were no real like red flags. Um, now if you asked my wife, there were all sorts of red funding, um, right. Like she knew, but like the people that are close to us and love us, they don't want to believe. Right. And, and, and sometimes we're good. Right. So it's like, you can kind of, you know, do this dance. Um, and you know, it's interesting. Cause sometimes like, like I wish I didn't have that success because I think that success allowed me, you know, really kind of, uh, enabled my behavior and allowed me to behave in ways and hide it, um, that allowed it to get much worse than it ever would have.

Sean Fogler (00:14:22): Right. Like, um, not that it, you know, it, it wouldn't have, but, but I just, I fully believe that, um, that that probably would have saved me, but that wasn't my story in the path that I took. Um, and so, um, yeah, so I just, you know, I would say like I started to use cocaine probably like a year or so after nine 11 and PR and it really, like at first it wasn't a lot, it was occasionally, it was, you know, a weekend here we can there. Um, and it kind of was like that the whole time though me personally, and my life was like, it was like this slow March down, like into the abyss. Um, until I met somebody, you know, a woman with a much worse problem than may, um, and started doing, you know, drugs with her much more frequently.

Sean Fogler (00:15:21): And that's kind of where I fell off the cliff. And I would say that was like in the last like two years. Um, and that was probably because I got into treatment in like 2015. So, you know, probably like 2013 close to 2014, probably the last year and a half. Um, and it was just, you know, that was a real, like dark time. Um, and I was in, you know, a lot of pain, um, like emotional pain and, uh, yeah, I was just, I was disconnected. Like I was disconnected from the world that was disconnected from myself. Um, and it's interesting cause I had like all these friends, um, you know, people around me, but you know, now, you know, and then you get into recovery and you realize like a lot of them, aren't your friends, um, you know, are never were your friends.

Sean Fogler (00:16:14): Um, and we're there for certain, you know, self-serving like reasons and, um, and which is kind of hard, right? Cause it's like you go through like this grieving process. Um, and, uh, and yeah, so, and then things fell apart. And I remember like my, my wife standing with my son in the kitchen, holding my son and looking at me and this was right near the end before I went to treatment. Um, and saying, I don't know who you are anymore. And my reaction was like, what are you talking about? What do you mean? And that was the moment. Like, that's another one of that, you know, I remember like, and I'm sure for you too, like you remember these moments, like along the journey that like really stand out and I immediately realized, wow, like you have no like perspective. You, you have, no, you don't even understand what you're doing, who you're affecting, how you're affecting things around you.

Sean Fogler (00:17:16): Like, you're, like I realized then I'm living in an altered reality and I'm going to do something, you know, dangerous and, and, you know, um, and I love my kid. Like I have a daughter and, um, that was my son. Who's now seven and I love them. And I was like, my God, like, I've got to like somehow do something. Cause I can't live like this. Um, and I want to be there for him. Cause like I F it's interesting. Like I always say suicide was not part of my story, but I kinda think I was trying to kill myself. Like, but, but slowly, uh, I didn't really have the courage to do anything dramatic. I think I was just on a high speed train to, to nowhere fast. Um, and so in 2015 I decided I was like, you know, and I'd never been to treatment.

Sean Fogler (00:18:04): I ain't never been to an AA meeting. I mean, I had been practicing medicine for over a decade. I didn't even really know what AA was, you know, which tells you something about like physicians, like in general, right? Their knowledge of, uh, of addiction and recovery and things like that. The vast majority of them have very little knowledge. Um, in fact, you know, somebody like yourself would have far more knowledge and experience, you know? Um, and so I went away to treatment and I went away for four months and I like dove in. Um, and I would say it took like about a month for like the fog to clear for me to even like a wake up. Um, and you know, it felt like it felt amazing, you know, and it wasn't easy, you know? Uh, I cried a lot. I was like super angry.

Sean Fogler (00:18:57): Um, you know, it was not a straight line. Let's just say that, um, it was very like, you know, up and down and, uh, lots of twists and turns. And, um, and honestly I figured, you know, my wife is going to leave me, but like I had to work on myself. Like I want it to be healthy and whole. And, um, and I, you know, I didn't know what the future was going to bring, but I was, you know, very like intentional and driven. Um, like I have been with a lot of things in my life to really make some like radical change and not live like that. And I, and I realized it's interesting because I always thought I was, you know, very free when I was using like drugs and alcohol. And I think one of the things I realized in that first month was like, wow, like that was the prison.

Sean Fogler (00:19:47): Like, this is freedom, you know? Um, and you know, which was a real, like for me, like totally kind of twisted my mind, you know, cause I never really had that realization, you know, and when I went down there, like I wanted, I was desperate and I wanted to go to treatment and I was like, somebody tell me what to do because clearly I don't know how to live, but I like in the back of my mind, I was like, Oh my God, this is going to be hell. Like, I'm never going to do drugs again. I'm never going to drink again. Come on. What are you talking? Like, that's just not possible. Like, like who does that? Um, but I did it, I'm still doing it. And so, um, yeah, so I spent actually three months down in Florida and then I went to another place in Kentucky for a couple of weeks, um, to do some like deeper work, like to do with like PTSD and like trauma.

Sean Fogler (00:20:38): And, uh, and I came home and I felt amazing. Um, but I was also like, you know, when you come out of treatment, it's like somebody turned up the volume on everything. Like the world around you is like on full blast. So I was going to a ton of meetings and, you know, we spent the next few months just taking care of myself. Like I didn't dive back into work. Um, and slowly after a few months I started to work. Like part-time like couple of days a week, it went, well, I felt good. And because of my experience and everything, I went through, I applied to an addiction medicine fellowship, you know, I decided like, that's what I want to do. I'm going to get out of anesthesia or maybe do a little anesthesia on the side, but I want to do addiction medicine. Um, and so I still, I got the fellowship, which was unbelievable, cause it had like one spot and um, and I started, it was like super excited.

Sean Fogler (00:21:38): There were great people and this is a place in Pennsylvania called Karen. You may have heard of it. It's kind of like the, the Betty Ford of the East, you know, um, and four weeks into, um, the fellowship. Um, you know, I get a call that, um, the police have a warrant for my arrest and this was about a year and a half into recovery. Um, I was like for what, like, you know, like, okay, yeah, I was using drugs. Like I don't, you know, like what could I possibly have done? And of course, you know, the sensationalistic crazy story, you know, my face splashed in the paper. And I was like, what is going on? Like, is this possible? And it's funny because one of my friends and another physician recoveries, like, yes, they call that like the tsunami from your past, you know, um, it comes back and, you know, assaults you when you're, when you're clean and sober.

Sean Fogler (00:22:38): And I mean, the reality is I would not have been able to make it through if I wasn't like in recovery. And I had like, you know, a really strong like group around me, I was going to tons of meetings and, um, was just really connected, you know, but it was horrible cause it was like really shaming, um, you know, professionally, I mean it was, you know, I was assassinated basically and, and I did some dumb stuff, you know, I wrote a handful of prescriptions to some, to the woman that I was doing drugs with. Um, absolutely should not have done it. Um, but you know, it was like, it was hard, you know, and it's like, it's like, I was like, I've been through nine 11, I'd been through like, you know, the world trade. I like got into recovery of filling. I climbed the mountain and then man, you know, it was, uh, yeah, I, I it's indescribable cause it was like really, it was just painful in so many ways. And you know, I don't know, that was a super dark time too. Um, unbelievably, like I've kind of like made it, you know, through, and, and that process took about two years. So that it's yeah. I mean, it was,

Matt Finch (00:23:59): It was, it was a long time. It was

Sean Fogler (00:24:03): Long time and there were some issues. Um, the ch it's interesting. So I ended up pleading guilty about a year into the process and then every time I would go to get sentenced, something would come up. So like there was a bomb cyclone, which is a weather anomaly, um, in Pennsylvania around Philadelphia. So the court shut down. Right. And then the next time, um, the judge that was overseeing my case had a stroke, um, had a stroke. Um, and then the next time the prosecutor, the assistant district attorney ended up resigning. So it was like these, like, so now, now it's like, you know, it's two years after I'm like, okay, like I pled guilty a year ago. Like, like I just want to move on with my life. Like, I mean, that process of going through the criminal justice system was, you know, as traumatizing and painful as anything.

Sean Fogler (00:25:03): And, you know, I mean, I'm a privileged, like white guy that's educated with like commit, you know, with people around me, good connections. And, and, um, and it was hard for me. I don't know how anybody can survive going through that, you know, type of thing. Like, like it's just like we've taken a disease. Right. And we've criminalized it. And then we've waged war on people. And, you know, I mean we're white, but you know, black and Brown folks, you know, you get it, you know, many fold worse than we do. Um, but you know, it doesn't do anything for the disease. It doesn't make society safer. Um, and this does not excuse any of my behavior, the things that I did. Um, it's just, it just doesn't work. I mean, this is a medical problem, but public health problem. Um, and you know, there are tones of that in my article, but, um, you know, so, so that ended.

Sean Fogler (00:26:02): And so like, I was like, man, what am I going to do? Like, um, I didn't go to jail. You know, I was lucky. Um, I, you know, was just put on probation. Um, so that was like a huge gift. Um, and so I was like, man, what am I going to do? Like I have, you know, a drug charge now my license is suspended. Um, Pennsylvania, the medical board has extremely like harsh, you know, suspension issues around, you know, prescribers, um, pro probably the harshest in the nation, you know, it's an automatic 10 year suspension. Um, right, right. And it's interesting because like New Jersey where I'm also licensed is three, and then you can get a, like a hearing. And I went and I also have a Florida license. And I went down to Florida last year in front of the board without an attorney and told them my story.

Sean Fogler (00:26:57): I said, Hey. And it was funny because I didn't realize how intense and formal that board process was. And there were like 40 cases on the docket. And I was the only doctor without a lawyer. And they were like four prosecutors from the board of health. And I just went up and was like, Hey, I'm going to tell you my story. This is what happened. You know, I hope you show mercy on me. And literally I'm talking to them. Like, I w like, I'm talking to you right now. And they literally wanted to give me my license back, like unanimously twenty-five people on this board and the reason why they didn't. And they were like, you know, for us to give you a license, but your license is suspended in Pennsylvania. Does it make sense? You've got like, they always go with the most stringent state.

Sean Fogler (00:27:40): Um, so it was looking for something to do. And I was passionate about, you know, addiction and trauma, like all the stuff we're talking about and drug policy. And I got connected to an organization called the Pennsylvania harm reduction coalition. Um, and I started doing work with them for about a year and a half that organization ended up dissolving, but I recently started, you know, a similar type of organization, um, called Elvis, which is with some of the people from my last organization where I do like advocacy work, um, and training, um, a lot of education around substance use disorders, harm reduction, you know, public health initiative, uh, initiatives, um, stigma related, uh, work. And I work with, you know, health professionals and law enforcement. Um, and it's been like a wild ride, but, um, and that's the really brief version of my story and like where I'm at today. Um, yeah,

Matt Finch (00:28:45): Great job. That was, you know, I love asking people just to tell their story, because then it's like a very entertaining, uh, you know, you lived through this parts of it were not entertaining for you, but for the listeners, knowing that there's a happy ending to all this, um, they get to come in and go, Oh, wow, here's this great story. That's got all these different issues that many people have struggled with. So they're getting to listen to your story and find similarities between their own life and then see the different resources and mindset shifts and even rehab strategy, recovery strategies that you've done. And that brought us all the way to the point where it's the main topic too, is the stigma of this addiction. Also the failed war on drugs. Um, the just it's a criminal policy right now. Right. You can actually get arrested.

Matt Finch (00:29:42): And then of course, some States, like I live in California, we're pretty cool here about like recreational marijuana now. And they're pushing a decriminalized silicide bin and stuff, but most other States it's in, I know Pennsylvania. I used to live in upstate New York and I went to Pennsylvania a few times and it seemed like a place that would be very strict on all that stuff. And so what brought me to you is, as you know, but the listeners don't is that amazing article that I think everybody in the world should read anyone that has addiction anyone that doesn't because it was so eye-opening about what exactly stigma is, where it comes from, how it hurts, how it prevents the recovering from an individual and the whole nation really, it's just, everything's intertwined. So if you could just talk about the stigma where, how you saw your colleagues when you were an anesthesiologist and

Sean Fogler (00:30:41): Yeah, yeah, yeah, no, thanks so much, Matt. Um, I really appreciate the, you know, the, the kind words in the article, um, you know, I wrote that article for my heart, you know, even though cause like I was telling you earlier, I mean, when you've lived it and you felt, you know, that stigma and really like, what is stigma, right? Like if you, if you break it down, I mean, like for me, I think it's discrimination, it's just flat out discrimination and, and it comes in so many different forms and I think, you know, American drug policy, you know, if you start with Nixon in the seventies and, and the war on drugs, um, it was really about controlling people, right? Different groups of people. Um, and you know, they waged a war on people using these laws to, to control them and criminalize them.

Sean Fogler (00:31:39): Um, and that goes for somebody who's casually using a substance, but it also, you know, affects people that are struggling with this disease. And you know, you know, I talk about it in the, in the article, how it's, you know, it's like this Mark of disgrace, like it's, it's this shame it's, you know, it's this entire structural thing that, that starts with like labels and stereotypes. Um, and really, you know, comes down to othering people, right? Marginalizing them. Like if you use a drug, you know, and there's, and there, and we know this from recovery, right? Like there's a hierarchy. Well, if you're an alcoholic, you know, that's bad. And if you've got a DUI, that's, you know, it's bad, but you know, the person who's doing cocaine is a little bit worse, right. And the one who's, you know, shooting heroin or fentanyl is even worse or methamphetamine.

Sean Fogler (00:32:34): We have this, like this hierarchy even in recovery and, and the reality is we're all just human. Like there is no difference. Um, but you know, in my mind, you know, Pete, like the reason why the overdose crisis is so bad. And the reason why, like, if you look at a graph, there was a recent, there was an article in the New York times, uh, in July that showed a graph of basically the last 20 years of what overdoses have done. And it is a straight March up there's, you know, 2018, there was a little blip downward, you know? Um, and I always say that like looking at overdose deaths as a Mark of, of, of success or to gauge our success is, is wrong. Right. It's like, um, just because people aren't dying, it doesn't mean people aren't suffering. Right. And they're not facing stigma and the discrimination.

Sean Fogler (00:33:31): Um, because you know, my idea of recovery is thriving and living, you know, a rich, connected life. Um, but when you're criminalized, you are disconnected, right. Employment, housing, um, you know, the way the world looks just socially, the way the world looks at you, um, these, you are cast out and, and for me, like I believe that that is what's actually killing people. Um, and that's what we have to address. And I think, you know, there are a lot of strategies that we're using that, that are very effective. Um, you know, and I mentioned in my article, like Naloxone distribution and medication assisted treatment, um, drug and alcohol treatment, I mean, it's all good stuff, but they're, band-aids, they don't actually address the problem. And, you know, the recent national survey on drug use and health in 2019, you know, looked at the number of people that go into treatment less than 10% of people are actually engaging in treatment.

Sean Fogler (00:34:36): So like what kinds of things are we doing for the other 90% of the population, right. And what are we doing to address, you know, stigma and, and that's like stigma in the community and the society. Right. Um, it's also structural stigma stigma because I w because I think, and I think this came across in the article, you know, I think, you know, our healthcare systems and other systems have taken us drug policy, swallowed it up, right. And then use that, you know, to inform, you know, their policies and they're harming people. They're not just harming people, they're killing people, killing people, families, communities, um, it's extraordinarily destructive. And I know it because they live it. Um, and I know it well. Um, and I think like, unless that changes, all our other strategies are just, you know, they're temporizing measures. They're, band-aids, they're, they're not actually going to make, you know, progress.

Sean Fogler (00:35:34): And, and I think, you know, if we don't deal with that, we're going nowhere fast and things are worse. And so, you know, now we're at a time where we have a global pandemic, which takes things to a whole other level. So in 2019, things were worse than 2018, right. And now we have this global pandemic, which is causing, you know, isolation, disconnection, uh, you know, uh, decreased access to services for people that struggle with this disease. Um, and th w and we know you, and I know very well, like that is as dangerous as anything. And then you layer that on top of all our toxic policies, people are dying, you know, they're not just suffering, they're dying. Um, and we need to change. We need change and we need, we need it fast. Um, you know, it's very hard to, to change a system like this.

Sean Fogler (00:36:31): Like, this is what I fight for, um, every day, you know, and what I try and work on. And there's, you know, I'm in a state that parts of the state, like Philadelphia, where I'm from is doing some amazing things. Uh, you step outside into the rural counties and it's another world. You know, people don't have access to services, they don't have access to mat. They don't have access to methadone. They don't have access to treatment, um, you know, among other things. And, you know, and, and a lot of like, there's a lot of like archaic, you know, attitudes and mindset that, and I think it comes back to like a lot of people think if you use drugs, you deserve to die. And that may sound harsh, but, but I, but I believe that, and like, we're human beings, you know, and I mean, the fact is, you know, coffee is legal. Alcohol is legal, cigarettes are legal, right. Those are drugs. They're harmful 90,000 people die every year from alcohol-related deaths. We don't talk about that. Right. Um, like, you know, we've chosen to criminalize what we've chosen to criminalize, but you're criminalizing people that are suffering and that, and people that are some of the most traumatized people, you know, that exist. Um, how could we possibly expect that to work? You know? Um, yeah. I don't know if I answered your question. I started rambling, but

Matt Finch (00:38:02): No, you did answer my question and you've been very comprehensive. So when I ask a question, I get way more and more fun things to think about and also talk about yeah. In your article, uh, th the part that you were talking about, stigma, where I think you were saying it come, it comes from history and then someone actually gets a physical Mark on them for doing something bad. Could you actually explain that story?

Sean Fogler (00:38:29): Right. I mean, sure. Um, you know, the, the Greeks used to D they would brand people, right. Your, a criminal, you know, you're an outcast and they would brand you, so they would know. Right. And then the article, you know, I think I said, I can't remember the exact line, but basically you're not actually branded, but you are right. We, we know, right. It's, it's the Scarlet, you know, the Scarlet letter that, that you're wearing that signifies to everyone that you're less than human, right. That you don't deserve the same care and compassion and support. Um, as other people, you know, you, you, you are, you are dehumanized, right. And that, and that goes on in our, and there are some amazing people in medicine today doing amazing things with addiction medicines. There's some amazing organizations, there's hospitals doing great things, but in general, you know, that's what in general, you know, the medical field, um, dehumanizes, you know, people suffer with this disease.

Sean Fogler (00:39:37): We don't, we don't treat them very well. And I always say, and I mentioned in my article, I think it starts with, how do we treat our own, right. If you look at how the medical community, you know, physician health programs, hospital systems, um, uh, you know, different employers, how they treat other physicians or nurses, or, you know, other health professionals that struggle with this, this disease to me, like that tells us everything we need to know. Right. And they, and they don't treat them very well, you know? Um, and it's interesting because since my article has come out, I've relieved, I've received some messages from some physicians around the country that are, have been through some really traumatic stuff like with the medical board and are suffering very deeply. And they've been shamed. They've been humiliated. Um, they've been professionally disconnected. They've been dehumanized to the point that, um, that they want to die, that they want to die, that they want to kill themselves, you know, and they're reaching out to me.

Sean Fogler (00:40:52): And I think like in medicine, in healthcare, we have this culture of silence, right. Even though we suffer more than the rest of the population, we were supposed to keep it quiet. Right. And why do people keep it quiet? Because like you mentioned earlier, you know, loss of your job, loss of your license, you know, professional humiliation, shame, the stuff that these doctors that are reaching out to me, um, some of what, you know, I've experienced, um, that's why they're hiding. And when, and you hide, like, you know, what, this disease that frequently leads to death, you know, especially with, you know, the drug supply, the way it is today. Um, and like we, to like that has to change. We need to like, like, we, we need P we need not just people, but people in the medical community to come out and say, Hey, like, this is my story.

Sean Fogler (00:41:47): Just like, we're talking, right. This is what I've been through. This was my struggle and have people, you know, love and support you, you know, and, and, and help you, you know, move forward. Um, because if we keep like nailing people to the cross, nobody's going to come out. If we keep like, doubling down on some of these, like real toxic policy policies, um, people are going to hide until they, until they die until they're dead. Um, we have to choose, you know, if you have cancer or you have diabetes, like, like this doesn't happen. If you have, you know, heart disease and you're on your fifth, like bypass surgery, and you're getting angioplasties and you're on all sorts of medicines and you continue to go to burger King or, you know, eat lousy food, um, you know, and you got chest pain and you're in and out of the ER, and it's costing us a fortune. Nobody's like, shaming, you stigmatizing, you taking your job from you, you know? Um, you're not cast out. Um, but if you're using drugs, you know, you are, and the interesting thing is like educated people, professional people, they use drugs, they use drugs. I mean, I know it I've seen it, I've done it. Like, you know, it, it's just, it's, it's like, I, it's really simple. It's like, when are we going to get honest? When are we going to actually start telling the truth about drug use in our society? Right.

Matt Finch (00:43:22): Because it will get, that's very dangerous too. Um, cause on, on one hand, I'm thinking, well, there is so many doctors, lawyers, nurses, and so many other types of professionals that are afraid of all the things that you just talked about, the stigma, and then the consequences of losing their career, getting publicly shamed, all that kind of stuff. So suffer in silence and sad or try to fix it on your own. But certainly don't tell anybody don't reach out and that's devastating for our whole entire nation, because those are the professionals that are helping to things run smoothly. I mean, you want your doctor sober, you want your lawyer sober. You don't want them, you know, on drugs and depressed and that's not good. And so just from like a financial standpoint, and then I really want to talk about some of these policies because that's not, I'm not an expert on any of that stuff.

Matt Finch (00:44:20): Uh, you sound like you're really making some things happen in this area and you're really involved. So I want to ask about that, but regarding the stigma and how you, that there's people that actually think addicts should just die. I have so much proof of that from reading comment sections at the end of, uh, news articles with comments, sections, YouTube comments, but it's more so a big news sections like Gmail news, Yahoo news, something like that, where I remember one story in particular broke out where I think maybe 12 or 15 people that bought drugs in the park this one day, all overdosed, it was obviously probably straight fentanyl or something. And the amount of comments at the end of that piece, where people were like, Oh, that's 12 or 13 less people, you know, sucking the suck in my tax money or something. Oh, good.

Matt Finch (00:45:15): You know, survival of the fittest. And, and I was just like, thinking, Holy moly, these people are totally ignorant about what addiction does to the brain, because anybody that has any clue on that has been trained up realizes that it's not just a matter of, to choose to quit or not. When your prefrontal cortex is disabled, your midbrain, hijack, dopamine, midbrain pleasure system, uh, imbalanced to where you can't find any joy in life or motivation without that dopamine boost, you're hooked, you're trapped. And like you said, the policies are keeping, you know, what do you, how do you feel about Portugal, their drug policies there when they went decriminalization free treatment and did it like in a pretty cool way to where it seems like they've got great results. What do you think? What do you think forward is for America?

Sean Fogler (00:46:09): Yeah, I, um, yeah, I th you know, I think it's very like local and regional. What works in one place doesn't always work. I think, I think that in general, like that philosophy, um, is a good philosophy. I think, you know, D I mean, even look California versus Pennsylvania, right. Versus New York versus Florida, like, there's a lot of differences and we have to, we have to figure out what is going to work. Um, I think we have to stop criminalizing people. Um, but we also have to like, you know, if we do that, which I think is a good thing, we have to bolster the systems around it. And it's not just more treatment. Like we need more treatment, we need evidence-based treatment and quality treatment, but remember not a lot of people want treatment and not a lot of people have access to treatment.

Sean Fogler (00:47:10): Um, and so we've got to do something for it, and that's actually the majority of people. Um, and I think that's where harm or harm reduction comes in and is really critical. And I don't think we give nearly enough funding to that cause because the reality is, I think we need a lot of different tools, right? I mean, I think at its most basic, you know, strip it down to his essence, we have to start, stop criminalizing the disease and criminalizing the people. And it doesn't mean excusing behavior, but we need to be able to direct people away from the criminal justice system. I think the criminal justice system is the wrong place to manage a disease. Um, you know, people talk about drug courts and, and you'll always hear stories of somebody that went through drug court and, you know, it's an amazing story in general.

Sean Fogler (00:47:58): I don't think they're very effective and very good. And I think it's just another, um, it's another, it's another strategy in the criminal justice system. I think we think we need one thing that Portugal has done is entirely pulled substance use disorders out of the criminal justice system and taking it away. Um, and I'm not talking about people who are trafficking, you know, large amounts of drugs and, you know, I'm preying on people, but I'm talking about people, you know, they're struggling with the disease though, though. That's tricky too, because many people that are dealing drugs also are struggling themselves. So, you know, there's no ads, there's no absolutes. Um, but I do think we need to change, you know, our entire mindset and our strategy and, and get people out of the criminal justice system. I mean, we have was something like 20% of people in jails or 20, 25% are there for drug-related charges more than half are struggling with a substance use disorder.

Sean Fogler (00:49:00): Um, most jails do not have, you know, evidence-based treatment or quality treatment for people that are struggling with this disease. Some have meetings. I mean, one of the things that I've been working on here in Pennsylvania is, you know, expanding medication assisted treatment to jails, but in general, I don't think people should be in jail, you know, for, for drug drug related crimes. I don't think it makes society safer. Um, I don't think, and these are life sentences, right? And like, we, we know that like a drug charge on your record, um, is not just, okay, you go to jail or you get probation. And then that ends, right. The collateral consequences. These are life sentences, right? They're life sentences. Um, and how's anybody supposed to, um, move forward? You know, how are they supposed to connect with the community, connect with their family, get a good job, be able to provide for their family.

Sean Fogler (00:49:58): You're always like, we, you know, we were talking earlier, you're always on the fringe. You're always other, you're always disconnected, but people are like, we'll get your together. Like, why aren't you doing, why aren't you doing more? Why aren't you able to do this? Right. And it's like, well, why, let me tell you why, like, this is the experience. And it's interesting because you know, I've done a lot of law enforcement training in Pennsylvania and have, you know, worked and spoken in front of like probation officers who are like, yeah, they're like, we know it doesn't work. This is the probation officers say, we know it doesn't work, but this is what we got. You know, you go to a rural County and they'd be like, yeah, we're telling them to go to two meetings a day. It's like a two hour car ride in the middle of, you know, each way.

Sean Fogler (00:50:46): Right. Because, because there's nothing like local, they've got to travel a long way to either get to the methadone clinic or the place where there's, um, you know, an IOP, um, or, or, or something else. Right. And they're like, we know it's not possible. We work with them, but it's like, we set these like unrealistic expectations. We saddle people, you know, with all these things that hold them down. Um, and then we're like, well, why are, you know, it's like throwing somebody in the ocean with a huge weighted vest, you know, it was like, why can't you keep your head above water? Well, you know, let me show you, why is the 50 pound jacket I'm wearing? Right. And so like, that's got to change and I'm not saying, you know, people shouldn't be held accountable for their actions because like I do believe like in law and order and respecting the law and, and, you know, safe communities, but what we're doing now, doesn't make things safer.

Sean Fogler (00:51:42): The recidivism rate, right. For people that are released on a drug charge within the first five years, it's something like 70%. I mean, it depends on the region of the jail. It's like 60 to 70% of those people just come back. Right. And why did they come back? They can't like they can't move forward. Right. Um, and especially somebody with a substance use disorder that part of their strategy, survival strategy, which is what it is, was for most of us to medicate our emotions and our, and our pain, um, they're in pain. And so they slip back, you know? Um, and so we like, there's a lot of things we have to change. Um, but I think like if our policies are informed by that and are compassionate and are informed by the understanding that people are human and this is a disease. Um, and I don't think it's just a disease, actually.

Sean Fogler (00:52:42): I think it's a learning disorder as well. Like in my case, I think it's a lot of how I learned. And, and once I kind of dug down and dealt with a lot of the underlying issues, I don't have those like urges. I don't really see drugs in the same way. You know, not that I would never think about it or anything, but I'm just not going to go down that road. But, um, you know, and I think like, I think that too, like, it's, it's this, it's this, you know, I look at it as like this real, like tangled kind of web of all sorts of policies and strategies and practices that are, that are holding us back. Because I think in general, even people in the criminal justice system, you know, work with a lot of law enforcement, they want to help. They have no idea how, you know, when you hear that analogy of like, when you have a hammer, everything looks like a nail.

Sean Fogler (00:53:33): Right. And I think that's true for a lot of law enforcement, right. They're like, I mean, I've been in so many like training classes where they're like, like, this is what we were taught. This is how we were taught to look at it. This is how we were taught to treat it and deal with it. Like, show me what else to do. Cause I don't know what else to do. Um, even though they, like, they know it doesn't work, but they don't know what else to do. And so I think they're, I think they're craving for something different, you know, and looking for other ways. Um, and the reality is like most of us have been touched by this disease where it's, whether it's either us, ourselves, you know, family, extended family, like, I don't know about you, but like, you know, I almost everybody knows somebody who's been affected, right?

Sean Fogler (00:54:21): Like this, isn't just some like rare small group of people. Um, these are millions and millions of people, you know, if you think about it, like they say, you know, 20, some odd million in the U S are, you know, struggling with this disease, but you think about all the families, you know, around that. Um, and I think that's probably like an under, under count. Um, but I think, you know, when you look at it, I mean, you're talking, you know, it's a huge population of people that have been affected that are struggling. Um, and we got to do something different because you know, now, you know, I think more money is coming down the pike. And with the change in the leadership in DC, you know, more money will come down the pike, um, for this disease. Um, but I think like reinvest it, like we're investing a lot of the time in the exact same strategies that have not been giving us good results.

Sean Fogler (00:55:18): Um, and I think we have to like get creative, um, you know, and, and yeah, like, medication's good and treatment's good. And harm reduction is good, but we've got to, you know, we've got to deal with the criminal justice stuff. Employment-related stuff, housing related things like it's, everybody's got to kind of do their part. And I think it's like, I think everybody's got a, can work together, right. To like kind of deconstruct this system that we have, that's destroying people and communities. Um, yeah. I mean, it, it's, uh, it's, it's a colossal job, um, and the Hill and the Hill and the health care. Yeah. Not to, you know, not to be depressing. No, but yeah, and it's an understatement, but I think there's so many smart people and great people doing some amazing work in different organizations. Um, and even in DC. Um, but it's like, we just, we need more of it and we need more funding.

Sean Fogler (00:56:21): And, and I think the hospital systems like a microcosm of everything else, you know, it's, I mean, nobody really talks about it. Um, I think it's easier for me to talk about it cause I'm like, you know, my license suspended, I'm not working in a system so I can stand out, but I'm not, you know, it's the truth, you know, it's, it's the reality of the situation. Um, and if we can't do it well in healthcare, how else are we going to do it anywhere else? Like, that's the place that people expect, compassion and love and respect and Hey, I'm suffering take care of me, you know, but we're, you know, we're, we're, we're killing people there, you know,

Matt Finch (00:57:02): That was profound. That statement you just made. And I had never thought of it that way. Of course, I've been the recipient of this stigma going to hospitals for acute withdrawal, whether it was alcohol withdrawal or heroin, or coming off a bunch of things where I just see the doctor looking at me, just shaking his head, like just could tell he just looked at me like he was visibly angry. Like that I, that I was taking up his time when he's got real patients to treat with that just came in from car wrecks and other things here. I am, I self-inflicted all this pain. I looked horrible. I looked just a man if I had a picture of me. So this, this discussed this, some people may not discuss so you can set it in our hospitals. If we can't even do a good job with treating substance abuse, that's our healthcare. If we don't even do a good job.

Sean Fogler (00:57:57): Yeah. And that's the dangerous stigma, right? Like that you have stigma from the public. And we know from research that physicians and healthcare professionals feel the same way about drug users, um, which is amazing to me, right. Because physicians are educated and, you know, you should understand and you know, but that's just not the case. Um, we also know that as physicians practice and they go further along in their training, the stigma and attitudes get worse. They've done a couple of studies on that, um, as, as they move on. Right. And to your experience right there. Um, and then the other thing that people don't really talk about is like the self stigma, right? Like the shame that we feel, um, which is deadly, is like, to me, that sh that toxic shame is more dangerous than any drug. Like, that's the kind of thing that will lead you back to drugs will lead you back to suicide and paralyzing depression, um, and rage.

Sean Fogler (00:59:04): And, um, like that is the stuff that I know is like, that is so painful. It's like somebody taking a knife and just gutting you, you know? Um, and, and like, we, I mean, that's part of the disease, right? We feel that shame, like we feel horrible about ourselves. We already DVD humanize ourselves. And then the public and our medical professionals and all our structures, you know, systems, layer, all this stuff on, and that's the messaging, right? If you do, if you do drugs, you're bad, you're a bad person. You're a bad human being. You can't be a loving father, a husband, a son, like you are not, but, but they tell you, you know, you know, share your story, don't do drugs, you know, share your story, get into recovery. Everything will be great. And, you know, I think stories are powerful. And I made a little jab in my article towards storytelling and stuff like that. I think stories are incredibly powerful and, and, you know, are able to foster like understanding and compassion and change, but it's not enough. Right. And it's like, how are our stories being used? You know, what are the dangers to us for sharing our stories? You know? Um, I'm not even coming on like with you today. Right? Like in the back of my mind, I'm like, you know, how much do I share? Like, how do you know, like I'm constantly kind

Speaker 7 (01:00:34): Of weighing, right? Like

Sean Fogler (01:00:36): How dangerous is this going to be? I mean, in some ways I'm like really blessed because I was so shamed and demonized, like when I got arrested that I feel in my mind, like anything I do now,

Speaker 7 (01:00:55): Who's going to be better. Right. And I, and I want it to

Sean Fogler (01:00:57): Tell the truth, not just for myself, but for, for all of us. Right. Because I know there's a lot of people that can't, um, you know, can't come out and, and so like, but I think the PR like Pennsylvania right now has a campaign. Um, that's being run by national organization, um, shatterproof, which is a great organization. They're doing great work. They're like, um, the founder, you know, uh, lost his son to overdose, um, you know, and is driven and passionate. And it's incredible. And, you know, they have this storytelling campaign in Pennsylvania and it's great, but you know, to me, I'm like, I'm asking the question, like, what does that change for us? How does it make it better for me and Matt, right. Like, you know, is, is some policy going to change? You know, am I going to be able to get a job?

Sean Fogler (01:01:53): Will I be able to get my license back? Will I, you know, whatever it is, will I be able to be treated as a human and not looked at, you know, not demonized? Um, I'm not so sure about that. And I don't think, you know, a lot of the research that's been done, um, I don't think it does make a huge change. I think it's important. And I think like, you know, understand the disease more and they relate it humanizes the disease and stuff. Um, and, and there are some benefits to it, but for me, I'm like, what does it change? Like how is the world going to be a better place for those of us in recovery? And those of us who are still using drugs and that's, if that's their choice, I support them and love them as much as if they're not right.

Sean Fogler (01:02:46): Um, I mean, that's just my mindset and my attitude, like what are we doing for those people? Um, you know, and those people are us. I say those people, those people are us. Like, we are all, you know, the same and connected. Um, you know, the world will tell us we're not and draw all these lines, you know, between us. But, um, we are all human, but we don't treat people that use drugs and people in recovery as human beings. And I think like, maybe that's just it on the most basic level, right? Like, please treat us as human what's that

Matt Finch (01:03:23): It's like caste system, right.

Sean Fogler (01:03:25): It is a caste system. Right. You know, and like, for me, like my experience, like I was in the cast of the doctor, you know, making lots of money doing this, and then you get your

Matt Finch (01:03:39): Top

Sean Fogler (01:03:42): And then, you know, tumbled down, you know, into a whole other, um, two years, what's that

Matt Finch (01:03:49): Two years going through the legal proceedings for this stuff to drop your spot in that cast. So big time.

Sean Fogler (01:03:56): Well, from the, I mean, from the time of arrest, you know, from like literally like once you're arrested and your face is in the paper, you know, everything changes. Um, and it's funny, I'm reading this book, um, called the Gulag archipelago, if you've ever heard of it.

Matt Finch (01:04:18): Uh, it's on my list. I heard of it from one of my mentors and it's looks really, really wrong, but I heard it, Scott, just the most amazing life lessons and just crazy. Yeah. True life, real life horrors of the 20th century. Right, right,

Sean Fogler (01:04:37): Right. Well, there's a chapter in there. I think it's called the arrest or something, but it's like, it kind of describes like how, like, you know, the switch has kind of flicked, you know, and everything is, is, is different than your, you know, everything changes and how it changes. And it's, it's pretty powerful. Um, and it's a little bit, I mean, it's a different book than a man's search for meaning, um, which is a book that I love, um, you know, which really talks about like resilience and hope and even in the worst possible circumstances. Um, and I th you know, and I do think like that's part of it too, is resilience and hope, right. Victor Franco. Right. Um, you know, in terms of moving through this stuff, but I'm like, if you can't give people hope, um, and you can't give them the, you know, you create this environment, that's that just suffocates them?

Sean Fogler (01:05:38): Like, how can you give somebody hope? You know, I think hope is like one of the most powerful things to, to, to allow us to like move forward through like me getting into recovery or moving through these challenging, you know, situations in life that many of us like face that have struggled with this disease. Um, and I think like all the policy, like all the stuff that we've been talking about tonight, I think like the policies are Suffolk. Like they're suffocating people. They're like, you're like, no, have faith have hope, be grateful, you know, think positive. And that stuff's powerful, but it's hard to see it when you are enveloped, you know, in this, in this oppressive web, um, that, that is really choking the life out of you. And so we have to, like, we have to somehow get rid of that. Right. And then give people, you know, tools and skills and, you know, wherever they are on the spectrum, whether they want to be go to treatment, whether they don't want it, whether they want to still be using drugs, like we have to protect them and love them and, and, and give them what they need, you know, um, and support them wherever they're at.

Sean Fogler (01:06:55): Um, we don't do that enough. Like, you know, even, even some of the most progressive like programs and people with there's still like this, like shopping list of, you know, things that you need to do to be worthy enough to receive care. Right. Um, and it shouldn't be that way. Like, you're a human being, you deserve care. Like, that's, it it's as simple as that, not do this. Don't do that. Go here. Don't go there, get rid of those friends, you know, pee in the cup, you know? Um, it's just, you know, we, it's a real mindset shift and I, I, you know, I don't know, I'm hoping America is more ready for that today. Um, I don't know. I think it depends where you are. Um, but I mean, I have hope, I have hope that there are a lot, you know, there is a movement growing.

Sean Fogler (01:07:53): Um, and, uh, and it was interesting cause you know, when that little clip with Hunter Biden, you know, how he, when he shot back, um, was pretty powerful. You know, it was pretty powerful. And, and his father, you know, in the debate looking into the camera and saying, you know, he loved, now he's a former prosecutor. He passed some horrendous laws back in the day, but you know, I'm hoping that, you know, I, I believe people are capable of change, you know, I don't. Um, and so, uh, you know, I'm hopeful that, that he's going to make some real change, right. Um, when it comes to drug policy, but that remains to be seen. Um, and, and in our healthcare systems, we got a long way to go. We've got a long way to go.

Matt Finch (01:08:43): Uh, yeah. I, I commonly say that we're in the dark ages of addiction treatment and this whole interview has been just basically a confirmation and my beliefs. And you also brought up and then we'll end after talking about this, uh, something really, really important that I want to take down further. You brought up the stigma of harm reduction, and I think that is such a great path forward, better harm reduction, therapies, and protocols, and much, much, much more access all over for harm reduction. Because most people with a substance use disorder, they don't want to just give up all psychotropic substances for the rest of their life. Oh, I had a little problem with alcohol now. I can't do any medical cannabis for pain, or I had a problem with heroin. I'm going to these meetings and they're saying, I can't do anything ever again, not even drink.

Matt Finch (01:09:38): That's really extreme. And that's for, that's a great one for certain people, but for a lot of people, I think harm reduction is just amazing when you teach people how to change the way that that's the biggest change I can tell from you, like the way you think nowadays, compared to the version of yourself that you were talking about, you're obviously a different person. And so when people can change their thinking about things and get access to these harm reduction, Hey, you know what, maybe they were starting to abuse alcohol, but not for a long time. Maybe they can get back to getting it under control and medications for medication management, more access to the methadone, Suboxone, Subutex. Like it's hard, a lot of people even to get those, unless you're living in a city that has plenty of doctors, but even that is very difficult.

Sean Fogler (01:10:30): Well, yeah, we have this mindset that it's all or none. Right. It's like one way or the other. And that's just, I mean, that's not how life works. Right. Um, it's, it's just not, it's all gray. And so like, we want people to be totally abstinent. I mean, that's not really human, right? Like that's, um, and it really is about, you know, understanding it's a philosophical shift, like it's understanding like, w w what does this person want? Like, it's up to them. It's not up to us. You know? And, and this is, you know, in regards to the medical system, like, this is what we do, right. We, we stand over people. It's very paternal, you know, we tell them what they need to do. Um, they may not want to do that. Right. And, and that, and that kind of attitude. And you see it in AA meetings, right?

Sean Fogler (01:11:25): Oh, he's using that. She's using this. That's, they're not really in recovery will. All that does is isolate people and they end up not coming back. And today, like somebody leaving, you know, walking out the door could be another death. Like the drug supply is really dangerous. You know, fentanyl, carfentanil, all these analogs from overseas. Um, people don't know what's in the supply. And so, you know, we need to embrace everybody. If you're interested in coming in, even if you're still using drugs or alcohol, we should still be loving you, supporting you, giving you what you need. And the reality is, I mean, a great example is syringe service programs like in Pennsylvania, they're still illegal and Philadelphia and Pittsburgh, um, have exceptions to this, but the state of Ohio, we're the only state in the Northeastern us that continues to criminalize a syringe, a clean syringe, which reduces HIV, reduces Hep C heppy, lowers rates of endocarditis C saves a fortune of money.

Sean Fogler (01:12:37): Even if you don't care about people, we continue to criminalize in this state. And this is one of the things that I'm working on now, um, you know, to decriminalize syringes in the state. And I think we'll have a bill soon. Um, but we like for what, it doesn't even make sense. The CDC, Amazon, right. It was the CDC is 30 years of data show that these places, you know, these programs are effective and save people's lives. And they're also like a place of connection and a place for marginalized communities to access care. Um, but we criminalize that, um, and people die because of that. Um, and it's just like, that's the mindset, you know, uh, that sets us back, um, because we think we're quote unquote enabling people, um, which, you know, if I give you a syringe, you're not going to go into inject drugs, just cause I give you a syringe, you know?

Sean Fogler (01:13:36): Um, it's, you know, people always use the analogy, like their seatbelts in cars, they don't make people drive badly or drive fast. Right. Like it's a protective mechanism. Um, but you, you know, I think like when I think about harm reduction, I, I look at it and I think about it as like a transfer of power. Like I think we need to be giving people their power back. Right. Right. Do you make the choices that are right for your life? Like who the hell am I to tell you? What's like, as long as you're not hurting other people, like, I mean, who I, to tell you what you should and should not do, um, that her own body like,

Matt Finch (01:14:17): Right. This is my body. I'll think I'll be the judge of what I'm going to put into it. And, um, yeah. What you were talking about that goes on in some of the 12 step meetings, you know, luckily there's a lot of members there that aren't dogmatic like that a lot of people will meet you where you're at, but that's what drove me, uh, away from them over and over again was I had a bad problem with alcohol back then, just so addicted to it. As soon as I took one sip, I was gone. And so I'd go in there and I'd take Valium, prescribed Valium and I'd smoke cannabis and I'd surf and stuff. That was how I was staying off alcohol. I was doing good, but the amount of that I got from people that knew that they just looked at me and they, they stigmatized.

Matt Finch (01:15:09): I felt shame and guilt at the one place you're supposed to have that unconditional love the love open-mindedness tolerance. I'm not seeing no tolerance. And open-mindedness man, it says the number one desire or the number one, the only requirement for memberships, the desire to stop drinking. It doesn't say anything about prescribed Valium and some medical cannabis. So yeah, even in there, even in the hospitals, even at 12 step meetings, you can get stigmatized. You have done such a fascinating job, but showing just how much it's actually weaponized stigma, which is what your article was about. Toxic shame. These are the real reasons why so many people are dying. Of course, there's the bad policies. There's the limited access to treatment treatment. Doesn't have huge success rates. It's pretty low success rates. It's a whole big mess. And you elaborated on a lot of these different areas. Uh, where can people find you? Where can people look more into your stuff, any resources where they can check you out.

Sean Fogler (01:16:13): Right. So, um, my email, uh, Shawn at Ellevest, E L M E V Y S T, let me, yeah. Hopefully spelled that. Right. Um, and you can check us out@elvis.com. We've just kind of got started. I'm on Instagram, I'm on LinkedIn. Um, I'm actually pretty active on Twitter. Uh, let me try, but yeah, I'm very, I don't know. Have you followed me on Twitter? Cause I, um,

Matt Finch (01:16:45): I, when I Googled you, I saw it come up. I didn't log in cause I haven't logged into Twitter and

Sean Fogler (01:16:50): In ages. Okay. Yeah. My Twitter handle is at Shaun S C a N underline, underscore Fogler, F O G L E R. Um, yeah, I, yeah, I, I, you know, Twitter, it's funny, like after I got arrested, I kind of stripped all my social media down because obviously a lot of people were stalking me. I'm not stalking, but obviously looking, you know, gawking, um, and slowly bit by bit, I've kind of like come back and I actually really liked Twitter. Cause I think if you fall, like if you follow kind of like a diverse group of people and you know, in the areas that you're interested in, um, they actually curate a lot of great like articles and things. And so it's like, I guess, you know, that's, I get a lot of great like ideas and, and, um, and get to engage with some great people on there. Um, so I like it a lot and I am not an investor in Twitter or anything, but then

Matt Finch (01:17:54): What's your Twitter handle? Is it just at your name?

Sean Fogler (01:17:56): It's at Sean. S C a N a underscore, uh, then folklore, F O G L E R. Yeah.

Matt Finch (01:18:03): Perfect. So we'll put all these, um, clickable links to these resources that you've mentioned, like the website Twitter then also of course at the very top of the show notes page of this episode, I'll be linking to your Epic article on the weaponized stigma. What's the, do you remember the exact title of it? It's your article, you

Sean Fogler (01:18:24): Right. Um, you know, the editor always picks the title, um, and his title was much better than mine. Um, you know, for the, um, for the SEO, I think they said they had my line stigma weaponized in any many forms helps fuel the opioid crisis. But the actual title of the article is as a physician and a patient I've seen the damage caused by the stigma of addiction. It must end. So that's the, yeah, that's the title.

Matt Finch (01:18:52): That second title was way sexier, way more compelling. I would have read it even if the, your title, but as soon as I saw the, your editors title, I was like, I'm reading this and I am really glad I did because now I get to, I learned a lot, not as much as I learned from interviewing you. Um, and I got to share you with our audience. And now I know, you know, we'll be colleagues, we're both fighting the same bright, you know, I want to follow all the stuff that you're doing because you got some exciting stuff going on. I'm more like I'm not messing around with any policies in any States or anything, but I'm doing the same thing. I'm just trying to progress the fields of addiction and mental health and reduce the stigma. Try to eliminate it one day, hopefully, maybe in 10, 20 years from now, everyone will realize that, Oh yeah, that's a health problem. And kids will be like, wow. It used to throw people in jail for robbing a painkiller that was not prescribed. They'll look at us like you guys, Eric man, it's totally barbaric.

Sean Fogler (01:19:54): That's funny you say that I have those thoughts all the time that like one day that we're going to look back and, and exactly what you said, just, you know, just totally, you know, just mind boggled, like, like what, what were you doing? How are you treating your caging people for, for a disease? Um, and I hope we get to that point. The other interesting thing is my article was actually picked up by the American society of addiction medicine. Oh, um, so on, so on Tuesday, this Tuesday, uh, just a couple of days ago, it was the lead story for ASAP, which is interesting because I've had like a number of addiction psychiatrists from around the country, reach out to me, you know, and say great article. But one of the common threads is like, wow, I never thought the American society of addiction medicine would have put that up.

Sean Fogler (01:20:55): And I think that says a lot about, um, them and our society and that change is coming and, and, and they know this and they understand that. Um, I guess somebody just needed to say it. I mean, I th there are people saying it, but, but probably not a lot of doctors saying it, um, or saying it in that way. So, um, you know, that's, that's exciting to me cause I, cause I agree. I, I was kind of, yeah. And I was stunned. I was really resistant, but, but pleasant really pleasantly surprised. And, and there's so many, I mean, there's so many amazing people working at the American society of addiction medicine. And um, I actually know some of them, you know, and they're doing incredible work and the fact that they would embrace some of those ideas, um, really gives me hope.

Matt Finch (01:21:46): Yeah. Yeah. Me too. When you said that it got picked up by a Sam, I was like, Holy moly. And so that was for, it was like a really personal from the heart juicy topic article and it, you know, it had science in it, but normally the ASM stuff's very scientific, like Mecca, like he's more kind of dry. So the fact that they're putting your stuff up there, congratulations. Well, it has been an Epic session. I've the time has just flown by anything else you wanted to say to the listeners before we end off?

Sean Fogler (01:22:25): Not really. I think we've said so much. Um, you know, and we've kind of like gone into some dark holes, but I think, uh, I mean the thing that we've been saying at the end that, that there's hope changes, calming, um, it's, you know, recovery is amazing. It's not, you know, it's not easy. I don't, you know, I hear about, you know, of her always heard about the pink cloud. I don't know what that, what the pink cloud is or what people were talking about. Cause I never really experienced it, but recovery is an amazing thing. And I think it is really about like human connection and, you know, meeting people like yourself and being connected to the community. And I think really hard now during like COVID and everything that's going on. I think there's a lot of suffering and especially in the recovery community.

Sean Fogler (01:23:13): Um, but I would say, you know, reach out, there are a lot of great online meetings and people, you know, like yourself and, you know, I like to think me too, you know, that are always here to support and I have people reach out to me all the time, you know, and I reach out to, you know, because, um, we're human and, you know, being in recovery is it's just not a straight line, but it is, it's an amazing journey. And um, I really think like anything is possible. I don't think people realize their human potential, what they're capable of, um, what life can be like. I think that's like part and that's why I think peer support is so important. Like when somebody can see, Hey, like look at Matt, look at the amazing stuff that he's doing, or look at Sean or look at whoever, you know, um, it gives people like hope and, and you know, it lets them know that, that it is possible. Like I hate the term recovery is possible, but because it's not possible, I think, I think it's the expectation. Like I think recovery, most people recover, right? You hear the stories, you see the awful stuff, but, but most people recover. Most people end up having a very connected, fulfilling life. And I think like that's a really important message. Um, but it's not always easy, you know, it's not always easy and we need each other, like I need other people. Um, that's how I, you know, thrive today is by, you know, by being connect

Speaker 8 (01:24:51): [inaudible].