Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on conversations with some really amazing people. Today, I’m talking with Alex Hogan, who is a multimedia journalist at STAT, which is a health and science news site from the Boston GlobeMedia partners.

Alex produces videos, illustrations and animations, all with the aim of making what may be very complex topics more accessible. In 2017, Alex produced the short documentary film “Runnin’,” which took an intimate look at the impact of the opioid crisis in his hometown of Somerville, Massachusetts.

I was wowed by this film, especially by how movingly it portrays the opioid crisis through a series of personal stories. To me, this technique and its powerful message can teach us all a lot about health communication.

Alex, welcome to Health Literacy Out Loud.

Alex Hogan: Hi, Helen. Thanks for having me.

Helen Osborne: The opioid crisis, oh my goodness, what a topic these days. Can you put this into context for us? When we use the term “the opioid crisis” or “the opioid epidemic,” what are you talking about and how can we frame this?

Alex Hogan: The opioid crisis has hit staggering new heights in the last few years, especially since the introduction of synthetic opioids, such as Fentanyl and Carfentanil, that often ship from overseas.

The real beginnings of the opioid crisis can be traced back to the late ’90s, particularly with the introduction of the pharmaceutical drug Oxycontin. That drug was marketed very aggressively. There was a lot of misleading information.

Helen Osborne: That drug was marketed just as a non-addictive pain reliever, right?

Alex Hogan: Absolutely. It was long-lasting pain relief.

The problem at the time they purported to fix was that other opioid drugs, such as Percocet or Vicodin, had short half-lives, so you would take it and it would only last for a few hours. You had to re-dose and re-dose and you might find yourself dosing every three hours all day long.

The idea with Oxycontin was that it would last longer. You could just take the pill once and it would last all day. They said because of that, a property of that was it would be less addictive, but that turned out to be not the case. It was incredibly addictive.

It became a blockbuster for the company. It sold millions upon millions of dollars.

Helen Osborne: And worldwide. It wasn’t just in the US, I think.

Alex Hogan: It wasn’t just in the US as far as I know, but I know it’s a uniquely American problem.

Helen Osborne: We have this problem, this drug, it became addictive and then you talked about other drugs. It’s gone way beyond that. Is there a link between the Oxy, Fentanyl and heroin even? Has it taken its own trajectory?

Alex Hogan: Yes. If you talk to any community that’s been impacted by the opioid crisis, you’ll recognize familiar beats. You’ll hear that people started abusing Oxycontin and then Oxycontin became a little bit more scarce and expensive, for a number of reasons.

The pharmacies started cracking down on it. A lot of pharmacies were being robbed, so they stopped stocking it. Supply and demand for the drug on the street, the value skyrocketed.

What’s interesting about Oxycontin is that it’s chemically so similar to heroin that if you have an addiction to Oxycontin, which the withdrawal symptoms from an Oxycontin addiction are incredibly violent and can last weeks, you can take heroin. It’ll relieve those withdrawal symptoms.

Helen Osborne: Wow. I went to a meeting in my town about our opioid crisis. I think it’s touched every community across the country. I was sitting next to one of our state representatives. He told me news I found shocking. Heroin is now cheaper than a six-pack of beer.

Alex Hogan: Yes, it’s very cheap. When Oxycontin was being sold on the street, I remember the street value of an 80-milligram pill was $80. It was basically a dollar a milligram.

An 80-milligram pill, when you built up a tolerance, wasn’t very much. It got to the point where, to maintain your habit, you had to spend hundreds of dollars a day. It was a combination of economics, honestly, for users and then scarcity.

When these people that were using these drugs were in the throes of withdrawal symptoms, it became common knowledge that for a couple bucks, you could get a bag of heroin and it will make all your withdrawal symptoms go away and give you very much the same effect as Oxycontin. I think, for a lot of users that were suffering with addiction, it was a pretty appealing choice.

Helen Osborne: Now we have this situation. It’s a crisis. There are deaths. It’s touched our family. It’s touched communities. I know it’s touched your friends, too, because that’s the foundation of the story behind “Runnin’.” It’s a very powerful film. We’re going to have a link to it on the Health Literacy Out Loudwebsite.

Just a quick recap, it tells the story of several of your friends, right?

Alex Hogan: That’s right.

Helen Osborne: Several friends who are using, have died, have not used and gone on from there.

We have this crisis. As you know, listeners to this podcast and I are particularly interested in communication and health literacy. I really want to get your sense of how this opioid crisis intersects with that world of communication.

Alex Hogan: I think that’s a great question. I think it intersects in a few different ways. Particularly with health literacy. I think one of the big problems that got the epidemic kicked off in the first place was there was an impression people had of “If it’s prescribed by a doctor, it can’t be that bad.”

If you’re more versed in health literacy, you would know that’s not necessarily the case. There are all sorts of substances that are prescribed by doctors that are unsafe if they’re not prescribed to you.

I can see what people are thinking, like, “My grandmother was prescribed this,” or, “My little brother was prescribed this for an injury. How bad can it be? It’s not like I’m shooting heroin. It’s just a drug the doc gave my brother for his collarbone injury.”

Helen Osborne: People explain it to themselves. They make their own stories about that, and they justify it. That’s really about putting new information into context of what is familiar. But in this case, that was not correct. Just because grandma might be taking it doesn’t mean it doesn’t have any side effects or it’s okay.

Alex Hogan: I just think if people were more educated on health literacy, that would not have been the impression that they had.

Helen Osborne: People are coming up with their own stories to get started. “How bad could this be? A doctor prescribed it.” Now they’re not just taking an occasional pill here or there. It’s becoming a daily routine in their lives. Now they’re deciding, “Heroin is similar to it. I’ll do that.” People are making day-to-day decisions not just to get started, but to keep going.

That’s what I’m talking about, the communication or the understanding part of it. Health literacy is not just about communicating health information out, but it’s about understanding how it matters to us and our own bodies.

Alex Hogan: The one thing I try to stress a lot, and this comes back to communication, is I think many people don’t understand, with opioid addiction, the withdrawal symptoms, when you try to stop, are so severe.

After just a few hours from the last time you used, there’s a host of terrible symptoms: hot sweats, cold sweats, cramping, throwing up, diarrhea, headaches and nausea. Anxiety is a huge one. This will last for days.

I think when it comes to why they would use a higher dosage or switch to heroin, a lot of it was just survival instinct. You’re in this incredible amount of pain and suffering. If it’s going to just take a higher dose or if that drug is not available at all and you use a different substance, like heroin, that may be more dangerous, you’re not thinking that clearly, I don’t think. You’re just thinking, “I need to make this feeling go away.”

On the flipside of that, for a lot of people from the outside who aren’t as familiar with opioid use, people that are using and have been using heavily, they can’t just stop on a dime.

It’s not coffee or cigarettes where you’re irritable and cranky and it’s uncomfortable. This is severe physical distress your body goes through.

I think if more people understood that, there’d be less of a stigma of “They’re just junkies out there getting high. They’re just using to enjoy the effects of the drug.”

In fact, that’s not the case at all in many instances. Once you get a tolerance up to a certain amount, you don’t even necessarily enjoy the drug anymore. You need that drug just to maintain a baseline of normalcy. If you don’t use, you’re going to be in a lot of pain.

Helen Osborne: That sounds like something we in health literacy or health communicators really need to emphasize. It’s not just the getting started, but it’s also what it takes to stop. We need to communicate that.

In your work, in your film, you do a lot of this through the role of story. Can you just talk about why you see that as a valuable way to communicate these difficult but life-saving messages?

Alex Hogan: I think it’s a very powerful way. I think in the documentary you really see the people’s faces and you see the pain in their eyes. You see, in some cases, the toll the drug takes on people physically. Hearing a voice and inflection, I just think telling a story through video is incredibly effective.

It’s one thing to read about things. There are, obviously, plenty of incredibly moving written pieces. I just think that it gives a new dimension to it where you can really see into these people’s eyes to what they are feeling. It gives that one more level of power to communicate these messages.

Helen Osborne: Actually, one takeaway, visual and memory, I have from watching your film is a young man who’s a good buddy of yours who you film at some point in the depths of what he’s struggling with, with his addiction. He doesn’t have any teeth and you ask him about losing his teeth. It was all part of the story.

Spoiler alert, but a good one I think, is that he’s doing much better by the end of your film, and he has teeth. To me, that visual message is just so powerful about the cycle and the possibilities of this. I thank you for doing that.

For our listeners, we’re probably not documentary filmmakers, at least I’m not, and I don’t know anybody but you who is. What would you recommend for everyday folks who care about health communication and want to do something to help in this opioid crisis? What do you recommend that we might do to make it even just a little bit better today than it was yesterday?

Alex Hogan: I think that’s a good question, and it also starts with the idea of health communication. One thing we can all do is help end the stigma of drug use. A big thing is avoiding stigmatized language. I’m guilty of it too from time to time.

Helen Osborne: Give me an example of stigmatized language.

Alex Hogan: You don’t want to say someone is “clean,” like, “He’s been clean for six months,” or, “He’s been clean for a year.” The flipside of clean is dirty and that’s stigmatized language. You’d want to say, “He’s in recovery.”

You wouldn’t want to say someone abuses drugs, because abuse has a negative connotation. You’d want to say, “This is someone with a substance use disorder.”

Helen Osborne: I’ve noticed that shift over the years from substance abuse to substance use.

Alex Hogan: Right. I think if we can all be more careful with how we speak about individuals with substance use disorders, it will go a long way to helping with the stigma.

The reason I think stigma is so important is because people are less likely to look down on someone with a use disorder. They may be more likely to seek out treatment and not hide it.

Helen Osborne: Do all those good clinical things we need to do of appreciating that it is a disease and illness, and being respectful of the person who’s going through this.

Alex Hogan: That’s right.

Helen Osborne: Here you are, you’re talking about communicating with a lot of professionals, clinicians and public health folks. What else would you have on your wish list that you’d like us to do?

Alex Hogan: This has probably been around for many years now. I wish there was a silver bullet. It’s a really tricky situation. People have been fighting for money, research and treatment options for years. There really isn’t any silver bullet.

I think one thing a lot of treatment professionals will tell you is that drug-assisted treatment works, whether it be Suboxone, buprenorphine or Methadone.

That also has a bit of a stigma, to be honest. All of those drugs are based on opioids, so a lot of people will have a problem and say, “How am I really not using drugs if I’m treating it with a drug that’s chemically so similar to the drug?” They say it’s like swapping one addiction for another. I don’t necessarily agree with that.

A good analogy I heard was it’s like a nicotine patch. Cigarettes and nicotine patches both share the same drug, which is nicotine, but the difference is with a nicotine patch, you’re not smoking anymore, which is a harmful behavior.

With opioid treatment drugs, by taking Suboxone supervised by a doctor, you’re not engaging in the risky behavior of a heroin addict, which may be meeting up with drug dealers, using intravenous needles or sharing needles. That leads to a lot of deaths.

Helen Osborne: Alex, as you’re talking about this and I’m recalling the community meetings I went to about this, I’m just really appreciating the complexity of this, even as it’s become politicized in a lot of different ways. Where should our money and efforts go? Should it be preventing someone from getting started? Should it be helping them to stop in a way that is safe and they will be able to stop? In the treatment, is it the family or community? It sounds like it’s so multifaceted.

I hope this conversation that you and I are having is just another one of those aha moments. We need to do something about it. I’m hoping our listeners of Health Literacy Out Loudthink about what piece of the puzzle they might be able to help with, even in a modest way.

I think that for all of us to take the moment, take the time, to watch your film “Runnin’.” It’s a really powerful reminder of how we can help and that there’s a need out there.

Alex, I would think that a lot listeners want to not only see the film, but also hear about STAT. How can they learn more?

Alex Hogan: STAT is at www.STATNews.com. We’re a health and science news site from the Boston GlobeMedia partners.

Helen Osborne: If I might add, it’s terrific. I get it every day, and I almost always click a link or two from there. STAT, I’m a huge fan. How about “Runnin’”?

Alex Hogan: You can find it on STAT News at www.STATNews.com/runnin. There’s a landing page there with “Runnin’” resources and information. From there, you can find a link to the film. There are also some links to how you can help.

Helen Osborne: Terrific. Thanks for that, Alex. We’re going to have it on your Health Literacy Out Loudweb page too.

Alex Hogan: Great. Thank you.

Helen Osborne: Alex, thank you so much for sharing this with us on Health Literacy Out Loud, for helping spread the word about this opioid crisis and perhaps giving us some hope about ways to make it better. Thank you.

Alex Hogan: Thank you so much for having me.

Helen Osborne: As we just heard from Alex Hogan, it’s important to communicate clearly, even about very timely and difficult issues like the opioid crisis. But clear communication like that is not always easy.

For help communicating your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you’re there, feel free to sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

New Health Literacy Out Loudpodcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Google Play, Stitcher Radio and the Health Literacy Out Loudwebsite, www.HealthLiteracyOutLoud.com.

Did you like this podcast? Even more, did you learn something new? I sure hope so. I did. If so, tell your colleagues and tell your friends. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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