Modern-Day Snake Oil

[Upbeat Guitar Music]

Mike: Welcome everyone. This is Avoiding the Addiction Affliction, and I'm Mike McGowan. This is brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, I'm looking at it here. And a grant from the State of Wisconsin's Dose of Reality: Real Talks, reminding you that opioids are powerful drugs, and that one pill can kill.

Mike: I'm also looking at that right here. My guest today is Michelle Sandberg, the Executive Director of the Hope Council in Kenosha, Wisconsin. The Hope Council is committed to reducing the impact of substance use in the community by providing education, prevention, intervention, treatment, support, and referral services, always meeting the needs of the people where they are without judgment.

Mike: We're gonna talk today about the incredible variety and availability of over-the-counter products that contain ... gosh, who even knows what they contain? We'll get into that. Welcome, Michelle. So nice to see you.

Michelle: Thanks for having me, Mike. I really appreciate it.

Mike: I love this. Michelle recently you and I participated in a round table discussion sponsored by the Hope Council about the availability and variety of products sold just about everywhere, and you purchased (laughs) and I wish I would've went with you, a lot of the products. Talk about what you found, and then we'll just go from there

Michelle: So the roundtable was interesting. It was an afterthought to bring products because we've done it so many times before, I thought, we're still talking about the same things.

Michelle: But I stopped into a vape store it was pretty late the night before, 9:00, 9:30, and it was absolutely incredible. I couldn't believe what I was finding. I started with the Kenosha, Racine, and Walworth County's Tobacco-Free Coalition back in 2019, and in that role we did a lot of environmental surveys.

Michelle: So we were going into different establishments that sold, convenience stores, vape shops, things like that, to identify areas that we needed to work on to educate people. So taking photos of placement and packaging and advertising. And at the time that I was doing this, it was really a great learning experience, but at that time, 90% of what we were looking at was nicotine or tobacco, maybe 95%, in different formats, and that was our focus.

Michelle: That was our concern, was the vape juices that were cotton candy and packaged to look and resemble packaging that kids had been familiar with. And there was maybe a small portion hidden somewhere on a bottom shelf of products that you just didn't really know what they were. You thought maybe it was fake or knock-off wannabe products.

Michelle: But that was the minority. That was a very small percentage. Today, walking into that same arena in the same sort of venues, landscape is entirely different. Unrecognizable. And I thought I was pretty educated. I thought I was keeping up. It's sensory overload now. You walk in and there's lights, and there's signage, and there is so much hemp/THC/unrecognizable products.

Michelle: Now 95% is that, and 5% is nicotine. That's regulated pretty well. It's stored behind the counters. There is limits on disposable nicotine products. The FDA's kind of throwing us for a loop right now with some flavors again, but it has changed entirely. It is completely the opposite. The stores have so many products that I couldn't recognize, but after catching my bearings and looking around, THC beverages, flour, edibles, gummies, chocolate, pre-rolls, pouches, disposable vapes, and a huge emphasis on mushrooms that are meant to imply that they're psilocybin, but... you don't know what's in any of this.

Michelle: There is absolutely no way to know, so I just started grabbing everything that looked interesting. I asked all of the shop owners what the most popular products were, and I will say it probably threw them because here's this random woman walking in at 9:30 at night by herself into this empty store asking what the popular stuff is.

Michelle: I'm sure they were all taken aback, but none of them showed that. None of them had any sort of hesitation. But it was very much different than I thought it would be, and I was able to get a huge sampling in after only, I think it was two stops. I thought, "I don't even need to keep going."

Michelle: I thought I was gonna have to go to several places, but just a big change.

Mike: And you said that all of those people were more than willing to talk to you even though they were like, "What are you doing?" And I thought when you said that, do they even know what they're selling? They can't.

Mike: They know what it says

Michelle: Right, I always try to approach people with an understanding that they probably are questioning why I'm there. I don't necessarily fit probably the typical customer profile, though I can't say with any certainty what that is. But I think showing up anywhere when you're 15 minutes before closing is probably kind of a off-putting situation to begin with.

Michelle: But when I go in asking questions rather than looking for a product, it might raise an eyebrow, but I try to address it really quickly because I know I'm going to be asking more questions, and I don't want anybody to feel defensive. So I ask the question, and if they ever answered, I would just go with it.

Michelle: But usually there's a "What do you mean, what's our most popular?" And that in and of itself was answer enough for me to realize that there is no one go-to anymore. In 2019, we were looking at Juul, and we were looking at specific brands, specific products in a very narrow window.

Michelle: Though there were a multiple ancillary products to it, there was a one go-to. Now I ask the same question, and they were like "What do you want? Do you want pre-rolls? Do you looking for flower? You looking for edibles? You looking for gummies?" So that starts the dialogue and the conversation, and it has been my experience that every single vape shop attendant, owner, I don't know what their role is, has been absolutely friendly, engaging, answers all my questions.

Michelle: So then I start to share why I'm there so that it doesn't turn into a weird situation. I explain that I'm not there to cause any problems or get anybody in any trouble. I'm simply there to buy as many products as I can to educate parents and other community members about products. I explain that I de-identify any store information because I don't want these educational groups and experiences to turn into a now we don't like this specific store because of this. So I say I take off any information about where these products came from. I just want people to see what's out there, and that does not bother them at all. They're happy to then engage the conversation. I did ask one of the people if he saw any reason why folks would still need to go to a dispensary across the border when they can get all of this right here, and he hesitated, and in so many words he basically said, "I still do, because I don't know what's in this. I've asked my customers the same question, and their feedback has been, I maybe cough a little bit more, or my throat hurts a little bit more from this stuff the next day." And his summation was that he still went to the dispensary. When you go to a dispensary in another state, you are getting products that are likely lab-certified for that batch, for that actual harvested crop that came out of the ground that created these other products, where these products here, the hemp products that we're seeing, have a lab sheet.

Michelle: But when you actually look at the lab sheet, if you scan that QR code and you go to that website, it's attached to some batch from four years ago to get levels from from... They all use the same two labs I'm noticing too, which... kind of odd. But there's absolutely no way to know what is in these things at all.

Michelle: The ingredients that are listed are just what they're telling us, and because there's no regulation, your guess is as good as mine. Something's making you feel weird. I don't know what it is, but something.

Mike: Yeah. For those of you who are listening, Michelle and I live in a state that does not have dispensaries and where marijuana is not legal, cannabis is not legal.

Mike: So you see a proliferation of the, all the delta products, right? And all that.

Michelle: Yeah. Delta-8, Delta-9, Delta-A, Delta-O, delta this, delta that. I don't know. The Hemp Bill was written such that it created and carved out delta-9 metabolite being the illegal product. And hemp contains .3% less of Delta-9, however, there is a myriad of other metabolites and cannabinoids within the cannabis family, and all of those can create that same sort of feeling.

Michelle: And it happens likely after ignition or heating it. So you can harvest hemp at a earlier date so that it still maintains that .3% in its harvest weight of THC, but once it's all processed, you are getting all sorts of goodness out of those plants. And then they can sell it legally, and then with that, the packaging makes it entirely confusing.

Michelle: At the round table, we heard even, folks in law enforcement saying "There's nothing we can do.

Mike: Yeah, they don't do anything, they said.

Michelle: No. What concerns me isn't necessarily that any specific product exists, it's that the marketplace is evolving faster than public awareness.

Michelle: Policy makers, educators, professionals, they struggle to keep up with what's available and how fast these products are being marketed. And secondarily to that then, the products are changing faster than our conversations about them. And if we want to protect young people, education has to move at the speed of the marketplace.

Michelle: And in its current existence...

Mike: No.

Michelle: It doesn't. I mean, science is slow, intentionally, but we need to speed up the education process so that it keeps up with the marketplace.

Mike: Okay, you know this. I'm in schools all the time. The listeners know this too. And we're still at the vape detector stage in a lot of schools I go into, let alone what you're talking about.

Mike: Michelle, what do you think is driving... We see some things going down among young people. Binge drinking, for instance. But we see a huge increase in some of these other products. What's driving that, do you think?

Michelle: That's a big question. Normalization. The environment right now I think is entirely overwhelming.

Michelle: We are being bombarded day in and day out with messaging, even more so since COVID, about what we should do, what we shouldn't do, wellness, health. And the conversation about cannabis is ongoing. And because there is no consensus at the national level, it goes state to state. So we're surrounded by states where kids know that they can go anywhere and buy it and it's legal.

Michelle: So if it's legal, it's safe, and it's just the politicians in this state that aren't, that are wrong or uneducated. And with that then too, you can't monitor what you don't recognize. So if we don't even know that these products exist and we think that these controls are in place, youth are left to, I assume, think that if you can buy it on the shelf at every gas station, it's gotta be safe, right?

Michelle: So I think the complicated messaging, the overwhelming just environment that exists right now within schools, within everything, people are stretched to the max. Kids aren't getting consistent messaging between home and school, and professionals and parents can't monitor what we don't know and what we can't identify.

Mike: I thought it was interesting. We had, at the round table had peer support people. We had therapists there, you had legislators there, law enforcement, and people from the school district who were very polite but contributed not much. And I thought, I get that because we tend, when we talk about youth, to put it on the schools.

Mike: You can't put everything on the schools. Not when they're asked to do so much.

Michelle: Yeah. Schools are there to teach our children, right?

Mike: Yeah.

Michelle: And we want the schools and we demand that the schools stay out of this subject and let the parents handle it. But then say, "Why didn't you teach about this?"

Michelle: There's no consensus, and I think kids feel that. Just like kids can pit one parent against another. When you're young and you wanna go out to your friends and stay up late and do a thing, and ask mom and she says no, and you kinda go to dad a different way. Kids get that vibe and they understand it and feel it.

Michelle: And I think the schools are stuck in the middle. They're part of my "Damned if they do and they're damned if they don't." So, also with that, communities react and schools react only after problems occur. We're invested in responding to addiction and overdose, but we are still not investing in prevention.

Michelle: You can't measure what doesn't happen, and prevention doesn't happen, so it's not a very easily reportable or quickly reportable metric. So the funding to support that doesn't exist, and it's, I think it's failing everybody still. It's being compounded year after year. It is important to invest in the addiction response, in the treatment, in the recovery, but we cannot forget about prevention, and we can't forget about that lived experience, like you said, the peer support and what they bring to this conversation.

Michelle: The future truly belongs to communities that invest in prevention before a crisis occurs, and that is, it's difficult.

Mike: We know, right? Education and prevention works, and it's cost-effective. And, all blah, blah, blah, blah, but it's difficult to get that funded.

Michelle: Yeah, because it's theoretical.

Michelle: It's measuring things that don't happen. It's woo-woo in some cases. That and we should be teaching children using evidence-based best practices, right? We're not gonna go in with our best guess and throw it out there, and often that can create unintended negative consequences. We are very limited to what we can offer students because evidence and best practices take a long time to develop.

Michelle: The speed that the marketplace and the landscape changes is in conflict with that entirely. I am so happy that I work for an independent non-profit agency governed by a board of directors that believe fully in science. We have physicians on our board, we have policy experts, and they fully support all aspects of best practices and evidence-based and evidence aligned, which means we know that this aligns with similar practices and processes that we've used in the past, so let's plug it into this situation here with youth.

Michelle: And being at an independent agency allows us to be nimble and do that and fill that role and change quickly, whereas a health department or a government entity is going to have to wait a little bit longer and get all of the layers of approvals, and we don't have time for that. By the time you get that in place, we are three steps down the road on the other side.

Mike: Yeah. Last week we talked to Dr. Sterling Elliot about this same topic, which is why I wanted to have you on, 'cause it fits perfectly. And he'd just gotten back from Washington where he was lobbying and working with legislators on a federal level, trying to get them to recognize exactly what you're talking about.

Mike: So how do we get legislators to formulate policies, procedures at every level to do the right thing or to do things that are helpful?

Michelle: The policy level change is what changes all the way down to the pond. So it affects everything. As an advocate for addiction research prevention, I am bound by and limited to some regulations in place and some controls from funding agencies that say that we can't lobby.

Michelle: Which means I can't go to a policy maker or a constituent and say, "I want to support this bill because of this reason and you should too." That's lobbying. What we can do, and what we must do always, is educate. So we have to keep providing the education, and that is what we can offer to support the legislative process.

Michelle: And even in our world, sometimes it's difficult to remember that we need to keep having the conversations again, and again.

Mike: Yes.

Michelle: Even though we had the same one maybe a year ago, or two years ago, or even six months ago. And that is why we had the round table. It was in the hopes of bringing together some community leaders to just keep the conversation going.

Michelle: It feels repetitive, right? We don't wanna keep repeating the same message because then we become just noise in the background. But, we think it's time to keep bringing this up and bringing people to the table because every time we do it, something else happens. It creates a little spark someplace, or it gives somebody an idea, or provides a little piece of education to somebody who didn't hear it the first time or remember it.

Michelle: And what I saw at the vape stores tells me we need to keep doing this more often because even the helpers need that refresher and that education.

Mike: I agree with that because one of the topics that came up, and it came up with Dr. Elliott, is something that you also ran into there, which is substances like Kratom and 7-0H, which they call gas station heroin.

Mike: And that people are having difficulties with. And it's not regulated at, currently, right?

Michelle: No.

Mike: People are taking it and developing addiction.

Michelle: So I think what they're using in a lot of those cases, Kratom first came on the scene years ago, and the first time I heard about it was here at Hope Council when we had clients that were trying to get off of opioids that were switching over to Kratom.

Mike: Yes.

Michelle: And we had to quickly get educated about that. So they're using it as a self-employed harm reduction or risk reduction model, and we don't know what the long-term effects are of that. It's not an evidence-based best practice. So while you have to look at it carefully through several lenses, if somebody is going to be using that product rather than injecting what they think is heroin or fentanyl, is that a better choice for them?

Michelle: Possibly. However, there is a much less likely chance that is the situation that every single person that is walking into these gas stations is purchasing those products for. So it then trickles down to the experimentation, and that's when that new line of addiction is this new avenue. Addiction is a disease.

Michelle: It doesn't exist in silos. It is not a personal choice. Nobody walked into that gas station to say, "You know what? I wanna throw it all away today. Let me try this." It's experimentation, it's a lack of regulation, and you don't know what you're drinking. You don't know what you're eating. You don't know what you're putting into you. Could it be more beneficial? That same argument can be had for vapes for people for versus cigarettes. Is it safer alternative to smoking? Yes. Cigarettes? Yes. Same model. So I can't poo-poo or dismiss somebody's efforts to make themselves healthier or reduce their own risk, but I can advocate and educate for youth and parents and everybody else to prevent initiation by folks.

Mike: Instead of best practices, it's social media, "Hey, this is what I did," right, influence. And you talked about drinking or whatever. We both got an email this morning from the Wisconsin Alcohol Policy Board that just reminded us of the stuff in convenience stores, which if you're listening to this and you don't know what we're talking about here, go into a convenience store and look at this.

Mike: There's sodas, there's teas that contain alcohol and other substances, sold right alongside sodas and teas, and all of the different energy drinks. And every time I see that, it takes me right back to the work that you did and we fought so hard with the tobacco stuff and the placement and product placement and all of that stuff.

Michelle: So there's good news. We know what works. We know what to do.

Mike: Yes.

Michelle: We have the playbooks from everybody already. We know what they're going to do next. We know how they're going to do it. We collectively need to employ all of those. Some of them don't work. You need to do all of them.

Michelle: It struck me when I went into the vape shops that all of the drinks were sold out of coolers. Why do I need to be able to purchase an ice cold 40% THC cocktail out of the cooler there if I'm not intending to get into my car and start drinking it on my way home? I think a very simple measure that could be employed would be to not allow refrigerated beverages to be sold at vape shops.

Michelle: Or no, no refrigerated beverages that contain anything other than FDA approved products. Why do you need that? Why do you need ready access to those? It's going to keep changing and we can't pretend like it's suddenly we're going to have the magic answer and response, but there are some guardrails we could put up.

Michelle: But once again, you look at that, who is going to enforce it? It's local law enforcement, and when they go in and they don't even know what the products are, or they have to assume it's legal because every one of those boxes makes it state, as such, but they don't have a lab test kit set up in their backseat of their car that they can tell you what's in it.

Michelle: And I just keep going back to that I can't say that it's wrong for everybody. I can't say that it's a bad option. But it's certainly questionable. And there is some questionable practices, and the fact that we're just turning a blind eye to it, ignoring it, is certainly not going to advance any healthier solutions or options.

Mike: And you wanna get the community on board too, right? You have, at the Hope Council, like a lot of places, you have a harm reduction vending machine in your entrance. And I don't think that you got 100% way to goes for doing that. You got some blowback for that. How do you get the community on board to doing what's right?

Michelle: So first of all, we can no longer use the word harm reduction, Mike. It is risk reduction.

Mike: Pardon me.

Michelle: Per the government SAMHSA. We are not participating in any harm reduction activities, which is just silly. Let's throw another word rule in here, that we need to just use a different word to...

Mike: Yeah, I ignore those, by the way.

Michelle: It's SAMHSA wrote two Dear Colleague letters about this very subject. But if you just pause for one moment and say, "What does risk reduction or harm reduction mean to me?" And most likely, your reaction in many rooms is, "Ew, that's not for me. That's not for us." But I have a couple very strong feelings on that.

Michelle: Number one is that dead people don't recover. Dead people don't recover. So everybody has an opportunity in this community to be allowed and afforded all of the interventions and supports that we can possibly round up for them. So in your life, Mike, when you get into a car, what is probably step one or two after you get into a car?

Michelle: You shut your door, you put your key in the ignition or you push a button, and then you put on your seatbelt.

Mike: Buckle up.

Michelle: Yeah. So you didn't say, "You know what? I am not getting in that car. There is a strong possibility I could be in an accident or thrown from my vehicle. I'm not getting in this vehicle."

Michelle: No. You used a risk reduction or a harm reduction method. You put on a seatbelt. We put airbags in cars because we know that accidents will happen. We have kids wear bike helmets. We put sunscreen on people. We use harm reduction every day in all aspects of our life, but for some reason folks are so opposed to opening their mind to the fact that just every other disease has different levels of care and treatment, there are interventions and risk reduction efforts that we can put into place.

Michelle: Because I truly believe everybody deserves an opportunity to get into recovery. And I mean that within every fiber of my being, so much so that when I hear other folks say, "We're gonna meet you where we're at," I want to say, "What's step two? Is step two throwing that person over your shoulder then and dragging them to the spot that you need them to be, tucked away in an abstinence-based treatment program against their will?"

Michelle: Because that's the only other level of care that most other entities offer. We will prevent an overdose by providing naloxone, which I think everybody is pretty much on board with now. That's a risk reduction model. That's a harm reduction effort. We'll meet you where we're at. We're gonna use appropriate language.

Michelle: We're gonna not call you an addict. We understand that it's a person-first centered language, but as soon as we do that, we need you to get your butt over here into treatment right now because that is our only offering. I think there is a lot of steps in between those two for a lot of people, and our agency's mission is to reach those folks, because those folks don't have anywhere else to turn.

Michelle: And that means we can offer health and wellness supplies. We can offer safer use supplies. We have partnerships with Vivint established so that we can provide syringes. We do not put those products in the vending machine, but the vending machine is loaded with harm reduction products like sunscreen, naloxone, drug testing supplies.

Michelle: I'm sorry, drug testing technologies. And things like wound care. In the wintertime we put Hot Hands in there to prevent frostbite. Risk reduction. We put ponchos in there, warming blankets. The vending machine is full of those supplies and I noticed in the last several years a big gap in our community.

Michelle: And the word harm reduction and risk reduction is a dirty word to a lot of people. But I'm trying desperately to reframe that message and show folks that you do use risk reduction in your life every single day. And if you are gonna walk the walk, if you're gonna say that, "We are with you. We are here for you. We support you, and we will do everything in our power to keep you as healthy as we possibly can," for some people that might mean providing safer use supplies and developing a trusting relationship, because I know that they can come here. They are in good hands. They will be cared for, and they trust us.

Michelle: Because someday with our constant contact that we have now, we will hopefully open that door and get them to take that next step. And we will sit with them in that next step, and we'll be there the next time they need to take that next step again, because it doesn't always stick. So that's where our true passion is.

Michelle: We've found our niche. We're going at it. And all of these parts I hope to never need, because I hope someday to be doing prevention so well that all of these other modalities won't be needed.

Mike: I've spent my whole life talking about I would love to be out of work. And that's part of it.

Mike: And you're right. long ago on this podcast, I can't remember what we were talking about, but I asked a mom who was involved in risk reduction. I said, "What do you say to people who say you're enabling?" She goes, "I tell them I am. I'm enabling them to live one more day. And that might be the day that they get better."

Mike: And that's such a great answer, right? We know what works, like you said.

Michelle: Yep. Dead people don't recover.

Mike: Yeah.

Michelle: Everybody's got a mother, brother, sister, family, everybody. Everybody. And I don't think for one moment anybody wants to go, "You know what? You picked this."

Mike: Yeah.

Michelle: "Sorry. You don't deserve these other things."

Michelle: So we've made it our mission to get those people. Everybody needs something. Not those people. We made every effort to get the supplies that folks in this community didn't have access to before. And it's precarious. It's an interesting position. We don't advertise it. We don't speak about it boldly and loudly, and I often feel bad about that.

Michelle: But it's a balance, right? We don't want to over-promote or encourage use, but we do wanna offer the resources to the folks that we know already need them. We're already supporting them, and now they have another safe space to go.

Mike: That's great. I know you're doing a lot. You've expanded your services so much, and you have to deal...

Mike: Like you said, you have to pivot on a dime. I think you're doing a lot of THC-based DUI stuff. Where 10 years ago it was all alcohol. And so you have to be able to be flexible in your agency to meet the needs of the community. And you're doing a great job.

Michelle: Thanks. Mike you taught me people don't experience addiction in neat categories.

Michelle: Yeah. So our services can't exist in neat categories either. And who better than an independent agency to be able to, tomorrow, when it's the next nitazine or xylazine or etomidate or 7-OH, whatever it is.

Mike: Yeah. We don't know.

Michelle: We're gonna be there. We will figure it out quickly. And whether you're trying to prevent substance use, struggling with active use, supporting a loved one that's usually the number one question that we get in our phone calls is, how do I help my loved one?

Michelle: Maintaining recovery, there should be a door for this community to walk through, and that's what the Hope Council is. It's all of it. And to eliminate any part of that, I think would be unfair.

Mike: Yeah. That's what the name is, Hope.

Mike: Michelle I really appreciate your dedication, your work, your insight, and thanks so much for being with us.

Mike: Those of you listening, watching, I'm putting links to the Hope Council. Many of you listen across the country and borrow ideas from other places. We know that happens. Feel free to do that.

Mike: As always, we thank you for listening, for watching if you're on YouTube. Be safe, be well.

Mike: And I think we both say this...

Mike: Yes, dear.

Michelle: I gotta throw a plug in here. Sorry.

Mike: Oh, plug away.

Michelle: Substance Use Summit is coming up in August.

Mike: In Wisconsin.

Michelle: Yep, Wisconsin DHS has the Substance Use Summit in Green Bay, which is gonna be really a neat conference, I think. We are presenting several different topics, and one of them is, how do you do the full continuum of care?

Michelle: How do you navigate prevention, interventions, treatments, recovery community under one roof? So to go along with that that whole thing, I just wanted to derive...

Mike: Well, there's so many of those things happening across the country. Just take advantage of them. And that's what I was gonna close with.

Mike: It's not just safe, be well, but be educated. There's numerous opportunities to learn, right?

Michelle: Yes. Let's talk again.

Mike: Yeah, let's do it. Thanks, Michelle.

Michelle: Thanks, Mike.