Shadowing Practice: What's the latest on the opioid crisis? - Learn English Speaking with Video
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Hello, and welcome to The Lancet Voice.
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My name is Niall Boyce, and I'm joined from New York, as ever, by my friend and colleague, Miriam Sabin.
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Hello, Miriam.
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Hi, Niall.
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Now, as you'll know, you, the listener, this is a specialist health podcast,
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but today we're talking about a story which has long since broken out of the health arena into books, TV shows, politics, in fact,
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the whole of American society, perhaps the whole of global society.
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This is, of course, the opioid crisis.
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We thought that this was a good time to check in and see where we are now with this story,
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where we're going, what needs to be done.
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And who better to help us with that than Nabaroon Dasgupta?
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Now, Professor Dasgupta is a senior scientist and Gillings Innovation Fellow at the University of North Carolina at Chapel Hill.
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He received the MacArthur Fellowship in 2025.
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So it's absolutely great to have you on the podcast.
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Welcome, Nabaroon.
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Thank you.
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Let's start by catching listeners up.
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When people talk about the opioid crisis or the opioid epidemic, what do they mean?
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And was the U .S.
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uniquely affected by this?
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The opioid crisis is an increase in overdose deaths that have spanned 30 years.
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The U .S has seen the highest numbers of overdose deaths in the world, but the phenomenon is something that has happened beyond North America.
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So how did it begin?
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Did it begin with prescription medications?
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What was the origin of this problem?
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So the origins in the United States can be traced back to the early 1990s
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when there was an influx of heroin overdose deaths, particularly among black men.
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We saw after that an sudden increase in prescription opioid overdose deaths starting about 1998 -2000,
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and that was related to more prescribing of opioid analgesics and leaking out from the supply chain than was probably medically necessary.
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From that point, we saw the problem kind of mushroom throughout the country, and then starting in the mid -2010s,
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we were seeing a reduction in overdose deaths and opioid prescribing at the same time with a shift towards heroin.
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And then heroin was starting to be replaced with fentanyl, but not just one kind of fentanyl, like a plethora of different fentanyl species.
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And then that kind of condensed during the pandemic to just being fentanyl as the primary driver.
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So it sounds to me like there were multiple epidemics going on at the same time.
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And then during the COVID -19 epidemic,
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you have an actual epidemic that is overlaid on these existing epidemics below.
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And I wonder if we could drill down a little bit further to some of these different populations
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and what was happening with them.
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So what do we know about if you think about the different groups as the U .S.
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Census defines them, anyone from, you know, Black Americans to Native Americans, whites in rural areas.
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Can you tell us a little bit about how they were affected and by what?
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Sure.
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So I think we can think of this as Rurality, Race, and Age.
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And initially, the understanding of the opioid crisis was that it was something that was predominantly affecting rural areas,
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especially during the prescription opioid times.
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And while the rates were high in rural areas,
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the absolute number of deaths were actually higher in suburban and urban areas.
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So it's kind of one of these classic public health problems of absolute risk versus relative risk.
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So I think, you know, a lot of the innovation and interventions and things were coming from both sides,
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where a lot of innovation actually happened at the rural level, because these drug problems were being,
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were happening in communities that didn't have as much of a stigmatized, racialized view of drugs.
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And they saw this as a new threat
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and had less baggage about harm reduction or methadone clinics or kind of things that had defined the 1990s and early 2000s.
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That's interesting.
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And it makes me wonder a little bit about, you know, some of the existing history in the U .S around harm reduction in general.
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You said that that might have been less of a factor in some more affluent communities, suburban communities.
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But I wonder if our listeners could benefit from some context on the politics of harm reduction itself in the U .S.
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Sure.
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So harm reduction was initially I don't know.
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came to the U .S as a concept of keeping people alive, particularly during the HIV -AIDS early days before antiretrovirals.
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A lot of the HIV transmission was happening through needle sharing.
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And our European colleagues demonstrated very clearly through a lot of rigorous research
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that using clean syringes as a public health tool would eliminate a lot of that HIV transmission.
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So this was absolutely a bedrock public health intervention during a huge international crisis of an infectious disease.
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What happened in the years that followed is a politicization of that.
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This was an era of just say no to drugs, and the focus was on abstinence only kind of modalities.
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At the same time, there was also great advances in addiction treatment
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that were happening and an expansion of the ability to treat addiction and opioid use disorder throughout the United States.
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So that became wrapped into harm reduction.
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So this is a controversial area, which is, I think that we know that the whole just say no approach is far too simplistic.
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But I think that a counter might be to say, well, you know, we understand the purpose of harm reduction,
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but what point does harm reduction become effectively throwing your hands up and saying,
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well, you know, no, we can't really do anything about people taking opioids.
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All we can do is make the consequences less harmful for them.
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Is it possible to run a harm reduction strategy in tandem with a compassionate,
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a patient -centered strategy that nevertheless does have abstinence or at least severely reduced misuse as an end goal?
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Absolutely.
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I think every harm reduction program is a more compassionate strategy.
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And every harm reduction program I've ever seen has abstinence as a possible end path for that individual,
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if that's the path that they choose, when they're ready to choose that path.
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And I think it's fascinating to hear harm reduction presented as controversial,
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because I think that happens in liberal cities and urban areas.
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But when I'm in rural Appalachia, the concepts of harm reduction have been embedded in the community for generations.
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I'll tell you a quick story.
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I was in, earlier in my career, I was presenting to a small community group in Wilkes County, North Carolina, and I was presenting on naloxone,
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the antidote that reverses a opioid overdose and how distributing that to people who use drugs can prevent overdose deaths.
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While some of those initial studies have been done in New York and Baltimore and Boston, and San Francisco.
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And so I presented to this community group, the most senior person in the room, bow tie, Southern accent, came up to me afterwards and said,
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we don't really need someone from New York coming in here and telling us about harm reduction.
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First of all, I'm not from New York.
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But he said, we already have been practicing harm reduction for generations
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because we know we can't just lock up our sons for providing for their families.
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What's interesting about that particular place is that it is the birthplace of NASCAR,
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and NASCAR was a direct history connected to running moonshine from the mountains to the cities. So,
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you know, what they explicitly told me is
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that there were generational accommodations at the margins of the law dealing with substance use,
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economic opportunity, and health.
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And what they were looking for was to have world -class,
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what is the world -class treatment and access options that they could enact in their own community with their own vernacular,
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with their own providers in a way that fit in with this intergenerational tradition.
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So does that apply also to safe injection sites and distribution of clean needles and syringes?
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I do a lot less with the safe injection sites just
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because in like I work mostly in rural areas
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or a lot in rural areas and the nature of drug use in those places are not urban concentration.
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It's actually much more, it'd be really handy to have if it was concentrated.
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Instead, what we have in rural and suburban areas is people using, you know, in their living rooms with small groups of tight -knit friends.
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And penetrating those networks with health resources is a very different story than opening a storefront where someone comes in
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and accesses services on a drop -in basis.
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So the whole approach has to be different
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and tailored to the rural communities to reach out to people within their networks and within their homes, it sounds like.
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That's exactly right.
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And it also sounds like it helps if you actually talk to those communities
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and understand the culture and the history rather than imposing things uniformly from top down.
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Absolutely.
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And I think there's almost a point where we as outsiders to another community will never fully understand.
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And I think it's that humility that you have to bring when you get asked to come to these places.
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And what I find is that having local champions who can really adapt
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and take the message forward is really the most important part of making a successful community partnership.
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okay
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so we've talked about the opioid crisis
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we've talked about how it's this mixture of what you might
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call illicit supply of medical supply of the different types of opioids
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which have emerged and which have been used over the years most recently fentanyl
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and we've also spoken about how you can maybe in practice reduce the harms for people who are using these drugs
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What about at the ground level, about at the level of supply?
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What can be done there to prevent people becoming addicted in the first place?
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So when we think about the opioid crisis,
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the arc of it, the supply is often defined by this word opioid because these molecules touch the same brain receptors,
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even though the molecules themselves have changed over time.
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In the same way, the people who are exposed to those molecules have also changed over time.
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And what we see right now, and the reason I'm hopeful that the recent decline in overdoses may become enduring,
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is that Gen Z's drug habits and drug tastes are very different from their parents' generation,
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their grandparents' generation, and their great -grandparents' generation.
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We're really talking about four generations of people and four generations of molecules.
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And what has happened at each of these intervals over the last 30 years is something called cohort replenishment.
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So if you looked at just the median age,
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for example, you would see that going up by a year for every calendar year that was progressing. And so
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that means it's a cohort of people who started using these substances at the same time who are getting older
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and continuing their use.
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Then there would be some kind of interruption, usually related to international scheduling or international regulation of illicit drugs,
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which would then bring a new opioid into the mix.
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And people in their 20s would usually be the ones who took that up.
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And then you would follow them year after year, the median age going up and up year after year.
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So it's been this cycle of cohort replenishment for literally three generations.
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What we're seeing now as Gen Z enters into young adulthood is
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that they are not using illicit opioids nearly as much as their parents were at the same age.
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And I think that is what gives me so much hope.
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Right now, Gen Z is 9 % of all overdose deaths, and usually the early 20s is a time of experimentation.
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This is when we traditionally would see an increase in overdose deaths, but we're not this time around.
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Does that apply to different groups, different socioeconomic statuses as well?
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It does seem to be relevant across different socioeconomics groups where we see some differences that is actually with race.
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And what we have seen in the United States is a cohort of older
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Black men who had initially, some even in the early 90s,
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started using heroin and had all sorts of other causes of health morbidity that were unrecognized, untreated,
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unable to be addressed as they aged
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and this is a cohort of folks who have seen their ranks depleted in a rate
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that is much higher than any other subgroup.
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So I'm going to ask you a question
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which you might not be able to answer but I'm going to ask it anyway.
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Why is it that
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Gen Z aren't so keen on opioids?
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Is it because supply has been cut?
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Is it because of public health messaging?
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Is it just because different generations do different things of different cultures or some sort of combination of these factors and more.
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So we do a lot of experiments with public health messaging, and we also implement interventions.
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In doing so, I can tell you how ineffective a lot of those efforts sometimes are.
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What I can tell you is
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that the most powerful behavior change pathway happens from individuals observing and experiencing what they go through in their own communities.
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I mean, there's over a million
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and a half children in the United States who have lost a direct relative to an opioid overdose death.
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Imagine sitting in a uncomfortable frock in a church pew
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and going through this very awkward and difficult family situation
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that is going to imprint a message avoiding this substance way more than anything that you teach in school,
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anything that you put on a billboard, and any publication that you put out. So essentially, it's experience.
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It's the fact.
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It's almost the result of what you described, which is that these multiple generations and eventually,
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the experiences presumably accumulate as well within a community and within individuals.
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And it's that sort of direct exposure, which seems to be an important factor.
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That's exactly right.
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And this is something that I'm very, very interested in and kind of the direction of my future research is on how drug cycles end.
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We spend a lot of time and energy on how drug cycles start.
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And, you know, there's alerts and outbreaks.
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This is the new drug.
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Be careful of this.
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Right.
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But we don't follow that story up on how it ends.
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And if you look back at crack,
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for example, we saw a very similar demographic shift away from younger people initiating problematic crack use in the 1990s,
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seeing the consequences of the elder generations.
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And I think this is part of what we, I don't know, it's part of something that's like so fascinating and so central to policymaking,
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to interventions, to where we put our resources, right?
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But we don't really understand how these cycles end.
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So this is a little bit like something in psychiatry,
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which is that we know that some people do get better from mental health problems without any kind of intervention,
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or perhaps when interventions have been tried and not worked.
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And we tend to say, oh, you know, spontaneous remission.
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And what that means is people get better and we just don't know why.
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And there's been surprisingly little investigation into that.
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So it sounds like a parallel process.
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But something which I'd like to ask about is attempts to control the opioid crisis, the opioid epidemic in communities and individuals.
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Have there been any unintended adverse consequences of attempts to tackle this problem?
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I think we can think about this in two different macro levels.
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One is on the international drug policy side and one is on the on the ground community based side.
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So one of the most remarkable aspects of the recent increase in overdose deaths is
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that it happened right after the Chinese central government banned the export of the raw materials that are used to make fentanyl.
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So that was 2018, with the United Nations falling in 2019.
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And right after that is
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when we saw the highest increase in overdose deaths in the United States from those drugs that were supposed to be controlled.
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And this is, I think, it's a condemnation of our drug control system,
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of our international drug policy framework that is kind of billed as the strongest panacea to making large -scale drug changes.
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But the evidence shows that that actually can have these unintended consequences and backfire.
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In this particular case, what had happened was that the exporting, once those bans went into effect in China,
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the raw materials were still flowing, but instead of shipping finished product from China, it was nearshored to Mexico.
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And because the raw material was harder to get, in theory,
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people who had greater access were the only ones
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that were able to have those connections back to those suppliers in mainland China.
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And so what you did effectively was empower
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and embolden a small handful of cartels to be able to perfect
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or to refine and mass produce fentanyl instead of being able to shut it down.
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And so it actually concentrated power and then what happened at the same time like obviously we know 2019
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And 2020, with the start of the COVID pandemic, was that there was this huge increase in overdose deaths.
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And I think
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that increase in overdose deaths is one of the biggest failures of public health in the United States
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that we have ever seen.
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I mean, we were talking about at the peak in 2022,
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2023, of over 100 ,000 people dying a year of a preventable condition which is just an astronomical number.
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And that was right after all these international controls were put into place.
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So I think that's one part of the story.
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The other part of the story is what was happening in
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the community as a reaction to the changing drug supply
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and seeing this incredibly devastating body count affecting literally every single county in the United States at the same time.
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And what we saw was that community groups came together and started asking, why is this happening here?
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What can we do to keep our neighbors alive?
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And that kind of curiosity, people had some spare time during the pandemic to actually read what was happening in other places,
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to watch videos, to have those
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Zoom meetings, to expand the possibilities of what was, you know, what the response could be,
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because people could see in every little town in America that the international control wasn't working,
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law enforcement wasn't able to arrest their way out of this problem, and people who are dying were their friends and their family members,
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and people wanted more compassion.
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They wanted those people back in their communities. And
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so there was a desire for humanity to enter into what
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had historically been a law enforcement only approach to drugs in the United States
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and the results of that have been so inspiring.
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I mean, you go to little towns in Indiana or Arkansas
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or Utah or any part of the country and there is someone who is bringing people together saying, this is a problem.
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We need more treatment.
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We need some harm reduction.
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We need to help people get back on their feet.
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We need to get treatment into jails and prisons.
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We need to break down barriers on how people get addiction treatment from medical providers, you know, asking questions like,
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how far do people have to drive to get addiction treatment for my community?
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And some places that answer is two hours per day, each direction.
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And that's and people saw that that is not OK.
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And I think some of the changes that we've seen over the last six years are really incredible.
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And, you know, we can point out the policy and technology that have changed.
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There's, you know, naloxone, which is the antidote, went over the counter. That helped.
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Telehealth expanded.
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There were less restrictions on physicians to begin, like general practice physicians, to start using some of the medications,
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new long -acting formulations of some of the medications for treating opioid use disorder.
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But at the same time, none of that would actually get into people's bodies,
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into the communities if it wasn't for the incredible work of all these little groups.
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And I'll just buttress that at the last moment here with this was also the time
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when the opioid settlement funds were just starting to be distributed.
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And so you had this confluence of wanting a humane change,
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compassionate change for your community with some additional resources, plus a kind of national awakening that we can do better.
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yeah how important do you think the role of journalism
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so the investigations that went on the media some of the books
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that were really sort of blockbuster on on bestseller lists around the opioid crisis um who was involved
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and why and for what profits how important do you think
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that was ultimately in in also helping to tell the voices of people at at at the individual level
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So I think media are a very powerful player in this realm.
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And I'm including fiction writers in here as well.
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And televised fictional portrayals also are part of the zeitgeist.
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And so I think the positive of that collectively has been a destigmatization of who is affected on a daily basis.
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The negative of that is that by harping on one storyline of bad actors that happened decades ago,
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takes agency away from people to act now.
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And this is, you know, attribution theory is a well -known part of health behavior and health understanding.
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And so the more that we shift, the more that we talk about this historical narrative,
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it becomes like, well, this was something that was set in motion years ago by people we have no control over.
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There's nothing we can do about this.
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And I think it really took the astronomical increase in fentanyl overdose deaths during the pandemic
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and the parallel public health response that was happening for a coronavirus
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that showed communities that they can actually do things to make changes,
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that they are, even though they don't have an MPH or an MD or a PhD after their names,
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they can be part of the public health system and make a meaningful change.
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So I think those things are really cool together.
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The other negative that we've seen, and we've published papers on this with the news media, is that by highlighting what the newest drug alert,
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the newest drug trend is for a rare drug that is maybe a little bit more potent or unusual in some way,
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but by doing that, it actually increases interest in that drug and causes suppliers in the U .S.
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to go out and seek sources internationally professionally to meet this new advertised by media demand.
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And we see this as a continuous cycle that happens every few months and is just disheartening to see.
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So from my perspective across the Atlantic, the opioid crisis has become wrapped up in a lot of social and political issues in the US.
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It seems to be wrapped up with the issue of left behind rural areas of poverty,
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of people who are feeling marginalized in society who might not have felt marginalized before, with what previous
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President Jimmy Carter might have referred to as malaise in the US.
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Is this still the case?
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Is the opioid crisis still seen as a sort of salient cultural and political issue in the United States?
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It is a salient political issue.
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It's something that even in the city I live in,
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a small southern city, this was a platform that was discussed by our local sheriff candidates regularly.
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And we hear it when I've testified in front of Congress.
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And so everywhere along the spectrum, I've seen strong bipartisanship on this issue.
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A lot of the strongest support for harm reduction has actually come from Republicans in the South, from the conservatives.
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You know, I think it's something that just cross cuts all areas of society.
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I think, you know, when we talk about, you mentioned kind of rurality as one of the places where this is showing up.
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I think, you know, looking at the extremes of rurality, which are often
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Native American reservations, that's probably the group demographically who is the most left behind.
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And for them, it wasn't a new problem.
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It was a hundreds of years old problem that had a new molecule associated with it.
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And that kind of legacy of colonialism,
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of exclusion, of genocide in the United States feeds directly into what we see now in the way
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that tribal organizations can access care, how oftentimes law enforcement first is a,
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you know, putting people in jail first becomes the priority
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and then we can get them some treatment maybe becomes the
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mentality instead of what we see in most of the rest of the country where it's let's get them into treatment.
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Let's get them, you know,
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putting them into jail one more time isn't going to finally fix their addiction problem and let's get them into medical care.
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So I think we do have to, I think there's new and I think there is also historical antecedents that are much deeper.
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So what future developments do you anticipate being needed now?
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What priorities should communities, politicians, researchers such as yourself be focusing on?
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At this moment, what we see is that 70 % of drug overdose deaths in the United States are happening among
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Gen X and millennials.
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And as the overdose decline continues,
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what we see is kind of a shrinking age graph where
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the mortality is becoming concentrated in people who are born between 1975 and 1990.
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And so while we try to think of, you know, in public health,
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it's often like, when do you throw everything at the wall and get everything to work?
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You know, it's really this population that bears the highest mortality in terms of age.
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Native Americans bear the highest in terms of rates.
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And I think those two are really important.
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Let's break this down.
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Like, what does it mean to be a Gen X adult who is now in their 40s
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or maybe even early 50s and is at the highest risk of dying of an overdose?
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Well, they may have, a lot of them have families, they have childcare, they have careers,
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they have other things that they need to do with their lives.
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And so drug treatment isn't just a doctor writing a prescription.
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It's also, you know, who's going to take care of my kid while I go to this appointment?
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It's transportation.
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There's a lot more responsibility that people of this age group face societally
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that we aren't really addressing to get them channeled into the most effective medicalized treatment modalities.
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So I think that's one concentration we need to look at.
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And the other is, you know, Gen Z and even, well, not quite yet Gen Alpha, But Gen Z's drug tastes have changed.
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And they're, like we said, not as opioid centered, but they're using a lot of cannabis and psilocybin and MDMA and ketamine.
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And so those things will cause different levels of societal harm.
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Maybe they're not immediately fatal, but they do change the way your brain functions
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when young folks whose brains are still forming have those molecules in their brains, right?
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So I think kind of understanding,
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I mean, we have so few medications and so few non -medical treatments even for any of those classes of substances, right?
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So I think now is the time to be developing and thinking about, okay, cannabis use disorder is real, and it does happen.
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And so what does cannabis harm reduction look like?
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What does de -escalating cannabis use for someone who finds their consumption pattern problematic?
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What do we do for them?
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And I think this is where the innovation needs to focus.
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And then prevention is also the last piece of this, where one of the most fascinating things that we found in our research is
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that the only age group that we saw an increase in overdose deaths
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when every other age group was declining were kids who were in middle school and early high school during the COVID pandemic.
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and they make up a small percent of the overall number, but their childhoods were interrupted because of the pandemic.
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That's usually a period when peers have conversations about drugs and there is some experimentation.
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Those conversations just did not happen and that education did not happen.
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And so we see kind of this bubble cohort, mini cohort of kids who are now starting to become adults,
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who are going to have, who are having serious addiction issues in a way that their other
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Gen Z peers are not.
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So I think that's a bubble we need to spend specific attention addressing.
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So now, Bruin, we're talking, we're recording this in late October, 2026.
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Now, a couple of days ago, The Lancet published a comment which was entitled
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The U .S.
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Opioid Epidemic at a Turning Point.
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The gist of this article is it's likely a good turning point, so overdose deaths going down.
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Is this your interpretation of the statistics?
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And do you think this trend will continue?
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Is this a glimmer of hope?
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I think it is a glimmer of hope.
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I thought that article was well written.
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And I agree with what the authors were saying.
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At this moment, I'm hopeful because of the changes that we're seeing in Gen Z in particular, with regard to opioid use.
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The other piece of this
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that we haven't talked as much about is how the drug supply has shifted dramatically over the last two years
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or so in the United States.
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And what we saw in 2024 was a massive wave of adulteration of the fentanyl supply.
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with extremely strong anesthetics and sedatives.
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And what this basically did was it drove people to say, hey, this dope is not making me feel good anymore.
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This is not giving me what I want out of my drugs.
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And we can talk about kind of why that adulteration happened,
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but it was a very defined period from spring of 2024 through just about January of 2026.
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And when you have any kind of consumer product and the consumer is not satisfied with that product,
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they either stop buying it or they look for alternatives.
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And in this particular case, you know, it's like we think of drug markets as these like all powerful external forces
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and that these molecules are hijacking brains, right?
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But in reality, the drug market made a mistake of adulterating it too heavily with things
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that were actually not stimulating the receptors in the brain that bring pleasure.
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And instead, we're just knocking people out.
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So when you fold that back in with, with folks who are in their forties and thirties,
393
like when they have careers and kids and other things to take care of, you can't afford to be knocked out for eight hours unexpectedly.
394
And if one bag of dope has fentanyl and the other one is cut heavily with these sedatives, you're playing this game of like,
395
what is going to happen?
396
Like there's no predictability.
397
And so what we've seen in our field work is
398
that this huge dissatisfaction with the American illicit opioid drug supply led people to find options or look for options.
399
And that was the word that we kept hearing.
400
And that was super fascinating is like this one word kept surfacing was like, what are my options?
401
Give me options.
402
And I think this is where it ties back into all the clinical expansion of clinical services
403
and the public health community groups were able to provide off -ramps to people when they were dissatisfied with their consumer product.
404
And I think this is really the other part of the encouragement and why I am hopeful things will continue,
405
and it's downward trajectory, is because some people were like, okay, I'm out of the game.
406
I've had enough.
407
This is not what I signed up for.
408
No, thanks.
409
How do I get out?
410
So we've been talking about the big picture here, but I think it's good at the end to draw it down to the individual level.
411
And I think the individual clinician might be interested in two questions.
412
And the first is, if I am a primary care doctor or a general physician, what should I think about when I'm prescribing opioids to people?
413
And then the second question is, what should be my main consideration right now when I'm helping people who have problems with opioid addiction?
414
What are the sort of short punchy bits of advice that you would give to those people?
415
When it comes to pain management, we have an aging population that is going to continue to need more pain management.
416
So looking at multimodal therapies, pain management therapies is great,
417
but also recognizing that some people do really need opioids in order to function, and that is okay.
418
Policies should not inhibit physicians from making that judgment,
419
and physicians should be open to prescribing what is needed.
420
And I think oftentimes pain patients get left behind in this conversation, but what we can see from our experience working with community groups is
421
that a lot of people who are now at the risk of,
422
uh, dying of a fentanyl overdose are pain patients who had been abruptly cut off from their pain medications.
423
And there's like a, we, we, we published a study where we, the, the average length of time between a last prescription
424
and drug overdose death is two to three years two to three years
425
so you know initially like from a clinical perspective
426
we were like oh the you know the risk period is
427
going to be two to three weeks right after a disruption
428
and tolerance but it turned out to be two to three years
429
and what that tells us is
430
that people who are being let go from clinical care because they had been on higher doses of opioids,
431
that they're looking for alternatives as well.
432
And this is where Kratom and TNeptine and some of the other quasi -legal drugs and cannabis too come into play.
433
But sometimes those people will go back to looking for opioids as well.
434
And so.. when treating pain, I know you wanted a punchy answer, but this is not a punchy short topic.
435
You know, the clinical management of these conditions is hard.
436
And I think, you know, having those honest conversations, I think the easiest thing to ask
437
if you're seeing in front of a patient is what has worked for you in the past.
438
And I think that applies just as much to pain patients as it does to addiction.
439
And what we have now is
440
so many people in the United States who have already been through a form of addiction treatment
441
and now maybe are so dissatisfied with the drug supply that they've got a little bit more resolve to continue with,
442
you know, to go back to that drug treatment, asking them, what worked for you in the past?
443
Was it a long -acting formulation?
444
Was it an oral one?
445
Was it buprenorphine?
446
Was it methadone?
447
Was it naltrexone?
448
Like, what worked for you before?
449
And I think that's the secret key that I hear from my clinician colleagues.
450
about how to work with people who have addiction, presenting now with the history of substance use disorders.
451
What I'm hearing is that this is a long story, it's a complex story, but nevertheless,
452
clinicians, individual patients, and communities still have agency in tackling this problem.
453
So thank you very much for joining us, Nabaroon.
454
Thanks as ever, Miriam, and thanks to you, the listener.
455
I hope that you've enjoyed this podcast.
456
If you want to read that comment on the US opioid epidemic at a turning point by Christina Andrews and Richard Frank,
457
you can read that with a lot of other fantastic content at thelancet .com.
458
But for now, goodbye.
459
And I do hope that you'll join us again next time.
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Vocabulary and speaking notes for this lesson
This speaking lesson is built on the video “What's the latest on the opioid crisis?”. This video has 459 sentences and 6114 words to shadow. The speech runs for 42:01. The speaker talks at a steady 146 words per minute, a comfortable pace for shadowing. 84% of the words are among the 3,000 most common in English; the rest is worth studying before you start.
Key vocabulary in this video
15 words from the video worth learning, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| overdose noun | /ˈəʊvə(ɹ)ˌdəʊs/ | An excessive and dangerous dose of a drug. |
| harm noun | /hɑːm/ | Physical injury; hurt; damage. |
| reduction noun | /ɹɪˈdʌk.ʃən/ | The act, process, or result of reducing. |
| addiction noun | /əˈdɪkˌʃən/ | A state that is characterized by compulsive drug use or compulsive engagement in rewarding behavior, despite negative consequences. |
| epidemic noun | /ˌɛpɪˈdɛmɪk/ | A widespread disease that affects many humans in a population. |
| intervention noun | /ɪntɚˈvɛnʃən/ | The action of intervening; interfering in some course of events. |
| molecule noun | /ˈmɑ.lɪ.kjul/ | The smallest particle of a specific element or compound that retains the chemical properties of that element or compound; two or more atoms held together by… |
| substance noun | /ˈsʌbstəns/ | Physical matter; material. |
| physician noun | /fəˈzɪʃən/ | A practitioner of physic, i.e. a specialist in internal medicine, especially as opposed to a surgeon; a practitioner who treats with medication rather than… |
| medication noun | /mɛdɪˈkeɪʃən/ | A medicine, or all the medicines regularly taken by a patient. |
| cannabis noun | /ˈkæ.nə.bɪs/ | A tall annual dioecious plant (Cannabis, especially Cannabis sativa), native to central Asia and having alternate, palmately divided leaves and tough bast… |
| prescription noun | /pɹəˈskɹɪp.ʃən/ | A written order from an authorized medical practitioner for provision of a medicine or other treatment, such as (ophthalmology) the specific lenses needed for… |
| innovation noun | /ˌɪn.əˈveɪ.ʃən/ | The act of innovating; the introduction of something new, in customs, rites, etc. |
| disorder noun | /dɪsˈɔɹdɚ/ | Absence of order; state of not being arranged in an orderly manner. |
| consequence noun | /ˈkɑn.sɪ.kwəns/ | An effect; something that follows a cause as a result. |
Phrasal verbs you will hear
| Word | Pronunciation | Meaning |
|---|---|---|
| go back to verb | To stem from; to originate in. | |
| go up verb | To move upwards. | |
| leave behind verb | To abandon. | |
| break down verb | To stop functioning. | |
| come together verb | /ˈkʌm tʊˈɡɛðɚ/ | To assemble; to congregate; to combine. |
| come up to verb | To approach. | |
| get out verb | To leave or escape. | |
| go down verb | To descend; to move from a higher place to a lower one. |
Sentences worth repeating
Short, complete lines from the video that you can reuse in everyday conversation:
- Let's start by catching listeners up.
- What can we do to keep our neighbors alive?
- What do we do for them?
- Is this your interpretation of the statistics?
- How do I get out?
Grammar in this video
The structures the speaker uses most, with the exact words from the video:
| Structure | In the video |
|---|---|
| Present perfect continuous have/has been + -ing — an action that started earlier and is still going on | have been practicing · we've been talking |
| Present perfect have/has + past participle — a past action that still matters now | have spanned · has seen · I've ever seen |
| Passive voice be + past participle — the focus is on what happens, not who does it | be done · can be traced · be replaced |
| Relative clauses who / which + clause — extra information about a person or thing | story which has · area, which is · people who use |
Pronunciation to watch
The speaker uses 69 contractions and reduced forms, such as I'm, we're, we've. Say them the short way, as you hear them.
- The “th” sounds: nevertheless /ˌnɛvɚðəˈlɛs/, methadone /ˈmɛθ.əˌdoʊn/
- The “sh” and “zh” sounds: reduction /ɹɪˈdʌk.ʃən/, addiction /əˈdɪkˌʃən/, intervention /ɪntɚˈvɛnʃən/, physician /fəˈzɪʃən/, medication /mɛdɪˈkeɪʃən/
- Long words — get the stress right: epidemic /ˌɛpɪˈdɛmɪk/, intervention /ɪntɚˈvɛnʃən/, medication /mɛdɪˈkeɪʃən/, innovation /ˌɪn.əˈveɪ.ʃən/, compassionate /kəmˈpæʃənət/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Shadow it sentence by sentence at normal speed, repeating each one until your rhythm matches the speaker.
- Record yourself and compare with the original, paying attention to words like overdose, harm, reduction.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.