Fatal overdoses are rising among adults 45 and older and stigma often keeps this age group out of the conversation. In this episode, Dr. Philip Chan, Consultant Medical Director at the Rhode Island Department of Health and a practicing primary care physician, discusses Rhode Island’s No Matter Why You Use campaign. Dr. Chan explains why middle-aged and older adults face elevated overdose risk, how isolation, medical prescribing, and a contaminated drug supply intersect, and why personal storytelling is key to reducing stigma about accessing care. The conversation also highlights Rhode Island’s overdose prevention strategies—from widespread naloxone access to community partnerships—and shares lessons other states can apply to save lives and start conversations sooner.
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This is Public HEALTH Review
MORNING EDITION for Monday,
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00:00:03,080 --> 00:00:06,120
February 2nd, 2026.
I'm John Sheehan for the
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00:00:06,120 --> 00:00:08,800
Association of State and
Territorial Health Officials.
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00:00:09,320 --> 00:00:12,520
Today, a response to fatal
overdoses that are rising among
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00:00:12,520 --> 00:00:16,560
adults 45 and older.
We talk with Doctor Philip Chan,
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00:00:16,680 --> 00:00:19,200
Consultant Medical Director at
the Rhode Island Department of
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00:00:19,200 --> 00:00:21,760
Health and a practicing primary
care physician.
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00:00:22,400 --> 00:00:25,680
Doctor Chan will discuss Rhode
Island's No Matter Why You Use
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00:00:25,680 --> 00:00:28,960
campaign and explain how
middle-aged and older adults
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00:00:29,200 --> 00:00:33,320
face elevated overdose risk, how
isolation, medical prescribing,
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00:00:33,320 --> 00:00:37,160
and a contaminated drug supply
intersect, and why personal
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storytelling is key to reducing
the stigma that surrounds
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accessing the care a person
needs.
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Doctor Chan This campaign Rhode
Island's Campaign of No Matter
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Why You Use, focuses on
substance use by adults 45 and
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older.
Why?
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It's a great question.
You know, we collect similar to
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all other states, we watch our
opioid surveillance at a very
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00:01:03,920 --> 00:01:05,200
close in the state of Rhode
Island.
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And we've noticed an increasing
rate of fatal overdoses,
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specifically middle-aged adults,
adults 45 and older.
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And it's quite striking really.
And it's really prompted us to
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consider what we can do more for
this age group.
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Is there any context to those
numbers?
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Has it risen as a result of the
pandemic?
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You know, I think it's risen for
a lot of reasons.
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You know, I think during the
pandemic, as you're alluding to,
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you know, a major complication
of the pandemic was isolation in
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general for, frankly, all of us.
But certainly as you get older,
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as most people know, you know,
older folks are more at risk of
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being isolated, and certainly
folks in middle age are more at
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risk.
And I think that that's played
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partly into it and with
isolation and with some of the
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other just general
comorbidities, other medical
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conditions that people have,
people middle-aged and older are
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often more at risk, frankly,
dying from opioids and other
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drugs in general.
So tell us more about the goals
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of the campaign and how you
developed it.
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So this past year, the Rhode
Island Department of Health
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released this campaign called No
Matter Why You Use.
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And the campaign was based on
some focus groups.
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It was based on some input from
the community.
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And the the consensus of the
campaign is, you know, no matter
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why you start to use, in this
case, opioids, you know, you
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want to think about these
issues, you want to think about
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overdose prevention.
Sometimes it's intentional, some
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a lot of times it's
unintentional, but you know, no
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matter why the reason you
started is that you were feeling
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sad and and isolated and alone.
Is it because you were in pain?
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You know, it's because you know
just you tried it once at a
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party, no matter why you use.
We wanted to draw awareness to
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the fact that this group was at
elevated risk of dying from an
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opioid overdose and we're seeing
it in the numbers and we wanted
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to do more to raise awareness
and also access to the resources
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that we have in this state.
Doctor Chan, you're a primary
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care physician.
You're practicing.
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Did the responses you heard in
these focus groups, did that
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match up with what you were
seeing in practice?
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It does, you know, I see, feel
like I spent half my time in
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primary care talking about
mental health, talking about
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things like depression, checking
in with people.
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And, you know, as we all know,
life is full of ups and downs.
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People, you know, a lot of good
times in life, but some bad
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times for sure.
And everyone deals with and
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handles those situations
differently.
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And there's a fraction of people
that do turn to substances for
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one reason or the other.
I know the campaign makes a big
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central focus of personal
storytelling and using these
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kinds of stories to drive home
that message.
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Is that right?
Exactly.
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And I think that that's one of
the key things that the campaign
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is really trying to address.
It's uncomfortable to talk about
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for a lot of people.
It's uncomfortable to say, you
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know, hey, doc, or hey, anyone,
you know, I may have a problem,
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right?
I may be addicted.
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Because the first step in
addressing all this is to be
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aware and just to start the
conversation and to start
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talking about it.
And really just to find someone
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that you can start talking about
it, hopefully a healthcare
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professional.
You know, I'd encourage people
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listening to, you know, talk to
their primary care provider, but
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just talk to someone in the
field just to start that
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conversation and acknowledge it
and, and talk about potential
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treatment options.
Yeah, it sounds like like the
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the goal is to sort of get that
conversation going, you know,
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before even talking about next
steps.
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Tell us more about the
partnership and collaboration
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that went into creating the
campaign.
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You know, one thing you know we
work, we're working towards here
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in Rhode Island with this
campaign is really also broad
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based collaborations across our
state.
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So public health department,
obviously our department,
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Department of Behavioral Health,
our executive Office of Health
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and Human Services, as well as
our community partners.
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And that's been one thing that
I've been really proud of our
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state is that we have really
significant community
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involvement in our efforts to
address the opioid epidemic.
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And you know, I feel like we we
partner with these folks, we
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listen to them, we work with
them.
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It really has been a team
effort, you know, and we're
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working to engage as well, our
primary care community.
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And lastly, Doctor Chan, could
you discuss or could you, could
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you expand on some sort of
lessons learned by Rhode Island
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that might be helpful for other
states?
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So great question.
So as I mentioned, you know,
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Rhode Island has has been a
leader in this regard and I've
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been proud to be part of our
response.
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The first is, is that it's
really, it really is a team
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based effort, you know, from my
perspective.
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And in the health department,
you know, health department,
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most health departments don't
offer direct services.
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So to, to, you know, to really
engage folks that may be at risk
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to provide services, we have to
partner with the community.
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We have to partner with clinics,
we have to partner with
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behavioral health clinics and
primary care clinics, emergency
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rooms, etcetera.
And I've been proud of our
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response here.
And I would really encourage
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many other states, you know, as
you think about this to really
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get feedback, input from the
community, to engage the
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community, to work with the
community to address these
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issues.
We've really tried to make
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naloxone available to, to, to
really everyone.
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We've had additional campaigns
and, and messaging that everyone
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should have access to naloxone
and certainly in hot spots
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where, where opioid overdoses
are known to occur.
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And we really freely distribute
naloxone across the state.
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We have vending machines through
our health department which have
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been very successful.
People can access these vending
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machines in hotspot areas 24/7.
There's been a lot of great
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uptake there.
I've been proud to, to, to be
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part of these efforts.
You know, we have a very strong
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Governor's overdose task force
which has brought together all
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these stakeholders led by a
fantastic person, Kathy Schultz.
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We have a opioid settlement
committee, advisory committee
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which is making use of our
opioid settlement funds which
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were obtained with our Attorney
General's office.
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And that's been exciting to
provide some additional
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resources to these efforts as
well.
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So I think the wheel in the tent
is there in our state.
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I think it's been nice to work,
including with our state
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legislature, with our governors.
Really the will is here to to do
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what we can to, to get a handle
on this.
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And it's had enough.
I can also say it's also had
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pretty significant effect.
So I think as a lot of folks may
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know, I mean, we've see, you
know, over 100,000 fatal
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overdoses a year in this
country.
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It has decreased for the latest
years that we have, has
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decreased a few percent.
But here in Rhode Island we've
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actually seen an almost 25%
reduction in fatal overdoses
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over the last couple years due
to these efforts.
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So we are ahead of the curve,
which I'm I'm proud of and I do
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think it's a combination of all
these efforts, including these
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communication campaigns and
messaging campaigns that we
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we've talked about today.
Doctor Philip Chan is consultant
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medical director at the Rhode
Island Department of Health and
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a practicing primary care
physician.
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National overdose trends
indicate the need for a
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comprehensive public health
approach that encompasses
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primary prevention of substance
use, overdose and mortality
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prevention, monitoring and
surveillance, and access to
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treatment and recovery services.
ASTO provides capacity building
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and technical assistance for
state and territorial health
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agencies in these areas to build
strong public health leadership
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for substance use prevention and
surveillance, establish
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effective multidisciplinary
partnerships, and support the
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implementation of policies that
are informed by evidence.
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Find more at the link in the
show notes.
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This has been Public Health
review Morning edition.
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00:09:26,160 --> 00:09:29,000
I'm John Sheehan for the
Association of State and
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00:09:29,000 --> 00:09:30,320
Territorial Health Officials.
00:00:00,720 --> 00:00:03,080
This is Public HEALTH Review
MORNING EDITION for Monday,
2
00:00:03,080 --> 00:00:06,120
February 2nd, 2026.
I'm John Sheehan for the
3
00:00:06,120 --> 00:00:08,800
Association of State and
Territorial Health Officials.
4
00:00:09,320 --> 00:00:12,520
Today, a response to fatal
overdoses that are rising among
5
00:00:12,520 --> 00:00:16,560
adults 45 and older.
We talk with Doctor Philip Chan,
6
00:00:16,680 --> 00:00:19,200
Consultant Medical Director at
the Rhode Island Department of
7
00:00:19,200 --> 00:00:21,760
Health and a practicing primary
care physician.
8
00:00:22,400 --> 00:00:25,680
Doctor Chan will discuss Rhode
Island's No Matter Why You Use
9
00:00:25,680 --> 00:00:28,960
campaign and explain how
middle-aged and older adults
10
00:00:29,200 --> 00:00:33,320
face elevated overdose risk, how
isolation, medical prescribing,
11
00:00:33,320 --> 00:00:37,160
and a contaminated drug supply
intersect, and why personal
12
00:00:37,160 --> 00:00:40,240
storytelling is key to reducing
the stigma that surrounds
13
00:00:40,240 --> 00:00:42,560
accessing the care a person
needs.
14
00:00:43,960 --> 00:00:48,320
Doctor Chan This campaign Rhode
Island's Campaign of No Matter
15
00:00:48,320 --> 00:00:53,400
Why You Use, focuses on
substance use by adults 45 and
16
00:00:53,400 --> 00:00:55,520
older.
Why?
17
00:00:56,120 --> 00:00:58,960
It's a great question.
You know, we collect similar to
18
00:00:58,960 --> 00:01:03,920
all other states, we watch our
opioid surveillance at a very
19
00:01:03,920 --> 00:01:05,200
close in the state of Rhode
Island.
20
00:01:05,560 --> 00:01:09,720
And we've noticed an increasing
rate of fatal overdoses,
21
00:01:09,920 --> 00:01:13,000
specifically middle-aged adults,
adults 45 and older.
22
00:01:13,400 --> 00:01:16,560
And it's quite striking really.
And it's really prompted us to
23
00:01:16,560 --> 00:01:18,720
consider what we can do more for
this age group.
24
00:01:19,440 --> 00:01:21,040
Is there any context to those
numbers?
25
00:01:21,040 --> 00:01:23,440
Has it risen as a result of the
pandemic?
26
00:01:24,160 --> 00:01:26,880
You know, I think it's risen for
a lot of reasons.
27
00:01:27,280 --> 00:01:30,120
You know, I think during the
pandemic, as you're alluding to,
28
00:01:30,520 --> 00:01:34,520
you know, a major complication
of the pandemic was isolation in
29
00:01:34,520 --> 00:01:38,640
general for, frankly, all of us.
But certainly as you get older,
30
00:01:38,640 --> 00:01:41,480
as most people know, you know,
older folks are more at risk of
31
00:01:41,480 --> 00:01:45,480
being isolated, and certainly
folks in middle age are more at
32
00:01:45,480 --> 00:01:47,080
risk.
And I think that that's played
33
00:01:47,720 --> 00:01:52,400
partly into it and with
isolation and with some of the
34
00:01:52,400 --> 00:01:55,960
other just general
comorbidities, other medical
35
00:01:56,160 --> 00:02:00,360
conditions that people have,
people middle-aged and older are
36
00:02:00,360 --> 00:02:04,640
often more at risk, frankly,
dying from opioids and other
37
00:02:04,640 --> 00:02:08,199
drugs in general.
So tell us more about the goals
38
00:02:08,199 --> 00:02:10,160
of the campaign and how you
developed it.
39
00:02:10,759 --> 00:02:13,520
So this past year, the Rhode
Island Department of Health
40
00:02:13,520 --> 00:02:16,720
released this campaign called No
Matter Why You Use.
41
00:02:17,120 --> 00:02:19,360
And the campaign was based on
some focus groups.
42
00:02:19,680 --> 00:02:22,080
It was based on some input from
the community.
43
00:02:22,600 --> 00:02:27,520
And the the consensus of the
campaign is, you know, no matter
44
00:02:27,520 --> 00:02:32,320
why you start to use, in this
case, opioids, you know, you
45
00:02:32,320 --> 00:02:34,880
want to think about these
issues, you want to think about
46
00:02:35,320 --> 00:02:38,960
overdose prevention.
Sometimes it's intentional, some
47
00:02:39,040 --> 00:02:42,720
a lot of times it's
unintentional, but you know, no
48
00:02:42,720 --> 00:02:45,680
matter why the reason you
started is that you were feeling
49
00:02:45,680 --> 00:02:50,560
sad and and isolated and alone.
Is it because you were in pain?
50
00:02:51,600 --> 00:02:54,280
You know, it's because you know
just you tried it once at a
51
00:02:54,280 --> 00:02:58,760
party, no matter why you use.
We wanted to draw awareness to
52
00:02:58,760 --> 00:03:04,880
the fact that this group was at
elevated risk of dying from an
53
00:03:04,880 --> 00:03:07,840
opioid overdose and we're seeing
it in the numbers and we wanted
54
00:03:07,840 --> 00:03:11,520
to do more to raise awareness
and also access to the resources
55
00:03:11,520 --> 00:03:14,720
that we have in this state.
Doctor Chan, you're a primary
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care physician.
You're practicing.
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Did the responses you heard in
these focus groups, did that
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match up with what you were
seeing in practice?
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It does, you know, I see, feel
like I spent half my time in
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primary care talking about
mental health, talking about
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things like depression, checking
in with people.
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And, you know, as we all know,
life is full of ups and downs.
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People, you know, a lot of good
times in life, but some bad
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times for sure.
And everyone deals with and
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handles those situations
differently.
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And there's a fraction of people
that do turn to substances for
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one reason or the other.
I know the campaign makes a big
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central focus of personal
storytelling and using these
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kinds of stories to drive home
that message.
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Is that right?
Exactly.
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And I think that that's one of
the key things that the campaign
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is really trying to address.
It's uncomfortable to talk about
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for a lot of people.
It's uncomfortable to say, you
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know, hey, doc, or hey, anyone,
you know, I may have a problem,
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right?
I may be addicted.
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Because the first step in
addressing all this is to be
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aware and just to start the
conversation and to start
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talking about it.
And really just to find someone
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that you can start talking about
it, hopefully a healthcare
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professional.
You know, I'd encourage people
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listening to, you know, talk to
their primary care provider, but
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just talk to someone in the
field just to start that
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conversation and acknowledge it
and, and talk about potential
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treatment options.
Yeah, it sounds like like the
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the goal is to sort of get that
conversation going, you know,
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before even talking about next
steps.
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Tell us more about the
partnership and collaboration
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that went into creating the
campaign.
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You know, one thing you know we
work, we're working towards here
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in Rhode Island with this
campaign is really also broad
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based collaborations across our
state.
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So public health department,
obviously our department,
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Department of Behavioral Health,
our executive Office of Health
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and Human Services, as well as
our community partners.
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And that's been one thing that
I've been really proud of our
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state is that we have really
significant community
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involvement in our efforts to
address the opioid epidemic.
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And you know, I feel like we we
partner with these folks, we
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listen to them, we work with
them.
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It really has been a team
effort, you know, and we're
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working to engage as well, our
primary care community.
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And lastly, Doctor Chan, could
you discuss or could you, could
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you expand on some sort of
lessons learned by Rhode Island
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that might be helpful for other
states?
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So great question.
So as I mentioned, you know,
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Rhode Island has has been a
leader in this regard and I've
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been proud to be part of our
response.
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The first is, is that it's
really, it really is a team
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based effort, you know, from my
perspective.
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And in the health department,
you know, health department,
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most health departments don't
offer direct services.
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So to, to, you know, to really
engage folks that may be at risk
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to provide services, we have to
partner with the community.
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We have to partner with clinics,
we have to partner with
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behavioral health clinics and
primary care clinics, emergency
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rooms, etcetera.
And I've been proud of our
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response here.
And I would really encourage
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many other states, you know, as
you think about this to really
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get feedback, input from the
community, to engage the
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community, to work with the
community to address these
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issues.
We've really tried to make
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naloxone available to, to, to
really everyone.
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We've had additional campaigns
and, and messaging that everyone
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should have access to naloxone
and certainly in hot spots
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where, where opioid overdoses
are known to occur.
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And we really freely distribute
naloxone across the state.
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We have vending machines through
our health department which have
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been very successful.
People can access these vending
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machines in hotspot areas 24/7.
There's been a lot of great
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uptake there.
I've been proud to, to, to be
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part of these efforts.
You know, we have a very strong
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Governor's overdose task force
which has brought together all
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these stakeholders led by a
fantastic person, Kathy Schultz.
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We have a opioid settlement
committee, advisory committee
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which is making use of our
opioid settlement funds which
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were obtained with our Attorney
General's office.
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And that's been exciting to
provide some additional
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resources to these efforts as
well.
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So I think the wheel in the tent
is there in our state.
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I think it's been nice to work,
including with our state
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legislature, with our governors.
Really the will is here to to do
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what we can to, to get a handle
on this.
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And it's had enough.
I can also say it's also had
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pretty significant effect.
So I think as a lot of folks may
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00:08:06,480 --> 00:08:10,400
know, I mean, we've see, you
know, over 100,000 fatal
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overdoses a year in this
country.
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It has decreased for the latest
years that we have, has
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decreased a few percent.
But here in Rhode Island we've
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actually seen an almost 25%
reduction in fatal overdoses
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over the last couple years due
to these efforts.
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So we are ahead of the curve,
which I'm I'm proud of and I do
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think it's a combination of all
these efforts, including these
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communication campaigns and
messaging campaigns that we
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we've talked about today.
Doctor Philip Chan is consultant
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medical director at the Rhode
Island Department of Health and
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00:08:46,640 --> 00:08:48,640
a practicing primary care
physician.
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00:08:49,400 --> 00:08:51,800
National overdose trends
indicate the need for a
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00:08:51,800 --> 00:08:54,360
comprehensive public health
approach that encompasses
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00:08:54,360 --> 00:08:57,440
primary prevention of substance
use, overdose and mortality
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prevention, monitoring and
surveillance, and access to
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treatment and recovery services.
ASTO provides capacity building
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00:09:04,520 --> 00:09:07,120
and technical assistance for
state and territorial health
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00:09:07,120 --> 00:09:11,040
agencies in these areas to build
strong public health leadership
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00:09:11,040 --> 00:09:14,280
for substance use prevention and
surveillance, establish
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00:09:14,280 --> 00:09:17,240
effective multidisciplinary
partnerships, and support the
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00:09:17,240 --> 00:09:20,360
implementation of policies that
are informed by evidence.
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Find more at the link in the
show notes.
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This has been Public Health
review Morning edition.
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00:09:26,160 --> 00:09:29,000
I'm John Sheehan for the
Association of State and
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Territorial Health Officials.