Signs of Teen Fentanyl Use

0:00:13 William Moyers
Hello everyone! Thanks for joining us for another conversation in our podcast series, Let's Talk. Brought to you by Hazelden Betty Ford. I'm your host, William C. Moyers. Joining me today, Dr. Sara Polley. Welcome, Sara!

0:00:26 Dr. Sara Polley
Yeah I'm happy to be here!

0:00:27 William Moyers
Thanks for being here today. We're gonna talk about fentanyl in just a moment. I know our parents and our other viewers will have a lot of interest in that. But I just want you to level-set for us first. You and I are here in a studio in Minneapolis, what's the state of affairs for youth and substances today?

0:00:46 Dr. Sara Polley
Yeah well there's a lot of interesting things going on. Kind of as we come out of the pandemic. I think one of the pieces of good news is that adolescent and youth substance use has actually held steady from last year—

0:00:56 William Moyers
Hmm.

0:00:57 Dr. Sara Polley
And so what that means is that we actually saw a decrease in overall substance use among young people during the pandemic in 2021. And so the data for 2022 has just come out, and many of those decreases have remained similar to what they were in 2021. So that's actually good news—

0:01:12 William Moyers
Yes!

0:01:13 Dr. Sara Polley
Is that less young people are using substances than they were in the five years previous to the past two.

0:01:19 William Moyers
Does that surprise you?

0:01:20 Dr. Sara Polley
It does! Because then that's the other piece that's very interesting, I think, is that the youth that were struggling before the pandemic and during the pandemic are continuing to struggle. And so we're seeing all-time highs in the amount of young people reporting symptoms of depression and anxiety, difficulties with families, are still there from the pandemic.

0:01:35 William Moyers
Mmm.

0:01:39 Dr. Sara Polley
And those that were using substances before the pandemic and then those escalated during the pandemic, those individuals, and then that's continued for them. So it's almost like we're seeing a split where there's the healthy kids are actually doing better, and the kids who were already struggling are doing worse. And those are the kids that we see come into treatment that are, you know, more dysregulated, more anxious, more depressed, more severe substance use disorders than we were seeing pre-pandemic.

0:02:00 William Moyers
Mmm-hmm. And a lot of those that you are seeing are young people who use fentanyl?

0:02:11 Dr. Sara Polley
That's right, yeah. 

0:02:12 William Moyers
What is fentanyl?

0:02:13 Dr. Sara Polley
So fentanyl is a synthetic opioid. And so an opioid is a medication—those medications were invented to relieve pain.

0:02:20 William Moyers
Mmm-hmm.

0:02:21 Dr. Sara Polley
And they have a lot of really important uses. Particularly fentanyl, which is a very potent opioid, is used a lot in emergency settings. And so if you were a patient that came in after a car accident and had trauma, the doctors would give you fentanyl because it works very quickly, it relieves pain, they use it during surgeries, before surgeries. And some individuals with chronic pain related to bone cancers and things can really benefit from fentanyl.

0:02:43 William Moyers
Hmm.

0:02:44 Dr. Sara Polley
So that's one of the things I always point out is that, you know, we hear fentanyl and it sounds very scary and we hear about it being used illicitly, but it's actually not an all-good or all-bad type of thing. It's actually a medication that has a lot of value. But then, like a lot of medications, you know, when used in higher amounts than what's intended when prescribed, it can cause euphoria—

0:03:02 William Moyers
Mmm-hmm. Mmm-hmm.

0:03:03 Dr. Sara Polley
And it can cause intoxication and so then, you know, now we find that the fentanyl that's available kind of illicitly is manufactured in labs which, you know, are not the same labs that are manufacturing it for medical purposes. And so then it's being put into pills and is available on the street.

0:03:19 William Moyers
How do you ingest fentanyl?

0:03:21 Dr. Sara Polley
Yeah, so it can be used either in a powder form or oftentimes it's pressed into a pill—

0:03:26 William Moyers
Okay.

0:03:27 Dr. Sara Polley
And then someone can either ingest that orally, they can put it into their nose, they can inject it, they can melt it and inject it into their vein using a needle.

0:03:34 William Moyers
Mmm. Okay. And there was a time when fentanyl was equated with nothing more than the fact that people were ingesting it accidentally—

0:03:44 Dr. Sara Polley
Yeah.

0:03:44 William Moyers
And it was killing them.

0:03:45 Dr. Sara Polley
Yes.

0:03:46 William Moyers
But what you have found is what?

0:03:47 Dr. Sara Polley
Yes. And so that's correct, so initially, I think when it was first available, people would be purchasing these pills on the street. And they wouldn't necessarily know that the pill contained fentanyl because the illicit manufacturer would design it to look like a different type of drug. 

0:04:01 William Moyers
Mmm.

0:04:01 Dr. Sara Polley
And, you know, what we're seeing now actually is that most of my patients know that the pills that they're purchasing contain fentanyl. And what they're looking for is to get a good high or a good level of intoxication and so they're intentionally purchasing pills that have fentanyl, because they're looking to kind of get the best feeling that they can get.

0:04:17 William Moyers
Is there something else that they're also seeking in addition to that euphoria? In other words, is it being—are they using fentanyl with something else?

0:04:24 Dr. Sara Polley
Yeah and so that's where it gets really dangerous and more specifically recently. Especially in the state of Minnesota. We've been seeing a lot of other sedatives now mixed with a pill that also contains fentanyl. And so, you know, the worrisome part is that these sedatives don't necessarily respond to some of the emergency interventions that we have for treatment of opioid overdose—

0:04:41 William Moyers
Mmm-hmm.

0:04:42 Dr. Sara Polley
And so that's where we're seeing people die really unexpectedly, again, because they know they're using fentanyl and they may know that it has additives and other sedatives in it. But they don't know how much or how those combine together and then they're accidentally overdosing.

0:04:56 William Moyers
Dr. Polley, you're down in the trenches, you see patients, what is their reasoning or what is their excuse? How do they explain to you that they're deliberately using fentanyl?

0:05:09 Dr. Sara Polley
Yeah. Well, it's like any addiction, right? It's like the same—I think of it sometimes like when you would speak to someone who's struggling with alcoholism, right?

0:05:18 William Moyers
Mmm-hmm.

0:05:18 Dr. Sara Polley
It's like they're in liver failure, they're cirrhotic, they're dying, and yet they're still drinking alcohol. And it's hard I think for somebody not struggling with an addiction or who's never been there to really understand. But as we know, addiction really takes control of decision-making.

0:05:31 William Moyers
Mmm-hmm.

0:05:33 Dr. Sara Polley
And so, many young people, they realize that it's not logical and that they could die, but they're just really driven by that primitive part of their brain that has been hijacked by their addiction to opioids—

0:05:42 William Moyers
Yes.

0:05:44 Dr. Sara Polley
Which is making them make decisions that they're not actually thinking about, they're just sort of going through the motions.

0:05:49 William Moyers
Are they aware, though, that fentanyl has been attributed to overdose deaths? Do they know that is a reality?

0:05:58 Dr. Sara Polley
Yes. So most of my patients know that. I'm actually really impressed by the majority of my patients trying to take safety precautions when they can.

0:06:06 William Moyers
What do you mean taking safety precautions?

0:06:08 Dr. Sara Polley
Yeah, good question. So, many people don't use alone. 

0:06:11 William Moyers
Ah.

0:06:12 Dr. Sara Polley
Many people have somebody within their group who's either planning to use much less than everybody else or not planning to use that day—

0:06:17 William Moyers
Mmm-hmm.

0:06:18 Dr. Sara Polley
They're only gonna use some other substances which they think are gonna be safer. So that person would be coherent enough to help those that were using something with fentanyl to be able to help. You know, there's Naloxone is a medication that can be prescribed and there's some push to actually have it available over the counter. Which can be used just by anyone in the community. It's a nasal spray that can reverse the effects of an opioid overdose.

0:06:39 William Moyers
Yes.

0:06:40 Dr. Sara Polley
And so, many of my patients actually have Naloxone with them when they're using with friends and they know how to use it. Many of them are aware of laws that exist that protect them—

0:06:49 William Moyers
Yes. Yes.

0:06:49 Dr. Sara Polley
In case they called 9-1-1. And so, I have many patients that will call 9-1-1 if they aren't able to wake up a friend who has used. Because I think most people don't want anyone to die—

0:06:59 William Moyers
Mmm-hmm.

0:06:59 Dr. Sara Polley
I mean they're not looking to really hurt anybody or hurt themselves. Again they're sort of just looking for a high because of their addiction.

0:07:04 William Moyers
That's interesting. So they know that they're using a very deadly substance—

0:07:09 Dr. Sara Polley
Yeah.

0:07:10 William Moyers
They're taking precautions for overdose—

0:07:12 Dr. Sara Polley
Mmm-hmm.

0:07:13 William Moyers
But that's not enough to deter them from using it anyway.

0:07:16 Dr. Sara Polley
Yeah.

0:07:17 William Moyers
Sort of like the drunk driver who puts his seatbelt on after he gets intoxicated.

0:07:22 Dr. Sara Polley
Yeah. Right, no that's exactly righ, yeah. 

0:07:24 William Moyers
Hmm.

0:07:25 Dr. Sara Polley
And I think the other piece that's really interesting from an adolescent development perspective is that most of my young people know that it's possible to die from overdose or die from fentanyl, they've even had friends that have died from overdose—

0:07:35 William Moyers
Hmm.

0:07:36 Dr. Sara Polley
But then they don't think that that would happen to them. Which is completely normative when you look at an adolescent. [Moyers laughs] Adolescents and their brains are made to sort of feel like they're special and the bad things that happen to other people won't happen to them. Which makes them so resilient and able to kind of grow through struggle. But it also it's not logical, right?

0:07:53 William Moyers
Right. [smiles, chuckles]

0:07:54 Dr. Sara Polley
It's like you've had two friends that use the same pill as you and they—one of them overdosed and the other one passed away, why don't you think that would happen to you? 'Oh, well, I have a higher tolerance than other people, I'm more careful than other people,' like they have narratives as to why that would be—

0:08:07 William Moyers
Yes.

0:08:07 Dr. Sara Polley
And again, it's not logical, but it's totally normal.

0:08:09 William Moyers
Of course. So before we move onto the how parents and educators can recognize somebody who might be under the influence of opioids, but maybe specifically fentanyl, I need to ask you this question though. I have, in my recovery community, there are people who talk about the fact that they are addicted to marijuana. And they seem to manage that. But then the day came when they purchased some marijuana that had fentanyl in it. Is it possible to have fentanyl in something as “benign” [uses air quotes]? 

0:08:43 Dr. Sara Polley
Yeah, yeah, well that's the scary thing, right? Is that yes, it's very possible. I mean, anything that you're obtaining illicitly, you're almost putting trust in untrustworthy individuals who are illicitly manufacturing and selling drugs.

0:08:54 William Moyers
Sure. Yes. Yes. Uh-huh.

0:08:57 Dr. Sara Polley
And so, again, it doesn't make sense, right? But yes, there can be fentanyl or other types of unexpected drugs like stimulants sometimes, methamphetamine, even in something that is considered more low-risk or benign like marijuana.

0:09:10 William Moyers
Mmm-hmm.

0:09:10 Dr. Sara Polley
It's very possible.

0:09:11 William Moyers
We get a lot of people who watch our podcast series who wanna know more about whatever the topic is. And I know we're gonna have a lot of parents tuning in who are gonna be terrified to hear what you're talking about in a lot of ways. 'Cause it's scary to consider that your child can be using something that can kill them like that. [snaps fingers] What should parents be watching for?

0:09:31 Dr. Sara Polley
That's a good question. So, one of the things I think that the media sometimes misses is that they go for the shock headline, right? They go for 'these kids were at a party and everything was fine, and then all of a sudden they died because they just all of a sudden used fentanyl.' [chuckles] And one of the things that we talk about with prevention work is that it's not like everything was going fine, there were no warning signs and then all of a sudden a kid is dead of fentanyl overdose.

0:09:55 William Moyers
Hmm.

0:09:56 Dr. Sara Polley
Oftentimes there are things that are happening leading up to the use of the fentanyl. And it could be that they didn't know they were using fentanyl, but it's not that—you know, kids were engaging in risk-taking behavior, using substances again that we talked about that are viewed kind of culturally as being not as bad, like nicotine or cannabis, or episodes of binge-drinking alcohol—

0:10:06 William Moyers
Mmm-hmm.

0:10:16 Dr. Sara Polley
So, if you have a young person who's engaged in those behaviors, I think that should really have your warning flags raised that that group is more at risk of an accidental or of using fentanyl intentionally—

0:10:29 William Moyers
Mmm.

0:10:30 Dr. Sara Polley
--And so it's important that we intervene early when we have young people using substances.

0:10:33 William Moyers
Mmm-hmm.

0:10:33 Dr. Sara Polley
One of the things we talk about a lot is that I think there's a belief that it's normal for youth to use substances. Right?

0:10:39 William Moyers
Right. [nods]

0:10:40 Dr. Sara Polley
So it's normal for a fourteen-year-old to have alcohol at a party, or it's normal for a sixteen-year-old to smoke marijuana with their friends. And when we look at the data, most young people are actually not using substances. And so it isn't really normative to have a young person who's using substances with friends or, you know, lying and sneaking around to use. And so those should really be warning signs to go and have your child evaluated by their doctor—

0:11:02 William Moyers
Mmm-hmm.

0:11:03 Dr. Sara Polley
You know, doctors will perform a screening questionnaire for a young person to determine if they're at risk of a substance use disorder. 

0:11:10 William Moyers
Mmm-hmm.

0:11:10 Dr. Sara Polley
And really trying to take it seriously. A lot of parents I think—it's a lot of work to take it seriously, right? When I say that I don't say that lightly.

0:11:18 William Moyers
Yes. Right. Yeah.

0:11:18 Dr. Sara Polley
 It's hard to find treatment. There's stigma associated with it, but, you know, if your young person is kind of gravitating towards risky decision-making, lying, there's family conflict, you know, you're noticing that things change with their engagement in school, those are all warning signs.

0:11:32 William Moyers
Mmm.

0:11:33 Dr. Sara Polley
So it's not that, you know, kids just all of a sudden use fentanyl and die—

0:11:37 William Moyers
Right. Mmm-hmm.

0:11:37 Dr. Sara Polley
-- I think there's a lot that we can do to kinda catch things going wrong early. 

0:11:41 William Moyers
When that happens, when we as parents or we as teachers in school or grandparents, catch somebody that we care about early on, and we direct them towards—well how should a parent talk to their children about the use of substances in general? And specifically opiates and specifically fentanyl?

0:12:02 Dr. Sara Polley
Yeah. Well I think so first of all, I think it's important as a parent to educate yourself. And so, there's resources through the government, through Hazelden—

0:12:10 William Moyers
Mmm-hmm.

0:12:10 Dr. Sara Polley
That can really educate you on what is fentanyl, where are we finding it, you know, the details I think are important for a parent to know. Just so that they can have an informed discussion. A lot of times kids know this information. [Moyers chuckles] And so if you try to approach talking to them—and even if you don't know, I think taking a curious stance, like, 'What do you know about fentanyl,' as the start of a conversation is good, right?

0:12:29 William Moyers
Mmm-hmm. Mmm-hmm.

0:12:31 Dr. Sara Polley
Because teens don't like you tell them what to do or what you know, especially if you don't know as much as them. [Moyers laughs] So really approaching it in kind of a curious way. You know, one thing I think that comes up is it's important I think for adults and for parents to be clear about what the expectations are. 

0:12:45 William Moyers
Ah.

0:12:46 Dr. Sara Polley
So that always is interesting to me. Like I'll meet with kids and I'll ask them, 'Well what does your mom think about your smoking marijuana?' 

0:12:52 William Moyers
Mmm-hmm.

0:12:53 Dr. Sara Polley
And they'll say, 'Oh, well, she's never actually told me,' or, 'I don't know,' or, 'I think that if she didn't know, she wouldn't really care.' Or, 'If it's not too big of a deal, she's not gonna care.' And so I think it's important for parents to be really explicit. Like, 'In this family, I am against you smoking marijuana, I am against you drinking alcohol, and if we find out that that happens then there will be consequences and we'll have to talk about it.'

0:13:09 William Moyers
Mmm-hmm. Mmm-hmm.

0:13:13 Dr. Sara Polley
And to just be clear about that. Just like you would be about any other safety-related behavior.

0:13:17 William Moyers
Mmm-hmm. Right. Right.

0:13:18 Dr. Sara Polley
You know, like, 'Put this seatbelt on or I'm pulling the car over' kind of thing.

0:13:21 William Moyers
Yes. Yes.

0:13:22 Dr. Sara Polley
And the other piece too is that obviously it's very emotional to find out that your child is using, if you find something in their room or you find out their friends have done something and you wonder if they have. And it's so important for adults and caretakers to work on their own emotional regulation.

0:13:37 William Moyers
Mmm.

0:13:37 Dr. Sara Polley
I can't tell you how many times, you know, a parent gets dysregulated because they found out that their child is doing something. And then it just turns into a screaming match. 

0:13:47 William Moyers
Yeah.

0:13:48 Dr. Sara Polley
A big conflict. Of 'I'm stripping your bedroom of everything that you have in there because I can't believe you did this to me.' Or 'I'm pulling you out of soccer.' 

0:13:55 William Moyers
Mmm-hmm.

0:13:56 Dr. Sara Polley
Or, you know, this kind of like large emotional reaction. I think it's really important for adults to take care of themselves and learn about their own coping—

0:14:03 William Moyers
Right.

0:14:04 Dr. Sara Polley
So that they can approach those situations which are really hard situations. In a calm manner.

0:14:07 William Moyers
Right. Yes.

0:14:09 Dr. Sara Polley
And it's not that you don't have consequences or you don't sort of be serious, but it's like you gotta stay calm during the conversation or you can't move forward.

0:14:14 William Moyers
Mmm-hmm. Mmm-hmm. What's the treatment for opioid dependence? Particularly fentanyl. Or are they all considered the same when it comes to the treatment?

0:14:25 Dr. Sara Polley
Yeah. That's a good question. So, we have a lot of really great kind of wrap-around treatments for patients with opioid use disorder. And so when I say wrap-around, what I mean is that we approach it from a spiritual angle, behavioral angle, from a medication angle. And from a mental health angle.

0:14:38 William Moyers
Hmm. Mmm-hmm.

0:14:40 Dr. Sara Polley
And so we really try to kind of provide individualized kind of multidisciplinary services to patients with opioid use disorder.

0:14:47 William Moyers
Mmm-hmm.

0:14:47 Dr. Sara Polley
Because many of them, again, it's not sort of an isolated issue, a lot of people with opioid use struggles also have mental health issues—

0:14:55 William Moyers
Yes.

0:14:55 Dr. Sara Polley
Again, family conflict, a lot of them have academic struggles because they've fallen behind in school due to their use disorder. And so it really involves kind of providing multidisciplinary intervention.

0:15:04 William Moyers
Mmm-hmm.

0:15:05 Dr. Sara Polley
You know, I wanna speak about the medications for opioid use disorder—

0:15:07 William Moyers
Please. Yeah.

0:15:08 Dr. Sara Polley
Because I think I often say that I wish that I had as effective medications for all of the substance use disorders as I do for opioid use disorder.

0:15:16 William Moyers
Mmm.

0:15:17 Dr. Sara Polley
It is a huge blessing that we have access to really effective medications. And so, one that we use very frequently is something called Buprenorphine. And I think there's a lot of misconception in the community about that medication.

0:15:28 William Moyers
Yes. Yes. [nods]

0:15:29 Dr. Sara Polley
You know, even among the Twelve Step abstinence community where I think it's getting better, but there still may be this thought that you're not really sober or really clean if you're using Buprenorphine.

0:15:40 William Moyers
Right.

0:15:40 Dr. Sara Polley
And so, the way that medication works is it actually goes into the brain and it goes to the opioid receptor. And rather than sort of like full-on giving it stimulation, like something like fentanyl or heroin would do, it gives it a tiny bit of stimulation and it blocks the receptor.

0:15:53 William Moyers
Mmm-hmm. Yes. Yes.

0:15:55 Dr. Sara Polley
And so what that does is it actually allows the brain, which has changed as a result of the opioid use, to heal itself. And so particularly in young people, I love working with young people because there's such potential for their brain to change!

0:16:06 William Moyers
Yes. Yes. 'Cause it's still changing! [chuckles]

0:16:09 Dr. Sara Polley
Yes! Exactly! And so, you know, we have—if I were treating an older person with an opioid use disorder, sometimes I have to have the conversation that this medicine might be something that you should be on for the rest of your life.

0:16:19 William Moyers
Yes. Yes.

0:16:19 Dr. Sara Polley
Because your brain may never be able to get back to that state.

0:16:22 William Moyers
Mmm-hmm.

0:16:23 Dr. Sara Polley
And you trying to be sober is gonna be really hard. And it's not fair that you need to work 250 percent just to stay alive—

0:16:31 William Moyers
Right.

0:16:31 Dr. Sara Polley
--We can give you this medicine to make it easier for you.

0:16:34 William Moyers
Yeah, it's a great point.

0:16:35 Dr. Sara Polley
And so, but with young people, I have a lot of hope. And I talk a lot about how this is really potentially gonna be a temporary thing. And your brain really has the ability to get back to how it was before you ever used opioids. 

0:16:41 William Moyers
Mmm-hmm. Mmm-hmm.

0:16:46 Dr. Sara Polley
And you're always gonna need to kind of take care of your spiritual, behavioral health. But that medicine may not always be something that you need to kind of manage your recovery.

0:16:54 William Moyers
Yes. And I know that a lot of parents talk to me about that concern. That well why would you—you know, 'My son is addicted to pain pills, but why would you get him off those pain pills and put him on a medicine that's got opiates in it?' And the response is because it quiets the craving brain and gives that young person a chance to develop resiliency.

0:17:08 Dr. Sara Polley
Yeah, yes. Yes! And it helps their brain to, again, revert back to how it was from before it ever used the opioids.

0:17:19 William Moyers
Yes. Yes. And what about recovery for young people with a medicine like Buprenorphine in the context of the Twelve Steps? Do they go hand in glove, can they fit together?

0:17:34 Dr. Sara Polley
Yeah. Well I think they very much can. I mean I think—the way that I sort of think about it is like any medical or mental illness that a person has, right, it's like you need adequate treatment for that. And then you can really live to your full potential and engage in the Twelve Steps and be able to kind of make recovery possible.

0:17:53 William Moyers
Mmm-hmm.

0:17:54 Dr. Sara Polley
And so, just like if somebody were working the Twelve Steps and had diabetes, I wouldn't say, 'Well in addition you have to kind of manage your blood sugar because you need to be able to do this on your own.' Like to me that isn't fair. Or, 'You have really severe depression and well you're just gonna have to like get it together and just do the Twelve Steps,' because to me it just feels unfair and it feels like we're setting people up for failure.

0:18:10 William Moyers
Right. Yes. Well and to this last question, talking about success and failure, I also hear from parents that feel that the treatment for opioid use disorder is futile.

0:18:30 Dr. Sara Polley
Ohh.

0:18:29 William Moyers
That the odds are against their young person. Could you just talk about the efficacy a little bit before we go here? The efficacy of treatment for adolescents in general, but more specifically for those who have an opioid use disorder.

0:18:42 Dr. Sara Polley
Yeah. Well I think it's really easy to fall into a place of hopelessness and despair, particularly because it is such a tragic situation with opioid overdose deaths.

0:18:49 William Moyers
Mmm-hmm.

0:18:50 Dr. Sara Polley
And again, you hear a lot of stories on the news about people dying and you see the numbers that are put out about the number of young people that have died. But, I think it's really important that--and I get to see this every day at work—I get to see people really recovering and really doing well.

0:19:03 William Moyers
Yes.

0:19:04 Dr. Sara Polley
And really putting opioid use behind them. And so I tell these stories a lot when I work with young people. Is I did an outpatient clinic where I followed people over the long term. And I had many, many patients who had been in recovery for many years. They were adults, they still took Buprenorphine for a medication to help them—

0:19:20 William Moyers
Mmm-hmm.

0:19:21 Dr. Sara Polley
--But they had families and lives and careers, and it was just like management of any other kind of like, 'Oh I have high blood pressure and I have to see my doctor every once in a while to get a refill on my meds.'

0:19:30 William Moyers
Mmm-hmm.

0:19:30 Dr. Sara Polley
You know, it wasn't something that was horribly tragic or really impacted them negatively. So, you know, and among all of the groups of people that are striving for recovery in treatment, young people are gonna be the most likely to be able to get themselves out of it and have it not be something that impacts them.

0:19:42 William Moyers
Yes.

0:19:44 Dr. Sara Polley
So I feel actually very hopeful. Particularly because of all the wonderful treatments that we have.

0:19:49 William Moyers
Yes. As a grateful parent myself, I am so pleased that young people can get access to care and can start that road of recovery much younger than I did.

0:20:00 Dr. Sara Polley
Yes. Yes. 

0:20:01 William Moyers
And while they're still in their early twenties and capture all their twenties and not waste them the way that I did when I was using a long time ago.

0:20:02 Dr. Sara Polley
Yes.

0:20:07 William Moyers
Dr. Sara Polley, thank you for ending us on a high note. Thank you for bringing your expertise and your passion to these issues. Because it's infectious. I can feel it across the set here.

0:20:18 Dr. Sara Polley
[laughs] Good!

0:20:19 William Moyers
And I know that you touch the lives of so many young people and their families. Dr. Sara Polley, thanks for being with us today.

0:20:26 Dr. Sara Polley
Thank you! [smiles warmly]

0:20:27 William Moyers
[turns to camera]
And thanks to all of you for joining us for another edition of Let's Talk. We'll see ya again sometime soon! [smiles]