Welcome back to my channel. I am pre-filming a lot of videos for Vlogmas, as you guys have seen.  It's currently November 18th as I'm filming these videos, but I needed to get some stuff pre-filmed so we were prepared for Vlogmas. Today, I am one, really prepared, and two, gonna be sharing with you guys my best purchases of 2019. I did some research amongst my peers to see if they had any other things that I rave about. I'm the friend that makes every other friend buy stuff. Like, I'm like the influence, like, online, but also, like, in my friend group kind of thing, so I asked them and they gave me some other ones, so I was like, that was a great buy, you know? I have a list on my laptop that I made of my best purchases of 2019. I hope you guys, one, are enjoying Vlogmas. If you guys are new here, hi, I'm Kinsey. I make lifestyle vlogs, lifestyle videos. I'm uploading every single day until December 26th, and I would love for you guys to stick around. I also am constantly posting other things on my Instagram of new product recommendations. I always link, like, stuff like that. Also, if you guys are into holiday gift guides, I have so many on my Instagram story this month, so follow my Instagram, check out my highlights. They're all gonna be there, and be sure to subscribe so you guys can stick around for the whole holiday experience over on Kinsey Elizabeth. I will link down below my Vlogmas playlist too, so you guys can start from the beginning if you want. So I have some items that I purchased in 2019 that were really great buys that I feel like were great investments, great pieces to buy, things that I just, like, naturally gravitate towards, things that I just don't regret, you know? Which, let's face it, that happens to a lot of us. So as always, I will have all these products linked down below. If you guys, I feel like this is also good for, like, maybe a What I Want for Christmas video, or a holiday gift guide, or whatever, so I'll have them all linked down below. Let me know if you guys picked up anything. And before this video even starts, or before we really get into it, I would love for you guys to comment down below your best purchase in 2019, something that you've got the most use out of. I love your recommendations. I love hearing from you guys. It's truly a community. And we're all just a really big, happy, nice, inclusive friend group over here, especially on the Secret Facebook group. So join that if you guys haven't already. But we're gonna get into the video. I have a lot of energy as I'm filming this. Where did my star group go? It's over there.  Okay, number one. This is really annoying. I'm not gonna get super into it, but it's about my Hot Pallaudis membership. It's a lot of money. It's really expensive.  It's more expensive than most Equinox gyms and stuff.  It's one of my favorite things I do. It's more than just the way I work out routine. Now it's a hobby. Something that I genuinely love so much that it makes me a better person. I'm the most fit and the most toned I've ever been. My body looks better than ever. And it's all because of Hot Pallaudis. And I also love the community there. I love the girls who work the front desk. I love the teachers. I just love everyone. I actually wanna have my favorite teacher on my podcast. So if you guys haven't already subscribed to my podcast, it's linked down below. I feel like if you guys liked my videos, you guys would love the podcast. It's my pride and joy. So yeah, I'm a Hot Pallaudis membership. Yes, I pay a god-awful amount of money for it, but it is worth every penny. Number two. Okay, so I got a pair of Levi's. I got two pairs, but the one I'm gonna talk about is the Straight Cage Leg Cage. Straight. I'm having all this linked down below. So it doesn't even matter if I'm asking for words. But these are so great. They're so flattering. I love them. The quality is amazing. I love how they fit. I honestly wanna get them in different washes, and I also need to get them maybe a size down at this point, but they're the best jeans. You guys ask me all the time, which ones I have, and I've answered it so many times, but I'll have it linked down below. Seriously, like the best, literally the best ever. Next thing I have is my Coverlabs phone case. So, beginning of this year, I ordered a phone case on the Daily Edit. I think that's how it is. It was like $100. It was the red one that had my initials on it. And honestly, like it didn't hold up. It got brown on the edges. I don't know if it's because I wasn't taking care of it or because I got red or whatever. I actually really liked the Daily Edit. But then I went on Coverlabs, and I had like two phone cases custom made for half the price that I spent on the one on the Daily Edit. I got KP, and then I got another one that says Piper. I haven't even switched to the Piper one yet. I think it's super cute. Like a phone case is just like a nice way to kind of like dress up a look.  So I just love having a nice phone case. I love personalized things. I love, like, I love my initials as KP because I think I'm combustible, you know? But yeah, I just like love that. I think it's so cool. It's so fun. And it was such an amazing price. I'm the biggest fan of Coverlabs, and I think they're really great for gifts. So, love that. The next thing I got is actually something I need to pick up today. I have to repurchase. But the Becca Priming Backlit Primer. Yeah, Molly recommended this to me. She had me buy it in Boston, and I was with her, and tell me how I somehow originally bought the wrong one, but then I took it back to support and exchanged it, which is something I normally don't do because I always forget to do that stuff. So I was proud of myself to even start off with this whole product buying thing. And then I got the right one, and I started using it, and it's amazing. I'm not using it today because I'm out. That's why I have to go pick some up. But it is the best primer. It makes your skin glow. It's really great for photos. It's just amazing. Honestly, you could even wear the primer with nothing on your skin, and your skin just like automatically looks so much better. So I love that. Big, big, big fan. Next thing I have is my Isle of Paradise self-tanner. I personally like the Moose one better. I have it in medium. It's the most natural glow. Not streaky, so easy. I even really like the Isle of Paradise mitt. I think that's the best mitt that I've used. Yeah, it doesn't have this like crazy bad smell. It doesn't make you look too crazy. It's a very, very natural glow. And if you guys are in the self-taining world looking to kind of dabble in it, I would recommend that even before like loving tanner, Saint-Tropez, just for beginners because it's not as scary to use. There's also the water, which I like the water, but the water is kind of scary because to me I'm like, where is this going on my body? Like I have the water, but I like the Moose a lot better just because I'm more familiar with the Moose and it's easier to tell where it is on my body and all that stuff. With that being said, I love the Saint-Tropez self-tanner, the Deluxe one. That's probably my all-time fave, and I love Loving Tan. But right now, I have a huge package from them, and it's in like dark and like that's way too dark for me so I can't use it. But yeah, next thing I have, my Aritzia boyfriend sweats. I'm wearing the boyfriend sweats. I meant to say Aritzia boyfriend sets, and by that I meant the sweats and the hoodies. They're the best. I have so many, I wear them all the time. I have a gray one and then I also have a green one, like lime bright green one. I want more colors, honestly. So comfortable, the boyfriend sweats I have on right now. They're so soft, like you have no idea. I don't even know how to describe it to you guys. Like I've talked about them in so many videos, but they're amazing. And something that I really have done this year that I think was a really good decision on my end is I've invested in better loungewear, like better sweats. One, sweats are in, so it made it easier. But two, like I actually wear that the most, like that's more my style, so it makes more sense for me to spend more money on that stuff when I wear it the most and I get the most use out of it rather than like something nicer that I'm gonna wear like once every three months, you know, so. I think for me personally, it's really worth it to buy nice sweats and nice hoodies because it also makes you look more put together and it's really like chic and cute, you know? My next thing is my outdoor voices sweats. So these sweats, if you guys were asking for the difference because I rave about both of these, the outdoor voices are nicer looking, they're really comfortable still, they're more easy style, not really sweat pant style. So the Arita ones are more sweat pant style and the outdoor voices are a little more jogger, more like stylish, if that makes any sense. So it just depends on your preference. I love both of them. I have the outdoor voices ones in black and gray and then I have the Arita ones in gray and little on green. But the outdoor voices sweats, I love them. I bought them when I was in Boston in August and I think that they're just like the perfect fit. With that being said, they stretch out in the butt pretty easily, which I think is annoying because you know when you wear sweats and they kind of stretch out, so maybe go a size down, but I get them in a size small, but love those really, really great buys. My next one, also something I'm wearing, my Yeezys. I have the 700s in analog, like right here. This is the first pair of sneakers I think I bought over like $200, I think. Like they were a little bit more expensive, I got them on go and I love them. Like big, big fan, I wear them all the time, like legitimately all the time. They're so gross. Like I need to get them professionally cleaned, but I love them. I want more Yeezys because I just wear them all the time again. Like my go-to style every day is like sweats and sneakers and stuff like that. Like I love that look and hoops, you know. As you can see, I love that look so much. So for me, it's definitely worth it to invest in nicer pieces rather than buy a bunch. The way that I look at this is that, like especially, okay, like you look at a hoodie that's 60 to $80. I'm gonna buy a hoodie, like I keep buying until I find the perfect fit. So I'm gonna buy maybe three or four cheaper hoodies, which actually is gonna end up in turn being more expensive than the one hoodie that I found that's the perfect fit.  So yeah, that's just how I feel about like buying nicer stuff. Not that it's like crazy and breaking the bank, but I do recognize it's like a little bit like more of a premium price, but for me personally, it's definitely worth it as I have just gone through so many clothes and like I'm constantly going through my closet at all times because I get a lot of stuff sent to me too. So I'm like, I don't wanna buy something that I'm just gonna get rid of in a month. Like I don't do that anymore. So I only buy like nice things that I know are gonna like enhance my wardrobe. Cause if not, I'm like, it's just not worth it. Next thing, my Ugg slippers. I literally had talked about these in the past through videos that I have filmed. They're the best.  I'm the biggest fan of Ugg. Literally couldn't be a bigger fan. As we speak right now, I'm like buying more online for my friend. But they're the best. I love the ones with the strap on the back.  I also got these in Boston. Molly and I got matching ones. I just think they're so cute. I actually also got a pair for my niece, my little cute niece Sophie that I love so much. Can't wait for her to be in the vlogs. But I love her and I got her pair so she can match with me. I don't even know if she's gonna like them but like I'll just be satisfied with the fact that we're matching, you know? But they're amazing. I wear them every single day. Every single item that I'm talking about is something that I pretty much use every single day with the exception of the self tanner cause I don't self tanner every day. Everything else, I literally use it almost every single day. My next thing are my Eritrea biker shorts. These are the best fitting biker shorts ever. I'm so passionate about the TNA line from Eritrea. As you guys know, this was the year of Eritrea for me. I found Eritrea. My entire church shops at Eritrea. That's like really how I found out. I think a lot of people like, are like, oh, you found that from so-and-so. It's like my church has been at Eritrea. Like that's all they wear. Also, a lot of the style in Spoe is not necessarily from influencers. Majority of it is from Hailey Bieber.  Anyways, I've been into Eritrea. I just didn't talk about it on my channel that much cause like, felt like no one really talked about Eritrea for some reason. I don't really know why. It wasn't until I got into the TNA line that I became obsessed with them though, I will say. But the Eritrea biker shorts are the best. I like the seven inch or the nine inch. They're the best. They're like, nothing is wrong with them. They're just the best. They're so flattering.  Make your legs look so good. Big fan. The next thing I have is a book. So I got this 40 day prayer divo. It's like circle, draw the circle. 40 day prayer challenge. I'm probably getting that wrong. It's on my Amazon shop page. Literally the best devotional book I've ever done. If you guys don't know what a devotional book is, it's like a few pages that you can read. This one in particular is like a short read, maybe a five to 10 minute read. You just read it every single day at some point for 40 days. Literally will change your life. So good. If you guys are looking for a new divo book, cannot recommend that to you enough. My friend Amanda Maddu posted like, all of her Instagram story and was raving about it. And so I was like, okay, I'm gonna buy it because she loves it. And it was like one of the best buys I've made all of 2019. So good. I'm just gonna continue to like read, like go through it and go through it and go through it again. And I'm just gonna get it honestly for a lot of people in my life. I think I'm gonna order like 10 of them and they just give them out because they're just so freaking amazing. It's the best devotional book I've ever done. My next thing that I purchased this year was my new vlog camera on the camera that I'm actually filming on now, the Canon M50. And then I have the 55 millimeter lens. I'm like looking at my lens as I do that. So I'll have them on my Amazon shop page. I already do, always under my camera equipment. If you guys are trying to get into YouTube, if you guys vlog, if you guys do any of that stuff, cannot say enough good things about this camera, this setup, it's a little bit bigger but it's not too crazy big. I feel like it's really up to my vlog quality. I feel like it makes me like more excited to film too. And I like that it's wide angled. Yeah, just better. It's like a step up from the G7X and I love it. Alicia and Remy are who I got the insma from. They told me everything. They've got, this is the camera that they use, I'm pretty sure. It is, not I'm pretty sure, that's why I bought it. And they were, we were recording a podcast in the studio and they were like, this is so much better and I was looking at theirs versus mine and I was like, you're right, it's so much better. So I invested into my business and I bought a new vlog camera and I'm the biggest fan, so I love it. The next thing would be my bags from the RealReal. If you guys follow me on Instagram or watch my vlogs or anything, you guys would know that I picked up a Louis Vuitton bag and a Fendi bag. So the Fendi side bag that I got, so cute. Oh my gosh, first off, these two bags, I love bags. That's like my weakness. Like I just freaking love a good purse. And the RealReal is a high end consignment.  And like the first time you buy a nice luxury bag, like I wanted to go to Barney's and buy a RAP Barney's because like that's what I love so much and like I have the experience and stuff and now I'm just like over the experience, I don't care, I wanna be like smart and practical. So the Louis Vuitton bag that I got, I'll just say the price, this was like 500. Definitely expensive. Like I'm not saying that this is cheap, but in comparison to what you would normally send for a Louis bag, very good price. And the Fendi bag that I got was 350. Also expensive, I recognize that. But what I am saying is that in comparison to Fendi, that is a really good price. I alternate between those two bags every single day. They are the absolute best bags. Like I just die for them. I love them so much. And yeah, I'm a big fan of the real real. I've become a big, the real real girl this year. My last thing that I'm gonna talk about are these hoops. I wear them every single day almost. And if I don't wear them, I wear my other Jennifer Fisher hoops. So I believe these are the baby Samira hoops and the many, I always get confused. They're the ones that were $300. I will have them linked below. Yes, they're pricey, but I had worn hoops every single day for like a year, year and a half before that. So my God, I think it's time to really invest in nice ones. Cause like it got to the point where like, mine was kind of gross and I was like, okay, I wear them every day. Again, like I said, I want to invest. So I bought them and I was like, I really hope I don't regret this and I've not regretted them one time. They're so light, you can't feel them. You never like, sometimes I feel like with other earrings there's how heavy you have to take them out. You don't even feel that you're wearing them. I want 15 more pairs. I'm a Jennifer Fisher girl for the rest of my life. And then I also have the baby huggies. Those are like only a hundred or like they're 95. Obviously not only but they're pricier but they're nicer jewelry and you get what you pay for and there's the best and I don't regret that at all. So that is it for my best purchase of 2019 video. I really hope you guys enjoyed. Again, I'll have everything timed below. I love you guys. I love Vlogmas. I just love uploading every day and I really hope you guys are enjoying. But yeah, with all the things said, I will let you guys go so I don't keep talking. But subscribe if you guys are new here. Follow me on Instagram. Tell me what your best buy of 2019 was. Down below. Love you guys so much and I will talk to you soon. Bye.


Hi everyone, Joe for JaspysCaseBrace.com coming at you with a Chronicles pack, which will help fill up this hit parade dual case break, which is coming up in a separate video in the next video. Very big thanks to everybody rallying around the break right here. Thank you. All teams are in. So two dice rolls. We're going to do the break itself first, as we always do. And then the second dice roll will be for the giveaway. So here's the first dice roll. Four in a one, five times for names and teams. One, two, three, four, and a one. Four in a one, five times for the teams. One, two, three, four, and a one. No trade windows in these little filler packs. I'm just going to jump right into the break and then right into the giveaway part. All right, Edward with the fill. Oh, I don't have to read all this stuff. That's just a filler pack. Here's the first half of the list right here. Thank you. And here's the second half of the list right there. All right, let's sort by team. Let's print and rip. We've got George Springer. We've got a Clayton Kershaw to 99 and Alec Baum. Looks like a little bit of glue right there on that Mickey Moniac. More Alec Baum. Jose Devers. Hyun Jung Yang. Anders Jimenez. Boba Shet. We've got an auto in the last. Nothing too crazy here. A couple Alec Baum rookie cards. Moniac is teammate. These guys are supposed to be pretty good. And of course Clayton Kershaw right here for my Dodgers. All right, but this isn't really the important part. The important part is who's going to win those hit parade spots. So let's gather all of your names again. New dice, the second dice and new list. So it's going to be the top eight. Top eight after four. Three and a one. Four times. Good luck. One, two, three and a one. Fourth and final time. So after four, it's going to be the top eight. So from nine on down, it's going to be sad times. Tim, especially sad times. You were very close, but no cigar. I appreciate you giving it a shot. Much happier times for the people in the top eight because you're in the next video. You'll be in that next break. Top eight, congrats to Nathan, Edward, Diana, Tim, Edward, Chris, Edward and Edward. Congrats to the top eight. We'll see you in the next video for that next break. Bye-bye.


Artists, I want to ask y'all, are y'all being creative with your experiences that you offer for your fans? Managers, are y'all pushing creativity when it comes to your fan experiences with your artists because my guy Omarion, Mr. O himself, he's doing a little something. I want to share this, we're going to talk. I had a little ad that passed my page, you know? I don't know why Omarion was targeting me how I fell into that subset.  Okay, okay. Yeah, he was probably just generalizing, all right? But, check this out, right? For those of you who cannot see, y'all are just listening. This says, the old experience, mind, body, and beyond. Clever. Show dates, 1106 in Atlanta, you got the DMV, he's going to New York and he's going to Philadelphia, right? I already, Omarion established artists, but this is different than that type of experience. He says, the ultimate connection, private exclusive. Oh, and they spell connection like kinetic, you know, in motion, this is spiritual. I didn't even catch that, okay. I was wondering about that angle off. I was a little nervous. Oh, you didn't even know if it was a doubt, bro. No, I did not. I did not. For the title. All right, the ultimate connection, private exclusive session with Omarion, tickets available and it's 250, 250 per ticket. Now we know Omarion is not an artist that people are really paying 250 to go to show these, I mean, who are people paying 250 to go to their show these days? I just learned that, you know, Paramore, the band, they're charging 400 for that show at the Tabernacle. 400. Yeah, that's what I learned. That's what Todd told me last night. Jeez. Exactly, so apparently them. Apparently them? Nothing that I can't think of anybody else. I mean, I'm pretty sure probably like the Kendrick's Drake. You know, the super high level. That's not even the low of it. They're still tickets lower, right? Yeah, yeah. They usually have at least like an $80, $90 window somewhere. You know, you in the back. So Omarion isn't somebody you would expect to be able to charge 250 for a show, but this is more than a show, right? So to give you a little bit more context, right? It says limited ticket, it's available also on a flyer. The old experience, mind, body and beyond, the ultimate connection must have a ticket to the event. All sales are final, you will receive details on the secret location via email. Ah, three to four days before the event. That is what I love, right? This is how you create a little mystery, but at the same time say, hey, we ain't figured this thing out yet and we're not gonna book our spot until we figure out how many tickets we sell. But I get it, I get it, I love it. I love it. So you flip your weaknesses and use it as a marketing. As a marketing strength, that's the game. Originals, I guess that's what Omarion takes you on the ultimate experience, elevating your mind, body and beyond, okay, give me some more. Go one-on-one with the king. Okay, so there's some one-on-one aspect to this. Okay. He's the king of unbothered. When did he get that title? You... Man, I was about to ask you that. What does that even mean? I mean, he has been pretty chill recently. Like, well, he's always been chill though. He's never been like a super out there guy, right? I, yeah, kind of, like, he's been relatively chill for still having to be out there as a celebrity. I give him that. And then there's a lot of stuff going on, like with the group, but he's still tried to kinda... Man, he's just trying to claim the title. That's all I'm gonna talk about, too. Like, he's like, nah, that's me, let me get that. Okay. Unbothered in this intimate healing experience. This isn't a show, this is a healing experience as he shares gems on mindfulness, principles, and practices on how to choose your joy and live an unbothered life. Oh, I love it, the branding on it. So he might be branding himself as unbothered king or whatever, and now he's reinforcing what that means. He's motivational speaking to his audience. That's all that's happening. That's how I'm taking this, right? Yeah, he's giving real shaman vibes right now. Now we're getting into the details. Okay, this unique session includes a personalized autographed copy of Unbothered, The Power of Choosing Joy. I'm assuming that's a book? I was just about, I was like, that's a long name for an album. It gotta be a book. Yeah, it gotta be a book. All right. Appetizing cuisine, we're gonna feed you. Soundbath healing, I don't know if y'all know about that soundbath, you know? You know about the soundbath, right? No. Aw, man, the girl's you date, bro, you always... I never even took me to a soundbath healing. Apparently I'm in the wrong day in four years. You don't even gotta go to a soundbath. All right, I'm about to look this up, right? Like I was missing out. Like I'm like, man, I don't know.  They're big on this type of stuff. Here we go, Jenae Ico doing a soundbath. This time we'll take it slow Take it slow Like a valve, how it's packed with things, while I'm using it. You don't have to have all that going. She's singing, hold up, hold up. I'm gonna find this real quick. We're gonna get to the point of this whole thing, but... Who might take me? I'm trying to find out what that's like. Soundbaths are more like, they got a little bowl. Here we go. How would you like to turn your innate passion for helping other people into a prosperous part? Get lost in the rest of her SEO. That seemed like her ball. Yeah, that's all it is, bro. I have seen this before. I've never been to one, but I've seen it before. You can buy them on Amazon for like 30 or whatever and just, you know, scoop that thing all around and do it. Do it work? Do it work. I mean, I haven't done it myself. Oh, you haven't done it? Yeah, you know, my girl requested, I just got it for a gift. So it worked for me to get what I wanted out of it. But I didn't do those soundbaths, I'll tell you that. Limited space on only 30 tickets available. Okay. Only 30, so he legit making it limited. Let me, let's go ahead and do the math. I don't even want to do it in my head right now. About 80 bands, maybe? Not 80, bro. I should be amazing. I'm a little, I don't know, man. I don't fly through in the mouth. Yeah. Somewhere. 7,500. No, that's interesting. That's not enough. I would think to bring out Omarion. Yeah, I think it would be more than that. We're breaking this down in real time, but again, we're going to get to the subject. You will receive details on a secret location via email again. So, all right, so this is basically a high ticket event, a higher ticket, I'll consider it more middle ticket. And this is something that a lot more artists should consider, not necessarily this, right? But you have these different experiences that you can do that aren't a part of a show. And the only thing that we see typically is the funnel of I have a concert and you can pay me a little bit more to see me backstage, all these other things, variations of things that I can do while I'm there, right? It's a pop-up marketing funnel there. I bet he's going to have some kind of marketing funnel within this event too. 100%, it's going to be merch. You pay here, but yeah, there's some additional merch. Yeah. I bet he'll, he could probably squeak in another 20 bands out of this event. Yeah, 100%, 100%. Some way. Probably be pool vendors that he own or something there. You know what I'm saying? Yeah, advertising a brand. There's more to it. So we're going to get that benefited out because I'm pretty sure there is, because I don't think Omarion is just stepping out for 7,500. Not that he is not enough. He doesn't do walk-out, walk-throughs and stuff like that. That he might get something like that here and there. But still putting up a whole event, I would expect him to have to want more. But one, he might do, this could be a prototype for a branding experience that he wants to build on, right? You get the footage, but you just try to break even. But then also I think there's a marketing funnel. But the point is, how creative are you guys getting with your audience? Because we need to see more of this, right? We need to see more of this. Everybody doesn't have the audience yet. But if you have an audience, right? A show is cool and all, right? But I'm still disappointed by what I've seen, the lack of creativity I've seen since the pandemic, right?  People won't get deeper into these virtual experiences. They're going to become more of a real thing. That was very much of a trend that didn't get utilized enough. Still hasn't got utilized correctly. And then people went right back to the same system. Now, after over, we just went about to wait for these shows. It was back. Finally it was back. Yeah, it was like all that time. And the wake-up call wasn't real. I'm not saying don't maximize what you can in this vertical of touring that's already established. Because the industry has a lot that pushes you in that way and go ahead and get that money. But you should at least start thinking a lot more about monetizing outside of that. So this is one experience we talked about. Well, we both know Kari did that really dope show during the live stream show. Yeah, live stream show during the pandemic. But again, he did it in an extremely dope way, right? It was branded. What is it called? The weird? This is weird, live stream or something? Something like that. Kari, forgive us if you ever hear this, that we aren't remembering it. But his whole experience was detailed where it was a variety show vibe.  Obviously he performs and his old branding of dropping his ads, which we maybe pull that up or something, but it felt like the theme for a TV show. It was thoughtful commercials. Yeah, let's play it that way. It's definitely something like I think if he had wanted to keep it going, he set it up in a great way that it could have turned into a series or a real show. It could have become an entire continued series and experience that his fan base is happy to fill a part of. Right? It could just be a one a year thing, kind of like. So if you look at Travis Scott with Astro World, right? Yeah. And that was themed, obviously had the album part of it as well. That whole thing was amazing. But the fans more and more come every single year. Yeah. Of course, it's a festival and that's something more specific. But you can do that with these side concepts because what it also gives you a way you can build a brand using your brand that becomes interesting in and of itself that you don't get to market when you're doing your music. Yeah. Oh, a variety show. At this point, people might just come because it's really fun. Yeah.  It was funny. It was cool. Who cares who Kari is? And then next thing you know, you might learn. You come closer to Kari as a part of the process. Or even if you don't, Kari still got your money. Right? So like that type of thing, there's so many ways to do that with these side experiences. Let me take a quick second to say if you're an artist trying to blow your music up or if you're a manager, a music professional, in general, trying to help an artist blow their music up, I have something that's a game changer for you and it's completely free. As you may know, we've helped multiple artists go from zero to hundreds of thousands of streams. We've helped multiple artists go from hundreds of thousands to millions of streams, chart on Billboard, GoViral, all of that stuff. And we've now made the way we've branded multiple artists and helped them go viral completely free step by step in Brandman Network. All you have to do is check out brandmannetwork.com. You apply, it's completely free. But the thing is, we're not gonna let everybody in forever. So the faster you apply, the better your chance of getting accepted. Brandmannetwork.com, check it out. Back to the video. So I go Mario on with this. He's hitting this entire fan base, right? The next thing you know, he starts to invite sound healers or shaman or whatever speaks to that fan base. Have a little motivational panels. Panels, right, exactly. And he's no longer even the center of it. It's just a concept almost like a festival or a seminar or a conference or whatever. And now you can probably charge more and more and more. And again, he was just the foundation of it. So this is a great way to use yourself not only to monetize your fan base in a different way, right? But also to set the foundation of a brand that started as adjacent to you, but you're attacking a vertical that, and to be honest, you can monetize a lot more easily than you can in the music space. Yeah, yeah, because people are paid for things to do a lot faster and they'll pay for music, right? You internalize it differently. You justify it differently, right? Like, oh, this is an experience, I get memories, this song is a song, right? And I'm already kind of thinking of the comments for this. And I know the next question is probably gonna be like, but how do we make these cool experiences for these people that's happened to us?   I was already gonna go to a sound spot, right?  I remember when Lil Yachty was first going on tour and he had this experience with like- I don't know what they be doing, though. You know, good deal. Well, I did not know you were about to say, Lil Yachty, what you said? Shout out to Yachty, bro. Yeah, this is really early tour experience with like you could just hang out with him and eat pizza and play like Uno or something, you know what I'm saying? Rory, you know Rory is right, like from Atlanta? Oh, that was earlier, yeah, Rory. He has the whole like in the woods thing, you know? I feel like, I feel like he just hangs out in the woods anyway, it's probably like his vibe, right? So I'm seeing what artists are like, hey, like what is something that I like to do that I can put together, see who else in my base is interested in it? And then from that, either I keep doing it, right? Or I pivot and I'm like, okay, they don't like playing Uno.  But I think it goes back to like just like, what else are you interested in outside of music? You know what I'm saying? Like what else do you like to do? What do you care about?  Like what have they seen like they will possibly be in based on like the interactions and conversations you've had with them. So the Amaro thing makes a lot of sense cause he's older, so he's probably at this point in his life where, you know, he's getting himself together spiritually. I'm doing all the stuff that he done done.  So it's probably like he looks like he does stuff like this anyway.  Yeah, bro. And I was built for that, but he looked like black Aladdin right here. He should have charged like, if it was me, it was me. I would have had the 250 one. I would have had like a $500, maybe 750, like Goddard meditation group where I got. Like you can come be here for this price, but then maybe five of y'all can get this extra ticket. Have you ever seen that? That might be there. That's what I'm saying. That might be the invisible funnel. And now I have you in this peer pressure space. Oh yeah, I get you saying that. I'm climbing you, everything here, right? And it's controlled to make you want a little bit more than I'm gonna. I ain't trying to scare you away with the price. Yeah, I'm not trying to scare you away with these additional prices, but I already got that 250 for you. I'm already here. And now you're spending separately because you forgot about the 250. You spent it already. Now you're just spending 500 or whatever that number is. That's what you might be doing. Yeah, I hope so.  But like you said, that has to be something deep. There's no way he's traveling to all these. I mean, I guess they're all not far in New York to Philly Philly, the DMV. Well, no, cause it went as first. So Atlanta, the DMV, the New York and then back down to Philly. There's no way he's putting all these travel arrangements together without some type of upsell and the funnel or something, you know what I'm saying? No way, no way. Might have to look deeper. I wonder if he already has like shows in those cities at the time and stuff like that. That'd be cool. That'd be interesting. But, but yeah, I think what you said is a good start, right? Like just what are you doing? Yeah, already. What do you like? And then there's different levels of it, right? So you have your fan base music, the main thing they know you for and they come to you for. Now you can take what you like and then figure out what level do I want to introduce this to my fans with? All right, so yeah, you said Uno. We could do some kind of private Uno experience or whatever, go hard with it. But I also could just play Uno versus a fan alive, right? And just be free in just another way to connect with them and build with them, right? Then, or I could play Super Smash Bros, right? Live, but then I also can host the whole Super Smash Bros tournament, right? And have them involved and then, you know, run that whole thing up, right? Then there could be, I don't know what it, I don't even know what it is. Well, there's a virtual live, I'm at a virtual tournament, right? But then you can do a real life tournament, right? And each of those come with their own different charges and the extra things you can do around it. But it all comes from that same idea of this is just another thing I do. Or like no name, I think she had a book club years ago? Yeah, she did, yeah. Something like that, right? And then you think about this, I have this audience that is reading books with me, right? You might always think, well, where's the angle I can monetize? Well, she might then in the future have recommend books based on author's planner because they know that she has this clout among people who actually are book buyers, right? You know, like an email list to blast and get sales and get affiliates or people are paying you with advertising costs, bring that speaker in, right? And there's other ways and people might have private experiences. Again, you get into the in-person thing. The in-person thing is always gonna be big in an environment that we're divided in this digital space, right? That's always gonna be a thing. So it's the stuff that you like. And then it's the stuff that is just a special experience as a whole. Like, you know, when Ryan Leslie did the whole castle experience, you know? I don't think so. Yeah, so he, I don't know how many times he did it, but I know at least one time for sure.  He's able to hit up his most real fans and they did a private experiences where he did a show in a castle.  And it was a private show for those people. And you put them in this space that, you know, they're not used to being to that level of experience. That's a whole another thing, right? It's one thing to just do something cool and private. It brings them closer to you. But another thing to do something that just takes them into a space and gives them access that they normally don't have. Yeah. And I think the opportunity to be around you, like a lot of fans just value, like being in your vicinity. Oh, I might, there's a, there's a high chance I could have a conversation with him. Much easier to think that when you're in a room full of 30 people, they're in a room full of 3000, right? Even if they don't really get to talk to you or never touch you or whatever, like they still think they're going into it. And a lot of people are kind of bound to that stuff. Like I had a homie, Tom, one time was going to throw like a kickball game at P-Monk. And he was going to charge for it, have his fans come out. But there were fans who were going to like fly out here, fly that. And I thought it was crazy, but like, they're going to fly from wherever they are to Atlanta for a kickball game. That's how much they liked this man. He ended up not doing it. I can't remember, I think it was like just logistical reasons, you know, P-Monk, man.  But that was one that clicked. The next I was like, man, bro, he got at least like 10, 15 people talking about, yo, when is it? I'll get my hotel. I'll fly out, right? And I don't think he was charging nothing crazy for it. I think he could maybe do like $20, $25 of signed up, you know, you get put on your teams when she, actually it might even been free. No, nothing.  You know, like use it kind of like a free funnel. Don't play the game. I could have a special like Tom kickball. Oh, sorry, yeah. For the teams, right? Yeah, actually, yeah. That's a, that's true memorabilia to move forward with. You know what I mean? Like not personable. Of course you have your regular merchant. Everybody has access to, but only y'all have this specific thing. Yeah. Yeah. It's a flex in the fan base. Yeah. It's a flex in the fan base. And that's exactly what you want to do. Give opportunities to your fan base members to flex on the fan base. That's all they want, bro. I just want to be like, hey, you a fan. I'm a bigger fan because I have, like I said, this is exclusive t-shirt. The only way you could get this is you pull up to Atlanta on October, whatever at 9 a.m. and play this game. And you weren't there, but I was.  So I am better than you as a fan. A good way to think about that too is NFTs, right? If you listen to a lot of the experiences people thought to make around NFTs and say, oh, well this is going to become possible.  The metaverse and all that stuff they applied it to. Okay, that still has to build out. And yeah, that's going to become possible. But doing these exclusive events, having special ways to know that if you can get in, whether it's a password, whether it's a specific card or your name's in a database, it's a list, all that exists. You can already do that. The symbols, like you said, like flex on the fan base with the t-shirt, all those abilities and possibilities already exist. For some reason though, it just takes people to like have that new outlet to actually see the possibilities for some reason. I think people just like, they're intimidated by trying to make it work in an old space. But it's like the old space is already proven that there are people that is willing to get it.  There's new opportunity, you could cap. But there also could not be people there that are looking for what you're trying to offer yet. That's why I think it comes down to Brezla. I can see that. You're free. But now that everything sounds like this is built to support that, you feel like there's a lower chance of failure and it's still in such a new space if I fail it doesn't look as bad than me failing in the real world. Yeah, exactly. Cause it's like, there's not a lot of people here yet. So it's like, if it doesn't hit, it's like running a bad ad on Facebook versus running a bad ad on like a new platform.  But Facebook is like, there are hundreds of thousands, maybe millions of people that saw your bad. So I think that it kind of comes down to like that same thinking. It's like, oh, I have the chance to like cap over here really hard, which is true. I have the chance to be, you know, we've been talking in the last episode to be able to say I was the first person to do X, Y, Z and whatever space, Y, so that's a narrative in itself.  That's a huge limitation when it comes to a lot of artists and potential embarrassment. You know, I don't know if that's part of insecurity that comes with, not just a lot of people in general, but especially the personality type who wants to be an artist. All right, but a lot of conversations that I have with artists, there's a lot of barriers or limiting beliefs that come around embarrassment of some sort, which is weird because you're supposed to want to stick out, right? And part of the stick out risk is potential embarrassment. Potential embarrassment. There's this concept that most people actually do not want to stand out. Most people end up think about artists. That's why we probably put certain people on a pedestal. Just because they are standing out and we innately understand that there's danger with standing out, right? And that's why the crowd doesn't want to stand out, right? Because if I'm out there, it's a risk. It's just me out here, right? Yes, there's a lot of rewards that come with it, taking that risk. If you happen to survive out there, but most people don't survive out there, all right? So you look at zebras. And I think it was, what's his name? Jordan Peterson, that was talking about this that I heard. He was talking about how zebras are, you know, they're striped. So you're like, well, how is that built for camouflage? Right? It's like the lions in this here are more camouflaged with the backdrop than zebras are, right? But they move in these herds. So they're more camouflaged amongst each other, right? And they're not standing out. The way a lion identifies them is, because especially, you know, lions often at times, they attack together, right? Oh, this one got a hobbling leg. They can barely move or that one's bleeding. So we can all agree that we're chasing this one. But when all of them are good, you just keep, you get lost. Oh, I was chasing that one off. I thought we were chasing that one, bro. I was like, nah, man, I'm not here. Like what's going on? So like that risk of standing out, right? That's how we translate that to humans. There's a lot of people, people say, there's this innate feeling out of the thing a lot of times, people want the rewards of standing out, but then that risk just to actually do it.   Yeah, people gonna walk up to you in public. Yeah, people walk up to you in public. And it's a weird feeling.   You know, dang, these people, they see me before I see them. Yeah, bro. I don't even know that.  Somebody out there that knows so much about you and you know nothing about them. It's a very wild feeling. Right, right, a very wild feeling. So I think most people, again, they admire the fact that someone else is willing to do that knowing that they aren't. Oh, well, yeah. All right, so, why do I even get on that anyway? Yeah, you smile like R is not one to stand out because it's like, it's a part of the job. Like you gotta kind of get over that. Right, right. And then that came from those who was derived from why they're willing to look at NFTs, right? In a certain way and do these experiences that they can already actually do. All right, so, bringing that full circle. Again, there's so many opportunities to do just cool stuff. Whatever your brand is, right? Amarion's doing this mind, body, soul type experience. Right, but you could do, you know, gaming. You can do music. You might like watching certain movies and your fan base might be really deep into it. Like if you've got a horror core audience and y'all are into horror movies. Yeah. That stuff looks like there's so many possibilities. So if y'all could dig in, be more creative. Again, the beauty of this, right? Is it actually easier to sell this type of stuff than it is a regular show? Yeah. Right, it's the equivalent of when you have a merchandise brand that can stand on itself versus, hey, all my merch is just my face on it. Your audience really gotta like you, if it's that, right? But if your shirt is, but God is dope, right? Yeah. Like, let's say Toby and Wigwig, I think I said that right, I don't know. God is dope would've been a great merch brand for him. Yeah. Right? All his stuff could say Toby, right? But a bigger brand for people that don't even know Toby would be God is dope, right? And it's a line with who he is and what the type of stuff that he speaks. So that's that example. So a lot easier to sell that type of thing, you still get the money, right? Look, you can end up being on your own brand's marketing. I'm almost looking like, who is this artist? Why do they have him showcased? They're on everything. Right? Why is he?  All right, so all those opportunities exist when you start to move outside of this space and place, but you can tie it back to your artistry where it makes sense and it creates new fans. And if it doesn't create new fans, it's at least creating new money. So I encourage all you y'all, y'all definitely take advantage of these opportunities, especially the way you can do it today, but we're gonna move on to another topic because Corey, you send in a really, really dope video.


Just a second, I will pull my PowerPoint up. All right. So, as Marie mentioned, I am a postdoc with the North Central Regional Center for World Development, which is hosted by Michigan State University. But I'm actually, as a postdoc, hosted at NDSU. So I'm on campus in Fargo. And prior to my postdoc, I was a parent educator for the PFRC in Region 5 in Cass County. So I still feel like I'm part of the NDSU family, although maybe I'm now sort of like a weird cousin of sorts. And if you're not familiar with NCRCRD, it's one of four regional rural development centers that work collaboratively with extension across the country and really like to focus on issues that cross regional boundaries. And of course, the opioid crisis is one of those issues that definitely crosses a lot of those boundaries. All right. So, let's see if I can... Okay. So just to kind of give you a roadmap for the next 45 minutes or so, I will start out with touching on some of the background regarding cooperative extensions recent work in this arena and then talk about the crisis itself. So that'll include some statistics on different facets of the crisis, as well as important factors involved in opioid misuse, addiction, and overdose. The majority of our time will be spent on possible ways of addressing the crisis. So this will be information from the published literature, from relevant bodies of research on what are the possible avenues for solving the crisis, and more specifically, what are the most appropriate and effective ways for extension to be involved in addressing the crisis. And then finally, we'll finish up with some examples within the NDSU extension system of projects and programs that are related to substance misuse prevention that I think exemplify some of the ideas that I'm going to talk about today. Oh, and right before we begin, I did want to just very briefly give some definitions here because a lot of times you'll hear people say opiates and opioids interchangeably, but they're actually different terms. I'm going to use the term opioids because it's more of an umbrella term. So opiates are really the naturally derived products like heroin, codeine, and morphine, whereas opioids include opiates but also synthetic and semi-synthetic drugs. So some of the big synthetics that people know about would be oxycodone, fentanyl, and methadone. So just to kind of upfront clarify, I will be using opioids as the term. And so I did want to start with a little bit of background about why I'm even talking to you about this today, and that really is because of an initiative that was requested and sponsored by ECOP that started in spring of this year, and the NCRCRD and my supervisor, Mark Skidmore, coordinated that, and we formed the Extension Opioid Crisis Response Work Group, which was a team of extension professionals from all over the country, included people from all sections of extension programming. So a lot of people from FCS, from community vitality, some 4-H, some egg, and then different ranks. So people who are community-based educators, some administrative staff, and researchers, and so it was really a nicely balanced team that came together to work on these issues. And specifically what ECOP asked us to do, there's a lot of different things, but I'm going to cover kind of the main ones here, was first to identify existing activities in the land grant system related to substance use prevention and the opioid crisis, more specifically, to organize information and resources that were identified through surveys. So we actually sent out a survey, an extension behavioral health program survey to all extension, to all land grant institutions across the nation to collect that information. And then we do have on the website we've created a report on that. And then so really the goal here was to identify needs and opportunities for land grant institutions to help address the crisis. And then we developed a strategic framework to coordinate a system-wide effort. And all of this information is posted on an e-extension website that was created so that you can see what are these resources, what's this information we've collected, and the various documents. And then once it's ready, our final report to ECOP will get posted on there as well. And so just to give you an idea of what this website is like, I've included the link there. And there are different portions of the website that you might want to visit. The About Us just describes what's the composition of the workgroup. We also had an expert partners group. And so it lists who those people are and what their affiliations are. A little bit of history on how it all started. And then really though I think what would be more interesting to most of you would be the tab on shared extension programming. If you go into there, there are eight different programs that we identified as programs being used across the nation by land grant institutions that look like they would be the kind of programs that people could fairly quickly and easily implement in their own systems. And so if you click on one of the programs, you can see more details including a description of it and sort of how it would be classified according to these different things like response types and target audiences. And importantly, you can click on there are some links to find out more information on that specific program. But then there are also these YouTube videos because the center hosted a series of approximately one-hour webinars where we invited experts on these programs to talk about sort of the nuts and bolts of the programs. And so there are YouTube recordings of those that you can find if you want to go watch them and learn a lot more about a specific program. And then of course the different resources and the ECOP final report will go on there. I believe there's a word version posted but it just, actually just yesterday reviewed the final formatted version. The Ohio State University is going to be publishing it for us so that should go out very soon. So definitely check out that website. All right, so we'll jump into some statistics here. And so this is an infographic from the Federal Health and Human Services Department with the most recent data on the epidemic. And as you can see it's not just one problem. There are a number of problems going on here that are interrelated. And I've added a few animations here to help you really appreciate the magnitude of the problem. And so here we go. So 11.4 million people misused prescription opioids in the last year. And that is almost equivalent to the combined populations of these five states that you see. So the combined populations of North Dakota, South Dakota, Kansas, Nebraska and Minnesota comes to about 12 million. So it's fairly comparable. And then over 42,000 people died from overdosing on opioids. And that's all types of opioids included together. And you can see below that's kind of parceled out into ones that are like the most common opioids that are prescribed versus synthetics versus heroin. But 42,000, just over 42,000. And that is roughly equivalent to the population of the city of Minot, which is where I grew up. So if you want to think about it that way, the entire city of Minot, that population, that's the number of people who died from overdosing on opioids. So some pretty heavy statistics there. To kind of bring it closer to home, one of the really major contributing factors to the crisis is really the over-prescribing. So high prescribing rates, which allows for availability of excess medication. So what often happens is that medication sits around. People put it in their medicine cabinets. They put it in their closets. They forget about it. So they've got all these pills sitting around. And nobody really notices if it goes missing because they forgot they even had it. So there's all this excess medication that can be easily diverted. And so when we look at the CDC keeps track of prescribing rates by county. So you can actually go to the CDC website and look for every state by county. And as you look at this, it's the rate per 100 persons. So if you see a number close to 100, that means that every single person in the last year, there are enough prescriptions that every single person could have had one. So as you look at this map, the top county is Ramsey with just over 100 prescriptions per 100 persons. So that would be categorized as a really high prescribing rate, potentially problematic for having all of this excess medication sitting around. Adams County, Foster, Eddie, Wells. So those are the top five. And there's sort of a little, you can see kind of towards the center of the state, there's sort of a little pocket there of really high prescribing rates. So that would mean that these are communities, these are counties where there's likely to be a lot of excess prescriptions sitting around. So I again encourage you to go to that website and take a look at more information about what's going on there. So it does look, you know, it obviously is a little bit alarming to see numbers over 100. But comparatively, if you look at other parts of the United States, it's actually pretty low in North Dakota and in most of the Midwest. It's really concentrated a lot more in the South, in Appalachia. So even though the picture looks pretty bleak here, this is really nothing compared to other areas of the nation. So as I mentioned, over prescribing is a big factor involved here. And I'm going to say more about that in a little bit. But I'm going to go through some different factors at different levels that have contributed in that play a role in the development of the crisis and also need to be considered when you think about addressing the crisis. And as part of the extension opioid crisis response workgroup, we completed a very thorough comprehensive literature review. And we organized that literature review largely using the eco-developmental model. So this is the framework we use to think about, you know, what are the important issues and how are we going to address them? And just to give a little background there, the eco-developmental model is really focused on risk and protective factors. So risk factors would be characteristics, and that could be at different levels. So biological, psychological, family, community, characteristics that proceed and are associated with higher likelihood of problem outcomes. And then protective factors are kind of the flip side of that, right? They're characteristics that are associated with lower likelihood of problem outcomes, or that would reduce the negative impact of a risk factor on problem outcomes. And these can vary quite a bit, the risk and protective factors, depending on developmental periods. So what you see for children is going to be a bit different than what you see for adolescents, and then different places in adulthood are going to have different risk and protective factors. And so really what I'd like to communicate here is that this model considers this really complex interplay of individual and contextual factors. So it's not a simple way of looking at the problem, but I think it really helps us understand how and why it's so difficult to address a complex issue like this. So when we think about individual level factors, one of the first ones that comes to mind is going to be genes, of course, so genetic predisposition. And so genes account for between 40 and 60% of susceptibility to addiction in general, and genes are also important in thinking about different personality factors and other conditions that might make an addiction more likely. So things like an individual's temperament, like risk taking and impulsivity, and then also their risk of mental health problems and sensitivity to drugs. Another issue that is linked to genes is the comorbidity of disorders, and so comorbidity means you've got co-occurring disorders. So it's very common for people who have a substance use disorder to also have anxiety or depression or any number of additional psychological disorders. And that is partially because of genes, but then also some environmental features that can bring about both, which we'll get into. But an important thing here is that the comorbidity of disorders, it could be because of genetic factors that make both disorders more likely, but it could also be the substance use disorder could also be linked to attempts to use substances in a way of sort of self-medicating for anxiety and depression that's not being addressed through professional avenues. So it is entirely possible that somebody who has anxiety and depression then develops substance use disorder due to not having addressed those underlying problems. And then there are some demographic factors, and I'm not going to really get into that too much. But if you want to read more about that, that's in the literature review, and really the two big ones would be gender, that there are different patterns in misuse and in overdose and in the way that opioids affect people based on if they're women or men, or some of that is due to differences in biology, right? So biological sex and gender are both important to think about. But the big one really is race and ethnicity. So you'll hear the opioid crisis described as a white problem, and so really what we've seen is that the rates of misuse and overdose are much higher in white populations. But based on my reading of the literature, this really isn't an individual factor. It's an artifact of socioeconomic stratification that really has allowed white populations to have better insurance coverage and therefore greater access to the physicians who write the prescriptions. So really it's a testament to that systems level stratification that you see. But even when non-white patients have access, they're less likely to be prescribed opioids. So even if they have health insurance and see a doctor, they're still less likely to be prescribed opioids. So clearly there's a systems level thing going on there. In terms of family context and development, parental monitoring and involvement are huge. They are protective factors against adolescent opioid misuse, and then of course parental modeling is extremely important. So that's why organizations like Parents Lead are so important. And so obviously right now I have to give a little nod to my former colleagues in the PFRCs across North Dakota because if you want to solve the opioid crisis, you cannot do that without parent education. So there's my little tip of my hat to the PFRCs. Related to this would be adverse childhood experiences or ACEs. I just refer to them as ACEs. And ACEs don't occur exclusively in the family or home context, but that is the primary source of ACEs for most people. And I could say a lot about ACEs right now, but I'll try to keep it brief. But basically the original ACEs research identified 10 specific ACEs that you can broadly categorize into child male treatment. So that would include physical, sexual, or emotional abuse, and then physical or emotional neglect. So there's five that are categorized as child male treatment, and then five that would be categorized as household dysfunction.  So again, you can see how family education is important here to prevent some of these things from happening. And so then when we look at the impact of these ACEs, what we see is that particularly during early childhood, these ACEs impact neurodevelopment in ways that really make emotion regulation difficult and impact decision making for the long term. So ACEs are a common source for many health risk behaviors and chronic health conditions, and that includes mental disorders and addiction. So preventing ACEs or trying to sort of mitigate the effects of ACEs, that's really become a major focus in terms of a public health effort. Moving on to community level factors, social networks are an important aspect. So the size, composition, functioning of social networks impacts the local availability of opioids, especially prescription opioids. And when you see strong social and kinship networks, that actually can facilitate the possibility of diversion. So when people have strong emotionally close relationships, it's actually more likely that medication sharing will occur or diversion will occur. Importantly, these kinds of strong social networks are very prevalent in rural communities, and rural communities disproportionately, they are the places that are seeing opioid-related problems. For many factors involved here, there are higher prescription rates in rural communities, and a lot of that is due to higher rates of arthritis and then manual labor jobs. But even if you control for those factors, prescription rates are still higher in rural communities. We've got the manual labor jobs there. Outmigration of young adults. So young adults who have really excellent educational and vocational prospects tend to move out, and that results in aggregation of high-risk young adults. So young adults who don't have those kinds of opportunities tend to stay in the community. Economic stress is a major factor, so low wages, lack of upward mobility, and then a big one is automation of manufacturing, so fewer jobs in manufacturing. Lack of access to treatment and limited services. So this would be lack of access to services to address mental health, lack of access to treatment for substance use disorders, and then when treatment is available, limited services. So in particular, a lack of access to medication-assisted therapies such as methadone and buprenorphine, and lastly disparities in naloxone use. So naloxone is that lifesaving medication that can be given when somebody is overdosing to reverse the overdose, and it's used much less frequently in rural areas. And then when we think about broader social and cultural factors, the big one that comes to mind is mental health stigma. So that'd be general mental health stigma, which interferes with being able to talk about difficulties and seek appropriate treatment, but there's even more intense stigma around opioid use specifically. So substance use disorders, there's just even more stigma associated with substance use disorders. Over-reliance on law enforcement and the criminal justice system to solve the problems. So a more fruitful approach would be community-based solutions that engage multiple social systems and try to make use of community assets. And then there's a lack of appropriate treatment while people are incarcerated. So while they're trying to recover and be rehabilitated, they're not receiving the services that they need, and then sometimes they don't have an appropriate transition plan for release. And then, as I said, I'd come back to this one, the over-prescribing. So really this is about insufficient regulation of pharmaceutical companies. And I've got the little in-forum picture there of the Attorney General filing a suit against Purdue Pharma. So Purdue Pharma is one of the big names here. In the late 90s and early 2000s, the marketing and sales activities of pharmaceutical companies were really pretty intense. And in hindsight's 2020, as they say, but really like, wow, some pretty intense stuff here. So direct to consumer marketing of addictive medications, hiring of drug reps to work as detailers. So they were literally provided with prescriber profiles that had detailed information on the individual physician and then trained in being engaging and interactive. And so essentially like meeting with an individual and having a lot of information about them so that you can directly market. Bonus systems for drug reps who achieved certain levels of sales. And Purdue Pharma, in order to increase OxyContin sales, they had all expenses paid symposia for healthcare professionals. And that included staying at luxury resorts for the medical professionals who attended that. And then marketing materials and branded promotional items. And then this last one, really disturbing, 15,000 copies of an OxyContin promotional video that had not been submitted to the FDA for review. And it downplayed the risk of addiction and exaggerated the effectiveness of pain relief. So really a lot of what has caused the current crisis or the catalyst is the overprescribing that is a direct result of these marketing activities. So when we think about addressing the crisis, there are a lot of possible solutions and it's going to take multiple attempts at multiple levels. There's no easy fix. It's going to require a lot of different initiatives. And so I in the literature view have divided these into different types. And so demand side solutions are going to focus on people who are using, misusing or at risk of misusing an opioid of any kind. So really this is the consumer side of things. And its demand side is about once a medication has been dispensed. Whereas the supply side focuses on the people who do the prescribing, who manufacture or dispense medications. And then lastly we've got large scale policy changes that would be enacted through political channels. In terms of demand side solutions, pain management alternatives are one possible way of addressing it. So identifying alternatives to using opioids for pain management. So over the counter medications, that's a big one. There's some interesting research that suggests that the combination of ibuprofen with acetaminophen is more effective than oxycodone in treating certain kinds of pain. So over the counter medications are inexpensive, widely available and can be highly effective. And then so a note there is that opioids are indicated and well supported for terminal care. But there's not actually a lot of evidence to support the use of opioids for non-malignant chronic pain. So really we should be trying many different things before resorting to opioids. But instead what has happened is that that's what consumers are demanding at this point and that's what they want. And there's a lot of focus on appropriately treating pain. So people want to take a pill at this point. A lot of people want to just pop a pill and have it solve their problems. But we need to shift in thinking about how we manage pain. So some of the more alternative approaches, one of them is medical cannabis. So there's some interesting research here on medical cannabis products like pills and tinctures being effective for chronic pain management. And of course less dangerous than opioids. Other approaches would include yoga, exercise and physical therapy. So those last three, yoga, exercise, physical therapy, those would not include taking a drug of any kind. Education on storage and disposal is really important. So you can see at the right here I've got the North Dakota Prevention tagline here, lock monitor take back. So there's a big health campaign right now for lock monitor take back. So really keeping medications secure while you have them, paying attention to what's going on with them or is medication disappearing? That shouldn't be. And then the big piece is disposing of them properly. So in order to do that, you need to have either permanent safe disposal sites in North Dakota. Most of, I think all of the county courthouses have safe disposal sites and drug take back events are another way of doing that. So having an actual community event dedicated to people bringing in their leftover medication to make sure that it gets safely disposed of. And then we have the realm of intervention and that can be divided into four different major categories. So you see on the right here we've got this picture taken from a National Research Council and Institute of Medicine document and it's the spectrum of intervention. So promotion and prevention would be more on the front end of things. Promotion would refer to trying to enhance individual competencies and capacities that function as protective factors. An example of this would be positive youth development approaches that attempt to promote optimal development or thriving by helping youth identify and pursue interests. Prevention is like promotion, so promotion and prevention are kind of linked, right? Prevention occurs prior to the onset of a disorder, but the main difference is between prevention and promotion is that prevention really explicitly and intentionally addresses risk factors. And then we've got treatment and maintenance. And so as the Extension Opioid Crisis Work Group completed our activities and took an inventory of different programs and activities of land grants across the United States, it was very clear that there's a lot more focus on promotion and prevention than on treatment and maintenance. So treatment would be an intervention for somebody who has a diagnosable disorder to either reduce their symptoms, manage the effects, and then if possible cure the disorder. Maintenance is really the long-term compliance with treatment goals, so that would be preventing relapse and recurrence. And so there are some institutions, there are some land grants that do some work, particularly with the maintenance part of it, but for the most part what we saw was a lot more focus on promotion and prevention. And then as a standalone, I did want to talk about community development.  But the research literature very clearly indicates that in order to solve this problem, we have to consider broader social contexts. So there are lots of economic conditions that are linked to opioid use disorder and then community capacity to address needs is really important. So economic development and community capacity building are essential aspects of addressing the crisis. Supply side solutions. Abuse deterrent formulations, that would be medications resistant to tampering. So there are physical or chemical barriers that make it difficult or impossible to misuse the medications. However, abuse deterrent is not equivalent to abuse proof and people who have a substance use disorder, especially if they're experiencing withdrawal, can find some fairly innovative ways to bypass those modifications. So this is not necessarily always the best solution. Training of medical professionals, obviously not really an area that extension can be involved in all that much, but still important. So in the literature it suggests that medical professionals need to receive a lot more training on social determinants of health and a lot more focus on pain management. And then in terms of treatment issues, more information on medication assisted treatment. Pharmacists as a point of intervention. So it's pretty rare for pharmacists to engage in screening and discussing misuse with patients, but they as the gatekeepers of these medications, they're the ones who dispense it. They're really at a critical juncture in this process where they really have that on the ground view of what's going on and can intervene if necessary. But unfortunately it doesn't happen very often and a lot of the issue is that they don't have the resources that they need to do that screening or the training or they don't feel comfortable. They don't feel like it's their role and so some of it needs to be empowerment of pharmacists to feel like, yes, they do have it right to ask these kinds of questions. And then lastly, prescribing guidelines and PDMPs. PDMP stands for prescription drug monitoring program. And so it's a database where prescription information can be tracked. So basically it tracks the not just who is receiving the prescription and the amounts or dosage, but who wrote the prescription. And in most states it's not a requirement to use PDMPs, it's voluntary, but the PDMPs allow for tracking of prescribing practices. So not only can they be used to provide information and kind of raise red flags about things like doctor shopping or if patients are running out of medications too quickly, they can also allow for tracking of the physician prescribing practices and can be used to identify physicians who might be engaging in unethical prescribing practices. So promoting or incentivizing provider use of the PDMPs would be, I think, would increase the effectiveness of the systems that are in place and then better information sharing capabilities is something identified in the literature. And then last we have our more grand scale policy changes. Medicaid expansion to ensure that economically vulnerable populations have access to the health care that they need. Health insurance coverage of medication assisted therapies, so not all insurance will cover things like buprenorphine, but medication assisted therapies are highly effective. Lifting federal restrictions to allow randomized controlled trials, examining medical cannabis as substitutes for opioids in pain management. So there's some interesting literature here coming out of states where medical cannabis is legal that demonstrates that when it is possible for chronic opioid users to instead switch to medical cannabis, they are able to completely stop using opioids and of course the cannabis products are safer. But because of federal restrictions, you can't do a true randomized controlled trial. You can't randomly assign people the conditions. So you can't engage in really the gold standard of research because of the federal restrictions. So people would like to be able to study this, not just for effectiveness, but also for safety, right? So that's one step in that direction. Modifying DEA regulations and processes to make it easier for physicians to prescribe buprenorphine. So as it stands, primary care physicians have to apply for DEA waivers to even be allowed to prescribe buprenorphine. And then there are restrictions on the number of patients that one physician can treat. So it's been suggested in the literature that there be some modification to this process that would make it more accessible for patients. And then lastly, shifting from prioritizing law enforcement and incarceration to prioritizing prevention, harm reduction and treatment. And especially when I'm talking about prioritizing, I mean putting the money there, right? So including a lot more funding in federal and state budgets for prevention. Because to date, a lot of the money has flowed towards treatment and the long-term maintenance stuff, which is definitely important. But if at some point we don't switch to greater emphasis on prevention, then we're going to have to keep putting money into treatment. So we really need to find ways to channel more money towards prevention. Okay, so the last important stuff here, extensions role. What role does extension play here? So the cooperative extension system is really uniquely positioned to address the crisis. A lot of that is because of the existing infrastructure in all states and counties. And diffusion of science with practice is our business. That's what we do, right? So we have the structure and the culture to do this. And extension agents in their communities often serve as change agents. In terms of the history of response, extension was involved in the rural crisis of the late 1980s. And at that time, it became clear that understanding mental health was an essential part of resolving the farm crisis of the 80s. And extension was definitely involved in addressing root causes of distress. So that would include economic changes, so helping people with work skills, right? Helping people manage with their economic pressures that they have. Extension agents out in the counties facilitated formation. And this is, I shouldn't mention, this is really just looking at extension, cooperative extension as a whole, not specifically NBSU. But just if you think about cooperative extension in general. So facilitating formation of community coalitions. Yes, we are working on farm and ranch stress again now, yep. And then recently there's been a lot more expansion of behavioral health programming within cooperative extension. And that includes substance use prevention. So mental health topics are receiving a lot more attention now than in the past. And there's a lot more emphasis on evidence-based programming as well as community level impacts. There are, however, some challenges involved here. First would be moving toward a common language. So particularly for community-based educators, they may not be well-versed in some of this information on what constitutes evidence-based. What would be evidence-informed, right? There are all these terms. There's a lot of jargon that's used by research scientists. And so the Journal of Extension, there are several articles in there that really discuss the need for greater professional development. That would help community-based educators be more proficient and comfortable in using this language and in identifying these kinds of programs. And then adopting evidence-based programs. So there are some issues here in terms of tensions between scientists and practitioners. Often there are different goals and priorities, especially when it comes to issues of fidelity of implementation and the ability to adapt the program to meet local needs. Knowledge, attitudes, and proficiency regarding evidence-based prevention programs. So this is something that could be addressed through professional development. I did want to just very quickly mention that one of the areas where attitudes are a bit of a bigger challenge is the world of 4-H, because of historical tension between positive youth development approaches and prevention approaches. So positive youth development tends to focus on promoting positive outcomes through building competencies, but then prevention really focuses on deficits and avoiding negative outcomes. But it's really important to note that both approaches are useful and necessary and that they're not incompatible or mutually exclusive. You need both. And then lastly, organizational capacity. So system openness to change is really important to consider. The port for evidence-based prevention within the organizations. Happing and human resources, of course. When we surveyed land-grant institutions across the country, a lot of institutions said we don't have the staff on the ground to deliver programs. We don't have experts in these areas. They just don't feel that they have the human resources that are required. And that is related to shrinking budgets, of course, which I don't really need to launch into a spiel about that. I think you all probably understand how that impacts human resources and how difficult and challenging it can be to even think about adding new programs when you're trying to just maintain, in a lot of ways, the programming that you have. And a lot of institutions across the country said that organizational capacity is really the problem, that they care about the crisis, they want to do something to help, but they just don't feel they have the capacity at this point. I have a few suggestions really identified through the literature that community-based educators should all have a basic level of behavioral health knowledge and skills. And I realize that that takes funding, that takes training, right? Professional development requires money. So my recommendation here is that, at a minimum, you have the responding to distressed people publication on hand for quick reference. So if you don't have that in your office, it should be fairly easy for you to obtain a copy. Prioritizing high-quality programs. So you've got to have good implementation and outcome evaluation for that. And I think that the PAIRS system is really a step in the right direction there to be able to track that information and demonstrate if programs are having their intended effects and if not, why? Why not? Addressing both risk and protective factors would be important. Multiple contexts and multiple portions of the lifespan. So really, that's a good question. Did all agents automatically receive the series of publications? I'm not sure, but I think that would be helpful to get those publications into the hands of all of the county staff. Oh, okay. Sorry, I got distracted by the comments. Capacity issues. So learning about innovative, highly impactful ways to deliver programs. So one example is Prosper, which is explained very in depth on the extension website. So I think that's definitely something to look into. So there's my little blurb about Prosper. So if you go to the website, you'll be able to read about that. And making use of Pivot to search for funding opportunities. So NDSU has a subscription to Pivot, which is basically a platform you can use to do customized searches for grant opportunities. It's really neat. If anybody wants to talk to me about that later, I definitely love Pivot. Okay. So very, very quickly, I just want to give a few examples where I think NDSU Extension is doing a great job. And these are some projects and programs that are on the right track. So the Mackenzie County Coalition, which is chaired by Marsha Helen Sauce. This coalition really focuses on prevention of underage drinking. And they have been able to do a number of systems, a number of PSE, policy systems, environmental change activities. So implementing card readers in bars and places where you buy alcohol to make sure that IDs aren't fake. Anyone who's under 35 has to be carded, cameras installed in and behind bars. Anyone selling alcohol, having to complete safe server training. And importantly, I want to emphasize that the community coalition model can be and has been applied to opioid misuse. It just happens to be the case that in North Dakota, we have a much larger problem with underage drinking and with binge drinking would be a big issue. So if there is a county, though, where the issue is more opioid misuse, then this county coalition format is a great way of addressing that, including multiple players bringing people to the table who all need to be in on that conversation and who can really combine their resources and expertise to make some of these important changes in their communities. I wanted to highlight this. This is actually, it was a small grant that has been awarded to a team, which is led by Amber Letcher at SDSU, but Megan Scott is part of this team. And the program itself, stepping up, it's social emotional learning for rural middle school youth. So they're going to be collaboratively delivering this program in a multi-state region. And it's a prevention program that their outcome that they're focused on is suicidality, so suicidal thoughts. But these kinds of skills and factors are involved in many, many other mental health issues. So this is a great example of a cross-state collaboration that focuses on prevention and use of evidence-based programming. So I highlighted at the bottom there that they've got a pretty exceptional plan for research. In addition to using an evidence-based prevention program, they've got a great plan for how they're going to evaluate it. And then lastly, the mental health training on Ivan. So I believe this is an annual training that different topics get discussed annually. And the most recent one, there was a section on emotional stress on the farm. So I think that is a very important one that's relevant to the opioid crisis. If you didn't participate in that, you can go watch the recording and learn more about that. I think that that is a really helpful video conference. Oh, concluding thoughts. Promotion and prevention seem to be more the area where extension can and should be involved. It aligns well with the mission and history of the land grant system. Addressing the crisis requires all extension program areas to work together. So it's tempting to think about mental health and behavioral health as within the realm of FCW, right? But when we think about, especially in rural areas and areas where farming and ranching are the dominant forms of economic activity, it's the A&R agents a lot of the time who are having the greatest interaction with our clients and who are in a position to really help people who might be in distress to find access to services, right? So it needs to be a coordinated effort across all extension program areas. Capacity is a challenge for many institutions. So ECOP and partner organizations are working on forming a response network that's sensitive to this. And then lastly, NDSU Extension, I think y'all are doing great work. So keep up the great work. And if you're interested in learning about additional ways to do more specifically with the opioid crisis, go visit the extension, the extension website and take a look at some of the information on there. And with that, we've got a few minutes for questions. And if you want the references for any of this, I can send you. You can email me directly and ask about a particular portion of the presentation or if you just want all of them, definitely feel free to contact me with follow-up questions. And I can get you those references. So with that, does anybody have questions? Allison, this is Jody. I have a quick question. Hey, so maybe this is what Lynette is referencing in the chat pod there. I read yesterday part of the farm bill that there's a piece that was designated for opioid issues in rural areas. It's in this new farm bill. So does anybody know if there's something more than what Lynette's reference here addresses? I'm not sure about that. That's a good question. Is Lynette still on? Yeah, she is. Maybe Lynette can speak to that? No? Okay. Anybody else? I can do a little more digging into it. I'm just curious. Oh, okay. She's going to respond. Just give her a minute. Yeah, disposal is definitely an issue. Oh, I've seen some interesting articles about on the coasts that there are muscles that are testing positive for opioids. You know, shellfish testing positive for opioids because medications are not being disposed of properly. So can you hear me? This is Lynette. Yes. Okay, good. Thanks. Sorry, I didn't have my headphones on. But yes, good question, Jody. There has been money in the past for rural health and safety grants. And that's part of the one that Megan has that Allison referenced earlier. There's other larger rural health and safety grants that have been given nationwide through extension. I believe and they've always come through extension. I believe that there was more money put in the firm bill for things like this and I'm going to go back and look. But there's just a lot of different things they're really trying to do and put into whether it's the firm bill or other operational dollars for extension for research around this issue.  And so there's becoming more money. We haven't gleaned through all the details on the firm bill yet, but I think that then there's always been some dollars in this regard. So we're hopeful. The message that I, the little note that I mentioned too was that there is a, it's called a solid waste management grant program. And it's really all about water quality. And so when we think about all of you that are working, especially in the agriculture arena and the water quality issues, natural resource issues that you're dealing with, there is a grant.  And again, it's probably something you would partner with a specialist on if you wanted to make this happen. It's for communities with less than 10,000 in population. But we just learned that there's extra points that will be given if there's some type of take back program with pharmacies or on opioids because of the solid waste that they're adding to the water supply. And so it's been kind of an interesting read and something more interesting to kind of learn about, but it's just becoming such a big issue. And so we're concerned. There are lots of concerns. And so there will be extra points with this USDA grant. So if you've got any ideas or thoughts or some creative way that maybe partnering with a specialist on, wow, this would be something we should do for our region that I'll forward it on. Terrific. Thank you, Lynette. This is Marie. For Allison, is there any last question for Allison? If there comes questions, I'm sure Allison, you'll be fine with them reaching out to you as well. Absolutely. Yeah, I want to thank you for sharing this wonderful research and helping us better understand the opioid problem in the U.S. and here in North Dakota what we as extension professionals can help with and do in our roles. So thank you so much for sharing that this morning. And thank you all for being on the call. It will be, it is recorded and so look forward under our long term downloads with FCW Webinar Wednesday. And we'll be back again after the new year. Our next webinar will be January 16th. So look for some information to come out for that. So thank you all for being part of this this morning. Thank you.


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