Author: Alicia Conners

Chris Chavez [00:00:00] In the court systems, it’s also amazing. I mean, I can share an experience where an individual was very upset. He was yelling at the judge, she was ready to arrest him. It was just not a good situation in general. And he started yelling and saying, you guys don’t know what it’s like, you don’t know how it feels. And I ask judges, can I go talk to him outside real quick? And I went and I talked to him. He says, no, you don’t get it. He’s like, I’m losing my kids. I’m doing this. And I was able to share with them. I said I had two kids that were adopted by my their grandparents because I was incarcerated. I’ve had to go through these struggles. I struggle with this. I didn’t have this opportunity either. I went straight to incarceration and didn’t get a chance to get out and prove myself to anybody. I need to get a chance to get out and do classes and comply with the DCS stuff. And I didn’t even have that option. And once he seen that, he seen that there was this whole other side in that it wasn’t set in stone, you know, and it wasn’t even that he trusted me. It was just that he was able to build that rapport with me real quick and say, okay, I need to I need to not be like this guy. And it was enough to where I think that it brought him to a place where he was willing.

Narration [00:01:16] This is Countermeasures brought to you by Emergent, maker of NARCAN^® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is a leading cause of accidental death, with so many families, loved ones, and friends behind these lives lost. This season, we’ll continue to explore some of the communities hit the hardest by the crisis, from prisons and construction sites to schools and elderly care. We will hear from changemakers offering a new way forward. Navigating the criminal justice system can be difficult for anyone. For those who struggle with opioid use or those who are in recovery, these challenges can become even greater. According to the National Institute on Drug Abuse, 65 percent of the prison population in the United States may have a substance use disorder. These challenges continue following release as well. Previously incarcerated individuals, or at least 40 to 129 times as likely to die from a drug overdose compared to the general public two weeks following their release. More can be done to support these populations. In this episode, we explore some of the organizations and individuals who are helping influence the system and facilitating recovery and support for incarcerated individuals, as well as continued support upon their release.

Jason Edgcomb [00:02:47] Yeah. So my name is Jason Edgecomb. I’m the jail superintendent at the LaSalle County Jail in Illinois. We’re about a mile or an hour and a half from Chicago. Right on Interstate 80. Got here just through, I’ve been doing this job for 14 years now, and in those 14 years, we’ve had some of our medical doctors who also treated people with substance use disorder on the outside. So they came to us and wanted to see what we could do for people in the facility, because they were seeing a lot of roll over, and the people they were seeing on the outside. We’re also coming back in here, and being then sitting in the jail without any sort of treatment. So that’s how we got to where we’re at.

Narration [00:03:30] LaSalle County Jail is one of the jails across the United States that has MAT or Medication Assisted Treatment, sometimes also called Medication Assisted Recovery, available in the jail. Originally, Jason didn’t understand the importance of these kinds of programs.

Jason Edgcomb [00:03:47] So the origin of this program was the doctor coming in. He worked at other facilities in Wisconsin and Michigan, some jails that did MAT services in those facilities. And he wanted to start doing them here. I knew nothing about it. I had a lot of faith in him, and I, and I kind of chuckled one day and just said, hey, whatever you want to do, I’m giving you free reign to do it. He could see that that was just me going along with it. So he came in and sat down with me and and that wasn’t good enough for him. He wanted me to understand it. Probably the most telling thing that he ever said to me, and you hear this a lot along all the circuits is people with SUD, you like to look at him and treat him like somebody who was maybe a diabetic. Just because they come to jail, you don’t stop giving them their medications, you don’t stop treating the diabetes. And just because someone comes to jail, we shouldn’t stop treating the disease of their substance use. So that kind of was a little bit of an eye opener for me. So when I looked at it and then that’s when I really started doing some more research on my own, talking more with him about it, talking to other people about it, and really trying to get involved with the community of people that offer help for people with substance use disorder.

Narration [00:05:02] Jason emphasizes that the medication has only one part of treatment. Resources like peer support, one on one, and group counseling and education are all critical parts of the path to recovery.

Jason Edgcomb [00:05:15] Yeah. So the I think that the easiest way to say that when you talk about the medications and a MAT/MAR program is that it’s only one part of the program, right? There’s not a medication that fixes anything. A big part of that is we highly recommend counseling people in our recovery, that they can sit down with our mental health provider. And, you know, maybe there’s a triggering effect for them that causes them to relapse or causes them to want to use. They can address that they have somebody in their life to address that with. Upon release, we do the same thing and we try to get them into that, get them set up with the counselor on the outside. If they’re not comfortable in an AA setting, because in AA  setting isn’t for everybody. You know, some people don’t do well in a 12 step. It’s important for us to find them that smart recovery, another avenue of some kind of be able to get them the the support that they need with those people. So the medication itself is a great first step. We have people that feel good on it. Again, when we talk about my sister, you could see the difference in her on a daily basis. So the great thing about the medications is it gives us that opportunity to get their head clear, so then we can work with them through all of the other aspects, to try to keep on that on the right path.

Narration [00:06:32] Chris Chavez, who you heard at the top of this episode, is the regional manager of community programs at HOPE Incorporated. HOPE is a peer and family run organization that offers support for people living with a mental illness or substance use disorder, as well as those in the criminal justice system. After being released from jail, Chris got a job at HOPE incorporated, where he has used his lived experience to help others.

Jason Edgcomb [00:06:58] I basically came into this field not knowing what I was doing. I had previously gotten in a lot of trouble. I was on probation the majority of my adult life. I worked only two jobs my entire life, so I worked at the same construction company and then I worked at HOPE. That’s it. And I was working construction. I did all my stuff. I got my life turned around, and I decided that I did not want to go back into the construction world. And so I went to some employment services. And when I went to them, they were trying to give me a job, but we were really struggling. Like with my background, I couldn’t get employment anywhere. I was just it was very difficult process. It was very frustrating. And my, you know, my case manager at the time, said, why don’t you become a peer support? I didn’t know what it was. I just said, okay, I just I just knew I wanted to do anything but go back to that construction life. So they got me my peer support certification. I applied everywhere. It was very discouraging because everywhere wanted a year experience, but I didn’t know how to get a year experience if I couldn’t get a job. So HOPE actually hired me. But they hired me as an admin assistant and so I started as an admin assistant. No clue what I was doing, just answering phones. Thank you for calling HOPE. This is Chris. And it was it was a very humbling experience. It was very different from what I’ve ever experienced. And so I kind of just went through and as I started learning and I started helping people. I started realizing how many aspects there are to the behavioral health world and to be able to help so many people through those avenues. Even with volunteering and everything else that I I’ve learned and I’ve adapted in my life, it’s, and it’s become a part of my recovery. And once I took off, I took off, I became a peer support, then a then in case manager, case manager to program manager. And now I’m a regional manager. So once I once I got a taste for it, I couldn’t stop.

Narration [00:08:59] Both in his role at HOPE Incorporated and from his own experience, Chris knows that there are a lot of barriers to someone getting the treatment and help they need to be successful in recovery and reentering society.

Jason Edgcomb [00:09:10] Some of the biggest barriers for incarcerated individuals, I think, is the treatment while they’re still incarcerated. There’s not a whole lot of programing. There’s not a whole lot of treatment. There’s you know, I really wish there could be more peers co-located in the jails so that they could offer services in groups in in helping them to assist with resources when they get out. Because even for myself, one of the biggest resource deficiencies that I faced was financial. Because even if you get arrested and you go in and it’s for 30 days, you know, have 30 days of bills and 30 days of no income, and it’s more likely that you’re going to go in [00:09:50]recidivate [0.0s] than to go out and try to figure it out the right way, because it’s very difficult. It’s very frustrating. It is hard even when you’re in there and you’re trying to call people, you’re trying to figure it out. Like even in my situation, I had money in my bank, but I couldn’t pay the bills because nobody had access to my money. So even though and then I got all these [00:10:13]leaf [0.0s] and everything and it just stacked up and it just set me back so far. And we encountered that a lot with these individuals. And it’s really sad that, you know, they, they end up using some sort of a substance. They get violated. They get sent to jail. They have to wait for a review hearing. Then they go to the hearing and then by the time they get out now, they’re just further behind than if they would have just got them into treatments or or offered them other assistance or resources while incarcerated to help them when they get out to not face those issues.

Narration [00:10:49] Olivia Sugarman is a postdoctoral fellow at Johns Hopkins Bloomberg School of Public Health, where she works in the Department of Health Policy and Management with a group called the Bloomberg Overdose Prevention Initiative. Olivia says that programs like the one run at LaSalle County Jail are the exception, not the norm. She also highlights some of the barriers that people who are reentering society face.

Olivia Sugarman [00:11:13] Let’s break it down two ways. So incarceration can mean a couple things. There’s incarceration in jail and incarceration in prison. And the difference between the two is important. So jail is pretty short term. So different states have different policies about who can be in jail. So usually it’s people who are waiting for a trial. That can be a period of months. That can be several months. It can be a few days. Other people in jails might be people who have been sentenced, but their sentences are about a year, 18 months. Whereas people who are in prison have been sentenced, their sentences are a little longer. So that’s the difference. So from a health perspective, think of, okay, incarceration, the period that you’re in a facility is kind of this catchment period. So what’s happening while you’re incarcerated with your health is kind of a black box, period. We’ll just leave it at that. So thinking of social determinants of health for reentry. So we don’t really know what’s happened while you’ve been incarcerated. Who knows if you’ve gotten preventative health. For people who use drugs, that could mean a period of abstinence without any kind of treatment. That conversation is changing. But that’s kind of been the predominant idea, is that people usually don’t get treatment while they’re incarcerated. So thinking about social determinants of health on the re-entry side. So say you get out as a blanket statement. Most of my work so far has been in prisons. So my slant is a little bit more there. But housing generally is huge, period. Like if you’re getting out of prison, like you haven’t been connected to broader society for a long time, where are you going to stay? Generally, you get out of prison, you get on in maybe 20 bucks in a bus ticket, or at least that’s the story in some places. What are the other supports available to you when you get out? So housing is one. Employment’s another big one. There was this big campaign around banning the box of, disclosing that you have have some kind of criminal record, whether or not that affects whether you get employed. And then, of course, your sustaining, I mean, so many things are tied to employment. Can you buy food? Can you continue paying for rent? Do you have health insurance? Are you able to afford health insurance if it’s not from your employer? That’s a big one. And then the third one, I would say, and this is less policy and maybe less concrete, but it connections to people and positive connections to people. So do you have family nearby who have some kind of housing option for you, so you can stay with them for some time, like people to help you get back on your feet and take care of some of the more tangible social determinants of health so you can be supported longer term.

Narration [00:13:46] Having strong, comprehensive support while incarcerated can make a huge difference in helping to set people up for success.

Jason Edgcomb [00:13:53] You know, we’ve had a couple of success stories through here. One of them, I think that really has affected me the most was we had a young girl that was coming in here. She got into the program. She my whole career she’d been coming in here, always with drugs, always having a terrible opioid problem. And she came in this time and she was looking at prison time and, and she got into this program and she kept waiting for a bed. And I don’t understand what, I never will understand what the way it was. But we had other people come and go. That facility’s accepted and they just never accepted her. So she was waiting and waiting. But the whole time she’s waiting, she’s doing all this recovery stuff and everything else. And I’m pushing the states attorney’s office, and I’m telling them, listen, she really needs drug court. Let’s keep her here. She’s doing so well. Let’s do this. And I couldn’t convince the state’s attorney’s office not to send her to prison. And then when the time finally came, I didn’t want her to find out about it in court. So I went down, and I talked to her one on one, and I looked at her and I said, I’m sorry. You know, I feel like I failed you. You’re working your rear end off to your sobriety. You know, I can’t get you in drug court as much as I’m trying. And she said, that’s okay. I’ve accepted the fact that I’m going to prison. And she says, you know, they’re they’re looking at eight years, but she says, you know, every time I’ve been to prison, they’ve always offered us programs for treatment. And I’ve never once taken one of them. And she says, I’m going to prison this time with a clear mindset, and I’m going to take every single class that they give me. And, I said, well, that’s great. I said that, but I just wish they would understand that, you know, you’re finally understanding your sobriety and that we can help you if we keep you here. I said, I just feel like I let you down. And she looked me in the eye and she says, there’s no way you let me down. She says, this has been the most life changing experience I’ve ever had. And she says, because of this, I’m going to go to prison. I’m going to continue to try to get better. She did a six year prison stint and 16 months because of everything she did when she went to the Department of Corrections. She got involved in everything. We went to a training class that had some counselors from the Department of Corrections there. They knew her by name, and they told me that she was amazing, and she came in with such a great attitude to her recovery. So I, you know, I think back on that one because it’s it shows that you can make a difference to people while they’re sitting here waiting for everything, no matter what the outcome is. Right? It doesn’t have to be a happy ending of them getting out of the county jail and going home. She had that right mindset that was, it doesn’t matter what happens to me now. I have a full future that try to change and look out for.

Olivia Sugarman [00:16:53] A lot of people in prison in jail have a substance use disorder of some kind of opioids or otherwise, but they don’t really receive treatment. Like health care received in carceral settings, it’s a whole other can of worms. I wanted to see what clinical what do you clinical trials have to say? How many have been done if any? What do they show us? And do they include things like social determinants of health. So and some of those interventions did. So in addition to providing and not even just medications for opioid use disorder, so things like peer counseling. I think a couple of them included naloxone training, which is what’s to the point of treatment, but rather overdose prevention. And basically what I found was people acknowledge that social determinants of health are important, but none of the interventions really included those explicitly. So there’s some work to be done. At the same time, and I’ll say this, it’s hard to include those, it’s a lot to include for one person at one time. People need a lot when you’ve essentially interrupted their lives for potentially decades, and then you’re trying to get them back on your feet. Like things move so quickly anymore. Even five years, it’s a long time to be away and try to reestablish yourself, especially when you have an untreated underlying brain disease like substance use disorder, and you’re trying to establish yourself.

Narration [00:18:10] While there are great results like those shared by Jason, there are still no universal standards of care for treatment for someone struggling with opioid dependency while incarcerated. It is up to management, like Jason, to decide what programs are included.

Olivia Sugarman [00:18:24] There are standards of care for the general population that are enforceable in a lot of different ways. Those enforcements generally don’t exist in carceral facilities, so a lot of people will say this Estelle v. Gamble Case that went through in the 70s, that essentially says that you have to provide medical care for people who are incarcerated, because not providing adequate medical care is construed as cruel and unusual punishment. And that’s kind of that. There is there’s federal policy, and there are internal policies that exist that require you to go through X, Y, and Z steps to make sure that people’s health care is taken care of. Those exist and I don’t want to negate that does exist. But as far as what’s enforceable, what’s measurable, what’s overseeable, it’s kind of up in the air, and a lot of it goes to the States and sometimes can be as granular as the in the individual facility. And in some ways, relies a lot on whoever the warden is or whoever’s running it. Like, what is their general sense around the acceptability of opioid use disorder treatment and opioid use disorder in general? Like how do they think about that question? The minimum is never the maximum. We’ll put it that way. I don’t know that there’s necessarily a cap on what people can offer there. So Maryland has just as an example, some states are passing policies that require jail facilities to offer each kind of opioid or a medication for opioid use disorder. That looks a lot of different ways. And working with someone now who is evaluating that policy and how the rollout is going. So that’s one way of ensuring that medications are made available. And again, medication is not the only option for some people. Some people prefer not to use medication. That’s fine. But there are peer support programs, I think, in [00:20:05]ANA going places [0.0s] like that. So that’s one way of doing it. Other facilities can elect to do it themselves. There’s not really a standard of care, but as the drug supply is changing. So I’ll acknowledge the fentanyl continues to dominate the drug supply. Then also just kind of it’s important to acknowledge people’s choices and giving them choices, even in a controlled environment like incarceration.

Narration [00:20:29] Olivia hopes to see the continuum of care outside of jail and prison improve to further increase chances of continued success after reentry.

Olivia Sugarman [00:20:37] I think it’s an important consideration, and I think it goes back to getting some kind of treatment while people are incarcerated. So in that paper that I wrote, the consensus from all those clinical trials was essentially start soon after you get in and stay out as long as you need to, and make sure that there are some kind of warm handoff on the other end. And I think that’s the biggest piece I know. I’ll be bold in saying it’s not rocket science, that we have demonstrated this over and over again. If people have continuity of care, that’s helpful. One policy that makes me hopeful, it’s very new and it’s hard to say how effective it will be because it just happens. So there are these things called 1115 waivers for Medicaid. So basically what states can do is apply for some kind of exemption from Medicaid policy. It has to be budget neutral. And I wouldn’t say it breaks the rules, but it might bend the rules of some policy that Medicaid has around either how much they’ll reimburse for something or whether they’ll cover something. There’s something called the Medicaid inmate exclusion policy within broader Medicaid legislation, which basically says Medicaid won’t pay for service, won’t pay for services for people who are incarcerated while they’re incarcerated, except for hospital stays. It’s like the the one asterisk. There’s a new round alone, 15 waivers going out that will allow states to cover, I think it’s up 30 days or more of health care costs reimbursable by Medicaid before people get out. That has a lot of promise for coverage. Generally, I think it has a lot of promise for warm handoffs. I mean, the jury’s still kind of out on whether or not those will be effective.

Narration [00:22:19] She also hopes education improves to help lower the risk of overdose upon re-entry.

Olivia Sugarman [00:22:25] Everybody’s at risk. So opioid naivety is a big issue. Knowing what’s in your drugs, knowing what you’re using, having the tools to combat something if you do or don’t know what’s in your drugs. So again, kind of the distinguish or the difference between being in jail and being in prison. So if you’re in jail, say you’re in for a week, you know, you’ve had some let’s pretend, let’s just play through the scenario. So say you’re in jail for like a week. You’re don’t have access to medications for opioid use disorder if that’s what you want to use. So then your tolerance is a little lower. You come back out. You might be more familiar with what’s in the drug supply. So like you might know what to look for. So it’s kind of a toss up, like, you use, you know what’s in your drugs, but your tolerance might be different. So that puts you at higher risk for overdose. From jail or if you’re in prison for a certain amount of time, say, a couple of years, you’ve been totally in this scenario, you’ve been away from drugs and using drugs for a long time. You don’t know what’s in the drug supply anymore. You haven’t been exposed to all these other things. You don’t have the information available to you. You use. Don’t have the tools. And then also put you higher risk for overdose. Also not people use drugs in jails and prisons. Like I don’t want to be naive about it. Like those still get in there, but do you have access to the same tools you would in the community if you had all the information, and if you had all of the resources available to you? Not necessarily. So, yes, there is a higher risk of overdose after release from incarceration for a myriad of reasons. The drug supply is also generally just very dangerous right now, and giving people information and harm reduction tools is really important.

Narration [00:24:17] Another barrier for people with opioid dependency is navigating the criminal justice system.

Jason Edgcomb [00:24:22] I think there’s always going to be a struggle between participants in the court system, because a lot of the times, even including myself, like I felt like I was a victim of the court system. It wasn’t my crime that got me there. It was the court system that they did it to me. And we see that a lot now. And even just the perspectives of you think when you’re incarcerated in a prison, the CEOs are on the opposite side. Right. And and that’s something that I like to share a lot at that parole orientation is I say it’s not a game of cat and mouse anymore. You’re you’re not behind the fence. You’re on the other side. Like, our goal is to keep you out. And I let them know, because now that I’ve worked with some of these people, I don’t know, like they don’t want to do all the paperwork. It takes more paperwork to write a word for you than it does if you’re just doing good. And the POs want you to do good. Pretrial offices wants you to do good because it’s less work for them, and it’s better for the community. And getting them to see the other side of that and to see that, that they don’t want to do that extra work, I think, is a way that they relate to, and it helps to break down that barrier of that it’s not them just trying to be out to get them into right that warrant and that it’s okay to call and ask questions. It’s okay to utilize us as peers to ask those questions, to utilize our relationship with parole, to to ask those questions or even the court systems. We drive a lot of people to courses and we educate people on them. We let them know, like, hey, this isn’t what that court’s about. This is this court. This is we know this judge. We know these people. So a lot of the times it’s us using our reports with the member to bridge with the rapport that we have with the courts.

Narration [00:26:01] Chris also uses his experience to help decision makers understand the issues facing people in prison and when navigating the criminal justice system.

Jason Edgcomb [00:26:10] It’s amazing how my background applies to so many different things in so many aspects. So like even the simplest things like the construction or the substance use, or the incarceration or the the full continuum of all of it, it’s it’s just some it’s being able to utilize those aspects when needed and, and being able to to share it when it applies. Because I’ve noticed, too, that, you know, people that are oversharing or it’s giving too much sometimes you can take away from the point we’re trying to get across. And it’s simple things like they could, the best example I can give you is when I was part of the Pinal County and they were saying, oh, we want to do these the screening systems, and we’re going to screen for substance use and we’re going to do this. And I said, who’s going to do those screenings? And they said, oh, we’ll have a CO do it. And I said, so when I was in your jail, I said, I wouldn’t even tell the nurse that I was using because I was afraid that it was going to be held against me when I went to court. So I’m far less going to be able to tell a CO how I truly feel in the struggles I’m truly facing and it needs to be somebody that’s not a part of that system, because they can flip. So like being able to give that insight of how it is when you’re in there, giving insight of of what the programing is, like, when sometimes when I hear some of these, you’ll say, oh yeah, we have programing here. And being able to say, okay, so what’s the capacity of that programing? Oh 30 people. So you’re telling me you have a thousand people in your jail in 30 year programing? You know, and it’s like bringing that that insight because it was a struggle for me. When I was in there, and, and you want to sign up for classes or you want to go to an even an NA meeting or, you know, to church, it’s a very short list of the people that are available to go. It was almost like, it made me feel like I wasn’t even good enough in there. If I couldn’t even make the list to go somewhere. I wasn’t available to go, because I had it reached that seniority in there to to make it. And so I think the bringing those aspects to a lot of these meetings and sharing how it made me feel when I was in there using my lived experience is probably the best part of the the whole job.

Narration [00:28:24] Peer support and navigating the court system is another key to helping people be successful.

Jason Edgcomb [00:28:29] Peer support is amazing in the aspect that we’re not another provider. We’re not there to work with you. We’re like, especially at our agency, we don’t drug test. We are not there to report to the courts everything the members doing. And we make this clear to the courts as well, that they were there to advocate for the member. We are not there to report for the member. We’re not there to drug test for probation. We’re not there to do home visits for probation. Well, we do with our member is our business. And the only time that we’re mandated to report is if they’re in danger to themselves or others. And it’s nice because the courts also see the effectiveness behind that, because then the members can can trust us. Because you think if you were to put yourself in their shoes and they’ve already felt like like we talked about the, the discretions between the court and the members and that that mistrust and then that they don’t really understand this new court system or this whatever to the new parole, because they could change their name and being able to really educate them and show them that is very different than just telling them to, if you know what I mean. So it’s like it’s it’s really just educating both parties of what our role is and making that role clear that it’s for the member and we’re there for them. Because if they were to tell us, hey, I went and used and then they go to court and they’re like, hey, we heard you used. Then they’re like, oh, I’m not telling that guy ever again, you know. And so we want to be that support. We want to encourage them. Hey, you should tell the judge, you should call your your appeal and let them know that you messed up. And this is what we’re going to do about it. We’re going to make a plan. And this is for your this is best for you. So that if you do at the drop and it comes up, it’s not like you got caught. It’s you were honest in the beginning. And educating them, kind of how that all works.

Narration [00:30:27] Jason believes that the criminal justice system needs to find a better approach to help people be successful. But he’s hopeful for the future.

Jason Edgcomb [00:30:34] When we talk about obstacles to this, I would think that the biggest obstacle is communication with the justice system. You know, you’re trying to help people. And yes, we do get some people in here who are just using the system to try to manipulate their court case. But such as a young lady, we get some people that are sincere in trying to better their lives and turn things around. You know, early on in all of this, when we actually had inmates in custody, we would have people that we’re trying to help and we’re trying to get set up, and all of a sudden they’d go to court one day and they’d come down from court, say, no, I got time served today, and our nurse has no time to get up any of our discharge planning stuff ready, and I’d have to work with the State’s attorney’s office and say, hey, listen, you guys told me that you weren’t going to do anything with this for, like, another two months. While we offered or something today, and they took the time served. We offered him this. He took the time served. So we’re letting him out. So you’re not doing them any justice. You’re not doing us any justice. We can’t get them the services to continue on. So we’ve worked a little bit on that. But that’s been a huge obstacle for us, is just having that communication so that people don’t just, you know, as we talked about earlier with the overdose straight out of custody, right. If we don’t get them out the door, Narcan, if we don’t get them any services, they go out right away. And you, we may never get them back in again. And that’s what we want to try to avoid. So that’s, that’s probably our biggest obstacle to not being able to see all these people upon release because we don’t know they’re getting released so quickly. As far as the corrections industry and these programs, I think that the corrections industry is behind the eight ball on this, but I think they’re starting to catch up. We do work here in Illinois with HMA, who sponsors a lot of jails and does a lot of work with jails doing this type of recovery. And HMA is also they do work in California and other in other areas. They’re currently getting ready to go and do a project in Michigan for the same stuff. So I do think we’re trending in the right direction. But of course, it would have been great if we could have been trending this way before everybody recognizes this opioid epidemic, right? But now that it’s here, now that, you know, we’ve lost so many people to it already, now we look and see. We have to react to it. So, you know, I think that we’re starting to catch up. Every year I go to the American Correctional Association conference, and every year there’s more and more training MAT/MAR. First year I went was probably in 2014. There was I didn’t see a single class on it. We went to Orlando a year ago, February, and I bet you there was at least a dozen different classes on MAT/MAR and in correctional facility. So, it’s starting to grow and you’re starting to see more and more of that, which is a good thing.

Narration [00:33:27] The corrections industry is one of the places where the most support is needed for people seeking recovery, but where there is inconsistency and care, for the most part, it is dependent on individuals and management to decide what programs will be available at the facilities. Both while incarcerated and after release, access to services and peer support can make a huge difference in the lives of people seeking support and recovery. Organizations like HOPE that offer services and advocate for their members are a critical component of driving this industry in the right direction. Formerly incarcerated individuals are also at greater risk of overdose once released for a wide variety of reasons, including decreased tolerance and a changing drug supply. Jails and prisons across the country are beginning to provide naloxone to people upon release, but it’s not a universal policy, and many barriers exist. Researchers like Olivia are working to understand how to better support this community. Programs like the one that is run at LaSalle County Jail, and organizations like HOPE Incorporated, are all steps in the right direction. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.

 

Congressman Dave Joyce [00:00:02] But unfortunately, it’s wreaked havoc on communities throughout Ohio and our country. And Ohio is continuously ranked as one of the top five states for the highest number of opioid overdose deaths. They’re starting to make a dent, if you will, in some progress moving forward. But it seems the pandemic created the surge again, and we were getting to lose more and more people. I won’t say just young people, but I think it goes across broad swaths of our population who have unfortunately succumbed to it. And now with the flow of fentanyl and it’s becoming a bigger problem.

Narrator [00:00:40] This is Countermeasures brought to you by Emergent. Join us as we explore the shifting, complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. In the final episode of this season of Countermeasures, you’ll be hearing from Congressman Dave Joyce, representative from Ohio’s 14th congressional district. Congressman Joyce has witnessed how his district has been affected by the opioid epidemic and the influx of fentanyl since he took office in 2013. But he and other members of Congress are working on legislation to equip communities and first responders to fight back. You’ll also hear from Jessica Hulsey, founder of the Addiction Policy Forum. Both Congressmen Joyce and Jessica are advocates for ensuring we are combating the opioid epidemic at a nationwide and policy level. Jessica joined Countermeasures for a third episode on supporting patients and families in crisis. If you’d like to hear more from Jessica, we encourage you to take a listen. Congressman Joyce is a former prosecutor of 25 years, an experience which made him very familiar with the effects that the opioid epidemic is having on communities.

Congressman Dave Joyce [00:02:02] When I first got here, we created a group of bipartisan former prosecutors, and we went around the room to try to figure out where we could be that had the most impact with our expertise. And to a person, it all came back to have a problem with opioids. And everybody had stories of it. Everybody knew somebody who was lost or had issues. And so from that, we we’ve tried to figure out areas in which we could help stop the flow and target the the help of individuals who were addicted to it. All came the conclusion that this was not your 28 day dry out of alcohol. This was going to take much longer. Six, nine months, two years for people to get on the other side, if you will, from what’s happened. So it was important that we do that, and it’s only gotten so much worse would because of the tragic flow of fentanyl into our country.

Narrator [00:02:59] He has seen how the increase in fentanyl and other illicit and adulterated drugs has impacted Ohio families.

Congressman Dave Joyce [00:03:06] Criminal organizations find ways to re-engineer the fentanyl in substances like xylazine and even more potent than standard fentanyl are more addictive and more lethal at far less doses. I mean, they show you the three specs all look like grains of salt would be enough to kill somebody. In a, you know, it happened a couple of years ago. It really broke my heart. A couple of Ohio State University students is young women went out and procured what they thought to be Adderall in preparation for their taking their final exams, and it was in fact fentanyl. And they both died of an overdose. Now, granted, they shouldn’t have been out there getting it in the first place because they weren’t getting a prescription from a doctor filled at a pharmacy. But the unfortunate byproduct of that is death. And these young kids on campuses throughout the country are being subjected to this from ruthless drug dealers that are out there. So I just want to make sure that we get the message out far and wide. If you haven’t got a prescription from doctor you filled at a pharmacy, don’t ingested because you just don’t know what it is. So one of the things that I’ve done since I’ve taken over as the chairman of Homeland Security appropriations was working with my Senate counterparts, and Senator Murphy and Senator Britt, myself and Henry Cuellar. And we want to target fentanyl and go after the crack down on it and go after the people who were supplying it.

Narrator [00:04:29] As part of his work to combat the opioid epidemi, Congressman Joyce serves as the co-chair of the House Addiction, Treatment and Recovery Caucus. This bipartisan group is made up of over 50 members of Congress committed to advancing solutions to the country’s multifaceted opioid crisis.

Congressman Dave Joyce [00:04:48] Serving as a co-chair, I work with a bipartisan group of legislators to try to advance legislation to handle the crisis. And we talk about a little bit before was the idea that, you know, treatment is important, and the lengths of treatment are different than any drug up to this point. But it’s also important to get people to understand and accept things like naloxone, which, you know, we had to introduce to the schools to combat this unforeseen grant, provide grant funding to public schools that can be used to purchase and store it, for the use in event of an on campus overdose. You got to be ready to deal with it wherever it is. And I think it’s important for government first responders to have the access to it so that as they come upon these tragic circumstances, they can do something about it.

Narrator [00:05:37] He has also introduced the Stop Pills That Kill Act.

Congressman Dave Joyce [00:05:41] In a current law, individuals who manufacture illicit methamphetamine are subject to major criminal penalties, but the same penalties do not exist for individuals that are doing this with illicit fentanyl. Stop Pills That Kill Act will help fix this loophole in the federal law. It’s bipartisan legislation that’s also bicameral. We got senators on board with this as well. It increases the criminal penalties and individuals who created this and the criminals that are manufacturing the fentanyl is changing in our laws need to reflect those changes. And these people need to be held accountable under the law.

Narrator [00:06:15] Jessica Hulsey’s goal when she founded the Addiction Policy Forum was to educate legislators about the realities of substance use. The Addiction Policy Forum has since expanded to include more direct services.

Jessica Hulsey [00:06:29] So when I first created APF, I did a lot of policy work, came from Capitol Hill doing work around drug policy and criminal justice policy, and really wanted to bring more patients, caregivers and individuals impacted by addiction into the fold to inform the issue, to create more resources, to bring more evidence based practice into kind of that policy arena. And we still do some of that work, but it really has expanded in the last, you know, eight years or so. We do a lot more direct services. We do a lot more research at APF. We do a lot more translation of knowledge. Because as I’ve we’ve been digging in and sort of jumping into this field, one of the main gaps is the lack of understanding the science and innovations and new strategies and solutions that are available. So we modify and change direction and jump in quickly when we find an area that is missing in our field where we can be of service. We don’t want to duplicate efforts. There’s so many amazing organizations and leaders in this field, but we do want to make sure that we’re filling those gaps. And one of the principles that I talk about with our team and we’re at when we’re out in our communities or with our instructors and our network of members and advocates and practitioners is trying to build the things that we wish existed. Right. There’s many things that I wish my family that my mom and my dad had available to them when they were literally in middle school, starting to struggle with substance use disorder, both coming out of homes that struggled with very severe alcohol use disorder. And we know that that’s a significant risk factor and adverse childhood experience. So what could have been different for them? What services programs, interventions knowledge knowledge transfer could have assisted? What are the pieces that we need to better integrate this into the health care system? What are the things that patients and caregivers need? What do they need to know?

Narrator [00:08:33] She continues to work to ensure the opioid epidemic is being confronted at the federal level. She says that legislators are often some of the most open to education about opioid use and dependency.

Jessica Hulsey [00:08:45] You know, it’s interesting, since I’ve, I’ve been doing this work for so long, and APF has been on the ground working with policymakers since we started the organization at the federal level, at the state level, at city and county level. And our federal lawmakers and policymakers can be some of the most open to solutions and a science pathway and looking at this through a health lens. I think if I was looking at our our full accomplishments list, we’ve worked on legislation that really has a response within health care and is expanding health care resources to addressing addiction at the federal level. And it has been wonderful to see, you know, an open response and a really sort of a focus and a willingness to address this and learn about innovations and kind of disease framework of addiction from our federal lawmakers. And that’s across both sides of the aisle. And I think Congress is in some ways one of the most educated bodies when it comes to addiction after some of the legislation that they pushed through and some really meaningful work.

Narrator [00:09:52] Part of this work was changing the way we talk about opioid dependency. A recent program was tested in Ohio with promising results.

Jessica Hulsey [00:10:01] So we’re really proud of the work that we’ve done to tackle the stigma around addiction. We have developed two novel stigma interventions. The first program was created for families and caregivers as well as the general public, and was tested in in Ohio in 23 communities. And I’m really proud of that work, because when you take the time to properly educate anyone, whether you’re a practitioner or a caregiver, about the science of addiction, understanding change behavior and priorities, correcting myths and misinformation that is so prevalent when it comes to addiction in the US. You really see a corresponding change in levels of stigma when you reeducate. Right? And it’s not just education. We have a lot of misinformation, so we really need to deconstruct that and replace it with accurate information about SUD. We partnered with amazing clinicians and researchers in the fields to piece this intervention together. We have over 100 instructors that are providing this program on the ground in communities, and that program is called enCompass: A Comprehensive Training on Navigating Addiction. Our second stigma intervention, which we’re testing right now through our anti-stigma initiative, is for practitioners. So physicians, nurses, criminal justice practitioners, educators, child welfare really want this to be an educational program that is accessible and effective for anyone who works in a field that is going to come in contact with those with a substance use disorder, which is a lot of fields.

Narrator [00:11:36] As uncovered this season, first responders are critical to the fight against the opioid epidemic, and Congressman Joyce is ensuring responders have the technology they need to effectively and safely identify and handle dangerous drugs like fentanyl.

Congressman Dave Joyce [00:11:52] Well, you know, at first I’ve introduced that providing officers with electronic resources or the Power Act to provide state and local law enforcement with high tech devices to detect and identify the dangerous drugs, including fentanyl. So if they see something before you think of a powder as potentially being cocaine or meth or something else that wouldn’t necessarily produce a contact death. It’s important that they have the tools that are necessary so that they can interdict these drugs is there before they get into communities. But it also established a new grant program for the Department of Justice to help state and local law enforcement agencies secure this high tech and portable screening devices so that they can make these decisions right there in the field and prevent officers from getting overdosed or killed because of their doing this. The other thing is, you have a lot of officers, unfortunately, who are coming upon us with such regularity, and you have county morgues where they can facilitate, they get a bad batch of of this drug into a community, and it kills so many people at one time. It overloads their morgue. And so they’re getting renting refrigerated trucks just to store bodies. I mean, that’s so sickening. But, you know, it also has a lot of stress on those officers. So we’ve introduced the Fighting Post-traumatic Stress Disorder Act to direct the AJ to develop more evidence based programs that we made available to public safety officers and for the country to treat and address the PTSD that comes with having dealt with these folks.

Narrator [00:13:18] Ensuring that EMS organizations of all sizes have access to tools and training is another important aspect of this work.

Congressman Dave Joyce [00:13:25] Introducing the Protecting First Responders from Secondary Exposure Act help state and local governments purchase containment devices, which are used to help safely store those narcotics and prevent them preserve those for evidentiary use so we can prosecute the people who are bringing them in, but also to provide subsequent training to reduce the first responders risk of the secondary exposure to these lethal substances. EMS providers in the state of Ohio or or most part voluntary organizations and so these people are not necessarily trained the same way as an inner city department would be. So we introduced the SIREN Reauthorization Act, which would grants local EMS providers the ability to purchase new technology and supplies, including naloxone.

Narrator [00:14:13] Jessica is hopeful for the future and the changes she is seeing at a policy level. Bills like the ones introduced by Congressman Joyce play an important role in confronting the epidemic.

Jessica Hulsey [00:14:25] I think a really big policy when right now in our field is the shift to providing naloxone over the counter. This is a huge shift, and we’re really we don’t want that to take away the other distribution efforts and availability of free naloxone to high risk venues and high risk populations, and patients and caregivers and those who have access to our patient group. But it is a step in the right direction and anywhere that we can start to tear down barriers to treatment, to overdose, reversal, medications, to prevention access, to harm reduction services. These are all big wins.

Narrator [00:15:05] Congressman Joyce is one of the many members of Congress who is working to combat the opioid epidemic in their districts and at the national level. This work, along with the work by organizations like the Addiction Policy Forum, are making an impact on this crisis. To learn more about Congressman Joyce’s work or about the Addiction Policy Forum, please visit the links in the show notes. Thank you for listening to this season of Countermeasures. We hope these new episodes have exposed you to new ways of thinking about the opioid epidemic. Educated you about opioid dependency and giving you hope for the future. Thank you to all our guests this season for sharing their stories and experiences. Thank you for listening to this episode of Countermeasures. To learn more about what a Emergent is doing to address public health threats like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.

Matthew Burgan [00:00:02] I think when we talk about the way that the opioid epidemic affects the community, I think it’s our natural response as humans is to go to the negative. If we lose one person to an opioid overdose, that’s too many. But the caveat is we remind ourselves of the good. You know, we look at the partnerships that we have now that we would not have had before, and those partnerships blossom into other partnerships. And it demonstrates that there’s things that we can do. There’s a saying in the fire service, right, 300 years of tradition unimpeded by progress. And here we’re able to show that we can change the way that we respond to calls. And if we can do that for opioids, maybe there’s other things we can do that for.

Narrator [00:00:45] This is Countermeasures brought to you by Emergent. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. First responders have been on the front lines of the opioid epidemic and have witnessed the progression of the crisis firsthand. According to the CDC, nonfatal opioid involved overdose, emergency medical services or EMS encounters increased on average four percent quarterly from January 2018 to March 2022. As opioid related calls have increased, EMS has had to adapt to the new reality, but our responders receiving the training and resources they need to be successful. And how can EMS partner with their communities to help combat the opioid epidemic? In this episode, we hear from first responders across the country about their experiences with the opioid epidemic. We uncover what they are doing in their communities to combat this crisis and what they think needs to be done. The voice you heard earlier is Matthew Burgan, a community paramedic at Frederick County Division of Fire Rescue. When Matthew first began working as a paramedic, opioid related calls were rare.

Matthew Burgan [00:02:16] A palpable increase noted in the number of overdose related calls and specifically the opioid related. I remember we used to get dispatched on overdose calls, and it was a big deal. You know, they didn’t happen very frequently. So when one came in, you got pretty ramped up about it and now it feels a little bit like the urgency has been lost, perhaps.

Narrator [00:02:37] Kevin Joles, the division chief of EMS for Lawrence-Douglas Fire Medical in Lawrence, Kansas, and EMS chair of the International Association of Fire Chiefs, has also noticed the increase.

Kevin Joles [00:02:49] There has been an increase of overdose calls throughout my entire career. And it gets it gets worse and worse. For the last few years in my position here in Lawrence, maybe was a little bit in denial, hoping that it really hadn’t hit the Midwest the way that some of our constituents were saying it was. And the Kansas Board of EMS had done a study and it really wasn’t really prevalent here in the Midwest, specifically in the state of Kansas. And so I, I didn’t believe it. However, here locally, we do have we do have an issue and it’s become increasingly higher over the last maybe two to three years. I actually believe that now it’s not that I think it was just more of a denial as opposed to belief. I didn’t want our community to be experiencing that. But we do have an increased frequency in overdose here and in the area.

Narrator [00:03:37] As overdose related calls increase, so does the risk of compassion fatigue. Compassion fatigue is a term that describes the emotional and physical effects of consistently treating patients who are in distress or experiencing trauma, which can contribute to burnout, cause emotional withdrawal, and even impact first responders’ ability to perform daily tasks.

Kevin Joles [00:03:57] The opioid crisis has definitely taken its toll on first responders. I would say on both the coasts, probably a little bit more than the the Midwest. Everything takes a little bit longer to get out into the middle of the country. Sometimes that’s good and sometimes that bad, that’s bad. If it’s fashion, it’s bad. If it’s a crisis like this, it’s good. In all reality, it is taking its toll on first responders. You know the increase we have folks all of all over the country that are running hundreds of calls a day in the city of overdose. I would imagine that nobody comes to work every single day thinking I don’t really care if somebody overdoses today. We want to be able to help everybody, regardless of their situation, even if we’ve seen them 25 times in the same month. But it does take its toll and it makes it more difficult to give the best care. But I know that the men and women across the country certainly don’t start out their day hoping that they see somebody suffer.

Narrator [00:04:49] In order to combat compassion fatigue, jurisdictions like Matthew’s have mental health support for their responders.

Matthew Burgan [00:04:56] I do think that there’s probably some cases where our responders are experiencing detriments to their own mental health as a result of the cumulative stress associated with the EMS response. In our organization, we are very fortunate to have a behavioral health specialist on staff, and she’s able to interface with our responders, identify when those issues are arising early and engage with them and connect them to resources that are specifically designed to help us. But I also recognize that we’re very fortunate in that regard. And I don’t know that every agency across the country has that same level of access, and it makes me worried about the quality of mental health care that we’re providing for our own in in less fortunate jurisdictions. There’s more of an emphasis being placed now on responder mental health than there ever has been, but we’re still not quite to where we need to be as a profession. And until we can really get a grasp on the compassion fatigue that our responders are experiencing and again, I think the way to do that is through the educational element. I think we still run the risk of of having our responders trying to manage in less than healthy ways, especially in those jurisdictions that don’t have a very comprehensive mental health program for their clinicians.

Kevin Joles [00:06:22] Time and time again with every interview that we do for a new firefighter. We’re in the middle of a hiring process for a firefighter. We’re in the middle of a process for mental integrated health paramedics. And usually the statement that comes out of a new candidate’s mouth during an interview is, I want to help people. And when you can’t help people or you’ve given all you can to help that person and they refuse or they just can’t get out of their own way, it becomes difficult. And so there are stigmas and some biases that are put on people and it’s unfortunate. But again, it’s the employee assistance programs and the peer support systems that we have to lean on to be able to encourage our folks that they are making a difference. They may not feel like it, but at the end of the day, they gave that person one more opportunity to to get help. And one day we can just hope that it then it helps and we can continue to say, I want to help people. And when that when that drive goes away, that’s that’s the time that you have to start thinking about maybe doing something different.

Narrator [00:07:16] EMS responders are trained to respond to a wide variety of emergencies. However, Matthew believes that many first responders don’t receive adequate training on recognizing and treating opioid emergencies.

Matthew Burgan [00:07:29] I think that the training that an EMS professional receives is lacking a little bit. I look at the way that we train our new recruits in my organization when we hire a new class that’s about 25 to 30 people and they go through a pretty rigid, paramilitaristic style academy process that lasts about 26 weeks. And in that 26 weeks, the majority of the training that they’re going to receive is focused on fire suppression and rescue operations with a a small fraction of it focused on emergency medical care. And what’s interesting about our profession in particular, specifically the fire based EMS system, is that we train our personnel to win 100 percent of the time. There’s a a very influential speaker by the name of Simon Sinek, and he describes this as game theory, and he calls that the finite versus the infinite game. Our personnel are the finite players. We have no objectives. We have established rules. And they don’t really change when our responders go on a call. In their mindset, they are there to to resolve that emergency. And so when that doesn’t happen, in the case of substance use, where the focus is on recovery more so than it is on the resuscitation alone, it can be a bit of a challenge. It can be, as Simon describes it, it can be a bit of a quagmire because the patients that we’re treating, they’re playing an infinite game. There are no rules. There are no objectives. The the objective is to live one more day and to stay alive long enough to get into recovery. And so when you when you put that finite player, right, the responder against the infinite player who’s the the opioid use victim, you get a bit of a rub. And I think it’s a challenge that a lot of our folks don’t have a true appreciation for because we don’t properly train our responders in addiction. In the typical paramedic curriculum, which is anywhere from 1500 to 2000 hours, you may get an eight hour session on addiction. And most of that’s focused on the treatment of the overdose, more so than it is that alteration in the brain chemistry and the way that substances affect the normal processing pathways and the decision making processes that people experience when they are using a substance.

Narrator [00:10:06] First responders rule as vital members of their communities puts them in a position to be critical players in the fight against the epidemic. First responders across the country have partnered with community groups and advocates to ensure they are an active part of the solution. Safe stations as a recovery support program model run out of various fire and police stations across the country. One program runs out of East Providence, Rhode Island, where John Potvin is a captain.

John Potvin [00:10:34] So the Safe Stations program really was designed to be a beacon of light for folks that needed help. So we kind of thought of it as a beacon of hope or light in the darkness, you know, for folks that are suffering. And really, we were trying to come up with a system where people could find help rather than just being brought to the emergency room, and really just a method to find a way to connect and increase access for folks that needed to be connected with a recovery program and just dropping them off in the emergency department wasn’t doing that. So they’re available 24 hours a day, seven days a week, and they’re staffed with trained personnel, EMTs and paramedics. And the whole premise and focus is to provide access. So for somebody who says, you know, I’m ready now, I want to be you know, I want to get to recovery. They can show up at our station. They’re well identified. And not every community uses fire stations. Some other places use police stations. But in the city of East Providence, those are all located at fire stations. So when they arrive, basically they just say, you know, that I’m here for a safe station or, you know, basically some I mean, obviously, the terms that they use, you know, their own words, you know, so sometimes people say, you know, I’m here, you know, I have a problem and I want I want help. So we’ll do a medical screening, make sure that they don’t have any acute, you know, medical issues going on. And then rather than, you know, throw them in the ambulance. And bring them to the hospital. We will call the recovery program and they will send a recovery coach to the station. We will stay with them. And then they will be connected with the help that they need.

Kevin Joles [00:12:26] So a safe station is important, in my opinion, for the simple fact that we’re able to give somebody help who may not have the ability to make a phone call. They feel more comfortable doing it in person as opposed to over the phone. It gives them a person to talk to in person as opposed to over the phone. We have a lot of initiatives 988, being one of them across the country that gives people somebody to talk to in a time of crisis and then we can connect those resources. But sometimes those people don’t want to share where they’re at. They’re not comfortable having them come to the house where maybe somebody is feeding that abuse. So being able to get away from wherever they’re at in a time of crisis and be able to come to the fire station, which would be considered a literally a safe place is a positive, in my opinion, and just gives them an opportunity to to get away from the the bad in their lives.

Narrator [00:13:15] Safe stations are only one element in a much larger ecosystem of support being developed to help those with opioid use dependency and to support EMS responders. In Matthew’s community, they have seen success with their peer mentorship program.

Matthew Burgan [00:13:29] We have these tremendous relationships with so many different sectors in the community, public sector and private alike. Our agency, we actually do get to enjoy the benefits of partnering with a peer recovery coach from our local health department and that peer recovery coach for people that hadn’t heard that term before. Somebody that had lived experience with addiction. We get to partner that peer with one of our community paramedics and they go out on a unit that’s sole purpose day in and day out, is to respond on substance use related calls with the deliberate intent of being an added resource, taking some of the burden off of the responders and leveraging the experience of that peer to help make a connection with the patient in a way that our responders simply are capable of doing. A lot of our folks don’t necessarily have that lived experience. And if they do, and a lot of times it’s very different than what the patients are experiencing that we’re treating. But they’re peer they’ve been there and they know what that’s like. And so it’s it hits a little bit different when it comes from somebody that that understands. I almost equated to having some street cred for me to sit and talk with the patient and withdraw. Having never experienced it myself, it’s very hard to truly understand what that’s like. But when I work with a peer, you know, they’ve been there and they get it. And a lot of times they’re using their insight to help guide my decision making process and my understanding of of where the call needs to evolve to. So that relationship is phenomenal. And the success of that unit is predicated 100 percent on that peer and their instincts and their abilities. We are very, very fortunate to have that connection. But it doesn’t just stop with our peer for the health department. We have connections all throughout our health department, so other other facets designed to help connect people to state Medicaid. We have connections in our local homeless shelters. Our hospital, we have tremendous connections there and we’re able to leverage those resources when we’re out on call to help kind of navigate people away from the health care system that really, quite frankly, don’t need to be there.

Narrator [00:15:50] In East Providence, access to naloxone has been another vital part of EMS response to opioid emergencies.

John Potvin [00:15:57] So we try and have a nalox box which has naloxone in it and a mask and gloves placed in every public building alongside every automated external defibrillator, so that we then if somebody overdoses while they’re in a city building, there is access to naloxone. The other thing is what we call grab and no naloxone. So we have naloxone placed in 13 locations throughout our city where it is just there in a box. You can just walk up, take it. No questions asked. There’s a little pamphlet that’s in there with a QR code that you can scan. It shows you a video. There’s also an info infographic that shows you how to use it. And it’s not designed as a response to an overdose at the time. It’s designed just to increase access to naloxone. And I know for a fact that we’ve had three successful resuscitations with the grab and no naloxone because they told us when the paramedics and any EMTs arrived. I want to say that with our 13 locations, we’ve distributed probably two to 300 doses, I think, in the past two years.

Narrator [00:17:14] Education is also key in the fight against the opioid epidemic. And first responders are active in prevention programs as well.

Kevin Joles [00:17:22] Here in our community, you know, luckily we have a pretty darn good basketball team here locally, the University of Kansas, the Kansas Jayhawks and and so a lot of kids and younger folks and older folks who like really look up to those to those key figures in with some of the NCAA rules changing for the names and likeness. They’re able to be on a lot of commercials and be and a lot of public access opportunities. So they are sure they we use them. I don’t necessarily use them personally, but the University of Kansas is doing that a lot with their players and getting them out in the community. And so using those types of figures. We do speak at schools, high school and up some and occasionally at some of the younger schools and we talk about prevention on some things. We do have a community that is very engaged. And so any time that we have an opportunity to share what we’re doing, we do that. We look, we’re instituting one accredited health program to be able to educate and go around as well within the schools and start always going to be clinical. It’s going to be some education driven opportunities and tasks for that group. So I think that every community has opportunities specifically here. You know, we try to take every single opportunity that we can.

John Potvin [00:18:33] We also try and provide information on how to use safely, which again, I think a lot of times people who still have that stigma about this think, well, gee, why are you telling people how to use safely? Isn’t that just perpetuating the problem? You know, my goal as an EMS provider is to try and get them to not overdose and hopefully connect them with a recovery so they can get themselves well. You know, unfortunately, if they overdose, then we lose that opportunity. But I think, sadly, some people think like, you know, you shouldn’t give people tips on how to use safely. But we also one of the components of that is we give out fentanyl test strips so that if you do use or you know somebody that does use that you could test to make sure that what you have is actually what you think it is and it’s not laced with opioid because it seems like everything in our city that is bought illicitly is contaminated with fentanyl. And one other thing that we give out is we have it almost looks like a bank envelope, like one of those little cloth envelopes with a lock on it that people can lock up their prescription medication. And realistically, it’s just keeping the honest people honest because you could cut it open. However, it does limit access, especially to younger folks are prescription medication. So we’re really trying to fight this epidemic from many different angles, you know, from the prevention with the community events and the education.

Narrator [00:20:06] In all of these communities, there is an abundance of things being done to support first responders, community members and those with opioid dependency. While we couldn’t cover them all in this episode, we encourage you to visit the show notes to learn more about what these communities are doing. While the opioid epidemic has had lasting impacts in communities across the country, Matthew endeavors to try to see the positive changes that have happened as the understanding of opioid use and dependency increases.

Matthew Burgan [00:20:35] We launched our our co-response pilot in October of 2020 and within a year of launching that, one of our law enforcement partner agencies launched a very similar co-responder model with a social worker. You know, I look at the positives, and that’s certainly one of them, right? The the outreach, the engagement. You know, we we haven’t necessarily done a great job of that in the past, and now we do. And so, you know, again, I think it’s tragic as the opioid epidemic is one of the ways that we can kind of abate that is is by also, you know, focusing on on the good that’s come out of that as well. We saw it with our co response model. When we started interacting with our responders and they would meet the peer recovery coach for the first time. You know, on the surface, it sounds a little bit ignorant, but but there’s a sentiment here that that I think really hits home or anything. I would hear people in the field say to me all the time, “Matt, that’s that’s a that’s a peer. They look normal.” And, you know, again, on the surface is a very ignorant comment. But what it tells me is that they’re starting to see what recovery looks like. And that’s not something we’re accustomed to. You know, people don’t call EMS on their best days. They they call them when the crisis is happening and they call them when things have gone sideways. And so we never get to see the good. We never get to see the recovery. The only thing that our responders ever get to see is the result of the act of addiction. And so one of the unintended consequences of our our partnership with our peer recovery program was our responders got to see success. And I think for a lot of people, getting to see that was was huge. You know, it’s again, not something they were accustomed to. So when they see a peer, it validates to them and the peers, to their credit, they do a huge job of validating it to all of our peers are very open about their experiences and they’ll be the first ones to point out, even before our responders can ask, that it was the role of the responder that helped get them into recovery. And that is just awesome to sit back and watch. I think if we had a little bit more of that kind of positive reinforcement, I think that could go a long way in addressing the compassion fatigue element as well.

Narrator [00:23:07] First responders continue to respond to overdose and opioid related calls across the country every day. Most responders have not received comprehensive training on opioid dependency and compassion fatigue is a real risk. Many responders work long hours and may not have access to services to help them cope with the realities of working in EMS and might not have a robust understanding of the realities of opioid use and dependency. But positive change is happening. Programs like safe stations, peer mentors and other preventative programs have become a central part of combating the opioid epidemic at the community level. Responders like Matthew, Kevin and John are critical to the fight against the epidemic. This episode is dedicated to all the responders who work tirelessly every day to keep our communities safe. Thank you to Matthew, Kevin and John for sharing their experiences. To learn more about the programs in each community, visit the links in the show notes. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider reading and reviewing Countermeasures on your preferred podcast platform.

Kobe [00:00:01] So as a kid going to camp, I’m thinking I’m the only one that deals with my problems. Nobody’s ever going to understand me. It made me feel at home because not only do I have people that have gone through what I’ve gone through, they’re now a family to me. So I can look at them and go to them for help.

Narrator [00:00:17] This is Countermeasures brought to you by Emergent. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. The opioid epidemic has touched the lives of people from all walks of life, including children. Children whose parents or family members are struggling with opioid dependency often feel alone, isolated and unsure where to turn for support. In this episode, we explore how to support youth who are impacted by the opioid epidemic and the positive impacts of these programs.

Brian Maus [00:01:08] So I’ve been working with kids, with families, with couples for 35 years now.

Narrator [00:01:16] Brian Maus is the director of Addiction Prevention and Mentoring Programs at Eluna. Eluna provides the funding and resources for their partners to run Camp Mariposa, a weekend camp for youth impacted by substance use disorder. They partner with local community organizations to run 120 camps across the United States.

Brian Maus [00:01:35] Like I said, Camp Mariposa is a year-round addiction prevention and mentoring program specifically designed for youth and teens who have a close family member who struggles with a substance use disorder. So our model is a pretty specific model. It’s a Friday to Sunday weekend camp program. We offer the programs every other month throughout the year, so six times a year. We offer evidence-based prevention programing, other support kinds of activities, along with fun, outdoor camp-based programing. So, the camp piece is really one of the key elements to the success of the program. We do ask for a one-year commitment from the youth who participate as well as the trained adult mentors. So that core programing has always been 9- to 12-year-olds, that that from the beginning has been kind of the bread and butter of the program. Organically over the last six, seven years, we’ve really begun to develop some teen specific programing. So we we started building in first peer mentoring, a junior counselor kind of program. So for teens who who had the interest had this skill set, you know, they could continue to participate in the program all the way up until they turned 18. They participated as a peer mentor, a junior counselor. I would say over the last five years now, we really have developed to very specific teen programing. So most often that looks similar kind of weekend based programing for teens. You know, we tried different things, but the teenagers really love to come back to camp. And that, you know, is their number one request. So we have we have the 9 to 12 year program. We add the teen programing. And then the other thing we added about seven years ago now, that again, I think is contributed to the recent success of the program is activities in between the camp weekends. So those are open to the kids. They’re open to their families as well as as the mentors. And those really are fun social programs.

Narrator [00:04:07] Camp Mariposa makes a huge impact on the lives of the youth who attend. Like Kaia and Kobe. Now adults who both attended Camp Mariposa as children in Sarasota, Florida. Through a Eluna’s partner, Jewish Family and Child Services of the Suncoast.

Kaia [00:04:22] I’m Kaia and I got involved with Camp Mariposa when I was nine years old. My fourth grade teacher heard a little bit about my situation, living with my mom as an addict and was somehow connected to JFCS. Then she handed me the flier and I went to my first camp and I’m super anxious and it turned out to be a lovely experience. I did want to go, but I was super anxious about going. I’d never stayed away from home. I didn’t know anybody I was going with. And then once I was there, I realized how much of a loving environment it was and how everybody was there to help me and nobody was there to put me down.

Kobe [00:05:04] So my name is Kobe Hills and I got involved in Camp Mariposa when I was in the third grade. During the third grade, I had a lot of anger issues, not being able to control my emotions. And there was a counselor at my school named Miss Missy, and Miss Missy actually worked with JFCS, so she ended up introducing me to them. And when I first started JFCS, they’ve only had around, I think maybe three or four camps. So I started relatively in the beginning. And then ever since then, it was a every other month basis. So every time we had camp I attended and at 14, that’s when you graduate. Because in the beginning of camp we never had a teen program like we do now. So I graduated at 14 and luckily for me, the camp grounds that we shared, I actually got hired and actually got hired for a job there. And it changed my own perspectives on life in a sense of when I worked there, I didn’t know what it was, and it ended up being a camp for kids and teens with disabilities and chronic illnesses. So I worked there from 14 to 18, came back to camp after we had our team program, and I’ve been there ever since. So about two years now.

Narrator [00:06:12] For both Kobe and Kaia. Going to camp gave them a place where they were free of judgment and able to just be kids. At the time they attended, there was no teen program, but both have now returned and are now mentors at the camp. Today, Camp Mariposa also includes programing for teens.

Kaia [00:06:31] After I aged out of camp when I was 14 because I wasn’t a teen camp, I struggled with substance abuse problems myself, so I really lost that support group. And then after my mom died when I was 18, I cleaned up my act, started to get my life together. And Miss Jeanette, who was the program director at the time, reached out to me and said, “Hey, I think you would be an amazing mentor”. So that kind of got me back into at first I wasn’t so sure. I was nervous. I’d have a lot of confidence in myself. But then once I attended my first camp as a mentor, I was like and super easy to connect with the kids. And it was like riding a bike. I was right back into the routine and able to connect and and help. Coming a mentor was important for me because I felt like I had an advantage almost when it came to helping kids, seeing their full potential. I was in your shoes. I’ve been there. I felt hopeless. Like this lifestyle that I’m living at home will never end. I feel like I could be an amazing role model to show these kids that one day you’re going to be an adult. You’re going to be able to create your own life, figure out who you are outside of this environment, and just do anything that you put your mind to.

Kobe [00:07:49] I believe everything comes full circle in life. So it’s I didn’t feel like I had to give back the camp. I didn’t feel like it was a necessity. I truly wanted to give back to camp because of all that they did for me and how it made me feel and how I can pick up the phone and call somebody whenever I’m feeling down. I want these kids to feel the exact same way. Just because you’re young doesn’t mean you don’t deal with adult problems. There’s an example, so, LSU came out to do surveys and I had a conversation with one of them and it really stuck with me. He said, these kids, their feet can’t even touch the ground yet they’re dealing with so much more than adults do in their life. So that really put it into a perspective that just because you’re little, just because you’re you’re small, I believe experience shapes us all. So maybe somebody that’s 50 has not gone to what, and maybe nine, ten, eleven year old us has gone through.

Narrator [00:08:41] Many children who enter the program have adverse childhood experiences or ACEs, which puts them at higher risk for negative health outcomes, including drug use.

Brian Maus [00:08:52] The kind of the typical kid who or youth who participates in the program has experienced a significant number of adverse childhood experiences. So the ACEs is the short acronym for that. The ACEs study really started in the mid-nineties. It looked at current health issues for for adults. It was in the San Diego area. That was anonymous surveys and they really found and it has over the last 30 years continued to be proven that there is a connection between some people might call it trauma adverse experiences during childhood. You know, and that continues to affect folks all throughout their life. You know that the things that the ACEs questionnaire asked about is things like parental loss. So that could be incarceration. It could be death. They ask about family, mental health issues, poverty, income insecurity, domestic violence, substance use disorders. All those things go into the the ACEs, there’s a large number of people who have at least one of the ACEs. But once you start getting above like four or so, then you can really start to see the long term impact. So I would say on average, the youth who participate in Camp Mariposa come in with an ACEs score of somewhere around four or five. You know, they come into the program having had these experiences. And so what the key for us really is to do is to flip that and really build positive youth experiences, positive childhood experiences, build protective factors to over time, lessen the impact of these experiences. So just to kind of give you a sense in general of the kids when they come in. About 90 percent have one or both parents who struggles with a substance use disorder. So overwhelmingly, it’s kids whose parents struggle. Eighty four percent have very low incomes in their family and they qualify for free school lunches. One of the stats that that always surprises me, over 80 percent to 81 percent have experienced some kind of loss during childhood. So that really goes back to the ACEs question around, you know, it could be due to incarceration. It could be due to death or it could be that that a parent is no longer involved in a child’s life. And about 80 percent, just under 80 percent have a family history of mental health issues. So so that gives you kind of a sense of the kids who come to the program. You know, I think one of the pieces that we look at is building relationships, building community over time in the program. So it’s definitely not a one and done. We do ask for that that years commitment. The reality is that a significant number of the kids as well as the mentors make multi-year commitments to the program. So we do take that long term approach.

Narrator [00:12:22] Dr. Claudia Black, one of the founders of Camp Mariposa and a pioneer in understanding the family dynamics of families impacted by substance use disorders, found that in many of these families, the rules are don’t talk, don’t trust, don’t feel. Being surrounded by children with similar experiences and fostering a safe and fun environment, lets kids be kids and breaks down these barriers.

Kaia [00:12:46] Being around kids who are in similar situations, if growing up was so important because I didn’t realize how many other kids were going through the exact same thing, and it helped me learn how to build relationships with people who were going through something similar and realize that I’m not alone. And there’s people who understand my situation and can help me.

Kobe [00:13:08] It made me realize that everyone, not everyone, is different. You know, you can look at people and not know their stories and until you’re in that on more vulnerable state because we all spent a couple of days together and as a kid you say all my troubles I’m the only one that goes through them. But when you meet every, when you meet more people, especially your age as a kid and you don’t know anything about life yet, all you know is just like bad experiences and you don’t know that that’s going to be trauma leading up to how you’re going to how you’re going to experience the world, especially when you’re older. So as a kid going to camp, I’m thinking I’m the only one that deals with my problems. Nobody’s ever going to understand me. And it made me feel at home because not only do I have people that have gone through what I’ve gone through, they’re now a family to me. So I can look at them and go to them for help.

Narrator [00:13:56] At Camp Mariposa, prevention and learning life skills are a big part of the curriculum to help break the cycle of substance use.

Kaia [00:14:05] Some skills I’ve learned from camp, I mean, there are so many. Just to name a few. I would say learning how to process my emotions in a healthy way was top of the list for me. I had so much anger and I was I was mad at everybody and everything, but learning how to channel that into for me, it was more sports at camp. Being physically active was a huge outlet for me. Also communicating with people effectively my emotions, using our statements and things like that was big at home when I moved in with my dad. Learning how to tell him, Hey, I’m frustrated and here’s why and here’s what’s going on. Mom helped us repair our relationship moving forward.

Kobe [00:14:50] We have a thing called the Seven C’s and I’ll list a few. So one of them is I can’t control it. I didn’t cause it and I can celebrate myself. So just knowing that I am not the reason why my family did this. I can control the way I act. I can control how I treat people and I can celebrate myself knowing that I’m not going to be in the same situations that has caused me to be the person I am today. There’s so much you can learn from camp. There’s you learn that there’s actually lifelong friendships in life. Like you think going to camp, a lot of people think a summer camp. So I’m only going to spend a couple of months with these people and never speak to them again. I personally have had really good experiences. I traveled up to North Carolina last year to go visit a counselor. So it shows you that it’s not just the camp, it’s not just, Oh, I’m going to come here and get taught for two days and then go home. Whenever I mention camp to people, I don’t tell them it’s a job because they always say, if you if you do what you love, you love what you do. Like I could not be getting paid at camp and I was still put in the same excitement. I was still put in the same being able to care for the kids is as if it was just me getting volunteer hours. So just knowing that it makes an impact on you to shape these kids. Like that’s what we’re doing. We’re essentially making the future because who knows, one of these kids who can become a doctor and save me one day, all because of the way I treated them at camp, but for them to know that they actually had a friend.

Brian Maus [00:16:16] One of the things that we have done in the last couple of years is, is to choose an evidence based prevention curriculum. So we’ve made the decision we want a kind of across the board to have standard prevention programing. So for us, we chose to good for drugs. It worked in our model. It works in the weekend. That’s a great curriculum that addresses specific kinds of things like the effects of alcohol, you know, understanding the safe use of prescriptions and over-the-counter medicine. So one of the things we learned was that kids, especially in the younger side, like if they hear that someone is taking medicine, they sometimes thought that that was just a negative right away. But there, you know, there there’s an emphasis on on understanding the safe use of medication. You know, the other thing I like with too good for drugs is there really is in addition to the drug prevention education, there’s time tested prevention activities like communication skills, finding trusted adults, you know, those kinds of like refusal skills and dealing with peer pressure, managing emotions. These are all things that also play really well. They’re good for delaying first use.

Narrator [00:17:54] This evidence-based approach has been very effective.

Brian Maus [00:17:59] I think the great news is that the program is truly breaking the cycle of addiction. So we have research partners at Louisiana State University and Clemson University, and we’ve developed a questionnaire that gets distributed twice a year at the camp weekends. And so these numbers kind of are are they been consistent over the last five, six years that we’ve been using the measure. So 95 percent of the youth have never been involved in the juvenile justice system. So these are the youth who attend the camp weekends, take the surveys. Ninety five percent have never been involved in the juvenile justice system, and 93 percent have never used a substance to get high. So those are really great numbers that that we’re extremely proud of. You know, and then we collect other other data on, you know, we talked about the goals a few minutes ago of the interpersonal connections. You know, the kids, you know, typically start out feeling pretty alone, isolated, don’t know other kids. And, you know, in the surveys, almost 100 percent, 97 percent report there’s adults they trust. So that’s huge for us, building those trusting adult relationships. And 95 percent of the youth have made friends at Camp Mariposa. So, again, those are coming from where they start. Those are great, great numbers.

Narrator [00:19:42] Center of Camp Mariposa’s mission is creating a sense of community.

Brian Maus [00:19:46] So, you know, the change that happens, breaking that cycle, you know, really comes through that community. So many kids start the program not knowing any other kids living in similar situations. They come two or three times in the first few months and they’ll start to say, you know, I’ve made some really good friends here. And then after about a year, it takes about a year, maybe a little bit more, they’ll say, this is like a second family to me. Sometimes they’ll say, this is like the family I wished I had. And so it’s the the other youth who participate, the other kids in the program, the teens in the program, as well as those trained adult adult mentors. You know, for I think the one of the big things we hear thing going with that sense of community is kids will say, I don’t feel judged here. So it’s one place in their life where they can talk about what’s going on. You know, and one of the other things I love is, is and kids, teenagers will be very clear about this. They’ll say, I wouldn’t be friends with some of the kids in the program outside of here, but they have these deep, intimate, really supportive relationships that that they value. But but on the outside they would never you would never see them together. And I think that’s what’s so great about, you know, building that community and taking the long term perspective and and having, you know, we talked a little bit about the peer mentors, the junior counselors, like having them come back. They’ve been where the nine year old who’s just starting out, they were there when they started the program. Now, you know, they you know, they the younger kids look up to the junior counselors, which is great. And so for the junior counselors, they love to give back. They love to be seen as this positive role model. So that really is important to the success of the program. And I think, too, that the mentors and that sense of community connection that, you know, a lot of the mentors have lived experience either, you know, themselves as a child growing up in a family with significant substance use.

Kaia [00:22:23] Coming a mentor was important for me because I felt like I had an advantage almost when it came to helping kids, seeing their full potential. I was in your shoes. I’ve been there. I felt hopeless. Like this lifestyle that I’m living at, at home will never end. And I feel like I could be an amazing role model to show these kids that one day you’re going to be an adult. You’re going to be able to create your own life, figure out who you are outside of this environment, and just do anything that you put your mind to.

Narrator [00:22:56] Programs like Eluna’s Camp Mariposa help children adversely affected by the opioid epidemic. But there’s still work to be done. Children need support year round from all areas of the community. The importance and effectiveness of forming a community and access to trusted adults and safe spaces have been demonstrated through programs like Camp Mariposa. Thank you to Kobe and Kaia for sharing their stories. To learn more about Eluna, Camp Mariposa and its partners, please visit the links in the episode description. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.

Jessica Hulsey [00:00:01] One of the physicians during that training said we didn’t learn this in medical school and it wasn’t in my residency and this needs to be made available to all physicians that are currently practicing or in training. And that was really helpful and such a heartfelt testimony from a physician that we trained.

Narration [00:00:23] This is Countermeasures brought to you by Emergent. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. As the opioid epidemic has changed and evolved, our understanding and responses have had to change as well, but have our systems kept up? Barriers to care, stigma and other factors all impact people struggling with opioid dependency when it comes to accessing the help they need. In this episode, we explore how the health care and social systems in the United States and Canada have responded to the epidemic. And what is being done to ensure that professionals on the front line are equipped with the knowledge and skills they need to best support people and have a meaningful impact.

Jessica Hulsey [00:01:26] My name is Jessica Hulsey and I’m the founder and executive director of the Addiction Policy Forum. APF is a national nonprofit organization and I’ve been in the field for a long time. We really wanted to address a lot of the major gaps that still existed in the field of addiction, including bringing patients and families to the table.

Narration [00:01:47] Founded in 2015, the Addiction Policy Forum or APF, is a nationwide nonprofit organization dedicated to eliminating addiction as a major health problem. This work includes helping patients and families in crisis, expanding prevention and early intervention programs, and increasing education among policymakers, medical professionals and the wider public.

Jessica Hulsey [00:02:12] I got involved in the addiction field because of the impacts that addiction has on my own family. My my younger years when I was a child was a lot of disruption and difficulty really caused by my parents struggling with the substance use disorder. So I was homeless and and in and out of the foster care system and then finally raised by my maternal grandparents when my mom went to prison for addiction related issues. And so at 15, I got involved in our prevention organization wanting to sort of use that, you know, lessons learned and lived experience and the knowledge of how destructive addiction can be in a family and a community, really try to make a change and and sort of help improve how we respond to this. Since then, I’ve worked in prevention, treatment and drug policy, came to DC when I was 17 and have been doing this this work. This is really my my life’s work. I call Addiction Policy Forum, a love letter I write to my mom every day. I lost my mom when she was only 50 to addiction related health consequences, though she’d had a number of years in recovery, and I lost my dad, who struggled with opioid use disorder and crack cocaine and stimulant use disorder when he was like 48 years old. So I tried to turn that tragedy and that difficulty into maybe improving and helping. What happens when addiction hits a family, when it hits a community, how can we respond and mobilize in a different way? And all of that sort of passion and and experience that my family has gone through, it really fuels my work.

Narration [00:03:55] Social worker Shannon McLaughlin has worked with marginalized populations for most of her career. She works in Hamilton, Ontario, a Canadian city that has been heavily impacted by the opioid epidemic. Shannon has seen how difficult it can be for those with opioid dependency to access the social and medical systems we take for granted.

Shannon McLoughlin [00:04:16] There are a lot of barriers to service. For instance, lots of marginalized people have had a bad experience historically with the medical health profession, either being having people be rude to them, having them being dismissed because they’re maybe they’re they’re dirty, maybe they’ve showed up with a garbage bag that has their stuff in it. People who are in the throes of an addiction, their lives are often very often disorganized and being able to get to an appointment on time consistently or even to have the ability to get to that place, to have the money or the transportation is often a real barrier. So there’s areas of fear, there’s barriers of access, there is barriers of historical interaction with the health profession previously. A lot of people who are on the street, they don’t have a fixed address. So there are at least in the city that I live in, there are outreach workers who will connect with people where they’re at and help them get to the appointments. People are really trying to bring those barriers down. But still, there are people who fall through the cracks and aren’t seen. Also, mental health often gets complicated. You’ll often see a mental health issue with the addiction or with the opioid use or whatever people are using. And so together, that makes it very difficult. There could be paranoia. There could be a little distrust, which is often based in real reality for these people.

Narration [00:06:02] Jessica and the Addiction Policy Forum have conducted research on this issue and have found that barriers still exist for many people. They have also seen the importance of holistic approaches to recovery and access to a wide variety of resources to help overcome barriers.

Jessica Hulsey [00:06:19] We did find some very consistent themes. These pinpoints are barriers to sort of finding treatment and recovery. They included the stigma or back to that thing of why people face stigma coming from health care providers, family members, friends and others, and other really tangible barriers, such as really long wait times to finding treatments, to finding services, not understanding where to get an assessment or how to navigate this very complicated process, insurance barriers and the high costs of programs and lots of policies that were really difficult to navigate like fail first and prior authorization. We also found barriers on sort of the tangible resources that people need to have accessible to them to be successful and healthy and well, such as transportation, access to food and housing and employment and resources. All of these these sort of pieces that can be really big hurdles to getting the care that you need. Other barriers included not knowing what level of care was appropriate for them at for yourself and not knowing where to go to sort of start that that process. And it’s really, I think, important that we take the lead from our patients, whether those who have an active use disorder or in recovery or currently seeking treatment so we can make improvements to this process and have low barrier access points to improve how we bring people into care. And no other space in our health care system, when we look at chronic health conditions, do we make it so difficult to start care when a diagnosis is made. And so that’s that’s where we should be heading in our goal. How long does it take a diabetes patient or a cancer patient or heart disease patient to start linking up with the tests with the doctors, the services and the treatments that they need?

Narration [00:08:13] There is progress being made to lower barriers to care in both the United States and Canada, however, there is still stigma present that affects people’s ability to get care.

Shannon McLoughlin [00:08:25] So say someone tries to access the ER. I would say, yes, that there is stigma baked into that system. I think now those systems are at least some of them are trying to look at themselves and perhaps crumble that cookie and maybe make a new one. But the language, you know, oh, we got a frequent flier. You know, you can sit there for a while. He’s here all the time. Well, that’s pretty disrespectful. But I know I’ve heard that language. They have legitimate reasons for being there. And but often I think people, you know, ERs are busy, fast paced, they’re crowded. I don’t know anywhere where you don’t sit for a really long time. And I think in those in those situations, people’s hidden bias may come out a little easier because you’re stressed and worn down.

Narration [00:09:21] Jessica is happy to see programs emerge that are designed to break down some of these issues.

Jessica Hulsey [00:09:26] There are some innovations that are out there that are doing such a great job with this. I’m a huge fan of the bridge clinics, so these low barrier access points to start treatment. Boston Medical Center has really developed an amazing program there. So we’re really talking about the availability of treatment on demand and starting care immediately, bringing in different clinicians and different services, but also inducting and initiating medications for opioid use disorder very quickly and then continuing that person and that patient with the care that they need. So I think we can look towards these sort of spotlights and and beacons of hope and programs that are popping up all over the country and figure out how we can expand and replicate them. So we start to change these barrier points.

Narration [00:10:15] Jessica and the team at the Addiction Policy Forum advocate for evidence based programs to help bridge some of the gaps and help lower barriers. And both she and Shannon believe multidisciplinary teams are a step in the right direction.

Jessica Hulsey [00:10:29] We have amazing programs in the criminal justice settings. In Cincinnati, Ohio, they have this amazing program where they’re providing evidence based treatment services to individuals who are incarcerated in their county jail, who have any type of substance use disorder and have a combination of medications that are available, pure recovery coaches that are available during incarceration, and also really focus on that transition to the community, which is a high risk time. And they’re starting to build recovery pods. So you have a residential unit that provides an extra level of care while people are incarcerated, and then we have harm reduction, recovery support services, recovery community organizations and supports that provide people with that long term care support that they need to manage their chronic health condition. So there are so many innovations that are available. I think it keeps it should keep us very hopeful, but also focused on how do we replicate these innovations and take them to scale. Also love the QRT models that we’re seeing pop up in the addiction space and that sense for quick response teams. And it’s kind of a growing model and it’s not just about that initial 911 response, but also when you see someone, let’s say in your emergency department for a non-fatal overdose, when we are able to reverse an overdose. And then places like Kentucky and Ohio, when you have teams that go out to provide services to that individual, because we know that those who’ve had a non-fatal overdose are at risk for another one. And we want to follow up that naloxone administration with connection to services. And you have these multidisciplinary teams all over the country that are doing active outreach to make sure that we make that we build that bridge to care after we reverse an overdose. And I love that work that they’re doing. We should be expanding and taking to scale quick response teams as well.

Shannon McLoughlin [00:12:29] I think multi-disciplinary teams work very well. So you have a psychiatrist, you have nurses, you have peer workers. I think peer workers, people have lived experience who can who can speak to people from a place that I can’t are really important at normalizing the the individual’s feelings and truly understanding what it’s like. Social workers, we do practical things like make referrals and depending on your role. You might pick up someone and take them to an appointment. You might do in-house visits to make sure that you know their groceries and stuff, they’re being fed. But I think multidisciplinary teams work very well because you pull the person, it treats people holistically. They need a social worker perhaps to for some therapy to talk about how they’re feeling.

Narration [00:13:27] The language and images we use impact stigma and how individuals with opioid or substance use disorder are treated by the medical system.

Jessica Hulsey [00:13:37] We’ve started in the field doing a lot around language and changing our language sort of really matters. How we talk about people who are struggling with addiction or in recovery. It sort of signals how we value individuals in a certain space. So changing words like addict and junkie to a person or individual with a substance use disorder or a person in recovery from a substance use disorder, changing language like a positive or negative urine screen. It’s not a clean or dirty screen because that dirty piece ain’t saying that to someone who has a positive urinalysis test and is really weighted down with blame and shame and judgment. And that language piece can really signal that we see this through that health lens.

Narration [00:14:25] Shannon also emphasizes the importance of language.

Shannon McLoughlin [00:14:29] I think that language is appropriate to all different situations, but everybody wants to be treated with respect and everybody deserves to be treated with respect. A lot of people aren’t treated with respect for for whatever reason, whatever reason it is, but that is going to alienate people and not feel that make them feel welcome, make them feel very wary and also not inclined to engage. They very may well be judged by whoever is seeing them, whoever is triaging them.

Narration [00:15:02] When Jessica began her work, there was still a lack of understanding that addiction was a disease and not a choice. There have been steps in the right direction, but the stigma that exists today is still rooted in these beliefs. Understanding how stigma continues to impact responses to the opioid epidemic continues to be important. While stigma may not be as overt as it once was, myths and misinformation are still prevalent.

Jessica Hulsey [00:15:30] What I’ve learned, what I’ve learned doing this work for so long is the pieces that are underneath stigma, right? So the the items and the areas that we need to correct to eradicate stigma are really about misinformation, lack of knowledge and myths that really exist when it comes to SUD. Myths like this is a moral failing, that this is a character issue that sort of devalues the entire population of individuals, not just who have are in recovery from a substance use disorder or seeking treatment, but devalues and sort of alienates individuals who use substances and are struggling or have this this chronic health condition. We also have these myths and misinformation that sort of feed into that or feed into sort of our our need to distance herself from this entire population. Right. And that’s what we really need to to correct. We want people to be reaching out to offering support to being helpers and that connection to care and not pushing our entire population away. As my mom and dad struggled with SUD, so I started with alcohol use disorder and cannabis and some pills and escalated into heroin and crack cocaine. There’s lots of between family systems and educators and jail systems and prison systems and child welfare and employers that they lost jobs from. There’s also people that came in contact with. But we don’t understand addiction in terms of how we can all be supportive and have a role in responding. And that misinformation sort of means that we miss these opportunities to engage. So when we start to correct misinformation that this is a health condition, it does start by behaviors. But humans participate in a lot of risky behaviors from eating things we shouldn’t eat, smoking risky sex, driving too fast. All these different different things that can lead to injury or harm. But understanding addiction through a similar lens, understanding that some of the behaviors that we define addiction as are actually symptoms of a brain disorder and really reinforcing that people do recover. Treatment works. We have medications with like a 75 percent rate of reductions of fatality. Could you imagine if we had a medication for cancer or heart disease that reduced your chances of death by 75, like 60 to 75 percent? There would be lines around the pharmacy in the hospital for those meds, and yet they’re underutilized. So when we deconstruct misinformation and we replace it with science-backed real information from a health lens, we really start to deconstruct and take away that stigma and replace it with a more compassionate health, health care based response.

Narration [00:18:20] Shannon is also hopeful that things are moving in the right direction. She works with students at McMaster Medical School to understand the biases they may not know they even have so that they do not carry them forward with them when they begin to practice.

Shannon McLoughlin [00:18:34] I think it’s about helping people who perhaps have not had exposure to some of the folks that they will be treating depending on where they choose to go in their career. But to look at the assumptions that you have, person who has feelings and maybe had a family and doesn’t have them anymore, maybe they had their kids taken away, or maybe they’re really struggling, maybe they’re in a intimate partner violence, and so you don’t know. And so I think it’s teaching students, you know, the medical profession of the future to approach with curiosity and no judgment, which is which is admittedly difficult to do, but that’s part of what school is, is, you know, you learn how to do brain surgery, but you also learn how to see people as people, not as addict. And also, this is not to say that this is widespread, that every medical professional, every social worker, every outreach worker. No, it’s like it’s like anything. There’s different people are different. People have different attitudes. They have different thoughts. They have different ways of approaching. But sometimes I think it can be kind of overwhelming. And if you see the same person in ER time and time and time again, and you think, well, why are they here? Some people, it’s a safe place for them, to be perfectly honest. They come in because somebody says hi to them. Not to say that they’re not there for some medical reason, but also they might be there for emotional and social reasons.

Narration [00:20:20] Jessica and the Addiction Policy Forum have also been providing training to health care professionals. And the programs are effective.

Jessica Hulsey [00:20:27] You know, we’ve been surprised about the reception of some of our education and, you know, stigma reduction efforts among health care providers. We were we were just on the ground at a hospital doing a training with physicians and nurses and even researchers in the room and providing more, you know, science-backed health care related information about SUD. One of the physicians during that training said we didn’t learn this in medical school and it wasn’t in my residency and this needs to be made available to all physicians that are currently practicing or in training. And that was really helpful and such a heartfelt testimony from a physician that we trained. So I think there is an openness. Sometimes when we’re out doing trainings, we do encounter certain rooms or certain practitioners who might be attached or very connected to some of their old misinformation or way of doing business. But when you sit with folks and convey the science, right, and there’s a huge gap in how we’ve relayed this information to so many practitioners in our field. When you take the time to sit with people and go through what we’ve learned and where we’re going and what innovations are available? I have yet to find a group of physicians, nurses, educators, those working on child welfare who aren’t ready for that information so they can do a better job of helping people.

Narration [00:21:55] Jessica is hopeful for the future and is optimistic about what she sees.

Jessica Hulsey [00:22:00] We have sort of a changing constellation of barriers such as fentanyl and its prevalence in our communities, which is creating more overdoses, more overdose fatalities we have. But for every barrier or hurdle that we encounter in this field, we have ten innovations, new treatments, new programs or innovations that can help patients and help families. So I think the good news here is that when we follow the science, when we replicate what we know what works, when we really focus on a health care response to addiction, we really can see significant improvements and reduce fatalities. So it’s kind of a one-two punch with lots of difficulty, lots of tragedy. Most of us have someone we’ve lost or someone who’s struggled with addiction in our lives. But if we really look to the programs and jurisdictions who are doing it right and implementing new ways to address addiction that have proven results, I think we can start to turn the tide.

Narration [00:23:12] Jessica and Shannon have both worked on the front line of this crisis. They have seen firsthand that it can be too easy for people to slip between the cracks or become alienated by our health care and social systems. But the future is promising. Employing evidence based approaches to treatment like bridge clinics and multidisciplinary teams, continuing to educate to help break the stigma and investing in prevention, intervention and harm reduction are all moving us toward a future without accidental overdose. To learn more about the Addiction Policy Forum or about the opioid epidemic in Hamilton, Ontario, please visit the links in the description. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit EmergentBiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.

Amanda Scott [00:00:01] You walk down the street from where you live and where you lived your whole life, and you all of a sudden see that there’s been this whole world of recovery this whole time. It’s been right here where you live. And I think that that gives a reality that I think a lot of people, while using, don’t know that recovery is possible or how common it is. It really gives you that like, “oh dang, again, this has been here like this, you have doing this all the time. I didn’t even know it.”

Narration [00:00:33] This is Countermeasures brought to you by Emergent, maker of NARCAN Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of Positive Change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. For those struggling with opioid dependency, feelings of loneliness, guilt and isolation can be overwhelming. Bringing awareness to the reality of opioid use disorder is an important part of building empathy and driving education. Resources like community groups, peer mentorship programs and other safe spaces are important tools in addressing the opioid crisis. In this episode, we explore the importance of community connection as a fundamental building block of the path to prevention, treatment and recovery.

Amanda Scott [00:01:35] My name is Amanda Scott. I am the prevention program director at Detroit Recovery Project. I’m also an individual that identifies as being in recovery, so I have been in recovery for 15 years and so it becomes a part of your life to a certain degree.

Narration [00:01:55] The Detroit Recovery Project is a private nonprofit corporation dedicated to supporting recovery, which strengthens, rebuilds and empowers individuals, families and communities who are experiencing co-occurring mental illness and substance use disorders. At Detroit Recovery Project, Amanda and her team work to provide access to integrated networks of effectively and culturally competent holistic health services. Amanda says that one of the biggest initial findings of the initial Detroit Recovery Project team was that this holistic approach was a necessity. People in recovery need support in various ways, from mentorship to writing their resume to finding a ride to their 12 step program.

Amanda Scott [00:02:39] So Detroit Recovery Project started in 2005 as a peer organization. So the idea was that a lot of individuals accessing substance use disorder treatment most often find that they go back to using pretty quickly after returning home from being in treatment or sometimes being incarcerated. There were peers that were using mental health services and that seemed to really help like navigate some of those bonds, like where do I get support? Who do I call at 3 a.m. when I feel like I’m going to crawl out of my skin? So they started that way. It was written by people who had lived experience. It was employed by people who had lived experience to serve, people who wanted to access recovery. But it became really clear pretty quickly that you couldn’t just address the substance use without like acknowledging all the other components of an individual’s life that have that outcome, right? Like if I just stop using drugs, but I still am on house without a phone and that was no support, like, how long am I going to stay off of those substances? And it can be pretty daunting.

Narration [00:03:49] Many people who have been impacted by substance use want to use their lived experience to help others in a similar way. Amanda Lick, director of Community Health Solutions at Emergent, is one such person. While she has never struggled with substance use disorder herself, she grew up watching her mother battle an addiction to prescription opioids.

Amanda Lick [00:04:11] So like my life story with the opioid epidemic or the way that opioids impact the lives of people happens not with my control, not really with my consent and happens in utero. So my parents hit a deer on the backroads of northern Michigan. My mom broke her pelvis in two places and my dad sort of struggled and suffered from brain damage because they were on their way to the hospital due to my dad withdrawing. So or at least that’s the story they’ve been told. So it’s really fascinating because as I have grown, I and learned and unlearned and just, you know, weaved through life, trying to make sense of who I am and how trauma has impacted me and how it’s created beautiful parts of who I am and how it’s created parts of me that I have to, like, dive deeper to understand. I’ve realized that the opioid epidemic was impact me long before I even knew. My mom died in 2007 from an overdose too, with prescription drugs. She died the first year that the CDC had died, like had said, more people in this country was dying from overdose due to prescription drugs than automobile accidents. So prior to that, I was a part of the whole generation of folks who saw their parents maybe take substance use and then become dependent and then become addicted to the substances. And I witnessed just like how damaging that was. And there were just a number of different factors that played into it. What I can do is tell our story, communicate how there are so many people that are just like me that have their own stories that are complicated and beautiful, that likely have been touched by the death or loss of someone that they loved that was also complicated and beautiful and also tell our story, but then also get to do the work that I do every day that makes a difference in so many lives.

Narration [00:06:20] Like many Americans, Amanda Scott and Amanda Lick both have personal experiences and stories that tie them to the opioid crisis. They have both witnessed firsthand the importance of community and the ability to openly share experiences with others. They have also both channeled their experiences into becoming positive forces, engaging with communities to create a network of support and resources to help. Amanda Scott and the team at Detroit Recovery Project follow the Healing Force Model of Recovery, a concept of the Wellbriety Movement, adapted from Native American teachings. The Healing Forest is a metaphor for the clinical treatment of addiction and follows that if you plant a tree in a sick forest, it will stay sick. But if you plant a tree in a healthy forest, it will heal and eventually thrive. Championing community resources and peer mentors to help those on the path to recovery is one of the first steps to curating a healthy and healing forest.

Amanda Scott [00:07:22] When you go to the bus stop and like wait for the bus in the morning and everyone’s smoking weed and that’s where everyone’s always smoking weed, like that’s like an issue for you. But like down the street, they have live music every day or they’re out on their porch playing music and like it’s not centered around substance use or drinking and it’s in the same neighborhood. But you don’t know because like your area of focus was always like, where can I use, who’s using? How can I use more? So the peer can help, like navigate that. Like, hey, right down the street there’s live music. It’s not centered around using, right? Like, so here’s this other thing you could do that is fun and healing and healthy and community and you just didn’t know. You just didn’t know was there. So that’s one thing a peer can offer. The other thing is, is I think it’s kind of a part of that full circle, which is if you get sober and you have like a criminal background as a result of your using, you are limited in what you can do. There’s only so much employment you can obtain. You’re that you kind of are forever held accountable for those behaviors. Recovery support is an opportunity to do something different where you can really access a level of employment that is maybe levels of employment or like a level of professionalism that you wouldn’t be able to access otherwise because so many, like white collar jobs, require clean criminal backgrounds. So like, it gives you a chance to also grow and to be a part of that healing forest by like being a part of like the community as like a gainful employee, which sounds strange, but it is like so it’s another part of like completing the circle to like giving space for people who are recovering to grow and like kind of level up in their lives.

Narration [00:09:19] The Detroit Recovery Project runs the Recovery Training Institute, where individuals can train to become a certified peer recovery mentor. Peers are paid for their services, and the program provides a new path for people in recovery to help others and also gain important skills that can transfer to other parts of their lives.

Amanda Scott [00:09:37] In the state of Michigan, they have made it so that peer recovery support services are billable services, which is great because that means we have a way to sustain funding for individuals to provide that service. But in order to do that, you have to have certifications. And those certifications have like a whole list of stuff, like you have to have 40 hours of SUD education, 16 hours of SUD ethics, 150 hours of continued education, the other 500 hours of shadowing. It’s kind of a lot. And then there’s an exam and then there’s like certain professionalism, things that some people in recovery might not have acquired the education on throughout their life based on maybe where they grew up or how long they’ve been using. You know, some people start using when they’re 13, 14, so they may have never truly written a professional email like that might not be something they ever did because they were doing other things. So the Recovery Training Institute provides all of that. It’s I think it’s like a month, maybe it’s six weeks and it’s like half day of classes where they kind of go through all those trainings and you do roleplaying and try to really make sure the individual has all the information to access the exam and pass the exam. And then we’re not the sort of fire, but we try to set the individual up to succeed with certification through the state. So we like try to help them set up the account that they’ll need and get everything uploaded, all that good stuff. And then if they want to apprentice with DRP, they can do that. We are recognized. So if you want to go on and do your 500 hours of apprenticeship as as you can and it is paid.

Narration [00:11:28] Amanda Lick’s Mother didn’t access community programing, peer mentorship or have a healing forced around her, but Amanda wishes she had.

Amanda Lick [00:11:36] The program that I wish my mom had had. So one, I guess there’s two programs I wish she would have had. It was she would have had more support as a young mom. So there are certain programs that support women who are pregnant, like early in their pregnancy and do home visits with those families. So I wish my mom had that because, you know, my mom was in the motorcycle accident and she was pregnant with me, broke her pelvis when we went, when she went to deliver me, it was a very stressful delivery. In fact, we almost both didn’t make it. So not only did we survive the motorcycle accident, which we probably shouldn’t have, then we survived the birth in which they actually asked my grandma, like, Which one do you want me to save? Because we don’t know that we can save both of them. And my grandma, of course, said her daughter, because my mom at the time was only 17 and luckily we both made it. But, you know, I look back, I have the birth records of when my mom gave birth to me and she actually was a very dedicated like mom and wanted to attach. And that was like a really beautiful thing to read that and to know that she was committed to being a really good mom in those moments. I just think she could have used some additional support. So now there’s lots of programs like that available for moms and dads and babies and toddlers that offer home visiting. And it’s really wonderful. The second thing I wish that my mom would have had was naloxone. Two things that probably would have made a huge difference in her life, the one having that program, and then the second, having her life saved when she was overdosing.

Narration [00:13:11] In her position at Emergent, Amanda Lick works with communities to get naloxone into the hands of people who may need it. Building awareness around naloxone and educating the public on how to use it is part of creating a holistic, community based approach to supporting those with opioid dependency.

Amanda Lick [00:13:30] I think the reason my job and other jobs like mine are important is that we are sort of the conduit of, you know, helping share best practices, like how how are others creating innovative ideas that are reaching people when they need it most in areas where they’re seeing high numbers of overdoses. So we kind of like have this really great view of the landscape and then can sort of maybe help accelerate some of the some of the program building by sharing something that’s already been done so that people across the country aren’t just having to start from scratch. And of course, they can find that other ways. But I think our team does a really good job of saying like, Oh, you’re thinking about finding a distribution solution in a high need area. Oh, have you thought about like vending machines or distribution boxes or. I know of this great program in Chicago that’s using libraries. Let me connect you to the person. We’re constantly learning, engaging. I think our team really is focused on, like so many of us, have our own personal story and how we’ve been impacted by the overdose epidemic over the last 20, 30 years that I think that we take that and carry it with us. And so it’s never about the product. It’s about how the product can help others and how can we help build better relationships, help strengthen communication, help improve programs and help people get what they need when they need it.

Narration [00:15:09] Making sure naloxone is widely available to those who may need it is one element of harm reduction, a spectrum of strategies that focus on keeping people who use opioids and other drugs alive and as healthy as possible. Amanda Scott says pushback against harm reduction tactics like syringe services every day and has even struggled with it herself.

Amanda Scott [00:15:30] So harm reduction is really about meeting people where they are. So it’s kind of like that gap of service like this applies as you do. But I think this probably applies to everything, right? Like there is a population of humans that are not currently able or willing to access further services for whatever reasons. So you have this group of people that aren’t ready to do something different. They are actively using. So going to them and providing that service and providing safe using equipment. I know that that’s one that like personally I haven’t struggled with was a little bit at first was like, is this perpetuating using, and I really just like to talk a minute and I thought about it. Like, I like I said, I’m a person on long term using. I personally know that like the last syringe I was using before I got sober, it was so faded, it didn’t have any of the numbers on the side anymore. The needle itself was bent and had rust on it. And I still used like it didn’t matter what the syringe looks like, you know. And I kind of like thought about that and was like, yeah, that never made a difference for me or anyone I knew. Is having syringe services going to make me high today? No, and not at all. And would having syringe services have like, perpetuated me using? No, not at all. The only thing is, is I probably wouldn’t have gotten cellulitis or cotton fever as often as I did.

Narration [00:16:59] Amanda Lick comes up against similar barriers when it comes to ensuring everyone has access to naloxone if and when they need it for an opioid overdose emergency.

Amanda Lick [00:17:09] So we can take a data driven approach. And that is incredibly important, like where we make naloxone available at the upon discharge and the ED, or we make it available upon release for those incarcerated folks for coming back out into the community. Absolutely, important programs need to be done, but other types of programs that make it available to people who are using other forms of drugs that may not realize that opioids are in it or programs that make it available to parents whose children have been given an opioid for surgery or grandparents who’ve been prescribed. I mean, really, at the end of the day, like if you have an opioid in the home or if you are a loved one, or even if you’re someone who doesn’t ever use an opioid, you could be at risk not knowing where these potential drugs are coming from. You know, 16 years ago, my mom died of an overdose. I knew she was using and naloxone wasn’t available the way that it is out in the community now. I wish it was because I would have given her some every time I saw her. She wasn’t injecting drugs. She wasn’t using drugs outside of well, she was using them illicitly in the sense that she was taking them, not how they were prescribed. But she would have said that she wasn’t using drugs, but she still should have had it. And she became a statistic and she became a statistic in the year that more people died of overdose than car accidents. To me, that life, my mom’s life is just as important and should have naloxone available to it as someone else who might be using four to five times a day. And that person should have naloxone available to them every single time that they use. And until that person dies, I don’t think we’re at that point of saturation yet. I don’t want to live in a space of fear where I’m like, Oh my gosh, anybody can be exposed and die at any moment. Like, that’s not I don’t feel like that’s a healthy place but I also we’re seeing record numbers of people who are using cocaine die because opioids are in their cocaine and they had no idea that they were at risk for a death from an opioid. And that’s super scary. Someone could try cocaine once and have no idea that they are at risk of dying and no one has naloxone available because they don’t consider themselves at risk. Just this idea that to a certain extent many people are at risk and we need to have access for those many people, regardless of whether they’re high risk or low risk.

Narration [00:19:52] While progress is being made, stigma and silence are still barriers to ensuring robust programing and support for prevention, treatment and recovery. Support from the community and peers can help fill this void and create a safe place for people affected by the opioid crisis in all its many forms.

Amanda Lick [00:20:12] I guess the first time I realized I had a problem or that my family had a problem, my family’s different was when I was in elementary school. My mom overdosed in front of me. It was where I knew my family was different. I knew that my mom was different. I knew that things just weren’t quite right necessarily, but I didn’t realize just like, how different. One of the things that people don’t understand about stigma is that it creates an environment of silence. So like me as a child, I was silent and didn’t feel like I could talk to anybody. I didn’t feel like I could talk about my own family. We didn’t talk about it in my own family. My mom would pass out. My other family members would, you know, pass out or do things and nod off or whatever. And it was like, no one talks about it. It just became our norm. I’ve always said this. I truly believe that, like, silence kills and it kills within ourselves. If we’re silent within ourselves, it kills within our families, it kills within our communities. We have to not be silent. But I think the reason we are silent is because the stigma and the shame that is placed on people who have a disease. And it’s just so unfortunate. Even our silence communicates something. And if you take a situation like those who struggle with substance use disorder and in families, for instance, it’s like it by not communicating about it, it becomes the norm. Or by not communicating about it, it it’s saying that we don’t care. By not communicating about it, it says that it doesn’t exist. And if you do see it exist while you don’t know what you’re talking about. It’s dishonoring our reality. It’s dishonoring the lives that matter to all of us, the lives that matter most to us. It’s truly silence kills and it perpetuates this idea that these human lives don’t matter.

Narration [00:22:22] Amanda Scott emphasizes the little things that we don’t talk about also matter.

Amanda Scott [00:22:28] Accessing food. We see a lot of dehydration in the winter. So like preventing deaths or other issues by people just like getting water, gloves and coats in the winter. I can tell you I have multiple like videos of participants being like nobody is talk to me like a human in years. If you’ve ever attempted to go to treatment, it’s not easy. It’s at least a minimum of a two-hour phone call to identify your level of care. And then it could be longer from there and oftentimes there’s waits. So having someone to help navigate that with you is really important, too. Even today, we have one young person who has over three years in recovery, but I was told that she might not be able to work in this space, this this particular grant anymore because she has a larceny from 2019. Mind you, she’s I completed her probation and stayed sober, really done all the things she needs to do. But because she has this, she’s not allowed to bill for services. Even though she’s done all the training and they specifically want a youth who’s in recovery under the age of 25 with lived experience. However, it has to been five years since that criminal charge, which is an insane amount of hoops to jump through. So just like I don’t know, there’s just a lot of like poor decision making. I think poor policy hasn’t really like looked at the truth of an issue and then a lot of like racism, stigma, bias that’s happening that I think in the last few years people have become more willing to look at. But I think that those are the things that hinder us. And as soon as things are an issue anymore there, unless those things get dealt with, they are going to be the things that continue to hinder us.

Narration [00:24:15] Amanda Lick and Amanda Scott are just two voices of the many in the U.S. and around the world who have been impacted by the opioid epidemic. We want to thank them for their willingness to share their stories and help break the silence and their important work cultivating healing forests in their communities. Having conversations about opioid dependency and overdose, supporting harm reduction strategies and championing those with lived experience are all key steps to combating the opioid crisis. We aren’t there yet. We need to have open discussions about community support in order to make an impact. To learn more about the Detroit Recovery Project, please visit the link in the description. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit EmergentBioSolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.

Narration [00:00:02] This is Countermeasures, brought to you by Emergent, maker of NARCAN® Nasal Spray. 

Join us as we explore the shifting, complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance, and offer a way forward to a better future. 

Across the country, Americans from all walks of life have been impacted by the opioid epidemic. For Crystal, a mom from Missouri, the epidemic hit home the night her teenage son overdosed on her front lawn. The incident was recorded by the family’s Ring camera, and Crystal uploaded the video to social media to help raise awareness about accidental overdose. She has since become an advocate in her community for education about the dangers of accidental overdose, and the importance of carrying Naloxone, an opioid antagonist that can rapidly reverse an opioid overdose.   

Crystal [00:01:12]: The night that the video was taken, I had let my 16-year-old go out with a friend who I typically hadn’t let him be around. he had gotten in some trouble with him, but they had recently had a friend overdose and die, on Fentanyl. I had seen that child at the funeral and I, I thought these boys seeing their friend in a box, that they would learn. I really trusted him after that because he did. I mean, he looked me in the eyes and he said, never again. And I believed that, and I allowed him to hang out with that friend. 

The next thing I knew was I heard the dog bark, and our dog never barks at night, rarely barks at all. Um, and so I kind of woke up a little bit, but enough to see my phone flashing because it was giving an alert, I thought that that was odd. And so, I grabbed my phone, and it was the ring doorbell and I brought the live feed up and all I saw was our front yard, but I knew that the dog had barked, so I thought, I’ll watch for another couple seconds. And the next thing I knew, I saw my son being carried by a friend to my front door.  

Narration [00:02:55]: EMS arrived, and Crystal’s son’s life was saved by Naloxone and the provision of emergency medical care. Afterwards, he went to rehab in order to start his journey to recovery. A journey he is still on today.  

Crystal [00:03:10]: So it was, it was hard for both of us, obviously. We had never been apart like that. He came home, and he seemed to have his head on a little bit straighter, and we decided that we were gonna work on his mental health and we would think about school when we needed to. And, um just really focus on getting him healthy. 

Well, after eight months, he relapsed and I came home to him slipping in and out of, you know, consciousness. And thank God for the education I had gotten because I was able to administer the Naloxone myself, and get him to the hospital myself this time. As a mother that breaks your heart. I was mad, and I was sad, and I still am…disappointed. There was a lot. It’s, there’s a lot of guilt too, a lot of emotions that go with all this. And there’s no rule book for how to, you know, get your kid healthy from something that’s so addictive. He did go back to rehab. This time on the other, on the other side of the state. So there, my kid is gone again. He was gone for another 60 days. He came home, and it wasn’t even a week, and I found some things and he’s currently in rehab again. 

Narration [00:05:13]: In this episode, we explore accidental overdose – the signs and symptoms, and how Naloxone works to reverse an overdose. We’ll speak to some of the advocates and professionals working to ensure the public knows the importance of carrying Naloxone, and how and when to use it.  

Overdose deaths – the majority of which involve opioids – continues to be one of the leading causes of injury-related death in the United States. 

Last year, approximately every seven minutes one life was lost due to an opioid overdose…that equates to more than 200 fatal overdoses every day, each with its own emotional toll.  

The opioid crisis does not discriminate, and can affect anyone, no matter their age, sex, race, or socioeconomic background.  

Dr. Bonnie Milas [00:06:05]: So, what happens during a drug overdose? And it’s important to recognize that nearly all of these overdoses involve an opioid. What’s happening is first the individual becomes unconscious, they fall asleep. If they’re discovered, you cannot wake them up. But then the other effect of the opioid on the brain, besides causing them to be overly sedated is that their breathing slows. 

Eventually their breathing will stop, and at that point, the brain is no longer getting oxygen, and the brain is critically dependent on oxygen for survival. And once you get over five minutes of not having oxygen to the brain, then brain injury can occur. But in that process, the heart is no longer getting oxygen either. 

So, the heart will eventually slow and stop as well. And that’s what happens. That’s the sequence of events when someone suffers a drug overdose. So, the sooner that we intervene the individual is just falling unconscious, and their breathing is just starting to slow…that’s the point at which it’s critical that we intervene. 

Of course, you can intervene at any point, but if we can intervene at that point, at its earliest, then that’s how we can prevent either permanent brain injury and or death. But it’s most important to understand that this is not a cardiac, a primary cardiac event. This is not a primary cardiac arrest.  

Instead, this is a primary respiratory arrest. It’s the breathing that stops first, and then eventually, if no one intervenes, then that’s how the heart eventually stops. So, it’s important for the public to recognize that it’s not the same, and you do have the opportunity to save them from dying. 

Narration [00:08:01]: The voice you just heard belongs to Dr. Bonnie Milas, a Penn Medicine physician, and Professor of Clinical Anesthesiology and Critical Care. Dr. Milas has both professional and personal ties to the Opioid Epidemic. As an anesthesiologist, she handles opioids every day as part of her work. She has also tragically lost two sons to accidental overdose.  

A large part of the work Dr. Milas does is to educate the public on the importance of carrying Naloxone, whether someone you know is at risk of accidental overdose, or if you think you’d never have to use it.   

Dr. Bonnie Milas [00:08:39]: Things that the public can do to intervene in an overdose situation would be to educate themselves first and foremost. So, there are many sites that you can turn to to seek out that information. Namely, I have, through my professional society, I have spearheaded the REVIVEme.com campaign. 

That is a website that is rich with content, and in fact, if you’re someone who needs to be convinced as to why you need to be ready in the home or in a public space with Naloxone, there is a, It’s kind of like a, uh, TED style talk where I try to convince people of the urgency that I have felt in the home because I have had on occasion in the home to have to rescue one of my sons. On a number of occasions. I have the skillset, but not everyone has that skillset. So, if you go to the REVIVEme.com website, it teaches you and implores you to be ready. And it also has links to where you can find Naloxone. It also talks about the importance of rescue breathing and maybe even the need for full on chest compressions or CPR, so that’s just one site that you can go to.  

The American Heart Association has a very nice opioid educational component as well, and in fact, the ASA and the American Heart Association we have a very close relationship. We have a joint statement essentially saying how important it is for the public to be educated and to intervene. And if you need CPR basic life support training, you can go to the American Red Cross and get that type of training as well. So those are just three websites that can be used for the public to become educated, to really know what to look for. 

So, things that I’m doing out in the public space is, first of all, I certainly do go out and talk to other physicians. I try to stimulate interest in my, not only my own professional society, but I’ve also spoken to family practitioners, pediatricians, about what we can do to really stem the tide of loss of life due to drug overdose.  

In addition, I also go out and talk to community groups. I work locally with my county health department and we teach people the very basics of what do you look for, calling 911, having a Naloxone product immediately on hand. And then basically, how do you rescue, what is the importance of that? And then where do you put your hands to intervene, If you really don’t want to rescue, breathe, if you don’t know the individual and you’re only willing to do hands only CPR. 

Narration [00:11:55]: Gay Owens, Senior Director, Global Medical Affairs at Emergent, has spent her career studying opioid antidotes – she knows the importance and impact of Naloxone becoming available over-the-counter for expanded community use. 

Gay Owens [00:12:11]: So, what I think is the biggest benefit to now having community-based Naloxone available in a retail setting is really for everyone to understand where there’s a risk of having an opioid…someone experiencing an opioid overdose. And that really has, unfortunately, in this opioid epidemic, really broadened, um, one from initially when the epidemic started from a prescription problem to now an illicit fentanyl, or adulterated drug problem. 

And so that now the epidemic numbers have continued to rise, and so having something available to the broader consumer and community use will allow someone to understand and recognize signs and symptoms of an opioid overdose, and now be able to actually have something to take action.  

So, a couple of things I think are needed in this environment in order for folks to understand where and when are the signs and symptoms of an opioid overdose, how to recognize them if you come upon someone who may have experienced an opioid overdose. 

And now, how to understand that there is a product available that could be utilized to potentially save a life. And as I mentioned, utilizing our human factor studies, understanding that a consumer could go in and be able to pick up this product, potentially have it in their home, have it on them available in order to save a life. 

It’s now really more critical than ever that people have something at the time, or when they witness a potential opioid overdose. Timing is critical, hence why we now have something available to a broader consumer group to make it more accessible.  

Dr. Bonnie Milas [00:13:53]: The significance of having Naloxone over the counter…I had already mentioned it’s easy access, but the other thing in terms of stimulating conversation, I think most people think of, first of all, of having a substance use disorder as being something that, well, they made a conscious choice to take that drug. 

Even at an initial stage, early on, early age, and that you willingly made that choice and therefore you can willingly stop anytime you want. Well, if you are knowledgeable about addiction and how that occurs, you would clearly understand that, we all make decisions and we may try something or do something, but very few of those decisions, especially at an early age, are something that ultimately you cannot undo. 

With the understanding of addiction, and with the way the brain receptors get reset, that they reset, in a manner in which the brain is constantly chemically imploring the individual to use. So, they’re constantly getting that messaging, and if they stop that, they are going to have a sickness, they’re gonna have withdrawal symptoms. 

So, you know, having the drug over the counter should stimulate discussions about addiction and about that mechanism. And I think too, that if we see people picking up Naloxone, and people are talking about it, that the image that we have of what a drug dependent individual, what they look like will also change. 

Because what is often portrayed in the media are pictures of, you know, I live in the Philadelphia area, so they’re pictures of Kensington…there are pictures of individuals who live in the Tenderloin area in California, and it’s an image of someone who is dipping out, falling asleep. Their pants are halfway down, or their dresses halfway up around their neck, and they’re urinating and defecating in public and they have a needle in their arm, and that’s the image that many people in the public have of this is a picture of what a drug addict looks like.  

Well, I can tell you that most individuals don’t look like that. And I know that my children, you would’ve looked at them, you would’ve met them, and you would have never guessed what they were struggling with.  

Highly educated, successful, and in fact, you may be working with somebody in your office space that is using on a daily basis, but you don’t know that. 

Narration [00:17:08]: Gay further emphasizes the importance of carrying Naloxone 

Gay Owens [00:17:12]: When you look at this from your own personal perspective, there are many variables that could potentially predispose someone to an opioid overdose, and those, some of those factors you may not know. So risk of having opioids, taking them either illicit or illicitly, but now as I mentioned, exposure to adulterated drug substances has really been what’s driving the opioid epidemic.  

So, you may not even know that someone’s at risk for an overdose. You may be in a situation where you’re not sure of what someone’s taken, and now as I mentioned, timing is critical. So now you have access to a product that you can utilize, but essentially an opioid overdose can occur at, you know, to no fault of one’s own doing. 

Where they may not even be aware, they’re exposed to this and yet their breathing has slowed, and now you have access to a product that could restore their breathing. Regardless of whether it’s in your home at an event, riding transportation. There are many scenarios where you may not know, and most likely you won’t know what someone’s taken, but now you have an ability to take some action that could potentially save their life. 

Narration [00:18:31]: But what can you do if you see someone you suspect is having an overdose, and how can you identify the signs?  

Dr. Bonnie Milas [00:18:40]: So, some of the signs that you would look for, say for instance, you are on public transportation…someone appears to be sleeping, but you notice that maybe their position is a little bit off, they’ve fallen forward where, um, anyone who’s not impaired, they might catch themselves. So, you see their positioning’s not quite right. Something about that doesn’t look right.  

Or maybe you see paraphernalia around that individual, but you might go over and see if you can wake them up. And you try to rouse them or shake them gently and say, “Hey sir, miss, are you okay?” And if it seems as though you cannot get them to respond to you, and if there’s also maybe nobody else around them that you can ask their circumstance, you know, did this person recently use, do they, do they use substances? 

From that point on, if you cannot wake them up, you would certainly want to call 911 at that point. Now, after that, you can also look at signs on the individual or about the individual. So if their pupils are pinpoint, see if they are breathing to see if their chest is rising and falling. 

Well, certainly if they are not breathing or if they’re breathing less than eight times per minute, then you know that something is clearly wrong. Their pupils are pinpoint, we’ve already mentioned their fingertips are blue or their lips are blue. And then you could say, well, even in the absence of, I don’t know, there’s no paraphernalia around the individual. I don’t know much, but that’s enough to get you to think that this is probably a drug overdose.  

Since I carry Naloxone, I would administer that nasal spray and if they are still breathing, I would potentially turn them on their side and I would stay with them until trained help arrives. If they are not breathing, if this is someone I know and somebody that I feel comfortable rescue breathing, then I would give two breaths and then a breath every five seconds. 

And if I didn’t know this individual and it was a situation where they were on the train and I didn’t have any protective mechanism, like a face mask where I could protect myself against the individual, then I might only do hands-only CPR. But those are kind of the basics.I have enough information there to tell me this is probably a drug overdose. 

Narration [00:21:21]: When it comes to reducing the number of deaths from accidental overdose, stigma remains a major barrier. Conversations about accidental overdose and opioid use are still considered taboo in many circles. Breaking the silence and stigma is critical as we continue to fight against the opioid crisis.   

Gay Owens [00:21:40]: So, stigma I feel, has played a big role with where we are with Naloxone education awareness, and now, distribution, or having folks have access to the product. So, stigma, again is this crisis initially started was around prescription opioids and those using prescription opioids as unintended potentially, or misuse and abuse of prescription opioids. 

That market then shifted to more one of heroin. And then now if you look at the waves of the epidemic, it’s illicit manufactured  fentanyl, as well as adulterated drug substances. And so I think stigma along the way… the data lags behind, we’ve always been looking at this product, or naloxone, as a potential for those with substance use disorders or opioid use disorders. We haven’t, again, normalized this to anyone in any situation could actually come across someone experiencing an opioid overdose. 

Again, unintentional, these are not intended opioid overdoses. And so now unfortunately, folks are being exposed to products that may not even be aware of because of the adulterated drug supply. And so, I think stigma really needs to be addressed. And now with potentially having, or now that we’ll have an OTC product, we can actually educate a broader consumer group on who could be, um, who has the potential to save a life, but who could potentially suffer an opioid overdose and what those signs and symptoms look like. 

And again, now with a broader distribution of Naloxone, we hope to have enough to avert, start to avert opioid overdose deaths from occurring. 

Narration [00:23:15]: After posting her video on TikTok, Crystal saw firsthand the power of speaking up and breaking the silence on how the opioid epidemic envelops families and communities like hers.  

Crystal [00:23:27]: Because awareness is the only way we are going to even get a handle on this. My son didn’t have time. His friend didn’t have time. You know, if, if we do not get a handle on this, I’m gonna have more friends lose children. The more that it gets out there, the more chance a mother knows what to do if that were to happen to her kid.  

I can’t urge enough. You, you have to have it on you ,and you have to know how to use it. It is very important. It’s just as important as you know, talking about other things that you talk to your teenagers about. Your kids need to know about this. I even know some of my teenage family members, who are carryingNaloxone because better safe than sorry.  

You know, and I want to bring awareness. I can’t get sober for my son, but I can share the video that literally makes you feel something inside when you are watching what happened to my kid and put that on a mom’s heart.  

You know, one thing is, is that when you, when you are big on social media, which I am not, that is the only video that has gotten that many video or views, um, I feel like you can get negative comments on anything that you could say, you could say “this cat is cute”, and somebody will have the nerve to say “No, it’s not.”  I’ve had nothing but great. Comments, of people are sharing their sobriety number of years. Moms who said, “I’m going to show this to my kid when they get home from school.”  

Just wonderful comments. Andt hat shows me that the reason for me putting it out is working because that’s all I want. I feel like if it’s kept quiet, it’s gonna hurt more people. So I say, say it loud and, and be truthful. 

Narration [00:25:36]: Dr Milas, Gay and Crystal are all outspoken about the importance of openness, awareness and education when it comes to accidental overdose.  

Dr. Bonnie Milas [00:25:48]: Reasons why people might think that, well, I don’t really need this drug. I, I hear a lot of times because someone might say to me, well, “I don’t have that problem in my family,” or “not my kid.” But what they are failing to recognize is that many people experiment, and they try a substance for many different reasons. 

And if they are inexperienced, and they’re not tolerant, then it could be a first time that someone tries a substance that they would indeed overdose. So, you might think that I don’t need this in my home, but in fact, you very well may and it’s too late. Once you discover your adolescent, or your family member down to say, oh, I guess I really did need that.  

It’s emergency protection that every home should have. So, if you either have someone in your home that has a substance use disorder, you have opioids in your home, or if you have anyone who may try a substance, then it is probably in your best interest and theirs, particularly in their best interest, for you to have that immediately available. 

I think if anyone is listening to me and you’ve heard what I have to say, that that in and of itself should be enough to stimulate you to go out and pick up the medication. It’s too late when you’ve already discovered the actual circumstance right in front of you.  

Now, why would you want to necessarily carry it in public? 

I would tell anyone that having Naloxone on you is essentially a sign that I care about members of my community, I care about my neighbors. I care enough that I went out and I obtained this medication. I have it on me. I have it with me, and I am willing and ready to respond.  

I consider this to be a sign of good citizenship, to have this available and to be willing and able to respond. 

Narration [00:28:21]: The Opioid Epidemic does not discriminate, and an accidental overdose can happen anywhere, anytime, to anyone.   

Carrying Naloxone puts the power to help reverse an opioid emergency in your hands, and has saved lives, including the life of Crystal’s son.  

Naloxone is just one tool in the fight against the opioid crisis. In this series we’ll explore the stories of people working to change the trajectory of the crisis.  

For more information about opioid overdose and the important resources available to you, please go to the links in the description of this episode.   

Thank you, Crystal, Dr Milas and Gay for sharing your stories and expertise.   

Thank you for listening to this episode of Countermeasures. 

To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit emergentbiosolutions.com

If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.