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[00:00:01] Hays We have a massive struggle in our nation. Hundreds of thousands have died, but we can stop that. Individuals can save lives. Naloxone is a tool for that. And we can empower students to not feel hopeless in the face of this insurmountable crisis. But you know that they can do their part. They can protect their peers. They can reach out a branch of compassion instead of isolation. And they can reach out a branch of love instead of rejection. And that’s what I want our education system to do.

[00:00:27] Narrator 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 the leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season will 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. Students are increasingly at risk of fentanyl overdose. Twenty-two high school age adolescents died each week in 2022 from an accidental overdose driven by fentanyl-laced counterfeit pills. Across the country, students are rallying together to help protect their peers, advocating for access to naloxone and better education about overdose, the adulterated drug supply and the dangers opioid misuse can pose. As you’ll hear in this episode, students want to participate in conversations about the opioid crisis and its effects and have become advocates for finding solutions. In this episode, we hear about efforts to allow students to carry naloxone at school and what young people are doing to address the crisis in their communities. Hays Stritikus, who you heard at the beginning of this episode, is a student from Durango, Colorado, who has become an advocate for allowing students to carry naloxone.

[00:02:00] Hays Durango is a town of about 18,000 people. So, we’re very small community. A student overdosed, actually, three students overdosed. Two ended up in the ICU and one, unfortunately, died from a fentanyl poisoning. And that kind of kick started a conversation in my town about drug abuse and, you know, the dangers of fentanyl and on the dangers of the opioid epidemic, which kind of transferred into naloxone and harm reduction work. I was an ex-officio student board member. My term ended just about the same time the overdoses occurred. And I’m also a twin, and my twin brother ran for class president on a platform of harm reduction and at drug education, which was pretty funny because everyone else is running on, you know, better school dances and more activities. And he’s sitting here talking about fentanyl test strips and naloxone. The students were very receptive of that. And that kicked off what equated to be about a year long struggle and conversation between students in our school district about allowing students to carry naloxone on campus, as well as what can be done to better educate students for drug use. Following our success in the state, our school board, my brother and I and a group of other kids founded the organization Students Against Overdose, which I currently serve as a co-director of, and we helped write a bill that made Colorado in that putting Colorado statute that students are allowed to carry naloxone on school campuses, as well as updating language regarding additive test strips.

[00:03:23] Narrator Montgomery County Public Schools in Maryland has also adopted a program to allow students to carry naloxone. Dr. Patricia Kapunan, a pediatrician and adolescent health specialist who served as MCPS’ school system medical officer, says that the policy was adopted earlier than in other districts, which put the school in a good position to address the crisis as it continues to evolve.

[00:03:47] Dr. Patricia Kapunan We addressed it at a system level earlier than some other districts who only now are looking at the tragic events and scrambling to respond. You know, we were in a good position because in Maryland, since 2017, every school already had naloxone. So we had a little bit of a head start. And when we came out and said illicit fentanyl is a huge problem, people were surprised. So the first barrier was, is this a problem? Yes, this is a problem. Is it in your community? Yes, it is in your community. And doing that at a time when not a lot of districts across the country were coming together at that level. But one of the things about having a voice for health at the system level is someone can say, hey, guys, this is what’s happening. So I think that initial barrier of just spreading awareness was the first one that we encountered, and we did that right at the time that, you know, a study came out in JAMA that showed an increase in youth opioid overdose deaths. And the, you know, most recent articulation of the monitoring the future study showed gave us more information about trends in substance use, especially that, you know, the subgroup of kids who are using opioids.

[00:05:07] Narrator Like many students, Hays was distantly aware of the opioid crisis. But after an overdose in his community and the response on social media, it suddenly felt personal.

[00:05:18] Hays I think everyone was distantly aware of the dangers of overdose and poisoning, but hadn’t been forced to confront that reality. And for me, in many students, what that looked like is, you know, seeing Snapchat stories of test your pills, throw out your pills, you know, be careful, you all are loved and trying to figure out what happened and calling people and seeing who’s okay. And that forced a very candid conversation, at least among students, about the dangers of drug use and kind of also the inadequacy of drug education, where very few people really fully understood the dangers of fentanyl use and which drugs can be laced. I think this wasn’t something we were really focusing on or many people were thinking about. And now, unfortunately, it is something that is on the minds of people.

[00:06:03] Narrator Like students, parents can sometimes underestimate the effects of the opioid crisis and can be resistant to acknowledging that it’s present in their community. However, most parents are open to learning more about naloxone and how their family can be prepared.

[00:06:17] Dr. Patricia Kapunan The kind of resistance that I’ve seen from parents is more like this is not a problem. This is not happening in our community. Can you show me the data that it’s impacting kids in AP classes? So I think that once we push through that, I haven’t seen a whole lot of resistance to, can you teach my child a lifesaving skill? And I think a lot of folks, you know, they see their kids being more independent. They see their kids maybe, you know, next steps after high school graduation, leaving home. So preparedness maybe has outweighed the fear of what access to that particular harm reduction strategy is.

[00:07:00] Narrator Jackson Taylor and Sujit Hegde are students in Montgomery County Public Schools, where Dr. Kapunan works, who have become involved in naloxone advocacy. As a senior, Jackson ran the student led task force against the opioid and drug crisis. In this role, he began traveling to other schools and spreading awareness and education.

[00:07:19] Jackson They told me how they have this huge training program created by the state that is the whole overdose response program. And I told them, Hey, I want to start teaching this to students and things like that. And around December, like right around Christmas, I’d say, there was something called the Save the Student Summit and was the first one of these that had existed. And it was the first time in the history of the state that a student gave a presentation to other students on this whole overdose response program. And I was the one there doing that. And when that happened, I’m thinking like I got a lot of great feedback from it and everything. And I got people that kept telling me, Hey, can you come do this here, come do this there. So it led to me going to schools during lunches, going to events on weekends, speaking at big student leadership conferences around the state and giving this presentation to kind of help expand the knowledge on everything.

[00:08:18] Narrator Sujit first became exposed to the opioid crisis when he began volunteering as an EMS provider, which led him to become involved in advocacy and testify to the Board of Education.

[00:08:29] Sujit So I think the most eye opening thing about the opioid crisis was that some people like to think that, you know, they live in very well off communities, that they won’t be affected by the opioid crisis. But the one thing I can tell you is that it’s the most unexpected places. I’ve had overdoses that are near my high school and my high school is in a pretty obviously well-off area. And to see that this is the place where I go to school and now, you know, someone’s overdosing. It’s really eye opening to realize that, like, you know, you may think that you’re not affected by this crisis, but, you know, you definitely are in ways that you don’t even know. There were definitely some things I was expecting, but I think it was anything it was about the thing that I wasn’t expecting. So, you know, I never thought I would get calls that are like so close to my school. You don’t think you will get opioid overdoses, but then you get the call and, you know, you see the unconscious patient. It’s super close. You know, it’s in a it’s a suburban area. You know, like I said, it just showed me that that is life. Like, everyone is affected by this. You know, my entire life I’ve been in a pretty well sheltered area. And to see that this is like the other side of life that I just never realized until I got involved with the EMS.

[00:09:38] Narrator Hays and Jackson both got involved with government to help make lasting change so that students could carry naloxone and receive training on how to use it.

[00:09:48] Hays So for our bill, the process with that was, you know, a number of times we’d had just employees of our school districts say we’re not the right place for this, take it to the state or like we will, but we want to make sure that our community is protected first. We reached out to our representative, Representative Barbara McLachlan, and started working on drafting up legislation for what we wanted to say. And what we wanted was basically, essentially every single district in America right now has a de facto ban on students carrying naloxone because they ban all medications, prescription or over-the-counter, unless they have an exemption from the school district. So hypothetically, I could get in trouble for having ibuprofen in my backpack. What we wanted was a state policy to create exemptions for every single non-private school in our state. That said that students must be allowed to carry naloxone and then encourage districts to educate students on the use and distribute it. We applied the same statutory language to fentanyl test strips, although we removed the encourage because encouraging district to distribute fentanyl test strips was something that was seen as controversial by a number of our partners on this bill. We furthermore included language to encourage school bus drivers to carry naloxone, as well as some statutory updates and to bring state statute up to more present terms. There was an incredible process. We had a group of students testify on this issue at the State House and State Senate over Zoom. And in the end, it passed with bipartisan support. I think, in the Senate, in both chambers, it passed with an immense amount of bipartisan support. It was added to the consent agenda in the Senate and I believe had only one individual vote in opposition. You know, the state of Colorado, not many people know this is actually the most partisan legislature, statistically speaking. And to see our bill be able to pass with the nonpartisan support was truly incredible. I think it showed the urgency and necessity of this, as well as the importance of education. We had a number of people who are representatives who originally voiced concern after listening to student testimony, after listening to public health testimony, kind of understand better why we need that. That’s one of the most important things about naloxone is we need more education so people understand that this doesn’t enable drug use and it helps save lives.

[00:11:59] Jackson Working as a page is kind of the highlight of my last kind of school year. It was a really great opportunity to kind of be there and see how legislation works and how it’s passed. As being in Maryland, we have a democratic supermajority and it was fun to kind of see how some people would sometimes cross lines and just how those would lay out in the end. At the same time, I got to meet a lot of the delegates, and when I’m on the floor, they are kind of talking. And then in this different nature, because they see us all the time, they are seeing the pages walk around, getting them coffee, things like that. And then I would have the opportunity to sometimes go up to them afterwards and talk to them about these ideas. And some of them, not some of that, most of them usually would always listen and they’d love to hear from it and get this kind of idea, the more younger generations thoughts on everything. During my second week, I met up with Delegate Joe Vogel, and I had been looking at the General Assembly’s website and I had been looking, every time I would get on it, I’d search for bills that involved naloxone and the opioid crisis in schools. And I realized he had a bill that was trying to expand education through K-12. I gave him my contact information. I told them, Hey, I want to help you fight for this bill. I told him on a day when he was very interested, to say the least. And in the end of it all, I testified before the Ways and Means Committee within and be this huge speech about this student perspective. The delegates were genuinely receptive. It’s just can we have that safety measure in place in order to allow students to, actually, like, how have help if there’s an issue, and especially answering the rise in things being waste, it really didn’t help. But for the most part, the delegates were receptive.

[00:13:56] Narrator With students across the country at risk for accidental opioid overdose, the stakes are higher for drug education. Dr. Kapunan stresses a nuanced safety first approach, rather than telling students to just say no.

[00:14:10] Dr. Patricia Kapunan There’s plenty of evidence that that whole period of that whole approach that was popular a few decades ago didn’t translate to sustainable changes in youth behavior. And like the whole package of just say no and how as a society, as a society, we handled drug use and illegal drug use and what we considered criminal was not equitable and actually caused a lot of harm. So I’m an adolescent physician, and anyone who has a teenager will tell you if you tell somebody to do something, they may just do the opposite. So, like just say no is kind of like I told you, you know, because I said so. And then that’s not a way that builds skill. So I have a colleague who was just talking to Ben Stevenson, who’s head of our Harm Reduction Unit here in Montgomery County, and he always reminds me it’s prevention in Harm Reduction Unit. Dr. K. And his approach to harm prevention, I think is like the real way, which is, you know, just reduce harm by telling kids not to do something, but you give them skills and a way and a purpose to move forward. You know, how do I say no, how do I act safely, how do I make decisions and why would I do all of these things? Right? So the don’t do this approach is like it’s not very useful, even for youngest kids, right? Don’t touch the oven. Like, do this instead. You know, don’t stand up. Put your, you know, put your bottom in your chair. Like we’re constantly telling teenagers what they’re doing wrong and what they shouldn’t be doing. And we could use more focus on what they’re doing right and how do they get to where they’re going and how do they decide what that is in the context of their strengths, interests and values.

[00:16:12] Hays So I think something when we talk about education, what’s important to remember is my generation is the Covid generation. My health was an online class. That we kind of met on Zoom. It was the very beginning of the Covid pandemic and no one really knew what was happening. So my drug education was a couple videos that were probably produced before I was born. You know, our school tried its best during Covid, but there’s only so much that can be done. I think very much in America we still suffer from the ramifications of DARE and Officer McGruff and all of these education systems focused solely on abstinence. And I think, you know, abstinence is a very important tenet of drug education. We cannot deny that. But at the same time, you have 1 in 5 students of the state of Colorado. Well, I’ve tried hard drugs before the time they graduate. You know, it’s based off the Healthy Kids Colorado survey data. All school districts do it right. So we can’t only use abstinence based education. I think that’s something that school districts across the nation are struggling with. It’s very uncomfortable to have to confront the fact that in a class of 30 students, you know, a large portion of them will have tried hard drugs by the time they graduate. That’s an uncomfortable fact. But it’s a truth and it’s a reality that students are living. And, you know, I think a lot of students receive only abstinence based drug education. And the problem is when students then eventually, unfortunately, engage in drug use, engage in substance use, you know, people don’t understand that it’s increases risk to mix alcohol and opioids. They understand, you know, different potential substance interactions or the risk of lacing. And the problem is then these students are unprepared for these hazards. And like I said earlier, this is the scars. You know, this is the ramifications of our society treating drug abuse as something that must be shunned and cannot be talked about. And what we needed is an education system that both teaches abstinence, but also teaches students the resources that are there does not alienate students. It does not teach them as criminals, but shows human compassion and provides realistic education that’s, you know, more useful and more practical for the reality that we live in.

[00:18:16] Narrator As you’ve heard in this episode, students want to be involved in the solution. For solutions to reach them, their voices need to be part of the conversation.

[00:18:25] Dr. Patricia Kapunan I think it’s critical and it’s like central to the work, right? And I think for us, without us, this time in history is really different. I tell it to parents all the time, this is not what you remember from like movies or the 70s or the 80s or even the 90s, which were pretty bad. And the only way for us to understand what teenagers are going through and what they need is to include them in the work. You know, they say, you don’t understand. And they’re actually right. I’m like, you know what? You’re right. I don’t know what you’re going through. I don’t know what it is you care about. And I learned this during Covid. You know, there was not a lot of youth directed public health education during Covid. We rapidly turned around to communicating with kids through telehealth. And sometimes if they were really sick, they would come into our teen center. But finding out what kids knew about Covid and what they cared about and how they were experiencing it, was completely different than like adults who are baking monkey bread and being lonely. Right. The way that you talk to kids about safety during a time where time in life where like they’re averse to being safe and they want to do more exploration. I’m trying to understand what they understood when nobody was talking to them about what was going on. Like, there was no way to help somebody through that without understanding what it was they knew, you know, how do we get them to know what they need to know, how is it impacting them and what are they ready to be able to do? You know, is a 14 year old ready to respond to an overdose and administer naloxone? What are they most worried about it during the pandemic when and maybe this is going too far off topic. When we looked at why, what would compel a young person to get a vaccine or wear a mask? And it wasn’t because I want to protect myself, It was things like because, you know, I my grandma was really sick and I would do anything for my mom or my family or, you know, it’s a peer norm. And it’s like really awkward when I show up and I don’t have my mask. You know, so there are different things and they’re not disingenuous or non generous things that motivate teenagers. There are very heartfelt things that motivate them, but they’re different than what motivates adults. And when adults try to solve problems, they sometimes don’t even know what the right problem is, let alone what the best solutions are. And I’m not saying that it should all come from youth, but they need to be at the table. So, you know, have you come to me all the time saying, I want to, you know, be a leader in this and this is what we should do, and we’re going to present this great white paper and solution to legislator X or leader Y. And what I tell them is just come to the table where we talk about the problems, look at the data and make the decisions because we need your voice in how the sausage is made. But if you’re over here and we’re over here solving problems in silos, it’s like not actually going to be the most effective way to collaboratively approach a complex problem.

[00:21:25] Hays Like students are starting to become more of a part of the conversation. But I still think a lot of it we’re excluded from. I think especially when we’re talking about like how we’re going to make these presentations or how we’re going to make these demonstrations we’re not involved in. But I think nowadays with advocacy becoming a bigger thing for students, I think we actually are. The fact that I had the opportunity to be a part of a student led naloxone demonstration that could be included in the health module, I think that’s a big step in the right direction because students relate more to other students. They don’t like to see some adult telling them what to do. And so if they see other students, I feel like there’s a more of a connection and there’s a higher chance that they’ll actually, like retain the knowledge that we’re trying to get.

[00:22:12] Jackson From my experience, I think adults are understanding about including the unique voice in the issue. I was never not listened to because of my age, thankfully. And if anything, I felt like it was kind of the opposite, where a lot of the adult also want to hear this youth perspective on the issue, and especially when it’s kind of kind of becoming a more issue with how much things are meaning ways and things like that. When you go out there and give them these statistics and things about how much overdoses are rising in schools, the statistics on just the overall overdose statistics within schools and things like that, and then how much things are becoming waste and how big of an issue that is becoming, they realize just how big of an issue this is for youth. And then I have like I said again, I was never not talk to you because of my age. And it’s all in all, I felt like it was quite the opposite where everybody was very eager to hear what I had to say. And with the right evidence, they were definitely very understanding and wanting to help the issue. And there’s an issue affecting everyone.

[00:23:27] Narrator Hays wants to continue his advocacy work as he goes off to college and still thinks there’s a lot of work to be done.

[00:23:35] Hays I would like to see more honesty and compassion. You know, we have a system that is a remnant of a war on drugs, which failed. We have a system that truly isolates individuals at a time when society must embrace them. In terms of more concrete policy, I would like to see naloxone education at every high school in America. I think, you know, at least in many districts, in many states, all students are trained in CPR. I’ve got my CPR certification when I was a ninth grader in high school. And that’s a great skill to have. It’s a lifesaving skill. And usage of naloxone is another lifesaving skill. You know, unfortunately, a high school student is probably more likely to encounter a peer overdosing, a peer with a rare heart disorder who needs CPR. And it’s treating naloxone with other best practice. We know as a fact that abstinence only education for drug use fails. It’s failed the students of the state of Colorado, where one in five of them will have tried hard narcotics by the time they graduate. That statistic is excluding marijuana, which is one of the most prevalent, which is the most drug narcotic used in the state of Colorado. Abstinence only has failed. It’s a regrettable fact, but it is a fact. And what we need to do is continue to educate students on the values and importance of abstinence. While already while also including real life implications. And like I said earlier, you know, carrying naloxone is a daily reminder of the dangers of fentanyl far better than anything we can do. Educating students that make have them have a peace, a reminder, but at the same time, empower them.

[00:25:14] Narrator Hays and Jackson are both heading off to college, but they hope to continue their advocacy work and continue to make change. Sujit is still in high school where he will work to get the locks on training implemented while continuing to volunteer with EMS. Students and young people have seen firsthand the effects of this crisis and they want to be an active part of the solution. Giving them tools like nolaxone and evidence-based drug education are important steps to raising a generation who understand that they have the power to help save a life, are compassionate about opioid dependency and knowledgeable about the risk of overdose. 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.

[00:00:01] Nikole The guilt and shame that comes with the other children not being present and say, you have a newborn. It’s tremendously difficult to watch the women go through. But having someone who could share those same emotions and not be judged like it’s just like the peer support, you know, having someone who’s going through or been through what you’re going through at the current moment just makes you not feel alone. You have, you know, you can share that without being judged. I think judgments, the big piece in this with the stigma of “I can’t believe she got sober for this kid, you know, or didn’t get sober for those children.” It’s hard. It’s really, really hard to say I am alone. I wasn’t the best mom with these previous children, but I’m doing the best I can for this new baby. But I’m still working on reunification with those children.  

[00:00:50] Narrator 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. For pregnant women and mothers who struggle with opioid dependency, caring for themselves and their children can be difficult. Access to compassionate and trauma informed care, basic services and support in their recovery can be difficult to find. Additionally, the guilt and stigma of opioid dependency can prevent them from seeking out and getting treatment for them and their children. Babies who are exposed to opioids in utero have unique needs and need unique support. Thankfully, there are organizations across the country that are helping mothers and children be successful, keeping more families together and setting them up for success. Tara Sundem is the co-founder and executive director of Hushabye Nursery in Phoenix, Arizona. Tara is a neonatal nurse practitioner with over 30 years of experience in the NICU. In 2015, she began to see a rise in babies coming to neonatal intensive care units that had been exposed to opiates. She learned that the hospital environment was not conducive to helping the babies through withdrawal. So she and her co-founder decided to start Hushabye.  

[00:02:36] Tara We opened our doors. We have a 12 bed unit here in Arizona where we can have Mom, baby, daddy stay in one room while baby goes through that acute withdrawal process, all while providing services for mom and dad to get them well. We started a program called the HOPPE program, which is Hushabye’s Opioid Pregnancy Preparation and Empowerment Program (HOPPE).  But essentially what it means is this you teach families what to expect, how to care for their baby. You give them all of this education which leads them to go, “I really am a good mom. I am a good dad.” They’re empowered and they know how to advocate for their little ones so that the little ones get the care that you and I would expect our babies to get. We are working today with 136 pregnant women that are struggling with substance use or have been prescribed medications for opiate use disorder, and our goal is, number one, healthy mom, healthy dad, healthy baby. And as long as it’s safe, keeping moms and babies unified, that is our ultimate goal. And, then looking at those families, helping them make sure that housing, food, transportation, that they have all of those barriers figured out and addressed so that they are able to take their babies home. We’ve served almost 800 babies today.  

[00:04:23] Narrator Babies exposed to opioids in the womb are born with neonatal abstinence syndrome. These babies need unique care which Hushabye provides, alongside help for their mothers.  

[00:04:35] Tara So neonatal abstinence syndrome or neonatal opioid withdrawal syndrome. So it’s NAS or NOWS. NAS means exposed to an opiate and any other substance. NOWS means only exposed to an opiate. But what it is, is it’s a constellation of symptoms that a baby has from or, or exhibits from opiate exposure while pregnant. Baby comes out usually within 24 hours, they start feeling it just like an adult. I had one mom explain to me a withdrawal as being worse than a migraine times 100. And when she said that, I was like that is exactly what we see with babies vomiting, diarrhea, inability to sleep, irritability, fever, sweats, chills. They cry.  They’re inconsolable. And it’s that constellation of symptoms gives them the diagnosis of any type of withdrawal. So our typical stay at Hushabye for a baby is, our goal is mom delivers in the hospital at 24 hours they do some testing that they have to do at the hospital. And then at about 26 to 28 hours, babies transfer to us along with Mom and Dad. We send an ambulance to pick up Mom. And it’s not urgent, but the ambulance picks them up, mom or dad, one can travel with the baby to Hushabye. We can get an Uber or medical transport for the significant other to be able to come and meet family or meet baby at Hushabye also. Baby comes in. Usually the baby that that we see initially is struggling. Having a really hard time screaming, irritable, frantic, can’t figure out how to eat and literally within 30 minutes quiet dark environment. We can shut the lights off and we have 1 to 1 caregivers. Meaning when Mom and Dad come in, they’re anxious from what had happened at the hospital. They’re exhausted. They haven’t showered. They haven’t eaten because they just haven’t been treated great. We’re like, get in the shower, get some clean clothes. Let’s get you some food. We have someone right here that’s going to hold your baby.That’s how we’re different at Hushabye then what the hospital is. The hospital, we just don’t have the hands. My peers do really good work with babies that are this big, or babies with heart issues, breathing issues, babies that are withdrawing need a different environment. And that is nonjudgmental, barrier free, trauma informed environment, which means that we’re looking at the whole entire, family system as the patients, not just the baby, because what we find is if we can de-escalate a mom and dad and we can get their energy being calm. I can put a baby that’s frantic into mommy’s arms, and that little one just melts and it’s like, oh, I’m back inside. This is the best thing. But we literally need to get mom and dad in the doors. Help them just take a few breaths, get them some food, get them a nap, have them meet with their peer support or their therapists to go, you know, that was really hard. I’m here. Thank goodness I’m here. And then we start doing more and more education with family or reinforcing what they learn prenatally. This soothing secrets, which are seven different techniques. You hold them sideline, you do a shush noise, which is mimicking mommy’s heartbeat, making sure that they can suck on a pacifier. We go through all of those things. What we found is this-  if we can get a baby to us within 24 hours, our average length of stay is eight days. Eight days. They’re able to get out of here, and we look to make sure that they are not being brought back into the hospitals, and they aren’t. What we’re able to do is make that baby’s baseline, that entire family’s baseline of calmness or anxiety is low. They’re very, I wouldn’t say they’re relaxed because I think they’re still anxious, but compared to where they are in the neonatal intensive care unit, the reason you see a difference is the environment for some.  

[00:09:29] Narrator Justin Phillips is the CEO and founder of Overdose Lifeline. Along with a wide variety of other programs to fill the gaps in treatment for opioid and substance use disorder. Overdose Lifeline recently opened Heart Rock Justus Family Recovery Center, a recovery home where women and children under the age of two can stay for up to 18 months.  

[00:09:51] Justin So at Heart Rock Justus Family Recovery Center, it’s really about recovery, supportive housing first and foremost. So we take women who are referred to us by the court or a treatment center. You have to have gone through some type of detoxification before you can come to us. We layer that recovery foundation with supports for pregnancy and all the unintended consequences that come with pregnancy and recovery that maybe are unrecognized at first. So, for example, perhaps you had children that you lost due to your substance use disorder. Perhaps you chose to give up your children due to substance use disorder. There’s a lot of trauma, and pregnancy comes with its own complications without adding on the layer of early recovery. So we involve occupational therapy, and we look at perinatal depression, and we really wrap the women around additional supports that are required for good maternal health care, in addition to recovery support.  

[00:11:00] Narrator Tara and Justin both emphasized that women generally, but especially mothers, are an underserved group that faced their own set of challenges. Some of the mothers coming into these programs have little or no experience caring for an infant. Navigating early motherhood alongside an opioid dependency or recovery journey can feel overwhelming and isolating.  

[00:11:21] Tara And so we have the HOPPE program, which provides education to families to ensure that they know how to get their babies through the withdrawal process. How do you help them soothe? Teaching them how to feed. Helping them know how to change a diaper. Which you kind of go, that’s a no brainer. But if you’ve never been taught, you’ve never babysat, you’ve never cared for anyone, you don’t know. Our families are very much those that are stigmatized and judged. And so in the hospital, when you’ve been judged going through labor, you definitely don’t want to ask that same person to go, ‘Can you teach me how to put a diaper on?’ You feel embarrassed, ashamed that you don’t even know that because you already have felt bad, because you have not been treated the greatest. And what we do is make sure that they know what to do. They know the signs and symptoms of withdrawal with their baby. They know what they’re looking for, and they can go into the hospital into that delivery knowing what to expect, knowing what their rights are, knowing what it’s going to look like if they have a C-section, and pain management. That is one program that we have. And then we do triple P parenting, which is an eight week, I think it’s eight weeks, maybe 12 weeks parenting class that I personally wish I would have had. They learn, you know, what are their beliefs and parenting and how they were raised and how to make it that, you know, why do we not spank anymore?  What is that, and why was that acceptable at one time? Why is it not? What does it do in the brain development? But it goes through all of those things.  

[00:13:10] Justin So at Heart Rock, we try to focus on all the elements of recovery and not just abstinence or harm reduction as it relates to drug use, but also good nutrition and how to have good nutrition, good self-care and exercise and and focus on, for example, those modalities that we know are beneficial to include meditation and yoga. And again, the perinatal supports that we provide, and the help through occupational therapy with parenting, there are very few houses like Heart Rock that allow women to come to recovery, supportive housing with their children, that also provide the additional supports that we provide. Because it’s challenging, but women have to choose between their children and their recovery often. And we know that recovery supportive housing is part of the best practice in the continuum of care of long term recovery. Some of the services that we provide and the supports that we provide, are really about the women’s place in the world, potentially alone in this pregnancy. So we provide doula services so the women don’t have to go to their delivery alone, because you often need an advocate in your delivery. And in substance use, we burn a lot of bridges, and we potentially have lost connection to family that would normally serve those roles without substance use disorder. We  provide support when the women have involvement with court, you know, so we go with them to court. We serve as advocates for them in court as well as for the children. When the Department of Children, Child Services involved, we then support advocacy around that as well.  

[00:15:02] Narrator Nikole Young is a director at Heart Rock Justus Family Recovery Center. This issue is particularly important to her as she’s been there herself. Nikole has recently reached five years of sobriety.  

[00:15:15] Nikole So a little bit about my story is that back in 2010, I went to a detox center at a hospital. I was detoxing pretty bad. All the symptoms,  I didn’t feel well. And I had a nurse come to me who had no experience in recovery. Substance use was not her story, nor was she affected by it immediately. Who kind of got the textbook advice for me, you know, asking me those questions,  “well, how does this make you feel?” She didn’t understand the process of what my brain goes through, when I put a substance in my body. So that kind of shut me down, it closes me out with people who don’t know what I go through or understand how my brain works. So I eventually relapsed. I mean, that’s just my story. When I went to a recovery house, in 2019, I had a staff member approach me and introduced me to the 12 steps. She had been what I’d been through. So she had depth and weight that could kind of catch me and say, hey, she’s got what I got. It gave me hope because she had beat this. She had fought hard enough to get where she’s at. She shared how she got there. And it’s that peer support that lets you know you’re not alone, you know, and you see other people and you have this community in this fellowship that have been through what you’ve been through. You know, our stories are a little different, but they’re exactly the same, if that makes sense. It allows you to connect on a level that no other person can connect with you on. And it’s so important just to have people say, “I’ve been there, you know, this is how I overcame that. I’ve been there, I’ve done that.” And that’s what I see a lot in the recovery house. In our house at Heart Rock is a lot of women say, “I don’t have my other kids, and I just delivered this baby, and I have all this guilt and shame that comes with it. And why couldn’t I do this for my other children? But I can do it for this baby.” There’s a lot of women here with that story, and they can offer that support and say, you know, I go through it too. We offer our Making our Moms Stronger group, and we do that to allow the women to learn how to express some of those emotions, while parenting. It is not easy to get sober and learn how to parent again and learn how to parent sober. It is so difficult and hats off to these women. My daughter had to go to foster care so I could get better. So they’re doing some big things, learning how to do this together, but it helps them relieve some of those emotions and speak about it and share their fears and ask the questions they can do with each other and with the child advocate present. So they can get that, yeah, they can bounce off each other. “Does this work for you?” No. “Does that work for you?” No. Or this works for me, “that sounds great.” And then we allow the women the 24 /7 support. If I need a break, I’m exhausted. I don’t have to go use a substance to keep me up. I can go take a nap because staff has my back and they will watch the kids ,if need be. I don’t have daycare today, but I still need to work to provide. We can help you out with that. We have someone here who’s hired directly for babysitting, so she can help out. They just have to put their childcare requests in any other time, you’d have to stay home. You can’t if you don’t have childcare. We help with that. We want them to be successful. We want them to learn how to do this self-sustaining. But in the beginning, you need help. You need that support. And that’s why it’s so important.  

[00:18:39] Narrator Peer support like that which Nikole and other members of the staff at Heart Rock can offer, is critical to these programs success. Tara shares Hushabye’s approach to peer support.  

[00:18:51] Tara Peer supports are probably our magic bullet here at Hushabye.  Having our moms, and we have two moms and a daddy, that have been through the entire program, be able to share their story, and help families understand, you know, “This is where I was at.” I mean, they’ll show pictures, they’ll show videos of their baby withdrawing. They will go through those times that they were still really struggling and very, very vulnerable, and being able to see what that does for someone that is struggling, it’s something that I can’t do. I have, you know, done very well in being able to help make an impact or a dent in many families’ lives with the opioid crisis. But my peer supports those with the lived experience. You just see families respond and cling on to them and they’re like, okay, you did it- how do I do it? We have one peer support that, she, over the years, tried to get well so many times. And with us she came to us five times. I think it was five times. We sent her to four different recovery centers. The fifth one was the first one she went to that she said it was awful and she ended up staying for a year, graduated from the program and doing great. But five times, five times she came back to her peer support and said, you know, this is why I didn’t do it, whatever. But she trusted her peer support. And every time she came back. Now, did she come back like that day and say, I left? No. But she came back in a couple weeks and said, “Okay, I really need help.” And every time the peer support and she was just like, okay, well let’s try this. And so peer supports, those with lived experiences, even those if you think of,  not even in the recovery community. When I was raising my kids, of course, I latched on to friends that had kids because you could sit there and chit chat about, “Oh, you’re doing this,” “My kids doing this,” ” How did you get over that?” “I got over this way.” You’re supporting each other. And that is what those with lived experiences are doing, their lived experiences, our experiences with raising kids and parenting while struggling or going through their recovery journey. It’s really the same thing,  just a little bit different. But it is the same thing. We need community and what we find and those that struggle with opiate use disorder or substance use disorder, any type of addiction, you isolate. And that is the thing that is just a deterrent to you being able to be successful in recovery. And I believe that the Hushabye program and our peer supports are able to build up that trust little by little. I always say get the families, get a little W, a little win and you get 3 or 4 little Ws, it’s that all of a sudden you have that big capitalized, capital W that big win and that big win, maybe we, you know, got you into detox or we send baby home with you or your DCFs case is closed. Nothing better than getting on one of our groups. We hold about 50, 50 to 60 groups a month, depending on the month. But getting in a group  and just doing that celebration in the first five minutes of my case is closed. Here’s my letter. And, you know, and they’re holding it up virtually or they have it with us, with them and they’re showing us, does this really say that it’s close? And it’s like,  “It does. You did all of this work.” 

[00:23:05] Narrator Many of the women who use services like Hushabye Nursery or Heart Rock face barriers to care and access.  

[00:23:11] Tara Yeah, the barriers that families encounter are enormous and they’re continuous. It can be anywhere from transportation. How do you get to the hospital having no phone? You know, insurance companies will say, well, we provide them with phones. Okay, but do you provide them with electricity to charge their phone? Do you provide them with the ability to go pick up the phone? Our insurance companies or Medicaid will pay for transportation to and from behavioral or medical appointments. But what’s interesting is our families, after they have their baby and the mom is discharged, baby is still in the hospital. Insurance will not pay for that mom to go visit that baby because the baby’s the client. It’s not the mom going to the hospital to get treatment. And so, many of our families get dinged by the hospital, by child welfare, saying “you didn’t visit your baby.” Okay, but they don’t have a car. They don’t have transportation, they don’t have electricity to charge their phone to be able to call, to get a ride. They don’t have jobs. All of those things. Stigma is a huge barrier to care. If you go somewhere and you don’t get treated well, why would you go back? And so I used to, when I was in the hospital, I didn’t understand opiate use disorder or substance use disorder and  I can’t say I totally understand. I learn every single day, but when I really didn’t get it, I would be like “this mom only got one prenatal visit,” and now I know when I’ve talked to families, I’m like, what was the barrier to getting you to your visits? And they’re like, ” they were so not nice to me. I do want to go back.” And I’m like, so they went to one appointment, but they didn’t go back because who would want to go back and get treated poorly? Many of my families don’t understand that they have that option to switch providers, to switch hospitals. They just have no clue that it’s an option. And so Hushabyes able to help them, or direct them to certain providers or hospitals that have been noted to be very trauma informed and treated other families well. So we have a mommy and daddy recommended provider list. Mommy and daddy recommended hospitals. Depends day, time, what staff is on, how they’re going to get treated. But there are definitely ones that are, more compassionate and meet these families where they’re at.  

[00:26:17] Narrator Nikole has experienced some of these barriers firsthand. Her daughter was not allowed to stay with her at the recovery house where she was detoxing.  

[00:26:26] Nikole So when I went to detox, my daughter stayed back with her dad, who was currently in active addiction. She came for a visit with me, and she hadn’t eaten. There was no food in the house. There was no clothes in the house to start school the following day. So I ended up keeping her with me at the recovery house. They didn’t allow children, so she had to go to foster care. She stayed in foster care for a year. But the difference I see from that to what’s happening here is I transitioned from not being a full time mom to being a full time mom. So that was a huge transition. It was very difficult. Just to take all those responsibilities on at once. At Heart Rock, they allow you to have those responsibilities and work with someone to have support, to be able to do those things. Thank God I had a foundation to be able to do so, because it’s a hard transition. But I did get to reunify with my children. Some of the women here at Heart Rock, recently we had a woman come in, she was on supervised visitations with her son. Recently, her case was just closed, and our son lives with us. Another success story, same mom, four year old child was in the termination parental rights status. She’s went to work. She’s dug in. You know, she’s had some challenges along the way, but she didn’t give up. She has now been reversed to reunification with her daughter. So those are huge stories that you don’t hear a lot of because you can’t do it alone. I mean, it’s been proven. The 12 steps are evidence based.  

[00:28:05] Narrator There is still a lot of stigma mothers with a history of opioid misuse face and seeking care.  

[00:28:11] Nikole The stigma in health care is still very much real. Very much real. I recently had a resident who delivered and self disclosed when she got there and was red flagged. Immediately social work came in and she had over a year of recovery. So it is there. And you know, she was kind of treated differently. But here’s the odd thing. She was prescribed narcotics. And she had asked them not to prescribe anymore. She did have a C-section so some of it was warranted. But when she had asked them to not prescribe her anymore, they were reluctant to stop the medication. So it’s kind of a double edged sword there.  

[00:28:53] Justin There is plenty of stigma as it relates to being a woman with substance use disorder and being a mother, and especially being pregnant, because some of these women have only found recovery into their pregnancy. So perhaps they did use substances during their pregnancy, and/or they have previous instances of losing children to the Department of Child Services. So they’re flagged in that way within the healthcare system especially. So we work really hard, which is one of the reasons why we provide an advocate during those appointments and during those. Birth deliveries, because there’s a very large amount of stigma around someone who uses substances in 2024.  

[00:29:39] Tara Do I feel that stigma is ongoing? I do. I think we’re getting better. I think at times you go, “Oh my gosh, this all went good. It’s working.” But do our families hit barriers over and over and over again? I have families that are not going to tell their kindergarten teacher that their baby was substance exposed. Even if it might help their little one. They know the implications of this teacher knowing that they struggled with substance use. That is just a ding and it’s just not going to be good. And so is it later on in life that they’re stigmatized? Yes. Medications for opiate use disorder are very stigmatized, even stigmatized in those that struggle with opioid use disorder, you see those individuals not being a support. But health care workers. Community members. We just don’t understand. And at times that I find that I’m like, “Oh I just said that.  That didn’t come out right.” Or I said that and I didn’t know that it was me being judgy. And then when my families say, when you said that this made me feel this way, I’m like, I had no idea. Now, do they feel comfortable with me? They do, because they know that I’m like, I am learning and I need you to tell me if I say something wrong. And if there’s something that makes you go, “I don’t want to come back,” I need to know, because otherwise that’s a barrier that we will never, ever overcome. And they’re really good at going, “when you said this, this is how it made me feel.” But how do you build that trust? You build that trust by meeting where they’re at. And our community is not meeting those that struggle,  where they’re at, always.  

[00:31:55] Narrator: Once mothers and families leave these facilities hushabye and Heart Rock, along with their community partners, set them up for continued success.  

[00:32:03] Tara Yeah, our community partners that we use are full range from housing, food, transportation, to employment. Helping someone, get their diploma. Helping them write a resumé. We’ve helped someone get a tire fixed because they just couldn’t get to their job. They didn’t have extra funding to be able to do that. We’ve helped get windows fixed in their house, because the Department of Child Safety said that it wasn’t safe unless the window was fixed using different community partners. Helping them fill out a one page application to get that $100 to be able to fix something, that it’s such a big barrier, that to me it would be here’s $100, fix it, get it done. To our families, they can’t, they don’t have the hundred dollars to fix it. Which means unfortunately, if they didn’t have Hushabye that baby would go to foster care because the window wasn’t fixed, and we’re able to do that. I would say on average when we meet a mom or dad, on average, the very first meeting, there’s 3 to 5 referrals to community partners, food, you know, you need rental assistance, you need electrical assistance, whatever that looks like. We partner with different food banks to make sure that our families have food while they’re here. We partner with the diaper bank to ensure that we have enough diapers on site for families and for the babies. We definitely have a niche, and we don’t need to overstep. We need to just stay and do what we do really well and use community partners for what they do so so well.  

[00:34:10] Narrator Tara, Justin and Nikole all stressed that there is a lot of work that still needs to be done. Hushabye Nursery and Heart Rock Justus Family Recovery Center are among a small group of facilities that exist that keep families struggling with opioid dependency and babies together. Many women are still afraid of being stigmatized or mistreated by health care providers and face barriers to treatment. There needs to be more education for health care providers, families and the general public about the needs of mothers, babies and their support systems who have been affected by the opioid crisis. 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 emergent biosolutions.com. If this episode resonated with you, consider writing and reviewing countermeasures on your preferred podcast platform.  

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.

Judith At the same time, though, my two sons around here, it became really big for kids to use OxyContin recreationally. And we had a young generation of a lot of people who got very addicted. And unfortunately, my son Roger, who was 18 at the time, and my son Corey, who was 15 at the time, both started a long life of addiction at that point. It’s still a battle for them, like they went from OxyContin. And then once you couldn’t find that anymore, it went to heroin. Now you can’t find heroin anymore, it’s fentanyl. And I said, like fentanyl makes heroin look like a cakewalk at this point. The amount of loss and deaths that we have due to fentanyl are just 100 times more than what they were with heroin. So on that personal note, I mean, I pretty much have lost my one son is living in the coast homeless, but my other son is living in the Bay Area and he’s living homeless. And I worry about him all the time. And I’m just work every day talking to him, trying to get him into treatment, you know. But the fentanyl is so hard for people to come off of that he doesn’t believe he can do it.

[00:01:29] Narrator 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. Native American and tribal communities have been some of the hardest hit by the opioid crisis. Historical trauma continues to have lasting effects in these communities. In today’s episode, we will uncover how the opioid crisis has affected Native American communities, but also the programs that are helping people reconnect with their culture and community to help combat this crisis.

[00:02:23] Nathan Billy But when we look at the impact of the opioid epidemic in our tribal communities, especially one piece that is an important piece of that impact, but it’s only one piece, and that’s the available data that we have. So, for example, when you see reports or read reports specifically from the Centers for Disease Control and Prevention or the CDC, you will often see that American Indians and Alaska Natives report some of the highest rates, if not the highest rates of impact from opioids, including opioid overdose in general, opioid overdose related deaths. Recently, especially in our communitiesm that’s been the impact of fentanyl. And that may be a combination of either intentional fentanyl seeking, or it could also be substances and frequently is substances that contain fentanyl or that are compromised with fentanyl. And the person who is using that substance is just unaware that a lethal dose of fentanyl is within that substance. And so we can see through those reports, oftentimes those high rates that are reported that stretch back a decade, and that can be very daunting. But what I think is important to note is so much of that deficit based reporting is just not contextualized. So you might see all of the charts and the graphs, and they’re helpful in one sense, but it’s all too easy. I think at this point to get what I would think of a statistical fatigue. So we sort of have, you know, how many times can you be inundated with charts and graphs when the impact of what is actually happening in our tribal communities, we lose that personal focus, the sense that these are our relatives, you know, behind all of those data points, behind those numbers and behind those those charts and graphs. Why have we reported the highest rates? Why do we see the highest rates in our communities? There are very specific reasons for that. And sometimes those reasons there’s either for lack of time or lack of space on the report. It’s just not really fleshed out. And it’s important that we be able to do that.

[00:04:15] Narrator Nathan Billy is a member of the Choctaw Nation of Oklahoma and is the director of Behavioral Health programs at the National Indian Health Board, or NIHB based in Washington, D.C.. His family members went through the boarding school system that many Native Americans were forced to endure beginning in the early 19th century. The goal of these schools was to assimilate Native American children by forcing them to speak English and keeping them away from their families, culture and religion.

[00:04:44] Nathan Billy I think it’s really important. It’s impossible, really, to separate the opioid epidemic and its impact on tribal communities from the foundations in historical trauma and the historical trauma in our American Indian Alaska Native communities. It’s very specific. It’s very unique to us. And when we look back and see that that historical trauma that stems from colonialism, aggressive imperialism, takeover of land, where we see land dispossession, forced relocation, we have a history, for example, of federal Indian boarding school policies where the federal government, in collaboration with religious institutions, sought to create and did create entire systems of programmatic effort to assimilate us, to erase our identities, to really destroy us. And I think it’s interesting that when we look at something like the opioid epidemic or what is the way out, how do we heal from this? A lot of times we hear about we’ll be strong and be resilient and there’s self-care. And, you know, I think a good response to that is how in the world do you self-care your way out of a system that was designed to erase you? That’s a burden that no one should have to bear, but it is a burden that we are asked to bear repeatedly. Work on yourself. Show yourself. Help yourself, you know, pull yourself up by your bootstraps. And that mentality, that rugged American individualism, that Western mentality is easy to say when you haven’t been forcibly relocated, when you haven’t had your land taken, when you haven’t had your children stolen from you and placed into an educational system that will not allow them to be native. And as we have seen very tragically with some of the recent reporting and ongoing reporting, as we investigate boarding school experiences, many of our children were never returned. They did not survive. They died. And that’s harsh to say that, it’s harsh to say that word, but how do you soften that? You know, this is a part where I think euphemisms are not necessary. Euphemisms don’t work. We need to to be able to safely and carefully say that together, that these are experiences of trauma that are well-established. My own grandfather, Albert, was a boarding school survivor, and he was sent to boarding school in Oklahoma where he was not allowed to speak Choctaw. He was not allowed to dress traditionally. The entire goal was for him to assimilate, for him to learn Western ways, for him to learn, to be able to dress a specific way, speak English, and ignore everything about his identity that was native.

[00:07:21] Narrator Charlene Bingham is a social worker from the Oneida Nation just outside of London, Ontario, Canada. Canada has a similar system of boarding schools called residential schools, where children often experienced abuse at the hands of the school leaders. The last residential school in Canada closed in 1996.

[00:07:41] Charlene Bingham Where I came from, because my mother was in residential school, I was in day school and so was my brothers. So residential school impacted our family by, one of them was the drinking. My mom, in order to forget to drink because the pain she saw and felt the drinking helped her forget that moment. She told me one time that she saw a little boy about seven years old, jumped from a two storey building because he couldn’t take it. When she was in there, she had to scrub the floors. She had to clean. For their meals, they had to eat maggots. Sometimes not even eat sometimes if they if they were being disciplined. It was a real hard thing for my mom to overcome.

[00:08:41] Narrator Generational trauma and mistrust in the medical system are some of the effects that this history has on communities. Nickolaus Lewis is a council member from Lummi Nation in Washington State. He is also the vice chair of the NIHB, the vice chair on tribunal self-governance, the recording secretary of the National Congress of American Indians and the chairman of the Northwest Portland area. He, like many others, believes that this history and the present are inextricably intertwined.

[00:09:11] Nickolaus Lewis You look at the whole history of this country, everything that this country has was on the backs, our ancestors and our tribe tribes across the country have tribute, they have agreements with federal government. And those are often broken still today. And when you look at our health care system, which is a treaty right. And you see how it’s chronically underfunded, helps fuel that distrust. Can you say that this is important, but then you don’t honor your commitments. But what we’ve seen is a lot of that distrust in using our people for studies, guinea pigs and things like that. Go back to the trauma when the government gave up blankets and smallpox and things like those. A lot of those things still a trickle down. You look at the boarding schools that and where our people were ripped away from their communities and beaten for speaking their language. There’s always been a level of distrust and we have to work harder at that and make sure that when we’re delivering our our health care, it is by us first and foremost. And that’s why I think it’s worked really is that culture on trying to let people know that we’re not here to cause harm or we’re trying to do the right thing. I hope by doing that over time, it’ll change the data that we see.

[00:10:38] Narrator Judith, whose voice you heard at the top of the episode, has firsthand experience with the devastating effects that the opioid epidemic and subsequent introduction of fentanyl has had on Native communities and families.

[00:10:51] Judith My husband had been a really hard working logger his whole life. He was a Yurok tribal member from the next reservation, and he had been a very hard working logger on the ground, driving three hours a day to work and back in, and he got an accident on the job and so he hurt his back and torso muscles in his back. And I remember at the time the doctors coming in because he couldn’t hardly walk and go to work. And they said, we have this new drug and it’s going to really help you. It’s long lasting and it’s not going to be addictive. And honestly, that was the beginning of the end. My husband, like most native people here, had had a lot of trauma in his life. He had grown up with a lot of trauma. What they started is maybe 120 milligram OxyContin went to 40 to 60 to 80 to 240 a day. And it just was a fast upward spiral of addiction. He was very discreet and I didn’t even know that. And then all of a sudden, you know, there was this harsh stop on the medication and all of a sudden people started realizing that these are drugs are addicting and they’re bad and they’re hurting people. So people weren’t weaned down. They were just cut off like, nope, you can’t have it anymore. And so they’re a large group of people, including my husband, went on to find other things. They were never going to handle that come down and not the cold turkey, I guess. There wasn’t much information or knowledge about (MAT) medication assisted treatment. So he quickly then at that point went on to heroin. And I actually did not know that for years until he got to more the end of his life. He handled it well and just very functioning. And that’s what a lot of people don’t understand, that people can be addicted but be very functioning. He helped take care of our grandkids. He was just like, you would never notice anything different. And then a few years ago, my oldest granddaughter, who me and my husband had raised a lot in along co-parenting with her mother, she started having a fentanyl issue, and she overdosed several times. We started looking for treatment for her. And for native kids to get into treatment, I mean, I don’t know about other kids, but here getting a child into treatment that young was almost impossible. It took like five months to find somewhere that would take her and she had to go five states away. And it was very traumatic. And we were cut off of her all of a sudden for months. And I’m happy to say that she is home now. She is in recovery. She’s clean. She’s happy. She’s now a thriving 15 year old. And so I’m grateful that she made it out of this mess at this point. And that’s just the personal people. That doesn’t count the money, the possessions, the you know, pretty much when you have people who are this into addiction, you’d basically lose everything and you lose people because people turn away from you also. You know, Judith must like it. She stays. Judith must like it. She doesn’t keep her kids out. Judith must, you know, there’s no support for the families. And that’s what I’m trying to build into my program that I run is support for families who are struggling with family members and addiction.

[00:15:00] Narrator Judith works at the K’ima:w Tribal Health Clinic and is also a writer. She has published a book called Reservation High that is informed by her experiences.

[00:15:10] Judith I didn’t really know where I was going with it, but I knew I wanted it to be from the person’s perspective who was struggling with addiction. I had a lot of friends who basically kind of turned away from me and would say things like, Well, I wish I was an addict so I didn’t have to work or be responsible or I wish I could take that easy way out. And I just thought, if you think that’s the easy way out, then you don’t know what you’re talking about because it’s the hardest life, right know. So I wanted to give people, I wanted them to like this character so that they could feel empathy. I wanted empathy. I wanted people to realize that nobody wants this. Nobody chooses this. And so that was my goal, to make these characters that people really would like, but then have her struggling. And a lot of people have gotten on to me because in there I do have a relapse. And they were like, How could you do that? That relapse is real. Let’s face it, people relapse. And so it is part of, you know, recovery. It happens. And all we can do is get up and move on forward. And so I wanted to show that that could be done and that it does happen to people. And it’s not some big mark against you because it happened. So while I was writing the book, I got about halfway through and my son Roger, who was struggling, and his significant other, Ethel, I had gotten to a writer’s block and basically I got about halfway through and I just didn’t know where I was going with it. And I was really frustrated. It had been sitting for like a month. I didn’t know how I was going to get it moved on where I was going, so I had set it aside and on March 21st I got the worst phone call of my life and it was that my son had been shot in the head, in the chest, along with two other men. And so we ran up to the scene. It’s about five miles from my house, and I pull up and nobody’s there. I just see my car he had used in a little trailer, little tiny travel trailer. And so I’m thinking maybe it’s a mistake, you know. And I run in and my son had was laying there with another man shot and we had to wait hour and 40 minutes for any kind of help. There was no ambulance. Everybody was staging. They were waiting for help to come from Eureka. I’m calling 911 every second, freaking out. In the end, my son was flown out to Redding and so we got in the car and we drove three hours to Redding and I took everything with me that I thought I would need. But the one thing I grabbed was my computer. Like, I wasn’t in my right mind. I grabbed clothes that didn’t even make sense together and stuff that, summer stuff, you know, just stuff that didn’t make sense. But the one thing I grabbed was my computer. And while we were at the hospital for the next week, I just kept working on the book because I felt like if I relaxed or slept or anything, that something was going to happen to my son. So I just didn’t sleep. And I stayed up and I kept working on the book and it just kind of took a life of its own. And so finally, my son is fine now. He did not have any debilitating things. You know, it was a hard trauma, wise and healing wise. It was a long couple months, but I just sulked myself into the book. And one month after he was shot, I had taken my mom to a doctor appointment in San Francisco. And while I was there, I got the next worst call of my life, and that was that. My only daughter and my youngest, my baby of my family had been stabbed three times by a DV incident. And at that point, I truly lost it. Like I cried for 18 hours straight trying to drive home from San Francisco. And I’m happy to say she, too, is all right. She didn’t die in that sense. But at that point I thought, I am going to finish this book if it’s the last thing I do. That just became my mission. That was April 28th, and I finished the book on June 25th. So whether I ever did anything with the book, I feel like it saved my life at a time when I needed something to sink myself into. So that’s what the book means to me. And I have had a few people read it and say that they went to recovery after they read it. They felt like it was something they could do. And they did go and they did stay. And so, you know, whether it was only one person in the world, I feel like it did its job at that point.

[00:20:27] Narrator All of the interviewees emphasized the importance of culturally centered treatment to combat the opioid crisis and help those seeking recovery.

[00:20:36] Nickolaus Lewis One of the things that we really do strive to do the best that we can, is making sure that our services go up to them, go out to the community. I think when you look in Western lens, we say come to the providers. In our lens and it goes back to the cultural component. We will take our services to the people. One example, we have a crisis outreach team that consists of people in our behavioral health department, that consists of people in our MAT program, but they will go up into, for example, homeless encampments where people are struggling and bring them medication or feed and just talk to them, let them know that they matter. We’re trying to encourage them to come into services where we’re putting that extra step in there and trying to get people connected. And I think that’s something that we have to do a lot more of is meeting people where they are seeing the struggles. When you’re you’re trying to talk to people that are struggling with addiction, you have to earn a lot of trust because they’ve had their doors shut from everybody in their life. And it’s a feeling of hopelessness is what it really feels like at times. And remembering that the root cause of this is trauma. And so having somebody come there that’s genuine with the best intentions. It takes time, but it really makes the most of the difference.

[00:22:11] Charlene Bingham My grandmother taught me some things to remember. She told me I’m an Indian first. She taught me my foundation, where I come from, who I am. And don’t forget it. So they use the medicines a lot in treatment. They bring in elders. Elders talk to them from their experience because they went through all the residential school peers and drinking, drugging and whatnot. So they walk with that person to get to a good place.

[00:22:51] Judith I noticed that when we got funding and we could actually start putting cultural classes, cultural identity stuff into our program, our success and the interest went way up. And so right now we’re working to bring up Hupa Language, and they are going to start working at the first of the year. But we do things like have cultural classes of basket weaving and carving for the men, beading, jewelry making. We’re going to do a mink hair tie, so if we can bring in the classes. And then we also, like, have people who do sweats and they go to different ceremonial things, but it builds in a resiliency. I think it’s right now the best gauge we have to keeping people from relapsing or to coming right back to it. In Hoopa, we weren’t like discovered, as they say, until the later 1850s, 1860. So we were here and didn’t have contact with non-Indians for a long time and a lot later than other tribes. So we have a lot of culture. But when people start becoming struggling with addiction, a lot of times they turn away from their culture. So we know that if we can bring them back and connect them, their success rates of staying abstinent goes way up.

[00:24:31] Nathan Billy We know in tribal communities that our culture is our strength. Just for example, in May of 2023, when we had our National Tribal Health Conference in Anchorage, Alaska, at the National Indian Health Board, our theme was culture heals, culture knows, culture leads. And that wasn’t chosen just because that has a beautiful ring to it, that all of that is absolutely true. Our culture is our strength. It is the path of healing. It is the center of our knowledge. It is the way to lead forward through healing. And I think what’s really important, we talk so much about risk factors. You know, what are the risk factors that we have in terms of opioid use that deficit based understanding of ourselves. But there are protective factors in our culture. There are protective factors of strength. There is so much to celebrate in that attempt to what was attempted to be taken away from us in some of these policies. There’s so much there that when we are allowed to or when we are encouraged or equipped to reclaim that, to revitalize that, to focus on that, that becomes our protection and that becomes a positive experience in the work that we do, for example, in HIV with adverse childhood experiences. One of the things we want to make clear is while it is so important, yes, absolutely, to talk about adversity and what those adverse experiences are. What about the protective experiences? What about the positive experiences that we can really encourage and what is positive within our tribes that keep us safe and that keep us healthy? That is what we need. And that is that is the the root of that healing. I think it’s important, since we talked about some of those experiences earlier, the federal Indian boarding school. My own tribe now operates a boarding school. But far from the boarding school of the past, which was externally operated with attempts to erase identity. We’re talking about identity, encouragement, cultural encouragement, where the school is purposefully engaging in youth stickball leagues. So for culturally specific stickball as a prevention effort to create that connection with youth so they can be a part of something that is culturally relevant to them, that is specific to our background and gives us that sense of reconnection with our communities. So what happened to us should never be confused with who we are. That is not our identity. That is something external that happened to us. It is not who we are. And yes, what has happened to us has resulted in some very real deficits. It has resulted in very real health disparities. It has resulted in some very specific concerns and issues and problems that we are having within this opioid epidemic. But the way through is that reconnection and that protection. So we talk about intergenerational trauma. Yes, there is intergenerational trauma, but there’s also intergenerational strength and intergenerational knowledge and brilliance. There are native ways of knowing that are the foundation for the help and the foundation for the healing. And so that’s where we see that that cultural reconnection being that way through that is the path for us.

[00:27:39] Narrator The NIHB is the voice of tribal communities at the national level. Currently, a priority is advocating to have the fentanyl crisis declared a national emergency.

[00:27:50] Nickolaus Lewis Coming out of the national trouble yet some that we had this past year, we did finalize a lot of our reports, our recommendations. There is some legislation that’s coming out from that. It’s not all health care. But I think when we talk about this in a crisis, we have to understand that it’s not just health care. We can’t treat our way out of this. You have to look at housing and look at jurisdiction, community safety, health care. It really touches on everything. And one of the best things that the federal government can do, and this is something we’re here working on, is highlighting these recommendations. These are things that we need. These are improvements I’m going to be working on advocating to have a national no opioid crisis in the country. I’m going to be meeting with the White House to talk about things like that. And those things, I think when we do those kind of things, it doesn’t just benefit tribal members, it benefits everybody. And I think that’s the beauty of our leadership that we have in Indian country is that when we’re doing this work, this benefits everybody. That would be a short answer. Is having the federal government really take the time to read our recommendations but themselves in our place? One thing I often asked people is how many funerals  have you gone to this past year? And I really ask him to think about that. Because in our communities, it’s not uncommon to go to the funeral a week. And when you are seeing somebody that you grew up with, somebody that was a family member or close friend died from something like an overdose at a young age, that causes trauma, that is unfortunately normalizing what our people are experiencing. And that’s not who we are. We shouldn’t be going to more funerals than we do birthday parties. That’s our reality today and we’re working hard to change that or being that voice knocking on every door we can to talk to them and make sure that they hear us. It feel like what we’re doing, we’re really uniting Indian country, was the common voice on saying this is an emergency. You know, when you look at the data, our people are dying three times the rate of anybody else especially in our area. We’re going to funerals far more often than birthday parties. But even uniting Indian country in uniting everybody that has a story of grief here, it’s not going to be enough to get this country to shift. What we’re talking about is working with our governors for the states and getting them to also call us. We’re trying to unite people. It doesn’t matter if you’re Republican or Democrat or religious belief, this doesn’t know the color of your skin. Once it gets a hold of you, it’s going to devastate all of us. And what we’ve seen is working with everybody to try to amplify this in a work was our county council. They’re getting ready to declare emergency, not crisis. And also call in President Biden to declare a working with our governor who’s funded to tribal state summits now in Washington state, working with them, trying to get President Biden. So I’m just encouraged to try to reach out to others as well. Is this, this is for all of us, this word. And we can’t do it alone.

[00:31:39] Narrator Native American peoples and tribes are not a monolith, and each have their own unique culture, history and priorities. However, culturally centered care grounded in community, traditional healing and understanding are vital parts of reconciling with the past and finding a way forward. If you’d like to read Judith’s book or a recent piece in The New York Times or learn more about the NIHB in their recent report, please visit the links in the show notes. Thank you to all of today’s guests for sharing their stories and insights. 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.

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.