December 1, 2025 • 39 mins
In this episode we have a conversation with Dr. Clement Chen and Caitlin O’Neill about substance use, medications for addiction treatment, and the power of person-centered care. Together, they explore the continuum of substance use, the rise of fentanyl and polysubstance use, the role of harm reduction centers, and the importance of trust, dignity, and connection in supporting people who use drugs. This conversation highlights how empathy, evidence-based treatment, and collaborative approaches can save lives and improve health outcomes across communities.
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(00:00):
Welcome to all teach.
All Learn (00:02):
Beyond the ECHO.
Examining public health challengesthrough an interdisciplinary lens.
Amplifying diverse voices, encouragingcritical thinking,
and promoting collaborative civic actionacross the health care system.
This season is powered by the Eagleton
Institute of Politicsas part of Democracy Week 2025.
Each episode will pair professionalsfrom different disciplines to model
(00:22):
how cooperation can improveoutcomes and equity in care.
I'll be your host, Sean Cuddihy,before we get started.
The theme of our first seasonis Productive Policy.
We'll be focusing on policy that promotespositive health outcomes and helps
providers to do their jobsto the best of their ability.
For our second episode,we are diving into the topic of substance
use medications for addiction treatmentand approaching these topics with empathy.
(00:47):
Today we are joined by DoctorClement Chen and Caitlin O'Neill.
Doctor Clement Chen is the academicdetailer and clinical pharmacist
specialist at the Northern New JerseyMedication Assisted Treatment Center
of Excellence, which is based at RutgersNew Jersey Medical School.
In his role, Clement provides consultativesupport to health care professionals
by offering mentoring, educationand technical assistance.
(01:09):
Caitlin O'Neill is a communitydrug testing
technician at the new Jersey HarmReduction Coalition.
They are a survivor, healer,and harm reduction advocate.
They became involved in harmreduction in the 2000
through a local syringe service program.
As a co-founder of the new Jersey HarmReduction Coalition, Caitlin is dedicated
to creating a world where individualswho use drugs have access to resources
(01:29):
for healing and self-determined care,regardless of their background or choices.
Both of our guestsserve as series leaders on our Matty Sud
Echo series,which will be returning this January.
In 2026. Thank you both for joining.
you could quickly
just describe what is substance useand what's your relationship to the topic?
thank you very much, Sean,for this opportunity to speak today.
(01:52):
And thank you, Caitlin, for joining me.
My name is ClementChen, as Sean had stated,
and I'm a clinical pharmacistwithin the Northern New Jersey Med
Center of Excellence.
I think it's important to distinguishsubstance use and substance use disorder.
I think of substance use on a continuum,like on an umbrella term.
And thinking about it
this way helps us to understandwhere substance use disorder lands.
(02:15):
Right.
This continuum at the ends includesno use at one end
and then substance use disorderat the other end.
And a substance use disorder is reallya chronic recurring disease that involves
the reward, motivation, and decisionmaking circuitry of the brain.
But what distinguishes it as a disorderis that it is characterized
(02:38):
by compulsive drug seekingand use despite harmful consequences.
Unfortunately,having a substance use disorder
today leads to a much greaterrisk of overdose deaths.
Many people who first became dependenton opioids
through legitimate prescriptionsturned to illicit sources when access
became restricted due to the regulationson the prescribing of opioids.
(03:01):
And from that 17,000or so people were dying
from prescriptionopioid overdoses in the early 20 tens.
During the next couple of years,a cheaper form, which we know as heroin
was formulated, leadingto a further, surge in overdose deaths.
And now today, most of the illicit opioidsupply contains highly potent
synthetic opioids, specifically fentanyl,which we know is 50 times
(03:25):
stronger than heroin.
And dependingon the type of fentanyl as well,
because there are other analogsof that base fentanyl molecule.
And really fentanyl was involved in over70% of all opioid
involved overdose deathsduring the Covid pandemic.
And today, we are now in an age of poly
substance use, where overdoses todayinvolve fentanyl.
(03:47):
But people are also using,drug supplies that may contain stimulants
like methamphetaminesor cocaine or sedatives like psilocybin
and meta targeting, which brings with thema whole set of different challenges
when it comes to treatmentand other strategies to reduce harm.
when I think of folks with substanceuse disorder and our role as healers
(04:08):
providers, it's about an approachthat expands access to evidence
based treatment
like medications for opioid use disorder,for people who use opioids,
supporting harm reduction strategiessuch as distributing naloxone,
and other strategies such as, distributionof clean syringes, which is legal
in new Jersey, via authorized harmreduction programs and very importantly,
(04:31):
addressing the social needsand the associated structural issues
that lead someone to use drugs,we call the social determinants of health.
one of the things I love about any timeClement and I work together on anything,
we have the amazing technical perspectiveand clinical perspective.
And I can bring sort of a first person,
(04:53):
or like street level perspectiveand it works really well together.
And so my, really most of my knowledge
and experience with drugsis as a person who uses drugs.
I have been a person who uses drugs
in some form or anothersince I was about 14 years old.
it was not initially substanceuse disorder.
Right?
(05:13):
We have things like experimental drug use,social drug use.
what I later found out was drug use.
That was, like a self-medication attemptto heal trauma from earlier in life
and trauma that intensified
as my substanceuse developed into substance use disorder.
we know that not everyone that usessubstances is going to develop
(05:34):
a substance use disorder.
there was a study from new Jersey policyperspective a few years back that said
that, 80, 84 or so percent of new Jerseyresidents, said
yes to having used a criminalized drugstronger than marijuana.
And only about 16% of those
84 identified having been diagnosedwith a substance use disorder
(05:55):
or identified themselvesas someone with a substance use disorder.
when we talk about substance use disorder,
as Clement said, it is very muchthe sort of end of the continuum.
Right.
And there are a lot of factors in that as,Clement spoke about,
it can be physiological factorsin the way the drug is affecting someone
lot of those effects are due to thecriminalization and the war on drugs,
(06:19):
which really becomes a war on peoplewho use drugs.
my perspective isI have that personal perspective
and as well as,some time being in recovery, sometimes
being an abstinence based recovery,I still consider myself in recovery
even though my recoveryis no longer abstinence based.
And I also work, at new Jersey HarmReduction Coalition,
(06:40):
providing direct services to peoplewho use our harm reduction center,
which is a full service harmreduction program, including sterile
syringes for safer injection, sterileglassware,
education around using naloxoneand overdose prevention, and now education
on how to know what you areabout to be using from this drug supply.
(07:02):
You both are very dedicatedto person centered care.
And with that in mind,let's talk about some of the methods
that are being used right now to addresssubstance use.
when we talk about addressingsubstance use disorders,
we also have to really think about isaddressing is a treatment.
And it's important to distinguishthese terms as well.
When we think about, this topic,I like to think of addressing
(07:24):
as an umbrella termthat takes like a comprehensive bird's eye
view, to reduce harms of substanceuse and, and substance use disorders.
And this kind of speaks at the globaland public health approach that includes
the various strategies employed, includingharm reduction, and social supports
(07:44):
like finding people, housingvouchers, employment,
as well as advocacyand policy initiatives in the space.
you're therefore looking at the socialand structural factors
that affect how substance use disorderis viewed from a global perspective,
which goes beyond medical treatment.
And so treatment is typically providedby health care professionals.
(08:09):
really to manage an individual's substanceuse disorders clinic clinically,
which includes counseling and medications.
And some patientsmay not want or receive treatment
but can still receive servicesand resources
such as harm reductionat harm reduction centers,
and that is still addressingthat person's substance use disorders.
(08:31):
Caitlin, I think that's a perfect segueinto kind of explaining maybe what harm
reduction centers really can offer people.
I was thinking, as Clementwas sharing about, someone very big
to the harm reduction movement,who we lost this year, Louise Vincent,
she was the former executive directorof the North Carolina Survivors Union,
which is a drug usersunion and a harm reduction program.
(08:54):
And she would always saythe opposite of addiction is connection.
really, where treatment beginsis where someone feels safe,
accepted and able to connectwith the people around them.
And we know from the past,that methods like criminalization
and forced treatment only causefurther isolation in a lot of people.
For some, they may work, but it isn'tan umbrella that works for everybody.
(09:18):
And as Clement said,
harm reduction is really about meetingsomeone where they're at.
what that means is we see what's going on.
there is absolutely no barrier to walkin the doors of a harm reduction center.
You don't need to even want to takea single item
that we offer you,just like come in for a cup of coffee.
(09:39):
We have absolutely zero policies around
whether or not someone is using drugsor plans to stop using drugs.
What we want to know is what supportsare you looking for?
We offer thingslike safer methods of drug use.
If you are going to continue using drugs,we want you to do that
as safely as possible without contractingHIV or various soft tissue infections.
(10:04):
We also make connections for peopleto pursue different types of health care.
we have a very low barrier process
of connecting someone to a medicationfor opioid use disorder,
or what we sometimes refer to casuallyas withdrawal management.
They may not even identifyas having an opioid use disorder.
(10:24):
But if something is in the wayand their, withdrawals are going to get
in the way of pursuing medical supportor a job or housing,
we can connect them to carethrough various programs
like the one that Clementleaves at University Hospital.
we also know that, like
sometimes people who use drugshaven't seen a doctor in a long time
(10:45):
because there's a lot of stigmathat comes around with that.
So we try to make really soft and warmhandoffs, to linkages
to care for the various thingsthat can affect someone while they're
using substances, including podiatrists,dentists, reproductive care, things
that people may have been removed from,or returning someone to care.
If someone is living with HIV
(11:06):
and they've been out of their systemof care for a while.
We want to make it really simple
for them to return to carewithout any shame or judgment.
And so at a harm reduction center,we believe
come as you areyou know, we celebrate small wins.
We celebrate using a new syringe.
Every time you inject, we celebrateswitching from injecting to snorting.
(11:26):
We celebrate using condoms.
We celebrate small winsthat might not feel like a win,
but we we celebrate any positive change.
I love that Caitlin and I really also seeharm reduction as the place
where people are connecting,like you said in that, quote,
building trust and connectionsthat can really
(11:50):
convince someone and open that doorto treatment and recovery.
And I think that's one of the major areaswe need to focus on
when trying to address,substance use disorders.
And I wanted to add, related to treatment,
we often hear the term or usethe term Matt.
Matt, you know, historically stoodfor medication assisted treatment.
(12:14):
But that term has kind of fallenon the wayside
because it made it appearas if medications were secondary
to a primary form of treatment,most appropriate to manage
specifically opioid use disorderwhen we now use the term,
we say medications for addictionstreatment and more specifically
for opioid use disorder, medicationsfor opioid use disorder or mood.
(12:39):
And when we talk about mood,we're really focusing on buprenorphine
and methadoneas the only FDA approved medications
that have mortalityreducing benefits of at least 50 to 60%.
think of Matt as an evidence basedmedical approach that reduces the harms,
(13:00):
so it can fit in that harm reduction lensby helping to stabilize, reduce,
or even stop, drug use to help
save lives,especially in this age of, fentanyl.
And if I may, Mattis not replacing one drug with another,
because with the use of medications,you are really helping
(13:21):
to stabilize that individualfrom not experiencing withdrawal.
And that allows the brain'schemistry to normalize you.
You eliminate or reducethat cycle of withdrawal,
which can also include intoxicationdepending on how severe that person's,
substance use disorderis, you can think about that
(13:42):
in the context of insulin for diabetes,where using the treatment
to control the disease and preventthe disease from being uncontrolled.
What's so awesome about that?
And, you know, medicationassisted treatment or medication
for addiction treatmentis, that there are so many possibilities.
I was recently heardsomeone say, well, shouldn't we be
(14:04):
convincing people to get off of thatas soon as possible?
And, you know,that's not for us to decide, right?
It's really for the individualto say when they're stable, right.
It gives a leg up to sort of gainsome what we call recovery capital.
Right.
Get a job,maybe have your maybe friends or family
that weren't a part of your lifeduring a chaotic period of drug
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use are back in your life again, andthose things start to make you feel good.
And so what's great about the medicationoption is it gives you that nice level.
You know,I'm not going to be in withdrawals.
That part of my brainis sort of occupied for now,
and I can focus on the other partsof my life that maybe I wasn't focusing on
during my chaotic use.
(14:46):
I think what's so greatabout the previous conversation is
how person centeredboth of your being with how you go
about helping peopleand just really being there for them.
Caitlin, you would also mentionthe importance of those warm handoffs
with health care providersthat you can trust.
How can we address stigma held by peoplewho are working in the health care
(15:06):
industry when they're providing carefor people who use drugs?
Yeah. So that that can be difficult.
You know, at new Jersey Harm ReductionCoalition, we do our best to educate
and use, lives are living experiencelike my own and our other workers.
You know, we are an organizationthat is led by, for people who use drugs
(15:27):
on various ends of that continuumthat Clement was talking about.
And so we use person first perspective toshare some of the things that people say.
we have participants of our programthat will share with us that they avoided
an important surgerybecause they were treated with stigma
when they walked in the door of theemergency room we share that directly back
(15:48):
to medical providers so that they can seethe impact they're having.
We also, focus on researchWe recently wrote a report,
about the impactof severe bacterial infections
and the impact that it hason the medical system of new Jersey,
because we sometimesfocus only on overdose.
But there are so many other waysthat people who use drugs are harmed
(16:09):
within the medical system.
And that can be, being afraidto receive care for an abscess
or some of the woundswe see related to psilocybin use.
And so the more we break down that stigmaand show with facts and figures,
you know, in 2019, New Jersey'sspent the state itself spent over $1
billion in Medicaid and Medicare costsrelated to severe bacterial infections.
(16:34):
And those are all thingsthat can be prevented with,
you know, care at the momentsomething happens.
those things are really importantto focus on.
We make sure that people understandwhen someone's entering a harm
reduction center.
It's not, oh, we're just going to usedrugs until something better comes along.
A lot of times, people haven't been giventhe space to really think
about their drug usein the same way that other people
(16:56):
are given to think about complexmedical conditions.
they're treated with dignity,when people are treated and met
with not told you're wrong,not told you should do better,
but you're just treated with dignityin the same way you would hope.
You'reanybody who treats you on the street.
A lot of things can happen,and things like people who use
a syringe service program or a harmreduction center are actually five times
(17:19):
more likely to enter drug treatmentthan those who don't have that access,
and they're three times more likely
to fully stop the drug that causesthe most problem in their life.
And so those are somereally powerful numbers.
And if we're not using harmor utilizing harm reduction
as part of the continuum of carefor people who use drugs, we're really
leaving a great part of the populationof drug using people in the dark.
(17:43):
And I think it's important for providersas far as their education to reduce
the stigma is instead of thinking about
why can someone just stop using drugs,we can instead think about why
an individual continues to use
and how can we addressand reduce any potential harms from that.
And as Caitlin said,a lot of different services
(18:06):
or within the harm reduction centersand just the different strategies
that we can employ,can can really help with that.
Caitlin mentionedthat first person language.
I think that alludes to the importanceof educating the provider
about that, the importanceof the whole centered approach,
really listening to the stories of people
(18:27):
and working together to devise strategiesaddress a person's substance use.
This contrast, in a way,with coming in as a provider already
with an agenda, don't need to, quoteunquote, fix any problem right away.
We just need to listen.
And that's about building trustin that quote that Caitlin brought up
regarding building connections.
(18:48):
And I think that opens the doorto even more conversations about goals.
And that can help person on that roadto recovery.
it's important that we respect a person'sdignity, while we help them stay safe.
What does the current drug supply
look like in new Jersey,and how is that impacted by policy?
(19:08):
the role of communitydrug checking technician.
That is something
I'm talking about all day, every daywith our participants especially,
and with other people doing community drugchecking around the country.
really, what we know nowin New Jersey, as Clement said earlier,
almost all of the, streetopioid supply is now fentanyl.
(19:30):
most peopledo not expect to receive heroin,
even if they use the word heroinfor what they're purchasing.
They know that there'sgoing to be fentanyl in that.
That is release in the opioid supplyand occasionally in the pressed pills
that are sold as synthetic opioids or,you know, like a prescription
pill that a pill made to mimica prescription pill.
(19:51):
So we know that already,
that sort of a baselinethat we're starting with, unfortunately.
And that is really, as Clementsaid, a result of some of the,
legal criminalization of drugs, the abruptstopping of opioid pain medication
prescriptions earlier in the 2000sand other unregulated drug supply itself.
(20:12):
And so we use that base level of fentanyl.
Some of the other thingsthat we're seeing,
many people have heard the wordxylene or tranq, and that is a veterinary
sedative that entered the drug supplya few years ago now we're actually seeing
as psilocybin has been criminalizedin the state of Pennsylvania, scheduled
psilocybin, in their drug sentencing,we're now seeing meta Toma creep up,
(20:36):
which is another veterinary sedative,but it also has a human.
And, ingestible versioncalled Dec's meditative machine.
And so that is a heavy sedative.
The meta Tolman that we're seeing cansometimes cause hallucinations.
Sometimes people thinkthat they were dosed with PCP or ketamine
(20:58):
or some sort of a dissociative,because we're seeing folks who will lose
an entire day to one bagthat they thought was just going to
maybe get them off emptyand help them feel better.
So we are in a state of an everchanging drug supply.
another thing we're startingto see in new Jersey, in New Brunswick,
where I'm doing our drug checking, are,local anesthetics in the drug supply.
(21:23):
Lidocaine, prochain and tetra cane
are showing up at unprecedented amounts.
that's another filler, right,that people are putting in to mimic
an effect of a drug they may not be ableto source because of criminalization.
don't know right now where that's going.
That's relatively new.
But we do know things like ifsomeone has a preexisting heart condition,
(21:45):
regular use of internal lidocaineuse can really aggravate that.
And so there are some thingson the horizon
that we're starting tolook at as we see these new drug trends.
Clement, anything to addmaybe about some of those trends
that you're seeing and maybe
what's being done on the treatment sideto address The changing supply.
because of the changing and unpredictabledrug supply
(22:05):
and the way that that it's evolving,you know, treatment providers
really must utilize strategiesthat truly keep people safe from harm.
for example, now that thethat fentanyl is fully omnipresent,
our existing medicationssuch as buprenorphine,
which was approved backin 22,002 by the FDA,
(22:29):
has has led to more challengesas far as starting that medication, right.
Thingslike fueling more withdrawal. Right.
Which we call precipitated withdrawal,
or feeling like backlike it doesn't work as well.
we must keep up, and understandthat because of this unpredictability,
we have to keep up withwhat's going on in, the drug supply.
(22:50):
And as Caitlin mentioned, it'sso unpredictable with, like, psilocybin
and meta automating, that we mustconsistently devise new ways and keep up
with, with research, to identify
what is the most optimal method.
And evidence based strategyto continue to keep people safe.
(23:10):
I want to make sure to add to the contextthat as we talk about these adulterants
that are increasingly strongerand more potent, it really is not stemming
from just some nefarious personwho sells drugs wanting to harm people.
I can't speak for every personwho sells drugs, but for the most part,
I know that they are in a situationdue to the environment they were exposed
(23:35):
to throughout their livesand the impacts of the drug war.
And generally,nobody is really looking to kill
the people that are buyingsomething from them, right?
That wouldn't be good for business.
But what we do knowis that the unpredictability of the drug
supply really stems from prohibition.
And there is something called the iron lawof prohibition that has been studied
(23:56):
since the 1920s, our original prohibition,alcohol prohibition.
And it basically says that any timethe government makes one substance
illegal, the demand doesn't go away.
Just because the supply does right,the supply goes away.
But it's human nature to want to escapeor achieve a feeling
or lose a feeling or whatever it ispeople are seeking in their use.
(24:20):
And so that demand is still there.
And so what we saw in the 1920sis very similar to what we're seeing here.
We saw an unregulated alcohol supplythat was not made by chemists
in a regulated way.
It was made by people, sort of armchairchemists doing the best that they could.
We saw botulism.
We saw alcohol poisoning.
And so we're seeing that mimicked.
first heroin was scheduled and we saw thatsort of removed from the streets.
(24:43):
It was replaced with fentanyl.
As fentanyl became scheduled,it's been replaced with psilocybin.
As psilocybin is becoming scheduled,it's being replaced with medicine.
Modine.
And it reallyyou can track things like that.
There's researchthat shows every time a drug bust happens,
overdoses increase in that neighborhoodbecause the demand hasn't gone away.
what Clement is talking about too,with Matty and different,
(25:07):
more creative optionsfor people who use drugs
is the fact that for some people,the very real truth is that
drugs are not going to stopbeing a part of their world.
But we do want people to knowthat they can be safer in their use,
or that they have other options, right?
For some people,that opioid is the thing causing
(25:27):
unpredictabilityand and making them feel chaotic.
And so they can stop that opioid use,whether through abstinence,
through a combination of abstinenceand medication, for addiction treatment.
And they can there isn't just one way.
quite often we focus on the drug supplyand blame the person selling.
(25:47):
But I always tell people unless they havelike an infrared spectrometer,
which they likely don't,they really don't know
what's in the drugsthat they're selling either.
I just wanted to emphasizethat that is very true in that,
you know, in the it's in the InternationalJournal of Drug Policy,
in the paper was called I couldn't livewith killing one of my friends
(26:08):
or anybody, a rapid ethnographic studyof drug sellers, use of drug checking.
And actually,one of their findings was that to address,
the the overdose crisis and save lives,
we need policies that also, supportpeople who are selling drugs
and for example, using harm reductionapproaches, for for people who sell drugs
(26:30):
That's a great segue to talk aboutwhat we're doing currently in new Jersey
to create better outcomesfor people who use drugs.
from a policy perspective,we have had some really great advancements
around drug policy in New Jersey in 2021.
We have the naloxone policy expansion,which was part of the Overdose Prevention
(26:52):
Act, it went from just one typeof naloxone to all FDA approved forms
of naloxone being legal in new Jerseyto not only carry, but to distribute.
We have a standing order,
which means a statewide prescriptionfor everyone over the age of 14.
have a programled by the Department of Human Services
that has about over 700 pharmaciesparticipating in the state,
(27:15):
where anyone overthe age of 14 can walk in and just say,
I need naloxoneand they don't have explain more.
We have advanced to a lot more community
based distribution of naloxone,which we know works.
We know that people who use drugsand the people in our families and close
social circles are most likely to bethe first person to witness an overdose.
(27:37):
And so by educating folkswho are in our lives
and people who use drugs ourselves onhow to respond when our friend falls out
or our loved one falls out,
that also eliminatessome fear that can come in, especially
in communities where calling nine one 1stMay come with fear of police brutality.
the, expansion of harmreduction centers has directly
(27:58):
led to a reduction in overdosedeaths in new Jersey.
The harm reduction expansion billwas passed two years ago, and in exactly
two years we have significantly reduceoverdose deaths in new Jersey.
And that literally alignswith going from seven
harm reduction centers statewide to 51,which we currently have.
(28:18):
And that is due to policy changesto realizing that a harm
reduction center is not appearing to dosomething horrible in your neighborhood.
A harm reduction center is addressingthe harms that have come with drug use.
And what we know in new Jersey is thatthere's not one single county where
we're not seeing overdoses, and thereforewe need support in every county.
(28:39):
We're looking forward
to continuing on themand continuing to expand harm reduction.
Right now, we know that the easierit is for someone to receive medication
for their addiction or opioid use disorderor their substance use disorder,
the better the outcome.
So rather than relying on someoneto seek a doctor themselves,
(29:00):
we have things like bridge prescriptionsto our harm reduction centers.
Right?
Or those quick referrals wherein new Jersey they're working on a rapid
referral program overall, we'realso working on taking advantage of the
the recent leave reduced,methadone regulations.
We know that more people is easierto become an opioid treatment center now.
(29:23):
And we're seeing somesome counties invest in mobile solutions
for for delivery of that thingsthat are practical for folks who may not
physically or financially be able tomake it to a clinic to receive their care.
the more options we have, the more thingsthat meet people where they are
both literally and figuratively,the better we're going to be.
(29:45):
last year, back in 2024, new Jersey,the new Jersey governor signed the bill
that removed harm reduction supplies from,you know, the paraphernalia laws.
So that help to eliminatecriminal penalties
associated with drug checking equipmentlike fentanyl and silencing test strips.
Syringe distribution,and also other supplies like,
(30:09):
using devices for mixing substancesand other objects for using substances,
especially when they're providedby an authorized harm reduction center.
So with all the legislation and all thedifferent policies that Caitlin mentioned
from this greater perspective, within ourthe state of new Jersey, you can see that
it favors a public health approach versusa criminalization approach.
(30:34):
And this is so importantto lowering the barrier to care,
supporting evidence based strategies,and supporting recovery
because people are more likely to engage
in care when they don't fear the penaltiesof carrying these lifesaving,
tools It's great to hear thatthe state is so dedicated
to improving outcomesfor people who use drugs.
(30:56):
I think it would be great
to hear about what individualsthemselves can do to also work
towards that mission of creating betteroutcomes for people who use drugs.
people can start with kindness.
We often are taught to keep to ourselves,walk over
someone slumped over on the street,don't give that coin to them.
You don't know what they'll dowith it. Right.
(31:16):
And and we have a lot of stigma aroundpeople who use drugs, visibly.
And people who use drugs visibly are oftenpeople
push the furthest to the marginswho have lost housing.
They may be living with substanceuse disorder,
but when you really thinkabout it, 84% of adults in new Jersey,
that's a lot of people, including peoplewho are using behind closed doors.
(31:37):
So sometimes it's
really dropping the stigmathat we have about our own substance use
that we've been taughtby the war on drugs,
There are things that are coming to lightin the way
that we've spoken about drugs for yearsthat are actually false.
And so it's things like podcasts like thiswhere we're addressing the truth.
Clinicians like Clement
and all of the folks at UniversityHospital who are warm and welcoming.
(32:02):
I don't know how many timesI've said to Clement,
if I had a prescribing pharmacist like youor I had a doctor
like Doctor Nico, right, or Doctor Nessen,how much safer
I would have felt, you know, owning upto some of the things that were happening.
And so really, as community membersand as neighbors, we can be kind.
(32:24):
We can do our bestnot to look askance or, spread rumors
about people's substance use.
We can do thingslike carrying the locks on
and let your neighbors knowthat you're carrying the locks on.
Right, and let people know I'm a safeperson to talk to about your substance
use or your child's substance use,or your partner's substance use.
I always believe that, we have advanced
(32:48):
so much in all of the waysthat we treat substance use disorder.
But if we force people behind closeddoors, that doesn't help anyone.
And so it can really startwith just kindness.
this is something that Caitlin
and we have talked
about throughout this podcastis that you must address the stigma
and view people who use drugsnot as people with moral failings,
but instead as another human beingwho may need care.
(33:11):
Right.
And we address before that we can useperson first language
normalized harm reduction within society.
Imagine if we saw harmthese harm reduction on these billboards
when we drive down the highwaysor really utilized social media to get out
the word that harm reduction centerscan be used by anybody, right?
Anybody?
(33:32):
I think there's that stigma that we see.
The harm reduction servicesor centers are only for people
who are actively using drugs.
And I and that is so not the case.
And I think it's important thatwe normalize that within our community.
So putting on billboards or things that wesee in social media can really help.
Folks understand.
And we must continue to support evidencebased care that includes muddy treatment.
(33:56):
As I mentioned, the harmreduction services
utilizing peer recovery specialists.
Right.
Importantly,which is happening in new Jersey,
from a clinician care model,this integrated care
model that integrates substanceuse disorder, behavioral health
care and physical health,making it easier one stop shopping.
(34:18):
They like to say right, but making iteasier for, people who use drugs,
who may have lots of social determinantsof health, making helping them get access
to all the care that they needwhen they need it in, in, in one location.
And from a public health standpoint,we must engage in policy and advocate
for those that would advance care,whether from a legislation perspective,
(34:42):
which we've discussed,new Jersey has been at the forefront
or even within healthcare systems and selves, right?
Policiesthat really support harm reduction.
We can also collaborate with each otherand organizations that are
that are truly doing this work. All right.
And then as we kind of approachthe end here, just a quick final question.
(35:03):
What is one thingthat you are both hopeful for
in this world of substance use?
With the coming New Year?
recovery is possible.
And we talked of when we make connections.
And it's that quote that Caitlin mentionedwhen we think that
the opposite of addictionis not surprising,
but the human connectionswe make with each other.
(35:24):
And that helps to reallyinstill the dignity,
the respect and the love we havefor people and for humanity in general.
And that helps them, helpspeople on the road to recovery
with our legislation, with,the ever expanding acceptance of,
the need to address, substanceuse disorders from a more,
(35:45):
humanized level, the more we're able to
to help peopleimprove their outcomes and reduce
overdose deaths and just get peopleon the road to recovery.
one thingI'm hopeful for is that people can start
to see that harmreduction is not antithetical to recovery.
(36:05):
You know, recovery is a form of harmreduction for some people,
the best way to reduce harm is abstinence.
Right?
And harm reduction embraces that.
It is not an opposite.
It is not in opposition to that. Right.
And so when we start there, as Clementsaid earlier,
you look at the continuumof substance use.
Harm reduction has somethingfor everyone on that continuum, right?
(36:28):
Harm reduction centers, as Clementsaid, have something
for everyone in the community.
We have safe syringe disposal,whether it's for hormone therapy,
whether it is for diabetes,whether it is for your cat
needing medicineand you don't know where to put this
sharps disposal containeror you don't have one, we can do that.
We can come collect syringesthat you see on your street.
(36:51):
If somebody didn't dispose of themproperly.
Harm reductionreally can meet everyone where they're at.
And I think that sometimespeople misinterpret
that harm reduction is in some wayopposed to abstinence based recovery,
but really recovery fallsunder the umbrella of harm reduction.
And for some individuals,
if not using any drugsis the way that you reduce that most harm.
(37:14):
We respect that,and I hope that folks learn that
and give give harm reduction a chanceand really see that people
who use drugs are just that, or peopleright where people
and at the heart of everythingwe want what everyone else has.
We have a rich inner dialogwith dreams and love and hope
and thoughts and peoplethat are important to us.
(37:37):
No different just because we might looka little different sometimes.
think that's a great pointto end this episode on.
I know we have covered a lot today.
We started with discussingthe spectrum of substance use
and how substance use disorderis really one extreme of that spectrum,
how harm reduction can collaboratewith traditional providers
and that harm reduction is really opento anyone, wherever they are,
(38:00):
on their journey of life.
We discuss the role of empathyand working with people to provide care
for addiction support.
And as well as the role of empathyin helping reduce costs
on our health care system.
We discuss the unpredictable drug supplyand the importance of needing to keep up
with evidence based
treatment and really, whatnew Jersey and individuals alike can do
(38:20):
to make sure that people in new Jerseyare having the best outcomes,
regardless of where they fall onthat spectrum of substance use.
I want to thank both of youfor being on this episode.
I think we have all learned a lotfrom your expertise.
For those
who are listeningto our conversation today,
if you want to dive deeperinto this topic, you can join
Caitlin and Clement on the SubstanceUse Disorder Echo series,
(38:43):
which will be returning Friday, January9th at noon in the New Year.
Sessions are held on select Fridaysfrom 12 to 1 p.m.
Eastern time.
And you can also check outsome of our other offerings
on our echo website, like our MaternalOpioid Intervention Echo.
Thank you both for joining me today,and thank you for those who are listening.
(39:04):
We'll be returning next month with anotherepisode focused on autonomy and health
care for individuals with intellectualand developmental disabilities.
See you next time.
Welcome to all teach.
All Learn (00:02):
Beyond the ECHO.
Examining public health challengesthrough an interdisciplinary lens.
Amplifying diverse voices, encouragingcritical thinking,
and promoting collaborative civic actionacross the health care system.
This season is powered by the Eagleton
Institute of Politicsas part of Democracy Week 2025.
Each episode will pair professionalsfrom different disciplines to model
(00:22):
how cooperation can improveoutcomes and equity in care.
I'll be your host, Sean Cuddihy,before we get started.
The theme of our first seasonis Productive Policy.
We'll be focusing on policy that promotespositive health outcomes and helps
providers to do their jobsto the best of their ability.
For our second episode,we are diving into the topic of substance
use medications for addiction treatmentand approaching these topics with empathy.
(00:47):
Today we are joined by DoctorClement Chen and Caitlin O'Neill.
Doctor Clement Chen is the academicdetailer and clinical pharmacist
specialist at the Northern New JerseyMedication Assisted Treatment Center
of Excellence, which is based at RutgersNew Jersey Medical School.
In his role, Clement provides consultativesupport to health care professionals
by offering mentoring, educationand technical assistance.
(01:09):
Caitlin O'Neill is a communitydrug testing
technician at the new Jersey HarmReduction Coalition.
They are a survivor, healer,and harm reduction advocate.
They became involved in harmreduction in the 2000
through a local syringe service program.
As a co-founder of the new Jersey HarmReduction Coalition, Caitlin is dedicated
to creating a world where individualswho use drugs have access to resources
(01:29):
for healing and self-determined care,regardless of their background or choices.
Both of our guestsserve as series leaders on our Matty Sud
Echo series,which will be returning this January.
In 2026. Thank you both for joining.
you could quickly
just describe what is substance useand what's your relationship to the topic?
thank you very much, Sean,for this opportunity to speak today.
(01:52):
And thank you, Caitlin, for joining me.
My name is ClementChen, as Sean had stated,
and I'm a clinical pharmacistwithin the Northern New Jersey Med
Center of Excellence.
I think it's important to distinguishsubstance use and substance use disorder.
I think of substance use on a continuum,like on an umbrella term.
And thinking about it
this way helps us to understandwhere substance use disorder lands.
(02:15):
Right.
This continuum at the ends includesno use at one end
and then substance use disorderat the other end.
And a substance use disorder is reallya chronic recurring disease that involves
the reward, motivation, and decisionmaking circuitry of the brain.
But what distinguishes it as a disorderis that it is characterized
(02:38):
by compulsive drug seekingand use despite harmful consequences.
Unfortunately,having a substance use disorder
today leads to a much greaterrisk of overdose deaths.
Many people who first became dependenton opioids
through legitimate prescriptionsturned to illicit sources when access
became restricted due to the regulationson the prescribing of opioids.
(03:01):
And from that 17,000or so people were dying
from prescriptionopioid overdoses in the early 20 tens.
During the next couple of years,a cheaper form, which we know as heroin
was formulated, leadingto a further, surge in overdose deaths.
And now today, most of the illicit opioidsupply contains highly potent
synthetic opioids, specifically fentanyl,which we know is 50 times
(03:25):
stronger than heroin.
And dependingon the type of fentanyl as well,
because there are other analogsof that base fentanyl molecule.
And really fentanyl was involved in over70% of all opioid
involved overdose deathsduring the Covid pandemic.
And today, we are now in an age of poly
substance use, where overdoses todayinvolve fentanyl.
(03:47):
But people are also using,drug supplies that may contain stimulants
like methamphetaminesor cocaine or sedatives like psilocybin
and meta targeting, which brings with thema whole set of different challenges
when it comes to treatmentand other strategies to reduce harm.
when I think of folks with substanceuse disorder and our role as healers
(04:08):
providers, it's about an approachthat expands access to evidence
based treatment
like medications for opioid use disorder,for people who use opioids,
supporting harm reduction strategiessuch as distributing naloxone,
and other strategies such as, distributionof clean syringes, which is legal
in new Jersey, via authorized harmreduction programs and very importantly,
(04:31):
addressing the social needsand the associated structural issues
that lead someone to use drugs,we call the social determinants of health.
one of the things I love about any timeClement and I work together on anything,
we have the amazing technical perspectiveand clinical perspective.
And I can bring sort of a first person,
(04:53):
or like street level perspectiveand it works really well together.
And so my, really most of my knowledge
and experience with drugsis as a person who uses drugs.
I have been a person who uses drugs
in some form or anothersince I was about 14 years old.
it was not initially substanceuse disorder.
Right?
(05:13):
We have things like experimental drug use,social drug use.
what I later found out was drug use.
That was, like a self-medication attemptto heal trauma from earlier in life
and trauma that intensified
as my substanceuse developed into substance use disorder.
we know that not everyone that usessubstances is going to develop
(05:34):
a substance use disorder.
there was a study from new Jersey policyperspective a few years back that said
that, 80, 84 or so percent of new Jerseyresidents, said
yes to having used a criminalized drugstronger than marijuana.
And only about 16% of those
84 identified having been diagnosedwith a substance use disorder
(05:55):
or identified themselvesas someone with a substance use disorder.
when we talk about substance use disorder,
as Clement said, it is very muchthe sort of end of the continuum.
Right.
And there are a lot of factors in that as,Clement spoke about,
it can be physiological factorsin the way the drug is affecting someone
lot of those effects are due to thecriminalization and the war on drugs,
(06:19):
which really becomes a war on peoplewho use drugs.
my perspective isI have that personal perspective
and as well as,some time being in recovery, sometimes
being an abstinence based recovery,I still consider myself in recovery
even though my recoveryis no longer abstinence based.
And I also work, at new Jersey HarmReduction Coalition,
(06:40):
providing direct services to peoplewho use our harm reduction center,
which is a full service harmreduction program, including sterile
syringes for safer injection, sterileglassware,
education around using naloxoneand overdose prevention, and now education
on how to know what you areabout to be using from this drug supply.
(07:02):
You both are very dedicatedto person centered care.
And with that in mind,let's talk about some of the methods
that are being used right now to addresssubstance use.
when we talk about addressingsubstance use disorders,
we also have to really think about isaddressing is a treatment.
And it's important to distinguishthese terms as well.
When we think about, this topic,I like to think of addressing
(07:24):
as an umbrella termthat takes like a comprehensive bird's eye
view, to reduce harms of substanceuse and, and substance use disorders.
And this kind of speaks at the globaland public health approach that includes
the various strategies employed, includingharm reduction, and social supports
(07:44):
like finding people, housingvouchers, employment,
as well as advocacyand policy initiatives in the space.
you're therefore looking at the socialand structural factors
that affect how substance use disorderis viewed from a global perspective,
which goes beyond medical treatment.
And so treatment is typically providedby health care professionals.
(08:09):
really to manage an individual's substanceuse disorders clinic clinically,
which includes counseling and medications.
And some patientsmay not want or receive treatment
but can still receive servicesand resources
such as harm reductionat harm reduction centers,
and that is still addressingthat person's substance use disorders.
(08:31):
Caitlin, I think that's a perfect segueinto kind of explaining maybe what harm
reduction centers really can offer people.
I was thinking, as Clementwas sharing about, someone very big
to the harm reduction movement,who we lost this year, Louise Vincent,
she was the former executive directorof the North Carolina Survivors Union,
which is a drug usersunion and a harm reduction program.
(08:54):
And she would always saythe opposite of addiction is connection.
really, where treatment beginsis where someone feels safe,
accepted and able to connectwith the people around them.
And we know from the past,that methods like criminalization
and forced treatment only causefurther isolation in a lot of people.
For some, they may work, but it isn'tan umbrella that works for everybody.
(09:18):
And as Clement said,
harm reduction is really about meetingsomeone where they're at.
what that means is we see what's going on.
there is absolutely no barrier to walkin the doors of a harm reduction center.
You don't need to even want to takea single item
that we offer you,just like come in for a cup of coffee.
(09:39):
We have absolutely zero policies around
whether or not someone is using drugsor plans to stop using drugs.
What we want to know is what supportsare you looking for?
We offer thingslike safer methods of drug use.
If you are going to continue using drugs,we want you to do that
as safely as possible without contractingHIV or various soft tissue infections.
(10:04):
We also make connections for peopleto pursue different types of health care.
we have a very low barrier process
of connecting someone to a medicationfor opioid use disorder,
or what we sometimes refer to casuallyas withdrawal management.
They may not even identifyas having an opioid use disorder.
(10:24):
But if something is in the wayand their, withdrawals are going to get
in the way of pursuing medical supportor a job or housing,
we can connect them to carethrough various programs
like the one that Clementleaves at University Hospital.
we also know that, like
sometimes people who use drugshaven't seen a doctor in a long time
(10:45):
because there's a lot of stigmathat comes around with that.
So we try to make really soft and warmhandoffs, to linkages
to care for the various thingsthat can affect someone while they're
using substances, including podiatrists,dentists, reproductive care, things
that people may have been removed from,or returning someone to care.
If someone is living with HIV
(11:06):
and they've been out of their systemof care for a while.
We want to make it really simple
for them to return to carewithout any shame or judgment.
And so at a harm reduction center,we believe
come as you areyou know, we celebrate small wins.
We celebrate using a new syringe.
Every time you inject, we celebrateswitching from injecting to snorting.
(11:26):
We celebrate using condoms.
We celebrate small winsthat might not feel like a win,
but we we celebrate any positive change.
I love that Caitlin and I really also seeharm reduction as the place
where people are connecting,like you said in that, quote,
building trust and connectionsthat can really
(11:50):
convince someone and open that doorto treatment and recovery.
And I think that's one of the major areaswe need to focus on
when trying to address,substance use disorders.
And I wanted to add, related to treatment,
we often hear the term or usethe term Matt.
Matt, you know, historically stoodfor medication assisted treatment.
(12:14):
But that term has kind of fallenon the wayside
because it made it appearas if medications were secondary
to a primary form of treatment,most appropriate to manage
specifically opioid use disorderwhen we now use the term,
we say medications for addictionstreatment and more specifically
for opioid use disorder, medicationsfor opioid use disorder or mood.
(12:39):
And when we talk about mood,we're really focusing on buprenorphine
and methadoneas the only FDA approved medications
that have mortalityreducing benefits of at least 50 to 60%.
think of Matt as an evidence basedmedical approach that reduces the harms,
(13:00):
so it can fit in that harm reduction lensby helping to stabilize, reduce,
or even stop, drug use to help
save lives,especially in this age of, fentanyl.
And if I may, Mattis not replacing one drug with another,
because with the use of medications,you are really helping
(13:21):
to stabilize that individualfrom not experiencing withdrawal.
And that allows the brain'schemistry to normalize you.
You eliminate or reducethat cycle of withdrawal,
which can also include intoxicationdepending on how severe that person's,
substance use disorderis, you can think about that
(13:42):
in the context of insulin for diabetes,where using the treatment
to control the disease and preventthe disease from being uncontrolled.
What's so awesome about that?
And, you know, medicationassisted treatment or medication
for addiction treatmentis, that there are so many possibilities.
I was recently heardsomeone say, well, shouldn't we be
(14:04):
convincing people to get off of thatas soon as possible?
And, you know,that's not for us to decide, right?
It's really for the individualto say when they're stable, right.
It gives a leg up to sort of gainsome what we call recovery capital.
Right.
Get a job,maybe have your maybe friends or family
that weren't a part of your lifeduring a chaotic period of drug
(14:26):
use are back in your life again, andthose things start to make you feel good.
And so what's great about the medicationoption is it gives you that nice level.
You know,I'm not going to be in withdrawals.
That part of my brainis sort of occupied for now,
and I can focus on the other partsof my life that maybe I wasn't focusing on
during my chaotic use.
(14:46):
I think what's so greatabout the previous conversation is
how person centeredboth of your being with how you go
about helping peopleand just really being there for them.
Caitlin, you would also mentionthe importance of those warm handoffs
with health care providersthat you can trust.
How can we address stigma held by peoplewho are working in the health care
(15:06):
industry when they're providing carefor people who use drugs?
Yeah. So that that can be difficult.
You know, at new Jersey Harm ReductionCoalition, we do our best to educate
and use, lives are living experiencelike my own and our other workers.
You know, we are an organizationthat is led by, for people who use drugs
(15:27):
on various ends of that continuumthat Clement was talking about.
And so we use person first perspective toshare some of the things that people say.
we have participants of our programthat will share with us that they avoided
an important surgerybecause they were treated with stigma
when they walked in the door of theemergency room we share that directly back
(15:48):
to medical providers so that they can seethe impact they're having.
We also, focus on researchWe recently wrote a report,
about the impactof severe bacterial infections
and the impact that it hason the medical system of new Jersey,
because we sometimesfocus only on overdose.
But there are so many other waysthat people who use drugs are harmed
(16:09):
within the medical system.
And that can be, being afraidto receive care for an abscess
or some of the woundswe see related to psilocybin use.
And so the more we break down that stigmaand show with facts and figures,
you know, in 2019, New Jersey'sspent the state itself spent over $1
billion in Medicaid and Medicare costsrelated to severe bacterial infections.
(16:34):
And those are all thingsthat can be prevented with,
you know, care at the momentsomething happens.
those things are really importantto focus on.
We make sure that people understandwhen someone's entering a harm
reduction center.
It's not, oh, we're just going to usedrugs until something better comes along.
A lot of times, people haven't been giventhe space to really think
about their drug usein the same way that other people
(16:56):
are given to think about complexmedical conditions.
they're treated with dignity,when people are treated and met
with not told you're wrong,not told you should do better,
but you're just treated with dignityin the same way you would hope.
You'reanybody who treats you on the street.
A lot of things can happen,and things like people who use
a syringe service program or a harmreduction center are actually five times
(17:19):
more likely to enter drug treatmentthan those who don't have that access,
and they're three times more likely
to fully stop the drug that causesthe most problem in their life.
And so those are somereally powerful numbers.
And if we're not using harmor utilizing harm reduction
as part of the continuum of carefor people who use drugs, we're really
leaving a great part of the populationof drug using people in the dark.
(17:43):
And I think it's important for providersas far as their education to reduce
the stigma is instead of thinking about
why can someone just stop using drugs,we can instead think about why
an individual continues to use
and how can we addressand reduce any potential harms from that.
And as Caitlin said,a lot of different services
(18:06):
or within the harm reduction centersand just the different strategies
that we can employ,can can really help with that.
Caitlin mentionedthat first person language.
I think that alludes to the importanceof educating the provider
about that, the importanceof the whole centered approach,
really listening to the stories of people
(18:27):
and working together to devise strategiesaddress a person's substance use.
This contrast, in a way,with coming in as a provider already
with an agenda, don't need to, quoteunquote, fix any problem right away.
We just need to listen.
And that's about building trustin that quote that Caitlin brought up
regarding building connections.
(18:48):
And I think that opens the doorto even more conversations about goals.
And that can help person on that roadto recovery.
it's important that we respect a person'sdignity, while we help them stay safe.
What does the current drug supply
look like in new Jersey,and how is that impacted by policy?
(19:08):
the role of communitydrug checking technician.
That is something
I'm talking about all day, every daywith our participants especially,
and with other people doing community drugchecking around the country.
really, what we know nowin New Jersey, as Clement said earlier,
almost all of the, streetopioid supply is now fentanyl.
(19:30):
most peopledo not expect to receive heroin,
even if they use the word heroinfor what they're purchasing.
They know that there'sgoing to be fentanyl in that.
That is release in the opioid supplyand occasionally in the pressed pills
that are sold as synthetic opioids or,you know, like a prescription
pill that a pill made to mimica prescription pill.
(19:51):
So we know that already,
that sort of a baselinethat we're starting with, unfortunately.
And that is really, as Clementsaid, a result of some of the,
legal criminalization of drugs, the abruptstopping of opioid pain medication
prescriptions earlier in the 2000sand other unregulated drug supply itself.
(20:12):
And so we use that base level of fentanyl.
Some of the other thingsthat we're seeing,
many people have heard the wordxylene or tranq, and that is a veterinary
sedative that entered the drug supplya few years ago now we're actually seeing
as psilocybin has been criminalizedin the state of Pennsylvania, scheduled
psilocybin, in their drug sentencing,we're now seeing meta Toma creep up,
(20:36):
which is another veterinary sedative,but it also has a human.
And, ingestible versioncalled Dec's meditative machine.
And so that is a heavy sedative.
The meta Tolman that we're seeing cansometimes cause hallucinations.
Sometimes people thinkthat they were dosed with PCP or ketamine
(20:58):
or some sort of a dissociative,because we're seeing folks who will lose
an entire day to one bagthat they thought was just going to
maybe get them off emptyand help them feel better.
So we are in a state of an everchanging drug supply.
another thing we're startingto see in new Jersey, in New Brunswick,
where I'm doing our drug checking, are,local anesthetics in the drug supply.
(21:23):
Lidocaine, prochain and tetra cane
are showing up at unprecedented amounts.
that's another filler, right,that people are putting in to mimic
an effect of a drug they may not be ableto source because of criminalization.
don't know right now where that's going.
That's relatively new.
But we do know things like ifsomeone has a preexisting heart condition,
(21:45):
regular use of internal lidocaineuse can really aggravate that.
And so there are some thingson the horizon
that we're starting tolook at as we see these new drug trends.
Clement, anything to addmaybe about some of those trends
that you're seeing and maybe
what's being done on the treatment sideto address The changing supply.
because of the changing and unpredictabledrug supply
(22:05):
and the way that that it's evolving,you know, treatment providers
really must utilize strategiesthat truly keep people safe from harm.
for example, now that thethat fentanyl is fully omnipresent,
our existing medicationssuch as buprenorphine,
which was approved backin 22,002 by the FDA,
(22:29):
has has led to more challengesas far as starting that medication, right.
Thingslike fueling more withdrawal. Right.
Which we call precipitated withdrawal,
or feeling like backlike it doesn't work as well.
we must keep up, and understandthat because of this unpredictability,
we have to keep up withwhat's going on in, the drug supply.
(22:50):
And as Caitlin mentioned, it'sso unpredictable with, like, psilocybin
and meta automating, that we mustconsistently devise new ways and keep up
with, with research, to identify
what is the most optimal method.
And evidence based strategyto continue to keep people safe.
(23:10):
I want to make sure to add to the contextthat as we talk about these adulterants
that are increasingly strongerand more potent, it really is not stemming
from just some nefarious personwho sells drugs wanting to harm people.
I can't speak for every personwho sells drugs, but for the most part,
I know that they are in a situationdue to the environment they were exposed
(23:35):
to throughout their livesand the impacts of the drug war.
And generally,nobody is really looking to kill
the people that are buyingsomething from them, right?
That wouldn't be good for business.
But what we do knowis that the unpredictability of the drug
supply really stems from prohibition.
And there is something called the iron lawof prohibition that has been studied
(23:56):
since the 1920s, our original prohibition,alcohol prohibition.
And it basically says that any timethe government makes one substance
illegal, the demand doesn't go away.
Just because the supply does right,the supply goes away.
But it's human nature to want to escapeor achieve a feeling
or lose a feeling or whatever it ispeople are seeking in their use.
(24:20):
And so that demand is still there.
And so what we saw in the 1920sis very similar to what we're seeing here.
We saw an unregulated alcohol supplythat was not made by chemists
in a regulated way.
It was made by people, sort of armchairchemists doing the best that they could.
We saw botulism.
We saw alcohol poisoning.
And so we're seeing that mimicked.
first heroin was scheduled and we saw thatsort of removed from the streets.
(24:43):
It was replaced with fentanyl.
As fentanyl became scheduled,it's been replaced with psilocybin.
As psilocybin is becoming scheduled,it's being replaced with medicine.
Modine.
And it reallyyou can track things like that.
There's researchthat shows every time a drug bust happens,
overdoses increase in that neighborhoodbecause the demand hasn't gone away.
what Clement is talking about too,with Matty and different,
(25:07):
more creative optionsfor people who use drugs
is the fact that for some people,the very real truth is that
drugs are not going to stopbeing a part of their world.
But we do want people to knowthat they can be safer in their use,
or that they have other options, right?
For some people,that opioid is the thing causing
(25:27):
unpredictabilityand and making them feel chaotic.
And so they can stop that opioid use,whether through abstinence,
through a combination of abstinenceand medication, for addiction treatment.
And they can there isn't just one way.
quite often we focus on the drug supplyand blame the person selling.
(25:47):
But I always tell people unless they havelike an infrared spectrometer,
which they likely don't,they really don't know
what's in the drugsthat they're selling either.
I just wanted to emphasizethat that is very true in that,
you know, in the it's in the InternationalJournal of Drug Policy,
in the paper was called I couldn't livewith killing one of my friends
(26:08):
or anybody, a rapid ethnographic studyof drug sellers, use of drug checking.
And actually,one of their findings was that to address,
the the overdose crisis and save lives,
we need policies that also, supportpeople who are selling drugs
and for example, using harm reductionapproaches, for for people who sell drugs
(26:30):
That's a great segue to talk aboutwhat we're doing currently in new Jersey
to create better outcomesfor people who use drugs.
from a policy perspective,we have had some really great advancements
around drug policy in New Jersey in 2021.
We have the naloxone policy expansion,which was part of the Overdose Prevention
(26:52):
Act, it went from just one typeof naloxone to all FDA approved forms
of naloxone being legal in new Jerseyto not only carry, but to distribute.
We have a standing order,
which means a statewide prescriptionfor everyone over the age of 14.
have a programled by the Department of Human Services
that has about over 700 pharmaciesparticipating in the state,
(27:15):
where anyone overthe age of 14 can walk in and just say,
I need naloxoneand they don't have explain more.
We have advanced to a lot more community
based distribution of naloxone,which we know works.
We know that people who use drugsand the people in our families and close
social circles are most likely to bethe first person to witness an overdose.
(27:37):
And so by educating folkswho are in our lives
and people who use drugs ourselves onhow to respond when our friend falls out
or our loved one falls out,
that also eliminatessome fear that can come in, especially
in communities where calling nine one 1stMay come with fear of police brutality.
the, expansion of harmreduction centers has directly
(27:58):
led to a reduction in overdosedeaths in new Jersey.
The harm reduction expansion billwas passed two years ago, and in exactly
two years we have significantly reduceoverdose deaths in new Jersey.
And that literally alignswith going from seven
harm reduction centers statewide to 51,which we currently have.
(28:18):
And that is due to policy changesto realizing that a harm
reduction center is not appearing to dosomething horrible in your neighborhood.
A harm reduction center is addressingthe harms that have come with drug use.
And what we know in new Jersey is thatthere's not one single county where
we're not seeing overdoses, and thereforewe need support in every county.
(28:39):
We're looking forward
to continuing on themand continuing to expand harm reduction.
Right now, we know that the easierit is for someone to receive medication
for their addiction or opioid use disorderor their substance use disorder,
the better the outcome.
So rather than relying on someoneto seek a doctor themselves,
(29:00):
we have things like bridge prescriptionsto our harm reduction centers.
Right?
Or those quick referrals wherein new Jersey they're working on a rapid
referral program overall, we'realso working on taking advantage of the
the recent leave reduced,methadone regulations.
We know that more people is easierto become an opioid treatment center now.
(29:23):
And we're seeing somesome counties invest in mobile solutions
for for delivery of that thingsthat are practical for folks who may not
physically or financially be able tomake it to a clinic to receive their care.
the more options we have, the more thingsthat meet people where they are
both literally and figuratively,the better we're going to be.
(29:45):
last year, back in 2024, new Jersey,the new Jersey governor signed the bill
that removed harm reduction supplies from,you know, the paraphernalia laws.
So that help to eliminatecriminal penalties
associated with drug checking equipmentlike fentanyl and silencing test strips.
Syringe distribution,and also other supplies like,
(30:09):
using devices for mixing substancesand other objects for using substances,
especially when they're providedby an authorized harm reduction center.
So with all the legislation and all thedifferent policies that Caitlin mentioned
from this greater perspective, within ourthe state of new Jersey, you can see that
it favors a public health approach versusa criminalization approach.
(30:34):
And this is so importantto lowering the barrier to care,
supporting evidence based strategies,and supporting recovery
because people are more likely to engage
in care when they don't fear the penaltiesof carrying these lifesaving,
tools It's great to hear thatthe state is so dedicated
to improving outcomesfor people who use drugs.
(30:56):
I think it would be great
to hear about what individualsthemselves can do to also work
towards that mission of creating betteroutcomes for people who use drugs.
people can start with kindness.
We often are taught to keep to ourselves,walk over
someone slumped over on the street,don't give that coin to them.
You don't know what they'll dowith it. Right.
(31:16):
And and we have a lot of stigma aroundpeople who use drugs, visibly.
And people who use drugs visibly are oftenpeople
push the furthest to the marginswho have lost housing.
They may be living with substanceuse disorder,
but when you really thinkabout it, 84% of adults in new Jersey,
that's a lot of people, including peoplewho are using behind closed doors.
(31:37):
So sometimes it's
really dropping the stigmathat we have about our own substance use
that we've been taughtby the war on drugs,
There are things that are coming to lightin the way
that we've spoken about drugs for yearsthat are actually false.
And so it's things like podcasts like thiswhere we're addressing the truth.
Clinicians like Clement
and all of the folks at UniversityHospital who are warm and welcoming.
(32:02):
I don't know how many timesI've said to Clement,
if I had a prescribing pharmacist like youor I had a doctor
like Doctor Nico, right, or Doctor Nessen,how much safer
I would have felt, you know, owning upto some of the things that were happening.
And so really, as community membersand as neighbors, we can be kind.
(32:24):
We can do our bestnot to look askance or, spread rumors
about people's substance use.
We can do thingslike carrying the locks on
and let your neighbors knowthat you're carrying the locks on.
Right, and let people know I'm a safeperson to talk to about your substance
use or your child's substance use,or your partner's substance use.
I always believe that, we have advanced
(32:48):
so much in all of the waysthat we treat substance use disorder.
But if we force people behind closeddoors, that doesn't help anyone.
And so it can really startwith just kindness.
this is something that Caitlin
and we have talked
about throughout this podcastis that you must address the stigma
and view people who use drugsnot as people with moral failings,
but instead as another human beingwho may need care.
(33:11):
Right.
And we address before that we can useperson first language
normalized harm reduction within society.
Imagine if we saw harmthese harm reduction on these billboards
when we drive down the highwaysor really utilized social media to get out
the word that harm reduction centerscan be used by anybody, right?
Anybody?
(33:32):
I think there's that stigma that we see.
The harm reduction servicesor centers are only for people
who are actively using drugs.
And I and that is so not the case.
And I think it's important thatwe normalize that within our community.
So putting on billboards or things that wesee in social media can really help.
Folks understand.
And we must continue to support evidencebased care that includes muddy treatment.
(33:56):
As I mentioned, the harmreduction services
utilizing peer recovery specialists.
Right.
Importantly,which is happening in new Jersey,
from a clinician care model,this integrated care
model that integrates substanceuse disorder, behavioral health
care and physical health,making it easier one stop shopping.
(34:18):
They like to say right, but making iteasier for, people who use drugs,
who may have lots of social determinantsof health, making helping them get access
to all the care that they needwhen they need it in, in, in one location.
And from a public health standpoint,we must engage in policy and advocate
for those that would advance care,whether from a legislation perspective,
(34:42):
which we've discussed,new Jersey has been at the forefront
or even within healthcare systems and selves, right?
Policiesthat really support harm reduction.
We can also collaborate with each otherand organizations that are
that are truly doing this work. All right.
And then as we kind of approachthe end here, just a quick final question.
(35:03):
What is one thingthat you are both hopeful for
in this world of substance use?
With the coming New Year?
recovery is possible.
And we talked of when we make connections.
And it's that quote that Caitlin mentionedwhen we think that
the opposite of addictionis not surprising,
but the human connectionswe make with each other.
(35:24):
And that helps to reallyinstill the dignity,
the respect and the love we havefor people and for humanity in general.
And that helps them, helpspeople on the road to recovery
with our legislation, with,the ever expanding acceptance of,
the need to address, substanceuse disorders from a more,
(35:45):
humanized level, the more we're able to
to help peopleimprove their outcomes and reduce
overdose deaths and just get peopleon the road to recovery.
one thingI'm hopeful for is that people can start
to see that harmreduction is not antithetical to recovery.
(36:05):
You know, recovery is a form of harmreduction for some people,
the best way to reduce harm is abstinence.
Right?
And harm reduction embraces that.
It is not an opposite.
It is not in opposition to that. Right.
And so when we start there, as Clementsaid earlier,
you look at the continuumof substance use.
Harm reduction has somethingfor everyone on that continuum, right?
(36:28):
Harm reduction centers, as Clementsaid, have something
for everyone in the community.
We have safe syringe disposal,whether it's for hormone therapy,
whether it is for diabetes,whether it is for your cat
needing medicineand you don't know where to put this
sharps disposal containeror you don't have one, we can do that.
We can come collect syringesthat you see on your street.
(36:51):
If somebody didn't dispose of themproperly.
Harm reductionreally can meet everyone where they're at.
And I think that sometimespeople misinterpret
that harm reduction is in some wayopposed to abstinence based recovery,
but really recovery fallsunder the umbrella of harm reduction.
And for some individuals,
if not using any drugsis the way that you reduce that most harm.
(37:14):
We respect that,and I hope that folks learn that
and give give harm reduction a chanceand really see that people
who use drugs are just that, or peopleright where people
and at the heart of everythingwe want what everyone else has.
We have a rich inner dialogwith dreams and love and hope
and thoughts and peoplethat are important to us.
(37:37):
No different just because we might looka little different sometimes.
think that's a great pointto end this episode on.
I know we have covered a lot today.
We started with discussingthe spectrum of substance use
and how substance use disorderis really one extreme of that spectrum,
how harm reduction can collaboratewith traditional providers
and that harm reduction is really opento anyone, wherever they are,
(38:00):
on their journey of life.
We discuss the role of empathyand working with people to provide care
for addiction support.
And as well as the role of empathyin helping reduce costs
on our health care system.
We discuss the unpredictable drug supplyand the importance of needing to keep up
with evidence based
treatment and really, whatnew Jersey and individuals alike can do
(38:20):
to make sure that people in new Jerseyare having the best outcomes,
regardless of where they fall onthat spectrum of substance use.
I want to thank both of youfor being on this episode.
I think we have all learned a lotfrom your expertise.
For those
who are listeningto our conversation today,
if you want to dive deeperinto this topic, you can join
Caitlin and Clement on the SubstanceUse Disorder Echo series,
(38:43):
which will be returning Friday, January9th at noon in the New Year.
Sessions are held on select Fridaysfrom 12 to 1 p.m.
Eastern time.
And you can also check outsome of our other offerings
on our echo website, like our MaternalOpioid Intervention Echo.
Thank you both for joining me today,and thank you for those who are listening.
(39:04):
We'll be returning next month with anotherepisode focused on autonomy and health
care for individuals with intellectualand developmental disabilities.
See you next time.
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