August 29, 2024 • 31 mins
Episode 8 - Emerging Overdose Detection Technologies and Hotlines
Featuring:
Ju Park, PhD MHS
Assistant Professor of Medicine (Research)
Director of Harm Reduction Innovation Lab
Stephen Murray, MPH, NRP
Director, Massachusetts Overdose Prevention Helpline
Harm Reduction Program Manager, Boston Medical Center
Host:
Ricky N. Bluthenthal, PhD
Distinguished Professor of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
Associate Director of Institute of Addiction Sciences, USC
Most people who experience a fatal overdose are alone at the time of use and death (solitary drug use). Real-time monitoring of drug use events and rapid connection to a peer responder or Emergency Medical Services could save lives if widely available. This podcast will describe the rationale for remotely supervised drug use via overdose prevention technologies and hotlines and provide examples for how these programs are working in the United States.
Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.
Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Learn more about PCSS-MOUD at pcssnow.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Kinna Thakarar (00:13):
I'm Kinna Thakarar and welcome to the
podcast series, Harm Reduction,Compassionate Care for People
Who Use Drugs.
Harm Reduction is a socialjustice movement started by and
for people who use drugs, andit's a philosophy of care and
practical set of strategies tooptimize people's health,
safety, and rights.
We want to acknowledge and honorthe long history of street
(00:33):
medicine and healthcaredeveloped by people with lived
and living experience to keepone another alive and safe
through community care.
Whether you're a seasoned harmto the concept, we're glad
you're here and hope you'lllearn something new and are
curious to explore seeingpatient care through a harm
reduction lens.
This podcast series is broughtto you by the Providers Clinical
Support System, Medications forOpioid Use Disorder Project, and
(00:56):
AMERSA.
kinna-thakarar--she-her-_4 (00:57):
This week, we welcome Dr.
Ricky Bluthenthal inconversation with Stephen Murray
and Dr.
Ju Park to discuss emergingoverdose detection technologies
and hotlines.
Our host, Ricky N.
Bluthenthal, PhD, is theAssociate Dean for Social
Justice and Vice Chair forDiversity, Equity, and
Inclusion, and a distinguishedprofessor in the Department of
Health population and publichealth sciences in the Keck
(01:19):
School of Medicine at theUniversity of Southern
California.
His research has established theeffectiveness of syringe service
programs, tested novelinterventions and strategies to
reduce HIV risk and improve HIVtesting among people who use
drugs and men who have sex withmen, documented how community
conditions contribute to healthdisparities, and examined health
policy implementation.
(01:41):
Stephen Murray, MPHNRP, is anoverdose researcher, harm
reduction program manager, andthe director of the
Massachusetts OverdosePrevention Helpline at Boston
Medical Center.
He is a retired lieutenant at alarge regional ambulance service
in western Massachusetts and hasserved as a first responder
since 2013, having worked bothas a firefighter and paramedic.
(02:03):
He regularly shares for anational audience about his
lived experience as a person whoused drugs and an overdose
survivor.
SIRM provides expert technicalassistance around the topics of
overdose prevention, emergencymedical services, and harm
reduction to a variety oforganizations, county, and state
governments across the country.
Dr.
(02:23):
Ju Park is a substance useepidemiologist who conducts
community based research onsubstance use and harm
reduction.
Dr.
Park's team, the Harm ReductionInnovation Lab, works to promote
the health and well being ofpeople who use drugs by
implementing and evaluatinginterventions to reduce overdose
stigma and other negativeoutcomes associated with drug
use.
The presenters reported nothingto disclose.
(02:46):
Thanks for joining us, Ricky,Ju, and Stephen.
Ricky Bluthenthal (02:49):
Thank you, Kina, and welcome, listeners.
It's great to have everyonehere.
I'm your host, RickyBluthenthal, and we have a real
treat in store for you today,where we're going to talk about
emerging overdose detectiontechnologies and hotlines.
Over the next 30 to 40 minutes.
You'll hear from two experts,Stephen Murray from Boston and
Ju Park from Rhode Island whohave both been involved in
(03:13):
remote sensing activities andoverdose prevention efforts for
decades.
So why don't we get started withyou, Ju.
How prevalent is solitary druguse and what are the associated
risks, especially concerningfatal overdoses?
Ju Park (03:30):
Thanks, Ricky.
It's great to see you again.
So when we talk about solitarydrug use, we're thinking about
using alone.
So that's the More common phrasethat might be more familiar to
your listeners.
We don't unfortunately have anynational estimates, but we know
(03:50):
that using alone is reallycommon.
When you look at survey datacollected from different cities
and towns across america About50 to 75 percent of people who
use drugs Report using alone atsome point in recent times.
And so it is a fairly commonthing.
And when we look at thesenumbers, we know that the risks
(04:16):
are great when there's no onearound to monitor you to call 9
1 1 to administer naloxone.
You are definitely at higherrisk of an overdose.
Stephen Murray (04:28):
Just to add into that as well.
I think from back to my own,use, and I would say the vast
majority of my drug use wasalone and like that seemed very
normal to me at the time.
There's a lot of reallyimportant sort of societal and
structural reasons why peoplechoose to use alone.
And if we don't acknowledgethose reasons, we can't
(04:49):
understand interventions to meetthem where they're using to
quote Kim Powers.
So like, I think about if you'reafraid that your family's going
to find out that you're usingyou would use alone in the
bathroom if you're staying withyour family in order for them
not to find you.
If you're afraid that your job'sgoing to find out that you're
using and you work at arestaurant, you may go use in
the walk in freezer to avoidbeing detected.
(05:10):
So people are using alone, butoften it's close by to others
that could be available to themin an overdose.
If they, one, didn't feelstigmatized enough to the point
where they had to be alone.
Or two, if they knew that theoverdose was occurring.
And so I think part of what whatyou and I are doing is exploring
how to fill that gap of like theperson is alone.
(05:34):
They may be near somebody orthey may be near first
responders yet without knowingthat that person is there or in
need-- they're not having theiroverdose reversed.
Ricky Bluthenthal (05:44):
There's another piece to that, which is
the sort of structural economicimmiseration that can often
follow hand in hand with chaoticsubstance use where people find
themselves in S.
R.
O.
S.
Right.
So a lot of the early studies Atleast on the West Coast about
fatal overdoses, vancouver andSan Francisco found that people
(06:04):
who were low income and stayingin single room only hotels were
at elevated risk of fatality.
So let's get into the nittygritty about these real world
interventions.
So Steven, why don't you tell uswhat you've been up to?
Stephen Murray (06:18):
Yeah, sure.
So I, Was involved with thisoverdose hotline going back into
early 2020 at the time that wasreally sort of pertinent that we
think about folks who areisolated and using alone because
COVID was rearing its head andwe were seeing unprecedented
amounts of social isolationacross the board.
(06:38):
At that time I was still workingactively as a paramedic, and
quickly saw we were having anincrease in fatal overdose.
I had heard about the Never UseAlone hotline, I think through
Facebook, and that got meinterested in this concept.
And so I helped to start up theNever Use Alone Massachusetts
line, which has gone on tobecome This line that we operate
(06:59):
now, which is the Massachusettsoverdose prevention helpline.
We are state funded through thedepartment of public health here
in Massachusetts.
We operate a 24 hour servicethat hangs out with people on
the phone while they're usingdrugs alone.
And in the rare event that theyoverdose, we're able to get help
to them.
We just had our 10th 911activation a couple of nights
(07:20):
ago.
I guess over the last year and ahalf.
But we've supervised more than2, 200 solitary drug use events
in that time.
Across all of the overdosedetection hotlines that exist,
and there's a few of them in theU.
S.
and Canada, I think there's beenmore than 400 overdoses
reversed, which You know, whilewe feel like it's not an
(07:40):
intervention that's really beenscaled to the population level
for those 400 individuals, thatmeant that they're still alive.
That's deeply meaningful to meto be part of that work.
We haven't really had the chanceto see it work at a bigger level
because we're only just thefirst place to get funding
really here in the U.
S.
to try to do it on a biggerscale.
Ricky Bluthenthal (07:59):
And then the peers play an important role in
your program, right, Stephen?
Can you talk about that?
Stephen Murray (08:04):
Our entire model is peer based.
So almost all of our operators,we've got almost 30 of them at
this point, are either peoplewith lived or living experience
or have a very close connectionto substance use.
Most of the ones that don't havedirect lived or living
experience actively work in harmreduction programs.
They're working with folks whouse drugs every day, in their
(08:25):
day jobs and then they're cominghome at night and answering the
phone for us.
They're really experiencedworking with our population, but
we actually have people sort ofacross the spectrum of use from
occasional, infrequent,recreational, up into people who
are cycling in and out of morechaotic use, up into people who
are in recovery.
Which can look different fordifferent people, whether it's
(08:46):
through, their own pathway orlike a California sober, or
they're in 12 step we see likeall different stuff in our
operator pool.
And as we move our way up ourchain both our full time
operators have lived experiencein some way.
And then I, myself as thedirector also have, lived
experience with overdose anddrug use.
(09:06):
It's really integral to ourmodel that the folks that answer
the phones.
Either have been there or arethere.
Understanding what it's like to,to be in a situation where
you're using alone and offeringsupport in the way that they
would maybe feel like they wouldwant to be supported.
Ricky Bluthenthal (09:21):
Cool.
Thank you.
So we know research can play animportant role in getting these
sort of harm reductionstrategies accepted and then
sometimes disseminated.
So what motivated you inparticular to get involved with
this remote supervised drug useintervention research?
Ju Park (09:38):
Well A couple of years ago, I was a naloxone trainer in
Baltimore, and we were invitedby a parent group out in the
county, rural Maryland, to givea naloxone training and at the
time, I hadn't thought about theissue of solitary drug use, but
(10:01):
a mother came up to meafterwards and told me that her
daughter had recently passedaway in a bathroom of a rehab.
And that, yeah, made me think.
Oh, how common is this?
And, you know, looking at thesurveys that have been done, it
seemed like a very commonproblem that was not really
(10:22):
being discussed.
And as Stephen mentioned COVIDpersonally, I think all of us
felt the isolation and couldunderstand why substance use
might have been increasing.
I was invited, fortunately, bythe Cobrae on opioids and
overdose to an event where.
An EMT by the name of StephenMurray gave a fantastic
(10:46):
presentation about the NewEngland hotline.
So that was a couple, I thinknow three years ago.
And, also met Gordon Casey fromBrave Technology Co op, and
others doing similar work and asa harm reduction researcher, I'm
always looking at interventionsthat communities really
(11:08):
appreciate, interventions thatcommunities developed
themselves, and that's really,at the heart of these Overdose
technologies that we arepiloting and evaluating in Rhode
Island
Ricky Bluthenthal (11:21):
Stephen has outlined the hotline method,
which is a little bit laborintensive.
But effective.
Have you explored some of theseother things like motion sensors
or Can you talk about that alittle bit?
Ju Park (11:31):
So we recently did a literature review and, found
that there are maybe threegroups.
Telephone hotlines are one groupof interventions.
The second group fixed siteinterventions, such as, reverse
motion senses, buttons that cango either on a wall or a ceiling
of a building to help detectoverdoses in real time and alert
(11:56):
nearby responders.
And then the third, mobile orwearables.
There are a number of apps, butalso watches and other tools
being developed, that are alittle more, technology heavy.
At the same time, doing thiswork, it's very clear to me that
none of these tools really workwithout the support of community
(12:19):
members, without buy in the, thestigma around substance use is
so real this housing issue thankyou program that I recently
visited, the patients that toldme that they like the idea of
these tools, but it's a realfear that the police are going
to show up if they overdose, orthey're going to get kicked out
(12:40):
of housing as you know, it's,it's been shown, in other
studies too and then also theloss of custody of children, and
that's another real barrier.
Some of these policies that wehave inadvertently causing or
perpetuating the problems thatwe're trying to solve.
It's an interesting space to beto do this work well, I think we
(13:02):
need to move on all fronts, thetechnology side, the scientific
evaluation side, but also thepolicy side of things.
Ricky Bluthenthal (13:09):
Well, that brings up, the concern about
ethical issues.
So, Stephen, can you talk atleast from your experience about
what are some of the ethicalconsiderations that come up with
implementing these remotesupervised drug use
interventions?
Stephen Murray (13:24):
There's a couple of different major
considerations from an ethicalstandpoint.
The first of course, comes downon the to the technology side,
which is is the technologysecure, are the data secure that
are being collected, because wedo still live in a highly
criminalized prohibition ladensociety where, Law enforcement
does have a vested interest incriminalizing folks who use
(13:47):
drugs.
As you really rightfully pointedout, criminalization is at the
forefront of the minds of ourcallers.
And so it needs to be at theforefront of our minds and
criminalization comes inmultiple forms too.
I mean, we support parents whouse drugs, we're worried about
criminalization in the form ofChild Protective Services.
(14:08):
That's just another example.
Housing is, policed in some way,where people are afraid that if
we activate the 9 1 1 system forthem, they may lose their
housing.
One of the most disturbingthings that we ever heard on a
hotline call was somebodytelling us that they were more
afraid of losing their housingthan they were of dying from an
overdose.
That is a really grim realityfor folks that are, they're
(14:31):
having to make that valuedecision.
Before they pick up the phone tocall us, they're thinking, am I
going to die if I don't use theservice?
If I use the service and I don'tdie, does that mean I'm going to
lose my kids in my house?
Like that is not a really greatplace for people to be starting
at.
When they're trying to make adecision that is about improving
their health.
So that's really the first ones.
(14:52):
How do we keep people'sinformation secure?
How do we keep them as safe aspossible from some of the other
prohibition related harms thatare out there?
We take that really seriously.
We don't collect any personalidentifying information about
people.
The only location data that wekeep is zip code.
Which we can even further,obscure or randomize if needed.
(15:13):
Then all of our data are kept ina red cap database, which has
very little identifyinginformation.
We also do record calls mostlyfor the safety of our callers,
and operators to make sure thatour rules are being followed and
operators aren't putting callersat risk and that callers aren't
also in turn harming operators.
(15:35):
But we've gotten much moreaggressive in our call recording
retention policy.
We now have calls deleted withinseven days and sometimes even
sooner than that.
Once they've been reviewed byour quality team to make sure
that nothing out of the ordinaryhappened.
It's a personal goal of mine toget that under 72 hours within
the next six months.
But part of that is scaling upour staff a little bit to make
(15:56):
that a possibility.
The other thing is that, We'veput a lot of things in place on
the same vein of like protectingcallers and operators is that
there is a lot of trauma bondingthat happens with folks when
they're talking on the phoneregularly.
A lot of our callers are repeatcallers.
They call every day, multipletimes a day, 10 times a day.
Every time they use, which iswhat we want, but they do get to
(16:17):
know the operators.
And so we do have pretty strictrules about exchanging personal
information between operatorsand callers in order to help
protect some of those boundariesand keep things as appropriate
and professional as possible.
So there's a lot at play there.
We have a code of conduct thatour operators have to initial
and sign and there's like 20items on there.
(16:39):
I had a reflection from a recentoperator who came on was like,
let me guess, all 20 of thosethings are things that have
happened on the line that you'renow accounting for.
And, and they're absolutelyright.
It didn't necessarily happen onour line, but we all talk, all
the different hotlines talk, sowe know when something happens
on one line, Oh, we bettersecure up and not make it happen
here.
There's a lot that goes intomaking sure that this is done
(17:00):
safely and professionally foreverybody involved.
Ricky Bluthenthal (17:04):
So let me ask you a question.
There is a line of thinking inthe world that suggests that
anything you do to keep peoplewho are experiencing chronic
substance use disorder alive isproblematic or enabling somehow,
have you addressed that in yourresearch and what's your
(17:24):
response to that concern?
Ju Park (17:27):
Yeah, that's the gut reaction a lot of people have
when they hear about harmreduction for the first time,
the concept of keeping peoplesafe, supporting them, even if
we don't agree with all of theirchoices.
Somebody mentioned at aconference recently that
actually Stephen and I presentedit-- when it comes to
(17:48):
evaluation, does it reallymatter if you only reverse, 10,
20, 50 overdoses?
And my response to that line ofthinking is that in my opinion
is that every life matters, butwhen we think about people who
use drugs as humans, asrelational beings, that is
(18:11):
someone's, you know, daughter,son, grandchild, that is
someone's father, mother....
I think maybe my experience is alittle different because I have
lost friends to overdose, butactually it shouldn't be that
different because according to anational study that was
(18:31):
published recently, 40 percentof Americans know someone who
has died of an overdose.
The stigma is real but from aharm reduction perspective, we
need to be keeping people safeand treating this like a health
crisis, values and morals asidethe goal really is to reduce
harm the harms, the socialharms, the health harms, the
(18:55):
economic harms, costs over atrillion dollars to the US
economy every year.
So I really hope that people whohave that reaction to patients
with substance use disordersreally think about, like, where
does that line of thinking comefrom?
Is it something that we trulybelieve or is it something that
(19:16):
we've been taught or our societyimposes upon us?
Ricky Bluthenthal (19:20):
Let me just follow up with you then.
So in keeping that in mind howdo you approach evaluating these
programs?
What are the things that you'relooking to see change or happen
over the long term wouldevaluate whether these are
effective or not?
Ju Park (19:35):
We really want to show the impacts, not just to
overdose numbers.
Overdose numbers are important,but there's a lot of stress and
burnout that happens incommunity organizations
specifically.
For example syringe exchangeprograms or housing programs,
the staff are wearing multiplehats, doing 20 things at the
(19:58):
same time and checking on thebathroom every 2 to 5 minutes.
It's a burden.
One of the things we're hopingto show is that these tools
could help alleviate some ofthat burden and cognitive
stress.
Right now, the study we have inRhode Island is only 12 months
and has only a few sites.
(20:18):
We are actively working tosecure longer term funding.
And I think that's That's wherewe are headed and that's what we
really need because theseinterventions, tools, whatever
you want to call them, take along time to really be
implemented and adopted.
Even the Never Use AloneHotline, it's been around since
(20:41):
2020.
When we go out and ask people,Hey, have you ever heard of the
Never Use Alone Hotline?
A lot of people have never heardof it.
The longer term studies ofwhat's really going to help us
understand what's going on andwhat's going to be most
effective.
Ricky Bluthenthal (20:57):
I like that you brought up the workforce
implications.
One of the things I hear andStephen describing the hotline
that he runs is the relationshipbuilding piece, which is
obviously really positive, butit can have this cognitive and
emotional burden for the peoplewho work in that space.
So I wonder, and this issomething for the other people
(21:18):
listening to this to think aboutis what are ways to reduce that
space in your community betweenpeople who have substance use
disorder and are at risk foroverdose death and the isolation
that comes with that.
Something to think about andmaybe we can return and reflect
on that towards the end.
so let's turn to the, thisAmerican life episode eight or
(21:41):
nine that I'm happy to reporthad me crying at the end of it's
very moving, And really, in my30 years of experience in the
harm reduction movement isprobably the best distillation
of what harm reduction can do.
So, Stephen, can you talk alittle bit about, how that all
came to be?
(22:01):
And what's up with the folksthat were including yourself
that were featured in thatepisode?
Stephen Murray (22:07):
Sure.
And thanks, Ricky.
I'm glad it was so meaningful toyou.
To the AMERSA audiencelistening, the things that
people came up and said to me atthe conference in November,
really deeply meaningful.
I'm glad that people felt heardby what we did it's 1 of the
most special things that I'vehad happen to me in this work so
(22:28):
far, having our peers, like, inthis space feel like the people
around them understood thembetter through that episode.
It came about in a weird way.
I think the way it started wasthat mary Harris from Slate went
down to Georgia withphotographer and reporter to see
Jesse and to learn about Jesse'swork.
And while they were down there,Jesse was taking hotline calls,
(22:49):
and they got onto the story ofKimber, because it's a very, if
you heard, it's a very,interesting story because we
were all sort of broughttogether in that moment, and
they were like, oh, we want totell that story too.
And so they actually went andpitched it to This American Life
and it became a collaborativeeffort between Slate and This
American Life.
It's now won a Writer's Guild ofAmerica award.
(23:13):
For best audio documentary thisyear.
It just won last week.
It also won a Gracie award, fromthe Women's Foundation, which is
really, it's just really specialthat it's being recognized on
the national stage.
It was intense.
I think I have about 20 minutesof audio in it and that came
from like six and a half hoursof interview time.
It became what it is, which iswe think somewhere between six
(23:34):
and 8 million people listen tothis American life.
It was one of their biggerepisodes, I think of the year.
It's been heard around theworld.
When I was at the conference,the INSU conference, which is
the, the International networkfor hepatitis and substances.
People from Australia had heardit.
it has an impact on theinternational harm reduction
community as well, which isagain, it's like, just really
humbling and special.
(23:56):
In terms of what's going oneveryone's doing well.
Kimber works for the massoverdose helpline.
She's our frontline operator.
She's a full time salariedemployee of Boston Medical
Center and just an amazingspokesperson for the work that
we're doing.
She regularly joins me givingtalks.
I'm sending her off on her ownnow to do talks as well, which
she does scarily well, forsomeone who has like no media
(24:19):
training..
The other thing is that Jessealso is working with us on the
hotline.
So she takes calls for ourhotline as well.
We're also scaling her up into amentorship role where she's
working with new operators.
To help them be better operatorsbecause nobody does it better
than her.
She's the, she's the bestoperator in the world.
As you heard on the phone, likeshe just does it with such ease
(24:39):
and grace, and so we're alldoing really well.
We talk regularly.
I owe Jessie B a call probably,yeah, it's really great to still
be involved with them.
What does it mean to, the harmreduction community it's it is a
view into what at our very corewe're trying to do, which is to
keep people safe and give themthe autonomy to make decisions
(25:01):
about their own health and to,like, help them to make those
decisions however they see fit.
It's just about one personcaring about another person and
being there for them withoutother preconceived ideas or
ultimatums.
A lot of us who've been inchaotic drug use, we're used to
everybody around us giving usultimatums about our use or
demanding that we do certainthings or, or putting us in
(25:24):
places against our will.
So in harm reduction, we take anopposite approach, which is just
to, to love people and help themto make decisions that feel good
for them.
I think that's a beautifulthing.
Ricky Bluthenthal (25:36):
Well said.
What do you think in terms of,returning to this idea of the
stigma itself an independentvariable in fatalities related
to substance use disorder.
What are some other things thatwe could do, whether it's in the
remote sensing world or othersthat would address those
challenges?
Ju Park (25:53):
Repairing relationships between people some people, when
we ask, you know, why did youuse alone, say it's because
there is no one else.
A lot of people have turnedtheir backs on them.
Finding ways to help peoplecreate meaningful relationships
(26:14):
or repair those relationships, Ithink will be really important.
And then something basic likenaloxone coverage.
We still are seeing not enoughnaloxone in the hands of people
who could respond, and moreinnovative interventions, like
nalox boxes and naloxone vendingmachines-- I think those are
really exciting.
(26:35):
Then also just doing outreach innon traditional places.
So we've been going to fast foodrestaurants, gas stations,
libraries, gyms, places thatdon't usually get targeted by
harm reduction interventions andorganizations, but are also
places where either they seeoverdoses on site or they
(26:57):
encounter people who may benefitfrom naloxone training.
So I think all of those thingscan really help.
Lastly, I would say that, lotthe organizations that come to
us and evaluation team for helpoften say we know what works.
(27:18):
We know what we're doing.
It's just we need help showingthat it does work.
And sometimes that's for theirfunders.
Sometimes it's for reportingpurposes, or sometimes it's to
build support in their communitybecause they get a lot of
pushback.
Where evaluators, researcherscan really help is by working
(27:38):
with the community members whoare already doing the work and
finding ways to support themrather than coming up with fancy
solutions and just implementingthem wherever they want to
without the community support.
Ricky Bluthenthal (27:52):
I just want to highlight again the hotline
and the people involved in thatare of a long line of people who
use drugs, designing programsthat are sustainable and
effective at preserving life.
And really what they need isjust the resources to bring it
to scale.
In Los Angeles County where Iam, there's been a real local
(28:15):
level initiative to Build out aharm reduction infrastructure
and that they're spending Ithink it's about seven or eight
million dollars a year now sothey're building these case
studies of people who've gonefrom chaotic use to maybe a
recovery home to maybe A job anda lot of those cases have this
issue around reconnecting withfamily one of the first things
(28:39):
that people want is thatreconnection and it brings to
the surface That in some waysit's a bit of a horror, right in
terms of we're told Oh, you knowshut them off cut them down
don't enable them, and in factThere seems to be emerging
evidence that that that kind ofapproach Just makes it worse for
people and the answer isactually community and
(29:00):
relationship.
Ju Park (29:02):
You just reminded me of something that Una Creek from
Brave said to me very early on,which was that these
technologies are about buildingconnections.
We had this whole philosophicaldebate about how the use of
social media and cell phones,and even, Netflix subscriptions
have actually caused us to bemore independent and more
(29:25):
isolated.
And so, isn't it funny thattechnological tools could
actually be used to form thoseconnections?
I totally agree with what youjust said.
And you just reminded me ofthat.
Stephen Murray (29:36):
I can just add to that too, that, I often get
asked why I was able to pullmyself away from chaotic drug
use and can't really put myfinger on it besides, immense
privilege and also that I wantedto stop using was a big part,
but also like my family neverturned their back on me and I
never lost that connection.
I always maintained my owncommunity, at least with my
(29:59):
family.
I have my mom, to thank forthat.
And my sister, my sister hasactually devoted her life to
working with families to dothat, with a nonprofit that she
runs, where they're working withfamilies as well.
I think that that is a reallyimportant part of this
connection and, and why I'mstill alive.
If you're ever at thatcrossroads where you're
wondering, do you cut yourfamily off or not?
Well, you can hear at least fromme that the the reason i'm still
(30:21):
alive is that my family stuck byme even when things were pretty
bad.
Ricky Bluthenthal (30:25):
Let's end on this note then and i'll quote
the famous stephen murray theanswer to compassion fatigue is
Compassion.
Well, thank you both very muchfor sharing your experiences and
innovations that you brought tothis field and and all the great
work that you're doing.
kinna-thakarar--she-her-_5 (30:46):
That was Stephen Murray, Dr.
Ju Park, and Dr.
Rikki Bluthenthal inconversation on harm reduction,
compassionate care for peoplewho use drugs.
Thank you for listening.
Kinna Thakarar (30:55):
Please take a moment to complete SAMHSA's post
event evaluation survey on theAMERSA podcast page at www.
dot AMERSA dot.
Org forward slash harm reductionpodcast.
We welcome any comments,questions, or other feedback for
presenters.
You can send those directly toAMERSA through the contact us
form at AMERSA.
org.
To learn more about theprovider's clinical support
system, Medication for OpioidUse Disorder Project, and AMERSA
please visit our websites atPCSSMOUD.
(31:17):
org and AMERSA org.
Funding for this initiative wasmade possible by Cooperative
Agreement No.
1 H 79 TI 086 770 from SAMHSA.
The views expressed in writtenconference materials or
publications and by speakers andmoderators do not necessarily
reflect the official policies ofthe Department of Health and
Human Services, nor does mentionof trade names, commercial
practices, or organizationsimply endorsement by the U.
(31:37):
S.
government.
I'm Kinna Thakarar and welcome to the
podcast series, Harm Reduction,Compassionate Care for People
Who Use Drugs.
Harm Reduction is a socialjustice movement started by and
for people who use drugs, andit's a philosophy of care and
practical set of strategies tooptimize people's health,
safety, and rights.
We want to acknowledge and honorthe long history of street
(00:33):
medicine and healthcaredeveloped by people with lived
and living experience to keepone another alive and safe
through community care.
Whether you're a seasoned harmto the concept, we're glad
you're here and hope you'lllearn something new and are
curious to explore seeingpatient care through a harm
reduction lens.
This podcast series is broughtto you by the Providers Clinical
Support System, Medications forOpioid Use Disorder Project, and
(00:56):
AMERSA.
kinna-thakarar--she-her-_4 (00:57):
This week, we welcome Dr.
Ricky Bluthenthal inconversation with Stephen Murray
and Dr.
Ju Park to discuss emergingoverdose detection technologies
and hotlines.
Our host, Ricky N.
Bluthenthal, PhD, is theAssociate Dean for Social
Justice and Vice Chair forDiversity, Equity, and
Inclusion, and a distinguishedprofessor in the Department of
Health population and publichealth sciences in the Keck
(01:19):
School of Medicine at theUniversity of Southern
California.
His research has established theeffectiveness of syringe service
programs, tested novelinterventions and strategies to
reduce HIV risk and improve HIVtesting among people who use
drugs and men who have sex withmen, documented how community
conditions contribute to healthdisparities, and examined health
policy implementation.
(01:41):
Stephen Murray, MPHNRP, is anoverdose researcher, harm
reduction program manager, andthe director of the
Massachusetts OverdosePrevention Helpline at Boston
Medical Center.
He is a retired lieutenant at alarge regional ambulance service
in western Massachusetts and hasserved as a first responder
since 2013, having worked bothas a firefighter and paramedic.
(02:03):
He regularly shares for anational audience about his
lived experience as a person whoused drugs and an overdose
survivor.
SIRM provides expert technicalassistance around the topics of
overdose prevention, emergencymedical services, and harm
reduction to a variety oforganizations, county, and state
governments across the country.
Dr.
(02:23):
Ju Park is a substance useepidemiologist who conducts
community based research onsubstance use and harm
reduction.
Dr.
Park's team, the Harm ReductionInnovation Lab, works to promote
the health and well being ofpeople who use drugs by
implementing and evaluatinginterventions to reduce overdose
stigma and other negativeoutcomes associated with drug
use.
The presenters reported nothingto disclose.
(02:46):
Thanks for joining us, Ricky,Ju, and Stephen.
Ricky Bluthenthal (02:49):
Thank you, Kina, and welcome, listeners.
It's great to have everyonehere.
I'm your host, RickyBluthenthal, and we have a real
treat in store for you today,where we're going to talk about
emerging overdose detectiontechnologies and hotlines.
Over the next 30 to 40 minutes.
You'll hear from two experts,Stephen Murray from Boston and
Ju Park from Rhode Island whohave both been involved in
(03:13):
remote sensing activities andoverdose prevention efforts for
decades.
So why don't we get started withyou, Ju.
How prevalent is solitary druguse and what are the associated
risks, especially concerningfatal overdoses?
Ju Park (03:30):
Thanks, Ricky.
It's great to see you again.
So when we talk about solitarydrug use, we're thinking about
using alone.
So that's the More common phrasethat might be more familiar to
your listeners.
We don't unfortunately have anynational estimates, but we know
(03:50):
that using alone is reallycommon.
When you look at survey datacollected from different cities
and towns across america About50 to 75 percent of people who
use drugs Report using alone atsome point in recent times.
And so it is a fairly commonthing.
And when we look at thesenumbers, we know that the risks
(04:16):
are great when there's no onearound to monitor you to call 9
1 1 to administer naloxone.
You are definitely at higherrisk of an overdose.
Stephen Murray (04:28):
Just to add into that as well.
I think from back to my own,use, and I would say the vast
majority of my drug use wasalone and like that seemed very
normal to me at the time.
There's a lot of reallyimportant sort of societal and
structural reasons why peoplechoose to use alone.
And if we don't acknowledgethose reasons, we can't
(04:49):
understand interventions to meetthem where they're using to
quote Kim Powers.
So like, I think about if you'reafraid that your family's going
to find out that you're usingyou would use alone in the
bathroom if you're staying withyour family in order for them
not to find you.
If you're afraid that your job'sgoing to find out that you're
using and you work at arestaurant, you may go use in
the walk in freezer to avoidbeing detected.
(05:10):
So people are using alone, butoften it's close by to others
that could be available to themin an overdose.
If they, one, didn't feelstigmatized enough to the point
where they had to be alone.
Or two, if they knew that theoverdose was occurring.
And so I think part of what whatyou and I are doing is exploring
how to fill that gap of like theperson is alone.
(05:34):
They may be near somebody orthey may be near first
responders yet without knowingthat that person is there or in
need-- they're not having theiroverdose reversed.
Ricky Bluthenthal (05:44):
There's another piece to that, which is
the sort of structural economicimmiseration that can often
follow hand in hand with chaoticsubstance use where people find
themselves in S.
R.
O.
S.
Right.
So a lot of the early studies Atleast on the West Coast about
fatal overdoses, vancouver andSan Francisco found that people
(06:04):
who were low income and stayingin single room only hotels were
at elevated risk of fatality.
So let's get into the nittygritty about these real world
interventions.
So Steven, why don't you tell uswhat you've been up to?
Stephen Murray (06:18):
Yeah, sure.
So I, Was involved with thisoverdose hotline going back into
early 2020 at the time that wasreally sort of pertinent that we
think about folks who areisolated and using alone because
COVID was rearing its head andwe were seeing unprecedented
amounts of social isolationacross the board.
(06:38):
At that time I was still workingactively as a paramedic, and
quickly saw we were having anincrease in fatal overdose.
I had heard about the Never UseAlone hotline, I think through
Facebook, and that got meinterested in this concept.
And so I helped to start up theNever Use Alone Massachusetts
line, which has gone on tobecome This line that we operate
(06:59):
now, which is the Massachusettsoverdose prevention helpline.
We are state funded through thedepartment of public health here
in Massachusetts.
We operate a 24 hour servicethat hangs out with people on
the phone while they're usingdrugs alone.
And in the rare event that theyoverdose, we're able to get help
to them.
We just had our 10th 911activation a couple of nights
(07:20):
ago.
I guess over the last year and ahalf.
But we've supervised more than2, 200 solitary drug use events
in that time.
Across all of the overdosedetection hotlines that exist,
and there's a few of them in theU.
S.
and Canada, I think there's beenmore than 400 overdoses
reversed, which You know, whilewe feel like it's not an
(07:40):
intervention that's really beenscaled to the population level
for those 400 individuals, thatmeant that they're still alive.
That's deeply meaningful to meto be part of that work.
We haven't really had the chanceto see it work at a bigger level
because we're only just thefirst place to get funding
really here in the U.
S.
to try to do it on a biggerscale.
Ricky Bluthenthal (07:59):
And then the peers play an important role in
your program, right, Stephen?
Can you talk about that?
Stephen Murray (08:04):
Our entire model is peer based.
So almost all of our operators,we've got almost 30 of them at
this point, are either peoplewith lived or living experience
or have a very close connectionto substance use.
Most of the ones that don't havedirect lived or living
experience actively work in harmreduction programs.
They're working with folks whouse drugs every day, in their
(08:25):
day jobs and then they're cominghome at night and answering the
phone for us.
They're really experiencedworking with our population, but
we actually have people sort ofacross the spectrum of use from
occasional, infrequent,recreational, up into people who
are cycling in and out of morechaotic use, up into people who
are in recovery.
Which can look different fordifferent people, whether it's
(08:46):
through, their own pathway orlike a California sober, or
they're in 12 step we see likeall different stuff in our
operator pool.
And as we move our way up ourchain both our full time
operators have lived experiencein some way.
And then I, myself as thedirector also have, lived
experience with overdose anddrug use.
(09:06):
It's really integral to ourmodel that the folks that answer
the phones.
Either have been there or arethere.
Understanding what it's like to,to be in a situation where
you're using alone and offeringsupport in the way that they
would maybe feel like they wouldwant to be supported.
Ricky Bluthenthal (09:21):
Cool.
Thank you.
So we know research can play animportant role in getting these
sort of harm reductionstrategies accepted and then
sometimes disseminated.
So what motivated you inparticular to get involved with
this remote supervised drug useintervention research?
Ju Park (09:38):
Well A couple of years ago, I was a naloxone trainer in
Baltimore, and we were invitedby a parent group out in the
county, rural Maryland, to givea naloxone training and at the
time, I hadn't thought about theissue of solitary drug use, but
(10:01):
a mother came up to meafterwards and told me that her
daughter had recently passedaway in a bathroom of a rehab.
And that, yeah, made me think.
Oh, how common is this?
And, you know, looking at thesurveys that have been done, it
seemed like a very commonproblem that was not really
(10:22):
being discussed.
And as Stephen mentioned COVIDpersonally, I think all of us
felt the isolation and couldunderstand why substance use
might have been increasing.
I was invited, fortunately, bythe Cobrae on opioids and
overdose to an event where.
An EMT by the name of StephenMurray gave a fantastic
(10:46):
presentation about the NewEngland hotline.
So that was a couple, I thinknow three years ago.
And, also met Gordon Casey fromBrave Technology Co op, and
others doing similar work and asa harm reduction researcher, I'm
always looking at interventionsthat communities really
(11:08):
appreciate, interventions thatcommunities developed
themselves, and that's really,at the heart of these Overdose
technologies that we arepiloting and evaluating in Rhode
Island
Ricky Bluthenthal (11:21):
Stephen has outlined the hotline method,
which is a little bit laborintensive.
But effective.
Have you explored some of theseother things like motion sensors
or Can you talk about that alittle bit?
Ju Park (11:31):
So we recently did a literature review and, found
that there are maybe threegroups.
Telephone hotlines are one groupof interventions.
The second group fixed siteinterventions, such as, reverse
motion senses, buttons that cango either on a wall or a ceiling
of a building to help detectoverdoses in real time and alert
(11:56):
nearby responders.
And then the third, mobile orwearables.
There are a number of apps, butalso watches and other tools
being developed, that are alittle more, technology heavy.
At the same time, doing thiswork, it's very clear to me that
none of these tools really workwithout the support of community
(12:19):
members, without buy in the, thestigma around substance use is
so real this housing issue thankyou program that I recently
visited, the patients that toldme that they like the idea of
these tools, but it's a realfear that the police are going
to show up if they overdose, orthey're going to get kicked out
(12:40):
of housing as you know, it's,it's been shown, in other
studies too and then also theloss of custody of children, and
that's another real barrier.
Some of these policies that wehave inadvertently causing or
perpetuating the problems thatwe're trying to solve.
It's an interesting space to beto do this work well, I think we
(13:02):
need to move on all fronts, thetechnology side, the scientific
evaluation side, but also thepolicy side of things.
Ricky Bluthenthal (13:09):
Well, that brings up, the concern about
ethical issues.
So, Stephen, can you talk atleast from your experience about
what are some of the ethicalconsiderations that come up with
implementing these remotesupervised drug use
interventions?
Stephen Murray (13:24):
There's a couple of different major
considerations from an ethicalstandpoint.
The first of course, comes downon the to the technology side,
which is is the technologysecure, are the data secure that
are being collected, because wedo still live in a highly
criminalized prohibition ladensociety where, Law enforcement
does have a vested interest incriminalizing folks who use
(13:47):
drugs.
As you really rightfully pointedout, criminalization is at the
forefront of the minds of ourcallers.
And so it needs to be at theforefront of our minds and
criminalization comes inmultiple forms too.
I mean, we support parents whouse drugs, we're worried about
criminalization in the form ofChild Protective Services.
(14:08):
That's just another example.
Housing is, policed in some way,where people are afraid that if
we activate the 9 1 1 system forthem, they may lose their
housing.
One of the most disturbingthings that we ever heard on a
hotline call was somebodytelling us that they were more
afraid of losing their housingthan they were of dying from an
overdose.
That is a really grim realityfor folks that are, they're
(14:31):
having to make that valuedecision.
Before they pick up the phone tocall us, they're thinking, am I
going to die if I don't use theservice?
If I use the service and I don'tdie, does that mean I'm going to
lose my kids in my house?
Like that is not a really greatplace for people to be starting
at.
When they're trying to make adecision that is about improving
their health.
So that's really the first ones.
(14:52):
How do we keep people'sinformation secure?
How do we keep them as safe aspossible from some of the other
prohibition related harms thatare out there?
We take that really seriously.
We don't collect any personalidentifying information about
people.
The only location data that wekeep is zip code.
Which we can even further,obscure or randomize if needed.
(15:13):
Then all of our data are kept ina red cap database, which has
very little identifyinginformation.
We also do record calls mostlyfor the safety of our callers,
and operators to make sure thatour rules are being followed and
operators aren't putting callersat risk and that callers aren't
also in turn harming operators.
(15:35):
But we've gotten much moreaggressive in our call recording
retention policy.
We now have calls deleted withinseven days and sometimes even
sooner than that.
Once they've been reviewed byour quality team to make sure
that nothing out of the ordinaryhappened.
It's a personal goal of mine toget that under 72 hours within
the next six months.
But part of that is scaling upour staff a little bit to make
(15:56):
that a possibility.
The other thing is that, We'veput a lot of things in place on
the same vein of like protectingcallers and operators is that
there is a lot of trauma bondingthat happens with folks when
they're talking on the phoneregularly.
A lot of our callers are repeatcallers.
They call every day, multipletimes a day, 10 times a day.
Every time they use, which iswhat we want, but they do get to
(16:17):
know the operators.
And so we do have pretty strictrules about exchanging personal
information between operatorsand callers in order to help
protect some of those boundariesand keep things as appropriate
and professional as possible.
So there's a lot at play there.
We have a code of conduct thatour operators have to initial
and sign and there's like 20items on there.
(16:39):
I had a reflection from a recentoperator who came on was like,
let me guess, all 20 of thosethings are things that have
happened on the line that you'renow accounting for.
And, and they're absolutelyright.
It didn't necessarily happen onour line, but we all talk, all
the different hotlines talk, sowe know when something happens
on one line, Oh, we bettersecure up and not make it happen
here.
There's a lot that goes intomaking sure that this is done
(17:00):
safely and professionally foreverybody involved.
Ricky Bluthenthal (17:04):
So let me ask you a question.
There is a line of thinking inthe world that suggests that
anything you do to keep peoplewho are experiencing chronic
substance use disorder alive isproblematic or enabling somehow,
have you addressed that in yourresearch and what's your
(17:24):
response to that concern?
Ju Park (17:27):
Yeah, that's the gut reaction a lot of people have
when they hear about harmreduction for the first time,
the concept of keeping peoplesafe, supporting them, even if
we don't agree with all of theirchoices.
Somebody mentioned at aconference recently that
actually Stephen and I presentedit-- when it comes to
(17:48):
evaluation, does it reallymatter if you only reverse, 10,
20, 50 overdoses?
And my response to that line ofthinking is that in my opinion
is that every life matters, butwhen we think about people who
use drugs as humans, asrelational beings, that is
(18:11):
someone's, you know, daughter,son, grandchild, that is
someone's father, mother....
I think maybe my experience is alittle different because I have
lost friends to overdose, butactually it shouldn't be that
different because according to anational study that was
(18:31):
published recently, 40 percentof Americans know someone who
has died of an overdose.
The stigma is real but from aharm reduction perspective, we
need to be keeping people safeand treating this like a health
crisis, values and morals asidethe goal really is to reduce
harm the harms, the socialharms, the health harms, the
(18:55):
economic harms, costs over atrillion dollars to the US
economy every year.
So I really hope that people whohave that reaction to patients
with substance use disordersreally think about, like, where
does that line of thinking comefrom?
Is it something that we trulybelieve or is it something that
(19:16):
we've been taught or our societyimposes upon us?
Ricky Bluthenthal (19:20):
Let me just follow up with you then.
So in keeping that in mind howdo you approach evaluating these
programs?
What are the things that you'relooking to see change or happen
over the long term wouldevaluate whether these are
effective or not?
Ju Park (19:35):
We really want to show the impacts, not just to
overdose numbers.
Overdose numbers are important,but there's a lot of stress and
burnout that happens incommunity organizations
specifically.
For example syringe exchangeprograms or housing programs,
the staff are wearing multiplehats, doing 20 things at the
(19:58):
same time and checking on thebathroom every 2 to 5 minutes.
It's a burden.
One of the things we're hopingto show is that these tools
could help alleviate some ofthat burden and cognitive
stress.
Right now, the study we have inRhode Island is only 12 months
and has only a few sites.
(20:18):
We are actively working tosecure longer term funding.
And I think that's That's wherewe are headed and that's what we
really need because theseinterventions, tools, whatever
you want to call them, take along time to really be
implemented and adopted.
Even the Never Use AloneHotline, it's been around since
(20:41):
2020.
When we go out and ask people,Hey, have you ever heard of the
Never Use Alone Hotline?
A lot of people have never heardof it.
The longer term studies ofwhat's really going to help us
understand what's going on andwhat's going to be most
effective.
Ricky Bluthenthal (20:57):
I like that you brought up the workforce
implications.
One of the things I hear andStephen describing the hotline
that he runs is the relationshipbuilding piece, which is
obviously really positive, butit can have this cognitive and
emotional burden for the peoplewho work in that space.
So I wonder, and this issomething for the other people
(21:18):
listening to this to think aboutis what are ways to reduce that
space in your community betweenpeople who have substance use
disorder and are at risk foroverdose death and the isolation
that comes with that.
Something to think about andmaybe we can return and reflect
on that towards the end.
so let's turn to the, thisAmerican life episode eight or
(21:41):
nine that I'm happy to reporthad me crying at the end of it's
very moving, And really, in my30 years of experience in the
harm reduction movement isprobably the best distillation
of what harm reduction can do.
So, Stephen, can you talk alittle bit about, how that all
came to be?
(22:01):
And what's up with the folksthat were including yourself
that were featured in thatepisode?
Stephen Murray (22:07):
Sure.
And thanks, Ricky.
I'm glad it was so meaningful toyou.
To the AMERSA audiencelistening, the things that
people came up and said to me atthe conference in November,
really deeply meaningful.
I'm glad that people felt heardby what we did it's 1 of the
most special things that I'vehad happen to me in this work so
(22:28):
far, having our peers, like, inthis space feel like the people
around them understood thembetter through that episode.
It came about in a weird way.
I think the way it started wasthat mary Harris from Slate went
down to Georgia withphotographer and reporter to see
Jesse and to learn about Jesse'swork.
And while they were down there,Jesse was taking hotline calls,
(22:49):
and they got onto the story ofKimber, because it's a very, if
you heard, it's a very,interesting story because we
were all sort of broughttogether in that moment, and
they were like, oh, we want totell that story too.
And so they actually went andpitched it to This American Life
and it became a collaborativeeffort between Slate and This
American Life.
It's now won a Writer's Guild ofAmerica award.
(23:13):
For best audio documentary thisyear.
It just won last week.
It also won a Gracie award, fromthe Women's Foundation, which is
really, it's just really specialthat it's being recognized on
the national stage.
It was intense.
I think I have about 20 minutesof audio in it and that came
from like six and a half hoursof interview time.
It became what it is, which iswe think somewhere between six
(23:34):
and 8 million people listen tothis American life.
It was one of their biggerepisodes, I think of the year.
It's been heard around theworld.
When I was at the conference,the INSU conference, which is
the, the International networkfor hepatitis and substances.
People from Australia had heardit.
it has an impact on theinternational harm reduction
community as well, which isagain, it's like, just really
humbling and special.
(23:56):
In terms of what's going oneveryone's doing well.
Kimber works for the massoverdose helpline.
She's our frontline operator.
She's a full time salariedemployee of Boston Medical
Center and just an amazingspokesperson for the work that
we're doing.
She regularly joins me givingtalks.
I'm sending her off on her ownnow to do talks as well, which
she does scarily well, forsomeone who has like no media
(24:19):
training..
The other thing is that Jessealso is working with us on the
hotline.
So she takes calls for ourhotline as well.
We're also scaling her up into amentorship role where she's
working with new operators.
To help them be better operatorsbecause nobody does it better
than her.
She's the, she's the bestoperator in the world.
As you heard on the phone, likeshe just does it with such ease
(24:39):
and grace, and so we're alldoing really well.
We talk regularly.
I owe Jessie B a call probably,yeah, it's really great to still
be involved with them.
What does it mean to, the harmreduction community it's it is a
view into what at our very corewe're trying to do, which is to
keep people safe and give themthe autonomy to make decisions
(25:01):
about their own health and to,like, help them to make those
decisions however they see fit.
It's just about one personcaring about another person and
being there for them withoutother preconceived ideas or
ultimatums.
A lot of us who've been inchaotic drug use, we're used to
everybody around us giving usultimatums about our use or
demanding that we do certainthings or, or putting us in
(25:24):
places against our will.
So in harm reduction, we take anopposite approach, which is just
to, to love people and help themto make decisions that feel good
for them.
I think that's a beautifulthing.
Ricky Bluthenthal (25:36):
Well said.
What do you think in terms of,returning to this idea of the
stigma itself an independentvariable in fatalities related
to substance use disorder.
What are some other things thatwe could do, whether it's in the
remote sensing world or othersthat would address those
challenges?
Ju Park (25:53):
Repairing relationships between people some people, when
we ask, you know, why did youuse alone, say it's because
there is no one else.
A lot of people have turnedtheir backs on them.
Finding ways to help peoplecreate meaningful relationships
(26:14):
or repair those relationships, Ithink will be really important.
And then something basic likenaloxone coverage.
We still are seeing not enoughnaloxone in the hands of people
who could respond, and moreinnovative interventions, like
nalox boxes and naloxone vendingmachines-- I think those are
really exciting.
(26:35):
Then also just doing outreach innon traditional places.
So we've been going to fast foodrestaurants, gas stations,
libraries, gyms, places thatdon't usually get targeted by
harm reduction interventions andorganizations, but are also
places where either they seeoverdoses on site or they
(26:57):
encounter people who may benefitfrom naloxone training.
So I think all of those thingscan really help.
Lastly, I would say that, lotthe organizations that come to
us and evaluation team for helpoften say we know what works.
(27:18):
We know what we're doing.
It's just we need help showingthat it does work.
And sometimes that's for theirfunders.
Sometimes it's for reportingpurposes, or sometimes it's to
build support in their communitybecause they get a lot of
pushback.
Where evaluators, researcherscan really help is by working
(27:38):
with the community members whoare already doing the work and
finding ways to support themrather than coming up with fancy
solutions and just implementingthem wherever they want to
without the community support.
Ricky Bluthenthal (27:52):
I just want to highlight again the hotline
and the people involved in thatare of a long line of people who
use drugs, designing programsthat are sustainable and
effective at preserving life.
And really what they need isjust the resources to bring it
to scale.
In Los Angeles County where Iam, there's been a real local
(28:15):
level initiative to Build out aharm reduction infrastructure
and that they're spending Ithink it's about seven or eight
million dollars a year now sothey're building these case
studies of people who've gonefrom chaotic use to maybe a
recovery home to maybe A job anda lot of those cases have this
issue around reconnecting withfamily one of the first things
(28:39):
that people want is thatreconnection and it brings to
the surface That in some waysit's a bit of a horror, right in
terms of we're told Oh, you knowshut them off cut them down
don't enable them, and in factThere seems to be emerging
evidence that that that kind ofapproach Just makes it worse for
people and the answer isactually community and
(29:00):
relationship.
Ju Park (29:02):
You just reminded me of something that Una Creek from
Brave said to me very early on,which was that these
technologies are about buildingconnections.
We had this whole philosophicaldebate about how the use of
social media and cell phones,and even, Netflix subscriptions
have actually caused us to bemore independent and more
(29:25):
isolated.
And so, isn't it funny thattechnological tools could
actually be used to form thoseconnections?
I totally agree with what youjust said.
And you just reminded me ofthat.
Stephen Murray (29:36):
I can just add to that too, that, I often get
asked why I was able to pullmyself away from chaotic drug
use and can't really put myfinger on it besides, immense
privilege and also that I wantedto stop using was a big part,
but also like my family neverturned their back on me and I
never lost that connection.
I always maintained my owncommunity, at least with my
(29:59):
family.
I have my mom, to thank forthat.
And my sister, my sister hasactually devoted her life to
working with families to dothat, with a nonprofit that she
runs, where they're working withfamilies as well.
I think that that is a reallyimportant part of this
connection and, and why I'mstill alive.
If you're ever at thatcrossroads where you're
wondering, do you cut yourfamily off or not?
Well, you can hear at least fromme that the the reason i'm still
(30:21):
alive is that my family stuck byme even when things were pretty
bad.
Ricky Bluthenthal (30:25):
Let's end on this note then and i'll quote
the famous stephen murray theanswer to compassion fatigue is
Compassion.
Well, thank you both very muchfor sharing your experiences and
innovations that you brought tothis field and and all the great
work that you're doing.
kinna-thakarar--she-her-_5 (30:46):
That was Stephen Murray, Dr.
Ju Park, and Dr.
Rikki Bluthenthal inconversation on harm reduction,
compassionate care for peoplewho use drugs.
Thank you for listening.
Kinna Thakarar (30:55):
Please take a moment to complete SAMHSA's post
event evaluation survey on theAMERSA podcast page at www.
dot AMERSA dot.
Org forward slash harm reductionpodcast.
We welcome any comments,questions, or other feedback for
presenters.
You can send those directly toAMERSA through the contact us
form at AMERSA.
org.
To learn more about theprovider's clinical support
system, Medication for OpioidUse Disorder Project, and AMERSA
please visit our websites atPCSSMOUD.
(31:17):
org and AMERSA org.
Funding for this initiative wasmade possible by Cooperative
Agreement No.
1 H 79 TI 086 770 from SAMHSA.
The views expressed in writtenconference materials or
publications and by speakers andmoderators do not necessarily
reflect the official policies ofthe Department of Health and
Human Services, nor does mentionof trade names, commercial
practices, or organizationsimply endorsement by the U.
(31:37):
S.
government.
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