Episode Transcript
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Kinna Thakarar (00:13):
I'm Keena
Thakkar 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
(00:54):
Support System, Medications forOpioid Use Disorder Project, and
AMERSA.
This week, we welcome AmeliaGoff in conversation with Dr.
Marlene Martin and Dr.
Kimberly Suh to discuss harmreduction in the hospital,
meeting people where they are.
Our host, Amelia Goff, NP, is anassistant professor of medicine
at Oregon Health and ScienceUniversity, where she works on
(01:14):
the multidisciplinary hospitaladdiction consult service,
improving addiction care team,and in the Low Barrier Addiction
Medicine Clinic, Harm Reductionand Bridges to Care, serving
patients across Oregon's ruraland urban communities.
Her particular interest isimproving healthcare systems to
increase access to evidencebased addiction care, including
integration of harm reductionand overdose prevention
(01:36):
services.
Marlene Martin, MD, is anAssociate Professor at UCSF and
Director of the Addiction CareTeam, ACT, at San Francisco
General Hospital.
ACT is an interprofessionalconsult service that provides
compassionate care focused onharm reduction, evidence based
treatment, and linkage to carefor people with substance use
(01:57):
disorders.
Drawn to medicine to addresshealth inequities and social
injustices, her interests lie insystems improvement and
innovation with a focus onaddiction, community
partnerships, Latina health, andcare transitions.
Dr.
Kimberly Hsu is an assistantprofessor of medicine with the
Program in Addiction Medicine,Division of General Internal
Medicine at Yale UniversitySchool of Medicine.
(02:20):
Currently, she serves as anattending physician Central
Medical Unit, Abt Foundation,which provides primary care to
patients receiving methadone andother substance use treatment
services and supervises fellowsand trainees within the Yale
Addiction Medicine FellowshipProgram.
She is also an attendingphysician on the hospital based
Yale Addiction Medicine ConsultService.
Her current research interestsinclude harm reduction, stigma,
(02:43):
gender, women, and substanceuse, and overdose response
strategies on local, state, andfederal levels.
The presenters reported nothingto disclose.
Thanks for joining us, Amelia,Marlene, and Kim.
amelia-goff--she-her-_1_ (02:55):
Right.
Thank you so much.
Kina.
Welcome listeners.
It's great to have everyonehere.
I'm Amelia golf and I'm yourhost for today's episode.
We have a great conversationplanned.
We're going to discuss harmreduction care in the hospital
setting.
I'm really excited to be herewith our 2 brilliant guests.
Marlene Martin and Dr.
(03:16):
Kim Su, who both have expertisein integrating and delivering
harm reduction care inhospitals.
First to kick us off, I'm goingto share our three learning
objectives for today's episode.
We're hoping that these will beimportant pearls that you can
take away from our discussion.
listening to the episode,listeners should feel confident
(03:37):
describing strategies and stepsto gain institutional support
for harm reductioninterventions.
identifying potential challengeswhen implementing these
interventions and ways toaddress these challenges, and
discussing how integrating harmreduction into standard
addictions care in the hospitalimpacts patients and staff
(03:58):
experience and outcomes.
Marlene, Kim, welcome.
Thank you so much for being onthe show.
It's wonderful to have you bothjoined today.
Would you mind introducingyourself to the audience?
Tell us about your current rolesand your hospital based
addiction care practice.
marlene-martin_1_04-26-202 (04:16):
Yes,
thank you so much for having us
here, Amelia.
My name is Marlene Martin.
I'm the Director of theAddiction Care Team at San
Francisco General Hospital and Iwork for UCSF and I'm also a
practicing hospitalist.
kimberly-sue_1_04-26-2024_1 (04:29):
I'm
an assistant professor at Yale
in the Yale Program in AddictionMedicine, and I see patients on
the Yale Addiction Medicineconsult service several times a
year, and I also see patients inthe outpatient setting doing
primary care at an opioidtreatment program.
amelia-goff--she-her- (04:44):
Terrific.
Thank you so much for beinghere.
start out, could you bothdescribe the models you've used
to integrate harm reduction inyour hospitals?
marlene-martin_1_04-26-2024 (04:56):
I'm
happy to get us started.
A couple of years ago we werelooking at whether providing
harm reduction services in thehospital would be something that
our patients would be interestedin.
We are based in San Franciscoand there's a few different
syringe service programs.
That are embedded throughout thecity and so we were wondering
what the role would be for harmreduction services in the
(05:18):
hospital setting.
And so 1 of our patientnavigators.
Led a needs assessment withpatients and ask them, like, if
they would be interested inservices, if so, what services
would they be interested in andwhy?
And we heard an overwhelming.
Yes.
From patients.
Some people were not familiarwith harm reduction and we're
really interested in learning.
Some people were new to SanFrancisco and not yet connected
(05:40):
to community syringe serviceprograms.
Others talked about when theyleave the hospital, getting to a
syringe service program may notbe their 1st priority amidst the
many other things that they haveto do when they leave.
So, once we showed there was aclear need from patients, we
then partnered with a communitybased organization, the San
Francisco AIDS Foundation, whichprovides and 1 of the syringe
(06:03):
service programs in SanFrancisco, and they were just so
wonderful.
They educated our whole teamabout harm reduction about
supplies.
About the education piece, andthen they also said that they
would be willing to provide thesupplies that we needed.
And so now, with the patientneed and with a community
partner in place, we then wentto hospital leadership and we
(06:27):
showed them the data we showedthe evidence for harm reduction
and we shared that we alreadyhad a community partner.
And then we worked with thehospital leadership and our
regulatory department to reallycreate a workflow and we partner
closely with nursing on this.
Then we were able to pilot theharm reduction intervention that
(06:48):
we planned after building aworkflow on 2 of our medical
surgery units.
With lots of input again fromnursing about, storage of the
kids when to give them topatients.
And once we did this in twounits and we showed the evidence
and the impact, we were able tobroaden our effort throughout
the hospital.
And then one of our healthnetwork physicians, Dr.
(07:10):
Joanna Eveland sort of spreadthis model throughout the city
at the other health networkclinics.
amelia-goff--she-her-_1_04 (07:15):
Wow,
that's an impressive amount of
collaboration and strategicplanning that was necessary to
pilot and integrate the work.
I really appreciate you sharingall those details.
What about in your system,
kimberly-sue_1_04-26-2024 (07:32):
Yeah,
I would say it's different than
Marlene's.
Actually, it's much moreinformal.
We have most of the suppliescome through the Yale Addiction
Medicine console service, wewanted to build on those
relationships similar to Marlenewith existing syringe service
programs.
in New Haven.
So we partnered with thecommunity health van at Yale
(07:53):
that does drug checking orsyringe service programs, wound
care in the community.
So they are a very wellestablished program.
And we felt it was reallyimportant to establish that
relationship, especially whensomeone's leaving the hospital
and going into the communitybecause of the chaos that can
happen when you're discharged,there's so much activity and
(08:16):
stress.
And we wanted to ease that.
And we wanted to really bringsupplies to people like
Marlene's program as well,knowing that similar to programs
like meds to beds, that it'shard for people to get what they
need.
And, let's decrease barriers tothat access.
So we talk to people about harmreduction, we talk to people
(08:37):
about educating them about saferuse, and if they're interested,
we give them supplies ondischarge, and we want to see if
they're enrolled as clients orparticipants in the syringe
service program so that they canhave ongoing longitudinal harm
reduction care, because really,if they're going to continue to
inject drugs or continue to usedrugs in other ways, we want
(08:59):
Then we really want them to havethose touch points and build
those relationships with syringeservice programs.
So, it also comes to us fromdifferent departments or
different other consult servicesmight consult us and we can
carry our supplies, from,provided from the syringe
service program.
amelia-goff--she-her (09:17):
Fantastic.
So there are some differences,but really both of your
addiction consult services havebuilt in this workflow to
deliver full spectrum Addictionservices, including safer use
discussions and supplies.
Kim, if you could tell us howharm reduction in the hospital
setting can address some of theinequities that we see in
(09:39):
addictions care.
kimberly-sue_1_04-26-2024 (09:41):
Yeah,
I mean, I think providing this
service and the education aswell as the supplies can really
directly address some of theinequities we see in addiction
care.
First of all, there are manypeople who are not on medication
for opioid use disorder, and wereally want to engage and care
for those people just as much aswe care for people who are on
(10:04):
medications.
We certainly want to start themon medications if possible, like
methadone and buprenorphine.
And we also want to provide itfor people who are on
medications who are using on topbecause we do know that that
happens.
And we know that we want toengage people in which they
might have limited Englishproficiency, people who might
have an uncertain sort of legalstatus in this country.
(10:28):
know that it's a way to engagepeople who use stimulants
primarily, as well as people wholack access to those structural
determinants of health, likethings they need to exist and
live on a daily basis, likehousing, transportation, and
phones.
The more we can create thattherapeutic relationship with a
harm reduction mentality andharm reduction supplies, see as
(10:50):
ways to address directlyinequities that are present in
access to harm reduction andaccess to addiction treatment.
amelia-goff--she-her-_1 (10:59):
Thanks,
Kim, for highlighting how we
really need to protect thedignity and health of all people
who use all substances and thehospital is an opportunity to be
thoughtful about equal access tothose resources and treatment
for minoritized, marginalizedgroups, including harm
reduction.
(11:19):
And Marlene, this is making mejump to and think about the
equity piece your recent studythat you conducted with your
team.
I'm wondering if you could sharewhat you learned when you
interviewed staff and patientsabout their experience with harm
reduction practices integratedinto hospital based addictions
(11:41):
care, and what the main resultsand takeaways were.
marlene-martin_1_04-26-2024 (11:45):
Yes
many of the things that we find
that harm reduction does incommunity settings In terms of
equity we found similar resultsin the hospital.
In our patients, we found thatit increased access to both
education and supplies.
I want to highlight theeducation piece because many
people practice in differentsettings.
Right?
In some settings where they maynot be able to give supplies,
(12:08):
but really the education and thephilosophy of harm reduction is
something that we can allincorporate in our practice
patients who identified as Blackand Latine particularly found
that they had not had a lot ofthe education and exposure to
harm reduction practices in thepast.
And then people who identifiedas primarily using cocaine and
(12:29):
methamphetamine also shared thatthey learned new harm reduction
practices.
The second thing that we learnedfrom the study was that the harm
reduction intervention in thehospital rebuilt trust and
improved the care experience forpatients.
People said that, they reallycouldn't believe that we were
offering harm reduction and thatwe acknowledged their goals,
(12:51):
right, which if it includedreturn to use, if it included
perhaps not necessarily startingmedication for opioid use
disorder, but that they feltseen when we offered them harm
reduction supplies.
And then we found that itcatalyzed culture change and
destigmatization and even, whenpeople express like, ongoing
stigma, the people who didexpress that shared that what
(13:13):
they had learned through theharm reduction intervention was
that it just made sense that thedata was there.
And of course, we should bedoing this.
We did face some challenges withimplementing this.
Some of those included thehesitancy about the legality of
this, and it was so good that wehad run this by many different
leaders across the hospital andhad them on board, had
(13:34):
regulatory on board.
And then as we were discussingthis with staff, people just
shared that they wanted moreeducation about substance use.
So that was kind of a surprisingresult that came out of, you
know, we're talking about harmreduction here and then, the
staff that we're chatting withare identifying actually, we
(13:55):
have this big need and desirefor education.
I guess it's not surprisingbecause none of us really who
trained earlier on had beenexposed to addiction education,
but that the culture wasshifting such that people were
now demanding this.
I think that was a surprisingpiece for me the remaining
stigmas I discussed and thenpatients who shared, there was
(14:17):
one patient who participated inthe study whose goal was
actually to not return to use,and they had a kit delivered
unintentionally.
And so they woke up and saw thekit there, and they were
wondering, like, why was thiskit delivered to me?
This is triggering.
And so just being really carefulin assessing patient goals as
we're performing thisintervention.
amelia-goff--she-her-_ (14:38):
Karleen,
this is such impressive work,
and I think the opportunity tothink about harm reduction is
not one size fits all.
And that final example is soimportant that patients are seen
as individuals and what'simportant to them and make sure
that we're centering theirpriorities and appreciate you
highlighting the need foreducation and that kind of
(14:59):
exciting finding that it wassomething that staff regardless
of discipline were interestedin.
I'd love to just highlight, youknow, Folks checking out that
publication since I think it'sso important in helping to
highlight that harm reductionneeds to be a standard of care
in hospitals.
Speaking of standard of care andwhat else we can be doing, Kim,
(15:21):
could you give us some adviceabout how hospitals and
healthcare workers who aremotivated to offer these
services and care, butpracticing in states where harm
reduction supplies to patientsmight be challenging to give?
For example, if they're in astate with limited paraphernalia
laws, could you talk a littlebit about that?
kimberly-sue_1_04-26-2024_1 (15:41):
I'm
really happy to.
One way to address this andanswer any questions and make
sure that what you're doing isethical and also in line with
regulations and rules withinyour state is to talk to the
Network for Public Health Law.
They're a great nonprofit legalorganization they focus
(16:02):
exclusively on understandinglocal, state, and federal laws,
especially regarding increasingaccess to harm reduction is a
main priority of them.
So feel free to.
Reach out to them, tell themthat, you heard this amazing
podcast and they can work withyou and advise your legal
(16:23):
counsel, or just advise you onwhat the laws are in your state.
There's also a law atlas online,and we can probably share the
link with you and some noteswhere you can look at syringe
policies and laws syringesconsidered something, it's
paraphernalia, for example and,better understand that for
yourself.
(16:44):
I think the goal for us asclinicians is really to develop
relationships with our harmreduction agencies.
If you have them in your stateand really trying to build out
those relationships willstrengthen the clinical care and
the advocacy that we can do.
If they're not there, there is anational online harm reduction
(17:05):
group called next distro dot organd they can send supplies to
your patients, you can offerthem that information and
they're a mail based syringeservice program with a bunch of
supplies as well as amazingeducation.
Another thing that I do inConnecticut that, you have to
check with network for publichealth law or others around you
(17:26):
is if you can't necessarilydistribute supplies directly to
think about how else can Ipartner with other types of
professionals who can get peoplewhat they need.
So can I work with pharmacies?
Can I work with pharmacists?
Can people buy them atpharmacies?
Can I prescribe syringes?
For some of my patients I doregulate prescribed syringes
with the ICD 10 code Z 20.
(17:49):
6 or, contact with or suspectedexposure to HIV.
And unfortunately in New Haven,we've had clusters of HIV,
including last summer.
So this is a very real situationtrying to provide people with,
what they need to stay safe.
amelia-goff--she-her-_1_04 (18:04):
Kim,
these are all great ideas.
I think center around beingcreative and doing what we can
as individuals in our differentcircumstances in different
states.
I'm just going to encouragelisteners to explore these.
figure out what might be bestfor your environment and your
practice, then we can sharethese resources and ideas on the
podcast page of the MRSAwebsite.
(18:27):
In a similar space, Marlene, canyou discuss how we can apply a
harm reduction lens in otheraspects of hospital based
addictions care?
marlene-martin_1_04-26-2024_1 (18:40):
I
think we can provide a harm
reduction lens really in all thework that we do in health care,
whether it's addiction focusedor not.
And when we talk about hospitalbased addictions care, Really
thinking about providingdignified and compassionate care
to the people that we're takingcare of one area of interest of
mine is how the policies that wehave in hospital settings and
how we respond to patients isaffected.
(19:02):
Right?
By written or non writtenpolicies, but by bias treatment.
So really thinking about, forexample, urine toxicology
practices.
Some hospitals have consentpractices around getting urine
toxicology tests.
Others do not.
For example, in our family birthcenter, Some of the individuals
(19:22):
working there found that grandtoxicologies were being
primarily performed in pregnantpeople who identified as black
and Latina, and this has hugeimplications, for child
protective services later on.
And so they change practices tonow having a standard uniform
practice that they finddecreases inequities and how
(19:44):
we're responding to differentindividuals.
Other ways that we can thinkabout harm reduction in hospital
settings is, person 1stlanguage, making sure that we're
educating healthcare workersabout using person 1st language
and how they're interacting withpatients and also documentation,
especially now that many peoplehave the ability to read their
charts.
Thinking about the meds we areoffering.
(20:05):
Or when people want to selfdischarge, what do we do?
if somebody is on intravenousantibiotics, are we offering
oral antibiotics?
Do we have them ready when weknow that somebody is sort of
going back and forth in theirmind?
Am I going to leave?
Am I not going to leave?
That decision often comes rightafter people sign out.
And if you don't have thosemedications ready for them,
they're not going to be able toget them.
(20:27):
So you can practice harmreduction by having that oral
antibiotic ready for people byhaving their buprenorphine,
buprenorphine ready for them incase they're, thinking about
self discharging.
This area of interest of mine,which is in hospital drug use I
know this is something that'shappening across hospitals.
I was at a national meeting ofhospitalists recently discussing
(20:48):
in hospital substance use andbest practices with Dr.
Ana Maria South.
And we asked everyone in theaudience, have you ever
responded to somebody usingdrugs in the hospital and every
single person raised theirhands.
And then, when we asked ifsomebody had had a patient
overdose in the hospital, nearlyeveryone again raised their
hands.
So I think this is somethingthat's very, very common.
(21:11):
And it's something that welooked at it in our own
hospital, because we found thatwe actually did have an in
hospital substance use policyand the original policy didn't
provide a lot of guidance aroundwhat to do, but 1 of the options
was interpreted as a 1st lineresponse was calling security
when somebody used substances inthe hospital or was suspected of
(21:34):
substance use.
In the matter of 2 or 3 months,we had a couple of people who
security was called for, and oursecurity is provided by the
local sheriff's department.
That was really harmful verypunitive response to patients.
We also learned that whensheriffs respond, they are sort
of subject to their own,regulations and practices.
(21:55):
The priority and health getsuperseded by this, more
punitive response, and thenreally thinking about the
context that many of ourpatients with substance use
disorders may have beencriminalized for their substance
use, especially black and Latinaindividuals.
This got us to really take aharm reduction or approach to
our in hospital substance usepolicy.
(22:16):
And when we did that, wegathered the interprofessional
group that was subject matterexperts.
And that was involved inresponding to in hospital
substance use.
We did an analysis of the mostrecent cases of in hospital
substance use.
And we really changed ourresponse to be able to really
take this harm reductionapproach and think about why are
people using substances in thehospital, they're often using
(22:39):
because their pain and theirwithdrawal is being under
treated.
They are bored and they aretriggered in the setting of
something that feels likepotentially a carceral setting
to individuals.
So.
If we offer addiction services,if we offer opioid withdrawal
and pain control that accountsfor high opioid tolerances,
(23:00):
people are going to be lesslikely to use if we are really
treating people with dignity andrespect from the minute they
walk in, perhaps they're notgoing to be afraid to disclose
that they use whatever they'reusing and that we can partner
and come up with an adequatetreatment plan and their share
when their dose is too low,because if we don't, people will
come prepared to take care ofthemselves, and potentially use
(23:22):
drugs in the hospital.
Or what we find is that peoplecall friends or their friends
come to visit their friends, seethem suffering and then give
them drugs.
Then those drugs may not be thesame.
supplier they're getting thedrugs from in the community.
They may have riskier use in thehospital, right?
They go into the bathroom.
So things that make them athigher risk for overdose.
Working with the hospital systemand the legal department, right?
(23:44):
To craft a policy that reallydecreases harm, centers the
patient and offers aggressiveaddiction services.
amelia-goff--she-her-_ (23:52):
Marlene,
this is such an important space
to think about all the ways thatwe can integrate and change from
a system level, individuallevel.
I really appreciated you talkingabout from modeling person,
first language for trainees allthe way to a larger undertaking
like your hospital did ofreviewing, updating the hospital
(24:14):
policies that were punitive andharmful to people who are using
drugs.
And then I think you're doingthat and then publishing it.
Creates a best practice roadmapfor other institutions who are
considering doing it themselvesand really also appreciate your
call out that it's so common andit's something that we really
(24:37):
need to address to make thehospital environment less
stigmatizing, less traumatizing,less of a space that feels like
incarceration for the patientswe care for.
So thank you to you and Kim forthe type of advocacy and systems
change work that you're bothdoing.
I am gonna just take a pauserecommend that listeners
(25:00):
consider how you can incorporatewith all these different
examples, a harm reductionphilosophy and care in your own
workplaces, then what you can doin your day to day interactions
with staff and patients to havethis lens in mind.
We've covered quite a bit, and Iwas hoping to kind of pull
(25:23):
together All of these themes anddiscussions with a case, Kim,
would you be able to describe acase that helps our listeners
better understand harm reductionin the hospital setting?
kimberly-sue_1_04-26-2024_1 (25:38):
I'm
happy too.
So the case that I have is a 30year old female who injects
drugs and she injects about Twobundles of fentanyl a day.
So heavy sort of use shepresents with fevers, rigors,
and she gets worked up forendocarditis and is found to
(25:58):
have tricuspid valveendocarditis.
The Yale addiction medicinecouncil service comes to see her
and really tries to, the firstand foremost thing is provide
aggressive withdrawal managementfor opioids, nicotine, and
anything else that she isexperiencing withdrawal from.
The patient elected to startmethadone.
(26:19):
So we titrated methadone prettyquickly up in a patient with
high opioid tolerance andsignificant Health issues that
needed to be addressed,including numerous echoes, both
TTEs TEEs, and then sort of CTsurgery evaluation for a
replacement valve.
We worked with the patientpatient was able to get mitral
(26:43):
valve replacement, able to stayagain, very important in that
aspect is to get significantamounts of additional.
phylogenous opioids on top ofthe methadone, short acting
hydromorphone it's often what weturn to and making sure that
pain is really well addressedboth before and after that
surgery, trying to make surethat patient is on a pretty good
(27:07):
dose a therapeutic dose ofmethadone on discharge.
at that time the patient's beenin the hospital for a long time
and we do often go back.
One of the fellows or a residentcan go back and really do a very
specific harm reductionchecklist and just talk to the
patient about theircircumstances that they're going
to be going home to.
(27:27):
Circumstances in which they wereinjecting before, educating
patients on safer injectionpractices, talking to them about
why they think they got it thistime and where they procure
their supplies.
In this instance, She had gottensome from a bodega and she
didn't share with anybody, butshe did reuse her own syringes
and she really didn't clean herskin and had some ways that we
(27:51):
could try to improve herinjection practices to make them
sterile and if she had enoughsupplies to not reuse them.
So on discharge, it was a greatsuccess story she was able to
access syringes in theoutpatient community by working
with our Yale community healthcare van on discharge.
We actually have a van that candeliver supplies to people,
(28:14):
which is pretty amazing.
And she became involved in thesyringe service program and was
able to volunteer and be a partof creating that community
change at the syringe serviceprogram, she was able to get
her.
Hep C treated and other issuesaddressed related to injection
drug use, as well as justgeneral health and well being.
That's an example of a casewhich we've been able to utilize
(28:39):
harm reduction supplies andeducation to really, help people
be healthy and, be educated.
And from programs like that, weactually made a website
specifically around endocarditiscalled safersubstanceuse.
org, where we interviewed peoplewith endocarditis from injection
drug use and we pulled togetherthe information that they said
(29:01):
that they wish they had had.
They didn't know you could getit from this.
You didn't know that he had itfrom this.
Didn't know you could get itfrom sharing a cooker.
so we pulled together a lot ofthat information on this
website, and we made a littlevideo that explains endocarditis
and how to have a harm reductionphilosophy to that with some of
us in addiction medicine, someof the hospitalists, and some of
(29:22):
the cardiologists and thecardiac surgeons, which is
really cool.
amelia-goff--she-her-_ (29:27):
Amazing.
I have so many thoughts, Kim,but first I want to say, I feel
like this really highlights youas a physician anthropologist,
just the way you told that storyand shared that experience for
this patient, which isimpressive.
And I think.
In addition to the resources andeducation that you described,
(29:47):
sort of the expansiveness ofharm reduction.
So from the beginning, when shecame into the hospital,
aggressive withdrawal paintreatment, and then all the way
through to when she was leavingthe hospital and becoming a part
of the social movement herselfand working in the SSP, which is
really exciting.
(30:08):
And I can attest to you, thiswebsite is a great resource for
trainees for and for patients aswell.
It's a great example.
Thank you, Marlene and Kim.
This has been reallyenlightening and rich
conversation.
I've learned a lot.
I'm sure our listeners havelearned a lot.
I would say you both Really arequestioning the status quo,
(30:32):
creating productive solutionsand systems level change, and
really appreciate you sharingthe lessons learned with us
about what we can do to createthis important culture shift.
Is there anything that you feellike are overarching takeaways
that you want to highlight forlisteners today?
marlene-martin_1_04-26-2024_1 (30:52):
A
couple of the things that we can
do include feeling empowered tocreate positive culture change,
modeling best practices inaddiction care and taking the
best care we can have patientstraining others to do so, and
then when possible, creatingsystems change so that the care
that we provide individuals canbe taken to a larger scale and
(31:12):
everyone can receive bestpractice addiction care.
amelia-goff--she-her-_ (31:16):
Amazing,
anything you want to add, Kim?
kimberly-sue_1_04-26-2024_131 (31:19):
I
would just add if you're
interested in learning moreabout the history of the harm
reduction movement that there'sa great recent history called
Undoing Drugs by Maya Solovitz,and it can provide some of the
background to the socialmovement behind harm reduction
and how it's been fought for bypeople who use drugs and people
(31:40):
who do sex work and really howwe can plug ourselves in as
clinicians how we can bettertreat pain and substance use
disorders, which we really hopethat you feel empowered to do
after listening to this podcast.
marlene-martin_1_04-26-2024_1 (31:53):
I
think the other thing that I
would also plug is one,something that I provide to many
of my patients who arerequesting harm reduction
education.
And even when I'm just Takingcare of patients on medicine is
the Never Use Alone Lifeline,there was a recent episode on
This American Life called TheCall that really nicely
highlights what this amazinggroup does, and so I encourage
(32:17):
you all to listen.
amelia-goff--she-her-_1_04-26 (32:19):
I
imagine there are going to be a
lot of listeners checking outboth that book and that
particular episode of thatpodcast.
I hope overall that this episodeempowers and galvanizes
listeners to start integratingharm reduction approaches in
their own personal practices andthat you're walking away with
some understanding of theopportunities and challenges for
(32:41):
integrating this type of work inhospital systems and how
important it is.
Thank you both so much for yourtime and for being here today.
Kinna Thakarar (32:52):
Dr.
Marlene Martin, Dr.
Kimberly Su, and Amelia Goff inconversation on harm reduction,
compassionate care for peoplewho use drugs.
you to tune in next time when wewelcome Patty Moreno, Sophie and
Leia Freymill Wong to the seriesto discuss insights from the
frontline, safer use supplies,and other harm reduction
interventions in an urbanhospital.
(33:18):
Please take a moment tocomplete SAMHSA's post event
evaluation survey on the AMERSApodcast 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.
(33:41):
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.
(34:01):
S.
government.
Thank you for listening.