August 22, 2024 • 41 mins
Episode 7: Innovative access to harm reduction support and linkage to treatment
Featuring:
Shelby Arena
Harm Reduction Manager, MATTERS
Joshua Lynch, DO, FACEP
Associate Professor of Emergency & Addiction Medicine, University at Buffalo Jacobs School of Medicine; Chief Medical Officer, MATTERS
Host:
Shoshana V. Aronowitz, PhD, MSHP, FNP-BC
Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing
The opioid epidemic is ever-changing and with contaminants like fentanyl and xylazine in the drug supply, lethal overdose rates have been increasing yearly. Programs like MATTERS offer multidisciplinary solutions to combat obstacles in accessing harm reduction resources and treatment. MATTERS employs innovative methods such as emergency telemedicine and electronic referrals to outpatient treatment. The emphasis on low-barrier access to supplies and treatment allows MATTERS to provide accessible and stigma free services. Collaboration with various groups ensures effective outreach and advocacy for policy changes to address the needs of people who use drugs with compassion.
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.
Shoshana Aronowitz inconversation with Dr.
Joshua Lynch and Shelby Arena todiscuss innovative access to
harm reduction support andlinkage to treatment.
Our host, Shoshana Aronowitz, isa family nurse practitioner,
community engaged healthservices researcher, and
assistant professor in theDepartment of Family and
Community Health at PennNursing.
(01:19):
Her research and clinical workis focused on improving access
to evidence based substance usedisorder treatment and harm
reduction services viainnovative delivery models,
including telehealth and mailbased programs.
Dr.
Lynch is an Associate Professorof Emergency and Addiction
Medicine at the University ofBuffalo.
He is the founder and chiefmedical officer of the MATTERS
(01:40):
Medication for AddictionTreatment and Electronic
Referrals Program, focused onprevention, education, increase
in access to treatment forsubstance use disorder, and
rapid referrals to long termsubstance use treatment.
He and his team have receivedover 20 million dollars in grant
funding for various publichealth initiatives in the areas
of substance use disorder andhepatitis C.
(02:02):
Shelby Arena, Harm ReductionManager with the Matters Program
earned her dual Bachelor of Artsdegrees in International
Relations and Latin AmericanStudies.
She is currently pursuing herMaster of Social Work at the
University of Buffalo.
She has worked in the health andhuman services sector since
2016, with experience educatingand counseling people in
reproductive health and justice,domestic violence and sexual
(02:24):
assault, as well as mentalhealth and substance use.
Shelby is an advocate for harmreduction and is passionate
about fostering communityconnections.
Dr.
Ronowitz disclosed that she isemployed as a clinician with
Ophelia Health.
Dr.
Lynch disclosed that he assistedemergent bio solutions with FDA
approval.
Shelby Arena reported nothing todisclosed.
(02:46):
Thanks for joining us, Shoshana,Josh, and Shelby.
Shoshana Aronowitz (02:49):
Thanks so much, Kina, and welcome
listeners.
It's so great to have everyonehere.
My name is Shoshana Aronowitz,and I'm honored to serve as host
for this episode.
Today we'll be talking about theMATTERS Network.
We'll be discussing what thisprogram offers, what makes it
unique, and how it can servefolks who may otherwise be left
out of the substance usedisorder treatment and harm
reduction landscape.
(03:11):
Over the next 30 to 40 minutes,you'll hear from two experts
with us today.
Dr.
Joshua Lynch, CMO and programcreator, and Shelby Arena,
manager of harm reductionservices.
It's so wonderful to have bothof you here.
Thanks so much for joining us.
Joshua Lynch (03:27):
Thanks for having us.
Shoshana Aronowitz (03:28):
To get started, I would love for you to
let listeners know, those whoaren't familiar with Matters,
what your program does and whatyou offer.
Joshua Lynch (03:39):
Great.
Thanks.
So the matters program startedoff as a way to solve the
problem of linking patients withopioid use disorder to treatment
out of the emergency departmentsand now has grown into a whole
set of resources that really,reside between a referral
environment and a receivingenvironment.
(04:00):
We can help facilitate referralsfrom emergency departments,
other parts of the hospital,correctional institutions such
as jails or prisons.
Drug courts, telemedicine, thescene of 911 calls.
So working with firstresponders, and then really, we,
we offer the patient through anelectronic referral platform the
choice of where they want to gofollow up at treatment
(04:24):
organizations that meet certaincriteria that we have
identified.
Additionally, offer somewraparound services that help
patients get over otherobstacles that they may face
when they're going through theprocess of getting hooked up
with treatment and getting to beretained in treatment.
And some of those, we can talk alittle bit more about them
(04:45):
later, but some of those involvea medication voucher to cover
the cost of buprenorphine forpatients that don't have
insurance, transportationvoucher that offers assistance
to people who need A ride totheir appointment and back.
Linkage to peer services if theywant to engage with someone with
(05:06):
lived experience that can helpthem through as they get to
their first appointment andnavigate through treatment.
shoshi-aronowitz--sh (05:13):
Wonderful.
As I understand it, your programis available throughout New York
State, is that correct?
Joshua Lynch (05:19):
It is.
It started in Western New York.
Then we started to work with thecapital region around Albany.
And now we're very proud to saythat we cover most of New York
State and New York City and LongIsland.
We'll be expanding toPennsylvania and New Jersey
later in 2024.
shoshi-aronowitz--she-he (05:37):
That's really exciting.
so what inspired you to buildsomething like this?
Joshua Lynch (05:43):
You know, we're working in the emergency
department, we are painfullyaware of the toll that addiction
takes on individuals.
For a long time, the solution tolink someone up to treatment
with substance use disordermental health in certain cases
was really limited to us givingthem a piece of paper with a
(06:05):
bunch of phone numbers on it oftreatment organizations and
sending them on their way.
That seemed to be okay for awhile.
I think many of us knew that,that we could probably do
better.
If you think about it, yourarely see headlines saying that
this hospital has rolled outstate of the art addiction
(06:26):
assessment and linkage program.
I mean, maybe you see it alittle bit more lately.
But for the longest time, wedidn't see investment going into
use disorder, like we saw forother disease processes, it's
not too hard to find crazyinnovation going around the care
for strokes and the care forheart attacks and other, you
know, other disease processes,that wasn't really the case for
(06:48):
addiction.
We knew that we had to dosomething different.
We knew we had to do somethingbetter.
Trouble is kind of where do youstart?
At times, especially with theway that the opiate epidemic has
evolved over the years,sometimes it seems like an
unsolvable problem and startingto kind of break it down to say,
just what are the patients need?
(07:08):
We know that the patients need afair assessment, access to good
treatment, in many cases, thatincludes medication, linkage to
a high quality place where theycan get good care, and that
should be free, it should beclose and it should be at a
place that they want to go.
We do that for other diseaseprocesses.
And, and part of the reason whywe wanted to start this program
(07:30):
is because patients withsubstance use disorder should be
able access to the best qualitycare too.
shoshi-aronowitz--she-her (07:35):
Yeah, that's a great point that you
made about how rare it is to seea big hospital system kind of
brag about a state of the artsubstance use disorder treatment
program the way they do maybeabout other programs that they
have.
So I'd really like to dig a bitmore into the harm reduction
services that Matters offers.
Shelby, can you talk a bit aboutthe vending machine program?
Shelby Arena (08:00):
Yes, definitely.
To build off what dr lynch said,we recognize that not everyone
who uses drugs is ready fortreatment or even needs
treatment, but with contaminantslike fentanyl and xylazine in
the drug supply, the risksassociated with drug use are
rising.
So that's kind of where our harmreduction services came from.
Placing these harm reductionvending machines in the
(08:21):
community allows people toaccess supplies where they're
at.
What makes our program unique isthe diversity of locations we've
partnered with not onlygeographically in terms of like
urban versus rural, but also in,you know, the physical
locations.
I'll also say, again, to followup on Dr.
Lynch, you know, being a smallpart of this larger program
(08:42):
allows us to connect folksdirectly to care if they are
ready for treatment.
That person will get theirmedication the same day they
reach out if appropriate.
With our robust level of, ofsupport services to see them
through that process.
shoshi-aronowitz--sh (08:55):
Wonderful.
What supplies are available inyour machines?
squadcaster-65dh_1_04-19- (08:59):
Right now we have fentanyl test
strips, xylosine testing strips,and naloxone.
shoshi-aronowitz--she-her-_ (09:05):
I'd like to give the audience a
second to reflect on places andspaces they think would be most
suited for a vending machine.
You talked about the program'suniqueness coming partly from
the different places that youhave machines and i'm going to
ask you in a second to tell usmore about it But I'd like the
audience to kind of think aboutwhere they would choose to place
(09:26):
machines if they were able tochoose Okay, with that in mind,
Shelby, take it away.
Your program from what Iunderstand, places these
machines in many diverselocations, including outside of
jails and police stations.
Can you talk a bit about how youdecide where to place the
machines and where you're seeingthe most usage?
Shelby Arena (09:47):
Definitely.
The decision making process interms of where to place the
machines is a joint decisionbetween matters and the
organization we're partneringwith, right now we have 15
machines across the state.
With matters being based inBuffalo, we can't be everywhere,
so we rely on our communitypartners to really be the boots
on the ground, managing thosemachines and also being the
(10:09):
experts in their community.
We had ongoing conversationswith folks who were interested
in having a machine to reallyunderstand their community, what
makes it unique and what theunique needs are in their
community.
So a lot of places depending on,you know, where they are and
what data they have access to,some places used overdose data
(10:32):
by zip code to pinpoint aspecific zip code where there
was high need for thesesupplies.
Other counties, more ruralcounties, just don't have access
to that type of data.
So it's more anecdotal, talkingto the community, talking to
community members to see wherethey'd like to see these
machines.
And then in other situations, itwas like, I know you mentioned
(10:52):
the jails and the policestations-- I think some people
might have a strong reaction tothose locations, but when we
find law enforcement partnersthat are excited about harm
reduction and want to activelyde stigmatize these types of
supplies within theirorganizations that's something
we really want to highlight.
(11:12):
in our first year of the programwe're really monitoring to see
what types of locations work, soin addition to jails Police
stations, we have them attreatment organizations, fire
halls, some private businesses,like a convenience store, a
supportive housing apartmentcomplex, and, and really just
trying to monitor those numbersand see what works and what
doesn't.
shoshi-aronowitz--she-he (11:34):
That's really interesting.
I'd love to hear more if youhave any evidence, anecdotal or
otherwise, speaking to thispoint you made about de
stigmatizing the supplies withincertain organizations-- so I
think it was you were referringto maybe police departments and
someone thinking that having avending machine there would help
maybe start a conversation aboutharm reduction in that place.
squadcaster-65dh_1_04-19-2 (11:57):
Yes.
in the beginning it is kind ofsurprising for some folks, I
think if law enforcement agencymaybe doesn't have a strong
presence in their community,especially in terms of substance
use or harm reduction that canbe a challenge to overcome.
We have partnered with twoorganizations that are both very
active in terms of overdoseresponse education getting their
(12:19):
officers out there with naloxoneand test strips at the scene of
any incident they're respondingto.
Both of the law enforcementpartners in our program have
specific divisions for overdoseresponse, and they go out into
the community, so they havebuilt those relationships and
still there are always folks whomaybe aren't 100 percent on
board.
(12:40):
So it's not only de stigmatizingthis within the community, but
also within these departments.
I actually spoke with one of ourpartners this morning, just
doing our monthly check in andshe was telling me about how the
chief is, very on board withthis, but some of his officers
were not initially, but nowthey're seeing the officers
utilize these machinesthemselves to stock their cars
(13:01):
and to get these supplies outinto the community.
shoshi-aronowitz--she-he (13:05):
That's really interesting.
It's hitting me right now that,for many of the listeners
thinking about a vending machinewe're imagining putting in cash
or using a card and purchasingsnacks or something like that.
Do folks need to pay for thesupplies that are in the
machines?
Shelby Arena (13:19):
That's a great question.
Everything in the machine isfree.
All of our machines areaccessible 24/7.
The majority of them areoutside-- we want to make sure
that they are as low barrier aspossible.
So folks just have to enter in afour digit code that is posted
on the machine, then their yearof birth and their zip code,
(13:40):
just for a few data collectionpoints while still keeping it
anonymous.
And then they're able to vend upto three of those supplies per
transaction.
So they can definitely just goin again and put in that four
digit pin and their informationto really dispense as many
supplies as they need.
shoshi-aronowitz--she-he (13:58):
That's great.
You also have a mail baseddistribution program for testing
strips.
Can you talk about the logisticsof operating a program like
this?
squadcaster-65dh_1_04-19-2 (14:09):
Yes.
So right now we are mailing ourfentanyl and xylosine test
strips.
We mail to individuals andorganizations across the state.
we again send these supplies outfree of charge.
We've gone through and error ofwhat's going to work best.
Originally, we sent them out 10test strips at a time in an
envelope and then we realizedpeople were reordering quite
(14:31):
frequently.
We wanted to make sure that wewere lowering that burden on
them.
So now we send out boxes of 100test strips to individuals and
up to 1200 test strips toorganizations across the state.
shoshi-aronowitz--she-her- (14:44):
Talk a bit more about how mail based
distribution can serve peoplewho may be underserved by Brick
and mortar harm reductionprograms.
squadcaster-65dh_1_04-19-2 (14:54):
Yes.
So we're very lucky at Mattersthat the kind of scope that we
have in terms of serving theentire state also the the lack
of barriers that we have interms of how much supply we're
able to distribute?
I know a lot of times at a brickand mortar facility their
constraints financialconstraints and they can only
hand out either one or five teststrips at a time so folks will
(15:18):
have to go in there every day.
And there are a lot of folksthat You Don't have the time to
do that, don't have thetransportation, or just
unwilling to do that so beingable to reach folks who able to
access brick and mortar harmreduction programs, you know, by
reaching them inside their homeis a big win for us in terms of
getting these supplies out intothe community.
shoshi-aronowitz--she-her-_1 (15:40):
Is there a way that users of these
distribution programs, I'mthinking both the mailbase
program and the vending machineprogram, can offer feedback to
Matters or make suggestions?
Shelby Arena (15:55):
Yes, we are always open via email and phone call.
We get actually several phonecalls a day from folks regarding
our test strip distributionprogram.
And we do have a couple ofmembers on our harm reduction
program, but also anyone on theteam really is equipped to field
these types of calls.
And we are working onimplementing some more community
(16:16):
based feedback models as well.
Shoshana Aronowitz (16:19):
Wonderful.
So if a listener is hearing thisand is thinking that they might
want to start A similar program,a mail based program where they
are, what advice would you offerthem about getting a program
like this off the ground?
Shelby Arena (16:35):
My biggest piece of advice is patience.
There is going to be a lot oftrial and error, at least that's
what we experienced.
As long as you're getting thesupplies out there, I think
that's a win.
In terms of scaling a programthat can be difficult,
determining who you want to sendthese products to.
Originally, we only shipped toofficial state partners but we
(16:58):
realized there was a bigger needthan that.
So then we expanded to otherorganizations.
and, I, I spoke about how westarted off with 10 test strips
to 100 test strips.
And so really just listening tothat feedback from your
community on what they need andhow you can best serve them, I
think is what's going to makeyour program successful.
Joshua Lynch (17:15):
I also think on the vending machine piece, it
may not be as easy as you thinkto place a machine somewhere.
There are a lot of feelingsabout these supplies being
publicly available outdoors.
And I think we were surprisedthat either on both ends of the
spectrum, we were surprised atthe ease of some of the
locations, and we are alsosurprised at the number of
(17:36):
challenges that would show up atother locations.
So Shelby's right (17:39):
patience is certainly key here.
Eventually it will work out.
Having multiple ways forpatients to get access to
supplies and get linked up totreatment, I think is really the
key.
Shoshana Aronowitz (17:50):
Do you have any advice about dealing with
maybe some pushback when itcomes to, you know, for example,
placing machines, or it soundslike you get less pushback about
the mail program, but justpushback in general about these
different innovative deliverymodels for supplies.
joshua-lynch--do--facep_1_04- (18:08):
I think keeping an open mind.
We could tell a lot of storiesabout interesting things we've
learned about the mail basedprogram, but things don't
necessarily go kind of the waythat you would expect.
Let's say you're looking tostart a vending machine program
and there's a site that mightseem perfect in geography but
the site is owned by amunicipality and sometimes
(18:30):
there's tons of layers to getthrough of approvals, like Adam
municipal or like governmentalagency be able to place a
machine outside.
In contrast, the conveniencestore machine that we have-- not
too many layers of approvals forthat.
know, Sometimes those types oflocations might be easier to
play something or to put it todistribute test strips or
(18:52):
whatever.
Just keeping an open mind.
We really want one at thelibrary.
Well, the library may have 10layers of approvals and it might
take you a year, which istotally fine, you can work on
some other easier wins whileyou're working through the
slower process of some otherlocations.
And the same thing would go withthere's a community event you
want to distribute test strips,some may be super easy to go do
(19:12):
that.
Others, maybe a bit morecomplicated, but I think the
important thing is don't giveup.
We pivot all the time.
If we have an event that wethink would be a great fit and
it's not, we don't give up anddon't do anything for awhile, we
quickly turn and realize, okay,well, how can we get to this
group of people in a differentway?
Shoshana Aronowitz (19:31):
That's great advice.
Thank you.
Can you remind us all, if folksare interested in ordering mail
based supplies how they do that?
Joshua Lynch (19:40):
The easiest way would just to be to go to our
website, mattersnetwork.
org, or download the freeMatters Network app by searching
Matters Network on Google Playor the Apple Store.
Shoshana Aronowitz (19:51):
Now I'd like to discuss a bit more about what
you offer to folks interested inaccessing treatment for
substance use disorders.
Josh, you talked about this atthe beginning-- what makes your
program unique in facilitatingaccess to low barrier treatment?
Mm.
joshua-lynch--do--facep_1 (20:13):
Being at one of the referral
environments that we had talkedabout in the beginning, like a
hospital engaging with acommunity outreach team being at
drug court, being released fromjail.
Those are opportunities toaccess the matters set of
resources and get linked up totreatment.
The other can be self drivenfrom home.
This involves our telemedicineresources and that has been a
(20:36):
highly utilized service line orhighly utilized front door into
getting treatment.
In Western New York, we have theability to offer emergency
telemedicine assessments 24hours a day.
And the rest of New York for nowis 12 hours per day.
Hopefully, fingers crossed, thatwill be 24 hours across New York
state soon.
The ability to initiate atelemedicine visit yourself
(21:00):
probably the easiest way to dothat is, through the app or
calling seven, six, fiveMatters.
And this is within New Yorkstate for right now.
That will get you linked up witha telemedicine coordinator that
will start the brief intakeprocess, just a few minutes.
Will they will tee you up towhat to experience when you're
on with the nurse practitioneror PA or physician that's
(21:23):
actually performing thetelemedicine assessment.
So that is a brief assessment,kind of exactly what you would
think it would be.
If appropriate, they willprescribe buprenorphine.
Typically those prescriptionsare between 7 and 14 days.
And then towards the end, theywill run you through the Matters
referral process, which gets youaccess to an appointment,
(21:45):
typically, that's within 1 to 3days the medication voucher, if
you need it, the transportationvoucher, if you need it, the
peer connection, if you want it.
1 thing we didn't necessarilytalk about was the scope of the
network so far.
So when we've mentioned a fewtimes that patients get to pick
where they go to follow up thisis a big deal to us.
We've worked very closely withtreatment organization partners
(22:07):
and have them offer up a littlebit of availability.
So.
Right now there are about 240treatment organization locations
across New York state thatreceive referrals.
They all chip in a little bit ofappointment availability.
And to their credit, we nowoffer about 2, 300 appointment
slots per week for people tochoose from, which is fantastic.
(22:31):
the treatment organizations getall the credit for that.
Whether you're getting linked upfrom an emergency department,
from the scene of an 911 call,or from the tail end of a
telemedicine visit, which wejust walk through, picking a
place to follow up where youwant to go is super important
and it doesn't necessarily needto be affiliated with the
hospital that you might besitting in.
Or if you are having an issueand you live in York City, but
(22:55):
you're visiting Niagara Fallsand you land in the emergency
department in Niagara Fallsbecause there was a problem--
you could pick to follow up at aclinic in New York City the
following day while you'resitting in a hospital in Niagara
Falls.
So, the ability to pick a placeto follow up at, even across the
state, is just as easy as itwould be picking a place to
follow up at down the street.
Shoshana Aronowitz (23:17):
That's amazing.
Yeah, that's incrediblyimportant.
Thinking about these receivingagencies where folks might be
referred to, we know that manysubstance use disorder programs,
unfortunately, don't follow Alow barrier model, meaning that
they might place many obstaclesin front of people who are
trying to receive care,especially medications for
(23:38):
opioid use disorder.
So how do you screen receivingagencies to make sure that the
places where you're sendingfolks are facilitating access?
Joshua Lynch (23:49):
That's a great question.
I would say that it's mucheasier to do the screenings now
than it was in the verybeginning.
Cause I think people realizethat low barrier access to
treatment is important andfrankly, the right thing to do.
Some of the regulations havebeen updated to allow for easier
access to medication.
(24:10):
we operate off of the Matters'mission, vision, and values
document.
Those can be found on ourwebsite as well.
We hold ourselves to thosestandards.
We hold the treatment partnersto those standards.
There's a couple of key pointswhen we're onboarding a
treatment organization andentrusting to help facilitate
(24:30):
referrals to their organization.
It's really just a couple ofthings; one is that they have to
agree to take patients as theyare, and that would include
having a way to handleresponsibly patients without
insurance, having the ability totake care of patients with
polysubstance use, or cooccurring mental health and
substance use disorderstogether, and we also expect
(24:53):
them to prioritize access tomedication, and what I mean by
that is that there can't beunnecessary requirements and
obstacles placed in the way forpatients that, for example,
let's say, before you see aprescriber, you have to attend X
amount of counseling sessions, Xamount of groups, and then we'll
(25:14):
schedule you an appointment withthe prescriber.
That's not necessarily in linewith low barrier access to
medication, which is superimportant to us.
We feel strongly that theevidence also supports that in
regards to patients retained intreatment and staying alive.
Those are really the qualitiesthat we're looking for in a
receiving organization.
And 1 example on the other endwould be, let's say there's a
(25:36):
treatment organization thatoperates as a cash practice,
doesn't participate withinsurance, doesn't have
reasonable ways for patientsthat are uninsured to get there.
And by reasonable, I mean, notcharging them tons of money to
get there.
Those types of treatmentorganizations would not be
eligible to participate andreceive referrals.
shoshi-aronowitz--she-her (25:51):
While you were talking, I was thinking
about some of the other issuesthat folks who are trying to
access treatment might face.
And I'm based in Philadelphia,and we are seeing, increasing
numbers of patients who want toaccess substance use disorder
treatment who have woundsrelated to injection drug use
(26:12):
and, many substance use disordertreatment programs not having
the capacity to treat theirwounds and substance use
disorder, so that can sometimesbe a barrier to getting into
care.
I'm curious if that has come upin your program, and you're
thinking around how to referpatients and how you screen for
(26:35):
some of these co occurringissues and potentially help
folks access the care they need.
joshua-lynch--do--facep_1_04 (26:42):
As you can imagine, across our
network of about 240 treatmentorganizations they vary in what
capabilities they have.
The minimum is that they offermedication for addiction
treatment, even below that wouldbe everyone has to offer access
to buprenorphine for now, we maychange that a little bit to
allow for additionalorganizations to participate,
(27:05):
but some of the treatmentorganizations also offer formal
medical care services, not justmental health and substance use
disorder.
Like, they may have primary caredoctors that work there, too.
We found that those that areequipped to offer primary care
are, first of all, greatpartners because sometimes
(27:27):
patients with substance usedisorder don't have a primary
care doctor and, and reallycould use their blood pressure
to be handled to or their woundsto be addressed.
We found that steering patientstowards those more, robust
treatment organizations that mayhave other things under their
roof, would be more beneficialto folks that are struggling
with a bunch of differentissues.
(27:47):
What hasn't come up yet is thatwhen someone is going through
the referral process and you cango to the matters network dot
org website and watch awalkthrough of what a referral
looks like.
So you would know what toexpect, but when someone is
picking where they want tofollow up at, they're seeing the
treatment organizations listedon a map, like a Google map,
(28:08):
with markers, you find somewherethat's in the geography that
you're interested in, you clickon the marker that will show
what the clinic's name is, whattheir address is, and then what
type of medication for addictiontreatment they offer, and
additionally, what otherservices they offer, and there's
a whole bunch of, things listedthere.
Things like hepatitis, HIV,other substance use disorders,
mental health, syringe exchangeor syringe supply services,
(28:31):
among many other things.
If someone knows that they needother issues addressed, that's
why we put them right there.
So It would be easiest if theypick a treatment location that
may offer multiple services thatalign with the patient's needs.
We try to get all that out ofthe way in the beginning because
we know that for many people,getting to an appointment is
(28:53):
tough and having them go to 2different appointments at 2
different places may beimpossible for some people.
We want to make it as easy andstreamlined as we can.
Shoshana Aronowitz (29:02):
That's great.
I love that it's on a map sothat people can really visualize
where the resources are.
So, do you follow up withpatients about their
experiences?
You know, after they go off andaccess care at the organizations
that you refer to, and if so,how can patients give feedback?
joshua-lynch--do--facep_1 (29:25):
Yeah, that's a great question.
The short answer is yes, we tryto follow up with every single
patient that's been referred allacross the state.
That Looks a little differentbased on where the referral is
coming from, what I will say iswe're super excited that later
this month we are bringing on asocial support coordinator.
And what this person will do ishelp to oversee that follow up
(29:47):
process, but also add anothersafety net layer of services.
So they call the patient tofollow up with them.
Hey, did you make it to yourappointment?
If you didn't make it to yourappointment, usually the first
question is what happened or howcan we help you?
they may identify other issuesthroughout that phone call.
Maybe the patient can't getthere because they don't have
(30:09):
access to transportation andthey didn't know about our
transportation voucher.
Or maybe housing is such anissue that that's prohibiting
them from getting intotreatment.
What we're hoping to do over thecourse of the second half of
2024 is to layer on thisadditional set of resources that
hopefully can help address someof these other needs that many
(30:31):
of our patients encounter andhelp work through some of those
obstacles that may be preventingthem from getting good
treatment.
Shoshana Aronowitz (30:38):
That's great.
Thinking about kind of like thenext stage of follow up, can
your program push treatmentorganizations in a better
direction?
I'm thinking if a patient has aconcern about how they were
treated or what they could andcouldn't access, does your
organization bring that back tothe clinic that they went to, to
(30:59):
say, this patient had this badexperience and what can be
improved, or maybe thinkingabout your criteria for
receiving agency to be includedin your referral network.
Do you think robust requirementsfor programs can maybe nudge
programs in the right direction?
joshua-lynch--do--facep_1_0 (31:19):
I'd like to think that we may play a
little role in helping push ourpartners to continue to be
better.
I mean we try to be every day.
Had the pleasure of working withsome really incredible and
motivating individuals that workall over New York state.
I will say in the beginning,when treatment organizations
(31:40):
were not able to commit to trulyprioritizing medication, for
example, they still had otherrequirements that patients
needed to meet before they wereable to meet with a prescriber.
Letting them know that we reallycouldn't send them referrals at
that point was tough, but I willsay to their credit, most of
them after those discussionseventually came back and said,
you know what, we reevaluated,we've built out a low barrier
(32:03):
pathway so patients can getreally true low barrier access
to medication.
Then we were able to bring themon and send them referrals and,
to me, we took that as, acompliment that maybe we played
a little bit of a role inhelping some organizations build
out low barrier access pathwaysto medication.
Shoshana Aronowitz (32:18):
I think that's great.
In that same vein something Ijust thought of to ask you, we
know that some patientsunfortunately encounter barriers
to buprenorphine accessspecifically at the pharmacy
level.
So maybe they're successful ingetting a prescription, but
that's only part of the hurdle,the next barrier comes at the
pharmacy.
Whether that be cost of themedication or stigma they face
(32:42):
from pharmacists or other staffat pharmacies, what does MATTERS
do to address those potentialbarriers at the pharmacy level?
Joshua Lynch (32:51):
There's a few approaches.
First of all, if you didn'tfollow up with our patients, we
would never know.
that's super important is to tryto keep that loop of
communication open andunderstand what experiences
they're having.
So that can look a few differentways.
If it's isolated issues with, Iwent to the pharmacy and they
told me I, couldn't get themedication for whatever reason.
(33:11):
Sometimes our folks will callthe pharmacy and try to
troubleshoot.
Sometimes I'll get involved orone of our other medical
directors might get involved.
To try to talk with thepharmacist and either explain
maybe they're uncomfortablebecause it was prescribed via
telemedicine or whatever otherissue.
Often times we can work out theissue by just talking with the
pharmacist or the pharmacy staffthemselves.
(33:32):
1 example is in 1 area of thestate with a particular pharmacy
chain, there were repeatedissues with access to
buprenorphine, at multipleretail locations.
Early efforts to try to talkwith the staff at the locations
really didn't work.
Matters is pretty plugged inwith the New York state
leadership at a variety ofdifferent entities, so we were
(33:55):
able to work with some folks inAlbany to try to redirect the
pharmacy chain to do the rightthing and provide appropriate
access to medication that wasappropriately prescribed.
So there's multiple ways some ofthat is one on one.
Some of that is through theadvocacy work that we do with
leadership in Albany.
I think a combination of thosethings has worked fairly well.
(34:18):
Still more work to do for sure.
But I think we're able to help,a lot of patients.
Shoshana Aronowitz (34:22):
That's great.
So we know also, that there arestark racial disparities in
access to evidence basedsubstance use disorder care and
harm reduction services.
How is matters addressing thesedisparities?
Shelby Arena (34:38):
We know racial disparities in healthcare and
access to resources aresignificant issues, but they're
often worse in the context ofsubstance use and harm
reduction.
Historically overdose rates havebeen higher in the white
community, but we've seen inrecent trends that the overdose
rates in communities of colorhave been drastically
increasing, while rates in thewhite community have been
(35:00):
decreasing, which really justillustrates the barriers that
communities of color face whenaccessing health care and
specifically harm reduction andsubstance use treatment
services.
There are many reasons for that,but the bottom line is, that
systemic inequalities, poverty,discrimination, inadequate
(35:20):
access to education andhealthcare facilities-- all of
these things are contributing tothese negative health outcomes.
For the Matters program in termsof, substance use treatment, you
know, our accessibility viatelemedicine is a great way to
reach folks in all areas.
It can prevent some of thatstigma people might face when
walking into a brick and mortarfacility.
(35:43):
It's also a great way to reachfolks with transportation
issues, and then additionally,our medication vouchers and
transportation vouchers alsoaddress some of those barriers
we talked about in accessingtreatment.
Josh talked about how we vet allof our treatment partners to
ensure that once we do thathandoff to the outpatient
treatment, that partner will beable to address all the needs of
(36:03):
the patient in terms ofcontinuing access to their
treatment.
And then in terms of our harmreduction programs, we've
strategically placed our vendingmachines in areas with high
rates of substance use andHoping to mitigate some of these
disparities.
Only are folks able to accessthese supplies, but they're able
to do that again in a way, wherethey don't need to have a direct
(36:26):
interaction with any health careproviders, which again is kind
of a stigma free way to getthese, supplies out into the
community.
I'm not sure if we talked about,we also have, a link to our
website on all of our vendingmachines in case people are
ready for treatment.
so our vending machines canserve really as a gateway to
substance use treatment andother healthcare services and
(36:46):
resources.
we have our partners in the areawho also provide a wide array of
services, that can also connectfolks to local health clinics
and, treatment programs and sothis holistic approach can help
address some of these issues,but it's more a systemic thing
that we need to continue talkingabout.
shoshi-aronowitz--she-her-_ (37:05):
One question that just came to mind
when you were talking about Thevending machines and also
thinking about the mail basedprogram Do you have any sort of
advertising campaign orawareness campaign to promote
knowledge about the servicesthat you offer so people who
don't know about them can learnabout them.
squadcaster-65dh_1_04-19-2 (37:25):
Yes, initially we are in our first
year of the program, the vendingmachine program, at least just
rolling it out, working all thekinks out there.
But we are working on yardsigns.
So like down the street, youcan, put a sign out that says
vending machine around thecorner, working on palm cards so
people on the ground in thosecommunities can, hand out the
resources, to let people knowwhere they can get these items
(37:47):
in the community, and I think wedo have, some, bigger ideas in
the works as well.
shoshi-aronowitz--she-her-_1_ (37:53):
I love the yard sign idea.
That's great.
Well, thank you both for thoseanswers.
Before we wrap up.
I Would love to hear you tellthis story that you shared with
me when we were talking earlierabout a couple that you were
able to link to treatment andget access to your services, and
I think it really does a nicejob highlighting what the
(38:16):
Matters network can do.
Do you mind sharing this storywith listeners?
joshua-lynch--do--facep_1_04- (38:21):
I always smile when I think about
this story and when I share it,and fairly early in the Matters
evolution, I was, so I'm anemergency physician, I work in a
few different emergencydepartments and I had been
seeing one particular patientwho had been struggling with
getting into treatment, stayingin treatment and we got about
(38:41):
the ability to kind of link herin, a new way, which was kind of
the beginning of the Mattersprogram at getting her access to
buprenorphine, which she waspleasantly surprised to hear
that we could do in the E.
R.
So she was optimistic about usgetting her appointment and
linking her to somewhere.
She actually wanted to go followup at and her significant other
was sitting in the room with herand there was some awkward
(39:03):
interaction between the two ofthem.
Finally she was like, well, Imean, he really needs to get
linked up to treatment too, buthe's not a patient here right
now, like an ER patient, but Idon't know if there's any...
could you help him too?, mattersoperates independently from
anyone hospital system or anyonetreatment organization.
So yeah, at the time we werecertainly able to help link him
(39:26):
up too, and he didn'tnecessarily need to become a
formal ER patient.
Some time had gone by and I hadthe opportunity to bump into him
again and I was able to followup with him.
He is doing fantastic and isback to work, has a great job,
and is doing great.
He just happened kind ofcoincidentally that, he was
(39:46):
sitting there.
We ended up getting in thisdiscussion with his significant
other and luckily they spoke upand get into treatment.
know, This doesn't have to be ahuge complicated process.
Like it can happen just as easyas that.
And if you have a tool like thematters program that you can
plug someone in that's exactlywhat it was designed for.
shoshi-aronowitz--she-he (40:03):
That's wonderful.
We love to hear those successfulstories.
So I think that's a great way towrap up this episode.
I really enjoyed talking withboth of you, learning more about
the program and thank you bothso much.
joshua-lynch--do--facep_1 (40:16):
Yeah.
Thanks for having us.
squadcaster-65dh_1_04-19- (40:18):
Thank you.
kinna-thakarar--she-her-_5 (40:20):
That was Dr.
Joshua Lynch, Shelby Arena, andDr.
Shoshana Aronowitz inconversation on harm reduction,
compassionate care for peoplewho use drugs.
Thank you for listening.
Be sure to tune in next timewhen we welcome Stephen Murray,
Dr.
Ju Park, and Dr.
Ricky Bluthenthal to the seriesto discuss emerging overdose
detection technologies andhotlines.
Kinna Thakarar (40:40):
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.
(41:02):
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.
(41:23):
S.
government.
Thank you for listening.
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.
Shoshana Aronowitz inconversation with Dr.
Joshua Lynch and Shelby Arena todiscuss innovative access to
harm reduction support andlinkage to treatment.
Our host, Shoshana Aronowitz, isa family nurse practitioner,
community engaged healthservices researcher, and
assistant professor in theDepartment of Family and
Community Health at PennNursing.
(01:19):
Her research and clinical workis focused on improving access
to evidence based substance usedisorder treatment and harm
reduction services viainnovative delivery models,
including telehealth and mailbased programs.
Dr.
Lynch is an Associate Professorof Emergency and Addiction
Medicine at the University ofBuffalo.
He is the founder and chiefmedical officer of the MATTERS
(01:40):
Medication for AddictionTreatment and Electronic
Referrals Program, focused onprevention, education, increase
in access to treatment forsubstance use disorder, and
rapid referrals to long termsubstance use treatment.
He and his team have receivedover 20 million dollars in grant
funding for various publichealth initiatives in the areas
of substance use disorder andhepatitis C.
(02:02):
Shelby Arena, Harm ReductionManager with the Matters Program
earned her dual Bachelor of Artsdegrees in International
Relations and Latin AmericanStudies.
She is currently pursuing herMaster of Social Work at the
University of Buffalo.
She has worked in the health andhuman services sector since
2016, with experience educatingand counseling people in
reproductive health and justice,domestic violence and sexual
(02:24):
assault, as well as mentalhealth and substance use.
Shelby is an advocate for harmreduction and is passionate
about fostering communityconnections.
Dr.
Ronowitz disclosed that she isemployed as a clinician with
Ophelia Health.
Dr.
Lynch disclosed that he assistedemergent bio solutions with FDA
approval.
Shelby Arena reported nothing todisclosed.
(02:46):
Thanks for joining us, Shoshana,Josh, and Shelby.
Shoshana Aronowitz (02:49):
Thanks so much, Kina, and welcome
listeners.
It's so great to have everyonehere.
My name is Shoshana Aronowitz,and I'm honored to serve as host
for this episode.
Today we'll be talking about theMATTERS Network.
We'll be discussing what thisprogram offers, what makes it
unique, and how it can servefolks who may otherwise be left
out of the substance usedisorder treatment and harm
reduction landscape.
(03:11):
Over the next 30 to 40 minutes,you'll hear from two experts
with us today.
Dr.
Joshua Lynch, CMO and programcreator, and Shelby Arena,
manager of harm reductionservices.
It's so wonderful to have bothof you here.
Thanks so much for joining us.
Joshua Lynch (03:27):
Thanks for having us.
Shoshana Aronowitz (03:28):
To get started, I would love for you to
let listeners know, those whoaren't familiar with Matters,
what your program does and whatyou offer.
Joshua Lynch (03:39):
Great.
Thanks.
So the matters program startedoff as a way to solve the
problem of linking patients withopioid use disorder to treatment
out of the emergency departmentsand now has grown into a whole
set of resources that really,reside between a referral
environment and a receivingenvironment.
(04:00):
We can help facilitate referralsfrom emergency departments,
other parts of the hospital,correctional institutions such
as jails or prisons.
Drug courts, telemedicine, thescene of 911 calls.
So working with firstresponders, and then really, we,
we offer the patient through anelectronic referral platform the
choice of where they want to gofollow up at treatment
(04:24):
organizations that meet certaincriteria that we have
identified.
Additionally, offer somewraparound services that help
patients get over otherobstacles that they may face
when they're going through theprocess of getting hooked up
with treatment and getting to beretained in treatment.
And some of those, we can talk alittle bit more about them
(04:45):
later, but some of those involvea medication voucher to cover
the cost of buprenorphine forpatients that don't have
insurance, transportationvoucher that offers assistance
to people who need A ride totheir appointment and back.
Linkage to peer services if theywant to engage with someone with
(05:06):
lived experience that can helpthem through as they get to
their first appointment andnavigate through treatment.
shoshi-aronowitz--sh (05:13):
Wonderful.
As I understand it, your programis available throughout New York
State, is that correct?
Joshua Lynch (05:19):
It is.
It started in Western New York.
Then we started to work with thecapital region around Albany.
And now we're very proud to saythat we cover most of New York
State and New York City and LongIsland.
We'll be expanding toPennsylvania and New Jersey
later in 2024.
shoshi-aronowitz--she-he (05:37):
That's really exciting.
so what inspired you to buildsomething like this?
Joshua Lynch (05:43):
You know, we're working in the emergency
department, we are painfullyaware of the toll that addiction
takes on individuals.
For a long time, the solution tolink someone up to treatment
with substance use disordermental health in certain cases
was really limited to us givingthem a piece of paper with a
(06:05):
bunch of phone numbers on it oftreatment organizations and
sending them on their way.
That seemed to be okay for awhile.
I think many of us knew that,that we could probably do
better.
If you think about it, yourarely see headlines saying that
this hospital has rolled outstate of the art addiction
(06:26):
assessment and linkage program.
I mean, maybe you see it alittle bit more lately.
But for the longest time, wedidn't see investment going into
use disorder, like we saw forother disease processes, it's
not too hard to find crazyinnovation going around the care
for strokes and the care forheart attacks and other, you
know, other disease processes,that wasn't really the case for
(06:48):
addiction.
We knew that we had to dosomething different.
We knew we had to do somethingbetter.
Trouble is kind of where do youstart?
At times, especially with theway that the opiate epidemic has
evolved over the years,sometimes it seems like an
unsolvable problem and startingto kind of break it down to say,
just what are the patients need?
(07:08):
We know that the patients need afair assessment, access to good
treatment, in many cases, thatincludes medication, linkage to
a high quality place where theycan get good care, and that
should be free, it should beclose and it should be at a
place that they want to go.
We do that for other diseaseprocesses.
And, and part of the reason whywe wanted to start this program
(07:30):
is because patients withsubstance use disorder should be
able access to the best qualitycare too.
shoshi-aronowitz--she-her (07:35):
Yeah, that's a great point that you
made about how rare it is to seea big hospital system kind of
brag about a state of the artsubstance use disorder treatment
program the way they do maybeabout other programs that they
have.
So I'd really like to dig a bitmore into the harm reduction
services that Matters offers.
Shelby, can you talk a bit aboutthe vending machine program?
Shelby Arena (08:00):
Yes, definitely.
To build off what dr lynch said,we recognize that not everyone
who uses drugs is ready fortreatment or even needs
treatment, but with contaminantslike fentanyl and xylazine in
the drug supply, the risksassociated with drug use are
rising.
So that's kind of where our harmreduction services came from.
Placing these harm reductionvending machines in the
(08:21):
community allows people toaccess supplies where they're
at.
What makes our program unique isthe diversity of locations we've
partnered with not onlygeographically in terms of like
urban versus rural, but also in,you know, the physical
locations.
I'll also say, again, to followup on Dr.
Lynch, you know, being a smallpart of this larger program
(08:42):
allows us to connect folksdirectly to care if they are
ready for treatment.
That person will get theirmedication the same day they
reach out if appropriate.
With our robust level of, ofsupport services to see them
through that process.
shoshi-aronowitz--sh (08:55):
Wonderful.
What supplies are available inyour machines?
squadcaster-65dh_1_04-19- (08:59):
Right now we have fentanyl test
strips, xylosine testing strips,and naloxone.
shoshi-aronowitz--she-her-_ (09:05):
I'd like to give the audience a
second to reflect on places andspaces they think would be most
suited for a vending machine.
You talked about the program'suniqueness coming partly from
the different places that youhave machines and i'm going to
ask you in a second to tell usmore about it But I'd like the
audience to kind of think aboutwhere they would choose to place
(09:26):
machines if they were able tochoose Okay, with that in mind,
Shelby, take it away.
Your program from what Iunderstand, places these
machines in many diverselocations, including outside of
jails and police stations.
Can you talk a bit about how youdecide where to place the
machines and where you're seeingthe most usage?
Shelby Arena (09:47):
Definitely.
The decision making process interms of where to place the
machines is a joint decisionbetween matters and the
organization we're partneringwith, right now we have 15
machines across the state.
With matters being based inBuffalo, we can't be everywhere,
so we rely on our communitypartners to really be the boots
on the ground, managing thosemachines and also being the
(10:09):
experts in their community.
We had ongoing conversationswith folks who were interested
in having a machine to reallyunderstand their community, what
makes it unique and what theunique needs are in their
community.
So a lot of places depending on,you know, where they are and
what data they have access to,some places used overdose data
(10:32):
by zip code to pinpoint aspecific zip code where there
was high need for thesesupplies.
Other counties, more ruralcounties, just don't have access
to that type of data.
So it's more anecdotal, talkingto the community, talking to
community members to see wherethey'd like to see these
machines.
And then in other situations, itwas like, I know you mentioned
(10:52):
the jails and the policestations-- I think some people
might have a strong reaction tothose locations, but when we
find law enforcement partnersthat are excited about harm
reduction and want to activelyde stigmatize these types of
supplies within theirorganizations that's something
we really want to highlight.
(11:12):
in our first year of the programwe're really monitoring to see
what types of locations work, soin addition to jails Police
stations, we have them attreatment organizations, fire
halls, some private businesses,like a convenience store, a
supportive housing apartmentcomplex, and, and really just
trying to monitor those numbersand see what works and what
doesn't.
shoshi-aronowitz--she-he (11:34):
That's really interesting.
I'd love to hear more if youhave any evidence, anecdotal or
otherwise, speaking to thispoint you made about de
stigmatizing the supplies withincertain organizations-- so I
think it was you were referringto maybe police departments and
someone thinking that having avending machine there would help
maybe start a conversation aboutharm reduction in that place.
squadcaster-65dh_1_04-19-2 (11:57):
Yes.
in the beginning it is kind ofsurprising for some folks, I
think if law enforcement agencymaybe doesn't have a strong
presence in their community,especially in terms of substance
use or harm reduction that canbe a challenge to overcome.
We have partnered with twoorganizations that are both very
active in terms of overdoseresponse education getting their
(12:19):
officers out there with naloxoneand test strips at the scene of
any incident they're respondingto.
Both of the law enforcementpartners in our program have
specific divisions for overdoseresponse, and they go out into
the community, so they havebuilt those relationships and
still there are always folks whomaybe aren't 100 percent on
board.
(12:40):
So it's not only de stigmatizingthis within the community, but
also within these departments.
I actually spoke with one of ourpartners this morning, just
doing our monthly check in andshe was telling me about how the
chief is, very on board withthis, but some of his officers
were not initially, but nowthey're seeing the officers
utilize these machinesthemselves to stock their cars
(13:01):
and to get these supplies outinto the community.
shoshi-aronowitz--she-he (13:05):
That's really interesting.
It's hitting me right now that,for many of the listeners
thinking about a vending machinewe're imagining putting in cash
or using a card and purchasingsnacks or something like that.
Do folks need to pay for thesupplies that are in the
machines?
Shelby Arena (13:19):
That's a great question.
Everything in the machine isfree.
All of our machines areaccessible 24/7.
The majority of them areoutside-- we want to make sure
that they are as low barrier aspossible.
So folks just have to enter in afour digit code that is posted
on the machine, then their yearof birth and their zip code,
(13:40):
just for a few data collectionpoints while still keeping it
anonymous.
And then they're able to vend upto three of those supplies per
transaction.
So they can definitely just goin again and put in that four
digit pin and their informationto really dispense as many
supplies as they need.
shoshi-aronowitz--she-he (13:58):
That's great.
You also have a mail baseddistribution program for testing
strips.
Can you talk about the logisticsof operating a program like
this?
squadcaster-65dh_1_04-19-2 (14:09):
Yes.
So right now we are mailing ourfentanyl and xylosine test
strips.
We mail to individuals andorganizations across the state.
we again send these supplies outfree of charge.
We've gone through and error ofwhat's going to work best.
Originally, we sent them out 10test strips at a time in an
envelope and then we realizedpeople were reordering quite
(14:31):
frequently.
We wanted to make sure that wewere lowering that burden on
them.
So now we send out boxes of 100test strips to individuals and
up to 1200 test strips toorganizations across the state.
shoshi-aronowitz--she-her- (14:44):
Talk a bit more about how mail based
distribution can serve peoplewho may be underserved by Brick
and mortar harm reductionprograms.
squadcaster-65dh_1_04-19-2 (14:54):
Yes.
So we're very lucky at Mattersthat the kind of scope that we
have in terms of serving theentire state also the the lack
of barriers that we have interms of how much supply we're
able to distribute?
I know a lot of times at a brickand mortar facility their
constraints financialconstraints and they can only
hand out either one or five teststrips at a time so folks will
(15:18):
have to go in there every day.
And there are a lot of folksthat You Don't have the time to
do that, don't have thetransportation, or just
unwilling to do that so beingable to reach folks who able to
access brick and mortar harmreduction programs, you know, by
reaching them inside their homeis a big win for us in terms of
getting these supplies out intothe community.
shoshi-aronowitz--she-her-_1 (15:40):
Is there a way that users of these
distribution programs, I'mthinking both the mailbase
program and the vending machineprogram, can offer feedback to
Matters or make suggestions?
Shelby Arena (15:55):
Yes, we are always open via email and phone call.
We get actually several phonecalls a day from folks regarding
our test strip distributionprogram.
And we do have a couple ofmembers on our harm reduction
program, but also anyone on theteam really is equipped to field
these types of calls.
And we are working onimplementing some more community
(16:16):
based feedback models as well.
Shoshana Aronowitz (16:19):
Wonderful.
So if a listener is hearing thisand is thinking that they might
want to start A similar program,a mail based program where they
are, what advice would you offerthem about getting a program
like this off the ground?
Shelby Arena (16:35):
My biggest piece of advice is patience.
There is going to be a lot oftrial and error, at least that's
what we experienced.
As long as you're getting thesupplies out there, I think
that's a win.
In terms of scaling a programthat can be difficult,
determining who you want to sendthese products to.
Originally, we only shipped toofficial state partners but we
(16:58):
realized there was a bigger needthan that.
So then we expanded to otherorganizations.
and, I, I spoke about how westarted off with 10 test strips
to 100 test strips.
And so really just listening tothat feedback from your
community on what they need andhow you can best serve them, I
think is what's going to makeyour program successful.
Joshua Lynch (17:15):
I also think on the vending machine piece, it
may not be as easy as you thinkto place a machine somewhere.
There are a lot of feelingsabout these supplies being
publicly available outdoors.
And I think we were surprisedthat either on both ends of the
spectrum, we were surprised atthe ease of some of the
locations, and we are alsosurprised at the number of
(17:36):
challenges that would show up atother locations.
So Shelby's right (17:39):
patience is certainly key here.
Eventually it will work out.
Having multiple ways forpatients to get access to
supplies and get linked up totreatment, I think is really the
key.
Shoshana Aronowitz (17:50):
Do you have any advice about dealing with
maybe some pushback when itcomes to, you know, for example,
placing machines, or it soundslike you get less pushback about
the mail program, but justpushback in general about these
different innovative deliverymodels for supplies.
joshua-lynch--do--facep_1_04- (18:08):
I think keeping an open mind.
We could tell a lot of storiesabout interesting things we've
learned about the mail basedprogram, but things don't
necessarily go kind of the waythat you would expect.
Let's say you're looking tostart a vending machine program
and there's a site that mightseem perfect in geography but
the site is owned by amunicipality and sometimes
(18:30):
there's tons of layers to getthrough of approvals, like Adam
municipal or like governmentalagency be able to place a
machine outside.
In contrast, the conveniencestore machine that we have-- not
too many layers of approvals forthat.
know, Sometimes those types oflocations might be easier to
play something or to put it todistribute test strips or
(18:52):
whatever.
Just keeping an open mind.
We really want one at thelibrary.
Well, the library may have 10layers of approvals and it might
take you a year, which istotally fine, you can work on
some other easier wins whileyou're working through the
slower process of some otherlocations.
And the same thing would go withthere's a community event you
want to distribute test strips,some may be super easy to go do
(19:12):
that.
Others, maybe a bit morecomplicated, but I think the
important thing is don't giveup.
We pivot all the time.
If we have an event that wethink would be a great fit and
it's not, we don't give up anddon't do anything for awhile, we
quickly turn and realize, okay,well, how can we get to this
group of people in a differentway?
Shoshana Aronowitz (19:31):
That's great advice.
Thank you.
Can you remind us all, if folksare interested in ordering mail
based supplies how they do that?
Joshua Lynch (19:40):
The easiest way would just to be to go to our
website, mattersnetwork.
org, or download the freeMatters Network app by searching
Matters Network on Google Playor the Apple Store.
Shoshana Aronowitz (19:51):
Now I'd like to discuss a bit more about what
you offer to folks interested inaccessing treatment for
substance use disorders.
Josh, you talked about this atthe beginning-- what makes your
program unique in facilitatingaccess to low barrier treatment?
Mm.
joshua-lynch--do--facep_1 (20:13):
Being at one of the referral
environments that we had talkedabout in the beginning, like a
hospital engaging with acommunity outreach team being at
drug court, being released fromjail.
Those are opportunities toaccess the matters set of
resources and get linked up totreatment.
The other can be self drivenfrom home.
This involves our telemedicineresources and that has been a
(20:36):
highly utilized service line orhighly utilized front door into
getting treatment.
In Western New York, we have theability to offer emergency
telemedicine assessments 24hours a day.
And the rest of New York for nowis 12 hours per day.
Hopefully, fingers crossed, thatwill be 24 hours across New York
state soon.
The ability to initiate atelemedicine visit yourself
(21:00):
probably the easiest way to dothat is, through the app or
calling seven, six, fiveMatters.
And this is within New Yorkstate for right now.
That will get you linked up witha telemedicine coordinator that
will start the brief intakeprocess, just a few minutes.
Will they will tee you up towhat to experience when you're
on with the nurse practitioneror PA or physician that's
(21:23):
actually performing thetelemedicine assessment.
So that is a brief assessment,kind of exactly what you would
think it would be.
If appropriate, they willprescribe buprenorphine.
Typically those prescriptionsare between 7 and 14 days.
And then towards the end, theywill run you through the Matters
referral process, which gets youaccess to an appointment,
(21:45):
typically, that's within 1 to 3days the medication voucher, if
you need it, the transportationvoucher, if you need it, the
peer connection, if you want it.
1 thing we didn't necessarilytalk about was the scope of the
network so far.
So when we've mentioned a fewtimes that patients get to pick
where they go to follow up thisis a big deal to us.
We've worked very closely withtreatment organization partners
(22:07):
and have them offer up a littlebit of availability.
So.
Right now there are about 240treatment organization locations
across New York state thatreceive referrals.
They all chip in a little bit ofappointment availability.
And to their credit, we nowoffer about 2, 300 appointment
slots per week for people tochoose from, which is fantastic.
(22:31):
the treatment organizations getall the credit for that.
Whether you're getting linked upfrom an emergency department,
from the scene of an 911 call,or from the tail end of a
telemedicine visit, which wejust walk through, picking a
place to follow up where youwant to go is super important
and it doesn't necessarily needto be affiliated with the
hospital that you might besitting in.
Or if you are having an issueand you live in York City, but
(22:55):
you're visiting Niagara Fallsand you land in the emergency
department in Niagara Fallsbecause there was a problem--
you could pick to follow up at aclinic in New York City the
following day while you'resitting in a hospital in Niagara
Falls.
So, the ability to pick a placeto follow up at, even across the
state, is just as easy as itwould be picking a place to
follow up at down the street.
Shoshana Aronowitz (23:17):
That's amazing.
Yeah, that's incrediblyimportant.
Thinking about these receivingagencies where folks might be
referred to, we know that manysubstance use disorder programs,
unfortunately, don't follow Alow barrier model, meaning that
they might place many obstaclesin front of people who are
trying to receive care,especially medications for
(23:38):
opioid use disorder.
So how do you screen receivingagencies to make sure that the
places where you're sendingfolks are facilitating access?
Joshua Lynch (23:49):
That's a great question.
I would say that it's mucheasier to do the screenings now
than it was in the verybeginning.
Cause I think people realizethat low barrier access to
treatment is important andfrankly, the right thing to do.
Some of the regulations havebeen updated to allow for easier
access to medication.
(24:10):
we operate off of the Matters'mission, vision, and values
document.
Those can be found on ourwebsite as well.
We hold ourselves to thosestandards.
We hold the treatment partnersto those standards.
There's a couple of key pointswhen we're onboarding a
treatment organization andentrusting to help facilitate
(24:30):
referrals to their organization.
It's really just a couple ofthings; one is that they have to
agree to take patients as theyare, and that would include
having a way to handleresponsibly patients without
insurance, having the ability totake care of patients with
polysubstance use, or cooccurring mental health and
substance use disorderstogether, and we also expect
(24:53):
them to prioritize access tomedication, and what I mean by
that is that there can't beunnecessary requirements and
obstacles placed in the way forpatients that, for example,
let's say, before you see aprescriber, you have to attend X
amount of counseling sessions, Xamount of groups, and then we'll
(25:14):
schedule you an appointment withthe prescriber.
That's not necessarily in linewith low barrier access to
medication, which is superimportant to us.
We feel strongly that theevidence also supports that in
regards to patients retained intreatment and staying alive.
Those are really the qualitiesthat we're looking for in a
receiving organization.
And 1 example on the other endwould be, let's say there's a
(25:36):
treatment organization thatoperates as a cash practice,
doesn't participate withinsurance, doesn't have
reasonable ways for patientsthat are uninsured to get there.
And by reasonable, I mean, notcharging them tons of money to
get there.
Those types of treatmentorganizations would not be
eligible to participate andreceive referrals.
shoshi-aronowitz--she-her (25:51):
While you were talking, I was thinking
about some of the other issuesthat folks who are trying to
access treatment might face.
And I'm based in Philadelphia,and we are seeing, increasing
numbers of patients who want toaccess substance use disorder
treatment who have woundsrelated to injection drug use
(26:12):
and, many substance use disordertreatment programs not having
the capacity to treat theirwounds and substance use
disorder, so that can sometimesbe a barrier to getting into
care.
I'm curious if that has come upin your program, and you're
thinking around how to referpatients and how you screen for
(26:35):
some of these co occurringissues and potentially help
folks access the care they need.
joshua-lynch--do--facep_1_04 (26:42):
As you can imagine, across our
network of about 240 treatmentorganizations they vary in what
capabilities they have.
The minimum is that they offermedication for addiction
treatment, even below that wouldbe everyone has to offer access
to buprenorphine for now, we maychange that a little bit to
allow for additionalorganizations to participate,
(27:05):
but some of the treatmentorganizations also offer formal
medical care services, not justmental health and substance use
disorder.
Like, they may have primary caredoctors that work there, too.
We found that those that areequipped to offer primary care
are, first of all, greatpartners because sometimes
(27:27):
patients with substance usedisorder don't have a primary
care doctor and, and reallycould use their blood pressure
to be handled to or their woundsto be addressed.
We found that steering patientstowards those more, robust
treatment organizations that mayhave other things under their
roof, would be more beneficialto folks that are struggling
with a bunch of differentissues.
(27:47):
What hasn't come up yet is thatwhen someone is going through
the referral process and you cango to the matters network dot
org website and watch awalkthrough of what a referral
looks like.
So you would know what toexpect, but when someone is
picking where they want tofollow up at, they're seeing the
treatment organizations listedon a map, like a Google map,
(28:08):
with markers, you find somewherethat's in the geography that
you're interested in, you clickon the marker that will show
what the clinic's name is, whattheir address is, and then what
type of medication for addictiontreatment they offer, and
additionally, what otherservices they offer, and there's
a whole bunch of, things listedthere.
Things like hepatitis, HIV,other substance use disorders,
mental health, syringe exchangeor syringe supply services,
(28:31):
among many other things.
If someone knows that they needother issues addressed, that's
why we put them right there.
So It would be easiest if theypick a treatment location that
may offer multiple services thatalign with the patient's needs.
We try to get all that out ofthe way in the beginning because
we know that for many people,getting to an appointment is
(28:53):
tough and having them go to 2different appointments at 2
different places may beimpossible for some people.
We want to make it as easy andstreamlined as we can.
Shoshana Aronowitz (29:02):
That's great.
I love that it's on a map sothat people can really visualize
where the resources are.
So, do you follow up withpatients about their
experiences?
You know, after they go off andaccess care at the organizations
that you refer to, and if so,how can patients give feedback?
joshua-lynch--do--facep_1 (29:25):
Yeah, that's a great question.
The short answer is yes, we tryto follow up with every single
patient that's been referred allacross the state.
That Looks a little differentbased on where the referral is
coming from, what I will say iswe're super excited that later
this month we are bringing on asocial support coordinator.
And what this person will do ishelp to oversee that follow up
(29:47):
process, but also add anothersafety net layer of services.
So they call the patient tofollow up with them.
Hey, did you make it to yourappointment?
If you didn't make it to yourappointment, usually the first
question is what happened or howcan we help you?
they may identify other issuesthroughout that phone call.
Maybe the patient can't getthere because they don't have
(30:09):
access to transportation andthey didn't know about our
transportation voucher.
Or maybe housing is such anissue that that's prohibiting
them from getting intotreatment.
What we're hoping to do over thecourse of the second half of
2024 is to layer on thisadditional set of resources that
hopefully can help address someof these other needs that many
(30:31):
of our patients encounter andhelp work through some of those
obstacles that may be preventingthem from getting good
treatment.
Shoshana Aronowitz (30:38):
That's great.
Thinking about kind of like thenext stage of follow up, can
your program push treatmentorganizations in a better
direction?
I'm thinking if a patient has aconcern about how they were
treated or what they could andcouldn't access, does your
organization bring that back tothe clinic that they went to, to
(30:59):
say, this patient had this badexperience and what can be
improved, or maybe thinkingabout your criteria for
receiving agency to be includedin your referral network.
Do you think robust requirementsfor programs can maybe nudge
programs in the right direction?
joshua-lynch--do--facep_1_0 (31:19):
I'd like to think that we may play a
little role in helping push ourpartners to continue to be
better.
I mean we try to be every day.
Had the pleasure of working withsome really incredible and
motivating individuals that workall over New York state.
I will say in the beginning,when treatment organizations
(31:40):
were not able to commit to trulyprioritizing medication, for
example, they still had otherrequirements that patients
needed to meet before they wereable to meet with a prescriber.
Letting them know that we reallycouldn't send them referrals at
that point was tough, but I willsay to their credit, most of
them after those discussionseventually came back and said,
you know what, we reevaluated,we've built out a low barrier
(32:03):
pathway so patients can getreally true low barrier access
to medication.
Then we were able to bring themon and send them referrals and,
to me, we took that as, acompliment that maybe we played
a little bit of a role inhelping some organizations build
out low barrier access pathwaysto medication.
Shoshana Aronowitz (32:18):
I think that's great.
In that same vein something Ijust thought of to ask you, we
know that some patientsunfortunately encounter barriers
to buprenorphine accessspecifically at the pharmacy
level.
So maybe they're successful ingetting a prescription, but
that's only part of the hurdle,the next barrier comes at the
pharmacy.
Whether that be cost of themedication or stigma they face
(32:42):
from pharmacists or other staffat pharmacies, what does MATTERS
do to address those potentialbarriers at the pharmacy level?
Joshua Lynch (32:51):
There's a few approaches.
First of all, if you didn'tfollow up with our patients, we
would never know.
that's super important is to tryto keep that loop of
communication open andunderstand what experiences
they're having.
So that can look a few differentways.
If it's isolated issues with, Iwent to the pharmacy and they
told me I, couldn't get themedication for whatever reason.
(33:11):
Sometimes our folks will callthe pharmacy and try to
troubleshoot.
Sometimes I'll get involved orone of our other medical
directors might get involved.
To try to talk with thepharmacist and either explain
maybe they're uncomfortablebecause it was prescribed via
telemedicine or whatever otherissue.
Often times we can work out theissue by just talking with the
pharmacist or the pharmacy staffthemselves.
(33:32):
1 example is in 1 area of thestate with a particular pharmacy
chain, there were repeatedissues with access to
buprenorphine, at multipleretail locations.
Early efforts to try to talkwith the staff at the locations
really didn't work.
Matters is pretty plugged inwith the New York state
leadership at a variety ofdifferent entities, so we were
(33:55):
able to work with some folks inAlbany to try to redirect the
pharmacy chain to do the rightthing and provide appropriate
access to medication that wasappropriately prescribed.
So there's multiple ways some ofthat is one on one.
Some of that is through theadvocacy work that we do with
leadership in Albany.
I think a combination of thosethings has worked fairly well.
(34:18):
Still more work to do for sure.
But I think we're able to help,a lot of patients.
Shoshana Aronowitz (34:22):
That's great.
So we know also, that there arestark racial disparities in
access to evidence basedsubstance use disorder care and
harm reduction services.
How is matters addressing thesedisparities?
Shelby Arena (34:38):
We know racial disparities in healthcare and
access to resources aresignificant issues, but they're
often worse in the context ofsubstance use and harm
reduction.
Historically overdose rates havebeen higher in the white
community, but we've seen inrecent trends that the overdose
rates in communities of colorhave been drastically
increasing, while rates in thewhite community have been
(35:00):
decreasing, which really justillustrates the barriers that
communities of color face whenaccessing health care and
specifically harm reduction andsubstance use treatment
services.
There are many reasons for that,but the bottom line is, that
systemic inequalities, poverty,discrimination, inadequate
(35:20):
access to education andhealthcare facilities-- all of
these things are contributing tothese negative health outcomes.
For the Matters program in termsof, substance use treatment, you
know, our accessibility viatelemedicine is a great way to
reach folks in all areas.
It can prevent some of thatstigma people might face when
walking into a brick and mortarfacility.
(35:43):
It's also a great way to reachfolks with transportation
issues, and then additionally,our medication vouchers and
transportation vouchers alsoaddress some of those barriers
we talked about in accessingtreatment.
Josh talked about how we vet allof our treatment partners to
ensure that once we do thathandoff to the outpatient
treatment, that partner will beable to address all the needs of
(36:03):
the patient in terms ofcontinuing access to their
treatment.
And then in terms of our harmreduction programs, we've
strategically placed our vendingmachines in areas with high
rates of substance use andHoping to mitigate some of these
disparities.
Only are folks able to accessthese supplies, but they're able
to do that again in a way, wherethey don't need to have a direct
(36:26):
interaction with any health careproviders, which again is kind
of a stigma free way to getthese, supplies out into the
community.
I'm not sure if we talked about,we also have, a link to our
website on all of our vendingmachines in case people are
ready for treatment.
so our vending machines canserve really as a gateway to
substance use treatment andother healthcare services and
(36:46):
resources.
we have our partners in the areawho also provide a wide array of
services, that can also connectfolks to local health clinics
and, treatment programs and sothis holistic approach can help
address some of these issues,but it's more a systemic thing
that we need to continue talkingabout.
shoshi-aronowitz--she-her-_ (37:05):
One question that just came to mind
when you were talking about Thevending machines and also
thinking about the mail basedprogram Do you have any sort of
advertising campaign orawareness campaign to promote
knowledge about the servicesthat you offer so people who
don't know about them can learnabout them.
squadcaster-65dh_1_04-19-2 (37:25):
Yes, initially we are in our first
year of the program, the vendingmachine program, at least just
rolling it out, working all thekinks out there.
But we are working on yardsigns.
So like down the street, youcan, put a sign out that says
vending machine around thecorner, working on palm cards so
people on the ground in thosecommunities can, hand out the
resources, to let people knowwhere they can get these items
(37:47):
in the community, and I think wedo have, some, bigger ideas in
the works as well.
shoshi-aronowitz--she-her-_1_ (37:53):
I love the yard sign idea.
That's great.
Well, thank you both for thoseanswers.
Before we wrap up.
I Would love to hear you tellthis story that you shared with
me when we were talking earlierabout a couple that you were
able to link to treatment andget access to your services, and
I think it really does a nicejob highlighting what the
(38:16):
Matters network can do.
Do you mind sharing this storywith listeners?
joshua-lynch--do--facep_1_04- (38:21):
I always smile when I think about
this story and when I share it,and fairly early in the Matters
evolution, I was, so I'm anemergency physician, I work in a
few different emergencydepartments and I had been
seeing one particular patientwho had been struggling with
getting into treatment, stayingin treatment and we got about
(38:41):
the ability to kind of link herin, a new way, which was kind of
the beginning of the Mattersprogram at getting her access to
buprenorphine, which she waspleasantly surprised to hear
that we could do in the E.
R.
So she was optimistic about usgetting her appointment and
linking her to somewhere.
She actually wanted to go followup at and her significant other
was sitting in the room with herand there was some awkward
(39:03):
interaction between the two ofthem.
Finally she was like, well, Imean, he really needs to get
linked up to treatment too, buthe's not a patient here right
now, like an ER patient, but Idon't know if there's any...
could you help him too?, mattersoperates independently from
anyone hospital system or anyonetreatment organization.
So yeah, at the time we werecertainly able to help link him
(39:26):
up too, and he didn'tnecessarily need to become a
formal ER patient.
Some time had gone by and I hadthe opportunity to bump into him
again and I was able to followup with him.
He is doing fantastic and isback to work, has a great job,
and is doing great.
He just happened kind ofcoincidentally that, he was
(39:46):
sitting there.
We ended up getting in thisdiscussion with his significant
other and luckily they spoke upand get into treatment.
know, This doesn't have to be ahuge complicated process.
Like it can happen just as easyas that.
And if you have a tool like thematters program that you can
plug someone in that's exactlywhat it was designed for.
shoshi-aronowitz--she-he (40:03):
That's wonderful.
We love to hear those successfulstories.
So I think that's a great way towrap up this episode.
I really enjoyed talking withboth of you, learning more about
the program and thank you bothso much.
joshua-lynch--do--facep_1 (40:16):
Yeah.
Thanks for having us.
squadcaster-65dh_1_04-19- (40:18):
Thank you.
kinna-thakarar--she-her-_5 (40:20):
That was Dr.
Joshua Lynch, Shelby Arena, andDr.
Shoshana Aronowitz inconversation on harm reduction,
compassionate care for peoplewho use drugs.
Thank you for listening.
Be sure to tune in next timewhen we welcome Stephen Murray,
Dr.
Ju Park, and Dr.
Ricky Bluthenthal to the seriesto discuss emerging overdose
detection technologies andhotlines.
Kinna Thakarar (40:40):
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.
(41:02):
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.
(41:23):
S.
government.
Thank you for listening.
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