July 25, 2024 • 34 mins
Episode 3: Insights from the Front Line: Harm Reduction Interventions in an Urban Hospital
Featuring:
Sophie Zhai
B.A. Public Health - University of California, Berkeley
Patient Navigator, Addiction Care Team at UCSF
Patricia “Patty” Moreno
B.S. Global Disease Biology - University of California, Davis
Patient Navigator, Addiction Care Team at UCSF
Hosted by:
Amelia Goff, NP
Assistant Professor, Oregon Health & Science University, Portland Oregon
Improving Addiction Care Team (IMPACT), HRBR Clinic
Episode three introduces San Francisco’s first ever hospital-based harm reduction program, led by Sophie and Patty with the Addiction Care Team at Zuckerberg San Francisco General Hospital. Together, they’ll reflect on the challenges they experienced with changing culture around addiction care in the hospital, and address strategies to combat stigma and staff burnout. They will share real-life impacts of patients who participated in their program, and explore exciting new projects for hospital-based harm reduction in the near future!
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
(00:57):
AMERSA.
This week, we welcome Lea FramelWong in conversation with
Patricia Moreno and Sophie Zaito discuss insights from the
frontline, safer use supplies,and other harm reduction
interventions in an urbanhospital.
Our host, Lea Framel Wong, is aformer community health worker
and graduating medical studentat UCSF.
She co authored a study onpatient and staff perspectives
(01:19):
on San Francisco General's HarmReduction Services published
this February in JAMA NetworkOpen.
Patty Moreno is from Stockton,California, and a first
generation Mexican Americancollege graduate from San
Joaquin Delta College and UCDavis in global disease biology.
Long term, she wants to become aphysician, contribute to the
addiction medicine community andaddress numerous barriers faced
(01:41):
by marginalized people in theCentral Valley.
She is currently working as apatient navigator with the
addiction care team at UCSFwhere she talks to patients
about their substance use goalsand provides guidance and
support in the intricatehealthcare system.
Sophie Zai grew up in the BayArea and obtained her degree in
public health at UC Berkeley.
She developed an early interestin community based care, working
(02:03):
for several years on streetmedicine teams to provide health
services directly at syringeexchanges and encampments for
the homeless.
Most recently, Sophie joined theAddiction care team at UCSF as a
patient navigator, where shehelps break down barriers to
addiction services.
She hopes to pursue a career inmedicine and continue advocating
(02:24):
for people who are mostvulnerable in her community.
The presenters reported nothingto disclose.
Thanks for joining us, Leah,Patty, and Sophie.
Leah Fraimow-Wong (02:34):
Thank you so much, Dr.
Thakkarar and listeners.
so great to have everyone here.
I am your host for this episode,Lea.
Really excited today to talkabout frontline insights on
hospital based harm reduction.
To kick us off, I'm going tolist out our learning objectives
for today.
One, you know, just being ableto describe what a hospital
based harm reduction programmight look like, being able to
(02:57):
identify common challenges forimplementing a hospital based
harm reduction program andstrategies to address them, and
really being able to explain thesignificance of offering harm
reduction to patients in ahospital setting.
Over the next 30 to 40 minuteswe're gonna get to hear from two
amazing experts with us today.
Patty Moreno and Sophie Zai whoare substance use navigators at
(03:19):
San Francisco General'sAddiction Care team.
It's so wonderful to have bothof you here.
Maybe just to, to start us off,tell us about your current role.
Sophie Zhai (03:29):
Thank you so much, Leia.
So, Patty and I are actuallypatient navigators on the
Addiction Care Team, or ACT,which is a multidisciplinary
inpatient addiction medicineconsult service at San Francisco
General Hospital.
ACT has been up and running forabout seven years now.
six years now.
And just in this last year,Patty and I have touched about
(03:50):
600 patients primarily in theemergency department and in the
med surg unit.
But we also see folks in ourpsychiatric emergency services
unit and also in our skillednursing facility.
And because we're working in asafety net hospital, we're
primarily working with folks whoare under resourced.
So 60 percent of the folks thatwe see are unhoused.
(04:12):
50 percent are unhoused.
are black or Latinx and most ofthem have public health
insurance or don't have anyinsurance at all.
Leah Fraimow-Wong (04:20):
Yeah.
It's so amazing to see how theaddiction care team has grown
over just these past six years.
And I understand that more andmore hospitals are kind of
continuing that trend.
But San Francisco General is oneof only a handful that provides
harm reduction services, eventhough that might kind of be in
the ethos of a lot of addictioncare teams.
(04:41):
Tell me about some of theservices that ACT provides.
Patricia Moreno (04:45):
Like Sophie mentioned earlier, we're a
diverse team with unique skillsand we all work really hard to
prioritize patient's substanceuse goals and their recovery.
And we advocate for moreinclusive and supportive
healthcare environment.
And the addiction care team, wereally capitalize off a, what we
(05:05):
call reachable moment during apatient's hospitalization to
start addiction treatment forthose that didn't necessarily
looked for care upon initialpresentation.
And it's really a continuum ofcare and a spectrum.
And particularly what Sophie andI do, we provide linkage to
services and that can look likeoutpatient resources,
(05:29):
residential addiction treatmentfor substance use disorders.
And we also talk to patientsabout harm reduction services
and safer use supplies, which isgoing to be the focus of our
podcast today.
Leah (05:42):
Oh, I'm so excited that you guys are here.
Tell us more about the Safer UseSupplies Program.
Sophie Zhai (05:50):
So, what's really unique about our program is that
we're actually the only ones inSan Francisco who are
distributing safer use suppliesdirectly from the hospital
setting.
And this program has beenrunning for about a couple years
now.
It was created by one of thepatient navigators on ACT, and
her name was Rachel Pereira.
(06:10):
She was able to do this bypartnering with.
syringe exchange programs in thecommunity.
I actually just want to say thatwe are super, super lucky to be
in San Francisco where we dohave an abundance of community
resources who are really thereto guide and support this whole
process of bringing harmreduction into the medical
setting.
Originally, these supplies wereprovided by the San Francisco
(06:33):
AIDS Foundation, and now they'rebeing currently provided by the
Alliance Health Project at UCSF,and they include safer smoking
supplies, safer injectionsupplies, fentanyl test strips,
and we also get naloxone fromthe Department of Health Care
Services.
Patricia Moreno (06:48):
To talk a little bit more about our harm
reduction workflow, what Sophieand I do when we talk to
patients about their substanceuse and their relationship
towards those substances andtheir goals, we find that the
patients are very ambivalentabout their, their substance
use.
And harm reduction is for peoplewho don't view cessation as an
immediate or attainable goal.
(07:10):
And Sophie and I, we reallyserve as a nexus.
Like a central point where weserve as advocates for our
patients and talk to them aboutharm reduction.
To get into our workflow, whatwe do is once the patient
requests a harm reduction kit,we talk to their bedside nurses
and also their primary team, wehave these brown paper bags with
(07:32):
stickers with our ACT logo andthe patient's name and their
room number, we give it to thebedside nurses so they can
safely store it in themedication cabinet.
So we don't give it directly topatients for safety precautions.
Once the patient discharges,they have their medications on
hand, their discharge summary--that's when the harm reduction
(07:52):
kits get distributed.
Leah (07:55):
That's, that's so cool.
I remember seeing so many ofthose brown bags across the
hospital.
And it always makes me smile.
You know, for our listeners,why, why should we give out
safer use supplies from thehospital?
Patricia Moreno (08:10):
Research shows that individuals who access
syringe services programs knownas SSPs, it can help patients
reduce HIV and Hepatitis C virusby 50 percent by incidence.
And the CDC also has showed usthat these programs, patients
are five times more likely toenter drug treatment and three
(08:32):
times more likely to reduceinjection frequency compared to
individuals who don't accessthese kinds of services.
We see infections all the time,Sophie and I, when we come in
here and we look at the consultlist for the addiction care
team.
People come in for endocarditis,cellulitis, even sometimes
(08:53):
accidental fentanyl overdoses.
So this is very common what wesee in the hospital.
Sophie Zhai (08:59):
I would say It tends to be the majority of our
patients who have somecomplication related to their
substance use or just have thisacute or chronic medical issue
that's being made worse becauseof issues related to their
substance use.
Leah (09:14):
I think it's really incredible the kind of shift to
thinking about prevention andlike, how do we get to some of
the upstream of what we'reseeing in the hospital every
day?
It's been a few years now withthese services-- I would love to
hear about how you all kind ofintroduce safer use supplies to
(09:35):
patients.
But before you answer.
Maybe I'll ask listeners to justkind of take a moment and
imagine you have a patient whoyou've talked to and they've
communicated that their goal atthe moment is to continue,
continue using substances.
How would you kind of open theconversation about harm
reduction and safer usesupplies?
(09:58):
As you think about that maybeSophie and Patty, you're really
kind of experts at this point.
And I know you each have yourown style.
How, how do you each approachthis conversation?
Patricia Moreno (10:08):
The way I typically approach talking to a
patient about their substanceuse, I leave it very open ended,
non judgmental, and I ask a lotof broad questions regarding
their substance use history.
We really let the patient leadon the conversation, and once we
start asking these open endedquestions, we get a lot of
answers.
(10:28):
We start understanding whattheir social situation is like,
in what environment are theyusing drugs, also what their
relationship to those substanceslooks like.
Many don't know what their goalsare all of the time.
Using motivational interviewingskills helps us really tease out
(10:49):
the, the relationship thatpatients have with substances
and what works, what doesn't,maybe what are some of the pros
and cons when they're usingthese substances, and then we
just go from there.
Sophie Zhai (11:03):
I think leading that way is super helpful for
actually understanding wherepeople are at with their drug
use practices too, what they'reusing how they're using how much
how often it gives us a reallygood picture of where people are
at with their current harmreduction practices, we can
answer some questions like arethey using test doses?
(11:25):
Are they carrying naloxone?
And are they using with somebodynearby who could potentially
call ems if there were to be anoverdose that were to happen.
How are they accessing supplies?
Are there any issues withaccess?
Are they sharing supplies whenthey are using?
These are all questions thattend to come out when we're
(11:46):
asking these like broadquestions when we're
understanding where people areat.
I just want to recognize thatmost of our patients are
actually teaching us about theirharm reduction practices.
A lot of them are doing a reallygreat job of integrating harm
reduction into their drug use.
They're able to teach us whennew things kind of come onto the
market and we're able tounderstand what's going on in
(12:08):
the community a little bitbetter when we meet them at the
hospital and do theseassessments.
For those of you out there whoare just starting out and taking
a history and learning how toengage your patients in
conversations about harmreduction, Patty and I actually
came up with this really coolmnemonic that can help be a
framework for when you're havingthose conversations.
(12:30):
The mnemonic is called DOPE andit stands for Drugs, Objective,
Paraphernalia, and Environment.
These are the four key things tothink about when you're asking
your patients about their druguse.
Leah (12:42):
Wow.
That's really helpful.
Drugs, objectives,paraphernalia, and environment.
I'm going to put that in my backpocket.
Is there ever a situation whereyou hesitate to offer someone
harm reduction supplies?
Patricia Moreno (12:57):
I'm really glad you asked that because sometimes
it can be a very trickysituation depending on what the
patient discloses.
There are green lights, thereare sometimes red lights or
yellow lights and a green lightto know when to offer harm
reduction supplies to a patientis when they outright tell us,
Hey, you know, my goal is tocontinue safely using, or I want
(13:21):
to reduce use, but I want tocontinue using substances.
I'm not ready to quit yet.
That's not in my near or longterm goals.
That's when we typically tellthem what we offer in our harm
reduction closet.
We even have this binder thatreally summarizes all the
supplies we offer in thehospital.
It was created by one of ourLBNs.
(13:41):
Her name is Xenia, we show thisto patients.
We also show this to staff justso they can know.
What exactly we're offering andhonor that transparency with our
patients and also ourcolleagues.
It's also very effective whenpatients say that they plan on
self directing their dischargeso they can go self medicate or
(14:02):
leaving against medical advice.
Sophie Zhai (14:04):
I find it super, super helpful in those instances
because we're When people aremaking that decision to self
direct their discharge, they'requite literally telling us that
they're going to go selfmedicate and use drugs.
And this is an opportunity forus to reassure them and let them
know like, hey, even thoughyou're doing this, we still care
(14:24):
about your safety.
We still care about you and it'san opportunity to still build
that relationship.
It's a way to continue thattrust if and when they come
back.
Patricia Moreno (14:35):
Within our roles, Sophie and I, it's really
important for us to establishthat trust with a patient like
you mentioned earlier and that'swhy we ask all All patients
indiscriminately if they wouldlike any of these safer use
supplies because we understandthat part of the recovery
process, it's a chronic diseaseaddiction and it's something
(14:55):
that we can prepare for if theyever find that they need those
supplies.
If a person returns to use, theyhave those supplies in hand.
And sometimes it's not only justfor them-- they can share it
with someone they know orsomeone else in the community.
We leave it very open ended forthem and make sure that they
(15:15):
have that option available.
Sophie Zhai (15:18):
I think you bring up a good point, in that, you
know, even though we might'vejust had this conversation about
abstinence, and that might bewhere that patient is at,
they're wanting to pursueabstinence, recognizing That
return to use is part ofaddiction.
It's something that we canprepare for.
Not saying that that person willreturn to use, but it's
something that we can prepareand offer and we put it out
(15:41):
there for patients in case theydo want to prepare for that.
Leah (15:45):
It sounds like what I'm hearing is it's really kind of
leaving the options open andreally being guided by kind of
that relationship and rapportand trust building of what the
patient's goals actually are andwhat they want to do after they
leave the hospital.
It makes me curious what havepatients responses been like?
Sophie Zhai (16:07):
I think most people have been pretty pleasantly
surprised that a hospital wouldeven offer safer use supplies.
And I think most of our patientsare coming from previous
experiences where they've facedstigma while being in the
medical setting.
It's a chance for us asproviders to build stronger
(16:27):
relationships with our patients,letting them know that, we're
here for you, that you haveoptions.
We're here to listen and supportyou.
And we care about your safety.
Most people have responded verypositively to it.
Patricia Moreno (16:41):
Sophie and I have interacted with a diverse
range of populations within ourpatients and I just wanted to
share one of the monolingualSpanish speaking patients that I
had that learned about harmreduction supplies and how they
really appreciated us havingthese services available to them
in the hospital.
(17:01):
This patient that I talked to,they had migrated from Latin
America and they had experiencedan unintentional overdose from
fentanyl.
They were smokingmethamphetamine every day to
stay awake for the long workhours that they had, and they
had no idea what naloxone was orthe importance of not sharing
(17:22):
any supplies with anyone and whyit's important to own your own
supplies and becoming awareabout harm reduction therapy
centers that exist in SanFrancisco.
I remember this patient tellingme, quote, no one I know ever
told me these things existed inthe city.
I'm ashamed to discuss it withmy family and friends because I
(17:43):
fear they will look at medifferently.
I do want to quit eventually butI know that once I leave the
hospital I might fall back intosmoking meth.
I'm grateful that you sharedthese resources with me and even
made me a kit that I can takehome.
No other hospital I've been tohas talked about my drug use in
a compassionate way.
That really stood out to me.
(18:04):
It made an impact on me, it justmade me excited and grateful to
know that our team is doing, isworking really hard in having
patients feel heard and feelrespected.
That way we can support them intheir recovery journey, however
that may look like.
Leah (18:23):
Wow, that's a really powerful testimony, Patty.
Thank you so much for sharingthat.
And also, I'm so grateful thatyou were able to have that
interaction with that patient.
It really resonates with what wefound in the study.
Last year we had the opportunityto do a qualitative study about
(18:44):
the harm reduction services atSan Francisco General, where we
interviewed 20 patients who hadreceived harm reduction services
and 20 staff who had worked withpatients receiving harm
reduction services.
What we heard from patients isexactly what both of you have
been saying that people feltreally seen and the offer of
(19:05):
harm reduction supplies oftenwas, kind of the first positive
experience that they'd had inthe healthcare setting.
A kind of sense of rebuildingtrust after really awful
experiences often in priorhospital stays.
Like you were saying about selfdirected discharges people told
(19:26):
us over and over again thatbecause of this positive
experience, they would be muchless likely to delay care in the
future.
The testimony that you gave fromthat patient, really highlights
one of the surprising findingsto us in the study, which was
that many patients who are inSan Francisco are actually
really linked into harmreduction services.
(19:47):
And as you said, Sophie, are theexperts who are teaching us as
providers and as staff.
But there are also a lot ofdisparities in access to harm
reduction.
What we found was that amongpatients who reported learning
new strategies, who had lessexposure to harm reduction, who
were learning about naloxone forthe first time, learning about
(20:08):
community resources really allof them were black or Latinx
including some Spanish speakers.
Offering these supplies in thehospital was really a moment of
reaching people where they wereat And being able to connect
with some folks who maybe arenot being reached by, by
services out in the communityand being that linkage point to
(20:30):
help people get where they needto go.
We've talked for a while nowabout patients but what have
your experiences been with theresponse from staff?
Sophie Zhai (20:39):
It's definitely been mixed feelings from staff.
We have a lot of people who aresuper on board with harm
reduction.
Maybe they've had some exposureto harm reduction in their
formal training or through otherprofessional or personal
experiences in the past.
We have some folks who aredefinitely very open minded with
(21:00):
harm reduction, but they don'tfeel super prepared to engage
their patients in conversationsabout harm reduction yet.
They feel like it might be alittle bit awkward.
They're not really sure how toapproach it.
But they're super grateful forACT services and for ACT
support.
Then we definitely have a fewpeople who are skeptical about
harm reduction.
I think some of that comes fromburnout, from seeing folks who
(21:25):
are coming in over and overagain who are using drugs.
I think some of it is also justrelated to like personal biases
against drug use.
Patricia Moreno (21:34):
Within those personal biases a lot of staff
have shared with us that theyfeel like they're enabling drug
use and they feel inadequate toaddress harm reduction.
We do get a lot of questionsfrom staff and they ask us if
harm reduction is actuallyreally effective.
We tell them that harm reductionacknowledges how using drugs can
(21:57):
be very risky.
And there are evidence basedways of safer using.
This started from the community.
I want to acknowledge thatbecause now we're applying this
to hospital and clinicalsettings.
So it's been evolving for sometime now.
Sophie Zhai (22:14):
Definitely a lot of the staff responses that I've
seen, they have questions like,is this really working?
Is there data behind it?
Some people feel like, Oh, Idon't know.
I feel weird giving it out.
I'm not sure if I'm doing theright thing.
I made this oath to do no harm,is that what I'm doing?
We definitely have a lot ofquestions when we do engage our
(22:34):
staff about harm reduction andsafer use supplies.
What you said, Patty, wanting toacknowledge that drug use can
come with a lot of risks butthere are safer ways of using
drugs-- that's really what we'retrying to hone in on.
Leah (22:48):
That completely resonates with what we found in the study
talking to staff.
I feel like the overwhelmingfeeling from the vast majority
of staff was profound sense ofgratitude for ACT and for the
harm reduction feel like, wow,this is one of the most
challenging parts of my job andI finally have some support and
(23:08):
someone telling me what I shouldbe doing and giving a framework.
What I thought was reallyinteresting were the staff who
were maybe a little bit moreskeptical or we heard from a
number of staff who wereinitially skeptical and their
views kind of changed over timewith exposure to harm reduction.
I feel like so much of that camefrom all of the really
(23:31):
incredible and challenging workthat, that you both are doing
every day and that priorsubstance use navigators have
been doing as well, as well asall members of the ACT team.
There's a lot of fruit, I think,in some of those conversations
that have been had.
Maybe for our listeners to justtake a moment to reflect, if you
(23:54):
noticed a staff member who youwere working with who seemed
uncomfortable around harmreduction, or some of the
services we've been talkingabout, how would you approach
them?
How would you engage them in aconversation?
Holding that in the back of yourmind, Patty and Sophie, you guys
are really experts at this now.
I've learned so much from youabout how you engage staff.
(24:16):
What do you do when you workwith staff?
What are some that you mighthave?
Sophie Zhai (24:21):
Responding to providers who might be a little
bit more skeptical about harmreduction, I like to understand
where that's coming from.
I find that most providersactually just want to keep their
patients safe.
They always, just want to makesure that my patient is safe.
I want to make sure I'm doingthe right thing and doing
everything I can keep them safewhile they're in the hospital.
What we find from patients isthat they want to feel safe when
(24:44):
they're in the hospital.
We actually have this sharedgoal of safety.
I think there is a way to kindof bridge what the provider's
goals are with what thepatient's goals are.
I think something important tokeep in mind is that
traditionally in medicine,addiction treatment was on an
abstinence based model.
We were looking for thisbenchmark of abstinence.
(25:05):
You know, when somebody came inwith a substance use disorder,
we would just counsel people ontheir drug use and then tell
them to stop using.
But as we know, that's not veryeffective.
It doesn't really work.
As providers, even though wetell people to stop using drugs,
that doesn't often happen.
Kind of reframing how we thinkabout addiction treatment and
(25:25):
what we're really looking for.
Some of that could just be likereducing a person's risk of
overdose or reducing their riskof infection.
These could actually bebenchmarks that we're looking
for and it can help us reframe,what are these positive changes
that we can make with ourpatients that don't necessarily
have to be abstinence based.
(25:46):
Once we kind of reframe that forproviders, they can really
improve their work experienceand that in turn really improves
the care experience of ourpatients.
Patricia Moreno (25:57):
I wanted to mention a little bit more of the
teachings that Sophie and I havebeen doing.
So we've been engaging withstaff in the intense care unit,
with nurses, also third yearmedical students, internal
medicine residents, we have donethis 45 minute training on harm
reduction where we go over acase study and we go over harm
(26:20):
reduction philosophy andprinciples and we're measuring
some core competencies from thepeople who participate in this
training to see if they can takea thorough substance use
history, if they know how saferuse supplies function and also
to see if they know of someresources that they can link
(26:42):
patients to for harm reduction.
Our research showed that afterthe training, these staff and
students were a lot morecomfortable with these
competencies.
We asked a pre and post survey,and we were able to see a huge
difference, and we also noticedhow the staff and students were
able to develop clinical skillsand to better treat patients
(27:04):
with addiction upon leaving thistraining.
That's helping with the culturechange around harm reduction in
the hospital.
Even though we're leaning intothe discomfort, and we know it
can be really hard to talk aboutwe're doing a lot of the work in
order for this to become morenormalized, in order for us to
move forward.
Sophie Zhai (27:24):
Definitely, not only did staff feel more
confident in talking to patientsabout harm reduction and about
their substance use, but folkswho we noticed were a little bit
more skeptical in the beginning,they were shaking their head,
they weren't really sure aboutharm reduction-- at the end they
were a little bit more engaged.
They were taking pictures of ourslides, of our supplies, and
(27:46):
they had a little bit moreinterest and more buy in.
I think even from a comfortlevel of being more open minded
towards this I think thetrainings that we did made a
huge difference.
Leah (27:57):
That is just so powerful.
I think that the work that youboth are doing is really
inspiring because based on thisand based on what came out in
the staff interviews, what weheard was just that for so many
people, this was a huge frameshift in how they even thought
about substance use, like youmentioned Sophie, even a
(28:18):
different framework besides anabstinence only model.
That goes on to impact everyinteraction that they have with
patients who have a substanceuse disorder, not even the ones
just involving harm reductionsupplies.
What came out in the interviewswas a number of people mentioned
how this went from somethingthat was one of the hardest and
(28:38):
most challenging parts of theirjob, that felt like it
contributed to burnout becausethey were telling patients to
stop and it felt like they werefailing all the time, to a model
that's a lot more humanisticactually felt aligned with their
values of meeting the personwhere they were and figuring out
(28:59):
how to best support them andbest support their health.
It ended up being something thatwas really fulfilling.
I think the change that you bothhave been a part of is so
incredible and it alsohighlights how much more work
there is to do and that this isa constant struggle.
It's a whole huge culturechange.
Where do you see all of thisgoing?
What are some of the things youenvision for the future?
Sophie Zhai (29:21):
I think expanding the harm reduction workshops
that we've been doing for staff.
Seeing if we can equip moreproviders with these skills to
engage patients in theseconversations and effectively
offer interventions that areharm reduction based.
So what happens when moreproviders are using harm
(29:42):
reduction in their standard ofcare?
And does that impact patientsatisfaction?
Does that impact patientexperience?
Maybe having some surveys onthat and seeing if there is some
kind of tangible impact that wecan see.
I think the other thing iswanting to refine the curriculum
a little bit more.
I know Patty and I have somethings in the works.
Patricia Moreno (30:03):
I would also love to see addiction care
services expand to other areas.
I know Sophie mentioned earlierhow in San Francisco we're so
lucky how we are rich with a lotof resources for harm reduction
and support services for this,but I would also love to see
more satellite programs in mayberural areas, in other cities,
(30:26):
maybe even more in my hometownwhere I'm from.
I know that there are gaps stillfor awareness for harm reduction
services.
I would really love to worktowards raising awareness for
this and even the legal aspect.
Continuing to do work in policyadvocacy and also activism
around harm reduction is sovital.
(30:47):
There's a lot of work to be donethere still, but I know that
this takes a multidisciplinaryeffort in order for us to
continue doing valuable andimportant work around harm
reduction.
Leah (31:00):
We're in the middle of a national overdose crisis and we
know these services work.
They need to be out there and beaccessible.
I feel like as we're talking I'mjust struck by how much
expertise you both have at thispoint for others who might want
to do just that and start asimilar program or integrate
(31:21):
harm reduction into theirpractice what advice would you
give?
Any lessons learned?
Patricia Moreno (31:27):
We know that addiction care treatment is a
continuum and addiction is alsocomplex and can exist across all
levels like spiritual,humanistic, cultural, and
social, and so much more.
My dream is to see all of us,medical staff, non medical
staff, community members,involve stakeholders even to
(31:49):
work together to pave the way torecovery.
I'm really excited to see howharm reduction will continue to
evolve over the next years.
Sophie Zhai (32:00):
Like Patty said, this is a group effort.
We need buy in from, fromnurses, from providers, from
everybody.
It really is this movement thatwe're all trying to get on board
with together.
Asking a lot of questions,understanding where people are
coming from, meeting patientswhere they're at, meeting
providers where they're at andtheir education and their
(32:21):
knowledge.
Also understanding that thiswork is challenging.
Making changes anywhere issuper, super hard.
So, but it's super super hard,but really, really important.
Props to anyone out there who isdoing this work.
Patricia Moreno (32:36):
We appreciate you.
Leah (32:38):
I appreciate the both of you.
I think that's a perfect way toend it.
Thank you so much for havingthis conversation today.
I feel like I've learned a lot,it's always just a joy to chat
with both of you.
Sophie Zhai (32:53):
Thanks, Leah.
Patricia Moreno (32:53):
Thanks, Leah.
Kinna Thakarar (32:56):
That was Patti Moreno, Sophie Zhai, and Lea
Fremont Wong in conversation onharm reduction compassionate
care for people who use drugs.
Be sure to tune in next timewhen we welcome Dr.
Tessa Rife Pennington, AndyRuggles, and Dr.
Beth Dinges to the series todiscuss leveraging technology,
expanding veteran access to harmreduction resources through
vending machines.
Please take a moment to completeSAMHSA's post event evaluation
(33:18):
survey on the AMERSA podcastpage 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.
org and AMERSA org.
(33:39):
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.
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
(00:57):
AMERSA.
This week, we welcome Lea FramelWong in conversation with
Patricia Moreno and Sophie Zaito discuss insights from the
frontline, safer use supplies,and other harm reduction
interventions in an urbanhospital.
Our host, Lea Framel Wong, is aformer community health worker
and graduating medical studentat UCSF.
She co authored a study onpatient and staff perspectives
(01:19):
on San Francisco General's HarmReduction Services published
this February in JAMA NetworkOpen.
Patty Moreno is from Stockton,California, and a first
generation Mexican Americancollege graduate from San
Joaquin Delta College and UCDavis in global disease biology.
Long term, she wants to become aphysician, contribute to the
addiction medicine community andaddress numerous barriers faced
(01:41):
by marginalized people in theCentral Valley.
She is currently working as apatient navigator with the
addiction care team at UCSFwhere she talks to patients
about their substance use goalsand provides guidance and
support in the intricatehealthcare system.
Sophie Zai grew up in the BayArea and obtained her degree in
public health at UC Berkeley.
She developed an early interestin community based care, working
(02:03):
for several years on streetmedicine teams to provide health
services directly at syringeexchanges and encampments for
the homeless.
Most recently, Sophie joined theAddiction care team at UCSF as a
patient navigator, where shehelps break down barriers to
addiction services.
She hopes to pursue a career inmedicine and continue advocating
(02:24):
for people who are mostvulnerable in her community.
The presenters reported nothingto disclose.
Thanks for joining us, Leah,Patty, and Sophie.
Leah Fraimow-Wong (02:34):
Thank you so much, Dr.
Thakkarar and listeners.
so great to have everyone here.
I am your host for this episode,Lea.
Really excited today to talkabout frontline insights on
hospital based harm reduction.
To kick us off, I'm going tolist out our learning objectives
for today.
One, you know, just being ableto describe what a hospital
based harm reduction programmight look like, being able to
(02:57):
identify common challenges forimplementing a hospital based
harm reduction program andstrategies to address them, and
really being able to explain thesignificance of offering harm
reduction to patients in ahospital setting.
Over the next 30 to 40 minuteswe're gonna get to hear from two
amazing experts with us today.
Patty Moreno and Sophie Zai whoare substance use navigators at
(03:19):
San Francisco General'sAddiction Care team.
It's so wonderful to have bothof you here.
Maybe just to, to start us off,tell us about your current role.
Sophie Zhai (03:29):
Thank you so much, Leia.
So, Patty and I are actuallypatient navigators on the
Addiction Care Team, or ACT,which is a multidisciplinary
inpatient addiction medicineconsult service at San Francisco
General Hospital.
ACT has been up and running forabout seven years now.
six years now.
And just in this last year,Patty and I have touched about
(03:50):
600 patients primarily in theemergency department and in the
med surg unit.
But we also see folks in ourpsychiatric emergency services
unit and also in our skillednursing facility.
And because we're working in asafety net hospital, we're
primarily working with folks whoare under resourced.
So 60 percent of the folks thatwe see are unhoused.
(04:12):
50 percent are unhoused.
are black or Latinx and most ofthem have public health
insurance or don't have anyinsurance at all.
Leah Fraimow-Wong (04:20):
Yeah.
It's so amazing to see how theaddiction care team has grown
over just these past six years.
And I understand that more andmore hospitals are kind of
continuing that trend.
But San Francisco General is oneof only a handful that provides
harm reduction services, eventhough that might kind of be in
the ethos of a lot of addictioncare teams.
(04:41):
Tell me about some of theservices that ACT provides.
Patricia Moreno (04:45):
Like Sophie mentioned earlier, we're a
diverse team with unique skillsand we all work really hard to
prioritize patient's substanceuse goals and their recovery.
And we advocate for moreinclusive and supportive
healthcare environment.
And the addiction care team, wereally capitalize off a, what we
(05:05):
call reachable moment during apatient's hospitalization to
start addiction treatment forthose that didn't necessarily
looked for care upon initialpresentation.
And it's really a continuum ofcare and a spectrum.
And particularly what Sophie andI do, we provide linkage to
services and that can look likeoutpatient resources,
(05:29):
residential addiction treatmentfor substance use disorders.
And we also talk to patientsabout harm reduction services
and safer use supplies, which isgoing to be the focus of our
podcast today.
Leah (05:42):
Oh, I'm so excited that you guys are here.
Tell us more about the Safer UseSupplies Program.
Sophie Zhai (05:50):
So, what's really unique about our program is that
we're actually the only ones inSan Francisco who are
distributing safer use suppliesdirectly from the hospital
setting.
And this program has beenrunning for about a couple years
now.
It was created by one of thepatient navigators on ACT, and
her name was Rachel Pereira.
(06:10):
She was able to do this bypartnering with.
syringe exchange programs in thecommunity.
I actually just want to say thatwe are super, super lucky to be
in San Francisco where we dohave an abundance of community
resources who are really thereto guide and support this whole
process of bringing harmreduction into the medical
setting.
Originally, these supplies wereprovided by the San Francisco
(06:33):
AIDS Foundation, and now they'rebeing currently provided by the
Alliance Health Project at UCSF,and they include safer smoking
supplies, safer injectionsupplies, fentanyl test strips,
and we also get naloxone fromthe Department of Health Care
Services.
Patricia Moreno (06:48):
To talk a little bit more about our harm
reduction workflow, what Sophieand I do when we talk to
patients about their substanceuse and their relationship
towards those substances andtheir goals, we find that the
patients are very ambivalentabout their, their substance
use.
And harm reduction is for peoplewho don't view cessation as an
immediate or attainable goal.
(07:10):
And Sophie and I, we reallyserve as a nexus.
Like a central point where weserve as advocates for our
patients and talk to them aboutharm reduction.
To get into our workflow, whatwe do is once the patient
requests a harm reduction kit,we talk to their bedside nurses
and also their primary team, wehave these brown paper bags with
(07:32):
stickers with our ACT logo andthe patient's name and their
room number, we give it to thebedside nurses so they can
safely store it in themedication cabinet.
So we don't give it directly topatients for safety precautions.
Once the patient discharges,they have their medications on
hand, their discharge summary--that's when the harm reduction
(07:52):
kits get distributed.
Leah (07:55):
That's, that's so cool.
I remember seeing so many ofthose brown bags across the
hospital.
And it always makes me smile.
You know, for our listeners,why, why should we give out
safer use supplies from thehospital?
Patricia Moreno (08:10):
Research shows that individuals who access
syringe services programs knownas SSPs, it can help patients
reduce HIV and Hepatitis C virusby 50 percent by incidence.
And the CDC also has showed usthat these programs, patients
are five times more likely toenter drug treatment and three
(08:32):
times more likely to reduceinjection frequency compared to
individuals who don't accessthese kinds of services.
We see infections all the time,Sophie and I, when we come in
here and we look at the consultlist for the addiction care
team.
People come in for endocarditis,cellulitis, even sometimes
(08:53):
accidental fentanyl overdoses.
So this is very common what wesee in the hospital.
Sophie Zhai (08:59):
I would say It tends to be the majority of our
patients who have somecomplication related to their
substance use or just have thisacute or chronic medical issue
that's being made worse becauseof issues related to their
substance use.
Leah (09:14):
I think it's really incredible the kind of shift to
thinking about prevention andlike, how do we get to some of
the upstream of what we'reseeing in the hospital every
day?
It's been a few years now withthese services-- I would love to
hear about how you all kind ofintroduce safer use supplies to
(09:35):
patients.
But before you answer.
Maybe I'll ask listeners to justkind of take a moment and
imagine you have a patient whoyou've talked to and they've
communicated that their goal atthe moment is to continue,
continue using substances.
How would you kind of open theconversation about harm
reduction and safer usesupplies?
(09:58):
As you think about that maybeSophie and Patty, you're really
kind of experts at this point.
And I know you each have yourown style.
How, how do you each approachthis conversation?
Patricia Moreno (10:08):
The way I typically approach talking to a
patient about their substanceuse, I leave it very open ended,
non judgmental, and I ask a lotof broad questions regarding
their substance use history.
We really let the patient leadon the conversation, and once we
start asking these open endedquestions, we get a lot of
answers.
(10:28):
We start understanding whattheir social situation is like,
in what environment are theyusing drugs, also what their
relationship to those substanceslooks like.
Many don't know what their goalsare all of the time.
Using motivational interviewingskills helps us really tease out
(10:49):
the, the relationship thatpatients have with substances
and what works, what doesn't,maybe what are some of the pros
and cons when they're usingthese substances, and then we
just go from there.
Sophie Zhai (11:03):
I think leading that way is super helpful for
actually understanding wherepeople are at with their drug
use practices too, what they'reusing how they're using how much
how often it gives us a reallygood picture of where people are
at with their current harmreduction practices, we can
answer some questions like arethey using test doses?
(11:25):
Are they carrying naloxone?
And are they using with somebodynearby who could potentially
call ems if there were to be anoverdose that were to happen.
How are they accessing supplies?
Are there any issues withaccess?
Are they sharing supplies whenthey are using?
These are all questions thattend to come out when we're
(11:46):
asking these like broadquestions when we're
understanding where people areat.
I just want to recognize thatmost of our patients are
actually teaching us about theirharm reduction practices.
A lot of them are doing a reallygreat job of integrating harm
reduction into their drug use.
They're able to teach us whennew things kind of come onto the
market and we're able tounderstand what's going on in
(12:08):
the community a little bitbetter when we meet them at the
hospital and do theseassessments.
For those of you out there whoare just starting out and taking
a history and learning how toengage your patients in
conversations about harmreduction, Patty and I actually
came up with this really coolmnemonic that can help be a
framework for when you're havingthose conversations.
(12:30):
The mnemonic is called DOPE andit stands for Drugs, Objective,
Paraphernalia, and Environment.
These are the four key things tothink about when you're asking
your patients about their druguse.
Leah (12:42):
Wow.
That's really helpful.
Drugs, objectives,paraphernalia, and environment.
I'm going to put that in my backpocket.
Is there ever a situation whereyou hesitate to offer someone
harm reduction supplies?
Patricia Moreno (12:57):
I'm really glad you asked that because sometimes
it can be a very trickysituation depending on what the
patient discloses.
There are green lights, thereare sometimes red lights or
yellow lights and a green lightto know when to offer harm
reduction supplies to a patientis when they outright tell us,
Hey, you know, my goal is tocontinue safely using, or I want
(13:21):
to reduce use, but I want tocontinue using substances.
I'm not ready to quit yet.
That's not in my near or longterm goals.
That's when we typically tellthem what we offer in our harm
reduction closet.
We even have this binder thatreally summarizes all the
supplies we offer in thehospital.
It was created by one of ourLBNs.
(13:41):
Her name is Xenia, we show thisto patients.
We also show this to staff justso they can know.
What exactly we're offering andhonor that transparency with our
patients and also ourcolleagues.
It's also very effective whenpatients say that they plan on
self directing their dischargeso they can go self medicate or
(14:02):
leaving against medical advice.
Sophie Zhai (14:04):
I find it super, super helpful in those instances
because we're When people aremaking that decision to self
direct their discharge, they'requite literally telling us that
they're going to go selfmedicate and use drugs.
And this is an opportunity forus to reassure them and let them
know like, hey, even thoughyou're doing this, we still care
(14:24):
about your safety.
We still care about you and it'san opportunity to still build
that relationship.
It's a way to continue thattrust if and when they come
back.
Patricia Moreno (14:35):
Within our roles, Sophie and I, it's really
important for us to establishthat trust with a patient like
you mentioned earlier and that'swhy we ask all All patients
indiscriminately if they wouldlike any of these safer use
supplies because we understandthat part of the recovery
process, it's a chronic diseaseaddiction and it's something
(14:55):
that we can prepare for if theyever find that they need those
supplies.
If a person returns to use, theyhave those supplies in hand.
And sometimes it's not only justfor them-- they can share it
with someone they know orsomeone else in the community.
We leave it very open ended forthem and make sure that they
(15:15):
have that option available.
Sophie Zhai (15:18):
I think you bring up a good point, in that, you
know, even though we might'vejust had this conversation about
abstinence, and that might bewhere that patient is at,
they're wanting to pursueabstinence, recognizing That
return to use is part ofaddiction.
It's something that we canprepare for.
Not saying that that person willreturn to use, but it's
something that we can prepareand offer and we put it out
(15:41):
there for patients in case theydo want to prepare for that.
Leah (15:45):
It sounds like what I'm hearing is it's really kind of
leaving the options open andreally being guided by kind of
that relationship and rapportand trust building of what the
patient's goals actually are andwhat they want to do after they
leave the hospital.
It makes me curious what havepatients responses been like?
Sophie Zhai (16:07):
I think most people have been pretty pleasantly
surprised that a hospital wouldeven offer safer use supplies.
And I think most of our patientsare coming from previous
experiences where they've facedstigma while being in the
medical setting.
It's a chance for us asproviders to build stronger
(16:27):
relationships with our patients,letting them know that, we're
here for you, that you haveoptions.
We're here to listen and supportyou.
And we care about your safety.
Most people have responded verypositively to it.
Patricia Moreno (16:41):
Sophie and I have interacted with a diverse
range of populations within ourpatients and I just wanted to
share one of the monolingualSpanish speaking patients that I
had that learned about harmreduction supplies and how they
really appreciated us havingthese services available to them
in the hospital.
(17:01):
This patient that I talked to,they had migrated from Latin
America and they had experiencedan unintentional overdose from
fentanyl.
They were smokingmethamphetamine every day to
stay awake for the long workhours that they had, and they
had no idea what naloxone was orthe importance of not sharing
(17:22):
any supplies with anyone and whyit's important to own your own
supplies and becoming awareabout harm reduction therapy
centers that exist in SanFrancisco.
I remember this patient tellingme, quote, no one I know ever
told me these things existed inthe city.
I'm ashamed to discuss it withmy family and friends because I
(17:43):
fear they will look at medifferently.
I do want to quit eventually butI know that once I leave the
hospital I might fall back intosmoking meth.
I'm grateful that you sharedthese resources with me and even
made me a kit that I can takehome.
No other hospital I've been tohas talked about my drug use in
a compassionate way.
That really stood out to me.
(18:04):
It made an impact on me, it justmade me excited and grateful to
know that our team is doing, isworking really hard in having
patients feel heard and feelrespected.
That way we can support them intheir recovery journey, however
that may look like.
Leah (18:23):
Wow, that's a really powerful testimony, Patty.
Thank you so much for sharingthat.
And also, I'm so grateful thatyou were able to have that
interaction with that patient.
It really resonates with what wefound in the study.
Last year we had the opportunityto do a qualitative study about
(18:44):
the harm reduction services atSan Francisco General, where we
interviewed 20 patients who hadreceived harm reduction services
and 20 staff who had worked withpatients receiving harm
reduction services.
What we heard from patients isexactly what both of you have
been saying that people feltreally seen and the offer of
(19:05):
harm reduction supplies oftenwas, kind of the first positive
experience that they'd had inthe healthcare setting.
A kind of sense of rebuildingtrust after really awful
experiences often in priorhospital stays.
Like you were saying about selfdirected discharges people told
(19:26):
us over and over again thatbecause of this positive
experience, they would be muchless likely to delay care in the
future.
The testimony that you gave fromthat patient, really highlights
one of the surprising findingsto us in the study, which was
that many patients who are inSan Francisco are actually
really linked into harmreduction services.
(19:47):
And as you said, Sophie, are theexperts who are teaching us as
providers and as staff.
But there are also a lot ofdisparities in access to harm
reduction.
What we found was that amongpatients who reported learning
new strategies, who had lessexposure to harm reduction, who
were learning about naloxone forthe first time, learning about
(20:08):
community resources really allof them were black or Latinx
including some Spanish speakers.
Offering these supplies in thehospital was really a moment of
reaching people where they wereat And being able to connect
with some folks who maybe arenot being reached by, by
services out in the communityand being that linkage point to
(20:30):
help people get where they needto go.
We've talked for a while nowabout patients but what have
your experiences been with theresponse from staff?
Sophie Zhai (20:39):
It's definitely been mixed feelings from staff.
We have a lot of people who aresuper on board with harm
reduction.
Maybe they've had some exposureto harm reduction in their
formal training or through otherprofessional or personal
experiences in the past.
We have some folks who aredefinitely very open minded with
(21:00):
harm reduction, but they don'tfeel super prepared to engage
their patients in conversationsabout harm reduction yet.
They feel like it might be alittle bit awkward.
They're not really sure how toapproach it.
But they're super grateful forACT services and for ACT
support.
Then we definitely have a fewpeople who are skeptical about
harm reduction.
I think some of that comes fromburnout, from seeing folks who
(21:25):
are coming in over and overagain who are using drugs.
I think some of it is also justrelated to like personal biases
against drug use.
Patricia Moreno (21:34):
Within those personal biases a lot of staff
have shared with us that theyfeel like they're enabling drug
use and they feel inadequate toaddress harm reduction.
We do get a lot of questionsfrom staff and they ask us if
harm reduction is actuallyreally effective.
We tell them that harm reductionacknowledges how using drugs can
(21:57):
be very risky.
And there are evidence basedways of safer using.
This started from the community.
I want to acknowledge thatbecause now we're applying this
to hospital and clinicalsettings.
So it's been evolving for sometime now.
Sophie Zhai (22:14):
Definitely a lot of the staff responses that I've
seen, they have questions like,is this really working?
Is there data behind it?
Some people feel like, Oh, Idon't know.
I feel weird giving it out.
I'm not sure if I'm doing theright thing.
I made this oath to do no harm,is that what I'm doing?
We definitely have a lot ofquestions when we do engage our
(22:34):
staff about harm reduction andsafer use supplies.
What you said, Patty, wanting toacknowledge that drug use can
come with a lot of risks butthere are safer ways of using
drugs-- that's really what we'retrying to hone in on.
Leah (22:48):
That completely resonates with what we found in the study
talking to staff.
I feel like the overwhelmingfeeling from the vast majority
of staff was profound sense ofgratitude for ACT and for the
harm reduction feel like, wow,this is one of the most
challenging parts of my job andI finally have some support and
(23:08):
someone telling me what I shouldbe doing and giving a framework.
What I thought was reallyinteresting were the staff who
were maybe a little bit moreskeptical or we heard from a
number of staff who wereinitially skeptical and their
views kind of changed over timewith exposure to harm reduction.
I feel like so much of that camefrom all of the really
(23:31):
incredible and challenging workthat, that you both are doing
every day and that priorsubstance use navigators have
been doing as well, as well asall members of the ACT team.
There's a lot of fruit, I think,in some of those conversations
that have been had.
Maybe for our listeners to justtake a moment to reflect, if you
(23:54):
noticed a staff member who youwere working with who seemed
uncomfortable around harmreduction, or some of the
services we've been talkingabout, how would you approach
them?
How would you engage them in aconversation?
Holding that in the back of yourmind, Patty and Sophie, you guys
are really experts at this now.
I've learned so much from youabout how you engage staff.
(24:16):
What do you do when you workwith staff?
What are some that you mighthave?
Sophie Zhai (24:21):
Responding to providers who might be a little
bit more skeptical about harmreduction, I like to understand
where that's coming from.
I find that most providersactually just want to keep their
patients safe.
They always, just want to makesure that my patient is safe.
I want to make sure I'm doingthe right thing and doing
everything I can keep them safewhile they're in the hospital.
What we find from patients isthat they want to feel safe when
(24:44):
they're in the hospital.
We actually have this sharedgoal of safety.
I think there is a way to kindof bridge what the provider's
goals are with what thepatient's goals are.
I think something important tokeep in mind is that
traditionally in medicine,addiction treatment was on an
abstinence based model.
We were looking for thisbenchmark of abstinence.
(25:05):
You know, when somebody came inwith a substance use disorder,
we would just counsel people ontheir drug use and then tell
them to stop using.
But as we know, that's not veryeffective.
It doesn't really work.
As providers, even though wetell people to stop using drugs,
that doesn't often happen.
Kind of reframing how we thinkabout addiction treatment and
(25:25):
what we're really looking for.
Some of that could just be likereducing a person's risk of
overdose or reducing their riskof infection.
These could actually bebenchmarks that we're looking
for and it can help us reframe,what are these positive changes
that we can make with ourpatients that don't necessarily
have to be abstinence based.
(25:46):
Once we kind of reframe that forproviders, they can really
improve their work experienceand that in turn really improves
the care experience of ourpatients.
Patricia Moreno (25:57):
I wanted to mention a little bit more of the
teachings that Sophie and I havebeen doing.
So we've been engaging withstaff in the intense care unit,
with nurses, also third yearmedical students, internal
medicine residents, we have donethis 45 minute training on harm
reduction where we go over acase study and we go over harm
(26:20):
reduction philosophy andprinciples and we're measuring
some core competencies from thepeople who participate in this
training to see if they can takea thorough substance use
history, if they know how saferuse supplies function and also
to see if they know of someresources that they can link
(26:42):
patients to for harm reduction.
Our research showed that afterthe training, these staff and
students were a lot morecomfortable with these
competencies.
We asked a pre and post survey,and we were able to see a huge
difference, and we also noticedhow the staff and students were
able to develop clinical skillsand to better treat patients
(27:04):
with addiction upon leaving thistraining.
That's helping with the culturechange around harm reduction in
the hospital.
Even though we're leaning intothe discomfort, and we know it
can be really hard to talk aboutwe're doing a lot of the work in
order for this to become morenormalized, in order for us to
move forward.
Sophie Zhai (27:24):
Definitely, not only did staff feel more
confident in talking to patientsabout harm reduction and about
their substance use, but folkswho we noticed were a little bit
more skeptical in the beginning,they were shaking their head,
they weren't really sure aboutharm reduction-- at the end they
were a little bit more engaged.
They were taking pictures of ourslides, of our supplies, and
(27:46):
they had a little bit moreinterest and more buy in.
I think even from a comfortlevel of being more open minded
towards this I think thetrainings that we did made a
huge difference.
Leah (27:57):
That is just so powerful.
I think that the work that youboth are doing is really
inspiring because based on thisand based on what came out in
the staff interviews, what weheard was just that for so many
people, this was a huge frameshift in how they even thought
about substance use, like youmentioned Sophie, even a
(28:18):
different framework besides anabstinence only model.
That goes on to impact everyinteraction that they have with
patients who have a substanceuse disorder, not even the ones
just involving harm reductionsupplies.
What came out in the interviewswas a number of people mentioned
how this went from somethingthat was one of the hardest and
(28:38):
most challenging parts of theirjob, that felt like it
contributed to burnout becausethey were telling patients to
stop and it felt like they werefailing all the time, to a model
that's a lot more humanisticactually felt aligned with their
values of meeting the personwhere they were and figuring out
(28:59):
how to best support them andbest support their health.
It ended up being something thatwas really fulfilling.
I think the change that you bothhave been a part of is so
incredible and it alsohighlights how much more work
there is to do and that this isa constant struggle.
It's a whole huge culturechange.
Where do you see all of thisgoing?
What are some of the things youenvision for the future?
Sophie Zhai (29:21):
I think expanding the harm reduction workshops
that we've been doing for staff.
Seeing if we can equip moreproviders with these skills to
engage patients in theseconversations and effectively
offer interventions that areharm reduction based.
So what happens when moreproviders are using harm
(29:42):
reduction in their standard ofcare?
And does that impact patientsatisfaction?
Does that impact patientexperience?
Maybe having some surveys onthat and seeing if there is some
kind of tangible impact that wecan see.
I think the other thing iswanting to refine the curriculum
a little bit more.
I know Patty and I have somethings in the works.
Patricia Moreno (30:03):
I would also love to see addiction care
services expand to other areas.
I know Sophie mentioned earlierhow in San Francisco we're so
lucky how we are rich with a lotof resources for harm reduction
and support services for this,but I would also love to see
more satellite programs in mayberural areas, in other cities,
(30:26):
maybe even more in my hometownwhere I'm from.
I know that there are gaps stillfor awareness for harm reduction
services.
I would really love to worktowards raising awareness for
this and even the legal aspect.
Continuing to do work in policyadvocacy and also activism
around harm reduction is sovital.
(30:47):
There's a lot of work to be donethere still, but I know that
this takes a multidisciplinaryeffort in order for us to
continue doing valuable andimportant work around harm
reduction.
Leah (31:00):
We're in the middle of a national overdose crisis and we
know these services work.
They need to be out there and beaccessible.
I feel like as we're talking I'mjust struck by how much
expertise you both have at thispoint for others who might want
to do just that and start asimilar program or integrate
(31:21):
harm reduction into theirpractice what advice would you
give?
Any lessons learned?
Patricia Moreno (31:27):
We know that addiction care treatment is a
continuum and addiction is alsocomplex and can exist across all
levels like spiritual,humanistic, cultural, and
social, and so much more.
My dream is to see all of us,medical staff, non medical
staff, community members,involve stakeholders even to
(31:49):
work together to pave the way torecovery.
I'm really excited to see howharm reduction will continue to
evolve over the next years.
Sophie Zhai (32:00):
Like Patty said, this is a group effort.
We need buy in from, fromnurses, from providers, from
everybody.
It really is this movement thatwe're all trying to get on board
with together.
Asking a lot of questions,understanding where people are
coming from, meeting patientswhere they're at, meeting
providers where they're at andtheir education and their
(32:21):
knowledge.
Also understanding that thiswork is challenging.
Making changes anywhere issuper, super hard.
So, but it's super super hard,but really, really important.
Props to anyone out there who isdoing this work.
Patricia Moreno (32:36):
We appreciate you.
Leah (32:38):
I appreciate the both of you.
I think that's a perfect way toend it.
Thank you so much for havingthis conversation today.
I feel like I've learned a lot,it's always just a joy to chat
with both of you.
Sophie Zhai (32:53):
Thanks, Leah.
Patricia Moreno (32:53):
Thanks, Leah.
Kinna Thakarar (32:56):
That was Patti Moreno, Sophie Zhai, and Lea
Fremont Wong in conversation onharm reduction compassionate
care for people who use drugs.
Be sure to tune in next timewhen we welcome Dr.
Tessa Rife Pennington, AndyRuggles, and Dr.
Beth Dinges to the series todiscuss leveraging technology,
expanding veteran access to harmreduction resources through
vending machines.
Please take a moment to completeSAMHSA's post event evaluation
(33:18):
survey on the AMERSA podcastpage 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.
org and AMERSA org.
(33:39):
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.
S.
government.
Thank you for listening.
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