SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
How Peer Recovery Patches Treatment Gaps
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You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. If you've been listening to this podcast for a while, you know that there is strong evidence for the effectiveness of addiction treatment, and that the biggest obstacle we face in combating the overdose crisis is an overall lack of access to that treatment. Health insurance is, of course, the biggest factor, and in Tennessee, our statewide average for people lacking insurance is over 12%, which is more than twice the national average. But even for those with insurance, they face a provider shortage. And then there's the problem with appointment availability. Even if a patient gets into a clinic, they better keep their appointment, or it might be a long time before they can make up for it. And if the patient lives in a rural area, they might have to drive 50 miles just to get there. So it really goes without saying that this is a difficult, frustrating, and sometimes humiliating experience. Imagine trying to work a minimum wage job while dealing with all of this. Do you tell your boss that you can't work on Monday because you have to drive to the next county just for your addiction medication? Would something like that even get you fired? It's not hard to imagine that the stress of all this makes avoiding the temptation of drugs even harder. So in all of this, is there anyone you can turn to? I guess this month, Rachel Loveday is exactly the kind of person you could.
SPEAKER_01It helps us to identify to a group because for so long we felt alone and nobody was there for us, and you know, that's part of our disease trying to keep us separated from positive people in our lives.
SPEAKER_00Rachel is a peer recovery specialist at McMahon Center, one of the premier treatment facilities in the Nuncho region. She and her team are contracted with UT Medical Center to help connect people who survive overdoses to treatment. When patients get stressed or confused or overwhelmed by the process and its difficulties, Rachel and other peer recovery specialists are there for reassurance and support. So far, this program at UT has seen huge success, with a significant increase in connecting ER patients to treatment. So what makes peer recovery specialists so effective? Well, it's simple. They're all in recovery themselves. I really enjoyed this conversation. Rachel and I get into some good topics here and address some of the more interesting aspects of addiction and its challenges.
SPEAKER_01So my name is Rachel Loveday, and I'm a team leader at McNabb Center, and I'm a contract employee at UT Hospital, which is our level one trauma center in East Tennessee. I'm a licensed master social worker, a licensed alcohol drug counselor, and a certified peer recovery specialist. A peer recovery specialist is someone who's had at least two years of continuous recovery. And to be certified through the state of Tennessee, they need to attend 40 hours of coursework training, 75 hours of on-the-job training, and have regular supervision with someone who can provide that supervision. They also require continuing education every year. And what it basically is is providing compassion and support to someone that may be struggling with substance use and or mental health disorders. And it comes in a variety of forms and a variety of settings. It just so happens that our program, which is called Hope United, is a program stationed at UT Hospital.
SPEAKER_00Okay. I I understand there have been a huge increase in interest in peer recovery. I, SAMHSA, CDC Foundation, I've seen a lot of new grants and things like that for work like this. Is is this an increasing trend for sure?
SPEAKER_01I'm I believe it is an increasing trend because we have something that education, book work, um, those types of things can't really provide. We have that lived experience. So we literally know what it's like to be in somebody's shoes. Um a lot of times people can sympathize and and care, like, man, you're going through a really tough time right now. But we literally know what it feels like. We know what it feels like to go through withdrawal symptoms, to, you know, be incarcerated, to feel that shame and and guilt.
SPEAKER_00Uh what does it look like from the inside? Because a lot of people don't understand what that looks like if they've never been there.
SPEAKER_01I can talk a little bit about the care that that people receive at UT Hospital. So, first of all, our program, we help uh patients regardless of payer source. So we we want to engage anybody that is willing to to engage with us. So if a person does not have insurance, it is a little bit more difficult to find help for them. If or if they have medical problems or mental health concerns, sometimes it can be difficult to find placement. We do have a few facilities in the area that will accept people on a grant basis. Um, and we're very grateful for those, but we could defin we could always use more of those, you know. If there's no openings here in Knoxville, sometimes we have to send people to other counties and you know, it it would be really nice to have him have them treated in the county that they live in.
SPEAKER_00Right. That's that's definitely a big issue. Um I uh from what I understand that, for example, especially in rural areas, there are situations where people are ordered into treatment as part of whatever probation or parole situation they're on. Uh but if the treatment is two counties away and they don't have transportation, that can be a very uh frustrating to say the least um barrier.
SPEAKER_01It can, and sometimes there's there's a weight for those treatments as well. And what we know about the disease of addiction is it's a disease that is killing people on a daily basis, you know, from overdoses or you know, medical complications. So the sooner we can get somebody into treatment, the better.
SPEAKER_00I feel like this is such a huge topic. Uh time and again we talk about transportation, we talk about lack of services, we talk about insurance. This has come up on our prior episodes. But I want to talk about stigma because I think that's probably at the heart of what peer recovery seeks to reverse. Um if the healthcare providers or the care team don't really quite understand it, there can be some I and some unintentional uh stigma that comes out, just some some background ways that we think and talk about things.
SPEAKER_01We do experience stigma uh on a regular basis, but I will tell you that the longer we've been at UT Hospital, the less and less stigma we're seeing. And part of that is because before we were at the hospital, the people they were seeing that had the disease of addiction or struggle with substance use disorder, you know, people say it differently, but the people they were seeing were were folks that were, you know, coming in and out, that were struggling, that maybe had legal problems, that were, you know, having to go to jail from the hospital, or, you know, they weren't seeing the other side of recovery. So part of our role is in an unintended role, it just happened to be this way, is that when they see us in recovery, which we have several navigators over there right now, they're able to see that people can recover. You know, they're able to see that there is another side to this. And what we found is that the providers, nurses, you know, everybody over there is really believing in us. And when they talk to patients, they bring us up and say, hey, you know, I've got this friend that works here. She's a navigator or he's a navigator, and they've been where you've been. Would you like to talk to them? Um so they're now buying into it and they're initiating the conversation and initiating the referral. Um, in fact, in times that we're not at the hospital because we're not 24-7 right now, they will leave us a note or a message, hey, can you follow up with this patient? They were wanting some help. So they're they're really going the the extra mile because they're seeing that people can recover. And we've done several things in the hospital as far as campaigns to try to reduce stigma. We have, you know, every year is overdose awareness on August 31st. So last year we had um kind of a display in the lobby to honor those we've lost to an overdose, and we also um celebrated those that are in recovery. So the cool thing about it too is we had our police officers that work at the hospital there with us in solidarity. Um and we had pharmacy and providers and nurses, and we're kind of just all there in support and saying, hey, and we're here for you. So that was a really neat experience.
SPEAKER_00There were a couple things that that you said I'd I'd like to talk about. Uh, but first, you you mentioned substance use disorder and addiction and said however people call it because people call it different things. Yeah. This is something I I've written about this through SMART. Um, in the academic policy making side of things, there is a big push and advocacy side, there is a big push for person first language. And I think it's a it's a very good cause. Uh, a person with substance use disorder as opposed to just calling them a junkie and things like that. Yeah. But I have noticed in the addiction community itself, there is uh or the substance use population, how uh there is a, and see it's just subconsciously happened here because of my experience talking with so many, that there is still a lot of this language used that we consider no longer person first. Uh that that, oh, I'm just an old drunk, you know, kind of thing. I I have encountered a lot of this. What do you think is the disconnect here? Because it's not just from other people in the policymaking sphere that we're trying to talk to, it's from within the community itself.
SPEAKER_01Yeah. So that's a good question. Um in the 12-step fellowship that I belong in, you know, I identify as an addict. Um outside of that fellowship, I would say I'm a person in long-term recovery. Right. So inside that that fellowship, the reason why I identify as an addict is it's it's part of our literature. And also we have to remember that it helps us to identify to a group because for so long we felt alone and nobody was there for us, and you know, that was part of our disease trying to keep us separated from positive people in our life. So the first part is so that we remember that we belong to a group and we, you know, we have worth and we have value. Um it's kind of like a family. You know, what I I heard you I was talking earlier to somebody and you overheard me talking about, hey, we're a family. Um and secondly, we always have to remember that it's a lifelong process. So I have to remember that I am an addict so that I don't think at some point that I've graduated or that I'm cured or things like that, because I want to remember that I have to work on my recovery for the rest of my life. So that's that's part of the the reason for that. The reason why I use substance use disorder outside of the fellowship that I'm in is because I want people to know that it is a disorder, is it is a disease, much like any other disease that you can find in a medical book. And because there's there's a belief in some people that um substance use disorder is a moral failing. Right. And it is not, it's a disease of the brain. Yeah. And so I want um to just emphasize that when I'm speaking.
SPEAKER_00The sense of community, so the almost driving power from it.
SPEAKER_01Yeah.
SPEAKER_00Yeah. Well, thank you for that. I I I thought that was very enlightening. Um the second thing you said um that law enforcement was there and was celebrating with you. I I couldn't help but notice that you felt compelled to mention that. It it indicates that there might be some sort of change. Do you think there has been a change uh uh amongst law enforcement in terms of how they perceive people with substance use disorder?
SPEAKER_01I think it's a work in progress. I come from a family of law enforcement, and you know, there's always that fear of of getting in trouble and fear of police, and you know, people are often fearful to go to the hospital because they think they're gonna get in trouble. Um, but what I've seen over the past four years since we've been there is them embracing recovery and embracing our people, even at times when our people can be difficult or challenging because they're not feeling well. I never thought that I would consider them my friends, but but I do because I also have my own criminal history. We're in and out of jail and those types of things because of my choices from my substance use. So th there was always that fear of I'm gonna be in trouble, and you know, your heart kind of races when you see them, but now it it my heart is filled with joy because I know that they they care about me. And they in truth is they might have always cared, but I was I was just nervous, you know.
SPEAKER_00Well, this this might be some good news then. Uh literally just this week, um, and and we're recording this on March 16th. Governor Lee signed in a law that decriminalizes uh it extends criminal immunity to people seeking treatment for an overdose.
SPEAKER_01Oh my gosh. That that is gonna be amazing. I I hadn't heard that, but that is such a a critical moment in somebody's potential recovery that I think I think that's gonna have a great impact. It just all depends on the person's willingness. Because remember, when you come out of an overdose, if you've uh had an eloxone used, that you're not feeling well. So there is that, you know, devil and angel on your shoulder of, you know, do I take this opportunity for recovery or do I leave and and try to get something to make me feel better right now?
SPEAKER_00That's exactly how Dr. Stephen Lloyd, he's a chair of our opioid abatement council. Yeah, wonderful man. He he once summarized this to us as uh it's a very vulnerable time. Hey, I just died. Maybe maybe I should look at what I'm doing, right? Uh but I I think it's important what you just said, that there's two very different directions you could go. And I know from my own clinical experience, I've seen a lot of people immediately leave AMA right after resuscitation.
SPEAKER_01And part of that too is the fear of legal ramifications. Absolutely. Because you remember, you know, I was talking earlier about there's that fear like if I overdose, then somebody's gonna know I use substances and I'm gonna get in trouble. Um and that's that's not necessarily true. That's not always true, but there's that there's uh false belief.
SPEAKER_00Yeah, no, I agree. And it sounds like uh it sounds like this bill might actually really cut to the heart of this. Um have there been other changes over the past few years that do you think have impacted in a positive direction and in terms of policy? For example, I w I would say the decriminalization of fentanyl test strips was probably one of these examples.
SPEAKER_01Yeah, um, I think that is very helpful um so that people can you know see what it is they're using. Because you just never know today. Um there's all kinds of substances out there and you think you're getting one thing and it's really another. And I think the the easier access to naloxone I think has has been a great move too. Um and having it distributed throughout the community.
SPEAKER_00Yeah, yeah. I could you speak a bit to the experience and and of course in a HIPAA compliant manner, but uh what your patients have faced uh in terms of the access to naloxone or uh the experience of not really knowing what they're taking.
SPEAKER_01Um there have been many a times where patients will come in and say I smoked a joint and I overdosed and it turns out it was laced with something, or I took this one pill, but it was really something else, and they overdosed. Um it happens multiple times. One thing um that we're trying to do is be able to distribute Narcan directly from the ER at UT so that if somebody comes in for an overdose, they can leave with that um in hand.
SPEAKER_00This I'm thinking now about how you said so many people in recovery come from a place where they're used to being alone. And uh just looking over some of the recent data uh that we got from Tennessee Department of Health about overdose fatalities. Umly about a fourth of individuals who did ultimately die had evidence of Narcan in their system, and it means most of them weren't even given a shot. And of course, a lot of those who did die, fentanyl can be so much stronger than what Narcan can counter. So leaving that aside, a lot of these individuals were found alone. Um, and of course, it's gonna be hard to administer naloxone to yourself if you're overdosing. What do you think it looks like going forward in terms of prevention? Uh because people seem to be dying most often alone.
SPEAKER_01Sure. Um there is a hotline, and I can look up the number for you here in a minute, but it's called Never Use Alone Hotline. Um, and it's throughout the United States. And what that is, is you can call a safe person on another line, and they will sit on the phone with you while you use.
SPEAKER_02Oh wow.
SPEAKER_01And then if if you don't respond within a few minutes, um they will send an ambulance right to your location. So before you use, you give them your location, uh, where you're at, um, and they will have that on file and they will sit with you while you use. Um it's actually, I think, going into other countries right now, and it's it's one of the one of the neatest harm reduction efforts I've seen.
SPEAKER_00Yeah, I've never heard of it. That's phenomenal.
SPEAKER_01Yeah. It's called Never Use Alone.
SPEAKER_00Really fast. I've never heard of this. This this is this thing's really innovative.
SPEAKER_01Yeah, it's uh it was initiated and began by Mike Brown, which is a harm reduction person. I don't know how to say it, but here in Tennessee.
SPEAKER_00Oh, he started in Tennessee.
SPEAKER_01Yeah. No kidding. Yeah. Um well he lives in Tennessee now. He might have started in Michigan, but I'm pretty sure he started in Tennessee. Um he's from Tennessee.
SPEAKER_00Wow.
SPEAKER_01Yeah.
unknownYeah.
SPEAKER_00In so many ways, we uh the the state uh this is what I try to remind people through this show is that uh Tennessee is really innovative when it comes to fighting the the opioid over uh the opioid crisis. I I have seen a lot of really unique things here.
SPEAKER_01Sure.
SPEAKER_00Anyway, I digress. Um you you mentioned you mentioned you've had people say they smoke marijuana and overdosed on fentanyl laced with there was a string of overdoses in Shelby County that were tied to laced marijuana. This this used to not be so common. It used to be much more often in the fake pills and the meth, but more and more I'm hearing about it in cannabis. Uh is is this something you're encountering a lot?
SPEAKER_01I mean, I wouldn't say a lot, um but I've seen it a few times. And the other thing we also have to keep in mind is sometimes it's easier for people to say that they smoked marijuana than they used a pill. So um sometimes they may not be as honest because of the fear of judgment. Right. And so it's more accepting to say I smoked a joint than you know I snorted some heroin. Right. You know what I mean?
SPEAKER_00So well that makes sense. Especially since attitudes towards the former have changed so much.
SPEAKER_01Yeah.
SPEAKER_00This has been the concern with these cannabinoids, the delta eights, delta, they're they're currently unregulated. Uh there is a bill moving through the legislature that would regulate it and and put some other restrictions such as capping uh sales to 21 and over. But I understand that because we're not watching how it's made, I mean that's at the crux of whether or not something may or may not have fentanyl. If there's no oversight into how something is made, there's really no telling what's in it, right?
SPEAKER_01I think so. And I think it's unless it comes from uh directly from a pharmacy in a prescription bottle, I wouldn't trust anything right now because uh the way that they're making uh and I say they by meaning drug dealers, uh they're making pills today. It looks exactly like um what a regular pill would look like. Um I think the other thing with uh with the Delta VII and those other types of vape devices on the C B D um I understand that those um substances help with anxiety some but I also know that it's really harmful for uh teenagers. to get a hold of and we've seen that when you know I don't know all the medical stuff but I do know that it causes some damage to their lungs and their breathing abilities. So I've seen that some in the hospital as teenagers trying to to use those delta 8 or THC vapes or whatever they're called.
SPEAKER_00Right, right. Yeah I I I know one study found uh that some of these have silicon and arsenic and heavy metals in in the liquids themselves just because they're just they're they're very poorly made.
SPEAKER_02Yeah.
SPEAKER_00Uh and and again this there's so many different companies it's hard to tell which is which of course but um have you had the patients talk about their kids much if they have any.
SPEAKER_01They do sometimes talk about their children but oftentimes they're not in their custody. Usually they're um with a family member or foster care but they do have the goal of reuniting. Um and I think that's when the conversation starts of how do we get you better, feeling better physically, emotionally, spiritually, all all those things to start your journey on on getting that goal.
SPEAKER_00Are there any ways do you think we can improve that? Because that's it's a wonderful goal. I think it's it it's an incredible motivator. But are there any is there anything standing in the way of facilitating that goal for people?
SPEAKER_01There's a lot of psychosocial needs that come along with recovery. So it's not just you know living without drugs or alcohol it's also housing, employment, having food and furniture and a safe place in a safe neighborhood there's so many different components that need to be addressed but I think initially having them go to some form of treatment whatever that may be you know detox MAT you know whatever path they want to go but getting them stable and to a point and then having those wraparound services a case management is is vital to to getting those needs met. Does that fall under your scope as well then uh helping them with these extra uh so typically our work especially in the ER is kind of like brief interventions. Um many times um you know we talked about earlier patients sometimes leave AMA because they're not feeling well and so we may just have a brief interaction with them. But what we do try to do is get them linked to resources, get them linked to treatment and we do send about 15 to 20% of the patients we see directly to treatment from the hospital. So I think we have a pretty good track record. You know people are coming in not even thinking about treatment but we're able to talk to them and use motivational interviewing and encourage them. So about 15 to 20% take that path and I think from there the treatment center, the treatment provider helps them get set up with aftercare services. But if a patient is not wanting to do any kind of treatment or they're not ready to to stop using and their plan is just to continue on, we talk to them about harm reduction, try to get them some naloxone, show them where they can get clean needles and set them up with some type of case management or mental health because we do want them connected in some kind of services.
SPEAKER_00Right, right no I and and for people listening that 15 to 20% that is an impressive number. Just blanket referrals to the ER do not have I don't think half that success rate of at least connecting to treatment. You know once they go to the treatment then there's that's that's another thing altogether but that's uh I think a very high rate. Uh what do you think is is causing UT to be so effective?
SPEAKER_01I think um well I'm kind of partial but our our navigators at McNabb and then we also recently have some Cherokee navigators I think that our drive to help people because we've been there is is pretty high. We also have strong relationships with community providers that are willing to work with us and they get phone calls from us all day and night so I think I think that's great. Since we've been there we have engaged over 7,000 patients and we've been there since August of 2019. So that is there's quite a few people that are struggling with substance use and I'm sure there's more than that that that we didn't get to talk to so the need is great for peer support. I think patients are more likely to agree to treatment when talking to someone who has been there because we can explain like this is what treatment feels like this is like what it what it's going to be like when you walk in the door this is you know what you're gonna be doing during the day this is how long you're gonna be there. Where are the biggest areas we can improve I'd say we have several gaps in the community um although we're doing the best we can I feel like there's more opportunities for recovery housing um sober living sometimes referred to as halfway houses and so if that's like a safe place for people to go while they're beginning their recovery journey. You know I myself stayed at a recovery house for 15 months and it really built that foundation for my recovery. It taught me how to to live like an adult how to pay bills and and have a job and be responsible and also get along with other people and have that sense of community that we were talking about earlier. I think another thing is um having more treatment beds available there's always a need for more treatment beds there's always a need for peer support as well I think that there's so much opportunities for peer support to be in many different areas in the community. Peer support can be in doctors' offices, you know your family physician, dentist's office I know that sounds crazy, but that's where my uh substance use began is through dental surgery. Wow. I think one of the gaps um in the community could be additional training for persons that are not familiar with substance use disorder and that can be law enforcement which they are doing some of that now. People with substance use disorder are integrated in every part of the community so you're going to see that um anywhere you go. So having more knowledge um is only going to help you interact with people better. You never know when that moment of when somebody is ready to do something different. So if you have that that moment you want to jump on it.
SPEAKER_00What can the average person do?
SPEAKER_01The average person um can carry an aloxone on their person carry that with them because you never know where somebody is is may have an overdose because people use substances throughout the community you know parking lots, gas stations, restaurants you just you just never know.
SPEAKER_00So having that I agree I carry it every time I'm downtown for sure.
SPEAKER_01Yeah for sure um the other thing is to remember that people that struggle with substance use are people just like you they're people that deserve compassion and kindness and even though you may see a a gruff exterior underneath there is somebody's daughter, somebody's son, somebody's mother or father and they're they're deserving of the kindness and compassion that you would give somebody else at the policy level and this is how I always finish out a podcast um and w no need for specifics but in general and it could be federal state or local but what things do you think you'd like to see that might make things better? I think what would make things better is our easier access to treatment for persons without insurance continuing the distribution of analoxone and continued education in the community about substance use disorder and having persons with substance use disorder be on that policy level on the state, city county level to be able to voice their opinion because there's there's a good friend of mine that says nothing about us without us. So if if we're gonna make changes um you know invite us you know have us be a part of the solution because we are very creative we've come from the depths of destruction and we've made our way out so we have we have some good ideas and some good insight as to what would be helpful.
SPEAKER_02Yeah.
SPEAKER_01I think it would be great. Um even even if it doesn't go to that level but just having you know someone regularly come in and consult or you know something of that sort so you get an idea of some things you may be missing because we're able to point some things out that you know some deficits or some gaps.
SPEAKER_00Blind spots.
SPEAKER_01Yeah yeah we're we're pretty smart people.
SPEAKER_00I think so also some of the most resilient people I've ever met in my life but um uh d something that that did strike me um you said it's not a 24 hour position but you mentioned someone calling you this morning at 6 30.
SPEAKER_01It sounds like it is a little bit 24-7 well I wa I was awake so I answered it and I knew it was from a patient room because you can tell by the number and if a patient room is calling you that early it's probably some sort of crisis. You know and if I'm awake I'm gonna answer it. You know? Yeah yeah so I mean because it is a a life or death disease. Now all my staff I make them turn their phones off when they're not at work because it can become um it can be draining you know if you you put so many hours in and by the end you're like this is enough.
SPEAKER_00Compassion fatigue yeah for sure yeah I know it's affecting providers for sure and nurses and everyone I'm yeah. Do you have any recommendations on what we can do for burnout?
SPEAKER_01I mean I like you just said make sure you unplug when you're off the clock but what I do for for myself for for burnout is make sure that I'm taking care of my own recovery. I have to make sure that I'm doing those things that I consider my medicine right so my 12 step meetings uh my work of my sponsor um my service work for the community those things are what I call my medicine and if I'm not doing those things then I feel off you know much like somebody with um diabetes if they're not taking their medicine checking their blood sugar then they feel off and it can be life threatening right well same for me if I'm not doing those things I can fall back to you know active addiction if I'm not taking care of myself so that's one thing I do is make sure to take care of my recovery and of course I recommend everybody in recovery does that the other thing is making sure that or trying to the best of my ability to leave work at work and when I'm not at work to spend time with my family and to do things that bring me joy. If I'm doing something outside of work I ask myself is this going to bring me joy? Is this going to bring me happiness? And if it doesn't then I reconsider doing it I just want to bring things in my life that add to it. So in in a majority of that I'm spending time with my husband and my bonus child. Um so yeah just making sure you take care of yourself whatever self-care looks like for you whether it's a bubble bath or taking a walk or reading the book just making sure that you know you put yourself as a priority.
SPEAKER_00Rachel thank you so very much I really appreciate you coming on. Well thank you for having me it's been a pleasure for more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu I'm Jeremy Corvellis. Thank you for listening and see you next month