Innovative Access to Harm Reduction Support and Linkage to Treatment

Episode 7: Innovative access to harm reduction support and linkage to treatment

Featuring:
Shelby Arena
Harm Reduction Manager, MATTERS

Joshua Lynch, DO, FACEP
Associate Professor of Emergency & Addiction Medicine, University at Buffalo Jacobs School of Medicine; Chief Medical Officer, MATTERS
 
Host:
Shoshana V. Aronowitz, PhD, MSHP, FNP-BC
Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing

The opioid epidemic is ever-changing and with contaminants like fentanyl and xylazine in the drug supply, lethal overdose rates have been increasing yearly. Programs like MATTERS offer multidisciplinary solutions to combat obstacles in accessing harm reduction resources and treatment. MATTERS employs innovative methods such as emergency telemedicine and electronic referrals to outpatient treatment. The emphasis on low-barrier access to supplies and treatment allows MATTERS to provide accessible and stigma free services. Collaboration with various groups ensures effective outreach and advocacy for policy changes to address the needs of people who use drugs with compassion.

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Transcript

Kinna Thakarar: 0:13

I'm Kinna Thakarar and welcome to the podcast series, Harm Reduction, Compassionate Care for People Who Use Drugs. Harm Reduction is a social justice movement started by and for people who use drugs, and it's a philosophy of care and practical set of strategies to optimize people's health, safety, and rights. We want to acknowledge and honor the long history of street medicine and healthcare developed by people with lived and living experience to keep one another alive and safe through community care. Whether you're a seasoned harm to the concept, we're glad you're here and hope you'll learn something new and are curious to explore seeing patient care through a harm reduction lens. This podcast series is brought to you by the Providers Clinical Support System, Medications for Opioid Use Disorder Project, and AMERSA.

kinna-thakarar--she-her-_4_05-24-2024_134040: 0:57

This week, we welcome Dr. Shoshana Aronowitz in conversation with Dr. Joshua Lynch and Shelby Arena to discuss innovative access to harm reduction support and linkage to treatment. Our host, Shoshana Aronowitz, is a family nurse practitioner, community engaged health services researcher, and assistant professor in the Department of Family and Community Health at Penn Nursing. Her research and clinical work is focused on improving access to evidence based substance use disorder treatment and harm reduction services via innovative delivery models, including telehealth and mail based programs. Dr. Lynch is an Associate Professor of Emergency and Addiction Medicine at the University of Buffalo. He is the founder and chief medical officer of the MATTERS Medication for Addiction Treatment and Electronic Referrals Program, focused on prevention, education, increase in access to treatment for substance use disorder, and rapid referrals to long term substance use treatment. He and his team have received over 20 million dollars in grant funding for various public health initiatives in the areas of substance use disorder and hepatitis C. Shelby Arena, Harm Reduction Manager with the Matters Program earned her dual Bachelor of Arts degrees in International Relations and Latin American Studies. She is currently pursuing her Master of Social Work at the University of Buffalo. She has worked in the health and human services sector since 2016, with experience educating and counseling people in reproductive health and justice, domestic violence and sexual assault, as well as mental health and substance use. Shelby is an advocate for harm reduction and is passionate about fostering community connections. Dr. Ronowitz disclosed that she is employed as a clinician with Ophelia Health. Dr. Lynch disclosed that he assisted emergent bio solutions with FDA approval. Shelby Arena reported nothing to disclosed. Thanks for joining us, Shoshana, Josh, and Shelby.

Shoshana Aronowitz: 2:49

Thanks so much, Kina, and welcome listeners. It's so great to have everyone here. My name is Shoshana Aronowitz, and I'm honored to serve as host for this episode. Today we'll be talking about the MATTERS Network. We'll be discussing what this program offers, what makes it unique, and how it can serve folks who may otherwise be left out of the substance use disorder treatment and harm reduction landscape. Over the next 30 to 40 minutes, you'll hear from two experts with us today. Dr. Joshua Lynch, CMO and program creator, and Shelby Arena, manager of harm reduction services. It's so wonderful to have both of you here. Thanks so much for joining us.

Joshua Lynch: 3:27

Thanks for having us.

Shoshana Aronowitz: 3:28

To get started, I would love for you to let listeners know, those who aren't familiar with Matters, what your program does and what you offer.

Joshua Lynch: 3:39

Great. Thanks. So the matters program started off as a way to solve the problem of linking patients with opioid use disorder to treatment out of the emergency departments and now has grown into a whole set of resources that really, reside between a referral environment and a receiving environment. We can help facilitate referrals from emergency departments, other parts of the hospital, correctional institutions such as jails or prisons. Drug courts, telemedicine, the scene of 911 calls. So working with first responders, and then really, we, we offer the patient through an electronic referral platform the choice of where they want to go follow up at treatment organizations that meet certain criteria that we have identified. Additionally, offer some wraparound services that help patients get over other obstacles that they may face when they're going through the process of getting hooked up with treatment and getting to be retained in treatment. And some of those, we can talk a little bit more about them later, but some of those involve a medication voucher to cover the cost of buprenorphine for patients that don't have insurance, transportation voucher that offers assistance to people who need A ride to their appointment and back. Linkage to peer services if they want to engage with someone with lived experience that can help them through as they get to their first appointment and navigate through treatment.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 5:13

Wonderful. As I understand it, your program is available throughout New York State, is that correct?

Joshua Lynch: 5:19

It is. It started in Western New York. Then we started to work with the capital region around Albany. And now we're very proud to say that we cover most of New York State and New York City and Long Island. We'll be expanding to Pennsylvania and New Jersey later in 2024.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 5:37

That's really exciting. so what inspired you to build something like this?

Joshua Lynch: 5:43

You know, we're working in the emergency department, we are painfully aware of the toll that addiction takes on individuals. For a long time, the solution to link someone up to treatment with substance use disorder mental health in certain cases was really limited to us giving them a piece of paper with a bunch of phone numbers on it of treatment organizations and sending them on their way. That seemed to be okay for a while. I think many of us knew that, that we could probably do better. If you think about it, you rarely see headlines saying that this hospital has rolled out state of the art addiction assessment and linkage program. I mean, maybe you see it a little bit more lately. But for the longest time, we didn't see investment going into use disorder, like we saw for other disease processes, it's not too hard to find crazy innovation going around the care for strokes and the care for heart attacks and other, you know, other disease processes, that wasn't really the case for addiction. We knew that we had to do something different. We knew we had to do something better. Trouble is kind of where do you start? At times, especially with the way that the opiate epidemic has evolved over the years, sometimes it seems like an unsolvable problem and starting to kind of break it down to say, just what are the patients need? We know that the patients need a fair assessment, access to good treatment, in many cases, that includes medication, linkage to a high quality place where they can get good care, and that should be free, it should be close and it should be at a place that they want to go. We do that for other disease processes. And, and part of the reason why we wanted to start this program is because patients with substance use disorder should be able access to the best quality care too.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 7:35

Yeah, that's a great point that you made about how rare it is to see a big hospital system kind of brag about a state of the art substance use disorder treatment program the way they do maybe about other programs that they have. So I'd really like to dig a bit more into the harm reduction services that Matters offers. Shelby, can you talk a bit about the vending machine program?

Shelby Arena: 8:00

Yes, definitely. To build off what dr lynch said, we recognize that not everyone who uses drugs is ready for treatment or even needs treatment, but with contaminants like fentanyl and xylazine in the drug supply, the risks associated with drug use are rising. So that's kind of where our harm reduction services came from. Placing these harm reduction vending machines in the community allows people to access supplies where they're at. What makes our program unique is the diversity of locations we've partnered with not only geographically in terms of like urban versus rural, but also in, you know, the physical locations. I'll also say, again, to follow up on Dr. Lynch, you know, being a small part of this larger program allows us to connect folks directly to care if they are ready for treatment. That person will get their medication the same day they reach out if appropriate. With our robust level of, of support services to see them through that process.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 8:55

Wonderful. What supplies are available in your machines?

squadcaster-65dh_1_04-19-2024_094503: 8:59

Right now we have fentanyl test strips, xylosine testing strips, and naloxone.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 9:05

I'd like to give the audience a second to reflect on places and spaces they think would be most suited for a vending machine. You talked about the program's uniqueness coming partly from the different places that you have machines and i'm going to ask you in a second to tell us more about it But I'd like the audience to kind of think about where they would choose to place machines if they were able to choose Okay, with that in mind, Shelby, take it away. Your program from what I understand, places these machines in many diverse locations, including outside of jails and police stations. Can you talk a bit about how you decide where to place the machines and where you're seeing the most usage?

Shelby Arena: 9:47

Definitely. The decision making process in terms of where to place the machines is a joint decision between matters and the organization we're partnering with, right now we have 15 machines across the state. With matters being based in Buffalo, we can't be everywhere, so we rely on our community partners to really be the boots on the ground, managing those machines and also being the experts in their community. We had ongoing conversations with folks who were interested in having a machine to really understand their community, what makes it unique and what the unique needs are in their community. So a lot of places depending on, you know, where they are and what data they have access to, some places used overdose data by zip code to pinpoint a specific zip code where there was high need for these supplies. Other counties, more rural counties, just don't have access to that type of data. So it's more anecdotal, talking to the community, talking to community members to see where they'd like to see these machines. And then in other situations, it was like, I know you mentioned the jails and the police stations-- I think some people might have a strong reaction to those locations, but when we find law enforcement partners that are excited about harm reduction and want to actively de stigmatize these types of supplies within their organizations that's something we really want to highlight. in our first year of the program we're really monitoring to see what types of locations work, so in addition to jails Police stations, we have them at treatment organizations, fire halls, some private businesses, like a convenience store, a supportive housing apartment complex, and, and really just trying to monitor those numbers and see what works and what doesn't.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 11:34

That's really interesting. I'd love to hear more if you have any evidence, anecdotal or otherwise, speaking to this point you made about de stigmatizing the supplies within certain organizations-- so I think it was you were referring to maybe police departments and someone thinking that having a vending machine there would help maybe start a conversation about harm reduction in that place.

squadcaster-65dh_1_04-19-2024_094503: 11:57

Yes. in the beginning it is kind of surprising for some folks, I think if law enforcement agency maybe doesn't have a strong presence in their community, especially in terms of substance use or harm reduction that can be a challenge to overcome. We have partnered with two organizations that are both very active in terms of overdose response education getting their officers out there with naloxone and test strips at the scene of any incident they're responding to. Both of the law enforcement partners in our program have specific divisions for overdose response, and they go out into the community, so they have built those relationships and still there are always folks who maybe aren't 100 percent on board. So it's not only de stigmatizing this within the community, but also within these departments. I actually spoke with one of our partners this morning, just doing our monthly check in and she was telling me about how the chief is, very on board with this, but some of his officers were not initially, but now they're seeing the officers utilize these machines themselves to stock their cars and to get these supplies out into the community.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 13:05

That's really interesting. It's hitting me right now that, for many of the listeners thinking about a vending machine we're imagining putting in cash or using a card and purchasing snacks or something like that. Do folks need to pay for the supplies that are in the machines?

Shelby Arena: 13:19

That's a great question. Everything in the machine is free. All of our machines are accessible 24/7. The majority of them are outside-- we want to make sure that they are as low barrier as possible. So folks just have to enter in a four digit code that is posted on the machine, then their year of birth and their zip code, just for a few data collection points while still keeping it anonymous. And then they're able to vend up to three of those supplies per transaction. So they can definitely just go in again and put in that four digit pin and their information to really dispense as many supplies as they need.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 13:58

That's great. You also have a mail based distribution program for testing strips. Can you talk about the logistics of operating a program like this?

squadcaster-65dh_1_04-19-2024_094503: 14:09

Yes. So right now we are mailing our fentanyl and xylosine test strips. We mail to individuals and organizations across the state. we again send these supplies out free of charge. We've gone through and error of what's going to work best. Originally, we sent them out 10 test strips at a time in an envelope and then we realized people were reordering quite frequently. We wanted to make sure that we were lowering that burden on them. So now we send out boxes of 100 test strips to individuals and up to 1200 test strips to organizations across the state.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 14:44

Talk a bit more about how mail based distribution can serve people who may be underserved by Brick and mortar harm reduction programs.

squadcaster-65dh_1_04-19-2024_094503: 14:54

Yes. So we're very lucky at Matters that the kind of scope that we have in terms of serving the entire state also the the lack of barriers that we have in terms of how much supply we're able to distribute? I know a lot of times at a brick and mortar facility their constraints financial constraints and they can only hand out either one or five test strips at a time so folks will have to go in there every day. And there are a lot of folks that You Don't have the time to do that, don't have the transportation, or just unwilling to do that so being able to reach folks who able to access brick and mortar harm reduction programs, you know, by reaching them inside their home is a big win for us in terms of getting these supplies out into the community.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 15:40

Is there a way that users of these distribution programs, I'm thinking both the mailbase program and the vending machine program, can offer feedback to Matters or make suggestions?

Shelby Arena: 15:55

Yes, we are always open via email and phone call. We get actually several phone calls a day from folks regarding our test strip distribution program. And we do have a couple of members on our harm reduction program, but also anyone on the team really is equipped to field these types of calls. And we are working on implementing some more community based feedback models as well.

Shoshana Aronowitz: 16:19

Wonderful. So if a listener is hearing this and is thinking that they might want to start A similar program, a mail based program where they are, what advice would you offer them about getting a program like this off the ground?

Shelby Arena: 16:35

My biggest piece of advice is patience. There is going to be a lot of trial and error, at least that's what we experienced. As long as you're getting the supplies out there, I think that's a win. In terms of scaling a program that can be difficult, determining who you want to send these products to. Originally, we only shipped to official state partners but we realized there was a bigger need than that. So then we expanded to other organizations. and, I, I spoke about how we started off with 10 test strips to 100 test strips. And so really just listening to that feedback from your community on what they need and how you can best serve them, I think is what's going to make your program successful.

Joshua Lynch: 17:15

I also think on the vending machine piece, it may not be as easy as you think to place a machine somewhere. There are a lot of feelings about these supplies being publicly available outdoors. And I think we were surprised that either on both ends of the spectrum, we were surprised at the ease of some of the locations, and we are also surprised at the number of challenges that would show up at other locations. So Shelby's right: patience is certainly key here. Eventually it will work out. Having multiple ways for patients to get access to supplies and get linked up to treatment, I think is really the key.

Shoshana Aronowitz: 17:50

Do you have any advice about dealing with maybe some pushback when it comes to, you know, for example, placing machines, or it sounds like you get less pushback about the mail program, but just pushback in general about these different innovative delivery models for supplies.

joshua-lynch--do--facep_1_04-19-2024_094503: 18:08

I think keeping an open mind. We could tell a lot of stories about interesting things we've learned about the mail based program, but things don't necessarily go kind of the way that you would expect. Let's say you're looking to start a vending machine program and there's a site that might seem perfect in geography but the site is owned by a municipality and sometimes there's tons of layers to get through of approvals, like Adam municipal or like governmental agency be able to place a machine outside. In contrast, the convenience store machine that we have-- not too many layers of approvals for that. know, Sometimes those types of locations might be easier to play something or to put it to distribute test strips or whatever. Just keeping an open mind. We really want one at the library. Well, the library may have 10 layers of approvals and it might take you a year, which is totally fine, you can work on some other easier wins while you're working through the slower process of some other locations. And the same thing would go with there's a community event you want to distribute test strips, some may be super easy to go do that. Others, maybe a bit more complicated, but I think the important thing is don't give up. We pivot all the time. If we have an event that we think would be a great fit and it's not, we don't give up and don't do anything for awhile, we quickly turn and realize, okay, well, how can we get to this group of people in a different way?

Shoshana Aronowitz: 19:31

That's great advice. Thank you. Can you remind us all, if folks are interested in ordering mail based supplies how they do that?

Joshua Lynch: 19:40

The easiest way would just to be to go to our website, mattersnetwork. org, or download the free Matters Network app by searching Matters Network on Google Play or the Apple Store.

Shoshana Aronowitz: 19:51

Now I'd like to discuss a bit more about what you offer to folks interested in accessing treatment for substance use disorders. Josh, you talked about this at the beginning-- what makes your program unique in facilitating access to low barrier treatment? Mm.

joshua-lynch--do--facep_1_04-19-2024_094503: 20:13

Being at one of the referral environments that we had talked about in the beginning, like a hospital engaging with a community outreach team being at drug court, being released from jail. Those are opportunities to access the matters set of resources and get linked up to treatment. The other can be self driven from home. This involves our telemedicine resources and that has been a highly utilized service line or highly utilized front door into getting treatment. In Western New York, we have the ability to offer emergency telemedicine assessments 24 hours a day. And the rest of New York for now is 12 hours per day. Hopefully, fingers crossed, that will be 24 hours across New York state soon. The ability to initiate a telemedicine visit yourself probably the easiest way to do that is, through the app or calling seven, six, five Matters. And this is within New York state for right now. That will get you linked up with a telemedicine coordinator that will start the brief intake process, just a few minutes. Will they will tee you up to what to experience when you're on with the nurse practitioner or PA or physician that's actually performing the telemedicine assessment. So that is a brief assessment, kind of exactly what you would think it would be. If appropriate, they will prescribe buprenorphine. Typically those prescriptions are between 7 and 14 days. And then towards the end, they will run you through the Matters referral process, which gets you access to an appointment, typically, that's within 1 to 3 days the medication voucher, if you need it, the transportation voucher, if you need it, the peer connection, if you want it. 1 thing we didn't necessarily talk about was the scope of the network so far. So when we've mentioned a few times that patients get to pick where they go to follow up this is a big deal to us. We've worked very closely with treatment organization partners and have them offer up a little bit of availability. So. Right now there are about 240 treatment organization locations across New York state that receive referrals. They all chip in a little bit of appointment availability. And to their credit, we now offer about 2, 300 appointment slots per week for people to choose from, which is fantastic. the treatment organizations get all the credit for that. Whether you're getting linked up from an emergency department, from the scene of an 911 call, or from the tail end of a telemedicine visit, which we just walk through, picking a place to follow up where you want to go is super important and it doesn't necessarily need to be affiliated with the hospital that you might be sitting in. Or if you are having an issue and you live in York City, but you're visiting Niagara Falls and you land in the emergency department in Niagara Falls because there was a problem-- you could pick to follow up at a clinic in New York City the following day while you're sitting in a hospital in Niagara Falls. So, the ability to pick a place to follow up at, even across the state, is just as easy as it would be picking a place to follow up at down the street.

Shoshana Aronowitz: 23:17

That's amazing. Yeah, that's incredibly important. Thinking about these receiving agencies where folks might be referred to, we know that many substance use disorder programs, unfortunately, don't follow A low barrier model, meaning that they might place many obstacles in front of people who are trying to receive care, especially medications for opioid use disorder. So how do you screen receiving agencies to make sure that the places where you're sending folks are facilitating access?

Joshua Lynch: 23:49

That's a great question. I would say that it's much easier to do the screenings now than it was in the very beginning. Cause I think people realize that low barrier access to treatment is important and frankly, the right thing to do. Some of the regulations have been updated to allow for easier access to medication. we operate off of the Matters' mission, vision, and values document. Those can be found on our website as well. We hold ourselves to those standards. We hold the treatment partners to those standards. There's a couple of key points when we're onboarding a treatment organization and entrusting to help facilitate referrals to their organization. It's really just a couple of things; one is that they have to agree to take patients as they are, and that would include having a way to handle responsibly patients without insurance, having the ability to take care of patients with polysubstance use, or co occurring mental health and substance use disorders together, and we also expect them to prioritize access to medication, and what I mean by that is that there can't be unnecessary requirements and obstacles placed in the way for patients that, for example, let's say, before you see a prescriber, you have to attend X amount of counseling sessions, X amount of groups, and then we'll schedule you an appointment with the prescriber. That's not necessarily in line with low barrier access to medication, which is super important to us. We feel strongly that the evidence also supports that in regards to patients retained in treatment and staying alive. Those are really the qualities that we're looking for in a receiving organization. And 1 example on the other end would be, let's say there's a treatment organization that operates as a cash practice, doesn't participate with insurance, doesn't have reasonable ways for patients that are uninsured to get there. And by reasonable, I mean, not charging them tons of money to get there. Those types of treatment organizations would not be eligible to participate and receive referrals.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 25:51

While you were talking, I was thinking about some of the other issues that folks who are trying to access treatment might face. And I'm based in Philadelphia, and we are seeing, increasing numbers of patients who want to access substance use disorder treatment who have wounds related to injection drug use and, many substance use disorder treatment programs not having the capacity to treat their wounds and substance use disorder, so that can sometimes be a barrier to getting into care. I'm curious if that has come up in your program, and you're thinking around how to refer patients and how you screen for some of these co occurring issues and potentially help folks access the care they need.

joshua-lynch--do--facep_1_04-19-2024_094503: 26:42

As you can imagine, across our network of about 240 treatment organizations they vary in what capabilities they have. The minimum is that they offer medication for addiction treatment, even below that would be everyone has to offer access to buprenorphine for now, we may change that a little bit to allow for additional organizations to participate, but some of the treatment organizations also offer formal medical care services, not just mental health and substance use disorder. Like, they may have primary care doctors that work there, too. We found that those that are equipped to offer primary care are, first of all, great partners because sometimes patients with substance use disorder don't have a primary care doctor and, and really could use their blood pressure to be handled to or their wounds to be addressed. We found that steering patients towards those more, robust treatment organizations that may have other things under their roof, would be more beneficial to folks that are struggling with a bunch of different issues. What hasn't come up yet is that when someone is going through the referral process and you can go to the matters network dot org website and watch a walkthrough of what a referral looks like. So you would know what to expect, but when someone is picking where they want to follow up at, they're seeing the treatment organizations listed on a map, like a Google map, with markers, you find somewhere that's in the geography that you're interested in, you click on the marker that will show what the clinic's name is, what their address is, and then what type of medication for addiction treatment they offer, and additionally, what other services they offer, and there's a whole bunch of, things listed there. Things like hepatitis, HIV, other substance use disorders, mental health, syringe exchange or syringe supply services, among many other things. If someone knows that they need other issues addressed, that's why we put them right there. So It would be easiest if they pick a treatment location that may offer multiple services that align with the patient's needs. We try to get all that out of the way in the beginning because we know that for many people, getting to an appointment is tough and having them go to 2 different appointments at 2 different places may be impossible for some people. We want to make it as easy and streamlined as we can.

Shoshana Aronowitz: 29:02

That's great. I love that it's on a map so that people can really visualize where the resources are. So, do you follow up with patients about their experiences? You know, after they go off and access care at the organizations that you refer to, and if so, how can patients give feedback?

joshua-lynch--do--facep_1_04-19-2024_094503: 29:25

Yeah, that's a great question. The short answer is yes, we try to follow up with every single patient that's been referred all across the state. That Looks a little different based on where the referral is coming from, what I will say is we're super excited that later this month we are bringing on a social support coordinator. And what this person will do is help to oversee that follow up process, but also add another safety net layer of services. So they call the patient to follow up with them. Hey, did you make it to your appointment? If you didn't make it to your appointment, usually the first question is what happened or how can we help you? they may identify other issues throughout that phone call. Maybe the patient can't get there because they don't have access to transportation and they didn't know about our transportation voucher. Or maybe housing is such an issue that that's prohibiting them from getting into treatment. What we're hoping to do over the course of the second half of 2024 is to layer on this additional set of resources that hopefully can help address some of these other needs that many of our patients encounter and help work through some of those obstacles that may be preventing them from getting good treatment.

Shoshana Aronowitz: 30:38

That's great. Thinking about kind of like the next stage of follow up, can your program push treatment organizations in a better direction? I'm thinking if a patient has a concern about how they were treated or what they could and couldn't access, does your organization bring that back to the clinic that they went to, to say, this patient had this bad experience and what can be improved, or maybe thinking about your criteria for receiving agency to be included in your referral network. Do you think robust requirements for programs can maybe nudge programs in the right direction?

joshua-lynch--do--facep_1_04-19-2024_094503: 31:19

I'd like to think that we may play a little role in helping push our partners to continue to be better. I mean we try to be every day. Had the pleasure of working with some really incredible and motivating individuals that work all over New York state. I will say in the beginning, when treatment organizations were not able to commit to truly prioritizing medication, for example, they still had other requirements that patients needed to meet before they were able to meet with a prescriber. Letting them know that we really couldn't send them referrals at that point was tough, but I will say to their credit, most of them after those discussions eventually came back and said, you know what, we reevaluated, we've built out a low barrier pathway so patients can get really true low barrier access to medication. Then we were able to bring them on and send them referrals and, to me, we took that as, a compliment that maybe we played a little bit of a role in helping some organizations build out low barrier access pathways to medication.

Shoshana Aronowitz: 32:18

I think that's great. In that same vein something I just thought of to ask you, we know that some patients unfortunately encounter barriers to buprenorphine access specifically at the pharmacy level. So maybe they're successful in getting a prescription, but that's only part of the hurdle, the next barrier comes at the pharmacy. Whether that be cost of the medication or stigma they face from pharmacists or other staff at pharmacies, what does MATTERS do to address those potential barriers at the pharmacy level?

Joshua Lynch: 32:51

There's a few approaches. First of all, if you didn't follow up with our patients, we would never know. that's super important is to try to keep that loop of communication open and understand what experiences they're having. So that can look a few different ways. If it's isolated issues with, I went to the pharmacy and they told me I, couldn't get the medication for whatever reason. Sometimes our folks will call the pharmacy and try to troubleshoot. Sometimes I'll get involved or one of our other medical directors might get involved. To try to talk with the pharmacist and either explain maybe they're uncomfortable because it was prescribed via telemedicine or whatever other issue. Often times we can work out the issue by just talking with the pharmacist or the pharmacy staff themselves. 1 example is in 1 area of the state with a particular pharmacy chain, there were repeated issues with access to buprenorphine, at multiple retail locations. Early efforts to try to talk with the staff at the locations really didn't work. Matters is pretty plugged in with the New York state leadership at a variety of different entities, so we were able to work with some folks in Albany to try to redirect the pharmacy chain to do the right thing and provide appropriate access to medication that was appropriately prescribed. So there's multiple ways some of that is one on one. Some of that is through the advocacy work that we do with leadership in Albany. I think a combination of those things has worked fairly well. Still more work to do for sure. But I think we're able to help, a lot of patients.

Shoshana Aronowitz: 34:22

That's great. So we know also, that there are stark racial disparities in access to evidence based substance use disorder care and harm reduction services. How is matters addressing these disparities?

Shelby Arena: 34:38

We know racial disparities in healthcare and access to resources are significant issues, but they're often worse in the context of substance use and harm reduction. Historically overdose rates have been higher in the white community, but we've seen in recent trends that the overdose rates in communities of color have been drastically increasing, while rates in the white community have been decreasing, which really just illustrates the barriers that communities of color face when accessing health care and specifically harm reduction and substance use treatment services. There are many reasons for that, but the bottom line is, that systemic inequalities, poverty, discrimination, inadequate access to education and healthcare facilities-- all of these things are contributing to these negative health outcomes. For the Matters program in terms of, substance use treatment, you know, our accessibility via telemedicine is a great way to reach folks in all areas. It can prevent some of that stigma people might face when walking into a brick and mortar facility. It's also a great way to reach folks with transportation issues, and then additionally, our medication vouchers and transportation vouchers also address some of those barriers we talked about in accessing treatment. Josh talked about how we vet all of our treatment partners to ensure that once we do that handoff to the outpatient treatment, that partner will be able to address all the needs of the patient in terms of continuing access to their treatment. And then in terms of our harm reduction programs, we've strategically placed our vending machines in areas with high rates of substance use and Hoping to mitigate some of these disparities. Only are folks able to access these supplies, but they're able to do that again in a way, where they don't need to have a direct interaction with any health care providers, which again is kind of a stigma free way to get these, supplies out into the community. I'm not sure if we talked about, we also have, a link to our website on all of our vending machines in case people are ready for treatment. so our vending machines can serve really as a gateway to substance use treatment and other healthcare services and resources. we have our partners in the area who also provide a wide array of services, that can also connect folks to local health clinics and, treatment programs and so this holistic approach can help address some of these issues, but it's more a systemic thing that we need to continue talking about.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 37:05

One question that just came to mind when you were talking about The vending machines and also thinking about the mail based program Do you have any sort of advertising campaign or awareness campaign to promote knowledge about the services that you offer so people who don't know about them can learn about them.

squadcaster-65dh_1_04-19-2024_094503: 37:25

Yes, initially we are in our first year of the program, the vending machine program, at least just rolling it out, working all the kinks out there. But we are working on yard signs. So like down the street, you can, put a sign out that says vending machine around the corner, working on palm cards so people on the ground in those communities can, hand out the resources, to let people know where they can get these items in the community, and I think we do have, some, bigger ideas in the works as well.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 37:53

I love the yard sign idea. That's great. Well, thank you both for those answers. Before we wrap up. I Would love to hear you tell this story that you shared with me when we were talking earlier about a couple that you were able to link to treatment and get access to your services, and I think it really does a nice job highlighting what the Matters network can do. Do you mind sharing this story with listeners?

joshua-lynch--do--facep_1_04-19-2024_094503: 38:21

I always smile when I think about this story and when I share it, and fairly early in the Matters evolution, I was, so I'm an emergency physician, I work in a few different emergency departments and I had been seeing one particular patient who had been struggling with getting into treatment, staying in treatment and we got about the ability to kind of link her in, a new way, which was kind of the beginning of the Matters program at getting her access to buprenorphine, which she was pleasantly surprised to hear that we could do in the E. R. So she was optimistic about us getting her appointment and linking her to somewhere. She actually wanted to go follow up at and her significant other was sitting in the room with her and there was some awkward interaction between the two of them. Finally she was like, well, I mean, he really needs to get linked up to treatment too, but he's not a patient here right now, like an ER patient, but I don't know if there's any... could you help him too?, matters operates independently from anyone hospital system or anyone treatment organization. So yeah, at the time we were certainly able to help link him up too, and he didn't necessarily need to become a formal ER patient. Some time had gone by and I had the opportunity to bump into him again and I was able to follow up with him. He is doing fantastic and is back to work, has a great job, and is doing great. He just happened kind of coincidentally that, he was sitting there. We ended up getting in this discussion with his significant other and luckily they spoke up and get into treatment. know, This doesn't have to be a huge complicated process. Like it can happen just as easy as that. And if you have a tool like the matters program that you can plug someone in that's exactly what it was designed for.

shoshi-aronowitz--she-her-_1_04-19-2024_094449: 40:03

That's wonderful. We love to hear those successful stories. So I think that's a great way to wrap up this episode. I really enjoyed talking with both of you, learning more about the program and thank you both so much.

joshua-lynch--do--facep_1_04-19-2024_094503: 40:16

Yeah. Thanks for having us.

squadcaster-65dh_1_04-19-2024_094503: 40:18

Thank you.

kinna-thakarar--she-her-_5_05-24-2024_141616: 40:20

That was Dr. Joshua Lynch, Shelby Arena, and Dr. Shoshana Aronowitz in conversation on harm reduction, compassionate care for people who use drugs. Thank you for listening. Be sure to tune in next time when we welcome Stephen Murray, Dr. Ju Park, and Dr. Ricky Bluthenthal to the series to discuss emerging overdose detection technologies and hotlines.

Kinna Thakarar: 40:40

Please take a moment to complete SAMHSA's post event evaluation survey on the AMERSA podcast page at www. dot AMERSA dot. Org forward slash harm reduction podcast. We welcome any comments, questions, or other feedback for presenters. You can send those directly to AMERSA through the contact us form at AMERSA. org. To learn more about the provider's clinical support system, Medication for Opioid Use Disorder Project, and AMERSA please visit our websites at PCSSMOUD. org and AMERSA org. Funding for this initiative was made possible by Cooperative Agreement No. 1 H 79 TI 086 770 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. Thank you for listening.