Stigma's Toll: A Podcast Series to Reduce the Stigma of Opioid Use Disorder Through Education

Thank you for listening to Stigma’s Toll. You have listened to five experts on Substance Use Disorder, and the stigma attached. We have explored different programs that aim to reduce the harm associated with drug use, reduce stigma and help those who use drugs stay as safe as possible. This included the University of Minnesota’s Medical Discovery Team on Addiction, The Steve Rummler Hope Network, Rural Aids Actions Network, a Medication Assisted Treatment program, and the Minnesota Opioid Project.  My hope is that through learning more about Opioid Use Disorder, and the associated programs, we may start to reduce the stigma within ourselves. We must work towards reducing stigma and help advocate for these types of programs, in our own communities. With this new knowledge, my goal is to inspire you to advocate for, protect, and help those who have Opioid Use Disorder. This can take the form of support at the policy level, or through donations to programs that are already doing the much-needed work. Remember, Dead people don’t recovery, we must help keep people who use drugs, alive long enough, to find stability. This epidemic is sadly far from over and continues to grow. We need help from all areas of our country, so we don’t continue to lose our loved ones. As each overdose death, is someone’s brother, sister, mother, father, son or daughter. We cannot sit by ideally, as we lose over 100,000 people each year to this disease, in the United States alone. For now, you can help use honor those who we have lost. Each year March 6th is” black Balloon Day” a day to remember and celebrate those we have lost to overdose, and August 31st is International Overdose Awareness Day, the world’s largest annual campaign to end overdose deaths. These campaigns have events all across the country, and the world, and I encourage you to find an event in your area. They are a powerful experience, and drive home just how powerful this disease is, and how powerless we may feel at times against it. But we cannot, and must not, stop the fight. Please stay tuned, for updates, and future interviews on the topic.

For this episode, we will be talking with Amy C. Sullivan,  an independent scholar and college professor. Her Ph.D. in U.S. History from the University of Illinois at Chicago focused on women’s history, children’s history, and the history of medicine. Specific research interests in these areas include the history of drugs, alcohol, addiction, and trauma studies. Her projects center life stories rooted in social change and healing through oral history, public history, and digital archives.

Dr. Sullivan has been a Visiting Assistant Professor in the History Department at Macalester College in St. Paul since 2015 and has worked as an independent researcher/writer for The Bakken Museum in Minneapolis and the National Library of Medicine in Bethesda, Maryland.

Dr. Sullivan literally wrote the book regarding opioid stigma in Minnesota. The book is titled “Opioid Reckoning, Love, Loss and Redemption in the Rehab State” which she wrote after working on the Minnesota Opioid Project, where she spent years traveling the globe, interviewing people regarding opioid addiction, and stigma. Her main focus was on Minnesota, though she did visit other areas, including Zurich, where they have had Heroin Assisted Treatment for years. She spoke to how that is viewed there and how it is similar to a Safer Consumption Sites. She spoke to how there is stigma regarding drug use, and not wanting “those people” in one’s “back yard,” thus opening Safer Consumptions Sites is a big challenge. Amy explained how we need to keep people alive long enough, to hopefully decide to get sober, which these sites help accomplish.

References:

Barry, C. L., Sherman, S. G., Stone, E., Kennedy-Hendricks, A., Niederdeppe, J., Linden, S., & McGinty, E. E. (2019). Arguments supporting and opposing legalization of safe consumption sites in the U.S. International Journal of Drug Policy, 63, 18–22. https://doi.org/10.1016/j.drugpo.2018.10.008

Behrends, C. N., Paone, D., Nolan, M. L., Tuazon, E., Murphy, S. M., Kapadia, S. N., Jeng, P. J., Bayoumi, A. M., Kunins, H. V., & Schackman, B. R. (2019). Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City. Journal of Substance Abuse Treatment, 106, 79–88. https://doi.org/10.1016/j.jsat.2019.08.010

Mays, J. C., & Newman, A. (2021, November 30). Nation’s First Supervised Drug-Injection Sites Open in New York. The New York Times. https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html

Mullins, L., & Hagan, A. (2021, December 16). New York City’s safe injection sites are a way to reduce drug overdose deaths, health official says. Wbur. https://www.wbur.org/hereandnow/2021/12/16/manhattan-overdose-prevention

I was able to interview Sarah Joy Costello-Fedje for this episode. Sarah Joy has worked in the field of SUD since 2008. She has a Masters in Organizational Leadership, is a Licensed Alcohol and Drug counselor and approved supervisor thought the MN Board of behavioral health. She is a certified brain injury specialist, has DHS approved training in Fetal Alcohol Spectrum disorder and has worked throughout her career with expecting mothers on MAT. She is currently a director of a Medication Assisted Treatment program in the Twin Cities. During our interview, she discussed how MAT is a best practice, which includes both medications for Opioid Use Disorder, as well as therapy. This combination allows people to achieve a level of stability in their life, and reduce the harms associated with drug use. Some of these harms may include blood borne pathogens, abscesses, overdose and other injuries. She explained how every client has their own goal in terms of recovery, and MAT is there to help them achieve that goal. This may be simply using in safer ways, or reducing use, not necessarily full sobriety. For some, they may use these medications forever, as part of their recovery journey. She explained the two main medications used, Methadone and Suboxone, and why one may chose one over the other. She discussed the benefits of these programs are more than just the medications, but access to resources, mental health, annual physical health screenings, and possibly most importantly, connection. We discussed pregnancy and MAT, and how it’s safer for someone who is pregnant and has OUD, to be on MAT, to reduce the risk of withdrawal, which can hurt the fetus, as well as reduce the dangers of using street drugs while pregnant. Stigma was a large topic of the conversation, including in regard to OUD, MAT and the clinics themselves. Finally, we discussed a little about how COVID19 affected the access to these medications, and the criteria for taking home the medications to dose, versus coming to the clinic to dose daily.

References: 

Vearrier, L. (2019). The value of harm reduction for injection drug use: A clinical and public health ethics analysis. Disease-a-Month, 65(5), 119–141. https://doi.org/10.1016/j.disamonth.2018.12.002

For this episode, we were fortunate enough to have Liz Johnson as our expert, who is dual credentialed as a Certified Medical Assistant and Certified Health Unit Coordinator. She holds a Bachelor of Applied Science degree in Healthcare Leadership and Administration from Winona State University and currently teaches health science courses at a local community college, in addition to her work in harm reduction. Liz spent two years working in county government providing MNsure case management and supporting the Public Health Emergency Preparedness team on COVID-19 response until November of 2020, when Liz joined the Rural AIDS Action Network (RAAN). RAAN is a community-based non-profit serving Greater Minnesota with HIV case management and support services as well as harm reduction programs. Her role as Harm Reduction Coordinator provides oversight and coordination of RAAN’s harm reduction and prevention programs, including several syringe service programs. Liz is passionate about providing education and reducing harms caused by stigma, misinformation, and inequities in communities across Minnesota.

In our interview, Liz helped explained what SEPs are, and that they are an evidenced based, public health strategy to help reduce risk. The programs not only prevent the spread of infection, but also help drug users with education to mitigate risk and help link people to services. She shares that these programs can help with food insecurity, housing, and medical services including help with accessing healthcare coverage. She spoke to the arguments that they enable drug use or increase drug use, but they have been proven not to do this. Liz explained that there are many benefits for a community to have a syringe exchange program such as keeping syringes off the streets and out of parks, as they accept used syringes back, to dispose of them properly. Liz goes into detail regarding how stigma affects her clients, the programs themselves, and funding.  The general theme of this interview was hope for the future, regarding these programs.

References: 

Ungar, L. (2020, February 16). 5 Years After Indiana’s Historic HIV Outbreak, Many Rural Places Remain At Risk. NPR. https://www.npr.org/sections/health-shots/2020/02/16/801720966/5-years-after-indianas-historic-hiv-outbreak-many-rural-places-remain-at-risk

Vearrier, L. (2019). The value of harm reduction for injection drug use: A clinical and public health ethics analysis. Disease-a-Month, 65(5), 119–141. https://doi.org/10.1016/j.disamonth.2018.12.002

For this episode, the expert on this topic is Alicia House, who is the executive director of the Steve Rummler Hope Network. She is currently a member of the opioid epidemic response council in Minnesota and found her passion working in Opioid Use Disorder treatment in 2017. She has held a variety of positions as an Intake Director, Outreach Director and managing sober living homes. She specializes in building and maintaining relationships, outreach efforts, client care and marketing. Alicia received her B.A. in English with an emphasis on composition, literature and cultural studies from the University of Minnesota Duluth.

The Steve Rummler Hope Network was instrumental in the legalization of Naloxone for all lay persons in Minnesota. This interview includes information regarding what Naloxone is, why it is important, and how stigma has affected Naloxone in Minnesota. Alicia shared a little of the history of the Network, and the process to legalize Naloxone in Minnesota. She did a wonderful job of humanizing those who use drugs, via sharing the experience that Steve Rummler had with Opioid Use Disorder. There was discussion of how opioids are being found in all drugs now, so this epidemic affects anyone who uses any drug, removing some of the stigma and “othering” of heroin users. She explained how to get Naloxone, and that everyone should carry it, as anyone could need it someday. She discussed race disparities among overdose deaths in Minnesota, which has some of the worse disparities in the nation.. She spoke to harm reduction, and how it is just meeting people where they are, that it is not encouraging use, but simply keeping people safer. She explained the importance of these programs, as people involved with harm reduction services are 8 times more likely to reach out and receive recovery services.

References: 

Earnshaw, V. A. (2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. American Psychologist, 75(9), 1300–1311. https://doi.org/10.1037/amp0000744

Mitchell, K. D., & Higgins, L. J. (2016). Combating Opioid Overdose With Public Access to Naloxone. Journal of Addictions Nursing, 27(3), 160–179. https://doi.org/10.1097/JAN.0000000000000132

Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry, 76(2), 208. https://doi.org/10.1001/jamapsychiatry.2018.3126

For the scientific background regarding Opioid Use Disorder, the expert is Dr. Mark Thomas who is a professor of neuroscience and director of the Medical Discovery Team on Addiction, a new research program funded by the Minnesota legislature to fuel cross-disciplinary collaborations and discover new treatment options. His research examines how addictive drugs alter the brain and how these changes can lead to compulsive drug use. His lab is now focusing on ways to disrupt addiction relapse. This team researches addiction and are trying to find new ways to treat it.

During our interview, Dr. Mark Thomas explained some of what the Medical Discovery Team on Addiction is, and how they are hoping to design transformative therapies to battle addiction. He spoke to the dopamine system in the brain, and how that is important to addiction, and how it plays a role in helping us do things that are important for survival. He spoke to the misconception that people use drugs only for pleasure, which adds to stigma, as many believe that drug users are being selfish and seeking pleasure. He explains that just because drugs release dopamine, it does not mean that pleasure is the draw to keep using, he reports that the science doesn’t back up the pleasure-seeking theory, which I mentioned earlier in the introduction. Instead, it is better explained as though once used the brain thinks that we need these drugs for survival, so pleasure is not even in the equation. The brain simply is saying, there is something important to survival in the environment, keep doing that. Dr. Mark Thomas explained that with advances in neuroimaging, they are able to view the brain’s functions in real time, which is very important to advancing research.  The most exciting and biggest advancement that he spoke to is the idea of neurostimulation as a therapy for addiction, to help create new pathways in the brain. They already have used this process to help manage Parkinson’s Disease, with great success. The hope is that through this stimulation, they may be able to cure addiction, or at least make it much more manageable.

References:

Bechara, A., Berridge, K. C., Bickel, W. K., Morón, J. A., Williams, S. B., & Stein, J. S. (2019). A Neurobehavioral Approach to Addiction: Implications for the Opioid Epidemic and the Psychology of Addiction. Psychological Science in the Public Interest, 20(2), 96–127. https://doi.org/10.1177/1529100619860513

Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry, 76(2), 208. https://doi.org/10.1001/jamapsychiatry.2018.3126

This introductory episode, will explain why it is important to learn about Opioid Use Disorder, and why we must fight against the stigma that is attached. 

References

Chappell, B. (2021, July 14). Drug Overdoses Killed A Record Number Of Americans In 2020, Jumping By Nearly 30%. NPR. https://www.npr.org/2021/07/14/1016029270/drug-overdoses-killed-a-record-number-of-americans-in-2020-jumping-by-nearly-30

Earnshaw, V. A. (2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. American Psychologist, 75(9), 1300–1311. https://doi.org/10.1037/amp0000744

Mitchell, K. D., & Higgins, L. J. (2016). Combating Opioid Overdose With Public Access to Naloxone. Journal of Addictions Nursing, 27(3), 160–179. https://doi.org/10.1097/JAN.0000000000000132

National Academies of Sciences, Engineering, and Medicine. (2016). Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. National Academies Press. https://doi.org/10.17226/23442

Rabin, R. C. (2021, November 17). Overdose Deaths Reached Record High as the Pandemic Spread. The New York Times. https://www.nytimes.com/2021/11/17/health/drug-overdoses-fentanyl-deaths.html

Volkow, N. (2020, April 22). Addressing the Stigma that Surrounds Addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction

Zwick, J., Appleseth, H., & Arndt, S. (2020). Stigma: How it affects the substance use disorder patient. Substance Abuse Treatment, Prevention, and Policy, 15(1). https://doi.org/10.1186/s13011-020-00288-0