Isabel Byon: 0:00

The New York State Office of Addiction Services and Supports, or OASAS, provides this podcast as a public service. Opinions expressed do not necessarily reflect those of the agency or state. This is Addiction: The Next Step.

Jerry Gretzinger: 0:21

Hey everybody, Jerry Gretzinger, your host for Addiction: The Next Step here, brought to you by the New York State Offices of Addiction Services and Supports, and if you've tuned in and checked out our podcasts in the past or if you've watched the video versions on YouTube, you know we're in a different space today. We're actually on location, because what we're doing this is something that we're really excited to do and it's to share some of the good work that's being done with the opioid settlement dollars. I'm sure people are familiar at this point with the opioid settlement funds the money that's come in to states around the nation to help with the opioid crisis, the overdose crisis, and there is a lot of great work that's being done with those dollars, and today we get to explain one of the many things that that's helping to support. And joining us today to talk about this program we're going to profile are Regina Hernandez. She is here. She's the Network Director of Addictions Programs with the Westchester Medical Center. We appreciate you sitting down with us. We also have Lauren Taliaferro.

Jerry Gretzinger: 1:18

Taliaferro right, Lauren Taliaferro, there's a lot of syllables in that second one, I'll make sure I get it right. But you are a social worker who works with the program. So, ladies, thanks so much for sitting down with us today.

Jerry Gretzinger: 1:29

So we are, we're here at the Westchester Medical Center and we're talking about something that's called a low-threshold buprenorphine program, and I was mentioning to you before we started recording that I think for those of us who work in this area, we say the words low threshold buprenorphine and we know we just say, oh, it's low threshold bup. Okay, we understand. But I think for a lot of people out there I mean, there's so many different types of treatments and avenues people can take when they're looking for help with a situation like this, they may go, yeah, okay, it's not the treatment. But so let's start before we talk about the specific program here. What does that mean?

Regina Hernandez: 2:04

When we say low-threshold buprenorphine, so what that means in a nutshell is providing easy access to services, not only low-threshold buprenorphine but other forms of MAT outpatient treatment, recovery services.

Jerry Gretzinger: 2:20

MAT medication-assisted treatment.

Regina Hernandez: 2:20

Medication-assisted treatment, yep. Basically meeting people where they're at, seeing what services could benefit them. Person-centered care. Letting the patient person who is encountering us in the program lead the discussion and help them navigate what services would work best for them.

Jerry Gretzinger: 2:36

And so by low threshold we mean that this is like an easy avenue for them to be able to access this

Regina Hernandez: 2:41

Lowest barriers

Jerry Gretzinger: 2:42

Right. And again for people who may not know, because again we make a lot of assumptions, buprenorphine is a medication that that helps with this addiction to substances, if you can just kind of expand on that a little bit

Regina Hernandez: 2:54

Absolutely. So, buprenorphine is one of a variety of medication assisted treatments that people use to treat their substance use disorder. People utilize buprenorphine in many formats. There is the popular brand name, but also people can use it in films, tablets, there is injectable formulations of buprenorphine, and basically it helps people maintain their recovery and a lot of people choose that as their primary form of treatment. But they also might use that in combination with other forms of treatment, such as if they're needing withdrawal and stabilization services, inpatient rehab, outpatient services, peer supports. So it is not a one-size-fits-all. It's very much tailored to the individual's needs.

Jerry Gretzinger: 3:45

Right, I mean. So obviously you know the kind of. The key deliverable here is the treatment with buprenorphine.

Regina Hernandez: 3:50

Mm-hmm.

Jerry Gretzinger: 3:51

But I think what is unique I think now that this is becoming more I don't want to say commonplace, but probably more of a practiced delivery is the whole low threshold aspect of it, and Lauren, I mean talk about that being able to offer it low threshold right. So basically, we're moving a lot of the barriers that are often in place of someone accessing this right.

Lauren Taliaferro: 4:17

Absolutely and to piggyback off of what Regina was saying is, in the past, buprenorphine, which is a medication it's been hard to get it to the patient, so there used to be many providers who were not willing or able to give the medication, and so there's been a very direct focus to make this easier for our patients because, you know, if you have a headache it shouldn't be so hard to get Tylenol type of thing. And that's kind of what the view is is how can we better service our patients and our community at large? This, unfortunately, is something that is happening across the country, and so it's awesome that there is more of a push to improve education, improve, you know, kind of the treatment that our patients are receiving, because we understand there's been a lot of it just hasn't been the way it should have been. So part of what I do here at the hospital is I work directly in the ER and we have patients who come to our ER looking for treatment and that may be inpatient, whether they need stabilization as they are trying to get to that next part of their recovery where they are abstaining and maintaining their sobriety. So patients come into our ER for a plethora of reasons. They may be looking for access to services they may just have questions of. I've never been in this circumstance before. What do the next steps look like? They may need medication to keep them safe in that moment, and so, inherently within this project and within this program, low-threshold buprenorphine just means get in here and let's see how we can help you.

Lauren Taliaferro: 5:59

And so for some patients it will be an admission to an inpatient program, such as here at our hospital, Westchester Medical Center, specifically our Mid-Hudson Regional Campus.

Lauren Taliaferro: 6:09

For some patients, I will be referring them to an outpatient office where they can maintain that medication and maybe also receive counseling services. For other patients, they may just need a listening ear and some validation and some person-to-person encouragement of it is okay, you are not in this alone. And so we've been allowed to kind of, you know, really tailor what we're doing to each patient's needs, because everybody comes in and in a different circumstances, everybody's life has looked differently, and so we now have the ability to treat our patients as such, whereas in the past it was kind of a lot more blanketed. And so we've been given such a great opportunity and we've been seeing the effects of it. We've seen a decrease in, you know overdoses in our community. We've seen patients coming in and being treated with kindness and respect and in turn that has had necessary and wonderful effects again in our hospital, in our facility, but again also our community at large.

Jerry Gretzinger: 7:11

All right, so I'm going to jump in there. So I think it's. I appreciate the breadth of that response because when I say you know what is low threshold buprenorphine and how does it help people, you went so far beyond the explanation of what buprenorphine does, right.

Jerry Gretzinger: 7:25

Because, that's the whole low threshold piece of it. There is everything that you could possibly imagine tied to this. It's making that connection with the people who need these services, and I think one of you said whatever they need, wherever they're at, we're going to meet them, we're going to help them. Buprenorphine is just one piece of that whole puzzle. But to go back to that too, I think there's often people who will say, okay, well, if somebody has been using a substance, how does another substance help them to kind of break that connection right? So I mean, I know, but I'd rather have one of you explain how it works for people at home. So somebody comes in, they're a candidate for buprenorphine treatment. What does it do to help them break that connection, that cycle they've been in?

Regina Hernandez: 8:13

So for many people it helps them maintain what normality is for them a normal level. So a lot of times the way I explain it is if somebody is diabetic, right, they take medication right to help them maintain a healthy level. Medication-assisted treatment for people with substance use disorder is very similar. They're taking medications not to replace one substance for another, but to achieve a level of normalcy for them, a level of what makes them able to function at a comfortable level, to live their lives, to have a quality of life, and whatever that quality of life means is up to them, and we support that with the services we provide. So medication-assisted treatment, in whatever form, is meant to not so much replace as to support and enhance somebody's quality of life.

Jerry Gretzinger: 9:07

And you know, I think too. I think, now that we have these treatments available, they are making such an impact. And, Lauren, again I'm going to go back to you because I know you have a lot of direct interaction with the folks who come in here seeking this and benefit from it. What sort of and I think you were starting to get at this when I jumped in before but what sort of changes are you seeing in the people's lives who've come in and said, okay, I want to do this, I want to make a change and have been able to use this treatment to their advantage?

Lauren Taliaferro: 9:45

Yeah, so the first thing that comes to mind is patients feel a lot more informed and like a participant in their care. So, based on the education they're given, they understand exactly what this medication is. To kind of speak to what you were saying before. Regina said it's not to replace but to support and assist in their recovery.

Lauren Taliaferro: 10:02

So they're tailoring so these medications do not necessarily have like psychoactive you know impacts or anything to that regard, but when patients come in, they are now able to know exactly what's going on. They have more of a voice in their care of I do want this medication or I don't want this medication, or I want to go this route, and so there's a lot more independence and involvement and because of that, you know again, we're seeing that patients are feeling they're leaving much more satisfied and much more on board with their plan, and so that means going forward. You know, aftercare and follow-up appointments are met and, you know, maintained at a much higher rate than they were in the past. Patients also, if they do fall off and we understand that can sometimes happen on our journeys.

Lauren Taliaferro: 10:53

There's much less shame and judgment when they do return to us, and so they're able to say, Lauren, I fell off the horse. What do we do next? And we say, okay, today is a new day, you know, let's start with where we're at. So, again, it's given our patients and our staff an ability to again be more person-centered, rather than necessarily specifically focused on treatment or medication or something of that sort.

Jerry Gretzinger: 11:18

How many? I mean, it's been what 14 months that we've been doing this program here, right Approximately? How many people you've seen come in and be able to take advantage of this?

Lauren Taliaferro: 11:29

I alone have had about 700 encounters.

Jerry Gretzinger: 11:31

Wow, 700?

Lauren Taliaferro: 11:33

Yes, sir.

Jerry Gretzinger: 11:34

I mean that's a lot. I mean we talk about the opioid sentiment dollars being broken up over the state of New York and what the good it can do. 700 people here in this one program

Lauren Taliaferro: 11:43

Yes, sir.

Jerry Gretzinger: 11:45

That's terrific. And the range of people coming in I'm sure all ages and different walks of life.

Lauren Taliaferro: 11:52

All ages, so our specific program is geared towards adults. So I've seen 18 year olds, but also up until we've seen people in their 80s. We've seen people from different demographics, as in race, cultural backgrounds, religions, socioeconomic degrees and statuses. So literally no two patients are alike. But once again, once we're able to get down to the nitty gritty of the person and really, you know, peel those layers back of the onion. A lot of our patients have had similar circumstances, even though they look different, and so again we're able to kind of tailor you know what? How specifically can we assist you where you are in your life and it won't look the same as the next person treatment, and I enjoy that about it. It's very, um, very tailored. But you would, you would couldn't imagine. Everybody in life has needed some assistance and I'm glad we're able to do it regardless of the circumstances yeah,

Jerry Gretzinger: 12:48

And then 700 of them right now.

Jerry Gretzinger: 12:50

So far, that's in counting that's in counting and so you know.

Jerry Gretzinger: 12:54

Then, Regina, I'm going to pop back to you too. You know, one of the things that we at OASAS are happy about, we're proud of, is the amount of settlement dollars we're able to get out as quickly as we got out there some. There are some states, for whatever reason it might be, they've had the dollars. They're still waiting to get most of them out the door. Would this program be what it is without those settlement dollars to help getting it to this point?

Regina Hernandez: 13:20

Absolutely not. I think that's why we're incredibly thankful for giving the opportunity to use these funds for low-threshold buprenorphine, primarily because having Lauren in the ED really expands our outreach. It allows us to touch more people in their greatest time of need. When we think about our workflow for how we plan to use the low-threshold buprenorphine opioid settlement fund dollars was really wanting to meet people at their greatest time of need, which a perfect example is the emergency department. People are coming in for a variety of reasons. Primarily, a lot of our patients, because they know we have an inpatient program, might be seeking services here, but other people might have experienced an overdose. Some people might just have indicators that would make them need substance use treatment services and and for that reason we have Lauren in there.

Jerry Gretzinger: 14:09

So, yeah, so again, ladies, I want to thank you for sitting down and chatting with us about this today, Just one of the many programs these funds are helping to support, and the difference that it's making, that you are helping to make, is just tremendous. We're so excited to be able to be a small part of what's happening here, and you know. Best luck for continued success with this. It's changing a lot of lives and that's amazing.

Lauren Taliaferro: 14:36

Thank you,

Regina Hernandez: 14:37

Thank you

Jerry Gretzinger: 14:37

All right, so listen this was a great conversation we had today.

Jerry Gretzinger: 14:41

Hopefully it was informative for you. If you want to learn more about the Opioid Settlement Fund and the dollars that are available, what it's supporting, or you just want to find out how you can access treatment like this, you can go to our website. It's oasas. ny. gov, o-a-s-a-s, dot N-Y, dot. G-o-v and, of course, if you want to talk to somebody right now, it's our hope line 877-8-HOPE-N-Y. 877-8-HOPE-NY. I'm your Jerry Gretzinger for Addiction: The Next Step. Until we see you again next time. Be well.