Breaking the Cycle: Medication Assisted Treatment and Opioid Recovery

In this episode of Your Rural Health Connection, we sit down with Erica Vining, Psychiatric Nurse Practitioner at Rural Health, Inc., to discuss the life-changing impact of their Medication Assisted Treatment (MAT) program in Opioid Recovery. Erica shares how this evidence-based approach is helping individuals struggling with opioid use disorder regain stability, improve their health, and rebuild their lives. Tune in to learn why MAT is such a critical tool in addressing the opioid crisis—especially in rural communities—and how compassionate, accessible care is making a real difference every day. 

Transcript

SPEAKER_03 0:01

Welcome to Your Rural Health Connection, a podcast that links you to healthier living in Southern Illinois. Whether you're tuning in from somewhere in Southern Illinois or around the globe, thanks for taking a little time out of your day to join us. We're so glad you're here. This brand new podcast presented by Rural Health Incorporated is all about you, your health, your community, and the resources that can help you live your best rural life. Our goal is to not just share what we do at Rural Health Incorporated, but to connect you with healthcare providers, services, programs, health events, and much more available to you in Southern Illinois. I'm your host, Shauna Ryan, Director of Public Relations at Rural Health Incorporated. I've spent over 30 years working in rural healthcare, and one thing I've seen time and time again is how easy it is to feel disconnected from the care and resources that are actually available to us. That's exactly why this podcast exists. To keep you informed, bridge those gaps, and make navigating your healthcare a whole lot easier. So let's get started because better health begins with connection. Today I'll be talking with Erica Fining, psychiatric nurse practitioner, about the medication assisted treatment program at Rural Health and how vital it is to saving the lives of so many struggling with opioid use disorder. Stay with us. We'll be back in 60 seconds.

SPEAKER_02 1:31

Whose mission is to provide quality services to all patients in need of health care while being committed to the overall health and well-being of the underserved.

SPEAKER_00 1:40

Hi, this is Cindy Flam, Chief Executive Officer of Rural Health Inc. For over 40 years, many across Southern Illinois have entrusted us with their health and well-being. Rural Health Inc. provides numerous exceptional services tailored to you and your family across five clinics in Union, Johnson, and Massac counties. We work with most insurance carriers, Medicare, Medicaid, and we even provide sliding fee discounts. Quality services for all and committed to the underserved. That's Rural Health Inc. We specialize in you. Give us a call at 618-833-4471.

SPEAKER_03 2:15

Welcome back to the Your Rural Health Connection podcast. I am so happy to have you with us today, listener. And I tell you, we've got so much going on at Rural Health. A lot of different things are coming up, but we're going to kick things off today. This is our first podcast, which I'm very excited to get going on. And uh joining me today is Erica Vining, psychiatric nurse practitioner here at Rural Health. Did I say that right? Is that right?

SPEAKER_01 2:39

I did. It is a mouthful, I know. So I um I'm dual certified actually in psychiatry and family medicine, but I do at rural health do psychiatry primarily, and then I'm also certified in addictions.

SPEAKER_03 2:49

Great. And and how long have you been at rural health?

SPEAKER_01 2:53

I started at Rural Health um in January of 2019. So I have been here just over seven years at this point. Okay, very good. That's wild to say out loud. I can't believe it's been that long.

SPEAKER_03 3:07

Well, I tell you what, it goes by fast. I know it does for sure. And you carry a lot of different hats here at Rural Health. Before we dive into what we're gonna talk about today, tell us a little bit about what you do here. What are some of the the different things that you're involved in here at Rural Health?

SPEAKER_01 3:25

Absolutely. So um I do primarily psychiatry down in Metropolis. So over the years I've worked at all of our offices except for Dongola at different points, but I've always been at Metropolis um since since I started here seven and a half years ago, a little over seven years ago. Um, and so right now I only come to Metropolis three days a week. Um, every couple weeks I go to Gorville for an afternoon to help them out with some ADHD evaluations, but I don't actually see patients up there beyond that. Um so I do primarily psychiatry and I do um quite a bit of addiction medicine in Metropolis as well. So a lot of that falls under our MAT program, which I think we're gonna talk about today, which are medications for opioid use disorders. Um, and then I also have treated several people, many people over the years for like alcohol use disorders, amphetamine use disorders, and other various substance use disorders.

SPEAKER_03 4:09

Okay, and we have five locations here at Rural Health. We have Anna, Dongola, Goreville, Viana, and Metropolis. And so are are you circling through all of those locations? Where, where do you land each day? How does that work for you?

SPEAKER_01 4:24

So I only come to Metropolis, I'm here three days a week. Um, when I first started at Rural Health, I was in Viana and Metropolis. I split time. After a couple of years, we really wanted to try to have a female provider in Anna, so I started going to Anna on Wednesdays. Um, so I did that for a while. And then about two years ago now, we kind of compressed it down. We had some other providers come on board. We have some wonderful other providers now in the behavior health department that are covering some of those other needs. So I was able to focus just on metropolis. So I'm in Metropolis Mondays, Wednesdays, and Thursdays now.

SPEAKER_03 4:54

Okay. All right. But if but if you're needed, you go.

SPEAKER_01 5:00

Yeah, I mean, I have filled in in other offices. If someone has like a a need, like is out for something, I can go to other offices. But yeah, not generally. Usually I'm just down here, but I can always go wherever they need me.

unknown 5:09

Okay.

SPEAKER_03 5:10

Do patients need to have a referral to get services through real health in this respect? How does that work?

SPEAKER_01 5:18

So on the mental health side of things, the psychiatric side almost always, yes. There are a few commercial insurances that will allow you to self-refer, but those are so um kind of few and far in between that we generally just ask that everyone has a referral to behavioral health. That can come from anyone, you know, primary care, whoever wants to send it over. Um, that's just for insurance sake. You know, if you are self-pay or using our slide scale and you want to self-refer, that's fine. Just make sure you let them know when you when you want to schedule that. Um, but generally, yes, we do require referral for the addiction health side of things, specifically like the MAT program, we do not require referral. So to get into that program, you'd not have to have a referral. Um, we want to be able to get people in pretty quickly and not have that as a barrier there for them.

SPEAKER_03 5:57

Okay, so let's go ahead and talk about the MAT, the MAT program, and and what does that stand for?

SPEAKER_01 6:02

So MAT stands for medication assisted treatment. Um, and that specifically is kind of an umbrella term for a group of treatments that we use for people struggling with opioid use disorders. Um, so that can include medications, which is kind of, you know, in MAT as a whole, we call it medication-assisted treatment, but it's not only medication. So there are also some different therapies and other types of like um resources that we can offer these patients. So not everyone who comes into the program comes in seeking medication, um, but when they do, in our program specifically, that is a buprenorphine containing product or um an naloxone containing product. So we don't do methadone at our location.

SPEAKER_03 6:40

Okay, so again, in the whole process of this is meeting the patients where they are. I hear that a lot here, and I'm excited about that. What does that mean for a patient?

SPEAKER_01 6:51

Yeah, so meeting patients where they are is kind of the hallmark of MAT programs. And sometimes you'll hear me use other terms such as MOUD or MAR. Those are all interchangeable. We prefer M O U D, which is medications for opioid use disorder, just to kind of to make it a little more concise and understandable, um, and also because we want people to look at it as a chronic disease process. And we feel like MOUD kind of sums that up a little bit better than MAT or MAR. Um, and so when we are meeting patients where they are, what we mean by that is regardless of where you're at in your substance use disorder. So whether you are just starting to think about sobriety, you know, if you've been sober for 10 years or, you know, you aren't even sure yet that you want to be sober. We're we're in pre-contemplation there, and maybe we've considered it, but really we're not even sure we're ready for that yet. Um, we'll meet you where you're at and we will come up with a treatment plan that fits whatever stage you are at in that process. And that's where the term harm reduction is applicable because regardless of what stage that is and what interventions we have, we're still reducing long-term harm and long-term mortality rates in that population.

SPEAKER_03 7:53

So, how effective is this program in helping someone to get through the use process? How, how, how, how what are you seeing here?

SPEAKER_01 8:03

Yeah, so I mean, anecdotally, I find it to be very effective. When we talk about efficacy rates and data and statistics and numbers, because everyone likes numbers, those are all gonna be more geared towards MOUD programs with medication specifically. So we're not gonna have as many numbers for patients who are coming into these programs and not taking buprenorphine products or methadone products. But when we look at those numbers, we know that our lifetime mortality rate for someone who engages in an MOUD program is gonna reduce about 60%, which is huge. I mean, if that's six in 10 lives that we can save that wouldn't have otherwise been saved, I think that's a huge benefit. And when we move outside of mortality and consider just the other aspects of recovery that can be helpful, we see um we see these patients who are able to get back in the work field, uh, the workforce and get their children back. And we see reduced um ER visits and reduced primary care visits. So we reduce some of that overload on the healthcare system because when we're using a medication to assist recovery, it's more of a structured situation where we know exactly what we're taking every day. We know that you know our medication is covered and we don't have to find, usually we don't have to worry about like buying on the street or finding money or doing whatever we're gonna have to do to be able to get that substance we were taking before. And so that allows for people to regroup their lives and we you know reassess their priorities and get back out there and just become, you know, productive members of of society again and get back in the workforce. And again, I see so many people just get their children back. We have reunification and we're just getting their lives back. It's really cool. It's a really cool program.

SPEAKER_03 9:30

It sounds like it for sure. Um now something that that we often hear when it comes to this program or programs like it. People ask, is this a lifetime thing? Are you are are you just trading one medication for another? What what are the benefits of it in that respect?

SPEAKER_01 9:48

Yeah, and that's something that I've heard a lot over the years, and I think it really can contribute to um to the stigma, which is a big problem in these programs and with these medications. And sometimes you'll even find, you know, recovery programs that are anti-MOED or anti-mat therapy. And I think that all comes back to what you said about are we just replacing one drug with another? Um, I think you have to consider that. Well, first, let's just talk about what the requirement is to enter into a MAT program or an MOED program. And that is going to be to have an opioid use disorder. And the key there lies in the word disorder. Um, so if someone is just taking a prescribed pain medication, um, taking opioids, you know, there's not, they're not trying to take more than they're prescribed, they're not trying to get some from friends or buy them on the street, we're not using, you know, heroin or buying fentanyl and all the different forms and and varieties that are out there now. We're not injecting or taking it ways that aren't prescribed. That's not a disorder. So we have to actually be struggling with our opioid use disorder to enter into these programs. And again, that's gonna look like taking more than what we're supposed to be, or you know, missing out on social functions because we're worried about where we're gonna get our next, you know, substance that we're gonna use, um, things like that. So when those patients enter into these programs, what we do is we take that chaos of their life away and we give them structure back. Um and so we take that disorder and we take that chaos, and we're able to give them prescription for a medication that will, for most patients, eliminate cravings, it will eliminate the withdrawal symptoms, and it's it's a structured dose. Um, when we're talking about buprenorphine specifically, it has what's called a sealing effect, and that's that's a little bit lower with buprenorphine, meaning that it's really hard to get high on. We really, it's really very difficult to abuse um Suboxone specifically because it's got you know naloxone in it and it's got the buprenorphine, but even just a plain buprenorphine product, it is not easy to get high on these on these medications. And that's why um, while they can have some street value, as people say, it's it's not going to be as significant because no one is really abusing these. They're using these because it's controlling these symptoms that have kept them from getting sober, which are the withdrawal symptoms or the cravings to use. Um, because it's very difficult once you get through that withdrawal period of being sick, and then you have these empty receptors and they're almost, it's almost like a bleeding wound and there's no bandage on it. So this medicine can go in there and kind of bandage that wound and patch it up and help it heal. So really, when I hear people say, are we just trading one drug for another? My answer is is no. I mean, if you look at it on a chemical aspect, sure, I guess we're taking one chemical substance and replacing it with another, but that that's I mean, that's consistent everywhere in everyday life. Um, what we're doing is we're taking away the chaos of the unknown and what is this substance that I'm buying on the street? What is this pill? Or I'm taking my script and going through it. Now I've ran out, you know, two weeks early and I have to go find something. And we're giving them the structure back of knowing I have this medication that is I really can't get high on, um, it's very protective. So I like to use metaphors a lot when I'm talking to people. And so this isn't necessarily a metaphor, but I describe it as if your opioid receptor is like a cup and that cup is empty. That's when you're gonna have those withdrawal symptoms. When we take Suboxone and we put it in that cup, it's very heavy. It's almost like an oil and water kind of kind of thing here. So if we're filling that receptor with that buprenorphine, we're wedging out anything else and it's sitting in there, and it is so heavy and so difficult to get that out, and that's where we reduce that overdose risk. So if you have this really heavy substance in this cup, you can throw other substances at it. You know, someone might slip up because recovery is not always a straight line. They might use heroin or or fentanyl or kratom or whatever it is they're using, and it's gonna try to get into that receptor and it's gonna have a really hard time doing it. And that's where this is harm reduction and where it's protective. So you're eight times less likely to have a fatal heroin overdose if you have suboxone on board, for example, because it is just so heavy and that receptor and so difficult to displace, but it's also gonna bandage that wound. So we're not going to have, you know, the withdrawal symptoms, um, the cravings. Something I think that's very important for people to understand is if you are listening and you've tried suboxone before and it made you really sick, um, this is not a medication that you want to try without guidance because you can't just take Suboxone. Um, there's a process, we call it the induction process. You have to be in moderate withdrawal to begin Suboxone. And why that is, is because of that cup we just talked about. So if you have an opioid or an opiate sitting in that cup, because Suboxone is so heavy, it's gonna wedge it right out. It's gonna knock it out of there and it's gonna peel that scab off and it's gonna cause what's called precipitated withdrawal, which means you're gonna immediately go into a really severe withdrawal state. Um, and that is where sometimes I'll hear people say, Oh, I hated Suboxone. I took it one time and I was so sick. Well, you have to be in withdrawal when you start it. If you are not in moderate to severe withdrawal, when you start this product, it is going to make you very sick. And that was not the medication, that was you not knowing how to take it. And that's why it's important to use these programs and use prescribers who know how to start it because it does work very fast. You are not going to feel good when you come in to start it, but within five to 10 minutes of taking the medicine, you're going to feel so much better. Um, it is not something you have to wait days and days to feel better. So it is very difficult to get through that 24 hours, that first 24 hours without anything because you're not going to feel good. But then you are going to feel so much better and we're going to get you back on the right path, and we're going to get you on the right medication. And it's just, it really is a life-saving medication. So I don't personally agree that we're trading one substance for another. Um, I think that just contributes to the stigma. But if you want to look at it that way, um, I just encourage you to reframe it as we are taking away the chaos of this disorder and we're giving you stability in place of that instead.

SPEAKER_03 15:23

Well, it's kind of like we talked in the past of if if you have a certain condition, a health condition not related to this, you're taking medications to get over that.

SPEAKER_01 15:33

Yeah, and we use diabetes a lot in that example. And I know it's it's kind of an overdone example, but it's such a good one because especially when when we talk about type 2 diabetes, many people have type 2 diabetes because of their diet. Okay. So if we want to compare that to a substance use disorder, you know that eating high carb and high sugar foods is making your condition worse, but you can't stop because you're addicted to these sugars and these carbs. So what we do is we give you insulin or we give you whatever medication it is to control your type 2 diabetes. And every now and then you may slip and still eat something high sugar, just like every now and then on the path to recovery. Sometimes we slip up and that happens. That doesn't happen to everyone, but some people it does. Um, but you have that insulin there protecting you. You have it helping your body out and helping, you know, keep those down. And can there still be long-term health consequences? Absolutely. Absolutely. Um, but we have a harm reduction medication and insulin too, because we are treating this medical condition and no one chose to be diabetic. And I promise you that no one is choosing to have a substance use disorder. It's a disease process just the same way.

SPEAKER_03 16:34

So are you seeing patients that have to be on the medication for life or is it a short-term thing? What do you what do you see there?

SPEAKER_01 16:43

Yeah, and I'll I'm gonna um kind of use the diabetes reference to answer this question as well. Type 2 diabetes can often be diet controlled. So you can be diagnosed with type 2 diabetes and you can change your diet and your lifestyle and exercise, and you can control that sometimes without needing any medication. Um, I look at this the same way. There are some patients who are able to take the medication for a certain period of time, and then their life gets into a better situation, and they're able to have more support in their life and more structure, and um they do come off the medicine. And then there are some patients who exist in a life of chaos, and that's not likely to get to get better, you know, and they might struggle a little more to come off, or some people just are so stable on the medicine, why mess with it? You know, if if it's protective and we're not hurting anything, um, why not stay on it? So I do have patients who stay on this medication indefinitely, and I do have many patients who have come off and have maintained their sobriety for several years without any relapse.

SPEAKER_03 17:40

That's wonderful. Uh so what age do you start seeing patients?

SPEAKER_01 17:45

Um, so for our MAP program, it's going to be 18 and up. Um we do we do require them to be legal adults so that they can consent to the process. So 18 and up, um, as old as you can go. Now, not everyone can take these medications. There are some medical limitations to that. You know, if you have a really advanced liver disease, um, buprenorphine products might not be the best option for you, but we do have other options. Um, we do have other medications and therapies and treatments that can be helpful, so don't let that be your reason to not reach out and seek help. Um, MAT, even though we generally referring to these medications, there are a lot of other medications that can be helpful.

SPEAKER_03 18:21

So okay, and you you bring up a good point here. Um living where we are in Southern Illinois. How is MAT in rural areas different from what we might see for resources for other areas? What what do we see down here?

SPEAKER_01 18:36

Yeah, I think the biggest difference to a rural area that we live in versus like a city or a more urban area is just access. So, you know, we might have a similar population to a city, but that's spread over hundreds of miles. And so, you know, it it can be tough to find someone who offers these services that's near enough to you that you can get to them because transportation can be an issue. Um, we do have a lot of resources though that can be helpful for that. So every one of our five offices has a prescriber for these medications. So if you are near any of our five offices, we offer these services, we can get you in there. Um, most FQHCs also offer these. So if you are listening or watching this and you're, you know, near Shawnee, like a Shawnee Healthcare Center or Christopher Rural Health, they most likely offer these services as well. Um, and beyond FQHCs, there are many providers that are offering this. The DEA in the past has required a waiver, so it was a little more difficult to be able to prescribe medications for opioid use disorders. Um, they did away with that a couple years ago, so it really opened up access a lot. Um, but in the past, when we had the waivers, it was a little easier to find us because you could do a search and see who was waivered. Now, because anyone can prescribe it without the extra training, um, you can't always find them on the searches if they don't self-register. So you can use the SAMHSA search. Don't depend solely on that. If you're like, oh, there's no one near me, don't let that be your excuse. What I would recommend you do is call the Illinois Helpline. Um, that is a state-sponsored um resource that we have. It is available 247-365. If it is Christmas Eve and you are ready to get sober, you can call the Illinois Helpline. Um, and Sean, I'll have you get that number. I don't think I have their card handy.

SPEAKER_03 20:10

That was gonna be one of my questions. So yeah.

SPEAKER_01 20:14

They're not sure I have it handy. Um, but they also have a website, you can text them and they will connect you with a provider in your area because they keep a list and they will also, um, if they find it appropriate, they can send in an emergency prescription for you. So if you are in that window where they feel you're appropriate to start Suboxone or start buprenorphine and it's safe for you to do so, they will send in a prescription. So we utilize them often if we have patients who have run out of medication because they've moved to the area, or if they're coming out of like an inpatient rehabilitation program and they know they're gonna run out of medicine, but they can't get to us for a couple weeks. The helpline generally will send in that script to bridge them. Um that way we're not running out. So they're a wonderful resource, they're always available. Um, please, please, please use them. They're just such a good, good help for us.

SPEAKER_03 20:57

I've got a phone number of 833-25 help. Is that it? That sounds right.

SPEAKER_01 21:03

Let me pull it up for you real quick. I always have their card right here and I don't have it handy, unfortunately.

unknown 21:09

Yeah.

SPEAKER_03 21:09

So something about our conversations, we can just kind of go on the fly. I love that.

SPEAKER_01 21:13

Yeah, we can figure it out. So, yes, you can call 833-657-7147, or you can text the word help to 833-234. And, you know, if you um are listening, you didn't catch that or you forget it, just Google Illinois Helpline. They're right there on the top. It's helplineil.org. They also have an online chat feature. So there's really no excuse not to reach out to them if you need them. You can text them, you can call them, you can chat with them online. Um, don't wake up at 2 a.m. and decide you want to get sober and be like, oh, well, there's no help for me. Do it right then. Because as we know, sometimes with substance use, things change a lot. It's very fluid. So we want to get people in quickly. And generally with our program, we do. Um, we'll get you in with Allie Brown really quick, we'll get you in with a prescriber really quick. So as long as your timeline allows for it, we generally will get people in within a week of them calling. So

SPEAKER_03 22:00

Number, we're gonna mention that again before we're done. Um Yeah, you you did mention just in this little conversation here that we just had that there are some barriers to Matt and how we can help. What are some barriers that you see where people go, I just don't want to do this? What are what are some things that you could tell folks?

SPEAKER_01 22:18

Yeah, I think we've really hit on the big ones. So the biggest barrier that I found personally has been um just access and just access to a prescriber. Um, there are prescribers out there that do telehealth. So even if you find that you're not close to one of us, that's why I still encourage you to call the helpline because they might be able to find you a prescriber that is in Chicago, but we'll do a virtual visit with you, you know. So um, even though access can be limited in person, um, that doesn't mean that it's not available for you. So please reach out to them because there is someone there that is willing to help you. Um, beyond that, stigma is definitely the the next biggest issue for me that I have seen. And that transcends beyond just the community stigma. I see patients stigmatize themselves often. Um and I also, you know, have dealt some with provider stigma. So, you know, some prescribers are not familiar with medication assisted treatment or why these medications are helpful, and they may even feel kind of like they're just replacing one problem with another. So I definitely encourage you, you know, if if someone is listening and you're a prescriber that's thought about using these products, and if you are just on the fence about it, or even if you have a question about a specific patient, or say you want to start sublicade and you're not sure um exactly what goes into that. I offer sublicade. I can explain to you the REMS process with that. Um, you know, this won't make sense to a lot of people listening, but if you're a prescriber listening, you'll understand to prescribe sublocate, you do not have to have a REMS as long as you use a REM certified pharmacy. But there are other guidelines that go into that. So, you know, the the medication can't go to your patients, it has to come directly to you. Um, I can give you some options for pharmacies that will do that. We have to have a double locking mechanism. So we can walk, walk through REMs if you're confused about it. Um, or if you are a person who is using the medicine and you're stigmatizing yourself, um I would just encourage you to again reframe it in your brain as I'm taking something that has made my life better and at no expense to anyone else. So everything comes with a risk, right? Every medication has a risk. Um, drug use has a risk. And so we're not gonna pretend that these medications are without any risk at all. But when you compare it to a street drug or a substance or taking well beyond the max daily limits of your prescribed medication, that risk is gonna be so much less in general with these medications. Um, so stop trying to hold yourself to the standards that other people have set for you. And that, you know, there's something that I worked with an addictionologist who used to say, don't let perfect be the enemy of good. Um I think that's really important to remember that often we strive for perfection and whatever that means for you, if that means being completely off all substances, don't let that sabotage you and be the enemy of what's good right now. Like if you're doing well in your medication, who cares? Who cares what other people think? Because you know what? If if they weren't there helping you get through it in the thick of it, they don't get to have an opinion on your life. And even if they were, you're still allowed to set a boundary. Um, don't let anyone judge you or make you feel bad for taking a medication that has saved your life, that has helped you get your life back. Um, and they can kick rocks as far as I'm concerned. Um I need really, I I I get very passionate about that because I just I've seen this medication help so many people get their lives back. Um, I've seen it just be such a godsend for people, and it just works well and at such a low risk compared to the lifestyles they were living before. And, you know, it it helps people get financially back on their feet. Medicaid covers Suboxone products really well, it covers sublocate, so there's no cost. So we go from spending all this money on substances to now we have this this cost covered and we can reallocate that money elsewhere to housing and transportation and food for ourselves and just getting our lives back. So, you know, if you um stigmatize people and you're listening and you're you judge them because they're taking a medication that has saved their life, then I mean, honestly, you can kick rocks too.

SPEAKER_03 26:04

Yeah, because this is, you know, honestly, anyone can become addicted at at any point. You know, it's it's not just a certain population of people, it can be anybody.

SPEAKER_01 26:14

Yeah, I think people in their mind when they think of like a drug user, so I definitely prefer the term a person with a substance use disorder because again, this is a disease process, but we're gonna we're gonna take it there for a minute. When you think of someone who is a drug user, we think of a specific population. I'm here to tell you that I have treated everyone in all walks of life. Um, I have treated people that go to church with you, that work in your churches with you, that work in government facilities with you, that work in medical facilities with you, that you would have no idea looking at them that they have a substance use disorder. Um, either one of us on this call could have dealt with a substance use disorder at some point in our life. So I really just encourage you to stop judging who you think is using drugs, because I promise you that there are people in your life that have used drugs or are struggling with with substance use right now, and you have no idea.

unknown 27:02

Yeah.

SPEAKER_01 27:03

You don't know. So um definitely don't let that be something that you use against people.

SPEAKER_03 27:09

Yeah. It is very much a hidden condition, disease. Unless it becomes violent or whatever, sometimes we don't think about it.

SPEAKER_01 27:16

It's ugly. I've said this a few times when we talk before like KFS 12 and stuff, but you don't see GoFundMe's for someone struggling with a drug addiction, right? We see them for a lot of other diseases, and that's wonderful. And I I really, really hate I'm gonna get on a soapbox here too. I see often on like social media and Facebook, well, why is Narcan free and my insulin is so much? That's not fair. Um, I agree that's not fair. Your insulin should be free too. But I don't think that we have to knock someone else struggling down to build ourselves up. I fully agree that I wish that medications were more affordable for so many things, but I don't think it's fair to think that someone is less deserving of treatment um because they don't have something that you deem worthy of a GoFundMe or of crowdsourcing or things like that. These medications save lives. Um and I think that just the same that you can get free Narchian, I think you should be able to get free insulin too. I don't even think that should be an argument. I to me that's it it's so frustrating. And it I type a lot of replies that I delete on social media, I will say that.

SPEAKER_03 28:20

We all kind of do that occasionally.

SPEAKER_01 28:22

Like, do they want to engage in this? Not today, but I just wish people understood that no one who has a substance use disorder wants to have a substance use disorder.

SPEAKER_03 28:30

Right.

SPEAKER_01 28:30

Like no one is choosing to do these things.

SPEAKER_03 28:32

No. Well, in in your position, as well as all of us here at River Health, at the end of the day, we want to do what's best for the patient. Absolutely. We want to make sure that everybody else is feeling the same way. And unfortunately, that does not happen. But what you're doing is really making a difference for the folks right here in our region and just being able to talk about it and you bringing it to the forefront of saying, look, it's okay, it's all right. This is what you can do to take care of it. That's what's so important for the people right here, and you just gotta have to take that.

SPEAKER_01 29:03

I I appreciate that. I just, you know, for people listening who have struggled with this or are struggling with it now, it's a very isolating disease process. So I never want anyone to feel like they don't have anyone. Um, and it is very okay to set boundaries. So if you have someone in your life that's abusing drugs and you usually do end up having to set those boundaries. No, I'm not giving you more money. No, you can't stay here and sleep tonight. Um, that doesn't make you a bad person. That's okay. That is completely okay. I'm not saying that. I'm not saying to just let them do what they're doing and and hurt you. Boundaries are not putting up a wall. Boundaries are putting up a wall with a door. And if you have to close that door, it can't be open right now. That's fine. That is completely okay. But that ends in a situation where people hit rock bottom, and sometimes that's what it takes. A lot of times that's what it takes is for your you to hit your rock bottom to reach out and get help. But that's where I want you to know that like I'm here. I'm here, you know, our other providers at World Health. We have 11 prescribers for MAT. Like, we're here if you're at rock bottom, or even if you've started to pick yourself up, or even if you've been in recovery for 20 years and you're just struggling right now because it's tough out there. Um, we're here. And of course the program has limitations and you know, we can't always save everyone. Um, but if you slip up and and you're listening and you've been in the program before and you're like, oh, I I did it, I tried it and it didn't work, try it again. Come on back. We're here, we're still here. Um, we generally have a 90-day re-entry, but that's not always, you know, that's not written in black and white. Um everyone has different stories and different reasons that they left the program. So reach out to Allie Brown for sure and talk to us. But just know that, you know, even if you just need someone to talk to, like we're we're definitely here to listen. We'll listen and we'll let you vent. And I can't always promise to fix it, but we'll try.

SPEAKER_03 30:44

Well, you know this program falls under here at Rural Health as a behavioral health program. But we also need to look at it as a medical program because you know, this affects the individual in a lot of different ways. It might affect how they're eating, how they're sleeping, how they're anything at all. It affects them all around. So if you knew somebody that needed medical help, you would do all that you could to make sure they got medical help. Why not do that with this? I agree. And so, yeah, we just want people to know that they can be open and honest about it, they can talk about it. It's not something that you have to hide in the shadows.

SPEAKER_01 31:24

Get out there and make sure something you also don't have to choose. So we can, you know, if you're coming in and you're struggling with substance use and we need to get you in the MAP program, we can also introduce you to our primary care providers as well and work on that medical side of things too, or the behavioral health side. Often people have co-occurring disorders, so you might be coming in with a significant mental health history, you know, history of schizophrenia or bipolar, depression, anxiety, whatever it is, um, and a substance use disorder. We can hook you up with those services too. So, you know, we have behavioral health at four of our five offices, we have primary care at all five of our offices, um, we have dental at two of our offices, soon to be three. So we have all of these other wraparound services that can be really needed, especially in the substance use population. Um, but you have to be the one to reach out. We can't do that part for you.

SPEAKER_03 32:08

Exactly. Okay, um, real quick, Erica, let's talk about where, once again, where folks can get help as far as the helpline and how they can reach us here at Rural Health.

SPEAKER_01 32:19

Yep. So if you are interested in rural health services, you can give us a call. Um, Ali Brown is who you're going to want to talk to for the MAT program. So you can call any of our offices and ask for Allie Brown. They will transfer you to her. Uh, she's very busy, so sometimes you have to leave a voicemail, but she will call you back. So if you get her voicemail, don't be discouraged. Please just leave her voicemail. I promise you, she will call you back. Um, sometimes Olivia Hand will reach out as well. She works with Allie. Um, so that is one way to get in touch with World Health. You can walk into any of the offices and say, hey, I really need to set up an appointment with Allie to talk about the MAT program and they will get that set up for you. Um and that that can happen at any office. That doesn't have to be in Anna. So if you are down here in Metropolis listening, you can walk in and say, Hey Brandy, I really need to set up an appointment with Allie to talk about the MAT program, and she'll get you in touch with Allie and we'll get you on the schedule. Um, if you are not in our our service area or you're too far away from us, reach out to your FQHCs in the same way. Um, you can use the helpline, which I'll give you that number again. It's 833-657-7147. Or you can text help to 833-234. Um, or you can go to their website, helplineil.org. You can Google that. They have a chat feature. You can call or text them through your browser if you don't have cell phone minutes. Um, so that is a really good option to get you set up with a bridge prescription if they find that that is safe for you and to get you in with a prescriber because they can connect you to someone. Um, we do have some other really good resources. So one of my favorites is a group called Live for Lolly. I'm gonna pull their website up real quick to make sure I give you the right website here.

SPEAKER_03 33:44

Yeah.

SPEAKER_01 33:44

So it is Live, so the word live, L-I-V-E, the number four, and then Lolly, L-A-L-I.org. So Live for Lolly is a harm reduction, uh not profit not for profit, and they are absolutely wonderful. They can also help set you up with a prescriber, but one thing that they offer is harm reduction supplies. So if you're listening and you're at that point in your substance use disorder that you're not ready to recover yet, but you wish you had some of these harm reduction supplies, they actually have a link on their website. So if you go to resources and you go down to overdose prevention and harm reduction on their website, um, they have a lot of good resources on there, but they also have trying to find their. Let me look real quick. The perks of a podcast I can look up. Okay, it might be under programs actually. Harm reduction mobile outreach. Yes, okay. So if you go to the liveforlolly.org website and you go to the programs tab, there is one that says harm reduction mobile outreach. They do have a mobile outreach, but if you scroll down a little bit, you'll see that you can request a mail order delivery of supplies. Um, and these are harm reduction supplies. So this includes Narcan. Um, this includes clean syringes and needles. This includes smoking kits if you are using inhaled drugs, um, and also fentanyl test strips. So if I always think people should have these handy. If you are using a substance and you're not sure what you're using, I actually had gotten these to a friend who texted me at one point after about a month and said, I think you just saved my life. You know, I got these drugs and I wasn't sure about them. And I tested them and they were positive for fentanyl. So um fentanyl test strips, which unfortunately are illegal in a lot of states, which is wild to me. They're considered paraphernalia, but um, in Illinois they are not. So they will send you a package. It comes in a plain manila envelope, um, is very discreet. It's not going to say, oh, we have clean needles to shoot up in here or anything like that. It's just a manila envelope. Um, I did order some things from them once just to have a stash in the office for patients, and it came in about two days. It was, it's just a really cool service. Um, there's no charge for it. They do Narcan training if you request Narcan, so they will teach you through a video like how to use Narcan. Um, I like to remind people too, don't be ashamed to have Narcan on hand. I always have Narcan on hand because Narcan is not for yourself, it's for the people around you. If you are overdosing, you can't Narcan yourself because you're the one overdosing, right? Um, so there are a lot of reasons someone would need Narcan. Maybe you have someone in your life who's on pain medication, maybe it's an older person who isn't metabolizing it well or forgot that they took their morning medicine and took it again and now they're overdosing. Narcan will save their life if they're overdosing on opioids, and it will not hurt them if they're not. So if you ever, sorry, I have the hiccups. I'm trying to talk between hiccups. If you ever see um see someone who's unconscious and you happen to have Narcan on you, you are not going to hurt them by giving them Narcan. Just do it. Okay. Um, just just just use the Narcan. And it's a nasal spray, it's not difficult to give. You don't have to have any specific medical training, and it really just does save lives. So you can also get Narcan through that that not-for-profit as well.

SPEAKER_03 36:40

Yeah, the instructions for Narcan are right on the box. You can't mess it up.

SPEAKER_01 36:45

Super easy to use. Yeah. Yep. It can be a little temperature um intolerant, so you don't necessarily want to keep it in your car or anything like that. But even Narcan kept in your car is gonna be better than no Narcan.

SPEAKER_03 36:56

So do we still have Narcan at Roe Health? We used to have a bunch.

SPEAKER_01 37:00

We do. We do. I think we're looking for a new supplier right now to get some more, but I always have Narcan here if anyone needs some. We've done some Narcan outreaches, usually around August, I think. Um Ali will sometimes come down, we'll set up a table and do some Narcan outreaches. In Metropolis, um, we have MicDAC, which is our drug and abuse coalition, and they have a couple vending machines, like free Narcan vending machines. I know there's one in the laundromat, and there's one in one of the gas stations. The police department always has Narcan. Um, you can purchase Narcan at your pharmacy. So we have what's called like a like a standing prescription in the state of Illinois. So essentially, the I think it's attorney general, surgeons general of Illinois just puts out a broad script, meaning that you don't have to have a prescription for it, but you do have to pay for it if you do it that way. So, and it I think it's about$30,$30. So it's not super cheap. Um, you can get it free in other places.

SPEAKER_03 37:45

So Yeah, and it comes with a couple doses per box, so you're sitting.

SPEAKER_01 37:49

It does. I will tell you that the newer stuff on the streets, like some of the new um fentanyl strains specifically, require multiple doses. And if you ever have to use Narcane on someone, you need to immediately call 911 because Narcane wears off. It is a very short half-life. Um, it's gonna bring them back around and then it's gonna wear off. And a lot of times people need Narcane drips and need IV drips to get them through that overdose process. So please don't give someone Narcane and walk away from them because it's it's only gonna last a bit of time and then it is gonna wear off. Um, also, this is a very hot button topic, but I'm going to say it. Um, and you can edit out the podcast if you want to, Shauna. But you cannot overdose on something like fentanyl just by touching someone. So I have seen people or heard stories of people dying because people knew they were overdosing or were scared to touch them. So if there is fentanyl on that person's body, obviously avoid it. You know, if you know it's there, avoid it. But just powdered fentanyl in powdered form, you will not overdose on that. Now, if you have recently put hand sanitizer on your hands or you have really wet hands, then yes, there could be some absorption there and that might cause a problem. If you get right up on it and inhale it, like snort it into your nose, um, you're gonna get some in your mucosal you know, membranes there and you might overdose. But please, if you see someone that you think is overdosing, don't let your fear of that stop you from administering narcan, administering CPR if necessary, calling 911, even if it's just hand CPR and we're not gonna do mouth to mouth. I mean, ideally, you know, we still recommend the two breaths, but but even compressions are gonna be better than nothing. Um, please give the narcan. Please don't delay care. Just touching them is not going to cause you to overdose. Um, you know, if you just jumped out of a pool, please dry off, dry your body off. Don't take super wet hands or freshly hand-sanitized hands and then directly touch fentanyl powder or an unknown substance. But if you have dry hands, you are not going to overdose by touching powder fentanyl.

SPEAKER_03 39:45

Um, no, we're gonna leave that in. That's a good point. I I'm glad.

SPEAKER_01 39:49

It's a very contested. I know we see often um stories in the media. I know there's a talk show host, John Oliver, who is very um contested. I mean, he's a very he's one of those that just has big opinions, but he did a wonderful special on it. And I think everyone should watch it, just talking about how, you know, we see these people, it's generally a panic attack. They're having a panic attack. This is not a true overdose. Um, often you won't even, I mean, you you don't see the drug in their system because they actually didn't get any of that drug. Yeah. Um, so please don't delay care to someone just because of that fear that touching them will then cause you to overdose, because most likely that is not going to happen.

SPEAKER_03 40:25

Well, and you bring up a good point. Yeah, there's a lot of misinformation out there. And if somebody has questions, ask. Yes, they can't.

SPEAKER_01 40:32

I'm happy to provide the data to support anything that I have said today. I've not said anything that cannot be supported by peer-reviewed sources and medical clinical data, not just Google. Um, I can I can always provide those to support anything I've said.

SPEAKER_03 40:47

Very good. Very good. All right. And listener, just for you, just so you know, we are going to be putting those um websites for the the liveforlolly.org and the Illinois helpline. I'm gonna put that in the description for the podcast today. So you should be able to grab that and and click on that. Should you need some help or you want to share that with others? We want to make sure that you have that as well. Um we have covered a lot today, Erica. Is there anything anything else you want to share?

SPEAKER_01 41:14

No, I think I I mean I really think that we hit the big things. This just my big takeaway here is if you're listening and you are struggling yourself or you know someone who is struggling, like don't be afraid to reach out. You're not gonna find judgment here. You know, I can't speak for for every person. I would hope that would be a similar experience everywhere, but um, I'm not judging you. I definitely want to help you. That might not look like what you think it should look like, but I definitely want to help you, so please reach out.

unknown 41:38

Okay.

SPEAKER_03 41:38

Well, thank you so much for taking time out of your very busy day with me today. You have been all over the place with us lately with with talking to people about Matt, and and we appreciate it. I appreciate all your help. I really do. Learn it a lot.

SPEAKER_01 41:52

I'll always talk about it.

SPEAKER_03 41:53

Oh, well, we'll have we'll do this again. We're gonna do this a few times a year just so we can keep it current.

SPEAKER_01 41:59

Perfect.

SPEAKER_03 42:00

Well, listener, that's gonna wrap up this episode of your rural health connection. We hope you enjoyed it just as much as we did bringing it to you. We are inviting you to listen to all of our podcasts. We're gonna have much more coming soon and more ways for you to listen. Uh, this episode can also be viewed on our YouTube channel at Rural Health Inc. And uh tell you what, if you're wanting more information about Rural Health Incorporated and the many services that we provide, just give us a call right here at 618-833-4471. Again, that's 618-833-4471. You can also visit us online at ruralhealthinc.org and make sure to follow us on Facebook and Instagram to stay current on even more things taking place throughout our region. From all of us here at Rural Health Incorporated, thanks again for listening. We hope you have a wonderful day.