How a Small Town Community at the Epicenter of the Opioid Crisis has Become a Beacon of Recovery Nestled in a hollow in the heart of Appalachia—in the historic coal mining town of Hazard, Kentucky—a renovated Kmart store serves as recovery central to a population hit especially hard by the opioid epidemic. It's where family practitioner Morgan Birch, DO, and her colleagues at Primary Care Centers of Eastern Kentucky and Mountain Comprehensive Care Center welcome patients to the Pregnancy & Beyond clinic, a holistic health care program for families with addiction that is funded privately and through state and federal grants. As the name implies, Pregnancy & Beyond started out serving expectant moms and newborns, but the program has evolved out of compassion and necessity to meet the addiction treatment and recovery needs of the whole community. "We developed Pregnancy & Beyond as a harm-reduction initiative to provide prenatal care as early as possible, including medication-assisted treatment for women with opioid use disorders," Dr. Birch explains. "But many women who came through our program were returning home to significant others and family members who were actively using. We needed to help everyone in the home if we hoped to turn things around for the families we serve." The "beyond" part of Pregnancy & Beyond really took off when word got out that anyone and everyone in the community had a safe, nonjudgmental place to get help with addiction. "Almost from the start, our program has been at full capacity even though we've never advertised that we provide addiction care," Birch shares. "Patients just seem to find us." That doesn't mean walking through the clinic door is always easy. "There's still so much stigma associated with the disease of addiction," Birch comments. "We always tell our new patients they've already done the hardest part—by showing up." Pregnancy & Beyond stands as a model of care integration, or what addiction experts today call "recovery-oriented systems of care"—where behavioral health services are incorporated into the mainstream of health care, and community resources are leveraged to support addiction prevention, treatment and recovery. Partners from the Hazelden Betty Ford Foundation have worked alongside Birch and her colleagues at several junctures—instructing clinicians in evidence-based therapies, providing treatment curricula for patients and training peer coaches/recovery support specialists. "Peer support makes all the difference for my patients in early recovery," Birch attests. "It's easy for me, as a physician, to tell a patient what she needs to do, but to have someone who's walked in your shoes, who understands the everyday issues and challenges, who knows how recovery really works . . . well, that's everything. That's where healing happens." Birch also credits the greater Hazard, Kentucky, community with embracing the Pregnancy & Beyond program. "If a patient comes to me who hasn't been able to take a bath or wash her clothes or eat a healthy meal, we take care of those needs first, thanks in large part to this community. We have washers and dryers here, we have food boxes, we can help with finding shelter—because all of the research tells us that effective health care is about meeting patients where their needs are. Sometimes the most pressing need is a bath and place to sleep that night. After we see to those needs, we can get going on the patient's care plan." By design, much of that care happens under the same roof with integrated teams and what Birch likes to call "warm handoffs" across different types and levels of care, including family and adult medicine, behavioral health care, obstetrical services, prenatal and parenting education, pediatrics, dental care and pharmacy services. Birch sees family practice physicians as ideally situated to lead the way forward in integrated addiction care. "As primary care physicians, we get to know our patients and we understand their circumstances and concerns," she explains "And we can be there for our patients with resources and support before, during and after substance use treatment, as they learn how to manage a chronic disease."