Mobilizing Against Addiction: Local Efforts Address the Opioid Crisis

0:00:16 William Moyers
Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues related to substance use prevention, research, treatment, and recovery from addiction to alcohol and other drugs. My name is William Moyers, I'm your host and I've been with the organization for 23 years. But before that I was a patient, both in 1989 and again in 1991. Hazelden Betty Ford is known as being a provider of addiction treatment and of course that is what our bread and butter has been for a long time. But the organization is much larger than that in its mission and joining me today is Jordan Hanson. Jordan really is not only the face of a lot of the other things we do in the organization, but you're down in the trenches doing those things. Talk a little bit about our consultation services and the services we provide.

0:01:05 Jordan Hanson
So our consultation and training department has been in 20 states over the past year. We are, you know, really day-to-day invested in communities and organizations and in—individuals. And so our response lately has been directed mostly towards the opioid crisis and yet at the same time it's, you know, our hope is to—to help people heal from addiction in general.

0:01:28 William Moyers
And you're seeing that problem not just in the law enforcement community or the criminal justice community but in ERs of hospitals and then overall in communities particularly rural communities. Talk about the problem in each of those three areas.

0:01:44 Jordan Hanson
Yeah. So when we think about people who have diagnosis of opioid use disorder, if you think about overdose, if we think about the health conditions that people often suffer from, we're seeing a tremendous amount of suffering in the community at large. But the places that it shows up most visibly are often emergency departments of people who have suffered an overdose or they have a comorbid health condition. We see it in overtaxed judicial systems in courts and community supervision. And then we're starting to see places where they don't have care. So if we look at a rural community often times, well essentially people are suffering what is often an invisible sort of crisis of their own.

0:02:29 William Moyers
So what is it exactly that we at Hazelden Betty Ford are bringing to these institutions and to these communities?

0:02:38 Jordan Hanson
What we're bringing is an integrated care model that is as effective in an emergency department as it is in a correctional setting or a community supervision setting. And really it's a model of evidence-based practice as it relates to medical care. Including medication-assisted treatment, evidence-based practices for clinical services and case management. And then the third component is peer support. And so this—this fusion between these three things is in many ways intuitive, but for anyone who's worked in this field for very long we kind of live the difficulties of having these three pieces align in a way that makes sense and is culturally specific for each community.

0:03:19 William Moyers
So on that note, I found recovery in Atlanta, Georgia in 1994. Grady Hospital is right there, it's always been known as the public hospital of Atlanta, and really the public hospital of Georgia I think, it seems like, and/or the largest one at least. And it was always known as the place where people who couldn't afford medical care would go. So what is happening in Grady Hospital as it relates both to the problems caused by substances and the solution that you're helping them with?

0:03:49 Jordan Hanson
Yeah. So Grady Hospital and Emory and Morehouse Universities have banded together to start a program to help people at the point of contact the place they need it most. And so—

0:04:00 William Moyers
In the ER?

0:04:01 Jordan Hanson
In the emergency department. So, when I first visited the emergency department at Grady Hospital it's newer, beautiful, you know, 35/40-bed emergency department. Huge inner city safety net hospital, you know. They were full the day I visited, there's folks hanging out in the hallway. But what we saw was a program that got people the help as quickly as possible when they needed it the most. As we all probably know, folks who are suffering from substance use disorders, the window of opportunity is often very short. And so really what they’re doing is capitalizing on adverse health consequences including an overdose to really start treatment. And we're seeing tremendous results. This is the type of program that if it were present in every hospital in the country, we would put a major dent in the crisis tomorrow. And this is what gets us excited and why we're investing so heavily in these types of pilot projects. How do we build something that’s scalable and that can be replicated in basically any community in the country?

0:05:07 William Moyers
So from Grady Hospital in Atlanta to a rural jail community in Kentucky, talk about what's happening there.

0:05:18 Jordan Hanson
So the crisis is the way I describe it is hype—hyper local. So if you have a county in say, you know, let's just pick Kentucky, we do a tremendous amount of work in Kentucky. If you look in the far eastern side in the Appalachian kind of foothills in the mountains in Prestonsburg and small towns like that, the crisis looks very different than it might, you know, in Lexington or Louisville. But the solution at least we have a framework that’s similar. And so bringing those three components might look different in each community, but it's found—we found that to be effective. So for example, we're working with the Kenton County Detention Center in Northern Kentucky, it's just across the river from Cincinnati, and what we're doing is working to bring medication-assisted treatment into the jail setting in a way that's safe and it's also part of a holistic treatment approach that continues post-release.

0:06:12 William Moyers
So then it's not just the use of medication like Suboxone or Vivitrol but it's that holistic, Twelve Step approach that has always been at the cornerstone of what we do—

0:06:20 Jordan Hanson
Right.

0:06:21 William Moyers
—at Hazelden Betty Ford.

0:06:22 Jordan Hanson
Yeah. And this is something that is, I mean when we went to visit Kenton County Detention Center you walk into what appears to be an average sort of cell block. There's 50 guys in there, and they've created a therapeutic community in which recovery is thriving. And their leaders have kind of come to the same conclusion that we did, you know, early 2012 I think it was when we decided, you know, what—we need to look at all the options that we have. And so they have this—this population that's at tremendous risk. And they said, look, we're not gonna abandon recovery and we're not gonna abandon, you know, what we know works clinically. But what we need to include is—is the utilization of this medication. And so it's really a pretty impressive treatment approach. And I think it again much like Grady Hospital if this were present in every large county jail, I think we would see recidivism drop, I think we'd see recovery rates, you know, rise and I think we'd also see costs, you know, plummet. And so this is again one of the things we're trying to do is have these pilots that demonstrate efficacy and can be replicated.

0:07:28 William Moyers
Then there's the third component which is the community at large and I know that a lot of what communities have been thirsting for is good information. Talk about how we have connected to some of these communities.

0:07:43 Jordan Hanson
So communities often approach us in a state of crisis. Sometimes a state of panic. It's—it's—this is the type of crisis like it—along with being hyper local, it moves very quickly.

0:07:55 William Moyers
Mmm.

0:07:56 Jordan Hanson
And so, you know a wave of Fentanyl or other, you know really, really potent opioids will come through a community and often the devastation will occur in two days. And you'll see, you know, 20 overdose deaths. So people come to us and they—and they're looking for a solution and often times, the first thing that we do is convene a—a group of stakeholders. And to me that's—that's anybody who cares about their community. This isn't about drugs. This is about people and working together to find a solution. And this is one thing that, you know, I think it's consistent with Hazelden Betty Ford throughout the years is we bring the best of science and the best of these wisdom traditions. And it's not a zero sum game, it's not mutually exclusive. How can we bring the best of both of these approaches to effect change? And so creating a space where everyone's welcome, and we can all learn together and we can all try together and mess up together but really establishing kind of a you know planting a flag saying this is—this is our community we're gonna do something about this.

0:08:59 William Moyers
And what are the results I mean—you know we've known about the problems of addiction to alcohol and other drugs forever, I mean for centuries. William White chronicled that in Slaying the Dragon, which a lot of us find is our Bible in terms of the history of—of addiction and treatment and recovery. Do you feel like you're making a difference? What do you—how do you see that? How do you measure that?

0:09:22 Jordan Hanson
There's a lot of ways to—to measure that. There's lots of ways to look at data. One of the things with William White, you know, he talks about the story is data. So anecdotes and testimony and that's a really immediate response that we use to gauge our success. But sometimes more importantly what we need is long-term research data. And what we found is one of the first communities that we started working in St. Elizabeth's Healthcare System in Kentucky. We were at a meeting, well we were actually doing a training with some of their clinicians, and they released their new data as it related to admissions and overdoses. And they found a significant reduction in overdoses. And this is the first time in, you know six—six years that we've been working with them that this has occurred. And, you know, there were, I'm getting kinda choked up thinking about, there were tears. 'Cause you have people that are working day in, day out, nights, weekends, shoulder to the wheel trying to make a difference and we finally are starting to see results. And I think this is—this is the power of a community that's united in an approach. It doesn't mean that we all have to believe the same things or work the same way, but if we can work together, we can make a difference.

0:10:36 William Moyers
How do you balance the realities of technology in addressing these issues with that human touch that is so important, the one that gets you teared up?

0:10:47 Jordan Hanson
Yeah. This is the balance that I think we need to strike if we're gonna change the way that we approach this. Is that we can no longer afford to rely entirely on anecdotes or—or stories. As powerful as the stories of personal redemption or recovery are, equally powerful are—are large-scale data projects. And so we're bringing in, you know, big data partners. We're bringing in tech partners and we're bringing in third party academic institutions working with the University of Kentucky, working with Emory University, to try to capture the small scale successes and—and see if that's representative of what's going on in the community.

0:11:25 William Moyers
We have about a minute left. I wanna just, to end if we could, on that note by asking you do you—'cause I know your story—do you—how do you use your own journey to to affect the people that you're working with in the jail in Kentucky or in the ER at Grady?

0:11:46 Jordan Hanson
In my personal recovery, I'm in long-term recovery, for me that means it's been about ten years since I found it necessary to use alcohol or other drugs. And the thing that is constant is change. And you know some of the—the touchstones for me are, you know, more will be revealed. And sometimes I don't know what that is and what's coming. [Moyers chuckles] And lots of times I don't enjoy it. But the idea of resting on our laurels and the successes that we may have had previously and saying, you know, what this is good enough, I don't feel like that's acceptable. And so what we're faced with is—is how do we stay true to who we are and allow for change and improvement? And that's a, it's been an invigorating sort of process for me at least.

0:12:30 William Moyers
Well as a fellow traveler and a colleague at Hazelden Betty Ford I sure appreciate not only your personal experience and your passion but your professional expertise and the way you've used all of that package to change the lives of people from coast to coast. Thank you, Jordan Hanson for joining us today.

0:12:47 Jordan Hanson
Thanks, William.

0:12:47 William Moyers
Thanks all of you for joining us for another edition of Let's Talk, a series of podcasts on the issues that matter to the Hazelden Betty Ford Foundation, and of course the issue that matters to us as our viewers and our listeners. On behalf of our executive producer Lisa Stangl, I'm William Moyers. We hope you will join us again for another podcast of Let's Talk.