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OPEN ACCESS, OPEN MIC WITH LYNN MADDEN
Episode 16th June 2022 • Open Access, Open Mic • Red Rock Branding
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CEO, Lynn Madden talks about the life changing and life saving work of the APT Foundation. The APT Foundation has been committed to the promotion of health and recovery since 1970.

www.aptfoundation.org

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Welcome to the latest episode of Open Access Open Mic, the podcast with the APT Foundation. The APT Foundation is here to help employers, communities, and families care for people who may be living with opioid or other substance use. Serving the Greater New Haven community through an evidence-based open access model.

since it was founded back in:

eatment since its founding in:

And voice for the provision of treatment for people, particularly those with opioid use disorders. Over the years, the foundation has grown to the point where we now serve about 8,000 unique persons every year with a very broad range of services. That includes, you know, primary care services, which are embedded in our substance use program so that our patients have access to great primary care.

We deliver vocational services. We have a residential program. That features a women's program, a men's program, and a great program for women and children. And we have five locations in the Greater New Haven, Connecticut area where we serve people who have substance use disorders and mental illness. And we use medications for opioid use disorder, particularly methadone and buprenorphine to a very large degree.

We are unique in that this is an A Walk-in access program and what that means is you can walk in five days a. Regardless of your ability to pay, we will give you a full assessment with licensed professionals and we will match you with treatment and offer you a treatment program that day if in fact you need one.

That sounds incredible. Now, I'm a Brit, as you can hear. I know a little bit about treatment that is available in the UK for this sort of thing, and it's rubbish. There's certainly very limited walk-in open access of this nature. Is that a common. Here in America or is apt quite unique in that? Yeah, APT is quite unique and really was on the forefront of thinking about walk-in access and what that really does to benefit people who are seeking treatment, particularly people who are seeking treatment for substance use disorders and where I'm excited to let you know that we're about to move to seven day a week.

Walk-in access. Wow. So here in the next couple of months, in June, we'll start with six days a week and we are hoping if we can staff it because it's been funded by the state of Connecticut, if we can staff it, we are gonna move to seven day a week open access. So that's really exciting. It's incredible.

That's absolutely incredible. That is life changing for so many people. I think it's really important to think about open access like this. People with substance use disorders by definition have difficulty hanging on to motivation. Their skills around being organized are not very good when they're using substances, right?

Because they're frontal lobes. Are actually compromised, so the brain is compromised. That's the definition, or one of the definitions of how we diagnose substance use disorders. So expecting somebody to make an appointment, keep that appointment off into the future, show up on time, bring all the proper things with them, like insurance card or other pieces of paper, and then come back again to receive services.

That doesn't work very well. And here in the. That means about 50% of appointments that are made for initial assessment are not kept. People don't come to their appointment. Absolutely. And what we do then is we blame it on the person. We say, oh, they're not ready. Right? So instead, what we did here is we flipped that upside down.

We said, what are we doing wrong? What could we be doing better? Is maybe another way to put it, what could we do better? How can we meet folks really where they are? Right? So if they just have a short window of motivat, Let's capitalize on that. Yeah. Come today, come tomorrow. You have that thought. The services are available.

It is literally a window of opportunity that you kind of have to grab because that window is, can be quite fleeting, you know? That's fantastic. Seven days a week. Incredible. Now you have been in the hot seat, but apt for some 16 years. Now you are the c e O. Can you tell me a little bit about your career today and how it kind of has evolved since you first got involved in the.

and mental healthcare back in:

Along the course of that, I became very attracted to the work and I. Must say that I became more and more aware of how difficult it is to navigate the system for people who have mental health and or substance use disorders in ways that are no longer difficult, at least in the United States, to navigate the system for other life-threatening.

Kinds of chronic illnesses. So there was a big gulf from my observation, right, between what it's really like to have one of these chronic illnesses and what the urgency is in providing you treatment. So I became more and more interested in that. I'm a real student of public policy. I have a doctoral degree in public policy and social change, and I began to really think about and analyze the policies that we were using as a state and or a nation.

Right, and thinking about how do these policies really illustrate or not how we feel about people with substance use disorders, how we actually treat them right? And a lot of them are relatively exclusionary. That's kind of a very short career trajectory. And one more thing, I think it's important to mention.

I had an opportunity. In:

Improving continuation in treatment, reducing treatment, NoShow, and increasing admissions. This became known as NEX or the NEX Foundation these days, right? Mm-hmm. . So it was funded by Robert Wood Johnson and the United States Center for Substance Abuse Treatment, and it was really predicated on the idea that most people who need treatment for a substance use disorder, Don't receive it.

Most people don't receive it. Fewer than 20% of people who need substance use treatment receive it in any given year. Wow. And they're dying. People are dying in droves. This kind of leads me on to my next question beautifully. It's almost as if you knew what I was gonna ask. Help me understand the scope of the problem.

You, we see the headlines, we see the billboards. Tell me a little bit about the scope of the problem in everyday terms that we can all understand. How frequently are people dying, potentially unnecessarily? How bad is this opioid crisis and what's the breakdown, I guess? Where are you seeing changes? You know, I've read a little bit about this, about how perhaps the younger end of the spectrum we're seeing some improvements, but you tell me you're.

Yeah, I mean, again, using data from the United States, there are about 20 million people, give or take, who have a diagnosable substance use disorder, and as I said, fewer than one quarter of them are able to navigate into treatment in any given year. Wow. When it comes to opioid use disorder, what we're seeing is an increasing and.

Death rate from opioid overdose. And some folks are pointing to this as a result of the introduction of both fentanyl and other kind of synthetic opioids into the marketplace. And while that's true, that's a relatively newer phenomenon over the last several years, this overdose death rate from opioids, it's been climbing for 20 years.

es, the c d C. Death data for:

Mm-hmm. . And as you point out, many of them are younger people, but opioids really are, you know, in the diagnostic spectrum across the lifespan of people for a whole variety of reasons. Opioids are particularly deadly, right? So you can drink alcohol for a long time and it might not kill you. Yep. Right. The same is not necessarily true for opioids and the supply of opioids.

It changes from time to time so people don't always know what they're taking. Mm-hmm. , there are not necessarily services to keep them safe in every community, like syringe service programs or you know, like syringe service programs and accessibility to Narcan or other kinds of ways that they might save their lives or prevent.

Do you think that's because people essentially don't know what they're buying? And do you think there was a difference when, I guess when the internet arrived? Have you seen a, an increase in that respect with people purchasing online and not knowing what they're buying? I mean, I think that's a hard question to answer and maybe I'm not the right person to answer that question.

I do think that there is an escalation in the availability of synthetic opioids, which are not hard to make, right. Synthetic opioids unfortunately are not hard to manufacture, but I think it's important to keep in mind that the opioid crisis is not new. Right. We've been, this crisis has been going on for some time now, and I would call it two decades where we've had a serious and growing problem with opioids.

Right? So not just heroin, which is where everyone's head goes when we first start talking about that, and heroin is still with us. And it's much more pure than it used to be. But we also have, you know, legally manufactured opioids, which are widely available or had been widely available in many places in this country on the streets and are highly addictive.

Mm-hmm. . In a community forum last fall, you referred to the overlapping of the pandemics of opioid use disorder and of course covid 19 as the global syeb. Can you talk to me a little bit about the concept of a syeb and how this affects your work and the people you serve? Absolutely. So a syndemic is a situation where you have more than one kind of health crisis on your hands, but also perhaps that is, that overlaps with some of the social determinants of health.

Such as potentially race or socioeconomic status. So what we see when we look at Covid 19, we look at opioid overdose and death. We look at the concurrent growing rates of hepatitis C. Viral Hepatitis and H I V, right? What you see is that this is a endemic that's very complicated. There's a Venn diagram that you can draw here, and there are some people who are affected by all four of these conditions.

We know that people who use substances regardless of the substance that they use, are more likely to acquire covid 19. So specifically to your question, they're more likely to have negative effects of Covid 19, such as being hospitalized. That number goes up if you happen to be a person of. Right. So you can see where these things overlap, right?

So the biggest driver in some parts of the country and in the world, so Eastern Europe and Central Asia is a good example of this. The biggest driver of the acquisition of H I V. In Eastern Europe and Central Asia is injection drug use. Most of that injection drug use is the injection of opioids or poppy shirka, as they call it, right in that part of the world.

But people are unaware. That is also the part of the world with it. We have the most rapidly escalating acquisition of H I V and death from H I V Wow. In Eastern Europe and Central Asia. So we're talking, you know, in other parts of the world about ending the H I V epidemic. Yeah, right. That's a big initiative right now, Uhhuh in the us but yet you have a huge swath of the world where there is great harm coming out of this pandemic.

Yeah. Right. Yeah. Related to the, how these illness states, if you will, are related to one another. Sure. And here in the US where you have pockets of H I V actually breaking out in places like West Virginia, which has the highest overdose death rate. In the United States from opioids, we're now seeing kind of a lagging indicator there some pockets of H I V infections that are breaking out.

Why? Because if you can't get into treatment for one, you usually don't get into treatment for the other. And vice versa. It sure you explain it so simply. I think you just need to walk to the White House and just say, listen, I've got a plan. I'm gonna take care of this. This is how we're gonna do it. Bang some heads together.

That's a very English phrase. The app Foundation website refers to your open access model. We've touched on that earlier. Tell me a little bit more. I mean, the seven days a week is gonna make a huge difference and people who are uninsured health is serious business in this country. Anybody can access your services at your open access walking clinics.

Is that correct? Yes. That's it. That's how it works. Absolutely. Anyone can, anyone can walk through the door. We will give that person a full evaluation with a licensed individual. And we will help them create a treatment plan. And if we have the kind of services that we need, and we generally do, we will offer those services the same day.

That's incredible. So if this service includes a medicine for, let's say for opioid use disorder, you'll receive the prescription that day or you'll receive the medicine that day, depending on which medication is actually prescribed for you. You'll also have a full physical with a licensed. You'll have blood work.

We do all of the things. So we try to get a whole picture of what's happening for you and then we, I call it negotiation. We sit down with you, which is what they do. We do in the rest of the healthcare universe. When we diagnose someone with a chronic illness and we say, Hey, this is what's going on with you.

Here are your choices. What do you think? , what are you really interested in? Because some people are not really interested yet in the full-blown services that might be in their very best interest, right? Mm-hmm. . But if they're offered something, my experience is, and the literature now suggests that if you offer them something, you make it clear that they're actually welcome here.

You are welcome here. We care about what's happening for you, as evidenced by we're gonna give you something today, or at least make an offer right now for you today. Then they're more likely to come back again. I love that partnership approach. I mean, that is really kind of, you're holding somebody's hand, you're not wrapping their knuckles, and you are guiding people on a path of where you'd, you know, hope for them to be in the future, but they're taking at their pace.

I like the carrot approach, I guess, isn't it? It's the carrot approach and that's really empowering for the person involved. For sure. So how easy is it to replicate this model? For me, it sounds incredible size. I am a Brit, so I'm not used to such a. I guess is the word I'm looking for, . How easy is it to replicate and where are other treatment sites starting to adopt this?

Open access? Don't think it's difficult to replicate, so the way that we were able to achieve open access here was really one step at a time. So this is an approach that comes out of engineering. Basically, you identify the barriers in facilitators and you systematically pick them off one step at a time until you get where you want to be.

, right? So we started out in:

That's a long, long time . So what do you think people do for those 26 days if they truly have a substance use disorder? I'll tell you what they do. They use. Right, because that is the nature of the disorder that they're actually trying to live with, right? So we did one thing at a time. We just tried to get timeliness down one step at a time.

So one of the first things we did is we changed the order of events. Cuz you have to have a physical, you had to have a test for tuberculosis at that time. You had to have a full-blown evaluation. Those took place on multiple. Over time, and they were all appointments, so we said, we're not gonna make any appointments.

Instead, what we're going to do is we're gonna do all of those things the first time you come in. Absolutely. Yep. Right. You might be here a little longer, so your day might be here a little longer and you might have to wait half of an hour because someone walked in before you, but by the end of the day, it's all done.

Yeah. And absolutely you're gonna get your medicine if you're a good candidate for. When it's taken advantage of that window of opportunity, that's a huge, huge improvement and OB to observe it and to fix that problem and move forward. I'll tell you the other thing, clear is it's very efficient. So one of the barriers that some of my colleagues across the country and in other countries cite is that, well, we wouldn't be able to pay for that because how do you staff to this, right?

Well, you, you stack to the volume that you actually see developing. So what you do is you commit to taking care of everyone who shows up. And you don't. I didn't know at first exactly how many people were gonna show up and how many staff we needed to take care of them. Right? So you just have to re-engineer your system a little at a time.

, at this point, we had about:

Those numbers, the. I gonna go work. I mean, I'd put good money on that. I have to be honest, I'm not betting person, but I would definitely put money on those numbers going up because it is about harnessing that motivation in that moment, that window of opportunity, and to be able to take care of all of the appointments, which are never gonna be kept.

In one sitting. Yeah, absolutely. That's the way to go. Incredible. Incredible is substance use. Getting in the way of your ability to partake in activities you once enjoyed or maintain any aspect of daily life, opioid or other substance use disorders can be treated safely and effectively. Reach out to your local treatment network through samh sa.gov.

Find treatment. That's S A M hsa.gov/find treatment to start medicine and begin your recovery, brought to you by the APT foundation.org. What does the a typical day look like? Because I mean, you are obviously now talking about opening on the Saturday and Sunday. You are going to have to assess the staffing requirements, the cost requirements, cuz there is gonna be a cost attached.

And I guess you'll regularly assess what staff you require based on the number of patients that are gonna turn up. What does a typical day look like in one of your clinics? Well, they're all different. So where people walk through the door is called the access center. We literally named it what it is.

It's the Access center at APT Foundation. Right. It has its own entrance. It's on a bus route. You can get off the bus 20 feet before the door and you can come inside. There's a cup of coffee for you. There's a glass of. There's a computer. You can sit and do Facebook if you'd like while you're waiting. Wow.

There's actually several computers. We have a spot we call the living room, which we've had to close down a little bit during the pandemic, but it has a TV in it. We have snacks that we pass out a couple times a day, and you just hang there until it's your turn. So you get there, you sign up. We have days when two or three people walk in.

I believe our record is that we've had 28 people walk in on one day. Wow. For evaluation. Goodness. May. Yes. Yes. And we see them. It's a busy day. Yes. In the same building. Now again, this grew over time. We've learned to stack our way into this over time, in the same building on a different floor, we have APT Foundation primary care services.

We see those people have their evaluation in the Access center. They go upstairs to the primary care program. They have a full physical. Again, they might wait for a few minutes because there's someone before them, and that's also a functional primary care program. We're seeing other patients or patients who are already established with us at the same time that you have your blood drawn as a patient because that's a requirement and it's good clinical practice anyway before medications are prescribed.

And then you go back downstairs if you're going to receive, let's say methadone treatment and you get a dose of methadone that. . So you literally receive methadone that day, or you receive a prescription and you might go off to the pharmacy and pick up buprenorphine with instructions about how to take it or to bring it back with you and let us observe you taking it.

So it's a pretty busy place. Mm-hmm. now simultaneously in that access center, so you have evaluation going on, you have outpatient services, which are all drop-in groups. . So there's a menu like going to a restaurant and you look at the menu and you decide what group is suitable for you and you go to it.

You can go to three groups if you'd like, cuz you're not having a very good day. Mm-hmm or you're bored today or it's cold outside. But the requirement is that you have to come at least once a month to a group cuz that's the regulatory standard. But we have people who come once a month cuz they're feel like they're doing fine.

We have people who come several times a. Right. So that's all happening in the same space with the same clinical team. Yep. And then you have methadone treatment services, including the dispensing of medicine also happening in that space. So the patients are not identified by diagnosis. There's also psychiatry services happening there.

So primary care, psychiatric care, methadone maintenance therapy. You have outpatient services and evaluation services all happening simultaneously. Multidisciplinary team. Doctors, licensed clinicians. Clinicians who are training, including residents and fellows, nursing staff, right? Vocational specialists, they're all in the same space, and the patients actually navigate the day.

There's a menu on the wall. They drop in and out of the groups that they wanna be in. And this is another thing that is relatively different, right? That most programs say, well, you need to go to have services with Claire because she's the best person for you. We actually let the clients decide that It's so empowering.

Getting off of the bus. By the way, it sounds like it's short of sending an Uber. You've done everything to encourage people to attend from the coffee, from the welcome, from the living room, to the multidisciplinary services that are available to then working with a professional to construct your own treatment plan, essentially.

That's fantastic. It's really empowering to, you know, to make decisions that suit their lifestyle. Cause there's not a one size fits all. That's incredible. I have matured into this over the years, you know, and I think about it a lot. Why does open access work, or what does it really mean? And you're really hitting on something that I think is important, right?

There is a generalized set of ideas that people with substance use disorders are not capable of making decisions in their own best. But I would suggest that they're not often faced with decisions that have choices that they appreciate. So my mom would say, listen, choosing between two bad choices is not a choice.

It's a dilemma, right? So if in fact you create a situation, Where whatever they select is okay and good and may add up to something great. Ultimately people will navigate that in general. So most people do very well. So we don't need to tell people what to do. We need to make available to them the options that actually promote their health and living with their substance use disorder.

I love it. I love it. It's like a breath of fresh air to me. Like I said, though, I am a foreigner. Question for you. Reading over the daily schedule for the clinical on Congress Ave, new Haven, we see open houses listed. What is someone likely to see and understand about you by attending an open house and are they open to the public?

Those are open houses for patients, right? So patients are in different places in their own treatment journey. So some of them might be new. Sometimes people always come at six o'clock in the morning, for example, because they have a job and they're not aware that we have other services that might be available to them.

So open houses are ways of. Promoting some of the uniqueness of the care continuum here at the App Foundation. The other thing we do in the open houses is really talk to people about what else they might like to receive for treatment. What are you interested in? Right? So we run the gamut. We have horticultural groups.

We have. Poetry groups. We have groups that are focused on trauma. We have groups that are focused on, you know, planning for being with your family over the holidays. It just all depends on what people are interested in. So they might come here and literally go to a We Fit group. Yeah. And where they're doing a bit of exercise and hopefully reducing their chronic pain that many of our patients actually live with this literal menu of service.

The menu is informed like it is in the rest of the universe and in the real restaurant world. You don't put things on the menu that no one buys. Absolutely. Yeah. Right. So it's a consumer informed model, if you will. Mm-hmm. in the true sense of treating the person with the substance use disorder. As a consumer, what do you want?

Yeah. And how can we help you get there? How do you manage that? How do you canvas, I guess, opinion on. People would like, you know, and, and how do you find new ideas to try and see if the take up rate is high? Give me the simple answer as we ask them. Right. So they're straightforward kind of answers.

They're, they literally survey this basis. Yeah. Well, I call it focus group on the fly. The pandemic has interrupted some of these kinds of things, although we are regrouping now, but we had a good more than a decade prior to the pandemic. We would put out small surveys that say things like, what's going well for you here?

What could go better? What's it really like to be you? Sort of thing. And then we track group attendants. So the groups happen throughout the day. People can select into a group. If we have a group that only two people ever go to, we say, let's think about something else. Now, the other thing I really wanna be clear about here is the staff are incredible.

So people who work in this kind of model really come to embrace it, right? It's not how most people were trained, and they come up with ideas. You know, because they learn their about their patients in wholly different ways. By seeing them navigate this kind of approach, seeing different people every day, as opposed to just your own quote caseload, right?

They see people at different phases of recovery. Yeah, because some of the people are new and some of them been hanging around for a while, so the staff become just a key ingredient in terms of, you know, keeping everything fresh and being that flexible to accommodate. And you wanna do that. You think that's a good idea.

Fabulous. And then facilitating it. Yeah. No two days are gonna be the same for your clinicians. That's for sure. They're not. And we did do some interviews of our clinicians a couple of years ago now. We just published a paper where we interviewed our counselors and clinicians literally on how they experienced this open access model.

Right. So this was a peer-reviewed, published paper, I'm happy to say. And the purpose of doing it is, Was really to be sure that we were developing our clinical teams in the right way, that we could sustain and hold up this set of open access ideas to understand whether people liked their jobs or not in this environment, because it's so important to like your job.

And what we learned is that they could come up with a few, you know, sort of negative thoughts about open access, but they came up with about 10. That number of positive views regarding open access, right? And we then feed that back to the staff here, and that engenders some conversation about where we're going next.

Amazing. Okay, so open access sounds fantastic. Saved lives. Accessibility, flexibility, just incredible. What isn't working. In the world of substance misuse and mental illness, what puts fire in your belly and gets Lynn Madden mad? . What? What keeps me, what keeps me up at night? Honestly, yes, that's what I want.

We wanted to scale up substance use treatment in a meaningful way. We would, we are putting so many resources toward the provision of substance use treatment in this country and in other countries. If we wanted to scale up. Which isn't neat, it's kind of messy. If we really wanted to scale up treatment, we would do it.

And what that says to me is that there remains a kind of cultural disdain for the person that becomes addicted to substances and that different substances have, I think, different levels of stigma. And opioids, and particularly injecting drugs has a very high level of stigma, right? So there remains this narrative, which may be somewhat underground, that people have brought this on themselves, or that somehow they deserve the consequences of their behaviors.

We do not have this narrative. when it comes to things like diabetes or chronic obstructive pulmonary disorder, right? Yeah. Even though, or lung cancer. Mm-hmm. , even though these illnesses which are chronic and difficult and often deadly illnesses, even though they may have been jumpstarted by behaviors, we hold onto that really for substance use disorders and particularly for illegal substance use.

Mm-hmm. , keeping in mind that both alcohol and tobacco are legal. Yep. They carry less stigma. Yep. Even though they cause more deaths in the world. No. The use of tobacco is the leading cause of death in the. Yep. Right. But there's nowhere near the level of stigma attached to that, that there is attached to the use of illicit drugs, and particularly, again, I would say opioids.

So if we wanted to change this, if we really had the political will to change it, we would do it. Now, I see some movement in that direction, but I have a hard time just looking at the data that came out just recently, and 107,000 people have died just in this country in one. From opioid overdose, many of which are preventable.

We passed the 1 million mark of deaths from opioid overdose in in this country with this most recent reporting. Keep in mind that every death from opioids is attended by 30 non-fatal opioid overdoses. Wow, 30. So multiply that 1 million number by 30 and you get 30 million people who are ODing, and then of course, being a drain on society and on facilities and service.

When if we put the money in the first place into potentially an open access model, we may have alleviated that pressure. So, I mean, I think it's hard to necessarily prove a negative, but I can say that, you know, of the opioid deaths that happened in the state of Connecticut in the last year, fewer than 10 of those people were enrolled in treatment at the time of their.

the numbers? Um, about about:

Right. It's not that nothing else works, it's that if you really want high numbers from an effective point of view, you have to take a medication. Yeah. Such as methadone or buprenorphine. Yeah. What we can say is that entering treatment, With one of those medicines means that you are less likely to die of overdose in your lifetime, even if you don't stay in treatment, and you are less likely to die of any other cause than you are if you are an untreated person who's addicted to opioids.

Why do you think that is? Is that because you are opening a, a door if you like that there's a possibility that it doesn't always have to be like this. You mean there's the old myth, isn't it? Once an addict to always an addict, it's not true. I think it's a kind of provocative question, but the reason I think it is honestly, is that people enter treatment for reasons of their own, and those reasons don't necessarily go away.

We've created kind of a difficult situation for people because we have this, what I call one and done idea. I enter treatment, I'm fine. Everything's gonna be like this, you know, straight road with the magic pill, woo, everything, right, , and that's just not true. The reality is that most people. Have to enter treatment between five and seven times before they gain a one year period of non-opioid use.

That's about the same with tobacco use by the way. You know, there's a lot of data that's out there that suggests that the rate of relapse to your previous behaviors in a chronic disease model is about the same among people with diabetes as it is among people with substance use disorders, for example.

Yeah, highly stigmatized relapse. When in fact we could normalize it. Geez, that must be so hard. We say to our friends who are trying to quit smoking. I tried one time and it was, you know, we have a lot of empathy for that. We have less cultural empathy for people who admit that they have a substance use disorder and then relapse to substance use.

Absolutely right. They're bad people. They weren't ready. , they chose this path. All of that kind of narrative. So I think if you enter substance use treatment and people are nice to you, and the literature would suggest that you enter an evidence-based treatment like opioid agonist therapy with one of these medicines we've been talking about.

Mm-hmm. , and you get the right dose, that's a predictor of coming back into treatment. Mm-hmm. and. You tell people, look, if you relapse, which most people really do come back tomorrow. Yep. No. What would happen then? What if we really welcomed them and like we do with people who are diabetic, who have DI living with diabetes, right?

You say to them, if your blood sugar gets over this number, call me. Yeah, right? Measure your blood sugar. Make sure that you give us a call. If this happens, oh, what have you been eating? You better take a better care of yourself and here's a couple ways you could do that. We could do the same. And I think we need to, it's just the stigma.

The stigma is killing people. Your zip code kills you. At least zip code is an American term, but your region or your state or your municipality Yeah. Is because there's so much local control. Yes. Over the laws and regulations that have to do with the provision of treatment for substance use disorder, again, in ways that are not commonly played out for the treatment of other chronic illness.

Yeah, no, I'm, I'm fortunately familiar with it. We call it the postcode lottery in the uk. You know, is this drug gonna be approved or not? It depends on my local authority, so it's not ideal. So in public remarks, you have framed access to medication for opioid use disorder as an issue of social justice.

Explain how you see those connections between kind of social justice and public health, and what does that mean on a practical level for people reaching out for. I think it's an issue of social justice, that access to treatment for all healthcare needs is an issue of social justice. When you get into the provision of care for chronic disorders, including substance use disorders, the people who manifest these disorders have.

Some of the social determinants of health going hand in hand with their propensity to manifest. For example, if you live in a community of lower socioeconomic status, then you are more likely to develop a chronic illness including a substance use disorder. Even though perhaps at least in, again, in this country, people of color use substances at a lower.

Right. They have a higher propensity for actually developing the disorder and a lower propensity for being able to access care. So it's hard to disentangle that, isn't it? If you access treatment earlier in your life, would you have developed this disorder or not? Maybe not. Yes. Yeah. Right. It's chicken and egg.

Yes. It's like diagnosing a cancer early, you know, intervention. Could it, you know, potentially save your life? Yeah, it could, but we actually know it does. Yeah. And then the other, the other piece that I, that I want to put out there is that when you become diagnosed with this substance use disorder, you in the eyes of many cultures, you become your d.

You are a disposable person in some cultures or you're not a person to be prioritized if the resources are rare, right? So when a resource tight environment, a person with a substance use disorder goes down the priority list, despite the fact that they're actually not their disorder, they're just a person, but they become their diagnosis in a way that, again, is not as p.

In the management of other chronic illnesses? Definitely not. It's outrageous, you know, just thinking I instantly, my head went to organ donation. Instantly, you know, because there's gonna be a list of questions of you, this, this, this, and this. You know? And less than a human. What a horrible thought. Lynn, it's been so fun talking to you today.

I think we should do it again. Let's do it every week. Let's put fire in your belly. I want gonna do topic of the week. With Lynn, we're gonna change the world. One podcast at a time. I hope. Thank colleagues, Claire, that would be lovely for you to talk with. Let's do it. Let's do it. It's been such a privilege to learn more about what you're doing.

It can't be easy when you're permanently fighting a wall of stigma and incredible challenges. But what you're doing on at grassroots level for ordinary folk who are just looking for professional care is outstanding. It's, uh, to be commended truly. I'm so impressed. I knew a little bit about you. I now know a little bit more as do our listeners.

So Lynn, thank you so much for your time today. I'm being a part of Open Access, open Mic. Thank you so much, Claire. And again, I wanna emphasize no one does this alone. We have a tremendous and terrific staff here at the App Foundation. Thank you for taking the time to listen to this episode of Open Access Open Mic with the APT found.

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