Archways' Threads

Narrator 00:02
Welcome to Archways' Threads, a show focusing on the threads of family and recovery support services that help make up the tapestry of life in recovery. Join us as we share stories from peers and participants in the field and practice of peer recovery support and family support and strengthening. And now your host, Archways' CEO, Michelle Lennon.

Michelle Lennon 00:25
Hey everyone: Michelle Lennon here, host of the Archways' Threads podcast, and we are continuing our conversation with Carina Raya, and we hope that you have listened to the earlier episode and enjoy the rest of the series with her. Thank you.

Michelle Lennon 00:44
But you know, the DEA agent that spoke at a prevention conference that I was at recently had shared like--the overdose death rates in the United States right now, it's like 911 happening every two days, and we barely talk about it. And we're pulling that funding right now, and it's like I said, as an independent I'm like, we've got to get along to have solutions. And I love like what you were saying, like, this is about being solution-focused, sharing your story with a purpose, and it's not about pushing an agenda other than to let's make things better for people.

Carina Raya 01:21
Yeah, that's my agenda, and I'm gonna keep pushing it.

Michelle Lennon 01:23
Yeah. You go, right?

Carina Raya 01:25
I'm glad that you brought up the statistic, though, so how overdose rates have gone down. And, you know, being a data-focused person, you know, I've recently written like a 50-page grant proposal for a school, and I had to look into a lot of information about OnPoint in New York City.

Michelle Lennon 01:46
Oh, yes?

Carina Raya 01:47
Yeah, so...

Michelle Lennon 01:48
Sam Rivera's place.

Carina Raya 01:50
Yeah, if I could meet him, I would be so happy. You watched this, hey! Hello!

Michelle Lennon 01:55
I'll put it in the video.

Carina Raya 01:56
Yeah. So learning, you know, the overdose rates went down, and that's because of harm-reduction programming.

Michelle Lennon 02:05
Yeah.

Carina Raya 02:05
Like, that is what it is attributed to, because we started giving people Narcan, and there are syringe services programs. I mean, don't even get me started about syringe services programs. So I was 18. I had never done heroin before in my entire life. I did not know how to know whether a syringe was clean or used or like whatever. Like I had probably never even seen a syringe in my life. Literally, the first time I ever used heroin, and somebody had a single-wrap syringe, which like, "Duh, you can like put it back in the package." But I was 18. It didn't occur to me. I didn't know people, like, lied or anything that, either. So this person who I knew had hepatitis, and he knew I knew, so he was like, "Cool, this one's a good, new syringe." He just like gave me my first shot of heroin. Literally got hepatitis the first time I ever did. Okay. So, and it's like, it blows my mind, you know, like--back in my day, you couldn't go to a pharmacy even...

Michelle Lennon 02:22
Wow, wow.

Michelle Lennon 02:38
Yeah.

Carina Raya 02:38
And buy syringes.

Michelle Lennon 02:46
Yeah.

Carina Raya 02:48
Like people had to reuse them, because there was no other option. And like, when people complain about, say, "Oh, if they don't give people syringes, they won't use drugs." Well, I think that's just the most ignorant thing I've ever heard. But I remember another great public health program, that probably does not exist today, is there was a telehealth thing where if you had hepatitis and you had gotten it genotyped, you could have a telehealth appointment--before Zoom--you just call the phone. And somebody was like, "Oh, you have Hep C, great. I'm going to send you Mavyret, and then you're going to call me every like, I don't know, maybe three weeks or something, until you're finished with it. You're gonna get a blood test and tell me how it goes." I didn't have to pay. Like it was awesome, and I didn't have hepatitis after having it for 10 years.

Carina Raya 03:55
Yeah, public health programs. Gotta have them.

Michelle Lennon 03:59
Yeah, because people don't realize--like, I think about the, I go back to the access. So for us, it was a community healthcare worker's salary basically, that was on that particular funding source. And this particular individual also does alternative peer groups. So I want to say like, we worked out our funding issues so that she did not lose her job, you know, but we could have been in a different boat, you know. And many centers are in a different boat, where they, you know, don't have any other rabbits to pull out of their hat, you know. But you know, she works with like alternative peer groups, which are youth. And she does some individual casework, you know, working with individuals in recovery. And I think about, you know, if--for just one position that you know, cost maybe fifty to sixty thousand a year to support, right? And the funding we were getting from the healthcare disparities grant was like $41,000, so we patched her job together basically with multiple funding sources. And you know, when I think about the idea of getting rid of that position, to me it's crazy to think it's saving money, because if we avoid one arrest by one, you know, of one of those youths, if we avoid one hospitalization, one emergency room visit, one overdose, one case of hepatitis, you know, like it pays for it, ten times over in some cases.

Carina Raya 05:25
Is there any chance that I can--I brought my computer with me, and I wrote literally the numbers how much New Hampshire can save in emergency department visits.

Michelle Lennon 05:36
Oh, yeah. Yeah, Carina has some pretty startling statistics as part of the research she's done as a student. So you want to share some of the statistics?

Carina Raya 05:44
Yeah, yeah. So you mentioned, you know, when we take away somebody's salary, we think we're saving money, or when we take away like a grant for a program, we think we're saving money. But that doesn't fully think through the entire chain of events from, you know, the beginning to the end of somebody going through treatment. So, let's see. Estimates from Premier, Inc., the healthcare improvement company known to collaborate with HHS, state that an opioid-related emergency visit costs $1,264 per person, and when the patient gets admitted, so with complications like an infection or whatever, the costs rise to $15,763. So in Hillsborough County, that means you're looking at around $1.3 million in opioid-related emergency department visits alone every year, and that number jumps to a staggering $15.8 million if each patient were to get admitted with complications. So that means just in Hillsborough County with the number of opioid-related emergency department visits that are reported through the New Hampshire opioid dashboard database--or it's actually the NHDMI--that every year between $1.3 and $15.8 million is spent on opioid-related emergency department visits. So when we pay for programming, you know, which is approximately $40,000 for somebody's salary, okay, that's a fraction of that cost. And if that person keeps people out of the emergency room, we are saving huge amounts of money in public health dollars, whether that be--I mean, not to generalize, but a vast majority of people who are struggling with substance use disorder are on Medicaid. So that's a lot of Medicaid dollars.

Michelle Lennon 07:57
Yeah.

Carina Raya 07:57
Which can certainly go to a lot of other like health promotion programs when they're not, you know, being tied up in emergency department visits.

Michelle Lennon 08:06
Yeah. Yeah.

Carina Raya 08:08
Yeah.

Michelle Lennon 08:10
I think that we know one of the things that's difficult is like it's hard to measure prevention, right? Because you can't measure what doesn't happen.

Carina Raya 08:18
Well, except---

Michelle Lennon 08:20
Except we now have data from things like the BARC-10s that shows the rates of accessing these things goes down once they're connected to a recovery center.

Carina Raya 08:32
I think some really like mind-blowing information about prevention, right--a big complaint about, you know, people who use drugs is like, "Oh, we see like homeless drug addicts, and it's like poisoning the community, and like people don't feel safe to go outside, and there's drug-related litter." And, like, whatever, which sure, seeing people intoxicated in public and drug-related litter are legitimate concerns. Nobody likes that. Got it. So when we talk about prevention, there's a number that I keep you know telling everyone. I'm like, "Hey, tell your friends." So OnPoint New York City has two overdose prevention centers, in East Harlem and Washington Heights, and in the first year--so one year--first year that they were open, the overdose prevention centers prevented 40,000 instances of public drug use, 40,000 instances of public drug use, and they collected over 400,000 pieces of hazardous drug-related litter that would have been in the community otherwise.

Michelle Lennon 09:40
And were found in the parks before, which everybody was complaining about. And like, because I happened to see Sam Rivera, Sam's at a conference in Washington, and he was sharing like the parks have cleaned up because they're not leaving their trash there anymore. Yeah.

Carina Raya 09:58
Yeah. And as much as we think it's difficult to measure prevention, and I think that there is really compelling evidence that something like an overdose prevention center does have the capability to measure the impact of prevention, and it's staggering.

Michelle Lennon 10:17
Yeah. Sometimes it's difficult too, because I have found recently that sometimes the political whims overtake the data--you know, that we can have the evidence right in front of us, but it takes, you know, one person that's maybe lost a loved one, that's just very angry, that just wants everybody who uses drugs to be arrested, you know. And there's been conversation in our states about mandatory minimums again. And you know, at first, the rates that they were talking about, it was personal use. It, you know, the intent is to stop fentanyl from coming in, you know, stop dealers, you know. But you know, one of the things that we're trying to talk about is like, you know, when somebody's driving all the way to Lawrence to pick up their stuff, they're not getting, you know, just for them. They're going to pick up for their friends, you know. You're not going to stop it by arresting one person and sending them to jail for three years. In that social network, somebody's going to pick it up. Now, you've just created a second dealer in the community. And, you know, sometimes like the follow-through and the thinking, like you said, is not there. Like, where is this going to lead?

Carina Raya 11:23
Right.

Michelle Lennon 11:24
You know, and if the underlying concerns are not addressed, because there's no mental health system to turn to or there's no way to access that trauma counseling to deal with like the underlying reason why somebody may have started medicating themselves, because I often think that self-medicating is another reason.

Carina Raya 11:46
A huge, huge reason.

Michelle Lennon 11:47
Yeah and you know, or can't access--like my husband's recovery would not have stabilized, except that he was able to access care at Dartmouth Hitchcock and go through numerous surgeries. And at first it was because of Medicaid, and then, you know, eventually on private insurance, you know, because I work full-time now. I have insurance. He's on my insurance and you know, and for him, he's actually working now. And I look at that, and he could have been somebody that was on disability for life, you know, but because of access to these programs, like he--and I do think like people sometimes misunderstand or they have this impression that people access these resources, and then they stay dependent on them. But all of the goals...

Carina Raya 12:33
Not true.

Michelle Lennon 12:34
Yes, there you go. Right. Not true at all. But like vocational rehab, I mean that whole program exists to help people.

Carina Raya 12:41
They're paying for my school now.

Michelle Lennon 12:42
Yeah, they're fighting for--

Carina Raya 12:43
They're helping me with the MD.

Michelle Lennon 12:44
Yeah, and getting back to work, right?

Carina Raya 12:47
Because, let me tell you, my ability to pay back what I received in Social Security is a lot higher when I have an MD than compared to when I didn't.

Michelle Lennon 12:56
Yeah, you know.

Carina Raya 12:57
Because it's worth it.

Michelle Lennon 12:58
Right.

Carina Raya 12:59
But I want to mention, you know, how the political whims and things tend to get like confused. Right, so New Hampshire has made it clear that they're an abstinence-first state, which I think is super ironic, because like liquor stores exist.

Michelle Lennon 13:16
And they welcome you at our border.

Carina Raya 13:18
Yes, that's--huge, giant barns filled with booze is not abstinence first, first of all. But so that's a reason why a lot of the political will is not behind something like an overdose prevention center, because they're like, "Oh well, it's condoning drug use." Like a liquor store isn't. So what they have found is when people are engaged and using an overdose prevention center, so public drug use decreases. Drug-related litter decreases. Transmission of HIV and Hep C decreases, and you know what else decreases?

Michelle Lennon 13:58
Substance use.

Carina Raya 13:59
Yeah, substance use.

Michelle Lennon 14:00
Yes.

Carina Raya 14:00
Over time, it has shown that providing people more services and a safe place to use drugs makes them use drugs less. So it is entirely an abstinence-based policy. Taking away drugs and preventing, "preventing," people from using drugs or "accessing" like drugs or drug paraphernalia does not like equate with abstinence.

Michelle Lennon 14:22
Right.

Carina Raya 14:22
It equates with desperation, and people--you know, increased crime or increased diseases and sickness and trauma and like people less likely to be able to break that cycle of chaotic drug use. But providing people with services and people they can trust and positive relationships and a lack of judgment, and you know, releasing them from stigma, allows them to move forward in their life. It is abstinence-based.

Michelle Lennon 14:50
Yeah. And I think, like harm--we talk about harm reduction, like, if you go, you know, to the very basis of what harm reduction is. Like, I have my motorcycle license. I have a motorcycle. Like, I would wear a helmet, you know, to reduce harm. And I crashed three times.

Carina Raya 15:04
We don't have the helmet law or a seat belt law.

Michelle Lennon 15:07
No, we don't. Harm reduction by choice, right? And..

Carina Raya 15:12
Right, by choice. So shouldn't we have a choice to be able to utilize an overdose prevention center?

Michelle Lennon 15:16
Well, there you go, right? Or just to be able to access new and unused needles. We had different pharmacists in our region who just took it upon themselves to decide not to sell needles to people that didn't have a prescription from a doctor. And when that happened, like you said, desperation takes root. We had a participant who shared with us, he actually ripped a needle-disposal unit off the wall of a public bathroom and took it home.

Carina Raya 15:46
Yeah. It makes perfect sense, because they've probably only been used once.

Michelle Lennon 15:52
Yeah.

Carina Raya 15:52
And, like, they're probably not in bad shape. So, "I don't know. I'll take them home and bleach them, sure."

Michelle Lennon 15:56
Right, right. Which is horrific from a public health standpoint.

Carina Raya 16:01
It's horrific, but I also want to point out because, you know, I think people who have engaged in chaotic drug use do have a lot of ingenuity.

Michelle Lennon 16:09
Right.

Carina Raya 16:10
That is a lot of ingenuity right there. And when we see people enter recovery, like that ingenuity doesn't disappear.

Michelle Lennon 16:16
Right.

Carina Raya 16:16
You know, we can take the skills that people have who have suffered with, you know, drug use or mental health issues, and channel that into something positive and creative, like. There's a reason to keep people who have used drugs alive and to, you know, have them be productive in society, because there are important characteristics that they, you know, embody.

Michelle Lennon 16:37
Well, because the skills are the skills, right? So if you have these really awesome problem solving-skills that you've learned to use in life, let's use them for good.

Carina Raya 16:47
Yeah.

Michelle Lennon 16:48
Yeah, that's awesome. Just thinking about harm reduction, I--you know, you picked up one of the T-shirts that we had out front that said "The War on Drugs Hurts."

Carina Raya 16:58
Yeah.

Michelle Lennon 16:59
And I'll give a shout out to Robert Ashford for this one, because I got it from him. But one of the things--so I was a history major originally.

Carina Raya 17:11
Right.

Michelle Lennon 17:11
My first degree from UMass was actually in history with a minor in women's studies. And I go back and I think about historically how we got here. And of course, the War on Drugs was really a war on people. We know this historically, contextually, you know, with the issues of Maryland and in different places, really rooted in racism and you know, a lot of prejudice against poverty. And it was really a time where we were really washed over with community programming to think, you know, you could just say no to drugs and that addiction really wasn't a thing. It was all a choice, you know. And you know, thinking about the brain as an organ was something we generally don't do. You know, we tend to think the brain is the seat of the mind and the will, and that everything is a choice. And it was Lindy Keller years ago, who she's retired now from DHHS. She had worked...

Carina Raya 18:14
Oh, right.

Michelle Lennon 18:15
She had worked, yeah...

Carina Raya 18:17
She's lovely.

Michelle Lennon 18:18
She is lovely. And she had done a training on addiction in the family, which was life-changing for me, probably 20 years ago now. But I was doing family support work, and my home visiting caseload was working with young women affected by both poverty and under the age of 21 and pregnant, and my caseload solely was basically all young women who use drugs, and my boss at the time sent me to a ton of training. And one of the trainings I went to, Lindy Keller had done this training. And one of the things that she had said about addiction to certain substances was that the brain as an organ has way more power over us than we think. It's not an act of the will that we breathe. And I thought about that.

Carina Raya 19:09
Yeah.

Michelle Lennon 19:10
And she compared the compulsion to substances, because you know, she talks about the definition of addiction, the addiction on its own, you can find it, you know, and define as that chronic compulsion to do something regardless of being very conscious of negative circumstances, you know. And talked about like the primitive part of our brain, and how a lot of our automatic functions are rooted there, and that's part of the brain that's affecting them. I mean, we talk about dopamine uptake, cited some things like that, about the pleasure principle and all of that, but like that compulsion to breathe. And use the example of if your head was held under water and you were told, you know, not to take a breath. Like logically, you can know that if you take the breath, you're gonna drown, right? But you're gonna take that breath, because your compulsion from your brain is so incredibly strong to inhale, long before you would suffer brain damage.

Carina Raya 20:16
Yeah.

Michelle Lennon 20:17
And you still do it.

Carina Raya 20:18
I mean, let's see. I think you phrased compulsion as like the desire to go through the behavior regardless of negative consequences.

Michelle Lennon 20:27
Yeah.

Carina Raya 20:28
Right. So that hit me. So another reason why like, "Oh, people who have used drugs, like how they can, you know, have a positive place in society right?" I know that starting a journey to med school at 30 years old is freaking crazy. Like I'm literally probably giving up ever having like a family or really making like long-term friends. Like I'm moving around all the time, and I'm accruing like massive debt. Like every time I have to like sign my MPN, it's like you're gonna have--like, my loans are 10 percent, you know, but I am doing it even though I know there's negative consequences. So being able to, when you're not engaged in chaotic drug use, having that ability to do the thing, which sometimes is the right thing--like often doing the right thing has negative consequences. Standing up against people who are being racist or discriminatory is the right thing, and does it have negative consequences? Yes it does, a lot. So when we talk about people who have used drugs, again another positive thing is like, "Okay, well, if you're compelled to do drugs like that's not great. But if you're compelled to do other things that may have negative consequences, but maybe it's the right thing, great."

Michelle Lennon 21:48
That's so interesting.

Carina Raya 21:49
I want to create a positive spin on things.

Michelle Lennon 21:51
Well, and the thing is, you have the ability to count the cost, you know, count the cost, and it's more worth it to you.

Carina Raya 22:00
Mm hm.

Michelle Lennon 22:00
You know, to pursue this career.

Carina Raya 22:03
Mm hm, and you know, when I was 18, it was more worth it for me to like use heroin than it was to not

Michelle Lennon 22:10
Yeah.

Carina Raya 22:10
And I couldn't articulate why at the time. I don't necessarily, like I don't--I'm not of the mind where I regret any of my behavior. I don't think I made the wrong choices then.

Michelle Lennon 22:23
Yeah.

Carina Raya 22:23
Like...

Michelle Lennon 22:24
That's hard for people to accept, but I will tell you, working with youth, we do not take youth on this journey of a mad rush to abstinence, because we know now because of, you know, the science, and because of what we know now about studies on early childhood trauma or traumatic backgrounds or different incidences that kids have gone through, you know, that usually there is a reason, and that the behavior is communicating something, and getting to the root of what is it communicating becomes a little bit of the goal.

Carina Raya 22:59
Yeah.

Michelle Lennon 22:59
And I'll never forget, because like the seven challenges, which is one of the evidence-based programs that we use, has a journaling activity that comes with it.

Carina Raya 23:09
Nice. That is so important.

Michelle Lennon 23:11
And it's not, it's not like--I don't talk to to the youth like this, you know. Our coaches do, you know. And then there's a component of the journaling where it's like back-and-forth dialog, but it's not done face-to-face. It's all done in writing.

Carina Raya 23:27
That's awesome.

Michelle Lennon 23:28
And we're really good about not judging, you know, what the youths share. But when you have somebody, and it could be a youth, it could be anybody really, who shares something, we usually ask a question. So, one of the questions on the BARC-10s or, you know, through most of our program is, "Have you used the substance, you know, that you're trying to abstain from?" And I say that because, you know, people don't quit everything. I think that's another myth of recovery, right, that you have to quit everything. Like some people can't use opiates, but they're fine to have a drink here and there, you know. So with the youth, we kind of treat it the same way and ask them questions like, "Have you used the substance that you've been trying to abstain from since you last wrote?" And if they say, they say, "Yes, I smoked," like they talk in an informal register, right? So it's like, "Yeah, I smoked weed with like three of my friends last week," and then again like, "I snuck out and was like on the roof," or something like, you know, we respond some way like that. We don't sit there and condemn them for that behavior. We'll ask the question of, "What did you get out of that?"

Carina Raya 24:40
Mm hm.

Michelle Lennon 24:41
When you have a young person say, "It stopped me from killing myself that night"

Carina Raya 24:47
Yeah.

Michelle Lennon 24:47
How do you say it was the wrong choice to make?

Carina Raya 24:49
No, I totally agree. And I think with young people, how you said, like you don't do like a hard, fast like journey to abstinence. That's really smart, but I think it's gonna be hard for people to do, because like with young people, the results are not necessarily something that you can see for many years. For example, when I was in high school, when I was a senior, you know, I had already turned 18. I moved out of my mom's house, and I was living with my boyfriend and we were doing heroin and everything. So I had stopped kind of coming to school all the time, and my principal was like, "You know, what's going on?" I was like, "My boyfriend has like mental health issues. He doesn't always want to drive me to school. Like we don't have any money. He does drugs, like we're--I'm struggling. Like I don't know what to do." And he was like, "Okay, well, if you come to school three days a week, and then you do like three hours of class, and then you sit in my cafeteria and pick up trash for the rest of the day, I will pay you to pick up the trash."

Michelle Lennon 25:49
Wow.

Carina Raya 25:50
Little did I know. So the woman who like, you know, watched the cafeteria, she was like the attendant, or whatever, was in recovery. She was in AA, and I would hang out with her all day, and I did not stop using drugs at that time. And I did not, you know, get into recovery for many years, but she never judged me for that, for one. And for two, she maintained this like non-judgmental curiosity, asking about how I was or like what I was interested in, and just having like a, you know, genuine conversation with me. And I looked forward to that, so it made me go to school. I graduated, I got my diploma.

Michelle Lennon 26:33
She had a huge impact on your life.

Carina Raya 26:35
Yeah, you can imagine. And I still think back, you know. Like I don't remember exactly the things this woman had said to me, but I remember the time that she took to connect with me.

Michelle Lennon 26:47
Yeah.

Carina Raya 26:48
And like that mattered a lot, and it has not ever stopped mattering.

Narrator 27:01
Thank you for listening to Archways' Threads. If there is a topic you'd like to see us cover, email us at podcast@archwaysnh.org or call us at 603-960-2128. Visit our website at archwaysnh.org to learn more about the Archways family of recovery and family resource centers.