My computer has some charge, but my power is going in and out a little bit. So if I drop off, hopefully I'll be back soon. But my name is Chelsea Kimura. I am an Inupiaq descendant, and I'm a social worker by training. I now serve as a training and technical specialist for the Obeyed Response Network, and I work out of the Northwest region. And this really means that I work to help connect communities and organizations to the free resources that the ORN offers. Stephanie and Dr. Sarah Spencer are here today to present. And Stephanie, whenever you're ready, can we pull up our slide deck? Thank you. So today we're going to be talking about addressing stigma and substance use disorder treatment. Can we go to the next slide, please? Sorry, I'm having some technical issues here. No rush. Awesome. Thank you. So we just want to acknowledge that today's session, as is everything the ORN does, we are graphed by SAMHSA. Next slide, please. Many of you are probably familiar with the Opioid Response Network, but we're grant funded by SAMHSA to provide free training and consultation to communities across the country. So we can provide resources for most topics that are related to opioid and stimulant use prevention, treatment, recovery, and harm reduction. I do want to remind everybody the session today is being recorded. The recording should be available for you all in about two weeks. So once that link is ready for you, I will make sure that we get that over to your team. Next slide, please. All right, now I'd like to introduce our two presenters for today's session, Dr. Sarah Spencer and Stephanie Stillwell. Stephanie Stillwell is a registered nurse with a diverse background in the healthcare industry. She has facilitated multiple local and statewide coalitions throughout the state of Alaska, actively works to empower individuals and communities to cope free and shift systems that will bring positive change to the health and well-being of Alaskans in Vietnam. Stephanie is a Anishinaabe woman from Lac Lafoye First Nation, Ontario, Canada. And Dr. Sarah Spencer is here with us as well today. Dr. Spencer is a family practitioner and addiction medicine specialist providing treatment of substance use disorders in rural Alaska for over a decade. She is the volunteer medical director and founding member of Megan's Place, the first rural syringe access program in Alaska. She also partners with the state of Alaska's Project Hope. She currently works at a community clinic as an addiction medicine physician. And with that, I will go ahead and turn it over to Stephanie and Dr. Spencer. Thank you both for being here. OK, hi, everybody, I am Stephanie, as Chelsea just gave us our gave you all of our introductions today. Today, again, we're going to talk a little bit more about addressing stigma in substance use disorder treatment. And the next week will be the presentation on trauma informed practices. So for today, our presentation is really going to include talking about the misconceptions of substance use disorder and understanding the stigma's impact. And then we're going to talk a lot about the language, the role that language plays in shaping perceptions and cultivating empathy as we explore different strategies to reduce stigma, which ultimately improves patient outcomes. And then we're also going to dive into analyzing different case scenarios that work toward addressing stigma related challenges with STD treatment. So I am also since I'm having some technical difficulties, I'm going to stop my video, but you all should still be able to see my screen. And let's hope for the best here. All right. Awesome. OK, so. Stigma. Generally, you know, the relationship between substance use disorder and stigma is extremely complicated. Our understanding of what substance use disorder is has definitely shifted over the years. And thankfully, you know, continued research really helps us move the idea that we classified substance use disorder as a moral failing. And instead, now we understand that it's a disease that affects our brain. It's not a moral failing or choice. But there's still a lot of continued stigma that really makes it difficult for people who are living with substance use disorders. So just generally speaking, what is stigma? Stigma is a harmful misconception that somebody forms about a group or a person because of certain situations that that person might face in their life. So there are many different stigmas that people who are living with or in recovery from substance use disorder face. And so we're going to kind of touch on a lot of different aspects of stigma today. But generally, you know, we're going to talk a lot more about this in this presentation. But the most effective way to reduce stigma really does involve how we talk and what language we use. And so by becoming more aware of how much words really do matter, the stigma can be reduced or even eliminated. So that's what we're going to dive into today. So this part, feel free to come off mute if you want to. But I really want to hear some of the words that come to mind when you think or hear about somebody that has survived cancer or is currently fighting cancer. So let's hear some of the words that you often hear people describing those folks as. Strong. Yeah. Yep, exactly. Strong willed, resilient. They're they're warriors, they're survivors. You know, just really generally we're seeing a lot. We hear a lot more of like these really empowering terms that people use to describe somebody who's who's going through this particular disease. You know, but what about what do we often hear when people are describing somebody with substance use disorder? What are some of the ways we things that we hear people describe them? Perhaps it's a dirty, they're abusers or, you know, we hear clean versus dirty a lot. So, you know, when we really think about it, the different languages that are used to describe individuals with cancer versus those who are who have substance use disorders, it really does highlight the major issue of stigma that we still have today. You know, it shows us that there's very clear differences in how people perceive these very different health conditions. So this can be attributed to both historical stigmatization, you know, that what we just mentioned, how, you know, historically addiction was rooted in viewing it as a moral failing rather than a health issue or a lack of understanding of the science of addiction. Or how the media continues to portray substance use disorders or even, you know, criminalization of drug use over the years. So, you know, it's it's we're definitely making progress. So recent years, we've seen a lot of movement to really change how we talk about substance use disorders. We're here today as an example of really working toward and striving to reduce stigma by, you know, promoting empathetic language and just really paying attention to what we're, how we're speaking about things. So it's really important to remember that both cancer and substance use disorders are equally both severe health challenges that people who are affected by either of them should really receive the same amount of empathy, respect and support. So, yeah, you know, when we're referring to people who are in recovery, we, you sometimes hear them being described as clean, you know, which implies that they were at one point dirty or impure. So this, again, is perpetuating some of that harmful stigmatization. So we really want to work on avoiding the words clean and dirty. You know, it's important to recognize that people who are in recovery are not and never were dirty. They are courageous people who are really working to overcome these challenging conditions that they have in their lives. And, you know, I love this quote by the social worker who kind of took the situation when a coworker used some stigmatizing language and really flipped it and kind of, you know, showed this non-stigmatizing way to describe. But this quote says, when coworkers ask me if a client is, whoops, if a client is clean, something is going on here. So a client is clean, I will say, yeah, they are, no, there was no detectable mal-order and their hygiene was good. Their clothes were laundered and they were weather appropriate. So just kind of like thinking of ways that we can deter stigmatizing language by really, you know, highlighting like, you know, if we're looking at this literally dirty means this versus having a negative or positive talk screen. So there's also just generally, you know, language matters. So when we're looking at changing the way we speak about people with substance use disorders, we really want to pay attention to some of the things like instead of referring to somebody as an addict or an alcoholic or a junkie, you know, it's a person who uses drugs or some person with substance use disorder. Again, we're avoiding the clean versus dirty. And instead of saying things like former addict, we can talk about them as a person in recovery, a person who has previously used drugs. So something that really brings us to that person first. Also, when we're talking about, you know, things like drug habits or abuse, we want to switch that into talking about opioid or substance use disorders, regular risky or unhealthy or heavy use. And again, something that we'll be touching on a little bit more today is, you know, it's not substitution or replacement therapy, but it's actually medication for addiction treatment. And one thing that I also like to remind people is like instead of a relapse, let's think of it as a recurrence of symptoms of the disease. And one last is addicted babies or babies that are born addicted, let's talk about them as babies who are born with an opioid dependence or babies who are born with neonatal abstinence syndrome. So there's really easy ways that we can just become more aware of how we're speaking about people who have substance use disorder. So again, you know, we want to really pay attention to what language we're using. And so that even, you know, goes to MAT at one point, you know, we talked about this as medication assisted treatment. But from, you know, best for today, we're saying it's medication for addiction treatment, or it's MOUD, which is medication for opioid use disorder. And additionally, like when it comes to stigma, there's just so many different types of stigma when it comes to substance use disorder. So, you know, there's stigma from within the self stigma. This is when, you know, individuals blame themselves or feel ashamed because of their substance use disorder. So they think they're failures because of what society says or, you know, and this self stigma makes it really hard for people to feel like they're worthy or they should ask for help. You know, there's also stigma from community. So people who are in the community, this could be friends or family neighbors. They may even look down on them or people who use medication for addiction treatment may have stigma from even within the recovery community saying that, you know, taking medication is, you know, doesn't make them abstinent. So they're not in real recovery, which is a real stigma that's out there. There's stigma from clinicians. So unfortunately, even some health care workers can still be biased because of their own stigmas. So it's just really important to address that, you know, this can really impact how patients receive treatment, whether it's for a substance use disorder or any type of health condition that they are getting treatment for. If a clinician has their own stigma or belief about substance use disorder. And then there's like stigma from the outside, external stigma from society. This really involves the public's perception of addiction, substance use disorder. It's what we see on TV and the media. Unfortunately, the media has a way of perpetuating these negative stereotypes or using derogative language that just kind of deepens that negative image of substance use disorder. And so this has a huge impact on a lot of different spaces, but particularly it can work toward negatively impacting policy decisions or how the government chooses to support different programs. So this is really important and a big reason why we need to really focus on providing a lot of education on substance use disorder and addiction. And, you know, there's huge impact of stigma. So the impact of stigma on substance use disorder, again, is just far reaching, damaging. Stigma diminishes the belief that addiction is valid and that it's a treatable health condition. This can hinder people from seeking help, period. It can serve as a barrier to employment, housing and relationships. And if people don't have housing, employment or stable relationships, this really does perpetuate cycles of instability. So stigma also can discourage public support for treatment funding or funding that provides other services for people in recovery, enables insurance limitations. It can, again, impact punitive laws. People are, you know, that are affected by substance use disorder tend to refrain from seeking certain services because of feelings of unworthiness. They might also encounter different, you know, stigma or judgment from folks within their care, receiving care. Again, you know, stigma impacts potentially clinical care and treatment decisions, which leads to less effective support. And additionally, it's really intertwined with, like, these ongoing myths about drug use and substance use disorder and all the other misunderstandings that really make it really, really challenging for some individuals to receive the care that they require. So, and specifically when we're talking about the indigenous community, there's, you know, just a lot more health inequities that are continuing to occur within this population. You know, the devastating impacts of colonization are still felt today. Oppression, marginalizations and the impacts of historical and intergenerational trauma really just contribute to these health inequities for indigenous folks, which, you know, is why we have this disproportionately higher rate of substance use disorder amongst American Indian and Alaska Native individuals. And in fact, indigenous people are less likely than non-indigenous people to seek treatment for especially mental health concerns. It's, you know, this fundamental lack of, like, understanding of why this is has really resulted in indigenous people being held responsible for their own health inequities, which, you know, perpetuates that stereotype. That, like, right here, you know, what's the myth about, you know, Native American folks being predisposed to alcohol use disorder as false as, you know, it says like that their people are naturally predisposed to alcohol use disorder. The reality of all of the different things that go into the reasons for the inequity, you know, even within our own Indian health services, in addition to historical trauma and generational trauma that has impacted indigenous folks, you know, there's a lot of historical trauma that has impacted indigenous people. There's the real reasons why people have that indigenous people might have mistrust for government or Indian health services, you know, for example, one is like the real example of sterilized forced sterilization of indigenous women, which is, you know, it's just really, there's just so many different layers that go into the inequity in this population. Let's see. Okay, so I'm going to turn this over to Dr. Spencer now. Okay, sorry, for some reason, the toolbar wouldn't pop up. So I had no way to unmute myself. Sorry about that. Okay, I can I can re, um. I can share from my end, I think now. Silence. Okay, are you able to see the slides now again? Yes, that looks good on my end. All right. Okay. Sorry about that. So I just want to run I just want to go over a few a couple of cases that can highlight some. Issues that might come up when patients are are seeking medical care. So, I have, I have 2 cases that I want to highlight, and then we're going to kind of come back to them again a little bit later on in the presentation. So, 1st, 1, I want to imagine that you're taking care of this patient is a 26 year old male. He has a history of opioid use disorder and IV drug use. He's presenting to the emergency department with back pain. He looks anxious. He's sweaty. He's restless. He looks really disheveled. He has visible track marks on his arm, and he is kind of fervently asking for something to help relieve his pain. His urine drug screen today shows as positive for opioids and methamphetamine, and when the provider looks at the prescription drug monitoring program, it can show that he used to be prescribed buprenorphine, but the last time he was prescribed that medication was about 6 months ago. So, I just want you to kind of think about this person and maybe patients that you've taken care of that reminds you of this and and how this person might be treated in the emergency room. Next, this is a. So, we have a 32 year old woman who presents in active labor a month early. This mom has been injecting drugs 4 times a day lately in her pregnancy. She actually has had 2 emergency room visits for drug overdoses during her pregnancy. The baby is born dependent on drugs and has to stay in the NICU for a little while during the hospitalization. The mom's condition, they're able to stabilize her, get her on medications, and she's no longer injecting drugs and baby is discharged with mom. 2 years later, the father of the baby is actually also injects drugs and is still doing so. And 2 years later, the child finds a syringe, which accidentally injects itself and results in hospitalization to treat overdose in the child. So, you know, kind of think about, you know, how do we think about pregnant people who use drugs? How do we think about issues related to child safety and kind of what kind of deep feelings this might bring up in us? Okay, I'm going to try to see if I can play this video and let me know if you can hear it. And if not, Stephanie, maybe you can help me here. Are you guys able to see this video? It's not playing on my end. What's that? It's not playing on my end. I just see the video screen. I can put the link in the chat unless we want folks to watch it. It's only a minute long. Let me see here. Okay, now we can see your screen with the YouTube video. Okay, all right. Let's see if this works now. Let me know if you can hear it. I'm not able to hear it, but my Wi-Fi is also not free. No, I can't hear it either. Okay, all right. Okay, so maybe this is not going to work. Do you have any other ideas, Stephanie? I have subtitles. I can read the subtitles. I can share it on my end again. We'll just play. I'll go straight to the YouTube here. Let's see if... Make sure my share sounds. Yeah, probably actually if I... Okay, let me know if you can hear that. I really felt the stigma of addiction. I mean, from everybody. I wouldn't go to this. Yes, we can. Just because I knew that as soon as I got there, as soon as they looked in my chart and saw that I had a history of heroin addiction or saw the abscess in my arm, I was instantly labeled a junkie. I was left in the hallway for hours asking for a glass of water. I'd be ignored for hours. Even when I went there for something that had nothing to do with pain and I wasn't requesting pain medication, they would automatically think that's why I was there and tell me that before I even said anything, don't think you're getting any narcotics from us. And it's debilitating. It kept me from, for a long time anyway, from getting treatment. I was afraid that everybody would think I was a junkie and a disgusting, dirty person. That language clean or dirty or, even the word addict has so many connotations to it that it's just, it's sad and it's killing people. It's literally killing people because it perpetuates the stigma and it prevents people from getting treatment. All right, I'll give you the sharing so you can get that. All right, okay, able to see the slides again then, I hope. Yes, I don't see them in the chat. really model that first person language back to them and share about why it is important. We're gonna touch on some of the kind of specific ways in which stigma may affect someone's treatment when they're seeking treatment for opioid use disorder. So one is stigma around the medications themselves. So historically, medication-free treatment or what used to be called abstinence-based treatment, which is also a language you see, right? Like many forms of treatment, people can achieve abstinence and that doesn't mean because people are taking medications that it's not abstinence-based treatment. But medication-free treatment historically has kind of the most support within the community and treatment field versus medication like methadone having very high levels of stigma around it. But if you actually look at the comparativeness of these treatments, as far as reducing overdose risk, encouraging people to stay, being able to stay in treatment and meet their goals, the medication-free is the least effective. And in fact, greatly increases people's risk of death versus buprenorphine or methadone are much more effective and really help to reduce morbidity and mortality and help to keep people in treatment and meet their goals. There is a huge, one of the big stigmas around medication-aerobic use disorder is that it's substituting one drug for another, right? Like, oh, that's buprenorphine, that's methadone, they're just addiction and it's gonna be just as hard to come off that as coming off of heroin and it's just substituting one drug for another. And that really addresses kind of the underlying, it gets to the underlying issue of the difference between physical dependence and addiction. So if you have many medications that we prescribe for many health conditions, a blood pressure medication, seizure medications, you develop a physical dependence on them. And if you stop them suddenly, you can have some pretty bad withdrawal symptoms and bad physical effects that go along with that. So just because a drug creates a physical dependence in the body does not mean it's addictive. When you're addicted to something, you keep using that, the use is completely out of your control and you continue to use it in compulsory way, your health is horrible, you're getting in trouble with a law, your wife left you, all this horrible stuff is happening, but you keep compulsively using the drug versus the medication for treatment, that medication helps you to improve the quality of life, it reduces your morbidity and mortality, it helps you to stay on track, it helps you to get healthier and healthier. And in most cases, people are able to take that medication in a way that continues to improve their health. So they're two very different things, addiction and physical dependence. Harm reduction is also a very stigmatized part of healthcare. Harm reduction is healthcare, it's tertiary prevention and harm reduction programs, when we think about harm reduction programs, the most stigmatized harm reduction programs are probably syringe exchange or syringe access programs that, hey, we're just enabling people and encouraging them to use drugs, we're not helping them. But in reality, there's tons and tons and tons of data about harm reduction programs that they are very effective at increasing engagement and treatment. So people who use syringe exchange programs are five times more likely to then engage in substance use treatment versus people who aren't using these programs. They also dramatically reduce costs to society by reducing the spread of disease. And they just really create, and they reduce risk-taking behaviors and they create a safe nonjudgmental space where people know that they can come to get help when they're ready for that. And harm reduction principles can be applied throughout our care for patients outside of substance use disorder as well. We use harm reduction in all kinds of ways in life. So when we wear seat belts and life jackets and having condoms, having speed limits on the road, these are all things we do to try to make risky behaviors less harmful to ourselves. And so it's a universal precaution that we can really apply to all individuals regardless of kind of what their status is. The other stigma that comes up or issue that comes up is that us setting goals for patients versus allowing the patient to set their own goals and determine what is success. What's success in treatment? Success in treatment is not just about abstinence. A lot of times, that's sort of what we think of, like, what's the point of a drug treatment program? So people stop using drugs, right? And our true goal, when we're talking about treating opioid use disorder, the goal is not for people to stop using opioids. That's great. We love that if that happens. But the real goal is that I don't want people to die. I want them to not get infectious diseases. The patient, what's their goal? Maybe they wanna go to work. They wanna keep their kids. They wanna not go to jail. They wanna not feel sick from withdrawal every morning. These are all kinds of wonderful goals, and none of them specifically require abstinence, right? Abstinence, great, it's one goal, but it doesn't have to be every goal. And what we've seen is that medication for opioid use disorder can reduce morbidity and mortality, even in patients who don't achieve abstinence, who are continuing to struggle with drug use or dealing with polysubstance use. We can still help to improve their quality of life and reduce their morbidity and mortality, even if they aren't able to achieve abstinence through the use of medication. Another area in which stigma and biases can kind of sneak in sometimes is in places like mutual support groups. And I think we, you know, mutual support groups, so 12-step programs, so this is like NA, AA, it tends to be a go-to of like, of course you should use that, right? Of course, you know, hey, have you gone to an NA group? Have you gone to an AA group yet? You should do that, but it can be, sometimes that can be counterproductive for some people depending on, you know, the context of that particular mutual support group. So in some mutual support groups, they are not supportive of people taking medication for opioid use disorder. And specifically in NA, they still have a very specific, like in their guidelines, that people who are taking medication for opioid use disorder, they can be prevented from speaking at meetings or acting as sponsors. They can be, you know, can't identify themselves as being in recovery and they can get, people can get pressure from these mutual support groups to actually stop taking their medication. Now, mutual support groups can have lots of benefits to really creating that, you know, recovery support environment that people need, but it's really important before we refer people to these groups that we really kind of find out from someone who's actually going to that local, because these groups are locally controlled. And so every group is different. So it's important before referring someone to one of the local groups to make sure that that group is gonna be supportive of that person, you know, getting the medical care that they need to just check with that before we refer someone there. And there are online groups that are, there's an online group called MARA, Medication Assisted Recovery Anonymous, I think it's something like that, which is, it's basically it's 12-step groups specifically for people who are on MOUD, which can be nice if you don't have a local group to support people like that. And this is just another way to kind of think of really, how do we identify our internal biases and how do those root beliefs, root internal beliefs affect the way that we treat patients? And really to really acknowledge that we all have root perceptions and internal beliefs and internal biases because of, you know, our history and the lives that we have led. And to not acknowledge that, you can't really make change in the way that we're interacting with the world around us until we really identify and address kind of those core beliefs and how they affect our actions. So when we shift our view to assume that people who use drugs, they know how to take care of their bodies, to care for their loved ones and their communities, they're capable of making rational choices that can be trusting, then we're able to really have this capacity to connect with and have empathy for people who are struggling with drug use. So this one gives an example of, if our root perceptions are that people are, people who use drugs are not trustworthy, then are lazy or sick, and we say, well, they're probably lying. They don't have the willpower. They can't help themselves. And in that case, we might project our own agenda on them because they're not people doing themselves. We may make a bunch of requirements that they have to do all these things because otherwise they're not gonna succeed. And really not allow a patient to control the path of their recovery. Versus if we have the root beliefs that people who use drugs are capable, trustworthy and caring, say that, hey, they're capable. They're telling me the truth and they do care about the people who are around them. And that way we can work together to create plans based on the patient's goals and asking them to, helping them to guide that treatment in a way that's gonna be successful for them. So just a review of some of the ways that we can help to reduce stigma. So first, which we talked over and over again, is really focusing on our language and using person-first, respectful, medically accurate terminology when we're talking about people who use drugs. Providing education that really portrays people as human beings, to educate people in the healthcare field about the disease of addiction and about the very effective treatments that are available for it. Personalize substance use issues. It's encourage people who have lived experience with substances to share those experiences. People in recovery, because of the stigma, they're scared to even talk, even when they're in long-term recovery. So really helping people to share those stories. When we hear those stories of success, and there's so many of them, we don't hear it enough. It can help us to really understand that people can and do recover. And share, and even if it's not your story, you can share the stories of other people around you, that you know of recovery and the good things that have happened to people who are dealing with addiction. SAMHSA actually has this nice guide about digital storytelling to help patients learn about how they can share their stories and how people in recovery can help others who need help. And that can be very, it can be very empowering for people to share their story. It can be very scary thing to do, but when people do it and do it successfully, and it can be very empowering for people. So when we're approaching the treatment of people who have substance use disorders, we want to meet people where they are that, where they are at in a trauma-informed, non-judgmental, safe place, so that then they feel safe working with us to take them someplace else to where they want to be. So we wanna treat all patients with respect and dignity, regardless of their severity of disease or whether their disease is active or whether their disease is in remission. We want to speak, teach, treat everyone with the same respect and dignity. We wanna work with patients for the patients to set their goals for the care, not to be authoritarian and tell people, you know, this is your goals and this is what you're gonna do. And we wanna offer a broad level range of support to meet people where they're at, you know, to help the patient who wants to be completely abstinent from drugs just as much as we help the patient who's not really sure if they wanna stop using drugs or not, but, you know, they'd like to get their hepatitis C treated or, you know, maybe they like to have something else, you know, they like to reduce their use of opioids, but maybe not their use of meds. Like, we should be able to support all these people no matter where they're at in the spectrum of readiness for recovery. It's the patient's right to determine their level of care and we should never discharge a patient for return to use. So we would never discharge a patient from care for exhibiting, you know, signs of their active disease for their diabetes or their blood pressure or their asthma, right? And we shouldn't do that in substance use disorder either. We should provide support for people whether their disease is active or not. And this is a nice online resource, shatterproof.org. It has some nice videos and information about how we as health professionals can make a huge impact in people, you know, feeling safe and getting the care that they need. If we can be, you know, we can be part of that solution by creating, you know, treating people with empathy and creating that safe kind of judgment-free zone where people are able to seek the care that they need. These are some training videos that, you know, the organization that provides free education that you can check out. All right, I'm gonna stop there and take time for Stephanie and I to answer questions. I just wanted to say thank you for everybody taking the time to do this training. I think it's really important for us as a team and thanks for the presenters for educating us on some things. realized that I didn't for some reason the slide got cut out about the first case that we never went back over the case the back guy who had opioid use disorder and he was in the emergency room with the back pain asking for pain medication and kind of what would you do with that medication so that was a true story of a patient that I had and he actually he actually went to emergency room three times with the same complaint over the course of a week before he was actually accurately diagnosed and he was kind of like left both times frustrated because they were just saying hey you just want pain medication there's nothing wrong with you we're not going to give you opioids get out of here but he had an epidural abscess and and once they actually but the third time he showed up and they actually figured that out and he got medevac for anchorage and he was hospitalized for like three weeks and so that's just like another example of you know and I hear I hear these stories from patients on a regular basis I think they feel safe telling me these stories because they have us you know when they're in our office they feel safe and like they can share anything um and and just their frustration with like their fear of accessing the medical system and not getting appropriate care so Thank you, Sarah, for presenting and Chelsea. Do we have any last minute questions for Dr. Spencer or Stephanie? Will be able to receive for this course, and so I will go ahead and send out instructions to do that. Probably sometime tomorrow morning the training. Recording will be available in about 2 weeks. Once that is available, you'll be able to log in and receive your.

Chelsea Kimura

Inupiaq descendant

training specialist

Opioid Response Network

stigma

substance use disorder treatment

empathetic language

personalized care

medication-assisted treatment