I welcome everyone we will get started in just a few moments. Okay, good afternoon, everyone, and welcome to today's webinar titled Addressing OUD and BIPOC Communities, Part One, Treatment and Recovery for African American Communities, hosted by the Providers Clinical Support System in partnership with the National Council for Mental Wellbeing. Thank you so much for joining us today. So before we begin, I'd like to cover a few housekeeping notes. Today's webinar is being recorded and all participants will be kept in listen-only mode. The recording and slides will be made available on the PCSS website within two weeks. There will also be an opportunity to ask questions at the end of the webinar, so we encourage you to submit your questions throughout the webinar in the Q&A box located at the bottom of your screen. So today we have two presenters. The first presenter is Dr. Michelle Durham, Vice Chair of Education in the Department of Psychiatry at the Boston University School of Medicine, also known as BUSM, and the Boston Medical Center, also known as BMC. Dr. Durham is a board-certified physician specializing in pediatric and adult psychiatry with additional board certification in addiction medicine. She practices clinically at BMC and is a clinical associate professor of psychiatry and pediatrics at BUSM. Her public health and clinical roles have always been in marginalized communities. Dr. Durham is also the Director of Clinical Training for the BMC Transforming and Expanding Access to Mental Health in Urban Pediatrics, also known as TEAMUP, a grant-funded initiative to bring mental health care into the pediatric primary care setting in federally qualified community health centers. Our second presenter is Andre Johnson. Mr. Johnson is the Founder, President, and CEO of the Detroit Recovery Project Incorporated, a nonprofit certified community behavioral health clinic with two clinics and two recovery houses in the Detroit metropolitan area that delivers services to more than 3,000 people annually. Mr. Johnson is currently a third-year student pursuing his doctorate degree in clinical psychology at Michigan School of Psychology. He is known internationally for his work in the field of addiction. In 2016, Mr. Johnson was recognized by President Barack Obama as a 2016 Champion of Change for Prevention, Treatment, and Recovery. He was appointed by former Secretary of Health, Human Services to serve a three-year term as a National Advisory Council member, excuse me, for the Center for Substance Abuse Treatment and Substance Abuse Mental Health Service Administration, and is an active member of the Third Judicial Circuit Court team. Mr. Johnson is also a board member of the Wayne Center, an agency that provides services for the mentally ill and the developmentally disabled. Dr. Durham and Mr. Johnson do not have any disclosures. Not all harm reduction views are supported by the federal government or SAMHSA, though some harm reduction approaches have demonstrated promising results. The overarching goal of PCSS is to train a diverse range of healthcare professionals and the safe and effective prescribing of opioid medications for the treatment of pain, as well as the treatment of substance use disorders, particularly opioid use disorders with medication-assisted treatments. So the learning objectives for today's webinar is to identify existing inequities and access to quality substance use treatment and recovery services for African-Americans, discuss the contextual issues and treatment barriers that impact rates of substance use disorders and opioid overdoses in African-American populations, explore the use of specific outreach strategies and recovery supports to increase access and engagement in care of African-Americans, and examine the use of effective harm reduction strategies within African-American communities. So now I will turn it over to Dr. Derm to begin the presentation. Thank you so much for that warm introduction, Emma. And thanks to Emma, Casey, and Erin, the National Council on PCSS for inviting me to speak today. I'm also really excited about the chat. I don't think I've been in a meeting recently where everyone's so excited to be here, so that's nice. And for someone in cold Boston right now, I wish I was in Louisiana with whoever just said they were listening from Louisiana. As a native Louisianan, I miss that weather. I'm happy to be here today and presenting with Andre. I think this is super important. I'm glad that we both get to do this presentation together to really focus our energy on, I hope at the end of this talk, what we all need to be doing better to engage Black people in getting the treatment and access to treatment that they so rightfully deserve. Next slide. So in all of my talks, I always like thinking about how do we define health equities and think about that, next slide, as we think about health disparities. You hear both of these terms a lot in the literature, a lot probably in the last two years more so than ever, which is a good thing for public health in general. But I wanna really help people understand today what I mean. When I think about health disparities, I think about population differences and health outcomes, period, across the board. Why I use and chose to use health inequities throughout my talk today is because it's really thinking about how inequities arise that make populations vulnerable to illness or disease, but the caveat is through unjust, avoidable, and unfair distribution of protections and supports. That's the difference that I believe of what's affecting the Black community in particular when we think about health outcomes and our purpose of our talk today when we think about opioid use disorder. And when I think about structural inequities, there are all those things that we know that affect our lives, where we live, where we work, where we play, all of that is impacted by policy decisions. And we have historically known that there have been structural inequities that determine some of these policies that have really unfairly put people at a disadvantage and put people at a disadvantage based on the color of their skin. Next slide. So I'd like to think a little bit about what we're discussing today and the importance of this particular topic. Next slide. Substance use has been identified as the number one health problem in America. And of 2018, only about 18% of people And of 2018, only about 18% of people identified as needing treatment actually received it, leaving about 17 million people who didn't receive care for a treatable health condition. For Black Americans, 90% diagnosed with a substance use disorder did not seek out or receive addiction treatment. Cannabis use is roughly an equal among Black people and white people, yet Black people are about four times as likely to be arrested for cannabis possession. Discrimination, racism, social pressures play a role in substance use within the Black community. And we're gonna delve into that particular point today. Next slide. So mental illness and substance use disorder in Black Americans overall in 2019, the National Survey on Drug Use and Health demonstrated that rates of mental health and substance use and or substance use disorders had a 10% increase from 2018 for Black people. Next slide. We know that between 2018 and 2020, drug overdose death rates increased across all racial and ethnic groups, but they increased the largest for Black people and American Indian and Alaska Native people. This is a crisis. We should be thinking about this in our work. We should be thinking about how do we do our work better. We should be thinking about what is wrong that people are dying at these rates. Next slide. White people continue to account for the largest share of deaths due to drug overdose, but people of color are accounting for a growing share of drug overdose deaths over time. And we see that we're seeing this in research time and time again. As a result of this increase, Black people now account for this disproportionate share of drug overdose deaths relative to their share of the total population. So Black people represent 17% of the U.S. population, sorry, 13% of the U.S. population, but their drug overdose rates are 17% of that. This is a crisis. I think I'll say this time and time again, maybe through this presentation. There's gotta be something that we need to do differently in order to get people the care they need. Next slide. So Dr. Helena Hansen is a psychiatrist and does a lot in thinking about substance use disorder for decades. Her research delves in not only to substance use, but also thinking about the inequities at play. And she stated in the Guardian 2022, just this year, an article that stated, drug overdoses are increasingly becoming a racial justice issue. One that has been exacerbated by the COVID-19 pandemic, but stems from historic inequities, including high rates of incarceration, the economic disenfranchisement, and the loss of community cohesion in Black communities. Next slide. That same study, the National Survey on Drug Use and Health, also showed that Black people in particular, sorry, Black Americans, yes, in particular, are not getting the treatment. So treatment gaps exist within a unique historical context, creating these really stark differences in whom and who gets treatment and who doesn't get treatment. We're saying 90% of people with a substance use disorder are not getting treatment. Those people that have a co-occurring mental illness and substance use disorder that are 18 or above, 91% not getting any treatment. Anybody with a mental illness period, regardless of the substance use disorder, about 67% are not getting treatment. Next slide. So part of this is like thinking also about why are we at the place we are today? And I do believe, and a lot of work has been done in the policy arena, as well as thinking about the U.S. drug policies in the 20th century, and how that has really shaped, essentially, how we think about drugs, how we think about, how we decide, how we stigmatize people who use drugs, and really the criminalization of substance use, period. This started, next slide, with the Harrison Act in the 1800s, but then moved on, next slide, into many other acts and drug policies that really have shaped what we see and what we do. The Harrison Act, in particular, that's not noted on this slide, that came prior to the 1920 National Prohibition Act, really set the policy landscape. That act uncoupled addiction from medical practice, leaving drug policy to be created through a lens that stigmatized and criminalized individuals in need of treatment. They essentially said that physicians could not prescribe medicine for someone who came in with a substance use issue. So what we see over the next decades over this slide is policies that criminalized possession, created the war on drugs that has essentially, if no one has failed, and it ultimately impacted Black people and other people of color at far higher rates than their white counterparts. All of these policies have impacted Black people more than their white counterparts. Next slide. Despite relatively uniform rates of substance use among racial and ethnic populations, there is this disproportionate rate of drug arrest for Black Americans. Next slide. The ACLU report entitled, A Tale of Two Countries, really documented this persistent inequality. It showed that the increasing number of states actually legalizing or decriminalizing if we take one substance in particular, cannabis, it really has not reduced the national trends and racial inequities, which has remained unchanged since 2010. Black people are more likely to be arrested for cannabis possession. And in some states, Black people were up to six, eight, or almost 10 times more likely to be arrested. In 31 states, racial inequities were actually larger in 2018 than they were in 2010. And this is when we're thinking about the legalization of cannabis. So all in all, there's really a significant disparity in how the legalization of cannabis has really helped decriminalization. And so policy, even though we were able to change some policies, there are still inequities that many of us are now stating, well, these inequities look like based on stereotypes, based on the way people look, based on a lot of bias and ultimately racism. Next slide. This slide really shows these graphs of the disproportionate rates of incarceration as compared to the US population for Black people. And what the drive home message for me in this slide is really thinking how people of color experience discrimination at every stage of the carceral system. They're more likely to be stopped, searched, arrested, convicted, partially sentenced, and saddled with a lifelong criminal record. This is particularly the case for drug law violations. Black people, again, 13% of the US population are consistently documented to use substances at similar rates to people of other races, but are about 30% of those arrested for drug law violations and nearly 40% of those incarcerated in state or federal prison for drug law violations. Next slide. This leads right to the likelihood of lifetime imprisonment for one in three for Black men, one in three. And as we know, when in prison, there's a cascade of events that follow, being denied child custody, voting rights, employment, getting a loan, any type of licensing, any type of financial or student aid, anything to do with public housing or any other public assistance. So even if a person doesn't face jail or prison time, a drug conviction often imposes a lifelong ban on many aspects of their social, their economic, and their political life. Next slide, please. And we can't forget, I mean, some of us may be mental health clinicians on the call today and thinking about the mental health toll of all of this, regardless of what came first, the substance use issue, the mental health issue, the difficulties in life, there is a psychological toll when all this isn't happening to people. Human Rights Watch wrote a report on the human toll of criminalizing drug use. Two quotes from that. They disrupt, disrupt, disrupt our lives. From the time the cuffs are put on you, from the time you're confronted, you feel subhuman. You're treated like garbage. You're talked to unprofessionally. Just the arrest is aggressive to subdue you as a person, to break you as a man. I consider myself an addict and sometimes I worry what I'm using because they search you for no reason. The cops know me. Most of the time they see me, they stop me, they search me. It makes it harder to live life when you're walking down the street, watching your back, but at the same time, when you don't have your drug, it makes you sick. Next slide. So Michelle Alexander so poignantly and the new Jim Crow in 2010. So we haven't come very far now in 2022, but nothing has contributed more to the systemic mass incarceration of people of color in the United States than this war on drugs. Next slide. I'm gonna move into talking a little bit on equities and OUD treatment and why that historical context I believe is so important. We should all know that. I'm giving you a glimpse of history. There's more, I'm sure all of us would need to know about this, but in this short talk today, I want you to know at least some of that historical context to set the stage for some of the reasons things are happening the way they are now. Research has shown colleagues, Legis Setti and her colleagues in Michigan in 2019, analyzed outpatient prescriptions and found that black patients were 70% less likely to receive a prescription for buprenorphine at their visit when controlling for payment method, sex, and age. It really demonstrated at this time that buprenorphine treatment is really concentrated among white people and those with private insurance or self-pay. Those with fewer economic resources are even less likely to get these FDA approved medications to treat addiction. So we really need more policy and research efforts to address racial and ethnic minorities and economic differences in treatment in order for people to access, engage in treatment. We also know that with mental health parity legislation, Medicaid expansion, we still, the proportion of self-pay buprenorphine visits remain relatively steady, even though there've been expansion and parity from a policy level. A study in Ohio in particular has showed how physicians or only half of the physicians are still prescribing buprenorphine. There's stigma involved with that, which we can touch on in a little bit. And then also some of the study also show there's just widespread financial barriers for low income folks to gain access to buprenorphine treatment. Next slide. So I didn't wanna leave it at just that. We can't just blame it on socioeconomic status for why people don't get access to treatment. This study shows that exactly. Killaroo in 2020 followed essentially people who were privately insured. So these are black people who actually have insurance and they were still half as likely to obtain treatment following an overdose compared to non-Hispanic white patients, even when they're privately insured. So it's not just a socioeconomic factor. Next slide. Andra Kock Christow in 2021 wrote a paper and thinking about these complexities and what is the issue with, we have FDA approved treatment, black people are not accessing them at the same rates. Buprenorphine treatment, she says, is largely unavailable to people of color, the very people who could most benefit from its lower stigma. And why she's saying that is, next slide, when we're comparing this to methadone maintenance treatment programs. There are about 1,800 opioid treatment programs nationally, otherwise known as OTPs. They're highly regulated by federal and state governments. They're highly stigmatized and they have historical roots as well on this war on drugs. The regulations framed methadone treatment not as part of a physician patient therapeutic relationship, but as part of a tightly controlled system with extensive surveillance that implied distrust of patients. So here's another example of distrust in the medical system, in the healthcare system for black people in particular. And many black communities view this as a source of social control. And rightfully so in many ways, because what we've seen during the pandemic is that many of these state and federal guidelines were loosened, right? Methadone clinics, typically you have to line up, there's people congregating and they didn't want that happen. They didn't want people getting exposed in that way. And so once, right, you can go and get your one take-home visit per week, that was loosened during the pandemic. And now there's 14 day take-homes for quote unquote unstable patient and 28 days for stable patient. Who decides that? OTPs decide that. We can talk about bias, stereotype, discrimination, the subjectivity when it's not rooted in science, in any type of objective data, and who decides how many take-homes you get. So despite the wealth of evidence supporting methadone treatment, it remains highly stigmatized, excessively regulated. And most people with opioid use disorder lack access to any type of long-term methadone treatment. Next slide. So what can we do? In my final few minutes, I'm gonna run through these slides to give Erin the rest of the time. Next slide. But thinking about how do we think about ultimately the whole person when they come into treatment? I put this slide here because we can't think of just treating the opioid use disorder in isolation, just thinking about the medicine or the therapy modality that we may be using, but really thinking about everything. I hope I've set up that I do believe, hold heartedly, that racism is part of a social determinant of health. When we think about social determinants of health, we think of downstream and upstream. And if we don't get rid of those upstream social and institutional inequities around racism, discrimination, classism, and poverty, we will constantly in the healthcare field be dealing with addressing these health outcomes, poor nutrition, chronic disease, shortened life expectancy for black people, infant mortality, black women dying at higher rates when they're having a baby. We have to also think about addressing individual social needs in the part of substance use treatment. Thinking about housing, transportation, how are they impacting about getting a job, getting their income? All of that really has to be thought about if we're really gonna promote the person thriving in the healthcare industry and in the recovery. Next slide. So I think about many things when we're thinking about how do each of us think through a racial equity lens? How do we incorporate this into our practice? I think that the minority stress framework is one that stems from several social and psychological theoretical orientations. It's really that relationship between a marginalized group and the dominant group and the resulting conflict within that social environment. And so what I mean by the minority stress framework is that there are assumptions that there are stressors unique to those that are not stigmatized. There are stressors unique to black people. And some of these are socially based. Most of them are socially based based on the color of their skin. We have policies that are rooted in structural racism and inequities. So all of us are doing work with people who have opiate use disorder and who are being treated as a black person. We also have to think about their intersecting identities. We have to think about the community that they're coming from. And we have to understand all pieces of them in order to engage them and retain them in treatment. Some of this work has to be done with the community. Every single one of us on this webinar today are coming from a different community. The community needs to be engaged in this process of thinking about how do we incorporate equity into our policies, even within our community health center, our OTP, wherever we are. Bringing in the community to help engage in that process is critical. How do we think about patient-centered and trauma-informed care? Discrimination, stigma, racism is a form of trauma. We have to address that. We have to talk about race and clinical encounters. If we're scared to talk about that or if it makes us uncomfortable, we need to talk to get our own supervision and think about talking to other colleagues because we have to be able to address that with patients. How do we use inclusive language and culturally responsive care? Looking around our clinics, our pamphlets, brochures, our videos, everything we're using to get people into treatment and maybe that first step in engaging. Does anything look like them? Speak the language that they speak. Think about that. Education and training for staff is critical. We have to come to terms with our own racist ideas, our own stereotypes, our own biases as people that work and want to engage people in treatment. We have to think about how do we engage in more webinars like this, get other trainings for your staff in order to think about what biases are at play that make you engage with a person differently and then they disengage from care. Last but not least, we have to, in all walks and everything we're doing, decrease stigma, racism, and discrimination. Next slide. Some other key principles in thinking about how do we make treatment timely and readily available? We know that substance use disorders in general or opiate use disorders in particular for the purposes of today, it's on a continuum. People will move on that continuum, right? Of wanting treatment, not wanting treatment, wanting to do part of a treatment, but maybe they're really ready to engage and how do we help them do that? Here at Boston Medical Center where I work, we have every entry point into the hospital, there is no wrong door is an approach we use. So from the emergency room to an outpatient clinic to you're going to see your primary care doctor, there is a way to engage somebody in substance use disorder treatment. Needs to focus on the whole individual and not just the substance. What other factors are hindering that person's success? I'm thinking about how long you want to engage that person in treatment and then thinking about other therapies that are culturally responsive. Next slide. Regardless of the type of medication to the points I just made, we can initiate treatment, but we also want to help people engage and retain them in treatment. And that is going to be with that relationship building, how they were treated during that initial encounter is so pivotal to keep them engaged and what other supports are they going to need to be engaged? Next slide. I'm going to skip this slide for the purpose of time and next slide. One, on this particular slide, I wanted to just show a culturally responsive, culturally tailored example. Dr. Ayanna Jordan and Dr. Cheryl Bellamy at Yale and NYU are using a church-based model called the Imani Breakthrough Recovery Program to really think about a faith-based approach for the Black and Latinx community to engage them in treatment that is culturally, spiritually, and trauma-informed. They have a group component and they have a wellness component. And with all of that, they're always thinking about relationships, community supports, and recovery supports in the model. Next slide. Workforce is extremely important. Too few providers of medication for OUD exist, period. 16% of specialty SUD treatment programs in the U.S. offer any medication for opiate use disorder. Many providers of medication for opiate use disorders do not accept Medicaid. That creates a huge access barrier for people with Medicaid coverage. Next slide. Two programs, one at Yale, one here at BU BMC, we're really thinking about how do we think about the workforce in general? How do we get people more comfortable with engaging people with substance use disorders from a culturally responsive way and treating the co-occurring mental health and substance use as well, and not that people have to be siloed and go to different providers to get the care that they need. Next slide. The workforce here as well, thinking about nurse practitioner, Graykin Center here at Boston Medical Center, we've launched a fellowship program for nurses to provide comprehensive, immersive, and specialized treating in the care of persons with SUD. It's one of the nation's first addiction fellowships for registered nurses. The also, SAMHSA has a physician assistant training program thinking about a standardized SUD curriculum as part of the PA education. So also just expanding our workforce, the more people that understand SUD, the more people that understand opioid use and can think about the culturally responsive care, the better for our patients in general. Next slide. Next slide. I end with just a couple of slides on making sure we all know the criteria for opioid use disorder and really not being afraid to get people the help they need if they're meeting some of these criteria and they're really, wherever they are, on severe or mild or moderate or in remission, how do we keep them engaged in treatment and thinking about that? So this is just explaining what is that criteria for opioid use disorder in general and when engaging people for therapy or what kind of treatment they're willing to engage in regardless of the point of severity that they're at. Next slide. And last but not least, just the different advantages and disadvantages when we think about opioid use disorder medicine. Andre's gonna talk a lot about the other treatments for opioid use disorder, but thinking about agonist versus a partial agonist versus an antagonist medication. So opioid agonist medications work by activating the mu receptors in ways that kind of have that same rewarding effects for people. Methadone is a full agonist that fully activates that receptor. Buprenorphine is a partial agonist, so it partially activates that mu receptor and it has a sealing effect that diminishes its potential to cause rewarding effects. And then the opioid antagonist medication prevents opioids from activating the opioid receptor system, unlike methadone or buprenorphine. Sometimes people get leery of prescribing things like buprenorphine because they're thinking that people are gonna divert the medication, that somehow they're gonna, but that is really not happening. And what we think from a research perspective, what has been done to date is that really people sometimes divert or get off the street because they don't have access to the medicine to begin with. We saw the workforce issues of people not prescribing medicine and not offering medicine, period, to people that was dated from the Lagisletti and Kural studies as well, that not being even offered a medicine to help with their substance use issues. So how do, you know, there are advantages and disadvantages to every medicine, regardless of their medicines for opioid use disorder. How do we talk with people about that and also help engage in all of those other aspects I mentioned earlier of what are the other things hindering from them engaging in treatment? Next slide. So opioid disorder is treatable through, excuse me, medication. Thanks everybody, I'm okay. So my last slide is opioid disorders treatable through medication, recovery supports, evidence-based therapies, racism, stigma, discrimination, and policy institution and interpersonally mediated have profound inequities in black people receiving timely accessible treatment. We need to think about culturally responsive care that recognizes our own biases, our own stigma and discrimination toward black people and create services that are attuned and aligned with the community culture. With that, I thank you all and I'll pass it on to Andre. Wow, thank you, thank you, thank you so much, Dr. Durham. And thank you to the National Council for Mental Wellbeing team, Erin, Casey and Emma. You all have done an excellent job pulling this together. So I'll talk about recovery-oriented systems of care as it relates to intersecting with harm reduction. Next slide, please. The educational objectives of my presentation will be to really understand and develop evidence-based best practices related to the intersection of harm reduction. As you all can see, we are in Detroit, the great Motor City, aka Motown, and it's cold right now. Next slide, please. So Detroit Recovery Project is a nonprofit organization that was established in 2005 to really work towards reducing the high recidivism rates. At the time, we averaged 15,000 people in treatment and we discovered that 80% of those people were relapsing within the first 30 days of completing treatment, whether they were in treatment or methadone programs here in the city of Detroit. And at that time, I was challenged to start what we know as Detroit Recovery Project to develop and create recovery program and to support people wherever they are and meet people where exactly they are. Next slide, please. Fast forward over the last couple of years, we were blessed to receive funding from SAMHSA that helped to really launch our certified community behavioral health clinic. And it allowed us to expand our services to include not only recovery support services, but also include physical health services and mental health services as well. So we have psychiatry, medical doctor, nurse practitioners, and we're really approaching this as it relates to holistic care, holistic care of services for the individuals that we serve. Next slide, please. And as we evolved, we've also really campaigned for prevention. And when I say prevention, I'm talking about a little bit of not only prevention, relapse prevention for people who are in recovery, but also harm reduction. And harm reduction and syringe services, we know they go together. However, there tends to be lack of actual resources to support syringe programs. But we do have, we've done some fundraising and some private support from individuals and foundations to purchase syringes. We pass out about 150,000 syringes per year. And we have an array of harm reduction activities. We have a mobile crisis unit out in the community 24 seven. We have a HIV AIDS prevention staff that's providing rapid HIV testing, rapid hepatitis C testing, also linking people who are positive, linking them to care. We also have a collegiate recovery where we're involved in some of our community and universities and building a strong collegiate recovery community. The recovery community is large, it's untapped in all aspects of our society. And so it's important to just embrace the power, the community and meet people wherever they are. We're also just launched a youth community center as well, where we're targeting young people between young adults, 18 to about 25 years old, and building a recovery community within that population. Next slide. We are a city with a large medical marijuana dispensary. We have over two to 300 marijuana dispensaries throughout the city of Detroit. And so as you all know, marijuana is readily accessible in our community. So we have a number of evidence-based best practices that we use to try to curtail alcohol, tobacco and other drug use that's among young people. And we're also working to combat, as you all know, Dr. Durham had done an excellent job talking about the inequities and we're working to reduce some of the inequities, particularly around HIV and hepatitis C. Those numbers have not really gone down in the last 20 years. So here in Detroit, we see the alarming numbers of not only SUD and incarceration, but the health disparities that exist as it relates to some of these other illnesses and diseases that come as a direct result of substance use disorder usage. Next slide, please. This here is just a picture of our mobile vehicle that's moving around throughout Detroit. Some people call it the Scooby-Doo van. We have a full medical clinic on this mobile unit. Next slide. Next slide. And obviously this is a real picture of a client. One of the clients that we see on a regular basis, our nurse staff, nurse practitioners often ride with our team as well and help to provide medical care for these individuals. A lot of people, long-term or long-term IV drug usage and poor blood circulation and abscesses, et cetera. And so we provide, you know, cleaning drug, using supplies. We provide education on safe smoking and Jackson practices, but more importantly, we provide linkage to care for people who need treatment, wound care, et cetera. Next slide. That's Amanda, one of our just fantastic staff. She's a person, long-term recovery over several years of being clean. And she talks about, you know, spending time incarcerated, talks about using heroin. And now she's just a thriving, bright young lady who's actually leading our whole youth recovery department unit. She's just doing so well. So I love to highlight some of the staff, but also, as you can see, these are just some of the bullets that discuss some of the operation of our mobile unit, but also, and of course, motivational interviewing is a key component to really engage the people who are like sitting somewhere on the Viaduct or somewhere on the corner or what have you. Next slide. I was sharing with the team earlier where we're right in the belly of the beast. We're in an area, one of the highest prostitution areas in the city of Detroit, particularly transgender prostitution. The whole gamut, drug using, drug investment community, we're right here where the people trying to meet the heart, where some would say hard to reach population. And these just here, these just gives a glimpse of some of the programming's titles that we have, particularly as related to some of our funding initiatives as it relates to recovery. We know that recovery people come from the jail system. They come from the prison system and they're just everyday community folks. And so our role and goal has been to continuously mobilize this community so that we can continue to support the recovery community at large. Next slide, please. Here just provide some of the examples of some other services we provide as relates to SBIRT doing screening, brief intervention and referrals to treatment. And again, one-on-one mentorship, recovery coaching, a variety of 12-step support groups, life skill workshops, wellness, yoga. We do mindfulness meditation. We have a fitness gym, a pool area. We have recovery housing. And again, advocacy is a major important part. Dr. Durham talked a lot about policy. We've been sought out in our state and local government to advise on some policy issues to try to change these policies. Like for example, the box where you complete a job application, people have to write yes or no as relates to felony. Major issue that often keeps and prevents people from securing meaningful employment. And it's a lot of work that needs to be done, not enough. Next slide, please. We've also launched Recovery Training Institute. One of the things we discovered being in the urban areas that most of the training that occurs, it's around the state of Michigan. And so oftentimes the people who need the training that's right here in the heart of Detroit don't get it. And so we've been fortunate to provide recovery coaching training to help individuals become certified recovery coaches in the state of Michigan. And this has turned out to be a very positive program. We've trained well over 200 individuals in the last four years. Next slide, please. And that's just a flyer that kind of talks about and highlights some of it. Next slide, please. Oh, and I did want to mention, go back, please. And as you'll notice, we also became a registered apprenticeship program with Department of Labor, which is also an opportunity to help us expand our behavioral health workforce, because we know that addiction has grown. However, the workforce staff has not grown as fast as addiction has grown in our community. And so we have a lot of people aging out of leadership positions in this area and our region, and we need to continuously entice and be creative about training future leaders of tomorrow that works in this field. And so I was really happy to hear Dr. Durham talk about the nurse practitioners and some of the fellowship opportunities they have out in Boston. Next slide, please. Here's just some of the bullets that highlights a variety of evidence-based best practice interventions that we use. Most of these are, you can find on SAMHSA's website. Next slide, please. This here is just some of the recent data that we collected around some of our programs. As you can see, we served 863 individuals in the last year that received primary care and behavioral health services, as well as group support. Out of that, 125 received recovery coaching. Then we have, you know, when we do a lot of building communities of recovery, which has really mobilized the community statewide, we were able to reach out to nearly 700 people. And our recovery training institute over the last, this past year, trained 100 people. And then these are just some of the other data. Next slide, please. Okay, takeaways. Proper planning prevents poor performance. Understand your population, quality of life. Understand some of the biological and environmental stresses I think is important. And then obviously, as we understand that, we can begin a design and develop programs that truly meet the population where they are. And lastly, we need more boost on the ground services. We need people in the community that can have an impact and connect with the community. And I think that will conclude my presentation. There are some references for you all who may be interested in retrieving some of that information, but I know we don't have too much time left. So I wanted to make sure we had enough time for Dr. Durham and I to have Q&A. Thank you all so much for your patience. Okay, thank you so much, Dr. Durham and Mr. Johnson for such a comprehensive and informative presentation. So with that, we are now ready to take questions from the audience. So it looks like Dr. Durham has already answered this in the Q&A, but I think this is a really important question just to answer out loud for everyone to hear. Speaking of methadone, why is it that historically black folk get offered methadone instead of buprenorphine? Our challenge is that community members who can benefit from bup are already prescribed high doses of methadone and would have to taper down to 30 milligrams to transition. So one of the things I know about buprenorphine when it hit the market years ago, it really wasn't necessarily designed for the black people. You know, it was really designed for working white people. It was designed for people to go to their primary care physician and get access to buprenorphine. And in Detroit, it was designed for black people to go to their primary care physician and get access to buprenorphine. And in Detroit, we average about 10,000 people. We can drive down different parts of the city and see people in line at seven o'clock in the morning getting this methadone maintenance. And so I think really the buprenorphine was it's now been a lot more accessible in order to prescribe it. You had to go through a lot of trainings. A lot of doctors didn't wanna go through the trainings that was required by SAMHSA, but it's become slowly more available I think in urban communities. Dr. Durham, did you have something you wanna say about it? Yeah, no, I agree with that. And I guess the other thing I'll add is to somebody else had made a point that there are some states that aren't covering it. And some of that we've seen in research, right? There aren't, and if people are uninsured or underinsured, then they're just gonna use methadone, obviously, that's gonna be the only thing accessible to them. But within, part of this is what we saw that people that were working and did have private insurance, they weren't even being offered. And so something you said, Andre, at the beginning of your presentation is that ultimately I think you gotta meet people where they are and what they want. Like if somebody, are we presenting all options to people? And that I don't know for sure. Are we presenting both the methadone and buprenorphine option to folks? Or are we just deciding as clinicians, oh, you can only get methadone and oh, you look like you could do buprenorphine. And that's something we have to reconcile as a field to make sure we're giving, we're offering everything and giving them pros and cons and helping people then decide what would benefit and be helpful to them. This goes along, I guess I'll just go ahead and say it with another question someone asked about, well, someone said methadone is more effective than buprenorphine. And there's no research to show that to date. But what happens that maybe people aren't dosed at the appropriate dose of buprenorphine. So are people just giving too low of a dose? Like that's a problem, but that one is more effective than the other is not accurate. There's no, at least research to this point to support that. Great, thank you both. Another question, clearly we know that the Just Say No campaign has not been effective. So what are some effective school or community interventions to prevent exposure to these drugs? Andrew, do you want to take that? You know, I'm just thinking, so like the Say No campaign, I don't want to go down that. I think Dr. Durham talked about Michelle Alexander and the Jim Crow and the war on drugs and how all of that wasn't necessarily, how it was totally ineffective. But when we talk about kids in schools, we need programs in schools where drug uses are more prevalent. I mean, some communities based on zip codes, we know that drugs are more prevalent. And so we need more programming to really provide more intervention and prevention programs in those areas where the challenges exist most. We know the zip codes, we know the locations, but again, we have to be creative and strategic to ensure that those areas where there's more drug uses, violence, and all that stuff kind of go together, particularly in high schools and middle schools in this urban community. But it's no one size fit all. It has to be a collaborative approach. It has to be a community approach. And I think that's what's really important. Really good programming that I think we've been successful with has always involved a variety of, as CACA or Community Anti-Coalition of America talk about just the whole collaborative approach that bridges the church community, the business sector, the nonprofit sector, the recovery sector. Again, each community is different and I think we have to develop programs unique to the community. Yeah, and the only one other additional thing I say, I agree with all of that. Like there is no one size fits all approach, but someone who's also a child psychiatrist as myself, like in child work and adolescent work, it's just always important to engage the family. And kids that start using substances at an early age, even what we quote unquote call experimenting, people like to call it experimenting, we need to talk about it. We need to talk about it and the family should be engaged in talking about it. So I'll just, I'll leave that there. Perfect. Great. Along the same lines of engagement, in terms of outreach and connecting with the community, are there any complications with the quote unquote traditional supports of AA and NA? This person says that in their experience, AA and NA are not always the most diverse of organizations. So just thinking about how we can better engage folks. Well, I think again, it's all about each community. Fortunately for me, I'm a person of long-term recovery, which means I haven't used no drugs, no alcohol in over 33 years. So I've been very connected with the AA and NA community here in our region throughout the country. And so everything is somewhat political, right? And it's just about knowing who are the people you can bridge and build relationships with. The 12-step programs you discussed are anonymous. So a lot of times there's a way to, I always say there's more than one way to skin a cat. It's just being able to build relationships and work together where people can have a shared mutual common interest to heal the community and build a community. And I think it just takes an understanding. People are interested, but sometimes people connect with the wrong people who are not connected with the community. For me, I think we've been successful because one, I've been a leader in our community as a professional individual, but I also know a number of leaders in that space. And it was easy to kind of bring people together and say, hey, this is what we need to do for the larger community. Any more questions? Let's see. We have a comment here that incarceration also has an impact on medical care. Could you talk a little bit more about how that impact manifests? Well, I think, for example, we have programs that target people coming out of prison and jail to conduct HIV testing. You get tested when you go into the jail system, but you don't get tested when you come out. So that's just one area. I know that when people come out of prison, they come out HIV positive. That can have an impact. That has an impact on our medical system. Or people come out of the hospital, I mean, coming out of prison with other comorbidity challenges, whether it's physical health or substance use challenges that never were treated or addressed. And so that has an impact on our medical system. Dr. Durham, did you have anything to add in terms of incarceration and medical care? I don't know if I'm fully understanding the question, which may be so. I don't know if I'm answering correctly, but I guess my overarching statement is that we shouldn't use the carceral system to start people in treatment. And that sometimes is what ends up happening, right? Like people are using drugs in the community. They get stopped for some possession or use. And then all of a sudden, they're at a point where now they're in front of a judge. And then all of a sudden, we're using the legal system incarceration to get people treatment. And that is, we need to be working in a very different way of how do we get people treatment earlier. And no other than the opioid use disorder and the opioid crisis to exemplify what we're talking about. Cocaine was very much, you have a problem, you are a bad person and you need to go to prison. Opioid has been much more of a white problem initially. And it was, oh, you have a disease, you need help. How do we get you into treatment? How do we keep you out of the carceral system? I hope we've learned a lot from this opioid epidemic because we did not learn from the cocaine epidemic. What we still see is the carceral system is almost like it's the answer. So I think we need to be thinking way ahead before people get stuck in and out then of the carceral system, because of the reasons Andre just said as well is that you get out and then all of a sudden, you don't have access to anything to help get you back on your feet. So how can we think of this, I think differently from the get-go? Great. It looks like we have time for just one more question. So let's close out with, do you have any good guidance on how substance use disorder treatment programs, recovery and harm reduction programs can be less discriminatory and more culturally responsive so that they're more acceptable and respectful to black communities and able to better engage black communities? I think that's a little bit of what we started. This is a brief presentation today from both of us. And I do think what both Andre and I think have said is that you have to start with whatever community you're serving. So I gave the example of what's happening in the New Haven area with the black church. They assess their community and that doesn't mean that Andre's community, my community or another community down the street here in New Haven, they don't assess their community. They assess their community and that doesn't mean that Andre's community, my community or another community down the street here in Boston, that everyone wants to engage in the church for their treatment because they're actually doing treatment within the church setting. All of our communities are different. Black people are not a monolith. I want to say that again, like black people are not a monolith with different intersecting identities come from different walks of life, just like white people. And so assess within your community, do an assessment, bring people in, figure out, hey, what can we do differently in this setting to engage people? One of our faculty members here is doing a community advisory board. I mean, from start to finish of like, what questions should we be asking? How should we have people come to when they do the meeting, what should it look like? What should we have? Every detail is important to make it a comfortable setting for people to want to have treatment, engage in treatment and retain them in treatment. So that's a hard question to answer in like a minute. But I do think the one thing to start with is like wherever you are, there are people there that are by and from the community and we have to listen. We're not doing that enough. We don't do that in academia where I sit. I know that. We haven't done that in healthcare. And so we need to reimagine what this looks like. And then we have to go to our policymakers too and do more research in these areas so that we can get more funding as well. So I know it's this huge cycle of work that we all have to do. But at a personal level, each one of us has bias. Each one of us probably has stereotypes that are ingrained and we need to think differently about how we approach people and have some insight into that. So whether that is starting to engage in, you know, do you have black friends? Do you talk to other black people? Like even engaging at that level so that you can see people in a different light because I think people are only looking at people like through one lens. And that is not fair to every single individual who's coming in for treatment in our various clinical settings. Well said. I would just add, understand the narrative in those communities. Sit down and listen and collect stories, collect the narrative so you can better understand the individuals and the needs that these individuals have. Because sometimes it's easy for people on the outside to recommend what people need and not really know exactly if you're hitting home. And so if you really want to know your community, sit down and talk to your community. And a good way to do that is just saying, hey, we're going to have a lunch and learn and break bread. And, you know, Dr. Durham talked about community needs assessment. Assess it. That was the very first thing I had done before we started Detroit Recovery Project was we've done a community needs assessment survey on 400 people. And we sat down and we had a series of survey questions that was developed by a small group. And then we develop a bigger survey to really get an understanding of the needs. And so all the services that we provide have been strategically provided based on the needs of our community. All right. Well, that's all the time that we have today. I'd like to thank Dr. Durham and Mr. Johnson again for presenting today. We are so appreciative of both of your willingness to share your knowledge and expertise with everyone. Thank you. It's been a pleasure. A pleasure meeting everyone and thank you all. Yes, thank you all. Some great questions. Thank you. So before we close for today, I'd like to make everyone aware of two resources offered through PCSS that may be of interest. First, the PCSS Mentor Program is designed to offer mentoring assistance to those in need of more one-on-one interactions with one of your colleagues to address clinical questions. And we also have the option of requesting a mentor for the mentor directory or PCSS can pair you with one. So for more information, please visit the PCSS website noted on this slide. Secondly, PCSS offers a discussion forum comprised of PCSS mentors and other experts in the field who help provide prompt responses to clinical cases and questions. There is a mentor on call each month who is available to address any submitted questions through the discussion forum. I mean, you can create a new login account by clicking the image. Hey, Joseph, how you doing, man? The registration page. And this slide consists of a consortium of lead partner organizations that are part of the PCSS project. And finally, the PCSS website, contact info and social media handles are all listed here if you would like to find out more about the resources and trainings offered. So once again, thank you all for joining our webinar today and we hope you have a great rest of your day and a great rest of your week.

webinar

Addressing OUD and BIPOC Communities

Treatment and Recovery

African American Communities

inequities

culturally responsive care

social determinants of health

harm reduction approaches

barriers to medication-assisted treatments

health disparities