All right, I think most people are connected now, so we can go ahead and get started. Good morning, everyone. My name is Emily Mossberg, and I am a technology transfer specialist with the Opioid Response Network. And Carl, you can go to the next slide, if it will let you. There we go. Perfect. Yes, before we get started, I just want to acknowledge that funding for today's presentation was made possible in part by a grant from SAMHSA. The SAMHSA-funded Opioid Response Network assists organizations and communities by providing free training and consultation on topics related to prevention, treatment, recovery, and harm reduction for opioid and stimulant use disorders. And you can go ahead to the next slide. And to do this work, we utilize consultants who are located all over the country and who can respond to local needs. And anyone can submit a request for assistance on our website at opioidresponsenetwork.org. And today, the Opioid Response Network is honored to be partnering with Community House Mental Health to bring you training on substance use disorder and opioid use disorder 101. Just a note, we are recording the session and it will be available in about a week for revisiting or sharing with anyone who was unable to attend. And if you have any questions, feel free to put them in the chat. And with that, with gratitude, I will go ahead and pass it over to our consultant and trainer for today, Dr. Carl Hyshaw. Thank you, Emily. I appreciate that. Amali, I really do appreciate the invitation to be in the space. As Emily mentioned, my name is Carl Hyshaw. Full disclosure, I am not a medical doctor. I'm a doctor of social work. So just wanna make sure that is very clear. I am pleased to really be with you. I fashioned myself as this interventionist who really works at the intersection of health and wellness issues, including HIV, housing stability, youth engagement, restorative justice matters, and mental health, including substance use disorders. I happen to be the founder of the Ahmad Institute. Ahmad is a community-based organization. Our name is after an acronym of Arming Myself Our name is after an acronym of Arming Minorities Against Addiction and Disease. We are a peer-to-peer recovery community organization based in South Los Angeles. I founded this organization in large part because I was seeking to find support within a specific community. I was struggling and I needed to find support. And so I created Ahmad. And Ahmad is a Swahili word that means support. I wanna be clear as we get ready to get started that I don't profess to have all of the answers, but rather I found myself addressing these issues within my community. And I've been seeking to learn more and more every day. And so I consider myself to be in constant learning and development. And I hope that many of you who are also in learning and development are willing to share and provide feedback as you see fit. I am certain that I don't know everything. And I am also certain that it is probable and possible that others in the room will know a lot more than me. I'm gonna go to the next slide. I wanna make it clear that I did take some liberties with regards to accessing resources from other presentations that have been prepared before me. And so my presentation really is an adaptation of the work of others who came before me. We're gonna hopefully address each of these objectives really to discuss the impact of substance use and the key points of consideration related to addiction and specifically opioids. And we're gonna describe risk factors for substance use and substance use disorder. And we are going to identify strategies to reduce the harmful effects of substance use and review things to consider to providing support. This is somewhat, this is one-on-one. So let's just really be clear that there will be room to go in deeper with regards to many of the things that we will talk about. So why don't we just go ahead and jump right on into the subject matter? There really are some alarming statistics concerning drug overdose deaths in the US and it paints a grim picture of escalating public health crisis. In 2021, the nation witnessed more than 106,000 lives lost to drug overdoses. This number is just not a statistic. It represents individuals from all walks of life leaving behind a void in families and communities across the country. And while there are implications across all communities, I would be remissed if I did not mention that there are glaring disproportionate impacts on marginalized communities like people of color and those within the LGBT community, which I belong to. The surge in fatality marks a significant escalation in the crisis reflecting deeper underlying issues such as increased availability of potent synthetic opioids like fentanyl, mental health challenges and systemic barriers to accessing effective treatment and support. This dramatic increase is further underscored by the rate of overdose deaths, which rose by 14% from 2020's rate of 28.3 per 100,000 population to 32.4% per 100,000 population in 2021. So such a dramatic uptake signals an urgent need for comprehensive strategies that address both prevention and intervention aiming to curb the devastating trend that continues to claim more than 100,000 lives annually. The rise in synthetic opioids and drug overdose death marks a significant and troubling trend with the ongoing crisis. And synthetic compounds excluding methadone have really become the dominant force behind the overdose surge. These potent substances are responsible for an overwhelming 88% of opioid-involved overdose deaths. And in 2021, opioids were implicated in more than 80,000 fatalities accounting for 95% of all drug overdose. This is a clear indicator of the devastating impact that synthetic opioids have had on public health. And the crisis is compounded by the increasing incidence of drug overdoses involved psychostimulants like methamphetamine both with and without synthetic substances. So this alarming trend underscores the urgent need of comprehensive strategies to combat the proliferation of deadly consequences. So the deadly impact of fentanyl really cannot be overstated. What is fentanyl? So really a mere two milligrams equivalent to a few grains of table salt can be fatal for most people. This small amount makes dosage control virtually impossible for street-level drug preparations leading to a high risk of accidental overdoses. And emergency services have reported a significant increase in fallouts related to fentanyl, stretching resources thin and highlighting the drug's potential danger. And the ripple effects extend beyond individual users. Families are torn apart by grief and loss. Communities suffer from increased crime and diminished safety. And we know that our local healthcare systems are involved or excuse me, overwhelmed by the urgent need for treatment and overdose reversal interventions. So the spread of fentanyl into the illicit drug market represents just not just a public health crisis, but a complex social issue that demands comprehensive strategies, including education, prevention, treatment availability expansion and other strategies to mitigate lethal impact. So as I was preparing for this discussion, someone along the way pointed out that I should make this local resource known and I encourage each of you to explore it. It is the King County Overdose Death Rate Dashboard. So according to King County Public Health, fentanyl deaths in the county have skyrocketed, increasing 42% from 2021 to 2022. And then the dashboard goes deeper into the data showing the spike in overdose calls, all of which lined up with the increasing death rate. And this chart is just as alarming as the previous. So understanding addiction really requires a comprehensive look at the intricate dance between genetic predisposition and environmental influences. While genetics accounts for 50 to 75% of an individual's risk of developing addiction, according to the National Institutes of Health, this complex condition cannot be attributed to heredity factors alone. Environmental elements such as exposure to drugs, stress levels, social networks play a crucial role in triggering or mitigating addictions onset. The brain's mechanism involved in addiction underscores the interplay between biology and environment. It's really illustrating how external stimuli can influence gene expression and potentially lead to addictive behavior. The initiation of substance use during adolescence is really a significant predictor of the future of addiction. Marking a critical period in an individual's development. Observational studies shed light on this alarming trend, revealing that nine out of 10 people grappling with addiction began their substance use before reaching the age of 18. This early exposure interrupts the natural progression of brain development, heightening the risk of developing addictive behaviors. The stat also underscores a stark reality. One in four Americans who started using any form of addictive substances in their youth now battles addiction. This evidence underscores the urgent need to understand and address the profound impact that early engagement with addictive substance has on long-term health and societal well-being. So understanding the intricate dynamics of behavioral development requires a keen understanding of both risk and protective factors that influence an individual's trajectory. Risk factors such as aggressive behavior in childhood, insufficient parental supervision, and community poverty can significantly predispose individuals to developmental challenges and maladaptive outcomes. These elements often interact with the environment in complex ways, potentially setting a foundation for future behavioral issues. And then conversely, protective factors, they serve as buffers against these risks. They're attributes like self-efficacy, robust parental monitoring and support, along with accessible neighborhood resources. These all play pivotal roles in fostering resilience amongst adversity. By navigating the interplay between the risk and the protective elements, we gain insights into the mechanisms that underpin behavioral development and uncover avenues for intervention and support. Developmental risks. So early temperament and attachment in the earlier youth are considered part of the developmental risks. And then in middle school, the way in which young folks engage or display self-control or aggression, the degree to which there's permissive parenting, all of that plays a factor. And then in adolescent years, academic mastery, school engagement, parental supervision, and of course peers, and similarly in young adults, adult role models, leaving home and college, these are all things that can create risk with regards to addiction. Biological risks. I hope it's okay. I'm gonna go ahead and skip this slide, but I did wanna leave it in for folks to really consider the biological risks in the mix of their understanding, but I'm gonna go ahead and keep moving over that slide. The psychological risks. The intricate relationship between substance use disorder and mental health conditions such as depression, anxiety, and psychotic disorders is multifaceted and deeply intertwined. Individuals grappling with SUD often find their struggles compounded by current occurring mental health issues, which can both precipitate and exacerbate substance use. Depression and anxiety can drive an individual towards substance use as a form of self-medication, seeking temporary relief from their symptoms. Conversely, the chronic use of substances can lead to the development of worsening or depressive anxiety symptoms, creating a vicious cycle that is hard to break. And then those with psychotic disorders may find that substance use aggravates their symptoms or triggers new episodes. Understanding this complex interplay is crucial for developing effective treatment strategies that address both SUD and co-occurring mental health issues concurrently. And then environmental risks. Understanding the role of environment plays involves examining how external factors shape behavior and predisposition towards addictive substances. Exposure to environments where substance use is normalized, such as within family settings or peer groups, that significantly impacts an individual's likelihood of engaging in similar behavior. High levels of conflict and poor communication within the family can exacerbate vulnerabilities leading to substance use as coping mechanisms. And additionally, weak family dynamics fail to provide the necessary support and guidance, leaving individuals more susceptible to external influences that promote substance use. And this complex interplay really underscores the importance of addressing environmental factors in preventing and treating substance use disorder. Association with other conditions. So in 2022, the landscape of mental health and substance use disorders amongst adults age 18 or older painted a complex picture as detailed in this SAMHSA National Survey for Drug Use and Health Annual Report. This is a chart from that report. This period saw a continuation of trends from previous years alongside emergent challenges exacerbated by global events, including the lingering effects of the COVID pandemic. And the report categorized conditions into any mental illness or any serious mental illness alongside substance use disorder, really providing a comprehensive overview of the state of mental health and substance use dependency in the adult population. The year underscored that the prevalence and the impact of these conditions on individuals' lives, families, and communities at large. And mental illness range from moderate psychological distress to severe disorders that significantly hindered daily functioning. And substance use disorder remained a critical concern with alcohol and opioids and emergent substances contributing to the multifaceted public health issue. But the data collected in 22 served not only as a reflection point, but also lays a blueprint for understanding patterns, identifying gaps in care and support system and redirecting resources towards the effective interventions. I encourage you all to pick up that report. It really does provide insight, invaluable insight for policymakers, people like us, healthcare providers and community leaders aiming to address the challenges head on. Again, this is a SAMHSA National Survey on Drug Use and Health Report. Understanding the link between substance abuse and mental health conditions. So substance misuse at its core can lead to a range of physical and psychological problems from liver damage and heart disease to anxiety and depression. And the relationship is not merely one way. Individuals with pre-existing medical conditions may turn to drugs or alcohol as a form of self-medication inadvertently setting the stage for addiction. The psychological effects of substances on the body can directly cause certain medical conditions to worsen over existing ones. For example, opioids can lead to gastrointestinal problems among other health issues. And it is commonly known that alcohol misuse increases the risk of a liver disease, such as cirrhosis. And addiction often leads to neglect of general health care, exacerbating chronic conditions like diabetes and hypertension due to poor management. And psychologically, substances that offer temporary relief from substance symptoms, but ultimately they contribute to a cycle where both mental health disorders and addiction feed into each other. Substance misuse and medical conditions are often entangled in this kind of reciprocal dynamic that demands comprehensive treatment approaches addressing aspects simultaneously. And the interplay between chronic pain and addiction forms a significant broader nexus. Chronic pain that can stem from various medical ailments or injuries not only debilitates individuals physically, but also exerts profound psychological distress. In an endeavor to really mitigate the relentless discomfort, many really do turn to opioids to really mitigate that discomfort. And so the transition from a legitimate medical use to dependency is significant. And over time, the body develops tolerance, necessitating higher doses to achieve the same level of pain relief. This escalation can foster an addictive cycle where the pursuit of pain alleviation becomes intertwined with the compulsion for the drug itself. And the psychological aspect of chronic pain, the constant battle against its limitation can exacerbate feelings of depression and anxiety. This further fuels a reliance on substances as a form of escapism or self-medication. So again, chronic pain serves not merely as a physical ailment, but as a catalyst that propels individuals into the throes of addiction. The challenge of managing that co-occurring disorder in addiction treatment is multifaceted issue that complicates the path to recovery. And so when addiction is accompanied by medical and or mental health disorders, the complexity of treatment intensifies. These co-occurring disorders demand an integrated approach to care that addresses both the addiction and the medical conditions simultaneously. And treatment plans must be highly individualized, taking into account the unique interplay between a person's addiction and their medical condition. This level of personalization requires extensive resources and time. And these are luxuries that many treatment facilities are stretched too thin to afford. And I'm sure I'm speaking to the fire when I make that statement. So the social impact in the context of opioids and substance use disorder, particularly as it relates to incarceration, is especially complex and multifaceted as an issue that really has far-reaching implications across various demographics. But with notable disparities among people of color, it often leads individuals down a path marred by legal troubles and subsequent jail time. Once entangled in the criminal justice system, or I dare say the criminal legal system, because I struggle with thinking that justice is a part of it, these individuals face incarceration, which marks just the beginning of a long-term societal impact. So families are torn apart, as I said earlier. Children are displaced. And once incarcerated individuals reenter society, they often, and after they reenter society, they often face insurmountable challenges in securing employment, reintegrating successfully into the criminal records. And then jail, the jail time at all does little to address the root. And so without proper treatment and support systems in place, recidivism rates just really remain high. And consequently, the cycle perpetuates a systemic issue that affects community cohesion, economic stability, and public health resources, highlighting an urgent need for reformative approaches that prioritize rehabilitation over punishment. And then the ripple effects of partner violence exacerbated by opioid addiction and incarceration extends far beyond the immediate harm to victims, permeating various layers of society in profound ways. When opioid addiction takes hold, the dynamics within a relationship can dramatically shift, often escalating tension and leading to increased incidents of partner violence. This destructive path not only inflicts physical and emotional trauma on the victims, but also sets off on a cascade of secondary societal impacts. Children exposed to such environments are particularly vulnerable, carrying the psychological scars into adulthood, which may affect their future relationships and mental health. Before I start going further, is there anyone who wants to chime in on anything that I've said? Are there disagreements? Are there co-signing? Or is it okay that I keep going on down this road? I will keep on going down this road. So what can you do to prevent opioid misuses? What can we do with our clients and the people we work with every day? We have to really be willing to talk about it. We should have these conversations in non-judgmental ways about preventing drug misuse and overdose. And we need to talk with the people we come into contact with to be safe, really coming from this harm reduction approach. You know, abstinence, of course, is ideal, but a harm reduction approach is necessary for many people. Only take opioid medication as prescribed, but always store them in secure places and dispose of unused medication properly is an important thing that we should talk to clients about. We need to talk to clients about understanding their pain, knowing what addiction is, and being prepared for overdose and having naloxone and other overdose-reversing drugs that could save life. You know, there are many within my community when I started initially talking about harm reduction and broadening the tool belt to work with the individuals we work with, there were some alarming concerns. Some traditional 12-steppers pushed back with great understanding. But in an effort to really reach more and more, we really had to kind of embrace and expand our understanding of harm reduction as we talk about it as a, a part of our toolbox along a recovery journey. There are many pathways to recovery, and sometimes a harm reduction approach is absolutely appropriate. There are really many mechanisms for harmful drug effects. You know, kind of the direct is really based on individual's desire, you know, to be intoxicated, which can lead to overdose. Other direct effects are based on undesired effects, illness, chronic sickness, disease. And then there are indirect harmful effects based on the method of administration, and then other indirect rates, ways based on associated behavior, contracting HIV or STDs are indirect harmful effects. Or mechanisms for drug effects. The science of addiction, key components that drive compulsion, that compulsive drug use is a dopamine release that leads to subjective feelings of pleasure and reward and reduction in feelings of stress. Helping our clients to understand this as what's happening is a part of the work. Repeated use of override impulse inhibition, the dorsal straddle circuit, repeated use and it's also associated with discomfort when stopped, which leads to more use, withdrawal and mood dysregulation, and dysregulation of executive functions. It's important that these things are talked about with clients so that they better understand what's happening with their bodies in their drug use, part of the education piece. What really makes addiction a disease? Addiction is a disease because it has defined causes, genetic and environment, and they are observable consequences, behavior as well as biological. And it makes it a disease that is really based on science. It's what the medical doctors have also agreed to. It's widely agreed. And so addiction is a chronic relapsing disease that affect the brain and cause compulsive drug seeking and use despite harmful consequences. This is really understood and advocated by the National Institute on Drug Abuse, the American Society of Addiction Medicine, and the American Medical Association amongst others that are authorities on the matter. Comparison to chronic conditions like depression, type two, diabetes, hypertension and asthma, similar treatment adherence and reoccurrence rates result from voluntary behavior that are difficult to manage behaviorally. They may be caused in part by genetic factors and response to ongoing treatment. So some will have to engage in lifelong management of the condition just like any other chronic disease. So this slide compares reoccurrence rates substance use disorder and recovery with patients or in clients who suffer from diabetes, hypertension and asthma. And reoccurrence rates are similar for drug addiction and well-known chronic illnesses. So reoccurrence is common and similar across the illness as is adherence to medication. Thus drug addiction should be treated and evaluated like any other chronic illness. Opioid use disorder, moderate or severe are medical disorders that can be treated effectively with medications and comprehensive services. There is no reliable cure, but clients who comply with treatment regimens have more favorable outcomes. And understanding addiction from the disease model framework is essential for medication-assisted treatment, MAT. And there's been a lot of MAT advocacy happening throughout the nation. One would say, does relapse to drug use mean treatment has failed? And my answer is no. The chronic nature of addiction means that relapsing to drugs use is not only possible, but it's likely, especially in one's earlier steps. Relapse rates are similar to those of other well-categorized chronic medical illnesses, such as hypertension, asthma, which also have both physiological and behavioral components. So relapse is the return to drug use after an attempt to stop has failed. And treatment of chronic disease involves changing deeply embedded behavior. So relapsing back to drug use indicates that treatment needs to be reinstated or adjusted or that alternative treatment is needed. So no single treatment is right for everyone. And treatment providers really must choose an optimal treatment plan in consultation with the individual, the client, and should consider the client's unique history and circumstances. There is no one size fit all within substance use disorder. The initial decision to take drugs generally is voluntary. However, with continued use, a person's ability to exert self-control comes seriously impaired. And so the brain imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decision-making, learning, memory, and behavioral control. There is science to this. And the scientists believe that these changes alter the way the brain works and may help explain the compulsion and the destructive behaviors of a person who becomes addicted. The activation of the brain's reward system really is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be profound that they neglect other normal activities in favor of taking the drug. And the pharmacological mechanisms for each class of drug are different, but the activation of the reward system is similar across substances and producing feelings of pleasure or euphoria, which is often referred to as high. Tolerance. When the brain is flooded with outside substances that mimic natural endorphins, the system gets confused and it thinks it's making too many endorphins and shuts the process down. And the brain produces more receptors to increase uptake and balance intake. And prolonged use means more receptors that need to be filled to produce the same effects. That's tolerance. And the receptors have, at the same time, have become desynthesized to the endorphins and the substances. So prolonged use creates more opioid receptors as a part of drug regulating associated with more use. And this really results in the entire system being dysregulated. What happens next? The system becomes reliant upon external substances. Now the body needs more substances to get the same effect, but because they increase influx, receptors also down-regulate until they basically shut down. And at this point, the balancing act is to avoid the withdrawal and the natural system becomes unstable when substances are removed. If we can spend just a little bit of time talking about specific terminology, drug use, misuse, and addiction. And there's been a great shift over the years to really use more humanistic and appropriate language and I think all of us within the field of work, sometimes we are still changing our mindset, not using words like calling people an addict, not saying whether someone is clean or dirty. All of those language shifts are important as we seek to de-stigmatize the way in which we address and engage people in care. But drug use, that term is any scope use of illegal drugs. The term risky drug use really refers to the improper unhealthy use of a medication as prescribed or alcohol in moderation, include the repeated use of drugs that to produce pleasure, that alleviate stress and alter or avoid a reality. It also includes- Hey Carl, oh, sorry to interrupt you. I think your screen is frozen. You're still back on the withdrawal slide. I think it was supposed to be on the slide after that, but we're not seeing that slide. You don't see drug use, risky use, addiction? No, not yet. I think it's like slowly going there just so everyone knows. I think there's just a little bit of a lag. So we're on the accurate terminology slide. It's hopefully it's still moving forward. There we go. Now we're on, I think we're on the correct slide now. We see drug use, risky drug use, and addiction. Yes, I'm sorry. Maybe I should turn off my camera. Yeah, that's fine, that's fine. Yeah, I am in a hotel with slow internet. So, but yes, addiction. Uh-oh, looks like we just lost him. Hopefully he'll hop right back on. Sorry everyone, oh, there he is. Looks like I fell out and I came back again. Yeah, at least you came back on fast. OK, is my screen still sharing? No, it is not. I think you need to re-share. I am so sorry. Hopefully it's sharing. It says that it's sharing, but we're not seeing anything on your screen. Oh, there it goes. OK, we're good. I am so sorry about this technology. And it's OK. So addiction generally refers to substance use disorders at the severe end of a spectrum characterized by a person's inability to control the impulse to use substances, even when there are negative consequences. And behavioral changes are also accompanied by change in the brain functions, especially if the brain's natural inhibitions and rewards center. And my slide is not advanced either. There we go. Hopefully you can see an advanced slide. So then again, back to more terminology, tolerance and withdrawal. We're not seeing that slide just yet, just so you're aware. I don't know why it's being so slow. Oh, there we go. Now it's just a little bit of lag. OK, and I will start pushing the button a little earlier, if you will. Tolerance. Yeah, needing to. Oh, no. Thanks for your patience everyone. Hotel Wi-Fi, definitely not the greatest. Stay calm, Carl. And we will get to this. So hopefully it is sharing again. I've switched over to a hotspot. Oh, good. Hopefully that will help. It's just that my hotspot was going pretty slow, which is why I was trying to use the hotel's piece. So hopefully we're good. Hopefully... Screen is still loading. It says double click to enter full screen mode. It just looks black right now. Oh, there we go. Okay, we're good. Okay, something's happened. Okay. So with withdrawals, I'm going to move on, but we, I think we have hit the nail on the head with regards to understanding tolerance and we know what withdrawals are. And then I'm going to move on to the next slide. And I mentioned this a little bit earlier, related to language and stigma. And it is dragging on my end, not wanting to advance. Are you able to see slides that say language and stigma? Yes, we're on the correct slide now. Okay, so again, as I mentioned, we have, as a community, really started to switch our language to change things so that the language doesn't stigmatize people with specific health conditions. So personal stigma really can present a shame or self-hatred. The whole point is to help remove that. Social stigma really involves negative perceptions and the labels that lead to isolation and rejection. And institutional stigma, which includes negative treatment and attitudes from health care providers and media, law enforcement. All of these things are important and contribute. The language that we use contributes to the degree in which individuals are able to access care. And those suffering from the disease of addiction who feel stigmatized, they're less likely to seek treatment. They're going to be less likely to stay engaged, and they're more likely to feel isolated in the work. And so the real stigma of substance use disorder really does come into play in our language. And again, more terminology, harmful bench, heavy displays. I thought I had deleted some of these slides here. Okay. Principles of drug addiction treatment. I just wanted to cover a few important points that are related to addiction being complex but treatable. Again, reminding us that there are effects. It really affects the brain and our behavior, and there's no single treatment that is appropriate for everyone. And treatment can be readily available in communities. And the effect of treatment really attends. Okay. Hopefully, this will be better this time. Again, remaining in treatment for an adequate period of time is critical. And as I got cut out at the last time, I was wanting to make the point related to effective treatment across multiple needs. People don't live their lives in bubbles. And so providing to people who have multiple needs, it's important that all of those needs are being touched upon in some sort of a way. That's just especially important, really using kind of a team approach, if you will, to the work at which we do as engaging clients. And that's what we try to do at Ahmad through our peer-based work with navigators, medical benefits specialists, recovery coaches, all providing a team approach to someone along their recovery journey. Behavioral therapies, including individual, family, or group counseling, they really are the most common forms used in substance use treatment and highly celebrated. And more and more medications are an important element of the treatment for many people when combined with behavioral therapy. And an individual's treatment and service plan, again, must be assessed continually and modified over the course of time to make sure that things are meeting his or her changing needs. Many drug-addicted individuals also have other mental health disorders that we talked about. And again, medically-assisted detoxification is only the first stage of an addiction treatment. And by itself, it really does little to change long-term drug misuse. Treatment does not need to be voluntary to be effective. People can get it over time. And then drug use during treatment must be monitored continuously as lapses during treatment do occur. And then finally, treatment programs should test patients for HIV, Hep C, hepatitis B, tuberculosis, and other infectious disease, as well as provide targeted risk reduction counseling, linking clients to treatment as necessary. Now, many counselors and providers use this comprehensive treatment model that really does seek to address a person's hope. Not many. Many are growing to want to treat people from a whole-person point of view. And addressing all of these subpoints is especially important in the work that we do. Treatment modalities, individual pathways. There are many pathways to recovery, whether, again, it's clinical or behavioral or individual groups. Peer support programs. Contingency management. There are a growing number of self-help organizations or 12-step groups and fellowships to connect people with. Mindfulness and meditation. Faith-based support. Experimental therapies and pharmacological and medical assistant treatment. Again, it's growing, especially within medical assistance treatment for opioid use disorder. I actually thought we had deleted some of these slides here. So, for opioid use disorder, there are three medications that are used for MAT treatment, and it's methadone. Methadone usually happens in more kind of, for lack of a better word, feral clinic-type environments. Bercamutadine, which I can never say the word, never say the word, often is associated with insurances and an office setting. And then Nalnextron, the version that is—I want to get the right term. I'm sorry. The intramuscular injection for Nalnextron is what's approved for opioid use disorder. Nalnextron also has a pill form that is used for alcohol addiction treatment. How the medication works for opioid use disorder. All three work to reduce or block the effects of the opioids. Methadone really fully occupies the receptor, like a key to a lot. And then buprenorphine does not complete it blind. They feel or they act as a filter. And then the Nalnextron are non-narcotic blocks to the receptors and is a barrier for other opioids. All of these longer-acting medications have greater affinity to the opioid receptors, and that is what the scientists are saying. And that is why MAT is such a growing cool in our toolkit of work with our clients. Nalnextron is approved by the FDA to prevent overdose for heroin, morphine, oxycotin. And again, it's an injection or a nasal spray. I'm going to skip that. I'm going to flip over to see if there are any questions or discussions that we can have now as we get ready to come to a close not too far from now. I apologize again for the technical assistance issues and my Wi-Fi issues. But are there any questions that we have? Any comments that we have? I didn't necessarily want this to turn into me blah, blah, blah, blah, me talking. I was hoping that we have some dialogue. And anything that you all have to say, I greatly appreciate it. And if not, no worries. Well, I have a quick question between Vivitrol, Suboxone and Subutex and Methadone. Can you expand a little bit on the appropriateness for use for what clientele we would use those for? So I'll be honest, that's going to go further into my knowledge base. It does seem as if much of it is going to be dependent upon a client's payment source and whatever medical provider that they are working with. My understanding is, you know, some of the methadone clinics, well, at least here in California, is supported by what we call Medi-Cal and the publicly supported funding source for treatment. Buprenorphine is not supported by that payment source and there have been discussions that the other options, there needs to be more advocacy to make them available across the board. But I'll be honest, it's a little bit beyond my knowledge base, if that makes sense, Mollie. No worries. Thank you very much. Thank you. Any other questions or feedback, suggestions? So as I get ready to close out, I just, I again want to just point out that the work that I do is more from a grassroots community based setting. We really are about building rapport and community and really surrounding folks with peer support as an important component along their recovery journey. And so what I do day to day with the people I work with is spend lots of time helping to connect, yes, people to the resources and treatment alternatives, but especially important to us as an organization is the connection to community and building upon community is a part of the work that we do. And we really advocate for that across the board. I am going to go ahead and switch to the next slide for you all to do a ORN evaluation survey. If you could click the link below or take a screenshot of the QR code and do that evaluation, that would be very helpful for the folks at ORN as they do their planning and engagement and as they bring on others to do this work across the network. That's it. I'm going to turn it back over to Emily. Thank you, Carl, and thank you, everyone, for being with us and bearing with technical difficulties. I did put the survey link in the chat as well, because that can be easier to click. We can also scan the QR code through your phone. But if there are no other questions, I guess we can end here. I will have the recording of this session along with the slide deck materials available within a week, and I will send that to Molly to distribute to you all. I guess one last final call. Any questions? I'd just like to thank you both for doing this presentation. I think there is one question in the chat, but I'd like to thank you both for taking the time and effort to present this to us. We're very grateful. Of course. Kylie, you have a question? Yeah. I just unmuted myself. It was in regards to comparing it with other chronic illnesses. First of all, can you hear me? I can hear you. Okay. So with the comparison with other chronic illnesses, I was just curious, because of the psychological component in regards to the willingness, unwillingness, and other traumatic experiences in an individual's life, do you think it's doing substance abuse disorder a disservice? It almost seems like it's minimizing the totality of what substance abuse disorder encompasses. And I was just wondering that maybe it's almost minimizing it when you compare it to, like, diabetes or something like that. What do you think in regards to that? Well, I guess from my perspective, I can hear and see why that may raise an eyebrow. But chronic diseases are chronic diseases. You know, if you think about diabetes and someone who may be overweight, whose behavior, their eating behavior, may be contributing to their chronic diabetes, and they're not able to get their A1C levels in order, in large part because of their behavior and because they haven't been engaged in their medications as the doctor prescribes, there are life-threatening consequences that come with diabetes. You know, hypertension, you know, the diet and salt and the way in which people behave with regards to changing behavior to increase their, to better improve their numbers, they're just as chronic. There's just an opportunity to have a fatal reaction, if you will, to the way in which you treat your body on these other chronic diseases. Definitely see a correlation with that now. I was just wondering, I was like, hmm, that seems to be diminishing it in a certain sense. But with that comparison, the elaboration on it, I could definitely see the correlation. Right, right. I think also with that comparison, the benefit is really noting that the way that we treat other chronic diseases sometimes is different than how people treat substance use disorders. So kind of comparing it, you know, we don't judge people with diabetes who continue to eat certain foods. We don't, you know, turn them away or stigmatize them. So I think in that way, just comparing it in that way can help people understand just, you know, the benefits of seeing it as a chronic disease versus just something people are choosing. No, the stigmatization associated with substance abuse disorder is definitely real. And just the way people approach it from a comprehensive standpoint is definitely different. But when you categorize it, again, with hypertension, diabetes, and the milieu of other chronic illnesses, destigmatizing it is definitely, I think, a step in the right direction. And then with the advent or, you know, the push for MAT, medically-assisted treatment, really that concept of chronic disease and treating it from a medical standpoint, that notion is especially important. And I think that's how the scientists and the doctors are approaching it, again, from that medical standpoint, as a chronic disease that can be treated medically. Of course, with other supports that are intended to provide support for a long-term recovery. Okay, that's all I got. Thank you. Thanks for your question. Anyone else have anything? All right. Well, thank you all for your time. Molly, I'll be in touch. Thank you again, Carl, for your presentation today. We appreciate your time. Thank you. Thank you all. Bye, everyone. Thank you, Carl. Thank you, Emily.

Opioid Response Network

substance use disorder

opioid use disorder

SAMHSA

Ahmad Institute

peer-to-peer recovery

medically-assisted treatment

chronic illnesses

holistic treatment

individualized treatment plans