Speaker 0 00:00:00 Hey, thanks for tuning in again, to let's talk addiction, a bipo perspective. We wanna make you aware of our new email. If you need to contact us, you wanna send some feedback on the program. You can get in contact with us at let's talk
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[email protected]. Send us questions that you'd like to hear us discuss online. We'd be happy to include them in a future episode of the podcast. I'm Dr. Alfonso brown. And now let's get into this week's episode of let's talk addiction, a bipo perspective. Hello, everyone. If you're like most people, when you think of the dynamics of the opioid crisis and who it affects you think of rural and middle America, and most of those people are not individuals or members of the bipod community. Well, that all changed in 2021 reverse time ever. African Americans led all racial, ethnic groups in opioid related deaths. This had never occurred before. It's a curious fact, and an even more astounding finding what exactly changed over that time for several factors, it was a pandemic, more stress, mental illness, more political violence, and also national unrest. Yet it is unclear any of these factors influence this outcome. Well, today we're gonna start to talk about this challenging topic and hopes of trying to come up with some explanations. We'll then follow up in a subsequent episode where we look at potential solutions. You won't wanna miss this episode, join us today for let's talk addiction. A
Speaker 3 00:02:12 Name is Ernest Allen and, um, uh, today's topic is going to be, we're gonna be talking about overdose, race, uh, rates amongst the bipo population. Um, and we're gonna, uh, try to talk about some solutions and how, uh, this, this very serious serious health issue can be mitigated. And with that I pass, I allow, uh, everybody else the, the, our rest of our panel to introduce themselves. Go ahead, Leo.
Speaker 4 00:02:49 Good afternoon. I'm lay. I am recently grad from the base program. I am currently out on medical leave. I'm also a person with long term recovery, and I'm glad to be part of the panel. Thank you.
Speaker 3 00:03:11 Thank you, sister Melinda,
Speaker 5 00:03:14 Um, sister Melinda. Good afternoon, everyone. Sister Melinda. Pein. I'm a Catholic sister of St. Joseph. Um, I work as a chaplain. Um, I work with men and women in recovery and recently graduated from the base program.
Speaker 3 00:03:30 Thank you, Robert. Hello everyone. Good afternoon. I'm Robert Conley. I'm a public servant. Um, I work for volunteers of America in Boston, healthcare for the homeless, um, also a recent graduate of the base program, and I'm glad to be with my colleagues today. Thank you, Dr. Alfonso.
Speaker 0 00:03:58 Hi, everybody Alfonzo. I'm a clinician. I work with Cambridge health Alliance, um, on the Harvard teaching hospitals. I'm also, um, a clinical director at new beginning health PC, which is an addiction, um, treatment specialist clinic. I'm also a recent graduate of the base program and definitely happy and proud to be here with, uh, the steam group of colleagues on this panel. Uh, thank you.
Speaker 3 00:04:23 Okay, well, we're gonna begin, uh, overdose rates, overdose, um, is not a new issue actually. Uh, it's been a serious health problem, uh, for the past 10 years. However, with the introduction of fentanyl in the, uh, COVID virus, uh, rates have escalated. And with that, I will ask the panel to, uh, discuss their knowledge regarding, um, some root causes and some statistics regarding overdose rates. Anybody may chime in.
Speaker 5 00:05:04 I don't think that we should be so surprised about the increase of, um, overdose rates in, um, in our communities specifically, because I don't think we've ever dealt with this country. Our communities have never really dealt with the problem of ad addiction. And it, I, as I read the articles, especially the one on increases in the disparity of us drug overdose deaths by race and authenticity. I I'm saying to myself, a duh, of course, there's an increase in overdose deaths. And we, I mean, we didn't need COVID to tell us right, that this is what was going to happen. I think there, for me, there's two specific issues. One is we have never dealt with, um, race and, and trauma and we've we, and, and the eco economic, um, disparities in this country specifically among our communities, ha have always been an issue and therefore drug rates are high and therefore overdose rates and death are higher. And so until we specifically deal with those issues, that's what is going to continue to happen.
Speaker 3 00:06:26 Okay. I think, uh, let me just say this, uh, one of the problems, uh, uh, with we got in the past, um, the coroners and medical people, uh, didn't actually diagnose death as overdose. And I, I had several friends that died that I know of that died from overdose, but they caused a death, was like heart attack stroke and things like that. When I know they, they definitely died from an overdose. So I think just within the past, um, few years or so, they just begun, uh, to recognize death as being an overdose rather than causing it some something else.
Speaker 0 00:07:20 Well, Alfonso brown, uh, chime in, I, I was, uh, actually, um, very, uh, surprised by this recent, um, revelation that, um, in the period from 2019 to 2020, um, that there was an increase that, that individuals of African American descent in the us had the highest overall increase. And I think this was individuals age 65 and older mm-hmm <affirmative>. Um, because in my experience in the clinic that that's just not what I, what I've seen. Um, and I think the general conception had been that while, um, all communities were suffering from, um, problems with drug addiction and, and usage, um, that, uh, this was not the overdose related deaths was not something that we saw primarily in the African American and other bipod communities. So I, I was really surprised by why that was the case and why it took place for the first time, actually in the last, um, year and a half, two years. Uh, and so, uh, I hope that one of the things we can touch upon today is why that's actually the case. And if this data is real, which I think it is, and, and why it's happening now, what what's transpired in the last two years that has led to this. And as a system, Melinda was pointing out, I think, um, it doesn't bode well for our communities that
Speaker 5 00:08:49 No, in, in my
Speaker 4 00:08:54 Personal opinion, what has brought light to it in, in the last few years is the change in the population of people that are being identified as overdosing. I, I, you know, I have a really hard time, you know, with how, you know, mass and cast is identified. You know, they keep talking about mass and cast as if it's a new problem. Mass and cast is not a new problem. The only thing new about what's going on on mass and cast is the color of the people that are mass in cash. We have been overdosing for years, no light ever shined on it. Now all of a sudden the population of people have changed and the death rate is going up dramatically.
Speaker 4 00:09:54 It's bringing light to it. Mm-hmm <affirmative>. And so this is not a new problem. I had a conversation with, um, uh, uh, uh, I don't know whether he wants to be a Congressman or, or I, I honestly don't do the politic thing. And I honestly like to engage in conversations with him to be an idiot. And so, you know, they wanna talk about all the things they wanna bring to the communities and they wanna be stationed in the communities cuz they wanna help the community. And so me being a person and lived experience and long term recovery, I wanna know what you're gonna do about the opioid crisis and in my community, since you all wanna bring so much light and, and support and money to our community, what is your plan for that? And I gets, well, how long is it going be in discussion for, because we hear this regularly. You want me to come out and vote for you because of what you wanna do in my community for the population of people that I, I live amongst my children, my grandchildren, your grandchildren, and you all keep telling us the same thing. All we're talking about it, well talking is cheap. We wanna see some results. And at the end of the day there wouldn't be this much light shin on addiction in the crisis, if it was not affecting other it's my
Speaker 0 00:11:36 Yes. Excellent point. I'm I'm gonna ask everybody, whoever's not speaking. Please remember to mute your microphones. So, so that we reduce any echo, uh, background and, and I think we'll give the Florida system Melinda to follow up on that. Uh, can I also make a suggestion, um, because we might have viewers outside of the immediate area, maybe we should define what really we mean by mass and cast <laugh> and what that as our folks might not understand, uh, thing system, Melinda, I think you have the floor you can unmute. Um,
Speaker 5 00:12:17 No, I was saying that when you look at each of the articles, the reason why we're talking about it now and mass overdoses, I would agree with, um, uh, Mr. Allen, it would, it's just something that we're talking about now where you recognize it as overdose and death, where we didn't before we didn't associate the two things and what Lile says. Um, I, you know, we have to be, so we need to be more proactive if we know that the people that keep saying we're gonna do something about it, we have to find a way to make them do what they're supposed to, to do in our communities, because, um, if we don't do it, we know they're not gonna do it.
Speaker 3 00:13:13 Well, I like to say, um, good point layout and, um, Melina and, and bro barns. Um, my perspective is that the inequality of healthcare that black and indigenous people have by people of color have, and the disparities of, of the healthcare that they do get and the information I think the more information of, of, of stuff that could be done to prevention for prevention will actually help, um, that rate, that high rate that we ha um, have, um, you know, you have, um, prescription drugs, um, like Brupenorphine, and I think it's another drug, um, that's prescribed, but it's prescribed to methadone,
Speaker 0 00:14:01 I guess,
Speaker 3 00:14:01 Methadone. Um, it's described to people that's in the suburbs, people that have money and they're not out there on the mass and cast where the, where it's overdose, they having prescription drugs for their habits. And, um, what's happened is the information, they get the information and then they get a, a prescription. And they're not out there with needles in their arms with, with, um, taking this, this fentanyl, um, this lower level of a drug, a synthetic drug, I think the synthetic drugs and with the price of cheap and people are mixing it back in the days, they used to mix it with qu eye Bonita rat poison. Now, today they said something about at my job. Um, we had an overdose where a girl overdosed in the bathroom on Monday, um, and people missed it because they did three rounds before they realized she was there. But, um, what they said is they have this new stuff, horse tranquilizer. And when they mixed that into the drugs or the heroin or the opiate, the, um, the Narcan won't even bring you back, the Narcan won't even bring you back. That's something I found out this weekend from, from just at work. Um, you know, if somebody has that, Traer mixed with the opiates, when you Narcan that individual, they're not gonna come back. So that's my little piece on that, that subject. And I comment later,
Speaker 0 00:15:39 I wanna say excellent points to my colleagues and I, I wanted to ask, um, uh, just, uh, one question, uh, again, this is a, a new development and Mr. Allen, you brought up earlier the point that there might be an issue here of misclassification of, of overdoses. And Leo brought up that same point earlier. Um, I wanted to, to dive a little bit more in depth with that, because, um, if that is an explanation for what's going on, then again, why wasn't this, um, seen earlier what changed in the last year and a half, uh, to make this, uh, an issue that's coming to front and Rob, I also wanted to know if you could comment a little bit on what you see, because you're actually directly on the front line, uh, mass and cast. Um, and, um, you know, if you can tell us a little bit about, um, you know, what you, what your role is there and what you're seeing, and also whether you were surprised by this data as your experience been like folks like myself who have practices in areas where we don't see a lot of, um, individuals I've always wondered about this. So go ahead.
Speaker 3 00:16:54 Well, for, for me, um, I've been working ever since the mayor said that she was gonna, um, clean it up, um, and, and house people. So they went from harm reduction to low threshold. So low threshold, meaning that you bringing women off the street, um, that was on the street, sleeping, intense, sleeping on the sidewalk, and you have a low threshold. They can come in with an earliest name because you have street workers that go out there that been out there six months before this happened and know their names, their real names, and, and know their street names. They can come into the program, they have an am street box where they can bring their, their uses. They can bring their needles, they can bring their heroin, they can bring their cocaine. Um, they get a sweetheart kit when they leave a sweetheart kit consists of a, um, two straight shooters or, um, with, with, with, with condoms, um, with, um, vitamin C it break down the crack, cuz the crack breaks, it breaks down, it breaks down the crack or it breaks down the drug.
Speaker 3 00:18:02 Um, so what I, what I see over there, um, has much haven't changed the initial look for the TV when they bulldozing the tents. Um, it, they, it painted a good picture that Madison class was on the, um, men being cleaned up. But I, I just wrote through on my way home and it's, I, I have video next week. I send it to you and if you can upload it to, to the classroom, everybody to see, um, you have people with needles in their arms, you have people passed out on the street, you have police with the lights on not doing nothing. You have women that get hit. Um, it'ss almost like a zoo. Um, but that's, that's the population that, that I serve. I work in a women's shelter. Um, um, Thursday through Monday, um, like I said, overdose is, is, is not nothing new when somebody's overdosing.
Speaker 3 00:19:02 We are required. I'm a supervisor not to say overdose. They having hard problem or they having breathing problems. Cause you say overdose, the ambulance come so many times for overdose. They don't even come when they take their sweet time. So we are trained not to even say it's a overdose or potential overdose. We are trained to say they're having heart problems or they they're not breathing or they're unresponsive, but not to say overdose. So, um, it's, it's, it's a growing problem. I, I think that inequality of treatment, um, like my colleagues says, I think information and, um, you know, would, would, would be a start, but it's, it's money in it's big business and homelessness, his big business in drug companies. Um, you know, it came from the island. Um, a lot of the in transit people that not from the city of Boston, a lot of them, um, a lot of 'em don't look like us, but we have some that are like us.
Speaker 3 00:20:09 And it's, it's a shame because we have people that need the treatment, but don't have the information or trust the system enough to actually get in the program. So we have these programs that feed you that give you a bed that can, that you can take a shower, but the access to our people to get 'em, they don't have the information. And then when they try to get in, it's all booked up. You know, it's like I walked, um, across one of the girls in our program, one of our programs and she was laying on the bed with a blanket, with a guy, um, having, you know, sex when she has a bed in our program. You know, you have a bed, come on. What you doing? Laying on the street with a guy. Oh, her her boyfriend is like, well, I tell her to go home. I tell her to go home, but she won't be here with me. So these are some of the problems that we face down there. Um, but like I said, it's education, um, in, in the quality of the healthcare and the information has to be pumped out.
Speaker 3 00:21:12 Thank you. I, I, I, I wanna, uh, can you guys hear me? I want to comment on, on, on, um, one particular thing. Um, this is, uh, extreme, uh, an extreme discriminatory practice. He just said that he has to say that an individual is having a heart problem or having a stroke or having some other kind of problem. Now we know as professionals, addiction professionals, we know that if an individual is overdosing or has overdosed on a particular drug, then when the paramedics do come in order to effectively treat this person, they need to know what drug that individual are, are overdosed on. And if they don't have that information, then the death rate is going to be much higher. So this is a discriminatory practice. Okay. Now, when we talk about, uh, people of color or bipod people we know, and Jane mentioned it, Leo mentioned it, our sister, uh, Melinda mentioned it.
Speaker 3 00:22:31 Let's talk about structural racism. We know that that's a major cause of health disparities, but there's another thing that we need to look at particularly, uh, uh, uh, from bipo, uh, uh, folks from their perspective and Dr. FZO and I talked about this earlier, we talked about trauma informed care, and the reason that that's important, the reason, uh, trauma inform care is important because a lot of individuals that's been out there addicted on drugs, have been severely traumatized and particularly females and not single in that population out, but we know some of the experiences that females have. Okay. We know that some of the males, we have, uh, young males prostituting themselves and being, uh, subject to, to, to, to the same vicious, uh, behaviors. You know what I mean? So in our professionals, I'm talking about African American professionals, that's in the field, recommend that folks be treated regarding their trauma.
Speaker 3 00:23:43 So we must understand what an individual has been through. Okay. But when I hear something like Robert just said, and not down on your job, cause I know you do you do the best possible work that you could do. But that shame on the system, when I hear someone say, uh, you have to lie and save. Somebody has, has, uh, uh, experience in something else because they won't come. If they hear a person, uh, if you say the person has overdosed, come on. And this is so, so like Leo said, Le talked about, uh, our representatives, you know what I'm saying? We have some power and we in a position to do something about that through our representatives. If you don't speak on this policy, that's causing people to die. I'm quite sure some people gonna die on the way to the hospital. Then we gonna vote you outta office. Mm-hmm <affirmative> alright. I'm gonna, I'm I'm gonna pass it on to Leo.
Speaker 4 00:24:49 So, you know, Ernest, um, I have had occasion to meet with, um, several different representatives. Um, sorry, you gotta call me right back. Um, I've had an opportunity to meet with several different, uh, representatives in my path, um, that say that their, um, agenda is the recovery teams. Um, and some of the things that I've said to these representatives, uh, that you need to be getting your information from the frontline people, right? You're getting your information from the agency sources and, and, and I don't wanna call out the agencies, but most of us that work in this field know the agencies that are behind making some of these new policies and rules. And I have to say shamefully that I know some of the people that sit on those boards, I'm getting an echo, is everybody muted.
Speaker 4 00:25:57 I'm I, I, I, I know some of the folks that are sitting on those boards that also have lived experience that are making some of these decisions around low threshold and, uh, uh, uh, harm reduction. And part of the biggest problem I think that we are seeing is that we have to approach every person with trauma informed care, but the population of people that are working with the people that have trauma also have trauma. Most people that work in this field of addiction services have either been affected directly or indirectly by trauma on some level. And if we are not addressing our own trauma and we're not treating our own trauma, it's almost impossible for us to be there and work with a population of people that we know have been traumatized. And so our state representatives need to start getting their information from the frontline workers.
Speaker 4 00:27:04 Cause we're the people that are out there. I also work, um, with Rob, um, matter of fact, in, in, in almost two of the locations, um, one, he just moved on from that. We worked together with that population of women. And I also worked for volunteers of America as a recovery coach with the trauma in trauma infected population. And so when I talk to these St state representatives, I wanna know what type of, uh, uh, recovery teams are they putting in place to support the information, to support the problem. And so, again, the where they're getting their information from, it's sad to say the agencies are not doing a good job. Like you said, Ernest, the agencies are not doing a good job when we have to call and say the person unresponsive, because we can't tell them that they've overdosed, alls we can say is they're unresponsive. And so that's some of the biggest problem is that the population of people that are working with the people that are trauma, uh, uh, infected are also trauma infected. So we are treating trauma, informed people with trauma ties people,
Speaker 0 00:28:28 I think system Melinda had a commentary.
Speaker 5 00:28:31 So I, you know, I, I just so didn't agree with the article on meeting people where they are. I wanted to, to restate it, meeting people where they are is not a harm reduction program. I just, I don't see that as a viable way to help people through trauma, their mental health issues by, you know, I understand what Rob was saying. They get a, give them a clean bed, a clean bed and a needle, and they get, I, I just, I never agreed with it in Chicago. Our harm reduction was we gave them a place to stay with a clean bed. And we talked about their tr we worked on these women and their trauma. These were women that were on the street that were prostitutes for years and years. So we get that to me, that is effective harm reduction. The other stuff that I'm reading is putting a bandaid on the problem and then sending them out.
Speaker 5 00:29:40 Our kit was, they stayed for a substantial number of months in a program. And we spent months on just the trauma that they had, their childhood trauma. We had social workers that came in and this was expensive. And these women didn't have to pay for it. The, the, um, local government in Chicago in this, this, um, in the west side of Chicago, Chicago decided that they were going to dedicate their resources to these women in this house and deal with their trauma, then deal with the drug addiction. And another important piece of the program that I worked in was education vocational skills to get them out of the positions that they were in and to get them viable jobs. When they came out of this place, transition them into apartments that were affordable because they were in, um, vocational programs and they got skills and enough money to have an apartment, then talk about reunification of their children.
Speaker 5 00:30:54 So I'm so not in favor of this bandaid of harm reduction. We have to decide that these people are important enough that we spend every resource that we have to get them every service that they need, no matter how expensive it is to, to resolve the pro. I think that's the only way we do it. It's trauma. It's RA dealing with racism, it's education, it's reuniting them with their families. And I mean, we were committed. These women stayed for more than a year in the program and then transitioned into apartments in Chicago and then were unified with their HIL. That was our kit. Our kit was let's get to the trauma, let's get to the mental health issues, trauma going all the way back to their childhood. The number of women that were telling me they were raped by, uh, father and an uncle, the family history of drug and abuse, starting with that, I think is much more effective than that to me was harm reduction to get to sobriety.
Speaker 4 00:32:15 So I just have a question for sister Melinda, sister, Melinda, and then state of Massachusetts. We have a, a thing called a Corby. That's a barrier it's getting to housing to get to, uh, uh, Tojo. How did y'all get around that in Chicago?
Speaker 5 00:32:29 It wasn't the state of Massachusetts,
Speaker 4 00:32:31 Right? That's
Speaker 5 00:32:37 Have to work. Cheryl Coley Rivera is a, a state legislator who worked on programs. So that quarries would not be an issue for the, so you gotta work with people in the legislature, but in Chicago, they decided through in the mayor at the time was Ron Emmanuel that we have to do something about this problem. We create barriers so that people can't get a job. It can't get an apartment. So what do they do? And it's called Leonard ministries. They bought up an old, uh, 1920 apartment building for women called harvest house. And they dedicated federal and state money to creating studio apartments for these women. So it harm reduction means it's ongoing. It's not like you give them something and say, you know, like fend for yourself, try to find a program. It means that the state and the city and the local government has to be committed either.
Speaker 5 00:33:45 You want this problem solved, or you don't, and it's going to mean it's gonna cost money. It's going to co you're gonna have to have dedicated counselors who understand that this is a problem. And then you can't. Once these women left the sober house, we, there was still an assessment on them. We didn't just call them up on the phone. You go to visit them in that apartment complex, where a bunch of women who were still working the program, but they had jobs. And, and so I think you, you have to do all of those things. I think in this country, we're so missing the point. And one of the issues is how committed are you to your brother or sister who's in trouble? How com really, how committed are we to that? And in order to change policy, in order to change this, we have to say, I'm, I'm committed to working with my brother and or sister on this issue and what can I do to help improve your life? What can I do to help you, um, get where you need to go? And they were really committed. It's a small program in Chicago, but I think that is a model that we all should be looking at, but it's an expensive model. And it means a great deal of commitment in order. But what is a person worth, worth? Everything. We should be committed to that. And we, we, we are not, this country is not
Speaker 3 00:35:25 Sister Melinda. I would like to add and jump in. Um, a lot of this, um, what you saying is true and we don't do this for the money. You know, we, we, we have, have to survive because the money don't match the work that we do. But we do this for the love of our fellow man and women. And like you said, harm reduction is to do less harm is possible. But what I was talking about is low threshold. This is something else. They come up, that's lower than harm reduction, where these women that come into this thing, they give them housing. If they work the program, these women, some of them be in the sedation chair two times or three times a week. Right. And if they follow the program, they'll give them a section eight voucher. They don't have to make up their bed.
Speaker 3 00:36:21 They don't have to clean up their room. Nobody does it for 'em. So they live as if they living in the street because it's low threshold. Okay. And that's why they have amnesty boxes when they bring their amnesty boxes in, they go through a security check, but some of 'em are crafty. They put it in their bra, a loaded needle, a loaded works. This that stash it, or it gets through security check. Layo will do a room check and say, Uhuh, give me the needle, give me the needle. The women would say, I'm gimme my box or put it in my box, or I'm going outside. I'm going outside to use because they don't want to discard it. So with this low threshold program, their model is the model for low threshold is if we get them in the door and they don't have no requirements, but just to come, that's one less person that's in the streets.
Speaker 3 00:37:18 And we, we have services for them to utilize. And we meet them where they're at, which I don't agree. I'm like with you, but you have to meet people where they're at, but you, we meet them where they at and it'll catch on if one success or two success. So we get some success from this or this person come in low threshold, but they move up to harm reduction and move up from harm reduction into their own place working. And this, that, and another that's that's the model that it should be. But with low threshold, we have a girl been there. Six, six months has a section, eight voucher, but she, she wanna live in beacon hill. She, she, she goes, look at places. She have a section eight voucher for like $2,200, but she wanna go live somewhere where it's $4,000. So she stays there in the program because she gets her, her SSI, or she gets her food stamps.
Speaker 3 00:38:14 And she's in the program, all the food free in the beds free. And she's the baby of the program, cuz she was the first member of the program and she still did seven months later with a section eight voucher worth $2,200. So that that's my take. And I turned over to brother Ernest. Um, here, here's the thing. Um, I, I completely understand where both of you guys are coming from, uh, Robert, your program. As I understand it is a, even though you call it a, uh, harm reduction, it is a, what you call a, a means tested program. In other words, you have to do certain things in order to qualify for those services. Uh, system Melinda, uh, is talking about my understanding of this. And there's a program similar to in, um, Washington, the state of Washington. And it is a housing first program, right.
Speaker 3 00:39:20 And what they do, their aim, you know, and it all depends on, uh, uh, a program's mission. What is your mission? Is your mission, uh, to end homelessness or is it to treat the addiction? So the housing first program is mission is the end homelessness. So it is, they don't do what is called means tested. In other words, the individuals don't have to do or stop drinking or stop using drugs in order to get this particular service. You don't how to do nothing, but be in need. Okay. So now and Washington, the state of Washington, I forget the name of the program, but the program was highly successful. All the individual had now you gotta pay your rent. Okay. You have to do that. But what happened, the person was given a set of keys. Okay. There's no case manager coming to visit you, seeing, checking on you, seeing what you need, what that you doing, the right things that you stand sober.
Speaker 3 00:40:23 No. And what they found is the, uh, uh, uh, I won't say the majority, but a lot of the individuals that participated in this program ended up getting clean on their own or resolving their issues because the primary issue, I mean, come on shelter, which we know that's a basic human need. And, uh, and if the basic human needs are missing there, ain't much more to think about or that the individual's capable of thinking about, you know, to get a person, a roof over their head and get them some food. And now they can think clearly and they can see more clearly what's impacting their lives. Negatively is cause of them to get caught up in this vicious, vicious cycle. Okay. So I agree with what sister Belinda said that that particular, uh, uh, uh, uh, model works. However, there's also harm reduction, uh, models that work methadone, Suboxone, all those are harm reduction. Okay. Aimed at preventing, uh, uh, that we think is aimed at preventing addiction. No, it's aimed at, uh, preventing, uh, criminal behavior. Okay. That's what methadone does for individual helps the individual get stable. Okay. Now Roberts and Les's program, their program is basically, they say, you could do anything you wanna do. Okay. Our mission is to not allow you to kill yourself by being exposed to the elements.
Speaker 3 00:42:09 You know? So we talked about some different things here, you know, and it all depends on what, what particular organization's mission mission is.
Speaker 4 00:42:18 Agree,
Speaker 3 00:42:19 Agree,
Speaker 4 00:42:20 Agree, agree. And you know, Ernest, you know, you know, my that's been my, my, my, uh, uh, uh, soapbox, spiel housing, right? The, the security and the stability of housing allows you some freedom to be able to think about what it is that you can and cannot do. And, you know, we have folks that we are providing shelter for, but there's no security in those shelters. You gotta maintain your, uh, uh, your what's the word I'm thinking, um, your survival skills in them, shelters, you gotta always be guard in them. Shelters. There's no security in no shelters. You can't go into a shelter and lay down and go to sleep peacefully. You gotta sleep in your shoes cause they come up missing. You gotta talk anything of value. Like there's no security. So it doesn't allow you to freedom to be able to say, okay, I can put down these survival skills and so that I can move to the next destination.
Speaker 4 00:43:26 And so when we provide that basic need of housing, for which unfortunately our federal dollars in the state of Massachusetts doesn't allow convicted, uh, uh, criminals to have access to, or, or, you know, people that have substance use disorder to have access to we create and keep this vicious cycle going because you cannot act somebody to put down the very thing that has been keeping them alive or surviving in order to get to the next destination. And so Boston, and this is just Boston. Don't other experience with any other state is their, their programs are not designed for people to succeed.
Speaker 4 00:44:19 Again. I believe that they're getting their information for what's next in this crisis from the wrong people. They need it from the frontline people. We're on the front lines. You need to have a table, a advocacy board of people that are on the front lines that are working in these facilities saying, okay, this is what we seeing. And this is what we believe is going to be successful if nothing beats a failure, but a try and you they've tried several other things, harm reduction, low threshold, no threshold, you know, uh, um, and we're still in the crisis. So it's time for our public officials to get it for real, to get it together, like for, to get it together. We can keep talking about this stuff. They can keep putting the statistics out and the numbers out, but nothing's changing, but the numbers they're going up. That's mine.
Speaker 0 00:45:25 I, I, I, um, I had a go ahead. Go ahead. I'm sorry. I had a question as I was listening to this convers, there's some interesting points that were brought out in the articles that I wanted to draw attention to, because I think some of this data that was presented is not what you would think it is. For example, you know, part of the reason why we're having the discussion now is because we realized that the opioid associated deaths, the opioid deaths and saw over overdose death went up in the African American community for the first time ever. But the interesting, one of the interesting points was that it seemed like this rate of increase was highest in 65 year olds and greater. Now, I don't know if anyone saw that in the data, but I was asking myself, why would 65 year olds in particular be affected by this much more?
Speaker 0 00:46:16 The PO the, the percentage increase was greater than almost greater than 50%. Um, the other point, which I want, which sort of has been gotten at, but D addressing what, um, you you've been saying direct rail. And to an extent robed, the same thing was, um, one of the outcomes that they found was that if you lived in a community where there was access to medication associated treatment, I Suboxone and methadone, your risk of overdose was higher. So you have to ask yourself, why is it that if the, um, the treatment is there, you're seeing this rate of increase, which is much higher, um, despite the therapy, or at least one part of the therapy being there. And it might be as has been articulated so well when my colleagues Jane said this earlier system, Melinda gave this description of the successful plant in Chicago and lay you're, you're speaking to the fact that, um, you know, a lot of this might be that we're not getting the right people who the questions are being asked to, but, but the question still remains when you look at mass and cast.
Speaker 0 00:47:27 And for those who don't know, mass and cast is an area here in the Boston area. It's the intersection of Massachusetts avenue in Melina CA Boulevard. And it's essentially an open near 10 city and to an extended drug market. Uh, but it sits behind or in front of, or alongside, um, a shelter facility. Uh, there's a county jail nearby there, and there's also one of the largest and well that's well funded, uh, op um, drug and substance abuse treatment programs in the state. So the question is whether or not access is an issue that needs to be addressed. And cuz you know, the access is there for all of the components, law enforcement, um, uh, homelessness in terms of the shelter and then treatment, but it's not accessible. And so I, I wanted, if we can talk, I know we're our time is running. I, but I wanted us to, to maybe touch upon some of these things as they pertain to the excellent points that you've brought up, why is it that we saw this increase in death?
Speaker 0 00:48:33 It increased in, in several age brackets. They, they did it, I guess by 10 to 15 year old age brackets, but greatest in 65 year olds. Why would that be? Um, the other thing was that if you were in a community where there were resources available to treat addiction, you had a higher risk of, um, of, uh, of having an overdose and, and that doesn't seem intuitive to me either. Um, but one thing you might want to think about is there is a stigma with treating, you know, disease and, and, and for people who are older, um, they might not want to admit that they have a problem until it's too late. Younger people might not care, but if you're older and you've got a problem with drug addiction, that that might be something that you don't want a lot of people knowing. Oh, I don't know.
Speaker 0 00:49:20 And then the third is, as I mentioned, um, how do we propose a solution? Some of you have already, uh, have mentioned this, um, well has mentioned, um, about working with, um, the people on the front lines and getting their input and Rob than listening to what you said, you're about as close to the front lines as we get. Um, you know, uh, it's interesting, these points that you brought out about how things have to be described. And, and I don't know, maybe one of the reasons why that is happening is because you won't get, as you mentioned, you will not get there's so many people who potentially could overdose that if you say there's an overdose, it might be now that we've become desensitized to the fact that people are gonna overdose there. I, I don't know, but I think you guys brought up excellent points and, and I just wanted see in the many minutes, if we can try to judge some of those questions that I asked solution,
Speaker 5 00:50:17 I get,
Speaker 0 00:50:18 Go ahead, system
Speaker 5 00:50:19 Melinda. No, I was just saying, I've gotta go. I've gotta, I've gotta go, but can I just Robert, can I just say one thing and then I, uh, so I think number one, maybe they weren't looking at those stats and then maybe we just started paying attention to the 65 and above maybe it's the economic free fall that we've just gone through, but I tend to think we just weren't looking at it before. I don't think it should be a surprise. I don't think it's anything new. We just, we weren't paying attention to it before. I that's my opinion.
Speaker 3 00:50:57 Although, although, um, that, that, that age group was, um, I very high, um, uh, seven times the increase, I believe. Yes, but the, but the age, uh, uh, group that, uh, has the highest rate is the age group of 15 to 24. Um, it could be, uh, that, uh, like, like Dr Alfondo said the younger folks probably just don't care and not really not cognitive of their behavior in terms of the elderly folks, I believe. And, and, and, and, and I wouldn't, um, say this is written in stone, but a lot of that O O the O overdose has to do with, um, prescription drugs rather than, uh, fentanyl or heroin, um, you know, or, you know, you know, and particularly, uh, habituates, benzodiazepines, and probably some opiate prescription drugs as well. Um, I think that that may contribute to that, not reading the labels.
Speaker 3 00:52:11 There's a lot of things that we could, we could, we could, uh, point at and look at, uh, not reading the labels, uh, uh, perhaps, uh, taking a, a habituate or benzodiazepine and drinking alcohol. Uh, we know that, um, uh, if, if you, if you using in, uh, uh, uh, uh, uh, CN, um, S uh, depress it's five O and you mix that with a CNS depressant, then it does what you call potentiate and potentiate is like, it increases the drug 10 folds. For example, if you take a habitual and then you drink alcohol, now, the problem with that is habitual and alcohol have similar what they have called similar molecular structures. So what happens as a result, it increases the impact or effect of that alcohol, or it potentiate each other to the effect that it will not take much for individual to overdose.
Speaker 3 00:53:16 So I think, uh, like, and like in the labels of most medications, um, particularly, uh, CS depressive, they always caution, uh, do not indulge or do not drink alcohol. And, you know, cause cause because the, the, the, the end result of that could be fatal. So I think that might be one of the reasons I'm not saying that is the reason, but I, I think that might be a reason, you know, like, uh, like I said, we all know folks that have overdosed on, on, on, on drugs. I used to work in a shelter and, um, I know an individual, uh, they used to do, um, they used to, uh, shoot, shoot dope, shoot up heroin. And, and, and if the heroin that they use, wasn't strong enough just to, before the fentanyl, uh, uh, era, uh, wasn't strong enough, and they would use a habituate to increase the high problem with that is when folks are nodding out, they were noding out permanently <laugh>, you know what I'm saying? So, you know, so those are the issues. Those are some of the issues that we need to look at. Now, let me just say this and I'll pass it. Uh, there are variety of things that we can do in the way of solutions. You know, one is education two, I believe, uh, everything that, uh, is try harm reduction, uh, other different models, housing first, whatever model that you can think about that model will work for someone.
Speaker 3 00:54:58 Okay. So what we gotta think about is not one hat fits all, because whatever model that we going to use, it's not gonna remedy everybody's problem, but for some folks, it's going to be something that they can use, pick up on and say, okay, and we can prevent perhaps Ernest. I think that was an excellent point, um, with, um, over medicating with prescription drugs, um, for the elderly, not really singing, um, labels, um, not reading correctly, not remembering when the last time they actually took their meds and over medicate that way. Um, you know, um, as they get older, more frail, their heart get weaker or, or, and stuff like that. So when they accidentally over medicate on a prescription drug and it's called the overdose, um, it's because of, um, manage medication. That's not being, um, managed for them. You, you, you, you, you, you follow me.
Speaker 3 00:56:05 So I, I, I, I understand that. And I think with the, with the young kids, the, the spike, the, um, 18, the 24, them, the ones, them, the rebels them the weekend, warriors them, the ones that they're invincible at that, at that age, you know, um, one of the guys I'm in the program do diagnosis, co current program. We got a guy that's 24 and he, he had to be, um, revived with, um, Narcan and like, said to the individual, well, what made you do? Because I can die and come back. And I'm like, what you mean die and come back. Well, I just did it. <laugh>, you know, he's 24, you know what I mean? He's like, well, I just did it. I just died. And he came back and I'm like, come on, you got people that love you. Your parents love you.
Speaker 3 00:56:56 You have counselors here, you have group here and this, that, and nothing. And he's like, yeah, that's, that's fine. But you know, I'm out here and I'm like out here, what I'm living. And I'm like, well, if you, you know, because we in the program, I'm a professional. If you call that living, there's other ways of living without dying and coming back. So, um, you know, so with the, that, that age population, you know, cause you know, it's, it's substance abuse. It's like I said, co-occurring so you deal you, the more you deal with the mental health, sometimes the substance abuse go up. Sometimes the more you deal with the substance abuse, the mental health go up. So it's a fine line. And it takes clever counselors and clinicians to actually, and in a provider provider to properly get the person on the right site meds and the meds to bring them down off the drugs.
Speaker 3 00:58:00 It's, it's, it's a, it's, it's a, it's a balance. And then two, you reach that balance. You may have a lot of problem with guys in that 18 to 24 range because they're running. They, they, they, they, they they're, they're running from, from what I see, um, a lot of these programs also, uh, now trying to do wraparound services. Once we get a guy, we keep him in our program, we don't let him go to another program. We, we push him onto the next services our program have, and then push him onto the next service push to, to it. So keep the money inhouse, so to speak. And when you're doing right, that's probably a good thing as an agency, but when you're just keeping them for the bed in the money, then it's, it's, it's, it's, that's that mal feces come in. You, you you're doing harm.
Speaker 3 00:58:58 You, you, you, you you're doing harm, maybe not at the first level, but at the second or the third level, you know, and like we talked about in the base class completion or discharge, I see guys get they complete, but they didn't complete from completing the program, you know, but it's looked at as a success because they completed whether it was disciplinary because they didn't show back up. So I that's my take on that 18 to 24 in that 65 and over also lack of information and barriers to information, because everything is on the internet. Everything is computerized and, you know, they're the old school way. They don't wanna use the computer. They don't want to get on, um, Chromebook, I mean, um, word or, or, um, look up Google. They don't have time for that. They, they, they, they pass that. That's, they're not part of the information highway, a lot of the 65 and over, you know what I mean? My mother won't even get a cell phone. She's eighty, eighty seven money. I get one with the big buttons. You can see, Nope, I want a house phone. I don't want none of that new technology. So the 65 and older, sometimes they behind in the information of the technology and they lose their life because of that, because they're not informed of what don't go through. What, that's my take on that. Thank you all. Any closing, uh, statements, Leo, and then we'll go to, uh, Dr. Alfonso.
Speaker 4 01:00:48 No good, good conversation. Um, good topics. Um, a lot of different perspectives. I think that we're all going in the same direction. We have the same goal. Um, I, I think that, you know, um, harm reduction in low threshold need to be rewrote. It, it needs to be re reevaluated, right? I mean, how long have, has it been in existence? What's the outcome? Like, what's the progress? What was the motive? Like? What was the motive behind it? Like, what was the goal? Like, you know, how many people we gonna keep alive? How many people we gonna house? I think that all those questions are important. I think they need to be answered. And I think it all needed to be reevaluated because if we're, uh, uh, determined to fix the problem, then we have to know what the problem is and how to address its root issues. And I don't think that's happening
Speaker 3 01:01:50 Dr. Brown,
Speaker 0 01:01:54 Uh, uh, Rob and Leo two. Excellent, uh, summaries there, the end points and, and, uh, uh, this has been a great discussion today. I've got a lot to think about <laugh>. I, I, I wanted to throw one question out for the group as well. Um, uh, mass and cast is bordered, correct me if I'm run by Roxbury and Dorchester, these are two fairly large. I lived in Dorchester, so I know <laugh>, but, uh, just like making sure these are two fairly large communities. Um, the majority of which are, um, individuals of, uh, within the bipo community live in. Um, but it appears to me that a lot of the individuals you see out and mass and cast do not fit into that, um, that, uh, you know, those, those groups primarily, I think you guys touched upon this earlier. Um, you know, and this is a topic for another time in terms of how this got started.
Speaker 0 01:02:50 A lot of these individuals, there are normally went to the long island facility, um, out in board in Quincy and Boston, but, um, have since come into the area. But again, this speaks to the question that we were talking about about, um, why this increase took place now. And I, I lived Dorchester for a decade and I would have to drive by mass and cast pretty much every day on my way into and outta work. And the question that always arose in my mind is that it doesn't appear like a lot of these people seem to be from the area. Exactly. And this, this might have changed now in terms of the population dynamics. And, um, and, and so I wonder again, given the light of the articles that we were discussing today and this increase, you know, why that's the case? And if so, are we even looking in the right place?
Speaker 0 01:03:44 Are these overdose deaths occurring, not in an open area like that, but more so in the, uh, in the cities or other areas where these populations are. Um, I, I told you more I've done out in the suburbs does not seem to, to say that either. It, it, that's not who you see, that's, it's dying from overdose death. So, uh, this has been curious where the population is. And then again, since we're about solutions here as well, what can we do target? And then one other thing, um, I'd wanna leave with the group is I think we we've talked a lot about harm reduction and, and low threshold today. This is something we might wanna revisit and maybe even take time to do surveys out in the communities because, uh, I've spoken to folks in the community. Um, and there's some people who have very strong opinions about harm reduction and it's benefits versus it's.
Speaker 0 01:04:37 Uh, so it's interesting that two first frontline workers like selves layout and Rob have very strong opinions about it. I'm still trying to gauge him. It's all positive, all negative. Um, but, uh, I've spoke to folks in law enforcement and they have mixed emotions about it as well. And whether it's EF EF effective and also other individuals within the community, um, who they have a questionable thoughts, but it has been successful. As we pointed out in Washington state, that's where the initial model came from. We studied that this year in the base classes and a system Melinda was talking about in Chicago. And there are other places where this has been successful. I think the original origins came from the HIV community, uh, in the eighties, um, when, uh, they were looking at ways to help curb the spread. And they found that needle exchanges and things like that were very helpful and help save lives. So I think at a, a later date, we should investigate that fundamental question, whether or not these, these approaches are good, whether they're relevant in what we have going on here and as future, um, leaders and, and operatives in this area, should we be adopting principles that continue to sustain these things?
Speaker 3 01:05:53 All right. Thank you. Thank you. Um, I want to thank the panel each and every one of you all. Um, it's very, very, very good discussion. Um, but I want everybody to hold their thoughts and hold their questions because next week, we're gonna be talking about solutions to this opiate, uh, or to this overdose problem and the, um, information or the text that we are gonna be reviewing and talking out of is called training and educating public safety to prevent overdose among black and indigenous and people of color communities. Uh, and I wanna thank, uh, Dr. Alfonso for, uh, uh, researching that and finding that for us and sending it to us. So that is what we're gonna be talking about, uh, next week. So until then, like I said, we conversations this talk addiction
Speaker 2 01:07:19 9 1 1.
