Latest / Recovery Chronicles / Recovery Chronicles Ep. 176 - Jennifer Pelster, Western Plains Public Health

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Recovery Chronicles Ep. 176 - Jennifer Pelster, Western Plains Public Health · Recovery Chronicles

• 0:05
  Speaker 1: Welcome to Recovery Chronicles. My name is John treg and
• 0:07
  Speaker 1: my sober date is June seventeenth, twenty nineteen. Join me
• 0:12
  Speaker 1: as we hear from people who are on this stream
• 0:14
  Speaker 1: that we call recovery. Welcome to this episode of Recovery Chronicles.
• 0:22
  Speaker 1: This is Joan and today I have with me Jennifer Pelster.
• 0:26
  Speaker 1: Welcome Jennifer.
• 0:27
  Speaker 2: Thanks for having me. Jennifer.
• 0:29
  Speaker 1: Can you tell us a little bit about so First
• 0:32
  Speaker 1: of all, where are you working right now? And tell
• 0:35
  Speaker 1: us a little bit about your role there.
• 0:37
  Speaker 2: So currently I am a registered nurse at Western Plains
• 0:40
  Speaker 2: Public Health and Mandan. We recently had a name change.
• 0:44
  Speaker 2: We were formerly Custer Health. But my role there is
• 0:49
  Speaker 2: the Disease Prevention Program Supervisor. So it's a big fancy
• 0:53
  Speaker 2: name that means I coordinate all of our infectious disease
• 0:57
  Speaker 2: programs everything from HIV, hepatitis, see all the STD's, gonna ria, chlamydia, syphilis,
• 1:04
  Speaker 2: as well as our syringe service program, the Good Neighbor Project.
• 1:08
  Speaker 1: Okay, so tell me a little bit about that, like
• 1:12
  Speaker 1: how did it get started and what was the reason
• 1:14
  Speaker 1: for starting it?
• 1:16
  Speaker 2: So excuse me a little bit of history. Syringe service
• 1:22
  Speaker 2: programs syringe access programs. That term can be used interchangeably,
• 1:28
  Speaker 2: but they've been around for years. They weren't legalized in
• 1:32
  Speaker 2: the United States until the mid nineteen eighties. The first
• 1:37
  Speaker 2: legal funded styrrange service program was actually in Tacoma, Washington
• 1:43
  Speaker 2: in eighteen excuse me, nineteen eighty eight. And that's about
• 1:47
  Speaker 2: the same time too, that the federal government enacted a
• 1:51
  Speaker 2: law that says you cannot use federal funds for syringe
• 1:56
  Speaker 2: service programs. So, like I said, they've been around the
• 2:02
  Speaker 2: United States and around the world for many years. But
• 2:05
  Speaker 2: North Dakota finally legalized syringe service programs in twenty seventeen.
• 2:13
  Speaker 2: Legislation have passed a bill that said that they were legalized,
• 2:17
  Speaker 2: but they have to be approved through the Department of
• 2:22
  Speaker 2: Health and Human Services. So what we have to do
• 2:25
  Speaker 2: is we have to submit an application every year with
• 2:29
  Speaker 2: our plan that outlines what we're going to do, what
• 2:32
  Speaker 2: we're not going to do, and kind of what our
• 2:34
  Speaker 2: goals are. It also states that we cannot use state
• 2:39
  Speaker 2: funds to buy supplies for the program, but we can
• 2:43
  Speaker 2: use state funds for staff time, development of the program, evaluation,
• 2:48
  Speaker 2: those things. And then in twenty nineteen they further clarified
• 2:55
  Speaker 2: that persons who are in possession of appropriately collected syringes
• 2:59
  Speaker 2: and are protected from penalties of possession of a controlled substance.
• 3:05
  Speaker 2: I am not a lawyer, so I don't give legal advice,
• 3:08
  Speaker 2: but that Century Code is kind of open to interpretation.
• 3:15
  Speaker 2: So some people think it's just the staff, some people
• 3:19
  Speaker 2: think it's participants. It's not really clear. So, like I said,
• 3:25
  Speaker 2: I'm not a lawyer. It's open to interpretation. But kind
• 3:30
  Speaker 2: of backpedaling. When I got into nursing, I knew I
• 3:34
  Speaker 2: didn't want to be a traditional nurse in a hospital
• 3:36
  Speaker 2: or clinic. It just was not me. So when I
• 3:40
  Speaker 2: graduated nursing school in twenty eight, I went directly to
• 3:46
  Speaker 2: the North Dakota State Penitentiary. So that's kind of where
• 3:49
  Speaker 2: I got my nursing career started. That is kind of
• 3:53
  Speaker 2: where I developed a passion for harm reduction, substance abuse,
• 3:57
  Speaker 2: infectious disease. So after I left there and I was
• 4:03
  Speaker 2: at Western Plains Public Health, I did help out at
• 4:08
  Speaker 2: the time the Morton County Jail, so we would do
• 4:11
  Speaker 2: testing and stuff there. We were also contracted with some
• 4:14
  Speaker 2: of the other smaller county jails as well to provide
• 4:17
  Speaker 2: nursing services, and through these experiences, it helped me realize
• 4:22
  Speaker 2: that North Dakota is lacking, lacking hugely with services for
• 4:30
  Speaker 2: people who have addiction, people who use injection drugs. So
• 4:35
  Speaker 2: that kind of sparked a fire. So luckily, our administration
• 4:41
  Speaker 2: has been very supportive. Our Board of Directors is very supportive.
• 4:44
  Speaker 2: They see the need and so once the state legalized
• 4:51
  Speaker 2: SERM service programs, we knew right away that we wanted
• 4:55
  Speaker 2: to be on board. So we submitted our application and
• 4:58
  Speaker 2: plan and we were actually the first syringer service program
• 5:02
  Speaker 2: authorized in the state of North Dakota, Okay. So we
• 5:06
  Speaker 2: started our operations in January of twenty eighteen is when
• 5:12
  Speaker 2: we officially opened. So we're coming up on year seven already.
• 5:18
  Speaker 2: It seems like forever ago, but yeah, yesterday. So just
• 5:24
  Speaker 2: through the years, expanding as the world changes. You know,
• 5:29
  Speaker 2: Initially it was focused on preventing the spread of HIV
• 5:33
  Speaker 2: hepatitis C, and as we grew got experience, it was
• 5:39
  Speaker 2: so much more than that. It was helping the whole person,
• 5:45
  Speaker 2: anything from mental health referrals to HIV hepatitis C testing,
• 5:50
  Speaker 2: referrals for treatment, testing for STDs, wound assessments, healthcare referrals
• 6:00
  Speaker 2: for absesses, things like that. And over the years we've
• 6:06
  Speaker 2: kind of changed our practice model as well. But currently
• 6:11
  Speaker 2: and for the last few years, we contract with face
• 6:13
  Speaker 2: it Together. So every day that we are open for
• 6:16
  Speaker 2: our surrench service program, we do have a peer to
• 6:20
  Speaker 2: peer navigator in our building so they can meet with
• 6:23
  Speaker 2: clients right then, right there, not here's their card, callum
• 6:28
  Speaker 2: make an appointment.
• 6:29
  Speaker 1: That's awesome. Good. So starting out, I think with with
• 6:35
  Speaker 1: you know, any programs that are evolving around substance use,
• 6:40
  Speaker 1: no matter where you are, sometimes you can be met
• 6:42
  Speaker 1: with some friction and and just I think that's probably
• 6:45
  Speaker 1: mostly from a lack of understanding or maybe education. What
• 6:49
  Speaker 1: did you see when you first, you know, first kind
• 6:52
  Speaker 1: of kicked that off, especially being the first one in
• 6:54
  Speaker 1: the state in North Dakota. You know, you were the
• 6:58
  Speaker 1: you were the starting point for so how what did
• 7:00
  Speaker 1: that look like for you guys? And you know, we're
• 7:03
  Speaker 1: kind of where is that taking you now?
• 7:07
  Speaker 2: As a lot of people who are impacted by substance
• 7:11
  Speaker 2: use disorders know the stigmas, it's always one of the
• 7:16
  Speaker 2: biggest barriers. People have this misperceived conception that people are dirty,
• 7:23
  Speaker 2: which I hate that term. And they don't understand that
• 7:27
  Speaker 2: substance use disorders are a mental health disorder. They think
• 7:32
  Speaker 2: it's a choice. And I don't know one person on
• 7:36
  Speaker 2: the face of the planet who woke up and said
• 7:39
  Speaker 2: I want to be addicted today.
• 7:40
  Speaker 1: Yeah, for sure.
• 7:43
  Speaker 2: So it's kind of been hit or miss with law enforcement.
• 7:47
  Speaker 2: We're trying to build, you know, relationships and collaboration with
• 7:50
  Speaker 2: the Bismard Piti and the man the UNPAD, But they
• 7:54
  Speaker 2: know what we're doing. They kind of occasionally depending on staff,
• 7:59
  Speaker 2: you know, they they see the importance of it, but
• 8:01
  Speaker 2: they also have the law enforcement side. And like I said,
• 8:05
  Speaker 2: with me having that corrections background, I get both sides.
• 8:09
  Speaker 2: I totally get the legal side of you know, the
• 8:12
  Speaker 2: possession of control and substances. I get all of that.
• 8:16
  Speaker 2: But I'm also a nurse and my role is to
• 8:20
  Speaker 2: care for people holistically in meeting them where they're at. So,
• 8:26
  Speaker 2: if you're homeless, what can we do to help you
• 8:29
  Speaker 2: along with your substance use disorder. Years ago, I did
• 8:35
  Speaker 2: a conference and there was a sheriff from Colorado and
• 8:41
  Speaker 2: he made a comment that really impacted my thought process
• 8:45
  Speaker 2: around all of this, and it really hit home, and
• 8:48
  Speaker 2: I share this every time I can. A lot of
• 8:52
  Speaker 2: people have the misconception that syringe service programs enable people,
• 8:57
  Speaker 2: and they're not complete incorrect, But we're not enabling them
• 9:03
  Speaker 2: to use drugs or do illegal things. We are enabling
• 9:07
  Speaker 2: them to be as healthy as they can be given
• 9:09
  Speaker 2: their current situation. We are enabling them to create healthy
• 9:14
  Speaker 2: relationships and support, and we are enabling them to reach
• 9:19
  Speaker 2: out and take that next step for treatment services when
• 9:23
  Speaker 2: they are ready.
• 9:26
  Speaker 1: And so I think that that is a really important
• 9:30
  Speaker 1: point to make. We hear that too sometimes in terms
• 9:33
  Speaker 1: of the term enabling, especially when it comes to the
• 9:38
  Speaker 1: use of syringes. But the reality is is that people
• 9:43
  Speaker 1: are going to if they're addicted, they're going to use anyway,
• 9:46
  Speaker 1: and so if we're able to help them from spreading
• 9:51
  Speaker 1: other diseases or whatever, you know, the reasoning may be,
• 9:55
  Speaker 1: then it's just one step further in helping people. It's
• 10:00
  Speaker 1: pretty tough for somebody to take that step forward for
• 10:04
  Speaker 1: recovery if they're also battling a whole bunch of other
• 10:06
  Speaker 1: health problems, yes, said kind of the Okay, so how
• 10:10
  Speaker 1: did that look like for you in terms of starting
• 10:14
  Speaker 1: You were the first in the state in North Dakota.
• 10:16
  Speaker 1: So what tell me more about that, like what does
• 10:19
  Speaker 1: the state look like now, because I am not aware
• 10:22
  Speaker 1: of other options or other cities what they do.
• 10:25
  Speaker 2: So currently there are five syringe service programs in North Dakota.
• 10:30
  Speaker 2: I said we were the first ones. There's also one
• 10:34
  Speaker 2: in Fargo. Grand Forks has a syringe service program, might not,
• 10:38
  Speaker 2: and then I believe it's a valley city has one.
• 10:42
  Speaker 2: I know there's a couple other ones that have been
• 10:44
  Speaker 2: granted their authorization, they just haven't been up and running yet.
• 10:48
  Speaker 2: They're still working on some of the logistics. One thing
• 10:52
  Speaker 2: that's really interesting too is that every syringe service program
• 10:56
  Speaker 2: across the state is different based on their plan and
• 11:00
  Speaker 2: that they submit with the state in North Dakota. So
• 11:04
  Speaker 2: I would say ours is probably one of the most
• 11:07
  Speaker 2: restrictive programs, which can be a barrier, But like I said,
• 11:11
  Speaker 2: we are governed by a Board of Health, so we
• 11:13
  Speaker 2: got to kind of take their input with what we do.
• 11:19
  Speaker 2: So some of the requirements for our program are you
• 11:23
  Speaker 2: have to be eighteen. We do not check photo IDs.
• 11:26
  Speaker 2: It is the honor system. We will take your word
• 11:31
  Speaker 2: if you say that yup, you're eighteen. We will enroll you.
• 11:36
  Speaker 2: We do require HIV and hepatitis C testing upon enrollment
• 11:41
  Speaker 2: and then every year they're after so on an annual basis,
• 11:45
  Speaker 2: we can test people for HIV and hepatitis C every
• 11:48
  Speaker 2: six months if we deem it's necessary because they're sharing
• 11:52
  Speaker 2: supplies or they're having survival sex multiple sex partners, so
• 11:59
  Speaker 2: we can do that and it's based on our nursing judgment.
• 12:04
  Speaker 2: So other than that, the only other real requirement per
• 12:09
  Speaker 2: se is that they return their dirty supplies to us.
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  Speaker 2: So we give them a sharp container with our good
• 12:16
  Speaker 2: Neighbor logo sticker on it, and so that way they
• 12:20
  Speaker 2: have a place to safely put their use supplies. So
• 12:23
  Speaker 2: when they're not carrying them around in a backpack or
• 12:26
  Speaker 2: in their pants pocket, you know they have a safe
• 12:28
  Speaker 2: place to put them. So we don't count each syringe.
• 12:33
  Speaker 2: We just go based on weight, so it's an estimate,
• 12:36
  Speaker 2: it's not an exact science. So we do that. That's
• 12:41
  Speaker 2: one of our requirements. They can come every two weeks.
• 12:45
  Speaker 2: That started around COVID time. They were allowed to come
• 12:49
  Speaker 2: every week prior, but it just works better, which was
• 12:52
  Speaker 2: really surprising, but again we learn as we go. It's
• 12:57
  Speaker 2: nice because then they have two weeks of supplies, and
• 13:00
  Speaker 2: if they're homeless or they don't have transportation, it's not
• 13:03
  Speaker 2: such a burden for them to try to come every week.
• 13:07
  Speaker 2: Gives them that little bit of leeway. So yeah, so
• 13:11
  Speaker 2: we provide them anything from clean syringes, cotton filters, cooking tins,
• 13:20
  Speaker 2: turn kits, alcohol pads so they can clean the injection site.
• 13:25
  Speaker 2: We do provide antibiotic ointment and band aids so if
• 13:29
  Speaker 2: they have a miss or an abscess that they're trying
• 13:32
  Speaker 2: to manage on their own, or they've been on antibiotics
• 13:35
  Speaker 2: from the doctor and they just need something to get
• 13:37
  Speaker 2: them by while it heals. We do provide that. We
• 13:41
  Speaker 2: do have narcan. We have both the injectible, the lozone
• 13:46
  Speaker 2: and the nasal narcan. So there's a short training that
• 13:50
  Speaker 2: they do and we give them the kits, and those
• 13:55
  Speaker 2: kits are free to anyone in the community too, not
• 13:57
  Speaker 2: just our participants, so there's family members or you have
• 14:02
  Speaker 2: a friend or family member suffering from substance use, you know,
• 14:05
  Speaker 2: you can come in and get those kits from us
• 14:07
  Speaker 2: as well, so we do that. We recently started giving
• 14:13
  Speaker 2: out fentanyl test strips, so people who want to make
• 14:18
  Speaker 2: sure that their supply doesn't have fentanyl in it. They
• 14:21
  Speaker 2: can use those. It's not one hundred percent, but something's
• 14:23
  Speaker 2: better than nothing. And then we recently started giving out
• 14:28
  Speaker 2: xylazine test strips as well because we're starting to see
• 14:30
  Speaker 2: that in some of the drug supply in our communities.
• 14:33
  Speaker 2: And unfortunately, there is no reversal medication for xiolizing. It's
• 14:38
  Speaker 2: all supportive measures. So we're doing a lot of education
• 14:40
  Speaker 2: to for our clients as to what to do if
• 14:45
  Speaker 2: they witness an overdose, making sure that they're calling nine
• 14:47
  Speaker 2: to one one, just knowing that they will be protected
• 14:52
  Speaker 2: by the Good Samaritan law if they are cooperative. That's
• 14:56
  Speaker 2: one thing that people are really hesitant with because of
• 15:00
  Speaker 2: they're bad experiences with law enforcement, because of the stigma
• 15:03
  Speaker 2: with addiction. So we really try to stress to people
• 15:06
  Speaker 2: that if you are at an overdose, you witness an overdose,
• 15:10
  Speaker 2: call nine one one and cooperate. So yeah, so we've
• 15:16
  Speaker 2: been doing a lot of education with that lately too.
• 15:18
  Speaker 1: So so before we get into the NARCAN, just a
• 15:21
  Speaker 1: couple of questions I have. What did you see initially
• 15:25
  Speaker 1: when you started with the with the syringe program in
• 15:28
  Speaker 1: terms of let's just say in a month, like what
• 15:32
  Speaker 1: kind of you know? I imagine it took a little
• 15:34
  Speaker 1: while for people to become aware of the service, right,
• 15:36
  Speaker 1: just like anything, yep, So what you know, what kind
• 15:39
  Speaker 1: of did you see then? And you know, where do
• 15:41
  Speaker 1: you think you are now in terms of the number
• 15:43
  Speaker 1: of people that you serve every month for that for
• 15:46
  Speaker 1: the syringe or needle I'm sorry type service?
• 15:50
  Speaker 2: Initially it was slow, very slow. We would see ten
• 15:55
  Speaker 2: fifteen people in a week and we were like, oh
• 15:57
  Speaker 2: my lord, we were so busy. Was new. We didn't
• 16:01
  Speaker 2: know what to expect where Now the end of January,
• 16:06
  Speaker 2: we were up to five hundred and twenty five in
• 16:08
  Speaker 2: world participants. So on a monthly basis, right now we're
• 16:12
  Speaker 2: averaging between eighty and one hundred and twenty clients a month.
• 16:16
  Speaker 1: Okay, And so I think another thing that comes to
• 16:22
  Speaker 1: mind for me when you talk about that, you talked
• 16:25
  Speaker 1: about referrals, right, So if someone comes in there's a
• 16:30
  Speaker 1: health concern, what is your relationship with you do you
• 16:35
  Speaker 1: have like you know, relationships set up or you know,
• 16:39
  Speaker 1: how what does that look like for someone if they
• 16:41
  Speaker 1: are if you you know, identify that there's an infection
• 16:44
  Speaker 1: for example, or something more serious, what kind of what
• 16:48
  Speaker 1: does that process look like for that person.
• 16:51
  Speaker 2: So if they have an abscess and it looks minimal,
• 16:58
  Speaker 2: we might just give them, you know, the antibiotic ointment
• 17:01
  Speaker 2: and band aids. If it looks like something more severe
• 17:05
  Speaker 2: where it's severely infected, it's starting to tunnel underneath their skin,
• 17:11
  Speaker 2: you know, if they start having signs of cellulitis or
• 17:14
  Speaker 2: streaking up their arm or something more serious that could
• 17:17
  Speaker 2: lead to sepsis, we either send them to their primary
• 17:21
  Speaker 2: care provider if they have one, or a lot of
• 17:24
  Speaker 2: times we do a lot of referrals to the emergency room.
• 17:27
  Speaker 2: We don't like to do referrals to the emergency room,
• 17:31
  Speaker 2: but if they have a severe infection that needs immediate
• 17:36
  Speaker 2: you know, treatment, we will. Okay, we don't have funding
• 17:43
  Speaker 2: for transportation, but we are funded off of grants and donations.
• 17:48
  Speaker 2: So when we do have extra donation money, we like
• 17:51
  Speaker 2: to try to purchase bus tickets. There's a bus stop
• 17:54
  Speaker 2: right outside of our office, so if we have a
• 17:57
  Speaker 2: client that needs to be seen and they have no transportation,
• 18:00
  Speaker 2: you know, we can give them that bus ticket to
• 18:02
  Speaker 2: get them to the Bismark Clinic or one of the ers.
• 18:06
  Speaker 1: Okay, Okay, So I think that that kind of leads
• 18:12
  Speaker 1: me into more of the topic of the Narkhan piece. Right. So,
• 18:19
  Speaker 1: at heartview, narcan is pretty much everywhere you look throughout
• 18:22
  Speaker 1: our entire facility, whether you're an account or you're an
• 18:28
  Speaker 1: addiction counselor it's you know, it's it's readily available and
• 18:30
  Speaker 1: it needs to be. But what kind of tell me
• 18:35
  Speaker 1: a little bit about getting that up and running right
• 18:38
  Speaker 1: Because I run into people all the time they ask
• 18:40
  Speaker 1: me about narcan and I and I think for some people,
• 18:43
  Speaker 1: if they're not working in that industry, they're not going
• 18:45
  Speaker 1: to know, right, But tell me how that kind of
• 18:48
  Speaker 1: looks for you guys when you got started with the
• 18:52
  Speaker 1: entire narcan piece of it of bringing it to the
• 18:55
  Speaker 1: community and incorporating it in too basically into the community. Yep.
• 19:02
  Speaker 2: So when we started the program, we put that in
• 19:05
  Speaker 2: our state plan that that would be one of the
• 19:07
  Speaker 2: things that was required of our staff. And part of
• 19:11
  Speaker 2: our supplies that we offer was the We started with
• 19:15
  Speaker 2: the injectible miloc zone and you know, we get it
• 19:20
  Speaker 2: from a wholesale distributor, so it's not cheap, but it's
• 19:25
  Speaker 2: cheaper than other places that people buy it from so
• 19:30
  Speaker 2: we get it for a reduced costs and so we
• 19:35
  Speaker 2: don't make it required for our participants to do the training,
• 19:39
  Speaker 2: but we offer it to every single person. Initially, when
• 19:44
  Speaker 2: we started the program, a lot of people would say, Oh,
• 19:48
  Speaker 2: I don't use heroin, I don't use ventanyl, I don't
• 19:51
  Speaker 2: use opioids, I don't need it. But as time progressed,
• 19:57
  Speaker 2: we kind of changed the way that we offered the
• 19:59
  Speaker 2: t too. You might not but the drug supply might
• 20:04
  Speaker 2: have it in it and you're not aware, or someone
• 20:08
  Speaker 2: might be using something that you're not aware of. So
• 20:12
  Speaker 2: just bringing that awareness that just because you're not seeking
• 20:15
  Speaker 2: that type of drug doesn't mean it's not in your supply.
• 20:21
  Speaker 2: And then as time went on and more funding became available,
• 20:26
  Speaker 2: we have a stake Opiate Response Grant through the Department
• 20:29
  Speaker 2: Health and Human Services, and so with that funding and
• 20:33
  Speaker 2: that partnership, we are able to get the nasal NURC
• 20:36
  Speaker 2: hand kits. So then we started using that as well.
• 20:40
  Speaker 2: So now our clients have the option of do you
• 20:43
  Speaker 2: want the injectible or do you want the nasal, And
• 20:46
  Speaker 2: there again it's their personal preference and their comfort level,
• 20:50
  Speaker 2: because when you're in an overdose situation. It's a shock
• 20:56
  Speaker 2: me being in healthcare. I kind of go into autopilot
• 20:58
  Speaker 2: and I just kick in, you know, this is what
• 21:01
  Speaker 2: I got to do. Where people who aren't experienced with that,
• 21:05
  Speaker 2: or if it's their first overdose witness, they're probably going
• 21:08
  Speaker 2: to be more comfortable with the nasal versus having to
• 21:12
  Speaker 2: draw up a syringe of the lock zone and then
• 21:15
  Speaker 2: administering it and things like that, So we give them
• 21:18
  Speaker 2: the option whatever they are comfortable with.
• 21:22
  Speaker 1: I think it's something that when I when I've had
• 21:27
  Speaker 1: people ask me, I think it's important for if you
• 21:30
  Speaker 1: could kind of just walk through what narcan is and
• 21:34
  Speaker 1: what it does to this system, because I'm not sure.
• 21:37
  Speaker 1: You know, people hear about walls for an overdose, Well
• 21:39
  Speaker 1: what does that mean? And so can you kind of
• 21:41
  Speaker 1: give us an overview of that.
• 21:44
  Speaker 2: So what it does is it just blocks those receptors,
• 21:47
  Speaker 2: so it kind of reverses the overdose, kind of brings
• 21:50
  Speaker 2: the person too. And the thing with that too is
• 21:55
  Speaker 2: some people might respond after one dose of the narcan,
• 21:59
  Speaker 2: or some people it might take two, three, four, five doses.
• 22:05
  Speaker 2: Every person is different, just like every drug affects every
• 22:09
  Speaker 2: person different, Narcan affects people ultimately in the same sense,
• 22:14
  Speaker 2: but at a different rate. So how much they need
• 22:18
  Speaker 2: depends on what they're using, how they're using, how much
• 22:20
  Speaker 2: they're using, things like that. So the other thing too,
• 22:25
  Speaker 2: if narcanan a lock zone is if a person or
• 22:29
  Speaker 2: you suspect their overdosing, if you give it to them
• 22:34
  Speaker 2: and it's not an opioid, it's not going to hurt them.
• 22:37
  Speaker 2: So you are better off giving it and hoping it's
• 22:42
  Speaker 2: an opioid versus not giving it. So we tell everyone,
• 22:46
  Speaker 2: if you suspect an overdose, give it because it's not
• 22:50
  Speaker 2: going to hurt them.
• 22:51
  Speaker 1: Okay, And so yeah, I mean I think some people
• 22:54
  Speaker 1: are afraid are afraid of it, right.
• 22:56
  Speaker 2: I mean.
• 22:58
  Speaker 1: I was talking with one of our patients a few
• 23:03
  Speaker 1: weeks ago, and he had talked about that when he
• 23:07
  Speaker 1: would go to parties or go and hang out, that
• 23:10
  Speaker 1: narcan was just basically sitting right there next to whatever
• 23:13
  Speaker 1: their substance was. And I think that you know, that's
• 23:19
  Speaker 1: good that they're aware that you know that what it
• 23:23
  Speaker 1: does and what it can do for them. But I
• 23:25
  Speaker 1: think that I opened my eyes a little bit. Honestly.
• 23:28
  Speaker 1: It kind of surprised me when he said that because
• 23:30
  Speaker 1: I I didn't think about it from that perspective, and
• 23:33
  Speaker 1: so I'm wondering, like, what do you see that things
• 23:37
  Speaker 1: are like surprising to you about the use of narcan
• 23:41
  Speaker 1: or people's receptiveness to just taking it, Like you said,
• 23:46
  Speaker 1: it's free, yep, right, So what are you What are
• 23:49
  Speaker 1: some things that kind of surprise you with that as
• 23:51
  Speaker 1: you've worked through this.
• 23:53
  Speaker 2: Like I said in the beginning, there were a lot
• 23:56
  Speaker 2: of things that were new. I said, Me and my staff,
• 24:00
  Speaker 2: our nursing staff, none of us have used injection drugs.
• 24:04
  Speaker 2: None of us have kind of been down that road.
• 24:08
  Speaker 2: So initially a lot of things were very eye opening
• 24:12
  Speaker 2: because I almost felt like our clients were educating us
• 24:16
  Speaker 2: more than we were educating them, which I am so
• 24:20
  Speaker 2: thankful for that They're willing to share those experiences and
• 24:23
  Speaker 2: their knowledge with us sure, just like we can share
• 24:26
  Speaker 2: our healthcare knowledge with them. So that aspect of it
• 24:31
  Speaker 2: has been really unique and I enjoy it. But yeah,
• 24:38
  Speaker 2: like I said in the beginning, just a lot of
• 24:40
  Speaker 2: new things. Now nothing really surprises me. And I don't
• 24:48
  Speaker 2: mean that in a negative way. It's just you work
• 24:51
  Speaker 2: with so many people that have been through so many
• 24:54
  Speaker 2: unique experiences and situations, and I mean some of them
• 24:59
  Speaker 2: are absolutely hard breaking and devastating. So it's just, you know,
• 25:04
  Speaker 2: every person's different, every person's situation is different.
• 25:10
  Speaker 1: Do you what are you seeing in terms of the
• 25:16
  Speaker 1: trends of like drug use and you know, like you
• 25:19
  Speaker 1: talked about fentanyl now being probably incorporated more into drugs
• 25:25
  Speaker 1: and you have the test strips for that. You know,
• 25:29
  Speaker 1: what are you finding some of the newer things that
• 25:31
  Speaker 1: are you know that your patients are talking about, or
• 25:34
  Speaker 1: you know, things that are like that that the community
• 25:39
  Speaker 1: most likely wouldn't be aware of.
• 25:43
  Speaker 2: I mean North Dakota, at least the clients that we see,
• 25:49
  Speaker 2: meth is still by far the number one drug choice
• 25:53
  Speaker 2: by far. Next, I would say, would probably be a
• 26:01
  Speaker 2: close tie between heroin and prescription medications, whether it's they're
• 26:09
  Speaker 2: seeking out fetanoyl or it's percocet or delauded, any of
• 26:14
  Speaker 2: those things are kind of up there with with the heroin.
• 26:19
  Speaker 2: And then another surprising thing too is the misuse of
• 26:24
  Speaker 2: suboxone in methadone. I mean, it absolutely has its purpose
• 26:30
  Speaker 2: in treatment. I know we had one client who was
• 26:38
  Speaker 2: in recovery. He was a unique situation, but he had
• 26:43
  Speaker 2: an addiction to that poke of injecting. That was his rush.
• 26:48
  Speaker 2: So he was on syboxone and once or twice a
• 26:54
  Speaker 2: week he would dissolve it and inject it versus taking
• 26:58
  Speaker 2: it orally. But to him it worked, and you know,
• 27:01
  Speaker 2: he got his clean supplies and and things like that. So,
• 27:06
  Speaker 2: I mean everyone's different, but we are seeing an increase
• 27:11
  Speaker 2: in the number of people seeking out fentanyl, which is alarming.
• 27:19
  Speaker 2: I mean, yes, we're giving out the test trips, but
• 27:21
  Speaker 2: if you're seeking out fentanyl just for use, it's scary, right.
• 27:29
  Speaker 2: We get fearful for our clients because we know a
• 27:32
  Speaker 2: lot of times how that ends up. So just doing
• 27:34
  Speaker 2: a lot of education of you know, don't use alone,
• 27:38
  Speaker 2: having the lockzone available, knowing the steps to take, knowing
• 27:42
  Speaker 2: the signs of an overdose, things like that.
• 27:46
  Speaker 1: So as a you know, as you're with your agency
• 27:50
  Speaker 1: and with some of the things that you're facing, obviously,
• 27:56
  Speaker 1: funding is always a battle, right, So I don't think
• 28:01
  Speaker 1: that that piece would come as a surprise to anyone.
• 28:03
  Speaker 1: But what are some of the other things that you
• 28:05
  Speaker 1: that you know that are some of the struggles as
• 28:08
  Speaker 1: far as your agency and the things that you're trying
• 28:11
  Speaker 1: to achieve.
• 28:13
  Speaker 2: By far. Like you said, the funding. I do a
• 28:16
  Speaker 2: lot of grant writing, so we do have the funds
• 28:20
  Speaker 2: to buy the injection supplies. Other than that, the biggest
• 28:28
  Speaker 2: struggle we have is breaking down the stigma making people
• 28:32
  Speaker 2: aware of the program. It's still surprising that we've been
• 28:36
  Speaker 2: around for seven years and a lot of people still
• 28:38
  Speaker 2: don't know this program exists or they don't have the
• 28:43
  Speaker 2: correct information of what our program is. Partly because I feel,
• 28:50
  Speaker 2: again this is just my personal opinion, I feel a
• 28:54
  Speaker 2: lot of the misinformation around Syringer Service programs is just
• 28:58
  Speaker 2: that title surrender service programs, because we do more than
• 29:03
  Speaker 2: just the injection supplies. Like I said, We're providing HIV,
• 29:08
  Speaker 2: hepatitis C, STD testing, We're giving referrals for treatment, We're
• 29:12
  Speaker 2: giving referrals for healthcare, for housing, for behavioral health services.
• 29:18
  Speaker 2: Even if they don't have insurance and they need Medicaid,
• 29:20
  Speaker 2: you know, we can connect them with a pure navigator
• 29:22
  Speaker 2: so they can get that and then with that too.
• 29:27
  Speaker 2: You know, we're giving vaccines, so if they're not fully
• 29:31
  Speaker 2: vaccinated for hepatitis A, hepatitis B, tetanus, flu, covid, if
• 29:36
  Speaker 2: that's what they want, you know, we can get them
• 29:39
  Speaker 2: up to date with that. So kind of seeing that
• 29:41
  Speaker 2: whole person aspect of it, not just the addiction and
• 29:46
  Speaker 2: the substance use.
• 29:47
  Speaker 1: Yeah, that makes sense, and understanding and realizing that it's
• 29:54
  Speaker 1: it's a health thing. And so even though I think
• 29:58
  Speaker 1: that you said the stigma piece of is incredibly hard
• 30:01
  Speaker 1: to overcome, and I and I think we would be
• 30:03
  Speaker 1: silly to say that that isn't going I mean, it's
• 30:06
  Speaker 1: not going to go away, but continuing to educate the
• 30:09
  Speaker 1: community is a piece that I think is what's most crucial.
• 30:15
  Speaker 1: So if someone wants to say that they are like,
• 30:18
  Speaker 1: I just really want to know what you know, I
• 30:21
  Speaker 1: would like to know more about this, or they maybe
• 30:23
  Speaker 1: have a group of people that want to understand more
• 30:26
  Speaker 1: about what you're doing. What kind of what do you
• 30:29
  Speaker 1: guys do for that in terms of helping with the
• 30:32
  Speaker 1: education piece?
• 30:33
  Speaker 2: Yep. So if there's any businesses, community organizations that want
• 30:39
  Speaker 2: more information about our Surrender Service program, they can go
• 30:44
  Speaker 2: ahead and reach out to me. I do a lot
• 30:45
  Speaker 2: of outreach presentations as far as what we do, the
• 30:50
  Speaker 2: services we provide, that type of thing. I mean, I've
• 30:54
  Speaker 2: given presentations to colleges, to different organizations, in the communities,
• 31:01
  Speaker 2: the nursing schools I hit up quite a bit, So
• 31:05
  Speaker 2: just anyone that's willing to listen and wants more information.
• 31:09
  Speaker 2: I'm always willing to try to decrease the barriers and
• 31:13
  Speaker 2: the stigma any way that we can.
• 31:15
  Speaker 1: And do you help with training if someone wants to
• 31:18
  Speaker 1: have NARCAN training, Like is that something that or do
• 31:21
  Speaker 1: you work with someone that provides, say some business wants
• 31:25
  Speaker 1: to Yep, we learn more about just specifically administering our CAN. Yep.
• 31:30
  Speaker 2: We have a nurse in our office who does a
• 31:32
  Speaker 2: lot of outreach and training for businesses in the central
• 31:37
  Speaker 2: part of North Dakota, everything from law enforcement, to schools,
• 31:41
  Speaker 2: to churches to anything. If they want it, we will
• 31:46
  Speaker 2: get it. And that's one thing too that we offer
• 31:49
  Speaker 2: through our state Opioid Response Grant. We can provide those
• 31:53
  Speaker 2: people with the free NARCAN kits as well. So for
• 31:58
  Speaker 2: like Hayley's or that does that, she follows the state
• 32:02
  Speaker 2: training plan for the NARCAN when she does those outreach events. Now,
• 32:09
  Speaker 2: if someone comes into our office and wants the training,
• 32:11
  Speaker 2: like I said, it's available to anyone. All of our
• 32:15
  Speaker 2: staff is trained in NARCAN and how to train people
• 32:19
  Speaker 2: how to administer it. So the nasal narcan, it's pretty
• 32:23
  Speaker 2: self explanatory. It's very simple, straightforward. The injectible it's a
• 32:28
  Speaker 2: little bit more intricate because of the drawing up into
• 32:32
  Speaker 2: the syringe things like that. So the manufacturer actually has
• 32:36
  Speaker 2: a very good training video, but it's like twenty minutes long,
• 32:39
  Speaker 2: which is way too long. It is way too and
• 32:44
  Speaker 2: goes way too into the depth. So a few years
• 32:48
  Speaker 2: ago we actually created our own training video for the
• 32:53
  Speaker 2: injectible narcan or milock Zone that we have posted on
• 32:56
  Speaker 2: our website. So anyone that has had the training, if
• 32:59
  Speaker 2: they need to refresher, they don't need to come back in.
• 33:02
  Speaker 2: They can just go to our website and review the video.
• 33:04
  Speaker 2: I think it's three and a half minutes, but we
• 33:08
  Speaker 2: kind of walk through the signs of an overdose, how
• 33:11
  Speaker 2: to draw it up, and how to properly administer it
• 33:14
  Speaker 2: and where it should be administered.
• 33:17
  Speaker 1: Yeah, I watched the video and I've been through training
• 33:21
  Speaker 1: in the past with nar cant and in terms of
• 33:24
  Speaker 1: the nasal, one of that one is Yeah, it's very straightforward.
• 33:28
  Speaker 1: It's not something scary, but I think it's very helpful
• 33:32
  Speaker 1: to just know just those main components so that you're
• 33:36
  Speaker 1: just prepared because you just don't know, and you have
• 33:39
  Speaker 1: that little piece of information, you have the NARCAN available,
• 33:42
  Speaker 1: you could save someone's life. And so, you know, that's
• 33:45
  Speaker 1: just tremendous, and you know, the things that you guys
• 33:49
  Speaker 1: are doing, it it's amazing and I'm just I'm so
• 33:53
  Speaker 1: glad that you're in the community and that you're providing
• 33:55
  Speaker 1: that service. And it's huge for people, I mean, and
• 34:00
  Speaker 1: it's huge for the community to be able to help
• 34:03
  Speaker 1: prevent the spread of diseases. And so I think that
• 34:06
  Speaker 1: that's just you're doing a really great job. And so
• 34:11
  Speaker 1: okay again, so tell me again what what what is
• 34:14
  Speaker 1: your website so people can find you and learn more.
• 34:17
  Speaker 2: Her website is www dot Western Planes with an s
• 34:23
  Speaker 2: p h dot org. And then we have the days
• 34:27
  Speaker 2: in service for our syringe service program on there at
• 34:29
  Speaker 2: our Mandown office.
• 34:31
  Speaker 1: So let's take a little bit different lens on this
• 34:35
  Speaker 1: in terms of how the spread of the disease can
• 34:39
  Speaker 1: affect the community. Right, So talk about a little bit
• 34:42
  Speaker 1: about let's talk about the financial piece. What does that
• 34:44
  Speaker 1: even look like for someone that is infected with HIV
• 34:49
  Speaker 1: for example, Yeah, so.
• 34:52
  Speaker 2: HIV is spread through blood, semen and vaginal mostly creations.
• 34:57
  Speaker 2: So that was one of the main points why surrencher
• 35:01
  Speaker 2: service programs got started years ago in the eighties. It
• 35:06
  Speaker 2: was because they noticed that a lot of people who
• 35:09
  Speaker 2: were infected were men who have sex with men, or
• 35:11
  Speaker 2: they were injection drug users. So last the CDC had
• 35:18
  Speaker 2: reported is one person who has HIV AIDS, the average
• 35:24
  Speaker 2: cost of their lifetime of care is roughly five hundred
• 35:28
  Speaker 2: thousand dollars for one person.
• 35:30
  Speaker 1: Wow.
• 35:31
  Speaker 2: So if you take that in a financial perspective, that
• 35:35
  Speaker 2: five hundred thousand dollars too, we would pay for treatment
• 35:39
  Speaker 2: and medications and all the things. We could fund supplies
• 35:43
  Speaker 2: for a program for many years, five ten years, And
• 35:47
  Speaker 2: that's just the supply portion of it. And again, like
• 35:52
  Speaker 2: I said, that's one person. That's not including people who
• 35:55
  Speaker 2: are infected with hepatitis C. There is treatments for hepatitis C.
• 36:01
  Speaker 2: They're roughly twenty to sixty thousand dollars give or take,
• 36:05
  Speaker 2: depending on the length of the treatment and what medication
• 36:11
  Speaker 2: is used. But like right now, thirty three percent of
• 36:14
  Speaker 2: our participants have hepatitis C. So trying to get those
• 36:18
  Speaker 2: people into treatment to get them cured essentially of their
• 36:24
  Speaker 2: active hepatitis C. We do have people in our program
• 36:28
  Speaker 2: that do have HIV, and so I always say, it's
• 36:31
  Speaker 2: not if we have an outbreak, it's when. And like
• 36:36
  Speaker 2: I said, that's part of the reason why we require
• 36:39
  Speaker 2: testing upon enrollment and then every year. There are some
• 36:42
  Speaker 2: programs in the state that don't require the testing, but
• 36:46
  Speaker 2: they offer it but it's not required. But we just
• 36:48
  Speaker 2: feel that it's important for people to know their status
• 36:52
  Speaker 2: so we can educate them on healthier lifestyles, healthier liver
• 36:57
  Speaker 2: how to prevent the spread of you know, HIV, hepatitis
• 37:00
  Speaker 2: see if they have it, things like that. But yeah,
• 37:05
  Speaker 2: prevention is a key and that's one of the key
• 37:07
  Speaker 2: points of this program. Like I said, one person with
• 37:11
  Speaker 2: HIV half a million dollars, that is a lot of money.
• 37:15
  Speaker 1: That yeah, that is crazy.
• 37:19
  Speaker 2: And then we also have a satellite location in Beulah.
• 37:23
  Speaker 2: That one is by appointment only. Again there we don't
• 37:26
  Speaker 2: ask for identifying information. If you want to be called
• 37:30
  Speaker 2: twix or tutsi role, that is what we will call you.
• 37:33
  Speaker 2: We don't need your real name. We will call you
• 37:37
  Speaker 2: by your real name if you don't prefer it. And
• 37:40
  Speaker 2: so they can do that. There's that and then like
• 37:46
  Speaker 2: I said, in Beulah, they also do the same thing
• 37:49
  Speaker 2: that we do in the Mandan office. Amber is our
• 37:52
  Speaker 2: nurse up in that area, but she also comes to
• 37:54
  Speaker 2: our Mandan office once a month to help out with
• 37:57
  Speaker 2: our Mandan location, so she's very active and involved as well.
• 38:01
  Speaker 1: Okay, okay, Well, just as a reminder, it's Western Planes
• 38:06
  Speaker 1: pH dot org, so please check them out, Please contact
• 38:10
  Speaker 1: them if you have any questions or if you're looking
• 38:13
  Speaker 1: to learn more, take advantage of that resource that's in
• 38:17
  Speaker 1: our community, to keep yourself informed and to to just
• 38:21
  Speaker 1: keep helping helping our community and being aware of the
• 38:26
  Speaker 1: of the resources that are available. So thank you again
• 38:29
  Speaker 1: so much for your time and thank you for shoving me.
• 38:40
  Speaker 1: Thank you for joining us on this episode of Recovery Chronicles.
• 38:43
  Speaker 1: Find out more about heartviewat k dot org and keep
• 38:47
  Speaker 1: moving forward, remembering the story is yours and you are
• 38:49
  Speaker 1: the author.