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Transcript

S4E10: Building a Seamless Road to Recovery in King County · Empathy Affect

• 0:01
  SPEAKER_03: Across the country, there's been a rare piece of good news in the substance use landscape.
• 0:06
  SPEAKER_03: Overdose deaths have finally begun to fall.
• 0:10
  SPEAKER_03: But that story looks very different depending on when you're standing.
• 0:15
  SPEAKER_03: In King County, Washington, the crisis hit particularly hard, and it hasn't loosened its grip in the same way.
• 0:22
  SPEAKER_00: Just in the last 30 days, we've seen multiple people overdosing in the streets of Seattle while covering the fentanyl crisis.
• 0:30
  SPEAKER_03: In 2023, the county lost more than 1,300 people to overdose, more than in any year on record.
• 0:37
  SPEAKER_03: And most of them from fentanyl.
• 0:40
  SPEAKER_03: Deaths have eased since, but they're still more than double what they were before 2020.
• 0:47
  SPEAKER_03: And progress has been fragile.
• 0:49
  SPEAKER_00: One thing is clear.
• 0:50
  SPEAKER_00: Fentanyl has a firm grip on its users, and this city where it continues to take lives every day.
• 0:57
  SPEAKER_00: Now everyone's making it okay because more and more people do it.
• 1:01
  SPEAKER_03: This September is recovery month, a time to remember those we've lost and to hold on to something just as true.
• 1:11
  SPEAKER_03: That people do recover every day, everywhere.
• 1:17
  SPEAKER_03: That belief is at the very heart of our guests' work.
• 1:22
  SPEAKER_03: Brad Feingood is a strategic advisor at Public Health Seattle in King County, where he leads the county's overdose prevention and response, and where he was named its very first recovery champion.
• 1:34
  SPEAKER_03: He came to this work carrying a loss of his own.
• 1:38
  SPEAKER_03: But he holds on to the conviction that recovery is possible for anyone if the help is there the moment someone reaches for it.
• 1:47
  SPEAKER_03: That's what King County is trying to build.
• 1:50
  SPEAKER_03: Not a single lane, but a wide road with several paths leading there.
• 1:57
  SPEAKER_03: Tens of thousands of units of naloxone distributed to save lives minutes after an overdose.
• 2:04
  SPEAKER_03: Buprenorphine offered in the field to reduce withdrawal symptoms and cravings.
• 2:10
  SPEAKER_03: A place to land like a treatment bed instead of walking back out alone.
• 2:15
  SPEAKER_03: Because keeping someone alive and helping someone recover are two different jobs.
• 2:22
  SPEAKER_03: And in a county still counting its losses, both are urgent.
• 2:31
  SPEAKER_03: This is Empathy Affect, Forest Marsh Media's podcast that explores the human side of government.
• 2:37
  SPEAKER_03: I'm Melissa Szynski, and today to commemorate Recovery Month, we'll get into how a community still navigating a tricky substance use landscape is building a road to recovery and refusing to give up on anyone.
• 2:54
  SPEAKER_03: Brad, welcome to Empathy Affect.
• 2:56
  SPEAKER_03: It's wonderful to have you here in honor of Recovery Month this month.
• 3:00
  SPEAKER_03: I'm really excited about this conversation.
• 3:02
  SPEAKER_01: Thanks, Walsa.
• 3:03
  SPEAKER_01: I appreciate you uh reaching out and I appreciate getting to be able to share some of the work that we do here in Seattle, King County, and why it's all uh meaningful.
• 3:13
  SPEAKER_03: Yeah, definitely.
• 3:15
  SPEAKER_03: So, as strategic advisor leading overdose prevention and response for public health in Seattle and King County, can you start by sharing what your day-to-day work looks like?
• 3:28
  SPEAKER_01: Yeah.
• 3:29
  SPEAKER_01: So my job is really multifaceted.
• 3:33
  SPEAKER_01: We get to do a lot of work in a lot of different systems.
• 3:37
  SPEAKER_01: Uh, the thing that I think is most important about my day-to-day work is really about being a community.
• 3:42
  SPEAKER_01: It's about meeting with community partners, with providers, and really with a lot of people with lived experience.
• 3:52
  SPEAKER_01: As we go about designing programs that work for King County and try to get people the help that they need, it's really so important to be grounded in the community, both the community that is struggling with substance use and also the community of providers who are out there day to day working with people, you know, out on the street with people, trying to engage people and trying to get people the services they need.
• 4:18
  SPEAKER_01: And so we know that community knows best about what they need.
• 4:22
  SPEAKER_01: And so it's our job just to come alongside them and help promote the work that they do to get people help because you know, people who are out there struggling with substance use disorder really um often don't want to be struggling and they want the help.
• 4:36
  SPEAKER_01: And if we can uh provide and stand up the right services, then people will be willing to get the help that they need and uh engage in a pathway towards recovery.
• 4:47
  SPEAKER_03: That's totally fair.
• 4:48
  SPEAKER_03: Lived experience, people who are on the ground, seeing the work, doing the work, tend to know this better than anyone else.
• 4:55
  SPEAKER_03: Speaking of which, um, I understand that this work is also quite personal to you.
• 5:01
  SPEAKER_03: You lost your brother to an overdose a couple of decades ago.
• 5:04
  SPEAKER_03: I'm incredibly sorry about that.
• 5:07
  SPEAKER_03: Would you mind sharing a little bit about how that loss has shaped how you navigate this work and how you show up to it every day?
• 5:16
  SPEAKER_01: Yeah, thank you.
• 5:17
  SPEAKER_01: And thank you so much for the kind words.
• 5:19
  SPEAKER_01: It really has shaped the work that I do.
• 5:23
  SPEAKER_01: And really, I look at the work that I get to do on a day-to-day basis of helping to provide services for people with substance use disorder at risk of overdose, you know, in in this great county in King County and Seattle area.
• 5:37
  SPEAKER_01: It's just really an honor and a privilege because I know that, you know, my brother died of an overdose, you know, over 20 years ago, New Year's Day, 2004, 2005.
• 5:49
  SPEAKER_01: And every single person out there is my brother.
• 5:54
  SPEAKER_01: They have a sibling, they are somebody's kid, often they're parents of somebody.
• 6:00
  SPEAKER_01: And so it is truly personal, and it's personal for every single person out there.
• 6:06
  SPEAKER_01: Rand uh came out with some research about a year or two ago, and their research said that 42% of the American public know somebody who died of an overdose.
• 6:18
  SPEAKER_01: That's that that was an astonishing number.
• 6:21
  SPEAKER_01: You know, I teach at the University of Washington also, and you know, whenever we start um a conversation, I'll ask people to raise their hand if they've been impacted by overdose.
• 6:32
  SPEAKER_01: And it's rare that I'm in a uh in a classroom or or or doing a talk or in community, and the vast majority of people haven't been impacted by somebody um with an overdose and that knows somebody who who's passed away from an overdose.
• 6:48
  SPEAKER_01: And it just goes to show you, too, that the suffering that people have out there in the community, it's really a coping mechanism often.
• 6:55
  SPEAKER_01: And we know that there's no one size fits all for services, right?
• 7:01
  SPEAKER_01: Everybody out there is different.
• 7:03
  SPEAKER_01: You know, a couple of years ago we reached a horrible high in this country of a hundred thousand people dying of an overdose.
• 7:10
  SPEAKER_01: That's a hundred thousand individuals that all needed something, they all needed something different, they all needed services.
• 7:16
  SPEAKER_01: And so, you know, my personal experience with my brother dying of an overdose is really rooted in the fact that every single person out there who's struggling is connected to somebody.
• 7:27
  SPEAKER_01: And for the title of your podcast, Empathy, a fact, right?
• 7:32
  SPEAKER_01: If we can show empathy and if we can come alongside people, then we can help move people into the help that they need.
• 7:39
  SPEAKER_03: Yeah, I know it's often easy to look at the national headlines that talk about people in numbers, but ultimately these are people who are family members and in our community.
• 7:51
  SPEAKER_03: So I definitely hear and fill you there.
• 7:54
  SPEAKER_03: Being in this work for about 25 years or so now, I'm curious to see how you've seen the overdose crisis change throughout time and where we are right now, where um death rates have fallen, but the drug landscape has gotten more potent.
• 8:13
  SPEAKER_03: What are you seeing and how do you hold hope and honesty throughout it?
• 8:18
  SPEAKER_01: Yeah, you know, I'll be perfectly honest that some days it is hard to have hope because, you know, we are surrounded by so many people who are out there struggling.
• 8:30
  SPEAKER_01: So I think it's really important to name that.
• 8:34
  SPEAKER_01: But you know, when we're out there with community, we see people who want to get better, we see people who are struggling, who who want a better life.
• 8:42
  SPEAKER_01: And being able to see that provides hope, right?
• 8:46
  SPEAKER_01: Because we know that if we can provide the the help and services that people are are willing to receive that and to move into a better life and to into working towards recovery.
• 8:56
  SPEAKER_01: You know, when I started 25 years ago, there there's certain aspects of of the struggle that people are having that haven't changed, right?
• 9:05
  SPEAKER_01: Like, you know, we know that people are impacted by trauma and adverse childhood experiences.
• 9:12
  SPEAKER_01: They often are impacted by poverty and houselessness that make substance use a coping mechanism, right?
• 9:20
  SPEAKER_01: And so there's certain things that haven't changed.
• 9:22
  SPEAKER_01: But what has changed really, as you mentioned, is the lethality of the drug supply.
• 9:28
  SPEAKER_01: Uh, when I first started 25 years ago, it was really an agricultural-based drug supply.
• 9:33
  SPEAKER_01: Cocaine, heroin were the major drugs of choice that people used that were out there.
• 9:39
  SPEAKER_01: And that was driven by our an agricultural process, right?
• 9:44
  SPEAKER_01: Like you had to farm, you know, the poppies and bring those in.
• 9:48
  SPEAKER_01: And so it was limited by what was grown, by um, by potency, by the seasonality of crop growing, and things have changed remarkably.
• 9:59
  SPEAKER_01: Our drug supply is predominantly fentanyl and methamphetamine, a very synthetic drug supply that can be produced 24 hours a day.
• 10:08
  SPEAKER_01: It doesn't rely upon the seasons, it doesn't rely upon how much rain we got.
• 10:13
  SPEAKER_01: It's synthetic and it relies upon chemicals and precursors.
• 10:17
  SPEAKER_01: And so um that also makes it a lot more malleable and um the potency can change.
• 10:24
  SPEAKER_01: And so a lot of the work that we do is also keeping an eye on the drug supply and uh the adulterants that are in the drug supply and what comes in so that we can keep an eye on it from a public health standpoint, but also help empower people to let them know um what's in their drug supply.
• 10:40
  SPEAKER_01: I think when COVID happened, that also brought these convergences of really difficult situations that our community was in, getting information out there to people, having people understand about the lethality and the risk of a potent drug supply.
• 10:57
  SPEAKER_01: We saw fentanyl first come into our community here, especially on the West Coast in the form of counterfeit pills.
• 11:02
  SPEAKER_01: So people actually thought that they were getting a legitimate pill often, and they were getting a counterfeit pill that just had fentanyl and and some filler in it.
• 11:10
  SPEAKER_01: And now we're seeing that evolve also um in the fentanyl that's coming into our community.
• 11:16
  SPEAKER_01: So we're really hopeful, you know, we um we saw a significant drop in overdose rates from 23 to 2025, about a 32% decrease.
• 11:27
  SPEAKER_01: And we're continuing to see that decrease hold steady for for 2026.
• 11:32
  SPEAKER_01: But one of the things we know is that, you know, as things have changed in my 25 years of working in this field, there's a good chance that things are going to continue to change and evolve.
• 11:42
  SPEAKER_01: And so we need to we need to continue to lean into the needs of people and uh evidence-based services that work.
• 11:49
  SPEAKER_03: Yeah.
• 11:49
  SPEAKER_03: I'm really curious to hear a little bit about what has contributed to the the drops, but I also want to go back to the fact that you say that you spend a lot of time connecting with the communities impacted and the people serving.
• 12:04
  SPEAKER_03: So, since you've spent so many years learning about what actually helps people, I would love to learn about what interventions are genuinely making a difference on the ground.
• 12:18
  SPEAKER_03: And what are the newer innovations you're most excited to be building on in this space?
• 12:25
  SPEAKER_01: Yeah, one of the things I really feel really fortunate about is that we do have interventions that work.
• 12:31
  SPEAKER_01: We have some significant tools at our disposal that um, if we can get them to people in a way that they're willing to receive them, then can help stabilize people and help change their life.
• 12:42
  SPEAKER_01: I want to reiterate the fact that we need to be able to get tools to people in a way that they're willing to receive them.
• 12:50
  SPEAKER_01: When I first started in this work 25 years ago, as you mentioned, we had a lot of um services that were set up for people to jump through hoops, right?
• 12:59
  SPEAKER_01: Like if you can jump through this hoop and this hoop and this hoop and really prove that you wanted to change, then we'll give you the treatment and services that you need.
• 13:07
  SPEAKER_01: And we know that that left a lot of people behind.
• 13:10
  SPEAKER_01: And so uh a lot of what we've done is been like changed our system of care to be able to go to people.
• 13:17
  SPEAKER_01: Um, and that comes with listening to people and providers, as we talked about earlier.
• 13:22
  SPEAKER_01: We have some really effective medications to treat people with opiate use disorder, both methadone and buprenorphine, two effective medications that reduce overdose risk by 50% or more in study after study after study.
• 13:36
  SPEAKER_01: And now there's a form of buprenorphine uh that is uh comes in a shot that's a long-acting injectable form of buprenorphine that really helps stabilize people over time.
• 13:47
  SPEAKER_01: Uh, people aren't having to decide whether or not make that decision every day of do I take my medication or do I use fentanyl?
• 13:54
  SPEAKER_01: And so the long-acting injectable buprenorphine form can help stabilize people over time.
• 14:00
  SPEAKER_01: Um, and as I said, we've really done a lot in our community to go to people and to lower barriers for care.
• 14:08
  SPEAKER_01: We started deploying mobile methadone vans.
• 14:12
  SPEAKER_01: The DEA changed some regulations a number of years ago.
• 14:15
  SPEAKER_01: And so now we have a number of mobile methadone vans.
• 14:18
  SPEAKER_01: So rather than having to cite a fixed site methadone clinic, our vans can go to actually where people are congregated and we can make data-driven decisions to understand where people are at that are struggling and bring treatment to them.
• 14:34
  SPEAKER_01: And as I mentioned, you know, buprenorphine has been a game changer and especially long-acting injectable buprenorphines.
• 14:41
  SPEAKER_01: We started a new facility called the Orca Center, which is our post-overdose center, which really helped allow people a place to go post non-fatal overdose and/or a walk-in where they can go and see an addiction medicine doc and chill and relax in a place that's that's really uh convenient and amenable to them.
• 14:59
  SPEAKER_01: The last thing I'll say is that uh, you know, naloxone, Narcan's the name brand of naloxone, and naloxone is the overdose antidote.
• 15:08
  SPEAKER_01: And that uh we've really focused a lot on getting naloxone out there far and wide, and especially to people who are closest to coming across or observing a non-fatal overdose.
• 15:21
  SPEAKER_01: And so last year here in King County, we distributed 72,000 noloxone kits.
• 15:27
  SPEAKER_01: So we want to make sure that if if somebody's gonna see if somebody has a chance of seeing an overdose, that they're equipped with the life-saving tools that they need to save somebody's life.
• 15:36
  SPEAKER_01: So those are amazing.
• 15:38
  SPEAKER_01: Um, I'll just say also that one of the areas that we still don't have a lot of tools in our disposal is around people who use stimulants and methamphetamine.
• 15:47
  SPEAKER_01: There has been clinical trials and research time and time again.
• 15:50
  SPEAKER_01: And there are some medications that that will help people.
• 15:53
  SPEAKER_01: But again, we know that there's not a one size fits all answer for people.
• 15:59
  SPEAKER_01: And so um being able to use the tools at our disposal, lower barriers, so that people can access care has been transformative.
• 16:08
  SPEAKER_03: Yeah, that's some amazing insight.
• 16:10
  SPEAKER_03: Um, seeing where some of the gaps still are, but also where you've been pushing uh evidence-based innovations.
• 16:18
  SPEAKER_03: I have friends of mine, myself, who have started to carry around Narcan.
• 16:22
  SPEAKER_03: They will say that I don't think I'll ever use it.
• 16:25
  SPEAKER_03: But if it's in war hands, it's better than not, just because you never know.
• 16:29
  SPEAKER_01: Absolutely.
• 16:30
  SPEAKER_01: You know, an anecdote that I can share from my brother passing away is when he died of an overdose, there were signs that he was having an overdose.
• 16:44
  SPEAKER_01: There were opportunities to intervene.
• 16:46
  SPEAKER_01: The person who was with him that day, A, did not recognize that those were signs of an overdose, and B did not have naloxone.
• 16:54
  SPEAKER_01: So um I can't tell you how important it is to not only to be able to carry naloxone, but also to understand what an overdose looks like.
• 17:02
  SPEAKER_01: Because if we can uh provide that training for the community, this is what to what an overdose looks like and be able to intervene, my brother could well be alive today.
• 17:13
  SPEAKER_01: So I can't, I can't um say how important that point is enough.
• 17:18
  SPEAKER_03: I'm sure we can link some resources in our show notes for folks who who want to know, because even if you're not sure, you can use Narcan and it or naloxone and it won't adversely affect someone.
• 17:30
  SPEAKER_01: That's right.
• 17:30
  SPEAKER_01: So using naloxone if somebody is not having an overdose has no side effects, right?
• 17:36
  SPEAKER_01: But understanding what an overdose looks like, being able to respond to somebody, trying to uh wait, awake them, uh, not using naloxone if it's not needed, uh, because it does throw somebody into a precipitated uh withdrawal.
• 17:49
  SPEAKER_01: The other thing I'll say real quick on naloxone, since we're rounding out that point, is about how important the Good Samaritan law is and how far states have come in implementing the Good Samaritan Law.
• 18:00
  SPEAKER_01: So the Good Samaritan Law basically um says that you can use naloxone and uh not be afraid of prosecution.
• 18:09
  SPEAKER_01: Um, and you can call 911, at least here in Washington state, you can call 911 and know that you can save a life, right?
• 18:18
  SPEAKER_01: And um even if you are using drugs with somebody being able to call 911, have response on scene uh without being afraid that you're gonna be prosecuted for having drugs or using drugs.
• 18:30
  SPEAKER_01: Um, we want people to be able to save people's lives.
• 18:33
  SPEAKER_01: And we know that often it's other people who are using drugs who are going to be closest to people who are experiencing an overdose or their family.
• 18:40
  SPEAKER_03: So I want to talk a little bit about, you know, the unfortunate incident of an overdose and how you can turn that into a doorway, how you have this wonderful Orca center uh to give people to go um somewhere after having an overdose.
• 18:58
  SPEAKER_03: I want to zone in on this moment.
• 19:01
  SPEAKER_03: And if you could walk us through why those first few hours, encounters matter so much to not just saving someone's life, but maybe getting them on that pathway to recovery.
• 19:12
  SPEAKER_01: Yeah.
• 19:13
  SPEAKER_01: You know, we did some research and we went back and looked at our EMS data from 2019 to 2021, and we found that the a risk, uh, an initial non fatal overdose had a tremendously high risk of another overdose within the 30 days following that non first non-fatal overdose.
• 19:32
  SPEAKER_01: And so we know that even the fact of having a non-fatal overdose is a risk factor for a subsequent overdose, and that there's a possibility that at any time that a non-fatal overdose can turn into a fatal overdose.
• 19:46
  SPEAKER_01: And so that time period, being able to act um and as as a system and be able to respond to somebody and provide somebody that help.
• 19:55
  SPEAKER_01: We also know, I mean, I'm a therapist by trade, and I also know that we want to be able to capitalize on a moment when somebody might want to change.
• 20:04
  SPEAKER_01: And often that moment of having a non fatal overdose is a moment that people will reflect upon and want some other type of service.
• 20:13
  SPEAKER_01: We started the Orca Center, as we mentioned earlier, to be able to have a place to be able to take people in a way that's humanizing, in a way that people can get the care and services they want.
• 20:24
  SPEAKER_01: Because before that, we had two options.
• 20:27
  SPEAKER_01: We had the hospital and the emergency department, and we had jail.
• 20:31
  SPEAKER_01: And we, you know, from talking to people and talking to community members, we know um that people have had significant traumas going to jail and going to the emergency department before.
• 20:43
  SPEAKER_01: And so we wanted to give people a place uh to go where they can receive that service.
• 20:49
  SPEAKER_01: And we know that um, you know, our partners at Seattle Fire Department will also start people on buprenorphine in the field after they've received naloxone, in addition to transporting people.
• 21:00
  SPEAKER_01: And so we know that moment is so critical.
• 21:03
  SPEAKER_01: And to be able to have a place to take people right then and there starts people on that path of recovery.
• 21:09
  SPEAKER_01: Because if people walk away, there's a good chance we might not see them again as a system to be able to connect people.
• 21:15
  SPEAKER_01: And so really taking that moment, seizing that moment, and really um tying people in on a pathway of recovery at that moment is so imperative.
• 21:23
  SPEAKER_03: Yeah.
• 21:24
  SPEAKER_03: I'm wondering, um, amid all this, you know, you are one governmental agency within the Seattle King County area, and you mentioned the fire departments.
• 21:36
  SPEAKER_03: I'm sure there are lots of partners who, you know, must be involved in trying to meet people where they're at.
• 21:43
  SPEAKER_03: So, what does it actually take across your counties, government, and care centers and community partners to integrate these entryways for recovery to the people who need them?
• 21:58
  SPEAKER_01: Yeah, uh that's a great question.
• 22:00
  SPEAKER_01: Because it needs to be seamless for the person who's experiencing the substance use disorder, the mental health crisis that they're in.
• 22:08
  SPEAKER_01: It needs to be a system that's coordinated and connected.
• 22:12
  SPEAKER_01: Cause we often have so many providers that are working with people.
• 22:16
  SPEAKER_01: And so we continue to work on, we have a work group right now that our King County executive, uh Grumay Zahala, has chartered called Breaking the Cycle.
• 22:26
  SPEAKER_01: And that work group is meant to bring people together from cross systems to understand what do we need to serve the person at the center better?
• 22:34
  SPEAKER_01: Because often as a system, we think about, you know, our system role, but sometimes we lose track of the person at the center.
• 22:41
  SPEAKER_01: And so we we continue to lean into um, you know, better uh communication mechanisms across different provider networks.
• 22:49
  SPEAKER_01: I'll say that there's a lot of privacy rules out there that are really aimed to protect people's data, protect people's information about them.
• 22:58
  SPEAKER_01: Um and so we continue to try to innovate and try to uh work across these systems.
• 23:03
  SPEAKER_01: But in the moment, it's really uh our providers just do an amazing job of really connecting across these provider systems.
• 23:10
  SPEAKER_01: So uh Seattle Fire Department might see somebody, or any fire department might see somebody who's experiencing an a non-fatal overdose or who's in a in a moment of struggle.
• 23:20
  SPEAKER_01: We also have other sort of crisis locations that might uh work with somebody.
• 23:26
  SPEAKER_01: And then making sure that that warm connect is there for that next episode of care so that people can get from one place to another place.
• 23:34
  SPEAKER_01: We put a lot of resources and emphasis on linkage to care because we know that we can't leave people behind and that people often fall through the cracks moving from system to system.
• 23:44
  SPEAKER_01: So, so as a system communer that we are at the county at public health and as our partners in human services, it's our job to make sure that our providers have what they need to be able to work together and have the resources uh to be able to connect people to that that that next linkage of care.
• 24:00
  SPEAKER_03: Right.
• 24:01
  SPEAKER_03: And as you do connect with members of the community, especially people who are impacted or who have overdosed, who need that help, um, who need that seamless connection as you're talking about, what are you hearing from them?
• 24:16
  SPEAKER_03: And what do those voices say about the work you're doing and where it needs to go, what's working, maybe what's not.
• 24:24
  SPEAKER_03: I'd love to hear a little bit more.
• 24:26
  SPEAKER_01: Yeah, you know, as part of our opioid settlement work, we we did a whole community engagement process.
• 24:31
  SPEAKER_01: We have a number of other mechanisms where we engage with community members and ask them what it is they need.
• 24:38
  SPEAKER_01: And time and time again, it's around lowering barriers to service.
• 24:42
  SPEAKER_01: As I talked about earlier, our old system of care made it so people had to jump through all these hoops.
• 24:49
  SPEAKER_01: And the more hoops that they jumped through in order to get to that end goal at the end of the rainbow was the the prize of treatment, right?
• 24:58
  SPEAKER_01: And so we know now, um, and in talking to people that that didn't work for people and that if anything, that had was counterproductive.
• 25:06
  SPEAKER_01: Um, and so we've really had to really reimagine what our system of care looks like.
• 25:11
  SPEAKER_01: So being able to provide services in the field, better outreach services uh for people, and more harm reduction services for people.
• 25:19
  SPEAKER_01: Because, you know, the truth of the matter is is people might not always be ready to change or to, you know, uh to engage on a an abstinence or or treatment.
• 25:30
  SPEAKER_01: But if we can provide harm reduction services, we can keep people alive uh and keep them healthy long enough so that when they are ready, that we'll be there and we'll have that type of relationship with them where they trust us, they know us, and uh they feel safe coming to us.
• 25:47
  SPEAKER_01: I was in a training this morning, actually.
• 25:50
  SPEAKER_01: And one of the participants in the training, who's a service provider, was talking about how harm reduction services kept him alive, it treated him when he had some other complications.
• 26:01
  SPEAKER_01: And when he was ready, he knew where to go.
• 26:04
  SPEAKER_01: And so really providing those entry ramps for people at different places is imperative.
• 26:09
  SPEAKER_01: And that's what community continues to tell us, and that what that's what we continue to lean into.
• 26:14
  SPEAKER_03: Yeah, and that's a huge part of how we get from not just the I hear this all the time, but not just surviving, but thriving.
• 26:22
  SPEAKER_03: You know, you need to create those multiple pathways where people can get to a point where they're ready to make change and people's lives are worthwhile and um, you know, worth saving at any point.
• 26:36
  SPEAKER_03: So I really appreciate you underscoring that.
• 26:39
  SPEAKER_03: We'll get to the opioid settlement funds a little bit more in a second.
• 26:43
  SPEAKER_03: I know you just touched on it, but I'd love to talk about this network of crisis care centers that your your team is standing up for, uh, rebuilding residential treatment beds that the region lost a little bit ago, and launching post-crisis follow-up teams this year, which is really exciting.
• 27:04
  SPEAKER_03: I'd love to hear a little bit about why that capacity initially disappeared in the first place and what this change means for someone, you know, in that narrow window when they're finally deciding that they're ready to find an open door instead of a wait list or, you know, maybe giving up on themselves altogether.
• 27:25
  SPEAKER_01: Yeah.
• 27:26
  SPEAKER_01: Yeah, such a good question.
• 27:28
  SPEAKER_01: You know, I think a lot about often about the people who work in the system and how how often they are like not compensated well because our system doesn't really pay for these services well.
• 27:41
  SPEAKER_01: You know, we value people's well-being and betterment, and often we don't fund the services, you know, well.
• 27:49
  SPEAKER_01: And so being able to keep services, you know, up to date, keep um, you know, buildings and infrastructure that you know, Medicaid doesn't or or an insurance doesn't necessarily pay for, um, is a lot of investment.
• 28:04
  SPEAKER_01: And so sometimes we as um as the system conveners need to take a step back and ask ourselves, are we providing the services that's um needed and best for people?
• 28:16
  SPEAKER_01: And I think that's what we did when we, when the community, when King County uh uh community passed the crisis care center levy, which is a community investment in these crisis care centers.
• 28:28
  SPEAKER_01: Our crisis care centers, they're part of a changing landscape, I'll say nationally, about opening uh unconditional front doors, right, for people to walk in.
• 28:39
  SPEAKER_01: And so we're gonna have five of these that are opening um across the county.
• 28:44
  SPEAKER_01: One of them is already open.
• 28:46
  SPEAKER_01: It's a 24-7 walk-in.
• 28:48
  SPEAKER_01: Anybody having a behavioral health crisis can walk in at any time and receive, receive the care that they need.
• 28:55
  SPEAKER_01: So they can receive behavioral health urgent care.
• 28:57
  SPEAKER_01: There's a there's a um a 23-hour observation unit, there's a the and there's ability to stay a little bit longer if people need.
• 29:04
  SPEAKER_01: And then whatever the needs are, they can enter a system of care, right?
• 29:09
  SPEAKER_01: We're not gonna leave people behind.
• 29:10
  SPEAKER_01: Like you said, the the the crisis follow-up um that happens from from that point.
• 29:15
  SPEAKER_01: We have one crisis care center that's open already, and um they have served over 5,000 people in the uh short amount of time that they've been around.
• 29:25
  SPEAKER_01: And so, you know, having a place, you know, sort of like the ORCA Center where people can just walk in by themselves and or be diverted by the system of care so they, you know, aren't in costly beds at a hospital and or a jail that don't necessarily serve them well, um, we can really treat people and treat their whole health.
• 29:46
  SPEAKER_01: You know, one of the things I'll just continue to reiterate is we have to treat people for what they need.
• 29:52
  SPEAKER_01: And nobody is no, no two people are alike.
• 29:56
  SPEAKER_01: And um, you know, we have to treat people holistically because if we tell people that they have to go over here for substance use treatment and they have to go over here for mental health treatment, and they have to go over there for housing, then they're never going to be able to access those services.
• 30:09
  SPEAKER_01: And so um, really providing that front door, like at the ORCA Center, like at the crisis care centers, and being able to um help people get the ongoing care that they need is imperative to the health of the community.
• 30:21
  SPEAKER_03: Yeah, I really love how you share that.
• 30:23
  SPEAKER_03: And it reminds me too of SAMHSA, the Substance Abuse and Mental Health Services Administration.
• 30:29
  SPEAKER_03: They've been having a recovery month series and just an event that happened this week.
• 30:34
  SPEAKER_03: Someone was talking about how there are as many roads to recovery as there are people who need recovery.
• 30:41
  SPEAKER_03: And I think the model you're setting up really speaks to that.
• 30:45
  SPEAKER_03: And I'm hoping that it will, you know, open so many doors for people.
• 30:50
  SPEAKER_01: Yeah, I just want to give credit really to like our community providers also who recognize the services that people need.
• 30:58
  SPEAKER_01: Um, our partners at the Seattle Indian Health Board just reopened a reimagined Thunderbird treatment center that was closed right before COVID.
• 31:07
  SPEAKER_01: And I was out there just about a week ago and saw just this like wonderful, beautiful place of healing.
• 31:15
  SPEAKER_01: So it's not this transactional place where somebody's gonna go and you know, just do 28 days and get out and you know, be struggling.
• 31:22
  SPEAKER_01: This is like a place where people can go and they can heal in community.
• 31:27
  SPEAKER_01: And um, so reimagining really what we want our system of care to look like is something that that is so important for our community and providing that access to the a whole person's needs, not just, you know, just one part of their needs.
• 31:42
  SPEAKER_03: Yeah.
• 31:43
  SPEAKER_03: And it also speaks to, I think, what differentiates recovery and treatment, which I feel like some people may conflate, but treatment can be like that very acute kind of moment where people need care.
• 31:56
  SPEAKER_03: And then um recovery is, you know, embracing a person in their whole from you know, the conversations I've had and just what I've seen and like what really differentiates it.
• 32:05
  SPEAKER_03: Going back to the opioid settlement funds for a second, that's been really transformative for a lot of communities.
• 32:12
  SPEAKER_03: You mentioned before how you used it to do an assessment.
• 32:15
  SPEAKER_03: But you know, it is a finite amount from what I understand for your county.
• 32:20
  SPEAKER_03: It's put aside about$3.5 million a year until 2038.
• 32:26
  SPEAKER_03: But how are you thinking about this sort of pivotal moment and spending it in a way that builds sustainable systems of recovery and care?
• 32:38
  SPEAKER_01: Yeah, I mean, great question.
• 32:40
  SPEAKER_01: I think when I think about the opioid settlement funds, I always think it's significant and so important, and yet is not going to be transfor transformational in what we have um available to us in the community.
• 32:54
  SPEAKER_01: So we really think about our opioid settlement funds within a larger strategy of uh services that we have.
• 33:03
  SPEAKER_01: So um here in Seattle King County, we're really fortunate in that we have a sales tax that we call the bridge that also helps fill some of these gaps and holes in our bigger service.
• 33:14
  SPEAKER_01: You know, we have Medicaid, which, you know, has been transformational.
• 33:18
  SPEAKER_01: I was in this work before Medicaid funded substance use disorder treatment services.
• 33:24
  SPEAKER_01: And so that's part of the picture.
• 33:26
  SPEAKER_01: And so it's really about thinking about, you know, and having the grander vision of what do people need and how do we plug some of these holes in?
• 33:34
  SPEAKER_01: Um, and the the settlement fund has allowed us to do that.
• 33:38
  SPEAKER_01: We've partnered with a lot of community-based organizations to implement our settlement funds.
• 33:44
  SPEAKER_01: We have a great project that happens just down the street from here at the Chief Seattle Club, which serves our native community members primarily.
• 33:52
  SPEAKER_01: And we've embedded a substance use disorder counselor at from one of our uh medications for opiate use disorder clinic there.
• 33:59
  SPEAKER_01: Um and that's allowed us to go to where people are at and where people are are struggling and connect them, you know, with medications for opiate use disorder.
• 34:08
  SPEAKER_01: So really providing those connections for people and um the settlement has really provided those opportunities.
• 34:15
  SPEAKER_01: It's also provided us a lot of opportunity to get life-saving supplies like naloxone out to places and communities that have asked us for it.
• 34:25
  SPEAKER_01: And so being able to continue to be able to respond to community need is really what the settlement has done for us here in the county.
• 34:33
  SPEAKER_03: Yeah, I love hearing about that.
• 34:36
  SPEAKER_03: I wouldn't want to uh let you go today without talking about anti-stigma, which, you know, we've come a long way in people opening up, talking about their stories, but it's still something that can be a barrier for a lot of people to want to, you know, embrace recovery or share their stories.
• 34:53
  SPEAKER_03: But um I understand that your team has led an anti-stigma public campaign called Don't Count Us Out and some others too.
• 35:02
  SPEAKER_03: But um Don't Count Us Out aimed to share that addiction is a treatable condition.
• 35:09
  SPEAKER_03: That millions of people do recover and that everyone can recover.
• 35:13
  SPEAKER_03: It shouldn't be written off.
• 35:14
  SPEAKER_03: So, why is changing that story and confronting stigma head-on such an integral part of the public health work that you do?
• 35:24
  SPEAKER_01: Yeah, such a great question, such a great reason for this podcast, such like the important reason for um to be able to talk and share the story.
• 35:34
  SPEAKER_01: I remember when my brother died and this shame that I experienced um and the stigma that I personally experienced having a brother that died of a drug overdose.
• 35:44
  SPEAKER_01: And I think about so many other families that I've talked to that, you know, that don't want to talk about their experience, that are ashamed that their loved one was struggling.
• 35:55
  SPEAKER_01: And um, how that keeps uh people from being able to access the services that they need.
• 36:02
  SPEAKER_01: So, you know, when we think about stigma, we think about it from a community-wide stigma stigma, like community-wide basis of the way that people see people with substance use disorder.
• 36:12
  SPEAKER_01: We think about it as far as the families and family units and structures and you know, and then also from people who might need uh treatment and services themselves and are ashamed because of their substance use.
• 36:25
  SPEAKER_01: Um, so it's so important to be able to tell those stories.
• 36:29
  SPEAKER_01: We know that people, uh, when they are willing to tell their stories of recovery, when they're willing and able to uh show what they've been able to persevere through, I think that it does so much to being able to open the doors to people that they're able to access the services, that they're willing to do that.
• 36:51
  SPEAKER_01: And, you know, it's our job as um a convener of the system, as somebody who works in the system to help people tell their stories.
• 36:57
  SPEAKER_01: We did um a campaign last year, as you mentioned, don't count us out.
• 37:02
  SPEAKER_01: And we count metrics sometimes in our communications lane, and we got you know eight and a half million impressions.
• 37:08
  SPEAKER_01: So we know that the the reach is far and wide.
• 37:11
  SPEAKER_01: One of one of my colleagues who was brave enough to tell his story got over a million views on YouTube.
• 37:17
  SPEAKER_01: So we know that change is impactful and and people being able to share their voice is so powerful.
• 37:24
  SPEAKER_03: Yeah, it certainly lets people know that they're not alone um to have empathy if um you know folks aren't themselves in those shoes, but you know, see fellow people as people.
• 37:36
  SPEAKER_03: And you know, I think this sort of brings us to a really good conclusion, um, which is amid all the work you're trying to build that lasts, what do you hope recovery in King County looks like five years from now?
• 37:50
  SPEAKER_03: And for someone who is struggling out there or who loves someone who is, what do you want them to know?
• 37:57
  SPEAKER_01: Yeah, I think it's everything we talked about today, right?
• 38:01
  SPEAKER_01: That like that people who are struggling with a substance use disorder are our family members, there are community members.
• 38:09
  SPEAKER_01: Um, our native friends refer to people who need services as their family, right?
• 38:14
  SPEAKER_01: It's it's all of us, it's all of us in the community.
• 38:17
  SPEAKER_01: And that whole help is available and help doesn't have to be painful and help doesn't have to be difficult, but sometimes it is as people walk through their change process.
• 38:29
  SPEAKER_01: But the second thing I would say is that we want services to be accessible for people in a way that they're able to receive it.
• 38:35
  SPEAKER_01: So lowering barriers to care, um, people can receive care anywhere they go, and that really being a front door uh to next for them.
• 38:44
  SPEAKER_01: And next can look like a lot of different things, but it's what people need and what people are asking for so that we can meet people where they are at.
• 38:53
  SPEAKER_01: I'd also say that, you know, five years from now, I imagine a more seamless system.
• 38:59
  SPEAKER_01: It's a system that'll connect people and work with people and follow people as they transition from episodes to care to episodes to care.
• 39:07
  SPEAKER_01: You know, you mentioned earlier that this is National Recovery Month.
• 39:12
  SPEAKER_01: Here in King County yesterday, we passed a proclamation for National Recovery Month.
• 39:17
  SPEAKER_01: Our King County Council uh does as they do every year.
• 39:20
  SPEAKER_01: And they also recognize a recovery champion.
• 39:23
  SPEAKER_01: And so this year's recovery champion is somebody who's been an inspiration to me ever since I've been in this community.
• 39:31
  SPEAKER_01: He's a person who rides his bike around doing outreach to youth who are struggling with their substance use and often unsheltered.
• 39:39
  SPEAKER_01: And he said something yesterday that really makes me think of our future state and where we want to get to and where we're trying to get to now.
• 39:49
  SPEAKER_01: Um, he said, we meet people where they're at.
• 39:52
  SPEAKER_01: We don't leave people where they're at.
• 39:54
  SPEAKER_01: And that, and that to me is everything that we're that we're striving for is to meet people where they're at and to walk with people along the road and not leave them where they're at.
• 40:04
  SPEAKER_01: So that's what that's the system that that I imagine leaning into things that we know work and uh working with people on their terms.
• 40:12
  SPEAKER_03: Beautifully said.
• 40:13
  SPEAKER_03: Uh your yourself and your your colleague who um, you know, congrats on their award.
• 40:18
  SPEAKER_03: I understand that you also have won this award in the past.
• 40:20
  SPEAKER_03: So I need to applaud you for that and for the work you're doing.
• 40:23
  SPEAKER_01: Thank you.
• 40:24
  SPEAKER_03: Brad, this has been such an honest and generous conversation.
• 40:28
  SPEAKER_03: And I hope we can get to that point of um seamless entry, seamless care.
• 40:34
  SPEAKER_03: I know it's a work of progress and that um, you know, the fact that you're looking toward that is, you know, what matters just as much as getting there.
• 40:42
  SPEAKER_03: Um, so thank you for your time and the hope that you and your team bring to this work and uh for sharing a little bit with us today on the show.
• 40:51
  SPEAKER_01: Yeah, thank you.
• 40:52
  SPEAKER_01: And thanks for uh, you know, having this opportunity and also um talking about empathy, right?
• 40:59
  SPEAKER_01: And bringing empathy to a place that sometimes empathy can be lost really easy.
• 41:03
  SPEAKER_01: So um having human stories, talking about the work that's being done and the and the needs that our community has is so important.
• 41:11
  SPEAKER_01: So thank you.
• 41:11
  SPEAKER_01: Thanks for having me.
• 41:16
  SPEAKER_03: As we've wrapped up our conversation, I kept thinking about how Brad mentioned seamlessness.
• 41:21
  SPEAKER_03: When someone finally reaches for help, the difference between them finding an open door versus a dead end is built on purpose.
• 41:29
  SPEAKER_03: By government offices and care centers that choose to coordinate instead of work in silos, by people in the fields who meet others with empathy instead of judgment, and by leaders who keep listening to the people who've lived it.
• 41:44
  SPEAKER_03: What Brad describes is really a lot of people deciding together that no one is beyond reach, and then doing the patient, deliberate work of stitching their efforts into paths where people can walk toward recovery.
• 41:58
  SPEAKER_03: If you or someone you love is struggling, help is real and available.
• 42:02
  SPEAKER_03: You can reach the Substance Abuse and Mental Health Service Administration's National Helpline at 1-800-662-HELP, or the National Suicide in Crisis Lifeline at 988.
• 42:15
  SPEAKER_03: If this episode moved you, do one small thing that helps others find it.
• 42:20
  SPEAKER_03: Follow Empathy Affect wherever you listen, leave a review, and share it with someone who should hear it.
• 42:26
  SPEAKER_03: It all genuinely helps.
• 42:28
  SPEAKER_03: Take care of yourselves and each other in the meantime.
• 42:31
  SPEAKER_03: I hope you'll join me next time.
• 42:32
  SPEAKER_03: Thanks, y'all.
• 42:38
  SPEAKER_02: Empathy Effect is a product of Forz Marsh.
• 42:41
  SPEAKER_02: You can reach us at Forzmarsh Media at forzmarsh.com with any feedback, questions, or inquiries.
• 42:48
  SPEAKER_02: If you want to know more about today's guest, are interested in participating with Forrest Marsh, or becoming a part of our community, check out our show notes for more information.