80: Local Government’s Response to the Opioid Epidemic – Is it Enough (Sort Of)

Is local government doing enough to address the opioid epidemic? It can often seem like the local health department or government, especially in smaller, more rural areas, isn’t doing enough. We talk with Cecil County Health Department’s Deputy Director, Division of Addiction Services, Mike Massuli, to find out more about the services the county offers. We explore why certain services are picked to be implemented, why some might not be chosen, and the challenges faced in trying to establish programs to help the community. We explore using scientifically backed methods and what the health department sees as the definition of their role in addressing the opioid epidemic. Join the conversation by leaving a message, emailing us at RecoverySortOf@gmail.com,  or find us on TwitterFacebook or Instagram, or find us on our website at www.recoverysortof.com.

Here is the website for Rewrite Your Script

Cecil Addiction Treatment Coordination Hotline (CATCH) phone line: 443-245-3257

Here is the episode with ACEs

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Transcript:

recovery sort of is a podcast where we discuss recovery topics from the perspective of people living in long-term recovery this podcast does not intend to represent the views of any particular group organization or fellowship the attitudes expressed are solely the opinion of its contributors be advised there may be strong language or topics of an adult nature and welcome back to recovery sort of i’m billy i’m a person in long-term recovery i’m jason i’m recovering and today we are here with mike masouli he is the deputy director of addiction services for the cecil county health department mike’s been there 23 years has been a long time advocate for recovery and recovery services so mike please tell us a little bit about yourself and how you got into this kind of work and what you’re doing these days sure uh well first i’d like to say uh jason billy thank you very much for inviting me onto the podcast it’s a real exciting opportunity to talk about um recovery in diesel county and and you’re absolutely right i’ve been in cecil county working at the health department and addiction services for pushing 23 years i think this june will be 23 maybe 24 years and during that time i’ve seen a whole lot change in cecil county a lot of really really neat things have come so i think this is a great opportunity to talk about some of that to shine a light on recovery which often unfortunately doesn’t get the attention right but there’s a lot of recovery a lot of good things that exist in cecil county that i think deserve uh to be talked about when i started um i started as a counselor working with um adults and adolescents and i had the good fortune over the first several years that i was there to work in a lot of settings with a lot of different populations adults children their families at the health department in the schools in the detention center out into the community and i i think and i am not a person in recovery um but i do appreciate and and um hope that i can be um a good advocate and a good supporter of recovery because what i saw during those early years was um really opened my eyes to the uh to the strength and to the power and to the value of folks who who are able to with a lot of support sometimes change their lives and you know become the members of society that they want to be and that kind of drove me on my i don’t want to say my mission but my career why i stayed at the health department for so long was able to move up from counselor to supervisor to a clinical director to now being deputy director to kind of help shape a lot of the things that we do awesome and so you were around sort of what i’m going to call pre-opioid epidemic and uh like for for me personally i got my first introduction to recovery you know if you want to call it you know 12 steps or inpatient rehab through the health department i got in some trouble early on as a teenager my parents took me to the health department and they introduced me to i think i went inpatient at that time i can’t remember it’s been so long ago i was like 17 years old but anyway in cecil county it seems like that uh well i guess i’ll just ask you like what is the role of the health department when it comes to like addiction and the community and and is it a treatment provider is it a treatment coordinator is it therapy and counseling is it all those things like what exactly is the role of the health department i think it’s a little bit of all of those things and i think it’s evolved um so yes i i was there before this current opioid epidemic but it’s almost a tale of two different opioid epidemics when i started in 98 it was at the tail end of what was back then the heroin epidemic nationwide and and you know one of the things that that surprised me when i came to cecil county to work was that cecil county was you know one of the epicenters of it nationwide um and i i’m not the best with remembering statistics exactly so i’ll quote just kind of a range but there was a um an understanding that during that time that like like 60 to 80 percent of the heroin that was seized in this country came from that stretch of i-95 from like dc to philly or dc to new york something right but the point being is that there was a lot going on right here locally at that time um and at that point when i came in the health department was a treatment provider we had a really large outpatient intensive outpatient service so folks would come to us for treatment right and i think that’s a key back then that they would come to us oftentimes because something happened right you mentioned getting in trouble and being brought to the health department and we did a great job at that right you know the court system social services families people would come in and there wasn’t a lot else we weren’t the only ones at that time but there wasn’t a lot else at that point for folks to come get help and that was the role of the health department right and the role you know the kind of population that we serve were folks who didn’t have access to other types of services meaning folks primarily who were uninsured well times have changed i think cecil county should be very proud of the fact that since then treatment options have grown tremendously right there are several providers in the county that offer outpatient and intensive outpatient uh treatment options there’s providers that provide mental health therapy for children adults and families there’s folks that do medication supported recovery or medication assisted treatment there’s a lot of connection to services that don’t exist easily in the community for folks like residential detox and and inpatient treatment so there’s a lot more than there ever has been but one of the other big things that changed and that kind of changed the role of the health department is very few folks at least comparatively to the past are without health insurance so all those providers that have grown up mostly largely are able to serve most of the folks in cecil county so what the relevance there the importance of the question is the health department’s role has kind of changed right so we evolved from being this really large treatment provider where we had a census of maybe 300 people at any you know pretty steadily so that’s really taking a back seat because the capacity exists in the community so one of our roles now is is evolved to become a i think you mentioned it a coordinator or a hub when it comes to treatment our role is largely to make sure that the community providers are accessible to the folks in the community that need it yeah and i like that i think you know from from what i’ve seen if you can get it like community providers that kind of specialize in their own area they can hopefully as an independent agent you know i don’t say this politically but broker things a little better or handle certain issues a little better they aren’t sort of mired in some of the bureaucracy and things and and hopefully they can more efficiently get some of these services provided and of course you know back when i was 17 and introduced to recovery like it seemed like the only recovery that was really introduced or offered back then was either a a or n a and cecil county anyway and that was the two options that you know but you can go to a 12-step fellowship and it’s abstinence-based and that was all that there seemed to be right um and then they had some i think it was like i did some different i can’t remember what it was called back then but some sort of like inpatient more like educational stuff you know we go in each week you get some kind of education on how addiction affects your brain and how it does this and that and it was it was fine i don’t know that it helped me much to stay clean but then it was like just go to meetings right and so that was the recovery that was out there and nowadays we see a lot of different options as far as like you mentioned medicated assisted treatment there’s abstinence there’s you know all these different options for recovery and i think that’s a good thing um 100 yeah and so more recently i guess we’ve seen this introduction or it’s become more popular it’s not a recent idea but it’s definitely become more popular the idea of like harm reduction and harm reduction techniques or methods uh that we’re seeing come about in the community um i don’t know does the health department have a i don’t know i don’t know if you even need to speak for the health department let’s say it a different way um so so what do you think of that how that stuff’s coming to evolve things like needle exchange and and the different mat suboxone methadone those programs like do you think that’s a helpful tool to have that we’re starting to embrace i think hands down absolutely and that that’s one of the things that cecil county has done really well um over the years is to embrace you know science-based evidence-based programming to to you know enhance and to strengthen the local resources that are available right there’s a couple of things that that i think are important to talk about here um you know we’re talking about the evolution of the health department’s role and we talk about on the treatment side we kind of become a hub where we can make sure we connect folks with the right services another thing that the health department as a public health agency is responsible for doing is ensuring you know identifying the needs of the community so trying to keep our finger on the pulse of what’s going on through needs assessments and surveillance trying to kind of understand what the needs are so then we can make sure that the community has the right resources to meet those needs and and you’re one of the things that i think is undoubted undoubtable you know is is certain is that not everybody with a substance use disorder you know needs the same things for recovery so the program that you went to billy may have met your means needs may have not met your needs may have met some of them etc but when that was really kind of the only thing that existed here’s your path if you want to get well you go here and then you do this that was great for those people that it worked for right that were in a spot to benefit from that but there was a whole large population that probably weren’t getting served well and we have this tendency as humans that when we see somebody not do well and we think we’re giving you resources what do we do we blame right we say up you know that person doesn’t want to get better they’re not ready to get better etc etc as opposed to what we should do is say okay what doesn’t exist that would actually help that person do what it is that they want to do which is to recover and so you mentioned harm reduction absolutely right harm reduction is part of that continuum of services medication is part of that medication is kind of the gold standard right now for folks with an opiate use disorder does that mean that it that it’s the right mood for everybody no but overall we see that folks with an opioid use disorder do better in recovery engaging in in behavioral health treatment etc with medication of some sort on the harm reduction front right and you mentioned the syringe portion of it harm reduction is a philosophy of services and it’s not a particular project or or service and that that philosophy is really well suited for substance use right and essentially that philosophy speaks to a couple of things that individuals should have access to service with little to no barriers folks deserve and should have a right to service even if they’re not at a point of being ready to or able to commit to somebody else’s idea of what the right outcome is and what i mean by that is we should still provide services to somebody they should have access to this type of healthcare even if they’re not at a point to commit to abstinence right that abstinence-based recovery that you talked about before and so harm reduction is really about that and and um cecil county again is one of the leaders in the state when it comes to developing real specific substance use disorder harm reduction services the health department starting back i believe in 2017 or 2018 we did a pretty intensive um community needs assessment around harm reduction services and specifically syringe services right and we talked to a lot of stakeholders in the community a lot of people that might benefit or utilize the services and what we found was that was a right that was a good thing to develop in cecil county so starting in april of 2019 we started our harmony project which is a comprehensive harm reduction program that offers peer support offers syringe services offers linkage and connection to infectious disease services hiv hepatitis wound care safer sex uh linkage to treatment basically anything and everything anything that a person might need we make it available voices of hope has a harm reduction program as well and i believe they started their community-based outreach uh backpack outreach um the october prior to that so i think october of 2018 and the reason i would go into that depth and could talk for hours about this program because it’s been so impactful is it represented um a shift in um that was consistent with the way that the health department was evolving over the years which is instead of waiting for people to come to us like we talked about before you get in trouble you come see us no no no no that that that doesn’t work for everybody let’s go into the community right so backpack walks through neighborhoods deliveries going out to meet people where they are being available for them based on what they want that’s the harm reduction philosophy that that’s taken and i i don’t have the exact number on my off the top of my head right now but nearly a thousand people have been enrolled in the program since its inception and we’ve seen amazing outcomes just based on some surveying last year folks who were participating in that program spoke really highly of the fact that they experienced fewer overdoses fewer infections fewer trips to the hospital to treat something that was substance related and increasingly spoke of the opportunities that they had to talk to a peer about treatment and this was a population that wasn’t being served before by our existing treatment programs yeah and one of the myth well i’m going to call it a myth nowadays but one of the things we had heard from some of the other advocates in recovery is that that old philosophy of that you know you have to wait till someone hits a bottom or that you have to wait till they’re in crisis to sort of introduce you know recovery is is a bad approach you know that that we can reach out to people earlier on and and meet them where they’re at and you know let them know hey we love you and we care about you you know maybe you’re not making the best choices right now but we want to sort of you know give you some options give you some resources to hopefully not you know harm yourself harm others you know and then when you’re ready you have these relationships built that people are way more willing to reach out and engage absolutely and uh i mean even as as a person in 12-step you know fellowship abstinence-based recovery like that has been a weird transition for me personally like i know 10 years ago if you’d have said oh yeah you’re gonna be a person that’s in in support of like uh medicated assisted treatment and needle exchange i would have said you know you’re crazy i just said all the stereotypical things that’s enabling that’s you know just legal drug dealing like all the things that we say um just being uneducated in in the subject and and not really thinking much beyond whatever i’m doing must be the right way you know and what i’m doing now is it and this is what everyone else should be doing and it works for me so it should be fine for everyone else um so it’s great to see like the the community or at least you know the the people impacting the community starting to embrace some of these ideas and and as a recovery community that we’re beginning to educate ourselves and change some philosophies on that because i don’t know about you but i think we’ve lost the war on drugs i don’t think that’s went very well and uh you know there’s always that push that we need tougher laws and we need you know tougher sentences and and it’s like when do we sort of tap out on that idea and say that isn’t working and let’s try something else and just see what happens and i think as you mentioned at least in the short term because it’s only been a couple years we are seeing more people engaging with recovery we’re seeing more recovery opportunities open up recovery housing different programs um so what other like have you seen a growth in community supports in cecil county um you know you mentioned community partners i have a vague idea of kind of what that is but what is that and how do they work like your relationship or the health department’s relationship with community partners you know we really need to look at substance use disorder and and behavioral health you know larger as a as a health condition and and i think if we continue to do that and and really understand what that means and promote that that messaging then we’ll understand that you know it really does take and require a wide range of services interventions outreaches to folks to help you know the community overall get get bigger right and this is not a problem that is isolated to an individual or to a family it’s a community-wide problem so the response has to be a community-wide response you know you mentioned some of the the legal side of it and and there are parts of that that are extremely important in in the response to substance use but that’s not it and and i think you’ll hear a lot of our law enforcement partners even echo that statement these days that you know we cannot arrest our way out of this problem it’s a health condition right um and and i could talk a whole lot about the stigma and and some of the misunderstandings that that are behind it maybe we can get to that in a few minutes but about 13 10 12 13 years ago um cecil county adopted a four pillar approach to the substance use issue in cecil county and those pillars are prevention treatment recovery support and public safety public safety being our law enforcement and emergency services a lot of the first responder community and doing that kind of um accomplished a couple of things for for accounting one was it organized right and said look all of these pillars are equally important prevention right services that exist to hopefully stop or delay the initiation of substance use you know to hopefully stop the development of a disease of the of the disorder um and then prevention is is a little more complicated like overdose prevention harm reduction can kind of fall under that as like later stage prevention treatment you know when somebody is sick you need to have all the services that are there that that are necessary to help anybody who’s sick get better right the right way recovery support’s huge and that’s all those kind of gap services right so those we’ve mentioned peer specialists i think a few times today um recovery supports or any of those services that that exists to help people become successful in recovery because it’s got to be more than treatment right you need housing you need transportation you need access to employment you need somebody that’s going to be supportive and help guide you through the system and in the public safety piece of it there’s definitely a huge role for that but when you take those pillars and when we started kind of organizing our response and trying to make sure that there was working between them what came out of that was partnerships and so part of the reason why cecil county’s uh response is so strong these days is because of our really tight partnerships and it’s not new cecil county has always been known for having strong partnerships but it’s really really developed into some really neat ways so and and at the risk of forgetting or missing some folks you know our behavioral health provider community is super tight right and what i mean by that are public and our private treatment providers all work together all communicate all collaborate on on initiatives we have our our social service agencies department of social services we’ve got our our probation partner drug court partners juvenile services the public school system has been an amazing partner cecil college our law enforcement agencies um private partners like voices of hope and and and on and on and on that has been necessary to identify and to create these opportunities in the community for everybody to in you know in their own sectors identify okay how does this issue affect us what’s our role in being part of the solution and then how do we work together to leverage resources and support one another to get better and it’s i think this is relevant now i’ve talked a whole lot about all these great things that are happening in cecil county right all these new opportunities for treatment and all these new services and all these partners and and it is absolutely true and i think you mentioned um you know all the recovery in cecil county it’s amazing to see what some of our our our private citizen our private partners have done right you know we’ve gone in the span of several years to not having any recovery house beds to having a ton of recovery house beds the numbers over 140 or something like that um which is really amazing right and that that’s a representative of a partnership we talk about treatment access and more people coming into recovery and the question becomes in why doesn’t everybody else see that and despite all those really good things that have happened there have been challenges that seem to kind of outpace some of this good work and it’s really unfortunate because it overshadows and it leaves in some people’s minds it’s impression that you know what what is happening isn’t working and nothing could be further from the truth yeah and and i think that’s common when you’re trying to do innovative or new things like you’re going to hit stumbling blocks or unforeseen challenges and you know it’s the ability to respond and adapt to that that makes a difference you know but yeah we’ve seen uh just in in different attempts at recovery bring up different struggles you know like you know now that we have all this uh widened uh how to say this nicely without offending everyone so we have this widened opinion on what we think recovery is nowadays and so in a 12 step fellowship there comes an influx of people that want to be a part of that fellowship but then we tell them this isn’t the place for that you know and that happens and those are kind of growing pains of a of a community you know when you have all these new and innovative things going on um same as we’ve seen some challenges with recovery housing and and are we bringing people now we’re attracting people from sort of that we’re already outside of our communities now we’re bringing more people in to a system that’s kind of already you know being pretty taxed i mean we have a pretty bad addiction problem here in cecil county and so we get recovery housing and that attracts people that aren’t even from here now we’re bringing new people in with with more uh needs and and so those are interesting challenges that we just hopefully don’t look at and and throw out you know the baby with the bath water so to speak like the benefits outweigh some of those minor inconveniences right i think you’re 100 right we use the analogy sometimes of the table right you know we’ve invited more people to have a seat at the table and that’s great that’s what you need right to to evolve and to create a system that’s going to be responsive to more people’s needs and have more voices at the table but now everybody’s kind of jockeying for position and bumping elbows at the table so they’re done there are challenges inherent in growth and one of the other things that happens when you get more eyes onto a problem is all of a sudden more people are looking at it right it’s like we need more help we need more help and the second that we get more help now more people are looking at it now it’s opening up other folks eyes and now they’ve got opinions on it they have approaches and so it’s sometimes that almost in and of itself magnifies it right because now more people in the community more organizations are aware of it and talking about it and it just feels like that the problems become more overwhelming it existed before right substance use existed before the opioid epidemic we had real challenges and so it hasn’t gotten worse just because we’re looking at it but it’s gotten the attention and because it’s gotten the attention it gets the publicity to so to speak and then that publicity gives it that aura of and not to undermine or understated it is bad you know there are real challenges

this episode has been brought to you in part by voices of hope inc a non-profit recovery organization made up of people in recovery family members and allies together members strive to protect the dignity of those that use drugs and those in recovery by advocating for treatment harm reduction and support resources and mentoring please visit us at www.voices and consider donating to our calls

so the cecil county health department obviously a government entity right um and i think there’s a lot of flack and and push back from some places that maybe this the health department doesn’t do enough right maybe they don’t care enough maybe they’re putting on this illusion of yeah yeah this matters because that appeases some people but then when it comes down to it it’s like whatever taking that criticism out of the way for a second right i i think the cecil county health department’s response is probably behind the progressive curve and yet still far in front of the population of cecil county uh political curve if that makes any sense and so i guess if you step back for a second and you think about the populace of cecil county and you think how would they solve you know the addiction problem or the substance use problem i i’m picturing like the old west right like just start shooting people in the street or something i don’t know something ridiculous right and so how hard has that been to try to sit somewhere in that right where you have the internal pressure of maybe you have people in the health department themselves that really don’t go along with the more progressive ideas you have people outside of it that are pushing back against progressive ideas but then you also have entities that are like why aren’t we doing what oregon or portugal’s doing right like why aren’t we way ahead of where we’re at how difficult is it to grow in that atmosphere of all this pushback from almost every direction of you’re not getting it right right well and i appreciate the way that you kind of started that right the sometimes uh a public entity the governmental entity can be in a tough spot um and i i kind of respond a couple of different ways the maryland department of health has been very open to bringing in opportunities for new innovative types of solutions right so just the fact that that you know we were able to talk before about this harm reduction programs that’s coming from the state health department you know that’s evidence that that there are folks at upper levels recognizing the need to evolve recognizing the need to to grow and expand and to you know incorporate evidence-based science-based uh solutions even if they’re not necessarily at the the forefront of the public’s understanding of what’s an appropriate response um and then locally we were early adopters with some of those things right you know we’re fortunate in seasonal county in the health department that we have leadership and progressives not necessarily a word that i would look to but i’d say innovative evidence-based appropriate services to to continue to fill that that continuum of care um that’s necessary we’ve had leadership that has been supportive of exploring it so to that end um i think i mentioned briefly before that before we started up our our harmony program the comprehensive harm reduction program that does incorporate syringes and and wound care and all that other stuff we had done narcan you know we were one of the early counties in the state to really develop a robust narcan distribution program in the state and and the response community-wide was similar right there was a lot of and i’m not going to say pushback but there was a lot of questioning right and that questioning comes from a place of not understanding and and it’s interesting um despite that our partnerships that we talked about a few minutes ago allowed us to be at the table with the folks and have the conversations and sometimes those conversations and part of our role as the agency looking to bring these in are to be able to educate hey this is what these are it’s not just what you think about it’s not the legal drug dealing that you were talking about it’s not um enabling right this is what it is this is how it’s done and this is how it becomes you know productive for the community so a ton of education and sometimes when you know we’re in the midst of doing that it feels like it’s really slow you know we started talking about the harm reduction program in 2017. in fact i think a little before that our health officer brought in a group of us from my division at the health department and voices of hope early on to talk about that it was several years before the program launched and i think maybe that can contribute to jason what you were kind of talking about that behind the scenes right like you know the the belief about health department or public folks but there’s a lot of work that’s going on to say okay there are these things you know we have a problem there’s these solutions that exist that can maybe not solve the problem but make it incrementally better this county needs it and and here’s the undertaking here’s the path that we need to go through to make it happen right um i have a really good friend and she and i used to debate all the time marathon or sprint marathon or sprint and and she was always a sprinter right we got to do this mike we got to do this we got to do this we got to do this now we got to do this now and then i was always like yep but we have to do it the right way and the health department’s like yeah we got to do it the right way that way when it actually lands and it actually starts it’s sustainable if that makes sense um and in our county and there’s been a health healthy dialogue right about some of these programs but they’re accepted you know or they’re at least established you know we’ve been operating the harm reduction programs for two and a half years in cecil county with minimal minimal negative response naloxone which wasn’t you know wasn’t welcomed with open arms early on is recognized as a valid um part of the response by pretty much all sectors now right um so i think i i think i’m i hope i’m answering the question there um uh it can be challenging sometimes and you know our role really is to be thoughtful to be fact-based to be intentional to be transparent um it doesn’t always work the way that we’d like but yeah how much does the health department follow whoever’s the county executive so like we just had a change if if we were to get some county executive who maybe was a more uh conservative leaning individual who really wasn’t happy with the services the health department offers how easy is it for them to come in and just change all that do they have any say in that well so county government’s been a real valuable partner for the last several years um like immensely so um pushing back a little more than a decade early on during the opioid epidemic when unfortunately cecil county was identified as you know one of the top in the state for overdose per capita the governor started his outreach into communities in cecil county with a roundtable discussion up here and at that time the county government and the health department partnered to really develop a plan and a response and and to kind of organize the counties uh yeah the county’s response to substance use and that that’s maintained since then and and so through that partnership a lot of really good things have come out of it and i think maybe part of the answer that i could get to too is funding is part of it right so it depends on where dollars come from if dollars dollars are coming from local from county well there’s some influence if dollars are coming from outside well then there’s some influence or there’s less influence if that makes sense yeah so i think it’s kind of a complicated answer you know ultimately we’ve been really fortunate with the leaders in this county who have been willing to to have conversations and to understand and to almost defer to the expertise so to speak of the health department even if not fully always understanding um um and i’ll give you a kind of an example of that so harm reduction right all of those things billy that you mentioned before about enabling and legal drug dealing or what have you that’s not a philosophy that is unique to substance use in fact it exists in so many other areas of our day-to-day life that we don’t even think twice about right but because it we apply it to substance use because substance use has such a negative perception because there’s such a stigma people look at it negatively right and and i could go through some real silly or or simple examples of harm reduction we talk about things like speed limits and and seat belt laws and helmet laws and protective equipment for our kids when they go out and play sports right sunblock is one that’s often used you know things that exist not to stop the behavior that’s potentially harmful like oh if i do this i may get hurt or if i’m out in the sun i may get a sunburn or skin cancer whatever we don’t stop and we create these resources and these approaches to to simplify or to reduce that risk but there’s more there’s a more relevant one right you know our society is is challenged with other health conditions beyond substitutes high blood pressure and and heart disease etc some of those are lifestyle influ influenced right meaning people’s diet and lack of exercise and overworking and over stress contribute to that i go to the doctor because i’m having symptoms of it and the doctor says you need to do this this this and this to get better and they give me medication to lower my my blood pressure i go back in six months or a year my blood pressure’s still up high and my weight hasn’t gone down and when the doctor asked me if i’ve been doing any of my exercise i’m like they don’t stop treating me right they continue to provide me my medication etc and treat my symptoms i share that example as a way to say that that was part of the education that we’ve done with folks county government and other partners-wise that when harm reduction was coming in and they’re like now and we don’t really understand it that was part of the education right that got people maybe not to you know warm hug and embrace but to say okay we at least see that there’s a thoughtful approach to this there’s an application for it um and you know talk to about and we’re fortunate to some extent too a lot of the services that we provide trying to think what the best way to say this is you know one of the reasons why people push back is that and i think very frankly a lot of the community doesn’t think that people with substance use disorder are deserving of our of other people’s resources why do my taxpayer dollars go to this why do i you know and i totally understand that perspective especially for folks who have been fortunate to not have been as affected by this personally as others have but it’s amazing pretty much any of the responses or or services or programs that that have been developed to treat substance use to make it better are beneficial or proven beneficial to the community at large right and so that’s part of that education too and that’s part of the relationship that we’ve had whether it’s county government it’s private citizens it’s law enforcement it’s it’s other behavioral health providers to say look you know these things an investment in doing this in cecil county will also result in this right hopefully yes less utilization of the local emergency department for substance related medical issues less overdose fatalities less offenses less you know and and so to that end jason we’ve been able to work with folks maybe don’t necessarily jump in or or or buy into everything 100 have been willing to be supportive right right you mentioned one thing about the programs uh that we have currently while they are you know they are making a difference they are working i don’t want to say wonders but working a lot in in our county you know there’s a purpose for them we’re seeing the results of them they’re scientifically based thank god we’ve come so far from 1998 with a better understanding and a better implementation of this but you also said these aren’t going to solve the problem which is an interesting statement right and so i don’t know that and i’m not trying to get you in any trouble here i’ve i don’t know that i’ve ever worked somewhere where there wasn’t at least some policy or part of what i did that i didn’t agree with i’m like that’s stupid that doesn’t work why do we do it that way we should do it this other way or something else i’m just curious from your standpoint is there any piece of the health department’s response to the substance use in the community that you feel doesn’t really work all that well and and what i i know worldwide in general we’ve never really solved this yet but what could we do to get closer to solving it in your mind okay so two parts yes what maybe i don’t agree with or i think could be done differently and then what could be done to get closer to get us closer yeah okay yeah and i’m not intending to be overly diplomatic with the response to the fact they’re doing really well but um you know i this is such a complicated look we haven’t even scratched the surface of what contributes to the severity of the substance use disorder right and it’s you know that that kind of tired cliche of peeling an onion layer after layer after layer and the deeper you get the more pungent or the more difficult it seems right one of the things i used to try to teach new counselors coming into the field was their patients weren’t necessarily getting sicker over time sometimes it was a product of that clinician getting better at working with their patients to bring out deeper issues right so there’s a lot of recognition and and acknowledgement of of aces right adverse childhood experiences right and the impact on those things those experiences as a child not just on my behavioral health meaning that if i’ve experienced you know some of these adverse childhood experiences i’m more likely to develop addiction later in life but just our overall health right so we’ve we identified it there’s work to being done locally to develop systems to intervene identify them earlier to intervene provide service etc but again that’s not going to be the solution um i don’t want to get too far away from that initial question so because it’s so complicated right i don’t really know what the right the silver bullets going to be and and i don’t know if there’s anything that i could personally say like even if i were to take off my health department cap if there’s anything that i could say about the health department’s response or even cecil county’s response that i would say you know what we shouldn’t be doing that and i and and i’ll kind of give a general reason why it is such a complicated issue and this county the health department and the people that i’m fortunate enough to work with within the health department and i really do need to shout out our leadership as well as our community partners have been amazing to be open to address these head-on and so we’ve done so much in such a short amount of time that other communities look here sometimes for example hey how are you doing this hey how are you doing that hey we were told by our state administration to come talk to you guys because you started this program by no stretch am i trying to say that we’re the best at everything because we make mistakes but i think that approach to um dealing with the issue far outweighs anything that might have been a misstep and honestly there’s not a single thing right now i mean i could point to things like i wish we had more resources i wish we had a a stronger applicant pool when we have vacancies to to there’s a lot of challenges that we have there are times that i wish we were outside of the state bureaucracy with certain things right because it can be tedious and tiresome um and just to kind of put the nail in that part of the the question unless you have follow-up is um in the personal testimonial for this i moved from cecil county a long time about 12 13 years ago 14 years ago quite a distance away and i stayed here working despite the commute and everything because of how much i believe in what’s happening here locally compared to other places you know other counties in maryland or other places in delaware where i live now and so did that answer the first part jason if you want to push on any of that i think so i i do actually uh so you mentioned maybe the community resources the bureaucracy is there a portion because you know originally you had mentioned that the health department was treatment and now it’s kind of evolved into being more of a hub a coordinator and doing a whole lot of other stuff what part of the services the health department is taking on do you feel like for you at least would probably be better off if the health department dropped it and somebody else did it like what do we need to outsource so that it can be done more efficiently because of that bureaucracy um that’s an interesting question and i think that’s one that’s on the table for a lot of local health departments at this point and i think the question is is that’s evolving like trying to figure out what that right role is so there’s this debate between the public sector and the private sector and what each one’s role is right and that’s still being determined and i think one of the real important parts is a that nobody rushes into anything and creates a system that’s hard to then reverse back right it’s easier to evolve with what you have as opposed to try to go back and regain or reclaim something right a couple years ago um when we were the maryland department of health was really um was a strong advocate right to um for local health departments to partner with private community-based organizations and to develop partnerships and so we did that right and we had done that to some degree previously but that what that means to partner is different for everybody right you know does partner just mean that you guys talk does partner mean that you share funds does partner mean that you share responsibilities does partner mean somebody one person does it and the other person oversees it you know it’s what’s right for the community um and and it requires you know understanding the strengths of each and i i forget jason if you said or billy you said it growing pains right there are growing pains to that type of a partnership as well right and you know i think we’re still trying to figure out what the strengths are and what the right moves are there are programs that the health department delivers um directly meaning we provide the service and there’s uh programs that the health department um uh vends out or you know supports community groups to do it and i think that’s probably gonna be a continuation or an ongoing thing that evolution trying to find the identity and if i could speak frankly too there are some um challenges you know we i think it may have been evident in what i’ve said so far is that you know we take a lot of pride in the work that we’ve done as a health department you know and not just us again that’s recognizing the work in the community but a lot of pride in in the role that we’ve had to play in it and that’s important right you know because we’ve done it well it’s not just empty pride it’s just a lot of really neat things that have happened in cecil county and the health department’s been a good hub again not the only part of it a lot of partnerships a lot of support etc and we’re growing faster than ever before with community-based groups so i think the future is still kind of being written there but it definitely is going to um involve a partnership and i’ve been trying to figure out when the right time for a plug is but can i use this as an opportunity to to share you know and and kind of promote one of these opportunities we’re talking about that partnership private organization doing things government organization doing things um you know cecil county starting last fall effectively or fully is home to a 24 7 substance use disorder crisis hotline we refer to it as catch it’s the cecil addiction treatment coordination hotline so 24 hours a day seven days a week a person anybody dealing with a substance use issue whether it’s the individual themselves their families or just anybody can call this number and speak with a live peer specialist and that peer specialist is trained as an and as an expert at helping to identify and understand the need and be that kind of guide that that director that connected with local resources and make sure that that process is happening you know we always talk about the window of opportunity or striking while the iron’s hot and this is a step toward that now there have been several iterations of this moving forward but we have that now 24 7 this catch line 443 245 3257 somebody’s going to get a a live peer specialist and that is a partnership between the health department and a community-based organization voices of hope where the funding is used and the resources are used to make sure that that 24 7 is there and there’s things that community-based groups are especially adept at doing there’s things that the health department’s adept to doing um and i think this is a good example of learning that and hopefully you know not just learning now but using these as lessons moving forward i’m trying to think if i want to ask this or not i guess i will so with the the catch line and that i mean so is there a plan to make that a place to where people can go because i don’t know if cove you know coven’s been so weird with so many things where now so many things are closed or not open is is there a plan to have like a place people can because what you think of i mean for most people in crisis typically what’s going to happen is for a parent like your child’s gonna overdose if you’re lucky they survive you go and get them at the hospital um i know you probably can’t agree to this part but our hospital here the response isn’t usually great to most people with the substance use they’re going to send them out with a list of places to call and send them out the door and then those people walk out like okay what do i do next it’s 2 30 3 o’clock in the morning you know where do i go because they don’t necessarily know oh there’s a helpline you hope that that information is getting transmitted from the hospital i have my doubts but you know i i know you can’t say that but you know they’re you know here you’re handing people a packet of information saying go call someone later and this is not a crisis like a broken ankle where you can go get therapy later or go get a cast later like i said this is a an immediate need life and death so is there anyway that’s a long way to say is there a hope to have you know the the catch program a 24-hour place where people can go after i guess covet or whatever absolutely yeah so um yes kovid yes coveted was an interference and again you know iterations of this being developed um but the plan was for last march right around covey time for this just to be an in person and then there were going to be a couple of different facets you know in person starting and this is part of that intentional and and kind of over time development thing right but there was a plan for there to be um in person walk in accessibility not just at the health department but in the local hospital and then cove it hit and and had to go virtual and i will say this there are in-person opportunities at this point right so not everything is cut off a hundred percent because of covet and you hit on a key challenge that we have in this community billy no matter how much good stuff is developed good services good programs good people that are available and no matter how much promotion and talking and sharing there’s always people who don’t know right and so you know maybe answering part of the an earlier question one of the things that could be done differently is more community education more community promotion um and i think there needs to be probably some new and different innovative ways to do that because you know it’s amazing the number of times you have you talk to somebody even sometimes within our own organization and you share a resource that people have done i’ve been guilty of it you know resource has been shared with me and then later i asked somebody oh hey do you know where you go for something like this and like i told you about this you have an email about it like oh okay right um so yeah and the intention is when covid lifts and some of these restrictions look we can continue and and hopefully have an in-person walk-in center right and you know there’s a lot of changes in the community and you know there are real challenges with some of um some access to care and you know we talked earlier about um you know one of the health departments or public health’s role is to ensure access well you know that that perception of the reality and the perception of the way folks with substance use disorder are received and or welcomed by organizations is part of that access and that needs to be addressed right you know and that doesn’t that’s not isolated to any one organization unfortunately i’ve seen behavioral health providers who sincerely want to be helpers not be open and receptive and warm right you know you talked before about some of the resistance within the recovery community to things like medication well you know so that is that that exists kind of across the board um we’re constantly in communication with a lot of the partners trying to you know again educate and promote increased access to service um i do think that we’re gonna see changes locally um specifically with say access to the hospital um and i think things are in process to make some changes there’s been recently an acquisition of a local hospital by a large organization that that does some really innovative and neat things at other hospitals that they operate so did that answer the question yeah okay i want to make sure i’m not okay well and in fairness you’re always in a fun place because as the recovery community you know and advocates for recovery our job is to bang on the table and make a lot of noise and demand demand and then hope that you know some crumbs fall this way you know because there is a there is a big bureaucracy and it you reminded me of resources like i remember i used to work with a guy that did like purchasing for the military he purchased stuff for it was dover air force base actually he worked there and he did all the purchasing of supplies and equipment and stuff like that and he would tell us every year they make a long story he gets to the end of the year and he would have some money left so he would just spend all the money and stockpile all this stuff so then he’s like giving out uniforms and giving out boots and giving out all this stuff because they have all the excess and so you know you say well you know why don’t you just say you don’t need it like that’s government money he said if we don’t spend it all they’re going to take it back next year and then if i need it next year i don’t have it so i don’t know that that’s specific to bureaucracies i think individual businesses do that too it’s like well i have these resources i’m not going to give them back i’m just going to i need to keep hold of of what’s mine in case i need it and now with all these new and innovative approaches there’s lots of people banging looking for money and it’s like how do we get this money freed up because there isn’t an unlimited amount of funds or resources available so and things are time limited so you know we could talk we could probably have you know a series of podcasts on the bureaucracy and where there’s some good to the bureaucracy and when where there’s some challenges and some some not so good to the bureaucracy um you know one of the other things just uh maybe as we’re wrapping up you talk about there not being an unlimited pot of funds right and that’s absolutely true there’s also not an unlimited window of those funds being available nor is there an unlimited use of those funds so you know you mentioned the opioid epidemic you know that’s kind of where a lot of this started early questions well it took many many years or several years maybe not so many it took several years before that right and what started as as a rise in fatal overdoses attributed to prescription medications it took several years before that you know was translated into funds right well guess what a lot of those funds are earmarked for now opiates so you know one of the things i’d like to to kind of point out and and cecil county has done it is in the process has done a really good job and is in the process of do you of continuing to strengthen this is to take those and develop programs in such a way that are sustainable beyond the time of those funds and you know create a no wrong door approach right because just because there’s a 24 7 cat line doesn’t mean that everybody calling that is going to have an opiate use disorder and so there’s been a lot of good work and and i believe our partners would say that there’s been good work and maybe it’s not always perfect work but good work to say okay how do we expand this to make sure that somebody calling with an alcohol use disorder or somebody calling for marijuana or somebody calling for something else gets served no wrong door approach we’re going to connect you to the right resources hopefully seamlessly somebody who’s calling they don’t have a substance use disorder it’s more mental health developing those connections to make sure again it’s a no wrong door because ultimately you know going back to kind of jason your question about the almost a silver bullet i don’t know that we’ll ever get out of this completely but i think the um you know one of the ways that we will make some significant headway in in it as far as you know how severe the illness is in people and how severe the impact is is by simplifying access for folks you know what make a number make a place that people can go to make it so that no matter what door i walk in when i when i develop the courage to walk through that door and start speaking that that is going to serve me even if they’re not the right program for me they’re not going to just tell me go to this place they’re going to sit they’re going to engage me they’re going to do that warm hand-off it’s about going upstream right it’s another thing that that we’re doing there’s been there’s a few examples right now of us taking resources and developing programs that go to folks immediately or as immediately as possible after something happens that might create some motivation or some openness to change as opposed to waiting six to nine months you know for the court system to work something through and send them to us um so it’s it’s it’s continuing to increase access and making sure that when that person takes advantage of the access that the resource is there to actually serve them so tomorrow morning you wake up and you got this gigantic bag of money on your front porch that says mike uh we need you to put this into the biggest need for cecil county right now in substance use services um so do you you take this money do you think the biggest need is an inpatient treatment center in cecil county do you think it’s you know 20 new recovery houses do you think it’s pumping that money into some program that’s already there where do you put that what do you do with it what’s our biggest need here um so after jokingly i ask questions like okay who gave me this money what are the strings on this money what are the requirements not us because we don’t have it how long will this money last right because these are all things and and and i’d say that somewhat jokingly but somewhat serious because that’s not all that uncommon hey here’s dollars maybe because of what you said billy we’ve got year-end money left over and so instead of buying a lot of boots it’s hey what can you guys do with this and it is real easy to say hey you guys had all this money and what did what came of it but if that money is not if it’s a one-time thing if it’s a system that really influences what can and will be done effectively right because the last thing anybody wants to do is start something and then have to stop it in a little bit right and that really is a challenge um the sustainability piece is a real challenge but um no strings no consideration of of of any of that stuff um i think having a place where folks in crisis can go for stabilization makes a ton of sense right right um and stabilization means a whole lot of things to a whole lot of different people right it might be to detox and physically become it might be to get off the streets and have a safe place to live and to stay it might be just you know what i’m not really at risk of withdrawal i’ve got a safe place i’ve got a roof that i can say but if i’m not with you until a bed opens up then maybe i’m not going to keep that bed i’m maybe i’m not going to feel this way tomorrow unless i’m with you until that bed opens up and now i will do an asterisk on that and say that that is you know my response at this point um it might not be the right one necessarily awesome can i ask one final question we’ll let you go um so i was told you were actually kind of credited with starting voices what ended up being voices of hope so where did that idea come from was that something from you or maybe from a directive or was that something you had come up with and how do you feel that’s gone like do you regret that decision sometimes

so i think there could be a straight line drawn between what you know the seeds and and where it is today but that that straight line may not be as as straight as i imagine or maybe some leaves so some of the early seeds were you know talk about kind of how the way programs start and stop and evolve and try to fill gaps you know and i’ll try to keep this brief you know one of the challenges with addiction services we know addiction is a lifelong illness for many people but services that that treat addiction are often really short-lived right six months your discharge you’re gone see you later and it’s that that gap in between where folks you know we all struggle we all experience things there wasn’t easy access to get support again without committing to another six months of treatment or something like that right and so there was this um this idea called continuing care that was starting to get pushed for you know uh many years ago and that idea was even when you completed a program we as the the state funded agency we were there for you we would still maintain contact right and we had our some of our counselors would do that and maintain contact with their case so sometimes our peer specialists would do that and what we learned and peer specialists i don’t know if we’ve defined we probably don’t have to define for this audience but peer specialist are individuals and sustained long-term recovery who’ve also received professional training to be

part of the solution a peer recovery specialist started taking on some of that responsible responsibility and proved to be really effective at it and then that kind of evolved into this idea amongst our peers to develop a in-house group to invite program alumni back in right and then that kind of evolved to become something about you know let’s go out in the community and provide recovery advocacy and support and and myself and and jennifer turk would talk about this a lot kind of some of the ideas that sprung from that and talked about things like you know developing resources and and building on the strength and the and the the passion within the recovery community to help give back and to be referred to things like the recovery army back then right you know utilizing a lot of people who wanted to do good stuff wanted to give back in some way and and how would that create and there were some really long lengthy um conversations um oftentimes late into the evening about that um and then that became voices of hope which was part of the health department for a while part of our division and it met in the health department for a long time and and then there was a period where um i think the ambition and the division of voices of hope grew to a point that really didn’t sit well in a government organization you know i can’t do advocacy you know i can’t do lobbying i can’t go and and push for a particular issue political or otherwise i can educate i can right but i’m neutral i’m i being the health point where we’re neutral um so that’s when voices kind of splintered off became their own private non-profit and over the years uh became what they are today and i am very proud of what they do yeah i know there could be a headache sometimes for you so um so yeah that was all the questions i had yeah no i i appreciate you coming on it was great i think it was informative and i think it’s easy on the advocacy side where we want things to change and we want help to point fingers at the government at the health department and and look honestly like two hours from now i’ll probably do it again right i’m not saying that i’m completely changed my life or anything but i do think it’s good to step back and realize that i mean i hate to say it could be worse it definitely could be worse but it’s also like i i think the health department’s doing the best they can right i i don’t know that they could exceed the scientific evidence and start just trying random stuff you know uh and experiments in the community to try to fix this i don’t know if they really could do that i don’t know if there’s funding for that i know you’re working with and i think you brought up a lot of points about okay there’s funding will there be funding in three years right i don’t want to start a program that’s going to work for three years and then get cancelled because the funds stop like there’s a lot more to it than just why the hell aren’t you helping us it’s good to see that well and just then to finish on that if i could you know it’s weird um it’s kind of this double-edged sword you need to be able to go out and do things and try things right some of the culture and it’s not just in cecil county but anywhere that you guys referenced before you know there’s a potential ripple or shadow effect that becomes very dangerous right or or potentially impeding meaning if i go and i try something and i do something and i don’t have a lot of good reason and thought out planning for it and it doesn’t work or something happens as a result of it that that can i could do all the education we can do all the education training etc to try to take a misconception or a mis-held belief and and make some positive progress and change somebody’s mind right and i can share a thousand examples of the good that this did and a single occurrence that’s consistent with that previously held misconception can undo all of that and and change that good will and change that openness and partnership so you know i think that’s just you know an example again of you know there’s there’s intentional methodical approach there’s other ways to go in and try things and i do think that i will say cecil county is better for having the health department i think cecil county is better for having the private programs that we have i think cecil county’s got a really good network of local behavioral health programs i think our public safety and our governmental partners um all do a a a really amazing job and have done so um even and i think jason it’s huge what you just said sometimes it’s important to take a step back and look at things through a different lens sometimes so um i would just like to say too in addition in addition to the catch line uh i’d encourage folks to visit rewriteyourscript.org it’s rewriteyourscript.org it’s a go-to for cecil county folks for prevention treatment recovery support overdose prevention a lot of local information a lot of local faces a lot of local resources are available on that website it’s regularly updated and that’s a resource that we really like to promote for folks when they don’t know where else to go go visit that and find something awesome well thank you very much for your time and thank you for your years of service you know here in cecil county it’s like we say to everybody that’s an advocate out there it’s thankless work and it’s never ending need so thank you for your time and and you have a good day appreciate it thank you so much thank you jason it’s nice meeting you it’s nice meeting you mike all right have a good day guys did you like this episode share it with people you think might get something out of it check out the rest of our episodes at recoveryswordup.com also while you’re there you can find ways to link up with us on facebook twitter instagram reddit youtube anything we’re always looking for new ideas got an idea you want us to look into reach out to us

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