Managing addiction and supporting recovery takes time, training, and legal processes that few can afford alone.
Dr Jennifer Potter, Professor of Psychiatry and Associate Dean for Research at UT Health, San Antonio discusses the ‘Be Well Texas’ programme of training and technical assistance, and what she sees as the next steps to remedy the drug addiction problems facing the people, and the social fabric, of America.
Read the original research here: https://doi.org/10.1371/journal.pone.0234425
Image credit: Africa Studio/Shutterstock
The following transcript is automatically generated
Hello, I’m Will. Welcome to Researchpod.
There are many paths to opioid use disorder , but for todays podcast, the way in matters less than the way out.
Social, medical and emotional support is proving more effective than criminal punishment in managing addiction and supporting recovery, but providing that support takes time, training, and legal processes that few can afford alone.
Today I’m speaking with Jennifer Potter, Professor of Psychiatry and Associate Dean for Research at UT Health, San Antonio about training and technical assistance made available to healthcare professionals through ‘Be Well Texas’, and what she sees as the next steps to remedy the drug addiction problems facing the people, and the social fabric, of America.
Doctor Potter, good morning and hello.
00:01:02 Dr Potter
Good morning, how are you doing today?
I’m keeping very well and thank you very much for joining us.
I imagine that things have been quite interesting for you at work in the last year and a half.
00:01:12 Dr Potter
Yes, I don’t imagine how anyone right now who works even remotely with healthcare or any industry doesn’t anchor themselves in time right now as it relates to pre imposed pandemic.
00:01:23 Dr Potter
You know the interesting thing with substance. Use to jump right in there. Is that so much changed. And yet in some ways nothing changed because.
00:01:31 Dr Potter
The job was still the same.
00:01:32 Dr Potter
Same, we have people that use substances and for some of them they run into trouble and need additional support.
00:01:41 Dr Potter
What’s interesting about the pandemic, I think, is that it highlighted in an unexpected way the myriad challenges that people have getting access and as a result, a typical person might be thinking well. How do you get to your doctor if this is something that’s important or?
00:02:01 Dr Potter
What if your entire treatment system was shut down?
00:02:06 Dr Potter
So in the midst of worrying about whether or not we can transmit or get or acquire or pass this virus, people who had healthcare conditions had to think about all the other ways that they navigate the myriad complexities in the what is known as the US health care system.
00:02:26 Dr Potter
Never has the role of social isolation and stress and its relation to substance use. I think been highlighted in modern times the way it has with COVID because and this is, this is my observation, but I think what happens is that you realise that a lot more people are walking in the shoes of people with stress.
00:02:47 Dr Potter
And anxiety so each of us in our own way can find a way to connect with people who are struggling even more.
00:02:55 Dr Potter
What’s interesting about the pandemic is it’s it’s global, but it’s also very local, so the challenges and the way we navigated it in Texas.
00:03:03 Dr Potter
I think are similar but also dissimilar to how other parts of the country and this?
00:03:08 Dr Potter
And this is just anecdotal, but as I was coming home early in the pandemic when I was concerned for my friends who were physicians that I work with and I was concerned for my daughter in New York and I was just tired of it all and we didn’t know what was going on. And it was even hard to see, you know.
00:03:28 Dr Potter
Science as a scientist I I live in that world and I’m I’m proud of our methods and our approach.
00:03:34 Dr Potter
And some of the attacks on it, and the vulnerabilities of the scientific method were really exposed early in the pandemic, ’cause everything was so fresh and novel and new.
00:03:45 Dr Potter
But I noticed myself I was coming home and I probably had a few more drinks of wine than I would typically have.
00:03:53 Dr Potter
That’s not something that I’ve ever really monitored in my personal life, but yet the stress I was under made me realise how these are universals. You know, we look for ways to ease suffering, and we use substances.
00:04:06 Dr Potter
In functional ways, so for me it was a real example of.
00:04:11 Dr Potter
Insidious the onset is of something that we all think of as normal, which and I would argue substance use is a normal behaviour. Humans have used substances for a variety of reasons, for a very long time.
00:04:25 Dr Potter
But when that functional relationship between a desired outcome and the use of a substance to get there predominate’s to the expense of other ways to cope like exercise or spending time with family, it really highlights how these things can set in and creep along and. And that’s a long answer, I know.
00:04:46 Dr Potter
But it’s it’s really important because I think it’s connected.
00:04:50 Dr Potter
To what we need, and again, it also points out the challenges that we’ve had with access more.
00:04:57 Dr Potter
More people are exposed to a substance. More people are likely to become vulnerable as a result of that exposure.
00:05:03 Dr Potter
We have the perfect storm of stress and isolation and again substance use and then we find ourselves in a very unique set of circumstances.
The stigma associated with substance use has barriers to overcome in that way compared to other disorders.
00:05:22 Dr Potter
Absolutely, the example I give when I’m speaking to community audiences is when a family member is discovered to have cancer. Casseroles come out and you’ve got a freezer full of treats and things to heat up.
00:05:36 Dr Potter
If someone shares the story of a substance, use struggle in their family. It’s very often the case that that’s quietly not talked about and we turn away from those folks, and that’s not universal, but I I think there’s a fear that comes with managing substance use in a family or a loved one or in yourself.
00:05:55 Dr Potter
That makes it very different
00:05:58 Dr Potter
00:05:58 Dr Potter
It is a funny word because it’s almost stigmatising to say stigma and to call it out that way and make it another. I think we do it for simplicity and because we need to acknowledge it.
00:06:12 Dr Potter
But I honestly, you know, I’ve been thinking a lot lately about how to approach stigma and so my work really is not about often talking about stigma, although I do. Sometimes it’s really about applying all that I’ve learned.
00:06:27 Dr Potter
In health care and from the research we do in a way that treats substance use and substance use disorders.
00:06:35 Dr Potter
Normally that they really are part of life for some people, for reasons we’re still seeking to understand, they may be more vulnerable and we need to approach that with all the love and compassion we would give to anyone with any type of health condition with a single minded focus on improving.
00:06:56 Dr Potter
Quality of life and reducing the consequences of the symptoms associated with it and providing relief to the best. The best that we’re able.
00:07:05 Dr Potter
We have ways to improve, right? So people spontaneously remit from what we call a substance use disorder. The vast majority of people who try substances and engage in substance use don’t go on to develop what we call a substance, use disorder or also known as an addiction.
00:07:26 Dr Potter
And there’s a subset of people who are going to need help.
00:07:29 Dr Potter
The challenge is getting science based help to them as quickly as possible and supporting recovery because unfortunately, you know, addiction can be life threatening and we need.
00:07:41 Dr Potter
To treat it that way.
Which leads early on to all of the work at UTexas Health in San Antonio. If we could dig into a bit more about the organisation, the people inside of it and behind it and who you are working with as well.
00:07:54 Dr Potter
My background as a scientist has always been working on the development of behavioural and pharmacological treatments for substance use disorder, but I also.
00:08:05 Dr Potter
And deeply committed to compassionate, evidence based treatment. And if you say that enough in public settings, it turns out that somewhere along the lines people are going to listen and they might actually say, Gee, we would like to trust you with.
00:08:21 Dr Potter
Starting to solve problems based on science and for someone who works in my field. It’s a very rare opportunity to have that moment where you can take the science that you’ve worked on for so many years and your public health background and deploy them in a way to actually make an impact on our communities. And so that’s what I think.
00:08:41 Dr Potter
Is our noble experiment that we’re undertaking or are in the midst of right now.
00:08:46 Dr Potter
UT San Antonio is the largest.
00:08:50 Dr Potter
And to some extent, the only academic health centre in Texas and we are in the southernmost tip of a very large state, right as you approach the border to Mexico through Laredo and many other cities, and the reason I anchor what we do in place is because a lot of our work is focusing on what is Local and what is universal?
00:09:13 Dr Potter
And the challenges of applying local context while also appreciating at the end of the day. They’re just some things.
00:09:19 Dr Potter
That that work.
00:09:20 Dr Potter
It’s how do we get those to work in a local area?
00:09:23 Dr Potter
And so UT San Antonio has a medical school, which is where I work. That’s really focused on this. You were mentioning stigma earlier.
00:09:33 Dr Potter
What I’m really appreciative at my university is is that we have a level playing field for all health challenges and when you come to the table with approach.
00:09:42 Dr Potter
Problem and some solutions were able to deploy that in a way that creates the space that we need to work on the problem and so in the case of.
00:09:52 Dr Potter
Addiction we have here at Utah Health San Antonio a number of folks that have a pretty unique pedigree to deploy to this problem.
00:10:02 Dr Potter
Specifically related to substance use and opioid use disorder.
00:10:05 Dr Potter
Because we are a State University, we have some unique capacities to partner with the Texas Health and Human Services.
00:10:13 Dr Potter
And that provides us a very unique.
00:10:19 Dr Potter
To work as a partner with the public health infrastructure for the state of Texas. And we started this journey to do that really focusing on opioid use disorder a number of years ago.
00:10:31 Dr Potter
And it’s it’s Co located in time with the highlighting at the federal level of the challenges related to opioid use.
00:10:39 Dr Potter
Disorder and the morbidity and mortality associated with that.
00:10:45 Dr Potter
Being a state entity, we can partner with other public health organisations in a way that allows us to really be consultants and actively involved in problem solving.
00:10:57 Dr Potter
The Health and Human services has some extraordinary people that work there that have a really great road map for where they want to go.
00:11:06 Dr Potter
The challenges in execution because we’re a very large state, it can be unwieldy, so being able to partner with the university allows us.
00:11:17 Dr Potter
To work quickly and rapidly and help to overcome some of the challenges that the state might have if they were allocating all of those resources and deploying and executing on them uniquely.
00:11:31 Dr Potter
Anyone who knows academia might laugh a little bit at thinking of us as nimble.
00:11:37 Dr Potter
But that’s really the experiment that we’re doing. Is is really trying to understand how we can take the very best of academics?
00:11:45 Dr Potter
What is so great in local public health infrastructures to increase the benefit of these federal dollars and in a very complex system?
00:11:55 Dr Potter
So you just heard me say federal, state, local, public, university, and that’s really our job is to understand and be laser focused on improving the lives.
00:12:06 Dr Potter
Of people who are struggling with something related to opioid use or substances.
And from there we can start looking at the different kind of interventions that there are in terms of harm reduction and compassionate policy.
Some of the stuff that you’re either offering on site or you’re trying to engineer the social system towards treating people to tackle the problem.
00:12:28 Dr Potter
Our work started relatively small. We received funds.
00:12:33 Dr Potter
Via the state. For a very immediate solution to an extremely immediate problem. And that was that in Texas, there are not enough individuals who are trained and qualified and registered with the Drug Enforcement Agency to be able to prescribe buprenorphine.
00:12:54 Dr Potter
Buprenorphine is one of three medications that are FDA approved to treat opioid use disorder.
00:13:01 Dr Potter
It is not an easy road for healthcare provider, to get this X waiver, it’s called an X waiver and so our work was really focused on how can we overcome the activation energy.
00:13:16 Dr Potter
How can we make it easier for healthcare providers to be part of the solution to treating opioid use disorder by doing this very?
00:13:25 Dr Potter
Simple thing that is also very complicated and what I mean by that is.
00:13:31 Dr Potter
Getting a waiver on your DEA licence is actually straightforward.
00:13:36 Dr Potter
But in the United States, what has happened is is that there has been this eight hour training required to be able to get this X waiver, and so we had a year where we underwent a series of exercises and campaigns to increase the number of folks that were prescribing buprenorphine.
00:13:56 Dr Potter
For opioid use disorder, but I think even more than that individual project, it was an opportunity for us to flex our muscles and understand how to apply science to the social problems that we were seeing related to substance use disorder.
00:14:14 Dr Potter
Subsequent to that, we have established a provider network that covers most of the regions in Texas. We’re not there yet, but what brings all of these folks together in a network is it is a mix of providers we have public and private for profit, not for profit.
00:14:35 Dr Potter
The common thread is that all of these groups are providing office based treatment for opioid use disorder.
00:14:42 Dr Potter
The long term goal is that we can continue to build this collegiality in this diverse network such that we’re able to continue to utilise them as a vehicle for providing evidence based care.
00:14:56 Dr Potter
We have this network we are currently working on increasing their capacity to provide buprenorphine treatment. Again, that’s one of the FDA approved medicines to treat opioid use disorder.
00:15:09 Dr Potter
More recently, we are expanding to be able to provide capacity to treat alcohol use disorder.
00:15:17 Dr Potter
Many people do not realise it, but in the United States there are medications that are approved to treat alcohol use disorder.
00:15:25 Dr Potter
There are also behavioural treatments that are available. So how do we actually get those to the people who need them?
00:15:33 Dr Potter
I am very fortunate because I know this and so if someone in my family was having this difficulty, it would be relatively relatively and there’s a big qualifier there straightforward for me to go and identify a provider.
00:15:47 Dr Potter
But if you don’t even know the treatment exists, if you do not even know that it is comfortable and appropriate to go to a health care provider and say, I think I might have some difficulty, I’m noticing that I’m using X or Y more that I’m using alcohol in a way that makes me uncomfortable. Are there treatments for that?
00:16:05 Dr Potter
If people don’t even know that it’s OK to ask that question, then we need to work with health care providers to make it accessible and to make people comfortable raising these issues, which again goes back to the the ugly word stigma because you start to wonder well, why don’t they know that?
We recently spoke with the Rocky Mountain Poison Drug safety team about their work into stimulant use and death.
Do you see the same approach is working between stimulants and opioids? I talked about the squeezing of the balloon.
00:16:40 Dr Potter
I call that substance use whack a mole. I think of a carnival where you’re trying to beat down one thing and then it pops up somewhere else and so there there is an argument to be made that we need to think holistically about. What are the root causes of a substance use disorder?
00:16:57 Dr Potter
But there’s also, I think, if we take a step back even further, we need to understand that substance use is going to happen, and I would include alcohol in this as well.
00:17:08 Dr Potter
So the 1st order of business is that people are going to drink. People are going to use drugs, so at the very foundation if they are going to use.
00:17:18 Dr Potter
These substances we need to Ensure that that they are safe.
00:17:22 Dr Potter
That they are able to have access to what they use in a way that will not de facto cause harm to them beyond the substance use.
00:17:34 Dr Potter
So alcohol is a good example of this. There’s a reason that alcohol is regulated and licenced and we have distributors.
00:17:43 Dr Potter
You know, if you have a glass of wine or a bottle of beer, you will see something that indicates the percent alcohol in that.
00:17:52 Dr Potter
If you think about it, that’s Actually harm reduction, right? Because people know what they’re drinking. If we were all drinking homemade liquor in all its forms, we wouldn’t know what we were consuming.
00:18:04 Dr Potter
So just by default, I think of that as something it’s regulated harm reduction, right?
00:18:09 Dr Potter
The problem is with drugs that are illegal. We don’t have those same types of quality control and it becomes inherently dangerous beyond the substance use to utilise substances when we don’t know what’s in them.
00:18:24 Dr Potter
That in fact brings us to some of the challenges that we’re having with the illicit drug supply in many communities in the United States.
00:18:32 Dr Potter
Because very often, individuals who are purchasing these, they’re not purchasing them anywhere that’s regulated. There’s no quality control. We do not know what is in those.
00:18:42 Dr Potter
Rumour and myths abound about what is or is not in the drug supply, but there are factual components as well.
00:18:50 Dr Potter
We know that drugs off the street there may be contaminants, things that that are in there that result in them being less safe when they use, and that’s just so so important because I can’t… Treat somebody who’s dead.
00:19:06 Dr Potter
And if if they are subject to a drug that is mixed that they don’t understand, that increases the risk of an overdose. If there’s something they weren’t expecting, or if it’s if it’s purer or stronger.
00:19:19 Dr Potter
The other thing is that we have programmes that connect drug use to other diseases. The most obvious example I can give is infectious diseases where if somebody is using a needle to use a drug just by virtue of the fact that it is injectable, there is the possibility.
00:19:40 Dr Potter
That they may cross contaminate, or they may infect somebody else, and so the simple example is somebody who might share a needle.
00:19:47 Dr Potter
That needle should not be reused.
00:19:50 Dr Potter
Do I want people to inject drugs? Not particularly different people have different comfort levels around this. I personally just don’t think that that’s as good an idea.
00:20:02 Dr Potter
I’d like to find another way for them to find joy or pleasure or relief or whatever it is. That’s the reason that person might use.
00:20:11 Dr Potter
But at the end of the day, it doesn’t really matter.
00:20:13 Dr Potter
What I think.
00:20:14 Dr Potter
What matters is that that person after that engagement is safe, and so syringe service programmes are a way to make sure that an individual has access to the materials that will keep that drug use safe.
00:20:30 Dr Potter
The other reason that syringe service programmes are important is that we know that when people are engaged with them, they’re also more likely to engage in treatment subsequently.
00:20:40 Dr Potter
But my job is not to push, preach or proselytise treatment. My job is to be available and have programmes that are available when that individual is ready.
00:20:51 Dr Potter
And this is one of the things we talk a lot about is we want to make that treatment on.
00:20:57 Dr Potter
It’s different in some ways from other diseases in that.
00:21:02 Dr Potter
You call up, you say. I think I have this or I’m concerned about this and you go to your doctor or your health care provider and you make an appointment and you get it with substance use.
00:21:12 Dr Potter
Sometimes it’s a little bit different. The waits are longer for care. Good treatment implies long waiting lists and.
00:21:22 Dr Potter
Sometimes the decision to seek treatment doesn’t happen on my 9:00 to 5:00.
00:21:27 Dr Potter
That may be a moment at 3:00 AM or you know midnight or or early in the morning and it’s it’s just really important to have the support available when that person is ready so that we can begin that process of engaging them in in treatment or other support services they might need.
That is a very good launching off point into Tx Moud. The acronym that stands for and hoping that I’ve said it right out loud and all of the programmes they’re in. The boots on the ground work that’s happening to make all these things happen.
00:21:58 Dr Potter
Sure, so what’s been great about our work is that there is a body of science to support addressing substance use disorder.
00:22:07 Dr Potter
I and others have often thought that one of the greatest public health failures of our time, and I will fully agree that COVID kind of knocked us off.
00:22:16 Dr Potter
Number one has been our approach to substance use and substance use disorders because, unlike COVID, which is why I like this comparison, we actually have some really great treatments that work.
00:22:27 Dr Potter
This is a failure of execution to deliver these programmes. So we’ve built over the past 50 to 75 years. A really strong knowledge base about what to do.
00:22:40 Dr Potter
What Texas MOUD is I like to call it.
00:22:44 Dr Potter
Or Texas medication for opioid use disorder, What we do is we manage a suite of interventions at multiple levels that are intended to increase access, overcome barriers to treatment and and lift the treatment community up in a way that.
00:23:04 Dr Potter
Makes it easier for individuals to get access to compassionate evidence based care for substance use disorder in this case, particularly opioid use disorder. And when I say evidence based care, I’m really talking about treatments that work.
00:23:18 Dr Potter
And that the benefit is this is not anecdotal treatments that work. This is the preponderance of evidence suggests in high quality gold standard research clinical trials in this case.
00:23:32 Dr Potter
That these interventions actually have the best possible evidence that it’s going to help an individual.
00:23:40 Dr Potter
We have a provider network and this is a collection of programmes throughout the state that provide office based treatment that’s buprenorphine or naltrexone.
00:23:54 Dr Potter
That network also includes a set of programmes that deliver methadone treatment, which is the third FDA approved medication to treat opioid use disorder.
00:24:04 Dr Potter
That provider network also includes throughout the state of Texas, a network of peer recovery support specialists, and these are individuals that are not healthcare providers. These are people with lived experience.
00:24:16 Dr Potter
Parents, they have used drugs or alcohol. They are in long term recovery and they are professionals who are trained and certified to work with individuals with an opioid use disorder or other substance use disorder and work on the recovery process.
00:24:34 Dr Potter
People can quit drugs everyday.
00:24:37 Dr Potter
Maintaining that recovery involves a set of behaviours that I argue live beyond just the cessation of the substance use.
00:24:47 Dr Potter
This is everything from re entering the workforce, dealing with any legal issues that may have happened, addressing separation.
00:24:57 Dr Potter
From loved ones, rebuilding your peer support network, rebuilding the people in your life, and re engaging with them because ultimately we want people to have.
00:25:07 Dr Potter
Of a rich, rewarding life, whatever that means to them that allows them to have all the tools in their toolkit to navigate our very difficult lives so fundamentally, this is about finding that hope and that thread or multiple threads to pull that will help you.
00:25:27 Dr Potter
Go from quitting everyday to actually no longer using substances and having a life that is additive, not subtractive.
You mentioned being kind of on call to try and help people at whatever times that they need help. I understand you have a virtual clinic in the works to deliver that in the moment. Care for whoever needs it at whatever time.
00:25:50 Dr Potter
Yes, this is one of those things of the old lemons out of lemonade.
00:25:56 Dr Potter
One of the things that we’ve seen since the pandemic is that we had to pivot to taking all of this digital know how and the digital tools that we have and utilising them to deliver care.
00:26:10 Dr Potter
When you can’t be face to face and in person and so the virtual clinic, it’s going to allow us to take the very best of technology and afford people the opportunity to have care even when they’re not in the same room with somebody. And so this is a very new approach for Texas. I would argue it’s a new approach.
00:26:30 Dr Potter
Nationally as well, because what we are doing is linking.
00:26:36 Dr Potter
Providers in one part of the state with people who are seeking treatment all over the state to be able to do this network.
00:26:45 Dr Potter
One of the things that we’re hoping is that as a result of this, we essentially can meet people where they’re at. So if they make that phone call in the early hours of the morning.
00:26:56 Dr Potter
There’s someone on the other end of the line that isn’t just a helpline saying hey, I hear you, I’m here with you, which is important, but they’re also a person who can make an offer they can offer.
00:27:07 Dr Potter
Would you like to talk to a therapist or or G based on what you’re saying, it sounds like you might be having more challenges with a drug or alcohol than you might realise.
00:27:17 Dr Potter
Would you like me to make an appointment for?
00:27:19 Dr Potter
You and then have that warm handoff from that initial call to an actual date and time and virtual space.
00:27:27 Dr Potter
Or brick and mortar space where that individual can immediately get that help.
00:27:33 Dr Potter
What we know is that as you go along that pathway, we start to lose people their momentum shifts, they go from yes I need help right now to.
00:27:43 Dr Potter
Well, I’m feeling a little better.
00:27:45 Dr Potter
Today, maybe I don’t need to do this because it’s scary to seek treatment for some people and we know that if you can give people these warm handoffs.
00:27:54 Dr Potter
Along the treatment pathway, they’re much more likely to actually be able to make that visit and have that first encounter with a therapist or a physician to discuss their case.
00:28:07 Dr Potter
And then, as warranted engage in treatment as a result of that. So we’re really trying to build what I hope is coming through is is a system of care.
00:28:16 Dr Potter
It’s not just a virtual clinic, it’s not just a call centre. It’s not just a provider network. It’s not just training providers to do a better job. It’s all of those things working in concert.
00:28:26 Dr Potter
Together in a way that can really be transformative with how we approach this problem.
And do you have any testimonials from either people who’ve been through the programme or people who are being trained up for this to? I guess, speak to its value.
00:28:41 Dr Potter
Now I think our strongest data, because data is a process and we’re continuing to collect this, and we’re relatively new is from our echoes, so ECHO is a telementoring model that provides HIPAA compliant consultation services. That means that we’re able to provide using digital.
00:29:00 Dr Potter
Technologies across large geographic areas like Texas Telementoring that allows individuals to continue to maintain their clinical skills and get additional clinical training and mentoring around cases in a way that maintains patient privacy.
00:29:16 Dr Potter
Project Echo is a programme that was launched out of the University of New Mexico and what we appreciated about it is it allows us to train individuals in the field.
00:29:27 Dr Potter
It’s it’s sort of like the give a man a fish and it’ll eat for one day. Teach a person to fish and they’ll fish for a lifetime and so.
00:29:37 Dr Potter
Even more than some of the other work that we do, if we can increase the capacity of providers throughout Texas to be able to do this work, that’s going to live and exceed anything that I can do. Or, you know, our set of providers can do, because it’s just it’s a scaling issue.
00:29:54 Dr Potter
What we’ve been struck by is how extraordinary some of the providers are, and just giving them that little bit of boost, giving them that the guardrails for when they treat that they’re able to bring a problem to some experts that we have and bounce it off them, increases their comfort level that they can deliver.
00:30:14 Dr Potter
This evidence based project and so that’s an example of execution.
00:30:19 Dr Potter
The other piece that we’re doing is when we started these projects, we worked with a growing field called implementation Science.
00:30:27 Dr Potter
The challenges of deploying treatment that works are complex, and it’s we’ve known this for a very long time implementation. Science is a relatively new field that really focuses.
00:30:39 Dr Potter
Not so much in the data on the effectiveness of an intervention, but how it was deployed in a way that adapted to local context and ensured that it was delivered with Fidelity. That gives the intervention the greatest likelihood of success.
00:30:58 Dr Potter
If I consider buprenorphine in evidence based practise, what we do is study. How do we deploy that in Texas to maximise its utilisation because we knew it worked in the 1st place. We just need to get.
00:31:09 Dr Potter
The treatment deployed.
How does a recent paper of yours about if there were an effective pharmacotherapy for cocaine use disorder fit in with your ideal harm reduction future?
00:31:24 Dr Potter
So unlike Opioids, Stimulant use disorder and I’ll put cocaine and methamphetamine is the two focal drugs of use that can lead to a stimulant use disorder continues to be a significant problem in the United States.
00:31:42 Dr Potter
It is increasingly the case that even when we look among opioid related morbidity and mortality, there will be stimulant use as well and so.
00:31:53 Dr Potter
This is just an extraordinary problem. We can address opioids, but again, what I don’t want to do is think of addressing opioids as part of a game of substance use.
00:32:07 Dr Potter
Whack a mole going around and OK. We dealt with opioids, but wait now there’s methamphetamine we really need to think holistically.
00:32:13 Dr Potter
00:32:15 Dr Potter
There are no.
00:32:16 Dr Potter
FDA approved medications to treat stimulant use disorders. And you know, it’s funny. I say this.
And I’ve gone.
00:32:25 Dr Potter
On a long journey with this.
00:32:26 Dr Potter
I say this as I’m trained in clinical psychology. I believe in the power of behaviour change. I believe in the power of intervention at the behavioural level.
00:32:35 Dr Potter
To help an individual to activate their intrinsic motivation in a way that permits them to do something.
00:32:43 Dr Potter
Having said that, because of my work in substance use disorder, I have observed that in some cases medications are important. They have this immediacy that is important.
00:32:55 Dr Potter
They can sustain somebody they can help to support an individual’s recovery. While we do this additional behavioural work as necessary with the individual so the fantasy about a medication to treat.
00:33:08 Dr Potter
Stimulant use disorder is it’s just critically important. It’s been very challenging to do though, and so there are a lot of different outcomes that we need to look at beyond just 100% unilateral cessation of that stimulant use.
00:33:24 Dr Potter
So it’s just, it’s just.
00:33:25 Dr Potter
A very important issue I am part of a group called the National Institute on Drug Abuse Clinical Trials Network and that is really more about.
00:33:38 Dr Potter
Conducting high quality, rigorous controlled clinical trials that are randomised to continue to add to the toolkit of interventions that we have.
00:33:49 Dr Potter
We have a number of trials underway as part of that that are looking at continuing to develop medications for stimulant use disorder.
00:34:00 Dr Potter
Those as they come online need to be shovel ready in some way. One of the reasons that we had the difficulties that we did deploying treatments that work for opioid use disorder is because we kind of. It was almost as if we thought if we build it, they will come. Tada we have buprenorphine.
00:34:20 Dr Potter
Tada, it is something that we can use in an office based setting, not in a highly controlled, highly regulated methadone treatment programme.
00:34:28 Dr Potter
But we built it. We said it was available.
00:34:31 Dr Potter
And not enough people came.
00:34:34 Dr Potter
And so the other piece of our work and this links back to implementation. Science as well, is really understanding what do patients want.
00:34:43 Dr Potter
What do people who use drugs want? What do providers want? And if we were to offer a treatment like this, would providers that work in primary care settings even be interested?
00:34:56 Dr Potter
What are their fears? What are their concerns, and how can we understand that so that when a medication is rolled out, we’re better?
00:35:04 Dr Potter
Able to have it.
00:35:05 Dr Potter
Connect to the people who would benefit from.
00:35:07 Dr Potter
00:35:08 Dr Potter
And this applies both to behavioural and pharmacological trials, right? And so it’s it’s really. What can we do in the environment and in the local context?
00:35:17 Dr Potter
That’s going to help us make it ready so that when we have the treatments that work, we can deploy them.
00:35:23 Dr Potter
We have a beautiful treatment for stimulant use disorders called contingency management and that’s providing incentives to people to reduce their substance use.
00:35:35 Dr Potter
Unfortunately, we have failed to deploy this in any large scale way because of the complexities in how to pay for contingency management.
00:35:45 Dr Potter
And we’re back where we started at conversations around you know what’s uncomfortable? It’s uncomfortable for people to talk about substance use. People are very uncomfortable with.
00:35:55 Dr Potter
But people ask me what I do, and I say I work in substance use disorder and addiction, and I typically get 2 responses.
00:36:02 Dr Potter
One is the oh and then they never talk to me again. That’s all right, but the second is that I hear that they have a family member or they might be in recovery. And all of this feels very disconnected. But at the end of the day, we have to understand.
00:36:16 Dr Potter
How we view and feel about substance use disorders and implicitly this judgement that we have around people that use drugs, including ourselves.
00:36:27 Dr Potter
And and how that impacts how we deliver health care to people with substance use disorders.
00:36:34 Dr Potter
With methamphetamine and with cocaine, we need to continue to develop treatments we desperately need those treatments, but we need to also be studying and understanding how we’re going to be able to.
00:36:45 Dr Potter
Successfully deploy those.
00:36:47 Dr Potter
And that’s really a gross expansion of what that that paper was talking about, but it really speaks to the heart of what we were trying to communicate is.
00:36:56 Dr Potter
Maybe it’s not just about long term treatment with the medication. Maybe it’s about a treatment that we could provide in an emergency room to someone presenting acutely for a stimulant exposure methamphetamine.
00:37:08 Dr Potter
00:37:09 Dr Potter
That would provide them somehow interim treatment, for example, would reduce the likelihood of an overdose and provide a gateway to treatment in a way that that slowed the disease progression.
If you could change one law in America today, what would it be?
00:37:29 Dr Potter
You know, I would probably legalise drugs. That’s more than one law though.
00:37:34 Dr Potter
It took me a long.
00:37:35 Dr Potter
Time to get.
00:37:35 Dr Potter
There I will say legalising drugs is something that I’ve tended to stay away from.
00:37:42 Dr Potter
Because what I care about are the individuals who are struggling, whether it’s legal or illegal is really secondary to me.
00:37:49 Dr Potter
It’s that group of people that go on to develop. A problem however.
00:37:53 Dr Potter
I have come to believe that the laws around drugs have become such a distraction in the United States to my intended.
00:38:02 Dr Potter
Goal, which is for individuals who use substances who go on to develop a problem and need help or want help for that.
00:38:09 Dr Potter
They really are no longer functioning in a way that’s useful, and that doesn’t take away from the fact that there are many drug related crimes and all of these things that people talk about.
00:38:21 Dr Potter
And yes, I’m concerned about safety and all of those things. But if we don’t overhaul our laws around drugs, we will never get ahead of this problem.
00:38:30 Dr Potter
And your kids will be at risk and my kids will be at risk and our communities will be at risk until we really look at how we treat drugs and the engagement with the Criminal justice system.
If people want to stay in contact or find out more about your research and your work, where can they find you online? Or if they are in Texas, maybe at a health centre.
00:38:51 Dr Potter
The easiest way to find us is to go to Texas MOUD, That’s medication for opioid use disorder, TXMOUD.org
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