 Hi everyone, welcome to the addiction recovery channel or arc. I'm Ed Baker and I'm your host I'm very pleased as usual to be with you here today. Today. We have a distinguished guest dr. Brandon Marshall Dr. Marshall, thank you for being on the show Thanks for having me and I'm looking forward to the conversation. Yes Dr. Marshall is a PhD a professor of Epidemiology at the Brown University School of Public Health He's the founding director of the People Place and Health Collective at Brown University Dr. Marshall focuses on substance use epidemiology With a specific emphasis on harm reduction research and overdose prevention His team evaluates programs and policies that aim to improve the health and well-being of people who use drugs He is the principal investigator of multiple National Institute of Health funded projects including the Rhode Island prescription and injection drug use study or rapids and Providence a randomized trial to prevent overdose death in Rhode Island Brandon is also the scientific director of prevent overdose R.I Rhode Island's drug overdose surveillance and information dashboard He works closely with the Rhode Island Department of Health to track Measure and evaluate efforts to address the state's opioid overdose epidemic He also serves as an expert advisor to the Rhode Island governor's overdose prevention and intervention task force Again once again, Dr. Marshall, thank you so much for bringing your expert expertise to the show. Oh Thank you for inviting me out of I can't wait to get into the topic today, you know I like to just give a little context in Vermont my home state Where we're getting beat up in 2021 we had 217 drug overdose deaths 217 This number has quadrupled since 2010 in 2021 Vermont had the highest rate of overdose death in America and this trend continues into 2022 and There's no reason to believe it is not going to continue into 2023 Now I'm gonna read you a sentence from Governor Philip Scott's veto of H728 H728 was a bill an act relating to opioid overdose response services This is his quote From my standpoint It seems counter-intuitive To divert resources from proven harm reduction strategies to plan injection sites Without clear data on the effectiveness of this approach close the quote So I'd like to begin the show there doctor Marshall Without clear data Okay, let's talk about data. Let's talk about global data Let's talk about data that you've studied on overdose prevention centers. What what is what what are the facts telling us? You know, these are interventions that have been highly studied in Europe in Australia in Canada for decades, you know the first overdose prevention center opened in Vancouver in Canada in 2003 and like my supervisor used to say when I was fortunate to serve on the team that was evaluating that facility This is one of the most highly studied public health interventions in the country The research in other countries has been exhaustive. It's looked at both individual outcomes among people who use these facilities and their impacts on the communities in which they're located and So that statement is just untrue when we look at the global data We have a really good idea Scientifically of what impact overdose prevention centers have on people who use them and on the communities in which they're located. I think I've I've seen a paper that you authored citing the statistic, I think it was a 35 percent reduction in overdose death surrounding the overdose prevention center while There was a nine percent reduction overall in the same city. Is that is that correct? Is that accurate? That's right? That's right. Yeah, that's right. Can you talk a little bit about that? 35 not to mention that millions of injections have happened over the course of these centers And there's never been a death not one death millions of injections not one death Plus the surrounding areas show a reduction in death That's right, and you know We had known that going into that research that there had never and still hasn't been a Death in any overdose prevention center anywhere in the world But the goal of that work that you're describing was to understand the impact on community overdose fatality levels and We worked very closely with the provincial coroner's office to understand exactly when and where Overdose deaths were happening in the city of Vancouver both before and after the facility opened in September 2003 and we carefully matched those cases and Found exactly what you described a 35 percent reduction in overdose deaths in the immediate Neighborhood in which insight the facility is located compared to a nine percent reduction in the city of Vancouver overall We also accounted for other factors too that could change overdose Fatality rates things like underlying changes in drug use patterns in the community Policing practices and that effect really remained and so it's pretty clear evidence at least to me anyways And a finding that's been corroborated in other countries that these facilities, you know Not only save lives, but they actually reduce overdose death at a community level Yes, you know and I mean that's so encouraging and so refreshing, you know in light of the incredible Tragedy of what we face today in America. I think the people are saying a hundred and eight thousand But I think the correct statistic is a hundred seven thousand six hundred and twenty two Americans people in America lost to drug overdose in one year We have fentanyl Infiltrating the entire unregulated drug supply that them fatemaine cocaine counterfeit Adderall oxycodone alprazolam A heroine if a person takes any one of those drugs today. They're at risk for death We've never seen anything like this. So to me as I look at it in my little state and I see people dying To me it's what we're doing is tantamount to denying life-saving Interventions to people at high risk for death is Is there any other way to to perceive America's reluctance to embrace over those prevention centers? No, I think for any other public health problem that was associated with that much Unnecessary pain and suffering we would be doing everything possible to try to improve the public's health and to save lives and Only in situations where we at the end of the day have tremendous stigma, right? This is something you've talked about on the show before That I think prevents us from taking sensible steps from a public health perspective to address This problem. So that really is I think you're right the way to Understand this problem and to understand why we continue to fail to make the changes needed in our approach to actually, you know, bring that number of Unprecedented lives lost down You know that that's interesting that you mentioned stigma the the addiction recovery channel was born out of a devotion To contribute to eliminating stigma and we're in our sixth year now. We've been doing this for six years We've had people from all levels of interventions all walks of life Law enforcement medicine state government city government treatment recovery people who use drugs people in recovery all Contributing to diminishing stigma John Kelly From the recovery research Institute who wrote that paper that famous paper in 2010 Comparing person with a drug use disorder to drug abuser That was the beginning of our countries like focusing their attention on language was on the show and I asked him I said dr. Kelly Do you think that stigma plays a role in America's reluctance to embrace overdose prevention centers? He said of course and his answer was so his answer was so simple He says stigma causes people to misinterpret data They misinterpret data. They don't see the data The data that you see the data that I see they misinterpret say oh, it doesn't work They the the research is flimsy It'll never work in a rural state It'll never work in a rural state that has a city with forty three forty five thousand people in Burlington Intensive we're a miles. That's not the description of a rural state. It would work in Burlington We have the mayor the city council the state's attorney All in favor of an overdose prevention site, but what we have blocking it is a governor and a health commissioner who are dug in dug in and unwilling to even pass a bill that was designed to Develop a study group. They won't even study it So this is what we're up against when I look at states like Rhode Island States like New York and I'd like to go there now because these are two shining examples in America That have embraced overdose prevention centers, so let's talk about your state first Rhode Island Sure so We've been on a pretty incredible journey I have to say and and this is something that I Shouldn't say harm reduction and recovery advocates have been pushing for years So this is not something that happened overnight in our state This is something that the community both the harm reduction and recovery community have been pushing for have been asking for and we were incredibly fortunate to have a governor listen and Pass a bill last year that authorizes overdose prevention centers in our state now there are you know some challenges there It is a pilot a program the law sunsets after two years So we have to get going to start to open these facilities. We can talk about that From a research side that means we've got to hit the ground running and understand how they might work in Rhode Island How we can improve their effectiveness how we could do this better than in other countries? That's something I want to talk about as well And then something else we can talk about is that the bill does require that municipalities approve The siting of a location before the license from the health department is given and so that's a potential barrier And we can talk about where we are right now in Rhode Island Working through that but there is you know some layers I think that we're still working towards to end up with an actual open facility like in in New York But I'm hopeful that we're we're getting there and we're tackling these challenges and barriers every day And that we will see an overdose prevention center open in the state in 2023 Well, you know there seems to be two roads roots in America so far There's the outside the legislature route which happened in New York with a lot of support but without legislation Then there's the legislative route, which is happening in Rhode Island. Now, I've kind of I paid a little bit of attention to your your task force on Allocating opioid settlement funds and let me tell you when I saw That you had your and you're one of the experts on the committee when I saw that my heart was leaping with joy And I want you to talk about that it looks to me and correct me if I'm a little bit off But it looks to me like two point five million dollars of opioid settlement funds have been earmarked For overdose prevention centers. Is that true? 2.25 That's this fiscal year. So that represents You know a year's worth of funding and my hope is that support for overdose prevention centers will continue in future Settlement allocations. It's a 17 or 18 year settlement So this is really a tremendous and new source of funding to address the overdose crisis And I'm so happy to see that our committee in the state that's overseeing this funding Really has identified overdose prevention centers as a critical part of the puzzle to address the problem and To support them financially and as far as I'm aware, this is the first jurisdiction in the US that is going to be financially supporting overdose prevention centers as a strategy And so that is happening right now The funding should be made available very shortly and organizations that wish to apply to open a harm reduction center What we're calling you know an overdose prevention center will be able to Apply for that funding very shortly This is incredible news. This is incredible news for my viewers in Vermont and my viewers elsewhere because people have been reluctant to Begin to believe that what you've done is possible The argument is oh the Department of Justice You know the safe house Litigation is not resolved Therefore we can't earmark any of this money for an overdose prevention center So that doesn't seem to be the case Rhode Island went ahead anyway Do you care to talk about that process or what the thinking was that went into that? I think people could learn from that sure Yeah, and I have to say because the meetings are public I can I can talk about the process there was little I should say no opposition and that we heard as a committee and very little opposition that I'm aware of once the decision was made public and Described in the media. So I think you know a lot of the concern about at this point the Quote-unquote controversial nature of these interventions is just not bearing out I think so many Rhode Islanders have been personally affected by the overdose crisis. They know friends I know family members. They know colleagues who have died of an overdose or who know people who have lost loved ones to overdose and I think we're seeing a sea change now where the public imagines can imagine what this intervention looks like and what it aims to do which is to Save lives and help people access resources and treatment So I think we've been effective in Rhode Island at getting that message out there at explaining what these programs do and I believe the opposition is is You know diminishing greatly and in some cases not there At all we can talk more about more localized neighborhood dynamics That is something that still Keeps me up at night. Honestly the degree of nimbyism that we may experience as organizations aim to actually open a facility But at a state level and in terms of actually dedicating resources to get these facilities open The opposition has just you know not been there And I think that's in part due to the the pervasiveness of the crisis And how many people have been infected and then the amazing work that advocates have done on the ground here for many years to Educate the public and to explain that this is an evidence-based public health approach That's just Remarkable I'd like to just mention also that one of the things I noticed about the panel itself or the committee itself Was that there was a segment where I think there were it was called experts and I think there were four or five Noted experts on the panel. Is that true on the settlement advisory committee? Yes, that's yes That's correct. Yes, there are city and town representatives representatives from the health department and some other civil society and then Expert advisors including people with lived experience as well See I as I when I looked at that and saw that I thought the the committee was designed in a way that Guaranteed like objective data To be introduced into the deliberations and that to me was very refreshing that it wasn't going to be dominated by special interests That there was going to be actual expert input. Did you have a part in that? I Did you know I've been very happy in any Venue or with any group to talk about what the science has shown around overdose prevention centers So I've been you know playing my role in educating lawmakers here in the state other Interested groups law enforcement really anyone who's willing to hear what the science to show. I'm happy to speak with so That has been happening and and I think a similar process happened in these committee deliberations I should say the other framework that our state is using as well is that right, you know We have 17 years worth of funding through these opioid settlements right now. We have Just a tremendous crisis of overdose preventable overdose death And so we are it's you know focusing our funding on interventions that save lives You know, that's where we feel we need to do the most amount of work right now And so that is reflected in the large degree of harm reduction funding That's going through the settlement over the next few years our hope is that over time We'll be able to focus more on the social determinants of health the treatment system in the state the housing crisis That's going on all of these things We know play a role in perpetuating the overdose crisis the goal is to over time shift funding to address some of those Underlying drivers of the overdose crisis, but the thinking the framework is that right now We have an unprecedented number of Rhode Islanders dying for preventable drug overdose every year We we need to do something about it and one of the most immediate ways to address that Specific problem is through harm reduction interventions like overdose prevention centers You know, I mean it makes such perfect sense and that they even think that We could think differently is is is difficult to understand how that couldn't be So obvious to people. I think that the two words and then it's not obvious to people or it gets Confused and kind of you know covered up by stigma the the two words. I think that the the opioid settlement uses Two words that stick out to me were were efficacy and immediacy And and it sounds like you've grasped both of those perfectly Efficacy and immediacy in saving lives. There's nothing that works better for this most at-risk population Than an overdose prevention center. What is your view a friend recently sent me a paper It studied drug overdose death from 2010 to 2018 and it cited that drug overdose death as a result of injection had Increased eightfold in ten years Is that is that your impression that most ended that most of the deaths we're seeing are by injection drug use The last time I looked at the data in Rhode Island, I would say about 35 40 percent of The overdose deaths had some evidence of injection drug use. So I would not say the majority and that was several years ago You know and what we've seen I think in Rhode Island and in other states is a shift to inhalation of substances like Crack cocaine methamphetamine And so that carries with it, you know specific types of challenges and risks as relates to overdose prevention centers This issue came up in the state committee that was tasked with developing the regulatory framework for overdose prevention centers And those regulations will actually require Operators of an OPC to offer services for people who inject and smoke their drugs So that looks like, you know a vented room or some other way to safely allow to smoke and you know, that was That was is important. I think for two reasons, you know You want these interventions to be as accessible as possible to the broadest population of people at risk for overdose And we know people who spoke drugs or at risk for overdose and then it was also seen as a racial justice issue We know from our data that people who smoke or inhale substances are more likely to be people of color at least in our state And so if services aren't providing options for that population in particular We're only perpetuating some of the inequities in access to harm reduction and treatment services that we've seen in the past and So, you know, that was something that I learned a lot about watching that process unfold here in the state and really nailed in for me the importance of providing the broadest array of services at an overdose prevention center so that it's accessible and useful to the Diverse populations of people who use drugs in our state and in other settings as well Yes, it was from from the reading than that I'm doing and the people I'm speaking with I'm under the impression that the more An overdose prevention site becomes integrated into the system the more likely it is to marginalize certain populations and that we need input from people who use drugs in policy planning and It seems to me that that's what you had in Rhode Island. It's the Nothing about us without us. Did you did you embrace that? That is What we hope to embrace honestly Ed, you know, we could do much better I think we have a very strong recovery community in Rhode Island and Wonderful recovery advocates people in leadership roles Who are driving a lot of these conversations around harm reduction? What we do not have honestly are the voices of people who are actively using at the table And so I think that's something that we need to do a lot better as We start to develop and implement these services, you know something I've learned from on point in New York City They have two sites. I'm sure as you know and the sites are designed slightly differently to meet the needs of distinct populations, you know some One is more medicalized and one is more peer-driven and I I've enjoyed learning about why they decided to have two different models And how they're acceptable in different ways So there are sort of more and less medicalized models of overdose prevention centers One is not necessarily better or worse But you do need to make sure that whatever service you provide medicalized or peer-based or what have you That it is what people who use the facility want and you only learn that by Talking to people who are actively using or who would use the service Yeah, so that's something that we have to continue to do here and you know in other Jurisdictions as we see OPCs get implemented. Yeah, I think that I think the site in Washington Heights is peer-driven and the site in Harlem is More more of a medicalized model, but I mean what what you're saying is is So in Rhode Island anyway You need to engage people who use drugs in policy formation A little bit more going forward. That's a goal you'll have and and from month from where I sit and what I see and overdose prevention center and Engaging people and showing them that they're safe and That they can trust you and they can come and not be judged and not fear being punished It's the perfect way to begin to engage them in relationships. That would lead into Including them in policy development. I mean it you just can't do it. It has to be a process But it seems like you've got the perfect pieces in place To do that eventually Yeah, that's right and that is so critical to OPCs overdose prevention centers is to build that rapport and that And to respect people's autonomy and and then through the building of relationships You know then That's where the engagement with other services might start. That's where you're right We might have that trust in place for people who use drugs to to then You know take leadership roles ideally in the expansion or the design of other services So I'm hoping that what you're saying is true that as we implement overdose prevention centers We will see more of that Voice and active engagement of people who use drugs in the in the expansion of these services. So let's let's hope we get there Let's hope we get there Beautiful, you know, it's it's wonderful thinking that you have like 18 years of funds Coming in that that that you can use and um, yeah, you know, you know, you know, you're familiar with Katelyn see from New York Yes, we're both Canadians. So Thank you Katelyn and Brandon. Thank you She was on the show and um, she talked with such love About the people who utilize on point. It was just beautiful and to hear that, you know People people come in to use drugs in a safe environment where they're cared for where they're comfortable Where they don't have to hurry where they don't have to worry about being arrested or being attacked Where they they feel a sense of like being at home and They have a barber. They have a laundry. They have all kinds of other services for people. She told me they never Discharge anyone without discharging them to another service. It isn't just come in utilize the service and leave There's always activity going on that's geared toward engaging the person. How are you doing with housing? How are you doing with your court case? How are your kids? Do you have enough food for your dog? You know, what's going on with you? They get to know people and People who use drugs The way these people use drugs that is the most refreshing interaction that they can ever have. They're so Denied that kind of of interaction that that they it seems that Once they begin to engage in that that's one of the reasons they come back to the center is for that and that that to me is just Beautiful I talked to Ann Livingston who was one of the co-founders of van do About our efforts with with people who use drugs back when when they organized to advocate for van do And she said that she invited them Over to our house and what she did was she asked them What can we what can we do for you? What do you need and she said? Invariably and every every group she stops and that's what she does as well She does is organize people who use drugs. She said what they do is they'll weep at That they're so touched by someone actually looking at them and caring about them From the heart that it makes them weep Yeah Yeah, you know because so many other systems that are designed to help like the medical system at the end of the day We see often as much or if not more stigma, right? And so even in the places where we think we should be able to turn to for help for health care Unfortunately, that is just not the case. They're punitive. They're stigmatizing you know and so a lot of people have had such negative experiences with the Existing medical and social service system that this can be one of the first places in a long time Anywhere is where people go and they feel respected. They feel listened to and they feel like their needs are met So it's a very special environment in that way, you know And again sort of speaks to the in just unbelievable stigma that operates not just generally in society but in the medical and social service systems as well And and so that's I think even more so why OPCs are are just so important and so special and so effective at And addressing some of these some of these health issues, you know a neurovalk of Speaks eloquently to that in a number of her papers how there is stigma in the health care profession There is stigma in the service professions the professions that are dedicated to dealing with People people with addiction. She's not afraid to to call call that out You know, I think we've mentioned John Kelly a little earlier in language. I think in in America In in over the past seven or eight years. We have come light years in and being aware of stigma and changing our language The office of alcohol and drug abuse programs in Vermont Vermont is now the office of drug use services Nora Valkov she was on the show told me that NIDA the National Institute on Drug Abuse The name was changing to the National Institute on drugs and addiction. So, yeah, even even the bureaucratic political wheels Have, you know done what they've need needed to do to change some of the the big Stigmatizing language, but in the field if someone says addict, you know people kind of look at them now like what are you? How come you're not saying person with drug use disorder? It's become the norm We've come a long way with language But I think what's happening is there's a danger in that The danger in that is that we think because we've changed our language that we've eradicated stigma When stigma has deep deep roots and you can use all the proper language, but still be driven sometimes Implicitly or unconsciously by stigma and I do believe that where that's most evident is when you have people with power and people with money Diffusing to allocate money toward science proven interventions like overdose prevention centers It's like the acid test for stigma. You can use all the right language But why aren't you using the funds? Find the funds follow the science. It's just not happening. It's happening in Rhode Island and it's happening in New York Yeah, you know, and I think what else I've seen too at is the interaction of and they feed off each other stigma and then incredibly harmful misperceptions about how Drug use works and they're so closely tied to each other You know, so one of the most harmful misconceptions I Continue to hear and this gets to your point where like using better language is good But we also need to address these misconceptions too It's this idea that people will only want to Engage in treatment or recovery services once they quote-unquote hit rock bottom Oh, and that these kinds of services like OPCs are therefore not effective because they Prevent someone from doing that. So let's just like disentangle this harmful stereotype for a moment First of all nowadays, even if that was true hitting rock bottom is deadly for many people, right? So at just at face value, that is a deadly strategy At this point given the toxicity of the unregulated drug supply and in fact, we know that it's just not true Right that it is not an effective way to engage someone. It's incredibly harmful The opposite is actually true you need to build a network of trust and love and support around people and that is the way to more effectively engage rather than pushing people away and Feeling like that will be more effective at the eventual outcome. And so I think like How to address the societal Misconceptions of how addiction works. I don't have the answer to that but I see it being incredibly harmful as these of the You know reasons for not implementing things like OPCs. Does that make sense? It makes it makes Perfect sense. It made me gasp when you brought it up because it makes this perfect sense. It's so absolutely important We think in America that the way a person finds their way out of Problematic or very harmful drug use is through discomfort Well, let them get as uncomfortable as they can. We'll arrest them put them in jail. We'll stigmatize them Prosecute them persecute them will make them so uncomfortable that they'll stop taking drugs Which couldn't be further from the truth all those kinds of behaviors cause a person to feel so discouraged that there's no Where to turn which is an incentive to keep taking drugs When when when hitting bottom when you said that I mean it just it's just so Archaic to even think that First of all like you alluded to with fentanyl You will die long before you hit bottom. There's no time anymore to hit this so-called bottom I thought about it the other day and and um What came to me is people do not need to hit bottom People need to hit safety That's what they need to hit safety when a person who's having a life characterized by the symptoms associated with with with drug use Hits an environment or is exposed to an environment that's safe Where people look at them and care about them like Anne Livingston. What do you need? How can I help you? Not like you know, you have to go into treatment for a hundred and eighty days No, no no demands. No, no unrealistic Expectations no judgment no stigma concern and you said it love. What can we do for you? How can we help you when a person hits that and it has to be congruent? It can't be just words It has to be congruent with the way the person is inside. I want to help you I'm not just calling you a person with substance use disorder because it's politically correct I I believe you have worth. I believe you have dignity. I'm here for you When a person hits that and feels that safety, they're engaged They're engaged and then we can help them do You know the the along harm reduction philosophy What whatever positive thing they want to do They're engaged in it. This is what I want to do. I want to get a place to live I want to get a haircut. I want to get more food for my dog. I want to go back to school. I Want you Pernorphin, you know, what whatever we can help them do whatever they want to do Yeah, yeah Exactly and that's the magic of overdose prevention centers So I'm glad we I'm glad we hit on this Ed because it's so critical to understanding I think what they're doing and how they do it so well Talk about that talk about the magic because the magic to me the magic of overdose prevention centers is the magic of harm reduction Can you talk a little bit about that? What is that the essence of harm reduction as opposed to abstinence-based treatment or You know as opposed to all other types of interventions. What's the essence of harm reduction? No, we often use the term meeting people where they're at, right, but I think it's deeper than that. It's it's about Truly listening and understanding someone's both immediate needs, you know, you're Using and we want to protect you from overdose. That's an immediate need that we can address through public health tools But then as you said, what are your longer-term goals? You know, do you want housing? You should do you want? Employment options, you know, do you need to find a different place someone else to be with some? Other situation that we can help you get to so it's through that True listening I think where a lot of the essence of harm reduction actually comes from so it's yes Meeting people where you're at but core to that is actually empathetic listening and then being able to have the tools to To make those changes and that and that's where you actually resources going back to our earlier point, right? You know, you then need financial support and resources to then enact those changes and That's where we need policy makers law makers to step up and actually, you know, fund these kinds of services at a real level Yes, and you know It's and it's listening over time Not just once I'm listening to you, but every time you come in I'm listening to you And I'm getting to know you and I'm giving you the time I'm setting aside time to be with you and I'm having eye contact with you My body language tells you I care enough about you to be here with you Tell me about yourself because we're talking about the population That has you know suffered discrimination Disenfranchisement stigma prosecution incarceration, you know for for decades We're children of the war on drugs. I'm not I mean I was born before it But from the war on drugs it goes be back before that in history But since the 70s in the war on drugs and this is why I have nothing but but sympathy and compassion for people with stigma Because we've been Inundated with stigmatizing information since birth It's been coming at us through the media through TV through movies through spoken language Through belief systems. We're taught it. We're all taught it so People with substance use disorder They've been victimized by an entire culture and Overcoming that and trusting is no mean feat No mean feat we have to listen to them continuously over and over again And you know, that's where I think science can play a role right is that we aim to Collect the data to understand the impacts of these kinds of programs in large part to push back against these harmful untrue Misconceptions of how in this case harmful or problematic drug use works, right? So that's really at the end of the day why I love what I do is because The studies that we do, you know, yes or sort of showing impacts on health outcomes And that's very interesting But the end of the day time and time again when we do harm reduction research We see that the findings help push back against those harmful misconceptions and misperceptions of how Drug use works in our societies So, you know, that's kind of what keeps me going at the end of the day Even if we don't always get wins and we face, you know it lots and lots of pushbacks It keeps me going because I'm hopeful that if I keep doing what I'm doing and that if you keep doing what you're doing And that if we keep spreading the message and that includes scientific evidence that we will get to a better place with harm reduction in the US so that's that's The framework that I operate from at least on a daily level. Yeah, you know, I mean, I am I am Very very hopeful. I you know, I I'm a person I'm in recovery myself For a very long time. I injected drugs for years. I was houseless For years, I've been incarcerated I you know, I've been beat up by the war on drugs and somehow I made it and It from my own personal experience the beginning of my making it was being exposed to a group of people Who there was no stigma in the room? in fact in fact They valued me Because I was a person with addiction That was I mean to talk about a healing Sav that was something that really really got my attention and My life has been different ever since now with a lot. It's been a lot of work, but it's been different ever since so I am I'm a I have an unrelenting hope and an unrelenting determination because of people like you people who are out there like really on the tip of the spear Doing the hard research and taking the hard stand and organizing people and and involve politically. It's just really You know a Great thing to be to be a part of now before we close. I just like to um I Like to just say one more thing about Kalin C. Down in New York City there I'm a trained social worker I'm a master's level social worker and when I learned about social work and Doing counseling and therapy and all that we were taught that you know if somebody's under the influence of drugs You know you you really shouldn't you know even go there. There's there's not they're not going to remember anything You know just you can't counsel someone like that Katelyn C and on point there that they're turning that around They have a team of social workers on board That sit with people before doing an after injecting or smoking drugs and Counsel them and engage them in counseling relationships. This to me is to really think outside the box Yeah, to really break through that stereotype. I can engage this person. I Can interact with this person this person who will remember me Maybe this person will be motivated to trust me and have counselors in there Attempting that this to me is so so encouraging just way way outside the box Yeah, and you know, especially because so many of our existing interventions Try to reach people when they're feeling Amongst their worst, right? Like we've spent a lot of time trying to design emergency department-based overdose prevention interventions and It's challenging because by definition people coming into the emergency department Don't feel well. They might be coming out of an overdose. They might have had naloxone administered Yeah, I might be in drawl and so it's like I'm so appreciative of people who work in the ED and Are are making those efforts to engage but it's so tough because People don't feel well in those moments, you know likewise in prison systems It's like we focused a lot on building up our treatment system in the in the jail and prison system Which is which is good, but it's like you wonder You know, could we do this better? And in fact, I think overdose prevention centers give us that little nugget of an answer, right? That like when is it most effective to connect with someone to read someone to talk about Other services that they might be interested in perhaps the most effective time to do that is actually post-consumption and So I I'm looking forward to learning more from Kalin and others at on point and as we implement OPCs here About exactly that, you know when how how do they? How do they think about these conversations? Social work practice and and what does that mean when we have that Rather unique moment in the context of an OPC, which is engaging with someone post-consumption So I think there's a lot there at to learn more about and I'm so glad people like Kalin are Innovating and pushing the envelope on that Certainly in the US if not globally so so beautiful so beautiful now I it's my understanding that you're not only Conducting research in Rhode Island, but you're also are you affiliated with? The on-point in New York City, will you be doing research there along with NYU or what what's going on? so we are we are planning to partner and The reason why we would like to do a what we call multi-site evaluation So a coordinated evaluation between OPCs in New York City and Rhode Island is because they're going to look very different Providence is a very small city compared to New York City Probably the volume of people using the sites will be much smaller The services are going to be different the design of the OPCs will be different So we thought there was a lot of value in partnering to understand Like how these sites are going to look different and how they might operate distinctly and very you know in their effectiveness In these two contexts, so that's the idea Yeah, we currently have a grant under review at the National Institutes of Health So hopefully that is successful and we'll be able to start a a full you know fully funded federal Government funded evaluation in 2023. So keep your fingers crossed that that is funded And I'd love to come back over the next few years and chat with you about what we learn in in both New York City and Rhode Island, I would love I would love to have you back and To me that's is so encouraging because you know scaling this kind of program of fitting this kind of program into different environments You know is is paramount Can't just have them in gigantic Cities with dense populations. They have to be scalable to other environments. I'm very interested in that my City of Burlington. We have 45,000 people. We had 51 deaths in one year We have a heat map of overdose death in Burlington, which shows of an extremely high concentration right in the city and If you overlay that heat map onto public transportation with a central location It makes it very easy to get to an overdose prevention site So, you know, we're looking at kind of scaling this to you know a small city Yeah, but resistance to that idea always comes with oh, it's never been done in a small city So research like yours will will help us will guide us now. That's great Thank you. Thank you doctor for being on the show Brandon for being on the show. I wanted to um, I Wanted to end the show You know, I'd like to give you the opportunity two opportunities actually one To speak to people who are at risk for death What what do you want to say to them and the other to speak to advocates who are advocating for overdose prevention sites? Mm-hmm. Mm-hmm. Thanks for the opportunity to do this To people who use drugs or who might be at risk for overdose You know, what I would like to say is that I know that a lot of the research that we have we do we have done is Honestly Not, you know, not great as I said earlier We need to be more thoughtful about how we actively listen to people who use drugs and truly engage them in our research To make it stronger and better So that's my commitment for this forthcoming evaluation is to work on that You know what I mean and make that more effective So that this evaluation is something that we can all be proud of and really stand behind So, you know for anyone out there in Rhode Island or elsewhere, please reach out to me and And I'd love to chat about partnering on how to actually do more truly Engaged community engaged research more effectively and then to advocates. I would say the same thing Please reach out to me I'm happy very happy to chat about the research that we've done the research that's been done in other countries Because I've I've seen the benefits, you know talking about the scientific evidence isn't everything It's not going to convince everyone. I found that personal stories are incredibly powerful stories like your ed Yours ed this conversation. We're having connecting with people one on one is incredibly powerful for changing Minds, but I believe that scientific evidence plays a role in this discussion and can help get people there to understand The merits of these types of interventions. So I'm happy to be part of that discussion here in Rhode Island elsewhere You know anywhere we might be thinking about we're trying to open overdose prevention centers reach out and I'm really happy to do What I can to help in that goal You know, thank you. Thank you, Brandon. Thank you so much and um I can uh, we can add a slide to the show with your contact information Great. Please do that. Please do. I will be in touch with you You know in the future to to to follow your work um We I can speak for the You know community here in Vermont and and probably everyone You know in America or all the people who are in the field Where we're so indebted to science So indebted to science for for focusing your resources On this on this most pressing problem. So so thank you. Thank you very much Thanks so much for all that you do at it's been such a delight and a pleasure chatting with you today I really enjoyed it