 Hi everyone and welcome to the addiction recovery channel. I'm Ed Baker. I'm your host Thank you. Thank you so much for joining us today. Today. We have as our guest Kailin C. Kailin. Thank you. Thank you so much. It's a pleasure to be here. Thank you for having me. Yes Kailin is the senior director of programs for both the Washington Heights corner project and the New York harm reduction education project Serving Washington Heights East Harlem and the Bronx in New York City She was the program and development lead for the historic opening of the first two sanctioned overdose prevention centers in the United States congratulations Kailin Thank you so much on behalf of our entire team. Thank you. Yeah before moving to New York in 2016 Kailin worked in Vancouver Canada developing and operating innovative award-winning drug user focused Programs again. Thank you for being bringing your talent and your expertise to the United States Kailin Thank you for having me. Yes. I wanted I thought it would be good For for the audience if you could just to share a little bit about What it was that got you interested in this particular field Working with this vulnerable this most vulnerable population Yeah, that's a great question I Come from a family single mom family and my mother Suffers from mental health issues herself and and the two of us we had a tough time when I was younger and and I I fell into my own use as a very young person and you know, I'm very fortunate that I Managed to find some supports that worked for me when when I was at my most chaotic and at my most through my more higher risk periods of my life, but It really My experience with my mom and my own struggles when I was young Really sort of changed the way I felt about I should say just as a sort of a bit of a disclaimer I'm from Canada originally as as Ed mentioned when we have universal health care in Canada So if my mother and I going through what we went through Struggled to get care that was relevant to us and helpful to us In in a country with universal health care. What must other people go through who have more stigmatized challenges than even my mother and I had Marching forward in time a little bit to when I was a working adult And and really had kind of come through most of my own drug use struggles. I Went to then I was living in Vancouver at the time and I just remember just My jaw hitting the floor when I visited the downtown East side and just looking around and saying Something else has got to be possible for for these people who are suffering so much With their own addiction issues and are so cast to the margins of society. It was really a you know, we often In in our work, especially in the harm reduction field talk about the moment that the fire was really lit in our bellies for this work and And moving to Vancouver and visiting the downtown East side for the first time was was that moment for me where it all came together between what I went through with my mom When when we were really struggling through Our early years together and and what I saw in the downtown East side and I just knew that there was a better way And I was very fortunate to land at the PHS community services society amongst a team of people who believe there was a better way So I was very fortunate to learn from the best of the best About what harm reduction and drug policy reform programming can look like And and I was further blessed to be able to bring what I learned in Canada to New York in 2016 Thank you. Thank you for your candor. I appreciate that So the fire was lit in your belly, you know The better or worse and I haven't looked back The birth of commitment. Yeah, deep deep personal and professional commitment. Thank you, Cameron So, you know in America today in Vermont today there's a lot of talk about you know the possibility of overdose prevention sites and Unfortunately, there's a tremendous wall of opposition and in my view, it's based in like the absence of accurate information and And furthermore like the presence of stigma Now I'd like to begin there. I'd like to begin with you now You're seven months into on point in New York an overdose prevention center I'd like to begin with like an explanation just a basic explanation to the public From somebody who really knows who's who's has this lived experience What what is on point? What what is an overdose prevention center? What what happens there? Who's served? That's great. It's a great question a great place to start and I and I want to start by saying as well that I understand I Understand the hesitance in the US There are no other overdose prevention sites in the country to look at there are no other examples in the US So I I'm not somebody who shies away from Or is frustrated by The lack of understanding in the hesitance around this intervention What I find positive is is forums like this one where the question can be asked and the dialogue starts So for me, this is a very positive thing So what is an overdose prevention center? It's a it's a place. It's a room or a facility Where previously acquired illicit substances or prescription medication Can be consumed under the supervision of trained staff who will intervene in the event of an overdose or other medical emergency Generally speaking these sites provide the supplies required to consume the drugs and keep them in the site That's one of the number one benefits of an overdose prevention center None of the paraphernalia that's used for the consumption leaves the site So they have a really immediate and tangible impact on improperly discarded Drug use equipment in parks and public spaces in the neighborhoods where they're located To they really focus on safety stabilization and education so It may seem like a bit of a controversial statement and perhaps it's too early in the program to start rolling out the controversial statements But the least interesting thing that happens in the drug consumption room or an overdose prevention center is the consumption itself It's everything all of the beautiful support work Counseling and education and relationship building that can happen When you actually allow people to consume the drugs They want to consume the way they want to consume them in a safe and controlled environment When that pressure is off Suddenly you have a captive audience and our case managers can get in there and our health educators can get in there and our social workers Can get in there and do all of that beautiful work To advance people to their goals many of their goals are treatment Some goals are housing some goals or employment or reunification or family whatever they may be But overdose prevention centers are proven to be a very great conduit for that additional care care and furthering those that that kind of work three Fundamentally absolutely without question. They save lives So they pick up the entire instance of drug use from an unsafe often public setting and they Transport it into a safe controlled and private environment This takes into account the needs of the community, right? The community doesn't want to see public drug use the community doesn't want to see people You know sort of under the influence and perhaps in danger in the community They don't want to see discarded paraphernalia all of the instance of use happens in a controlled environment and Our staff is trained to respond at the level of a registered nurse Allowing us to give a very high level of care and resolve the medical issue whether it be an overdose or something else Ourselves in the site. So this is an incredible cost savings to emergency services The hospital system and to the police and enforcement agencies Well, thank you, and that's that's a great place to begin with a comprehensive description you know, I I wondered about the because it seems to be a it's a medical procedure and Ethically, you know, it would seem that your staff would have to be adequately trained So you're saying that the staff is trained a sort of along the at the same level as a registered nurse Is that what I heard you say? Yes, so this is something very unique about our program And something that we would hope should this Intervention be replicated across the country, which we hope it will be We would hope that this is a standard of training that the other safe Consumption sites or overdose prevention centers will adopt So I'm not saying that every staff is a registered nurse I'm saying that we train our staff to respond in the same way and to the same level as a registered nurse But we are relying heavily on oxygenation oxygen therapy Agitation and other interventions and we are de-emphasizing the use of naloxone We're able to do that because we're there at the onset of the medical emergency To sort of drive the point home I reviewed our most recent set of data just a few days ago I think we're sitting at roughly 360 overdose interventions since we opened November 30th of those 360 overdose interventions, we've only had to call the ambulance five times That's like a little bit of a mic drop moment right there I understand that and that that speaks to the expertise of Your staff, you know a lot of what happens in the community is out here when it comes to understanding over those prevention sites and I am a little frustrated with it and and but because the information out here is so inaccurate What you're sharing with us today? Not many people really know You know sometimes overdose prevention centers are called injection sites So it gives the general public this idea about all that's happening there is drug injection When that couldn't be further from the truth it seems to me that what you're saying is the Self-administration of drugs is a point to connect with the whole person and Then move from there what at one point isolated the person and caused the person great shame Because of an overdose prevention center is that same point is a place where someone's dignity is recognized Their worth is recognized They're affirmed they're engaged and there I think you called it gentle curiosity They're paid a respectful curiosity respectful curiosity. They're they're paid attention to talk a little bit about that respectful curiosity Okay, you might have to remind me to get to that because I just want to back up to something We're having a back-and-forth here at The idea of the safe injection site So the movement Has moved past injection and the reason that's happened is Largely because we acknowledge that people consume drugs the route of administration Is more varied you can smoke snort Drink There are lots of inject. There are lots of ways to consume drugs It also has evolved to include these other modalities or modes of administration Because fentanyl is in not just the opiates fentanyl is in the entire drug supply So if we look at what of what our original mission is is to preserve life to ensure that folks using drugs survive the overdose So they have an opportunity to engage in care or to work towards their goals Which of course you don't if you don't survive an overdose. You can't go to treatment. You can't reconnect your children nothing But we have a responsibility to work with all drug users not just injection drug users And and so our sites are poly modality sites You can smoke snort sniff swallow or otherwise inject any drug not just heroin and cocaine anything K2 crack morphine psych medication whatever it is That's so important because the drug supply in this nation more so than almost any other is Incredibly dangerous So I just wanted to clear that up. Yeah in terms of respectful curiosity That's a philosophy that Really encourages our staff to see people but to see them Through a lens of love compassion and understanding That act of witnessing Acknowledging personhood for people who use drugs is just can be quite mind-blowing at times because nobody does it They're invigible people in our society So our programs in our spaces seek to undo some of that and it's almost this act of Convincing a person that they that their life has value and that they matter And we do that through respectful curiosity. So we check in with people we build relationships that are really authentic An example would be somebody comes in they have an overdose They come in the next day. We check in how are you feeling? Do you need anything? Do you want to talk before you do your dose? Do you have any questions? How's that obsessed doing? I know you had that housing appointment. Did it go okay? But really like we would with friends or family So inviting them into a community to create that sense of belonging The other thing I would say about our sites is that our overdose prevention centers are Colocated within our larger program. So they're not just standalone sites We have really comprehensive programs with harm reduction mental health units social workers That do sessions boost side with participants in the OPC offering one-on-one counseling We have medical care nursing care We have doctors who can do health assessments Primary care sexual health care medication-assisted treatment We have lounges and showers and computers and food and holistic services with acupuncture and acupressure The point is to address the whole person Not just the consumption your consumption does not define you You are a person with multiple needs and we've created dynamic programs that seek to address the entire person This also means that when somebody is finished in our overdose prevention centers, we're not discharging to the street We're discharging into one of our other program elements and that's really a thoughtful and intentional and strategic design element of our programs because we design programs for the participants that use them But we also design them keeping in mind the needs of the community where they're located Any smart program designed for people who use drugs takes into account those two stakeholders Not just the one That's beautiful. It's like the epitome of patient centered care Yeah, you know, and that's that's a thing that's sort of a hill that I like to die on these days This is this is the thing that really gets me going You know, we have all these buzzwords. Don't we especially in the health care, you know trauma-informed care downstream health impacts And patient centered care or patient direct centered care is kind of one of the buzzwords of the moment What does patient centered care look like for people who actively use illicit drugs? It's a thought exercise. I challenge us all to do It's a tough one because patient centered care for people who use drugs Necessarily requires employing harm reduction practices And I'm really proud of the work that on point is doing because we're really putting our money where our mouth is and doing authentic patient directed care for people who use drugs with outcomes that are Blowing projections out of the water already at six months in When we first opened the sites the Department of Health in New York City Projected that one overdose prevention center operating for one year in New York City would save 130 lives We've opened two sites We've saved a hundred and four three hundred and sixty Interventions so far and we've only been open for six months. It's incredible. It's incredible and As far as outcomes go, I know that there were I think you had said it's probably changed now Since our last conversation, but I think there were 1400 participants At your programs. That's an incredible number of people who had been using drugs alone With no one with them at risk for death that are now no longer Experiencing that that type of risk 24,000 uses I think you said that's correct and I Now it's up to 355 Overdose reversals. I'd like you to know amp of five ambulances, right? No, no police involvement I'd like you to know hospital stays Can you can you approximate the? the savings in cost That are generated by by on point That is the million-dollar question. No pun intended. We don't have the exact number But it's it's in it's in the millions at this point an ambulance ride a hospital stay a dispatching of a detective team That's expensive that's in the hundred thousands per person We we we are projecting We're working with the health the health department and the NYPD and the hospital system to determine the amount But it's projected to be in the million so far to say nothing of the system Logjam that were that were really preventing, you know, the emergency rooms are Really in a phase of recovery post COVID The health care system as we all know because y'all live through it together took an incredible beating during COVID That system is tired and healing The emergency services ambulance care workers same thing Really really went through it during COVID and me to break in our recovering and our short staff and then the police You know, the police do not want to be responding to overdose calls. They don't have the time. They don't have the resources and frankly You know, no disrespect to the police. They're not that helpful They they make it worse So I just want to touch very briefly on a relationship with law enforcement because I think it's important and it's the question Many folks have how do you coexist in New York City with the NYPD? What is that relationship like? I'm very pleased to say it's a partnership and it's very positive We went to the NYPD at a very senior level to discuss with them that this was going to happen fully expecting pushback And that's not what we got. We got thoughtful and intelligent questions about how The police could partner with us questions from the police on What do you want us to do in relation to the site Do you not want us around and we said no, it's not that we don't want you around We don't want you to do anything that would Communicate to participants that it's dangerous for them to access the site because if participants don't use the site It won't succeed What we do understand is that you have a duty To police the neighborhoods where our sites operate and to respond to the citizens needs when they call you So we want a symbiotic relationship with you We are gonna do our best to not call you But if we do we want you to understand that we've called you because we do need you On the flip side what would be really helpful for us is if you see people in the neighborhood who are using Or who are in distress instead of picking them up Call us and we'll come and get them the NYPD took it a step further and said can you make us a card? So that when we're talking to those folks and they see the card with your branding and your logo They know that we're serious and that it's not a trick. They asked us to create a resource so that they could help Get people into the site for us We and of course we did that We did roll calls at both of the precincts in both of our neighborhoods and those were tough rooms We were a little nervous, you know, very stiff, you know, the officers all in Information fully expecting not a single question and that none of the officers would visit the site Of course, the opposite happened tons of thoughtful questions about what the site did and what it didn't do How they could help and then every single officer from both precinct Visited the site and continued to ask questions and they made sure they were literate and they understood how they work and now here we are six months later and The relationship with both precincts continues to be very positive. That is really something that is really something Nice to hear that I'm sure. Yeah. Yeah, very glad, you know and along those lines. Well, I do believe that That your health department was was 100% behind you Do you care to talk about that a little bit now the health commissioner? I think I do and this is really a Little bit of a call to action. We did not do this alone We are the provider who had the experience And the gumption To do it But we had incredible backing and support from the New York City Department of Health the New York State Department of Health particularly the Office of Drug User Health and City Hall I Cannot overstate how invaluable that partnership has been for us the bravery of the New York City and New York State Department of Health to Say the time is now. This is overdue We have an obligation a moral obligation to Acknowledge the status quo is not working to end this epidemic We can do more and this is a part of the solution They were lockstep with us on this journey to get the two sites open. They've been incredibly supportive since the sites launched and I just really want to encourage other jurisdictions other health departments to Really look at what they can do to support their providers their harm reduction service providers in their jurisdictions to do the capacity building the training Securing the infrastructure and resources to ensure that these programs can take up the mantle and consider opening sites on their own with full backing and support From the health departments the burden of opening is these sites and for advocating for these sites should not be on the providers alone This is a public health issue and the health departments do need to come out of the shadows and say we're gonna do our part To support these providers to do this important work on the ground Yes, I mean I couldn't agree more with you that the time is now and You know, unfortunately, I mean, how did you how did you build support with the health department? Where did you where did you start? We started by saying we can do better. We need to do more This is the path forward so as as a provider as a harm reduction agency We took a seat at the table And I think sometimes as providers as CBOs as harm reduction agencies We sometimes feel that we we don't have a stake in the game We're sort of in the margins a little bit and I Would encourage providers To stand up a little taller and and take on a leadership role with their health departments We need to sometimes do some knowledge sharing With our health departments and that that sometimes that sometimes feels a little backwards in a way But some of our health departments are not entirely harm reduction literate And we shouldn't be afraid of teaching our health departments or engaging in a knowledge exchange with our health departments with the goal of increasing understanding and capacity About about these evidence-based tools because they are evidence-based widely studied peer-reviewed research Just stacks of it over the last 35 years, but sometimes our health departments do need us to lead And and that's and I think that's really what we did here. We're fortunate that our health department said You know that sort of allowed us that space And and and we're very very grateful for that, but it is very much a partnership But it really did start by by saying We we want you to consider These interventions very very seriously as an agency. This is where we're going and we really want you to come with us You know just along those lines I mean do you have any idea about how many years it took to get to the place where the health department? Would open to you. I mean was a groundwork laid over a long time. Oh, yes This this predates me by a million years. Yeah, I Would argue and I'm not sure everybody in the New York calm reduction scene would agree with me But I think the vast majority would The fight for safe consumption sites goes back to the act up movement. Hmm. Yeah, we're through inch exchange started Yeah, these are not new ideas the first safe consumption site opened in Burns, Switzerland in 1986 and had an immediate tangible just Off the charts impact on the community there in a positive way And and I think, you know, I every time somebody comes into our site I you know, we I just can't help but think of all of the activists Going back to the act up movement all of the people who lost their lives all of the people who fought for syringe exchange In a way, it's it's all related But it's been a it's been many many decades that people have been fighting for this in New York when it the language was developed around Overdose prevention centers and bills started to be drafted and presented to the state legislature That's going back almost 10 years. Yeah, maybe more. Yeah Well, that's I mean that's encouraging. We've had You know and to see that commitment that stick to itiveness that fire in the belly, you know for for for decades It's beautiful. Nothing happens overnight and this is very controversial But it looks like it's worth it for what's having, you know, because of what's happening in New York. Your experience is so rich, thank you For sharing it, you know in Vermont And what happens if I disagree with you on your own show? Oh, I don't care. Go ahead disagree with me disagree with me So whenever people say, you know, how long did it take to get the sites open? I really do believe the answer I just said that really the seeds were planted during the act up movement and it's been well over a decade but then I get really frustrated because it shouldn't take this long and You know, it doesn't happen overnight people in harm reduction say that all the time It's gonna be years before we get this off the ground. We don't have years We have to act now and the amazing thing about a safe consumption site Is that at its most simple? It's a table and two people. That's it Yeah, it doesn't have to be anything complicated. If we wanted to open consumption sites tomorrow across the country We could you don't have to build anything And in our story in the New York story And I wonder if Sam my boss is gonna kill me for saying this. I don't think he would the window in which We decided Sam and I decided we were gonna do this We were gonna open the sites in partnership with the city in the health department To the day they opened Including hiring the staff training the staff writing the policies and procedures and building both sites that window was Maybe one month And I just I say that as an example of when there is will when there is political will Can happen overnight And I I mean I you're not disagreeing with me at all. I agree with you 100% I wanted to happen now or yesterday Yeah, we we in Vermont. We've been looking at this for years. There's been bills in the legislature There's been advocates You know raising public consciousness in Vermont. We have our health department and the you know the government The state administration the governor on down has embraced fentanyl test strips Safe syringe programs We've decriminalized the possession of small amounts of buprenorphine we've we've embraced um you know Every harm reduction intervention And funded them we have programs. We have mobile units We're naloxone. We have a lot of things going on that are very very positive the justice involved population has you know medication Phobia use disorder While while incarcerated. I mean we've come a long way over the years But it's this last piece This overdose prevention center or overdose prevention site piece That seems to be standing alone we had a bill Two weeks ago h728 and there were were you know harm reduction measures and there was also a the creation of a study group to review the literature the research to have expert testimony and to you know document recommendations as to whether or not An overdose prevention site would be feasible in vermont. We would be able to scale it to vermont how much would it cost Where would it be located? We know in my area chitenden county. We have heat maps Showing where death is concentrated We have the mayor who's come out in favor of an overdose prevention site We have the city council who's in a series of resolutions Um in support of an overdose prevention site We have our state's attorney, uh sarah george in support. We have our attorney general Um tj donovan in support. We have a whole we have a whole avenue that's stacked up the governor vetoed the bill Saying that it was counter-intuitive to Divert money from proven Um programs to something as you know Uh controversial and and unproven as uh and he called it an injection site He didn't even call it an overdose prevention site and we have the health commissioner Right with him on that Saying things like the research doesn't support it That's what we're up against in vermont. It's coming down to a moment where where there's going to be you know A lot of a lot of heat About this because people like you and people like me Are fed up and where we're tired of seeing our neighbors die. So you got you got me going there for a minute Yeah, so I mean we're on the same page I'd like to I mean I wish I wish we could get together and and and come up with a plan that in 30 days And I guess that's the next question. So you And and sam revere and your team When you came up with this idea and you actually implemented it you did it even with the department of justice You know and this whole um safe house You know A predicament you you you took a risk that you would be prosecuted. How did you how did you manage that? I mean because that's one of the things that's holding us back here Great question, so We As is very obvious. We do not have federal permission And we don't have state permission We do have support from the city And the city and state department of health We sam and I uh and our board of directors and our entire organization We are incurring the risk of opening these sites in this political landscape We didn't We didn't take on that responsibility lightly. There was a risk analysis that we did at a federal state and local level Level who's in power now who's coming in who supports the issue who's against the issue and we really looked at the various players All of this with an eye To that 108,000 fatalities number And really thinking Is is this the time There were a couple precedents that we looked at as well Before we made the decision to go forward and open the sites It's probably very obvious to you what those precedents are one is Rhode Island And the other was Philadelphia the safe house case Both under trump They were not as far along as we were they didn't have sites picked out. They hadn't built anything They hadn't hired staff no policies and procedures written And one of course as we well know very famously The safe house folks received a cease and desist letter from DOJ And they're now uh in in the midst of uh of a legal dispute And the Rhode Island crew was visited by the FBI and was sort of um had some other kind of like threatening, um I guess actions uh from a federal level Here we were we had sites built we'd written policies and procedures Um, we had been running an unsanctioned program at both locations for six years Sanjay Gupta had been in Uh and had seen the unsanctioned program and did a piece about it And there hadn't been any interference We We in that moment said What this signals to us is there is a conversation happening at DOJ around Figuring out a way to allow the operation of these sites And we saw our responsibility Is to open the sites and make that conversation easier So we needed to make sure that our program was very well designed And very well executed and that the work was going to speak for itself And I think that that's we've achieved that Um as as mentioned earlier the early outcomes from the sites are off the charts Um, we have treatment providers Coming in and working in the overdose prevention centers themselves in a way they have never worked with us before Um, we are stabilizing people who have never experienced a period of stability in their drug use We're connecting people to further care. We're getting people housed and most importantly, we're keeping people alive Since we opened our sites You know, I'm not gonna lie. There was a period where Sam and I were like, oh god, what's gonna happen? Are we all going to jail? Um, nothing happened. No one came Um, there was a lot of media coverage We made sure that we shouted our successes from the rooftop All of that was strategic to make sure that we were making that conversation at a federal level easier We have had an open door policy And what that means is anyone who is not 100 behind us has questions has concerns or is critical of these sites We made them a priority to come in and see the sites And I want to state this very clearly for your audience Ed This is an open invitation to anyone from vermont government or from the vermont health departments to please come and see our sites We'd love to host you and show you around, but that was very deliberate too There are very deeply held Each of us has very deeply held feelings about drugs people who use them the drug war And and our biases around around this are are really really Driving the bus in terms of what we think about safe consumption And we fill in the blanks ourselves, right? And and usually to the negative we picture shooting galleries people flocked out everywhere This is a public health service And when you come and see it and you meet the staff and you see the way it works And you feel what the room feels like and you see all the other supports Um, I I am convinced Some of those biases will shift um some visitors of note The southern district of new york has been through caroline meloni has been through Senior officials at the on dcp have been through All of this signals to us as well the conversation is happening at a federal level Arm reduction was uttered for the very first time in a state of the union address by president biden the conversation is happening Um The safe house ruling being delayed as many times as it has We feel and and so does the safe house legal team that that has a lot to do with our opening the sites DOJ is rethinking the way They're going to rule on that case because of the early positive outcomes from the new york overdose prevention sites Wow, thank you so much. I can't even thank you enough for blazing The trail and it's my fondest hope that that vermont will get right behind you And um, i'm going to take up your offer on visiting I'll be trying to put together a team. I'll let you know to come down there Hopefully the governor and the health commissioner and some key legislators along with some providers and uh We would love to to to see, you know, what you're doing more more close up calin. Thank you so much The time the time is now And you know mentioning the 108,000 lost ones last year, I mean What once you begin to focus on that? You you can't really focus on anything else That we do have and you said it you said the word you said a moral Obligation and that that rings so true to me that this goes beyond Anything to that deepest moral place one one last question about um Like the community itself You know like the building next door, you know the apartment building next door the the bodega You know across the street, you know, what what is the community? Saying about about, you know having um on point as part of the community We're in new york city. We're in a very urban densely populated area It's impossible for us to find a location for these sites where there's nobody around It's also an impossibility To get everyone on board going back to that idea that we all have very deeply held Feelings and opinions about drugs and drug use and many of us have have been impacted By drugs and drug use in our in our families and with our loved ones having said that The majority of the stakeholders in both of the neighborhoods where we work have Come on this journey with us I'm not going to sit here and say everyone lined up and said sign me on as an ardent supporter There was there were definitely pockets of real resistance in both of our neighborhoods Our responsibility is to stay the course with those folks and and walk them through it That's patience Lots of conversations lots of transparency Making sure they know the team and inviting them into the spaces Undoing some myths and some misperceptions about the sites And also knowing that there is common ground. We might not agree on everything, but there there is common ground to be found One of the issues in particular we ran up against in harlem is Real and it's an issue that we actually agree is a problem, which is the oversaturation of methadone programs In in east harlem a low-income area And there were some community groups in east harlem who came out very strongly Against the sites when we opened them conflating what we were doing with the methadone programs What they didn't realize was that the service that we're offering is completely different Um and that we had been in the neighborhood doing this work very quietly for 22 years Same in washington heights washington heights was not a new program Um washington heights had been working in in washington heights corner project has been operating in washington heights since 2005 So we were a long-standing trusted providers working with this population in our neighborhoods for a long time And that went a long way to helping us Gain the trust of the community around some of these newer newer interventions But community engagement around programs for people who use drugs is never going to be simple It's never going to be easy if it were there would be a manual on it and everyone would do it it just requires patience and consistency And and being comfortable being uncomfortable These are tough conversations. They bring up a lot for people And and we on both sides Have to kind of be okay with that So short answer The sort of the community groups in harlem who are very happy to talk to the media early on when we first opened Um and tell them how terrible the program is Have have it sort of officially issued a statement saying they no longer want to be contacted as the official opposition Um that they that they fully understand what the sites are trying to do And the role that we're intending to play in the neighborhood and that they support the objectives of the program Great, great. Nice work. And uh, you know, I I I hear that part about commitment and patience and being there over the long term Great great work You know, so we're about to wrap up now and um I just want to I want to thank you You know from the bottom of my heart. I want to extend An invitation to you to come back at some future point. Maybe when we had some research data You know that we can we can discuss and um, you know some more, um You know firsthand lived experience of what's going on there in new york To the viewing audience to my audience I mean it seems to me clear that You know our marching orders are very very clear that we have to stay focused on this We have to learn about this. We have to talk to each other about this. We have to talk to our neighbors about this You'll have access to the show Share the show widely Share it with legislators with neighbors with family members with people who use drugs share with everybody And let's raise our consciousness and not give up You know, this is a time for us to join together and use the governor's veto really as a source of Additional strength and additional commitment that that the voice of the people has to be strong And the voice of the people in vermont We was clear in the legislature We want additional services for our neighbors who are dying You know kaolin we lost two hundred and fifteen vermonters in 2021 the number of deaths has quadrupled since 2010 and this is with you know granted the state and the you know, we put all kinds of programs out We have a buprenorphine program called hub and spoke Which which which other states they would die to have it It is a model and it's it's going great But we've not yet developed ways To meet those people that are still in the shadows the people who have suffered the pain of stigma The people who who don't don't feel worthy the people who have been arrested and are afraid of Being prosecuted or for whatever other reason or not Sort of capable at this point of using traditional services Those are the people that I hear that you are touching That you are having gentle curiosity or you know, those are the people who really matter to you And this is what has to happen in vermont where we're just below the necessary Level of motivation right now, but we can feel it in the air. We're approaching it. So Your contributions i'm sure i'm sure will help us once again. Thank you My absolute pleasure and um, you know, I would just say for anybody who is really Worried about the scaling up of the overdose prevention center model across the u.s To to not fear this. This is one tool We believe very strongly in prevention and treatment and all of the other pillars This is one intervention That seeks to redress A needless loss of life And it's very very good at doing that Overdose prevention centers do not create drug users They don't um, they don't They're not enticing to youth Therefore a very specific population who have chronic and relapsing addiction issues And they work very well at stabilizing that population and connecting them to care So it's one tool that would be used in addition to Um, overhauling and expanding the treatment center doubling down on prevention programs Um, overhauling the housing system creating Educational opportunities that are more equitable employment opportunities that are more equitable Um, really really, you know addiction as we see it in the u.s. Today is a societal issue Um, and it's going to require all of us to come together as a society to start undoing some of the harms Um, thank you. Thank you, Ken