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Mind and Body

Digging for more than outrage and anxiety

Why reporting on what occurs at the Governor’s Task Force on Overdose Prevention and Intervention is important

Photo by Richard Asinof

A colony of sea lions and the tourists face off against each along the beach in San Diego, a metaphor perhaps for the often tenuous connection between mind and body, participant and observer.

By Richard Asinof
Posted 7/16/18
The power of engaged communities to work together to address the number-one public health crisis in Rhode Island – the opioid epidemic – continues to grow, despite the absence of in-depth reporting on the sea change underway.
If the director of DCYF can voice the need to develop a comprehensive public health strategy to address the diseases of despair and how they disrupt families, with a focus on prevention, will that become a point of emphasis in the new strategic plan being developed by the Governor’s Task Force? How can yoga become a focus on healthy strategies for young mothers battling substance use? How will the Recovery Navigation Program run by The Providence Center be re-established as a diversion program for those with alcohol intoxication? Is there a plan for how fentanyl test strips will be distributed in Rhode Island?
A few observations from my recent travels to and from California: many of the passengers were young families, including those traveling with young infants, while most of the stewards and stewardesses were middle-aged, old enough to be the grandparents of the young children, reflective of demographic changes in the workforce often not visible as a result of ongoing economic disruption.
A tweet from KQED, the public TV station in San Francisco, reported that there were “more dogs than kids” in San Francisco, which apparently has the lowest percentage of children of any American city.
The sign from the highway in San Diego advertised “cage free day care,” which I first mistook to be a sardonic comment on the Trump administration’s efforts to separate children and families seeking asylum at the U.S. border, until I realized it was for doggie day care. The next day, a lawyer representing the Trump administration in federal court in San Diego said she could not be available if needed over the weekend because she had dog-sitting responsibilities in Colorado.
Finally, San Diego and the state of California are making a major investment in a new above ground rapid transit public transportation, paralleling the major north-south highway.

PART ONE

PROVIDENCE – Reentry into Rhode Island after time away is often one of culture shock: near midnight, after 12 hours of travel time, outside of T.F. Green airport, encountering the rudeness of an unruly, obese passenger, wearing a scruffy Patriots cap, waiting for transport to the long-term parking lot, loudly complaining that the next shuttle bus would not arrive for another 45 minutes, barking gruffly like a male seal lion to whomever would listen to him, as if he were performing on an open-air microphone for talk radio, only to have the next shuttle bus arrive less than two minutes later.

“Will you admit that your were wrong?” ConvergenceRI asked, politely, as the shuttle arrived, still in a California state of mind.

No answer from the rude person.

“You were wrong. Why not admit that your were wrong?” ConvergenceRI asked again.

More silence.

Again, after having boarded the shuttle, ConvergenceRI asked: “Why is it so difficult to admit that your were wrong?”

The rude person finally replied: “You don’t know anything about me. I will never admit that I am wrong.”

Welcome back to Rhode Island.

Report from the front lines

The next day, on Wednesday morning, July 12, ConvergenceRI attended the monthly meeting of the Governor’s Task Force on Overdose Prevention and Intervention, where more than 50 members and community advocates gathered to hear a number of presentations, reports and updates from the front lines about the number-one public health crisis in the state – and in the nation.

Call it a different kind of splashdown into Rhode Island reality: the meeting offered an antidote to the rude airport encounter, where civility and good will prevailed, even when there were undercurrents of strong disagreement.

Attending the meetings on a regular basis is the kind of in-depth reporting absent from many news media outlets in Rhode Island; it takes stamina to pay attention to the details and nuances that will not be found in any news releases or pressers [the trade name for news conferences].

It requires patience and persistence to listen to what was being said, even if it might not result in any dramatic, anxiety-provoking, breaking news headlines – the stuff of outraged Facebook posts. And, as is so often the case, there were no other news media present: no cameras, no microphones, which translates into no coverage.

But, there was plenty of “news” to be found, as folks shared the slow, sometimes difficult progress being built around collaborative efforts to combat the epidemic of opioid deaths in Rhode Island, which has brought together law enforcement personnel, state agencies, community partners, recovery community advocates and clinical providers in the same room around a common agenda, talking in earnest with each other.

Dividing line between politics, policies and outcomes
The first item on the agenda of the July 12 meeting was a certificate to acknowledge that Westerly Hospital, owned by Yale New Haven Hospital, had achieved a Level 3 standard of care designation certified by the R.I. Department of Health for treating overdose and opioid use disorders in delivering humane, evidence-based care of patients.

Translated, it means that all emergency rooms and hospitals in Rhode Island now have a recognized common standard for treating patients for overdoses and opioid use disorders, the first state in the nation to do so, an impressive accomplishment.

A second piece of good news, delivered by Rebecca Boss, the director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals: thanks to the persistence and dedication of Rhode Island’s congressional delegation, the state will be receiving $12.55 million in new federal funding from the Substance Abuse and Mental Health Services Administration to support programs such as recovery housing, expansion of residential treatment and peer recovery counseling efforts. In addition, Rhode Island will be receiving $3.7 million from the Centers for Disease Control and Prevention to further its efforts to develop community-based partnerships to address the opioid epidemic.

Translated, it means that more than $16 million in new federal funding will be coming to Rhode Island to support many of the state’s innovative efforts to combat substance use and abuse and prevent overdoses.

[A third piece of news, shared after the meeting: Tom Coderre, senior advisor to Gov. Gina Raimondo, and co-chair of the Task Force, will be serving as acting interim director at BHDDH while Boss undergoes knee replacement surgery.]

On the ground
Three different community groups – from Woonsocket, from Providence, and from Tiverton/Portsmouth/Little Compton – shared their stories on what they were doing to combat the opioid epidemic in their neighborhoods, as part of the Community Overdose Engagement initiative, or CODE. Some 25 different towns and municipalities have developed such plans.

Dennis Bailer, a peer recovery specialist with Project Weber/RENEW, talked about setting up tables on the sidewalks outside supermarkets in Providence such as PriceRite to distribute free Narcan/Naloxone kits in a public space.

Michelle Taylor, director of the Community Care Alliance of Woonsocket, spoke about creating a “serenity center” on Thursday and Friday evenings and on weekends where people can meet one-on-one with peer recovery specialists, as part of a collaborative, multifaceted approach. The partnership includes: Woonsocket Prevention Coalition, the Woonsocket Health Equity Zone, Community Care Alliance, Thundermist, Landmark Medical Center, Woonsocket Police, Fire/Emergency Medical Services, Discovery House and Gateway Healthcare.

Rebecca Elwell and Ray Davis from the Newport County Prevention Coalition spoke about their efforts to create an initiative called “Faith and Fire,” including publishing a prevention toolkit to help bring hope and healing to faith-communities, addressing stigma from the pulpit as well as coordinating their activities with firefighters.

The stories, once again, were not the kind of “shattering” news events that make the headlines, but rather important vignettes about the way that communities are creating their own avenues of engagement, to support connectedness, to diminish stigma, in a collaborative fashion, sustainable progress that often gets measured one life at a time.

Pivot to prevention
Next on the agenda was Trista Piccola, director of the R.I. Department of Children, Youth and Families, who spoke about her agency’s efforts to address what she called “the shared priorities, particularly around the economic instability of many of our families, substance use, mental health, and the needs of parents of very young children.”

The goal, she continued, was to put the emphasis on prevention-related outcomes and “to define child safety as a public health issue,” not solely as a DCYF issue.

Translated, it means zeroing in on prevention efforts so that vulnerable families and children receive the support they need when they need it.

Among the initiatives underway are the upgrading the agency’s data system to better track issues such as opioid addiction and partnering with stakeholders such as Family Court and the Rhode Island Family Treatment Drug Court.

The numbers shared by Piccola showed the increasing toll of substance use on families in Rhode Island: in fiscal year 2017, the number of children removed from home, due to parental substance use, including alcohol, was 375, or 32.8 percent of children removed, compared to 326 children removed in 2010, 22.2 percent of children removed.

What we do in Rhode Island, Piccolo continued, “to first address serious mental health, substance use, family violence, and poverty in our communities matters most in the lives of families and children and whether they reach our doorstep.”

Translated, Piccolo and DCYF appear to be beginning to make the connections to the diseases of despair [although she did not use that term] and the economic and family disruption that occurs, making it part of the conversation.

Two items of conversation worthy of note: Davis, who had recently come back from a meeting in Ohio, asked Piccolo if DCYF was capturing in its database the reemergence of methamphetamines, which had once again become rampant in Ohio. Piccolo said that it was not currently part of the data menu capturing drug use but that it could be added.

Dr. Jody Rich, director and co-founder of The Center for Prisoner Health and Human Rights at Miriam Hospital and a member of the Task Force, offered a comment to the representatives from the Faith and Fire initiative to make sure that medication assisted treatment options were part of the conversations offered to those seeking help through faith-based initiatives, noting the evidence-based success of such treatment.

Lawsuits
Next up on the agenda was Neil Kelly, deputy chief of the Civil Division at the Rhode Island of the Attorney General. The R.I. Attorney General recently filed civil suit in state court against certain opioid manufacturers and distributors over their alleged campaign of unfairly, deceptively and fraudulently marketing and promoting opioids in Rhode Island.

Kelly answered questions about the differences between this suit and other legal action being brought in federal court by municipalities, saying that the remedies being sought are better addressed under the framework of the state. [He didn’t mention another key difference between the lawsuits – the fact that the attorneys bringing the federal lawsuit will be collecting a 30 percent fee from whatever may or may not be awarded the plaintiffs.]

Can we talk?
With all the presentations, there left little time for public comment, some three minutes worth, despite any number of issues percolating: continuing questions about criticisms voiced about the “Truth” ad campaign; questions about the priority of harm reduction strategies moving forward and how they will fit into the new Task Force strategic plan being developed; and questions about whether there is a need to develop different strategies for men and women in treatment and recovery, with a focus on young mothers.

In an election year, the ability to engage in such discussions in a public forum such as the Task Force creates an opportunity to move beyond a potential partisan divide, one that is currently being exploited by some candidates, including Republican candidate Robert Flanders, who is challenging incumbent Democratic Sen. Sheldon Whitehouse.

Flanders has used hyperbole to accuse Whitehouse of having “blood on his hands” when it comes to the opioid epidemic, despite Flanders’ own apparent absence from addressing the opioid epidemic during the last decade, in contrast to the apparent leadership demonstrated by Whitehouse. [See Part Two.]

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