Mind and Body

Empathy or empathic break

A conversation about how to reframe the conversation around recovery and treatment in Rhode Island

Photo by Richard Asinof

Linda Hurley, CEO of CODAC, in front of the agency’s mobile recovery unit at the Rally4Recovery.

Photo by Richard Asinof

Jonathan Goyer, Linda Hurley and Tom Coderre at the Rally4Recovery on Sept. 17.

By Richard Asinof
Posted 9/25/23
Linda Hurley, CEO of CODAC, in a question and answer with ConvergenceRI, seeks to reframe the conversation around recovery and medication-assisted treatment?
How has the ongoing failure by the Governor and the General Assembly to increase rates for Medicaid providers contributed to the ongoing crises in substance misuse, homelessness, and primary care? Will Brown University step up to the plate and invite author Barbara Macy to give a talk about harm reduction? Why is the new Housing Department playing a game of brinksmanship when it comes to announcing funding for housing interventions to keep “unhoused” Rhode Islanders in shelters during the coming winter?
At the Rally4Recovery, ConvergenceRI encountered a director of a Rhode Island nonprofit that had just received a multi-million dollar grant from SAMHSA to set up a new behavioral health clinic. But when asked about the new OHIC report that recommended a $45 million increase in Medicaid rates for providers, the director said that she was unfamiliar with the report. ConvergenceRI suggested that the director read the latest two editions, which had reported in in-depth fashion on the OHIC report.
It struck ConvergenceRI that one of the most destructive forces operating in Rhode Island today is the absence of comprehensive news coverage that breaks down the existing silos. Everybody seems to be content to live in a protective bubble. As a result, there is an absence of connectedness – and an empathic breakdown down of community.

PROVIDENCEWhat do we talk about when we talk about recovery? It can be a perplexing question, given the hit-and-miss way that the most news media covers the work of the recovery community, too often with a skewed focus on the perverse annual overdose death toll metric – 434 in 2022, 435 in 2021.

How do we measure recovery – a long-term process – in terms of lives saved, families preserved, and neighborhoods reborn? How do we tell the stories of sobriety?

In ConvergenceRI’s experience, there is a tendency by the news media to alternate between telling titillating stories that exploit and manipulate the levers of fear, mayhem, and anxiety, and news stories that promote the prowess of the media outlets own expertise – the “you heard it here first” self-congratulation syndrome.

As a result, the dramatic swings in coverage tend to drive competent news reporting into the shadows. For instance, the news coverage of Rhode Island’s efforts to establish a harm reduction center has often demonstrated the way that the pendulum keeps swinging back and forth between polar opposites.

On one extreme, there is the faux outrage manufactured by talk radio jocks such as Matt Allen on WPRO, calculated to manipulate the listening audience into a frenzy, claiming that the new center would serve as a way of legalizing the heroin trade – using government funds to do so.

“Why don’t you just shoot me now!” ConvergenceRI believes he had heard Allen proclaim over the airwaves one afternoon, expressing an apparent exasperation about what he believed was the misguided policy behind the harm reduction center.

On the other extreme, there was the recent coverage by reporter Katie Mulvaney of The Providence Journal, who detailed efforts undertaken by a woman in recovery to help pregnant women in Rhode Island get access to the care they need.

Mulvaney’s story, “From addiction to advocate, RI’s mission to help pregnant mothers battling with substance abuse,” published on Thursday, Aug. 10, provided a lesson in storytelling, in convergenceRI’s opinion. It began: “Katie Merchant Gonzalez has two phones on her at all times, ready to take calls day or night. She knows that many of the callers on the other end are fragile and struggling – pregnant women or new moms wrestling with substance-use disorders. She also knows just how narrow the window is to get them the help they and their babies need. So when someone calls, Katie picks up.”

One could say, in a clever turn of phrase, that the news media in Rhode Island is suffering from an undiagnosed bipolar disorder.

[Editor’s Note: Nationally, there is a wealth of in-depth reporting by WBUR’s Martha Bebinger and the New York Times’ Jan Hoffman – and, of course, the reporting by Beth Macy, author of Dopesick and Raising Lazarus. But, for whatever reasons, their work is rarely cited by Rhode Island news media.]

The more important question, in ConvergenceRI’s opinion, is this: How can we reframe the ongoing work of the recovery community in Rhode Island?

An important conversation
ConvergenceRI attended the Rally4Recovery held in downtown Providence on Sunday afternoon, Sept. 17, and had an opportunity to sit down and talk with Linda Hurley, CEO of CODAC. That conversation led to a series of questions and answers, in an attempt to reframe the conversation around recovery in Rhode Island.

ConvergenceRI: How does the conversation around harm reduction and recovery in Rhode Island need to be reframed?
HURLEY: Nationally, when we look at the current landscape of services for those with opioid use disorder, we see increasingly strident discourse.

We need to talk about the 80 percent we agree on instead of the 20 percent that is unclear. A simple continuum of care is prevention, harm reduction, treatment, and recovery.

Peer recovery support services are critical to comprehensive provision of services in all [aspects] of the continuum.

In Rhode Island, we’ve recognized the importance of street outreach in harm reduction to lower OD death rates.

Street outreach/harm reduction is peer-driven. Unfortunately, we see the lack of civil discourse blatant on a national level.

I am begging for this to stop. We are in crisis. We need all providers of service to respect our respective missions — our compassion and competence — and collaborate. And not just between harm reduction groups and peer recovery specialists but between all segments of care and between those who fund us and those who are funded. Please respect the science, the evidence, and be kind.

ConvergenceRI: Would a visit and a talk by author Beth Macy [Dopesick] help to change the current landscape?
HURLEY: Absolutely. She will provide historic context as well as a strong focus on recovery – in any way someone may define their recovery.

ConvergenceRI: What is the responsibility of health care reporters to get the story right? What are the consequences of reporters getting the story “wrong” and being willing collaborators in pushing out false narratives?
HURLEY: It is critical for reporters to not just report accurately but also comprehensively. Media is our primary way to reach those that need our services—and that is a remarkable responsibility. It means the difference of someone accessing lifesaving services or taking the risk of not accessing those services.

In cases were journalists report “drama” or instances of conflict for readers, listeners, or viewers instead of focusing on solid narratives about accessing life saving services, the system of care is undermined.

This overwhelming, frightening public health issue needs to be addressed by providing the public with the very real knowledge that recovery is attainable practically at their doorstep – evidence-based care that works.

ConvergenceRI: When I occasionally listen to talk radio when I am driving, what I call taking the temperature of the intemperate, I have been struck by the vehemence by both Dan Yorke and Matt Allen on WPRO in attacking the new harm reduction center, using incorrect and inflammatory descriptions of what is planned.
Without sounding paranoid, it seemed that there is a coordinated agenda being promoted, particularly around the messaging and phrasing being used to attack the harm reduction center. Am I over-reacting to the way I hear the issue is being discussed and framed on talk radio?
HURLEY: Absolutely not. When the Providence Journal announced the award for Project Weber Renew to open the Overdose Prevention Center and mentioned CODAC as a partner, in one business day, we lost the opportunity of a mortgage and a Rhode Island community city council severed its relationship with CODAC.

ConvergenceRI: How successful has CODAC’s mobile van been in meeting people where they are in the community?
HURLEY: Thank you, Richard, for asking this. CODAC’s mobile treatment unit has been remarkably successful. We are actually expanding due to this success. We now have two mobile medical units, and we are anticipating a third.

We have been reaching a population, as you know, in Woonsocket that has been without care for opioid use disorder. Some 25 percent of those that we serve there are without homes. Anecdotally, we’ve been informed that community primary care and urgent cares have seen a decrease in substance use disorder/opioid use disorder, admissions, since we’ve been providing the services.

We just received a National Institutes of Health award to measure, with Brown University, the clear success of literally meeting people “where they are.”

ConvergenceRI: Why has it been so difficult to push the General Assembly to increase the rates paid to Medicaid providers for behavioral health services? I keep thinking that a visit from Beth Macy to Rhode Island, which could include an opportunity for her to engage with legislative leaders, might help change the narrative. Is that wishful thinking?
HURLEY: I believe that that visit is extremely timely. As we are looking at the results of the statewide rate review, (public comment was just this past Friday), it was determined by those who studied this that a little over a 14 percent increase is required across-the-board for behavioral health.

This will now of course go to the state budget conversation with our legislators. Ms. Macy’s strong and competent voice will only enhance this effort.

The reason that this has reached such a crisis point is because many of us in behavioral health have not received even a cost of living adjustment in anywhere from 10 years to more than 16 years.

It has been the overdose crisis, and strong, persistent voices of legislators such as Sen. Josh Miller and Sen. Lou DiPalma, among others, that have continually brought this issue forward to this point.

Many more of our lawmakers’ constituents have been impacted be this disease, increasing the responsiveness of their representatives at the State House. In my career of 35 years in this field, budget battles are annual events and will of course continue – but we are much closer to being heard now - more than at any other time.

ConvergenceRI: There appears to be a conflict in the recovery community around “expertise” — the differences between academics and peers, the differences between investments in equity and the investments in competence, and whose voices get “heard” in news media coverage. How would you describe the differences, and what might serve as a healing narrative moving forward?
HURLEY: I will begin with the academics and peers apparent conflict. There is certainly a decreasing gap, at least on the side of academics, in understanding the value of peer recovery support services.

In Rhode Island alone both Dr. Rosemarie Martin and Dr. Brendan Marshall of the Brown University School of Public Health have received millions of NIH grant dollars to study the effectiveness of peers in various points of intervention relative to the continuum of care.

There continues to be a tension between the peer community and treatment offering evidenced-based care. As the voice of peers has continued to grow and to be respected nationally, that voice is influenced by many for whom opioid treatment programming, licensed by the DEA, has proven unsuccessful.

It was ineffective and inefficient for them. That is real. Over-regulation for opioid treatment programming is a manifestation of stigma against those with the disease and those who provide care for those recovering from that disease.

Within that context, receiving medication-assisted treatment in a holistic and individualized way was historically a challenge.

If we didn’t discharge individuals who weren’t compliant [whatever that was interpreted to mean], we were accused of just shoring up our budget. We would actually receive negative audit reports from both national and state-agency auditors. I personally was cited for allowing individuals to remain in MAT for opioid use while they continued to use or struggle with cocaine.

Over the last 10 years, this has changed dramatically in many of those treatment environments. Very few people come to the clinic “every day.” No one is “kicked off” the clinic for missing a counseling appointment, having a positive urinalysis result, or an inability to pay.

We are cognizant that every single time someone who comes to us for care is not receiving optimum care, they are at risk for overdose death.

The lethality of substances available on the street can be and is often demonstrated in just one “use.” The changes in care have been tremendously positive.

But for many of those whose voices are strong, this was not the case. It is heart-breaking. But treatment is no longer what has been described as a paramilitary extension of the DEA.

The DEA along with SAMHSA, both locally and nationally, have worked hard to keep communities safe from misuse of the medicines and increase flexibility for those of us registered as providers to provide clinically indicated, individualized care vs. expansive regulatory mandates.

Opioid treatment programs have been described as cartels by U.S. Rep. Donald Norcross of New Jersey and others as recently as last Wednesday in a congressional briefing in Washington, D.C. Again civil discourse is required to take what is positive from both positions and collaborate on including all that will decrease this horrid public health crisis. We in the treatment field have felt the impact of this increasingly.

Peer recovery support specialists are needed, as I said earlier, at all points. They are needed for their experience. Many are not, however, physicians, licensed clinicians, or nurses -- just as many of these practitioners are not peers.

This is not an either/or situation. We need all voices and most importantly the voice of our expert – the person coming to us for care. This voice seems to be lost in the tension over what field “knows best.”

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