Addressing OUD Stigma in Rural Emergency Departments

We talk with staff from St. James Healthcare, an acute-care hospital in southwest Montana, and Tammera Nauts from the Montana Primary Care Association about how the emergency department at St. James approaches patients experiencing opiate addiction or overdose. Part of a statewide program to better respond to and treat opioid use disorder (OUD), learn how St. James is helping lead the way in reducing the stigma around OUD in rural health care.

Transcript

Joslin Hubbard  0:00  

We're here at St. James, we talk about it now. And we don't stigmatize substance use. It's okay to talk to us just about your substance use just like it's okay to talk to us about your blood pressure or your laceration that you're being seen for whatever you're coming to the ER for.

[Music comes in]

Beth Brown  0:19  

Welcome to Breaking Barriers in Rural Health, a limited series podcast from Mountain Pacific. We are sharing what is working in rural mental health and health care and discussing ways to replicate these successes. We're also shining sunlight where it's needed by identifying breakdowns and gaps in care. Ultimately, we aim to improve the health and well-being of our healthcare communities, and anyone listening into this podcast. Now here's the latest episode in Breaking Barriers in Rural Health.

Dr. Eric Arzubi  0:54  

Today hear, we're here to discuss what appears to be a growing and successful program at St. James in Butte. And we'd like to introduce folks who have joined us today in our inaugural podcast. So thanks, everybody, for joining. And I know, maybe Tammera, you can introduce yourself, and then introduce the rest of the team.

Tammera Nauts  1:12  

Good morning. Thanks for having me. I'm Tammera Nauts. I'm a duly licensed clinician, LCSW, LAC, and a work for the Montana Primary Care Association. I'm the director of IBH special projects, which really focuses on Sud and medications for opioid use disorder. My history is I worked in treatment for about 25 years, all levels of care and was recruited by MPCA to come and not supervise anyone or implement anything, but share wisdom and facilitate systems change in Montana. So we started this project few years ago, and I am so delighted to have with us the star of the show, which is St. James out of Butte, Montana. We have Joslin and Annie with us and as well as Amber Rogers from Mountain Pacific Quality Health who is our partner, one of our partners on this, so I'm going to hand it over to Annie and Joslin.

Joslin Hubbard  2:05  

Hi, I'm Joslin Hubbard, I am the ER navigator at St. James here in Butte, Montana. And part of my role here is to help facilitate individuals who are experiencing substance use disorder and get them connected to resources, both in the ER and then outpatient.

Annie Sutton  2:22  

Hello, my name is Annie Sutton and I'm the Director of Emergency and trauma services here at St. James in Butte, Montana.

Dr. Eric Arzubi  2:30  

Thank you guys. Amber, would you like to introduce yourself?

Amber Rogers  2:33  

Sure, Amber Rogers, and I'm just going to be in the background. Happy to be a partner with all of these lovely folks.

Dr. Eric Arzubi  2:39  

Right? So I'm wondering who can who can start us off and explain a little bit of what the program is when it started. And what's happening right now.

Tammera Nauts  2:49  

So I can jump in here. This started in in 2021. We are our positions are funded our IBH team positions are funded primarily through state opioid response dollars and the state. My state contact and partner was very interested in emergency department work because it was a national trend that was starting to be the thing and it seemed like some low hanging fruit. concurrently. One of our trainers, Dr. Dan Nauts had been involved with the Massachusetts General program, observing what they were doing having lots of contact with their physicians back there and figured this was a pretty wonderful program or project to go after for rural America would really serve us well. At the same time, mountain Pacific quality health was also looking at this project. So Amber and I, because we partner anyway on many things, decided to join forces and do this together. So we were able to bring out the California Bridge Project and the Michigan opioid project to do a training for 11 sites that were the recipients of grant funds through an RFP that was issued by the state.

Dr. Eric Arzubi  3:59  

And so I so just to kind of recap bits of big picture is making the treatment of opioid use disorder available in the emergency room setting. Right because I think typically people think about it being in in other settings.

Tammera Nauts  4:12  

Correct. And we know that people that access emergency department services for accidental overdoses withdrawal symptoms are many and repeated. And what the research bears out is that with a program like this A Walk in induction and rapid referral to either your internal primary medicine clinic or community partner reduces those emergency department visits by at least 50% in that population.

Dr. Eric Arzubi  4:38  

Wow. 50% drop. So tell us what was going on in St. James before this program and how much of a problem was it and why did it become important to address?

Joslin Hubbard  4:48  

I think before this program, we weren't really addressing the opiate use crisis in terms of you know, when someone came in post overdose or experiencing withdrawals, our providers would treat them you know, with fluid and some anti-nausea medication and give them a list of places to follow up with. And so before this type of care, we just weren't sure how and our providers were a little nervous about prescribing Suboxone, it was new for them. So that was, you know, really kind of a change in how we how we approach these patients. After we implemented it, we've done a lot of stigma reduction, training, and education, and individuals who have experienced opiate use disorders to try to help us all be more understanding and accepting and helpful for people who are in this situation.

Dr. Eric Arzubi  5:36  

How big of a problem, was it? And is it still a pretty big problem? I mean, how many? Like what's the impact on the emergency room of folks coming in struggling with opioid use disorders, I mean, to maybe as a sense of either volume, or anxiety or stress or distress, or, because it has an impact on the on the overall approach to treatment, because I know, typically, right, in emergency rooms, people struggle when somebody shows up with either in a mental health crisis, or a crisis involving substances, you know, unless you're trained to do that, it's stressful, and you feel kind of helpless, sometimes

Annie Sutton  6:10  

higher volumes with the mental health and substance use disorder, I mean, we were seeing a lot of utilization. And this way, now that we have a program like this, you know, they have the outside resources, so they're not coming to us daily, or on a weekly basis, we have a very small er, our set up here, with 11 rooms. And so when you have five mental health patients, or substance use disorder patients, I mean, they could come and spend hours upon hours and this way with a program like this, and we can make them feel better, and we can get them connected on the outside with community resources. They're not staying that long lengths of stay in our ER, and we're easier to get people in and out.

Dr. Eric Arzubi  7:04  

So what does so I guess, what does it look like somebody comes in either, you know, they, you know, either because they told you, or they may have been had a urine test. And they show that there, there's some opioid intoxication, let's say, or perhaps withdrawal, what happens, what happens at the emergency room at St. James, that maybe doesn't happen in a typical rural emergency room setting,

Joslin Hubbard  7:25  

I would say that it starts with a conversation and an understanding of what the patient is experiencing, talking to them in a non judgmental way about their opiate use. And so it opens up the door for the conversation to then bring up that we can initiate Suboxone, or if they're not ready for that, we can at least give them a Narcan kit to go home with or we can get them appointments made and you know, go that route, but just instead of, you know, either labeling them or not talking about it, here at St. James, we talk about it now. And we don't stigmatize substance use it's, it's okay to talk to us just about your substance use just like it's okay to talk to us about your blood pressure, or your laceration that you're being seen for whatever you're coming to the ER for.

Tammera Nauts  8:12  

But one of the things that's really unique about these programs is that the emergency departments partner with their community providers if they don't have an internal primary care clinic, so St. James partners with Southwest Montana Community Health Center, and what we know is that with these rapid referrals or warm handoffs with a preset appointment that patients are going to follow through about 82% of the time. Wow. So and the goal is now of course, a lot of folks may come in on a Friday or Saturday. The goal is you want to you want that appointment to happen. 2448 at the most 72 hours out from their emergency department visit, the emergency department is able to give the patient enough medicine to last until to cover until there have been time

Dr. Eric Arzubi  8:59  

If Sir, give me so the induction of Suboxone actually starts right there in the emergency rooms right there in the and then discharged with a prescription or that prescription for suboxone for a few days.

Tammera Nauts  9:09  

Either a prescription or for medicine.

Dr. Eric Arzubi  9:12  

Okay, got it. Sorry to interrupt.

Tammera Nauts  9:13  

That is what is probably one of the well, on par with the most effective parts of this program is that they're walking out with an appointment time 10 o'clock Monday morning, Southwest.

Dr. Eric Arzubi  9:24  

Now is that we're, sorry, is that we're partnering with so the Southwest Community Health Center

Tammera Nauts  9:28  

in St. James. Gotcha. So like, St. Pat's has a couple of different partners in Missoula. Billings Clinic has, you know, their whole network that's, that's starting to happen, etc. So just depending on the community that you're in, the goal is to have an appointment in hand and a place to show up in rural placements. And we're and I worked very hard with a few of our rural hospitals that received these grants. Part of the issue was coverage, right coverage, coverage. It's like not having a provider that I got prescribe her that was willing to prescribe MAUD. So we had some psych coverage. We had telehealth coverage in some of those areas. So anyway, that's what the goal is have an appointment. continued service, that's no

Dr. Eric Arzubi  10:12  

so. And again, that was Yeah, that's a whole Boy, that's a whole other story and up and, you know, trying to stand up emergency room coverage for entire state that can be a little onerous, and the axis is definitely needed.

Tammera Nauts  10:24  

No, concurrently is one at least one other thing to tale on what Joslin was talking about, concurrently with another set of partners through the Public Health Institute, Holly Jordt, and also the state prevention bureau. We are I should say they were able to absolutely cover the state with Narcan kits. So any healthcare site provider can order up to 500 kits at no charge covered by the state online. So we've got a lot of Narcan kits out there, thank goodness. So every patient would leave with one or family member would leave with one. You know, we still have a long way to go there. But we are Montana is doing a great job. So

Dr. Eric Arzubi  11:05  

I'm curious, because introducing these programs, as you sort of alluded to, can be pretty challenging, because there's, there's a way especially healthcare change is very difficult to implement and execute. There's a lot of resistance to change. It's interesting, right? Because in healthcare, we'd like to complain that things aren't great. But then when it's time to change, we don't want to change. So that's a whole other conversation. But I guess what I'm curious is, because when I was speaking to Dr. Knotts, about a month or two ago, he was telling me about the great work of St. James, which is kind of what inspired us to have this conversation. And he said, St. James is doing it right. So I guess I'm curious is, what is it about St. James, that makes it possible to do it, right. Greg has I'm guessing St. James is able to do it right and others and not something, something's different. what's available, what's the ingredients? What's a recipe for so that St. James is actually able to pull this off?

Tammera Nauts  11:53  

Joslin Hubbard that's the difference. So it's your bow. Okay, I don't need to put you on a spot Joslin. But I just really want to highlight how you all and your reputation as far and wide beginning with the Meadowlark project. So Joslin just has a way about her and the providers that she works with that she's extraordinarily motivating, not pushy, in any way, shape, or form. But she is very motivating, and presents herself as okay, this is here, this is happening. This is exciting. We're doing it. Where should we start? Move forward? No argument.

Dr. Eric Arzubi  12:32  

Every program like this needs a champion this, this stuff doesn't happen without a champion on the ground. Right. So what is it that kind of energized you to actually make this make this happen? Why are you the right champion for this, this particular project at St. James, because to me that, that's the important and exciting part of the story here, right is for others, for others to be able to do this, they need to identify champions. So how do you identify a champion or what makes a champion effective to make to pull this off?

Joslin Hubbard  12:58  

I think for myself, and my colleagues, you know, the providers that I work with, I think it was just presenting it to them in maybe a way that they hadn't seen before. And, you know, I was grateful to have the support of the administration at the hospital, as well as Annie, my, my boss, and Montana Primary Care Association was willing to come in and do trainings. But it's that constant kind of reminding them of what we're doing, right. So when we have a patient come in, oftentimes, they have 1011 patients that they're treating at once. And so until things become habit, I'm there reminding them, Hey, have you thought about maybe 20 bucks on for this patient? Or have you thought about this? Do you think they'd be a good candidate for Suboxone? Or what about helping them and just kind of leading by example, a lot with language that we use, making sure that we're not referring to people in derogatory terms ever, that we're just really trying to be, you know, leaders.

Dr. Eric Arzubi  13:55  

I'm sorry, interrupt it, but it sounds like right for to make this right wasn't what this thing where you can just say, Okay, we've a grant, here's the manual, and leave it in the ER and walk away, there's no way you can pull that off. You need to be on the ground, holding hands advocating patient by patient day by day. That's, that's, that's pretty cool. You were able to do that, within remind, can you remind us are your clinical background? And then why did you do you're always in the ER every day? Or is it something you just said, You know what, I gotta run with this, and I'm gonna be in the ER every day because this is the only way it's gonna work.

Joslin Hubbard  14:25  

So yeah, I have social work background, but I am not a clinician. And I had been in the emergency room for some time and then I jumped over to OB and did the metal arc initiative with the Montana Healthcare Foundation, and kind of led that thing and got that up and running. And then when this opportunity came back, I am now in the ER full time so I'm there Monday through Friday, and then availability, you know, on some nights and weekends for calls or brainstorming sessions, I guess, but, you know, just there and I sit in the nurse's station I sit directly behind the doctor. It's that bump ability model. I always Call it or you bump into each other, because out of sight out of mind, right, so if I'm not there, to remind them of this, this program and the service that we can offer, maybe hopefully they will use it. But you know, they also have a lot of things where they're dealing, they're dealing with life and death in the emergency room. So sometimes things get overlooked. And so you know, just to be there, to remind them of what we have, and to, you know, help encourage, and then do that follow up, you know, so when Tammera was talking about setting up with Southwest Montana Community Health Center, it's that takes an extra phone call. And so making sure that we have that all set up, and doing that kind of coordination of care for the patient and follow up and building relationships with the providers down there, which we have an amazing, amazing set of providers, but Kara Howard is our main point of contact, and she's been fabulous to work with and their behavioral health team down there to just make sure that we have everything set up. So that, you know, like Tammera said, that's much more success rate when we can have them leave with their prescription and with appointment follow ups. And we've kind of gone as far as to make sure that the patient actually leaves with the medication in hand from the emergency room, because we know that there's some stigma or some barriers to care. And so making sure that we dispense them with the medication from our ER, so they don't have to make any more stops on the way home, they can go there. And then they can just show up for their appointment the next day.

Dr. Eric Arzubi  16:18  

That's great. And I'm wondering, I just curious like about maybe a story or two, one, I'd love to hear maybe something about a patient experience something. I don't know a story that kind of supports your the idea that this is something that that's worthwhile pursuing. And also be interested in hearing any aha moments for providers, physicians or other clinicians in the ER, where they're like, huh, it's actually it's kind of good, we're doing this.

Joslin Hubbard  16:47  

We had a patient that had Annie just reminded me a patient that have come in several times to the ER and was kind of tying up resources or doctors couldn't figure out what was going on with some back pain. It was her chief complaint. And then, you know, the more we did some digging, you know, that brief intervention come to find out she is struggling with opioid addiction. And so she was experiencing some withdrawals. And so setting her up, because she had, you know, been getting stuff illegally off the streets, but wasn't able to, or didn't want to do that, maybe but she wasn't, she was afraid to tell us what she was experiencing. And so until we kind of sat down and had the conversation, we were able to like, set her up, got her she had immediate relief in the ER, watched her for a little bit cetera. And, you know, she we haven't seen her back in the ER, and she had been seen, I think three times in 10 days. Prior to that, and setting up, you know, we had gone as far as an emergent MRI to see what was causing, you know, the pain that she was saying and so, you know, to ask that's a big success, right? Not only is hopefully she healthier, because she's not getting substances off the street, but also it alleviates a lot of resources and time and opens the beds up for other patients to and she's at a more appropriate level of care for what she made.

Dr. Eric Arzubi  18:01  

Got it. Thank you for sharing. That's a great story. What and what about on the other side on the on the SIR physician or clinician side where maybe there was some initial resistance, and now people like oh, this, this might be helpful.

Joslin Hubbard  18:15  

We had one doctor who was kind of, you know, willing to try it, but not super bad and we had a patient who was just screaming and pain, going through withdrawals. And just super uncomfortable, he couldn't examine her at all to even get near her. We I went back to her chart, we kind of talked about things I went and visited with her and then brought him back in, he initiated Suboxone. But she met the criteria. And within 30 minutes, 45 minutes, she was sleeping peacefully. She was comfortable. She again followed up, we haven't seen her back. And for him that was a huge like, gosh, I you know, I was ready to do everything to try to figure out what's going wrong with her, you know, she was abdominal pain was what she had stated was her chief complaint and, you know, very concerned about, you know, is this a surgical patient and come to find out, you know, it was her body going through withdrawals as well as what she was experiencing. And so that shortened her stay up significantly. Plus, she was manageable, she was comfortable. They were able to talk about other things going on once she was comfortable with her medical care. And so it provided her with better care. And as well as our provider was like, gosh, this was this made my life a lot easier, which was wonderful.

Dr. Eric Arzubi  19:27  

That's great.

So curious for maybe for some other emergency rooms or other hospitals that are maybe have heard of this and have thought about it and are sort of on the fence or maybe even still pretty resistant. What would you say to them about kind of your experience and why it's a worthwhile pursuit, even though again, this is this is hard, right? I mean, most people I think agree that access to care is important and treatment is important, but like we talked about before, people don't love change. So are there any kind of lessons learned about what worked in terms of Trying to bring a group of people along in this process, and maybe some things that you would tell your colleagues and other hospitals about.

Joslin Hubbard  20:09  

My experience working with providers is that they respond best to their peers. And so I think having Dr. Knotts come in and do education with them, help them to understand how the medication works better, as well as some prescribing things. But then, you know, moving forward is it is hard work in it, not everybody is receptive. And that can be tough, you know, that those individuals rights to self determination, sometimes it's hard to hard to see when they're not really ready to do that. But just, you know, looking at looking at stories follow up having that close relationship with South southwest Montana Community Health Center, and being able to talk to Kara, you know, did the so and so's show up and hearing Oh, yeah, and they seem so much better. And they came again for a second time, and just knowing that we're really making an impact in our community. And these aren't, the people that we treat are our neighbors and our colleagues. And you know, they can be anybody. And so, you know, just understand that we're really helping people and helping our community is really rewarding. And so I encourage anybody to kind of create that relationship with their outside provider, to get the feedback on how people do post er, because the our providers and nurses, they never get those stories. And so I think that that's been really powerful for me to bring back to our providers and our nurses who do remember that gentleman who came in on the E an ambulance, we did Narcan, and go blah, he's doing great. Now, it's two months later, and he's working, and he's got his kids and he's doing and he's healthy. That really helps, I think, remind them what they're doing, and then kind of reinforces the good that they're doing.

Dr. Eric Arzubi  21:39  

I think it's I think it's powerful, right? That's, after all, most of us, I would argue, pretty much everybody at some point went into health care because of those stories and that feedback. And so I think it's critical as curious. Tammera what. So here we are, we have St. James's success story and doing great work to treat folks with opioid use disorders out of the emergency room. What can we hope for in terms of the rest of the state and other emergency rooms? Kind of looking forward? How do things look? And what can we do to help others along? 

Tammera Nauts  22:11  

So that's kind of a long answer. So, you know, there's some things that are getting in the way, right, in healthcare in general, there's obstacles there, staff shortages, people are very tired after COVID are still rolling out a COVID. Oftentimes, you know, emergency departments aren't sure if there's a problem with opiates, in within their communities. And there's od map data to show that we have access to show by county what we're looking at for overdoses, accidental overdoses, fatalities, and Narcan administration. So there's a lot of obstacles. And so people are kind of resistant to having more work, right. But as Joslin was talking about the work is actually cut down and doing and doing this. And I think the other piece is that providers, they're a little apprehensive, a little scared about prescribing, you know, a blueprint, morphine product, it seems big and unknown. So we were over at St. Pete's, and we were training, we did many trainings, so we could get all shifts, all staff in the emergency department. And so between the seven o'clock at night, and then the next day, I think we started at 730. In the morning, the emergency department director came in and said, You're just not going to believe this. But the provider that participated at seven o'clock the night before actually did an induction that night on their shift, and was shocked at how easy it was. Wow. So that's like immediate, immediate, immediate results, testimony feedback. So they're, they're doing great. Another thing that stands in our way, not just healthcare providers, but in our culture is the extraordinary stigma that's associated with substance use disorders, how we think about these patients with this chronic illness. That's just like any other chronic illness in medicine that we manage, there's a mistaken belief that it's a choice or a failure, that use is happening. So one of the things that we train on deeply is language and stigma. And so all of the emergency departments that we've worked with have incorporated language and stigma training. So we were up north at one of the hospitals and we did their entire emergency department and probably most of their hospital staff and emergency department manager, toward the end of this training was like, oh, oh, I get it, how I talk to the EMS workers when they're bringing in a patient with a potential overdose. And how they talk to me is so problematic, right? He was able to identify those really derogatory terms that were being used. He says, We have to train every single EMS worker in the state. So it's awesome to see the realization come through that substance use disorders. It's not a choice there. I don't know any adolescent that goes to bed thinking, When I grow up, I want to be addicted to substances. That's not how it works. This is a lot of brain involvement, genetic involvement. This is a chronic illness that requires lifelong management. And when our workers start understanding that, you know, that whole perspective changes the compassion comes on. It's also important to acknowledge that this particular population profile is a high burnout can result in a lot of high burnout, right?

Dr. Eric Arzubi  25:29  

Meaning the clinicians and the workers that are caring for this population, is that what you're referring to?

Tammera Nauts  25:35  

Can really promote a high level of burnout in our healthcare workers. But with interventions like what we're talking about, and how Joslin has described, these are the sorts of things that make all of our jobs easier in health care, and actually produces rewards. So those outcomes Joslin, those stories that you're sharing with your staff, those are the things that really fuel the fire and prevent burnout.

Dr. Eric Arzubi  25:57  

Well, to your point, I think, I think one of the things that's underappreciated and in my experience, and having worked as part of a hospital system and in emergency rooms and doing this work, that's exactly right, I think people make an assumption that is going to serve at work and cause more problems. And the actual reverse is true. And so for example, right? I know, I've seen, I've met folks who work in the emergency room who feel helpless and hopeless, when somebody shows up with a substance use disorder or in withdrawal, like I don't know what to do, but now we're giving them a tool, we're giving them a tool to provide an intervention that actually makes a difference, and it's potentially life saving. And so, in theory, this could be rewarding, it could reduce work, because that patient won't need to come in the emergency room every three or four days. So you're actually solving problems. And at the same at the same time, right, that creating more sense of reward and fulfillment, hopefully, in the people that are that are serving our neighbors.

Tammera Nauts  26:54  

I think the other thing too, that cannot go without mentioned is the increase in fentanyl that we're seeing in all of our substances, obviously, opioids but methamphetamine and marijuana. So when someone comes into the emergency department, whereas before maybe this rapid induction was not available, now it is and that can really save a life right before if this was not available, a patient would go out potentially use again, potentially have a lethal level of fentanyl that they didn't know about within their substance that they're using and, and die. So this is really another ultimate prevention strategy that we can put on our list and have in our toolbox.

Dr. Eric Arzubi  27:35  

Absolutely. And I guess the other thing I would add too, is one of the things we talked about. And this is one of the things that's I think very tiresome to me. And I think many of us in sort of this, this field, especially when we think about advocacy and change and transit and transformational changes. I feel like we keep bringing the same headlines every year after year after year, I arrived in Montana 10 years ago, I'm still seeing the same headlines that suicides a problem, we don't have a mental health care system. So this is allowing us and almost empowering us to go from feeling oh my god, we're helpless and hopeless to actually, we might actually be changing some things and helping and changing things for the better. Because as you guys know, as well, if not better than I do that folks who complete suicide are often using some form of substance, it just makes it somehow it kind of affects the ability to think make good decisions, and then ultimately can increase up and can increase risk for suicide. Amber, what are you saying?

Amber Rogers  28:31  

I just wanted to remind everybody out there that might be listening, that the regulations have been loosened. So you no longer have to although we recommended and tamaraws group does an awesome job teaching people about medications for opioid use disorder, but there's no requirement to obtain a certain number of credits. And there's no need to do a notice of intent to prescribe. And so the barriers for that have been less than and we need more primary care providers to speak up, stand up and start making a difference in their community so we can spread these patients across a greater number of practices. 

Tammera Nauts  29:13  

Yeah, thanks, Amber for bringing that up. You know, it until the DEA has removed the requirement for the eight-hour waiver training education, we still do what's called a MOUD bootcamp. (Nice.) So it's a four hour for any provider who wants to begin utilizing medications for opioid use disorder to talk about dosing and inductions and how it works and why it works and cetera…

Dr. Eric Arzubi  29:36  

And I'm guessing it's available virtually? 

Tammera Nauts  29:39  

Yes, it’s virtual. It's free and there’s CME.

Dr. Eric Arzubi  29:42  

You were talking about sorry, I'm sorry, interrupt that we were talking about the elimination of the requirement of the eight-hour course.

Tammera Nauts  29:47  

Yeah, so right now any provider can prescribe buprenorphine product and so I'm trying to think of a tagline some kind of a you know, media promotion that says something like this has gone from the responsibility of Yes, those in specialty care to the responsibility of all of us.

Dr. Eric Arzubi  30:04

Absolutely. That’s absolutely true. So I wonder, is there anything else that we need to be sort of bring to the attention of the folks who are listening. Quick shoutout to St. Peter’s in Helena for what you shared, so I think that’s wonderful. Again, what I’m hearing is you need some key ingredients. You need a passionate champion who’s willing to put in the work on the ground. You need a community partner, right, for the quick referrals into the community from the emergency room. You need ongoing education, and really sharing those success stories sort of feeding them back to the emergency room because that gives people really the sense of things are getting better.

Tammera Nauts  30:43

You know, and I think, within the healthcare continuum, all of us are part of the healthcare continuum. Emergency departments, hospitals, clinics, substance use disorder treatment centers, mental health agencies, we are all part of that continuum. I think now this has turned work in the emergency department into very low-hanging fruit.

Dr. Eric Arzubi  31:04

What do you mean?

Tammera Nauts  31:05

Very easy to do. Incredibly easy to do. Very effective. You’re gonna see an immediate positive outcome, reduction in those emergency department visits by patients with opioid use disorders. You know, it’s just a very easy thing to do. And for anybody who is listening out there, MPCA is available to come to your site and do any sort of training that you need regarding MOUD or SUD. So, MOUD boot camp, language and stigma, you know, whatever might be beneficial. You don’t have to wait for the webinar. 

Dr. Eric Arzubi  31:39

Thanks. And how about folks at St. James? Anything else you wanted to bring to the table?

Joslin Hubbard  31:44

I guess, just to kind of say, you know, because we’re doing this, we’re not seeing people line up at the doors for this. (Good point.) Because I know that was a question our providers had and a worry, right. So we’re, you know, providing the service, but it’s not changing, if anything, it’s decreasing the number of patients we see, because they’re not coming on a continuous basis, so we’re not seeing an increase of patients, you know, seeking out this. It’s available for those in need, and it’s making our providers and our nurses’ jobs easier, which is helping with all that they have to go through. And then it’s also helping those patients.

Dr. Eric Arzubi  32:21

Thank you for saying that, because I’ve gotten it so much, as soon as you make a service available to folks with mental health, with mental illness or substance use disorders, I get, people say to me, oh build it, and they will come, and we won’t be able to serve all the people that all of a sudden are going to start seeking treatment. That’s nonsense. These are folks that are going to be showing up to healthcare anyway. Now we have another tool in our toolbox to actually be able to make a difference and help these folks. So I’m really glad you mentioned that and then, you know, the other piece is really just a reminder to folks who are maybe still on the fence around this is this is part of whole-person care. People with substance use disorders and with mental illness actually have worse physical health outcomes, so if you’re someone who’s focused exclusively on physical health, guess what. Treating these disorders will improve your overall outcomes as well, so really ignoring this is really at your own peril and at the peril of the patient you’re treating. And so I encourage everyone to really lean into this and the outcomes will get better, but we all need to jump on board. Now so thanks, everyone, for joining today. This has been Breaking Barriers in mental health and addiction care in rural America, and again, I’m Dr. Eric Arzubi, cofounder, CEO of Frontier Psychiatry, and look forward to speaking with you all again. Thanks. 

[Music]

Beth Brown  33:39

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