Opioid and Chronic Pain Response Program

Thank you so much for coming up to Estes Park on a day that’s not snowing, which is nice.
You guys were very fortunate. Although I think you probably would have come up anyway-
You guys are Colorado people. So I’m really excited to hear more about the program that you all are running because obviously there’s a tremendous need for the work that you all are doing. And what’s exciting to hear is how Boulder Community Hospital has adopted this program into the community. So I want to talk a little bit first and I’m going to look to you Amanda first to talk about the nature of the program.
I understand that the focus is to address the opioid crisis in our communities and also the growing issue of chronic pain because I know that they go hand in hand.
Can you share more about the program and specifically about the three primary initiatives of the program?

Yeah, absolutely. So you’re spot on. We were in existence to be a response to the opioid epidemic and the way we look at it being part of the medical system is addressing that from the inside out. And we’re really lucky and grateful that the hospital is so supportive and they are behind us and they have a lot of faith and trust in Shelby and I to build something that we’re really passionate about. And again, just very grateful to be doing.

We live in the BCH Center for Mind Body Medicine and like you mentioned, because of the huge overlap with opioid use disorder and chronic pain, we are working with a specialist there who is addressing pain from a neurological standpoint and trying to get the brain to rewire those neural pathways and give pain cues differently from the body. He’s also got some integrative therapies in-house there. Massage, acupuncture and reiki. And those are modalities that we encourage both for folks living with chronic pain, trying to put new tools in the toolbox. But of course 100% also for people in recovery because the healing touch research, the body of research that’s growing around acupuncture, reiki for supporting recovery is just… I mean the evidence doesn’t lie, right? So addressing those things from two different sides, connecting people with services within BCH but also within the community because we most certainly don’t put a container on it for keeping people just seeing BCH providers. We’re also very connected with the community in Boulder County, both treatment-wise and folks that do bodywork interventions. And it’s been really fabulous because we’ve been welcomed with open arms by nearly everybody we talk to and connect with. So we’re able to provide a menu of options for participants in the program that want to get connected with these things that they may one, not have ever tried before but maybe never even heard of before. So, to distill down how we do that is by providing service navigation and short term case management for folks to get connected either to recovery services, pain services, or both making it really low barrier and very client driven to find out, what are their goals and how do we help them get there?

So do you have to be a patient at Boulder Community Hospital in order to be eligible for the program?

Nope, not at all. Because we get about a third of our referrals from our community partners that have never seen a BCH provider.

And you all have only been open for less than a year, correct?

Six months.

And how are you all funded?

Through the City of Boulder Sugar-Sweetened Beverage Tax money and the BCH Foundation.

Pain crisis or was it that perpetuated the desire to take some of those funds and redirect them into this program?

So, the money that we get from City of Boulder is filtered through what’s called the Health Equity Fund. And they put out there, request for proposals in 2018 and I don’t know exactly how one of the… So the social worker in the Infectious Disease clinic, she’s the one that wrote the grant for the program this year. I don’t remember how she got wind of it, but her and our CMO got wind of this money that was available.
And one of the categories for the RFP was innovative programming. And as far as we know, nothing else like us exists in healthcare system anyway. So they decided that they wanted to apply for this money and in tandem with that make additional changes around how we address opioid prescribing and the opioid epidemic in the bigger picture, right? So in addition to us, we have primary care providers who can prescribe Suboxone in an office based setting and our emergency department also does Suboxone induction now. So we again feel really lucky that all this converged at the same time to be supports to one another. And again, to just offer those different services for people and seeing what fits and they can try on a number of different things.

I think that’s what’s great about what you’re talking about is that you’ve got first of all, a med-surg hospital that’s taking an approach to respond to this crisis that we’re having around opioid addiction and chronic pain issues and utilizing various modalities to do it. So it’s not just a traditional medical model, but the fact that there’s an interest in looking at almost alternative Western medicine or Eastern medicine approaches that oftentimes most facilities would kind of-
It’s really great to see the progressiveness of what they’re looking to do and the fact that you’re creating something that’s very individualized. That allows people to look at what fits best for them, which is terrific.
I’m thrilled to have you guys in the community and I know that there’s a huge need for it and I’m hoping that this will be a model that can be replicated in other communities. I’m assuming that you all are probably going to be looking at that from a data side as well to see if it’s something that can be, because I think it’s needed for sure.

Agreed. And yeah, absolutely. We are tracking every little piece of data that we can. Yeah, we don’t have outcomes just yet, just because we’ve only been at it for about six months. But yeah, by this time next year we’re hoping to have some pretty significant tales from what the different interventions have helped support.

And you’re an actual clinical or licensed clinical social worker. And I noticed online that you spent some time working with children with congenital heart defects and HIV. Can you share more why you wanted to get into the field of social work and what you hope to do with your work in addressing this particular issue, which is obviously very different than what you came from?

Yeah, I’d love to. So what got me into social work was I have been in therapy off and on since I was a teenager. And I had a phenomenal therapist throughout my teenage years. And I think that was the first little glimmer for me that, “Oh, I think I want to do something like this.” I knew I never wanted to prescribe, so I didn’t ever want to go to the psychiatry-psychology route. And I don’t want to go to medical school. And I didn’t want to have that kind of responsibility of… Just medication seemed like a whole other layer that I wasn’t interested in. I wanted to be more boots on the ground, kind of in the fray with people. And when I was an undergrad I was a sociology major, so some of my professors were social workers and they had a really big impact on what I was thinking for towards the future.
And then when I got out of undergrad, I read a book called And the Band Played On about the HIV epidemic and I got so mad and wanted to do something-

Because of your social justice side.

100%. And so that… And I had flirted with the idea of graduate school and a master’s in social work. And I was learning too through applying for different jobs and really looking towards what I wanted to do longterm. A master’s was going to be a requirement. It’s going to be the ticket to ride essentially. But yeah. Then when I read And the Band Played On, that sealed it for me and I was like, “well, and I’m going into HIV work after that.” There was no question. And again I just got really, really lucky and started working with the Boulder County AIDS project after I graduated from… I went to DEU for my masters and saw a lot of addiction and recovery and trauma. HIV seemed to be the crossroads just of a lot of different chaotic layers for people. And I was so drawn to the work and to the community and to the story of, I think you’re absolutely right, the social justice side of like, “well, why are we stigmatizing people?” It would be amazing to read through obituaries from young men that died in the late 80s and early 90s of natural causes, 29 years old that died of natural causes.
Okay. So that was like the stigma piece and just it really invigorated me to be a voice for that community as best I could be. So when I was in graduate school also I did my second year field placement with the Addiction Research and Treatment Services in there, recovery clinic specific to people living with HIV and helped seeing other infectious diseases. So I’ve always liked this… I love this population. And like I said, working in HIV, I saw quite a bit of drug use and substance use disorder. And then, yeah for one year I worked in pediatric congenital heart disease and realized very quickly that peds is not my population. I’m just not cut from the cloth to work in pediatrics. And I worked in a cardiac ICU and it was just too hard. It was just too sad.  It was too sad all the time. So once this opportunity presented itself, I jumped at it and was incredibly flattered and honored that they offered me this position and it’s not as clinical as I’m used to. I still get to flex the clinical muscle every so often, but it’s affecting change at a higher level because now I get to decide what the interventions look like and Shelby and I get to decide how to move forward with spending the grant money responsibly and what’s going to have the biggest impact for the most people to try and address things at the root.

So really looking at macro level change. And so with Shelby, both of you are tag teaming this initiative together, which was really impressive to be able to be a part of something from the ground up. And I know you had talked to me at lunch around your background a little bit. Can you share more about, what propelled you to say yes to this position? You’re the patient navigator, which I’m assuming you spend a lot of time doing more direct care services.
So what does that look like for you and the work that you’re doing and what was it that made you say, “yes, I want to take this position?”

So my bachelor’s degree is in social work, master’s in criminal justice. But right after my undergrad around 2014, I started working at a methadone clinic. I was very young and naive to a lot of things and I learned a lot about addiction, the layers that it has on the family, mental health, substance abuse, criminal justice. Growing up, my own family had substance abuse problems, diagnosis.
Shelby Souther: So that’s what really drove me to work at the methadone clinic. But from there I wanted to have a more rounder or professional view. So I went back to school for criminal justice. I interned at a Probate and Family Court, got to see how that side of the system affected or substance abuse affected that system just with like adoptions and things like that. I worked at a probation department and I got to experience… This was back in Massachusetts, their diversion programs, drug diversion. So how Mass was helping people with substance abuse. Because at first in the beginning when I went back to criminal justice, I was mad like Amanda. I was mad about what? How they were responding and turning people who had substance abuse, they weren’t recognizing it as a disease. It was criminogenic, which is totally not true. So that’s why I went back to criminal justice.  Moving here, it was actually just a family decision we moved. I saw this posting in April. And actually the posting, it was for a master’s in humanities or something like that, which I didn’t even qualify for. But I got an interview and I think honestly it was just like the well-rounded that I have of incoming for Mass, a state that was hit so hard by the opioid epidemic of heroin, fentanyl. I saw clients die weekly, wasn’t easy. So I think that’s what I can bring to this program and Amanda and I are striving. We have goals and hopes and we’re getting or we’re meeting them and we have great ideas that we’re putting into motion.

That’s fantastic. And so tell me a little bit about what you do as a patient navigator.

So, a patient navigator, it’s a lot of case management and just service navigation. So Amanda and I, weekly we go out, we meet new agencies and new practitioners in the realm of substance abuse and chronic pain. So say I get a referral. It just really, it’s an informal conversation I have with them. What are your goals? What’s going on? What are your goals for treatment? What are your barriers? Why haven’t you done this? What do you want to do in three months? In six months? And then just going from there. So if they don’t have an insurance, I’ll help them apply for Medicaid. If they don’t have transportation, we try to get them hooked up with bus passes and giving them options of treatments. Not just saying, “this is the one,” and done. Saying, “here are all the levels of care that you could potentially go to. Which one do you like? We’ll see if an insurance will cover that one. If not, we’ll go to the next level of care.” Just things like that.

It’s really kind of individualized. Their next step in their journey.

Right. Meeting them where they’re at, including harm reduction.

It’s just another example of why this particular model is so important because you’re not looking at this and saying, “we’re the solution” but that, “we’re just part of the process.” “We are part of the plan.” Which is so important when we’re working with people who are struggling with addiction or chronic pain to move away from this old philosophy of, “if you go to this program you’re going to be cured, everything’s going to be fine.”
Right. And you guys have created sort of this ecosystem where there has to be a lot of interplay between different agencies in the community to help people based on where they’re at. And I think that’s what I think is going to help solve the problem over time.
We would love to get to know a little bit about you both, kind of behind the program. So I’m going to turn to you Amanda first and just ask. So I’m a huge podcast person clearly and I listen to a lot of podcasts because I drive up and down the mountain into Estes and from Estes to Lafayette. So I’m always listening to different podcasts. I noticed because I did Facebook stalk you a little bit. So I did notice that you’re also a fan of James Altucher. For those who don’t know, he’s a quirky kind of podcast entrepreneur that is actually quite brilliant. And I know that you listen to podcasts so I’m just curious, who’s your favorite and what is your favorite podcast and why?

So I’ve got a couple, I don’t know if I could actually pinpoint a favorite. There’s one that I’m a huge fan of. It’s called Incident Report and it’s by a guy named Dr. Zubin Damania. ZDoggMD is his handle. And he’s a physician. He’s a former hospitalist. I think he did primary care for a little bit as well, but got so burnt on the medical system because I mean, we’ll be honest, a lot of parts of it are broken. So he got out of traditional medicine and is trying to form what’s called Health 3.0 and just facilitate a culture shift. He had his own clinic for a while. He’s trying to be really innovative in addressing the needs of our healthcare staff because our frontline staff, I mean nurses especially, the burnout rate is so high and what turned me on to him was a colleague of mine posted a video by him and he instead of… I mean he uses the word burnout for sure, but he also describes it as moral injury. And these things that we do in these hard jobs wound us at our core and it’s so hard to bounce back from those sometimes. And how do we avoid that or how do we teach people what to do with that?

Well, and how do you deal with resiliency around it? We are going to make sure that this gets in the show now so people can understand more about it, but Incident Report is what it’s called?

ZDoggMD. And when I just need to take a brain break, Armchair Expert with Dax Shepard. I love that one.

I haven’t heard of that one.

Well and he’ll tell you, I mean he talks about it all the time. He’s in recovery and he will talk all the time about before and after sobriety and how still even… Because he’s an actor and he’s married to a famous person but he still goes to a meeting I think maybe every day but… And he will totally own to that. Like I know it’s supposed to be anonymous but I’m an aiyen. But normalizing it is what I love and having the conversation around recovery and the reality of self medicating with substances and filling whatever hole might be in your soul with a drink or a pill or a needle.

And then Shelby, if I were to offer the word harmony, what do you think it needs to live a life in harmony?

To live a life in harmony, I would say just to find peace in that it can be defined differently with every person but… And just be connected with your mind, body and soul, whatever way that might be. If there’s a higher power or if there’s not, but just really being in the moment accepting who you are, appreciating it and hopefully being thankful and some kind of happiness. I’m not going to say happiness, its different for everyone. But just peace with where are you at in the world, your egos and not wanting more than you can have.

It’s interesting you said, “be comfortable with who you are.” I think that’s a really good point. I really like your definition. Thank you. And if folks who are hearing this today wanted to get in contact with you all, learn more about the Opioid & Chronic Pain Response Program, how can they get in touch with you?

A couple of different ways. The best way is probably to reach out. Shelby, you can give Shelby a call, her number is (303) 415-8659 you can go to the website and our contact info is there as well. Bch.org/opioid. People can also learn, we’re linked to the Mind Body word page too so they could learn more about Dr. Fanestil and the Center for Mind Body Medicine and all the wonderful offerings they have there. But I would say, yes, start with a phone call or checking out the website and tell us how we can help.

Wonderful. Amanda and Shelby, thank you so much for taking the time. Really appreciate it.