In this episode Maren discusses how she reduces harm caused by opioids. Maren talks about her role facilitating Extension’s pain management classes and peer support program. She shares a few of the pain management strategies that are covered in these Extension classes, some of the history of the opioid epidemic in rural places like Utah, what can be learned talking to people who have struggled with opioid abuse, and how doctors can approach this health crisis. Maren will also be a speaker at the next upcoming Blue Plate Research event. The HEART of the Opioid Epidemic: A cutting-edge program to address substance use disorder in Utah can be attended online 11:30 a.m-1:00 p.m. on August 19th at https://www.usu.edu/blue-plate/
Wyatt Archer: [00:00:00] What advice would you give to a person who's nervous about attending a pain management course for the first time
Maren Wright Voss: [00:00:12] The main advice is come knowing that there's hope because when you get into a pain management workshop, People come to us feeling like they've tried everything, their doctors have tried everything and they're still in pain and they come to this workshop without hope.
But you know, you can have hope because at the end of this workshop, just universally people report, their pain levels are going down.
I'm Dr. Marin Wright Voss. I am health and wellness faculty with Utah state university extension.
Wyatt Archer: [00:00:48] Pain management courses and peer support specialists are two tools that can reduce opiate caused harm here in Utah.
In this episode, Dr. Marin, right boss explains how these tools work and how she's making these tools accessible to people in rural areas around the state. By the end of this episode, you'll understand some of the factors that led us into this opioid epidemic, the harm it causes to people's lives and what it took for people to wake up to this societal problem.
I'm Wyatt Archer. And you might be thinking that there's nowhere to turn to for help, but you are listening to this instead, a podcast from Utah State University's Office of Research,
Maren Wright Voss: [00:01:38] Data science, and figuring out, um, what will make a difference is one of the most fascinating things a person can study. We get a lot of things wrong. We put policies in place, that create all of these harms. Just for example, when, patient advocates thought that we needed pain as the fifth vital sign, we just had no idea where that would lead us in this, um, opioid epidemic we're in now.
And so when you have the numbers and you can evaluate the data and we have these national data sets that give us information about people's lives and all these different factors, it's kind of like unlocking the secrets of humanity. It's kind of a fun place in space to be.
Wyatt Archer: [00:02:25] Does it ever feel like you're just looking down on a hospital and being like, what are they doing?
How can I change what they're doing to make things better?
Maren Wright Voss: [00:02:30] Yes, absolutely. Because, um, I'm not in the day-to-day of making those decisions and making the call on what to do. I'm on the outside. You know, pulling up the, the surveys and the data and trying to figure out, like, why did things go down the way they went down and, and which factors played the biggest role.
And then, um, making sure that people know that those factors were important so that they can make better decisions. System-wide next time.
Wyatt Archer: [00:03:00] Finally caused people to recognize the opioid problem, because I remember seeing billboards in like 2017 and then going like, oh wait, that's what I was affected by in my family growing up.
So what kind of push things to the edge where people realized there was a problem?
Maren Wright Voss: [00:03:13] Yeah, I'm not sure. The greatest story, but it used to be that the drug problem was not something real America had to face. It was in back alleys. And, um, it was a little bit hidden alcoholism, sometimes stayed hidden in the family, but with the opioid epidemic, it started to hit, um, more Americans, more pocketbooks and people started to realize that this was a problem that needed to be dealt with.
It's. Often came from a prescription bottle and all of Americans go to doctors and get prescriptions. And, um, when it started to hit middle-class America. Like, I don't think this is the best rationale, but that's when it started to get enough political pull that people started to pay attention, started to put policies in place and money that way in order to make a difference.
Wyatt Archer: [00:04:05] when people with money and a little bit of power started seeing the negative effects, that's when people started taking it
Maren Wright Voss: [00:04:11] seriously. Right. And it's not just seeing the negative effects. Um, I think it's when it hits home for them, when it's their aunt, their nephew, their, um, yeah. Their daughter. Yeah,
Wyatt Archer: [00:04:22] it gets, so it gets started with a prescription bottle.
Maren Wright Voss: [00:04:26] happened. Yeah. I'm not the expert on the history of the opioid epidemic. And I think that you can, um, make some arguments on either side as to what happened because we've had opioid epidemics in the past as well. So, um, early 20th century, there was an opioid crisis as well. And we kinda got through that as we read about today's opioid epidemic.
You see the references to this happened before opium was used. There were things they called Uber. Oh, opium, dens, opium, dens. Yeah, exactly. Um, and American, I would use it as a panacea. They'd give it to their infants. Um, and it was just a sort of catch all drug to take away the pains of the day. And you started to see.
The same kind of addiction issues back in those that earlier time that we're seeing today. And at the time you started to have some policymakers recognize the harms and that's when opioids became a classified drug that you could only get by prescription. And Coca-Cola, wasn't able to put drugs in there.
Drink anymore. And we made laws to protect people. Um, but then more recently, um, there was this outcry from the public that they wanted better pain management and, um, patient advocacy groups started talking about the right to pain medication and to pain relief. The American medical association came up with this idea of pain as the fifth vital sign that we needed to monitor patient's pain and make them comfortable.
And that just happened to align with pharmaceutical companies, also producing pain medications and marketing them in a way where they were able to address that need. But at the same time, there were some early articles published in the journal of American medical association that suggested. These pain medications weren't addictive and that they, um, did not have the kind of risks that we now know that they have.
And those two things going together made doctors perhaps a little too easy on prescribing, made the medications too available. And, um, that started to lead to some of the problems we see today. So
Wyatt Archer: [00:06:39] in addressing this opioid epidemic, like you're not a physician, you're not a pharmacologist. How are you addressing this issue?
But is your role in that right?
Maren Wright Voss: [00:06:48] Again, we bring evidence-based strategies out in community. That's the whole point of extension in the land grant university mission. One of the ways we found is that as we heard from people that they did not have alternative pain management strategies, clean rural areas in America, um, there's fewer resources for your clinics.
And so it's just much easier to write a prescription, send somebody home with medication, but there's a bunch of other strategies. The evidence shows work really, really well. So one of the things we do is we make sure that these, um, alternative pain management strategy programs are available out in our communities.
There are so many strategies that people can use to manage pain, and if they incorporate those, then they don't have to take the opioids as often. And that's really all that needs to happen in order to reduce the opioid epidemic because. You only start to have problems with the opioids when you get into high dosage rates and they're taken for a long period of time and the body builds up the tolerance and then the body also sort of changes how it's processing pain and the opioids over time become less effective.
And so then it gets to the point where people are taking so much, it can get into that overdose risk range.
Wyatt Archer: [00:07:59] How does the body change when it processes pain?
Maren Wright Voss: [00:08:02] Yeah. Process called neuromodulation of pain. The nervous system becomes overly sensitized. And so it's more reactive. It responds with a higher pain experience to simple.
Prompts, but in a person who has this hypersensitized nervous system than just the touch of someone's hand could cause them to have pain. And that's not because their tissues are any different it's because the brain is just reacting differently to its experience. When people are using opioids and when they have been experiencing chronic pain, it creates that stress, um, a chronic stress experience that makes them more like they feel more pain going forward.
And so if we can walk that back, we can teach them these other strategies to calm down the nervous system. Sometimes you can have a better impact on pain than just chronic opioid use.
Wyatt Archer: [00:08:54] So why are rural communities hit harder? Um, opiate abuse. So
Maren Wright Voss: [00:09:00] there's several things that, um, we've seen in our rural communities.
We've actually written some research about this. One of the things is that people in rural America often are doing jobs where they're more likely to get injured. Some of the farming jobs, uh, mining jobs. Um, and so you'll see higher rates. Long-term injuries. But along with that, that doesn't mean people quit working.
Their families still depend on them. So they're going to work with these long-term injuries. And so they are relying on medication to get them through the Workday. So that's one of the factors. And so you'll have higher rates of opioid prescription. Just because people have more of a need along with that though, they have fewer other alternatives that aren't going to be as many physical therapists or if they are it's, you know, um, 60 miles to the next town before you can get to one.
And how do you fit that in, at the end of your Workday? So the, some of the surfaces might. Sort of available, but they're not readily available and accessible. And so people have fewer other alternative options for managing their pain. Other than with the medication. One of the other things that they point out in terms of the opioid abuse problem is that social networks can networks, kinship networks are, um, integrated in a way that people are much more likely to share their medicine with a family member or a friend.
Um, And there isn't that guarded relationship of no, I shouldn't. And so, um, you see more of that sharing and that can sometimes lead to situations where some people might misuse the medication and then that it, the thing is when it starts to get used for something other than the specific pain purpose, then it doesn't end with a prescription bottle.
Um, soon people are not able to get doctors to give them. Then once a person can't get it from their aunt Sally anymore. Then the, eventually they may turn toward an illicit source and then we have another source for opioid problems out in rural America.
Wyatt Archer: [00:10:56] Why am I interviewing
Maren Wright Voss: [00:10:57] you here? I am extension faculty.
That means we're out in the counties. I am in salt lake county and Twitter. Um,
Wyatt Archer: [00:11:06] and what's the value of having. Extension faculty spread out throughout the state, instead of just up in Logan where you'd be really convenient for me to talk.
Maren Wright Voss: [00:11:16] Right. So I am part of a new. Group of faculty that extension hired called heart.
So that's health extension advocacy research and teaching heart has that general idea of health extension. So it can be anything about health, but when they started it, it was because Utah was having this opioid epidemic, this opioid crisis. And so they asked the new health faculty to put a little bit of a focus on trying to do opioid harm reduction.
And that's one of the things we've put our effort into. We've made communities. Partnerships and alliances that have helped us to work on that opioid problem. And so I've been able to get some grant funding to support my communities. I'm able to bring like information that is easy for people to understand why there's these harms around opioids, how to decrease the risks, how to be safer.
Um, so that's one of the areas we've been focusing.
Wyatt Archer: [00:12:14] If I were to follow you on an interesting day of research, um, what kind of stuff would I see you
Maren Wright Voss: [00:12:19] doing? The thing I'm passionate about is like writing grants, which is like not interesting to anybody else. No, I'm
Wyatt Archer: [00:12:25] interested. Why are you passionate about writing grants?
Maren Wright Voss: [00:12:29] Hi, I love writing grants. Writing grants is this fun, collaborative process where you see a need and you get to creatively, think about what will fix that. And you get to partner with, um, the first partner you'd find is the people who want to give you money. What is their vision? What are their goals? Why is it that they want, um, to provide money for, um, for programming.
And so you find one, that's a match first. And so it's exciting to sort of look at who's out there and who is passionate about, um, supporting this type of programming or cause. And so when you find a fun. That you want to ask for the money, then, um, you have to come to them with a really well-developed project, which requires a lot of other partnering.
And so you put together this team of professionals and community members and, um, and then together you formalize what are the ideas that are going to fix this problem and adjust this need. And you write that proposal up, along with the budget and all the other little details that are required. It's usually about two months of work, um, a lot of emails and, um, and making connections and talking to people, um, to bring something that just starts as an idea into a fully developed proposal.
Um, and then you submit it and you wait. And, um, so far with the support of all the USU. Extension administration. They have a whole like grants writing, team support so far their support. Um, we've been successful in every one of our applications because there is a need, there are great partners in Utah and, um, and there's a lot of work to do.
Wyatt Archer: [00:14:07] So you have two main programs you're working on to help with this problem. One of them is the peer support model and the other one is pain management courses. So let's start with the pain management courses. How are these courses more? So when I just, the title of that makes me think it's just going to be like a class with somebody telling you to calm down and to be mindful and just like.
And that just doesn't sound helpful. How are these classes more than that
Maren Wright Voss: [00:14:36] really good question. So with these classes, there's three things. People are getting. One is they're getting the information on a pain management strategy that they may or may not have tried before. Another thing they're getting is a chance to try it in some small way.
And so we have, when we talk to people about physical activity, there's this moving easy program that the Stanford, um, based program incorporates. Hm. It's really simple movements, turning your head, stretching your neck to one side than the other. Rolling your shoulders, you know, um, kind of pointing and flexing your feet it's movements that someone could do, even if they were in a wheelchair.
But it's really fascinating to see how after 10 minutes of doing these simple movements, everybody feels better. Their shoulders are more relaxed. They feel, um, You know, less of the kinks and the, um, aches and pains that you have when you're just sitting in a chair and it doesn't matter how healthy you are.
Everybody ends up feeling better. And even though it's so simple, we have patients, um, clients telling us that, um, that they're doing it with their granddaughter, that like, they just love it, that now they do it before they go to bed at night. Like, it just really makes people feel better. And so even though people know they need to stretch and exercise, um, practicing it.
Focused on relieving your pain gives it a slightly different spin and it helps people in a slightly different way. So they're getting to try things out. Um, but the other thing they're getting is connection with other people who are struggling in the same way they are. I actually think that might be one of the biggest benefits of these, um, pain management groups and other people are sharing ideas of what they've tried.
They were offering support. Um, but they're also just getting a sense of connection with people and like people understand them and what they're going through and social support when people have it, we know that reduces pain. It also like improves. Like it reduces depression. It reduces a lot of things, right.
And so the social support they get from these groups, I also think is helpful. And we hear a lot of people saying that they'll keep up with the group members after the workshops have ended as well as because that's so beneficial.
Wyatt Archer: [00:16:53] Yeah. Yeah. So if somebody's coming from a small town, like, I think I'd be really nervous to go to one of these courses for the first time.
So I guess if I was attending a class for the first time, Like what kind of building would it be in? Would it be in a church community center, like back at somebody's home, um, who is running it? Is it somebody from USU extension? Is it just a volunteer and then. Who else may I see in one of these courses?
Maren Wright Voss: [00:17:20] So lately we've been able to do some online workshops because of COVID and that's been amazing because a lot of times when people are in pain, it's hard to get out of their house. And so we've been able to bring the education right into their homes. But when we have the workshops in person. In any of a number of settings.
So we've had lots of success them in senior centers. Um, there's a lot of seniors who want to take advantage of the classes, but that's all, they have a nice community room and it's a nice space to bring the classes. So the whole, all the community members can come sometimes you'll see it. If a health clinic has, um, a meeting room space, they may offer it right there at the health clinic.
Um, extension often has meeting rooms out in our counties. And so, um, it might be an extension classroom as well. Um, but there's really no limit on where these classes could be held. The type of people you'll see there. Um, really. Span the whole spectrum because the people are having chronic pain issues, span the spectrum, all ages, races, genders.
And so you'll see the 20 somethings who, um, have had them. Careers disrupted from some, um, recent pain diagnosis. You'll see some of the seniors who may be struggling with mobility issues. So it really just depends. Um, but you'll be comfortable because there's a lot of different people who show up to these courses.
Cause a lot of people experienced. So in
Wyatt Archer: [00:18:44] these pain management courses, what are the strategies people are given and how did those.
Maren Wright Voss: [00:18:50] Yeah. So we have found that there's a bunch of things people can do to manage their pain other than medication. Um, but maybe, and important part of it. It's actually one of the strategies we go over is knowing all your medication options and how to vary them and how to work with your doctor to make sure your medication options are working well.
So that's one of the strategies. A bunch of others. So one of the ones that we hit on really hard is called action planning. And it's a part of every single session. And it's really a glorified version of goal setting. It focuses action planning. One of the things it does is it makes sure that the goal someone's setting is something they really want to do, because we know if you don't want to do it, you're not going to do it.
And then because we're making these action plans in a group, there's that little bit of accountability, because you're going to tell people about it at the end of the week. And. Following those little simple steps of goal setting. Um, people find that they just feel so empowered by achieving their goals and that it's transformative.
So, um, so action. Planning's a big one that we hit regularly, but there's also other, um, skills that people learn. One is mental distraction. I mentioned how you can visualize a lemon, um, and. And you know that your brain can create these powerful images and you can use that brain power. In other ways to distract yourself from the pain distraction can be as simple as watching a TV show, but it can also be, um, things like using relaxation strategies.
Um, a walk through a park or on a beach, some of those visualization strategies people use, so we can use mental distraction and we teach people some of those skills. Um, some others are like pacing and planning. So a lot of times with people with pain, we'll try to do too much at once or sometimes there'll be afraid of their pain and they'll do nothing at all.
And either one of those gets you into negative cycles. And so if people schedule and plan and pace, There, um, activities. We can help them to manage pain in that way. They talk about being, um, time-bound instead of pain bound in your decision-making about what to do, think about how much time and what your capabilities are.
And don't wait until the pain is too much to make that decision. We teach people better sleep strategies, because if people are sleeping better, that we know their pain levels go down, their stress levels go down, managing negative thinking is another strategy that we can go through. We try to tell people that depression and negative emotions are just another symptom.
Um, along with your pain, it's not separate from your pain, your pain is going to create some negative thinking. And so you want to interrupt that negative thinking. And if you can interrupt that you're going to interrupt the pain and the symptom cycle that leads to pain. There's some cognitive based strategies that we can use to teach people how to change their thinking too.
Reevaluate a situation. Communication is another strategy that we teach in our pain management. A lot of times, um, when people are in pain, they can be a little more irritable. And so their demands can come across in the wrong way. Um, people who are around a person in pain sometimes don't want to voice what they need.
And so it can lead to some communication. Right. Dysfunction in a family. And so better communication tends to help people get the support they need. And, um, not only are they feeling more love and joy in their relationships, but they're also actually getting their needs met in a better way. So that's a strategy we could run through some basic problem solving.
So some of you may have. Pro and con list when you're thinking through your options. Um, we do some simple strategies like that to make sure that as people are evaluating their options, they're able to, um, to make some, some good decisions about it.
Wyatt Archer: [00:22:37] Um, how do we know that these classes work?
Maren Wright Voss: [00:22:40] So luckily since they're based on Stanford's, um, model, they've done a lot of research around, um, what are the outcomes from these classes in general?
We know from Stanford's research that they people take fewer opioid prescription, like their, um, use of the opioids goes down after attending the classes that their pain levels go down. Um, and that their quality of life improves.
Wyatt Archer: [00:23:05] So what are you researching or what are you doing to support these classes?
Are you, um, just trying to get people on board or are you coordinating them? What's your role?
Maren Wright Voss: [00:23:16] So my main role in pain education is addressing a community need. So people told us they need more pain management options. And then I found that through the state of Utah, they have a grant funded program where they were bringing these Stanford based, um, education programs, um, to the community, but not out into our rural areas of Utah.
Um, they just didn't have the staffing for that. So I was able to get the teacher, um, training for it so that I could be one of the people facilitating it out into accounting. And then other than that, it's just letting people know that it's now there, it's now an option and helping them to sign up and get access to the program.
Wyatt Archer: [00:24:00] Are you working to like modify the program to make it more doable in rural settings with less training or?
Maren Wright Voss: [00:24:06] Oh yeah. As I mentioned in order to bring the Stanford based program out to our community, it required having a facilitator who could go spend a week taking the training who can then offer it on an ongoing basis.
Two facilitators, you need funding for the manuals. And there's a lot of pieces, parts that go into, um, offering the evidence-based Stanford program. And we wanted to offer pain, education, pain management, um, information in a way that had. A lower bar was easier to just bring right out to your church, to your local community center.
And so here at USU, we were able to modify based on the same, evidence-based the same principles of payments. And create a curriculum that we call peace, it's pain, education, and community empathy. I mentioned earlier that one of the things I think benefits people the most in these programs is the connection they get with other people who are struggling with pain.
And so we create. Really simple scripts for a facilitator to be able to read that talk about a pain management strategy, give people a chance to practice it. And then we just spend the next 30 to 40 minutes letting people talk to each other about their pain experiences, what's going on. Um, what options are available in their community, the resources they can share.
And so it's a little bit more like a support group with just a little bit of a pain education prompt at the beginning. And so that makes it really easy for just any community member, any person who wants to be an advocate for, um, pain management to facilitate one of those classes, follow a script, bring people together and have this shared experience where we can find ways to manage our pain together.
And so we're bringing that out into the communities and just piloting right now. Right.
Wyatt Archer: [00:26:01] How do opiates affect people's lives here
Maren Wright Voss: [00:26:04] in the us? So one of the research projects we did was called opioid narratives. And we were just all about listening to people's stories of the opioid epidemic in Utah. And one lady had told me that at first she took the pills for pain, but then she said, of course, I started to realize they gave me energy.
They may be not care about what was going on in my marriage at the time. And I just used them as my go-to for emotional problems, as well as my physical pain. So you can hear in her saying that she used it as her go-to that the substance was. They started to become more important than the people in her life.
And I just found that so fascinating. You saw this fading away of the person's actual relationships until the substance itself was kind of the primary relationship that person had with the world. We had this one, man, tell us I went to my hotel room and I said, Shut myself up with the perfect amount. And it took me to a world of, I don't care.
And I just think like, what's that like to be in this place where you're in so much pain, so much distress that you would rather be in a world of? I don't care of nothingness and. Okay.
And that actually knowing that that's where people have been is sort of the story of our peer support specialists. That's been their story and they've come through that to the other side. In fact, we have this one, um, peer support specialist that works with you. Saara that? She said my messages now my message.
And I think that's part of why peer support specialist. Are so powerful when they work with people in recovery is because they're able to share their lived experience. And they're able to come with a message of hope because they've been there and they've come to the other side. And then they're also able to do that without judgment, because they totally understand what takes you to that place.
But they also know that you can get out of it. So this
Wyatt Archer: [00:28:05] kind of leads into. The other project you have, um, which is the peer support network. How does that relate to you? Saara
Maren Wright Voss: [00:28:15] sorry. I was one of those first collaborators when I was first doing my job as health and wellness faculty. I'm trying to understand the opiod epidemic.
So I started to hear a lot about you. Saara Utah support advocates for recovery awareness in Utah. And. All of the good work they were doing. One of the programs I heard about first is that they would show up at an emergency room after a person had been in overdose and they could talk to the person. And talk them through that experience and connect with their families in a way that the clinical social worker on staff couldn't.
And so they were doing this really important work, um, in Utah. And one of the things that I started to understand was that that peer to peer interaction is really important in the healing process. UCR has been one of our collaborators on a number of our grants. Um, we're running a grant right now to build the peer workforce in Utah and they have a member that serves on our advisory board just because we think of them as the experts in peer support and advocacy.
Wyatt Archer: [00:29:21] You're saying peer workforce. And I think oftentimes stuff like this, somebody is like volunteering to be like in AA sponsor or like run a group or something. How is this different than that?
Maren Wright Voss: [00:29:34] It's a really good question because, um, peers are an old idea made new again. So like you said, um, AA has always had this idea of having a sponsor.
Um, and it's because of the success of a. That the medical field started to recognize, I think the value of peers. And so recognizing that they started to sort of formalize bringing peers, which are sometimes called paraprofessionals into the, um, uh, formal treatment teams. Um, and one of the things they found with peers as they started to have them in the workforce is that they found that people were port better quality of life in their treatment.
They have. Better sustained treatment. That means they stay in treatment longer, which means they're having better outcomes. They stick around and treatment. When there's a peer, that's there to talk to them. They also found that they have fewer hospitalizations. And so the overall cost of treatment goes down.
So peers are just a really valuable part of the treatment. And as they started to realize these great benefits of having peers on your formal treatment, uh, medical staff, then, um, Medicaid started to reimburse peers for the important work that they're doing, which is even better. So now, um, a person can get the support they need from a certified peer support specialist.
And, um, And the medical team can bill for some of those service hours so that it is a compensated form of, of treatment. And the workforce can be sustainable, which is
Wyatt Archer: [00:31:08] important. Is Medicaid the only insurer paying peers currently.
Maren Wright Voss: [00:31:13] So typically when Medicaid covers, um, then a lot of times the other insurance companies will cover it in a similar fashion.
Wyatt Archer: [00:31:19] Um, cool. Are there theories or reasons why people respond better to peers than they would a professional?
Maren Wright Voss: [00:31:29] Some of the reports we get from patients is that, um, peers are like less judgmental and they, um, are more comfortable sharing more of their story being a little bit more real. So Justin at the Utah Nebo health systems gave this example and he says that he can hire a peer.
And that person might just be out at say a gas station and they'll notice someone who's off having a smoke and they can just walk up and have to start a conversation. And as they're just checking in with somebody just in a normal interaction pattern, if there's a need, if that person has been using substances, if there's a behavioral health need, they're able to just say, Hey, I know this guy, um, in a place where you can get some help for that.
Why don't I go with you? And we'll, um, I'll show you how to get that help. And just because they're on the same level, it's not like you have to show up at a clinical office, um, telling the person that you need help. They're just talking to someone at a gas station, they're able to see the need and they're able to connect people to those services.
And so peers just have that ability to be where people are. And that seems to be part of why it's so effective.
Wyatt Archer: [00:32:38] And to see who needs help, see, who
Maren Wright Voss: [00:32:40] needs help. Yeah. They see you they've been there and
Wyatt Archer: [00:32:44] have the guts to take you to the doctor.
Maren Wright Voss: [00:32:46] Yeah. But it just starts with a, Hey, how you doing? Right. Can just be that easy.
Wyatt Archer: [00:32:52] Yeah. And so what's your role in this peer support program?
Maren Wright Voss: [00:32:56] So I heard about that. Value of peers. I also heard it's hard for people who want to become certified peers to get the trainings. Sometimes they have jobs that won't give them time off. Um, and there may be other reasons that make it just hard to drop everything for a week and go show up at a training.
And so we were able to. Develop a hybrid version of the training that allows people to do half of it online. Yeah. And then to show up at a two day training, that's easier to fit into a weekend or, um, a couple evenings, um, over the course of a week. And so, um, we were able to write a grant, um, to provide some extra funding, to get this training.
Two potential peers in Utah, the whole idea being to build the workforce, our rural areas really are understaffed in their, um, medical and behavioral health teams. And so if we can get a few more trained peers out into the workforce, then we're meeting the needs of people out in rural Utah.
Wyatt Archer: [00:33:54] So we know how.
The P how people benefit from the peers. How do the peers benefit from the people
Maren Wright Voss: [00:34:02] in the work? Right. She going to do some research on this? I'm super excited. Um, we're partnering with the state department of substance abuse and mental health to create a survey, um, to ask questions of all the people who've been certified as peers in the state of over the past decade.
Um, and one of the things we want to find out is how has being a peer impacted their own recovery and their own life, but some of the. Total information. And some of the things we sort of see in the literature seems to be that peers themselves have more sustained recovery working in the field, helping others supports their own recovery.
And it's easier for them to stay on track in their personal goals and development as well. And quality of life is better and really feel like they're making a difference and they are. Why do
Wyatt Archer: [00:34:46] you care about this problem?
Maren Wright Voss: [00:34:50] I care about the problem. Cause I care about people. Um, when we listened to the stories of Utah's opioid epidemic and, and talk to people.
Like the way that they fell into their roles, the addiction was just so frightening. I mean that there wasn't any intent. They weren't doing anything outside the norms of society. They were just being people living their lives. And they ended up having their lives dramatically altered by opioids and by its addictive potential.
And so, um, It's nice to work in a space of trying to help people, um, of trying to make sure people know about the risks and trying to prevent those kinds of harms from happening in the future.
Wyatt Archer: [00:35:39] Is there something about having a prescription. So having permission from a doctor to take that drug that makes people feel safer.
Maren Wright Voss: [00:35:47] Oh my gosh. Yes. So that's one of the things we heard so much was that people thought it was safe because it came from a prescription bottle and it's almost like this huge sense of betrayal. Once you realize that, um, the harms outweigh the benefits, um, Because it came from a doctor's office, it came from a, um, prescribed license, um, approved path.
Um, so yeah, absolutely. That's one of the things that I think is so frightening about it. I think it's also one of the reasons why America woke up to the problems of the opioid epidemic when they hadn't, when it was injected heroin on them.
Wyatt Archer: [00:36:28] Um, how have prescribers changed in the past few years to respond to it?
Maren Wright Voss: [00:36:34] So we've seen prescribers change in a way that's, um, not always hugely positive. So, um, I talked to one prescriber who, after the overdose of one of her clients, um, Totally transformed her practice and went in a really positive direction of making sure that her patients had pain education with opioid monitoring.
So, um, making sure that when they were getting prescriptions, that we were watching the amounts and that they were getting information on all the alternative ways to manage pain at the same time. So it can go in that direction. And, um, we've seen a lot of doctors aware of the risks and so they're reducing.
Prescriptions, they give fewer pills or lower doses to their clients, but we also have occasionally seen that when a doctor starts to get uncomfortable with, um, patients asking for the medication that they completely cut the patient off. And, um, You'll see this in the graphs. If you look at it that as our prescription opioid rates have gone down, our use of heroin street, drugs have gone up.
And so there's a lot of clients in that situation who are turning to the streets for their heroin. And, um, that's not necessarily where we want them to be either. Obviously. A better approach, em, and one that's being recommended and that we're trying to get happening out in our community clinics. Yeah. Is for doctors to give patients medication for opioid use disorder.
So there's this whole class of medications. Buprenorphine is probably the most common famous one where patients don't get as much of a high, um, but they manage their symptoms. So they don't go into withdrawal at the same time.
Wyatt Archer: [00:38:25] Addiction sentence, maybe other pains.
Maren Wright Voss: [00:38:28] Yes. Um, I don't, it's still manages their pain symptoms at some level.
Um, but at this point when the patients are on really high doses, a lot of times pain, wasn't the main problem at play. Anyway, doctors say that when you give patients this medication for opioid use disorder, um, you can. Help keep them safe so that they don't have overdose risks. It addresses the, um, the pain and the other issues that they're having, that they're coming to the doctor for.
Um, and then we don't have to just cut patients off and leave them feeling desperate. We need to get more doctors willing to not just cut a patient off and send them off to the pain clinic management center. Um, but treating them in their community clinics with MOU. Medication for opioid use disorder. Um, because a lot of times when you cut a patient off, they're not going to go somewhere else and they will instead turn to the illicit sources for the medication.
And so if we can treat them in our community clinics, hopefully we can prevent that problem. As we shift from prescription opioids to unfortunately, more of those street drugs that we're seeing.
Wyatt Archer: [00:39:39] If you had a magic wand to change, people's understanding about one thing. What would that be? I
Maren Wright Voss: [00:39:46] think something that could really help if I had a magic wand is for people to feel like when a person takes medication for their opioid use disorder, that they're just like any other patient taking medication for an illness.
There's so many people who feel like. You have to be what they would call drug-free. And yet we're fine with people taking cholesterol, medicine, and insulin for medical conditions. And one of the things we're finding is that when people have been addicted to opioids, their brains and their bodies react differently, and that they've changed in a way that you can't fix that with the.
10 day or 20 day or 30 day withdrawal. It just doesn't change that fast. And they really need ongoing medication to get to a place where they have a high quality of life and that could take years. And so medication during that period, um, helps people continue to work and to love and to live their lives.
And there shouldn't be any shame in taking the medication that produces those outcomes.
Wyatt Archer: [00:40:57] Thank you for listening to this episode of instead, if you'd like to hear more from Dr. Marin, right boss RSVP for her blue plate research presentation, it will be taking place virtually on August 19th. You can find more information at blueplateresearch.usu.edu. This episode was produced and edited by me, Wyatt Archer, with the help of Thomas Sorensen as part of our work in the Office of Research at Utah State University.