AC3 podcast Episode #4

Author: Vicki Ballas

Harm Reduction interview with Monica Erickson from the LMAS Health Department

August 31, 2021

AC3 logo of the Alger County Communities That Care United and Thriving

Vicki Balls: Welcome to the Alger County Communities That care podcast series. I am Vicki Ballas, Alger and Marquette County Community Nutrition Instructor from Michigan State University Extension. MSU Extension is partnering with Alger County Communities That Care or AC3 for short, to provide informative and real conversations from our community. AC3 is a coalition of community members working together to keep Alger County united and thriving by providing programs and resources that promote a safe, healthy, and prosperous environment for all youth and adults in Alger County. Welcome to our fourth episode. Today, we are talking with Monica Erickson who is a registered nurse for the harm reduction program at LMAS health department, That's Luce, Mackinac, Alger, and School Craft. Welcome, Monica.

Monica Erickson: Thank you for having me.

Vicki: You bet. Can you tell us about this harm reduction program? What it's all about?

Monica: Yes, so I'll start with kind of the history of why we have this program. And basically it is because hepatitis C was increasing in our districts of Luce, Mackinac, Alger and School Craft. And the health department wanted to do something to make sure that we didn't have an outbreak of any blood-borne diseases in this area. So the state of Michigan made a ranked list of hepatitis C vulnerability counties and Luce is number 2, Mackinac is number 4, and Alger is 28. So all of them are pretty high on the list of vulnerable Counties for an outbreak. And they're finding that many of those cases are people aged 18 to 35 who are involved in injection drug use. So to mitigate that risk, we started our Harm Reduction Program, which is a syringe exchange program. We've seen at great increases and all counties in the UP for hepatitis C especially. So we started this program to help curb those numbers and get people into treatment and do some of that testing. So I guess I should talk about what kind of services that we provide. It's a mobile unit, so it's a van and its me, the registered nurse and our peer recovery coach who goes with me to do direct outreach with people. So the peer recovery coaching services, our recovery support. We use motivational interviewing, which is tool that we use to help people get to where they want to be with their goals. So when we meet with people, we talk with them about where they want to be in regards to their lives, what they, what their goals are, that they want to use less substances if they want to be able to live a life where they have a consistent job and housing and things like that, and then we help them to get to that place. So our peer recovery coach does a lot of more like case management type things where we help get people jobs and we help get people the tools that they need to be successful. And she does a little bit of job coaching like what is and isn't appropriate to do on a job site and resumes and interviewing skills and things like that. So we do safety planning for maintaining and obtaining sobriety. We teach relapse prevention and coping mechanisms to people. The Narcan training and distribution and Narcan nasal spray that reverses overdoses, also known as the generic naloxone, do condom distribution and other safe sex education and supplies. We have resources for STDs like chlamydia, gonorrhea, et cetera, treatment and prevention. We do HIV and hepatitis C rapid testing from the van so we can find out if people are at risk for having those blood-borne diseases that we can help link them to care. We link people to social services as needed or other contexts that may be needed. And we reduced the spread of the blood pathogens like HIV and hepatitis C. We've been running for about over a year. We started the week that the shutdown started happening. in Michigan. Vicki: That's large gamut of things that you cover. The public really focuses on the needle exchange, but you listed so many more things that you do as part of that harm reduction program.

Vicki: I didn't realize there was that much that you that you covered. So that's pretty impressive.

Monica: The needle exchanges really like the smallest part.

Vicki: Ya, but yet gets so much attention. In the very beginning you mentioned who was second for hepatitis in the UP. First?

Monica: It's all of Michigan is ranked and the first is actually Baraga (not Gogebic) in the Upper Peninsula. So we have a lot of high-ranking county's even near us, which is risky in and of itself.

Vicki: Yeah, So that's a really large gamut of things that you do to help people. How do these folks say they want help and they hear about this. How did they participate in the program?

Monica: So if a person is interested in engaging with us, it's kinda risky to reach out to somebody and ask for help in this situation because people are afraid they don't want us to tell on them or tell other people about it. And that's the thing with kind of small towns. People know so many things about their neighbors and things that people are afraid to reach out, but it's not it's nothing like that. It's confidential. We, they're protected by HIPAA, so I couldn't talk about it if I wanted to. So nobody's names or anything like that. The people can remain anonymous for as long as they would want to. Some of the people that I start meeting with. I don't even know their names are where they live or anything like that. We meet at a library or we meet at a gas station. They want to go buy a pseudonym or something like that, and that's totally fine if they're comfortable with that. And then over time we build trust and rapport and I get to know more about them and better able to help them. But it takes a lot to reach out for help a lot of the times. So somebody would find out about our program. We have flyers around town. Word of mouth is a big one. So people find out about our program and they just reach out. And we will say, okay, we'll come see you in the van, wherever is convenient for you. They'll say If they want to meet at the house or at a gas station or library or anywhere that they're comfortable with. And we'll go and have just a conversation with people. We try not to do a ton of paperwork and things like that. So basically we'll just meet with them and say, what do you need, What are you working on? What do you want to see different? Well, it's very non-judgmental. We only ask what is appropriate and that time if they're really nervous and don't want to talk, then we don't talk a lot, it's just kind of whatever that they would need. It's very meet them where they're at, just help them at that moment with whatever they're going through. So then we would meet with them. You had to ask them what they need help with and then try to figure it out from there.

Vicki: Wow, that sounds great. to handle it that way. That's awesome! Would they contact the health department and say they want to participate?

Monica: They can contact the health department or they can do my direct number, which is on our flyers and they can call or text or whatever. They feel the most comfortable with.

Vicki: Wow! Nice, That's great. So is there ever any backlash from communities that judge or look negatively upon people who are users?

Monica: Well, I'd say that the stigma is pretty high towards people who are engaged in substance use, especially in this area. All of the communities that we serve are very different from Alger County to Mackinac County is a two hour drive, so you've got a lot of different views along that way, smaller towns, bigger towns, things like that. So that is something that we take into consideration. We haven't had any actual complaints about our program. We haven't had anybody be upset and call the health department or anything like that. I know that people can talk about it on the internet and be upset on Facebook comments especially with some of the other programs that do some interviews and things like that with the news. And I see some of those kind of hateful comments, but we haven't had that experience here.

Vicki: Oh, that's good. I know that there has been some negative backlash for other health departments and other areas about this. People thinking that they don't deserve this help or that we shouldn't be wasting money helping them. We're all people in this world trying to make it. It's just really frustrating for me to hear negativity about trying to help people. Can you talk about the people who are receiving this program? And I don't mean specifics you can talk about, but can you give us the human side of these folks? You know, what are they like?

Monica: So they're just normal people. They're your neighbors, they're people that you wouldn't expect are engaged in substance use, their people that are maintaining jobs a lot of the time, going to work, taking care of families, things like that, and we're just trying to get them to a more safer substance use, possibly abstinence along the way. We don't push for anybody to be abstinent. We try to get them into whatever method of use is safer. We try to get them to get to where they want to be with their goals, that people engage with us, want to get help and use in a more safe way. They want to receive our services, especially our peer recovery coaching. The people are very kind, happy to have us, happy to see us. They, a lot of times people along their path of substance use burn bridges with their family and natural supports in it. And I think it's very nice to have somebody in their corner that is an unbiased person that can support them and help them through it, so that they can build up those natural supports and get back with their families in a better way.

Vicki: They're not the people that you think of live in the gutter somewhere. And even if they were, we would want to help those folks too. These aren't like you said, these are neighbors. This is a good program, a good helpful program that people need.

Monica: The guiding light of harm reduction is that we help people where they're at so that they don't need to reach the rock bottom that everybody talks about. So what if there was a way that people could see that they're going down a path that they don't want to go down, engage with somebody to help motivate them out of it, to help them see what's happening, to help them get the tools that they need to be in a safer place so that they don't have to ruin their entire lives. Because it's a myth that they need to reach rock bottom before they can change. We can help them along the way. We don't have to have people ruin everything, going to prison, things like that, overdose and dying. We can help them along the way. And I think it's, it can be upsetting when people say that they don't want to help people that are using substances, or especially that they do want to help people, but not like this, not with harm reduction. So they want them to lose everything before they even out stretch a hand to help them.

Vicki: Ya, wow! Now that's a really good point. I think, I think this program is wonderful. I'm so glad we have it here in the UP. I think this is something that we should all be very grateful for.

Monica: Especially that we will eliminate that barrier that people don't have to drive to get to us or anything. We can come straight to them and we can meet them where they're at. And instead of having them have to come to a scary office situation or get rides to go places. We can come right to where you're at. Vicki: And fill out crazy amounts of paperwork and be really intimidated by all of that and like you said, scared that someone's going to come and arrest them. And this is really, this is true, real, help that you're offering here. I think it's great, I love it! Monica, how many people have you provided this program to over the last year? Monica: In our first year, we've had 41 total participants. So that's 41 people that we've met over at Luce, Mackinac, Alger and School Craft Counties. It was projected from Michigan Department of Health and Human Services staff that we would probably go about nine months without having anybody before we would finally engage with people in the community. Because it is kind of hard to find people that don't want their secret known. They don't want people to know that they're using. But we have a fantastic peer recovery coach who is so welcoming to people and able to be that person for a lot of people that she, those 41 participants, we wouldn't have had hardly any success without her and her expertise in the situation. So we have 41 people. Everybody always wants to know how many syringes we've given out and receive back. So we've given out 13,074 syringes in that year. And we've actually received back 14,053 because people are nervous to get rid of those, they don't want to throw them away. They don't want to leave them places, obviously because that's not safe. So when we started going to people's houses and things like that, as we build more trust people gave us all of the syringes they had in their homes that they were afraid to get rid of in like mason jars and detergent containers in large amounts. We were able to get back from before they were participating in the program. And you haven't had a single instance of syringe litter found anywhere.

Vicki: Wow, that's impressive.

Monica: Yes, The people to engage with us want to use more responsibly. They want to be safer. They want to get rid of the syringes they want to use less. They want to not use at all. And we help them get there. People can get in trouble if they have syringes with like drug residue because that gets them the paraphernalia charges. When we drive and I pick those, that medical waste up, then it reduces that barrier for them. People aren't afraid to have it because they just give it to us. Let me get rid of it. Sometimes people are concerned that since we give away syringes for free, people are more likely to use syringes that they weren't using before or they're more likely to use more drugs than they were originally using. And the evidence shows that that is not an issue. The research shows that people actually use much less once they start engaging with a program like ours. And there has never ban a documented case of somebody who has never used drugs going to a harm reduction program to get syringes and start using substances for the first time.

Vicki: Can you talk a little bit about about the reuse of syringes and why that's not a good idea?

Monica: Yes. So reusing syringes is not good for vein care, especially there can be pathogens and diseases left on syringes so you don't want to keep reusing them. You especially don't want to share syringes or anything involved in drug use. So any of the supplies that you would use, you would want to use clean supplies. So we make sure to educate people on that, we make sure to educate people to do things like washing your hands, washing the body part that you're trying to inject into because we don't want you to have any infections or abscesses because bacterial infections that can be caused by drug use like e\Endocarditis that can impact the lining of the heart and causes major problems, especially down the line. So when people start using safer or maintain their sobriety, then they start having all these problems down the road. And we want to make sure that when people are done with using drugs, that they can live a healthy life instead of having endocarditis that involves having your like heart valves replaced and things like that, major surgeries. We don't want people to have Hepatitis C. We want them to use sterile syringes. We don't want people to have HIV that they have to deal with for the rest of their lives. And of course, the cost savings that goes along with that, It costs $400 thousand to treat hepatitis C and it cost less than 10 cents for a clean syringe. So we really want to help people out and have them use more safely. And then I guess I should go into statistically people are five times more likely to enter treatment and subsequent recovery when they engage and a harm reduction program like ours. So people are very motivated to get better with their substance use when they engage with us, they have somebody that cares about them and cares about their health. Wanting to help.

Vicki: That's fantastic, you know, we can pay 10 cents per needle or we can pay millions later to treat these folks, you know, this is such a more cost effective, humane thing to do. Monica: And then it goes back to treating people before things get way out of hand. You don't want them to reach rock bottom. We want people to get better, and better their lives where they're at. And instead of having to go to prison and go in hospital settings because they've overdose, things like that. Very permanent damage to their lives. We want to just help them.

Vicki: That makes so much sense to do this program. Did this originate from our health departments? Is this a government program? How did the star?

Monica: Yes. So our health department received funding because the CDC deemed this area as high risk. So Chippewa County, next to us, has a program and they've had one for about four years now, and Marquette County Health Department has had one or maybe two years. And so we are one of the newest, all the counties in the UP are beginning programs like western UP Health Department has started one, Dickinson Iron has started one. So everybody's getting on board with this evidence-based programming.

Vicki: The UP is, there on top of this. We're not always left behind, were not always ignoring all of these issues. This is really an effective way to address these issues. So it's awesome, love it. Can we talk a little bit about overdose Awareness Day? I know that the AC3, the Alger County Communities That Care group, is partnering with the LMAS Health Department and other agencies for Overdose Awareness Day. On August 31st, we are having a Narcan drive at the Chatham Co-op from nine to one o'clock if you would like to come out during that time. And you will receive a goody bag that has NARCAN in it and many other information and other items. So come on out and possibly help someone. Save someone's life. Can you talk a little bit about Narcan and what it is and who it's used for and who can get Narcan and why would they want to have it?

Monica: Yes. So Narcan or Naloxone as its generic name is, is a medication that's given. It's an opioid antagonist if somebody were to ingest opiates. So things like Tylenol threes, Vicodin, any thing like that along the way with like Suboxone, heroin, fentanyl. Those are all opioid. So the narcan works on opioids and only opioids. So if somebody is taking those medications, it can cause respiratory distress or they can stop breathing or have reduced breathing. So when somebody is given, Narcan it bumps out the Opiate from the brain, the receptors in the brain it kicks them out temporarily and puts itself in that area. So the Narcan binds to those receptors so that the person can start breathing normally again, the Narcan that we give out is a nasal spray, so it's easy to administer. You don't have to do anything with needles or syringes. It's just a quick nasal spray that you would give to somebody. And if they are not using substances and it won't do anything, the side effects are that would be like a bloody nose or a local reaction, something like that. So it's not going to be a bad thing that you would just give it and see what happens if you, somebody is having problems breathing, everybody that is prescribed an opioid should have Narcan because it's not just people that are using substances not how they're prescribed that could use it, it's people, especially the elderly who would take a pain pill, take a nap, wake up, and be in pain and and take another one too closely together. And then that could be too much. They could accidentally overdose. And so if they have that Narcan with them, it gives you some time before 911 would get there, you would get to a hospital, especially in our huge district. Alger County is the size of Connecticut, so it takes time for emergency services to be able to get places, especially in inclement weather, which happens pretty often. It's important for people to have that as part of a first aid kit. It's very easy to use. The instructions are very simple and include pictures, things like that. So as part of a first aid kit for a home or for people that travel quite often that may see things on the road at gas stations, things like that. It could save a life and it's something important to have. There's a standing order for it in Michigan, so anybody can grab some Narcan. We have it for free at the Narcan drive that we're doing August 31st, that coincides with overdose Awareness Day and all of the counties in the UP are participating in overdose awareness day, whether it's on August 31st or they choose an alternative and most of them are doing it on that day.

Vicki: Our last Narcan drive that we had, a lot of people said, I don't need that, I don't know anybody who does opioids. And I just really want to bring attention to the fact that doctors prescribe opioids all the time. It's a problem in our country. A lot of people are taking them through prescriptions and it does happen often where senior citizens are taking it like you just you explained, or they forget that they took it and they take it again and again and again because of dementia and then they overdose. And so it's really important to have Narcan on hand to help save lives. Also, children can get into somebody's medications and overdose. And also the people that are taking opioids that are not prescribed to a doctor or abusing their people to their families, their children, their lives are as valuable as anyone's. So it's important to be prepared and maybe you can help save a life someday.

Monica: And like I said before you, you don't know? I wouldn't have known who was engaged with our program beforehand. I would have had no idea that they were engaging in substance use. So you don't know who your neighbors or your friends, or your family or your kids are engaging in some substance use,.

Vicki: right, Exactly. We really need to get rid of the stigma of drug use. And replace it with how can we help? We need to help Folks. You know, it's prevalent because the makers opioids are being sued because they just pushed it too hard on everybody. And people are dying and they're all getting sued for this. They should be, but it's still a drop in the bucket for them. They made so much money off of all of this. Monica: For ten people, there were 11.3 opiate prescription. So there are a lot of opiates in this area. And that means a lot of opiates for kids to get their hands-on, things like that. I don't know if we want to get into how storing your medication safely is a good idea because there are so many prescriptions and this area especially so be careful with that. Vicki: Yeah, it sounds like we should all have them Narcan sprays on us. That's alarming.

Monica: Lot of chances for things to get out of hand.

Vicki: What else do we want to talk about?

Monica: I forgot to include that we also do vaccinations for hepatitis A, hepatitis B, and TDAP. So like tetanus shots, we get people up to date with those.

Vicki: That's awesome! What a great program.

Monica: Syringe service programs reduce new HIV and viral hepatitis infections by decreasing the sharing of syringes and other injection tools, new HIV injection infections have dropped by 80% among people that inject drugs since the start of syringe service programs than a late 1980s. And that's in the United States and other countries. Syringe service programs have been around longer than that.

Vicki: Well, that's huge! So it's not really something new The syringe exchange?

Monica: Just getting on board.

Vicki: Yeah. It's, it's been around for a long time and has shown how effective it is.

Monica: It reduces needle stick injuries from among law enforcement as well. So they benefit from reduced risk of needle sticks. There's not, people aren't using syringes and then just leaving them, they're putting them in their sharps container after the first use and they're using a clean one so there's not dirty syringes around for police to accidentally touch or emergency service personnel to actually touch or step on or things like that. So it's just much safer.

Vicki: Which we know is this an issue, fantastic. Well, this program just sounds wonderful. I'm so glad that you were able to bring this to light to all of us in our community just to inform everybody or what this program is all about. So, you know, if they do hear about it, they don't just first jump to negative conclusions and judge it, this way they have all the information that this is a win-win for everybody really. So Monica, before we say goodbye, is there anything else that we haven't touched upon that you wanted to make sure we talked about today?

Monica: I would just like people to know that we're non-judgmental. If anybody wants to reach out for help or they're concerned about a family member, they are concerned about a friend or anything like that would be happy to talk with. What happens a lot is that we start meeting with people who have concerns for a friend, or a roommate, or a family member. And we talk with that person that has those concerns. And then a lot of times it does end up being that the person was afraid to say it was them because they were afraid that they would get in trouble and things like that. So that if you have anybody in your family or friends or roommates that you are concerned about or you know, somebody that is struggling, feel free to reach out to us and we can give you that information and help you understand what's going on so that you can share that information with the person that your loved one. And then we can maybe help engage with them down the line if they become comfortable with that. Vicki: That's great. Do you have a phone number for the Health Department that people can call?

Monica: I do. My cell phone number is 906-322-4444. And people can feel free to call or text that number, whatever they're more comfortable with. They don't have to give a name or anything like that. And then we will help them wherever they are at.

Vicki: So Monica, I just want to thank you for taking the time to talk with us today. It was really informative. I am really glad that this program is available for the Upper Peninsula.

Monica: Thank you for having me. I'm glad to share our information with anybody and hopefully we get more participants even through this podcast.

Vicki: Ya, spread the word everyone. Thank you for joining us for this episode of Alger County Communities That Care, promoting a safe, healthy, and prosperous environment for all youth and adults. We hope you tune into our next episode. For more information on AC3, visit us online at Alger Funding for this podcast comes from the US Department of Agriculture's Supplemental Nutrition Assistance Program or snap MSU, as an affirmative action equal opportunity employer committed to achieving excellence through a diverse workforce and inclusive culture that encourages all people to reach their full potential. Michigan State University Extension programs. And the materials are open to all without regard to race, color, national origin, gender, gender identity, religion, age, height, weight, disability, political beliefs, sexual orientation, marital status, family status, or veteran status issued in furtherance of MSU Extension work acts of May eighth and June 30th, 1914 in cooperation with the US Department of Agriculture. This information is for educational purposes only. Reference to commercial products or trade names does not imply endorsement by MSU Extension or biased against those not mentioned.

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