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Opioid Use Disorder: Understanding Clinician Stigma to Encourage Behavior Change - Shared screen with speaker view
NaRCAD Technical Assistance
07:13
Welcome, all!
NaRCAD Technical Assistance
07:20
We're happy you're here today for this important discussion.
Vishal Kinkhabwala
13:44
Lansing, MI
Mary Beth Warren
13:49
Kansas
Allyson Schulz
13:51
Connecticut
Chris Trujillo
13:53
Albuquerque, NM
Amanda Benedetti
13:54
Cleveland, OH
Edward Rubin
13:54
tuning in from Las Cruces, NM
Alisen Guyet
13:56
Virginia Beach, Virginia
barbara Keleher
13:59
Philadelphia, PA
Nerissa Caballes
14:02
Chicago, IL
Lauren Linder
14:06
Columbia, South Carolina
Amy Wiebe
14:07
Saskatchewan, Canada
Kelly Kretzer
14:09
Orland Park, IL
April Vince
14:13
Local health department-Cuyahoga County , Ohio Cleveland area
NaRCAD Technical Assistance
14:17
Welcome from so many diverse landscapes!
NaRCAD Technical Assistance
14:51
We're so looking forward to hearing your thoughts about how stigma has impacted or created challenges in your work.
NaRCAD Technical Assistance
15:04
Thank you, Nadejda!
kylie lanman
15:49
Northeast OR
Nicole Sealfon
16:04
Baltimore, MD
NaRCAD Technical Assistance
17:14
Great to see so many familiar folks, and welcome to those who are new.
Kylie Smith
20:10
Kansas
NaRCAD Technical Assistance
21:33
Comes from Greek, used from a process used where those who were oppressed were tattooed or branded with a mark to identify those as 'lesser'.
NaRCAD Technical Assistance
22:01
"Morally polluted persons."
NaRCAD Technical Assistance
22:21
-Stigma is something that 'detracts' from a person or group in a way that does not support or build a person up.
NaRCAD Technical Assistance
22:48
That 'marking' is social in our current culture.
NaRCAD Technical Assistance
23:01
-Who has it? We all have a little bit of stigma.
NaRCAD Technical Assistance
23:30
We characterize individuals--we place this on others, and its a characteristic of those who place the stigma vs. it being a true characteristic of the person to whom the stigma is applied.
NaRCAD Technical Assistance
23:58
Origins: What we learned growing up, esp. from parents; can also be what we ourselves had experienced.
NaRCAD Technical Assistance
24:43
In healthcare, especially with clinicians, it comes from experiences where providers apply an experience that has occurred with one patient, or some patients, as a generalization across an entire group of patients.
NaRCAD Technical Assistance
25:25
Stigmatizing also places the person labeling others at a higher stance/elevates the person doing the stigmatizing.
NaRCAD Technical Assistance
25:44
Self-stigma occurs as well, sometimes within recovery groups.
NaRCAD Technical Assistance
26:11
Looking at stigma in relationships:
NaRCAD Technical Assistance
26:34
-Patients are often fired from a practice, which doesn't happen with other diseases.
NaRCAD Technical Assistance
27:16
-Providers can stigmatize detailers; they may assume that there is an ulterior motive, which creates resistance, especially if they lump detailers in with pharma reps.
NaRCAD Technical Assistance
27:56
-Detailers may have stigma towards providers in thinking that certain providers/clinics don't practice well, or have a 'bad reputation'.
NaRCAD Technical Assistance
28:23
The words we use make a big difference.
NaRCAD Technical Assistance
29:00
-"Addicts" - this may be used by both patients and providers. Preconceived images come to mind.
NaRCAD Technical Assistance
29:23
Person-centered language is key. Examples: - A person with a substance use disorder. A person who uses drugs.
NaRCAD Technical Assistance
29:49
This helps people understand that those with OUD are real people, with real stories.
NaRCAD Technical Assistance
30:05
(Good point, Laura!)
NaRCAD Technical Assistance
30:17
Yes, not using words like "clean" or "dirty" are also key.
NaRCAD Technical Assistance
30:39
We'll share some resources for person-centered language vs. stigmatizing language.
NaRCAD Technical Assistance
31:42
Important to also look at tone within other contexts like program materials, 'contracts' with patients, etc.
NaRCAD Technical Assistance
32:03
Framing that indicates an expectation of problematic behavior is not helpful.
NaRCAD Technical Assistance
33:53
Addiction is not a moral failing.
NaRCAD Technical Assistance
34:09
Don's own stigma shifted over time.
NaRCAD Technical Assistance
34:34
Indicators/factors can include genetics, trauma, etc., not 'moral choices'.
NaRCAD Technical Assistance
35:17
Don shares a story: His brother has had alcohol use disorder. A comparison: both Don and his brother both had beers early in their teenage years.
NaRCAD Technical Assistance
35:39
Don and his brother's reactions were different.
NaRCAD Technical Assistance
35:47
Same choice; different outcomes.
NaRCAD Technical Assistance
36:26
Focus on treatment and making life better vs. a moral failing. It's a chronic medical condition.
NaRCAD Technical Assistance
36:36
Disease changes/alters the brain of the person with OUD/SUD.
NaRCAD Technical Assistance
37:00
Empathy is key.
NaRCAD Technical Assistance
37:33
Nadejda shares evidence re: OUD as disease.
NaRCAD Technical Assistance
37:51
Decision-making deficits match those with damage to prefrontal cortex.
NaRCAD Technical Assistance
38:15
Have also been MRI studies that show that the damage makes it difficult to make decisions that we deem as 'wise'.
Laura Heesacker
38:47
Nadejda and I worked with a group of healthcare staff the other day and when we asked them to identify the largest contributor to burn out a significant number of them mentioned "dealing with the daily lies"
Edward Rubin
38:56
These brain changes are similar to trauma effects
NaRCAD Technical Assistance
39:41
Thank you, Edward. That's helpful to reflect on, especially for those folks who have both endured trauma and substance use disorder.
NaRCAD Technical Assistance
40:17
Thanks for that snapshot, Laura--helps to illustrate Don's words about experiences coloring stigma.
NaRCAD Technical Assistance
40:43
Critical to have team member alignment:
NaRCAD Technical Assistance
40:56
Developing programs, prescribing medications in primary care settings, etc.
NaRCAD Technical Assistance
41:13
If philosophical alignment goes unexamined, this can be a major barrier at long-term, effective change.
NaRCAD Technical Assistance
41:51
Don's work in Alaska with native people re: online education buprenorphine sessions.
NaRCAD Technical Assistance
42:12
At a recent session, it was clear to see divergent viewpoints amongst clinicians.
NaRCAD Technical Assistance
42:24
Talking those out resulted in more team alignment.
NaRCAD Technical Assistance
43:16
Also different viewpoints with relation to behavioral health providers' views.
Laura Heesacker
43:31
We still have many primary care practices/providers who do not feel it is within the scope of Primary Care to treat OUD/SUD
NaRCAD Technical Assistance
43:41
These variances in approach and attitude can have a ripple effect across other key components of healthcare access, including scheduling, etc.
Laura Heesacker
44:40
For those of you who have not discovered it yet, there is a fantastic podcast called "Last Day" it is one of the best on this topic, check it out
NaRCAD Technical Assistance
44:42
Laura, that's a great thing to bring up, and during the Q+A session, I'd love to tee that to Don and Nadejda with regards to how detailers may be able to deconstruct that stance.
NaRCAD Technical Assistance
46:09
Positive experiences can also encourage clinicians and practices to be more open to changing their approach.
NaRCAD Technical Assistance
48:59
Harm reduction approaches are also key, and focus on establishing individualized relationships.
Nadejda Razi-Robertson
49:05
Ok! Thanks, Bevin!
Edward Rubin
49:20
Do you co-prescribe Narcan with Rx for Suboxone?
April Vince
50:19
This has been a wonderful presentation. Thank you presenters!
Randall Knoebel
51:14
what are the methods you've employed to help reduce the implicit bias that in some cases is hardwired in from a very early on in their training?
NaRCAD Technical Assistance
51:18
Please go ahead and type your questions into the Q+A box.
Laura Heesacker
53:28
One thing that has been helpful is if a practice has access to Behavioral Health Staff that they send those BH staff through the X-waiver/Data Waiver Training, this helps them become more confident in supporting their medical provider partners
NaRCAD Technical Assistance
54:41
Great suggestion, Laura! This aligns with what Don just shared beautifully.
Alejandro Enriquez Zamalloa
56:45
story of self, story of us, story of now
NaRCAD Technical Assistance
56:58
YES, Alejandro!
NaRCAD Technical Assistance
57:13
That's a great process to apply.
Laura Heesacker
57:59
Nadejda and I like to use this acronym VEMA-which stands for Validate, Educate, Motivate and Activate, We strive to always Validate before we try to Educate, you can always tell you have not validated enough if you are hearing any defensiveness, or "Yes buts...
Edward Rubin
59:12
VEMA is similar to Stages of Change model...
Laura Heesacker
59:25
Due to the fast paced nature of medicine it is so natural for care providers to immediately jump to Educating followed by Activation...and not takin the time to explore the "Validation and Motivation" concepts
NaRCAD Technical Assistance
01:02:37
To all attendees: What kind of situation do you feel most unprepared to face in a detailer:clinician discussion around OUD?
NaRCAD Technical Assistance
01:02:54
Please type your thoughts here!
Mary Beth Warren
01:05:53
Detached
Alisen Guyet
01:06:02
angry
Kylie Smith
01:06:16
Close Minded
Allyson Schulz
01:06:16
Betrayed
Edward Rubin
01:06:25
recovering themselves, depending on how they did it.
Laura Heesacker
01:06:25
overwhelmed
barbara Keleher
01:06:32
"I don't want to deal with those patients"
NaRCAD Technical Assistance
01:07:35
Thank you, everyone!
NaRCAD Technical Assistance
01:07:48
Solutions:
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01:08:00
1. Make your ask small. "Can you try this with 1 patient"?
NaRCAD Technical Assistance
01:08:18
2. Ask them what they're experiencing with their own patients.
Laura Heesacker
01:08:28
What about encouraging PCPs to use Bupe for a patient on Rx opioids who has developed a complex dependency?
NaRCAD Technical Assistance
01:08:46
3. If they're presenting with feelings like anger and frustration, asking them to share their feelings more and get to the 'nugget' of their challenge.
NaRCAD Technical Assistance
01:09:27
Yes, roll with the resistance! :)
NaRCAD Technical Assistance
01:10:03
"The Gripe and the Treasure Hunt" tool:
NaRCAD Technical Assistance
01:10:10
1 person is complaining and venting.
Laura Heesacker
01:10:16
The Gripe and the Treasure Hunt is really great!
NaRCAD Technical Assistance
01:10:19
Listener's job is to try and find the piece that matters.
NaRCAD Technical Assistance
01:10:36
This is needs assessment, step two on the Structure of a Visit list.
Laura Heesacker
01:10:44
Listeners are "Hunting for the Treasures" (Values)
Laura Heesacker
01:12:18
Right...sitting in the resistance chair..
NaRCAD Technical Assistance
01:19:21
Tips from Don and Nadejda:
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01:19:24
-Recognize your own stigma
NaRCAD Technical Assistance
01:19:42
-Ask yourself: "Would I be happy or upset if a safe injection sites opened up in my neighborhood?"
NaRCAD Technical Assistance
01:20:03
-Be both friendly and informative.
NaRCAD Technical Assistance
01:20:11
-Have evidence/a study ready to go.
NaRCAD Technical Assistance
01:20:41
-The most important thing about the first visit is to be invited back for a 2nd visit!
NaRCAD Technical Assistance
01:20:45
Nadejda shares:
NaRCAD Technical Assistance
01:20:56
-"People need to know that you care before they care what you know."
NaRCAD Technical Assistance
01:21:15
-Due to the multidimensionality of this topic, including stigma, the above quote is key. Establish the relationship!
NaRCAD Technical Assistance
01:21:24
-Find the treasure in the gripe!
Anna Morgan
01:21:47
Evaluation link:https://www.surveymonkey.com/r/JuneWebinarEvaluation_2020WebinarSeries
Anna Morgan
01:22:00
Opioid Safety Toolkit:https://www.narcad.org/opioid-safety-toolkit.html
Anna Morgan
01:22:12
2020WebinarSeries: https://www.narcad.org/webinar-series.html
Laura Heesacker
01:22:50
Thanks everyone! This was fun!
NaRCAD Technical Assistance
01:22:54
Thank you everyone for attending!
NaRCAD Technical Assistance
01:22:58
Thank you to Don and Nadejda!
Nadejda Razi-Robertson
01:23:05
Thank you all so much for your participation!
NaRCAD Technical Assistance
01:23:28
Thanks for all of your insights, Laura!