Dr. Jody Ryan, chief medical officer at WellPower
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We recently sat down with Dr. Jody Ryan, chief medical officer at WellPower, to discuss trends in substance use. Dr. Ryan is a board-certified and American Board of Addiction Medicine (ABAM)-certified psychiatrist with a specialty in addiction medicine.
Question #1: What are some of the trends you’re seeing around different types of drugs in Colorado, in particular opioids/fentanyl and psychedelics?
One of the trends we’re seeing right now is that opioid use is increasing among people of color – the gap between white people and people of color in terms of opioid use is shrinking. This means that we need to continue to evolve how we outreach and offer treatment to people who are affected by opioid use and addiction.
Fentanyl continues to be a significant focus, and it’s really saturating all types of drugs these days and spawning new variations. Assume that anything you buy on the street has fentanyl in it, unless you can prove it doesn’t by using a test (but even if a street drug does not contain fentanyl, that doesn’t mean it’s safe).
There is a lot of attention on psychedelics right now, as well. There has been some intriguing data on the possible treatment applications of these drugs; however, much research still needs to be done on the safety and efficacy. This is especially important in figuring out who might be able to benefit and who might stand a higher chance of being harmed. What can be helpful in one context can be very harmful in another. Meanwhile, there is increasing interest in expanding access to psychedelic drugs for the general public, with various levels of safety protections. In Colorado, for example, psychedelic mushrooms are on this year’s ballot.
Providers find ourselves needing to be realistic and take a harm reduction approach. This means preparing to have more conversations with people we serve around the expanding availability of psychedelics in a way that’s pragmatic and productive: first, making sure they know the risks, and then if we get the sense that they’re going to make a different decision, walking them through questions like what’s the setting, who’s going to be with you, what happens if you have a bad trip or a medical emergency – things that can minimize harm.
The conversations around psychedelics are similar to those we’ve been having around cannabis for a while now. Some people use cannabis as a way of relaxing or managing anxiety; however, if you’re experiencing psychosis, cannabis can make things worse so you need to be extremely careful, particularly if you have a family history of psychosis. People have different reactions to different substances, so what seems fine for one person doesn’t mean that it’s a good option for everyone.
This is why a lot of conversations among healthcare providers right now are about how to talk to the people we serve about cannabis use. It can be difficult these days because marijuana is legal in Colorado, so it’s a legal drug that can end up being quite harmful in many cases.
Speaking of legal drugs that can cause harm, another thing that’s sometimes overlooked is alcohol. If you look at the one drug that causes the highest morbidity and mortality at the highest cost, it’s alcohol. It’s still important to pay attention to it, even though opioids are making more headlines right now.
On the provider side, we’ve been updating our practices around treating alcohol use as well. We’ve implemented additional steps to assess the actual level of alcohol use before doing things like prescribing benzodiazepines because of how the two interact.
Question #2: How is WellPower Responding to These Trends?
We’re doing a number of things, both in terms of our approach to treatment and how we engage with communities.
Earlier I mentioned harm reduction – this well-established public health approach is a big focus for us at WellPower. It’s about minimizing the negative effects of health-related behaviors, in particular around addiction and substance use.
This means a few things: we’re making fentanyl test strips available so people can test their drugs to see if there’s fentanyl in them. Studies show people make different decisions about substance use when they know whether fentanyl is present. The whole point of this is to keep people alive so we can build trust, have conversations about what they want and what they want to do, and offer additional resources, all with the ultimate goal of helping them discontinue their use.
We’re offering naloxone (brand name Narcan), which reverses opioid overdoses and saves lives. It’s becoming more common for people of all walks of life to carry it – from law enforcement to first responders to anyone in the general public – so they can step in and save the life of someone who is overdosing. In Colorado, you can purchase naloxone without a prescription at many pharmacies, so I encourage everyone to consider having some on-hand.
In terms of community engagement, we’re looking at how we can evolve our treatment model that supports our ability to truly meet people where they are. Our current model is geared toward catching people at the end point where they’re already experiencing addiction, which presents barriers to people coming in and getting engaged in treatment. So, we’re looking at how we can do things differently where we don’t pathologize but instead connect with people where they are; help them change the people, places and things in their lives that perpetuate their substance use; and offer therapy and medication assisted treatment to support them from the medical side – all in a way that empowers them to direct their own recovery.
We also need to provide better access, better engagement, better awareness of disparities that exist because of the structure of how treatment is traditionally offered. This goes back to how the populations who are using opioids are changing. We have to adapt as well.
Along those lines, we are doing a lot more with peer support and utilizing the expertise and leadership of people with lived experience. This allows us to adopt a much more patient-centered perspective. A person in treatment is often going to value the guidance of someone who’s been through a similar set of challenges much more than they would value mine.
We’re starting an addiction work group to see how to make resources more accessible on the front end, and creating an advisory council comprising people with lived experience to help improve the quality of treatment.
Finally, we’re updating our organizational provider license to be able to treat people with a primary diagnosis of substance use disorder. Right now, our license requires people who come to us for help to have a mental illness diagnosis first, and then we can treat their addiction if it’s related to mental illness. This limits our ability to provide the kind of support many people need.
At the heart of all this is that we’ve got to bring it all together and have a cohesive approach that’s person centered and community focused. We’re making a lot of progress. There is so much more to come at WellPower in the near future.
Be sure to watch for next month’s Report to the Community, where we’ll talk again with Dr. Ryan and get some specific tips for dealing with addiction during the holidays.