Giving Voice to the Voiceless

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding Addiction Affliction, brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the state of Wisconsin's Dose of reality, real talks that reminds you that opioids are powerful drugs and that one pill can kill. I'm Mike McGowan.

Mike: How many times have you heard people say about our government? Yeah, but what are you gonna do about it? Well, while some of us wonder how anything in our government ever gets done, some people actually work with the government and get things done. Libby Jones, my guest today, is one of those people. Libby is the program director at the Overdose Prevention Initiative.

Mike: She has a Bachelor of Science degree with an emphasis on government from William and Mary and a Master's of Science degree with an emphasis on human rights from the London School of Economics. Her job is to build governmental support for programs that help people with substance use disorder issues, who have little or no voice.

Mike: God bless you, Libby. Thanks for being with us. How are you?

Libby: Oh, I'm great. Thanks for having me, this is gonna be fun.

Mike: Oh, I am looking forward to this so much. Well, first I would start out with the general, tell us about the Overdose Prevention Initiative.

Libby: Yeah, so the Overdose Prevention Initiative, we are a DC based group that focuses on advancing federal policies, kind of in three main areas.

Libby: One is expanding access to treatment for Americans with substance use disorder. The second is reducing the overall death toll from overdose in America. And the third is really to break stigma around substance use from a policy standpoint. We are non-partisan. Every day our team works with congressional offices on both sides of the aisle.

Libby: We are walking back and forth from the house side to the Senate side pretty much every day. And we work with federal agencies that on both the public health side of the shop and also law enforcement. 'Cause really we have to have both of them at the table for a lot of these discussions. But ultimately what our goal is, is to find real policy solutions that will save lives at the end of the day.

Mike: Well, you also focused a lot on I was reading your stuff on people who are incarcerated.

Libby: Yes.

Mike: And I told this, I talked to people about this all the time. People who are in jail are eventually gonna get out, right?

Mike: And if they don't address their substance use disorder issues, they're going back in. Right?

Libby: Right.

Mike: So what does effective treatment look like in those settings?

Libby: Your point about folks getting out is exactly why it's so important. Incarceration is one of those key intervention points, right?

Libby: We need to make sure as, as a collective, as a society, that we have no wrong door to treatment, right? People are gonna need treatment. Some will need treatment, you know, come to ask for treatment in an emergency room, in an ambulance, but a lot are going to have that clarity that they need treatment during incarceration.

Libby: So we do have an obligation to meet people where they are and in that moment. But also, our work is about overdose prevention. We are trying to reduce the burden of death in this country from overdose, and we have a lot of data that shows that people who are immediately released from incarceration are some of the most vulnerable folks in our society to die from overdose.

Libby: There's one study that we cite frequently that says folks with an untreated substance use disorder are 129 times more likely to die in the first two weeks after release. So it's not just a good to have, it's a must have if we are going to address that the overdose deaths in this country. And we are working really closely with members of Congress to kind of educate them on this point.

Libby: So one of the things that we did you know, you talk about giving a voice to the voiceless.

Libby: People who are incarcerated cannot effectively lobby their members of Congress. So we had to bring members of Congress to the jail. So last year we organized a field trip. We took members of the Congressional Addiction Treatment and Recovery Caucus.

Libby: There were about seven members of Congress and the White House drugs are, we took them on a field trip to the Fairfax County Detention Center in Virginia. And we kind of arranged it with Sheriff Kincaid and Fairfax County so that these members of Congress could go and spend about 90 minutes in the cell block talking to people in their jail population who are for the first time receiving treatment behind bars.

Libby: And it's those types of experiences which are so helpful to getting policy makers to understand the power and the impact that treatment during incarceration can have, and it's treatment during incarceration has a direct impact on saving lives. And we also believe that treatment during incarceration will lead to safer communities and healthier communities on the outside.

Libby: 'Cause your point is well taken. Recidivism will continue if we don't stop that cycle of addiction.

Mike: I'm sure you've heard it. What do you say to those people that say, well, forced treatment, forced education just doesn't work.

Libby: I mean, we're not talking about forced treatment. What we're talking about is people who are incarcerated. Sometimes this is the first healthcare encounter they're going to have. This is gonna be a chance to be screened for these substance use disorders, and we need to have it available during incarceration if people want it. I don't disagree. There's evidence that shows that forced treatment doesn't work. However, it's a key intervention point. And if someone who's recently been arrested or who is being incarcerated, if they need and they want treatment, it needs to be available. So that's kind of my take on it.

Mike: Well, and you never know you right? You never know when somebody's going to get the aha moment. Or when I worked in the jail, sometimes you would see people curled up so the other inmates couldn't see them reading the big book or, or one day at a time, and it's like something's clicking there right?

Libby: Right, right. We've gone to tour multiple jails, and when you speak to people who are incarcerated, who for the first time have been offered treatment during incarceration, it can be very transformational, you know, and it changes the trajectory of people's lives.

Libby: I agree. I don't think that forced treatment is viable for most folks. Right. It just doesn't stick. We have evidence that shows that forced treatment is not effective. But what we do know is that that intake point, you know, at the time of arrest during incarceration, is a very critical point for a lot of people who need treatment, and it's a tragedy when they, you know, need that treatment and it's not available.

Mike: You know, in 2022, you helped, your organization helped Congress pass the Mainstream Addiction Treatment Act. For those unfamiliar with it, talk about that a minute.

Libby: Oh the MAD Act is what we call it, but this bill will always be very close to my heart. The United States has a history of making it harder than it needs to be to get treated right? (laughs)

Mike: (laughs) Yup.

Libby: You, you know this, right? And before the passage of the MAD Act in 2022. Only about, and this is an HHS figure, only about 7 to 10% of US physicians had the ability to treat a person with opioid use disorder. And that's because, again, we make it more difficult than it has to be. There were outdated federal regulations that made it unnecessarily difficult for doctors to prescribe medications to treat opioid use disorder.

Libby: So before the MAD Act, these federal regulations required doctors to seek additional medical training often at their own expense. File additional paperwork with the DEA to get special registrations and, you know, welcoming additional oversight over their prescribing records.

Libby: I know a lot of doctors. I'm sure you do too, and I don't know any doctors who willingly want to have more paperwork and more oversight. Right. And so as a consequence of, you know, essentially well-meaning federal regulations, we then have, we've tied our own hands, right? 7 to 10% of physicians could prescribe just as the overdose death rate was soaring.

Libby: And so what we needed was all hands on deck. We couldn't tie our own hands anymore. So our group worked with a number, hundreds of other organizations across the country to get this bill passed. And I think one of the things that was so overwhelming for me was to see public health groups, faith-based groups, law enforcement groups all coming together to fight for this piece of legislation, which ultimately what it did was it removed those barriers for medical providers to provide this medication. Because the unintended consequence is not just we needed a higher number of prescribers.

Libby: I think what's clear, particularly now that those federal barriers have been removed, is how much stigma t hat was created by these federal regulations. Right? There's this idea that, well, if it's highly regulated by the feds and we have to go through all these hoops, then there's something inherently wrong about this medication.

Libby: There's something that is dangerous about this medication or treating these types of patients. The bill passed at the end of 2022, but it's going to take years, if not decades, to combat that stigma that's associated with this. And that's a lot of the work that our team does, is we recognize that there are policies that creates stigma, that create unnecessary barriers, and that's what we've gotta go after.

Mike: Well, so that begs the question then. How do you go, and this is a big one I know. How do you go about educating those who can enact change? Because what you're working daily with people where this is not their number one area of expertise, it's down the list of ways.

Libby: Yep. No, I mean, you're exactly right. You know, in my opinion. Stigma kills.

Mike: Mm-hmm.

Libby: The impact is of stigma alone against people who use drugs. There's a stigma against help seeking. And we need to really work on that on a societal level. What we try to do is really humanize addiction.

Libby: When we're working with members of Congress this is one of the issues that, one of the increasingly rare issues where there's true bipartisanship. And the reason why is because there are 535 members of Congress. Every single one of them has people who have died of overdose, who are struggling with a substance use disorder.

Libby: And so it doesn't matter if you represent a rural community or an urban community. This is in your district. And I think that helps us when we're working with these offices because every member of Congress wants to find solutions to this problem. And we really have to humanize this issue. There was a survey that came out, I believe, as in 2023 that said that one in 10 Americans have a loved one who has died of an overdose.

Libby: That's overwhelming. For me, what I have found the most effective tool in combating stigma is stories. Getting your story out there. There's no better way of humanizing this issue. And I think it takes a tremendous amount of courage, but I'm always overwhelmed by the family members or the people who are in recovery who go to their member of Congress and tell them their story. That is really key.

Libby: In terms of kind of the tactics that we use. We are sending all these great stories and case studies up to Capitol Hill. But you know, one of the things that we did, which I think has been helpful is my team organizes a Naloxone training for members of Congress and their staff every year.

Libby: Every September to commemorate National Recovery Month, we will bring in usually their med students who do a Naloxone training. And I have witnessed this, I've watched this with my own eyes and you know, you put the Narcan dose in someone's hand, you show them how easy it is to do, and you talk about how it's effective, you know, 75 to a hundred percent of the time.

Libby: And it's empowering and once you hold it in your hand and you realize how easy it is, that is a great way of combating that stigma that people have about harm reduction, about, you know, people who use drugs. So there are certain things, you know, certain tricks that we up our sleeve, I guess you could say, in telling these stories.

Mike: Well, let alone if they ever have the opportunity, as I'm sure you have and I have, of watching someone who's overdosing be administered...

Libby: And just see them come back.

Mike: It seems like a trick, you know.

Libby: I mean, it's called the Lazarus drug, right?

Mike: Yeah.

Libby: It's amazing. And I think that things like Naloxone trainings are also empowering, right?

Mike: Mm-hmm.

Libby: You're like, I can do something, right? I am armed with this little device that I can keep with me. One member's office contacted us after one of the Naloxone trainings that we did, and they reported that one of their staffers had revived someone.

Mike: Awesome.

Libby: It was a bystander here in DC And that they had saved somebody's life with the Naloxone training that we had provided. I mean, and that just gives you goosebumps, right? That you do this to be educational and you know, just to hear that almost immediately it was put into practice is pretty, pretty cool.

Mike: Well, you mentioned that the members of Congress represent all facets of society from urban to rural, to suburban to whatever.

Mike: And you know, to ask the hard ones, in the last seven months we've seen slashing of funding for programs. We've had people on here whose programs have been cut.

Libby: Yeah.

Mike: What do you think about that? And talk about some of your wins at the same time? I guess.

Libby: I mean, it's devastating. You know, you're talking to folks whose programs are getting cut.

Libby: We have had in the last 12 months a lot of progress. You know, in terms of drug overdose deaths. For the first time in many years, we are seeing progress. For me, it seems counterintuitive to take your foot off the gas as soon as you start seeing results. You know, I understand that there's a lot of pressure on cutting budgets and reducing the deficit, but it seems like why would you cut these programs that are actually working? Right? If you're looking to cut programs that are inefficient or ineffective, don't cut the programs that are literally saving lives. It just, it doesn't seem to make a whole lot of sense.

Libby: I am personally concerned that the cuts that we're putting into place now will take years to correct.

Mike: Yeah.

Libby: My team has heard me say this before, but when the overdose crisis really took off, right when it really was reaching crisis levels. As a nation, we looked to the addiction medicine community to kind of build the plane as they were flying. Right?

Libby: In 2018, Congress passed the Support Act that gave a lot of local community grant programs right. To enable communities to literally build the plane as they're flying. They were trying to figure out what's gonna work. Five years from that, we're seeing that these programs are working right.

Libby: And now those same people that we put in the place of having to build the plane as they were flying it are now being asked to jump out of that plane without a parachute. Right? (laughs) And, you know, how are we going to make that up? I don't know. But all I do know is that we need to keep the momentum going.

Libby: And these programs that we're talking about are worth the investment. You know, we talk about return on investment. Every life saved from treatment or harm reduction, every life saved, that's a person who can go into recovery. And a person in recovery you know, those folks are employable. They pay taxes, they take care of their families.

Libby: I can't think of other programs that have a more direct impact on building safer, healthier communities. There are 23 million Americans that are in recovery. Each of those people have loved ones. They're taking care of their families and their jobs.

Libby: We can't pull the rug out now.

Mike: And you also addressed the disparity that comes with socioeconomics and there's a lot of disparity when it comes to socioeconomic status in our country.

Libby: Oh, absolutely. That's something that we are very, very sensitive to. You know, we believe that it shouldn't matter your race, where you live, what your income is, or what your insurance level is, everyone should have access to these resources. We know there are huge disparities amongst, for example native American, Alaska native populations. They have the highest per capita overdose death rate. We need to be focusing on that.

Libby: Black Americans have a much higher overdose death rate than white Americans, but also, whether or not you're covered by insurance. That is something if the Congressional budget office is predicting something like 16 million Americans will lose Medicaid coverage.

Mike: Mm-hmm.

Libby: That's going to be devastating for particularly this field that you and I are working in. Medicaid is the largest provider of funder of treatment services in this country.

Mike: Well, and talk about rural people. I mean kids, what is it, 40% of the kids in this country are on Medicaid.

Libby: Yes.

Mike: So we're talking about you take that away. Where are they gonna get access to treatment?

Libby: A lot of these folks are working.

Mike: Yes.

Libby: We're not talking about, you know, folks who are unemployed. We're talking about millions of Americans who are working and who are receiving Medicaid.

Mike: 75%.

Libby: Yeah.

Mike: Yeah.

Libby: Exactly. And so that will be devastating. And I don't know how we make up for that. Going back to your earlier point about federal funding there are a number of these grants programs, for example, that are administered by SAMSA. A lot of those grant programs make up the gaps for supporting services that aren't covered by Medicaid.

Libby: So here we are, we're gonna take Medicaid away, and then we're gonna put extra strain on these grants that are also being cut or eliminated. And you can kind of see you're in the tunnel and you see the freight train coming. And we are gonna have to see how we deal with the approaching train.

Mike: Well, so let's go back then to if you had in a room every legislator or local representative. What do you wish they understood?

Libby: I mean, I wish they understood the gravity of Medicaid cuts. I will say that personally. Personally, I think that, you know, we know Medicaid is the largest funder of Medicaid supported, or of treatment services.

Libby: And the cuts to Medicaid will be disastrous. I want them to understand that for people who are in pain and they're not physical pain or mental pain, it's not illogical to seek relief from that pain. And if you can't go to a doctor or an emergency room and get treatment and help, it's not illogical to go to the streets.

Libby: And that's what unfortunately is what's going to happen. It's not a moral failing. It is, you know, part of the human condition.

Libby: And I've been very impressed with a number of members of Congress who have stepped forward and talked about their own family's struggles and kind of made this a very personal issue. And just appealing to the humanity of everyone. Everyone has stories, everyone has loved ones who've been impacted in some way by this epidemic.

Libby: And kind of appealing to that sense of humanity.

Mike: Every time there's an economic downturn or something, we see the usage levels go up. I mean, recent history, just look at, I know it's a different issue, but when COVID hit, alcohol usage went through the roof and it's still is high in many, in many communities right?

Libby: Absolutely. Yep. Absolutely.

Mike: And so we can predict, I think right, as you have less access to treatment and resources and an economic downturn that you might end up seeing a rise in some of the substance use.

Libby: It's not speculations, this isn't Libby Jones telling you like what I see in my crystal ball.

Libby: We know, we've seen this before.

Mike: Yes, we have.

Libby: To your point about COVID. Exactly. We saw this in the early two thousands. As pain medication prescribing went up and then the federal government, the state governments put the hammer down on prescribing.

Mike: Yep.

Libby: Then what happened? It forced people to street drugs, and people were forced to do that because treatment wasn't available.

Libby: There are so many examples in recent history where this has happened. This isn't speculation. We know what's going to happen. And this is not the time again to, to take your foot off the gas.

Mike: No. It's a straight line from Vicodin to fentanyl.

Libby: Exactly. Yeah.

Mike: So what gives you hope? Because clearly you can't do this day to day without thinking We got a shot.

Libby: Yes, let me just say this. I feel like I'm extremely lucky that every day I get to go to work and I get to fight for something that I'm really passionate about.

Libby: Right. At the end of the day am a girl from West Virginia who has kind of made it my life's mission to give back to my community, and I realize that that is a privileged position to be in. What gives me hope is meeting people in recovery. What gives me hope is going to the jail and talking to people who are incarcerated about, you know, now that they have access to treatment, that they're hopeful for their futures.

Libby: The more time you spend talking to people in recovery, talking to folks who've overcome their substance use disorder. There's no way that you can't be hopeful. And that you wanna go out and keep fighting. Last week I was, I told my team this, we were, we had a series of hill meetings one day last week, and we were going from the house to the Senate, to the house, to the Senate, and it is hot, and it is humid.

Libby: It is just almost unlivable in DC right now. And when I got home from being, you know, all these hill meetings, both of my feet were literally bleeding, right. Just, it was, it was a, a rough day right. To be walking back and forth. But you know what, I would do that every day if, you know, because we were, we were there with people who we were accompanying a, a police chief from Ohio and his team that were talking about the work that they're doing with people who experience non-fatal overdoses.

Libby: And, you know, the amount of I, there was no shortage of amazing stories that this crew shared with us, and that is, is reason for hope.

Mike: Awesome.

Libby: Because the more, again, you can't deny that these stories have power. And that's what keeps me going.

Mike: Awesome. Libby, I'm so glad you could join us.

Mike: I coincidentally, last night, I heard a young woman, I think her name was Kyla Scanlon she wrote a book called In This Economy and she was on the Comedy Central with John Stewart.

Libby: Yeah.

Mike: And he asked her a question about how is it that the Defense Department and other departments see a raise in what they get, even though they've never had an auditor can pass an audit.

Mike: And then we're cutting some of the other programs. And she said they have advocates. And people on Medicaid don't. Well, I'm so glad that they do, and that you're one of them.

Libby: We are out there and we're fighting the good fight. I mean, literally till our feet are bleeding. There's a whole contingency here in DC that are fighting for Medicaid and for access to healthcare.

Libby: I mean, you read in my bio and at the start of the podcast, I'm not an addiction medicine specialist. I actually have no medical background. I have a graduate degree in human rights, which my parents still can't understand how I could be employed. Right. That's what this is. It's a human rights struggle. And you know, that's something that I think about often. It's about just basic human rights. And that's why we're out here fighting.

Mike: And decency.

Mike: As always, for those of you who are interested, there's links to the resources for the Overdose Prevention Initiative and Ms. Jones attached the podcast. Libby, thanks so much. Let's do this again as we see the effects down the line.

Libby: Yeah, let's do this.

Mike: Yeah.

Mike: Thank you for listening, watching. We hope you find, help, support wherever you are. As always, thank you for listening. Be safe. Never give up and keep walking even when your feet are bleeding.