This post is a bit different than my previous posts, but important, nonetheless. Whether you are a person who uses/used drugs, know someone that uses/used drugs, or if you work with folks who use, this community alert post is for you!
A (somewhat) novel substance called Xylazine is showing up in the illicit drug supply [especially in the Northeast]. Xylazine is most commonly found in illicit opioid substances, such as fentanyl, pressed pills, and heroin, but is also increasingly being found in other substances such as cocaine or meth.
According to Christine Vestal, a staff writer for Stateline, “Xylazine started showing up routinely in the drug supply in 2019 but didn’t take off until the coronavirus pandemic began in 2020 (Vestal, 2023). The Northeast is most significantly impacted by this novel substance, with CT ranking 3rd highest out of all these United States, regarding
What We Know
According to the Food and Drug Administration, Xylazine (Zie-luh-zeen) is a non-opioid agent that FDA originally approved in 1972 as a sedative for use in veterinary medicine and is not approved in the use of humans (FDA, 2022).” Xylazine may be sold under the common street names, tranq, tranq dope, sleep-cut, and gas station heroin.
Associated Health Risks
– Heavy sedation
– Significant risk of overdose & death
– May impact the body’s ability to carry oxygen to tissues, causing severe skin wounds
– agitation, severe anxiety, a feeling of unease
– high blood pressure & rapid heart rate, though not always present
Repeated exposure or use may lead to dependence & withdrawal symptoms. Some users report Xylazine withdrawal symptoms as being as, or more, severe than heroin or methadone; symptoms include sharp chest pains & seizures (DEA, 2022). Xylazine withdrawal symptoms may interfere with or undermine any efforts of obtaining appropriate OUD treatment and may even further perpetuate an individual’s drug use, according to the DEA (2022).
Xylazine & Naloxone
– Xylazine does not respond to Naloxone, however, Naloxone should always be administered anytime an opioid overdose is suspected
– Oxygen therapy/rescue breathing must be administered in the event Naloxone is not effective in the reversal of the overdose event, highlighting the heightened importance of calling 911 in the event of an overdose
– More education must be provided to the public, to dispel many misconceptions on how to respond to an overdose appropriately, including how much Naloxone to administer & the need to provide rescue breathing between doses of Naloxone
How WE Can Respond
-Share the signs & symptoms of xylazine exposure with PWUD and folks that work with at-risk individuals
The most critical thing we can do is continue to educate the public about the presence of Xylazine in the drug supply, especially increasing awareness among folks most at-risk for encountering the drug. A great example is depicted below. The Savage Sister organization passes out these informational cards to people who use drugs during street outreach in Pennsylvania.
Farm to City: Xylazine as a Drug of Abuse
In Philadelphia, ‘tranq’ is leaving drug users with horrific wounds. Other communities are bracing for the same
Working in the human services field is hard work, but working with at-risk and underserved populations, such as those living with substance use or other mental health disorders, reaches another level of difficulty. Peer workers, like myself, experience an array of traumatizing events through our daily work, such as losing participants/clients to overdose. A recent study suggests, that “even a single exposure to a fatal or non-fatal overdose can lead to considerable stress, burnout, and overdose-related compassion fatigue (Mamdani, et al, 2021).” As peer workers, we are exposed to traumatic events such as overdose on an ongoing basis, which creates the perfect environment for compassion fatigue & burnout to occur. As a peer worker, the following are just a few examples of what I experience through my work; a participant overdosed twice in just 6 days. Another woman I am working with lost custody of her children, she is, of course, devastated. There are several individuals living outside (in New England in January, nonetheless), and all we, (outreach/peer workers) can do is offer food, warm clothing, supplies, and of course, linkage to community resources & support(s) when/if the need is identified by the individual. Now, consider the impact(s) on police officers, paramedics, and other frontline workers who respond to the ever-increasing opioid overdoses, witnessing people overdose, some fatal, sometimes multiple times in a single shift. Not only that but the frustration peer workers experience hitting barrier after barrier while trying to link individuals to opioid use disorder (OUD) services and very limited treatment options. Additionally, there is absolute heartbreak when we are confronted with knowing there is nowhere to send individuals coming to us seeking housing resources. Quite frankly, for many folks, living outside [exposed to the elements] is a more appealing & safer bet than going to a shelter or asking for help because of the stigma, shame, & judgment they fear they will face, and from my experience, they are not wrong to worry about such things. If you recall in my last blog, I told a few participants’ accounts of facing judgment, shame, & discrimination while trying to access services in local emergency departments for their opioid use disorder. There are hundreds more stories such as these of individuals trying to access housing resources.
Self-Care is Key
As an empath, this all weighs on me as I am sure it weighs on all of us doing this hard [at times, impossible] work, which I have been doing for almost 10 years now and luckily got some sound advice during that time that has stuck with me throughout the years. And, of course, there were some lessons I just had to learn the hard way, through my own mistakes. Learning to care for my own well-being [FIRST]was imperative to my ability to continue doing this incredibly rewarding, but often, painful work. Peer workers must ensure they take intentional steps to ensure they care for their emotional, spiritual, physical, and mental well-being before they can effectively help anyone else.Key Components of Compassion Fatigue (CF)
According to Ontario HIV Treatment Network (2019), there are 3 main components of experienced among service providers addressing substance use include “emotional exhaustion (feeling drained of all emotional capacity), depersonalization (experiencing cynicism, helplessness, and detachment), and lowered sense of personal accomplishment (a belief that one’s work is not significant).” Working with victims of violence and trauma changes the worldview of service providers (peer workers) and puts individuals and organizations at risk for a range of negative consequences (Bell, et al., 1990).” Organizations have a significant impact on a peer worker’s risk for experiencing CF, including “a reduction in the workforce, inadequate training & development opportunities for peer workers, and the lack of an appropriate venue to express feelings (Dougherty & Horowitz, 2021).”
The following are well-known sources of burnout among peer workers; unreasonable client caseloads, the balance of work/home/community commitments, a negative work environment (including inequitable pay compared to non-peer colleagues), and lack of colleague support/recognition (whether only perceived or reality). The Peer Recovery Center for Excellence stated, “unaddressed secondary trauma often leads to compassion fatigue, and if left unaddressed, CF may result in burnout, that according to many studies, may not be reversible (Dougherty & Horowitz, 2021).
Vicarious trauma also referred to as secondary stress trauma (SST) can have far-reaching impacts which include, higher staff turnover rates, poorer job performance, and, unfortunately, some peer workers may even return to using substances due to this work-related stress. Lack of self-care, boundaries and proper supervision are also contributing factors.
Interventions More research needs to be done surrounding the impact CF & BO has on peer workers, however, with the implementation of policies, procedures, practices, and programs, vicarious trauma-informed organizations can be created, according to the Vicarious Trauma Institute (2015). The Peer Recovery Center for Excellence provides examples of how to reduce your likelihood of CF & BO from occurring, in their 2021 Online training titled, “The Impact of Compassion Fatigue in Peer Support Work.” The training lists “building compassion satisfaction, as well as building blocks of empathy and healthy detachment” as ways to reduce your risk of experiencing CF or BO (Dougherty & Horowitz, 2021). Compassion satisfaction & compassion fatigue can be looked at as the positive & negative consequences of doing peer support work.
My Plan to Reduce Peer Worker’s Risk of CF
I have found that I best process the trauma, grief, & loss I experience in this work by talking about it with my fellow peers. It is beyond reassuring to know that the person you are sharing your experience with can empathize with the feelings you are experiencing through their own lived experiences. Peer support work is evidence that representation and lived experience, matters! We can create as many vicarious trauma-informed policies as we want, but if peer workers do not have a seat at the [planning] table, the future success of said policies is questionable at best. That is why I have decided, with the support of PPI’s leadership team’s support to create a Peer Worker Alliance group (not settled on the name yet, lol). The group will provide a safe space for peers to connect with their peers who are doing similar work in the surrounding area to discuss, process, and support each other through the myriad of issues that arise in this work, including secondary traumatic stress, compassion fatigue, & burnout. My hope is to eventually provide training and workforce development opportunities through this group as well. Stay tuned for more information surrounding this new endeavor! I am very excited to get started and will provide you with more information as soon as I am able. As always, if you or someone you know is living with substance use disorder and are in need of treatment services, recovery support(s), or harm reduction supplies, including Naloxone, please feel free to call/text me, Jess, @ 860-336-9412!
Key TermsPeer Workers “Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD), according to BMC Psychiatry (2022).”Compassion is “a feeling of deep sympathy and sorrow for another who is stricken by suffering a misfortune, accompanied by a strong desire to alleviate the pain or remove its cause, according to the Peer Recovery Center of Excellence (Dougherty & Horowitz, 2021).”Fatigue is “extreme tiredness, typically resulting from mental or physical exertion or illness (Dougherty & Horowitz, 2021).”Compassion fatigue (CF) is “the physical, emotional, and psychological impact of helping others, often through traumatic or stressful life events, according to WebMD (2020).”Compassion satisfaction (CS) is defined as “the pleasure we derive from being able to do the work we do. The compassion we experience in doing our work provides a sense of satisfaction (Dougherty & Horowitz, 2021).”Burnout (BO) is defined by the World Health Organization (WHO) as “physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment (WHO, 2019).”Vicarious trauma (VT) is “the exposure to the trauma experiences of others” (Peer Support, 2003), and is reportedly an occupational challenge for peer workers and many other professions.Self-care “is an essential social work survival skill and refers to activities and practices that we can engage in on a regular basis to reduce stress and maintain and enhance our short- and longer-term health and well-being. (University at Buffalo, 2023).”ReferencesCompassion Fatigue: Symptoms To Look For (webmd.com)The Bell Tolls for Thee & Thine: Compassion Fatigue & the Overdose Epidemic – ScienceDirecthttps://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00449-1PowerPoint Presentation (peerrecoverynow.org)Introduction to Self-Care – University at Buffalo School of Social Work – University at Buffalo
I am going to share a few experiences from the field, telling the stories of individuals I have had the pleasure of meeting in the last nine or so years that I have been involved in this work. I hope it provides a unique insight into the lives of individuals living with substance use disorder (SUD), and the impacts of living with that medical condition. My hope is that by telling these stories, shining a light on the egregious mistreatment, discrimination & for some,downright medical neglect, will reduce the consistent barriers and overall harm(s) people living with SUD experience while on their journey of recovery/remission from SUD/OUD.The individuals who were brave enough to allow me to share their experiences with all of you will remain anonymous to protect their confidentiality. First, I thought I’d qualify a bit by sharing one of my experiences facing judgment, shame, and discrimination within a self-help community.
My StoryI recently celebrated 10 years in remission from opioid use disorder (OUD)! For the first 7.5 years of my journey, I had been extremely active in a well-known self-help group, I shared my experience, strength, & hope as part of the H&I committee, which is a program that brings members of the self-help group to treatment programs and inside jails/prisons to share their journey of recovery & stories of hope. I actively worked with a sponsor, writing the twelve steps, sponsored women, guided them through the steps, and held just about every trusted position one can hold within the organization. The thing is, to hold most (if not all) of those positions, to sponsor those women, to bring my message of hope to other individuals inside hospitals & institutions (treatment settings), I had to lie, or at least felt the need to omit a very significant part of my story of recovery. Because of the stigma associated with the use of Suboxone to treat OUD, I did not feel safe sharing that part of my story.Secrets Keep You SickSecrets eat at you, they will grow into shame and guilt, and if you are not careful, may result in a setback/relapse. Luckily, that wasn’t part of my story. But the loss of my soulmate/best friend & the father of my son gave me the strength, to be honest with the friends who felt more like family, about being on a medication used to treat OUD, and those relationships changed. All of them. Talk about the feeling of shame and abandonment. But today, I live authentically & have friends who love me unconditionally, regardless of what medications or methods I use to continue my journey of recovery. Today, I get to use my experience to encourage others to live out loud, without shame. I like to say my biggest objective in this work is to provide a safe space allowing individuals to come just as they are, feeling safe without fear of judgment.
According to an Online NIH Journal, titled “Overcoming medication stigma in peer recovery: A new paradigm”, “This stigma has particularly been expressed as an issue among NA groups. NA states in its official literature that although all individuals should be welcome to attend meetings, those who use medications are not yet considered “clean” and groups may choose to prevent individuals on medication from sharing experiences or leading meetings (NIH, 2019).”
“L’s” StoryA woman I’ve known for many years shared many of the instances of shame, stigma, and discrimination and how its impacted her recovery journey. “L” shared with me a time she went to the emergency room with a torn ligament and another type of injury of the knee. “L” reported that before she even saw a doctor, she was told by a nurse, “we cannot give you narcotics!” Here’s the thing though, she hadn’t asked for narcotics, she wouldn’t ask for them, because she is on Methadone (medication to treat opioid use disorder). We all know the stigma associated with medications used to treat OUD. “L” was discharged with nothing but a list of local specialist doctors to call. It would take several more humiliating trips to the emergency room and many appointments with primary care and specialist providers before “L” found any relief for her pain. Medical professionals if you are reading this, PLEASE, do better.
“B’s” StoryMeaningful employment is another significant and continuous barrier that people who use(d) drugs face. “B” has been in remission for nearly three years, and has had no additional involvement with the criminal justice system in that time, yet continues to run into roadblockafter roadblock while trying to find employment. For instance, “B” has completed all the relevant qualifications and certifications courses to become a Recovery Coach, but as soon as a potential employer runs a criminal background check, they are excluded from the hiring process.Remember, this is to work within the recovery community, if they cannot get hired here, then where?
Peer Work’s Where It’s AtWe know peer support works. It is a very effective method for engaging at-risk and underserved population(s), especially those living with substance use disorder. According to a Substance Abuse and Mental Health Service Administration (SAMHSA) study, titled, “Value of Peers”, peer recovery support provides the following, “improved relationship with treatment providers, increased treatment retention, increased overall satisfaction with the treatmentexperience, improved access to social support greater housing stability, reduces emergency service utilization, reduced re-hospitalization rates, reduced substance use, and a decrease of criminal justice involvement (SAMHSA, 2017).”If individuals with lived experience with substance use disorder can offer all these benefits to people currently struggling, why is their past criminal justice involvement held against them? We know people who use drugs often commit crimes to support their substance use. When individuals stop using and engage in the treatment, in most cases the criminal acts stop too. Program Directors and Human Resource Personnel must keep this fact front of mindwhile seeking candidates to fill peer recovery support positions.
“D’s” Story“D” is a participant of mine who reported he had gone to a local emergency room in opioid withdrawal, requesting to be started on Suboxone, which has been promoted in the addiction field as an option at this hospital. Not only did this individual NOT get to start treatment for his OUD, but a nurse laughed out loud and reportedly said, “We don’t do that here, I can give you a Tylenol.” He was discharged without any assistance for his medical issue, whichOUD, is, in fact, a well-documented medical disorder. This individual was not only discriminated against, but he was also humiliated, and most tragically, he was discharged with not even a list of resources. Luckily, he found his way to Perception Programs’ Mobile MAT Van and was able to start treatment for his OUD and begin his recovery journey.
Do No HarmThese stories are the rule, not the exception, when regarding how people with substance use issues, even those in remission, face mistreatment, and stigmatization, and often are either dismissed entirely or treated as if they are undeserving of resources, services, and support simply because of their medical disorder. My goal is to continue to shed light on this issue, increasing the community’s awareness of the problem, which will hopefully put pressure on institutions, organizations, and other treatment & hospital systems to ensure ALL individuals they serve receive the dignity & respect they deserve. The overarching goal, above all else… do not harm.
If you or someone you know may benefit from any of the services offered on the Mobile MAT Van, please contact Jess @ 860-336-9412. We can also be found on Facebook, Instagram, our website, or by calling any of our three offices.
Krawczyk, N., Negron, T., Nieto, M., Agus, D., & Fingerhood, M. I. (2018).Overcoming medication stigma in peer recovery: A new paradigm. Substance abuse, 39(4), 404–409. https://doi.org/10.1080/08897077.2018.1439798https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087684/https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/valueof-peers-2017.pdf
I wanted to circle back to something I have put great emphasis on in my previous posts,which is the importance of raising awareness surrounding the stigma associated with substance use and how it impacts those living with substance use disorder (SUD), more specifically, opioid use disorder (OUD). I do not like raising an issue, without also providing solutions. I will discuss why I view stigma as a human right’s issue, as evidenced by what I observe in the field. I will also provide ways in which we can all help reduce the stigma & shame people living with SUD face.
Through my professional & lived- experiences working, living, & recovering within the substance use community, I have attained this deeply -rooted belief that stigma is a moral & social justice issue, that is causing significant barriers to people accessing treatment services & supports for their use, increases people using alone, which dramatically increases the chance for overdose & death.
In my role as a Mobile Outreach Worker (MOW), I spend countless hours, having countless conversations, with countless individuals, debunking myths & misinformation surrounding OUD
& MOUD. It is my job to provide people with facts about opioid use disorder & the medications used to treat it. Facts that are backed by science & grounded in evidence.
Somehow I am still amazed each time I hear people say things like they don’t support MOUD treatment because they don’t view it as really being in “real recovery”, or it is “replacing one drug for another.” Neither of these are true. In fact, SAMHSA’s website states, “Medications used for MAT are evidence-based treatment options and do not just substitute one drug for another (SAMHSA).”
The stigma people experience around their substance use can have devastating results, which may include the loss of hope for themselves & their recovery, how they are perceived, or even treated within our systems and institutions (hospitals, jails, treatment facilities, self-help groups, etc.).
SUD stigma can also have a great impact on the families of these individuals, fostering a lack of understanding & support for their loved one who is struggling, instead of creating space that feels safe enough for them to ask for help .
Stigma is so deeply ingrained in how society discusses , views, and treats those struggling with SUD. This concept proves true whether discussing people in remission/recovery from OUD, those on a MOUD as part of their treatment regimen, such as myself, or, most importantly, individuals who are in current active or chaotic use.
Individuals who are prescribed medications used to treat their opioid use disorder (MOUD), like Suboxone and Methadone, often face additional stigma and discrimination surrounding their use of these medications, it’s impact felt on multiple levels. According to an Online Medical Journal, titled “Human Rights, Stigma, and Substance Use,” “medication assisted treatment (MAT) is the current gold standard of care for treatment for opioid dependence, since its use is associated with reduced risk for relapse and mortality, yet stigma may present a barrier to its use, including stigma associated with MAT use within sectors of the treatment community, (Wogen & Restrepo, 2020).”
I will never forget a participant I lost a few years ago because of the stigma associated with/MAT. Part of a self help group, he wanted to write the 12 steps with his sponsor. His sponsor told him he would need to get off of methadone before he could start writing the steps with him. Heeding his mentor’s advice he got off the methadone and died less than 2 weeks later from an overdose. “Some peer led groups and 12 step recovery support programs may not support MAT use, and consequently individuals in recovery who are on MAT may experience stigma from peers or group facilitators or, perhaps unintentionally, be persuaded to discontinue MAT use”, according to Wogen & Restrepo, (2020).
In my opinion, the single best way to combat the stigma associated with SUD is utilizing Person-First Language when discussing substance use, treatment, & recovery. Words are extremely powerful and the words we use to discuss SUD or any other mental health condition, undoubtedly has an impact on society’s perceptions, attitudes and behaviors toward those living with SUD. “Language frames what the public thinks about substance use, treatment, and recovery, and it can affect how individuals think about themselves and their own ability to recover ”, according to NIH’s Online Medical Journal (Wogen & Restrepo, 2020).
We also must be willing to hold the people around us, whether our friends, family members or colleagues, accountable for the words they use to discuss SUD. Of course there will always be those who refuse to increase their knowledge or change their views, attitudes or behavior towards people with SUD, but I refuse to be one of them. I always try to remain teachable in everything I do or know.
I have included a few resources that provided examples of person-first language surrounding substance use.
Additional Barriers to Accessing MAT Services
In my last blog post I discussed the significance that transportation barriers can play in access to care. There are many other barriers individuals face while seeking treatment for their substance use, these include, treatment capacity (long waitlists) and a lack of willing and trained providers with available time is a challenge. Additionally, the stigma associated with MAT treatment cannot be underestimated, fear of losing employment or incarceration, cost of treatment, shame & stigma associated with SUD treatment, [especially stigma associated with MAT treatment], lack of treatment resource knowledge, and the fear of losing their children (DCF involvement).
The Need for Mobile MAT Services
The Mobile MAT van will be going to six CT communities, including Willimantic, Danielson, Putnam, Jewett City, Norwich & Taftville. Estimates show that 53% of counties in the U.S. lack access to a MAT provider (Barriers to MAT, n.d.).” Before the Mobile MAT program servicing these rural CT communities, they would have most likely been included in the 53%. The need for these services is dire. An example of how desperately OUD services are needed. I went to Jewett City last week (before the official launch of the MAT van) to pass out flyers, introduce myself and get a lay of the land. In less than an hour and a half I had had made connections with three individuals, connected another individual to Suboxone services, distributed 6 Narcan kits, 8 fentanyl testing strips, 3 safe use kits, 40 sterile syringes, 60+ condoms, and 3 wound care kits.
Mobile MAT Van Services & Supports
The Mobile MAT van provides a safe, non-judgmental & supportive environment for [all] individuals. Whether a person is ready to engage in Suboxone treatment for their OUD, or the individuals that may not be ready to stop their use, we have services & supports to help. The MAT van offers an array of harm reduction, prevention, and recovery support services, including community-based Suboxone induction, safe use supplies (syringes, safe use kits, Narcan), linkage to mental health & primary care services, referrals to treatment [detox, IOP, Methadone, etc.], access to peer support services, and connection to other community resources.
I recall a time, not too long ago when individuals seeking MAT services (specifically Suboxone) would often be told to either callback in a few days or be given a first-time appointment 2 weeks out. I often wonder how many lives we lost to overdose due to those unacceptable long wait periods.
MAT Saves Lives
Using a harm-reduction, person-centered approach, meeting individuals where they are [quite literally] to provide these critically important services, will most certainly save lives.
Welcome! We are Glad you are Here.
Thank you for taking time to read the first ever “Changing Peer-Ceptions” blog post. My name is Jess Morris, a certified community health worker, recovery coach, and a person in long-term remission from opioid use disorder (OUD). I have the privilege of being the Mobile MAT Outreach Worker at Perception Programs, Inc (PPI) for their brand-new Mobile Medication-Assisted Treatment (MAT) Van. The non-negotiable qualification for the job? Lived experience. I could not have imagined that almost 10 years ago (walking into detox), I would end up with a career in which I got to use my experience to provide hope, support & empowerment for individuals with SUD. My work as an Outreach Worker feels like it was created just for me! I will be forever grateful for the opportunity to do the work I love, with the most amazing people. Work that has never felt like work. What a gift.
I hope this blog will increase the community’s awareness around substance use, reduce substance use-related stigma, and reduce the number of overdose deaths. By providing community education on medication-assisted treatment (MAT), promoting harm reduction practices, and highlighting the benefits of utilizing peer support services, we can increase access to evidence-based and effective treatment for opioid use disorder (OUD, and reduce the stigma associated with substance use & MAT services. Using my professional and lived experience will provide individuals with the knowledge to change negative perceptions associated with substance use disorder (SUD). Creating a safe space where anyone can ask for help without facing judgment, guilt, fear, or shame, no doubt will save lives.
Opioid Overdose Crisis
The Mobile MAT program is an innovative approach created to help combat the devastating & ever-increasing opioid overdose crisis that has been ravishing our community (and many others), for years. The opioid overdose crisis has impacted Connecticut more significantly than most other states. Connecticut is in the top 10 states which have the highest overdose death rate in the United States, according to Trend CT, an Online News Article (Tran, n.d.).
Why Mobile MAT Services?
MAT stands for medication-assisted treatment. There are a few different medications approved by the FDA which are used to treat opioid use disorder (OUD), they include, Suboxone, Methadone, and Vivitrol. The Mobile MAT van uses telehealth to provide easy access to Suboxone MAT treatment. There are several barriers that impact individuals capacity to access MAT. Individuals living in rural communities have limited options in choosing a MAT provider because most treatment programs tend to be in urban areas. They also have longer drive times and fewer public transportation options for accessing MAT services, according to the Center for Rural Health (2021). Understanding the importance of reducing all treatment barriers, we (PPI) implemented the use of telehealth MAT services to remove the many barriers many individuals face while accessing treatment, especially those living in rural areas.