In this episode of Policy Outsider, Rockefeller Institute Fellows and members of the Institute’s award winning Stories from Sullivan research team Patricia Strach, Katie Zuber, and Elizabeth Pérez-Chiqués discuss what has happened to substance-use treatment access and effectiveness during COVID-19. The episode presents audio clips from interviews conducted by the researchers with treatment providers and workers on the frontline followed by discussions of the researchers’ impressions and findings. The episode also features an introduction by State University of New York Chancellor and former Rockefeller Institute President Jim Malatras who provides background on the Institute’s opioid crisis research, which began during his time as president.


James Malatras, Chancellor, State University of New York

Patrica Strach, Fellow, Rockefeller Institute of Government

Katie Zuber, Fellow, Rockefeller Institute of Government

Elizabeth Pérez-Chiqués, Fellow, Rockefeller Institute of Government

  • Transcript

    Transcript was generated using AI software and may contain errors. 

    Alexander Morse 0:04

    After more than a decade of increases, overdose deaths finally saw a decline in 2018, the most recent year for which we have data. Yet this positive trend may have come to an abrupt end in early 2020 as the United States faced COVID-19. Anecdotal evidence from the frontlines of the pandemic suggests communities across the United States may be experiencing a spike in overdose deaths as economic uncertainty continues and social distancing impacts patients’ access to treatment. This is Policy Outsider. I’m your host, Alex Morse. On today’s show, we’ll examine what has happened to substance-use treatment access and effectiveness during COVID-19. You’ll hear audio clips from interviews conducted by Rockefeller Institute researchers with treatment providers and workers on the frontline. Following the clips, the researchers will share their impressions and what they’re learning about how to handle an epidemic in a pandemic. But first, you’ll hear from State University of New York chancellor and former Rockefeller Institute president, Dr. Jim Malatras, on the background of the Institute’s research on the opioid crisis, which began during his time as president. And one final note, we’ve recorded today’s conversation over Zoom, the video teleconference platform. Please bear with us through any occasional sound issues as it doesn’t take away from the conversation, coming up next.

    Jim Malatras 1:36

    In 2017, opioid misuse was skyrocketing in New York and the nation. We at the Rockefeller Institute wrote report after report on it, no matter what was being tried to slow it down, it wasn’t working. In fact, the more policymakers attempted to solve the problem, the worse is seemed to get. It wasn’t because of bad intentions, quite the contrary, people desperately wanted to get answers. The Rockefeller Institute of Government’s research team wanted to figure out why this was. The result was Stories from Sullivan, a deep dive into the opioid crisis in a small rural community in upstate New York. When we launched the project, we called it research in real time, the readers got to follow along as the researchers conducted their work and we didn’t know where the journey would take us. We also did things outside of the box. There were reports but they were issued during the course of the research. We used video, photography, and blogs to tell the story. Eventually, it was woven into a comprehensive understanding of the opioid crisis and how to solve it. Stories from Sullivan has been and continues to be based in real time on the ground research, meaning seeking out and speaking with people who are affected by the crisis and the governmental response to it, so policymakers can know what’s actually happening. Since November 2017, the award winning research team has conducted more than 170 interviews with doctors, nurses, social workers, families, people in recovery, and others. Preliminary findings are available on the Rockefeller Institute website. Key questions we want to answer: What does the opioid problem look like on the ground in New York State communities? How have communities responded? What do people on the ground need from government to address it? Epidemic In a Pandemic is the same team taking this real time research approach to the opioid crisis amid the pandemic when rapid regulatory changes and extreme stressors from COVID-19 are affecting how we administer care. Specifically, the Stories from Sullivan research team is examining what is happening to the substance-use treatment access and effectiveness during COVID-19. This is not hyperbole when I say this is perhaps the most innovative and important study ever conducted on the opioid crisis and the team is being recognized for their efforts. They will receive the Outstanding Public Engagement in Health Policy Award from the American Political Science Association section on health politics and policy for their Stories from Sullivan series in September. This episode features audio clips taken from interviews with providers. That to me continues to be the most profound part of this project, the humanity. The study is not just numbers, charts, and graphs. Behind those numbers, charts, and graphs are people who are struggling, families who need support, and healthcare workers who need help to do their jobs. That’s the beauty of the Stories from Sullivan project, the research has always put the voices of those affected by the opioid epidemic—patients, providers, parents, and others—at the center of research.

    Alexander Morse 5:10

    Today, I’m with Stories from Sullivan researchers, Patty Strach, Katie Zuber, and Elizabeth Pérez-Chiqués. We’ve invited the researchers to discuss their latest research, Epidemic In a Pandemic, which explores what is happening to substance-use treatment access and effectiveness during COVID-19. As part of their research, Patty, Katie, and Lissy, conduct interviews with the people on the frontlines of the opioid epidemic, those suffering from substance-use disorder and service providers who help care for them. On today’s episode, we’ll be hearing clips from some of those interviews. But first, let’s begin with introductions. Patty, why don’t you start?

    Patricia Strach 5:49

    Thanks, Alex. My name is Patricia Strach. I’m a professor of political science and public administration and policy at the University of Albany. I’m also fellow at the Rockefeller Institute of Government.

    Alexander Morse 6:00

    And Katie?

    Katie Zuber 6:01

    Thanks, Alex. My name is Katie Zuber. I’m a doctoral lecturer in political science at John Jay College of Criminal Justice and I’m a fellow here at the Rockefeller Institute of Government.

    Alexander Morse 6:11

    And Lissy?

    Elizabeth Pérez-Chiqués 6:13

    Hi, Alex. I’m Elizabeth Pérez-Chiqués, assistant professor of public administration at CIDE in Mexico and a fellow at Rockefeller Institute.

    Alexander Morse 6:23

    Great to have you all on today’s show. Thanks for being here. Let’s just jump right into our first topic, which is policy change.

    Patricia Strach 6:31

    Well, Alex, substance-use services are heavily regulated. But during the pandemic, federal and state agencies had to relax the substance-use service guidelines to make it easier for people who need help to get it. At the same time, service providers had to put in place social distancing measures.

    Interview Clip 1 6:49

    Medicare said, “We’re going to reimburse you for a telemedicine visit the same way we would reimburse you for an in-office visit.” So that was an increase of 30 percent over what telemedicine was recognized before. That incentivized everybody to say, “Hey, do this because otherwise you’re gonna die.”

    Interview Clip 2 7:15

    When we talk about things like access, pre-COVID, people would call and we would give them an outpatient appointment. We know the windows of opportunity for motivation, sometimes they’re short. So we would try to get them in within a day or two, and some people would show up and some people wouldn’t. Now with telephone services and really being able to bill for an intake over a telephone service, people are able to call, we’re able to have a conversation about, what are you looking to do? What’s going on? How can we support you? We do the intake over the phone and then they start treatment the very next day. It’s given us the ability to do a broad system rapid access to support and to medication-assisted therapy in a way that really removes a lot of barriers that we’ve had in the past.

    Interview Clip 3 8:21

    We are required to do a lot of documentation with clients that required the client signature, they’ve actually waived that and allowed us to, you know, like authorizations, treatment plans, different forms like that, they’ve allowed us to put in their name if they are unable to sign but we’ve reviewed it with the client and the client gave permission.

    Interview Clip 4 8:43

    We started developing COVID procedures, while staff and clients started off as a couple of paragraphs. Its already a four page document that we had to put together, you know, that includes social distancing, hand washing, everybody has to wear masks—client and staff—where groups take place, how groups take place, the facility cleaning requirements, how we clean our HVAC system, our ventilation systems in our programs, you know, protective equipment for our staff and client—gowns, masks.

    Alexander Morse 9:26

    These all sound like positive developments for care services for substance-use disorder in the wake of COVID-19, which shows policy can move pretty quickly when there’s a need. Why were there limits prior to the pandemic?

    Elizabeth Pérez-Chiqués 9:40

    To the point of that it can move pretty quickly, that’s something we heard from providers. This is a government response to a crisis. This is what a government response looks like. In the field before, we used to hear that it was insufficient and things like even if it’s not an emergency, act like it. And then, I don’t know if Patty and Katie, you want to add something about that?

    Katie Zuber 10:08

    We noticed prior to the pandemic, that this was already a highly regulated field. I think part of that is that these were well-intentioned regulations designed to protect and promote client safety. But oftentimes, some of these restrictions can have adverse consequences. So you can think about that in the context of limits on the provision of methadone, for instance. Providing daily doses of methadone can really limit the possibilities of diversion, possibilities for overdose. But these limits can also create additional hardships for people who lack transportation or who have jobs that make it difficult for them to get to a health center every day. A lot of these highly regulated areas are well intentioned on behalf of policymakers but oftentimes can have adverse consequences for people who are seeking substance-use services. I think a related point is this idea of stigma. In the context of the opioid epidemic, our understanding of substance-use disorders has changed significantly. We’ve gone from thinking about substance use, as not a moral failing. It’s not the accumulation of bad choices, it’s really a disease that affects the brain. But these highly stigmatized views of substance use leading into the opioid epidemic and even stigmatized views of people who are in the treatment community have sometimes resulted in these more punitive, highly-regulated policies that can affect service provision.

    Patricia Strach 11:36

    One of the things that we heard from providers was that there’s no other area that’s quite like substance-use services. On the one hand, these are very powerful prescription drugs, people are getting methadone as a Schedule 2 drug, according to the federal government. So it’s very tightly regulated. But on the other hand, it is a medication that people need to take. It’s not the case that if someone were a diabetic, and then they would have to get medication in quite the same ways, so there’s a kind of a two-pronged kick here. One is the fact that these are very heavily regulated drugs. And two, as Katie is saying, there’s this sense of stigma that the people who are taking these drugs might not necessarily be trustworthy.

    Alexander Morse 12:21

    Katie, returning to what you said, learning more about substance-use disorder, we’ve already known that there has been substance-use disorders for decades. And so maybe we’re just desensitized to the issue as opposed to COVID, which struck us very quickly, we were primed to act.

    Katie Zuber 12:39

    Yes, I do think that a lot of people say that we are not going to be able to arrest our way out of this with respect to the opioid epidemic, for example. And it is true that our understanding of substance-use disorder is changing. But even so, some of that stigma that we’ve been talking about still resides. That’s not necessarily the case with COVID, where it appears that, again, COVID is not accidental. It can happen to everyone. And I think the response has been, and I’m sure we will talk about this later, but the response has been much quicker and swift.

    Alexander Morse 12:43

    We also address the barriers some of the regulations that might have been well-intentioned, but have limited access as we move forward through this pandemic. Talking about how COVID affects this, we heard in that last clip, there was a checklist of safety precautions and social distancing guidelines. Now this can be onerous for any business or service, but especially care service providers for substance-use disorder. Could you elaborate on how those challenges affected care providers and participation?

    Patricia Strach 13:21

    So as you mentioned, Alex, the social distancing requirements, every business has to put them in place and every business struggles with how to do so. I think the difficulty when you’re talking about substance-use provision is that it is something that can’t wait. I can go to a dentist in six months. But if I need care for a substance-use disorder, I may not be able to wait six months for that. So limiting access, reducing the number of people in a facility has been really difficult both for the facilities who don’t like turning people away and also for the folks who are showing up at those facilities wanting care. We’ve noticed a particular difficulty is in urban areas like New York City that were hit very hard by COVID. Also, the social distancing measures are much harder for them. In rural areas, substance-use treatment facility may be one floor, there may be empty rooms in the same building that are being unused that they can expand into, there may be a lawn out in back that they can use, there’s a parking lot at some places where they can also utilize all those different spaces. In New York City, they just don’t have the flexibility with space. We’re talking about inpatient treatment facilities with bunk beds. We are talking about elevators going up and down and stairways and having to figure out a way to get people into treatment in those kinds of circumstances is challenging across the state, but especially challenging where space is at a premium.

    Katie Zuber 13:48

    Just to work off of what Patty was mentioning, we’ve seen through our interviews, how geography, and particularly the rural versus urban divide, maps onto the response. But we’ve also seen that there’s been a disproportionate impact on some of these residential services. So the actual types of services as well. So again, people who offer long-term residential facilities where there’s two or three people sleeping in the same room, when they go to meals back and forth together, these kinds of things have been especially challenging for people who are offering residential services. So thinking about when you have a large number of people living in a congregate care setting, how do you make sure that everybody is socially distancing in an otherwise confined living space?

    Alexander Morse 15:20

    Which I think we will elaborate more on that as we get to the next topic on infrastructure. But I just want to ask one question about when I think of care for substance use, I usually think of hands-on participation and buy-in both from the providers and those who are in-care. We heard briefly about the introduction to telehealth to bridge some of these gaps caused by the pandemic. What are the general feelings about this shift, the perspective from the providers those in-care, and you, the researchers?

    Patricia Strach 16:43

    Well, telehealth was the one innovation that providers spoke about the most that had a huge impact on what they do. It allows those people who provide outpatient services, those people who have people come into the office, to see more people and to see them increase the number of people showing up for their appointments. People are able to access services more quickly and more people are able to access them. It has been a real game changer in terms of getting people in the door. But it’s not the universal answer, because you cannot see people face-to-face, you cannot provide the support that providers want to provide and that people with substance-use disorders want from the care that they’re getting—a one-on-one personal connection that they feel that they’re not getting.

    Alexander Morse 17:37

    I’ll have some more questions about telehealth, but I’ll save them for after the next section. Moving on to the next topic, infrastructure.

    Katie Zuber 17:45

    So in the national news and the national headlines, there’s been a lot of discussion about deaths of despair. And that’s a term that’s really used often to describe what we are thinking is happening in rural America. But one of the common threads of our research is this idea that we don’t necessarily think that it is despair in and of itself that’s killing people, there are these real, tangible mechanisms that make it easy for people to acquire and to get access to opioids but, at the same time, make it really difficult for them to get help, particularly for substance-use disorders. What we’ve noticed is that the COVID-19 pandemic has actually flipped the script, turning assets in some areas, for example, easy access to public transportation in urban areas, like New York City, into liabilities. So rural providers actually have the advantage of more space.

    Interview Clip 5 18:37

    You have a facility with 50 beds, 100 beds, or 150 beds, or whatever the number of beds you have. But those beds typically work in a facility where there was one dining room where those 50 people had to eat together in that one dining room, or 100 people, or whatever the number of the facility. Most facilities only have one elevator in the building, even if it’s several floors. So that became a challenge. The whole question of social distancing in the care building became a very difficult challenge in terms of how you protect people, isolation units, quarantine ability in timely care settings, all of those things were almost impossible to do. And I’m not saying it couldn’t be done. But a lot of facilities had to restructure the facility, downsize the number of the population, move people to the other locations, etc, etc. Now, outpatient program, we began to develop means to call people in their home to give them Nig counseling sessions over the phone. We had to develop guidelines to get to every worker so that they made sure they were covering the essential components of a good telehealth call. Asking health questions, asking questions about people’s well-being, what they were doing to sustain themselves, what activities they were engaged in. We had to create resources for people to do. We had to look at it from a psychological point of view in terms of impact of too much television watching and too much reading of newspapers and news, because all of the news that was coming at people who are already locked into a confined space was really damaging psychological news about where a lot of our clients turned to, they were asking us questions about, is the world coming to an end? How bad is this? Is it going to get any better? The level of the anxiety was palpable in our client population. But we did that. We transitioned to calls every day. We developed Zoom platforms to do group. We got waivers from the state. The state allows providers to be able to do all these things. To telepractice and amateur you.

    Interview Clip 6 21:28

    When the governor had said, reduce your workforce to 75 percent, to 50 percent, that was exceptional for us. That made a huge difference, at least in our organization, because it freed up offices, it allowed some of our shared workspaces to be spread out.

    Alexander Morse 21:56

    So that sounds like competing viewpoints. In the first clip, we hear about the challenges of trying to adhere to social distancing guidelines. But in the next clip, it seemed like the staff reductions and increased office space actually helped care providers. Why the discrepancy?

    Patricia Strach 22:13

    I think the common theme is that the change in regulations helped in some ways and hurt in some ways. In some ways, it was beneficial. And in some ways, it wasn’t. And a lot of that had to do with what kind of services were being provided. A lot of it had to do with where those services were located. So in terms of what kind of services are being provided, the residential facilities, these inpatient programs, where people go to a facility for a longer period of time, they had a really difficult time, because social distancing meant they had to reduce their census. In the outpatient clinics, the guidelines, the changes in prescribing for medication assisted treatment and the loosening of the federal regulations, the increased reliance on telehealth helped them. It made it easier for them to do their jobs in some ways. So in that case, just what kind of provider you were made a difference. In terms of where they’re located, the urban providers, as we heard in that clip, had a really difficult time finding more space, finding extra space, getting people up and down between floors in elevators that only one or two people were allowed to be in. So it really just depended on what they had access to before the pandemic and, ironically, a lot of the problems prior to the pandemic, rural areas had huge transportation issues getting people into care and telepractice changed that for them. People were much more able to access that care. In urban areas, the lack of extra space made it particularly hard for them and public transportation was something that many people wanted to avoid. So it really flipped the script between rural and urban areas.

    Katie Zuber 24:19

    I think a lot of rural providers, in particular, really pointed out that their census inpatients increased significantly when they were able to do things via telehealth and not just televideo, meaning video conferences, but literally telephone audio communication as well. They were reporting a greater number of patients turning up to appointments. A greater number being able to induct patients into treatment at a much faster rate than when they required face-to-face in-person visits. So we’re just being able to see, especially in these more rural areas that suffered from transportation issues in the past, being able to access clients a lot quicker and a lot faster than they had prior to the loosening of the restrictions on telehealth.

    Alexander Morse 25:09

    So sticking with telehealth, what’s the current state of the telehealth infrastructure? Katie, you mentioned that people were getting more participation because of the access to telehealth. So in rural areas, do they have adequate staffing to address the new people who are conferencing via telehealth?

    Katie Zuber 25:29

    One of the interesting things I think we found is that some providers are better off than others when it comes to telehealth. There were some providers who were already invested in telehealth. Who had already gone through this process of beginning to transition services and develop services that could be offered in that way. There were other providers who were either just beginning to develop their telehealth infrastructure or hadn’t done it at all, but were forced into that position of having to pivot very quickly. So I think the infrastructure varies depending on where particular providers were and to what extent they were already in the business of offering telehealth services. But one of the things that we definitely saw is that providers were responding and I think the word they often used was “pivoting” in these really creative ways that were going to allow them to provide services without any kinds of disruption, but in a way that was going to protect and promote the interests of both their clients and their staff. So one ROW provider that we talked to said, “We had very little experience with telehealth. We’re in the process of developing that infrastructure.” But they actually used a private caller ID blocking so that they didn’t have cell phones issued to their staff. But their staff could use these private caller ID blocking services to be able to continue connecting with clients, even though they were out of the office and working from home. So again, the infrastructure there is uneven depending on who you talk to and where you talk to. But again, a lot of providers have pivoted in ways that allowed them to continue services despite where they were in that area.

    Elizabeth Pérez-Chiqués 27:08

    I want to add another important piece in this, the clients, do they have a cell phone? How much data do they have? And something we heard consistently was that some of the most vulnerable populations, they were unable to reach some of these populations that might be living in the streets, for example, or even the limitation of not having data or enough minutes in a government-issued cell phone represents.

    Alexander Morse 27:36

    So following up on that, what do folks need from policymakers to help accelerate the use of telehealth?

    Elizabeth Pérez-Chiqués 27:44

    Maybe more focus on the client side of things, how something to really bridge that access to the most vulnerable populations so that they might continue receiving services in one way or the other. This goes back to the prior conversation. But one thing that everyone I think said was that this is great to have this flexibility. But this should only be one more of the options that providers and clients have. And it should be based on what is best for the client. So it’s not a substitute and it definitely leaves out a group of people policymakers do have to help address to bridge that that gap.

    Alexander Morse 28:31

    I think that’s a perfect way to encapsulate it. It’s not a substitute or necessarily an alternative. It is just one more component of care.

    Katie Zuber 28:39

    One of the things and I don’t know if this is the right place to interject this, but a lot of people were very happy about the transition to telehealth. It helped people provide services with as little disruption as possible in the context of a pandemic. But one of the resounding things we heard from providers is that telehealth should not replace face-to-face counseling and services in any way. So when we think about, what does this look like in the future, a lot of providers really were very concerned about the loss of human touch. The one counselor that we talked to said, “When somebody is grieving, to be able to just offer your hand on their forearm just to help ground them.” That human touch communicates a level of compassion and empathy that just cannot be replicated in the context of a telehealth online virtual visit. So, not being able to have that human touch made a lot of people say, “Yes, telehealth is really fantastic, great thing, but when we think about this in the future, telehealth should not replace face-to-face services.”

    Alexander Morse 29:47

    And finally, our third topic, prophets of doom.

    Elizabeth Pérez-Chiqués 29:52

    Like everyone else, providers see what is happening during the pandemic, yet, they also have a window into the opioid epidemic that is still going on. They believe opioid overdose deaths are going to get worse. They are also frustrated, because they see that when governments want to act, they can. Things are really bad and government can mobilize, but it hasn’t prioritized the opioid epidemic like it has the pandemic.

    Interview Clip 7 30:23

    We’re already seeing it. Again, it’s like we’re prophets of doom, like we have a crystal ball and we’re saying, here’s what’s gonna happen next. Watch domestic violence, watch the suicides, watch the overdose deaths spike during this period. You don’t need to be a specialist in my field within mental health. It’s just logical that’s going to happen and it has happened.

    Interview Clip 8 30:59

    So, all along, we’ve participated in erbi math and we’re tracking the data from the middle of March, which was about the time that we in our county had our first confirmed case of COVID-19. Between then and the end of June, or currently, middle of June, we saw a doubling in the number of overdoses, which is pretty concerning. So I think there were a little over 100 overdoses from January through June 10 or 11. Let’s see if I can get the actual numbers, I wrote them down yesterday, 105 overdoses, 10 of which were fatal. And that’s from January 1 to June 11. And since the middle of March, the number of overdoses doubled. So staying at home and what we can and can’t do, and access to care and treatment and access to services have all been impacted, and people have been severely impacted economically. Many people have lost their jobs or livelihoods, I have not been able to go to work, especially if they were with a family member that tested positive or they were in quarantine. It’s sort of like double jeopardy. And if any of those families having a family member with a substance-use disorder, just makes it that much more difficult.

    Alexander Morse 32:47

    “Prophets of doom” is a scary term. And to hear folks anticipate a spike in deaths from overdose to despair is both frightening and disheartening. What was it like for you to be in the room and participate in these conversations?

    Patricia Strach 33:06

    We actually get that question a lot. What’s it like to hear these stories? And it’s hard to hear these stories, but we get to go home at the end of the day. And I think that’s one of the important things to remember is that there are people who live this day in and day out. The people who have substance-use disorders, the family and friends of those people, the people who work in the fields in whatever capacity with these folks, they’re the ones that don’t get a break. So that’s really what we think about when we hear these kinds of stories is that they’re dealing with something and they’re like watching a speeding train coming, asking for more help and feeling at the same time that they’re not getting the support that they need to help the people who need it most.

    Katie Zuber 33:54

    I think Patty, really hit it on the head, it’s incredibly difficult and at times heartbreaking to hear these stories, but we have the benefit of being able to go back home at the end of the day. But when you think about it from the vantage point of the provider, it’s incredibly frustrating as well. When we first started this project back in 2017, we talked to providers who said, “We saw the opioid epidemic coming 10 years ago, we saw this happening, we waved the flag, we told government what they wanted to know. And just now it’s finally becoming a problem.” And it’s frustrating to the sense that you know that this may be happening all over again. I think we really need to listen to what providers are saying and we really need to realize that if people cannot get the help that they need, if they’re afraid and isolated in their homes, if the services that they need are not accessible, this is only going to get worse and the opioid epidemic is only going to get worse. So I think it’s really important that we think about that and that we listen to what providers are saying, because they’ve seen this before. We need to listen to that.

    Alexander Morse 35:15

    So Katie, you just mentioned that some of these care providers, they were waving the flag. They anticipated this opioid crisis for years. But maybe governments, policymakers, communities were slow to act. But we’ve also seen that with COVID-19, we can act relatively quickly. We can make changes. So does that bode well for the future of care for substance-use disorder? Or does that not provide a ton of comfort?

    Katie Zuber 35:47

    I think it encourages us to really pay attention. We talked to a mother once who said, “This is an epidemic, we need to treat it like an epidemic.” And I think that’s very true for this. We have to think very carefully about how to proceed and what we’re doing. We’ve talked to both providers and people in substance-use treatment who have said, “This doesn’t make sense, I can walk to the local neighborhood and liquor stores are open, but my face-to-face counseling sessions aren’t considered essential.” So I think that it’s obvious to us now that when there is a crisis, when there is an emergency, government can respond quickly, we just need to make sure that we are holding them accountable to both the global pandemic as well as the opioid epidemic that we have here.

    Elizabeth Pérez-Chiqués 36:41

    One of the things is there is this sense of instability in the field. Are we going to be long standing? Are we going to be properly funded, ever? They’re a crucial part of the safety net. Yet, they are not necessarily treated that way. And it’s reflected in the funding, in their capacity to pay their staff, to compensate them for the specialized services and the risks they take. They have not been able to do that, not just now, but historically. And now it becomes even more evident when they are really thoroughly risking their lives to continue to give lifesaving support to others. So that’s another of the things, they have to be listened to, they have to have a seat on the table, they are the experts on these policies. Should not be formed and then have them come in, but have them sit in the policy collaboration process. Just wanted to comment on that general sense of instability from the provider side.

    Alexander Morse 37:58

    Continuing on those lines, what else do providers need to help address substance-use disorder, from policymakers, from the community, from anywhere?

    Katie Zuber 38:09

    One of the common themes, again, that we’ve heard from people in the treatment community and the provider community is “nothing about us without us.” So providers need resources, they need financing, they need financial support, they need a loosening of restrictions that allow them to exercise discretion and make adjustments in the context of a pandemic. But there’s this real sense that they just need government to listen to them, that when government’s making decisions about what the appropriate rules and regulations should be about, what loosening of restrictions should stay in place. At the end of the day, we need to put providers at the table so that these rules and regulations are informed by their experience, informed by their expertise, and not something that is just imposed on them from above. So again, resources is really important, but being included in those conversations about what to do next and how to build it better, so to speak, need to include providers. Bringing these folks to the table and actually giving them an opportunity to share their expertise and to share their experience, so that whatever government does come up with next actually addresses what they’re experiencing on the ground.

    Patricia Strach 39:22

    Another thing that we’ve heard is stability, and a lot of people are frustrated right now with the constant changing, the constant shuffling of rules. And what would be helpful is to say, “Hey, for the next 18 months, here’s the rules that you’re going to be operating under. These pandemic regulations are going to hold so that you can prepare, you can plan, you can staff, you can design whatever you’re going to design, and knowing that it’s going to be there for whatever that amount of time is.” I think that’s not unique to providers, I think a lot of industries feel that way. They want the same kind of thing that Google employees just got, which is to know when they’re going back in the office. How long before they have to think about things changing again?

    Alexander Morse 40:07

    I think we can all agree on that. I don’t particularly like the phrase “return to normalcy” because when has anything ever been normal. But just having a sense of stability, like you said, having your voice represented in the conversations and feeling like you’re valued, and being a participant is really important. And so finally, I just want to ask you one last question, where’s your research taking you next?

    Patricia Strach 40:34

    Well, we have just finished a series of focus groups, nine focus groups. Eight with substance-use service providers and one with clients. So we are going to be combing through those data and really trying to understand what is happening on the ground right now during COVID. That’s where we’re focused now. And then in the future, we are hoping to figure out how public health works by examining this issue more carefully.

    Katie Zuber 41:03

    The only other thing I’d add to that is sometimes one of most interesting things about working on this project, for me, has been sometimes we don’t always necessarily know where we’re going. And we’ve ended up in places we didn’t necessarily anticipate. And I will say, we’ve been doing this research since November of 2017, when we first conducted our round of interviews and having that really solid foundation and understanding of what the opioid epidemic looks like in these local communities has really enabled us to dig deep into really understanding how COVID-19 layers on top of that to address the problems that are already preexisting there. It’s been a great aspect of this research that we’ve ended up in places we didn’t necessarily expect. But it’s contributed significantly to our understanding of the epidemic.

    Elizabeth Pérez-Chiqués 41:58

    I agree with Katie and I think we embrace that not knowing. Where we’re going to go next. But also, knowing that we have this huge responsibility to get this information out to policymakers and to the community.

    Alexander Morse 42:17

    Patty, Katie, Lissy, the Stories from Sullivan team participating in real time on the ground research. Wherever you guys go, we’ll be following. Thank you so much for taking the time to talk to us about this subject.

    Katie Zuber 42:33

    Thank you Alex.

    Alexander Morse 42:51

    Substance-care providers perform an incredibly difficult job, even more so now in the wake of the global pandemic, but it shouldn’t be a thankless job. On behalf of Patty, Katie, and Lissy, and the entire team at the Rockefeller Institute, I want to say thank you to all the healthcare providers who continue to find solutions to problems and put the needs of their patients and clients first despite the ever changing and dynamic landscape surrounding substance use. This research would not be possible without their time and contributions, and we are especially grateful for their commitment to fighting back against the opioid crisis. Thanks again to Jim Malatras for recording today’s special introduction. And if you’re interested in learning more about substance-use disorder and the award winning Stories from Sullivan research, please visit our website at Thanks for listening, I’m Alex Morse. Until next time.

    Alexander Morse 44:59

    Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York State and the nation. Learn more at or by following RockefellerInst on social media. Have a question, comment, or idea. Email us at [email protected].

Policy Outsider

Policy Outsider” from the Rockefeller Institute of Government takes you outside the halls of power to understand how decisions of law and policy shape our everyday lives.

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