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Welcome to Nevada week.

I'm Amber Renee Dixon.

September is national recovery Month and its purpose is to promote new evidence based treatment and recovery practices with drug overdose, a leading cause of maternal mortality in Nevada.

Roseman University is focused on helping pregnant and postpartum women struggling with substance use disorder.

Roseman says unlike other programs, though, theirs starts by addressing basic needs and if a patient relapses, they do not automatically discharge them.

That program is called empowered.

And here to explain how needed it is in Nevada are Doctor Farzad Kamyar, assistant professor at Roseman University College of Medicine, and Amani Wilson, program coordinator at Empowered at Roseman University College of Medicine.

Thank you both for joining Nevada Week.

Thank you for having me.

You and Amani, not only are you a program coordinator, but you are also a former patient with your powers.

Will you tell our viewers about your struggle with addiction?

Yes.

So, my struggle with, addiction started, end of 2018, and, I spent, whole year trying to figure out how to reach out for help, addiction in my family.

It was kind of like a taboo type of ordeal.

Nobody used any kind of substances.

So for me to have a substance use disorder or be addicted to a drug at that time was like, what do we do?

So, eventually, a lot of things happened.

It and it ended up coming out about my addiction.

So, looking for help was the hardest thing.

I spent a lot of time looking for rehabs, but, I guess I didn't have the right insurance at the time, so that was very trying.

Throughout that time, I ended up becoming homeless.

As well as, being homeless, I found out I was pregnant with my daughter, and I was at help with Southern Nevada, waiting in line for, their housing program.

And, I met this young lady, and she was like, oh, you're pregnant?

And I'm like, yeah.

She goes, I just delivered my daughter and I use this program called empowered.

You go to them.

They have lots of resources and they will really help you.

You had disclosed to her that you were using.

Yes, yes, yes.

That was kind of how our conversation started.

And so, she gave me the number and I ended up calling and that was, I want to say around, I call it a little bit before me.

And, they were in transition.

They were going from dignity to Rose Lee University.

And so, when I did my intake.

Now, this is why I love empowered because most programs, they're like, you call, are you ready?

Okay, we'll come in at your scheduled appointment.

And that said, if you miss it, it's no follow up calls or anything.

So when I went to empowered, I scheduled for my intake appointment and I missed it.

And instead of not hearing anything, I got a phone call.

Hey.

You okay?

Well.

Let's reschedule.

I missed that one, too.

I missed three appointments, and, I and I could tell, like she wasn't.

She never showed any frustration, but in my head, I felt like, okay, you're kind of irritated.

Let me get my back into this, into this intake.

And on the fourth time, best care ever.

I left that intake with clothing items because I was hungry.

I mean, hungry, homeless.

I was angry and homeless, but I was, homeless at the time, so I didn't have any clothes that fit me well, being pregnant.

So they gave me a lot of, maternity clothes.

I left there with hygiene, items and, just a sense of having somebody there to support me.

And, when they transition to Rosemead University, that's when, they had therapy.

They had everything there.

And so, when they transitioned, I already delivered my daughter and my daughter wasn't in the NICU, And they gave me bus passes to be able to get to and from the main queue to see my daughter, which was a blessing because granted, as a mom, you're going to do any and everything you need to, but having those few extra hours of sleep, absolutely amazing to be able to have that bus pass.

And I remember them dropping it off at the hospital for me so I can go see my daughter and just those steps and going into, their therapy treatment.

Now, my favorite piece is the peer support that they have.

Peer support is absolutely amazing.

It's someone who has been through the struggle, through an addiction, substance use disorder.

And they're now, they've had their time in recovery and now they're able to be like a guidance to you.

I used to call my peer support.

She started at six in the morning.

I called her every morning at six, if not 559 every morning to just tell her about my day.

Tell her about what transpired over the night.

It's a lot of drama in that world.

It's so long.

And she would talk to me.

She went, make me feel like you're worth it.

Because a lot of the times your mind plays tricks on you and you start to feel like, what am I doing this for?

I'm never going to, I'll probably just keep in this state of relapse, you know, you start to wonder that, and then you wonder, am I ever going to get my child back?

Because in my addiction, I did lose guardianship over my oldest son.

And so you start to and just having that encouragement, having people to give you, help you think things through.

Well, if you keep using this, if you don't use, you can have this and just keeping you on track.

I do love that key aspect.

Where do you stand now with your children?

Actually, they're both home with me.

It's such a blessing.

I'm truly blessed with the gift of being able to, raise my two children.

Honestly, doctor Camara, around this time that Amani was finding empowered.

Where were you?

What were you saying?

Yeah.

So we were seeing all the effects of an epidemic, right?

An epidemic of substance use disorders.

Most recently, we're calling it sort of the opioid epidemic.

So we were seeing what we call morbidity and mortality.

But what that means is like death and destruction.

That's what that means.

So all sorts of really horrible health outcomes, not only for pregnant individual mom, but also for a baby.

Right.

Whether in utero, like during pregnancy or afterward.

And so that's what sort of led to various programs being started, particularly empowered, to try to mitigate or lessen those effects of substance use.

Why then?

Because it was so prevalent.

It was so prevalent.

And why do you think.

Yeah.

Times weren't looking too good.

Right.

And accessibility I mean, it's multifactorial, right.

So substance use is multifactorial, whether it's, you know, the, the genes that make you up, right, that we think provide maybe 50% of the risk factor, but then there's all sorts of things like environmental factors, the substances at play.

And we were going through a period starting let's call it's 90s.

But let's say 2000 is when it really took off this thing of the most recent phase of the opioid epidemic, and it really skyrocketed with just prescription opioid use individuals who are presenting right for some sort of ailments, they get prescribed an opioid.

And unfortunately, the rest can be history.

When it comes to developing a substance use disorder, particularly if you're take opioids for more than seven days, then your risk of developing an opioid use disorder are 2 to 3 fold, which is significant.

Then you throw in methamphetamine getting really potent methamphetamine, really available methamphetamine, advent of mass produced fentanyl.

And you've got this sort of cascade that leads into really high numbers of substance use.

Amani can you tell me about the stigmas you have faced as a pregnant woman who was also using oh so many It's unfortunate.

It really is very unfortunate.

The stigma is that women, mothers, who are who suffered or who are suffering with the opioid or stimulant use or any kind of substance use, a lot of it I've faced words from our physicians.

I went, go, to get my health care, and I would be treated not so kindly.

A lot of just negative comments.

Not using person first language, so.

Oh, you're an addict.

Instead of saying, oh, you're somebody suffering with, stimulant use disorder or a substance use disorder, because those things make a difference.

I've had been to the point where you get to these, healthcare places and you get treated so bad, or they're looking at you in a type of way, or they're making comments, or they're not taking your blood correctly and accusing you like, oh, I got to use substances.

You mean you can't handle getting your blood drawn type of radials to the point where it's hard and it's very discouraging?

And, I hate to say this, but during my pregnancy, what my daughter, I did miss a few appointments because I was scared of being looked at a certain way or just other factors that, you know, you may, think about, like such as CPS and whatnot.

Those are the things that you're very nervous about.

So empowered helps you advocate for yourself.

And that's the biggest key that helped me.

So like, let's say if I do have a doctor's appointment and maybe I don't know what to ask or whatever, I can go meet with empower it before they can go.

Hey, this is I want you to make a list.

Bring your lists with you.

That's what our protocol manager always says.

Bring your list with you, with your questions and ask these questions.

Let's say I was like, really nervous.

And I'm like, been traumatized by the doctors.

I could ask somebody to come with me and they would join me, accompany me to my appointment.

Doctor, can you give some sort of insight into why medical professionals would be so forward with this stigma?

Yeah, because that's been the norm.

It's been status quo for decades and decades.

What you're supposed to do, are you taught to do that?

So generally, no, I'm going to try to make a blanket statement that says it's not what we're taught to do, but it's sort of when you haven't been taught what to do, then it lends itself very well to what is the environment, right?

What is our society?

How does our society view things?

Because then that becomes the norm, right?

So if I'm a physician in training, let's say 40 years ago, where substance use disorder was not something really talked about, right.

I was never trained.

And so now I'm living in this world, right?

I'm living in this country.

And I see things like on the media, in the news, for example, in common portrayal of substance use.

Is that moral like ethical failing.

And it only happens to folks that are doing it to themselves and really aren't the best of folks.

Yeah.

And now we find totally wrong.

Right?

Totally wrong.

I will say with confidence and substance use disorder does not discriminate, does not discriminate against race, color, socioeconomic status, where you live, what career you have, what profession, what degrees.

So it's all sort of encompassing and ubiquitous.

And I think that now that sorting, sort of helping folks realize now with the new education.

So for example, at the College of Medicine, which just started, we are absolutely integrating what we call best practices, right, evidence based practice into our curriculum so that the doctors and clinicians of tomorrow hit the ground running, sort of already knowing how to treat, understand and speak with, communicate with folks that are suffering from any mental health issue, which includes substance use disorder.

And that leads into your call for universal screening expert.

Yes.

What is that and what difference would that make in this particular scenario with new moms and women who are pregnant, who are also struggling with addiction?

Yeah, absolutely.

So as that acronym stands for screening, brief intervention and Referral to treatment.

And this is something that clinicians have been really good at for decades and decades and decades.

Again, I'll bring in sort of the analogy to other chronic diseases like diabetes and high blood pressure.

We screen for diabetes and high blood pressure.

My guess is, Amber, every time you've been sort of in a clinician's clinicians office, they've checked your blood pressure.

Yes.

And that's screening for high blood pressure.

And then if they find something, they will do something, right.

We don't ignore.

We don't sort of curtail to the side.

So that's what we're asking for.

We're asking to screen universal.

You said it's the key because we don't want to target.

I don't want to look at someone and say, you look a certain way.

Let me ask you some questions about substance use.

I want to make sure that I ask it of everyone who comes in the door.

And that's the best practice, right?

Universal screening.

And in the world of mental health and substance use, I don't have a blood pressure cuff.

I don't have a blood test.

Right now.

Our best practice is what we call valid.

Using a validated tool, which is questions, whether it's questions that I'm asking you in person or questions that I've placed on a form and that you simply answer like things like yes or no, have I use substances in the past, yes or no to my parents, use substances, etc., etc.

so then that allows clinicians to screen for and if something pops positive and it's looking like this individual may be, then I'm going to further ask questions.

I'm going to perform what we call a brief intervention.

It's basically asking you questions.

Is it something that you think is going on and do you think you want treatment?

And if yes, then I'll do the referral to treatment piece which completes expert.

We do it for many of our major medical diseases.

We're not doing a good job when it comes to mental health and substance use.

That's the big ask.

We have run out of time.

I have so many more questions, but I really appreciate both of you making the time to join Nevada Week.

Thank you, thank you.

I appreciate you.