Pregnancy and substance use disorder.

It's a problem in Nevada that one university is tackling in a nontraditional way.

Plus, those really great doctors and the students that are associated with them want to do research.

And we don't have that here.

Las Vegas needs lab space for research, and the city is holding a $10 million competition for it.

That's this week on Nevada Week.

Support for Nevada Week is provided by Senator William H. Hearn.

Stat.

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.

We continue with more health care news.

Now, the city of Las Vegas is accepting proposals for a biosciences incubator lab, and the winner will get $10 million.

What the city stands to get in return for that?

Nevada Week recently spoke with Jason Morgan, CEO of Carrot Net.

That's the company managing this online competition.

And we also spoke with Brian Knutson, Las Vegas mayor pro tem, also the city councilman of Ward one, home of the Las Vegas Medical District, which is where this future lab will be located.

Here's how he described this multimillion dollar venture, known as the Bio Health Innovation Challenge.

So the best way for me to explain it is talking about my family.

I've been here for 20 years.

I'm fortunate enough to be a councilman in Las Vegas, and I have the experience of having a couple of very, very sick children when they're younger.

I spend a lot of time in the hospital.

Great hospitals here, great doctors, great nurses.

But health care here is significantly further behind where it is in other parts of the country.

So when I talk to doctors and nurses in the middle of the night, and I have a lot of exposure now to the health care field, what they tell me is missing in Nevada is expanded bio health research lab space.

Those really great doctors and the students that are associated with them want to do research.

And we don't have that here.

So here we come to a bio health innovation challenge, making sure the rest of the world knows that Las Vegas is a place to relocate or to build a business here.

And we want you here in Las Vegas.

Jason, you said you have done this in the past.

What work have you done here in Las Vegas?

You also said that you have done this kind of competition process for NASA, even.

Absolutely.

So about a dozen years ago, the US Department of Commerce hired our firm to work with three cities Las Vegas, Hartford, and Greensboro.

Now, at the time, our mayor pro tem was working in the planning department, and he was the one that actually applied for the grant that the city received in order for us to work with the mayor and to run a competition here that focused on new economic development in the city of Las Vegas.

We went on to build the company out, and we work with NASA.

We work with the various states governing regional authorities.

Any time NASA, for instance, would want to run an open sourcing competition.

They would work with us and we're very proud of our relationship with NASA.

We're one of many contractors to them.

But I think generally, whether you're talking about local government issues or national government issues, the theme here is that more competition is better than less.

And so we run these competitions and we hope to bring in new talent, new technologies to help cities solve problems.

Mayor Pro Tem, we were talking off camera ahead of this, and you asked me about the Las Vegas Global Economic Alliance, which has is promoting this industry wants it as part of economic diversification.

But in that overall goal brought in several companies from out of state.

And, I think tried to woo them into moving to Las Vegas.

How is this like that or not like that?

So the LPGA, they created health care is a vertical because if Las Vegas were to go into another recession, which we've experienced that many times, health is the most stable economy next to gaming.

So you want to have an active, vibrant healthcare industry.

The locate was part of the LPGA and all the cities and county contributed to recruiting some of the biggest companies around the world to think about relocating to Las Vegas.

Eight of the 15 companies were healthcare related.

We know the world is thinking about Las Vegas because of a variety of reasons.

Some of it's our healthcare indicators, some of it's our aging population.

The sports industry in particular creates a Mecca for health care.

To think about why would you come to Las Vegas?

Well, we now have all kinds of sports teams.

We have youth and sports, and it's a major conversation starter.

So those 15 companies, I know they're still thinking about Las Vegas, but I don't think we should be wooing them.

I think they should be wooing us.

We just need to let them know that we're interested.

And that's what this competition is about, is letting those bio health firms around the world know that Vegas is here to stay, and this is a place to come and do business.

And Jason, how are you getting that message out worldwide?

What's nice about our outreach and engagement strategy is that there's a backstop.

So if you go to Bio Health Innovation challenge.org, you can see exactly what's required to participate, how you're going to be assessed, who's going to assess you and what those rewards are.

And so to promote a message that says please come here, please come to this website.

The registration deadline is January 22nd.

Please register to apply.

We can marshal a campaign that starts to attract national and international interest.

Unfortunately, there are many programs like this where you end up begging more questions than answers.

So we've tried to create a place where people can come to see exactly what is required of everyone to compete for resources here in Las Vegas.

Mayor Pro tem, there are requirements for applicants.

They have to have a certain amount of money available upfront.

So the city of Las Vegas is is willing to put $10 million out there.

But there are requirements.

We're not just going to throw away money.

We're not just giving it away to any one group.

It's going to have to be a very competitive process.

They're going to have to demonstrate that they have $20 million to put into the downtown Las Vegas Medical District, and we want to figure out how we can leverage our $10 million with their $20 million to bring about a better healthcare experience for Nevadans.

So how competitive do you expect this to be?

How many applicants, for example?

Our hope is is 25 applicants.

But let me let me tell you this.

I'm very excited.

The city just signed a deal two months ago with Nevada State University because they heard about what we're doing, and they wanted to be a part of the downtown medical district.

So they'll be launching brand new undergraduate degree programs for for people to enter into the health care field.

We also I can't say who it is, but we have a major university that is in negotiation with us to come in to the Las Vegas Medical District, to talk about bio health lab space and without even signing up for the competition.

Yet we know there's already interest in coming in to downtown Las Vegas.

So I think the competition is going to be icing on the cake.

Just putting it out there means that Las Vegas is putting in putting its name out there, for the rest of the world to say this is a great place to do business.

And as Nevadans, we need to welcome them because we need greater health care here.

What is the ultimate goal after you have this lab established?

What do you believe the ripple effects will be here in Las Vegas?

So for my son, when he was hospitalized, we had to go out of state eventually.

Like I said, great doctors, great nurses.

The infrastructure for health care here is about 30 years behind.

And that's scary to say it, but I've lived through it.

We had to go out of state.

What the ripple effect is, is that ten, 20 years from now, Nevada catches up.

Nevada is providing the right health care.

Access is health care is available for everyone who needs it and wants it.

And we are caught up with the rest of the country.

That is the ripple effect of what we're doing.

And we are going to need some, some groups outside of Nevada to look into Nevada to say, we can come there, we can help diversify your economy and we can provide better health care for your residents.

Last question.

How do you determine a winner?

Who takes that and that be you, Jason?

Or so our job is to provide data.

But ultimately, the city council gets to approve how city how city dollars are spent.

So if you go to the website bio Health Innovation Challenge dot, where you can see who those judges are in that first round of assessment, you can see the scoring tool that they're going to use.

And you can even read about the algorithm that we used to make sure that that scoring process is fair.

Once those judges have scored our applicants, they provide that data to the selection committee, which is the city council.

And the selection committee ultimately uses that information to inform a final awardee.

In this case, the money would be a grant to.

That sounds so complicated to me.

So here's how I would say it is.

You have a bunch of really committed people that are trying to make the world a better place, trying to improve health care.

They start talking to each other, they submit an application, there's a panel of judges.

So on the panel of judges, we have hospital CEOs, we have scientists, we have lawyers, we have economic development folks.

So when they submit their proposals, we have all these really important, critical people in Nevada looking at the proposals.

And I'm almost willing to bet there's going to be these collaborations that happen outside of the competition to say, hey, maybe Umkc hospital wants to partner here because they got they saw part of this application and there's a good partnership there.

Once those judges talk, they'll narrow it down to a smaller group of people.

The city council will rely on experts.

So it's not going to be it's not going to be me as an individual saying, I like your firm, come to Las Vegas.

It's going to be me relying on the expertise of scientists and lawyers and hospital CEOs and other doctors that are saying this group is good for Las Vegas.

This is how we improve health care.

And that's what I think is most important about this process, is it builds these collaborations that right now we all kind of operate in silos.

And Nevadans deserve people who are working together to improve health care.

And the decision will be made when the fall of next year, fall of next year, just because we're talking about this, and I appreciate you letting us come in and talk about this in the next six months, I'll be doing two ribbon cuttings for groups that are coming in, because we started talking about this six months ago, because they see that Las Vegas is a place that wants business to come in, wants to improve health care, and there's lots of people out there that just wanted to be asked.

That's what we're doing is we're asking them to come to Las Vegas.

My producer brought up a really good point ahead of this that at one point, it was hard to believe that Las Vegas could ever become a sports hub.

Is it possible that this will be the same for health care in Las Vegas?

That is all I think about.

And it comes back to my kid staying at Unmc hospital.

Great doctors, great nurses.

No one wants to be there for a month and I was there for a month, and it's all I think about it that keeps me up at night is how can I improve health care so that other people don't have that same experience?

This is my best way.

This is my best foot forward to make health care better here in Nevada.

How are your children doing now?

They have a lot of energy right now.

They are very healthy right now.

I'm so proud of them and we wouldn't have gotten anywhere without the health care we do have in Nevada.

But Nevadans deserve a lot better.

My children deserve a lot better and this is how I'm going to do it, is by making other people compete to see how great Las Vegas is.

But my kids have a lot of energy.

They're making me very tired right now.

Gentlemen, thank you so much for joining Nevada Week.

Thank you so much.

I appreciate it.

The $10 million for this initiative comes from the Las Vegas Redevelopment Agency.

The city says the agency serves to revitalize certain parts of Las Vegas, and gets its funding from a percentage of a property tax established when the agency was created in the 1980s.

For more information on the bio Health Innovation Challenge and on the empowered program at Roseman University, go to our website, Vegas PBS.org, and I'll see you next week on Nevada Week.