(soft music) - Patients come to the hospital in opiate withdrawal, surprised to hear that they were in opiate withdrawal because they've only used cocaine.

What they didn't realize is that they were developing an opioid dependence without ever knowing it.

- You know, they don't hear the messages about opioid use disorder and getting into treatment because they think that's not them.

They're just using cocaine, they just use it sporadically.

This is a party drug.

- It's become infiltrated in the drug supplies of not only heroin or opiates, but unfortunately most people know someone that's been impacted by fatal overdose.

(soft music) - Over the last few years, we've really seen fentanyl kind of take center stage in the opioid epidemic, particularly locally, but in many parts of the country.

And fentanyl is a much more concentrated drug.

- It's a synthetic opioid that about 10 years ago was predominantly found in the illicit drug supply of what we usually think of as heroin.

- Fentanyl is very cheap, it's very accessible and it hooks people into whatever they're using.

So we're seeing a lot of cocaine that is spiked with fentanyl.

- It can produce a more extreme high, although it's shorter lasting than heroin.

In what we've seen, the majority of overdose deaths from opioids are fentanyl.

- Before we really understood the pathophysiology and the physiologic changes in the brain that occur with opioid use disorder, I mean, people were very judgmental among people who were suffering with opiate use disorder.

They would say to those individuals like, "Why don't you just stop?"

like it was a choice, but it's not a choice.

- That has a lot to do with how the opioids react with the neurotransmitters, which is basically like where the opioids sit and cause activation and cause pain relief and euphoria.

- Then they'll bind to the opioid receptors in their brain cells.

And where it really stimulates the brain is in the pleasure center.

So the person experiences this extreme feeling of pleasure.

What happens is the opioid receptors, first of all, they become less sensitive to opioids, and then also their opioid use sprouts out more opioid receptors.

So it takes a much larger dose of opioids to experience that same high.

People continue to use initially to seek that high, develop these severe withdrawal symptoms that are extremely unpleasant.

- The withdrawal itself is enough to drive them to want to make it go away so bad that they will seek out more opioids to keep them out of withdrawal.

- [Gale] They develop headaches, muscle aches all over, nauseousness, vomiting, diarrhea.

- And most people get to a point that they're not using anymore to get high.

They're really just using to feel normal and staying out of withdrawal.

That gets them in a position where they feel trapped.

- But those physiologic changes are never going to go away in the brain, and so they're going to continue to have these empty opioid receptors that are driving them to get opioids.

- [Emma] Unfortunately, right now, we're up against about 100 years of history in a country like the United States.

100 years of history of thinking about people who use drugs as either products of a moral failure or products of a criminal mind.

- People have to think of opioid use disorder as a chronic illness.

You know, it shouldn't be stigmatized.

I mean, we don't stigmatize diabetes, we don't stigmatize cancer, so it's the same issue.

There are physiologic changes there in the brain, and it requires medication to be treated and feel well.

- The drug supply in our communities is not the same as it was when a lot of drug treatment programs started.

Homelessness or prevalence of people being unhoused based on national data is rising dramatically.

Anxiety and depression also rising dramatically right now.

Communities have to have a variety of tools and interventions that can appropriately meet people where they're at.

That's usually a phrase that's used to describe harm reduction.

The likelihood of lapse is very real, and we kind of have to normalize that.

Most people aren't going to overnight stop using substances, especially when we're talking about addiction or dependence to a very strong thing like fentanyl.

We think people need state-of-the-art medical care.

So you're person first.

For us, human dignity is a big deal in healthcare and in harm reduction, and especially working with people who use drugs.

We recognize that despite what someone has been through, despite what they have to do to survive on a daily basis, and despite the conditions that they're living within, we recognize that they're a human being, that you get greeted with a smile and you get greeted with a cup of coffee.

And although we are there to serve people who use drugs, you might spend quite a while with us before anyone asks you anything about your substance use.

- What our responsibility is as a community is, again, not being judgmental and offer people options to use more safely, keeping them alive until they're ready to get into treatment.

Giving people access to naloxone or Narcan is the trade name.

If someone is overdosing from opioids, it kicks out the opioids and binds to these opioid receptors, so that's an opioid antidote.

It's really important that we start people on medication addiction treatment with either methadone, which is a very low potency opioid that in the appropriate prescribed doses will not cause people to get high.

Buprenorphine, Suboxone is the trade name most commonly used, which looks like opioid to the opioid receptors and they can go on with their life and regain their life that they've lost because of this chronic illness.

- In western New York, you can get a prescription for buprenorphine and linkage to an appointment 24 hours a day.

You literally can do this from the safety of your home and the anonymity of your house.

Big piece of it is access and linkage to treatment and increasing access to medication.

- So we have a few components that's our opioid overdose response training, teaching people how to recognize the signs of an overdose and then distributing Narcan or naloxone.

We also have a fentanyl test strip distribution program, Xylazine test strip distribution program in our vending machines.

- [Joshua] And they're all outside, so you don't have to go in and talk to anybody.

No one knows your name, we don't ask for your name, and you can get those supplies right from the vending machine or you can request them from the MATTERS program and we'll mail them to you.

- Test strips, fentanyl test strips and xylazine test strips, are an extremely important harm reduction tool.

They are things that help people who are not quite ready to stop using drugs to do so in a safer way.

- Harm reduction is not just drug use.

Like, harm reduction is stuff we do every day like wearing your seatbelt in the car, wearing a helmet while you're riding a bike.

And if you think about it like that and kind of look at drug use that way, that drug use in and of itself is a dangerous behavior, but there are ways to do it safer.

- Success means saving lives, period.

We've got to be able to innovate, do new things, reach people who aren't engaged in care right now.

When people are struggling or facing challenges, they need support, not punishment.

They need to be built up, not knocked down.

- It's important not to give up, and being a support for that person probably means more than you think, and oftentimes, is a big piece of their recovery on its own.

That's the time that they need you the most, and the time that you really should not give up on them.

- Everybody can play a role in combating our opioid use disorder by providing compassion, love, not being judgemental with people who are struggling.

That can save lives, that can be a game changer.

You can be the person that can make that difference.

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