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Someone You Know: Facing the Opioid Crisis Together – An MD’s Perspective on Inclusive Recovery

Someone You Know: Facing the Opioid Crisis Together - Dr. Jeanmarie Perrone

In this second episode of season 3 of the Someone You Know: Facing the Opioid Crisis Together podcast, I invite Dr. Jeanmarie Perrone — director of medical toxicology and addiction medicine at the University of Pennsylvania, and founding director of the Penn Medicine Center for Addiction Medicine and Policy — to discuss her career in addiction medicine, combatting the stigma of opioid use, the impact of newer treatments, the advantages of virtual care, and a lot more.

Listen to our conversation here:

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A full transcript of the episode is also available below.

Season 3, Episode 2 Show Notes

Here are some of our favorite quotes from this episode, resources that were mentioned, and a segment breakdown. Thank you for listening!

Quotes

On what inspires Dr. Perrone in her work every day…

[I’m inspired by] the stories and the engagement we get from patients who find out for the first time that there is treatment, and that they don’t have to jump through hoops to get started on a medication.

It’s terrible to watch this disease and have nothing to offer. Conversely, it feels so satisfying to be able to offer something and watch people get into recovery.

Not every day is a success story, but every single week, we can be touched by a barrier that someone was able to overcome, or someone who took one step in the right direction. It’s really fulfilling.

On combatting the stigma against opioid use disorder…

Addiction is a chronic relapsing disease of the brain, just like diabetes is a chronic relapsing disease of the pancreas. Equating those two as a medical problem validates patients’ huge challenges and the life-threatening risk from this disease.

You’re entitled to see a doctor for this and be treated, just like you are for your hypertension or diabetes. Having that paradigm in the emergency department, and being able to hand our patients off to primary care providers, has created this network of clinicians who are committed and able to do something.

On the impact of fentanyl on opioid misuse…

104,000 people died of overdoses last year. And that really is being attributed to the potency, legality, and ubiquity of fentanyl in the drug supply.

We’ve really tried to saturate our community with Narcan. And we know that that’s effective, but it’s being outpaced by the spread of fentanyl. So, there’s a lot of work to do there.

On inequities in access to opioid use treatment…

Looking at equity across almost all health conditions, we’re seeing huge gaps, like in high blood pressure care and cardiac care. Unfortunately, as we probe into addiction care, those same inequities exist.

Patients who have opioid overdoses have a very low rate of getting into treatment in the next 30 days, regardless of color. But when you break it down by race and ethnicity, the patients who are white have double the rate of people who are non-white.

On overcoming the mindset surrounding the abstinence treatment model…

Abstinence is the basis of Alcoholics Anonymous and a lot of other alcohol treatments, and it’s probably the thing that everybody has a lot of familiarity with. Somebody who’s struggling goes away for 30 days, then they come back, and they go to meetings. And the whole paradigm is to stop drinking, get rid of all the alcohol in the house, get rid of everyone who may influence somebody to start drinking again.

But that’s not the way the story goes with opioid use disorder, unfortunately, because the cravings and the change in the brain that occurs, the neurochemistry really doesn’t get fixed in 30 days. And that patient, who now hasn’t had opioids for 30 days, is even more vulnerable to fatal overdose. And the fact that they need to hide their use so dramatically leads to people running off, getting opioids, hiding somewhere, and then, unfortunately, having a fatal or non-fatal overdose in an area where they’re fearing being found out again.

On the significance of Suboxone (buprenorphine and naloxone) in treating patients undergoing opioid withdrawal…

A couple of years ago a young girl tried to quit opioids on her own. She was having so much nausea and vomiting, and was just so sick, that she called an ambulance. And in the emergency department that day, we said, ‘Look, have something for you that will stop the vomiting and make you feel better. You can start it right now, and we’re going to give it to you in half an hour. Are you okay with that?’ And she said, ‘Oh my God, I didn’t know that was a possibility.’

We gave her one dose of Suboxone, and she just felt OK. She wasn’t intoxicated. She just felt normal, she said. And she was so relieved and so grateful.

That reversal — from ten-out-of-ten of misery to just feeling normal — is a gift. And people don’t know, families don’t know, that there is a treatment that can mitigate the symptoms of withdrawal and get you off of these highly lethal fentanyl and other opioid compounds.

On the difference the CareConnect Warmline has made

Through support from the Philadelphia Department of Public Health, we created the CareConnect Warmline, a substance use portal that patients can call. Their first call is answered by a substance use navigator who either has personal or family experience with substance use challenges. It’s an adjunct to the emergency department, allowing patients to get care in a patient-centered way.

It’s a lot less expensive than going to the emergency department. It’s a lot more favorable in terms of the barriers that patients have, like transportation, childcare, and appointment making. They can get treatment within a few hours. And that’s really the goal — mitigating the harms of opioid use disorder by having a low-barrier treatment option.

On improving access to treatment in Philadelphia and beyond…

We are making great strides in access, but we do need to expand a little bit more. We need to get more health centers and primary care practices comfortable with this. And it’s a big shift.

When Baltimore had a heroin escalation in the ‘90s, they basically opened more methadone clinics, they got more buprenorphine prescribers, and they watched the death rates go down just because treatment access expanded. I would love to see that turnaround in Philadelphia.

And telehealth has been a wonderful strategy. Our model with the CareConnect Warmline is growing, and hopefully we’re going to be able to work with the state to grow it more in rural areas that don’t have access.

Episode Segment Breakdown

00:00 – 06:22: I introduce the podcast and introduce Dr. Perrone. She describes how she came to specialize in addiction medicine and what motivates her and keeps her engaged in opioid use treatment.

06:22 – 10:48: I talk with Dr. Perrone about the stigma associated with opioid use disorder and the increasing influence of fentanyl on opioid use and overdoses.

10:48 – 16:28: Dr. Perrone explores how buprenorphine and Suboxone have revolutionized the treatment of patients undergoing opiate withdrawal and the increasing role of primary care practices in treating patients with opioid use disorder.

16:28 – 19:45:  Dr. Perrone describes the genesis of the CareConnect Warmline and the advantages of telehealth in opioid use treatment.

19:45 – 23:48: Dr. Perrone talks about health inequities in opioid use disorder treatment and why an abstinence approach is ineffective in treating patients with opioid use disorder.

23:48 – 28:30:  Dr. Perrone shares the goals of the Penn Medicine Center for Addiction Medicine and Policy and the impact that she would like to have in her field, both locally and nationally.

28:30 – 31:40: Dr. Perrone acknowledges how the Independence Blue Cross Foundation has supported her work.

Additional resources  

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Full Transcript

Season 3, Episode 2 Transcript: An MD’s perspective on Inclusive Recovery

Heather

You’ve been at this work for many years. I won’t date you. But your bio, you know, takes it back a couple of decades at this point. And first, I wanted to just understand a little bit more about why you went into this field of medicine. Obviously, in today’s world, we’re talking a lot more about substance use disorder and addiction medicine.

What was it like when you started and what was some of your thinking going into this field?

Dr. Jeanmarie Perrone

Yeah, it’s been quite an evolution. It’s a really good question. I actually did an emergency medicine residency at Thomas Jefferson in Philadelphia. I was really interested in the concept that emergency physicians treat everyone who walks through the door regardless of insurance or other status, and we treat people in the order of the acuity of their disease. So, it’s not it’s not like other places where people make appointments and there’s insurance, you know, a prerequisite. So, I love that about emergency medicine, and I love that we could take care of a variety of diseases across the age spectrum. After my emergency medicine residency, I did a two-year fellowship in medical toxicology at Bellevue in New York, and that was really studying poisonings and overdoses, but not just substance use. It was people who had depression and tried to overdose on pills. And fortunately, in that era, a lot of medications got safer and people were doing better because we were actively making policies to prevent poisonings and overdoses in children by having safe packaging and a lot of other strategies. So that when I started my actual career in emergency medicine and medical toxicology at Penn, poisonings were less common for the first five or ten years, or serious poisonings were. But then we started seeing this new subset of people, which was people who had become dependent on opioids because of pain medication. And what we really saw in that era was a lot of liberalization of opioid prescribing that was supported and promoted by various sort of misguided incentives around treating pain. It was a nice concept to treat pain aggressively but that did not mean or should not have meant everyone gets opioids, and so that fueled a lot of interest in opioids. It fueled a lot of overflow and opioids that got into teenagers and other places. And so that’s when I became aware that we should change prescribing. And I started trying to teach clinicians and colleagues that really for young people with, you know, sprains and strains, they should get ibuprofen instead of oxycodone. So from that work over a few more years, that evolved into picking up the pieces of the patients who now had opioid dependance and opioid addiction. And that’s when I started doing addiction medicine care. So, it’s been an evolution and a lot of observations made in the clinical environment of where the needs were and who was being left behind and who was being harmed by some of our practices.

Heather

With the longevity of your clinical experience and in substance use disorder, addiction medicine, how do you what drives you? What motivates you to keep engaged? And maybe this is it maybe it’s in part, you know, that you are an emergency medicine physician still obviously practicing, what’s kept you engaged?

Dr. Jeanmarie Perrone

Yeah. I mean, I think it’s many different things. I think it’s the clinical environment. Like you said, you know, the stories and the engagement we get from patients who find out for the first time that there is treatment and that they don’t have to jump through hoops to get started on a medication. So that’s really satisfying. And I work with the most amazing team of people who are both in recovery or have gone into this work because they’ve suffered with a family member who struggled and they’re just, you know, really wonderful harm reduction advocates. So we have an amazing team at the Center for Addiction, Medicine and Policy. And honestly, it’s the circle that they have brought in with patients and success stories that just makes it so satisfying. So, you know, not every day is a success story, but there’s always some something every single week where we can just be touched by a barrier that someone was able to overcome or, you know, one step in the right direction. And it’s just really fulfilling.

Heather

I think that really does speak to also the issue of stigma

Heather

What does that look like? The stigma of addiction. And in emergency medicine, you’re saying, you know, emergency medicine is attractive to you because it’s all people. You’re going to see many disease states you’re going to see people at various stages of need. What is what does stigma look like to you?

Dr. Jeanmarie Perrone

Yeah. I mean, I think that we’ve evolved a lot in the emergency department, but in the early days, stigma looked like people calling patients, you know, the word drug addict that persisted, a drug addict coming in for a fix. And they would apply that to people who had opioid use disorder or people who were coming in who had pain problems and were coming in asking for pain medication because their chronic disease had them dependent on opioids. So, we did a lot to reframe the challenges that patients faced. We did a lot. I really give a lot of credit to a nurse that I’ve been working with for about ten years, Rachel McFadden, who came and just came along as a partner. She was a student, I think, when I first met her. But her work has really been to reshape the language around treating patients. And she’s just an admirable character. And the way she presents herself in the emergency department is really one that her colleagues want to emulate. So, seeing her being respectful and kind to patients and the rapport that she can get to a patient, my patients are afraid and they’re scared and their feet feel sick and you know, she treats them with compassion and blankets and really love and they you know, they turn around and they give her that love right back. And her colleagues see that, and I think that’s just been a model for, you know, we’re all in this together. We don’t we don’t we should be had adversarial positions. We should be trying to help everybody equally. So, it’s evolved a lot. But I think that we have a lot of advocates now on our own, our nurse and clinician teams that we didn’t have before.

Heather

That’s great to hear, been in a tremendous backslide in terms of where we are today compared to two, three years ago in overdose deaths. Back in 2020 there a stat about 25% increase across 25 emergency departments for opioid overdose rates, not death rates but just the rates of overdose from opioids. What are you seeing today?

Dr. Jeanmarie Perrone

We are still seeing a lot of missed opportunities. There are, you know as you know statistics. 104,000 people died of overdoses last year. And that really is being attributed to the potency, legality and ubiquity of fentanyl in the drug supply. So, we’re seeing fentanyl in cocaine, we’re seeing fentanyl in methamphetamine and we’re just seeing, I think fentanyl really being inexpensive and widely available. So, it’s almost like that Oxycodone 15 years ago was easy to find on the street. Now people who maybe aren’t looking for that kind of potent substance, but it’s just there. People are getting exposed when they didn’t ever intend to be in that in that route. So, we’re seeing more overdoses and people who don’t use opioids. So, you know, people who are using cocaine historically and an opioid gets into their cocaine supply, they’re opioid naive, so they don’t have tolerance and they just have an overdose. So that’s where Narcan comes in. We really tried to saturate our community with Narcan. And I think we know that that is effective, but it’s being outpaced by the potency of fentanyl. So, there’s a lot of work to do there. We know that, you know, buprenorphine or Suboxone treatment protects against opioid overdose, but people don’t have wide awareness of that. And so there’s a lot of opportunities for education and then just what we call low barrier for getting people into treatment without, you know, 30 days of, you know, agreeing to go away or, you know, we just need to like start treatment the same way people want to get started.

Heather

Maybe we can talk a little bit more about that because you’ve been at the forefront nationally and certainly here in the Philadelphia region of a lot of that work. Do you want to talk a little bit about whether it’s the research side or the program side of things that are happening that you’re involved in to increase those early initiation rates for our individuals?

Dr. Jeanmarie Perrone

Yeah, I sure would. About four or five years ago, we started kind of educating our colleagues and it was, like I said, a little bit of a kind of next step from changing our opioid prescribing to adding buprenorphine or Suboxone to the skill set of emergency physicians to be able to start somebody who came into the emergency department second withdrawal. I can remember a young girl who took an ambulance to the hospital a couple of years ago who had tried to quit on her own. She had started using oxycodone from her family member. I think actually originally it was prescribed to her. And then when her prescription ran out, she just started using another family members. And over the course of six months to a year, she’d had multiple episodes where she went out of her way to get opioids or was buying opioids on the street and now realized that what she was buying was actually not oxycodone anymore, but pressed fentanyl tablets and that that really terrified her. So, she quit about 48 hours before she came to the hospital, but she was having so much nausea and vomiting and was just so sick that she called an ambulance and we were in the emergency department that day. And, you know, we just said, look, we have we have something for you. We have something that will stop the vomiting, will make you feel better. You can start it right now and we’re going to give it to you in half an hour. Are you OK with that? And she said, oh, my God, I didn’t know that there was a possibility. And we gave her, you know, one dose of Suboxone and she just like felt OK. She wasn’t intoxicated. She just felt normal, as she said. And she was so relieved and so grateful and just that that reversal of being a ten out of ten of misery to just being normal is a gift. And people don’t know families don’t know that there is a treatment that, you know, that that can mitigate the symptoms of withdrawal and get you off of these you know, highly lethal fentanyl and other opioid compounds.

Heather

We often, I think, assume that the patients will know how to advocate for themselves or that there is a mistrust with the medical profession. And of course. Right. If you prescribe me an opioid now, you want to put me on a different medication, what does that look like in your world? Because there’s got to be a mix of very different attitudes and perceptions even among colleagues, but also among patients.

Dr. Jeanmarie Perrone

Yeah. So I mean, before, you know that patient scenario, we would have a patient like that come in and she would get treated with a variety of medicines to make her feel less miserable, none of which would work completely. So, you know, it became more of a possibility that emergency physicians could actually start writing prescriptions for Suboxone. So about around that same year, five years ago, we there was a lot of you know, there’s a lot of regulations around opioid prescribing that goes back to the 1920s. But in order to prescribe Suboxone, you actually need to take an eight hour course. And that’s a big commitment for clinicians. So around that time a few years ago, we actually tried to get all of our emergency physicians to take that course and that was a big hurdle. But we did it over a six week period. Everyone took the course. So 100% of our prescribers and providers were able to treat anyone. We started a program through all of our downtown emergency departments where people could come in and we could start their first prescription or start their first dose of medication and then hand them off to our primary care providers who had also taken that course and who were basically integrating addiction care into primary care. So these patients would have high blood pressure and heart disease, but they also had opioid addiction, but they didn’t have to go to a different clinic for their opioid addiction. You know, addiction is a chronic relapsing disease of the brain, just like diabetes is a chronic relapsing disease of the pancreas. And so equating those two as a medical problem, you know, validates the patients huge challenges and life threatening risk from this disease with you’re entitled to see a doctor for this and be treated just like you are for your hypertension and diabetes. So having that paradigm in the ED and being able to handoff to our primary care providers has created this network of clinicians who are committed and able to do something. You know, it’s terrible to watch this disease and, you know, there’s nothing I have to offer. And conversely, it feels so satisfying to be able to offer something and watch people get into recovery. I know for my primary care colleagues, they often tell stories of, you know, when they told their practices that they wanted to do this, there was a little bit of pushback. And now that those same people who. Pushback in the office setting are the ones who bring in the birthday cake for the woman who celebrates a year of recovery and coming to the office and so, you know, it’ s a wonderful thing to participate in the joys of recovery and patients new lives and getting back to work and family in a successful way.

Heather

That’s incredible. I do want to keep going with things that you’re involved in. We could literally talk all day about things that you’re involved in. But Care Connect does it, something we could talk about and have a little bit more about.

Dr. Jeanmarie Perrone

So really in the pandemic, we had this great program of people coming to the EDI starting care, but people weren’t coming to the aid during the pandemic. And patients would be calling our recovery specialists and say, you know, I need a refill of my Suboxone or I dropped out of care, but now I want to get back into care, but I can’t go to the E.R. because I’m terrified. And so we started in March and April of 20, 20. The DEA and other organizations changed the regulations around prescribing buprenorphine. There used to be a requirement that you had to have an in-person face to face visit in order to do that. And because of the pandemic that was waived to allow telephone and audio visual telehealth so we really started doing that in in sort of spontaneously. It was a little bit of a challenge because we had to make a patient encounter. We didn’t have a medical record. There wasn’t anyone set to do this. So we did a lot of improvisation. But what we learned was that the patients loved it. They didn’t have to come to the ED, and we even as much as we were proud of what we were able to do, it’s not the most friendly environment. It’s an expensive environment. So we’re able to shift that through. Support from the Philadelphia Department of Public Health. We created the Care Connect Warm Line, which is a substance use navigation portal so that patients can call their first call is answered by a substance use navigator who either has personal or family experience with people with substance use challenges, and they navigate them. Are you someone who you think you want? Methadone? Here’s what we can offer you in terms of morphine. We can get you started today. If that seems like a good option for the patient, you then connect them with an appointment with our pen medicine on demand, which is our Penn virtual urgent care. And the writers there have been trained in morphine prescribing. So, they’re a wonderful group of nurse practitioners who will then meet with the patient officially, either by phone or by a visual telehealth and start a prescription and prescribe to a pharmacy. And we can support the patient getting to the pharmacy and then starting that recovery journey. We also make appointments back to our primary care. So, it’s really an adjunct to the emergency department and allowing patients to get care in a patient centered way. It’s a lot less expensive. It’s a lot more favorable in terms of the barriers that patients have. Transportation barriers, childcare barriers, appointment making barriers. They have a treatable moment, and they can have treatment within a few hours. That’s really the goal of mitigating the harms of opioid use disorder by having a low barrier treatment option.

Heather

I think it’s incredible. And I think it really does demonstrate when you can start to meet people where they are and really and get not only get them in that moment, but make sure that what they the types of resources the individual the patient needs are available to them. Like you said, low barrier. When we talk about addiction and the history of addiction in our in our country and where we are today, I wanted to just get your thoughts on equity and equitable access to treatment and recovery supports and what you’re seeing as an emergency physician throughout your career.

Dr. Jeanmarie Perrone

Yeah, I think, you know, as the importance of looking at equity across almost all treatments we’re seeing huge gaps. I think you could look at high blood pressure care. You can look at cardiac care. Unfortunately, as we probe into addiction care, those same inequities exist. Patients who have opioid overdoses have a very low rate of getting into treatment in the next 30 days, regardless of color. But when you break it down by race and ethnicity, the patients who are white do have double the rate of people who are essentially nonwhite. So we know that there are inequities. We’re not sure if those are insurance based, because sometimes when you stratify by insurance, the inequities exist. So we’re looking at other challenges. Is it because people. Not aware of treatment options, or are they not interested in taking a medication for it for this problem? Is it because of religious reasons? So there’s really quite a lot of work to be done to explore why the gap exists. We are doing a lot of efforts in some of our communities around our downtown hospitals to try and identify what factors people would be more comfortable exploring. Because whether you look at methadone or buprenorphine or, you know, other inpatient treatments, there has been this equity gap across all of them. And unfortunately, abstinence is a very challenging route to be successful. Abstinence is the basis of alcohol, Alcoholics Anonymous, and, you know, a lot of alcohol treatment, which is probably the thing that everybody has a lot of family and other familiarity with somebody who’s struggling goes away for 30 days and then they come back and they go to meetings. And that’s the whole paradigm is to do drink, you know, stop drinking, get rid of all the alcohol in the house, get rid of everyone who may influence somebody to start drinking again with opioid use disorder. The treatment it really the successful treatments, either buprenorphine or methadone, really require a patient to take a medication. And that medication reduces their risk of overdose death by 60%. So having this dramatic evidence basis for medications is hard to translate to the public because people really love this idea of you know I paid to have my son go away for 30 days. He came back we watched and really closely and you know he did great. But that’s not the way the story goes unfortunately because the cravings and the change in the brain that occurs the neurochemistry is really doesn’t get fixed in 30 days and so those cravings they will you know somebody will they will recover and we know they will recover. And that that patient who now hasn’t had opioids for 30 days is even more vulnerable to fatal overdose and the fact that they need to hide their use so dramatically leads to people running off, getting opioids hiding somewhere and then, you know unfortunately having a fatal or non fatal overdose in an area where they’re fearing being found out again. So it’s a bad cycle and I think a lot of education around why medications are important is really probably the biggest stigma we need to overcome because you know, clinicians have it, too. Clinicians think that we’re sort of substituting one medication for another and we need to really overcome that with the evidence.

Heather

I think that is a great segway into what again, your work. I wanted to make sure we had a minute to talk about the Center for Addiction Medicine and Policy that you are founder of. Can you can you share a little bit more about the focus of the center and what the objectives and goals are of that work?

Dr. Jeanmarie Perrone

Yeah, I can you know, I think Penn is a powerhouse of research and clinical care particularly cancer care, transplant care, primary care. But when it came to addiction care, our focus was a lot more on research and a little less on clinical opportunities. I often told people that if you’re, you know, your 20-year-old son was diagnosed with Hodgkin’s lymphoma that you would look at our website and you wouldn’t know which amazing expert to you know to try to get an appointment with.

Dr. Jeanmarie Perrone

But if your son was diagnosed with opioid use disorder at 20 which is probably ten times more fatal than Hodgkin’s disease at this point, you wouldn’t be able to find a clinician or as of a few years ago who specialized in that. So we really wanted to bring the power of Penn’s clinical research and education. You know Expertise to integrating that across all the departments that we’re doing little bits of work.

Dr. Jeanmarie Perrone

So primary care, medicine, internal medicine, family medicine, emergency medicine, and psychiatry all together have a little piece of this. But we really needed to integrate across those because there is no Department of Addiction medicine. And so we’re really still working together to create more educational opportunities in the medical school and more clinical opportunities for students to shadow us in the emergency department or shadow us in primary care doing this work and elevate the field of addiction medicine, which is relatively new compared to you know, cancer care or other things that we do and really make it a top priority, given that it is the cause of so much mortality in our city.

Heather

Absolutely. I mean, the work that you do and I know that you and you’re part of these amazing teams as well, it’s just so incredible. You kind of alluded to this earlier.

Heather

It’s not always a happy ending. There’s not always that like that’s those are the most satisfying when you have to have your stories. But, you know, you want to have impact in your work, right? It’s why I became a doctor. What’s the kind of impact that you want your work to have either locally or nationally?

Dr. Jeanmarie Perrone

It would be wonderful in Philadelphia to be able to track you know, there’s this graph that I show about buprenorphine in Baltimore. So the evidence that medications work and when they had a heroin escalation in the nineties, they basically opened more methadone clinics, they got more buprenorphine prescribers, and they watched the death rates go down just because treatment access expanded I would love to see that turnaround in Philadelphia.

Dr. Jeanmarie Perrone

And it’s possible we are making great strides in access, but we do need to expand a little bit more. We need to get more health centers and primary care practices comfortable with this. And it’s a big shift. You know, it’s hard to teach physical emissions to do something new. And I think telehealth has been a wonderful strategy. And I think our model with the Care Connect Warm Line is growing and hopefully we’re going to be able to work with the state to grow it more in rural areas that don’t have access.

Dr. Jeanmarie Perrone

But I would love to see the turnaround in Philadelphia that could be correlated with more medications and more easy access treatment opportunities. And that’s possible both in a data analytics, you know, we have we have ways of tracking this data and also and just treatment access. I think I think more younger clinicians are getting this training in school.

Dr. Jeanmarie Perrone

We are actually starting an addiction medicine fellowship at Penn, which has been also a long-term goal of ours that we’re going to start in July. So, creating the pipeline of more clinicians because at this point we have a handful of literally five people who are addiction medicine boarded and we probably need 100 for our health system. So, growing that pipeline and also creating the treatment opportunities with low barriers for people to just walk in and get care or pick up the phone and get care.

Dr. Jeanmarie Perrone

I think that’s really where we’re going in the future and it can make that turnaround impact.

Heather

I think that gives Kansas, as you know, the obviously foundation has been committed to this work for a number of years now, and it’s part of how our paths connected and crossed and hopefully continue to get to work with you on all of all of the great work that you’re doing today and certainly on the strategies that you have in mind for the future.

Heather

I could spend way more time than you have talking about some of your more recent endeavors with hearings, et cetera. But I’m just really appreciative of you making the time for us and our listeners to hear from you. Today.

Heather

And I think that you have given an incredible perspective from someone who’s been in the field longer than a lot of the mainstream narrative has been around and it’s important and it’s important that you that we keep supporting you as a leader in this space.

Dr. Jeanmarie Perrone

So thank you. I would love to thank the foundation a couple of years ago, three or four years ago, you supported one of our first pilot studies in getting clinicians X waiver. And as I mentioned, there was this whole eight hour requirement that clinicians had to take in order to get comfortable. And we thought that if we gave people a 20 minute version of it, they could feel comfortable prescribing buprenorphine or administering Narcan in the emergency department.

Dr. Jeanmarie Perrone

And that study actually did demonstrate in 110 or so clinicians that if you gave them the short version, they’d get the idea. And that’s and we found that a third of the patients that they got, the short version actually were able to give buprenorphine in the emergency department and that’s actually even more pivotal now that the eight hour training is not required for emergency physicians.

Dr. Jeanmarie Perrone

But what we’re finding is people still want a short version of how to do this. So we’re still relying on those training work that we did that you supported, and hopefully that will continue to be a strategy for the quick fix and make this really part of everyone’s early education on addiction treatment that is becoming part of medical school, basic science education.

Dr. Jeanmarie Perrone

So, I thank you for your support.

Heather

We appreciate the opportunity always to collaborate, and I look forward to our continued conversations, not on this podcast, of course, but our continued conversations around ways we can keep moving that needle. And, and again, getting to a place that you are very confident that we can be as a as a city and as a region in terms of getting folks into treatment. So thank you again so much.

Dr. Jeanmarie Perrone

I hope we can talk again in two years and with that graph together.

Heather

I hope so too. And I hope it can be I hope we can be even more connected on how to get there.

Dr. Jeanmarie Perrone

Thank you. That’s a great vision.

Heather

Thanks. Thanks, Dr. Perrone. Great seeing you.

Dr. Jeanmarie Perrone

You, too. Thank you for your time.

Disclaimers
This podcast contains opinionated content and may not reflect the opinions of any organizations this podcast is affiliated with.
This podcast discusses opioid use, opioid treatment, and physical and psychological trauma, which may be triggering for some listeners. Listener discretion is advised.
This podcast is solely for informational purposes. Listeners are advised to do their own diligence when it comes to making decisions that may affect their health. Patients in need of medical advice should consult their personal health care provider. The purpose of this podcast is to educate and to inform. It is not a substitute for professional care by a doctor or other qualified medical professional.

Heather Falck Major

As the first executive director of the Independence Blue Cross Foundation (Foundation), Heather Falck Major is responsible for advancing the Foundation’s thought leadership and grantmaking to drive equity and impact health in communities across southeastern Pennsylvania. With nearly two decades of healthcare experience, first as an underwriter and more than ten years in corporate philanthropy, Heather has helped shape the strategy and programmatic direction of the Foundation since its launch.

Heather has day-to-day oversight of the Foundation’s grants administration, operations, and programmatic initiatives and the Foundation’s Institute for Health Equity, a $15 million commitment to advance health equity in our region and nation. She is responsible for Foundation communications, including managing editor and contributing author of its award-winning publications and is the host of the Foundation’s internationally reaching podcast, Someone You Know®. Heather is a member of the Corporate Engagement Advisory Committee at her alma mater, the Pennsylvania State University, and serves in advisory and committee roles for the PA Action Coalition and Urban Affairs Coalition. Heather is an inaugural member of the Leonard A. Lauder Community Care Nurse Practitioner Fellowship Advisory Board at University of Pennsylvania School of Nursing and was recently appointed to the Board of Consults for the M. Louise Fitzpatrick College of Nursing at Villanova University.

Heather resides in Philadelphia with her husband, son, and their Great Pyrenees dog.

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