Reframing Substance Use Disorder, with Cheryll Moore

Cheryll Moore has extensive grant administration and project management experience with the Erie County, New York, Department of Health and has directly administered and implemented numerous grant projects over the past 20 years. She has been a leader in addressing the opioid epidemic in Erie County, providing naloxone trainings to first responders and community members and integrating data to focus her efforts. She also manages the nationally recognized community-engaged intervention known as the Erie County Opioid Epidemic Task Force to reduce opioid-related overdose deaths.

Resources:

• Carry Narcan, and know how and when to use it. Text (716) 225-5473 to have Narcan mailed to you for free.
• Seek treatment. Local hospital emergency departments can connect patients to immediate medication assisted treatment, a long-term care provider and a peer who can help with every stage of recovery. Ask for NY MATTERS.
• Seek support. The Buffalo & Erie County Addictions Hotline is available 24/7 with referrals for individuals and their families. Call (716) 831-7007.
• Never use alone. Have Narcan and a friend with you who is not using drugs, or contact a service like Never Use Alone (neverusealone.com)
• Test your drugs for fentanyl and xylazine even if you think it is cocaine or another substance that is not an opioid. Free test strips available from the Erie County Department of Health. Call (716) 858-7695.
• Bars, restaurants and other public establishments can order free materials from ECDOH, as available. Visit bit.ly/ECDOHNarcan for order form or call (716) 858-7695.
• Words Matter - Terms to Use and Avoid When Talking About Addiction

Credits:
Credits: 
Host/Writer: Sarah Robinson, MPH | Kara Kane, MA
Guest: Cheryll Moore, Director, Erie County Opiate Epidemic Task Force; Medical Care Administrator, Erie County Department of Health
Production Assistant/Audio Editor: Sarah Robinson, MPH 
Theme Music: Dr. Sungmin Shin, DMA 

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Transcript

Sarah Robinson  0:00 
Welcome back to Buffalo HealthCast, the official health equity podcast of the University at Buffalo, School of Public Health and Health Professions. I'm your host and production assistant, Sarah Robinson, and I'm thrilled to welcome you to our exciting new season. Over the past seasons, we've delved deep into critical topics such as COVID-19, nutrition, equity, food insecurity and more. But this season, we're taking it up a notch as we continue our journey into the heart of one of the most pressing public health issues of our time, substance use disorder. We'll be meeting with experts, activists, and individuals who have experienced substance use disorder firsthand. Together, we'll examine the intersection of health disparities, socioeconomic factors, and systemic barriers that perpetuate substance use disorders within marginalized communities and beyond. Each episode, we'll unpack the latest research policies and innovative solutions aimed at breaking down these barriers. We'll ask the tough questions, challenge assumptions and empower our listeners to take action. So whether you're a seasoned advocate, a healthcare professional, or simply someone curious about the world of substance use in health equity, Buffalo HealthCast is your go-to source for thought provoking discussions and tangible solutions. Join us for another season of discovery, empathy and change-making. Together we'll strive to create a world where health equity isn't just a buzzword, but a reality for everyone, regardless of their journey through substance use disorder, or other related health conditions. Everyone has a right to good health and we're here to spread that message.

Hello, and welcome to Buffalo HealthCast. I'm here today with Opiate Epidemic Task Force Director Cheryll Moore, a longtime leader in public health around substance use disorder and its response. She leads local collaborative efforts to address the opioid epidemic by expanding treatment and harm reduction outreach. Cheryll is a regular speaker at nationwide conferences and trainings, and we're fortunate to have her expertise in the program. You want to introduce yourself and share a little bit about your background?

Cheryll Moore  2:25 
Sure. Good morning, thank you so much for having me. My name is Cheryll Moore. I'm with the Erie County Health Department. And in my role here I am the director of the Opiate Task Force. So I'm able to bring a personal passion into my work. And it's really critical when we talk about this epidemic today. My background - I've been in public health for over 30 years, I've been here at the health department 25 years, worked in many other different aspects. So I've worked in the world of social work, I also have a degree in nursing. So my background is pretty diverse here.

Sarah Robinson  2:57 
Could you start us off a little by setting the stage, talking about the history of the opioid epidemic in Erie County and how we got to where we are?

Cheryll Moore  3:04 
Sure, absolutely. It's not just Erie County, it's across the whole country, we have a huge issue with prescribing. We had a problem where we identified pain as vital sign - it is not a vital sign. There was an op-ed article placed in the New England Journal of Medicine by Purdue Pharmaceuticals. They are the manufacturer of Oxycontin. In this article, and it was an op-ed, that's an opinion, it was not research. What they did is they had this new drug called OxyContin and they looked at one provider's medical records - it was a very large practice - over the past year and said, hey, people are doing great on this medication prescribe away. It was the beginning of our problem here. Prescribing happened rather rapidly. We identified pain as a vital sign - it is not - it's a symptom that something's going wrong. Something needs to be addressed, underlying. From that point on people were self-medicating, they were doctor-shopping, they were going from one doctor to another without a coordinated response. So nobody really knew what prescriptions they were getting. We didn't really understand what was happening. But what was happening to them is many people were going onto opiate use disorder. They're having chemical changes in their body, they were struggling with the cycle of withdrawal, and really trying to feel okay. It was not about having a party. It was not about going out on a Friday night and, you know, hanging out. It was about trying to mitigate the symptoms of withdrawal. 2014 in New York State, we put a law called I-STOP in place, that limited access to these prescriptions. And from there, we saw an escalation of death.

Sarah Robinson  4:34 
So where are we today with data around opioid poisoning deaths?

Cheryll Moore  4:37 
So today, we're not in a good place. We're also seeing a different individual. At the beginning of the epidemic, as I shared, it was mostly people that were struggling with prescription opioids. When they lost access to them they transferred to street drugs. Heroin is the original opiate - it comes from a poppy farmer field, very costly, but it's also a natural, so it only gets to a certain potentcy. We've learned a lot about this disease and the way this disease works. The more you take, the more you need. Your body continues to develop receptor sites so your tolerance increases. And this really explains the doctor shopping phenomena that we really didn't understand what was happening. Today, we do know that when we cut people off in January 2014, because that can't happen anymore, people were pretty creative. They went to the street. They purchased pills on the street, they emptied out their linen closets. They got things from family and friends. And that ended real quick. By about three months into 2014, those were not accessible anymore and street drugs took over. When we talk about that, it's things like heroin, but also at that point, fentanyl hit our community. Fentanyl; 50 to 100 times stronger than heroin on the street. Today, all we really see is fentanyl. And we think it's in response to disease. It's a much more severe disease that we see out there. So in 2014, in our county, we had 128 confirmed deaths due to opioid overdoses. Now, when we jumped up to 2016, the year that the task force was formed, we had 301 deaths. That number escalated and it was mostly fentanyl, we were learning a lot about it. This is illicit fentanyl, this is much different than the prescription type. It is a powder that is brought into drug cartels, it is modified from the type that is approved by the FDA and DEA. Very, very hard to find and we're thinking it gets a little bit stronger each time. We think the equivalent of three to five grains of salt - so if you think about how much that is, that's all it takes to kill a non-opioid user. So illicit fentanyl. So 301 deaths and that was in 2016. We changed a lot of things. We got treatment accessible, I can literally call up a doctor on my phone today - a program called MATTERS. Really neat, I can get you a link to care on the spot. You can get a treatment agency picked out where you want to go within two weeks and can get a peer to help you get on your journey. Much different. We got the death numbers down 256, and that was in 2019. And then COVID. The isolation of COVID has changed us drastically, changed the face of our community, changed our whole nation. Everybody went home, we did what we needed to do, but we lost a lot of people, learned a lot about the epidemic. People were alone. This isn't a whole homeless person's disease. This is anyone's disease. It's your next door neighbor. It's your coworker. It's the person in line at the drugstore. You have absolutely no idea who it is. And our death numbers escalated. Last year, 2022, we had 307 confirmed deaths due to opioids - higher than we've ever, ever seen. This year in 2023, it's going to be worse. As of July 28, we have 245 deaths that are both confirmed and probable. When I say probable, it means we're waiting the results of the toxicology screens, but we're pretty good at that today. We know from the scenes kind of what's going on. Law enforcement has gotten very good at documentation. The ME's office has gotten very good also. So if we continue on that course we're talking over 400 deaths this year. That is not good. Now, the person's changing, the drugs are changing. We talked about a transition from prescription opioids to street drugs today and we've been able to open treatment. We get people to treatment really well. We talk about things like suboxone, methadone. People need medication. Really working on taking the stigma away. But other things happened at the same time. Drug cartels are nobody's friends. Today, the drugs are different. The majority of the deaths that we see when we look at the toxicology screens are an adulteration of cocaine cut with fentanyl. When we looked at last year's data, and we're talking about the 2023 data, 81% of the deaths so far this year, are combination of fentanyl and cocaine. Much different. This is not somebody that is cycling in the withdrawal cycle. Many times the social user tends to be much older. Cocaine is not a cheap drug. We're learning more, and who has money? Adults do. There's also a perception in the community that cocaine is safe. It's not safe. It's not a safe drug. There is not any safe drugs out there today. Today, the social drugs, when we see things, we talk about social, we talk about things like Molly, MDMA, we talk about ketamine. We also talk about pills. Pressed pills, if you're getting a prescription and you think you are getting a pill that you know what it is, unless you are getting it at a legal pharmacy, you have absolutely no idea what you're getting today. We're seeing more and more there.

Sarah Robinson  9:48 
Wow. So moving on to our theme with this podcast, which is health inequities, how do you think that they show up with substance use disorders both in Erie County and beyond? Are we seeing certain groups more vulnerable or affected more by substance use disorders than others? Or is it what you said - an "everyone" disease?

Cheryll Moore  10:10 
Across the board. And it's a good question. When we listen to the national news, they keep talking about the biggest increasing cause of death in 18 to 49 year olds is opioid overdoses. In Erie County, that is much different. We're talking about an older population, if we want to talk about an inequity - huge. We're talking 50 year-olds, 60 year-olds. When we talk about a component of our population, that is about 10-11% of our population, but we are now experiencing 25% of the deaths. That's huge. That's giant. We talk about race and ethnicity. That is changing. More people with black and brown skin are being affected. Many more people of Native American descent are being affected also. Beginning of the epidemic, the death numbers really aligned with the demographics of Erie County. People of color were really underrepresented. So were Native Americans. People of Caucasian, white descent, it lined right up, 79% white in Erie County, 79% of the deaths were white. We were seeing an under number when we talk about communities of color. In our community, about 14% of our community is a community of color, is about 10% of the deaths. Today we're seeing about 27%.

Sarah Robinson  11:20 
Wow.

Cheryll Moore  11:21 
So, it has shifted. It is not neighborhood specific, we're looking at that, we're looking at ages really, I think is really where we're going here. Ages and types of drugs. There is a perception, with stimulant drugs like cocaine, that they're okay. In an older population. I've heard comments such as, 'I did it in the clubs in the 90s'. We're in 2023. This is a different drug. It's a different world, we really, really need to be careful.

Sarah Robinson  11:52 
And with all that in mind, what is the current state of the counties response in the task force work? I know you touched on it a little bit, but go into detail more about what is happening here.

Cheryll Moore  12:02 
Sure. So the task force meets quarterly. And what we do at the task force meeting is, the seven workgroups report out all the work that's been occurring for the past three months, really not an interactive, it's more of a report out. And then, the feedback comes back and the seven workgroups take the feedback from people that are there and address the issues that they bring up, so really collaborative. Today, changing much differently, outreach activities, a lot of harm reduction. Harm reduction is how we reach people where they are at on their terms. So, in our department, we have many outreach activities that are based on harm reduction, standard areas where people can come they can get Narcan, they can get test strips that can get linked to care on their terms, not on our terms. Community Education Group, consumer education is really working on changing the language. People are not interacting with folks who call them bad names. We can't do that. We have to be respectful. We have to treat people with dignity. So they're working very hard right now on scheduling media visits, to go back to all the media outlets to revisit how we speak about people, the types of pictures we put up there that are triggers, really to change how our community interacts with folks. So that's one area. Matters is expanded. We now have physicians available 24 hours a day, it had been from 11 to 11. So much easier, you know, people can get treatment on their terms, when they need it, not when someone else determines it for them. Training for doctors, that's changed. Today, it's really neat that you no longer need to get a waiver in order to prescribe buprenorphine. So, we're really working with providers to try to take the fear away, to educate them on you know, this is no different than any other opioid you prescribe. And, this person is going to be much healthier, and much happier. And you're going to have a much better patient. So, education with providers also taking fear away there. Other things that taskforce has been redoing, really expanding Naloxone access. We know, if someone isn't breathing, there is no chance of recovery. So, we need to give people a chance, and we need to give them all the chances in the world that they want.

Sarah Robinson  14:13 
I'll add that, Erie County is doing a great job with making the Naloxone and Narcan trainings very accessible, very available. It's great that you're able to do it virtually and get people certificates and send people Narcan. I know I did a training with you a few months ago and I still have my Narcan in my car ready to go if I need it. So definitely something to consider. If you're listening to this, sign up for one of those trainings. They're always happening.

Cheryll Moore  14:40 
And we've expanded access. You can text us, literally sit in your house and text us and we will mail information out to you. We will mail Narcan out to you, we will mail test trips out to you, whatever you need anything to make it as accessible as possible. So all you need to do is text us at 7162255473, it can be 24 hours a day. I will tell you mailings happened during the work week. It will get all stressed. I'm like, but it's during the workweek and they will go out right away. Okay?

Sarah Robinson  15:09 
Perfect. So for our audience, what resources, besides the Narcan trainings that we and the Narcan that we just talked about? What resources does the Erie County Department of Health have for people who are struggling with substance use disorders?

Cheryll Moore  15:23 
We have a whole harm reduction unit. So, we have supplies for folks. We have hygiene kits, we have wound care kits, we have clean syringes, we have Narcan, we have access to clean stems for people, we have access to treatment. And the best part, I think in the whole world, we have our peers, we have a whole team of people in Luke recovery, that have been there, done that, and sometimes just having that shoulder to lean on, to have that person to talk to. And that's what they're there for. They're not going to walk the journey for someone, but they are there to share their experiences, to try to help get over homes, to provide advocacy, to do training with folks. Nobody wants to be sick, I will tell you that. Behaviors we see make us think people want to be sick, and they don't. So getting people in good treatment on their terms. It's amazing how successful it is. Now, then again, we have a second cohort. And this is where this can be really helpful. Anyone listening to this? The cohort is doing cocaine today, much different, not necessarily somebody that does drugs every day, very social, maybe a one time user, this individual telling them they need treatment doesn't fly very well. Because do they? That's I don't know, you know, this is an occasional use, much different. We need to be very careful. We need to get that messaging out to people. And the more we get that messaging out that people, if you're going to socially use these products, you need to test it, you need to go very slow. You need to taste it and have somebody there with Narcan. Education today, teach other, critical. Ask anybody listening to this podcast. Please go talk to two people. This is how we are going to change this in our community.

Sarah Robinson  17:13 
In our conversations before this interview, we talked a little bit about the stigma around substance use disorders, and what your team is doing to reduce and end that stigma. So, how is substance use disorder stigma harmful and what can be done about it?

Cheryll Moore  17:26 
And, I'm glad you brought that up. The stigma around STD and that's really the shortened way to address it is huge. A someone is being called a junkie, they're being called an addict. Those are bad words, we don't call people bad words and expect them to respond appropriately. So, interacting with people appropriately, using good words, people will come in and they'll be like, Wow, you were dirty at your meeting. My question is, why you didn't shower? Like what's going on here? We're talking about people's toxicology reports is what we're actually talking about here. But a way to address someone, why are they dirty? That's not appropriate at all. You have a positive report or a negative report. We use different terms in any other chronic disease, and we have to normalize the same terms in substance use disorder. When we talk about inequalities and we talk about inequities. This is huge. If you are diagnosed with diabetes, we don't call you, "Hey, you bad diabetic". You know, if you have asthma, I don't refer to you as, "Hey, you asthmatic". But we do this in this disease for some reason, and we think it's okay and it's not. It really isn't. The most important part to address inequities here is to work with people with lived experience. And people with lived experiences, voices need to be heard, they need to be respected. They need to be followed because they know so much more than anyone else. This cuts across all ages, all races, all ethnicities, all genders. Respected, honoring, and treating people with dignity and really honoring the experience that they have and listening with open ears.

Sarah Robinson  19:05 
Can we go through, I guess, a short list of like some of the super stigmatized terms and maybe talk about what are more appropriate things to say just for our listeners?

Cheryll Moore  19:16 
Let's use the right terms.

Sarah Robinson  19:19 
At this point, Cheryl reached behind her into a stack of papers in her office and handed me one that had a list of offensive and unfortunately, commonly used terms when we talk about substance use disorder, and the alternative terms that we should be using that are less offensive and more respectful. And I will definitely be linking this information in the show notes. Because it is so important for us to know when we're talking about substance use disorders. And we can definitely include this resource in the show notes as well. But I think it would be helpful to hear.

Cheryll Moore  19:49 
Right, so here at the department, we've developed a piece partnering with the NIH, took some information from them. This is across the whole country, talking about words, words that matter. We don't call people addicts, we call them people struggling with substance use disorder. If it is opioids, it is called opioid use disorder. When we talk about medication, it is not substituting one drug for another. It could be medication assisted treatment, or MAT or medication for opiate use disorder, MOUD. Stratifying this out from other treatments makes it different. And it shouldn't be different. This is just a chronic disease that you're going to treat for the rest of your life. So normalizing, that makes a big difference too. I did kind of address this quickly, when we talk about people being dirty and clean. If somebody has a high glucose level, we don't tell them they're dirty. We say how can we work with you to modify your diet and your exercise, get you the correct medications, to get you managed and in control. And we ask the individual like what works for you. So changing that conversation there, really understanding that people, we can't call people addicts, and I will keep going back to that. Now individuals that are in recovery or struggling along their journey, their language identifying themselves and each other is a completely different subject. Because people will say, "Well, I was at a group and they called each other an addict", that's a different issue, completely different issue. How we self identify is much different than the community identifies. So I think that's something that people struggle with many times. Things such as needles, sharps, syringes, using the correct terms for them. Understanding that there are correct terms, correct terms for drugs, we don't need to call things like crazy names. We need to call things what they are, worked in sexual health for many, many years. If you use the appropriate terms, it normalizes the situation.

Sarah Robinson  21:50 
Perfect. So for professionals, clinicians, health care providers, and advocates, what can they do?

Cheryll Moore  21:58 
They can open their door and have a conversation with their patients, when we're talking about professionals and physicians. Don't shy away from it, scary subject for many, but have the conversation. There are tools that are available for medical practices, they can get trained on how to implement these tools. For medical practices, these are billable, and we understand that they have to stay in business. So they can be trained on that they can reach out to us here at the health department, we'll get them trained up, they can identify their patients, and then the best part, they can get the best referral sources for them to get them help that they need. So when we talk about that, don't shy away, don't ignore it, do not ignore or don't bounce pass that. If an individual starts a conversation with you, as a provider, don't change the subject. Best thing we can do is say I'm always here for you. We're talking about advocates in the community, friends, family members, that's a whole another issue. When we talk about that, that's not the professional. Very hard for individuals that are living in their families, that have issues going on in the families. You have to realize no one woke up one day and, I'll say it again, and said 'I think I'll be a drug addict'. No one did that. But that is untreated disease that we see. We can modify the behaviors with good treatment, bad behaviors go away, and the individual ends up in a much better place. A much, much better place. So, families friends, and I will speak to it personally, we our own best friend and our own worst enemies. Whatever you do, something is better than nothing. And the best thing we can do for our loved ones, is love them. I think today we have to understand that this is everyone. We don't know who it is. We have opinions, but they are not facts. Always look for the facts. They're available on our website. Understand who we're talking about. Don't judge your neighbor, your friend, and take care of each other.

Sarah Robinson  23:56 
Wonderful. So thank you so much for taking the time to speak with us today. This was really informative. We'll share all the resources that we can in the show notes. And really just help to spread awareness about this and hope that people are able to get the help that they need. Thank you so much.

Cheryll Moore  24:13 
Thanks for having me. Yeah, we appreciate it.

Sarah Robinson  24:16 
I would love to just once again thank Cheryl Moore for being such a delightful guest and for kicking off our season on substance use disorder here at Buffalo HealthCast. We continued our conversation privately off the record about substance use disorder after this interview was complete. And, talking to Cheryl was always just such a pleasure, and I'm so grateful that we were able to have her on the podcast. I'd also like to give a quick shout out to Kara Kane, who is the Public Information Officer at the Erie County Department of Health. She reached out and helped us coordinate this episode and helped write the questions. And really, we couldn't have done this episode without her, so, thank you so much Kara. Also the music for podcasts, for Buffalo HealthCast, was written and recorded by the Dr. Sungmin Shin of the UB music department, so thank you, Dr. Shin. And this episode was recorded and edited by myself, Sarah Robinson. Thank you so much for tuning in. Can't wait to see what we have in store for this next upcoming season at Buffalo HealthCast focused on substance use disorders. Buffalo HealthCast is produced by the UB School of Public Health and Health Professions. Make sure to follow us on Twitter, Facebook and Instagram and anywhere you get your podcasts and make sure to check out the show notes of this episode, to find all the resources that Cheryl discussed, along with many others. Thank you so much!