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FOCUSING ON FAMILIES: At our clinic, we serve many parents who have achieved years of recovery. We’ve celebrated some big wins with our parenting clients this year, including completing peer recovery certificates, being admitted to highly competitive degree programs, having CPS cases closed, and buying homes. We get to watch their children grow and thrive throughout the years as they accompany their parents to clinic appointments.


In addition to our direct services with pregnant parenting moms and their families, creating connections to other service providers and providing community education and outreach are keys to our program’s successes. We frequently work to connect our patients with a number of other organizations including Whatcom Health and Human Services, PeaceHealth, Sea Mar, Bellingham Comprehensive Treatment Center, Catholic Community Services, New Way Ministries, Lummi Counseling and many others.


I co-chair a committee of nurses at the PeaceHealth Childbirth Center who are interested in becoming champions in caring for families with substance use disorders (SUDs). Our goal is improving the care of people with SUDs who deliver at the Childbirth Center. We cover topics such as Medication for Opioid Use Disorder (MOUD), pain management in opioid tolerant patients, and motivational interviewing. We’ve had the honor of hearing patients share their stories, including

their SUD history, recovery story, experience accessing health care, and the stigma they experienced as they sought care.


This past year, I provided education on topics such as overdose/Narcan, MOUD, stigma in health care, and trauma-informed care. Audiences included those attending the Whatcom County Perinatal Task Force Conference, Whatcom County Detox, PeaceHealth Childbirth Center and Pediatrics nursing staff, Whatcom Community College students, sober living programs, and several other community organizations.


The fentanyl epidemic has taught us that community and connection are more important than ever. I have been on a team co-facilitating the Lummi New Beginnings Moms in Recovery group that meets weekly at Lummi Counseling Services. We discuss various recovery, health, or parenting topics and also do crafts and play games. It is a safe place for Moms to share openly with one another without judgment. When resources allow, I would love to revive the Moms’ group that we had at CMA a couple years ago, to foster connections and support among the new Moms we

work with. Our ongoing needs include

more access to sober family housing,

transportation, and baby supplies.

Natalie Andrews RN Nurse Care Manager

- Natalie Andrews,
CMA Perinatal
Public Health Nurse

TREATMENT WORKS. RECOVERY HAPPENS.
One client who has been working with CMA for many years is an example of the tenacity required to find recovery, and the remarkable results of those efforts. She grew up as a child of trauma in a home with active substance use. Later as an adult, she struggled for years with opiate and methamphetamine use. Her life was chaotic as she fought to find her way, in treatment for her SUD at times, then out and using again. Eventually she lost custody of her children, and wound up with multiple serious medical conditions related to her substance use that required hospitalization and surgery. Despite the years of struggle, she continued to engage with various community resources and care providers, working her way toward recovery. Eventually, she was able to stabilize on Medication for Opioid Use Disorder (MOUD) treatment, a best practice proven effective for OUD, and we’re happy to report that she’ll be celebrating 5 years in recovery soon! She had another child a few years ago. Throughout her pregnancy she feared CPS would become involved upon delivery because of her past history, but life had stabilized and there was no need for CPS involvement this time. She has managed to build a solid foundation to share with her child and is working to pursue her life goals. She completed an intense course of prerequisite classes over the past couple of years and was accepted into a very competitive health-care degree program this past fall. She just completed her first quarter with straight A's and remains strong in her recovery.

Mindful Body Awareness Training for people in MOUD

CMA has been one of five clinics participating in a federally funded study through the University of WA to look at the benefits of a mind-body program called Mindful Awareness in Body-oriented Therapy (MABT) for people on medication for opioid use disorder (MOUD). MABT teaches body awareness and mindfulness skills to develop skills for emotional awareness and regulation that people can integrate into their daily lives. The MABT program was delivered individually once/week for 8 weeks. The study enrolled 303 people, half of whom received MABT in addition to treatment. Those who enrolled had been in treatment for at least 2 months, and the majority for over 1 year, 50% had chronic pain, and the male/female ratio was 50/50. Approximately 45% indicated ongoing moderate to severe symptoms of anxiety, depression and/or post-traumatic stress disorder.


The results were positive. Of those who received MABT,
77% completed the program and indicated improved body
awareness and mental health, and reduced pain and opioid
craving than those who did not receive MABT (from study
enrollment to 3 months post enrollment).
Participants who received MABT said that this program:

  •  Increased awareness and acceptance of emotions and physical sensations

    • “One thing that I have learned through MABT is to give myself grace, and that it’s okay to feel stressed or overwhelmed. That, instead of running from it, to just sit with it and accept the hard things that are going on and that I have a lot on my plate. I’ve learned to really accept my emotions more and just be with them verses trying to bottle them all up.

I’ve also learned that certain physical pains in my body sometimes can have an emotional connection to them as well."

  • Taught them new skills to help regulate emotions and manage pain

    • “I learned how to slow myself down including my breathing, thinking, & my body. I learned how to dive internally into my body and listen to it. I learned how to distinguish different sensations in my body & what they were trying to say. I learned different tools to cope with physical pain as well as outside stressors.”

 

  • Empowered them to engage in self-care

    • “I am making decisions for myself, like getting my hair cut. I am putting on make-up and taking time for myself. Taking a walk or a drive to have time to myself. Listen to praise and worship music.”

  • Supported their recovery

    • “It just helped me concentrate on my body more than the drugs and it made me feel connected to my body and keep it sober and it made me want to nurture my body and care about it more and give it the things it needs.” For more information on this study, please contact Cynthia Price: cynthiap@uw.edu


Vanessa Romero was Cascade Medical Advantage’s MABT Research Coordinator. She oversaw the implementation of this project in our clinic, and her work was an important factor in the positive outcomes for the patients involved.

The struggle to quit using opioids continues… in a new phase. There’s never been a better time to quit, and it’s never been harder. People genuinely do get temporary relief of pain and suffering from the use of opioids, but unfortunately, they can develop a tolerance quickly, needing more and more over time to find the relief that came so easily at first. Attempts to escape pain become a paradox as tolerance builds and additional pain from withdrawal sets in, leading to desperate behaviors…. behaviors that lead to more pain and problems.


Fentanyl (and its synthetic analogues or “fentalogs”) is not only much more powerful, cheaper and easier to produce than older opioids, but chronic fentanyl use builds up in a person’s fat and muscles so their bodies need more time to metabolize and excrete it. Chronic fentanyl use results in someone suffering withdrawal for a much longer period of time than was the case with prescription opiates, such as oxycodone or illicit drugs like heroin. The medications for opioid used disorder (MOUD), buprenorphine/naloxone and methadone still work very well, but we now have to wait longer initially, for a few days at least rather than hours, before the medication brings relief from the nausea, strong cravings and urges to use.


A number of properties of fentanyl are uniquely more
dangerous compared with other opioids, leading to much
easier death by overdose (OD). For example, “wooden chest
syndrome” seen with the fentalogs, is a sudden complete
muscle rigidity that prevents breathing. Snorting,

smoking, or injecting fentanyl can quickly lead to sudden death. Larger doses of naloxone are often needed, and must be given sooner than with a heroin OD, to be effective in saving lives.


Locally in NW Washington in the 1980-90’s, we saw street OxyContin being sold for one dollar/milligram, or $80 for an “oxy 80.” As this product became less available, inexpensive heroin became more prevalent and cost only $25 a gram; later its price rose to $100 per gram. In recent years, we have seen fake Percocet, blue tablets marked M30, which were fentanyl, sometimes given away for free initially, then costing $10 a tablet on the street. Now they’re available for as little as a dollar a tablet. Euphoria or death for just $1.00! And now we also see Fentanyl powder and tablets in various colors looking like Skittles widely available at low cost on the street.


But the good news is that successfully quitting the use of opioids is greatly enhanced by the proper use of MOUD, and avoiding the “people, the places and the things” associated with former drug use. Strong social support, counseling, “clean and sober” housing, making amends, cleaning up the wreckage, and spiritual transformation, finding purpose, overcoming stigma and shame are all integral to recovery.

Recovery is not easy, yet people do

it all the time. It’s a wonderful life 

transformation. We are grateful to

be part  of our patients’ recovery

journey.      ~ Adam

Adam Kartman MD
Don Logan SUDP

RESOURCES

CAN MAKE ALL THE DIFFERENCE


A key factor in recovery is resources offered by a vast group of providers in the area, and Don is practically a walking directory for finding partners to help with the issues people face as they emerge from addiction. He can often assist patients with intakes for other providers by phone (versus in-person at 5 AM!), connecting patients also struggling with trauma or mental illness with mental health providers, accessing residential treatment when needed, or connecting with other specialized care.
Once stability begins to return for patients in recovery, Don also helps patients move on to rebuild their lives by getting their GED, connecting with employment supports (like WorkSource or Vocational Rehabilitation), or getting started on an educational path such as college or technical school. People in recovery are often more successful when they are able to build new prosocial relationships and activities, and disconnect from the influences that had been in their orbit while their addiction was active. Don is very proud of the 8-page list of resources and collaborative partners he has compiled. It will be an important tool for patients and other providers after he retires this year.

Don Logan is CMA’s Care Navigator assigned to St. Joseph’s Hospital and PeaceHealth Medical Group. In the past 12 months, he’s provided 165 consults to patients in the Emergency Department, One Central, the hospital’s Intensive Care Unit and various other hospital and medical care settings in the area. He also serves patients at the CMA Clinic. Don’s primary role as a Care Navigator is helping people transition into opioid use disorder (OUD) treatment (or treatment for other substances), usually beginning in the hospital, and then assisting with their transition to ongoing care at the Clinic or with other providers. He often sees “brave, resourceful” people who have experienced “years of misery” find “solace” as their recovery begins to take shape. Often, their success hinges on OUD treatment with suboxone, a medication that allows patients to manage their triggers, avoid cravings and remain abstinent. 
Don has been involved with the “Clean and Sober” community for more than 35 years, and his experience in the area helps him shepherd new patients to find meetings they can relate to, and other people seeking recovery to connect with. He’s gratified by contributing to the reunification of many families as parents get well, and proud of the family-friendly environment at the CMA Clinic, where children of patients can feel comfortable playing in the toy box or visiting with Don’s terrier, Violet, while their parents check in with clinic staff. (Don and Violet pictured above left) 
Since 2022, Bellingham has seen a steep rise in the availability of fentanyl, and even harsher consequences for people who use it. It contributes to the acuity of addiction and worsens the complications people face, both while they are using and when they try to quit. Being proactive in getting folks into treatment as early as possible is critical because “it matters when you catch it.” Overdoses continue to plague the region. 
The good news is the medications shown to be effective for other opioid addictions, such as suboxone, also work for fentanyl, but transitioning to those medications is trickier and more difficult to manage for patients using fentanyl. Sublocade, a longer acting monthly medication for OUD, has been a “huge boon” to patients at CMA, and even insurance companies serving Medicaid clients will cover its cost. This is cause for some hope as managing life and remaining abstinent is easier for patients when they don’t need to dose daily.

A HEARTFELT TRIBUTE TO ERIC HARRY 


This past year we lost a dear friend and colleague. Eric Harry (May 6, 1972 – May 18, 2023) was a Care Navigator for Cascade Medical Advantage, in the hospital system and throughout the region. Eric assisted us tremendously in helping individuals overcome addiction. He was a fierce advocate for trauma-informed care, social justice, and recovery from substance use disorder (SUD). His work was featured in our last newsletter. 


Eric had tremendous energy and passion, and when I think of a sparkler, a golden sparkler burning brightly, but also burning for only a short period of time, it reminds me of Eric and his life which tragically ended too soon. In that regard, two quotes come to mind, first Reinhold Niebuhr’s Serenity Prayer: 


“God, grant me the Serenity to 
Accept the things I cannot change, 
Courage to change the things I can, 
And Wisdom to know the difference.” 


But another courageous truth that reminds me of Eric is: 


“I'm no longer 
accepting the things I cannot change ... 
I'm changing the things I cannot accept.” 
—Angela Davis 


Eric was an instrumental force in achieving significant culture change in the local medical community as he worked to improve attitudes and approaches to many previously stigmatized patients. Eric helped foster a recognition and acceptance of the value of medications for opioid use disorder and social supports to many medical providers.
 


Eric brought a deep well of empathy and compassion to his work. As one colleague, Steve Bass, a Peer Recovery Counselor, observed on a filthy downtown street one day: 


“Looking down the street was Eric kneeling on one knee, talking to the gentleman in the wheelchair gathering information of how we could help him.” 


Our partner, Martha Gillham, MD, said this about Eric’s legacy: 


“He has changed our community for the better. He has helped to educate us that addiction is a disease, not a moral failing, to see that harm reduction is a worthy goal. He has also helped us to see that people are not defined by their disease. The people we care for are not junkies or addicts, they are our parents, spouses, siblings, neighbors and children who struggle with a dangerous chronic illness. They are also our friends, who despite knowledge and expertise, tragically may not survive the disease they understand so well...” 


Eric is missed by the many people

he touched. Our sadness for the

loss of this life, full and blossoming,

mingles with the sadness for the

loss of possibilities not realized. 


With immense grief, 
Adam

Eric Harry SUDP

AND YET, LIVES GO ON CHANGING FOR THE BETTER… 
For example, one of the patients Don Logan has worked with for many years was a parent whose addiction had resulted in separation from his family. Because he felt a responsibility to not be around his child while he was actively using, he had lost contact. Reconnecting with his child was an important motivator for this Dad to seek help. Since successfully completing his treatment, he has managed to build his own business and reunify with his child who now lives with him. 

TREATMENT WORKS. RECOVERY HAPPENS.


SPECIAL THANKS TO THE COMMUNITY SUPPORTERS WHO MAKE OUR WORK POSSIBLE:

  • PeaceHealth

  • WA State Health Care Authority, Division of Behavioral Health & Recovery

  • Chuckanut Health Foundation

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