Volume 33 Number 30 Szalavitz’s harm-reduction history a must- August 2, 2021 read for the field Print ISSN 1042-1394 Maia Szalavitz is often viewed as an Online ISSN 1556-7591 enemy of treatment. Her frequent Bottom Line… outspoken criticism of substance The new — and first — book about use disorder (SUD) treatment, the history of harm reduction and its intersection with addiction is out, In This Issue… mainly on social media, make the Mfield cautious about her. But in fact, and worth a read. Our page 1 stories an important book her solid reporting and journal- about the history of harm reduction, ism make Undoing Drugs, her new We talked to Szalavitz last week including an interview with author book on the history of harm reduc- about the book, which was released Maia Szalavitz, and the challenges of tion and the connection to addic- July 27. replacing retiring longtime SSTAR CEO tion, essential reading, especially “I thought about this for many Nancy Paull. for treatment providers. At a time years, and in fact, I was afraid of . . . See stories, this page when books about SUDs, especially doing it because there’s so much about opioids and especially by about writing about a political Meeting: Make OUD medications people who previously had opioid movement that’s really hard,” said available in jails and prisons use disorder (OUD), are flooding Szalavitz, who herself is in recovery . . . See page 3 the market, it’s a pleasure to read from OUD, and was in treatment Recovery-informed theory: one that is so well informed. See Book page 2 Make room for experience . . . See page 6 Retirement of a longtime leader triggers States make $26 billion opioid deal with major drug companies a soul-searching process . . . See page 6 Any planned departure of an orga- longtime CEO Nancy Paull plans to nization’s top administrator gener- leave the organization next January. ates a healthy amount of anxiety The carefully designed components among staff, and often the commu- of its search for a new chief exec- 2019 recipient of Henrick J. nity served as well. When the exit- utive can offer guidance to other Harwood and Robert E. ing leader has been at the helm for addiction treatment organizations Anderson Award in A Recognition of an decades and has shepherded a suc- that soon will face the retirement Individual’s Distinguished cessful organizational transforma- of top leaders from a baby boomer Service in the Field of Addiction Research, tion, the level of concern about the generation that largely built the sub- NEWSLETTER WRITING Training, and Evaluation. future can rise exponentially. stance use treatment industry from The team at Fall River, Massachu- the ground up. setts–based SSTAR (Stanley Street Using the term “addiction treat- Treatment and Resources) is experi- ment organization” to describe Honorable Mention 2016 Michael Q. Ford Spot News 2016 Journalism Award encing the full range of emotions as SSTAR is something of a misnomer, actually. Paull’s decision to pursue FIND US ON FOLLOW US ON Bottom Line… a fully integrated behavioral health As SSTAR searches for a new chief and primary care model, at a time when most saw only insurmountable adawnewsletter ADAWnews executive, it is emphasizing the importance of engaging its existing hurdles to such a move, transformed © 2021 Wiley Periodicals LLC staff and remaining true to its SSTAR into a federally qualified View this newsletter online at wileyonlinelibrary.com health center (FQHC) operation DOI: 10.1002/adaw integrated care mission. See SSTAR page 7

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Book from page 1 but “at least it shows that you’re get- when you’re making money from with methadone in her 20s. “You ting somewhere.” something,” said Szalavitz. This is have to decide who to put in and And, as Szalavitz stresses in one of the risks that harm reduc- who to leave out, and that’s hard Undoing Drugs, there’s a difference tion is facing via co-option as well. for me as a human being,” she told between being a service provider For treatment, Szalavitz pro- ADAW. “There were several other and being a radical on the street. moted “evidence-based treat- people I thought might [write this Both are part of harm reduction. ment that appropriately cares for book] who didn’t, and I realized She also looks at the harm- patients.” As for 12-Step modalities, that people’s memories go.” reduction origins, when it comes she doesn’t think there is any basis With so much money being to syringe exchange, in HIV and for its incorporation in treatment. added to the SUD pie — in preven- AIDS. The HIV-AIDS activists like “It’s fine to recommend 12-Step, tion, treatment, recovery and now ACT UP were out in force, profes- but to teach people that they are harm reduction — there is “always sional and accomplished a lot; why powerless over alcohol interferes the danger of co-option,” said Sza- hasn’t the drug-using community with what we know, which is that lavitz, responding to our ques- been able to do the same? “I don’t the idea of powerlessness can make tion about how formerly grassroots think it’s surprising that we haven’t people relapse more badly.” organizations would handle new seen that kind of activism” by drug Another reason Szalavitz grants. “This can be very difficult, users, people in recovery and their opposes incorporating 12-Step especially when you have people advocates, she said. “By the time groups into treatment is that “you who have no experience manag- the AIDS epidemic happened, gay can get that for free elsewhere.” ing” these grants, she said. The big- people were less criminalized” Her bottom line: “Treatment should gest danger is that “co-option takes than they had been, or than drug be treatment; self-help should be the spirit out of” the harm-reduc- users are now. Also, many people self-help.” tion movement, she said. in recovery “just want to get on However, she thinks the 12 Steps However, staying grassroots with their lives; some are devoting hold benefits for everyone. “I believe means staying less effective than their energy to becoming counsel- that every human being could ben- harm reduction could be, some ors,” she said. efit from taking a moral inventory,” say. “Every movement wants to go she said, referring to Step 4. “But mainstream,” said Szalavitz. “But as On treatment you cannot give someone a sense of Monique Tula [executive director of Of people in recovery, Szalavitz meaning and purpose — that has to the Harm Reduction Coalition] said, told ADAW that “if they do end up come from within.” the goal is to challenge the main- being advocates, it’s for the treat- Actual SUD treatment should con- stream and bring them along toward ment industry.” (This comment was sist of cognitive behavioral therapy, your position.” not in passing; if she hadn’t said this relapse prevention, motivational That said, Szalavitz acknowl- many times during our interview, we interviewing and other tools “that edged that there is “always a sad- wouldn’t have included it.) have been tested,” said Szalavitz. ness” when co-option takes place, “You have a different interest And for OUD, the best treatment

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It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw August 2, 2021 Alcoholism & Drug Abuse Weekly 3 is medication, something harm reduction brings to the table, according to Szalavitz. “You can use “I’m also hopeful about young medical medication as part of abstinence, students who say ‘We are going to treat this in the sense that they are just tak- ing that medication, not taking any like a disease’ instead of ‘Get Out of My additional drugs, getting on with their lives, all that good stuff,” she Emergency Room.’” told ADAW. “Or you can use it so Maia Szalavitz that people are maybe using fen- tanyl just two days a week.” With alcohol use disorders, she reduction seems like an obvious a well-organized structure that admits, the scenario is very differ- thing, but people don’t realize it has allows reading chapter by chapter, ent. There are medications, but they a history,” she told ADAW. “Every- so you don’t need to read it start don’t work for everyone. body needs to work very hard to finish. But unlike purely schol- against a backlash. I love the radi- arly authors, Szalavitz has the cre- Next steps cals, but it’s also the case that try- dentials of past drug use, a close Asked about her next steps, Sza- ing to change drug policy” requires affiliation with the pain and drug- lavitz said, “I’m not 100% sure — I some diplomacy. “There’s a great using community and the trust of want to make sure this book gets young generation of harm reduc- both official authorities and harm enough attention and people know tionists coming up now,” she said. reductionists. That’s a big burden, it’s out there.” The many interviews “I’m also hopeful about young med- but one Szalavitz is ready for. in the book are fodder for an online ical students who say ‘We are going Harm reduction is here to stay, archive, if she can get permission, to treat this like a disease’ instead of and Szalavitz’s book won’t be the last because there was — as always with ‘Get Out of My Emergency Room,’” one to cover it. But it’s a great start. • such a huge endeavor — so much she said. “They are a force for good.” she couldn’t use. “I’m also just trying Many think Szalavitz is more Undoing Drugs: The Untold to get back to my regular journalism advocate than journalist, but her Story of Harm Reduction and the in the area,” she said. book is not a polemic (despite Future of Addiction, is published by In general, she also wants to see her quotes to us such as “AA was Hachette. For ordering information, “better drugs journalism in gen- based on rich white men”). The go to https://www.hachettebook- eral.” For harm reduction, she has book is full of anecdotes but also group.com/titles/maia-szalavitz/ concerns about coverage. “Harm has a solid index, footnotes and undoing-drugs/9780738285764/.

Meeting: Make OUD medications available in jails and prisons In Medications for Opioid Use • methadone and buprenorphine Barriers to treatment with metha- Disorder in Jails and Prisons: Mov- regulation, done or buprenorphine include the ing Toward Universal Access, a • low-threshold treatment, fact that only opioid treatment pro- report summarizing a meeting • collaboration between security grams (OTPs) can provide the med- April 20 led by the Johns Hop- and medical staff, ication for the treatment of OUDs. kins Bloomberg School of Pub- • harm reduction and • Few jails and prisons have suc- lic Health and updated last week, • reentry services and Medicaid cessfully obtained licensure to medical and public health experts enrollment. operate as OTPs so that they can from across the country call for Everyone in a jail or prison dispense methadone for OUD making methadone and buprenor- should have access to all forms treatment on-site, the report phine universally available in jails of pharmacotherapy for opioid notes. “The few licensed OTPs and prisons. use disorder (OUD) — and there operating out of jail or prison Funding for the report came are currently three approved by settings report the process took from Bloomberg Philanthropies and the Food and Drug Administra- years, which is too long given the Arnold Ventures. tion: naltrexone, methadone and urgency of the overdose crisis,” The update notes that there are buprenorphine. The barriers to the report notes. There are also five key areas where there are cur- treatment with methadone and requirements imposed requir- rently significant barriers, but also buprenorphine are laid out clearly ing counseling. Instead, the opportunities for change: in the report. Continues on page 4

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Continued from page 3 report recommends that meth- adone be available on a “medi- The authors noted that jail and prison cation-first approach,” which the security and medical staff who work with authors define as “an approach to providing MOUD [medication methadone and buprenorphine must for opioid use disorder]without pre-conditions.” There is also the collaborate for such programs to be successful need for security by OTPs, which and support recovery. do not account for already exist- ing security systems within jails and prisons. • Patient-centered care. The cor- health needs other than sub- • While partnering with a com- nerstone of any substance use stance use. Substance use ser- munity OTP is technically an treatment program — includ- vices in correctional settings option, most jails and prisons ing those in jails and prisons should holistically address would find it “logistically chal- — must be individual patient patient health through offering lenging or financially infeasi- choice. Individuals should have other services, including harm- ble” for such an arrangement rights to choose whether to reduction and mental health to deliver daily methadone dos- receive treatment, and should services, and these services ing. The report notes, however, be able to engage in shared should also be based on the that the new mobile metha- decision-making with their cli- principles of individual choice. done regulations (see “Mobile nician about how best to real- Holistic attention to health also methadone now approved for ize their goals. recognizes the importance of licensed OTPs,” ADAW July 4, • Racial equity, Black, Latinx integrated and continuous care https://onlinelibrary.wiley.com/ and American Indian/Alaska with community providers after doi/10.1002/adaw.33120) do Native/Native Hawaiian people release from incarceration. create this possibility, so that are disproportionately incarcer- The authors recommend that existing OTPs could deliver ated, which shapes their access existing regulations be revised, or methadone to jails and prisons. to evidence-based treatment that regulatory language be clari- • The 72-hour rule allowing the services. In this report, the fied, to reduce barriers to dispens- prescription of methadone or authors refer to the combina- ing methadone and prescribing buprenorphine without a license tion of discriminatory policies buprenorphine in prisons and jails. could be used by jails with and institutional practices that One solution would be for the DEA high volumes of people cycling has led to unfair treatment of and the Substance Abuse and Men- through for short, multiday peri- minority populations as struc- tal Health Services Administration to ods, but the Drug Enforcement tural racism. Programs treat- work with the National Commission Administration (DEA) has pro- ing OUD in jails and prisons on Correctional Health Care to cre- vided unclear guidance on must develop specific plans ate more flexible requirements for whether this can be done without to address discrimination and OTPs located in jails and prisons, an OTP license or an X-waiver, bias that could lead to unequal according to the report. according to the report. Even dur- treatment in carceral settings. ing reentry, when people are leav- • Commitment to evidence. Treat- Security ing jails and prisons, coordinating ing opioid use disorder with The authors noted that jail and take-home doses is a “major chal- MOUD is an evidence-based prison security and medical staff lenge” requiring coordination practice. The evidence about how who work with methadone and with community providers. to scale-up programs and opti- buprenorphine must collaborate • Caps on the number of patients mally help patients under real- for such programs to be success- to which a single clinician can world conditions is evolving. The ful and support recovery. All staff prescribe buprenorphine con- practices described in the report should be trained. One problem, strain the number of incarcer- are informed by existing evidence however, is that stigma toward peo- ated people with OUD that about what works for OUD, and ple with OUD is a barrier to such carceral medical staff can treat. further research should guide the coordination. In jails and prisons, Consensus values of the meet- implementation of programs in this stigma is magnified by the “dis- ing include that the programs treat- real-world settings. parate goals” of correctional staff, ing OUD in prisons and jails follow • Holistic attention to health. who view their role as preventing these principles: People with OUD often have contraband and diversion in the

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw August 2, 2021 Alcoholism & Drug Abuse Weekly 5 facility, and medical staff, who dis- advocates for MOUD and is will- Not surprisingly, there are few pense medications that have histor- ing to be persistent in changing good examples of alliances between ically been smuggled into facilities, the culture of the facility; the CLS and harm reduction, the mainly so that people can relieve • changing language and vocab- report notes. One beachhead for withdrawal symptoms. ulary throughout the facility such practices could be expand- Challenges in this arena are sig- when discussing substance use, ing efforts to offer naloxone, which nificant, according to the report: such as using nonstigmatizing, rescues people from opioid over- • Staff may not understand OUD science-based and person-first doses, prior to release from incar- and MOUD due to lack of edu- terms; and ceration, the report notes. Another cation and misperceptions. • reviewing policies that impact could be creating partnerships For example, security staff are individuals with OUD, along between criminal legal system enti- familiar with buprenorphine as with education and training, ties, community-based treatment commonly smuggled contra- which will work to reduce programs and harm-reduction pro- band and are concerned that it stigma and discrimination viders. Increasing awareness and will be diverted if dispensed in toward individuals with OUD. stigma reduction, involving peers the facility. This view of MOUD and eliminating abstinence as a may lead to tensions between Harm reduction requirement of parole supervision the security and medical staff. Harm reduction itself may be are also suggested. • Changing the culture of the car- anathema to many of the jail and ceral system is difficult. Non- prison staffers, even though it “is a Medicaid medication treatment is the holistic and humane approach to Linking people to health insur- norm in most facilities, and addressing the health needs of peo- ance at the time of release is essen- security staff is more familiar ple who use drugs,” according to tial if they are to receive treatment. with keeping buprenorphine the report. Providing access to clean Since Medicaid is not allowed for out of a facility than with the syringes — a lynchpin of harm people in prisons and jails, helping process of dispensing it. reduction — is not likely to happen these people get enrolled before • Individuals with OUD in the soon in jails and prisons, but that they leave the facility is something carceral system often encounter doesn’t stop the group from recom- that should be required, certainly stigma due to factors that may mending that these policies be more if they are to continue to receive include incarceration, substance widely adopted. However, these medication when they leave. Com- use and structural racism. challenges seem insurmountable: munity-based treatment provid- • The use of medication itself can • Stigma against drug use in the ers should be able to connect with be stigmatized by staff and res- criminal justice system has their prospective patients before idents as not producing “true deep roots. release, including having access to recovery.” • Attitudes around drug use in the medical records. Solutions include: criminal legal system (CLS) have Abolishing the federal “inmate • educating and training historically centered on absti- exclusion” policy would be a step existing staff on the topics of addic- nence as a primary goal. Even toward keeping people in pris- tion, OUD and MOUD, and ensur- existing substance use treatment ons and jails covered during incar- ing that new staff are educated on services in the CLS rarely allow ceration, but implementation varies these topics from the beginning of for continued drug use, despite widely by state and county. their career (education and training other health benefits of engaging Specific recommendations include: should work to combat stigma asso- nonabstinent patients in treat- • States should implement ciated with these topics and empha- ment and other health services. streamlined Medicaid docu- size medication treatment as the • Many jurisdictions continue to mentation requirements and standard of care for OUD); outlaw certain harm-reduction automated data-sharing pro- • implementing peer education strategies such as sterile syringe cesses to make it easier to from correctional staff at other possession that further criminal- complete applications. They facilities that have implemented ize harm-reduction efforts. Thus, should also implement spe- MOUD to help make the case efforts to integrate harm reduc- cific outreach and enroll- that programs reduce diversion, tion in the CLS would have to ment efforts and resources illicit substance use and behav- address the entire spectrum of dedicated to people who are ioral disruptions, improving the law enforcement, including laws incarcerated, including using safety environment of facilities; related to drug paraphernalia and carceral staff to help process • finding a champion in leader- the policies and practices of com- applications and peers to help ship who understands OUD and munity supervision agencies. Continues on page 6

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Continued from page 5 continuity of care for people suspension and termination, and educate people on health cov- who are reentering. the gaps in coverage it causes. erage and, where applicable, • Facilities with effective Medic- An important first step in eas- MCO [managed care organiza- aid enrollment programs should ing the inmate exclusion would tion] selection. also distribute naloxone imme- be the passage of the Medicaid • State policies, such as those diately after release and can bill Reentry Act, which would allow in Ohio, New Mexico, Louisi- Medicaid for these services. for Medicaid coverage in the 30 ana and Arizona, that require • Anticipated SUPPORT Act guid- days prior to release. MCOs to provide in-reach ser- ance offers an opportunity for • States should assess whether vices prior to release can also Medicaid-funded services to be there is an adequate network facilitate continuity of care. provided 30 days prior to release. of providers to accept people • Additional investments should However, implementation of this undergoing reentry. For exam- be made in specialized reentry guidance, particularly for jails ple, programs that are required providers, such as the Transi- where a release date is often to report “infractions” to parole/ tions Clinics Network. The use unknown, may be challenging. probation do not fit a low- of telemedicine and peer nav- • Legislation to eliminate the threshold paradigm, and may igators and access to carceral “inmate exclusion” from Medic- interfere with adequate access medical records can facilitate aid would remove the need for to treatment post-release. •

JOURNAL WATCH Recovery-informed theory: Make room for experience In “Interdisciplinary Expansions: of subjective experiences of recov- the article: recovery measurement, Applying Recovery-Informed The- ery, according to the article, which identity processes and systems ory to Interdisciplinary Areas of was published in Alcoholism Treat- engagement. Recovery Science Research,” Jessica ment Quarterly in late 2020. Various Finding out how individuals recover M. McDaniel and colleagues write aspects of recovery could be inves- from SUDs has been, for many, the that recovery science needs to be tigated by using recovery-informed holy grail of how to treat this disor- expanded to understand how peo- theory (RIT), which in turn could der. Many people recover without any ple with substance use disorders lead to new approaches in clini- treatment at all, but how? • (SUDs) get better. cal, professional and community Rarely are the experiences of peo- contexts. For the study, go to https://www. ple with SUDs included in research, The three preliminary areas of tandfonline.com/doi/abs/10.1080/0 and this accounts for the dismissal RIT application are reviewed in 7347324.2019.1701598.

States make $26 billion opioid deal with major drug companies Late last month, a bipartisan “The urgency of the problem con- In a joint statement, the three dis- group of state attorneys general tinues,” said Attorney General Herbert tributors said, “While the compa- announced a deal that would give H. Slatery III of Tennessee at the news nies strongly dispute the allegations them — before lawyer and other conference announcing the deal. made in these lawsuits, they believe fees, of course — $26 billion, and “It’s just relentless.” Tennessee would the proposed settlement agreement in turn would release drug maker receive more than $500 million. and settlement process it establishes Johnson & Johnson and the drug In an emailed statement, Michael are important steps toward achiev- distributors Cardinal Health, Amer- Ullmann, executive vice president ing broad resolution of governmen- isourceBergen and McKesson from and general counsel of Johnson & tal opioid claims and delivering civil liability in the opioid epidemic. Johnson, said, “We recognize the opi- meaningful relief to communities The deal, reported by Jan Hoff- oid crisis is a tremendously complex across the .” man in July public health issue, and we have deep Still being negotiated: a separate 22, comes after almost two years of sympathy for everyone affected. This deal between the companies and battling and will, if finalized, give settlement will directly support state Native American tribes. money to local governments as well and local efforts to make meaningful as states, all of whom would prom- progress in addressing the opioid cri- Not over yet ise not to bring future lawsuits. sis in the United States.” The agreement doesn’t address the

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher’s permission. Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw August 2, 2021 Alcoholism & Drug Abuse Weekly 7 thousands of other lawsuits against Washington’s attorney general, in the lawyers representing thousands of other defendants, who include phar- Times. “It stretches woefully insuffi- counties and municipalities, as well maceutical manufacturers, drugstore cient funds into small payments over as some states, in the opioid litigation. chains and distributors. nearly 20 years.” He added, “We are According to one negotiator on Purdue Pharma and the Sackler looking forward to walking into a the committee, some states would family are negotiating a separate set- Washington state courtroom to hold have to pass laws locking in how tlement with plaintiffs — probably these companies accountable for the opioid settlement money would for more than $4.5 billion — as part their conduct. Washington families be used and precluding future lit- of bankruptcy restructuring. devastated by the opioid epidemic igation. But this negotiator, Joe Before any checks actually go deserve their day in court.” Rice, did emphasize that the pay- out, the agreement must be formally States must also persuade local- ments had been intended to be approved by the states and all their ities, even those who did not file used almost exclusively to address municipalities, who have 30 days to lawsuits, to agree to the deal. the opioid epidemic. Rice, who also review the offer and structure. “The lawyers will do a lot of the helped negotiate the tobacco settle- If the states don’t agree, the com- strong-arming of their clients, the ments, conceded that much of that panies could walk away from the localities, into agreeing to the settle- money had been diverted to balance deal and negotiations would have to ments, because if the deal doesn’t go state budgets rather than go to treat start anew. Some states were already through, the lawyers won’t get paid,” smoking issues. “Notably, the set- refusing to sign. Elizabeth Burch, a law professor at the tlement funds are not intended to “The settlement is, to be blunt, University of Georgia, told the Times. compensate families of the victims not nearly good enough for Wash- More than $2 billion of the $26 bil- of the two-decade-long opioid cri- ington,” said Bob Ferguson, lion agreement would go to private sis,” according to the Times. •

SSTAR from page 1 Needs of today’s workplace search process; he is focusing on and shaped a broader community- Adding another layer of complex- making sure the staff is fully engaged focused mission going forward. An ity to the search for new leadership in the process and that its questions important factor in the organiza- in the field is the frank national dis- and concerns are addressed. “The tion’s executive search has been an cussion of what today’s workplaces engagement of the staff is critical to insistence that this mission will not should look like, as issues around the selection of the right person,” change under new leadership. diversity and work-life balance have Capoccia said. A written document from Ford come to the forefront. To that end, the search firm Webb Associates, the Massachu- “As the composition of our pop- released a written document that is setts-based executive search firm the ulation evolves, if we want these as much geared to the staff as it is SSTAR board of directors has cho- organizations to remain relevant, the to prospective CEO candidates. The sen to conduct the search for a new leadership and staff need to reflect document reinforces the organiza- CEO, states that while bureaucracy the population,” said Capoccia, a tion’s commitment to the team that and funding continue to challenge colleague of Paull when he served has been instrumental in SSTAR’s the integrated care organization’s as the top administrator at CAB successes. “The devotion, flexibility efforts to respond nimbly to emerg- Health and Recovery Services in and innovation our staff has brought ing community needs, “this method- Massachusetts. Racial and language to this work is precious,” the doc- ology has become a national model diversity will be a must in organiza- ument reads. “Our commitment and we are resolved to carry it for- tional leadership, he believes. to them is to find an experienced ward to the next level. We are com- For her part, Paull also sees many leader and manager who can help mitted to continuing on this pathway, female executives soon to be mak- them grow professionally, grow and to empowering our next CEO to ing the same life decision she is the organization, and continue our introduce whatever improvements (Paull turns 70 next year), and she innovative and devoted service to and reforms are needed to do so.” hopes the new generation of leaders our clients and community.” “What I have found among the will maintain some of the areas of A more striking component of the staff is a consistent message about the focus she and her colleagues have document written by the search firm mission and the values, and the desire prioritized. “I hope there is a focus leaves the door open to SSTAR hir- to maintain them,” Victor Capoccia, on special populations,” she told ing an individual from outside the a longtime addiction treatment exec- ADAW last week. treatment field as CEO. “While sub- utive whom the SSTAR board has The SSTAR board brought on ject matter expertise in this field is a brought on to engage staff during the Capoccia to work in concert with plus, we are also open to individuals search process, told ADAW. Ford Webb Associates during the Continues on page 8

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Continued from page 7 with experience in other fields who Coming up… have the core skills and values out- lined in this document, and who can Virtual: The annual conference of the American Psychological Association will motivate and lead a strong profes- be held August 12-14. For more information, go to https://convention.apa.org/ sional team,” the document states. Virtual: The National Prevention Network conference will be held Ford Webb Associates principal August 24-26. For more information, go to https://npnconference.org/ Ted Ford Webb told ADAW that in theory, hiring someone from out- The Cape Cod Symposium on Addictive Disorders (CCSAD) will be held side the field and having that person Sept. 8-12 in Hyannis, Mass. For more information, go to https://www.ccsad.com/ work closely with a team of clini- Virtual: The International Society of Addiction Journal Editors annual cal experts could appeal to younger employees, who prefer less of a top- meeting will be held September 12-13. For more information, go to down management approach in https://www.isaje.net/annual-meeting.html today’s work environments. Virtual and in-person: The European College of Neuropsychopharmacology Paull, who is not highly involved Congress will be held Oct. 2-5 in Lisbon, Portugal. For more information, in the search process, confirmed go to https://www.ecnp.eu/ecnpcongress/congresses that SSTAR is considering candi- dates from both within and out- Virtual and in-person: The 2021 conference of the International Network on side the organization, SSTAR has 424 Health and Hepatitis in Substance Users will be held Oct. 13-15. For more employees and an annual budget of information, go to https://inhsu.org/2021-conference/ over $29 million. She hopes to have Virtual: The Addiction Health Services Research Conference will be held the opportunity to work with her Oct. 13-15. For more information, go to https://www.ahsrconference.org/ successor for a few months before she retires. Webb says the four-page back- Her desire to pursue an inte- community focus, SSTAR has seen ground document describing SSTAR grated health model stemmed from only a minority of those served and the open CEO position is the experiences HIV patients were being referred to ongoing treatment designed to convey that this is not encountering in the early years of in the organization. “We look at our a typical executive search, in that it that epidemic. “Nobody wanted patients, see what they need and will involve a hard look “behind the to touch those people at the time. deliver,” Paull said. curtain” of where the organization is These were our patients,” she said. Capoccia recalls that Paull was and where it needs to go. “Recruit- In its more recent history, SSTAR unafraid to confront challenges when ing is often a one-dimensional pro- initiated an open-access model of she decided in the early 1990s that cess, a fairly sterile exercise. I think service, with an opioid triage com- she wanted to develop a community that’s a huge mistake,” he said. ponent that involves participation health center. “I told her, ‘You’ll find from medical professionals, mas- opposition from the state’s health SSTAR well-positioned ter’s-level clinicians and recov- centers’ about dividing the pie. She Webb said SSTAR is operating ery coaches. Reflecting its broad said, ‘We’ll deal with that.’”on.”• from a fairly stable position as it searches for a new leader, though it will have to develop more manage- ment expertise to make up for the In case you haven’t heard… void in institutional memory Paull It’s probably not unusual for patients to seek help for kratom addiction, will leave. but we don’t hear about it very often. Still, “I got in trouble with kratom Paull said SSTAR’s status as an — I was getting it online; could I have some of that buprenorphine?” is FQHC has positioned it well dur- not an unprecedented question for physicians to hear. Recently a case in ing the pandemic, allowing it, for which such treatment was successful was posted in a medical journal. For example, to conduct 40,000 COVID- the case study, go to https://journals.sagepub.com/doi/full/10.1177/ 19 tests in the community. “SSTAR 20503245211021193. This was, as Peter Grinspoon, M.D., observed, quite stepped to the forefront,” she said. a large dose of kratom the patient was taking, and trying to withdraw on But the daily pressure involved in her own by using kratom tea probably would not have been effective. The that convinced her that maybe the episode occurred during the pandemic, when it would have been very time was right for her to set a retire- ment date, after she had been con- difficult to find other treatment, and patients self-treating all kinds of templating the move for a while. problems were falling between the cracks as COVID-19 took precedence.

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw A Wiley Periodicals LLC publication. View this newsletter online at wileyonlinelibrary.com