Transcript: Young Adult Opioid and Substance Use Webinar

Stephanie Ballard

Welcome to those of you who are here. If you're here to learn about young adults and opioids, you are in the right place. You've joined the right meeting. Congratulations. A few housekeeping notes before we dive into the material. So all attendees are currently in listen only mode. If you have any technical problems, questions, comments, throughout the webinar at all, please type them into the chat box.

We'll pause a couple of times throughout the presentation to have some discussions. We'll also have a few times throughout for Q&A. And I also do like to mention that if we don't have time to get to your question, please don't feel that we've ignored you. We will reach out, after the presentation via email. I also would like to note that we will be sharing the slides of this presentation, along with some resources.

The recording of the presentation. To all participants in attendance as well. Next slide. So quick introductions. My name is Stephanie. You'll be hearing from me lots today. Myself and Melissa from La Familia will be leading today's webinar. I have over ten years of experience working within the substance use and mental health industry, including direct clinical experience as a licensed professional counselor.

As well as a certified drug and alcohol counselor. I've worked with youth, adults, families in both residential group and individual settings. Melissa, who's joining us today from La Familia, has also been in the substance use disorder industry for over ten years. She's certified with the California Consortium of Addiction Programs and Professionals. Her background is in medication assisted treatment, DUI, perinatal drug court, and most recently, she transitioned to working with adolescents and the population.

Next one.

So this project presentation was prepared under a grant from the Office of Juvenile Justice and Delinquency Prevention. The US Department of Justice. This work is also supported by the Alameda County Probation Department. Now here's a quick look at the agenda for today. There's really large, largely four main things we want you to walk away with after the webinar.

So one really what are opioids? Two. How do we identify the signs of opioid use and opioid use disorder? Thirdly, how do we talk to somebody or how do we start a conversation, with someone who we might be concerned about? And then lastly, what are the next steps that we can take or how can we get them to help if they should want it?

Again, keep in mind that throughout the presentation today we will have opportunities for questions and comments. So I strongly encourage you to contribute whenever possible. Excellent. I would now like to introduce you all to a very special guest, someone who has been instrumental in bringing this webinar to you today. Michelle. Chirag Michelle is the director for In Your Corner and works with the Alameda County Probation Department.

She has a master's in public health and is also fluent in Spanish. Michelle has worked for more than 20 years in the private and public sector. She is passionate about applying her cross system knowledge to help solve complex problems that ultimately improve health equity and address social determinants of health. I'll now pass it over to Michelle, who's going to provide you guys with an insight into who in your corner is why we're here today.

As well as give you guys some insight into data surrounding the opioid epidemic. Michelle. 

Michelle Schurig

Hi, everybody, and thank you so much for the intro, Stephanie. I really appreciate it. My personal connection to opioids is that I grew up right on the border of West Virginia and Appalachia. As many of you know, that's really the epicenter of the opioid crisis.

And in this country and it's unfortunately devastated, in lots of towns across the region. But anyway, that's that's really my, personal connection to this work. And I just wanted to think really quickly. All the partners, we have a multi-agency task force that's been coming together since 2018 around this topic. The social change has been central.

We've partnered with the Social Change RI to help us develop, the approach. And this campaign. And they've done an amazing job. So thank you so much to them. We also have our community partners, Urban Strategies Council and LA Familia who is co facilitating today. We've had a lot of help from social services and special call out to Gloria Carroll and Nathan Hobbs from behavioral Health.

And chief still at probation is the chair of the task force. She. This is our last month in public service, so we're wishing her an amazing retirement. And then doctor Kathleen Clanton with health Care Services administration. She's a medical officer there. They've all been involved in this project, and this really couldn't have been done without them.

As Stephanie mentioned, this is funded by DOJ and the In Your Corner campaign, an initiative really aims to reduce stigma and increase awareness around opioids and substance use. And by doing so, we really hope to increase engagement of our young adults in foster care, and create a space safe space for them. So today, I'm really excited that we're going to be able to share some resources and tools that were developed for the community.

We'll go into those more later. But we will be sharing a digital toolkit, and we'll be looking forward to your your feedback on this toolkit, because we're going to be doing a revised version that'll be up to date and current. So the next steps for the project, before we get into some of the data, is that we hope to train young adult peers to become trainers of these substance use materials and to be able to outreach in the community.

And we're also looking for your feedback on some of the materials in the future so we can make it even better. And finally, if you'd like to get involved in this project, as a champion or advisor, especially if you work with young adults and extend to foster care in East Oakland or Oakland. Please reach out to me.

We'd love to get more supporters. And, changing stigma and increasing awareness is is possible, but it's a long process and it requires a whole all hands on deck approach. So real quickly, just wanted to go through some of the justification for this project, which is really, got overshadowed by whole Covid a little bit. As many of you know, the opioid crisis is a public health crisis.

And even before Covid. Drug overdoses increased by 20% in the United States and led to the loss of 81,000 lives. So that's huge. And we're not looking forward to seeing the data in 2020. Because, you know, with Covid, a lot of people don't have access to care. A lot of people are isolated. There's a huge mental health toll.

So we're kind of concerned that the numbers are going to be even more alarming during Covid. And then in Alameda County, we are seeing an uptick. And even though historically we've been beneath the California average of deaths from opioids, we're seeing a steep increase. So the rate of deaths for 20 to 24 year olds increased by more than 500%, between 2019 and 2020.

And black African-American community was the most impacted, than other any other ethnicity in Alameda County. Also, there were 103 any opioid related overdose deaths. 

Stephanie Ballard

Opioids. Why we're here today is so to get an idea of how familiar are all with opioids. We're going to do a quick poll. So you all should now see a poll on your screen.

We'll give it a few minutes for you all to answer. Just see, we're at. So the question is, are you familiar with what opioids are? Yes. No. And I am not sure.

Okay. We're going to go ahead and close the poll.

So it looks like we have a variety of answers here. So about 67% of people on the webinar today are yes indeed familiar with what opioids are. But 11%, is not familiar and 24% might not be sure. So for some of you, what we're going to go over, it might be a refresher for others of you, it might be new information.

So now opioids are a class of drugs that have been used for hundreds of hundreds of years. As I mentioned earlier, mostly to treat pain. They've also been used to treat symptoms such as coughing, or even diarrhea. Back in the olden days, opioids are naturally found in the opium poppy plant, which some medications actually today are still made from.

However, other opioids are made by scientists in labs. For some people, you may have heard people talking about opioids or have opioids even in your medicine cabinet at home, and not even necessarily realize that. And you can largely bucket opioids into three categories. Prescription opioids, fentanyl and heroin. And we'll describe each of those in the following slides.

So first off we have prescription opioids. These are opioids that are prescribed by doctors to treat severe pain. Most often which is sports injuries. Sometimes they're prescribed for dental work such as getting your wisdom teeth out or a root canal. Or cancer. And when prescription opioids are taken as prescribed, they are relatively safe, and can reduce someone's pain for the short term.

It's not common that you'll see opioids prescribed for a long period of time. But here's the warning. Along with this, that sometimes, you know, is misunderstood is that even though they are prescribed by a doctor, they do have serious risk and side effects. Most certainly when misused or used over longer periods of time. Now, some prescription opioid pain medications such as OxyContin, Vicodin, they do have effects that are very similar to that of heroin.

Another misconception people sometimes have is that I'm taking a prescription opioid. So it's not as bad as taking heroin. But, in fact, they're made of the same chemical compounds sometimes. So due in part to that, some of the research that has been done suggest that misuse of prescription opioids may actually open the door to people using heroin at a later date.

There is a study done in 2011 that showed that 80% of people who used heroin had first used, opioids in the form of a prescription. It's also important to note that prescription opioids may not always be what they seem. Again, we have these misconceptions about them that maybe they're safe because, they're they're regulated. They're prescribed by doctors.

But at times people consume them thinking they're safe. But recently, the DEA, the Drug Enforcement Administration, issued a warning alerting the public of a mass influx of counterfeit prescription pills. So these are pills that are being made on the streets illegally. And a lot of them are containing containing fentanyl. Which we will discuss next.

So you've heard us mention fentanyl a couple of times today thus far. This is really the second classification of opioids. It's been, more talked about lately over the past 5 or 7 so years. Most certainly this past year, it's been brought into the public's eye more so, it's a synthetic opioid pain reliever, meaning that, it's typically made by scientists in the lab.

It does use the same chemical structure as the poppy plant. And again, similar to prescription opioids, fentanyl can be prescribed, but it's most often prescribed for the treatment of severe pain. It's most commonly used for really advanced late stages, of cancer patients. Now what's important to know about fentanyl is it is similar to prescription opioid morphine.

However it's 50 to 100 times more potent. So this is something that many people who use it aren't aware of is its extreme potency. And what we've started to see over the past year or so is that illegally made or distributed fentanyl is now the most common drug involved in drug overdose deaths in the United States.

So when we see it, in the illegal drug markets, it's often sold for its heroin like effects. It's often you don't often see it being sold specifically as itself, as fentanyl, but it's often mixed with other drugs. So it's often mixed with heroin. Cocaine. We've seen being mixed with marijuana. As I mentioned earlier, counterfeit prescription pills, and other drugs.

And this is really with or without, the user's knowledge. So individuals who are using it with the knowledge, of it being fentanyl or of it being laced with fentanyl. They're really seeking this out in order to achieve a greater high for, say, however, many who are using even first time users, they're not aware that fentanyl is present in the drugs that they're taking, which is a really, really scary thing.

Considering it's such high potency again, 100 times stronger than morphine. So even the smallest littlest amount of it could cause an overdose or a death. Next slide. Lastly, and perhaps the most known opioid is heroin. This is, by all accounts, an illegal opioid. It's typically injected. What some people don't know is that it can also be snorted or smoked.

It's typically sold as a white or brownish powder, but it can also be sold as what they refer to as black tar heroin, which is it's it's it's really sticky and substance. They compare it to like roofing tar. Or it can be really hard, kind of resembling, what coal might look like. Now, what we've seen, over the past several years is that there's been an increase, sharply across the United States.

With heroin use all across the board. So all genders, all age group, all all income levels with the greatest increase of use being among our young adult population. So those 18 to 25 and having worked in the substance use field for a while now, I feel as though a lot of individuals, even those who use heroin themselves, have had or have the idea that they would never use heroin.

Right. It's kind of like the, the, the one drug that they would never use. I would never use that. However, there's been a multitude of studies that have been released that have shown that, again, many individuals begin with prescription opioids thinking that they won't advanced to heroin, but in actuality, they are very likely to advance to heroin use.

Some even more alarming data that I've recently saw is that some of the newer data is starting to show that heroin is now frequently being reported as the first opioid people use. So there's, research saying that, you know, individuals using prescription drugs will advance to heroin, but we're starting to see more individuals starting off with heroin, before advancing to it.

Next slide.

Now, we felt it was important to share some common opioid street names. As many substances are discussed or sold under illicit different names, especially amongst our young adult population. So some drugs will share nicknames as they share a chemical similarity, which is true for a variety of opioids. So some common street names, of prescription opioids fentanyl and heroin.

So opioids in general include white stuff China girl China white oxy cat's really popular smack each and brown. I think as those of us working with young adults, it's so important to educate yourself on the various names as many of us, myself included, have heard people or young adults talking about opioids and not even necessarily realized it.

And might also be helpful for when you do have conversations with young adults surrounding drug use. If we can use their language that they prefer, we might be able to connect with them. In a bigger way. And by no means is this list exhaustive. It's constantly changing as well. So perhaps if there's some you've have heard that you don't see on the list, you could enter them into the chat for everybody.

Next slide. So now we've talked a bit thus far, on the potential for opioid use amongst adults as well as what opioids are. We're now going to transition into talking about signs and symptoms. So how you might identify that someone might need help. And when we think about signs and symptoms for opioid use again it's not a, blank bucket that you can put everything in, but it can really be broken down into three categories.

So one, signs of addiction, which might not necessarily mean they have an opioid use disorder. Actual signs of opioid use disorder or addiction. And lastly signs of opioid overdose. If you haven't been paying attention much this far. I hope your ears perk up now and you really tune in, because gaining knowledge around signs and symptoms is one of the simplest, easiest things that we can do to get us one step closer to being able to not only help individuals, but possibly save lives within our communities.

But now, before we move forward, we'd really like to know from your experiences or perhaps from friends or maybe other colleagues. What changes have you seen in young adults or what have you heard that might be a sign of opioid use? And if you'd enter those into the chat box.

And someone said Moody, most certainly we see that often, in individuals who are using intoxicated as well as those struggling with addiction themselves, there's going to be mood changes, isolation, most certainly. One of the key signs of addiction is a loss in activities that they once used to enjoy. Just great coming in. Someone put sleepy. This is a common, physical symptom of opioid intoxication, which we'll talk about a bit later.

Sleepy or as someone put in the chat, nodding off. Most certainly weight loss, body aches. You guys got it. Awesome group. These are almost certainly relevant things. And that could be signs for opioid use or, opioid use disorder. So I'll move on to the next slide. Now. So as I mentioned there's kind of three categories but we can break it down in.

So first being opioid and intoxication. This is a condition or a state in which an individual is not just high from using opioids, but they have a body wide symptomatic response. That has the potential to make them ill or actually impair them. And again, I want to emphasize, remember from the spectrum that we talked about earlier.

Opioid intoxication does not necessarily mean opioid use disorder. Right. So now regardless of the potency, the duration of use, the signs and symptoms of intoxication can all look the same. So one of the most telltale signs, and you can see on the image on the screen is pinpoint pupils. So they're going to look really, really, really, really tiny.

And this is a, symptom specifically of opioid use. The individual may appear, as some of you mentioned, drowsy. They might not offset. Kind of looking, like moving their head. Kind of like this. Falling asleep intermittently. If they are snorting the opioid, which you can do. They might have a runny nose. They might actually have nose sores.

They might have needle marks if they're injecting opioids. And because of the effect on the central nervous system, they may also have really depressed, depressed, low or shallow breathing mood swings, which all of you, emphasized in the chat. Apathy, euphoria, depression might explain. Now moving on to opioid use disorder or addiction. This can be diagnosed by a mental health or medical professional.

And remember what we discussed earlier about opioids. And addictions affect on the brain. It's characterized by an increased tolerance, which is the need for increased amounts or decreased effects with continued use of the same amount. Essentially, they need more of the drug to get that high. With opioids, specifically heroin use, you'll hear the slang term I'm chasing the dragon.

Actually, how our bodies work is the first time you take take heroin and take an opioid. You'll never feel that level of high again. So they're constantly trying to chase that high. They're constantly needing more of the substance to get their. Secondly, you have uncontrollable cravings. Also have an inability to control use, even though it's having a negative effect on major role applications.

So school or relationships or housing. Next slide. Now some of the signs and symptoms we just discussed might be difficult to notice. There are a handful of behavioral and physical signs and symptoms of addiction that might be more easily noticed. So change in peer group, changes in appetite, carelessness with grooming, money problems, stealing medication from others, frequent flu like symptoms.

Scabs, sores. Puncture rooms. So while there's the character the the typical signs of addiction that you might see, there's also these behavioral and physical signs that might accompany them. Next slide. Now I do want to emphasize this statistic. When drugs are misused or taken in large amounts, an overdose is a risk with severe symptoms of overdose bleeding to death.

We know from the data, as well as from the increase of use in fentanyl, that opioid overdoses are a real threat within our communities. Every day, 128 people in the US die. Specifically in Alameda County. In 2019in their most recent set of data, 103 opioid related, overdose deaths happened. So in the next portion of this webinar, we'll give you some real life strategies for how to identify that.

So to further drive home the point of the importance of having this knowledge, a report from 2017 showed that over 70% of all overdose deaths among those aged 15 to 24 involves an opioid of some sort. Again, this is another point in the webinar where I hope your ears perk up and you tune in. So during an overdose, breathing can be dangerously slowed or stopped, which can cause brain damage or death.

Unfortunately, the good news here is that you don't have to be a medical professional to identify the signs and symptoms, or to help. So signs and symptoms of opioid overdose include small pinpoint pupils, falling asleep, loss of consciousness or shallow breathing. Choking limp body. The eyes might not be responsive to light if a light shined on them.

And then we also have some factors that might increase our risk, for overdose. And this is important to know with our young people who sometimes might not have this, this knowledge. So combining opioids with alcohol or certain other drugs. What we see often is opioids being prescribed to us. Xanax or benzodiazepines. These are all things that can increase the likelihood of an overdose.

Next slide. So now one of the strongest tools that we have in our fight against opioid overdoses is naloxone. This video is going to provide you with an overview of kind of what naloxone is, as well as what to do if you believe someone has overdosed.

Naloxone Administration video being presented

Video Narrator 

Naloxone is now available in most places without a prescription. Naloxone is a temporary antidote for opioid drugs, which include, but are not limited to heroin, fentanyl, morphine, codeine, oxycodone, and hydromorphone. You should get naloxone if you suspect someone has overdosed on an opioid. Suspect an overdose when someone isn't responsive and they have at least one of the following signs.

Not breathing. Slow and soft breathing. Making snoring or gurgling sounds. Their body is limp, cold and clammy. Skin bluish lips and nails pinpoint pupils. If you think that someone has overdosed, stay calm and call 911. Each dose of naloxone can only stop the overdose for about 30 minutes. To get naloxone using a needle, uncap the vial, insert the needle and slowly draw the naloxone into the syringe.

Inject from the lock zone into a muscle in the person's arm or leg. It isn't necessary to remove their pants or shirt to administer naloxone nasal spray. Place the tip in either nostril and press firmly up on the plunger. If the person is breathing, put them on their side to protect them from suffocating or choking if they aren't breathing.

Perform rescue breathing if you know how. Until the paramedic arrives. And finally, while waiting for the ambulance, remember, stay on the line with 911. Don't try to get the person up because they could fall. Don't put them in a bathtub or shower because they could slip, drown, or go into shock. And don't give stimulants like crystal meth or caffeine because it can make them sicker.

Stephanie Ballard

So, as you heard from the film, naloxone is available in most places without a prescription. In addition to some independent pharmacies. So Walgreens, CVS, Rite Aid, some places, some targets even have it. Walmart's and a lot of them are providing it in those places. But California is then one of the leaders in that initiative.

Next slide. So the video went over what to do briefly. If you think someone has the overdose. But here we'll go into it in a more in depth. I will say it is at times difficult to tell whether a person is just really high from opioids or if they've actually overdosed. But best practice hands down across the board.

If you are not positive, treat it like an overdose. So there's five steps that you can follow to assist. I mentioned you don't have to be a medical professional. It can be a family member friend. Anyone really can follow these and help. So first step is to always immediately call 911. Secondly, if you have naloxone, administer it.

Naloxone cannot harm somebody if they are not overdosing. It cannot harm somebody if they are on another substance. It's harmless. All it can do is save their life. If they are overdosing. Thirdly, do your best to try and keep the person awake and breathing, but do so in a safe way. So as the video, slightly alluded to, you don't want to try to get them to stand up if possible.

You can put them in a recovery position which is laying on their side with their hand beneath their head. And then lastly, you want to stay with the person until emergency helps arrives. And then there's also, again, as the video alluded to, there's some things that you do not want to do because of risk of harm.

So you don't want to ever hit or try to forcefully wake or move the person. It will only cause further injury if you're unaware, if you're unable to awake the person through shouting. Rubbing your knuckles on their sternum or like pinching, it's likely that they're unconscious. I think one of the things that I've seen in a lot of films is putting a person in a cold bath or shower, throwing cold water on their face.

This is a big don't. This can increase the risk of falling, drowning, or going into shock. Another thing that I've seen depicted in pop culture films often is trying to make a person vomit. You don't want to do this. Again, this increases the risk of harm. Such as choking. Inhaling vomit. There's actually a number of opioid overdoses that are because that person has actually choked on their vomit.

And it can cause a fatal injury. Next slide.

I do want to mention the Good Samaritan law. As some of you may know, many overdose deaths are preventable. Yet people often fear arrest or charges amongst themselves if they call 911 for help at the scene of a drug overdose. So at the Good Samaritan laws are designed for is to encourage people to seek help for the overdose victim by providing them with limited protection from arrest, charge and or prosecution for low level drug violations.

This law is something that I've often found many in the community, most certainly young people are unaware of. And perhaps that there was more awareness around it and less fear and calling for help. More lives could be saved.

Now we've gone over the signs and symptoms of use, addiction and overdose. We're now going to transition to talking, to talking to someone that you're potentially concerned about. So I'll launch a quick poll to get a sense of how many of you have had difficult conversations with use about drugs or alcohol. So yes. No. Or I'm not sure.

And while you guys are filling out the poll, one of the questions that came in is how are in a lock zone and Narcan different. It's a great question. Narcan is actually the brand name for naloxone. Similar to how you have, brand names for opioids. So they're the same thing. One of them is just the brand name.

So. Wow. Wonderful. This is amazing. So it looks like 83% of you have had difficult conversations with youth, about drugs and alcohol, because about 17% of you have not or you're not sure. So this is great. We'll have some time throughout to kind of share your experiences. And I think that perhaps you'll learn something new.

And for those of you that have not to most certainly can take some things with you as well. So next slide.

So before we provide information and how to have an honest and open conversation with young adults, we would be remiss if we did not address the stigma associated with substance use disorders. If you'd all take a few minutes to read the quotes on your screen. These are from actual young adults in Alameda County that we had interviewed to start this project.

So we know from the research that, individuals with opioid use disorders are often, reported to being blamed for their substance use. Looking back at what we discussed earlier, there's physical, mental, emotional, changes happening to an individual, and they shouldn't be blamed necessarily. Research has also found that stigma is a major barrier to seeking help.

Having found that only 35% of adults with opioid use disorders have received treatment in a given year. Further, one of the huge statistics, in our finding is that from the beginning of experiencing addiction symptoms to actually getting treatment, it's 4 to 7 years on average. Next slide.

So one way you can help break down this barrier is by learning to have an effective conversation with a young person who is struggling and an effective conversation really begins with taking a hard look at the language that we're using. And the signals that it's sending to young people. We want to support. So stigmatizing language, whether used intentionally or unintentionally, can construct a space that may be unwelcoming.

So many common phrases used to talk about people who use drugs imply stigma, judgment, and perhaps shame. And it's easily understood in overtly derogatory terms such as junkie or crackhead. But language matters in much more subtle ways and can reveal assumptions about a person, or their substance use that may be unfair, inaccurate, or harmful. So for considering the time that we have left, I'm not going to go through all of these.

But again, you guys will receive this PowerPoint. And you can look back and reflect upon these. If you do anything as an advocate or provider. One of the simplest changes that we can make is to contribute to decreasing stigma. By changing the words that we use surrounding substance, use, and individuals with substance use disorders. Next slide.

Next slide.

So now we'll move on to providing some tips for when and how a conversation with a young adult. You're concerned about. While I'm going through this, as a lot of you had mentioned, that you have had hard conversations. If you want to enter into the chat box, anything that's been helpful and this doesn't necessarily have to be a hard conversation with a young adult about substance use.

I think we can learn from a lot of different scenarios. So this might have been a hard conversation you've had with a coworker, a boss, maybe your husband, maybe a friend. Just go ahead and throw those in the chat and everyone keep an eye on them. So as we mentioned before, talking about drugs and alcohol with young adults might not be easy.

Before having a conversation, it's really important to get in the right frame of mind. If you're nervous, try doing something that relaxes you, like taking a walk or talking it through with a colleague. And then secondly, we really want to reduce alarm bells, right? We want to find a place for the young adult and ourselves can be comfortable.

So try to find a comfortable setting. This might be for you guys taking a walk outside. I've had clients of mine who, you know, they don't feel comfortable in the confines of our space, and so they're more open if we're outside of the building. If you're in an office, try to turn off distractions such as music, computer screen, cell phones, and you want to make sure that you're also being conscious of your body language.

You want to make the young person comfortable. So if they're sitting, perhaps you said, I saw this scenario once where it was a parent and they were talking to a child and the parent was standing up in the child or sitting down. It was almost as though they were hovering over them, trying to talk to them about this really touchy subject.

And that's just not going to work. We want to make the youth as comfortable as possible. So this is being mindful of your whole body presence. You know, instead of having your legs crossed or your arms crossed, make sure you're kind of open, presenting as open and remain a maintain a relaxed posture per se. You also want to practice using open ended questions.

We often get caught in starting conversations with yes or no questions, right? How many of us have said, have you had a great day today? Right? It doesn't really leave it open for for anything besides yes or no. It also might prevent young adults from opening up or sharing how they actually feel about a scenario. So, for example, instead of saying, do you know about opioids, you might ask, can you tell me what you know about opioids?

Not really. Opens it up. For more. You also want to make sure young adults are both heard and understood. So make sure you're implying active listening. So repeating what they're saying keeping eye contact. And keep an open mind. Don't make assumptions. If young adults feel judged, if anyone really feels dumb, judged or condemned, we're we're less likely to be receptive of the message.

I also wanted to note there's a few quotes on this slide, from Alameda County Youth. Looking for most importantly, empathy and support from those helping them. And really, you can do this by following some of the tips that we just mentioned. But also truly trying to acknowledge the other person's point of view, acknowledge what they're going through.

Ask questions and and learn more. Next slide. So a large part of having a conversation with a young adults in regards to substance use concerns is being prepared to provide opportunities for help. So on this slide here there's six examples of what you can do to really help yourself prepare and provide those opportunities. One of the biggest things that I find is that young adults for all of us, we're bombarded with advertisements and information, all day.

Young adults are most certainly getting a lot of their information, most of their information, if not all from their peers. So sorting through what is good or bad information can be daunting. So one of the ways that you can help them be good consumers of information is taking a moment to share with them the knowledge that you have.

Around what opioids are around, what treatment options they have, around where they can get help or what help even might look like. And at the end of this webinar, we will provide you with a list of resources that you can review, as well as those that you can share with you with youth themselves. And lastly, I think it's really important whenever you're having a conversation with youth to leave that door open, right.

Let them know that you're there to talk in the future. The first conversation that you have with young adults, might be the first in an ongoing conversation about drug and alcohol use. So it's important to let them know that they can come to you. They can talk to you again. And one of the tactics that I found really helpful is you might also, again, it's putting them kind of in control.

You might also ask them permission to check in. That might open the door for you to follow up with them in the future. And after this first conversation or each conversation you have, you might check in with them in a week or even the following day just to see how they're doing. Next slide.

So in the next slides to come, we'll discuss the steps or treatment options for young adults. However, so far we have covered a lot of information. So we wanted to pause, see if there are any questions. It looks like a few came in around naloxone. Narcan. Different. Someone also asked, what's the cost of naloxone? So this is going to vary, really.

A lot of local, local organizations will actually hand out, naloxone for free. Sometimes insurance will cover it. Sometimes you can pay out of pocket for it. It just really largely varies. And the resource guide that we're, sending out, as well as some of the tools that we'll discuss later. There's a bunch of different, organizations and resources which you can find further information on that.

And it looks like we don't have any other questions came in at this point. So again, feel free to throw them in there. We will pause again in a little bit. To get to them. So next slide. So when we're thinking about what is next or how you can really help a young adult, it's important to pause and remind yourself.

This is a hard one for me as well. But meeting people where they're at is about giving them what they need, when they need it. And I say, this is hard for me, and it might be hard for, It might be a hard lesson for any of us, as many of you are on this call, that are on a path that involves trying to help other people.

Sometimes. Most certainly, we might want to help the other person grow or heal more than they necessarily want to themselves. But if we're really in the helping profession, we have to learn to meet them where they're at. That's going to it. That's going to be what's going to help them the most. So there's two theories on the screen that can really help explain this concept further.

So the first being Maslow's hierarchy of needs. In this theory really suggests that an individual's basic human needs need to be met in order for them to advance to other human needs, like potentially getting sober. So, for example, if an individual doesn't have a roof over their head, or perhaps they're struggling to find where their next meal is going to come from, is their substance use really the priority at that point?

Perhaps helping them meet that basic need becomes the priority. And as providers, we have to be able to adjust, as I said earlier, meet them where they're at. We can also look at this in relation to the spectrum. Of addiction, if someone is on one end of the spectrum, are we going to force them into what the person on the end of that spectrum might need?

It's really about being flexible in our approaches. Secondly, we have the trans theoretical model of change. The theory is based on the concept that behavioral change is in a single event, but really ebbs and flows. And it's gradual over time. Again, depending on what stage a person is in, their needs are going to be much different.

And it's important to authentically engage and include the young adults in this decision making process. Include them in thinking about what they need, what treatment supports might feel right for them. By giving them a choice in what happens next. Research has shown that it significantly improves treatment outcomes. So be prepared. Come with knowledge, come with resources, but really engage them in that conversation about where they're at so that you can provide them with what they need in that moment.

Next slide. So now let's take a look at treatment options. Emphasizing for individuals that might be at this stage not every individual who's struggling or using might be at this stage. So there's a countless number of options. But the emphasis here is that there's not one size fits all approach to treatment. Again, as I've been stating, it's about being flexible.

What works for one person or what one person might need is not the same for another. So for example, some individuals with severe forms of addiction will choose to enter into a detox program. This is where they can safely manage withdrawal symptoms. Withdrawal symptoms can be anything from anxiety to body aches to nausea. And again, it's that physical withdrawal from the substance, that's associated with the changes in our brain, the physical changes that we spoke about earlier.

And the benefit about detox programs, is it an individual entering into them? It might decrease their chances for relapse. So if I feel better, if my withdrawal symptoms are being maintained and I'm not feeling all achy, I might be less likely to then actually go in and use a substance. Others may enter directly into residential or inpatient care.

Participating in these forms of treatment mean that they're actually residing in the facility in which they're receiving treatment. And then we have outpatient programs. These can really, really vary in terms of intensity. And types of services offered, but they're typically a few days and hours a week. And all for the most part, all types of formal treatment usually have a variety of individual, family and group therapy involved.

Again, keeping in mind that concept of what might work for somebody might not work for all. And then lastly, many individuals at some course in their treatment will engage in recovery support meetings such as alcoholic or Narcotics Anonymous. And these in my own experience, have been instrumental. For individuals, it provides them with really that peer support group.

And relationships that all of us most certainly crave. Next slide.

So some of you may have heard of medication assisted treatment. Otherwise referred to as Mattie. I think it's important to mention, as we're talking about opioids, it's the use of FDA approved medications in combination with counseling, and behavioral therapy. So an individual might be, involved in residential or involved in outpatient while also taking mat medications.

And what research has found is that the use of medication assisted treatment, has shown a reduced rate of opioid use. Fewer overdose deaths related to opioids, decreased criminal activity, as well as an increased retention and treatment, amongst other things. So overall, Nat is medications really aiding and managing those cravings or withdrawal symptoms that an individual, coming off of opioids might have, which ultimately enhances their overall recovery.

And due to its benefits, it's really recommended that when doing your research into available programs, one of the things that you ask, if they provide or have access to is prescribers of medication assisted treatment. Next slide. So another approach to looking at providing help and treatment. From a again meeting the individual where they're at perspective is harm reduction.

The National Harm Reduction Coalition describes it this way, that harm reduction supports and celebrates any positive change, resisting a narrative that would treat the substance use spectrum as a moral ladder. So one person's positive change may be to start smoking heroin instead of injecting it, thereby reducing the risk of both overdose, and of many infections.

Another is may be to shift from heavy use to occasional use in order to make more time for a job or relationship. And another is may entail giving up one or more substances entirely to prevent harm. Next slide. So one of the things you can do with young adults is to provide them information about harm reduction strategies.

There's a few listed on the screen here. But I do want to emphasize that there's tons and tons and tons of them. So there's a link on this slide that I strongly encourage you guys to reference back to, to get an idea for, because there's just a ton. And again, some might work for other, some might not work for some.

But going quickly over these three. So you have syringe access. This is the distribution of sterile syringes. Safer drug supplies, and education to people who inject drugs. So you might find a local organization who provides this, or you might provide it yourself. Another strategy is opioid overdose prevention. So this is educating clients, their families, their friends, coworkers, peers, on the signs and symptoms of opioid overdose and how they can respond.

And then thirdly, with the increase in norm, you could educate again everyone in your circle, including the young adults. On fentanyl in general, as well as inform them if they're at risk of using opioids about the ability to test for the presence of fentanyl in the drugs they're using, using fentanyl strips. Again, tons of ways that you can educate on harm reduction.

I strongly encourage you to visit the resources on this page. Next slide. So another thing that you can do for harm reduction is educate unsafe storage and disposal. You can also educate their loved one or caretakers on this. There's a startling statistic that came out that 70% of people misusing opioids are actually getting them from family and friends.

Further, again, as I kind of alluded to earlier, four out of five new heroin users reported misusing prescription opioids. So remind clients, their loved ones to store medications in a safe and secure spot away out of sight. I store my medications in a lock box. I recommend people to also do this. That way other individuals coming into my home can't be tempted or have access to them.

And then strongly encourage clients and their loved ones to safely dispose of of medications. I think we all might be guilty of having old or unused prescriptions lying around. The best way to dispose of them is to drop them off at a local safe disposal site, and you can find a list of these via the link on this slide.

Next slide. Lastly, as some of you may have guessed, hopefully, from our discussion earlier. Educate. Educate. Educate clients staff your whole circle on naloxone. Simply put, again, locks on can save lives. I strongly believe that it's one of the strongest tools that we have in the fight against opioid overdose deaths. Emergency responders, police, doctors, EMTs can administer naloxone, but so can providers.

Family, friends. Anyone? Really? So that being said, provide this information to young adults, provide it to their loved ones strongly encourage each household to have at least one kit on them, and also take this opportunity while you're talking about naloxone, to inform them of the Good Samaritan law. So with that, sure, you guys are all, welcoming, having a new voice.

I will introduce Melissa from LA Familia. To go over her program and share some more information.

Melissa Martha

Hello. Thank you. Thank you for that beautiful presentation, Stephanie. A lot of useful information. I know it's later in the afternoon, so I hope. I hope everyone is still with us. We can just stretch for a minute here. We're going to go over a little bit of, who I am and what we do. My name is Melissa Martha and I am with La Familia.

And I take great pride in being a part of such an amazing organization. La Familia has been around since 1975. We do a variety of services, so we we do services such as mental health, adult, mental health, reentry, diversion services, employment services and STD services. So we also.

I'm going to talk a little bit about my program specifically right now. My program is our adolescent program, and we serve those as young as the age of 12, all the way up to age 21. We also have an adult program for 18 and up. We have special programs for women, pregnant and parenting, our perinatal program, which is also located in the Fruitvale area.

Our youth center is located at 3209 Glendale Street and the Oakland, also on the Fruitvale. We also serve ten high schools in the Oakland and Alameda school districts, and our adult services, again, are in the Fruitvale area.

And I here is our website. If you like to click on again, we offer so many different services and we heard Stephanie talking about meeting our clients where they're at. So, if we do find that our clients do need housing or food or mental health services, we're able to connect or serve our clients with those services prior to study.

So then we can help them meet their basic needs. Before that, before that.

So a lot of times when we receive phone calls, a lot of the providers are like, what's next? So when somebody does call, whether it's a provider, a family member, for instance, with my program, a lot of times it's probation, a concerned parent, teacher, counselor, we get the phone call. We try to schedule an appointment within 72 hours.

And because of this pandemic, we're able to be very flexible. And again, meet the client's where they're at and meet their comfort levels. So we can do telehealth. We can do it in definitely meet the client where they're at. So we'll schedule an appointment within the first 72 hours during the initial appointment. We'll will conduct an assessment. During the assessment, we'll screen for the level severity and determine the use and additional resources for the level support such as mental health, employment, housing, education and general health.

As well. Once that appointment is, can then we'll go ahead and schedule for our next appointment. Usually, depending on the kids can be a little antsy. So depending on their participation, engagement. The assessment will continue in to their next appointment. So then we can conclude it, and then we'll start scheduling, engagement and like, give them or provide them with a schedule.

And this is what treatment will look like. So then we can get the parent or the caregiver involved because usually they're coordinating treatment and providing the transportation. So we like to get everybody involved as possible.

And next we have. Resources.

Just.

So these are some of our partners. If we're not able to provide some of these services. Victory outreach. If somebody is looking for someone, something a little bit more faith based, we truly believe this is we all try to wrap around. And if a client's needs are not being met with our do not match our services, we'll try to find somewhere that does, outreach to who is more faith based city team, Salvation Army, Cherry Hill.

Perhaps the client will need detox services before coming to us. We'll go ahead and assist, with that placement. La Familia does not provide residential services for SE for adolescent services or perinatal. We do have a men's residential services. So we are contracted. We have Alameda contracted with, advent who has a residential service in Morgan Hill. So we like to coordinate that with, with the adolescent in need.

And then we will also, if we do see the need again, again in the assessment, we will we will make every phone call necessary to place anybody in need. To meet the level of need for these, for these clients.

Okay. And that's. I think I'll turn it back to Stephanie. 

Stephanie Ballard

Thank you so much, Melissa. And if any of you have, questions specifically for Melissa regarding any of the resources that she provided or La Familia in particular, feel free to throw them in the chat. One of the things when she was talking that that came to mind was, I think, when we're thinking about next steps for our clients or what it looks like when a client goes to contact a treatment provider, something that I found really helpful is to use that as an opportunity to engage them and ask them again what they need.

So I've had many clients of mine who, you know, sometimes taking that step of actually calling to get help is the hardest part of their journey in their minds. So actually asking them, do you want me to call with you? What can I do to help prepare you? Do you want me to be there when you call?

Do you want me to be on the phone? And just opening up as an opportunity for, supporting them in another way. And if I may add, Stephanie, real quick, because I know, we're short on time. Yeah. I mean, in Oakland and being, you know, with a monolingual population, a lot of times, the hand-holding or the, the warm handoff looks a little bit different for us.

So it's more like the parents coming in and having a cup of coffee and us making the phone call with the families and educating them and letting them know this is what treatment will look like. This is what to expect. And that's really where, the heart of our work comes from. And, you know, so much came up for your, part of the presentation is, you know, when talking to the youth, it's, being a parent and a provider certainly has its advantages.

And, you know, I talked to these. See it the same way I talked to my kids. I keep it real. I don't sugarcoat anything. And, I found that approach is very, success. Oh, absolutely. I think it's because we, as I think young adults can sense, sense our our nonsense in a sense. So. Yeah. You know, being real, authentic, honest, you know, you're more likely to get that response back from them as well.

Right? And I'm sure, Michelle can, testify to that even when you're working with kids, you know, in this justice system, too, they smell that, too. And, you know, that boys and their, you know, and they smell it and they feel it. So it's like, I mean, well, and this is what this is what it is.

I'm. Why. So there's more receptive to that. That approach I believe. So, absolutely. If anybody needs, any helpful terms as far as talking to your young people, please, I encourage you all to, reach out to to me or my team will be happy to help you. Thank you. Melissa. So now we're going to move on to talk about, a couple of resources.

And then we do have some time for some questions at the end. So if you haven't got your question in yet, feel free to throw it into the chat box. Next slide.

So as we mentioned earlier, there's a number of different treatment options that are available to young adults. Including, a number of different organizations in Alameda County where young adults can get help. So one of the simplest things you can do, to help a young adult or their loved one who are at risk of or currently using substances is to provide them with one of the pocket cards that you see on the screen.

These are called in your corner pocket card. They were developed as part of the in your corner initiative, by experts in the field of addiction and help from the local community. Further, they were actually reviewed by young adults in the community for feedback. We really wanted to make sure that they would be well received by young adults in the community.

And now going back to Maslow's Hierarchy of needs. The pocket card starts with basic needs, right? Such as food, housing, wound checks before moving on to treatment. So again provides them with what they might need, depending on where they're at. And then when making the decision, I do want to know for inclusion or exclusion of resources on here, it was really important to narrow down the choices.

As some of us may know, working in the industries that we do, if someone's in a crisis, we don't want to overload them. We actually want to narrow down their choices as it can help them, if they're using or struggling. And if anybody's interested in receiving some of the pocket cards, you can reach out to Michelle.

Her email is on the screen here, and she can help get some physical ones in your hands. You can distribute these to young adults. Parents, anyone, anyone who you think might benefit from them. Providers, even themselves. Next slide. So secondly, we strongly encourage all of you to go and visit and bookmark, the link on the bottom hand corner of their screen here in your corner, alameda.org.

To bookmark download print save in your corner opioid and other drug awareness toolkit. This toolkit covers a lot of what we discussed today, but most certainly in more detail. It is chock full with resources. This is a, view of the flip book. So there's a bunch of different ways in which you can interact with it and consume the information.

So this is the flip book version. You can also download a PDF version of it that's printable. And then we also have all of the information on a web format. And this is intended for everyone on the call today. But really, anyone who works with or is an advocate of youth in extended foster care. And it's housed on the Alameda County Probation website.

It expands upon sign symptoms of substance use, how to have a conversation, what to do after a conversation with a youth? Stigma reduction as a whole in the workplace. How to increase help seeking behaviors. Also working with the extended foster, foster care population, and those using substances. It also provides information on providing a trauma informed approach.

Harm reduction strategies and then has a whole ton, like I mentioned, of resources and local referral information. And at this point, we've got about ten minutes to spare, so we're going to open it up for Q&A. I'll answer a few questions that came in previously. So we have one question. If a person states they were a person with a substance use disorder, is it concerning if they are not in any long term recovery support services?

So again, I think this goes back to kind of the, looking at people and, and substance use in general on a spectrum. And kind of the not one size fits all approach. I think it depends on what they identify their needs to be, where they might be on that, on that spectrum. I've worked with clients who are in long term recovery, long term sobriety, who were involved in, a handful of treatment recovery services.

Involved in support groups. And then at points in their life decided that they didn't need it. And that was fine. And that points they didn't need it and it wasn't fine. So I really can't put a yes or no to that. I think it just completely depends on the individual in their situation.

Let's see. Someone asked, what type of MAT are used? So you can look for opioids in particular. There's also been some research done on using medication assisted treatment for alcohol. As well as tobacco. But for opioids specifically, there's really three kind of buckets. So you have buprenorphine, which suppresses and reduces cravings for opioids.

And then you have the non which reduces opioid cravings and withdrawal and also blunts the or blocks the effects of opioids. So if someone was taking methadone and they actually consumed opioids while taking methadone, they actually wouldn't get a level of high from using opioids blunts kind of it or blocks it. And then there's also naltrexone, which blocks the euphoric or sedative effects of opioids and prevents feelings of euphoria.

So similar it kind of blocks or blunts the effects of opioids. So if an individual takes them, they don't get the same effect, which would increase chances, of them maintaining sobriety.

Now question came in. Is there any way for a nonprofit. Or organization can receive naloxone for free? I have heard of that. Most certainly. I don't have the information at the top of my head. About that. Yeah. Sorry. And I mean to interrupt, but I just wanted to jump in to say that I provided a URL in the chat box.

But maybe I sent it to the panelists by accident. That could be it. And so the attendees, I would not be helpful, but let me I can send that to everybody. But there is yeah I see yeah. There's a place you can go. It's, it's the naloxone distribution project, and you can get up to 2400 units of Narcan.

Naloxone for free. And it's a really short application project. You just have to have a stand. It will leave a standing order, but, we can post the URL to that information. That's amazing. Thanks, Michele. Sure. And with that, we have a few minutes to go. Again, if you have any more questions. Go ahead, throw them into the chat box.

With the time that we do have left, I will pass it back to Michelle. I'll pass it to Michelle.

Michelle Schurig

Hi, everybody. So thank you so much for attending today. Again, if there are any questions, feel free to reach me after this webinar as well. And if you are interested in receiving some pocket cards, just send me an email. And let me know. We do have a way to print those out on the web page, but if you want actual copies of the, pocket cards and please send me an email or my emails on this, slide right here.

And and yeah, if you have any questions, any comments, any thoughts, maybe you want to, learn more or you have colleagues who you think might be interested in learning more. We can share, the recording of this webinar, but there might also be opportunities in the future to do maybe some boosters or refreshers, depending on, you know, the need out there.

So I just wanted to take an opportunity to say thank you so much. To Stephanie, and Melissa for an it is such an incredible presentation and really helpful. I learned definitely a few things that I did not know before, even though I've been staring at these materials. So thank you so much. That was really helpful. And today, but I just wanted to thank you all for attending and thanks to the presenters for doing such an amazing job.