Jason Lucey, Assistant Dean, Advanced Practice Programs and Assistant Professor, Nursing shares his thoughts on substance use, recovery, and training future nurses
September is National Recovery Month, marking the importance, power, and strength of recovery from alcohol and drug use. The month promotes the reality that recovery is possible for all, but the word itself has many meanings – among them, returning to wellness after illness or injury, and growth.
In this edition of The IHP Interview, Assistant Dean, Advanced Practice Programs and Assistant Professor of Nursing Jason Lucey dives into the topic of substance use, care, and why the war on drugs has been a catastrophic failure. The below conversation has been edited for brevity and clarity.
You have decades of experience in the substance use field. How did you first get involved?
My experience in the phenomenon of substance use came directly from my clinical practice. I worked for many years as a nurse practitioner in both Massachusetts and New Hampshire in emergency room and urgent care settings in the early 2000s, just as the dramatic problem with prescription opioids was affecting our country.
I quickly realized that as a healthcare provider, I wasn’t prepared for it. So, as a way to make my day easier and my interactions with people who are using substances go a little bit better, I did a lot of self-guided learning, reading, and reflection on what works best.
Since then, I've been involved in a number of different ways in policy change, increasing access to critical resources like naloxone for overdose prevention, and in promoting and implementing harm reduction strategies to help people who use substances stay well in spite of their use. In my home state of New Hampshire, I was one of the founding members of the New Hampshire Harm Reduction Coalition, a nonprofit organization that works to mitigate the harmful effects of substances but also provides health care services these individuals typically don’t have access to in the traditional health care system.
What has kept you involved with this community for so long? Where does that passion come from?
The fact that people who use substances, especially illegal ones, don't receive basic dignity and compassion - especially in the healthcare system - is a key motivator for me. That’s a tragedy, and one I'm trying to eliminate.
As is common for many, I’ve had some personal interactions in my family with individuals who use substances. It’s true that whether in moderation or not, we all use substances to some degree. So, when substance use escalates and has negative effects on someone’s life, it affects not only the individual but their family and community too. This is a challenge that we have not yet solved in healthcare. But I’m hopeful that through better care and improved policy, we can make a difference and improve people’s lives by operating differently than we have in the past.
What does “operating differently” mean to you?
In society, treating people who use substances like human beings instead of criminals seems like a natural first step. We know that addiction can affect anyone from any walk of life, just like diabetes or heart disease can. What those ailments have in common with addiction is that not only can they happen to anyone, behavior change plays an integral role in recovery. For people with diabetes it might be diet change, for example. And yet, in society, we support individuals with diabetes or heart disease as they recover and as they work towards behavior change – which can be challenging. The same is not usually true for those who use substances. If they do not change immediately and go from problematic use to abstinence, society has been known to cast them aside and further stigmatize them, instead of supporting them, ultimately perpetuating the issue at hand.
Today’s opioid crisis and overdose crisis are leading to completely and wholly preventable deaths, which enrages me. With increased drug regulation, we could protect our drug supply, namely from the looming threat of fentanyl. There could be more safe consumption services sites throughout this country to help people who are using to do so safely. Improving community access to naloxone and things like that can help, but we need to expand access to those services within traditional health care models. There are so many ways to ensure more folks survive their addiction and receive the help they need.
You mentioned safer consumption sites, which can be a divisive topic. Can you talk a little bit about that?
It's understandable that people are initially taken aback by the concept of safer consumption services; that’s often the initial response to harm reduction services. The oldest and most well-known harm reduction service is giving sterile syringes to people who inject their substances. Evidence shows that the outcome of this service has been entirely positive over the past 50 years – it hasn’t increased drug use or crime. It has simply increased safety, reduced transmission of disease, and increased the number of potential entrants into treatment and recovery programs.
I often think of it like this: if your loved one was the person injecting, this is what you’d want. You'd want somebody to be there to help them stay alive and live another day. With that, we should want it for everyone’s loved ones. I am an eternal optimist; hope is an important thing to maintain.
All in all, addiction has a fairly good prognosis, if you stay alive. Addiction has a remission rate between 62% and 72%, according to the Recovery Research Institute and SAMSHA, respectively. But the problem with life-threatening substances is that if you die, you can't go into remission.
You mentioned that earlier in your career, you weren’t prepared to work with individuals using substances. Has healthcare education changed to better train future clinicians?
Here at the IHP, we have integrated multiple touch points about people who use substances and how to take care of them into our curriculum. We’re actively training our nursing students how to help, encourage, and promote more positive health outcomes for those using substances and are even offering integrated training on buprenorphine, a medication prescribed for people with opioid use disorder to help them maintain stability. Our goal is that all Nurse Practitioners who graduate from the IHP are prepared to administer it and discuss it with patients.
We are also currently working on a few projects related to substance use training this year, including simulated experiences for students. These opportunities give students a safe educational environment to practice the art of talking to people who use substances. Often, this is more impactful than receiving a lecture or doing a reading. It's actually the application of practice.
What do clinicians need to do in order to be successful in working with those who use substances?
In a sense, people who use substances in a problematic fashion are all around us. These are relationships that we all have, in our families and friends, and with that, we all carry with us deeply ingrained biases about drugs and consequently the people that use them. Everything we’ve ever learned about substances and those who use them, dating back to childhood, has sent messages to us about what to think and how to act. Largely, these individuals have been stigmatized and society has told us that those people are bad - and that’s just not true. Everybody knows someone who is a good person but has a bad health problem.
As healthcare providers, we have to do the hard work of undoing our own personal biases about people who use substances in order to effectively care for them. I can teach students all day long about the evidence and what they should do with these patients but there is the internal work that needs to be done.
In our world today, the War on Drugs has really been a war on people. And with that, the War on Drugs has been a catastrophic failure. The way that we're waging it right now, it disproportionately affects people of color and communities of color and has led to tragic deaths, increased incarceration rates, and look where we are right now; 100,000 people per year die of drug overdoses and that number is on the rise. It clearly has not worked. We need a new approach. And by new approach, I mean the oldest approach in the book: treating people with basic compassion, dignity, and trust, and treating everyone as a person who has value regardless of their choices.
What are your future goals, for the IHP and beyond?
My vision for the IHP is that we become a center of excellence for substance use training and become experts in curriculum development and scholarship in the field. I do this work on a daily basis - it's my love and my passion - so I bring it into the classroom with me all the time. But I’d love for the IHP itself to become an educational hub for this education.
In the near term, I personally intend to continue infusing meaningful and evidence-based teaching techniques around substance use into our courses. Since I oversee multiple nurse practitioner tracks, I have the opportunity to disseminate and diffuse this coursework in multiple different programs.
That's what drives me, the fact that if you do this a little bit better, the person receiving your care will have a better outcome.
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