Heather Lee (Host): Hi there everyone. Thanks so much for joining us for this latest episode of Medically Speaking. I'm your host, Heather Lee, and I'm joined here today by Dr. Joshua Lynch, Medical Director at DeGraff for Emergency Medicine, DeGraff Medical Park, and also Brigid Keane, who is an Outreach Coordinator for MATTERS.

Thanks for being here.

Joshua Lynch, DO: Thanks for having us.

Brigid Keane: Yeah, thank you.

Host: Yeah, we have a, a, a lot to talk about. I guess we'll dive right in. So your career in emergency medicine actually started, you were a volunteer firefighter, is that right?

Joshua Lynch, DO: Yep. That was the very beginning and um, I worked on the ambulance for Rail Metro downtown overnights during college.

Host: Yeah, I would imagine you've probably seen a whole lot.

Joshua Lynch, DO: Yeah, yeah. Seen a whole lot as far as patients go and also seen, have seen the medical system change over the last 23 years or so.

Host: Yeah. How has it changed?

Joshua Lynch, DO: Um, you know, I think that, that, that reliance on the hospitals and the medical system really is, is kind of shifted, um, you know, with the landscape of health insurance companies and access to primary care, um, ease of access to the emergency department that, you know, that, that, that looks different for patients now than it did 20 years ago.

 Um, you know. Primary care was really kind of the center of a patient's medical, um, like medical journey. And now it's, it, you know, it seems that primary care has kind of been pushed and strained and now other parts of the system really need to kind of need to catch up and adapt.

Host: Sure. Now, what drew you to, uh, drew you toward emergen uh, emergency medicine?

Joshua Lynch, DO: Um, anyone that knows me knows that I can't sit in an office, so, um, or really anywhere for very long. So, emergency medicine was kind of a natural fit and starting off in EMS was a great way to get my feet wet and learn, um, about kind of the basics and then kind of just continue my medical training and, uh. It was a, just a natural progression.

Host: Yeah. And part of that progression was moving on to critical care transport. Tell me a little bit about your involvement with that and uh, flying as well. Right?

Joshua Lynch, DO: Yeah, so towards the end of residency, um, I really started working a lot with Mercy Flight of Western New York and, um. That was just, that was great. That was a passion that came out during residency, uh, transporting critically ill patients and also working with one of the few nonprofit aeromedical systems in the country left still today. Um, and that took, uh, that really kind of took my medical knowledge and put a twist on it and, um, made me get comfortable working in, in an environment with minimal resources.

Host: Yeah. And scratches that itch too for not being, you know, on the ground and, and sitting in one place for too long.

Joshua Lynch, DO: Yeah, right. And the cool factor was there so.

Host: Yeah, definitely. Um, and also co-author for a textbook chapter.

Joshua Lynch, DO: Yeah. So, ems, when, when EMS was becoming its own actual specialty, uh, there really wasn't an EMS physician textbook. So one of our colleagues in Syracuse started this massive project of writing an EMS medicine textbook. And thankfully many of us, um, in Buffalo were invited to help him with the project. And, um, uh, myself and another, uh, physician in at UB wrote a, um, uh, hemorrhage chapter for the EMS Medicine textbook.

Host: All right. So spreading that knowledge. Yeah. You know, with future generations. Let's dive into, uh, MATTERS and in opioid addiction. I guess first, what fuels both of your passions, uh, to help those who are facing, uh, such an issue?

Joshua Lynch, DO: Yeah. You know, working on the ambulance in Buffalo and in a variety of emergency departments, you know, substance use and mental health issues are front and center and you know, historically they, they haven't necessarily got the same degree of urgency as things like strokes and heart attacks.

Um, I think there's a

Host: There's a stigma attached to it for a lot of people.

Joshua Lynch, DO: Yeah, for sure. And it's also, you know, it's also for, for strokes, let's say stroke for example, that's a fairly, um, kind of defined diagnosis, right? Someone comes in, they have symptoms, we do the tests, we make the diagnosis, we give the treatment.

Um, we're fortunate enough to have some of the best treatment for strokes in the world right here. Sure. Uh, in Buffalo. But things like substance use disorder, mental health, people may be less likely to uh, be forthcoming about the symptoms that they're having and maybe they're, they, they present with another medical problem that, uh, um, is a consequence of substance use disorder.

Heather Lee (Host): How do you sort of break down Bridgid, that, that, that wall, that barrier when it comes to the stigma that often surrounds it so that people, number one, don't feel ashamed to come forward to seek help, but so that others are, are willing to offer that help and be a part of the solution versus part of the problem?

Brigid Keane: Yeah, I feel like one thing that we really do and we try to do very well is make it personal. Um, we treat every person that is referred through our program, like a person and we listen to them. If they want to talk about their medical needs, that's great, but if they also want to talk about personal things going on, we, we really take the time to listen.

Um, which I think goes a long way. And you can see that when, uh, the feedback we've gotten from patients as well as, uh, patients that continue to use us or, Hey, a friend told me about this great program and, um, I wanted to try it out, like I'm looking to get into treatment and, and I was recommended to come here.

So, um, I think that's one of the things is just really treating people like they're people.

Joshua Lynch, DO: Yeah. I think gi, giving them choices too, um is another huge, another huge thing. So, you know, traditionally patients that came into the hospital with opiate use disorder, that interaction would usually end not on a good note and end with us you know, giving the individual, you know, a piece of paper with some phone numbers on it and, and kind of sending you on your way. Um, that, that helped us sleep at night, but it didn't really do much for the patient. So, you know, giving them choices, building this network, having great people like Bridgid and others that interact with people on a, on a personal level and letting them know that they have some choice in their medical care like they would in any other aspect of medical care, um, you know, I think has really helped us a lot.

Host: And let's dive into MATTERS and how it works. Um. Medication for Addiction Treatment and Electronic Referrals. Um, walk me through the steps of how somebody, when you first come into contact with them and the next steps towards getting them on the right path.

Brigid Keane: Yeah, so it's a fairly simple process and um, the idea behind it is that anywhere, anytime you encounter someone with opioid use disorder, um, you can put a referral through in less than five minutes, and they're connected to treatment, um, as well as wraparound services as soon as the next day.

Um, so it's an electronic platform that can be access, accessed, um, 24/7. So, um, either on our mobile app or on our website. Um, so there's no problem with, oh, they're, they're not operating right now, or it's not within business hours. Um, you can use it anytime, anywhere. Um, and the individual is not only set up with that treatment, uh, appointment the next day or whenever they choose, but they're also, uh, they have access to a ride to and from their first appointment, um, a ride to and from the pharmacy to pick up their medication. Uh, we also will pay for their medication if they are uninsured or underinsured. Um, just another way to ensure the patient's success in, um, their treatment journey. And then we also offer peer support. So we'll connect them to, um, a local peer organization depending on where they are for just an added layer of support, um, in their, in their treatment.

Host: I like the fact that it's 24/7 because let's face it, somebody who is dealing with opioid use disorder, it's not a nine to five. There are no, you know, business hours, so to speak. It could be any time of day. When you talk about the referrals, who is actually doing the referrals? Are we talking about doctors? Are we talking about law enforcement? Who has access to, to put in that referral to get the ball rolling?

Brigid Keane: Yeah, that's a great question. Anyone. So we did start off with, um, emergency room physicians, but quickly realized you don't need to have a certain license or degree to be able to put this through. I mean, it's, it's basic information, we ask for demographic information. Um, and then really the individuals choosing where they want to follow up for treatment, um, and opting in for these additional services. So, um the organization, the way it works is they'll sign on with us, um, if they are in a setting where they feel they'll encounter individuals, um, in these scenarios or, um, it would be useful for them. And once they're signed on, um, they're able, anyone there is able to facilitate a referral.

Host: Talk about how big of a deal this is. I think back to when we were kids and we learned about, you know, people who had problems with drugs. It was, there was a, a picture of a person, you know, who was an addict or a, a dealer, you know, it was the shady person in a dark alley.

The truth of the matter is, is this can affect anyone. It can affect friends, family, people. We know a neighbor next door, um, all different ages, different races. It, it doesn't discriminate. Um, how does a, a program like this really make sure that everyone gets the care that they need and, and as quickly as possible?

Joshua Lynch, DO: You know, I think I, I think the, you know, we, we built this to be equally as efficient in an emergency department or on a street outreach team group, uh, patients coming out of, uh, incarceration or, um, even being referred from a primary care office. So we understand and we've watched the opioid epidemic change, uh, over the years and, you know, it looks a bit different today than it did in, in, I guess, kind of in the beginning.

And, you know, we've adapted and we wanted to make sure that the resources that we have for people, primarily getting you hooked up with treatment can be done, um, you know, as easy as possible. And just as easy as in, in a primary care office in the suburbs as it could be from a county jail. The process works the same and that's also why it's all electronic.

So the barrier of waiting on, on hold, um, you know, to, to get, look at appointment availability from one clinic. You realize that's not going to work. You call somewhere else, they may not answer, or it might be a week for the other, you know, for another treatment organization. So we took all that work out of it, built in appointment availability, right in the system so people can choose.

And there's a lot of appointment availability. So across the state there's about 2,500 appointments a week that are available. Um, several hundred a week right here in Western New York.

Host: And I think changing the way that you do things, it adds a level of dignity to, uh, addressing the issue.

Brigid Keane: Yeah, definitely. Um, we started, actually, we hired a support services coordinator. So, um, in addition to getting individuals linked to treatment, um, those other supports that they may be struggling with. So that might look like, um, needing an an ID or, um, needing connection to housing. So really being able to support with more than just the treatment aspect has been, um, I think fueled our success and, um, the patient success in utilizing our program.

Host: Without giving away any names or too much personal information, are there any stories that come to mind where you just looked at them and said, this worked exactly the way that we wanted it to? I'm sure that there are, are many stories, but any in particular that you can share?

Joshua Lynch, DO: Bridgid may have more a, a more recent example, but, um, I, so in the very beginning when, when there was not much structure, we didn't have a team of people, um, there, I was seeing a patient, uh, at one of the, one of the, one of the local hospitals and he, um in discussion that came up that he was struggling with opioids and hadn't necessarily been hooked up with treatment. So again, in the infancy of MATTERS, I don't even know if it was called MATTERS at the time, but it was the, it was, looking back, it was exactly what we wanted to accomplish. We were able to get him linked up with a, uh, treatment organization that had already agreed to kind of take referrals from some of the emergency departments, um, and his significant other that was sitting in the visitors' chair, um at the time, also said, you know, I, I, I'm struggling too. I don't know that you can help me because I'm not a patient here, but Wow. Um, and you know, he was happy that she offered that up. So we were able, she didn't need to be a patient in the ER, didn't matter. We could link her just the same way as we did him and, um and we ran into him kind of by coincidence in a different emergency department for a totally different reason. And he had a house and a great job, and was doing fantastic and got engaged and was doing just amazing. So, you know, I, I think that people forget about that side of this when they're thinking about opiate use disorder and, you know, at, at times for some it may, you know, feel like an irreversible process.

 Um, but it's not, and you know, Bridgid talks to people, many people a week that are doing fantastic. And they just needed, you know, they just needed some of the obstacles cleared out for them. And that's, you know, that's another, another objective that we have.

Host: And again, big picture, that's what MATTERS does is removes a lot of those obstacles. Right?

Brigid Keane: Right. And that's, I mean, comes from the obstacles that they're facing. We actually have to listen to them and, and then utilize and change our system to, to help, um, address those obstacles. Um, we had a patient actually in the last month that, um, when we first started contacting them to see how treatment was going, weren't, weren't very, weren't doing very well, wasn't very happy with the way things were going.

Um, but after we were able to provide a ride, I'm pretty sure we provided actually multiple rides, um, for this individual. But, um fast forward to the 60 day mark where we're con contacting them, they're engaged in treatment, um, things are going great and, uh, they were more than thankful for us. And that, I mean, that story can, I'm sure has happened many times over many patients, but, um, it's just really, those are the people that we are like, okay, this is why we're doing what we're doing.

Yeah.

Joshua Lynch, DO: You know, one more note about the hospital. I think just it's important to know that, not only across the Kaleida system, but really, you know, across many hospitals in Western New York and, and, and across the state and beyond. Um, this is a resource that's available today and anyone can download the App, MATTERS Network is what you search on Google or the App Store.

And we can help link a patient that a medical staff member might have, a discharge planner might be struggling with, and it doesn't have to be just in the emergency department. It can be on the floors, it can be in the ICU, it can be in the outpatient setting. Um, so you know, this isn't something that is coming soon or you have to apply for or anything like that, right in the palm of your hand, you just download, right?

You can just download the app today and help someone that you might be thinking about.

Host: Why aren't we seeing more physicians starting the treatment for opioid use disorder?

Joshua Lynch, DO: Yeah. Um, there were, um, the, the stigma is definitely, um, a big factor. I think that the medical community kind of as a whole has slowly gotten better with this, but it's still a real problem. There were other obstacles that that required additional training and hurdles to get over to be able to prescribe the medication to treat opiate use disorder. Thankfully, many of those are gone, but we won't, we, you know, we, we didn't really expect prescribing to go up significantly, um, by, you know, passively.

So, um, you know, I think people need to understand and medical professionals specifically that there are easier ways to do this now. It's not a huge deal. You are not extra liable if you decide to treat someone's opiate use disorder. Um, in, in fact, it's probably the opposite, uh, that if you're treating someone's, you know, all of their problems then is including opiate use disorder, then that's better for them too. So, um, you know, access to medication, understanding how to use it, understanding that it's not super complicated. Um, and hearing some stories of people that are success are successful, uh, you know, I think will help.

Host: Yeah. So this is sort of bridging the gap. Um, as part of this program, there are also harm reduction supplies, right, that are provided for folks?

Brigid Keane: Yeah, so harm reduction is one of the newer components of our program, but this is really, um, was developed to help those that are aren't, aren't quite ready for treatment or, um, that are still actively using. We want to help people use as safely as possible. Um, so that when they are ready for treatment, that, um, we can help them there. But so we do provide, um, individuals and organizations with, uh, drug testing strips. So anyone that's actively using can test their supply, know what they're ingesting. Um, these are free to order on our website, um, for anyone, we'll send them right to their address.

You don't have to put in your real name. Um, whatever you're comfortable with. Um, we also, another way to get supplies out in the community is we have harm reduction vending machines. So we have 17 that are live out in the community, and these are accessible 24/7. So they're all in areas where they're, they're outdoors.

Um, all you have to do, you go up and you, um press an access code, you enter your year of birth, um, and then you can dispense up to three products. So there's instructions right on the machine, how to use it, and you can use it as many times as you want. Um, this is just another way to get supplies in the hands of, uh, community members, for those that might not be comfortable ordering it right to their house or, um, going to a community organization that distributes our supplies to get them.

Host: And what do you say to the folks, because I'm sure you've heard it before, why are you providing these types of things? Because it's just helping people use easier. Um, I don't, I know that addiction and, and the process of, you know, getting clean, it's not a straight line. There's not a necessarily an easy start and a finish for a lot of folks. It's, it's a rollercoaster. You talked about it a little bit, it sort of gets folks on the right path and then when they're ready right, they can come for, for the help that they need.

Brigid Keane: Right. The reality is, I mean, you can't, uh, you can't force anyone into treatment. And I think this, these are just, um, additional steps to help them succeed. Um.

Joshua Lynch, DO: Yeah, I mean there definitely are critics about that part. Um, but you know, you can, I guess you can look at it, you can look at it from a couple different angles. One, you can just, um, uh, not offer anything but linkage to treatment and you will help a certain percentage of people and you will not help a larger percentage of people. So, um, you know, our, our thought is that we want to treat everyone on the whole spectrum of readiness. And maybe someone's a little bit ready and they want to do something safer, but they're contemplating treatment.

So, okay. Well, in response to the evolution of the opiate epidemic and contamination of drugs with other drugs, why not better educate them to do something safer? And this isn't just, um, you know, us thinking this is a good idea. We, everything we do, um, you know, obviously we're part of the, part of UB. So everything we do, we want to look at from an objective, uh, program evaluation perspective and do research when we can to make sure that we're doing it the right way, scientifically so we can give evidence-based recommendations to other people.

Host: Yeah. And you've actually presented not only across the country, but around the world when it comes to MATTERS and how this program works. What is the reaction from, from other, you know, professionals, health professionals, you know, around the world, and how do we stack up, we being New York State or even the US when it comes to some of these other places?

Joshua Lynch, DO: Yeah. You know, I think that the reaction changes based on, on where that discussion is happening. If it's happening in New York, the reaction sometimes, uh, is something along the lines of why didn't we know about this? And, um, you know, awareness not only just for the MATTERS program in general, but awareness for resources, for opiate use or stigmatized, um, disease processes, like HIV and hepatitis, awareness remains a huge problem.

 So that's kind of the reaction here. If the, the, the kind of tone of the discussion nationally is, um, kind of exchanging ideas and I think we're doing some things great. I think we're behind the ball on other things. There are some legislative issues that need to catch up that New York is not the, in the, in the front of the line for.

So, um, you know, those are things that we leverage our partnerships in Albany that we've built for over many years, to make sure that things like that happens. Looking at, kind of comparing this to work that's done in other countries, it's really a mix. There are, you know, some countries, um, you know, over in Europe that, that have a much different approach in regards to embracing people where they're at. Helping them get to the next step at the kind of a pace that's appropriate for them and also, you know, appropriate for their recovery.

Host: I would imagine it's as much a learning curve for you guys when you go to these other places and, and learn from their professionals, um, stuff that you can take back here that, that we can, you know, put into action.

Joshua Lynch, DO: Yep, yep. Absolutely. And that, and that's really, you know, why we all spend time traveling to learn from others to, to share what we're doing and, and ultimately, you know, provide better care for, for our patients.

Brigid Keane: Yeah. And I think one thing is we're not reinventing the wheel. We're using already existing resources and linking, um, just providing a link that wasn't there before.

Host: And that can make such a huge difference when it comes to somebody who is, is seeking that help.

Joshua Lynch, DO: Yeah. You know, there's a lot of um, you know, I think we, we've been fortunate across the country to have resources come in the form of opiate settlements, op opiate settlement funds. And, you know, obviously we want to make sure that all of those, those funds are used in the most appropriate way.

And that also, uh, we keep that in mind as we expand pieces of the MATTERS program and, and grow it. And, you know, even today it remains a very lean program. We're not building buildings. Um, we're, you know, leveraging, as Bridgid mentioned, preexisting resources. Vetting treatment organizations that we're linking patients to, to make sure that they share the values and putting the patient first and helping the clear obstacles.

Host: What would your message be finally, to somebody who maybe is, is struggling with opioid use disorder and is afraid to take that first step, um, what would you say to them in terms of the help that is out there, the help that you guys are offering?

Brigid Keane: I would say give us a call.

Joshua Lynch, DO: Yeah, it there, it, it's easier than you think. You don't need to get on a stage in front of a bunch of people and announce, you know, your issues. Right. Um, and in western New York, there is a 24-hour hotline that will connect you to a telemedicine provider that can get you access to medication and linkage to treatment again, 24-hours a day in Western New York.

So you can do the majority of the care from your own home or a friend's house, or a counselor's office or wherever. So, um, the 24-hour hotline, the MATTERS network app, it's, it, it, it's easier than you think.

Host: Yeah. And that's why we're here today because we are the stage. Right. Letting people know. Because you said the part of the problem is, you know, people not knowing that you're out there and what you're offering.

Mm-hmm. Right. So again, MATTERS is Medication for Addiction Treatment and Electronic Referrals. If folks want to learn more, where can they go?

Brigid Keane: Yeah, so you can go right to our website, um, which is mattersnetwork.org. Um, you can download our mobile app, which is Matters Network. If you type that in on, um the App Store. Um, it's available both on iPhones and on the, um, Android. And, um, you can also give us a call, which is 765-Matters is our, is our number.

Host: All right. A lot of really great information. Bridgid Keane, thank you so much. Dr. Lynch, we appreciate your time and of course we'll have to stay in touch and as you know, more things come about and you guys are working on more interesting things.

We're happy to share it with our audience.

Joshua Lynch, DO: Great, thanks.

Brigid Keane: Thank you.

Host: Thanks for tuning in for this latest episode of Medically Speaking.