Eliminating the Stigma of Opioid Addiction

Dr. McDonough: 
There is no doubt that our country is facing one of its greatest health issues, and that is the opioid epidemic.  We certainly can point fingers to blame, we certainly can talk about the issues and obviously the horrible outcomes, but we also need to look at what we are going to do down the road and what can be done to help this situation. 

Hi, I’m Dr. Brian McDonough.  Welcome to Primary Care Today on ReachMD.  Our very special guest today is Lorina Marshall-Blake.  She is a President of Independence Blue Cross Foundation, and right now the foundation is looking at this issue, identifying the issue, and I think you represent one great effort, and I know there are many efforts around the country.  Tell me a little bit about what you are doing with your organization to help deal with the opioid issue.

Ms. Blake:
Okay, let me tell that we have this awesome—I call it public awareness campaign called Someone You Know, and the whole intent is, it’s the Independence Blue Cross Foundation’s effort to address the opioid crisis.  And we figure we can’t do it by ourselves.  We’re working with local government agencies, schools, communities, organizations, health care providers, to humanize addiction and remove the stigma as a barrier to treating this whole opioid issue, because 1, we find that one of the biggest issues is stigmatization and that people are embarrassed so, therefore, they won’t go for help.  So, how do we put a face on it?  And that’s why I get so excited about this campaign and that there are real people telling their story.  They are real people that are sharing their experience and what they are going through, and in many cases, they are recovering and they are becoming whole again, and so it’s very hopeful. 

When you just mentioned it yourself, when you said it’s probably one of the biggest crisis that we’ve ever faced, I’m going to say since the AIDS issue, I mean, 1,200 people died last year in Philly with regards to the whole opioid issue.  So, again, we are attempting to go out there, tell people about it.  We do it through these wonderful videos where we have actual people that are telling their story, and there is nothing like that “picture is worth a thousand words,” and you actually have on the website individuals—and that’s independencebluecrossfoundation.org—who are telling their story. 

Again, I mentioned we can’t do it by ourselves.  It’s a collaboration.  It’s those different organizations.  It’s Independence Blue Cross Foundation.  It’s the Penn State University Justice Center for Research and the Pennsylvania Department of Drug and Alcohol Programs or the Share Your Opioid Story.  So, there are like 120 stories that are on the website, and as a result of that, you can even load up your own story.  We feel that by people telling their real-life story, not only people in recovery but people supporting people who are in recovery, again, someone that’s lost someone to addiction, so we try to cover every single one of those bases, and I think the key is just letting people know, Brian, that they’re not alone.  You’re not alone out there.  There is help.  There is hope.  If I said one thing about this campaign for me, it is so hopeful and that people can move to recovery. 

So, again, it’s an opportunity to get the information out.  We have it on bus shelters, on the back of the bus, on 95, on digital, so it really is everywhere, and it’s across Montgomery, Bucks, Delaware, Chester and Philadelphia County, which is our footprint.

Dr. McDonough:
Right, and I think, Lorina, you’re making some really good points.  Obviously, it’s a national audience.  In fact, I think you’re joining us from Houston tonight.  But the issue itself is one that it’s in every community, every town, and every practicing physician is dealing with it.  In fact, certainly with HIPAA, whatever, I’m not going to give up information, but today I was covering for another physician, and it was an opioid medication.  The person looked as if it was a legitimate reason, but I go on the alert system—and where I practice, we have the PMP, you look up—and I said wait a minute, this person’s getting it from 2 other physicians in 2 other states.

And then you realize, “Oh my gosh, what a problem this person has.”  Now, 3 years ago we weren’t quite so aware or in tune to that.

I think most physicians now are looking at it, but I think you’re taking it the next step, which is a really important one, which is there is such a stigma associated because—we grew up watching TV and, you know, the person selling heroin was always on the police show and they were always…

Ms. Blake:
Yes, was always the bad guy.

Dr. McDonough:
Right.

Dr. McDonough:
And now what you’re realizing is these are people in anybody’s home who maybe the grandmother was given opioids when, perhaps, they shouldn’t have or they didn’t use them, but they’re in the—they’re in the cabinet, and you can be hooked so fast.

Ms. Blake:
If individuals get the opportunity to look at the videos, there’s a gentleman on one of the videos, Brian, and Brian says that “We are not bad people trying to be good. We’re just sick people trying to get well.”  And that just came to the heart of it for me about…  Last weekend I had the opportunity to go to a recovery barbeque where people were telling their stories.  In many cases, those who are in recovery are so passionate about it, and what he calls it, he calls it the gift of recovery.  It’s a gift for him, and as a result of that gift, he wants to give back.  It’s a gift that keeps on giving.  So if we can get the information out and really conversational…  I think, again, when you look at what it was with AIDS, it was huge, it was daunting, and not that it has gone away, but it has become more manageable, more bite-sized, for lack of a better word.  And I think even with this whole opioid, we have got to get our arms around it, and I think we do it bit by bit.  It’s our campaign, Someone You Know, or someone else out there, but I think it’s all of us collaborating together, working together, convene…  I call it consistently consistent with our messages that, “Guess what?  Someone you know needs help and you can, too, help them.”  And there are resources on the website that can direct people to places that they can go, so there are many ways, you know, to do that.

Dr. McDonough:
You’re listening to Primary Care Today on ReachMD.  I’m your host, Dr. Brian McDonough, and with me today is Lorina Marshall-Blake.  We’re talking about the opioid epidemic, and we’re talking about Someone You Know, which is really a project designed to help those on opioids or formerly on opioids or with someone they love on opioids to be able to understand that this addiction is not something to be ashamed of.  Lorina is the President of the Independence Blue Cross Foundation.  You related it to HIV/AIDS, which I think is a really good analogy.

Dr. McDonough:
And I remember interviewing former Surgeon General C. Everett Koop when he was alive. And we were talking about the early days of HIV/AIDS, and he, on 3 different occasions, had conversations with then-President Ronald Reagan who agreed with him.  “We should talk about AIDS. We should go out and we should make big announcements.”  But his handlers each time had convinced him not to talk about it, and then eventually they started talking about it. But one of the big barriers to that was the lack of communication and the stigma.

And I think what you’re doing here is getting to this as quick as you can without that delay because really, the stigma does have a major impact for people seeking help. They don’t want to be associated.  They don’t want to hurt their job.  They don’t want to do…And before you know it, it’s too late.

Ms. Blake:
They don’t want to be embarrassed.  You know, “I don’t want anybody to know.”  Then you are functioning with it.  I also say and in some sense, it’s a family affair because it affects everybody.  It affects everybody in the family.  As I look at what we are trying to do under the opioid campaign that we’re doing, Someone You Know, there really is an effort called STOP which it falls under, and that STOP is under an acronym that is Supporting Treatment and Overdose Prevention, and under that, again, is this whole Someone You Know campaign.  Then, Dr. McDonough, I don’t know if you’ve heard about the Warm Handoff.  We’re working with people that when they get into the emergency room, that they have the opportunity to get into recovery, alright?  And that’s called the Warm Handoff.  So again, we’re studying that to see how well that is working.  Again, we’re even doing research to see if this Warm Handoff actually will work also, and so it’s many problems.  We’re working with the Salvation Army.  We’re working with the Boys and Girls Club. We’re working with Caron, which is one of the leading organizations.

Dr. McDonough:
So, now as an organization… I mean, and it’s great to see.  I mean, obviously, you work in all areas of health care, insurance, those sorts of things. But the foundation itself, you obviously targeted this and recognized it as a major health issue in 2015 to 2020 and beyond.  Was it a group decision?  Was it something where your foundation said, “Gee, this is obvious”? How did this evolve?

Ms. Blake:
Again, when I think of the Independence Blue Cross Foundation, I call us boots on the ground.  Okay, we’re there.  If you look at the other things that…  We work along with 44 clinics throughout the same region that I just talked about, and we serve the uninsured and the underinsured.  Again, we’re into the nurse…  We support all 21 nursing schools, and then we have the social determinants of health, which is where the STOP campaign falls, and then we have the grants that we do to organizations that are out there fighting it.  So, again, it is our…  I say it is part of our mantra to make sure that we reach out and help those that are in need, and we’ve been doing that from the beginning, helping bring solution, resolve.  In one of the videos, it talks about the underdog.  We want to make sure that we’re there.  and if you look at even the history of just Blue Cross and not even talking about the foundation, they’ve been around for over 80 years, and they’ve been there, and they’re going to continue to be there, and because we are, indeed, the foundation or the philanthropic arm, we’re able to do some things that they can’t do.

We are with the people.  It’s about the community.  There was a song years ago called It’s A Family Affair, and I go back there again, and that it is all in the family and we’re all cut in some way, and I don’t think there’s anybody that cannot raise their hand and say there’s not someone they don’t know who is in this situation.

Dr. McDonough:
And one of the things you have with the Someone You Know is that there are these stories.  So, for physicians around the country who may want to look at them or use parts of them with their own patients or whatever because they could…

Ms. Blake:
Sure.

Dr. McDonough:
What is the website?

Ms. Blake:
Okay, the website again Ibxfoundation.org.

Dr. McDonough:
Ibxfoundation.org and that’s I B and the letter X foundation.

Ms. Blake:
Or you can just put in IndependenceBlueCrossFoundation.org.

Dr. McDonough:
And that would be something, again, if you’re listening to the program, just check it out, because there are opportunities.

Ms. Blake:
It’s awesome.

Dr. McDonough:
I think what you’re saying is so true, that if people see people they can relate to… I mean, as a physician, I can talk about stuff.

I can talk about the health issues and things, but what this really does, it gives them an opportunity to look at others who are in similar situations and they are not being preached to, and I think that’s so important.

Ms. Blake:
That’s the key.  I think people need to know that they matter.  You do matter.  It’s important to us.  And again, if I go back to the foundation, it’s important to us that people feel whole, that people feel healthy, people know that they’re not alone, they’re not out there by themselves, that there is someone out there that really, really cares.

Dr. McDonough:
Lorina, this program always goes way too fast, but I want to ask you:  Is there anything I did not bring up that you think we should have discussed before we do wrap it up?

Ms. Blake:
I think you did talk about the key is this whole part about stigma, putting a face on stigma and that take away this de-stigmatization so that people don’t feel alone, they don’t feel like they’re cornered, they don’t feel like they don’t have any hope.  I think that’s the key, and I think we’ve talked about that, but that’s right at the heart.  And again, that it’s not any one of us—it’s all of us working together, partnering together.  You mentioned earlier that there are other organizations that are doing it.  I think it’s important that we partner together and to continue to encourage people to get the support that they need, okay?  And whether that’s getting themselves into recovery or finding resources to help someone battling with opioid abuse, that they can do that.  And help is on the way.  Help is out there.

Dr. McDonough:
Lorina Marshall-Blake, President of the Independence Blue Cross Foundation, I know you’re taking some time away from your schedule in Houston.  I want to really appreciate you for joining us.  It’s an important message.  And again, for those listening, if you want to check the website, it’s ibxfoundation.org, and there are those stories there.  You’ve been listening to Primary Care Today on ReachMD.  I’m Dr. Brian McDonough.  Until next time, Be Part of the Knowledge.