AMERSA Talks

Turns out, the most powerful tool against addiction stigma might just be someone society once gave up on.

Despite significant advancements in addiction treatment, stigma remains one of the greatest barriers to care for individuals struggling with substance use disorder (SUD). Among healthcare professionals, stigma can manifest in ways that impact patient outcomes, access to care, and overall recovery success. This episode will explore how leveraging peers—those with lived experience in recovery—can be a powerful tool in combating stigma in medical settings. We will discuss real-world applications of peer support, the latest statistics on stigma in healthcare, and actionable strategies for fostering a more compassionate approach to SUD treatment.

Learning Objectives

• Review the reality of stigma and its impact on healthcare
• Identify the role of peers in recovery and two major healthcare environments
• Identify strategies for integrating peers into the workforce

Key Takeaways

• Peer support can dramatically reduce stigma in healthcare by humanizing the recovery journey and modeling successful outcomes.
• Stigma among healthcare providers often stems from bias, not lack of evidence, making peer training and integration critical.
• Successful integration of peers requires clear role definitions, workflow systems, and true cultural acceptance across healthcare teams.

Timestamps

• [00:36] Why stigma is the biggest barrier to addiction treatment
• [03:55] Healthcare workers’ surprising views on MAT (medication-assisted treatment)
• [06:00] The personal cost of stigma: a real-life story
• [09:05] What is peer support and why it’s powerful
• [12:35] How peers dramatically increase treatment engagement
• [15:00] Peers working in emergency rooms: how it changes outcomes
• [18:45] Peers in primary care: building trust and continuity
• [22:15] Key steps to integrating peers into healthcare teams
• [26:40] Supervision and mentorship strategies for peer specialists
• [30:59] Lessons learned: how to really defeat stigma in healthcare

Links

• AMERSA
• Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424857/

Find us online at amersa.org/amersa-podcast 

Frontiers in Substance Use & Stigma & Substance Use are sponsored by Provider’s Clinical Support System – Medication for Opioid Use Disorder (PCSS-MOUD). Learn more about PCSS-MOUD at pcssnow.org.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Substance Use Across the Lifespan and Innovation in Action are sponsored by the Opioid Response Network (ORN). Learn more about ORN at opioidresponsenetwork.org.

Funding for this initiative was made possible (in part) by grant no. 1H79TI088037 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

We’ve been blaming Appalachia for a healthcare crisis it didn’t create. 

Addiction in Appalachia isn’t what you think. This episode unpacks the nuanced reality of substance use disorder in a region that’s been stereotyped, ignored, and misunderstood for too long. Through powerful stories and clear strategies, it reveals how healthcare professionals, community leaders, and people with lived experience are fighting against systemic stigma and rebuilding trust.

Dr. Devin Oller, a primary care and addiction medicine physician at the University of Kentucky, and Kayla Strother, a certified advanced practice nurse specializing in adult geriatric primary care, join Kate Roberts to lay out the layered social, political, and economic drivers of treatment resistance in Appalachia. From language shifts and provider education to jail protocols and peer-led movements, this episode is a roadmap for changing care where it matters most.

Learning Objectives

• Review a framework for exploring Appalachian patients’ beliefs and knowledge about SUD
• Examine patients’ experience within the larger narrative about SUD in Appalachian communities
• Identify ways to address internalized stigma in healthcare settings and the community

Key Takeaways

1. Stigma in Appalachia isn’t just social—it’s systemic, and it directly blocks access to treatment through regulation, perception, and fear.
2. Positive portrayals and community-first approaches, like peer support and harm reduction, are transforming how addiction is treated.
3. Federal policy shifts are not enough without local engagement and context-aware delivery of care.

Timestamps:

[02:59] History and media’s role in shaping Appalachian stigma

[07:00] The SNL skit that encapsulates a harmful stereotype

[10:55] What "Demon Copperhead" gets right about addiction

[14:58] The real transportation problem in rural Kentucky

[17:59] State regulations vs. patient needs

[23:55] Misconceptions around "treating one drug for another"

[27:00] Role of harm reduction and community orgs

[31:00] Inside the Healing Communities Study

[34:00] The impact of lived experience campaigns

[42:55] Language changes that can change everything

Links

• AMERSA
• Demon Copperhead, by Barbara Kingsolverhttps://bookshop.org/p/books/demon-copperhead-barbara-kingsolver/18506689?ean=9780063251984
• Ramp Hollow, by Steven Stollhttps://bookshop.org/p/books/ramp-hollow-the-ordeal-of-appalachia-steven-stoll/8907054
• State alignment with federal regulations in 2022 to relax buprenorphine 30-patient waiver requirements, Anita Silwal, et. Al.https://pmc.ncbi.nlm.nih.gov/articles/PMC10206439/
• Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities, Ramin Mojtabai, et. Al.https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.05162
• Film: Harlan County, USA (1976)

Find us online at amersa.org/amersa-podcast 

Frontiers in Substance Use & Stigma & Substance Use are sponsored by Provider’s Clinical Support System – Medication for Opioid Use Disorder (PCSS-MOUD). Learn more about PCSS-MOUD at pcssnow.org.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Substance Use Across the Lifespan and Innovation in Action are sponsored by the Opioid Response Network (ORN). Learn more about ORN at opioidresponsenetwork.org.

Funding for this initiative was made possible (in part) by grant no. 1H79TI088037 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

We don’t have a drug crisis—we have a policy crisis. 

In episode one, Allyson Pinkhover, MPH, CPhT, CHO and Dr. Joe Wright explore some of the ways that urban planning, zoning, policing, and the location of addiction services combine to create or enforce a geography of containment. In Boston, Wright argues, land prices and the politics of what another scholar describes as “complaint-oriented policing” led to a smaller and smaller area in which visible drug use and homelessness were tolerated, and services for people with substance use disorders were located. This kind of geography, variations of which can be seen in many cities and towns, can create both problems and opportunities for patients as well as complex challenges for substance use care and public health.

Key Takeaways

1. Urban planning and zoning laws play a massive but overlooked role in shaping substance use patterns in cities.
2. The concept of ‘Hamsterdams’ reveals how some cities create designated spaces for drug use without public acknowledgment.
3. Effective policy solutions require looking beyond criminalization and understanding the root causes of addiction and containment.

Timestamps:

[00:00] Introduction – Setting the stage for the discussion on zoning, real estate, and drug containment zones

[02:15] What are ‘Hamsterdams’? – Explaining the concept of drug containment zones

[06:40] How zoning laws influence substance use – The hidden role of urban planning in drug policy

[11:55] The connection between real estate and drug containment – How property values and urban design affect policy

[17:20] Public policy decisions that shape urban drug landscapes – Examining the role of legislation

[22:45] Why some neighborhoods become containment zones – The factors that push certain areas into this role

[28:30] The ethical debate around containment policies – Who benefits and who suffers?

[34:10] What actually works in harm reduction? – Examining successful policies from various cities

[39:05] Lessons from cities that changed their approach – Case studies and alternative strategies

[42:10] Final thoughts and solutions – Where do we go from here in policy and public health?

Links

• AMERSA
• Dr Joe Wright
• Dr Joe Wright on LinkedIn
• Dr. Joe Wright on Bluesky
• Allyson Pinkhover on LinkedIn

Further Reading

• Complaint-Oriented Policing: Regulating Homelessness in Public Space, Chris Herring
• Homelessness is a Housing Problem, Gregg Colburn & Clayton Page Aldern
• The Death and Life of the Great American Cities, Jane Jacob
• Arbitrary Lines, Noland Grey
• Fighting for Space, Travis Lupick
• All Health Politics are Local, Merlin Chowkwanyun
• The Color of Law, Richard Lawson

Find us online at amersa.org/amersa-podcast 

Frontiers in Substance Use & Stigma & Substance Use are sponsored by Provider’s Clinical Support System – Medication for Opioid Use Disorder (PCSS-MOUD). Learn more about PCSS-MOUD at pcssnow.org.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Substance Use Across the Lifespan and Innovation in Action are sponsored by the Opioid Response Network (ORN). Learn more about ORN at opioidresponsenetwork.org.

Funding for this initiative was made possible (in part) by grant no. 1H79TI088037 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Episode 8 - Emerging Overdose Detection Technologies and Hotlines

Featuring:
Ju Park, PhD MHS
Assistant Professor of Medicine (Research)
Director of Harm Reduction Innovation Lab

Stephen Murray, MPH, NRP
Director, Massachusetts Overdose Prevention Helpline
Harm Reduction Program Manager, Boston Medical Center
 
Host:
Ricky N. Bluthenthal, PhD
Distinguished Professor of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
Associate Director of Institute of Addiction Sciences, USC

Most people who experience a fatal overdose are alone at the time of use and death (solitary drug use). Real-time monitoring of drug use events and rapid connection to a peer responder or Emergency Medical Services could save lives if widely available. This podcast will describe the rationale for remotely supervised drug use via overdose prevention technologies and hotlines and provide examples for how these programs are working in the United States.

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode 7: Innovative access to harm reduction support and linkage to treatment

Featuring:
Shelby Arena
Harm Reduction Manager, MATTERS

Joshua Lynch, DO, FACEP
Associate Professor of Emergency & Addiction Medicine, University at Buffalo Jacobs School of Medicine; Chief Medical Officer, MATTERS
 
Host:
Shoshana V. Aronowitz, PhD, MSHP, FNP-BC
Assistant Professor, Department of Family and Community Health, University of Pennsylvania School of Nursing

The opioid epidemic is ever-changing and with contaminants like fentanyl and xylazine in the drug supply, lethal overdose rates have been increasing yearly. Programs like MATTERS offer multidisciplinary solutions to combat obstacles in accessing harm reduction resources and treatment. MATTERS employs innovative methods such as emergency telemedicine and electronic referrals to outpatient treatment. The emphasis on low-barrier access to supplies and treatment allows MATTERS to provide accessible and stigma free services. Collaboration with various groups ensures effective outreach and advocacy for policy changes to address the needs of people who use drugs with compassion.

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode 6: Putting Harm Reduction to the Test: Drug use, Pregnancy, and Parenting

Featuring:
Leah Warner, NP, MPH
Street Medicine San Francisco Department of Public Health

Simone Vais, MD
UCSF Department of Family and Community Medicine

Host:
Jamie Lang
New Beginnings Case Manager, Homeless Prenatal Program

Pregnancy and the postpartum period challenge our notions of harm reduction and force us to address fundamental questions: who is our patient, and who is the primary focus of our harm reduction efforts? Is it the birthing parent, the fetus, the baby, or the entire family unit? Join host Jamie Lang and presenters Simone Vais, MD, and Leah Warner, NP, MPH, as they navigate through two intertwined journeys—one of substance use and recovery and another of pregnancy, birth, and parenting. On this journey, we inevitably encounter values that might be in conflict with one another, such as the family unity, recovery, and safety. Episode six delves into these dilemmas, exploring the tensions that arise and examining various harm reduction strategies applicable at different points along the continuum.

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode 5: Harm Reduction for Alcohol Use Disorder: Managed Alcohol Programs

Featuring:
Tanya Majumder, MD, MS 
Physician with the San Francisco Department of Public Health

Alice Moughamian, RN, CNS
Nurse Manager with the San Francisco Department of Public Health

Hosted by:
Soraya Azari, MD

In this episode, we present the San Francisco Department of Public Health’s Managed Alcohol Program (MAP), the first of its kind in the country. Managed alcohol programs offer the opportunity to improve the physical, mental, legal, and social health of patients with alcohol use disorder using harm reduction strategies. Guests discuss the theory behind MAP, the history of how the San Francisco program came to be, the ethical dilemmas that arise from this kind of work, and hopeful success stories. While research suggests that abstinence-based programs are not necessary for all individuals with alcohol use disorder--harm reduction strategies for alcohol use disorder have yet to gain prominence as treatment options. 

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode 4: Leveraging technology: Expanding Veteran access to harm reduction resources through vending machines 

Featuring:
Tessa Rife-Pennington, PharmD, BCGP
Harm Reduction Coordinator
Clinical Pharmacist Practitioner
San Francisco Veterans Affairs Health Care System
Volunteer Clinical Assistant Professor
University of California, San Francisco, School of Pharmacy

Andrew "Andie" Ruggles (he/they), LCSW
San Francisco Veterans Affairs Downtown Clinic

Hosted by:
Beth Dinges, PharmD
Harm Reduction Coordinator
Clinical Pharmacist Practitioner
VA Illiana Healthcare System

Episode four introduces harm reduction vending machines (HRVMs)! HRVMs are an evidence based and successful strategy to address many barriers Veterans face when seeking harm reduction strategies, including syringe services programs, overdose education, and naloxone. Presenters Andie Ruggles and Tessa Rife-Pennington, from the San Francisco Veterans Affairs Health Care System Harm Reduction Program, discuss how and why their program chose to implement HRVMs, how the machines work to increase Veteran access to resources, key implementation strategies and lessons learned, opportunities to include multidisciplinary team members and learners, and ongoing future research.  

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode 3: Insights from the Front Line: Harm Reduction Interventions in an Urban Hospital

Featuring:
Sophie Zhai
B.A. Public Health - University of California, Berkeley
Patient Navigator, Addiction Care Team at UCSF

Patricia “Patty” Moreno
B.S. Global Disease Biology - University of California, Davis
Patient Navigator, Addiction Care Team at UCSF

Hosted by:
Amelia Goff, NP
Assistant Professor, Oregon Health & Science University, Portland Oregon
Improving Addiction Care Team (IMPACT), HRBR Clinic

Episode three introduces San Francisco’s first ever hospital-based harm reduction program, led by Sophie and Patty with the Addiction Care Team at Zuckerberg San Francisco General Hospital. Together, they’ll reflect on the challenges they experienced with changing culture around addiction care in the hospital, and address strategies to combat stigma and staff burnout. They will share real-life impacts of patients who participated in their program, and explore exciting new projects for hospital-based harm reduction in the near future!

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode 2: Harm Reduction in the Hospital: Meeting People Where They Are

Featuring:
Marlene Martin, MD
Associate Professor, University of California, San Francisco
Director of Addiction Care Team, San Francisco General Hospital
Director of Addiction Initiatives, Latinx Center of Excellence

Kimberly Sue, MD, PhD
Assistant Professor of Medicine (General Internal Medicine), Yale School of Medicine

Hosted by:
Amelia Goff, NP
Assistant Professor, Oregon Health & Science University, Portland Oregon. Improving Addiction Care Team (IMPACT), HRBR Clinic

Episode two highlights how hospitalization is a known opportunity to offer addiction services, including harm reduction. The philosophy of harm reduction and harm reduction supplies can be incorporated into healthcare settings. We describe two approaches to implementing harm reduction in a hospital setting, with a focus on obtaining support, implementation, challenges, and lessons learned. The two resources presenters wished to share with listeners can be found at: lawatlas.org & nextdistro.org . 

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.