Opioid Epidemic Hero of the Month

Introduction and upcoming to OC and efforts against opioids

For this month’s Opioid Epidemic Hero of the Month, we would like to introduce Tiffany Hwang, a substance use navigator (SUN) at UCI Health. Her role entails bridging patients from the Emergency Department or hospital to outpatient clinics, and ensuring they receive a prescription that can last them until their first appointment at an outpatient clinic where they can continue receiving their medication assisted treatment (MAT) appointments. Tiffany graduated from UC Irvine with a degree in Public Health, where she had initial interests in furthering her understanding of drug use. Working as an Americorps VISTA gave her the opportunity to help mitigate the Opioid Epidemic in Orange County, where she eventually found herself becoming a SUN after developing a hub-and-spoke system and partnering with the CA Bridge Program for UCI Health. The services Tiffany has provided as a SUN has helped countless patients in Orange County who are struggling with substance use disorder (SUD) to bridge their way towards treatment plans that not only help them with their recovery, but fit their lives regardless of where they are.

Current work, and Effects of COVID-19

Currently Dr. Mario is working as the National Medical Director of Substance Use Disorder and Social Determinants of Health at Molina Healthcare. He is also the treasurer on the Board of Directors for the California Society of Addiction Medicine (CSAM), Co-Chair for the American Society of Addiction Medicine (ASAM), and the Committee for Practice Management and Regulatory Affairs. Locally, he works with the coalition of community clinics to assist Federally Qualified Health Centers (FQHCs) with their Addiction Medicine needs. In particular, he has done recent work with Korean Community Services (KCS) Healthcare in Orange County.
The COVID-19 pandemic impacted many physicians, including Dr. Mario, by pushing a transition to telemedicine. Dr. Mario believes that telemedicine has improved the access of care during these times, and has proved to be a useful tool for many providers and patients who need long term treatments and are at high risk to COVID-19. Nowadays Dr. Mario assists in the efforts of the Opioid epidemic through training individuals to get X-waivered, mentoring providers, and improving Addiction Medicine programs across the state.

Accomplishments, Future plans, and More

Some of Dr. Mario’s accomplishments include his work at Molina Healthcare, where he helped lead the creation of both the Pain Safety Initiative and an Opioid Usage Model of Care which has helped redesign care management across 15 states. It helped create uniformity in opioid care for providers, policymakers, and treatments. In the short term, Dr. Mario looks to continue to support the development of opioid prescribers in the OC area, such as at correctional facilities. Working with the Coalition of Community clinics he looks to improve the impact of the OC’s FQHCs by educating his colleagues on the necessary training to prescribe these opioid treatment plans. In the long term, and the bigger picture Dr. Mario looks to improve state and national policies around substance abuse from addiction medicine nomenclature to aligning policies to benefit patients with OUDs and their families.
Some of the organizations Dr. Mario would like to recognize include CSAM for having some of the most amazing individuals that want to improve the lives of folks with substance use disorder. Also the Be Well Initiative from MindOC that is a collaborative group of providers in Orange County that exemplifies the team effort that is quintessential for the efforts against the Opioid Epidemic.
Overall, if you were to ever receive a piece of Dr. Mario’s wisdom you will feel his passion radiate throughout the room regardless if it is in person or through a Zoom call. Dr. Mario’s ability to help his patient’s have the courage to self actualize and overcome their challenges they initially did not believe they could overcome is amazing and something only gained through the years of experience he has gone through.

The Opioid Epidemic Hero of the Month is a new series we're starting in 2021 to recognize and appreciate the providers and heroes who are contributing to the battle against the Opioid Epidemic. Each month we will be highlighting a new Hero that has helped the community of Orange County be a safer place.

Current Work and Impacts of COVID-19

   Dr. Hurley works for the county of Los Angeles as the Director of Addiction Medicine and is involved in a variety of efforts and initiatives surrounding providing medications for addiction treatment of those with alcohol, tobacco, and opioid use disorders. COVID-19 has impacted Dr. Hurley’s work by pushing both administrative and most clinical meetings to a virtual setting. However, Dr. Hurley continues to see patients at the LA County jail in person. Dr. Hurley has observed a worsening of opioid overdose during the global COVID-19 pandemic and he explains that many who were previously in remission have unfortunately relapsed in recent times. He suspects that lifestyle stability is a key factor in OUD remission during the pandemic as many lack access to telephones and housing.

Accomplishments, Future Plans, and Advice for Students

   One of Dr. Hurley’s major accomplishments during the pandemic is working with LA County to arrange local sites where those suffering from homelessness can both quarantine and shelter during the pandemic. By spacing individuals out and providing them with housing at these sites, Dr. Hurley believes that this is a both novel and promising way to assist the homeless during the pandemic that provides increased lifestyle stability. In addition, Dr. Hurley has been able to expand medication assisted treatment of OUD during the pandemic due to suspended federal regulations that required waivered providers to be physically present with patients in order to prescribe medications such as buprenorphine and naloxone. He has worked with the city to train a group of outreach workers to quickly link people to these types of medications through a phone line, enabling patients to get started on life saving medications much quicker than before.

   Dr. Hurley’s future plans surround the challenge presented by the prevalence of patients with OUD seen in various settings. He explains that people with OUD present in hospitals, ERs, clinics, and many medical settings but access to OUD treatment is not necessarily available in all of these settings. As such, Dr. Hurley aims to work with local leadership in LA and OC to prepare clinics and other medical establishments to treat or link patients with OUD to the appropriate resources.

   For students interested in Addiction Medicine and/or Addiction Psychiatry, Dr. Hurley suggests to rotate and get involved in multiple different experiences. He explains that students are often only able to have one or two experiences and it is not always enough. He recommends getting as much exposure as possible to the field which will enable students to understand the different parts of Addiction Medicine more thoroughly - whether it be care directed at reducing opioid use or harm reduction care (i.e. needle exchange programs). Dr. Hurley recommends that students attending meetings such as the California Society of Addiction Medicine (CSAM), American Society of Addiction Medicine (ASAM), and the American Academy of Addiction Psychiatry (AAAP) in order to network with others in the field. He suggests the book: Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White as an insightful read for those interested in the field. Overall, Dr. Hurley has been vital in combating addiction in Southern California and continues to have a momentous impact on the Opioid Epidemic.

Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com! We would love to include them in our series.

Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com! We would love to include them in our series.

February 2021 - Dr. Brian Hurley

Introduction

For our first Opioid Hero of the Month we would like to introduce Dr. Mario san Bartolome! He is a triple boarded physician in family medicine, addiction medicine, and preventive medicine. He attended medical school at UC Irvine’s School of Medicine in the joint MD/MBA program, and completed his residency at Long Beach Memorial Hospital. Growing up, Dr. Mario was exposed to some of the challenges that vulnerable populations faced, such as, limited access to healthcare and language barriers -- often having to translate for his family members at local health clinics. These challenges inspired Dr. Mario to pursue medicine. Dr. Mario began his efforts against the Opioid Epidemic during his medical training where he frequently saw patients with substance use disorders. Although these patients presented with addiction problems, Dr. Mario understood that they struggled with a range of other issues including homelessness or domestic abuse. While some providers asked what their patients needed, Dr. Mario asked how these needs arose. Although many see Addiction Medicine as part of the field of Psychiatry, Dr. Mario sees it as an extension of family medicine in that the patient needs to be treated holistically. His experiences have helped him understand the challenges low socioeconomic groups face when they add a substance use disorder on top of their already vulnerable positions in society.

Current Work and Impacts of COVID-19

Some of Tiffany’s current work as a SUN includes connecting patients to outpatient clinics and social services, ensuring these patients receive MAT medications while they await their first outpatient appointments, and overall being an advocate for these patients’ needs. Working as a SUN has helped Tiffany learn about the stigma associated with SUD; a majority of patients struggling with SUD want to get out of their addiction, but it is much harder than people looking on the outside would understand. Tiffany discussed how, unfortunately, many times these patients feel scared or apologize when they ask for help because they feel like a burden when they come seeking help at a clinic or hospital. She mentioned that in order to help mitigate this feeling, it is important to remind the patient that they are not a burden, and that we are there for them. Tiffany noted that a large barrier experienced by certain patients receiving care is homelessness, because the patients do not have a safe place to store prescribed medications, they can get robbed, and some homeless shelters are not a good environment for someone trying to recover from drug use. These factors also lead to pharmacies being less inclined to want to dispense medications for them. Thanks to Tiffany’s persistence, she has been able to help many of her patients receive their initial treatment, which they may have never obtained if not for her passion to want to help them.

According to Tiffany, the effects of the COVID-19 pandemic have reduced the amount of people coming into the Emergency Department, reducing the volume of patients that she sees. Also, transitioning to telehealth helped many patients make it to their appointments because it only required a phone call. An issue that came with this is that homeless patients needed a phone, and still currently needs to be addressed today.

Accomplishments, and Future Plans

One of Tiffany’s proudest accomplishments was being able to normalize this program in the hospital, and being able to reach patients not only in the Emergency Department, but also the inpatient population at the hospital. This not only helped reach more patients, but motivated more physicians to become x-waivered and provide more patients with MAT services. Tiffany’s future plans look to continue improving healthcare for the homeless population through USC’s street medicine program, where a collaboration of healthcare professionals looks to meet the homeless population where they are comfortable and help overcome the stigmas that they may have. Tiffany would like to thank the Korean Community Services (KCS) for their help in developing the program she is working in now, and Dr. Cameron Harding at UCI Health who helped normalize her program into the hospital.

Is there an Opioid Epidemic Hero in your community in Orange County? If so, let us know at saferxoc@gmail.com! We would love to include them in our series.

March 2021 - Dr. Chun Chiang

Current work, and how COVID-19 has affected work
Now providing healthcare in these correctional facilities, Dr. Chiang has learned how these populations are significantly underserved. During their time there Dr. Chiang and his team do their best to get a baseline of these patients’ health, and to educate these patients as much as possible on the importance of follow-up, and routine check-ups once they are released and need to go towards other providers. Some of the challenges Dr. Chiang faces treating these patients with opioid use disorder (OUD) is the long term treatment of these patients, and the development of healthy networks to help these patients maintain sobriety beyond their treatment. COVID-19 impacted Dr. Chiang’s work by causing an immediate transition towards more strict precautions when treating these patients. It was difficult to educate these patients on better lifestyles because of the conditions they were already in, and it was difficult to do things such as social distancing.

Accomplishments, Future plans, and Shoutouts
Some accomplishments Dr. Chiang has accomplished in his work include initiating more patients on MAT in the last 12-15 months than most single correctional facilities in the same time period. This has provided patients across Orange County the opportunity of recovery that they deserve. Dr. Chiang’s short term plans for the future include increasing the amount of x-waivered providers and getting more providers more comfortable initiating MAT programs with more of their patients. In the long term, Dr. Chiang would like to create a program outside of these facilities for his patients to transition if they do choose to transition to long term care after they are released. He would also like to move towards a low barrier approach where we can provide medication to patients with OUD with less barriers than with a high barrier approach that requires a longer standardized assessment. Dr. Chiang understands that this is something difficult to introduce to many providers, but with the perseverance and support from him and his team they look forward to being able to lighten the fear providers may have with this approach. Some organizations and individuals Dr. Chiang would like to shout out are the California Society of Addiction Medicine, the Orange County Sheriff’s Department, Dr. Brian Hurley, and Dr. Mario san Bartolome. Dr. Hurley has helped Dr. Chiang set up the program they are currently using in the correctional facilities in Orange County, and Dr. Mario has helped be a subject matter expert for their providers to consultat with. We have seen both of these physicians on SafeRxOC in our previous two highlights if you would like to check them out. Overall, Dr. Chiang is a significant figure in the Orange County community that’s not only helped improve our MAT programs in the correctional facilities, but has served as an amazing advocate for pushing towards more MAT services for all types of patients.

Current Work and Impacts of COVID-19

Being in Orange County for more than 20 years, KCS has seen many changes over the years. The demographic changes that have occurred in the county are significant. The county is now 22% Asian, and being a female Asian leader and provider she has been able to understand how behavioral health programs need to be tailored for communities of color. Additionally, the substance use disorder field has gone through many different phases, the latest one being the reintroduction of healthcare professionals into this field of mental health services. During the COVID-19 pandemic, at KCS they provided all the frontline services they could, from navigating patients through information and providing COVID-19 tests. Thanks to the quick transition to telehealth, there was a lower no show rate and they were still able to stay in excellent contact with their patients.

Accomplishments, and Future Plans

One of Ellen’s proudest accomplishments in the county is being able to provide and operationalize medication assisted treatment services and mental health services for all communities that her clinic is serving. In terms of her short term and long term goals, Ellen looks to continue improving opioid use disorder (OUD) treatment with integrated whole person care. Ellen believes it should not be the patient’s burden to go to 100s of places to receive the care they need, from social services to OUD treatment. Ellen’s future goals include developing KCS into a place where patients can receive all the care services they may need in one place.

Finally, Ellen would like to thank everyone along the spectrum of care in Orange County who has helped the community in any way possible. Ellen reaches out with empathetic arms to the hospitals, clinics, and services in the county because she understands that providing these services is not easy, and is often not well-rewarded. To all those heroes, thank you. Overall, substance use disorder services are not yet diversified, but Ellen intends to bring her strength as a substance use disorder professional and an Asian American to provide cross-sectional services for these individuals.

May 2021 - Ellen Ahn

Introduction and upcoming to OC and efforts against opioids

This month’s Opioid Hero of the Month is Ellen Ahn! She is the executive director for the Korean Community Services (KCS) Health Center, a federally qualified health center and community clinic. They run one of the largest medication assisted treatment (MAT), drug, and alcohol programs in the county. Ellen’s work leading KCS has provided countless patients in the community with a wide variety of services, ranging from mental health first-aid programs to typical healthcare programs. Ellen grew up in the Southern California area of Los Angeles Koreatown but pursued higher education outside of California, earning her law degree and returning to settle in Orange County where she worked in a corporate law practice. Ellen’s journey towards fighting against the opioid epidemic started when she began volunteering at the nonprofit organization of KCS more than 20 years ago, and before she knew it Ellen fell in love with her work. Her time as a volunteer soon developed into a career that she loved, with enough passion to become the executive director. Part of Ellen’s motivations for choosing this career against the Opioid Epidemic includes her family’s past medical history of mental and alcohol use disorder, and the lack of people working in this cross sectional area of behavioral health and substance use disorder services in colored communities. In order to better help these individuals, Ellen went back to school for social work and became a certified drug and alcohol counselor, providing quality substance use disorder services when she returned to KCS.

January 2021 - Dr. Mario san Bartolome

Opioid Epidemic Hero of the Month

April 2021 - Tiffany Hwang

Introduction and upcoming to OC and efforts against opioids

For this Month’s Opioid Epidemic Hero of the Month we would like to introduce Dr. Chun Chiang who is the Medical Director for Correctional Health Services at the Orange County Healthcare Agency. He is responsible for the healthcare services to patients at the detention facilities in Orange County. He started his journey in Orange County when he first attended undergrad at UC Irvine. He attended medical school at the Medical College of Wisconsin and did his residency at Long Beach Memorial Hospital in Family Medicine. Dr. Chiang’s efforts against the Opioid Epidemic started with mainly pregnant patients at these facilities who needed treatment not only for themselves but for their child as well. In 2019, he has helped many prescribers receive their x-waiver to create a larger MAT program in Orange County.

Introduction and Path to Addiction Psychiatry

For our next Opioid Hero of the Month, we would like to introduce Dr. Brian Hurley! Dr. Hurley is an Addiction Psychiatrist who attended medical school at the USC Keck School of Medicine in the joint MD/MBA program with the Marshall School of Business, and completed his residency at Massachusetts General Hospital and McLean Hospital. Dr. Hurley grew up in Los Angeles, and after training in Boston and New York, returned to LA County to work on expanding access to addiction treatment. He first became involved in addiction treatment as an undergraduate working towards the methamphetamine epidemic. When Dr. Hurley was a resident in 2009, the national conversation around opioid usage began to be described as an ‘epidemic,’ and years later, as a 4th year resident he was the chief resident in Addiction Psychiatry. Dr. Hurley went on to complete an Addiction Psychiatry fellowship which allowed him key, front-line opportunities to treat those with Opioid Use Disorder (OUD). Dr. Hurley conceptualized his work as helping those with OUD through the use of technology in the form of medications such as buprenorphine to treat addiction.