Bianca McCall: CASAT Podcast Network. Welcome to the NOCE Dose Opioid Crisis Unplugged. The NOCE Dose Opioid Crisis Unplugged is a concise and insightful podcast offering a deeper dive into the realities faced by professionals combating the opioid epidemic. Join us as we reconnect with expert panelists from our listening sessions, providing a behind the scenes look at their work and insights into the pressing issues of prevention and diversion, harm reduction, opioid use, treatment, recovery and reoccurrence prevention. Good morning everyone and welcome to the top talk of your Tuesday and if you can believe it, I October 14, 2025. Full steam ahead into the fourth quarter. this listening session today being brought to you by the Nevada Opioid center of Excellence, also known by the acronym NOCE. My name is Bianca D. McCall, I'm, your moderator for today's event and for those who joined us back in June. This is the second part to the two part series designed to examine how opioid use disorder impacts specific, specific populations. So today we're going to explore intergenerational and biological effects of opioid exposure from the womb through later life stages, birth and beyond. And we're talking about the long term developmental and communicative effects of in utero opioid exposure, including feeding, bonding and neurobehavioral concerns like learning, memory, links to adhd, autism and more. I'm also looking forward to connecting the nutrition discussion with recovery outcomes and of course integrating clinical experiences with lived experiences to inform Nevada strong, developmentally sensitive, appropriate and fair intervention strategies. So in the spirit of a little football, let's get to the WHO DAT and the WHO Day. And sorry, I'm not talking about the New Orleans Saints for you fans out there, nor the Cincinnati Bengals out there. But let's get a little out there to hear from subject matter experts whose passions, whose purpose, whose promising work engages leadership and service in our opioid response communities. Our expert panelists today are Dr. Annie Lindsey, who is a professor and extension specialist at the University of Nevada, Reno. Go pack. Go. Not the Green Bay Packers. She also conducts research, she assesses, she identifies and responds to public and behavioral health issues across the lifespan. She has conducted interdisciplinary health related research approaches to help individuals in recovery with a focus on resilience and evidence based programming addressing poor nutrition and eating pathology, physical inactivity and body dissatisfaction. Who you talking to? Body dissatisfaction. She does this to augment existing treatment for substance use in prisons and recovery centers. And she serves as an expert Panelist for the Pacific Southwest Rural Opioid Technical Assistance Project, which you can go ahead and just call Rhoda. And she conducts clinical training for the CASAT transfer center networks. Dr. Lindsay has published several peer reviewed journals, and articles and fact sheets and creative audio visual projects. And she's a fellow at the American College of Sports Medicine. She serves on numerous local and national committees, advisory boards, editorial panels, she's awarded and decorated and we are so grateful to have her here with us today. Welcome Dr. Lindsay. And and the next step, we have a, speech language pathologist, Amy Thatcher, who is a passionate educator and advocate and Perhaps the only one person on 170 passenger flight who would choose to sit next to me in a middle se and talk shop across time zones about opioid exposed infants. Right. but when she is not the perfect stranger on a train or stranger on a plane as I call her, Amy speaks on topics including neonatal feeding therapy, caregiver empowerment and interdisciplinary collaboration in hospital settings. She's a member of the national association of Neonatal Therapists. Yes, Amy is a seasoned speech language pathologist and neonatal feeding Specialist with over 15 years of clinical experience supporting medically fragile infants. She's based in Santa Fe, New Mexico, a sister city and state of sorts, one might say within the context of, opioid use disorder. Nevada and New Mexico both have elevated overdose rates, evolving fentanyl challenges and methamphetamine co use. And both New Mexico and Nevada are mostly rural Mountain west states, which presents unique challenges for healthcare infrastructure and treatment access. And I'm excited to hear what came over in a hot air balloon in today's discussion. So Amy brings a rare blend of clinical precision, of compassionate care and leadership. Her expertise spans oral motor assessments, swallow evaluations and individualized feeding interventions with a specialized focus in infants affected with neonatal abstinence syndrome. so thank you so much Amy, for bringing your expertise to today's important discussion. And rounding out our expert panelists for today is Dr. Ebony January, known around the ways of 15 US states and more, including Nevada as Dr. EJ. Dr. EJ is a board certified OB GYN, health equity advocate and business visionary who believes that real change happens when we combine expertise with intentional action. And Dr. EJ's mission is to improve maternal health outcomes by blending medical expertise with cultural, cultural awareness with advocacy and education. And her vision is to ensure that every mother, regardless of background or circumstance, has the knowledge, the confidence and the community that she deserves to experience a healthy, informed and empowered motherhood. Journey. Thank you so much, Dr. E.J. for carving out the time and space on your travel and on your tour schedule to join us today. So on behalf of our panelists and our team here at NOCE we want to thank everyone on the line for your participation in today's session. And if you haven't done so already, which I've seen a bunch of us have, please, feel free to drop your name, your titles, credentials, your organization in the chat and so we can all get familiar with who's in the room. And the NOCE team will be actively monitoring for your responses and your comments throughout today's session. We've, carved out some time today to reflect on those comments and we'll select, we're going to select two case studies to review and to consider resources, and support for individuals and families who you, as the participants, have identified as vulnerable and in need. So if you're currently facing challenges in locating resources for your infants, for your children, for your birthing mothers, for your families that are impacted by opioid use disorder, please send some, drop some case study details, please. No, no protected health, but just some high level case study details in the chat. And we'll spend some time at the end of today's session pooling known resources here in Nevada and reviewing the ones that our panelists and the NOCE team have, put together for you today. So let's begin by raising some awareness around some of the issues that we're seeing impacting our special populations, birth and beyond. I want to start off by going right to Dr. Ebony January. Dr. E.J. thank you again for, for joining us today. How are you doing?

Dr. Ebony January: I'm, good. I'm good. How about yourself?

Bianca McCall: I can't complain. I always tell people any day above ground is, is a great one, and so can't complain at all. I want to ask you, Dr. EJ, as we're looking at some of these issues, right, how do systemic inequities and cultural blind spots in maternal health, specifically, how does that, exacerbate the risk associated with opioid use during pregnancy? And what intentional actions, as you put it, can, health systems take to close those gaps?

Dr. Ebony January: Sure. You know, I think we should really call it what it is, right? Pregnant women struggling with addiction aren't being failed by medicine. They're being failed by systems. And too many of our policies are built to punish, not protect, those women. And too many hospitals are designed to treat diseases and not people. And really, too many communities are forced to survive on broken Systems that were never really built to protect those women in the first place. And so when we talk about systemic inequities, we're talking about unfair rules that make it harder for women to get care simply because of their zip code, their insurance, the color of their skin. And so when we talk about cultural blind spots, we're talking about care that doesn't listen, doctors who don't see the whole woman or the chart. So in neighborhoods like 891-018-9106, there in Nevada, women are up to three times more likely to rely on Medicaid or public assistance. They often live in areas with fewer hospitals, fewer mental health providers, and more pharmacies that dispense other medications than prenatal vitamins. And so then you add pregnancy in the mix in a system that criminalizes mothers instead of supporting them, and you get a perfect storm, right? Higher overdose rates, more premature births, babies that are born to nas, and mothers that are too afraid to ask for help. And this isn't about personal failure. It's about systemic neglect. And you really can't heal in a system that is built to punish you. So we say pro life, but we criminalize the very women trying to bring life into the world. Health equity isn't about charity. It's about fairness. And every mother deserves a chance to live and deliver safely, no matter her zip code or her past. A, mother's history with opiates should really, should trigger care, not cuffs, right? You can't separate mental health, addiction, and motherhood. They're intertwined threads of the same story. We don't just need more clinics. We need more compassion built into the system. So, you know, we have punitive laws that still make pregnant women afraid to be honest about their drug use because honesty means losing their child. Cultural bias makes more providers assume addiction is a choice instead of a medical condition. Language barriers and lack of culturally relevant education leave women confused or ignored. Fragmented care forces mothers to choose between their recovery meeting, their prenatal visit, or picking up their child from daycare because they can't do it. All, right? We're everything to everyone and nothing to ourselves. And lack of trust means that women would rather just give birth alone than face judgment in the hospital. So when we talk about, like you said, real solutions, we have to make addiction treatment part of maternity care, right? We won't make a diabetic wait three weeks for insulin. So why do we make mothers wait for addiction treatment? And positive drug screen shouldn't equal a police report. It should trigger a, Care plan. You know, we need to train every provider from the front desk to the OB to understand what cultural context, trauma, and bias means. Pregnant women need compassion, not suspicion. You know, every woman has a story, and if we listen before labeling, we could save more lives. Like, you're talking about someone like myself, who.

Bianca McCall: My mom.

Dr. Ebony January: I'm the daughter of an addict.

Dr. Annie Lindsey: Right.

Dr. Ebony January: And you have so many people who wanted to just throw her away, but if they understood why she did what she did, then she would have been able to be more well received or to actually get more help. Right. So if we partner with doulas, peer recovery coaches, community health workers who share cultural and lived experience, they reach the mothers the system overlooks. Healing starts where trust lives, and that's in the community. So, we have to make sure that we connect healthcare and social care. A mother can't think about prenatal vitamins if she doesn't have food, housing, or safety.

Dr. Annie Lindsey: Right?

Dr. Ebony January: I'm grieving. I just lost my mom a year ago, and I just had one of my friends put up a, ah, hammock in my office. So, you know, I got this big, pretty background here, but you can't see my. My hammock is over here. you can't have a hammock if you're homeless. Right. You know, it's the same thing for care. So care must include access to housing programs, job training, and postpartum support. You can't talk about maternal health without talking about mental health, housing, and hunger. And it's really just that simple.

Dr. Annie Lindsey: Wow.

Bianca McCall: Wow. Dr. January, thank you so much for that thoughtful response. That thoughtful, and culturally comprehensive response. As you're talking about culture, I hear race, I hear ethnicity, I hear zip codes, in your socioeconomic demographics, I hear, mothers. And incorporating that lived experience, I hear, other groups that oftentimes don't have that voice. When we're talking about culture, economics specifically, I'm hearing, different mothers, different folks, different strokes in different life walks. Thank you. What a powerful statement to open this listening session up with. there's so many things, the system, the system that's failing, the system that's criminalizing. I heard trigger, you know, care, not cuffs, and our ifs and our thens, and how we're responding as providers. And healing starts where trust lives. Trust. This concept of trust and, the relationship that's involved in a trusting relationship with our healthcare systems certainly cannot begin when there's, so much of a barrier of stigma and of, Bias, as you put it, Dr. Ah, January. And I want to go and move towards the discussion of stigma. And I want to ask you, Amy, have you seen, stigma act as that barrier, that primary barrier to care for pregnant and postpartum people who use opioids or stimulants, and what approaches have proven most effective in creating a more compassionate, and recovery oriented environment?

Amy Thatcher: Yes, Bianca, I can't tell you how much that, everything Dr. January said is so true. And I think it's too easy to judge people when you haven't walked in their shoes. And these people judge themselves too. And they've been judged so much that they can't get their own health care, much less prenatal care. So you walk into this, this, this ob gyn, maybe you don't even. You've just found out you're pregnant, and the first thing they're going to do is take a drug test and then from that point on, you're stigmatized. They have, you know, they go into the hospital, they have their baby, and they're probably going to have some sort of withdrawal. So how do we support those babies without judging where they came from? I learned early in my career that judging does no good. There's no I, by the grace of God, by the grace of the universe, maybe I didn't make a decision that may have taken me down that, that same path. And so how do I support the person in front of me, the person. Not the person who's an addict, the person, the human, that parent. How do I support them in their, their attempt to raise this child? So I think that it's really in our community, the resources just aren't there. I was doing a lot of research in Nevada and it feels really, it feels good to see all the resources that are available in Nevada. And so I'm really excited to dig in. More to that. let's see. I, I think that we, you know, you Talked about trust, Dr. January. You talked about that, building trust, that relationship. And when I walk in a room, I'm there much longer than a nurse is there. I'm there an hour, hour and a half, sometimes every day for a couple weeks to really teach this family how to provide care for their, their child, their baby. And at that same time, we can both become vulnerable. I can tell stories, they can tell stories. And then we can share this anecdotal information that we can help them start to care for themselves as they care for their baby. No matter how much time they get to spend with that baby, we want to really support them caring in this controlled, supportive environment. Yeah.

Bianca McCall: Ah, you know, thank you so much for that, Amy. And you know, when you talk about stigma and you talked about, you know, how do we, how do we provide this care, and really eliminate the judgment of where we come from, you know, and looking at us as we're humans, we're people, and stigma is largely this, this act of, it's radical act against love and more towards judgment of where we've come from. And it's interesting when we talk about healthcare systems, a lot of times the conversation is meet people where they are and the risk involved, the detriment that's involved when we meet people where they are, only to judge them for where they've come from. And so when we look at the system that encourages, that breeds, you know, that, that barrier, that stigma, you know, there's, what I'm seeing are many opportunities, right? Because we got to look at, okay, how many, how many children are born every day, you know, and how many opportunities as we're, as, Dr. January mentions, pro life, you know, and the mothers that are, that are bringing life into this world. and something else that you said, Dr. EJ, that really resonated with me was, was the we're everything to everyone and nothing to ourselves. And then, Amy, you, you, you know, you emphasize, you know, just that value right. When that's taken away by, by this judgment. And so, Doctor, Dr. Lindsay, I want to, I want to go to you and I want to talk about these opportunities that we have. You know, we, these opportunities that we have to not judge, to meet people where they are, not to just judge them for where they're, where they've come from. But what are the biggest, perhaps missed opportunities that you see, Dr. Lindsey, across these health care systems to integrate fairness, these equity driven, developmentally sensitive strategies that address opioid exposure from infancy through later life.

Dr. Annie Lindsey: Yeah. So I do a lot of applied research on gender differences, and I think one of the biggest missed opportunities is addressing. And actually, Dr. Janu January hit on this. So if we're saying the same thing, it's probably big, to address the social and the human capital that drives substance use disorders, especially in women. So just to give you a little picture, reproductive age, women are the fastest growing population in the area of, addiction and opioids. Single mothers even at more risk. I've been following the data for about 30 years. And the first 15 years after 2000 deaths involving synthetic opioids rose 850%. The next five years after that, from 2015 to 2020, it rose 1,000% in women. So yes, we have more men when you look at men to women. But there's reasons why some women aren't going into treatment. but the steep incline of women, getting addicted and dying from opioids. And one of the reasons is history of trauma. Right, they're taking it for trauma. these are the primary caregivers. So maybe 1 in 10 people in Nevada for instance are women in prison and the other 10 or 11 are men. But for every woman, she's the caregiver for those children. And so I think, you know, on the law side we need to support, you know, child support to give her, you know, priority. She doesn't have childcare, she doesn't have family support, lower paying jobs, no education. And honestly there's a lot of hormonal and biological differences we need to look at. the data shows that women experience cravings more often than men. They're more likely to self medicate. They use smaller amounts of opioids for a shorter period of time before becoming dependent. Maybe because of their, you know, body composition then opioids, they use opioids for longer periods of time and in higher doses. So it's a big problem. And more than anything because these are the caregivers and the next generation of our children. And probably one other thing that I would mention, it's not typically mentioned in environments like this, but I think another missed m opportunity is minimizing, the risk of social media in our children in our teens. Our moms are learning about it, but it's coming up so the generations are following. It's a big debate between like big tech and parents. Well, whose fault is it? Whose responsibility is it? It's not that we need to all be part of this is the more big tech that we get, the more we have to get involved. We should be teaching it in health classes, building resilience for kids from pre K all the way to college. because the question isn't if they're going to use social media or TikTok or whatever, it's how are they going to use it. We need to empower them to be their own filters, you know, talk about and validate things for them like mood, emotions, anxiety, stress, even body image, disordered eating, risk of suicide, help them recognize among their peers. You know, one pill can kill. Understanding that you don't have to be Addicted to drugs to die from, from that, healthy behaviors, nutrition and physical activity even, you know, I think everybody should know Narcan and have Narcan available like we do cpr. So you know, I guess overall it's starting. It's working with the mother to support her and help her support next generation of children. If we want to look at these across the lifespan.

Bianca McCall: Gosh, another powerful response, powerful statement. one pill can kill. You don't have to be addicted to drugs to die from them. And bringing into the conversation, Dr. Lindsey, the risk involved or surrounding social media. And when we talk about the media and these platforms, the entire objective of pulling in these audiences, of influencing large numbers of people is to, to collect data and to utilize data to sell them something. Right. And, and you talked about some of the, the, the largest sellers, you know, in, in our society when you talk about, you know, how, how it is that we are reflecting on our, our body image, on, on the things that we consume. Right? We're consuming media, we're consuming messages, we're consuming food and substances as well. And that is all being controlled and influenced by these platforms, by social media. And everybody's at risk. There's no exempt population right across the lifespan. the more that we engage in big tech and resilience certainly has to look at that, how we're engaging with technologies. Going back to the body image and the body dissatisfaction. That's something that, as I'm, as I'm introducing you, it is really hitting close to home. And especially when we take a look at the gender, nuances, as you put it, for women and body image, the rates of body dysmorphia and how that's interconnected, ah, with substance use disorder. And you also talk about some nutritional values and things. Can you speak to how nutritional status and some of these concepts having to do with our body, our body image, our perception of who we are manifested into the physical form. Can you talk about how that specifically influences recovery and recovery outcomes for women and families impacted by opioid use?

Dr. Annie Lindsey: Yeah, it's huge. I mean, so I mentioned women are greater risk. But first of all, we cannot isolate opioids alone. We have a methamphetamine problem. And it came long before the opioid problem came about. The opioid exposed it because, like for instance in San Diego where they analyze urine specimens, in 2024, 60% of fentanyl positive specimens were methamphetamine. They Found methamphetamine in there. They weren't looking necessarily for the opioid, but maybe the meth. And I think the 20, 20 or 25% were, cocaine. So we really have a stimulant problem as much as an opioid problem. And for young women, you know, methamphetamine and heroin or opioids, they use them synergistically. You know, it's the magic pill for most moms. I need to get up, then I need to come down, I need to get up, I need to do this. And it affects the dopamine. And so, you know, going back to the early 2000 UCLA Integrated Health Substance Use or Integrated Substance Use, center found that the top two reasons women use methamphetamine is weight and energy. I mean, every woman, we all want that. Like, there's nothing wrong with that. It's just that that's how they're addressing that. And so, you know, and one of the biggest, really nutrition men or women issues in recovery is malnutrition. And when we talk about malnutrition, it doesn't mean, you know, you're skinny and you don't have enough food. That's what people default to, to be blunt. it means we have deficiencies, we have excesses of certain nutrients, and then we have inability to utilize certain nutrients. Right, like methamphetamine. If you're, if you're using methamphetamine, you can't process or, utilize calcium very well. So that's why we see, you know, teeth and hair problems and things like that. but it's very prevalent. And studies have shown as much as 88% of people coming into treatment have, need some type of nutritional guidance. 50% are clinically deficient, and a, fourth of them are moderate to malnutrition. So, you know, what we do know is that similar to decrease in, or similar to, common chronic diseases, the impact of diet quality can extend to mental illness. And we are not talking about that enough. We have got to, look at early intervention, address nutrition and physical activity and comorbidity like eating. And just as a quick example, your brain needs nutrients. The nutrients for all of you therapists and psychology people. Nutrition nutrients restore and regulate hormone signaling which affects neurotransmitters. It stabilize mood, it reduces cravings, it reduces blood sugar and alcohol. Proteins are the foundation of neurotransmitters. it helps support concentration, motivation, energy, carbohydrates, aid in serotonin and they're the major source of energy for the brain. fiber restores good bacteria to decrease inflammation. And one of my favorite topics right now is omega 3s. They are linked to lowering, decrease or decreases in PTSD, depression, anxiety, suicide, homicide, bipolar. And this isn't like Google, what do you call it? Just going online and looking at Google Internet. We're talking about meta analysis that chef shown this. So it's a big thing. It's another missed opportunity.

Bianca McCall: Bianca, that is a huge missed opportunity. And mind you, I'm moderating. Yes, but I'm also taking mental note, taking actual note, writing all the stuff down because it's not talked about enough. Dr. Lindsay, I don't hear too much when we talk about recovery, when we talk about reducing, risk, preventing injuries and such. Ah, we don't talk about nutrition enough. And again, going back to what's been said so far is just the consumption when we're consuming messages, energy, people, places, things. But also the substances, the substances piece, we're only looking at the, the detrimental substance, right? We're looking at the drugs, the alcohol, the co uses of stimulants and things. But all of what we consume really goes into painting this picture of what recovery looks like and the potentials and the outcomes of recovery, what that looks like. And so thank you so much for ah, dropping these nuggets and really illustrating the connection between nutrition and between our experiences of our women in recovery. I love that we're shifting kind of focus towards what are some possible solutions, what are some things. Yes, these are missed opportunities. But as we are, conducting and reviewing these meta analyses, you know, what, what's working, what, what are we taking from that data and what are we applying? What are you all seeing, applied in practice now and in research that's actually going to be able to have an impact on, on these populations. Dr. Ebony, I want to go back to you and talk about, you know, something that you brought up, you brought up, you know, the lived experience piece as well. And that being a driving factor and focus as a practitioner, being able to see kind of the problem as a systemic issue. All of these multidimensional, or multilayered, factors that are going into how do we arrive, how do we show up in these systems? And so I want to ask you with maternal health outcomes and how they often depend upon the medical interventions. Right. And also the family centered support systems. Let's talk about all the systems that are involved. How do you see the Roles of clinical providers and social service providers complementing one another. Because I know you talked about, you know, bringing in doulas, bringing in, you know, other, other types of providers to form this team, around our, our, our consumers. Right? So, so how do you see clinical providers, social service providers, complementing one another and supporting birthing people impacted by substance use?

Dr. Ebony January: It's absolutely necessary. You know, in a nutshell, clinical care saves lives, but the social care helps women keep living. So when you talk about social determinants of health, right, that's everything in a person's life that affects their health, that's not their health care, right? So a social worker is going to connect families to their basic needs. The housing, the food, transportation, childcare. The mental health person is going to help with counseling. Because we know that, most, women with OUD have some type of mental health condition. They're going to help, also navigate complex systems. Right? I have a sick father and when I tell you, trying to navigate the healthcare insurance system when I needed a drink, okay, so just imagine that. So you need a team. When even the pregnant woman who does not have oud, they need a team. I talk about the village. You know, we just talked about this a couple weeks ago about the village. You need a village. And that means an interdisciplinary approach, you know, in order to make sure that we treat the whole person to improve outcomes. And together that forms just a complete continuum of healing addressing both the medical needs and the social determinants of health, essentially. So, integrated teams means the behavioral health person, the peer doula, the case manager, child welfare. As, Dr. Lindsey stated, making sure that they have childcare, physical, emotional, social. It's all connected.

Bianca McCall: Sure, sure. You know, what, what stood out to me or what, what popped in my mind, Dr. EJ, when you said, clinical care saves lives and social care keeps us living, I thought about what I hear so much, in our communities nowadays. I hear life is life in. Have you all heard that? Life is life in. And the reason why that comes up is, I think when life is life in, you know, we need that social care. We need, again, the, the medical interventions, combined with the family centered support, right? And the holistic care, to be able to support our mothers and our families. Especially when life is laughing. And it's not, it's not if life is lifeing, it's when life is life.

Amy Thatcher: Right?

Bianca McCall: Because it, it's going to do that for, for all of us. So, so I completely appreciate, that it takes A village. I, I'm also gonna you're not gonna do it, so I'm gonna do it for you. The Shameless Plug M. your book, Empowered Motherhood actually it's, it serves as, is this really kind of easy to follow manual. and it addresses and it, and it answers so many questions about the, the family building process. You know, we're talking about pre pregnancy, during pregnancy, afterwards. And, and you talk a lot about that, the village and all of the not only clinical providers that must be involved on, on that, that team, what I call that squad, but also the, the social, you know, the social members that, that need to be involved. because it, it does take a village and what is in that village? It looks different for everybody. Everybody. Right. And Amy, I wanna, I wanna go to you because I wanna, I wanna talk about your experiences in neonatal care and family engagement being such a key component of your team's success. You know, you've got some published work and have done some research in this area as well. And so in neonatal care with family engagement being a key to your team's success, what are some strategies for empowering families to take this active role in non pharmacologic interventions for opioid exposed in exposed infants?

Amy Thatcher: You know, everything that everybody said has like led up to this little point and, and this whole listening session is leading up to some more things that everybody is going to talk about a little bit later. But going back to you know, Dr. Lindsay was talking about nutrition. Right. So the, the best way, the most, the, the evidence based practice that we use instead of stepping down babies from their opioids, using methadone, using different things is to eat sleep console. Okay, so there's, it's esc. Eat sleep console. And where do you get that, that eat sleep console from? One of the hardest things for babies, born to parents with oud is eating. It's really hard for them to coordinate that sucks, wallow, breathe pattern, to organize the fact they're starving but they don't know how to suck. And so what else do they need? They need to be able to eat, they needed to be able to sleep to have that energy and they need to be able to be consoled in the best possible way by their parents. So what the best thing that they can do is we can teach these parents how to feed their babies, help their baby sleep and then have them be consoled with that familiar, you know, the scent, the familiar voices, you know, I can console A baby. But if it's not my baby, that's not the voice that they've heard their entire time in the womb. So teaching the parents how to feed their babies, how to give the care for their babies, how to change their diapers, how to, to get them to be able to sleep, they're going to learn how to do that for themselves too. Right. So when you take the. Teach them how to do those things for them, their babies, all of a sudden they, they start realizing what they're doing for themselves. And so it's such a neat experience to see a parent that I've worked with for two weeks, and I walk in and they say, my baby took it all for me, you know, the entire feed for me, and in 20 minutes. Because we want to make sure that they're not spending that energy in their withdrawal process and they're not taking in as much nutrition because problems is, is if they're not going to gain weight, they're not going to leave the hospital.

Dr. Ebony January: Yeah.

Amy Thatcher: So, you know, going back to, you know, what, what calms their infant, what calms you. Right, yeah. How do you feed your infant? How do you feed yourself? What are some of the things that you can put in your body? And then, you know, how do you provide care for that baby? How are you going to provide the care for yourself? So those anecdotal conversations that we have, and that Sleep console has just been so wonderful.

Bianca McCall: Yeah, no, I love that. Eat Sleep console. what I love most about this is that you're speaking my language, Amy. And so for anybody who knows me, knows that, every, every bit of education, I always mention that it starts with self. I'm a huge proponent of starting with self. And, and I love what's been said about, you know, mothers, women feeling like, you know, we're everything to everybody else, we're nothing to ourselves, is there's this concept that we need to feed everybody else. coming from an empty cup, you know, and not really knowing, not practicing. And, and, and, you know, when we're, experiencing challenges, with substances and having toxic relationships or abusive relationships with the substance, you know, we, we oftentimes, don't know, don't practice how to pour into our own cups. And so I love with Eat Sleep console, that's, that's the, the objective. Right. It starts with, with pouring into yourself and, and by that way, you know, cup running over, by that way, being, able to teach and, and, and to feed others and to feed our, our Infants. And so I, I love this. I love that. At the centerpiece is, is education. Right. We talked about, or Dr. E.J. rather said, Ah, healing starts with, with trust. And, and that trust. There has to be some sort of familiarity. And with familiarity is that learning. And with learning is that education, that learning, that literacy in that education. Dr. Lindsey, I want to ask you, how can this physical literacy in early childhood activities, how can they be used as protective factors for children that are growing up in families where opioid and stimulant uses are present?

Dr. Annie Lindsey: Yeah, I mean, it can have a huge role, but like, Amy said, I mean, it has to engage the family.

Amy Thatcher: Right.

Dr. Annie Lindsey: We can't go in and help children ourselves. It has to come from the family. And so my first thing would be that we have to stop as a society shaming mothers with substance use simply because they're moms. And that's what we do. We, we put them above everybody else. Oh, I can understand having a drug addiction, but a mother of children, this is the highest, one of the worst, I told you increases that we're seeing is reproductive age. Women. Being a mom is not a protective factor against substance use disorder. And I think we forget that, nor does it prevent or fix addiction. Addiction is addiction. And, we know that mothers are not going to go into treatment, because they don't want to lose their children. I call them mama bears. And in most states, if they go into addiction, the state says, sorry, we have to take your kids. They don't want. They don't. They want to keep their kids. They want to get better, but they want to keep their kids. And if they do get arrested, they'll farm the children out to their sisters, their mothers, their grandmothers, a lot less than we think will end up in cps, in a good foster home. So that's the first thing is protective care. we have to realize that that's not protective care. We have to focus on family reunification and not separating moms during the treatment. And then secondly, in seeing that I've worked with thousands of moms in treatment and help them promote these healthy behaviors around the family. It's a great approach to unification. Right. Eating together, being active together as a family. It's something they feel, they don't feel sometimes qualified to help with school, homework or whatever. But they're like, let's all eat together, let's go to the store together. Let's. Let's lear how to eat healthy. Because these kids are facing major, you know, aces or adverse, you know, child experiences related to executive function or instability or depression and even disrupted attachment. So I've seen a lot of mothers, you know, work with their families. There are, I think somebody asked in the chat about how do we change the laws? I don't know how we change the laws, but I know that the more that our recovery centers allow for reunification during treatment, that's the first line of defense. And some kids have done this, Bianca. Some of these kids are. They visit their moms in prison. They visit their moms in jail and they're like, not me. Not today. This isn't going to be me. You know, what makes them resilient? And I think that, you know, they can buffer these risks from, you know, early self learning, early self regulation, and building routines like study and sleep habits. nutrition is sports. physical literacy, which is sort of the hierarchy of physical activity, helps build resilience in young children. Even yoga, if you read up on yoga, there's a ton of studies right now in the literature that it's a very promising strategy even for preschoolers, and they are overwhelmingly positive. It has helped kids with self, regulation, dysfunction, trauma exposed, kids, economically disadvantaged, and the same with nutrition. so we're seeing these. I mean, nutrition has great impact on behavior as well as on, brain function as well. So I guess I would just say that our goal would be to help mothers teach their children to value health, nutrition, physical activity. Do it as a family. Don't single a child out. Don't single mom out. This is a thing. We have to eat and we have to move. And so let's do it as a family and help. Help bond those relationships through that. You know, attachment and trust is still important. And I see children every day visit their moms in prison and in jail. And you know what? Their moms are still their role model. I don't care what people say. Even the moms go, I'm not a very good role model. I go, but you are a role model. So, you know, it doesn't matter whether you want to be or you don't want to be. They're still like, mommy, Mommy. I want to be like Mommy.

Bianca McCall: Yeah, no, absolutely. Absolutely. It has to be done as a family. And as you're saying this, Dr. Lindsey, I'm envisioning, our, facilities, our organizations, our agencies, our providers, our practitioners, creating these environments, that encourage this reunification, that encourage this family, bonding and engagement in these activities. I also thought when you said going to the store together, I Thought, ah, a lot of mothers are going to be like, I don't know about that, bringing my kids to the store. Right. but doing these things, cooking together and learning about nutrition and being active together, ah, so important. And I appreciate, just that, that sentiment of, let's create. Let's co. Create. Let's collaborate with our families and create these opportunities to be able to practice that, to be able to engage in that, you know, in our. In the services that we deliver. And it's completely appropriate to. To ask about, you know, how do we. How do we, recommend, and advocate for policy changes and things of that nature? And Dr. Lindsey, I want to stay with you on this, but if. If I hear reunification, reunification a lot earlier. Right. And during treatment, as kind of like a suggested change. But along those lines, if you can recommend policy changes or clinical innovations or community interventions that would improve outcomes for our opioid affected populations across the lifespan, what would they be and why?

Dr. Annie Lindsey: Well, one we just talked about, and that is the reunification. And to your point, maybe mama doesn't want to take her children to the grocery store. I get that. But if you take one child at a time, if you're able to, and you say, hey, who's going to pick out. Do you want to pick out the vegetable we're going to have for dinner? If they get to pick it, they will eat it, and so will you. It's not just saying, come with me? It's like engaging them in fun, healthy activities. So, I can't not say that the biggest policy change for me would be that all of our. Our facilities for women and bring their children together. Right. if you don't have children, then that's different. But if they do, we cannot separate them and then expect them to come back together after mom is better and it's going to work. award. And I see her there. Garcia, we put together a little article on this and interviewed moms, and they're like, I want to do better, but for my kids isn't enough. So that's the. Probably the biggest one. One other one I want to mention really quick, I know this sounds crazy, but, and we're hoping to do a clinical trial right now on this with young mothers is maybe supplementation of nutrition, certain nutrition, things like omega 3s, because there's no pharmacotherapy for methamphetamine. We have methadone for opioids, but for methamphetamine, there's nothing. They need something to calm their brains down, increase that dopamine a little bit, in order for them to go in and then get the treatment they need. So maybe there are some facilities in California and some in Utah that actually give all their clients nutrition supplements for the first three months of their therapy. And, and, you know, I think there could be something to that, and then we follow it with education and then teaching those life skills. But I would like to see that as a local policy in treatment facilities, focus more on nutrition early on, not as a nice little thing that our clients get to do after they've done everything else we want them to do. It needs to be early, a boost for the brain, get their brains thinking better, and then let's focus on helping them, you know, with the other. Other sources.

Bianca McCall: So absolutely no, thank you so much. And, and, I want to open the same question up to the other panelists as well. and, and going to you, Dr. EJ, if you could recommend a policy change or an innovation or an intervention, what would it be and why?

Dr. Ebony January: Sure. It would definitely be making sure that, we, we address punitive laws and how we address, women when they test positive for, you know, opiates or just any drug when they come to the hospital. Right. It's the minute they test positive for something, we're getting social services involved and, you know, they're on edge and it totally affects them. You know, they worry about children. It's a whole, you know, debacle when it happens. And so we definitely need to start looking at those laws. you know, and it completely affects outcomes, and it also affects how they treat the children that are at home, because we're not thinking about those. Ah, as well. There are children at home, and now they're pregnant with another child and they tested positive for opiate. And now those punitive loss need to be addressed and they need to be changed. You know, if you test positive. Now, let's talk about treatment rather than handcuffs.

Amy Thatcher: Yeah.

Bianca McCall: Yeah. No, thank you so much for that. And Amy, I'm going to pose the same question to you. but I also want to add in, you know, something that came up, And I believe, Dr. Lindsay, you. You brought up the, you know, to Dr. EJ's point, when there is a positive test and there's this, this refusal to go into treatment and things like that, this, this desire to keep the kids. And so we'll. We'll put the, we'll send the kids with, with a family member. so then we get into kind of like this, kinship caregiving. And, and how do we. How do we integrate, our. Our kinship caregivers, our family members into this family system for. For education, into this family system for support, and advocacy, especially, you know, when we're. We're engaging, law and justice systems. And so I. I know I'm pouring on quite a bit there, Amy, but, but I. I wanted to get your unique perspective on. On if there could be a policy change, what would it be? Or if there can be an innovation or an intervention, what would it be and why? But also I want to. I want to think about and consider our kinship, family members and caregivers.

Amy Thatcher: Wow, that's a. That's a can of worms right there.

Bianca McCall: Sure.

Amy Thatcher: So, you know, to. To everybody's points, this kinship guardianship. Do you know that those kinship people don't have to do a drug test? All right, they don't. And, it's up to the people, let's say at the hospital, to say, I don't think that that's a good idea. So when we see that, we talk about, you know, did we see interactions between those family members and the baby and the mom, the. The. This. This group, this family? I've seen some really horrible interactions. You know, sometimes the dad's out there and I walk in and they. They just have them on speakerphone or on FaceTime. And we're just getting all of this just verbal abuse to this poor mom who is sitting there trying to take care of her baby. Now going back to the village. We need a village to take care of the. These, these babies and these moms. Right? These. We have poured to the mom so that they can pour into their baby. So what would be an, the best thing for me, A policy change. My wish list, my dream place would be like a communal living area where they could have their. The. The substance abuse, the mental health counseling, the nutrition counseling. They could get some. They could learn how to cook, and then they can take care of each other and their kids and they learn these good practices where they have some people maybe that are there taking care of their grandkids or whatever, but a, communal living space where they can have all of these. These resources there so that they can learn outside of. Exactly. Somebody just said creating a family and creating a family, that village outside of their. Their family that may be abusive, that could have been providing that trauma. So I don't always think that having a kinship guardian that hasn't been fully vetted and you Know, a lot of them, they're. I can tell you more than once that we're just like, I don't think that. That. That grandma, that auntie, that uncle, they are on something. And we don't have, as hospital workers, we don't have the authority to say, here, go take a drug test. And you know, the children, youth and families here in New Mexico, I'm sure it's the same in Nevada. They're just overwhelmed. And there's not enough families, good families to help these babies. And so why can't we create an environment where we can help a lot of people in a community? So that would be my wish list.

Bianca McCall: Yeah. No, I love that. As we've talked about some of the recurrent themes of today's discussion, it takes a village. And so operating like a village and having this communal living, where there are. There's this holistic, there's this wraparound care, and compassion and also service, there's leadership, there's a mobilization of championship, where there's skill building and skill modeling and skill building and all of these things. I believe it was Dr. Lindsay that mentioned, one of the failures in the system is that we isolate, we. We remove, someone who has a dangerous relationship with substances, and we treat and we rehab, we heal, and then we return, to a system that's already adapted to that injury, to that agent being injurious. and so when you talk about kinship, families and caregivers and guardians and things, they've adapted to the injury, you know, and there's that strained relationship. And without this communal living, without this family support, without changes in laws and schedules in which we, intervene and we, return, we reunify, in this injurious separation, then, you know, without those things, then we are not healing those relationships, as a system, as a village, the village is not. Is not healing. And the village needs to heal. Am I wrong? In saying this? Because when we. When we say it takes a village, it's always been a village. Ah, substance use and, And. And the risks and the trauma and the tragedies, it affects the entire village, not just one person. And so, so we need. We need to heal the village. And we need to. We need to create environments to where an entire, family and village and system can be healed. And so I, I thank you, you all, for your responses to that. You know, when. When I, When I talk about. And when I think about village and when I think about family, on one Level, you know, we're, we're talking about different members, different agents, different participants within the system or within this family. But then when we talk about generations, right. In the intergenerational nature of opioid exposure, for example, then we start talking about some different levels, layers and dimensions. Right. And so considering the intergenerational nature of opioid exposure, what strategies can we implement now to break these cycles of risk and strengthen resilience across multiple generations? And, and again, I'm gonna, I want to open this up for, for all of you to, to share your unique perspectives. let's start with, with Amy on this one.

Amy Thatcher: Wow, that's You're coming up with some good questions, Bianca. So when we think about that intergenerational, exposure to. I mean it's, it's poverty, it's, it's illiteracy, it's, it's low education. So I've seen babies come in, they're like, oh yeah, I remember you. You helped me feed my other two kids. So I've been feeding babies for 15 years and I've seen lots of change, I've seen lots of good. I've also seen lots of really sad things happen so intergenerationally. Oh, let me see how I want to say this. We've got to break the cycle. And the only way to break the cycle is to have that support system. And it may be the support system outside of the family unit. So.

Bianca McCall: Yeah.

Amy Thatcher: And come back to me. Come back to me.

Bianca McCall: I will, I will. I mean you're, you're, you're bringing up some important, antidotes here like the. Addressing poverty and literacy education. That seems to be kind of at the center of today's discussion. Support systems, and increasing impact and reach, to support systems that may not be a part of the nuclear system because there needs to be some healing. so, so we need to make some, some immediate connections, develop these, these new pathways, to healing that may be outside of, of, of the family, the nuclear family system is what I'm hearing, from you. And so bringing it to, to Dr. E.J. next. Dr. E.J. what do you think? You know, considering the intergenerational nature of the subject matter, what strategies can we use to, to break the cycle, as Amy's saying.

Dr. Ebony January: Yeah, it, it really is tough, right, because this, this runs deep. Really, really, really, really, really deep. And it's really going to take a multifaceted approach. Right. It's, it's like the social determinants of health. Right? The social determinants of health is so many things. This is financial, right. This is educational. This is. Is, social. This, these are, you know, this is food, right? These. This is so many different things that you have to approach in order to address this particular issue. And so it really takes a multidisciplinary approach, in order to, to do this. But I do think that we have to. You and you mentioned this before, which was meeting people where they are. I still think that we have to meet people where they are. Right. because that's what the social determinants of health are, is meeting people where they are. And, you know, no different than that. Most people don't understand that there's a difference between equity and equality. Right? Equality meaning that we all have access. Equity meaning that we understand that people. I see your. Okay. Equity means that, we are all starting from a different place. So I think that we have to start with. Many people are going to their churches, right? So if people are going to their churches, then we need to start partnering with community based organizations. We have to start partnering with community based organizations. We are operating in silos, but people go to where there are resources. For example, I worked, for fqac, fresh out of residency. I wanted to work for fqhc, because I wanted to work in the community. And we used to do a turkey drive every single year. And I'm actually partnering with them this year to do a turkey drive. We know that the communities come into the turkey drives. When we get them there, we're giving them some type of healthcare. And so we switched it up one year to make sure that they got their blood pressure checked before they got their turkey. and then you start to partner with churches, right? Because we know that maybe they're going to go to church because the church has resources. So you have to get very, very creative and combine a want with the need. Right? They want this, but they need this. And so that's how you address the community that is affected by something like opiate use disorders, in my opinion.

Bianca McCall: Yeah, no, thank you for that. Connecting the wants and the needs. Also, what I'm hearing, and perhaps because I'm a food, I'm a known foodie, food is the way to my heart. And so, yes, before the turkey. Bianca, get your blood pressure checked. That makes total sense to me. and also, you know, with regards to food, you know, I recently, taught a class and showed a video talking about the epigenetics of not ah, only substance use but mental health crises. And there was a study that was done and they showed that 19 century Scandinavian men, who went through a famine and you know, a complete famine, they noticed that generations forward, it actually improved their health and reduced their risk for things like heart disease and cancers and things like that. And so they, they connected the experience of what impacted their nutrition and how that influenced or impacted their health, you know, generations forward. And so you know, going to the expert on this, I want to, I want to ask Dr. Lindsay the same question that was posed to the other two panelists. when we look at the intergenerational nature of this subject matter area, what are some ways that we can break the cycles? What are some things that we can do now? And let's, let's talk about nutrition. Let's bring that back up and, and how perhaps through epigenetics and the evolution of our DNA expressions.

Dr. Annie Lindsey: Huh?

Bianca McCall: What can we do now that could have a lasting impact?

Dr. Annie Lindsey: Yeah, I mean I think the intergenerational thing is probably one of the biggest issues. And I think I, love what Amy said that we don't drug test those. She called them kinship guardians. I think it was a great way to say that. And the families, I mean I'm teaching the class right now because I like to keep my finger on the pulse of what's happening out at the women's prison. And when I talk to these women, the generations, these women sometimes, many cases, either learned how to do drugs from their mothers or their family members. They were shamed by their family members, they were shamed by their mothers about their weight. And if we don't address those kind of weight concerns and those kind of, of you know, issues that are related to that. They're, they're mama bears. I already said that they're going to go back and they're going through self medicate and that's when they develop comorbidities like eating disorders and things like that. And then they pass them down to their children and once you start talking about with them they're like, oh my gosh, I just realized that this is, came from my mom and now I'm doing it to my children. I. And so we actually literally teach them how to change the way they view themselves from you know, generations that's come to them and then how they pass that along. So and, and I can't not go back to social media again. Right. Because that's a That's the self medication, like, let me go there and see what I can find. And that's where we, you know, we see people going to social media for. And there's so much misinformation and comparing themselves to other people, bullying and shaming and all that. And it happens from the youngest to the oldest. And it just fuels, fuels the use of substances as a form of medication. so somehow we need better initiatives for controlling and educating people. ah, you know about this online access, but it is generational and that is a big part of programming that we do for these young women is to talk about those generations. And how do we. I call it sidestepping the generation because it's passed down and passed down, you know, almost biblically, right from thousands of years. And when do we sidestep and say, nope, not today, we're going to go a different way. But it's a big thing, the intergenerational. It probably plays more of a role than people imagine. And Bianca, you said talk about the village. The village isn't just the family. We're the village. Who do you people know in their families that are. Take. Somebody just said on the chat, I'm taking care of my grandchildren. You know, where are your, where is your support system?

Bianca McCall: Right, right. Gosh. and now you're asking questions. Dr. Lindsay, I'm excited, I'm excited to see what the participants, how they've responded throughout this session. I do want to mention too, and just because, you know, I'm an existentialist and I, and I say this all the time when, I look at our different human experiences as being the series of separations, right? And separations gone on too long without that healing, without that coming together of our village, it creates injury. And then we're responding, we're adapting to those injuries, to those traumas as our human experience, as the human condition. And so when I talk about separation experiences, birth is the first one in our recorded memory. Our first, incident or injurious separation, you know, which can be very traumatic for, for most of us, you know, whether or not you, you're, you're talking about substances being exposed to, to opioids, that. That is a compounded trauma to our first, first separation experience. And so I want to go back to birth, and I want to talk about, you know, the, the initial hospital phase of a newborn. And, and I want to, I want to hear from you all, what, what education. What education and strategies and interventions. Do you believe are most important to support the bonding, that reunification between the baby, the infant and their. Their family, their mother. And how can these strategies be sustained and adapted as the child grows and throughout the lifespan? And let's start with, with Amy, because I know that you and your team, you focused on this directly, in your research and in your studies. And if you can, will you talk a little bit about, what you and your team were able to accomplish, before. Before talking about. Yeah, this education and the strategies that are needed for sustainable, support.

Amy Thatcher: So we try to give the. The parents a vested interest in, change. M. So if the family, if the parents want, they. They're able to give those types of. Of cares that e. Sleep console. And they have a vested interest in changing and like Dr. Lindsay said, moving. Right. Changing that intergenerational pattern. If they have the vested interest in change, perfect world, right? They would get some of that information before they have the baby. Lots and lots of times these patients come in here, these moms come in here, and they've had zero prenatal care there. You don't know how far along they are. So when they come in and they used fentanyl and methamphetamines that day, three times before they walked in the door, how do we take that information and we immediately get them help? Now there are different, different, clinics in our community that can help in different ways. If that patient, if that mom can immediately get into some treatment and immediately get some, let's say, Suboxone, some methadone, some sort of treatment plan, and they can commit to that treatment plan. We can keep them here at the hospital. Many of them leave. Many of them leave because they just need to go get their next, you know, their next, use. But if we can get them here right now, getting them, you know, past this withdrawal period, then we can get them vested. Invested in the care of their baby. And then once we do that, it can be sustainable. We let those patients, the moms stay with their babies in the hospital, they can leave to go get their treatment and they come back. And we can really support that in this controlled environment. Because it's hard enough having a baby without opioids involved. Can anybody tell me that it's hard to have a baby without that involved? When we add that extra on top and we can give them this controlled environment where they learn how to take care of their baby, baby, then maybe they have this vested interest in continuing. We can get them into treatment. We're feeding them. We are. We're showing them how to care for their baby and they're helping with bonding. Now we talked, you know, we're talking a lot about the illegal substances, but we also have a lot of people that come in that are on treatment programs. So how do we support that bonding? Right? If they're on a treatment program and they've not had a relapse, what about breastfeeding? Right? What about being able to breastfeed their baby? I'm also a, lactation consultant, and so I try and help with that as well and really support that bonding with the baby in the breastfeeding arena. You get that going, they're not going to want, they're going to want to keep on their, their, their treatment plan, and hopefully they can sustain that through getting into recovery as they leave the hospital.

Bianca McCall: And so what I'm hearing is, the feeding process is such an integral piece of the bonding between the baby and the mother. And getting that right, if we get that right and we get some education as early as possible, around the feeding especially. And again, eating, what is it? It's, it's eat, sleep console, sleep console, you know, doing that as early as possible, it sounds like that, produces these sustainable, these positive and sustainable, outcomes, for the child throughout the lifespan. Dr. EJ, what, what do you think? What are, what are some strategies? What are some, you know, education that we can provide to support that bonding.

Dr. Ebony January: I was actually going to say the same thing as Amy. You know, you want, if you, you think about this, this is a person who is prone to habit forming, right? You want to teach them to create good habits, right? You want to exchange one good habit for another, or you want to play up the fact that this is someone who, who likes habits. So if I can get you to bond with this baby by as simple as skin to skin and show you that this is something good and get you to, switch this habit out for that bad habit, you will want to continue this as Amy stated, or breastfeeding. I want to continue this. So I'm going to go to treatment and exchange this bad habit for a good habit that I enjoy. And I want to have this. I want to continue this relationship with my baby. So these are, great educational tools that we tend to give within the hospital. Obviously, as the ob, once, you know, once the baby's delivered, I tell moms, oh, now I'm just, you. I'm just here for you. You know, they're like, what? You know, but in that Moment I at least try to make sure that they do skin to skin. I promote breastfeeding, you know, for those reasons as well. but I completely agree with Amy, but also, like I said, playing up the fact that this is someone who likes habits. And so I'm going to switch out the bad habit for the good habit, meaning let's breastfeed. Let's skin to skin and start to bond more.

Bianca McCall: Yeah, I love that. Replacing habits. Replacing habits. And Dr. Lindsay, what are your thoughts? Education strategies?

Dr. Annie Lindsey: You know what, I hate to tell you, but I'm going with a hat trick here because that was my same thought in the beginning. This is a triple threat, really.

Dr. Ebony January: The breath.

Dr. Annie Lindsey: I mean, you've got two incredible health care providers on, on, on this panel. but that, that's not something you see normally in healthcare. And the breastfeeding is one of the best bonding and from a nutrition world, that's the greatest thing you can do. And I think that people don't breastfeed enough for, you know, for obesity, for family, for bonding. There's so many great things, nutrient value, that they're seeing with the role of breastfeeding. And what, you know, one thing is that, that a lot of physicians will just default. The mother says, I tried and it didn't work. And they're like, okay. And they go straight to formula. And we have to educate healthcare providers and doctors to say, no, there, you have to, you're gonna have to take a little time and help them. I mean, I just, I heard Amy talking about how she does that. It's, it, it requires hands on, teaching these women how to do that. And one other thing on the breastfeeding, I'm not an expert in breastfeeding, so I'm, But I know the power of it is the role the father plays. If the father's present and part of the family is there's some really great, there's some really great resource even in our state, about involving the father in the breastfeeding process. Like what is his role, Right, in supporting that process?

Bianca McCall: No, and thank you so much. I know we've talked a lot about mothers on the line, we've talked about villages and families and things like that, but have not spoken a ton about the role of, our co parents and our fathers and things. So thank you so much, Dr. Lindsay, for bringing that into the discussion as well.

Dr. Ebony January: Bianca, I have a quick response to that. if you don't mind, please, please, Dr. Lindsay. I'm a pusher. I You won't just say, oh, no, it didn't work for me. Not with me. Not. Not Dr. EJ, I will get a lactation consultant in a New York minute on you. Okay, I will. I'm all up in your business. I am going to ask, okay, well, why didn't it work? let me see. And, you know, the nipples too big. You know, those kind of things. So, no, I'm going to push. in addition to that, as you. You made another great point is I will get the dad involved. And in fact, you know, but my book is really, you know, I really talk a lot about getting dads involved, and dads should not be innocent bystanders in the exam room or the labor room. And we are at a critical juncture where they can no longer be innocent bystanders in the labor room because we are losing moms. and so that. It was a very key point that you made, not just for breastfeeding, but just across the board. So thank you for that.

Bianca McCall: oh, yes. Our dads, our co parents, are not innocent. Not innocent by any means.

Dr. Ebony January: Right? Co parents or support people in general.

Bianca McCall: Yeah, no, thank you so much. And at this time, I've seen so many things be dropped in the chat. I want to make sure that, our participants, they are also getting their questions answered, to the panelists. You've made it through the lightning round of questions. We've asked some deep, some complex, some multi layered, questions of you. And so just incredible, incredible responses, incredible thoughtfulness and experiences that have been shared. this is just been an amazing conversation, so far. And, at this point, this time, with just a few minutes to spare, I'd love to give our panelists each a minute or less to share any final thoughts or what I'd like to call the mic drop messages before we close for today. And we'll start with Amy.

Amy Thatcher: Oh, great. You're gonna start with me. so many things through this whole. This whole webinar. It's been such, an honor to. To talk with you. I think that the mic drop moment for me is meeting people where they are and knowing that you need you. You could be in their shoes in any. Any moment in your life. And your kids, your sister, your brother, they could all be in that place and letting go of what, you think of their path and just meeting them where they are so that you can help them form their new path. Yeah.

Bianca McCall: Wonderful. Thank you so much, Amy and Dr. Lindsay.

Dr. Annie Lindsey: I think it's kind of similar along the same lines about meeting them where we're at. But, there's just so much shame with this population, and it's not helping. It's a big population. And I think the reason that, that. That these women a lot of times turn to substance uses is because they've got to do this on their own. They don't want to lose their children. And so they do what it takes, whether it's, you know, prostitution or, you know, it pays 4,000, $5,000 a night instead of, you know, Applebee's for $15 an hour. I mean, men get, you know, 30, $40 an hour to slam a hammer, but we don't. We probably buy that as an option. So they're in. They're a very high risk, especially single mothers. And, we're not going to fix the problem by shaming them. I think we have to look at them as a young, struggling single mom, which we all get, and put aside how they're dealing with it, because that's not what they want either.

Bianca McCall: Thank you so much for your insights today as well, Dr. Lindsay and Dr. EJ. I don't anticipate you're going to have any issue with a mic drop statement.

Dr. Ebony January: 1. I want to thank everyone. this was absolutely fantastic. this really is therapeutic for me. truly, as the daughter of an addict, I truly feel that if we build a system that's safe for the most vulnerable mother, we build a system that's safer for everyone. You know, every mother deserves more than just survival. She deserves support, safety, and truly a chance to survive. So thank you. Thank you. Thank you so much.

Bianca McCall: and thank you. And to echo the sentiments coming from the chat, thank you so much, to all of our panelists for your time, for the space, for your sharing of knowledge and expertise, the incredible conversation for today. Thank you, participants, for joining us. the final words that I would love to leave you all with, before giving it to Jamie to let us know what next steps are. But the final words that I'd like to leave you with, they're never my own. but I like to adapt them. Ah, from one of my favorite poets, Amanda Gorman. but she says, in not these exact words, but whoever inspires you to do the work that you do and to see the. The beauty in every experience to lead with compassion, which we heard a lot about today, to care enough to have shown up today. They are our captains. And let us walk with these warriors. Let's charge on with these champions and carry forth the call for our captain. Today, this week, the remainder of the month, the fall, the winter, and whatever year, we celebrate them by acting with courage and compassion, by doing what is right and just. And it only takes just one of us to inspire change, to inspire healing and recovery in all of us.

Amy Thatcher: Foreign.

Bianca McCall: Thank you for listening to the NOCE the Opioid Epidemic Unplugged. We hope that you found this episode compelling and informative, and we ask that you please share this episode with your friends and your colleagues. And if you want to learn more, please visit our website at www.nvopioidcoe.org. the number the NOCE Dose podcast is brought to you by the Nevada Opioid center of Excellence, or NOCE NOCE is dedicated to developing and sharing evidence, informed training, and offering technical assistance to professionals and community members alike. Now, whether you are a care provider or a concerned community member, NOCE provides resources to support those affected by opioid use. Funding for this activity was made possible in whole or in part by the Nevada Department of Health and Human Services, DHHS Director's Office through the Fund for Resilient Nevada. CASAT Podcast Network.

Bianca McCall: This podcast has been brought to you by the CASAT Podcast Network, located within the center for the Application of Substance Abuse Technologies, a part of the School of Public Health at the University of Nevada, Reno. For more podcast information and resources, visit casat.org.