Overdoses have claimed more than one million American lives in the past two decades. The situation is dire—but there is hope. Dedicated professionals in communities across the country are leading the charge to save lives, providing evidence-based, compassionate support directly to people in need. This interview series spotlights these inspiring individuals, sharing their work and insights.
Dr. Lipi Roy, MD, MPH, FASAM is Medical Director of MOCJ (Mayor’s Office of Criminal Justice) Transitional Housing at Housing Works, an Addiction Medicine Physician at St. Ann’s Corner of Harm Reduction, and a well-known medical commentator, speaker and writer who has been featured in outlets such as MSNBC and Forbes. She’s also on Shatterproof’s Scientific Advisory Board.
Dr. Roy took the time to talk to us about harm reduction, the effectiveness of addiction medications, and the inspiring resilience she sees in her patients.
Housing Works is a New York-based nonprofit dedicated to fighting HIV/AIDS and homelessness. When the COVID-19 pandemic hit New York City, Housing Works advocated to provide better care for homeless and justice-involved New Yorkers by providing health services at hotels-turned-shelters in partnership with the Mayor’s Office of Criminal Justice (MOCJ) and the Department of Homeless Services (DHS).
Prior to my current position, assumed October 2021, I served as Medical Director of COVID Isolation and Quarantine Sites, a DHS-funded initiative. Because these projects emerged in response to the pandemic, I remind my team that the work we collectively do is unprecedented and historic. When I was first hired by HW in June 2020, I was tasked with implementing medical services at multiple hotels for the city’s most vulnerable men and women in the midst of a global infectious disease outbreak – this had never been done before. I worked closely with our fellow, newly-hired Director of Clinical Operations to interview and hire clinical (nurses, nurse practitioners, medical assistants) and admin staff; create and implement clinical protocols; purchase medical equipment; lead daily virtual clinical huddles; discuss complex medical and psychiatric cases; trouble-shoot staffing and operational issues, both internal and inter-agency.
At the same time I started at Housing Works, I also joined St. Ann’s Corner of Harm Reduction (SACHR) where, once a week, I treat patients with opioid use disorder (OUD) in one of the most underserved regions of the country, the Bronx. SACHR’s philosophy is to meet a person where he or she is by creating a safe haven and offering nonjudgmental care for individuals experiencing substance use, poverty, mental illness and other stigmatized conditions that undermine their ability to access compassionate, high-quality care they need and deserve.
I fell into the field of addiction medicine quite by chance.
In my first position after completing internal medicine residency training, I served as a primary care physician to Boston’s homeless population. About a year and half later, my colleague’s research findings revealed that the leading cause of death among our patients was drug overdose. This was 2013, before we saw daily headlines about heroin, fentanyl, and the "opioid epidemic." This data transformed the way I provided care. I worked very closely with substance use counselors and psychologists; I underwent considerable training including board certification in addiction medicine.
Having a better understanding of addiction or SUD has not only made me a better physician but a better human being. On the first day of medical school, we learn that our best teacher will be our patients. Never has this been truer than with individuals experiencing SUD; my patients have taught me how the relapsing and remitting nature of addiction impairs their brain and their subsequent inability to modify their behaviors. Perhaps the most meaningful lesson was their resilience to survive and thrive, despite varying exposure to stress and trauma. It's heroic. My patients deserved my unequivocal and compassionate attention and care.
No two days are the same! My work as medical director at Housing Works consists of many administrative and leadership responsibilities, carried out through virtual meetings, phone calls, research, and writing clinical protocols and workflows. I also make on-site visits with staff.
At SACHR, I work closely with the manager of drug user health and the medical assistant to coordinate services for patients. They conduct the initial screening, and then I perform a comprehensive evaluation (either in-person or via televisit), assess their needs and create a treatment plan which often includes addiction medications like buprenorphine (a.k.a. Suboxone) as well as other services tailored to the patient (like therapy, psych or PCP referral, food, clothing, job assistance, etc.)
I also spend a great deal of time merging my passion for medicine with media in an ongoing effort to educate and empower the public about accurate and relevant health information. COVID-19 has been stressful and confusing for so many. As an MSNBC and NBC News Medical Contributor, I discussed all health aspects of the pandemic – from mitigation measures like masking and distancing and clinical manifestations of SARS-CoV-2 (respiratory, cardiac, neurologic) to treatment and vaccinations, and mental and emotional repercussions of isolation. As a Forbes Contributor, I have written about various health topics including the gastrointestinal manifestations of COVID-19, the pandemic’s impact on jails and prisons, burnout among frontline healthcare workers (myself included) and the recent suicide death of Regina King’s son (as well as Anthony Bourdain and Kate Spade). I have had the opportunity to interview celebrities such as Mary J. Blige, Ciara and Tony Hale about breast cancer, cervical cancer and asthma, respectively.
I have devoted my career to serving the underserved, many of whom are disproportionately impacted by SUD, mental illness, pain, and trauma. One of the biggest challenges faced by marginalized populations is stigma – instead of receiving low-barrier access to services (health, legal, educational, employment, etc.), they are judged, shamed and criminalized. These are women and men who want to live normal lives just like you and me.
Strategies that incorporate the philosophies of harm reduction are perhaps most successful. The harm reduction model is based on a belief in – and respect for – the rights of people who use drugs. Their motto is to meet people where they’re at and help reduce the negative consequences associated with drug use. If, for instance, a patient wants to quit using heroin, then I offer evidence-based options (e.g. medications like buprenorphine and behavioral therapy) to help him or her achieve that goal. Alternatively, if a person tells me they’re not ready to quit drinking alcohol, I respect their decision. I use motivational interviewing techniques to explore their substance use (e.g. What do they enjoy about drinking? How would life be different if alcohol were no longer part of it?) Empathic, nonjudgmental listening is crucial in establishing trust. Moving at their pace to achieve their goals; not mine. That’s key.
Perhaps the most common myth or misunderstanding about SUD is that it’s a moral failing or weakness. The public still believes that a person misuses substances because she or he is bad, lazy, stupid, weak-willed, not driven enough, etc. In reality, SUD is a chronic, relapsing and remitting disease of the brain that causes compulsive drug-seeking and use despite harmful consequences to the individual using drugs and to those around him or her. SUD/addiction is not a sign of moral weakness or failure.
Another common myth is that medications for OUD (MOUD) like methadone or buprenorphine simply substitute one addiction for another. In reality, they are evidence-based medications that reduce uncomfortable cravings and withdrawal symptoms, and enable people to achieve recovery. I have many patients who are now in long-term recovery because MOUD has enabled them to graduate from school, get a job, pay their bills and care for their children. SUD is a chronic illness that needs long-term treatment. Just like people with diabetes need insulin or people with asthma need inhalers, chronically.
I wish more people knew that SUD is a chronic medical condition that is both preventable and treatable. I specifically wish that people in decision-making positions knew this. Namely, judges, prosecutors, police officers and policymakers. Unfortunately, people with SUD in the U.S. face criminalization instead of compassion and care. The U.S. criminal justice system also discriminates against people of color who use drugs. The so-called "War on Drugs" – essentially, a war on black and brown people – has been declared by the Global Commission on Drug Policy as a colossal failure: drug addiction should be treated as a health issue, not a criminal one.
We need widespread access to evidence-based MOUD for individuals experiencing OUD. Unfortunately, strict federal and state regulations restrict clinicians like me from prescribing lifesaving medications like buprenorphine and methadone—the latter can only be dispensed at specialized opioid treatment programs, or OTPs; in contrast, methadone deregulation (and prescribing by primary care providers) in Canada, Australia and some European countries has resulted in increased treatment capacity in these nations.
We need to meet both medical and psychosocial needs of people with SUD: housing, education, employment, child care, mental health, legal services, etc. Such comprehensive treatment and care requires major and consistent investment at the federal, state and local levels of government.
We also need significant investment in SUD education for health professionals (doctors, nurses, NP/PAs), law enforcement, judges, policymakers and of course family and loved ones of people with SUD.
Lastly, we need cross-industry, cross-country collaboration. We know that SUD impacts people from all walks of life, irrespective of gender, race, profession, socioeconomic class. From pro athletes to prison guards and rock stars to realtors, SUD does not discriminate. As such, I would like to see more collaborations between addiction professionals and representation from fashion, finance, Hollywood and music industries. Let’s get people the care they need and deserve when they need it … not when they hit rock bottom.
My patients give me tremendous hope. They have shared their deepest concerns and placed their trust in me – despite having their trust violated by authority figures time and time again – in order to lead a better life. They have overcome tremendous obstacles and have shown me the true meaning of courage and perseverance.
I recently met a 27-year-old man who was using about 30 bags of heroin each week, stealing from his family and from local stores, in and out of jails for theft and drug possession (“I can’t live like this anymore, but I just can’t stop”). I started him on buprenorphine 8mg sublingually twice daily. Within a few weeks, he was down to 2 bags per week, enrolled in night school to complete his GED, and repairing his fractured relationships with his parents and siblings (“My mind is blown. I haven’t felt normal like this in years.”) This, to me, is success.
Perhaps just a reminder that everyone is under a lot of stress. We are being pulled in so many different directions. We need to be mindful of the mixture of emotions that people are feeling: isolation, sadness, frustration, anger, confusion, anxiety. Self-care is so important, and it is not selfish! Find activities that you enjoy, that relax you. I meditate daily, pray each night, play piano, exercise regularly, watch comedy, and spend time with family and friends. Mental and emotional health is health.