Fighting Fentanyl: Melanie Yates and the Josh Siems Act

We delve deep into the heart of the opioid crisis, focusing on the devastating impact of fentanyl. Our special guest, Melanie Yates, LMSW, a May 2023 graduate from the University of Maryland School of Social Work, shares her personal journey of loss and her relentless pursuit to make a difference.

Melanie's efforts led to the passing of the Josh Siems Act, a groundbreaking legislation that mandates Maryland hospitals to test for fentanyl. October is National Substance Abuse Prevention Month, so please join us as we discuss the importance of substance abuse awareness, the challenges of navigating the political system, and the hope for a safer future. 

Warning: This episode discusses topics of addiction, overdose, and family loss.

Listen to The UMB Pulse on Apple, Spotify, Amazon Music, and wherever you like to listen. The UMB Pulse is also now on YouTube.

Visit our website at umaryland.edu/pulse or email us at umbpulse@umaryland.edu.

Transcript

Dana Rampolla: 0:03

October is National Substance Abuse Prevention Month. So here on the UMB Pulse, we'd like to take this opportunity to speak with a recent graduate of the University of Maryland School of Social Work, Melanie Yates. Melanie graduated this past spring and she received her Master of Social Work in May. And she's already been making a tremendous impact here in Maryland. And actually she started before she even graduated. Um, she submitted a bill that's now known as the Josh Siems Act, which was named for her late boyfriend who passed away from a fentanyl overdose. Um, the act requires Maryland hospitals to test for fentanyl now, which is something that normally has not been done in the past. And it was signed into law by Governor Wes Moore in the spring. The law became effective on October 1st. For her extraordinary work, Melanie was awarded the Clinical Fieldwork Award from the School of Social Work, Office of Field Education, an exemplary clinical award, which is chosen by her peers. So, a word of caution to our listeners. This episode tackles conversations about addiction, about overdose, and about family loss. It hits close to home for me as two years ago, I lost my youngest brother due to a fentanyl overdose. And this legislation was not in place then. So I think it's an encouraging conversation. I hope that you can listen through its entirety to hear not only the great work that Melanie has done, but how laws are changing to help our own family members who might have addictions and who might go through something like this in, in their

Jena Frick: 1:36

lives. You're listening to the heartbeat of the University of Maryland, Baltimore, the UMB Pulse.

Charles Schelle: 1:56

Melanie, uh, thank you for joining us and being here on the UMB Pulse to share your journey and your story. We hope this can help not only inspire others. But ultimately save lives through the work that you're doing.

Melanie Yates: 2:09

Thank you so much for having me.

Dana Rampolla: 2:11

In our opening, we referenced your work and how you've helped make some significant changes in the area of drug use in Maryland and drug testing in Maryland. And here on the UMB Pulse, we like to talk about our change makers, people who are from the university who are making a difference in the real world. And as a recent graduate of the university, you have a great story to tell. So before we get into discussing your meaningful work, let's start with who you are. You were a student at American University. You received a bachelor's degree in environmental science. So what were your original aspirations and how were you led to wanting to even work in behavioral health?

Melanie Yates: 2:48

So when I originally was in school, I really wanted to be a marine biologist, um, and I really wanted to study sharks and I, that's why I pursued an undergrad in environmental science, um, did a bunch of internships, didn't find anything I really loved. So for the remainder of my twenties, really, um, I tried every job known to man. My brother said I should be a career coach because I tried everything. Um, I, you know, moved to Nashville, I moved abroad for four years. I worked everywhere, I worked in bars, I worked as a barista, um, I worked in merchandising for a while. Tried. Um, and then when the pandemic hit, I think I just like everybody else was trying to reassess your life. Um, and I was trying to figure out what brought me meaning because I just wasn't loving what I was doing. I was living in Ireland. I was pretty isolated. They had pretty strict lockdown rules and I just wasn't feeling fulfilled in my life and social issues has always been something I really cared about. I'd been kind of contemplating moving back to the U. S. Um, and I decided to apply to social work school because I had one of my friends who had just started and I thought what she was doing, it sounded really interesting and always been really addicted and interested in addictions work. Um, for some reason, the opioid epidemic when it first began, um, you know, really 15 years ago was something that just really interested me. And that was something that I was interested in pursuing along with prison social work. So I was really interested in forensic social work as well. Um, so I came into UMB interested in both addictions and forensic, and was lucky enough to actually work at UMB's law school for my first internship, doing forensic social work, and getting to work in the prisons, and starting to work with people with addiction issues. And that is... It's where it led me to my second year internship at Johns Hopkins Broadway Center for Addiction, and I just fell in love. I love working with this population, um, I think it's a forgotten population, especially in social work. Um, a lot of folks think that we just work with kids, but almost all my clients are, you know, 50 plus and have had chronic homelessness issues, um, chronic addiction issues, and Just lending a helping hand is something that I find really meaningful.

Dana Rampolla: 5:14

Wow. Yeah, that really, really is impactful. And so, fast forward, um, when you were enrolled at the University of Maryland School of Social Work, you worked on something that resulted in the passage of the John Siems Act in the General Assembly, and that requires fentanyl testing in Maryland hospitals. So, if you don't mind, before we talk about the law, what would you like people to know about Josh?

Melanie Yates: 5:41

I think the thing to know about Josh is he, and I think, I think you hear this a lot with people who have passed from addiction and overdose is that they were the light, but like, I've never, I've never met anybody that like Josh that can make you feel so seen and known and heard. There were a thousand people at his funeral. We had to, we were literally overflowing into the parking lot because people couldn't get a seat. Um, that's how many lives he touched and he was 31 when he passed. But he, I think, made probably one of the biggest impacts. It was truly astonishing. You walk down the street and when we were dating, it got a little annoying. Cause I'm like, babe, we got to go to like, we got a restaurant. We got to wait things to do. And he's like, but I know that person. Let me just say hi. Like, oh, that's somebody's mom. Like, let me just run over the street and say hi to her. And he just loved loving people. And I think that's something that a lot of people, um. Tend to forget about people with addiction issues is that they're human. They're not just their addiction there's so much more to them and he was funny and kind and was a rabid Ravens fan and a rabid Orioles fan and Just really loved living Thank you for sharing that. You got me teared up.

Charles Schelle: 6:59

Yeah. Yeah. This, uh, this will be a tough episode for, for some folks listening and then for you sharing, so we appreciate everything, um, ultimately for the benefit of others, revisiting this crucial moment, you know, unfortunately when he passed, take us through what happened at the hospital. Is this where things really kind of change when we learn about test results and this take place in Maryland near, near DC, is that right?

Melanie Yates: 7:23

Yep, so right on the border. So he was living in D. C. at the time and I was living in Baltimore, so we did a medium distance relationship. So we kept swapping weekends. So we got to the hospital and He was there on a ventilator, and at the time, his family and I had just assumed that it was a fentanyl overdose. He, um, became addicted to Oxycontin in college. His friend had an injury and had some extras, and it was 2009, so nobody really thought anything of something you get from the doctor. Um, And for whatever reason, he fell in love with it. And so Oxycontin was easy to get back then. And obviously, as regulations changed and laws changed, it became harder and harder. And eventually he was buying from a dealer and there were hits saying, Hey, you know, heroin's a lot cheaper. Um, and when you're already, um, physically addicted, it's, it's basically like you have a glass of water across the way and you're so thirsty, you're going to die, but you can't drink it. That's How I think you would equate the feeling and he and then eventually, you know, ended up with fentanyl because fentanyl has basically overrun the drug market in the U. S. Um, I think it was something like 90 percent now of all opioids in Maryland are fentanyl, not heroin, even though everybody will swear it's something else. Um, so when we saw him in the hospital, we just assume it was a fentanyl overdose. His parents had seen him the day before, and we had essentially been planning an intervention to send him back to rehab for significantly longer. Um, than he had been before. And when we got there, it took probably three days to get our test results. Give or take, um, we knew that he wasn't going to live. His heart wasn't able to keep pumping on its own. He wasn't able to keep breathing on his own. We were waiting for the transplant team to essentially get together and find all the recipients so that we could try to donate as many organs as possible. And a nurse came in. And, um, he had just happened to pull out the drug screen and we were like, Oh, well, what, what happened to come up? Cause like, we were just curious what came up and they're like, Oh, only cocaine. And we were like, cocaine. And we're like, okay. Um, and it's very common, you know, for people who use opioids to sleep all use cocaine and, um, fentanyl, heroin, whatever, at the same time to kind of regulate yourself. Um, but then we were thinking, did you, did you have a heart attack? And then I'm thinking, I would rather have you die from an opioid overdose where you just slowly go to sleep. I don't want you to have a heart attack and have passed. And so. For a couple days after we were just very confused as to why, um, also when we went to his apartment within that time, we found the fentanyl, um, they call it blues. They're like little blue cats with blue powder right on his thing, um, right on, sorry, and right on his side table. And I was like, okay, so I see the fentanyl here. I see the straw that you were using. Um. I'm confused how only cocaine has showed up and about a month later, so we had, after that time, we had just assumed, okay, maybe it was just cocaine, maybe it had gone out of the system too quickly, fentanyl processes, like 24 to 72 hours, we were just basically explaining it all away, and, um, the sciences are close with a doctor that works at Johns Hopkins, and... And he said, Oh, it's probably because they didn't test for it. A lot of times they don't come up and test for fentanyl. They knew he was already dead, if put it quite frankly, and they don't need to run the extra test. Um, and that's how I found out that fentanyl is not included in the standard drug screen. So of course, heroin is not going to come up, um, opiates are not going to, um, appear on the drug screen because he didn't have any in his system. And he had synthetic opioids, which is. Very minute difference that I think even I've heard some doctors and nurses missing, um, and I think especially the general population is the assumption that, well, we know fentanyl has taken over Maryland and the U. S., wouldn't it just be logical that it's already included in the drug spree? Um, and that is how I found out that it wasn't. And I kind of had the crazy idea, like a month to the day actually. Um, and I texted my best friend saying, is it crazy that I think I might try to pass a law in Maryland? And she was like, well, what do you mean? And I was like, I'm going to see if I can try to get fentanyl testing onto the standard drug screen. They did it in California last year. So like, is it crazy to think I could do this? And she was like, it's not crazy.

Charles Schelle: 12:24

Thank you for sharing that. That's incredible. Like the, the detail. And, and just how everything unfolded where you go down a rabbit hole essentially with with regulations and finding out things. And as you said, you're trying to explain stuff away, but then it comes up, you're like, wait, there's something here. And so what did you learn further about hospital testing? And I guess what's known as the federal five, right? And, and how much you had to dig through and to be prepared before you started. You know, wanting to, to present a law.

Melanie Yates: 12:59

So I think a rabbit hole is the perfect description. Um, that is also how I described it, or I just went through basically a research rabbit hole and the research that really caught my eye that I thought was to me, the critical piece for getting this law passed was a university of Maryland medical systems study that had come out, I believe. 2019, or initially, um, that found that only 5 percent of overdose patients are being tested for fentanyl in the Maryland health systems. Um, I ended up reaching out to those researchers, they then were saying, Oh, we're already actually doing more research on, it was a few hospitals, um, along the Chesapeake between Baltimore and DC, and they actually came out with their findings. in February of this year, and that actually ended up citing our law in it that reinforced, hey, it's still not being done, even though this is now four years ago that we published these studies and we encouraged hospitals to change these policies. Um, so I think I did probably about a month, um, reading every single article on the California bill, um, talking to the researchers. And then I reached out to my first supervisor at UMB at the law school and I said, Hey, Lawyers might know something about classical law, this might be crazy. And she connected me to one of the professors at the law school who was like, Hey, I think my clinic would want to take this on. Um, and I think we can assign one of our student attorneys. I think this is a really great piece of legislation. And I really honestly couldn't have done it without her. Um, and without the help of Will O'Malley, who ended up being my Like a student attorney, um, student intern, and he and I started creating this law based around the California law, and we picked apart pieces that we wanted to take out. So they've got a sunset clause on theirs, wherein, um, a few years, the law will no longer apply. We're like, we're going to see if we can get away with that not being in there and just reworking a little bit and trying to better it as we went. And so it's probably a good. Um, and I thought we were going to do this in 2024 and will was like, I think we can get it done this session. And I said, okay, let's go. It's my last semester. I'm about to take my licensing exam. Like, let's just hit it. So we did. That's incredible.

Dana Rampolla: 15:31

Melanie, one of the things that we talked about when we did an interview when you were graduating and we talked about how May 9th, which had just been around, was Fentanyl Awareness Day. Back then, you tweeted something to the effects of hospitals seeing an uptick in Fent cases. Explain what that means to me. Are there actually more Fentanyl cases or is it just because it's being... Mixed with drugs, we're seeing an uptick in those numbers. Can you differentiate between the two?

Melanie Yates: 16:02

So what we're thinking is that it's not necessarily that people are using more fentanyl. It's that it's now just becoming more apparent how mixed in it is into other drugs. Um, specifically cocaine is so cocaine deaths are the number two deaths in Maryland for overdoses. What we're finding is that overdose deaths that have been Um, labeled as cocaine deaths because they were just tested with the standard five are actually seeing a more of an uptick of this might have actually been a fentanyl related death that we just didn't even recognize. Fentanyl use itself, intentional fentanyl use isn't on the rise. It's just permeated into literally everything now. And so now that we're testing for, we're just seeing bigger numbers. And a lot of people will be like, well, we already know fentanyl is a problem. So why do we need the bigger numbers? Well, we need to know what exactly it's in. We need to alert drug users, especially kids who are just first starting to experiment. Um, a lot of times they won't even think twice about fentanyl. And that's a lot of like, I mean, I've talked to some of the kids, like they'll just be like, Oh, it's, it's not a problem. It's like, we're not using that, blah, blah, blah. And a Xanax pill off of Joe Schmo down the corner. You don't know what's in that, and you need to be able to protect yourself. So it's actually the testing that's giving us better data, really. Yep. And so that was a big, um, kind of like one of our big sticking points with the law. It's not just, you know, we wanted to know, and frankly, we did want to know what Josh died from. Um, but it's also that, how are we going to create programs off of data that's inaccurate? What if we're really underestimating the amount deaths by fentanyl and we're just kind of being like, Oh, we know it's bad. It's okay.

Charles Schelle: 17:56

You were mentioning studies earlier. There's that's a University of Maryland School of Medicine study that said out of the 83 percent who were positive for the drug, only 5 percent knew that they had taken it. So that gives your point about how that awareness. Isn't there, um, for people to think that they're getting something clean, right? Off the streets, shifting back to. Lobbyist mode really, as now you've done your research right now, you have to navigate the political system and you had that student mentor and I guess you'd like to say student lawyer. So, um, how did, how did you prepare yourself to map out a game plan and, um, you know, go down to the General Assembly and knock on doors and, and, and even find time for somebody to listen to you.

Melanie Yates: 18:48

We didn't even have time to go knock on doors, um, by the time we had a general idea and we had essentially skeleton written a law based on, um, California's law and talking to Dr. Ronit Lev, who's the doctor who wrote the California law. Um, we were at the deadline for submitting, um, Like new legislation for the year. So we couldn't even go to Annapolis and actually knock on doors. So we were calling everybody that we knew. Um, so I was reaching out to everybody and their parents and seeing like, does anybody know a Senator or a, like a Maryland state representative, I need somebody, um, and we ended up getting in contact with, uh, Joan Vogel. So he's a new representative. He's Gen Z, he's young, he's hungry. He is. Um, really interested in the same sort of policies that we are and because he was a freshman delegate, he was saying, Hey, I actually have like room on my roster. I can, I can put you on and I think this is great. And to us, it's really a straightforward bill. I mean, we had, uh, you know, other delegates really saying over and over again, I've heard a hundred times this is a common sense bill, but this is the first time I've actually heard a common sense bill. And I felt really proud of that as well, because I was like, thank you. I see it too. Um, and so we called Joe and Joe and I had a virtual meeting. He's like, I think we can get this done. I'm literally going to have my chief of staff run over there right now and drop it into their basket before 6 PM, which is the deadline. And that started the ball rolling. That's incredible.

Charles Schelle: 20:42

Hopefully that's inspiring for more people to enact laws that they want to see change. And that, you know, if you do a lot of hard work, sometimes if it makes sense, it will find a way to get done. Um, so that's really amazing. And then, So you had that done, I'm just getting it submitted and then it actually gets passed in the General Assembly and, um, the governor signs it into law in the spring. It's renamed for Josh. And now as we're recording this, we're only a couple of days away from, uh, law taking effect on October 1st. So knowing that this has become real here, you know, coming out October. And the change it will bring, has it, has it helped you at all, knowing that this is becoming a law that's going to change lives and at the same time, maybe helping your healing journey in some way, along, along with, um, his family's healing journey?

Melanie Yates: 21:44

I definitely think so. And I think especially initially, this really gave us some purpose to kind of put our energy into it. I feel like the first six months, you kind of. Or in like a daze or a not even quite numbness, but it's everything's foggy and it's almost as you're not really in reality. And so for, you know, his parents and I, it was a great way to channel our energy and for me, this year has passed incredibly quickly. And I actually realized last week, I was like, Oh my gosh, it, it goes into effect like next week. I was like, Whoa. And so for me, that was pretty crazy. I think this has probably been The most meaningful thing I've done in my life and granted, I'm, you know, only 31, but I think it was something that needed to be done as well. And I think, you know, I think Josh would have been proud. He loved politics. So I think he actually would have been a great politician. I think this is just a nice way to honor his memory and to Help other people as well.

Dana Rampolla: 22:52

Yeah, definitely helping other people you read the numbers and it's it's scary and and most families You know when I was growing up this one if you knew of someone who overdosed it was a big deal It was scary. It was shocking. It was kind of had a Taboo thing attached to it, but nowadays it's you hear it every other day It's so common and it's so sad and so many losses and families affected and you know I go back to we just keep thanking you for being so open and sharing your story because it It is sad and we started out Melanie by talking about you and where you were in school when this all happened I mean for our listeners this happened in the last six months. This isn't like the last five years Melanie's been working on this. So tell me in addition to To getting a law passed, how, how did you really balance that with grad school? Because you, you recently graduated and started your own new career.

Melanie Yates: 23:46

I was really blessed with my professors that I had. So it'll be one year in on, on October 14th. So in a little over two weeks. Um. And I took about three weeks off of school. I emailed my professors and said, quite frankly, Hey, I don't think I'm going to come in right now. My boyfriend died of an overdose. And honestly, being in, you know, UMB School of Social Work was a blessing because all my professors are like, absolutely, whatever you need. We can write extensions. Um, we will figure it out for this, you know, second to last semester. And I took about three weeks off, um, and I just tried my best on that last semester. Um, I did end up getting all A's, which is great, it's difficult, but I was also doing well before then, so that was helpful. Um, I did consider dropping out, um, and Josh's family was like, don't do that. You work so hard. Um, but what if I instead just buy a house and remodel it? I do something else else. I could do anything. It was before I really started diving into the law and actually giving myself a task basically. Um, and that last semester I drank a lot of Red Bull. Um, I was tired. So I had three classes and I had chosen my classes, um, based on what I really wanted to take. Yeah, and classes that I thought would be very helpful for my career. So it wasn't plus classes. So I was like, Oh crap. So now I'm here and I've got these classes and they're going to be very important. So I can get a clinic off on those. And then I had scheduled my licensure for spring break as well. So that was a craziness, but I honestly was either working on school, the law or Um, studying for my licensure from like eight to eight almost every day. I think I gave myself like one half of an afternoon off, but it was, I wouldn't do it again. I would not do all of it again. I would absolutely pass the law and all of it, but I think I needed to manage something better in the spring because I was running on fumes, but I, once the ball got rolling, you can't stop and we didn't want to stop. And once I kind of saw that, I was like, this might actually. get somewhere and do something. I was like, well, we can't stop now. We have to keep going. That's awesome. Well, it says a lot about you as a person to have been able to, that you continued, like, you didn't start out with the idea to do it, but you pushed yourself through it, you graduated, you did, made some really important changes, that really says a lot about you. I hope you're finding a little time to breathe and relax now. And, you know, Keith. Yeah, I've got evenings off now, which is amazing. No more homework.

Charles Schelle: 26:44

We know that the law passed in Maryland and you mentioned the California one. Well, do you know, I guess what this looks like for other states and how common this is for testing?

Melanie Yates: 26:54

So pretty much categorically, no other states test for it. Um, it would have to be something that's implemented by the American Medical Association and they're not necessarily keen to have things legislated, which I absolutely understand. And at the same time, change needs to happen. Um, I know there is a law getting, at least moving through the process in Pennsylvania right now, and I had some folks in Virginia reach out to me about the law because they wanted to pass something similar, so there's definitely rumblings. In the state of trying to get things done state by state. There is also still a federal push. Um, so the mom in California who helped pass that law has been really working on trying to get it federally pushed. Unfortunately, the federal government can't mandate laws for the states based on the 10th amendment. So we're trying to work some way around to just. update the regulations. Um, so it's a little bit more complicated to just do a sweeping oversight, but we're hoping at least that the knowledge that, hey, this isn't being done and this really should be done. And how do we, you know, change the federal five more frequently? It's not changed since I think the 1960s. So when is it time to maybe phase out some drugs and phase in other drugs? When is it? you know, fiscally beneficial when are we seeing enough numbers for things like that? So that's potentially a doctoral project for myself, but when can we update and when should we update? Cause I think this really should have been done 10 years ago when we started seeing such a slight.

Charles Schelle: 28:37

You're now a licensed clinical social worker in the Baltimore area. What does your work focus on now?

Melanie Yates: 28:43

So I am a dual diagnosis therapist in West Baltimore, so I have. Um, or I work at an outpatient clinic, and I deal with folks who have been diagnosed with some sort of substance use disorder and a co occurring mental health diagnosis, so that can be anything. I've talked to bipolar, depression, anxiety, PTSD, um, so I work with folks who have been experiencing chronic homelessness, we give them a place to stay, and then they also enter treatment with us. So we can hopefully, you know, get them all drugs and... back working and however they kind of want to live their life.

Dana Rampolla: 29:21

That's incredible. Um, before we, we sign off, Melanie, October is National Substance Abuse Prevention Month, and a few, few months ago you tweeted, Use test strips, have Narcan, and never use alone, which seems pretty self explanatory. Do you think people are listening? Do you think that message resonates?

Melanie Yates: 29:42

I wish. Um, I think test strips are becoming more common for people who are using cocaine, um, active drug users and people who, with a diagnosable substance use disorder, don't really care. Um, they don't really have enough time. They're, for whatever reason, not really going to use it. Um, I think test strips are great for capital drug users. Um, people, and I would say especially folks who are using cocaine who are not intending to try to use any sort of opioid. I've definitely been seeing an increase in folks using test strips there. Narcan, I think more people are having it. I think it's still so expensive. Um, you know, you can get it from Baltimore City for free, but that's not true across the state from Maryland. And I think if we made it accessible and made it very cost effective, people are going to have it more often. All of my clients have been written a Narcan prescription by their doctor, however, it's still going to cost certain amounts of them to get it, and is that worth it, based on, you know, a very tight income? Um, I think the using alone is something... That I think a lot of people underestimate, um, I think because drug use, especially for people who suffer with, you know, an addiction issue, they're going to use a loan. It's a shame filled activity. They're not going to be like, Hey, mom, girlfriend, whoever, I'm going to go use in the bathroom, so be careful. But there are hotlines that you can call and it'll be a person that'll sit on the phone with you while you use and you have to respond in a certain amount of time. Otherwise, they'll call 911 and. You know, send somebody out for a suspected overdose. And so there are other avenues that you can use and reach out to try to make drug using safer because I don't think it's realistic to say, don't do drugs. It's just not going to happen. It's not going to happen in any city. It's not going to happen in any socioeconomic class. It's just not going to happen. So it's how are we going to use in a safer way? And how are we going to recognize when there is an addiction issue and these are the treatment steps that, or the treatment options that you can take and something that'll get it before you're 10, 20, 30 years deep and it's a lot harder to get rid of.

Charles Schelle: 32:06

Melanie, thank you for sharing your story and being so open about not only the personal loss, but shedding light on, on this serious and life changing topic and how other people can ultimately be helped in light of a tragedy. So you, I think truly have brought UMD's mission to life to improve the human condition and serve the public good of Maryland. So thank you for everything you do and best of luck in your future. Um, cause undoubtedly you're going to do something terrific again.

Melanie Yates: 32:37

Thank you both for having me. I appreciate it. Thanks, Melanie.

Jena Frick: 32:46

The UMB Pulse with Charles Shalee and Dana Rampolla is a UMB Office of Communications and Public Affairs production, edited by Charles Shalee, marketing by Dana Rampolla.