Steve Woolworth, PhD, the new CEO of Evergreen Treatment Services, has big shoes to fill. Molly Carney, the longtime CEO, is retiring, and Dr. Woolworth—at the helm of the Seattle, Washington-based opioid treatment program (OTP) for only six weeks when we interviewed him in February, was humble about his familiarity with the controversies of the day, such as the move to “x the x-waiver” regarding buprenorphine prescribers.
Steve Woolworth, PhD, the new CEO of Evergreen Treatment Services, has big shoes to fill. Molly Carney, PhD, MBA, the longtime CEO, is retiring, and Dr. Woolworth—at the helm of the Seattle, Washington-based opioid treatment program (OTP) for only six weeks when we interviewed him in February, was humble about his familiarity with the controversies of the day, such as the move to “x the x-waiver” regarding buprenorphine prescribers.
About the patient population coming through Evergreen’s doors, however, he is well prepared to serve them. And he cut right to the chase when we asked him about the role of counseling in treatment for opioid use disorder (OUD). “There is a lot of recognition that medication-assisted treatment is not a cure,” he told AT Forum. “It is overdose prevention.” He’s also familiar with the research: “MAT lowers overdose by more than 75%—even more with methadone than with buprenorphine,” he said. “We don’t have the same research base for Vivitrol,” he added, noting that induction with Vivitrol, which requires a week of total abstinence, is “challenging.”
Dr. Woolworth had yet to attend his first meeting of the state chapter of the American Association for the Treatment of Opioid Dependence (AATOD), but when he does attend, he will bring a full background of the care needed for this population with him. It’s not just medical care: it’s housing, mental health, education, criminal justice, corrections—keeping people out of jail and prison, or getting them help if they need it while they’re there and afterward—and more.
Committed to the Community
Dr. Woolworth started working in non-profits when he was 15 years old, and has been working in community-based services ever since. Most recently, he was vice president of Pioneer Human Services, one of the country’s oldest and largest reentry organizations. “In that role I helped design and oversee a low-barrier harm reduction program for people with OUD, which led to lower arrests,” he said, referring to buprenorphine treatment. At Pioneer, he was responsible for several innovations, including the first residential treatment program in Washington State to use all three medications—methadone, buprenorphine, and naltrexone—to treat OUD. Program completion rates are more than 80%.
Under Dr. Woolworth’s leadership, Pioneer also opened the Snohomish County Diversion Center, which helps people stay out of the criminal justice system, and, instead, get treatment—the low-barrier harm-reduction program referenced above.
Evergreen is one of the first OTPs in the country to utilize mobile vans for methadone (as well as other medication). “This is continuing, but we need to get better at it,” said Dr. Woolworth. “There is room for us to improve our impact and the number of people reached.”
Homelessness, Addiction, and Incarceration
Why Evergreen? “It was a leadership challenge to be CEO, an opportunity for me personally, but also part of the inspiration to me is that Evergreen is uniquely situated to address homelessness, addiction, and incarceration at the same time,” said Dr. Woolworth. There are many good organizations working on each of those three issues, but it’s important to work together in an integrated fashion, he said.
Dr. Woolworth is also president of the International Community Corrections Association, which is also looking at the problem. And that problem is simple: the same individuals are showing up in each system—jail rosters, prison rosters, emergency departments, emergency shelter systems, public health outreach, and addiction treatment. “We have all of these resources scattered across separate systems, each with different practitioners,” he said. “We know these folks are high utilizers moving in an out of different systems—we have services that can and should be focused solely on them.”
Over the next 10 years, “bending and flexing and integrating systems” in ways that address whole-person health and the full social determinants of health will be essential, he added. ‘We know that people’s health care has less to do with health care than it does housing and safety and access to clean air and water. These are things that the health system has no control over.”
In fact, there is a lot of duplication of work going on, and the work that is taking place is often not patient-friendly. Not even close. “We have cadres of people all working with these patients, all of whom are struggling with trauma, telling them they need to show up at this or that appointment, at a certain time,” said Dr. Woolworth. “There are opportunities at the systemic level to rethink what institutions should really be addressing in this space.”
And he suggests rethinking the role of some of the legacy professions in this space. Much of the confusion about addiction exists because it’s been treated as a criminal justice problem. “For decades we have invested in this ineffective war on drugs and have not acknowledged that addiction is an actual disease that should be addressed as a public health crisis,” he said. “We have a lot of housing providers who will evict people for substance use. We still have private housing providers who make it very difficult for people to be on addiction-treatment medication.”
Right now, a focus is on doing induction in jails—with methadone or buprenorphine—so that when people are released, they don’t overdose, he noted. “We’re starting to see correctional institutions recognize this,” he said. This is especially true of some state prison systems. But there are still 10 to 11 million people who cycle in and out of local jails a year, and many have to detox cold turkey. “We need all different strategies to make this work.”
Steve Woolworth, PhD, the new CEO of Evergreen Treatment Services, has big shoes to fill. Molly Carney, the longtime CEO, is retiring, and Dr. Woolworth—at the helm of the Seattle, Washington-based opioid treatment program (OTP) for only six weeks when we interviewed him in February, was humble about his familiarity with the controversies of the day, such as the move to “x the x-waiver” regarding buprenorphine prescribers.
About the patient population coming through Evergreen’s doors, however, he is well prepared to serve them. And he cut right to the chase when we asked him about the role of counseling in treatment for opioid use disorder (OUD). “There is a lot of recognition that medication-assisted treatment is not a cure,” he told AT Forum. “It is overdose prevention.” He’s also familiar with the research: “MAT lowers overdose by more than 75%—even more with methadone than with buprenorphine,” he said. “We don’t have the same research base for Vivitrol,” he added, noting that induction with Vivitrol, which requires a week of total abstinence, is “challenging.”
Dr. Woolworth had yet to attend his first meeting of the state chapter of the American Association for the Treatment of Opioid Dependence (AATOD), but when he does attend, he will bring a full background of the care needed for this population with him. It’s not just medical care: it’s housing, mental health, education, criminal justice, corrections—keeping people out of jail and prison, or getting them help if they need it while they’re there and afterward—and more.
Committed to the Community
Dr. Woolworth started working in non-profits when he was 15 years old, and has been working in community-based services ever since. Most recently, he was vice president of Pioneer Human Services, one of the country’s oldest and largest reentry organizations. “In that role I helped design and oversee a low-barrier harm reduction program for people with OUD, which led to lower arrests,” he said, referring to buprenorphine treatment. At Pioneer, he was responsible for several innovations, including the first residential treatment program in Washington State to use all three medications—methadone, buprenorphine, and naltrexone—to treat OUD. Program completion rates are more than 80%.
Under Dr. Woolworth’s leadership, Pioneer also opened the Snohomish County Diversion Center, which helps people stay out of the criminal justice system, and, instead, get treatment – the low barrier harm reduction program referenced above.
Evergreen is one of the first OTPs in the country to utilize mobile vans for methadone (as well as other medication). “This is continuing, but we need to get better at it,” said Dr. Woolworth. “There is room for us to improve our impact and the number of people reached.”
Homelessness, Addiction, and Incarceration
Why Evergreen? “It was a leadership challenge to be CEO, an opportunity for me personally, but also part of the inspiration to me is that Evergreen is uniquely situated to address homelessness, addiction, and incarceration at the same time,” said Dr. Woolworth. There are many good organizations working on each of those three issues, but it’s important to work together in an integrated fashion, he said.
Dr. Woolworth is also president of the International Community Corrections Association, which is also looking at the problem. And that problem is simple: the same individuals are showing up in each system—jail rosters, prison rosters, emergency departments, emergency shelter systems, public health outreach, and addiction treatment. “We have all of these resources scattered across separate systems, each with different practitioners,” he said. “We know these folks are high utilizers moving in an out of different systems—we have services that can and should be focused solely on them.”
Over the next 10 years, “bending and flexing and integrating systems” in ways that address whole person health and the full social determinants of health will be essential, he added. ‘We know that people’s health care has less to do with health care than it does housing and safety and access to clean air and water. These are things that the health system has no control over.”
In fact, there is a lot of duplication of work going on, and the work that is taking place is often not patient-friendly. Not even close. “We have cadres of people all working with these patients, all of whom are struggling with trauma, telling them they need to show up at this or that appointment, at a certain time,” said Dr. Woolworth. “There are opportunities at the systemic level to rethink what institutions should really be addressing in this space.”
And he suggests rethinking the role of some of the legacy professions in this space. Much of the confusion about addiction exists because it’s been treated as a criminal justice problem. “For decades we have invested in this ineffective war on drugs and have not acknowledged that addiction is an actual disease that should be addressed as a public health crisis,” he said. “We have a lot of housing providers who will evict people for substance use. We still have private housing providers who make it very difficult for people to be on addiction treatment medication.”
Right now, a focus is on doing induction in jails—with methadone or buprenorphine—so that when people are released, they don’t overdose, he noted. “We’re starting to see correctional institutions recognize this,” he said. This is especially true of some state prison systems. But there are still 10 to 11 million people who cycle in and out of local jails a year, and many have to detox cold turkey. “We need all different strategies to make this work.”