Harm Reduction to Health Reformation - Darian Du

Hello all! My name is Darian Du (he/him pronouns), and I’m currently an undergraduate junior at UNC-Chapel Hill pursuing a major in Psychology working at the Morse Clinic in Durham, NC.

Though I wasn’t always passionate about psychology and mental health, my love for it began in high school, enrolling in AP Psych, (misguidedly) thinking that it could help resolve my mental health challenges. While indeed, there were some tangentially-related habits and/or techniques that I would end up applying to my life, by far my largest takeaway from the course was how fascinating the human mind really is – concepts and processes I had intuitively noticed growing up were finally given names and relation to one another in a way that was clear. I was hooked.

At the same time, I developed my background in healthcare. As a tutor and volunteer coordinator at an after-school youth center for immigrant children whose families sought political asylum, I noticed in conversations with parents during pickup that these adults often suffered from chronic conditions. This intrigued me – our city isn’t known for lacking healthcare, but it seemed that there were a lot of families in the area still suffering from treatable conditions. This bothered me, and challenged a misconception I held: access and proximity to care doesn’t mean patients aren’t still ill. Even for the patients that were undergoing treatment for their conditions, their suffering would not be alleviated all at once. Possibly not ever. As for mental health, it seemed patients fared no better – my patient experiences working with mental health professionals from Boston University on the development of Ethan (a mental health AI chatbot), mirrored the same themes of constant interaction with care and presence of condition.

I wanted to learn more about how those with chronic conditions are impacted by their illness – how did they manage such a balance of care, illness, and their own lives? – and how could the system improve to accommodate this necessary infrastructure in their lives in the least intrusive, most effective way possible? For a potential answer, I examined the effects of a multi-payer healthcare system by studying abroad in Florence, Italy for a year, doing a cost-effective analysis of Italian patients with similar chronic conditions, analyzing their spending vs their respective patient-reported outcomes in comparison to American patients, and presented my findings. To learn more about the biological underpinnings of chronic illnesses, I worked in Dr. Rob Vassallo’s lab and in Dr. Victor Montori’s KER Unit at the Mayo Clinic, working with the former to make use of RNA packaged in exosomes to treat patients with COPD or PF, and the latter to analyze a new intervention to treat ESKD patients through Capacity Coaching.

With the Gil Internship, I was able to further develop my understanding of how those with chronic illness interact with care through a different perspective by working at the Morse Clinic in Durham with Dr. Eric Morse and Dr. Jun He. There are 10 Morse Clinics all across North Carolina, and at the Morse Clinic, we offer medications to treat opioid use disorder, like naltrexone, vivitrol, Sublocade, Brixadi, buprenorphine or methadone. Buprenorphine and methadone are the most commonly used by our patients, both decreasing the likelihood of relapse by reducing withdrawal symptoms and cravings. All new patients undergo a “Commitment to Counseling,” an agreement to meet with their counselor at least once a month for the first year, and patients are also able to earn “take-homes” of their medication to dose at home, contingent on good behavior, clean urine screens, and provider consent. This is done to make things easier on our patients, not needing to have to travel to the clinic every few days! To further assist patients in their journey, the Morse Clinic offers individual and group counseling, orientation programming, and access to a recovery group, relapse prevention group, and a Pregnant/New Mothers group.

My role at the Morse Clinic includes coordination and consolidation of opiate/opioid help resources across all 100 NC counties to help streamline spending to go towards effective programs/interventions. North Carolina is slated to receive 1.4 billion USD to combat the opioid crisis through 2038, but the process of deciding what gets funding is murky and bureaucratic. By gathering the county contacts in one place, along with documented opioid treatment programs that have shown promise, delegating money to effective programs will be easier and simplified.

Additionally, I am currently working on bolstering our patients’ physical health through coordination of care. At the Morse Clinic, we have access to our patients’ files, and many of them are not up to date on their annual physical, or do not have their coordination of care or release of information forms filled. This puts our patient at risk, leaving them with no established baseline for their health and at risk for less-noticeable pathologies, while their primary care provider goes uninformed about their treatment details at the Morse Clinic. I comb through each and every patient, searching for these forms, and meet with the patient or their counselor if I see they’re incomplete. If they do not have a primary care provider, I provide them with resources and referrals to local community clinics. For the future, I am currently working on a project that will help automate this process upon patient intake, rather than requiring manual input.

To be helping the Morse Clinic while developing interpersonal and technological skills in the field I love while meaningfully contributing to such a vital issue such as the opioid crisis in North Carolina, I could not be more thankful. This work is incredibly fulfilling, and I intend on continuing my passion for psychology and medicine while working with patients with chronic conditions in the future. Thank you to everyone who has been here to help me with my Gil Internship: Dr. Steve Buzinski, Dr. Eric Morse, Dr. Jun He, Richie Gray, and Emily Dolegowski. Your continued support and loyalty to the program have been integral in how profound this experience has been to me this semester, and I couldn’t have done it without you guys.