For Liz Wolkin, nurse and program manager of ScalaNW at the Health Care Authority (HCA), improving care for people with substance use disorder is both professional and deeply personal.
As a young person, Liz navigated polysubstance use disorder and its various harms. During this time, they didn’t have many sources of self-esteem, but volunteering at a syringe exchange harm reduction organization was a turning point for them. It was something to be proud of and learn from. The syringe exchange allowed them to contribute to their community as a meaningful collaborator, where they were treated with respect. They realized they could be someone who uses drugs and make a difference in their community.
That experience shaped how Liz sees care today.
“It showed me how powerful it is to meet people where they are and let them come to change on their own terms,” Liz said.
Eventually Liz entered recovery, and harm reduction was a guiding principle. They decided to go to nursing school and found their talents could be put to good use in the emergency department where they worked with patients with opioid use disorder (OUD). They saw how people with OUD often weren’t provided with services or relief. The result was frustration for patients and medical staff: clinicians found themselves unable to offer effective care and patients faced stigma and judgment. “When you’re there to help but don’t have the tools to do it, it feels bad,” they said.
Over time, that dynamic contributed to burnout, compassion fatigue, and an increasingly strained care environment.
ScalaNW
That gap is exactly what Liz now works to address through ScalaNW, HCA’s free program to reduce stigma and improve access to care for patients who use opioids and other illicit drugs. ScalaNW gives emergency departments, hospitals, and acute care providers a direct link to evidence-based clinical support and 24/7 scheduling for patients who could benefit from medications for opioid use disorder (MOUD). ScalaNW has provided pathways to lifesaving medications like buprenorphine and methadone – both highly effective in treating OUD. The program helps providers feel more confident addressing OUD and supporting their patients.
ScalaNW partners with hospitals across Washington. Today, the program has worked with 35 hospitals across 24 counties, with particularly strong engagement from rural hospitals.
“We get really great feedback from the hospitals in rural areas,” said Liz. ScalaNW is free, centralized, and does not require contracts. Hospitals can access training, consult support, and get practical tools without taking on additional administrative burden. This model allows smaller hospitals to participate without needing the same level of resources as larger systems.
At the recent Northwest Rural Health Conference, Liz presented their personal story and talked about ScalaNW. Attendees approached Liz to share their appreciation. Many spoke about the importance of improving care for people with OUD and the challenges they face in rural settings. Through conversations at the conference, they were able to share resources, tools, and real-world examples of how the program can support providers.
ScalaNW.org offers many resources, including clinical protocols for treating patients with substance use disorder and harm reduction information. Liz’s work shows that reducing stigma and providing evidence-based care to people who use drugs has an immense impact.
Visit ScalaNW.org to learn more and how to enroll your facility.