Laura Silverman: Some people figure out their path as they move along it. Others knew where they were going from the start. Joshua Lynch is one of these.

Joshua Lynch: I can't remember wanting to do anything other than medicine.

Laura Silverman: Lynch joined the fire department as soon as he turned 18, following in his grandfather's footsteps. He trained in all kinds of emergency response there, eventually becoming an EMT and certified scuba rescue diver. At the same time, he was studying psychology at UB, a more interesting path to med school than biology, he thought, since it allowed him to delve into subjects like neuropsychology and pharmacology. Today, Lynch combines all of his interests as a professor of emergency medicine at UB, an emergency physician in multiple hospitals, a medical director of Mercy Flight and several volunteer fire departments, and the founder and medical director of MATTERS, a multi-state treatment and prevention program for opioid use disorder.

Welcome to Driven to Discover, a University at Buffalo podcast that explores what inspires today's innovators. My name is Laura Silverman, and in this episode, I'll be speaking with Professor Lynch about his passion for emergency medicine and his tireless efforts to combat the opioid epidemic.

Dr. Lynch, thank you for joining us. Before we get into your work, let's talk about your grandfather. I understand he was quite an inspiration for you as a child.

Joshua Lynch: He certainly was. He was a volunteer firefighter as long as I can remember, and one of the chiefs. I spent a lot of time with him at either the kitchen table watching baseball, or fishing, and we’d talk about, you know, the stories that he would experience helping members of the community. And you know, I didn't realize it then, but that would become, really, an inspiration for me, kind of moving forward and thinking about my entry into the field of medicine.

Laura Silverman: So you joined the fire department at 18, the same year you started college, and those were very formative years for you. Can you talk about that?

Joshua Lynch: Yeah, so the volunteer fire department, I thought, was a great way to combine helping the community but also learning a little bit about medicine at a pretty early age. And the best part was there are so many opportunities that the volunteer fire service offers—obviously fire training, EMT class, and even kind of unique things like the whole scuba certification. And that opened up other doors for other trainings and networking and meeting people.

So really, that was a great start, and that led into me working as an EMT in downtown Buffalo throughout college as well, which taught me not only more medicine, but a lot of life lessons, and gave me a good perspective, really, kind of how medicine applies to the community.

Laura Silverman: Okay, so in addition to doing everything you were doing with the fire department and EMT, you're going to UB. You kind of took a different approach to medical school preparation than other people, right?

Joshua Lynch: Yep, I was given some advice that you should major in something that you're the most interested in. And you know, I think when people think of pre-med, they think of biology majors, and that, you know, the reason for that is there's so much overlap between the pre-med requirements and the requirements of a biology degree. There are other paths, and for me, psychology seemed to be super interesting, especially the pharmacology aspect of, you know, learning about medications for depression and anxiety and other things.

Laura Silverman: And then in medical school, again, you kind of have an atypical experience. What were those years like?

Joshua Lynch: Yeah, so I went to LECOM, the Lake Erie College of Osteopathic Medicine. The atypical experience actually started at the interview in Erie, Pennsylvania, where we were interviewing for the school in Erie, and it was almost like a casual offer to be considered for the first class to start off the school in Bradenton, Florida, just north of Sarasota. And I remember thinking, ‘Sounds like a great place. Yeah, you know, I'm interested in that.’

And it was great. The curriculum was focused primarily on case-based learning or problem-based learning, and it was minimal time spent in a lecture hall. And for me, that also fit well with my personality and learning style. And it was very interesting. The school was not quite finished by the time we started, the faculty was brand new to this brand-new school, and there were no upperclassmen to learn from. So our class was really kind of on its own, with a group of faculty that were getting to know each other, and we had a lot of opportunities that you might not have in a traditional school that's been established for a long time.

Laura Silverman: Right, right. One of which was, I understand, you kind of set up all of your own rotations.

Joshua Lynch: Yep. So I think the lesson learned there was, if you were assertive, you could set up a great experience. And luckily, I was. So we had the opportunity to kind of take what the school was offering at that time in third year and take those rotations, or if you had connections or interest or the desire to set up rotations in other places, you could do that.

So I kind of took that and ran with it, and ended up doing a couple rotations in Florida, and then really bounced all over the place for about a year, between Cleveland, Detroit, Philly, Pittsburgh and Buffalo, and then kind of settled back in Buffalo for fourth year rotations. But got to meet a lot of great people along the way, and got to see medicine delivered in different ways in different cities, which, you know, looking back, was a great experience.

Laura Silverman: Yeah, but you still wanted to end up in Buffalo, right?

Joshua Lynch: You know, I got to watch emergency medicine be delivered through the eyes of a young, inexperienced EMT working in Buffalo. And I always kind of had an awe for that. And you know, combining the kind of community commitment to continuing my medical training and residency at UB was really kind of, like, always the dream.

And of course, I looked at some other universities and other programs, and the residency education for emergency medicine in Buffalo is really incredible. It sets you up to work anywhere. The diversity in clinical sites where you train throughout the course of residency spans from rural hospitals to suburban to the downtown hospitals that we have. And rotating through those different sites gets you to a point that you're comfortable and experienced and knowledgeable to be able to take care of anybody, anywhere. And not all programs do that.

Laura Silverman: So you were still a resident when you became a medical director of Mercy Flight, which is a critical care air medical transport service. We talked earlier, and you mentioned that that was fun, which caught me a little off guard. Can you tell us why that was fun, or what made it fun?

Joshua Lynch: Yeah, so I was approached by one of their leadership, actually during a clinical shift as a resident at ECMC, and there was an opportunity that was coming up to be a medical director there. And what people might not know is Mercy Flight is one of the last remaining nonprofit air medical transport companies in the country. They are very mission driven, and they put the patient first, and they deliver amazing critical care transport. And for me, I like things that are exciting and new and innovative, and for me, all that packaged together equals fun. However, I take the aspect of delivering care to the sickest people very seriously, and that is an opportunity with Mercy Flight to be able to do that.

Laura Silverman: That must be challenging, delivering care in a helicopter.

Joshua Lynch: It's definitely something different. And really kind of takes emergency medicine and critical care, it puts it in a different environment with less resources. You know, there's no one to call for help when you're in an airplane or in a helicopter, but you're with patients when they need you the most. So you figure it out as you go and, you know, take care of the patient and get them to where they need to be.

Laura Silverman: So switching gears here, how did you end up focusing on addiction medicine?

Joshua Lynch: You know, I think that it boils down to the fact that emergency physicians see suffering in the emergency department every day, and we often see people struggling with addiction and substance use disorder, and it's kind of a problem that you're not really sure where to start. You know, if someone has chest pain, like it's pretty easy to, ‘All right, we got to get you to a cardiologist. Let's make that easier. We’ll get you a stress test. We'll get you whatever you need.’

So I experienced that for a period of time, and then, then I watched it, it happened in my family, and I watched my uncle struggle with it for many years, until he unfortunately overdosed in his early forties and passed away. And then the same thing happened with my brother-in-law, and he ended up passing away from an overdose as well in his twenties. And you know, if that's not motivation to try to fix something, I don't know what is.

So that's really kind of how things shifted about 10 years ago to kind of really focusing efforts on, what do we need to do? How do we need to deliver better addiction care, and how do we make people be able to access it?

Laura Silverman: I'm sorry to hear about your family members. I'm wondering, like, 10 years ago, before you started what you are doing now, what was the situation like? Like if they were in a hospital?

Joshua Lynch: Yeah, the situation wasn't good. In most emergency departments, if you came in after an overdose, you would either leave because you would wait so long to get cared for, or you would leave with a list of phone numbers, you know, that may not be accepting new patients or not take your insurance or discriminate in some other way. And that was really the case of what opiate use disorder care looked like in the ER.

Laura Silverman: So you started doing Narcan trainings in the community, working with other medical leaders in Buffalo, applied for various grants. By 2017 you launched MATTERS, which stands for Medication for Addiction Treatment and Electronic Referrals. How did MATTERS address these problems that you had been seeing?

Joshua Lynch: Yeah, so, you know, we started focusing our efforts in the emergency department, and primarily because emergency physicians really weren't trained specifically in managing this. Narcan training seemed to be an easy place to start, and so we started training our colleagues on that. We also trained a lot of police departments and first responders to just try to get Narcan out there as kind of a safety net.

And then really kind of switched focus to training emergency physicians on starting medication for addiction treatment right in the emergency department, which really was never done—little spots around the country, but really hadn't been done in a widespread effort. To make matters worse, at that time, physicians had to undergo an extra four or eight hours of training to be able to even prescribe the medications to treat patients with opiate use disorder. It's just ironic that no extra training was required to prescribe oxycodone.

So we trained emergency physicians and, you know, many were reluctant to get on board at first—more training, more, you know, perceived hassle for some. Luckily, they started to kind of come around and take the trainings and consider using the medications. But another major obstacle was, okay, if we start people on medications, where are we going to send them to get treatment? The perception back then was, no one has any room, the appointments are full, people aren't going to go and, you know, so that was another obstacle that we needed to work to get over.

Laura Silverman: Okay, so how did you deal with that problem of people not having anywhere to go after they left the emergency room.

Joshua Lynch: So starting as kind of a real easy approach, I just went and met with a couple treatment organizations and asked if they could get people in within a day or so of us seeing them in the emergency department. And surprisingly, the first two or three places that I reached out to and met with said yes. And then we asked more places, and they said yes. And the next thing you know, you know, a year later, now we have a network across Buffalo of places that have set aside some appointment availability for us, and now patients can end up having a choice. That, kind of, that's really how things started to grow in Buffalo.

Laura Silverman: Mhm, okay, so since that time, MATTERS has grown a lot. It's expanded across the state and even beyond. We'll get to that in a minute. It is also much more comprehensive.

Joshua Lynch: Yeah, MATTERS has expanded both in geography and in scope. We developed an electronic application for people to be linked to treatment that's accessible 24 hours a day, with appointment availability built in. And now you have a couple hundred places to pick from across New York State, which ends up amounting to about 2,000 appointments a week. The point of that scale is that, regardless of where you are, you can be presented with choices.

Laura Silverman: Even if you're in the, you know, the middle of the countryside, there will be a place for you.

Joshua Lynch: Yeah, so that's a good point. If you're in the North Country or in Central New York, where there aren't tons of medical options to pick from, for anything, what we've done there is layered on telemedicine. So you can pick something that works for you. Having that be all electronic takes about two minutes or three minutes, and that can be done not only just from the ER. There are a lot of other instances where people with substance use disorder need a hand getting hooked up to treatment, and so we've worked with county jails across the state, with the state prison system, with homeless outreach teams, community organizations, first responders, anywhere where someone with substance use disorder could be having an issue.

The other important thing here is seizing the opportunity when it presents itself. And what we've learned by looking at overdose data is, oftentimes, people will have some encounter with the health care system or first responders or public service, in one way, shape or form, before they have a fatal overdose. And we want to make sure we're in the position to capitalize on every one of those opportunities.

Laura Silverman: There are a bunch of other new parts of the program as well, right?

Joshua Lynch: Yep. So we also follow up with patients at a whole bunch of different time points after we engage them initially, not only to make sure that they didn't fall through the cracks, and if we need to reconnect them, we can, but also ask them what other things that they need help with. And we learned very early on that patients needed help getting access to medication and getting access to transportation. So we built a transportation voucher system that allows people to get a ride, no questions asked, no application, no waiting, no none of that, to their appointment, but also to the pharmacy to get their medications. And we built a medication voucher program in partnership with tons of independent pharmacies, but also major chains like CVS and Walgreens and Wegmans, all over the state, so people can just get their medications for a couple weeks while they get things figured out, they get insurance figured out, or whatever else. And all of those things have to be in place, because if one of those things isn't, none of it works.

The last expansion, which happened during Covid, was the telemedicine piece of this, and we talked a little bit about the ongoing virtual care, but using telemedicine as a front door—that has turned out to be very attractive to people. One hesitation that many people may have, not wanting to go to the emergency department, is going to the counter and writing opioid withdrawal on the check-in slip, or telling somebody that. That’s a non-starter for some people. They just won't do it. Maybe they had previous experiences where someone rolled their eyes at them when they said that, or whatever, it doesn't matter what it was. So we expanded the pre-existing telemedicine services to offer a front door for addiction, and that's been available for 24 hours a day in Western New York for several years, and it's very highly utilized by people.

Laura Silverman: You also have harm reduction?

Joshua Lynch: So not everyone's ready for treatment right away. Over the last few years, we have introduced harm reduction techniques such as pretty low barrier Naloxone or Narcan distribution. And as we've watched the opiate epidemic evolve, we have seen the fentanyl supply contaminated with other things, cocaine contaminated with fentanyl… so distributing test strips so people can be informed, if they're still going to use drugs, to be able to do that safer. And if they're not ready to go to treatment, why wouldn't we help them do something safer?

Fentanyl and xylazine are two of the test strips that we distribute, but we hope to expand that, and this has been a statewide distribution project. We just passed the 22 million test strip mark of distribution. We've also created a statewide network of harm-reduction vending machines that are all located outside so that you don't need to explain yourself or say or talk to anybody when you're getting supplies.

Laura Silverman: So I know you do a lot of research on all of these various aspects. Can you give us what you've learned about how successful the program has been?

Joshua Lynch: Well, I think one of the most important things that we've looked at recently, and we published a paper in the summer of 2024, comparing follow-up rates and retention and treatment rates for people that were seen in the emergency department and then referred to care versus people that were seen on the emergency telemedicine assessment service that we talked about and referred to care. And it turns out the patients that started off with telemedicine followed up at a much higher rate.

Both groups, I should mention, followed up at higher rates than kind of the national average of 10 to 20% of people that have opiate use disorder actually getting access to care. So we were happy to see that, but we were really encouraged to see how well the telemedicine group did. That number was about 65% of patients, and that's over triple the national average, probably even more than that. We know that once they have a positive, efficient and effective first appointment visit, they're more likely to follow up in the future.

Laura Silverman: You’ve gone beyond New York now, right?

Joshua Lynch: Yep. So in the spring of 2025 we started services in Allegheny County, Pennsylvania, in the Greater Pittsburgh area, and the plan is to expand to other counties in Pennsylvania as well. We are also working with New Jersey on a proposal to facilitate linkage to treatment across the whole state of New Jersey. And there's a few other states that we're working with now, just to try to understand what their needs are and layer in kind of the pieces of MATTERS that would help.

Laura Silverman: So if someone is listening to this today and they're struggling with addiction, or they have a family member who's struggling, how do they get started?

Joshua Lynch: So the easiest way to do that through MATTERS, at least, would be to download the MATTERS Network app by searching MATTERS Network, by going to mattersnetwork.org, or by just calling 765-MATTERS, and that can get you access to telemedicine assessment, access to treatment, harm reduction supplies and anything else.

But specifically, just a piece of advice for someone who might be struggling with a family member or a friend, it's easy to get frustrated and kind of give up. But I will tell you, that's kind of the opposite of what you should do, and sticking with that friend or family member or coworker, helping them to see resources that are available, like MATTERS, would really be something great.

Laura Silverman: Well, it certainly seems that MATTERS helps them in that process.

Joshua Lynch: Exactly. The whole point is to make access to resources easy, available 24 hours a day, and give multiple options for people to find something that works for them.

Laura Silverman: Well, thank you so much. This has been really fascinating, and thank you for the good work you do in the community.

Joshua Lynch: My pleasure. Thanks for having me.