Magazine article Addiction Professional

Surviving an Overdose: What's Next? Peers Are Successfully Engaging Rescued Patients in a Path toward Recovery

Magazine article Addiction Professional

Surviving an Overdose: What's Next? Peers Are Successfully Engaging Rescued Patients in a Path toward Recovery

Article excerpt

Recovery coaches who are peers--individuals in recovery--are now in hospital emergency departments (EDs) where patients have been rescued from opioid overdoses via naloxone, providing hope and a path toward treatment. The first program ofits kind in the country, Anchor ED, based in Providence, R.I., is making this happen and is being viewed as a model by other states.

In the program, peer recovery coaches aim to convince patients in the ED to move forward into recovery. The goal from the point of view of the state of Rhode Island, which is helping to fund the program, is to get every overdose survivor in touch with a recovery coach.

Recovery coaches at Anchor do not steer patients toward any particular treatment program or type of treatment, or even to treatment itself, says Deb Dettor, director of recovery support services at Anchor Recovery Community Centers, a recovery support component of The Providence Center community behavioral health organization.

"We give them the whole gamut of options," Dettor says. "If they want recovery coaching, if they want [medication treatment], if they want an inpatient program--we will literally help them go where they want to go. If they say on the spot where they would like to go, we can get them there."

The mindset of people who have just been rescued from an opioid overdose is not conducive to thinking clearly about next steps, however. Moreover, that says nothing of the physical illness they are experiencing due to withdrawal symptoms. The naloxone that saves someone's life also precipitates withdrawal in the opioid-dependent.

"You didn't want to be here, you didn't want to see any of us, you didn't want to end up in the hospital with an OD being 'Narcan-ed' back to life, you are physically sick because of being in withdrawal, you are angry," says Dettor. "There are so many barriers to seeing anyone at that point. So when someone says to you, 'Do you want to talk to a recovery coach?', you say, 'I don't want to see anybody.' That's a real barrier."

What is often keeping the patient from saying yes is shame, says Dettor. "This illness is just maddening in that way--the level of shame, embarrassment, horror," she says.

She recalls the time when she went to the hospital with alcohol poisoning. "There you are covered in puke. You can't believe your life has come to this place where you have no control," she says.

INTERPRETING THE EARLY DATA

Anchor ED was under the gun back in the summer when a report revealed that 45% of patients recovering from overdoses in Rhode Island hospitals do not see a recovery coach. But Dettor says it is not accurate to say that 45% of overdose survivors refused intervention. Rather, 45% were not actually connected to treatment--perhaps because they declined to meet with a recovery coach, or because they were never offered the chance.

"All of the hospitals in Rhode Island are supposed to ask every person [who survives an overdose] if they want to see a recovery coach," Dettor says. "Sometimes they don't do that. Staff may not be trained."

If the patient is offered the chance to meet with a recovery coach and turns it down, that can be addressed in several ways, Dettor says. For example, it might be better if the recovery coach could just talk to the person, instead of the hospital staffer first asking the patient if this is acceptable.

Anchor has started a pilot program in which every overdose survivor who says no to seeing a recovery coach will be asked if he/she could be contacted the next day. For this to work, the patient would have to sign a release form, allowing the hospital to give the patient's information to Anchor ED, says Dettor.

Anchor also asks the hospitals to give information about the recovery coach to patients, although that leaves it up to the patient to reach out. "Often social workers who discharge patients say to contact us," says Dettor. …

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