Recovery coaches who are peers—individuals in recovery—can go into hospital emergency departments (EDs) where patients have been rescued from opioid overdoses via naloxone, and provide hope and a path toward treatment. The first program of its 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.
The program uses peer recovery coaches who try to convince patients in the ED to get 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 seen by a recovery coach.
Recovery coaches at Anchor do not steer patients toward any particular treatment program, or particular 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 when they 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 (Narcan) 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,” she says. “The level of shame, embarrassment, horror.”
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 their 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.
Anchor's numbers show that of all people who were seen in the emergency department by a recovery coach, 86.8% did agree to engage in some kind of recovery plan, she says.
“We might see you in the emergency department, and not get you engaged, but then the outreach team may see you in the street, and approach you there,” adds Dettor. “Our goal is always about connecting you with resources to help you get into recovery.”
Rebecca Boss, the state substance abuse director in Rhode Island, has championed the Anchor ED program from an early stage, getting other single state authorities interested in how it works. “I know when Becky presented about this a couple years ago at our annual meeting there was a great deal of interest,” recalls Rob Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD). “Other states gravitated to her to talk about the mechanics.”
Anchor ED began with a conversation Boss had with people at Anchor, when she heard them say, “People just want to talk to somebody,” says Morrison. “That was the light bulb moment. They just want to talk to someone who’s been where they are.”
Law enforcement involvement
While some states may choose to have public safety officers, police or fire, involved in peer recovery interactions with overdose victims, that doesn’t happen in Rhode Island, says Dettor. “We have no connection with law enforcement,” she says. “In Pawtucket, where our primary recovery center is located, the police department is very supportive. … If we need help from them they’re right here, in a positive way.”