There have been concerns that police involvement could mean that the overdose victim will be asked about where the drugs were obtained; law enforcement has a legitimate mission to keep these drugs off the streets. But this also could have a chilling effect on patients’ willingness to be contacted by a police-related recovery coach.
“We don’t care where you got your drugs,” says Dettor. “We’re more interested in how we can get you into recovery.”
Dettor, who worked for two decades in treatment, has been working in recovery support since 2004. “To me, this is where the hope is,” she says. “We’re having a much bigger success with engagement.”
“I think it’s great that the police departments are trying this,” says Patty McCarthy Metcalf, executive director of Faces and Voices of Recovery. “But I think it’s a slippery slope. Unless they are guided by standards, then we’re creating something that could be a sideline, and not real recovery coaching.”
Standards for peer work include appropriate training for peers in ethics and boundaries, and supervision of peers by programs that understand the culture of peer recovery, says Metcalf.
At Anchor, all of the recovery coaches are in recovery from a substance use disorder (in some cases, from an opioid use disorder), and some have had the exact same experience of being rescued with naloxone. Others are in medication-assisted treatment. “Recovery coaches will use their own story when it’s appropriate to identify what they have gone through,” says Dettor.
The Anchor ED program, created by Anchor Recovery Community Centers, The Providence Center and the Rhode Island Department of Health, is part of a much larger system, including two recovery community centers where people can come in every day to receive a variety of support services. Anchor also houses recovery coaches in the state's prison facilities.
Debating peer qualifications
Does someone need to have professional training, a degree, or a license to be a peer recovery coach? “This is one of the debates,” says Kimberly A. Johnson, PhD, director of the federal Center for Substance Abuse Treatment (CSAT) under the Substance Abuse and Mental Health Services Administration (SAMHSA).
“Do you need to have a master’s degree to have that conversation? Many people have answered, ‘No, you don’t need to have a master’s degree to do motivational interviewing and get someone to engage in treatment,” Johnson says.
What she likes about Anchor is that its efforts are not tied to one treatment center. “They just ask if someone would be interested in different things that are out there,” she says.
At a time when someone has just gotten revived from an overdose, the peer “has a level of understanding of what that experience is like,” Johnson says. “It’s a very similar model to the rape crisis model, in which they send people who have had this experience. The peer model has been used for other emergencies, so it’s not an unknown.”
Another benefit of the Anchor model is that the overdose survivor doesn’t have to engage right then and there, in the emergency department. “A lot of people don’t decide on treatment at that time,” Johnson says. “So what Anchor does—following up over time—is critical.”
SAMHSA’s State Targeted Response (STR) to the Opioid Crisis grants, the two-year, $1 billion program authorized by the 21st Century Cures Act, is helping to fund new initiatives following in the footsteps of Anchor ED, says Johnson. New Jersey is using $3.5 million of its $13 million for each year for the Opioid Overdose Recovery Program, which was started before the grant but is being continued with its help. “We also have grants to start up peer recovery organizations,” says Johnson.
“This whole concept of trying to reach out and find people, and engage them in treatment, instead of just waiting for them to show up, is a good thing,” she adds. “There might be some issues with some of the models, but just the fact that people are realizing it’s not just about having an open door, that we need to take the next step and reach out to people and get them engaged. And when they say yes, we need to have treatment for them.” That treatment isn’t necessarily going to be a residential program for every person, she says.
“The nature of the crisis is forcing things to speed up so that different approaches are tried,” says NASADAD's Morrison. “They know it’s not always a slam-dunk the first time, but if there’s something done, other than walking out the door, that gives some level of hope.”
Alison Knopf is a freelance writer based in New York.
Peers' work can take a toll
Even as prescription opioid misuse is declining, opioid overdoses are continuing to rise, mainly as a result of illicit fentanyl. First responders now need to carry extra doses of naloxone, because more are needed if the overdose drug was fentanyl. “It’s heartbreaking to watch so many people die,” says Anchor Recovery Community Centers' Deb Dettor. “A lot of our staff are former heroin addicts. We’re all blown away by this.”
In recovery work, it’s important to be available, so that when someone is ready the help is there, says Dettor. “We keep doing the work knowing that a point comes when people are just ready,” she says. But she adds that even if someone might not be ready for recovery, that doesn’t mean he/she is ready to die.
“We don’t know if we’re doing hospice care or helping people on the road to recovery,” says Dettor. “We never know.”
Meanwhile, recovery staff have to support one another. “One of my brand new staff lost his first person last week,” says Dettor. The patient had overdosed and had been revived four times. The fifth and final time, he died.
“It’s like a war zone,” says Dettor. “We go to the emergency department over and over again.”