Recovery coaches at ERs try to help opioid addicts avoid another overdose

 July 22
 Five months into his job at a 24-hour walk-in behavioral health center here on Staten Island, Tarik Arafat has a new assignment: on call at a nearby hospital to counsel people who have just been revived from opioid overdoses.

In recovery from drug addiction himself, Arafat, 25, said he understands why someone who uses drugs would be more comfortable talking to him than to a medical professional. “My job is to open myself up and be like a toolbox for them,” he said. 

Arafat’s mission — and that of other recovery coaches, as they are called — is not to persuade overdose survivors to get into treatment but to offer advice on how to get started once they’ve decided they’re ready to quit. If they’re not interested when he meets them in the emergency room, he’ll follow up with phone calls after they leave the hospital. He’ll also advise them on how to use drugs more safely, if that’s what they choose to do.

Nationwide, tens of thousands of opioid overdose victims have been saved over the past two decades by first responders, friends, relatives and bystanders who administered naloxone, an antidote.

But the majority of those who are rescued from near death go back to using drugs as soon as they leave the hospital, pushed by the brutal withdrawal symptoms that accompany an opioid overdose reversal.

 In fact, the likelihood of a second overdose among those who survive a first is high, said Hillary Kunins, assistant commissioner for New York City’s alcohol and drug abuse agency.

To reduce those odds, New York City, Connecticut and Massachusetts are replicating a Rhode Island program that sends recovery coaches such as Arafat to hospital emergency rooms to meet overdose survivors and offer them support.

Officials in at least seven other states — California, Maine, North Carolina, Ohio, Oklahoma, Texas and Vermont — have been talking to the program’s founders over the past year about starting similar programs. New Hampshire and New Jersey have created similar programs.

Harm reduction

Called AnchorED, the Rhode Island program dispatches recovery coaches to the bedside of overdose survivors in every hospital in the state. The coaches let the survivors know what resources are available to help them quit or how they can reduce their chances of a fatal overdose.

In the three years since the program started, AnchorED’s recovery coaches have counseled more than 2,000 overdose survivors, with 87 percent of them opting to engage in some type of recovery service after being discharged from the ER, according to Michelle Harter, director of the state-funded program.

Not all of those who engage in recovery services — such as detox, spiritual guidance, medication-assisted treatment, peer counseling, job training and nutrition programs — end up quitting drugs, Harter said. “But we help them get started on a recovery pathway of their choice.”

New York City’s new program, called Relay, is starting by employing 18 recovery coaches at hospitals in three of the communities hit hardest by overdoses.

 The plan is to set up similar programs in seven more hospitals by 2019, at an annual cost of $4.3 million. While the hope is that more people will get into treatment, the city’s primary goal is to reduce overdose deaths, Kunins said.

In addition to offering overall support, recovery coaches in New York’s program will talk to survivors about where to find drug treatment and mental-health services and how to pay for them, as well as how to reduce their risk of a fatal overdose.

They’ll distribute naloxone kits, train survivors on how to use them and tell them where they can get clean syringes and needles to avoid contracting HIV/AIDS and hepatitis C.

Once patients leave the hospital, the recovery coaches will follow up with daily or weekly phone calls for 90 days or longer. But recovery coaches will hand off the work of providing services to a team of addiction specialists, health-care providers and case managers.

Arafat, for example, will rely on colleagues at Community Health Action of Staten Island to provide counseling and support services and to make referrals to local mental-health and addiction treatment providers. He’ll take calls about overdose patients from nearby Richmond University Medical Center during his regular shift, 4 p.m. to midnight. Two other recovery coaches will cover the rest of the day. They expect to receive roughly one call a day.

In general, the job of a recovery coach is to help overdose survivors stay alive and as healthy as possible and work toward recovery when they’re ready. “I know that no one could talk me into getting treatment until I was ready,” Arafat said. “I feel like this is what I was meant to do.”

Recovery coaches — sometimes called peers, peer professionals, outreach workers or people with lived experience — are not new. They’ve been working with people with mental illness and drug addiction for decades, and they have proved to be highly effective at gaining patients’ trust and engaging them in programs designed to improve their health and long-term survival.

More than 33,000 Americans died of an opioid overdose in 2015. With the advent of fentanyl and other powerful synthetic opioids in the illicit drug supply, the number of deaths is increasing dramatically, according to the Centers for Disease Control and Prevention.

In Rhode Island, George O’Toole was the first recovery coach dispatched to an emergency room when the program started in July 2014. He was on call from 8 p.m. Fridays to 8 a.m. Mondays. But demand was so high that hospitals started calling him throughout the week, too.

By 2015, AnchorED was sending recovery coaches to 10 hospitals around the clock, seven days a week. Today, O’Toole manages a staff of 20 coaches who assist not only opioid overdose survivors but also people who come into emergency rooms for alcohol- or drug- related problems.

When people land in Rhode Island emergency rooms after an overdose, a nurse or doctor asks them whether they would like to talk to someone about recovery and harm-reduction services, O’Toole said, and most refuse.

“I get that. They just overdosed. You ruined their high. They’re embarrassed, ashamed and don’t want to hear about it,” he said. “The ones who agree may already be motivated. They realize they just died and got brought back to life, and they need a plan for how that isn’t going to happen again. That’s why we’re here.”

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