October 17, 2017
“For a lot of these patients, it’s been a revolving door. We treat them, they leave and they come back to be revived again. There’s more hope now that they’ll get treatment.”
From her station on the front lines of the opioid epidemic, Rebecca Moyer has a unique perspective.
As a RASE (Recovery, Advocacy, Service, Empowerment) Project recovery specialist partnering with Lancaster General Hospital (LGH), she’s often the first person to offer overdose survivors hope for their futures.
Moyer and her colleagues at RASE Project Lancaster, a recovery community group, are just a phone call away when emergency department staff begin treating patients revived with Narcan. The opiate blocker can reverse the effects of an overdose but can also plunge the patient into immediate, painful withdrawal and can make them angry and confused.
“You see the desperation in their eyes, but they don’t know what to do,” Moyer said. “When you first step into recovery, it’s very overwhelming, especially when you’re dealing with the consequences and the wreckage of your life.”
The Importance of “Warm Handoffs”
LGH began partnering with RASE Project Lancaster in July to coordinate “warm handoffs” for overdose survivors ensuring that opioid-overdose patients have an immediate pathway to the appropriate treatment level of care. The partnership is part of a statewide effort to stop the cycle of repeat overdoses.
The state Department of Health, and the state Department of Drug and Alcohol Programs developed the warm-handoff protocol in conjunction with the Pennsylvania College of Emergency Physicians.
Other Penn Medicine hospitals are instituting similar programs, working with community partners through a state-designated Center of Excellence at Penn Presbyterian Medical Center.
Since July 1, LGH has recorded 31 referrals to RASE, whose team members respond to the emergency department within an hour to inform patients about their options and link them with the appropriate recovery support services and resources. In some cases, they wait with them until they are transported to the appropriate level of care treatment provider.
Three RASE specialists are now on-call around the clock, with the non-profit organization looking to hire a fourth to help handle demand.
Conversations Begin In The Emergency Department
Before this summer, emergency physicians would attempt conversations with revived patients about the hazards of their addictions and possible treatment options.
In many cases, those conversations were one-sided, acknowledged Jolyne Barnett, LGH emergency department nurse manager.
“There was no standardized process, and we weren’t experts at it,” Barnett said.
“Given the lack of resources for addicts, the ED staff felt that there were limited options to provide help to these patients.”
The emergency department physicians and nurses have embraced the RASE partnership, seeing it as an opportunity for individuals to enter into recovery, Barnett said.
“For a lot of these patients, it’s been a revolving door,” Barnett said. “It’s a tough population. We treat them, they leave and they come back to be revived again. There’s more hope now that they’ll get treatment.”
Helping Patients And Families Move Into Treatment...And Recovery
In her first several week-long rotations, Moyer reported an average of at least nine calls from LGH. Between the program at LGH and a similar one at another nearby hospital, RASE Project helped 18 Lancaster County patients move into treatment in July and August.
Among the key partners Moyer and her colleagues refer patients to are recovery support specialists provided through Lancaster General Health and T.W. Ponessa & Associates in Lancaster–both state-designated Centers of Excellence.
RASE Project professionals also provide families members of overdose survivors with support and information that can help them to begin their own recovery process.
RASE began offering services in Lancaster County in 2005. An office a few blocks from LGH provides recovery coaching, support groups, medication-assisted recovery, coordination of care, recovery housing for men, and a recovery center. Partial funding is provided through the Lancaster County Drug and Alcohol Commission.
Their expertise in the area of recovery-support services, combined with their own personal recovery experience, provide a critical link at a critical time.
Pennsylvania Gov. Tom Wolf has estimated 4,500 drug overdose deaths are possible in Pennsylvania this year. In Lancaster County, Coroner Stephen Diamantoni, M.D., reported in September that the county already surpassed the total number of drug overdoses for 2016.
Many overdose survivors, Moyer said, try to avoid talking about detox immediately after being revived, instead hoping to escape and take more drugs to alleviate the aches, nausea and fever that come along with unsupported withdrawal.
“The sickness is what drives a lot of people away immediately,” agreed Kristin Varner, director of training and advocacy for the RASE Project. “In a perfect world, there would be immediate bed-to-bed services so that they never leave the doors between the ER and detox.”
Instead, Moyer uses her own experiences as a recovering individual with four years continuous recovery to make a connection. She stays with them in the hospital emergency department, offering them confidential advice and sometimes continuing the conversation after discharge or fielding a call for help weeks later.
Whether the patient accepts Moyer’s help immediately or not, she views the opportunity to interact as a positive.
“I can come to them with a deep level of understanding and empathy,” Moyer said. “They know they can use us as a tool for the recovery process. No matter what, we’ve planted a seed.”