From rescue to recovery: OD patients get help they need
It's becoming a familiar saga in New Jersey: An addict overdoses on heroin or a prescription painkiller and is saved by an EMT or a cop using the rescue drug Narcan. But, sadly, many of those who are saved turn around and go back to using.
Yet there is hope for an end to this vicious cycle: A new program brings recovering substance abusers into hospital emergency rooms to counsel overdose patients — helping hundreds to get clean in an effort that is rapidly expanding.
Unlike physicians, nurses or social workers, recovery "specialists" can share a personal narrative of a wrenching addiction that robbed them of families, jobs, homes, freedom and dignity — and of how they reclaimed their lives.
“The peer-to-peer recovery is one of the biggest advances in the management of addiction and overdose that we’ve had in this country,’’ said Dr. Mark Rosenberg, chairman of emergency medicine at St. Joseph’s Regional Medical Center in Paterson, which says it treats an overdose patient once a day, on average.
EMS crews and police throughout New Jersey have saved nearly 20,000 lives in the last three years by administering Narcan to people who had overdosed on heroin or prescription painkillers, state data show.
That’s 23 people a day this year — parents, college students and long-time addicts who were on the brink of death. So far this month, those saved in Bergen County include a 53-year-old Upper Saddle River woman, a 41-year-old Lyndhurst man and a 49-year-old Elmwood Park man, bringing the total this year to 164, according to the Bergen County Prosecutor's Office.
As the scourge continues, the roster of fatalities will grow beyond the more than 2,000 reported statewide from January 2014 through June 2015, the most recent state data available.
“We see them every day at the food store, at the bank, and you never realize what secrets and demons they’re dealing with," Rosenberg said. “The only ones who can talk to them and open them up to hear those demons are the people here," he said, referring to the recovery specialists.
At St. Joseph’s, 54 percent of the 217 patients approached by recovery specialists from April through September are getting help — admitted to residential treatment or participating in intensive outpatient therapy or a 12-step program, said Michael Santillo, director of integrated care services at Eva’s Village, a network of shelters, rehab and other services in Paterson that trains and provides the specialists.
The program is set to expand to St. Mary’s Hospital in Passaic and Chilton Memorial Hospital in Pequannock, Santillo said.
Increasingly, the newer, stronger heroin is claiming a different population than in prior decades: It’s more suburban, users are typically in their 30s and 40s, and they are more likely to consume at home, experts say. It is also commonly laced with the potent painkiller Fentanyl, which is increasing overdose rates.
In Monmouth and Ocean counties, among the hardest-hit regions, specialists assisting at hospitals in the RWJ Barnabas Health network are also reporting good news: Half of the 500 people approached this year are in treatment, said Connie Greene, vice president for the network’s Institute for Prevention. Only Camden County had more drug-related deaths in the first half of 2015 with 85, state data show. Ocean and Monmouth reported 76 and 64, respectively, in the same time. In one recent weekend, 26 heroin overdoses were reported in Ocean County – all reversed by Narcan.
“It’s thrilling to see the numbers of people who are going into treatment and recovery,’’ Greene said. “There’s also a beautiful paradigm shift to service this population. They move from anger and hopelessness to find there’s a better way.’’
Experts had been attempting to set up such a program for years, using physicians, nurses and social workers in the emergency room, but it wasn’t effective, Greene said. As the specialists became involved, they had hoped to see perhaps 15 percent of patients going into treatment, but the specialists have proven to be far more effective.
Newark Beth Israel Medical Center, also a member of the RWJ Barnabas network, welcomed the first recovery specialists earlier this month, apparently not a moment too soon: They visited a dozen overdose patients, double the number the hospital had expected, Greene said. Meanwhile, a new crew of specialists will be trained to work in Hudson and Middlesex counties by early 2017, and Greene is seeking yet another grant to cover Mercer County in the next several months.
'He's not alone'
Demetria Washington, a recovery specialist in Passaic County, speaks a language that substance abusers understand. The Paterson woman, who had abused heroin and crack cocaine for 18 years before getting clean eight years ago, has guided several people into recovery this year, she said.
She sprung into action three nights before Thanksgiving when a charge nurse requested her help in the psychiatric ward at St. Joseph’s. A young man had several issues, among them alcohol and heroin abuse. He was not overdosing, but the outreach work extends beyond those saved by Narcan.
“I talked about how I am in recovery and I understand how he’s feeling," Washington said.
After sharing more about their lives — the chaos and exhaustion that follows addiction, the bridges burned with loved ones, shame and the dead ends — the patient said he wanted a new start. Washington, aided by patient navigators at Eva’s, succeeded in getting the man into treatment two days later in Paterson.
“I wanted him to know he’s not alone,’’ she said. “I gave him a hug. I let him know I’m here.’’
The recovery specialist programs are funded through the state Opioid Overdose Recovery Program, which launched in 2015 with a $1.3 million grant in areas hit hardest by overdoses — Camden, Essex, Monmouth, Ocean and Passaic counties. Local agencies that received grants of $225,750 include Turning Point and Eva’s Village in Paterson.
In Bergen County, Prosecutor Gurbir Grewal and social service agencies have continued work initiated in 2015 by former Prosecutor John L. Molinelli, who got the program going with seed money from the Prosecutor's Office.
In September, Grewal also announced the formation of a task force, dubbed Operation Helping Hand, the first of its kind in New Jersey. It offers people charged with drug possession the chance to enter a five-day detox program run by Bergen Regional Medical Center in Paramus, an option several have taken advantage of.
The county recently graduated nine former substance abusers to be recovery specialists. They plan to begin working early next year at Hackensack University Medical Center, Holy Name Medical Center in Teaneck, The Valley Hospital in Ridgewood and Englewood Hospital and Medical Center, said Ellen Elias, senior vice president of prevention and community services at Children’s Aid and Family Services. The $225,750 grant to Bergen County is expected in December, Elias said.
Dr. Barbara Schreibman can’t wait. She is the medical director of Englewood’s EMS service and associate chief of the emergency department, which treats a few overdose patients a month.
“Right now, we reverse them, they wake up, they are better and they are discharged,’’ Schreibman said.
One in 7 families affected
Naloxone, sold under the brand Narcan, among others, works by reversing the depression of the central nervous system and respiratory system caused by opioids. It works in two minutes when given intravenously and takes a little longer after being injected into a muscle or sprayed into a nostril.
“We suggest they get into recovery, but it’s all we can do,’’ Schreibman said. “There are people who come back multiple times, and it’s very frustrating for us and their families. We’re really good at dealing with emergencies; we’re not really good at dealing with addiction.’’
To become a specialist, people must be in recovery for at least three years, undergo background checks and receive extensive training. They are paid $75 to be on call for a 12-hour shift. If they consult with a patient who opts for recovery, the programs have patient navigators who handle the details of insurance, treatment options and other details. The specialists are then paid $125 to follow up for a few months.
Just this month, the U.S. Surgeon General released its first report on substance abuse. It affects one in seven U.S. families and claims an American every 19 minutes, but only 10 percent of those addicted receive treatment. The economic impact of drug and alcohol misuse and addiction amounts to $442 billion a year — topping diabetes at $245 billion, said Vivek Murthy, surgeon general.
The report calls for removing the stigma from addiction, noting that every $1 invested in viable treatment options for substance abuse disorders saved $4 in health care costs and $7 in criminal justice costs.
In Bergen County, the number of Narcan saves by law enforcement was 21 in 2014. The following year, the combined saves by EMS and police grew to 331, and so far this year, as of Oct. 27, the number reached 348, according to the state Attorney General’s Office.
In 2014, 81 Bergen County residents fatally overdosed, about half from heroin, state data show. A 59-year-old Englewood Cliffs man who overdosed on Nov. 23 marks the 74th fatal overdose in the county this year, according to the Prosecutor's Office.
Paying it forward
Mary Alice Stout, a 34-year-old Ridgewood woman, could have been one of the sad statistics.
Before kicking a heroin and crack cocaine habit, she nearly died from an overdose. Her arms were so infected from shooting up that emergency physicians told her she might have to have one of her arms amputated. She weighed 80 pounds. Her father would later tell her he had composed her eulogy in his head but couldn’t bear to write it down, fearing the worst.
Now a healthy 120 pounds, Stout is a college graduate, a ball of energy and gratitude, and a recovery specialist ready to pay it forward.
One of the gifts of recovery was “being around people like me,’’ Stout said. “That was the best feeling. [Learning that] I’m not crazy. It’s why I feel this will be awesome. The feeling when you’re in addiction is nobody loves me, there’s no one to talk to.’’
Greene acknowledges that less than a year of data is not enough to determine conclusively that the program will have long-term impact. Recovery experts are conducting long-term studies to monitor progress.
One question that has emerged is how to persuade someone who has been saved by Narcan to go to a hospital, where a recovery specialist can intervene. Many overdoses may happen at home and are reversed by Narcan through a prescription written by a family physician, experts say.
“We’re missing a huge population because we’re not bringing them to the hospital,’’ said Dr. Mark A. Merlin, chief medical officer for the Monmouth Ocean Hospital Service Corp. (MONOC), the largest EMS service in New Jersey, covering 175 municipalities in Monmouth, Ocean and parts of Bergen, Passaic, Hudson and Essex counties.
“The question becomes, what’s the legality of bringing someone to the hospital who is alert and oriented?’’ he said.
Ocean County Prosecutor Joseph D. Coronato has taken the extreme measure of mandating that police administering Narcan ensure that patients go to an emergency room, even if they have to tell a user they may be criminally charged, a complaint that would later be dismissed.
The reason? The county lost 118 people to overdoses last year, and with 160 to date so far, the year is likely to finish with a dramatic increase, Coronato said. Furthermore, 72 percent of the deaths involved Fentanyl, which can be active in a user's system longer than the Narcan antidote lasts.
“If they don’t take them to the hospital and in 15 minutes the person is in trouble again, you don’t have the Narcan and you don’t have a way to save the person’s life,’’ Coronato said. “The only way we can ensure they have a fighting chance to survive is to be monitored for a period of time.
“That’s why we are drilling down and trying to make a difference. It also gives the recovery coach a chance to grab them and get them into detox and treatment.’’
Email: layton@northjersey.com
Deaths
Drug-related deaths for 2014 and 2015, through June 30:
New Jersey: 1,304, 723
Bergen County: 81, 45
Passaic County: 61, 29
Hudson County: 64, 51
Monmouth County: 111, 64
Ocean County: 132, 76
Source: Attorney General's Office