More than 1,000 Rhode Islanders have died from accidental drug overdoses in the past five years. Many more have been revived, thanks to first responders and emergency room workers.
But the growing number of overdoses has stretched those doctors and nurses. Rhode Island Public Radio’s Kristin Gourlay spent an evening in the Rhode Island Hospital emergency room for a firsthand look at how they are responding to the crisis.
Emergency departments try to take care of so many overdose patients, but the work can be frustrating. Now, a relatively new program, using "recovery coaches," is trying to help everyone through the process.
Inside Rhode Island Hospital’s emergency department on a Friday night, nurse Clayton Bennet stays close to the ambulance bay – ready to help triage. A few patients wait for evaluation on stretchers. Bennet is the charge nurse, basically the chief problem solver, on duty until 11 tonight. Before then, he says, anything could happen. But he wouldn’t be surprised to see another patient who has overdosed on heroin or prescription drugs. Rhode Island Hospital takes care of at least one overdose patient a day, more than 400 last year
“[We] pull people out of cars, people come running up with the friends or people they’ve been partying with in their arms, ‘Oh my girlfriend passed out, she needs help, she’s not breathing,'" says Bennett.
Bennett and the other nurses have to be ready to move quickly.
“It’s all through the day, not just a certain hour. It’s first thing in the morning, it’s at night, in the middle of the afternoon.”
Bennett says overdose patients are rushed into a trauma room, nurses put in an IV, and give a drug called Narcan. That’s the opioid overdose reversal drug. Staff here use it so often it’s become a verb, as in: “we narcaned him, and he came to.” Emergency department nurse Christopher Polakowski says narcaned patients can be angry, because when they wake up, their high is gone.
“They’re combative or upset or demeaning and yelling and rude. I don’t know, it’s distracting," he says. "And it takes away from the people who really need help.”
Rhode Island Hospital officials say Polakowski’s point of view doesn’t reflect the hospital’s. They say addicts are just as sick and deserving of help as any other patient. But caring for overdose patients can be rough, like with this patient Polakowski helped recently.
“I turned my back for a second and he started hitting me in the back. But that wasn’t so bad. I’ve had other nurses who went to the ground with patients, hurt their knees. One other nurse got punched in the chest; another nurse got punched in the face. So it happens.
(Loudspeaker: "3 minutes ETA...")
That’s a three-minute warning to Polakowski and the rest of the triage team that an ambulance is about to arrive with a patient who needs a head scan. Meanwhile, an overdose patient has come in. And doctors have called in a relatively new resource to help: a recovery coach. The coaches are peers, not medical staff. Many are former addicts trained by the Anchor Community Recovery Center to talk with an overdose patient about treatment.
Donna Price is the recovery coach on call tonight. And she’s just seen her first patient of the evening. Now, she finds a quiet space just off the main triage area to talk about their conversation.
“I think he was happy to know that I was a recovery coach, that I was a recovering addict, and that I wasn’t there to judge him in any way, shape, or form, and that I could identify where he was coming from because I remember my last time in an emergency room," Price says.
Price was a heroin addict. She’s been off the drug for 20 years. But this patient reminded her how horrible it felt to wake up in a hospital bed after an overdose.
“I remember seeing my father’s face in the round circle of the emergency room doors, and me telling the attending doctor do not let him back here because the shame and the guilt was just too much. And as I was leaving this person, their father approached," says Price. "And of course I could not talk to him about anything, but I could just see the look on their face when their father approached, and it brought me back, way back.”
Price is part of a growing army of recovery coaches working in emergency departments across the state. They serve as guides to the world of recovery, lighting a path for addicts who see only darkness ahead. Price says her work complements that of doctors and nurses.
“Nothing like peer to peer support. Nothing like being approached by another recovering drug addict or alcoholic that can help you in your time of need, and knows exactly what you’re going through at that moment, that a hospital staff might not know about.”
Price says the medical staff are great, but in one of the busiest emergency departments in the region, it’s tough to do more than stabilize the patient and hope he or she accepts the offer of help. Rhode Island Hospital gives every overdose patient a Narcan kit, a list of referrals to treatment options, and for a little over a year now, the opportunity to talk to a recovery coach if they want to. If they don’t, the hospital can’t hold them.
“We can offer them assistance, but they need to want it. That’s the first thing that anyone needs to get recovery.
This is emergency physician Thomas Haronian. He’s taking a break in the doctor’s lounge to talk about what the hospital used to do for patients, before the recovery coach program got started.
“So before we had Anchor personnel available, we would give them a list of places, organizations they could call. And that was really it. We could talk to them, we could try, we could get their family involved. And ultimately if they walk out of here themselves, it’s pretty unreliable.”
Their chances of getting into recovery are pretty unreliable, that is. Now, Haronian says it’s helpful to have recovery coaches on call, someone who can spend the time with a patient. Someone who knows the recovery terrain better than he does.
“We know intellectually there are these strategies, but we don’t get a lot of training in it and we probably could use more. And up until the last couple of years also we probably didn’t have the volume we could practice on and get good at it.”
Volume’s not the problem now.
“It’s pretty scary, and frustrating," says Haronian. "We see patients come in over and over again, some of the same patients. We’ve had young people come in here and die.”
And that is the conundrum at the heart of this crisis: doctors and nurses and emergency medical technicians can save overdose patients’ lives. But they can’t necessarily convince those patients to stop using drugs. Addiction is a chronic, relapsing brain disease, and the road to recovery can be bumpy.
But rather than leaving the emergency room with a list of phone numbers and a Narcan kit, patients now have the option to go home with the name and number of someone who will follow up with them and help them take the next steps.
Someone like recovery coach Donna Price, who’s getting ready to go home now and watch TV. She knows another call could bring her right back to the emergency room before the night is over. And she knows her next patient might not be ready to accept help. That can be frustrating.
“Because you want to do so much for people," says Price. "You want to shake them and say ‘you can have this, you know?
You can have this happiness I have, she wants to tell them, from being in recovery for 20 years.
“But it doesn’t always work like that. Not everybody is ready," she says.
Until they are, hospitals and first responders do what they can. Recovery coaches have talked to dozens of patients, and many of those patients have followed up with treatment appointments. They can’t reach everyone, but they believe they’re making some kind of difference.