How Do You Help Addicts Who Don't Want It? Timing May Be Key.
By Lynn Arditi
A peer counseling program in Rhode Island that has become a national model for its hospital-bed outreach to drug-overdose survivors is up against a daunting statistic.
Nearly half of all patients hospitalized in Rhode Island for drug overdoses -- 45 percent -- refused to speak with a recovery coach, according to state health department data released Wednesday during a meeting of the Governor's Overdose Prevention and Intervention Task Force.
The high refusal rate prompted some soul-searching questions by task force members enlisted by Gov. Gina Raimondo to curb the state's drug-overdose deaths, which in 2015 ranked fifth-highest in the country.
The program, called AnchorEd, launched as a pilot in 2014, was modeled on recovery coaching in prisons. The program trains people in recovery from addiction to become coaches who are dispatched to hospital emergency departments to speak with people who have overdosed. The goal is to make a connection with the patient immediately, presumably when they're most receptive to getting help.
Rhode Island's AnchorEd has spawned similar programs in Massachusetts, Connecticut and New York City.
In Rhode Island, the number of people who died of accidental drug overdoses in 2016 rose 16 percent, to 336 deaths, compared with 290 deaths in 2015, state health department data shows.
During the first six months of this year, 757 people who overdosed showed up at hospital emergency rooms around Rhode Island, Joseph Wendelken, a hospital spokesman, said. Of those, nearly 500 overdose survivors were asked while in the hospital if they wanted to speak with a recovery coach, and 45 percent -- 223 patients -- refused the offer.
"That's a really huge percentage," Meghan McCormick, an epidemiologist at the Rhode Island Department of Health who presented the data, told task force members. "This is maybe not the best time to reach patients ..."
Jonathan Goyer, an adviser to the governor's task force and a manager at the Anchor Recovery Center, said the high refusal rate may have something to do with the way hospital staff present the services. "You'll always get refusals," he said in an email after the meeting, "but I think a lot has do with language and empathy exhibited by hospital staff."
George O'Toole, manager of the AnchorED program, was not surprised at the 45-percent refusal rate. "I thought it would be even higher than that," he said. "A lot of people that come into the emergency room are so embarrassed and ashamed, they want to get out of there and don't want to deal with it."
One new approach being tried at two hospitals is to ask people who refuse to speak to a coach if they are willing to be contacted the next day.
Dr. Nicole Alexander-Scott, director of the Rhode Island Department of Health, said health officials are working with hospitals to get the consent-for-treatment forms to include recovery coaching so a coach can contact them after they're discharged.
"One of the barriers has been getting consent while people are being seen" in the hospital, Alexander-Scott said. "We will be assessing the improvement with that change."
Dr. James V. McDonald, chief administrative officer of the state Board of Medical Licensure and Discipline and a task force member, said the high refusal rate is symptomatic of opioid addiction.
"I think it speaks to one of the symptoms of this chronic disease," he said. "Not everybody who overdoses is ready at that point to enter treatment ... Jonathan Goyer talks about the window of willingness. The window of willingness isn't always at the point of overdose, but it might be the next day."
(c)2017 The Providence Journal (Providence, R.I.)