(The Current PrEvents column appears monthly in the Times Argus. This column is reprinted with permission by Central Vermont New Directions Coalition.)
By ROBERT PURVIS
About three years ago, Drs. Mark Depman and Javad Mashkuri of Central Vermont Medical Center’s Emergency Department realized that the hospital was going to be called upon to play a much larger role in connecting their patients who have substance use disorders with appropriate treatment. They also realized that they knew little about the substance abuse prevention, treatment, and recovery programs in their own community.
Supported by the Health Department’s Division of Alcohol and Drug Abuse Programs (ADAP), these doctors brought together all of the programs in Washington County to forge what became known as the Washington County Substance Abuse Regional Partnership, or WCSARP. WCSARP has met monthly ever since (with the hospital providing lunch!). It was primarily because of the strength of these relationships, fostered by the hospital’s leadership, that Washington County was selected to develop a pilot project that is becoming a model for similar programs around the state.
When Congressman Peter Welch brought his traveling Roundtable on Opioid Disorder to Barre on July 2nd, Dr. Mashkuri was there to present the fruits of our collaborative work. One of the exciting new programs he described pairs the Turning Point Center of Central Vermont in Barre, with the Emergency Department of CVMC, to bring peer recovery coaches into the Emergency Department (ED.) These coaches engage with patients who have undergone the reversal of an opioid overdose, or who have been identified as suffering from another substance use disorder. The belief is that a peer coach can forge a connection with a patient that will continue after discharge and increase the likelihood that they will follow up with substance abuse treatment and recovery. Dr. Mashkuri is adamant that new approaches like this one involving peer recovery coaches, are necessary to address the complexities of addiction, which he describes as “one of the most difficult diseases a practicing emergency medicine physician like me has to treat”.
The Turning Point in Barre is one of only three recovery centers in Vermont that won grants to pilot this program (the other two are in Burlington and Bennington). As Dr. Mashkuri described the hospital’s partnership with Turning Point, which had just gone “live” that day, a beeper went off and a man jumped to his feet and quickly left the room. That man was Ray Richardson, Recovery Coach Supervisor for Turning Point. He was leaving to be sure that one of his recovery coaches would respond to the page from the ED.
Over the three months following that auspicious start, Turning Point coaches responded to 98 calls from CVMC. And as a reminder that our epidemic of substance use disorder goes far beyond the opioid crisis, 47 of those responses were due to alcohol, while 33 were due to opioids, 9 for cocaine, and 9 for other drugs or multiple drugs. Our commitment is to respond to all calls from CVMC within thirty minutes, twenty-four hours a day, seven days a week. We’re not quite there yet, but we should be once our three newly-hired coaches are fully trained and on the job in early November.
Over time, the data that all three pilot sites are collecting will indicate how well we are doing: How many individuals with whom our coaches engage are following through with substance abuse treatment once they leave the hospital? How many of those who complete treatment continue into a healthy, stable recovery? But even at this early date we are encouraged by the individuals who are consenting to follow-up contacts from our coaches once they leave the hospital, and who are keeping in touch as they take their first tentative steps towards recovery. We are also gratified by our relationships with CVMC’s Emergency Department and other medical staff. They demonstrate by their work with us every day that they appreciate the role that peers play and respect what our coaches bring to the mix.
The unique dimension that peer recovery coaches provide is the bond they can create with the person suffering from a substance use disorder. A peer is someone who has a personal experience with addiction and recovery; they know what the patient is going through because they’ve been there. The peer does not judge them, but conveys by example that recovery is possible, and provides a spark of hope that they can recover, too. Once this bond is established, the peer coach can use his or her skills to help the person take an honest look at where they are in their life and their substance use disorder—not to criticize, but to help them develop a positive plan to get from where they are to the life they can have in recovery. As Dr. Mashkuri noted, “Programs like the Recovery coach effort demonstrate our willingness to engage people with lived experience who not only provide a calming and non-judgmental presence for people in acute crisis but also serve as the ultimate role model for what is possible in successful recovery.”
When clinicians and peers work together in this way, with their respective roles complementing and reinforcing each other—when patients feel they are supported by a team that both understands them and is with them from their hospital bed to their home after discharge—they feel more confident in the care they receive, and are more likely to follow through with suggested next steps. At least this is our hope and belief, as a healthy, durable recovery is our goal for everyone who suffers from a substance use disorder.
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