Nicole O’Donnell has experienced two opioid overdoses. She has never forgotten the way she was treated at the hospital emergency room.
“They were awful,” the Philadelphia area woman says. “They were mean, just very cold.”
Once she was stable, she says, “I was just told to leave. I didn’t even have a ride.”
More than a decade later, O’Donnell, 39, is making sure others have a different experience – and that at least one hospital system’s emergency department is a possible gateway to recovery.
O’Donnell is a certified recovery specialist serving three Philadelphia hospitals run by the University of Pennsylvania.
Her job: To counsel people dealing with the same struggles she has faced with opioid addiction and recovery.
While she talks to patients in many settings, she says, some of her most important work happens in the emergency department.
As part of a program that began with a state grant in 2018 and will expand with federal funds this year, O’Donnell is on call to respond any time emergency staffers treat a patient for an opioid overdose.
She’s also called when patients show up with illnesses or injuries related to opioid misuse.
Her mission: to let people in crisis know that treatment and other help is available – and that someone cares.
“I just introduce myself and explain that I understand why they are there and that I’ve been there myself,” O’Donnell says. “I just want to get the conversation started about how I can help them not die.”
O’Donnell, who is training to be a psychologist, is backed by a medical staff ready to offer an immediate dose of buprenorphine. That’s a medication that can prevent withdrawal symptoms and cravings and, when used for a longer time, can help people recover from an opioid use disorder.
In years past, emergency physicians rarely offered the drug, or other nudges toward treatment. But “we have really pivoted 180 degrees,” says Jeanmarie Perrone, a professor of emergency medicine based at the Hospital of the University of Pennsylvania.
Perrone led a committee that recently updated opioid guidelines for emergency departments statewide.
The new philosophy, she says, is that “treatment is our business.”
Starting this year, hospitals that establish practices that guide addicted patients toward treatment will get cash incentives from the state.
The guidelines encourage emergency staffs to offer initial doses of buprenorphine. Providers also are urged to arrange “warm hand-offs” for patients ready to enter treatment.
In practice, that can mean having someone like O’Donnell available to talk with patients and, if desired, accompany them to treatment center doors.
A second counselor joined O’Donnell on the job this month, with the goal of providing round-the-clock coverage.
Still, Perrone says, “not everyone who is post overdose is ready for treatment.” Those who decline it are given supplies of the overdose antidote naloxone and encouraged to keep in touch.
“We say, ‘You aren’t thinking about treatment today, but we want you to know that when you are ready, we are here,'” Perrone says. “‘When you are ready, please, please come back and bring your friends.’”
“Success is when the people stay engaged no matter what,” O’Donnell says. “A lot of them do in stay in contact with me.”