Connecting During Crisis: Overdoses Amidst the COVID-19 Pandemic
[cross-posted with the Penn Center on Mental Health]
Fatal overdoses remain staggeringly common in Philadelphia, and challenges presented by the COVID-19 pandemic have only served to exacerbate the crisis, especially for Black residents. Following the stay at home order in March 2020, the weekly number of emergency medical service calls for overdose events increased. The pandemic halted service of Philadelphia’s alternative response unit, which pairs a caseworker and paramedic to respond to overdoses in the Kensington area. Community-based organizations have been redoubling efforts to help patients but have been overwhelmed by need and limited resources.
Recognizing that community resources for people who use drugs are threatened by this pandemic, an interdisciplinary team of certified recovery specialists, social workers, nurses, and physicians at the University of Pennsylvania created the “Warmline” in the spring of 2020 to field calls from people seeking connection to treatment for opioid use disorder.
The Warmline serves as a referral mechanism for same-day access to medication for opioid use disorder (MOUD), which was made possible by a regulatory change in Spring 2020 that allowed providers use telehealth to initiate highly-effective and life-saving medications such as buprenorphine. This care has often been initiated in the emergency department and sustained through a referral to an outpatient clinic.
Warmline in Action
With the goal of regaining the primary caretaking role of their 3-year-old daughter, a couple sought treatment for opioid use disorder at Prevention Point Philadelphia. Unable to initiate same-day treatment for the couple, a community organization’s case manager gave them the phone number for the Warmline. The couple called the Warmline, talked to a nursing student volunteer who then looped in Nicole, the certified recovery specialist. Nicole explained to the couple that they could present to the emergency department and she would meet them there. The couple did just that and were able to receive treatment and care from a compassionate team of certified recovery specialists, nurses, and physicians. This couple continues to be engaged in treatment and now regularly sees a primary care provider who specializes in addiction medicine.
If you or someone you know in the Philadelphia area could benefit from services for an opioid or substance use disorder, the Warmline can be reached Monday through Friday from 9am to 5pm at (484) 278-1679. Free naloxone (a medication that reverses the effects of an opioid overdose) for Philadelphians is available by mail at https://nextdistro.org/phillytypechoice.
Key to the success of the Warmline are the trained social work, nursing, and pre-med students who field calls and facilitate a warm handoff over the phone to the lead certified recovery specialist, Nicole O’Donnell. While the quantity of calls to the Warmline has been modest, the quality of the connections made have been life-changing. Callers, who often sound nervous, skeptical or sometimes desperate when they call, often end the call filled with hope. Nicole has found that telling people that she will “meet you on the other end” has led to remarkable rates of same-day engagement among Warmline callers. While the Philadelphia Department of Public Health has compiled a helpful list of resources for people who use drugs, the person-first approach of the Warmline team seems to facilitate unprecedented engagement.
It is fitting to write about the Warmline as we emerge from the holiday season, which can be an isolating and lonely time of year for many people. We are facing a resurgent pandemic that has once again closed businesses in city and filled our hospitals. An estimated four Philadelphians die daily from an overdose. Now, more than ever, we need tailored and equitable services and policies for people who use drugs. We need them to know that we have always cared.
The COVID-19 pandemic has taught us that lowering the barriers to treatment is not only possible, but also long overdue and effective. Connections to treatment through telephone—whether directly to a provider offering medications via telehealth, or to a peer in recovery who is trained to connect individuals into care—must continue in our post-pandemic world. Lives depend on it.
Rachel French, BSN, RN is a doctoral research fellow in the Center for Health Outcomes and Policy Research (CHOPR) at Penn Nursing; Nicole O'Donnell is a Certified Recovery Specialist at Penn Presbyterian's Center for Opioid Recovery and Engagement (CORE); Utsha Khatri, MD, is an LDI Associate Fellow, a fellow in the National Clinician Scholar Program at Penn, and an emergency medicine physician.