On a cold morning last winter, Christopher Hinds says he woke up early, sick from withdrawal. He called a friend and they trekked across a highway, walking for more than two miles through the snow on a street without sidewalks to buy heroin.
鈥淵ou don鈥檛 think about nothing but getting it when you鈥檙e sick like that,鈥� he says.
On the way back home, Hinds couldn鈥檛 wait anymore. He says he went into a Subway restaurant and snorted the powder he had just bought. He thinks it was actually fentanyl, a synthetic opioid much more powerful than heroin.
He remembers his vision getting blurry soon after he exited the restaurant. 鈥淚 don't remember anything after that, so I imagine that's where I fell out,鈥� he says. He collapsed in someone鈥檚 yard. His friend took off, and somebody called 911.
Hinds says it was his fifth overdose in three months.
Thousands of people overdose every year across the U.S. The ones who survive are often taken to emergency rooms. In 2014, there were 538,100 opioid-related ER visits, according to the . So far this year in Indianapolis, where Hinds lives, EMS has recorded 1,200 emergency runs during which patients required the opioid overdose antidote naloxone. Hundreds of those overdose patients are transported to the emergency department at Eskenazi Hospital for treatment and observation.
Some emergency room doctors see this influx of patients as a missed opportunity 鈥� and at one hospital in Indianapolis, they鈥檝e started to try to intervene to connect their patients with treatment instead of simply discharging them.
鈥淥nce they鈥檙e stabilized...really not a lot was happening,鈥� says Dr. Krista Brucker, an emergency physician at Eskenazi. 鈥淸They were] getting, at best, a handout on where they could try and get treatment, and then being sent on their way.鈥�
Brucker and her colleagues at Eskenazi Hospital have started to do more. In early 2016, they piloted a program, called Project Point, giving overdose victims concrete support to get into treatment.
A staff member will meet with the patient at their bedside and talk to them about treatment options. If the patient is willing, staff will make them an appointment with an addiction specialist. They also discuss using clean needles, using naloxone and getting tested for diseases such as hepatitis C that are spread through injection drug use.
Funding from the Fairbanks Foundation received earlier this year will allow the program to expand (The Fairbanks Foundation also supports Side Effects Public Media.) In 2016, Project Point saw 83 patients, with 44 percent attending a follow-up visit. Since January, the program has been able to provide services to more than 180 patients. Social workers with the project help patients with other needs, including transportation and signing up for insurance.
鈥淭he one thing that we heard a lot of before we started the program was 鈥楾hey鈥檙e not going to want to talk to you, they鈥檙e just going to want go out and get high again,鈥欌�� Brucker says. But she says that wasn鈥檛 true of the patients she saw. Brucker says that overdoses can act as a sort of wake up call: People who have nearly died will be more likely to seek treatment.
That was true for Christopher Hinds after he overdosed again. 鈥淓very time the same thing pops in my head, and it's my son,鈥� he says. 鈥淭he next thing on my mind is getting help.鈥�
Around the country, other hospitals have started programs like Project Point, but they鈥檙e not easy to run effectively. Patient often face delays between an overdose and an appointment with an addiction treatment specialist.
Dr. Gail D鈥橭nofrio, an addiction researcher and physician at Yale School of Medicine in New Haven, Connecticut, says those delays can lead to relapse. Patients often express a desire to get into treatment after an overdose, "but then what happens is they start to withdraw,鈥� she says. 鈥淚t鈥檚 an overwhelming craving, and there鈥檚 nothing they can do except try and find their next bit of drugs.鈥�
Her team at Yale-New Haven Health System had been connecting overdose patients with referrals to treatment. They decided to start prescribing patients an addiction medication, buprenorphine, to prevent withdrawals while patients waited for their appointments at addiction treatment centers.
顿鈥橭苍辞蹿谤颈辞鈥檚&苍产蝉辫;迟别补尘&苍产蝉辫; research comparing this approach to a referral-only approach. The researchers found patients who received buprenorphine in the ER were more than twice as likely to be in treatment 30 days later than patients who only received a referral. Another study showed that the benefits of immediately providing buprenorphine had dropped six months later. D鈥橭nofrio attributes the drop-off to the short period medication was provided; after 10 weeks, patients had to be transitioned to another treatment program or tapered off of buprenorphine. Stopping medication increases the risk of relapse.
Brucker says she and her team are interested in trying D鈥橭nofrio鈥檚 approach of immediately prescribing buprenorphine from the ER, but there鈥檚 a bigger problem: There aren鈥檛 enough providers to continue treatment in the community. Patients going through Project Point can still experience week-long waits for their first doctor鈥檚 appointment, Brucker says.
鈥淚 think there鈥檚 probably more bang for your buck expanding access [to treatment] in the community and then rapidly linking people to care,鈥� Brucker says. 鈥淲hen we can do that well, then maybe we鈥檒l start prescribing buprenorphine in the emergency department.鈥�
For patients who don鈥檛 get a referral from Project Point staff, the wait to get into treatment can be even longer, Brucker says.
Christopher Hinds says he dealt with that issue before. He called multiple treatment centers he knew about in Indianapolis, with no luck. This time, Project Point was able to connect him to a treatment center, where they started counseling and prescribed buprenorphine to help manage his addiction.
Hinds now wants to become a peer recovery coach, to help others with addiction. And he says his family is cautiously optimistic about his recovery. He has relapsed a couple times 鈥� a normal part of addiction treatment. But he says it鈥檚 going well, that he is back in touch with his emotions, which his addiction had numbed.
鈥淚鈥檝e had 鈥� genuine happy moments,鈥� he says. He even cried watching the television show 鈥淐hicago Med.鈥�
鈥淚t was a good cry,鈥� he says. 鈥淚t felt good.鈥�
This story was produced by , a reporting collaborative focused on public health.
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