Warm Handoffs – A Brilliant Idea

“Never forget where you have been.  Never lose sight of where you are going and never take for granted the people who travel the journey with you.”

There is a brilliant technique designed to get people with substance use disorders into recovery, called a “warm hand-off” that I want to share with everyone. Understanding this information helps everyone understand behavior associated with addiction, recovery, and the steps we need to take as a society to combat this horrible disease.  So, please join me in this post, “Warm Handoffs – A Brilliant Idea”.

What is a Warm Hand-off?

A warm hand-off is something that is set into motion by a person arriving at a hospital either because they overdosed, or they were injured in some other way due to their addiction.  Hospitals involved in this program then contact an individual in recovery who comes to talk to that person in order to help them see their need for rehab and to help them find a facility that will take them.  I had heard about this a few years ago, but this was the limit of my understanding.  The idea of having someone with intimate knowledge about addiction (someone in recovery) talk to a person in crisis (immediately after an overdose or serious injury) sounded like a great idea to me.  I knew that there was more to learn but I did not know who to contact.  I found out from a newspaper article a few weeks ago that The RASE Project was active in warm hand-offs in the Lancaster, Pennsylvania area, so I contacted them.

The RASE Project

I called The RASE Project, which is headquartered in Harrisburg, PA and was told that I should speak with Sandy Fisher, the Recovery Specialist Programs Supervisor.  I called Sandy and we had a great telephone conversation that taught me much more about warm hand-offs.  For starters, warm hand-offs are part of a program that is sponsored by the Commonwealth of Pennsylvania.  Pennsylvania requires that within each county in Pennsylvania, there must be an organization that is funded to provide warm hand-offs in that county.  The RASE Project is that organization for Lancaster County.

All of the major hospitals in Lancaster County participate in this program and they call the RASE Project anytime, night or day, that someone comes into the hospital having overdosed or otherwise seriously injured themselves as a result of addiction.  The RASE Project has five people in recovery that are tasked with providing support in the form of a warm hand-off.  Each person takes a turn on call 24/7 for a week at a time to answer the call from the hospital.  Each of the “Recovery Specialist to Warm Hand-Off for Overdose Survivors Program” members is a Pennsylvania CRS (Certified Recovery Specialist).  To become a CRS, an individual must be in recovery, must take many hours of classroom instruction and must pass a test.  Each of these individuals also works as a recovery center monitor, as well.

The individual on call talks to the person in crisis and attempts to get them to agree to go to rehab.  In the best case, this help is desired and The RASE Project staff will attempt to get them in a rehab facility as quickly as possible.  In the worst case, the person refuses to speak with the RASE Project staff member, in which case they are left with a packet of information in hopes that they may change their mind.  Sometimes, an individual is initially resistant to help but they come to the RASE Project facility a few days later seeking help.  The Lancaster facility also provides recovery coaching, recovery support groups, Buprenorphine (Suboxone) Care Coordination, and all day drop-in services.

Up until a few months ago, warm hand-offs were only for those revived from an overdose.  Like any good program, a need was identified to provide this service to anyone seriously injured by their addiction and it now helps them, as well.  I asked about our son’s survival of an overdose and if no one came because they saw that he had our support and was agreeing to go to rehab.  Sandy said that was probably the case but that they are not called 100% of the time.  The good news is that they estimate that they get the call from the hospital about 80% of the time and that number is improving as word gets out.

What is it like to Provide Warm Hand-offs?

Sandy suggested that I should stop by the RASE Project facility at 121 East Orange Street and speak with someone who goes to the hospital and provides a warm-handoff.  I met Brandon Hildebrand and he agreed to speak with me about his role in warm hand-offs.  We had a wonderful conversation that started with the general information provided by Sandy but soon led to a more personal discussion.  The one thing that I wanted to ask Brandon was how difficult it was to go address someone who was in the same position that he had been in years before.  Was this a trigger that might make him want to use?

Just as a reminder, triggers are smells, sounds, places, things, and tastes that remind an person of the times when they used and cause them to want to use again.  Triggers are a “trick” that the addictive part of the brain uses to try to get an someone with a substance use disorder to seek out the substance that their brain thinks it needs to survive.  Triggers lessen with time in recovery, but they may never totally go away.

Brandon said that what he experiences sometimes is not so much a trigger but it can take him back to his using days and all of the pain that he caused people. That is why he works his 12-step program and contacts his sponsor and support group.  In his words, you must have a very strong program to do this work.  Let that sink in for a minute.  The people that provide warm hand-offs willingly go into an environment that will remind them of their past and challenge their recovery, so that they may help others in the same situation that they have worked to put behind them.  Past posts have explored things that make recovery such a tremendous challenge.  These people charge into the teeth of the dragon to help save their fellow man.  Can there be anything more noble?  But still people look down on or fear those in recovery.

Challenges to Warm Hand-offs

So why wouldn’t someone who just virtually died want to get help to get away from the thing that tried to kill them?  Part of the answer to that question is the twisted thinking in the brain of someone with a substance use disorder.  Even though the drug almost killed them, the part of their brain associated with addiction is convinced that the drug is necessary for survival.  So, they don’t want to go to rehab where they cannot get access to that drug.

There is another issue that causes challenges for those trying to help someone get into rehab.  The source of this problem is Narcan/naloxone which I hope to discuss in a little more detail in the next post.  Narcan is what saved the person overdosing but it does so by instantly taking them from high to withdrawal.  When the addicted brain is thrust into withdrawal, it responds by trying everything at its disposal to get the individual to use.

The result of the brain’s efforts is an intense desire/craving to use that is so powerful that it is difficult to focus on anything else.  This is the challenge for the person attempting to help them get into rehab.  Most don’t want that help and even if they are not strongly opposed to it, they have a hard time focusing to understand the help being offered.  Some medical facilities are offering a therapeutic drug such as Suboxone/buprenorphine as the individual is recovering from their overdose and this acts to damp down the cravings and help them focus.

Brandon noted that recently he has seen more people that are happy to see him and want his help than in the past.  He believes (and I think that he is correct) that this is occurring because of the prevalence of fentanyl in street level drugs.  Fentanyl is much more potent than heroin and a fentanyl overdose is resistant to Narcan.  While the availability of Narcan is decreasing overdose deaths, fentanyl is having the opposite affect and that is scaring some people.

I often speak of “drug brain” as if it is all consuming and always present but that is not entirely true.  Remember that I noted people with substance use disorder typically think they can stop when they are high and know that they can’t when they are withdrawing.  Brandon put this another way that I think is very telling.  He said, “I didn’t want to be sick. I wanted to stop but the drug always wins.”

Is it Worth it?

Warm hand-offs are a great idea to help get people into rehab and recovery and they do work.  Warm hand-offs may put those people in recovery that are trying to help at risk of relapse. And they don’t work as often as we would like due to the many obstacles such as:

• The altered part of the brain of someone with substance use disorder believing that their drug of choice is necessary for survival;
• The difficulty that the person has in focusing because their brain has just been thrown into withdrawal; and
• Difficulty getting a willing participant into a suitable rehab facility quickly.

Despite the hard work, risks and difficulties in making warm hand-offs work, I absolutely think that they are worth the time and money.  The concept is excellent and perhaps we will find ways to reduce the obstacles, such as the use of therapeutic drugs to reduce the effects of withdrawal.

Do you have thoughts or experiences to share? Please comment, let’s work together and help each other to understand this problem.

NOTE:  You may have noticed that I stopped using the term addict in this post and I replaced it with “person with substance use disorder”.  I initially did so at Sandy’s suggestion that there is a great deal of stigma associated with the word addict.  I understood Sandy’s point but I feel disingenuous when I use what I perceive to be euphemisms.  I am currently taking the coursework to become a Certified Family Recovery Specialist in Pennsylvania and this same thing came up in that class.  I expressed my reluctance there and the instructor made a very good point.  First and foremost, when we are trying to help people we must be sure that we do no harm.  If the term addict has a strong stigma such that it may be hurtful or may cause the people that we are trying to educate to hold onto their misconceptions and stigmas then we should not use it.  From now on in this blog, I will only use the term addict when I think that it is necessary for the point that I am making.

I hope that you will join me next week for a discussion of “Naloxone (Narcan)”.