Connecting During Crisis: Overdoses Amidst the COVID-19 Pandemic

Posted on: January 15,2021

AUTHOR: Rachel French, BSN, RN, Nicole O’Donnell, and Utsha Khatri, MD

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.

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.