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How an on-call addiction specialist at a hospital saved a life


The U.S. set a disturbing record last year - 107,000 lives lost to drug overdose. Hospitals often see people at risk who come in to be treated for other conditions, but very few hospitals have someone who specializes in addiction medicine. But that may be changing as WBUR's Martha Bebinger reports.

MARTHA BEBINGER, BYLINE: Just after Christmas last year, Marie opened her eyes one morning and realized she was gasping for air. She managed to call 911.

MARIE: I woke up, and I, like, couldn't breathe. I, like - I thought - I was so scared. I - like, hurry, hurry, like, you're going to die.

BEBINGER: At Salem Hospital, just north of Boston, the staff treated Marie's chronic lung disease. We're not including Marie's last name here because she, like about 1 in 9 hospitalized patients, has a history of addiction to drugs or alcohol. So the next day, when a doctor told Marie her oxygen levels looked good, Marie said, wait. There's something else the doctor needed to know.

MARIE: He said I could be released. And I said, I have to tell you something. I'm a heroin addict, and I think I'm starting to be into, like, heavy withdrawal. I literally can't move. Please don't make me go.

BEBINGER: Most hospitals in Massachusetts and across the country do not have anyone on call trained to treat addiction. So every day, patients like Marie stumble out of the hospital while in painful withdrawal.

LIZ TADIE: They're left on their own to figure it out, which unfortunately usually means resuming use 'cause that's the only way to feel better.

BEBINGER: This is Liz Tadie. She helped launch a different approach for Marie and other patients at Salem Hospital. That day, when Marie said, please don't make me go, her doctor called Tadie, a nurse practitioner certified in addiction medicine. Tadie prescribed buprenorphine, a medication that's helping Marie manage her addiction to opioids. After leaving the hospital, Marie continued to see Tadie for treatment and support.

MARIE: That I wasn't going to be left alone, like, that I wasn't going to have to call a dealer ever again, like, that I could delete the number. And I want to get back to my life. I just feel, like, grateful.

BEBINGER: Tadie has used success stories like Marie's to unravel decades-old stereotypes about addiction and explain treatment options. That means Tadie, a nurse, is often teaching physicians who get very little addiction training in medical school. They aren't always receptive.

TADIE: Sometimes I would recommend a dose and somebody would give pushback. Initially, I got to know the hospital medicine doctors here, and they, over time, were like, OK, we can trust you.

BEBINGER: When a hospital like Salem recognizes that addiction medicine is a specialty, as they do with cardiology or pulmonology, it can change the hospital's culture. Jean Monahan-Doherty is a social worker at Salem.

JEAN MONAHAN-DOHERTY: There was finally some recognition across the entire institution that this was a complex medical disease that needed the attention of a specialist. People are dying. This is a terminal illness unless it's treated.

BEBINGER: But Monahan-Doherty has colleagues who still dismiss patients with an addiction.

MONAHAN-DOHERTY: Sometimes you hear an attitude of, why are you putting all this effort into this patient? They're not going to get better. Well, how do we know? If a patient comes in with diabetes, we don't say, OK, they've been taught once and it didn't work, so we're not going to offer them support again.

BEBINGER: Still, at Salem Hospital, there are often more daily referrals for addiction care than one specialist can handle. And yet now, when overdose deaths have reached a record high, most hospitals are not offering addiction care, says Honora Englander, a national leader in addiction specialty programs.

HONORA ENGLANDER: People with substance use disorder are coming to our hospitals now. We can't wait. We have to do better. And this is the time.

BEBINGER: Englander says federal financial incentives for hospitals would help. Salem Hospital used a grant to start its addiction specialty service. But now that's ended, and the specialist, Liz Tadie, just left for a new job. Some Salem Hospital employees say they're worried about their program, but hospital leaders say it will continue.

For NPR News, I'm Martha Bebinger in Salem, Mass.

RASCOE: This story comes from NPR's partnership with WBUR and Kaiser Health News.