Catholic Medical Center in Manchester is your typical general hospital: they deliver babies, set broken bones, perform heart surgery. And it might be as good a place as any to witness how the opioid epidemic is transforming healthcare in New Hampshire.
As the opioids have taken a grip on the state, hospitals have been inundated with patients suffering from addiction. Not all those patients land in a hospital because of an overdose. They’re being treated everywhere – from the nursery to the operating room.
In the Emergency Department at Catholic, Dr. Rory Symons describes practicing medicine overseas, with heroin addicts in Ireland and people with HIV in South Africa. She says opioid addiction in Manchester is as bad or worse than anything she's ever seen.
"As a doctor you sit around and you tell sort of like what are your war stories," says Dr. Symons, "and the worst war stories I can think of from here in New Hampshire are related to opioid addiction - by far. I have never seen anything like this. I cannot overstate it enough. It is overwhelming, out of control. This is a tidal wave. This is the worst of the worst I’ve ever seen of anything anywhere."
In Emergency Departments alone last year there were 6,000 patients struggling with opioid addiction statewide, with more than 1,000 being treated right here at Catholic Medical Center. Those patients are mostly in their 20s and 30s, but they range from newborns to the elderly.
Dr. Symons says they’re the sickest of the sick. Some overdose in the field, then die in the emergency room. Others have serious infections from injecting heroin with dirty needles – infections in their spine or their hearts.
Other times hospital staff are surprised to learn a patient who’s sick is also addicted.
"We’ll have someone who has a bowel problem, or a heart problem, or their diabetes is out of control – and they’re addicted to an opioid," says Dr. William Goodman, Catholic Medical Center's Chief Medical Officer.
Others patients come in just looking to the get more drugs.
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On the wall of the Emergency Department, there are signs that, in so many words, warn opioid addicts they shouldn’t try to trick doctors into prescribing them narcotics. Symons says she is on a defensive footing that undermines the doctor-patient relationship.
"When somebody comes in and says I have lower back pain, maybe your first gut reaction is like, 'I’m not giving you painkiller,'” she says.
About 40 percent of opioid addicts who come to the ER at Catholic Medical Center are sick enough to be admitted to the hospital, and a lot wind up in the Intensive Care Unit. Some survive overdoses but are brain dead. Others are wheeled here to recover from surgeries for infections caused by their drug use.
Tracie Fahie has been a nurse at Catholic Medical Center for 22 years. Fahie says that mistrust of patients addicted to opioids has made her quicker to call security.
"I think we put up our guard a little bit," says Fahie. "And then we also can have the family members [and] friends – so called friends – searched, so that it’s the safety of the nurse."
Treating addiction in a hospital just seems to erode trust between doctors and nurses and patients.
The cuddling protocol
But one wing of the hospital that has a lot of success with patients addicted to opioids is the Special Care Nursery. Dr. William Edwards, a neonatologist, says for years babies born addicted were treated in critical care units, which are overstimulating environments.
"It’s taken quite a while for us to actually figure out that that’s probably the worst place to manage withdrawal symptoms," says Edwards.
Now, Catholic Medical Center treats these babies in quiet rooms designed for one mom and her baby. Some babies get morphine to wean off their addiction. But a lot do better without the morphine – instead they get a sort of cuddling protocol.
"Being held, skin to skin. Being talked to, sung to. Fed. It’s pretty simple," says Edwards.
A community approach
Here’s what’s not simple about treating all these patients. A hospital can fix the infection or get you through detox. It can’t help patients navigate their addiction after they’re discharged. Which is why so many patients come back again and again.
And that’s forced another big change at Catholic Medical Center. Hospital staff are talking more to first responders and treatment centers throughout the city. Dr. Goodman says the goal is to make the hospital a step along the path of addiction treatment, not a revolving door for people who can’t get healthy.
"Never did I dream that in my quest to reduce disease and suffering would I be on a first-name basis with the chief of police, the attorney general, the mayor. But this problem is so complex you can’t just treat it in the hospital because you’re downstream and it’s too late," says Goodman
Goodman says he’ll know the state has turned the tide when fewer opioid addicts are coming through the door – and when the ones that do come through can continue healing when they leave.