Nicole O’Donnell’s first love was benzodiazepines. The Delaware County native was first introduced to the drugs (most often used for treating anxiety) in what she calls “the typical way” – partying with pills. But, she quickly found that pills are expensive, and other, harder drugs like heroin and fentanyl are cheaper and easier to access.

Throughout the United States, hospitals and healthcare workers are on the front lines of an opioid epidemic that’s ravaging communities, families, and individuals. In 2016, there were more than 63,600 drug overdose deaths. That same year, 80 percent of overdose deaths in Philadelphia involved opioids, including prescription painkillers, heroin, and fentanyl.

Nicole, now 39 years old, a mother of two, and working toward a bachelor’s degree in Psychology, spent more than a decade in and out of treatment for addiction to various substances before finding her path to recovery. Her journey, a winding road with its fair share of obstacles– including two overdoses of her own and losing her sister to an overdose – led her to Penn Medicine’s Center of Excellence, a managed care system headed by Care Coordinators Alyssa Faia and Lauren Carbone that provides people with opioid-related substance use disorders with the care and resources they need to find their own paths to recovery.

As the Center’s Certified Recovery Specialist (CRS), Nicole provides people struggling with addiction (Penn patients and non-patients alike) with peer support and guidance, often drawing on her own experience to forge unique and trusting relationships with those whose situations are all too familiar.

Though Nicole’s role within the Center is new – she’s been with Penn for only a few months – her colleagues are the first to say that for many patients, having someone on the team who has quite literally been where they are, is invaluable. I sat down with Nicole – and Alyssa and Lauren – to learn more about how her experiences and the lives she’s seen claimed by addiction give her purpose and fuel her journey.

Q: Let’s start with your role here. What is a CRS, and how do you interact with patients?

A: A Certified Recovery Specialist is someone who has experienced addiction and recovery and has gone through training and certification to help others through their recovery. In the Center of Excellence at Penn Presbyterian Medical Center, we provide hands-on assistance to patients with opioid-related substance abuse disorders by making sure they stay in treatment, receive the follow-up care they need, and are supported within the community. I’m part of a coordinated care team that provides what we call “warm hand-offs” to new parts of the treatment process. 

Q: So, you’re a peer to these patients?

A: Yes, exactly. I’m not a clinician. I tell patients all the time, “Come and meet me, I’m not that fancy, but I’ll get you hooked up with the fancy people who can help.”

Q: Now let’s go back to how you got here. Can you tell me about your own addiction and recovery?

A: It started because I picked up benzos and couldn’t put them down. The first time I was in treatment was in 2000. I was 21, and I was in recovery for two years. But then I found opiates. I was using again until I went back to treatment in 2006, but that time didn’t stick either, and then my addiction got worse. From 2006 to 2009 was the worst part of the addiction. I’m an overdose survivor; I overdosed twice – Narcan and the whole bit. Then, I finally found recovery on January 1, 2009.

Q: What made January 1, 2009, different from the other times?

A: Withdrawal made it stick that time. It dawned on me that I wasn’t using because it was fun or I was getting high; I was just using to feel normal. My boyfriend went to jail, and at that point I just said, “I can’t do this anymore because I’m just postponing withdrawal.” That’s all using was in the end. I didn’t go to treatment; I detoxed on a couch because I was so sick I couldn’t move.

I knew that the process of going to treatment meant I was going to have to move and speak to people, and I wasn’t in a frame of mind to do that. I figured that if I just went through it, I wouldn’t do it anymore, and I didn’t.

Q: Tell me about your experience after your overdoses. Were there resources offered to you? Any help at all?

A: Absolutely nothing like this existed for me. That’s why the warm hand-off resonates with me. I was taken to the hospital, and people were so mean. They didn’t care if I had a ride home, they were just done with me. I wasn’t so far gone at any point that an offer to help wouldn’t have resonated with me, but they gave me no resources. Nothing. It was probably 2006 – so it might have been a product of the time. Maybe we were in an epidemic, but it wasn’t like it is today. Nobody knew about the opioid issue, and [the prevalence of] fentanyl was just starting. There wasn’t much education about opioid addiction, and the stigma was real then. Things are a lot different now, and I’m lucky that I get to see this change and advocate for people getting help.

Q: Without any offers to help, how did you get through it on your own?

A: Oh, I didn’t do it on my own. My family was my support system. I moved back home, and they were driving me to meetings, giving me my dollar for the basket. They were so supportive, and if I didn’t have that – which a lot of people don’t – I don’t know that I would have been able to stay in recovery. I mean, for what? If nobody’s helping you, what’s there to keep you on the path?

Q: What inspired you to take on the role you’re in today?

A: When I was sober for six years, I lost my sister to an overdose. Jess died on December 14, 2014. My epiphany moment that I needed to do more in the recovery world was at a meeting. I remember it was a Monday night, and I thought, “where are all the people that don’t make it to the meetings?” Because my sister didn’t like meetings. “Where are all the people like her?” It was her dying that put the thought in my head that I needed to do more.

Two weeks later, we had a 5K fundraiser in Delco for my sister, and that’s when I started to find all the resources that I hadn’t known existed. Penn was actually one of the organizations that received some of the money we raised. At a recovery walk, I met other people who were advocates and learned about Certified Recovery Specialists. I joined the CRS school and, honestly, I didn’t have any expectations, but I thought I’d see how it goes.

As part of the course, you have to have do 100 hours in the field, like an internship for certification. My placement was with Angels in Motion (AIM), a non-profit that does outreach to the homeless and addicted on the streets. Once I found AIM, I was home. About a year later, I ended up on their board and still do a lot with that organization as a volunteer. I got my certification in May 2016, and a few months later, I started working at PRO-ACT [a grassroots advocacy and recovery support initiative working to reduce the stigma of addiction and ensure the availability of adequate treatment and recovery support services in Southeastern Pennsylvania].

Q: What kind of services do you provide as a CRS?

A: I provide peer support in the community. For example, yesterday I met someone from the Mothers Matter program who had to go to court and didn’t want to go alone, so I met her there. Today I’m going to a narcotics anonymous meeting with another client. I also meet people as they’re coming into the ED with overdoses.

Q: Walk me through this. What happens when a patient comes into the ED with an overdose? How do you hear about them? How do you approach that patient?

A: Someone comes in, they are treated by the clinical team, and once they’re stable, someone from the team will call us. If patients are indifferent about treatment or not forthcoming about an addiction issue, that’s my forte. They’re a lot more comfortable talking to someone who is also in recovery. We offer suboxone, outpatient counseling and treatment services, or they can just come talk. My door is always open, and most people are really receptive to peer support. It just depends what the patient is struggling with and what they need.

Q: How many patients have you seen since May?

A: Oh gosh…. Counting all of the programs – outpatient, inpatient, ED – we’ve seen a lot. Plus, I’m up in the units with our inpatients, and then I see them as they transition to outpatient. That’s my favorite – getting to see them when they come in, then as inpatient, and then transitioning to outpatient. I like going through all the steps with them. We probably see at least one or two in-patients each day. I have a patient who’s been in here for 40 days. I visit her on the unit at least weekly, just to talk.

At this point in our conversation, Alyssa chimed in.

“That patient is a prime example of why Nicole’s role is so important,” she said. “Multiple staff members had gone in to try to talk to her, and she completely shut down. You could see the wall go up. But then as soon as Nicole came in, there was an instant connection. Her role is so crucial.”

“I just said, ‘Listen, I’m in recovery. I can tell you want to talk, so we’re going to talk,’” Nicole said. “Alyssa and Lauren are amazing, but sometimes I see that patients just don’t want to talk to someone who hasn’t gone through what they’re going through.”

“Nicole also meets with some of my patients,” added Lauren, who also shares an office space with Alyssa and Nicole. “I’m one of the counselors here, and when I get assigned people who are new to recovery – they’re at a point where they’re ready to do recovery but very fragile – I always ask Nicole to see them because they connect with her on a different level.”

Q: And how long do you see patients, or how long do you stay in touch?

A: I stay with them forever. I have patients who I discharged from Chester County who moved to a recovery house in Philadelphia and will still call. When I meet with somebody consistently for months and then suddenly they stop showing up or they’re not answering the phone, yes, I absolutely track them down. I track them down because I don’t want them to die. I like going into the community – it’s what really helps the relationship. Patients, if they relapse, are more likely to call and tell me, and we can work on how to get them back. That’s where I’ve seen this role be different than a clinical role.

Q: Your role is still very new.  What does success look like for you?

A: If somebody struggles but they stay in touch, that’s the success because I can navigate them back to clinical services. It doesn’t mean they’re back to work – those are also successes – but for me and my role and the time that I’ve been here, them staying in touch when they’re struggling is really the success.

I’ve seen a lot of my patients go from inpatient treatment back to the community successfully. Many are doing well and stay in touch and stop in when they are here. I expect to see some going back to work in the near future.

Q: Can you tell me about one of your success stories?

A: Oh, the man I met at the PPMC spring health fair warms my heart. It was a beautiful Saturday, and we were doing community outreach. A guy came over to the Center of Excellence table, and you could see he just wanted to talk, but he needed someone to ask. So, we asked. I said, “Is there anything we can do for you?” and he just started crying.

I took him to a quiet spot, and I talked to him – it wasn’t even that long – and he told me everything. He had been in a treatment program and left. He experienced a relapse and was now homeless and dealing with addiction. He came to the health fair because there was food, and he was hungry. He only came over to us because in order to get the free sandwich, you had to visit a certain number of tables.

So, we talked and he told me he didn’t have an ID, but he needed one to get into treatment. We made a plan that the following Monday he would go see his case manager at the organization he was working with to get his ID, and then he would come see me, and I’d get him set up for an assessment to be an inpatient for treatment. Turns out, his case manager was off that Monday. I was at the suboxone clinic, and the assessment center called because he had gone there looking for me. I came back to my office, and he was here waiting. He said, “My case manager is off, and I still don’t have an ID. What can we do?” Well, it turned out Penn had his ID in the system from years ago that was still valid, so we were able to get him an assessment. Everyone took part in getting him help and making this happen. It was meant to be – he was meant to show up here. He stayed here, and I got to see him through his treatment, and just in the last few weeks he left and went to a long-term rehab program. The food at the health fair got him there, but he got a lot more than a sandwich.

Q: But surely not every patient you see is at that stage where they’re ready to be committed to recovery?

A: No, not everybody’s ready, but my role is to meet them wherever they are at all times. If you tell me that your pathway to recovery is going to be catching butterflies, I am going to find you a damn net. Whatever your pathway is, we’re going to find it.

If they’re still using, but they showed up to meet with me, I know they’re at least interested in recovery. They might not be ready, but they’re interested. And they have less of a chance of dying if they’re engaged in something – even if I can just educate them about harm reduction, that’s something.

Q: What about the other challenges that contribute to substance abuse, such as family or housing issues?

A: Because of the trust level I have with patients, they will tell me what’s going on with their families or whatever else is stopping them from going into recovery – or what triggered them. I just meet them wherever they are. My boundaries are a little bit different than a clinical role. They aren’t mandated to see me – they just trust me.

If I know someone experienced sexual trauma that may be contributing to their addiction, we get them connected with JJPI [the Joseph J. Peters Institute, which provides clinical care to individuals and families suffering the effects of trauma]. Or if I know that they’re an inpatient, we talk about it, and then there are things that Lauren can address in therapy. I support them when feelings come up from a peer perspective as someone who has gone through some of these things, but I’m not going to process trauma with them. It’s more about connecting them with resources.

Q: How does your role contribute to your own road to recovery?

A: I’ve had several different pathways in my own recovery. Right now, this pathway is about giving back. I see people in the ED on life support from using. That reminds me every day that that’s not the road I want to take. I treat everybody as if they are my sister. If my sister had walked into Penn, I would want someone to welcome her. That’s the person I try to be for everybody who walks in. I love this role because I truly get to meet people where they are, and that’s part of my own recovery. It all goes back to gratitude. I wouldn’t be able to go to school if I was using. I wouldn’t be able to pay my bills if I was using. I couldn’t help people if I was using.

Q: We talked about the successes. What about the people you lose or who don’t make it? How do you deal with those losses?

A: I try to stay in the middle. People make decisions for themselves both ways. I don’t take credit for the successes because when I lose people – which happens when you’re doing outreach on the street – I can’t take on the burden of people not making it to recovery. Losing someone is hard. With my sister, she’s not suffering anymore, and her death gave me purpose. I have to get to that place with everyone we lose. Their deaths fuel us to help more people. Everything I do is in the name of the people we’ve lost. I have to give their deaths purpose.

Q: Can anyone come see you?

Yes. Anybody. I will take them from 40^th and Market, and I’ll say “You look like you need some help. Let’s go.” The Center of Excellence is open to anyone.