Peer Recovery Specialist Eric Ezzi and his wife with their daughter.
For any patient in the hospital, their stay entails a constant stream of health care professionals visiting the room; physicians and nurses and techs monitor their condition and map out their care plan, administer IVs and medication, food services deliver their meals, a social worker may stop in to discuss how to access housing resources after discharge, and EVS keeps the patient’s room clean and sanitized.
For some patients at Penn Presbyterian Medical Center (PPMC) there is one more potential member of the team: Eric Ezzi, a certified recovery specialist, will come to meet with patients who are experiencing addiction. But he is not there to add to the cacophony of monitors and hospital staff. He is there to listen.
While Ezzi’s goal is to help as many people as possible who struggle with addiction enter recovery, he doesn’t rush to bring up the subject. In his first meeting with a patient, Ezzi focuses on how they are doing at that moment: are their withdrawal symptoms tolerable? Are they in pain? Do they have any concerns? Is there anything the doctors or nurses are doing that they do not understand?
Throughout their stay, Ezzi will continue to check in. One of his most important roles is communicating medical terminology in a way that the patient can understand, and articulating to the care team what the patient might be experiencing.
Ezzi is particularly adept at this role as translator because he has been in the patient’s shoes: he struggled with opioid addiction for over fifteen years. Now in remission, he wants to help patients understand that while recovery might seem impossible, it is worth it, and he is there specifically to help them through it if they want.
A role like Ezzi’s exists as part of Penn Medicine’s efforts to address the urgent drug addiction crisis in Philadelphia, by supporting and healing patients with substance use disorder, regardless of what immediate health issue brought them in for care.
A crisis in the community
In the past decade, the drug addiction and overdose crisis has intensified, with overdose fatalities from opioids and stimulants reaching a record high in Philadelphia in 2022.
At the same time, fentanyl, an opioid 25 to 50 times more potent than heroin, has spread in unregulated drug supplies and is now involved in 88 percent of opioid overdoses in the US. Because of its high potency, withdrawal symptoms from fentanyl are more intense and more difficult to manage than from other opioids like heroin and oxycodone. What’s more, new drugs like xylazine represent an emerging threat, which has complicated treatment for patients with opioid use disorder and is associated with serious skin wounds.
With so many people experiencing the impacts of addiction, it is no surprise that some of them will be hospitalized at some point. But recent research has shown that the growing addiction crisis leads to an increase in patients leaving the hospital before they complete treatment, a trend associated with increased likelihood of death and hospital readmission. Previous research shows that patients with addiction cite withdrawal and pain as their reason for discharge prior to medically advised.
And while substance use disorders (SUDs) are recognized as chronic and treatable medical conditions, studies reveal that individuals with these disorders still face discrimination and stigma. A stay at the hospital can be stressful for any patient, and interacting with doctors, nurses, and other members of the care team can be daunting under the most ideal circumstances. These challenges are heighted for individuals with SUD who are admitted to the hospital. They often wait until their illness or injury is very severe before they go to the emergency department, or are hesitant to disclose drug use, as they fear being stigmatized and mistreated by hospital staff.
Compassionate care for all patients
With the addition of Penn Medicine’s Addiction Consult Service at PPMC in the spring of 2023, a team of physicians, addiction medicine fellows, social workers, and peer recovery specialists aim to provide compassionate care to all patients at PPMC, regardless of their substance use history.
The program addresses unique concerns for patients dealing with substance use, helps them navigate resources within the health system and in the community, and offers guidance for accessing treatment.
“Recovery from addiction is a complicated process, and is not linear for many patients,” said Samantha Huo, MD, an assistant professor of Clinical Emergency Medicine, and Director of the Addiction Medicine Consult Service. “And while the rate of return to use and non-adherence to medications for individuals with addiction is on-par with that of other chronic conditions, like diabetes or heart disease, the negative stigma around substance use adds additional barriers for patients to recover, and their concerns in the hospital might not be taken as seriously.”
The addiction consult service is an initial step towards improving care for patients struggling with addiction and reducing this stigma.
“No matter what challenges a patient might be facing, they deserve to receive care and be treated with dignity,” Huo added.
When a patient with a heart condition is admitted to the hospital for a surgery unrelated to the condition—like a hip fracture—the patient’s surgeon can call in the Cardiovascular Consult Team, which can advise them on how to manage the patient’s medications and condition during and after the operation.
Similarly, when a patient with a SUD is admitted to PPMC for conditions like infections or illness unrelated to their addiction, their care team can call in the addiction consult service to advise on the patient’s pain and withdrawal symptoms and start conversations about recovery treatments.
“We would love to help all patients with substance use disorders access treatment or start medications—like buprenorphine or methadone for patients with opioid use disorder—and hospitalization can be a reachable moment for patients who do not engage frequently with the healthcare system,” said Huo. “But not every patient is ready to take that step, and our team exists to meet them where they are. Regardless of whether an individual is ready to start treatment, they are deserving of compassionate care.”
Someone who has been there
During their time at PPMC, individuals seen by the addiction consult service will meet with a peer recovery specialist, also called a Certified Recovery Specialist. Eric Ezzi is that person.
Ezzi credits his own recovery to his experience with various hospitals and treatment facilities. Now, he uses these interactions to relate to the patients he meets with and speaks with them from the heart about the benefits of taking the first step towards recovery.
“I’m in a unique position where I understand addiction and recovery from a medical standpoint as well as from having experienced it myself,” Ezzi said. “A huge part of my role is to translate between the language of medicine and the language of the heart, and to earn the trust of patients before discussions about recovery even start.”
Having been there himself, Ezzi stresses the importance of honesty and empathy from a care team. While other members of the addiction consult service team might discuss pain management and other concerns related to their care plan with each patient, Ezzi starts out slower, meeting with individuals to get an idea of where they are mentally and emotionally, and determining what they want to get out of their stay at the hospital.
“Some patients aren’t ready to take the next step, and that’s perfectly fine,” Ezzi said. “Part of these conversations is building a relationship and planting seeds. Sometimes I simply keep them company and make sure their pain is taken seriously and addressed.”
When patients do express an interest in treatment or a curiosity about recovery, Ezzi and the consult team are a resource to explore options that are the right fit for each person. Ezzi added, “I can empathize with people suffering from addiction, and now that I am on the other side, I’m energized and excited to help others recover and see all of life’s possibilities.”
Ezzi speaks candidly with patients about his own experience in recovery and knows how impactful it can be to have the support of someone who has been there before.
“Listen, if I’m going to climb a mountain, I want a guide who has climbed that mountain at least once before,” he said. “I know it takes a village for one person suffering from addiction to get back on their feet, and I’m here to remind them that my team can be part of that village and help lighten their load so they can take the first step towards recovery.”
Learning together as part of a village
Ezzi poses with his wife, Nicole, and their daughter, stepdaughter and stepson, pose together on their wedding day.
The interdisciplinary nature of the addiction consult service adds a huge benefit for the team and patients. “We all learn from each other,” Ezzi said. “I learn more about new treatment options and how the drug supply is affecting patients, and the physicians learn about specific concerns or other barriers folks face when approaching recovery.”
Ezzi stresses how important peer recovery specialists are in providing care for individuals with SUD. “Because of this role, providers can relate to patients better, and patients receive better care. It helps to remind both groups that everyone is doing their best.”
Huo adds, “Eric has taught me so much about the patient experience and he is often able to reach folks in a way that other members of the team aren’t able to.”
Outside of his role at PPMC, Ezzi is an active member in recovery groups and has even mentored other young men through the recovery process.
Ezzi is also thrilled to reconnect with family. He recently married his wife Nicole, who is also in remission from addiction, with whom he has a stepdaughter, stepson, and ten-month-old daughter.
“There was a time when every day I was scared I wouldn’t make it to the next day. Recovery has invigorated every facet of my life. It is an honor to be able to help others see the same light at the end of the tunnel that I did.”