As the world confronted COVID-19 and its ripple effects, a quiet epidemic was growing in communities across the United States, hidden by the virus’ overwhelming impact: opioid use disorder. Between clinic closures, extreme social isolation, and the stress of living in a global health crisis, the pandemic stripped away the tools many people use to overcome their addiction.
“Before COVID-19, we thought we had a handle on illicit opioid use and that overdose deaths would decrease moving forward,” James R. Langabeer II, PhD, EdD, says. “But the pandemic changed everything.”
In 2018, Langabeer created the Houston Emergency Opioid Engagement System (HEROES) to directly connect people in need to recovery and treatment services. Combining the resources and expertise of McGovern Medical School at UTHealth Houston and UTHealth Houston School of Biomedical Informatics, the HEROES team receives data on opioid overdoses from the Houston Police Department and Houston Fire Department, and they dispatch recovery specialists to perform individualized outreach.
“When people are caught in the cycle of addiction, they don’t often seek help on their own. That is where HEROES steps in,” Langabeer explains.
Each week, Ashley Mackie, a paramedic and firefighter with the Houston Fire Department, travels with specially trained peer recovery coaches to visit people who have recently experienced an overdose. Going door to door, they speak to survivors about assistance and the opportunity to enter recovery through HEROES.
“A lot of people are surprised to hear about the program,” Ashley says. “We have also seen tears of happiness from individuals who feel trapped in their addiction and are looking for a way out.”
HEROES connects people interested in recovery to medication-assisted treatment on the same day through Memorial Hermann-Texas Medical Center— something that other treatment programs often struggle to provide. With medications to ease cravings and withdrawal, patients also attend behavioral counseling and peer coaching to learn how to sustain long-term recovery.
In the past, people with opioid use disorder often fell through the cracks in the health care system. While first responders and emergency departments could reverse the immediate effects of an overdose—and while recovery programs did exist—no program bridged the gap between the two. It often fell to individuals combatting addiction to find and initiate recovery, and barriers like long waitlists, high costs, and lack of transportation often prevented access.
By leveraging community partnerships and contacting overdose survivors directly, HEROES helps to fill these gaps and bring new hope to people experiencing opioid addiction. In collaboration with the Houston Recovery Center, peer recovery coaches—people who have experienced addiction firsthand and overcome it—work with HEROES to conduct outreach and answer calls around the clock, providing support and mentoring to people in the program.
“HEROES is unique because it sets up a clear pathway for individuals to go from an overdose to a recovery program,” says Leonard Kincaid, MBA, Executive Director of the Houston Recovery Center. “An overdose itself is not enough to change someone’s behavior. People need the therapeutic intervention that HEROES provides.”
The program has also benefited from private philanthropy and the collective generosity of the public. Crowdfunding campaigns have driven new support for HEROES, helping to provide everything from medication and safe housing to training for individuals in recovery who are interested in becoming peer coaches themselves.
“Nearly 90% of individuals with opioid use disorder who need treatment are not currently receiving it,” says Langabeer. “Every contribution toward HEROES—no matter the size— helps us reach more of these people and grow our program.”
Few have witnessed the pandemic’s impact on the recovery community like Ashley, who has worked alongside HEROES for nearly three years. An experienced nurse before she joined the fire department, Mackie changed careers to become a firefighter and paramedic.
“I felt restless staying in one place, and I wanted to do more with my skills,” she says. “Now, I get to bring help to the people who need it most.”
When the pandemic hit, Ashley and the HEROES team had to adapt to a rapidly changing public health landscape. Like so many other services, HEROES shifted to a virtual environment for peer meetings so that participants could retain access to the supportive community that makes recovery possible.
“In some cases, we were able to reach even more people in an online format since they did not have to worry about transportation,” says Langabeer.
As the pandemic’s impact wanes, HEROES has returned to in-person operations, helping to break the isolation that has challenged so many people in recovery and driven others to start using harmful substances.
“Building personal connections is critical for people on their sobriety journey,” says Langabeer. “The ability to see people, give them a hug, and share stories face to face is invaluable.”
Since 2018, HEROES has served more than 5,000 people across Houston, and many more continue to need help in the wake of COVID-19.
“So many people have this disease,” Langabeer says. “We are seeing more and more people publicly address mental health issues, but advocacy and support for addiction programs still have a stigma.”
Philanthropic commitments to HEROES help the program fund critical services that most grants do not cover. Thanks to this generosity, people with opioid use disorder can access the vital resources needed to begin their path to recovery and start rebuilding their lives. Continued support can further help expand educational opportunities in addiction medicine and ensure that more people can access the care they need to achieve long-term recovery.
The HEROES team is further collaborating with other mobile health initiatives throughout Houston. For instance, Langabeer serves as a co-investigator with Jordan E. Lake, MD, the local leader of Project Integra, a study that provides mobile access to HIV prevention and treatment services for people with opioid use disorder who use illicit intravenous drugs.
Additionally, the HEROES team has created a 24-hour toll-free hotline exclusively for Texas first responders to address their own substance use disorders.
“In our peer recovery meetings, we always ask, ‘What is your why? What is your purpose?’” Langabeer says. “For HEROES, our why is the people in our programs: the people working hard to overcome addiction and turn their lives around.”