In opioid crisis, even treatment workforce is at risk

When Dallas Fetterman, who helped found a Philadelphia-area addiction treatment organization, was found dead of an apparent heroin overdose two weeks ago, those who knew him grieved deeply.

But they weren't entirely surprised. Fetterman, who was CEO of Liberation Way, was in recovery himself.

"People in recovery sometimes relapse," said Deni Carise, medical director of King of Prussia-based Recovery Centers of America.

The treatment industry is filled with employees in recovery. Local estimates range from less than 30 percent of the staff at residential programs that hire highly credentialed employees, to 90 percent at unregulated recovery houses, where house managers typically are recent clients. Professional conferences aimed at executives in the field often schedule daily 12-step meetings on-site.

"We recommend hiring people who are in recovery," said Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania. "To take a straight person and teach them the nuances and subtleties of addiction is a much harder enterprise," Beck said.

They spot details, she said, such as cars that lack antennas because they've been broken off and used to smoke crack cocaine. People in recovery will see someone "nodding off" — a sign of being high on heroin — whereas a never-user might think they were just tired.

A staffer getting high is the kind of relapse that might come up once every couple of years, said Jason McLaughlin, chief operating officer at the Wedge, a publicly funded outpatient program in Philadelphia, where about three-fourths of  more than 200 employees are in recovery.

But "we have never had a staff person overdose on site, or offsite, to my knowledge," he said.

McLaughlin, like others in the field, points out that potential employees must be carefully assessed.

"If a client completing treatment says, 'I'd like to work here,' I say great," he said, but first the person needs to get through the first year of recovery and enroll in a community college degree program in behavioral health. That person might eventually be hired as a counselor assistant, under close supervision.

Knowing that relapse is a possibility, good treatment programs say they develop more robust versions of the employee-assistance programs typical of many employers. They try to create work environments so nurturing that the first person a relapsing staffer would tell is his boss.

"In my 21 years at Caron, I've helped manage three cases where a staff member relapsed. In each of those situations, the individuals asked for help," said David Rotenberg, executive vice president and chief clinical officer of Caron Treatment Centers.

The Wernersville, Pa.-based provider will pay for an employee's treatment at another facility, he said, and then bring the person back to Caron in nonclinical roles while establishing  recovery before resuming contact with patients.

Recovery Centers of America hires a few people recently in recovery who may have legal problems that would stop other potential employers. They work at corporate headquarters and have no interaction with patients. Executives have discussed having a 12-step group on site to support them, perhaps with meetings at lunchtime.

"It is not a job. It's a passion. People really want to help others get well," said Carise, the chief clinical officer.

The stakes are especially high with heroin. "If someone relapses due to alcohol use or cocaine use it doesn't often lead to death," Carise said.

Heroin use has been increasing nationwide, as some people whose addictions began with prescriptions for opioid painkillers such as oxycodone run out of money for the far-pricier pills. Dealers are giving out free samples or mixing heroin with much deadlier ingredients such as fentanyl, which may not be discovered until multiple fatal overdose cases show up at the medical examiner's office.

Only a fraction of these deaths make news reports.

On May 16, Paul Yabor, well-known in Philadelphia's drug-using community for trying to save lives by handing out clean needles and distributing emergency overdose-reversal medication, was found dead on a needle-covered slope near the railroad tracks in Kensington. On May 21 in Chester County, two men died in a house with needles and baggies that tested positive for heroin and fentanyl. The district attorney's office described them as counselors in a halfway house, but the Pennsylvania Department of Drug and Alcohol Programs later said in a statement that the house was unregulated and the men were not licensed clinicians.

Fetterman, the CEO of Liberation Way, died May 17 in Florida, where he had recently bought a vacation home and was scouting properties for a new treatment center location, said Michael Armstrong, an administrator at the organization. Local paramedics had responded to 25 overdose calls in the previous several days, the Palm Beach Post reported.

Despite his title, Fetterman, who was 38 and lived in Collingswood, had recently been acting more like a consultant and had no patient contact. Still, 500 people attended his memorial service, Armstrong said.  Liberation Way is stepping up efforts to support its 100 employees, so that anyone is "able to say to a supervisor, 'I'm struggling,' and not be afraid of losing their job."

Nearly a decade ago, many people were astonished when the board of directors at Caron issued an open letter of support for president and CEO Doug Tieman, 10 weeks after his highly publicized drunken-driving arrest following a fund-raiser he ran at Mar-a-Lago, known these days as President Trump's "Florida White House."

Tieman, 61, described that period two weeks ago in a blog for the inspirational website Guideposts.

"On the outside, my life looked great. On the inside, I was rotting away. My secret ate at my soul. That is what secrets — and untreated addictions — do. From my work, I knew exactly what was happening to me," he wrote. "I knew I needed help, but where could I go? Word would get out that the CEO of Caron was in rehab. Then our organization and the addiction treatment field and, even worse, the recovery of thousands of people would be called into question. I prayed about it constantly. Even God didn't seem to have a solution."

The post was titled Getting Arrested Saved His Life: A Tale of Sobriety and Grace. Tieman completed six weeks of residential treatment in another facility and returned to Caron after four months. He is now in his 22nd year as president of the Berks County nonprofit. Revenues are up more than tenfold (the Scaife family donated $1 million during the 2008 Florida fund-raiser), and Caron is one of the largest treatment programs in the country.