BOSTON — Recovery coaches are central figures in helping people who battle addiction, and they’re increasingly a key part of the state’s response to its opioid problems.
Gov. Charlie Baker wants to integrate the coaches more into the health care system by creating a process to license them.
The plan raises some concerns, however, among those who worry that a new bureaucracy could put a damper on those willing to help former addicts in recovery.
“Training and certification is paramount, but we don’t want to create barriers for people who want to do this,” said Mark Kennard, director of community services at Bridgewell in Peabody, who said he supports licensure. “We need to make sure they don’t get lost in this process.”
One provision of Baker’s recent proposals to address the state’s opioid problem calls for a commission to recommend standards for credentialing recovery coaches, while “formalizing”their role in the addiction treatment process.
Recovery coaches, many of whom have wrestled with substance abuse on their own, help addicts get clean, find work and get their lives back in order.
Baker, a former health care executive, says the lack of professional standards and regulatory oversight means many private insurers are unwilling pay for coaches. That hurts recovering addicts’ chances of staying clean, he said.
“One of the biggest problems we have right now is that people detox, and then they’re kind of on their own for everything that happens after that,” Baker, a Republican, said recently. “In the long run, that’s never going to solve this problem.”
As Massachusetts continues to battle an opioid problem that has claimed thousands of lives, health officials are more often turning to former addicts for help.
Long-term recovery remains one of the biggest hurdles to breaking the cycle of addiction.
Several hospitals — including Massachusetts General and Brigham and Women’s hospitals in Boston, and Union Hospital in Lynn — are adding recovery coaches to emergency room staffs and long-term substance abuse treatment programs.
When addicts overdose and show up at the ER, they meet a coach who acts as a case manager.
Union Hospital hired seven recovery coaches as part of a project involving North Shore Medical Center and Bridgewell, which provides substance abuse treatment.
Leaders of the program say they’re hoping to expand the successful initiative by bringing on more coaches. They’ve asked the state for more funding.
Wendy Kent, Bridgewell’s director of behavioral health and prevention programs, said the coaches are effective because they share common experiences with patients, building trust.
“It’s beneficial for them to have the opportunity talk with someone who has been in their shoes — who they can relate to,” she said.
Kent said the coaches, who traditionally are enlisted after someone gets out of detox, are increasingly on the front lines in hospital ERs.
“The opportunity to reach someone when they’re in a crisis situation is obviously going to be greater when they’re in the emergency room,” she said.
A move toward a professional class of recovery coaches isn’t without concern, however.
Kennard, at Bridgewell, said he fully supports professional licensure for coaches but doesn’t want a certification system to become so rigid or cumbersome that it prevents former addicts who want to help others from getting involved.
Kent said there are also concerns about former addicts who aren’t ready to be mentors.
Most health care providers require a minimum of two years of sobriety to work as a recovery coach, but Bridgewell requires them to have been clean for at least six years.
“They’re dealing with a broad range of highly complex issues, including mental health disorders, and many of them are not ready to provide that level of care,” she said. “They’re still struggling with their own challenges.”
There are currently no legal requirements to certify recovery coaches, but the state Department of Public Health’s Bureau of Substance Abuse Services has for years operated a weeklong Recovery Coach Academy, which trains coaches to work at hospitals and other facilities.
The program has trained about 1,000 coaches to date, in addition to nearly 200 recovery coach supervisors.
Last year, the agency began certifying recovery coaches and requiring them to take additional training in ethics, cultural competency and motivational interviewing, according to a department spokeswoman. Then they must complete 500 hours of supervised work as a coach.
To date, at least 18 people have been certified through the program.
The agency has set new rules that go into effect next year requiring further training and an exam to become certified, among other requirements.
The state spent about $1.3 million in the previous fiscal year on pilot projects assigning recovery coaches to 11 ERs, including at Beverly Hospital and Addison Gilbert Hospital in Gloucester.
Baker’s initiative comes as state data show the number of opioid-related overdose deaths trending downward for the first time in 15 years.
Last month, the Department of Public Health reported that 1,470 estimated overdose deaths in the first nine months of 2017 represented a decline of about 10 percent from the same period a year earlier.
More than 2,000 people died from opioid overdoses in Massachusetts last year, with Essex and Middlesex counties particularly hard hit.
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group. Email him at firstname.lastname@example.org.