When Matthew Sheppeck, 27, an addiction outreach specialist who works in Kensington, spotted a young man slumped against the wheel well of a parked car, his training on how to use naloxone kicked in.
Story by Ilene Raymond Rush
Photos by Peter Tobia
Kneeling beside the man, he began a sternal rub. When the individual didn’t respond, Sheppeck called 911, then applied pressure to the tissue beneath the man’s nails. Still receiving no reaction, Sheppeck lifted the man’s head and applied Narcan – a brand name of naloxone – to his right nostril. It took a second dose before the man came to.
The experience shook Sheppeck.
“It was a bit of a rush, you’re walking down the street and making close physical contact with a person and you’re trying to make sure they stay alive,” he said. “It took a little to decompress from that.”
Sheppeck is one of three addiction outreach specialists who work with David O’Gurek, an associate professor of Family and Community medicine at the Lewis Katz School of Medicine at Temple University.
O’Gurek is the co-medical director of TRUST (Temple Recovery Using Scientific Treatments) Clinic, which includes a mobile medical van that has parked along Kensington Avenue since July on Mondays through Thursdays to assist individuals dealing with homelessness and substance use.
The effort has received $1 million in funding from the Center for Bioethics, Health and Policy at Temple. Since the outreach program started in November of 2018, the three addiction outreach specialists have made over 600 contacts with 217 individuals, 50 of whom have agreed to join O’Gurek’s program to use buprenorphine, a medication used to treat adults with opioid use disorder.
The team also distributes naloxone.
Although Sheppeck has not witnessed any deaths from overdoses since he started working for the group last November, he says overdoses are familiar occurrences in the neighborhood.
“If you overdose on the avenue, usually someone within twenty feet has Narcan,” he says. “Which is a really good thing, since otherwise there would be many more deaths.”
“Naloxone saves lives and I’m a huge proponent for people learning to use it,” adds O’Gurek, 36. “But I also feel strongly that people should know how to use it.”
O’Gurek’s program works to improve the health and lives of people impacted by homelessness and substance use disorder. Supported by a board whose members live in the community or work in local nonprofits, it tracks individuals, helping them to access social services and offering evaluations for everything from medical issues to childhood trauma. Patients are also asked if they might be interested in receiving buprenorphine.
“We’re certainly not pioneers,” says O’Gurek. “There have been mobile vans or ‘street medicine’ for years.”
He points to earlier mobile methadone units, which fell under a government moratorium, and to other units currently on the streets of Philadelphia, including one run by Prevention Point.
But he does see his effort as a new model to try to comprehensively confront the problems of homelessness with the community’s support and input.
While stressing that the program is about the community and not about research, O’Gurek’s team is studying their efforts to measure the impact and see if they are making a difference.
O’Gurek’s emphasis on listening to the community comes from his own background growing up in an extended family in a small town in Carbon County’s Summit Hill, near the town of Jim Thorpe. It was a small town where “if you did something bad on one side of town, your mother would be yelling at you from the porch by the time you got home.”
His interest in medicine stemmed from talking to his fellow townspeople during his summer’s home from college while working at a local bank.
“Talking to people and hearing about their lives got me interested in the notion of family and the greater sense of what that looks like in a community,” he says.
Students take to his message and teaching, so much so that this year’s medical school class dedicated their yearbook to O’Gurek.
On the van, O’Gurek puts into practice this notion of forging interpersonal connections with patients, instructing his students that “whether it’s addiction or primary care, having some sense of closeness is what patients look for, particularly in a primary care physician.”
While Narcan is a big part of his practice, and although it’s extremely effective, an unnecessary dose can leave a patient feeling very sick.
“Widespread education on how to utilize it, why to carry it and making sure that it is in as many hands as possible is great,” he said. “It should be in well intentioned hands who are following the protocol as it should be done.”
Although O’Gurek has administered the drug multiple times during over the past several years, often while he is simply walking along a city street, he shrugs off any idea that he ‘saved a life.’
“You could look at it that way, but I see it as doing a civic duty and fulfilling my responsibility as a citizen,” he said.
All of which fits in with his central idea: that along with scientific knowledge, caring for others is at the basis of the healing community.
“Medicine always called on me to be a fighter for the underdog,” he says. “I loved working with urban and marginalized communities, a population not receiving the respect or care they deserved and felt like it was our role in medicine to do more for them.”
“We don’t want to pretend that we have the answers,” he says. “We want to gain people’s trust.”
“We’d like to put ourselves out of business,” he says. “This is the bridge mechanism to facilitate that.”