In Pennsylvania, the opioid epidemic has killed more people than any other health crisis in the state’s modern history, with fatal overdoses ranking the fourth highest in the country. The disaster is so acute that Governor Tom Wolf last year issued the first-ever Statewide Disaster Declaration for a public health crisis in Pennsylvania. Wolf and other state leaders are working harder than ever to increase access to treatment, including outpatient medication treatment.
Dr. Julie O'Hara is one medication treatment expert who has answered the call of this battle. Recently named for the second time a "Top Doc for Addiction Medicine" in Philadelphia, O'Hara brings her own harrowing experience to her role as Center Medical Director for CleanSlate's two outpatient addiction centers in Philadelphia as well as its center in Scranton. O'Hara's journey facing addiction personally has given her a remarkable ability to connect with patients in ways that have made her popular and beloved throughout her career in addiction medicine.
(Pictured: Dr. O'Hara with her parents at the opening white coat ceremony for medical school in 2000. A family history of addiction, driven by trauma, would eventually lead O'Hara to pursue a successful career in addiction medicine.)
“Ten years ago, if you had asked me if I would be working in addiction medicine, I would have laughed," she says now. Addiction was such a painful part of her family background that she wanted to run as far away from it as possible.
"My entire life has been shaped by addiction," she reflects. "The thought of choosing that path seemed impossible."
(Pictured: Leo O'Hara with his three sons, Stephen, Alan, and Kevin (L-R). A tragic accident would set the family on a path of addiction.)
O'Hara's relationship to addiction began after a devastating tragedy when her family still lived in England.
While crossing the street, her seven-year-old brother, Stephen, was hit by a car and killed.
Both parents blamed themselves; the boy was fetching a newspaper for his dad. "My mother could not exit the street on which the family lived without driving over the precise spot where Stephen was killed," says O'Hara. "It was all too much for her."
(Pictured: The O'Hara family in happier times, a year before Stephen's death.)
O’Hara was born after the family moved to the U.S. for a fresh start. The initial joy over the birth of the family's first daughter did not last long, as grief returned and both parents sought solace in alcohol.
After 23 years of marriage, O'Hara's parents divorced. "We were all victims," O'Hara says. "It was a violent, explosive household infused with blame and guilt." O'Hara's mother was too griefstricken to care for her consistently. After O'Hara moved in with her father, he sought out therapy. "There is no hope for you to heal if I don’t get well myself," he told his daughter.
(Pictured: The O'Haras trying for a fresh start in the U.S., with baby Julie. The family's enduring grief over Stephen's death led to addiction and further devastation.)
O'Hara eventually received her Bachelor’s Degree at the University of Pennsylvania, a Master’s Degree in Applied Statistics at Villanova, and spent the next ten years as a Special Studies Consultant in the pharmaceutical industry.
Life had stabilized for O'Hara. Even her mother was now a consistent, supportive presence in her life, though still occasionally relapsing with alcohol.
O’Hara excelled, finally embracing life with a promising career, a beautiful daughter and the next one on the way.
Then the unthinkable happened.
In 1992, one of O'Hara's two remaining brothers, Alan, was diagnosed with HIV. He died a terrible, anguished death from AIDS the following year, on his 34th birthday.
O'Hara's second daughter had just been born four weeks earlier.
(Pictured: Alan O'Hara, standing to the left of his father [top, middle], eight months before his death.)
Alan was the sibling hit hardest by Stephen’s death. He had struggled emotionally growing up in the U.S., not able to move beyond his grief, just like his mother. He turned to drugs and disappeared for a couple years in the Philadelphia streets of Kensington.
While AIDS was the fatal blow, addiction took his life.
It was a heartbreaking end to a painful journey. At every corner through his illness, Alan was faced with stigma and discrimination, denied resources that his family had sought on his behalf.
"I had such anger seeing my brother being turned away, refused housing and jobs," O'Hara says. "I would think: 'This is someone's son, someone's little boy, someone’s big brother.' I still tell myself that about every patient that I see."
O’Hara vacillated between despair and fury. She was forced to watch her parents destroyed yet again. Her own devastation as she witnessed her brother’s suffering and death was "nothing in comparison" to what she felt for her parents, as she saw them suffering.
“There just aren’t words to describe the sight of your mother and father completely broken and inconsolable," she remembers. "Watching them stand over yet another dead son, each clutching one of his hands, brought me to my knees. My mother’s sobs did not sound human. They echoed off the walls. It is that single moment that is by far the most painful of my life.”
O'Hara thought this would be the end of her mother for good. “We all crashed and burned for a while," she recalls.
But four years later, her mother asked for counseling.
Unbeknownst to her surviving brother and O'Hara, the psychologist made plans for her mother to enter a rehab facility for alcoholism. She was then transferred to another facility, which specialized in grief counseling.
(Pictured: O'Hara's mother with O'Hara and daughters, just prior to entering rehab and grief counseling. Before then, she always wore a heavy burden of sadness.)
Four weeks turned into four months, and on her mother's day of discharge, O’Hara witnessed a miracle.
“Walking towards me was someone I barely recognized," she remembers. "I could even see it in her step – that quiet, unshakeable strength. I ran into the arms of my mother, who I discovered was the most courageous woman I have ever met. My mom became one of my greatest support systems. Her love for my children and me was unconditional.”
A magic touch
O’Hara found herself retaking inventory of her life. She left her husband, and with two young daughters to care for she began medical school. School and residency under those circumstances were possible only with the assistance of both parents and her remaining brother.
But addiction still found O'Hara, personally and professionally.
Her first week as a traditional internist, she entered the exam room of a young man who was curled up on the floor and sobbing uncontrollably. At a loss, O’Hara simply sat on the floor next to him and let him cry. After several minutes, the patient sat up next to her and confessed his polysubstance addiction and how he was now facing the prospect of losing everything.
Whatever she said or did, it worked; that day was the last that this patient ever used. O'Hara ran interference with his boss and landlord, buying some time so that the patient could be detoxed. One year later, this man had his life back, was promoted at work, and had bought a house.
Word spread amongst patients that O'Hara had a magic touch, and strangers began tracking her down to ask for help.
"I discovered that I did well working with patients suffering from addiction," O'Hara recalls. “I suspect that most of that was because of my comfort level with addictions and an ability to see that the person is not the addiction.” She found her career evolving to include more and more addiction treatment, which finally became full time as she worked at an inpatient addiction facility.
But even with a magic touch, her experience treating patients became disheartening.
“Regardless of powerful connections established with inpatients, once discharged the relapse rate within one year approached 95%," O'Hara says. “Worse, with chance of relapse high, so was the chance of OD and death, as patients failed to understand that they no longer had tolerance.”
Turning point with medication treatment
At work, O'Hara found herself increasingly drawn to medication treatment, which she learned about through her mentor in the addiction field. She was contemplating starting an outpatient practice of her own when she discovered CleanSlate, and was pleased to see that the company's model echoed her own interest in moving towards outpatient treatment using medication.
O'Hara began as the Medical Director at CleanSlate's center in Scranton, then moved to Philadelphia when the company opened its first office in S. Philadelphia. Currently, O'Hara rotates between CleanSlate's two Philadelphia centers as well as the center in Scranton.
(Pictured: Dr. O'Hara with Alisa Scarantino, Center Manager of CleanSlate in Scranton, PA.)
Since beginning at CleanSlate in Philadelphia, O'Hara has dived into the emergency in the city head-on, developing partnerships with organizations like Prevention Point, Philadelphia Fight, and other community leaders.
"I thought I knew what a state of emergency was," she says. "I didn't. After the first meeting with Prevention Point, I climbed into my car and cried. I was surprised by the intensity of my reaction. I simply couldn’t believe what had evolved in my hometown.”
O'Hara and her team have made inroads but still encounter roadblocks, especially when it comes to stigma. "We found one of our patients beaten and robbed. We cleaned him up - and the pharmacy wouldn't even give him a script. These people get so pushed around. It's a tough population to keep motivated to continue coming back."
O'Hara is happy to have turned her professional focus to medication treatment. "The beautiful thing about addiction medicine is that there is finally consensus around the country about how the neurophysiology works," she notes. Even if there isn't consensus about treatment for polysubstances, there is growing acknowledgment that medication treatment for opioid and alcohol use works.
"I'm passionate about what we stand for and I love this company," she says.
As part of CleanSlate's value system, O'Hara believes in educating patients about their recovery, because she knows that they can manage better when they understand what to expect.
Towards that end, she approaches her patients with ease and attention, no matter what the circumstance. "I never have a script, I never walk in with an agenda," she says. "Initially I tried to do that. But now I am very much myself. I ask patients to tell me what's going on and what brought them here. The patient needs to feel that they have been acknowledged and heard. Everyone needs that."
Based on her own experience, O'Hara is careful in how she encourages patients.
"'It gets better' are words that rarely suffice to be helpful," she says. "'This is about as bad as it gets,' on the other hand, is immensely reassuring. Things feel less overwhelming with that perspective."
O'Hara tells her patients that they already have everything they need to get better. “We are just here to help you along the way,” she says.
Hope, healing, peace
In January 2013, O'Hara's mother passed away. There was a haunting coincidence: she died on the anniversary, down to the minute, of her son Stephen’s death five decades earlier.
Last month, O'Hara's father also passed away. That loss is too fresh for O'Hara to comment on just yet.
(Pictured: O'Hara's father with her daughters, Taylor and Kristin, on their last family vacation. The O'Haras were active in helping to raise their granddaughters after recovering from their own addiction and trauma.)
“The beauty of my family’s story is that despite horrific loss, each one of us managed to find some measure of healing," she says. "As for my last remaining brother and me, our journeys were made possible by our parents. Our success in life is because of our mother and father, not in spite of them."
O'Hara has a wisened perspective on what it means to heal.
"Healing does not imply the presence of unbridled joy," she says. "Rather it means finding the peace that results from acceptance.”
While her parents could laugh, be witty, and entertain friends, O'Hara recognizes that there was always a part of them which was sad. "You could see it when one of them turned their heads to gaze out a window, stop and listen to the words of an old song," she remembers. And that ever-pervasive sadness was independent of any drug abuse; "It was simply life’s terms when two of your four children die terrible deaths right in front of you," says O'Hara.
Now O’Hara uses her own experience to teach people that there is always hope. "I tell people that - no matter what - they can find the peace to move forward."
All of us have peace within our grasp because we always have choices, O'Hara believes.
"Even in the worst circumstances, where we can't exact change,” she says, “We can always choose to accept."
A favorite passage that helps O'Hara make peace with her own story is from Albert Camus. His words articulate a vision of strength and courage that she wishes for all of her patients, as she works with them every day towards a path of recovery and hope:
"In the midst of hate, I found there was, within me, an invincible love.
In the midst of tears, I found there was, within me, an invincible smile.
In the midst of chaos, I found there was, within me, an invincible calm.
In the midst of winter, I found there was, within me, an invincible summer.
And that makes me happy.
For it says that no matter how hard the world pushes against me, within me, there's something stronger - something better, pushing right back."
(Leo O'Hara with his son, Stephen, during "the happiest time of his life." Both now forever at peace.)
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