In the middle of your shift you get the call, “unconscious person.” This is yet another grey area within the mountain of calls received in a given shift working in EMS (emergency medical services). Grey because of the unknown, unconscious from what? Only moments separate you from the answer. As you enter the home you find a young woman lying on the floor. Her breaths are agonal (she’s grunting but not breathing normally), her fingernails and mouth show hints of cyanosis (bluish tinge), her pupils are dilated but she has a faint (threadlike) pulse, you see track marks on both arms. Nearby on the floor the culprit of this unconscious victim, a residue laden spoon and syringe…it’s a heroin overdose.
According to data from the National Institute on Drug Abuse, over one half of people using heroin are addicted to the drug. Sadly, the median age of abusers is around 23 years old. In the time of life when you are just figuring out what life is really all about, some young people are risking their lives to get high. Recently, in addition to the white, dark brown or black tar heroin used by addicts a new and dangerously powerful combination has hit the streets, heroin laced with the drug fentanyl. This combination is proving to be deadly even among first time users due to its lethal recombinant. Heroin abuse is reaching a tempest in cities and towns all across the United States. Nowhere is this as powerfully demonstrated as right here at home in Central Ohio, where on November 12, 2015, Mayor, Michael B. Coleman, related that in September of this year alone EMS responded to over 200 calls linked to heroin overdose! This is not a temporary crisis, this is a growing epidemic.
Those within the EMS drag-line are accustomed to responding to a variety of calls in a given shift, but some sights stick in the psyche like superglue. Overdose cases can be one such call. Many in the emergency response field are also parents and with the average age of heroin users trending younger, sometimes you can “feel” the victim’s parent’s grief and anguish – particularly if 911 was called too late and the victim’s life was not able to be saved. Heroin addicts can sometimes make decisions while high that under normal circumstances they would never have fathomed themselves doing. Being an EMS responder you see both sides, including when innocent victims get hurt or worse as a result of addicts highs or need to get high. If the stress of responding to such cases is getting to you, or you personally have a friend or family member who needs help in dealing with addiction there are resources available to help you.
What, if anything, can be done to reduce the EMS call volume related to heroin overdose?
Enter Naloxone (Narcan). Narcan, as it is typically known within the medical field, is an opiate reversal drug. Narcan’s effects can reverse the primary symptoms (particularly useful with respiratory distress) of overdose victims. Many states are taking proactive approaches in the administration of Narcan by trained laypersons in addition to the professionally trained EMS first responders to help reverse the effects of heroin overdose. But will this curb the rise in EMS calls related to heroin overdose? A great deal of thanks and gratitude to the Webmaster of the Fire Department of New York City (NYC) EMS, who stated, “It (narcan) will not lower overdose calls, but it will save (the) lives of those who do overdose.” I also thank Columbus, Ohio, Chief of Trauma (EMS) Systems, Timothy Erskine, who stated, “The administration of Naloxone (narcan) by anyone is a harm reduction strategy. It will not stop people from becoming addicted to opiates, or treat current addiction, it will just treat the current overdose.” Both speak to a simple reality, heroin cases and overdoses are on the rise without an end in sight.
November 18, 2015 in Southeastern Ohio one of the largest drug seizures in area history was made (to the tune of $1 million in street value along with the arrest of a major Mexican drug cartel member). With that seizure, however, underlies a bigger question – what was the demand on the streets negating a shipment of drugs that large? After all, it’s simple mathematics, supply = demand and vice versa.
Is legislation going to become a partner in reducing the amount of overdoses?
New Jersey EMS has an integral approach to EMS calls and narcan administration stemming from a May 2013 law introduced by that state to provide immunity for witnesses and victims of overdose who call 911 for help. Likewise, the State of Illinois introduced the 911 Good Samaritan Overdose Law into its legislature providing similar anonymity to those who call 911 for help. Will other states, including Ohio follow suit in the wake of increasing overdoses? Only time will tell.
Ultimately, treatment and long term support provided to addicts seems the only viable solution to curbing the skyrocketing trend of heroin overdose. Even in this, at least in our State and area, a variety of catch twenty-twos exists. Some (but not all) long term drug treatment facilities will not admit an addict who does not test positive for heroin (or drugs of abuse) at admission. So, for an addict recovering from an overdose that has been discharged from a hospital, and managed to stay clean from heroin in an attempt to turn life around, you would have to get high in order to be admitted to the facility. How frustrating that must be, to have to reintroduce a drug that, depending on which strand is used, may kill you before you have the chance to get clean for good. Perhaps such treatment facilities should revisit their admissions protocols in order to facilitate those who are committed and desperate to make a change to save their lives.
Solid commitment to a program, even with the most supportive family and group of friends, can be a challenge to a heroin addict. Changing more than just a mindset is necessary, often it is changing where you hang out, who you hang out with, even where you go for leisure activity. To see a more in-depth forum on how heroin affects victims, families and the community, I strongly encourage you to tune in to WBNS 10Tvs upcoming special, “Heroin at Home” an hour long presentation, November 30, 2015 at 10 p.m. EST. (Special thanks to Jodi Andes, Supervisor of WBNS 10 Investigates, for permission to feature this upcoming presentation in this article.)
If you are on heroin or you know someone who is, there is hope and help available. We may not be able to overcome this epidemic but we can use the EMS tools available to improve outcomes. Until next time – good health to you!