EMS Fights Opioid Epidemic

 Fighting opiate addiction is every bit as important as fighting the other diseases we encounter -- STEMI, stroke, trauma, sepsis and the like.

There is a tremendous article on the  JEMS website by Dr. Alex Garza and Dr. Sophia Dyer about EMS joining the fight against the opiate epidemic in a broader way than just responding to overdoses and administering Narcan.

EMS Data Can Help Stop the Opioid Epidemic

Read it, and then consider what is happening in your EMS system.

In ours, we are treating increasing numbers of patients addicted to opiates, some who get Narcan, some who don't, some who go to the hospital, some who refuse at the scene.  We see them all, but not all of them get into the system to get help.  Like those scene refusals, many of those who go to the hospital, leave AMA before they get a chance to get counseling.  While not all of them will desire or enter counseling, the health care system should at least be there near to the time of overdose offering help.

The fight against opiate addiction involves many players in the community.  EMS needs to be at that table, sharing what information we have and asking how we can best help -- through data collection to provide real time surveillance, through counseling patients who refuse transport, providing education to family members and friends on overdose scenes about where they can get Narcan for the next occurrence or where they can go to get counseling or into a treatment program, or as some cities are doing, providing Narcan to family members, prealerting EDs to arrival of opiate overdose patients so counselors can be available to provide intervention, and I am certain there are other ways we can help.

I am very excited to be attending such a meeting in Hartford this week, anxious to hear about the efforts community groups are making in the fight, and anxious to hear how we in EMS can best help.

I will report back on the meeting, and other efforts I learn about.

If you haven't already done so, seek out education on the nature of the opiate epidemic and of the disease.  The JEMS article is a great primer.

Election Day

 A 10-year-old girl was shot in the face in Hartford yesterday. She wasn’t walking down the street or riding a school bus, she was in her own home when the bullets raked through the front door. She doesn’t live on a busy street like Park Street or Albany Avenue where criminal activity can be going on at all hours of the day. She was on a quiet residential street with sidewalks and front lawns and single family homes. Clearly she was not the intended target of the bullets, just collateral damage. This isn’t the first time a child has been struck by a bullet in this country much less the first time in Hartford. Kids getting shot is pretty commonplace in urban American. Still I thought for certain it would be a big story of the national news. I envisioned the presidential candidates talking about it in their final speeches before the country. Sadly it is hard to find more than a brief mention of it a day later. An AP wire story, two minutes on the local news the night it happened, and it is already on its way to being forgotten.

A half mile away on the Avenue, the dealers are selling heroin bags with fairies on them.

People can complain all they want. They can rant against Washington. They can call one candidate corrupt and the other a spoiled imbecile. They can choose not to stand during the national anthem. But for damn certain everybody ought to vote Tuesday.

10-year-old Hartford girl shot in the face

Bad Batch?

 Hartford Cops: Rash of Heroin Overdoses Part of Upward Trend

 After a lull of a few weeks, the overdoses started going out again this week.  An hour after I left work Tuesday night, there was a triple OD that is widely being reported in the news, along with two other overdoses not long after.  The papers haven’t reported it, but I know of an additional overdose earlier in the day, who required two mgs of Narcan intranasal to resuscitate as well as a presumption the next day that the medics believed to be heroin related -- a young person with a heroin history found cold and stiff alone at home with no apparent trauma.  That person once toxicology reports are in may well be be added to the list of heroin deaths in the state that is estimated to reach almost 900 this year.

The police are working overtime to determine if this is due to a new bad batch of heroin (perhaps with Fentanyl) or just an anomaly.  My money is on a bad batch.  The police released pictures of the two brands found at the scene.  One skull and cross bones, which has been all around town for almost two months, and the second -- RR Rockafeller, an Australian apparel maker insignia, which is new this week.  The police say they not only want to find and arrest the dealers behind the heroin, they want to alert the substance abusing public to be careful.  I applaud them for this!  Police departments all over the country are recognizing that heroin users are a vulnerable population who need help rather than scorn.

Users will act in two ways due to the publicity.  Some will seek the brands out, hoping it will give them the El Dorado high they have been looking for since they were first seduced by heroin.  They may be cautious about using it, but some will get greedy and no doubt do too much.  These are people whose brains are not functioning properly due to the circuitry damage the disease has inflicted in their heads.  Other users will take caution.  They don’t want to die, they just want to get through the day.  These people need to be warned.  Fortunately the police are working with community groups to get the word out and help keep people safe.  

As far as EMS, we need not only to keep doing our job as we have been, but we need to explore other avenues to help.  These include:

1. Providing overdose information about how to obtain and administer Narcan to people who are on scene at the overdose (Provided your hands are not full resuscitating the patient.
2. Consider initiative that other states have embarked on -- allowing EMS to Pass Out Narcan to family members or friends and neighbors

Trick or Treat

 

Some heroin dealers in Hartford have switched up their drug stamps to celebrate Halloween. Drug Users are being treated to brands such as Killer Clowns, Freddy vs. Jason and Casper (the Friendly Ghost).

The question for the users on Halloween (and one every day they buy): is their special envelope a trick or treat?Are they getting heroin? And what is it being cut with? Brown sugar, baby formula, Benadryl, rat poison, caffeine, paracetamol, chloroquine, quinine, flour, chalk, talcum powder, sucrose, starch, powdered milk, acetaminophen, Fentanyl, or Carfentanil? (1) Will the bag get them high or will it kill them?
I wonder when they buy, did the dealer wear a Scream mask? Was he dressed like a killer clown? Did he wear a Donald Trump mask, or was he dressed like Superman? Did he hang skeletons and carve and light jack o'lanterns to guide the drug users to his evil drug lair?

And when the drug users look at themselves in the mirror on Halloween, do they hope that it is all just a scary dream that they will wake up from and everything will be normal again? Instead of finding themselves alone in a public restroom, will they be in their own bathroom off the master bedroom where their pretty wife waits for them, and their darling children are asleep nestled in their bedrooms of the house built with hard work and sweat.

All just a dream

Just a dream.

Please just be a bad Halloween dream.

(1) Wouldn't it be nice if heroin dealers had a better business accreditation in which they certified their product was free of impurities? Users then wouldn't have to play Russian Roulette every time they scored. I am not there yet, but every day I grow closer and closer to thinking we need a model where addicts are allowed to purchase their dope in an inspected pharmacy and use in a clean setting, oversee by medical people with access to narcan and substance abuse treatment.

he Wolf and the Sheepdog

 

In the Looney tunes cartoon, Ralf E. Wolf and Sam the Sheepdog go to work each morning, exchanging greetings while punching the clock.

"Morning, Ralph," the dog says.

"Morning, Sam," the wolf replies.

Then it is down to business. The wolf spends his hours trying to steal the sheep and the sheepdog spends his hours trying to stop the wolf.

At the end-of-the-day when the factory whistle blows, Ralph and Sam punch out, wishing each other good night, before heading home presumably to their families, a hot dinner, and a sound sleep. They return the next day to do it all over again.

It is a vision of the world that I would like to believe in. I sometimes think of Hartford in the same terms. In the morning at the bakery on Park Street, there are drug dealers, drug users, police and paramedics all in line for their coffee, doughnuts, or breakfast sandwiches. Everyone is convivial. Then it is off to work.

The dealers try to sell their product, the cops try to stop them. The users try to use, and we try to see that no one gets hurt.

When I respond to the city lockups or even on arrest scenes where we are called to evaluate a person in handcuffs who may have fallen during a foot pursuit, there is often a common courtesy, even friendliness, among everyone in the same way that players from rival sports teams may chat at halftime or during timeouts. This, of course, is not always true as there are often times where there is a certain chest-puffing, accompanied by profanity and anger, between victor and the fallen. Still, I like to think there is a comradeship of us all belonging to the same city and same species. I remember after the UConn Men's basketball team won their first national championship in 1999, shocking the world by upsetting Duke, everyone in the jail house was in high spirits, cops and robbers both, saying "How bout those Huskies!"

An idealist, I believe we are all, at essence, just people, following the course of our lives that we don't always control. I was more likely to become a paramedic than a drug dealer. The cop came from a family of cops, the drug dealer from a family of drug dealers, the drug user found himself there after an accident, prescription painkillers that he grew too fond of, or maybe a childhood of abuse that rewired his brain and made him less likely to make the proper choices. I, of course, ended up there because I watched the TV show Emergency and had a crush on Dixie McCall.

As a paramedic, I have had, in my ambulance, injured cops, shot drug dealers, overdosed users, and fellow EMS responders with blown-out backs. They are all patients and I treat them the same. We have conversations, we talk about our families. I believe there is a fundamental goodness in most of us.

But clearly there is darkness in the world. There are cops who cross the line, there are paramedics who don't give a shit, and there are drug dealers without conscience.

I am going to take the position that not all drug dealers are evil at core. Bear with me on this. There are some dealers who I believe are honest businessmen who just want to make a living, and who adhere to basic principles. They provide a product to people who would be sick without it, people who come to them freely. They pay their associates fairly, they charge fair prices, and they deliver the product they advertise. They don't rip their customers off. They develop a clientele, who they look out for, sometimes extending credit during hard times, maybe giving them an extra bag at Christmas or on their birthday. These dealers do not want their patients to die.(1) They want them to be Happy, to feel Passion, to find Peace. These dealers and there may only be a few -- I do not know --are a different breed from those who have only darkness in their hearts. Those dealers are the ones spiking select doses of their heroin with fentanyl to deliberately cause fatal overdoses to increase advertising for their brands. Those predators are the ones who put Carfentanil in their bags a drug that could kill not only the patient, but the cop, the medic, the lower level drug dealer selling it on the street and the child who picks up the wrapper with the panda bear on it . They are the villains who cross the line in the same way a rogue police officer delivers an unnecessary beat down or a paramedic lets a patient die out of laziness or spite. There was no pure evil in the Looney Tunes world, but that was after all just a cartoon.

1) Writing this, I had a vision of a benevolent dealer who along with the bundle of Crazy Monkey gives each customer a small plastic shopping bag containing clean needles, Narcan, and pamphlets about where to get substance abuse treatment.