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A Southern Colorado Cure for Washington’s Healthcare Reform

Pueblo doctor John Thomas runs a direct primary care model practice, where a flat monthly fee is all that’s required for care.

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Insurance is never billed at On Point Primary Care, run by Dr. John Thomas, a Colorado native who set up the practice as a first of its kind south of Colorado Springs. Photo by Jason Prescott

Dr. John Thomas, a family doctor in Pueblo, is sidestepping Washington politics on healthcare with his practice.

The back and forth between congressional Republicans and Democrats on repealing and replacing The Affordable Care Act even had President Donald Trump admitting, “Nobody knew health care could be so complicated.”

But Thomas doesn’t think the topic has to be. He wants to help simplify things by changing the way Puebloans, at least, view health care.

Thomas runs On Point Primary Care, which he describes as an “efficient three-room family medicine clinic” where he offers patients “unheard-of access … via email and text, spends up to an hour with them during office appointments and provides a lot of medical services and prescriptions at seriously discounted rates.”

On Point takes advantage of an alternative payment model for primary care that bypasses insurance companies altogether. In the model, called Direct Primary Care or DPC, patients are billed a monthly “membership” fee, which for adults runs between $35 and $75 depending on age.

“The fee covers all of their basic primary care needs, and their insurance plan (if they have one) is never billed,” Thomas says.  “The model allows for improved access, unlimited visits, discounted medications, labs and radiology services without insurance copays or deductibles.”

Dr. Thomas’s practice comes as a godsend to those unable to take advantage of Colorado’s expanded Medicaid program but who can’t afford health insurance. “A majority of our patients are hard-working citizens whose income is too high to qualify for Federal programs and who simply cannot afford even the least expensive insurance offered on the marketplace,” Thomas says. “We offer a cost-effective way for these people to get primary care. Otherwise, they would probably use emergency room or urgent care centers for routine care. That is too costly for everyone and does not give these folks any continuity of care.”

The people who Thomas treats are considered outlaws under the current Affordable Care Act, which mandates that those who do not receive government medical assistance or who are not covered by their employers buy health insurance on their own, regardless if they can afford the insurance or not, or pay an ever-increasing annual fine to the IRS.

Under the most recent GOP plan that passed the U.S. House of Representatives on May 4, the individual mandate under ACA would be eliminated. So it stands to reason the Republican plan would be a win-win for Thomas’s Direct Primary Care model and the majority of his patients should the individual mandate’s elimination remain in the Senate version. In addition, the DPC model can share its victory with certain health insurers who provide less-expensive catastrophic plans that insure against cancer, heart disease and other serious ailments that the DPC model does not address.

Yet what might or might not happen to ACA is not what has Dr. Thomas excited. ACA’s possible repeal was only a secondary legislative interest to the doctor compared to an action taken this year by the Colorado General Assembly. Gov. John Hickenlooper signed the Direct Primary Health Care Services Act (HB 17-1115) into law on April 24.

“The bill will further elevate DPC as a viable practice model to achieve the quadruple aim in health care — improving population health, increasing patient satisfaction, reducing per-capita health care spending and addressing clinician and staff satisfaction,” Thomas said. “With the possible elimination of the individual and employer mandates under the Republican federal health care plan, we have an opportunity to provide cost-effective, quality primary care to people who are in need.

“We have no pre-existing symptoms restrictions, and we welcome those who cannot afford insurance coverage. We would like to see the development of an inexpensive catastrophic care plan that would pair perfectly with the DPC model. Unlike our complex third-party insurance system, there’s no great mystery to On Point Primary Care: you simply pay for a service and you get that service. That is how health care once worked, and we are bringing it back with the human element at center stage.”

However, Thomas elaborates although he encourages his patients to have insurance coverage as a “back-up plan” against catastrophic events or in-patient hospitalizations, “it is important that our patients understand that our monthly subscriber fee is not an insurance premium and that we do not offer insurance.” Yet if his patients want such insurance, Thomas said he is happy to point them in the right direction.

Thomas’s DPC practice is not limited to patients with no health insurance and, in fact, prefers to work with patients who have cheaper insurance with higher deductibles and copays. “We also see a group of patients who participate in Medical Health Share programs. Although not for everyone, these programs facilitate sharing of health care costs among individual members. The programs function similar to insurance and are probably the best alternative to conventional health insurance for about half the cost. Some programs will even reimburse members for our monthly subscription fees, too.”

You might call the DPC model a career obsession for Thomas. A Denver native, he received a degree in Kinesiology at the University of Colorado Boulder. From there, he completed his Doctor of Medicine at the Medical College of Wisconsin in 2002.  After that, he received his board certification in family medicine through a Medical College of Wisconsin-affiliated program and later became an assistant clinical professor with that college in 2005. He opened On Point Primary Care about a year ago.

“We came to Pueblo because I had an opportunity to be at the forefront in changing primary care in America,” the doctor said. “When my children ask me later in life why we left Wisconsin, I wanted to be able to reply, ‘Because I wanted to create a medical practice I believed in.’ I’m blessed that we have opened a clinic with integrity as its foundation. I’m able to provide my patients with the quality of medical care that I was taught and that they deserve.”

Thomas’s practice is one of 620 that operate using the DPC model in 47 states. More than 10 percent of those clinics are in Colorado. On Point was the first independently owned DPC clinic to open in the state south of Colorado Springs.

“We just don’t need insurance for common medical issues in primary care. Removing ourselves from the traditional fee-for-service model reduces costs from both a business and a care perspective by 70 to 90 percent,” Thomas said. “Therefore, we are able to pass these cost-savings on to our patients by providing better care and increased services for less out-of-pocket expense.”

Thomas says the typical DPC clinic sees 700 patients per year whereas the average fee-for-service provider, which takes health insurance, sees between 2,000 and 3,000 patients per year. And that explains why Thomas can spend much more time with his patients than most other doctors in Pueblo.

“We have been well-received in the community,” Thomas said. “Our patients have been the most vocal proponents and supporters of On Point Primary Care. The clinic’s growth has exceeded my initial expectations for its first year and will achieve 50 percent of our total capacity by July.”

He adds he will stop taking new patients when he is unable “to deliver accessible, cost-effective quality care to my patients.”

Although Thomas would be content to leave his clinic as is. He is open to the possibility of expansion. “Currently, I am considering the logistics of creating satellite clinics in the southern area of Pueblo and in Pueblo West, but I think this is a few years away. Creating additional clinics to serve more people would require that I connect with like- minded care providers who share similar care philosophies. I have other ideas about establishing a multi-provider integrative clinic as well. Time will tell.”

And time will tell if a new GOP-inspired national health care plan would make clinics like On Point Primary Care more popular among patients, particularly those in Pueblo.

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1 Comment
  • Carol

    I pay Blue Cross Blue Shield $850/month for insurance having a $6000 deductible. I’m not likely to ever meet my deductible, so basically I pay out of pocket for all of my exams, drugs, and routine tests. Before I joined On Point Primary Care, I’d see my doctor once or twice a year for a 10-minute, $150 visit. I never got good care and never was given time to really talk about medical questions that concerned me.

    In contrast, for $75/month, I now receive WONDERFUL care from Dr. Thomas as often and for as long as I need to see him. Quick question: I text him. Longer question: I schedule a phone conference. Need to show him something: I schedule an exam. On Point has saved me SO MUCH on drugs and tests that my subscription has basically paid for itself. I will NEVER go back to an insurance-based doctor now that I have seen the difference that a Direct Primary Care physician can make to my health (and to my pocketbook!).

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Middle schoolers have a plan to stop rock art tagging in Western Colorado

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Courtesy gjhikes.com

GRAND JUNCTION, Colo. (AP) — Arron Buehler’s day in a western Colorado canyon might not have had the Hollywood panache of Ferris Bueller’s day off, but something about seeing Buehler’s name scrawled on the sandstone escarpment gave Chris Joyner pause.

Joyner, spokesman for the Grand Junction Office of the Bureau of Land Management, looked at Buehler’s name — and those of many others emblazoned on rock in a canyon south of Grand Junction — and said that, paradoxically, there might be a reason for hope.

It was just last year that Buehler posted his name, next to Elizabeth, who left her mark in 2017.

Few of the names appeared to be more than a year or two old, and, “That tells me there’s opportunity here,” Joyner said.

The more recent the markings, the more likely the vandals are to be found, and the more likely it is that other methods might discourage younger people from following Arron Buehler’s lead, Joyner said.

Joyner and BLM archaeologist Alissa Leavitt-Reynolds are working in Grand Junction to deal with vandalism on federal lands, whether it be by graffiti artists such as Charley Humpy (who helpfully added, “Remember me” next to his name and yes, the BLM is doing all it can to achieve total recall), drug users ditching evidence in the desert, mayhem by “marksmen” and plain old dumping.

As much as Arron Buehler and a multitude of companions — Brian, Charley, Dizz, Dominique, Kay, Megan, Elizabeth, Jon, Sam and Tosha all seem to be begging for court dates (and Tosha, did you know your name covered an ancient petroglyph?) — Joyner said prosecution ought not be the only response to a growing trend of vandalism and worse on western Colorado’s rocky outcrops and arid landscapes.

Citations for vandalism aren’t tracked by the Colorado U.S. Attorney’s Office, which prosecutes offenses on federal land, so no precise numbers are available.

An Army veteran, Joyner is using his post 9/11 GI Bill funds at Johns-Hopkins University to study ways to divert people from what he terms “dysfunctional visitor behavior.”

“Dysfunctional visitor behavior” has a more authoritative ring than “vandalism” and “littering” and Joyner said he hopes that a scholarly approach can help agencies fend off some of the destructive activity on federal lands before it takes place.

Some of his research suggests that “informed participation in nearby historic and cultural sites” can influence the way many residents perceive those sites, Joyner said.

The students in Ginger DeCavitch’s social studies classes at Mount Garfield Middle School experienced “informed participation” last summer.

DeCavitch took her students into Bangs Canyon to see the mica mine and found the defaced escarpment “as we were stepping over broken beer bottles and charcoal” from fires.

Vandals had used charcoal to scratch names and slogans on the rock, DeCavitch said.

“They call it tagging” and few participants see any issue with defacing the rock, taking selfies and posting them on social media, DeCavitch said.

She contacted the BLM soon afterward to see if her class could help clean up the mess they found.

“They all wanted to go back,” enough that some students hauled 40-pound containers of water down an occasionally difficult trail to help clean the site, DeCavitch said.

Her middle school students sat silent as members of the Southern Ute tribe described how they perceived the canyon and the ancient markings, many of which had been defaced, DeCavitch said.

Far from being discouraged, her students were enthused about tackling the enormity of the defacement, DeCavitch said.

“We have a plan that we’ll be back,” she said.

Introducing young people properly to wild lands is one way to discourage future vandals and dysfunctional visitors.

It’s one “foot-in-the-door” tactic that Joyner hopes land managers take up.

Visitors also can be endowed with a sense of ownership by agreeing with a simple proposition — the idea that one ought not litter on public lands, for instance — and then be brought along to agree with how to visit them appropriately, Joyner said.

It’s part of a human tendency to want to be consistent, he said. People who agree not to litter tend to want to build on that as opposed to act in contradictory fashion, he said.

Even providing a small gift or trinket can engender a sense of responsibility among potential vandals, Joyner said.

Other techniques include the “broken-window” approach — the idea that replacing broken glass as soon as it’s found and thus denying miscreants their moment of victory — isn’t as easy as it might be in other environments, Joyner said.

DeCavitch’s class, for instance, learned that while cleaning up a mess might eliminate an eyesore, it also could erase history.

Her eager middle-schoolers couldn’t go forward with the cleanup until members of the Southern Ute Tribe, headquartered in Duchesne, Utah, approved the plan, DeCavitch said.

While Joyner’s studies have suggested that males 16 to 25 who live within 60 miles of Grand Junction are the likely offenders, one look at the escarpment suggests that young women are more active participants than crime statistics might suggest, Joyner said.

One study suggests that younger people prefer non-coercive approaches, but Joyner said that doesn’t mean the BLM is losing interest in prosecuting vandals and others.

Far from it.

BLM officials routinely contact school officials and consult high school yearbooks to match the names they come across with people who could be prosecuted.

Some miscreants make it easier, posting selfies of themselves with their works. Some even lower the level of difficulty by including hashtags.

The criminal exposure can reach felony levels because of the difficulty and expense of dealing with cleaning up or restoring the markings that date back hundreds of years.

If the malefactors are found, Joyner said, “We don’t write warning tickets.”

___

Information from: The Daily Sentinel, http://www.gjsentinel.com

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The #WhatNow of #MeToo for the #COLeg

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AP Photo/David Zalubowski

When several lawmakers, lobbyists and staff at the state Legislature came forward this fall to allege they were victims of sexual harassment by lawmakers, two big questions followed: how often does this happen? What can be done to prevent more cases?

Reporters have asked state officials the first question repeatedly, returning to readers with little response from the state. The latter prompted a conversation from leadership, but as for what’s next—how the allegations, formal complaints, and legislature’s response—will impact politics under the gold dome and whether women will feel any safer is to be determined.

So far, top state lawmakers have decided to hire a human resources officer—who would be independent from the legislature—to be a contact person when incidents involving sexual harassment are brought forward. Now, leadership is tasked with handling and investigating such claims.

The group also decided to hire an independent consultant to review the legislature’s sexual harassment policy, and lawmakers, staff, and aides will undergo another round of sexual harassment training this year. Typically, those working at the Legislature are only required to go through training every two years.

Those changes are a good start, said Erin Hottenstein, executive director of Colorado 50/50, an organization that aims to get more women in public office. But the legislature stopped short of changing any current policies. And Colorado 50/50 called for an entire overhaul.

“I’m very pleased that there was a recognition that the policy needs to be improved,” Hottenstein said.

But there weren’t any specific recommendations regarding transparency, which Hottenstein said is significant in looking at what happens next.

Lawmakers and staff said they couldn’t disclose how many sexual harassment claims that leadership in each chamber have received because they were personnel issues.

“I think there’s a way to be transparent and safe,” Hottenstein said. “There should be a high- level summary document that shows on a certain date a sexual harassment complaint was made and who it was against and a date of a deposition and what the result was.”

Hottenstein said transparency becomes crucial in these cases because it leads to accountability and the public’s right to know what actions the people elected to office are taking.

In October, Pueblo Rep. Daneya Esgar broke her silence posting on Facebook that she was no stranger to sexual harassment and experienced it just a week earlier with a colleague she works with regularly as a lawmaker. The post was part of the #MeToo movement after a New York Times expose highlighted the stories of several women who said they’d been sexually harassed or assaulted by Hollywood producer Harvey Weinstein.

Then, a flood of other allegations were brought to the surface in Colorado politics. Rep. Faith Winter said fellow House member Steve Lebsock had harassed her at a legislative party in 2016. Winter and a lobbyist say they filed formal complaints against Lebsock.

An intern said Sen. Randy Baumgardner harassed her with sexually suggestive comments. The same went for Sen. Jack Tate of Centennial, who was accused of telling an intern that if she wanted to get ahead in her career, he could help.

Rep. Paul Rosenthal, who is openly gay, allegedly groped a man and used his seat to try and get a date with another.

But the case between Lebsock and Winter gained the most attention, even prompting Lebsock to take a polygraph test, which the administrator says he passed, to prove his innocence. Lebsock has hinted that the entire incident may be a case of dirty politics, alleging that Winter is the one lying.

When several lawmakers were asked if the case would mean a splintered Democratic party in the House, they were unsure, but optimistic about the session.

Still, there haven’t been any resignations over the allegations, though several, including leadership and editorial boards from across the state, said these legislators should step down from their seat. Some even called for House Speaker Crisanta Duran to step down from her position because she promoted Lebsock to a chairmanship despite knowing there was an incident between him and Winter.

The transparency piece has yet to be addressed by state lawmakers, and it’s unclear whether any policy or legislative changes will address that in the coming months. But for what it’s worth, the women who have broken their silence about sexual harassment in the Legislature are supportive of the changes leadership has discussed.

“I’m encouraged to see the direction leadership is taking when it comes to developing new and independent methods of dealing with complaints of sexual harassment at the Capitol,” said Esgar, who still hasn’t named the colleague she said grabbed her thigh at a legislative event earlier this year. “I’m hopeful that new ideas are still being formulated and considered, when it comes to ways to change the culture itself.”

The lawmaker added that a new session will certainly mean new ideas will come to light, “it’s our responsibility to lead the state in changing cultures to help make work environments safe and productive for all employees on every level.”

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Overdose overload: Addicts in distress put the strain on first responders

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The opioid and heroin epidemic has created a growing number of drug overdoses, which are taking their toll on first responders in southern Colorado’s urban and rural areas – first responders who are charged with administering initial treatment at the scene and transporting distressed addicts to hospitals.

Brandon Costerison, who is a spokesman for the National Council on Alcoholism and Drug Abuse and based out of the St. Louis area, says there are two trends coming out of the opioid and heroin epidemic. The first is positive: Hospitals, once overdosed addicts are brought to their facilities for initial treatment, have been more and more able to put those addicts into long-term treatment programs with the help of community support. Costerison likens overdoses to heart attacks in that essential follow-up treatments concentrating on “high blood pressure and all the other things that caused the heart attack” are needed for preventing heart failures in the future. He adds that not all communities, particularly those in rural areas, can offer follow-up treatments for addicts who overdosed and who often leave the hospitals and/or incarceration without getting the treatment they need to get off drugs and prevent future overdoses.

The second trend, though, is most disparaging: the high number of overdosing addicts has put a strain on first responders to get overdose patients through emergency room doors. Costerison says that emergency medical technicians have about two to three hours to get opioid addicts who overdose to the hospital. He adds that he has relatives in the Pueblo area and wonders about the toll put on EMTs in southeast Colorado’s rural areas, where the nearest medical facility could be as far as 45 miles away or even greater.

Third strike, and done?

As for the toll overdoses take on a community in terms of dollars and cents, Costerison refers to a June 28th story appearing on the USA Today website about an Ohio town that has suffered such financial losses from repeat opioid overdose calls that its city council morbidly discussed a three-strikes rule. Middletown, Ohio, which has less than half the population of Pueblo, actually ruminated over leaving a distressed opioid addict for dead if that person was treated and taken to the hospital by the city’s EMTs for an overdose two times prior.

The city council cited, among other things, the high cost of Narcan, the drug used to counter the effects of an opioid overdose. “That somebody’s life is only worth a few bucks is really disconcerting,” Costerison says.

A call last month to Middletown city media representative Shelby Quinlivan humanely revealed that the three-strikes discussion “went nowhere” and the councilman who brought up the idea did not get re-elected and will leave his post this month.

Thankfully, a discussion like the one had by the Middleton City Council would be highly improbable in Pueblo.

Pueblo Fire Chief Shawn Shelton explains that, although his firefighters are also trained as EMTs, they don’t take anyone to the hospital and in at least some cases don’t administer Narcan. He says the City of Pueblo contracts with a Greenwood Village-based national company called American Medical Response or AMR for those services. (AMR has a similar contract with Canon City.)

In AMR’s hands

In regards to opioid and heroin overdoses, Pueblo firefighters and police officers usually arrive at the scene first, then call AMR, which sends EMTs and an ambulance. The AMR EMTs in many cases administer the Narcan and then transport the overdose patient to the hospital. AMR then bills the patient or the patient’s insurance provider for the Narcan and services rendered. The only expense for the city is for the firefighters to call and observe the AMR EMTs, and those firefighters would be on duty anyway.

Also Shelton’s firefighters have observed that, like in Middletown, there have been a number of addicts in Pueblo who repeatedly overdose, but figures on just how many were not readily available.

As an aside, the fire chief says Narcan, which is also known by the generic name naloxone, is only a temporary fix that lasts a relatively short time before the negative symptoms of the overdose – vomiting, dizziness, seizures, etc. – return. Shelton says addicts often get angry after the Narcan is administered (to help save their lives) because it interrupts or ruins the heroin high for which they paid a lot of money to buy on the street.

Mike Lening is operations manager for AMR’s South Region, which serves Pueblo, most of Pueblo County (except for Rye and Beulah), and Fremont County. He says an increase in opioid overdoses across his region “makes it tougher” on his company’s resources (EMTs and equipment). As for the cost of treating overdosing addicts, who most often cannot pay for AMR’s services, Lening says his EMTs do not curtail their services based on someone’s perceived inability to pay for them. He adds that sometimes in rural areas his EMTs have to transport patients to hospitals that are “up to 45 minutes to an hour away.”

As for the urban area, Lening says AMR has seen “a little bit of a spike” in opioid overdose calls in the city of Pueblo recently.

By the numbers

Although Lening says he cannot come up with the total number overdoses his EMTs treat during any given time frame, the Pueblo Fire Department was able to come up with statistics relating to the number of times Narcan has been administered in the presence the city’s firefighters during their calls. Pueblo Fire Inspector Erik Duran, who is also the fire department’s information officer, provided a chart that shows in 2014 either firefighters, AMR EMTs or Pueblo police officers administered Narcan during calls labeled as drug overdoses and alcohol and other poisonings 69 times. Duran explains that roughly 95 percent of those calls are in fact overdoses. That number increases dramatically in 2015 to 92 calls, then goes down to 73 calls in 2016, and back up again to 84 calls from January 1st to mid-December of last year. Other calls during which Narcan was administered, which might have been overdoses, are those in which the victim was unconscious or near unconscious at the scene and there was no telltale paraphernalia when first responders arrived, so the victim’s medical condition could not be immediately ascertained. In those calls, AMR EMTs took over treatment. Those numbers are 32 such calls in 2014, also 32 in 2015, 48 in 2016 and 37 during most of last year. And yet during other city fire department calls, which again might have been overdoses, the victim received Narcan during treatment and died at the scene. The numbers for those calls are two in 2014, one in 2015, six in 2016 and five for most of 2017.

Rural areas not immune

EMT resources in rural areas are being stretched, to say the least. Alamosa Police Department Capt. Samuel Maestas says that the cost of opioid overdose calls for his city had been steadily on the rise until they “flat-lined” recently when the city took advantage of a state grant giving rural areas the funds to purchase Narcan. The move also allows Alamosa police officers, who are usually the first to arrive at the scene of an overdose, to administer the drug before EMTs from San Luis Valley Health arrive to transport addicts to the hospital thereby taking fire department personnel out of the picture in most instances. San Luis Valley Health provides emergency medical response, through its Alamosa Ambulance Service, for the city of Alamosa and all of Alamosa County.

Ted Andersen is the director of the Alamosa Ambulance Service and he estimates that his company’s emergency call volumes for overdoses have increased by roughly 24 percent from the start of 2015 to the beginning of last month. Andersen says, “We almost don’t have enough ambulances to handle all the overdose calls,” adding that the cost of keeping those ambulances stocked with Narcan is astronomical. Also, Andersen says he needs more EMTs because of the heroin and opioid crisis, and EMTs are in short supply mainly because they require four years of training – much like registered nurses do.

Andersen explains that most of the distressed addicts his EMTs encounter are transients (homeless and from out of state). He adds that many of them are repeat, to coin a phrase, overdosers, who­ – once they are hospitalized – refuse the long-term treatment that would get them off heroin and opioids for good.

Andersen theorizes that addicts come to Colorado without jobs because they know marijuana is legal here and surmise local officials are lenient when it comes to other drugs. He says he has heard that Pueblo, Colorado Springs, and even Denver are dealing with the same issue.

At the scene of the overdose, the EMTs usually encounter an addict who is either not breathing or having seizures. Andersen says EMTs are putting their lives at risk because, once the Narcan is administered, the addict becomes hostile. “It’s like they’re saying, ‘Hey, man, you just ruined my $200 high. Thank you very much!’” he says. Then the punching and kicking begins.

Andersen says his EMTs now wear protective vests to counter these violent reactions. To avoid conflict at the scene in the first place, the EMTs, if possible, try to clear the patient’s airway and get him or her stabilized without using Narcan. Andersen says they save the Narcan treatment for the emergency room, where the environment is more controlled.

What to do?

Southeast Colorado’s first responders are seeing their resources being stretched to the limit when it comes to handling overdose patients – many of whom are repeatedly coming into contact with EMTs because they refuse long-term treatment. The National Council on Alcoholism and Drug Abuse’s Costerison says in St. Louis the opposite is true. They have overdose patients who want treatment and can’t get it largely because Missouri, unlike Colorado, has not expanded its Medicaid program making long-term treatment unaffordable to most addicts. Yet Costerison says St. Louis has instituted a peer program whereby addicts, once they are done with initial overdose treatments and are in recovery, receive bedside counseling from former addicts who also have been through overdoses. Costerison says the peer program has been more effective at urging distressed addicts into long-term treatment than suggestions that they should get help by medical professionals who have not been through the addicts’ ordeals.

However, St. Louis has a population of almost three times that of Pueblo, so it might be difficult for Pueblo and particularly the smaller communities in southeast Colorado to find enough recovered addicts to be on call whenever an overdose occurs. So a solution to the problem of overdosing addicts may remain elusive for some time. Meanwhile, first responders are risking life and limb and taxing their resources to save opioid addicts from themselves.

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