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

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.”

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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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