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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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Colorado

Some parents worry new drug approval could shift States’ attitudes on medicinal cannabis

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COLORADO SPRINGS, Colo. — Some American parents who for years have used cannabis to treat severe forms of epilepsy in their children are feeling more cautious than celebratory as U.S. regulators near a decision on whether to approve the first drug derived from the marijuana plant.

The U.S. Food and Drug Administration is expected to issue a decision by the end of the month on the drug Epidiolex, made by GW Pharmaceuticals. It’s a purified form of cannabidiol — a component of cannabis that doesn’t get users high — to treat Dravet and Lennox-Gastaut syndromes in kids. Both forms of epilepsy are rare.

Cannabidiol’s effect on a variety of health conditions is frequently touted, but there is still little evidence to back up advocates’ personal experiences. The U.S. Drug Enforcement Administration has long categorized cannabis as a Schedule I drug, a category with “no currently accepted medical use and a high potential for abuse.” That strictly limits research on potential medical uses for cannabis or the chemicals in it, including cannabidiol, or CBD.

But for years, parents desperate to find anything to help their children have turned to the marijuana-based products made legal by a growing number of states.

Meagan Patrick is among the parents using CBD to treat symptoms in their children. She moved from Maine to Colorado in 2014 so she could legally get CBD for her now-5-year-old daughter, Addelyn, who was born with a brain malformation that causes seizures.

“My child was dying, and we needed to do something,” Patrick said.

As for the potential approval of a pharmaceutical based on CBD, she said fear is her first reaction.

“I want to make sure that her right to continue using what works for her is protected, first and foremost. That’s my job as her mom,” Patrick said.

Advocates like Patrick became particularly concerned when GW Pharmaceuticals’ U.S. commercial business, Greenwich Biosciences, began quietly lobbying to change states’ legal definition of marijuana, beginning in 2017 with proposals in Nebraska and South Dakota.

Some worried the company’s attempt to ensure its product could be legally prescribed and sold by pharmacies would have a side effect: curtailing medical marijuana programs already operating in more than two dozen states.

The proposals generally sought to remove CBD from states’ legal definition of marijuana, allowing it to be prescribed by doctors and supplied by pharmacies. But the change only applies to products that have FDA approval.

Neither Nebraska nor South Dakota allows medical use of marijuana, and activists accused the company of trying to shut down future access to products containing cannabidiol but lacking FDA approval.

Britain-based GW Pharmaceuticals never intended for the changes to affect other marijuana products, but they are necessary to allow Epidiolex to be sold in pharmacies if approved, spokesman Stephen Schultz said.

He would not discuss other places where the company will seek changes to state law. The Associated Press confirmed that lobbyists representing Greenwich Biosciences backed legislation in California and Colorado this year.

“As a company, we understand there’s a significant business building up,” Schultz said. “All we want to do is make sure our product is accessible.”

Industry lobbyists in those states said they take company officials at their word, but they still insisted on protective language ensuring that recreational or medical marijuana, cannabidiol, hemp and other products derived from cannabis plants won’t be affected by the changes sought by GW Pharmaceuticals.

Patrick Goggin, an attorney who focuses on industrial hemp issues in California, said the company would run into trouble if it tried to “lock up access” to marijuana-derived products beyond FDA-approved drugs.

“People need to have options and choices,” he said. “That’s the battle here.”

Legal experts say the changes are logical. Some states’ laws specifically prohibit any product derived from the marijuana plant from being sold in pharmacies. The FDA has approved synthetic versions of another cannabis ingredient for medical purposes but has never approved marijuana or hemp for any medical use.

A panel of FDA advisers in April unanimously recommended the agency approve Epidiolex for the treatment of severe seizures in children with epilepsy, conditions that are otherwise difficult to treat. It’s not clear why CBD reduces seizures in some patients, but the panel based its recommendation on three studies showing significant reduction in children with two forms of epilepsy.

Denver-based attorney Christian Sederberg, who worked on the GW Pharmaceuticals-backed legislation in Colorado on behalf of the marijuana industry, said all forms of marijuana can exist together.

“The future of the industry is showing itself here,” Sederberg said. “There’s going to be the pharmaceutical lane, the nutraceutical (food-as-medicine) lane, the adult-use lane. This shows how that’s all coming together.”

Alex and Jenny Inman said they won’t switch to Epidiolex if it becomes available, though their son Lukas has Lennox-Gastaut syndrome.

Alex, an information technology professional, and Jenny, a preschool teacher, said it took some at-home experimentation to find the right combination of doctor-prescribed medication, CBD and THC — the component that gives marijuana users a high — that seemed to help Lukas with his seizures.

“What makes me a little bit nervous about this is that there’s sort of a psyche amongst patients that, ‘Here’s this pill, and this pill will solve things,’ right? It works differently for different people,” Alex Inman said.

The Inmans moved from Maryland to Colorado in 2015 after doctors recommended a second brain surgery for Lukas’ seizures. The couple and other parents and advocates for CBD said children respond differently to a variety of strains.

The Realm of Caring Foundation, an organization co-founded by Paige Figi, whose daughter Charlotte’s name is attached to the CBD oil Charlotte’s Web, said it maintains a registry of about 46,000 people worldwide who use CBD.

For Heather Jackson, who said her son Zaki, now 15, benefited from CBD and who co-founded the foundation, Epidiolex’s approval means insurers will begin paying for treatment with a cannabis-derived product.

“That might be a nice option for some families who, you know, really want to receive a prescription who are going to only listen to the person in the white coat,” Jackson said.

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Colorado to toughen car pollution rules

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Colorado’s governor on Tuesday ordered his state to adopt vehicle pollution rules enforced in California, joining other states in resisting the Trump administration’s plans to ease emission standards.

Democratic Gov. John Hickenlooper told state regulators to begin writing rules that incorporate California’s low-emission standards with a goal of putting them in place by the end of the year.

Hickenlooper said the strict standards are important to Colorado, citing climate change and noting the state’s elevation makes pollution worse.

“Our communities, farms and wilderness areas are susceptible to air pollution and a changing climate,” his order said. “It’s critical for Coloradans’ health and Colorado’s future that we meet these challenges head-on.”

Hickenlooper’s order came about three months after the U.S. Environmental Protection Agency announced it would not implement stricter emissions rules adopted by the Obama administration. Those rules would have started with the 2022 model year.

California has a waiver under federal Clean Air Act allowing it to impose tougher standards than the U.S. rules. Currently, California’s standards are the same as the federal standards. But if the Trump administration foregoes the stricter Obama-era rules, California could still impose them or others.

The law allows other states to apply California’s standards. Colorado would be the 13th state, excluding California, to do so, said Luke Tonachel, director of the Natural Resources Defense Council’s clean vehicles project. The District of Columbia has also adopted the rules.

The states that currently apply California’s rules are Connecticut, Delaware, Maine, Maryland, Massachusetts, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont and Washington.

“Colorado is recognizing along with other states that the federal rollback is both unjustified and harmful, so the governor is joining others in protecting his state’s citizens,” Tonachel said.

The Colorado Automobile Dealers Association said California standards might not be a good fit for Colorado because a higher percentage of Coloradans buys pickups, SUVS, vans and all-wheel-drive vehicles, which burn more gas.

“We’re disappointed that the state of Colorado, the governor, or regulatory board or anybody else would cede air quality control regulation to an out-of-state, unelected board in Sacramento (California),” said Tim Jackson, president of the association.

The Obama rules would have required the nationwide fleet of new vehicles to get 36 miles per gallon (15 kilometers per liter) in real-world driving by 2025. That’s about 10 mpg (4 kilometers per liter) over the existing standard.

The EPA announced in April it would scrap the Obama-era rules, questioning whether they were technically feasible and citing concerns about how much they would add to the cost of vehicles. The EPA said it would come up with different rules.

California and 16 other states sued the Trump administration over the plan to drop the tougher rules. All the states that joined the lawsuit have Democratic attorneys general. Colorado, which has a Republican attorney general, did not join.

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Mass uncertainty – White House unclear how it plans to reunite separated children

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Trump administration officials say they have no clear plan yet on how to reunite the thousands of children separated from their families at the border since the implementation of a zero-tolerance policy in which anyone caught entering the U.S. illegally is criminally prosecuted.

“This policy is relatively new,” said Steven Wagner, an acting assistant secretary at the Department of Health and Human Services “We’re still working through the experience of reunifying kids with their parents after adjudication.”

Federal officials say there are some methods parents can use to try to find their children: hotlines to call and an email address for those seeking information. But advocates say it’s not that simple.

In a courtroom near the Rio Grande, lawyer Efren Olivares and his team with the Texas Civil Rights Project frantically scribble down children’s names, birthdates and other details from handcuffed men and women waiting for court to begin. There are sometimes 80 of them in the same hearing.

The Texas Civil Rights Project works to document the separations in the hopes of helping them reunite with the children.

They have one hour to collect as much information as they can before the hearing begins. The immigrants plead guilty to illegally entering the U.S., and they are typically sent either to jail or directly to an immigration detention center. At this point, lawyers with the civil rights group often lose access to the detainees.

“If we don’t get that information, then there’s no way of knowing that child was separated,” Olivares said. “No one else but the government will know that the separation happened if we don’t document it there.”

Olivares has documented more than 300 cases of adults who have been separated from a child. Most are parents, but some are older siblings, aunts, uncles or grandparents. Some are illiterate and don’t know how to spell the children’s names.

More than 2,000 minors have been separated from their families since early May. The children are put into the custody of the U.S. Department of Health and Human Services with the aim of keeping them as close to their parents as possible and reuniting the family after the case goes through the courts, said Wagner.

But it’s not clear that’s working.

According to Olivares, the agency is generally “very willing to help,” often helping to find a child even if there’s a misspelling in the group’s records. But if a child has been transferred out of a government shelter — including if the child has been deported — agency representatives won’t give any information.

“Sometimes the parent gives us contact information for a relative,” Olivares said. “If they have the phone number right and the phone number is working … we call that number and sometimes we’re able to locate that relative and ask them what they know.”

In May, the Department of Justice adopted the zero-tolerance policy in which anyone caught entering the U.S. illegally is criminally prosecuted. Children can’t be jailed with their parents. Instead, after the adult is charged, children are held briefly by Homeland Security officials before being transferred to Health and Human Services, which operates more than 100 shelters for minors in 17 states.

The department has set up new facilities to manage the influx of children, and Wagner said they were prepared to expand as more children come into custody.

The children are classified as unaccompanied minors, a legal term generally used for children who cross the border alone and have a possible sponsor in the U.S. willing to care for them. Most of the more than 10,000 children in shelters under HHS care came to the U.S. alone and are waiting to be placed with family members living in the U.S.

But these children are different — they arrived with their families.

“They should just give the kids back to their parents. This isn’t difficult,” said Lee Gelernt of the American Civil Liberties Union.

Gelernt represents a Brazilian asylum seeker in a closely watched lawsuit that seeks a nationwide halt to family separation. The woman, identified as Mrs. C in court documents, was split from her son for nearly a year after entering the country illegally in August near Santa Teresa, New Mexico.

On Tuesday, Olivares’ team had seven people left to interview with five minutes left. They took down just the names, dates of birth, and countries of origin of the children.

“One woman (said), ‘What about me, what about me?'” Olivares said a few hours later. “She wanted to give us information because she realized what we were trying to do.”

___

Associated Press writer Elliot Spagat contributed to this report.

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For every contribution, we put 100% back into producing original and amazing journalism. That's a promise only a local and independent newsroom can promise. Take heart because you will fuel stories just like this one and the future of journalism.
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