Drug Addicts

The heroin epidemic is getting a lot of play in Connecticut. In 2015, according to the latest numbers there were 415 heroin deaths in the state, triple the number three years ago.

There is a bill in the legislature to require all first responding agencies in the state to carry naloxone. Here’s a news article about it:

Narcan Bill Draws Early Support in Connecticut

There is some controversy that this may be overkill and too costly as you would have the potential for, in some cases, four responding agencies all showing up on the same scene with their Naloxone ready to go. Not everyone would use theirs, and the drugs would expire and need to be replaced, at quite the hidden cost as the price of Naloxone continues to skyrocket and the availability has at times been scarce.

You could make an analogy to defibrillators. So what if all four agencies carry defibs? The first one there is the one to use it, and the sooner the better. Naloxone is a little different. If the agency has a bag valve mask and two people (or one skilled in one man bagging), they can breathe for the patient until the Naloxone arrives.

According to the above news article, the state police have saved 65 lives using Naloxone. My guess would be they have used it 65 times. That does not always correlate to a life saved. If the police breathe for the person, the Naloxone will show up eventually. And as we in EMS know, Naloxone only works on living people. Once someone’s heart has stopped, Naloxone does not restart it.

In Hartford, neither the fire department nor police department have Naloxone yet (that I know of), although I know at least the Fire Department will be getting it soon. They often beat us to the calls, and are usually doing a great job of bagging the patients prior to our arrival. I am all for them carrying it, and taking care of the problem before we get there. If I had to choose between police and fire getting Naloxone, I would want the police to have it because they often arrive first, and I haven’t seen them use a bag-valve mask for years. And they can recognize when someone needs it. I step out of the ambulance, the officer usually says, “you’re going to need your Narcan.”

On these two calls, police and fire were at the first scene before we were. Young woman is unresponsive in a parking lot with agonal respirations. We think the boyfriend called 911, but it might have been a passerby. While the woman is cyanotic, and breathing at 4 a minute, she comes to with stimulation, and we decide the Naloxone is unnecessary. She admits to doing a bundle of heroin (10 bags) — a little more than she usually does. She had given herself a strong dose, but hasn’t quite overdosed. Her lethargy is what she was seeking. We put her on capnography and give her a little shake if she starts to nod off too much. We have conversation with her on the way to the hospital. She has been using heroin for years. She is also on methadone, but she missed her daily dose at the dispensary that morning. We ask her how she got started on heroin, and she says she started with prescription opiods following spinal fusion surgery. She got hooked on them, and when she had a hard time getting enough to ease her pain and addiction, heroin was cheaper and easier to find. She keeps asking us where her pocketbook is. We say her boyfriend has it. The officer on scene gave it to him. We think once the boyfriend knew he wasn’t being arrested, he offered to hold the pocketbook. The girl is quite upset that he has her pocketbook.

“But he’s your boyfriend,” we say, “He called 911. He saved your life.”

“You can’t give him my pocketbook,” she says.

“Why not?”

“We’re drug addicts!” You morons.

She asks again at the hospital about her pocketbook, and then asks if her boyfriend is there yet. Nope, no sign of the boyfriend. She starts wailing. She knows him better than we do.

The second call is at a public restroom. It comes in as a cardiac arrest. Based on the address, I say it is going to be another heroin overdose and I am right. Another kid in his twenties from the suburbs goes into the restroom and doesn’t come out. A maintenance man had to open the door with his key. The kid is lying on floor, cyanotic to the max, breathing two a minute if that. We have beaten fire there. The police officer who was there first doesn’t have Naloxone or a bag mask.

In the end it doesn’t matter. We get our bag valve mask out and give him our Naloxone and he soon comes around.

“I don’t need Narcan,” he says.

“We already gave it to you. You were blue.”

He curses.

His story is he and a buddy came in to the city to score. He says he only did one bag and hasn’t used for a while. I am not certain I believe him. We ask him how he got started. Motorcycle accident. Broke his leg in multiple places. Did you get put on Percocets? I ask. Six months worth, he says, then he cut me off. His buddy doesn’t ask for his wallet, but on the way to the hospital, he looks in his wallet and shakes his head when he sees it is empty.

Here’s what I think. I am all for the widespread availability of Naloxone. Give it to the addicts; give it to their families and friends. Give to any first responding agency that thinks they will use enough to merit stocking it or who is willing to pay for the one life they may save.

Both these addicts were in their middle twenties and they looked horrible. Ghost white complexions, jittery, hollow eyes, bad teeth, scarred limbs. They are not alone, there is an army of them out there. It reminds me almost of the walking dead. People want to know how the epidemic started and who started it?

We have to look at ourselves, the health care system. Most of these people had normal lives. They got hurt, and they were put on terribly addicting drugs by doctors they trusted, and doctors who likely thought they were doing the right thing. Not everyone put on a six month course of Percocets for their injuries became an addict, but plenty did, and the drug destroyed them.

415 died in Connecticut last year. Did they all come to heroin the same way? Probably not. Each had their own story. But there is a clear pattern. And their stories all end the same. The way things are going the number will likely be higher this year. The walking dead are on our streets.

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