These are my comments on the draft report developed by the Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis.
People who have suffered a nonfatal overdose are at the high risk of suffering a fatal overdose. A recent study out of Massachusetts suggested that one out of ten of these patients will die of an overdose within a year.(1) Since EMS has contact with these patients at a pivotal time in their live, EMS has an opportunity for intervention either through educating them (and their families)to rehab options or where to obtain naloxone and clean needles for those who are not ready to quit. Some EMS services even leave naloxone with users and their families.
The manner in which EMS treats these patients is also critically important. If EMS treats them as people who are suffering from a chronic disease as opposed to people with character flaws, then they can help reduce the stigma that any opioid users face that can be a barrier to them seeking help. Improved education for EMS personnel into the science of addiction is needed if EMS is going to play a role in helping people toward recovery.
Harm Reduction should be emphasized in EMS education and in EMS Treatment. In area of high intravenous drug usage, designated EMS vehicles or stations could function as a needle exchange site, providing users with clean supplies as well as information about rehabilitation. Clean needles and supplies will not only help the spread of disease such as AIDS and Hepatitis C, it can prevent endocarditis and other infections that are rampant in the user community.
EMS data offers as unique look into the epidemic and can provide real-time data surveillance and early warning of spikes in overdoses and bad batches if done properly. A study from North Carolina has shown the naloxone is a poor surrogate for tracking opioid overdoses because many overdoses do not need naloxone and that naloxone is often given to people who turn out not to have opioid overdoses. (2) A better way is to require EMS to install the data element “suspected opioid overdose,” and track this. In Connecticut, we have conducted a pilot study of using our Poison Control Center as a repository of EMS overdose information. In the pilot, EMS responders in Hartford called poison control shortly after each overdose they responded to, and answered a series of questions about the overdose, including patient demographics, place and route of overdose, whether naloxone was needed and in what dose, and identification of any paraphernalia. (4) The project is expected to slowly expand statewide, and will eventually be linked to the HIDTA (High Intensity Drug Trafficking Area) OD map software to show location of overdose. (3) The project was able to identify unique heroin brands linked to overdoses as well as information about users who thought they had bought cocaine, overdosing on opioids.
Emergency Medical Services, which has been underutilized in the fight against the opioid epidemic, can be a leader in the fight contributing surveillance, data collection, and early warning alerts, as well as education and harm reduction to the traditional role of emergency treatment.
1. 402 One-Year Mortality of Opioid Overdose Victims Who Received Naloxone by Emergency Medical Services
Weiner, S.G. et al. Annals of Emergency Medicine , Volume 70 , Issue 4 , S158
2. Joseph M. Grover, Taibah Alabdrabalnabi, Mehul D. Patel, Michael
W. Bachman, Timothy F. Platts-Mills, Jose G. Cabanas & Jefferson G. Williams (2018)
Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid
Overdoses in a Large U.S. EMS System, Prehospital Emergency Care, 22:3, 281-289, DOI: