Prehospital providers are on the front lines of the current opioid addiction epidemic. Those that have yet to experience the power of saving a life with a simple bolus of naloxone likely won’t have to wait long given that over 28,000 people died in 2014, and an additional 2.2 million Americans currently struggle with opioid addiction.
President Obama recently attended the National Rx Drug Abuse and Heroin Summit. While there, he announced new initiatives to fight the epidemic via a $1.1 billion funding package requested by the White House that includes:
- Doubling the number of patients a physician can treat for addiction
- Mandatory medical school training on prescribing opioids
- Expanded treatment options for patients with Medicaid or Children’s Health Insurance Program
- Expanding medication-assisted treatment programs in poor and isolated areas
- Increased the distribution of naloxone
First responder access
Due to the simple administration requirements, a growing number of municipalities allow police officers and firefighters to carry naloxone. Stories of the lives saved by first responders aren’t hard to find and they are growing in number.
The decision to train and equip public safety personnel is one of realistic desperation. Police officers and firefighters typically arrive on scene quickly, and with the right training they can learn to administer naloxone even with limited medical knowledge.
Areas where first responders don’t have access to naloxone are behind the curve. Given the degree of attention the opioid epidemic is receiving at the federal level, it is likely only a matter of time before these locations catch up. EMS agencies in these areas should be advocating for increased access to naloxone as well being prepared to train and potentially equip other first responders.
Provider safety
Patients with an addiction to opioids don’t pick where they overdose. In fact, given the ongoing stigma and legal issues surrounding addiction, the locations chosen to shoot up or pop pills aren’t done with provider safety in mind. That said, a growing acceptance of safe locations for addicts to shoot up may change the environments in which EMS responds.
As I’ve advocated for in the past, scene safety isn’t good enough. But in the case of these patients, concerns over provider safety should center on the physical hazards of the scene as well as the behavioral hazards of the patients, their friends and nearby family members.
Patients receiving naloxone can wake up dazed and confused, and don’t always appreciate losing their high, regardless of the provider’s intentions. For such a simple drug to administer, the after effects can be anything but.
Ethics of providing care to addicts
For those that have never known what addiction feels like or watched a loved one battle through its vice-like grip, having empathy for these patients can be difficult. Addicts are victims to their own decisions; they deserve the same type of compassion we reserve for more stereotypical patients.
They should not be shamed, they should not be judged; they should be cared for with the same professional courtesy we reserve for everyone else. We cannot forget that addiction is disease.
