How community paramedics can respond to the opioid overdose epidemic
Community paramedics have an opportunity to change EMS response to overdose and addiction through application of harm reduction techniques
SALT LAKE CITY — The increasing rate of opioid overdose deaths shows the traditional EMS response to an opioid overdose patient of respond, resuscitate and relapse is ineffective. Dan Swayze, Center for Emergency Medicine COO and vice president, described a new community paramedicine intervention for opioid addiction at the EMS Today preconference at the Salt Palace Convention Center.
There has been a 400 percent increase in overdose deaths from 1999 to 2008 and opioid overdose is now the leading cause of accidental death in the United States. Medication-assisted treatment, including suboxone and rehab are two options for care community paramedics to learn about. In addition, community paramedics can deliver harm reduction education, like safe needle use, to opioid addicts who are not ready for addiction recovery.
Swayze's new program has just received its first group of 20 patients from the health system. Community paramedics are beginning to reach out to the group of patients who meet the criteria for high emergency department drug seeking.
Memorable quotes on community paramedic response to heroin
Swayze gave a primer on addiction and then described the opportunities for community paramedics to assist opioid addicts. Here are some memorable quotes from his presentation:
"Overdoses are the leading cause of accidental death. In 2016, 38 percent of overdose deaths were from prescription pain relievers and 25 percent were from heroin."
"You [community paramedics] need to learn the language of addiction. ROSC in the addiction field is Recovery Oriented System of Care. Let's try to help them recover from their addiction. ROSC needs to be focus of CP intervention of care."
"After discharge [from mental health services or jail] is a vulnerable time for addicts because of their lower tolerance and return to the same environment."
"Would you be willing show your heroin user how to shoot up safely? Who is showing them [addicts] how to shoot up? [A community could ask a patient], 'If you are using and not interested in quitting let's discuss how to use safely.'"
Top takeaways on community paramedic response to opioid addicts
Swayze made a compelling case for the role of community paramedics in the treatment of addiction, beginning with overdose treatment and following through with post-discharge follow-up and readiness to help addicts receive recovery treatments.
1. New response to opioid overdose is needed
The traditional EMS response to an opioid overdose patient is "response-resuscitate-relapse" and the cycle is likely to repeat, with the only interruption of a patient's death. The cycle is response to a 911 call, resuscitate the patient with naloxone and then the patient is likely to relapse. A community paramedic response to the opioid overdose epidemic is an alternative pathway that is based on the language and care techniques of addiction medicine.
2. Understand addiction pathophysiology
Swayze, using several educational videos, described the pathophysiology of addiction. In another video, an addict described his use of heroin not to get high, but just to feel normal. Withdrawal is an unpleasant experience for the addict. EMS providers need to let go of the notion that opioid addiction is a choice that the addict can control and that this is somehow a self-limiting problem.
3. Community paramedic intervention after discharge
After discharge from jail or mental health services is an extremely vulnerable time for overdose death. A community paramedic can be part of the system of care to help an addict avoid relapse to previous behaviors by helping the patient get to rehab, make lifestyle changes, attend group meetings and keep other outpatient appointments.
4. Community paramedic focus on harm reduction
Widely available naloxone is just one component of a harm reduction effort for opioid addicts. Community paramedics can also deliver other harm reduction messages, such as not sharing needles. Teaching family members to understand the science of addiction and how to use naloxone is another harm reduction technique to prevent addicts from using heroin alone or in a locked room.
Harm reduction is not enabling use. It is an attempt to keep an addict safe until the patient is ready for rehab and long-term treatment.
5. Community paramedics staff a 'Safe Station'
Swayze, after answering an audience question about safe houses for opioid addicts to use with supervision from bystanders able to monitor the user and deliver naloxone, segued into a description of and need for safe stations. EMS, fire and police safe stations are a place for addicts who are seeking addiction recovery treatment to ask for help without fear of arrest or incarceration.
Learn more about opioids, harm reduction and naloxone
Here are additional articles to learn more about opioids, harm reduction, naloxone and community paramedicine.
- 5 EMS innovations for combating opioid overdose epidemic
- Introduction to medication-assisted opioid dependence treatment for EMS
- Why drug addiction is a brain disease
- 5 things to know about naloxone
- How to fill the EMS empathy gap for opioid addicts
- Why increasing access to naloxone doesn't enable addicts
- EMS distributed naloxone kits may make a difference
- 5 ways to welcome an overdose patient back
- Narcan, addicts and the cult of public shaming
- Naloxone reversal: Turning helpers into haters
- Naloxone intranasal or auto-injector; which is better?
- Naloxone: Drug Whys
- How to build fire-based community health care programs
- Experts discuss issues facing community paramedicine
- Community paramedicine: How EMS can work smarter, not harder