Addiction in EMS: The real tragedy behind the headlines


These days, people see a headline like, "Texas EMS captain accused of taking painkillers from ambulance," and they respond instantly with utter disbelief and absolute disdain; with a degree of livid condemnation that makes Al Qaeda seem like pussycats. They stand tall and bellow about the higher standard and the contemptuous breach of ethics and law. For shame!

They don't need the facts and they don't need extraneous information to detour them from their righteous opinions about how society is breaking down. The fact that it happened is all they need. If this was the 1600s, that captain and all like him would be burnt at the stake for such a despicable transgression in the face of a society that trusted him for their very lives.

The real tragedy is that such headlines and the subsequent reactions are not at all uncommon. More frightening, though, is the frequency with which addiction leaches into the ranks of EMS providers in every corner of the world. Is it a sign of a collapsing society? Are the Four Horsemen (of the Apocalypse) on the horizon?

Give me a break!
It may be true that those who would steal or in any other way allow addiction to compromise the delivery of EMS must be removed from service, at least temporarily, but to castigate them as untouchable or irretrievable is even more despicable than the underlying act.

Over the years, I have been fortunate enough to have established a base constituency of loyal EMS1.com readers; individuals who enjoy and even apply much of what I write. I cannot begin to describe the pleasure that gives me and you will never know just how grateful I am for it. 

Today, though, I call on those readers and all others to give this column and these words some special consideration.

More than anything, EMS is a superhero's business made up of flawed, mortal human beings who face the same demons as the rest of society. Much like the rest of society, addiction is one of those most awful and cunning demons. However, it is our response to that demon that matters more.

We're all human
Awhile back, I received a call from a paramedic I had known for a long, long time. He was a true believer; a provider in it to do good more than to do well. By the tone of his voice, I could tell he was in some serious trouble. His voice did not lie. He was.

It seemed that some time earlier he had suffered an injury off the job. The injury resulted in several surgeries and months of painful recovery, physical rehabilitation and pain medicine. It started as a as-needed remedy for intense pain, but became a physical necessity.

When the actual pain no longer necessitated the monthly refills, the feigned pain took over. When that excuse had run its course, new injuries and favors from friends took over. The cycle had begun.

Back at work, he became adept at leading his double life; on the job he was clean, sober and clear-headed, but off-duty the pills took over. The decline was slow, but steady. It would not be long before he would lose all control.

One day, on a call with the entire crew, he found himself in the home of a patient whose medicine cupboard was a veritable treasure trove of pain killing goodies. Jackpot!

While logging all of the medicines, it was easy to drop a full bottle of a certain pain killer into his pocket, and he did…completely undetected. The patient was transported and the scene was cleared and his addiction would be fed for a little while longer.

However, as he exited the scene with his supervisor, he was struck with a blunt and harsh realization: This is not who I am and it's not who I want to be! While still at the curbside, in front of the patient's home, he pulled the bottle from his pocket, handed it to his supervisor, and said: "I have a problem. I need help."

His supervisor considered the heartfelt and painfully honest plea for help.

But he was fired. He was stripped of his license. He was reported to local authorities and was charged with multiple felonies by the District Attorney. That was the response from his supervisor and the rest of the morally superior lemmings up the chain of command.

He asked for help; now he was looking at serious prison time. This brings us to the frightened and helpless tone in his voice when he called me.

Thankfully, his story ends with the proper treatment: A new career and the entire criminal case being dismissed. Unfortunately, similar stories continue to play out in agencies, both public and private, all across America. They do not, or will not, end so well.

Tough love
Addiction is not at all unique to EMS. Addiction does not care what you do or who you do it with. It doesn't care what color you are or what continent you were born on or what language you learned first. It does not care how much money you make or where your parents went to school. Addiction is real and it is self-perpetuating.

So how do we deal with it in EMS?

Once you know that you are dealing with a problem of addiction, no matter what it is, apply the principles of tough love and unconditional equity.

Father Merrin said it best in 1973's The Exorcist: "…Especially important is the warning to avoid conversations with the demon. We may ask what is relevant but anything beyond that is dangerous. He is a liar. The demon is a liar. He will lie to confuse us. But he will also mix lies with the truth to attack us. The attack is psychological, Damien, and powerful. So don't listen to him. Remember that - do not listen."

Addiction is the same demon that hides behind promises, lies and misdirection. You will want to believe, but you cannot afford to. You may have to walk with or even carry him or her to a place where real help can be had, but you cannot put him or her or yourself in a position where he or she will have access to the object of the addiction or the resources to procure it.

If you are a supervisor or a partner or someone else on the perimeter of EMS, offer and provide whatever help you can until you simply can't. And always remember that any addict is only as strong as his or her willingness to get well.

Unconditional equity
As it should be with our patients, individual providers are to be treated equally in all circumstances. If equal treatment means you have no choice but to enforce a zero tolerance policy, then so be it. If equal treatment means that one person is afforded the opportunity for rehab, then so shall they all.

Whatever the response to the specter of addiction, it must be open, transparent, equal and defensible in court. The biggest mistake many agencies make is to hide or attempt to cover up addiction issues among their ranks.

I am involved in a case in which an agency was finally forced to fire a ranking officer for abusing alcohol on the job. The problem is that they have been aware of the issue for years and even secretly sent him to rehab. All the while, other members of the same agency have been terminated for mere allegations of substance abuse off the job or otherwise disciplined by the now former officer for a variety of dubious alleged policy violations. I predict that the agency has some serious problems ahead.

In the end, I urge everyone to take a breath and recognize that EMS captains don't just wake up one day and decide to steal narcotics from ambulances. While I don't know the specifics of that particular case, I do know that addiction is real and it is treatable. It grows like a cancer until it is wiped out or the host is dead.

I believe we owe it to those who have risked their lives for others to help them through their own darkest times before we simply cast them upon the trash heap of used and now useless human beings.

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