Officials question naloxone use on repeat overdose patients
This vicious cycle experienced by many addicts has added a new facet to Ohio's grim war against opioid abuse: compassion fatigue
By Catherine Candisky and Marty Schladen
The Columbus Dispatch
COLUMBUS, Ohio — Six times Nikki Dixon has been saved from likely death by heroin overdose because quick-acting friends and emergency responders used the drug antidote naloxone to revive her.
But all she remembers is waking up feeling each time like she had the worst possible case of the flu—cold sweats, vomiting, stomach in knots and everything smelling repulsive—and craving another fix to take away the pain of drug withdrawal. Within hours, the 24-year-old Columbus woman was using again.
This vicious cycle experienced by many addicts has added a new facet to Ohio's grim war against opioid abuse: compassion fatigue. While some emphasize how naloxone saves lives and gives drug users another chance to get into treatment and escape the drug's hold, others say that the antidote is being used as a crutch, allowing addicts to continue abusing drugs without consequence.
"It's just reviving somebody who's going to go back and get high the same day," said Butler County Sheriff Richard Jones. "It's a war that we're losing."
Deputies in the Cincinnati-area department don't carry naloxone, often called by its brand name, Narcan. But in Columbus and many other parts of Ohio, emergency responders have used the opioid-reversing drug to save thousands of lives.
"You hear from the public, 'Why don't you let them die?' ... We're not God; we don't decide who lives or dies," said John McFarland, Police Chief of Martins Ferry, in eastern Ohio. "We have the ability to save them, so we do."
Overdose deaths in Ohio are skyrocketing, eclipsing 4,100 last year, according to a Dispatch survey of county coroners.
However, the toll would be far higher without Narcan. Besides emergency responders, it's being administered by drug addicts themselves and is available to anyone without a prescription at many pharmacies and community clinics.
"All the users carry it on them. I know I did," said Dixon, who started taking pain pills at age 13 before switching to heroin.
The Columbus Division of Fire administered Narcan 316 times in May alone, or more than 10 times a day, said Assistant Chief James Davis. That's almost double the 161 times the drug was administered in May 2016.
Statewide, emergency medical responders treated nearly 13,000 overdose patients with Narcan in 2014, the most recent data available from the Ohio Emergency Medical Services. That's a 127 percent increase in the past decade.
Even Narcan's advocates acknowledge that while the drug is saving lives, it's no cure for the drug epidemic. If overdose victims don't go into immediate treatment, most overdose again. And that's a problem in Ohio, where addicts often have to wait months to get into a program that can help them.
Narcan clears opioid receptors in the brain and then locks onto them for up to 90 minutes, throwing addicts into immediate withdrawal. So for those who don't want or can't get treatment, that means rushing to again use a drug that almost killed them so they can avoid the vomiting, cold sweats, diarrhea and other symptoms of withdrawal.
Dixon experienced that pain firsthand but was still surprised by the reaction she got after giving Narcan to a friend who overdosed on heroin.
"His lips turned blue and he was like dead. I gave him Narcan and I didn't think that he was going to come back... so I tried the second one thinking that it wasn't going to make a difference, but it brought him back to life," she said.
"He just kind of woke up and coughed. He sat up and coughed. He wasn't worried about anything but I ruined his high... He was mad at me for saving his life... I'm like, 'You idiot, I just saved your life.'"
Lt. Robert Chromikof the Summit County sheriff's office said, "It's kind of like dealing with the walking dead."
Jones is frustrated with the epidemic that has led to three births in his jail–one in the toilet.
"My policy is, I'm not going to do it," Jones said of Narcan. "We are the police. We have life squads."
One reason Jones doesn't want deputies administering the drug is because it puts them in danger if they stoop down to revive people.
"These people don't always like the police, and it's a very dangerous situation for the police," Jones said.
As it seeks to cope with the opioid epidemic, southwestern Ohio's Washington Court House Police Department has adopted a different approach that has sparked widespread controversy.
As in Butler County, police in Washington Court House don't carry Narcan. In fact, officers have the option of slapping a misdemeanor charge on those who overdose repeatedly and use Narcan to recover. Since Jan. 1, officers in Washington Court House have charged 26 people with "inducing panic" — a statute generally meant to stop people from raising false alarms or threatening violence.
Critics said fear of the charge would make people reluctant to call authorities in the event of an overdose, but Police Chief Brian Hottinger said he has seen no evidence of that. Since the beginning of the year, 156 overdoses have been reported in the city of 14,000.
Hottinger said his city has been unfairly accused of seeking to punish those with opioid addictions. The new policy isn't intended to jail people longer or fine them more, he said.
"If we can charge them with inducing panic, we can get them into municipal court," and possibly into treatment, Hottinger said. "We're using it as a way to deal with people who need help, but are not asking for help."
A city councilman in southwestern Ohio's Middletown has asked whether it's possible for city emergency crews to stop responding to drug overdose calls as costs for those calls mount. Council member Dan Picard says arresting people who overdose increases the burden on taxpayers and strains the court system.
He suggests issuing a court summons to individuals who overdose and ordering them to do community service. City Manager Doug Adkins declined to comment on Picard's suggestions until he gets an opinion from the city's law department. He has said that Middletown is on pace to spend $100,000 on naloxone, while having budgeted only $10,000 for the year.
For Columbus police, the decision about whether to carry Narcan is voluntary. But for one cop who does carry it, there's no debate about what to do if he sees someone overdosing.
Columbus Police Officer Ed Chung has used Narcan 18 times to revive overdose victims while on patrol in the Hilltop neighborhood west of Downtown. All but one survived.
He has heard the concerns, but his feeling is that he's simply saving a life.
"I've been given a tool, and I'm utilizing that tool to try and make sure that person makes it," Chung said. "I'm doing my job—what we're supposed to do: help people.
"At the end of the day, it's your brother, it's your sister, it's your son, daughter, mother, whoever; it's someone who is being loved by somebody... There is always someone who cares about that person."
The reality, Chung and others say, is that many addicts repeatedly overdose before seeking help.
He and others noted that Narcan not only saves drug addicts, but it's also frequently used to revive law-enforcement officers and children who inadvertently come in contact with deadly drugs.
Katie Clark, a nursing supervisor at Maryhaven, an alcohol and drug treatment facility in Columbus, said most of the people who seek treatment have been saved one or more times by Narcan. Patients are sent home with two doses of the antidote.
"You get clients who come in and say 'Hey, thanks for that Narcan. It saved my life. My mom used it on me or my friend used it on me,'" Clark said.
"I view addiction as a disease. If someone is having an allergic reaction, I'm going to give them an EpiPen. If somebody overdoses, I'm going to give them Narcan. If somebody is in a diabetic crisis, I'm going to give them insulin. If you have the choice to save a life, why wouldn't you?"
Dixon used for 11 years, and after deciding to get help waited five months for an opening in a residential treatment program. She realizes it's difficult for people to understand why she would use again within hours of being revived with Narcan.
"I could have died," she said. "Today I'm grateful, yes. But at the time, it's such a strong disease, you live to use and use to live. You don't think about anything else. When you are doing heroin, you are sick without it. You can't function without it."
Narcan, Dixon said, could save "somebody's life that will later on get it together, like me. I wouldn't be here without it."
For those who care for people like Dixon, however, the crisis is taking a toll.
Davis, the assistant Columbus fire chief, said some in his department are working 24-hour shifts saving people and then taking Narcan home to deal with addiction problems in their own families.
"At some point, they don't have anything left to give," he said.
Lisa Deranek, an emergency room physician who doubles up as Medina County coroner, said saving people only to have to save them again is hard. She hasn't yet had to deal with the corpse of somebody she saved earlier in the ER—but she said "it's inevitable."
"It's such a frustrating problem, because as an ER doc we're supposed to save lives," she said. "We're saving lives, but it's only temporary."
Like others, she cautioned that Narcan is no panacea.
"Just throwing Narcan on this opioid fire is not going to fix it," she said. "I'm afraid the government thinks it is."
Dr. Joshua M. Sharfstein, associate dean for public health practice and training at Johns Hopkins Bloomberg School of Public Health, said Narcan saves lives but recovery requires timely access to treatment.
"Frankly, if you are just doing Narcan it's likely you'll have to go out again because it's important to do, because you're saving their life, but it's also important to have the next step...what are we doing to engage them in treatment?"
Copyright 2017 The Columbus Dispatch