How to fill the EMS empathy gap for opioid addicts

Education and acceptance of addiction as a disease is needed for EMS to bridge the empathy gap and join the effort to solve the opioid overdose epidemic

By Nathan Harig

Walk into any EMT classroom, into any new-hire job interview for an EMT or into any volunteer EMS agency and ask an individual why they decided to get into EMS. For a sizeable majority, the answer will be some variation on the desire to "help people."

They were "called to care," the 2016 EMS Week slogan.

A nasal-administered dose of naloxone.
A nasal-administered dose of naloxone. (AP Photo/Stephan Savoia)

We spend time training on resuscitation skills. We memorize medication dosages for those experiencing heart attacks, low blood sugar, allergic reactions and more. We learn about new vehicle technologies, implement quality improvement plans and training to make sure we’re at the top of our game.

We want to be seen as the most capable responders for our community, the people to call when something goes wrong and the experts in the field of mobile emergency care of any illness. So, why does everything change when that illness is opiate addiction?

Marshal Isaacs, MD, medical director at the Dallas Fire-Rescue Department, gave a powerful talk on addiction during the Pinnacle EMS Leadership conference. Isaacs presented the reality that the imagined "addict" differs greatly from those who actually suffer addiction.

Perception of addiction is not reality

In many cases, providers let their prejudices get the best of them. We paint a mental picture of a homeless, down-and-out drag on society instead of facing the stark reality that many of those addicted are employed and look exactly like you or me. In fact, an addicted person may even be working right now on an ambulance or in an emergency department next to you. Our perception of an addict is far removed from reality. 

With the opioid overdose crisis continuing and naloxone administration being a regular news item, each time an article is shared I see a similar theme of comments which are focused around how they — the addicted patient — made a choice and should suffer the consequences of their overdose. Some comment writers even boldly advocate the patient should be allowed to die.

Comments blast the cost of naloxone compared to reimbursement rates for these presumed deadbeats. Commentators go on to say that naloxone enables addicts, even when faced with evidence from the National Institute of Health that shows take-home naloxone has reduced drug use in populations that have received it and promotes cleaner syringe habits that reduce HIV and hepatitis transmission [1].

It’d be one thing if these comments were limited to the general public, but our own community of professionals has engaged in this negative behavior, even at great personal risk to their jobs. A provider in Massachusetts was suspended for calling his patients "losers" who deserved to die when they overdosed. It’s an attitude far different than that which we cited as the motivation for why we get into EMS.

Many cheered the no-nonsense realism of the "One Breath From Death" campaign, a program from West End Ambulance in Pennsylvania, which asks heroin overdose patients which funeral home they desired for the "next time."

Scared-straight tactics might not help solve this crisis. Instead of encouraging a patient to get help, it may prompt addicted individuals in the future to avoid reporting an emergency, thinking their local ambulance doesn’t care about their life. The card lacks the one thing that would make it truly worthwhile for a patient — resources to find treatment for the disease of addiction.

Apathy, hostility prevents treatment

Issacs pointed out that we’d be appalled if we heard colleagues refer to a diabetic as a "sugar whore" or a cancer patient as a "tumor head." Yet, somehow it is acceptable in EMS to call an addicted individual a "crack whore" or "crack head."

Despite our medical training, we’re forgetting that addiction is an illness. True, it starts from somewhere, but all diseases do. Choices that impact a person’s fitness, driving ability and dietary habits all contribute to the diseases we treat on the street right now. Why should addiction be any different?

Opiate abuse did not appear overnight. This crisis has been building for nearly 15 years and will likely take at least as long to solve. Many addicted individuals didn’t wake up and decide to do heroin, but instead were introduced to opiates through prescription drugs.

Further, only a small portion of addicted individuals enter into the EMS system. Many have found ways to creatively hide their addictions. Issacs shared statistics suggesting 10-12 percent of physicians struggle with drug abuse, higher proportionately than the rest of the population, due in part to the stressful nature of the job. It’s likely that some of the EMS partners you’ve worked with are struggling with addiction as well.

After we accept the history of the crisis and that addicted individuals come from all walks of life, we need to realize that addiction is a disease. It requires treatment and support.

When people face down cancer, significant illness or major surgery, the community rallies around them to support their recovery. This mentality needs to be the same in EMS providers treating the disease of addiction.

By being apathetic and even hostile to the growing epidemic around us, we’re delaying its ultimate solution. Trying to simply scare patients just breaks down a trust we work so hard to build. EMS needs to make sure we’re active fighters for the cure, which includes naloxone for immediate lifesaving administration and follow-up care to get those suffering addiction off these deadly drugs. If we’re only doing one half of the equation, we’re not fully solving the problem.

The most successful long-term treatment programs often pair those who have recovered with those who are addicted. The added understanding from a peer is a stark contrast from the bullying some caregivers demonstrate dealing with patients or talking about the crisis in public.

Many addicted individuals already despair with their disease and see no path back to health or societal acceptance. They see the response and stigma from both the public and professionals in health care and wind up even less likely to seek out help. Telling a patient they were blue and near death is one thing. Empathizing with their disease, offering to link them with treatment and showing them EMS is truly "called to care" is another. We have a responsibility to be the type of responders we say that we are; to be there for our community and to be advocates for all patients.

EMS needs to lead

When accidental deaths prompted the 1966 National Academy of Sciences – National Research Council to publish the historic "White Paper," it created an entirely new field for paramedicine. At the time, accidental death and disability were the "Neglected Disease of Modern Society." In the introduction to this founding document, the authors found "The general public is insensitive to the magnitude of the problem" and advocated that "Public apathy to the mounting toll from accidents must be transformed into an action program under strong leadership [2]."

EMS leaders answered the call to raise ambulance standards, train providers and create systems of care to address this need. We need to fill the empathy gap that exists right now by educating ourselves further on the crisis, better understanding the people involved and learning what’s being done to fight the epidemic. Empathy, not apathy, creates change. It is empathy that’s needed to solve the overdose crisis, and it begins with how we show we’re committed to answer anyone’s call for care.

1. Bazazi, Alexander R. et al. "Preventing Opiate Overdose Deaths: Examining Objections to Take-Home Naloxone." Journal of health care for the poor and underserved 21.4 (2010): 1108–1113. PMC. Web. 2 Aug. 2016.

2. National Academy of Sciences and National Research Council. Accidental Death and Disability: The Neglected Disease of Modern Society. Washington, DC: The National Academies Press, 1966. doi:10.17226/9978.

About the author
Nathan Harig is the Assistant Chief of Administration at Cumberland Goodwill EMS in Carlisle, Pennsylvania, where he oversees technology, data and quality management, outreach, and public relations for the department. A paramedic, Nathan also holds a Bachelors of Arts in Political Science from Saint Vincent College in Latrobe, Pennsylvania and a Masters of Arts in TransAtlantic Studies from Jagiellonian University in Krakow, Poland.

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