LIMA — The ubiquity of Naloxone, an overdose reversal agent which was relatively unfamiliar to the public several years ago, is being credited for a downward trend in overdose fatalities and emergency department visits reported in 2018.
The number of opioid-induced overdose admissions to the emergency departments at Mercy Health–St. Rita’s Medical Center and Lima Memorial Health System fell from 489 in 2017 to 247 in 2018, following a similar trend reported by EMS providers who administered fewer Naloxone doses last year than the year prior.
Preliminary data suggests overdose fatalities in Allen, Auglaize, Hardin, Mercer, Putnam and Van Wert counties fell too.
But 2017 was a particularly dire year for overdose fatalities. Nearly 5,000 people in Ohio died of an unintentional drug overdose that year, up from 4,050 in 2016, according to the Ohio Department of Health. There have been 18,500 unintentional drug overdose deaths statewide between 2012-2017.
Still, community leaders who work closely with individuals addicted to heroin and opioids are cautiously optimistic that the increased availability of Naloxone is helping reduce deaths, as those same leaders work to expand substance abuse treatment.
“We’ve learned to save their lives more quickly,” said Tammie Colon, executive director of the Mental Health and Recovery Services Board for Allen, Auglaize and Hardin counties.
Using Naloxone to avoid the ER
Some overdoses are likely going unreported as Naloxone, also known by the brand name Narcan, is now available to the public without a prescription, making it easier for users to avoid contact with law enforcement and paramedics.
“We would always recommend that they call 9-1-1,” Colon said. “But they’re not going to, and part of that is because when the client revives … they don’t want any public attention brought to them out of fear of criminal consequences. We advise it, but we know people aren’t doing it.”
Just how many people are declining to call 9-1-1 is unknown, and even those who do often decline to go along with paramedics.
Lt. Andre McConnahea, public information officer for the Allen County Sheriff’s Office, estimated that the “vast majority” of individuals revived by deputies from his department refuse to go to the emergency room.
“They think they’re better now … We urge them as much as we can to go with EMS and get professional help, but it’s on them whether they want to or not,” said Deputy Justin Kirk, who has administered Naloxone while on duty for the Allen County Sheriff’s Office.
Quick fix, not a cure
But Kirk described Naloxone, which is only effective in reversing the effects of an opioid-induced overdose, as a “quick fix,” not a cure.
That’s because Naloxone can wear off within about 90 minutes, according to Tami Gough, director of prevention and health promotion services for the Allen County Health Department.
Gough encourages people who pick up free vials of Naloxone from the health department to call 9-1-1 after administering Naloxone, but she said it’s hard to track how many people follow her advice.
She said there are misconceptions regarding how Naloxone works. For one, Gough said individuals revived by Naloxone often feel sick and are at risk for withdrawal, which may increase that individual’s desire to use opioids again to go back to feeling normal.
“It doesn’t just make you feel normal,” Gough said. “It makes your body zoom into withdrawal. You can become what they call ‘dope sick.’”
Kirk added, “They don’t like going through withdrawal because it’s very painful. So they go out there and reuse again. Like I say, Narcan’s just a quick fix. It’s not the life-saving techniques,” such as those used by the emergency department.
Susan Hawk, behavioral health chief of clinical integration for Mercy Health-St. Rita’s Medical Center, agreed that opioid withdrawal is “very tough.” To help those patients, Mercy Health-St. Rita’s opened an opioid detox center in 2017 and recently expanded its inpatient treatment center so that opiate services are available 24/7.
“The fear is, if you don’t get them in, that they’re going to go use and if they get ahold of anything, they can harm themselves,” Hawk said. “They take more than what they need, or they’re taking stuff that’s laced with other stuff. Our goal is to get them in right there, right now and help them when they’re most ready to help prevent them from getting sick, because one way or another they’re going to have to have help getting through that tough withdrawal.”
Hawk said St. Rita’s saw about 45 opioid detox patients in all of 2018, but that number is 50 in January 2019 alone.
“We have found that people are asking for help much more frequently, and we’re giving it to them,” Hawk said.
Naloxone may be saving some lives, but many heroin and opioid users have already died.
McConnahea, the public information officer for the Allen County sheriff, described this as the “grim reality” of the opioid crisis.
“A lot of users are dying … The people we deal with, we deal with over and over and over,” he said. “If one of them disappears off the radar for us, we’re hoping it’s treatment. In a lot of cases, they might be dead. Or they stopped and moved on to meth.”
Gery Thobe, chief deputy for the Mercer County Sheriff’s Department, said some users have simply gotten “wiser,” even if they haven’t stopped using heroin or entered treatment.
“I’ve heard things such as what they call Narcan parties, one subject has Narcan and everybody else is shooting up … so there is one person there to give them the drug,” Thobe said. “It’s kind of scary, actually.”
Now experts await what’s next.
“Everyone’s on pins and needles ahead of the game for what may be coming after the opioid piece,” said Rick Skilliter, associate director of Prevention Awareness Support Services and a former Bluffton police chief.
While Naloxone is effective in reversing the effects of opioids in an overdose, it is not effective with other substances.
“The fight is an ongoing battle that we’re continuing on a daily basis,” Skilliter said. “We’re seeing the fruits of a lot of hard work by a lot of people over the years. … We have lost people of all age ranges in the region, but the collective community coming together to work to change the face of the tragedy and try to bring about change in a matter of a year or two says a lot about all the people that have been working on the project to turn it around in such a short order.”
Reach Mackenzi Klemann at 567-242-0456.