Pubdate: Sun, 17 Aug 2014
Source: Journal-News (Hamilton, OH)
Copyright: 2014 Cox Ohio Publishing
Contact:   http://www.journal-news.com/
Details: http://www.mapinc.org/media/915
Author: Rick McCrabb
Bookmark: http://mapinc.org/topic/naloxone

INCREASED USE OF HEROIN ANTIDOTE COSTING CITIES

One way to gauge the depth of the heroin problem in the area is the 
increase in the use of Naloxone by local fire departments.

Naloxone, also known as Narcan, can reverse the effects of a heroin 
overdose, and the Hamilton and Middletown fire departments are 
reporting an increased use of the drug at an increased cost to 
cities, officials said.

Hamilton Fire Department personnel administered 432 doses of Narcan 
in 2013, and 342 doses in the first seven months of 2014, an increase 
of 13 doses per month, according to Mark Mignery, Hamilton's 
Emergency Medical Services Coordinator.

In Middletown, the city ordered 130 doses of Narcan this year, and so 
far 109 doses have been used, according to Jackie Phillips, health 
commissioner in Middletown. During the same time period in 2013, the 
city used 88 does, she said. The number of doses administered in 
Middletown has increased every year for the past fives, according to 
data analyzed by the Journal-News.

If the trend continues, the cost of Narcan, which ranges from $14.20 
to $27.10 per dose, will add to the cities' budgets, officials said. 
Based on the current price tag and 2014 Narcan projections, Hamilton 
is expected to spend $2,200 more this year than in 2013 and 
Middletown is expected to spend about $1,000 more.

"We are all going to pay for it, regardless of whose budget," Phillips said.

She said the cost of treating heroin can't only be measured in 
dollars and cents. It's also taxing on community services.

"It's like an octopus," she said. "We have to get to the root of the problem."

Each of Hamilton's three front-line EMS squads carries six doses of 
Narcan, and each of the five front-line engine companies carries two 
doses. The fire department also carries a supply of Narcan in a 
pharmacy medication dispensing machine at Fort Hamilton Hospital, 
which can hold up to 40 doses at a time.

At any given point, the fire department could have between 28 and 70 
doses on hand between the medic squads, engine companies, and the 
dispensing machine, according to Mignery.

Health officials are quick to point out that while heroin overdoses 
and Narcan typically are linked, the administration of Narcan can 
occur for numerous reasons, not just opiate overdoses. Also, they 
said, some patients receive more than one dose of Narcan to produce 
the desired effect.

Middletown Division of Fire Cpt. Todd Day, also an EMS officer, 
recently made a presentation to the Butler County Heroin Task Force. 
He said the Middletown fire department places supply orders every 
Friday, and without fail, Narcan is at the top of the list.

When fire personnel arrive on the scene of a possible overdose, Day 
said, they look for "signs and symptoms." Typically, those suffering 
from an overdose, have pinpoint pupils and depressed respiratory 
drive, he said. If the firefighters determine it's an overdose, they 
inflate the patient's lungs, start an IV and administer 2 milligrams 
of Narcan, which may take effort within 30 seconds, Day said.

He said Narcan sends signals to the brain that help the patient "come 
out of it." Sometimes, he said, the patient vomits and become violent 
because their "high has been ruined."

Day said those addicted to heroin have bodies "wrecked by the poison."

Medics sometimes deal with what Day called "functional addicts," 
those who know their names, day of the week. They sometimes refuse to 
be transported to the hospital, but they're encouraged to seek 
medical treatment because after a certain amount of time, they can 
relapse, he said.

Day said the patients are offered what he called "an A or B plan," 
either go to the hospital or jail.

Philips has heard complaints from residents who wonder why paramedics 
revive those who overdosed from heroin since those addicted are 
likely to overdose again.

"Everyone deserves a second, third and fourth chance at recovery," 
said Phillips, who called Narcan "a wonderful drug" because of its 
effectiveness.

She called the rise in heroin use, and the related deaths, "tragic 
and puzzling" at the same time. Back in the mid-1960s, Phillips said, 
heroin use was "a big issue," then it seemed to fade away for about 
50 years until the recent surge.

She blamed the increased use on what she called "a loss of 
connectivity." Families and friends are broken, she said.

"There seems to be a loss of hope," she said.

Butler County officials are seeing an increase use of heroin, and 
more deaths are attributed to the highly-addictive drug.

In the first quarter of 2014, of the 114 total cases investigated by 
the Butler County Coroner's Office, 50 were attributed to drug 
overdoses, a 139-percent increase from the first quarter of 2013, 
according to Coroner Dr. Lisa Mannix.

Warren County Coroner Dr. Russell Uptegrove said he also has seen an 
increase in heroin overdose deaths.

In the first quarter of 2013, there were 186 total death 
investigations in Warren County with eight of them being drug 
overdoses. Of those eight cases, five were heroin overdoses. The 
first quarter of 2014 shows 181 death investigation with 12 overdoes 
and six of those from heroin.
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MAP posted-by: Jay Bergstrom