EMS and the opioid crisis has become one of the most frequently discussed topics in the medical community.
Search the internet and you will find a plethora of articles detailing the crisis we face in the U.S. How did we get here, why is it so difficult to fix, and what is the relationship between EMS and the opioid crisis?
There are some alarming statistics surrounding addictions, according to the National Center for Drug Abuse Statistics.
- 21% to 29% of patient’s prescribed opioids for chronic pain misuse them.
- 8% to 9% develop opioid use disorders.
- 4% to 6% transition to heroin if they have misused prescription opioids.
- 80% of people who use heroin started with misuse of prescription opioids.
- Opioid overdoses increased by 30% in 14 months between 2016 and 2017 nationwide.
- In the Midwest, overdoses rose 70% from 2016-2017.
- Opioid overdose in large cities increased by 54% in 16 states during this time.
In 2017, the opioid overdose rates climbed extraordinarily, with more than 47,000 Americans dying of opioid overdoses and 36% of those deaths involving prescription opioids.
Additionally, in 2017, according to the Center for Behavioral Health Statistics and Quality, 1.7 million people in the U.S. suffered from substance use disorder related to opioid pain medication and 652,000 suffered from heroin use disorder.
From a healthcare worker’s perspective, these situations become exhausting.
Some examples include repeated responses to the same people who have overdosed on opioids, giving Narcan regularly to the same patients who we term “frequent flyers,” working at an ER where the same patients return time and again because of opioid-induced emergencies, and getting screamed at by a patient demanding Dilaudid or morphine.
All of these scenarios are probably pretty familiar to most healthcare workers.
The origins and consequences of the opioid crisis
In the 1990s, pharmaceutical companies convinced the medical community that there would be no adverse reactions if they prescribed opioids for chronic pain, says the National Institute on Drug Abuse. The pharmaceutical industry argued patients would not become addicted to prescription opioid pain relievers and the medical community bought into it. Providers freely handed out prescriptions, and thus began the epidemic that has since gripped the U.S.
As more people became addicted to a substance that doctors once deemed “safe,” the methods used to dispense these medications came under question.
Unfortunately, by the time we’d made this realization, we were already a nation knee-deep in addiction. At the mercy of a broken system, these patients, fueled by a newfound addiction, often began shopping around for physicians willing to give them opioids. Pill mills popped up and doctors lacking scruples continued to weave this web of addiction.
With criminal charges and lawsuits levied against manufacturers, and pill mills closing, we must deal with the aftermath — a country riddled with opioid addiction and not many nationally approved safe alternatives for these patients. Furthermore, we tend to shame addicts who fell victim to this addiction.
Healthcare and the opioid crisis
As a society, it is important that we acknowledge how this happened so we can begin to develop the necessary empathy toward these addictions.
Healthcare workers, burned out by drug overdose situations, often become jaded and lose compassion for patients suffering from addiction. We collectively begin to criticize drug users, assuming they are weak and incapable of resolving their addiction. We do not see them as human beings suffering from something seemingly beyond their control.
If addiction was so easy to beat, then wouldn’t there be more success stories?
A Sept. 2019 study published in the Journal of Addiction Medicine estimates that 1.2 million American adults reported recovering from an opioid addiction.
The study reports the road to opioid recovery is much more daunting and requires significantly more resources than it takes to kick alcohol addiction.
According to U.S. News and World Report, the study noted between one and four years, known as “mid-recovery,” people who resolved an opioid problem proved four times more likely to have used pharmocotherapies (drugs such as methadone or buprenorphine) to prevent cravings or relapses when compared to people in mid-recovery with alcohol addiction. Those in opioid addiction recovery were 2.5 times more likely to use formal addiction treatment and approximately twice as likely to use recovery support services and mutual help organizations than than those recovering from an alcohol problem.
Unfortunately, these treatment services can be costly and scarce, especially in rural areas where the opioid crisis has hit the hardest. Combine this with the difficulties rural EMS face in terms of staffing and response time, and the link between EMS and the opioid crisis only becomes murkier.
While the medical community appears to have contributed largely to this crisis, we have done little to fix it other than rendering shotgun therapy.
A story of addiction
I recently interviewed a recovering opioid addict who presented some alarming recollections about her experience as an addict. Unlike people who become addicted to heroin after they misused prescriptions, the story of “Quinn” is different. Her story reflects the need for greater understanding of the relationship between EMS and the opioid crisis.
Growing up surrounded by drugs
Both of her parents had past struggles with addiction, so she had to grow up fast.
After her parents divorced, she was raised by a single mother, and money was very tight. Quinn began selling marijuana and cocaine as a teenager to help support the household, unbeknownst to her mom. Being no stranger to the drug life, Quinn began using heroin in her late teens. Her friends did it, so she wanted to try it.
Of her first experience with heroin, Quinn said, “I immediately liked it, but I wouldn’t do it a lot because it made me throw up every time.”
She didn’t use regularly and eventually kicked the habit. But, after a car accident she required hospitalization, resulting in the administration of narcotic prescriptions.
She began misusing the pills and started getting them off the street when her prescriptions ran out. Eventually she found herself going back to heroin because it was cheaper and easier to obtain. She said there were many times she tried to quit, but the stress of life, lack of support and a broken system that seemed to set people up for failure turned her back toward addiction.
Facing judgement
When asked about the availability of clean needles, Quinn explained that although the law changed years ago to allow addicts to be able to purchase clean needles from a pharmacy, it is still at the discretion of the pharmacist. Quinn recalls that if she looked or acted like an addict, pharmacies likely would deny her the right to purchase clean needles.
“I would have to dress up like I was going to a job interview just so the pharmacist didn’t suspect I was using the needles for drugs and deny me the purchase,” she said. “This is a problem with the system that needs to change. No one is going to convince a drug user at that moment that they should just quit, so why encourage the use of needle sharing? Why not at least ensure that the spread of diseases like HIV and hepatitis is decreased by making it illegal to deny the sale of clean needles?”
Quinn said she often felt judged as an addict.
“Even now that I am clean, there are still people who don’t — and will never — believe me when I say I am clean,” she said. “You burn bridges with addiction, and then those people walk away from you. Now there is one less person to support you when you try to truly quit.”
A need for greater empathy
When sharing her experiences with EMS workers and at hospitals during her years as an addict, she recalled “a couple” of overdoes situations.
“One time they found me passed out in my car,” she said. “The paramedics were kind to me, gave me Narcan to bring me around and brought me to the ER where I walked out a few hours later. Another time, I was unconscious in my house from heroin, and again they gave me Narcan and brought me to the ER. The paramedic that was in the back with me told me that I was a piece of (expletive), and that I was wasting her (expletive) time that she could be using to save the life of someone deserving.”
“Those words hurt pretty bad.”
Quinn said the comment sticks with her, even today.
“I understand that people have bad days, and they get burned out on dealing with repeat drug users, but comments like that certainly don’t help anyone want to quit,” she said. “It doesn’t help their self-esteem at all.”
When it comes to EMS and the opioid crisis, expressing empathy for the victims of addiction can only help.
Quinn on the mend
Quinn has been living a sober life for several years now, but it has not been without its challenges.
“Addiction is not just about getting clean,” she said. “It is about changing your routine because addiction IS routine. Every day is about preparing for how and when you are going to obtain your fix. When you get clean, you have to replace the routines with something else.”
To this day, Quinn doesn’t promise those close to her that she will never go back to drugs.
“I have made that promise in the past, and you look like an idiot when you fail,” she said. “I just tell people that I will do my absolute best to never go back.”
Quinn is candid and realistic about the road to recovery. She knows it is one that she will have to stay focused on in order to succeed. Quinn hopes that in time, people who have never had addictions can step back from judging others. Then, we can work toward a united goal of helping those people find real and life-changing solutions to addiction.
The relationship between EMS and the opioid crisis
In the EMS profession, staff often get overworked and sometimes abused by patients under the influence of drugs and alcohol. So, there are times when it’s easy to fall into the trap of stereotyping.
We must remind ourselves of the oath we took as healthcare professionals and remember to treat everyone equally. We are not in the position to offer judgment, but rather to provide unbiased care to each person we serve. The opioid epidemic plaguing us is not one that was born simply from peoples’ desire to overindulge and chase the high.
In part, the healthcare industry largely contributed to this problem by irresponsibly dispensing narcotics for years. We’re at a point where we must view this as a humanitarian crisis, apply less judgment and find realistic solutions. If we don’t, we are going to continue to unnecessarily lose people to addiction.