Dear Neighbor:  

When Washington Ambulance is dispatched for a patient with chest pain, we expect that we will find a patient with chest pain.

When we are dispatched for an overdose, we try to set aside all expectations. We know that we do not know what we will find when we arrive on scene.

To begin with, the dispatch term "overdose" covers a wide range of situations. Patients may include small children who have helped themselves to tasty vitamins or the family's laundry detergent packets, as well as people having adverse reactions to prescription medications or dietary supplements. We may be dispatched for patients experiencing adverse reactions to marijuana. And of course, we have been dispatched for overdoses of heroin and other narcotics.

During the first three months of 2016, Washington Ambulance was dispatched for ten overdose calls, including:

4 calls for overdoses/adverse reactions to prescribed medications

1 call for an adverse reaction to hallucinogenic mushrooms

1 call for an adverse reaction to medical marijuana 

1 call for an alcohol overdose

1 call for an overdose of alcohol and an unknown quantity of pills

  

To get an expert's insight on this crisis, we called Donna Campbell, Executive Director of Greenwoods Counseling Referrals, Inc., in Litchfield.

Q:  Heroin has been around for a long time. Why do we have an epidemic now?

A:  About five or ten years ago, there was a turning point in U.S. medical practice, a whole move towards the belief that "nobody should be in pain." That led to an enormous increase in the prescription of opiod painkillers. Kids have easy access to opiate pills, either because they have been given a prescription or they have raided the family medicine cabinet. Addiction sets in very quickly. When they can't get the pills, they turn to heroin. It is cheap and provides a bigger high. I think also that heroin has lost its stigma. But because most heroin is laced, it is more toxic.

A:  There's been a lot of press about the difficulty of getting into treatment or rehab. Can you comment about that?

Addiction is a progressive disease. If someone is just starting to realize that they have a problem, it's very feasible to help them with different outpatient resources. The problem that we have is helping the person who is further along in addiction. Often there are windows of time and opportunity when they want to get help. The challenge is to get them help in that window. We get calls from people standing on the sidewalk outside of a hospital, saying "I OD'd, I've just been discharged from the hospital, and now I want to go to rehab." They are medically stable, so they don't need to be in a hospital anymore. But if they go straight home, they're very likely to relapse quickly. It's a scramble to try to help them.

Q:  All this talk about rehab. Twenty eight days in rehab is not going to cure anyone, is it?

No. But inpatient rehab gives you time to figure out what the problems are while keeping the person clean and developing a plan. If you take someone from an inpatient hospital setting and send them straight back to where they came from, with the same triggers, the same people, the same situation - they are going to relapse. Also, many many addicts have dual diagnoses - for instance, bi-polar disease and drug addiction. If you have time and resources, you can work with the addict and their family to develop a continuum of care. For instance, you may follow a stay in rehab with intensive outpatient therapy. 

If you don't have time and resources, access to healthcare becomes a real problem. We do what we can, and so do the families. It's especially challenging when a family is just beginning to come to grips with the issue.

"I said to my son, I want you to write your obituary. Because I would not know what to say. Do you understand that you almost died? He kind of shrugged. He didn't care about living anymore. What a ride it has been. The things we have done. Telling our son, 'No, you cannot live here at home.' We came to that decision the hard way, after he had stolen from us. We learned that we were just enabling him to continue using.    Our story is the same as lots of other people. My son had a serious accident - in his case it was a skiing accident - and he was prescribed oxycodone for the pain. We did not realize how dangerously and quickly addictive it was. He did not know. And once the addiction had hijacked his brain, it was easy for him to find heroin.   What I would want to say to other parents is this: You're not alone. This problem is everywhere. It is here in Washington, for sure. Also, I would want them to know there is help. I cannot say enough about the people who helped us. And there is hope. My son has been clean for almost two years now. I am so proud of him. I told him, 'You're my hero.'"

Efforts to prevent addiction go back as far as the human experience of addiction, and that goes back to antiquity. It's clearly a complex issue.

The emergency room physicians to whom we look for medical guidance believe that the two most important things that you can do to defend yourself and the people you love against the risk of addiction are to increase your education and reduce your exposure. 

Learn about addiction. There's a great deal of excellent information available on the web. To get started, we particularly recommend the Caron Foundation's Understanding Substance Abuse & Addiction, along with the Narcotics Anonymous questionnaire Am I an Addict? and Nar-Anon's 20 questions. Nar-Anon's questionnaire will help you wrestle with the question of whether a family member is an addict. 

The Hickory Stick Bookshop stocks many books covering the broad area of substance abuse and addiction. We asked owner Fran Keilty if she could recommend some books on the topic. Her list of suggested titles (see complete list below) included the novel Cost and Dry: A Memoir. 

Don't use narcotic medications to treat pain. Rather, work with your doctor to explore alternatives that are non-addictive. DO NOT KEEP EXTRA NARCOTICS IN YOUR MEDICINE CABINET. This is such a known risk factor that the CDC has designated this Saturday, April 30 as National Prescription Drug Take-Back Day. On this day, law enforcement agencies are working to provide Americans with a safe, convenient and responsible means of disposing of prescription drugs. On that day, there will be collection sites in many Litchfield towns. Conveniently for us, the New Milford Police Department will allow you to drop off prescription medications at their headquarters at any time.

When we asked Dr. Tom Koobatian if he had any special tips for parents, he said "Understand the risks, educate your children about them, and keep a constant dialogue open about drugs, alcohol and addiction. Be aware that drug deals are much easier these days thanks to texting. The text numbers are shared and the drug deals are easily made. If you're worried that your kid is using drugs, check his or her cell phone texts."

When we respond to an overdose, you can expect that we will be focused first and foremost on the immediate medical emergency.

In the extreme case of a life-threatening opiod overdose, we will move very quickly to administer NARCAN™, to take other measures as necessary, and to get the patient to the hospital, with a paramedic on board. If the NARCAN™ is successful, the patient will wake up feeling extremely angry (because their high has been ruined) and also nauseous. They may vomit, and they may have projectile vomiting. This creates the potential for a threat to the patient's airway and breathing. If you have a NARCAN™ prescription for an addict in your family, you should be aware of these risks. If you are administering NARCAN™, you should also be calling 911, since the patient will need further care.

In other overdose situations, where the patient is conscious and breathing, we will try to find out as best we can what the patient has taken and how much they have taken. In the case of suicide attempts, a patient may have swallowed many different pills.

We would like you to be aware that withdrawal can also be dangerous. Alcohol withdrawal is particularly dangerous, in a medical sense; both Danbury and Charlotte Hungerford have specialized medical alcohol detoxification units. Drug withdrawal may be medically dangerous, depending on the specifics of the situation; moreover, a patient who is withdrawing from opiods is going to be in extreme discomfort and will seek drugs to relieve their pain. That means relapse. A patient who is having acute drug withdrawal symptoms should be evaluated in an emergency setting. That means either going to the emergency room or calling 911.

In most overdose and poisoning cases, we will go to New Milford Hospital, as it is closest and very capable of managing any overdose emergency. However, in the case of a patient who calls 911 because they are experiencing withdrawal and/or seeking rehabilitation, we will most likely go to either Danbury or Charlotte Hungerford.

Finally, in life-threatening overdose situations, Washington Ambulance will also dispatch members of our Patient Assistance Team (the PAT Team) to assist the family, whom we see as secondary patients. However, the first priority is always to take care of the primary patient with the medical emergency.