Emergency department staffers in the front lines of the opioid war

Published on Saturday, 12 August 2017 21:33
Written by LISA BACKUS

STAFF WRITER

NEW BRITAIN - It’s not unusual to see the staff of the Emergency Department at the Hospital of Central Connecticut running to retrieve an unresponsive person who is overdosing on heroin or fentanyl.

Every second counts when someone has stopped breathing due to an overdose, said the hospital’s Emergency Department director, David Buono. The key is to make sure the person gets a dose of Naloxone, commonly called Narcan, as quickly as possible before their heart stops beating.

“We have to go out into the parking lot and take them out of the car,” Buono said. “It happens about once every other month.”

Sometimes, they are blue, said Dr. Andrew Lim, vice chair of the Emergency Department at Bristol Hospital, who added that his ED deals with about 500 overdoses a year or more than one a day.

Buono estimates that about 70 percent of people who are brought to the ED for an accidental drug overdose are taken there by ambulance. The other 30 percent are brought by friends in a car - a dangerous decision since a person can suffer brain damage or die if the overdose isn’t treated within eight minutes from when the person stops breathing.

“Unfortunately they do arrive in a car pretty close to death,” said Lim, who added that about one in five overdose patients brought to his ED are done so by private vehicle.

The number of overdoses the HOCC ED sees varies, Buono said. “We can get two a week to a couple a day,” he said.

Last year, there were 917 fatal overdoses in Connecticut - a nearly 300 percent jump since 2012 when 357 people died. The increase in the number of deaths can be attributed in part to the increase in the use of fentanyl, a drug about 50 times more powerful than heroin, officials said.

Although the figures for the first six months of 2017 won’t be completed until the end of August or September, the state’s chief medical examiner, Dr. James Gill, said the number of acute drug intoxication deaths is not decreasing.

“We should know by the end of the summer if it is holding steady or increasing,” Gill said. “We are still seeing numerous deaths with fentanyl.” 

Buono and Lim are on the front lines of the battle. In 2016, New Britain and Bristol placed fourth and fifth in the state for the number of residents who died from accidental drug overdoses.

Most people arrive at the ED alert after being saved from an accidental overdose by paramedics, firefighters or police. Thanks to state legislation enacted as the number of fatal overdoses spiked, first responders carry Narcan.

The trick is now to get a person who has been revived with Narcan, which ruins their high and sends them into withdrawal, to stay in the hospital for a few hours to make sure the overdose doesn’t come back. It’s an even bigger hurdle at HOCC to get patients to consider treatment.

“Once they are medically cleared, almost all of them don’t want treatment,” Buono said. “Once they’re safe, they just want to go back home.”

About 95 percent of people who are revived from an overdose and who are spending time in the HOCC ED in New Britain, do not show an interest in entering treatment, Buono said. In Bristol, about 50 percent of those who are revived at least seem interested in treatment, Lim said. They are provided support through the hospital’s crisis counseling staff and at the very least will be checked on a week later to see how they are doing. But there is no way of knowing exactly how many people have actually gone into treatment once they leave the ED, he said.

Both hospitals will issue a prescription for Narcan for the patient and their family before they leave. In New Britain, patients who express an interest in treatment will be given a list of detox centers they must call themselves.

On the one hand, people must want treatment for it to be effective, Buono said. But on the other, it’s nearly impossible for someone who just overdosed to navigate finding treatment on their own, said Patricia Rehmer, a former state Department of Mental Health and Addiction Services commissioner who is now the President of the Behavioral Health Network for Hartford Healthcare which includes HOCC.

“When you are revived with Narcan, it’s not a very pleasant experience,” Rehmer said. “Traditionally what Emergency Depart-ments have done is give people a piece of paper with five different numbers and said call these. That’s not going to work.”

But a new initiative launched in February by the Connecticut Community for Addiction Recovery is already having an impact on the number of people who are seeking treatment immediately after an overdose, Rehmer said.

The ED Recovery Coach Program trains those who have successfully gotten their addiction under control and family members who have dealt with those with addictions to support patients who have overdosed while they are still at the emergency department.

It’s a chance to tell patients, I have been where you are and I made it out, Rehmer said. “ED staff don’t have time to support someone or find a place for treatment,” she said. “An ED Recovery coach can say to someone, I was where you are five years, recovery is very possible.”

The results of the first few months are encouraging, Rehmer said. “The first month they saw 84 individuals and got 84 individuals into treatment,” she said.

Although HOCC doesn’t participate in the program, Rehmer would like to get ED recovery coaches at every hospital under the umbrella of Hartford HealthCare. “A lot of people just want to get out of the ED and go get drugs,” Rehmer said. “You have to get people the minute they saw yes.”

Lisa Backus can be reached at 860-801-5066 or Lbackus@centralctcommunications.com.



Posted in The Bristol Press, Bristol, General News on Saturday, 12 August 2017 21:33. Updated: Saturday, 12 August 2017 21:36.