Opiate users who suffer a non-fatal overdose are at the highest risk for having a fatal overdose.
Many of these people are hard to reach by traditional substance use and health care professionals. EMS can make a difference with this population.
Whether the patient refuses further care and transport at the scene after being resuscitated or whether they go to the ED and then check out AMA, EMS has the opportunity to intervene. Here are three models an EMS system should consider.
Provide Treatment Information.
If there is a toll-free number for substance use help in your state, as there is in Connecticut, give them that number, or give the number of the local harm reduction coalition.
In Connecticut call 1-800-563-4086.
Department of Mental Health and Addiction Services Access Line for Opioid Users
Greater Hartford Harm Reduction Coalition
Give your patient information on where to obtain treatment, and/or if they are not ready for treatment, provide them with information on where they or their family members can obtain Naloxone.
In Connecticut, you can walk into a participating pharmacy and get an immediate prescription for Naloxone. If you have insurance, the Naloxone you receive can be had for a small co-pay or even free.
Naloxone in Connecticut
If your patient was sharing needles, tell them where they can get clean ones.
In Hartford the Needle Exchange Van, which also provides Naloxone and Naloxone training is at the following locations Monday – Friday:
Don’t be judgmental. Remind your patients if they are going to use, they should never use alone. They should avoid mixing opiates with benzos. They should have a plan for an overdose. If they are using heroin from a new source, they should consider doing a tester shot first to determine potency.
If, as in Connecticut, a person can call 911 to report an overdose and be exempt from criminal prosecution (unless they are selling drugs), remind them to always call 911 without fear of retribution from the law.
Leave Naloxone on Scene
More and more EMS systems are going to a model where EMS is allowed to leave Naloxone at the scene of an overdose. You will need approval to make certain you are complying with state laws and your local medical direction. We are working on a protocol for Connecticut, where EMS will be able to provide Naloxone, after documenting they have provided training to the recipient, and have recorded the recipient’s information in case there is a recall on the drug.
Paramedics in North Carolina and in Cleveland, Ohio are providing Naloxone kits to high risk patients in their communities.
Cleveland EMS Providers to Distribute Overdose Kits
N.C. County Allows Paramedics to Provide Precautionary Narcan Kits
Link with Social Services
Link with local health and community professionals to provide follow-up visits to users who have suffered an overdose.
Here is an excellent article that describes how first responders in various parts of the country are offering noncoercive treatment help.
What’s Next After Narcan?
Breaking someone from the grips of opiate addiction is difficult and we cannot expect every patient we make contact with will respond, in much the same way we can’t expect to bring back each patient we find in cardiac arrest. But we need to try. It’s what we do. Every year, every month, every day that someone lives who might have otherwise died is a victory. Let users know that they are not alone, that we are here ready to help.