Saturday, February 18, 2017

Police: Opioid reversal drug saves lives, but addiction crisis must be addressed

Posted Feb. 2, 2017
Falls Lt. Nelson Whitney 
She was almost dead, Nicholas Pinto said, when he found her.


When the 33-year-old Falls police officer arrived at a recent medical emergency call for an unresponsive 21-year-old woman in a hotel room, he found her pulse was weak and her breathing was shallow. Near her body, Pinto noticed a syringe and an empty plastic baggie, both common signs of heroin use. 
Pinto has been at similar scenes more than a dozen times in the last year. He was ready to respond, he said, every time.
He pulled out a plastic device, smaller than a cellphone, that has become as much a tool of his job as his handcuffs and gun. The device carries the lifesaving medication called naloxone, which blocks the effects of opioids on the brain and restores breathing immediately when injected or inhaled. 
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Using Falls Township records clerk Colleen Rugg as a model, Falls Police Cpl. Nicholas Pinto shows how a naloxone injector could be used to reverse an opioid overdose. The EpiPen-like injector wasn't triggered in this demonstration.
Pinto injected the woman with two doses of the medication, then administered oxygen until the ambulance arrived. The paramedics administered more naloxone, disrupting the woman's opiate stupor. She lived.
Of the 87 drug overdoses Falls police handled in the last two years, slightly more than half the people survived after an officer administered naloxone, according to police officials. Pinto is responsible for one-third of those overdose reversals.
“It always feels good to save somebody," he said. “It doesn’t matter what kind of circumstance it is.”
Falls was one of the biggest users of naloxone (brand name, Narcan) among Bucks County police departments, along with Bristol Township (113 opioid overdose reversals) and Bensalem (54 reversals) between 2015 and last year, according to county data. Combined, the three departments alone are responsible for nearly two-thirds of opioid reversals reported by Bucks County law enforcement since 2015.
But police in the larger communities aren't the only ones using the medication to reverse overdoses.
"There aren't many officers that haven't used it, so far," said George McClay, the police chief in Morrisville, among the smallest Bucks County communities with 16 police officers.
Departments using naloxone
Twenty-eight of the 36 Bucks County police agencies, including county park rangers, have reported their officers have used the free naloxone supplied to them by a coalition of government agencies and insurers over the last 21 months. Newtown Borough is the only police department that has refused the free medication. Police Chief Tony Wojciechowski has refused to publicly say why, though the borough council is considering a request for the District Attorney's Office to equip borough officers
In neighboring Montgomery County, officers in 35 of the 49 law enforcement agencies carry naloxone. A little more than half of overdose reversals by police are attributed to five departments there, including Abington, according to county data. Montgomery County started distributing the medication in March 2015, according to David Brown, deputy director of emergency management services. Over 22 months, police administered naloxone to 157 people and 142 survived, according to county data as of January.
In an effort to reduce Pennsylvania deaths from opiates, the Pennsylvania District Attorneys Association partnered with the Pennsylvania Department of Drug and Alcohol Programs (DDAP), the Pennsylvania Commission on Crime and Delinquency and private health insurers two years ago to provide free naloxone to law enforcement officers. That program was launched after state lawmakers approved the medication's use by police and others with no formal medical training, and provided immunity from prosecution to those who administer it or seek help for someone who overdoses.
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Packages contain Narcan, the brand name for the opioid overdose reversal drug naloxone. Police in Falls and most other Bucks County communities carry the medication and have reversed hundreds of overdoses since 2015.     
As of December, police in Pennsylvania had saved more than 2,100 lives using naloxone provided through the Pennsylvania District Attorneys Association program. All police departments in 18 of the state’s 67 counties carry the drug, according to DDAP. The remaining counties had some police departments carrying it or plans were in the works to do so.
Bucks County had at least 191 opiate reversals, the third highest by Pennsylvania law enforcement, as of December, according to DDAP; Montgomery County ranked sixth, with at least 134 reversals.
Police officials who were interviewed for this article said they believe it makes sense to carry the drug, since saving lives is part of their job. Medical emergencies typically account for the largest volume of police calls and police frequently beat rescue squads to the scene, they said.
But others worry the wide availability of naloxone provides addicts with a false sense of security and discourages them from seeking treatment.
“We hear that from time to time, but if it affects someone they know, they have a very different perspective on it,” said Richard Long, executive director of the Pennsylvania District Attorneys Association, which reimburses law enforcement agencies for naloxone purchases.
Montgomery County's Brown described the police feedback as "overwhelmingly positive." 
"Literally (patients) are walking to the ambulance," he said. "It's remarkable."
Dealing with an epidemic 
Some officials expressed frustration that while naloxone is saving lives, much more needs to be done to reverse the growing opioid epidemic.
“Is it taxing the local resources? Absolutely,” Bristol Borough Police Chief Stephen Henry said. “It’s beyond frustrating because I don’t see anyone coming up with a game plan -- an addiction and law enforcement strategy.”
In both counties, police officials said they don't track how many times they revive the same person, but even departments where the drug is frequently used, the estimated number of repeat saves is under 10 people. 
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Corpl. Nicholas Pinto, of the Falls Township Police Department, shows what opioid-reversal medication EVZIO, a naloxone HCl injection device, looks like, at the Falls Township Municipal Complex.
Hilltown Police Chief Christopher Engelhart estimated his officers have administered naloxone about eight times over the last two years. In the largely rural Upper Bucks community, police often arrive at the scene a few minutes before the ambulance, he said. While he agreed the drug is an important lifesaving tool, he said some officers have expressed mixed emotions about it.
“Some are not overly thrilled with it and some expect it to be part of the job,” Engelhart said. “We are concerned that part of this, unfortunately, seems to be a bit of a revolving door. It’s saving their lives in that particular instance, but it’s not long term.”
He had an officer administer naloxone twice to the same man, Engelhart said. Both times, he said, the man stood up, shook hands with the officer and thanked him -- then refused medical treatment from the rescue squad. The incident is why Engelhart believes the law needs to be updated to require that someone revived with naloxone in the field be medically cleared at a hospital.
Bensalem Public Safety Director Fred Harran said he is frustrated that there is not more being done to deal with the opioid epidemic. 
“I have a 233-percent increase (in overdose deaths) with Narcan on the street. I think that number would have been 533 percent without Narcan,” Harran said. “You can’t put a price on saving your loved ones, but we’re not hitting the problem at its core. We’re ignoring the problem. Narcan is a Band-Aid on a bleeding artery. Narcan is a great tool, but it’s one tool in a toolbox that is fairly empty.”
In an effort to add to their toolboxes, Bensalem and Falls police launched programs last year offering free, 24-hour assistance to anyone who wants to enter a substance abuse treatment program -- no questions asked.
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Falls police Lt. Nelson Whitney talks about his department's use of naloxone to reverse opioid overdoses, which have increased substantially since 2015. 
To Falls Lt. Nelson Whitney, such an outreach program makes sense. Fatal overdoses in Falls nearly doubled, from 14 to 25, between 2015 and last year, he said, and the department averages six to eight overdose calls a month. The department is among the ones where officers carry both nasal and auto-injected naloxone.
Pennsylvania is among the states hardest hit by the opioid epidemic, particularly the southeastern region that includes Philadelphia and its suburbs, according to federal Drug Enforcement Agency data. More than 3,300 people in the state died of drug overdoses in 2015, a 23 percent increase over the prior year, according to DEA data. At least one opioid was present in toxicology results in about eight of every 10 of those deaths, according to the DEA.
Locally, coroners in Bucks and Montgomery counties each reported record-high numbers of accidental drug overdose deaths last year, mostly attributed to opioids.
Nearly half of the 254 Montgomery County coroner cases in the first six months of 2016 were drug overdoses, and opioids were present in 90 percent of those cases. In Bucks County, 140 of the 683 cases the coroner’s office handled through late December involved drug overdoses, with opioids present in at least 75 percent of cases. Toxicology is pending on another 30 cases.
Bucks County Coroner Dr. Joseph Campbell said black market fentanyl that is showing up in overdose toxicology reports is stronger than anything he has ever seen. Fentanyl is a synthetic opioid that is similar to morphine, but many times stronger than heroin and requires higher doses of naloxone to reverse an overdose.  
"I don't think there is enough Narcan being carried on the street to keep them from dying (from fentanyl),” Campbell said. “It kills and it kills quick.”
Opioid overdoses are keeping police busy in many communities.   
Some weeks, Falls' Pinto said he responds to an overdose call every night.  
“This is the worst I’ve ever seen,” he said. “It’s so prevalent.”
That's why Pinto said he carries two doses of naloxone on every shift -- and some nights he uses both before the end of his shift.
Often, after reversing an overdose, Pinto finds himself trying to convince the person that death was narrowly averted. The typical reaction is denial. “Most of them don’t believe it,” he said.
Family and friends of people whose overdose was reversed are always extremely appreciative, the officer said. The people he saves, though, rarely offer their thanks, including the 21-year-old woman in the hotel room.
“Few and far between," was how Pinto described the times he's thanked by people whose overdoses he's reversed.
Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @JoCiavaglia

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