that navigate patients to the most appropriate venue for their care.
A program in Palm Beach, Fla., is offering a promising alternative
that begins the detoxification and recovery services while the patient
is in the hospital, and continues the services after the patient goes
home. 3 The detox process starts in the hospital with the administration
of buprenorphine, which significantly increases the likelihood that a
patient will successfully quit. The buprenorphine administration continues when the patient returns home, where the drug is administered
daily for the following week by paramedics.
In addition to the medication, paramedics are accompanied by a
peer recovery specialist who works on a longer-term plan for recovery with the patient through a network of inpatient, outpatient and
community-based services. Palm Beach, which modeled their program
after a similar service in New Haven, Conn., may provide a recovery-oriented system of care model for areas where traditional recovery services aren’t available immediately after an overdose.
THE VICIOUS CYCLE
As communities struggle with the opioid epidemic, a growing number
of EMS agencies describe an increasing rate of provider burnout caused
by treating overdose patients. If the EMS provider thinks treatment is
futile, their usual compassion turns to agitation and annoyance. Many
begin to believe that overdoses are a necessary risk, and a consequence
of the patients’ bad choices. Their hope is that the threat of death will
motivate the patient to quit their drug use.
However, more than one addict has described that the addiction
to heroin quickly transitions from seeking the euphoria of the drug
to using it simply to feel “normal.” As their tolerance increases, withdrawal symptoms begin sooner after their last use. The result is that
patients become more dependent on the drug simply to function normally and avoid the symptoms of withdrawal.
Their dependence becomes a source of guilt and frustration as
they begin to engage in riskier behaviors to sustain their addiction.
To cope, they often turn to even more frequent drug use. When they
finally overdose and are resuscitated by a burned-out paramedic or
police officer who reminds them how worthless they are, the result is
sometimes tragic. Rather than discourage future use, our burned-out
colleagues’ reactions may inadvertently tap into the patient’s shame
and need to use more.
Fortunately, the evolution of MIH-CP programs provide a way
for our systems to break the cycle, and may provide a more effective
approach to the epidemic. JEMS
Dan Swayze, DrPH, MBA, MEMS, is vice president and COO of the Center for Emergency Medicine of Western Pennsylvania Inc. and is the project manager for the CONNECT Community
Paramedic program. He can be contacted at firstname.lastname@example.org.
1. Manchester, NH Fire Department’s Safe Stations Program. (April 5, 2017.) Addiction Policy Forum.
Retrieved April 30, 2017, from www.addictionpolicy.org/single-post/safestations.
2. Safe station. (n.d.) City of Manchester Fire Department. Retrieved April 30, 2017, from www.
3. Capozzi J. (April 21, 2017.) Heroin epidemic: As deaths rise, program a ‘glimmer of hope’ for
life. Palm Beach Post. Retrieved April 30, 2017, from www.mypalmbeachpost.com/news/