Should repeat overdosers be forced into rehab?

CINCINNATI – Rescuing the city’s sick and injured is what Kyle Swadener signed up to do as a Cincinnati firefighter and paramedic.

What Swadener didn't expect was that he would be saving the same lives – over and over and over again – as hundreds of area residents repeatedly overdose on heroin and powerful synthetic opioids.

“Most of the people I’ve made runs to, I’ve seen them multiple times for overdoses,” Swadener said. “I’ve made as many as three runs to the same person in one day.”

Curbing repeat overdoses could be key to alleviating the strain placed on first responders and the escalating costs communities face as overdoses continue at record levels, some local leaders say.

RELATED: Overdosed and overrun: a state of crisis in Ohio

“We’re in emergency mode, with 50 to 70 overdoses a week and up to four to five people dying,” said Newtown Police Chief Tom Synan, who leads Hamilton County’s Heroin Coalition. 

The national spotlight was cast on Middletown last month, when councilman Dan Picard questioned if the city could stop responding to those who overdose three or more times.

"My proposal is in regard to the financial survivability of our city," Picard told the Washington Post."If we're spending $2 million this year and $4 million next year and $6 million after that, we're in trouble. We're going to have to start laying off. We're going to have to raise taxes."

In Cincinnati, overdose calls for emergency response crews are on pace to exceed last year's 2,365 runs, said Cincinnati District Fire Chief Cedric Robinson.

The city’s spending on Narcan is climbing, too. Already this year, Cincinnati has spent $85,000 and expects to exceed the more than $103,000 spent in 2016.

“I can’t remember the last time I used just one dose of Narcan,” Cincinnati paramedic Nick Guilkey said. “The drugs are just so much stronger, it’s taking more and more Narcan just to get them breathing properly.”

The spike in overdose calls are also taking a toll on first responders.

“We’re at a tipping point,” firefighter and paramedic Lt. Jeffrey Neal said. “Not only are we making the normal amount of runs we already make, but you throw in these repeat overdoses  -- it wears on you. Everybody is about ready to crack.”

280 people responsible for 666 overdose calls

In Hamilton County, officials with the Heroin Task Force are working to better understand the complex issue.

Since January, the task force has been tracking emergency responses police have made to overdose calls to better understand the complex issue.

“What we’re really talking about here is a small amount of people who are responsible for a large number of runs,” said Tom Fallon, investigative commander for the task force. “If we can find ways to identify the most high risk, frequent flyers, and get them into treatment, then we can start breaking this cycle.”

Through the end of May, the task force has learned:

  • One person overdosed and was revived 21 times during the review period.
  • Of the 1,095 emergency runs police made for overdoses, more than 60 percent were calls for someone who had overdosed at least once before.
  • Fewer than 280 individuals were responsible for at least 666 overdose runs that local police agencies made through the end of May.
  • Fewer than 70 people have overdosed three or more times.

But the data only represents a portion of all of Hamilton County’s overdoses, Fallon said. Emergency room and fire and paramedic data aren’t yet captured.

Authorities say the actual numbers are likely to be much higher.

“This is just a starting point for us,” Fallon said. “We’re still trying to figure out the best way to collect the most comprehensive data.”

As the task force learns more about who is frequently overdosing, the next big challenge is figuring out how to get them into treatment.

“People who are overdosing multiple times, they are very ill and so there’s a realistic expectation here that they probably aren’t going to volunteer to go treatment,” said Kelly Firesheets, who leads an opioid misuse prevention program at Interact for Health in Norwood. “The question becomes: What mechanisms do we have to encourage them or require them to go?”

Newtown Police Chief Tom Synan said he’s floated the idea of using “pink slipping” to involuntarily admit frequent overdosers into treatment.

The term pink slip refers to Ohio’s involuntary civil commitment process which allows the state to hospitalize a person with mental illness against their will for at least 72 hours if they represent a risk to themselves or others.

“If we could involuntarily admit them, like we do a mentally ill patient, it could go a long way to getting us out of emergency mode so the resources aren’t stretched so thin,” Synan said.

Hamilton County Commissioner Denise Driehaus said it’s a concept she’s “open” to exploring.

“We’ve got strains on the whole system,” she said. “If we can’t figure out how to address those that are overdosing the most, multiple times, and try to figure that piece out, we’re going to continue to have that kind of strain.”

 

Cincinnati paramedics work to revive a woman who overdosed while using heroin in August.

Other options include ramping up the work local Quick Response Teams are already doing. The teams, which include first responders and local addiction counselors, follow up with individuals who have overdosed to encourage them to enter treatment.

“Ideally, the best place to start would be to make it easier to get into treatment than it is to buy heroin,” Firesheets said.

‘There are a lot of people who care’

For now, the task force is just collecting and reviewing police response data, Fallon said.

Ideally, the work could lead to a pilot program with a local law enforcement agency – but Fallon said the effort is still too new to know what that might include.

Eventually, he said, he hopes that work can be expanded to capture more data sets – including records for those admitted to local emergency rooms and other area first responders.

“If we can start to narrow down this high-risk group, then it begins to make this problem feel much more manageable,” he said. “There are a lot of people working on this, and a lot of people who care which is a good place to start.”

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