OPIOID OVERDOSES
Bracing for the worst
PAINKILLERS: OPIOID ADDICTION’S DEADLY PATH Thursday: Dying too young Friday: Road to addiction Saturday: An addict’s tale Monday: Desperate crimes Today: In the trenches Wednesday: Kicking the habit
Someone dumped the 17-year-old boy, unconscious and nearly dead, out of a car in front of the hospital and drove away. He had just overdosed. He wasn’t breathing.
It’s a shocking example of how bad the opioid epidemic has become, changing the way emergency response crews do their jobs. Police and paramedics now carry respirators. Emergency departments are faced with diverting resources away from people suffering heart attacks to save overdose victims, like that teenager.
“He had no pulse and was basically dead in the back of the car,” said Dr. Paul Bradford, an emergency department physician at Windsor Regional Hospital’s Ouellette campus. “He was dropped off in the ambulance area. We grabbed that kid and we gave him the antidote, gave him some adrenalin, did CPR and we got him back. Then he pulled the tube out and said, ‘I’m out of here, you can’t keep me here.’ That’s how powerful the addiction is .... He just wanted to get out of here and go do it again.”
The crisis shows no sign of slowing. Essex-Windsor Emergency Medical Services is expecting a 40 per cent spike in opioid overdoses this year. In 2014, local paramedics administered Narcan — a brand name of the medication naloxone that counteracts the effects of opioids — to 51 patients with confirmed or suspected overdoses.
Justin Lammers, deputy chief of professional standards, said the number dipped slightly to 48 patients in 2015 before increasing to 58 last year. This year, by the end of April, paramedics had already given naloxone to 28 patients.
Paramedics have started carrying extra naloxone to deal with the increased threat.
“It’s alarming,” said Lammers. “I think the community as a whole should be concerned about that. Essex-Windsor EMS is working closely with public health. There’s a working group to try and come up with a plan on how to combat this.”
Representatives of the Windsor Fire and Rescue Service didn’t respond to repeated requests for comment about how they’re dealing with the issue. But police and paramedics facing the crisis on the front lines are also growing increasingly concerned about new powerful drugs that can go airborne or be absorbed through the skin, making efforts to revive an overdose victim potentially lethal.
In March, RCMP in Vancouver intercepted 140,000 doses of fentanyl in crystalline form. It had been shipped from China, addressed to a house in Windsor.
The drug, which is 100 times more powerful that morphine, is usually prescribed in patch form for cancer patients and others in severe pain. But Windsor police said the newest street version comes in different, far more dangerous forms, like powder.
If fentanyl powder gets into the air, it can be accidentally inhaled or absorbed through the skin, causing an overdose. Windsor police Const. Andrew Drouillard said a dose the size of a grain of sand could be deadly.
He said Windsor police patrol officers have received special training on dealing with the drugs, and are equipped with kits that include respirators.
Along with opioid antidotes, paramedics also carry safety gear with them, including full-length gowns, gloves and respirators.
“More than anything, it’s being aware of the scene you’re in and paying attention to some of the indicators that might lead you to believe you’re dealing with that substance,” said Lammers.
He said Essex-Windsor EMS also has increasing concerns about carfentanil, the newest powerful opioid to hit the streets. A common legitimate use for the drug — which is 100 times more potent than fentanyl, 4,000 times more potent than heroin and 10,000 times more powerful than morphine — is tranquillizing elephants.
“With the increase in potency of the drug comes the increase in aggressive measures for us to treat them,” said Lammers.
“Absolutely the paramedics will have to administer more Narcan.”
Bradford said the “biggest challenge” for his emergency department has been juggling resources as injured or overdosed drug addicts put an increasing demand on the health-care system.
“It sucks us away from the heart attacks, the traumas, all of these things,” he said.
“It’s very resource intensive. I have to step away from somebody having a heart attack or a stroke because this person isn’t breathing and needs an airway, so it’s pretty compelling. It’s an aggressive issue that’s happening that ties us up.”
It’s not only overdose cases taking up emergency department time. Many drug addicts end up in the hospital as trauma patients.
“These same medications are used when you’re driving a car or doing something on a roof, so you become a trauma patient, and part of the reason you fell off the parking garage is because you were on crystal meth or opiates,” said Bradford.
“So that might not be a true overdose, but it led to you getting injured, because you were abusing a substance like that. It’s costing us a fortune in time and staff resources and money, as well.”
Addicts can continue to put pressure on the health-care system long after overdosing. Not everyone dies from an overdose, said Bradford, but that doesn’t mean they walk away unscathed.
“There are a lot people who don’t die, but they’re horribly disabled because of what happened,” he said. “Their brain didn’t get oxygen for nine or 10 minutes and so now they’ve got massive deficits ... just like it was a massive stroke. This is the other side of it. You see the horrible consequences of these drugs.”