Scram­bling for in­no­va­tive ways to stop opi­oid over­dose deaths

Modern Healthcare - - NEWS - By Steven Ross John­son

June was an­other rough month in Manch­ester, N.H. Over the course of 30 days, there were 99 sus­pected opi­oid over­doses, six of which were fa­tal. That’s the most over­doses in a month so far in 2017, ac­cord­ing to Christo­pher Stawasz, re­gional di­rec­tor of emer­gency med­i­cal ser­vices provider Amer­i­can Med­i­cal Re­sponse.

It’s the con­tin­u­a­tion of a dan­ger­ous trend for any city, let alone one with a to­tal pop­u­la­tion of 110,000. From Jan­uary to July 4, there were 419 sus­pected opi­oid over­doses, com­pared with roughly 400 for the same pe­riod last year. And for all of 2016, there were 787 sus­pected over­doses, 90 of which were deadly, ac­cord­ing a re­port is­sued by Mayor Theodore Gat­sas.

Sim­i­lar to their coun­ter­parts in Colorado, Ohio and Wash­ing­ton—or any­where in the na­tion, for that mat­ter—public health lead­ers in Manch­ester are search­ing for any in­no­va­tive in­ter­ven­tion that can help turn the tide. They may have found one.

Last April, af­ter a para­medic helped a col­league’s rel­a­tive get treat­ment for his ad­dic­tion, the city launched the Safe Sta­tion pro­gram. Now, all 10 of Manch­ester’s fire­houses are a safe haven where peo­ple strug­gling with ad­dic­tion can seek as­sis­tance. Paramedics are avail­able 24 hours a day, 7 days a week, to con­duct a full med­i­cal eval­u­a­tion be­fore trans­port­ing the pa­tient to a lo­cal hos­pi­tal’s emer­gency de­part­ment or a treat­ment fa­cil­ity.

The process takes less than 15 min­utes, Stawasz said. That’s com­pared to the weeks or even months it some­times takes to get treat­ment. A re­cent New Eng­land Jour­nal of Medicine study showed that only 21% of peo­ple ad­dicted to opi­oids in the U.S. re­ceived any treat­ment be­tween 2009 and 2013.

“You’ve got a very small win­dow of time when peo­ple are will­ing to go for that help,” Stawasz said. “The beauty of this pro­gram is that it cap­tures them when they are most will­ing to get the help, and it gives it to them very quickly.”

From May 2016 to June 2017, more than 1,800 peo­ple sought help through Safe Sta­tion. All of them went to ei­ther an emer­gency room or treat­ment fa­cil­ity. There is no threat of ar­rest or judg­ment, ac­cord­ing to those run­ning the pro­gram. The pro­gram has been cred­ited with re­duc­ing the num­ber of emer­gency calls due to over­dose by 30%, ac­cord­ing to Stawasz.

It’s been so suc­cess­ful that the seven fire sta­tions in Nashua, N.H., adopted the pro­gram last Novem­ber. Nashua has its fair share of prob­lems, too: 31 opi­oid over­doses resulting in four deaths in June and a 28% jump in sus­pected opi­oid over­dose deaths from Jan­uary to June. From Novem­ber through June, 576 peo­ple used the Nashua Safe Sta­tion pro­gram.

Both cities have part­nered with Har­bor Homes, a not-for­profit provider of pri­mary and be­hav­ioral health­care and sup­port­ive ser­vices, to ex­pe­dite mov­ing Safe Sta­tion pa­tients into re­hab.

On the other side of the coun­try in north­west Wash­ing­ton state, public health of­fi­cials are tak­ing an equally un­ortho­dox ap­proach to com­bat­ing an opi­oid cri­sis.

“In this epi­demic that’s spi­ral­ing out of con­trol, we should take ad­van­tage of ev­ery tool that we pos­si­bly can,” said Dr. Jeff Duchin, public health of­fi­cer for King County, Wash.

Last year, Duchin co-chaired a task force cre­ated by Seat­tle Mayor Ed Mur­ray to ad­dress the opi­oid epi­demic. One con­tro­ver­sial rec­om­men­da­tion was to set up sites where drug users, un­der su­per­vi­sion of a health pro­fes­sional, could in­ject il­le­gal drugs. The idea is to not only mon­i­tor the ad­dict, thus low­er­ing the risk of an over­dose, but also con­nect them with

treat­ment when they are ready. The site would also pro­vide ster­ile nee­dles to re­duce the spread of infectious dis­eases such as HIV or hep­ati­tis through shared nee­dles. About 100 such sites cur­rently op­er­ate in more than 60 cities world­wide.

Fed­eral and state laws pro­hibit safe in­jec­tions sites in the U.S., but some cities are con­sid­er­ing them and the Amer­i­can Med­i­cal As­so­ci­a­tion’s House of Del­e­gates in June voted to en­dorse some safe site pi­lot pro­grams.

The Mas­sachusetts Med­i­cal So­ci­ety is also sup­port­ive. MMS Pres­i­dent Dr. Henry Dorkin said safe in­jec­tion sites have worked in other coun­tries. The or­ga­ni­za­tion be­gan ex­am­in­ing ap­ply­ing the same ap­proach in the U.S. af­ter other more widely ac­cepted ac­tions such as nee­dle ex­changes and nalox­one failed to re­verse the ris­ing num­ber of over­dose deaths. City lead­ers in Philadelphia, San Fran­cisco and Ithaca, N.Y., have all pro­posed them—while rais­ing con­cerns over the per­ceived ac­cep­tance of il­le­gal be­hav­ior.

Stud­ies of sites in Aus­tralia, Ger­many and the Nether­lands show re­duc­tions in over­doses, crime and risky be­hav­iors.

“There is still this fun­da­men­tal, in­grained thought that it’s just some­thing about the per­son and it’s not an ill­ness,” said Dr. Michal Frost, di­rec­tor of in­ter­nal medicine at the Hor­sham Clinic, a be­hav­ioral health fa­cil­ity in Am­bler, Pa. He be­lieves that’s sti­fled in­no­va­tion.

In­deed, the last new opi­oid ad­dic­tion treat­ment ap­proved by the Food and Drug Ad­min­is­tra­tion was buprenor­phine in 2002. The drug had been on mar­ket since 1981 when it was first used as a pain-re­liev­ing re­place­ment for mor­phine. Nal­trex­one has been ap­proved as a treat­ment for heroin since 1984, and methadone has been in use since the late 1940s.

Most new med­i­ca­tions are sim­ply a vari­a­tion in the way buprenor­phine, nal­trex­one, nalox­one or some com­bi­na­tion of those com­pounds are de­liv­ered.

Pa­tient ad­vo­cates hope that Pres­i­dent Don­ald Trump’s poli­cies will cut reg­u­la­tions that tie doc­tors’ hands in treat­ing ad­dic­tion and sup­port new ways to make main­te­nance treat­ment more ac­ces­si­ble. Thus far, the ad­min­is­tra­tion’s most vis­i­ble step has been cre­at­ing a panel tasked with eval­u­at­ing new and proven op­tions. The com­mis­sion missed its dead­line to sub­mit an ini­tial re­port rec­om­mend­ing fed­eral ap­proaches that can be taken to com­bat the opi­oid epi­demic.

A Manch­ester fire sta­tion helped place Madisen Peter­son, left, a heroin user who has been clean for over four months, in re­cov­ery at Seren­ity Place, where he also vol­un­teers.

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