New approaches needed as overdoses flood hospitals
Charlie Stewart knew just what to do and say after paramedics brought the woman to the Mount Carmel West hospital emergency department after she nearly died of a heroin overdose.
She was crying, scared and didn’t want to walk out of the hospital only to use again. But she was new to Columbus and didn’t know the resources or whether she had the strength to attempt recovery again.
“She was in a bad place,” Stewart said.
After getting to know her and her situation, he helped get her signed up for Medicaid and into a detox bed within a matter of days.
“I want people to know that there’s hope,” he said. “And I want them to see the potential I see in them.”
Stewart is not a doctor, nurse or social worker. He’s a recovering addict who, through training and experience, knows a thing or two about what to do to upright a life. It’s what makes him so effective, his hospital colleagues say.
The hiring of peersupport coaches, who have been addicts themselves, is just one of many ways that local hospitals are trying to better support patients struggling with addiction and ending up in their emergency departments.
Between 2009 and 2014, Ohio saw the greatest jump in opioid-related emergency department visits of 44 states, with a 106 percent increase, according to a report by a division of the U.S. Department of Health and Human Services. South Dakota came in second with a 95 percent increase; Georgia, third, with an 85 percent jump.
In addition to treating overdoses, emergency department staffers also see people with skin and soft-tissue infections caused by their drug use or, in more serious cases, heart and spinal infections, said Dr. Alan Gora, chairman of Mount Carmel West’s emergency department.
The rate of hospital inpatient stays in Ohio because of opioid use also increased 52 percent from 2009 to 2014, according to the latest available data from the Agency for Healthcare Research and Quality. It’s just another piece of grim proof that the abuse of heroin and narcotic painkillers has hit alarming levels, officials say.
“I’d like to tell you that the percentages have fallen or flattened since 2014, but they haven’t,” said Amy Andres, a senior vice president with the Ohio Hospital Association.
From 2014 to 2015, there was a 39 percent increase in the number of Ohio emergency room visits due to opioids. Last year, there was a 41 percent jump, according to an analysis by the hospital association.
People also can sit on a waiting list for weeks before a detox bed opens up, and some recovery programs take only private insurance or pay, leaving those with fewer financial resources fewer options, experts say.
A few hospitals across the country have had early success with administering buprenorphine, a medication that blocks opioids from affecting the brain, to stabilize patients in the emergency department before referring them to medication-assisted drug treatment. But the practice is relatively rare and most local hospitals said they’ve only started talking about the possibility.
Central Ohio’s emergency responders are increasingly being overwhelmed by overdoses caused by heroin laced with potent synthetic drugs such as fentanyl and carfentanil, an animal tranquilizer so strong that a few grains can be lethal. There were a record 3,050 overdose deaths statewide in 2015.
That figure is expected to be shattered when final 2016 numbers are released this year. According to figures compiled by The Dispatch from county coroners, there were at least 4,149 people who died of overdoses last year. That doesn’t include tallies from six small counties that didn’t respond to the newspaper’s requests.
“It’s devastating, and I don’t see it getting any better unless we can stem the flow of drugs getting into people’s hands,” said Dr. Terrill Burnworth, director of the emergency department at Licking Memorial Hospital in Newark.
The one piece of good news: More overdoses are being reversed than ever before.
The percentage of emergency department patients who died from opioid-related overdoses at hospitals statewide dropped from 21 percent in 2009 to 14 percent in 2014, largely due to getting naloxone in the hands of more people, Andres said. The medication abruptly and effectively counteracts deadly overdoses and is now being administered by paramedics, hospital staff and even family members who have received some basic training.
Since starting a pilot program in July, University Hospital East has dispensed 220 naloxone kits to patients who have been treated in the emergency department or their families, said Ken Groves, a nurse manager at the Near East Side facility.
“The best thing we can offer them is an element of hope and a feeling of being supported until they’re ready to seek treatment,” Groves said.
The hospital also has an addiction counselor who helps with emergency room and inpatient consultations, he said.
Since the end of March, OhioHealth has sent 36 patients treated at one of its four emergency departments in Columbus, Marion, Pickerington and Westerville home with naloxone, said Dr. Krisanna Deppen, a family physician who specializes in addiction medicine.
“I think there’s a lot of stigma associated with naloxone, and some people believe we’re enabling bad behavior,” she said.
But like other chronic diseases, such as diabetes, addicts can’t change their behavior overnight, Deppen said. And naloxone is just a tool to keep them alive until they can start to work on recovery, she said.
Similar to Mount Carmel West, its Marion hospital is working with a local drug and alcohol addiction group to hire peer-recovery coaches, whom they hope patients will trust because of the common experiences they share.
Stewart, 25, of Hilliard, said he started “drinking and partying a little too much” as a teenager. He also started taking painkillers after breaking his collarbone in a snowboarding accident.
A misdemeanor theft arrest in 2013 led him to the courtroom of Franklin County Municipal Court Judge Scott VanDerKarr, who at the time presided over a “drug court.”
Stewart said he has been clean and sober since and helping others seek treatment. He joined Mount Carmel in November and has been working with people struggling with addiction since January. He also has a personaltraining business as part of his quest to get a “healthier body, mind and spirit.”
After discharge, Stewart helps patients with food stamp applications, housing, job searches or whatever they need to start down the path toward sobriety.
The one out-of-state woman he helped get into detox is in a daytreatment program now. He also helped get her brother into detox recently.
“Last week she sent me a text that said I had saved her life,” he said. “It’s just so humbling and amazing to touch people’s lives this way.”