More fu­neral homes on alert for opi­oid ex­po­sure

Work­ers see risk from overdose vic­tims’ bod­ies, drug-us­ing mourn­ers

The Washington Post - - RELIGION - BY LIL­LIAN REED

bal­ti­more — Tucked be­tween cat­a­logues for em­balm­ing flu­ids and mor­tu­ary stretch­ers, two doses of the opi­oid an­ti­dote nalox­one sit in a cab­i­net near fu­neral di­rec­tor Jef­frey Gair’s desk.

“It’s just in case,” Gair says he thinks to him­self be­fore lock­ing the cab­i­net door each night.

The mor­ti­cian at Peace­ful Al­ter­na­tives Fu­neral & Cre­ma­tion Cen­ter in Ti­mo­nium, Md., has never opened the plas­tic cas­ing around the Nar­can nasal spray, which is used to coun­ter­act the ef­fects of an opi­oid overdose.

Still, Gair some­times won­ders how much longer his sup­ply will go un­used.

As the num­ber of drug-re­lated deaths in Mary­land con­tin­ues to climb, fu­neral di­rec­tors are call­ing them­selves the “last re­spon­ders” in the opi­oid epi­demic. The moniker rep­re­sents an anx­i­ety within the cen­tral Mary­land fu­neral in­dus­try over how ag­gres­sive li­censed mor­ti­cians should be in pre­par­ing for over­doses at their busi­nesses.

They worry that syn­thetic opi­oids such as fen­tanyl and car­fen­tanil could be on a de­ceased per­son’s body or on the clothes of a mourner, in­ad­ver­tently ex­pos­ing staff mem­bers or guests at the fu­neral home to dan­ger. These drugs can be lethal in amounts as small as a grain of salt when in­haled or ab­sorbed through the skin. In Har­ford County, Md., a sher­iff ’s deputy and two emer­gency med­i­cal work­ers were treated in May for ex­po­sure af­ter re­spond­ing to a re­ported overdose.

The Na­tional Fu­neral Di­rec­tors As­so­ci­a­tion rec­om­mends that its mem­bers across the coun­try pre­pare for the re­al­ity that some­one — a staff mem­ber or a guest — can suf­fer from ex­po­sure. It says mem­bers should train staff to ad­min­is­ter nalox­one and to rec­og­nize the symp­toms of an overdose. News out­lets in Chicago and Canada have re­ported on fu­neral homes stocking nalox­one.

The ques­tion that David We­ber, the spokesman for the Mary­land Fu­neral Di­rec­tors As­so­ci­a­tion, hears the most from peers is, “What else can we be do­ing to pro­tect our­selves from opi­oid ex­po­sure?”

Train­ing staffers to ad­min­is­ter nalox­one is prob­a­bly the only mea­sure that fu­neral homes have not yet em­ployed en masse, We­ber said. The owner of David J. We­ber Fu­neral Homes in Up­per Fells Point and West Bal­ti­more is him­self se­ri­ously con­sid­er­ing get­ting trained to ad­min­is­ter nalox­one.

“I think it’s right on the cusp of a trend,” We­ber said. “I think it will hap­pen.”

While stocking nalox­one is still seem­ingly rare among cen­tral Mary­land fu­neral home op­er­a­tors, sev­eral told the Bal­ti­more Sun they were mulling the de­ci­sion.

Howard McCo­mas of McCo­mas Fu­neral Homes in Har­ford County said this week he in­tends to move for­ward with re­search­ing how to get his staff trained to ad­min­is­ter nalox­one.

“To be re­spon­si­ble to the com­mu­nity, it’s some­thing we have to address,” McCo­mas said. “I do see it as a pos­si­bil­ity in the near fu­ture that we’ll move down that road.”

Opi­oid over­doses in Mary­land reached an all-time high in 2017, with more than 2,000 fa­tal­i­ties. Schools and li­braries in Mary­land have re­sponded by hav­ing nalox­one at the ready.

Some Mary­land fu­neral di­rec­tors have reser­va­tions about keep­ing nalox­one on hand. We­ber won­dered whether his in­surance com­pany would ob­ject to it as a po­ten­tial li­a­bil­ity, in case some­one treated with the drug be­came ill or was hurt. Fu­neral di­rec­tor Lee Stallings, owner of Stallings Fu­neral Home in Anne Arun­del County, won­dered whether mourn­ers were ac­tu­ally com­ing to funerals high.

How­ever, many fu­neral di­rec­tors said their busi­nesses have un­der­taken opi­oid preven­tion and ed­u­ca­tion ini­tia­tives in their com­mu­ni­ties, of­ten part­ner­ing with law en­force­ment and med­i­cal per­son­nel to share in­for­ma­tion about the dan­gers of the drugs.

In 2017, the Tri-County Fu­neral Di­rec­tors As­so­ci­a­tion, a Mary­land trade or­ga­ni­za­tion, de­vel­oped an ad cam­paign, “We Don’t Want Your Busi­ness,” to raise aware­ness of the opi­oid epi­demic and pre­vent deaths.

The as­so­ci­a­tion also distributed a book­let to its mem­bers called “Opi­oid Epi­demic: How Fu­neral Di­rec­tors Can Re­spond.” It was pub­lished by the In­ter­na­tional Or­der of the Golden Rule trade or­ga­ni­za­tion, which has since sold 23,000 copies na­tion­wide. The book­let in­cludes ad­vice for mit­i­gat­ing the risk of opi­oid ex­po­sure dur­ing the em­balm­ing process and a rec­om­men­da­tion to train staff to ad­min­is­ter Nar­can.

Gair, along with five staffers at Peace­ful Al­ter­na­tives, de­cided to at­tend free train­ing on how to use the nasal spray as the busi­ness saw a grow­ing num­ber of overdose vic­tims and their be­reaved friends and rel­a­tives. The Mary­land Overdose Re­sponse Pro­gram of­fers free in­per­son train­ing to the pub­lic, which in­cludes ad­min­is­ter­ing nalox­one.

“You have to re­al­ize if you have a user whose ser­vices are held at your busi­ness, there could be oth­ers in at­ten­dance,” Gair said.

Fu­neral di­rec­tors in Bal­ti­more and Har­ford coun­ties said they have in­creas­ingly dealt with in­ci­dents of drug use on their prop­erty or among mourn­ers. The owner of Can­dle Light Fu­neral Home in Ca­tonsville has called po­lice five times on in­di­vid­u­als, who were not fu­neral guests, us­ing drugs on his prop­erty.

Staffers at Stauf­fer Fu­neral Home in Fred­er­ick County pledged $10,000 to fund a doc­u­men­tary film about the opi­oid epi­demic af­ter a man strug­gling with the ad­dic­tion stum­bled through their door look­ing for help.

At MacNabb Fu­neral Home in Ca­tonsville, a mourner at­tend­ing a fu­neral of some­one who had over­dosed walked two blocks to a McDon­ald’s where she over­dosed in the re­stroom. Po­lice said they were able to re­vive the woman, but she re­fused fur­ther treat­ment and left the restau­rant alone.

“Be­fore, fu­neral di­rec­tors used to carry smelling salts. Now, you carry Nar­can,” said Jim Schwartz, MacNabb’s fu­neral di­rec­tor.

Over the years, fu­neral in­dus­try stan­dards na­tion­wide have pro­gressed to where mor­ti­cians carry spe­cial kits, in­clud­ing res­pi­ra­tors and dis­pos­able cov­er­alls, as a pre­cau­tion when go­ing to a home to pick up a body, Schwartz said.

Schwartz has con­sid­ered at­tend­ing a nalox­one train­ing ses­sion but said he also feels safer know­ing that sus­pected overdose deaths in Mary­land are first han­dled by a med­i­cal ex­am­iner be­fore the body is trans­ported to a fu­neral home.

Fu­neral home owner Stallings said he sees lit­tle need to keep nalox­one at his busi­ness. He said the idea might have come up thanks to fire­fight­ers and other first re­spon­ders, some of whom moon­light at fu­neral homes, who have treated over­doses in their full-time jobs.

Mor­ti­cian Bran­don McNair, who works for March Fu­neral Homes in Bal­ti­more, has spent time as a firefighter over the years. McNair said he does not carry nalox­one at his fu­neral home job but is prac­ticed in iden­ti­fy­ing signs of an opi­oidrelated death when the fam­ily does not share the cause.

“We’re so used to deal­ing with over­doses, we’ve come to look for clues,” McNair said. Those might be the young age of the de­ceased, no ev­i­dence of ill­ness or no men­tion of nat­u­ral causes.

Gair said no com­mu­nity, no age and no de­mo­graphic is ex­empt from the opi­oid epi­demic. Any­one could carry a lethal dose through his door.

He keeps the Nar­can near, but he tries not to think too hard about who might one day need it.

“It’s never crossed my mind I could use this on my­self or staff,” Gair said. “No one asked be­fore. But it’s pos­si­ble.”

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