{"id":1758,"date":"2024-03-27T15:34:49","date_gmt":"2024-03-27T15:34:49","guid":{"rendered":"https:\/\/healthyretirementnews.com\/index.php\/2024\/03\/27\/a-paramedic-was-skeptical-about-this-rx-for-stopping-repeat-opioid-overdoses-then-he-saw-it-help\/"},"modified":"2024-03-27T15:34:49","modified_gmt":"2024-03-27T15:34:49","slug":"a-paramedic-was-skeptical-about-this-rx-for-stopping-repeat-opioid-overdoses-then-he-saw-it-help","status":"publish","type":"post","link":"https:\/\/healthyretirementnews.com\/index.php\/2024\/03\/27\/a-paramedic-was-skeptical-about-this-rx-for-stopping-repeat-opioid-overdoses-then-he-saw-it-help\/","title":{"rendered":"A paramedic was skeptical about this Rx for stopping repeat opioid overdoses. Then he saw it help."},"content":{"rendered":"
\n

Fire Capt. Jesse Blaire steered his SUV through the mobile home park until he spotted the little beige house with white trim and radioed to let dispatchers know he\u2019d arrived. <\/p>\n

There, Shawnice Slaughter waited on the steps, wiping sleep from her eyes. <\/p>\n

\u201cGood morning, Shawnice,\u201d Blaire said. \u201cHow are you feeling today?\u201d <\/p>\n

\u201cI\u2019ve been good, I\u2019ve been good,\u201d Slaughter said. \u201cMuch better.\u201d <\/p>\n

Three days earlier, Blaire \u2014 a paramedic who leads the fire department\u2019s emergency medical team \u2014 met Slaughter at a nearby hospital. She had overdosed on opioids. It took four vials of an overdose reversal medication and dozens of chest compressions to get her breathing again. <\/p>\n

At the hospital, Blaire told Slaughter about a free program that could help. It wouldn\u2019t just connect her with a recovery center but would also get her doctors\u2019 appointments, plus rides there. More important, she would get medicine to alleviate withdrawal symptoms so she wouldn\u2019t search for drugs to ease the sickness. Blaire would bring that medication, daily, to her home. <\/p>\n

\u201cI have a son,\u201d Slaughter, 31, told Blaire. \u201cI need to be alive for him.\u201d <\/p>\n

Every morning since,\u00a0Blaire had driven over for a check-in. He reminded Slaughter of appointments and took note of what she needed: clothes, food, help with bills. <\/p>\n

And at the end of each visit, from a lockbox in the back of his car, he dispensed to her a couple of tiny, lifesaving tablets.<\/em> <\/p>\n

Those tablets \u2014 a medicine called buprenorphine \u2014 represent a tidal change in the way counties in Florida and other states are addressing the opioid crisis. The idea: Get addiction medication to people who need it by meeting them where they are. Sometimes, that\u2019s on the street. Sometimes, it\u2019s in the driveway of a big house with a swimming pool. Sometimes on the steps of a modest home like Slaughter\u2019s. <\/p>\n

******** <\/p>\n

For a long time, many people who could benefit from buprenorphine, commonly known by the brand name Subutex, couldn\u2019t get it. <\/p>\n

Until recently, doctors needed a federal waiver to prescribe it to treat opioid use disorder. Amid misconceptions about treating opioid use disorder with medication, only about 5% of doctors nationally underwent the training to qualify. And in 2021, only\u00a01 in 5 people\u00a0who could have benefited from opioid addiction medication were receiving buprenorphine or another drug therapy. <\/p>\n

But as evidence supporting the drug\u2019s efficacy grew and the urgency mounted to curb opioid deaths, Congress axed the waiver requirement in late 2022, clearing the way for greater availability. <\/p>\n

And in rare cases, such as in Ocala, medics on the front lines began bringing treatment to patients\u2019 front doors. <\/p>\n

In Florida, the state-run Coordinated Opioid Recovery Network, known as the CORE Network, provides guidelines on medicine distribution to areas hit hard by overdoses. Services through the network are free for patients, funded by money from the state\u2019s opioid settlement. <\/p>\n

The network looks different in each of its 13 counties. Not all hand-deliver buprenorphine. But the common goal is to create a single entry point for services that have typically been siloed and difficult for patients to navigate, such as mental health care and housing support. <\/p>\n

In a recovery landscape rife with shoddy facilities and prohibitive price tags, simplifying the path for patients stands to make a meaningful difference. <\/p>\n

\u201cWe know that the more people are in contact with services, the more they\u2019re treated with respect, the more likely they are to reduce or cease drug use,\u201d said\u00a0Susan Sherman, a public health professor at Johns Hopkins University. <\/p>\n

As\u00a0opioid settlement dollars\u00a0continue to come in, state officials have said they hope to expand to more counties. <\/p>\n

******** <\/p>\n

Becoming a firefighter and paramedic satisfied Blaire\u2019s craving for adrenaline and his conviction, informed in part by his Christian background, that he was put on this Earth to help others. <\/p>\n

At 20, he imagined responding to car crashes and heart attacks, broken bones and punctured flesh. But after years on the job with Ocala Fire Rescue, the calls began to change. <\/p>\n

At first, Blaire felt some resentment toward the people overdosing. His team was suddenly responding to hundreds of such calls a year. He viewed drug use as a moral failure. What if a grandmother had a heart attack or a kid drowned while his team was on an overdose call? <\/p>\n

Unlike with other emergencies, he never really felt he was saving a life when responding to an overdose. It was more like delaying death. <\/p>\n

Over and over, he\u2019d pump a patient full of naloxone, an overdose reversal medication often known by one of its brand names, Narcan, and drop them at the hospital, only to find they\u2019d overdosed again after being discharged. One Christmas, he said, he responded to the same person overdosing five times on a single shift. <\/p>\n

\u201cI didn\u2019t understand it. I thought that they wanted to die,\u201d said Blaire, 47. \u201cI\u2019m embarrassed to say that now.\u201d <\/p>\n

About a decade ago, the scope of the epidemic had already come into full view to Blaire\u2019s crew. It seemed the team was responding to overdoses at big houses in wealthy neighborhoods nearly as often as they were in the park and under the bridge. <\/p>\n

One week, his team went to a home on a cul-de-sac with two kids and a swing set \u2014 the kind of place families take their children trick-or-treating. <\/p>\n

The dad had overdosed. The next week, it was the mom. <\/p>\n

\u201cMoney can mask any problem, but we\u2019ve seen it from the top to the bottom,\u201d Blaire said. <\/p>\n

Over time, Blaire began to understand addiction as the disease it is: a physiological change to someone\u2019s brain that traps them in a dangerous cycle. Maybe it started with a prescription painkiller after surgery, or an indulgence at a party, but the majority of people weren\u2019t using drugs to get high, he realized. They were using them to avoid being sick. <\/p>\n

\u201cImagine the worst flu you\u2019ve ever had, then make it a lot worse,\u201d Blaire said. <\/p>\n

When a person dependent on opioids stops taking them, their body goes into withdrawal, often accompanied by shakes, nausea, fever, sweating, and chills. Though rare, people\u00a0can die from opioid withdrawal syndrome. Still, historically, the emergency health care system has focused on reversing overdoses, rather than treating the withdrawal side effects that keep people returning to drugs. <\/p>\n

In the past, Blaire said, he saw patients released from the hospital with little more than a phone number for a recovery center. Getting an appointment could be challenging, not only because of wait times or insurance complications, but because the patients weren\u2019t stable\u00a0\u2014\u00a0they were in withdrawal. To make it through the day, Blaire said, they\u2019d often use again. <\/p>\n

\u201c\u2018Good luck, you\u2019re on your own,\u2019\u201d Blaire said. \u201cThat\u2019s how it was. And that doesn\u2019t work for somebody who is sick.\u201d <\/p>\n

Under Blaire\u2019s leadership, Ocala Fire Rescue sought to stop the revolving door by launching its Community Paramedicine program and the Ocala Recovery Project in 2020. <\/p>\n

They modeled it after overdose quick-response teams around the country, which vary in makeup. These mobile teams, typically helmed by paramedics like Blaire, connect people who have overdosed with services aimed at stabilizing them long-term. On some, a registered nurse embeds with paramedics in an ambulance or SUV. Others have a therapist or peer recovery coach on board. Some are bare-bones: a single responder with a phone on 24 hours a day. Some get in touch with patients through a call or a home visit after a reported overdose. <\/p>\n

Others, like Blaire\u2019s team, intercept patients at the hospital. <\/p>\n

Blaire likens the system to that of a trauma alert \u2014 a message sent to medical centers to ready a response to near-fatal car wrecks or shootings. When a trauma alert goes out, operating tables are cleared, CT scanners are prepped, and responders stand by for arrival. <\/p>\n

\u201cWe set the same system up for overdoses,\u201d Blaire said. <\/p>\n

Now, when somebody in Ocala overdoses, whether it\u2019s on opioids, alcohol, meth, or cocaine, an alert goes out, notifying Blaire and his team, a peer recovery coach, a behavioral health specialist, and a local recovery center. <\/p>\n

His team usually beats the ambulance to the hospital. <\/p>\n

The next day, team members follow up at the patient\u2019s home. <\/p>\n

Then, last May, under the guidance of the EMS medical director, Blaire\u2019s team started offering addiction medication to opioid users, too. <\/p>\n

Since then, Blaire said, his team has connected 149 patients with treatment. Only 28 of them have needed additional intervention, he said. <\/p>\n

******** <\/p>\n

When Blaire first heard about buprenorphine, he was skeptical. <\/p>\n

How could giving somebody with an addiction more narcotics help? <\/p>\n

That common response misunderstands the reality of addiction, said\u00a0Nora Volkow, director of the National Institute on Drug Abuse. <\/p>\n

People perceive that one drug is being substituted for another, Volkow said. Instead, the use of medications like buprenorphine is more akin to those that treat other psychiatric conditions, like mood disorders or depression. <\/p>\n

Research shows that opioid addiction medication \u2014 including drugs like methadone \u2014 can greatly\u00a0reduce the risk\u00a0of overdose deaths, and increase a person\u2019s retention in treatment. But a\u00a0study out of the New York University\u00a0Grossman School of Medicine found that nearly 87% of people with opioid use disorders don\u2019t receive any. <\/p>\n

Such addiction medications work by stimulating opioid receptors in the brain. <\/p>\n

Opioids \u2014 like oxycodone or fentanyl \u2014 are what experts refer to as \u201cfull agonists.\u201d Imagine an opioid receptor as a rounded bowl. A full agonist \u2014 like fentanyl \u2014 fits perfectly in that bowl and latches tightly to the receptor. <\/p>\n

Buprenorphine is a \u201cpartial agonist.\u201d It fits in the bowl \u2014 and satiates a craving \u2014 but doesn\u2019t completely bind like a full agonist. Instead, it eliminates withdrawal symptoms so people won\u2019t get sick or crave illicit drugs, without producing a high. Second, it counteracts the effects of other drugs, so a person can\u2019t overdose on other opioids like fentanyl or heroin while taking it. <\/p>\n

And for somebody who already uses opioids, overdosing from buprenorphine is nearly impossible. <\/p>\n

\u201cThey help a person regain control of their everyday life,\u201d Volkow said. <\/p>\n

******** <\/p>\n

On this Monday in January, Blaire pulled into Beacon Point, a local treatment center, just past 2 p.m. <\/p>\n

He\u2019d spent his morning calling on people like Slaughter, but now he was meeting paramedics from his team. After nearly three weeks of home visits, a man in the recovery network program was set to have his first appointment with a doctor. <\/p>\n

Blaire has found that once people are stable on buprenorphine, more often than not they want to get into a treatment program. <\/p>\n

While Blaire waited, a woman walking out of the center approached, smiling. <\/p>\n

\u201cI just got my first clean urine analysis,\u201d she said. \u201cI\u2019m doing great, I\u2019m so excited.\u201d <\/p>\n

\u201cThat\u2019s awesome news,\u201d Blaire said, a smile stretched across his face. He\u2019s often stoic, straight-laced, with combed hair and aviators. But when he lights up, his all-business exterior gives way to gentleness. <\/p>\n

Jacqueline Luciano is sober for the first time in 30 years. She\u2019s proud, glowing, and Blaire is proud, too. <\/p>\n

Luciano first came to Blaire through a referral when she was living at a women\u2019s shelter. She said she had $20 in her pocket and wanted to get high \u2014 needed to. <\/p>\n

Fentanyl withdrawal had left her shaky and cold. Her stomach was seizing, her muscles spasming. To quell the agony that day in early January, she went on the hunt. <\/p>\n

Luciano said she had first used drugs when she was 9. Her family had been torn apart by pills and powders, she said, a sickness she\u2019d inherited. <\/p>\n

But this time, a woman \u2014 \u201clike an angel\u201d \u2014 passed her a number for someone who she promised could guide her into a brighter future, blame-free. Luciano, 39, paused, skeptical. <\/p>\n

Then she gave Blaire a call. <\/p>\n

For about a week, Blaire delivered her a daily dose of buprenorphine using a Safe RX bottle \u2014 essentially a trackable pill bottle with a lock code to limit who can open it. He helped connect her with food and clothing donations. <\/p>\n

And as Luciano started to feel more like herself, absent of cravings, she began to hope. <\/p>\n

Blaire got her an appointment with doctors at Beacon Point, then drove her to her first screening. Now, in the parking lot, she thanked him for everything. <\/p>\n

\u201cIt made all the difference in the world,\u201d Luciano told Blaire. \u201cI really didn\u2019t think that I could get better. I didn\u2019t. But I am.\u201d <\/p>\n

As a tear rolled down Luciano\u2019s face, Blaire\u2019s phone rang. <\/p>\n

******** <\/p>\n

The call came from the health department. A man in his 40s or 50s had come some 40 miles from Gainesville, Florida, for help, steered through word of mouth. <\/p>\n

He\u2019d tried to get into a recovery center there but said he was turned away. Something about insurance and a criminal record had stood in the way. <\/p>\n

It\u2019s a pattern that drives Blaire crazy. He\u2019d seen it a lot before his team was formed. People would get a moment of courage or clarity, only to be told \u201cnot yet.\u201d <\/p>\n

\u201cYour first answer has to be \u2018yes,\u2019\u201d he said. \u201c\u2018Yes, I can help you.\u2019\u201d <\/p>\n

He knew about a woman who had come from 25 miles out of town, then was told to come back days later. She didn\u2019t have a car or a home to return to. <\/p>\n

\u201cThey didn\u2019t even offer her a ride,\u201d Blaire said. \u201cSometimes you only have one shot.\u201d <\/p>\n

Blaire has learned that building trust starts with a small offering. A car ride. A sandwich. Help getting a government ID. Anything to show that you care, that you\u2019re useful. That you see someone trying. <\/p>\n

Outside the health department, a man in muddied jeans and a frayed T-shirt stood waiting on the curb. He introduced himself as Jetson and didn\u2019t give a last name. Blaire shook his hand before they loaded into the car. <\/p>\n

\u201cSo what brings you this way?\u201d Blaire asked, once both were buckled in. <\/p>\n

\u201cI heard there were services here,\u201d Jetson said, his voice gruff, quivering. \u201cI\u2019ve tried to stop using so many times, but I keep messing it up.\u201d <\/p>\n

\n
    <\/ul>\n<\/div>\n

    Jetson shook his head. <\/p>\n

    \u201cWell, I\u2019m glad you found us,\u201d Blaire said. He asked the man if he wanted to go to the recovery center for a screening. He did. <\/p>\n

    Over the 10-minute drive to Beacon Point, Blaire and Jetson talked, not about drugs or meds, but life. Baseball. Cabbage (good when fried). <\/p>\n

    When they pulled up, Blaire handed Jetson a card. <\/p>\n

    \u201cPlease call me,\u201d Blaire said. \u201cIf you need anything. We can get you help.\u201d <\/p>\n

    For a moment, the men sat there. Jetson pulling at his fingers. Taking deep breaths. <\/p>\n

    Then, he got out of the car \u2014 Blaire\u2019s card in hand \u2014 and walked through the glass door. <\/p>\n

    This article was produced through a partnership between the Tampa Bay Times and KFF Health News.<\/em> <\/p>\n

    KFF Health News<\/em>\u00a0is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about\u00a0<\/em>KFF<\/em>.<\/em> <\/p>\n<\/p>\n

    This post appeared first on cnn.com<\/div>\n<\/div>\n

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