9781422274316

HOWFIRST RESPONDERS AND ERDOCTORS SAVE LIVES AND EDUCATE OPIOID EDUCATION

OPIOID EDUCATION

FENTANYL: THE WORLD’S DEADLIEST DRUG HEROIN: DEVASTATING OUR COMMUNITIES PAINKILLERS: THE SCOURGE ON SOCIETY ALTERNATIVE TREATMENTS FOR PAINMANAGEMENT HOW FIRST RESPONDERS AND ER DOCTORS SAVE LIVES AND EDUCATE TREATMENTS FOR OPIOID ADDICTION UNDERSTANDING DRUG USE AND ADDICTION

HOWFIRST RESPONDERS AND ERDOCTORS SAVE LIVES AND EDUCATE OPIOID EDUCATION

ASHLEY NICOLE

MASON CREST PHILADELPHIA | MIAMI

Mason Crest 450 Parkway Drive, Suite D, Broomall, Pennsylvania 19008 (866) MCP-BOOK (toll-free) • www.masoncrest.com

© 2020 by Mason Crest, an imprint of National Highlights, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, taping, or any information storage and retrieval system, without permission from the publisher. Printed and bound in the United States of America. CPSIA Compliance Information: Batch #OE2019. For further information, contact Mason Crest at 1-866-MCP-Book. First printing ISBN (hardback) 978-1-4222-4384-8 ISBN (series) 978-1-4222-4378-7 ISBN (ebook) 978-1-4222-7431-6 Library of Congress Cataloging-in-Publication Data on file at the Library of Congress Interior and cover design: Torque Advertising + Design Interior layout: Tara Raymo, CreativelyTara Production: Michelle Luke Publisher’s Note: Websites listed in this book were active at the time of publication. The publisher is not responsible for websites that have changed their address or discontinued operation since the date of publication. The publisher reviews and updates the websites each time the book is reprinted.

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CONTENTS

Chapter 1: What Do First Responders and ER Doctors Do? .... 7 Chapter 2: What Does the Opioid Crisis Look Like? . ............. 21 Chapter 3: How Do First Responders and ER Doctors Prevent Opioid Overdose? ................................... 37 Chapter 4: How Do First Responders and ER Doctors Treat Opioid Overdose? ......................................... 49 Chapter 5: How Are Laws Changing? ...................................... 61 Chapter 6: How Can Medical Professionals Change the Scope of the Opioid Crisis? ................................... 73 Chapter Notes ............................................................................ 86 Series Glossary of Key Terms ................................................... 88 Further Reading . ....................................................................... 90 Internet Resources .................................................................... 91 Index . .......................................................................................... 92 Author’s Biography and Credits .............................................. 96 K E Y I C O N S T O L O O K F O R : Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments, and much more! Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

First responders—paramedics, emergency medical technicians (EMTs), law-enforcement officers, and firefighters—are on the front lines of the war against opioids.

WORDS TO UNDERSTAND

benzodiazepines —a class of medications that work with the central nervous system to treat medical conditions like anxiety, alcohol withdrawal, and seizures. Common benzodiazepines include diazepam and lorazepam. compassion fatigue —physical exhaustion, mental exhaustion, or emotional withdrawal experienced by individuals who care for sick or ailing patients for an extended period. dependency —a reliance, in this case on a type of substance to avoid withdrawal symptoms. fentanyl —a powerful synthetic opioid typically used to treat severe pain. It is much more powerful than morphine. gross domestic product —the monetary value of all goods and services produced or provided in a country over the span of one year. hepatitis —a medical condition caused by inflammation of the liver.

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How First Responders and ER Doctors Save Lives and Educate

1 CHAPTER

What Do First Responders and ER Doctors Do? At around 3 pm on January 22, 2008, Heath Ledger’s housekeeper tried to rouse the actor from bed so that he could meet with his masseuse for an in-home appointment at his Manhattan apartment. The two women found him unconscious. Within 15 minutes of realizing Ledger was unconscious, one of the women called 911. While on the phone, they administered CPR in an attempt to revive him. It was no successful. About seven minutes later, paramedics and first responders arrived at the apartment. By 3:33 pm, the paramedics had tried to revive the actor. It was to no avail. The actor was pronounced dead at 3:36 pm. However,

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What Do First Responders and ER Doctors Do?

authorities suggested he likely had been dead for one to two hours by the time they arrived at the scene. The Aftermath of Heath Ledger’s Death In February of 2008, the Office of the Chief Medical Examiner of New York released a statement. Based on the initial autopsy and toxicological analysis of Ledger’s body, it became clear to investigators that he suffered from acute intoxication as a result of several drugs, including oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine. They ruled his death an accident “resulting from the abuse of prescribed medications.” It appeared to authorities that Ledger may have been going to several different doctors for various prescriptions, as a single doctor would be unlikely to prescribe all of these medications to be taken at the same time. The medications Ledger had been taking could have been prescribed for a variety of reasons, including chronic pain, anxiety, or insomnia. But a doctor would not necessarily prescribe benzodiazepines like diazepam and alprazolam to a patient who was already taking opioids like oxycodone or hydrocodone. In recent years, it has become nearly impossible to escape stories of opioid addiction and dependency . The story of Heath Ledger’s death was a shock to the nation when it happened, but death resulting from opioid overdose persists. His story also shows that when you are dealing with an opioid- related overdose, every second matters. Heath Ledger’s story is just one example of the many deaths associated with prescription drug abuse in the spotlight. Media cover the rising effects of opioid abuse, especially as first responders and ER doctors step in more often to handle these cases.

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How First Responders and ER Doctors Save Lives and Educate

Award-winning actor Heath Ledger was only twenty-eight years old when he died of an accidental overdose of opioid painkillers.

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What Do First Responders and ER Doctors Do?

UNDERSTANDING OPIOIDS

The term opioid painkillers is used to refer to prescription drugs like oxycodone, hydrocodone, codeine, and morphine. The most common brands of prescription opioids include OxyContin and Vicodin. When used as prescribed, these medications are often helpful for addressing physical pain following surgical procedures and severe injuries. Unfortunately, these medications are often misused and abused. Not all opioids are prescription medications. The class of substances also includes natural drugs like heroin (which is processed from opium poppies) and synthetic drugs like fentanyl . Heroin and fentanyl both affect the body and brain in similar ways as other opioids. They can also lead to dependency and addiction issues based on the body’s response to the drug and the sense of euphoria the drug can create. In the United States, opioid prescriptions have increased significantly. In 1991, doctors wrote 76 million prescriptions for these drugs. In 2013, they wrote nearly three times as many (207 million prescriptions). Between July of 2016 and September of 2017, emergency room visits linked to opioid overdose rose about 30 percent throughout the United States, according to the Centers for Disease Control and Prevention (CDC). The increased use of opioid prescriptions, and the sharp rise in overdose deaths, has created a public health crisis that the federal and state governments have been battling against for several years. First responders such as paramedics, EMTs, and law-enforcement officers are in the front lines of that fight.

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How First Responders and ER Doctors Save Lives and Educate

The Role of First Responders in the Opioid Crisis First responders at the scene of an opioid overdose are typically emergency medical technicians or paramedics. They are typically the first point of interaction and help for those suffering a medical emergency. A first responder can provide first-aid, CPR, defibrillator service, and now often medication that can prevent an overdose from becoming fatal. Usually, first responders are emergency medical personnel, but they can also be fire fighters, police officers, and sometimes even teachers and other professionals who aren’t necessarily certified. The role of a first responder is to ensure that the scene is safe and to assess the breathing and circulation of the victim.

Opioids like fentanyl are so potentially dangerous that even a brief exposure to large quantities can result in an overdose. This federal agent is wearing a protective suit and mask while investigating an illegal fentanyl lab.

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What Do First Responders and ER Doctors Do?

The role of first responders in attacking the opioid epidemic has increased significantly in recent years. In the first half of 2018, first responders in Escambia County, Florida, responded to at least 176 opioid overdoses—an average of one per day. The same group of first responders deployed a drug called naloxone, which reverses the effects of opioid overdose, more than 280 times. Today, first responders wear their own protective equipment at opioid-related emergency scenes to ensure they do not face negative exposure to drugs and other chemicals. First responders wear gloves as often as possible, as even bedding and clothing can be contaminated or have airborne concentrations. They often have to sanitize the ambulance between fentanyl overdoses. Still, first responders sometimes face other dangers. For example, people who wake up from naloxone treatment may be violent, aggressive, and unaware of what has happened

Scan here to learn how first responders handle opioid overdoses:

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How First Responders and ER Doctors Save Lives and Educate

to them. The fact that first responders are working in an uncontrolled environment, such as on the street, means many different variables are involved. First responders report that they often already know who the patient is going to be when they arrive at the scene of an opioid-related incident. They are often familiar because the individual has already been the victim of overdose in the past. Also important to keep in mind is that response time is critical in opioid overdose cases. Every time an ambulance has to respond to an opioid overdose, first responders pose a danger to the general public because they must arrive on the scene quickly. Ambulances moving quickly through intersections are at higher risk for vehicle and pedestrian accidents. As a result, local first responder organizations have to assess the best ways to manage their time while getting to the scene of an incident. A common issue among first responders is compassion fatigue . Compassion fatigue often results from repeated exposure to the effects of crisis, often leading to burnout. First responders contend with exhaustion, overwhelming feelings, changes in perceptions of safety, traumatic memories, doubts about their own work, anxiety, and even the possibility of disconnecting from reality. The Role of ER Doctors in the Opioid Crisis In years past, emergency room doctors have been given a bad wrap for allegedly causing the opioid epidemic by prescribing opioids for patient injuries. The truth is that the rate of opioid prescriptions varies wildly across emergency rooms, and also that heavy opioid users are more likely to receive prescriptions from primary care doctors rather than professionals in the emergency room.

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What Do First Responders and ER Doctors Do?

New federal guidelines for prescribing opioid painkillers make it much less likely that emergency room doctors will dispense these medications to people who come in complaining of pain.

While emergency room doctors are not the sole cause of the opioid crisis, they are certainly working hard to fight it. In fact, one 2015 study demonstrated that the biggest decline in opioid prescriptions among specialists from 2007 to 2012 occurred among ER doctors. Emergency room doctors also express having been physically assaulted at work more recently in the last few years. One survey showed three out of five respondents reporting assaults within the last year. Additionally, seven out of ten respondents claimed ER violence has increased in the last five years. Some doctors believe opioids may be one of the causes, claiming about half of these assaults are

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How First Responders and ER Doctors Save Lives and Educate