quote:

Originally posted by parabellum:
My question is why bother? Just let them go. It's what they want.

This is the general feeling of most first responders, particularly with the repeat offenders. Unfortunately we are legally required to intervene. If there wasn't the possibility of the safety net that is narcan, these people would either think twice or disappear and no longer be an issue.

I've personally heard multiple OD patients flat out tell the medics when asked why they keep doing the shit that they know they'll just get narcan'ed if they OD so they don't care about it.

The synthetic stuff does seem to have an effect on the heroin now, though. Fentanyl and carfentanyl make it so that people take less than they used to and it either really screws them up or pushes them into an OD when they otherwise might have been 'ok' (relative terms, of course)

quote:

In Sunday's newspaper it stated that someone dies every two hours in South Florida from a heroin overdose

What, there's a person who dies and is resuscitated so he can die again two hours later? And keeps repeating this cycle? That's awful!

2 to 3 overdoses each and every day.

quote:

Originally posted by Lefty Sig:
Have you found in your experiences that legal prescription opiate use, and eventual abuse, leads to addiction, and then to heroin use?

I've heard this "gateway" story but I'm not sure I believe it.

In my area, the crack down on the "pill mills" pushed the increased use of heroin and methamphetamine. Those who still get pills have been crushing and injecting them. Two nights ago we had an OD death of a guy who was found naked in his laundry room, shit himself, and was found by his 14 and 19 year old sons. Can you imagine the psychological effects his children are now going to suffer?

quote:

Originally posted by V-Tail:

quote:

In Sunday's newspaper it stated that someone dies every two hours in South Florida from a heroin overdose

What, there's a person who dies and is resuscitated so he can die again two hours later? And keeps repeating this cycle? That's awful!

No, a different person dies every 2 hours from a heroin OD. Not counting the ones that are saved with Narcan.

OP, that's one shocking statement coming from an ER health care provider. If we can seal the border and deport the shit stains pushing that fucking heroin on our people, we just MIGHT get a handle in this thing.

Please don't become jaded. We all need you.

quote:

Originally posted by qcsmitty:
OP, that's one shocking statement coming from an ER health care provider. If we can seal the border and deport the shit stains pushing that fucking heroin on our people, we just MIGHT get a handle in this thing.

Please don't become jaded. We all need you.

Hopefully I didn't shock you in a way that makes you think I've given up. Far from it. Ive been doing Emergency Medicine for 25 years, and fully expect another 15 until retirement. It's in my blood, it's who I am. It was just a rant to blow off some steam. But the crisis is very real. Whether one believes it's nature vs nurture, choice vs disease (there's a thread over in the Lounge on all of that), it's killed people left and right, from all walks of life. I don't know what the "something " is, but something needs to be done.

All I, and my EMS colleagues, are doing is picking up the mess. I remember an allegory relating us to constantly jumping in the river to save a drowning person. As soon as we get to shore, we have to jump right back in for the next save. Never get a chance to see who's pushing all these folks into the river in the first place.

Thanks for your concern about me, but don't worry. I'm always going to jump back in for the save.

But will someone finally figure out who the hell is getting them thrown in the river in the first place?!?!

With the topic of this thread in mind, how has your ordering been for opioids and benzos changed throughout your career?

I'd imagine you don't prescribe them as much, and rarely send anyone home with a script for more than 5 pills...

quote:

Originally posted by amsmith281:
With the topic of this thread in mind, how has your ordering been for opioids and benzos changed throughout your career?

I'd imagine you don't prescribe them as much, and rarely send anyone home with a script for more than 5 pills...

It's changed quite a bit. Florida has a Rx drug monitoring site which shows who Rx and which pharmacy a Rx was filled for an individual. I check patients on that site frequently. I also don't Rx a significant quantity of any of those meds. If you're "clear" on the site and have a subjective pain problem, you might get 6-8 pills. Even if you have an objective cause for pain (a CT scan proven kidney stone or a fracture) we often don't prescribe more than a few days worth of meds. Unfortunately, the abusers have spoiled it for the legitimate patients. The crisis is so prevalent that the underlying principle is "First, do no harm."

No. This is not the dealers/pushers fault. This is 100% the users fault. There's nothing that can be done to effectively stop the smuggling. If they shut down the border, they figure out some other way. Prohibitions NEVER work.

quote:

Originally posted by qcsmitty:
OP, that's one shocking statement coming from an ER health care provider. If we can seal the border and deport the shit stains pushing that fucking heroin on our people, we just MIGHT get a handle in this thing.

Please don't become jaded. We all need you.

I've heard hospitals are running our of Narcan on a regular basis.

I just got home from a ConEd class about... you guessed it, Narcan. The state of Iowa is adding into our protocols. I live near a town of about 2500 people, many of them imagrants, and the only recent fatal overdose we had was foxglove. Had to do with weird imported chew, from India. Anyway, long story short, if it's a problem in Iowa, it's a big problem.

quote:

Originally posted by DitchDoctor911:

quote:

Originally posted by qcsmitty:
OP, that's one shocking statement coming from an ER health care provider. If we can seal the border and deport the shit stains pushing that fucking heroin on our people, we just MIGHT get a handle in this thing.

Please don't become jaded. We all need you.

Hopefully I didn't shock you in a way that makes you think I've given up. Far from it. Ive been doing Emergency Medicine for 25 years, and fully expect another 15 until retirement. It's in my blood, it's who I am. It was just a rant to blow off some steam. But the crisis is very real. Whether one believes it's nature vs nurture, choice vs disease (there's a thread over in the Lounge on all of that), it's killed people left and right, from all walks of life. I don't know what the "something " is, but something needs to be done.

All I, and my EMS colleagues, are doing is picking up the mess. I remember an allegory relating us to constantly jumping in the river to save a drowning person. As soon as we get to shore, we have to jump right back in for the next save. Never get a chance to see who's pushing all these folks into the river in the first place.

Thanks for your concern about me, but don't worry. I'm always going to jump back in for the save.

But will someone finally figure out who the hell is getting them thrown in the river in the first place?!?!

Thank you for what you do, friend. Great post.

Had a 35 yo OD last night, had about an hour of CPR, 8mg of Narcan, and is intubated in the ICU, certainly brain dead. Hopefully he doesn't have HIV or hepatitis and can be an organ donor.

Worse than heroin though I think is the one who crush and inject Opana, that shit seems to just stick to heart valves and cause horrible endocarditis. I saw maybe one case of endocarditis in med school and residency, now probably 20 in the past 2 years, all young people shooting up. A couple even continuing to do so after getting a valve replacement! This type of stuff really saps what compassion I have for drug users.

quote:

Originally posted by barndg00:
Had a 35 yo OD last night, had about an hour of CPR, 8mg of Narcan, and is intubated in the ICU, certainly brain dead. Hopefully he doesn't have HIV or hepatitis and can be an organ donor.

Worse than heroin though I think is the one who crush and inject Opana, that shit seems to just stick to heart valves and cause horrible endocarditis. I saw maybe one case of endocarditis in med school and residency, now probably 20 in the past 2 years, all young people shooting up. A couple even continuing to do so after getting a valve replacement! This type of stuff really saps what compassion I have for drug users.

What is Opana?

^^^
http://www.drugfree.org/news-s...used-in-rural-areas/

https://www.washingtonpost.com...m_term=.b291d873ad60

Maryland Gov Hogan declares opioid ‘state of emergency’

By Bill Turque March 1 at 5:03 PM

REISTERTOWN, Md. — Maryland Gov. Larry Hogan on Wednesday escalated his administration’s response to the opioid-addiction crisis, declaring a “state of emergency” and committing an additional $50 million over the next five years to beef up enforcement, prevention and treatment services.

Hogan (R) signed an executive order calling for the state of emergency, an instrument many jurisdictions use to coordinate anti-opioid and heroin strategies. The action fulfills a campaign promise he made in 2014 but temporarily shelved after taking office in favor of other legislative and executive initiatives.

The governor, who lost a cousin to addiction years ago, said the declaration underscores what he described as “an all-hands-on deck approach” to growing rates of heroin, opioid and fentanyl use.

“The reality is that this threat is rapidly escalating,” Hogan said, appearing with Lt. Gov. Boyd Rutherford (R) and a large contingent of state officials at the command center of the Maryland Emergency Management Agency outside Baltimore.

Heroin and fentanyl, a powerful synthetic opioid, killed 1,468 Maryland residents in the first nine months of 2016, up 62 percent from the same period in 2015, according to state data. Many of those who overdosed initially abused prescription painkillers and other opioids. The trends are part of a nationwide opioid epidemic.

State officials acknowledged that the emergency declared Wednesday bears little resemblance to the kinds of mobilizations that are typical after severe weather emergencies or extreme civil unrest, and usually involve curfews and travel restrictions.

They said the death toll from opioids justifies use of the state emergency management agency to break down bureaucratic silos separating different bureaucracies and local and state officials.

“It gives us the ability to leverage the resources that are available,” said Clay Stamp, Hogan’s senior emergency management adviser, who will lead the statewide effort.

He and others could offer few specifics. Stamp, a former director of the state emergency management agency and the Talbot County Department of Emergency Services, agreed that details were “squishy” at this point. He also said he’d been tasked with the job the day before Hogan’s announcement.

At the same time, Stamp said his experience would help him coordinate law enforcement, social services and public health providers. He said “clear, specific goals” will be announced soon.

Opioid abuse has been a signature issue for Hogan. Shortly after taking office, he formed a task force headed by Rutherford that has made nearly three dozen recommendations on drug policy. The governor has proposed bills that include measures to limit prescriptions of opioid-based painkillers and to increase prison sentences for dealers.

[Growing number of Md. babies born with drugs in their systems]

Hogan said he will submit a supplemental budget request to lawmakers for the five-year $50 million expenditure. He did not say where the money would come from.

Although some parent activists and other advocacy groups have applauded Hogan’s efforts, others say he should do more — including devote more resources and attention to long-term residential treatment.

“We don’t need education, and we don’t need more law enforcement,” Mike Gimbel, a former Baltimore County drug czar and a recovering heroin addict, said in a statement Wednesday. “We need treatment on demand. Ten million new dollars is a drop in the bucket.”

Carin Miller, president and co-founder of Maryland Heroin Awareness Advocates, saluted Hogan for high-profile he’s given the crisis, saying the governor’s “been wonderful since he got into office.”

But Miller, whose grassroots organization works to draw attention to the opioid abuse and place addicts in treatment, echoed Gimbel’s call for increased focus on detox, medical and counseling programs. “When people reach out to us, we are beside ourselves,” she said. “Nine of 10 times we are sending them to Florida or other states for treatment.”

Hogan said at the announcement Wednesday morning that the state cannot shoulder the entire burden by itself, and that federal and local governments, along with the nonprofit sector, have to step up.

One idea the governor categorically rejected: a proposal by Del. Dan Morhaim (D-Baltimore County) to create “safe” sites for heroin users, where trained professionals could protect them from overdose and unsanitary needles.

Morhaim, a physician, calls the idea part of a “harm-reduction strategy.” He proposed legislation to make it happen last year, and has introduced a similar bill this year.

“I think it’s absolutely insane. . . . Maybe he wants to get a license to sell heroin,” Hogan said, referring to the lawmaker’s role as a consultant to a prospective medical marijuana dispensary and his advocacy of laws that allow medical cannabis.

The Maryland General Assembly is examining whether Morhaim’s involvement in the medical marijuana company poses ethical issues.

Morhaim’s opioid bill echoes recommendations by researchers at the Johns Hopkins Bloomberg School of Public Health, who published a study saying Baltimore should open two safe drug-consumption places.

In an e-mail Wednesday afternoon, Morhaim demanded an apology from Hogan, and reiterated past statements that he had not violated any rules in working to launch Maryland’s medical cannabis program.

“Governor Hogan’s statements are patently false, and he knows it.” Morhaim said. “I strictly complied with the ethics laws.”

I'm old enough that I've had a couple of friends die from complications of heavy drug use. The first one was a friend of mine who was in a motorcycle wreck and got hooked on pain killers and then somehow moved into cocaine, taking huge amounts of both. He died when he was 26. Another friend had severe back pain from a work accident. He never got enough of a supply to really control his pain, so he began drinking and buying drugs illegally. Eventually, he got so messed up that an intervention was done and he agreed to go to rehab. When he was about to leave, he decided to take a bath, but almost as soon as he got into the tub, he started having chest pains, and never made it to the hospital. He was 39. The autopsy showed he was also about to go into liver failure from all the booze and percocets, and also had kidney damage. Any of my other friends who had drug issues seemed to grow out of them and are fine now.

As a scanner listener, the OD rate has exploded, I hear the calls constantly. The rules regarding the prescribing of opiates has helped fuel this whole deal. My mother had all kinds of issues the last 12 years or so of her life, and she was on major opiate painkillers, both Oxicontin and Percocets. The hoops she had, well, I had to jump through to get the stuff refilled were ridiculous and if she lost some pills, well, there were no extras, so it was a huge deal for her. She used to try to skip or prolong doses to build up a supply in case something happened and she wound up short. It was just a huge hassle and made her have stress she didn't need. Her bad vision caused her to drop pills occasionally and many of those got crushed, and it was a constant worry when she got low towards the end of her pills.

Politics
Punish the people who need the meds. Raise taxes to cover the Narcan to save the undesireables. Increasing victims all around

One other thing about drug or alcohol abuse is the long term effects it has on the user. I am 64 now and see many friends from the 60's and 70's passing away before they are 70 years old. Many of them were abusers of both drugs and alcohol. I am convinced that they would have lived far longer if they had not been abusers when they were young. Most straightened out but are now passing away younger than I ever imagined. The new heroin and designer drug epidemic is much more devastating than anything I ever saw back in the 60's or 70's. The cartels are ramping up production and quality to unheard of levels now. Thanks to all the medical industry professionals for all their hard work.