Ask the Opioid Dependent Patient, Not Law Enforcement, About Incidences of Opioid Overdoses

The Dubuque, IA Telegraph Herald recently featured a news article by Alicia Yager entitled “Law Enforcement Divided on Overdose Intervention.” In it, she references Richard Jones’, the sheriff of opioid-ravaged Butler County in Ohio, refusing to equip his deputies with Narcan. He believes requiring deputies to administer Narcan puts them in danger and the cost of repeatedly treating people with Narcan are “sucking the taxpayers dry.” “All we’re doing is reviving them. We’re not curing them.” Opponents of Narcan believe it has no lasting impact on the death toll.

Nearby sheriff Robert Leahy of Clermont County in Ohio says “from my personal experience it is right thing to do.” The nasal spray makes it simple to administer, it’s not a major burden to track and maintain supplies and that it’s a natural extension of our mission to serve and protect. Leahy further states “no matter what their plight is and how they got to where they are, it’s not for us as law enforcement to decide whether they live or die.”

Ms. Yager then cites local law enforcement leaders in the tri-state area of Wisconsin, Illinois and Iowa, who are happy to include Narcan in their tool box to help people who might otherwise die. The Dubuque County sheriff’s department and Dubuque police department in Iowa carry Narcan. According to Dubuque Drug Task Force statistics, there were 15 opioid-related overdoses with four resulting in death. Those figures are an improvement from 2016 which had 28 overdoses and nine deaths. Dubuque police chief said he is aware of three instances of reviving an overdose victim since July of 2017, when they began carrying Narcan. Officers in Jo Daviess County in Illinois don’t carry Narcan yet but will do so as part of a state wide mandate. Grant County in Wisconsin doesn’t see a need for Narcan yet and have only used it once. Although they don’t see the effects of an opioid epidemic, they are happy for the opportunity to administer it if needed.

But here’s the thing. Law enforcement is not in a position to know how many fatal or near fatal overdoses occur within their jurisdiction. We can’t rely on their statistics for an accurate count of how many people have nearly died.

Why? Given the legal consequences of possession of an illicit substance, people who are in trouble will resist calling for help, unless absolutely necessary. In spite of Good Samaritan laws, in which there are to be no arrests for someone who tries to save a life, drug users are suspicious. They will try to handle the overdose without intervention from paramedics or law officers. With increased distribution of Narcan to the public, we may see fewer reported overdoses and more people being saved by a peer or family member.

Additionally, in cases of fatal overdose deaths, families may choose privacy over public stigmas. The death certificate may list cause of death as respiratory failure and not opiate overdose. These deaths may not get counted in statistics. Stigma, such as perpetuated by Richard Jones in Butler County, Ohio, prevents people from openly sharing that a loved one died of the disease of addiction. There is no such stigma of a family member dying of cancer.

In Yager’s column, she references a fear of violence from someone who has been revived with Narcan. Sheriff Jones said that people can be combative when they come to, and “an officer bent over giving Narcan could get a brick to the head.” This language is unnecessarily inflammatory and sensational. It is true that an opiate dependent person who is revived with Narcan will wake to pain. Narcan works by stopping the overflow of opiates to receptors leaving them with no opiates in their system and inducing withdrawal symptoms. However, they are no more likely than any other patient in pain to react with aggression. Officers are trained in tactics of restraints and will surely remove any nearby bricks that could cause harm to themselves.

When Jones says “All we’re doing is reviving them, we’re not curing them” he is correct. Narcan is a tool to keep people alive. It is not treatment. Law enforcement is not expected to provide treatment. Their purpose is to serve and protect, even if it takes 20 uses of Narcan to protect them. He also says Narcan has no lasting impact on the death toll. This may also be correct and some statisticians believe the epidemic will get worse over the next six years. But even one more day of life to a loved one is precious. Can you look into the eyes of a grieving parent and justify withholding Narcan because it would have no lasting impact on the death toll? Of course not.

So where do we turn for more accurate figures? To the patients who are dependent upon opioids themselves. I did an informal survey of opioid dependent people in this tri-state area two years ago and repeated it last week. In 2015 I surveyed a group of ten people who were in drug treatment for addiction to opioids (heroin or pain killers). Among these ten people, they had experienced eleven overdoses. When asked how many overdoses they had witnessed or known of among their peer group, they counted more than sixty. When asked how many of those overdoses resulted in death, they counted twenty-two.

Last week I again surveyed a group of seven people who are in treatment for an opioid dependence. Six people had experienced a total of eleven overdoses. When asked how many overdoses they had known of among their peers, they counted eighty-four. Among those eighty-four overdoses, thirty-two had died as a result of the overdose.

Admittedly, this is not a scientific study but it does indicate that patients are better informed than law enforcement officials. News columns that look to law enforcement to understand the nature and extent of an opioid crisis can mislead the public. It is important for law enforcement to be equipped with Narcan, but it is imperative for patients to have Narcan and easy access to treatment.