Why Doesn’t Our Local Hospital See More Overdose Deaths?

You may be aware of the opioid epidemic in the US right now. Opioids include heroin and prescription pain medication. There are now nearly 100 deaths a day from opioid overdoses. Deaths from opioids have been rising sharply for years, and drug overdoses are projected to increase. The toll could spike to 250 deaths a day, if potent synthetic opioids like fentanyl and carfentanil continue to spread rapidly. It is estimated that the death toll over the next decade could top 650,000.

I wear several different professional hats. One of my hats is that of a substance abuse counselor at Galena Clinic, a drug treatment facility that provides medication to opioid dependent people. We provide Methadone and Suboxone to people who can benefit from its properties. These medications reduce opioid withdrawal symptoms, decrease cravings for opiates, and blocks euphoria if the patient returns to opioid use while taking these medications.

Galena Clinic, located in rural Jo Daviess County, has treated a small handful of people who stopped treatment and later died of an overdose. Our current patients have paid tribute to hundreds of friends or family members who have died, but not necessarily in our small town. We were recently asked by an administrator of our local hospital, why they were not seeing more people in their emergency room who suffer overdoses.

Before I answer this question, I want to contrast our treatment clinic with a clinic in Duluth, Minnesota. I was recently in Duluth for a professional training and had the opportunity to ride along with a K9 police officer on an evening shift that lasted about five hours. Over this time we responded to a complaint of a man who surfed the library computer for pornography; a young woman who had been sexually assaulted and requested a ride home; and we intervened in a domestic dispute resulting in taking a woman to jail on a previous warrant. Additionally, we responded to a very serious domestic situation requiring multiple officers and emergency medical services. We also provided back up for a drug sting operation in which police attempted to arrest a heroin dealer. The dealer escaped but others were arrested. It was a fascinating experience.

While in the officer’s car, I noticed a Narcan kit which is used to reverse opioid overdose. This led to a conversation about the opioid epidemic in Duluth. He had not personally used the kit to rescue a person from overdose. However, he perceived heroin and pain pills to be the top drug of choice in Duluth. When asked if there was a medication assisted treatment clinic in Duluth that offers Methadone or Suboxone, he replied that to his knowledge there was previously a clinic that was shut down. He was of the belief that police were frequently called to the clinic for illegal activity. I asked where the patients were transferred for their medication. He thought they traveled two hours away to access treatment. He told me of a woman who drove back from this distance and got into a car accident, killing two pedestrians. I asked what caused the accident, and he looked surprised at my question, saying “Well, didn’t the Methadone cause the accident?” This indicates a stigma against medication assisted treatment. A stable maintenance dose of methadone does not cause impaired driving. I later learned that there is a closer opioid treatment clinic in the area that patients were transferred.

We made two trips to the Duluth jail to drop off people who were arrested. While there, I asked a female officer if the jail allowed people who were prescribed Methadone or Suboxone to maintain their medication regime while incarcerated. It can’t be fun for the staff to deal with sick inmates. I expected to hear a prohibition against these medications, but I was not expecting intense hostility toward opioid addicts. She said “They got themselves hooked on opiates, they deserve to suffer withdrawal.”

What I gleaned from my ride-along was that Duluth has a strong stigma against medication assisted treatment. The failure of the previous clinic tainted the value of this treatment. The correctional system administers punitive measures towards people who have become dependent on opioids rather than rehabilitative measures. Further, there lacks solid education about this problem and its prevention.

I want to go back to the question of why our local hospital does not have more people seeking emergency help for opiate overdoses. Duluth, Minnesota is quite different from Jo Daviess County.

First, our county is smaller. Duluth is a major port city in the US. Its population of 86,000 is much denser than our rural county of 22,000. Neighboring Dubuque County, Iowa has a population of 97,000 and has a larger overdose death rate. Dubuque hospitals are more likely to see overdose deaths than our Galena hospital.

Second, Jo Daviess County has received Galena Clinic without prejudice. Our staff has experienced the community as kind and generous. Our clinic has received a large donation from the Josh Serpliss Hope Fund of First Presbyterian Church of Galena, Illinois. They chose to name the Fund for Josh Serpliss since he was the son of a pair of members who was going through drug treatment – apparently successfully – but made a fatal decision to go for one last high and died as a result. They donated a large amount of money to provide Narcan to our opioid dependent patients. Our patients have the tools needed in the case of overdose to help themselves without going to the hospital.

Third, Jo Daviess criminal justice system operates along best practice guidelines for opiate dependent people. For instance, the county jail allows Methadone and Suboxone patients to maintain their medication while incarcerated. The majority of US jails do not allow inmates to continue these medications. They require withdrawal from medications which can be dangerous, and which puts the opiate user in jeopardy of overdose death upon their release. And, Jo Daviess Drug Court is open to members who are prescribed Methadone or Suboxone. Unlike some drug courts, they do not require people to withdraw before participating in the program.

Fourth, our clinic follows federal regulations and operates under best practice guidelines. Galena Clinic undergoes numerous reviews from regulating bodies. We have consistently been granted multiyear accreditation. We don’t have complaints of illegal activity that have not been scrutinized. If validated, we take action to prevent illegal or dangerous behaviors. We believe that our treatment clinic is well regarded, thereby reducing stigma against opioid addiction. We provide substance abuse education to the community.

Lastly, there are fewer people experiencing overdose because many of our local opioid addicts are in recovery and we’ve raised awareness in the community. We are proud of the people who have benefitted from treatment and improved their lives as a result of recovery tools.

We would like to express our gratitude to Jo Daviess County for being a welcoming body. Your openness has saved lives. Well done.