A State of Addiction: On the Front Lines

Oct 18, 2017

Over the last 15 years, the rate of opioid-related drug poisoning deaths has rapidly increased across the state. According to the Utah Department of Health, prescription opioids have been responsible for more drug deaths in Utah than all other drug categories, such as benzodiazepines or illicit drugs.
Credit Utah Department of Health



“There are many times when families are affected by this and it's not always the homeless person or the stressed out dad—it can be the mom, at home. They could have three kids; they could have regular family life like anybody else and just not be able to deal with something quite well at the moment,” said Corey Larsen, firefighter paramedic for Ogden City.

“And those to me happen a lot. I see those more than I thought I would. That surprised me when I started working here full-time. It still shocks me sometimes when [we go on an overdose call and] I am like, oh, your life seems so good. Why are you having this problem? You just realize that everybody has something that ends up happening to them or something that they have to deal with and those problems are always dealt with and sometimes that's what they turn to.”


In 2015, there were 410 opioid-related deaths in Utah. If you look at a map of hotspots in the state where the opioid epidemic has hit the hardest, downtown Ogden is a high risk zone. It ranks first in overdose deaths and in the top ten for emergency room encounters. First responders like Corey Larsen are busy here and naloxone is a standard tool in their emergency kits.


That's because naloxone – or narcan – is a drug that works by blocking the brain's opioid receptors. This helps reverse an overdose from both prescription and illicit opioids by allowing a person's depressed respiratory system to recover. Basically, naloxone allows people to start breathing again.


“It's really hard when you wake up a 22-year old kid and try to explain to him that he's just about died, and he's upset, he's crying, he's angry,” Larsen says. “It's not a pleasant thing to explain to them that this is going to kill you eventually.


“And there's much more to it,” Larsen says. “My training with mental health is so minimal that when someone is having a problem like an addiction issue that is something that gets very deep. So what I try and do is let them know that I don't think it's weird what has happened. It's not uncommon to overdose, but I try to express the gravity of the situation. A lot of times parents ask us, 'What are we doing wrong?' or 'What can we do?' And in all honesty, I don't have an answer for them.”


Larsen feels there's a gap between what first responders are equipped to do for people trapped in a cycle of addiction and what they need to break out of it. He suggests it may be an opportunity lost when paramedics like him revive individuals from an opioid overdose without having information to provide them or their loved ones about potential treatment and recovery services.


“For me, if there is programs out there I would love the education on it; I would love to be able to distribute that information while I've got them—the same with any service that we have, mental health, or long-term care,” he said. “We are more than willing to help in any way we can. We want to help. But an ambulance is really a poor substitute for a doctor's office or a psychiatrist. And sometimes that's the only healthcare these people have. We go and try to do the best job that we can, we treat them with respect, and we talk to them about their problems, but in the end, we're just aren't who they need.”


Larsen admits this is typically outside the scope of what first responders are one scene to do in an emergency. When they are called, first and foremost, they're try and save a life. And this is where naloxone helps.


Since 2014, Utah legislators have passed a series of laws that expand naloxone access to non-medical personnel and encourage them to use it if they encounter someone experiencing an opioid overdose. For pediatrician Jennifer Plumb, this is an important first step in battling the state's opioid crisis.


“We are the first to admit that this is not by any means the solution to this crisis, but it is the initial point of keeping people alive while we get better at dealing with addiction and the opioid scenario that is happening nationwide,” she said.


Plumb co-founded the nonprofit Utah Naloxone with her brother to make naloxone rescue kits widely available to people across the state and to train community members how to administer it. This project is deeply personal for them. The Plumbs know what it's like to lose a sibling to an overdose.


“Anyone who struggles with substance use disorder one of the hardest things for them is not feeling like they matter,” she said. “And I went through that with my brother when he was trying to get sober and through recovery. I wish that there were less Andys. I don't want another family to plan a funeral this weekend.”


While naloxone is not a new drug – it's been around since the 1970s – until recently, it was primarily only carried by first responders in Utah. But with hundreds of people dying each year from opioid overdoses, the Plumbs wanted to get this powerful antidote into the hands of people whose loved ones are risk. Because the thing about naloxone is, it only works if you use it.


“It's not a pill. So it's not something that could accidentally be pulled off of something,” Plumb said. “It's either an inter-nasal spray or an injection. It's really one of the most amazing substances out there. There are no ill effects if someone gets naloxone and they're not experiencing an opioid overdose.”


Plumb has used naloxone herself—many times—in the emergency room at Primary Children's Hospital. That's where she sees the trickle down effect of the state's opioid problem. During one shift, four children under 5 years old were brought in after overdosing on prescription opioids they ingested in their homes.


“Fortunately, all of those children were revived with naloxone and all of them survived, and all of them went home, you best believe, with their families and a naloxone kit in hand,” Plumb said. “Because these substances are not going away and so the best thing that we can do is try to educate people about having [kits] safely in home and preparing for a worst-case scenario—because they happen.”


Plumb says that we need to curb society's appetite for prescription painkillers and provide support to opioid dependent people by connecting them to effective treatment. In the interim, she says naloxone can help save lives.


“Get this into people's homes and into people's hands,” she said. “I hope that as our state moves forward we don't just buy naloxone for the sake of buying naloxone, but we actually buy naloxone and get it out into the hands of the end users. That's where lives are saved. That's where folks who may not have had 911 called for them get their overdose reversed and that's where these truly impacting life-saving stories will happen.”


This series is brought to you in part by the Association for Utah Community Health, providing training and technical assistance to health centers and affiliates across Utah. More information available here.