Overdose response takes toll on responders

Sep. 19—Cumberland County emergency medical personnel responded to more than 92 calls for drug overdoses through August 2022. But the numbers of people in the community in need of medical care for a drug overdose far exceeds that number.

"We've had 172 calls where overdose was labeled as the primary cause," Daniel Coleman, critical care paramedic and training officer for Cumberland County EMS, told the Chronicle. "It might show as an overdose because that's what initially happened, but they're actually in cardiac arrest."

If a patient has already entered cardiac arrest due to an overdose when help arrives, Coleman said solemnly, "We're not getting them back."

"Narcan won't always save them," he said. "Sometimes it's too late when someone finds them."

The statistics encompass all types of overdoses, including alcohol, stimulants or opioids.

"We mostly deal with opioids," Coleman said.

Drugs like naloxone can immediately reverse an overdose from opioids like heroin when given quickly and correctly. Naloxone can be given through a nasal spray — called Narcan — or as an injectable drug. It can take three minutes for the drug to take affect. If there is no response after three minutes, a second dose can be administered and, if necessary, additional doses.

"It only affects opiates," Coleman explained.

Opioids includes heroin, fentanyl, which may be prescribed, and carfentanil, a synthetic opioid about 100 times more potent than fentanyl often found in street drugs.

Overdose incidents can fall into several categories. These can include unintentional drug use, over medicating, mixing narcotics, or refraining from using narcotics for a period of time and then restarting.

Elderly individuals may accidentally overdose on prescribed medication because they forget if they've taken their dosage.

Coleman said carfentanil and newer, more potent opioids may require additional doses of naloxone.

"Some patients are requiring numerous doses or Narcan or more Narcan on the initial dose just to get people back," he said.

According to statistics Coleman provided the Chronicle, there were 199 ambulance calls for overdose response in 2021 and 319 calls requiring overdose treatment.

Last year, there were 53 documented deaths in the county due to drug overdoses. These are cases known to public health officials and confirmed through autopsies and/or evidence found at the death scene.

The Tennessee Department of Health listed 12 deaths due to overdose in Cumberland County in 2020. The department has not yet reported 2021 overdose statistics.

In the first weeks of 2022, there were eight reported.

"The overdose response shocked us," said Bob Valerio, director of the Cumberland Prevention Coalition.

Earlier in the year, the coalition hosted a panel discussion on the increase in overdose deaths and calls in the community, with speakers representing local law enforcement and Cumberland County Medical Examiner Ben Gibson.

Valerio said the discussion "opened our eyes" to the challenges emergency personnel face when called to respond to a drug overdose. On Aug. 31, the coalition presented plaques and snacks to personnel at Cumberland County EMS, the 9-1-1 dispatch center, Emergency Management Agency, law enforcement agencies, fire departments and the Cumberland County Rescue Squad.

The discussion explored the collateral damage an overdose incident can have on children present in the home or the stress and fatigue of first responders.

First responders like EMS and law enforcement, are equipped with naloxone to reverse a suspected opioid overdose. The Prevention Coalition also makes Narcan kits available to the public paid for through a Centers for Disease Control grant.

"We blow through it," Valerio said of the coalition's supply of Narcan kits.

However, Naloxone causes immediate opioid withdrawal, which can cause additional symptoms such as vomiting and feeling nervous, restless or irritable.

"We've had patients become violent. They fight you. They spit on you. They cuss you. We treat them the same as we do all our patients — with respect and take care of them — but the conditions we see them and they put us in are sometimes not the best," Coleman said.

Once the emergency has passed, many patients decline further treatment or transport to a hospital for additional care. Cumberland County EMS statistics showed 42% of patients refused transport.

The community response to addiction and overdose includes prevention efforts, harm reduction, recovery opportunities and assistance after sobriety is achieved. Cumberland County has a large recovery community with numerous faith-based and nonprofit programs operating in the county.

To learn more about the Cumberland Prevention Coalition and area resources, visit www.cumberlandpreventioncoalition.org or find them on Facebook at Cumberland Prevention Coalition. The organization hosts monthly sessions related to the drug epidemic and community response.

Heather Mullinix is editor of the Crossville Chronicle. She covers schools and education in Cumberland County. She may be reached at hmullinix@crossville-chronicle.com.