First responders on the opioid crisis: ‘You recover or die’
Paramedic Chris Peischl knows some street addresses all too well. The ones he visits “over and over again,” each time to save someone from an opioid overdose.
Armed with life-saving naloxone, Peischl and his crews revive the same people again and again, and urge them to get help with their addiction. Most of the time, they refuse to even go to a hospital to be checked out.
And there’s nothing paramedics can do.
“They won’t admit that they have a problem,” said Peischl, director of operations for Cetronia Ambulance Corps in South Whitehall Township. “But, we continue to go, over and over again.”
His frustration mirrors that of the four other first responders who also participated in a roundtable convened recently by The Morning Call. The topic: an opioid epidemic that last year claimed more than 300 lives across the Lehigh Valley.
For a decade or more, all five of the first responders have been fighting an unrelenting foe, and even as the deaths grow at an alarming rate, the five show no signs of giving up the battle.
But, they do want more tools than just naloxone to fight an epidemic they believe will continue to kill for decades more. They want money for treatment, laws that would force addicts into court-ordered treatment and education programs to alert young people of the dangers of opioids, similar to anti-smoking campaigns.
During an hour-long discussion, the first responders stressed they would continue to give naloxone, an overdose reversal drug frequently sold under the brand name Narcan, because it saves lives. But they warned that its widespread availability is spurring a false sense of security in the community.
“Narcan doesn’t solve the problem,” Peischl said. “That’s just the Band-Aid approach. That’s not going to fix this.”
Asked when the Lehigh Valley would see some relief from the opioid crisis, the answers from all five sounded similarly grim.
“Not to be the negative Nelly, but the answer to your question is decades,” Peischl said.
Death moves to the suburbs
Heroin and prescription opioid addiction is not a new phenomenon, but the first responders at the roundtable said they saw a change several years ago in the type of person overdosing on the drugs.
Peischl, who worked as an Allentown paramedic for more than a decade before joining Cetronia about 10 years ago, said he noticed more addicted suburbanites around 2010.
“We would see people who were going into Allentown and [while] driving out, overdose on the side of the road,” Peischl said.
Don DeReamus, a longtime paramedic and administrator at Suburban EMS in Northampton County, said he saw an uptick in opioid-related deaths in his community about a decade ago.
Now, DeReamus added, stronger synthetic opioids, including fentanyl and carfentanyl are being abused.
“And the overdoses are harder to turn around and save lives now,” he said.
It’s not lost on first responders, especially the ones who work in both cities and suburban areas, that the public and media didn’t pay much attention to heroin and opioid addiction until young white people started dying almost daily.
“Nobody came to us when I was in Allentown and said, ‘How many overdoses did you correct?’ ” Peischl said. “It didn’t make the news because they were happening frequently. Then it goes out to suburbia. People are seeing it more. What once was an urban problem now is my neighborhood problem.”
Law ties first responders’ hands
In Lehigh Township, police Chief Scott Fogel’s officers too get called to the same addresses “over and over again” for reports of opioid overdoses.
Often they are unable to make an arrest. That’s because Pennsylvania’s Good Samaritan Drug Overdose Immunity Law, enacted in 2014, prohibits police from charging both a person who has overdosed on drugs and the person who called 911 to get help.
So, his officers can only watch helplessly as the addicted person refuses medical help and continues to deteriorate.
The chief said he’d like to see a law similar to one enforced against first-time drunken drivers, which allows suspects to avoid a criminal record, but forces them to address their drinking problem.
“It’s easy if you have a DUI,” Fogel said. “You pull the driver’s license. You tell them they have to meet this certain criteria to get their license back. Now, what equivalent do we have for drug addiction? Currently I don’t know of one.”
In both Lehigh and Northampton counties, first-time offenders of drug-related crimes may be eligible for accelerated rehabilitative disposition. But many addicted persons may never see the inside of a courtroom.
Especially in rural areas, police officers are often first on the scene of an opioid overdose and are the ones who revive addicts with naloxone. The officers often walk away from these situations worried about what the person will do next, Fogel said.
It’s easy if you have a DUI ... You tell them they have to meet this certain criteria to get their license back. what equivalent do we have for drug addiction?
Lehigh Township Police Chief Scott Fogel
“With drug overdoses, oftentimes the person is on their way up with their high and they are driving a car. Is this now going to become a crash? Is it now going to become a DUI? What are the other things that are going to happen?” he said.
Some drug addicts have already had some contact with law enforcement and may have a probation or parole officer monitoring them. It’s the ones who have never been arrested that concern police officers the most, Fogel said.
“Who oversees them if they are given a dose of Narcan and they recover and go right back to their circle that they’re normally in? How do you fix that? I think that’s the next question and the next step that needs to be figured out,” he said.
That doesn’t stop police departments from investigating drug overdoses, said Adam Miller, a detective with the Upper Macungie Township police. He noted that a recently updated law includes a charge called drug delivery resulting in death, which guarantees a drug dealer at least five years behind bars for selling a lethal dose. He said that gives detectives some teeth in those probes.
“I think one of the things that we have seen in the law enforcement community with the uptick in the heroin overdoses is that we are not only reaching out to those folks with the lifesaving efforts, but we’re actually treating overdoses as criminal investigations,” Miller said.
In Northampton County, prosecutors used the statute in October to send drug dealer Daniel J. Fisher Jr. to prison for three to six years. The lawyers for the 30-year-old Forks Township man argued Fisher was simply providing a fellow heroin addict with the means to stave off painful withdrawal, but a judge found Fisher profited from the sickness of others.
Is Narcan a “Band-Aid”?
In those cases where an overdose victim heeds an officer’s plea to seek treatment, first responders know they’re sending the person on a difficult quest.
There are few beds open in the Lehigh Valley’s drug treatment facilities, and many people suffering from addiction don’t have medical insurance. Gov. Tom Wolf issued a disaster declaration on the crisis last month, a move that was supposed to cut some of the red tape barriers to treatment, but first responders say they’re still hearing about long waits to get into rehab centers.
And many of the people who need help the most can’t afford it.
“These individuals who are overdosing do not, unfortunately, have insurance,” said Jeffrey D. Yanochko, EMS liaison for St. Luke’s University Hospital. “So unfortunately at that point, some have to make the choice — food or rehabilitation? They continue with the addiction at that point.”
We’ve seen flakka, we’ve seen K2, we’ve seen spice. And the government always tries to catch up with these new drugs, these synthetic drugs, and they can’t.
Don DeReamus, administrator of Suburban EMS
The bigger hurdle, the first responders said, is convincing an addicted person that suffering through painful withdrawal to get clean is worth it.
“Unfortunately, too many times it takes that individual to get to that rock bottom,” Yanochko said. “I’ve witnessed that firsthand, people who get to that rock bottom point and then they realize, ‘I do need the help.’ And that’s when you are able to make a difference with these people to show them that yes, we are there. We are your support staff. We are there to help you through all these problems.’”
Naloxone has been both a blessing and a curse, the first responders said. It undoubtedly saves lives, but makes some drug users feel invincible.
“It’s a false sense of security that you can go out and party hardy and if something bad happens, my friend has Narcan,” Peischl said.
First responders across the Lehigh Valley administered naloxone more than 1,000 times in 2017, county officials said. The medication also is available in drug stores without a prescription under a standing order signed in 2015 by state Physician General Dr. Rachel Levine.
Under Wolf’s disaster declaration, first responders at an opioid overdose may leave behind some naloxone. Most in the Lehigh Valley do not, however, out of financial and medical concerns.
DeReamus, from Suburban EMS, noted that a box of naloxone cost between $4 to $5 a decade ago. Today, that same box is $50 to $60, and Suburban can’t recoup that cost if the patient doesn’t have insurance or is covered by Medicare or Medicaid.
It’s a false sense of security that you can go out and party hardy and if something bad happens, my friend has Narcan.
Christopher Peischl, director of operations at Cetronia Ambulance
Also, he noted, long-lasting synthetic opioids like fentanyl may require multiple doses of naloxone spread out over a longer time period. Even after an initial dose may appear to have revived a patient, within an hour they can succumb again to an overdose.
“Our goal is to always try and get someone to the hospital,” DeReamus said.
Peischl also likened naloxone to a Band-Aid, but said some people talk about it as if it’s a cure for opioid addiction. That’s dangerous, he said.
“People ... they overdose and somebody wakes them with Narcan and they do it again. And they do it again. And that one time, nobody was there [with Narcan] and they die. And you want to go back to the family and tell them, you know, ‘We told you,’ ” Peischl said.
“Recover or you’re dead”
Experts say that the opioid epidemic will likely get worse before deaths finally begin to decline around the mid-2020s. Locally, first responders believe it’s going to take legislative intervention to open more treatment centers, and increased focus on stopping the flow of opioids onto the Lehigh Valley’s streets before the problem ebbs.
First responders also wonder why more isn’t being done by schools to educate young people.
“The education is there but you don’t really see it to the degree that we’ve seen it in the past,” said Fogel, the Lehigh Township chief, recalling the “Just Say No” messages of the Reagan era. “All those different things we used to do, you just don’t seem to see the tenacity right now.”
“The sad part with the law enforcement is there’s always something else,” he said. “We’ve seen flakka, we’ve seen K2, we’ve seen spice. And the government always tries to catch up with these new drugs, these synthetic drugs, and they can’t. So it seems like a never -ending battle.”
But even if all the drug dealers are locked up, the opioid crisis will continue unless people who are addicted reach out for help, the first responders agreed.
Nearly 1 in 2 Lehigh Valley residents has a direct connection to the epidemic, with 43 percent saying they “personally know” someone who has been addicted to heroin or another opiate, according to a 2016 Morning Call/Muhlenberg College poll. DeReamus counts himself among that number, and said he’s watched with dismay as the crisis has moved from the cities to his rural neighborhood.
“I’ve seen so many teenage kids that I’ve known from my sons in high school that are not here with us anymore because they could not recover,” he said. “It’s that serious. You either recover or you’re dead.”
State of Emergency
The opioid epidemic affects every part of our society. From families to health care providers to the first responders who rush to the scene of overdoses, it’s truly a community crisis. As part of a yearlong, multimedia series on the opioid epidemic, The Morning Call is hosting a series of roundtable discussions with community members who are directly impacted.
Our first session was with suburban first responders — Lehigh Township police Chief Scott Fogel; Jeffrey D. Yanochko, EMS liaison for St. Luke’s University Hospital; Don DeReamus, administrator of Suburban EMS; Adam Miller, Upper Macungie Township Police Department detective; and Chris Peischl, director of operations for Cetronia Ambulance Corps — on Feb. 6.