EMT Chas Carlson came to speak to our class about emergency response services, specifically in regard to overdose calls. He also brought along paramedic Joe Sobol, tactical paramedic Craig Hall and Officer Eric Miller from Delaware County.
These four guests had a different perspective from many of our previous guest speakers. I think their outlook on the opioid epidemic and addiction may be a little more pessimistic, given they are seeing the worst parts of addiction every day in their work. But it was also important and insightful to hear about the experiences they’ve had.
I think it was particularly interesting to hear about their criticisms of Narcan. Craig said the general public seems to think Narcan is a “miracle drug,” and he pointed out that it can’t save everyone. The speakers added that access to Narcan encourages some people to continue using drugs because they think an overdose isn’t as dangerous with access to Narcan.
Chas added that he has experienced emergency calls where someone spends too much time trying to use Narcan to save someone without first calling 9-1-1. This is a valid concern. When David Fialko from the Council of Southeast Pennsylvania came in to give our class a Narcan training, he stressed the importance of calling 9-1-1 immediately after determining someone is unresponsive to verbal cues and a soft shoulder shake.
Additionally, I think it was interesting to hear the criticisms of safe injection sites, or comprehensive user engagement sites (CUES). I think some of the criticisms that had valid points were: 1) Should the government ever be providing something harmful directly to citizens? 2) Will drug dealers be able to easily seek out people who use drugs by going to these sites and derail their recovery attempts?
I also think it was enlightening to hear from Eric that police officers still aren’t sure how to handle all instances of people utilizing the Good Samaritan Law in which people can call the police for help without being arrested if someone they’re with is overdosing — even if they are also using drugs. He added that some people still may not call for help if they have a warrant out for their arrest because in this case they are not protected by the law.
Overall, this was a really informative discussion, and I learned a lot.
What we really know is that states where Medicaid expanded had higher rates of hospitalizations before the expansion. We know that the rate of increase has been faster in states that expanded Medicaid. We know that in states with Medicaid expansion hospital treatment for opioid issues will be paid for by Medicaid. Now we can say full stop. The use of hospitalizations as your metric is problematic. What you really want to know is the incidence of abuse, and if that is increasing. Hospitalizations is just a proxy, and your priors should tell you that if a service that was not paid for is now being paid, the use of that service is likely to increase. I would have looked at other things also, or instead of this. Drug sales, arrest rates, narcan use, etc. Steve