About three times a month — every month — for the last two years, Highland paramedics have had to use a special drug to save the life of someone overdosing on opioids.
“I’m not saying that everyone in Highland is a drug abuser, but to paint the picture that there is no problem is not helping either,” Highland EMS Chief Brian Wilson said of a scourge that has plagued every corner of the country.
Naloxone, or Narcan, is opiate antidote that can pull a patient out of the death spiral often brought on by abuse of opioids, a group of drugs that includes heroin, fentanyl and several types of prescription pain pills. Administered by either nasal spray or an injection, naloxone can quickly restore breathing, brain function, and save the life of a person experiencing an opioid overdose.
Last year, Highland EMS used naloxone 33 times on people who were overdosing. In 2016, it was administered 32 times. So far in 2018, it's been used seven times.
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Highland Police Lt. Chris Conrad said economics — cheap prices and wide-scale availability — are partly to blame from the ever-growing amount of overdoses.
“At one point, heroin was so prevalent, and there was so much of it, that an addict could buy a dose for $6,” Conrad said.
Highland Police Sgt. Scott Athmer said local officers find drugs on people or inside a home or vehicle several times a week. In addition, drugs and addiction are often aggravating factors in other calls, ranging from domestic battery to burglary.
“Under this definition of ‘drug-related crime,’ my estimation would be that we deal with it multiple times a day and it is the most pressing issue that we combat within the city,” Athmer said.
Because police are often first on the scene of drug-related calls, they, too, have have started carrying naloxone. It’s standard equipment now in every Highland squad car, and every officer has been trained how to administer it. So far, police have used the antidote once, and it was successful, Conrad said.
Death toll continues to climb
Illinois has a standing statewide order that allows pharmacies and other organizations to provide naloxone to individuals at risk for opioid overdose, their friends/family, and other members of the general public, without the need for a direct prescription.
But despite the wide availability of this miracle of modern medicine, people continue to die.
In 2017, it is suspected that 87 people died in Madison County because of drug abuse, according to the Madison County Coroner’s Office.
“Statistics in Madison County reflect what is going on nationwide as the United States is in the midst of an opioid overdose epidemic,” said Madison County Coroner Stephen Nonn.
In Highland, there have been 11 overdose deaths since 2012, according to Nonn. Two of those deaths were last year.
Part of the reason for the high mortality rate among users is that opioids are so addictive.
“The reality is a person can’t make a one-time mistake with these drugs. Once is enough to start an addiction and create a lifetime of misery for the individual and their families,” Conrad said.
The 33 doses of naloxone administered by Highland EMS last year went to just 24 patients.
Another issue is that some of the most dangerous narcotics are often cut, or taken in combination, with other drugs. The cocktails can prove lethal with just a single dose.
“This is a plague hitting society, and just like when I was a kid and we had Nancy Reagan telling us to 'Just say no,' we need for kids — and adults, for that matter — to know ‘not even once’ when it comes to opioids,” Conrad said.
In November, five people overdosed in Wood River in the span of 12 hours — one of them died. At one scene, police found a mixture of cocaine and fentanyl.
Fentanyl is a synthetic opioid that, according to the DEA, has a potency 50-100 times that of morphine and 30-50 times more than heroin.
Last year was the first time fentanyl overdoses outnumbered heroin overdose deaths in Madison County, according to the coroner’s office. All four overdose deaths in Highland from 2016 and 2017 were a result of fentanyl or a fentanyl mixture.
“That is the kind of stuff you are dealing with these days — exceptionally, exceptionally powerful,” Wilson said.
The most common path to addiction
It is estimated that 80 percent of people who use heroin first misused prescription opioids, according to the National Institute on Drug Abuse.
Though drugs like Vicodin or OxyContin can treat severe pain, the strength and duration of those prescriptions can lead to a higher likelihood of addiction. And, for years, scripts have been written in large numbers.
According to the Illinois Prescription Monitoring Program, a federal tool used by healthcare providers to track and monitor prescription use and abuse, Madison County residents were issued 92,042 prescriptions for Schedule II drugs in 2017. Those are of drugs classified by the DEA “as having high potential for abuse, with use potentially leading to severe psychological or physical dependence.” Those prescriptions equaled about 7.29 million doses — enough for about 27 pills per Madison County resident.
That deluge of pills means they often fall into the wrong hands. Athmer said Highland officers have arrested children as young as 13 to 15 years old with drugs they have stolen from their parents or grandparents.
Doctors bring opioid battle to emergency rooms
Dr. Loren Hughes, president of HSHS Medical Group, which operates St. Elizabeth’s Hospital in O’Fallon and St. Joseph’s Hospital in Highland, said doctors are starting to change their philosophies.
Treating chronic pain, or pain that lasts for more than three months, with an opioid is highly discouraged in emergency rooms, said Hughes, a longtime emergency room medical director for HSHS in the metro-east.
“ER providers are encouraged to use non-opioid pain meds, consider referral to pain management, and recommend alternative modes of treatment such as yoga and therapy in lieu of opioid medications,” said Hughes.
But even if a doctor prescribes an opioid, the prescription will only last for a few days and never more than a week, Shaffer said. It is also best practice to check the patient’s prescriptions against the IPMP database, as well, he added.
Regardless, chronic pain is best treated by the patient’s primary care doctor, Shaffer said.
“When patients complain of chronic pain we address their immediate complaint as best as possible with non-opioid methods such as Tylenol, NSAIDS (anti-inflammatory drug), or muscle relaxers and ask them to follow up with their primary care physicians for further care,” Shaffer said.
When it comes to acute pain, most patients can be treated without opioids, Shaffer said. Traumatic injuries might warrant an opioid prescription, but doctors evaluate and risks and benefits of such a prescription before handing it out.
The search for a solution
The crisis has no easy answers — at least none anyone has found. But Highland leaders continue to try.
The city of Highland recently paired with Southern Illinois University Edwardsville for the launch of the school’s “Successful Communities Collaborative.” Through the program, SIUE students are helping to develop drug abuse programing and prevention methods for the city and schools. Their final is planned for the end of May.
The city also participates in the Partnership For Drug-Free Communities, a regional coalition of community leaders working together to address substance abuse issues in the bi-state area.
Highland is partnering with Chestnut Health Systems to create a list of resources offered regionally.
However, there have also been local initiatives. Education seems to be the closest thing to a cure.
Highland Police have presented several programs in the schools and to community groups, including showing the locally produced film, “The Heroin Project.”
“All of these are done to try to engage the community, because without their assistance in recognizing the issue and developing a plan to combat it, we can not be successful,” said Athmer, the HPD sergeant.
Wilson, the EMS chief, has organized a family support group that meets on the second and fourth Wednesday of every Weinheimer Community Center, located at 1100 Main St. in Highland. Meetings are held on the second floor and begin at 6:30 p.m.
“All I can say is, families who have this kind of problem in their family, it is extremely important for the family to get support,” Wilson said.