Mt. Lebanon Police Officer Thomas Rutowski got the call from 911 dispatch—a possible drug overdose. He was alone in his patrol car and showed up at the woman’s home, where two other people were waiting, one of them completely freaking out and the other attempting CPR on the victim. Rutowski had his Narcan nasal spray kit ready as he approached the body, on the floor in the living room.
First things first, he thought. “Scene safety. Where’s the needle?” he mused as he looked around for anything that could stick him. He saw nothing but the patient.
A. B. C. Airway. Breathing. Circulation. Two strikes for the first two. She was blue.
Rutowski pulled out the Narcan and squirted once into each of her nostrils. As he waited the few minutes for the medicine to reverse the effect of the opioid, he hooked her up to an automated external defibrillator to jump start her heart. He asked the others what had happened.
“Lying to us doesn’t help,” he says. Before he could shock her, she started to breathe. Within two minutes of his arrival, the ambulance crew arrived. Within five minutes, she was talking and refusing transport to the hospital.
So far, that’s how many people Mt. Lebanon police and fire officers have saved from drug overdoses with Narcan since last summer. (And that number is an increase from just a few weeks ago when the print edition of this story came out.) Rutowski has had three of those saves, which earned him a Life Saver award from the department.
Heroin and prescription drug overdoses are the number one cause of injury deaths in the country—killing more people than car accidents or guns, according to the U.S. Drug Enforcement Agency. More people in Allegheny County die of ODs each year than from traffic accidents and homicides combined. Last year, Mt. Lebanon had 16 reported overdoses of illegal drugs, 12 of them from heroin. Two people died. As of mid-April this year, we have had four calls.
Police and medics say patients range from teens to senior citizens. Every demographic. Every kind of Mt. Lebanon neighborhood. No specific time of day or year. Any time. Any day.
Narcan (naloxone) reverses overdoses of opioids of any kind: Street-level heroin taken recreationally; an accidental double dose of a pain killer taken by a woozy patient after surgery; a second fentanyl patch applied by a forgetful person who did not remove the first one, or a tablet ingested by an overly curious child. Naloxone typically works within two to eight minutes, and although it does not remove the opioid from the body, it blocks the high and allows for normal breathing, saving the person’s life. If it’s given to someone who is unconscious for other reasons, it won’t help but it does not cause harm. When patients awaken, they aren’t high, but they’re often furious.
Mt. Lebanon police and fire officers received training and started carrying the nasal spray version of naloxone in June 2015, after a 2014 Pennsylvania law allowed first responders to use it. “I think the program is going great, and it definitely is saving lives,” says Deputy Police Chief Michael Gallagher.
The same law also made it legal for friends and family members to get the medication over the counter at pharmacies and made them immune from prosecution for drug offenses for reporting the OD. The public can get a prescription for naloxone from a doctor or receive it directly from a pharmacist, using the state’s standing order, for about $65. Or people can receive naloxone kits and training free every Sunday from noon to 3 p.m. at the nonprofit Prevention Point Pittsburgh, 3441 Forbes Avenue in Oakland.
The health offices of all Mt. Lebanon schools, and the athletic office of the high school, now have naloxone, with trained principals, nurses and administrators the only authorized users of it. In April, Superintendent Tim Steinhauer sent a letter to parents explaining the school’s policy and procedures.
Medical Rescue Team South Authority, which responds to all Mt. Lebanon medical calls, has been using naloxone for at least 30 years in several forms, from intravenous dosage to nasal spray to intramuscular injection. MRTSA staff originally thought the police and fire wouldn’t need to use it much because the EMS response times are good. But sometimes police or fire arrives first, and even minutes help.
“Two minutes doesn’t sound like a big deal, but try holding your breath for two minutes,” says MRTSA Chief Todd Pritchard. “This has all been a game changer for us.”
Now, for the first time, ambulance crews are showing up at calls where the patient is alert because a family member has administered naloxone, and the crew is waved away with an “Everything’s fine.” Not seeking follow-up treatment could exacerbate the problem.
Patients who have taken naxalone should always go to the hospital to ensure they are stabilized and the medication doesn’t wear off, says Dave Kish, executive director of St. Clair Hospital’s emergency department. If the patient has used several types of opioids, including pills, the overdose can return once the pills kick in,
Patient consent is required for transport, however. To try to convince them to go to the hospital, EMS can connect to a medical command line, allowing patients to talk to a doctor who will advise them to come. Sometimes patients can be committed to the hospital for mental health issues, but there is no legal requirement that a rescued overdose victim be taken to the hospital, says Vernard Campbell, St. Clair Hospital’s pre hospital coordinator of emergency service.
“Our mission is to treat or assist in treating the victims. Once MRTSA arrives on scene, we relinquish care of the patient to them as they have a higher level of training,” Gallagher says, noting that OD victims are immune from drug charges related to the incident. “Our hope is that once the patient is transported to the hospital, the hospital staff provides some help or advice in dealing with the issue.”
At the St. Clair Hospital Emergency Department, post-overdose patients are offered a visit with the mental health nurse, who can help them access detox and rehab resources. “They do try to get the patient connected like that,” says Kish.
“The ERs are trying really hard to make a concerted effort more than before to get them into treatment,” says Lily Brindle, business development specialist at Greenbriar Treatment Center, which has an inpatient detox unit, inpatient rehabilitation and part-time care, as well as halfway houses. Once a patient leaves the hospital and the current crisis is over, however, the desire to seek treatment often goes away, she says.
“If you don’t get them [to rehab], they’re probably not going in until something else happens,” says Rutowski, who worked for years as the department’s undercover narcotics agent.
The best option for opioid addiction is three months of intensive treatment to fix the physical, psycho-social and spiritual aspects of the disease, Brindle says: “A session or two is not going to do it.”
Although the patient must participate in the cure, drug addiction is a disease, Brindle stresses. “You wouldn’t tell a family member with cancer, ‘Stop having the cancer. You’ll be fine,’ she says. “[Addicts] can’t just stop on their own.”
It’s hard work for the patient, and that’s if they can get in. Rehabs can be full. The patient may not have insurance or, when there is insurance, the co-pays can be high. Still, Brindle says, the main barrier to treatment is usually the patient’s refusal to participate, saying he or she can’t leave work or can’t leave the kids.
The rehab and detox beds at Greenbriar are often full, but they can usually get a patient in within a week, with the longest waits around three to four weeks.
Brindle says the most important step in the process is for family members to talk with the addict. Help him or her to recognize the behaviors related to the abuse, such as missing work, or not being able to function, rather than focusing on the drugs. Convincing the person to have an evaluation is the first step.
“If they follow the plan, rehab can really change their lives for them,” Brindle says. Rutowksi says he knows of a former addict who used 15 to 20 stamp bags of heroin a day, but received proper help and is clean.
District Judge Blaise Larotonda has seen many opioid addicts involved in crimes turn their lives around. “You just still can’t give up on them. The addiction is so powerful,” he says. “If Narcan can bring you back, hopefully, the family will get in gear and do what they need to do. I’ve seen quite a few people come back from heroin addiction who were almost dead.”
Rutowski’s blue woman called three days after her near death to ask about rehab. He gave her some information. A common referral source is re:solve Crisis Network, a 24-hour mental health intervention and stabilization network that has inpatient services as well as a mobile dispatch unit that will come to the patient if needed.
“We don’t have many options,” Rutowski says. “I think we have a bigger duty when it comes to getting them into rehab.”
Pritchard says medics are used to stabilizing patients and transferring them. But the changing nature of health care makes him think the EMS may be able to help steer patients in the right direction, even if patients refuse help at first.
“Maybe we do need to look at offering some sort of brochure as to where they could seek additional assistance,” he says. “If you save just one person…”