Editor’s Note: These remarks were originally delivered by Stephen Leffler, MD, at the UVM Medical Center’s Community Rounds Program in June 2014.
Our state is confronting what can only be described as an epidemic of heroin and prescription drug abuse. No question, this is a tough subject – but I’m glad to shed some light on it from the physician’s perspective.
First a little history: When I was a medical student at the Larner College of Medicine at UVM, I never saw or treated a heroin overdose. We learned about how to treat them and considered it a big city problem. For a Vermont kid it was like learning about malaria. Drug use was something that was talked about in the context of major urban areas, like New York City. I believe I may have seen one person accidentally take a bit too much of her pain medicine and everyone gathered to witness how the reversal medicine worked.
It was a different story entirely during my residency in Albuquerque, New Mexico. We saw two or three drug overdose patients daily. Heroin was common and we managed overdose and heroin complications on a daily basis. When I left New Mexico to come home, I believed I was leaving the stage of my career where heroin was a part of every ED shift. When I returned to Vermont, as an Emergency Department physician, drug overdoses were still very uncommon.
Things have changed: Today, heroin and prescription drug abuse are problems that are part of daily life here in Vermont. It’s on your block; in your neighborhood; it’s in your kids’ schools. Every day, you pass people on the street who are addicted to opiates and who are one mistake away from an overdose.
In our Emergency Department, on some busy days we see more overdose patients than victims of car crashes.
Recently, the local press reported that the UVM Medical Center saw eight overdose patients in a single night. The supply of opiates is not pure, and it isn’t mixed by a pharmacist. Something had been added to the supply and it was nearly killing people who took it believing it was what they were used to. at the UVM Medical Center that day, we saw more drug overdoses than any other complaint. One patient ended up in the ICU, but fortunately no one died.
On any given day in Vermont, emergency care providers also see the many other effects of opiate abuse – serious, lifelong infections such as Hepatitis C; abscesses; the destruction of every available vein in a person’s body; the addiction of unborn children.
In many respects, this is one of the hardest health issues emergency providers face. In the ED, we’re trained to take care of acute problems – a broken ankle, a cut that requires stitches; a heart attack. We are trained to help restore people and return them to the world, confident that they will heal and get the support they need.
There is no confidence with drug addicts.
Instead, after we revive them, we make them stay 4-6 hours in the ED. Once we determine that they’re safe, we release them, with little certainty about what the world will do for them. The support services that we currently have out there are so limited that the wait times alone can cause people to slip back into the situations that brought them to us. So, we release them, knowing that there’s a good chance these patients will be back – or worse.
There is some good news, here in Vermont and around the country. Recent attention to this issue has raised alarm, galvanizing us into action. We’re rolling out a program to expand treatment programs and funnel addicted people into them instead of sending them to prison, a program that is already being embraced as a national model. In Chittenden County, we have a program that screens individuals who have been arrested, allowing non-violent people to avoid jail time.
We are also addressing the front end of the problem – the role of prescription drug use, which got a lot of these people hooked in the first place.
We are working hard to decrease the amount of prescription narcotics out there, raise awareness among physicians, build protocols for our chronic pain patients, and share that information across the state. We have set a maximum dose for narcotics patients with chronic pain. We’re among the first in the nation to do this hard work.
We are working on solutions. But, make no mistake. Now that the problem is here, in our communities, we cannot be complacent with these initial efforts. We in health care must continue to ensure that we don’t start people on the path to addiction; and, as a society, we must work together, to help restore these individuals to the lives they deserve – and, in the process, restoring our beautiful state, to be free of these dangerous drugs that are killing Vermonters and leading our friends, neighbors and even children into addiction.
Stephen M. Leffler, MD, is the Chief Medical Officer at the UVM Medical Center, former Medical Director of the Emergency Department, and has been a practicing physician for 20 years. He grew up in Brandon, VT.