Nar-can-do?

What can cities do about repeat overdoses?

Artwork: Jed Helmers

By Sarah Sidlow

Quick quiz: What’s the best way to solve a city’s drug epidemic? Jail time? Rehab? How about good old fashioned tough love?

In Middletown, Ohio, a town overcome by drug overdose emergencies, that question is a tough one to answer. One Middletown City Council member, Dan Picard, has proposed a three-strike penalty system against opioid overdose cases. That means that EMS would not respond to an overdose victim who has required two prior interventions.

Harsh? Maybe. But Picard and other supporters argue that for multiple offenders, jail isn’t the solution—it’s part of the problem. They argue that multiple repeat overdoses strain the city budget and block up the city jail and court systems. And if overdose victims leave children behind, the emotional and financial strain on the community only increases.

Emergency responders carry Narcan to revive overdose victims. This year, Middletown will foot the bill for about $100,000 worth of Narcan—about 10 times what the city budgeted.

The real issue, though, is that the problem keeps getting worse. And legislators are desperate for a solution. (Not-so-fun-fact: one Dayton man has received Narcan treatment 20 times for heroin overdoses.) Many believe the epidemic is due in part to the fact that addicts know that in places like Middletown they can receive Narcan treatment in case of an overdose, so they feel “safer” using drugs.

But Picard wants to send a different message. “I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life,” he said. “We need to put a fear about overdosing in Middletown.”

An investigation is underway to find out whether a city is legally obligated to revive repeat victims.

Perhaps unsurprisingly, the city has received hate mail related to Picard’s claim.

According to City Manager Douglas Adkins, the state’s Good Samaritan law prohibits police from arresting people onsite for opioid-related activity. This is meant to encourage people to report overdoses.

Others argue that no matter the cost of the resources (or the familiarity of the victim) it’s an emergency responder’s job to, like, respond to emergencies. The oath to “do no harm,” they say, doesn’t come with a caveat or a bandwidth restriction. Moreover, many consider addiction to be a disease. Does that mean punishing an addict for a third overdose is equivalent to punishing a cancer patient for a third relapse?

Dayton Police Major Brian Johns put it a different way: “If I’m obese and I go have McDonald’s once a week and eat cheeseburgers, are you not going to do CPR on me because I have poor dietary habits?”

Overdose victims are just that—victims, many argue, and aside from that they’re also human beings. Even if they’ve fallen off the right track, it’s our job as a community to support them.

Another not-so-fun-fact: Fentanyl and similar opiates are responsible for 372 overdose deaths in Montgomery County through May 2017. That’s already higher than 2016’s total of 349.

Reach Dayton City Paper forum moderator
Sarah Sidlow at SarahSidlow@DaytonCityPaper.com.


Emergency, not death squads

First responders signed a contract

By Tim Walker

The opioid crisis worsens, and madness ensues. The clocks are ticking, my friends, and the shadows grow ever longer.

Imagine this scenario: you’re leaving your home, and as you open your front door you see someone unconscious, lying in a neighbor’s front yard near the street. Being the Good Samaritan that you are, you rush over to help this unknown fellow human being, who is experiencing some sort of medical emergency. As you kneel beside the person, hands shaking from fright, you take out your cell phone and desperately call 911. You hear sirens almost immediately—thank God, a policeman just happened to be nearby. This poor person’s life is at stake, and every second surely counts.

The black patrol car rolls up and stops, sending gravel flying, and an officer quickly exits the car and approaches the form on the ground next to you. Then things begin to get weird. The officer, losing his sense of urgency, rolls the figure onto his back, looks at him, then you, and shakes his head. “Overdose,” he says to you. “I know this guy well—he’s a heroin addict. Lives right up the street. But he’s reached his limit on Narcan… there’s nothing I can do but call a squad.”

Excuse me? Wait a minute… what? This is still the United States, isn’t it? That bright and shining example for the rest of the world? Since when do first responders make snap judgments about saving an individual’s life based on the amount of medical treatment he or she has received in the past? How is this even possible? How did we reach this point?

Middletown City Council member Dan Picard recently proposed a three-strikes penalty, suggesting that EMS should not even respond to any overdose victim who has required two previous interventions. “I want to send a message to the world that you don’t want to come to Middletown to overdose, because someone might not come with Narcan and save your life,” Picard told his local newspaper. “We need to put a fear about overdosing in Middletown.”

Not to be outdone, Butler County Sheriff Richard Jones, in an interview with NBC News a few weeks later, also earned national headlines when he reiterated his policy that his deputies will continue not to carry naloxone, or Narcan, the often-used opioid overdose treatment that has saved countless lives. “All we’re doing is reviving them, we’re not curing them,” the unrepentant sheriff said during the interview. “There’s no law that says police officers have to carry Narcan. Until there is, we’re not going to use it.” Sheriff Jones cited cost and safety concerns as the reason for his anti-Narcan stance.

This is insanity. In Trump’s America, evidently, it has suddenly become acceptable behavior to simply stand around and let people die.

Let’s imagine other scenarios—similar ones, perhaps—ones in which a person’s poor judgment might result in a desperate need of medical attention, attention that will be denied based on the victim’s bad decisions. A guy goes out to get some wind therapy on his new motorcycle, and doesn’t wear a helmet. When a driver doesn’t see him and pulls out right in front of him, the resulting accident is horrific. Should the first responders who show up on the scene simply shake their heads and say, “Well, it’s his own fault, you know. We’re not going to treat him—he really should have been wearing a helmet.”

Or let’s say a man eats too much fast food, smokes, and has a sedentary lifestyle. All personal choices he has made over the course of his life, surely, but when the inevitably resulting heart attack cuts him down and he’s left lying on the floor clutching his chest, gasping, should our civil servants smile at him and say, “We’re sorry, sir—honestly, you did this to yourself and it serves you right. Should have cut back on the Big Macs. Addict.”

The debate goes on, and it will go on for decades, as to whether addiction is a brain disease, as so many specialists insist, or whether addictive behavior is simply a personal choice that addicts make. In the end, it doesn’t matter.

Every first responder’s duty demands that he or she try to save, with every tool at their disposal, the life of any human being they’ve been called on to help. It is a simple equation, and those heroes who answer that call, thank God, almost unanimously agree that—even when the person they’re saving is a multiple offender—they will still do their best to save that person. Praying, all the while I’m sure, that the person they’re saving will decide to use that gift of life, that second chance, to get the help they need and improve their life situation.

There’s something simple and correct, something human, about that contract. It is something our first responders do for the rest of us. Perhaps our politicians and county officials can learn something from it.

Tim Walker, 52, is a writer, DJ, and chili cook. He lives with his wife and their two children in Northridge, and you can read more of his work at StretchYourBrains.com. Reach him at TimWalker@DaytonCityPaper.com.


Opioid, schmopioid

It’s not an epidemic, they’re not victims

By Ron Kozar

If you intentionally crash your car into a tree, don’t call me for a tow. If you deliberately set fire to your own house, don’t ask me to put it out. And if you overdose on opioids, don’t expect me to come to your rescue.

Come to think of it, opioids aren’t even in the same moral category as the car and the house. Opioids are worse. For all I know, it may be legal to burn your house down. And, depending on where it is, crashing your car into a tree may be legal too. Opioids, by contrast, are against the law. Libertarians like me may want to make drugs legal, but my side lost that argument. And, legal or not, using opioids is just plain stupid. Compared to an opioid user, a man who punches himself in the face looks smart.

That’s why I roll my eyes and change the channel when hectored about this so-called epidemic. If you want to talk about an epidemic, talk about zika or bird flu. Opioid addiction comes from a decision, not a virus. No mosquito can infect you with opioid addiction, and you don’t need antibacterial soap to avoid catching it. To speak of it as an epidemic and to speak of addicts as victims is to stack the rhetorical deck for the view that addictions and overdoses are diseases rather than choices.

And that brings us to our debate question, namely whether EMTs should drop everything and come the rescue of repeat overdoses just as they do with heart attacks, strokes, and other ills that flesh is heir to. My answer? Not with my tax money you don’t. If you want to help an addict who OD’s, help him yourself. Keep public emergency services out of it. And if my cold-hearted attitude means that more opioid users die, my answer is a big, fat “so what.” If they don’t want to die, they shouldn’t abuse opioids. If an addict doesn’t care about his own life, why should I?

Spare me your sanctimonious flubarb about how every life is precious. Precious to whom? Those sentimental memes on Facebook are wrong; the death of some drug-addled wretch does not make all of us poorer. In fact, it probably has the opposite effect on everyone but the dead addict’s mother. The only exceptions are the truly innocent, such as the babies we read about lately whose monstrous parents ply them with opioids. Send the baby an ambulance by all means, and send me the bill. But the addict? He made his own bed. Let him lie, or die, in it.

Judgmental, you say? You betcha. Our society needs to be more judgmental. Your indulgence of the opioid addict makes the problem worse. It is because of people like you that there are so many people like him. Telling the addict he’s a jerk and turning your back on him, as I do, discourages not only him, but also any sober but temptable people who might be in earshot. Your alternative, which is to coddle the addict and pay for his care, is no disincentive at all.

You who tell us we have a duty to rescue every user, you who say we should give him a government program and pay a regiment of social workers for his benefit, you are the same people who portray the addict’s drug use as something other than a conscious decision. That portrayal assumes the addict to be less than free and, therefore, less than human. I, in my callousness, have more respect for his humanity than you do. In my moral universe, the addict is a free man who made a choice. In yours, he’s little better than one of B.F. Skinner’s pigeons, conditioned by chemicals and responding to bodily humors. For me, his own sovereign responsibility for his every act is an unshakeable moral axiom. For you, his blamelessness is the only axiom, an axiom that denies any code of morality and leaves room only for sentimentality. In my view, he might overcome his woes by sheer, heroic will, as only Man can do. In yours, he can never be more than a clever primate. Talk of “sheer will” just makes you laugh.

In framing this debate, the City Paper calls my approach “tough love,” but I do not love addicts. The issue with opioid addiction, as with gambling, alcohol, and all the other addictions on our spoiled culture’s ever-lengthening list, is one not of love but of respect. If you tell people they’re sick and need a pill, then that’s how they will live. If you keep treating addictions as epidemics, and you keep calling addicts victims, then be ready for a lot more “epidemics” and a lot more “victims.”

Save our EMTs for real victims of real diseases.

Ron Kozar is a lawyer in Dayton. Reach him at RonKozar@DaytonCityPaper.com.

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Sarah Sidlow
Reach DCP editor Sarah Sidlow at SarahSidlow@DaytonCityPaper.com.

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