The five recent heroin overdoses in Presque Isle resulted in one death, and renewed local interest in addressing drug addiction.
Within the span of four hours Dec. 27, five people experienced apparent overdoses from what the Presque Isle Police Department said could have been an especially potent source of heroin, which the Maine Drug Enforcement Agency is now investigating.
Responding to overdoses and administering the treatment naloxone are something many emergency medical responders and hospitals are familiar with, said Daryl Boucher, director of patient care services at The Aroostook Medical Center.
TAMC and its Crown Emergency Care have long treated people who’ve overdosed on prescription narcotics, heroin, methamphetamine, bath salts, cocaine and alcohol, Boucher said.
The recent problem of heroin and prescription opioids have prompted Crown Ambulance and all EMS providers around the state to carry naloxone, also known by the brand name Narcan. The drug is an opioid antagonist, and can reverse the effects of opioids while bringing on “horrific withdrawal symptoms” for individuals with chronic opioid addiction.
“Narcan is short acting and often times narcotics are longer acting, and outlast Narcan’s effects in some cases.” In those cases, the overdose symptoms can return, including the respiratory system shutdown, low blood pressure and heart failure, Boucher said.
The EMS protocols followed at TAMC and elsewhere require individuals who are given naloxone to be taken to a hospital to be observed or for further treatment.
“It depends on how they respond,” Boucher said. “We don’t know the potency or composition of the substances. It’s not unusual to have multiple substances that have been injected.”
Few police departments in northern Maine carry naloxone, in part because emergency service providers are needed to transport overdose patients to a hospital, and in many areas without police departments, EMS are often their first to arrive on the scene.
There are also issues of cost for carrying naloxone and health issues for the individual, including if naloxone is administered by a family member or other lay people, because “that person needs to be transported to hospital,” Boucher said.
The issue of substance abuse broadly, particularly opioids, has been a challenge for health care providers.
“Narcotic use doesn’t discriminate,” Boucher said. “It goes across all socioeconomic classes. We have people who are insured and uninsured and provide care to all, whether they pay.”
Deaths from drug overdoses in Maine now exceed deaths from motor vehicle accidents, with more than 280 overdose deaths through September of 2016, according to Maine’s Office of the Attorney General.
Hospitals aren’t required to report information about overdoses and overdose deaths, as they are for medical issues like certain infections, and that can make it difficult to know exactly how many overdoses occur in Aroostook County or how often naloxone is administered.
“Some areas we do really well with reporting, and those have been federally mandated based on quality metrics,” Boucher said. “Those medical data are ahead of mental health and substance abuse.”
Long-term treatment options for drug addiction are not consistent and there is a particular need for acute drug detox and mental health rehabilitation.
Local behavioral health providers like Aroostook Mental Health Center and Life By Design offer those addicted to opioids therapy and medications that help taper off withdrawal symptoms. The two opioid addiction medications available in Aroostook County are Suboxone, an opioid replacement, and Vivitrol, a medication for alcohol and opioid addiction that blocks the effects of opioids.
Methadone, a stronger opioid replacement medication with a higher risk for abuse, is not available in Aroostook County.
“We need to figure out as a community how we’re going to confront this and work towards a solution,” said Pete McCorison, director of behavioral health services at Aroostook Mental Health Center. “We have to look at prevention, law enforcement, treatment and recovery.”
