January 17, 2020
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Against a surge in Narcan use, a united call for more drug treatment options

BANGOR, Maine — Dylan Sherwood was overdosing, slumped over a kitchen table.

After shooting up heroin with a few friends around lunchtime on July 1, the 21-year-old man didn’t feel well. He sat down at the table in a Bangor apartment. His eyes closed, his mouth gaped open.

“Dylan, are you OK?” his friends asked. He didn’t answer.

“We started yelling and shaking him, and his color started to change,” said one of the people in the apartment who witnessed Sherwood’s overdose, who asked not to be named.

His breathing stopped. His skin turned a terrifying shade of gray, his lips faded to blue. He looked dead, according to his friends.

One of the people who lives at the apartment had two doses of nasal Narcan — or naloxone, a drug that reverses the effects of an opioid overdose — which she brought home from a visit to a drug rehabilitation center in Massachusetts.

No one in the apartment had used Narcan before. They didn’t want to call an ambulance because it meant police might get involved.

Sherwood’s friends frantically read the instructions on the naloxone packaging, following a few steps to assemble the device before spraying the mist up Sherwood’s nostrils.

The next 45 seconds were excruciating, Sherwood’s friends said. He “woke up,” his breathing resumed. One of his friends led him to the bathroom, where Sherwood spent the next half hour vomiting, drenched in sweat, with no recollection of what happened after he first sat down at the kitchen table.

“They were just crying and I was just sitting there next to the toilet wondering what just happened,” Sherwood said Wednesday, sitting in the same seat at the kitchen table where he almost died less than a week before. “I was like paper, I felt so vulnerable.”

The Narcan brought him back, but it hasn’t saved him. Sherwood said he has been using drugs since he was 12, and continues to use them even after they nearly cost him his life.

Ever growing

Over the Fourth of July weekend, Bangor police officers administered Narcan for the first time, reviving a pair of suspected overdose victims. The department recently put Narcan in officers’ patrol vehicles through a partnership with Penobscot Community Health Care.

But that fact falls woefully short of revealing the full scale and dangers of opioid abuse in the city. On that same Fourth of July weekend, Bangor’s paramedics gave Narcan to nine other people.

The number of overdoses appears to be growing quickly, according to Bangor Fire Department officials, who have had access to naloxone for years.

In 2012, Bangor Fire Department EMTs administered Narcan 18 times. The next year, 31. Then 38. Last year, EMTs used Narcan 57 times.

Halfway through 2016, the Bangor Fire Department has administered Narcan 58 times, already surpassing last year’s total. Fire Department officials say they expect they could administer it 100 times by the end of the year. They have a stockpile in a basement storage room.

It’s a problem that Bangor Fire Chief Thomas Higgins said other departments across the state and country are grappling with. He said departments in Portland, Sanford, Lewiston and more rural areas have all seen an upward trend.

Statewide, paramedics responded to 2,194 overdoses in Maine last year, according to Maine EMS and the Department of Public Safety. EMS crews administered naloxone 1,475 times. More than half of those naloxone uses, a total of 787, happened in York and Cumberland counties. Penobscot County accounted for 154.

Those numbers don’t account for administrations by police departments or hospitals. To date in 2016, the numbers are roughly on pace with last year, with 708 naloxone uses by EMS across the state.

An overdose of heroin or other opiates such as prescription painkillers and methadone can depress breathing and the body’s nervous system, leaving users unconscious. Naloxone restores breathing, allowing users to potentially survive an otherwise fatal overdose. Administered through a nasal spray or injection, naloxone does not provide a high. The medication carries risks, including sudden and violent withdrawal that can lead to vomiting and aspiration.

“We’re not the cure, we’re not the answer to this problem,” Higgins said, and neither is Narcan. “We’re transporting them to emergency rooms, and that’s not what they need. We don’t have enough beds and we don’t have enough treatment centers.”

Some overdose victims, after being revived, refuse medical care, fearing it will get them in trouble or prompt a deeper police investigation. That can be dangerous. Medical experts urge people who have been revived by Narcan to take a trip to the hospital afterward regardless of how they feel.

When Narcan wears off, there’s a chance that the person still could succumb to the toxic effects of the drugs they took. Additionally, if a person avoids the hospital, they may not have the opportunity to be set up with a caseworker or be referred to treatment programs that might help them.

Dennis Nadeau, Bangor’s assistant fire chief, said paramedics are seeing more overdose victims who may have used drugs only a few times.

First responders also see a lot of familiar faces, visiting addresses where people have overdosed repeatedly. Capt. Greg Hodge, who works with the EMS division, said EMTs administer Narcan nearly every week to someone they’ve given it to before.

Tip of the iceberg

Even the staggering numbers reported by Bangor Fire Department and EMS crews across the state don’t tell the full story, because for every overdose victim saved by first responders, many more people are struggling with their addictions in the privacy of their own homes.

“[EMTs] are just seeing the tip of the iceberg,” Hodge said.

Forty days ago, the Maine Health Equity Alliance started handing out free Narcan to people struggling with addiction, as well as their friends and family members.

As of Thursday, they had distributed 64 naloxone kits through the alliance’s offices in Bangor, Ellsworth and Machias. The Bangor location handed out 47 of those kits, according to Ross Hicks, the agency’s harm reduction coordinator.

“We had a big rush initially following the press we’ve gotten,” Hicks said Thursday. “It’s tapered off since.”

Hicks said eight people have called the agency to report that they had used their kits to successfully revive someone after an overdose. Seven of those uses were in Bangor. He says he’d like to think the rest of the kits aren’t being used because people aren’t overdosing.

“The ideal outcome is that people stay alive long enough to enter some sort of recovery,” Hicks said. “This has been a decades-long problem in the making, we just seem to be at the worst part of it.”

Waiting game

Narcan brought Sherwood back, but it hasn’t affected his addiction.

“I used the same heroin again later that night, the same stuff that [almost] killed me,” Sherwood said.

That is the weight of his illness.

The friends who witnessed Sherwood’s overdose and brought him back from the brink continue to abuse drugs as well. One of those friends says he has overdosed “more times than [he] can count,” but never to the point where he has required Narcan.

Critics of naloxone have argued that it encourages further drug abuse, acting as a safety net or a “get out of jail free” card. No study to date has linked availability of naloxone to an increase in drug abuse.

“Addicts hate withdrawal and live their lives in such a way as to prevent it,” said Mark Publicker, a Portland-based addiction treatment specialist. “Do heart patients continue to smoke because they know that they can be saved by CPR?”

When an addict receives naloxone, it reverses the effect of the opioid, leading to almost immediate withdrawal and crippling sickness. Many then seek another dose of drugs in order to help them feel “normal” again.

“The reason why heroin-addicted patients overdose repeatedly — and so need to be given Narcan — is because they don’t have access to treatment,” Publicker said. “If you continue to use heroin the likelihood of overdosing increases. The question of long-term health effects from naloxone administration is simple: It saves patients from death and it causes opiate withdrawal.”

Without treatment, those withdrawal symptoms will and do drive a person back to the substance that nearly cost them their lives.

Sherwood says he wants help for his addiction, but has struggled to find it. He doesn’t have insurance, and says that has hindered his efforts to get help he can afford. The best he can hope for is to be waitlisted, because most agencies in the area that provide addiction treatment services are at capacity.

Bangor’s three medication-assisted treatment centers are full. One of those clinics, Penobscot County Metro Treatment Center, is vying for an expansion from 300 to 500 patients in order to empty its lengthy waiting list. That proposal is likely to spark a contentious debate in the city, in part because Bangor clinics are licensed to treat the same number of clients as clinics in Portland, South Portland and Westbrook combined. No treatment centers are operating north of Bangor, making it essentially the sole regional hub in northern Maine, and forcing patients to travel long distances for treatment.

Even that wouldn’t be the answer for Sherwood. He doesn’t want methadone or Suboxone because they’re just another drug, he says. He’s had stretches of sobriety and treatment in the past, but his addiction continues to take hold. He wants a residential detox program that will set him up with the care and therapy he believes he’ll need to successfully get off drugs and start turning his life around.

There is a 10-bed social detox facility in the works for Bangor, one that wouldn’t use medication-assisted therapy, but it could be many months before that is ready to open its doors to people hoping to enter recovery. Demand will vastly exceed capacity. The Department of Health and Human Services said Friday that the final draft of that proposal has been passed off to the Department of Administrative and Financial Services for approval.

The idea for that center resulted from the work of the Community Health Leadership Board, a group of area medical professionals and addiction treatment specialists that have been organizing to try to find solutions to the region’s drug abuse crisis.

Meanwhile, Sherwood continues to abuse drugs. He said he’s fully aware of the risks he takes by feeding his addiction, but that Narcan’s availability isn’t a factor in his continued use.

“It’s so much more than that, because addicts don’t fear death,” Sherwood said. “Nothing stops this disease. Not fear of death, not prison, not the desolation, not family leaving — or staying and experiencing the pain. None of the decisions made while you’re using are logical.”

“Some people want to criticize Narcan,” Sherwood said. “Yes, I’m still an addict, I’m still using, but I’m still a brother, I’m still a son.”

BDN Enterprise Editor Jackie Farwell contributed to this report. Follow Nick McCrea on Twitter at @nmccrea213.

 



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