Theresa Arnold can’t imagine a world without naloxone, a world where her daughter doesn’t survive.
The Springfield resident watched as her daughter was revived after overdosing on opioids in front of her while seeking treatment at a local clinic in January — the second time she had overdosed in three days. Without the revival drug commonly known as Narcan, Arnold’s world is one without her daughter.
“My daughter is still here because of it,” Arnold said.
The demand for Narcan has jumped as overdoses have escalated this year. Clark County officials say they will continue to use Narcan to reverse the effects of opioid overdoses, despite objections from some community members who believe the drug is being used too much.
The Springfield Fire/Rescue Division has used more 3,400 doses of Narcan in the past 10 years to revive people who have overdosed on opioids. As of March 13, the division has used more than 540 doses of Narcan this year — more than half of the 776 doses used in all of last year, Chief Nick Heimlich said.
McKinley Hall has seen too many people who have been revived with Narcan turn their lives around to ever consider stop using the life-saving drug, Chief Executive Officer Wendy Doolittle said. About 30 percent of people who have been revived with Narcan are in treatment and doing well, she said.
“We would never stop using it,” she said. “It is effective for many people.”
Yet many people believe addicts are abusing it — especially commenters on online stories. A few Springfield residents have also expressed concerns about its use to city commissioners, who discussed the issue at its annual retreat earlier this year.
Springfield resident Shelley Caceres told the Springfield News-Sun she believes too much Narcan is being used to revive people, especially those who receive up to six doses and aren’t arrested.
“They’re back out here on the streets the next day doing the same thing and you’re going back and doing it all over again,” she said. “You’re taking away from people who actually need help. The squad can’t get to the people who actually need help because they’re too busy aiding these drug addicts.”
The epidemic affects all walks of life, including the mother of three with Vicodin prescriptions for back pain who later turns to heroin to ease her addiction, said state Rep. Kyle Koehler.
“For some people, it’s easy to say, ‘Let ’em die,’” the Springfield Republican said. “Until it’s your granddaughter or your niece of your granddaughter …We can’t make that decision. We have to be about helping them as much as we can.”
2,200 lives saved
Ohio spent nearly $1 billion last year to battle the drug epidemic, according to the Ohio Department of Mental Health and Addiction Services, including $650 million to county mental health facilities.
In 2015, more than 1,155 Ohioans died of fentanyl-related drug overdoses, including 73 in Clark County. At the same time, more than 19,000 doses of Narcan were administered statewide to reverse the effects of opioids. It typically takes more than one dose to revive a patient from an overdose.
The Clark County Sheriff’s Office administered 51 doses all of last year but has already used 40 doses this year, according to Lt. Brad Barnhart.
The Springfield Regional Medical Center spent about $13,000 on naloxone used by first responders, according to hospital officials. The Emergency Department treated more than 650 overdose patients last year for all types of drugs, including opioids, cocaine and methamphetamine.
The current cost of Narcan is about $75 for two doses, according to the Ohio Department of Mental Health and Addiction Services.
About $1 million over the past two years has been spent to make sure each Ohio county has access to Narcan kits, said Ohio MHAS spokesman Eric Wandersleben. Those kits have led to more than 2,200 lives saved, he said.
The Clark County Combined Health District received about $5,000 as part of the project, which is used to purchase kits for the Clark County Sheriff’s Office.
Project DAWN — short for Deaths Avoided With Naloxone — will distribute the Narcan kits to anyone to help save lives, said Kelly Binegar, who runs the program at McKinley Hall, as long as the person completes a short training.
The program — which received $24,000 from the Ohio Department of Health last year — has handed out more than 180 nasal Narcan kits since May of last year, including 60 this year. Each kit includes two doses.
About 14 lives have been saved using the kits provided to Clark County, Binegar said.
“We believe the actual reversal number is higher, but we are finding people are reluctant to self-disclose,” she said.
The Ohio Department of Health will spend up to $400,000 this year for high-risk areas, spokeswoman Melanie Amato said.
The kits are passed out to people with family members or friends who may need help in case of an overdose, Binegar said. Peer support specialists will also bring Narcan to people who have recently overdosed, hoping to educate others in the home on how to use it.
Some people have received kits to help others who may have overdosed in a public setting, like a fast food restaurant, grocery stores and businesses.
“It saves lives,” Binegar said.
State lawmakers recently agreed to use $11.5 million to create drug courts to treat people not like criminals, but as addicts, Koehler said. Clark County needs a drug court to help prosecutors provide resources for addicts, he said. Koehler also voted for medical marijuana in Ohio because he believes it might help people ease their pain and avoid prescription opioids.
“I don’t like people using either of those drugs, if possible,” Koehler said, “but if you’re saying people can use an oil and not get hooked on heroin, by gosh, we better try that and that’s what we’re working towards at the state level.”
Doolittle no longer reads the online comments made about Narcan usage, but has heard the other side for many years.
“To me, they’re uneducated about the brain and how addiction works,” Doolittle said. “I’m not angry with them because they just don’t know what they’re talking about. It happens all over the United States.”
McKinley Hall often sees younger people who choose to start using cigarettes and alcohol later progress into other drugs, such as marijuana. Those who are pre-disposed to addiction are the ones who’ll they see later, Dolittle said.
“We’re judging people whose brain chemistry is completely out of whack,” she said. “We’re judging them because we’re looking at their behavior.”
Prevention measures and addiction education must be strengthened, Doolittle said, both at schools and in the community.
“To be having this conversation in 2017 where people still don’t understand addiction and the brain, it’s now scary,” she said. “I hear some pretty educated people still confused about how the brain works and this disease.
“It’s just scary when I hear comments of people saying ‘We’re wasting money saving lives’,” Doolittle said. “I can assure you the person who’s saying that, if it’s their kid, they’re not going to be saying that.”
The effectiveness of treatment would increase, Doolittle said, if there were more places for people to detox after being revived with Narcan.
“When you use Narcan and you throw somebody into a withdrawal, they’re sick,” she said. “If you can’t do anything at that point, then that person is just going to go back and use again because they’re sick. We have a gap here in the community when it comes to what you do after someone has had Narcan. There’s a huge gap here.”
‘Like its candy’
Caceres said she has to fight with insurance companies to get insulin for her mother and an EpiPen for her daughter, “but they’re giving Narcan to these people like it’s candy.”
She believes overdose patients revived with Narcan should be charged and sent to jail, similar to what’s taking place in Washington Court House, she said. The Fayette County city has started charging people who receive Narcan with inducing panic.
“Make them be responsible,” Caceres said. “Taxpayers should not have to foot the bill for them … I understand saving someone’s life, but you can’t save a life if they don’t want to be saved.”
The debate raged online last week with hundreds of comments on a post from the Springfield News-Sun asking about Narcan use in the popular Springfield, Ohio Crime Monitor Facebook group, which has more nearly 4,000 members. The page is dedicated to following crime news in Clark County.
Some Facebook commenters called Narcan a safety net for users, while others said addiction isn’t a disease but a choice.
Many of the commenters, including Springfield resident Denise Price, believe the drug should be used on patients, but not six or seven doses at one time. If revived, she said they should also be taken to jail.
“When they’re getting five or six doses of this, that’s becoming a problem,” Price said. “There are some people who don’t OD as much as others do. Narcan is helping, but it doesn’t help everyone.”
A friend’s daughter recently passed away from an overdose, Caceres said. However, she doesn’t believe she’d feel differently if it happened to someone in her family.
“You cannot help those who do not want to be helped,” she said. “You need to help the people who want the help and actually will do something to turn their life around.”
‘I’m going to die’
Arnold’s daughter grew up involved in sports and was always at the top of her class, she said.
“I did everything I thought I should do as a parent to make sure she was successful,” Arnold said.
Two-and-a-half years ago, things didn’t seem right with her daughter, she said. After her longtime boyfriend was murdered, she said her daughter began using drugs and was in and out of shelters.
“It got to the point where I could no longer have her in my home just because I have other children in the home,” Arnold said. “As a parent, you always want to take care of them. It was really difficult for me.”
In January, Arnold’s daughter overdosed at her father’s house and was revived with Narcan. She was transported to the Emergency Department and later admitted to a shelter. The hospital provided referrals to local treatment centers but Arnold said both had waiting lists.
MORE LOCAL STORIES: Read the latest news from Michael Cooper
“She needed help right then,” Arnold said. “She told me ‘If I go back on the streets, I’m going to die.’”
The next day, while seeking treatment at the Rocking Horse Center, Arnold’s daughter overdosed again — right in front of her mother. After going to the bathroom, Arnold came back and within a few minutes, turned completely blue and lifeless.
Rocking Horse personnel gave her daughter Narcan, then first responders used it again once they arrived on scene.
“I can’t even begin to explain that situation,” Arnold said. “To watch your child turn blue, have the life taken out of her right in front of you.”
After the second overdose, Arnold’s daughter asked for help. A few days later, she was in treatment.
Her daughter will have a 20-percent chance to fully recover, Arnold said. Without the Narcan, however, her daughter wouldn’t be here today.
She didn’t share anything about her daughter’s struggle for a long time, Arnold said. Eventually she joined the Dayton Family of Addicts support group, which now has a Springfield chapter that meets weekly at 6:30 p.m. Tuesday at the Mulberry Terrace Apartments, 120 W. Mulberry St.
Now Arnold uses Facebook to educate others about addiction but will often read negative comments about addicts online. Even though her daughter is in treatment, Arnold carries a Narcan kit in her purse in case she needs to revive someone in public.
“Can we put a price on human life?” Arnold said. “I pray for the individuals who make those comments that it never happens to them … We’re a middle-class family. I thought I did everything I could do as a parent. I never thought this could be our life.”
‘It’s what we’re going to do’
First responders swear to a medical oath to save those in life-threatening moments, regardless of the situation, said Heimlich, the Springfield fire chief.
“It’s our role and our function,” Heimlich said. “It’s what we’re going to do.”
Narcan has been in drug bags used by medics since Heimlich began his career with the fire division in 1987. Recently it has become a hot topic because they’re frustrated with the problem, Heimlich said.
“Some look for a compassionate solution and others don’t want to have to worry about it,” he said. “They don’t want to be responsible for it.”
The missing piece in the equation is that addicts aren’t able to get the services they need once they’re revived, Heimlich said. Many addicts often refuse treatment, and when others try to get help, resources or money may not be available to help them, he said.
“The system is like a gang plank (on a boat),” Heimlich said. “You’re just walking off the end of the plank because we’re not getting to where we need to be. That’s our problem.”
FIVE NEWS-SUN MUST READS
What is naloxone?
Naloxone, also known by the brand name Narcan, is a medication that can reverse an overdose caused by an opioid drug (heroin or prescription pain medications). When administered during an overdose, naloxone blocks the effects of opioids on the brain and quickly restores breathing. Naloxone has been used safely by medical professionals for more than 40 years.
If naloxone is given to a person who is not experiencing an opioid overdose, it is harmless. If naloxone is administered to a person who is dependent on opioids, it will produce withdrawal symptoms. Withdrawal, although uncomfortable, is not life-threatening. Naloxone does not reverse overdoses that are caused by non-opioid drugs, such as cocaine, benzodiazepines (e.g. Xanex, Klonopin and Valium), methamphetamines or alcohol.
Naloxone must be administered by a third-party because the overdose victim is unconscious or otherwise incapable of administering the medication personally. Due to a 2015 change in Ohio law, a pharmacist or pharmacy intern under the direct supervision of a pharmacist can dispense naloxone without a prescription.
Recognizing an overdose
If someone takes more opioids than their body can handle, they can pass out, stop breathing and die. An opioid overdose can take minutes or even hours to occur.
A person who is experiencing an overdose may have the following symptoms:
Slow breathing (less than 1 breath every 5 seconds) or no breathing.
Face is pale and clammy.
Blue lips, fingernails or toenails.
Slow, erratic, or no pulse.
Snoring or gurgling noises while asleep or nodding out.
No response when you yell the person’s name or rub the middle of their chest with your knuckles.
How to respond to an overdose
1. Try to wake the person up by yelling their name and rubbing the middle of their chest with your knuckles (sternum rub).
2. Call 9-1-1. Indicate the person has stopped breathing or is struggling to breathe.
3. Make sure nothing is in the person’s mouth that could be blocking their breathing. If breathing has stopped or is very slow, begin rescue breathing.
Step 1: Tilt their head back, lift chin, pinch nose shut.
Step 2: Give 1 slow breath every 5 seconds. Blow enough air into their lungs to make their chest rise.
4. Use naloxone and continue rescue breathing at one breath every 5 seconds.
5. If the person begins to breathe on their own, put them on their side so they do not choke on their vomit. Continue to monitor their breathing and perform rescue breathing if respirations are below 10 breaths a minute. If vomiting occurs, manually clear their mouth and nose.
6. Stay with the person until EMS arrives.
Source: State of Ohio Board of Pharmacy, Ohio Department of Mental Health and Addiction Services
About this series: Springfield’s Opioid War
The Springfield News-Sun has written extensively about opioid and heroin problems in Clark County in the past five years, including stories about multiple overdoses in one weekend and efforts to expand treatment options. This year, the News-Sun will take a deep dive into the community’s opioid epidemic and what local officials are doing to solve the problem.
By the number
3,468: Doses of Narcan administered by the Springfield Fire/Rescue Division since 2007.
776: Doses of Narcan administered by the division in 2016.
540: The number of Narcan doses administered this year as of March 13.
$13,000: The amount of money spent on Narcan by the Springfield Regional Medical Center’s emergency department last year.