Reb Close remembers the call. It was a Code 3, the most urgent call a hospital emergency room can get, and it was Code 3 pediatrics, meaning that particular emergency involved a child. The ambulance rolled up and paramedics rolled in a gurney bearing what Close calls “a beautiful little man,” a boy of about 18 months old. And the work began in earnest.
“They got his heart back and we were working on him and doing anything we could, and I realized he wasn’t responding,” says Close, an emergency room doctor at Community Hospital of the Monterey Peninsula. “And then we got the CT scan of his brain.”
A normal brain, she says, is beautifully colorful, representing all of the activity that makes a brain function. The beautiful little man’s brain, though, looked like it had been painted over. It was dark and devoid of life.
“And I thought, ‘No, no, no, I don’t accept this,’” Close says.
The beautiful little man’s brain was gone. He died of an opioid overdose after ingesting pain pills.
From beautiful babies who ingest medication to senior citizens who accidentally take one too many pills to teenagers with sports injuries who start using medication for legitimate reasons, then find they can’t function without it, we are a nation gripped by opioids.
More than 2 million of the 20.5 million Americans ages 12 and over who had a substance abuse disorder in 2015 were addicted to prescription painkillers, while another 591,000 had a substance abuse disorder involving heroin, according to the American Society of Addiction Medicine. The same year saw 20,101 overdose deaths related to prescription pain relievers, and 12,990 deaths related to heroin.
According to the association, in 2012 doctors wrote 259 million prescriptions for opioids – “more than enough to give every American adult their own bottle of pills” – and four out of five heroin users started out misusing prescription painkillers.
In Monterey County, doctors wrote 215,649 prescriptions for opioids in 2017, and 37 people sought emergency room care for opioid (excluding heroin) overdoses. Seven people died that year from opioid overdose.
To combat the problem, Community Human Services, Natividad Foundation and Montage Health are offering free training and free Narcan kits to county residents. Participants can attend one of two upcoming trainings and learn to recognize and respond to an opioid overdose and how to administer nasal naloxone, better known as Narcan, which can help reverse the effects of an overdose.
Close and her husband, CHOMP ER medical director Casey Grover, have seen the number of drug-related ER visits rise. And at Community Human Services, CEO Robin McCrae has also seen the number of admissions for opioid-use disorder grow. CHS wrote a grant to the State Department of Healthcare Services for $30,000 to fund the Narcan program, in which 360 Narcan kits will be distributed. Close and Grover will present, along with CHS Medical Director Edgar Castellanos, MD, and Natividad physician Christina Zaro.
“For many years we had a graying population of adults primarily seeking services for heroin addiction, and now they’re getting younger and younger, and typically it started with pain medication,” McCrae says. “The route to addiction is different for everyone.”
Close finds that when she mentions Narcan to patients, there’s stigma attached to the life-saving countermeasure.
“The first concern many people have is, ‘I’m not one of those people. I never overuse my medication,’” she says. So when she talks about Narcan, she puts it in terms people can understand, like seat belts or fire extinguishers. “I put it into normalcy. I talk about fire extinguishers. You don’t say, ‘I’m not going to burn my house down, I don’t need one.’”
Any physician can write a prescription for a Narcan kit, but the cost can be prohibitive. One patient told Close her insurance wanted to charge her $300. The free distribution is a great opportunity to avoid that cost, with the potential to save lives.
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