Md. EMS agency to leave naloxone with OD patients who refuse treatment

By Jeremy Arias
The Frederick News-Post

FREDERICK COUNTY, Md. — A new grant will help emergency medical personnel in Frederick County leave behind a lifesaving overdose reversal medication with overdose patients who refuse to go to a hospital.

The initiative will be rolled out as a pilot program in Frederick and eight other counties around the state once the Maryland Department of Health is able to put together a concrete list of guidelines for how it will work, said Dr. Barbara A. Brookmyer, the county’s health officer, announcing the program at a heroin consortium meeting in Winchester Hall on Wednesday.

“We’re hearing reports, over this past year, [of] increasing numbers of people refusing transport and it’s led to some ... frustration because of the concern that folks, if they’re not making it to the hospital, then they’re less likely to come in contact with a referral to one of our peer recovery support specialists,” Brookmyer said.

Naloxone, commonly marketed as Narcan, is already available without a prescription, and all county law enforcement officers and rescue personnel are trained and equipped with doses.

Doses of the drug are also given to overdose patients or their family members who agree to be taken to Frederick Memorial Hospital for treatment, but not all patients agree to be transported and EMTs were not previously allowed to leave the medication behind, Brookmyer said.

“It’s technically viewed as distribution of a medication, which, prior to this, was not an approved, authorized activity for them to do,” Brookmyer told the group of 17 heroin consortium members, including County Executive Jan Gardner, Sheriff Chuck Jenkins and others.

Referred to as the “leave behind” program, the new initiative serves as an added “harm reduction” tool to help first responders keep people alive and increase their chances to seek addiction recovery, said Tom Owens, the county’s fire and rescue chief.

“Really the basis of this program is the concern that an individual could refuse treatment, then overdose again and, if Narcan is not available, that overdose could be fatal,” Owens said.

As of April 30, the county was on pace to match recent years, with 124 opioid-related overdoses handled by law enforcement agencies this year, including 21 fatal overdoses, according to the sheriff’s office’s most recent totals.

The leave behind program drew some criticism from Jenkins, who said the prevalence of naloxone could lead to further gaps in his agency’s ability to track illegal opioid use.

“I’m just not sure that’s the right approach,” Jenkins said. “We’re leaving behind naloxone to basically say the next time you overdose, you self-administer or somebody else administers and you don’t report it? So I don’t see this as a real good strategy.”

Frederick police Capt. Patrick Grossman said he could sympathize with Jenkins’ concern, citing the importance of analyzing overdose data.

After each reported overdose, drug detectives try to interview victims to gain valuable information that could help them make arrests. Follow-ups can also help guide people with an addiction toward recovery services by allowing officers another chance to put that person in touch with peer recovery specialists, Grossman pointed out.

That said, Grossman ultimately agreed with Brookmyer and Andrea Walker, the county health department’s behavioral health services director, who argued that the leave behind program was worth implementing because it will help prevent further deaths.

“Yes, we will have gaps, most likely, in knowing who has had non-fatal overdoses; that’s possible and that should be expected,” Walker said. “But our number that we want to focus on is reducing the number of fatalities.”

Cynthia Terl, who was present at Wednesday’s meeting on behalf of the Wells House recovery center, also pointed out that, in her experience, access to naloxone doesn’t affect an addicted person’s decision to use drugs.

“If they are going to use, they are going to use whether they have Narcan or not,” Terl said. “The idea is, if they have the Narcan, then maybe they’re not going to die this time.”

Speaking after the meeting, Owens cautioned that, while the general framework was in place, the county has yet to receive firm guidelines from the state.

“Today’s meeting is actually so early on the front end of this, we don’t have a lot of the details coming yet because the word of the award of these pilot programs are just coming out,” Owens said.

Once the state sets its guidelines, county officials will sit down to hammer out how the model can best be implemented to fit how Frederick County handles its emergency response, Owens said.

At that point, county officials can begin looking at how else they could use the program to persuade overdose patients to seek treatment, even if they decline to be taken to the hospital.

Owens did not have an exact amount the state health department grant would allocate to the county or when exactly the program was likely to be up and running, again citing the early stages of the agreement.

Copyright 2018 The Frederick News-Post