Managing the Heroin Crisis

The October 2016 issue of Public Management magazine features the article “Managers Can Help Lead the Fight Against the Opioid Crisis” which lists 10 opportunities and recommendations for local leadership on heroin addiction.

I’m happy to report that we are well ahead of the curve of many cities in putting resources on the ground in this terrible epidemic.  The 10 recommendations were….

Take the lead to increase public awareness and engagement.

The City of Middletown partnered with Atrium Medical Center to host seven Heroin Summits with community leaders and activists to engage the public.  Our 8th Summit was held on Monday of this week.  I’ve tried to use my public speaking engagements and social media to get the word out on what this is costing the city in tax dollars, emergency room capacity, and lost health and lives of our residents.

Designate a Municipal Point Person on Substance Abuse Prevention.

Health Commissioner Jackie Phillips and I are probably the most involved in the heroin response at the city side.  We’ve been blessed by the addition of many partners to get the prevention message out in the community.  The schools, Coalition for a Healthy Middletown, the religious community, civic groups and many others are actively working to prevent future addiction.

Encourage Intra-Community, Regional and Statewide Collaboration

We’ve been very successful organizing all of the community assets, the city, the schools, Atrium Medical Center, the religious community, the civic community, the non profit community, interested citizens, past addicts, treatment providers, law enforcement and our local and state political representatives have all been actively involved in the Heroin Summits.

Develop a One-Page Resource Guide For Families and Those Seeking Treatment or Assistance

We’ve assembled all of the documents, resources, meeting minutes and progress reports on the city web page at the link below.

Pilot Innovative Programs Based on Local Needs

Translation: Try new things to stop addiction or reduce harm that likely will freak out the public.  I’ve said several times in public that if we had a toaster that had malfunctioned and killed 60 people in Middletown in the past year, we’d lose our minds, file a class action law suit and demand immediate justice.  Heroin addiction has such a stigma associated with it that we don’t even like to talk about it, let alone actively get involved in the national heroin epidemic discussion.

We are trying several different things right now.  The effectiveness of each effort will be measured over the next year or so to see if we had any impact.

Heroin Quick Response Team Colerain first tried this program locally and had success so we are duplicating their efforts.  The QRT is a three person team of one police officer, one paramedic and one social worker.   After police or fire respond to a heroin overdose, the team follows up and works to provide health resources and to get the addict into treatment.  As we see more and more addicts being revived by Narcan on multiple EMS runs, it becomes more imperative that we find a way to stop them from ODing and stop the need for multiple EMS runs and Emergency Room visits.   Our initial results have shown that the addicts are more receptive to our team after multiple overdoses.  We’ll have to see over a 6-12 month period how many people get referred to treatment and how many relapse.

At the 8th Heroin Summit at Atrium Medical Center on Monday, the team reported that they have created 221 case files since June 6, made contact with 168 addicts, helped 53 get into treatment (about 30%), and they are working with Middletown Municipal Court to not overlap or leave gaps in service.

Additional K-9s   We are picking up our 5th K-9 next week.  After finishing training, we’ll have drug sniffing dogs on every shift on almost every day.  Part of the fight in this epidemic is stemming the tide of heroin coming into the city.   We’ll use the dogs for suspicious vehicles, search warrants, etc., trying to find and remove drugs from coming into the city.  If the epidemic subsides, we’ll slow retire the dogs until we get back to our standard two K-9’s.

Chronic Nuisance Ordinance  Under the Chronic Nuisance Ordinance, if any property in town has two drug related events on the property, they will be labeled as a chronic nuisance property.  Once designated, if the city has to return a third time for an OD, the property owner is billed for the entire city response including MPD, the ambulance crew and any narcan, etc., used on the call.   We started actively enforcing this ordinance in August.  The warning letters are going out and we are seeing good response from property owners to remove drug activity from their properties.  This is one way to stop the locations where drug addiction are taking place in the city.

We have sent 35 notifications since July.  A couple of individual homes have changed hands as a result of the notification.  We are working with the owners of the Parkway Inn and an apartment building on Crawford Street, two locations that each have generated over 100 calls for service in the past year.

Middletown Municipal Court  Judge Wall has a Vivitrol program in place at the municipal jail.  If you are unfamiliar with Vivitrol, it is a once a month shot that shuts down the opium receptors in your body.  Short explanation… you can’t get high on heroin while on the shot.  Probation follows up with other services designed to keep the addict clean, get them back to work, and to get them back on a productive life cycle.   Judge Wall has put over 50 people on the program with good success.  What we and other jurisdictions are starting to see is that some addicts who can’t get high on heroin but still fight addiction, are switching over to another drug to get high while on the Vivitrol.  This all just goes to demonstrate that there is no silver bullet to solving this problem.

Publicize the Good Samaritan Law

Ohio now has a good Samaritan law that protects people from prosecution when they take action to intervene with an overdose.   Survival rates dramatically increase when medical intervention is quickly administered.  A few weeks ago we had over 35 overdoses in about a five day period.  Through the great work of our skilled paramedics, we only had one death during that run of overdoses.   We’ll talk at the October Heroin Summit how we can better get this word out to the public.

Partner with Schools to Implement Programs Aimed at Prevention

I’m very grateful that Dr. Ison and the school district have been on board and great partners since the very first Heroin Summit over a year ago.  They actively work with all summit resources to make prevention programs available in the school district.

Create Prevention Curriculum and Education Programs

We have developed through the Summit process several pieces of educational programming and they are available on the Heroin page on the city website.

Provide First Responders with Narcan to Prevent Overdose Deaths

As we looked at public safety responses to suspected overdoses, we found that EMS was generally reaching the overdose site at almost the same time as MPD.  Narcan is very expensive.  We’ve been fortunate to obtain grants for many of our purchases, but the cost to the city and the expenditure of your tax dollars on Narcan continues.  We are only outfitting the ambulances with Narcan at this time.  If we find that outfitting MPD would save substantial time and lives, we’re always willing to look at the situation a second time.

Create Safe Disposal Sites in Your Community for the Discarding of Prescription Drugs

The City of Middletown has operated a Prescription Disposal Site at the Division of Police for several years.  If you have unused prescription drugs, you can come to the police lobby at the city building and drop them off at any time of the day or night for safe disposal.

Despite all of these good ideas, our results this year are mixed.  Drug arrests are up over 50% from last year.  More dealers are going to jail and more addicts are being arrested and put into treatment than last year.  Violent crime and thefts are both down from last year.   That being said, our paramedics have responded to 413 overdoses year to date with 62 deaths.  With the introduction of fentanyl and carfentanyl, more than 1/3 of the overdose patients are requiring more than the standard narcan dose to recover from the overdose.

We act… they react.  We’ll continue to fight this on all fronts.



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