The Opioid Crisis: An Epidemic With an Underlying Epidemic
Updated: Feb 8
Remember the scene in Pulp Fiction when Mia Wallace overdoses on heroin and is stabbed with a huge hypodermic needle? Or on The Dirt when Nikki Sixx is stabbed with two syringes full of adrenaline to revive him from his heroin overdose? And Heath Ledger, Prince, Tom Petty, and Mac Miller? Well, this...opioid overdose...unfortunately happens a lot. Opioids are a psychoactive substance that work by attaching to opioid receptors that live on our nerves. The opioid then blocks the pain signals that are sent to the brain. In circumstances of drug abuse, when there is no observed pain, this causes a feeling of euphoria.
In 2017, more than 47,000 people died from an opioid overdose; more than half of those due to heroin. To remedy an overdose, emergency responders can use naloxone, a narcotic commonly known as Narcan, to instantly revive overdosed individuals. It has immediately sobering effects and can be used to wean addicts off of drugs like heroin.
Often times, Narcan can cause hypoventilation and cardiac arrest—if the overdose in itself hasn’t already caused a cardiac arrest. Deaths because of overdoses are frequently due to cardiac arrest, a secondary result of an overdose. Cardiac arrest is, in fact, more common in opioid overdoses than in non-opioid overdoses.
Unfortunately, 13.5% of cardiac arrests were due to hidden overdoses, and patients suffering cardiac arrest because of an overdose tend to present a non-shockable rhythm meaning that an AED will not shock and resuscitate. So how do emergency responders differentiate between an overdose and cardiac arrest?
Deputy Chief Steve Drewniany of Sunnyvale’s Department of Public Safety (DPS) explains how they differentiate between the two. “There’s always context. As soon as you arrive on scene you have context. It's maybe not the context of someone standing there and telling you. You see things as you walk in the room, smell things, you know things from previous contacts at that residence or in that neighborhood that give you the opportunity to narrow down your index of suspicion as to what it is. You're looking at the scene and you're looking at the indications that are at the scene that will help you make a determination about what's going on. The patient presentation, the environment they’re in, the paraphernalia that may be around, or a story that anybody may be able to provide.”
“If there's no one around you start the basic CPR steps,” Dave Rose, EMS specialist at the Sunnyvale DPS explained. “So we’re going to take things one step at a time to make sure that they're unconscious and not just napping. And then we get into their breathing and we check their pulse. And if they don't have one, we correct that situation. That's when the AEDs get used. The environment and the indications that you see at the scene is what's going to help you determine if you're going to administer Narcan or not. A lot of times, depending on the environment you’re in, you’re going to find them in a bathtub and ice and all kinds of things like that where people are trying to do their home remedies for an O.D.” Constricted pupils can also be telling of opioid usage.
Rose explained that “if they’re in the first 5 to 10 minutes, their heart is going to stop beating and therefore the machine will not shock once they become hypoxic, or oxygen-starved. Then the horrible happens.” This is because it is common for victims to display a non-shockable heart rhythm.
In the future, it can be predicted that Narcan will be placed alongside defibrillators and fire extinguishers.
In the same way that Good Samaritan laws protect
AED-deploying responders, more and more states are implementing legislation that will give Narcan-administering responders protection from liability.
For some, having an AED can seem trivial, but for others, it can mean 30 extra birthdays, 30 extra Thanksgivings, 30 extra Christmas’. It all matters when you’re saving lives. “These individuals can get married, have kids, then watch them grow and have their own kids,” Drewniany describes. “All of those life events they would not have experienced if we hadn't been there to defibrillate and resuscitate them. So when you look at the human capital that you're bringing back into the world it's a pretty dramatic impact when you start to get into the hundreds and hundreds.”
Having deployed thousands and thousands of AEDs, Deputy Chief Drewniany has been at the forefront of deploying AEDs in the Sunnyvale area. He’s saved countless lives and strives to continue to do so. He made so that the Sunnyvale mall was the first mall in Northern California to have public access defibrillators. Malls are always high in traffic, so this was a great place to install defibrillators, not to mention a great achievement.
Implementing a defibrillator program starts from the top down. Be sure to reach out to executives to propose your AED program. It shouldn’t be too hard to convince them to save lives.