This commentary is by Stacia Rice of Burlington, a Vermont emergency medical technician and a master’s in public health graduate student.
Across the country, an opioid epidemic is underway, and Vermont is not immune to this problem. In overdose situations, emergency medical service providers are typically the first point of contact for care for these individuals. With the increase of opioid use disorder, as well as an increase of fatal cutting agents, Vermont is seeing an increase in deaths related to opioid use disorder, and the standard of care differs greatly in emergency situations.
Covid-19 has increased the impact of the opioid epidemic due to the societal detriments it has brought to many Vermonters. With multiple agencies recognizing this issue, there have been efforts to create safe spaces for people experiencing opioid use disorder and programs stemming from the EMS system to help combat the opioid epidemic.
I am an EMT for Richmond Rescue, emergency department technician at UVM Medical Center, and former emergency medicine research student. From working in emergency medicine for years, I have seen the toll the opioid epidemic has had on the state of Vermont, and all the programs that providers and public health professionals alike are collaborating on to create a safer, healthier Vermont.
In 2012, 8.0 people per 100,000 died from opioid-related deaths. In 2022, 37.6 people per 100,000 died from opioid-related deaths, which is a 470% increase in only 10 years. Much of this increase has happened since 2020, the beginning of Covid-19 in Vermont.
Covid-19 has caused numerous social issues in Vermont; unemployment skyrocketed, more people became homeless, and social isolation was at its peak. All these factors contribute to the equation for opioid use disorder.
Naloxone (Narcan) has been an incredible tool in helping prevent opioid-related deaths. With easy administration, and with Narcan being available at almost every pharmacy, the number of opioid-related deaths theoretically should be dropping. With many overdose calls, however, people refuse transport following Narcan administration.
As EMS providers, if they’re alert and oriented, we can’t legally make them go to the hospital, which means they don’t have access to resources to help them with addiction recovery. With EMS providers acknowledging this, time, effort and money have been allocated to resources to aid the community in addiction-related care.
In Vermont, Narcan Leave Behind Kits have been issued to every EMS agency in the state. When EMS providers are on opioid-related calls, or any call where they see any signs of potential opioid abuse, they leave behind kits that contain 4mg Naloxone nasal spray, a pamphlet on opioid use resources, and directions on how to administer the Narcan. This is given to people regardless of transport.
This has been particularly helpful in rural communities, where EMS call-to-on-scene times can be upward of 25 minutes.
One resource for those brought to the emergency department is the Start Treatment and Recovery (STAR) study run by the Emergency Medicine Research Associates Program. When someone is brought to the emergency department for addiction related reasons, they are invited to join STAR. The study helps those with opioid use disorder by starting medicated-assisted treatment and follow-up for recovery.
Bennington EMS has assisted by partnering with Turning Point and aiding those who refuse transport. When people go to the hospital for an opioid-related reason, social workers and Turning Point are there to help the individual. When somebody refuses transport, however, there are pamphlets in the leave-behind kits for people, but there’s no direct help.
In those serviced by Bennington EMS, assistance is provided without ever having to go to the emergency department. They can give your name (if a release of information is signed) to Turning Point, which will contact you directly for addiction recovery treatment.
One of the misconceptions about opioid addiction in emergency medicine is the idea that providers typically administer Narcan, assure the person is stable, and discharge as quickly as possible. Although utilization of the emergency department has increased for both overdose calls and non-emergent issues, efforts are being made in both the pre-hospital and emergency department setting to support individuals with addiction.
It may not be perfect, and more still needs to be done, but it’s a step in the right direction for the safety and health of Vermont.
