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A paramedic was skeptical about this treatment for stopping repeat opioid overdoses. Then he saw it help

Lauren Peace, Tampa Bay Times, KFF Health News on

Published in News & Features

“Money can mask any problem, but we’ve seen it from the top to the bottom,” Blaire said.

Over time, Blaire began to understand addiction as the disease it is: a physiological change to someone’s brain that traps them in a dangerous cycle. Maybe it started with a prescription painkiller after surgery, or an indulgence at a party, but the majority of people weren’t using drugs to get high, he realized. They were using them to avoid being sick.

“Imagine the worst flu you’ve ever had, then make it a lot worse,” Blaire said.

When a person dependent on opioids stops taking them, their body goes into withdrawal, often accompanied by shakes, nausea, fever, sweating, and chills. Though rare, people can die from opioid withdrawal syndrome. Still, historically, the emergency health care system has focused on reversing overdoses, rather than treating the withdrawal side effects that keep people returning to drugs.

In the past, Blaire said, he saw patients released from the hospital with little more than a phone number for a recovery center. Getting an appointment could be challenging, not only because of wait times or insurance complications, but because the patients weren’t stable — they were in withdrawal. To make it through the day, Blaire said, they’d often use again.

“‘Good luck, you’re on your own,’” Blaire said. “That’s how it was. And that doesn’t work for somebody who is sick.”

Under Blaire’s leadership, Ocala Fire Rescue sought to stop the revolving door by launching its Community Paramedicine program and the Ocala Recovery Project in 2020.

They modeled it after overdose quick-response teams around the country, which vary in makeup. These mobile teams, typically helmed by paramedics like Blaire, connect people who have overdosed with services aimed at stabilizing them long-term. On some, a registered nurse embeds with paramedics in an ambulance or SUV. Others have a therapist or peer recovery coach on board. Some are bare-bones: a single responder with a phone on 24 hours a day. Some get in touch with patients through a call or a home visit after a reported overdose.

Others, like Blaire’s team, intercept patients at the hospital.

Blaire likens the system to that of a trauma alert — a message sent to medical centers to ready a response to near-fatal car wrecks or shootings. When a trauma alert goes out, operating tables are cleared, CT scanners are prepped, and responders stand by for arrival.

“We set the same system up for overdoses,” Blaire said.

Now, when somebody in Ocala overdoses, whether it’s on opioids, alcohol, meth, or cocaine, an alert goes out, notifying Blaire and his team, a peer recovery coach, a behavioral health specialist, and a local recovery center.

His team usually beats the ambulance to the hospital.

The next day, team members follow up at the patient’s home.

Then, last May, under the guidance of the EMS medical director, Blaire’s team started offering addiction medication to opioid users, too.

Since then, Blaire said, his team has connected 149 patients with treatment. Only 28 of them have needed additional intervention, he said.

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When Blaire first heard about buprenorphine, he was skeptical.

How could giving somebody with an addiction more narcotics help?

That common response misunderstands the reality of addiction, said Nora Volkow, director of the National Institute on Drug Abuse.

People perceive that one drug is being substituted for another, Volkow said. Instead, the use of medications like buprenorphine is more akin to those that treat other psychiatric conditions, like mood disorders or depression.

Research shows that opioid addiction medication — including drugs like methadone — can greatly reduce the risk of overdose deaths, and increase a person’s retention in treatment. But a study out of the New York University Grossman School of Medicine found that nearly 87% of people with opioid use disorders don’t receive any.

Such addiction medications work by stimulating opioid receptors in the brain.

Opioids — like oxycodone or fentanyl — are what experts refer to as “full agonists.” Imagine an opioid receptor as a rounded bowl. A full agonist — like fentanyl — fits perfectly in that bowl and latches tightly to the receptor.

Buprenorphine is a “partial agonist.” It fits in the bowl — and satiates a craving — but doesn’t completely bind like a full agonist. Instead, it eliminates withdrawal symptoms so people won’t get sick or crave illicit drugs, without producing a high. Second, it counteracts the effects of other drugs, so a person can’t overdose on other opioids like fentanyl or heroin while taking it.

And for somebody who already uses opioids, overdosing from buprenorphine is nearly impossible.

“They help a person regain control of their everyday life,” Volkow said.

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On this Monday in January, Blaire pulled into Beacon Point, a local treatment center, just past 2 p.m.

He’d spent his morning calling on people like Slaughter, but now he was meeting paramedics from his team. After nearly three weeks of home visits, a man in the recovery network program was set to have his first appointment with a doctor.

Blaire has found that once people are stable on buprenorphine, more often than not they want to get into a treatment program.

While Blaire waited, a woman walking out of the center approached, smiling.

“I just got my first clean urine analysis,” she said. “I’m doing great, I’m so excited.”

 

“That’s awesome news,” Blaire said, a smile stretched across his face. He’s often stoic, straight-laced, with combed hair and aviators. But when he lights up, his all-business exterior gives way to gentleness.

Jacqueline Luciano is sober for the first time in 30 years. She’s proud, glowing, and Blaire is proud, too.

Luciano first came to Blaire through a referral when she was living at a women’s shelter. She said she had $20 in her pocket and wanted to get high — needed to.

Fentanyl withdrawal had left her shaky and cold. Her stomach was seizing, her muscles spasming. To quell the agony that day in early January, she went on the hunt.

Luciano said she had first used drugs when she was 9. Her family had been torn apart by pills and powders, she said, a sickness she’d inherited.

But this time, a woman — “like an angel” — passed her a number for someone who she promised could guide her into a brighter future, blame-free. Luciano, 39, paused, skeptical.

Then she gave Blaire a call.

For about a week, Blaire delivered her a daily dose of buprenorphine using a Safe RX bottle — essentially a trackable pill bottle with a lock code to limit who can open it. He helped connect her with food and clothing donations.

And as Luciano started to feel more like herself, absent of cravings, she began to hope.

Blaire got her an appointment with doctors at Beacon Point, then drove her to her first screening. Now, in the parking lot, she thanked him for everything.

“It made all the difference in the world,” Luciano told Blaire. “I really didn’t think that I could get better. I didn’t. But I am.”

As a tear rolled down Luciano’s face, Blaire’s phone rang.

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The call came from the health department. A man in his 40s or 50s had come some 40 miles from Gainesville, Florida, for help, steered through word of mouth.

He’d tried to get into a recovery center there but said he was turned away. Something about insurance and a criminal record had stood in the way.

It’s a pattern that drives Blaire crazy. He’d seen it a lot before his team was formed. People would get a moment of courage or clarity, only to be told “not yet.”

“Your first answer has to be ‘yes,’” he said. “‘Yes, I can help you.’”

He knew about a woman who had come from 25 miles out of town, then was told to come back days later. She didn’t have a car or a home to return to.

“They didn’t even offer her a ride,” Blaire said. “Sometimes you only have one shot.”

Blaire has learned that building trust starts with a small offering. A car ride. A sandwich. Help getting a government ID. Anything to show that you care, that you’re useful. That you see someone trying.

Outside the health department, a man in muddied jeans and a frayed T-shirt stood waiting on the curb. He introduced himself as Jetson and didn’t give a last name. Blaire shook his hand before they loaded into the car.

“So what brings you this way?” Blaire asked, once both were buckled in.

“I heard there were services here,” Jetson said, his voice gruff, quivering. “I’ve tried to stop using so many times, but I keep messing it up.”

Jetson shook his head.

“Well, I’m glad you found us,” Blaire said. He asked the man if he wanted to go to the recovery center for a screening. He did.

Over the 10-minute drive to Beacon Point, Blaire and Jetson talked, not about drugs or meds, but life. Baseball. Cabbage (good when fried).

When they pulled up, Blaire handed Jetson a card.

“Please call me,” Blaire said. “If you need anything. We can get you help.”

For a moment, the men sat there. Jetson pulling at his fingers. Taking deep breaths.

Then, he got out of the car — Blaire’s card in hand — and walked through the glass door.

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This article was produced in partnership with the Tampa Bay Times.


©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

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