With drug overdoses on the rise, the battle continues to reverse the trend

Editor’s note: This is the second of a periodic series looking into the world of drugs, specifically prescription drugs and heroin, the devastating effects it can have on people and what is being done about it in terms of education and prevention.

MARSHALL – More Americans are now dying every year from drug overdoses than in motor vehicle accidents, with the majority of those overdoses involving prescription medications. Drug overdoses are also the leading cause of accidental death in Minnesota, sparking recent, potentially life-saving efforts throughout the state.

“Steve’s Law” – named after Steve Rummler, who died of an opioid overdose in 2011 – is Minnesota’s Good Samaritan + Naloxone legislation, which provides immunity to anyone who calls 911 in an attempt to save a life and now grants immunity to law enforcement and civilians who access and administer naloxone (known by the brand name Narcan) in an attempt to save lives, as long as the person acts in good faith.

“It grants immunity for those who call in an overdose,” Lyon County Sheriff Mark Mather said. “That’s part of ‘Steve’s Law.’ If they’re calling for help, and they’re both loaded, neither of them are going to be charged with anything.”

Naloxone, used by emergency medical services (EMS) personnel for more than 40 years, is an effective medication that reverses opioid drug overdose. It can be administered by intramuscular injection, as a nasal spray or intravenously (by medical personnel only).

“It’s such a no-brainer to use Narcan,” Balaton resident Patty Moe said. “Most of the kits come in a bag. (My husband) Brad (Sundquist) and I got trained on how to use Narcan, using a trainer one. It talks you through the administration process but doesn’t contain a needle or live drug. The live ones talk, too, though.”

In connection with the Steve Rummler Hope Foundation, Moe and Sundquist have been sharing their story – as grieving parents and as recovering addicts (alcohol and prescription drugs) themselves – in the hopes of creating more awareness regarding chronic pain, the disease of addiction and the dangers of abuse.

Like many of the Foundation members, the loss of a loved one – in Moe and Sundquist’s case, their 28-year-old son/stepson, Ryan Abrahamson, who died of a heroin overdose in October 2014 – prompted them to help make a difference for others in the future. That includes advocating to get Narcan in the hands of anyone – but especially emergency responders and law enforcement – who might help avert a future tragedy.

“My son was like a diamond – he had the most incredible smile that lit up so many people’s lives,” Moe said. “When he died, I vowed to help save lives, and for the first time in my life, I feel like all that Brad and I, and my kids, too, have been through may serve some purpose.”

The opioid epidemic

Opioids are medications that relieve pain. When taken as prescribed, opioids – such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine, codeine, methadone, fentanyl (Duragesic, Fentora), hydromorphone (Dilaudid, Exalgo) and buprenorphine (Subutex, Suboxone) – can be effectively and safely used to manage pain. But abuse, even a one-time large dose, can cause severe respiratory depression and death.

When misused or abused, opioid painkillers can mimic the effects of heroin – which is also an opioid, though illegal.

Heroin is sold as a white or brown powder, or as a black/brown tarry substance. It works very quickly and produces a powerful euphoria and sense of well being, with a high typically lasting for up to five hours. But it is very addictive and can lead to physical dependence within a week of use. The illicit drug also has devastating side effects and consequences of use – including death..

“Even with meth, out of the gate, you’re probably not going to die from it, but heroin, you do it once and it can kill you,” Moe said.

Opioids work by binding to specific receptors in the brain, spinal cord and gastrointestinal tract, minimizing the body’s perception of pain.

“Look at Phillip Seymour Hoffman (actor who died of a heroin overdose on Feb. 2, 2014),” Sundquist said. “Who knew he was high all those years? It gives you a lot of energy and changes how you feel about yourself. But the outcome is predictable. It’s either jail, treatment or death.”

Though it’s been nearly 13 years, Sundquist and Moe remember all too well how easy it was to become addicted to prescription painkillers. After both had painful surgeries (rotator cuff and back) they spent three years hooked on medications, transitioning from high-functioning addicts who had an enormous amount of energy to thin, sickly and financially devastated addicts.

“You could tell my health was beginning to decline,” Moe said. “It was bad. We should’ve both been dead. And we had no intention of getting addicted. We had good, clean sobriety for six years. It was like, ‘how did this creep in like this?'”

In 2013, the Centers for Disease Control and Prevention reported that more than 2 million people in the United States either abused or were dependent on prescription opioid painkillers in addition to more than 16,000 who died of overdoses. In Minnesota, 507 Minnesotans died from drug overdoses – 200 from prescribed painkillers and 91 from heroin overdoses – compared to 374 Minnesotans who died in motor vehicle crashes.

“I believe it’s one person every 12 minutes that dies of an opioid overdose in the United States,” Sundquist said. “It’s more than in car accidents. It’s crazy. And everybody thinks it doesn’t happen.”

Surviving an overdose

A person’s chance of surviving an opioid overdose depends greatly on how quickly he or she receives medical assistance – much like someone suffering from a heart attack. Encouraging bystanders to call for help without the fear of criminal repercussions should help save lives.

As of July 1, 2014, a person seeking medical assistance for someone experiencing any drug overdose, including alcohol poisoning, cannot be prosecuted for possession of drugs or drug paraphernalia. The overdose victim is also protected from prosecution.

“You can’t be prosecuted now for reaching out for help,” Sundquist said. “That’s a good thing because people, kids especially, shouldn’t be afraid to call for help if something goes bad.”

While the new legislation likely wouldn’t have saved Abrahamson – he was found dead in the morning at the home of a known drug dealer in Minneapolis – the hope is that it will save other lives. It may have saved the life of University of Minnesota-Morris student Laura Schwendemann, 18, who is thought to have overdosed on methamphetamine in October.

“The guy that was with the girl from Starbuck (Laura) hid her (in a cornfield) because he was afraid to call authorities,” Moe said. “All he had to do was call 911.”

An overdose can occur because of miscalculations or when someone deliberately misuses a prescription opioid or an illicit drug like heroin. During an overdose, one’s breathing and heartbeat slow down or even stop. Signs of opioid overdose include: extreme sleepiness, shallow breathing, purplish/blue fingernails or lips, pupils that are very small, being awake but unable to talk, vomiting and slow heartbeat and/or low blood pressure.

Narcan begins acting in 2-5 minutes, but it typically wears off within 30-90 minutes, so medical care is still needed after the opioid antagonist is administered.

Steve’s story

Health care providers wrote 259 million prescriptions for opioid pain medications in 2012 – enough for every American adult to have a bottle of pills. It’s been reported that Americans consume opioid painkillers at a greater rate than any other nation – twice as much per capita as second-ranking Canada.

For many, opioid addiction begins as treatment for acute pain – such as Moe and Sundquist did following surgeries – or for chronic pain – which can occur with patients who are terminally ill, physically injured or have degenerative conditions.

Steve Rummler was 28 years old in 1996 when he suffered a life-changing injury to his back. For the remainder of his life, he struggled with chronic pain. In 2005, Rummler was prescribed opioids by a well-intending doctor who had been taught that opioids were safe and effective for long-term use. Once addicted, Rummler began seeking prescriptions from more than one doctor in order to maintain the level of relief he was accustomed to.

Treatment helped, but only for a while. After multiple attempts at different treatment facilities, Rummler relapsed. When his prescription refills ran out, he sought out heroin – the first time he’d ever taken an opioid that hadn’t been prescribed – and it killed him.

Family members said that although drugs caused Rummler’s death, they did not define his life. Rummler was kind, smart, fun-loving, athletic, musically gifted and successful in many ways, they said. In his honor, the Steve Rummler Hope Foundation was established, with the goal of helping other who suffer from chronic pain and the disease of addiction.

While grieving Abrahamson’s death – he had been clean for more than six weeks when he sought out the heroin that killed him – Moe and Sundquist connected with Rummler’s fiance, Lexi Reed Holtum, who serves as the Foundation’s vice president.

“I became real active with the Foundation after Ryan’s death,” Moe said. “They have been promoting Narcan for first responders and law enforcement. It’s my passion to get the word out about having these Narcan kits on board and to help get training for them, too.”

The Narcan movement

Naloxone is a safe way to immediately reverse an opioid overdose. It is not addictive, cannot be used to get high and is fairly inexpensive (typically $20-$50) so the medicine has no street value, quelling fears about the potential for theft or abuse.

“It’s one more tool in the toolkit that we carry,” said Dan DeSmet, manager for North Memorial Ambulance-Marshall Region. “We carry Narcan in all of our trucks. That’s part of the state requirement as a ALS (advanced life support) provider, that we carry that medication. It’s very similar to an EpiPen injection for someone with an allergic reaction.”

Besides the obvious life-saving potential of Narcan, one of the best parts is that there are no side effects -no danger involved even if diagnosed or administered incorrectly.

“It’s used a lot of times for prescription drug overdoses that you would see for people who were unconscious, the unknown medicals,” DeSmet said. “That includes older folks who do not consistently take their medications and sometimes overdose accidentally on their pain pills. They don’t metabolize the drug as fast as some of the younger generation. You might not know what it might be exactly, but you can give it to them and it won’t hurt them.”

Training is also crucial in the life-saving effort. People need to know how to properly use Narcan.

“That’s part of the paramedic training,” DeSmet said. “We also continue to do training internally with our own agency as well. We’ve had a couple of cases in the local area that have had successful resuscitation because of the Narcan, as well as the other adjuncts that went with it, like the early arrival of law enforcement.”

North Memorial serves most of Lyon and Redwood counties, as well as parts of southern Yellow Medicine and Renville counties. DeSmet said that while they’re contracted with Redwood Falls, Marshall and Minneota, they also partner a lot with Cottonwood, Balaton and some of the communities that currently have basic life support (BLS).

“We help them out, like with providing Narcan,” he said. “Every ambulance service has primary service areas (PSA), and that’s assigned by the state of Minnesota. We normally wouldn’t travel outside of our PSA except to assist other agencies with different medical emergencies, with overdoses being one of those.

Since officers are often the first to arrive at the scene of an emergency, it’s important that they receive training as well. North Memorial does training for both the Sheriff’s Department and Marshall Police Department. Highlighted as one of the first in the region, the Upper Sioux Police Department was trained on and equipped with Narcan seven months ago.

“With your narcotic overdoses, a lot of the deaths are due to respiratory distress and depressions, so from an EMS perspective, it’s critical to work in collaboration with each other,” DeSmet said. “So we go out and train our first responders, sheriffs, police, all those folks, to make sure they know how to open airways, maintain breathing, do CPR, those types of things, until we get there.”

DeSmet noted that most EMS responses in southwest Minnesota are between 3-5 minutes, so the cooperative effort between the agencies plays a huge role in saving lives.

“We can’t save everybody, unfortunately, but we’re trying real hard,” DeSmet said.

Most recent Narcan developments

Just as Moe and Sundquist had hoped, the Narcan movement has made significant progress recently. In order to financially back the implementation of “Steve’s Law,” the Minnesota Legislature approved a $290,000 appropriation across the state.

According to Holtum, the initial appropriation will act as a “kickstarter” to distribute naloxone to regions with the highest needs – not surprisingly, many of the rural areas – throughout the state.

“Their objective is to put naloxone in the hands of first responders and law enforcement because they feel like they’re usually first on the scene for heroin or opiate overdoses,” said Ann Jenson, executive director of Southwest Minnesota EMS Corp. “Our 18-county region received $22,000 from that $290,000 grant, to put Narcan in their hands and go around and train them on the use of Narcan.”

Jenson attended a “Train the Trainer” event in November in Willmar.

“Those of us that are going to be out training people went to it,” she said. “It’s a big thing, to be able to provide training and the medication through this grant. Our goal is to put two doses in each squad car. We’ll see how far the money takes us.”

Many of the area police departments and first responders currently do not have Narcan in their possession. That includes Marshall Police Department, which has 19 officers.

“We haven’t provided it to our officers because there’s the maintenance of it,” Marshall Police Chief Rob Yant said. “We also haven’t seen a large incident of overdoses. The other things is, frankly, North has them and they’re on hand within Marshall. They would be called and could be there, in some incidences, at least as fast if not faster than our officers.”

Like DeSmet, Yant knows the importance of being prepared. He, too, credits the cooperation between emergency responders, including the fire department.

“All of our agencies work together real closely,” Yant said. “It’s about saving lives.”

Jenson’s hope is that Narcan becomes an every-day resource that is available, just like a defibrillator has become necessary in case of cardiac arrest.

“The Narcan is temperature controlled, so it has to come in from the vehicle,” Jenson said. “But we hope they’ll get accustomed to taking it in with the AED (defibrillator).”

While it will take time to complete the process, Jenson is excited about the opportunity to save lives in southwest Minnesota.

“Most ambulance services like North have Narcan, but some of the smaller ones don’t,” she said. “We’re going to be getting it to them, though. I’m headed to Montevideo (Wednesday) to train the law enforcement and first responders there. I have a couple of others pinned down already, too. I think it’s a great thing anytime you put help out there. That’s basically what we’re doing.”