Valley trend: Multiple doses of antidote required in opioid OD cases

Staff report

YOUNGSTOWN

When Boardman Fire Chief Mark Pitzer was first trained in paramedicine 15 years ago, emergency responders administered between 0.4 and 2 milligrams of the overdose antidote naloxone to patients.

Now, Pitzer said, an alarming trend has taken shape over the last several months. Members of his department are regularly dispensing as much as 8 mg of the medication to revive someone.

“It’s taking more and more doses of Narcan [naloxone’s brand name] to get them to even start breathing on their own,” he said.

Not only that, but his crew is getting called out for overdose cases more frequently than ever.

“This year, we’ve seen a marked increase in overdoses and unresponsive patients,” he said.

Police, too, have noticed an uptick this year.

“My sense tells me that it’s absolutely a definite increase,” said Boardman Police Chief Jack Nichols. “It’s almost a daily thing now.”

Data from both Trumbull and Mahoning counties put into perspective what Boardman officials, and many others in the Mahoning Valley, are seeing for themselves.

In both counties, the number of fatal drug overdoses so far this year are on pace to match or exceed last year’s record numbers. And dangerous drug mixtures are playing a bigger role in causing overdoses and rendering Narcan less effective.

In Mahoning County, there were 58 drug overdose deaths in 2013, 51 in 2014 and 68 in 2015. There have been 52 confirmed drug overdose deaths so far this year, said Dr. David Kennedy, Mahoning coroner.

The number of confirmed drug overdose deaths so far this year likely will rise as more lab test results are reported, he added.

“It obviously has increased our caseload. You’re seeing a lot more overdoses” that are fatal, Kennedy said of the heroin epidemic.

The number of confirmed drug overdose deaths reported by his office since the beginning of 2013 has exceeded the combined number of suicide and homicide cases his office has handled during that period. Mahoning County drug overdose deaths totaled 229; suicides (119) and homicides (89) totaled 208, Kennedy said.

The epidemic also has increased the demands on the coroner’s office for more thorough examination of the deceased, he said.

In the past, the coroner’s office often would externally examine the deceased and draw blood samples for drug testing, without doing a full autopsy, in suspected drug overdose cases, he said.

“Prosecutors are getting more aggressive. They want to prosecute drug dealers for manslaughter. To do that, I think they need an autopsy” to prove their cases, Kennedy said.

Trumbull County is on pace to exceed last year’s record of 87 overdose deaths, with 55 through July 19, 2016, newly released statistics from the Trumbull County Coroner’s Office show.

Of the 55 deaths, 22 involved only fentanyl and six involved only heroin. Twelve deaths included fentanyl as one of the drugs detected. Nine had heroin as one of the drugs found. Five had both.

In May it became clear that fentanyl had taken over as the leading cause of overdose deaths in the county, with more than half of the overdose deaths in the first 80 days of the 2016 involving fentanyl.

By contrast, only about a quarter of the overdose deaths in 2015 included fentanyl, the coroner’s office reported.

A few other drugs are still showing up in toxicology reports in 2016, including three cases in which cocaine was the only drug found.

The heroin-fentanyl mixture trend is one that Boardman officials see firsthand, several times a week.

“What we’ve found is that it [fentanyl is almost universally mixed with heroin,” said Nichols.

“I don’t understand the rationale,” said Pitzer. “It’s not creating a better high; it’s literally just killing people. It’s very concerning, and I’m not sure how we’re going to combat it.”

Warren and its ValleyCare Trumbull Memorial Hospital emergency room were the most prevalent locations for overdose deaths in Trumbull County so far in 2016, with Warren having 14 overdose deaths and the TMH ER having nine.

The emergency rooms at St. Joseph Warren Hospital and Northside Medical Center each had two. Niles had 10 overdose deaths. Hubbard and Howland had three apiece.

Having two or one were Cortland, Weathersfield, Liberty, Newton Falls, Masury, Kinsman, Mesopotamia, Warren Township and Greene Township.

Staff writers Ed Runyan, Jordyn Grzelewski and Peter Milliken contributed to this report.