The State of North Carolina received a grant for naloxone and has been distributing thousands of kits to EMS agencies throughout North Carolina. As a result of this distribution there has been a request from some of these agencies for a policy on how to handle patients who have their overdose reversed, but refuse transport. I know my recent columns have addressed the opioid epidemic and needle exchange issues, but this is an extremely important issue given that more people are now dying from overdose than car collisions. Children are also suffering from this opioid epidemic. Since 2004, North Carolina has seen an 893 percent increase in children born exposed to narcotics during pregnancy and a 25 percent increase in children going into foster care. Heart valve infections related to IV drug abuse have increased 13.5 times and sepsis has increased by a factor of four. EMS can be part of the solution to this out of control problem which is decimating our communities.
New Policy Regarding Naloxone
The new policy from the North Carolina Office of EMS addresses several issues. It gives guidance on how to determine if a person who has received naloxone from an overdose can refuse transport. The policy provides resources for patients in order to reduce the chance of a repeat overdose. It also addresses the best way to reduce future harm to the patient by policing up dirty needles, providing clean needles, and referring the patient to substance abuse treatment resources. This new policy does not require EMS to police up dirty needles or to provide clean needles. That is a local decision. The NCCEP EMS Committee is supportive of this policy. Many EMS providers have expressed frustration that they seem to be reversing the same people over and over. Repeat EMS visits related to overdose do happen, but the North Carolina data shows that only 4.6 percent of patients who received naloxone from EMS got repeat naloxone for overdose again from EMS within two weeks.
This new policy gives an additional tool to EMS whereby EMS can get a head of the problem. The policy is in the process of being updated by the North Carolina College of Emergency Physicians. An updated policy will be available in January 2018. Havelock Fire Rescue which is located in North Carolina is the first EMS agency in the nation which has started an EMS-based needle exchange program and they are having great success. Providing clean needles and policing up needles is the only scientifically proven way for helping people to stop using IV drugs. It also decreases the incidence of HIV and HCV in communities. This policy will help EMS move from being purely reactive. Now EMS can be proactive by helping to police up dirty needles, providing clean needles and by helping people find resources for treatment.