The Community Paramedicine Program saves lives, and to those of us who work or study in the addiction field, that comes as no surprise. The program gets at least two things right that The Addiction Dream has been doing wrong for too long: It picks people up where they are, but it doesn’t leave them there.
For context, first let me tell you a story about my late friend Sarah. Sarah became addicted to opioids at 19 and experienced her first overdose at 23. A bystander found her in a restaurant bathroom overdosing and unresponsive. They called 911. EMS arrived, they administered naloxone and Sarah was successfully resuscitated. Relieved, the first responders genuinely offered help, even offering her a ride to treatment. Sarah, while being resuscitated, was not doing well. Since she had been given naloxone, she had hasty withdrawal symptoms. This means that within seconds she experienced the full force of opioid withdrawal, a phenomenon that usually takes 3-5 days to occur. Physically and mentally, she suffered from miserable torment. Right now her mind would only allow her to think about how to make her suffering go away. She refused treatment and refused a trip to the emergency room against medical advice. Two weeks later, she overdosed alone in her apartment. She didn’t survive.
Sarah’s story is an all too common tale of a missed opportunity. The missed opportunity is more complex here than at first glance. Some find it easy to blame Sarah and claim that if Sarah does not accept the treatment, there is nothing we can do for them. But increasingly others have come to realize that just because Sarah refuses treatment doesn’t mean Sarah refuses help. Just because Sarah isn’t ready to do anything right now doesn’t mean she isn’t ready to do anything. If we don’t meet people where they are, we leave them behind.
Research shows that the overwhelming majority of people who use drugs, and even the vast majority of people with substance use disorders, are not treatment seekers. If inpatient treatment is the only type of support we can offer, none of the above cases will be helped at all. They fall through the proverbial cracks of the system and first responders are burdened with managing their chronic illnesses and complex psychosocial issues.
There is a better way. It’s called meeting people where they are or “harm reduction”. And the Community Paramedicine Program knows exactly how to do it. The program not only literally meets people where they are, but figuratively allows first responders to assist a victim of a nonfatal overdose, even if they refuse treatment. Through this program, people who were previously left behind after an overdose can now get help with housing, health care, transportation, access to sterile syringes, wound care, treatment services, etc., statistically reducing the likelihood that that person will overdose again in the future and increase the likelihood of a sustained recovery.
You often hear “addiction is a family disease” because addiction affects the whole family and the whole family can affect addiction. I would argue that addiction is a community disease. And just as addiction affects the entire community, the entire community has a role to play in influencing addiction. The Community Paramedicine program is an example of a community response to a community problem. As a person in recovery and a co-founder of Voices of Hope, I am proud of my community today.
Alex Elswick is a co-founder of Voices of Hope and an Assistant Extension Professor at the University of Kentucky.