Like many places in America, Middletown (Ohio) is struggling to deal with the opioid epidemic and the associated increase in the number of overdose calls to 911.
Middletown Fire Chief Paul Lolli told a local television news channel that his EMS and fire responders do six to eight opioid overdose runs per day.
According to that report, there were 532 overdoses reported last year in Middletown, there have already been 577 such calls this year. Last year, there were 74 overdose deaths; so far this year there have been 51 overdose deaths. Last year, the city spent more than $11,000 on naloxone. This year, the city has paid $30,000 for its naloxone supply.
As a consequence, Middletown is considering a controversial proposal to limit the number of times someone who overdoses on opioids can receive naloxone from first responders.
Middletown City Council Member Dan Picard is quoted in a news report as saying, “If the dispatcher determines that the person who’s overdosed is someone who’s been part of the program for two previous overdoses and has not completed the community service and has not cooperated in the program, then we wouldn’t dispatch.”
Picard said his plan is aimed solely at saving the city money, not culling the heard of drug users in Middletown (which will likely be an ancillary result if the measure passes and becomes city policy).
Here are five reasons why it won’t.
1. The call takers’ and dispatchers’ CBA
I’m going to go out on a limb here and hazard a guess that the collective bargaining agreement (CBA) with the city’s dispatchers and call takers doesn’t have a clause allowing them to make a go/no-go decision on a response to a 911 call. A call comes in and the dispatch is made, end of story.
We are on a dangerous path if we tell dispatchers and call takers to judge the veracity of calls, whether it is a multiple prowler call to the same location, or domestic violence calls to the same location, or a repeat overdose call. Just because it’s happened there multiple times before doesn’t mean that first responders should not be sent to the current situation.
In fact, in law enforcement, that’s what we call a clue. Simply because it’s happened there before indicates a high likelihood that it’s happening again.
2. Realities of government services
When a city or town begins providing a “service” of any kind, it is very difficult to discontinue it. No matter how much a program’s budget mushrooms out of control, once a city or town offers things like meals for the homeless, needles for the drug-addicted and other harm-reduction strategies, it is all but impossible to say to those populations, “Sorry, that didn’t work out as we had planned, so those programs are no longer available.”
Once any type of government program begins, it survives all manner of attack from those who favor more limited government. This is as true for local municipal governments as it is for those who stalk the halls of the United States Capitol in Washington DC. Killing such services is tantamount to political suicide for roughly half of all elected officials, and doing so usually requires a two-thirds vote. Therefore, once born, these things tend to live forever, despite the best efforts of conservatives and libertarians who despise bloated government.
Let this be a cautionary tale to any local government with an opioid addiction problem that has not yet begun a naloxone program for its first responders. You cannot put the toothpaste back in the tube.
3. Tactical and logistical problems
Yes, a CAD dispatch history search will display past calls to a given location, but drug users – especially heroin and opioid users – often cohabitate. The CAD will tell the dispatcher there have been two previous OD calls to that location, but which of the residents is presently in danger of dying?
In addition, a single recipient of those first “two strikes” of naloxone may end up overdosing at an entirely different location and receive a third dose from responders. Can you imagine the EMT/firefighter/cop showing up to that location and saying, “Oh, you again. Isn’t this your third strike? Sorry, I can’t help you.”
Not going to happen. All first responders know that the next of kin will soon be seated at the office of the local plaintiffs’ attorney hearing the words “negligence and failure to render aid” followed by a seven-figure dollar amount.
This brings me to the fourth reason this proposal is going nowhere: the city’s lawyers are looking at it.
4. The lawyers won’t allow it
The looming threat of lawsuits with massive payouts will influence the city lawyers to make the proposal disappear.
Yes, the city of Middletown has tripled its expenditure on naloxone in the span of one year (and that trend appears to be in no danger of being reversed), but the fact is there is far more risk exposure for the city in not providing those services (see also item No. 1 in this list) than there is for continuing it.
I’m no mathematician, but $20,000 or $50,000, or even $100,000 are all smaller numbers than what could be generated by even one negligent death suit.
5. It fails to address the real problem
The opioid epidemic is real and is costing government agencies across the country money and human resources. However, this so-called solution addresses only the symptoms of opioid addiction, not the disease.
Addicts can’t make sound decisions about their drug use – they’re addicts. They’ve lost their families, their friends, their jobs, their futures and anything else they ever once cherished. We cannot expect them to logically say, “Well, I’ve had the cops here twice to give me naloxone, I guess I should kick the habit now before I overdose again.”
Let’s be realistic. The only addict who is able to shake their habit is one who is fully invested in that objective. No city policy is going to do that for them – that only comes from within.
The EMTs, firefighters, and paramedics now callled to these ODs are basically stuck with the revolving door cops have been stuck with for years on offenses like prostitution. Until we deal with the supply side of the equation in a meaningful way, the Johns are going to get what the free market (even though it is the black market) has to offer.
Police1 Member “JackC” made a salient point in the comments section of our original news story on this matter: “If I stood on a corner selling lemonade laced with drain cleaner and people died as a result, what would I be charged with? How about those who are found to be selling this DEADLY product be charged with attempted murder or if proven a death was caused from their sale then murder. Charged federally. Death penalty in play. Otherwise this will just not end.”
Well said, sir. I could not have said it better myself.
