PASSED – Full 911 Good Samaritan Legislation in Michigan

Great news!!

Governor Snyder has signed both 911 Good Samaritan Bills.

These laws exempt individuals under age 21 from prosecution from drug-related charges when seeking medical aid for themselves or someone else.

Take a minute to thank  Governor Snyder, Rep. Sam Singh and Rep. Al Pscholka for their efforts on this issue.

The Bad News – There’s much more work to do.

An overdose is a major medical crisis, right? It’s not unlike a heart attack.

Here’s what happens when someone has a heart attack

1. A person has a heart attack at the grocery store and . . .
2.  . . . thank goodness, the store has an automatic defibrillator.
3. Someone has been trained to use the defibrillator and performs the rescue.
4. Someone else calls 911 to make sure the patient gets all the care they need.
5. The patient is taken to the emergency department and medically stabilized.
6. Once stabilized, the patient gets transferred to care that will address the cause of the heart attack and/or care that will prevent future heart attacks.
7. The patient’s treatment plan will generally include lifestyle changes. (Diet, exercise, etc.)
8. Then, the patient gets follow-up care that might include:
   • follow up appointments with specialists,
   • periodic tests to monitor for indicators of a recurrence,
   • self-monitoring (blood pressure), and
   • monitoring by the patient’ primary care physician.
9. If problems recur or there are indications of a potential recurrence, the care plan will be re-evaluated and the patient will get whatever care they need.

Here’s what happens when someone ODs and is rescued

1. A person overdoses and . . .
2.  . . . thank goodness, the someone has naloxone.
3. The person has been trained to use naloxone and performs the rescue.

Maybe, if they are lucky, these steps happen.

4. Someone else calls 911 to make sure the patient gets all the care they need.
5. The patient is taken to the emergency department and medically stabilized.

Naloxone is not enough.

We’d never tolerate cardiac patients being sent home without the proper care. Why should people with an addiction be treated any differently?

The good news

The good news is that there are models that work.

The Gold Standard

The best example of what should happen is the the kind of care that opioid addicted doctors, nurses, pilots and lawyers get. They all have low relapse rates and return to work at very high rates.

Here’s what would happen if one of them overdosed at work (or if it was known to their employer):

First, the recovery planning begins with some important assumptions:

• abstinence is the goal;
• full recovery with a return to full functioning is the expectation;
• addiction is a chronic illness and recovery requires long term treatment, support and monitoring; and
• for recovery to be durable, the addict must be an active participant in treatment and recovery maintenance.

The recovery plan is likely to include the following:

• Formal treatment. The first phase of formal addiction treatment for most of these professionals is residential care ranging from 30 to 90 days.
• Supportive services. Supportive services used by these professionals includes AA or NA 12-step groups, aftercare groups from their formal treatment programs, and follow-up from case managers.
• Long-term support and monitoring. After completion of initial formal addiction treatment, they develop a continuing care contract consisting of support, counseling, and monitoring for usually 2 to 5 years.
• Drug testing. Regular testing for 2 to 5 years, usually with more frequent testing at the start and reduced testing following periods of stable negative drug test results.
• Dealing with relapse. Relapses are usually addressed by a combination of increased intensity of care and monitoring and by immediately informing family and colleagues of the physician to enlist their support.

Other options

Buprenorphine (Suboxone) and methadone have been shown to reduce drug use, overdose risk, criminal activity and disease transmission.

Some people are able to stabilize and live normal lives on these medications but, at this point, there is no research demonstrating its effectiveness with quality of life indicators like employment.

Many people hope to use these drugs as an interim step toward abstinence. However, there is no established model for successfully transitioning buprenorphine and methadone patients to abstinence. A large federally-funded study attempting to do this reported, “near universal relapse.”

Another option is an injectable drug called Vivitrol. It is injected once per month and can protect against overdose. Unfortunately, it’s very expensive.

Which to choose?

The gold standard offers a path to full recovery, but it does demand a lot of structure, effort and lifestyle changes.

Many professionals prefer drug maintenance as a goal. It’s an easier plan to implement and many professionals are not confident that their patients are capable of drug-free recovery. (Look for professionals that are optimistic and believe in you ability to achieve full recovery.)

However, most patients and families, for a wide variety of reasons, prefer abstinence as a goal–the most common reason is that they want their life back the way it was before they became addicted.

Patients not sticking with the treatment plan is the biggest barrier to success with both approaches.

It’s harder than it should be

Getting the gold standard for yourself or a family member is likely to be very difficult. But, there are steps you can take to improve the odds.