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St. Louis County Declares An Opioid Epidemic

"No single agency or effort can end this scourge" — St. Louis County Executive Steve Stenger


July 06, 2018
St. Louis County declared an opioid epidemic last week and described the drug problem as nothing less than a public health emergency. An action plan was presented to save lives.

"No single agency or effort can end this scourge," said County Executive Steve Stenger at a June 28 press conference. "It is time for emergency action. We urge county residents to get educated about this crisis and recognize what they can do to help end it."

Opioid-related overdose deaths have risen 70 percent over the past five years in St. Louis County with 203 lives lost in 2017. The Emergency Declaration will help improve collaboration and coordination among local agencies.

Stenger was joined by the leadership of St. Louis County Department of Public Health, which will play a key role in implementing the detailed action plan addressing addiction and overdoses.

"We must address the trauma of addiction for people and their families," said Faisal Khan, M.D., director of St. Louis County's Department of Public Health. "We must also face the inequities in our system that lead to disparities in prevention, education, access to treatment and the availability of long-term recovery.

"We will be working with all of our community partners to help those in recovery find connections to services, support and hope," Faisal added.

Faisal Khan, M.D., director of St. Louis County Department of Public Health.

Dr. Zach Tebb, M.D., director of Emergency Medicine at St. Anthony's Medical Center.

Jesse Lavin, D.O., assistant medical director of Emergency Services at SSM St. Clare Hospital.
Twenty-five community partners in the effort attended the June 28 briefing, including representatives from the Missouri State Medical Association, Behavioral Health Network, Mercy, BJC HealthCare and SSM Health Care.

On the Front Lines

Hospitals are on the front lines, along with police and paramedics, in the fight against opioid addiction and overdose emergencies. Jesse Lavin, D.O., assistant medical director of Emergency Services at Fenton's SSM St. Clare Hospital, said the problem is at a crisis level.

"This is a complex problem that has gone unchecked in our community for too long," said Lavin. "We, as a society, can do better. Recognizing this is a problem is the first step. I'm encouraged to see Mr. Stenger and St. Louis County have made this a priority.

"Medical providers are faced with the harsh realities of this epidemic on a daily basis," added Lavin. "We see patients try to manipulate us and the system to further their addiction. We see patients lose their temper when we refuse to give them opioids. We see patients in withdrawal seeking help. We revive patients from overdoses watch them walk out the door in a matter of minutes. We also see the overdoses that end lives."

Lavin said hospitals like St. Clare are fortunate to have excellent pre-hospital care in greater St. Louis. Police, fire and EMS personnel have become very adept at administering Naloxone (Narcan). He said this intervention alone has saved countless lives in the community.

Use of the life-saving drug Naloxone has resulted in reversing at least 112 overdoses in 2017 alone. Missouri also has passed a Good Samaritan Law that allows people to call 911 to report an overdose without fear of being prosecuted.

"We do not report overdoses to law enforcement," said Lavin. "Emergency medicine takes pride in providing care to all members of society. We never want the fear of legal action to deter someone from seeking help."

Opioid abuse has been increasing nationally at a rapid pace. In 2002, total deaths in the United States from heroin and synthetic opioids were less than 5,000. In 2015, the figure jumped to 20,000.

No Typical Scenario

Zach Tebb, M.D., director of Emergency Medicine at St. Anthony's Medical Center in South St. Louis County, said there is no typical scenario when it comes to opioid abuse and resulting emergencies.

"There is the death or the near-death overdose that is dramatic and encompasses a massive amount of resources to resuscitate the patient, not always successfully," explained Tebb. "They are often dropped off by friends at the emergency department or brought in by law enforcement or EMS.

"Then there are the less dramatic presentations, such as the 25-year-old who is addicted to pain pills and brought to us by family looking for help," he added. "There's the patient with behavioral health needs, brought in by the police, who is homeless due to behavioral health and substance abuse."

Tebb also noted the elderly patient who is dependent on opioids for chronic pain, who falls or has other medical conditions related to chronic opioid use. There also are pediatric patients who access a grandmother's chronic opiate medication and come to the hospital to be treated for an overdose.

According to Tebb, the region needs to look at the issue of mortality and morbidity. The number dead from the epidemic is growing, but even larger is the number affected. So while only about one percent of opioid abuse patients may die, that leaves 99 percent affected who have complicating medical issues, along with complex legal and family concerns related to opioid abuse.

"The question for the community is not whether we want to put resources toward this epidemic; we are and we will continue to in high amounts through jail costs, court costs and expensive emergent psychiatric hospitalizations," Tebb said. "The question is whether we instead choose to put resources toward planning and funding comprehensive, proven approaches that decrease long-term costs toward getting insurance companies to cover proven medical and counseling interventions, and toward creating non-criminal justice avenues to treat addiction disorders."

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