Community paramedicine has become an effective vehicle for harm reduction. Harm reduction techniques move healthcare from reactive to proactive and gain significant traction in helping those with substance addiction.
Harm reduction techniques take an accepting, meet you where you’re at approach. Instead of pushing a “change or else” stigma, harm reduction practices seek to provide support, allowing those who use drugs to seek help when they’re ready.
Communities have enacted harm reduction around the country. Many EMS providers have found the practices non-judgmental and helpful.
How can community paramedicine address substance abuse? What practical steps can EMS and mobile integrated healthcare take to help reduce the effects of the drug pandemic?
Let’s discuss the possibilities.
Harm Reduction and the Role of Community Paramedicine
Harm reduction focuses on treating drug dependence as a health condition: not a crime. For example, someone with a history of anaphylaxis is often prescribed an EPI-pen and trained in using it. Harm Reduction advocates claim we should take the same approach to drug use.
Patients should be trained and equipped on safe needle practices and Narcan (naloxone) administration.
To those who feel this is an “enabling” practice, the counterpoint is this: The United States has engaged in “tough on drugs” type laws and policy since the 1980s. Many would say the US has seen no improvement after adopting laws that stigmatize those with addictions. In 2021, the USA surpassed 100,000 overdose-related deaths –a 28% increase from the previous year.
Harm reduction takes a new approach and hopes for a better result.
Here are several direct actions community paramedics are taking to care for those struggling with addiction:
- Education on needle use.
- Widespread naloxone education and distribution
- Monitoring safe sights
- Follow-up care and post overdose response teams
- A holistic approach to the patient’s health
Below, we’ll organize these approaches, giving a clear picture of how mobile integrated healthcare impacts harm reduction.
Note: Some of the practices described have caused debate in the public safety community. This article aims not to prescribe any treatment but merely to describe the methods used by programs around the country. Individual organizations and municipalities will need to decide what harm reduction techniques will work best in their community.
Community Paramedics Providing Education on Needle Use
Unfortunately, the scourge of the drug epidemic reaches beyond the immediate effects of overdose and debilitation and has the secondary effects of dirty needle use.
Here are some of the risks presented by needle use:
- Infectious diseases. HIV and hepatitis spread aggressively among those who use illicit drugs. If a needle is used multiple times by different people, this can exponentially impact the spread, as the disease is now disseminating on a greater than one-to-one ratio. As we’ve seen up close over the past two years (Covid pandemic), the spread of the disease is not an isolated event. The more it spreads, the more it will continue to spread.
- Local tissue infections. Beyond the possibility of contracting a systemic disease, dirty needles can cause a local tissue infection. These infections, if untreated, have led to tissue diseases like cellulitis and necrotizing fasciitis. In addition, dirty needle use is associated with systemic infection (sepsis) in some cases.
Community paramedics have an opportunity to reduce these risks. Below, we offer several ways to approach this issue.
The needle crisis:
- Education on safety. Community paramedics can spread the word about safe needle practices. Also, they can discuss the importance of sanitary needle use and the importance of abstaining from repeat or shared needle use.
- Education on needle exchange. The CDC recommended needle exchanges as a safe way to reduce the adverse effects of needle use. The key term here is “exchange.” This keeps a build-up of dirty needles from collecting on the streets, ensuring safety for the patient and safety for the community.
Read more about the Syringe Services Programs on the CDC’s website. As you’ll see, most Hepatitis C cases result from needle use.
Now, let’s address Narcan (Naloxone) distribution.
Widespread Narcan (Naloxone) Education and Distribution by MIH-CP
The use of Narcan has dramatically increased in the past four years. Narcan is a drug that rapidly reverses the effects of an opiate (Morphine, Fentanyl, Heroin, Oxycodone, and more).
Narcan has proved lifesaving. There has been an initiative to train and equip patients and family members who use narcotics. Depending on your state, patients may be eligible for a Narcan prescription.
This practice has become popular among those with an addiction. It’s also common to provide Narcan to people taking narcotics during rehabilitation.
For example, if someone is prescribed strong opiates after surgery, a physician may provide the patient Narcan (to be used only if needed) along with the opiate.
Community paramedics are in a prime spot to educate and equip community members on Narcan use. While Narcan is a relatively straightforward medication, patients must be trained on when and how to administer this lifesaving drug.
Community Paramedics can Monitor Safe-Use Sites
When an overdose happens, time couldn’t be more critical. The opiates will inhibit the patient’s respiratory drive, giving the patient only minutes before irreversible damage occurs.
Unfortunately, the average ambulance response time is rarely under five minutes. In urban environments, it’s challenging to meet a seven-minute response time. In rural settings, it’s nearly impossible. Throw in the national paramedic shortage, and we have a problem.
What’s the answer?
Some communities have found safe use sites to be a viable solution. Trained responders are posted near a location of known drug use, making them available for a response within seconds if something goes wrong.
While this may feel uncomfortable for some, providers and patients can agree that a lengthy resuscitation (or death) is best avoided.
Best statistics indicate that supervised injection sites may reduce drug overdose mortality.
Community Paramedicine and PORT
A Post Overdose Response Team, or PORT, is a group of professionals who respond to patients who have recently experienced a drug overdose. The goal of the PORT is to respond and offer support within hours after recovery or resuscitation.
Here are several ways the PORT offers help:
- Mental health services. They are there if the patient wants to work through psychological needs. Often, a member of the team is a mental health professional.
- Rehab professional. A drug rehab professional is also part of the PORT. They do not force or coerce the patient to seek rehab, but they ensure that help is available if they choose.
- Community paramedic If the patient has any health needs that must be addressed, a community paramedic ensures the patient receives the appropriate care. If the patient would like, the community paramedic can help guide them toward seeking more regular medical care.
You’ll notice the omission of direct contact with law enforcement. Patients are often slower to be honest if they feel threatened by legal action. One thing to make patients aware of is Good Samaritan laws. These laws allow bystanders to call 911 for someone having an overdose without risking any retribution.
If you’re curious, read our article on Post Overdose Response Teams.
Harm Reduction and Primary Care
While treating the patient’s drug use shouldn’t be overlooked, many addictions are compounded by other health issues.
Many patients who use or abuse drugs might need other medical treatment. For example, some patients began using narcotics because they were trying to numb a chronic condition. A reconnection with primary care services could benefit the patients, helping them take steps toward a safer lifestyle.
- Schedule regular appointments and work as a liaison between patients and primary care physicians.
- Monitor and help treat everyday ailments like diabetes, heart disease, and stroke.
- Offer weekly support to the patient. Even if they aren’t ready for rehab, they might accept weekly care.
Below, you’ll see why all these practices lead to a net positive.
Beyond Illicit Drug Use
Drug use affects all tiers of society, from the rich to the poor to the young and the old. But unfortunately, some people struggle with addiction in silence, worried about stigmatization.
Providing humane care for drug dependence doesn’t just help the person. It enables the community to thrive. Everybody benefits when cities and counties take a holistic approach to helping those who use drugs and implement forward-thinking harm reduction practices.
Here are the benefits:
- Less communicable diseases.
- Less dirty needles on the street.
- A healthy, happier workforce.
- Reduced strain on hospitals, EMS agencies, and emergency departments.
One of the keys to a promising harm reduction program is communication and connectivity.
Julota provides a cloud-based platform that connects you with community partners. What does this mean? It means you can safely share health information across patient platforms without changing your entire system.
The hospital can talk with EMS. EMS can connect with law enforcement. Law enforcement can unite with community mental health. Together, different services can unify, weaving a net of community protection.
Final Words on Community Paramedicine and Harm Reduction
Community paramedics have the training and the position to spearhead harm reduction programs. Reaching out to those struggling with drug abuse starts with quality harm reductions techniques. Not every community looks the same. Different approaches might work in other areas.
The key: keep an open mind and maintain strong connections in the community.
Use Julota’s contact form to see how their software can lower your costs, maintain strong partnerships, and keep ambulances on the road.