Heroin: emergency room sees rise in drug problem

10/09/02 12:00AM By Nina Keck
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Heroin use across Vermont has skyrocketed over the last five years and the fallout is widespread. In Rutland County, armed robberies tripled over the last two years and police say there have been many more arrests for fraud, forgeries and embezzlements. All crimes that police say are tied to an increase in heroin use.

Health care providers in Rutland have also seen the effects of heroin - especially in the local emergency department. VPR's Nina Keck visits the emergency department at the Rutland Regional Medical Center.

(Sound of physician with a patient) "We're just going to do an EKG ."

(Keck) It's a Saturday morning and the emergency department is fairly quiet. There's a toddler getting stitches and an 86-year-old being treated for chest pain. The fluorescent hallways are a strange combination of subdued action.

There's no one who's being rushed in because of a heroin overdose. No one who's seeking help for symptoms of withdrawal, and no one who's been hurt because of drug related violence. But ask any of the men and women who work in the emergency department at Rutland Regional Medical Center, and they'll tell you they see that stuff all the time now:

(Janice Austin) "Yeah, there has been an increase in the last few years. It's pretty incredible."

(Keck) Janice Austin is an emergency medical technician in the emergency department. She also works as an EMT for Rutland's regional ambulance service.

(Austin) "Last summer I was running a call with a rescue squad and we had a young girl who had overdosed on heroine. She still had a pulse but she had gone into respiratory arrest, in which we did bring her back and got her here. And when she was alert enough to realize she was still alive, she basically got up and walked out. She almost died, we were able to save her and she just turned out and walked out the door. And so yeah, that hit home. She was a beautiful girl - young, had the rest of her life ahead of her. Not that she's been the only one, but it really bothered me because I was there. I was helping to breathe for her - helping to make her better, bring her back."

(Keck) Austin says a week later the 18-year-old overdosed again and went into a coma. She was treated at a different hospital and Austin says she's not sure what happened to the girl after that. For veteran emergency nurse Joan Spaulding, the heroin death of a local teenager last summer was especially troubling.

(Spaulding) "I can still remember that day saying, 'What's going on in this town that kids are dying of overdose?' I mean it was a big wake up call for this ER - it was a shock. And I had worked in New York City, so I had been exposed to drug use there. And I was very disturbed when we started having heroine problems in this little town in Vermont."

(Keck) It's the overdoses and deaths that make the headlines. But Rutland emergency physician John Hartman says heroin abuse causes many other medical problems that people may not be aware of.

(Hartman) "People who develop these habits will neglect nutrition, will have very irregular sleep patterns. A lot of times people's abilities to function within their families and within their jobs are impacted by those kind of issues. In the longer term, all of the infectious disease processes. Everybody thinks about things like AIDS and Hepatitis - but there are a number of other problems that can be very significant. Skin infections, bone and joint infections, septic emboli to the lungs are all reasons that people can wind up in the hospital with really very significant disease."

(Keck) While HIV is more widely known, Hepatitis C - a chronic blood-borne infection that affects the liver - is spreading rapidly. According to the U.S. Centers for Disease Control, 90% of injection drug users become infected with Hepatitis C within six months of using injection drugs. And 80% of people who are infected with the disease show no signs or symptoms, and often don't even know they have it. Vermont health officials say that makes it very difficult to track the spread of the disease in the state. Rutland emergency nurse Joan Spaulding says she's seen first hand what Hepatitis can do.

(Spaulding) "I know of a child who became a drug addict. They were I think 17, and they needed a liver transplant already because of drug use. So that's a pretty scary consequence."

(Keck) Besides the problems caused by sharing dirty needles, emergency physician John Hartman says the drug itself - the heroin - may be tainted.

(Hartman) "There's no quality control on the street. So what you're buying as a mixture of heroin may be pure or almost certainly will not be. So things that are mixed into the product that people are buying on the street can cause these problems."

(Keck) These are problems that are not only costly to the individual in terms of quality of life, but they're costly to the hospital as well. Heroin addicts are less likely to have insurance. So, the hospital - and in effect the entire community - must pick up the bill for treating them. It's one more reason private insurance premiums keep going up. Dr. John Hartman says with heroin, everybody loses.

(Hartman) "The loss of citizens to these illnesses that take them away from happy productive lives is staggering, when you think of it. We're a fairly small community and for a community this size to have the degree of drug diversion and intravenous drug use and drug-related illness is quite concerning. We've got a whole generation of young people who are at risk."

(Keck) Seeing so many young people hurt by heroin prompted emergency nurse Joan Spaulding to join Rutland's Heroin Task Force. She admits that the more she reads and hears about heroin, the more frightened she is by the drug. She says the parents who come to the emergency room after their child has been brought in are so frustrated and lost. It's hard to watch, she says.

(Spaulding) "It really puts a lot of emotional strain on a nurse. It takes awhile when you go home to kind of unwind from it. Because there are problems there that you know need to be solved, but you're not sure who's going to do it or how it's going to get done."

(Keck) In addition to treating the problems caused by using heroine, Dr John Hartman says Rutland's emergency department must also treat the problems caused when people stop taking the drug.

(Hartman) "You read in the paper that a number of people have been arrested with a large amount of heroine or cocaine and in the following week we see a very noticeable uptake in the number of people who are requesting detox. As the supply dries up, they begin to have withdrawal symptoms, they start to feel bad. They try to seek relief not only from withdrawal symptoms but, if we're lucky, it's a wake up call and they really are serious about seeking help."

(Keck) National statistics indicate that about a quarter of emergency department visits concerning heroin are made by addicts who want to stop. Currently, opinions vary on the best way to help them do that. Everyone interviewed for this story agrees that if Rutland is going to adequately address its growing heroin problem, the whole community will have to help solve it. Doctor Harry Chen, medical director of the emergency department at Rutland Regional Medical Center is optimistic that things will get better. But he says the fact that many of the same people keep coming back to the ER with heroin-related problems shows that they've got a long way to go.

For Vermont Public Radio, I'm Nina Keck in Rutland.
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