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With opioids becoming more potent, Loudoun responders need greater doses of antidote

Doug Manuel with the Loudoun Volunteer Rescue Squad helps prep the ambulance for a shift. Times-Mirror/Alexander Erkiletian
A few years ago it would have been relatively rare for Loudoun County Volunteer Rescue Squad Chief Tony Mino to get a call about a heroin related overdose. Now, Mino says it's an average of one-to-two calls a week.

“It is not necessarily a young person's disease. Age doesn't matter. It can be teens to senior citizens. It could be rich or poor,” Mino said. “I have attended incidents where a 50-year-old overdosed and a 40-year-old lawyer overdosed.”

Mino has been working for Loudoun County Volunteer Rescue Squad for 10 years and as chief for nearly three years. He started working in rural Connecticut in emergency medical services as a volunteer in 1984.

Through an arrangement between Loudoun County and the local hospitals, the Loudoun County Volunteer Rescue Squad responders are equipped with Naloxone, an opiate antidote that negates the effects of heroin or other opioids in the body.

Naloxone can be given as a nasal spray, as an intramuscular injection or intravenously. Mino says intravenously is the quickest trigger, with the antidote working on an overdose victim in as little as 30 seconds. The nasal and intramuscular methods take around five minutes to kick in.

Narcotics bind to opioid receptors. When people use too much of an opioid, it leads to feelings of euphoria and sleepiness.

Mino explained how Narcan/Naloxone works.

“Opioid overdoses actually stop people from breathing. They affect the central nervous system and the desire to breathe,” Mino said. “When Naloxone is used, it binds better with the opioid receptors than the opioids do. It does it very quickly and negates the effect of the overdose. The effects last 30 to 60 minutes.”

Mino described the antidote as a Band-Aid to the problem. “Narcan wears off after around 60 minutes. So if there's a lot of heroin in the body, that can take over again.”

But not everyone who is experiencing a heroin overdose is given Naloxone. “A month ago I had a patient who'd done heroin, his respiratory drive wasn't affected, so I didn't give him it,” Mino said.

Naloxone might be a powerful life-saving antidote, but its potency is being increasingly compromised by the effects of stronger opioids making their way into the drugs market, like heroin cut with carfentanil. Carfentanil is an elephant tranquilizer 10,000 times more potent than morphine and 100 times stronger than fentanyl, another popular opioid favored by addicts.

According to Mino, when EMS come across overdose victims who might have carfentanil in their system, then much higher doses of Naloxone are needed to revive them.

“It's a challenge to our EMS. We are sometimes needing three times as much Narcan to wake somebody up,” Mino said.

Mino said he's also worried that first responders are not carrying enough Naloxone to deal with an unconscious man or woman with high levels of opioids in their systems.

Plus, saving a life using Naloxone doesn't necessarily bring gratitude from those who've overdosed.

“Giving Naloxone comes with risks,” Mino said. “It has a physical and a psychological impact. People can become angry because we have killed their buzz, they may get nauseous, become violent, their heart rate goes up.”

“To mitigate against such a response, only the smallest amount of Naloxone is administered, to help them start breathing. We try not to wake them fully,” Mino added.


Addiction is a choice not a disease!

Tomas, they are sometimes minorities too which is a triple fail.  If you are black or mexican and an addict AND a thief..well I don’t want you in my community!  You’re clearly a special person who understands the problems surrounding this issue.  Good on you for getting a no good loser brother into jail for us!

Hope for Leesburg July 31 - August 19, 2017 is being held under a big tent at 850 Edwards Ferry Road NE in Leesburg, Va.

Hope for Leesburg is a twenty-day series of events which provide an opportunity for us to focus on the One who can meet the deepest needs of the human personality, Jesus Christ.

“BURN” Saturday August 12, 9:00 AM – 9:00 PM All-day prayer and praise led by various local teams.

“OUTCRY” Saturday August 12, 4:00 PM - 9:00 PM
Incorporated in the day-long “Burn”, and jointly facilitated by Loudoun Burn 24/7, Fellowship of Christian Athletes, the Freedom Center, “OUTCRY” is a unified gathering of believers crying out to God in repentance, worship, and prayer for this rising generation… taking a stand against the waves of suicide, addiction, and drug overdoses ravaging the youth of Loudoun County… releasing hope, freedom and life.

I’m both surprised & appalled at the lack of knowledge about the disease of addiction, as well as the lack of basic human compassion. The opioid epidemic is taking the lives of more & more people daily; including LoCo residents from teens to older adults, all races, & all economic statuses.
@Fred - To call addicts “weak and stupid people…mostly thieves,” simply making a “life choice,” is false & ignorant to the facts about this horrible disease & those impacted. Sure, let’s just do what another heartless & uninformed commenter here said & “let them die” so we can save ourselves tax dollars, because these folks are obviously losers & of no use to society, right?! Are you serious? Are you human? I wonder if you’d be saying the same if your son/daughter, spouse, sibling, or close friend became addicted? If it was a matter of just choosing to stop, the problem wouldn’t exist & be growing rapidly. Try educating yourself & becoming part of the solution because recovery IS possible.

Can’t we just go back pretending there isn’t a problem? That will fix it and we can live happily ever after!

ChocolateDinosaur The art of trolling requires more finesse. What the French call a certain “I don’t know what”

Maybe a better way to help with this problem is this: Any time an addictive opioid is prescribed from doctor to patient, a third party doctor or rehab specialist must be involved to make sure the patient can get off the drugs when the prescription period is over. Doctors know when patients are lying. I once had a really good employee who had surgery, was prescribed opioids and got hooked on them. She pharmacy shopped to get refills anywhere she could, driving all over VA. Her work suffered and I almost fired her. I told her to leave the office for two weeks and not to come back unless she was clean. To her credit she went home and sweated it out and got off the drugs and she admitted all the pain she thought she was in was just her addiction making her think she was in pain. She went right back to being a top notch employee. A third party could have helped her, someone who specialized in knowing the symptoms of addiction as well as the treatments. Now, for hard, illegal drug users like heroin addicts- I have no sympathy. I lost a niece recently to a heroin OD and I have no sympathy for her, just the children she left behind.

Tomas - Assuming you’re statement is correct, “only weak and stupid people become drug addicts”, do they deserve to die?  Should we not at least try to save them?

Chris - I disagree vehemently. You have bad doctors who prescribe drugs to drug addicts. You have good doctors who prescribe drugs to wannabe drug addicts. You have good doctors who prescribe drugs to good patients. You have those who buy on the open market, which I have little to no compassion for addicts, like my brother that I sent to prison for many years. You can say what you want, but only weak and stupid people become drug addicts. I’ve been through more issues, surgeries, etc. than my entire street combined, unfortunately, and being terminally addicted, to anything, is a life choice. Fred/Chocolate - not only those burdens, but most are generally thiefs, robbers, etc. and place a massive strain on our court and penal systems. Their overall financial burden, which they rarely fund for personally, as they are too poor, gets rolled back directly into our taxes, ironically.

I’d take it a step further and say that suspending all emergency services would be in our best interest as far as saving money.  If you can’t make it through life on your own then you don’t deserve to live.

I’m with Fred on this subject. This is not a essential core government issue. Doctors need to foot the bill for their patients rehab not the taxpayer.

Keep in mind that many people become hooked because they are over prescribed by doctors for pain killers.  This is not an excuse but merely a fact.  Once the prescription ends the user is already hooked on the opiate.  They then have to continue using the prescription which is expensive or they turn to the cheaper option of heroin.  Yes they can try to stop but it’s not like just saying ok tomorrow I’ll stop using.

Addiction does not classified by status. So that is one of the stupidest things I have ever heard.  Have you ever seen someone withdrawal from Heroin?  I have.  It’s not a pretty site.  I’m a smoker and have quit on previous occasions.  The withdraws for a smoker are nothing compared to what someone who has been addicted to an opioid goes through.

You cannot just stop cold turkey! Your body goes through withdraw and that person could die. Drug addiction is such a serious problem is LoCo ( everywhere for that matter) but if they would stop building banks and putting up empty office buildings all over Route 7 then maybe they could utilize that space and maybe build a rehab facility for the addicts.

for such a “wealthy” county I cannot believe this goes on. These people who abuse heroin just need to go cold turkey. I used to smoke cigarettes for close to 5 years and just stopped cold turkey mainly because cost kept going up. They are like $5 in VA and $8 in MD a pack to date. For anyone who has quit…its is NOT easy.

If addicts die, you won’t have a reoccurring problem in the county and the drug dealers will run out of customers. Kill two birds with one stone if just stop using Naloxone.

Chief Mino - Thank you for your service.

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