In the weeks following the three tragic heroin overdoses and one death in the village of Quinhagak, communities across the Delta are asking about future treatment for overdoses in the region and heroin users in general. KYUK spoke with Ellen Hodges, Chief of Staff at the Yukon Kuskokwim Health Corporation— just one of the organizations trying to clean up the wreckage heroin leaves behind.
Hodges says YKHC is going at the problem from several angles.
“If we can prevent people from getting addicted to prescription pain pills, we can potentially prevent them from becoming heroin addicts," Hodges said.
Hodges has seen the rise of heroin in Western Alaska. She sees the loose regulations of prescription pain killers as the gateway to heroin use. YKHC has a program it calls a Prescription Pain Agreement with its patients, which means patients are given drug tests to determine if they might be at risk for abusing pain medications.
“This is program where patients who have pain from arthritis or other chronic but not terminal conditions can get prescriptions for opioids on a chronic basis," Hodges said.
Hodges says this is just one way to reverse the effect of years of over-prescribing opioids, but in some ways, the program has come too late. Just like in other places across the country, painkiller addiction has transformed into heroin addiction, and now YKHC has the challenge of dealing with overdoses.
“In a community this small," Hodges said, "even having one or two deaths is remarkable. Simply because it implies the number of active users you have is pretty darned high.”
When four people overdosed in Quinhagak, YKHC was in the process of distributing a drug called Narcan to its clinics, an effort underway since May. The drug can stop overdoses from being fatal. Quinhagak did not have the drug in stock at the time of the incidents, but Hodges says it might have been too late to use it anyway.
“So let’s say you have a family member or friend overdose with an opioid, and they quit breathing. It’s going to take, in the best of circumstances, ten or fifteen minutes for health care professionals to arrive at your side. It’s too late at that point. So that’s the thing about Narcan that people don’t realize, is that it’s not really a magic bullet," said Hodges.
Hodges points to the need for the education of the general public about how the drug can be used. She says the drug can be ordered without prescription directly from YKHC.
The day of the overdoses in Quinhagak, community health aides were able to give CPR to the victims, but Hodges says the workers are not trained to deal with overdoses.
“We’re not sure in a lot of ways, when someone has a sudden death in a village, whether or not it’s attributable to heroin, or alcohol, or other medical conditions that are underlying. I think in this particular case there may have been community rumors that there was heroin in the community, so they may have had an idea. But the first person they assessed, they may not have known that heroin was the cause of that person's condition or even the subsequent patients'. In some senses you would treat everyone with an emergency according to the BLS algorithm, which is basically the same no matter what the presenting complaint is. So in that sense, the level of care that our community health aides were trained to provide was provided," Hodges said.
The hospital is planning to open a new inpatient treatment facility for heroin and alcohol abuse as early as October. Hodges hopes the facility will be able to accommodate as many people as need help but says the biggest challenge will those same people returning to communities where heroin is still available.