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A radical proposal to withhold treatment to individuals frequently overdosing in an Ohio town drew so much national media attention that city officials have decided to stop publicizing the city's overdose data, a city official told Independent Journal Review.
After opiate overdoses and deaths in Middletown, Ohio, skyrocketed over the past two years, city council member Dan Picard proposed a rule to help save the city money and, he hoped, deter opioid abusers from making deadly decisions. Dubbed a “three strikes” proposal by the media, it would have allowed paramedics to refuse treatment to opioid overdose calls for individuals who had been identified as frequent offenders.
Picard introduced it informally earlier this summer, but then withdrew it in late July following legal backlash and extensive national press coverage. That included a Washington Post report that caused Trump administration officials to balk privately at Picard's comments.
Now, in response to national media attention, the city will not publicize the overdose data it usually includes in its annual heroin summit reports.
“We just felt that Middletown was being singled out,” Fire Chief Paul Lolli told IJR.
After a first call, individuals who overdosed would have been sent to court to pay a $1,104 fine — the average cost of treatment by paramedics for an overdose. After a second call to the paramedics for an overdose, the individual would be fined double the cost. In each sentencing, the individual could do community service in lieu of the fine. If dispatchers could identify the person overdosing as a third-time overdoser who had not paid their fines or done their community service, paramedics could then decide not to respond. Treatment and rehabilitation were excluded from the proposal.
Following the proposal's withdrawal, Picard suggested publicity that the measure had a tangible effect: a drop in overdose calls.
“They're down like 60 percent, so that's certainly helping us,” Picard said. He noted that though there was no proof to suggest a causal relationship between the proposal and the drop in overdose calls, Picard said the town's fire chief, Lolli, believed the publicity may have had something to do with it.
“The people out there are very afraid that no help is coming if they overdose,” Picard added. “I can't point to any particular facts. I can only point to the fact that I made the proposal and calls dropped off significantly after I made it.”
According to data obtained by Independent Journal Review, overdose calls in July were on track to be lower than those in June. There were 112 opiate overdose incidents in June and 57 incidents between July 1 and July 23.
The rule posed ethical, legal, and logistical quandaries: How would the city correctly identify third-time overdosers? Could a city refuse care to individuals? Was any of this even legal?
Picard was seemingly unfazed by critics, but when the ACLU sent a strong letter condemning the measure a week after it was introduced, it forced him to rethink his approach to the issue.
Though Picard, an attorney, had determined that he would not have run into legal issues, the legal opinion of the council and municipal judges determined it would be subject to lawsuits.
“My proposal was an effort to save the city money, and if my proposal was costing the city more money by running up huge legal fees, it defeats the purpose of my plan,” Picard told IJR.
Officials said Middletown, with a population of approximately 50,000, gets about four or five overdose calls each day. The cost of each dose of naloxone, the drug used to counteract the effects of an opiate overdose, is about $36. Thanks to more powerful opiates, such as fentanyl, becoming more common in the marketplace, first responders often have to use several doses of naloxone to make someone overdosing stable. This year, the city estimates that it will spend about $90,000 on naloxone, which makes up half of the budget for medications supplied in city ambulances, according to NPR.
One major problem, Picard says, is that many individuals overdosing are transients, coming into the city for a quick fix and leaving. Others don't have a permanent address or form of identification for billing. Another is that the city doesn't have the manpower to respond to all the overdose calls coming in. With only three paramedic units in the city, dispatchers often have to call in ambulances from nearby towns to respond to overdoses. Response time for these runs can take 20 minutes to a half hour.
Without Picard's measure, the future of overdose prevention in Middletown is unclear.
There are no public plans to open up publicly funded treatment facilities in the Middletown area, and while there are two private rehabilitation facilities, Picard doubts many of the individuals overdosing will seek treatment because many are transients or can't afford to check in. The city also has a needle exchange program and a voluntary program where participants are given Vivitrol, which helps fight opioid addiction.
“Prior to last year, this was not a serious problem for us,” he said. “We would need the money up front that we don't have.”
Editor's note: This story has been updated to include data on overdoses in June and July 2017.