The Opioid Epidemic: The Impact to First Responders
(Warning: Below is a description of the opioid crisis that some people might find triggering and traumatizing.)
I waited for the police and the fire department to come to my location. There was a report of a dead body, another casualty of the opioid pandemic. It was a person that I had worked with, and I had come to know. He had now laid deceased in a vacant building for the better part of a day. In the harm reduction movement, this was an unfortunate part of my role; I was a first responder. Not in the typical sense of the term. At best, I was able to educate people on how to stay alive, at the very worst, I coordinated with the medical examiner to notify the next of kin, and I identified folks that I worked with, who were now deceased.
Three years ago, I sat with two friends in a conference room on the Southside of St. Louis, brainstorming a plan to expand harm reduction in Missouri. Harm reduction is a philosophy that promotes an individual’s ability to choose to use substances, and that all tools should be given to individuals to stay as healthy as possible. It is about meeting people where they are, regarding their relationship with chemicals and other illicit substances such as fentanyl. In 2018, I transitioned into harm reduction full-time in St. Louis providing Street Outreach and services at a drop-in center within a zip code that had the highest death rates in Missouri.
Recently, I stepped back from the harm reduction movement, and although I felt guilty, it was what I needed to do. I needed to reenergize my soul and my passion for the work that I do. Without knowing it, I was slowly overdosing on the pain and trauma that I was witnessing every day. It was slowly eating me from the inside out. Just as we have a medication that can reverse an opioid overdose, some tools can help providers and first-responders with processing trauma and pain experienced daily by those with whom we work. The term for this is self-care. Self-care is often only offered as lip service, the last slide on a presentation that is obligated, but not many people are intentional about addressing. As a person who was struggling with compassion fatigue, mostly, I had lost compassion for myself; however, my friends and family could see it quite easily. I was quick to get angry and very rigid. The smallest thing would set off a response which was out of proportion. A participant’s death did not phase me as much as a slight from a coworker. I did not see it then, but it was genuinely impacting me, but I was not processing it in a meaningful way.
The opioid crisis that I have come to know is about people pushed to the fringes of society. The individuals lost within the opioid epidemic are our children, siblings, family members, and friends. The individuals who by societies’ perception have chosen drugs over their family obligations, or friendships. The latter perception ultimately paints a substance user as inherently wrong when, in fact, the person continues to use to avoid pain, a very human and reflexive characteristic. When we start viewing substance users as less about the substance they use and more about the reason that they use it, it is when we change how we are thinking about those who use substances.
They are forced to dig out of trash cans, live in places designed to hold trash, not humans. Every day I would work with people, some stuck in a seemingly endless cycle, of treatment, aftercare, and sober-living until they have exhausted all resources. It is a beautiful thing when community members trust you enough to drive a person who is overdosing to you. When that becomes something that done several times a week, it can begin to take a toll on you. For example, after working on one young man driven to my location, I had to breathe for him for ten minutes after administering four doses of Naloxone. Luckily, he survived. After working that case, we went back inside and started to work with other people that were seeking help, without any time to decompress or to process what happened. In the nights that followed, I would have dreams about him, and I would see the face of my newborn son.
A coping mechanism that I learned was not to look at a person if I had to find them deceased in a vacant building. I remember all of their names. I made it a goal to ensure that the medical examiner’s office was able to notify their family. For some families, it would be a shock, but for many, it would be a relief to know their loved one was out of pain. All of the individuals that I have worked on survived their overdoses, although a few eventually overdosed and died. It is a difficult thing to accept that there is only so much that we can do. I find that notion unacceptable, but it is really about discovering all I can do is build relationships with individuals who, outside of the dope man, might not engage another human in a meaningful way.
The National Institute of Occupational Safety and Health (NIOSH) identifies first-responders and public health workers are at risk of experiencing stress from what psychologists refer to as a traumatic incident. A traumatic incident is one that may involve exposure to catastrophic events, severely injured children or adults, dead bodies or body parts, or a loss of colleagues. In 2018, the overdose death rate in the United States was roughly 70,000. More people die annually due to overdose than all of the causalities in the Vietnam War. From my vantage point, it is appropriate to recognize that the opioid crisis most closely resembles a war, regarding the loss of life.
Often, working in highly traumatic situations, there is a risk, out of sheer necessity, to work a case by the numbers, a phenomenon observed in professions with high levels of stress and trauma, such as among first-responders and soldiers in war-time. Grab the Naloxone, sternum rub, 911, rescue breaths. The Naloxone has always worked for me, thankfully. The person is usually confused. We want to take the moments after to try and get the person linked to treatment. Moments before, that same person was on the brink of death. More than a couple were quite literally dead as I worked on them.
I have worked within social services for seven years prior. Trauma is something that I have come to know professionally but I am personally acquainted with, as a result of the opioid epidemic. Through my own family, my parents, and I, I have witnessed the toll that drugs can take. I have seen the erosion that occurs over time and the despair that fills the void. Nothing could have prepared me for what I would witness in the community. No amount of academics, professional training, or seminars worked. It was only by working with it directly, in real-world situations that I became acquainted with the intimate impact on trauma. There is a toll that trauma takes on you personally as you help others to deal with their trauma.
What we fail to discuss is the secondary toll trauma has on individuals within harm reduction spaces. The new industry standard is to use certified peer specialists. How are we anticipating the impact that secondary trauma takes on them? If we are not planning and preparing for it, then are we merely waiting for them to relapse at which time another peer takes their place?
NIOSH recommends that all workers involved in response activities help themselves and their coworkers and reduce the risk of experiencing stress associated with a traumatic incident by utilizing simple methods to recognize, monitor, and maintain health on-site and following such experiences.
Strong emotions are common reactions to a traumatic or extraordinary situation. Workers should seek mental health support from a disaster mental health professional if symptoms or distress continue for several weeks or if they interfere with daily activities. Emotional symptoms include:
- Loss of emotional control
- Sense of failure
- Feeling overwhelmed
- Blaming others or self
- Severe panic (rare)
As a result of a traumatic incident, workers may notice the following behavioral changes in themselves or coworkers:
- Intense anger
- Emotional outburst
- Temporary loss or increase of appetite
- Excessive alcohol consumption
- Inability to rest, pacing
A starting point might be to acknowledge the magnitude of trauma and catastrophic loss within the opioid epidemic; the toll it is taking on those who do this critical work and the resources that are needed to do this work. Only then can we start to look for the signs and symptoms of dealing with traumatic stress. Time away from the movement has allowed me to focus on my family, my newborn son, and it has allowed my heart to heal. I am ready to reenter the movement, but I do so with a piece of newfound knowledge and respect for how trauma and secondary trauma impacts my soul.
Sensational news reports and media stories typically touch on the personal loss that has been suffered but can never truly feel the depth of suffering preceding that severe loss. An omission for many that we work with that includes the pain and devastation leading up to death. When many ultimately succumb to the end, they are have arrived in a place where society views them as less-than-human. There are, however, a group of hard-working and dedicated harm reductionist, health professionals, and volunteers who are meeting folks where they are on the front line of this epidemic.
As I reflect on it now, my only regret is that I did not spend more time building in safeguards to help protect those who would do this critical work. Hind-Sight allows for a lot of second-guessing. What I know to be true is that as we, as a movement, maneuver to address an epidemic, we need to actively address how this epidemic is impacting those who are on the frontline, doing essential work within the movement. We must provide better care for people that are doing this highly traumatizing work.
Aaron M. Laxton, MSW, LMSW is an addiction therapist in St. Louis, Missouri. He co-founded the Missouri SAFE Project, Missouri’s 2nd Syringe Service Program. Both of his parents were opiate users, and he has lost three members of his family due to opiate overdose.