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Quick Response Teams take personal approach to ODs

March 13, 2018 GMT

HUNTINGTON - A simple small town value may soon prove to be one of the most effective methods in reversing the damage of the opioid epidemic in Huntington - once dubbed the “Overdose Capital of America” by national media.

To know your neighbor and their problems, to offer a kind word and a hand-up at their life’s lowest point have until recently eluded any systematic practice in the grand scheme of troubleshooting addiction. In the more than 4,200 overdose calls in Cabell County since 2014, a first responder’s job nearly always ended when the naloxone injection stopped. Once revived, the patient and paramedic parted ways, too often to be reunited under identical circumstances.

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But since last December, Huntington’s overdose victims have begun meeting a new type of care based on the simple, neighborly principals delivered right where they live - all in the belief that no person wants to live a life of addiction and will someday seek help if it became available.

Organized through Cabell County EMS, the Quick Response Team takes the field as a three-pronged effort by local medical care professionals, mental health specialists and law enforcement to visit every overdose patient in person within 72 hours of their overdose.

These teams assess each individual’s needs and develop a personalized plan for intervention, referring them to the region’s numerous addiction service providers often out of sight or mind for many struggling with addiction.

The three-person teams work a full work week, often more, each staffed by medical personnel from Cabell County EMS, a Huntington police officer and a representative from either the Prestera Center, Recovery Point or the Huntington Comprehensive Treatment Center.

The driving forces behind establishing Cabell County’s QRT began Aug. 15, 2016, when 26 overdoses were reported near Marcum Terrace in a matter of hours, propelling Huntington into the national headlines. Just as startling was an aftermath report from the West Virginia Department of Health and Human Resources, which found none of the victims had been referred for further treatment.

Searching for options with overdoses records skyrocketing, city leaders happened upon the Quick Response Team method, a program used in Colerain Township, Ohio. A Cincinnati suburb with the same opioid problems of the Ohio River Valley, the township was recording overdose totals in the low hundreds - while Cabell County was recording well over 1,000. Around 80 percent of overdose victims sought treatment after meeting with Colerain’s QRT.

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“That was a big light bulb on many of our parts that we’ve got to do this - it’s working, and we’ve got to do this in Huntington,” said Bob Hansen, director of addiction services at Marshall Health, who planned and organized Huntington’s QRT based on Colerain’s success. “I think everybody was ready to do something else and something different.”

The idea was unfortunately born as the City of Huntington was in the midst of financial woes in the first months of 2017, and the concept remained relatively dormant through the year except for around 30 unfunded, but encouraging home visits.

“I think we knew we were on to something, and then in the first week there was more validation that this is going to work,” Hansen said.

In late September, the program was shocked to life when it received a total of $1.35 million in grant funding over the next three years from the Department of Justice and Department of Health and Human Services, sending efforts to organize Huntington’s QRT into overdrive.

Three-fronted focus

Cabell County EMS, which already tracked every county overdose, naturally became the central command hub. The QRT’s medical component is staffed by the county’s own paramedics, who had previously responded to overdoses simply with naloxone rather than follow-up care.

“We’re tackling this in a way Huntington hasn’t seen before,” said Larrecsa Cox of Cabell County EMS, adding that many of clients she’s visited in her QRT capacity, she’s previously had to revive from overdoses as a paramedic.

At a QRT visit, the medical component is mostly there in an educational capacity to guide the patient toward the correct treatment options. Those who have liver complications, she explained, would be steered clear of a naltrexone, medication-assisted treatment option used to abate the effects of opioid dependency.

“We get to know them,” Cox said. “We try to establish a rapport with them so that they see we’re here to support them and not blame or shame them, or try to get somebody into treatment for numbers’ sake.”

The “quick” in the QRT name is for good reason - it’s by design that the team reaches its clients at one of the lowest points in their life, when they’re most likely to turn to treatment. It’s a very small window of opportunity, added Thommy Hill, a program monitor at Recovery Point West Virginia.

Now filling the clinician’s role in the QRT’s three-fronted focus, he knows addiction’s rock bottom better than most. Never in his own five years of addiction did he consider recovery an option.

“The party ends real fast when it comes to something like that,” Hill said. “When something’s got control of you, and you have to (use drugs) just to feel like you’re a normal person, who wants that? The disease of addiction is a vicious thing. It’s the only disease that will tell you that you don’t have a disease.”

It’s not uncommon for QRT clients to still recognize Hill from his darker days. Some can’t believe he’s in recovery, he said, responding that his life was no different than their own. Living under addiction comes with little self-worth, and just a little kernel of dignity or care- someone sticking their neck out for them, as he put it- can go a long way toward recovering a life.

“It just took somebody acting like they cared,” Hill said of his own first steps. “Deep down in everyone’s heart, they don’t want to be a dope fiend living in boxes, couch surfing, doing all that stuff. It’s just a matter of relating to them and getting them into the state of mind that they can change.”

Unlike the EMS or law enforcement members, a QRT visit may be the first time the patient has ever met with a clinician. In addition to Recovery Point, the QRT clinician’s role is also staffed by Prestera Center and the Huntington Comprehensive Treatment Center.

The goal isn’t to get more patients to one center or the other, but to choose a path to treatment most effective for the patient, such as a medication-assisted treatment like methadone, Suboxone and naltrexone, abstinence-based recovery or dual diagnosis, which is simultaneous treatment of addiction and any mental health issues.

Many of these treatment options are now covered through Medicaid should the patient qualify. If they are not enrolled, the QRT can also refer to the DHHR for help in signing up.

While seeing a clinician may be a new experience, many QRT clients have encountered law enforcement in one form or fashion. For some, a police officer may be one of the last people they want to see at the lowest point in their life - many with outstanding arrest warrants for low-level offenses.

For the Huntington Police officers who staff the QRT, it’s a delicate balance between acting as law enforcement and nudging patients toward their own recovery, said Cpl. Christina Trembly.

Officers dress in plain clothes when traveling with the QRT to appear more accessible, and will sometimes step back from conversation entirely if the client feels uncomfortable. There’s no reason to be aggressive in enforcing the law at that time, Trembly added, as getting the patient into treatment serves that purpose just the same.

“Somebody who is wanting to work with the QRT program (toward recovery) is going to be someone who will want to stop doing illegal things - doing drugs and buying drugs,” Trembly said. “That is our goal as law enforcement - that people aren’t buying, using or selling drugs.

″(Clients) making that step is as useful as us making an arrest. They’re already doing all the work for us.”

First fruits

It wasn’t long before the program began showing signs of success. Within the first week of visits, the QRT began encountering not only patients who wanted treatment, but others inside the same home who also wanted the team’s help.

“That was sort of our ‘A-ha!’ moment - that people were out there wanting help,” said Connie Priddy, QRT coordinator. “They just didn’t know how to get it or where that first step was. I think the QRT is going to be that first step for them.”

In their first month alone, about 40 people were referred into treatment, and Cabell County’s daily overdose average has declined by more than one a day since September 2017 to about three-and-a-half currently.

Time will tell if the QRT will have a tangible, proven impact, Priddy said.

“If one day I came in here and there wasn’t one overdose on our records the day before. That, to me, would be the ultimate goal,” she said. “But we’re not even close to that right now.”

It’s become a misconception that QRT visits first require an overdose, which is not the case. Referrals for a QRT visit can be made any time by calling 304-526-8541.

Follow reporter Bishop Nash on Twitter at @BishopNash.