by , [email protected]

Get them treatment. Now.

It’s the answer that area addiction experts have in response to a furious outbreak of overdoses in Cincinnati and Hamilton County that started with more than 30 people in hospitals on the weekend and another 21 people Tuesday night alone.

As officials were reeling on Wednesday, the addiction treatment community said there is a communication and protocol problem that prevents those addicted to heroin and opioids from getting into the most effective treatment. That treatment consists of medication with psycho-social counseling and wrap-around services to ensure people get to their appointments and remain stable.

“We’re using horses against tanks,” said Dr. Jeremy Engel, of St. Elizabeth Physicians. “Every individual at risk for impulsive use of heroin should have case management and be stabilized on medication – Vivitrol, Suboxone or methadone. As they are identified, they should be immediately connected to this treatment.”

Dr. Shawn Ryan, a certified addiction expert and founder of BrightView Health, an outpatient addiction medicine practice with offices in Norwood and Colerain Township, said all providers, from emergency staff to treatment centers and doctors who practice addiction treatment, should be connected.

“There needs to be communication among all the providers involved,” Ryan said.

“This is a serious, life-threatening illness,” Ryan said. “Nowhere else is there a complete lack of communication or lack of multiple doctors for a life-threatening disease.”

The Hamilton County Heroin Coalition alerted first-responders, police, emergency departments and treatment providers over the weekend and again on Tuesday to the surging number of overdoses so that those affected could be revived with naloxone. The coalition warned that many victims had to have multiple doses of naloxone – indicating that heroin was not the only substance in the drugs injected. All of the overdose victims survived in that period.

On Wednesday, however, a man died in Avondale, the victim of an apparent overdose.

Many of the overdoses this week occurred in West Side communities. Mercy Health handled 16 in a 24-hour period on the West Side alone, along with 10 Tuesday evening in its other four hospitals, spokeswoman Nanette Bentley said. It could not be learned where each of the other overdose victims were treated.

Ryan experienced the weekend overdoses firsthand while working in Jewish Hospital’s emergency room.

“It started Saturday. We had seven overdoses in six hours,” Ryan said. “One man … it was definitely carfentanil.”

Carfentanil, an analgesic used for elephants and other large animals, has been spreading through the United States and Canada. It’s the opioid that was spotted in heroin in Greater Cincinnati in July.

Akron and Columbus police departments reported overdoses from the drug in July, and the Hamilton County Heroin Coalition warned users, the general public, medical providers and law enforcement of its presence and potency.

Naloxone, the opioid and heroin overdose antidote, can work on carfentanil overdoses, as it can on fentanyl, a powerful prescription painkiller that’s been blamed for an increasing number of overdose deaths in the Tristate as well as the country.

Naloxone, also known by its brand name, Narcan, is a narcotic antagonist that blocks opioid receptors, forcing a person into immediate withdrawal and restoring breathing.

Treatment providers and public health officials recommend that anyone at risk for overdose, and people who are with them, carry naloxone and be prepared to call 911 and use as many doses as necessary on a victim.

Dr. O’dell Owens, the interim Cincinnati Health commissioner, said he is having everyone in the health department and clinics, “even our receptionist,” trained to use naloxone, so they can be prepared to help save lives.

“It is readily available without a prescription,” Hamilton County Health Commissioner Tim Ingram said.  “Don’t worry about administering too much naloxone.” He then recommended going to injecthope.com or to a physician for help finding treatment.

Ryan suggested people get the Adapt Pharma Narcan nasal spray. Narcan is the brand name for the generic naloxone.

In February this year, Adapt Pharma announced the commercial availability of the first and only FDA-approved naloxone nasal spray. The difference between this and others, Ryan said, is its concentration. The spray comes in a four-milligram concentrated dose.

“Everyone who uses or knows someone who uses should be armed and trained to use Narcan,” said Dr. Lynne Saddler, district director of the Northern Kentucky Health Department. “It is important for those with (it) to  call 911 first when they encounter someone who has overdosed, because the little bit of Narcan they have may not be enough and will require emergency medical assistance.”

At Mercy Hospitals, said Bentley, “We are ensuring that we have enough Narcan, the rescue drug, available to treat the overdose cases we see. Some of these patients require multiple doses or an infusion of Narcan and that can deplete supplies.”

Because of that, she said, the emergency staff can also “sedate patients and protect their airways … while they metabolize the drug from the systems.”

“We are also keeping in close communication with our emergency medical services and law enforcement partners to ensure we’re aware of situations such as more lethal heroin entering the region,” Bentley said.

Dr. Christine Wilder, a University of Cincinnati College of Medicine assistant professor who specializes in addiction sciences, said that ideally, anyone who overdoses should get acute medical care and be immediately connected to treatment services.

“The reality is that that is very difficult logistically to have a system that gets people appropriately into treatment,” she said.

Emergency rooms don’t as a rule have doctors who prescribe addiction medications, for example, she said.

In Northern Kentucky, the CEO of Transitions Inc., the region’s largest provider of addiction help, said he receives calls from a few doctors for when they see an immediate need for treatment for a patient – and he gets them in. “If they haven’t had breakfast, we say, ‘we’ll get them breakfast, have them come in,’ ” Jim Beiting said.

Brightview’s Colerain Township office opened two weeks ago and is accepting patients, Ryan said.

Brightview patients and families who call in for an appointment hear a series of questions, Ryan said, including this: “Have there been any recent overdoses?” If so, that moves the patient to quick care.