By Chris Kenning
(Reuters)

The paramedics find them everywhere – slumped over car steering wheels, barely breathing in doughnut shop bathrooms or dead in derelict apartments and expensive mansions

For the Cataldo Ambulance Service crews outside Boston on the front lines of the U.S. opioid epidemic, the flood of overdose calls is a grim daily reality, despite expanded access to overdose reversal drugs.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics John Gardner (L) and David Farmer care for a man in his 40’s who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder

 

“When I started, this was a rare thing. You did one or two here and there. Now, we do quite a few,” said Dave Franklin, 44, a supervisor at the private service that contracts with cities who has worked in the field for more than 20 years.

In Massachusetts, EMS opioid overdose calls hit 20,978 in 2016, up from 8,389 in 2013, according to a state report.

 

Boston-area paramedics face front lines of U.S. opioid crisis
A Cataldo Ambulance medic holds used doses of naloxone after medics revived a man in his 40’s who was found unresponsive from an opioid overdose in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder

 

Amid wider use by bystanders and police of naloxone, a drug that reverses overdose symptoms, state figures showed a small drop in opioid deaths in the first nine months of 2017 compared with 2016. But Franklin does not yet see a turning point.

“It’s not going away anytime soon. People are still dying regularly,” he said.

 

 

In the United States, deaths from drug overdoses have surpassed deaths by firearms and motor vehicle crashes, according to a 2017 Drug Enforcement Administration report.

President Donald Trump has declared a public health emergency over opioid abuse, promising to increase treatment but initially dedicating no money for it.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics and other first responders revive a 32-year-old man who was found unresponsive and not breathing after an opioid overdose on a sidewalk in the Boston suburb of Everett, Massachusetts, U.S., August 23, 2017. REUTERS/Brian Snyder

 

Opioids, primarily prescription painkillers, heroin and synthetic drugs like fentanyl, a pain medicine 50 to 100 times more powerful than morphine, are fuelling the crisis. Opioid-related overdoses kill 91 people in the United States each day, the Drug Enforcement Administration said.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Bystanders watch as Cataldo Ambulance medics take a man in his 40’s, who was found unresponsive after overdosing on an opioid, to an ambulance in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder

 

On Thursday, the Centers for Disease Control reported, based on the latest available figures, that the U.S. rate of drug overdose deaths in 2016 grew 21 percent from the prior year.

“It’s hard to watch, and it’s devastating,” said Domenic Corey, 27, who has seen the evidence up close working as a Cataldo paramedic.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics Rick Yunker (L), Derek Travers (C) and Timothy Stahl revive a 38-year-old man who was found unresponsive after an opioid overdose in the parking lot of a Walgreens drug store in the Boston suburb of Malden, Massachusetts, U.S., October 19, 2017. The man was revived with 4mg of naloxone. REUTERS/Brian Snyder

 

Mornings before starting his shift, another Cataldo paramedic, Andrew Simpson, grabs his stethoscope, intravenous supplies, scissors and pen light.

At the ambulance, he checks to make sure there is enough naloxone. They carry more than double the amount they once did because stronger opioids mean that multiple doses of naloxone are often required for someone who is barely breathing.

 

 

Simpson, 34, works at least two 24-hour shifts a week in a high-turnover job that can be stressful and where pay starts at $14 an hour. Just touching Fentanyl can send an EMS worker into overdose.

Simpson’s radio crackles with calls. Difficulty breathing. Person down. Unresponsive. Overdose. They turn on the lights and roll. From experience, they know it might be a man who overdosed into unconsciousness while driving, a teen or elderly user passed out in a park or an already stiffened corpse in a hotel room strewn with needles and powder.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics take away on a stretcher a man in his 40’s who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder

 

On arrival, they spray naloxone up the nose or inject it into the user, pump oxygen into lungs and wait. Some respond gulping for air or vomiting and confused.

“Why are you in my house? What’s going on?” Simpson recalled as a common question from recipients of his aid. Some people are grateful and repentant, crying, shaking hands and promising to get treatment. Others deny they took drugs at all.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medic Jenn Mercouris delivers naloxone through an IV in the arm of a 54-year-old man who was found unresponsive and not breathing after overdosing on opioids in a bedroom in a house in the Boston suburb of Malden, Massachusetts, U.S., November 9, 2017. The man was revived with 8 mg of naloxone. REUTERS/Brian Snyder

 

The calls often come in waves when fentanyl too potent for users hits the streets. Time of day matters, too.

“If it’s in the afternoon, there’s a much better chance they are still alive,” he said. “If we get the call at 7 a.m., they probably shot up the night before.”

The paramedics say they often see families torn apart in front of their eyes or bereaved parents.

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance EMT Matt Tavalone takes notes as a 42-year-old female kicks the roof of the ambulance after she was revived with 8mg of Narcan given to her by a housemate before EMTs arrived on the scene in the Boston suburb of Lynn, Massachusetts, U.S., August 14, 2017. The woman who overdosed on an opioid showed signs of withdrawal caused by the Narcan. REUTERS/Brian Snyder

 

“You see the parents, they’re crushed; just the look of defeat, you know? They lost the most important person in the world to them. I can’t even imagine. But you see it over and over again,” Corey said.

The cost of naloxone has risen with demand, eating into the service’s budgets, Franklin said. But they are also using their steady overdose runs to help some cities map drug hotspots and for police to visit users to urge them into treatment.

 

Boston-area paramedics face front lines of U.S. opioid crisis
A Cataldo Ambulance medic escorts a 39-year-old woman to an ambulance after she was revived from an opioid overdose in a home in the Boston suburb of Salem, Massachusetts, U.S., August 15, 2017. The woman was revived with 4mg of naloxone. REUTERS/Brian Snyder

 

“In the back of the ambulance, you talk to them and hope they get treatment,” Simpson said, explaining that most agree they need to get help. “But then at times I’ll see the same person three months down the line and they have overdosed.”

 

(Reporting by Chris Kenning; Editing by Toni Reinhold)

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics and EMTs, along with firefighters, revive a man in his 40’s who was found unresponsive after overdosing on an opioid in the Boston suburb of Salem, Massachusetts, U.S., August 9, 2017. The victim received a total of 12mg of naloxone. Nurses at the hospital recognised the man, saying he was brought in the day before after overdosing. REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
A 41-year-old man found unconscious after overdosing on opioids in the driver’s seat of a car, with the engine running and the transmission in drive, puts his hands over his head in the back of a Cataldo Ambulance at a gas station in the Boston suburb of Malden, Massachusetts, December 2, 2017. A used syringe was found in the car with the victim, who was revived with 10mg of naloxone. REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
A woman identified as the victim’s wife watches from the front porch as Cataldo Ambulance medics take a 54-year-old man to the ambulance. He was found unresponsive and not breathing after overdosing on opioids in a house in the Boston suburb of Malden, Massachusetts, U.S., November 9, 2017. The man was revived with 8 mg of naloxone. REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics Paula Gageiro (L) and Al Driscoll (R) take a man in his mid-40’s, who was found unresponsive and not breathing in his car after overdosing on opioids, to an ambulance in the Boston suburb of Revere, Massachusetts, U.S., November 8, 2017. The man showed signs of withdrawal in the ambulance after being revived with 8 mg of naloxone. In response to repeated questions from the patient about what had happened, Gageiro replied, “You made a bad decision, you were dead.” REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
A 41-year-old man slumps over unconscious after overdosing on opioids in the driver’s seat of a car, with the engine running and the transmission in drive, at a gas station in the Boston suburb of Malden, Massachusetts, December 2, 2017. A used syringe was found in the car with the victim, who was revived by Cataldo Ambulance medics and EMTs with 10mg of naloxone. REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance third rider Wayne Taft arrives at the hospital with a 61-year-old man who was found unresponsive in the doorway of an apartment building after an opioid overdose in the Boston suburb of Somerville, Massachusetts, U.S., August 28, 2017. When the medics returned to the hospital hours later with an unrelated patient, they were told the man who overdosed had still not fully woken up. REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medics Ricky Cormio (L) and Luke Magnant take a 40-year-old woman out of a grocery store where she was found unresponsive in the store’s bathroom after overdosing on opioids in the Boston suburb of Malden, Massachusetts, U.S., November 15, 2017. After medics revived the woman with 10mg of naloxone on the floor of the bathroom, police found out she had been arrested in the past for charges including assault and battery. REUTERS/Brian Snyder

 

Boston-area paramedics face front lines of U.S. opioid crisis
Cataldo Ambulance medic Paula Gageiro drives to a reported drug overdose in Revere, Massachusetts, U.S., October 24, 2017. REUTERS/Brian Snyder