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A supercharged form of heroin appears to be the cause of nearly 50 overdoses in nearby cities, putting local public safety officers on alert as they brace for the possibility of the drug's arrival here. The heroin is laced with fentanyl, a powerful painkiller used to treat patients recovering after surgery. The Drug Enforcement Administration calls the synthetic opioid 50 times more powerful than heroin. The combination offers addicts a more intense high — but sometimes with a deadly consequence. In Jennings County, about 80 miles south of Indianapolis, one person died and 11 more overdosed Tuesday. Several more people overdosed in the Cincinnati area on Friday, according to The Cincinnati Enquirer, with the number continuing to grow as recently as Tuesday evening. While paramedics in Indianapolis haven't witnessed a surge in overdoses, EMS officials issued a warning to all staff and firefighters to be aware of the highly toxic drug, said Dr. Not that Indianapolis has been immune. A few months ago, O'Donnell said, the area had a number of overdoses caused by fentanyl-laced heroin. Greg Westfall, the special agent in charge of the DEA's Indianapolis office, said undercover agents in Indianapolis have purchased what they thought was heroin, only to discover later it was straight fentanyl. The fentanyl sold on the streets is a knock-off of the drug that goes to pharmacies, Westfall said. It's made in underground factories in China, then shipped to Mexico, where cartels smuggle it throughout the U. On Monday, five pounds of fentanyl were seized during a traffic stop on I in Henry County. Police arrested year-old Gustavo Romero of California. In the beginning, Ernstes said the dealers were mixing, or 'stomping,' the fentanyl with heroin. In Seymour, police arrested Michael N. Purvis, a year-old man suspected of dealing the drug to those who overdosed. He also suffered an overdose. Purvis admitted to buying the drug from someone in Jennings County, who had likely purchased those drugs from someone in Cincinnati, police said. Purvis was held Wednesday in the Jackson County Jail on charges of dealing a controlled substance, according to online records. For four of the people who overdosed — three in one home — police were forced to use multiple doses of naloxone to reverse the effects of the opiate, said Craig Hayes, assistant chief of the Seymour Police Department. Police are waiting on lab tests, but they think the drug was heroin combined with either fentanyl or a similar but even more powerful drug called carfentanil, which is intended for use in elephants and other large animals. While Indianapolis has not seen an unusual spike in overdoses, paramedics have been on runs where multiple doses of naloxone are required to save a patient's life. Naloxone use has increased dramatically here in recent years. In , paramedics used naloxone times, Rochelle said. That jumped to 1, in the following year. Last year, it was used 1, times. This year, so far, Indianapolis is on track to reach 1,, with 1, uses to date. The record high came in July with uses. Over the Fourth of July weekend, there were 10 such calls one day and 12 the next, Rochelle said. You may save their life!! Call IndyStar reporter Vic Ryckaert at Follow him on Twitter: vicryc. Call IndyStar reporter Shari Rudavsky at Follow her on Twitter: srudavsky. Supercharged heroin puts Indy on alert. Facebook Twitter Email. Share your feedback to help improve our site!

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Official websites use. Share sensitive information only on official, secure websites. E-mail: Marlene. The work cannot be changed in any way or used commercially without permission from the journal. In-hospital substance use is common among patients with addiction because of undertreated withdrawal, undertreated pain, negative feelings, and stigma. Health care system responses to in-hospital substance use often perpetuate stigma and criminalization of people with addiction, long etched into our culture by the racist War on Drugs. In this commentary, we describe how our hospital convened an interprofessional workgroup to revise our in-hospital substance use policy. Our updated policy recommends health care workers respond to substance use concerns by offering patients adequate pain control, evidence-based addiction treatment, and supportive services instead of punitive responses. We provide best-practice recommendations for in-hospital substance use policies. Key Words: substance use disorder, opioid use disorder, hospital policy, acute care, addiction consult, equity. A young pregnant woman with untreated cocaine and opioid use disorder presented to our hospital in labor. She started methadone for her opioid use disorder and planned to enter residential substance use treatment with her healthy baby after birth. While transferring to a postpartum room, hospital staff noticed foil and a lighter among her belongings and called campus security as our in-hospital substance use policy suggested. The sheriffs, who provide campus security, responded, discarded the substance use supplies, and checked for outstanding warrants per their protocol. The mother had a parole violation, so they arrested her on discharge. She left the postpartum unit in handcuffs instead of entering addiction treatment and parenting her child as she had planned. Without policies, health care workers use personal beliefs about addiction when responding to in-hospital substance use. Addiction is viewed as a personal choice and moral failing, and abstinence as the sole outcome for clinical success. These responses are unsurprising as health care workers have been historically undertrained to care for people with SUDs. In-hospital substance use policies that center punitive measures are similarly harmful. They may result in riskier in-hospital substance use, overdose, patient-directed discharges, reduced trust, and increased stigma. As illustrated by our case, our hospital's former policy led with a punitive approach that resulted in patient arrests. Punitive responses to in-hospital substance use are common. However, the Joint Commission references the International Association for Healthcare Security and Safety Guidelines, which defers to individual health care facilities to develop policies regarding security's role in patient care. In-hospital substance use policies could facilitate therapeutic responses instead of leaving health care workers to apply potentially stigmatizing beliefs about addiction. Health care systems can perpetuate criminalization, racism, and inequities for people with SUDs, which are compounded for minoritized individuals. After identifying how our hospital's policy caused harm by suggesting that security respond to in-hospital substance use concerns, we convened an interprofessional workgroup of administrators, nurses, and physicians to revise the policy. Our group included addiction specialists who examined the literature, elucidated why in-hospital substance use occurs, and agreed on best practices for responding without punitive measures. The updated policy recommends a nonstigmatizing approach, starting with educating all patients, regardless of substance use history, about our in-hospital substance use policy. If substance use concerns arise, the policy guides health care workers to preserve patient dignity and respond with supportive interventions. It encourages obtaining patient permission to discuss substance use and then inquiring about in-hospital use with open-ended questions. This discussion is contextualized in concern for patient safety and desire to prevent addiction-related suffering. If patients endorse substance use concerns, we offer 1 adequate pain control that accounts for high opioid tolerances; 2 evidence-based medications for cravings, withdrawal, and treatment; and 3 other supportive addiction consult team services eg, daily visits, snacks, journals, radio, phone chargers that help patients tolerate hospitalization. We then remind patients of our in-hospital substance use policy. The updated policy states that substances and substance use supplies either be discarded or stored in the patient's hospital room in a cabinet locked by hospital staff until discharge. In the absence of clear risk of imminent harm to patients and health care workers, we do not involve security, increase surveillance, or search patient belongings. We coupled policy revisions with training for hospital staff, including information about addiction as a treatable disease, trauma-informed care, stigma, and person-first language. Although overall response to the revised policy has been positive, we have faced implementation challenges. Health care workers voiced concerns about personal and patient safety and legal repercussions. We discuss safety threats versus fears founded in racism and stigma, as well as rare situations, such as violence toward health care workers, in which security might be called. We approach patient safety concerns through education about addiction as a treatable disease. We review how adequately treating withdrawal and pain can decrease in-hospital substance use, thus reducing personal safety concerns, such as needlesticks, and other potential patient harms including infections, overdose, and encephalopathy. These discussions emphasize how our in-hospital substance use response can reduce patient-directed discharges, increase access to life-saving addition treatment, maintain tolerance to reduce posthospitalization overdose mortality, and improve patient and health care worker experiences and safety. Health care workers worry about legal repercussions, including losing their licenses because of handling unprescribed substances without security oversight. We mitigate these concerns by having legal, security, regulatory, leadership, and multiple hospital committees sponsor the policy. Based on existing evidence and our experience updating our hospital's policy, we recommend the following best practices for nonpunitive, in-hospital substance use policies:. Ensure the policy is patient-centered and does not include punitive measures, including security as a first responder. If security is included, confirm they are a last resort. Obtain legal, security, regulatory, nursing, and leadership sponsorship of the policy to ensure consistent messaging and support. Provide best-practice scripts of how to respond to in-hospital substance use concerns. Offer patients adequate pain control, evidence-based addiction treatment, and supportive care that helps them tolerate hospitalization. What does our revised policy look like in action? A patient with opioid use disorder was admitted, and his outpatient buprenorphine was inadvertently discontinued. He experienced pain, withdrawal, and cravings and used nonprescribed opioids. His team reviewed the updated policy and called our hospital's addiction consult team who reinitiated buprenorphine, recommended adequate pain control, and discussed the in-hospital substance use policy with him. He successfully completed treatment of his illness and was discharged. With increasing rates of substance-related hospitalizations and persistent gaps in addiction treatment, in-hospital substance use will continue. Health care systems can promote health and advance equity and antiracism by revising or developing policies to in-hospital substance use. These policies must dismantle stigma and punitive practices and facilitate compassionate, evidence-based addiction care. Further research should explore outcomes of in-hospital use policies and make best-practice recommendations for hospitals and regulatory agencies. Supplemental digital content is available for this article. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. J Addict Med. Find articles by Marlene Martin. Find articles by Hannah R Snyder. Find articles by Gillian Otway. Find articles by Leslie Holpit. Find articles by Lukejohn W Day. Find articles by Dominika Seidman. Published by Wolters Kluwer Health, Inc. The authors have no conflicts of interest to disclose. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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