​HOW IS THE CITY OF FARGO BATTLING OPIATES?

The City of Fargo was asked this week to have police and firefighters carry Narcan, which can reverse overdose effects, to combat the recent epidemic. They decided to have firefighters carry the drug, not police. The city also issued a statement from Fargo Mayor Dr. Tim Mahoney. HPR spoke with Mayor Mahoney about who should carry Narcan and how the city is fighting back against the rise in opiate overdose deaths in the city.

HPR: Why did you issue the statement now? Was it with regard to which of the first responders should carry Narcan?

Mayor Mahoney: I think a lot of people are concerned about what we are doing about this issue and we’re very concerned about it. I had Ruth Bachmeier (director of Fargo Cass Public Health) meet with a group of people and kind of do a task force to see what we need to do in regards to it. We just broke it down a little bit more.

So Narcan, who should have it and who should carry it? Police have a role in any kind of incident which we go out and take care of and we really want them focused on what their role is. We want fire to be on the medic part of it. So oftentimes we have a medic call get down, it’s got a drug overdose, it’s really fire and ambulance that it goes to resuscitate them and then police are there to add aid if there are crowd control issues in the area or something else going on.

They are not really expected to be the “first responder” on that person that’s drug overdosed. So if you break it down to that, what is your role and what do you need to do? The firemen are the appropriate people to carry Narcan, fire keeps their trucks in heated garages, the stuff is unstable so it makes sense that we get it in firemen’s hands. Up to this point, they had not been able to do that. So then the firemen and the ambulance would have access. The response time is usually less than five minutes.

But the other thing we want to get out there is this is a respiratory arrest, so these are young hearts and what happens is you don’t get oxygen and you die. If you breathe for them, they could survive so it’s not even a Narcan issue for them. Pocket masks are the other thing we’d like to put out there, it should be in their hands if their buddy goes down, you use a pocket mask -- it can keep somebody alive until help gets there.

The third part of the element is the good Samaritan law. The police are not going to prosecute somebody if you report a problem and we can save a life. There are a lot more overdoses going on lately and we have been using Narcan successfully to save people.

The other part of it is rehabilitation, rehab programs. The providers are getting together in West Fargo for a meeting and that meeting is going to discuss, “Ok I’ve got a problem, I need treatment, where do I get it and who is going to give it to me?” We’re challenging the health care system to get this thing figured out because oftentimes if somebody wants to come clean they don’t have insurance, or they don’t have coverage and it gets to be a problem.

You have some areas that are empty because they don’t have staff to fill them yet. Is that a possibility that we could get them funded or get some funding for them? That’s part of what the group is supposed to sit and talk about -- okay, we’ve got a problem, somebody admits to having a problem, how can we start to solve or take care of it.

HPR: How big a problem is this in Fargo? Obviously the amount of recent overdoses has people concerned. 

TM: We think nationally and locally, we’re seeing more and more users. Part of the issue is heroin prices have come down a bit. I find it interesting that if I were to write you a prescription of standard pain medication of 30 tablets equivalent to Percocet, that’s worth $20 a tablet, $600 on the street. The prescription drugs are getting expensive as well for somebody with a habit of heroin they can get it somewhat cheaper and get a higher high using that stuff.

Part of what we’re seeing is, the drug people who are pushing the drugs are pushing a stronger mix. Fentanyl is very powerful and so you may get your high but you also may get your death because it knocks out your respiratory system much more easily. When you talk to (Fargo Police Chief) Dave Todd -- and he talks to different people all across the nation -- we’re seeing kids slip into this type of drug and it’s just a dangerous drug.

HPR: Were you surprised by this issue when it started to become such a problem here?

TM: I was disappointed, just because as a medical provider I’ve always known heroin is a very powerful drug and a very dangerous drug. Quality has not been always there -- well, now we’re getting too much of a high quality and you are just really frustrated. (Fargo Police Chief) Dave Todd will try to get it off the street as quickly as he can and also you do the other part, try to tell the people hey they got stuff out here that is much more powerful than it ever used to be, be very, very careful if you are a user.

But I think the bigger question you have is that so where is society on this issue?

Should we have needle exchange? Should we allow the ability for us to look at this as an issue and try to solve the social issue of it as well. I think part of the frustration is with chronic addiction, it’s very difficult to deal with, the success rate is not high so people are a little bit frightened by the use of it or how to take care of it or treat it.

HPR: Is there a lot you can do as a city? How much of this is out of your control?

TM: Some of it is public health, how we can help, #1; #2 how we can educate and then we are also going to reach out to the public and say, “Ok public what do you want us to do?” A couple of the deaths, I knew the family, knew the kids, I mean it’s real tough to have that happen -- so I think what happens is, as with any problem, you ignore it until you realize it’s affecting people within your community who you know and it’s not a hidden disease, it’s out there in the open.

I think we have to begin to try to say what we are going to do about it and what we are going to do to manage this problem, and it goes higher up than us too. What does the state want to do, what does social service want to do, where do we want to put our money? Senator Judy Lee of West Fargo did a task force that they are looking at a human resource issue, what should we do and how should we approach it -- so the state is looking at it so there’s a variety of people. Is the usage up and if it is, what should we do about it?

HPR: What is your recommendation for members of the public to do in response to all of this?

TM: The thing we were talking about last night is opiates are an addictive drug and it’s four out of five of the top prescription drugs. So a lot of the data out there is you or your grandmother or mother or father have narcotics in the home. Kids pull them out, play with them, try them out, see what they are doing. So one of the things the public can do is get rid of any narcotics you don’t need in your home because that’s part of what break-ins are for.

People go into your house and find some drugs but even your own children can try them out and that’s a bad thing for people because then you get high and begin to use them.

What’s happened in the medical community, the AMA, the college students, everybody to take drug training and then to not prescribe as much.

And then there’s a variety of things that I have to do. Let’s say you came in and asked me for a prescription of 30 tabs, right? I am encouraged to make sure you haven’t asked another doctor two doors down for another prescription and to exercise much more scrutiny over--what do you need the pain pills for, why do you need the pain pills.

With a patient having surgery, oftentimes you have a session prior to surgery: okay, we are going to have to do pain management, how would you like us to handle that? I can give you this combination or what would you like?

Some now are saying I don’t want narcotics, how can I get through without narcotics? There’s a variety of strategies that way, so you can load somebody with Tylenol or Toradol, when you get done with your case so when you wake up, you don’t have as much pain so then you are not as uncomfortable as when you start out.

There’s some strategies to get you very comfortable when you are in the hospital and get over the hump and then you don’t need as many pain pills afterwards. So there’s a variety of different strategies I think you are going to see people bring into the market.

The last thing I’d leave you with is have you ever seen a smiley face in the hospital? So there’s a smiley face that’s usually in every room that says rate your pain and it says rate your pain zero to 10. If you are going into the hospital, what your expectation of pain level be afterwards, 10 or a zero, 10 being the worst.

It used to be you had to get to zero or one and then the problem was after you left the hospital, you were given a survey and one of the top 10 questions would ask you is how was your pain managed in the hospital. Oftentimes then as a provider you want to give too much, right? You want everybody leaving the hospital happy with a smiley face and their pain controlled.

But I think now society is going to have a bigger discussion about that. Where should we be? Should it be 4 or 5? Better than 0? There’s a lot of dialogue that’s going to go in a lot of different areas on this particular problem because once it becomes an addictive issue, people have to talk about [what to do about it].

We just wanted to put it out there that we are working on this, we are looking at having the best ways to approach it and we’ll continue to work at it. We view it as a serious problem.