On a warm, overcast morning in the spring of 2013, my company, Engine 4, received a call for an overdose. I was captain of the fire company in Huntington, West Virginia, at the time, and overdose calls were becoming routine. We donned our bunker pants and EMS gloves as we headed toward the west side of town, to an area known for drug use. As we pulled up to the address, a distraught young woman met us outside the door.
"She is in the bathtub," she said, pointing us toward the patient.
The tub was the first thing I noticed when we stepped inside the bathroom. It was full of pink-tinged water, with a needle floating on top. A belt still hung loosely around the mottled upper arm of the patient. As I stood there watching the paramedic check her for a pulse, I noticed she was a pretty woman, who was maybe in her early twenties. But there was no pulse, and the water was cool to the touch.
At that time, I really didn't realize that we were in the middle of an opioid crisis, let alone the most deadly drug epidemic in history. All I knew was what I saw as a firefighter and an ER nurse: Ten years ago, I began to see narcotic pill overdoses, and once I started seeing them, they quickly increased. Sometime during 2010 or 2011, we saw the pills give way to heroin as the overdoses continued to rise at an alarming rate.
Huntington has become the epicenter of America's modern opioid epidemic, with West Virginia's overdose death rate at ten times the national average. Synthetic opioids emerged in the 1980s and 1990s as a way to manage chronic pain and end-of-life care. But that quickly changed as pharmaceutical companies marketed them aggressively to physicians as safe for mild pain. Pills flooded the region. With Huntington's workforce employed heavily in jobs likely to produce injuries, like coal mining and timbering, in retrospect, a surge in addiction rates seems inevitable.
Back outside the apartment that spring morning, one of my firefighters was collecting information about the victim from the distraught woman we'd met when we arrived on scene. As we walked back through the apartment, I asked the paramedic if he had notified police. He said yes, followed by a few derogatory remarks about addicts. Anger took over my body, yet I did not respond. This is not the time or place to address bad attitudes or stigmatize our patient, I thought to myself.
I had witnessed thousands of emergencies in my twenty years as a first responder. This one knocked me for a loop. I kept thinking, What would cause a beautiful young woman to shoot up heroin in a bathtub? What happened in her life that led her to this deep, dark place?
Outside, the patient's mother was sitting out on a neighbor's steps. She was crying as family members tried to console her. I introduced myself and told her I was very sorry for her loss. She thanked me and began telling me about her daughter and her struggle with addiction. I learned she was very smart with a promising future. But after starting with a legal prescription of pain pills, she quickly got hooked and eventually moved onto heroin. I stayed to talk to the family for a while. Like I had observed many times before, it was clear the struggle does not stop with the one suffering from addiction — it affects the whole family.