After the OD: County looks at hiring post-naloxone case manager

Kristi L Nelson

There’s no question naloxone works well to keep people from dying after they’ve overdosed on opioid drugs.

But both emergency responders and those who are addicted also know there’s no guarantee naloxone will be there the next time the patient overdoses – and there will be a next time for many.

Knoxville Health Department Director Dr. Martha Buchanan is among those intent on finding a way to intervene after an overdose call. A naloxone collaborative of local emergency response agencies and advocates are tracking how often the overdose antidote is dispensed, but the group’s still looking for a way to engage patients after the emergency.

More than 28,000 Americans died from overdosing on opiates in 2014, a record high for the nation. That’s 78 people per day, a number that doesn’t include the millions of family members, first responders and even taxpayers who feel the ripple of drug addiction in their daily lives.

“There’s no wraparound for those folks,” Buchanan said. “There’s no followup being done other than through the hospitals, and the hospitals have limited capacity.”

Not only that, but people who overdose and regain consciousness after naloxone can – and do – refuse to go to the hospital.

Intervention if wanted

Buchanan has studied some other communities’ successes using a dedicated caseworker who responds to people after the overdose crisis, assessing other needs (such as chronic health issues, birth control or testing for HIV and hepatitis C) and helping those who want it find detox or treatment resources.

“They basically take over the case management of this individual, if the individual is willing,” she told the Knox County Board of Health at a meeting earlier this week.

Initially, the county would hire a single case manager to work daytime hours, said Buchanan. The position isn’t in the health department’s proposed budget for the next fiscal year, but she said grants may be available. County Mayor Tim Burchett said he supports trying the program and will fund the position.

“Behavioral health and drug addiction are two problems we must address in our community,” Burchett said. “Across our country, the opioid epidemic is shattering families, taking lives and costing taxpayers more and more money. In Knox County, we’re taking steps to address these issues, and this is one of those steps.”

Both said there will be preset benchmarks to measure the program’s success.

“If the pilot program doesn’t work, if we don’t see any significant change (in the numbers of overdose deaths or calls), we won’t keep funding it,” Buchanan said.

But if it does, she expects it to go to 24 hours, with multiple caseworkers. Although she’s not sure yet what the Knox County position might cost, similar positions nationally pay an average of $35,000-$40,000 annually.

She’s currently talking to other area providers, such as Helen Ross McNabb Center and Cherokee Health, to see how this program could work with them.

Buchanan would like to see the program up and running by year’s end – sooner, if possible.

“We all know access to (addiction) treatment is a limited resource,” she said. “But if I wait until we have enough treatment beds or enough treatment facilities, we’ll never do this. I just really feel like it’s the right thing to do, to step up and do more to address overdoses in our community.”


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