Dr. Chris Eberlein on an Overdose Spike in Western Wisconsin

Frederica Freyberg:
In western Wisconsin, a spike in drug overdoses led the city of La Crosse to issue a safety alert in recent days. What’s going on when overdoses were trending down? We asked Dr. Chris Eberlein, emergency medicine physician at Gunderson Health System and, doctor, thanks for being here.

Chris Eberlein:
Yeah. You’re welcome. Thanks for having me.

Frederica Freyberg:
So what are the overdose numbers that led to this safety alert?

Chris Eberlein:
So it’s more of a trend. So we’ve been watching overdose numbers really closely ever since probably early pandemic time, but only in the last several years have we really coordinated with EMS, both first responders, including fire, transport agencies, some other members of the county, Vivent Health, some others that respond to overdoses, and starting to pool data and sharing what we’re seeing in the community. So we had noticed, and thankfully so last year we had great numbers. You know, we’re still way too high, but it was like a 60% improvement year over year on overdose deaths and responses. So really a great trend. And we’re seeing that at the beginning of this year as well. And we would still go on about one to two overdose calls a week is what kind of the trend was throughout most of year. We get small spikes and we meet once a week and we discuss the data and we were just watching it. We had a few that were like 3 or 4 in a week but didn’t really meet our threshold to make any sort of announcement or change our response. And then over this course of the last couple of weeks, in late July, we were getting over ten responses in a week. And so, you know, you’re talking, you know, that’s a fivefold increase from what we were used to. And so that really made us take pause. And then it happened again in the next week as well. So this is why we, we figured we’d better get some word out. Figure out what we could do as a community. See if there’s anything we’re missing and hopefully prevent some people from having a bad outcome.

Frederica Freyberg:
Because you’ve said that you get concerned when overdose cases begin to increase in quick succession like that?

Chris Eberlein:
Yes.

Frederica Freyberg:
And that’s just a marker for something going on.

Chris Eberlein:
Yeah. And usually it is a change in supply, change in use pattern. And so we’re really looking at trying to figure out what that is. We did figure out what this one was. And it was actually a change in the supply of not opiates actually. What we are seeing is that fentanyl was intermixed with other stimulants, primarily cocaine and methamphetamine. So these users had no idea that they were at risk of an opioid overdose.

Frederica Freyberg:
So do these synthetic opioids combined with other drugs, like those of which you speak, render Narcan less effective?

Chris Eberlein:
They would not. Narcan would still be very effective for these, and still a critical component in our response.

Frederica Freyberg:
And so is it known where these drugs are coming from or is this just kind of the beginning of an investigation to understand the scope of this?

Chris Eberlein:
Yeah. And unfortunately, we usually, at our level, don’t ever get that information of where these are coming from. You know, that’s more of a law enforcement. Historically, you know, being in La Crosse, we’re between two major metropolitan areas as far as Chicago and Minneapolis. And so they come from one of those two areas, usually, at least that’s what I’ve been told by law enforcement.

Frederica Freyberg:
So what is your message to people, drug users who might, who might be using these substances and then suddenly there’s fentanyl mixed in. What is your message?

Chris Eberlein:
So there’s a few things to be aware of. One, any illegal drug could have fentanyl in it. You know, it’s something that is relatively cheap to produce, gets here in large quantities, easily mixed with other drugs. So I would assume that any drug that you use could have fentanyl in it. Use fentanyl test strips to test for fentanyl in the drugs. Those are legal and widely available and then never use alone. Always have someone there that could call 911 and preferably give Narcan as well as call 911, but you have to have Narcan available, test your drugs and have a sober bystander nearby that could enact help if you need it.

Frederica Freyberg:
How hard is it for you to see this spike and treat people experiencing it or to lose someone to it?

Chris Eberlein:
I mean, it’s always difficult. You know, this is something we’ve been dealing with for years now. You know, the country has lost hundreds of thousands of people to the opioid epidemic. I think it’s touched just about every family at some point over these last, you know, 15 years or so since it started. No community has gone without impact. And so when you see the spikes like this, you really want to try and get — because sometimes I feel that we can get a little bit complacent, especially when things are going well. And that was one of my concerns with this. You know, the overdoses have gone down. I just want to make sure, as you know, our whole team wanted to make sure that everyone was aware that it is still dangerous. And ideally, you know, we could get them to stop and get help. But this is the first step. You have to be alive to be able to do that. And this is the step to do so well.

Frederica Freyberg:
Dr. Chris Eberlein, thanks very much.

Chris Eberlein:
Very welcome.