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Emergency Physicians Help Lead Opioid Education Efforts

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When Dr. Ryan Squier first became an emergency department physician, he envisioned that he’d need to be proficient in dealing with things such as strokes, heart attacks and physical trauma.

The opioid epidemic has broadened Squier’s perspective significantly regarding the knowledge that medical professionals must have.

Originally from Toledo, and with a background of training at the first community-based emergency medicine residency program in the country, at Akron General Medical Center, Squier has served with Mid-Ohio Emergency Services in Columbus for about six years, working in many emergency departments throughout the OhioHealth system.

“In the past decade, and it’s mirrored in the news, what we’ve really seen on a daily basis is complications that have arisen from the opioid epidemic,” Squier said. “Whether it’s been the infectious causes, the psychiatric consequences, the consequences of overdoses of opioid dependents … there’s no real easy answer to get out of the rut we’re in right now.”

Squier has tried to become a part of the solution.

In 2016, he helped launch a campaign through the Ohio Chapter of the American College of Emergency Physicians called NIX Opiates to help fight teen opioid abuse in Ohio.

Squier made his first NIX Opiates presentation that year to administrators in the Olentangy Local School District, where he and his wife, Amy, and their four children reside.

Since that time, he’s visited middle schools and high schools throughout central Ohio.

“He spoke at a staff professionaldevelopment day back in September of 2016 and also spoke to our students that same month,” Olentangy Orange High School principal Trond Smith said. “I remember most of the feedback surrounded how easy opiates were to obtain, certainly easier than alcohol. In addition, his perspective from the frontlines in providing treatment of overdose victims was painful to hear, but necessary. The NIX Opiates initiative has been imperative in reaching those who need this education the most — young people who either recently have or may be faced with a decision regarding whether or not to use opioids.”


Since launching NIX Opiates, it’s become clear to Squier that “everyone” has a connection to opioid addiction, whether it’s a family member, friend or neighbor.

Despite that fact, among the misconceptions many have about opioid addiction is it’s not going on in their community.

“Even when we use medicine, we always caution people that it can be addictive and that you have to be very careful about utilizing it,” Squier said. “It’s common that I’ll have patients say, ‘You don’t have to worry about me, it’s not going to be me.’ The truth of the matter is we don’t know who it’s going to be.

“There are currently scientists looking to see if there is some sort of genetic trait that pre-disposes people to that addictive potential. Right now, we don’t know. We don’t know if it’s the 16-year-old who got in a car accident or the elderly 90-year-old who broke their hip who could potentially become addicted or dependent on an opioid. We want to understand that potential.”

Opiate addiction is what Squier calls a “common story,” and combating it requires educating people and not being judgmental.

“They started using thinking it wasn’t going to be them,” Squier said. “They didn’t decide they were going to start using heroin. They typically started by purchasing pills off the street, which got too expensive. Some began abusing them thinking it was a safe drug because it was a pill and it led to the pathway of more and more expense, and they inevitably began heroin, which is cheaper. Commonly those patients tell me, ‘I’m just using now so I can feel normal again.’ If they could turn back the clock and stop using and never have used it, they would, but they can’t function, they can’t get out of bed without using because of what happens to their body with this drug.”

Viewing pain as a necessary part of healing is something patients must understand when they’re first prescribed opiates.

“The thing is that it happens every day and it happens every day in central Ohio,” Squier said. “It’s not happening because they’re bad people. That’s the misconception. It’s important to educate because it’s important [in treating] the patient.”

Things are getting better

Other central Ohio physicians, such as Dr. John Leff, a trauma surgeon from OhioHealth Riverside Methodist Hospital, have been at the forefront of helping to educate people on the dangers of opioid abuse.

Leff is a member of The Stand Project, a community coalition formed in Upper Arlington focused on the prevention of substance abuse and providing a resource for students and families to easily find information, help and support.

Leff said his eye-opening moment came a few years ago when he was treating a young college student for an abscess on his arm. It quickly became obvious that the infection came from injecting drugs. The patient was well-dressed and had graduated from a suburban high school with a 3.9 grade-point average.

“As I was talking to this kid, I realize this nice young man was a heroin addict,” Leff said. ” That changed my whole point of view about drugs. I realize now there are no boundaries.”

He encourages parents to “be suspicious” of their children no matter how uncomfortable it is. ”Follow where they go. See who they’re hanging out with. Educate yourself, and be prepared.”

Initiatives such as The Stand Project and NIX Opiates appear to be working.

According to a report published in May by the U.S. Centers for Disease Control and Prevention, Ohio saw its number of heroin overdose treatments in emergency departments decline by more than 50 percent from 2017 to 2018.

Other states, including Kentucky and Pennsylvania, also had significant declines in hospital-treated heroin overdoses.

Others, though, such as Indiana and Illinois, saw increases in ED-treated heroin overdoses during that time frame.

Education, according to Squier, is one of the key steps in continuing to improve those numbers.

The reality of the situation, he said, is the average person goes through rehabilitation several times before breaking away from opioid addiction.

“Really, when we talk about NIX Opiates, we wanted to focus not on dealing with the legal aspect but on the, ‘Hey, we care,’” Squier said. “We’re doctors and we tell families horrible news in the emergency department and take care of devastating injuries. This is something we see and it breaks our hearts and it wears on us, knowing there’s got to be some way to stop this. There was research published in U.S. News & World Report that says that Ohio is actually on a decline, which is fantastic. It shows that we’re making some headway. This is not a solution that we’re going to ‘Narcan’ our way out of. We’ve got to be thinking of the people who are ready for treatment and get them access to the treatment.”

When a person experiences an overdose, reversal medications such as Narcan Nasal Spray can be used to reverse and block the effects of the opioid, but that doesn’t necessarily get to the heart of the problem, according to Squier.

With each of his four children ranging from 6 to 9 years old, his first step in teaching them about the effects of pills is that only the adults have access to medicine bottles at their house.

Programs such as NIX Opiates become appropriate when students begin heading into their teen years and throughout high school.

Seeing the effects of this crisis first-hand as a trauma surgeon, Leff says, “I don’t think this is a problem that will ever stop. I look at drugs as dream killers.”


Photography: Shane Flanigan/ThisWeek News