Small towns have benefits, one being that it only takes Blanchester paramedic Angie Schlake just a few minutes to respond to the familiar scene. Still, by the time she gets there, his face is blue and he's only breathing twice a minute.
Family and friends look on as the patient is hoisted in the ambulance, blissfully unaware their loved one is a heroin user. But Schlake recognizes his face; she's revived him before, just as she did dozens of other people this year.
Once the team is on the way to the hospital, she starts an IV and slowly injects the miracle drug that will save his life. Within minutes, the patient is opening his eyes.
And, he's angry.
“They come up fighting. They'll complain, 'You took away my high',” Schlake recalls. “They don't realize how close they were to death.”
The miracle drug is naloxone — commonly known by the brand name Narcan. The drug can reverse the effects of an overdose by blocking the brain's receptors that opiates latch onto and helping the body “remember” to take in air. The antidote's effects wear off in about a half hour, and multiple doses may be needed.
Clinton County emergency responders have been carrying it for years, but have been using it increasingly more as the heroin epidemic has exploded locally.
Last year, the Wilmington Fire Department administered the drug 15 times. It was used four times throughout the first two months of 2014, said Tim Doyle, a firefighter and EMT.
Naloxone is used in spurts. EMTs will go weeks without administering a dose, then use it several times in one week.
As heroin supplies dwindle, dealers will cut the drug with baking soda, sugar or even rat poison, among other products, making the product weaker and requiring a user to take more in order to achieve the same high. Then, when a new batch of pure heroin pulses its way through the county's veins, users continue taking the same amounts as before and overdose.
Naloxone is extremely effective when used properly, and can be used for any opiate overdose including morphine, Vicodin or Percocet, Doyle said.
“In my experience, it's worked 100 percent of the time, unless they're pulseless,” he said. “As soon as you push, almost instantaneously, it reverses the effect of the drug.”
The fire department buys naloxone from a local pharmacy for $23 each dose.
Within the last few weeks, local emergency responders have received a device that will allow them to administer the drug through the patient's nose using a mucosal atomizer device (MAD).
The device will allow faster delivery because responders don't need to find a vein — something that can be especially difficult on a patient who shoots heroin. It would also reduce responders' risk of a needle stick in cases where blood-borne diseases such as Hepatitis C are prevalent.
Now, governments and clinics are working on putting the device into the hands of who advocates say are the most critical group — people who abuse drugs, and their friends and families.
Supporters say the opportunity to save potentially thousands of lives outweighs any fears by critics that the promise of a nearby antidote would only encourage drug abuse.
At least 17 states and the District of Columbia allow naloxone to be distributed to the public, said Jeffrey Levi, executive director of Trust for America's Health, a national nonprofit that focuses on preventive health care.
Among them is New Jersey, which passed a law last year that allows members of the public to carry nasal-administered naloxone after getting training.
In Ohio, the drug is only available to authorized personnel.
Bills are pending in at least seven states to increase access to naloxone. In Tennessee and Utah, doctors would be allowed to prescribe it, and civil liability for those who administer it would be dropped. In 2012, the Food and Drug Administration held hearings on making naloxone available over the counter, but it has not yet done so.
Schlake, who has been a paramedic for 23 years, said the public should “absolutely not” be able to access naloxone. Family members and friends will not administer the drug properly, and the patient will not go to the hospital to receive proper treatment.
It also will allow users to feel “invincible” because they will know the anecdote is close by, she said.
“One of these days, they're not going to wake up,” Schlake said. “I think we're going to start seeing a lot more dead people.”