This article first appeared in St. Elizabeth Hospital's "Healthy Neighbors" magazine and then in KY Forward. It is written by Shelly Whitehead and is reprinted with permission.

“You can just see your patients dying in front of you”

When it comes to waging war against widespread community problems, thoughts generally don’t go to the local family doctor.

But that’s exactly what’s happening in Northern Kentucky these days. Bellevue family practitioner Dr. Jeremy Engel said he was simply fed up with seeing family after family at his St. Elizabeth Physicians practice being ripped apart by the scourge of heroin addiction. Grandparents raising their children’s youngsters because their own kids were addicted. Parents worried sick about a daughter or son so strung out on the dangerous drug that they had all but given up on life. And the tragic stories just kept on coming until one day this past summer when, for Engel, it became clear that something just had to be done.

“The day it really hit me was the day I had five out of 18 patients who either had a child or a grandchild currently on heroin,” he recalls.

“Then, that same evening, I was talking to an Emergency Department doctor who had so many patients come in on heroin that night that when he called me about a patient and mentioned that he was on heroin, it was just like part of the routine. As he and I talked, I just said, ‘This is crazy! We have to do something about this.’”

Rallying the troops

Dr. Engel is no stranger to community action. In 2008, he was instrumental in getting a bill passed in Kentucky to allow unmarried children under age 25 to be covered by their parents health insurance. And he’s been an ardent proponent of legislation to making smoking illegal in public places in the commonwealth.

Through these roles, he has made a lot of contacts in all sectors of government and industry, and late last summer, he tapped into dozens of those contacts to begin organizing a local battle plan against heroin abuse. It started simply enough, with an invitation to a two-hour brainstorming session in early October.

“We are in the early stages of developing a collaborative plan to address the heroin epidemic,” said the invitation that went to about 55 leaders in the healthcare, government, law enforcement and treatment communities.

“We are asking for you to please join us in developing a report that describes the impact of heroin in Northern Kentucky. Together, with other members of the community, we can identify current resources, improve communication, develop a strategy for public outreach and tap funding sources that can provide assistance.”

It was no small order. But, the 35 or so people who attended that initial meeting were both clearly motivated and frustrated with a problem that they described in all sorts of harrowing ways. Health care experts spoke of the skyrocketing number of babies being born to heroin-addicted moms. Treatment professionals talked of the need for better insurance coverage and more programs. And law enforcement relayed story after story of addicts overdosing in their cars with syringes still stuck in their arms.

After more than two hours of rapid-fire discussion, it was clear Dr. Engel’s “heroin roundtable” was off and running. In fact, within a month, that one group had become four more, each tasked with working to solve a separate part of this complex and vexing community health problem.

Dividing to conquer

Dr. Engel said one group is focusing its attentions on treatment for addiction and parity in health insurance coverage. The second committee is looking at the drug’s overall community impact, including related crime and legal issues, as well as healthcare needs and costs. The third committee is evaluating the community’s response to the problem, including addiction prevention, public safety issues and available community resources. A fourth and final group has been formed within St. Elizabeth Healthcare to determine how heroin addiction impacts the organization and its response to the problem.

“So the bottom line is that we’ve really got a lot of experts on the subject working on it now,” Dr. Engel said. “I’m not the expert. I’m just taking the lead to help gather information and build consensus on our mission.”

While Dr. Engel is extremely determined to make a dent in this widespread public health threat, he is not unrealistic. He said he knows that no effort – no matter how mighty or motivated – will ever reduce the number of heroin addicts to zero in this region or any other.

But he believes with a problem as big as heroin, you have to start somewhere. And he also believes it’s a very real possibility that with enough effort we could at least see the rate of heroin addiction level off, instead of continuing to increase, as it has locally, according to law enforcement.

The key to making that happen, in this case, starts with one very energetic and, at times, a little hard-headed family physician, who is determined to make things better for the families he serves, by making them better for the community we all live in.

“At this point, with heroin, I think you could say that ‘the kitchen’ is on fire and we have to put it out. … I mean, I’ve had very high-functioning patients end up in the hospital at a young age with permanent health complications because of heroin. Shooting up destroys blood vessels and infection goes right to the heart, so you have 20-some-odd-year-old patients now having to get valve replacements. …

“So I understand how bad this is and I think everybody else understands how bad this is. You can just see your patients dying in front of you and not able to come out of it to save themselves. So, as a family physician it’s my job to listen to the patient, reflect on their problem, and come up with a pathway to a solution. Now, basically, I’m just doing that on a larger basis across the community.”

Data provided by St. Elizabeth Healthcare

Shelly Whitehead is communications specialist for St. Elizabeth Healthcare. This story first appeared in Healthy Neighbors magazine and is reprinted with permission.

Photo: Dr. Jeremy Engel/Healthy Neighbors