By Alison Knopf
Two people died after a shooting at the highly respected Man Alive opioid treatment program (OTP) in Baltimore on July 15—the shooter, and one other man. “Fortunately, these kinds of incidents are rare,” noted Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD). In fact, the late Ira Marion, who was the beloved advisor to AT Forum for years, was shot (and survived) by a disgruntled employee in 1988 (https://www.nytimes.com/1988/05/18/nyregion/bronx-drug-adviser-shoots-supervisor-and-kills-himself.html). In a similar incident, a patient killed a clinic employee, then committed suicide (https://www.nytimes.com/1977/09/03/archives/clinic-aide-killed-by-patient-who-then-kills-himself.html).
Man Alive was the second OTP in the country.
Possibly the best news about the Baltimore incident is that there was no news. It could easily have become another “NIMBY” story. As it is, reports from police sources suggesting that the shooter was seeking methadone could not be corroborated.
But the incident did have ramifications for REACH Health Services, the OTP across the street, which had to take Man Alive patients that week. Yngvild Olsen, MD, medical director of REACH, talked about how this process went.
Incident Command Structure
REACH was there for the Man Alive patients. Eventually about 350 to 400 of the patients visited REACH for their medication every day that week. “We used an incident command structure,” Dr. Olsen told AT Forum. Some staff from Man Alive came over to help.
As for methadone logistics, REACH is fortunate. “We have a fairly healthy stock of medication, and we have the space for it,” Dr. Olsen said.
There was a registration station for Man Alive patients. “We had to have dose confirmation from their records, and we were able to print out a list of all their records,” Dr. Olsen said. “We could put together EMR profiles,” he added (referring to electronic medical records—an electronic collection of medical information, stored on a computer). After printing the list, a nurse practitioner and Dr. Olsen entered orders at another station.
The Staff Joins Forces
How did REACH staff handle a doubling of patients—not to mention a crisis—with likely trauma, and possible chaos—that week?
Dr. Olsen credits the four nurses. “They did a fantastic job the entire week,” she told AT Forum.
Monday—the day of the shooting—staff, along with Dr. Olsen, spent several hours, after dosing, creating EMR profiles. These were for the patients who, understandably, had not shown up at Man Alive after hearing what had happened.
“So, on Tuesday, it was extremely smooth sailing,” said Dr. Olsen.
Donuts, Take-Homes, Time Off; “Whatever You Need”
The Substance Abuse and Mental Health Services Administration (SAMHSA), which regulates OTPs, called Man Alive shortly after the shooting “and said, ‘whatever you need,’” said Dr. Olsen. Man Alive director Karen Reese wanted to be able to let her staff have the rest of the week to “decompress,” Dr. Olsen added.
At REACH, “we decided to provide take-homes on Wednesday for the rest of the week, except for those cases in which patients were so unstable we were afraid for their safety,” said Dr. Olsen. Something many people not in the OTP field may not realize: dispensing take-homes takes a lot more time than observed dispensing.
Another issue: that week was the hottest all summer. “We brought in fans, donut holes, water,” said Dr. Olsen.
It was a “community effort” involving staff and patients, she said. The second day—Tuesday—there were more than 900 patients.
Dr. Olsen said that the media “tried to get a negative story” out of this. “At the end of the day, there was no story,” she said. And she commended the Baltimore Sun for an “accurate and very supportive editorial.” For that editorial, go to https://www.baltimoresun.com/opinion/editorial/bs-ed-0717-methadone-clinic-shooting-20190716-vnftdmvvwrelpcjw73jfxkkc2a-story.html
Lessons to be learned: Having an “incident command structure” in case an incident occurs is a good idea for all OTPs. “Be prepared,” said Dr. Olsen. “Hospitals have this now, leadership that is trained in leadership command.”