By Lauren Dezenski and Max Lewontin

The Boston University Statehouse Program

When a bad batch of heroin makes its way onto Boston's streets, Susan Schiller is one of the first to notice.

As a shift commander for Boston Emergency Management Services, Schiller monitors calls into EMS. A call for cardiac arrest -- what Schiller terms a "bad call" -- usually means someone's heart has stopped beating because of a drug overdose.

Two or three bad calls in an eight-hour shift becomes a spike. Three or four days of spikes constitutes a trend. Schiller then alerts her crews to over the radio: "Keep an eye out, everyone. There's a bad batch out there."

Gov. Deval Patrick's declaration in March that abuse of heroin and prescription drugs had become a public-health emergency served as a call to arms for state politicians, who responded with proposed laws and additional funding to slow the addiction rate and improve access to drug treatment.

But the sense of crisis is nothing new for Schiller and other first-responders around the state who have been fighting the ravages of opiate abuse, addiction and death for years.

"Our war on drugs is failing miserably," says Schiller, who began working for Boston EMS as an EMT in 1991. "We need a new way to manage this, and I'm not sure what that is."

Police and EMTs who respond to the escalating numbers of overdoses in towns on Cape Cod to cities in central Massachusetts have become sentinels for evolving trends in drug abuse.


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The bad batch Schiller talks about is often heroin cut with another drug, often fentanyl, a powerful opioid used in operating rooms. Fentanyl-laced heroin has caused a dramatic increase of overdoses in Brockton -- 36 a month so far this year, compared to an average of 16 per month, according to Erik Johnson, general manager of Brockton American Medical Response, which handles emergency calls for the city.

But Johnson says he has seen a steady rate of overdose calls for the last decade.

"I haven't seen too much of a change," says Johnson, who has been an EMT since 1989. "For the previous 10 years, it's been pretty much the same."

What has changed, he says, is a demographic shift to younger victims who overdose on prescription drugs, a growing trend less common in Brockton than surrounding, more affluent towns.

"It's one thing to take a pill and another thing to stick a needle in your arm, so increasingly, we're getting a younger, more suburban group," he said.

Schiller has seen the same shift.

"In Boston, we track this, and it's possible there has been an uptick -- but you can absolutely see the demographic delineations of drug problems, and there's evidence that they do run along socioeconomic lines," she says.

Schiller thinks that shift in demographics may be behind the new realization among state leaders of a crisis that first-responders have been dealing with for years.

"It's sad, but kids OD all the time," she says. "I'm not sure what the big push now is."

First-responders are also slightly jaded about the impact of the anti-overdose drug Narcan, which Patrick wants distributed to more departments and civilians.

Patrick Glynn, head of the Quincy Police Department's anti-drug unit, said that although Narcan is an important weapon for police and other nonmedical personnel in combating overdose deaths, there is an overriding need for more long-term treatment funding.

"One of the big issues is the lack of inpatient beds," he says. "We know we can't arrest our way out of it, but we know that any money that comes from legislators or the governor's proposal is going to help increase the number of beds. It's going to increase the availability of treatment, and also education."