By Niki D’Andrea
Almost every day, Ernesto Altamirano saw someone overdose on opioids.
“And when I say overdose, I mean borderline dead. Maybe even sometimes clinically,” he says. “I’ve been on plenty of calls in my career as a fireman where I’ve seen opioid and heroin overdoses, plenty of them.”
A Phoenix firefighter and paramedic, Altamirano says there’s been a surge of calls over the past few years involving opioid overdoses. Between June 15 and December 28, 2017, the Arizona Health Services Department tracked more than 4,900 suspected overdoses and 716 suspected deaths. The problem’s reached such proportions that Arizona received a $3.1 million grant from the federal government to train more first responders in recognizing and responding to suspected opioid use and overdoses.
“It’s gotten worse since I first came on the job,” Altamirano, 40, says. “You don’t see some of the stuff that we see and you probably wouldn’t want to see as everyday citizens. When you go on a heroin overdose (call), for example, you see them not breathing and you see vomit coming out of the mouth. That’s it. That’s an eye-opener if you’ve never seen it.”
But Altamirano’s repeated exposure to the effects of opioid overdoses didn’t prevent him from falling into his own addiction to prescription painkillers when he was injured on the job a few years ago. And he’s not alone among first responders battling opioid addiction – they’re an increasingly high-risk group for opioid abuse because of their long work hours, lack of sleep, exposure to trauma and physical pain from on-the-job injuries, according to the Hazelden Betty Ford Foundation, which has a specialized treatment program for first responders.
Specialized addiction treatment programs for first responders are beginning to appear in many places, including Arizona. Altamirano completed a six-week outpatient program in June at the Recovia clinic in Scottsdale.
For first responders, the risk of damaging their reputation and losing their jobs may prevent them from seeking treatment or even admitting they have a problem, Altamirano says.
“When I first went there (to Recovia), I didn’t want anybody to know anything,” he says. “Because one thing you have that’s engrained in you, and you’ve probably heard this before as you’ve talked to first responders, is reputation. Your reputation. ‘Your reputation is everything’ they preach to you, back from when you start riding along and you do your EMT classes. Reputation, reputation, reputation is engrained in you.”
Altamirano says he’s now determined to help other first responders, and that’s why he’s sharing his story.
Former police captain Bill Reese, 54, also completed the treatment program at Recovia and now serves as a mentor for other people in recovery. “I would say to first responders, don’t let your pride get in the way, because you’ll never ever find a police officer that will admit that they’re on opioid medication or an alcoholic or any other pain-relieving avenues because that’s their career,” Reese says. “That’s their livelihood. That’s their family. That’s their credibility. And as a police officer, that’s all you have is credibility.”
“That’s part of the problem. If they admit to having mental health (issues) or PTSD or opioid addiction, that brands them,” he continues. “And you know, police are tough. ‘I’m strong. I’ve got to be tougher than everybody else. I can deal with it, I can handle it. I don’t have a problem’… I wish there were more officers out there that would talk about it. Say something.”
Altamirano and Reese each have positive outlooks on their futures and post-recovery plans for their lives. Getting to this point has been a harrowing and hopeful journey.
Prescription for disaster
When Bill Reese bent over to pick up a face mask for the softball team he coached back in 2008, he had no idea the moment would ultimately lead to the end of his career in law enforcement, the end of his marriage and the beginning of a decade-long battle to manage severe pain without pills.
Reese fell and hit the ground hard, resulting in two ruptured discs and a herniated disc in his back. He continued working for a year at his job as a police captain in Ohio, going to physical therapy and trying different treatments including pain medication his doctors prescribed to him. “We just kept getting worse, until the point I couldn’t even hardly get up and move around,” Reese recalls.
A back operation didn’t help, and Reese didn’t like taking prescription painkillers. So he stopped cold turkey. “At one point, I was just done with it all. I just quit,” he says. “And I was miserable for like, a week and a half going off of it all… I just stopped and it just didn’t work out.”
A year later, he was taking pills for the pain again. “It just progressively got worse again and they (doctors) put me back on stuff and they said I wouldn’t be addicted to it,” Reese says. “Well, at that time we didn’t know how addictive it is. I mean, this started back in 2008.”
“They said I wasn’t addicted to it, but dependent on it and used it for the pain, and they just kept giving me more and more and I was miserable.”
By that point, Reese had retired, earlier than he’d intended and not entirely of his own accord. His physical injuries made the job too dangerous for him and others around him, department supervisors said. “The state said that there is no way I could do it (continue working),” Reese remembers. “If I got into a scuffle or something, it could be more damaging. I could put other people at risk. So I was done.”
While in Florida in 2016, Reese had a bad fall while preparing for a hurricane. “I went down again and I couldn’t get back up, and we ended up having to do fusion (surgery), which got me back up to walking straight again,” Reese says. “But he (the doctor) said I would always have the pain.”
Reese’s marriage had deteriorated since his injury and over the ensuing years of failed treatments and physical pain. “It cost me my marriage. She just said she couldn’t deal with it and couldn’t handle it no more and moved on,” he says.
His physical condition also continued to deteriorate. Around Thanksgiving of 2017, Reese’s adult children, who live in Arizona, vowed to get him healthy and found a pain doctor for him in Phoenix. Reese really wanted to get off opioid painkillers. He says in all his years of taking pills, he never took more than he was prescribed – but that he was prescribed an awful lot.
“The doses I was on… I thought, you know, something’s not right, I shouldn’t be on this much of this,” he says. “We shouldn’t be taking more than 90 milligrams a day and I’m taking way more than that. I’m done… I didn’t have much of a life. I never took more than what’s prescribed, but I just couldn’t stand taking it no more.”
He told his pain doctor his position. “I said, ‘I’ve got to get off. I’m going off or I’m going to quit again. I sat in his office and cried for an hour,” Reese says. “You didn’t know which way to turn or what to do. I said, ‘You can help me or I’m quitting, but not coming back.’ And then he sent me to Dr. Stewart.”
Brave hearts and bitter pills
Dr. Laura Stewart is executive director of Recovia, a multidisciplinary clinic near Princess Drive and the 101 in Scottsdale. Recovia’s opioid detox program typically lasts about six weeks and takes an integrated approach that includes behavioral health, physical therapy and medical management in tandem.
“It’s a huge, integrated, 10,000-square-foot clinic. And it’s got all these different sections, but it’s also kind of like a big pod,” Stewart explains. “All the clinicians work together to help the patients, so it’s not like, ‘OK, you’re going to go here for physical therapy, and then you’re going to go to this department where nobody’s going to know you’re doing three separate things.’ It’s the integration of all three things, and that’s where the evidence-based treatment research is.”
“That’s how the opioid epidemic is going to be treated – if it’s integrated and it includes MAT (medication-assisted treatment),” she continues. “So that’s what we use here in our program.”
Recovia’s outpatient programs are also designed for people who are trying to maintain some sense of normalcy in their lives, especially professionals who may not want a lot of people to know about their situation or undergo an intensive inpatient treatment program.
Stewart says she sees many people in Recovia’s program who work in health care or as first responders, and that the stigma surrounding opioid addiction is a big barrier to treatment for them. “It’s a huge impact for them, because they’re in health care or they’re working around people who are dealing with this on an addiction level, so they know better,” she says. “In their mind, they know better. It’s very difficult for them to sort between ‘I need help,’ but ‘I’m helping people who need help,’ and ‘Wait, no – now it’s me that needs help.’”
That was a conflict for Phoenix firefighter Ernesto Altamirano. When he realized he needed help for his addiction, he had a hard time reaching out to his peers. “They (first responders) have that mentality that we don’t talk about things,” he says. “We don’t talk about our problems; we’re problem solvers. We’re supposed to solve the problem, not be part of the problem, and I think when it comes to opioid addiction, I think a lot of guys are in denial or they think they can handle it.”
Altamirano thought he could handle it. He says he was a different person before he started taking opioids for his injury. “I’m usually a very outgoing person. You can put me in a room with 20 people, give me an hour, and I’ll know everybody and their whole life story,” he says. “I was weightlifting and very active. I’d go to the gym and could do things with my boys. My nickname on the job is ‘The Closer,’ because I’m the guy that can go in and de-escalate any situation, no matter how bad the call goes. No matter whose fault it may be, I can go in and talk people down and make everything be OK.’”
Then he got hurt at work and chose to do therapy and pain management rather than have surgery. “That was years ago and I did fine. It was fine. Then I had an incident a couple years ago where I tweaked my back and I started therapy again and taking pain pills,” Altamirano says. “It got to the point where I wasn’t having the pain anymore, but I was still taking them… you truly do get a high from it. I got happy.”
“But then as time went on, that happiness turned kind of dark and chilly,” he continues. “The world didn’t seem as bright as it did when I first started taking the pills and I don’t know if that’s because I got so used to them that I had to take more. I’m not sure where that transition happened, but it went from enjoying it to changing my character. And now I’m not the gentleman that I had previously described to you.”
Altamirano didn’t like who he was becoming. “I am very involved in my kids’ lives. I consider myself to be a good father and a good husband and I’m good at my job that I love and been very blessed to have. And it got to the point where I was starting to suck at all of those things,” he says. “I wasn’t as productive as I used to be at work. I would just kind of go into my bunk and sleep or be by myself.”
One night, Altamirano and his wife had a big fight. She told him she thought he had a problem. The next day, his fire captain approached him and said he seemed different and wanted to know if everything was OK. “They had no idea what was going on at home,” says Altamirano, who told his captain he was fine.
After a couple conversations with other people and “not really liking who I was becoming as a person on the job and with my kids,” Altamirano says he went back to his captain, admitted he was addicted to painkillers, that he needed treatment and asked if his captain could help him.
“And he said, ‘absolutely,’” Altamirano recalls. “And the fire department for me has been – I can’t even describe in words how supportive they have been toward me in getting better. The Phoenix Fire Department has really, really taken care of me.”
The light at the end of the tunnel
Though Altamirano was hesitant and somewhat skeptical about treatment programs at first – “My thought of how a program is supposed to be is, you go into a group and sing ‘Kumbaya’ with a bunch of people,” he says with a laugh – he says Recovia’s integrated approach “has been great.” Instead of singing “Kumbaya,” he found himself doing yoga, HeartMath programs, physical therapy and taking the medication Saboxone to help manage his pain and withdrawal symptoms.
Now opioid-free, Altamirano thanks his wife Bianca “for being incredibly supportive throughout his whole thing… I would not be here without her.” He says he’s going to the gym again, spending more time with his boys, and “excited to get back on the truck again” at the fire department.
Reese, who completed a similar program at Recovia, says he’s looking forward to being healthy again. “I’ve traveled around a little bit and went to Ohio and to California,” says Reese, speaking on the phone during a visit to Florida. “I’m spending time with my kids and my grandkids and just enjoying life.”
Stewart says Reese and Altamirano are just two of many successful recovery stories. “I want to come from a place of hope, because of our treatment side. I think there’s a lot of media on how devastating this is, and how scary it is – and it is. People are dying every day,” Stewart says. “But I also think that, from the treatment side, I don’t hear a lot of hope about us getting through this, getting past this, moving on. This is a treatable epidemic and people do get better.”
“We can get so negative and so spiraled down about the stats that we forget that actually, there are a lot of people doing a lot of things, and they’re working,” she continues. “My favorite saying is ‘This too shall pass.’ And this shall pass. We’re going to get through it… I’d just like to see the light at the end of the tunnel.”
