Does saving people who OD on heroin enable them?

Robert Sena, with his 4-year-old son in the backseat of his car, met someone in a West Manchester Township parking lot one January night, bought heroin and took it.

He slumped over in the front seat. Sena's heroin source called 911.

Moments later, the son watched police officers pull his father from the car and try to save his life. It took at least two doses of naloxone to do it.

Responders brought his son to see him in the ambulance, Sena recalled. The boy was crying. He hugged his dad.

Sena is one of 225 people in York County who have been saved since police officers began carrying naloxone in April 2015, according to data from the York County District Attorney's office. The 27-year-old is also among the 109 who have required more than a single dose.

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And he's among those who have been revived at least twice. The exact number of people who have been revived multiple times is unknown, but police officers tell stories of reviving the same person on separate occasions.

Since a law was passed allowing police to carry the drug, officers in York County have used it 243 times through Aug. 8. Naloxone, given as a nasal spray or an injection, reverses the effects of a heroin overdose.

Statistics provided by the district attorney's office reveal how many times police departments have used naloxone and other details about the overdose victims. Eighteen people who have received naloxone have died. But the numbers also show that police officers carrying the drug have prevented the county's heroin epidemic from killing many more than it already has. A nearly 200-person death toll could be north of 400.

Getting naloxone doesn't mean an addict will stop using, and some officers wonder if the drug has enabled addicts. They know that they're fighting a war on drugs while also reviving people who might commit crimes to support their addictions.

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Sena, who was charged with endangering the welfare of a child in the January incident, admits he's blessed for being revived. The police officer who revived him said he was practically dead, he recalled. Sena is grateful that his son, now 5, didn't have to watch him die.

Still, an officer who has administered naloxone underscored the conflict for police.

"In the back of my mind, I don’t want people thinking that when they overdose there’s always going to be someone there in time to save them,” said Joshua Crimmel, a York Area Regional Police patrolman.

Quantifying an epidemic

Twenty municipal and regional police departments have administered naloxone in York County across at least 27 municipalities, according to the district attorney's data. Local departments have used it 243 times since April 2015. That number does not include two successful naloxone uses by Pennsylvania State Police, who reported no additional details.

No department has used it more than York City's — 63 times since April 2015. Three departments — York, Northern York County Regional and Hanover — account for more than half of the county's naloxone uses in that time period.

Wes Kahley, city police chief, declined an interview request. Officers with Northern York and Hanover did not return calls seeking interviews.

Other officers painted a vivid picture of what the county's heroin epidemic looks like at the scene of a suspected heroin overdose.

They happen in public restrooms, gas stations, parking lots and homes. Patients are unconscious and are taking shallow breaths. Their heart rate nearly stops and their veins scream for oxygen. Sena, for example, had no detectable breathing and had a bluish tint to his skin, according to charging documents from his incident.

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Officers assess the scene and look for evidence of heroin or opioid use like needles, spoons, powder, pill bottles or baggies. Sena had a fresh needle puncture on his right forearm, charging documents state.

Sometimes it's an obvious overdose. Josh Poplin, an officer with Southwestern Regional Police, found a woman in North Codorus Township slouched over a bathroom counter with a spoon and needle in the sink. That woman's daughter, in the 5- to 10-year-old range, had walked in on her mother after the woman's parents called 911, Poplin recalled.

Police ask questions of everyone who's around to establish where the drug came from and how much the person took, said Robert Lusk, an officer with Spring Garden Township Police.

There isn't much communication between the officer and the patient from revival to the two parting ways, Lusk said. If it's said at all, "thank you" typically doesn't come unless the two meet in court — for example, if the person ends up facing a theft charge or something similar. Sometimes overdose patients are charged with drug possession after they're revived, Lusk said.

Burglaries, robberies and thefts investigated by police often come from people supporting their drug addictions, said James Hess, patrolman with York Area Regional Police.

Reviving someone from an overdose is not the same as saving a baby from a burning car. The baby doesn’t really have a choice to squander a second chance at life, Hess said, but adults do. Naloxone, he said, is like a bandage for the heroin epidemic.

Sometimes the save makes a difference.

Lusk and another officer responded to a Spring Garden Township convenience store in February. One man was overdosing on the floor while another was overdosing in a car in the parking lot. Both were revived by the officers, Lusk said, and he got to see them weeks later at a hearing for a drug possession charge. He said he could hardly recognize the one man, who appeared healthier.

"You do get a good feeling bringing someone back around," Lusk said. "But you do wonder if this will enable someone. The two I know who got help — it was worthwhile."

Using naloxone

Officers will check the overdose patient for a pulse, Lusk said. If there isn't one, it's likely too late for naloxone.

Officers can inject someone with naloxone or spray it into a person's nose. The drug blocks the receptors that opiates bind to, like a road block, said Ted Hake, vice president of White Rose Ambulance. "No opiates can come in here, so they keep going down the blood stream,” he said. “It’s almost like an instant withdrawal.”

The nasal spray takes longer to work than the injection. Lusk has seen the injector given and, almost instantly, the patient's eyes opened. It could take a minute or two for the nasal spray to work.

One dose doesn't always do the trick.

Cops are probably re-administering naloxone if the patient is not yet awake or awake enough to talk, said Dr. Erik Kochert, program director in York Hospital's emergency room. And that's appropriate, he said, because people cannot overdose on naloxone.

Sena began taking visible breaths of air after his first dose, but he was still unconscious, charging documents state. He was given a second dose before he was put into an ambulance. While charging documents account for two doses, the district attorney's data indicates he received three. Once he was put on a stretcher and into an ambulance, he became alert and able to speak.

When an officer doesn't know if the patient has overdosed on heroin, it's OK to hit them with another dose or two, Kochert said. Even if the patient didn't overdose, naloxone won't cause any harm. It would just make the patient wake up and experience withdrawal, he said, which is better than not breathing.

After police give anti-overdose drug to heroin users, what happens next?

Doctors and nurses will administer smaller doses of naloxone more frequently, Kochert said. That allows patients to avoid the instant withdrawal that has been known to anger them.

WellSpan's emergency room naloxone usage has likely increased since 2013, Kochert said, because it's become common for people to drop off someone who is overdosing at the hospital. In some cases, an ER patient may have already received naloxone.

Once it wears off, the overdose could set in again. Officers and paramedics typically recommend hospitalization, but patients can refuse.

Crimmel couldn’t say whether the person he revived was taken to the hospital, but said the man had no interest in seeking medical help. He said he was fine, Crimmel recalled. “I said, ‘Sir, five minutes ago you were blue and lying on the floor.’"

Fixing a deadly situation

Lusk's department has given naloxone to five patients, all of whom were revived.

Spring Garden Township has had no repeat patients, which isn't the case for all departments. York Area Regional Police responded to the same overdose patient twice in five weeks, Hess said. The person required two doses May 28 and one dose July 2, according to the district attorney's data.

Even though the 2016 death toll from heroin overdoses is on pace to top last year’s, York County Coroner Pam Gay said naloxone is making a difference amid the county’s biggest drug crisis she’s ever seen.

“It saves lives,” she said. “Whether you believe it enables or not — it enables people to live another day.”

Revived addicts reverting to heroin are no different than heart attack victims who continue eating doughnuts, Gay said.

What she calls "naloxone fatigue" is feedback from jaded police, paramedics and first responders who are frustrated that people who nearly die of an overdose don't immediately quit abusing drugs and seek treatment. That's the definition of addiction, Gay said, and those people are deep into their addictions. "They're not going to change overnight," she said.

Repeat patients probably aren't common, Gay said, and an officer might ask: "Am I really helping these people?" Some don't want help, she said. Some don't know where to turn.

Sena had his wife, Carrie Sena, and their kids. She told Robert that if he was serious about recovery, she would work with him.

Carrie said she’s thankful for naloxone. More than that, though, she’s thankful someone called the police when Robert became unresponsive.

Robert Sena was charged with endangering the welfare of a child since his son was in the backseat. The caller didn't face any charges because of a law that sometimes gives immunity to people who call 911 when someone has overdosed.

“I don’t know the kid; never met him in my life,” Carrie Sena said. “Because of the Good Samaritan Law, he had faith in that law. Had he not, Robert would have never lived."

The Senas know people who have succumbed to overdoses. In one case, Carrie said, their friend died when someone with her didn't call 911 in time.

In the couple's first year of marriage, Carrie has seen Robert relapse and enter rehab twice. She’s heard people say things. That they wouldn’t stay with someone who overdosed with a kid in the car. She’s read online comments to the tune of, "Why waste time saving addicts?"

“If that was your husband, you wouldn’t feel that way,” Carrie said. “You would be thanking God that every cop in the county carries (naloxone).”

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What's being done?

There's work to do. The Good Samaritan bill was a start, but it isn't perfect, said Pam Gay, York County coroner.

The York Adams Drug and Alcohol Commission plans to implement a "warm handoff" program, which would put overdose patients in touch with someone who could coach them toward recovery options. But beds might not be available for those willing to enter treatment. If someone doesn't have a job or health insurance, it makes getting into some treatment programs even more challenging.

Medics using naloxone

When medics give someone naloxone, they report it to the state. There were about 9,200 naloxone uses by paramedics in Pennsylvania in 2015, according to the Pennsylvania Department of Health. The department would not disclose how many patients survived their overdoses or where in the state patients received the drug.

White Rose Ambulance gives patients naloxone about 160 times a year, said Ted Hake, vice president of White Rose Ambulance company.

What's it cost?

The York County District Attorney's office buys naloxone with money seized in drug busts. A 2 milligram kit costs around $50. The Pennsylvania District Attorneys Association reimburses the county with money paid from Capital Blue Cross. The health insurance company donates money — $150,000 thus far — to the district attorney's association. The association reimburses district attorney's offices in Blue Cross' 21-county coverage area.

Contact Mark Walters at 717-771-2032 or follow him on Twitter at @walt_walters.