Dr. Joan Papp always knew she wanted to be in a profession where she could help others.
When she began to see more overdoses, as well as more patients using opioids coming into the MetroHealth Emergency Department in Cleveland, the Brunswick native found a cause that hit close to home.
“Unfortunately, I think it affects us all. There are very few people who have not been touched,” says Papp, an assistant professor and emergency medicine physician in the Department of Emergency Medicine at MetroHealth Medical Center.
“I also have both family and friends who have struggled with addiction, in addition to the many patients that I care for in the ED.” - Dr. Joan Papp
Located in Cuyahoga County, MetroHealth finds itself at one of the epicenters of the opioid overdose epidemic, says Dr. Bernie Boulanger, the organization’s executive vice president and chief clinical officer.
In its latest “Final Drug Deaths Report,” the Cuyahoga County Medical Examiner’s Office found there were 320 overdose deaths associated with heroin in 2016 – a 136-case increase from 2015. Overdose deaths associated with fentanyl, a synthetic opioid that is prescribed as a pain medication, also increased from 92 cases in 2015 to 399 cases in 2016.
Total drug overdose deaths in Cuyahoga County in recent years have become the highest recorded in the county’s history, with 719 cases in 2016, according to the Medical Examiner’s Office report.
Watching this worrying trend, Papp, a graduate of the Medical College of Ohio in Toledo who completed her residency at MetroHealth before joining the staff in 2007, felt compelled to act.
In 2013, she founded Cuyahoga County’s Project DAWN (Deaths Avoided With Naloxone), which promotes overdose education and organizes the distribution of naloxone in communities throughout the state.
Naloxone, also commonly referred to as Narcan, is a drug that blocks and reverses the effects opioids have on a patient’s brain and respiratory system. According to MetroHealth, the Project DAWN team has distributed more than 5,000 naloxone kits and is credited with saving more than 730 lives since its founding four years ago.
In Ohio, recent legislation has made naloxone widely available to anyone in a position to assist a person experiencing an overdose. Currently, there are 58 Project DAWN sites in 45 counties. Gov. John Kasich’s proposed executive budget for the next two years includes an additional $2 million to launch new Project DAWN programs in communities with unmet needs.
Papp says Project DAWN must continue to evolve in order to match the rapidly-changing nature of the opioid epidemic.
“We have already increased the dose of naloxone that we include in our kits from 4 mg to 8 mg because fentanyl often requires higher doses to reverse.” - Dr. Joan Papp
“We are also seeking additional state and federal funding to support the expansion of our program,” she says.
Project DAWN is managed by the Office of Opioid Safety, a new office within the MetroHealth system led by Papp. Having opened July 1 of this year, the office focuses on “providing education to patients and providers on safer opioid prescribing and use,” Papp says.
An office manager, two trainers, and a senior medical educator join Papp at the new office, which is the first of its kind in northeast Ohio. Plans to hire a researcher/analyst, as well as another educator, are in the works pending additional funding, Papp says.
During its first year, the office is focused on developing tools and updating policies that will improve opioid safety. These are duties that Papp is well-acquainted with through her work as medical director of Project DAWN, as well as with the U.S. Attorney’s Heroin and Opioid Task Force, for which she serves as the chairperson of the health care policy subcommittee.
Additionally, Papp has previously provided testimony to Ohio House and Senate committees in support of various bills that promote expanded access to naloxone. She has received numerous awards for her work, including Crain’s Cleveland Healthcare Heroes – Advancements in Healthcare award in 2014, the Ohio Injury Prevention Partnership Award in 2015 and the Ohio ACEP Award for Advocacy in Emergency Medicine in 2016.
Carole Rendon, former U.S. Attorney for the Northern District of Ohio, says she commends Papp and MetroHealth for taking on a leadership role in the fight against opioid addiction.
“This new position will give her a bigger platform from which to continue her life-saving work and will make our community stronger.” - Carole Rendon
For Papp, increased collaboration and education are the office’s long-term goals.
“People may believe that prescription opioids are safer and cannot lead to overdose. Many of the prescription opioids are very powerful and can lead to addiction even when taken as prescribed,” she says. “We hope to reduce prescriptions of opioids throughout the system and ultimately reduce mortality in the county.”
For more information about Project DAWN, visit www.metrohealth.org/projectdawn. Visit stopoverdoses.ohio.gov to find a location near you to obtain naloxone.
Amanda Etchison is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Joan Papp, MD, FACEP is an Assistant Professor in the Department of Emergency Medicine at MetroHealth Medical Center, where she has been employed since 2007. She graduated from the Medical College of Ohio in Toledo in 2000 and the MetroHealth Case Western Reserve University residency program in Emergency Medicine in 2004. She is the founder and Medical Director for the MetroHealth Cuyahoga County Project DAWN program, an opioid education, and naloxone distribution program. Dr. Papp also serves on the U.S. Attorney’s Office Heroin Action Plan Committee and is Chair of the Policy subcommittee that meets monthly to address opioid policy-related issues facing our community. She is the recipient of the Crain’s Cleveland Healthcare Heroes – Advancements in Healthcare award in 2014, the Ohio Injury Prevention Partnership Award in 2015 for her work with Project DAWN and the 2016 Ohio ACEP Award for Advocacy in Emergency Medicine.
