Opioid Misuse Among First Responders: Inside SC4i's Community Panel Discussion

On the morning of Thursday, September 24, first responders, medical practitioners, and community members

filled Chapman Auditorium at the ENT Center in Colorado Springs for an Opioid Crisis Panel Discussion hosted by Status: Code 4, Inc. (SC4i). The free, two hour event was funded by the Pikes Peak Region 16 Opioid Abatement Council, and it opened up a conversation that first responders rarely get to have out loud: why opioid misuse happens in this field, and what can actually be done about it.

The morning began with a screening of Lifelines: Opioid Use Disorder, a short film that looks at opioid misuse through the eyes of first responders and medical practitioners.

From there, a panel of four local experts took the stage for a discussion built around SC4i's Opioid Crisis Curriculum, followed by an open question and answer session with the audience.

The panel included Dr. Daniel Crampton, PsyD, a retired paramedic and Co-Founder and COO of SC4i; Sabrah Jean Collar, PMHNP-BC, owner of Bloom Behavior Health; Nicole Weis, MA, LPC, LAC, Director of Healing and Community Programs at the Lyda Hill Institute at UCCS; and James McCoughlan, Community Paramedic Director at Ute Pass Regional Health Services District. Between them, the panel brought clinical, academic, and on-the-ground field perspective to a topic that touches nearly every department in some way.

Why opioid misuse happens

Nationally, an estimated 2.5 million adults lived with opioid use disorder in 2021. In Colorado, drug-related overdose deaths rose from 141 in 2016 to 224 in 2021, with fentanyl now involved in roughly a quarter of all drug-related deaths in the state. Those numbers touch first responders directly. Research shows that about 30 percent of first responders develop a behavioral health condition over the course of their career, compared with 20 percent of the general population, and healthcare professionals as a group misuse drugs or alcohol at notably higher rates than the public they serve.

The panel walked through the research on why. The most commonly cited reasons people turn to opioids are tied to managing pain, not chasing a high: coping with physical pain, coping with anxiety or low mood, and simply trying to relax after a hard stretch of work. First responders often have more access to opioids through their jobs, but the panel noted that most providers actually work hard to avoid using them personally, well aware of what misuse can do.

When pain and PTSI overlap

One of the panel's central topics was the overlap between post-traumatic stress injury (PTSI) and chronic pain, something the curriculum calls comorbidity. A 2018 survey of more than 5,000 Canadian first responders found that 23.1 percent self-reported clinically significant concerns with both a mental health condition and chronic pain at the same time, and that first responders with chronic pain were significantly more likely to also screen positive for PTSI, depression, and anxiety. Chronic pain alone is estimated to cost the United States 75 to 100 billion dollars a year in lost productivity and health care, and in this field it rarely shows up alone. SC4i's Trauma Healing Therapy program works with exactly this kind of overlap, since treating pain or PTSI in isolation rarely gets to the root of either one.

What keeps people from asking for help

The panel didn't shy away from the harder parts of the conversation either. Stigma, the belief that struggling with addiction means someone is weak or flawed, keeps many first responders from ever naming the problem out loud. In a profession built on self-reliance, admitting a struggle can feel like a risk to a career, not just a hard conversation. The panel also discussed moral injury, the lasting psychological weight of an action or inaction that conflicts with a person's own values, something first responders can carry home from a single bad call or from years of them. Left unaddressed, both stigma and moral injury tend to push someone toward isolation, and isolation is where opioid misuse often takes root.

A tool for checking in

To make all of this less abstract, the panel introduced the Stress, Pain, and Opioid Use Continuum, known as the SPOC model. Adapted from a continuum originally built by the U.S. Marine Corps for combat stress, it lays out four phases, Ready, Reactant, Injured, and Critical, and shows how stress, pain, and opioid use tend to move together rather than separately. The panel's key point was that movement between these phases runs in both directions. Someone in a harder phase today is not stuck there, and the coping skills and support available at every phase, from peer check-ins to professional treatment, are exactly how people move back toward Ready.

The full panel discussion, including the audience question and answer session, was recorded and is available to listen to above.

SC4i extends its thanks to Dr. Daniel Crampton, Sabrah Jean Collar, Nicole Weis, and James McCoughlan for sharing their time and expertise, and to the Pikes Peak Region 16 Opioid Abatement Council for funding the event. This panel is part of SC4i's broader Opioid Crisis Curriculum, which is also available to departments year round as an online training module and an in-person classroom lesson. Keep an eye on SC4i's upcoming events for future community panels like this one.

Frequently Asked Questions

What is the SPOC model?

The Stress, Pain, and Opioid Use Continuum (SPOC) is a visual tool adapted from a stress continuum originally created by the U.S. Marine Corps. It describes four phases, Ready, Reactant, Injured, and Critical, showing how stress, pain, and opioid use tend to rise and fall together. People move between phases in both directions, and coping skills and support exist at every stage.

Why are first responders at higher risk for opioid misuse?

On the job access to medications, high rates of chronic pain from physical injuries, and the overlap between post-traumatic stress injury (PTSI) and chronic pain all play a role. Stigma and moral injury, the weight of actions that conflict with someone's own values, can also keep people from asking for help before a problem grows.

Where can someone find help for opioid misuse or PTSI?

SC4i offers free, trauma-informed counseling and peer support to first responders and their families, along with training like the Opioid Crisis Curriculum discussed at this event. Visit sc4i.org or call (719) 822-3387.

SC4i is a statewide Colorado nonprofit that provides free, trauma-informed counseling, peer support, and wellness training to first responders and their families. The Opioid Crisis Curriculum discussed at this event is available to departments year round, as an online module, a short film, and an in-person classroom lesson. To learn more or bring this training to your department, visit sc4i.org or call (719) 822-3387.