First responders turn to spray for opioid overdoses

Mack Hutchison can describe in deliberate detail how he determines a patient has overdosed on an opioid.

First comes a basic assessment, said Hutchison, a paramedic at MEMS. Breathing. Pulse. Vital signs. Skin color. An overdose shows up in constricted pupils and slow respiration.

Ask bystanders and family what the patient was doing. Ask for a medical history -- diabetic or heart patient? Was the patient taking drugs or drinking alcohol? Is there drug paraphernalia at the scene?

If the diagnosis is opioid overdose, Metropolitan Emergency Medical Services paramedics go to naloxone, a medication that inhibits and reverses the effects opioids have on the brain. Hutchison, a paramedic since 1987, has employed naloxone many times, typically using an IV, he said.

First responders now have an alternative whose use is spreading -- brand name Narcan. It's naloxone in a nasal spray.

Two police departments in Arkansas -- Maumelle's and Jacksonville's-- have worked with the Clinton Health Matters Initiative to get Narcan into the hands of their officers. Police in Benton have carried Narcan since December.

"It saves lives, and that's our goal," Benton Police Chief Kirk Lane said.

Benton police got their first save Sept. 25. When the 911 call came in, Lane said, the caller said the patient was experimenting with heroin. When police arrived, they found drug paraphernalia.

Narcan was administered, and "we saved that person's life."

Lane made his remarks at last week's conference on the prevention of prescription drug abuse hosted by state Attorney General Leslie Rutledge and three state agencies. More than 700 pharmacists, medical professionals, educators and law enforcement officers signed up for the daylong gathering at the Embassy Suites in Little Rock.

At one point in a presentation by Lane and John Kirtley, executive director of the state Board of Pharmacy, Lane took out a Narcan tube and gave it a squirt.

It's that easy to use, he said. He then passed around his Narcan kit, about the size of a toiletry travel bag. Such a kit typically has two doses, in case the first doesn't do the job completely.

A drug company donated 100 kits to Benton, Lane said. The decision to equip his officers with Narcan was easy, Lane said. He recalled a conversation with a local monument-maker.

"He said, 'I'm tired of making gravestones for our kids, and over the last year I've made 14 or 15 of them.'"

The Clinton Health Matters Initiative, based in New York, has 25 participants in its program, CEO Rain Henderson said, including police departments, colleges, health departments, fire departments, recovery and treatment organizations, and social service organizations. The initiative has a regional office in Little Rock at the Clinton School of Public Service.

Participants are in Arkansas, Washington state, Arizona, Iowa, Texas, Ohio, New York state, New Hampshire, West Virginia, North Carolina, Georgia and Florida.

About 3,100 units of Narcan have been shipped nationally, with about 500 more pending.

Adapt Pharma, the manufacturer, has made a limited number of Narcan units available without cost for the program, Henderson said. A discounted price of $37.50 per dose, $75 for a pack of two, is also available for public safety agencies and universities.

Given the prevalence of opioids -- legal medications such as hydrocodone and illegal substances such as heroin -- people who have a family member at risk for overdose should get a Narcan prescription from a doctor, Kirtley said.

Pharmacists should also prescribe Narcan, he said, but state law on this point is unclear. He hopes the law can be clarified in the next legislative session, which begins in January. Prescription cost runs from $5 to $75 for a kit, he said, and the medication has a shelf life of about a year.

The Arkansas Department of Health reports that hydrocodone is the most-used prescription opioid in the state. Rates of use in 2015 varied from 20 doses per capita in Lincoln County to 65 doses per capita in Pike County.

At the conference, Kirtley said about 111 million doses of hydrocodone were prescribed in Arkansas in 2015. The state has a population of about 3 million.

All 33 sworn personnel at the Maumelle Police Department are required to carry a Narcan kit, Police Chief Sam Williams said. He keeps his kit in the glove compartment of his car. All have been trained, he said, and using Narcan is easy.

"Even I can do it," he said.

"The hard part is making that decision you're dealing with someone who has an Opioid addiction and is in the throes of an overdose. If you can put nose spray in your own nose, you can do this. If you don't get results, you can do it again."

His officers have yet to use Narcan, Williams said. Neither does the city have an increasing problem with opioid abuse.

"We know we have a defined opioid-addicted percentage of people here," he said, "just like every other society."

Jacksonville police will start carrying Narcan by Jan. 1, Capt. Kelley Smiley said. Officers must first be certified in CPR, he said, in accordance with the department's agreement with its physician of record.

"We have responded to some overdoses that resulted in the person being deceased by the time we got there," Smiley said. "We haven't responded yet to an overdose where we could have saved a life."

It's a matter of time, he said.

"Opioids are being abused at greater and greater rates in this area. A lot of our narcotic buys are fentanyl. We know it's out there and people are abusing it, so we're trying to get ahead of the game."

The National Institute of Drug Abuse describes fentanyl as a powerful synthetic opioid 50 to 100 times more potent than morphine. In prescription form, it's known by such names as Actiq, Duragesic and Sublimaze.

Street names for the drug include Apache, China Girl, China White, Murder 8 and others.

A recent fentanyl death involved a patch, Smiley said.

"The patch wasn't doing it for her, so she started chewing it to get the fentanyl into her system faster. That didn't turn out so well."

A concern about Narcan is what economists call moral hazard -- the lack of an incentive to guard against risk when one is protected from the consequences.

"Part of me is concerned that people, knowing Narcan is an antidote, may be willing to take a greater risk, thinking it will save them if they go too far," Jon Swanson, executive director of MEMS, said.

"Maybe it does and maybe it doesn't, depending on if your friends called in time. Or if you're on your own."

Denise Robertson, director of the prescription drug monitoring program at the Arkansas Department of Health, acknowledges the conflict between having a handy remedy and that remedy's possible encouragement of opioid use.

"Do we save a life or not? It's the chicken or the egg, and that's up for opinion."

Metro on 11/08/2016

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