How First Responders Can Reduce Opioid Overdose Deaths

Opiate painkiller overdoses are at epidemic levels in the United States, but the public health and public safety systems have not adapted sufficiently in response. A simple, inexpensive and life saving reform would be to have police, firefighters and other first responders carry naloxone (aka Narcan) as standard equipment.

Naloxone is a medication that reverses the effects of opiate overdose for about 30 minutes, which can be the difference between getting someone to the hospital and needing to get them to the morgue. There is some medical risk in its administration, but certainly less than letting an overdose persist. Because it is available as an intranasal spray formulation, no training in injection is needed in order to administer it. Naloxone administration should be accompanied by some basic life support (e.g., putting people in the recovery position, checking for airway blockage, doing CPR if necessary), but first responders already have those skills. They can therefore be trained to add naloxone administration to their clinical repertoire at little marginal cost.

Police in Quincy, Massachusetts have started carrying naloxone and the Boston Globe reports that they are reversing about one opioid overdose every 10 days. Disappointingly, firefighters have thus far refused to do so, even though they have had the training. I hope they change their minds before someone dies needlessly on their watch.

I have been working with my home state of West Virginia on this issue, after testifying about naloxone in front of a committee chaired by a legislator who is also fortunately enough a physician (Senator Ron Stollings, M.D.). The Senator is lead sponsor on a bill to equip first responders to carry and administer naloxone; it passed the senate unanimously last week.

Relative to other things I have advocated for over the years, it wasn’t hard to get elected officials interested; I think the lack of naloxone availability in the U.S. stems less from strong opposition to it (though there is some of that, as the Quincy firefighters demonstrate) and more from most people not having heard of the medication or understanding how it can enhance public health. I hope therefore that everyone who lives in a city or state with an opiate overdose problem will spread the word to their elected officials. Their ears may be more open than you imagine.

Comments

  1. caphilldcne says

    It would be wise not just to have first responders, but also injection drug users and their families, to have naloxone available. They can be trained to handle naloxone just as easily and of course are motivated to save lives of the people close to them.

  2. Keith Humphreys says

    caphilldcne: Yes, this is also being done in a number of U.S. cities, and I am learning about it from UK colleagues as well. But it isn’t as easy or as inexpensive: You have to do basic life skills training which few will have had before, about 90% of the distributed naloxone goes missing, and you need much broader coverage to have a population effect than you would with people who are first responders. And the motivational aspects are more complex than you may think. Parents are definitely motivated to use the naloxone on their drug addicted children, but drug users themselves vary in how they feel about it, some fear the consequences of ruining someone else’s high and therefore don’t want to use the naloxone even when they should (This surprised me, but there it is — I was also surprised that in years of doing this the London team has never had a user self-inject, for the same reason).

  3. Bruce says

    The Globe story wasn’t clear about their concerns: What’s the hangup — the potential downside — for the firefighters?

    • Keith Humphreys says

      Bruce: You got me. If you are willing to give an addicted person CPR why would you be averse to spraying narcan up his/her nose? I thought it was weird they were quoting a union rep — why is this a union issue? If the department purchases new respirators, does those need to be including in the next labor contract after a year of hard bargaining before they can use them to save a life?

      • says

        I’m going to guess it’s because public servants are under relentless attack by the right, and that firefighters are scared of anything that an unscrupulous scumbag could use to paint them as “soft on drugs”.

  4. caphilldcne says

    Sure, but for groups associated with syringe exchanges and who are already engaged in some ways with their health, I think it’s a nice add-on. Of course it always boils down to finding funding. I think one real problem is that because of fear of prosecution that people around IDUs are often afraid to call police and firefighters to help overdosing friends and that people who could be helped are not treated fast enough. There are some ideas for “good Samaritan” laws about this – e.g. if you are calling the police in an emergency, creating some kind of limited immunity around drug use might be helpful.

    I agree, the firefighters response is puzzling. My money is on prejudice and irritation about having to help injection drug users with maybe a small portion on fear of the potential reaction from drug users coming out of overdose extremely angry and sick.

    True story – I was at a conference in 2000 that had a panel on providing first responders with naloxone and an audience member described her specific concern that the San Francisco police would use it on people nodding out in doorways to steal their high. I thought I’d gone through the looking glass at that particular conference but it also helped me at least get some of the (IMHO misplaced) anger at first responders that some users feel. It’s discouraging that 12 years later we’re still just barely making inroads on getting naloxone out there.

    • Keith Humphreys says

      Hey caphilldcne: here are some ideas for “good Samaritan” laws about this

      Yes, been working on that too in much of the U.S. and feel the winds are at this policy’s back. College campuses, some states, many cities seem on board.

  5. caphilldcne says

    Regarding the Quincy program, I should add that it does seem like an amazing success (except for the firefighters response) and in fact they are engaging private citizens too (I don’t want my comments to imply otherwise).