OPIOID OVERDOSE DEATHS, PARTICULARLY FROM THE SYNTHETIC DRUG FENTANYL, ARE ON AN ALARMING UPWARD TREND — It's the drug that killed Prince — but the New Orleans Police Department (NOPD) has yet to issue officers naloxone, a drug which can revive an overdose victim in moments. In Louisiana, police have been permitted to carry and administer naloxone (brand name: Narcan) for nearly two years, but none do. And while few have heard of the legislation, others have yet to hear much about naloxone itself.
Whether the victim is a medical patient who mistakenly takes too much of a prescription drug or a recreational user mainlining heroin, the signs of an overdose are the same: victims' pupils constrict, they lose consciousness, respiration falters and stops, the skin becomes blue and they often appear to be dead before they really are. Naloxone prevents opioids from interacting with the central nervous system almost immediately after administration.
In short, it can bring a victim back from the brink of death.
Naloxone also is extremely safe. The drug has been used by paramedics and emergency room doctors for more than 40 years, is non-addictive and has no adverse side effects (although it can trigger withdrawal symptoms, such as severe headache and nausea, when given to an addict). In the past, the drug was administered primarily with a syringe, but modern delivery systems typically comprise either an auto-injector (some devices are equipped with voice commands) or an intranasal spray.
"If you drink a gallon of [naloxone], all you do is pee like a racehorse," said Robert Childs, executive director of the North Carolina Harm Reduction Coalition (NCHRC). "All it does is enable people to continue to exist."
Although only two overdose deaths in Orleans Parish were attributed to Fentanyl in 2014, of last year's 63 opioid deaths, a dozen of the victims had Fentanyl in their systems, according to the coroner's office. This year already, 19 of the dozens of people killed by opioids tested positive for Fentanyl. That means an increase of about 900 percent in Fentanyl-related overdose deaths — and it's only June.
To put that in perspective, in 2016, there have been 53 murders in New Orleans; as of this writing, there've been 48 deaths from accidental opioid overdose.
Yet New Orleans police don't carry naloxone — and Gambit couldn't find a single state law enforcement agency that does.
A spokesman for the city declined to answer questions for this story, also declining on behalf of Dr. Jeffrey Elder, director of Emergency Medical Services. In an email, the spokesman wrote, "The City is reviewing if NOPD should be trained to administer naloxone," and noted New Orleans firefighters and EMS workers are equipped with it.
Childs tracks law enforcement adoption of naloxone across the country and conducts training for departments interested in deploying the drug with patrol units. His organization is largely responsible for North Carolina's relatively early adoption of the drug. There, legislation permitting police to carry Narcan was passed in 2013; now, 81 agencies (out of around 350) across the state issue it to officers.
"We walk them through the program and then we train them if they need us to," he told Gambit.
Childs added that he does-n't encounter officers who, after seeing how easy it is to use, don't want to carry it daily. He likens naloxone to automatic external defibrillators (AEDs), which have made their way into many squad cars since their introduction.
"They're probably just as likely to use it," Childs said. "They encounter overdoses all the time. If you're an officer, you want to be equipped to protect the life and dignity of the people you serve. When we poll officers, we usually find that 80 to 90 percent of officers want to carry it. They encounter overdoses often. They want to be able to do their job, to save that person's life."
OFFICERS MAY ENCOUNTER MANY MORE OVERDOSES IN THE COMING MONTHS. New Orleans (and the United States) is going through an overdose death epidemic. Opioid overdoses already account for as many accidental deaths as automobile accidents and, in New Orleans, they could give the murder rate a run for its money.
Opioid overdose deaths have been on the rise nationwide and are connected to a sharp increase of the synthetic opioid Fentanyl on the illicit market. Much cheaper than heroin, Fentanyl also is 40 to 50 times more potent. Sometimes users mix it with heroin to get an increased "pop" in their high. Fentanyl may be ingested in pill form, smoked, snorted or injected, and a tiny amount can be lethal — in fact, users sometimes begin to overdose before they have finished injecting it.
"My sense is that this market is just waking up to Fentanyl, whereas other markets may be a little more advanced, with multiple sellers," Orleans Parish Coroner Jeffrey Rouse told Gambit. "This is a problem that I can only see growing. This is a drug that is highly lethal and, from what I'm hearing, also sought out in the user community for its lethality."
Rouse agrees that police units should adopt Narcan as part of their emergency response kits, but increasing the availability of the lifesaving drug in at-risk communities, including current opioid users, those likely to relapse and college campuses, is more important, he said.
"I think that the numbers of persons that may be saved [by officers on the scene] is a handful at most, so really I'm more concerned with having it pushed out into the com-munity, to have a Narcan kit on every corner, so to speak," Rouse said. "I'm paid to think in worst-case scenarios — I'm a pessimist by nature — but when I see this data and how [the number of overdose deaths attributed to Fentanyl has] grown, from two to 12 to 19 already this year, I can't help but shudder to think that New Orleans may be in the beginning stages of an exponential growth curve in this stuff."
Rouse added, "I think if we spend all our time and energy fighting battles to get [naloxone] into the hands of the police and then thinking we've done our job — that ain't it. It's got to get past them."
STATE REP HELENA MORENO, D-NEW ORLEANS, has spent several years sponsoring a suite of legislation aimed at doing exactly that.
Moreno's most recent legislation, which was signed into law last week by Gov. John Bel Edwards, further expands access to naloxone for third-party purchasers looking to acquire it for use on friends or family members. It opened the door to national pharmacy retailers, such as CVS and Walgreens, providing the community with access to naloxone kits without prescriptions. Moreno's latest bill expanded on similar legislation passed last year that allowed for a "standing prescription" so those who needed naloxone didn't first have to see a physician.
In 2014, Moreno successfully pushed a bill allowing law enforcement to carry naloxone and protecting first responders from liability with a "Good Samaritan" clause. All three of her naloxone bills passed the House and Senate with unanimous support — no small feat for a Democrat trying to pass drug legislation in Louisiana.
"Legislators definitely get it, and I've had countless legislators thank me for the work I've done in increasing access to this drug," Moreno told Gambit. "I even had a legislator who put a coroner's report on my desk from a month ago, and it was his nephew who had passed away. He said, 'Look, maybe if people knew more about naloxone ... maybe there could have been a different outcome, because by the time paramedics got there, it was too late.'"
Now, nearly two years after Moreno's first bill became law, Moreno seemed surprised that no law enforcement agency in Louisiana had adopted Narcan for daily carry.
"None?" she asked. "What about the State Police?"
No, not the Louisiana State Police (LSP), either, confirmed Michael Reichardt, a spokesman for the LSP. In fact, neither the NCHRC nor the Louisiana Fraternal Order of Police had knowledge of any agencies in the state currently equipped with naloxone.
Darrell Basco, president of the Louisiana Fraternal Order of Police, likewise had no knowledge of any agency in the state carrying Narcan kits. "To be honest with you, I don't know enough about it," Basco said. "I know it's supposed to be a counteractive for an overdose, and that's about it."
In Massachusetts, the Quincy police department has deployed naloxone over 500 times since it adopted its use in 2010, according to the city's newspaper, the Patriot Ledger. Similar results have been seen in other parts of the country, particularly the Northeast, (from where much of the Fentanyl seems to be coming, according to the Ledger), with 310 saves in Delaware County, Pennsylvania, and neighboring Philadelphia since police began carrying Narcan in 2014.
"It's very emotional to watch somebody that's completely blue come back to life, and that's exactly what happens."
– Donnie Varnell, trainer for the NCHRC
Southern cities have seen success, too, with North Carolina posting impressive statistics. Much of that state's relatively fast adoption can be attributed to the NCHRC, but some of the credit is due to Donnie Varnell, a retired lawman who headed the statewide drug diversion unit of the North Carolina State Bureau of Investigation (NCBI). Varnell, who was a police officer and sheriff before becoming an NCBI agent, is an advocate for officer-deployed naloxone. Now he works with the NCHRC, helping to train and equip agencies around the country.
"The last training I gave, one officer was 20 minutes away from his headquarters, and before he could get back to his department from my training, he stopped and saved an overdose victim at a traffic intersection," Varnell said.
Varnell acknowledged police agencies initially were skeptical about taking on another responsibility, particularly when administering naloxone meant using a syringe — before simpler intranasal devices and auto-injectors became widely available.
"In the beginning, we had plenty of naloxone and not many agencies carrying," he said. "That changed quickly as departments saw how easy the kits were to use and the dramatic effect they had on seemingly deceased victims.
"It's very emotional to watch somebody that's completely blue come back to life, and that's exactly what happens," Varnell said. "People are sitting there saying, 'Yeah, well, mom and dad thinks he's dead.' The training, of course, is to use your naloxone kit regardless. And so many times everybody thinks the person is deceased, and then their facial color goes from blue to pink in about 10 seconds."
For law enforcement agencies in North Carolina, the results spoke for themselves.
"Now we've got more agencies that want it than we have naloxone," Varnell said. "Once an officer makes a save, public opinion for that officer changes. I mean, you become the hero again. You're a lifesaver."
For NOPD, which struggles with its reputation, officers might embrace an opportunity to regain credibility while giving those on death's door a second chance.
"Let's face it, when the police show up, it's almost never for something good," Varnell said. "In this case, there's terrible trouble, but when you save someone's life, that family looks at you like you're a hero. It's not the most important thing, but let's face it, good PR is good PR."