The Seattle Police Department has received a lot of well-earned praise for its use of naloxone, an overdose-reversal drug sold under the brand name Narcan, to reverse seven overdoses in downtown Seattle over the past four months. SPD announced it was providing naloxone nasal spray to 60 bike patrol officers as a pilot program back in March; since then, the department has administered the drug six times and declared its commitment to continue the program despite what it describes as a “17-fold increase” in the price of the drug, according to Capitol Hill Seattle Blog.
At the same time as SPD’s widely heralded efforts were going on, the Downtown Emergency Service Center, which provides low-income housing and is the city’s foremost advocate for the “housing first” approach to combating homelessness, has quietly been saving lives using the same OD-reversal drug at a rate of one or two overdose reversals a month since last October, for a total of about a dozen, according to DESC administrative services director Greg Jensen. The agency started training staff at its 12 housing projects and clinical sites to use Narcan after a new state law took effect that allows naloxone to be prescribed not just to individual “good Samaritans” who wanted to have it on hand, but to agencies like DESC and SPD, which (because they’re institutions) weren’t able to get prescriptions for the lifesaving drug before.
“We’d had a few overdose deaths in our housing projects and so we saw that there was a need for us to have something available for reversing overdoses,” Jensen says. But, he adds, “I think it’s safe to say that we were surprised at the number of times we had to use [the Narcan kits].”
Naloxone works by blocking the effects of opioid drugs like heroin and prescription pain medications by ejecting the opiates from their receptors in the brain, allowing someone who has stopped breathing to breathe normally again. It comes in injection form but is more commonly distributed as a nasal spray kit, which requires only minimal assembly.
Danielle Burt, the project manager for DESC’s Interbay Place, supportive housing for 97 chronically homeless people with co-occurring disorders like addiction, has reversed four overdoses since she started working at DESC—three as an individual good Samaritan with her own prescription for Narcan working at the agency’s Canaday House on First Hill, and one at Interbay Place after the new law took effect. Burt says the last time she reversed an overdose, it was for a woman who had Type 1 diabetes and was also an active heroin user. The woman came downstairs one day complaining that her blood sugar was low, but when she passed out and stopped breathing in the building’s common area, Burt knew she was having an overdose. “She had been using in her apartment, and had come down thinking she was having a medical emergency from something else, and then passed out from the overdose,” Burt says. She gave the woman Narcan nasal spray, and by the time medics (who carry Narcan on their trucks) had arrived, the woman was breathing again.
It only took the medics about 3 to 5 minutes to show up, Burt says, but “it’s a respiratory crisis—why would I wait for medics to arrive if I had something that can potentially get them back to breathing?
“We all know that with any respiratory emergency, those few seconds can dramatically impact if an individual lives, and if they live, their functioning,” Burt says. “Three to five minutes is a really long time for somebody not to be breathing. There’s just this time variable that makes it makes sense” to have Narcan on hand, she says.
DESC director Daniel Malone says that as prescription opiates become less available and heroin use becomes more prevalent, “that of course brings less predictability”—and more overdoses. So far, only Medic One emergency medical technicians (known as medics) and the 60 bike officers in the pilot program are equipped with Narcan; firefighters, who are EMTs but not certified medics, don’t carry it. But firefighters are often the first responders when someone calls 911 for a suspected overdose; indeed, of the half-dozen Narcan reversals SPD has reported, at least one required bike patrol officers to ride to the scene of an overdose in progress and assist fire department EMTs who called and “asked officers to administer a dose of Naloxone, a life-saving drug used to reverse the effects of an opioid overdose,” according to the SPD Blotter blog. SFD spokeswoman Corey Orvold said she wasn’t aware of any overdose incidents where medics weren’t on the scene immediately, and says “I’m not sure if [giving all EMTs access to Narcan] has actually been discussed.” I left a message through Orvold with SFD’s medical director to find out more about the fire department’s Narcan allocation.
Ultimately, naloxone saves lives; it doesn’t solve the drug problem. But as harm reduction advocates are fond of pointing out, you can’t get into recovery if you’re dead, and drugs like Narcan keep people alive until they’re ready to get better. To that end, it seems wise to make them as widely available as possible, not just to good Samaritans and police officers on bikes but to anyone who comes into frequent contact with drug users. Eventually, Narcan, which costs about $75 a dose, could be as commonplace as defibrillators or even first aid kits.