Emails Reveal Tensions Over SPD’s Naloxone Use, Pressure to “Give SPD Some Positive Press”

Last month, I reported on apparent tension between the Seattle Police Department and the Seattle Fire Department, which runs the Medic One emergency response service, over the use of naloxone, the overdose-reversal drug SPD credits with saving at least eight lives since 100 downtown bike patrol officers started carrying the drug in March. Naloxone works by reversing respiratory depression in a person who’s having an overdose and enabling them to breathe on their own again; as part of a $50,000 pilot project funded by the city and the nonprofit Marah Project, researchers at the University of Washington are tracking SPD’s use of naloxone to see if it is more effective at reversing overdoses than rescue breathing or oxygen alone.

Since the project  began, SPD has been unreserved in its praise for naloxone and its success at “saving lives.” A typical SPD Blotter report, from June 29, begins, “Officers made yet another life-saving use of Naloxone yesterday after a downtown bike patrol in downtown Seattle spotted an unconscious man outside Westlake Mall in downtown Seattle.” But as I reported last month, SFD medical director Michael Sayre told me a different story. “Frankly, Narcan doesn’t really save lives. To the best of my knowledge, we have had zero cases where someone died because they had an overdose and the EMTs didn’t have naloxone.”

Now, emails obtained through a records request reveal that the Fire Department has pushed SPD since the beginning of the program  to back off on the effusive self-congratulation, to no apparent effect. One reason for Fire’s pushback is probably the longstanding turf battle that has existed between the two departments over emergency response. But efforts to get SPD to use more conservative, precise language when talking about naloxone were unsuccessfully at least partly because police chief Kathleen O’Toole has insisted on putting the most positive possible spin on SPD’s naloxone use, ordering SPD to continue describing the reversals as “saves” in order to “give SPD some positive press,” according to an email from SPD  police safety officer Steve Raymond.

The naloxone experiment kicked into high gear in mid-March, when a “Costco sized order of Naloxone,” as one email described it—120 doses, along with 50 nasal atomizers—arrived at SFD headquarters. One month later, on April 16, SPD’s Raymond emailed O’Toole with the news that “we just had our first save today,” a teenager. In that case, a bystander was already doing CPR when SPD arrived on the scene.

“A downtown bike unit deployed Naloxone and she started to breath [sic] a bit stronger after approximately one to two minutes. Fire arrived about two minutes after naloxone deployment and bag masked here [sic] for about a minute. She became alert and oriented,” Raymond wrote.

“Fantastic news! I’m copying our public affairs team,” O’Toole responded. The announcement went out one day later, under the headline, “Bike Officers Save Young Woman’s Life With Overdose Prevention Drug.”

After SPD’s first, ecstatic announcement, UW researcher Dr. Caleb Banta-Green, who is in charge of the study into SPD’s naloxone use, quickly asked SPD to use the term “overdose reversal”—not “save”—for a very specific reason: “Only about one [overdose] in 20 is likely to be fatal.” Every time SPD would go on to claim its officers “saved a life” with naloxone, according to Banta-Green, was in all likelihood an instance when an overdose victim would have recovered on her own, or when a less disruptive response (rescue breathing assisted by a special mask, for example) would have worked just as well. The whole point of the $50,000 study, Banta-Green told SPD officials, including O’Toole, in an April 17 email, was to find out whether naloxone improves outcomes and saves more lives than the status quo. (As Sayre noted in a later email, the woman SPD treated with naloxone on April 16th had been treated by a different bystander who happened to be carrying naloxone just four days earlier, and had been given naloxone to take home with her in case she overdosed again.)

As the emails reveal, SPD was likely never going to use the measured language preferred by Sayres and Banta-Green. On May 14, after SPD’s fourth announced “save,” Raymond wrote, “the chief wants to continue using the ‘save’ language. It is giving SPD some positive press in the community, which we could use desperately. This aspect is beyond my control.”

In line with that policy, the news stories continued as SPD continued to use naloxone to reverse overdoses: “Seattle Police Save Yet Another Life With Naloxone. “Seattle’s prolific pot ticket-writing cop saves heroin user’s life.” “Seattle Police Say They’ve Saved 3 People With Overdose Drug.”

That last story, which ran May 4, finally prompted Sayre to write an uncharacteristically testy email to SPD’s Redmond and UW’s Banta-Green. It read, in part:

I appreciate that SPD is interested in keeping the public informed about its activities. However, we need to do our absolute best to craft the right message. It’s really impossible to say that any of the patients seen by the police had “their lives saved” with naloxone. … It’s not just medically inaccurate; it creates political pressure to expand a pilot program when we do not have sufficient data yet to say what impact, if any, has occurred.

I strongly prefer language like “naloxone use” or maybe “possible overdose reversal.” That should be followed with a statement that we do not know what would have happened otherwise, and we are measuring the impact of this pilot program on the health of people using opiates. If necessary, we can emphasize the potential for unintended consequences and the expensive nature of the drug to drive home the need to study it.

Raymond said he would pass on the information to SPD’s public information office.

SPD spokesman Sean Whitcomb defends SPD’s use of the “save” language, arguing that while “yes, the program is going to be vigorously studied, our position remains that when we encounter people who are not breathing, who have no pulse, and naloxone reverses that state of being, that we have been part of a lifesaving intervention, and in light of the heroin epidemic and the amount of peole who are impacted by it, we want people to know that our officers are here to help. If someone sees someone–a friend, a fellw addict–who has OD’d, we want people to know that if they call us, we will help them.”

One month later, after two more “life saved” announcements from SPD, each followed by a flurry of emails (in one, Raymond complained, “My media unit is going to give me an ulcer”), Sayre seemed exasperated by a story on a fourth Naloxone reversal, saying that fire department medics had actually gotten the man breathing with manual ventilation before police officers even arrived on the scene. “Following the police administration of 2 mg of intranasal naloxone, the patient was discharged from [Harborview Medical Center] and returned 90 minutes later with a second overdose,” Sayre wrote. “I’m not so sure I would be in a big hurry to take credit for that care…” (Ellipsis in original.)

Redmond responded, with equal exasperation: “I think it is safe to say that on the initial incident, there was a ‘possible opiate reversal’ after the application of Naloxone. I can’t speak in regards to the second overdose. We never said that we cured him of his addiction. Just that we utilized Naloxone and it had a positive effect on the patient. It does not surprise me that the person went back out and used again. I think we will continue to see this pattern.” Sayre responded, “The problem with the story is the implication that the police saved the day when the fire crews didn’t have the right tool (naloxone) and instead were doing CPR.”

SPD’s pilot program ends March 17 of next year. The King County Heroin and Prescription Opiate Addiction Task Force plans to release its recommendations and final report in September.

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