Naloxone gives extra tool against opioid overdose

GILLETTE — When the Gillette Police Department handed out awards earlier last month to officers who had saved lives, they all involved administering CPR.

In most instances, they also used AED pads to get the person to resume breathing.

Those are the lifesaving techniques we’re accustomed to, those tried-and-true methods that have been around for years as one human being tries to keep another human being alive.

But the lifesaving techniques honored by the police department went beyond that.

Four of the five instances involved using naloxone, which reverses drug overdoses. Each of the four also involved using multiple doses of the drug.

As the seizure of opioid drugs like heroin and fentanyl have increased in Campbell County and Gillette in recent years, so has the presence of a potentially lifesaving tool to combat overdoses.

Naloxone, more commonly referred to by its brand name Narcan, has gained traction in Gillette as more law enforcement officers have joined Campbell County Health Emergency Medical Services in carrying and administering the overdose reversal drug in recent years.

The concept behind naloxone is simple. Once sprayed or injected, the medication spreads through the bloodstream and quickly reverses an overdose by blocking the effects of opioids on the receptors triggered in the brain.

Earlier this year, Gillette Police Chief Chuck Deaton said his department has seen a “huge uptick” in the use of naloxone while responding to overdoses.

The Gillette Police Department added naloxone to its officers’ tool belts in January 2020. It recently awarded five officers with Life Saving Awards for their use of it while on calls.

By the numbers, that aligns with the increase in heroin seized in Gillette. In 2019, officers seized 6 grams of heroin. Then in 2020, that jumped to 23 grams, and by 2021, it nearly tripled to 60 grams. The Sheriff’s Office seized another 9 grams of heroin in 2021.

Meanwhile, there were four overdose deaths in 2021, all involving fentanyl. That matched 2020, which had four fentanyl-related deaths and one other drug overdose death attributed to an opiate.

Naloxone training and use was nothing new for CCH paramedics and EMTs, but it wasn’t until recently that law enforcement officers consistently began carrying the anti-overdose medication.

Since receiving grant funding to arm its officers with naloxone in 2020, the police department has logged nine incidents in which the medication was used. But those numbers do not account for how many doses were used during each incident or other uses that have not appeared in the statistics yet, Police Lt. Kelly Alger said.

CCH EMS administered its most naloxone doses in 2020, when paramedics used the opioid antagonist 29 times. That year included a summer stretch of multiple overdoses caused by a similar batch of “bad” heroin, said Shawna Cochran, manager of CCH EMS.

“I’d say we definitely picked up the usage of it in the last three to four years,” she said.

From 2019 through 2021, EMS administered 79 doses on its own, but that number increases when factoring in how often police officers and Sheriff’s Office deputies have used the medication.

On each ambulance, EMS stocks 8 mg combined of naloxone that can be doled out in 0.4 mg increments, while each law enforcement officer is stocked with two packs of canisters, each that are 4 mg and each single use.

Chris Beltz, CCH director of urgent and emergent services, said paramedics noticed a rise in opiate overdoses about the time it began hitting the rest of the country.

“When those really proliferated, that’s when I think us and everyone else in the country started seeing more and more overdoses from those prescription painkillers,” Beltz said.

From the paramedic perspective, there seemed to be a “gradual increase” in heroin in the community over the past few years, “just not to the epidemic that you are seeing in other areas,” Cochran said.

“I think we are still not in comparison to that at all, but I think we have been trending up,” she added.

Up until about 10 years ago, CCH paramedics would use naloxone on basically any unconscious person, whether they were suspected of overdosing on an opiate or not, Beltz said.

“It was kind of one of those, ‘If you think it might help, just give it,’” he added.

But as medicine evolved, so did their approach to naloxone use. Now they have more clear indicators to identify overdoses, most of which have two of the following three signs:

Decreased pupil size

Decreased respiratory rate

Evidence of an opiate or paraphernalia in the area

“In that sense, we’ve probably reduced the usage,” Beltz said. “Now it’s only for clear clinical indication of an opiate overdose.”

Naloxone works on any opioid overdose. Those can range from elderly folks who accidentally take an extra dose of their pain medication to heavy heroin or fentanyl users who have amassed high tolerances to those drugs.

For responders, the opiate of choice does not particularly matter because the naloxone kicks in all the same.

“Unless there’s a prescription bottle saying ‘fentanyl’ sitting right there, we don’t know what kind of opiate it is,” said Cynthia Gunn, an intermediate EMT.

Once the naloxone is administered, the overdosed person often wakes up quickly, with their fight-or-flight system triggered, said Shane Kirsch, a shift supervisor for CCH EMS.

Then they wake up in a room full of cops, paramedics and perhaps other strangers in their comfort space, meaning the person’s state of well-being once awakened depends on the kind of overdose as well as the person involved.

“A lot of the time they’re not very happy when they wake up,” Beltz said.

The spray naloxone used by law enforcement officers is a single 4 mg dose, whereas EMS administers its doses in 0.4 mg increments. Although a full 4-mg dose is effective, it can sometimes be too powerful, sometimes even putting the overdosed person into a state of withdrawal.

“We like to do it just to the point of getting their respiration under control, getting them stabilized versus completely waking them up and potentially having to deal with a combative or agitated patient,” Beltz added.

When officers or deputies administer naloxone, EMS responds to handle any potential complications the person gets after coming out of their overdose. Especially in chronic drug users, it can cause “instant withdrawal,” potentially causing seizures, cardiac arrhythmia and vomiting.

Vomiting is particularly dangerous because of the lack of functional breathing often caused by an opioid overdose. The vomit can potentially block airways and cause asphyxiation.

“We have to be very careful about how much we give and managing all those potential complications,” Beltz said. “It’s not a harmless drug by any means.”

In 2016, the Wyoming Department of Health received a federal grant from the Substance Abuse and Mental Health Services Administration.

More than 8,000 doses of Narcan were distributed to law enforcement agencies, emergency medical services, pharmacies, schools, the University of Wyoming and other organizations.

Thousands of drug deactivation bags and hundreds of locking pill bottles and boxes were purchased and distributed throughout the state. These items help prevent prescription drugs from being used by someone without a prescription.

The grant ended in August 2021, and Wyoming was not selected to get another round of funding, putting an end to free naloxone. They are available at pharmacies, however.

Although there has been a rise in naloxone use, the opioid epidemic has not hit Wyoming to the extent that other parts of the country have faced. 

In Gillette, EMS responds to more meth overdoses, which come with their own complications.

And while naloxone has grown familiar around paramedics and law enforcement officers, it also has taken hold to some extent on a civilian level. Some opiate medications now come accompanied with a naloxone prescription, as well as training for how to administer it if needed.

By happenstance, Alger said officers didn’t start seeing an uptick in fentanyl cases in Gillette until around the time the naloxone grant kicked in in January 2020.

“Nationally, we see that stuff start hitting some of the bigger, crazier places but eventually it makes its way to us,” Alger said.

The types of drugs prevalent in the community ebbs and flows, Alger said.

“We are starting to see (heroin) a little more,” he added.

Officers go through training before handling naloxone. It can even be used on police dogs, if the need were to ever arise.

The police department recently replenished its naloxone supply, buying 25 boxes at $105 a pop to outfit 50 officers, Alger said. The unused naloxone is set to expire soon and the department is in the process of seeking another grant to buy its next round, he added.

This story was published on April 12, 2022.