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More seek to equip first responders with Narcan

Doses of Narcan, naloxone hydrochloride.

Tony Talbot/Associated Press

Doses of Narcan, naloxone hydrochloride.

A bad batch of heroin causing a spike in drug-related death rates across the state this year has led many communities south of Boston to consider equipping police with Narcan, an emergency naloxone nasal spray that revives patients who stop breathing during an opiate overdose.

The area is no stranger to Narcan. In 2010, the Quincy Police Department became one of the first in the country to carry the drug. Lieutenant Detective Patrick Glynn said Quincy has seen the same surge in the opiate overdose rate that has plagued the entire state. As of Wednesday, there had been 24 reported overdoses in Quincy since January, which is at least a 30 percent increase over this time last year, Glynn said. But only three of those overdoses were fatal; on Tuesday, State Police announced that across Massachusetts, homicide units have reported 185 overdose deaths since Nov. 1, not including cases in the three largest cities, Boston, Worcester, and Springfield.

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“Luckily, we haven’t seen the increase in the deaths that other communities have been experiencing. That’s because of the Narcan,” Glynn said in an interview. “If we hadn’t had it, we’d probably be looking at a 50 percent death rate.”

Quincy was one of four communities in the state — along with Weymouth, Gloucester, and Revere — to get Narcan for first responders through a pilot program run by the Massachusetts Department of Public Health. But most police cruisers in Massachusetts remain unequipped with the spray.

Brad Flannery, a firefighter and paramedic who helped coordinate the Weymouth program, said it is not as easy for towns to get Narcan without state assistance.

“We were really fortunate. The pilot program only took on five first-responder organizations,” he said. “There can be a lot of red tape. Because Narcan is a drug, you have to be licensed and trained to carry it. There are a lot of regulatory roadblocks.”

Now, local leaders are trying to make it easier for communities to equip their first responders with the life-saving drug. Norfolk District Attorney Michael Morrissey wants every community in his county to carry it, and last week he called on federal regulators to make the drug available over the counter to get it in the hands of more first responders and family and friends of addicts. Meanwhile, Dr. Daniel Muse, emergency physician and EMS director at Brockton Hospital, has agreed to write a standing order and prescription for first responders in Norfolk County, and Morrissey’s office is organizing a training session to speed up the certification process.

“Now it’s just a problem of getting communities to participate. We’re working on getting them all. Some of them are going to have to deal with Board of Selectmen and various chiefs,” Morrissey said. “I look at it rather simply: I’m hoping the state will soon include the use of Narcan in their general training for first responders and EMTs. I believe this is a tool they should be carrying in the tool box.”

Morrissey said that last year, there were 60 opiate-related deaths in Norfolk County, and he has already seen a spike in 2014, with at least one opiate death per week.

“It’s happening all over the county,” he said. “Over the past couple years, not one community has been spared an overdose.”

In December, Stoughton became the first town in the state to equip police cruisers with Narcan without the help of the Department of Public Health. Sergeant Brian Holmes said it took six weeks from the time the chief approved the plan to put it into action.

“We wanted to try to think outside the box to think of the best way to solve the problem,” he said.

Now, Holmes said, he has been hearing from other towns — including Marshfield, East Bridgewater, and Plymouth — that are interested in implementing Narcan but concerned about potential risks.

“They ask about collective bargaining issues. They want to know if Narcan’s going to be construed as a change in working conditions. I tell them we’re already first responders, so we’re already answering these calls,” he said. “They ask about liability issues, too. I always explain it this way: You’re more in a position of liability when you can afford a defibrillator and you don’t have one. This is no different.”

Muse said he also hopes to get Narcan for all 12 towns under his purview as emergency medical director for Brockton Hospital. He said he has fielded calls from Bridgewater, Hanson, and Brockton about certification.

“It’s taken on a life of its own. I’m trying to stem the tide long enough to get another training together like the one Michael Morrissey’s office is conducting,” he said. “Otherwise, it could be a daunting task, doing one department after another.”

Muse said he is happy to write a standing order — a set of prescribed emergency procedures that will allow first responders to administer Narcan without having to first call into the hospital — and to write a Narcan prescription for any community wishing to carry the drug.

“That was easy for me to say yes to, because it’s the right thing to do. It saves lives, and it runs no risk,” he said. “When they administer Narcan, the patient is either dead or nearly dead, and administering it is better than just standing there. I hope that there isn’t a physician in Massachusetts who wouldn’t have said yes to this.”

Glynn said that lately he has been hearing more from local public safety officials as well. In recent weeks, he has fielded questions from Norwood, Framingham, and a coalition of Cape Cod towns, all interested in combating the spike in drug-related deaths.

“I think it’s the uptick in overdoses this year, and the fact that a lot of our statistics are now being publicized,” he said. “The numbers do speak for themselves.”

According to Glynn, in the 17 months prior to Quincy police acquiring Narcan, the city saw 47 opiate-related deaths. In the 17-month period after the program launched, the number of fatal overdoses fell to 16.

In Weymouth, firefighters started carrying Narcan 11 months ago, and have administered the drug 56 times, with 54 of those cases reviving the patient. Statistics from the Weymouth Health Department indicate that the opiate overdose rate in Weymouth between 2008 and 2010 averaged about 13 deaths a year. In 2013, there were five.

“We’ve seen a sharp decline in overdose deaths since we started carrying it,” said Flannery. “We’ll find people who are turning blue and cold, or are breathing shallowly. They can be on the brink of death, and when you use the Narcan, they’re sitting up talking to you a few minutes later.”

The state pays for the Narcan kits distributed through clinics and to the four communities enrolled in the pilot program. Other towns wishing to equip first responders with Narcan will have to shoulder the cost through their public safety budget. Each Narcan kit, which contains two doses, costs about $40.

Glynn said Quincy has spent $10,000 in state funding over the past three-and-a-half years, and has saved 223 lives.

Flannery said he was surprised more first responders do not carry Narcan, though he conceded the issue can be controversial.

“One of the questions people ask me is, ‘Do you think it’s enabling, because [drug addicts] know we’ll come and resuscitate them and so they’re more reckless with their drug use?’ ” he said. “This addiction is a sickness. People don’t wake up in the morning and think, ‘I want to be a junkie.’ You don’t eliminate an epidemic by letting them all die.”

Prior to its pilot program, the Department of Public Health also used local clinics and support groups to target drug users and their friends and family, who are often the first to find an overdose victim. According to Hilary Jacobs, director of the state’s Bureau of Substance Abuse Services, since the state began distributing Narcan to civilians in 2008, 2,500 individuals reported using Narcan to reverse an overdose.

Manet Community Health Center, a nonprofit clinic in Quincy that joined that program in the fall of 2012, distributed 193 Narcan kits last year, according to Cynthia Sierra, Manet’s senior director of public policy, public affairs, and program development.

“For us, it’s about the relationship and the opportunity to link an addict, a person in recovery, or a family member to a safety net,” she said. “Without that initial Narcan conversation, the isolation would continue.”

Jacobs, too, said that Narcan was just one strategy in a multifaceted approach to fighting the drug problem.

But from a law-enforcement perspective, Glynn called Narcan “the best tool we have with this epidemic now.”

“We can’t arrest our way out of it,” he said.

Cara Bayles can be reached at carabayles@gmail.com.
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