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Wash. responders increasing availability of naloxone to save lives

In Yakima County, heroin-related deaths appear to be on the rise; five of the 26 overdose deaths last year involved heroin

By Molly Rosbach
Yakima Herald-Republic

YAKIMA, Wash. — Last year, Ryan Alonzo revived an overdose victim with Narcan, the brand name for a drug called naloxone that pulls people out of opioid overdose almost instantly.

Alonzo, 30, said he noticed the man’s symptoms right away: “It was extremely scary. ... His lips turned blue, he turned pale; he was slumped over, breathing weird, and he was unresponsive.”

So he injected him with a shot of Narcan, which he’d obtained at a harm-reduction clinic in Seattle’s U District. The man came to within minutes, confused and disbelieving.

Alonzo knows the feeling: He was revived with Narcan himself more than a year ago after accidentally overdosing on heroin.

Since then, he’s gone through inpatient addiction treatment at Sundown M Ranch near Selah and is committed to his path to recovery, working to regain visitation with his kids.

Without Narcan, he might not be here.

“I used to be ashamed and embarrassed, but I know that the more I share and the more I remember ... I might say something that changes somebody’s mind and saves a life,” he said.

As the U.S. grapples with a nationwide opioid epidemic that now causes more deaths per year than automobile accidents do, more local emergency responders are working to add Narcan to their arsenal of tools.

The Yakima Fire Department started carrying Narcan on every fire engine less than two weeks ago and has already saved one person. The Yakima County Sheriff’s Office received $17,500 earlier this summer to go toward Narcan, and is ironing out the logistics to provide it for all its deputies, along with any other law enforcement departments in the county who want to participate.

Several other fire districts in the county are considering adding Narcan as well.

Narcan works on opioids, including heroin and prescription painkillers such as oxycodone and morphine. In Yakima County, heroin-related deaths appear to be on the rise; five of the 26 overdose deaths last year involved heroin, according to the Yakima County Coroner’s Office.

Before the recent spate of Narcan adoptions, the county’s two private ambulance companies were the only local emergency responders to carry Narcan. Hospitals also stock the drug. But a new state law from 2015 has made it easier to obtain for other first responders, such as fire and law enforcement.

“This means when people are having an opiate overdose, they’re going to get treatment quicker,” said Tony Miller, director of Yakima County’s Emergency Medical Services. “A lot of times, fire departments are on scene before the ambulances are, so they can start treatment faster.”

Narcan comes in an injection or a nasal spray. For emergency responders, the injection costs roughly $10 per dose, and the nasal spray costs about $75 for a pack of two doses.

One hurdle first-responder agencies face is the storage and shelf life of Narcan. It’s supposed to be kept at room temperature, between 59 and 77 degrees, and typically is good for 18 to 24 months.

The Yakima Police Department has chosen not to carry Narcan because the cost was too high to equip the entire fleet of more than 100 patrol cars with something that might not be used before it expires.

“In a municipality with EMS services so close, it made more sense logistically and more practically to have them take care of it,” said patrol division commander Capt. Gary Jones. Ambulances and firefighters have “equal to or better” response times than the police, he said.

The Sheriff’s Office grant came at the end of June from the High Intensity Drug Trafficking Area, which provided the grants to the Yakima area and to Spokane as regions with high volumes of drug trafficking and money.

“We’re not going to be selfish and hoard this; we’re going to try to help all the police departments in the county that are interested,” said Sheriff Brian Winter. “We want to make that go as far as it can.”

The sheriff’s office has not yet purchased Narcan or put deputies through training, but the grant money must be used by the end of 2017, Winter said.

He compared the addition of Narcan to deputies’ supplies to the inclusion of AEDs (automated defibrillators) as a public safety measure.

“I don’t really feel constrained by typical tools for law enforcement, so if we’re going to be in the right place at the right time to save somebody’s life, whether it’s an AED or whether it’s Narcan, if we can afford to get those tools, then ...” Winter said. “We’ve already had a save with the AED where a guy is alive today. ... I’m hoping a year from now, we’ll be talking about one of my deputies in the right place at the right time with Narcan.”

But emergency responders equipped with Narcan is only a part of the solution, says Kim Hitchcock, who works in chemical dependency for Triumph Treatment Services.

The only place in Yakima County for individuals to obtain Narcan — if they use opioids themselves, or have a friend or relative who uses — is once a month at the Yakima Health District’s needle exchange, which operates for two hours every Friday afternoon.

The needle exchange sees an average of 80 to 90 people a week, said Emily Contreras with the Health District. It distributes roughly 5,000 needles a week.

Since the needle exchange began giving out Narcan once a month in April, 37 two-dose packs have been distributed, she said.

“I think it’s needed within the community,” Contreras said. “It’s requested by our clients, that’s for sure,” both for themselves and for people they know.

Having only one site for two hours a month isn’t enough, Hitchcock said.

“I believe anyone on any pain contract in the Valley should be given a Narcan kit,” she said. “We have older people that have fentanyl patches” — fentanyl is a synthetic opioid 50 to 100 times stronger than morphine, used for severe pain in conditions like cancer — “and they don’t remember they’ve put them on, and they have an inadvertent OD. Narcan can save a life in that situation.”

In Hitchcock’s mind, she said, there’s no good reason not to equip people who use opioids — or who have family members using opioids — with Narcan. Often, the actual first responders on scene at an overdose are not firefighters or paramedics, she said, but other drug users.

She has worked in harm reduction for many years, including running an independent syringe exchange in Ellensburg. Many people in the Yakima area end up going to the People’s Harm Reduction Coalition clinic in the U District in Seattle just to obtain Narcan.

“I know if we don’t have Narcan on the street, people die,” Hitchcock said. “We cannot arrest our people into recovery and we cannot hate them into recovery; we need to love the people until they decide that something’s going to change in their life, and if we can save somebody’s life with Narcan, it’s a chance for them to turn their life around.”

“If they’re dead, they’re just dead,” she said. “We can’t help them if they die.”

Copyright 2017 Yakima Herald-Republic

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