Narcan, the Eastside and how to curb the overdose epidemic

Emergency medical technicians in Redmond have been carrying the opioid overdose-reversing drug Naloxone since the spring of 2016, and last year alone first responders used it 47 times.

Naloxone, commonly known as Narcan, is a drug that has been around for decades and is used to quickly snap people back from an overdose. When it hit the market a few decades ago, however, it was applied intravenously, meaning that paramedics were only equipped with it from that time.

In recent years, a nasal spray solution was developed and Redmond EMTs and police have been equipped with it too.

Michael Hilley, the Redmond Fire Department’s medical services administrator, said the majority of the times Narcan was used, it was applied by paramedics since they are generally on the scene sooner.

The 47 applications of Narcan were also spread out over not just Redmond, but stations managed by the fire department in Kirkland and Woodinville.

The Bellevue Fire Department administered Narcan 68 times, 23 of which were inside the city itself, in 2016.

Hilley said his team responds to around 300 drug calls a year.

“Now, it’s a daily thing to go out and see a narcotic overdose, especially a heroin needle overdose,” he said.

Hilley began working at the department around 25 years ago, and said even around 15 years ago there were nowhere near as many overdoses.

Many of these overdose calls involve a victim who is on a cocktail of drugs, such as a combination of heroin, cocaine or methamphetamine. In these cases, the first responders will sometimes use Narcan to see if it has any effect on the patient.

The opioid epidemic, which has been sweeping across the country over the last decade or so often involves people who became addicted to prescription painkillers, Hilley said.

When doctors began prescribing less, or these pills became too expensive, many people switched to heroin.

“A lot of people turned to heroin just because it’s so cheap and coming in,” Hilley said.

The University of Washington’s Alcohol and Drug Abuse Institute tracks drug-related deaths and operates a heat map of overdoses from 1997 to 2015 in King County.

While these statistics don’t include deaths that occurred in ambulances or hospitals, it gives an indication of where people have been dying.

The map of Seattle is laden with overdose reports, but clusters appear in Kenmore, Bothell, Kirkland, Woodinville and Redmond. Eastern Bellevue has a significant cluster.

Deaths in Seattle and in cities to the south show overdose deaths at a rate of around 10 times that of the Eastside and east county. But many of the roughly 4,000 drug-involved deaths tracked by the UW range from the western shores of Lake Washington and stretch into east King County.

The data also shows that heroin deaths declined as prescription opioid deaths became more common in the 2000s, before they were surpassed by heroin-involved deaths in 2014.

Dr. Caleb Banta-Green, principal research scientist for the Institute, said the age of overdose victims has been steadily getting lower, with many people now overdosing in their 20s and 30s.

Historically, people who overdosed were in their 40s and had grown up in the 1970s and 1980s drug scenes.

But by the mid-1990s, prescription opioids were beginning to be prescribed more liberally. Many people who would later become addicted would try opioids recreationally in their teens.

The average age of first-exposure to recreational opioids is 15, Banta-Green said.

“This is something that really begins in adolescence,” he said. “…The issue is somehow they were exposed to pharmaceutical opiates.”

Banta-Green said roughly one in four people who try heroin are predisposed to addiction, and that people using prescription opioids for non-medical purposes to get high may have similar numbers.

But opioid overdoses are not a new problem, even as the epidemic hits younger age ranges.

Dr. Michael Sayre is the medical director for the Seattle Fire Department and said paramedics have been carrying Narcan since the 1980s.

In 2016, paramedics evaluated around 370 patients for opioid overdoses, and used Narcan in roughly two-thirds of those, Sayre said.

In recent years, their strategy to using it has changed, he said, as they now try and administer just enough to keep the patient breathing.

Administering too much can completely snap the patient out of the effects of opioids, meaning many people suffering from an overdose would refuse to be taken to the hospital and go into withdrawal. This limited the ability of medical professionals to monitor them and try and get them into treatment.

Patients in withdrawal are often agitated and feel physically sick.

“It was not good for anyone, it was not good for paramedics, and it was certainly not good for the patient,” Sayre said.

While Seattle has the highest concentration of overdoses, on the Eastside, Hilley said one of the hotspots his department has seen is along the Snohomish-King County border.

Some of the overdose clusters he sees can be directly attributed to dealers working in an area, Hilley said.

He gave the example of an individual who was selling to their neighbors when a handful of people overdosed in the area. When the dealer was arrested, the overdose hotspot cleared up.

It’s not surprising for Hilley to see people abusing a wide range of drugs, but the rate at which heroin is killing people is startling.

“The heroin thing is way overwhelming,” he said.

Narcan is being made more accessible to people across the country, thanks to efforts by stores like Walgreens, which sells the drug without a prescription in Washington state.

King County leaders have been trying to address the overdose epidemic.

In 2016, the county directed a task force to study ways to fight the epidemic.

The task force recommended a variety of measures such as expanding treatment access and outreach.

One recommendation made was to open safer drug consumption sites, where users could inject and use drugs in a supervised manor with a goal of stopping overdoses and reducing disease rates.

This idea was based off the Insite program in Vancouver, B.C., but which ran into opposition from groups in King County.

A group called Safe King County backed an initiative to ban county funding from going toward these sites. This initiative, I-27, was recently thrown out by a judge who said it was a matter of public health and not a decision that should be left to the initiative process.

Safe King County plans to appeal the decision.

Sayre said that while drugs like Narcan are invaluable for saving lives, the real key to tackling the epidemic could lie in expanding treatment and access to beds in rehab facilities.

Specifically, creating more space in treatment facilities as well as increasing access to medications like methadone and suboxone are critical. Patients in recovery can take these drugs to taper off opioids.

Suboxone in particular not only stops withdrawal, but blocks users from being able to get high for days after it is administered and is taken regularly.

“We will prevent more deaths if we spend the money on medication-assisted treatment,” Sayre said.

Banta-Green agreed, saying that both more treatment and easier access for people struggling with addiction was needed.

“If the general public knew that and demanded care and sought care, we could cut the overdose death rate by 50 percent tomorrow,” Banta-Green said.

Patients need to be able to access care quickly. Four drop-in programs were recently started in Seattle where patients can receive medicine-based treatment on the same day.

This is in contrast to what many health-care institutions require, which often involve lengthy screening processes and multiple doctors visits.

Banta-Green said there are no rules mandating when health-care providers can start patients on treatment, but that many use the lengthy wait times as a screening tool, essentially only taking on the least-risky and most stable patients while the rest are passed over.

“It’s convenient for the system, but it’s horrific for the patient, for the human being,” he said.

Shortening wait times, varying the types of programs and increasing capacity at treatment centers could help patients.

If health care and medicine were easier to access, many people currently addicted to opioids would likely take steps to get treatment.

During a survey at the King County needle exchange this year, three-quarters of the people polled said they wanted to get clean.

Part of the problem surrounding opioid use and addiction is a cultural stigma against people who use narcotics. Dismantling this stigma is an important part of curbing the overdose and opioid epidemic, Banta-Green said.

“What saves lives is people actually accessing care, and they’re not going to access care if seeking care is stigmatized,” he said.

Even though there aren’t as many overdoses on the Eastside, similar strategies could be used here to provide treatment and solutions for people suffering from opioid addiction.

“The Eastside is much more like Seattle than some illusion that we have of what the Eastside is like,” Banta-Green said.