If a person overdosed on heroin in Louisville as recently as 2015, their life was almost certainly in the hands of a medic with Emergency Medical Services, the only first responders in the city equipped at the time with nasal sprays of the drug naloxone to resuscitate them.
Though the burden on EMS has since increased due to an alarming spike in opioid overdoses, such patients are now increasingly receiving a potentially life-saving dose of naloxone even before EMS arrives — either from other first responders or private individuals now armed with the drug and trained how to use it.
Records obtained by Insider Louisville suggest that while fatal opioid overdoses began their troubling rise last spring — when fentanyl, an opioid up to 50 times more potent than heroin, entered the market — in perhaps hundreds of cases a victim was saved from what might have been death or serious brain damage by these new actors on the scene equipped with naloxone. These include first responders with the Louisville Metro Police Department and Louisville Fire Department, who since 2016 have been issued naloxone and trained on how to administer it, but also private citizens — as the Kentucky Harm Reduction Coalition has partnered with the Metro Department of Public Health and Wellness to distribute thousands of naloxone kits to the family and friends of those addicted to opioids in case of emergency.
In 2015, EMS treated 908 patients who received naloxone on an overdose run, with its personnel administering 2,703 doses (2 mg) of naloxone via Narcan — the top name brand nasal spray device for the drug. Twenty percent of EMS overdose runs that year involved a patient receiving naloxone, which at the time was widely perceived as indicating a troubling increase in Louisville’s heroin problem.
But 2016 would bring Louisville’s heroin and opioid crisis into the forefront as an unmistakable public health emergency, as heroin supplies were increasingly cut with fentanyl — a much more potent drug that typically requires multiple doses of naloxone in order to revive an overdose victim. That year, the number of patients receiving naloxone on EMS overdose runs more than doubled, increasing by 149 percent to 2,258, while such patients now made up 33 percent of EMS overdose runs.
The crisis only escalated in the first three months of 2017, as the number of EMS overdose patients receiving naloxone once again more than doubled from the same period in the previous year. This first quarter now saw 44 percent of EMS overdose runs involving a patient receiving naloxone.
One figure that did not double year over year was the number of doses of naloxone administered by EMS personnel themselves — despite more overdose patients receiving naloxone at the scene and those succumbing to fentanyl typically needing multiple doses to stay alive. Though the number of overdose patients receiving naloxone increased by 149 percent in 2016, the doses used by EMS personnel only increased by 28 percent. Likewise, the number of patients receiving naloxone at overdose runs has increased again this year by 118 percent, yet the doses administered by EMS has only increased by 16 percent.
This counterintuitive trend is highlighted by the fact that in each of the first three months of 2017, the total doses of naloxone administered by EMS personnel was actually less than the number of patients on their overdose runs who received naloxone.
Louisville EMS spokesman Mitchell Burmeister tells IL that this trend “could be attributable to additional first responders carrying Narcan and the increased number of citizens in our community trained in administering Narcan.”
January of 2016 was the first full month in which both LMPD and Fire Department personnel were equipped with naloxone, and from that time through the first quarter of 2017, they administered nearly 2,000 doses to over 1,600 overdose victims. While practically 100 percent of the EMS overdose patients receiving naloxone in 2015 had the drug administered by their own personnel, in 2016, police and firefighters administered 27 percent of the doses from first responders on such EMS runs, with that percentage increasing to 38 in the first quarter of 2017.
Still, even when accounting for all of the naloxone doses administered by all of Louisville’s first responders — as well as the emergence of fentanyl and fentanyl derivatives in the market — the dosage per patient remains on a downward trend. This suggests that in a growing number of cases, the loved one of a person with an opioid abuse problem is on the scene of on overdose first, administering the naloxone.
EMS counts an overdose patient as having received naloxone no matter if it was administered by EMS, LMPD, firefighter or a private individual — though the total doses provided by the latter are not recorded. Despite the potency of opioids on the market increasing, the average dose per naloxone patient administered by first responders has fallen from 3.5 in January of 2015 to 2.1 in 2016, and then fell further to 1.5 in the first quarter of 2017.
In response to the growing heroin crisis, the Kentucky General Assembly in 2015 passed legislation that included new provisions making it easier for agencies to distribute naloxone to individuals who are not themselves drug abusers or do not have a prescription, provided they are trained on how to administer the overdose antidote. The Kentucky Harm Reduction Coalition — a Louisville-based nonprofit formed that year — stepped into that role, partnering with local health departments to conduct training and distribution events throughout the state, but mostly in Jefferson County.
KHRC distributed 455 naloxone kits in 2015 — each containing two 2 mg doses — with most having the nasal spray delivery device, but some having the auto-injection devices that can be delivered through the skin of the upper leg or arm. The nonprofit partnered with the Metro Department of Public Health & Wellness and its syringe exchange program to deliver most of their 329 kits in Jefferson County that year, with the health department also obtaining additional kits and promoting the KHRC trainings.
The distribution effort picked up in 2016, as KHRC gave out 2,322 naloxone kits in Kentucky, 1,476 of which were in Louisville, with most being distributed at a health department training event. That pace accelerated in the first quarter of 2017, with 312 kits distributed in Louisville in March alone. Altogether, the KHRC has distributed over 7,000 doses of naloxone to individuals throughout the state, including over 4,700 doses in Louisville alone.
Dr. Joanne Schulte, the director of Louisville’s health department, tells IL that the recent statistical trends in naloxone usage is partly due to these efforts to supply the drug to those concerned about a loved one’s opioid addiction, as “there’s now more naloxone in the hands of private citizens, friends and relatives.”
She also lauds the leadership of the police and fire departments for being proactive and equipping their personnel with naloxone, recounting the anecdotes she heard at a recent heroin summit in Atlanta from city officials who had not taken such steps.
“There were police departments there that are not giving out naloxone, and they just had horror stories to tell,” says Schulte. “So I think it takes a lot of commitment on the part of our police and fire departments to agree to do it and to do it as effectively as they do it. They and the EMS people are definitely life savers, and that’s why it’s important to have it out there in the community.”
Schulte noted that early indicators suggest that overdoses have significantly declined in the two months since Louisville’s worst spike yet in February — suspecting that heroin users may have improved at spotting supplies laced with fentanyl — but maintains her belief that this epidemic has not yet peaked.