Where to get Narcan kits
Clark County
1101 East High Street
Springfield, OH 45505
(937) 328-5300
Call and ask for a Narcan kit to set up a training appointment.
Montgomery County
Samaritan Behavioral Health
Crisis Care
601 S. Edwin C. Moses Blvd.
Dayton, OH 45417
Phone: 937-443-0416, ask for a DAWN — Deaths Avoided with Naloxone kit
The kits are available free to Montgomery County residents but must attend a 90-minute training session held at noon on Wednesdays. Those attending are asked to arrive a few minutes early.
Covering the Crisis
Our team of reporters has stayed on top of the heroin epidemic to bring you important news on this critical public health issue.
Covering the Crisis
Our team of reporters has stayed on top of the heroin epidemic to bring you important news on this critical public health issue.
Covering the Crisis
Our team of reporters has stayed on top of the heroin epidemic to bring you important news on this critical public health issue.
Four times Dayton police Officer Willie Hooper brought Ashley Bullock back to life – not with CPR or mouth-to-mouth resuscitation but with a medication he wasn’t allowed to carry a few months ago.
A change in state law earlier this year aimed at bringing down the skyrocketing number of heroin deaths is giving addicts like Bullock a second chance — or, in her case, a fifth chance — of surviving an overdose and perhaps making it to treatment.
The law made it legal for friends and family members of heroin addicts — and cops on the beat like Hooper — to administer naloxone following training. Going by the trade name Narcan, the drug kicks opioids off brain receptors and in a matter of minutes allows a person nearing respiratory arrest to breath normally, avoiding a much-too-common cause of death in the Miami Valley.
“I was skeptical when it first came out about carrying it,” Hooper said. “Why should I carry this? Is this really my job or is my job fighting crime?”
Hooper is now a convert to what he says is a “wonder drug.” In a two-month span, the 29-year police veteran used Narcan to save three other lives in addition to Bullock’s.
Although numbers are not available on how many similar lives have been saved in Ohio, Dayton police alone estimate that the department has prevented 20 overdose deaths since officers began carrying the medication on Sept. 10.
Before the law took effect in March, only trained medics were allowed to administer Narcan in the field. Now, Dayton has 221 police trained. The training and kits have been distributed primarily to uniformed officers who are most likely to be the first to reach an overdose victim, said Lt. James Mullins of the department’s Narcotics Bureau.
Mental health and addiction experts say there is a misperception that heroin addicts keep using by choice and not because of a sickness. Some of the public may believe the Narcan kit programs are a license to avoid getting help.
“But that is not what research shows,” said Wendy Doolittle, executive director of the McKinley Hall treatment center in Springfield. “It shows that people who have experienced overdoses and were brought back with a Narcan kit are more likely to seek treatment after something like that happens.”
Hooper and Janet Bullock, Ashley’s mother, hope she finally gets help after living homeless on the streets and battling a three-year addiction to heroin. Bullock said she “pushed and pushed” to get her 26-year-old daughter jailed so Ashley could get court-ordered treatment.
Last Tuesday, Montgomery County Common Pleas Court Judge Steven K. Dankof granted Ashley intervention in lieu of conviction for a drug possession charge. She is in the Montgomery County Jail awaiting a bed to open up at a treatment center.
Hooper and his fellow officers became well-acquainted with Ashley as she bounced from dope house to dope house on Dayton’s east side. That’s where Hooper revived her the first two times — in a house off Clover Street and again along Xenia Avenue. The third time Hooper found Ashley overdosed on her mother’s couch.
Her most recent bout with death came Nov. 4. Janet Bullock found Ashley, who had moved back into her mom’s Dayton apartment last spring, crumpled in the hallway – lifeless, no pulse, turning blue. Janet called 911, rolled her daughter onto her back and started CPR as best she could.
Hooper soon arrived with other officers. They pulled Ashley from the confined hall and across the tan carpet to the middle of the living room. Hooper knelt down and pushed a syringe, spraying a two-milliliter dose of Narcan through an atomizer into Ashley’s nose. It was the fourth time he’d watched her revive from an overdose. Others have administered the drug to her as well.
“Believe me as a concerned parent – swear to God – I love my daughter. I want her to get treatment,” said Janet. “And if it wasn’t for (Narcan), I’d have done buried her a long time ago.”
Opioid antagonist
In clinical parlance, naloxone is a synthetic congener of oxymorphone — an opioid antagonist. It works only on opioids like heroin, hydrocodone, oxycodone and fentanyl, blocking the effects on the brain and restoring breathing in two to eight minutes.
Effective and versatile, naloxone can be given subcutaneously or intramuscularly through injection, intravenously or, as in the kits carried by law enforcement, by intranasal mist.
“It’s a very, very safe medication,” said Dr. Brian Springer, an emergency physician at Kettering Medical Center. Narcan is safe because it has no effect on a person not on opioids, isn’t habit-forming and has few side effects short of potentially thrusting an overdose victim into immediate withdrawal, he said.
“Withdrawal is uncomfortable, but it’s not life threatening,” Springer said.
The drug, however, will not reverse overdoses caused by non-opioid drugs like cocaine, benzodiazepines, methamphetamines, or alcohol, according to the Ohio Department of Health.
Narcan is not new. It’s been an emergency medicine staple for 40 years. But the drug is in high demand now as communities in every corner of the country grapple with a heroin epidemic.
The death rate from heroin overdoses doubled between 2010 and 2012 in 28 states, including Ohio, according to a Centers for Disease Control and Prevention report released last month. In Ohio the number of deaths climbed 300 percent between 2007 and 2012 with men aged 25-34 most likely to die of an overdose death.
Statistics from the Ohio Attorney General’s office show heroin killed 910 Ohioans in 2013, though the number is believed to exceed 1,000 due to nonconformity in the way county coroners track and classify deaths.
With help from legislation like the bill in Ohio, law enforcement agencies in at least 16 states had implemented naloxone programs as of October, according to the U.S. Department of Justice’s Bureau of Justice Assistance. The Dayton and Cincinnati police departments are among nine agencies with naloxone programs in Ohio as tracked by The North Carolina Harm Reduction Coalition, an early advocate for the officer programs.
The Ohio law contains a provision that protects officers from lawsuits in the event of a negative outcome.
Hooper estimated that about 80 percent of the officers in Dayton had initial misgivings about being required to carry the medication.
“They thought it wasn’t their job. But after we got trained and issued the Narcan, most officers saw that it worked and it can help people.” Hooper said. “I think they’re still trying to feel it out, but the majority of the department is OK with it.”
Even before the new law, the administration of Narcan by first responders was ramping up. In 2013, the year prior to the bill’s signing, naloxone was administered 12,131 times in Ohio, or an average of 33 times a day, according to the state’s EMS Reporting Incident System. By comparison, emergency responders administered the drug 10,589 times in 2012.
If the Dayton numbers are any indication, the numbers will likely increase again in 2014. Through Nov. 20, paramedics for the Dayton Fire Department had administered 759 doses, eclipsing the 646 doses over all of 2013. Each of Dayton’s seven advanced life support medics in daily service carries Narcan.
Allowing police officers to administer the drug is vital for saving lives, said Dayton Fire Department Capt. Jeff Lykins.
“They respond quickly and many times are there before we are,” Lykins said. “There are certainly more police officers than medic units or emergency transfer units. In that sense there are just more of them so they are able to get to remote parts of the city.”
Lykins said 10-20 percent of patients getting naloxone administrations receive double doses. It’s also standard procedure to administer the medication to an “unknown,” or any unconscious patient whose injury or illness is not readily apparent. But as the heroin epidemic has taken off, it’s now more obvious that a victim is overdosing when crews arrive, and often bystanders try to instruct the paramedics on what to do.
“The users know the name of the drug, which is always surprising when they ask for it – ‘Hey, give them Narcan’ – right when we pull up,” Lykins said. “That didn’t happen five years ago.”
Seeing victims almost rise from the dead has a profound effect on those administering the drug, though they are quick to point out that victims, once revived, should seek immediate medical help.
“That drug is an amazing drug,” Lykins said. “You can take somebody who is literally minutes from death and in two or three minutes they are walking and talking. It’s unbelievable.”
Demand growing
In addition to law enforcement, the bill Gov. John Kasich signed on March 11 allows family and friends of addicts to obtain Narcan kits with a prescription and training.
Springfield’s McKinley Hall began distributing kits containing two doses of intranasal Narcan to addicts and their friends and family members beginning in September, Doolittle said.
Last year, 17 people in Clark County died using heroin, accounting for fewer than half of all accidental overdoses. Alarm went through county’s drug prevention and treatment community this summer when opiate-related deaths rose to a shocking 72 percent of all accidental overdoses for the first half of 2014, Doolittle said. This year through June, heroin claimed 13 lives, according to the coroner’s office.
“It was time for us to figure out how to get a Narcan program here,” she said.
So far, 31 people have received kits and taken training at McKinley Hall, Doolittle said.
“Before we had the kits, I had a couple of phone calls from moms that were just desperate,” Doolittle said. “They called crying and frustrated and overwhelmed because they felt like their kid was going to be next.”
In Montgomery County, 85 people have died of heroin-related overdoses this year through August, according the Montgomery County coroner. Last year, 132 people succumbed to heroin in the county. While 44 of the heroin deaths this year occurred in Dayton, no part of the county has been spared. Deaths were reported in 18 communities from Brookville to Centerville, Englewood to Miamisburg.
The Narcan kits are available to Montgomery County residents at CrisisCare in Dayton through a program called Project DAWN (Deaths Avoided with Naloxone).
So far this year, Montgomery County residents have taken home 501 kits — 75 in November alone. The program is operated locally by Samaritan Behavioral Health and administered by the Alcohol Drug Addiction and Mental Health Services of Montgomery County (ADAMHS), using money from the human services levy. About $532,000 to date has been spent on naloxone kits and staff.
ADAMHS wants to expand the program in a county where two people die every three days from a drug overdose, said Andrea Hoff, director of community engagement and special initiatives.
“We’d like to it in the hands of everyone who uses opiates, and everyone who has a loved one who uses,” Hoff said. “That begins by physicians prescribing it and pharmacies carrying it.”
Prices rising
With Narcan in such demand, the cost of the drug has started to rise.
Just last spring, Colleen Smith, director of substance abuse services at Samaritan Behavioral Health, could order 10 doses of Narcan for $189 to supply Dayton’s Project DAWN site. Her most recent order ran $284 for the same number of doses.
“I’m concerned that the price will continue to go up,” said Smith whose budget is fixed through June 30. “The issue is we have a certain amount we’re funded for. It limits what we can purchase if the price is going up.”
Because of limited funding, each kit leaving the Dayton Project DAWN site may have just one dose of Narcan instead of the standard two, Smith said. A single dose could still give an overdose victim an extended window for police or paramedics to arrive and administer a second dose if needed.
McKinley Hall will be unable to get all of the 100 Narcan kits it hoped to pay for through an initial $5,000 grant. The treatment center paid $48.86 a kit for its first order of 25 before the price shot up to $88.65, Doolittle said.
Orman Hall, director of the Governor’s Cabinet Opiate Action Team, said the proven success of naloxone has increased the number of states aggressively implementing programs.
“It has not historically been a high-demand medication. There’s really only one use for it,” Hall said. But as states wrestle with the consuming problem of opiate addiction, and naloxone is seen as an effective tool for fighting it, both the demand and the price have gone up.
Hall said he has not seen any evidence that organizations are having trouble making purchases.
“It is clear that the price is escalating and I think it is reasonable to expect we may have some potential delays given the escalation in demand that we see,” he said. “We certainly hope that is not the case and we need to be looking for strategies to make sure that we secure the supply here in our state.”
‘She has a little boy’
For parents like Janet Bullock, Narcan has kept alive a hope their children can finally step away from addiction.
Bullock is grateful for all those who have given her daughter that chance for recovery and hopes Ashley can stay clean — for herself and her 4-year-old son.
“I hope she realizes she has a family that loves her,” Bullock said. “She has a little boy.”
Narcan has helped police officers like Hooper build trusting relationships with neighborhood residents weary of the drug houses, the crime and the damaged lives wrought by the heroin epidemic.
On his beat in East Dayton, Hooper has encountered overdose victims on sidewalks, in parked cars and collapsed on the floor of convenience store bathrooms.
“It has totally dominated this area,” he said of the heroin scourge. “It’s not uncommon in this district to get four overdoses in one eight-hour shift. It’s not uncommon at all.”
It is becoming increasingly common too for police officers to revive someone who is dying. That has served as its own community policing initiative. Instead of being cast in a role of attempting to calm sometimes hysterical family members while waiting for the paramedics to arrive, officers now can jump in and go to work.
“You have friends and family members around and they want us to save their loved one,” Hooper said. “It gives me gratification to know I’m not only helping the patient but the family.”
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