It seemed as if it was too late.
The overdosing individual was “clinically dead” when they arrived, State College police Officer Adam Salyards said. Officers had attached an automated external defibrillator to the person, but it could only suggest performing CPR.
So an officer administered a dose of naloxone, he said. Within a few minutes, the person was up and talking.
“It’s amazing,” he said. “People are clinically dead and we bring them back.”
Naloxone, or Narcan, is a medication designed to reverse the effects of an opioid overdose and has quickly become the go-to medication for first responders. This opioid antagonist can quickly restore normal breathing to a person suffering from a heroin or opioid medication overdose.
According to Dr. Kasandra Botti, 1 in 4 Pennsylvania families struggle with an opioid-related substance abuse problem. In 2015, there were about nine overdose deaths per day in the state alone, the Drug Enforcement Agency reported.
Botti is the medical director for the department of EMS at Mount Nittany Heath and serves as the Narcan medical director for State College police and the Centre County Sheriff’s Department.
For the past two years, Mount Nittany Medical Center has donated naloxone to local law enforcement, Mount Nittany spokeswoman Anissa Ilie said in an email. Emergency medical personnel also receive training in the administration of the medication as part of their regular curriculum.
This training is now part of the regular first-responder training for many police departments, including State College. Training for officers is state mandated, Salyards said, as well as annual in-service updates conducted by Salyards himself.
“For an officer to keep certification, they have to maintain first aid training,” Salyards said. “This training includes commonly used opioids.”
Anyone who’s had surgery has probably taken an opioid, he said, adding that “this stuff’s everywhere.” Common opioids include illegally obtained drugs like heroin, but also prescription medications such as morphine, codine, Percocet and Vicodin.
Officers carry a dose of naloxone in their patrol vehicles along with an automated external defibrillator, he said. While the number of doses given by police has remained low, it has certainly increased over the past year.
Centre County is no stranger to the opioid epidemic creeping across the state. Gene Lauri, director of Centre County Criminal Justice Planning, said 21 people died due to drug overdose in 2016 in Centre County.
The biggest public health crisis in Pennsylvania and possibly the country is the threat of opiates, prescription drug abuse and heroin abuse, Pennsylvania Physician General Dr. Rachel Levine said in a public health preparedness summit hosted in State College in 2015. A Pennsylvania Coroner’s Association report indicated 2,489 died from overdoses in 2014, a 20 percent increase from 2013.
Heroin was attributed to the deaths of a 33-year-old man found dead on a Megabus in Patton Township, and a 35-year-old woman found dropped by the side of a road in Ferguson Township. Both incidents occurred in 2016.
The naloxone program rolled out to the police officers in February 2016, he said, as different community groups, including the county’s Heroin and Opioid Prevention and Education Initiative, began a concentrated effort to push for law enforcement to carry the medication.
In 2016, State College police officers used naloxone three times, Salyards said. Two of those administrations were successful.
So far in 2017, the medication has been delivered by officers eight times, he said, with all doses successfully reviving the individual.
“That’s still not as much as some of the surrounding counties, where officers are using it multiple times a day,” he said, “but you can still see, that’s almost three times as much as last year.”
Salyards estimated the medication has probably been used by police departments around the county about 30-40 times since it was rolled out.
He also pointed out that individuals and families are able to purchase the drug for themselves, so there could be additional saves that the county doesn’t even know about.
For the Centre County Sheriff’s Department, that number has been significantly lower. Deputy Thomas Walk reported that the department’s naloxone program rolled out in July of this year on a Monday.
On Friday, they administered their first dose.
Deputies and Bellefonte police responded to a report of an unresponsive man in a Bellefonte parking lot, he said. The man was reportedly found unconscious in a vehicle showing signs of an overdose.
The deputies and officers were able to administer a dose and revive him, Walk said.
Sheriffs, who often act in more of a support role to the different law enforcement agencies in the county, he said, also carry a dose of the medication along with an AED in their vehicles. Kits are also available in the Centre County Courthouse, Temple Court Building, Willowbank Building and sheriff’s office, though the need to use one of those doses has not risen.
Fortunately, because of this police first-responder training, usage of the medication by region EMTs has been low, Centre LifeLink outreach coordinator and EMT Eliza Shaw said. Local officers often arrive on scene first, administering it when needed.
“This area is extremely lucky to have an excellent police force that will respond to medical calls with us,” she said. “With them being spread out across the area, and already on the road, they are often the first ones to arrive.”
All advance life support ambulances have been required to carry naloxone for decades, Shaw said. The practice of administering the medication was added to the basic life support scope of practice in 2015, but programs only came into effect this year.
All EMTs are trained through the center’s medical director, she said, and complete standardized training through the state Learning Management System.
“In short, we’ve carried it for decades, but our EMTs have only been able to administer it since Sept. 1, 2017,” she said.
Most ambulances at LifeLink are staffed by technicians at the ALS level, she said. There hasn’t necessarily been an increase in the number of times it’s been used, but now there are more people who can administer the medication when presented with an overdose.
LifeLink is seeing an increase in naloxone deliveries, Shaw said, particularly by police officers. However, she said it didn’t appear that there is an area that is experiencing more overdoses than others, at least in LifeLink’s coverage area.
Naloxone can be purchased and administered by everyday citizens in one of two forms, the CDT reported earlier this year.
Narcan, a brand name nasal spray, is the least expensive option. It costs about $130 and is covered by most insurances, including Medicaid. Evzio, which is an auto-injector, is typically not covered by insurance and can cost more than $3,000. After administration of the medication, 911 must be called.
Shaw advised that relying solely on naloxone in the case of an overdose was “not advisable under any circumstances.”
“When someone dies of an overdose it is almost always because their respiratory drive was suppressed so much that they stop breathing,” she said. “In these cases, naloxone is not effective because there is not adequate circulation to carry it to the receptors that need it.”
This advice was echoed by Bellefonte EMS Chief Scott Rhoat, who explained that, while naloxone reverses the effect of an opiate, additional treatment is still needed.
According to Rhoat, Bellefonte EMTs do not carry naloxone but are instead assisted by additional units through the Mount Nittany Medical Center, which are stationed at Bellefonte.
EMTs are able to provide the BLS to overdosed patients, while the ALS paramedics administer the medication.
“There’s a very small window to use naloxone,” he said. “The primary issue is lack of a good airway. We’re able to clear the airway and provide oxygen or ventilation, and that’s what keeps the person alive.”
This especially comes into play when a patient is given a dose, which could take a few minutes to work, but the patient is not breathing, he said, adding, “If you’re not doing anything else for them, you’re not solving the problem.”
Amnesty laws exist when it comes to calling police or EMTs regarding an overdose, Salyards said. If someone reports an overdose, amnesty is extended to the person who called in as well as the person who is overdosing.
If the person has a small amount of drugs or paraphernalia, they won’t be charged, he said. This does not cover every situation, he warned.
“This is aimed at helping the user change their mind, hopefully get them into some rehab and change their life,” he said.
A move by Gov. Tom Wolf in October sought to provide funding for naloxone to first responders, according to the governor’s office. The 2017-18 budget included $5 million in funding for the medication, saying the program will “create a fast, efficient means of getting these life-saving kits in the hands of first responders.”
More than 60,000 naloxone kits, which include two, 4-milligram doses in each, will be available to all 67 counties over a two-year period using the funding. The kits are supplied by Adapt Pharma, headquartered in Radnor.