When first responders respond to opioid overdoses, time is critical in helping someone to regain consciousness and stabilize.
With synthetic-opioid use on the rise, the drugs’ strong potency stands as a threat to both responders and users alike. Although the South Pasadena and San Marino fire departments have long been equipped to use the drug Naloxone, which reverses opioid overdoses, both cities recently took steps to equip their police departments as well.
Naloxone, sold under the brand name Narcan, among others, is a medication used to block the effects of opioids, especially in overdose. More than 70,000 drug-overdose deaths occurred in the United States in 2017, with opioids involved in 67 percent of the cases, according to the Centers for Disease Control and Prevention.
Opioids, used as painkillers, are a class of drug naturally found in the opium poppy plant. Some are made from the plant directly, while synthetic versions are made by scientists in labs using the same chemical structure.
San Marino Firefighter/Paramedic Jeff Tsai noted that use of synthetic opioids fentanyl and carfentanyl are increasingly being seen by first responders across the Los Angeles region and the country. Many drug dealers mix these synthetic opioids with other drugs, such as heroin, cocaine, methamphetamine and MDMA, to increase their potency, which in turn increases the chance for overdose, according to the Drug Enforcement Administration (DEA).
Many of the users don’t know about the synthetic additions. The threat to first responders comes when these synthetic opioids are present in the air, where they can be inhaled, such as an area they may enter where pills are being produced.
Fentanyl is 80 to 100 times stronger than morphine. Pharmaceutical fentanyl was created for pain management treatment of cancer patients, applied through a patch on the skin, according to the DEA. Carfentanyl is 10,000 times stronger than morphine and 100 times stronger than fentanyl and has a similar chemical composition, according to the DEA. It was originally produced as a large animal tranquilizer.
“These are all central nervous system depressants,” said Tsai. “So they slow your breathing down. They pretty much make you unconscious. Mainly it starts with the respiratory depression that will lead to respiratory arrest and pretty much death after that.”
In San Marino, the police department recently acquired Narcan for free through the Naloxone Distribution Project, an organization funded by the U.S. Department of Health and Human Services and administered by the Department of Health Care Services (DHCS) to combat opioid overdose-related deaths throughout California. Officers are currently working with the fire department to ensure proper procedures so that officers can administer it to patients if they arrive before paramedics with the fire department are on scene.
Tsai noted that Narcan is “extremely safe” and there are no side-effects, so even if a person is not suffering from an opioid overdose, there will be no negative repercussions.
Chief of Police John Incontro noted that the city has not seen much of an issue with overdoses but he wants to be prepared.
“It works, it’s effective and then hopefully with the right follow-up, these folks that are suffering with this addiction can get the help they need,” said Incontro.
Fire Chief Mario Rueda said his department is working to train police personnel in its usage. Although the fire department can administer Narcan through IV and nasal spray, the police will carry the nasal spray due to its ease of use for self, partners or a patient.
“It’s a good capability that now San Marino police has that only paramedics use to have,” said Rueda.
In South Pasadena, the fire department has long had the use of Narcan available as well.
“We’ve administered it for decades,” said SPFD Captain Anthony Porraz.
Every sworn officer in the South Pasadena Police Department recently received training on administering Narcan to fellow officers and people within the city who may need it.
Around four months ago, Sgt. Tony Abdalla led the department in the training, which included a four-hour class with instructional videos and practice use of unloaded samples. Just last month, SPPD put its training into action when officers responded to a person in the city who was unconscious with shallow breathing.
“When officers arrived, they did a quick analysis and discovered through interviews and physical signs that he was suffering from an opiate overdose,” said South Pasadena Police Cpl. Craig Phillips.
“They administered the Narcan, two doses, one dose in each nostril, and within approximately one to one in a half minutes, he was awake and speaking as the paramedics arrived.”