Narcan use spikes in state

  • Narcan usage and doses are still on the rise in the Monadnock region, according to local ambulance personnel. (Nicholas Handy / Monadnock Ledger-Transcript) Staff photo by Nicholas Handy—Monadnock Ledger-Transcript

  • Narcan usage and doses are still on the rise in the Monadnock region, according to local ambulance personnel. (Nicholas Handy / Monadnock Ledger-Transcript) Staff photo by Nicholas Handy—Monadnock Ledger-Transcript

Monadnock Ledger-Transcript
Tuesday, November 28, 2017 9:54AM

Alexis Murray-Golay was waiting for her 4-year-old daughter to finish a class at Peterborough Dance Theatre on the evening of Nov. 14 when a man she'd never seen before walked into the studio.

"I could tell that he was very high," said Murray-Golay, a Sharon resident and psychotherapist with previously experience in emergency care and crisis centers.

"I walked up to him and asked if he had a kid in the class. He said 'No,' so I told him he'd have to leave. He said, 'I'm trying.'"

With the man not doing well, Murray-Golay and another mom led him outside to a bench. That's when things took a very dramatic turn.

"He started dying," said Murray-Golay. "He was turning blue. He was not breathing."

A call to 911 was made while the other mother — a nurse – began trying to revive the man with CPR. 

Police were the first to arrive on scene but were not carrying naloxone – more commonly known by the brand name Narcan – a medication that can be administered to cancel the effects of an opioid overdose. Peterborough Ambulance arrived minutes later and were able to administer the drug. 

"It took quite awhile to get him back," said Murray-Golay. "It was not an instant recovery."

From 2015 to 2016, EMS Narcan administration has increased by eight-percent throughout the state of New Hampshire, according to data provided by the New Hampshire Department of EMS, with a 30-percent increase occurring from August to September this year. 

Hillsborough County has had the most EMS Narcan administration incidents per capita in September with 3.46 incidents per 10,000 population. 

“People seem to think that its the magic bullet,” said Peterborough Fire and Rescue Deputy Chief Joshua Patrick, who said that isn’t the case.

Patrick said Narcan usage has increased because of two major factors: a rise in overdoses and the need for more Narcan per overdose. 

Previously, Narcan doses were as low as .4 milligrams, according to Patrick, but the department now stocks 2 milligram doses.

“The initial dose is larger, but we also may need to administer more than one dose,” said Patrick. “We’ve had some people need up to eight doses, and I’ve heard stories of people needing as many as 20.”

Patrick said the larger doses and need for multiple doses is likely attributed to the increased potency of heroin and other drugs it may be laced with, such as fentanyl and carfentanil. 

“We all hope that things are going to get better, but it’s too hard to forecast,” said Patrick.

Narcan has been used at least once (but no more than ten times) in every town in the Ledger-Transcript’s coverage region except for Bennington, Dublin, Lyndeborough, and Sharon from the period of Oct. 1, 2016 to Sept. 30, 2017.

Currently, drug overdose deaths are projected to decrease six-percent from 2016 to 2017 throughout the state. There was a 10.5-percent increase in drug overdose deaths throughout the state from 2015 to 2016.

Locally, there have been overdose deaths reported in Rindge, Greenville, and Antrim this year. 

Sherry Miller, deputy chief of Antrim Ambulance, said her department has responded to three overdoses this month alone, and that her department has definitely seen an increase in overdoses and Narcan usage compared to last year. 

Miller has also noticed that people are potentially becoming more desensitized the to role of Narcan in an overdose situation.

“My perception is that many people don’t think it’s a big deal, because we can just pull out the magic pink box,” said Miller, who said many people on scene at overdoses immediately request for Narcan to be administered when first responders arrive. 

Statistically speaking, Miller said there is an ebb and flow to the number of overdoses Antrim Ambulance responds to.

“You can tell when a bad batch has come into the area,” said Miller. 

Michael Flynn, director of pharmacy with Monadnock Community Hospital, said Monday that the hospital provides Narcan at no cost to any ambulance service it has a medical resource agreement with. The agreement is also in effect for other medications stocked on area ambulances. 

Flynn said he couldn’t provide the cost the hospital has absorbed in supplying Narcan to area ambulance services – doing so would be against the agreement between the hospital and their medication provider – but acknowledged that the cost is “relatively inexpensive.”

Procedurally, every ambulance, rescue vehicle, or piece of eligible apparatus under the agreement is outfitted with enough Narcan to provide two patients care within a 24 hour period, an amount subject to the state’s Department of EMS protocol. After a dose of Narcan is used or soon to be expired, the ambulance in question can pick up another dose. 

Kristen Bernier, director of marketing and communications for Cheshire Medical Center, said the Keene hospital also provides Narcan to area first responders, giving out around 400 kits in the past year. At about $35 a kit, Bernier said the hospital has given around $14,000 in Narcan to area first responders in that time span. 

While Narcan is becoming more commonplace among area ambulance departments, the drug has also permeated people’s day-to-day lives. 

Natalie Neilson, the continuum of care facilitator for the Greater Monadnock Public Health Network, said her group has provided 43 Narcan training sessions and distributed 633 kits from July 2016 to June 2017 throughout the Monadnock region. 

The kits are provided at no cost to regional public health networks by the New Hampshire Department for Health and Human Services.

Prior to giving out kits, those interested are trained how to use the kits and are educated about state laws, misconceptions surrounding Narcan, and other useful information. 

Neilson said that she doesn’t believe that she has trained more people as of late than she has in the past, but has found that the kits she gives out have changed.

Once a two milligram, three-piece kit, Neilson said she now gives out a four milligram nasal spray. Neilson also said the change is attributed to drugs like fentanyl being laced with the heroin, increasing the potency. 

Reporter Ashley Saari contributed to this report.