Narcan available locally to fight overdoses; public education events planned

Health and safety officials have been warning about increasing drug overdoses in recent years, with a significant spike in January.

As of Feb. 21, there had been 154 opioid overdoses so far this year statewide and of those 11 were fatal, according to Colin Campbell, the public health emergency preparedness and community planner at the Cascade City-County Health Department.

In January, the Montana Department of Public Health and Human Services and the Montana Department of Justice, in conjunction with local law enforcement, identified a sharp increase in fatal overdoses.

From Jan. 11-23, a total of 28 non-fatal and eight fatal overdoses, likely due to opioids, occurred in 13 different counties affecting individuals aged 24 to 60 years old, according to the agencies.

Identified overdoses occurred in Cascade, Choteau, Custer, Flathead, Gallatin, Lake, Lewis and Clark, Missoula, Ravalli, Sheridan, Silver Bow, Yellowstone, and Mineral counties.

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Campbell told the Cascade County Board of Health during their February meeting that of the local incidents, the nonfatal overdoses ranged from 19-66 years old and the fatal overdoses were 20-40 years old.

Local first responders have been carrying nalaxone, an opioid-reversal agent, for some time and last year, CCHD made Narcan, a brand of nalaxone, available to the public.

In January, a DPHHS Health Alert Network message to local and tribal health departments, EMS agencies, law enforcement and public health agencies was issued, including the recommendation to have nalaxone on hand for individuals at-risk for opioid-related overdose and family members and friends of those at-risk.

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“Naloxone is a life-saving tool that is widely used in Montana when someone is experiencing an overdose,” DPHHS Director Charlie Brereton said in a release. “The timely administration of naloxone may successfully reverse an individuals’ symptoms and save their life.”

In an email from Benefis Health System, health providers told The Electric that Narcan is an opiate specific antagonist and only works on things like heroin, fentanyl, morphine and other narcotics. It has no affect on methamphetamine, marijuana, or sedatives such as Xanax and Ativan.

Benefis staff told The Electric that they’ve seen an increases in overdoses that are treatable with Narcan but the actual number of cases remains low.

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Benefis staff said they’re seeing a local issue of illicit marijuana use, which is not from a dispensary, and methamphetamine that have been sold with fentanyl in them. In that case, a user would have no idea they are ingesting or inhaling fentanyl.

Jeremy Virts, GFFR deputy chief of EMS, said that according to their data, they administered Narcan 34 times in 2022.

The gave the most of it on Thursdays between 9:30-10 a.m., following by Sundays, he said.

Christina Wood, operations chief for Great Falls Emergency Services, said that over the last six months, they’d responded monthly to an average of 11 overdose/ingestion calls and administered naloxone an average of four times.

As of Feb. 21, Campbell said CCHD had 124 boxes of Narcan each with two doses, so 248 doses were available for public distribution.

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He said the state limits them to ordering 100 boxes at a time, but said he didn’t know of any limit on how many times local agencies could order Narcan.

CCHD and other local agencies provide a use report to the state when they order Narcan.

CCHD also has injectable and nasal stray versions of nalaxone available to medical response and quick response units throughout the county, Campbell said.

Great Falls Fire Rescue, Great Falls Police Department, Great Falls Emergency Services and the hospitals have their own supplies of nalaxone.

Virts said that before fentanyl became prevalent it was primarily first responders using naloxone.

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As fentanyl use has increased, the civilian version was developed and more people are using it. That version is a nasal spray. Virts said they also have a form that can be administered intravenously.

In mid-February, a U.S. Food and Drug Administration panel voted to make Narcan available over the counter nationwide.

The FDA will consider that recommendation in late March.

Virts said that Narcan won’t immediately reverse the overdose and takes about a minute to kick in.

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Each publicly available Narcan dose has 4 milligrams and Campbell told the health board that there were reports of more doses being given to counteract an overdose.

Virts said because it takes a minute to kick in, that could be why some people are giving more doses of Narcan.

There’s nothing wrong with giving more Narcan as it won’t hurt a person, whether they’re overdosing or not, he said.

Virts said the public nasal version is only about 60 percent effective since it’s not always administered properly, the spray can get caught in nasal drop or congestion.

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He said that since there’s more civilian Narcan use, there’s different perceptions on how it works.

Woods, of GFES, said that most of the time EMS is successful administering one dose of naloxone in the field.

She said “multiple doses tend to be given by laypeople who are anxious to have the patient regain their respiratory drive and administer more naloxone then necessary.”

Narcan’s effectiveness is also drug dependent.

According to staff at Benefis Health System, depending on the type of drug taken and how much, it can take a lot of Narcan.

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Narcan’s effective time in the body is sometimes shorter than the amount and type of drug that was ingested and healthcare professional have to repeat the dosing.

If the overdose is large enough and Narcan doesn’t work quickly, healthcare providers will also put a tube into the patients lungs to break for them to keep oxygen flowing to their brain, according to Benefis staff.

Virts said that fentanyl affects the respiratory system and can cause a person to stop breathing. If that goes for four to six minutes, a person can sustain brain death, he said.

Patients can become agitated when Narcan is administered because it takes away the high and the patient can feel “uncomfortable and raw,” according to Benefis staff.

Benefis recommends backing up a safe distance within 15 seconds of administering nasal Narcan.

Virts said that in his years as a paramedic, he’s never had anyone angry with him for taking away their high when administering Narcan.

He said that when they wake up from an overdose, they can be disoriented and that can cause them to become combative.

Virts said that when responding to a call of someone in distress but don’t know the cause, will administer Narcan to see if it works to rule our an overdose.

They also have to use it sometimes for elderly patients who forget they’ve taken their medication and accidentally overdoses.

Virts said that any time someone administers a Narcan dose, they should call 911 since the person could still need medical attention, or the person could be experiencing something that mimics an overdose, such as diabetic shock or seizures.

Virts said they’ve found that often, people would put a person overdosing into the shower in an attempt to wake them up, which is typically ineffective.

He said that fentanyl is highly addictive so they also see repeat overdoses.

GFFR uses one microgram of fentanyl for pain management, Virts said. People using it illegally tend to take one to two milligrams, he said, but the dosage in illegal drugs is inconsistent, which can lead to overdoses.

Campbell said that in 2022, CCHD distributed 50-65 boxes of Narcan to the public.

They had no requests for Narcan in January, but gave out 26 boxes or 52 doses in February,

CCHD gives a short overview to members of the public on how to use the nasal Narcan spray.

Campbell said that occasionally members of the public give anecdotal stories of when and why they’ve used it, but the public has not reporting requirement for Narcan use.

The Cascade County Substance Abuse Prevention Alliance received a small grant from the MSU Extension Office to do some community outreach and education around fentanyl and is sponsoring several events in partnership with Alliance for Youth, Cascade County Sheriff’s Office, GFES, GFFR and GFPD.

The first of these events will be at the Great Falls Public Library, 301 2nd Ave. N. at 7 p.m. March 14.

The public is invited to these free community events, where they will learn about the dangers of fentanyl and hear from local law enforcement and first responders about what actions individuals can take to protect themselves, their families and their community.

Future community educational events are:

  • April 11 at 6 p.m. at  Wedsworth Hall, 13 Front St. S. in Cascade
  • April 18 at 6 p.m. at the Belt Performing Arts Center, 58 Castner St. in Belt