Hawai’i Police have revived five people from the effects of opioid overdoses with naloxone — likely saving their lives in the process.

As of earlier this year, about half of the department’s sworn personnel carry naloxone, and Assistant Chief Samuel Jelsma said they hope to eventually train and equip all officers, especially as police see a rise in opioid overdoses on the island.

HPD is the last law enforcement agency in the state to outfit its frontline officers with the life-saving medication. In 2017, HPD’s Vice sections received federal funding to carry naloxone, however, there were no recorded uses of the nasal spray or saves until April 2021. Jelsma said he believed the need for additional money prevented a rollout of naloxone across the department.

With an uptick in heroin confiscations and rise in fentanyl investigations, Jelsma said the effectiveness of the overdose-reversing medication Narcan, generically known as naloxone, became more significant for officers to carry.

While HPD was giving this issue a closer look, Jelsma said West Hawai’i Community Health Center approached the department about providing training on how to use naloxone as well equipping front-line officers with the antidote.

The department also maintains a backup supply of naloxone to replace any officers use to revive a patient or in the event, it is damaged.

Overdoses

The true extent to which naloxone is used to save those who have suffered an overdose is unclear as agencies record their data separately, making it difficult to track overall statistics.

Opioid overdose is marked by loss of consciousness and suppressed breathing, which can eventually result in asphyxiation.

Local organizations that distribute naloxone to their clients and patients counted a total of 20 overdoses related to all drugs on Hawaiʻi Island in 2020, according to Hawaii Health and Harm Reduction Center (HHHRC). Those organizations include West Hawaiʻi Community Health Center, Big Island Substance Abuse Council (BISAC) and Kumukahi Health and Wellness, which distribute the naloxone with the support of the Hawaiʻi Health and Harm Reduction Center. HHHRC is a statewide organization with a mission to reduce the stigma of substance abuse and provide services for at-risk groups.

The Department of Health counted eight non-fatal synthetic opioid overdoses related to fentanyl and the prescription pain medication tramadol, although it wasn’t clear if naloxone was used in these cases. HHHRC Executive Director Heather Lusk said the DOH total is different because that agency only counts non-fatal overdoses reported by hospitals and EMS. HHHRC, however, collects its data “directly from people who used naloxone on others and revived them – regardless of whether they then went to the hospital and got reported there.”

Fatal overdoses reported statewide have been rising since 2011. In 2020, there were 267 fatal overdoses recorded, according to the DOH death certificate database. Synthetic opioids, which include fentanyl, showed an increase in Honolulu County.

Fatal overdoses for all drugs reported by the DOH in Hawaii County have fluctuated over the past few years. While there was a drop in 2019 to 12, it spiked back up to 22 in 2020. There was no emerging trend in fatal overdoses related to synthetic opioids over the past few years on the Big Island, the DOH data shows.

While data about how many fatal overdoses in Hawaiʻi County isnʻt attributable to synthetic opioids, WHCHC Behavioral Health Programs Manager Alysa Lavoie said clients at the clinic have been sharing their experiences.

Lavoie started seeing a rise in overdoses among their patients in September. Around that same time, the clinic also started to see an uptick in reports of fentanyl use.

Two patients died from an overdose and four to five patients talked about overdosing, Lavoie explained. One of the fatalities, she noted was a result of suspected fentanyl.

“Iʻm positive thatʻs on the lower scale,” Lavoie said of the clinic’s stats. “I can tell you we have a problem, I can’t prove to you we have a problem.”

Historically, Lavoie said the clinic has seen one or two overdoses every six months, adding those are just the ones they’ve heard about through patients.

“I think things are going to get bad,” Lavoie said with the increase in fentanyl on the Big Island. “You try something once and you literally have the potential to die.”

Naloxone for the Public

In the past five years, Hawaii lawmakers passed legislation that brought naloxone into health clinics, police officers and the general public through pharmacies. The nasal spray is available for free at the procurement sites and pharmacies are allowed to prescribe it.

HHHRC was the first organization to procure naloxone in the state through the DOH, handing out 15,000 doses since 2018 statewide. The organization also offers grants to organizations that apply to obtain a supply of naloxone for one year. DOH also funds HHHRC to do training on the nasal spray.

Click here for information on grants and to schedule trainings through HHHRC.

These grants, awarded to Kumukahi in 2019 and in 2020 to WHCHC and BISAC, allowed them to become procurement sites.

Kumukahi, was the first local procurement site of naloxone. Since November 2019, they handed out 480 doses.

While the procurement sites were handing out naloxone to clients and patients, they can now provide group trainings on naloxone. Groups that go through the class, leave with a Narcan kit.

WHCHC is currently in the process of training HPD.

Lavoie said they are hoping to work more with elderly caretakers and service providers, as well as begin training for faculty and staff in public schools on the use of naloxone.

Lavoie said their staff is allowed to train anyone of any age to administer Narcan.

Click here for a Narcan training request form through WHCHC.

As of November, BISAC handed out 592 naloxone doses. Hannah Preston-Pita with BISAC said they’ve trained about 200 providers and health care workers at rural wellness hubs on how to use Narcan.

Lusk said naloxone is a safe drug. With sprawling rural communities on the Big Island, Lusk said, getting more naloxone to residents will save a life as it may take several minutes for EMS to show up.

Lavoie said there is a lack of awareness regarding the availability of naloxone as overdoses are an unseen problem that is now growing.

Tools for Saving

The Hawaii clinics also hand naloxone to clients and patients. BISAC has given Narcan to 20 clients who recently graduated from their program.

Click here for information on how to identify an opioid overdose and how naloxone can save a life.

“It’s giving them the tools to save themselves or others,” Preston-Pita said.

Lavoie said they are currently training staff to teach patients how to administer naloxone. Once taught, they are given a kit free of charge.

With the influx of fentanyl, WHCHC is working on procedures on how to distribute BTNX fentanyl test strips. Strips can be used to test whatever drug is being used by diluting the residue or crushed pill in clean water.

Test strips test for the presence of fentanyl and some fentanyl analogs. BTNX FTS does not detect all fentanyl analogs or synthetic opioids in general.

If positive for fentanyl, one line will appear on the strip.

“The main purpose is so people can make an informed choice about using,” Lavoie said of the use of test strips. “Generally, it’s another measure people can take to be safe as they can while they’re using.”

With the understanding that fentanyl is in their drugs, Lavoie hopes they do a smaller shot of heroin or take breaks between different drug use.