NYPD and DuPage County naloxone programs saving lives. CPD adoption remains uncertain

Scripted by Melissa Schenkman. Animated by Next Media Animation.

By Melissa Schenkman

The long-time drug user, the patient taking prescription opioid pain medication, the high school student experimenting with drugs, and the child who confuses pills with candy, all have one thing in common.  They all represent people at-risk of an opioid drug overdose, the people NYPD officers have been trained to save.

Police officers armed with naloxone nasal spray, the intranasal opioid drug overdose antidote, have saved 18 lives since a Staten Island program began earlier this year.

The success is spurring the department to make strides in expanding its training, with the goal of equipping the entire police force of approximately 35,000 NYPD officers with naloxone kits. That would extend the program across all five boroughs of New York City.

The next program launch will be in The Bronx, where the rate of unintentional drug overdose deaths rose above the rate in Staten Island in 2013, according to data from New York City’s health department and the Office of the Chief Medical Examiner.

“This type of program goes with our mandate to be good Samaritans for the community,” said Sergeant Steven Sarao, Special Projects Unit, Deputy Commissioner Management, Analysis and Planning. He trains officers enrolled in the program.

In west suburban DuPage County, officers are making headway in the fight against opioid drug overdoses with naloxone as well while the Chicago Police Department continues to grapple with whether to implement an anti-overdose treatment program.

DuPage County’s program kicked off with 364 trained officers at about the same time the Staten Island program began. To date, DuPage has trained 1,699 officers to spot opioid drug overdoses and use naloxone kits. As of Sept. 30, officers have saved 23 lives, according to the DuPage Narcan Annual Report. The program has been implemented at 33 different communities and government units such as the Illinois State Police District 2 within the county.

Prior to the program, DuPage County had a total of 39 opioid overdose related deaths in 2012 and 48 in 2013. Implementing the Naloxone Program has cut these numbers by half, with only 26 deaths in 2014.

“Police officers are usually the first ones there. The program provides them with better equipment for officers to be prepared to help the public,” Sarao said.

Where it all began

The number of opioid drug overdose cases in New York City rose from 8.2 per 100,000 in 2010 to 11.6 per 100,000 in 2013. That’s a 41 percent increase in a three-year span, according to the data from the city’s Department of Health and Mental Hygiene Bureau of Vital Statistics and the Office of the Chief Medical Examiner. And in 2013, 77 percent of deaths from a drug overdose involved a drug from the opioid class.

But Staten Island had the highest rates of opioid drug overdose deaths among all five boroughs, with 20.6 per 100,000 in 2011 and 20.1 per 100,000 in 2012, double the citywide average. In 2013, Staten Island residents also had the highest rate of opioid drug overdose deaths related to using prescription opioid pain relievers in NYC, at 7.3 per 100,000. 

After seeing these numbers, Anne Siegler and her department of health colleagues thought about how to combat the problem. Finding a solution led them to ask “Who are the people likely to be there saving lives?” The answer: police officers.

Staten Island, the smallest of the boroughs, with a population of 472, 621, was clearly the place to start.

A $50,000 federal grant made the program possible.

“It’s a small borough with such a big problem, “ said Staten Island Police Officer Christopher Fisher, who has been with the force for over nine years.

Drug overdoses do not discriminate

The stories of overdose victims reach far beyond the stereotypes. People have perceptions of drug overdoses, Sarao said. People think of habitual drug users, but anyone has the potential to have a drug overdose.

Officers have seen everything from the “accidental to overdose to suicide,” Sarao said. “It further illustrates the depth of the problem. It runs across all socioeconomic spectrums.”

It can happen to the elderly lady with cancer or the young child who mistakes colorful opioid pain medication for candy, both unintentionally ingest too much of the medication and then stop breathing.

Several prescription pain medications are in the same opioid class of drugs as heroin. These include morphine, methadone, oxycodone, oxycontin, hydrocodone and fentanyl.

“They are great pain relievers, but they all have a problem that can cause an addiction,” said Dr. Charles Martinez, Deputy Chief Surgeon for the NYPD and medical director of the Emergency Service Unit Tactical Medical Team.

Training

Sarao, Martinez and NYPD Inspector Edward Carrasco direct officer naloxone training.  They teach officers how to identify overdose victims, the questions to ask witnesses, how to administer intranasal naloxone to the overdose victims, and the laws at hand.

The program is a peer-based training program, where officers are trained and then go on to train fellow officers who often work in the same department. This enables trainers to have good insight into situations their fellow officers may find themselves in, Siegler said.

When it comes to using naloxone in both New York City and in DuPage County, the 911 Good Samaritan Law is at play. The law encourages anyone witnessing an overdose “to do the right thing and call for help.” It also affords some protection from criminal charges and prosecution to the overdose victims.

“We want this to be something positive,” Carrasco said. As part of the Good Samaritan Law officers collect non-identifying information from overdose victims.

“We don’t collect intel. Our purpose is to administer it and get them to the hospital to get them the help that they need,” Sarao said.

NYPD are afforded an additional level of protection by the Overdose Law in New York State. The overdose law “protects the non-medical person who administers naloxone in the setting of overdose from liability.” Liability is always a concern, though, when it comes to a medical intervention.

“It helps us to want to use it because we know there are no repercussions if we want to use it and it doesn’t work,” Fisher said.

Back at home

Dr. Steven Aks, an emergency room physician and director of the Toxikon Consortium at Chicago’s Cook County Hospital operates a naloxone program with patients who have an opioid addiction problem and their families.

He hopes to get more physicians actively engaged in prescribing naloxone and training families to administer it.

As a member of the American College of Medical Toxicology’s Board of Directors, Aks recently co-authored a position statement entitled, Expanding access to naloxone in the United States, published in Clinical Toxicology.

The statement concludes that access to naloxone beyond a healthcare setting is an important part of addiction treatment and a safety issue, stating:

“It is an effective medication whose timely administration will frequently prevent opioid-induced overdose death.  Current political and and medico-legal barriers excessively restrict access to naloxone for those in need.”

Over the years Aks has had many interactions with patients in an overdose scenario here in Chicago,  including those overdosing on prescription painkillers.

“The prescription opioid problem is on the radar. Managing chronic pain is controversial,” Aks said.

People who can’t get prescription painkillers, often seek out heroin, which is less costly, he said.

As for the Chicago Police Department, “Unfortunately our department has no current plans to implement a naloxone program, now or in the near future,” stated a representative of the Office of News Affairs, who responded in an email.

When an overdose occurs, the window of time to reverse course is only “precious minute,” Martinez said. Police officers are the first of the first-responders on the scene and the naloxone program makes those minutes count.

“The program is changing the role of the police officer from law enforcer to life saver,” Martinez said.