How many have been saved by naloxone in York County?
Photo of the opioid overdose kit to be used by Franklin County Law Enforcement.(Photo: Franklin County District Attorney’s Office)
Tracking saves is a difficult task, even as officials realize data is an effective tool to address the opioid epidemic
(York) — Earlier this month, York City firefighters were sent to the McDonald’s on George Street. But they weren’t there to fight a fire. The late-morning call was for a drug overdose.
A man inside the restaurant was unresponsive and barely breathing. So a firefighter took out a dose of naloxone, a widely-used drug that reverses the effects of opioid overdoses.
He injected it into the man’s thigh, much like an EpiPen allergy shot. Crews put a breathing mask on him. The firefighter gave him another dose of naloxone.
“Shortly after that, he came out of it,” said Chad Deardorff, deputy fire chief of York City Fire/Rescue Services.
Saves like that one are becoming increasingly common across York County. First responders — police officers, EMS and now some firefighters — are equipped with naloxone and trained to revive someone if an opioid such as heroin causes an overdose.
Emily Weichert, 35, of Spring Garden Township, walked into a press conference where state officials filled prescriptions for naloxone to demonstrate that now, across Pennsylvania, everyone can acquire naloxone at any pharmacy that carries it. Paul Kuehnel
For York City Fire/Rescue, that was the first recorded save, just three days after they started carrying naloxone. The department got a grant to help cover the typically high costs.
But, even as the antidote has become more available, keeping track of the amount of saves county-wide is a difficult task, having eluded even officials who recognize data can be an effective tool as they try to address the heroin epidemic.
“It is being used so broadly and in so many different venues that it is hard to track that data,” said Dr. Matthew Howie, medical director of the York City Bureau of Health and newly appointed leader of the York Regional Opiate Collective.
Naloxone is carried in some York County schools. Probation officers last year were trained to use it. York Hospital has it in its emergency department. York’s many recovery homes carry doses. Not One More, an organization that raises awareness about heroin’s dangers, uses grant money and its own funds to give naloxone to residents and to recovery homes for free.
Pennsylvania Physician General Rachel Levine filled prescriptions so any resident in the state can purchase naloxone at a pharmacy.
Part of Howie’s work will be to collect data on naloxone saves as well as identifying other areas where data would be useful in the overall fight against the opioid problem.
“There is a real need to define how big the issue truly is in our area and develop the necessary counter-measures to most effectively respond,” Howie said. “However, the number of our residents actively in opioid addiction and abuse is difficult to assess. Naloxone use in the field and in hospitals is one way to quantify the size of the epidemic, though admittedly it is a late marker.”
He pointed to a California state dashboard, which uses statistics, maps and other ways of charting its epidemic, as an example of using data, saying that would ultimately be a goal of his and the York opiate collective.
“Our focus is public education,” Howie said. “What I really want to focus on is maximizing that linkage to care and linkage to recovery.”
Who has what data in York County
The most complete data comes from the York County District Attorney’s Office. The office helps fund the county’s many police departments that carry the antidote.
In turn, police departments fill out forms for the DA’s office as they administer doses, noting the date, the person’s age, sex, where the overdose happened and even what evidence, like needles or other drug paraphernalia, was found at the scene.
Officers recorded 232 saves in 2016, including 33 in December alone — the most in a one-month period since police started carrying naloxone in 2015.
Data is broken down to show the age of the overdose victims, where they overdosed and when. For example, the majority of victims, 67 percent, were males. York City Police administered naloxone 66 times in 2016 compared to 41 by Northern York County Regional Police and 27 by Hanover Borough Police.
The age of victims varied, with many in their 20s, according to the DA’s office. The youngest victim was 17; the oldest was 60, the data show.
At York Hospital, 230 doses of naloxone were administered in the emergency department between August 2015 and July 2016, said Dan Carrigan, a Wellspan spokesperson. Those were doses given to all patients — including, for example, someone experiencing an “altered mental state” which may not be the result of a drug overdose.
“Naloxone is an old drug and we’ve had it in our treatment for a long time,” said Dr. Erik Kochert, interim chair of the emergency department.
Recently, York Hospital has been able to connect people who overdosed to treatment. They have a “warm hand-off” program where they connect someone with the RASE Project, a nonprofit that provides support groups and other treatment for people in addiction.
At Memorial Hospital, naloxone was used “about once a week” for people with overdose symptoms, said spokesman Jason McSherry. He was not aware of the hospital tracking how many saves there were.
But pulling out that data — how many doses were administered at hospitals — could be problematic.
Technically, someone revived by a police officer and brought in to a hospital might have to be revived again with naloxone, which would lead to duplicate data, officials pointed out.
That could happen because heroin, especially if its mixed with fentanyl, a highly potent synthetic opioid, has a longer half-life and can have lasting impacts on someone’s breathing.
No one, so far, has tracked the intricacies involved in this data, Howie said.
Naloxone save reporting concerns
Not One More helps supply recovery homes, said Alyssa Rohrbaugh, the chapter’s vice president. Since December 2015, she said, Not One More gave out 600 Narcan kits, which carry two doses each.
When a recovery home uses a dose, they can get a refill from Not One More, without any questions asked.
Rohrbaugh said the majority of the 600 kits were for families; recovery homes don’t ask for refills as often, and some houses have never asked.
Rohrbaugh expressed concern if recovery home regulations, which are being discussed on the state level, called for homes to report naloxone saves. Not One More has done a lot to build relationships with the recovery home community, and she said improvements have been occurring internally.
“If you start mandating recovery homes (to report saves), kids aren’t going to want to go there,” Rohrbaugh said.
There have been naloxone saves at houses, she said, but that doesn’t mean a house is performing poorly.
Plus, she said, she’s heard of instances where someone nearby a recovery home used a dose for an overdose happening down the street. So she worried about tracking that data.
For Howie, tracking the public usage of naloxone saves is difficult.
He said he’d be able to find out how many doses pharmacies sold, but tracking how many times a dose is actually used to revive someone after it’s purchased might be something impossible to track.
“There will always be certain areas that we’ll be blinded to,” he said.
This story is part of a partnership between WITF and the York Daily Record.