Sauver la vie des victimes d’overdoses d'opiacés en Massachusetts

Boston.com, October 20, 2011, By Meg Murphy

One afternoon, Brendan Holler collected his younger sister at school and returned to the family home in Houghs Neck, where he went upstairs to the bathroom, injected half a syringe of heroin in his thigh, fell to the floor, and stopped breathing.

Nancy Holler broke open the door a short time later and found her son lifeless, face down, blue. She screamed. Her father, a retired police officer, held his grandson’s head. The police were there within minutes, firefighters soon after, and with every arrival, the panicked mother asked a life-or-death question: “Do you have Narcan?’’

Nobody did. Chest compressions, mouth-to-mouth resuscitation, nothing worked. Eight minutes passed. The emergency medical technicians arrived, and, yes, they carried naloxone, known best by one of its more popular trademarks, Narcan. It is a nonaddictive substance, available as an intravenous injection or as a nasal spray, which binds to opiate receptors in the brain, temporarily blocking the high that depresses the central nervous system and slows breathing to the point of death.

Brendan was revived.

“If that ambulance had been on the other side of Quincy, my son wouldn’t have made it,’’ Nancy Holler said in a recent interview, more than two years later. “I was at the next City Council meeting asking, ‘Why don’t our police and firefighters have Narcan?’ We are talking about saving lives here.’’

Holler, along with Kathy Deady, also a Quincy mother of an adult son with an opiate addiction, lobbied for change. Fire and police personnel, the mothers argued, should possess the easy-to-carry medical aid capable of reviving a person overdosed on opiates when the death clock is ticking.

Today Quincy police officers do carry Narcan - resulting in 45 lives saved since June 2010, when they began packing the nasal spray in cruisers, according to Lieutenant Detective Patrick Glynn, head of the Quincy Police Department’s anti-drug unit. Advocacy efforts by concerned parents proved instrumental in sparking the change, he said, and some of the city’s police officers have now made four or five saves each, using Narcan.

The Quincy Fire Department cannot make a similar claim. While the city’s firefighters, as part of a state pilot program supported by, among others, the Office of the Mayor, have been trained to use Narcan, and offered a free supply, firefighters to date have refused to carry it.

Firefighters are not convinced that equipping themselves with Narcan is necessary or makes sense, said Ernest Arienti, president of the Quincy firefighters union. He said the union continues to explore the pros and cons.

“After we are through with these investigations, you may see Narcan on our vehicles,’’ he said, unwilling to set a decision date. “I’m not saying it’s not our job to revive people, because that’s what we do. There are just a lot of things involved with using Narcan.’’

Firefighters are considering legal liability, storage space, future costs, and safety issues, Arienti said.

So what happens if Quincy firefighters arrive at an emergency scene to find a person not breathing and succumbing to an opiate overdose?

“The ambulance is maybe 2 or 3 miles behind us,’’ said Arienti. While waiting, the firefighters would work vigorously, using traditional methods, such as CPR, to revive the person, he said.

“We do what we have to do to keep that person alive,’’ he said, and, when the ambulance arrives, an EMT will “hit them with the Narcan’’ as is appropriate.

“It is their job to administer it,’’ Arienti said.

Firefighters aside, the city of Quincy is lauded by the state Department of Public Health as a leader in opiate overdose prevention efforts, an active participant in its pilot program involving 12 Massachusetts communities in which eight sites, including Quincy’s Bay State Community Services, distribute free nasal Narcan and train people to use it.

The Quincy Police Department was the first in Massachusetts to join the program.

“Some people ask why we are saving drug addicts. We are part of EMS. Narcan is another tool as a first responder,’’ said Glynn, stressing that Narcan is nonaddictive and creates no high. “It holds no value other than to save a life - that is its only purpose,’’ he said.

Eighty-six people in Quincy have overdosed on opiates since last October, he said. Nine people died. Of the 77 survivors, Quincy police revived 45 using nasal Narcan. The remainder recovered naturally or due to alternate medical assistance, such as intravenous Narcan administered by an EMT.

“Narcan gives a person another chance,’’ said Glynn. “Is everyone going to be saved? Will every person go into counseling? Well, maybe not. But if a few people do - that makes it worth it.’’

Nearly all of those revived by police were between the ages of 25 and 39. In every instance a Quincy police officer has identified an opiate overdose in progress and sprayed the contents of a small vial of Narcan into the nostrils of the fallen, and it has worked, said Glynn. The person lived, every time.

In Massachusetts, more than 1,000 lives have been saved the same way since last September, primarily by private citizens, all of whom signed on for the free nasal Narcan and training lessons offered as part of the state Opioid Overdose Prevention Pilot Program, launched in 2007. The number of Massachusetts residents now enrolled stands at more than 10,000.

Holler and Deady both carry Narcan. As of July, 327 people in Quincy had signed on - and used the nasal spray to save 20 lives. In Brockton, 593 people were enrolled - resulting in 75 lives saved, said Department of Public Health spokeswoman Julia Hurley.

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