Knox County First Responders Gave Naloxone over 1,200 Times in 1 Year for Opioid Overdoses
Each day in Knox County, an average of three people get the overdose antidote naloxone from a first responder: paramedic, firefighter, police officer.
In a one-year period — between Oct. 1, 2016, and Sept. 30, 2017 — that meant more than 1,200 people got the drug in an emergency situation. And that number keeps going up.
For the past 16 months, the Naloxone Community Collaborative, headed by Metro Drug Coalition and made up of first-responder agencies and organizations with an interest in public health, has been tracking who in Knox County gets naloxone, which reverses the effects of opioid drugs on a person's breathing, bringing the respiratory system back to normal function.
The reason: They're looking for ways to intervene before the next overdose.
On Thursday, the collaborative released a report summarizing the data members collected and gave to Knox County Health Department epidemiologist Roberta Sturm.
— White males ages 25-39 were administered the most naloxone. By gender, 60 percent of people getting naloxone in Knox County were male; 40 percent were female. By race, 88 percent were white, 10 percent black and 2 percent another race or ethnicity. And the age groups 25-29 and 30-34 together made up half of those getting naloxone.
— Naloxone is most frequently given in the ZIP codes 37920, 37917, 37921 and 37918, but the greatest burden of suspected overdose, by rate, is in 37921, 37917 and 37916.
— A little more than 7 percent — 93 out of 1,268 — got naloxone from first responders more than once during the 12-month period. Most of those got it twice; the most any one person got it was five times.
"The rumor we always hear is, we're saving these addicts so they can use again," said Knoxville Police Department Chief David Rausch. "That's a very small percentage. ... We are saving lives, and they are changing lives.
— Eleven times when first responders arrived, more than one person at an address needed naloxone. And there were 151 addresses in Knox County where emergency responders had gone to the address more than once and given naloxone to someone there — anywhere from two to 10 visits.
— Most people — about 55 percent — who got naloxone from a first responder got 2 milligrams, the premeasured dose in the nasal spray that police officers carry. Nearly 18 percent got half that dose — 1 milligram. But more than 100 people needed a dose greater than 2 milligrams, because they didn't respond to the standard dose. That could mean they overdosed on stronger drugs.
This data is just a starting point. It doesn't, for example, count people who were given naloxone in hospitals or by friends, acquaintances or "good Samaritans," since naloxone is now available at pharmacies without a prescription.
And it could include people who didn't overdose on opioids but who had the symptoms — unconscious, not breathing, dilated pupils — when first responders arrived and so were given naloxone as a precaution. It could also include people who took medication as prescribed but still experienced respiratory distress, or children or elderly people who accidentally took medication.
Most of all, it doesn't tell what happened to the people after they were given naloxone. Did they receive treatment for addiction? Did the drug give them a second chance? Or did they relapse? Did they later suffer a fatal overdose?
The collaborative next wants to know and affect those outcomes, by following up with people who received naloxone and connecting them to care, and noting which ones end up back in area hospitals — or at the Knox County Regional Forensic Center.
"It can be very overwhelming for people to try to get into care," said Karen Pershing, executive director of Metro Drug Coalition.
TheNaloxone Community Collaborative also wants to use the data to focus opioid education and interventions in the areas where overdoses happen most often, better preparing first responders who are going into those areas. It wants to encourage more first responders and others to carry the drug, as Gov. Bill Haslam stated state troopers will, when announcing his plan Monday for dealing with the opioid crisis in Tennessee.
With the District Attorney's Office estimating 294 overdose deaths in Knox County in 2017, "we’re obviously still in the midst of an epidemic in our community," Pershing said. "Imagine if we didn't have first responders carrying naloxone, what those numbers would look like. All of those ... could have potentially resulted in other deaths."
The collaborative recommends doctors who are prescribing a narcotic give patients a naloxone prescription along with it, and pharmacists offer the drug to customers picking up opioid prescriptions — both actions already taken by some other states.
Pershing also said the coalition has asked state Rep. Bill Dunn to sponsor a House joint resolution asking the FDA to make nasal-spray naloxone available over the counter, "possibly driving down pricing."