"I think it would be a very safe assumption that because the medication is available over the counter, our numbers have decreased," says Brian Culpepper, clinical education coordinator for American Medical Response (AMR), which provides secondary emergency service in Denver but is the primary 911 responder in several other prominent Colorado communities, including Boulder, Golden, Colorado Springs and Pueblo. "It hasn't necessarily decreased patient contacts, but it's definitely decreased our usage."
We have no idea how many of these patients would have died without Narcan. But the possibility that hundreds of additional deaths could have occurred in Denver alone chills Culpepper and his peers to the bone.
The effectiveness of Narcan, the commercial name for Naloxone, its formal moniker, and ease of dispensing has led to it becoming standard equipment for organizations beyond those that specialize in health care. Narcan is currently being carried by officers with the Denver Police Department and staffers with the Denver Fire Department, in addition to paramedics dispatched by Denver Health Medical Center, the top provider of emergency care in Denver, and AMR staffers, who handle Denver Health overflow.
Denver Health managed the lion's share of Narcan uses in 2017, when its paramedics gave it out 811 times. Next came the Denver Fire Department, whose personnel used it 82 times. In addition, AMR dispensed Narcan thirteen times, and Denver police officers did so on four occasions. That adds up to 910.
Borland adds that the 811 uses of Narcan last year actually represents a falloff from the previous year, when it was used 994 times. Because paramedics under the Denver Health umbrella responded to 119,378 calls in 2016 and 124,849 calls in 2017, the rate of Narcan use dipped substantially over that period, from 8.3 per 1,000 patient contacts to 6.5 per thousand.
"There are a number of potential factors involved in that reduction that we would hesitate to speculate on," Borland allows. "But we have noted increased Narcan availability (to both our public safety partners at DPD and DFD and to the wider public)."
Narcan is certainly accessible. Last October, Walgreens announced that it would begin selling it without prescription in 46 states across the country, including Colorado, following the lead of CVS, which was already doing so in 43 states. GoodRx.com also lists its availability at Walmart, King Soopers and City Market pharmacies, among others.
Not that it's cheap. The online prices for Narcan at this writing are all in excess of $130. Moreover, questions remain about whether what the Drug Policy Alliance's Art Way describes as "the most chaotic" drug users can afford to spend that much money for a medical safety net or if they're so deep into their addictions that they might not be capable of making contingency plans. Nonetheless, Denver Fire Department Captain Jeff Linville believes that "a lot of these people aren't even calling 911 anymore. They're just pushing the Narcan themselves."
At the same time, the Denver Fire Department has other opioid-related issues on its plate. "Fentanyl seemed to start out on the East Coast, and it's trickling west," Linville points out about the extremely powerful narcotic, which contributed to the overdose death of Eric Bolling Jr., son of ex-Fox News commentator Eric Bolling, in Boulder last September. "We've been having conversations with the Denver Public Library about that. They're seeing users going into the building to shoot up in the restrooms, and our question is, what if they find Fentanyl? Because that's a full-fledged hazmat response. And if that's combined with carfentanil, which is even more potent, it's a full hazmat response, too. So we're prepared for that."
In this space yesterday, by the way, state representative Leslie Herod said the Denver Library's central branch, at 10 West 14th Avenue Parkway, had become a de facto safe-use injection site in the absence of an official facility offering this service. However, a bill to create a pilot program for such a center was pulled by sponsors earlier this week when Republican lawmakers balked at funding a center at which "illegal activity is brushed under the rug."
Given this development, it's a good thing Denver firefighters are well supplied with Narcan. If they don't need it this minute, they or their emergency-service colleagues probably will a few hours from now.