2024-001 Narcan January 5,2024 Report No. 2024-001
INFORMAL STAFF REPORT
TO MAYOR AND CITY COUNCIL
SUBJECT:
Combating Opioid Overdoses with Naloxone HCI (Narcan)
EXECUTIVE SUMMARY:
Drug overdoses in the United States and in Texas continue to rise each year, with Opioid related
overdoses rising the most, according to the Center for Disease Control and Prevention (CDC).
According to the CDC, more than one million people have died since 1999 from a drug overdose
and over 75% of these deaths have involved an Opioid. There are numerous versions of Opioid
based illegal drugs and prescription medical use Opioids on the market today. Fentanyl is the main
Opioid that is currently in the news, and is available, both legally and illegally, which can cause
death when improperly administered.
In 2021, the CDC reported that there were 106,699 drug related deaths, of which 80,411 involved
Opioids. In 2022, the Texas Department of State Health Services (DSHS) reported that Opioid
related deaths in the state accounted for 2,782 deaths,which is a sharp increase from 1,982 deaths
in 2020. In Denton County, DSHS reported that Opioids accounted for 54 deaths in 2022, which
was up from 42 in 2020. The 54 Opioid related deaths in 2022 represents approximately 6 deaths
per population of 100,000 in Denton County(54 deaths with an estimated population of 911,783).
In 2022, by comparison, Collin County had approximately 8 per 100,000, Dallas County 9 per
100,000,Tarrant County 10 per 100,000,and Travis County approximately 17 deaths per 100,000.
Locally,the Denton Police Department reports having responded to I I confirmed Fentanyl related
deaths since September 2022.
To help combat Opioid overdoses,there is a medication that can temporarily reverse the effects of
Opioids; Narcan. Narcan is a common brand name of Naloxone HCI, which is a medication that
has been around since the 1960s. The primary use of Narcan is for the emergency treatment of an
Opioid overdose. Slowed, shallow, or absent breathing is the most common effect of an Opioid
overdose that Narcan is designed to temporarily reverse.
When effective, Narcan is a medication for reducing and/or reversing the effect of an Opioid
overdose temporarily. The downside of Narcan is that it only works for a relatively short period of
time. The effective half-life of Narcan is approximately 30 to 60 minutes while the average half-
life of Opioids is approximately 3-7 hours or even as long as 24 to 36 hours with Opioid
medications such as Methadone. This means that the positive effect of Narcan on a patient can
wear-off well before the body has time to process the negative effects of the Opioid. Therefore, it
is vital the patients of Opioid overdoses who have been given Narcan are transported to a hospital
emergency room (ER) even if they are acting completely "normal" after being administered
Narcan. These patients need to be closely monitored in an ER and many receive additional doses
of Narcan until their body can excrete the Opioids from their system.
January 5,2024 Report No. 2024-001
DISCUSSION:
Who has access to Narcan in the City of Denton (COD)?
Fire Department:
Traditionally, the Fire Department (FD) and local ERs have carried and administered Narcan for
years. Narcan was not available to the public as an "over the counter medication" purchase, such
as Tylenol or Advil. Over the past 2 years,the department has administered Narcan approximately
117-120 times per year, and the department has seen a documented positive patient response to the
medication in approximately 20-22% of the time. The remaining 78-80% of the patients were not
suffering from the effects of an Opioid overdose,but were having at least some symptoms that can
mimic an Opioid overdose. It is important to note that Narcan cannot adversely affect those NOT
experiencing an Opioid overdose when administered, as described above. Each fire engine, truck,
quint, and ambulance in-service by the Fire Department carries Narcan. In addition, Fire
Department personnel that operate staff vehicles have been given Nasal Narcan to carry in these
vehicles.
Police Department:
Six years ago, as Opioid use began rising in North Texas, the Denton Police Department (DPD)
proactively began acquiring Nasal Narcan for their officers to carry,through various resources for
free. They have also distributed Nasal Narcan to each officer and continue to maintain a stock of
Nasal Narcan for their officers. Police officers had previously been excluded from carrying Narcan
since it was a prescription medication. This exclusion changed in October of 2017,when the Texas
Attorney General issued an opinion that officers can treat Opioid overdoses and protect themselves
based on Senate Bill 1462 that was passed in 2015. Nasal Narcan was initially obtained through a
grant and afterward through the"More Narcan Please"program administered by the University of
Texas Health and Science Center at San Antonio. In 2023, the Texas Division of Emergency
Management helped distribute Narcan to eligible law enforcement partners across the state through
the governor's anti-fentanyl initiatives. Denton PD received 320 units of Narcan in September
2023 to distribute to officers. Prior to being authorized to carry Narcan, officers must attend a
training given by members of the Denton Fire Department.
Denton Community Shelter:
The staff at Denton's Community Shelter has access to and carries Narcan at their facility for
emergency use if needed.
Other COD Facilities:
The COD currently has over 90 owned and maintained AEDs throughout the City. Most of these
AEDs are in COD buildings and in AED Wall Mounted Cabinets. In January and February, the
FD plans to acquire and place Nasal Narcan OD Kits in each of these wall mounted AED Cabinets.
This will place at least one Opioid Overdose Kit (Nasal Narcan) in each COD Building. Staff at
January 5,2024 Report No. 2024-001
each building will receive training on how to administer Narcan from the Denton Fire Department
prior to the Narcan being placed.
Homeless Outreach Team (HOT):
The paramedic assigned to the HOT Team carries Nasal Narcan with him when the team is
conducting outreach.
COD outreach partnership with Recovery Resources Council:
The COD has partnered with the Recovery Resources Council to help combat drug overdoses.
This team consists of a counselor from their program and a Fire Department paramedic that go out
monthly. They try to contact overdose patients who have been served by the department. The goal
of the program is to offer these individuals services to keep them from becoming an overdose
patient again. The counselor also offers the patient and/or other family members Nasal Narcan free
of charge, if appropriate, based on the type of overdose.
University Facilities:
UNT has already begun adding Nasal Narcan in their AED cabinets on their Denton Campus.After
the first of the year, the Fire Department will contact TWU and NCTC to see if they also plan on
adding Narcan to their AED Cabinets.
DISD:
It is believed that at the beginning of this school year Denton ISD added Narcan to all their
campuses. Staff will follow-up with Denton ISD after the winter break to confirm this.
Retail resources for Narcan:
In early 2023, The Food and Drug Administration approved Narcan as an "over-the-counter"
medication,which means that it can be purchased without a prescription. Currently the retail price
of Nasal Narcan is around$44-$45 for a 2 pack(approximately$22 per dose)without any coupon
or other discounts. It is available at local pharmacies, including CVS, Walgreens, Walmart, etc.
Other Sources for Narcan:
There also appears to be various organizations that offer free or reduced price of Narcan for
individuals. Some non-profit organizations also offer mailing the Narcan to individuals.
How is the City of Austin attempting to combat Opioid overdoses?
The City of Austin is trying to reduce the number of Opioid overdoses in pretty much the same
fashion as the City of Denton, albeit on a larger scale and with a few additions. Two noticeable
outreach programs that Austin has that the City of Denton does not, include the following:
January 5,2024 Report No. 2024-001
• Austin has an outreach team that attempts to make immediate contact with suspected
Opioid overdose patients with their goal of reaching out to the patient before they are
released from the hospital and offer them counseling resources, Narcan, etc. (The City of
Denton currently tries to reach Opioid overdose patients at high risk for reoccurrence
within a month.)
• Austin has partnered with some non-profits and assisted them in getting Narcan if they
can't source it on their own. These non-profits have distributed Narcan in variety of
methods including at least one "Free Vending Machine" and at large festivals that are
hosted in Austin.
CONCLUSION:
Through the Police and Fire Departments, the City of Denton has various programs in place to
address suspected and known Opioid overdoses. In cases that Narcan is warranted, the Police and
Fire departments carry Narcan to be administered.
As Federal and State Laws have changed over the past few years,Narcan has become readily
available for emergency use in several public locations, including Denton's Community Shelter,
DISD school campuses, and throughout UNT's Denton Campus. It is also planned that within
the next 60-90 days Narcan will also be placed in all the AED Cabinets in City of Denton
buildings. The CDC has recently allowed Narcan to be sold over-the-counter without a
prescription, so anyone seeking to purchase Narcan can do so at pharmacies located in the City.
Community members can also search for additional resources to get Narcan for free or reduced
cost.
The Denton Police and Fire Departments plan to continue building their internal programs as
outlined. The Police and Fire Departments will encourage community members to follow the 5
steps on what to do if you think someone is overdosing, as suggested by the CDC, to include:
• Call 911 immediately.
• Administer Naloxone (Narcan)
• Try to keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Stay with the person until emergency assistance arrives.
The Police and Fire Departments will continue analyzing data to focus efforts on reducing
Opioid overdoses in the City of Denton through outreach and other Community Risk Reduction
efforts. If Council makes a policy decision to purchase Narcan for the community, it will likely
have to be purchased over the counter, and not under the Fire Department Medical Director's
License. As the Opioid crisis continues,police and fire will continue to monitor best practices
and make recommendations in adjusting our programs as needed.
January 5,2024 Report No. 2024-001
As stated in the Executive Summary above, it is crucial in an Opioid overdose that the patient is
transported to an ER even if they become fully alert and awake after being given Narcan. The
reason for the need is because the half-life of Narcan is much shorter than most Opioids and the
patient may need additional doses of Narcan over an extended period before the Opioids are fully
excreted from their system.
EXHIBITS:
FD Narcan Administration By Age
35% 32%
30%
24%
25%
19%
20% 21%
20% 17% 16% o
14%15/o
15%
10% 9% 7% 7%
5% 10%
15-20 21-30 31-40 41-50 51-60 61-
■2022 ■2023
FD Narcan Administration by Sex
80% 73% 70% 750 0
70% 63%
0
58%
° 50%50%
50% 42% 38%
0
0 27% 30%
30% 25/0
20%
10%
0%
15-20 21-30 31-40 41-50 51-60 61-
■Male 0 Female
January 5,2024 Report No. 2024-001
FD Narcan Administration By Month
18 16
16 1T
14 13 13
12 10 11 11 12 11
10 9 09 99 0 9
8 7 7 7
6 0 5
4
2
0
,aoJatJ e�`�acJ �atr PQ�\ O`�o�et ,e�pec oe��ei
Q P heQ� �o Qe
■2022 ■2023
FD Documented Patient Improvement After
Narcan Administered
60%
50%
50%
40% 41% 38%
30% 29%
30% 25%
22°20%
20% 11° 7% 2% 4%
10% 0
0% '
0%
-50 51-60 61- Total
■2022 ■2023
STAFF CONTACT:
Kenneth Hedges, Fire Chief