Narcan

A photo illustration of Narcan, an opioid reversal nasal spray.

Franklin County Sheriff Steve Pelton said his deputies have seen a rise in opioid overdoses this year and the coronavirus pandemic may be to blame.

“It has something to do with it,” Pelton said. “People haven’t been working and are at home.”

The opioid heroin has replaced methamphetamine as the illicit drug of choice in Franklin County, Pelton said, and it’s coming from St. Louis. “The methamphetamine we see now is shake and bake, mainly for personal use.”

Pelton said as of Aug. 28, county deputies and the Multi-County Narcotics and Violent Crimes Enforcement Unit have investigated 107 opioid overdoses.

In 2019, the two entities investigated a combined 77 opioid overdoses.

Pelton said despite the increase in overdoses this year, overdose deaths are not rising as swiftly given the widespread availability of Narcan, which can help reverse an opioid overdose. Not only do deputies and police officers carry the life-saving antidote, but anyone can purchase it at some pharmacies without a prescription.

“More people have Narcan at home now,” Pelton said. “They are giving the doses prior to us getting there.”

A “Good Samaritan” law passed by the Missouri Legislature and signed by then-Gov. Eric Greitens in 2017 also has helped prevent more overdose deaths, Pelton said. The original purpose of the law was to save lives by encouraging those in overdose situations to call for emergency medical help without fear of getting into trouble. While good in its intention, Pelton said the law makes the job of law enforcement more challenging.

Washington Area Ambulance District Chief Terry Buddemeyer said Narcan has helped reduce the number of overdose calls the ambulance district receives, but when they are called, first responders can offer a stronger dose of Narcan that is longer lasting. “We explain their shot was very short acting and 40 to 50 percent of those we offer it to accept it.”

Buddemeyer said if the patient is alert, oriented, and is able to sign a refusal, the patient is not transported to the hospital despite having just survived an overdose. “It’s completely their call. We can’t make them go,” Buddemeyer said. “It’s the same if the police administer the Narcan before we get there.”

Earlier this week, the Drug Enforcement Agency (DEA) warned law enforcement about batches of methamphetamine laced with the deadly synthetic opioid fentanyl.

The substance has been seen in Franklin County sporadically for the past three years, according to Jason Grellner, Mercy Hospital’s regional director for public safety and a former commander of the Multi-County Drug Task Force. Encounters with users can be extremely volatile for them and responders, he said.

“The meth suppresses pain receptors and raises the heart rate,” Grellner said. “The fentanyl suppresses breathing and the body is basically fighting itself. A first responder may come into a situation where they give Narcan to counteract the fentanyl. Then they are left with a highly agitated patient who can feel no pain.”

Grellner said Narcan, drug education and a tightening grip on opioid prescriptions is helping reduce the number of drug overdose-related emergency room visits.

“In the 1980s, physicians were pushed to use opioids as the best pain management solution, but that isn’t the case now,” Grellner said. “Despite Missouri being the only state without a prescription drug monitoring program, Mercy and its physicians cooperate with the St. Louis County Prescription Drug Monitoring Program (PDMP)

Grellner said Tylenol and ibuprofen are being prescribed more for pain management. “When opioids are prescribed, the amount of pills is limited to a smaller supply,” Grellner said. “People aren’t able to go to their medicine cabinets to find dozens of pills left over from a surgery they had three years ago.”

Grellner said overdose patients who do present in the Mercy ER are met by counselors to help them with the addiction. “At that time they are given kits with information about recovery and Narcan is included in the packets,” Grellner said. “This Narcan distribution directly to users and all Franklin County first responders is saving lives.”

The numbers prove his point. There have been 14 opioid-related deaths in Franklin County so far this year, with the most recent occurring in June, according to Franklin County Medical Examiner Kathleen Hargrave. That compares with 43 overdose deaths last year.

Hargrave said many of the drug overdose deaths last year were from a mix of drugs, with fentanyl found in the systems of half of the victims. Methamphetamine was the most prevalent drug mixed with opiates and was found in the systems of 22 of the overdose victims. Hydrocodone, Oxycodone, cocaine and half a dozen other prescription drugs were also ingredients in the overdose deaths.

In 2018, there were 49 opioid-related deaths in Franklin County.

Grellner said the types of drugs being abused are cyclical and each presents its own challenges to first responders and physicians.

“We had cocaine and crack in the 1980s, then meth in the 1990s,” Grellner said. “The opioid epidemic started with prescriptions and then moved to street opioids. We are about two years behind the East and West coasts. Right now, they are seeing a resurgence in cocaine and crack cocaine use.”