Omaha firefighter explains how to give Narcan in case of an opioid overdose
For years, first responders have reversed fentanyl and other opioid overdoses with naloxone.
Commonly called by the brand name Narcan, the reversal agent has been used by Omaha Fire Department medics and the Douglas County Sheriff's Office for years. With the ability to be administered as a nasal spray or as an injection into a muscle or vein, naloxone could completely reverse opioid overdoses in just a few minutes.
"It works very quickly and we have very good success with it," said Eric Hallagan, an Omaha Fire Department lead paramedic and firefighter.
It normally takes no more than a couple of doses of Narcan to reverse a fentanyl overdose, but a new type of synthetic fentanyl -- 50 to 100 times more potent than traditional fentanyl -- has emerged and requires more doses of Narcan to reverse an overdose, said Douglas County Sheriff Aaron Hanson. Hanson said the drug is known as carfentanil and it has been making its way into the United States via Mexican drug cartels.
"It's so potent that it results in numerous doses of Narcan to recover someone who's engaging in an opioid overdose," Hanson said.
The emergence of the stronger carfentanil, along with xylazine (a tranquilizer used by veterinarians) that is resistant to Narcan because it's not a synthetic opioid, threatens to upend what Hanson said has been significant progress made in Douglas County in the reduction of fentanyl overdose deaths. Hanson said fentanyl overdose deaths declined by more than 40% last year compared to the year before.
Hanson said the Sheriff's Office, in conjunction with other law enforcement and legal agencies including the Omaha Police Department, Douglas County Attorney's Office, U.S. Attorney's Office and Drug Enforcement Administration, sought to address fentanyl overdoses after the county saw at least 89 people die from fentanyl overdoses in 2020 and 2021. Thirty-three people died of an opioid overdose in 2023.
Hanson said the Sheriff's Office first started seeing carfentanil hitting the streets and getting into correctional facilities late last year.
"The cartel chemists are always trying to get ahead of law enforcement," he said. "They're always trying to create the newer, cheaper, more potent drug."
With carfentanil and xylazine "changing the game," Hanson said, "We're going to have to find ways to address it."
One possible alternative to naloxone is a reversal agent called OPVEE. OPVEE, also known by the generic name of nalmefene, can be administered nasally.
Dr. Jerome Adams, who was surgeon general during President Donald Trump's first term, told The World-Herald that, at $37.50 per dose, OPVEE is comparable in price to Narcan yet is up to four times stronger in its ability to reverse fentanyl overdoses.
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Currently nalmefene is only available as a prescription in Nebraska, unlike naloxone, which is available over the counter. Adams said nalmefene is specifically designed to reverse fentanyl overdoses while naloxone was originally designed to reverse heroin overdoses.
"We're bringing heroin tools to a fentanyl fight and, in many cases, we're losing," Adams said.
Although the Food and Drug Administration approved nalmefene as a fentanyl overdose treatment agent in May 2023, not everyone is convinced nalmefene is the best way to treat fentanyl overdoses.
In a September 2023 statement, the American College of Medical Toxicology and American Academy of Clinical Toxicology said nalmefene should not replace naloxone as the primary opioid antidote.
The two medical organizations cited the lack of data showing nalmefene is more effective at treating fentanyl overdoses than naloxone. They also expressed concern that nalmefene binds much more strongly to opioid receptors than naloxone, which could cause fentanyl overdose patients to have a more intense withdrawal reaction.
"When somebody is passed out and you give them Narcan, they suddenly wake up and get somewhat agitated. But it doesn't last very long," said Dr. Alëna Balasanova, an addiction psychiatrist with Nebraska Medicine. "The concern (with nalmefene) is that you're going to be precipitating a withdrawal in somebody that is going to last a while. It's very uncomfortable. That may actually lead to them possibly using opioids to treat that withdrawal."
Adams acknowledges the concerns raised by his medical colleagues but he said those concerns have been "rarely observed."
"What you're actually doing is giving people a better opportunity to save a life with fewer doses administered," he said. "I would rather have someone alive and then we can deal with precipitated withdrawal if it occurs than not."
Officials in Douglas County said they were open to learning more about overdose reversal agents. Meantime, the Douglas County Health Department is working to expand the availability of Narcan. Last week, the department added the reversal agent to its five free health product vending machines stationed in Omaha. The vending machines are located at:
Douglas County Health Department, 1111 S. 41st St.Omaha Public Library -- Charles B. Washington branch, 2868 Ames Ave.Siena Francis House, 1117 N. 17th St.American Dream, 7402 F St.Nebraska Urban Indian Health Coalition, 2226 N St.
Leah Casanave, the Health Department's division chief for community health, nutrition and clinical services, said the department added Narcan to the outdoor vending machines thanks to Nebraska's share of money allocated through opioid lawsuit settlements.
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