Editorial: Strengthen action against fentanyl

The national opioid crisis loomed larger in Hawaii last weekend when suspected overdoses on the drug fentanyl, involving five people in a Waikiki hotel room, ended in the death of two of them. And that tragedy has accelerated the pace of two initiatives already underway in an attempt to rein in the public health risk.

One is a proposed mandate for bars and nightclubs to stock naloxone — known by its brand name, Narcan — a medication that works well to rescue a person who has overdosed on an opioid. Proponents of that measure, City Council Bill 28, have not yet made the case for that regulatory step.

But the other initiative, Senate Bill 671 passed by the state Legislature, is a straightforward effort to decriminalize possession of a fentanyl test strip. That one deservedly has won Gov. Josh Green’s endorsement.

Fentanyl is a synthetic opioid painkiller that often is added to other drugs “because of its extreme potency, which makes drugs cheaper, more powerful, more addictive and more dangerous,” according to the Centers for Disease Control and Prevention. The test strip helps people detect that fentanyl has been mixed in, without fearing that the strip would be classed as illegal drug paraphernalia.

The considerations are more complex for Bill 28, which passed second reading before the Council on Wednesday.

That measure, introduced by Councilmember Tyler Dos Santos-Tam, states that its purpose “is to promote public health, safety and welfare by enhancing access to naloxone hydrochloride,” or Narcan.

Enhanced access is the correct public-health goal, but it’s not clear that the targeted venues are the most common sites of overdose events, and whether a government mandate would yield the kind of risk-reduction that’s envisioned. Additionally, the cost for a dose, currently approaching $100 retail, needs to be driven down.

If Bill 28 is passed, “establishments that primarily serve alcohol” would be required to maintain naloxone on premises and to train managers on administering the drug. These include businesses licensed by the Honolulu Liquor Commission to serve liquor as a restaurant, dispenser, tour or cruise vessel, cabaret, brewpub or small craft producer pub.

The reason is that the fentanyl interaction with alcohol can be deadly. But as Emergency Medical Services paramedics discovered when they responded to Sunday morning’s call to the Outrigger Waikiki Beach Resort, fatalities can occur at a hotel room — as well as any number of locations.

John Valera, administrator of the state Department of Health Alcohol and Drug Addiction Division, said the agency has been disbursing free doses of Narcan to EMS personnel and others under the Hawaii Opioid Initiative (hawaiiopioid.org).

It’s currently funded through the State Opioid Response Grant, he said, but the aim is also to tap the state’s share of the federal court settlements with Purdue Pharma and other opioid makers. The totals are not yet finalized, Valera said, but Hawaii is anticipating it will be in the neighborhood of $100 million, disbursed over 19 years.

The scale of the problem is enormous, and it’s a moving target. Nikos Leverenz, a manager of the nonprofit Hawaii Health &Harm Reduction Center (HHHRC), said drug combinations now trafficked on the mainland include xylazine, which is not resolved with Narcan, he said.

HHHRC is one distributor of free Narcan kits (visit www.hhhrc.org/naloxone to request a kit). Increasing naloxone access on a voluntary basis would be the preferrred approach, but it belongs in many more first-aid kits, statewide. And more doses of public education on this critical public-health threat should be part of the state’s prescription.