Council unanimously advances Narcan bill

The Honolulu City Council unanimously voted Wednesday to advance legislation that would require bars, nightclubs and other high-risk venues to carry nasal sprays of naloxone, which is used to reverse opioid overdoses.

Bill 28, “Relating to Naloxone,” introduced by Council member Tyler Dos Santos-­Tam, will return June 21 to the Committee on Housing, Sustainability and Health and could pass out of the full City Council on July 12.

It is still unclear who the primary enforcer of the program will be. Heather Lusk, executive director of the Hawaii Health and Harm Reduction Center, said they will be central in assisting the city’s response to the opioid epidemic, which nationwide has resulted in the deadliest overdose crisis the country has ever seen.

During her testimony, she said HHHRC, in partnership with the state Department of Health, has 50,000 doses of naloxone ready to distribute to the community.

“I know there have been concerns about this bill and the burden this may place on establishments, and I want to say there’s a lot of community partners like HHHRC that are very willing and able to provide free training, help distribute naloxone to sites and do whatever it is to help our locations be ready,” Lusk said.

The public can currently request free training in administering naloxone and a free mail-order naloxone kit from the HHHRC website that provides two doses of Narcan, the brand name for the naloxone nasal spray. Lusk also said that Scarlet Honolulu, a Honolulu nightclub, has already committed to implementing a vending machine that would dispense doses of naloxone.

The hearing came three days after a suspected fentanyl overdose at a Waikiki hotel resulted in two deaths and three hospitalizations.

“While many of us are mourning what happened at the Outrigger over the weekend, I don’t know that having naloxone in that setting would have changed the outcome,” Lusk said. “At the same time, we know that having naloxone at bars and nightclubs has saved lives on this island.”

On behalf of the Kapalama neighborhood security watch, Angela Young testified that her first reaction to the bill was that it “enables people to feel safe while doing drugs,” but upon further research she said she feels that the city’s approach to the opioid crisis is “balanced.” Still, she emphasized the importance of considering holistic solutions.

“You have to look at it as a whole picture instead of from the assumption that, with one bar experience, young people go to bars on opioids,” Young said.

Honolulu Emergency Serv­ices Director Dr. Jim Ireland also testified that in the past few weeks, EMS has responded to at least one fentanyl overdose per day. He said that the overdoses are occurring “all over” Oahu in people’s homes, illegal game rooms, city park bathrooms, city beaches, hotel rooms and businesses.

“In the last week or two, I can’t think of any (fentanyl overdoses) that happened in a bar or restaurant, but as we’ve discussed before, alcohol and partying sometimes goes along with drug use and illegal drug use, and I think that was the thought, I believe, behind this bill,” Ireland said.

Ireland said the bill takes steps to potentially save lives in the community because if naloxone is quickly administered to a victim of an opioid overdose who is unconscious but still breathing, they are able to make a full recovery. However, he said that naloxone should not replace a trip to the hospital as the drug can still be in their system and they could still go unconscious once the naloxone wears off.

“If you wake up with Narcan while you’re still breathing, you might get an ambulance bill or an emergency room bill, but you’re not going to get a $100,000 ICU (intensive care unit) bill,” Ireland said. “If you regress into cardiac arrest and are in the hospital for three or four days longer, it’s going to be exponentially more expensive.”

In response, Dos Santos­-Tam asked Ireland, “So, in your estimation, the very relatively cheap cost of one of these (naloxone doses) would easily be paid for by somebody avoiding being incubated or having some other kind of intervention?”

“I think the cost would be recouped for just one person,” Ireland said.

According to Ireland, paramedics currently use a dose of Narcan that is 10 times higher than administered 30 years ago in order to combat the high amounts of narcotics that people are ingesting.

“The nasal spray is new and that’s why it can be used by the minimally trained public. Nasal spray is super easy, it’s harmless,” he said. “The deployment and the technology and the way that Narcan is made now has allowed us to basically expand the number of people that can save lives.”