Hundreds of potentially fatal drug overdoses have been reversed in Hawaii in the past three years since the opioid-overdose antidote naloxone was made legal to distribute, according to the Hawaii Health and Harm Reduction Center.

Naloxone is an emergency medication used to stop overdoses from heroin, an opiate, or synthetically-made opioids.

Fatalities related to opioids are rare in Hawaii — only 53 drug overdose deaths in 2017 involved opioids — but the latest count of 232 reported overdose reversals suggests naloxone has been put to good use since 2016.

“That’s just what’s reported,” said Leilani Maxera, the outreach and overdose prevention manager at the Health and Harm Reduction Center, which provided the latest count. “We imagine the number is higher especially in rural areas like on the Big Island.”

Courtesy of Pennsylvania Governor Governor Wolf

Drug overdose is the leading cause of accidental death in Hawaii. Overdoses can occur after the ingestion of too much of a drug, whether or not it is an illegal substance, a prescription medication or something found on pharmacy counters.

In 2016, a new state law made it legal to carry the antidote in case a friend, client or the drug users themselves were at risk for an overdose. The center distributes the medication for free on Oahu, Kauai, Maui and Hawaii through its partnership with the state health department.

“Those who are most likely to be present when someone overdoses are other people who use drugs, family members and service providers,” said Maxera, who conducts opioid overdose prevention trainings for social service providers, health care agencies, treatment centers, mental health specialists, law enforcement and other organizations. “The people who can really make a huge difference are now the people who are carrying it.”

Kavika Puahi

Naloxone is usually administered through injection or a nasal spray. It stops overdoses of opioids and heroin, but it does not prevent deaths caused by drugs such as benzodiazepines, cocaine, methamphetamine or alcohol.

By 2017, the center had trained nearly 500 people on overdose prevention, rescue breathing and naloxone administration, including people who inject drugs, their friends or family, community partners, law enforcement and the general public.

Maui County Police Department Capt. John Kaupalolo IV said there have been a total of six deployments of the nasal spray Narcan Kit since Maui implemented the program last year.

“All of them were successful in reviving the individuals,” he said.

Naloxone has also been provided to participants in HHHRC’s syringe exchange program, which aims to reduce transmission of HIV, hepatitis B virus, hepatitis C virus, and other blood-borne pathogens via the exchange of sterile needles.

Hawaii’s syringe exchange program, created 30 years ago, is one of the largest in the U.S and was the first to be state-sponsored and state-run.

People often use a combination of drugs, not just one. Naloxone is still helpful because it could potentially prevent harmful effects of fentanyl, a powerful synthetic opioid — traces of which have been found in other drugs, including methamphetamines.

“We have to keep in mind opiates aren’t the drug of choice here, it’s methamphetamines,” Maxera said. “We try to do overdose prevention education around naloxone and opiate use, even with people who use methamphetamines and who are poly-drug users. They’re also at risk for an opiate overdose.”