Opioid overdose deaths have skyrocketed in the Upstate, particularly those involving fentanyl, the drug that killed Prince.
But there’s a drug that paramedics and emergency room doctors have been using for decades that immediately counters the often-deadly effects of heroin, fentanyl and prescription painkillers.
One year after South Carolina lawmakers passed a law that allows first responders to carry and administer naloxone, Greenville County Sheriff’s deputies have it in their patrol cars and Greenville Police officers soon will. They are two of seven law enforcement agencies across the state trained to administer the opioid antidote once only used by medical professionals. Others in the Upstate, including Fountain Inn and Greer, are interested in getting naloxone, too.
And in early December, pharmacists in South Carolina will be able to dispense the drug over the counter to people who often are the real first responders in drug overdoses – family and friends of the users.
“It will save lives,” said Carol Reeves, executive director of the nonprofit Greenville Family Partnership that works to keep kids off drugs, alcohol and tobacco through education and working with families, schools, businesses and communities.
It already has.
“Heroin is white, middle and upper class. It’s the people who wait on you every day, the people who you interact with at work.”
-Carol Reeves, Greenville Family Partnership executive director
Greenville County Sheriff’s deputies were trained on the signs of opiate overdose and how to administer an auto-injected version of Narcan (the brand name of naloxone) on a Thursday in June.
The next night, a deputy responded to a call and found a victim with the signs of an opioid overdose – unconscious with pinpoint pupils, bluing skin and very slow “guppy” breathing. He stuck the Narcan auto-injector into the victim’s thigh, delivering the miracle drug that knocks opioids off the brain’s opioid receptors and allows the person to breathe again.
Fifteen minutes later and across the county, a second deputy administered Narcan on another overdose call.
“It buys time,” said Greenville County Sheriff’s Office Sgt. Jeff Ward, who is also a paramedic. “Both deputies administered naloxone and both the victims walked out of the hospital.”
A couple weeks later, a deputy responding to a wreck call on Howell Road discovered two people who had OD’d on heroin and administered Narcan to both.
“These people are literally dying in front of you,” Ward said. “And naloxone can bring them back in a matter of minutes. It’s amazing to see. We [deputies] are usually first on the scene, before EMS and fire departments.”
And if naloxone is given to somebody who is overdosing on a non-opioid such as cocaine or somebody who isn’t overdosing at all, there are no side effects. There is no danger of somebody being addicted to naloxone, either.
“It really only serves one purpose, and that’s to keep them alive until EMS arrives or they get to the hospital,” said Adam Brickner, executive director of the Phoenix Center.
Reeves said that although her organization promotes prevention and education over harm reduction, she supports the new law, passed in June that allows pharmacies to dispense naloxone without a prescription.
“It’s not that heroin addicts are carrying it around in their pocket just in case. They don’t think that way. The truth of the matter is they sometimes get very angry because they spent money to get high and naloxone brings them completely around,” she said. “But heroin addicts may not know that the heroin they’re buying is laced or has been replaced by fentanyl because fentanyl is cheaper to produce.
“(Naloxone) buys time.”
-Greenville County Sheriff’s Office Sgt. Jeff Ward
Opioid abuse – and overdose deaths – have been on the rise nationwide. More than 29,000 thousand people died from opioid overdoses last year; not quite 34,000 died in car crashes.
In South Carolina, Greenville County is the epicenter of opioid-related deaths. In 2015, 71 people died from opioid overdoses, rivaling the number of lives lost in wrecks. The year before, 65 people in Greenville County died from opioid overdoses, nearly twice as many as died in Charleston, Lexington or Richland counties.
In the first six months of this year, 26 people died of drug overdoses, according to the Greenville County Coroner’s Office.
Opioids had been reserved for cancer patients in chronic, excruciating pain but that changed in the mid-1990s when pain advocacy groups and doctors specializing in pain management started pushing for opioids to be used for chronic non-cancer pain. By the late 1990s, opioids were used by patients in post-op, with back pain, for sports injuries and to relieve migraines.
By 2010, doctors were writing enough opioid prescriptions to medicate every American adult every four hours for a month, according to the South Carolina Prescription Drug Abuse Prevention Council.
Prescription pain medications involved in the most overdose deaths include hydrocodone, oxycodone and methadone, according to the CDC.
Efforts to limit prescription drugs have led to an increase in heroin use, local officials said.
“Prescription pain pills are more expensive on the streets, so the illegal market fills that niche,” Brickner said.
Reeves agrees, saying, “If you’re addicted to pain pills and doctors are pulling back on the number of prescriptions they write, heroin becomes an option.”
But that creates another problem, one that can instantly kill.
Fentanyl is the most potent narcotic known. The man-made opioid is 50 times stronger than heroin and 100 times stronger than morphine, according to the Centers for Disease Control and Prevention website. It’s also cheaper to produce than heroin, so dealers are lacing heroin with fentanyl or replacing it with it altogether.
In Greenville County in 2015, there were 33 fentanyl-related deaths. That’s more than five times the number of fentanyl-related deaths in 2013.
It’s a problem that’s not likely to go away soon.
“There’s a huge problem with opiates,” said Deborah Johnson, manager of the Phoenix Center’s Medication-Assisted Treatment program. “And now that opiates have become so expensive on the streets, people are turning to heroin.”
The Phoenix Center opened an MAT clinic four months ago. Seventy-five patients are getting treatment through anti-craving drugs such as Suboxone and methadone and other therapy.
“The end goal is to keep somebody in recovery as long as we can,” Brickner said. “Methadone helps do that.”
To illustrate how much the problem has grown, Johnson said Greenville’s first methadone clinic opened in the 1990s. There are now nine in the Upstate.