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®&%ARTa 0 RFI 6.1.D. - Page 6 LAW ENFORCEMENT OFFICERS + NARCAN = LIVES SAVED FROM OPIOID OVERDOSES' Issue I Summary I Background I Discussion I Findings I Recommendations Request for Responses I Methodology I Bibliography I Glossary I Appendixes I Responses ISSUE Should law enforcement officers and public employees in San Mateo County be trained and equipped to provide emergency opioid overdose medication to prevent deaths? SUMMARY The opioid epidemic is not somebody else's problem. Over 42,000 Americans died of opioid overdose in 2016.2 In that year, opioid deaths in California exceeded 1,900, including 19 people in San Mateo County (the County).' Opioids of all varieties can kill. Abuse of heroin and prescription opioids are the leading causes of opioid overdose in the County. New opioids pose an even greater threat. Fentanyl and its derivatives are opioids 50 to 100 times more powerful than prescription opioids (such as Oxycodone) and heroin. While not yet reported being found in the County, carfentanil, an illegal laboratory -created analog that is estimated to be 10,000 times more powerful than morphine, has been increasingly implicated in overdose deaths nationwide. Carfentanil and other powerful fentanyl derivatives not only endanger the lives of users but also present a potential source of accidental exposure (through skin contact or breathing airborne particles) for law enforcement officers and other first responders. 4A lethal dose of Fentanyl may be as low as 2 to 3 milligrams, less than 3 grains of salt.5 Opioid overdose may induce respiratory failure which, if left untreated, will lead to severe brain damage and death within minutes.6 Administration of naloxone is the standard emergency treatment to reverse opioid overdose. Naloxone is safe, fast acting, and effective, having been used by medical personnel in its injectable form since 1971.' 1 NARCAN® (naloxone HCl) Nasal Spray is the first and only FDA -approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. Use of the term "Narcan" in this report is neither an endorsement of NARCAN nor Adapt Pharma, Inc. Narcan is used in this report as a generic reference to intranasal naloxone. 2Centers for Disease Control. "Understanding the Epidemic" Last modified August 30, 2017. <httvs://www.cdc.Qov/dru2overdose/eDidemic/index.html>. 'California Department of Public Health, "San Mateo Numbers at a Glance" California Opioid Overdose Surveillance Dashboard (2018). Accessed February 26, 2018.<httDs://DdoD.shinvaDDs.io/ODdash vl > a DEA Public Affairs, "DEA Warning to Police and Public: Fentanyl Exposure Kills" Drug Enforcement Agency, June 10, 2016. <httDs://www.dea.eov/divisions/ha/2016/huO61016.shtml> 5 U.S. Department of Justice, "A Briefing Guide for First Responder" Drug Enforcement Agency, June 6, 2017: 9. <httDs://www.dea.eov/drueinfo/Fentanvl BriefineGuideforFirstResDonders June20l7.Ddf>. 6 Zawn Villines, "What Happens After a Lack of Oxygen to the Brain" Spinalcord.com. Last Modified June 13, 2016.<httt)s://www.SDinalcord.com/bloe/what-haDDens-after-a-lack-of-oxveen-to-the-brain> Food and Drug Administration. "Summary Review for Regulatory Action: NARCAN® (naloxone hydrochloride) nasal spray," FDA Approved Drug Products. Last modified January 24, 2017. <httDs://www.accessdata.fda.eov/druesatfda docs/summary review/2017/2084lls001SumR.Ddf> 2017-2018 San Mateo County Civil Grand Jury