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6.1.D. - Page 10 Naloxone Naloxone (naloxone hydrochloride) is an opioid antidote that blocks opioid overdose and reverses its symptoms. It is a safe, non-narcotic drug that can be easily administered nasally or by injection.27Naloxone is considered safe enough to administer as a diagnostic tool with unresponsive patients to eliminate opioid overdose as a possible cause.28 Narcan®, the brand of naloxone that is commonly used by emergency responders, is a nasal aerosol spray. An opioid overdose may cause respiratory failure, which can lead to asphyxiation, cardiac arrest, and death.29 Once administered, naloxone can reverse the overdose and restore breathing within minutes. 30 However, prompt medical attention thereafter is essential because the effects of naloxone can wear off before the opioids. 31 Timely emergency administration of naloxone is essential. As Figure 1. shows, when opioid overdose causes breathing to stop, permanent damage can result within minutes. 32 Between 30-180 seconds After one minute After three minutes After five minutes After ten minutes Figure 1. Timeline after Breathing Stops Loss of consciousness Brain cells begin dying Brain damage is likely Coma and brain damage are almost inevitable Death is imminent While paramedics in the County carry naloxone, they may not arrive at the scene of an opioid overdose in time to save the victim. The required Emergency Medical Services (EMS) response times for the County shown in Figure 2. are illustrative. Law enforcement response times may be substantially less.33 27Centers for Disease Control and Prevention, "Expanding Naloxone use could reduce drug overdose deaths and save lives" CDC Office of Media Relations, April 24, 2015. <httr)s://www.cdc.eov/media/releases/2015/pO424- naloxone.html> 28 Grand Jury interview with County official. 29 Department of Health and Human Services, "Opioid Overdose Toolkit" Substance Abuse and Mental Health Services Administration, January 2017: 15. <httDs://store.samhsa.2ov/shin/content/SMA14- 4742/Overdose Toolkit.ndf> "German Lopez, "How Fentanyl became America's leading cause of overdose deaths" Vox, December 21, 2017. <httr)s://www.vox.com/science-and-health/2017/5/8/ 15454832/fentanvl-carfentanil-opioid-eDidemic> 31 Peter Lurie, et al. "Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing" Journal of Prehospital Emergency Care (Vol. 21: 4) 2017: 1. <httvs://www.tandfonline.com/doi/full/I 0. 1080/ 10903127.2017.1315203> 32Zawn Villines, "What Happens After a Lack of Oxygen to the Brain" (2016) 33 Grand Jury Interviews with City and County law enforcement leadership. 2017-2018 San Mateo County Civil Grand Jury