EASTHAM — According to data from the state Dept. of Public Health, calls to emergency medical services for opioid-related emergencies — that is, overdoses — decreased on the Outer Cape last year.
There were “approximately 26” such calls in 2022, and “approximately 17” in 2023, according to the DPH, which defines its numbers as “estimates” because of inconsistent data reporting across various EMS providers.
According to both Eastham Police Chief Adam Bohannon and harm reduction specialist Kim Powers, executive director of the nonprofit Access HOPE, that downward trend is more likely the result of the wider availability of Narcan, a lifesaving medication that can reverse opioid overdoses, than of decreasing use of opioids.
The increasing prevalence of Narcan is “a great thing,” Bohannon said, but it also means “there may be overdoses happening that we never know about if individuals are self-treating.”
Powers agreed and added that such rescues are a good thing.
“You want people who use drugs to rescue each other,” she said. Many users and their loved ones might hesitate to call 911 for fear of the consequences of a visit from law enforcement, Powers said. If there is Narcan on hand, an overdosing person can be quickly rescued — Narcan works almost instantly to block the neuroreceptors that opioids act on — without losing critical minutes or involving law enforcement.
The Outer Cape is increasingly “blanketed with Narcan,” Powers said. Community organizations like the AIDS Support Group of Cape Cod, town health and police departments, and EMS organizations are all helping to distribute it. Under “leave behind” protocols, police and EMS workers can give out Narcan doses after they respond to calls.
The doses are easy to use — they look like single-serve packets of nasal spray — and can now be found in “nalox boxes” across the Outer Cape. There are 10 such boxes in Provincetown, including one in town hall, and efforts are afoot to install them in more bars and restaurants near first aid kits.
(“Narcan” is a brand name; the medicine itself is called naloxone, hence the term “nalox box.”)
The AIDS Support Group tracks its nalox boxes carefully, both to make sure they’re always full and to generate data on how often and when they’re being used, said the group’s chief program officer Heather Murphy. Those data show that Narcan use was up 30 percent on the Outer Cape last year, with an even distribution across zip codes.
That information can help inform further outreach, including training sessions on Narcan and the deployment of more nalox boxes, said Murphy.
How Many Deaths?
State data on opioid overdose deaths here don’t show much of a pattern at first glance: there were two deaths in the Outer Cape towns in 2015, zero in 2018, five in 2019, and two in 2022.
But the four years from 2015 to 2018 have only six recorded opioid overdose deaths between them, while the four years from 2019 to 2022 have 15.
It can be hard to be sure of a trend when overall numbers are small. Opioid deaths have risen noticeably in Barnstable County as a whole over those same years and on Nantucket and Martha’s Vineyard as well. Since the same trend is evident across the Cape and Islands, the Outer Cape’s increase in overdose deaths is probably not a fluke of small numbers.
The Eastham Police Dept. recently decided to acquire a “TruNarc device” that can detect fentanyl in drug samples using FTIR technology. The device costs $30,000 and will be paid for with a federal Justice Assistance Grant, Chief Bohannon said.
Bohannon said the TruNarc was purchased mainly to protect officers from skin or air contact with fentanyl, which he said can lead to overdoses.
But the American College of Medical Toxicology and the American Academy of Medical Toxicology have published a joint position statement saying that such overdoses effectively do not exist.
“To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids,” the groups wrote. “In the unlikely event of poisoning, naloxone should be administered to those with objective signs of hypoventilation or a depressed level of consciousness, and not for vague concerns such as dizziness or anxiety.”
According to a CBS report featured on the American College of Medical Toxicology’s website, the belief that handling fentanyl can kill first responders started with a Drug Enforcement Administration video from 2016. That video, which is still on the Dept. of Justice’s website, featured Acting DEA Administrator Chuck Rosenberg telling law enforcement officials that accidental exposure to an amount of fentanyl “equivalent to a few grains of sand can kill you.”
Bohannon also said that the TruNarc device will be available to “local community members,” specifically other Outer Cape police departments.
Powers said that the TruNarc device could be used in a harm reduction effort to protect civilians by screening for contaminated drug supplies. She imagines a scenario where a parent of a high schooler finds a pill and brings it in to the police station to get tested.
If the pill were contaminated with deadly levels of fentanyl, the parent could find out “that day instead of waiting two weeks — and that makes a difference,” Powers said. “If there are 150 pills in the high school, and we don’t know for two weeks, that could be really problematic.”
Powers frequently sends drugs from the field to be tested at the Brandeis Opioid Policy Research Collaborative, she said, which then adds the results to its StreetCheck app to help users know about contamination in the local drug supply.
It takes about two weeks for the samples to be tested, however, which Powers said is more than enough time for a dangerous substance to spread widely in the community.
For now, the TruNarc tool is intended “more for officer use than for public use,” said Eastham Health Agent Hillary Greenberg-Lemos.
Down the line, however, nonprofits engaged in harm reduction — or parents who find a pill in the laundry — may find the TruNarc instant-testing tool to be valuable.
Senior Reporter Paul Benson contributed reporting.