During the first quarter of 2023, emergency medical services responded to 1,328 suspected drug overdoses in Davidson County. Nearly 142 of those overdoses were fatal. Naloxone was administered in 47 percent of instances, accounting for at least 600 doses of the overdose-reversal drug commonly known by one of its brand names, Narcan.
It’s not uncommon for people brought back from an overdose to refuse further medical treatment, says Jeremy Reese, regional overdose prevention specialist for statewide drug prevention organization STARS. As part of the “Leave Behind” program — a new collaboration between STARS, the Metro Nashville Police Department and the Nashville Fire Department — first responders leave kits with those who just survived an overdose, in hopes of preventing a fatal one.
“In those types of situations, these people are refusing service to the ER, but they just overdosed and we’re leaving them with nothing,” Reese says. “That’s where the Leave Behind program comes into play. These officers, they are the ones that are feet on the ground. They are there in those high-energy situations where we unfortunately cannot be.”
Naloxone distribution in Davidson County centers on nonprofit outreach organizations, and the occasional person who approaches STARS for supplies because they cannot afford it. Over-the-counter Narcan was recently approved by the FDA, though has its own barriers to entry.
Officer Michael Hotz is head of MNPD’s neighborhood safety unit, which focuses on overdose death and drug distribution investigations. He says he’s been pleasantly surprised about the response to the Leave Behind program since it started earlier this year. The unit uses data on fatal and nonfatal overdoses to do outreach in Nashville’s most prone neighborhoods — typically those closest to the interstate, he says.
“The need for it and the desire for it in the general public, I’ve actually been quite impressed by and a little shocked by,” Hotz tells the Scene. “Not only is it individuals who are suffering from substance use disorder that are an obvious high risk of an opioid overdose that are willing to get these drugs and training from us, but also people who have a loved one or someone very close to them who’s suffering from substance use disorder who would want to be ready to intervene in the case of a potentially fatal drug overdose.”
The program is paid for through state grant dollars. STARS’ regional overdose prevention specialists train first responders to distribute the kits, which contain two doses of Kloxxado (a double-strength dose of naloxone, compared to Narcan), recently legalized fentanyl test strips and information about opioid use disorder recovery. So far, first responders distribute around 50 kits per month, but there is capacity to expand, Reese says.
The number of fatal drug overdoses has increased each year since the Metro Public Health Department started keeping track in 2016. Hotz says he believes harm reduction strategies like these kits are an answer to getting those numbers down. When he started at MNPD 13 years ago, there was a prescription pill problem, which morphed into heroin.
“When that morphed into the fentanyl epidemic, that’s when we really saw the unfortunate snowball effect,” Hotz says. “Its addictiveness and deadliness combined for the perfect storm.”
Just as the city’s first responders are getting organized about distributing naloxone, and the state legalized fentanyl test strips, another drug came on the scene. Earlier this month the Metro Public Health Department released a public health advisory on xylazine, an animal sedative showing up in overdoses. There are testing strips available for xylazine, but opioid reversal drug naloxone cannot reverse effects of xylazine on breathing, as it is not an opiate.
“It’s throwing gas on a fire,” Reese says. “It’s super scary. We’re starting to see the effects of it.”
