Is Narcan nasal spray enough? Some say shot needed to fight fentanyl overdoses in Austin.

Blaise Finnegan, who now works for an Austin-area recovery program, was parked in his car outside his home when he overdosed on fentanyl after taking what he thought was an oxycodone pill a few years ago, he said. His roommates found him and called 911.

Paramedics were unable to revive him by using two sprays of Narcan, a nasal spray that uses naloxone to reverse overdoses, said Finnegan.

Then they gave him a naloxone shot in his thigh that delivered the opioid reversal drug straight to his bloodstream. That instantly woke him up.

"It saved my life," said Finnegan, who said he is an addict in recovery and is the lead admissions coordinator for the Rise Recovery program that partners with Family Hospital Systems. Family Hospital operates urgent care facilities called Family Emergency Rooms in Round Rock, Cedar Park, Georgetown and at a Lakeline location. It also has hospitals in Round Rock and Lake Travis.

Dr. Henry Higgins, the chief executive officer of Family Hospital Systems, is among those who say officials need to make the intramuscular injections of naloxone more available to first responders, school district leaders and other groups that deal with fentanyl overdoses.

"I'm concerned because of the track we are on," Higgins said. "Everyone is focusing on the nasal naloxone spray called Narcan." "One spray (of naloxone) is not OK, especially in this day and age with the increased potency of fentanyl we are seeing," he said.

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One spray of naloxone takes two to three minutes to hit the bloodstream and only delivers 40% of the reversal medication to a person's body, Higgins said. In contrast, a shot enters a person's bloodstream immediately and delivers 100% of the naloxone, he said.

"The problem is that what we are having to treat often requires five to six to seven sprays of Narcan," he said. "If I'm a first responder or I'm a parent or a football coach and think I'm armed because I've got one canister of Narcan, I may not be able to save a kid's life because I don't have enough Narcan."

The Hays school district, which has the Narcan brand naloxone nasal spray at all campuses, has had to use as many as four doses of it in some overdose incidents, district spokesman Tim Savoy said. "We haven't talked about shots yet, but we continue to look at all of our options to combat fentanyl."

"Since last summer, six students in Hays CISD have died from fentanyl poisoning," said Savoy. "None of the deaths were on campus. We have had to administer Narcan seven times on campuses, and all students in those cases survived. We are aware of 17 additional overdoses of students in the community who survived, but had to receive Narcan."

Fentanyl is a synthetic opioid that is sometimes prescribed legally for pain management, but it can be fatal when used illegally because even small amounts can kill a person.

It is up to 50 times stronger than heroin and 100 times stronger than morphine, according to the Texas Department of State Health Services. One illegal counterfeit pill can contain a deadly amount of fentanyl, officials have said.

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The naloxone shot is easy to use because it has a small needle that is deployed when someone presses a button on the syringe, said Dan Hobson, director of the Rise Recovery program at Family Hospital Systems. The shot is administered to a person's thigh, he said.

Hobson, who also is a member of the student health advisory committee for the Leander school district, said the parents and teachers he talks to about the risks of fentanyl addiction are "past the point of being afraid of needles."

He said he recently recommended the naloxone shot to the mother of two sons. Her 16-year-old son, who already had survived an overdose, gave a counterfeit pill to her 12-year-old son and also took one himself, said Hobson.

"The 16-year-old didn't go unconscious, but the 12-year-old did," he said. Their mother was out of naloxone nasal spray, and it took 15 minutes for an ambulance to arrive, said Hobson. He said the 12-year-old boy survived and is now in recovery.

"We showed the mother how to use the naloxone shot," he said.

Not everyone agrees that the public needs to use the naloxone shot to reverse fentanyl overdoses instead of the nasal spray.

“While Narcan is effective when given in the muscle and in the vein by trained paramedics, Williamson County EMS suggests that Narcan nasal spray be used by the general public and law enforcement partners because it is simple to use, effective and eliminates the potential for needle sticks," said Dr. Taylor Ratcliff, medical director for Williamson County EMS.

In the past six months, intranasal Narcan was given to nearly half of EMS patients presumed to be having an opioid overdose, and it was effective, said Amy Jarosek, clinical captain for the Community Health Paramedic program with Williamson County EMS. "Our paramedics are able to provide Narcan via more invasive routes once they arrive,” said Jarosek.

Hobson said in response that "increasingly it has been our experience, and that of first responders, that the strength of fentanyl is increasing, and as a result more doses of intranasal are required."

"The fentanyl problem is getting worse," he said. "There are over 200 variants of fentanyl in Texas. Some are stronger and longer lasting. To me, it seems irresponsible to ignore the issues or refuse to change our mindset until another catastrophe happens."

The Leander school district's student health advisory committee recommended to the school board in May that nurses' stations on campuses be equipped with a naloxone shot. The nurses currently have only the nasal spray. The school board has not taken action on the recommendation.

The Round Rock school district, which stocks naloxone spray on its campuses, did not reply to a request for comment about whether it has considered putting naloxone shots at its schools.

Williamson County officials said they did not have figures on how many people in the county have died from fentanyl overdoses in the past year.

The latest data from the U.S. Centers for Disease Control and Prevention show that 83 people died from drug overdoses in Williamson County from September 2021 to September 2022, but that doesn't show how many of the overdoses are from fentanyl.

Family Hospital Systems, which has three facilities in Cedar Park, Round Rock and Travis County, treats about 1,200 to 1,500 people for substance abuse each year, said Hobson. Seventy percent of those people test positive for fentanyl, he said.

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Texans can buy naloxone shots without a prescription at any CVS pharmacy, said Amy Thibault, a CVS spokeswoman.

The state is also offering naloxone to organizations through the Texas Targeted Opioid Response, a project of the state's Health and Human Services Commission. The project has received $5.5 million in federal grants to distribute naloxone in fiscal 2023, said Magaly Ayala, a commission spokeswoman.

The University of Texas Health Science Center at San Antonio is distributing naloxone for the state in nasal sprays and shots upon request at MoreNarcanPlease.com.

Finnegan, who has been working as an admissions coordinator for the Rise Recovery program since Oct. 1, said he usually carries a naloxone shot with him. It's helpful to have at sober events for people recovering from addictions because "it's easy to relapse," Finnegan said.

The last time he used a shot was about two years ago when someone overdosed in a parking lot outside a 12-step meeting in San Antonio, he said.

"It worked, and when paramedics arrived the person was still alive," he said.

This article originally appeared on Austin American-Statesman: Some say Narcan shot needed to fight fentanyl overdoses in Austin