Overdose Reversal Training Brings Supplies, Education to Texas State University

Callie Crow shows Texas State University police how to administer shots of the overdose-reversing drug naloxone into silicone skin injection pads (Photo by Lina Fisher)

"Does anybody know how many first responders have lost their lives to fentanyl exposures in the United States?" Callie Crow asked the Texas State University Police Department last Thursday at TXST's Round Rock campus, prompting them to "take a guess." The chief ventured 100. "Would you be surprised if I said none? I know you've seen the body-cam videos." Crow went on to debunk the 2021 viral video that convinced many in law enforcement this year that just touching fentanyl means certain death. At the end of the training, she gave the department 40 doses of naloxone, an overdose reversal drug, and demonstrated how to administer an injection using fake skin.

It's vital education like this that Crow, a veteran paramedic, offers through Drew's 27 Chains, her nonprofit that provides naloxone training sessions to law enforcement throughout Texas. Her warm, no-nonsense delivery hints at a deeply personal connection, a through line in her sessions: She lost her 27-year-old son Drew to a fentanyl overdose in June 2020. The responding police officer had naloxone on him, and didn't use it. Thus began Drew's 27 Chains, which bridges the gap in law enforcement's education: "I help them get those protocols in place," she told the Chronicle. Last week in Round Rock, Crow showcased three types of delivery systems: Narcan and Kloxxado, nasal sprays that contain 4 milligrams and 8 mg of naloxone respectively, and Zimhi, a 5 mg intramuscular shot. Texas State opted for Zimhi, which Crow says is her preference as well, as it might wake someone up faster than the nasal sprays. All three come in single-use units.

She stressed that administering naloxone is protected under the law (2015's Senate Bill 1462) and that it won't have an effect unless someone is experiencing an overdose: "If there are no opioids in your system, it's like water." She showed the officers how to recognize an overdose (unconscious, not breathing, pale skin) and underscored the urgency of administering naloxone right away, as it only takes four to seven minutes' lack of oxygen to begin losing brain cells.

She also explained that first responders need to be prepared to administer a second dose, because fentanyl's release time is slower than naloxone's. Someone may overdose again later, so monitoring them even after they've woken up is essential. She pointed out the scope of the crisis, using her 27 years of experience as a paramedic to tell stories of deaths from overdose being miscategorized as stroke or pneumonia, underscoring that not all who overdose struggle with addiction: "When you see [reported overdose] numbers, triple them at least."

Crow just quit her job (for the second time) to do training full time. Her schedule is packed with departments requesting her services: "I'm taking sort of a leap of faith, hoping that I get funding, hoping that I get grants to be able to continue to do this," she told the Chronicle. Earlier this year, her naloxone supplier More Narcan Please – a federal grant-funded program at the UT Health School of Nursing in San Antonio – ran out, so she went back to working as a paramedic. After The Texas Tribune highlighted her work, she received more doses from the companies that manufacture Zimhi and Kloxxado, and More Narcan Please re-upped its supply as well.

While the naloxone distribution network is still largely comprised of small organizations like Crow's and the Texas Harm Reduction Alliance in Austin, more funding and inventory are coming from the $26 billion multistate settlement with four opioid makers and marketers, to be paid out over the next 18 years. Texas' $131 million (so far) share of the settlement will go into three buckets: $12.6 million to 1,400 local entities in early 2023 (including a total of $720,000 to the city of Austin and Travis County); $57 million to be appropriated by the 88th Texas Legislature next year as part of the 2023-25 biennial budget; and $61 million to the Texas Opioid Abatement Fund Council, which is setting up an application process for funding and naloxone supplies. State Rep. Donna Howard, D-Austin, says she'll file legislation to legalize fentanyl testing strips, a longtime goal of harm reduction activists: "I'm hoping to use the fact that I'm a nurse and connected to health care to emphasize that this is a public health issue, rather than a law enforcement issue. And that the bottom line is, we can't get people into recovery if they're not alive."

Crow says TXST PD is only the second campus police department that has sought her training: "I feel like campus is a big hot spot for where this is going to happen. I think they should train every RA and have it at the end of their halls. Anyone can be trained. I want to see these in gas stations, Buc-ee's and QTs. High schools, churches, homeless shelters. Why isn't [naloxone] there for anyone to use?" For now, the first responder to the scene of an overdose is typically a police officer: "When I get on scene, especially the 38,000 students I'm responsible for, there's no reason I don't have Narcan," said the TXST PD chief. "Our officers are trained in first aid, CPR, AED. It's just another tool."