This is the fifth part of a month-long look at opioids in Georgia, specifically the SunLight Project area of Valdosta, Thomasville, Moultrie, Millegdeville, Dalton, Tifton.

ATLANTA – Terry Hawkins was headed home at the end of his shift when the call went out over the radio: a young woman was unresponsive in her home.

The Forsyth County sheriff’s deputy recognized the address. He had arrested a woman there years earlier for heroin possession, but he soon learned it wasn’t the same person. It was her 25-year-old sister.

“I did CPR shoulder to shoulder with the mother while she was screaming at the top of her lungs for Jesus to save her daughter,” Hawkins said.

But it was no use. The young woman, who had come out of a 90-day treatment program days earlier, was gone. She had overdosed on heroin.

“When I left that scene, I said, ‘OK, nobody should have to go through that again without a tool that may have worked,” Hawkins said.

The deputy started making some phone calls.

‘A miracle drug’

That was in the spring of 2015, nearly one year after Gov. Nathan Deal signed a measure allowing all first responders, such as EMS, police officers and firefighters, to carry an overdose reversal drug called naloxone, which is often sold as a nasal spray called Narcan.

Hawkins said arming police officers – who may be the first on a scene – with the antidote was not a hard sell for the agency.

“Whereas before we may have had to sit with someone and essentially watch them take their last breath, here’s something that can change that,” he said. “So it’s pretty well received.”

Deputies were equipped with it by the end of the year. A few months passed without any overdose calls, and then one came through in early 2016: The friends of a woman in her late 30s had found her unresponsive. She had overdosed on heroin.

The Narcan worked.

Since then, deputies in Forsyth County, which is about an hour north of Atlanta, have administered the reversal drug 29 times. All but three, which involved heroin, were successful.

Hawkins suspects the three reversals that failed likely involved fentanyl. The department has recently increased the strength of the naloxone doses to contend with the emergence of this powerful prescription painkiller that can be deadly when mixed with other drugs.

When a person overdoses on an opioid drug, the part of the brain that regulates breathing shuts down.

Naloxone, which has long been used in emergency rooms, can temporarily reverse the effects. The person will still need medical attention.

“At the risk of being a little melodramatic, we are pulling people from the jaws of death,” said Hawkins, who now trains other law-enforcement agencies on how to administer naloxone.

“Because without medical treatment on these overdose incidents, they will just stop breathing and then the death process begins and they will go,” he added. “For some people, the drug is almost a miracle drug.”

The sheriff’s office uses drug seizure funds to pay for the naloxone kits. Hawkins said that amounts to about $2,000 every couple of years.

“That’s incredibly cheap for what we get out of it,” he said.

First on the scene

It has now been nearly four years since lawmakers voted to put the reversal drug in the hands of law enforcement and other first responders. It appears to be commonplace in many patrol cars all across the state, but there’s no state entity that officially tracks its usage.

At least 147 departments are equipped, according to Georgia Overdose Prevention, which distributes naloxone kits and monitors the use of naloxone in the state. Those agencies have reported at least 177 reversals.

Nearly 100 of the agencies, spanning 53 counties across the state, paid for the opioid antagonist using grants from Medical Association of Georgia Foundation.

Those departments have reported reversing 63 overdoses – a number that is likely under reported, said Dallas Gay, who co-chaired the foundation’s Think About It campaign and whose grandson died of an opioid overdose in 2012.

“We don’t know how many of those would have died, but we know that life is flowing out very quickly with an opioid overdose. Breathing is shutting down, and it’s imperative that the very first help on the scene administer naloxone,” Gay said.

Gay said a handful of officers initially expressed apprehension about administering naloxone because they saw it as a medical service best left to paramedics.

When the program wrapped up recently, awarding its last kits to accountability courts serving Hall and Dawson counties, there was a waiting list – something Gay attributes to the growth of the opioid epidemic.

Vernon Keenan, director of the Georgia Bureau of Investigation, whose agents carry naloxone, said law-enforcement officers in the state started off carrying it for their own protection, since some drugs can be inhaled or absorbed through the skin.

But now the officers also have it handy because they may be the first on the scene.

Keenan said he hasn’t encountered the kind of concerns about naloxone that have surfaced in some other parts of the country. An Ohio sheriff made national news this year when he refused to let his deputies carry it.

“What I have heard is frustration of having revived the same person several times,” he said. “They’re revived and then later, the officer responds and has to do it again. Multiple uses on the same person who is not going into treatment.”

SunLight Project coverage areas

A look at the law-enforcement agencies in the SunLight Project team coverage area, which includes Thomasville, Valdosta, Moultrie, Tifton, Milledgeville and Dalton, revealed that not all agencies are carrying naloxone.

Some reported not yet seeing the need for it.

The Thomas County/Thomasville Narcotics/Vice Division, which is funded by city and county governments, is the only agency equipped with naloxone in that area. The division has not had to use it.

Thomasville Police Chief Troy Rich said the opioid reversal drug would be beneficial if an increase in overdoses develops.

“There have not been any overdoses to my knowledge my officers have responded to,” Rich said.

The following have also not equipped their officers with naloxone: Valdosta Police, the Lowndes Sheriff’s Office, Milledgeville Police, Thomas County Sheriff’s Office, and Tifton police and fire departments.

Valdosta Police Chief Brian Childress said the Valdosta Police Department is considering the use of Narcan but only after his officers have training in using it properly.

Others, such as the Colquitt County Sheriff’s Office and Moultrie Police Department, are also exploring it.

In Thomas County, EMS reported using the reversal drug three or four times a month, sometimes on elderly patients who become confused and ingest too much of their medication.

Todd Daniel, paramedic training captain for South Georgia Medical Center in Valdosta, said the opioid epidemic has not affected Lowndes County as badly as other areas, but even so, it’s had an impact.

“It doesn’t seem to matter if they’re rich or poor. We’re bringing people back from all over town,” Daniel said, adding that paramedics there slowly administer the drug through IV.

The sheriff’s offices in Baldwin and Tift counties have equipped deputies with it but haven’t used it.

In Dalton, police officers began carrying Narcan in the form of a nasal spray in June. It’s been used once. Whitfield County Sheriff’s Office deputies carry it in their patrol cars. It’s also in the county jail.

At Hamilton Medical Center in Dalton, where all ambulances carry Narcan, the hospital’s paramedics had administered Narcan 83 times as of the beginning of October. By comparison, they used Narcan 85 times in all of 2016. Some of the reversals were done on the same people.

Paramedics can administer the drug by injection, through the nose or through a tube placed down the throat. Each dose costs about $36, and paramedics can give multiple doses if necessary. The patient is responsible for the cost.

“We aren’t trying to wake them up. We just want to stabilize them, get them breathing and get them to the (emergency room),” said Scott Radeker, director of Hamilton Emergency Medical Services.

A handful of school districts in Georgia have also started keeping naloxone in their on-campus clinics. In places such as Whitfield County and Dalton, the school-resource officers at some schools have it. Dalton is also discussing whether to equip its school nurses.

“We don’t have Narcan in our schools right now,” said Jennifer Steedley, spokeswoman for Valdosta City School System. “Unfortunately, I’m sure that day will come and schools will need it, but thank goodness, at least for Valdosta City Schools, it hasn’t yet.”

Lisa Williams, associate superintendent with Thomas County Schools, said district officials are considering it. She likened it to having EpiPen and Albuterol on hand.

“Anything to help save a life would be beneficial,” she said.

Three years after empowering the state’s first responders to administer naloxone, state lawmakers went even further this year.

Now, anyone can go into a pharmacy and purchase the reversal drug without a prescription – a change meant to curb accidental drug overdoses.

That legislation was called the Jeffrey Dallas Gay Jr. Act, named for a 21-year-old from Gainesville who overdosed in 2012.

His grandfather, Dallas Gay, a retired businessman in town, was already involved with the local hospital and so had a front-seat view of the emerging community crisis.

But his grandson’s struggle with opioid addiction made the crisis deeply personal.

“The epidemic is so great. It’s becoming manifest in every community,” Gay said.

Gay identified three particularly troubling details about the morning Jeffrey died that he would set out to address in hopes of preventing similar tragedies.

For one, the person who was doing drugs with Jeffrey did not call for help for fear he would be arrested. There was no naloxone in the house, leaving his father helpless once he discovered his son’s dire condition. And the police, who arrived before EMS, also did not have naloxone and were not trained on how to render aid for opiate overdose.

“It’s not unique to Jeffrey,” Gay said. “It happens thousands and thousands of times across this country every year.”

Since then, state law has been changed to grant amnesty to people who call for help in the case of an overdose, even if they were also using drugs. Parents can buy naloxone without a prescription. And police across the state are being equipped with the reversal drug and trained to use it.

The inner circle

The attention in Georgia is shifting to the people who often have the best opportunity to intervene when someone has overdosed: family and friends.

But these people can also be the toughest to convince.

“For a parent to go purchase naloxone, that is an overt affirmation of ‘I have a drug abuser in my circle of influence or in my life somewhere,’” said Sgt. Terry Hawkins with the Forsyth County Sheriff’s Office, which equips most of its force with naloxone.

“That’s what I worry about,” he added. “Those are the ones where the naloxone is even more effective than what we have in our patrol cars, because when they find someone unresponsive, even on a good day for us, we’re still four or five minutes away versus a person who is right there and who can administer it immediately.”

Gay said he has a new mission: Advocate for training everyone to be a first responder.

He’s focused now a new program called Three Steps to Save a Life, which urges people to call 911, give naloxone and then administer first aid when they discover someone who has overdosed. More information can be found at http://opioidoverdoserescue.com.

Gay described acquiring naloxone for a loved one as an “insurance step” – something that he says means moving past the stigma of addiction.

“You have to be willing to say, ‘This is a disease, not a character or moral failing. This person has a disease in my family just like it was leukemia or a brain tumor, and we’re trying to deal with it,’” Gay said.

“Only when you think of it in the terms of what it really is – a disease – can you be honest with yourself and honest with other people,” he added.

Georgia Overdose Prevention distributes kits to active opioid users, people in recovery, those beginning methadone treatment and others at risk of overdosing. The group also provides kits to the family and friends of these individuals.

They have tallied 844 community overdose reversals since 2014, when the law changed.

The state Department of Behavioral Health and Developmental Disabilities is also using a federal grant it received this year to provide training and distribute 4,500 naloxone starter kits in the community and 2,600 to the department’s community service boards. Another 500 kits will be distributed to first responders.

‘Opportunity to save a life’

The reversal drug is available to the public in a few different forms. The most recognizable is likely Narcan, a nasal spray. A kit usually costs about $150 and includes two doses.

There’s also an auto-injector that can cost as much as $4,000. The most affordable option comes in a vial and is injected using a syringe.

“Most of the insurance companies I’m seeing are covering the Narcan nasal spray for a zero dollar or a lower co-pay,” said Austin Tull, a pharmacist at Carter’s Pharmacy in the Atlanta area, which keeps naloxone in stock.

Walgreens announced last month that naloxone will be available at all its pharmacies. The CVS website says its pharmacies in “most communities have naloxone on hand and can dispense it the same day or ordered for the next business day.”

But the cost, coupled with the low demand so far, may be why naloxone is not on the shelf at some local pharmacies in Georgia.

“There’s not a huge number of people coming in and looking for this,” said Greg Reybold with the Georgia Pharmacy Association. “There’s a huge number of people who could benefit from it.”

Reybold said the association encourages pharmacists to keep naloxone in stock.

“The better the access, the better the result,” he said.

Tull, the pharmacist, said he’s seeing more interest in naloxone among the public, but said the reversal drug is still underutilized.

He urged his colleagues in the state to have at least one form of naloxone on hand, even if no one has come in asking for it yet.

“That could be an overdose missed,” he said. “Especially with the uncertainty of what’s in these street drugs. It can happen in just a moment, and you don’t want to miss that opportunity to save a life.”

Look for the next part of the on-going series on opioids in next Sunday’s editions.

The SunLight Project team of journalists who contributed to this report includes Patti Dozier, Alan Mauldin, Charles Oliver, Will Woolever, Eve Guevara, Jordan Barela, Thomas Lynn and Terry Richards. Editors are Jim Zachary and Dean Poling. To contact the team, email sunlightproject@gaflnews.com.