By Amanda Eggert EBS Senior Editor

BIG SKY – First responders in Gallatin County have changed the way they treat suspected opioid overdoses following a series of incidents that appear to have resulted from powerful synthetic painkillers.

“Nationally, over the last year or two, there’s been an increase in the number of synthetic opioids such as fentanyl that have been showing up in street drugs, and those are much more potent [than heroin],” said Eric Lowe, an emergency room physician at Bozeman Health Deaconess Hospital.

According to the Centers for Disease Control and Prevention, fentanyl is up to 100 times more potent than morphine, and many times that of heroin. The CDC also reports that deaths resulting from synthetic opioids other than methadone—a drug often used to treat addiction to opiates such as heroin—increased by 72 percent nationally between 2014 and 2015.

Lowe, who also serves as the medical director for most of Gallatin County’s emergency medical services, recently advised first responders to be more aggressive in their use of opioid antidote naloxone. He issued the recommendation last month based on what he was seeing in the ER: a string of overdose patients who required larger or repeated doses of naloxone to be revived.

“Overdoses from [synthetic opioids] are much harder to treat and require much higher levels of reversal agents,” said Lowe, making a comparison to heroin overdoses. “There’s also a much higher rate of overdose with them just because the … margin of error is so small when you’re dealing with something that’s measured in micrograms.”

An opioid overdose usually develops due to the severe slowing of a patient’s respiratory rate. “Basically, it’s respiratory arrest that can lead the heart to stop and go into cardiac arrest,” Lowe said.

Naloxone, which is also known by its brand name Narcan, blocks opioid receptors. If the appropriate amount is administered in time, it can reverse an overdose and save a life.

Lowe isn’t necessarily updated on the status of a patient once he’s finished administering treatment, so discerning the exact drug involved in the overdose is difficult. “One hypothesis locally, that has been seen other places, is that illicit manufacturers are mixing fentanyl with other substances and pressing them into pills to resemble other prescription meds such as oxycodone or hydrocodone,” Lowe said. “It may be unknown to [the user] what they are truly getting.”

Information about an overdose resulting in death can be obtained through a toxicology report, but it takes time. The Gallatin County Coroner’s Office is currently wading through a backlog of cases, and it’s often months before an autopsy’s been completed.

Missouri River Drug Task Force Commander Ryan Stratman said the Gallatin County Sheriff’s Office responded to a medical call in Big Sky in early September that resulted in a fatality, though he couldn’t confirm the cause of death. On Sept. 18 he said that it would probably be another two months before he sees results from the toxicology report.

According to a September 2017 report released by the Montana Department of Justice, the Montana Crime Lab is struggling to expand its testing and technology to meet the growing demand for drug testing. “Montanans are increasingly exposed to synthetic drugs such as fentanyl, a deadly drug that can be cut into heroin. These synthetic drugs are harder to test for, but they are also more lethal,” the report noted.

Montana Attorney General Tim Fox wrote in the introduction to the report, titled “Addressing the Impact of Drugs,” that although heroin contributes to a small share of overall drug violations in the state, there’s been “astronomical” growth in that segment from 2010 to 2015—more than 1,500 percent.

Two men were arrested in West Yellowstone on Feb. 14 of this year after a traffic stop for speeding resulted in the discovery of 25 grams of heroin. According to a story reported by KBZK, the two men were accused of dealing heroin. In a video appearance from jail, Skyler Stillwell told the judge he was waiting tables at a Yellowstone Club restaurant. Sanford Gardner told the judge he was working as a restaurant manager in Big Sky.

Brandon Kelly, Big Sky’s resident sergeant with the Gallatin County Sheriff’s Office, said, “The last year it seems like the opioids really kind of ruled the day as far as drug use.” However, he added that apart from the Valentines Day case, he’s not aware of any other large seizures of heroin or prescription painkillers recently in the Big Sky area.

Based on what he’s seen in Bozeman’s ER, Lowe doesn’t think there’s been a sharp increase in southwest Montana’s opioid supply; rather, he thinks “a new drug hit the scene.”

In addition to the opening of a methadone clinic in Belgrade in September 2016, policy changes may be on the horizon for Gallatin County. Earlier this year, the Montana Legislature passed a law known as the Help Save Lives from Overdose Act that opens up access to naloxone, allowing it to be prescribed to organizations.

Stratman said the Gallatin County Sheriff’s Office is considering taking advantage of the new access. “We are looking into potentially carrying it, but that has not been decided yet,” he said. “That will be for our sheriff [Brian Gootkin] to decide.”

For his part, Lowe’s on board with law enforcement carrying naloxone. “I think that’s great. [It] mirrors a national push,” he said. “There’s a paucity of resources for people with drug addiction nationally, but locally as well,” he added.

Kelly stressed that early medical attention is critical, and he urges people to bring in help immediately if they suspect there’s been an overdose. “Call the fire department and law enforcement. At that point in time we’re not looking at criminal charges, we’re looking at life saving. … We’re worried about making sure that person is going to get proper treatment.”