The last time Walter Brown overdosed, he'd been sober for 13 years.
The 58-year-old Charleston resident was hospitalized last fall after developing a blood infection, a complication following a major car accident in 2015 that left him in an induced coma for weeks. Brown was treated for the infection and sent home with a prescription for opiate pain pills.
While he'd been hooked on similar medication in the past, Brown said he had been able to use the pills for pain relief after his accident without abusing them. It was years since he'd gotten high.
This time was different.
"I went to the pharmacy, and before I went to the car I (overdosed)," he said, laughing a little. "I OD'd and went right back in the same room, woke up with the Narcan. Man I hate that stuff. It saves your life, but it makes you feel like crap."
Brown was one of thousands of South Carolinians dosed with Narcan in 2016. The drug, known generically as naloxone, counteracts the effects of opiates, such as OxyContin, heroin and fentanyl.
Its use jumped by 39.7 percent statewide from 2015 to 2016, according to data provided by the S.C. Department of Health and Environmental Control.
Since the drug was introduced in the 1970s, it has been carried by paramedics — who still administer it more than any other first responder — but more police officers are being trained in its use under a new DHEC program.
While the rise in use means more lives are being saved, experts also say that it points to a need to focus on treating the persistent, deadly problem of opiate abuse in communities throughout South Carolina.
A rise in use
Emergency medical service agencies across South Carolina administered Narcan 6,427 times in 2016, according to DHEC. Charleston County saw 417 administrations while Berkeley County and Dorchester County saw 229 and 189 administrations, respectively.
Those numbers are up compared with 2015 when paramedics statewide administered the drug about 4,600 times, DHEC said. Charleston County saw 262 administrations that year while Berkeley County and Dorchester County saw 39 and 117 administrations, respectively.
For Carl Fehr, division chief with Charleston County EMS, these increases come as no surprise.
“We’ve definitely used quite a bit more of it here recently than we have in the past," Fehr said. "It’s a pretty widespread problem that we have out there."
Opiates work in the body by blocking nerve receptors so that a person feels less pain. They can also lower a person's breathing rate, potentially leading to death.
Narcan knocks opiates off those receptors and allows them to function normally again. While it has been hailed as a miracle drug against opiates, Narcan cannot be used to treat victims who overdose on other drugs, such as cocaine, methamphetamine and ecstasy.
A new frontier
In September, Charleston police officials announced they were the first law enforcement agency in the Lowcountry to train and equip their officers with Narcan, part of a DHEC program created in 2015 following the passage of the S.C. Overdose Prevention Act.
By Sept. 14, Senior Police Officer Jud Haithcock became the first in his department to use it in the field.
Haithcock responded to a residence on Windermere Boulevard where he dosed a 24-year-old man with a nasal spray version of the drug.
"EMS showed up probably three or four minutes later," he said. "By the time they had him in the back of the ambulance, he had already started coming to."
It's simply another useful tool that officers can use to help people, Haithcock said.
"I’ve been to (calls) prior to us getting issued the Narcan, and you have to do CPR and hope you can keep them going long enough until the EMS shows up," he said.
After Haithcock's call, there was only one other Narcan deployment by a Charleston police officer in 2016, but he and others expect the program to grow.
Senior Police Officer Chris Freshman hopes the department's efforts will act like a pilot program for other agencies.
While police often see overdoses, those calls pose challenges for law enforcement when they arrive on a scene.
“People don’t want to tell us what it was (they took) because they’re afraid they’re going to go to jail," Haithcock said. "Our main priority is to keep them alive."
The reluctance is putting more people in danger, Fehr said.
The brain can go four to eight minutes without oxygen once a person stops breathing or has a respiratory rate so low that it's ineffective, he said. After that, there’s irreversible brain damage.
"Much past that 10-minute time range, you’re looking at death," Fehr said.
Overdose patients still need to be hospitalized even after the crisis seems to be over because Narcan lasts for about 30 minutes and most opiates break down more slowly.
"There is still potential that they’re going to relapse, go back into respiratory arrest and potentially die," Fehr said.
He also recommended that 911 callers stay at the scene to direct paramedics or police to the victim, give CPR and provide other help.
“There’s a lot of things they can do just to help someone out," Fehr said. "That’s kind of the key — that they aren’t afraid to help someone out that needs it.”
Treating an epidemic
Despite Narcan's life-saving potential, stemming tide of opiate addiction requires treating the disease.
Dr. Sarah Book, a professor at the Medical University of South Carolina, has treated patients at Medical University Hospital's Center for Drug and Alcohol Programs for the past 12 years.
The stigma associated with drug abuse is a major challenge because it makes recovery harder, Book said.
In a Post and Courier article published earlier this month, Horry County Coroner Robert Edge said that he believed that while Narcan is beneficial because it saves lives, it also perpetuates a cycle of addiction.
Book said she understands why some may be apprehensive but that these attitudes are harmful.
"The idea that naloxone increases drug use isn't supported by current research," she said. "In my opinion, it's not ethical to compare a potential, narrow downside of increased drug use to the huge upside of saving life. These individuals who are revived with Narcan are interfacing with the medical community, and that interfacing might be a vector into treatment."
For recovering addicts like Jessica Jayroe, the road to treatment began after years of struggle.
The 28-year-old Georgetown resident became addicted to pain medication after C-sections. She eventually started using heroin.
“I'd overdosed 10 times in a year,” Jayroe said. “I was given Narcan every time and I honestly don't know how I'm still here. That wasn't enough to stop me.”
Jayroe said she was only able to fully commit to treatment after she hit rock bottom, losing custody of her kids and having her family tell her she wasn’t welcome at home anymore.
Today, she's been sober for three years, regained custody of one of her children, is on her way to regaining custody of the other two and runs a successful business.
Weekly treatment at the Charleston County Department of Alcohol and Other Drug Abuse Services, more commonly known as the Charleston Center, has been instrumental in her progress, she said.
Brown, too, gets treatment at the Center.
Aside from taking methadone, a commonly used treatment for opioid addiction, he said a ritual helps him keep everything in perspective.
"I get up at 4 o’clock every morning so I can be out here at 6 when they open (the Center), so I can see the miracle every day," Brown said. "There’s about 20, 30 addicts getting their medicine when that opens up, and that reminds me that for a heroin guy, a true addict, to be clean for a day — that is a miracle."