This is the third story in a three-part series on the use of Narcan by law enforcement. Read part one here and part two here.

El Paso Police Officer Jose Alvarez was conducting a routine traffic stop in Central El Paso in December 2020 when a security guard flagged him down: a man was unresponsive, lying face down on the ground just blocks away, drug paraphernalia by his side. Alvarez ran over and called for emergency services. He then administered Narcan, reviving the man.

Alvarez later received the El Paso Police Department’s life-saving award for the act, an honor the department bestows for successful rescues.

Most officers in Alvarez’s position wouldn’t have had Narcan on hand to respond to that situation because the EPPD has only enough supply for less than 10% of its officers. Unlike growing numbers of police departments nationwide, the EPPD does not require all officers to carry Narcan when they’re out in the field.

That could soon change, with the promise of new federal funds that can be used for Narcan. But it’s unclear whether implementing a more robust Narcan program is a priority for El Paso police.

Internally, EPPD officers have been asking for increased access to the opioid reversal drug for years, though the amount of Narcan kits distributed within the department has not changed since 2018.

Part 1: Narcan on hand: EPPD patrol officers don’t carry Narcan amid skyrocketing overdose deaths

Part 2: How one police department’s Narcan program saved hundreds of lives

City leaders and advocates say a lack of interest among EPPD leadership is a barrier to adopting harm reduction approaches toward addressing the opioid crisis, linked in part to stigma around substance use disorder. Narcan, fentanyl test strips and syringe exchange programs all are tools used in harm reduction, a set of strategies for minimizing the negative consequences of drug use.

Adan Dominguez, program manager at El Paso opioid crisis center Punto de Partida, would like the Police Department and the city to adopt more harm reduction approaches for responding to rising opioid overdose deaths, but said stereotypes and misconceptions about their effectiveness get in the way.

“It’s like sex education, thinking that having Narcan promotes more use, or (that) the syringe service promotes more use of heroin. It doesn’t really, it just educates and saves lives,” he said.

Punto de Partida has provided Narcan to approximately 20 EPPD officers who walked in looking for it, Dominguez said, and the center has been involved in Narcan training efforts at the Sheriff’s Office.

EPPD spokesperson Sgt. Enrique Carrillo said the police’s primary role in responding to opioid overdoses is to enforce existing drug laws, though he added that officers could provide basic first aid assistance if they are trained and have access to Narcan. That’s a far cry from the harm reduction approach used by Arizona’s Tempe Police Department, which responds to overdoses through a public health lens, where the initial police encounter is the first step in connecting the person who overdosed with substance abuse recovery services.

Resistance to harm reduction approaches isn’t unusual among police officers, according to Dave Hanson, the Narcan program coordinator at the Tempe PD and a veteran police officer.

“I think there’s a common belief sort of police wide, ‘You’re putting more pressure on me as a police officer. You want me to be a social worker, you want me to be a mediator, you want me to be this, you want me to be that,” he said.

Hanson wasn’t a proponent of Narcan at first, and said he struggled with feeling blame and judgment toward people who use drugs. But after going on an overdose call as a detective and not having Narcan on hand, his perspective shifted. Watching the man die while desperately giving him CPR and chest compressions to no avail, Hanson wished he had Narcan to quickly stop the overdose.

“We (police) put tourniquets on people, we pull people out of cars, we react to whatever is happening, and in those calls we don’t hesitate,” he said. “We don’t go, ‘Wow, you’re drunk. Maybe you’ve made some poor choices. So I’m gonna stand over you and kinda let you bleed a little bit.’”

Barriers to improving Narcan access for El Paso police

Much of the El Paso Police Department’s current Narcan distribution is geared toward preventing accidental opioid exposure among officers, rather than using it on the general public, according to spokesperson Sgt. Robert Gomez. That’s why every police station has a Narcan kit for the area where narcotics are processed — out of the 85 kits distributed within the EPPD, nearly half go to narcotics units.

The risk of accidental fentanyl exposure has been a particular concern for Police Chief Greg Allen, according to internal emails El Paso Matters obtained through open records requests. Allen declined to be interviewed for this series.

“Let’s make sure all precautions are being taken!!” Allen emailed his assistant chiefs in 2019, forwarding them an email about opioid exposures and K-9 officer safety.

Although it is possible for officers to be accidentally exposed to opioids, there have been widespread misconceptions among law enforcement about the danger of coming into physical contact with fentanyl. A 2018 directive circulated among the EPPD claimed that fentanyl “can cause immediate death upon contact;” in reality, opioid overdoses happen from injecting or ingesting the narcotic, not solely through physical contact. 

Risks remain for officers out in the field due to the lack of Narcan, according to an email Officer Robert Azar Jr. sent to Lt. Jason Johnson of the El Paso Police Training Academy in August 2021 about the need for additional Narcan in the field.

“It’s safe to say that if an officer gets exposed (to opioids) they are going to be in trouble, hopefully someone gets to them ASAP,” Azar wrote.

The El Paso office of the U.S. Drug Enforcement Administration and local ports of entry have had dramatic increases in fentanyl seizures in recent years, coinciding with increased overdose deaths in El Paso.

Gilberto Pérez, a harm reduction consultant who was based in El Paso until 2020, said he encountered resistance from the EPPD when advocating for greater harm reduction measures, like more Narcan access throughout the city and a syringe exchange program.

Pérez expressed concern about the effectiveness of solely expanding Narcan access for police when there isn’t adequate protection for El Pasoans who call 911 to report an overdose.

Texas enacted a Good Samaritan law in 2021 to provide callers with immunity from drug possession charges. Though seen by some as a way to encourage people to seek medical help during an overdose, Pérez said the law has so many loopholes that it offers minimal protection.

El Paso would need to pass a more comprehensive Good Samaritan law locally in order for increased Narcan access among law enforcement to be truly meaningful, he said.

“Without (a better Good Samaritan law) then no, it wouldn’t be super beneficial for a police officer to carry Narcan because we will continue targeting people who use drugs and feed into mass incarceration,” he said.

The limitations of El Paso’s Crisis Intervention Team

Police forces have widely adopted the Crisis Intervention Team model as a way to respond to crisis events involving people with mental and substance use disorders through a behavioral health lens. It involves collaboration between law enforcement, medical providers and public health stakeholders.

EPPD’s CIT program is geared more toward responding to a mental health crisis than a drug abuse-related one, said city Rep. Alexsandra Annello.

Annello was a leader in expanding funding for the EPPD’s CIT team, but said that limited substance abuse recovery services offered by the program’s medical partner, Emergence Health Network, affects the likelihood that the EPPD could implement a program akin to that of the Tempe Police Department. In Tempe, the partnering behavioral health provider follows up with people who have overdosed, connecting them with peer counselors and other addiction recovery services.

EHN is the county’s mental health authority, not the local behavioral health authority — a broader designation that entails additional state funding for comprehensive substance abuse recovery services, said County Commissioner David Stout, who has served on EHN’s board since 2015. 

EHN leadership has discussed applying for status as the county’s behavioral health authority with city leaders, but did not get the impression that was something the community wanted, EHN spokesperson Rene Hurtado said. The county does not have a local behavioral health authority.

Annello said part of the push for EHN to become the behavioral health authority was so that substance abuse recovery services could be integrated into CIT.

“I think it’s a conversation that can still be had — but (the process for gaining that designation is) very heavily regulated,” Annello said.

Stout, who led efforts to increase CIT funding for the Sheriff’s Office, said he formed the impression that there wasn’t an appetite for expanding substance abuse crisis response at the EPPD, based on conversations he had with EHN staff. The sheriff’s Narcan program is not part of their CIT program.

“What I was led to believe is that it wasn’t something (EPPD) felt was needed and so they weren’t willing to try to advocate for funding for it,” Stout said.

Hurtado said EHN would be open to changes for how the EPPD CIT team responds to overdoses.

“If there is going to be a significant change to the way the (CIT) program is administered or if there is going to be additional components added, it would happen with law enforcement being the lead,” Hurtado said. 

Funding is always an issue when it comes to Narcan, particularly for larger police departments, said Lisa Cleveland, who runs the UT Health San Antonio School of Nursing More Narcan Please program through which El Paso County and Punto de Partida get their Narcan supply. The El Paso Police Department has four times as many officers as the Sheriff’s Office.

Cleveland said there are statewide funds that law enforcement can specifically apply for, such as the Governor’s Office Criminal Justice Grant Program, to purchase Narcan.

National opioid lawsuit may mean more city funds for Narcan

The city of El Paso opted to join a nationwide opioid lawsuit settlement in mid-December that could yield the city $1.2 million in damages for “opioid remediation uses,” according to city spokesperson Laura Cruz Acosta and emails obtained by El Paso Matters.

These funds can be spent on expanding Narcan training and increasing distribution, according to a list of remediation uses provided by the Texas Attorney General’s office. Cruz Acosta did not say whether the city plans to use any of the funds on Narcan, though she acknowledged that it was an option.

A Dec. 10, 2021, email from City Attorney Karla Nieman to the city manager, police chief and other city leaders said “use of the (settlement) funds will go towards training and resources for 1st responders to respond to overdose situations.”

El Paso County will receive $682,459 from the same settlement. Stout said the county has not yet decided how the funds will be used, but thinks they should consider using them for the Sheriff’s Office Narcan program if needed.

Sgt. Carrillo, spokesperson for EPPD, said in February that the department is seeking available federal funding for more Narcan, but did not specify whether he was referring to the settlement funds.

If current Narcan accessibility is a problem for patrol officers, Annello said it’s important for the City Council to know about it, so they can help address the need.

She said she has never heard the EPPD communicate an issue regarding Narcan availability since she joined the council in 2017.

“If there is a concern with the Police Department that they want these things … if this is something that staff is asking for, for the good of the community and it’s not been reiterated to the (city) council, that’s really problematic,” Annello said.

Correction: This story has been updated to include a comment from police spokesperson Sgt. Enrique Carrillo that police provide basic first aid to overdose victims if they have training and access to Narcan.

Cover photo: El Police Department headquarters. (Corrie Boudreaux/El Paso Matters)