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What happens when someone ODs on heroin at 30,000 feet? It depends on the airline.

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The friendly skies are not immune to the opioid crisis happening on solid ground. But how an overdose is handled at 30,000 feet -- and whether a life-saving antidote is available -- depends on which airline you're flying.

Handling an opioid overdose has become almost commonplace at hospitals across the country. Emergency responders have been equipped with an easy-to-use form of the drug naloxone to bring people who've OD'd back to life. Doctor Anil Punjabi, a third-year cardiology fellow at Boston Medical Center, said he's seen his share of overdoses in his training. But they were nothing like what happened on an August flight between Boston and Minneapolis.

"I heard an air hostess ask, 'Is there a doctor on board?' The way the air hostess said it, I knew something was very wrong," he recalled in an interview with Circa.

Punjabi sprung into action to help a woman on the flight who was unresponsive, with blue lips and gray skin. In the hospital, he would have had every tool at his disposal to help. But at more than 30,000 feet in the air, doing CPR between the seats, he was missing something. The federally required medical kit every airline carries didn't have the one thing he needed: naloxone, the antidote used in many opioid overdoses. Most know the drug by its brand name, Narcan.

"It’s not required to be on board the aircraft," Sara Nelson of the Association of Flight Attendants-CWA told Circa. "Not all airlines are arming us with the tools we need to save lives."

Nelson represents the men and women tasked with keeping the cabin under control on every flight. And she said nobody wants naloxone or Narcan on planes more than this group, not just to protect customers but also its members, who may inadvertently handle a dangerous drug that could cause an overdose. Circa covered the potential danger for first responders in this situation back in May.

"In this country right now we have an opioid epidemic," she explained. "We are first responders and we're the only first responders that don’t have access to Narcan to be able to save peoples’ lives when they are in a drug overdose caused by an opioid."

Adapt Pharma, which makes Narcan, told Circa it supports the move and said getting airlines to stock the product is part of its future agenda.

For now, flight crews without the antidote rely on a lifeline to the ground. In Pittsburgh, one of those lifelines is UPMC STAT MD, an emergency medical consultation service that handles calls for 16 airlines. The clinic's physicians are available 24-7 to answer calls made from a flight and talk through whatever medical emergency the crew is facing.

"They could be 6,000 miles away and 30,000 feet above us. So it becomes a combination of art and science."
Dr. TJ Doyle, Medical Director - STAT MD
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Dr. T.J. Doyle is the medical director of this facility, which operates out of the University of Pittsburgh Medical Center. He said when the phone rings, it could be anything. Overdoses, although rare, are becoming more common.

"There does seem to be an increase. And when it does happen, they’re pretty dramatic," Doyle explained.

Still, overdose calls don't even crack the Top 10 for this program, according to data it has collected and analyzed over the years. MedAire, an Arizona-based company that provides similar medical consulting for 160 airlines globally, echoes the statement. Regardless, Dr. Paulo Alves, global medical director for aviation health at MedAire, said they want clients prepared.

"Even if the frequency of events is low, if you want to do something then you need to have this sort of tool in flight," Alves said. "We’ve been recommending it to all our clients to have it for quite a long period of time."

"What happens on the ground is mimicked in the air, so as there's an increase on the ground, there's a high likelihood there's going to be an increase in-flight as well."
Dr. Moneesh Bhow, emergency medicine physician - MedAire

Dr. Moneesh Bhow handles emergency calls for MedAire's MedLink program. He told Circa the company has not yet seen a shift in protocols for carrying the drug. "On an industry level, there is some discussion about it, but there is no definitive requirement to have Narcan on board," he said.

Right now, Circa discovered, airlines by and large don’t have naloxone or Narcan available for flights. The Association of Flight Attendants-CWA could only confirm one airline, United, carries the antidote. The organization indicated its safety committee for Spirit was actively working to get the product on-board. We called other major carriers and found that Frontier and Alaska said they do as well. Other carriers we contacted, including Southwest, Delta, American and JetBlue, told Circa they do not carry naloxone or Narcan. They don't have to, at least not yet.

Rep. Scott Perry (R-PA) said the House Transportation Committee has asked the Federal Aviation Administration (FAA) to examine the issues associated with adding naloxone or Narcan to the medical kits that are required on U.S. flights. The examination is part of a reauthorization bill, according to Perry.

The International Air Transport Association, a trade group that represents more than 80 percent of the world's major carriers, told Circa it recently discussed stocking the antidote on airlines with expert medical associations and the Civil Aviation Organization. The consensus, a communications rep told us, was that it was not necessary for aircraft kits at this time.

But in an interview in his home district in Harrisburg, Perry disagreed, saying "This is exploding in our communities. We see it in our neighborhoods, we see it all around us. Are we going to wait until there’s a tragedy? That seems foolish."

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We asked Perry if there was a threshold for when overdoses became problematic enough to mandate the availability of naloxone or Narcan on flights. "You can anticipate the problem is going to come. We’re in the business of solving problems," he said. "Why can’t we solve it before it happens? There’s always concern about another mandate, another burden on business, on taxpayers. That’s realistic. But once again, do you want to be sitting next to that person that’s having the overdose and there’s nothing that can be done about it?"

Even with this life-saving drug on every flight, experts are quick to point out it won't solve everything when overdoses happen in the sky. "It’s not a panacea or miracle cure for this epidemic," Doyle explained. "There may be other downstream effects that you weren’t aware of. These aren’t people who are going to wake up, smile, thank everyone and then check into rehab on landing."

But after using the tools in the medical kit and doing CPR in-flight to bring back a woman who overdosed, Punjabi says he'd rather have the antidote as an option. He said the patient he helped got Narcan at the gate from EMS responders and quickly rebounded. He doesn't know what happened after that. Punjabi never even learned the woman's name. But he says not having a critical tool at his fingertips has given him different purpose. He's interested in activism on the topic, and greater conversation about the need for having the drug on planes.

"At the end of the day, life is about constant improvement," Punjabi said. "And to use this, if I can use this one incident to prevent something bad from happening in the future or helping others, it’s well worth it."

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