Austin EMS Says Overdoses Now Require Up to Six Narcan Doses

Austin officials declared Thursday National Overdose Prevention Day amid a spike in overdoses across the city, as Austin-Travis County Emergency Medical Services warned that reversing an opioid overdose now frequently requires far more naloxone than it did just months ago. EMS Capt. Christa Stedman said that in the last month, some overdose victims have needed up to six doses of Narcan to become responsive, a sharp increase from the one to two doses that were typically sufficient before.

The proclamation, read by Council Member Ryan Alter, came one week after EMS crews responded to a noticeable surge in overdose calls. Stedman attributed the escalation to an increasingly toxic and unpredictable drug supply in which fentanyl is being mixed with other synthetic opioids, over-the-counter antidiarrhea medications, antihistamines, and other compounds that complicate both the overdose itself and the medical response.

Why one or two doses are no longer enough

Naloxone, sold under the brand name Narcan and available as a generic nasal spray, works by binding to opioid receptors and blocking the effects of opioids during an overdose. For years, first responders and bystanders were trained to administer one to two doses and wait for the person to resume breathing. But as the unregulated drug supply has become more adulterated, that standard protocol is proving inadequate in an growing number of cases.

Stedman told the Austin American-Statesman that current batches causing overdoses in the area often contain fentanyl combined with other substances, creating what public health officials call polysubstance overdoses. These mixtures can overwhelm the body in ways that a standard naloxone kit may not immediately counteract. The added compounds may also deepen respiratory depression or introduce other physiological complications that extend the time it takes for a victim to stabilize.

University of Texas-related social media accounts have also begun warning about cychlorphine, a synthetic opioid tied to a string of overdoses across the country including in Texas. The substance is not detected by standard fentanyl test strips and, like the mixtures Stedman described, can require multiple doses of naloxone to reverse. While cychlorphine has drawn national attention in recent weeks, Austin officials emphasized that the broader problem is the overall complexity of the drug supply rather than any single emerging compound.

Local leaders push prevention and surveillance

Dr. Desmar Walkes, the public health authority for Austin and Travis County, stressed the need for rapid information sharing among response partners. "The illicit drug supply remains unpredictable and dangerous," Walkes said. "We must continue timely surveillance, rapidly sharing information with our response partners."

The warning lands in a city that has invested heavily in harm reduction infrastructure over the past year. Travis County has expanded its network of free naloxone distribution sites to 45 locations, including wall-mounted kiosks and outdoor vending machines, and recorded a 22 percent decline in total drug-related accidental deaths between 2023 and 2024. But the new data on multi-dose reversals underscores a difficult reality: even as fatal overdoses fall, the survivors who do make it to an ambulance are often sicker and harder to treat than they were in previous years.

EMS officials are now advising anyone who carries naloxone, whether a first responder or a community member, to keep administering doses until the person becomes responsive or until professional help arrives. The advice reflects a growing consensus among harm reduction advocates and emergency medicine specialists that the old training models, built around the assumption of a single opioid causing the overdose, no longer match the clinical reality on the ground.

A national pattern in local data

Austin is not the only city grappling with harder-to-reverse overdoses. Across the United States, health departments and emergency medical services have reported that fentanyl-adulterated supplies containing xylazine, medetomidine, benzodiazepines, and other sedatives are stretching the limits of bystander intervention. While naloxone remains effective against the opioid component of these overdoses, the additional substances can prolong unconsciousness and respiratory compromise, requiring more doses, longer observation, and sometimes airway support that bystanders cannot provide.

The CDC's provisional data shows that fatal drug overdoses have fallen for three consecutive years nationally, a trend driven in part by wider naloxone distribution and expanded access to medication-assisted treatment. But the decline in deaths has not meant a decline in nonfatal overdoses, and the growing complexity of the drug supply means that every saved life may require more resources, more training, and more medication than it did even two years ago.

For Austin, the immediate priority is making sure that the city's extensive naloxone network is stocked with enough product to meet the new demand, and that the people who use those dispensers understand the revised guidance. As Stedman made clear, the difference between one dose and six can be the difference between a survivable overdose and a fatal one, and the people most likely to witness an overdose, friends, family members, and peers, are the ones who need that information most.