As of Jan. 1, Honolulu became the first U.S. city to mandate that its roughly 869 alcohol-serving bars, nightclubs and restaurants keep naloxone nasal spray on hand to counteract opioid-related overdoses.

In part, the new law arose following a mass overdose incident at the Outrigger Reef Waikiki Beach Resort in June. The incident caused two deaths and three hospitalizations.

The Honolulu Police Department said fentanyl was at the scene.

By July the City Council voted to approve Bill 28 — introduced by Council member Tyler Dos Santos-­Tam — which was deemed the country’s first legislation of its kind. Mayor Rick Blangiardi signed the bill into law later that month.

The measure — coming four months after the U.S. Food and Drug Administration granted initial over-­ the-counter approval to Narcan, the trade name of the naloxone opioid-­reversal medication — was initially conceived by local Honolulu bar and nightclub owners, who attested to accidental overdoses that occurred in their establishments.

“Naloxone is a necessary tool these days in light of the national opioid epidemic. It should be available and accessible in as many places as possible, in the same way we have fire extinguishers and defibrillators in case of emergencies,” Dos Santos-Tam said in a written statement. “This new law will not only save lives, it will hopefully set an example for other cities throughout the United States.”

The Honolulu Liquor Commission — which in recent months has come under scrutiny for chronic understaffing, low morale and questionable policies and practices employed by its investigators while enforcing liquor laws on Oahu that have resulted in two ongoing federal civil rights lawsuits — is expected to police the new naloxone law.

“Bill 28 does not preclude enforcement action by the Liquor Commission if a licensee is not in compliance with state liquor law or Liquor Commission rules,” Scott Humber, the mayor’s communications director, told the Honolulu Star-Advertiser via email.

He said the Liquor Commission as well as Dos ­Santos-Tam’s office have distributed 469 naloxone kits to local taverns and nightclubs.

Meantime, Humber noted any business found in violation of the law — mainly, having no naloxone on the premises — could face a fine “of not more than $200.”

The city’s approval of Bill 28 had coincided with the state Department of Health and its partnership with nonprofit Hawaii Health and Harm Reduction Center, or H3RC, to provide free doses of Narcan to all Hawaii residents.

According to Dos Santos-­Tam’s office, DOH agreed to provide two doses of Narcan to all liquor licensees in each of the counties in Hawaii.

That action follows a state-level agreement made in July involving two national settlements totaling $26 billion. The settlements were reached as a result of investigations and litigation over pharmaceutical companies that allegedly fueled the nation’s opioid crisis.

In this case the 50 states signed on to the agreement involving three major drug distributors — Cardinal, AmerisourceBergen and McKesson — as well as drug manufacturer Johnson &Johnson.

As a result of those settlements, the state of Hawaii netted $78 million. Of that amount, Oahu received 9.3%, or about $7.25 million — money earmarked to fund free Narcan doses to Hawaii residents.

According to Dos Santos-­Tam’s office, the Liquor Commission agreed to provide free “starter doses” of Naloxone to all liquor licensees, using portions of nearly $1.4 million in opioid settlement money for replacement doses.

One owner of a Chinatown nightclub supports the new law.

“Overdoses happen, especially when mixed with alcohol,” Robbie Baldwin, owner of Scarlet Honolulu, said in a written statement. “I do not want to see well-­meaning and law-abiding business owners being punished for an overdose that occurs — beyond their control — on their property. This bill helps prevent this worst-case scenario.”

In general, opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl or legally prescribed pain relievers such as oxycodone, hydrocodone, codeine and morphine, among others, DOH says.

Past state-level review of the rise of opioid-related overdoses has revealed an alarming trend: From August 2017 to August 2018, 59 opioid-overdose deaths occurred in Hawaii.

By 2020 that number jumped to 274 deaths, a 364% increase, DOH says.