Four months after the Federal Drug Administration approved the overdose-reversing drug naloxone for over-the-counter use, Honolulu is poised to become the first major U.S. city in the nation to require that bars, nightclubs and other establishments that serve alcohol have the lifesaving medication on hand.

The Honolulu City Council passed Bill 28, introduced by Tyler Dos Santos-Tam, on Wednesday. The move follows last month’s mass overdose in a Waikiki hotel room in which two people died and three others were hospitalized.

“We can’t keep letting this happen,” Dos Santos-Tam said in a news release.

Like much of the nation, Hawaii is grappling with increasing numbers of people dying of drug overdoses, many of them related to fentanyl, a powerful synthetic opioid that is often mixed in with street drugs.

The Hawaii Department of Health reported 59 opioid-overdose deaths in the state between August 2017 and August 2018. That increased to 274 in 2020, according to Bill 28.

People who drink alcohol and take opioids have a higher chance of overdosing because both substances repress the body’s respiratory system.

The bill requires that restaurants that serve alcohol, as well as brew pubs, cabarets, tour or cruise vessels that dock in Honolulu and others with liquor licenses maintain a certain amount of naloxone, also known by the brand name Narcan, on their premises and train managers in how to administer the medication.

Honolulu Mayor Rick Blangiardi issued a statement saying he looks forward to signing the bill into law.

“We have witnessed a staggering rise in overdose deaths, and the profound strain it has put on our healthcare system and our first responders has been especially taxing. We cannot stand idly by while this crisis continues to endanger our residents,” he said.

Hawaii is witnessing an alarming increase in the use of fentanyl, said Jim Ireland, who directs Honolulu’s emergency services.

“Our neighbors and friends who should still be here, are no longer with us,” he said in the news release. “We believe this bill will save lives.”

To help businesses get naloxone, the Honolulu Liquor Commission will provide free starter doses for all liquor-licensees. Plans are in the works to use opioid settlement funds for replacement doses.