On Sept. 13, Buncombe County Health & Human Services issued an alert on social media and to local groups like the Homeless Coalition about a spike in overdoses in the county.
“Please be advised, over the last several days there has been a continued spike in probable overdoses in Buncombe County,” the email alert from spokesperson Stacey Wood read. The alert continued, “we strongly encourage agencies to distribute naloxone,” and it urged drug users to test substances with fentanyl test strips before use.
Although the purpose of BCDHHS’ alert was to warn the community about potential overdoses, it also put naloxone, a primary weapon in the fight against the opioid epidemic, front and center. Naloxone is a Food and Drug Administration-approved overdose reversal medication. Those who work in the field of harm reduction — meaning the strategies to reduce harm to physical and sexual health that can result from drug use — say this lifesaving drug that is easy enough for a layperson to administer can’t be distributed widely enough.
Kevin Mahoney, peer support specialist at Mountain Area Health Education Center, says that after an overdose is reversed, an individual may become more open to seeking treatment in that vulnerable moment. “[Alcoholics Anonymous] folks say ‘wait for the miracle to happen,’” Mahoney explains. “The idea is to keep people alive.”
The ultimate hope for people with opioid use disorder is to address the greater systemic issues or underlying trauma that brought them there. But “we can’t do that if they OD,” Mahoney says.
An average of nine people died from a drug overdose each day in 2020 in North Carolina, which was a 40% increase over the previous year, the N.C. Department of Health and Human Services announced in March.
How naloxone works
Using opioids, including prescription drugs like Percocet or OxyContin, or “street” drugs like heroin, can slow or stop an individual’s breathing, which is an overdose.
Naloxone is an opioid receptor antagonist, meaning it kicks off anything that is bonded to it, explains Carriedelle Fusco, a MAHEC family nurse practitioner and co-director of office-based opioid treatment services. It only works for opioid overdoses — not for overdoses of the drug class of benzodiazepines, like Xanax.
Naloxone can be administered as a nasal spray, commonly known by its brand name Narcan, or through a shot in the thigh. “With Narcan, it’s just one spray into a nostril,” explains Justin Shytle, who provides training on naloxone for Sunrise Community for Recovery and Wellness, a recovery nonprofit staffed by peer support specialists. (BCDHHS is a partner of Sunrise.)
“The intramuscular [shot] can seem a little intimidating, but really, it’s just pulling up a syringe with a vial, and then the shot would go into a muscular area,” Shytle says. He compares its ease of use to an Epipen, a device that administers epinephrine to stop a life-threatening allergic reaction.
The American Medical Association notes that 80% of opioid overdose deaths happen outside of a medical setting. That means there is a likelihood that naloxone will be administered by a friend, family member, coworker or bystander. Sunrise has focused on increasing access to naloxone at sober living facilities and addiction treatment centers, according to Lance Karner, the harm reduction coordinator at Sunrise.
“It’s important for people coming out of [addiction] treatment to know how to use Narcan,” he explains. As with people who are leaving incarceration, an individual who has been sober for a time may have a lowered tolerance and be more inclined to overdose.
How to save a life
Naloxone is increasingly available in Asheville. During fiscal year 2020, Sunrise distributed 856 naloxone kits, says Karner. People who used naloxone on themselves or others reported it reversed 162 overdoses.
This fiscal year, Karner says Sunrise distributed 1,983 naloxone kits and 450 opioid reversals were reported. (Karner says Sunrise primarily distributed the intramuscular naloxone shots.) “Out of every four we give out, one is saving a life,” Karner says.
Adds Shytle, “Just having the Narcan out there has been wonderful — it’s been a lifesaver.” He means this personally: Shytle had Narcan administered to him for the first time to reverse an overdose at age 17, he tells Xpress.
He sees making naloxone more accessible in Asheville as a positive thing. “For us at Sunrise, we always have some to hand out to make sure people have it,” Shytle says and demonstrates that he’s carrying Narcan in his messenger bag. “I’ve had to bring back quite a few people” with naloxone, he says.
Sunrise receives naloxone training requests from individuals and groups. For example, Sunrise recently did one-on-one training with residents of the Deaverview Apartments, a public housing community, Karner says.
Amy Upham, executive director of Eleanor Health Foundation, put together kits of Narcan and informational packets, and distributed them to businesses in downtown Asheville and in West Asheville during the holiday season in 2020. When she dropped off kits to business owners, she would explain what Narcan is. Only one business — a restaurant in West Asheville — refused a kit, saying “‘We don’t need that,’” Upham remembers.
Mahoney from MAHEC says he always keeps naloxone with him. “It’s like having a phone with you or your water bottle — you don’t go out without it,” he says.
Naloxone does not have a negative effect if it’s administered to an individual who isn’t overdosing. (For example, if a person is unresponsive because a stroke is in progress.) And North Carolina has a “Good Samaritan Law” which protects anyone who administers naloxone “if the person has a good-faith belief that the other person is experiencing a drug-related overdose and the person exercises reasonable care in administering the drug to the other person.”
How naloxone came to Buncombe
In Buncombe County, naloxone is dispensed by a licensed health care professional through BCDHHS. The department began dispersing the medication around 2016 through a grant with Sunrise, says Upham, who is BCDHHS’ former opioid response coordinator.
Naloxone also can be accessed through Buncombe County Sheriff’s Department at the Buncombe County Detention Center. Leaving the criminal justice system is one of the most dangerous times for a potential overdose to occur as an individual’s tolerance for the drug may have lowered while incarcerated, says Upham. “Folks coming out of prison are 40 times more likely to die of an opioid overdose if they use again,” she says, citing research on over 200,000 formerly incarcerated people in North Carolina published in the American Journal of Public Health in 2018.
Previous Xpress reporting notes that any individual who is identified as having an opioid use disorder at intake at the detention center is given an opioid reversal kit when leaving the jail. The detention center is in the process of stocking a vending machine with free naloxone, says Sheriff’s Office spokesperson Aaron Sarver.
I was wondering when the Naloxone vending machine idea would come to Asheville.
Why is 1,983 naloxone kits being distributed and 450 opioid reversals reported by Sunrise alone in one year something to pat each other on the back about? Actually canceling the Illegally Manufactured Fentanyl traffickers and ending at least 80 percent of the SUD activity are signs of strategy and innovation using ethical logic.