Alaska has seen a major spike in opioid overdose deaths. Naloxone is a key part of the strategy to prevent more.

PALMER — At all times, Kurt Hoenack has a naloxone overdose kit packed in the trunk of the car he uses to transport clients, ready to save a life at a moment’s notice. The worker at MyHouse homeless youth shelter in Palmer wears a kit even when not working.

The unassuming bag contains two doses of naloxone nasal spray – also known by the brand name Narcan – which can quickly reverse the effects of an opioid or heroin overdose even after someone has stopped breathing. The kit also includes test strips that can help users determine if a substance contains high-potency fentanyl, as well as gloves and a face shield to safely administer CPR.

The pack in Hoenack’s truck is one of thousands of free kits that have been distributed or will soon be distributed by the state’s HOPE Project as a key part of Alaska’s strategy to prevent overdoses.

This year, state program employees and volunteers collected and distributed 12,000 kits to numerous agencies, public health centers, public needle exchanges, individuals and nonprofit organizations. Currently, there are enough supplies for about 12,000 more people, said Theresa Welton, section chief at the Office of Substance Abuse and Addiction Prevention.

Welton and others involved in overdose prevention efforts explain the state’s strategy of distributing as many kits as possible — while educating Alaskans about the dangers of counterfeit pills that too often look like Oxycontin blue, prescribed by a doctor but containing a lethal dose of fentanyl – has become increasingly important as Alaska’s overdose rate has risen sharply to become one of the highest in the nation.

Alarming figures

According to preliminary data from the federal Centers for Disease Control and Prevention, between February 2021 and February 2022, Alaska reported the largest increase in overdose deaths of any state by a significant margin.

While the country as a whole saw a 6.2% increase in overdose deaths during that time, Alaska saw an increase of at least 69%, according to the CDC. In 2021, 245 Alaskans died from drug overdoses compared to 146 in 2020.

This year is set to be just as deadly. Between January and March 2022, 51 overdose deaths were reported in the state, compared to 54 in the same period of 2021, Welton said.

“These numbers are alarming and concerning,” she said.

It is difficult to track the effectiveness of the distribution of Narcan kits in preventing overdoses in the state, because agencies and individuals are not required to report their use. Still, the state tracked at least 300 cases of lives saved by naloxone from 2017 to 2020, and the department distributed more than 50,000 doses of treatment during that time, Welton said.

Hoenack said anecdotally it’s hard to measure the strategy’s effectiveness because of the shame and stigma associated with addiction, but he has no doubt it has saved lives.

“It’s like suicide prevention: if you’re successful in suicide prevention, you may never know,” he said.

The clients he sees usually don’t talk openly about their substance use until after they’ve recovered, and he rarely hears stories about the Narcan he dispenses. Sometimes it may seem like a last resort rather than a solution, but he always has faith that it feels good.

“It’s definitely a band-aid solution,” Hoenack said. “But you know, the hope is that we can catch people wherever they are – and if they’re in the middle of an active addiction and they need a Narcan kit, we can do that. If they need to be educated about the dangers of fentanyl, we can do that…. It’s just meeting them where they are.

[Alaskans can now dial 988 to access a suicide prevention hotline]

Very wide radiation

Denise Ewing’s eldest son, Gabe, died of fentanyl poisoning in January.

“He had been taking medication that he didn’t know contained fentanyl,” Ewing said. “He was using alone, so there was no one to help him with naloxone or care.”

Since the death of her son, Ewing, who works as a public health nurse in Sitka, has helped educate the thousands of seasonal workers who arrive each summer to work on fishing boats and in processing plants about the dangers of fentanyl. and how to prevent an overdose. . She calls the Gabe Awareness Project.

“I started attending new employee orientations, as well as teaching the masses who came in for seasonal employment, naloxone, what opioid abuse looks like, emergencies and what you do , and how can you help,” she said.

Signs of an opioid overdose include unconsciousness or inability to wake up, limp body, drowsiness, slow or irregular breathing or heartbeat, and cold or clammy skin. Knowing these signs, carrying Narcan in case a loved one overdoses, never using alone, and testing substances for fentanyl can help prevent overdoses.

Ewing said the boat captains she met were enthusiastic about carrying Narcan and knowing how to administer the drug – which is especially important in situations where crew members are away from the ship. shore and receive prompt medical attention.

Hoenack, with MyHouse, said he gets a mix of people asking for naloxone for themselves and those wanting it for loved ones. Hoenack himself carries a kit even when not working in case a loved one needs his help.

“I wear it because it’s like, well, that’s where we are now,” he said. “We just have to be able to react to whatever happens.”

“It saves lives”

Last year, six out of 10 overdose deaths in Alaska were linked to fentanyl, according to Dr. Anne Zink, Alaska’s chief medical officer.

Fentanyl is so deadly because of its potency and the small margin of error for a lethal dose. The synthetic opioid is often associated with other counterfeit pills or drugs. Many of those who died from it may not have known that fentanyl was involved — which is why some advocates refer to deaths caused by fentanyl as poisonings rather than overdoses.

In a recent interview, Michael Troster, executive director of Alaska’s High Intensity Drug Trafficking Zone Task Force, held up a small packet of sugar – about a gram – to illustrate a point.

“If it was heroin, it could kill you,” he said. “If it was fentanyl, it could kill 500 people.”

Troster said part of the reason Alaska’s rise in the overdose rate was so high last year was that the state took a little longer than the lower 48s to see the devastating effects of the fentanyl that other states have seen in 2020.

“If you look at where the Lower 48 was maybe 18 months ago, that’s where Alaska is today,” he said.

Troster said one challenge he’s encountered is an “ignorance factor,” as a perception among some who believe Narcan’s offering enables drug use.

But he says saving someone’s life gives them a chance at recovery – something he’s heard before from Sandy Snodgrass, an Anchorage mother who lost her 22-year-old son Bruce. from fentanyl last year.

“She said fentanyl kills you before you have a chance to recover. I thought it was deep,” Troster said.

More broadly, there are three components to Alaska’s efforts to reduce drug trafficking and overdoses, Troster said: demand reduction, treatment and enforcement.

“We think of, like, a three-legged stool. If any of those legs are overrated or underrated, then all of this is advice,” he said.

But the administration and distribution of Narcan straddles all three levels – police and other officers carry Narcan, and teaching Alaskans how to use and the importance of carrying the life-saving drug is a form of both treatment and education. Narcan is an important piece of the puzzle.

“It saves lives,” Troster said. “I don’t think there’s any other way to put it.”

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Elizabeth J. Harless