‘I couldn’t stop dying’: Naloxone saving Ohio lives
Shane Hunter heard a series of muffled noises and indiscernible voices as he drifted in and out of consciousness.
He felt groggy, like he was waking up from a nap before rolling over and falling back asleep. Hunter didn’t realize it at the time, but he was actually in a dreamlike state of limbo — straddling the line between life and death.
For Hunter, who was addicted to heroin at the time, it was at least the ninth time he hovered across this macabre threshold over just five days in 2018. Each time, he had overdosed and was revived with the opioid reversal drug naloxone.
“Once I started shooting, it was game over,” Hunter, 43, of Circleville, said of his heroin use. “I couldn’t stop dying. I was dying all the time.”
Naloxone saved Hunter’s life — over and over and over again.
But despite serving as a lifeline for Hunter and Ohioans for decades, naloxone data remains scant and it’s unclear just how much of the overdose reversal drug gets used or expires without ever being administered. Instead, it’s personal stories like Hunter’s that have built a case for naloxone as potentially the most critical tool in fighting the opioid epidemic.
The lack of data is due in part to the nature of naloxone, experts said. While people who are revived with it are encouraged to head to an emergency department at a local hospital to be evaluated by medical personnel, it’s unlikely that everyone does.
Ohio’s Project DAWN — a network of opioid overdose education and naloxone distribution programs— increased its distribution of naloxone 42% from 205,584 kits in 2022 to 291,289 kits in 2023, according to the Ohio Department of Health. That increase in kits led to an 11% jump in known overdose reversals, going from 18,244 in 2022 to 20,289 in 2023.
Although the data is piecemeal, it still makes a compelling case for naloxone, said Dr. Bruce Vanderhoff, director of the Ohio Department of Health. And Ohio’s efforts must be working, Vanderhoff said, as the number of overdose deaths dropped 5% in Ohio in 2022 to 4,915 while increasing nationally by 1%.
“It’s a challenge, because recording a known reversal requires people to tell us that the reversal occurred,” Vanderhoff said. “So, we know that this data that we have ... is an undercount. But if anything, given how many reversals we’ve been able to record ... This is proving to be very important to save lives.”
Anticipating naloxone shortages
Naloxone has become such a key tool in fighting the opioid epidemic that there have actually been shortages of it
in recent years.
A 2021 study published in the medical journal “The Lancet” found that naloxone scarcity remained a problem nationwide and that distribution of it should be substantially expanded in nearly every state.
To ensure naloxone isn’t in short supply throughout Ohio, the state has spent millions to fulfill orders by Project DAWN, behavioral health treatment providers, prisons, law enforcement and harm-reduction organizations that aim to reduce death with the understanding that not everyone struggling with an addiction will always successfully abstain from drug use.
Ohio spent more than $51.2 million to provide 723,574 naloxone kits from 2019 through 2023, according to the Ohio Department of Mental Health and Addiction Services. That doesn’t include naloxone sold through pharmacies and other nonprofit groups that don’t get federal funding.
Ohio has avoided shortages of naloxone, due in part to Recoveryohio, an initiative launched by Gov. Mike Dewine that’s designed to bring together efforts to fight the opioid epidemic. The initiative has improved coordination between multiple state agencies, such as the Ohio Department of Health, the Ohio Department of Mental Health and Addiction Services, the Ohio Department of Rehabilitation and Correction and more, said Aimee Shadwick, director of Recoveryohio.
“There was a national shortage of naloxone a few months ago but we actually were able to anticipate which of those formularies where there were shortages, so our local communities didn’t (suffer),” Shadwick said.
The price of nasal naloxone has come down significantly in the past several years from around $100 or $80 to $45 per kit, which contains two doses, said Dennis
Cauchon, founder and president of Harm Reduction Ohio. The price drop allowed states like Ohio to stock up on more nasal spray naloxone rather than the less-preferred injectable version, Cauchon said.
While Cauchon said Ohio’s Project DAWN is “arguably one of the best in the country,” others aren’t so lucky.
Although it’s not Harm Reduction Ohio’s primary mission, the nonprofit does try to help people in other states who struggle to get
ahold of enough naloxone kits. Just a few weeks ago, Cauchon said Harm Reduction Ohio gave a woman from North Carolina 25 expired kits, which studies have shown can still be effective at reversing overdoses and are better than not having naloxone at all.
“We encourage everyone, if you have expired or shortdated naloxone to send it to us,” he said. “Because we have sort of unlimited naloxone . ... We will send it to other states ... so that it
doesn’t go to waste.” Getting naloxone into Ohioans’ hands
While making sure there’s enough naloxone to go around is critical, figuring out how to get it into the hands of Ohioans who need it has proven to be another issue.
The FDA helped solve part of the problem in 2023 by making Narcan, the namebrand type of naloxone, available to be sold without a prescription over the counter in stores. But some Ohioans may be shy about purchasing naloxone at public stores and at $45 per kit, may also find the overdose reversal drug cost-prohibitive.
Around Columbus, vending machines with free naloxone aim to alleviate those issues, said Dr. Mysheika Roberts, Columbus Public Health commissioner. Vending machines are located at Equitas Health on Long Street, Huckleberry House on Kenmore Road, Community Medical Services on Dublin Road, at SAFER Stations on Park Avenue and at the Central Outreach Wellness Center on Broad Street. Naloxone is also available at Columbus Public Health headquarters on Parsons Avenue and via mail order, Roberts said.
“It’s a great service that we have and allows us to get (naloxone) to people who might feel a little uncomfortable talking to someone about getting what they need,” Roberts said.
Statewide, naloxone is also available to order for free by Ohioans at naloxone.ohio. gov, said Shadwick.
Ohio has also gotten very intentional about putting naloxone where it might be needed the most.
The state added so-called “Naloxboxes” at 49 college campuses, including in dozens of buildings at Ohio State University. When Recoveryohio began hearing from communities about how people were often overdosing at rest stops, Shadwick said they added the boxes to 65 rest areas along Ohio’s highways.
Some branches of the Columbus Metropolitan Library system also have the boxes on site.
“(We) wanted it in as many public locations as possible, just like you would have an AED in case someone would have a heart attack,” she said.
Limiting naloxone could mean ‘a lot of people will die’
Although naloxone has become a dominant tool in preventing more overdose deaths, it still faces politicization.
An Ohio sheriff in 2017 drew national attention for saying that his deputies would not carry naloxone. In Middletown, a council member also garnered attention when he suggested emergency workers should consider not carrying the drug.
Many in law enforcement, including Columbus police and emergency medical services workers, continue to carry naloxone on the job, and the state tracks the doses administered by EMS throughout Ohio. With 3,991 doses administered by EMS in 2023, Franklin County used the most doses, data shows.
“People living with the disease of drug addiction are still out there,” Roberts said. “There’s still a need for addiction services.”
If it weren’t for naloxone, Hunter said he wouldn’t be alive today, let alone be entering his sixth year of recovery and working to help others overcome their addiction at House of Hope in Columbus’ Victorian Village.
Hunter began taking oxycodone in 2009 after a doctor prescribed it to help him deal with pain from Crohn’s disease, an inflammation of the digestive tract. It took two or three years for Hunter to realize he was addicted to the drug and several more to get clean.
Even after the opioid epidemic has ravaged parts of Ohio, Hunter said he sees people on Facebook and other social media platforms saying things like addiction is “their choice” and “let them die.” He’s seen others argue about whether people should be allowed to use naloxone more than two or three times.
Although words like that are hard for Hunter to see, he said he chalks them up to coming from people who don’t have firsthand experience with addiction and who don’t understand how easy it is to get addicted. Still, he wonders what would have happened to him if thoughts like those about naloxone had prevailed.
“What if they said we’re just going to Narcan him once or twice and if you don’t come out of it, then that’s it?” he said. “If they put that kind of limitation on Narcan, a lot of people will die.”