The state of Indiana is dedicating tens of thousands of federal dollars to making naloxone, the opioid-involved overdose reversal medication, publicly available every day and around the clock.
On February 5, Governor Eric Holcomb announced that the state will be partnering with the harm reduction nonprofit Overdose Lifeline to bring NaloxBoxes—hard acrylic boxes that can be mounted to an exterior wall—to all 92 Indiana counties. Every NaloxBox will contain between six and eight naloxone doses and treatment referrals, and volunteers will monitor the need for refills. Overdose Lifeline will be purchasing 215 units and shipping from the manufacturer for $58,000 through funds from the federally-administered State Opioid Response grant.
For Justin Phillips, Overdose Lifeline’s executive director, the expansion could be a game-changer. “We know individuals who are actively using will not always feel comfortable reaching out to an organization and if they are comfortable not all safe places are available 24 hours a day, seven days a week. These boxes will remove any barrier that exists with the exception of transportation,” she told Filter. NaloxBoxes will be strategically placed, according to Phillips, mostly in “areas where we can track high incidence of EMS response to overdose” and “high areas of need.” A confirmed list of locations is not yet available.
Another naloxone expert from the state believes this is an important step towards making availability universal. “In the long term, we need to have naloxone available in every AED kit, in every first aid kit, and easily accessible to all community members,” Christopher Abert, founder of Indiana Recovery Alliance and now executive director of Southwest Recovery Alliance in Phoenix, Arizona, told Filter. “NaloxBox moves us a little closer to that goal.”
An Indiana public health official hails the program’s potential to advance the dignity of people who use drugs. “NaloxBoxes are just one innovative strategy we’re using to support Hoosiers with substance use disorders. By normalizing access to this overdose reversal tool, we’re reducing the stigma often associated with opioid overdose,” said Dr. Jennifer Sullivan, secretary of the Indiana Family and Social Services Administration, in the Governor’s press release.
Overdose Lifeline has been making naloxone more accessible since 2015, around the time when fentanyl started proliferating in markets across the country. In part as a result, overdoses have sky-rocketed to ever-more-historic highs, and it’s only getting worse during the COVID-19 pandemic. Between June 2019 and June 2020, the state’s drug users faced a 26 percent increase in fatal overdoses, a rate well above the nation’s average increase of 21.3 percent, according to the latest federal data.
In light of the outbreak in May 2020, Governor Holcomb gave them almost a million dollars to boost the naloxone supply available to communities. Within eight months, the group reports on their website that they’ve distributed 22,000 doses.
The Office of Governor Holcomb is framing the effort, in part, as a way to relieve mounting pressure on the Indiana health system amid COVID-19. Increasing administration of naloxone by emergency medical service (EMS) responders and the “limited access to resources” by under-capacitated local public health departments licensed to distribute naloxone are cited by the press release. “The state’s partnership with Overdose Lifeline, Inc. allows local health departments to devote their resources to the COVID-19 public health emergency,” stated the Office, which didn’t respond to Filter‘s request for further comment.
Community administration of naloxone could also help people who use drugs steer clear of encounters with EMS responders and the police. Since at least the early days of the pandemic, law enforcement have been criminalizing overdose survivors or abandoning those yet to be revived. In February, an Indiana county prosecutor was revealed by Filter to be exploiting naloxone-based overdose reversals to criminalize survivors. Then in April, a different county’s police department was refusing to administer naloxone out of fear of COVID-19 transmission, despite public health agencies advising otherwise, as Filter reported. The inventor of Narcan, an intranasal naloxone brad, even denounced the policy.
Correction: Filter misgendered Justin Phillips. It’s now changed. We sincerely apologize for our assumption.
Photograph of a NaloxBox courtesy of NaloxBox.org