Casey Johnson stepped into the bathroom of a Westport bar recently and immediately sensed something was off.
She saw two still legs and hair grazing the floor in a neighboring stall.
Johnson knocked on the stall door. She yelled. But when Johnson got no response, she grabbed the naloxone she always carries, crawled under the stall and found a person struggling to breathe.
The nasal spray Johnson used next saved the person’s life.
Naloxone, sold under the brand name Narcan, offers an over-the-counter medication that rapidly reverses the effects of opioid overdoses. Addiction experts and health care workers contend the medication should be in every medicine cabinet, first aid kit and purse. It should also be in the room anytime someone is using opioids.
“We want naloxone in everyone’s first aid kit, absolutely,” said Johnson, a harm-reduction specialist at First Call, a Kansas City nonprofit focused on helping people struggling with drug and alcohol addiction. “More importantly, we want naloxone present at every single overdose.”
Despite efforts to make Narcan much more widely available, addiction experts in Kansas City say lifesaving medication gets tucked away in medicine cabinets, at health clinics or on store shelves where it goes unused.
Meanwhile, outreach programs struggle to get the medication in the hands of drug users.
“Naloxone should never be sitting on a shelf long enough to expire,” said Johnson, who is recovering from an opioid addiction. “Every overdose death is preventable, but people need access to … naloxone.”
The stakes keep climbing amid a national addiction epidemic and, in recent years, the spread of drugs made far more lethal by tiny traces of fentanyl. The drug is up to 50 times more potent than heroin and 100 times stronger than morphine. Across the United States, fentanyl claims an increased share of overdose deaths and drives up the number of drug overdose deaths.
In 2022, 72% of Missouri’s 2,180 overdose deaths involved synthetic opioids such as fentanyl. The state says those same types of drugs accounted for nearly half of 1,366 overdose deaths in 2017. In Kansas, fentanyl and other synthetic opioids accounted for 56% of the state’s 738 drug overdose deaths in 2022, compared with less than 10% of the 326 overdose deaths in 2017.
A dose of naloxone, delivered as a nasal spray or with a syringe, offers the most effective way to save a person whose heart or breathing has stopped following a potentially fatal dose of an opioid like fentanyl, heroin or a prescription pain drug like OxyContin.
Given quickly enough, naloxone effectively reverses opioid overdoses. And it’s safe. It’s been around for 50-plus years. Give a dose to somebody who’s not overdosing on opioids? No harm done.
“We know naloxone is a safe way to save a life,” said Chrissy Mayer, chief community-based services officer with DCCCA, the Lawrence-based nonprofit that distributes naloxone kits for free by mail throughout Kansas. “It is a very neutral drug.”
In a 2020 advisory, the U.S. Centers for Disease Control and Prevention urged public health departments, health care providers, addiction specialists and others to stock up on naloxone and get it where it can most likely save a life.
The Substance Abuse and Mental Health Services Administration, the federal agency that spearheads public health outreach, has increased funding for naloxone, fentanyl test strips and syringe programs. Programs to supply clean syringes to drug users remain illegal in Missouri and Kansas, but fentanyl test strip distribution became legal in both states in 2023.
The U.S. Food and Drug Administration made naloxone available without a prescription for the first time in March, when it approved the Narcan 4 mg nasal spray for over-the-counter sales. Then in July, the agency gave the same nonprescription status to RiVive, a generic 3 mg naloxone spray.
The move opened the door for pharmacies, convenience stores, gas stations, grocery stores and bars to keep naloxone handy. It also made it possible for a recent push in Kansas City to put Narcan on the street where anyone can find it.
Care Beyond the Boulevard, a nonprofit that provides health care to homeless people in Kansas City, purchased 30 Narcan dispensing boxes that look like newspaper boxes and placed them throughout the community. Since last summer, boxes have been installed at public libraries, fire stations and other publicly accessible locations.
The grant funding used to buy the boxes could not be used to stock them, so Jaynell Assmann, a nurse practitioner who founded Care Beyond the Boulevard, is working with other organizations to fill the boxes with naloxone.
Keeping them full, some addiction experts worry, may be a challenge given the short supply of free Narcan. But leaving them empty, they worry, could be worse than not having the boxes at all.
On a recent morning, the dispensing box inside the foyer of the Kansas City Health Department was down to two Narcan kits. Johnson said she’s never seen that box fully stocked.
Inside the health department, past a reception desk and security guard and up a flight of stairs, another dispenser was more fully stocked with boxes of Narcan nasal spray. But addiction advocates worry that many drug users would not be comfortable making their way that deep into a government building.
If someone who needs naloxone finds the dispenser just inside the health department’s door empty, or any of the free dispensers around town, Johnson said that could create a dangerous situation by eroding people’s trust that they can find it in an emergency.
But cost matters. And although federal regulators opened naloxone for anyone to buy, the purchase price can limit the availability.
At a retail pharmacy, a two-dose box of nasal naloxone can run $47 to $100. The name-brand version Narcan could cost as much as $146 for a two-pack. Some insurance plans cover the drug, but coverage varies. That means even someone with health insurance might have a hard time affording the overdose-reversal drug.
Nasal naloxone is a newer formulation of the drug, which makes it more expensive, experts said. And it’s manufactured by only a handful of companies, limiting price competition.
“Pharmaceutical companies have to make money,” Assmann said. “We can’t pretend they should not be making money. But there should be a limit on what — for a lifesaving drug — they can charge.”
Injectable naloxone only costs about $3 for two doses. But that form of naloxone involves filling a syringe and injecting the medicine into someone’s muscle. That creates a higher barrier for many people to feel comfortable using it. And even though needles used for the medication could not be used for illicit drugs, some organizations want to avoid sending any needles out into the world.
Johnson insists the more affordable injectable naloxone can best increase supplies. But even FirstCall, which is on the front lines of treatment, runs into bureaucratic barriers related to injectable naloxone. FirstCall employees can distribute injectable naloxone, but for liability reasons, they can’t administer it, Johnson said.
Mayer said DCCCA in Kansas was “not comfortable” sending needles to people.
Residents can request free naloxone kits by mail in Missouri through MoNetwork, which will send nasal or injectable naloxone, and in Kansas through DCCCA, which provides only nasal spray. Free doses are available at health departments and other public locations, like libraries across Kansas City. And organizations like Confluence HRKC, a harm-reduction collective, deliver naloxone and other supplies around Kansas City. The nasal spray will remain effective unopened for three years.
Still, health advocates caution that naloxone costs money even when it’s given away.
FirstCall has always made providing free doses of naloxone a priority, Johnson said.
“You can text my Google phone number, and I will deliver it. No questions asked,” she said. “You can show up to our office and request it. No questions asked. You can receive it at any community event we’re at.”
But the free doses FirstCall was getting from the Missouri Institute of Mental Health have dried up. FirstCall is still purchasing naloxone with money from SAMHSA and money set aside in its own budget. But those sources have limits. FirstCall can buy doses for a discounted bulk, nonprofit rate, but that rate is still costly — around $45 for two doses.
“We’ve never had enough naloxone,” Johnson said.
Between July 2020 and December 2022, the Missouri Institute of Mental Health supplied more than 29,000 naloxone kits to agencies in Jackson County, 1,059 in Clay County, 316 in Cass County and 45 in Platte County.
Last year, DCCCA Inc., the Lawrence-based nonprofit agency that distributes naloxone kits across Kansas, mailed just over 4,000 to Sedgwick County, 2,800 to Johnson County, 1,900 to Douglas County and 1,300 to Shawnee County. Saline, Wyandotte and Leavenworth counties each received around 1,000 kits.
More people are getting the message that they need to have the medication on hand, Mayer said.
“Anyone who is at risk for overdosing should have naloxone,” she said. “If you have an opioid in your home, you’re at risk.”
While the urgent need is to get naloxone to drug users, it’s also important that the medication be available to people prescribed opioid pain medication in case they accidentally take too much. The CDC recommends that health care providers offer naloxone to any patients receiving an opioid prescription, particularly those at increased risk for opioid overdose.
But in reality, the agency estimates that is only happening with one in 70 high-dose opioid prescriptions.
Mayer said DCCCA has heard from family members who say they administered Narcan to a grandparent who mixed up pain medication and accidentally overdosed. It can happen to anyone, she said.
“If someone gets a pain reliever after hip surgery or after having their wisdom teeth out,” Mayer said, “they should also get naloxone.”
Accidental overdoses are a serious concern, health experts said. In November, the Missouri Child Fatality Review Program state panel released a report that revealed 43 children — including 10 under the age of 5 — died of fentanyl poisoning in the state in 2022. Thirty-two of those deaths were ruled accidental, up from four in 2020. The review program, which falls under the Missouri Department of Social Services, is considering how to address the trend, said Terra Frazier, a child-abuse pediatrician at Children’s Mercy Hospital who chairs the panel.
Kansas City Mayor Quinton Lucas has also been pushing efforts to study the issue of fentanyl overdoses. In November, he announced an overdose fatality review board to analyze fentanyl-related deaths and said the city’s health department would hire two investigators to investigate overdose fatalities.
Meanwhile, some groups that focus on harm reduction — helping drug users get supplies like naloxone to stay alive while they’re using — say too many bureaucratic obstacles still get in the way.
In Kansas City, a harm-reduction advisory committee formed this summer wants to remove some obstacles by working directly with drug users to find out how resources can best be deployed to help reduce opioid deaths. The task force includes a handful of treatment professionals but is driven by drug users.
“There’s a lot of needed attention on the subject right now,” said Melissa Smith, director of population health at KCCare Health Center in Kansas City, one of 25 organizations in the country to win the SAMHSA grant for harm-reduction efforts. “But we need to make sure that we’re listening to the voices of people who we are trying to help.”
Resources
- How to use naloxone nasal spray
- How to use injectable naloxone
- Missouri map of free doses of naloxone
- CDC information about fentanyl
- SAMHSA opioid overdose prevention tool kit
- CDC tips for recognizing an overdose
- Missouri resources
- Kansas naloxone request form
- Missouri naloxone request form
This story was originally published by the Kansas City Beacon, a fellow member of the KC Media Collective.
