A synthetic opiate called fentanyl is behind a surge of drug overdoses in Alaska. As a result, overdoses in the state have become so deadly that one of the tools used to fight them has changed.
Naloxone is an overdose reversing drug that’s found in opioid emergency kits distributed by the state to places like the Glory Hall, Juneau’s homeless shelter. The shelter had been short on what people casually call Narcan kits — Narcan is the brand for naloxone — for the last several weeks. Luke Vroman and other harm reduction advocates in Juneau were starting to get worried.
But last Friday the shelter received a battered cardboard box filled with new kits. This fresh shipment didn’t contain Narcan at all. It was full of a new brand called Kloxxado that has twice as much naloxone in each dose. This box has fifty kits in it — that’s 100 doses of naloxone.
“It comes with two, so it’s like four of the old ones,” said Vronan as he unzipped one of the kits. “Which is good because it is taking more than one for people, you know.”
If you haven’t seen naloxone before, it looks kind of like that allergy spray that goes up your nose. Except instead of reducing sinus inflammation, it blocks or reverses the effects of opioids.
Vroman said it takes a lot more to bring people back from an overdose now that fentanyl is in most of the drugs around here. He’s seeing the effects at the shelter.
“I’ve worked with Glory Hall for two and a half years, and in the last year, I’ve seen 300% more overdoses,” Vroman said. “None of them deadly, thank God. But yeah, just a lot more overdoses.”
Fentanyl is more deadly than heroin because it’s a lot stronger and can precipitate an overdose in really tiny amounts. It exists because there are medical applications for fentanyl where those tiny doses are closely monitored, but it’s really dangerous on the street where there’s no oversight.
Getting that increased dosage of naloxone is part of why these emergency kits were so scarce for awhile — and not just in Juneau, but across the state.
Karol Fink, a leader in the chronic disease prevention section of the state’s health department, oversees the state’s supply of free naloxone through a program called Project HOPE.
“About mid February, we were being cautious with the amount of naloxone we sent out to our partners,” she said. “We ran out probably in early March.”
She said finding a higher dosage of naloxone meant the state had to renegotiate with vendors, which took time.
“We also didn’t realize how quickly we were going to run out because there was a surge of opioid deaths in the Mat-Su area, and that really brought attention to the issue,” said Fink.
That meant there was an increase in demand for the kits. Fink said the new shipment of naloxone arrived earlier this month, and the program packed up thousands of new kits to distribute across the state.
They’re needed. Nearly 300 Alaskans died of opioid overdoses last year, and most of those deaths involved fentanyl.
“From a public health perspective, this is unprecedented. And the state of Alaska and health officials, we are very concerned,” she said.
It’s not slowing down, either. The state’s drug task force seized twice as many grams of fentanyl in the first three months of this year than it did in all of 2021.
And, to be clear, the shortage was just of that free naloxone through Project HOPE. People could still get the drug with a prescription.
Dolores Van Bourgondien, a nurse at an addiction treatment clinic in Juneau, traced the explosion of fentanyl in Alaska back to about a year ago. Over the course of two weeks last April, the number of her patients with fentanyl in their urine went from 2% to nearly 14%. She said now it’s more than half.
“What we’re seeing on the street, what we’re seeing in our toxicology, what we’re hearing from our patients, okay, preempts anything that comes out kind of publicly,” she said.
She said naloxone and things like recent drug busts across the state help slow deaths down, but the pace is relentless.
“I think everybody’s who’s involved in this, we — you just feel as if you’re paddling upstream, you’re not making any headway,” she said.
Naloxone is only a short-term fix to the most acute symptom of addiction. It gives people like Van Bourgondien time to connect people who use drugs to the other resources they need for long term recovery — things like treatment, housing and access to mental health care.