Over-the-counter naloxone products are now available at many nationwide pharmacies as of earlier this month. This also comes as a nationwide study from Stateline that reports accidental overdose deaths are the leading cause of death for people under 40 in 37 states, including Kentucky.
It says Kentucky’s death rate for those aged 40 and under has increased by 19 percent from 2018 to 2022, at a rate of 142 deaths per 100,000 of the state’s population. Half of those deaths are from accidental overdoses.
Van Ingram is the executive director of Kentucky’s Office for Drug Control Policy. He says one of the underlying causes is the proliferation of fentanyl, a man-made opioid that is cut into other drugs. The CDC says synthetic opioids like fentanyl are up to 50 times more potent than heroin. Ingram said that leads to a lot of problems.
“People who may think they're buying a prescription pill, people who may think they're buying cocaine or methamphetamine will often find fentanyl as an active ingredient,” Ingram said. “And that has really caused overdose deaths to increase.”
That’s combined with the effects of the COVID-19 pandemic and 2020 lockdown. As restrictions ended, Kentucky was one of eight states to report a major decrease in its total overdose deaths. There was a five percent drop in 2022 compared to the year before.
Kimberly Hines is a recovery coach at Voices of Hope, a Lexington-based nonprofit that focuses on harm reduction for those suffering from substance use disorder.
“I know people who had, you know, 18, 30 years of sobriety, and they weren't getting into meetings in person, they were doing everything online,” Hines said. “Their sobriety suffers too.”
COVID brought on several other underlying causes. It was more difficult for people to reach out to pain clinics and mental health resources, and the lack of regular wages meant more housing instability.
Holly Buchenroth is an assistant professor at Eastern Kentucky University’s Emergency Medical Care Program and previously worked at the Lexington Fire Department.
“The shelters closed down in Lexington for a period of time, and we didn't know what to do,” Buchenroth said. “Everything went into lockdown, and people were displaced. And they may have maybe fallen in with a different crowd and started picking up bad habits.”
From the first day of 2022 to September 15 this year, the Lexington Fire Department administered Narcan to 3,342 people. Of that number, 49 percent were under the age of 40.
“Because Narcan is so safe to give, even if opioids are not present, we often gave Narcan,” Buchenroth said. “But it still, I think, speaks volumes to how much we were seeing it.”
This month, Narcan has become widely available over-the-counter at chain pharmacies like Walgreens and CVS. Advocates like Buchenroth are completely in favor of expanded access.
“You've got the layperson now that can carry it, if you maybe are an addict yourself or have a loved one that's an addict, you can carry that Narcan and get it very readily now,” Buchenroth said.
However, there are concerns with cost.
“It’s expensive,” Buchenroth said. “Retailing now at $44.99. That's a lot of money for the average Kentuckian.”
And oftentimes, Buchenroth says it takes more than one dose to nullify the effects of fentanyl.
“When I first started my career as a paramedic, the dosage for Narcan was four milligrams,” Buchenroth said. “Routinely, I administered up to 10 milligrams of Narcan for an overdose.”
Pharmacists have traditionally been able to offer Narcan at lower costs through physician protocols or through insurance. Monica Roberts is a pharmacist who works with the University of Kentucky’s HEALing study, which helps provide naloxone access to the counties across eastern Kentucky that need it most. She said it’s possible to process that over-the-counter Narcan as a prescription, if insurance allows.
“It takes a little bit of time, they've got to kind of do the whole thing where they put it in the computer and bill your insurance and all that,” Roberts said. “But it is possible that that could save some folks some money if they're trying to access it.”
Roberts said if cost is a concern, it’s also a good idea to check directly with local county health departments or local nonprofits.
“Sometimes it's limited in the hours that you can get it,” Roberts said. “Sometimes it's limited to different programs. But that's probably where I would start is to contact the local health department and ask them because they would know what other programs exist as well.”
Overall, though, advocates like Starry Johnson, program coordinator at Voices of Hope, say the availability of more readily accessible life-saving drugs is worth every life they can save.
“That is something that's very close to my heart,” Johnson said. “I am a Narcan-crazy lady. I was Narcanned six times myself in active use, and I would not be here if it were not for Narcan.”
