It takes only seconds to open a box of Narcan, seconds to peel back the seal on the secondary packaging, and seconds to read the instructions. It takes even less time to decompress the nasal naloxone spray — an opioid reversal drug — in someone’s nose.
Those seconds add up to a handful of minutes, and as Prevention Coordinator at Chestnut Health Systems Randi Derrig puts it, “minutes can save a life.”
Just last week, it saved James' life.
“I’ve never needed it myself. I don’t use heroin. I’ve maybe used $20 worth in the last 20 years. A match head a couple of times here and there.”
While not a regular heroin user, the west Bloomington resident — whose last name is being withheld for privacy — overdosed on it last week.
“It was just literally the size of a match head,” he explained. “I woke up and heard that they had to use four of them.”
That’s four doses of naloxone — the medication in Narcan. Two were from James’ supply. Two from the EMS that were called in. Of the six Narcan doses, James didn’t administer any on himself. It’s not possible to do so. Someone has to be nearby to either inject intravenous naloxone or spray Narcan to reverse an overdose.
Luckily for James, there were others around, and he still had some Narcan from JOLT Harm Reduction in Peoria. He doesn’t keep it for himself. He doesn’t typically use opioids, but he does keep a supply in his house, offering it to anyone who might need it.
“It makes me feel good that I can help people because a lot of times family isn’t included in people’s lives when they’re using,” he said. “Obviously, because they’ve been shunned until they can get clean.”
James says he didn’t have a family of his own for a long time. He was taken from his mother at age five and grew up in foster care.
These days, the list of people who’ve been using James’ Narcan is growing. He says he’s been seeing it used more and more as of late.
“I have not really had a big dealing with it except for recently in the past six months maybe, and I’ve lost,” he paused, his eyes filling with tears before he restarted, “I’ve lost so many people.”
An opioid crisis
Experts say it’s no longer any one group that needs to have Narcan on hand. Everyone should.
“There's not a community that's not been touched,” said Sue Tisdale, a community educator for Trillium Place.
Trillium Place is one of the state’s Opioid Overdose Education and Naloxone Distribution programs, and it’s affiliated with Carle Health in Peoria. There are several in the state, all of which can provide Narcan free of charge to the communities they oversee.
Tisdale oversees McLean County, among other municipalities. She says overdoses are at an all-time high nationwide. She added that overdoses require a quick response for successful reversal, which naloxone — more specifically Narcan nasal naloxone — can provide.
“Naloxone is a medication that’s been around since the 1960s,” she said. “It is safe, it is as non-toxic as water if it is administered to someone that's not experiencing an opioid overdose, and everyone should be trained, educated and equipped,” she said.
Even in McLean County, where overdose deaths have been below 30 per year, county coroner Kathy Yoder said there may be an increase this year.
This increase is part of the reason JOLT Harm Reduction is trying to expand efforts in McLean County. Their outreach has previously been in Peoria — where they are based — and Tazewell County.
It is a Drug Overdose Prevention Program(DOPP) with the state. Through this enrollment, JOLT gets free Narcan to distribute around town, similar to Tisdale at Trillium Place but on a much smaller scale.
The closest place with free Narcan in McLean County would be Chestnut Health Systems — another DOPP — that provides Narcan to organizations including the McLean County Center for Human Services, as well as individuals.
How to use Narcan
Chestnut Prevention Coordinator Randi Derrig oversees the Narcan distribution. She also does monthly community-wide training on how to use Narcan and private training.
She also has a short five-minute training she can teach someone in a pinch. It starts with background on Narcan, explaining that it’s the nasal spray form of naloxone. She mentions where people can get Narcan, including Chestnut, and how easy it is to use.
“You can’t mess it up,” she said, adding that “the instructions are on the back of the box.”
In her training, Derrig also notes the signs of an overdose. She says a person “might be completely knocked out. They might be kind of dozing in and out. They might also have pinpoint pupils or very shallow breaths.”
The actual demonstration takes around 30 seconds. Just a half minute for Derrig to open the box of Narcan — though hers was already open, she mimed opening it — take out one of the two doses that come in every box, open the foil seal, take the small white applicator in her hand, lift it to an imaginary nose, and decompress the Narcan, which can be done with just the thumb.
One of the great things about Narcan, Derrig explains, is that it’s “pre-loaded” with the medication. As soon as it’s out of the package, it’s ready for use.
“You just push it in once,” she said. “All the medication comes out, and then it should be completely empty. At that point, you can throw it in the garbage.”
But once a dose of Narcan is administered, a person’s job isn’t necessarily done. Derrig said to immediately call 911 after the first dose, to stay by the person’s side, perhaps give CPR or rescue breaths, and monitor the person.
“With fentanyl in our drug supply, we're seeing that it does take multiple doses of Narcan to reverse an overdose,” she said.
That’s why Narcan boxes come with two doses of the medication. She said if two to three minutes after the first dose is administered the person doesn’t wake up and EMS isn’t there, to administer a second dose in the other nostril.
But after five minutes, EMS should be there.
“And then your job is done,” Derrig said. “So you've done everything you can at that point — giving the Narcan, starting CPR — and that individual can get further help.”
For people who don’t have the time for even this short five-minute training, Derrig said naloxone should be carried. She keeps it in her purse.
“You never know when you’ll encounter someone that might have had an opioid overdose, you don’t know if one of your loved ones might get confused with a medication and take too much of it even if it’s prescribed legally,” she said. “It’s just a very safe medication to have.”
Harm reduction goes beyond Narcan
But unlike Chestnut Health Systems or any other organization in McLean County, JOLT offers harm reduction kits. This means they provide clean syringes, sterile water, and other health tools for those who use drugs.
“Our goal is twofold,” explained JOLT Director Chris Schaffner. “It's to saturate the community, so just anybody in the general population that wants Narcan, we can give it to them for free, but also specifically putting it in the hands of … people who are using the kinds of drugs you can overdose and die from.”
Schaffner said JOLT does intensive outreach to find the people in communities who use drugs. And even afterward, to build rapport. In McLean County, they mainly do this through mobile outreach.
“A lot of times, it was just me driving around in my minivan, with the back of it loaded with resources for folks,” he said.
More recently, it’s been Nakota Facker — a full-time nurse in Peoria who also works with JOLT — in her silver Nissan Versa. She’s been doing this since March. Last Monday, she stood outside her trunk, taking inventory. Boxes and clear plastic bins are neatly stacked in the trunk and part of the backseat, filled with supplies.
There are the harm reduction tools for drug safety, which include both Narcan nasal spray and intravenous, or injectable naloxone. The latter of the two, JOLT buys out of pocket and hands out for free, as it’s not offered free by the state through DOPP enrollment.
In her trunk, there are also blankets, tents, hats, gloves, cleansing wipes, and other items for the unhoused population Facker visits regularly.
Facker typically visits McLean County twice weekly. She stops at a handful of locations to make drop-offs. She explained how she does the harm reduction work.
“We basically started with just going to places that we were told would have potentially encampments, and we kind of just met people,” she said. “And then every week, our outreach list grows more and more.”
Now, Facker has a handful of regulars in Bloomington-Normal that she visits both at encampments and homes. Not everyone JOLT Harm Reduction helps is unhoused, and not all of them use opioids. Their work is expansive.
When she arrives at a site, the first thing Facker does is say hello. She sits down and asks them how they’ve been. Sometimes, she hugs them.
“We're kind of there to reinstill that you deserve autonomy and dignity and you deserve to know that your life has meaning,” she said. “You are not disposable, that you are valuable.”
Monday was filled with lots of hugging. Facker didn’t know about James' overdose before she showed up. She assures that overdoses aren’t frequent.
“It's not every day that I come in, and I'm talking to a client who was just reversed the day before. I mean, it happens, but it's a reminder of why we do the work that we do,” she said.
This is so people like James feel supported and have access to the life-saving resources they need. Before leaving, Facker hugs James and tells him she loves him.
One of the other people Facker regularly visits is Amy, an unhoused woman who’s been staying in Normal. Her last name is being withheld for privacy.
Facker heard about where Amy was staying a few months ago and decided to stop by.
“She had talked about her boyfriend that uses opiates, and he is not an individual that initially I maybe would have formed a connection with, without her, and just showing up and being present there,” Faker explained.
Amy said that she is thankful for Facker.
“She has a relationship with me and a relationship with him, and a relationship with us, and so she brings things for us and she takes care of us,” Amy explained.
Since getting the Narcan from Nakota, Amy says she and her boyfriend have already had to use it.
“What I remember is I went to lay down, but what [my boyfriend] said was, I was talking to him, and suddenly just started convulsing and like foaming at the mouth,” she said.
Her boyfriend thought it was an overdose, so he acted. He used a box of Narcan — two doses — and called EMS. They came and gave her four additional doses.
Amy said they were all ineffective. She says she had taken opioids a few days prior, but she thinks it was a seizure.
But Amy says she’s thankful for her boyfriend’s quick thinking.
“[He] did absolutely the right thing with what he had on hand, and given the situation,” she said.
She added that she now knows what to do if her boyfriend has an overdose.
“I'm extremely grateful that I am more educated now than ever,” Amy said, breaking off at the end. “Don’t make me cry,” she says to Facker after a pause, as she wipes away a tear. Facker immediately leans forward and embraces Amy.
Facker has to depart soon after, to visit another of her regulars, who was in the hospital. She made a pit stop at Dairy Queen first to grab a frozen treat for him. He’d been requesting it. By the time she’s done with her check-ins, four hours passed. It’s a longer day for Facker, but well worth it.
Barriers to access, barriers to progress
Director of JOLT Harm Reduction Chris Schaffner said it’s situations like Amy’s and James’ that prove how important it is to get naloxone into communities.
“There's this myth out there, that first responders on the overdose crisis are law enforcement or EMS and that's just not true,” he said. “They do play a role in that, but the first responders are actually other people who use drugs.”
Andrew Kolodny, medical director for the Opioid Policy Research Collaborative housed at Brandeis University, said with the uptick in overdoses, anyone can be a bystander.
“There should be Naloxone available at the local Starbucks because there are people dying of overdoses in the bathroom at Starbucks and at other restaurants,” he said.
Kolodny said it should also be available at schools and universities. In McLean County, the school districts currently have or will have Narcan on site by 2024, per law. None of the districts plan to distribute Narcan, though District 87 in Bloomington and District 19 in Ridgeview are both DOPP enrolled, meaning they could.
Illinois State University stocks it for police, Student Health Services and Redbird EMS. Students are the only people able to get Narcan as individuals.
Police departments in Bloomington and Normal also carry Narcan.
But accessibility can sometimes be the bigger issue. The FDA made nasal Narcan available over the counter this year, so places can purchase a box — with two doses — for $45 each.
Schaffner says Narcan thus far has been associated with substance users. Reducing barriers to access helps reduce prejudice against people who buy it.
“It's on the shelf next to toothpaste and ibuprofen and other just run-of-the-mill daily medications that we all use, and to see it sitting up there almost normalizes it as well so it's not such a taboo thing to have,” he said.
But not all local pharmacies keep it on the shelves.
In Bloomington-Normal, it’s a mix. Some pharmacies still require a prescription. Of those that had it available for purchase without a prescription, some it on the shelves. Others put it behind counters, requiring customers to ask for it to make a purchase.
Schaffner, Derrig and Tisdale all recommended McLean County get a Narcan vending machine. This way, people can have 24-hour access to Narcan in a known location.
Derrig says Chestnut has been looking into it, but there is a cost barrier. The non-profit is continuing to look into it, though. Derrig says ideally there’d be one vending machine in Normal — probably near ISU — and another in Bloomington.
In the meantime, Andrew Kolodny of the Opioid Research Policy Collaborative warns against focusing solely on Narcan as a solution to the opioid crisis. He says this is a reactive measure and that McLean County — or any other county — should also have preventative measures.
“We have to treat people who are opioid addicted, and we have to prevent people from getting this condition in the first place,” he said.
Kolodny says doctors and dentists should be hypervigilant when prescribing opioids. He adds that the opioid treatment drug Buprenorphine — an opioid itself — should be more readily available. Buprenorphineis an FDA-approved drug for treating those who are already addicted to opioids.
Narcan, Kolodny added, is not going to have the greatest impact long-term.
“We have to keep doing the best we can with Naloxone, but it's really like sticking your finger in the hole in a dam,” he said.
For the current opioid crisis, Narcan is just the start. But to access it free in McLean County, contact JOLT Harm Reduction or Chestnut Health Systems.
Coming Thursday on Sound Ideas, find out what the McLean County Health Department is doing to increase access to Narcan in the community and what the county is doing with its share of money from a large settlement with drug makers.
