Alaska saw a major spike in opioid overdose deaths. Naloxone is a key part of the strategy to prevent more.

PALMER — At all times, Kurt Hoenack has a naloxone overdose kit packed in the trunk of the car he uses to transport clients, ready to save a life at a moment’s notice. The employee at MyHouse shelter for homeless youths in Palmer carries a kit even when he’s not working.

The unassuming bag contains two doses of naloxone nasal spray — also referred to by the brand name Narcan — that can quickly reverse the effects of an opioid or heroin overdose even after someone has stopped breathing. The kit also includes test strips that can help users determine whether a substance contains highly potent fentanyl, plus gloves and a face shield for safely administering CPR.

The pack in Hoenack’s truck is one of thousands of free kits that have been distributed or will be soon by the state’s Project HOPE as a key part of Alaska’s strategy to prevent overdoses.

This year, employees and volunteers with the state program assembled and distributed 12,000 of the kits to numerous agencies, public health centers, public syringe exchanges, individuals and nonprofits. Currently there are enough supplies for about 12,000 more, said Theresa Welton, a section chief with the Office of Substance Misuse and Addiction Prevention.

Welton and others involved in overdose prevention efforts say the state’s strategy of distributing as many kits as possible — while educating Alaskans about the dangers of counterfeit pills that too often look like blue, doctor-prescribed Oxycontin but are laced with a deadly dose of fentanyl — has become increasingly important as Alaska’s overdose rate has risen sharply to among the highest in the nation.

Alarming numbers

According to preliminary data from the federal Centers for Disease Control and Prevention, between February 2021 and February 2022, Alaska reported the largest increase in overdose deaths of any state by a significant margin.

While the country as a whole saw a 6.2% increase in overdose deaths during that time period, Alaska experienced at least a 69% jump, according to the CDC. In 2021, 245 Alaskans died from drug overdoses compared to 146 in 2020.

This year is on track to be just as deadly. Between January and March 2022 there were 51 overdose deaths reported in the state compared to 54 in the same period of 2021, Welton said.

“These numbers are are alarming and concerning,” she said.

It’s difficult to track how well Narcan kit distribution is working to prevent overdoses in the state because agencies and individuals aren’t required to report when it is used. Still, the state has tracked at least 300 instances of a life being saved with naloxone from 2017 to 2020, and the department has distributed over 50,000 doses of the treatment during that time frame, Welton said.

Hoenack said that anecdotally, it’s hard to measure the effectiveness of the strategy because of the shame and stigma associated with addiction — but he has no doubt that it has saved lives.

“It’s like with the suicide prevention stuff: If you succeed at suicide prevention, you might never know,” he said.

The clients he sees are usually open about their substance use only after they’re in recovery, and he rarely hears stories about the Narcan he distributes being used. At times, it can feel like a last resort rather than a solution, but he still has faith it’s doing some good.

“It’s definitely a Band-Aid solution,” Hoenack said. “But you know, the hope is that we can catch people wherever they’re at — and if they’re in the middle of active addiction, and they need a Narcan kit, we can do that. If they need to be educated about the dangers of fentanyl, we can do that. ... It’s just meeting them where they’re at.”

[Alaskans can now dial 988 to access a suicide prevention hotline]

Outreach far and wide

Denise Ewing’s eldest son, Gabe, died of fentanyl poisoning in January.

“He had taken some drugs that he did not know had fentanyl in it,” Ewing said. “He was using alone, so there was no one there to help provide him with any naloxone or any care.”

Since her son’s death, Ewing, who works as a public health nurse in Sitka, has been helping educate the thousands of seasonal workers who arrive each summer to work on fishing boats and in processing plants about the dangers of fentanyl and how to prevent an overdose. She’s calling the outreach Project Gabe.

“I started going to the new-employee orientations, as well as teaching the masses that came in for seasonal employment, about naloxone, about what opioid misuse looks like, about emergency situations and what you do, and how can you help,” she said.

The signs of an opioid overdose include unconsciousness or inability to wake up, limp body, falling asleep, slow or irregular breathing or heartbeat, and cold or clammy skin. Knowing those signs, carrying Narcan in case a loved one overdoses, never using alone and testing substances for fentanyl can help prevent overdoses.

Ewing said the boat captains she’s met have been enthusiastic about carrying Narcan and knowing how to administer the drug — which is especially important in situations where crew members are far from shore and prompt medical care.

Hoenack, with MyHouse, said he gets a mix of people requesting naloxone for themselves and those wanting it for their loved ones. Hoenack himself carries a kit around even when he’s not working in case a loved one needs his help.

“I carry it because it’s like, well, that’s where we’re at now,” he said. “We just got to be able to respond to whatever happens.”

‘It’s saving lives’

Last year, six out of 10 overdose deaths in Alaska were linked to fentanyl, according to Dr. Anne Zink, Alaska’s chief medical officer.

Fentanyl is so deadly because of how potent it is, and how small the margin of error is for a deadly dose. The synthetic opioid is often laced with other counterfeit pills or drugs. Many who have died from it may not have known fentanyl was involved — which is why some advocates refer to deaths caused by fentanyl as poisonings rather than overdoses.

During a recent interview, Michael Troster, executive director of Alaska’s High-Intensity Drug Trafficking Area taskforce, held up a small packet of sugar — about a gram — to illustrate a point.

“If that were heroin, that might kill you,” he said. “If that were fentanyl, that could kill 500 people.”

Troster said that part of the reason Alaska’s overdose rate increase was so high last year was that the state took a bit longer than the Lower 48 to see the devastating impacts of fentanyl that other states saw in 2020.

“If you look at where the Lower 48 was maybe 18 months ago, that’s where Alaska is today,” he said.

Troster said one challenge he’s encountered is an “ignorance factor,” such as a perception among some who think that offering Narcan is enabling drug use.

But the way he sees it, saving someone’s life gives them a chance at recovery — it’s something he once heard from Sandy Snodgrass, an Anchorage mother who lost her 22-year-old son, Bruce, to fentanyl last year.

“She said fentanyl kills you before you have a chance to recover. I thought that was profound,” Troster said.

More broadly, there are three components to Alaska’s efforts to reduce drug trafficking and overdoses, Troster said: demand reduction, treatment and enforcement.

“We think of, like, a three-legged stool. If one of those legs is overemphasized or underemphasized, then the whole thing sort of tips,” he said.

But administering and distributing Narcan overlaps with all three tiers — police and other officers carry Narcan, and teaching Alaskans how to use and the importance of carrying the lifesaving drug is a form of both treatment and education. Narcan is an important piece of the puzzle.

“It’s saving lives,” Troster said. “I don’t think there’s any other way to say it.”