The clear acrylic box mounted on the wall appears unassumingly plain to anyone who walks past.
But inside that container is a medication that could mean the difference between life and death. The box, called a NaloxBox, contains doses of naloxone, a substance that blocks the toxic effects of opioids and can save the lives of someone overdosing.
Those most intimately involved in Indiana’s opioid crisis see the NaloxBox as a vital tool in the continued fight against unnecessary deaths.
"Having it readily on hand, as opposed to having to wait for EMS to respond, is going to save time and have a great opportunity to save someone’s life," said Justin Phillips, founder of Overdose Lifeline, a nonprofit organization that helps people affected by addiction and substance use disorder. "It’s really dangerous out there right now, with practically anything anyone is misusing."
A new partnership between Overdose Lifeline and the state of Indiana will hopefully make naloxone more accessible to those who need it. The nonprofit organization, with support from the Indiana Family and Social Services Administration’s Division of Mental Health, plans to buy and install more than 200 NaloxBox units throughout the state, including at least one in every county.
Officials are accepting requests from community entities who want to place the boxes at accessible and highly visible areas.
“Our mission is to save lives from a disease that has devastated communities across our state,” FSSA Secretary Dr. Jennifer Sullivan said. “NaloxBoxes are just one innovative strategy we’re using to support Hoosiers with substance use disorders. By normalizing access to this overdose reversal tool, we’re reducing the stigma often associated with opioid overdose.”
In the struggle to reduce overdose deaths from opioids, naloxone has proven to be an incredibly effective tool. Also known by the brand name Narcan, the medication is an opiate antidote that reverses an opioid overdose.
When a person ingests a toxic amount of opioids such as heroin or prescription pills such as OxyContin, Percoce or Vicodin, their central nervous system and respiration system is depressed and breathing slows down or stops. Naloxone attaches itself to opioid receptors in the nervous system, blocks the effects of opioids and reverses the effects of an overdose.
Use of the medication in Indiana has increased every year since 2017, from 7,878 administered doses that year to 13,265. Johnson County reported 914 instances of naloxone use over the same time period.
Still, opioid overdoses are on the rise. Throughout Indiana, 816 people died in the first six months of 2020 after overdosing on opioids, 65% of the total number of opioid overdose deaths in 2019.
Increasingly, the powerful opioid fentanyl, which is 50 to 100 times more powerful than morphine, has been found in illicit drugs of all kinds.
"Even if you’re not misusing an opioid or don’t believe the risk of an opioid exists for you, if you’re purchasing drugs from someone on the street, there is a chance there is going to fentanyl in it, and that the potential for overdose exists," Phillips said.
Since it was founded in 2014, Overdose Lifeline has worked to distribute and train people on the use of naloxone. Phillips founded the organization following the death of her son, Aaron Sims, of an overdose in 2013. Their mission is helping individuals, families and communities affected by addiction and substance use disorder, particularly issues involving opioids. The group focuses on advocacy, education, harm reduction, prevention and support.
Increasingly over the past five years, Overdose Lifeline has worked closely with state officials on naloxone initiatives. In May of 2020, Gov. Eric Holcomb announced a collaboration with the organization to fund a nearly $1 million distribution of the medication throughout the state.
The NaloxBox program is an addition to that collaboration.
“Making overdose response tools like naloxone readily available to any Hoosier who may encounter an individual suffering from an overdose is critical in addressing the drug epidemic,” Holcomb said in a statement. “We’re committed to raising awareness about the need for bystanders to carry this lifesaving drug, which is why we’ve made it available via so many avenues, oftentimes at no cost to Hoosiers.”
One of the overwhelming benefits of the unlocked NaloxBox is that it is available any time, 24 hours a day, Phillips said. Most doses of naloxone are kept at pharmacies or agencies working with those in recovery. If an individual is concerned about themselves or a loved one and want access to naloxone, they often have to go to a local health department, go to a pharmacy or reach out to Overdose Lifeline or one of its participating partners.
But each of those options has barriers, from limited hours to the stigma attached to asking someone else for help.
"A NaloxBox is essentially no barrier, other than you have to get to a box," Phillips said. "You don’t have to be worried about judgment, because you’re not going to have to interact with anyone and you can go there any time of the day or night."
After being introduced to the NaloxBox concept, Phillips and Overdose Lifeline prioritized spreading these containers throughout the state. Indiana officials supported the effort. Overdose Lifeline negotiated to purchase 215 boxes for $58,200. That money comes from the state opioid response grant, awarded to Indiana by the federal Substance Abuse and Mental Health Services Administration.
In distributing these boxes, Overdose Lifeline is working with a network of 35 community partners to find appropriate locations. The goal is to find community advocates who are already addressing substance misuse in their own areas, Phillips said.
Considerations for placing the boxes include places where naloxone use and EMS response for overdoses is heaviest, as well as in neutral locations where people would not feel fear or concern about going to get the medication, Phillips said.
Since the NaloxBox partnership was announced last week, more than 50 groups have requested a container. Phillips expects more to come.
"We’re collecting those right now, but we’re really being strategic about choosing the partner and having them work with us to chose that location," she said. "The community advocates know their communities better than we do."
