Christy Couvillier knows the sensation well. Waves of heat overtake the senses. Breathing slows. If her breathing stopped, her body would fail. But a dose of naloxone administered to Couvillier, a recovering opioid addict, prevented that overdose from killing her. She could breathe again.
Couvillier is now six years sober, which she attributes to the second chance naloxone gave her. She now leads the Lafayette chapter of Millie Mattered, an opioid crisis advocacy organization.
Naloxone, also commonly referred to by the brand name Narcan, is becoming more available in Lafayette through the efforts of advocates like Couvillier and public health agencies. Access appears to be having an impact, dropping the rate of overdose deaths locally. But hurdles remain in the supply chain, keeping the overdose-reversing drug from wider availability. Those fighting the opioid crisis hope to change that.
The stakes are high, Couvillier says. Her own son, Hunter Cleamons, died from overdose. It’s what spurred her to advocacy: to spread naloxone as far and as wide as she could.
“There would be so many dead people,” Couvillier says. “I couldn’t even imagine a world without [naloxone].”
This year, Lafayette saw a peak of 21 overdose deaths in April, data from the Lafayette Parish Coroner’s Office shows. In July that number dropped to eight deaths. The drop is most likely because of more ready access to naloxone, says Keith Talamo, chief medicolegal investigator at the coroner’s office.
“It could be because of Narcan, getting [Narcan] to people sooner and public awareness because right now, public awareness is huge,” Talamo says.
The turn is encouraging, but the scale of the crisis remains daunting. Overdose deaths in Lafayette Parish increased more than 300% between 2015 and 2021. Of the 137 deaths in 2021, 73% of those came back positive for fentanyl, a powerful synthetic opioid.
If trends continue, Lafayette will have 140 overdose deaths by the end of 2022, Talamo says, still a very high number. Before the decline in month-by-month deaths, Lafayette Parish was on pace to exceed 200 fatalities, recording 67 overdose deaths between January and April.
Naloxone was first brought to market as a nasal spray, under the brand name Narcan, debuting in 2015. The active drug locks onto brain receptors to quell the effect of opioids temporarily and buys time for emergency responders to arrive and stabilize the patient.
In the past, there was virtually nothing a bystander could do for an overdose victim, besides making sure they didn’t drown in their own vomit. The drug is easy and safe to administer, equipping anyone with the power to save a life even if they don’t have medical training.
Naloxone’s effect lasts only 30 to 90 minutes. If opioids are still present in the system, the overdose can continue. It’s crucial for victims to get to treatment immediately after taking a dose, health officials say.
Despite its limitations, it’s been a game changer, Couvillier says. She has “Narcan’d” several people over the past few years and advocates that everyone should carry a kit with them everywhere. It can give an overdose victim a chance to seek treatment, she says.
“You’ll hear the argument: [but] Narcan doesn’t treat the problem,” Couvillier says. “It just enables them to breathe just like every human has the right to be able to breathe.”
Harm reduction is the term most experts use for this approach. And it’s not without some controversy. Critics say harm-reduction strategies enable addiction. Harm-reduction advocates like Couvillier say the problem is availability. Overdoses are skyrocketing, and communities need all the help they can get to stop the fatalities.
Couvillier’s advocacy has had an impact. Earlier this year, she gave Jay Brookes four doses of Narcan to hold on to. Brookes hoped she would never have to use it. But one night, the call came.
“I got a call at 10:30 [p.m.],” Brookes says. “I needed to go down the street with Narcan because somebody was overdosing, and they didn’t know how to use it. She’d been unresponsive for 20 minutes.”
Brookes Narcan’d her. The victim survived.
“It is scary. But in the moment, I wasn’t thinking about any of that,” Brookes says. “I just needed to be there for her. The next day, it really took its toll on me.”
Brookes went on to create Harm Reduction Hotties and now works alongside Acadiana Harm Reduction, a group of volunteers who distribute naloxone. Grassroots organizations like these bridge some of the gaps that have limited the distribution of naloxone.
Naloxone is available without a prescription, but it can be expensive. Patients on Medicaid can get it free under a standing order of the Louisiana Department of Health. But many want to avoid the stigma of buying an overdose drug in public.
Accessing naloxone in bulk for organizations like Harm Reduction Hotties is challenging, too.
The supply available for local organizations isn’t enough, even when you add in what state government has. LDH has distributed more than 30,000 Narcan kits statewide, says Quinetta Womack, director of substance use disorders at LDH.
Fentanyl, the powerful synthetic opioid, is the leading cause of overdoses, and it’s also among the hardest overdoses to reverse. That late-night call, Brookes says, was for an opioid-related overdose. And it took all four naloxone doses to revive the victim. Multiply that by the roughly 1,000 overdoses happening each year in Louisiana, and it’s easy to see how state resources are stretched thin.
“We don’t have enough funding to supply Narcan to the entire state of Louisiana,” LDH’s Womack says. “We do have to be strategic with our partners and our dissemination plan.”
In Lafayette, LDH works with the Acadiana Area Human Services District to stockpile naloxone. From there, it’s up to locals to make distribution happen. For the most part, that means supplying first responders and law enforcement agencies with kits and bringing what they can to community events.
Funding is a problem up and down that supply chain. The human services district uses a lot of its resources to get Narcan to local emergency services and education institutions, says Executive Director Brad Farmer.
“[The struggle is] looking for funds so other entities may be able to afford their own Narcan. It just isn’t readily available,” Farmer notes. “An organization may have the Narcan, but is it in the hands of the people that need it, and when they need it? That’s an ongoing concern as well.”
LDH is working on a plan to streamline the process of obtaining Narcan, according to Womack.
A “hub and spoke” model will create a centralized hub, served by an online platform, where anyone can register to become a distributor if they meet eligibility criteria. (Eligibility criteria have not been finalized.) The hope is to create a network of distributors throughout the state besides local governments and other public agencies, Womack explains.
“The premise of the hub and spoke is to have more availability at the local level through the main hub so that they’re not all having to go through our offices or [local governments] to order,” says Dr. Leslie Brougham Freeman, director of prevention services at LDH. “The hub is going to be able to provide it because they have direct access to Narcan.”
The drug may have its limitations, but it can keep people alive. Expanding access to naloxone and other harm-reduction strategies can mean the difference between life or death, advocates and officials agree.
“Harm reduction allows us to meet them where they’re at. We’re not judging them,” Brookes says. “We’re showing up in a way that nobody else is, and when they’re ready, the resources are available.”