Get your Narcan! Old newspaper boxes are being used to distribute overdose medication

CHARLESTON, West Virginia – For decades, Jeff Card's family business was known for producing the once ubiquitous tin cans in which people could buy newspapers on the street.

If you reach into one of its containers today, you might find something completely different and free: naloxone, the drug used to treat an opioid overdose.

Since the U.S. Food and Drug Administration approved over-the-counter sales of the drug over a year ago, more and more naloxone distribution containers have been popping up across the country. Naloxone, a nasal spray commonly known as Narcan, is used as an emergency treatment to treat drug overdoses.

Such boxes – which are located in neighborhoods, outside hospitals, health departments and supermarkets – are a way for advocates for people with substance use disorders to make Narcan, which costs about $50 over the counter, available to those who need it most. Similar to small free libraries that hand out books to anyone who wants one, the metal boxes, once used as newspaper bins, are unlocked and do not charge a fee. People can take as much as they feel they need.

Proponents say the containers help normalize the use of the drug – and are evidence that the stigma surrounding its use is steadily decreasing.

Sixty Narcan containers were distributed in 35 states in honor of Save a Life Day on Thursday – a naloxone distribution and education event launched in 2020 by a West Virginia nonprofit. The containers were purchased from Card's Texas-based Mechanism Exchange and While Repair still serves newspaper customers, it has expanded its production to other products in light of the decline of the newspaper industry.

“It's a blessing and a misfortune,” said Card, who began making the Narcan containers more than two years ago. “For us, it's fortunate that we have something we can build, but it's unfortunate that we have to build this, given how bad the drug problem is in America.”

Opioid deaths were at record levels even before the coronavirus pandemic, but skyrocketed when it struck in early 2020. The U.S. Centers for Disease Control and Prevention estimated there were about 85,000 opioid-related deaths in the 12 months ending April 2023. But the number has since declined. The CDC's estimate for the 12 months ending April 2024 was 75,000 – still higher than at any point before the pandemic.

The reasons for the decline are not yet fully understood, but it coincides with the fact that Narcan, a drug that was difficult to obtain in some communities, is now available over the counter, as well as the increasing spending of funds from legal settlements between governments and drug manufacturers, wholesalers and pharmacies.

The U.S. Food and Drug Administration approved Narcan to treat overdoses back in 1971, but its use was limited to paramedics and hospitals for decades. Narcan nasal spray was first approved by the FDA as a prescription drug in 2015, was approved for over-the-counter sale in March, and was available in major pharmacies last September.

“That removed the barriers. And that's when we realized, 'OK, now we need to improve access. How can we get naloxone into communities?'” said Caroline Wilson, a social worker and patient in recovery from West Virginia who coordinated this year's Save a Life Day.

Last year, all 13 Appalachian states participated in the day, initiated by the West Virginia-based nonprofit Solutions Oriented Addiction Response. Community organizations in hundreds of counties distributed Narcan and fentanyl test strips in parking lots, outside churches and clinics and trained people on how to use them. They also work to educate the public about myths surrounding the drug, including that it is not safe to keep it in easily accessible places. Narcan has no effect on people who use it without opioids in their bodies.

This year, the effort expanded to 35 states and the slogan was “Naloxone Everywhere.” The group sent out 2,000 emergency kits containing a dose of Narcan to be placed in places like supermarket bathrooms or parks. The 60 tin newspaper boxes – which sell for about $350 each – were purchased with grants.

Aonya Kendrick Barnett's harm reduction organization Safe Streets Wichita set up one of the first Narcan containers in Kansas in February — she calls them “Nalox boxes.” The boxes, which are now sold by various companies, can also look different. Some look like newspaper boxes, others like vending machines.

Since a Narcan container was installed on the machine – to access the medication, all you have to do is enter a zip code on the keypad – around 2,600 packages are distributed every month.

“To say, 'Hey, we have a 24-hour vending machine, come here and get what you need – no blame,' is so brave in this Bible Belt state and helps me break down the stigma,” she said.

Kendrick Barnett said there is no room for prejudice when it comes to what she calls life-saving health care: “People are going to take medication. It's not our job to judge or condone that. It's our job to make sure they get the necessary health care they need to survive.”

The Save a Life Day box her organization received will be placed outside her new clinic, which is scheduled to open in October.

Larry Tuite, a 74-year-old stained glass artist from Eerie, Pennsylvania, said he became alarmed as overdoses increased in his town. He began leaving Narcan packets on the windowsills of convenience stores in town that sell products such as pipes and rolling papers. He was shocked at how quickly they disappeared.

“No matter how many I give out, I use them up very quickly,” says Tuite, who keeps the drug boxes stacked against the walls of his one-room apartment.

The Save a Life Day container he was allowed to set up outside one of those stores has helped him distribute even more Narcan. At least a dozen people have been saved by the medication he distributed, he said.

Tasha Withrow, a recovering patient who leads a harm reduction coalition based in Putnam County, West Virginia, said Narcan was never available to her while she was taking opioids.

“People can just reach in and take what they need – that didn't exist back then,” she said as she filled a container in a residential neighborhood earlier this week. “Now to actually see that there is some access – I'm glad we've made at least a little bit of progress in that direction.”

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AP journalist Geoff Mulvihill contributed to this report.