Old newspaper boxes are used to distribute the overdose drug, Narcan | West Virginia

CHARLESTON, W.Va. (AP) – For decades, Jeff Card's family business was known for making 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 opioid overdose reversal drug.

In the more than a year since the U.S. Food and Drug Administration approved sales without a prescription, naloxone distribution containers have proliferated across the country. Naloxone, a nasal spray most commonly known as Narcan, is used as an emergency overdose treatment.

Such boxes, posted in neighborhoods, outside hospitals, health departments and convenience stores, are one way those who support people with substance use disorders want to make Narcan, which can cost about $50 over the counter, available to those who need it need the most. Similar to Little Free Libraries that distribute books to anyone who wants one, the metal boxes that once served as newspaper containers are unlocked and require no payment. People can take as much as they feel they need.

Advocates say the containers help normalize taking medications — and are evidence that stigma surrounding taking them is steadily decreasing.

Sixty Narcan containers were distributed in 35 states on Thursday to mark “Save a Life Day,” a naloxone distribution and education event created in 2020 by a West Virginia nonprofit. The containers were purchased from Card, Texas-based Mechanism Exchange & Repair, which still serves newspaper customers but has expanded into manufacturing other products given 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. “We are lucky to be able to build something, but it is unfortunate that we have to build exactly that given how bad the drug problem is in America.”

Opioid deaths were already at record levels before the coronavirus pandemic, but they skyrocketed when it hit in early 2020. The U.S. Centers for Disease Control and Prevention estimated that there were about 85,000 opioid-related deaths in the 12 months ending April 2023. But they have since fallen. The CDC estimate for the 12 months ending April 2024 was 75,000 – still higher than at any time before the pandemic.

The reasons for the decline are not fully understood. But it coincides with Narcan, a drug that has been difficult to obtain in some communities, becoming available over the counter, and at the same time increasing funding from legal settlements between governments and drug manufacturers, wholesalers and pharmacies.

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

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

Last year, all 13 Appalachian states participated in the day, which was led by West Virginia nonprofit Solutions Oriented Addiction Response. Community organizations in hundreds of counties are distributing Narcan and fentanyl test strips in parking lots, outside churches and clinics and training people to use them. They are also working to educate the public about myths surrounding the drug, including that it is unsafe to store in easily accessible places. Narcan has no effect on people who take it without opioids in their bodies.

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

Aonya Kendrick Barnett's harm reduction coalition Safe Streets Wichita installed one of the first Narcan containers in Kansas – which she refers to as “Nalox boxes” – in February. The boxes that are now sold by different companies may also look different. Some look like newspaper boxes, others like vending machines.

Since installing a Narcan container in a vending machine — which only requires entering a ZIP code on the keypad to access the drugs — about 2,600 packages per month have been distributed.

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

Kendrick Barnett said there is no room for judgment when it comes to what she described as life-saving health care: “People are going to do drugs. It is not our job to condemn or tolerate it. It’s our job to make sure they get the health care they need to survive.”

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

In Erie, Pennsylvania, 74-year-old stained glass artist Larry Tuite said he was increasingly concerned about the increase in overdoses in his city. He began leaving Narcan packages on the window sills of 24-hour markets around the city that sold products such as pipes and rolling papers. He was shocked at how quickly they disappeared.

“I use up the amount I give out very quickly,” said Tuite, who stacks boxes of drugs on the walls of his studio.

The “Save a Life Day” container he was allowed to set up in front of one such store helped him distribute even more Narcan. At least a dozen people were saved by the medicine he distributed, he said.

Tasha Withrow, a recovering person who leads a harm reduction coalition based in Putnam County, West Virginia, said Narcan was something she never had access to when she used opioids.

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

AP journalist Geoff Mulvihill contributed to this report.