On a bright September afternoon, a group of volunteers in purple shirts pulled a navy wagon through a quiet neighborhood in Elyria in northeast Ohio. Inside were boxes of Narcan — the brand name for naloxone, the medication that can quickly reverse an opioid overdose by restoring normal breathing.
“Hello! We’re giving away Narcan kits for accidental overdose,” Natalie Karn, a community health nursing supervisor with Lorain County Public Health, called out to a man on the other side of a screen door. “Would you like one for your first aid kit?”
Some residents waved them off, but others stopped to ask questions. One man pulled his car over. “Can I get two?” he asked. “My neighbor lady’s got a teenager living with her.”
This outreach is part of Project DAWN — Deaths Avoided With Naloxone — a statewide program that operates in 83 of the state’s 88 counties and is named after an Ohio woman, Leslie Dawn Cooper, who struggled with substance use disorder before dying from an opioid overdose in 2009.
Lorain County was one of the first in the state to make naloxone available outside hospitals, starting in 2012 with police officers before expanding to churches, apartment buildings and now doorsteps.
A few years ago, the county began using overdose data to pinpoint high-risk neighborhoods. Since launching that targeted effort, residents have saved more than 600 lives — what health officials call “bystander saves.”
The impact of the naloxone availability has been remarkable: the county’s 911 logs show a bystander had already administered Narcan before responders got there in about 30% of overdose calls. Two years prior, that was the case less than 5% of the time.
In just three years, overdose deaths in Lorain County have dropped 55%. Across Ohio, preliminary data show the statewide decline is about 17%, with many rural counties seeing slower progress.
“We don’t see declines like this in other health outcomes so quickly,” said Mitch Dandurand, the epidemiology supervisor at Lorain County Public Health.
But the county’s progress could be threatened by recent funding cuts — a $3 million trim to the state’s harm-reduction budget and additional proposed federal cuts could force communities to decide to potentially cut these programs, or tap their local settlement dollars that may have been planned for other uses.
Shifting attitudes toward naloxone
When Lorain County first began distributing naloxone, Karn said not everyone was supportive.
“There was a woman who told me, ‘I think there should be a limit. You can’t just keep bringing people back,’” Karn recalled. “Her son’s a police officer, and she said he was frustrated because he kept seeing the same people over and over.”
That stigma still lingers in parts of Ohio. Butler County restricted police officers from carrying naloxone, and Karn said a mayor even ordered a library to remove a public naloxone box.
"The fact that people are willing to use [naloxone], even when it’s not someone in their household, shows how far we’ve come.”Natalie Karn
But in Lorain, acceptance has grown. The day Karn went door knocking a homeowner shared she had recently used a kit on a stranger she found unconscious outside.
“She ran to her bathroom, grabbed the kit and used it,” Karn said. “She doesn’t know what happened after, but that person was alive when the ambulance came. The fact that people are willing to use it, even when it’s not someone in their household, shows how far we’ve come.”
The chance to keep breathing
Andrew Therens knows firsthand what that chance means. After returning from Afghanistan, he struggled with PTSD that led to a heroin addiction.
“I was climbing over a concrete abutment to get back to my car,” he said. “That’s when the opiates I took kicked in. I basically overdosed on the side of the road like some roadkill. Luckily someone called an ambulance. They gave me Narcan. It’s disorienting and painful, but it gave me the chance to keep on breathing.”
Now a peer recovery supporter, Therens helps others navigate recovery.
“Seventy-five percent of the people I met in rehab and got sober with are no longer here. I wonder how many would still be if (naloxone) was accessible like it is now.”
Moving beyond Narcan
Lorain County now has 77 naloxone distribution partners and recently installed a free harm-reduction vending machine at Family Planning Services. It dispenses naloxone kits, fentanyl test strips and condoms. More than 175 kits have been taken since May.
But Natalie Karn emphasizes that expanding access to naloxone is only the beginning.
“Naloxone is an emergency medication,” she said. “It’s for that critical moment when someone is overdosing and on the brink of death, to get them breathing again. But recovery and substance use are multifaceted. To have real success, people need employment, transportation, mental health care and someone in their corner providing support.”
The same week volunteers pulled their wagon through Lorain’s neighborhoods, a new 24/7 crisis receiving center opened in the county to connect people with mental health and substance use treatment. As Karn and other county health leaders see it, it’s one more way to build out the support network to help the community heal.