CLEVELAND, Ohio -- Ohioans' lives were saved more than 20,000 times last year because they had access to naloxone, the drug often referred to as brand name Narcan, that has the power to quickly reverse an opioid overdose. New data from the Ohio Department of Health shows that distribution of naloxone kits increased by 42% in 2023, putting more of the life-saving drug in the communities that need it most.

The push was coordinated through Project DAWN, which stands for Deaths Avoided With Naloxone, a network of organizations from robust health departments to small community groups. Since 2012, the state-led program has been distributing kits of naloxone growing from a distribution of fewer than 3,000 naloxone kits in 2014 to nearly 300,000 kits in 2023.

"The program has had very impressive growth over its lifetime," said Bruce Vanderhoff, director of the Ohio Department of Health. "We are increasingly having a more dramatic impact through this program and its ability to save lives and bring about reversals."

The community distributed kits contain the medication in a single-use nasal spray, though medical providers will sometimes use it as an injectable medication. By opening use to the public and making naloxone more readily available, the chances that someone experiencing an overdose will get the lifesaving medication in time dramatically increases.

Community naloxone distribution is an important part of what's known as "harm reduction," an approach that reframes opioid crisis management from an illegal activity to a medical condition. Interventions focus on preventing risky behavior, reducing drug use consequences and promoting paths toward treatment and recovery.

At a national level, former President Barack Obama began introducing harm reduction into federal substance misuse plans, that have since reemerged under President Joe Biden's administration. The U.S. Department of Health and Human Services incorporates harm reduction as a key part of its overdose prevention strategy.

Scott Osiecki, CEO of the ADAMHS board of Cuyahoga County, an area leader in distributing harm reduction resources, said that availability of these supplies, such as naloxone and test strips that detect when opioids have been laced with deadly fentanyl, is the best defense available against overdose deaths. He and his colleagues are continuing to expand their harm reduction efforts into new avenues so "people can stay alive to get treatment and live in recovery."

The board distributes a variety of resources free of charge throughout Cuyahoga County with the help of a growing list of partners such as the MetroHealth System, a Project DAWN administrator, which helps to monitor distribution locations and keep supplies stocked. Resource distribution is paired with community awareness campaigns in target areas, based on overdose statistics from the medical examiner's office.

Osiecki said comprehensive medication information and instructions are included with all of the naloxone that the board and its partners distribute, and mini training sessions are offered at the community events. He hopes those sessions, which teach what naloxone is and how to administer it, reduce the mystery surrounding it and emphasize the importance of also calling for care.

Vanderhoff of the Ohio Department of Health said that although naloxone saves lives when it's widely available, once a person is revived, it's still important that they get to a hospital to treat any potential symptoms of withdrawal.

"This is still a 911 event," Vanderhoff said. "Withdrawal is a very serious medical phenomenon, and it requires a medical professional to help manage it."

Those working in EMS -- including Chris Caimi, Euclid fire platoon chief and EMS coordinator, and Robert Bures, a Parma firefighter/paramedic -- echoed that concern.

Naloxone is intended to restore basic vitals and get the patient out of immediate danger; afterward, they often remain incoherent and unable to walk and talk. And untrained layperson, who doesn't understand that, might end up administering more naloxone than necessary, possibility increasing the risk of withdrawal symptoms.

That said, Caimi and Bures noted that large doses of naloxone aren't associated with any major medical risks, and the possibility of experiencing withdrawal is far outweighed by the benefit of putting naloxone within easy reach.

"Getting people to the point of going through withdrawal is not what we want. It's not a pleasant experience," Bures said. "But is being in pain and throwing up preferrable to not breathing? Yes."

Amanda Lynn Reese, chief program officer of Harm Reduction Ohio, said that "panic dosing" often occurs when someone witnesses an overdose, becomes scared and expects naloxone to make them all better.

"If you're a regular opioid user, and you receive a high dose of naloxone, it happens," Reese said. "Yes, the symptoms of withdrawal are very challenging and difficult, but they're temporary. People should be mindful to not cause unnecessary distress, but I think most of us would rather be alive and uncomfortable than dead and comfortable."

Likening carrying naloxone to having a fire extinguisher, she asks that everyone -- whether they know someone struggling with drug misuse or not -- to carry the lifesaving tool.

"You might never need it," Reese said. "But if you do, you want to have it."