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Narcan hits Southern California streets — and soon store shelves — to fend off the opioid crisis

June 30, 2023

“Do you need any Narcan?”

Annastasia Rose Beal’s voice rang out cheerfully as she stepped off of an electric skateboard one gloomy Wednesday afternoon and approach three men seated on a Santa Ana sidewalk at First and Lyon streets, with a blend of motels, other low-slung businesses and palm trees about.

Beal was doing what she often does: handing out for free the drug that can cancel out, in miraculous fashion, opioid overdoses.

In a crop top, sneakers and jean shorts, the 28-year-old Beal didn’t ask the men what drugs they may have been on. She didn’t ask if they were homeless. She did make light conversation and asked how she could help.

The three men turned into five. A woman across the street gazed at Beal’s wagon she had been towing — yes, behind her electric skateboard. It was stacked high with boxes of Narcan, water bottles, condoms, hygiene wipes, and electrolyte drink mix packs. The woman crossed First and Beal waved her over and asked:

“What can I get you, my dear?”

The woman, about Beal’s age, took the proffered box that was the size of a palm. It held Narcan.

Beal had struggled with opiate addiction as a teenager in Irvine. “These are my people,” she said. Many of her friends from that time are dead.

Now is different. The drug is commonly called “Narcan,” which is actually the brand name of a device that dispenses naloxone like a nasal spray. The drug can also be injected into the muscle. Finally, it has become widely available and is considered a major weapon — but not the cure-all — in the fight against the opioid-overdose epidemic sweeping the country in part because of fentanyl, which can be lethal at just two milligrams.

The San Bernardino, Riverside, Orange and Los Angeles County sheriff’s departments now all carry naloxone. In 2021, for example, Orange County sheriff’s personnel gave 219 doses of naloxone to 117 people, said Carrie Braun, a spokesperson for the agency. Forty-six of them were in the jails, with the rest on the streets.

Last October, the Los Angeles Unified School District approved naloxone for every K-12 school. That month, the Orange County Board of Supervisors approved six $20,000 grants for the drug’s purchase by school districts. In January, a new law began requiring community colleges and Cal State campuses to keep the drug on hand, too. And in 2022, some state lawmakers started pushing for another law that would make libraries, bars, and gas stations stock up on naloxone.

The U.S. Food and Drug Administration recently approved making Narcan, or naloxone, available over the counter. Soon, anyone at least age 18 will be allowed to buy it off of the shelf. For now, pharmacists can provide the drug without a prescription, albeit once they’ve finished opioid-education requirements.

Beal distributes Narcan through her organization, the Irvine-based Harm Reduction Circle she started in 2021 with co-founders Emma Webb, Dylan Waller, and Hannah Halbers. Their group had to get state approval to hand out the drug.

Beal says she maintains meticulous records of her group’s distribution, keeping the nonprofit in the California Department of Health Care Services’ Naloxone Distribution Project, which delivers the drug by the pallet. Beal also trains people how to use the nasal spray, which is so easy to use, she said, that her 8-year-old daughter, Samantha, learned to do it.

In 2023 so far, Harm Reduction Circle has distributed more than 11,000 doses. In 2022, the group said Narcan it supplied reversed 170 overdoses. In the vast sea of approaches to the opioid epidemic, saving lives — not evangelizing on the dangers of drug use — is Beal’s focus.

“Everyone should be carrying Narcan,” she said.

Naloxone’s cost can be a barrier to its success.

It’s about $140, on average, for a standard, two-dose pack of Narcan spray. The injection is $40 to $60. California is looking to partner with a manufacturer to produce affordable naloxone.

“Today’s market lacks access to a low-cost naloxone nasal spray and relying on the market to self-correct is uncertain, underscoring the need to support development, manufacturing, or procurement of a low-cost option,” Andrew DiLuccia, a spokesman for the state Department of Health Care Access and Information, said in an email.

Major national retailers, such as CVS and Walgreens, carry the drug as do many other pharmacies. But months after the FDA’s announcement, it’s unclear when consumers will actually be able to get the drug off of shelves as easily as grabbing Pepto Bismol or Advil.

Since the FDA’s March announcement, Andres Hanna, a pharmacist who owns Yee’s Pharmacy in Long Beach, said he has regularly checked with manufacturers and looked for FDA updates about when over-the-counter naloxone will be available.

“Once (FDA) approved it, I checked this right away to see if the wholesaler has it so I can get some,” Hanna said. “(But) no one knows anything, it’s not available anywhere.”

The FDA, in an email, casts the spotlight elsewhere when saying when naloxone will hit shelves: “The timeline for availability and price of this OTC (over-the-counter) product is determined by the manufacturer.”

Naloxone used for the emergency treatment of known or suspected opioid overdose may soon be approved for over-the-counter consumers purchases. Andre Hanna, a local pharmacist, currently carries the medicine and is eager to put it on his shelves once it is available in Long Beach on Thursday, June 15, 2023. (Photo by Brittany Murray, Press-Telegram/SCNG)

Annastasia Rose Beal rides her Onewheel electric skateboard as she hands out Narcan, water, condoms and other supplies to people along First Street in Santa Ana on Friday, April 14, 2023. Beal runs an Irvine-based nonprofit called the Harm Reduction Circle.
(Photo by Jeff Gritchen, Orange County Register/SCNG)

Annastasia Rose Beal hands out Narcan, water, condoms and other supplies to people along First Street in Santa Ana, on Friday, April 14, 2023. Beal runs the nonprofit, Harm Reduction Circle.
(Photo by Jeff Gritchen, Orange County Register/SCNG)

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Emergent BioSolutions, which makes Narcan, is “working toward a late summer launch this year,” spokesperson Assal Hellmer said in an email, without elaborating on what needs to first be done.

For now, Hanna has naloxone behind the counter, which he can furnish to those who don’t have a prescription if they are 18 or older. Also, doctors prescribe naloxone along with opioids for their patients as a safeguard, he said.

But Hanna wants to make it even easier for the public to get — from shelves out in the open. Last month, he went to a funeral for someone who suffered an opioid overdose.

Ryan Marble, a 38-year-old security guard who lives in Santa Ana and works for a motel on First Street, regularly sees people using drugs. While at work, he said, he has administered naloxone at least three times. When Beal arrived that Wednesday, Marble happily accepted the Narcan.

“This isn’t going to fix it,” Marble said. “It’s putting a Band-Aid over it. Our government needs to do better.”

Matt Capelouoto lost his 20-year-old daughter, Alexandra, to fentanyl.

An Arizona State student who aspired to become a social worker, she died in 2019 at their Temecula family home from an accidental opiate overdose. In Capelouoto’s words, it was a poisoning — what Alexandra believed was an oxycodone pill, he said, turned out to be laced with fentanyl. In February, the 23-year-old Riverside man who sold her the pill was sentenced to federal prison.

“I will never say my daughter died of a drug overdose, my daughter was poisoned,” the father said. “She did not make a wise choice (but the) fact of the matter is this person sold her a counterfeit pill.”

Capelouoto emphasized that he “110%” supports making naloxone accessible. But more needs to be done.

“For (myself and the) majority of parents that I speak with, all of our kids died by themselves,” he said. “There was nobody around to administer Narcan. So how do we address those deaths? People like to say we’re not going to arrest our way out of this, we’re not going to Narcan our way out of it, either.

“I do support it, but it’s not an end-all. And we need to have a wide variety of tools to help save the lives that are lost.”

Capelouoto advocates for drug dealers getting charged with murder if someone dies from fentanyl poisoning their product caused. The stance has gained traction with some district attorneys.

Naloxone is not new. It was developed in the 1960s and gained FDA approval in 1971; in subsequent decades, it was primarily used by first responders and hospitals. No longer.

Dr. Sid Puri, a substance-abuse expert with the Los Angeles County Department of Public Health, said he disagreed with any notion that making naloxone widely accessible is somehow enabling drug use.

“If someone was coming into my office, and they have really, really high sugars, my first instinct isn’t, ‘Go out and eat better and exercise before I give you medication or any treatment to reduce your diabetes,’ it’s, ‘I’m giving you medication, I’m giving you something to reduce the risk and to help you in your current situation,’ ” Puri said.

“And that same way, someone struggling with substance use disorder needs naloxone (or) they need sterile supplies because that reduces overdoses and deaths and disease transmission.”

Puri said the over-the-counter approval is “huge” — it normalizes naloxone in everyday places.

“When we think of the way that people have to get naloxone now, they have to get prescribed or they have to go into a pharmacy, they have to give their ID and insurance card,” the medical doctor said. “All those are barriers, especially for people who are experiencing homelessness, or who are using drugs and feel completely stigmatized by the medical and pharmaceutical industry anyway.”

Naloxone, Puri added, has no known harmful side effects and isn’t addictive; the only downside is the user could go through withdrawals. If someone is given naloxone and they aren’t on opioids, it has no effect.

For those on an opioid, naloxone reverses the effect. It can restore normal breathing in two or three minutes. Multiple doses may be needed if a more potent opioid such as fentanyl has been ingested, according to the Centers for Disease Control and Prevention. Naloxone lasts 30 to 90 minutes in the body. Opioids can stay in the system longer — another reason additional doses may be required.

Administering naloxone is covered under California’s Good Samaritan Law, which protects those who act in good faith to assist someone during a medical emergency.

“If people are alive, we can at least link them to treatment services, we can understand their goals and help them reach them in a safe and effective way,” Puri said. “The dam is broken, and we are watching this wave wash over us. But naloxone is a lifejacket for a lot of people that would otherwise just completely die and drown. So I think this is a step in something.”

Annastasia Rose Beal rides her Onewheel electric skateboard as she hands out Narcan, water, condoms, and other supplies to people along First Street in Santa Ana on Friday, April 14, 2023. Beal runs an Irvine-based nonprofit called the Harm Reduction Circle.(Photo by Jeff Gritchen, Orange County Register/SCNG)

After an hour on the streets, Beal meandered along First on her way to Grand Avenue, her first turn on her way home to Irvine on her electric skateboard.

She has bigger plans for Harm Reduction Circle. The group has started providing free meals on certain days and setting up naloxone distribution at events such as concerts and festivals and on college campuses.

A few more people popped up as she walked. One man she gave a pack of M&M’s. Another woman chatted with Beal for 10 minutes and took a box of Narcan before heading off to a bus stop.

Beal hopped off of her electric skateboard intermittently, leaving boxes of Narcan on a bench, on the top of a trash can, on a curb, and near some bushes.

She hopes whoever needs it, finds it.

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