The largest distributor of the overdose-reversal drug naloxone in Ohio is based in several rooms above River Road Coffeehouse in Granville. This is the headquarters for the advocacy organization Harm Reduction Ohio (HRO). Last year, the nonprofit distributed some 40,000 doses of naloxone. This year, it hopes to distribute more than 50,000 doses.
Most of the naloxone comes from the Ohio Department of Health, with the rest arriving via the pharmaceutical industry charity Direct Relief, Remedy Alliance for the People, and donations from other programs. The naloxone is distributed through an online platform and a network of 400 lay distributors around the state.
It's an enormous operation that goes largely unnoticed by the patrons of the coffee shop, save for when trucks block the driveway and folks unload box after box, carrying them up the rickety old steps to the second floor.
Those steps creak and sag as one might expect from an old, wooden farmhouse, which was built around the middle of the 19th century by Justin Hillyer, according to Theresa Overholser, senior archivist at the Granville Historical Society. The Hillyers sold the house to Curtis Howe, who later sold it to a Bancroft. These three families are inextricably linked in local lore because they were all anti-slavery advocates. There's reason to believe that these families were also involved in the Underground Railroad – and maybe this house, as well.
There's no way of knowing for certain, but some anti-slavery families worked together to shuttle formerly enslaved people northward. That the house is situated along a long-suspected route adds evidence to the probability column. It's not a stretch to believe that this house was once a way station on the road to freedom, or to believe that the people who lived here played a part in a larger human rights struggle.
That’s usually how it works. People with names no one knows show up and do the work, persistently committed to building toward a more inclusive, just world.
In the 1990s, Dan Bigg of the Chicago Recovery Alliance began distributing naloxone at a time when it wasn’t widely available or even legal to distribute. Bigg became a sort of Johnny Appleseed for community-centered overdose reversal, believing that people who use drugs and the people who love them should be empowered to save one another. Bigg, along with countless others whose names we'll never know, helped flood the streets with the so-called Lazarus drug.
When Harm Reduction Ohio started to distribute naloxone around the state, organization president Dennis Cauchon said there were many barriers, but that untold folks behind the scenes worked to dismantle them. The way Cauchon tells it, when he built the HRO website, he was immediately inundated with requests for the drug. At the time, he didn't know what naloxone was. As he did his research, he wondered, with so many people dying in Ohio, why don't we have ready access to it?
Naloxone was available through a doctor or the health department, but that required special training and appointments, and the cost could be prohibitive. Distributors had to track names and addresses. And Ohio required a “terminal distributor of dangerous drugs” license, even though naloxone is not a dangerous drug. Dr. Robert Massone agreed to sign the medical protocol on behalf of HRO – putting his own license on the line. Then, Cauchon said, Cameron McNamee, Director of Policy and Communications at the Ohio Department of Health, helped change regulations that were slowing distribution, getting rid of unnecessary paperwork and working to make naloxone available over the counter. McNamee, Cauchon said, has played a huge part in reducing overdose death. Now, access to naloxone is excellent in Ohio. It's one of the things the state has gotten right.
Estimates for this year are that overall deaths will decrease – an effect of less fentanyl in the drug supply and, maybe, more naloxone in the streets. But while deaths of white people in Ohio are falling, deaths among Black people continue to rise. Stimulant users are making up an increasing share of deaths. And the fentanyl in the supply is still killing people.
That makes the work of distributing naloxone all the more pressing. Doing so is a logistics puzzle – tracking and mailing orders, maintaining a stock of naloxone, organizing volunteers. HRO’s AmandaLynn Reese oversees this complex exercise. She finds and trains volunteer lay distributors and maintains the organization's vast network. Distributors include individuals as well as community access points such as salons, gas stations, churches, libraries and restaurants. They join the network through word of mouth, from networking at community events, or by signing up online. (You can sign up to be a volunteer here.)
Reese says the median age for volunteers is around 40, and most are women. They include students, medical professionals, concerned citizens, people who use drugs, people in recovery, and those who have lost a friend or family member and want to do something to help. It takes all kinds, Reese said. People with different worldviews and from different walks of life but aligned in the same mission.
Reese’s mission, along with that of outreach activist Kelsey Bates, is to improve naloxone distribution and saturation in underserved areas and demographics, getting naloxone into places with high mortality zip codes and into the hands of people of color and people who don't identify as opioid users.
Four years ago, people were openly hostile to Reese and her work. “I've had people call me things. I had a guy knock my table down at an event. Not anymore. Now people are okay with it but don't think it's for them,” Reese said. “We need to get people to think of it as a part of regular first aid."
Reese began carrying naloxone out of a desire to protect people she loved. At the time, she would distribute six or so doses to people in her circles every month. Now, she's a central part of a statewide network. She's also quick to downplay her part in all of this. "I stand on the shoulders of legends who did this before me,” she said. “I didn't start this. I'm not doing this alone."
She’s right. She’s not alone. There are lifesavers among us, all over Ohio, many in places where you’d least expect it. "It's a new Underground Railroad," Cauchon said. "It's a force that believes in the value of these human lives."
It’s a collective assertion that people who use drugs are deserving, and that their lives are significant and valuable.
