AURORA | Someone near you starts to show signs of an opioid overdose. Then they stop breathing. That person has six minutes before their brain cells start to die.
What would you do?
Six minutes is barely enough time to call 911 and for the emergency responders to arrive in time.
Say you are in a busy place. That gives you six minutes to find someone who can help. Now, consider that person is not just a stranger, but a loved one—a cousin, a sibling, a parent or even your child.
“I can’t, I can’t put words to what it has felt like to lose a son to something that he experimented with,” Anthony Alvarado said about his son, who died from fentanyl poisoning after he experimented with Percocet that he didn’t know was laced with fentanyl.
Someone administering naloxone to his son could have saved his life.
Aurora is considering installing one or more naloxone vending machines, paid for by outside funding for opioid overdose prevention, but some city lawmakers fear it could promote drug use.
“I just want to make sure we’re not promoting any sort of, you know, safe injection sites, and for me, that kind of teeters on that,” Councilmember Danielle Jurinsky said during a May city council meeting about a plan to procure the vending machines.
The city is on track to receive more than $3.4 million over the next 17 years as part of Colorado’s share of national opioid settlement funds to help combat the opioid crisis, and naloxone — also known as the brand name Narcan — vending machines were one prevention proposal.
Local, regional and national public health officials say naloxone has become an important tool in pushing back rising numbers of opioid overdose. Denver has installed the vending machines in hospitals and, most recently, police stations.
As stronger forms of opioids continue to flood the black market and can now be found in a variety of other drugs such as marijuana, Percocet, cocaine, MDMA and methamphetamine, opioid overdoses have greatly spiked in the last five years, and only began reducing after Colorado took strong preventive measures, according to state health officials.
“During the global pandemic, my son found himself in isolation and disconnection, and even knowing all of the education and support in those moments of struggle, in those moments of not being willing to ask for help, in those moments of unknowing,” Alvarado said.
He said the fentanyl-laced Percocet took his son’s life at 17.
“That completely turned our life upside down,” he said.
Alvarado is the founder of Rise Together, a youth empowerment program founded to break the stigma and silence around mental health and addiction. He was previously an addict who became an advocate for addiction recovery before his son died, and he said he actively modeled education for his son, never imagining it would happen to his own family.
“I was joining stages with mothers who have lost children,” he said. “I could have never imagined that I was going to be sitting in the same group that they are, and I’m now a grieving parent who has lost a child. Young people deserve access to this education, and young people are not the only ones dying.”
He said that the nation’s elderly are also dying at much higher rates from unintentional fentanyl overdoses. Several university and government research sources say that overdoses among Americans over 65 have quadrupled over the past decade.
Overdoses in all age groups spiked during the pandemic and only recently started to decrease again, after mass education, reduced stigma and naloxone availability became more common practice.
The age-adjusted rate of drug overdose deaths nationwide increased from 8.9 deaths per 100,000 standard population in 2003 to 32.6 in 2022, according to the National Center for Health Statistics. The rate decreased to 31.3 in 2023. Those rates decreased between 2022 and 2023 for people ages 15–54, but increased for adults aged 55 and older.
Colorado had similar numbers, showing a minor increase in overdose deaths from 1,799 in 2022 to 1,865 in 2023, according to the Colorado Center for Health and Environmental Data. There was a more significant increase in opioid-related deaths from 1,160 in 2022 to 1,292 in 2023. All of the younger age groups decreased from 2022 to 2023, but all age groups older than 35 years increased in overdose deaths during that time.
Of the opioid related deaths in 2023, 311 occurred in Adams and Arapahoe Counties, and an additional 39 in Douglas County, totaling 350 lives in all three counties, an increase of 30 deaths from 2022.
There were 442 non-fatal opioid overdose-related emergency department visits in Adams, Arapahoe and Douglas Counties in 2023, Calli Tucker, Aurora’s Crisis Intervention Program administrator, said during a study session in April.
It means those three counties had more people who were saved from overdoses than people who died.
A report from the Centers for Disease Control and Prevention found a 13.9% decrease in fatal overdoses in Colorado from October 2023 to October 2024 compared to the previous year, according to the University of Colorado Anschutz Medical Campus.
The deaths caused by synthetic opioids, such as fentanyl, dropped 28.5%, from 1,192 to 852, according to the article. Colorado Consortium for Prescription Drug Abuse Prevention, which is part of CU Anschutz’s Skaggs School of Pharmacy and Pharmaceutical Sciences, said that one reason the fatal overdose rate has declined is that naloxone is readily available for anyone to have.
“Research showed that 73.3% of drug overdose deaths in Colorado in 2023 had at least one potential opportunity for intervention, most often by a bystander,” Tucker said during the meeting. “Which speaks to why the focus on opioid abatement fund strategies is so crucial.”
Proven Solutions
Whether the person has an addiction, is using drugs recreationally or is experimenting for the first time, the first and most important step is keeping people alive to recover and move on, addiction experts say.
“We can only help a person to lead a productive life if they are alive,” said Dr. Aleksandra Zgierska, professor of family and addiction medicine at Pennsylvania State University. “Only then, they can enter treatment, only then, they can learn from their mistakes, however we approach it, but it’s only under those circumstances. So keeping people alive is our primary goal.”
Naloxone is an opioid overdose antidote that works by essentially bumping the opioid off key receptors in the brain, a mechanism that helps reverse overdose symptoms like slow breathing, Dr. Brandon Marshall, a professor of epidemiology at Brown University, said.
“Naloxone, as a substance, is used to reverse overdose, not to prevent overdose,” Zgierska said. “People are dead unless naloxone is administered by bystanders, which means that everybody should have naloxone to help those who overdose.”
Narcan is the popular brand name for naloxone. All forms of naloxone are considered safe, and naloxone can now be obtained without a prescription in every state, as mandated by law. Naloxone, as a nasal spray, can be easily administered to someone who is experiencing an overdose.
Bystanders who administer naloxone are advised by professionals to call 911 and, ideally, perform mouth-to-mouth resuscitation until the person regains consciousness. If the person does not respond after three minutes, professionals recommend administering additional doses of naloxone. The need for added doses has become more common with “super fentanyl” like nitazenes, which are another form of synthetic opioids that can sometimes be more potent than fentanyl.
Dr. Eric Hill, the medical director for Aurora Fire and Rescue, said that there is still oxygen in the blood that can somewhat prolong the time of brain cell death. He said that administering mouth-to-mouth breathing to the person can help keep oxygen flowing to the brain. He said naloxone and mouth-to-mouth can both greatly aid emergency responders as a life-saving measure while they are en route.
“In terms of Aurora Fire’s travel times, 90% of AFR’s departmentwide travel time for first-arriving apparatus for fires and medical emergencies in 2024 were within 6 minutes, 42 seconds or less,” City of Aurora spokesperson Jennifer Soules said in an email.
Just because the person is conscious doesn’t mean they don’t need to see a doctor immediately. Naloxone is used to revive and stabilize the person before they are taken to the hospital or to see a doctor.
That doctor visit also provides professionals with an opportunity to discuss addiction treatment options with the patient, if it’s warranted.
“Addiction is a chronic disease and requires treatment by healthcare professionals,” Zgierska said.
Zgierska said that an overdose gives medical professionals a better ability to speak with people face-to-face and refer them to possible treatment opportunities. Stigmatization can make it more challenging for individuals to seek help.
“If we further stigmatize drug use and addiction, it’ll be harder and harder to bring people to treatment or even disclose that they have a problem,” Zgierska said.
A “non-judgmental tone” is a significant factor in one of their opioid prevention campaigns, dubbed “Keep The Party Safe.”
Keep The Party Safe, which is led locally by the consortium with CU Anschutz, is aimed at occasional and recreational drug users between the ages of 18 and 45 who are unaware that fentanyl can be found in drugs including cocaine, MDMA, meth and heroin. Counterfeit versions of prescription drugs, including Xanax and OxyContin, are also a danger, according to a research article from CU Anschutz.
“Research shows that when naloxone is made more widely available, overdose deaths decrease,” Marshall said. “One potential barrier I want to highlight is cost. Some pharmacies may charge upwards of $50 for just one naloxone kit, which could be unaffordable to many people who might benefit from having naloxone and administering it in the case of an overdose.”
Zgierska and Dr. Alice Zhang, assistant professor in the Department of Family and Community Medicine at the Pennsylvania State University, is the lead author of the review on the effectiveness of naloxone vending machines with Dr. Zgierska.
“One aspect of the vending machine that is not available through traditional means is that it’s available 24/7,” Zhang said. “It’s available after hours when businesses are closed. We’re seeing data from our vending machines that they’re being used from like 9 p.m. to 5 a.m., so that’s when most people aren’t typically awake.”
Zhang said they also found from a survey given through the smart vending machines that 38% of the people said they were getting naloxone to be prepared if they encounter an accidental overdose.
“Some of the survey data that we have showed that over half of the respondents thought that the vending machine was able to help reduce stigma around addiction and naloxone,” Zhang said.
Typical over-the-counter pricing for Narcan is $50 for a two-pack of nasal spray. In 2019, the state of Colorado created the Opiate Antagonist Bulk Purchase Fund, which provides free naloxone to qualifying entities. The problem is that KFF Health News reported last year that the fund is quickly depleting.
Other funds are coming from legal settlements after the opioid crisis, but those funds are also limited and reserved for all opioid prevention and abatement measures.
Aurora is on track to receive more than $3.4 million over the next 17 years as part of Colorado’s share of national opioid settlement funds to help combat the opioid crisis.
The grant funds come from legal settlements with pharmaceutical companies, distributors and retailers found to be responsible for fueling the opioid epidemic, Tucker said during the study session.
As of 2024, $1,737,942 in opioid settlement funds have been made available to the city, with only $245,540 approved so far for vans and buses to transport people to and from the Aurora Navigation Campus. The center is Aurora’s work-first, one-stop shop facility for handling homelessness in Aurora. It’s expected to open later this year.
An agreement with the state allows expenditures to fall within specific areas, including treatment, prevention, services for children, support for first responders, community leadership, staffing and training, research and related administrative costs.
According to Tucker, city staff proposed four initial funding projects based on the city’s history and available evidence:
- Consulting services to access Medicaid billing, estimated at $125,000.
- Implement naloxone vending/resource distribution sites, estimated at about $10,000 for each site, possibly two or more sites.
- Expanded emergency medical services for opioid overdoses, estimated at $112,000
- Expanded intervention services in response to opioid overdoses, estimated at $55,000-$87,000 per site, with possibly two sites.
Although there has been recent national news about Medicaid funding cuts, the opioid settlement money appears to still be secure, according to city officials.
Addiction has little to do with resolution
“It does not matter what you look like, or where you’re from,” Alvarado said. “Addiction does not discriminate, and we are tired of hearing that it’s just the addict’s problem. We are people. We are humans, and we deserve respect and support, period.
One in five teens has already tried prescription drugs illegally, according to the Center for Addiction and Substance Abuse. The majority, 76% of these teenagers, buy these prescription pills illegally, according to the 17th Judicial District Fentanyl Fact Sheet.
“Addiction is part of the inability to process pain,” Alverez said. “So you can address that deeper core issue, that’s where you start to see that form of recovery. But it takes a community.”
The pipeline from experimenting to misuse and addiction is not far. Repeated studies have found that in many cases, addiction behaviors can serve as coping mechanisms for physical and psychological pain, according to the National Library of Medicine.
Through Rise Together, Alvarado has taught more than 300,000 students about substance use and mental health. The crisis impacts people across all demographics – from high school cheerleaders to students from various socioeconomic backgrounds, according to Alvarado.
Addiction is usually about underlying systemic issues like poverty, disconnection and unprocessed pain, Alvarado said. The settlement grant money the city is receiving for opioid prevention and treatment is from pharmaceutical companies taking advantage of those issues, prioritizing profits over people, and creating easily accessible addictive medications.
“Don’t ever be that person who says it will never happen to you because until it impacts you personally, whether it’s a loved one, a family member, a child, a cousin, brother, uncle, sister, you name it,” Alvarado said. “The stories, while they might be different, nobody went into it thinking, oh, man, I’m going to be an addict and I’m going to die from this substance.”
If anything, being saved from an overdose can create a “cascading” effect where people who live through an overdose are more likely to become advocates who want to save other people’s lives, Zgierska said.
Similarly, having access to naloxone does not enable people to indulge in their addictions.
“Research dispels concerns raised by some people in the past that naloxone’s availability may increase someone’s likelihood to take more drugs,” Zgierska said. “In fact, research confirms the opposite – lack of naloxone’s availability increases the likelihood of death.”
According to Alvarado, communities must approach addiction with compassion, education and support. By reducing stigma and increasing access to resources such as Narcan, lives can be saved.
“It’s not a matter of mental weakness,” he said. “It’s more of a matter of maybe mental fitness to be part of that conversation. It goes back to more access to education and more support for people who are struggling in the process, and that they’re experiencing life in a healthy way.”