ALASKA’S DELAYED NALOXONE RESPONSE ANOTHER REVELATORY LETHAL EXCEPTION TO WIDESPREAD DROPS IN OPIOID OVERDOSE DEATHS
As in South Dakota, Iowa, San Francisco, Nevada, Tennessee, Utah and Washington, lack or delay of effective naloxone campaigns to reduce harm from expert treatments predicts OD death trends
by Clark Miller
Published November 14, 2025
Over the pathological course of America’s worsening opioid crisis, Alaska is an outlier among outliers. Not only different, like South Dakota, Iowa, San Francisco (and here), Nevada, Tennessee, and Washington, in the delayed onset of naloxone campaigns that would turn around, at least temporarily, persistent surges in opioid overdose deaths.
But an outlier also among those outliers, an exception in ways we will see are entirely congruent with the lethal rule, and are revelatory.
Things have not gone well for vulnerable Alaskans and their families trapped in a confluence of factors contributing to a worsening opioid crisis, nor for state, local, and community-level entities attempting to provide relief.
From a very recent (October 2025) report in The Guardian that outlines some of the forces –
Overdoses have been declining nationally since August 2023, but Alaska is far behind in that progress. Overdose fatalities did not begin to decline in Alaska until July 2024, nearly a year after they started to decline nationally. They began to climb again this February, according to Centers for Disease Control data.
The state’s large size and small population alone make overdose prevention a difficult task. For some, healthcare is only accessible by helicopter.
Alaska’s remoteness makes it a target for drug trafficking. Pills can sell for upwards of five times what they fetch in the lower 48. The Guardian’s analysis of CDC data showed that in 2024, Mat-Su saw an overdose fatality rate of 51 per 100,000 people and Anchorage saw a rate of deaths of 68 per 100,000, compared with 24 per 100,000 nationally.
In the Matanuska-Susitna Valley region of Alaska, north of Anchorage –
Mat-Su, which is the size of West Virginia and largely rural, saw an 82% increase in overdose fatalities since the national peak of the crisis in 2023, one of the highest in the country. The atmosphere of emergency here is palpable – a handful of Mat-Su residents the Guardian spoke to had witnessed or personally reversed an overdose within weeks. Alaskans say their culture of rugged independence is isolating for people struggling with substance use – but many fentanyl users here rely deeply on their communities to stay alive. …
Indigenous people most at risk
In Alaska, Indigenous people make up around 15% of the overall population, but are 44% of the homeless population. As in the rest of the country, Indigenous Alaskans are more vulnerable to substance use disorder and overdose.
[emphasis added]
Isolation of high-risk users is, as solidly supported by reports and research, a lethal problem. That’s because emergency revival by naloxone – increasingly by peers and passersby, anyone proximate, because seconds count in an overdose – is the factor saving lives and responsible for recent, widespread drops in OD deaths.
The ‘many fentanyl users” in Alaska who “rely deeply on their communities to stay alive” are ultimately vulnerable when their encampments and social ecologies are disrupted, as in another outlier state, Nevada.
When supportive communities face ‘clean-ups’
In many cases, the military and even Alaska law enforcement work to help expand naloxone access. But initiatives to “clean up” the city, like encampment abatements, tear apart communities who rely on each other to stay alive – and “make everything more dangerous” according to Venus Staten, program director of Four A’s. …
Evictions in neighborhoods like Williwaw can also break up drug communities and increase overdose deaths. A local nonprofit called Families for Improved Safety and Health (Fish) has been encouraging developers to buy drug properties and replace them with new houses
True North Recovery is headquartered in Wasilla, across the lake from Williwaw. Its primary mission is providing substance use treatment, but it also works in tandem with local organizations and law enforcement to help potential clients across Alaska access basic resources. Josh Engle, who manages crisis services at True North, said he goes into homeless encampments when an abatement is on the horizon, to help people get shelter and resources.
The strength of these communities is obvious, but so is the danger they face. Just a week before, Engle tried to get shelter for a group of six people before their Anchorage encampment was to be cleared. One woman told him, “I won’t go anywhere if [my friend] can’t get housed, too, because he saved my life last night from being raped.”
The critical takeaway from those descriptions is a hard truth: it’s not the physical disruption or deprivation of resources, or even rape, that is fatal when an encampment is disrupted – it’s the loss of proximate social capital functioning as emergency life-saving response, of familiar companions ready to reverse with Narcan an otherwise fatal overdose.
A local news report from October 2025 is no less grim than that from The Guardian –
ANCHORAGE, Alaska (KTUU) — Drug overdoses continue to be a deadly problem in Alaska, with the latest state data, reviewed by Alaska’s News Source, showing a 40% jump — with the state predicted to be in the top 10 in the country for overdose deaths once updated mortality rates are released soon.
Alaska recorded its deadliest year for drug overdoses in 2023, with 357 deaths representing a more than 40% increase according to preliminary data cited by Sen. Dan Sullivan’s office, even as the United States experienced a significant 25% decline in overdose deaths nationwide.
The vast majority of those deaths were fentanyl-related, according to Dr. Robert Lawrence, the Chief Medical Officer for the Department of Health in Alaska. Alaska is predicted to be in the top 10 in the country for deaths related to overdoses once updated mortality rates are released.
Alaska’s overdose crisis stands in stark contrast to the positive national trajectory, making it a geographic exception to broader improvements in combating the opioid epidemic. …
“It looks like the number of deaths from overdoses will have actually fallen in 2024 by maybe up to 5%,” Lawrence said. “So it’s not a huge drop. It’s just very slight. We would think of it as more of a plateau. The good news is it did not go up further.”
Official 2024 death counts are not yet available, though Lawrence indicated “new numbers will be out soon.”
Some background, context, and reality checks
Both of those media accounts, like this NPR attempt to mystify the causes and course of the worsening epidemic, miss things that are critically important, some established facts, some facts that we will explore in future posts, all which require us to reject and abandon the narrative that at all costs – all costs – must be protected.
That opioid fatal overdose rates across the nation have not been in significant decline until recently is a necessary lie, as is the portrayal of Alaska as standing alone “in stark contrast to the positive national trajectory”.
The exceptions are numerous, and revelatory.
Here’s an example, from 7 years ago, pre-pandemic, of the determinative role now established generally for naloxone campaigns accounting for reductions in opioid overdose deaths.
More widespread and more generally accross the U.S., as illustrated in the line graph above, opioid OD deaths were on the decline over approximately 2017 to mid-2020, associated with increasing efforsts to distribute naloxone – although nothing like the dramatic, targeted, layperson-focused campaigns of the past few years – then with an upturn in deaths as stay-at-home orders and quarantine degraded naloxone training and distribution, and relocation of unhoused high-risk opioid useres to single-occupancy lodging generated the type of isolation that is a barrier to effective implementation of Narcan use.
Pandemic effects reality check
The necessary fabricated rationalizations for pandemic surges in opioid overdose deaths have been invalidated (and here, and here) and were never supported by evidence. Instead, the response to relax safety standards and essentially lift restrictions on initiation (including by phone) and dispensing of medically provided substitute opioids, along with shifts to online provision of treatment and America’s gold standard fellowship/treatment model (and here), resulted in gold standard treatments becoming dramatically more available after a few months of COVID onset.
Nullifying the fabricated social, psychological and stress-based rationalizations for surging OD deaths, the trends from that period clearly indicate that the pronounced upturn began NOT over the initial weeks when uncertainties, disruptions, fears and stress were peaking, instead with a lag of a month or two when those substitute opioids (buprenorphine and methadone) established as fueling high-risk opioid use and deaths began being increasingly and with reduced safety restrictions being provided to high-risk opioid users, some of the relevant evidence described here, and here.
And what about, from that ALASKA’S NEWS SOURCE report above, this?
“Alaska’s overdose crisis stands in stark contrast to the positive national trajectory, making it a geographic exception to broader improvements in combating the opioid epidemic.”
Actually not stark, instead numerous states and locales also evidencing persistently increasing deaths and all of those, as exceptions, supporting the lethal rule: that only if and after implementation of effective, massive, targeted, layperson-focused naloxone campaigns, albeit delayed compared to most of the U.S., did opioid fatal overdoses decrease. Those exceptions include South Dakota, Iowa, San Francisco (and here), Nevada, Tennessee, and Washington.
And definitely not an exception to “broader improvements in combating the opioid epidemic“, because there are no such “improvements” as distinct from desperate, emergency naloxone campaigns to prevent deaths that are due to expert gold standard treatment failure. Those emergency naloxone saves, not any “treatment” effects, are the sole moderating force that are – in effect through serial saves and the associated hypoxic brain events – generating “another epidemic” of high-risk opioid users impaired in cognitive funtioning and increasingly more vulnerable to impulsive, high risk use, increasingly less able to engage effectively in the one evidence-based treatment for problem substance use, psychotherapy.
That’s not good.
So how do we understand what’s going on in Alaska, an outlier among outliers?
As in other locales, consistently, it’s the naloxone
And among states and locales “late to the game” – late to organize, fund, and successfully implement the targeted, intensive, layperson-focused naloxone campaigns that have accounted entirely for recent drops in opioid OD deaths – Alaska has been even later.
Anchorage police did not begin carrying naloxone until 2023, and over-the-counter naloxone was not available in pharmacies until September 2023. There have been concerns about costs for the Narcan kits, with fentanyl overdoses typically requiring multiple units.
Alaska began to implement measures to get Nacan into schools – but not until September of 2024.
Distribution was increasing mid-2023, including in Anchorage, where supplies ran short. Those efforts are consistent with the transient drop in OD deaths beginning 2024, but focused on populated areas and with no evidence of the types of street-level, targeted door-to-door campaigns used, for example, in Chicago and Philadelphia.
As late as October 2024, an Alaskan media news report noted concerns that at that time, “Many tribes struggle to provide overdose-halting naloxone and other medications because of chronic underfunding for health services”, Alaskan Native populations hardest hit by high-risk opioid use and potential for fatal overdose.
Under even unexceptional circumstances, supplies required for successful naloxone campaigns are uncertain.
Most of the Alaska health department’s supply of Narcan, a prescription medication that can quickly reverse the effects of an opioid overdose, ran out over a month ago, making it harder for the public to get access.
Health officials, who say new shipments arriving this week should help relieve the problem, blamed a combination of factors. They include a miscalculation on the state’s part of how much of the medication to order, shipping delays and rising demand linked to a recent spike in opioid deaths. …
The state received seven pallets of the medication on a barge this week, and Fink said the state should be able to assemble the kits and fill all orders by the end of the month.
The Interior AIDS Association in Fairbanks has been running low on the kits typically supplied by Project HOPE since the beginning of the year, according to Maya Bowers, who works in prevention outreach. …
It often takes weeks for a shipment of naloxone to arrive in Alaska, she said.
Those supply and implementation delays are not the whole problem
Among states, Alaska is first for remoteness, dispersal of its population, and geographical and weather challenges to travel. Compounding that, Alaskan Native populations are both differentially affected, with highest prevalence of high-risk opioid use, and are the most isolated.
The small planes that often bring in supplies and a few passengers to remote areas are no match for the types of concerted, well-funded, community-based outreach, training, and distribution campaigns that have been successfully used in urban and other more dense populations in other states to get Narcan where it can be effective – in the hands of trained laypersons who are, day-to-day, proximate to high-risk opioid users. And as noted above, disruptions of encampments of mutually-supportive high-risk users, as in Nevada, work against the potential life-saving benefit of Narcan training and dispensing.
So, additional, combined effects of challenges to distribution, training, and resupply of naloxone, along with disruptions of those efforts, must be added to features that make Alaska an outlier among outliers – almost uniquely disadvantaged in the potential, to date, for the only known moderator of opioid OD deaths to be successfully implemented.
An outlier, like all others, proving the lethal rule – that unless and until successful, targeted, layperson- and community-based naloxone campaigns are implemented as harm reduction, gold standard treatment failure persistently and predictably drives a worsening epidemic.
Cultural factors are not determinative
Native population cultural and social forces and practices are important and complex, subject for a future post.
They are not determinative of the causes, course, and effective versus failed responses to high-risk opioid use, as illustrated by the example of the Wisconsin Menominee tribe, described in this December 2024 post.
From that post –
That Drug Addiction Intervention Team started distributing the life-saving opioid overdose reversal drug naloxone (Narcan), targeted to areas of high risk in the community.
Caldwell said the tribe also used data to find “hot spots,” places in the community with a disproportionate number of overdoses, and “hot times” when overdoses were happening more frequently. Using that data, she says the community was able to get recovery coaches on the ground to help make people aware that resources were available.
She said the community also worked on harm reduction, which included increasing the supply of fentanyl test strips and Narcan. Fentanyl test strips are small strips of paper that can detect the presence of fentanyl in different kinds of drugs, and Narcan is a medication that rapidly reverses the effects of an overdose.
“Narcan is critical,” Caldwell said. “I know there’s a lot of opinions out there thinking that we’re giving this stuff out, and it just is making people overdose or use more. But in all reality, it’s saving a life. It’s nothing more than that.”
Caldwell said she believes making Narcan available to “anyone and everyone” is likely the “No. 1 thing that changed within this community to help drop our overdose rates.”
As described in its 2023 annual report, the community health center had been providing expanding medication assisted treatment (MAT) with prescribed Suboxone since 2018, with opioid overdose deaths predictably mounting and triggering the urgent campaign for community outreach and Narcan provision in 2023, followed by the sharp reversal of the lethal trend and drop in opioid overdose deaths.
The tribe’s story is a condensed and dramatic version of what has been seen consistently everywhere, in cities, locales, and diverse states – the predictable, established lethal effects of American experts’ gold standard “proven” treatments fueling a worsening opioid crisis, in recent years moderated by intense, targeted emergency naloxone campaigns that serve as harm reduction, at the same time masking persistently mounting high-risk opioid use and overdose. As seen in –
All that’s missing is for major media to twist the remarkable Menominee story of community harm reduction into an intractable mystery or validation and major triumph for that lethal gold standard medical dispensing of substitute opioids.
NPR, for example, has just the right reporter for that critically important public message.
[End of prior post excerpt]
To whatever extent Alaska is able to marshal resources and overcome barriers to saturate and continuously re-supply its populace with trained, layperson naloxone responders, the once-outlier state will join others across the U.S. – in deepening a worsening crisis fueled by expert treatments and hidden by expert lies and the lethally false promise of serial overdose revivals.
