“An employee lost a friend. He was 17. And it was just…” Evan Breshears’ voice trailed off.
He looked out the window of Queen’s Palace, the vape shop he manages in Helena. The afternoon sun streamed in wide and bright. Cases of sparkling glass and glowing neon lined the perimeter. Candy-colored vapes and bright cellophane packages colored the walls.
“We’ve all got some story of recovery. And we’ve all lost people to opiates,” Breshears continued. “It just seemed like the right thing to do.”
According to state and county officials, Queen’s Palace is the first shop of its kind in Montana to become a naloxone distributor. The initiative was the brainchild of Breshears and Tia Norine, manager of the Queen’s Palace location in Butte. Naloxone is the generic name of a drug more commonly known by its brand name, Narcan. The drug rapidly reverses the effects of an opioid overdose.
“Here at the shop, we’re like the land of misfit toys. We’ve all been through it, we haven’t had anything handed to us, and we understand the struggle,” Norine told Montana Free Press. “That’s what makes this place such a good fit.”
While opioid use has fallen nationwide, fatal overdoses are rapidly rising. After a decade-long decline, overdose deaths in Montana spiked 39% post-COVID, and reached an all-time nationwide high of 109,6802 in 2022, according to the Centers for Disease Control and Prevention. Experts point to the ubiquity of fentanyl, a powerful synthetic opioid 50 to 100 times stronger than morphine.
Jason McNees, head of the Helena Indian Alliance’s Medication for Opiate Use Disorder Program, sees it firsthand.
“I personally hear of 30 to 50 overdoses annually,” McNees said. “Just as the state began to get oxycodone under control, fentanyl emerged. It’s far more powerful, far more deadly.”
“It’s bad,” Breshears agreed. “Heroine, MDMA, cocaine? It’s all cut with fentanyl. Same with prescription drugs. Some don’t work, some kill you immediately.”
That harrowing reality was confirmed in a new study by the CDC, the national public health agency. It showed opioids played a role in 80% of cocaine overdoses and 65% of overdose deaths involving stimulants in 2021.
While naloxone has been on the market since 1971, it wasn’t widely accessible until 2016, when the FDA approved an intranasal applicator. Since that time, most states have passed naloxone access laws. The laws authorize standing prescriptions for naloxone so individuals, companies, and government agencies can order the drug free of charge. In states with naloxone access, opioid overdose deaths have decreased by 14%, according to a national study. And that number could be higher. Studies show that bystanders are present at one in three overdoses involving opiates. Naloxone is easy to use and the applicator is the size of an AirPod case. But wide-scale distribution has encountered obstacles.
“A lot of times you’ll hear, ‘This is replacing one drug for another,’ and that’s not what it does at all,” McNees said. “I think it’s just a lack of education.”
“The only thing it does is reverse the effects of opiates in the brain,” he added.
Kellie McBride, director of Lewis and Clark County Department of Criminal Justice Services, agreed.
“It doesn’t hurt to have it, and it doesn’t hurt to administer it,” McBride said. “The more Narcan we have in the community, the better opportunity we have to save that life. And if you save that life, you can point that person toward treatment.”
Resolving opiate addiction — a.k.a. opiate use disorder (OUD) — is not as simple as the will to change.
Opiate use changes the chemical composition of the brain. Medications for OUD balance those chemicals — dopamine, norepinephrine and serotonin — allowing time for the body to begin producing them at normal levels.
“So you’re able to think clearly, able to function. It reduces those withdrawal effects, giving you a fighting chance,” McNees said.
In Montana, drug overdoses are the fourth-leading cause of death. In 2017 the state issued a standing order for naloxone. The authorization from the state Department of Public Health and Human Services was renewed in 2023, allowing organizations and individuals to order naloxone for free. But implementation has been difficult.
“They approved these vending machines for Narcan, but then they put them in courts and probation offices where people who need it most are never gonna go,” Breshears said.
“The location of distributions has been a big barrier,” McNees agreed. “After a couple of years and thousands of dollars, I think everybody realized it’s not getting to users.”
According to McBride, Lewis and Clark County was the first in the state to get naloxone vending machines. It purchased three with a federal grant and thought hard about where to place them.
“We know we have individuals coming in [to the Law and Justice Center] who have friends and family struggling. We wanted it to be in a safe, secure place, and we wanted it to have the greatest impact possible. But are users going to come into law enforcement offices to pick [naloxone] up? I don’t know. It can be intimidating,” McBride said.
The county placed the other machine at Our Place, a drop-in support center run by Good Samaritan Ministries. For the third, McBride said the team reached out to a number of bars in town.
“They didn’t want to send the message that their clientele were users,” McBride said. “It was unfortunate because that’s not it at all. It’s that we all have friends and family members who struggle with addiction.”
The team at Queen’s Palace isn’t worried about that.
“It’s so heartbreaking to see the judgment these people face. From people who don’t know, you know?” Norine said.
“It’s a no-brainer,” Breshears said.
“Evan [Breshears] reached out, and it was the simplest thing to get going. Government entities have all these hoops they have to jump through,” McNees said. “But individuals? They can just sign up and have it shipped to their business, no questions asked. It’s just such a great idea.”
Beginning this month, little pink-and-white boxes of Narcan greet you as you walk into Queen Palace, sitting unassumingly atop a glass case. They’re there for the taking, free of charge.
“We’re not pushing anything on anybody,” Breshears said. “We have meeting schedules for AA and NA too, in the corner. Stuff people want but don’t want to ask for. We just want to make it available.”
And it’s not just for users.
“A lot of people think, ‘I’m not using so I don’t need Narcan,’” Breshears said. “You mean you don’t go into parking lots? Bathrooms? Gas stations? You don’t know what you’re going to walk in on. It’s like a fire extinguisher, an EpiPen. You hope you don’t need it, but it’s good to have.”
McBride agreed. “We’ve had family members drop by and say, ‘I wish I had this earlier.’” Just the other day a delivery driver stopped by for a few boxes. “He said you never know what you’re going to walk into, and he wanted to be prepared.”
Norine hopes Queen’s Palace is part of a broader destigmatizing movement.
“My thing is: You treat everyone who walks through that door the same,” Norine said. “Addicts aren’t going to go somewhere where they feel judged. And that’s why this is a good idea. Because who am I to judge anybody? I don’t know you, I don’t know your situation and I don’t care. I love my job, and I love you.”
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