Missoula looks to curb overdose deaths with free, accessible medication

Four new vending machines dispensing opioid-reversal medication will be available starting next month in Missoula’s hotspots for overdose calls — no quarters needed.  

The United Way of Missoula County is facilitating the Dose of Hope project in partnership with the Missoula Drug Safety Coalition and Missoula Public Health in an effort to reduce the county’s opioid overdose deaths, which increased 83% from 2019 to 2022.  

“We want to see those fatalities go down, and if people have access to Narcan, we’re less likely to see more overdoses,” said Leah Fitch-Brody, substance use disorder prevention coordinator for Missoula Public Health. “Even if a more potent batch of drugs is coming in with fentanyl in them or opioids in them, this can address that.”  

Once installed in April, a free outdoor vending machine at the Mountain Line bus station will be accessible 24/7. People will have access to indoor machines at the Missoula Food Bank, the Johnson Street shelter and Hope Rescue Mission’s drop-in center during business hours. 

The United Way received about $43,000 from the Independent Emergency Room Physicians Trust to purchase and maintain the vending machines. Narcan nasal spray for the machines will be provided for free from the state through a federal grant. 

Naloxone, commonly referred to by the brand name Narcan, is a medication that reverses an opioid overdose. It does not help with overdoses from other drugs, like methamphetamine.  

As drug overdoses increase nationwide, largely driven by fentanyl, health officials have stressed the importance of naloxone being widely available. 

Statewide, drug overdose deaths increased from 141 in 2019 to 202 in 2022, the most recent available data, according to the Montana Department of Health and Human Services. In 2022, Montana recorded 113 fatal opioid overdoses. Eighty-four percent of those deaths, or 95, were related to fentanyl overdoses. 

Fentanyl, a powerful synthetic opioid, is about 100 times more potent than morphine and is often mixed in with other drugs in varying amounts, increasing the likelihood of a fatal dose, according to the United States Drug Enforcement Administration. 

Missoula County recorded 10 fentanyl-related overdose deaths in 2022, up from zero in 2019, according to the DPHHS data. Those made up nearly half of the county’s 22 total drug overdose deaths and almost all of the 11 fatal opioid overdoses in 2022. 

Last year, Missoula recorded 18 drug overdose deaths, with fentanyl the primary suspected drug for at least half, according to preliminary data from the Missoula County coroner. 

While overdose deaths have fluctuated over the last 10 years, the number of fentanyl-related deaths has been continuously rising since 2019 as the drug becomes more available in the state, Fitch-Brody said.  

In February, Missoula Public Health sent out an alert about a fentanyl-related overdose spike of four non-lethal overdoses within five days, including two in the same 24 hours.  

Statewide and in Missoula County, fatal drug overdoses are most common among residents 25- to 44-years-old, followed by those 45- to 64-years-old, according to state health department data. 

Montana’s Native American population is disproportionately affected by overdoses, Fitch-Brody said. In 2022, the drug overdose death rate among American Indian/Alaska Native residents was 67.9 per 100,000 people, compared to 15.6 per 100,000 among white Montanans, according to the health department. 

Lack of Narcan accessibility is one of various factors that play into the disparity, Fitch-Brody said. 

In Montana, like most states, naloxone is available from the pharmacy without a prescription. People can also buy Narcan over the counter for $45. The cost with insurance varies, and may be cheaper with Medicaid, said Shannan Sproull, Dose of Hope project manager for United Way. 

Missoula Public Health and Open Aid Alliance provide free naloxone, and other organizations may have it available for clients or on hand in the case of an emergency, Sproull said. 

Although free, getting naloxone from those locations still presents the barriers of finding and visiting those locations during operating hours and asking someone for it, Fitch-Brody said. 

The Missoula Drug Safety Coalition, which includes Missoula Public Health and the United Way, started looking into the project after Helena got three Narcan vending machines last spring, Sproull said. 

The United Way took the lead on the project because it falls under the organization’s long-standing commitment to improving community health and health equity, CEO Susan Hay Patrick said. 

“It seemed like saving lives, literally saving lives, was something that we thought was important,” she said. “Yes, it’s an enforcement problem, but really it’s a public health crisis in our community, state and country, and we wanted to do what we could to address it.” 

Soon after Sproull contacted Helena about its machines, the Independent Emergency Room Physician Trust reached out to the United Way offering to fund the project, she said. The trust was created in 2022 as part of bankruptcy proceedings for opioid manufacturer Mallinckrodt Pharmaceuticals and distributes money for programs that lessen the harm of the opioid epidemic, according to its website.

The trust provided the United Way with just under $33,000 to purchase the four machines and $10,000 to maintain and stock them, as well as to track their use for a year, Sproull said.  

Along with Narcan, machines will be stocked with fentanyl test strips from the University of Montana’s Students for Sensible Drug Policy program and resource information packets. 

A QR code linking to a United Way webpage with a video of how to administer Narcan and treatment and recovery resources will be printed on the machines, Sproull said. The sites will also include a 1-800 peer support number and information on the state’s good Samaritan law, which protects people overdosing and those calling 911 to report them. 

To choose the vending machines’ locations, the coalition looked at data from the Overdose Detection Mapping Application Program, software available to government agencies, to find where the most fatal and nonfatal overdoses were occurring. 

Five main areas in Missoula saw the most overdoses: downtown along Ryman Street, around the Poverello Center on West Broadway, around Russell Street near the Salvation Army and Missoula Food Bank, North Reserve Street around various shopping centers, and near the intersection of Reserve and Brooks streets. 

Mountain Line agreed to host the outdoor vending machine at its downtown transfer station on Pine Street, allowing 24/7 availability, Sproull said. 

Poverello Center leaders said a machine would be more useful at the Johnson Street Shelter as long as it remains open, Sproull said. The Missoula Food Bank and Community Center, on Wyoming Street off North Russell Street, and Hope Rescue Mission, on Latimer Street off North Reserve, also agreed to house vending machines. 

Every organization the group reached out to partner with had a positive and supportive reaction, Sproull said. Providing Narcan at multiple locations people access every day will help lower barriers and normalize obtaining the medication, she said. 

“It should help reduce stigma and get it into more peoples’ hands than currently,” Sproull said. “If I wasn’t doing this project, it wouldn’t occur to me to get Narcan and have it on hand. We want to make people aware and get it into more peoples’ hands and save some lives.” 

The coalition expects the project to succeed and will continue to seek funding for it, Hay Patrick said. The United Way received requests for the vending machines in more rural areas of the county and hopes to expand to those locations, she said. 

All residents are encouraged to use the machines to get free Narcan, said Fitch-Brody with Missoula Public Health. 

“These machines are for everyone,” she said. “Everyone should carry Narcan because you never know when a situation might arise when you might need it.” 

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