In Maryland and across the country, fentanyl-related fatal overdoses have continued to increase.

The synthetic opioid is up to 50 times stronger than heroin, and since at least 2019 has been responsible for about 2,000 overdose deaths a year across the state — more than any other substance. The drug has pushed Baltimore’s fatal overdose rate to a level never before seen in any major American city.

Experts say it’s linked to overdose deaths involving other drugs, including cocaine, heroin, benzodiazepine, and methamphetamine, according to Maryland Department of Health reports.

In an effort to help Marylanders take steps toward protecting themselves and others from the powerful drug, as well as other opioids, The Baltimore Banner has laid out options for accessing naloxone, which reverses overdoses.

What is naloxone?

Naloxone is a medication that can reverse an opioid overdose.

There are a couple of different ways the medicine can be administered, depending on the brand. A well-known brand is Narcan, which is administered nasally. Other types require injecting the medicine into a muscle of the body, or sometimes into a vein or under the skin with a needle, according to the National Institute on Drug Abuse.

Naloxone works quickly, only taking around one to three minutes to start reversing an overdose, according to Harriet Smith, director of education at the Baltimore Harm Reduction Coalition.

The medicine will only have an effect on someone experiencing an overdose from opioids, such as heroin, fentanyl, oxycodone or codeine. It will not help someone who has overdosed on a different substance, like cocaine.

How can I access naloxone in Maryland?

All Marylanders should be able to get naloxone at their local pharmacy, Smith said.

Last year, the U.S. Food and Drug Administration approved Narcan for over-the-counter use without a prescription.

Some pharmacies may not stock naloxone, but most do, she said. The Maryland Department of Health advises Marylanders to call ahead to make sure a pharmacy has naloxone in stock.

Naloxone is covered by many insurance plans, Smith said, though the co-pay may vary. That’s likely one of the easiest ways for insured Marylanders to access the drug, Smith said, should they have funds for the co-pay and for transportation.

If you are not insured, or can’t get transportation to a local pharmacy that stocks naloxone, there are other options.

Across Maryland, there are Overdose Response Programs that offer naloxone for free, as well as training on how to use the medicine.

The state health department provides an extensive list of ORPs on its website, where Marylanders can access naloxone for free. Residents can also use a map on the department’s website to see ORPs in their area.

The list indicates that there are around 45 ORPs in Baltimore City alone, including the Baltimore City Health Department, SPARC Women’s Center, Health Care for the Homeless, Baltimore Safe Haven, Behavioral Health System Baltimore, and Baltimore Harm Reduction Coalition, among many others.

According to the list, there are also 15 ORPs in Baltimore County, as well as seven in Howard County and ten in Montgomery County. The list indicates there are also ORPs in Anne Arundel County, Calvert County, Carroll County, Dorchester County, and Cecil County, among others, as well as 21 ORPs that operate statewide.

Smith said Marylanders should keep in mind that certain organizations “may have stipulations about who they serve.”

For example, the Baltimore Harm Reduction Coalition’s stipulation “is that you are not getting it for your place of employment ... they are a person who uses drugs or they’re around people who are likely to experience an overdose resulting from opioids, and they’re not able to afford the pharmacy option or get to the pharmacy option because of transportation issues,” Smith said.

Some ORPs may also offer free naloxone by mail, according to the Maryland Health Department’s website.

Find Overdose Response Programs in your county by browsing the map below.

How do I use naloxone?

The Maryland Department of Health offers five steps on how to use naloxone, should you suspect someone may be experiencing an opioid overdose.

The first step, according to the department, is to “firmly rub your knuckles up and down the middle of the person’s chest” in order to try to get their attention.

If they do not respond, the health department says, call 911.

Step three is to administer naloxone, according to the health department.

“Peel back package to remove the device,” the department instructs. “Place the tip of the nozzle in either nostril until your fingers touch the bottom of the person’s nose. Press the plunger firmly to release dose into nose. If first dose doesn’t work within 1–3 minutes, give second dose.”

Then, “lay the person on their back. Tilt the chin back. Remove anything blocking their airway,” the department says.

“Pinch the person’s nose closed and cover their mouth with your mouth. Blow 2 regular breaths, then give 1 breath every 5 seconds. If trained in CPR, do chest compressions,” the department says.

Until medical help arrives, according to the health department, put the person in “recovery position: face and head turned to the side, top hand placed under head, top knee bent to support the body.”

The health department provides this 45 second video illustrating the five steps on its website.

Alissa Zhu contributed to this report.