Ingham County Health Officials Urge Overdose Precautions After Weekend Spike

What happened

The Ingham County Health Department is urging residents to take precautions after a spike in drug overdoses over the weekend, including at least one suspected overdose death. The department shared harm-reduction guidance for people who use substances, and for the family members, friends and caregivers who look out for them.

The guidance is short and specific. Health officials recommend that people who use drugs:

• Go slow. Even if you have used a substance before, you may not know what else has been mixed into it.
• Use fentanyl test strips. Test substances for fentanyl before using them.
• Start with a small amount. Wait to see how it affects you, and stop immediately if anything feels unusual.
• Never use alone. Have a sober person nearby who can call for help if something goes wrong.
• Keep naloxone (Narcan) nearby. If you suspect someone is overdosing, give naloxone immediately. The medication will not harm someone who is not experiencing an opioid overdose.

For people who do use alone, the department points to the National Overdose Prevention Line at 800-484-3731, a service where a volunteer stays on the phone and can send help if the caller stops responding.

Ingham County — which includes Lansing and East Lansing — has run an overdose-prevention collaborative, the Ingham Opioid Awareness & Prevention Initiative (IOAPI), since 2015. The group brings together health officials, treatment providers, law enforcement, first responders and nonprofits with a stated goal of reducing overdose deaths and the stigma that keeps people from asking for help. Its existence is itself a reminder that this is not a new problem for the county, even as the specific warning changes week to week.

Why a nonfatal spike is taken seriously

A cluster of nonfatal overdoses is one of the earliest signals available that the local drug supply has changed — or that a bad batch, or a stronger-than-usual one, is moving through a neighborhood. It shows up in emergency departments before it shows up in death records, which is why public health agencies watch it closely.

The CDC's DOSE-SYS system, which collects nonfatal overdose data from emergency department records across 47 states and the District of Columbia, exists precisely to catch these shifts early. County health departments use the same signal at the local level: a weekend that runs above the expected number of overdose-related emergency visits is a reason to push naloxone and harm-reduction information out to the community before the next weekend.

Two clinical facts make the message urgent without being alarmist.

First, naloxone wears off before some opioids do. NIDA notes that naloxone reverses the effects of opioids for roughly 30 to 90 minutes, while the opioid that caused the overdose can remain in the body longer. That means breathing can slow again after someone seems to recover. NIDA advises that people who have been given naloxone be watched constantly and monitored for at least two hours after the last dose, and that more than one dose may be needed — particularly with potent synthetic opioids such as fentanyl. If you use, carry more than one dose.

Second, a fentanyl test strip is a useful tool, not a guarantee. Test strips can detect fentanyl in a sample, but they will not detect every adulterant, they can miss fentanyl that is unevenly mixed through a batch, and they say nothing about potency. A "clean" result is not proof that a substance is safe, and the county's advice to start small and go slow is what covers the gap the strip leaves.

What to do if you suspect an overdose

The steps below are the same whether the person is a stranger, a friend or your own child.

1. Look for the signs: very slow or stopped breathing, snoring or gurgling sounds, blue or gray lips and fingertips, pinpoint pupils, cold and clammy skin, extreme drowsiness, or being unable to wake the person.
2. Give naloxone right away. Nasal spray or injection both work. It cannot hurt someone who is not overdosing on opioids.
3. Call 911. Tell the dispatcher that the person is not breathing normally and that you have given naloxone.
4. If you gave a nasal dose, give a second dose after two to three minutes if breathing has not improved, and keep going until help arrives.
5. Lay the person on their side so they do not choke, and stay with them. Do not leave someone alone after naloxone — the medication wears off before the opioid does.
6. If you are in Michigan, call for help without fear. Michigan's Good Samaritan law is designed to encourage people to call 911 during an overdose instead of walking away from one.

If you use substances, the items on the county's list — test strips, naloxone, a person who is not using nearby — are the same ones that make the difference in the first few minutes. Tell the people you live with where the naloxone is kept. Locked-up medication and clear household expectations still matter for families, but in an active overdose, naloxone and a phone call are what buy time.

Where to get naloxone in Ingham County

Naloxone is available in Michigan without a prescription, and Ingham County makes it easier than most places to get it for free.

• Pharmacy locator: The Ingham County Health Department maintains a map of Michigan pharmacies approved to dispense Narcan. You can call ahead to confirm availability and co-pay. Co-pays are $0 to $3 for people with Medicaid and up to $149 for some other insurance plans.
• Free by mail: Free Narcan can be mailed to you at no cost through nextdistro.org/michigan.
• Vending machines: The county publishes a map of public locations where naloxone is available free of charge, and MDHHS publishes a statewide vending machine map.
• Training: For free naloxone training, or help requesting a supply, contact the department's prevention coordinator, Tammy Maidlow-Bresnahan, at (517) 887-4315.

Where to get help

• SAMHSA National Helpline: 1-800-662-4357 — free, confidential, 24/7 treatment referral and information, in English and Spanish.
• 988 Suicide and Crisis Lifeline: call or text 988.
• Michigan MiSUD Locator: find substance-use treatment and recovery services across Michigan through the MDHHS opioid resources site.
• Poison Control: 1-800-222-1222, for questions about what a specific substance can do.
• In an emergency: call 911.

If you or someone you love is ready to stop, medication for opioid use disorder — buprenorphine or methadone — is the most effective tool available, and it can usually be started quickly. Asking a doctor, an emergency department or a treatment program about it is not a sign that someone has failed; it is the same step that helps people survive the weeks after an overdose, when the risk of a second one is highest.

Nobody is expected to manage this alone, and nobody should have to guess about the supply on their own.