A last year showed that just over 86% of Montana’s 2-year-olds had recently received the measles, mumps, and rubella immunization. That figure has decreased in recent years, according to earlier surveys, and at the University of Montana, said the latest rate is “well below” the ideal 95% threshold for community protection against highly contagious diseases.

But beyond that statewide estimate, information about Montana’s local and regional immunization trends is hard to come by. State officials no longer collect aggregated vaccination reports from schools and child care centers, or the included data about medical and religious exemptions. The administration of Republican Gov. Greg Gianforte discontinued the practice after he signed striking the requirement.

The last of the localized reports were from the 2018-19 school year, before the disruptions of covid-19. Without the information, Newcomer said, local and state officials have struggled to strategically prevent the spread of vaccine-preventable disease.

“State averages are helpful, but really drilling down to county level or smaller geographic levels are really what we need to assess risk of outbreaks,” she said.

Montana is the only state that no longer collects immunization reports from local schools, creating a data gap for the Centers for Disease Control and Prevention. The information shortage also affects city and county health officials who may not have their own data-sharing agreements with school districts.

Supporters of the 2021 measure to stop collecting data said they were aiming to protect students’ personally identifiable information and medical records and did not intend to cancel the reporting system in its entirety.

“I wasn’t trying to bomb the system. I was just trying to make sure children had their privacy respected,” said Jennifer Carlson, a former Republican legislator and the sponsor of the bill the state health department cites as the reason for discontinuing the data collection.

State lawmakers to undo the 2021 policy, while keeping privacy protections for individual student records. After stalling earlier this session, the Democratic-sponsored advanced in March with bipartisan support, clearing the House with a 66-31 vote.

The bill, sponsored by Democratic , has also received support from the state health department, an agency within the Gianforte administration.

Republican said that he believes the bill is good policy for the state.

“It’s important that public health authorities have access to aggregate information so they can track where vaccinations are not being used,” he said.

Montana hasn’t confirmed a case of measles . But with more than across Texas, New Mexico, and 17 other states, one child confirmed to have died from the disease, and another death under investigation, Newcomer said she and other disease experts are “on edge” about Montana’s defenses. Three cases have been confirmed in March south of Calgary, in the Canadian province of Alberta, which shares a border with Montana.

“I like to say that when vaccination rates drop in a community, it is not a question of if. It’s a question of when measles is going to come, because it is so incredibly contagious,” said David Higgins, a pediatrician and researcher at the University of Colorado Anschutz Medical Campus.

Higgins used to work in Montana when the law requiring schools and state officials to share data was still in place. He said he’s disappointed in the 2021 rollback, given how outbreaks begin at the hyperlocal level.

“When community leaders don’t have a good understanding of the local level of vaccination and community immunity, that’s a significant challenge,” Higgins said. “They’re hamstrung without having that data readily available.”

Measles is one of the world’s most contagious diseases, , much more so than covid. It can be very dangerous, especially for infants and children under 5 who have not completed the two-dose vaccination series. Infectious particles can hang in the air and on surfaces for up to two hours. People carrying the virus can spread it up to four days before they begin showing symptoms.

“If we do have a measles case arrive in Montana, and particularly if it arrives in a community that has low vaccination coverage, we’re going to see spread over like a multi-week or even multi-month period,” Newcomer said. “So an unvaccinated person can get sick simply by going into a school, store, or home where someone infected with measles recently was.”

The infection can have short-term and long-term consequences for people who are not immunized, including encephalitis, pneumonia, deafness, blindness, and death. State and community health departments have been advertising free MMR vaccinations at clinics throughout the state for anyone who needs them.

While HB 364 is aimed at increasing data collection, other vaccine measures in the state legislature are advancing that would make it easier for children to be exempted from standard immunizations required to attend schools or child care centers.

A recent version of , which has been amended several times, would create an “informed consent” exemption in which a parent or guardian could decline immunizations for school-age children without stating a reason.

Supporters of the bill said that some families struggle to receive exemptions on the grounds of religious beliefs or medical causes and want broader flexibility to opt out of requisite vaccinations against measles and other infectious diseases, such as pertussis. According to Montana’s most recent reporting, from the 2018-19 school year, roughly 3% of children in public schools had a religious or medical exemption.

SB 474 also would strike another part of state law that allows schools and day cares to deny admission to children because they are unvaccinated, an exemption included in a 2021 law aimed at protecting unvaccinated people from discrimination. The lawmaker sponsoring the current bill called the carve-out for schools and day cares an “aberration” in Montana law.

“There’s no reason that they should be discriminating based on vaccine status,” Republican said during a March debate on the Senate floor.

Emrich and others framed the bill as enabling individual decision-making around vaccinations based on how well a parent knows their own child.

“Vaccines are pretty effective,” Emrich said. “If you’re concerned about unvaccinated children, you have the option to get your kid a vaccine to protect them in whatever way you want. This bill is really about choice.”

During the debate, opponents of the bill contended that the lower Montana’s overall immunization rate drops, the more at risk many community members are, including those who, because of age or medical issues, can’t be vaccinated.

, a Democrat representing Bozeman, said that vaccinated Montanans, including children, are acting as “shields” against contagious diseases like measles and pertussis. But if vaccination rates continue to drop, Neumann said, that protection will only get weaker.

“We just saw a kid die of measles [in Texas]. It’s going to continue, and it is going to be scary. It is going to be deadly,” Neumann said. “It feels like a luxury right now. We can choose. It is not going to be if we continue down this path.”

The bill passed the state Senate on a 28-21 vote. It is now under consideration in the House.

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Kratom, which originates from the leaves of a tree native to Southeast Asia, is also touted for helping relieve pain and opioid withdrawal symptoms. But it can have wide-ranging mental and bodily effects, according to the federal Drug Enforcement Administration, addiction medicine experts, and kratom researchers. Reports of have surfaced in recent years, though often in combination with other substances.

But the drug is in a gray federal regulatory area: It’s designated by the DEA as a “,” but it is not considered a controlled substance. in 2023 to study kratom has not advanced.

The lack of federal regulation and congressional action has left it to states to step into the complex debate over how to clean up supply chains and protect users.

The kratom industry itself wants to help address this regulatory void. A bill drafted by the American Kratom Association, a national industry lobbying group, is pending in the Montana Legislature. In its current form, the industry-dubbed “Kratom Consumer Protection Act” would ban sales to people under 18 and restrict which products can be labeled as “kratom” based on the amount and potency of two chemical components, mitragynine, and 7-hydroxymitragynine.

Similar industry-backed bills have passed , including Oregon, Texas, Kentucky, and Maryland, according to the American Kratom Association website. Other states, including Wisconsin and Arkansas, have enacted kratom bans by listing it as a Schedule I controlled substance.

, a University of Florida researcher who has studied kratom since 2016, said industry-written bills often hinge on producers accurately representing what’s in their products. Lawmakers and the public in Montana may not be convinced that the proposed legislation will put public health considerations above commercial interests.

“Naturally, a company is driven by profits and making sure that they can retain their profits,” Grundmann said. “I’m skeptical of self-regulation.”

Whether the Montana bill will be effective hinges on the state’s having enough resources to regulate the industry, as well as industry retailers honestly testing and marketing their products, he said.

The bill’s sponsor, Republican , said she’s trying to bring her fellow lawmakers up to speed on a substance that few people understand. Nicol said she delayed ’s first committee hearing to give herself more time to speak with legislators and to hear from groups that support and disagree with the industry’s suggested approach. She indicated she’s open to amending the bill, though it has not yet been rescheduled for a committee hearing.

“We’re going to be changing our minds and learning things and molding this as we’re going,” Nicol said in a February interview.

Researchers and addiction medicine experts have struggled in recent years to pin down kratom’s health effects and patterns of use. A estimated that 1.7 million Americans age 12 and older used the substance in some way the year before the study.

Medical providers and addiction researchers in Montana say patients often don’t disclose their kratom use to health care providers. Some consider it an herbal supplement, a perception driven by its accessibility in gas stations and vape shops, rather than a mind-altering and potentially addictive drug.

Megan Zawacki, a physician assistant and addiction medicine specialist in Helena, said many of her patients seek help for misuse of other substances and aren’t easily convinced of kratom’s negative side effects.

“The majority of my patients that are using it can’t even quantify to me how much they’re using,” Zawacki said.

But if their use spirals into addiction, she said, the consequences of the substance become clearer. At her clinic in Helena, Zawacki said, more of her patients are currently being treated for kratom addiction than for opioid use disorder.

“I’ve had two patients specifically in the last calendar year tell me, ‘We need to bring legislation against kratom,’” she said. “Because it is so readily available and so misunderstood that it just is wreaking havoc on their lives.”

Depending on how it’s manufactured and how much users consume, kratom can function as a stimulant or a sedative. Though not an opioid, its key chemical components can target opioid receptors in the brain, leading some advocates to cite its potential for helping opioid users manage withdrawal.

Zawacki and other Montana providers say they have prescribed buprenorphine to help patients stop using kratom — the same treatment often used to manage opioid addiction.

Some Montana advocacy groups that work to prevent substance misuse have also flagged concerns about kratom use among minors. Beth Price Morrison, with the Alliance for Youth in Great Falls, said her organization has pressured gas stations in the area to stop carrying kratom products or at least keep them behind the counter.

“Our youth are really struggling with mental health right now, and they turn to substances to cope. And this stuff is easily accessible,” Price Morrison said.

Price Morrison and Nicol expressed support for raising the age limit on kratom sales to users 21 and older, rather than 18, which is in the current draft of the American Kratom Association bill.

The legislation would allow state regulators to screen kratom products coming on the market in Montana and create a registry of permitted distributors. Vendors would be banned from selling or promoting kratom products whose concentration of 7-hydroxymitragynine exceeds 2% of the total alkaloid content.

The American Kratom Association and other supporters say that such a restriction would help weed out natural forms of kratom from synthetic, higher-potency concoctions. Some kratom researchers have endorsed this type of market regulation, citing the chaotic array of products currently allowed to sport kratom labels.

Grundmann, the University of Florida researcher, said there has been an “evolution” in the United States of products being labeled and sold as kratom.

“The kratom that was on the market then was basically ground-up leaf powder that was not further concentrated,” Grundmann said. “What we have seen in recent years is even stronger extracts that focus specifically on mitragynine and 7-hydroxymitragynine. These should not be seen as ‘kratom’ any longer.”

Grundmann, who supported a similar version of legislation in Arizona in 2019, said Montana’s bill is a starting point for regulation. He said other states, including Colorado, began with a common framework and in recent years.

Price Morrison, the youth prevention advocate, said she has broader misgivings about any bill that normalizes the sale of kratom in Montana. In an ideal world, she said, she would like to see the product banned completely.

“We know that availability drives use. And when a product is marketed as regulated, it gains legitimacy,” Price Morrison said. “And more people, including those who are vulnerable, end up using it.”

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The nearly 150-year-old Montana State Hospital has recently struggled to care for patients and retain staff. The problems came to a head in 2022, when federal investigators yanked the hospital’s federal certification — and funding — from the Centers for Medicare & Medicaid Services because of a pattern of patient deaths found to be preventable, as well as injuries and falls.

Since then, Republican Gov. Greg Gianforte’s administration has launched a complex and expensive overhaul of the Montana State Hospital’s operations with the goal of regaining certification. That outcome may require years more work and tens of millions in additional funding from the Republican-majority legislature.

At least some lawmakers begrudgingly acknowledge the protracted scenario, reflecting on the time spent trying to pressure the state health department to move at a faster pace.

“I think it’s going to be done when it’s done,” said Republican Sen. Dennis Lenz, a longtime lawmaker who sits on the health department’s budget committee in the state legislature. “It’s like telling your teenager, ‘Come on, get your act together. Come on, put your clothes away.’”

Lawmakers in this session have the power to add or restrict money for Gianforte’s health department and write laws related to state hospital oversight, admissions, and discharge processes.

Health officials in the Gianforte administration are neck-deep in efforts to renovate the facility, slow its revolving door of leaders, and increase staff retention. Lawmakers are instead turning their attention toward ways to strengthen mental health services outside the hospital — an effort urged on by other mental health care advocates.

“I think the future of the hospital, and whether or not it will improve enough to be considered meeting the minimum federal standards for a hospital, rests on whether or not Montana can build up its community-based services,” said David Carlson, executive director of Disability Rights Montana, a federally appointed watchdog group that advocates for patients in state facilities. “They’re so interlinked. And we’re putting too much pressure on a singular hospital in Warm Springs.”

The state hospital’s campus, located in southwestern Montana near Butte, treats criminally and civilly committed patients. Inspectors decided to decertify the hospital after identifying numerous violations of patient care standards, including deaths, infection control issues related to covid-19, repeated falls, and medication mismanagement that amounted to “chemical restraints.”

In the wake of that loss, the hospital’s top-level leadership has rotated through . Medical staffers have strongly criticized new mandates and changing protocols. The facility relies on expensive contracted health professionals, and, until this month, a consulting firm to oversee the hospital’s operations. Waitlists for the unit of criminally charged patients are persistently long, bogging down court cases and leaving suspects incarcerated in jails throughout the state.

In mid-January presentations to lawmakers, state health officials gave mixed reviews about how the hospital is improving.

The facility has discontinued the use of chemical restraints entirely, officials said, and recently hired a permanent CEO and chief medical officer. Doug Harrington, Montana’s state medical officer, said the facility is also seeing more interest from prospective employees applying for open positions.

“The short answer is yes, things are changing. And it will take time; it’s not going to happen overnight. But the seeds have already been planted, and we’re seeing some of the fruit growing up,” Harrington told lawmakers on the health department’s budget subcommittee.

Harrington also acknowledged that the timeline for regaining certification from CMS was pushed back to 2026 due to physical repairs at the central hospital.

“When you start tearing the wall out, you frequently find fungus, black mold, infectious agents in the water of the cooling systems,” he said. “We need to shut down an entire wing and move those patients somewhere else so that that can be sealed off and worked on.”

Last fall, the state began moving patients to a 20-bed space in Helena leased from Shodair Children’s Hospital to allow for the renovation of one of the hospital’s wings.

In total, the Gianforte administration has requested that the legislature greenlight a one-time allocation of almost $61.5 million to continue to cover the cost of contracting clinical and nursing staff at the state hospital. The facility’s two-year budget, including that request, is more than $167 million.

Another high-priority upgrade for the hospital is the creation of a comprehensive electronic health records system.

Funding for that project — approximately $27.6 million to cover all state facilities — was originally approved by the legislature in 2023. But state officials have yet to ink a contract for the electronic system, and they say the cost could change during negotiations with a future vendor.

The state estimated in January that the electronic records project, from development to implementation, would take three years. A spokesperson for the hospital said the department expects to have a contract signed and to begin that timeline in March.

Previous efforts to legislate change at the hospital are still in motion. Lawmakers in 2023 that directed the state to move patients with a primary diagnosis of dementia, such as Alzheimer’s disease, or a traumatic brain injury out of the hospital and into community-based facilities better equipped to care for patients with memory issues and other cognitive disabilities.

The bill set a deadline for those patients to be moved by the end of this June. Jennifer Carlson, a former Republican lawmaker who chairs a committee to oversee that transition, said the department still has patients in residence who are subject to the legislation, but she’s feeling optimistic about meeting that target.

Another bill from 2023 required the state health department to share unredacted abuse and neglect reports with Disability Rights Montana, the designated federal civil rights inspector. But since the law took effect, staff turnover and changing protocols at the hospital made for inconsistent application of the law, officials with the advocacy group said.

David Carlson of Disability Rights Montana, who is not related to Jennifer Carlson, said lawmakers’ and advocates’ time may be better spent this session on trying to reduce the number of patients that hospital staffers are struggling to care for. One strategy is to finalize the transfer of memory-care patients targeted by the 2023 law to community-based facilities, he said, and help grow local mental health crisis services.

Even with those changes, he added, the responsibility for high-quality patient care rests with the Gianforte administration and the hospital’s leadership team.

Ultimately, if medical standards and internal protocols don’t improve, David Carlson said, the last branch of government that can put a check on the hospital’s operations is the judiciary. Disability Rights Montana has previously represented patients suing state institutions over civil rights violations and errors in patient care.

“That’s not a threat. That’s just a description of how this all works,” Carlson said. “Accountability will come from some branch of government. The administration can embrace it themselves and get ahead of it. The legislature can lay it on there, or we can have the courts do it.”

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She was riding in a car on the back roads of the Flathead Indian Reservation in western Montana when she lost consciousness. Someone in the car grabbed a small bottle of naloxone, sprayed it up her nose, and performed CPR until she came to. Coon said having quick access to the overdose reversal agent, also known by the brand name Narcan, was incredibly lucky.

“The times I wasn’t administered naloxone, it’s a miracle that I made it out,” Coon said. “People brought me back by shocking me with cold water and doing CPR. But that’s not a for-sure ‘I’m going to bring you back to life,’” Coon said.

Nearly two years later, Coon is a recovery coach for a local program, Never Alone Recovery Support Services, and earning a degree as an addiction counselor from Salish Kootenai College. She keeps doses of naloxone in her car in case she needs to help other people.

But, she said, she worries about the drug’s lack of accessibility, particularly in rural areas like her own. The state and tribal health departments’ distribution pipeline has been inconsistent, and the $50 price tag for a two-dose package of naloxone at the nearest Walmart puts it out of reach for many people.

“How are we supposed to afford this drug that’s ultimately to save the lives of ourselves and those around us?” she said.

Montana health officials are considering a new strategy to make naloxone more accessible. Drawing on a pool of behavioral health funds set aside by lawmakers in 2023, health officials within Gov. Greg Gianforte’s administration have proposed installing two dozen naloxone and fentanyl testing strip vending machines around the state at behavioral health drop-in centers and service locations for homeless people.

The $400,000 plan to build, stock, and maintain 24 vending machines for a year has not yet been approved by the governor, a Republican running for a second term, who ultimately decides how the funds allocated to the Behavioral Health System for Future Generations Commission are spent.

Details from the state’s Department of Public Health and Human Services about where the machines would be located and how they would be operated remain scarce.

The opioid-related death rate in Montana in recent years, from 3.6 deaths per 100,000 residents in 2017 to 11.3 per 100,000 residents in 2023. The death rate is higher among Native Americans: Native people in Montana died of opioid overdoses at a rate of 33 deaths per 100,000 people in 2023 — more than three times the rate for white people.

Naloxone has emerged as an important tool to combat opioid overdoses. When administered quickly, it attaches to receptors in the brain targeted by opioids, blocking the drugs’ effects.

Across the U.S., vending machines that distribute naloxone and other health supplies free of charge are of the battle against opioid overdoses. Different versions of the model are being tried in .

In a 2023 report, the described the use of vending machines to distribute naloxone and other “harm reduction” supplies — first-aid kits, pregnancy tests, sterile syringes, and more — as a public health tool that became more widespread during the social distancing era of the covid-19 pandemic. But the popularity of the model has continued to grow since, especially in places with hard-to-reach populations.

“They provide services to [people who use drugs] with far fewer barriers than fixed-site programs and even mobile outreach,” the report stated. Harm-reduction vending machines, it continued, “may also provide greater privacy and anonymity.”

The proposal from the state health department would be the first instance in Montana of vending machines being funded directly by the state, as opposed to the few now funded through public grants or private philanthropy.

Jami Hansen, prevention bureau chief for the state health department’s Behavioral Health and Developmental Disabilities Division, spoke about the proposal during a May meeting of the state behavioral health commission. She framed vending machines as a targeted way to fill gaps in a sparsely populated state that doesn’t offer consistent access to addiction treatment and naloxone.

“Having something available that they could utilize themselves would be very, very beneficial,” Hansen said.

Some local public health groups in Montana — including those in Missoula, Helena, Kalispell, and Big Horn County — have already begun using vending machines to distribute free naloxone, drug testing strips, and other health supplies. In Helena, three machines purchased by Lewis and Clark County have been distributing free Narcan nasal spray and safe drug disposal pouches — used to dissolve prescription and recreational pills — for more than a year.

Kellie Goodwin McBride, director of the county’s criminal justice services department, said her team originally tried to embed the machines within local businesses — a downtown bar, a laundromat, and a convenience store — but repeatedly struck out. Sometimes, there wasn’t enough space for the machines. In other cases, McBride said, owners worried that a Narcan vending machine would convey that the business condoned or welcomed drug use.

Instead, the county installed vending machines in a nonprofit drop-in center serving local homeless residents, the state district court building, and the Law and Justice Center downtown, which houses the municipal court and county sheriff’s department. That machine, McBride said, gets the most use.

Unlike some other models, the Narcan vending machines in Helena don’t require user registration or codes to access the materials inside, making it impossible to track who is taking naloxone or if it is being used. McBride and her team acknowledge there is no consistent way to know how many opioid-related deaths the vending machines have helped prevent.

Jessica Johnson is the health education supervisor at the Southern Nevada Health District, which helped create the first vending machine collaborative in the contiguous U.S. Johnson said the project was designed to distribute naloxone and sterile syringes to reduce the spread of infectious diseases among people who inject drugs. found 41 fewer overdose deaths than expected were recorded in Clark County, where the machines were located, during the first year of distribution.

Johnson said one of her takeaways from the program is the importance of listening to the community’s most at-risk people. The resulting harm-reduction kiosks or vending machines can look as diverse as the places they’re located.

Public health workers across the nation have added toothbrushes, tobacco-use cessation kits, and other supplies to their vending machines based on feedback from the populations they serve, Johnson said.

While organizational hosts have not yet been chosen, Montana health department spokesperson Jon Ebelt said the agency’s recommendation to place machines at drop-in centers and sites serving homeless people is based on a desire to reach people with serious mental illnesses and others who are already seeking services at those locations.

Ebelt confirmed the department did not reference opioid overdose data or demographic information about people who most often overdose in Montana when deciding where to place the machines. Rather, he said, the decision was “based on community-based programming and existing contracts with low barrier service sites.”

Under the proposal, Ebelt said, community hosts of the vending machines will be able to select many types of additional harm-reduction supplies to distribute, “as each community has different needs,” but sterile syringes will not be among the products available in Montana’s machines. The state plans to pay for one year of supplies, after which it may use federal grants to stock the machines, and federal funds to purchase syringes for illegal drug use. Ebelt did not respond to additional inquiries about that decision or whether sites would be able to add syringes and other materials supplied through independent funding.

This article was produced through a partnership between ºÚÁϳԹÏÍø News and Montana Free Press.

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Coon estaba en un auto por los caminos secundarios de la Reserva India Flathead en el oeste de Montana cuando perdió el conocimiento. Alguien en el auto tomó una pequeña botella de naloxona, la roció en su nariz y realizó resucitación (CPR) hasta que recuperó el conocimiento.

Coon dijo que tener acceso rápido al agente de reversión de sobredosis, también conocido por su nombre comercial, Narcan, fue muy afortunado.

“Es un milagro que haya sobrevivido las veces que no me administraron naloxona”, dijo Coon. “La gente me devolvió la conciencia echándome agua fría y haciendo CPR. Pero eso no garantiza que te vayan a devolver a la vida”, agregó Coon.

Casi dos años después, Coon es entrenadora de recuperación para un programa local, Never Alone Recovery Support Services, y está obteniendo un título como consejera de adicciones en Salish Kootenai College. Lleva dosis de naloxona en su auto por si necesita ayudar a otras personas.

Pero dijo que le preocupa la falta de acceso al medicamento, particularmente en áreas rurales como la suya. El canal de distribución de los departamentos de salud estatal y tribal ha sido inconsistente, y el precio de $50 por un paquete de dos dosis de naloxona en el Walmart más cercano lo vuelve inaccesible para muchas personas.

“¿Cómo se supone que vamos a poder pagar por este medicamento que en última instancia es para salvar nuestras vidas y las de los que nos rodean?” dijo.

Oficiales de salud de Montana están considerando una nueva estrategia para hacer que la naloxona sea más accesible.

Basándose en un fondo de salud conductual reservado por los legisladores en 2023, oficiales de salud de la administración del gobernador Greg Gianforte han propuesto instalar dos docenas de máquinas expendedoras de naloxona y tiras reactivas de fentanilo alrededor del estado, en centros de salud conductual y lugares de servicio para personas sin hogar.

El plan de $400,000 para construir, abastecer y mantener 24 máquinas expendedoras durante un año aún no ha sido aprobado por el gobernador republicano, que se postula para un segundo mandato, quien en última instancia decide cómo se gastan los fondos asignados a la Comisión del Sistema de Salud Conductual para las Generaciones Futuras.

Los detalles del Departamento de Salud Pública y Servicios Humanos del estado sobre dónde se colocarían las máquinas y cómo se operarían siguen siendo escasos.

La tasa de muertes relacionadas con opioides en Montana en los últimos años, de 3,6 muertes por cada 100,000 residentes en 2017 a 11,3 por cada 100,000 residentes en 2023.

La tasa de mortalidad es más alta entre los nativos americanos: las personas nativas en Montana murieron por sobredosis de opioides a una tasa de 33 muertes por cada 100,000 personas en 2023, más de tres veces la tasa de las personas blancas no hispanas.

La naloxona ha surgido como una herramienta importante para combatir las sobredosis de opioides. Cuando se administra rápidamente, se adhiere a los receptores del cerebro a los que se dirigen los opioides, bloqueando los efectos de las drogas.

En todo Estados Unidos, las máquinas expendedoras que distribuyen naloxona y otros suministros de salud de forma gratuita se están convirtiendo en en la lucha contra las sobredosis de opioides. Diferentes versiones del modelo se están probando en al menos .

En un informe de 2023, el describió el uso de máquinas expendedoras para distribuir naloxona y otros suministros de “reducción de daños”, como kits de primeros auxilios, pruebas de embarazo, jeringas estériles y más, como una herramienta de salud pública que se hizo más común durante la era del distanciamiento social durante la pandemia de covid-19.

Pero la popularidad del modelo ha seguido creciendo desde entonces, especialmente en lugares con poblaciones a las que es difícil llegar.

“Proporcionan servicios a [personas que usan drogas] con muchas menos barreras que los programas en un sitio fijo e incluso la divulgación móvil”, afirmó el informe. Las máquinas expendedoras de reducción de daños “también pueden proporcionar mayor privacidad y anonimato”.

La propuesta del departamento de salud estatal sería el primer caso en Montana de máquinas expendedoras financiadas directamente por el estado, a diferencia de las pocas que ahora se financian a través de subvenciones públicas o filantropía privada.

Jami Hansen, jefe de la oficina de prevención de la División de Salud Conductual y Discapacidades del Desarrollo del departamento, habló sobre la propuesta durante una reunión de mayo de la comisión estatal de salud conductual. Dijo que las máquinas expendedoras son una forma específica de llenar vacíos en un estado escasamente poblado que no ofrece acceso consistente a tratamientos para la adicción y naloxona.

“Tener algo disponible que puedan utilizar ellos mismos sería muy, muy beneficioso”, agregó Hansen.

Algunos grupos locales de salud pública en Montana, incluidos los de Missoula, Helena, Kalispell y el condado de Big Horn, ya han comenzado a usar máquinas expendedoras para distribuir naloxona gratuita, tiras reactivas para drogas y otros suministros de salud.

En Helena, tres máquinas compradas por el condado de Lewis y Clark han estado distribuyendo aerosol nasal Narcan gratuito y bolsas para la eliminación segura de drogas (usadas para disolver pastillas recetadas y recreativas) durante más de un año.

Kellie Goodwin McBride, directora del departamento de servicios de justicia penal del condado, dijo que su equipo intentó inicialmente integrar las máquinas en negocios locales, como un bar céntrico, una lavandería y un mercado, pero fallaron repetidamente.

A veces, no había suficiente espacio para las máquinas. En otros casos, dijo McBride, los dueños se preocupaban de que una máquina expendedora de Narcan diera la impresión de que el negocio toleraba o acogía el uso de drogas.

En su lugar, el condado instaló máquinas expendedoras en un refugio sin fines de lucro que atiende a residentes locales sin hogar, el edificio del tribunal de distrito estatal y el Centro de Justicia y Leyes en el centro, que alberga el tribunal municipal y el departamento del sheriff del condado. Esa máquina, es la que más se utiliza, dijo McBride.  

A diferencia de algunos otros modelos, las máquinas expendedoras de Narcan en Helena no requieren registro de usuarios ni códigos para acceder a los materiales dentro, lo que hace imposible rastrear quién está tomando naloxona o si se está utilizando.

McBride y su equipo reconocen que no hay una forma consistente de saber cuántas muertes relacionadas con opioides han ayudado a prevenir las máquinas expendedoras.

Jessica Johnson es la supervisora de educación sanitaria en el Distrito de Salud del Sur de Nevada, que ayudó a crear la primera colaboración de máquinas expendedoras en el país. Dijo que el proyecto fue diseñado para distribuir naloxona y jeringas estériles para reducir la propagación de enfermedades infecciosas entre las personas que se inyectan drogas.

Un estudio de 2022 registró 41 muertes por sobredosis menos de las esperadas en el condado de Clark, donde se ubicaron las máquinas, durante el primer año de distribución.

Johnson dijo que una de sus conclusiones del programa es la importancia de escuchar a las personas que están en más riesgo de la comunidad. Los quioscos o máquinas expendedoras de reducción de daños resultantes pueden ser tan diversos como los lugares en los que se encuentran.

Trabajadores de salud pública de todo el país han agregado cepillos de dientes, kits para dejar de fumar tabaco y otros suministros a sus máquinas expendedoras según las sugerencias de las poblaciones a las que sirven, dijo Johnson.

Aunque aún no se han elegido a los organizadores, Jon Ebelt, vocero del departamento de salud de Montana, dijo que la recomendación de la agencia de colocar máquinas en refugios y sitios que atienden a personas sin hogar se basa en el deseo de llegar a personas con enfermedades mentales graves, y a otras que ya están buscando servicios en esos lugares.

Ebelt confirmó que el departamento no se basó en datos de sobredosis de opioides ni en información demográfica sobre las personas que más a menudo sufren sobredosis en Montana al decidir dónde colocar las máquinas. En su lugar, la decisión se basó en “programación comunitaria y contratos existentes con sitios de servicios de salud mental y adicciones”.

Agregó que, según la propuesta, los anfitriones comunitarios de las máquinas expendedoras podrán seleccionar muchos tipos de suministros adicionales de reducción de daños para distribuir, “ya que cada comunidad tiene diferentes necesidades”, pero las jeringas estériles no estarán entre los productos disponibles en las máquinas de Montana.

El estado planea pagar un año de suministros, después del cual puede utilizar subvenciones federales para abastecer las máquinas, y los fondos federales para comprar jeringas para el uso ilegal de drogas. Ebelt no respondió a otras preguntas sobre esa decisión o si los sitios podrían agregar jeringas y otros materiales suministrados a través de financiación independiente.

Este artículo se produjo a través de una asociación entre ºÚÁϳԹÏÍø News y Montana Free Press.

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She wanted to have covid tests on hand to help prevent an outbreak from sweeping through her business, but stores were sold out. She spent days making calls and searching online. When Stanley-Lehman finally got her hands on a box of tests later that month, it was too late — a child’s family member, unknowingly infected, had exposed the day care to covid. The virus quickly spread to four others, including kids and staffers.

“We got the tests just in time to close down,” Stanley-Lehman said.

Rapid antigen tests for covid have emerged as a public health tool that can help keep schools and businesses open. They are less accurate than polymerase chain reaction tests, known as PCR tests, which must be sent to a laboratory for results. However, the rapid tests’ turnaround time of as little as 15 minutes can spot cases early and, through quarantines and isolation, prevent infected people from spreading the virus at schools, businesses and other workplaces. But a box containing two at-home BinaxNow tests, made by Abbott Laboratories, costs $24 at a retail pharmacy — and they are often in short supply.

The tests are much more accessible for those who are part of Montana’s state-run, free rapid test distribution program, which gives away at least two types of BinaxNow rapid antigen tests and a third non-antigen test called Abbott ID Now from the same manufacturer, Abbott. This fall, the state delivered as many as 113,000 antigen tests to hospitals, health clinics, government offices, local health departments and others.

But communication on how to access tests has been inconsistent, such as with certain detention centers and child care providers. While some jails are screening symptomatic inmates with tests from their local public health department, other law enforcement officials hadn’t heard of the availability of the state’s rapid tests at all.

Tina Bets His Medicine, assistant to the sheriff in Roosevelt County, said jail staffers there had not received rapid tests from the state or been trained on how to use them. “We’re definitely interested,” she said. “That would eliminate some problems for us. Because we certainly don’t want people sick in our jail.”

The state has communicated with schools and local health officials about the program, but it hasn’t been more broadly publicized in the past two years. Of the state’s covid-19 public service announcements, none advertise a supply of rapid BinaxNow tests or explain how to apply for shipments.

Eligibility requirements for the free tests can be complex. Some school districts are ordering recurring shipments of tests for students and staff members. But private child care centers and private employers have to obtain a federal waiver to administer certain kinds of tests. And others who are eligible either don’t know about the tests, don’t want them or are stretched too thin to add another burdensome covid task.

The result is an uneven distribution of the state’s free tests. State officials cited several reasons for that, including the federal waiver restrictions. A limited national supply chain also means officials must prioritize recipients.

But some public health officials see the gaps in test distribution as another indicator of an overwhelmed and under-resourced public health system.

Drenda Niemann, Lewis and Clark County’s public health officer, said many children and families in her county can get tested through school districts while other residents have few options when pharmacies sell out.

“It’s really hit-or-miss and we’re just doing the best with the resources that we have,” Niemann said. “There’s no consistency.”

Montana’s Department of Public Health and Human Services said it distributed nearly 550,000 BinaxNow rapid tests from October 2020 through this October. DPHHS sent 45% of those to hospitals and health clinics, according to a Montana Free Press and KHN analysis of the state’s data. An additional 13%, or about 73,000 tests, went to assisted living and long-term care facilities.

But only 5%, or 26,500 tests, went to a category titled “Other,” which includes group homes, services for people with disabilities and child care centers. That comes to slightly more than 70 tests a day for that entire category, statewide. During the same period, fewer than 2% of all tests distributed, approximately 11,000, went to dozens of state corrections facilities and jails.

Other states, comparatively, have swung open the gates to testing. Tennessee created a program for interested businesses to obtain covid test kits, free of charge, with on how to qualify. Colorado BinaxNow rapid tests directly to homes free of charge. Around the Washington, D.C., region, libraries offer them at no cost.

Both the Trump and Biden administrations have encouraged of rapid tests. The Biden administration aims to boost testing by tests a month.

“In an ideal world, you would have readily available testing much like we see in countries in Europe, where families can get 10 tests a day for their home,” said , director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

In ordering Abbott BinaxNow tests, Montana is careful not to stockpile more than it can deliver before the tests expire after 12 months. It sent 51,200 tests to Colorado in May that were close to their expiration date. The state doesn’t track how many tests go unused after they’ve been distributed.

Montana Gov. Greg Gianforte spokesperson Brooke Stroyke said that testing is an important component of the state’s pandemic response and that the state distributes tests to eligible vulnerable and underserved populations based on local health officials’ input.

“After all, local leaders know the needs of their communities best,” Stroyke said.

Missoula County is using rapid Abbott ID Now tests, the third kind of rapid covid test the state is distributing. The Abbott ID Now is not an antigen test but a molecular test similar to PCR tests. The state has distributed an average of 3,120 of those tests a month.

Those tests can be more reliable, county officials said. Brian Chaszar, its covid-19 operations section chief, said his county has access to plenty of tests and is able to get the word out about what’s available.

He said some businesses and groups are bound to get missed in a large county and not every place will opt to receive tests, whether it’s because of the workload or potential backlash against covid precautions, particularly in some school districts.

“I have no envy for principals of those schools,” Chaszar said. “Some parents really want masking and testing, other parents want to have nothing to do with it and refuse to participate in it.”

With the rise of the contagious delta variant this fall, the state increased distribution of tests to public and private K-12 schools that asked for them.

“We would like as many K-12 schools to tap into these resources to help schools to stay open and be safe,” Todd Harwell, the state health department’s public health and safety administrator, wrote in a September email to local and tribal health officials.

But DPHHS spokesperson Jon Ebelt said supplying rapid tests directly to private businesses is complicated by federal regulations that require each business to receive a waiver to administer them.

Ebelt said most of the state-distributed tests are tethered by those federal rules, which he said offer “better reporting and quality control” and are less expensive.

One of the two types of antigen tests the state receives from Abbott doesn’t need a federal waiver, but it has a far more limited supply of them. Since June, the state has doled out about 18,000 of those at-home tests. Ebelt said the state’s limited stock of the less-regulated, at-home tests has been prioritized for other entities, such as local health departments.

“We were very concerned that we would not be able to secure enough tests from our supplier to expand distribution,” Ebelt said. Although some businesses such as child care providers could apply for federal waivers to access more tests, Ebelt said DPHHS did not think that was the best route because of the additional work for those “already understaffed” groups.

One former DPHHS official disagreed with the department’s interpretation of federal rules. Jim Murphy, formerly the state’s lead epidemiologist, said the state could find a way to distribute tests to day cares and other businesses if it provided proper training and oversight.

Ideally, Murphy said, the public health philosophy for navigating the pandemic should be focused on solutions rather than hurdles.

“We shouldn’t find obstacles here,” he said. “We should find ways to get these tests in the right hands.”

One workaround offered by health officials in Montana has been to connect child care centers with a federal through the U.S. Department of Health and Human Services, the same program Stanley-Lehman of Billings used to order tests for her child care facility. Ebelt said the department knew of nine Montana child care providers that had signed up to work with that program by early November. As of this year, Montana had nearly child care facilities.

Montanans’ access to tests varies by county, partly because of how many tests local officials request and how they are used. Joe Russell, health officer for the Flathead City-County Health Department, said that he knows people are struggling to find tests but that it’s not all on the state to advertise that tests are available.

“Sometimes it will fall to us, the county, and sometimes it’s the responsibility of the business, you know, to push forward and ask,” Russell said.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).