Tucked between catalogs for embalming fluids and mortuary stretchers, two doses of the opioid antidote naloxone sit in a cabinet near funeral director Jeffrey Gair's desk.
"It's just in case," Gair says he thinks to himself, before locking the cabinet door each night.
The mortician at Peaceful Alternatives Funeral & Cremation Center in Timonium has never opened the plastic casing around the Narcan nasal spray, which is used to counteract the effects of an opioid overdose.
Still, Gair sometimes wonders how much longer his supply will go unused.
As the number of drug-related deaths in Maryland continues to climb, funeral directors are calling themselves the "last responders" to the opioid epidemic. The moniker represents an anxiety within the central Maryland funeral industry over how aggressive licensed morticians should be in preparing for overdoses at their businesses.
They worry that synthetic opioids like fentanyl and carfentanyl could be on a deceased person's body or on the clothes of a mourner, inadvertently exposing their staff or guests at the funeral home to danger. These drugs can be lethal in amounts as small as a grain of salt when inhaled or absorbed through the skin. In Harford County, a sheriff's deputy and two emergency medical workers were treated in May for exposure after responding to a reported overdose.
The National Funeral Directors Association recommends its members across the country prepare for the reality that someone — a staff member or a guest — could suffer from exposure. It says members should train staff to administer naloxone and to recognize the symptoms of an overdose. News outlets in Chicago and Canada have reported on funeral homes stocking naloxone.
The question Maryland Funeral Directors Association spokesperson David Weber hears the most from peers is, “What else can we be doing to protect ourselves from opioid exposure?”
Training staff to administer naloxone is probably the only option funeral homes have not yet employed en masse, Weber said. The owner of David R. Weber Funeral Homes in Upper Fells Point and West Baltimore is himself seriously considering getting trained to administer naloxone.
"I think it's right on the cusp of a trend," Weber said. "I think it will happen.”
While stocking naloxone is still seemingly rare among central Maryland funeral home operators, several told The Baltimore Sun they were mulling the decision.
Howard McComas of McComas Funeral Homes in Harford County said this week he intends to move forward with researching how to get his staff trained to administer the naloxone.
”To be responsible to the community, it's something we have to address,” McComas said. “I do see it as a possibility in the near future that we'll move down that road.”
Some Maryland funeral directors have reservations about keeping naloxone on hand. Weber wondered whether his insurance company would object to it as a potential liability, in case someone treated with the drug became ill or got hurt. Funeral director Lee Stallings, owner of Stallings Funeral Home in Anne Arundel County, questioned whether mourners were actually coming to funeral services high.
However, many funeral directors said their businesses have undertaken opioid prevention and education initiatives in their communities, often partnering with law enforcement and medical personnel to share information about the dangers of the drugs.
In 2017, the Tri-County Funeral Directors Association, a Maryland trade organization, developed an ad campaign, “We Don’t Want Your Business,” to raise awareness of the opioid epidemic and prevent deaths.
The association also distributed booklets to its members called "Opioid Epidemic: How Funeral Directors Can Respond.” It was published by the International Order of the Golden Rule trade organization, which has since sold 23,000 copies nationwide. It includes advice for mitigating the risk of opioid exposure during the embalming process and a recommendation to train staff to administer Narcan.
Gair, along with five staffers at Peaceful Alternatives, decided to attend a free training on how to use the nasal spray as the business saw a growing clientele of overdose victims and their bereaved friends and relatives. The Maryland Overdose Response Program offers free in-person training to the public, which includes doses of naloxone.
"You have to realize if you have a user whose services are held at your business, there could be others in attendance," Gair said.
Funeral directors in Baltimore and Harford counties said they have increasingly dealt with incidents of drug use on their property or among mourners. The owner of Candle Light Funeral Home in Catonsville has called police five times on individuals, who were not funeral guests, using drugs on his property.
Staffers at Stauffer Funeral Home in Frederick County pledged $10,000 to fund a documentary film about the opioid epidemic after a man struggling with the addiction stumbled through their door looking for help.
At MacNabb Funeral Home in Catonsville, a mourner attending a funeral of someone who overdosed walked two blocks to a McDonald's where she overdosed in the bathroom. Police said they were able to revive the woman, but she refused further treatment and left the restaurant alone.
“Before, funeral directors used to carry smelling salts. Now, you carry Narcan," said MacNabb’s funeral director, Jim Schwartz.
Over the years, funeral industry standards nationwide have progressed to where morticians carry special kits, including respirators and disposable coveralls, as a precaution when going to a home to pick up a body, Schwartz said.
Schwartz has considered attending a naloxone training, but said he also feels safer knowing that suspected overdose deaths in Maryland are first handled by a medical examiner before the body is transported to a funeral home.
Funeral home owner Stallings said he sees little need to keep naloxone at his business. He said the idea might have come up thanks to firefighters and other first responders, some of whom moonlight at funeral homes, who have treated overdoses in their full-time jobs.
Mortician Brandon McNair, who works for March Funeral Homes in Baltimore, has spent time as a firefighter over the years. McNair said he does not carry naloxone at his funeral home job, but is practiced in identifying signs of an opioid-related death when the family does not share the cause.
“We’re so used to dealing with overdoses, we’ve come to look for clues,” McNair said. Those might be the young age of the deceased, no evidence of illness or no mention of natural causes.
Gair said no community, no age and no demographic is exempt from the opioid epidemic. Anyone could carry a lethal dose through his door.
He keeps the little bottle of Narcan near, but he tries not to think too hard about who might one day need it.
“It’s never crossed my mind I could use this on myself or staff,” Gair said. “No one asked before. But it’s possible.”