Whenever he can, Shane Shelton offers neighbors naloxone, an overdose reversal medication, and a place to sleep out of the cold.

The 54-year old’s home is known as the “Dog House” in Williwaw, Alaska – on the outskirts of Wasilla in Matanuska-Susitna (Mat-Su) borough. In this neighborhood, family homes with manicured lawns sit side by side with yards piled with old tires and tarps, some with makeshift walls nailed around them to hide the mess and avoid fines. People come to the Dog House to get high – and keep one another alive. Shelton said he had administered naloxone more times than he could count, and cannot get enough of it.

“You go down around me, I’ll use as many as I have,” Shelton said. When someone is experiencing an opioid overdose, recommendations say to administer naloxone nasal spray, also known by the brand name Narcan, every 2 to 3 minutes until the person begins breathing normally, and to give rescue breaths between doses.

Shelton, whose own life has been saved with Narcan on multiple occasions, described waking up “with some dude sucking face with me” – a reference to rescue breaths – and the smell of window cleaner.

“That’s the Narcan, smells like window cleaner,” he said.

Boxes of assembled naloxone kits are loaded onto an Anchorage health department truck. Photograph: Ash Adams/The Guardian

It is unpleasant for both parties. Shelton recalled using naloxone for the first time on his wife not long after fentanyl first became widespread in Alaska’s drug supply around 2020. “It sends you straight into withdrawals and viciously.” Seeing her like that disturbed him, “I walked off the property in tears.”

Overdoses have been declining nationally since August 2023, but Alaska is far behind in that progress. Overdose fatalities did not begin to decline in Alaska until July 2024, nearly a year after they started to decline nationally. They began to climb again this February, according to Centers for Disease Control data.

The state’s large size and small population alone make overdose prevention a difficult task. For some, healthcare is only accessible by helicopter.

Alaska’s remoteness makes it a target for drug trafficking. Pills can sell for upwards of five times what they fetch in the lower 48. The Guardian’s analysis of CDC data showed that in 2024, Mat-Su saw an overdose fatality rate of 51 per 100,000 people and Anchorage saw a rate of deaths 68 per 100,000, compared with 24 per 100,000 nationally. .

Alaska’s overdose death rate increased while the US as a whole went down

Mat-Su, which is the size of West Virginia and largely rural, saw an 82% increase in overdose fatalities since the national peak of the crisis in 2023, one of the highest in the country. The atmosphere of emergency here is palpable – a handful of Mat-Su residents the Guardian spoke to had witnessed or personally reversed an overdose within weeks. Alaskans say their culture of rugged independence is isolating for people struggling with substance use – but many fentanyl users here rely deeply on their communities to stay alive.

Shelton sees himself as a caretaker. “This place is called the Dog House because we collect every two-legged stray in town,” he said. A parrot named Petey crawls along his arm as he speaks.

About an hour south, in Anchorage, people in homeless encampments look after one another, too. The city recently cleared many of their tents, so they come from somewhere deep in the woods to collect clean syringes and snacks from the Four A’s, a local harm reduction organization with a van for this purpose.

Harm Reduction is both a type of community work and a philosophy – practitioners believe it is more realistic and effective to help people reduce their risk when it comes to activities like drug use and sex than it is to expect them to abstain. A common example of harm reduction is distributing clean needles so people can inject drugs without risking HIV or hepatitis infection.

A recently cleared camp along the Chester Creek trail in Anchorage, in August 2025. Photograph: Ash Adams/The Guardian

Oscar, a 50-year-old resident of the Mountain View encampment, said he had reversed 34 overdoses in the last two years. He believes that everyone should carry naloxone and learn CPR.

“You don’t do drugs alone. That’s the number one rule,” Oscar said. He has used “many different types of drugs”, depending on what’s available, and said fentanyl is by far the most dangerous. He switched from injecting it to smoking after passing out in front of a propane heater and waking up on fire. Burn scars cover most of his right arm, a puss-filled cyst nearly doubles the size of his right hand, and part of his left index finger is missing.

Indigenous people most at risk

In Alaska, Indigenous people make up around 15% of the overall population, but are 44% of the homeless population. As in the rest of the country, Indigenous Alaskans are more vulnerable to substance use disorder and overdose.

Volunteers build naloxone kits at the Farview Recreation Center in Anchorage in August. Photograph: Ash Adams/The Guardian

At a naloxone kit build event at the Fairview Recreation Center in Anchorage, people in uniform mingled with locals and even tourists to assemble kits with naloxone, rubber gloves, mouth covers for rescue breaths and instructions.

Jennifer Summers of the Alaska Native Tribal Health Consortium, said it was important to keep historical trauma in mind when thinking about Indigenous populations. The event was organized by the Alaska Health Department’s Project Hope, and brought together health, community and military organisations, including the Alaska Military Youth Academy and the National Guard.

Summers said the legacy of colonization, disenfranchisement and forcible boarding schooling all contribute to risk. “Substance use is a form of survival,” she said. But the medical system will often reduce people to their addiction. “That’s where stigma is created,” Summers added.

Indigenous communities have many reasons to be skeptical, Summers said, after all. “The healthcare system allowed us to get to this place with opioids.”

When supportive communities face ‘clean-ups’

In many cases, the military and even Alaska law enforcement work to help expand naloxone access. But initiatives to “clean up” the city, like encampment abatements, tear apart communities who rely on each other to stay alive – and “make everything more dangerous” according to Venus Staten, program director of Four A’s.

Oscar, who is a member of the Alaska Tlingit tribe, said: “Is it really illegal to be homeless? I was born and raised here, and for over 10,000 years, my blood has been on this land,” He added: “So technically, anywhere I put my head is my home.”

Volunteers load boxes of assembled naloxone kits onto an Anchorage health department truck. Overdose fatalities did not begin to decline in Alaska until July 2024, nearly a year after they started to decline nationally. Photograph: Ash Adams/The Guardian

Oscar continued: “I want them to help us build an area where we can camp safely, where everybody can come and go as they please.”

Evictions in neighborhoods like Williwaw can also break up drug communities and increase overdose deaths. A local nonprofit called Families for Improved Safety and Health (Fish) has been encouraging developers to buy drug properties and replace them with new houses.

On Labor Day weekend, Fish held a barbecue to get property owners on board with a clean-up initiative that would tackle the remaining drug houses. Many of them, including the Dog House, are owner occupied. In a speech describing his vision for the project, Mat-Su borough planner Jason Ortiz said he would work with law enforcement to force the Dog House and others to comply.

While some Fish members said they would not be forcing anyone out, others clearly wanted the Dog House residents gone.

Coming togetherJosh Engle, crisis services program manager at True North said: ‘This is stuff that these people deal with on a daily basis, it’s life and death.’

True North Recovery is headquartered in Wasilla, across the lake from Williwaw. Its primary mission is providing substance use treatment, but it also works in tandem with local organizations and law enforcement to help potential clients across Alaska access basic resources. Josh Engle, who manages crisis services at True North, said he goes into homeless encampments when an abatement is on the horizon, to help people get shelter and resources.

The strength of these communities is obvious, but so is the danger they face. Just a week before, Engle tried to get shelter for a group of six people before their Anchorage encampment was to be cleared. One woman told him, “I won’t go anywhere if [my friend] can’t get housed, too, because he saved my life last night from being raped.”

“This is stuff that these people deal with on a daily basis, it’s life and death,” Engle said. While he helps people with more basic struggles, he also gently encourages them to consider treatment.

Engle feels qualified to do this work as he was once homeless and addicted to fentanyl. Ninety-two percent of True North staff are themselves in recovery and 23% are former clients, including Engle.

Sharon Chilton, clinical case manager, outside of True North Recovery Day One Center in Wasilla. Chilton is one of several employees at True North who was a former client.

Engle said that even if someone is not interested in treatment at first, slowly building trust can help them change their minds. It is vital that a bed available at that exact moment.

In Mat-Su, there are not enough recovery beds for everyone that needs them, but the industry is growing rapidly. Both True North and MyHouse, a youth recovery organization, have expansions planned. Most of True North’s clients are on Medicaid, and those reimbursements, as well as grants, fund their continued growth. MyHouse vice-president, Michael Carson, said a $23m federal appropriations grant from Senator Lisa Murkowski will fund a new youth recovery center.

True North has also launched a mobile crisis unit that works with police. The idea is that it is often more effective to give people services and the option of treatment, than to arrest them. Different versions of this model, which originated in Portugal, are becoming popular around the country. Portugal has succeeded in dramatically reducing overdose deaths using this model alongside other policy changes, including drug decriminalisation. In the US, crisis intervention has shown early promise .

My House Youth Services in Wasilla, Alaska.

During one crisis call the Guardian witnessed, a Wasilla police officer had requested assistance with a young woman on the street with her boyfriend and puppy. The woman said she was suicidal, and had been unable to get her depression medications after she was kicked out of substance use treatment. “I’m going to hand you over to these guys, because I know this uniform can be triggering for some people,” the officer said. The crisis team called her pharmacy and got her clothing vouchers for the MyHouse thrift shop. When asked if she would be interested in trying treatment again, she laughed and said no. But at the thrift shop, she read a MyHouse slogan aloud to her boyfriend: “Devastation comes and goes, redemption heals and grows.”