A Day in the Life…
Quietly parked on a side street, somewhere between St. Teresa of Avila Church and Ketcham Elementary School, the Family and Medical Counseling Services (www.fmcsinc.org) health van waited to serve neighbors and visitors of Ward 8. Tyrone Pinkney and Terrance Cooper, needle-exchange coordinators, awaited clients patiently.
One client who joined them shortly after 10 a.m. was Christine, who came on board the van escaping the summer heat. She was quiet, reserved, not looking at anyone directly but not looking away. She had nothing to hide but she didn’t overshare, speaking only when spoken to.
As Cooper asked her some basic questions, she unfolded that she was 51 years old, had no health insurance and was not a diabetic. He offered her fresh syringes and condoms.
“You need any Narcan?” Pinkney asked.
Cooper explained the basics of how to use the intranasal spray.
In and out in less than 10 minutes. “Take care. Be safe,” Pinkney called out after her.
The District has been hard hit by the opioid crisis for decades, but the supply is being contaminated with fentanyl, a synthetic opioid analgesic that is 50 to 100 times more potent than morphine. Fentanyl has been stealthily seeping into the heroin supply on the streets. Not only does it kill long-term substance users but oddly it also raises the popularity of the supply.
Dr. Tanya Royster, director of the Department of Behavioral Health, explained that the intended use of heroin is not to flirt with death. “Some of the men who came back from wars and other traumatic experiences either started using over there or began using when they came here. And they found, for lack of a better word, a rhythm. They use a certain amount in order to function. Some of them have jobs. Many of them have homes. They have families. And they use enough where their symptoms are alleviated, it gives them the desired effect, but they have not experienced the significant negative consequences that the rest of us would anticipate from drug use, or at least not enough to deter them.”
Most opioid-related fatal overdoses between 2014 and 2018 occurred in Wards 5, 7 and 8, with 2017 being the hardest for Wards 5 and 7. The faces of these deaths are overwhelmingly black, male and between the ages of 50 and 59.
Resurrection with a Nasal Spray
The antidote to an overdose, though, is also on the streets. Naloxone, aka Narcan, is an intranasal spray that can be used to reverse an overdose. It’s FDA-approved, safe and effective. It comes fully assembled, pre-measured and ready to use, so nearly anyone can use it.
It is so safe to use that even if it’s given to someone who did not use opioids, it won’t cause damage. Just three years ago, naloxone was only carried by first responders and paramedics.
DC is following the lead of other cities like Baltimore that are aiming to make naloxone widely available. Select providers in the city such as Family and Medical Counseling Services and HIPS receive monthly supplies of naloxone to distribute.
“We get a lot of requests for Narcan,” explained Pinkney. “There weren’t a lot of requests for it in the beginning. It has gotten a lot better. Some people still won’t call the ambulance. Most of the time I’ll ask if people want them. The people that run the houses where people go to shoot up request the Narcan. They don’t want to blow their spot up. So they have Narcan. They don’t want to call the ambulance.”
He added, “Most of the time I don’t have to offer it. I go through like 145 a month. There’s never a month where I have leftover. I rarely see someone say they don’t need it.”
City officials are encouraging as many people to learn about naloxone as possible. Bystander administration has been shown to greatly increase the odds of recovery from an overdose. According to a statement from DC Health, naloxone has been casting a wider and wider net:
- In May 2016, DC Health began distributing 1,000 naloxone kits.
- In June 2017, DC Health purchased an additional 2,500 naloxone kits that are being distributed through community partners.
- DC Health currently distributes approximately 400 kits per month.
- As of June 2018, over 600 overdoses have been reversed by DC Health’s kits.
So, if naloxone is so easily used and effective, why are people still overdosing?
“A lot of clients don’t believe it can happen to them,” explained Pinkney. “If someone overdoses, they run to get the dope from that supplier. Or they’re using by themselves; something we tell them not to do.”
Another barrier is stigma. Naloxone is only used for opioid overdoses. If someone is carrying it around, it is easy to assume they are associated with illicit drug use. Substance-use disorder is a disease of secrecy.
In July 2018, DC Health and the Department of Human Services (DHS) partnered to launch a pilot program to make naloxone available to staff at low-barrier and emergency homeless shelters. Over the past year, 184 overdoses took place at DHS emergency and low-barrier homeless shelters. From May 1, 2017, to April 30, 2018, Fire and Emergency Medical Services (FEMS) transported 1,904 suspected opioid cases. Of that number, naloxone was used 668 times. Additionally, during this same timeframe, FEMS transported 33 suspected opioid cases where CPR or death was indicated. Of that number, naloxone was used 18 times.
As the opioid crisis continues to infiltrate the country, more overdoses are bound to occur. But now, everyday citizens can be the first responders who save lives instead of witnessing deaths. Be encouraged to help.
For more information about needle exchange, Narcan or general healthcare, visit Family and Medical Counseling Services.
Candace Y.A. Montague is the health reporter for Capital Community News. Follow her on Twitter @urbanbushwoman9.