One recent afternoon, on a dirt trail in one of Oakland’s notorious drug zones, a man who had just injected himself with heroin stopped breathing. His eyes rolled up in his head. Johnny Fielden, a fellow heroin user, grabbed an emergency overdose kit from his backpack. He filled a syringe with naloxone and plunged a long needle through a hole in the man’s jeans, straight into his thigh.
“A lot of people tend to bail when something like that happens,” said Fielden, a 32-year-old Oakland resident. “But I stick around and try to help.”
The man whom Fielden said he saved from a potentially fatal overdose six months ago might have become just another statistic in what public health officials have called the deadliest drug epidemic in U.S. history. According to the Centers for Disease Control, there were more than 30,000 opioid-related deaths in 2015. More Americans are now dying from drug overdoses than car crashes, and those fatalities have been fueled by the opioid crisis.
Fielden got free naloxone at a weekly needle-exchange in Oakland, and because of it, he said he has been able to save a number of people who had overdosed. He visits the site on San Pablo Avenue run by the nonprofit HIV Education and Prevention Project of Alameda County (HEPPAC) on a regular basis to swap his dirty needles for clean ones and pick up naloxone refills.
HEPPAC also runs Contra Costa County’s three needle-exchange program sites in Richmond, Bay Point and Pittsburg. It distributes naloxone provided by the New Leaf Recovery Foundation. That nonprofit is run by volunteers and is struggling to stay afloat through donations.
Naloxone — often referred to as Narcan — blocks opioid receptors in the brain to counteract the effects of an overdose. It comes in a spray and injectable form, and has long been used successfully by paramedics and hospital emergency room staff to treat overdoses.
Despite evidence that training opioid users and those close to them to use the drug saves lives, the organizations that provide it say they haven’t been able to get the funding to purchase enough of the drug to keep up with demand.
Yet as opioid-related deaths continue to mount, there are efforts in some areas to make the drug more widely available. Early last year, Alameda County launched a pilot opioid prevention and education program that would help fund naloxone-distribution kits through needle-exchange programs.
Five months ago, Santa Clara County implemented an opioid-prevention program through its needle-exchange program that included naloxone kits. In August, the Foothill-De Anza Community College District Police Department began equipping its officers with naloxone, joining the San Francisco Police Department and a growing number of law enforcement agencies around the country that carry the lifesaving drug.
When the opioid epidemic affected mostly poor and black urban populations, there was a more punitive approach to drug use, said Savannah O’Neill, coordinator of Alameda County’s Overdose Prevention Education and Naloxone Distribution Project. However, with the runaway abuse of OxyContin, Vicodin and other prescription drugs, the face of opioid addiction has become increasingly white, moving into suburbs and rural areas. As the demographics have changed, the epidemic has gotten increased attention, and more public funds are being directed to fight it.
“My goal is to use this money to ensure that people who have always been dying from overdose and are affected by overdose have access to the resources,” O’Neill said. “We’re really focused on getting naloxone into the hands of people who use drugs because they are the ones most likely to save someone.”
According to HEPPAC, people who received the kits reported they had used them 65 times in 2016 to prevent a potentially fatal overdose.
At a Friday needle exchange on San Pablo Avenue in Oakland, O’Neill sat in a chair on the sidewalk training IV drug users to administer naloxone. Gayle Phillips, a 60-year-old African-American woman who is homeless, said paramedics saved her life 20 years ago with the drug when she overdosed. A month ago, she had a scare with a friend.
“I had to do the water thing and slapping him and talking to him,” she said. “But if I’d had the Narcan, it would have been a lot easier.”
Various community-based programs and service providers have been distributing the emergency kits for more than two decades to drug users, their family members, friends and others who might witness an overdose. According to a Harm Reduction Coalition survey of 144 organizations that provide naloxone to laypersons, 152,283 people received the overdose reversal kits between 1996 and June 2014, resulting in 26,463 overdose reversals, mostly heroin.
“I guarantee you there are a huge percentage of people who use IV drugs and opioids who will end up overdosing because their friends, and even their family, are not willing to call an ambulance,” said Linda Hickman, director of nursing for the New Leaf Treatment Center in Lafayette. “So it’s like it needs to be in their hands.”
She said the opioid epidemic has cut a wide swath in Contra Costa County.
“We see it in the rich and the poor and everyone in between,” Hickman said. “We have kids from really fancy high schools in the area who often start on pills and switch to heroin.”
Hickman volunteers at New Leaf Recovery Foundation, which raises funds for naloxone to be distributed at the county’s needle-exchange programs sites. She said a large donation is running out, and the organization needs more funding help to keep going.
One night this month, a white van was parked in a dirt field at the end of a muddy road, sandwiched between a church and an auto parts store, off Willow Pass Road in Bay Point. It was 7 p.m., cold and dark and pounding down rain. The weather was so brutal the two workers couldn’t set up their tables and instead huddled in the van.
A bent figure holding a giant umbrella made his way toward them from the main road. Alex Riveira, 50, a heroin user who lives in a tent nearby, had come for a set of fresh needles. He asked Rosario Cerda, one of the HEPPAC workers, for naloxone.
Riveira said he injected his wife with the drug a year ago when she overdosed, saving her life. “You’d rather have it and not need it, then need it and not have it,” he said.
The desire to be prepared is what also led Foothill-De Anza Community College District Police to train its officers to use Narcan inhalers. There haven’t been any reported overdoses on campus. However, Chief Ronald Levine said when he learned that emergency medical services teams had used the drug to treat overdoses in Cupertino, Sunnyvale, Los Altos Hills and other communities that the school serves, he wanted his officers to carry it.
“Even though we are a commuter college and don’t have student residences, I’m not blind to the fact that whatever happens in our community happens on our college campuses,” Levine said. “I’m not a guy who thinks the sky is falling, but I just know one of these days, we’re going to run across a situation where someone is suffering from an overdose and we’ll be able to use Narcan to save people.”
