It does one thing and one thing only. It brings people back to life. It’s a miracle.”
Julia Negron doesn’t mince words when she talks about naloxone, the drug she is licensed by the state of Florida to dispense in Manatee County and surrounding areas through the Suncoast Harm Reduction Project.
Naloxone, often known by the brand name Narcan, rapidly reverses an opioid overdose. An opioid antagonist, it works by knocking overloaded opioid receptors clear, allowing the brain to regain essential functions, like breathing, that overdose can cause the body to effectively forget. It has no side effects if applied to a person who doesn’t have an opioid tolerance.
For people who are physically dependent on opioids, it will cause precipitated withdrawal through the same function that saves lives: by blocking the opioid. Precipitated withdrawal is painful as all hell—take it from someone who has been rescued with naloxone in the past. It feels like a surge of panic from the depths of your belly, and grows into a tide of nausea, aching limbs and feverish body chills. Nobody wants to have naloxone administered—which is why it’s ridiculous to think that people use opioids more recklessly if they know naloxone is around. But that transient pain is a small trade-off for your life.
Like Negron says, naloxone is an atomized miracle. And it becomes especially vital during the holidays.
While naloxone is a crucial, life-saving tool year-round, the December holidays bring up specific stressors that make access extra-important, says Keith Brown, director of health and harm reduction at the Katal Center for Health, Equity, and Justice in Albany, New York.
“First, there is the obvious link between the holidays and stress and anxiety; there’s pressure to be on your best behavior and not screw up and embarrass your family,” he says, voicing a sentiment that’s relatable to people in remission, recovery, or active drug use or addiction alike. The holiday joy mandate can be especially problematic for people with co-occurring disorders; combating the desire to use, or use chaotically, is acutely challenging for someone trying to measure up to an impossible ideal of glee while in the throes of depression, for example.
“The holidays will ratchet up your risk.”
Then, Brown explains, there are the logistical risk factors that come into play. “For people who are actively using, the holidays can throw folks off their routines […] if you’re not in your usual environment, you might have to take increased risks.” These include buying from an unknown supplier, whose product may be different than what the person is used to. In 2017, overdose deaths spiked to over 70,000 yearly.
A major contributor to those deaths was illegally manufactured fentanyl, a short-acting synthetic opioid 100 times more potent than morphine. And it’s not just showing up in heroin baggies.
Jesse Harvey, founder of the Church of Safe Injection, a harm reduction group that hopes to use the DEA’s religious exemptions to legally get drug users access to sterile syringes, has been distributing fentanyl testing strips along with naloxone out of his van in Lewiston, Maine. He says he’s found the uber-potent opioid in cocaine, methamphetamine and pressed pills meant to mimic Xanax.
Journalist Christopher Moraff reported similar findings for Filter earlier this month, after applying hundreds of fentanyl tests to drug supplies across Philadelphia. Fentanyl in non-opioid street drugs is particularly dangerous, because these users may not have an opioid tolerance at all, making them especially susceptible to overdose.
The holidays compound this issue, Brown notes, not only because seasonal travel could mean buying from a totally different supplier, but also because people who end up stuck at family gatherings might feel compelled to double-up on their doses as a means of compensating for having less frequent opportunities to use. “The holidays will ratchet up your risk,” Brown concludes.
He is not alone in this assessment. On December 13, the Pennsylvania Department of Health distributed 6,100 naloxone kits to drug users and their friends and families from 80 different sites across the state.
“The timing was partially […] because we know how difficult the holidays can be for many people who are dealing with an opioid use disorder, and the important role naloxone plays as a life-saving medication,” says Nate Wardle, the press secretary for the Pennsylvania Department of Health.
The emphasis on family bonding leaves some people feeling left out and, potentially, more prone to reckless use.
The efforts of health departments, grassroots harm reduction centers and individuals operating more-or-less legally out of vans are critically important during a time of year when the emphasis on family bonding leaves some people feeling left out and, potentially, more prone to reckless use.
Matthew Klukowski, the outreach supervisor at Rebel Recovery in West Palm Beach, Florida, recalls how lonely he felt on his last Christmas before he became abstinent from drugs. “I was in Troy, New York, downtown, and a lot of people were Christmas shopping. It started snowing, and I thought it looked so pretty. I saw families walking around and thought it looked nice to do be doing that, but it was such an out-of-reach concept for me at the time. I felt I was never going to be one of those people Christmas shopping with friends and family.”
I have similar memories; the way Christmas trips to visit extended family in New York and New Jersey gave way to desperate evenings alone or with a using partner in Seattle, wandering through wispy snow in search of a dealer who would serve me on the holiday.
I remember the last year before I enrolled in methadone treatment. My husband and I cajoled my mom and son into opening presents early so we could duck out in time to connect with a dealer. He was all the way across town and we didn’t have equipment on us.
I had to yell my husband out of bleaching a borrowed syringe. Instead, he sang army cadences while we marched across the dark, cement wasteland of Seattle’s Lake City neighborhood, barely making the last bus running on the reduced holiday schedule.
We rode in sweaty, anticipatory silence back to our motel. The bleak, rhythmic hum of the bus and the dark space of Lake Washington were in tune with our holiday spirit. We missed our stop, which meant we had to walk the expanse of the Aurora bridge—dubbed “Suicide Bridge” for very literal reasons—back to our shitty motel, where our equipment awaited us.
I did my Christmas shot in my groin, standing pants-down in the cold leaky bathroom of a motel that was supposedly one of Kurt Cobain’s stomping grounds, once upon a time. Merry Christmas.
Nancy McConnell, the program director at Rebel Recovery, says that during the holidays “people feel more isolated, alone, depressed, especially with problematic drug use […] the whole holiday season, the media, everything is set up in a way that’s showing you you’re supposed to be with somebody in this warm loving environment, in the bosom of your family, but a lot of people in the grips of addiction don’t have that.”
Access alone is not enough. Education is another crucial component to saving lives during the holidays. Thom Duddy, vice president of communications for Adapt Pharma, which produces Narcan nasal spray, says some of their most important work revolves around awareness. “We help people understand first of all what is an opioid […] many people know heroin and fentanyl are opioids but may not realize the hydrocodone in their medicine cabinet is an opioid.” He says they also work to ensure people know what an overdose looks like and how to respond.
“There is a completely harmless substance that could have saved my child’s life and I hadn’t even heard of it.”
Janice Spring, who works with Negron at the Suncoast Harm Reduction Project, understands the importance of education more intimately than anyone should have to. Ten years ago in September, she lost her son, Derek, to an opioid overdose, just two weeks after his 18th birthday.
“I knew nothing,” she recalls, her voice breaking. “I didn’t know the danger he was in. I didn’t know how to recognize the signs of an overdose.” She says she first learned about naloxone five years after his death, when she met Negron at a conference. “That there is a completely harmless substance that could have saved my child’s life and I hadn’t even heard of it […] I was just blown away. It’s incredible.”
In response to the idea that keeping naloxone on hand could “enable” someone to continue using, she says, emphatically, “It is enabling; it’s enabling them to stay alive so they have a chance to recover. There’s no recovery if they’re dead. It’s enabling love. It’s enabling the idea that your life matters.”
Brown from the Katal Center says that it’s crucial too for families of current or former opioid users to have naloxone on hand, even if they don’t agree with the person’s drug use. “Whether they’re in recovery 10 years or actively using, everybody should carry naloxone.” He adds that it’s important for people to realize their tolerance could begin to drop, increasing risk of overdose, as early as three days post-use.
“If you’re worried about somebody,” Duddy aptly summarizes, “go get naloxone.”
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