A line is forming outside Glide Church in San Francisco’s Tenderloin district. People are waiting to get dinner or to get sent to another shelter for the night. But that’s not what Jana Lee* is here for.
Note: We’ve changed one of the names* in this story due to the sensitive subject
It’s also syringe access night here at Glide, and Lee is getting a prescription refill. Glide volunteer Kevin Smith asks for her name, jotting it down in a binder.
Every Tuesday from 7pm to 9pm, anyone can come get their free “longs,” “beestingers,” and — in Lee’s case — a naloxone refill. She used her last dose of the anti-overdose drug this morning to save her friend’s life.
“He's coming down on his usage, but he gets really strong stuff when he does get it and he's just been going out, like, he's been O.D.-ing,” Lee says.
Naloxone, also known by it’s brand name Narcan, is what Lee used to save her friend from a heroin overdose. Before administering the Naloxone, Lee did something called a sternum rub. Rubbing someone’s sternum — in the middle of their chest — is a common way to check whether someone is having an overdose or just nodding off. After trying the sternum rub, Lee realized her friend was having an overdose, and she put her Naloxone to use. Rather than injecting it, she used a nasal device. She says she’s not comfortable using a syringe.
“Those are really hard for me to use because — I don't use needles myself, but a lot of people around me do,” Lee says.
Lee is worried that it will take her too long to get the Naloxone drawn up into the syringe. But Glide doesn’t have the nasal injectors tonight. All Lee can get are “musclers,” -- large syringes that inject Naloxone into the thigh muscle.
The DOPE Project
Glide and four other syringe access programs in the city get their supply of Naloxone from the DOPE (Drug Overdose Prevention and Education) Project, which collaborates with the San Francisco Department of Public Health. The project started more than 10 years ago, and it’s responded to the nation’s increase in opioid addiction and overdose deaths.
Eliza Wheeler is the project manager at DOPE.
“It's just pure public health,” Wheeler says. “It's the clearest. You give people this tool, you teach them how to use it, they use it — they avert a death potentially.”
The Dope Project uses what’s called a standing order to buy Naloxone and make sure it gets to organizations like Glide and their volunteers, who then give it to people like Jana Lee. This means a doctor only needs to write one prescription, but that prescription allows people who are trained but not medically certified to give out the drug.
They’ve been doing it this way since 2010. Prior to that, a doctor or nurse practitioner had to be physically present to refill and issue Naloxone prescriptions. Wheeler says this has dramatically increased the amount they can distribute.
Wheeler points out that when it comes to overdoses, opioid users or people close to drug users are the real first responders.
“So people tend to use drugs with other drug users,” she says. “They don't use drugs with police officers and their parents for the most part. … And also drug users had been witnessing overdoses and responding to overdoses for as long as there were overdoses, trying their best to revive their friends and family or whoever it was: their partners — strangers, sometimes.”
Wheeler herself has used Naloxone several times over her 20 years of needle exchange and harm reduction work. Harm reduction is a philosophy focused on making drug use safer for those who are unable or unwilling to stop. The emphasis is on reducing negative consequences, rather than trying to stop people or punish them for drug use. Giving the Naloxone directly to users fits right into this approach. Wheeler says some people are so scared of punishment, they might not contact first responders in an overdose situation.
“That's really a powerful fear, [and] powerful distrust of a system that is very real for people,” she says.
She’s personally seen cases where an overdose is occurring, but people are too scared to call 911.
“I've heard parents — like not drug users, [but] parents — afraid to call 911 for their child. They would rather have their own Naloxone to revive their kid who struggles with substance use than call 911, because they're just afraid of how their kid will be treated, or will they be arrested and they don't want them to go to jail,” Wheeler says.
Is it (Cost-)Effective?
The DOPE Project and the San Francisco Department of Public Health collect data at access sites for research on the effectiveness of the program. Between 2010 and 2015, reported overdose reversals in San Francisco increased fourfold. It’s hard to know what this number actually means — Is it because there’s just more drug usage now? Or are they just doing a better job tracking the Naloxone they give out? Regardless, Wheeler says for her, there’s no question the program is worth it.
“I mean, if it cost a million dollars it would still be cost-effective,” she says. “We spend a million dollars in this world on a whole lot less than a human life.”
The price of Naloxone keeps going up, which makes doing this work more difficult. According to Wheeler, the DOPE Project doesn’t purchase the nasal device Jana Lee prefers because it’s doubled in price. Still, she tells people not to worry about the supply running out.
“I can't guarantee what kind of Naloxone you're going to see when you open that box,” Wheeler says. “But you're always going to see some.”
The DOPE Project and other similar organizations have special pricing contracts to get Naloxone at discounted rates, and they also get donations. But they’ve still had close calls. Earlier this year, the DOPE Project’s purchasing contract was put on hold for legal review, and Wheeler couldn’t purchase Naloxone.
“I think that when we finally got that order placed, when the contract got approved, we had maybe 50 vials left or something like that, like something crazy. I couldn't sleep. Yeah. It was really stressful,” she says.
But for Wheeler, that stress is for a worthy cause. She says reversing an overdose is not just about the person whose life is saved, but it’s also about the impact on the person who administered the Naloxone.
“You'll hear stories of, ‘Oh I saved someone, I can't believe I saved someone, I was like a superhero,’” she explains. “Maybe for that moment they feel slightly less like a piece of trash, which is what the world treats them as for most of their waking hours.”
Jana Lee echoes this idea. She says being able to save her friend’s life has definitely had an impact on her.
“At least you know there's a good reason for you to be on the planet, because you can help someone else,” Lee says.
The emotional impact of saving someone’s life hasn’t been quantified or studied. But The DOPE Project isn’t focused on that aspect. It’s just getting Naloxone out there to the people who need it.