Fentanyl: Harm Reduction
Alexandra Capelouto died two days before Christmas in 2019. Her father and mother found her in her room. She was 20 years old. Alexandra was not a junkie. She was not looking for fentanyl. She purchased what she thought was oxycodone on Snapchat. It contained five times the fatal amount of fentanyl. Two days before Christmas, in the safety of her parents house, fentanyl ripped her life from her. “Her death was marked as an overdose, but as far as Matt Capelouto [her father] was concerned, his daughter had been poisoned. “
Following her death, the Capelouto’s learned about “hundreds of thousands” of similar tragedies from parents nationwide. A criminal investigation was opened and these grieving parents set out to do something about this crisis. The Capelouto’s headed to Sacramento, along with “dozens of parents and hundreds of letters in support,” to propose their bill, Alexandra’s Law, to the Public Safety Senate Committee on March 23rd. The law would “address ‘implied malice’ for drug deaths similar to drunk driving deaths from the 1982 People vs. Watson case.” Under this law, if someone was arrested for dealing, they would be given a warning of the danger of the drug and their part in selling it. If the same individual should continue to sell and someone dies, they then could be charged with murder.
And guess what the result was?
The bill failed to pass. It needed 3 out of 5 votes. The parents were understandably enraged. In their opinion the committee “voted for drug dealers to be able to poison and murder our children and poison our loved ones.” The bill received only one vote from Senator Rosilicie Ochoa Bogh (R-Yucaipa). Another member of the committee who did not vote in favor of the bill explained that if the bill passes it would increase incarceration rates across the state. This member, Senator Sydney Kamlager (D-Los Angeles), asked during the hearing: “These counterproductive over incarceration policies also do not work, how do we find the righteous middle that works for everyone? “
Senator Sydney Kamlager cared more about keeping incarceration rates down for people knowingly and willingly selling counterfeit drugs that are now killing this nation’s youth than passing a law that would incentive those dealers to think twice before selling their deadly product.
These are our representatives. How can we possibly fix this issue if the people tasked with passing laws have this mentality? This line of thinking should have been applied to cannabis charges because cannabis does not kill people. Perhaps they are trying to atone for that colossal mistake. So now that we have a drug that is killing Americans at an alarming rate, of all socio-economic levels and more importantly children, these reps want to worry about incarceration rates. This is not the time for that. This is the time to act.
harm reduction
While our government fails to consider the needs of the American people, we must ourselves act as a community and work towards helping our most vulnerable. This is where harm reduction comes into play. Harm reduction does not condone the use of drugs. Its purpose is not to enable drug users. No, the purpose is to recognize that people will do drugs. Our children will experiment, the mentally ill will self medicate, the drug addicted will continue to use to quiet their demons. Instead of ignoring these facts, harm reduction accepts them as reality and aims to mitigate deaths and reduce the spread of diseases. By informing ourselves we are ensuring that our children do not die upon their first try, that the mentally ill will not die while seeking to relieve their pain, and the drug addicted will not die on our streets alone and forgotten.
If you do not care, if you think this is not your problem, if your reaction is “they should just say no” then you can continue pretending that you exist in a vacuum, detached from the problems our society faces, but do not get in the way of those trying to help.
Unfortunately, “getting in the way” of a solution (and saving lives) is exactly what the stigma and misconception around harm reduction has led to. Fentanyl testing strips, for example, have been historically banned under drug paraphernalia laws. These strips are a common sense solution and would enable people to test their drugs to ensure they are not contaminated with fentanyl, which is literally life saving. With the increase in overdose deaths, more states are moving to decriminalize these testing strips. “Experts say fentanyl test strips are valuable not just for those who use opioids but also for those who use stimulants, such as methamphetamine and cocaine, which are increasingly becoming contaminated with the drug.” Fentanyl testing strips were created by biotech company BNTX in 2011 intended for use by doctors to detect prescription fentanyl in their patients urine. The harm reduction community began using them when fentanyl became increasingly present in drug overdoses.
Keep in mind that many fentanyl overdoses are happening to people who have no idea their drugs are contaminated with fentanyl. Contrary to the belief that the strips would encourage people to use more drugs, the opposite is in fact true. According to a 2019 study published in the International Journal of Drug Policy in which 125 people in North Carolina were surveyed about their use of fentanyl test strips, using the strips actually led to safer drug using behaviors. For example, “43% reported that a positive fentanyl test result encouraged them to [use] less of a drug, administer a test shot, inject slower, or snort the substances instead of injecting them…testing slows them down during the preparation process and it makes them think more about the drugs they are using and how they are using.”
It seems to be clear that testing strips would have positive results but there is confusion as to where they are legal. A recent legal review published in Drug and Alcohol Dependence found that “it is clearly legal to possess some or all drug checking equipment in 22 states, and clearly legal to distribute it to adults in 19 states. In 14 states where distribution of drug checking equipment is not clearly legal generally, it is legal when that equipment is obtained from a syringe services program. Potential penalties for violations range from small civil fines to multi-year jail sentences.” Legal uncertainty, cost, and stigma are the barriers we need to address in order to have widespread access to the tests. Toward that end, the Biden administration did lift restrictions on the use of federal grant funds for buying fentanyl test strips in April of 2021.
NALOXONE (Narcan)
The harm reduction method we are most aware of is Naloxone, also known by the brand name Narcan. Naloxone immediately reverses an opioid overdose by acting as a barrier. It blocks the effects of opiates on the brain and restores breathing. It comes in two dominant forms, a nasal spray, popular for its ease of use, the other is injectable (or sometimes auto-injectable); harder to use without training because it involves needles. In the documentary “Ten Dollar Death Trip” by Documentary Central we hear from addicts, dealers, and harm reduction activists alike. We get to see Jen, an employee for harm reduction organization Spikes on Bikes, get ready for her shift. Workers like her patrol alleyways “administering life saving medical interventions, their secret weapon is Naloxone.” She explains that reversing an opioid overdose is easy with the use of Naloxone, but we continue to have increasing deaths because people use alone. Once a person ingests fentanyl, you have about 3 minutes to administer Naloxone. The following are signs of opioid overdose:
Falling asleep or losing consciousness
Slow, weak, or no breathing
Choking or gurgling sounds
Limp body
Discolored skin- purple or blue (especially in lips and nails)
To use Naloxone you place the nozzle up the nose and press the plunger firmly. You wait 2 minutes, while calling 911, and you give a second dose if the person is still unconscious. For recovery position you place the person on their side to prevent choking, leg bent, arm bent, hand under chin. Try to keep the person awake and mouth open to keep them breathing. Stay with the person until emergency assistance arrives, do not be afraid to call 911 if you are intoxicated. There are laws to protect you when you are attempting to save someone.
Naloxone can be difficult and expensive to source, with varying rules regarding its distribution in each state. Without a prescription or insurance, it will cost you around $141 at your local pharmacy. But more and more organizations are fortunately popping up to help with the distribution of Narcan. With festival season well underway, harm reduction activists are teaming up with festivals and artists to ensure that Narcan is available at concerts.
Last year Morgan Godvin, Portland-based editor and harm-reduction activist direct-messaged the rap group Atmosphere, with an ask to pass out naloxone on their upcoming tour. She was not expecting a response but to her surprise, “not only did Atmosphere respond, they enthusiastically agreed.” Along with a network of volunteers, she gave away naloxone at Atmosphere’s shows across the country. Together they were able to prevent over dose deaths. “At the show in Albuquerque, we literally saved people's lives,” Godvin says. “The harm reductionists there reversed two overdoses: one during the show, one in the parking lot after.” Godvin’s organization, Beats Overdose, is now ready for another summer tour.
This Must Be the Place , a nonprofit, was recently founded by Ohio-based couple Travers-Hayward and William Perry with a similar mission to deliver Narcan to big-crowd summer events. “Starting at the end of May, they will travel around the US to hand out Narcan at eight festivals, including Tennessee’s Bonnaroo, Cleveland’s Wonderstruck, and the legendarily raucous art festival Burning Man in Nevada’s Black Rock Desert.” Perry states that they knew this summer everyone would want to attend festivals and party, perhaps even more so than usual post lockdowns. They figure there will be a “large population of people who aren’t habitual drug users but who decide to dabble. With no tolerance, chances of overdose are especially likely.” With the drug supply being as contaminated as it is, the worry of potential overdoses is definitely palpable.
Feed the Streets LA, a nonprofit started in 2015 by a couple of friends looking to be of service, teamed up with the band Dead City Punx and will be present at all their shows handing out Narcan and test trips. The band created a video to illustrate how to administer Narcan. The video was shared on both the band’s and the nonprofit’s social media. Bringing much needed awareness to their communities.
In regards to clubs, “New York mayor Eric Adams’ office recently launched an initiative to encourage bar owners and other nightlife leaders to stock Narcan.” But, a venues decision to allow Naloxone depends on each club’s security staff. To add to the problem of access, there is a Naloxone shortage. DanceSafe education manager Rachel Clark emphasizes the need to have Narcan on hand but to avoid stockpiling.
This crisis is not slowing down. We will continue to lose lives unless we face the problem head on. We must acknowledge that people will continue to use and stop misunderstanding harm reduction. In regards to our government, both parties are culpable. One side is concerned with keeping incarceration rates down, the other, continues to spread misinformation about harm reduction centers.
As Emily Einstein, PhD, chief of the Science Policy Branch at the National Institute on Drug Abuse states “Harm reduction is a super critical element for addressing our overdose crisis…People think a lot about prevention and treatment, but harm reduction is really for people who are currently using drugs, and their lives are valuable."
For more information on where to find free Narcan, information about overdose prevention, training, referrals, and harm reduction services in Los Angeles head over to https://www.laodprevention.org/ , call (323) 325-5445, or email ODPREVENTION@DHS.LACOUNTY.GOV