They Can’t get “Clean” if They are Dead

They can’t get clean if they are dead.
     Tracey, you saved two of my best friends lives. You sent out Narcan kit to a friend who was there when they both overdosed on heroin that definitely cut with fentanyl/fentanyl analogues. Both friends collapsed after ten minutes when they dosed and thankfully the friend with the Narcan kit that you sent him had the kit in hit car.
After my friends collapsed; the sober friend ran to his car and retrieved the kit then he administered the Narcan to them. Within 2 minutes my two friends were brought out of the overdose and were fully conscious.
So thank you, thank you so so so very much for sending those kits. You've likely saved hundreds of lives, including my two friends. Two days after that very close call, both of those friends admitted themselves to inpatient rehab. 
My friends have now been clean a little over a year now. You truly are an amazing individual for doing what you do. Again thank you from the bottom of my heart. You're an angel.
    Harm Reduction did not come naturally to me. I truly believed  it was enabling- supporting people to continue in their addiction. Despite the fact that harm reduction, had saved my life, I was not a true believer until the day I was one.
   The first time I heard the term “harm reduction”, was in January 2000. I was what could be described an avid “book thumper” in a twelve step program. If it wasn’t recommended in one of the texts of this program, it was not for me. I had a protective fear of drug use that had morphed into a potentially unhealthy fear of people who used drugs. This makes perfect sense in light of the fact that this was my first and only run of sobriety. I had started to adopt the program language of “addict” having a fatal “disease” and needing to remain vigilant to keep the important “time in the program”. My whole world view was shaped by what other folks told me I needed to do. Truthfully, I think I needed that in the beginning. If it was brainwashing, I needed my brain washed. I needed structure. I needed tools. Most of all, I needed some kind of hope that I could maintain my new way of life. I am very grateful for those early years and the people who were willing to help me.
    My first professional job was as a peer counselor. Many of the things I believed personally were slowly starting to come in conflict with what I was being told professionally. “Any door is the right door”, I was told. We want to support people in their own individual process. “But what about…” I bit my tongue. I decided to try to listen. The agency I was working for asked me if I would be willing to attend a conference in Seattle Washington related to the heroin epidemic of the late nineties. It was now January 2000. The program read: “Heroin overdoses and overdose fatalities are steadily increasing in North America and around the world. Many overdoses are preventable, often with simple and inexpensive interventions based upon scientific research, epidemiological and ethnographic insights, and common sense.” When I look back at this, who could have know that it would foreshadow what was to come with the American opioid crisis.
     Harm Reduction, I would learn were strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also based around the idea that people who use drugs are people first, people deserving of the highest quality of life possible. In the early moments, I felt my views were being called into question. I quickly learned that abstinence was in conflict with Harm Reduction. A person would never be able to “get clean if they are dead”. It made sense. Clean wasn’t even a term people used- it was stigmatizing- implying that drug use was “dirty”. Drug use was a medical issue, not a moral failing. It was a public health responsibility to care for those who were most vulnerable. In many cases, this was people who are using drugs. Prevention of overdose was the new hole in a leaky network of public and community programs attempting to save lives. This was the first time I heard about overdose prevention in terms that made sense to me.
    Overdose prevention was an area where I was told we could absolutely prevent deaths.  In the drug counseling I was performing, it might take months or years to ever see results. I felt a building excitement in the room. There was strong sense that the people using drugs wanted to take action along side other types of first responders. The users themselves felt powerless- they wanted to save their fellows. With training, the conference was presenting tools that had an above average chance of saving a life from overdose. This would involve a combination of rescue breathing, putting the person in the rescue position and calling 911, and giving the population the opioid overdose medication naloxone to use.
   These practices based in evidence were a departure from what I had experienced in my years of active drug use. We followed a series of urban myths that included injecting the victim with speed, putting ice down their pants, throwing them in a cold shower, or trying to make them throw up. As a worse case scenario, friends might dump their comrade off in front of the Emergency Room, wasting valuable time in their travels. Calling the paramedics could bring swift retribution from authorities as I had experienced myself.
    In the winter of 1992, I enrolled in a methadone detox. Methadone, a long lasting opioid, was considered a “replacement” therapy. I would give up the damage of illicit heroin use in exchange for the stable effects of having a medication consistently in my system that filled those same receptors. Once stable for a few days, my dose would be reduced to zero over the course of three weeks. My boyfriend at the time and I enrolled together, tired of the hustle. We both reported a sense of feeling “normal” within a day or two. Without the shared drive of heroin driving the wheel, the relationship quickly evaporated into a quiet friendship that still exists today.  Despite the fact that these types of quick detoxes are generally unsuccessful unless conducted in a controlled environment, we both wanted to stop so badly we gave the clinic both our money and our best effort. After using the first day, we stopped using heroin. That piece of the puzzle was briefly solved.
   There were other pressing issues. What would my life be like both without him and without heroin? For the past six months, my life had revolved completely around these two things. I was been financially supported by my seventy one year old sugar daddy who paid for my first few days of treatment. He was “an AAer”, probably a sex addict. Fortunately, viagra did not exist. The whole endeavor made me sick to my stomach.  I was young, I was bored, I was damaged, and I was alone- awake for the first time in many years. This was kick number three.
Despite my reservations, I had gone five weeks heroin free.  That would soon change.
   I would lay in bed, reviewing how I could have possibly gotten involved in the sex trade, abandon college, and my family all in the pursuit of dope.I was trying to regain my strength and my health when the boredom slowly creeped down the hallway, as did the older lady down the hall in search of a partner to use with. A few days later, I stopped saying no to her requests.
    The first time I was hit with the Narcan as we only knew naloxone back then, it was at the scene of the overdose of a friend. I was on my third or fourth day back on heroin (hiding this of course) ashamed of myself. A neighbor had offered to give me a bit left over which was all I needed as my tolerance had been reduced to almost nothing. I was barely impacted by my dose when I heard a gurgling noise.
You overdosed and it took me 20 mins to revive you. Right when I was ready to give up, the police and the paramedics kicked in the door. You opened up your eyes like two seconds before they opened the door. Someone must have heard me gasping and called the paramedics. They took you and forced me to go with you to the hospital and get narcanned. Then, you told me the whole way to the hospital "why didn't you let me die? it was my time to go." I think you had taken some klonopins. You overdosed a few times I've seen where you had to be given mouth to mouth but that time you seriously almost died. In fact, I almost left you because you were so blue I didn't know how long you had been out. - my response to the Overdose Victim in 2014
    The police offered me an ultimatum- either I would agree to be “narcanned” and transported to the hospital or I would go to jail for drug possession. I was narcanned and trapped to a gurney for close to an hour until I was unstrapped. I then discharged myself “against medical advice”.
    Over the course of the next year, I would only use heroin a handful of times. The methadone was not perfect. It had helped me. I had reduced my use and achieved my goal of no longer being strung out on heroin. I wasn’t trying to quit all drugs at that time.
     In Seattle, it finally clicked in my mind that I wasn’t so different from the folks that were still using drugs. In many ways, our goals were the same. Looking back, I had wanted to save my friend and worked with the limited tools I had- a few CPR classes I had taken in high school. Despite what I knew could be consequences to me, I stayed. I reacted. I tried. I got involved.
   It should also be noted that forcing a clearly conscious opioid user to get a shot of naloxone is nothing short of physical abuse. I had argued “if I am overdosing- how could I possibly have saved her?” No one cared to hear my side of the story. Fortunately, procedures have changed in San Francisco in the winter of 1992. In the rest of the country, not so much. Good Samaritan Laws are still not a 100% guarantee against harassment. I saved many lives in my years of active drug use using rescue breathing and/or calling the paramedics. I was an advocate of harm reduction before I knew what it was.
 The woman who had overdosed is a married, co owning a business with her partner in my hometown. The boyfriend from the methadone story? Also many many years heroin free. Are we the one percent? No, we are one of the many.
    After I left that conference in 2000, I began to realize that it had been Harm Reduction that had saved my life time and time again. Prevention efforts are frequently devalued because their impacts are not always obvious. When I outlined my experiences with what is known as Harm Reduction, they were significant. I was provided clean syringes in the Era of AIDS when HIV was extremely prevalent in IV drug using communities. I was able to retain my status as HIV negative during a time when HIV was, in fact, a rapid death sentence for many. The antiretroviral medications that prolong lives today were not widely available very close to the time I stopped using drugs. I was given sterile water, alcohol wipes, and education on injection hygiene. This played a role in not contracting endocarditis, a condition that has caused no less than three of my friends to have to undergo heart surgery under the age of 35. I was given condoms to prevent both sexually transmitted infections and unintended pregnancies of which I have had neither.
    Harm reduction got me to a place where I could finally put active drug use behind me. In 2014, I started sending naloxone to opioid users, their friends, and families through the mail. I was inspired by the lack of available resources for large sections of the countries. The Conference on Heroin was in 2000. I was working at the first city sponsored naloxone program in 2003. Over a decade later, with overdoses rising at record levels, naloxone completely out of reach for the average individual. What started with two doses, became four, became a steady stream of trips to the post office.
    hey, so, idk if it would have gotten to death status, but you definitely can add one to the number of people you helped. I never in a million years thought I'd use what you sent, but someone I know whos been away for a while went a little hard with some opana and I ended up using a vial when breathing got weird. Wasn't worth risking it and she was happy I did. Feel free to use this text without my name. Thanks for doing something really special - if God exists he has a special place for you <3. From reddit messages

While I am entirely certain I was not the first person to put some naloxone in the mail, I was the first person to make the choice to go public. Civil disobedience is the is the active, professed refusal of a citizen to obey certain laws of the state, and/or demands, orders, and commands of a government when those laws are incorrect or unjust. Sending out naloxone was an act of civil disobedience. I was certain that the majority public opinion would be on my side and the laws would follow. We Americans are sensible people. We are a caring people. We want to act. We want to do something. We want to save our loved ones from accidental overdose. We want, in fact we need, to have naloxone on hand.
  I’m a former marine and was in college with a 4.0 GPA with every opportunity afforded to an American white male (hah) before I ruined it all after getting a Percocet script after a surgery. Like you said, people vilify junkies and think it could never happen to them or that poor parenting is to blame. I also live in the Bible Belt and I’d like to talk about how hypocritical southern baptist views can do more harm than good. But anyway I don’t have any ulterior motives in messaging you. I just admire you so much. Thanks for humoring me Facebook message.
     How do we decide who will live? Currently, it appears to be a matter of luck and economics. If you happen to have insurance, if you live close to a major city, if advocates have had success pressing for a program in your area, or if you can afford to purchase it, you might have naloxone. If you are uninsured, live far from a syringe exchange site, live in an area that frowns on harm reduction, or cannot afford to purchase the drug for $100 at the drug store, you probably are reliant on the paramedics or other emergency responders to be the only source for naloxone. Things are changing. Incrementally, more and more places are responding to the idea that everyone deserves saving. In states like North Carolina, syringe exchanges are operating out of pawn shops, treatment centers, fire departments, churches, and any place willing to partner with them. There are currently 26 exchanges operating in the heart of the Bible Belt, showing that common sense public health policy is not exclusive to the more liberal Northern States. Syringe exchange and distribution of naloxone without a prescription is 100% legal in North Carolina demonstrating that what may seem impossible, with a ton of hard work and vocal advocates, is entirely possible.
    First off, I want to reiterate a huge THANK YOU for everything you do!! I love that you do this, and want you to understand how grateful I am to you: I have never contacted you before, never even commented on one of the narcan kit posts, I bet when you saw my post you were like "who is this girl again? Do I know her?"; but I know you, one of your kits saved my husband's life.
We were at a friend's place, having some fun on a Friday night. He mixed it up, handed me my dose, and did his, just as we have done a hundred, no a thousand, times before; while I was distracted trying to get mine in, he fell out. Luckily, the friend we were with had gotten a kit from you "just on a whim", and it saved his life. He was a horrible shade of blue and so so cold by the time we got him dosed; I was certain he was gone...but he made it, and he's fine now. (speaking of, isn't it the creepiest thing how they're dead, you're so sooooo positive they're dead, and then they're suddenly alive again?? It's like watching a zombie movie.) So thank you via Reddit message












Comments

  1. I wish more people thought like that but sometimes wonder if there should be a tiny little bit of parental conditions? My bf ran drug and gambling habits off his mom's dime mostly for several years in his 30s. But he'll never be dying on the street, never forced to live a criminal lifestyle, be so estranged that they don't know if he's alive. He did go back home to get clean. Mostly clean and his mental health in such disarray it took over a year to consistently act like a human vs hiding in the basement, suicidal. Felt kinda bad but told him I've never had the opportunity to wallow to such a degree, and maybe forcing himself to do a few things could at least distract from suicidal thoughts, feel less shitty about himself. But with no real rules & restrictions, it took a long time. He's finally employed after a year and a half and seeing what he can do to outrun winter depression, not wanting to go back to what he's barely escaped. I was really upset for a long time, why be doing the same thing there with just less drugs and more loneliness than to at least be here with me? But trying to understand he needed it. And only very recently realized that it's actually better for both of us.

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    1. My mother was a huge supporter for me. My father was a huge barrier. Family issues are such a strange emotional stew

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