Volume 20 Issue 5 | June 15 - 21, 2007

Downtown Express photo by Lorcan Otway

A young man held the head of an unconscious man who had overdosed in Tompkins Square Park on June 6. A third man had administered a life-saving injection of Narcan to the OD victim, then run off, after he had called 9-1-1 and the dispatcher had questioned whether he was licensed to administer the drug.

A (good) shot in the arm is keeping junkies alive

By Lucas Mann

On Wed., June 6, a young man fell to the ground in Tompkins Square Park after overdosing on heroin. A friend in his group administered a shot into his arm while other friends called the police. That shot saved a life.

There have been a lot of those shots going around the Lower East Side in the past few years, thanks to an organization called the Lower East Side Harm Reduction Center. The injection administered by that kid was naloxone, marketed in its injection form under the name Narcan. This young civilian had Narcan and the prescription to administer it, because the Harm Reduction Center gave him both. It’s part of a program that the organization began running in 2004 that teaches heroin addicts to save a friend who has overdosed, and gives them the tools to do so.

Narcan — an “opioid antagonist” — is injected into the muscle tissue of the upper arm and is quickly released into the bloodstream to counteract the effects of the opioid in the victim’s body. Dr. Sharon Stancliff, medical director of the citywide Harm Reduction Coalition, described the full process.

“When people take too much of any opioid, they nod off, and from one to three hours later they lose the will to breathe,” she explained. “Narcan goes in and boots the heroin off their receptors, and links onto the receptors itself. It doesn’t have any activity on the receptors, but it blocks the heroin from affecting the person’s system for 30 to 90 minutes. They should still go to the hospital, but those 30 to 90 minutes are enough to save someone.”

The result looks something like a miracle. John Penley, a longtime East Village resident who has witnessed a Narcan revival, said, “It’s like a movie where you see a vampire come back from the dead.”

One young man in Tompkins Square Park last week, who wished not to be identified, spoke just two days after he himself had overdosed and been saved with a dose of Narcan.

“It feels like, all of a sudden, you just wake up,” he said. “You don’t remember what happened, you don’t even know who you are for a second.”

A park figure known as L.E.S. Jewels, who leads a group who call themselves the “Gutter Pirates,” described a similar experience of being saved.

“One time, I just popped up in the ambulance and I was alive again,” he said. “I got right out of that ambulance; I didn’t even need the hospital.” As well as having been on the receiving end of Narcan, Jewels, like most of his friends, had been trained by the Harm Reduction Center himself, and has saved friends who overdosed by administering Narcan to them.

Jewels, like all others trained by the center, has a card giving him license to carry Narcan and administer it in a situation that he deems to be an opiate overdose.

Jewels recognized that, without the available Narcan, he and many of his friends would be dead.

“If people don’t carry it [Narcan] around, by the time the ambulance gets there, some kid is dead,” he said. “Junkies like going far away from society to get high and you never know what the dope’s gonna be like. The only people who are gonna be around when somebody OD’s are the other junkies with him.”

Dr. David Rosenthal, who runs the Lower East Side Harm Reduction Center, spoke of the positive feelings that can come from the sense of power to be able to save a friend’s life.

“Naloxone is like anything else, when people feel they can care for themselves, they feel better,” he said. “We give people a way to help each other and we give them a second chance, as opposed to dying.”

Christine Norton, who administered the Narcan that saved Jewels’ life, spoke of how much better she felt, with Narcan in hand.

“I’ve been around this park [Tompkins Square] since I was 15, and I’m 40,” she said. “It’s my home. I’ve lost too many of my friends, so the ones I have left, I cherish. The needle exchange asked me if I wanted to do it [become certified] and, of course, I did. The summer before last, I was able to save six different people.”

Norton is one of many people in the Lower East Side who now carry Narcan.

“Since 2004, we’ve trained 399 people,” said Tom Smith, coordinator of the center’s Overdose Prevention and Reversal Program. “Since then, we’ve had 105 reported reversals, and that’s not including the Tompkins Square Park numbers, because we haven’t collected that data yet.”

Smith also emphasized how they do not simply give out the Narcan kits.

“It’s a two-part training process,” he said. “First, we encourage people to be safer and teach them how not to overdose in the first place. But then we also give them the tools to minimize their risks, if they do find themselves in that situation. The shot is easy and it always works. You cannot mess it up.”

The willingness to put tools in the hands of those who need it is part of the Harm Reduction Center’s core philosophy.

“I think what we provide is an opportunity to utilize services that aren’t usually welcome to many people,” Rosenthal said. “We work with folks who, oftentimes, when they go into other settings, they get berated and talked down to. Services should be available to anyone, regardless of if they’re drug users.”

This philosophy extends back to when the center, at 25 Allen St. between Hester and Canal Sts., first opened in 1992. It was one of the first organizations to have a needle exchange — providing clean needles to I.V. drug users. The center reached out to the community to make the needle exchange even more readily available, despite the opposition that such facilities often face. And it has worked.

“Syringe exchange is one of the clearest ways to prevent H.I.V.,” Rosenthal said emphatically. “If you look at the number of new H.I.V. cases, especially those in intravenous drug users, since 1992, the increase has dropped drastically.”

The Harm Reduction Center’s dispensing of Narcan prescriptions grew out of its needle exchange program and similarly bucked convention.

“We were the first in the city to hire a physician to prescribe naloxone,” Rosenthal said. “We got a small grant to start it and now every harm reduction program in the city has a naloxone program.”

Stancliff, of the citywide Harm Reduction Coalition, says the success that began on the Lower East Side has spread through the city as a whole. She remembers the Lower East Side Harm Reduction pilot project first training around 80 people in 2004.

“Since then, the SKOOP [Skills and Knowledge on Opioid Overdose Prevention] program has trained 2,400 people,” she said.

On a personal level, those who have experienced the lifesaving ability of Narcan, individually appreciate the program’s power.

“I wouldn’t be standing here talking to you if it wasn’t for Narcan — that’s it,” said Jewels.

His friend Kid Sidney Street was equally animated in his praise for the Harm Reduction Center.

“I’ve been down here working with the needle exchange for years,” he said. “This stuff [Narcan] should be legal for the simple fact that we have that right: to live. The only reason f---ers don’t want us to have it is because they want us dead and not spreading our diseases or leaving our needles around. But guess what? Now, with the needle exchange, we don’t share [needles] anymore and we don’t spread viruses.”

Street also had a recent experience with Narcan.

“Two weeks ago, a girl OD’d at Odessa restaurant,” he said. “By the time I kicked the door in, she was purple, but I saved her with that s--t [Narcan].”

Rosenthal is happy with the positive effects the Narcan program, as well as the needle exchange, has had on people, and said that the center would continue to reach out and train as many people as possible. In fact, the Harm Reduction Center plans on increasing its outreach services.

“We’ve begun doing H.I.V. testing at nontraditional venues, and that includes even sex clubs,” he said. “Early treatment results in less mortality.”

Just as needle exchanges initially faced opposition, Narcan use still faces criticism. According to Stancliff, however, there’s no downside to the drug. One must still call 9-1-1, because if somebody has overdosed on something other than an opioid, Narcan won’t help — but neither will it harm them further. Still, as of the antidote’s legalization here in 2005, New York is one of only three states that legally allows people to carry and administer prescribed Narcan.

Another problem is that people who are helping a friend may be reluctant to call 9-1-1 if they have heroin on them. Both Jewels and the man who requested anonymity remembered times where police threatened to arrest a person who had just saved a life by using Narcan.

“New Mexico now has a law stating that if 9-1-1 is called for a life-threatening situation, like an overdose, there will be no arrests at the scene,” Stancliff said. “We hope to someday have that here.”

Until then, the Lower East Side Harm Reduction Center will continue to prescribe Narcan for all those who wish to be trained.

Norton pointed out just how qualified she was to inject Narcan — during her years of being a drug user, she always could find a good vein to hit.

“I’ve been clean for five years,” she said. “But, I mean, we’re junkies out here. We’re really good at hitting people.”

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