Earlier this month, in a house on a Venice canal, three people believed to have used cocaine died after apparently ingesting the potent synthetic opioid fentanyl. A fourth person was hospitalized and survived.
Accidental overdose deaths involving fentanyl are increasingly common.
There’s no way to know, of course, but it’s possible they survived if they had access to an easily accessible nasal spray called Narcan, which reverses an opioid overdose.
Or they might have refrained from using it if they had first tested the substance with an easy-to-use kit that can detect fentanyl, which kills thousands of Americans a year – and many of them. don’t even know they’re doing it. danger.
“I doubt it ever happened to cocaine users to test it,” said Dr Gilmore Chung, director of addiction services at the Venice Family Clinic. “But we see fentanyl in all drugs.”
Fentanyl, which is cheap to produce and much more potent than heroin, can look like black tar or white Chinese heroin, cocaine, or crystal meth. It can be squeezed into pills and appears to be OxyContin, Xanax, or Valium. Musician Prince died of a fentanyl overdose; he thought he was taking Vicodin.
âIf someone tells me they’re taking heroin,â Chung told me, âI guess until proven guilty that they’re taking fentanyl. After years of use, people become confident – âHey, I know what Black Tar Heroine looks likeâ – and you test it and you don’t. “
Chung is one of many specialists who take an informed approach to drug treatment. He practices harm reduction, a public health strategy that aims to reduce the negative consequences associated with drug and alcohol use. It recognizes that drug and alcohol abuse is here to stay and that users are human beings who deserve respect.
This means that they should have access to clean needles, for example, which reduce the rates of HIV transmission. Or maintenance programs that use Suboxone or methadone to prevent withdrawal and cravings, and help reduce the risk of death from an overdose. (Unfortunately, nothing similar exists for methamphetamine and cocaine users.) Opioid users are advised to never use alone and always have access to Narcan. Some countries have even set up supervised injection sites.
Instead of demanding abstinence, Chung helps his patients figure out how to be safer and healthier and, of course, find a path to sobriety if that’s what they’re after.
“We meet people where they are,” he said, “as opposed to where we would like them to be.”
On Thursday evening, I had a long conversation with one of his patients, Zachary, 31, who asked to be identified only by his first name, to protect his career.
Zachary’s addiction trajectory is quite typical. In his late teens, he began using prescription opioids like Vicodin and anti-anxiety drugs like Xanax.
As public health experts worried about the growing number of opioid overdose deaths and the enormity of the crisis became evident, prescription opioids became harder to come by.
âAll of a sudden everyone went from prescription drugs to heroin,â Zachary said. “It was so much cheaper.”
But when the drug cartels realized that it was easier and cheaper to produce fentanyl, heroin became scarce.
Zachary told me that he had lost count of the number of times he had overdosed and had been resuscitated with Narcan; he used it to revive friends on several occasions.
California is one of the few states that allows anyone to buy Narcan without prescription and protects anyone who administers it from liability. It is available at most CVS pharmacies.
Zachary always had it on hand.
By his mid-twenties, he had already spent four years on drug court-ordered probation, although he never really stopped shooting heroin and cocaine. One day, he and his girlfriend branded what they thought was heroine.
He dozed off, and when he woke up, his girlfriend, who was seven months pregnant, was sitting on the floor with her legs crossed, her arms resting on the coffee table. When asked if she wanted ice cream and she didn’t respond, he touched her shoulder. “She just fell,” he said. He briefly revived her with Narcan and called 911. She died in hospital. The baby could not be saved.
âIt turned out to be pure fentanyl,â Zachary said. “After that I took a spiral, really out of control.”
About four years ago, he found the Venice Family Clinic and Dr Chung after suffering seizures from drug withdrawal.
âI dreaded going there,â said Zachary, who had seen many doctors over the years to get Suboxone. âHe was so understanding. It was the first time I had experienced this. “
Zachary is fortunate to have found himself in the care of a doctor who did not judge him, humiliate him or force him to abstain in order to continue treatment.
âAs soon as you kick someone out, it’s them against the world,â Chung said. âIf you work with them, you have a chance to make them a better day. “