Let me start by saying that I am not a doctor. I have more experience than many in this particular area, but my words are based on real life experience and not science. My trainings are long behind me. I do check in for new thoughts and techniques, but i have yet to lose anyone and quite a few were flatlined when I started.
The opioid epidemic, as it has been named, has touched pretty much everyone in one way or another. I am one of them. I have reversed 23 overdoses so far. Two of those were dogs that got into a stash.
I used fentanyl for quite a while. I didn’t particularly want to. I liked smoking heroin tar on foil. Sadly, fentanyl became so pervasive that it was economically and practically impossible to avoid. Many people fall in this way. Prescription pills are so expensive, and frequently fake, that sustaining a habit is impossible except for the very wealthy. Even the wealthy will eventually get a pressie (fake pills) if they aren’t fastidious about testing.
These days, the overdoses come less and less from fentanyl users. The majority of people i come across who overdose are people who have other substances contaminated by the powerful opiate. There is one major exception: fentanyl users who have been in treatment (especially mandated against their will) who get back to the streets and, for one of a huge list of reasons, decide to use again. Their tolerance is down and they get knocked right on down.
The shame of relapse is a huge killer. Because of the stigma, they make the fatal choice of using alone. There is no one around to save someone who is hiding their use.
If it sounds like I am calling out the courts, some of the 12 step programs, various treatment facilities, and society in general, that would be because I am. Assholes. For some people they can be amazing and wonderful. They are also directly responsible for the deaths of millions.
Another thing that gets overlooked is the trauma people experience who revive an overdosing friend, peer, loved one, or stranger. There are massive amounts of energy and resources poured into helping overdose victims. That is fantastic. I’m glad to have seen it from the background.
Eight of the revivals I did were on one person. She was clinically dead by all measures I know at least twice. Once she fell to the ground and when I turned her over to administer the narcan, she was covered in blood. Once, there was only one narcan dose available, and I blew a breath into her nose in hopes it would spread the naloxone deeper into her body (there is no science to that–she was purple with no heartbeat and I loved her). The air went through her sinus cavity and hit me in my own neck.
That has happened twice to me. I can’t describe the sensation, physically or emotionally, to feel your own breath touch your skin from someone else’s mouth. In fact, I have trouble describing the effects of dealing with these situations in general, but I’m here to try.
First, the anxiety is unimaginable. You might be a witness to the death of a human being. Even if you don’t know them, that’s a heavy weight. There is also the pressure. In some circles, those with folks who have seen even more than I, a couple of people jump to attention, and instructions are given from the sidelines. The suggestions are often contradictory and unhelpful because they all come at once.
More commonly, you are the only one there who is going into action. One person might nervously take instructions, but it seems like people are so scared to do something wrong that they don’t act at all. A human life is in your hands and you are now responsible for it. There are good Samaritan laws sometimes, but they are ambiguous.
Then there is the physical nature of it. CPR, naloxone spritz, rescue breaths, more naloxone, pour water or ice on them, some people might blow crack (stimulant but science says not helpful, who knows?) in their mouth…I have had people require more than fifteen minutes and eight doses to revive. It is tedious and intense. You are told to call an ambulance, but most situations people overdose in are those where first responders are not welcome and actually endanger many. Ambulances come with police..
Success can also be temporary. If someone has never been exposed to fentanyl, and the exposure is large, the naloxone can wear off in about 30 minutes, and they can lose all function again. In the case of someone with a chemical bond to the drug (addicted to it), naloxone induces what is known as precipitated withdrawal. All of the fentanyl has been ejected from the receptors, so that person is suddenly in the worst withdrawal you can imagine in minutes (it usually takes a couple of days to reach that point where you puke and shit yourself).
They need more fent. If you called an ambulance, this isn’t an option. The paramedics and hospitals will do nothing to ease the pain of withdrawal. In the streets, someone has, or at least can procure, some “get well” (a small dose to ease the suffering).
People who overdose wake up oblivious to what has happened 99 percent of the time. I have had people argue about it despite the five expended Narcan sprays at their feet. They don’t remember a damned thing. They are just awake and confused and then often ill.
If the first responders do get involved, the people who overdose are inundated with avenues to get help and next steps for days or even weeks afterwards. The person who saved them often can’t even ride with them in the ambulance, and no one asks how they are doing.
It is absolutely a PTSD worthy event to save someone, let alone lose someone. I want to know what is being done for people like me who have witnessed more death than many combat vets and medics. Maybe this is my cry for help. It isn’t just for myself though. The ranks of us with more revivals (I prefer this term to reversals) than we can count on our fingers and toes is large. It is growing. I’m sure I could find some statistics to prove all of that, but I know it personally. I am one of these hurting people. We talk with each other and remark, “I just said that to ____! Why doesn’t someone do something?”
It can be hard to do things. There is funding, but it goes to uptight and unrealistic groups out of touch with people who use drugs (PWUD). That isn’t a blanket truth. There are good folks out there, but how many people will hire actual PWUD that know more than the studies? I once had a trained social worker ask if i was testing my fentanyl for fentanyl. Not to make sure i was getting what I paid for, but thinking i was trying to avoid that which I sought.
