Anna McConnell and staff at Glide Memorial Church’s needle exchange program were elated earlier this month by the robotic voice coming from a Narcan auto-injector — a small handheld device used to reverse the effects of opiate overdoses.
“To inject, press black end against outer thigh,” the injector advised them, as night fell in the Tenderloin district.
McConnell, the program’s syringe access coordinator, complied with the instructions. Her coworkers stopped setting up boxes filled with fresh needles of all sizes, instead listening in to the innovative Narcan device, a counterpart of limited quantity to the standard syringe and nasal spray forms. And then it began to count down: “Five, four, three, two, one — injection complete.”
In a few simple steps, the Narcan auto-injector has the potential to save a life — no syringe required. In the last year alone, the DOPE Project recorded 365 reports of prevented overdoses by Narcan devices through 10 partner programs, including Glide.
“I’ve done two Narcans myself,” McConnell said, turning the brand name for Naloxone into a verb. Both times, she opted to use the syringe version of the product to pull people out of overdoses.
“It’s a pretty powerful experience,” she said.
The DOPE Project’s recorded amount of opiate-overdose reversals has increased over four years; from 58 in 2010, 122 in 2011, 276 in 2012, 274 in 2013, to 365 last year.
“What we’re really dealing with is death,” said Eliza Wheeler, executive director of The DOPE Project. “So our numbers [the overdose referrals] don’t really reflect how many people are using but how many people are not dying.”
In recent years, overdoses from prescription opiates have surpassed the amount of heroin-related deaths in The City. Ninety people died from prescription opiates in 2012, compared to 10 heroin-related deaths that same year, according to the most recent estimates by Phillip Coffin, director of substance use research at the San Francisco Department of Public Health.
The DOPE Project has aimed to prevent such deaths since 2003, when it teamed up with the San Francisco Department of Public Health to distribute Narcan at needle exchanges. It has since expanded to about 70 sites per month, including jail health and substance-use treatment centers, Wheeler said.
Whenever a person returns to a Narcan distribution site to refill on the drug, a worker or volunteer records whether the person used Narcan to reverse an overdose, gave it away or lost it. Last year, 49 of the 365 reversals were reported to the needle exchange at Glide, McConnell said. “That means almost every night that we’re open here someone comes in that’s going to use Narcan,” McConnell said. The needle exchange is set up Monday and Tuesday nights, but the church offers Narcan and Narcan training every weekday.
Heroin use across the Bay Area remains low, according to the most recent data from the National Institute on Drug Abuse. Heroin treatment admissions only slightly increased between 2011 and 2013, making up 16.4-17.5 percent of all admissions in the Bay Area. Likewise, treatment numbers for other opiates including prescription drugs oxycodone and morphine stabilized in those years.
People become at risk for an overdose depending on whether or not they mix drugs, the strength or quality of a drug and the user’s tolerance — such as if the user was just released from prison or relapsed, McConnell said.
“A lot of times we’re the first kind of medical providers that people have interacted with,” McConnell said. “It becomes a conversation about so much more than the Narcan.”
McConnell said her firsthand experience with administering Narcan on the street has made it easier for her to empathize with the people she trains.