Alex, 37, rents a room in a house in Philadelphia’s Kensington section, the epicenter of the city’s drug culture. He grew up in western Pennsylvania and has been involved with drugs since he was in high school, when he would drive from his parents’ home to Baltimore or Kensington for heroin or crystal meth. As the years passed and his addiction grew, Alex moved to Philadelphia to be near the drug markets. As both a user and seller, Alex’s client base is wide and diverse, from the homeless guy pushing a shopping cart to drive-by heroin tourists from the suburbs. His stories of life on the streets always contain colorful, ugly surprises.
Like many addicts, Alex makes use of the needle-exchange program at Philadelphia’s Prevention Point, located in Kensington. The program helps prevent the spread of HIV and Hepatitis C among the hundreds of addicted homeless who make use of its services. It also regularly distributes drug “goodie bags” containing everything an addict on the road might need: clean needles, tiny portable “cookers” with spoons and straws for cocaine and methamphetamine, an assortment of sanitary supplies like Handi Wipes and hand sanitizer, a Nature Valley protein bar, and a small can of Narcan spray to be used in the event of drug overdoses.
Narcan, under the brand name of naloxone, was approved for use in 1971 for patients experiencing overdoses on pain medication during or after surgery. In the 1990s, Narcan emerged from the guarded environs of hospitals onto the streets of American cities, where drug overdoses had become a daily occurrence. The Philadelphia Department of Health reported 1,214 unintentional overdose deaths in 2020, an increase of 6 percent from 2019. Fentanyl was involved in fewer than 10 percent of drug overdose deaths in the city in 2010 but accounted for 81 percent of drug-overdose deaths in 2020.
Police departments used Narcan, though many officers expressed frustration when they found that they were reviving the same addict multiple times. Some cops came to think of Narcan as a pointless tool, since many of the revived addicts didn’t seem to care whether they lived or died. Why, asked skeptics, didn’t an addict’s near-death experience prompt him to seek long-term rehab? This question has led some to believe that the indiscriminate, widespread street use of Narcan often enables addiction, despite its value in saving lives.
Narcan today is accessible for purchase to anyone. Librarians at the McPherson Square Branch of the Free Library of Philadelphia in Kensington, located in the vortex of the city’s drug subculture, began using it in 2017 to revive people who overdosed inside the library and on the surrounding property. One minute they would be cataloging books; the next minute they were on the grass outside, reviving the latest overdose victim. In one instance, children using the library had to be ushered downstairs when dispatchers were called to help revive someone who had collapsed in the restroom. Local and national press hailed McPherson librarians as the city’s heroic “first responders.”
Narcan vending machines are presently available in Chicago and Las Vegas, as well as in a number of jails in Michigan, Colorado, and Oakland County, California. A pilot program, called Narcan Near Me, will soon be tested in South and West Philadelphia, where “Narcan Nasal Spray—Two Pack” will be available in dispensers bearing the instruction: “Break Glass in Case of Overdose.” Presumably, if the city’s pilot program works (would unbroken glass be regarded as a failure?), Narcan dispensers would spread throughout the city. Will these dispensers appear in front of, say, a Wawa or a Dollar General, the way cigarette machines did in the 1960s? If Narcan’s easy access means that addicts become more reckless in their drug use, will the addition of Narcan vending machines on city streets make it less likely for an addict to seek long-term treatment, when a temporary fix is so readily obtained?
“Reducing morbidity and mortality through expansion of naloxone distribution responds directly to the epidemic of unnecessary opiate overdose deaths,” says the National Library of Medicine, which maintains that “negative social perceptions of drug users and an abstinence-oriented approach to drug dependence limit the political will to advocate for harm reduction interventions.” It is true that criminalizing drug addiction isn’t the same as treating it—but neither is institutionalizing Narcan without seeking ways to address the roots of addiction. At best, naloxone is a stop-gap measure. That’s why the proliferation of Narcan vending machines in cities like Philadelphia seems less like progress than raising the white flag of surrender.
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