The fight against the opioid crisis in US clubbing

FIGHTING THE CRISIS

Fentanyl was developed in 1959 and introduced as an anesthetic in the 1960s. It’s normally used as a last resort for patients in severe pain, or who have over time developed a tolerance for less potent opioids. It works by binding to the opioid receptors in the parts of the brain that regulate emotion and pain. In small doses it can induce feelings of euphoria, but if someone isn’t used to opiates, they can easily overdose. Telltale signs include shallow breathing, pinpoint pupils, discoloured or cold skin and vomiting. 

If a person has overdosed on the drug, their breathing will start to slow down and soon the lungs will stop sending oxygen to the brain. Naloxone reverses this effect by binding to the same receptors and blocking the drug’s path. The medication’s effects are minor if given to someone who doesn’t usually consume opiates, but it can be quite painful for someone with high levels of the drug in their system — too much, and it can send them into withdrawal. 

Danielle Pickering has administered naloxone a number of times, on opioid addicts and clubbers who’d unknowingly consumed fentanyl. “The thing I always try to tell people who have never touched a stranger in this way before is that it’s going to feel terrible, it’s going to be scary and you don’t really know what to expect,” she tells DJ Mag. 

In 2019, Pickering gave Flax naloxone training. “I brought a whole bunch over to her place to show her how to use it,” Pickering explains, “and that day, when I was teaching her, we just sat at the kitchen table, drank coffee and brainstormed for a couple of hours.” By the end of the conversation, they had the sketchings of an idea for Flax to run by her friends, and soon after, Last Night A Deejay Saved My Life was born. The NYC-based collective decided to focus on fighting the opioid crisis within the nightlife community — but first, it needed supplies. 

As of July 2017, every US state had passed at least one law making naloxone more widely accessible, many by removing the need for patient-specific prescriptions. Prior to the change, individuals could receive the medication, but it was often noted on their health records, potentially driving up their insurance costs. Post 2017, pharmacies and opioid crisis organisations were permitted to distribute it to individuals without a prescription.

“The reason behind that is if you give it to somebody who’s not overdosing, it does no harm,” Flax explains, “so they made it more accessible, but the problem was — and still is — that it costs $140.”  

Pickering reached out to the Greater New York City Black Nurses Association, which runs an opioid overdose prevention programme and has access to a regular supply of naloxone. Dr. Julius Johnson, a member of the association, liked the collective’s ideas and agreed to help lead its first workshop, which was held at The Lot Radio in December 2019.

“We want to meet people where they are, because it’s such an important aspect of healthcare that people tend to forget,” Johnson tells DJ Mag. “So we came, we did one workshop and it felt like we should expand it to other places, so I told Lauren I was all on board.” 

Naloxone can be administered as an injection or nasal spray, which is commonly known by its brand name, Narcan. “You want to check and make sure that the person is actually unconscious first,” Pickering explains. If they don’t respond, she recommends a sternum rub: making a fist and rubbing the knuckles along the sternum bone, applying as much pressure as possible. “That’s hard to do on a stranger, it’s invasive, but you want to make sure that you’re not able to wake them up some other way.” 

The injection can be delivered in a series of doses and is generally administered on the outer thigh or upper arm muscles, but the nasal spray, Pickering tells us, needs no priming. “You just take it out of its package, put it up their nose and it’s one click — super easy and quick. And then you put them in the recovery position.”

HARM REDUCTION

In 2014, white Americans were twice as likely to die from opioids as Black Americans, but by 2019, overdose death rates among Black Americans had more than tripled, and last year, overdose deaths in Black and Hispanic populations grew faster than in white ones.

Johnson was keen to offer support to this new group of accidental users. “Once we scanned through those statistics and we saw that this is not just a white middle America problem — that the problem was in our urban, lower income neighbourhoods as well — we needed to do something about it,” he says. 

The US opioid crisis dates back to the mid-’90s when Purdue Pharma introduced OxyContin to the public. The pharmaceutical company’s heavy-handed publicity campaign, which downplayed OxyContin’s addiction risks, has contributed to a crisis which has killed some 200,000 people in the last two decades. Last year it admitted to a series of criminal activities, including lying to the Drug Enforcement Administration (DEA), bribing doctors to over-prescribe its drugs and paying illegal kickbacks to a healthcare company. But despite this, the family-run business was recently allowed to declare bankruptcy, shielding anyone associated with the company from future lawsuits.

The second epidemic, which began around 2010 with a rapid increase in heroin death overdoses, was followed by a third in 2013. Some argue that this phase is the most lethal, in part because those cutting the drugs are incapable of discerning the difference between a safe and deadly dose. The result being that, where the prescription and heroin epidemics drove up the number of users, the spread of fentanyl is driving up the number of deaths.