Out of harm’s way There’s an antidote for heroin overdose, and a former addict is among those working to spread it far and wide
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About the antidote Naloxone, also sold under brand names such as Narcan, reportedly reverses the overdose effects from OPINION
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GREEN
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Highs and lows
opiates, including heroin and prescription painkillers, by taking over the opiates’ place on the brain's receptors. Different formulations of it can be injected into a muscle or vein, or sprayed into a nasal cavity. It was approved by the Food and Drug Administration in 1971. It’s been available by prescription in Nevada for a long time, but it was effectively illegal until 2013, when a statute was changed to decriminalize possession of syringes. (The nasal spray version wasn’t an option then; that wasn’t approved by the FDA until 2015.) Naloxone can have side effects including nausea, sweating and fever, but, in the experience of Cindy Green—a 17-year veteran EMT, supervisor and educator for ambulance service REMSA—it very often doesn’t. She and her colleagues administer the drug about 53 times a month. (Green stressed that “53” isn’t necessarily the number of opiate overdoses that REMSA responders encounter monthly. If they find someone unconscious and they don’t know why, they might administer Naloxone to rule out an overdose. She didn’t have a number readily available, but she said that happens noticeably often.) “The medicine itself will never hurt you. It will only benefit you,” Green said. Livernois had been
FEATURE STORY
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ARTS&CULTURE
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ART OF THE STATE
krisv@newsreview.com
counseling or medical help don’t get it. “Stigma kills,” he said. “It’s the number-one killer. If you woke up tomorrow with a giant, festering wound on your arm, you’d go in. Many times, a heroin user with a similar problem would avoid a hospital visit. Many times a provider treats you like dog shit. The way that they look at you, you’ll never go again. … Stigma is a real bitch.”
This is not a nice, neat, linear story of a guy hitting rock bottom and suddenly coming clean. It took Livernois six or seven more years to kick heroin. The last time he took it was in 2012. During those six or seven years, he volunteered at the syringe exchange in Salinas, moved to Reno, and joined with a few other activists to start a grassroots group called the Public Health Alliance for Safety Access (PHASA). That group formed in large part to push for a law that would make naloxone more widely accessible. Among the members of the fledgling group were Melanie Flores, an activist named Penny Jernberg from Truckee, and Livernois’ now long-term partner, Leslie Castle. “They were really stoked when I showed up on the scene,” Livernois said. “They had everything they needed except an actual drug user. They didn’t have anybody to bridge the gap between them and the community they want[ed] to serve. Sometimes it’s hard to find people to self-identify.” He pointed out that identifying as an addict is hard to do in a lot of circumstances, and that often because of that people who need
In a position to help Today, Livernois is a community outreach worker for Change Point, the syringe services program at Northern Nevada HOPES. The program provides clean needles, which helps slow transmission rates of HIV and Hepatitis C. It also offers counseling, access to rehabilitation programs and HIV and Hep-C testing. Livernois said that HOPES makes a point of hiring staff members who represent the communities they work with. Sometimes, for example, the non-profit health organization seeks out transgender employees or Latino employees. In his case, he said, “You can’t really put out a Craigslist ad saying you’re looking for somebody who used to shoot heroin, who’s been to prison, who’s been homeless, but that is what they were looking for.” Livernois, now 38, has a slim build, a long salt-and-pepper beard, a piercing on each side of his lower lip, and intense brown eyes. Fashionwise, he might fit right in with his clients at the exchange, but he’s alert, articulate and authoritative on the job. It’s clear
Photo/Kris Vagner
oshua Livernois woke up hazy, sick and splashed with Dr. Pepper in a hospital bed in Salinas, California. He couldn’t piece together the events of the previous day or so, and he’s still not even sure which year it was, probably 2005 or ’06. He’d been using heroin off and on for about 10 years and almost daily for five. “There was some crazy dope in town,” he said. “I don’t know what was up with it. It tasted different than normal, had kind of a vitaminey flavor.” As a long-time user, he didn’t often get what he craved, which was “the full effect of being fully loaded.” This new heroin, he said, “got me really, really high.” This much he remembers: He’d been homeless for a while. His then-girlfriend had been in jail for a couple of weeks. They were in a motel room with a few other friends. They were on a four-day bender doing MDMA, crystal meth, alcohol and that potent heroin that had just hit town. This part he pieced together later: After he shot up, he started babbling incoherently. His friends worried that he might be overdosing. Two women loaded him into a car and drove toward the emergency room. On the way there, he passed out, turned blue and started breathing shallow, infrequent breaths. The driver stopped at the home of an acquaintance because it was closer than the hospital. The acquaintance gave Livernois an injection of naloxone, which he said helped him recover from the overdose, and eventually the two women got him to the hospital.
by Kris Vagner
feeling pretty bad when he woke up that day in Salinas, though. In fact, he described it as a “fucking miserable, miserable experience,” a type of situation that Green explained this way: “I guess there is a small caveat. If you have a major addiction, you could see some withdrawals. You do typically upset the person when you give it, because you take away the high.”
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THIS WEEK
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MISCELLANY
“ OUT OF HARM’S WAY” continued on page 14
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JUNE 23, 2106
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