On a recent weekday, Venus Woods stacked cardboard boxes holding syringes in a giant, white van in a parking lot behind an office building in Anchorage. She was prepping the van to head out as a mobile needle exchange to give out these supplies as part of the work she does for Alaskan AIDS Assistance Association, or 4As.
Every week, she drives the van, parks it in the Mountain View neighborhood of Anchorage and waits. It has a sliding window on the side and people come up to it to exchange their used syringes for new ones. Needle exchanges like this reduce HIV and hepatitis transmission by 50% because people don’t share needles as much.
The organization also gives out safer drug use supplies like alcohol wipes, tourniquets, and clean cotton balls. Those supplies help prevent health complications like abscesses and chronic wounds, which are common for people injecting drugs.
And they also give out Kloxxado. That’s a stronger version of Naloxone that can be used to reverse an opioid overdose. Woods said people tell her they’re using the overdose kits.
“I mostly hear things like, ‘It’s amazing. It saves people’s lives. I had to use that several times last week,’” said Woods.
According to the state health department, organizations gave out about 30,000 kits in Alaska last year. Anyone who gets a kit takes a short training. They learn how to use the nasal spray and that they must call 911 afterwards for medical attention.
But Woods said, in practice, people aren’t calling.
“I think the majority of our syringe access clients do not utilize emergency rooms,” said Woods.
Woods is in recovery, so she also speaks from personal experience. She said people who use drugs are sometimes treated differently by doctors and in hospitals, so they may not want to get medical care. And the research backs this up. People who use drugs sometimes avoid healthcare because of past mistreatment or dehumanization.
She said that stigma can combine with someone’s personal shame about their own drug use. But she said there are practitioners in Alaska who are doing it right, and the state is getting better.
Coleman Cutchins is a clinical pharmacist for the Alaska Department of Health. He said he doesn’t want people to avoid care because they fear stigma. He said people go into health care to save lives. And he’s deeply worried that people aren’t getting medical care after an overdose.
“I just want to stress how unsafe it is to not call 911,” said Cutchins. “Anytime somebody gives Naloxone, they’re trying to save a life, which is great. But the full part of saving that life is: giving naloxone, start CPR, call 911.”
Cutchins said in an opioid overdose, the person forgets to breathe. A reversal drug like Narcan helps by kicking opioids off of the receptors in the brain. But Narcan doesn’t last as long as opioids do. He said people should give multiple doses of naloxone while they’re waiting for an ambulance. But it’s still possible to overdose after getting naloxone.
“There’s instances where someone seems totally fine and then, you know, an hour or so later, they go back- or even a few hours later, they go back into that respiratory depressed state,” said Cutchins.
He said even if people survive an overdose, they could have other medical problems – like brain damage from low oxygen.
“The quicker that someone can get treatment, the better off, the less likely they are to have a long term injury from it,” said Cutchins.
Robin Lutz is executive director of 4As. She said even if it’s best practice to call 911 after an overdose, it’s not realistic. One reason is that the physical experience of having an overdose reversed is extremely unpleasant.
“What we hear from people is that it’s a kind of immediate, what we call ‘dope sick,’” said Lutz. “So you just feel like you’re an immediate withdrawal. And that’s a terrible feeling. It’s like the flu times 50.”
People may not want to be in an emergency room environment after that. And they may also be worried about arrest. Good Samaritan laws in Alaska protect someone overdosing or helping another person with an overdose, regardless of whether they possess a personal amount of illegal drugs.
“People know that, I think, on kind of an intellectual level,” said Lutz. “But, I think it’s really hard to believe that if you’ve had negative experiences, an interaction with law enforcement, which a lot of people who use drugs have because drug use is illegal.”
But good samaritan laws only protect people in an overdose situation if they stay with someone until they get medical help or the police arrive.
Lutz said that however people are using it, Naloxone is essential and is saving countless lives.
“People really depend on it.” said Lutz. “I can’t imagine if our state didn’t have access to Naloxone right now what our overdose deaths would look like.”
She said their organization gave out 2,500 overdose kits last year–in Anchorage, Mat-su Borough, and Juneau. She said at times, people were requesting the kits and they didn’t have any left to give.
