Overdose kit distribution: A how to guide

I’m not much of a host. But with the opioid epidemic getting worse, I knew we had to start doing overdose-kit distributions. The whys seem obvious. As a medical director for a large mental health and substance abuse non-profit agency —CMHA in New Britain— I see too much death. The toxicology reports from the state’s medical examiner increasingly come back positive for fentanyl, which is now present in over 50 percent of our fatal ODs. At 50 to several-thousand-times-more potent than morphine, fentanyls—yes, there are more than 20— from China have thrown gas onto the fire of America’s opioid epidemic.

As events are not my forté, I needed help. It reminded me of the old-time movies my parents and grand-parents watched where Judy Garland and Mickey Rooney would rally the neighborhood kids to put on a show. We brainstormed.

“There needs to be food.”

“It should be late enough in the day so people can come after work.”

“It can’t be too long.”

“There need to be enough kits for anyone who wants one.”

“How are we going to get the word out?”

“We have to advertise.”

CMHA recently purchased the old D&L Department store in downtown New Britain, and when it’s fully rehabbed it will be our mother ship —a couple years down the line. It has two amazing street-level windows. We’ll do them up to announce the event. We’ll make a poster, and a friend of mine whose son died from an overdose will loan us a beautiful memorial quilt from Wolcott.

Suddenly, what felt like a Tupperware party, got real. Each of those beautifully stitched squares was someone’s child. To hear my friend Karen talk through them brings an awful clarity and tears. Lives filled with promise, turned to something monstrous, first with pills prescribed by a doctor for a sports injury, or obtained from friends or a family member. Then came the black-tar heroin from Mexico, more potent than anything that had ever been on the street. Now, it’s fentanyl bought over the dark web from China, with tiny doses that bring irresistible profits and predictable deaths.

We plan the event. Evelyn makes a poster. We get a picture from the DEA web site that shows how much fentanyl is needed to kill a person; it’s a miniscule amount. We work on the colors. We enlist helpers, Beacon Pharmacy to provide the overdose kits; insurance, including Medicaid/Husky will pay for it. Danielle helps me find the resources to pay for kits for people with no insurance. We order 30 double dose boxes of an easy to use nasal spray. Best to stay away from needles.

Mark Jenkins, the CEO of the Greater Hartford Harm Reduction Coalition, the guy who drives around the worst neighborhoods in Hartford distributing clean needles, cookers, and condoms, will provide the brief training on how to give the medication that will reverse an overdose.

I’ll say a few words as well, but mostly it’s about getting the kits out there, but more too. It’s providing basic, and life-saving, education around this pernicious addiction. Someone revived from an overdose will use again, they almost must as it puts them into withdrawal. One study from Boston looked at people who’d had an overdose reversed, 10 percent of them were dead within a year. A dose of naloxone (Narcan) is a chance. But if it’s not coupled with immediate offers of treatment, it may be a slim chance that leaves the revived individual running back to the same dealer who sold them their last lethal dose.

But as I met with a woman who’d lost her 27-year-old daughter to overdose, she stressed the importance of hope. She’d never given up on her child, despite multiple overdoses, rehabs, times of sobriety, and times of relapse.

“There are success stories,” she said. And that’s the truth, there are many paths to recovery. But without an overdose kit at the time it’s needed, the flame of hope goes out. Personally, I know several people who were revived more than once, and now have years of abstinence.

As one friend in recovery said, having naloxone is like having a fire extinguisher. You hope you never need it, but if you do, you’re damn glad it’s there.”

Charles Atkins, M.D., is a psychiatrist, author, and the chief medical officer for Community Mental Health Affiliates (CMHA), a multi-site behavioral health and substance abuse agency in New Britain, Torrington, and Waterbury. He is a member of the volunteer faculty at the Yale School of Medicine.