Un hombre de mediana edad abrió, con mirada cautelosa.

“Hola, señor, ¿cómo está hoy?”, le preguntó Elie, que tenía puesta una chaqueta con el logo de la Campana de la Libertad, del gobierno de la ciudad. “Mi nombre es Marsella. Estoy trabajando con la ciudad. ¿Ha oído hablar de las sobredosis que están ocurriendo en el vecindario, verdad?”.

El hombre asintió. Elie señaló los folletos que tenía sobre sobredosis de drogas y programas de tratamiento para la adicción. Levantó una caja de Narcan, una marca de naloxona, que puede revertir una sobredosis de opioides.

“Lo que estamos tratando de hacer es que esto llegue a todos los hogares. ¿Alguna vez ha oído hablar de esto antes?”, preguntó Elie antes de entregarle al hombre una bolsa de tela llena de folletos, tiras de prueba de fentanilo y la caja de Narcan.

Elie y otros trabajadores de medio tiempo de la ciudad y voluntarios forman parte de una campaña puerta a puerta a gran escala en Philadelphia que tiene como objetivo equipar los hogares con naloxona y otros suministros para prevenir sobredosis de drogas.

Los funcionarios de la ciudad esperan que este enfoque proactivo transforme a la naloxona en un artículo que esté en los botiquines, para evitar que las personas mueran por sobredosis, especialmente los residentes negros.

En Philadelphia, en 2022, según datos de la ciudad, un récord de murieron por sobredosis de drogas. Entre los residentes negros, las muertes aumentaron un 20% respecto al año anterior, y muchas ocurrieron en casas.

“Lo mejor que podemos hacer para que estos productos sean más accesibles es simplemente dárselos a las personas”, dijo , subdirectora de la de la ciudad, hablando sobre la bolsa de tela con naloxona y otros suministros.

“No le estamos preguntando si está usando drogas. El objetivo aquí es realmente construir una responsabilidad colectiva. Como personas de comunidades minoritarias, como vimos durante la epidemia de covid, nadie viene a salvarnos. Para nosotros, esta es una herramienta que podemos usar para salvarnos a nosotros mismos”.

Esta iniciativa de distribución tiene como objetivo llevar suministros de prevención directamente a personas que de otro modo no los buscarían por sí mismas, y concientizar sobre las sobredosis más allá de Kensington, el epicentro de la epidemia de adicción de la ciudad.

Los encuestadores planean golpear más de 100,000 puertas en los “puntos calientes” de Philadelphia, con tasas crecientes de sobredosis de opioides, muchos en comunidades minoritarias.

El aumento de las disparidades raciales en las muertes por sobredosis es una de las consecuencias a largo plazo de la , dijo McLoyd. Las políticas de esa campaña nacional llevaron a décadas de tácticas policiales agresivas, perfil racial y largas condenas de prisión, afectando de manera desproporcionada a personas de color y a sus comunidades.

La investigación muestra que los afroamericanos siguen representando por drogas y servicios de protección infantil.

“Por eso, está muy claro por qué las personas de minorías podrían ser reacias a levantar la mano y decir: ‘Soy una persona que usa drogas, necesito esos recursos'”, dijo McLoyd.

Otras comunidades han distribuido naloxona y otros suministros, aunque . Lo que está haciendo Philadelphia podría convertirse en un modelo para otros lugares densamente poblados, dijo , vicepresidenta de iniciativas sobre el uso de drogas en , una organización de salud pública que trabaja con gobiernos locales en siete estados para abordar la epidemia de opioides.

“Hay algo intensamente personal en un compromiso humano”, dijo Heller. “Y que alguien toque a tu puerta para hablar sobre el uso de drogas y el riesgo de sobredosis y que haya algo que se pueda hacer, creo que es realmente poderoso”.

A lo largo de los años, la naloxona se ha vuelto más accesible que nunca, apuntó Heller. Ahora se puede y se puede recibir por correo, está disponible en especializadas y algunas farmacias ahora venden el spray nasal de Narcan sin receta.

Pero siguen muriendo por sobredosis de opioides cada año.

Eso significa que los esfuerzos de prevención y los mensajes sobre la crisis aún no llegan a algunas personas, dijo Heller. Y para Heller, llegar a las personas significa ir donde están. “Tenemos que pensar así cuando pensamos en la distribución de naloxona”.

El proyecto de divulgación en Philadelphia está financiado en parte por los pagos de acuerdos de demandas nacionales contra fabricantes y distribuidores de opioides, .

Se espera que la ciudad reciba alrededor de $200 millones en aproximadamente 18 años de acuerdos con AmerisourceBergen, Cardinal Health, McKesson y Johnson & Johnson.

De la iniciativa forman parte muchas de las mismas personas que comenzaron a hacer divulgación como parte del censo de 2020.

No todos responden a la puerta. Algunos no están en casa. En esos casos, los trabajadores dejan un volante en el picaporte de la puerta que ofrece información sobre los riesgos de las sobredosis, y contactos para obtener más recursos.

Los equipos de encuestadores, a menudo con intérpretes de idiomas, hacen una segunda ronda de visitas en el vecindario para llegar a las personas que no vieron la primera vez.

En un jueves reciente, los encuestadores de Philadelphia estaban tocando puertas en los vecindarios de Franklinville y Hunting Park. Según datos de la ciudad, en este código postal, aproximadamente 85 personas murieron por sobredosis de drogas en 2022. Eso es menos que las 193 personas que murieron por sobredosis en Kensington el mismo año, pero mucho más que las pocas muertes vistas en los vecindarios más ricos de la ciudad.

Los encuestadores se acercaron a una residente, Katherine Camacho, en la acera, cuando salía de su garage. Camacho les dijo que estaba al tanto del problema de las sobredosis en su comunidad y luego aceptó con entusiasmo una caja de Narcan. “Voy a llevar esto conmigo, porque, como dije, a veces estás en la calle conduciendo a algún lugar y podrías salvar una vida”, les dijo Camacho.

En cuanto al esfuerzo de divulgación de Philadelphia, Camacho dijo que cree que “Dios está poniendo a estas personas para ayudar”. Mientras entraba en su casa llevando la caja de Narcan, agregó que quería hacer su parte para ayudar.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

A middle-aged man appears with a wary look on his face.

“Hello, sir, how are you doing today?” asked Elie, wearing a royal-blue jacket embroidered with the city government’s Liberty Bell logo. “My name is Marsella. I’m working with the city. You heard about the overdoses that are going around in the neighborhood, right?”

The man gives a cautious nod.

Elie gestures to the pamphlets she’s holding about drug overdoses and addiction treatment programs. She holds up a box of Narcan, a brand of naloxone, which can reverse an opioid overdose.

“What we’re trying to do is get this in everybody’s household. Have you ever heard of this before?” Elie asked before handing the man a tote bag filled with more pamphlets, fentanyl test strips, and the box of Narcan.

Elie and other part-time city workers and volunteers are part of a large-scale, citywide door-to-door campaign in Philadelphia that aims to equip homes with naloxone and other drug overdose prevention supplies.

City officials hope that this proactive approach will normalize naloxone as an everyday item in the medicine cabinet, and prevent people from dying of overdoses, especially Black residents.

In Philadelphia in 2022, a record from drug overdoses, according to city data. Among Black residents, deaths were up 20% from the year before, with many happening in private homes.

“The best thing we can do to make these things more accessible is to just give them to people,” said , deputy director of the city’s , speaking about the tote bag with naloxone and other supplies. “We’re not asking you if you’re using drugs. The goal here is really to build sort of a collective responsibility. As Black and brown folks, as we saw during the covid epidemic, nobody’s coming to save us. For us, this is a tool that we can use to save ourselves.”

The canvassing initiative aims to take prevention supplies directly to people who might not otherwise seek it out themselves, and to spread awareness about overdoses beyond Kensington, the epicenter of the city’s addiction epidemic. Canvassers plan to knock on more than 100,000 doors in Philadelphia’s “hot spots” — with escalating rates of opioid overdoses, many in minority communities.

Widening racial disparities in overdose deaths are among the long-term consequences of the , McLoyd said. Policies from that national anti-drug campaign led to decades of aggressive police tactics, racial profiling, and lengthy prison sentences, disproportionately affecting people of color and their communities.

Research shows that Black Americans still account for a of drug arrests and child protective services.

“Because of that, it’s very clear why Black or brown people might be hesitant to raise their hand and say, ‘I’m a person who uses drugs, I need those resources,’” McLoyd said.

Other communities have distributed naloxone and other supplies, albeit on a than Philadelphia.

What Philadelphia is doing could become a model for other densely populated places, said , vice president of drug use initiatives at , a public health organization working with local governments in seven states to address the opioid epidemic.

“There’s something intensely personal about a human engagement,” Heller said. “And somebody knocking at your door to talk about drug use and overdose risk and that there’s something that can be done, I think is really powerful.”

Over the years, naloxone has become more accessible than ever before, Heller pointed out. It can now be and through the mail, it’s available in specialized , and some drugstores now sell Narcan nasal spray over the counter.

But of Americans are still dying from opioid overdoses every year. That means prevention efforts and messaging about the crisis are still not reaching some people, Heller said. And to her, reaching people means meeting them where they are. “That means physically, that means in terms of what they know about something, what their perception is of something, and their beliefs,” she said. “We need to think like that when we think about naloxone distribution.”

The Philadelphia canvassing project is funded in part by payouts from national lawsuits against opioid manufacturers and distributors. The city is set to receive about $200 million over roughly 18 years from settlements with AmerisourceBergen, Cardinal Health, McKesson, and Johnson & Johnson.

The initiative is staffed by many of the same people who initially started canvassing as part of the 2020 census count.

Not everyone answers the door for the canvassers. Some aren’t home when they come around. In those cases, workers hang a flyer on the door handle that offers information about overdose risks and contacts for further resources. The teams of canvassers, often with language interpreters, later make a second sweep through a neighborhood to reach people they missed the first time.

On a recent Thursday, Philadelphia canvassers were knocking on doors in the Franklinville and Hunting Park neighborhoods. In this ZIP code, about 85 people died of drug overdoses in 2022, according to city data. That’s fewer than the 193 people who died of overdoses in Kensington in 2022, but much higher than the few deaths seen in the city’s most affluent neighborhoods.

The canvassers approached a resident, Katherine Camacho, on the sidewalk, as she came out of her garage. Camacho told the teams she was aware of the overdose problem in her community and then eagerly accepted a box of Narcan.

“I will carry this with me, because, like I said, sometimes you’re in the street driving somewhere and you could save a life,” Camacho told them. “And if you don’t have these things, it’s harder to do so, right?”

Camacho said she’s seen how the opioid crisis has caused suffering in her neighborhood and across the city. As for Philadelphia’s canvassing effort, she said she believes that “God is putting these people to help.”

As she headed into her house carrying the box of Narcan, Camacho said she wanted to do her part to help, too.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Philadelphia police officers Kenneth Harper and Jennifer Torres were in their patrol car sitting at a red light when a call came in over the 911 radio dispatch.

“This job says ‘female complaint in reference to dispute with daughter, suffers from bipolar, infant on location,'” Harper read off the computer near the front seat.

The officers got a little more information from the dispatcher: A mother needed help with her adult daughter who had become combative after drinking alcohol.

It was a Friday morning. Harper and Torres quickly drove off in the direction of the address they were given just a few miles away. They traveled in a white SUV, absent of any police markings, with a third team member in the back seat, . Gardner is not a police officer. She’s a mental health clinician and social worker.

“Do we know the age of the daughter?” Gardner asked the officers. She was preparing a list of possible services and treatment options.

As the team pulled up to a row house in North Philadelphia, the mother was waiting for them outside, on the front stoop. They spent 40 minutes with the family, working to de-escalate the immediate tension, provide the mom with support, and connect her daughter to treatment services.

The trio returned to the patrol car and got to work documenting what had happened and recording the visit in an electronic database.

Officer Torres commented on the adult daughter: “In regards to her mental health, she is taking care of herself, she’s taking her medication, and she’s going to therapy, so we don’t need to help her too much on that aspect.”

“She’s actually sleeping right now, so I gave her my card and she’ll call us whenever she wakes up,” Torres added.

Soon, the radio crackled with their next call, to a home across town where an older woman with a history of mental disorders had wandered outside naked.

This visit took longer, over an hour, but had a similar outcome — help with the immediate mental health crisis, a connection to follow-up services with a case manager, and no arrest or use of force by police.

New Ways to Respond to Behavioral Health Needs

Emergency dispatchers in Philadelphia are increasingly assigning 911 calls involving people in mental health crises to the city’s Crisis Intervention Response Team, which pairs police officers with civilian mental health professionals. This model is called a “co-responder program.”

Cities with to meet the rapidly increasing demand for behavioral health crisis intervention, at a time when and in have become painfully familiar.

Big questions persist: What role should law enforcement play in mental crisis response, if any? How can leaders make sure the right kind of response is dispatched to meet the needs of a person in crisis? And what kind of ongoing support is necessary after a crisis response call?

City officials and behavioral health professionals often don’t have easy answers, in part because the programs are new and hard data on their effectiveness is scarce. Without a single, definitive model for how to improve crisis response, cities are trying to learn from one another’s successes and mistakes as they build and adjust their programs.

The Philadelphia Police Department established its Behavioral Health Unit in November 2022 and officially launched the co-responder crisis teams as a main feature.

The department said its goal is to meet people’s immediate behavioral health needs, avoiding arrests or use of force, if possible. Philadelphia’s program has answered about 600 calls since December 2022 — and only one case resulted in an arrest as of November 2023, according to city data.

In about 85% of cases, people experienced one of four major outcomes: They were connected to outpatient mental health and social services, voluntarily entered psychiatric treatment, were involuntarily committed to treatment, or were taken to a hospital for medical care.

“I think the practical experiences that people have had has really opened up a lot of people’s eyes to what the work does, how it’s actually reducing harm to the community,” said , director of Philadelphia’s Office of Criminal Justice.

Give a Social Worker a Dispatch Radio

City officials in Philadelphia looked to such cities as Los Angeles, Houston, and Denver, which have developed their own models over the years. They contacted people like Chris Richardson.

Richardson in 2016 helped found , which pairs police officers with mental health professionals, like Philadelphia’s CIRT program.

Denver residents had been unhappy with the status quo, Richardson recalled. At the time, rank-and-file police officers were the only ones responding to 911 calls involving people in crisis.

“We just heard a lot of those communities saying, ‘We wish there was something better,'” he said. “That’s what kind of gave us that ability to start those conversations and start a partnership.”

Getting buy-in from law enforcement and other emergency response teams took time, Richardson said. Eventually, the co-responder program grew to include all police precincts and several fire departments.

Then, Denver city and county park rangers began requesting the aid of mental health professionals to accompany them while on patrol in public spaces, and during emergency calls.

“And then, somewhere in the middle there, we were like, you know, give a social worker a radio. We’re like, why are we sending police to this, in general?” he said. “How do we take police out of things that don’t need policing?”

Denver then launched a second model, its civilian response program, in 2019. It brings together paramedics and mental health professionals to — no police officers involved.

Now, Denver uses both models — the co-responder program with police, and the all-civilian response program — to cover Denver’s crisis needs. Richardson said both programs are necessary, at least in Denver.

“It’s a spectrum of care with behavioral health crises,” he said. “Some of it is really low-level. No threats, no safety concerns, no legal issues.”

But sometimes responders or community members may face serious safety concerns, and that’s when a co-response team that includes police officers is needed, Richardson said.

“We want to make sure that that person in crisis is still getting taken care of,” he said.

Getting the Right Responders to the Right Call

Officials in Philadelphia want the police co-responder program to work in parallel with the city’s existing network of civilian-only mental health response teams. The co-responder program is dispatched by 911, while the all-civilian program is activated when residents call 988.

The launched in July 2022, providing a three-digit number that can be dialed from any phone by people who are suicidal or experiencing a behavioral emergency. Calls are routed to a network of over 200 local and state-funded crisis centers.

“A large percentage of Philadelphians are not aware of 988,” said , commissioner of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services. “I like to say that people are born knowing to call 911, kind of come out of the womb and they know to call 911. And we really are trying to reach that kind of level of awareness.”

To help sort incoming calls, 911 dispatch centers in Philadelphia have been hiring mental health professionals. They can screen calls from people in crisis who don’t need a police response, and forward them to 988.

Other cities and states are also struggling with confusion over how to handle the overlap between 911 and 988 calls.

Although 988 is a national network, calls are taken by regional call centers, which are overseen and managed by local governments. The federal Substance Abuse and Mental Health Services Administration said it is working on “ between the two services,” but it’s currently up to states and counties themselves to figure out how 911 and 988 work together.

National data collected one year after 988’s implementation showed that most calls to the service can be handled with conversation and referrals to other services. But 2% of calls to 988 require rapid in-person intervention. In most states, the responding agency is 911, which deploys traditional law enforcement, or co-response teams, if they’re available.

Next Steps: A Safe Place to Go

In states where awareness of 988 is higher, some behavioral health leaders are focused on a lack of continuing care resources for people in crisis.

During a July press conference marking one year since 988, Shari Sinwelski, the head of California’s biggest crisis call center, described the ideal crisis response as a three-legged stool: “someone to talk to, someone to respond, a safe place to go.” The idea was in 2020.

In California, 44 out of its 58 counties have some form of mobile crisis response, meaning a team that can travel to someone in need, according to a conducted in partnership with the County Behavioral Health Directors Association of California.

However, the preparedness of these teams varies significantly. The survey identified that many of them don’t operate 24/7, have long wait times (up to a day), and aren’t equipped to handle children in crisis.

The same survey found that around 43% of the state’s counties didn’t have any physical place for people to go and stabilize during and after a crisis. WellSpace Health is California’s second-biggest 988 center, by call volume, and is located in Sacramento County. A few years ago, WellSpace leaders decided it was time to open a crisis stabilization unit.

In summer 2020, WellSpace unveiled the Crisis Receiving for Behavioral Health center, known as “Crib,” in downtown Sacramento. The center receives people experiencing a mental health crisis or drug intoxication and allows them to stay for 24 hours and be connected to other services. The group says it has served more than 7,500 people since opening.

Physical locations linked to services, like Crib, are a crucial part of a well-functioning 988 system, said , national director of government relations and policy for the National Alliance on Mental Illness.

“Those crisis stabilization programs are really key to helping somebody not languish in the ER or unnecessarily get caught up in the criminal justice system,” she said.

Snow said it’s too early to know how the nation is progressing overall on building up these kinds of centers.

“This is something I am dying to know, and we just don’t,” she said.

Snow explained that the crisis care system has roots in law enforcement, so it tends to replicate law enforcement’s decentralized and locally led structure.

“It makes it harder to look at it from a national perspective and, you know, be able to identify exactly where are these services and where are the gaps in services,” she said.

Building additional crisis centers, and hiring enough response teams to respond quickly, at all hours, in more areas of the U.S., would require significant investment. The current system relies heavily on state and local government funding, and more federal support is needed, Snow said.

In 2022, a group of legislators introduced the in the House of Representatives. They were able to pass several provisions, $385 million for certified community behavioral health clinics, which operate 24/7 crisis care, and $20 million for mobile crisis response pilot programs.

The bill was , with the goal of passing the remaining sections. A significant provision would force Medicare and Medicaid, as well , to reimburse providers for crisis services.

This article is from a partnership that includes , , , and Ä¢¹½Ó°Ôº Health News.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Coming off a year with a record number of opioid-related overdose deaths in the United States — in 2022, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics — community health workers and addiction medicine experts were hopeful that the arrival of Narcan on retail shelves might make it easier for people to get the medication.

And, ultimately, prevent more fatal overdoses.

But it’s unclear whether the move will actually expand access to Narcan. Experts worry that its unpredictable retail price, sporadic availability on store shelves, or general consumer confusion about potentially having to ask a pharmacist to retrieve it will mean that fewer people than expected will purchase Narcan to have it at the ready when an overdose occurs.

“It’s not by any means a game changer,” said , a family nurse practitioner and assistant professor at the University of Pennsylvania’s School of Nursing in Philadelphia. “I don’t think it’s a step in the wrong direction. I just think it’s a tiny, tiny baby step that does not deserve a round of applause.”

“We should not be under any illusion that this is going to meaningfully change things for a lot of people,” she said. “But we need to be moving in this direction. We just need to be doing it faster and with an understanding that this is just way overdue.”

The over-the-counter marketing and sales of Narcan in March. Manufactured by Emergent BioSolutions, it started arriving in stores in early September, with a for a two-dose package with a .

Enduring Barriers to Access

As an over-the-counter product, Narcan ideally would appear on store shelves in the same way as ibuprofen and cough medication.

But at several drugstore locations in Philadelphia, “over the counter” means it is stocked and sold from behind the pharmacy counter. That requires people to wait in line and ask a pharmacist to buy Narcan.

“Having to go talk to the pharmacist who may or may not know you, it’s not comfortable for people, and that’s a barrier that this is supposed to eliminate,” Aronowitz said. “It’s counterintuitive. It needs to just be on the shelf, and someone can take it.”

Keeping Narcan behind the counter will especially deter people who use drugs, said , chair of the Department of Emergency Medicine and director of the Division of Medical Toxicology at Rutgers New Jersey Medical School.

“For those who don’t have substance use concerns, they might go in and just ask for the product and not be concerned about what the other person’s thinking,” he said. “But that’s a mental state that’s very hard for most of us to put ourselves into if we don’t live the life of somebody with the stigma and the marginalization that is so associated with substance use.”

Another potential barrier is related to affordability. Despite the suggested price of $44.99 for a two-dose pack, nothing is stopping individual pharmacies and other retailers from charging more. At least one drugstore in Philadelphia was selling it from behind the pharmacy counter for $72 a box.

“The higher the price, the fewer people who are going to splurge to have this with them in case somebody else needs it,” Nelson said.

That’s especially true for people with low incomes who are facing other daily financial challenges, Aronowitz said. Even $44.99 may be too steep for many consumers.

“That’s a lot of money to be spending on something if you need food today, if you have a headache and need ibuprofen today,” she said. “You think you’ll probably need naloxone, but it’s not a guarantee that you’ll need today, so why spend the money?”

are also available at most pharmacy stores, but consumers need a prescription from a medical professional.

Most states have also adopted some kind of , which authorizes pharmacists to dispense naloxone immediately to someone even without an individual prescription.

For some consumers, purchasing naloxone via prescription could remain cheaper than buying it over the counter. Many private health insurers — and public programs like Medicaid and Medicare — cover the cost of these prescription sales.

State officials in Pennsylvania, New Jersey, and Delaware confirmed to NPR and Ä¢¹½Ó°Ôº Health News that their Medicaid programs, which offer health insurance to people with low incomes, will cover the cost of the new Narcan spray if a pharmacist puts the order through as a prescription.

In California, a bill is headed to Democratic Gov. Gavin Newsom’s desk that — both public and private — to cover most of the cost of naloxone, and other FDA-approved opioid-overdose reversal drugs, in the nation’s most populous state. The bill would allow insurance plans to charge a maximum copay of $10 per package, and it would sunset in five years.

Aronowitz predicted that if cost deters people from buying over-the-counter Narcan, it will fall upon nonprofit organizations and so-called harm reduction programs, which already distribute naloxone for free, to continue efforts to distribute it to a larger population of people.

Health Departments Try to Do More

In Los Angeles County, health officials have launched a unique push to get Narcan into the hands of an overlooked demographic when it comes to the overdose epidemic: Latino immigrants.

The rate of fentanyl deaths among Latinos in L.A. County , according to the county Department of Public Health.

In 2016, 25 Latino residents died of fentanyl overdoses. By 2021, 551 Latinos had died. It’s unknown how many of those people were immigrants because country of origin isn’t a required data point in overdose reported data. Still, county health officials are proactively reaching out to immigrant communities with their harm reduction efforts.

While Mexico doesn’t report an opioid use epidemic as the one in the U.S., overdoses in that country are increasing — — and there’s a growing need for Narcan.

In Los Angeles, Martha Hernandez, a county community health worker, makes frequent visits to local consulates for Spanish-speaking nations, where she gives short, sharp demonstrations tailored to her audience, instructing them on how to effectively use Narcan.

“I go to five Latin consulates,” Hernandez explained during a recent visit to the city’s Mexican consulate near MacArthur Park. “I use myself as an example. A lot of us go to our hometown, Tijuana is the closest one, and we go and get medication, especially painkillers. [I tell them] ‘a lot of them have fentanyl in the medications’ and you’ll see their wide-open eyes, like ‘Whoa, that is true.’”

Narcan is , so immigrants are unlikely to know much about it. But in the U.S., Narcan’s new availability without a prescription, along with the ongoing surge in overdoses, has made consulates a new priority for enhanced outreach and training.

One common misconception Hernandez runs into surrounds Narcan’s packaging, which says “nasal spray” in large letters on the box.

“People do mistake the fact that it’s nasal [spray]; they think it’s for allergies,” she said. “That’s where you see the necessity of educating our community because a lot of people will say, ‘Oh I need it, I have allergies.’”

A Captive Audience

The main room of the Mexican consulate in L.A. feels like the lobby of a department of motor vehicles, with long waits amid rows of hard plastic chairs. On a recent morning, about 30 people sat waiting for their new Mexican passports or ID cards.

Hernandez walked in front of the assembled group, holding brightly colored public health brochures above her head.

“Simple words, colorful brochures, nice and easy. The way you approach them is the key to getting your message across,” she said.

She told the captive audience they’ll learn how to save someone from dying of an opioid overdose.

Hernandez told them Narcan is not a substitute for medical care, but it can quickly prevent an overdose from becoming fatal. And it’s so easy to use that the training can take as little as 10 minutes, she said.

It’s not always clear if someone is experiencing an overdose, but Hernandez told the group that they should still call 911 and administer Narcan.

“I tell them, ‘If I saw my mom on the floor, I would administer Narcan,’” Hernandez said. “Why? Because my mom will go to her sister’s house and say, ‘My neck …’ or ‘My knee hurts,’ and her sister will pop out a pain medicine [that she has]. A lot of us, being Latinos, will pop it into our mouth. How do I know what she put in her mouth?”

Fake prescription pills are , especially in Western states. The share of overdose deaths involving counterfeit pills more than doubled comparing a three-month period in 2019 to the last quarter of 2021, and the percentage more than tripled in Western states, according to a from the CDC.

The report found those who died from overdoses with evidence of counterfeit pill use, compared with those without it, were more often younger, Hispanic, and had misused prescription drugs in the past.

Jose Magaña Lozano, 67, works in cement construction in L.A. and has lived in the U.S. for 30 years.

“I’ve only seen opioid overdoses on TV,” he said in Spanish. “Hopefully I never have to witness an overdose happen, but if in case I do see it happen, at least you know what to do, and at the very least you can help a little.”

But for younger generations who went to high school in the U.S., and who grew up during the raging opioid epidemic, the problem is all too familiar.

“I’ve actually learned it [Narcan] in high school because you’d be surprised, lots of people were doing drugs and overdosing,” said Luis Armas Ramirez, who was part of the group at the Mexican consulate in L.A.

“Latinos, we don’t really take it seriously like that, especially because it’s something very private,” he said.

Armas was excited to receive a free box of Narcan while waiting for his travel documents.

“[Narcan] is, like, crazy expensive. I believe that things happen for a reason, so if I’m seeing it [Narcan] now, God’s timing is never wrong, I may see an overdose next week, you never know,” he said.

Hernandez gave three demonstrations at the Mexican consulate and gave out a total of 45 boxes of Narcan. The next day, she headed over to the Guatemalan consulate to teach more immigrants about the increased danger of opioid overdoses in America, and how they might help.

Gillian Moran-Pérez contributed Spanish translation assistance to this report.

This article is from a partnership that includes , , , and Ä¢¹½Ó°Ôº Health News.

Ä¢¹½Ó°Ôº Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ä¢¹½Ó°Ôºâ€”an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).