Will arming citizens with Narcan work?

By William Mackenzie,

Sometimes it seems like we’ve taken leave of our senses.

Narcan, the Opioid overdose-reversal drug, arrived at many Portland area stores this week, no prescription necessary.

One thing that caught my attention in media coverage of Narcan’s expanded availability was the observation that there are concerns about Narcan’s affordability for addicts. It would seem to me that if an addict can afford Opioids, surely he can afford Narcan. But that, of course, leads to another question. If an addict buys Narcan, would he administer it to himself in case of an overdose? Not likely, I’d think.

All this makes about as much sense as Multnomah County’s decision in July to distribute tinfoil, straws, glass pipes and “snorting kits” to addicts around Portland.

Fortunately, the county backtracked and suspended the initiative three days after Willamette Week disclosed the poorly thought-out plan.

“Our health department went forward with this proposal without proper implementation protocols,” said County Chair Jessica Vega Pederson. “And in that light, I am suspending the program pending further analysis.”

Meanwhile, the City of Portland has left in place, and is expanding, its “safe rest villages”.

The seven Safe Rest Villages scattered around the city offer a host of services, including laundry, showers, flush toilets garbage recycling, first aid and medical care.

But is ”rest” really what all the homeless moving into these villages need? Drive, walk or cycle around Portland day or night and you’ll encounter camps filled with people who are “resting” and when they aren’t resting too many are looking for or using drugs, breaking into cars, and stealing stuff, all sorts of stuff.

Portland Police recently recovered a steel drum, a saxophone, tattoo equipment, more than $10,000 worth of LED lighting and even a stolen litter of 3-week-old puppies from a homeless camp. In another police action in the Big Four Corners Natural Area, cleanup crews pulled out more than 150 stolen cars, tons of trash, and even some live pigs.

The problem is that while millions of dollars are being spent on these villages, residents can access all their services with no quid pro quo, in other words, without doing anything in return. A resident can literally do nothing all day and night but stew in his or her despair. What the villages don’t offer or require is meaningful work.

Wouldn’t it make more sense to organize teams of Village Rest residents to get out and paint over the graffiti that’s defacing surfaces all over the city.? Or pick up the proliferating trash and needles? Or clean up abandoned waterside campsites?

Then there’s the suggestion that adults in Oregon request a prescription for Narcan on their next visit to a pharmacy or primary care doctor, so they can rescue people who have overdosed.

The Oregonian recently ran a story about an addiction medicine nurse and a mother of two young adults who keeps a dose of Narcan in the glove compartment of her car, another in her backpack and a third dose on top of her dresser at home.

“My kids know how to use it and they know where it is,” she said. “Honestly, if you live in Portland, Oregon, you don’t know when you might be someone who comes across someone who is overdosing.”

I can see wanting to protect your children or friends, but, honestly, how realistic is it to expect an army of do-gooders carrying Narcan in their pockets and purses to intervene when they encounter a random person splayed out on a Portland sidewalk or in a tarp-covered tent? Is this really the answer to the plague of Opioids? Frankly, I even hesitate to tell somebody their smoking is bothering me.

And are well-meaning Oregonians prepared for the reactions of those administered Naloxone? Emergency workers say the reactions of overdose victims are frequently hostile.

A manuscript published by the National Library of Medicine reviewing research on Opioid overdose reversals using naloxone in New York City noted that the most reported reversal outcome included a wide range of angry, hostile and/or aggressive outbursts by the overdosed person following their return to consciousness.

One study presented sociological work that focused on violence arising from naloxone administration. The authors remarked that such aggression ‘”…tends to receive a passing mention rather than close attention by social scientists.”

And now comes word that Portland’s flailing Mayor, Ted Wheeler, wants to bring in a San Francisco-based nonprofit, Urban Alchemy, that hires formerly incarcerated convicts to patrol troubled areas to address street-level issues rooted in addiction, mental illness and homelessness. The plan is for Urban Alchemy to deploy outreach patrols in the city center where Portland police has struggled to maintain patrols.

“We want to make sure that that presence, the things we need in place to keep downtown Portland on the path to recovery, is there 24/7,” said Jon Isaacs, the Portland Metro Chamber’s assistant director for public affairs.

It’s reminiscent of Curtis Sliwa’s Guardian Angles, formed in the 1970s to patrol New York’s subways and streets combat crime and violence in the city. The group, unarmed, but trained in karate and prepared to make citizens’ arrests , drew strong public reactions, positive and negative. ” The New Yorker described the group as “… a civilian crime-watch group whose recruits became street icons for patrolling scuzzy subway cars, intimidating chain snatchers, making the occasional citizen’s arrest, and irritating the police.”

What are the chances Urban Alchemy will be another ill-advised fiasco for Portland?

It’s a weird world out there.