James Washington has used naloxone to reverse six overdoses in the past six months.
Six times, he has watched the drug stop addicts from dying in parts of the District hit hardest by the city’s growing opioid epidemic.
“It’s a dream, a best-kept secret,” said Washington, who supervises peer educators at Family and Medical Counseling Services in Southeast Washington. “And we don’t have enough.”
Opioid overdose-related deaths in the District have nearly tripled in two years — from 83 in 2014 to 231 in 2016. But advocates say city officials are not providing community health partners enough naloxone to stem the growing epidemic and have not written regulations to make naloxone available in pharmacies without a prescription.
“The city’s actions are not meeting the need, and people are dying,” said Kaitlyn Boecker, policy coordinator at the Drug Policy Alliance, an organization that has sought to roll back the nation’s war on drugs.
The District began providing naloxone kits in October to two community health groups, Family and Medical Counseling Services and HIPS, formerly known as Helping Individual Prostitutes Survive. But leaders at the organizations said the initial supply didn’t come close to meeting demand.
For five or six consecutive months, there wasn’t enough naloxone available at Family and Medical Counseling Services, said Diane Jones, director of special programs and field education.
“We ran out about the second or third week of every month,” Jones said. “The people coming to us knew they were going to overdose or their using partner was going to overdose. But we couldn’t do anything — it was horrible.”
HIPS saw similar shortages, and only since July — when the D.C. Health Department announced it would increase its supply of naloxone — has the group been able to meet demand for the naloxone kits, said Cyndee Clay, executive director of HIPS.
Clay thinks the city should be doing even more.
“We’re not extending into new communities because we’re worried about meeting the current need,” she said. “We know how to fix this. I can’t understand why there is this holdup.”
A bill to make naloxone available in D.C. pharmacies was unanimously passed by the D.C. Council and signed into law in February, but the Health Department hasn’t rolled out regulations that would allow pharmacies to begin selling the drug without a prescription.
“We have not seen any sort of urgency from the Department of Health,” Boecker said. “No one is sure where they are in this process.”
Michael Kharfen, a D.C. official who is in charge of naloxone distribution, said he was not clear on the timing of the regulations. Jasmine Gossett, a spokeswoman for the Health Department, said that the matter is before the Board of Pharmacy and that she could provide no further details.
Council member Vincent C. Gray (D-Ward 7), who chairs the council’s Committee on Health, said he “absolutely” wants to see naloxone available in pharmacies without a prescription. He thinks Mayor Muriel E. Bowser (D) should be doing more to implement the regulations — and quickly.
“There are no easy answers here, but when you have an opportunity to reverse more overdoses, then you should take it,” Gray said.
Neighboring Maryland and Virginia are among six states that have declared state emergencies because of the opioid epidemic and have made naloxone available without a prescription.
The number of deaths in the District, which has a population of 680,000, is smaller than the number of deaths in Maryland and Virginia, which is one reason its epidemic receives less attention, Boecker said.
In 2016, 231 people died from opioid-related overdoses in the District — compared with 1,856 in Maryland and 1,138 in Virginia.
But the opioid overdose rate in the District is higher than the rate in Maryland or Virginia; the District reported approximately 33.9 opioid overdose-related deaths per 100,000 residents in 2016, compared with 13.6 deaths per 100,000 people in Virginia that year. In Maryland, there were 17.4 opioid-overdose related deaths per 100,000 residents in 2015; information for 2016 was not available.
Washington, the supervisor at Family and Medical Counseling Services, is a 64-year-old recovering addict who grew up in the Southeast neighborhood known as “Simple City.” He said the spike in deaths is due to the introduction of fentanyl, a synthetic painkiller, and other additives that are increasingly found in street drugs such as heroin but can be 50 or 100 times more powerful.
Washington and his fellow peer educators, who travel with a nurse, offer information about recovery programs and practical tools — including providing clean needles and naloxone kits.
In neighborhoods from the Potomac Gardens Apartments complex in Southeast to the Southwest neighborhoods near Nationals Park, the epidemic shows no signs of slowing, Washington said.
“As long as someone, somewhere, is getting paid, this fentanyl is going to stay on the streets,” he said.
The majority of recent opioid overdose-related deaths have involved older black men and have taken place in the 5th, 6th, 7th and 8th wards. In 2016, 78 percent of all opioid-related deaths were among African Americans, and 81 percent were among adults ages 40 to 69.
“There are people in our city who may have been using heroin for decades, let me just be frank,” Bowser said at a news conference in July. “The message we’re sending them is that there are different drugs in the supply that you cannot manage, and one dose could kill you.”
Jones described the people most affected by the opioid epidemic as “a lost population” often overlooked by the city.
“It’s not young white kids dying, so there is not this moral outrage pushing D.C. to actually do something,” Clay said. “Poor black men are dying, and there is not the same push. That is really sad.”