A Time-Out for Death

By Neville Elder 10/20/14
Free Narcan kits give hope to parents in Staten Island OD epidemic.
Millie Shea Neville Elder

I’m sitting with 50 people in the brand new teaching auditorium at Staten Island University Hospital (SIUH) on Staten Island, the somewhat overlooked and disparaged borough of New York City that The New York Times calls heroin’s new hometown.

During the lecture Dr Kirane told us that everyone should carry an OD kit; so dire is the epidemic of overdoses in Staten Island.

From where we sit another 50 people stare back at us watching from the huge screen behind the lectern on the stage. We’re connected by video. The embarrassment of looking at each other is perhaps defused by the idea that we’re looking into a mirror. Everyone in these rooms has at some point come into contact with an addict and many have witnessed an overdose [OD] from opioids or opiates. Opioids are prescription synthetic pain relievers based on morphine. Opiates are products, like heroin, derived from the morphine poppy. Most people use the term 'opiate' to refer to both types of narcotic. Of those present, some are professional first responders—EMTs, cops, nurses, some medical students. The rest are family members of addicts desperate to regain some control in their lives.

We are all here to learn about Naloxone, the miracle anti-OD drug being handed out to anyone that wants it by New York City’s Department of Heath and Mental Hygiene (NYCDOH). If applied to a victim during overdose it will relieve the effects of opiates before they kick in again 45 minutes later, possibly returning the victim to an OD state once again. But that small window of time is enough to summon the emergency services. It’s a time-out from death.

During the instruction—which lasts an hour—Dr. Harshai Kirane, the director of addiction at Staten Island Hospital, shows a video of how to spot the symptoms of overdose and how to apply Narcan, the brand name for Naloxone. An overdose caused by an opiate is characterized by shallow breathing, lips and fingers appearing gray and, of course, a loss of consciousness. His instructions are very clear: the first thing you do is call 911, then if the subject isn’t breathing, give mouth-to-mouth resuscitation and apply the Narcan. The drug is only useful in an opiate OD and would not harm someone who is not having an overdose.

With the kit the DOH gives away there are two doses of Narcan in a small blue bag with a nasal spray or a syringe shot. The kit also includes surgical gloves and rescue breathing mask. The shot doesn’t have to be given intravenously, a single puncture in the shoulder with the syringe and the drug will enter the bloodstream immediately and reverse the effects of the opioids. A blast of spray up each nostril from the atomizer will do the same job. It’s a simple and non-invasive action that anyone can perform.

During the lecture Dr Kirane told us that everyone should carry an OD kit; so dire is the epidemic of overdoses in Staten Island.

I sat behind Millie Shea, a 66-year-old grandmother who grew up in New Dorp on Staten Island’s south-side. When I asked her why she was here she told me:

“For my children.”

Millie has direct experience with overdose. Her daughter was 13 when she started using drugs. She’s 30 now and has spent the better part of 10 years struggling to stay clean. Millie clearly remembers a day five years ago when she came home to find her daughter collapsed on the kitchen floor.

“Everything had fallen down on her. I called 911. What had happened was..they gave her methadone and Suboxone [to get her off Heroin] and what she had done was take heroin [on top of the] methadone and Suboxone. I don’t know how she survived - I thought she was dead.”

In 2006, New York State (NYS) introduced the ‘Opioid Prevention Act’ allowing the NYCDOH to distribute 50,000 Naloxone OD kits. According to Dr. Hillary Kunins, an Assistant Commissioner at the NYDOH, these kits, which include two doses of the intra-nasal form of Narcan, were given to community groups and targeted those at risk of OD and their families "including active drug users in a position to observe overdoses themselves.”  

Dr. Kunins told me Staten Island has been the focus of an aggressive campaign by the DOH to combat an overdose rate four times higher than any NYC borough. Dr Kunins is the Director of Bureau of Alcohol and Drug Use Prevention Care at the NYDOH. 

“We noticed a few things..about SI, that rates of prescribing opioids..was higher than other boroughs and for that reason one of the initiatives was to disseminate what we call safe and judicious prescribing guidelines by going door-to-door to more than 1,000 prescribers to discuss our guidelines with them.”

Dr. Kunins believes that sensible prescription practices and raising awareness of the potential risk of overdose coupled with the Narcan program will help reverse a disturbing nationwide trend—skyrocketing OD deaths due to both heroin and prescription opioid abuse.

Recently released data shows a decrease in OD’s in 2013, though it still remains remarkably high.

Millie Shea’s family is riddled with alcohol and drug abuse. The daughter who overdosed (Millie asked me not to use her name) started off by using ecstasy and marijuana. 

“She would disappear on weekends and she wasn’t showing up at school—I knew she had a problem. I have four children and she’s my youngest, her brother had meningitis four times—we were really involved with getting him healthy. [I think] she got lost in the shuffle."

By the age of 20 she’d moved on to prescription pills.

“She was nodding out, you could see in her eyes—It was pills. They’d [her daughter and friends] take and try anything. I was really horrified. We took her to the hospital, put her in rehab but unless she wanted [to get clean] it wasn't going to work. There was so much going on, my son was sick, my eldest was an alcoholic, and my husband was an alcoholic since the womb! Big history.”

Millie received little help in coping with an addict in the family.

“[My daughter] had a little girl—I raised her. And I was forced by the school system to learn about drug addiction. I went to the YMCA. There was a program called 'little steps,' me and my granddaughter went. I was just flabbergasted because everything I was doing was wrong.

“You know you’re supposed to have tough love and throw them out of the house? I was quite the enabler! Oh, your friend got thrown out? He can stay too. It snowballed; it was a nightmare!

“I threw her out in the height of a blizzard. It was horrible. I called my counselor and they said ‘you can’t take her back.' You have..to make the decision.. Everyone around her was dying; I fully expected to have to bury her.”

Millie felt powerless. There was nothing she could do: she discovered that only her daughter, the addict, was responsible for escaping from the cycle of addiction.

“I realized I had to do something for me..I had to get healthy..and make a new life. I have to help [my] kids that wanted a life get on course, each child needed different stages of tough love, it was quite difficult.”

Narcan has empowered Millie:

“I figured if she would ever come to my house in a bad condition again I would have something available. So [when I heard about] Narcan, I said, this is great! I wish I'd had it at that point," Millie said, referring to when her daughter OD’d in the kitchen.

“I have something that maybe, God forbid if the situation came about....I would know what to do. It awoke in me too that I don't know CPR! After all this! I should! Having gone through Hurricane Sandy..and all this.. You have to know so much now for physical and mental health, you almost have to be a trained doctor to survive in Staten Island! 

“It's up to us. It's survival of the fittest now. [Narcan] gives us the feeling that at least finally there’s something to help the parents. So they can help their children.”

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British born Neville Elder is a writer,photographer and filmmaker. He's been sober since 2006, lived in New York since 2001 and is in no hurry to move back to a Brexited Britain. He writes the odd murder ballad with his band Thee Shambels and teaches photography at the New York Institute of photography. Find him on Linkedin and Twitter.