By Lynn Arditi
Published June 6, 2015
CENTRAL FALLS — Down the block from a convenience store, the doors of a yellow van slide open and a team of outreach workers spills onto the sidewalk.
Keith Thompson, red baseball cap cocked to the side, works the block like a salesman chatting up customers. He can spot a heroin addict: Glassy eyes. Swollen hands. Skin sores.
A middle-age man leaves the store and Thompson moves in.
Thompson reaches into a paper bag and pulls out the “bait” wrapped in shiny foil. The free condoms make the younger guys laugh, but almost nobody turns them down. And it fills precious seconds while Thompson waves over his co-worker for the harder sell: naloxone. The medication, known by its brand name Narcan, is an injection or nasal spray that can resuscitate people who overdose on opiates.
Thompson, a veteran HIV/AIDS prevention worker with Aids Care Ocean State, is part of a grassroots effort to reduce the number of overdose deaths in Rhode Island, where the estimated per capita rate of fatal opioid overdoses is now 20.4 percent — more than twice the national average in 2013 and higher than neighboring Massachusetts and Connecticut.
The street-level outreach is a test-run for a community distribution effort led by PONI — Preventing Overdose and Naloxone Intervention — which has given away over 1,900 doses of naloxone in Rhode Island since the start of 2014. That’s about 70 percent of all the naloxone dispensed during that period by area hospitals, residential treatment programs, pharmacies and the state prison combined, according to the most recent available data.
The PONI program is rooted in a harm-reduction approach, such as the one Rhode Island adopted 20 years ago to combat the spread of HIV/AIDS. Back then, the Health Department’s needle-exchange program — along with passage of a state law that decriminalized possession of syringes and allowed their over-the-counter sale — reduced cases of HIV/AIDS associated with intravenous drug users from 40 percent in the mid-1990s to less than one percent today.
“We practically eradicated new cases of HIV because of injection drug use,’’ said Michelle McKenzie, a senior project director at The Miriam Hospital and a co-founder of PONI. “It was truly dramatic. It was a public health intervention that was hugely successful.”
The needle-exchange, McKenzie and her colleagues say, serves as a model for the lives that could be saved if enough resources are devoted to naloxone intervention.
“Every backpack, every glove compartment, every medicine cabinet should have naloxone,’’ said Dr. Josiah D. “Jody” Rich, an infectious disease specialist at The Miriam Hospital who worked to legalize needle exchanges. “It’s sort of like vaccinating around a disease outbreak. … Whenever there’s an outbreak you vaccinate around the entire village.”
The AIDS Care Ocean State outreach workers walk the streets every weekday, giving away condoms and sterile needles. But naloxone remains a scarce commodity; the state grant that finances this outreach specifically prohibits the organization from using its money to buy the medication, so it relies on PONI for their supply.
On this April morning, a group of nine health workers fans out across this one-square-mile city where state health officials say eight people died in 2014 from accidental drug overdoses.
There is Jonathan Goyer, a 27-year-old street outreach worker from the nonprofit Project Webber, who organized the event. Goyer has been handing out naloxone kits ever since he was saved by a friend, who administered nalaxone when Goyer overdosed in 2013 .
And there’s Raynald Joseph, 32, prevention supervisor for AIDS Care, who carries a yellow LL Bean backpack with 10 naloxone kits donated by PONI. He hurries over to Thompson and his “customer” and pulls out his clipboard with three printed pages: a medical history form, an instruction form and a service agreement.
“We want to make sure you don’t use alone, and don’t mix drugs,’’ Joseph says, going down the list.
“Do you know rescue breathing?”
During an opioid overdose, heart rate and breathing slow down — sometimes to a stop — which is why rescue breathing, also known as mouth-to-mouth resuscitation, is critical.
“Yeah,” the man replies.
Joseph runs through a checklist — recognizing the signs of an overdose, the best injection sites, the rescue position shown in one of the instructional diagrams — and a dozen or so questions listed on the intake form about drug-use history. It takes about 20 minutes before he presents the donated Walgreens medicine bottle containing two doses of injection naloxone provided by the PONI program.
“If you have any questions,’’ he said, “just call these numbers.”
“Thank you,” the man replies.
Another outreach worker offers, “You want help quitting?”
“No,” the man says, shaking his head and walks off.
That response doesn’t surprise Thompson, who is 55 and has been doing prevention outreach work since the early 1990s.
“We’re not substance abuse counselors,” he says. “It’s not about saving everybody, because everybody don’t want to be saved.”
They head down Broad Street to a busy grocery store with a sign in the window that reads “We Accept Food Stamps.”
It’s the first of the month, payday for residents on the federal Supplemental Nutrition Assistance Program, formerly known as food stamps. The timing of this effort is no accident. The first of the month is when people have money to buy groceries — and drugs.
Outside the store, a man tries to sell food stamps to customers for cash. The outreach workers approach and he turns away, but his friend, with sunken eyes and swollen hands, asks Chris Cotham, a recovery coach from Anchor Recovery Community Center, about getting on methadone. The man is given a package of clean needles, naloxone and phone numbers to call.
“Come down to Anchor,’’ Cotham says, “and ask for Chris.”
On Dexter Street, Thompson scans for more customers, darting back and forth across the street like a human ping-pong ball. When his coworkers catch up, he’s talking about overdose prevention to a woman who looks to be in her 20s, rail thin, with sores on her cheek and swollen hands.
“Yeah, I had to do it the other night,” she says. “She was going out fast …”
She didn’t have any naloxone, but she performed rescue breathing.
“Did you call 911?”
Joseph catches up to them and pulls out his clipboard.
On Twitter: @LynnArditi