Charlie Interview

I would choose death over Naloxone
–Charlie

Key Findings

Based on Charlie’s experience as an addict and serving the population, he does not think addicts would use or want the device, they are against naloxone
Savage Sisters would need a new funding source as currently Naloxone is free from the State
When asking about Xylazine prevalence in dope, Charlie said naloxone is “helpful” but stressed O2 as the new standard of care

Savage Sisters Background

Savage Sisters focusing on Harm Reduction in the Kensington neighborhood of Philadelphia. The organization works with people coming out of jail needing housing for recovery, as well as unhoused people who are given showers, clothes, wound care, and snacks often through the use of custom outfitted Sprinter vans. They see 60-80 people a day in their drop-in services.

On a larger scale, Savage Sisters tours around the country speaking about Harm Reduction and Educating the public about the epidemic.

Charlie’s Biggest Issue: Unhoused Forced into Jail or Rehab

Charlie primarily works on wound care for the unhoused. He also performs several OD reversals a week using IM naloxone. He was an unhoused user of fentanyl in Arizona before this job and has a deep knowledge of the population. His primary concern is that the city is making homelessness more and more illegal and as a consequence, the population he works with are being forced towards rehab or jail.

Funding for the Device Seems Hard

Naloxone is free from the state, so Savage Sisters would have to find funding for the device. The majority of users do have Medicaid, but don’t have IDs, so in order to have devices paid for by Medicaid, people would have to first get an ID, then register for Medicaid, and then go to a pharmacy to pick up the device. Considering most people in this state struggle to hold on to personal possessions and follow plans, this seems highly unlikely.

Charlie Thinks there are Two Groups at High-Risk of Overdosing

Charlie sees many people coming out of jail in his work. He thinks the time in jail and not using creates a very risky situation where tolerance is low and the dope on the street is more powerful than when they went in.

He also sees people being released from rehab as a high-risk population, but he seconded the comment from my Meaghann Interview, that rehab centers don’t want to track OD numbers.

The greatest current risk in overdosing is the increased use of Xylazine in the dope found in the neighborhood and it’s resistance to naloxone. Because of that, the new standard of care in Harm Reduction is O2, with naloxone being seen as still helpful but not the foolproof solution it once was.

Charlie is Skeptical of the Device

He can only speak from his personal experience, but stated that when he was using, he would rather die than have someone administer naloxone to him. The withdrawal is extremely painful and death was not his primary concern. He would imagine that some portion of the population he works with would feel the same. He also mentioned that getting phones is easy and holding on to phones is extremely difficult. He thinks less than 10 percent of the people he works with have access to a charged phone consistently. In Arizona, where Charlie is from, it was easy to hold on to phones, but in Philadelphia robbery of the unhoused is extremely common.

In addition to lack of access to phones, Charlie doesn’t think people in his community would want to wear the device, the device would need to be able to administer multiple doses of naloxone, and Savage Sisters would need to find additional funding, or would have to get IDs for all the unhoused wanting to use the device. But the biggest issue is that most people are against naloxone.

He is always optimistic about new solutions to help the population, so Savage Sisters would be willing to pilot a free program.

Links here

Developing an Opioid Sense and Alert Device Dove is a little box that sticks to your arm with replaceable adhesive patches. It monitors your SPO2, heart rate, and movement. When the device