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And Ohio is far behind the curve and just responding to the staggering numbers – the fact that there's an increase in white, middle-class suburban users can easily be seen as a prod for action. There are already 188 programs nationwide to distribute naloxone, some with unfettered easy access, others with slight hoops to jump over. The point, however, is that from Boston to Chicago and D.C. to New York, cities have responded to the heroin and opiate epidemic through intertwined tentacles of education and prevention, treatment and law enforcement, and also accessible naloxone.
With 161 ruled cases of heroin-related deaths in Cuyahoga County in 2012, 72 of which occurred in the suburbs, there's been a delayed call to action that resulted in D.A.W.N.
"There was a meeting not too long ago where the FDA basically said they wouldn't mind a prescription medication of nasal naloxone," says Papp. "But we have to get a pharmaceutical company to do that, and there are only two companies in the United States that manufacture naloxone. There's someone working on it now, and hopefully sometime in the next year or two, it'll be on the market. But it has to wind its way through the FDA."
On this Friday morning in April, one user, an older black gentleman with a cane, a jean jacket and glasses, comes through the Free Clinic just after it opens. He'll watch a short DVD about the medicine and its administration. He'll receive two vials, as well as a packet of information. He declines to be interviewed for this story, though as with most addicts and users
Scene encountered over the course of this article, that's not a strange request. All that matters is that he showed up.
Brett, another recipient of naloxone who is a former addict of both Oxycontin and heroin, is forthright in his habit and desire to spread the word to his fellow users, though he's been clean for months now.
He started when he was 24, a nurse's aide out west in Elyria. He'd developed a back problem – softball-sized knots beleaguered his daily activities – and the pain grew too much to bear. His girlfriend's best friend was over his house one day; he was flat on the floor. An offer of Oxycontin arrived. Take a quarter of a 40-mg tablet, she said. It'll take away all your physical pain.
It did more than that.
"After 30 minutes, I felt nothing," says Brett, wearing a Tribe jersey and hat, tattoos covering his arms. "Then I felt like I was going to throw up, just sweating profusely. So, I took a shower. Just after that, I felt perfectly fine, like I was floating. Those drugs, they take away all your physical and mental pain."
He began to take Oxys supplied by friends and bought off the street. Soon, a habit formed. He lost his son, he lost his job, he started dealing and stealing to support his habit.
"I would steal candy from the dollar stores," he says. "And then go resell it to the convenient stores around town. I had a $450 a day habit. There would be times when I would be walking around in the dead of winter in shorts and a t-shirt. It's a full body orgasm."
Like so many pill users, Brett soon turned to heroin – it was cheaper and more readily available.
"Pills got to be a pain in the ass to find," he says. "Especially after they changed the formulations."
He overdosed five times alone in 2011. And like so many users and addicts, he used with friends, and has witnessed his fair share of overdoses and the ineffective ways in which users try to solve the problem. In fear of law enforcement, many don't call 911 or take ODers to the hospital. Instead, they throw them in a cold shower, toss ice on them, or give them a dose of Suboxone, an opioid withdrawal drug that contains a small bit of naloxone.
His best friend died in his arms two years ago. The Sunday before he talked with Scene, he attended a friend's funeral; he had another the Sunday after, both from heroin overdoses, and the latter of which was a friend whom he introduced to the drug.
"I remember the first time I got sick on the pills," he says. "I told my friend I couldn't come out because I was throwing up, I said I know when I have the flu. He asked if I had any pills around. I told him I had an 80 mg in the bedroom. He said take a quarter and call me back in half an hour. It only took 15 minutes. I called him back and I felt perfect."
"I've been clean eight months now after I fucked up briefly last year," he continues. "But I put a message out on my Facebook that I have this drug, just so people know I have it. It's a life saver."
"Thank God Dr. Papp had the fucking balls to do this," says Roger Lowe, the other half of the Free Clinic's needle exchange van team, along with Chico Lewis. Lowe's been on the crew for five years.
Like Chico, Lowe is a former user himself – first joint at the age of 8, just about every drug known to man until he was 22, clean for 18 years now – and can identify with the clientele.
"I didn't do heroin," he says, a low-slung hat over his reddish brown hair, looking very much like the musician that he is when he's not manning the white van on the west side in the mornings and the east side in the afternoons, Monday through Friday. "It was taboo: you're going to die if you do this. It wasn't that accessible."
Lowe's mom died of a heroin overdose two years ago; she, however, wasn't even a heroin addict. She started doing it after getting into pills.
On the streets five days a week, Lowe and Chico know just about every user in Cleveland on a first name basis. They know who disappears – "We maintain an informal death registry of sorts," he says. "Someone will ask about a guy, and we might be able to tell them, 'Yeah, we saw him,' or, 'You probably won't see him again." – and they provide HIV and hepatitis testing, as well as direct users to treatment facilities and social outreach programs.
Needle exchanges are illegal in Ohio – why and how is a whole other conversation – but cities can grant emergency actions, which is how the Free Clinic's program, the only legal needle exchange, began in Cleveland after Mayor Michael White declared an AIDS emergency in 1995. Still, it's a one-to-one exchange – bring a dirty needle, get a clean needle – and they can't work with minors or outside of Cleveland.
"If I had my way, and I've testified in Columbus on this, you know how you see food trucks going down the street?" he says. "You'd see my needle van following right behind. It works. We have people wanting us to go to Parma and we just can't."
Chico and Lowe have seen first-hand how the heroin epidemic has changed over the years, and they have endless stories to tell. There's the one about the former suburban high school football player who came to the van. They asked what the hell he was doing there. "I got hooked on painkillers, and when they ran out, I started using heroin," he told them.