L.A. Adds Oxygen to its Anti-Overdose Arsenal

Who would’ve thunk that oxygen would arise as the be-all to end-all overdoses? Certainly not the wielders of naloxone (aka Narcan), who’ve seen the miracle drug reverse opioid overdoses with nearly unfailing results. And certainly not the addicts, who, quite frankly, are far too gone by this point to think anything. Heck, it’s doubtful anyone but our ace first responders fully figured out that oxygen could both help mitigate opioid overdoses and help mitigate the overdose effects of drugs other than opioids.

Then again, since oxygen is humankind’s most basic essence, it makes perfect sense that it would be so essential to life.

And in keeping people alive.

That’s what the good folks at Homeless Health Care Los Angeles (HHCLA) have discovered. It’s also why they’ve taken what they’ve learned to the streets of Downtown L.A.

They’re called overdose response teams, and right now they’re currently concentrated on L.A.’s notorious Skid Row. How do we know? Because reporter Emily Alpert Reyes hit the streets with HHCLA, then wrote all about it for the Los Angeles Times.

Homeless Healthcare Care’s Simon Angel Melendrez and Aurora Morales served as Reyes’ guides. And most useful they were too. No, not so much because Skid Row is all that dangerous (though it can be a bit more than iffy), but because it took the highly-trained HHCLA team to identify the numerous overdose victims from among the more numerous bodies peppering the streets.

Then came the subsequent attending to. The Skid Row teams “are armed not only with naloxone,” notes Reyes, “but also [with] cylinders of lifesaving oxygen.” Why? Two reasons. First, because “it can take minutes for someone to start breathing again” while Narcan takes effect. And second, because “many overdoses also involve more than one drug, including non-opioids such as xylazine (tranq) which do not respond to naloxone.”

“This is the cutting edge of overdose response,” said Shoshanna Scholar, director of the harm reduction division at the L.A. County Department of Health Services.

Oxygen

Wiki says “oxygen is Earth’s most abundant element. Wiki also says that after hydrogen and helium, it is the third-most abundant element in the universe.” In other words, oxygen doesn’t just permeate peoples’ places; it permeates places where people probably will never ever even go. If they do though, you can bet they’ll be tethered to oxygen.

Oxygen has a shady history. Its discovery belongs either to Swedish pharmacist Carl Wilhelm Scheele, who “produced oxygen gas by heating mercuric oxide and various nitrates in 1771–72”; British clergyman Joseph Priestley, who “focused sunlight on mercuric oxide and liberated a gas he named ‘dephlogisticated air’” in 1774; or French chemist Antoine Laurent Lavoisier, who later claimed to have discovered the new substance independently. It should be noted however that Lavoisier had been told of oxygen’s discovery first in a visit by Priestly and then, quite probably, via a letter from Scheele. Yes, the Frenchman denied ever receiving the letter, yet a copy was found among Scheele’s belongings after his death.

It should also be noted that Polish alchemist, philosopher, and physician Michael Sendivogius (aka Michał Sędziwój) described a substance contained in air and wrote all about it in his 1604 work Twelve Treatises on the Philosopher’s Stone drawn from the source of nature and manual experience. Sendivogius referred to this substance as ‘cibus vitae’ (‘food of life’). And Wiki says Polish historian Roman Bugaj later claimed it was identical with oxygen.

As for the name though, well, that credit goes to Lavoisier, who changed ‘vital air’ to oxygène in 1777. Lavoisier’s tag comes from the Greek oxys (acid, literally “sharp”, from the taste of acids) and -genēs (producer, literally begetter), “because he mistakenly believed that oxygen was a constituent of all acids.” This was wrong. And a throng of British scientists said so too. Those Brits also believed Priestly had beaten Lavoisier to the proverbial punch. By then though “oxygen” had already wormed its way into day-to-day usage.

We should add that much of that worming can be attributed to Charles Darwin’s grandfather Erasmus Darwin, whose poem “Oxygen” appeared in a very popular book called The Botanic Garden (1791).

Who did what when and where vis-a-vis oxygen is probably much less important than the fact that “most living things need oxygen to survive.”

“Oxygen helps organisms grow, reproduce, and turn food into energy,” says the American Museum of Natural History. “It gives our cells the ability to break down food in order to get the energy we need to survive.”

Oxygen and Overdoses

It’s impossible to say how many lives have been saved by naloxone (Narcan or otherwise). Heck, even a best estimate would come glaringly short of the mark. In the first place, very few agencies keep track of how many times they’ve had to employ the overdose-reversing drug. In the second, very few addicts have been saved only once or twice. Most hardcore addicts have had Narcan administered to them a half dozen times or so. If those addicts live on the streets, well, that number could easily double.

Yet as miraculously effective as Narcan happens to be, the miracle drug isn’t infallible. Often it needs to be deployed two or three times in order to reverse an overdose. Sometimes not even multiple doses will do. Not because the user has ingested too heavy a jolt of opioids, but because they’ve ingested xylazine or some other drug that an opioid agonist like Narcan can’t reverse. With tranq being mixed in with more and more fentanyl, those instances are rising higher by the day.

That’s where oxygen comes in.

Opioid Overdose

Kailin See, senior director of programs at OnPoint NYC, told the L.A. Times that “an opioid overdose is fundamentally ‘a slow cessation of breath,’ so it makes sense that really your No. 1 tool should be oxygen.”

See should know. Not only has OnPoint NYC been deploying oxygen among its any harm reduction efforts, but they’re the ones who tipped HHCLA to the practice. OnPoint then helped Homeless Health Care get properly situated to serve the teaming streets of L.A.

That includes copious training. “The Homeless Health Care teams undergo 16 hours of initial training and run regular eight-hour drills to keep up their skills,” said Darren Willett, director of the nonprofit’s Center for Harm Reduction.

It’s that training, and the teams’ capacity for all-around support, that has helped change the game.

“The idea is that with oxygen and support, you might not actually need to reverse an overdose at all,” said Dr. Brian Hurley, medical director of the substance abuse prevention and control division at the L.A. County Department of Public Health.

Indeed, “preventing someone from ever losing consciousness with oxygen, in turn, means they can avoid having to turn to naloxone, which can hurl people into a painful withdrawal.”

“That pain can spur people to take more drugs to alleviate it, which exacerbates the risk of them sliding back into an overdose when the naloxone wears off,” See told Reyes. “Because opioids can linger in the body longer than naloxone, people are supposed to be monitored for hours after getting the medication.”

That of course isn’t always possible. It also doesn’t mean naloxone isn’t still the first go-to.

“The Skid Row teams default to using naloxone when they find someone who isn’t breathing,” writes Reyes. “But keeping oxygen flowing as they do so has helped them stabilize people faster and see quicker results — such as color coming back to the face — as the medicine takes effect.”

Healing Properties Chimes in on Harm Reduction

Healing Properties first covered the work of OnPoint NYC back in April when we cited their overdose prevention centers. We actually did a lot more than cite OnPoint’s groundbreaking efforts, which include safe consumption sites; we also included a nice slice of Kate Knibbs’ WIRED interview with OnPoint Director Sam Rivera. We also made sure to mention Beautiful Boy author David Sheff’s New York Times piece that told of OnPoint staff reversing at least 700 overdoses over the previous 12 months.

While everyone from local NIMBY’s to the Federal Government is arguing against OnPoint’s safe consumption sites, they forget to add that its programs also include case management, mental health services, low-threshold medical services, as well as hepatitis and HIV testing and treatment. Add its overdose-reversing and oxygen implementation programs to the mix and you’ve proof the organization has the wherewithal to determine how best to treat the streets. In fact, we believe they should be recognized as the Gold Standard in street level addiction treatment.

OnPoint NYC has most certainly become the Gold Standard in saving lives before the street gobbles them up. So have the good folks at Homeless Health Care. And both should be cited accordingly.

As we said back in April, addicts can’t find recovery if they are dead. And if it takes a few extra efforts to keep them alive, well, what’s the harm?

In other words, we don’t see the harm in harm reduction.

Harm Reduction

And HHCLA’s efforts represent harm reduction at its most vital. If anything, they’re pushing it to the next level. After all, the Skid Row team isn’t just saving lives; it’s diminishing the harm overdoses bring to those saved lives. And consequently ensuring there’s still a vibrant life to go back to.

As for what happens after a street team intervenes, well, that’s the proverbial million dollar question. A question that would forever hang in the air without someone there to answer.

What do you think? Are you behind the efforts of Homeless Healthcare Los Angeles? How about OnPoint NYC? Do you think overdose prevention has its limits? Or do you believe harm reduction should go as far as necessary to save someone’s life? If you leave your thoughts in the Comments, we’ll gratefully respond.

In the meantime, if you or a loved one is battling drugs and/or alcohol, opioids or otherwise, please give us a ring. We’d be honored to help get you over the hump and well on your way to recovery. If you or yours has ever suffered an opioid overdose, we’d like to help make sure it never happens again. If you or your has thus far been spared the scare of such an incident, we want to help keep it that way. Because not even a double-dose of Narcan and oxygen can guarantee a wholly positive outcome. So why risk it?

Skid Row Mural Photo courtesy Wikimedia Commons; resized via ImageResizer