“I’m gonna go lie down,” I said, or I think I said, but maybe I said nothing.
I walked into my friend’s bedroom and had trouble focusing my eyes.
And I fell. The bed became a dark cloud, and I sank ― slowly, deeper and deeper. This is what I was looking for. I wanted something more than asleep. I wanted to be comatose. I wanted my brain to stop, to completely stop.
I could stay here forever. The thoughts became dormant. My brain was silent; I was suspended. Occasionally, a sharp but distant sound interrupted the quiet. The sound clawed its way in. It made me aware of how vast this darkness was. Slight, and then bigger, chills slid over me, making me feel uneasy in the still and boundless black.
I was overdosing.
In August of 1998, at 24 years old, during what was one of endless relapses in my 15-year struggle with heroin addiction, I overdosed in my friend’s apartment.
As it became more frequent, I realized that the faraway sound was my friend, who was crying, screaming at me, shaking me. I drifted out of my body and saw her on the bed, practically on top of me, violently trying to get me to wake up.
I jerked my body up.
“What is your problem?” I screamed, my voice incoherent.
“Oh God, Erin, Erin, get up, get up! You weren’t breathing,” she choked out through tears.
I repeated myself, “What is your problem? I was just lying down for a minute.”
Struggling to get up, I realized that the bed was soaked. I felt like I couldn’t walk. My movements were stiff, jerky, uncontrolled. Completely disoriented, I swung my arm around and accidentally hit her in the face.
I made my way to the bathroom, slamming into walls, unable to get my balance. When I finally made it, I looked in the mirror. My face was icy gray and my lips were blue. They were blue. I began to fall out of consciousness again.
My friend managed to get me in the shower. Had she not found me and performed rescue breathing and gotten me into cold water, I would not be here. I’d had other close calls before this, but this was the worst. And it wasn’t the last time I used heroin; I continued cycling through relapse after relapse for another four and a half years.
I’ve been in recovery now for more than 18 years, but that day still haunts me. Sometimes at night, half-awake, I feel panicky and I sit up because that drift, that one that comes just before sleep, reminds me of what was almost a permanent drift.
In 2020, more than 93,000 people died by drug overdose in the U.S., a near 30% increase over 2019, the highest number ever recorded at that point. With potent synthetic opioids, namely fentanyl, flooding the market and finding its way into other drugs, this number is likely to increase.
Undoubtedly the stress of the pandemic and all of its repercussions has kept people isolated in more extreme ways. More prone to using drugs alone; without the same access to support groups, MAT (medication-assisted treatment) programs, and Narcan (the brand name for naloxone) distribution programs; and lacking the human contact we all need, people dealing with substance use disorders are in greater danger than ever before.
For the past decade, I have openly shared about my experiences with addiction and my path to recovery. I’ve done this in my advice column, in articles and in my book about it. I understand what it’s like to not be able to stop, even when it might kill you.
While I don’t have all the answers, there are a couple of things I know for sure. First, people can’t recover if they’re dead. You might be thinking this is obvious. But our overarching treatment protocols in this country don’t put that thought in the foreground. The push toward 12-step programs and abstinence shouldn’t be the No. 1 priority; keeping people alive should be.
It’s heartening to see increased awareness about overdose prevention. In New York City, programs like online naloxone training and free Emergency Overdose Rescue Kits have become more visible. Harm reduction services in general have greatly improved in major cities. But I worry about those who do not have access. I have spoken with people who had to drive hours and across state lines for medication-assisted treatment. And the pandemic has made this all the worse.
I spoke with author and advocate Tracey Helton Mitchell about the effects of the pandemic on drug overdoses. “The pandemic offered a rare window of opportunity to change policies about how medication-assisted treatments are implemented in this country ― more take-home doses, increases in telehealth, changing some prescribing guidelines, to name a few improvements,” she said.
The pandemic, Mitchell said, has led to naloxone shortages and the closure of successful programs in West Virginia, New Jersey and Indiana. These disruptions, she remarked, along with the social isolation, have made the administration of overdose prevention medication nearly impossible.
Love in the Trenches ― a Maryland-based nonprofit organization for parents of those struggling with addiction, aimed at erasing shame and educating people ― is certified to distribute Narcan and conduct Narcan training sessions. Co-founder Shawn Nocher spoke with me about the Narcan shortages the group has encountered: “We are supposed to get regular Narcan deliveries from the state as part of the Opioid Response Team and we actually ran out. Our last boxes expired mid-July and we just this week got our order in. I was told it was a supply chain issue.”
There was a near 18% increase in deaths by overdose in Maryland in 2020 and the first quarter of this year saw an additional 5.7% increase from 2020 numbers. Fentanyl was involved in 92.2% of opioid-related overdoses statewide, yet fentanyl testing strips are not as readily available there.
Nocher noted the prevalence of fentanyl in Maryland, saying, “I get ‘Bad Batch alerts’ on my phone when overdoses rise and they were constant in February/March of this year.”
“Anecdotally, all of the deaths for members in our group have detected fentanyl ― absolutely every single one,” she added.
I asked Mitchell about the efficacy of fentanyl testing strips in making drug use safer. She said, “Fent test strips are one tool but we need a whole arsenal. They can be effective in tipping a person off to the presence of fent in a place where it was not expected. I think it’s important to have test strips AND Narcan. Also having a friend on hand who WILL use the Narcan and/or call 911 is important. I can’t even count how many people I have heard of have died with Narcan close by.
Last week, I spoke during Dopey Podcast’s virtual observance for International Overdose Awareness Day. In the chat box, attendees wrote the names of those they’d lost to an overdose, and I realized it’s impossible for me to quantify the number of people I’ve lost over the years to addiction, because it’s an endless list. I thought about that day in 1998 and the many other near misses I had. I would not be alive if I were in active addiction today. I never would have survived the introduction of fentanyl.
I cannot emphasize enough how vital it is to educate folks and do everything we can to make accessing harm reduction services as easy as possible, without shaming or judging those who need these services.
Harm reduction is not enabling.
Labeling it as such threatens lives and amplifies the stigma around addiction. Harm reduction is the first and only stopgap for many drug users. Increasing visibility and access to harm reduction services is the way forward. September is National Recovery Month and there is no better time to talk about this. For more information on where to access services, check out the National Harm Reduction Coalition.
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Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.