Karen revives Patricia then looks after her for the rest of the day
Preferred Name: Karen
Gender: Female
Age: Early 30s
Who is Karen?
Karen lives in Melbourne and is homeless. She is married with one child. She describes her ethnic background as ‘Aboriginal’: she was born in Australia, as were her parents. Her primary source of income is a Commonwealth Disability Support Pension*. She has participated in overdose response training on two occasions and thinks that people who consume opioids should participate in refresher training every six to 12 months. Karen and her husband have revived people with take-home naloxone many times.
Brief Outline:
Karen recounts a time when she gave take-home naloxone to a friend, Patricia, who overdosed in front of her. Although Karen was concerned about Patricia’s plan to mix heroin with ‘pills’, she didn’t feel able to stop her. When Patricia showed signs of overdosing, Karen revived her with the naloxone that her husband was carrying. She also looked after Patricia for the rest of the day to ensure she didn’t consume more heroin. In her account, Karen reflects on how the situation made her feel at the time, describing it as a ‘catch-22’.
It turned out I was right. Straight after we took it, Patricia began swaying and the next thing you know, her head’s just hit the cement slab, just gone donk instantly. She’d overdosed, so I started going into my husband’s bag to get out the naloxone. As soon as she went down everyone else moved back, I suppose I didn’t because I’m a pretty strong-minded person, but one of my mates turned Patricia on her side. Then my mates were trying to wake her up but she was just not responding. I was sitting there trying to work out how much naloxone to give her. When I got the injection ready I injected it into the big juicy part of her leg.
Then I waited a couple of minutes to see if she was starting to wake up, but she wasn’t. She was starting to breathe a bit better, but she still wasn’t waking up, so I gave her another little jab. I gave her a smaller amount the second time. I had to be careful to make sure that I didn’t either overdo it or underdo it with the amount of naloxone. She woke up after the second dose of naloxone, and five minutes later she could walk.
While this was going on, my anxiety was going through the roof, knowing that this person’s life was in my hands. I was also worried that I could end up being wrongly charged with a crime (see also, Police encounters).
When she woke up, Patricia was initially pretty upset that she’d been given naloxone. Then later she seemed to forget that she’d overdosed at all. She didn’t even realise that it all went down, and that I’d brought her back. We looked after her for the rest of the day to make sure that she didn’t take more heroin or anything as that could have made her overdose again.
These situations are a catch-22. I felt bad because I kicked her fix – took away the effects of her heroin – but at the same time I felt good, because at least she was still around the next day. So when someone is overdosing, I have to weigh up the pros and cons of giving them naloxone (see also, Experiences with take-home naloxone).
Although Karen found responding to overdoses with take-home naloxone stressful, she had done it many times, and said she would do so again in the future. ‘So many thoughts go through your head when you’re doing it, but at the same time, you wouldn’t be human if you didn’t try and fix [people who have overdosed.]’
Karen (F, early 30s, Vic, non-prescribed opioids) describes in detail using take-home naloxone to revive a friend who had overdosed. (Note: strong language)
We all just picked up, and one of my girlfriends, she takes a few pills too, and I asked her specifically, ‘Did you have any pills?’ She goes, ‘Last night I did’ and I go, ‘What time last night?’ And she goes, ‘Oh, about seven or eight’, but then she started slurring her words and I said, ‘What time?’ And as soon as – she went back earlier: ‘Oh no, five or six’, and I’m like, ‘Yeah, no, she’s not going to handle [this]’. So anyway, we mixed up, because she was still sick and slurring from the pills, but trying to tell someone ‘no’ when they haven’t had their morning fix is like trying to tell someone you are not getting a coffee or a feed for the next week; it ain’t going to happen. So we all went to our normal spot and had it [the heroin]. The next thing you know, I finished getting myself, and I turned around and she’s, like, swaying, and I’m, like, ‘Are you all right?’ And she went, ‘Yeah, I’m all right,’ and then the next thing you know, her head’s just hit the cement slab. Just gone donk, instantly, and I’ve gone, ‘Oh shit.’ […]
Everyone else sort of moved back, because, I suppose because I’m a pretty strong-minded person, but everyone moved back. One was turning [her] on [her] side, and I was going into my bag, because I had my husband’s bag. By this time my mates are there trying to, like, smack her in the head, trying to wake her up, because she was just not responding. So I ended up pulling down – I ended up sucking it back, I think I sucked it back to 15 or 20 – and pulled down the side of her thing, because me and her were the only females, so I ended up having to do it, as no one else wanted to. Pulled it down to her side, and got the big juicy part on her leg, and just jacked it into her leg.
I waited a couple of minutes, still smacked her in the head, seeing if she was starting to come through a bit more, she wasn’t. Like, she was starting to breathe a bit better, but she still wasn’t waking up [or] alert, so I gave her another little jab, but not as much. I didn’t want to overdo it, but didn’t want to underdo it either. So I think the second time around I gave her 15, and then by that stage, she was starting to come to, about five minutes later she was coming through, walking around, but she was pretty upset that we even narced her, but then an hour later she didn’t realise that we did narc her, because she was, like, ‘Did you? I didn’t know.’ And this is after carrying her down three flights of stairs, and she didn’t even realise that all went down.
Karen (F, early 30s, Vic, non-prescribed opioids) describes overdoses as ‘high-pressure situations’. She feels people need to learn the most effective way to respond to them.
Yeah, especially in a high-pressure situation, you are trying to think … like, if you’ve just had a car accident and you’re just in shock, who are you going to think to call? Like, fair enough, you’d call the ambulance, but then after that, who would you call after? It’s the same situation. You are in a high-pressure situation, you don’t know how you are going to respond, because every single time could be totally different, so you don’t know how you are going to react until that time comes, and that is one thing that sort of needs to be broken down. You don’t know. Every situation is totally different to the first one. They could have dropped, fair enough, but the main thing they all have in common is they’ve dropped. But they could be 1,001 different nationalities, 1,001 different sizes, 1,001 different amounts of drugs or different drug combinations in the system. [What we need is] to get the right combination [of responses] together and put it out there, so everyone gets the right idea.
Also questioning the ways illicit drugs are governed, Karen (F, early 30s, Vic, non-prescribed opioids) suggests that some policing strategies make overdose more likely.
There’ll be a big sweep [by the police], [which will] get [drugs] off the street for a couple of days. All you are doing is pushing them into the houses, into people’s backyards and all that. Where[as] if they had a place where people could go in, do what they do, go in there, you know what I mean? […These strategies] push people into hiding. Not just their homes, anywhere … nooks, crannies, dark ways, alleys and therefore, people won’t know if they’ve got a dead corpse behind the back of their property because they’ve had a shot. That’s all they’re doing. It’s not like they are cleaning the streets up, the streets are going to be the streets no matter how much you pretend [otherwise].
Recently, Karen (F, early 30s, Vic, non-prescribed opioids) was consuming heroin with a group of friends. Her friend Patricia had also consumed other drugs (‘pills’), and while Karen was concerned about this, she remembers that she didn’t feel able to intervene. Karen’s concerns turned out to be justified when Patricia began experiencing an overdose. Karen was quick to respond, and began preparing some naloxone that was in her husband’s bag. (Note: strong language)
So we all went to our normal spot and had it [the heroin]. The next thing you know, I finished getting myself and I turned around and she’s, like, swaying, and I’m, like, ‘Are you all right?’ And she went, ‘Yeah, I’m all right,’ and then the next thing you know, her head’s just hit the cement slab. Just gone donk instantly, and I’ve gone, ‘Oh shit.’ […] Everyone else sort of moved back, because, I suppose because I’m a pretty strong-minded person, but everyone moved back. One was turning her on her side, and I was going into my bag, because I had my husband’s bag, so I was getting [the take-home naloxone] out.
Karen (F, early 30s, Vic, non-prescribed opioids) compares take-home naloxone with other healthcare tools such as EpiPens®. (Note: strong language)
Diabetics carry their medication around in case they drop. Other people carry an EpiPen [in case] they get a reaction. This is the same concept – in case someone drops, that’s what naloxone is for. So it’s not hurting anyone, and anyone who does use [opioids] isn’t going to sit there and pump it in their arms anyway, because it’s just going to fuck them up real bad. So unless it’s something that is needed, not many people want to play with it anyway […] It’s liquid to bring someone back who’s near dying.
Take-home naloxone is available at Karen’s (F, early 30s, Vic, non-prescribed opioids) local primary health centre, however, she suggests it would be good if she could get it from the Melbourne-based drug consumer outreach service called Foot Patrol.
It would be easier to be able to get it off the Foot Patrol […] Say it’s a payday, yeah, and everyone picks up big on their payday. Regardless how much they use, on their payday they always pick up big. Well, it would be easier when you go get your fits [injecting equipment], to get it from an easier access point [like Foot Patrol], than having to go to a doctor to get a script, to go get it filled. It would just be easier to go in and get it and leave with it. It’s like having a fit bin. You’d put your fit in there if you got given the bin, but if the bin’s not there, what do you do with it?
Karen (F, early 30s, Vic, non-prescribed opioids) describes how take-home naloxone affects her emotionally. As she explains, it makes her grieve overdoses she wasn’t able to reverse, and worry about the overdoses that may happen when she’s not present to reverse them.
It affects me a lot though, because, like, two of my mates have died and I sit there and think, ‘Well if I’ve saved these [other] people, why couldn’t I [save them]?’ You know what I mean? But I wasn’t there to administer it […It’s good] to know that I have done it [in the past], and they’re still around for another day. I would like to think that they would [then] go on to help someone else too […] That’s my biggest thing: feeling left alone, isolated and not being able to do anything. So that’s the only thing I carry with me is the grief and worry about what I can’t do.
The importance of interpersonal relationships appears again in Karen’s (F, early 30s, Vic, non-prescribed opioids) account of how she and her husband talk about the best ways to respond to overdose. Like her, he has used take-home naloxone a number of times.
If someone says ‘Someone dropped’, we all instantly go, ‘So did you bring the Narc [naloxone] out?’ That’s where other people wouldn’t really talk about it. I suppose that’s one good positive thing about being with a bloke that has saved people too. We can talk about it and figure out which way does best for others.
Karen (F, early 30s, Vic, non-prescribed opioids) speaks about her concern that she will be ‘judged’ by her GP if she asks for take-home naloxone.
I haven’t gone to my normal GP and spoken to him about [take-home naloxone] because of the judgmental side of it. [This] comes up all the time and you think, ‘Okay, I’m going to get judged because I’m carrying this around, which means people might think I’m a druggie.’ So you have a lot of stereotypes that a lot of people worry about, and I am one of those who worry about it. [So I don’t feel comfortable asking for it.]
Karen (F, early 30s, Vic, non-prescribed opioids) says she doesn’t carry it in her bag any more, but her husband still does.
My husband usually has one [take-home naloxone kit] in his bag. It’s like a ‘you are ready to [go] kit’. But we’ve been in trouble. The weird thing about it, we’ve been in trouble with the police for holding it. […I have been searched by police in public] more than once, but it happened most recently, like, three months ago. I literally got caught and I got my whole bag tipped out, and they asked what it was. They actually took me back to the police station so they could call a doctor up to prove that that [the] script [I had in my bag] was naloxone and it wasn’t anything else. […] Yeah, that’s why I’m not carrying it. My husband carries it because he still thinks, ‘Well, I don’t care if they’re going to reprimand me’ […] The police need to broaden their horizons on knowing what naloxone is and understanding that it’s actually beneficial and helping people, [rather] than abusing us for holding it.