Police are embracing a miracle drug that is helping to keep opiate addicts alive. But it can't save everyone
The 13th Precinct on the South Side is a patchwork of landscapes that bear little resemblance to one another. Brick-lined urban streets give way to industrial parks, then to highway strip malls, followed by undeveloped fields and clusters of houses that look like they were slapped together with spare parts. It runs from Alum Creek Drive west to I-71, and from Merion Village south almost to the Pickaway County line. This massive police precinct is loosely based on the 43207 ZIP code that leads the city in drug overdoses by a wide margin. To learn something of the opiate epidemic, this is as good a place as any to start.
Officer Zach May loads his gear into a cruiser in the parking lot of the Columbus Police substation on Woodrow Avenue. He’s been a cop for two years and has spent the last eight months assigned to the 13th Precinct. On a Thursday shift in April he tours the South Side, first along Parsons Avenue between Jenkins Avenue and Hosack Street, an area known for its heavy opiate activity. Later, he rolls past suspected dope houses off of South High Street, pointing them out one by one. Nearby, a banner about weekly recovery meetings hangs across a church. Overdoses aren’t exactly a shock around here. May says he saw three during his very first day on patrol.
The city’s rash of overdoses is driven by fentanyl, the ultra-powerful synthetic opiate often mixed into heroin. “If there’s not fentanyl in it, it’s not good anymore,” May says. Users now expect the added high it provides. The preliminary data from the Franklin County Coroner’s Office show that heroin-related overdose deaths actually dropped significantly from 2016 to 2017, from 144 to 84. Fentanyl-related deaths more than made up the difference, increasing from 144 to 346. Overall, there were 520 overdose deaths in 2017, an increase of about 47 percent.
Back in the parking lot at the 13th Precinct substation, officer Brian Becker displays the remedy that’s gaining favor among police: naloxone. He pulls out the delivery device, a clear syringe with a nasal spray applicator on top. Half the dose goes up one nostril of an overdose victim, half up the other. The naloxone, commonly known by the brand name Narcan, binds to opiate receptors in the brain, blocking the uptake of more opiates and usually reversing the effects of an overdose within minutes. Opiate users—who may be unresponsive and on the brink of death—often wake up shortly after receiving the dose. There’s no risk of abuse and no side effects. For a community struggling with an unprecedented level of overdoses, it’s nothing short of a miracle.
Becker has been a cop for seven years, five on the South Side. He was asked hypothetically by a police health care worker if he wanted to carry naloxone several years ago. He told her he didn’t need it because firefighters and EMS squads carry it, and they always beat him to overdose scenes anyway. But as the problem escalated, Becker was among the first officers to get naloxone when the Columbus Police began the pilot program in May 2016. He thinks he’s used it four times, and all but one person survived.***
Officer Ed Chung spots two men leaving a suspected dope house on Warren Avenue on a Monday afternoon. One cuts across a convenience store parking lot, past a tire store and into another house. Chung follows him in his police SUV. He drives around the block and backtracks across an alley behind the home, but there’s no sign of the man. He starts running the license plates of the half-dozen cars parked out back, looking for warrants. This is how he spends his shifts, always scanning, always moving.
“I probably burn a path in the roads by circling and circling and circling,” he says. He’s been on the force for three and a half years, most of that here on the Hilltop, Precinct 19. While the South Side is vast and disparate, this West Side precinct covers a relatively compact grid. The section with the most crime is so tight it feels claustrophobic, like policing a sandbox. Drugs are just as prevalent here as on 13—a lot of dope, a lot of guns, a lot of action, Chung says. The 19th Precinct substation on Sullivant Avenue is in the 43223 ZIP code, which has the second-most overdose deaths in the city.
Like Becker, Chung was in the initial group of officers to carry naloxone, given first to cops in precincts 13 and 19 because of their high overdose counts. He has administered it 29 times, and 28 people have survived. His constant movement and close proximity to most calls allow him to be first to the scene more often than not. Some of his colleagues call him NarChung.
It’s hard to know the exact extent, but most of the crime he sees traces to drug activity in some way, Chung says. Several officers on the South Side say that nearly all the people they arrest for theft and shoplifting are feeding a habit. Prostitutes walking along Sullivant are a conspicuous reminder—they’re kept on the corners by their addictions, and in many cases by the human traffickers who control their access to drugs.
Chung likes working this area because of the volume and range of 10 codes—the radio signals that correspond to different crimes and runs called out by a radio dispatcher. A 10-8 is a burglary in progress, and a 10-28 is a homicide. A 10-34 is an unknown complaint, while a 34-C is a request to check on someone’s well-being. A 34-O is an overdose, a recent addition to the 10 codes thanks to its growing frequency.
When they aren’t dispatched on runs, the cops in the 19th Precinct spend time watching dope houses, following suspicious cars and hoping to make drug busts that lead back to a dope house. “Just like fishing, you throw out a line and hope for the best,” Chung says. They give information from users to undercover officers, who make buys in the houses, then they shut down that house. But another one quickly pops up somewhere else. It’s an elaborate, futile game of cat and mouse.
Today’s surveillance comes up empty, but it’s not always so quiet. Three people overdosed and one died in a 30-minute span during the previous night. There are a lot of good working-class people in the neighborhood, Chung says, but many are beaten down, always in crisis. “There’s a lot of fragile people out here,” he says, “so it’s easy for them to fall into a life of narcotics abuse in general.”***
Like many Americans, Mark Voils’ slide into heroin addiction was greased by OxyContin pain pills. In 2009, he finished a two-month stint in treatment at Maryhaven but began using again. He remembers asking his brother a question, and then the heroin overcame him. He woke up confused, an IV in his arm, surrounded by cops and paramedics. He was immediately sick from withdrawal caused by the opiate-blocking effects of the naloxone that medics gave him. He overdosed a second time in 2010. Again medics revived him. He continued using.
Lt. Dennis Jeffrey hears frustration from officers who wonder why addicts can’t just stop, why they can’t make an effort to help themselves even after they’ve been saved. Jeffrey oversees training for the police’s Crisis Intervention Team, or CIT, which deals with mental health and substance abuse, and he manages the police’s naloxone program. When it first began two years ago, there was resistance from some cops who felt that saving addicts wasn’t part of their job. It’s a tough sell, convincing crime-fighters to revive users after decades spent believing they could arrest their way out of the drug problem. Jeffrey tries to sway them by humanizing the issue: The overdose victim is someone’s relative. “I have family members that are drug-addicted,” he says, “and I would hope someone would help them in their time of need, regardless of why they got there or what decisions they made to get there.”
There also was some public pushback, primarily on social media. Cops say people post that tax dollars shouldn’t be wasted on reviving addicts—that the city would be better off if police let them die. Voils says overdosing users were already being left untreated by those close to them for fear of involving the police. “People were scared to reach out to call, so it was killing people,” he says. State law now protects anyone who calls in an overdose from being charged with a minor drug offense, Jeffrey says.
For Voils, there was no moment of reckoning. By 2011, he was just sick and tired of the lifestyle required to maintain his habit. “Every other time around, I would do it for my parents, I would do it for my wife, I would do it for the courts. I would try to get clean for everyone except for me,” he says. “This time I decided to get clean, it was because I was ready.”
His brother wasn’t fortunate enough to reach that point. He died of a fentanyl overdose in 2015, not long before the police began carrying naloxone.
Voils is now the director of admissions across Maryhaven’s local facilities, including the Addiction Stabilization Center, an opiate urgent care facility that opened in January to provide triage, detox and 30-day residential treatment. Maryhaven’s system once had a daily wait list for detox of upwards of 100 people, says the center’s director, Andrew Moss. The new facility was intended to improve access to care, one of the key goals of the 2017 Franklin County Opiate Action Plan. Now people are admitted right away.
In May 2017, the Alcohol, Drug and Mental Health Board of Franklin County provided funds to create the Rapid Response Emergency Addiction and Crisis Team, or RREACT, which nudges people toward treatment. When someone receives naloxone from EMS, social workers from Southeast Healthcare meet them at area hospitals to connect them to resources. For those who decline a hospital trip, a plainclothes cop and a medic or a firefighter conduct follow-ups to encourage users to accompany them directly to treatment, often to the stabilization center.
The fire department, which has carried naloxone for 40 years, provided the initial training for police to use the drug, which costs $32 a dose, Jeffrey says. Jim Davis, the assistant fire chief of training and emergency medical services, says cops are frequently able to treat victims in the crucial four- to six-minute window when there’s still a good shot at reviving them. The police were bystanders for decades while EMS and fire crews provided aid, but now they feel obligated to help stem the tide of a bottomless epidemic. About 525 of the department’s 1,863 officers carry naloxone, and in mid-April, Jeffrey received permission to train every cop on patrol and every outgoing academy class.
During the 2016 pilot, the police used about 60 doses. There were about 285 uses in 2017. Through early May, cops have administered 183 doses, which puts them on pace for 526 in 2018. Davis says his fire and EMS units use naloxone on an average of 10 patients a day. In the last eight years, they’ve dispensed about 36,000 doses.***
Officer Joe Curmode III likens the police department’s shift in mentality on opiates to the turning of a giant cruise ship. It’s slow, but it’s happening. Curmode is a proponent of the naloxone program because he was tired of waiting around when he beat fire and EMS crews to the scene of an overdose. He’s also motivated for personal reasons—his cousin died of an overdose last summer.
Curmode has been patrolling the 13th Precinct on the South Side for about two and a half years, most of his time as a cop. He also works on the RREACT squads, which go out during weekday afternoons and evenings to check on those who have overdosed in the last 24–48 hours, he says. That, too, can be futile. Many people who overdose are transient, and even the ones they find frequently turn down the offer of a ride to a treatment facility. Curmode is also CIT-trained and was involved in the naloxone pilot along with Chung and Becker. As of early May, he’s dispensed 32 doses. Almost everyone has lived. Almost.
One in particular haunts him. Curmode responded to a house where two kids had found their dad in the bathroom after an overdose. They were pulling him out of the tub when Curmode got there. The man didn’t make it. “Every time that happens I think about my cousin. I think about all my family that’s gone through all this addiction, and it never gets any easier,” Curmode says. “And that drives me even more the next time to get there as quick as I can.”
To him, using naloxone isn’t any different than performing CPR or triage on a gunshot victim. His job is to save lives, and naloxone is just another tool. This is 21st century policing, he says. He’s a de facto medic one minute, a domestic counselor the next, a mediator between neighbors after that, and then he chases down a felon who ran from a traffic stop.
That dynamic is readily apparent during Becker and May’s shifts on the South Side. Police dispatchers issue them the following runs: a man who was beaten violently with his own skateboard, a freeway wreck involving a COTA bus, interference with child custody, a man who thought he found human remains (the coroner’s office later deems them to be pig bones), a minor who got jumped, a well-being check on a caller’s friend who’s really high (no one answers the door) and a home invasion in Canal Winchester that requires 11 minutes of white-knuckle driving across the South Side to discover there’s no break-in after all.
People often call the cops because they don’t know who else to contact, Becker says. Naloxone doesn’t add much complexity to his job, but it does feel like a “cascading of responsibilities.” He says it’s too early to tell if the new resources—naloxone, the stabilization center, RREACT—will help, but following up right after an overdose seems promising. “Even if you can get one in 10 to accept treatment, that’s better than zero,” he says. “Keep chipping away.”
At 10:32 p.m., another cop radios Becker to inform him of an overdose at Alvis House, a nearby halfway home for ex-offenders. When he arrives, the stench of vomit fills the entryway. The resident was turning blue when Alvis workers found him. They performed chest compressions, mouth-to-mouth resuscitation and administered five doses of naloxone. Typically, EMS crews and firefighters will give one dose every three to five minutes, says Columbus Fire Lt. Jeff Blair, who’s already on the scene. But the man wasn’t responding, and staff members don’t deal with overdoses daily, so they just kept pushing the miracle spray up his nose.
He’s conscious now, sitting on a bed in his room, leaning over with his elbows resting on his thighs. Firefighters from Station 14 arrive and strap him onto a gurney to take him back to OSU Hospital East, where he’d been less than two hours earlier.***
Every corner of the city is affected by opiates, but Davis noticed a telling trend on the fire department’s maps of overdose locations. The hardest-hit neighborhoods correspond to areas with the highest incidence of infant mortality, gun violence, human trafficking and income inequality. “So to be honest,” he says, “I’m not sure how we address the issue of addiction and opiate[s] in our community without having a conversation as a community about the other social determinants of health care.”
It’s an intractable problem, and one that’s getting more complex and deadly. Some people have started to use methamphetamines or cocaine in combination with fentanyl, hoping they’ll balance each other out, Jeffrey says. Fentanyl, and the even more potent derivative carfentanil, is the most pressing challenge. Curmode says people are overdosing faster than ever, needles still in their arms, and it’s taking more naloxone to revive them. Some days he feels like the Dutch boy struggling to plug the leaking dike, running from overdose to overdose to overdose. “It’s definitely getting worse, and you can see it on the street,” he says.
Just after 6:30 p.m. on the West Side, Chung and officer Max Jacobs pull their SUVs up to the sidewalk that leads to the emergency room entrance at Mount Carmel West hospital. Jacobs opens the door for a woman in the back seat of his cruiser. He picked her up after her mother called 911 to report that she was talking about killing herself and then walked into traffic. Chung talks to the distressed woman while she smokes a cigarette. She doesn’t want to hurt herself, she explains. She’s been trying to get clean.
Her sister and her mother arrive. The three of them stand in a semicircle on the sidewalk. The mother tells her daughter she needs to go to rehab. “Aren’t you tired?” she asks her daughter over and over. “Aren’t you sick and tired of being sick and tired?” Her sister shivers against the chill of an unseasonably cold April evening with a numb expression on her face. “I don’t know you anymore,” she says finally.
Chung asks the woman if she’s interested in getting treatment at the Addiction Stabilization Center. He’s part of RREACT, and he can get her in right now. She agrees. She’s mostly been stoic until this point, but now she starts to cry. “You saved my life,” she tells him. The mother hugs Chung and thanks him. The woman gets in the back of his SUV for the short trip to the Merion Village facility.
Jacobs, Chung and the woman all walk into Maryhaven’s multistory brick building. Staff members take her to a triage room to assess if she’s a good fit to stay. Jeffrey is working special duty just inside the front door, and a cop and a firefighter with RREACT are already in the cramped lobby on their sixth call of the day. The center has had 422 people arrive since opening in January, and more than 40 percent of those have come through the RREACT program, according to Moss, the center’s director. The woman gets accepted for treatment, and she thanks Chung again before he leaves.
Over dinner at Josie’s Pizza in Franklinton, he’s reflective. People may talk about Darwinism, natural selection, let the addicts die. Maybe even other cops have said that. He doesn’t agree with everything he encounters—the calls the police get, the choices people make, why he’s involved in certain situations at all—but for him it’s simple when it comes to overdoses: Cops are there, and they have naloxone. “If you look at it from a human perspective, that person—right, wrong or indifferent—they’re in a crisis, and you’re there to help them in that crisis,” he says. “That’s the way you have to treat every situation.”
His rationale is the same for the woman who went to the stabilization center, even though she didn’t require naloxone. She was an addict in crisis, and they gave her what she needed but didn’t know how to put into words. He didn’t have to talk her into it, he just had to let her know a place like that existed. And who’s to say what the outcome will even be. “I don’t know if I’ve helped her,” Chung says. “We put her in the right direction, and that’s it.”