Entering Clarion Alley off of Valencia Street ensures that you will come face to face with the Grim Reaper. In his shadow is a reclining woman surrounded by a cache of pills, needles and booze. She’s in the midst of an overdose, about to be saved by a yellow-clad superhero named Narcania who injects her with a syringe of Narcan.
The triptych-told tale aims to raise awareness about the anti-overdose drug (a trademark of Naloxone) and to encourage the availability of it as ipecac, an over-the-counter remedy used to induce vomiting. Dr. Phillip Coffin, director of Substance Use Research in the HIV Prevention Section of the San Francisco Department of Public Health, who works closely with the Drug Overdose Prevention and Education (DOPE) Program, said ipecac used to be kept in a family’s medicine cabinet.
“We’re not there yet,” Coffin said.
The mural by San Francisco artists Mike Reger and Erin Amelia Ruche is part of an outreach campaign to get the public there. It’s sponsored by DOPE and funded by the Department of Public Health.
“What we really want people to get involved with is harm reduction as a philosophy,” said 33-year-old Reger. “We want the average person to know what Narcan is and that overdose deaths are preventable, and then maybe they’ll get involved with trying to help.”
At present, Narcan, which blocks the effects of opioids like heroin, hydrocodone (found in the prescription painkiller Vicodin) and oxycodone (found in prescription painkiller OxyContin,) can either be administered with a needle or a nasal spray. A prescription, however, is required, and those wanting one must know how to administer the drug.
Since 2003, the DOPE Program has offered that training as well as take-home Naloxone prescriptions to needle exchange participants, staff and clients of SRO hotels, shelters and other community groups. Additionally, anyone who wants to equip themselves with the tools to stop an overdose can go to DOPE and receive training and a Narcan kit.
The drug has reversed nearly 1,000 overdoses since the program began, according to the Department of Public Health.
The mission of the current campaign “is to empower drug users about how to respond to others and their friends,” said Eliza Wheeler, project manager of DOPE. “We want more people who may not be involved to know that this simple treatment exists.”
Quick, over-the-counter access to easily-administered Narcan can happen once the Federal Drug Administration approves a Narcan atomizer. But according to advocates, that could be years away.
At present, the nasal spray method is carried out with an off-label atomizer, but it remains unavailable unless someone undergoes training through DOPE and acquires a third-party liability prescription.
Both Wheeler and Coffin stressed that an informed public is a critical step in putting pressure on lawmakers and healthcare administrators for both tighter regulations of painkillers and increased availability of Narcan.
“There are a lot of opioids out there in people’s cabinets,” Coffin said. “Informing them about the need to understand overdose prevention is important. We’re not going to stop every overdose, but we should be able to stop every witnessed overdose.”
Prevention and intervention are especially relevant at a time when prescription drug abuse in San Francisco and across the country is steadily rising, according to the Centers for Disease Control and Prevention (CDC.) Drug overdoses are the leading cause of injury deaths in the United States, killing more than 15,000 people each year, according to the center. Of that number, 60 percent of them are caused by opioids like Vicodin, OxyContin or Methadone.
Ruche, who has successfully administered Narcan twice to a friend overdosing on opioids, pointed out that the casual attitude towards prescription painkillers makes it ever the more important for people to understand the risks.
“A lot of people may not think that knowing about overdose prevention is important to them,” she said. “Now, so many people take prescription painkillers that it kind of affects everybody.”
The mural seeks to raise the community’s awareness.
“The people who undergo our trainings at our usual places are very drug savvy,” Wheeler said. “But lots of people out there who are using opiates like Vicodin or Percocet don’t know anything, from what an overdose looks like to the attitude of authorities and EMTs towards people who are having one. Not only are they not equipped with the knowledge, if a situation happens, they might be afraid to call for help.”
Clarion Alley was chosen very deliberately, Wheeler said. The sheer number and diversity of people walking down that street opens up the conversation.
Wheeler said that work like the mural, which marked the end of the Overdose Awareness Day March on August 31st, greatly added to the public dialogue about drug abuse. People from Tenderloin SROs, needle exchanges and treatment programs mingled with people walking down the alley with $4 coffee, Instagramming murals.
“The best part of this mural is that people on the street, who may not know anything about Narcan or overdose prevention, start talking about it and it becomes community knowledge,” Wheeler said.
Reger and Ruche, who are longtime friends, said this isn’t their first foray into public outreach. Reger co-founded Mission Mini Comix, an artists’ collective that mainly produces political and social welfare comic books. The artists have created two comics about drug overdoses and Narcan, which they hand out around the city.
The muralists have both been personally affected by drug abuse and want to help reduce the stigma associated with helping, rather than punishing, people on drugs.
Moreover, they said, it is critical that people understand the basics of how to spot and prevent an overdose, as well as what not to do.
“A lot of people might think you resuscitate a person like they did on Pulp Fiction,” said Reger, referring to an infamous scene in the movie in which an overdosing Uma Thurman is dramatically stabbed in the heart with an adrenaline-filled syringe. “We definitely don’t want people to take drastic, uninformed measures into their own hands. We’d rather they team up with places like DOPE or volunteer at a needle exchange program and know how to get people help.”