SEATTLE — Pinpoint pupils. Discoloration. Blue or gray lips. Clammy skin. Slow breathing. Loss of consciousness.
These are the symptoms of an opiate overdose, volunteers with This Must Be The Place told passersby at the summer Day In Day Out music festival in Seattle Center. The nonprofit aims to prevent overdoses by traveling to music and arts festivals across the country, handing out free kits of naloxone, the fast-acting, life-saving medication that can reverse an opiate overdose within minutes.
“Is this for overdoses? Oh sure, I’ll wear one. I’m down for saving a life,” remarked one glitter-studded festivalgoer who stopped by the booth and grabbed one of the hundreds of colored lanyards that held an 8 mg dose of naloxone, enough to save a life.
Casual drug use has always gone hand in hand with the music scene, but with fentanyl making its way into the picture, someone’s fun night out can quickly turn deadly. To raise awareness of the new danger, efforts by groups like This Must Be The Place focus on education and accessibility, rather than the “just say no” mentality that often dominates discussions about illegal drug use.
Harm reduction efforts, and their focus on reducing the stigma of addiction, are key to the U.S. Department of Health and Human Services’ overdose prevention strategy. A clinical perspective roundtable, held by the Reagan-Udall Foundation for the Food and Drug Administration, found fentanyl screening and drug checking should be part of a public health framework alongside harm reduction and addiction treatment.
But the work is fraught with challenges. Advocates have to overcome preconceived notions of who is most susceptible to fentanyl addiction and how it looks when someone is revived after overdosing. Venues have to navigate archaic laws passed during the height of the war on drugs, raising concerns about potential liability businesses may face for carrying naloxone. And each day, more and more fentanyl floods the market, often mixed in with other drugs, leading to the possibility of accidental opioid use.
William Perry, director of This Must Be The Place, said a big part of the job is explaining that an overdose can happen anywhere, anytime. Equipping bystanders who may never use drugs in their life is critical to battling the opioid epidemic, he said.
“We basically want to make this as normal as a Band-Aid,” Perry said. “At a festival, we’re going to meet all different types of people, so educating them on how to care for each other, how to be vigilant and watch over each other, creates this massive blanket of safety.”
In between sets at Day In Day Out, a screen by the stage flashed “Free Narcan.” Naloxone, also known by the brand name Narcan in a nasal spray form, works by knocking opioids out of brain receptors, reversing overdose symptoms.
This is the second year the Ohio-based nonprofit This Must Be The Place, named after the Talking Heads song of the same name, has taken to the road.
“In my personal journey through my substance use disorder, overcoming opioid use disorder had a lot to do with music,” Perry said. “It’s a space I know.”
The age range commonly found at music festivals — from teenagers to 40-somethings — is about the same age group most at risk of a fentanyl overdose, Perry said.
And according to the nonprofit’s anonymous survey results, nearly two-thirds of the people who got naloxone from the booth said they know somebody who has overdosed. However, only 35% of the respondents said they have received naloxone before.
Haleigh Bridgan stopped by the booth as soon as she saw it. Her younger brother is addicted to fentanyl and has been struggling with homelessness for years, and she has had six friends die from fentanyl overdoses. She usually stores naloxone in her bedside table.
The shame and judgment surrounding drug use, she said, is one of the biggest barriers to helping people battling substance use.
“There is hope for people who are addicted,” Bridgan said. “You have got to be diligent.”
Perry said one woman who took a kit later sent an email saying she used it the very next day, when she was on Capitol Hill and saw a stranger overdosing in the park. She administered the dose and revived the person in seconds.
One of the most common misconceptions people who stop by the booth have, Perry said, is that people experiencing homelessness are the most likely to be substance users. But, he noted, fentanyl knows no boundaries.
Another myth he tries to dispel is the idea, repeated by some politicians and law enforcement officials, that fentanyl can be absorbed through skin. That’s not only wrong, but potentially dangerous, according to UC Davis Health.
“It’s an extreme problem, because if someone is overdosing, [other people are] afraid to touch that person, which means they’re afraid to save them,” Perry said.
Complications for venues
The Crocodile has been one of Belltown’s preeminent live music venues for 30 years. A mostly standing-room fixture of Seattle’s music scene, featuring a giant crocodile skeleton hanging from the ceiling, it has hosted most of the city’s greats. When the team reopened The Croc in a new location at the end of 2021, they started talking about carrying Narcan on site as a precaution.
But it still makes general manager Shaina Foley nervous.
That’s because of a line of text in the congressional Anti-Drug Abuse Act of 1986, commonly referred to as the “crack house statute.” The law makes it illegal to manage any business for others to use or distribute controlled substances. Many venues don’t want to publicize that they have Narcan on site out of concern that they’re opening themselves up to liability, said Nikki Barron, a spokesperson for nonprofit Seattle Musicians Access to Sustainable Healthcare, or SMASH, for short.
“It’s like they’re saying ‘Hey, come here and do drugs, because we’ve got equipment for you if something bad happens,’ “ Barron said.
A SMASH program, the Anti 27 Club, aims to raise awareness about the normalization of substance use among musicians. The program was named for the so-called 27 Club of popular artists and celebrities who died at age 27, including Washington natives Kurt Cobain and Jimi Hendrix. Part of the program, which partners with Public Health — Seattle & King County, has included a workshop that provided Narcan doses and instructions on spotting an overdose to local venues.
Dr. Joseph Palamar, an associate professor at New York University’s Langone Medical Center, said the crack house law informed the RAVE Act, a bill sponsored by then-Senator Joe Biden in 2002. The next year, the act was reintroduced, renamed and tacked onto the PROTECT Act — the law that codified the Amber Alert system.
“If I was governor of my state or mayor of my town, I would be passing new ordinances relating to stiff criminal penalties for anyone who held a rave — the promoter, the guy who owned the building. I’d put the son of a gun in jail,” Biden said in a March 2001 congressional hearing.
Employees at The Crocodile, Foley said, are careful. They won’t give people so much as aspirin. After getting SMASH training and talking with their insurance agents, the team decided to keep Narcan in their first aid kits.
“It’s been really hard to navigate reversing some of those instincts that you have to keep yourself uninvolved,” Foley said. “We feel it’s worth the risk, because you could potentially save someone’s life, and we have.”
One night in the spring, a security guard noticed someone lying by an alley across from the venue, passed out. The guard administered Narcan and called 911, and the person woke up within about a minute.
When medics arrived, the person refused care and walked away. Employees saw them in Belltown again a few weeks later.
That person was lucky. Typically, naloxone can only reverse an overdose for 30 to 90 minutes. Many opioids are stronger or remain in the body for longer than that — which is why someone should call 911 and get medical attention as soon as possible.
Though officers have told Foley the venue would not get in trouble for giving Narcan to people inside or outside The Crocodile, she still has concerns.
Foley said she wishes state or federal law would safeguard venues for having Narcan and test strips on site, like Washington’s 911 Good Samaritan Overdose Law, which prevents people who call 911 to report an overdose from being prosecuted if they are in possession of drugs.
“We know that we’re liable for everybody’s safety when they’re under our roof,” she said. “As a venue, if we were to administer Narcan to somebody and they had a bad reaction, would it be our fault? Would we be responsible and potentially liable for any kind of injuries that that person may have had?”
Drug market inundated
Many people at risk of overdosing may never know they’re taking fentanyl.
“People will say ‘I doubt anyone is doing heroin here,’” Perry said at the Day In Day Out festival. “Well, probably not, but guess what? Somebody out here has popped a Xanax they didn’t get from a pharmacy. … That could be a problem.”
It’s impossible to know, in many cases, what someone thought they were buying before the drugs they were taking killed them. But Mitchell Gomez, the executive director of DanceSafe, believes the vast majority of those deaths are due to accidental cross-contamination. DanceSafe is a national drug-checking nonprofit advocating for healthy and safe drug use in nightlife spaces by selling test strips and distributing educational materials.
The work is a constantly moving target due to the nature of drug prohibition, Gomez said. New drugs enter the market much faster than they used to. Manufacturers can even use artificial intelligence to design new substances.
“Probably the most important thing is the realization that this is not about trusting your source,” Gomez said. “We hear that all the time, ‘I trust my guy.’ This is not happening at the retail level.”
Very few substances have not been adulterated somehow, Gomez said. There’s never been laboratory proof of fentanyl in marijuana or psychedelic mushrooms, but it has been found in party drugs like cocaine, ketamine and MDMA. Anecdotally, Gomez said cocaine and methamphetamine seem to be most likely to be adulterated with fentanyl — likely because they overlap with opiate-smuggling networks.
Furthermore, because someone who dies of a fentanyl overdose may mix drugs, it’s often hard to say which substance, exactly, had traces of fentanyl.
Nationally, many opioid overdose deaths involve cocaine or other psychostimulants. From 2019 to 2021, cocaine-involved opioid deaths rose nearly 54%.
In a National Library of Medicine study, Palamar, the New York University professor, surveyed adults entering randomly selected electronic dance music events from 2018 to 2022, asking them whether they agreed that some dealers sell cocaine containing fentanyl. By the end of that time frame, the number of people agreeing with the statement increased by over 50%.
The people who became notably more likely to agree with the statement were white, had some college education, were over 26 years old or had not used cocaine in the past year.
Despite growing awareness, a significant number of people surveyed still didn’t fully understand how fentanyl has entered the drug supply.
“Some people simply think this is a myth,” Palamar said in an email.
Testing drugs can prevent accidental fentanyl use, Gomez said. Using a fentanyl test strip only takes minutes and a small amount of drugs, about 10 milligrams, according to the Centers for Disease Control. But, Gomez warned, it’s safest to test the entire supply to avoid the “chocolate chip cookie effect,” when the fentanyl hiding in a drug might be missed in a sample. Testing the whole supply involves getting the drugs wet before using a test strip and later dehydrating it in an oven for the drugs to be used.
Drug testing, Gomez said, would ideally be available for free at public health clinics. But it’s not at most, and fentanyl test strips are often hard to get for free. The state Department of Health announced earlier this year it would spend about $100,000 to distribute roughly 75,000 fentanyl test strips.
Public attitudes toward drug use, advocates said, is ultimately the biggest barrier to preventing overdoses.
“For 10 years, I’ve been trying to get the government to put us out of business by treating this as a public health emergency,” Gomez said.
Prohibition is the biggest thing standing in DanceSafe’s way, Gomez said. Because heroin was made harder to smuggle, a synthetic opiate like fentanyl took over the market. It’s not unlikely, Gomez said, that yet another drug could take over the fentanyl market one day.
“Because we don’t regulate drug sales, and because we leave drug sales in the control entirely of unregulated marketplace actors, this is just structural to the market itself,” Gomez said. “This is not a thing that is going to go away, probably ever.”
The music scene is different from the general market, Gomez said. But promoting health and safety in nightlife spaces, advocates say, is a path toward bringing harm reduction efforts to everyone in the country who may use opiates.
Perry said using is just one choice in someone’s whole lifetime of choices, and holding people accountable doesn’t mean shaming them.
“This promotes care, compassion, and people staying alive,” Perry said.
How to prevent opiate overdoses:
- Keep naloxone readily available on you and at home. Check with your local health department or community-based organization to see if they distribute naloxone at no cost. You can also talk with your health care provider or pharmacist about being prescribed naloxone, also called Narcan, if you or someone you know is at risk for an overdose. King County residents can order online to have free naloxone mailed to any address. Washington state residents with a mailing address outside of King County can fill out an online order form at https://st.news/naloxoneWA.
- Test your drugs. Fentanyl test strips can be acquired through community-based organizations like Hall Health for University of Washington students or online through King County at https://st.news/teststrips. Fentanyl strips through DanceSafe are available for purchase at https://dancesafe.org/fentanyl and can be shipped to all 50 states.
- Avoid mixing drugs. Mixing stimulants like methamphetamine and cocaine, depressants like opioids and alcohol or a combination of both can kill you.
- Don’t rely on a previous source or experience. Knowing where your drugs come from doesn’t mean they’re safe. Even if you have used drugs before, your body could react differently every time.
- Never use drugs while alone. Make sure the people around you are aware when you have taken drugs in case they need to give you naloxone or call for emergency assistance. Always let people know you have naloxone on hand and where you keep it in case of emergency.
- Ask for help when you’re ready to get treatment for your addiction. Recovery is possible — it’s OK to ask for help. You can find evidence-based treatment and service options near you by visiting findtreatment.gov or by calling 800-662-4357 any time.