Spotlight: Harm Reduction Q&A with Bernie Lieving

According to the New Mexico Department of Health, New Mexico had the 11th-highest drug overdose death rate in the United States in 2020. That same year, 2 out of 3 drug overdose deaths involved an opioid. One New Mexican died from a drug overdose every 11 hours. Tragically, the numbers are just getting worse. Since 2020, drug overdose deaths have been increasing by over 200 each year.

It's hard to comprehend how much potential the opioid epidemic has robbed from our Santa Fe arts community. We hope that by using our platform to share this guidance, we can contribute to our community and work together to prevent additional unnecessary loss.

Recently, I attended a training on harm reduction and overdose prevention in Santa Fe led by Bernie Lieving, a local overdose prevention educator and public health social worker. I visited Bernie at his office in Santa Fe to talk more about this terrible epidemic affecting our families and our loved ones.

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How’d you get started working in overdose prevention?

I started to get into punk rock at the age of 17 in Northern California in late ’79 and I very quickly had a shift in my socio-political perspective on the world. I had always been on the fringes but I started realizing the world wasn’t working, or at least wasn’t working for some people. I had a number of friends who used heroin. I was also using drugs and experimenting and witnessed how they struggled with their addictions and how they were treated. This isn’t theoretical for me. People have died in my life and it impacts me.

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Why is this important to talk about?

We know people are going to use substances so let’s make sure they stay safe and healthy. It’s about ensuring that the most marginalized among us are treated with dignity and respect and have opportunities to stay alive. My work is about human rights and treating people with kindness.

Interventions should be person-centered and harm-reduction-oriented, and involve looking at human beings as experts in their own lives.

The people suffering are our brothers, sisters, fathers, mothers, and friends. They’re us. We like to otherize people thinking we’re better than them. Life can be hard for anyone.

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What are the problems right now in terms of helping people stay safe?

The unregulated criminalized street drug market and the unpredictability of street drugs. When I was in the hospital for a femur fracture, I got 25-30 micrograms of fentanyl in an IV to treat my pain. One fentanyl pill bought from the street could have 125 micrograms in it while another one might have lower amounts. If we had decriminalization of drugs, people would be able to know what they’re getting so they’re not taking huge doses of fentanyl.

Another problem is people using alone. We have become more isolated, not only because of the pandemic but because of our phones. There’s an organization called Never Use Alone where you can call their number and they’ll be on the phone with you when you use. If you’re unresponsive they’ll send emergency services. So far, no one has died using this service.

If you’re going to use, use less than you normally do to see what the potency might be, don’t use alone, and have Naloxone around. If you’re smoking something, don’t inhale for so long or so deep. If you can, use with someone. Take turns using and monitoring each other. Have NARCAN and know how to use it.

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What is NARCAN? How does it work?

NARCAN is the brand name for a drug called Naloxone. Naloxone is a medication that antagonizes the opioid off the receptors in the brain, and temporarily the receptors in the brain like NARCAN better. NARCAN nasal spray takes a minute or so to work. It lasts for 30-90 minutes and helps a person start breathing on their own again.

NARCAN is a safe medication to give anyone across the lifespan (pregnant people too) and has fewer side effects than aspirin. I teach people to use NARCAN anytime on anyone who is unconscious and not breathing; if they’re not having an opioid overdose they’ll be fine. It doesn’t interfere with any other medical intervention that needs to occur. It’s only used to rule out an opioid overdose.

You can also give Naloxone in an IV, intra-muscular injection, or breathing tube. I teach people how to give it as an intra-muscular injection that is cheaper and a lower dose but just as effective. I can supply anyone with this.

If someone has a poly-substance overdose, NARCAN only works on opioids. It doesn’t work on alcohol or sleeping pills or any other drug.

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What’s the shelf life of NARCAN?

Three years from the date it was made. The Naloxone for the intra-muscular injections has a two-year shelf life. But studies have shown that Naloxone products are 90% effective even thirty years after they have expired. So if that’s all you’ve got, give the expired NARCAN because it’s better than nothing. I can replace anyone’s expired NARCAN for free.

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What should you do if you think someone is having an overdose?

Signs someone might be experiencing an overdose include not breathing enough or not breathing at all, blue-ish, purple-ish, grey-ish nail beds and lips, unconsciousness and non-responsiveness. 

Call 911, give NARCAN, and attempt rescue breathing. Someone who has overdosed is craving oxygen. Roll them on their side in case they vomit so their air passage is clear. Give NARCAN every two minutes until they wake up, or until the paramedics get there. NARCAN will not reverse the effects of a cardiac arrest but if the opioid overdose is the underlying concern, at least you’re giving them NARCAN.

NARCAN only works for 30-90 minutes so there’s a potential you could give NARCAN and revive someone, but their overdose can come back. If that happens give more NARCAN until the paramedics arrive.

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Where do you get NARCAN?

From public health offices and various community organizations like the Mountain Center, Southwest Care Center, La Familia Medical Center, or Santa Fe Community Services. You can buy it at a pharmacy without a prescription and if you have Medicaid you can get NARCAN at a pharmacy for free.

I can send NARCAN anywhere in New Mexico. I’ll even overnight it if I have to. If you live outside of Santa Fe, I can recommend places you can get NARCAN wherever you are.

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How do fentanyl test strips work?

The strips are a qualitative test, not quantitative. It measures whether it’s present, but not how much is present. They have extensive information on how to test your drugs, and instructions on how to reconstitute the drug after you’ve tested it.

I get fentanyl test strips from DanceSafe and ship them all over the state for free.

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What do you hope to see in the future?

Hopefully, we’ll have a more sophisticated drug-checking system where you find out not only the presence of fentanyl but also get an extensive analysis and see what other drugs are present, if any. I’d like to see the decriminalization of drugs, treatment instead of incarceration, access to harm-reduction person-centered centers, and overdose prevention sites where you have a place where you can be revived, and get food, primary medical care, housing opportunities, or behavioral health services.

We need better language around it too. Language informs behavior, policy, and law. If we use stigmatizing, dehumanizing language, instead of person-first language, that’s going to inform how we engage with others. People are more than the sum of their drug problems. They should not be defined by one aspect of their being.

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What would you say to someone who says “harm reduction just allows people to keep using drugs”?

We practice harm reduction in our daily lives all the time. Seat belts are a form of harm reduction. The only thing it enables is health and wellness and staying alive.

Follow Bernie on Instagram at @publichealthpunk505 or reach him at 505-270-5943 or [email protected].