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The fight against the opioid crisis in US clubbing

Shocked by the spate of accidental opioid overdoses in the US clubbing community, DJ and producer Lauren Flax decided to take action. With the help of healthcare professionals and friends, she launched Last Night A Deejay Saved My Life, a harm reduction programme that is saving clubbers’ lives

Around 150 people every day, or six people every hour, died from a synthetic opioid overdose in the United States last year. The total number was around 55,000, up from 29,000 in 2017 and 5,000 in 2014. Fentanyl, a drug 50 times more potent than heroin and 100 times stronger than morphine, is a major contributor to the rising death toll, as dealers eager to bulk up their supplies continue to cut the stuff with cocaine, ketamine, MDMA and other drugs.  

The benefits of fentanyl for drug dealers are two-fold. It’s cheaper and easier to obtain than heroin or cocaine, and offers an intense but short-lived high, ensuring repeat customers. The problem is that it can be deadly at a very low dose, depending on a person’s body size and tolerance. For this reason the US opioid crisis, in the eyes of many, has entered its most dangerous phase. 

“These accidental fentanyl overdoses have been in my view for a very long time,” New York-based DJ and producer Lauren Flax tells DJ Mag. “This isn’t just about heroin addicts, it can affect the person that just goes out once in a while and might take a bump of coke here and there. It doesn’t matter if you’re an avid drug user or not. It’s important people understand that. A few grains can take you out.” 

In mid-August, six people died after taking fentanyl-laced cocaine in Suffolk County, New York state. On the West Coast, comedian Fuquan Johnson and two others suddenly died after taking cocaine at a house gathering in Los Angeles, and in King County, Washington state, 34 residents died of a fentanyl overdose this July alone. Unlike in previous opioid epidemics, many of those dying from overdoses are unaware of the fentanyl present in their supplies. After a series of deaths in the clubbing community, Flax decided to take a grass-roots approach and organise training for DJs.

“I started this because I wanted to get naloxone in the hands of all my friends who were DJs and have them start travelling with it,” she explains. “If something happened in the club, people could come to us in the booth and we could help, but I realised that was a pretty small number, and we needed to reach a bigger group of people — bar staff and patrons.” Sceptical of the government’s willingness to tackle the issue, Flax reached out to her friend Danielle Pickering, a triage nurse working at New York’s Callen-Lorde community health centre, for harm reduction training and naloxone supplies. “I was like, ‘how do we fight this on a local level?’”

FIGHTING THE CRISIS

Fentanyl was developed in 1959 and introduced as an anesthetic in the 1960s. It’s normally used as a last resort for patients in severe pain, or who have over time developed a tolerance for less potent opioids. It works by binding to the opioid receptors in the parts of the brain that regulate emotion and pain. In small doses it can induce feelings of euphoria, but if someone isn’t used to opiates, they can easily overdose. Telltale signs include shallow breathing, pinpoint pupils, discoloured or cold skin and vomiting. 

If a person has overdosed on the drug, their breathing will start to slow down and soon the lungs will stop sending oxygen to the brain. Naloxone reverses this effect by binding to the same receptors and blocking the drug’s path. The medication’s effects are minor if given to someone who doesn’t usually consume opiates, but it can be quite painful for someone with high levels of the drug in their system — too much, and it can send them into withdrawal. 

Danielle Pickering has administered naloxone a number of times, on opioid addicts and clubbers who’d unknowingly consumed fentanyl. “The thing I always try to tell people who have never touched a stranger in this way before is that it’s going to feel terrible, it’s going to be scary and you don’t really know what to expect,” she tells DJ Mag. 

In 2019, Pickering gave Flax naloxone training. “I brought a whole bunch over to her place to show her how to use it,” Pickering explains, “and that day, when I was teaching her, we just sat at the kitchen table, drank coffee and brainstormed for a couple of hours.” By the end of the conversation, they had the sketchings of an idea for Flax to run by her friends, and soon after, Last Night A Deejay Saved My Life was born. The NYC-based collective decided to focus on fighting the opioid crisis within the nightlife community — but first, it needed supplies. 

As of July 2017, every US state had passed at least one law making naloxone more widely accessible, many by removing the need for patient-specific prescriptions. Prior to the change, individuals could receive the medication, but it was often noted on their health records, potentially driving up their insurance costs. Post 2017, pharmacies and opioid crisis organisations were permitted to distribute it to individuals without a prescription.

“The reason behind that is if you give it to somebody who’s not overdosing, it does no harm,” Flax explains, “so they made it more accessible, but the problem was — and still is — that it costs $140.”  

Pickering reached out to the Greater New York City Black Nurses Association, which runs an opioid overdose prevention programme and has access to a regular supply of naloxone. Dr. Julius Johnson, a member of the association, liked the collective’s ideas and agreed to help lead its first workshop, which was held at The Lot Radio in December 2019.

“We want to meet people where they are, because it’s such an important aspect of healthcare that people tend to forget,” Johnson tells DJ Mag. “So we came, we did one workshop and it felt like we should expand it to other places, so I told Lauren I was all on board.” 

Naloxone can be administered as an injection or nasal spray, which is commonly known by its brand name, Narcan. “You want to check and make sure that the person is actually unconscious first,” Pickering explains. If they don’t respond, she recommends a sternum rub: making a fist and rubbing the knuckles along the sternum bone, applying as much pressure as possible. “That’s hard to do on a stranger, it’s invasive, but you want to make sure that you’re not able to wake them up some other way.” 

The injection can be delivered in a series of doses and is generally administered on the outer thigh or upper arm muscles, but the nasal spray, Pickering tells us, needs no priming. “You just take it out of its package, put it up their nose and it’s one click — super easy and quick. And then you put them in the recovery position.”

HARM REDUCTION

In 2014, white Americans were twice as likely to die from opioids as Black Americans, but by 2019, overdose death rates among Black Americans had more than tripled, and last year, overdose deaths in Black and Hispanic populations grew faster than in white ones.

Johnson was keen to offer support to this new group of accidental users. “Once we scanned through those statistics and we saw that this is not just a white middle America problem — that the problem was in our urban, lower income neighbourhoods as well — we needed to do something about it,” he says. 

The US opioid crisis dates back to the mid-’90s when Purdue Pharma introduced OxyContin to the public. The pharmaceutical company’s heavy-handed publicity campaign, which downplayed OxyContin’s addiction risks, has contributed to a crisis which has killed some 200,000 people in the last two decades. Last year it admitted to a series of criminal activities, including lying to the Drug Enforcement Administration (DEA), bribing doctors to over-prescribe its drugs and paying illegal kickbacks to a healthcare company. But despite this, the family-run business was recently allowed to declare bankruptcy, shielding anyone associated with the company from future lawsuits.

The second epidemic, which began around 2010 with a rapid increase in heroin death overdoses, was followed by a third in 2013. Some argue that this phase is the most lethal, in part because those cutting the drugs are incapable of discerning the difference between a safe and deadly dose. The result being that, where the prescription and heroin epidemics drove up the number of users, the spread of fentanyl is driving up the number of deaths

While some argue for abstinence, groups like Last Night A Deejay Saved My Life advocate a harm reduction approach. Their advice is threefold: to know your supplier, never use alone and always test your drugs. Fentanyl strips, small slivers of paper, can detect the opioid in pills, powder and liquid form and are an inexpensive way of avoiding an overdose. “I have a friend who found a big bag of drugs and luckily she brought it home and tested it,” Flax tells us. “It was positive for fentanyl and she poured it down the drain. I just found out a couple days ago and my heart just jumped.”

So far, Last Night A Deejay Saved My Life has run seven sessions and trained hundreds in how to administer naloxone. It has also moved location to Queens club Nowadays to accommodate the growing number of people turning up, which often peaks into the triple figures. Clubs still seem reluctant to address the issue head on, and decades of stigma around illicit drug-taking means few are willing to share their story, but Flax thinks the tide may be turning. 

“In the last few months there have been a lot of overdoses in Brooklyn, so people are starting to take note,” she says. “I’m noticing other groups coming up with harm reduction meetings. This is amazing, as I don’t want to be doing this all the time.”

The collective has plans to grow in other states and even abroad, but with a similar grass-roots approach. “I want other people to take the lead and we can just keep expanding as much as we can. This is why Last Night A Deejay Saved My Life is a collective. I want to grow it and make it your go-to website to click on and find out where you can go to different harm reduction groups in different cities.”

Read DJ Mag's recent report on the importance of harm reduction and drug checking in UK clubs here

Ria Hylton is DJ Mag's staff writer. You can follow them on Twitter @ria_hylton

Lauren Flax photo credit: Andy Egelhoff