Up to 350 lives saved in 14 months.
That’s the figure DAP Health cites regarding one element of its harm-reduction program, based on the number of people who report they’ve used Narcan/naloxone on someone who was suffering from a drug overdose.
Did the people who received 1,360 packages of Narcan (that’s the brand name; naloxone is the generic) from DAP Health really use it to save 350 lives from May 2022 through June 2023? Probably not—but even if the program has saved half that number, or a tenth, that’s powerful. And getting naloxone into the hands of people who can use it is just one of the varied elements of the program, which also include free HIV and hepatitis C testing, fentanyl test-strip distribution, syringe-service (aka needle-exchange) offerings, and neighborhood syringe-cleanup teams.
While syringe-service programs and similar efforts were once denounced as enabling bad and dangerous behavior, the science is in—and the programs work. According to the federal Substance Abuse and Mental Health Services Administration, “Harm reduction is an evidence-based approach that is critical to engaging with people who use drugs and equipping them with life-saving tools and information to create positive change in their lives and potentially save their lives. Harm reduction is a key pillar in the U.S. Department of Health and Human Services’ Overdose Prevention Strategy.”
CJ Tobe, DAP Health’s director of community health and sexual wellness, oversees the harm-reduction program.
“A lot of people think that the harm-reduction program may be something where people just come, they get services, and they leave,” Tobe said. “What the program really is, is it’s connecting with people who use drugs to say, ‘You know what? We accept you and love you and care for you. … We’re here to help you safely. We’re here to connect you to medical care, to behavioral healthcare. We’re going to connect you to our outpatient drug-free program.’ This program’s really about building a bridge of trust, connecting people from the community to their medical home here at DAP Health to just talk about what’s going on and how can we help you.”
DAP’s harm-reduction team has been doing most of its work out of a mobile clinic, which has been visiting various spots in Palm Springs four or five times a week, for a total of about 24 hours per week. From May 2022 through June 2023, 3,059 patients have been served.
“We’ve been really focused on the unhoused population,” Tobe said. “… We knew it was really the biggest need in this city—to establish those relationships and connect them to other services, like primary care, mental health, housing, food, etc. We’re now authorized now by the state Health Department to amend our current syringe-service license to include a fixed site, at 1445 N. Sunrise Way.”
According to the Riverside University Health System, 859 people in Riverside County died from drug overdoses in the county in 2022—and Tobe said a disproportionately high number of those occurred in the Coachella Valley. Naloxone is one of the key weapons in the battle against drug-overdose deaths; if it’s given to someone who is overdosing, it can save their life.
“(Signs of an overdose include a) limp body, shallow breathing, those kinds of things,” Tobe said. “You’re going to call 911 immediately. You’re going to administer Narcan. You’re going to stay with the person and tilt them on their side to make sure that if they are throwing up or vomiting, they don’t choke. … They’re going to need more Narcan/naloxone to actually completely reverse that and save their life. That one piece that we give out, that one Narcan/naloxone that we give out, it’s essentially to buy time until medical professionals can come.”
There’s been a national shortage of naloxone. However, the situation is improving, and while naloxone can be purchased at pharmacies, it’s expensive. Tobe said a recent survey of local pharmacies showed that a single dose of generic naloxone costs at least $32.
“Anybody can walk in (to a pharmacy) and get this, but they’re going to have to pay for it,” Tobe said. “As we know with PrEP, for example, which prevents HIV, people aren’t going to pay money for these things if it’s preventative. It needs to be free. … As soon as we get a shipment, we request another one from the California Department of Public Health.”
Tobe said DAP Health is working to make naloxone as readily available as possible. Three hotels have agreed to have fentanyl-testing strips and naloxone in their lobbies, and DAP Health hopes to get naloxone vending machines—up to five of them—into local businesses this summer.
CJ Tobe said he’d like to see Desert Hot Springs and Indio as the next to desert cities added to the program. He’d also like for more vending machines to be placed in the community, including some that can be accessed all the time.
“We know getting access to these needed supplies and education and information in a vending machine at these businesses is going to be great for saving lives and getting people information on where they can access resources,” Tobe said. “It’ll be a vending machine that’s going to include Narcan, but also a lot of other supplies as well—Narcan/naloxone, fentanyl testing strips, HIV self-test kits. … The harm-reduction vending machines are not going to offer syringes or pipes. Instead of putting in money, you’re going to just fill out a short survey, because we’re going to want some data. After every completed survey, they’re going to be able to select three free items from that vending machine.”
DAP’s harm-reduction program is one of three currently authorized in Riverside County—there’s one that serves Riverside, and another in the Hemet/Temecula/mid-county area—and it’s authorized only within Palm Springs’ 92262 zip code.
“We want to expand to other desert cities across the Coachella Valley that would benefit from this program,” Tobe said. “We currently do provide Narcan/naloxone and fentanyl testing strips out of our satellite clinic in Indio. We want to amend our license at some point in the future to include other desert cities specific to the syringe-service aspect.”
Tobe said he’d like to see Desert Hot Springs and Indio as the next to desert cities added to the program. He’d also like more vending machines to be placed in the community, including some that can be accessed all the time.
“We want to move vending machines outside of businesses and strategically place them for 24-7 access in the community,” he said. “Where those are going to go depends on conversations with city leadership, the police department, the fire department and emergency response on where they think these vending machines should go. … Maybe outside of a library; maybe it’s going to be in a park. Maybe it’s going to be outside DAP Health, or a Revivals store. It’s going to be a conversation to get feedback and buy-in.”
While the community has been largely supportive of DAP’s harm-reduction program—including positive comments by city leaders and Police Chief Andy Mills—some downtown business owners have expressed concerns about the optics of having a mobile clinic offering syringes, naloxone and fentanyl-testing strips in busy areas packed with tourists, like Arenas Road. I asked Tobe how he responds to such concerns.
“The location we picked on the corner of Arenas has been one of the most engaged locations with the unhoused population, or anybody really needing these services, including people who may be walking into one of the establishments who stop by and grab Narcan or naloxone, because they’ve been watching the news, and they’ve seen that there have been so many deaths due to overdoses that they want to be proactive. They want to just have the conversation about, ‘OK, what can I do to save a life?’”
For more information on DAP Health’s harm-reduction program, visit www.daphealth.org/harmreductionfaq.
I’m proud to have volunteered 8 years for DAP, serving 5 years on its Community Advisory Board. I had learned from a number of local HIV Specialists that well over 50 percent of their patients are using and abusing Meth and other substances. It seemed that DAP Health offered very few substance abuse services even knowing of the tremendous need. I am delighted that the situation has changed very much for the better. CJ Tobe has been a great leader at DAP and has developed, with the support of DAP leadership, many needed and important substance abuse and harm reduction programs. Caring for a community means addressing all its needs, pretty and not-so-pretty. I am so pleased that DAP Health is moving very much in the right direction. They listened.