Last July, in a little house in Ashburn, Virginia, Nichole Causey’s son told her he was going to take a shower. Causey, who owns a small business that does window tinting for homes, was working on her laptop in the living room; her son, Kyle, headed to the bathroom, which adjoined Nichole’s first-floor bedroom. A few minutes later, Nichole heard a strange sound coming from the bedroom, a kind of guttural grunt. When she went into the bedroom, Kyle was lying on her bed, seemingly asleep, entirely naked.
“I was embarrassed,” Nichole said when I met her more than a year later, in the Shenandoah Valley town of Staunton, Virginia, where she now lives. “It’s weird to see your grown child butt-naked. I hadn’t seen him like that since he was 6, 7 years old.”
Kyle was 23 that July day. Nichole covered him up with a blanket and went back to the living room. Kyle had struggled with drug addiction for several years, and she assumed he had passed out. “I figured he just needed to sleep it off,” she said.
But after a minute, she returned to the bedroom. The noises he was making were disconcerting. And when she shook him, he didn’t respond. Kyle was not asleep. He had overdosed, and the opioids in his bloodstream were blocking his brain’s commands to his body to breathe. He was suffocating.
If you’re a parent of a teen, you may have already read a number of stories like this, terrifying articles about parents discovering their children after an overdose. The articles feature grim photos of the survivors looking into the distance, and are full of dire warnings about how the opioid epidemic has struck families: the athletes who get hooked on medication, the students who buy what they think is one Adderall pill from a guy on Snapchat and drop dead in the front yard. Moms and dads I know pass these stories around helplessly, discuss them in person, turn over and over in their minds every parent’s worst nightmare: a child dead in a moment, due to a single mistake.
This is not that kind of story. That’s because Nichole Causey had, in her kitchen cabinet, a miracle medication called Narcan. She saved Kyle’s life with Narcan, which is simple to administer and works nearly instantly to reverse an opioid overdose.
When I tell parents in my community about Narcan—the brand name given to the anti-overdose drug naloxone—they can’t believe what they’re hearing. Narcan nasal spray has no side effects, cannot harm anyone, contains no opioids. All it does is save lives.
It’s true that I, and many of my suburban friends and neighbors, have been sheltered from the worst of the opioid epidemic. What is eye-opening to us surely seems like eye-rollingly old news to people in other parts of the country, places that have seen the epidemic ravage their communities—places like Carter County, Tennessee, where children as young as 6 are taught to administer Narcan. But the combination of cheap fentanyl and social media is transforming America’s opioid problem in ways that make it more dangerous than any drug epidemic the country’s ever seen. In addition to still-growing numbers of overdoses killing people suffering from drug dependency, nonhabitual drug users are now dying in waves from single pills purchased on apps like Snapchat and TikTok. Stories like these begin to explain why the number of U.S. teenagers who died from fentanyl soared from 253 in 2019 to 884 in 2021.
“When people hear the words fentanyl and overdose, what they understand is the old war on drugs, and people suffering from addiction,” Chris Didier, whose son died at 17 after taking a counterfeit Percocet he bought online, recently told the Washington Post. “And not to take away from those who struggle with substance abuse, but the new demographic is people who unwittingly consume fentanyl thinking they are taking a harmless product, and they don’t really understand they are taking a huge risk.” In 2021, the Drug Enforcement Administration issued a public warning about counterfeit pills. “The amounts are staggering,” DEA Administrator Anne Milgram said. “The counterfeit pills are driving so much of it.”
Parents reading these stories feel helpless and overwhelmed. Your child could die from a single pill, in your house, before you even know there’s a problem. If you’re one of those parents, I’m here to tell you that there’s a simple, safe medication you can get that can protect your children and their friends. Narcan can save their lives. And there’s a good chance your local government will give it to you for free.
“Grab a person’s earlobe and drive your fingernails together as hard as you can,” Jim Dooley said. “If the person doesn’t respond at all, there’s no set of benign circumstances that would explain this behavior. This person is dying.”
Dooley calls himself Jim the Narcan Trainer. A volunteer for Arlington County, Virginia, he sets up a table at street fairs, neighborhood parties, and county events to spread the gospel of Narcan to anyone who’ll listen. On this fall afternoon, he was in his living room with Christal Platt, a counselor and mother of two teenagers, training her how to use Narcan.
Dooley has white hair and a soft, reedy voice. He lives in a modern, Minecraft-looking house in Arlington; on the wall of his living room is a certificate recognizing his work for the Intergovernmental Panel on Climate Change, which won the Nobel Peace Prize in 2007. Dooley was a U.S. government climate scientist until he quit in 2014. “It’s good for my soul,” he said of the essentially full-time role as Narcan evangelist he’s taken up since then. “Saved me from a bad heart attack, and bad bosses.”
The one-hour training he was giving Platt was an extended version of the 10-minute spiel he’d given me that summer at a neighborhood yard sale. In both, he focused on a few crucial points. In Virginia, as in many states, you are not at any risk of a lawsuit or prosecution if you try to help someone suffering an overdose. Narcan should be used immediately on anyone who is totally unresponsive. All you do is open it, stick it in the person’s nose, and squeeze the dispenser once. That’s it. If they are suffering an opioid overdose, within a minute, they will be awake.
Platt met Dooley at the farmers market one Sunday morning. She was worried, she told me, about her kids throwing parties where pills might make an appearance: “If they want to find a way, they will.” She said that her primary worry about Narcan was that she might hurt a child by giving them this medication, if it turned out they were not suffering from an overdose.
“So there’s no danger from using it if it’s something else?” she asked.
“The only thing this medication does is save lives,” Dooley said. “No side effects. Any paramedic, the first thing they’ll do if they come up on you and you’re unresponsive, they’re going to give you Narcan. Because there’s no downside.”
Dooley picked up a torso-sized dummy of the type you’d see in a CPR class. He acted out a scenario in which the dummy was an unresponsive person: talking to them, shouting at them, shaking them by the shoulders, pinching their earlobe. “So you call 911,” he said. “What I really encourage you to do is instead of asking 911, ‘What should I do?,’ you just take action. You don’t need to have a conversation about ‘What’s her respiration look like,’ ‘What’s her skin color look like.’ ” Dooley made a let’s move things along gesture with his hands. “You know this person is in trouble. You tell 911: ‘I’m at the central library. There’s a person here having a medical crisis. I have Narcan. I’m gonna give it to her.’ ”
He showed Platt the Narcan, a small plastic bottle with an applicator at one end. “This contains one dose, and only one dose,” he said. “So if you squeeze it to check if it works? Now it contains zero doses.” He stuck the applicator up the dummy’s nostril and squeezed once. “That’s it. Now you stand back. When they come out of it, they are not going to feel good. All they need from you is for you to be kind.”
At the end of the training, Dooley handed Platt a box containing two doses of Narcan. She signed and dated the box. “I’m going to see if I can find, like, a cute little bag for my Narcan,” she said.
The leading edge of drug safety policy has long moved past the abstinence-only messages I recall from my high school days. The watchword now, sensibly, is “harm reduction”: policy and tools that make it more likely that people who take opioids, on purpose or accidentally, are less likely to die from them. Narcan is the most crucial tool in the harm reduction arsenal. Just in my county, Arlington, the police department counts 65 lives saved so far in 2022 by Narcan. The county will give you free Narcan after a short training performed by Jim the Narcan Guy or a number of other county employees and volunteers. Any pharmacy in Arlington will give you Narcan without a prescription, and your health insurance should pay for it, thanks to a standing order in the state of Virginia. Every library in Arlington has Narcan in a little box next to the defibrillator.
“It’s not some weird fringe medication,” said Ginny Lovitt, head of a Virginia harm-reduction foundation named after her brother, who died of an overdose in 2013. “It’s starting to be everywhere.”
Nichole Causey had gotten her bottle of Narcan at a local pharmacy in Ashburn. Last July, she ran to grab it from the kitchen cabinet while dialing 911. “It was very surreal,” she told me. “It’s a crisis, but it doesn’t feel like a crisis.” Kyle was still making the weird snoring-like noise, which Causey now understands was a well-known danger sign called the “death rattle” by Narcan trainers like Dooley. She checked Kyle’s blood-oxygen level with a pulse oximeter she’d bought at the beginning of COVID: 50. That’s not good, she thought.
The 911 dispatcher kept asking her questions. “Can you tell me how frequently he’s breathing?” “Can you tell me what he might have taken?” Causey says she remembers feeling unbelievably annoyed with the operator, even though she knew she was just doing her job. “She’s walking me through a protocol, but every second counts.” She kept telling the operator she wanted to give Kyle the Narcan, but the operator kept telling her to wait. “Finally, after two or three times, I just was like, Fuck it. I’m giving it to him.”
She remembers it took Kyle less than a minute to completely wake up. Coming out of an overdose with Narcan is not a comfortable situation, Kyle told me. Your body has essentially been forced into instant withdrawal. “That’s like the flu times a thousand,” he said. “Your bones hurt.” But by the time the ambulance arrived, he’d put on some clothes and was sitting in the living room.
“I don’t think they would’ve gotten there in time,” he told me. “It took them a while.”
The crew helped Kyle into the ambulance, and Nichole followed them to the hospital. In the ER, a doctor turned to her and said, “Nice save, Mom.”
So you’re a parent of a teenager. Maybe your child has used drugs. Or maybe your kid just goes to parties sometimes; you think there’s probably some drinking; you hear stories of pills. How can you get trained in Narcan, and get a bottle to keep in your kitchen cabinet?
The first thing you should do is Google to see if your local health department offers free Narcan training and distribution, or can refer you to a community organization that does. You’re also almost certainly entitled to walk into your pharmacy and get Narcan without a prescription, although that may be news to your pharmacist. Even though every state in the country has waived the prescription requirement to get a box, not every pharmacy carries the medication, and not every pharmacy clerk knows (or follows) the rules. As Jessie Singer points out in her book There Are No Accidents, a 2018 study of California pharmacies revealed that fewer than 1 in 4 were willing to distribute Narcan without a prescription; in Texas, half the surveyed pharmacies refused to bill insurance for Narcan. (Without insurance, Narcan typically costs more than $100 a box, though an online service like GoodRx can cut that cost substantially.) Only half of Michigan pharmacies have signed on to the state Narcan distribution program, according to a recent survey. A University of Michigan ER doctor noted that decisions like this come from “not prioritizing this population as being important” because of the stigma around drug use and drug treatment.
The SAFE Project, another nonprofit founded by the survivors of an overdose victim, has compiled a useful state-by-state guide to rules and regulations, as well as links to many local community organizations. If a family member is at risk and you can’t find affordable Narcan anywhere in your community, an organization like NEXT Distro can help; they mail free Narcan to at-risk people without insurance and without another way to get their hands on the medication. But many cities and towns have active and engaged health departments, filled with people like Jim Dooley who would love nothing more than to teach you about Narcan and hand you a box for free.
So: Get trained. Get a box. (You don’t need to hoard doses. One box is enough.) Tell your kids what it is and what it’s for, and encourage them to get trained. (Teens can, and should, get trained in Narcan.) Urge them to bring Narcan with them to parties, to concerts, on road trips. Make sure your local pharmacist knows that you want her to stock and supply Narcan to those who need it. Email and call local officials to make sure that Narcan is available in public buildings and in schools. Heck, why not bring a dose with you wherever you go, maybe in a cute little bag?
And tell the other parents in your neighborhood what you’ve done. Yes, you want them to know that this medication exists, medication that might save the lives of the kids you’ve known since they were little. But just as important as that is to spread the gospel of harm reduction, and to battle the stigma attached to the disease of drug dependency. “When drug use is stigmatized, the risk of overdose increases in myriad ways,” Singer writes, and so every step each of us takes to erase that stigma can help save lives.
It’s important, most of all, to do away with the idea that having Narcan is some kind of endorsement of illegal behavior. “You’re not inviting drugs into your house by getting Narcan,” Ginny Lovitt told me. “No one buckles their seat belt and thinks, ‘Finally, I can get in a car crash!’ ” There’s no stigma around a car crash, she pointed out, so everyone willingly engages in a practice to help them survive if something goes wrong. “That’s what harm reduction is,” she said. “It’s seat belts.”
I don’t know that I’ll ever need to use the box of Narcan in our kitchen cabinet, or the ones that I’ll send to college with my kids. I sure hope not. But having them, and knowing how to use them, and knowing they know how to use them, is incredibly empowering. So much of being the parent of teens is feeling helpless about the many, many dangers that face them. “There’s so many things we can’t do anything about,” Lovitt said. “But Narcan is so simple. It’s miraculous.”
Toward the end of our conversation, Nichole Causey echoed that sentiment. “The thing Narcan gives is hope,” she said. “Because otherwise I would’ve been standing there watching him die.”
In the end, Nichole Causey’s story wasn’t every parent’s nightmare of a fatal overdose. It isn’t the perfect happy ending you might hope for, either. Kyle is still an active drug user; he’s years into an addiction that has taxed his mother’s resources and upended her life. Nichole moved to Staunton because Ashburn, the house, her old life—they all held too many difficult memories.
And yet it is, also, a happy ending, even if a precarious one. “He’s a good kid,” Nichole told me. “Charming. Winsome. He knows how to make you smile, even when you don’t want to smile.” And, she added, he’s alive.
