An Overdose Antidote Goes Viral
Matt Pfisterer was in his office at a public library in Middletown, New York, when a colleague in the second-floor children’s room called to tell him that someone was sunbathing on the lawn outside.
This sounded odd to Pfisterer, who suspected it might be a medical situation. He headed outside, bringing along a security officer. In the grass, they found a woman drifting in and out of consciousness. Ants were crawling on her shirt. They ran inside, had someone call 911 and grabbed a naloxone kit. Pfisterer remembers his hands shaking as he got the medication ready and sprayed it into her nose. About 30 seconds later, she sat up.
The timing of the episode, which took place in 2016 at the Middletown Thrall Library, was fortuitous. Just three weeks earlier, a social services provider had offered a community training in administering naloxone, a drug that rapidly reverses opioid overdoses. Pfisterer, his assistant, and multiple security guards signed up. In recent years, as the nationwide opioid crisis had hit their small community 50 miles northwest of New York City, they had found themselves calling emergency responders several times to help overdosing patrons. “Before the general news is out, people in libraries know what’s going on,” says Pfisterer, director of the Thrall Public Library District. “They’re on the street, right? They’ve got their ear to the ground.”
Matt Pfisterer, director of the Thrall Public Library District in Middletown, New York, offers naloxone training to his staff. Credit: David Degner
The opioid crisis has tightened its grip on communities across America. More than 80,000 people in the US died of overdoses involving opioids in 2022 — almost quadruple the total in 2010. In response, people like Pfisterer are equipping themselves with the overdose-reversing drug naloxone with help from local governments and community-based organizations. The approach is turning high school students, transit workers and music festival staff into de facto first responders.
Efforts are building to tackle opioid addiction before it begins, and telemedicine policies from the COVID-19 pandemic make it easier for people to get treatment. But experts say there’s still a long way to go before the crisis subsides. In the meantime, naloxone is becoming a key tool for reducing stigma and saving lives. “We all have loved ones, family members, friends who may be experiencing problems with drug use,” says Magdalena Cerdá, director of the Center for Opioid Epidemiology and Policy at New York University Grossman School of Medicine, “so having naloxone readily available to respond is important.”
The opioid crisis has been mounting since the 1990s, when millions of patients began receiving prescriptions for powerful painkillers like OxyContin that had just come on the market. Over time, some people developed substance use disorders and turned to street drugs, particularly heroin, which was often cheaper than pills. Then, around the mid-2010s, a synthetic opioid started to spread: illicit fentanyl, easier to produce than heroin and up to 50 times more potent, making it much easier for people to accidentally take too much. What’s more, because fentanyl is cheap to make, it’s often mixed into other drugs, such as heroin or cocaine, or pressed into counterfeit pills meant to look like prescription medications. Fake pills are especially dangerous for an increasing number of people self-medicating with drugs bought through social media. From mid-2019 through 2021, 84 percent of adolescent overdose deaths involved illicit fentanyl and 25 percent involved fake pills, according to the US Centers for Disease Control and Prevention. People can overdose on fentanyl without even knowing they’re taking it. This has led to a particularly dangerous moment. “The main challenge is the lethality of the drug supply that is leading to an unprecedented number of people dying from overdoses,” says Cerdá.
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