Noam Barnard saved someone from dying of a drug overdose just 45 minutes before being interviewed for this story.
“It’s been a day,” he tells CityBeat. “Fortunately my neighbor saw what was going on and called me. I was having lunch with my girlfriend and we ran over quickly, and that person is alive right now.”
Barnard is an organizer for the Coalition for Community Safety (CCS) in Cincinnati. He’s the go-to guy on his street in Clifton Heights for naloxone (brand name Narcan), the nasal spray used to stop a drug overdose. But he doesn’t just keep an eye on the people struggling with substance abuse disorders in the park; Barnard also is leading an effort to arm the city’s bartenders with the tools and training needed to stop accidental drug overdoses.
“The real issue right now is that party drugs of all sorts are being cut with fentanyl,” he says. “The risk is so high, especially if you’re buying from someone you don’t know or you vaguely know. Unless you’ve been following that stuff since Bogotá, it’s not safe.” (Colombia, which is where Bogotá is located, produces 90% of the cocaine in the United States, according to the U.S. Drug Enforcement Administration.)
In February, a message went out on the SOAR app alerting users to a bad batch of cocaine laced with fentanyl going around in downtown Cincinnati (SOAR stands for “Safety, Outreach, Autonomy, Respect”). The app, which was developed by Ohio State students in 2019, offers an anonymous route to reporting laced drugs in Ohio. It also sends push alerts detailing bad batches of nearly every illicit drug, all laced with an unknown level of fentanyl.
According to Harm Reduction Ohio, a nonprofit that tracks Ohio drug data, 35.9% of Ohio’s illicit drugs contained fentanyl in the last quarter of 2021 — a 10% increase from earlier in the year. AmandaLynn Reese, director of outreach and engagement for Harm Reduction Ohio, said supplies of common party drugs — like cocaine — laced with fentanyl have been sneaking up on those who casually take hits.
“There are people hitting key bumps in the bathroom in OTR and hitting the floor,” she says.
Officials from Harm Reduction Ohio say that around 5,300 Ohioans died of an overdose in 2021, and 1,497 of those deaths were cocaine related. Data from the Ohio Department of Health on mortality shows that at least 1,083 of those cocaine deaths were caused by laced fentanyl.
“That’s a lot,” Reese says. “That’s a lot of Ohioans, and that’s a lot of people who loved those people.”
Hamilton County is one of Ohio’s top 10 counties for overdose deaths as a result of cocaine, according to data analyzed by Harm Reduction Ohio. Reese says that at least 15.2% of the cocaine examined by the state’s crime lab contained fentanyl in 2021, so there is no way to know what you’re buying without testing.
“If you have a baggie of powdered sugar and flour and you shake that baggy up and you draw it out into lines like you would cocaine, you’re not going to know how much sugar or flour is in those lines,” she says.
Reese theorizes the pandemic lockdown at the nation’s borders caused changes to the drug supply chain, forcing domestic dealers to bulk up with synthetics like fentanyl.
“I saw a huge increase after the pandemic hit and the borders were closed,” she says. “When the borders closed and other drugs struggled to get into the United States, you could make (fentanyl). You could make it right here.”
The data from Ohio’s crime lab shows an uptick in fentanyl appearing in other drugs right at the onset of the pandemic, jumping from 21.8% to 29.5% in the second quarter of 2020. That number remained steady until the end of 2021, when lacing hit a record high of 35.9%.
But Reese says Ohio’s high overdose death rate gives the state a false image of heavy drug usage.
“Ohio, specifically, does not have a drug use problem,” she says. “We actually are very, very low on the drug users per capita compared to other states.”
The overdose numbers and drug use figures seem at odds with each other at first glance. The Centers for Disease Control and Prevention lists Ohio as having the fourth highest overdose death rate in the country, while a national survey on drug use from the Substance Abuse and Mental Health Services Administration finds that Ohio ranks 25th in the nation for drug usage.
But to Reese, this means Ohio has one of the most fentanyl-laced drug supplies in the country.
“We are seeing it in pressed pills that look very real,” Reese says. “We’re seeing Adderall and Xanax and pain pills of every variety that are laced with fentanyl. Cocaine is often laced with fentanyl, meth is often laced with fentanyl. People don’t know that’s what they’re using. People who have smoked crack-cocaine for 30 years are being introduced to fentanyl totally unaware.”
Fentanyl is tasteless and colorless, with no smell or discernible features, which is why Reese encourages those who use drugs to test their batches before using.
“People are always going to use drugs; we just want them to know how to use them safely,” she says. “Everyone is always preaching about recovery or abstinence, and the reality is that people are going to use drugs. People have autonomy. It’s just about teaching people the skills they need to stay safe.”
The standard protocol to test a batch of drugs for fentanyl involves dissolving a small amount of the drug in water and dipping a detection strip into it for 15 seconds. The strip then is placed on a flat surface for five minutes, when colored lines will indicate whether or not fentanyl is present. Typically, one line indicates that there is fentanyl in the drug and two lines means there isn’t, but packaging will show instructions and how to determine if the test was valid.
Harm Reduction Ohio supplies fentanyl test strips to Barnard at the Coalition for Community Safety, who then distributes the testing supplies, along with naloxone, to anyone in the city who wants it.
At first, CCS approached bars in 2021 to propose Narcan training. But lately, the bars have been reaching out to them, Barnard says.
“I’m not going to stop people from doing drugs in the bathrooms of bars and nightclubs,” Barnard says. “If we can put test strips out there and make the stigma go away about people being afraid of that, I think a lot of people might stay alive.”
One of the latest bars to go through training is Somerset in Over-the-Rhine, where Emma Robinson is a manager. She says that in order to save lives, staff members have to be realistic about what intoxicated people do.
“What people do to chill out and have a good time is not our business, but it’s becoming our business because our friends are dying,” she says. “And it is so prevalent and it does go hand-in-hand with drinking culture and alcohol culture.”
Robinson initially was nervous about being responsible for giving someone naloxone, but she says the CCS training was easy for the entire Somerset staff.
“I was so anxious about doing the Narcan training,” Robinson says. “But afterward I was like, ‘Oh? That’s it? Well yeah, let’s fuckin’ do this.’”
During Narcan training, participants learn what an overdose looks like, how to watch for signs of a potential overdose and what to do in such an emergency. Guides walk bartenders through how to administer both nasal spray naloxone and injectable naloxone, no matter which form they’ll have on hand.
The bartenders then learn what types of reactions to prepare for and are told to call 911. They also get a rundown on how to use fentanyl testing strips.
While Harm Reduction Ohio and CCS require a quick training session for those who stock up on naloxone, Barnard says people should not hesitate to use it, even if they’re not totally sure a person is overdosing.
“Narcan is not going to hurt you otherwise,” he says. “I could physically spray some in my nose right now, and while it might be uncomfortable, it would not affect me in any way, shape or form.”
Identifying an overdose might not be obvious to everyone, but Barnard says there are signs to look for.
“They’re going to have extremely dilated pupils, even in dark light their pupils will be very small,” Barnard says. “Another thing to look out for is lips turning blue. What happens with opiate overdoses is it kind of shuts down your respiratory system and ultimately you choke to death, which is horrifying, but it’s an obvious sign when you see discoloration in the skin. They might have a hard time breathing. Even if they don’t smoke cigarettes, it might sound like they smoke two packs a day.”
Naloxone is the only thing that will stop an overdose that’s in progress, but Barnard says fentanyl test strips are the other necessary piece of the harm reduction equation.
”There’s been situations where someone is secretly doing party drugs where they aren’t supposed to, and suddenly someone’s experiencing a fentanyl overdose,” he says. “The test strips are there so if you happen to be engaging in an activity like that, at least take a few minutes and test it and make sure you’re not going to accidentally die.”
Some restaurants and bars are providing fentanyl detection strips to encourage safety. A sign in the restroom at OTR Chili points to where guests can grab some.
“We did this the weekend after the Super Bowl,” says Aspen Barbro, head server and bartender at OTR Chili. “We get a late-night crowd on the weekend, and it is kind of more like an industry crowd where drug use is more common. I just wanted to make sure we’re keeping our city and our industry safe.”
The bathroom at OTR Chili is open to the public and is often used by people waiting in line to get into Rhinegeist Brewery, which Barbro says adds to the need for test strips.
Barbro says the signs in the restroom have raised a few eyebrows during the daytime hours, but the business has fielded no complaints so far.
“A couple suburban moms have asked, but no one’s really pushed back and been negative about it,” she says.
Across Elm street at e19 Lounge Bar & Discothèque, management has removed fentanyl test strips from the restrooms until new staff members can go through Narcan training.
Zach Shumate, the club’s new general manager, says the strips will be back.
“We are prepared for it,” he says. “None of us are strangers to hearing about overdoses.”
“Obviously, we don’t allow illicit substances on the premises. That is not something that is a part of the culture that we just accept about this business. We’re trained to prohibit that use in our establishment,” Shumate added. “Fentanyl is going to be in something one way or another. We would just be ignorant to not have access to (testing).”
Managers at Comfort Station in Walnut Hills — a zip code with the highest overdose death rate in the state for Black men, according to data collected by Harm Reduction Ohio in collaboration with researchers at Ohio State University — are anxious to get their bar staff trained on Narcan administration.
“I would feel better having (Narcan) after knowing the training,” says Aaron Boyle, bar manager at Comfort Station.
Boyle says he has accepted the reality of drug use in bars.
“How many times have you heard somebody say, ‘I only smoke when I drink, I only do this when I drink?’” Boyle asks. “If the bar doesn’t have the testing supplies at the ready at that moment, you can always find somebody who has access to it.”
The demand for training and supplies is higher than ever for the Coalition for Community Safety, Barnard says. He is planning an event where more than 100 Cincinnati bartenders will receive naloxone training at once, adding that you don’t have to be a bartender or business owner to get the CCS training if you want to carry Narcan.
“The important thing is that as many people who can carry Narcan have it and know how to use it,” Barnard says. “In 10 years or so, I’ve seen a huge amount of personal friends of mine get taken away as a result of the opioid crisis. It’s disturbed me in such a way that I feel like something needs to be done.”
The free training session, which will take place on April 25 at Somerset (139 E. McMicken Ave., Over-the-Rhine), is aimed at those in the hospitality industry, but Harm Reduction Ohio’s Reese says anyone is welcome to join. It will include information on how to administer Narcan, basic CPR and anti-stigma information, per the event description from CCS. Learn more and find out how to register at instagram.com/cincyccs.
Robinson at Somerset says there is a cultural shift happening within the service industry in Cincinnati, and bartenders are largely on the same page about being the first line of defense against drug overdoses.
“We have a solution. It’s a short-term solution to something that’s a much larger and more complicated issue, but it’s here,” Robinson says. “I think where we’re at now in Cincinnati, because we’ve seen so much loss and so many issues and so much sadness from laced party drugs, I think so many people in our community and in our city of Cincinnati are saying, ‘You know what, we’ve had enough.’”
Harm Reduction Ohio offers free naloxone and fentanyl test strips on its website. Participants must complete a training video to place an order. Those who are looking for in-person training and supplies can email CCS at [email protected]
Naloxone and test strips are also available through other local organizations and even pharmacies. Greater Cincinnati HIV/AIDs service organization Caracole has a harm reduction supply vending machine available 24/7 at its Northside headquarters that dispenses naloxone and test strips for free. First-time users need to fill out a survey before getting a 90-day access code. The aforementioned SOAR program will also mail out five free fentanyl test strips via their website thesoarinitiative.org.
Drug stores such as CVS and Walgreens also dispense naloxone, though it is not free. Many insurance companies will pay for or reimburse people for brand-name and generic naloxone, but those without insurance are on the hook for a $90-$140 charge, pharmacists tell CityBeat.
For more information on Harm Reduction Ohio, visit harmreductionohio.org. Follow the Coalition for Community Safety at instagram.com/cincyccs.