Public overdose deaths in Denver turn bystanders into first responders

Z Williams was jogging on the edge of Cheesman Park when they noticed a man lying among the trees along East 8th Street. It was June 6, one of the first nice days of a rainy summer, and Williams figured the man was resting in the sunshine.

But from a closer vantage, Williams could see that something was wrong. The man’s skin was gray and pale. He wasn’t moving. Syringes lay in the grass next to him.

Williams knew how to respond, unlike many of the grocery store workers, baristas, bartenders and other Denverites who find themselves unwittingly on the front line of the state’s overdose crisis. Even while out for a jog, Williams was carrying naloxone — enough to give the man two doses of the overdose antidote.

“Then I looked at his face and could tell he hadn’t been breathing, and I knew it was a pretty long shot,” said Williams, who uses they/them pronouns.

An ambulance crew pronounced the man dead at the park.

As Denver’s drug crisis escalates and overdose deaths in public spaces rise, Williams is among the increasing number of bystanders who have been thrust into the role of first responder. The number of people who died of overdoses in Denver public spaces more than tripled between 2018 and 2022, data from the city’s Office of the Medical Examiner show. Eighty-seven people overdosed and died in Denver’s public spaces in 2022 — up from 26 such deaths four years earlier.

This year is on pace to be even more deadly. At least 72 people overdosed and died in public during the first six months of 2023. They accounted for more than a quarter of all 265 drug deaths in Denver in that time period.

People have died in bars, in bus stations, in parks. They have taken their final breaths in a city recreation center, a liquor store, a church. In parking lots, rail yards and alleys.

The increase in public deaths is thrusting the overdose crisis further into public view, and into the lives of passersby, as city and state leaders grapple with how to respond. More and more, retail and grocery workers are the ones finding people slumped over or cold. Joggers and commuters administer first aid and call 911.

“You’re walking around and you’re like, ‘Somebody should do something and see if that person is OK,’ ” said Lisa Raville, the executive director of the Harm Reduction Action Center, which provides clean needles and supplies to drug users; its staff has responded to dozens of overdoses. “And you look around and you’re like, ‘Oh, actually, that’s me.’”

As the potent and fast-acting opioid fentanyl has come to dominate the drug supply, it has increased daily drug use for people who use it and sent overdose rates surging. Just under 1,800 Coloradans overdosed in 2022, a slight drop from the year before but well above pre-pandemic years. Denver’s overdose rate so far this year is 16% higher than last year at this point — raising fears that the plateau may have been a false peak.

State lawmakers, as they attempt to address the overdose crisis, are weighing several bills to increase treatment access and curb the death. One measure would allow supervised drug-use sites to open in willing Colorado cities. Legislators set aside nearly $20 million last year to purchase naloxone, the opioid overdose reversal drug, in bulk. More than 250,000 doses were distributed in the state between July 2022 and March 2023.

It’s unequivocally a positive step that more people carry naloxone and can prevent overdose deaths, experts and advocates said.

Though exact data is difficult to corral, hundreds of overdoses in Colorado have been reversed thanks to naloxone administered by members of the public in recent years, according to data from OpiRescue, a smartphone app that allows users to report naloxone use.

But as a result, an increasingly large swath of the public is exposed to the critical responsibility and trauma of attempting, and at times failing, to save someone’s life.

“We can’t overstate the impact of coming upon an unresponsive person has on that community member,” said Kim Gorgens, a psychology professor at the University of Denver. “It’s a traumatic experience — I mean capital-T traumatic — and warrants really special attention for that person.”

Williams had started running because their job — as co-director of a social justice legal center — is stressful. Since discovering the man in the park, they jog less often, and never at Cheesman. Williams had weathered overdose deaths before, as an EMT and within their own family.

This death reactivated those past traumas.

For a time, Williams saw the man’s discolored face every night before drifting to sleep. They know the standard response from some people is, “He used drugs, what did he expect would happen?” But Williams wants the public to see that man in Cheesman Park the way they’d see any other community member struggling for help.

“How do I treat this person in a way that I would want my loved ones to be treated if it was them?” Williams said.

“Larger community trauma”

One day last summer, Danny McCarthy was getting ready to turn right onto Colorado Boulevard, headed to lunch with his wife and infant daughter after an early afternoon doctor’s appointment. He’d maneuvered around a car that had stopped abruptly at an intersection just off of the busy main street.

Just before he turned, his gaze lingered on the car for a moment.

The driver’s seat seemed to be empty. But in the split second before McCarthy turned, through the car’s tinted windows, he could make out a shape slumped against the driver’s side door.

“Oh (expletive),” McCarthy thought. “There’s someone in there.”

He pounded on the car’s windows, but the driver didn’t stir. Another man who’d stopped smashed through one of the car’s windows with a hammer taken from his work van. A third man, an off-duty paramedic, climbed into the car, shifted it into park and began massaging the driver’s sternum — a painful technique used to spark a response from a person who may be unconscious or overdosing.

As McCarthy watched the off-duty paramedic and then an ambulance crew work to revive the driver, he felt “pretty worthless,” he said. He realized he didn’t know what else to do.

The hypotheticals have played out in his mind: What if he hadn’t looked over before turning, hadn’t lingered for an extra second, hadn’t stopped to pound on the man’s windows — what then?

Like others interviewed for this story, McCarthy doesn’t know the name of the stranger he tried to save. He later called the police officer who’d responded to the scene and asked about the man’s condition.

The driver had recovered, and the officer hinted that it was an overdose.

“It was just lucky I was at the right angle” to recognize a problem, said McCarthy, who works as a lobbyist. “Maybe someone else would’ve freaked out and kept driving and not known what to do. I hope folks wouldn’t do that, and I don’t know if I’m necessarily in a position to pass judgment, because … none of us are being asked and consenting to take that on.”

Burden is “too heavy” to shoulder alone

Responding to an overdose is inherently traumatic for anyone, said Gorgens, the psychology professor.

Medical professionals with training — and who expect to become involved in situations like that — can struggle. It’s even more difficult for people who lack training and a community of people with similar experiences to share with, Gorgens said.

“It’s the kind of thing that we’re expected to carry alone,” Gorgens said, “and it’s too heavy for that.”

Raville, the harm-reduction advocate, has responded to several overdoses. She ticks off the times that her staff has had to sprint up city blocks because someone reported a possible overdose nearby. Her small staff alone has now tallied up to 36 reversals, she said.

Even as an expert and front-line advocate, Raville is not immune to the trauma. For a week after she provides first aid to someone who’s overdosing, she said, she sees that person’s face whenever she closes her eyes. She regularly gets calls from people asking for a therapist recommendation. Williams came to her after finding the man in Cheesman, and Raville told them to have a plan to sleep.

“Are we in the industry? Absolutely,” Raville said of the center’s staff. “But are we also not human? That (expletive) with your sleep. The grief is wild. For us, the grief on the front line is that we don’t have time to grieve because so many people are coming through. Then you feel guilty for … grieving one person over another, and you take it home with you at night.”

“I can only imagine the larger community trauma,” she continued.

Still, it’s critical that people stop and intervene if they believe someone has overdosed, advocates said.

“We risk getting so depersonalized to each other … that you assume someone else is going to address the problem,” Gorgens said. “That’s a luxury that the Starbucks worker or the grocery store worker or librarian doesn’t have.”

“I don’t want to find someone dead in there”

Krystal Espindola had been working for King Soopers for more than seven years when she found a woman lying on the floor in a store bathroom.

Foil, a BIC pen and a lighter were on the floor next to the woman.

“Just the way she was lying on the ground, I knew that something was wrong,” Espindola recalled.

She and a manager for the grocery store, at East Hampden Avenue and South Monaco Parkway in Denver, called 911. After paramedics took the woman away, Espindola went home.

“I didn’t want to go to work for a few days, not knowing what I would find in the bathroom,” she said.

Six years later, her husband would be exposed to drugs in a different King Soopers bathroom.

Mario Espindola was using the restroom at work in November when he smelled a metallic odor and saw a glass pipe shattered on the floor.

“My heart was beating so fast, I could see it through my shirt,” he said.

Since then, the 50-year-old has been afraid to use the bathroom at work. He will wait painful hours for his shift to end so he can go home and relieve himself without having to worry about being exposed to drugs.

“What gets me is, I don’t want to find somebody dead in there,” he said. “I like my job, but I don’t like going there because of this. I feel angry about it because it’s not just me that I’m speaking for.”

As the overdose crisis grows, Raville has provided training sessions on how to recognize and respond to an overdose. She’s given training to bars, legislators, halfway houses, schools, policymakers, coffee shops, professionals and other de facto first responders of Colorado’s overdose crisis.

She estimates she provides between five and 10 trainings a week.

The act of getting trained is a way to embrace the diffused responsibility that comes with addressing the crisis, Raville and Williams said, and it’s acknowledgment of the current reality. But not everyone is sure that everyday workers should be tasked with that responsibility.

Grocery stores have locked their bathrooms and changed the lighting inside them to make it more difficult for users to use drugs, union officials and workers said. Workers encounter drug use — a lingering smell, an unconscious user, discarded needles or pipes — on a daily basis, said Kim Cordova, the president of the local United Food and Commercial Workers union.

“Nobody signs up to sell groceries thinking you’re going to see that,” she said. “There’s no training to deal with it. You’re afraid to go to work.”

Should workers learn how to use naloxone?

Cordova said the union has debated whether it wants members trained on how to administer naloxone. On the one hand, Raville and others say, it’s better to be educated than not — especially if drug encounters are a daily occurrence. A key provision of the state’s overdose response is getting overdose antidotes into the hands of as many people as possible.

“What I like about it is it says, ‘I have a responsibility for the people around me,’ ” Williams said. “In a society that’s taught us to be very isolated and very self-focused, seeing people worried about other people’s well-being — the thing with Narcan (is), you can’t use it on yourself, right? It’s inherently for someone else.” (Narcan is the brand name for naloxone.)

On the other hand, Cordova said, union officials aren’t sure they want their workers to have that responsibility. For one, they aren’t paramedics. She also expressed concern about the mental health impact of trying and failing to save someone’s life.

Or what if the overdose victim reacts violently?

And besides, Cordova wondered: Weren’t the grocery store chains big enough to address this problem without requiring grocery workers be deputized as first responders?

“You’re also understanding that our members care about their customers and their community, and they don’t want to see people dying,” Cordova said, adding: “But then you live with that guilt. The fact that workers are being put in that situation is really a problem.”

Riya Bunker was helping to close the day shelter for unhoused people where they worked when a client called them into the shelter’s main room. Inside, a man sat on a chair, drooling.

When Bunker shook his shoulder, he slumped backward — his pupils reduced to tiny pinpricks.

Bunker, who uses they/them pronouns, knew it was an overdose and ran for the Narcan in the office. But they’d never been trained on how to use it. Bunker and their supervisor panicked: Should they lay the man on the ground, as the instructions said? Or should they not move him, like their first-aid training had instructed?

“I was reading the Narcan instructions as this man was dying,” Bunker said.

They decided to call 911 and wait. Paramedics arrived within minutes and whisked the man away in an ambulance.

The day shelter staff called the hospital the next day to check on the man. He had died.

The overdose and death shocked Bunker. As the days passed, the shock faded into grief and guilt.

It broke their heart, they said.

“Afterwards, I felt personally responsible,” Bunker said. “Like, if I had taken the time to seek out training on my own, this wouldn’t have happened.”

The shelter hadn’t trained Bunker how to use Narcan or how to respond to an overdose, though part of her job was to make sure people weren’t using drugs in the facility. She responded exactly how she was trained — she called 911.

The man’s death inspired Bunker to seek training on how to use naloxone, and now they carry it everywhere. They make sure to check on people slumped over on the street to make sure they’re okay.

“Now I’m so passionate about harm reduction — and about the average Joe and Mary and Jane knowing how to use Narcan,” Bunker said. “So when they’re walking downtown with their friends, they can say: ‘Oh, that’s the signs of an overdose.’ ”

Drug users stand on front line amid policy debates

As grocery store workers, parents driving to lunch, and shelter workers find themselves thrust into a public health crisis, drug users have long sat squarely on the front line.

They are simultaneously most at risk of death and, often, in the best position to stop overdoses among other people who use drugs.

Two days before he sat inside the Harm Reduction Action Center in August, studying a bowl of oatmeal, Taron Jackson revived a man overdosing a few miles away.

Jackson, a meth user who’s been unhoused for the last six years, was on the corner of Alameda and Broadway south of downtown when he saw a crowd behind the Sinclair gas station. The panicked group stood around a man who was overdosing. His face was turning purple.

Of all the would-be first responders, Jackson was the only one with naloxone on him.

“I put it up his nose,” Jackson said matter of factly, “and he came back to life.”

Someone called 911, and an ambulance took the man away. Jackson went about his day, hanging around the streets and alley corridors of Broadway and the Capitol Hill neighborhood.

A former high school basketball player in Aurora, his substance use has escalated over the past two decades as the threads of his life have unraveled. His mother died in 2004. Then his father was murdered by Jackson’s best friend in a dispute over rent and a flatscreen TV, he said.

He’s starting smoking fentanyl, five to 15 pills a day.

He mostly keeps to himself and avoids more violent parts of the city. Jackson’s a little nervous about overdosing, he said, though he tries to keep his fentanyl use in check. His risk is exacerbated by the stigma he feels: He smokes in alleys alone to avoid the stares and glares of passersby. If he doesn’t, he can feel their eyes and sense the shifts in their body language when they see him.

He carries naloxone, but he can’t use it on himself. If Jackson were to overdose, he likely would rely on a stranger to save him.

“I don’t know. I don’t got too many friends,” he said. “People are quick to pass judgment against me.”

Legislators and policymakers struggle to find solutions for people like Taron Jackson, and the public nature of some drug use has divided advocates on both sides of the debate about how the state should respond.

For people like Raville and Williams, who found the man in Cheesman Park, the public overdoses are Exhibit A for why the state should embrace supervised drug-use sites.

For Cordova, and for many businesses as well as some Democrats and Republicans, public drug use is a sign of poor security and enforcement. It also raises concerns about risks to the general public from violence or contact with contaminated needles.

Policymakers in at least three states have authorized supervised drug-use sites to open. In Colorado’s statehouse, a Democratic-controlled committee in April narrowly killed a proposal that would’ve allowed cities to open such sites here.

That debate is likely to return this winter: Legislators, including one of the swing votes who sank the proposal in the spring, are drafting another bill that would give the state and local authorities more control over the facilities. That bill is being drawn up alongside at least four other proposals intended to curb the tide of overdoses and help drug users reach — and stay on — a path to recovery.

On Aug. 31, for International Overdose Awareness Day, activists and advocates hosted a die-in inside Colorado’s Capitol, lying down on the building’s rotunda steps.

Williams was there. They spent their day moving between the Capitol protest and a memorial event at the Harm Reduction Action Center for people who had died of drugs.

A wall on the outside of the building slowly filled up with photos and names of people who’d overdosed. Inside, a permanent memorial is gradually spreading over interior walls.

After trying to save the man at Cheesman, Williams placed a framed picture on the wall in his honor. They still didn’t know his name.

The memorial is an image of grass and a small piece of paper. Written on it is the man’s date of death and the words: “Rest well.”

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