On Dec. 10 of last year, Frank Altamirano was on his way to work at Civic Center Station. He’s a supervisor for Hunters Point Family, one of the nonprofits BART partners with to manage its system’s elevators. In the middle of morning rush hour, he was flagged down by a rider who’d found a man overdosing on the platform. Luckily, Altamirano had the tools to help. Rushing to his locker, Altamirano grabbed the overdose-reversal drug naloxone — also known as Narcan — and ran back to the man, who by that point “was turning blue and his pulse was almost non-existent,” as Altamirano put it.
The medication did the trick.
“What struck me was as soon as the naloxone hit, I could literally watch his chest begin to move as his heart started beating,” Altamirano said. “He woke up and I told him, ‘You’re playing with death, man.’ ”
The situation was made more profound for Altamirano due to a personal connection. He’d had a good friend overdose and die only months before.
Local TV media loves to sensationalize homeless people’s use of BART hallways to escape rain, cold, and wind. But behind every headline screaming about “junkies” is a serious public-health crisis. The safety of BART’s nooks and crannies, combined with the stigma around street-drug use, means that people who use frequently overdose alone and die on the Bay Area’s biggest transportation network.
This has been happening for years. We wrote about Jessica St. Louis, who died of an overdose at West Dublin Station last summer, and barely a month after her death a man’s body was found in a bathroom at Bay Fair BART Station in San Leandro. BART police — who are often first on the scene to discover a fatal overdose — have never had any tools at their disposal to help. While the paramedics BART contracts with carry naloxone, the officers themselves have not had access to the life-saving drug — until now.
“I think that we’re going to encounter more situations like this,” BART Board Member Bevan Dufty says of Altamirano’s effort. “The reality is law enforcement and police officers deal with all societal problems, whether it’s homelessness, substance abuse, or domestic violence. Giving officers a tool — not a punitive one, but a lifesaving one — is really a good thing. It’s a core construct of community policing and I’m grateful the chief is implementing it.
“I don’t think this is about normalizing usage,” he adds. “Open use simply shouldn’t be happening.”
Instead, Dufty says, people should be able to use in safe injection sites — an issue the BART Board has yet to vote on, but which he believes is collectively a “big supporter” of the idea.
Altamirano’s actions and the positive press surrounding it were no doubt key in arming BART officers with naloxone. In the past, when SF Weekly inquired with BART about the inaction, we were given several excuses: the physical logistics around carrying nasal naloxone (which measures three-by-three inches square), the training it required to administer it, and the erroneous perception that treating someone who’s overdosing could harm or kill the person administering the cure.
“There are considerations regarding the safety of our police officers administering medical services to a potential overdose victim,” BART’s Media Relations Manager Jim Allison told SF Weekly way back in August 2017, when we first asked why the department’s officers weren’t carrying the drug. “In June, the Drug Enforcement Administration issued the following warning regarding fentanyl: ‘There is a significant threat to law enforcement personnel, and other first responders, who may come in contact with fentanyl and other fentanyl-related substances through emergency or life-saving activities. … Any substance suspected to contain fentanyl should be treated with extreme caution, as exposure to a small amount can lead to significant health-related complications, respiratory depression, or death.’ ”
This was an unfortunate reference. Medical experts have time and again proven that the risk of exposure to fentanyl while treating an overdose victim is zero. The only risk of overdose would be if an officer found the drugs and consciously ingested them.
“Incidents where responders were treated for alleged ‘exposure’ were exhibiting symptoms of what appears to be anxiety or panic: dizziness, rapid heartbeat, sweating, even fainting — which are not symptoms of fentanyl overdose,” the Harm Reduction Coalition wrote in a paper on the topic. “Media accounts that are not based in evidence and journalists who fail to do their due diligence to ensure accurate reporting further perpetuate this dangerous misinformation. These stories cause very real harm — they perpetuate fear and stigma against people who use drugs resulting in negligent care, isolation, and diversion of resources toward law enforcement and away from life-saving programs.”
And this is where the key problem in BART police carrying naloxone lies. The language the transit department uses to describe addressing this life-threatening situation is still, even after the decision to carry the medicine, dehumanizing and problematic.
“Personnel administering Naloxone should make every effort to don personal protective equipment — Nitrile gloves, at a minimum — before contacting any infected subjects,” stated BART, despite the fact that no one experiencing an overdose can infect anyone else. Overdoses are not contagious.
As a result, harm-reduction professionals in the Bay Area are skeptical about this new deployment of naloxone, particularly since they offered resources and training in this area years ago, which the transportation agency never acted on.
“While I can appreciate that BART police are finally deciding to carry naloxone, it’s important to remember that people who use drugs and their loved ones are still and by far reversing the most overdoses in San Francisco, compared to any other group of first responders, including EMS and SFPD,” the Drug Overdose Prevention and Education (DOPE) Project’s Kristen Marshall tells SF Weekly. “If BART police were actually interested in the health and wellbeing of people who use drugs and live outside in the Bay Area, they’d examine the ways that those communities are over-policed and over-criminalized, and all the ways their agency plays an active role in perpetuating that harm. Carrying naloxone is the very least they can do.”
While the effectiveness of BART police in reversing overdoses remains to be seen — the naloxone training doesn’t start until March — adding a life-saving tool into their arsenal of supplies is unequivocally good. The primary responsibility of BART is to get people safely from Point A to Point B, and acknowledging the vast myriad of ways that safety can be compromised is a step in the right direction.