[The map above shows naloxone providers’ reports of whether naloxone confiscations from local clients are: Not a Problem (white); A Small Problem (green); A Medium Problem (yellow); or A Big Problem (red). The article provides a fuller explanation.]

The greatest tool that first responders and people who use drugs have in immediately combating an opioid-involved overdose—like those which killed almost 48,000 people in the US in 2017—is naloxone. Sometimes known by the brand-name Narcan, naloxone is available as a nasal spray or in muscle injection form and can be used by anyone after a short training. Naloxone is an opioid antagonist; it blocks opioid receptors in the brain and immediately sends a person who might otherwise die into withdrawal.

When a person overdoses on an opioid, their breathing slows to a stop. Two tell-tale signs are when their lips turn blue and they’re unresponsive to verbal or physical attempts to wake them. They might also fall in and out of consciousness before becoming completely unresponsive. Lack of oxygen to the brain leaves them at severe risk for brain damage and eventual death.

Naloxone has no dangerous side effects—although sudden withdrawal is highly unpleasant—and no effects if used on someone who did not take an opioid. It simply saves lives, and has already saved tens of thousands in the US.

Despite this vital and entirely benign purpose, kits containing naloxone are frequently confiscated from people who need it in certain parts of the country. These confiscations happen in locations including jails, hospitals and treatment centers. They are carried out by many professionals who should know better, but most often by law enforcement.

“Sadly it is a justified fear.”

“Almost every time we are distributing supplies there is someone who expresses needing them but being afraid that the police will arrest them for having them,” says a participant in Autonomous Harm Reduction of Evansville in Indiana. “Sadly it is a justified fear.”

Naloxone is not a federally controlled substance. Seizures of this lifesaving medication are therefore never legally necessary, and are driven both by ignorance and the kind of prejudice that prompts media questions about whether overdose reversal “enables” addiction. Every time a dose of naloxone is confiscated, the chance that someone’s life will be saved by it is removed.

“Any confiscation is … a huge problem in my opinion,” says Nicole Chimento, deputy director at Community Action for Social Justice in New York City. “Taking a life-saving medication from a person that is most likely to use it is appalling and reckless. I also think that this is a very under-reported issue. Most drug users are ‘used’ to this treatment from officers, so instead of reporting it, they just deal with it as if it’s expected.”

Asking Naloxone Providers to Report Back

To see where naloxone confiscations are being reported, I contacted 68 providers of the medication across the United States and received 40 responses. Most were needle exchanges that provide free opioid overdose reversal training. I asked each of these providers the same questions:

1. Do you keep a record of what happened to people’s naloxone kits when they come back for a refill?

2. Have people reported naloxone confiscations to you?

3. Are people currently reporting confiscations?

4. How severe is this problem in your area?

The map at the top of this article uses color-coded pins to reflect the responses I received to Question 4.

The good news is that the majority—21 of the 40 respondents—said that naloxone confiscation is not a problem in their area. Nine said it is a small problem; three called it a medium problem; and seven said it is a big problem.

The majority of providers kept records when giving out refills. Some said that it used to be a bigger problem but had gotten better in recent years—often because of meetings with police or government leadership, trainings with officers, or lawsuits against police departments.

Many pointed out the difference between intramuscular and intranasal naloxone as a factor that affects confiscations. In the context of negative attitudes and varying laws around syringes, muscle syringes and vials of clear liquid are more likely to be confiscated than a plastic nasal spray bottle.

Some Unexpected Variations by State

Although the sample size was small, there were notable variations by state. All three of the providers that I contacted in Washington State, for example, reported naloxone seizures as not a problem. Three providers in Connecticut gave a range of answers.

Sometimes the responses contradicted stereotypes about different states and regions. Three out of four respondents in North Carolina, for example, said that confiscation is not a problem. This Bible Belt state didn’t have legal syringe exchange until a couple years ago.

“The fact that we’re so conservative and late to the game in harm reduction means that we got to learn from everyone else’s mistakes,” says Cat Nelson, founder and program director of Queen City Needle Exchange in Charlotte. “Because we fought so hard… we’ve got support in unlikely places.” The North Carolina Harm Reduction Coalition got sheriffs to support harm reduction legislation early on. Now, officers receive naloxone training from NCHRC—and how it works.

In liberal California, meanwhile, three out of four respondents called confiscations a big problem. In Orange County, syringe exchange has been shut down in the last year, leaving people who inject drugs without a safe place to get free supplies. Eliza Wheeler, who oversees the DOPE Project’s overdose response in San Francisco, says that their issue is mostly with the Department of Public Works, not the police.

“This is not naloxone-specific,” she says. “It just means that people have their naloxone taken because it’s with all their other stuff that’s taken. Most of the scenarios where police take naloxone it’s because they are arresting the person—we very rarely hear reports of cops just taking naloxone and nothing else… Although law enforcement actively harass and police unhoused people, their belongings are actually disposed of by DPW.”

Property confiscations like these are common for people experiencing homelessness in West Coast cities such as San Francisco and Los Angeles.

Naloxone Confiscations Are Never Justified

Between 2016 and 2018, I worked at Homeless Health Care’s Center for Harm Reduction to provide free overdose reversal trainings in downtown Los Angeles. Overdoses on drugs like heroin, “spice” and cocaine are often reported in the Skid Row area.

People came in every day for naloxone kits, often after using one on someone to save their life. New people came in to learn and get their first kit. Other times kits were lost, stolen, given away, expired—or were confiscated by someone doing their job.

He died a few months later of an overdose—the night after the LAPD confiscated everyone’s naloxone.

I first became aware of confiscations from clients during training sessions. I learned to take more notice of this issue in the summer of 2016, when I heard about Carter’s overdose.

Carter* was one of the first clients I met when I started as an intern in Skid Row. I was working my first weekend shift and he was in the lobby as we were closing. He was a homeless veteran, tall, and fairly loaded on heroin. After we closed he stayed around a little longer and suggested a YouTube video for us to watch before we started cleaning—the Kneehigh Park sketch from Chappelle’s Show. “It’s aaall drugs to me.” He watched with us by holding up a metal spoon and adjusting the reflection so he could see over the desk.

He died a few months later of an overdose—the night after the LAPD confiscated everyone’s naloxone kits in a sweep of the area where he stayed.

The Fourth Amendment to the Constitution of the United States guarantees “the right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures…” Naloxone confiscation is unreasonable search and seizure.

At least 43 states allow naloxone distribution without a prescription from a doctor, including all four states in which confiscation was reported as a big problem (California, Indiana, Rhode Island and Connecticut).

Naloxone is, again, not an illegal drug. Its medical use is to save the life of a person dying from an opioid overdose. Each instance of confiscation is a violation of individual rights that puts people more at risk of dying from a preventable overdose.

As people continue to die and be counted as victims of the overdose crisis and the War on Drugs, it is not just because of a lack of access to this lifesaving medication, but because there are individuals with authority who break the law in order to persecute people who use drugs.

*Name has been changed to protect family’s privacy.

Map created by Lucas Marten for Filter.