NORTH ADAMS — This spring, Kimber King went to detox for two weeks and then to rehab, but was kicked out after she stopped at a store while out for a medical appointment, breaking a program rule. She came home to her apartment in North Adams.
"I didn't want to tell my family I was out of rehab," she said. "I ended up using, and I was home by myself."
She remembered a business card in her wallet for a hotline called Never Use Alone that she picked up when at a needle exchange in North Adams. The hotline takes the caller’s location and stays on the line with them while they use drugs. If they become unresponsive, the operator calls emergency medical services.
"I know the people who ended up dying are the people who come out of rehab and use,” King said. “I just wanted to be safe.”
She called the number. If she hadn't, she likely would be dead.
The hotline is like a virtual version of a supervised consumption site, also known as supervised injection sites — places where people can use drugs they bring while trained staff watch for overdoses. Hotline supporters say it's a useful harm-reduction tool to decrease overdose deaths.
Jessica Blanchard, a volunteer hotline operator who lives in southwest Georgia, picked up the phone when King called.
“I always anticipate the worst happening,” said Blanchard, who has been volunteering with the hotline for a year. “But, I doubled down on how I felt with her because I knew what a high risk she had of becoming unresponsive.”
That's because tolerance can change after detox or a period of abstinence, increasing the risk of overdose.
When King did become unresponsive, Blanchard called for help. Stephen Murray, a lieutenant with Northern Berkshire EMS, was a member of the team that responded.
"We showed up for a reported overdose, and nobody was there who was awake and answering us," he recalled. "That's usually a sign somebody has called 911 and got nervous and ran.”
Sometimes people leave because they are afraid they will get in trouble, he said, even though a law in Massachusetts bars people who call for medical help because of an overdose from facing drug-possession charges.
The EMS team gave King naloxone, medication that reverses an opioid overdose, and Murray gave her lifesaving breaths, King said.
"At that point, I woke up. I remember it pretty well," King said. "It's a lot, seeing all those people in your house. ... Stephen was really good about being like, 'I'm here, you're not in trouble.' They asked me, 'Why did the person that was here leave you?' ... I said I was on the phone with Never Use Alone.”
Murray was shocked when he found out that Never Use Alone had brought him to King's door. He has been in recovery from substance use disorder for 10 years. Outside his work in EMS, he is an administrator for the Never Use Alone hotline, training volunteers and reviewing calls for quality assurance.
"Kimber would be dead had she not called the hotline. It would have been another horrible fatal overdose," he said. "The impact that has on the community is monumental. ... The ripple effect is terrible."
Murray launched an additional Massachusetts hotline to augment the national one. From Great Barrington to North Adams to Plymouth, Murray said, he and Never Use Alone have distributed thousands of business cards like the one King picked up and put in her wallet.
“The sad part is that in the time we've launched the Never Use Alone hotline, more than 100,000 people have died from fatal overdoses," Murray said. "Any of those 100,000 could be Kimber, had they called the hotline. And Kimber could have been one of those 100,000.”
Overdose deaths increased in 2020
Across the country last year, overdose deaths hit a record high, of 93,000, the Centers for Disease Control and Prevention recently reported. In Berkshire County, 56 people died of opioid overdoses last year — that's an increase of 44 percent from the previous year — according to preliminary data.
During the first six months of 2021, fatal opioid overdoses statewide decreased by an estimated 5 percent compared with the same period in 2020, recently released preliminary data shows.
During the first three months of 2021, Northern Berkshire EMS responded to 15 overdose calls, two of which were fatal, according to early data from the group, which serves North Adams, Williamstown, Hancock, Clarksburg, Florida, Rowe, Monroe and New Ashford, as well as the Vermont towns Stamford and Readsboro.
The COVID-19 pandemic proved difficult for those with substance use disorder. Support meetings weren’t held in person, and people struggled with isolation, King said.
“A lot of people were suffering,” she said.
During the first few months of the pandemic, Northern Berkshire EMS responded to an increase in fatal overdoses, rolling out to nearly as many fatal overdoses during the first four months of the pandemic as it did in all of 2019.
In Murray's seven years in emergency medical services, he has not seen an overall decline in the number of fatal overdoses.
"That tells me what we're doing isn't working," he said. "I am really sick of responding to fatal overdoses. It's incredibly heartbreaking."
The hotline has the support of some local organizations. The Berkshire Overdose Addiction Prevention Collaborative, for example, gave money to print hotline business cards.
"We're so happy that he contacted us and asked us to support the Never Use Alone effort," said Jennifer Kimball, coordinator for the collaborative and principal planner for public health at the Berkshire Regional Planning Commission. "Because the drug supply is inconsistent. ... We know it's a fact that people who use alone are at a higher risk of death of overdose. People cannot Narcan themselves. It may seem odd to people, but this is a very effective tool."
The hotline has taken 4,000 calls, according to its website. It uses a phone connection to replicate a supervised consumption site, which does not exist in the U.S.
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“We’re kind of filling a void where people aren’t able to access these sites in person,” Murray said. “But, we can have someone sit on the phone with them in case they overdose, and activate EMS.”
Operators can help people find treatment resources if asked, but it’s not their goal, Murray said. “The only thing we are doing is staying on the hotline until you feel you’re safe.”
Blanchard, a former emergency room nurse in Georgia for more than a decade, got involved in the hotline a year ago, volunteering as an operator. She also is the organization's education director.
Blanchard said she is the last operator called in the phone-tree system.
“I know if a call makes it to me, I’m it. I’m at the end of the line,” she said. “I never turn my phone off.”
She has taken calls in the middle of the night. The work is worth it for her.
“I had a caller call me back one day and he said, 'Jessie, because of you, my momma didn’t have to pick out my casket today.' Those are the things that keep you answering the phone. To find out someone who you made a call on moved into long-term abstinence. Or has worked on themselves in such ways that they now have a relationship with their family. ... Or they are able to see their kids. That’s good stuff.”
No one who has talked to a program operator has died, Murray and Blanchard said. But, it's not risk-free. Callers are notified that the system isn’t foolproof, Murray said.
The hotline's goal is to lower, not eliminate, risk, Murray said.
"People ask all the time; ‘Can you keep me safe?’ " Blanchard said. "No, using drugs is dangerous. What I can do is call you some help if you get in trouble."
She, Murray and King support the idea of creating supervised consumption sites.
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Legislation filed in the Statehouse would create two or more supervised consumption sites, as a pilot effort, “for the purpose of reducing the risks of disease transmission and preventing overdose deaths.” A virtual hearing is scheduled for both bills Sept. 27 at the Statehouse.
A legal battle has been waged over a proposed supervised injection site in Philadelphia, which would have been the first in the country.
Amy Lieberman is a senior attorney at the Network for Public Health Law's Harm Reduction Legal Project. When it comes to the hotline, she said, "No federal or state statute makes it illegal to simply know that someone is using a controlled substance in another place," she said in an email. The Berkshire District Attorney's Office promoted the hotline in a public service announcement last year.
“We operate in what seems to be a legal gray area," Murray said. He points to good Samaritan laws, which protect people who call for help when someone has an overdose. Forty-seven states, including Massachusetts, where the law also protects the person who overdoses, and the District of Columbia have some type of law, according to the Government Accountability Office.
"That is our guiding philosophy, that the actions of our operators are covered by good Samaritan laws," Murray said. "It gets more complicated with supervised consumption sites because those are physical locations. The people who answer our calls are just people. They are not mandatory reporters."
To avoid any possible interference with Murray's job at Northern Berkshire EMS, he is not a hotline operator and plays an administrative role instead.
Opponents of safe-consumption sites say they enable people to use drugs. State Rep. William "Smitty" Pignatelli, D-Lenox, said that when he first heard of the sites, he saw them as "just a place to legally inject heroin — that was my initial knee-jerk reaction.” He since has changed the way he thinks about them and now feels it's a step toward treatment.
King does not view safe-consumption sites as enabling people.
“People are going to use drugs either way," she said. It's about reducing risk for her. Legalizing the sites, she said, "I think it would save a lot of people."
Recently, she had a cousin die alone of an overdose. “It could have been easily avoidable.”
‘I just want this stigma to go away’
King is telling her story with the hope of changing public views of substance use disorder.
"I had to feel ashamed about this all the time. I just want this stigma to go away," she said.
"I want people to know you can't hate us any more than we hate ourselves. We do this because we have some underlying trauma. Usually, mental health issues. Everybody is struggling. Some people do it with legal things like alcohol or gambling. It doesn't make anybody 'less than.'”
Since King first called the hotline, she has gone back to rehab.
"I'm not perfect," she said. "I’m just taking it day by day now.”
Blanchard and Murray are part of her recovery now — she texts Blanchard and often sees Murray.
"They’ve had a huge impact on my life,” King said. “I'm just blessed to have met them and have them be a part of my sobriety.”
On the Fourth of July, King went to a barbecue at Murray’s house.
"He's so far in his recovery," she said. Seeing him with his family, she said, "He's thriving. It's obviously a good person to look up to."
King, a waitress for years, has been interested in being an EMT. She is planning to start a class in September.
"After this experience with Stephen, I’ve been looking up EMT courses,” she said. “He’s definitely inspired me to chase this dream. … Now, I’m going to do it.”
Since the hotline helped her, she now hands out the business cards to other people.
"I give them out all the time," she said. "I'm hoping that maybe I can save another person.”