A story years in the making: At-home overdose prevention

I've been wanting to write a story about home-based supervised consumption for many years because I keep hearing about parents, siblings, a partner or kids who do this but are too ashamed to talk about it. They do it in secret the same way that people feel like they have to hide their addiction to drugs and often alcohol.

Some families set up informal systems with their kids: Always tell me when you're using. Always leave your bedroom door or the bathroom door open. If no one is home, call someone in the family and stay on the line so if you overdose, your brother, sister, aunt, mom or uncle can call 911. All of these families keep naloxone, the drug that can reverse an overdose, handy. Many family members brush up on CPR and rescue breathing.

The idea of standing by while someone uses drugs, whether in a home or a sanctioned clinic, is controversial. Many people feel it encourages continued drug use instead of prioritizing treatment.  And there's a law, passed during a surge in crack cocaine use, that says it’s illegal to open or run a place where people use controlled substances.

But with fentanyl making the drug supply more dangerous than ever, there’s more focus on keeping loved ones alive. I spoke to several moms in Massachusetts about visiting while they kept an eye on a child who was using drugs. For various reasons, it didn't work out.

Then, someone introduced me to Renae.

Renae supervises drug use in her home because she believes it’s necessary to save lives. She started doing this when her daughter was using opioids, and over time it expanded to include some of her daughter’s friends and then other people she’d met.

How did Renae get here?

Renae started off as a mom who was sure her kid wouldn’t do drugs. But then her daughter, Brooke, got depressed and stopped going to school. They were fighting and arguing a lot. Brooke left home and got addicted to opioids.

Renae often didn’t know if Brooke was dead or alive. One afternoon, after a month of unanswered calls and texts, Renae was driving and saw Brooke, walking down the side of the street. There, in the car, her head explodes with this epiphany: Brooke’s alive. That’s all that matters.

So Renae does this complete 180. She starts buying Brooke Narcan, one brand of naloxone. Eventually, she buys Brooke needles. Brooke is living in cheap motels, sleeping wherever she can find shelter, sharing everything Renae gives her with friends. Renae realizes she has to take care of this whole community of people if she wants to be sure her daughter has the supplies she needs to do the least harm possible during her addiction.

Fast forward to today 

Less than a year after that epiphany, Renae started running an organization that delivers needles, Narcan and other supplies to parks and vacant lots every week. These can be dangerous areas, so she has spotters at each location who signal if she has to pack up and leave.

In her home or backyard, Renae lets people she’s come to know use drugs while she’s there so she can revive them if needed. It’s a DIY overdose prevention center. She does rescue breathing if the person needs it, and will give naloxone if necessary. Renae says she’s done this more than 30 times and never lost anyone.

She lives in this gray space that most of us wouldn't think about occupying, navigating between supply drop-offs in dangerous areas of her city and earning money in her day job to fund the outreach work.

Reporting on something that may be illegal

I’m not sure prosecutors know that home-based supervised consumption is happening as often as it is. I talked to several legal experts and couldn’t find any cases where a family member had been prosecuted for supervising drug use. But Renae's not just a parent monitoring her kid anymore. She's doing this for a wider community of people. This potentially puts her at risk. So we took some steps we don’t in our typical reporting.

We don’t use full names. We don’t tell you how old anyone is, what they do for a living or where they live. We also altered Renae’s voice and the voices of some of the participants. We tested lots of different voice alteration options and talked to experts before deciding on what you hear in the audio stories.

We don’t have any pictures of Renae or her participants. An NPR illustrator helped tell the story visually.

There were lots of meetings and discussions about safety procedures, and what I could or couldn’t do while visiting Renae. NPR, our partner on this story, has a person who handles reporter safety issues. An opportunity came up one night to observe overdose prevention outside Renae’s home. It was a place where drugs are sold. Editors advised me not to  go.

Why it's important to get this story out

There are lots of reasons. One is to recognize that overdose prevention, or supervised consumption, is happening all the time, even though we as a society are all tied up in knots about the rules and whether we should allow this.

I first heard about monitoring drug use from moms who wish they’d done it. They live with agonizing memories — trying to get into a child's locked bedroom or a bathroom to revive them. By the time emergency medical services got there, it was too late.

Supervised consumption happens among families experiencing an addiction to alcohol as well. In a few cases, it started after a drunk driving charge, or after a mom bailed a child out of jail, met them at an ER or picked them up off a street. One difference is that monitoring alcohol consumption is legal but pretty much anything connected to illegal drug use is not.

Renae tells one very personal, fraught story about the decisions she’s made, the struggles she still has and the consequences. As Renae says, she doesn’t have a blueprint for other parents, but she’s willing to show what she’s doing and why.

Renae's work also raises policy questions about how we, as a society, deal with addiction. We often punish drug use, try to force people to stop using and shame them or cast them out when they don’t. The foundation for Renae’s approach is compassion. She's all about making connections. She's all about building trust that will eventually help the people she works with regain dignity, self respect and become their best selves.

As one of Renae’s participants says, “If there was more of that, I can’t imagine how different things could be.”

That’s why this story is important. Massachusetts has spent more than $1 billion on addiction prevention, treatment and recovery since 2015 and is still seeing record numbers of overdose deaths. That money doesn’t begin to include what the state has spent on the incarceration of people with an addiction, emergency medical services and hospitalizations related to drug use. Renae says she’s sharing her story because something needs to change.