Some in Kensington say police are using Narcan on people who aren't overdosing

One morning this summer, Roxy was sleeping on the sidewalk in Kensington.

The next minute, she said, "I thought I was in heck."

A police officer, she soon learned, had dosed her with the overdose-reversing drug naloxone. The lifesaving medication blocks the potentially deadly effects of opioids — but also can send people who use drugs, as Roxy does, into immediate, painful withdrawal.

The 49-year-old woman, who declined to give her last name because she feared retribution, said she had not been overdosing. She said some police wielded naloxone callously, to prod people to comply with orders to clear the sidewalk — and she believed that's what had happened to her.

The sudden withdrawal sent her to the hospital in agony, she said. "I told the doctor, 'Either kill me or give me something for the pain.'"

Naloxone nasal spray, better known by the brand name Narcan, was approved by the FDA in 2015, and has reversed thousands of overdoses in Philadelphia. The city has distributed more than half a million doses to residents, drug users, and community groups to mitigate the death toll of the opioid crisis.

But amid Mayor Cherelle L. Parker's Kensington crackdown, some people are accusing police of administering the nasal spray, or threatening to do so, on people who are not overdosing as a way to extract compliance or punish resistance. A dozen people who spoke with The Inquirer said they had personally witnessed or experienced what they deemed dubious naloxone use by Philadelphia city or transit police.

Some harm-reduction providers were particularly incensed by a video circulating online, from March, that showed a SEPTA police officer repeatedly telling a man to get off the steps of a Market-Frankford El station. Then, when he didn't get up, the officer dosed him with naloxone.

Heather, who declined to give her last name for fear of retribution, said she has witnessed police unnecessarily deploying naloxone many times since she became homeless in Kensington in 2020.

She has also overdosed, and received Narcan, several times. The medication saved her life — but left her in anguish. "You feel like your soul is being ripped out of you, and you can't stop it. It's like the worst symptoms you've ever had, all at once."

As a result of the painful withdrawal, people who have been given naloxone are likely to use again, putting them at risk for another overdose.

One recent evening, she said, she climbed on top of her sleeping friend to block officers who were attempting to dose her.

The setting is a section of the city, centered along Kensington Avenue, where public drug use is rampant and police officers walking foot beats essentially supervise hundreds of unhoused people in addiction. Overdoses and other medical episodes are routine.

Drug arrests remain well below pre-pandemic levels, despite occasional sweeps targeting people for narcotics offenses and open warrants.

Instead, many officers spend their shifts dispersing crowds of drug users, only for another crowd to return to the spot hours later, according to an Inquirer review of hundreds of hours of livestreamed footage from Kensington and Allegheny Avenues. When a person in a drug-induced haze doesn't react to orders to disperse, officers often use their gloved fist or a nightstick to rub the person's sternum, a painful but effective wake-up call.

Kelsey Leon, a harm-reduction organizer with the Community Action Relief Project, said that in recent months she has heard more complaints of officers threatening naloxone use while on those rounds. Some people living on the street in Kensington, she said, dubbed one particularly aggressive officer "The Narcan Fairy."

In other cases, harm-reduction providers — some of whom have personally reversed hundreds of overdoses — said failures in training had led to police misuse of naloxone. They blamed misinformation, as well as confusion stemming from the unpredictable effects of various animal sedatives in the street drug supply. Those tranquilizers, such as xylazine, can cause people to be heavily sedated, and are not affected by naloxone since they are not opioids.

Philadelphia police and SEPTA representatives said officers are trained to deploy the medication when appropriate — and, when in doubt, to err on the side of administering naloxone.

"It is safer to administer the naloxone and rule out opioids than it would be to not administer the drug and delay potentially lifesaving medication," Philadelphia police spokesperson Sgt. Eric Gripp said.

Learning curve

Overdoses began spiking in Philadelphia nearly a decade ago as fentanyl, the ultra-potent synthetic opioid, replaced heroin on the streets. The same year that naloxone nasal spray hit the market, 2015, the Philadelphia Police Department began training officers on how to identify the symptoms of an overdose and properly administer the medication.

It was not unusual, in the early years, to see the learning curve play out on Kensington Avenue. Drug users occasionally fended off overzealous cops who, mistaking an opioid-induced stupor for a deadly overdose, were readying the nasal spray.

Today, thanks to city efforts, the lifesaving drug is now abundant in Philadelphia. City agencies distributed 117,000 doses last year alone, while emergency medical providers and firefighters directly administered about 6,400 doses, and the police more than 100.

More than 1,600 Philadelphia police officers carry the medicine on their beats, including 65% of the Kensington patrol.

Police are called on to administer the medication relatively rarely these days, city data show, as many people who use drugs carry the medication themselves. Experts say the widespread availability of naloxone has contributed to a modest decline in overdose deaths in Philadelphia. They were down about 7% last year from 2022's all-time high of 1,413 deaths. (Nationally, overdose deaths fell 10%, according to the National Center for Health Statistics.)

But nearly a decade into the fentanyl crisis, police officers and paramedics still face disputes over whether people are overdosing or simply in a state of heavy sedation.

"It's not always that straightforward [to diagnose]," said Jeanmarie Perrone, director of the Center for Addiction Medicine and Policy at Penn Medicine. Signs of overdose include pinpoint pupils, lethargy, and decreased breathing — with slowed or stopped respirations being the most critical factor. But some diagnoses are clear-cut: "If someone can say a few words, they don't need Narcan."

And even from one agency to the next, training protocols vary.

The Philadelphia police directive indicates that naloxone is to be administered to people who are "unresponsive." It states that people who have no pulse are never to be administered naloxone — even though medical researchers are still studying whether the drug could improve the survival rates of people in opioid-related cardiac arrest.

On the other hand, SEPTA's Transit Police, who have contended with a surge in drug activity on train and bus lines since the pandemic, follow a policy that defines overdose symptoms far more broadly: "lack of or labored breathing, unconscious or semiconscious, pinpoint pupils, confusion, and presence of drug paraphernalia."

Perrone said that it would be important for responders to consider those symptoms in context before reaching for naloxone. For instance, "I would hardly call [confusion alone] a reason to do it in the community," she said. "Generally, that might suggest that somebody is awake."

One officer. 'Well over 100' doses.

SEPTA police administered more than 350 doses in the first half of this year. That puts the agency on track to deliver six times the naloxone in 2024 than the far larger Philadelphia Police Department administered in all of last year.

The video of the SEPTA Transit Police officer that drew criticism this year is one of the few documentations of a disputed Narcan incident. Twenty minutes of body-worn camera footage viewed by The Inquirer shows a more complicated encounter than the brief clip circulating online.

On March 8, Officer Darren Petty found a man lying unresponsive under the stairs at Allegheny Station in Kensington. For several minutes, he tried to wake the man up.

While the man was unconscious, his skin did not appear discolored. It was not clear that Petty checked his breathing. "I'mma hit you with Narcan to make sure you're alive," Petty told him after a few minutes, "cuz you keep going in and out."

Petty dosed him with the nasal spray. He called for a medic over his police radio, then turned the man on his side. "You were dead on the platform, man," he told the man, who refused medical care.

Petty helped the man out of the train station. But, minutes later, Petty encountered him again, sitting on the steps outside. That's when a bystander began filming as Petty told the man to leave. But the man didn't heed the officer's orders and appeared to doze off. Petty gave him another dose of naloxone.

Reached by phone, Petty said he acted as necessary to save the man's life. "Obviously it worked," he said.

He said he's administered naloxone "well over 100 times" in his two years working as a SEPTA transit officer.

"All addicts will tell you you shouldn't use it until the person stops breathing, but at that point you're not using naloxone — you'd be conducting CPR," he said. His concern, when he encounters people who appear to be high, is "to make sure [they] don't slip into a coma state," he said.

SEPTA Transit Police Inspector James Zuggi praised Petty's handling of the situation.

"It's better to be safe," Zuggi said. "They have a job to go out there and try to save this individual's life. The days of walking past them are gone. We're trying to help."

Both PPD and SEPTA train officers not to wait until a person stops breathing to administer naloxone.

But Rosalind Pichardo, who has personally reversed more than 2,400 overdoses and trained thousands of people on how to administer Narcan through her nonprofit, Operation Save Our City, was skeptical.

She views the signs of overdose as straightforward: If someone is turning blue or struggling to breathe, they need naloxone. If not, they probably don't.

She said she had particular concerns about Petty, having witnessed his overuse of naloxone. "He's known for that. You can be sleeping, and he's going to Narcan you," she said.

Still, other harm-reduction providers said they have faced the ire of people who showed all the signs of overdose and were revived, only to argue that they hadn't needed Narcan in the first place.

Zuggi said that SEPTA has received no complaints about Petty, or any other officer, in connection with naloxone.

On the contrary, Zuggi said, Petty is in line for a commendation for his work with people in addiction.

The tranq effect

Better training could lead to fewer disputes, both harm-reduction experts and medical professionals said. The Philadelphia police naloxone training course runs 30 to 45 minutes. The training run by Savage Sisters, by contrast, takes two hours.

Harm-reduction providers in Kensington said that today they still hear rampant misinformation about naloxone — much of it from police and other responders.

One recent myth held that, because of the xylazine and other tranquilizers contaminating the drug supply, at least two doses of naloxone are needed to reverse an overdose. Another myth: Giving naloxone to someone who has ingested tranq would be fatal.

Pichardo said she has had productive conversations, particularly with rookie police, about how to identify and respond to overdoses.

But other harm-reduction providers described clashes with police and paramedics over how to help people.

Thomas Frey, an organizer with the Everywhere Project, a volunteer-run group, said in June he was checking on a friend who was unconscious, but breathing normally, when "the cops pushed me out of the way and gave him Narcan. I said, 'All you did is put him in precipitated withdrawal. Now he's gonna be in agony when he wakes up.'"

He also described seeing a different officer use the nasal spray on a man who was conscious but not following an order to clear the sidewalk.

Police "warned him two or three times. He wasn't moving. And so they shot it up his nose," Frey said. The man got up and trudged away. "That's certainly how you get someone agitated."