Opioid Crisis: Reducing harm, one vending machine at a time

Dec. 4—TRAVERSE CITY — Lou Gamalski, a volunteer with Harm Reduction Michigan, was sitting in her car outside a bar in Antrim County, looking down at her phone and texting a colleague, when a man knocked on her window.

"It was the middle of the day," Gamalski recalled. "He had his young daughter with him. I rolled down my window and he said, 'Hey, can I ask what you're doing?'"

Gamalski, a retired social worker with an endlessly cheerful manner, said she answered the man's question, then braced for the response.

Gamalski had just finished unloading a refurbished newspaper vending box from the back of her car and setting it up on the sidewalk in front of the bar, then stocking it with 48 boxes of naloxone.

Naloxone is the generic version of the medication Narcan, used to reverse opioid overdose.

Stocking the nasal spray version of the medication in repainted newspaper boxes, placed with permission around Michigan, is the newest initiative by Harm Reduction Michigan, a statewide healthcare nonprofit (previously named "MiWhoSoEver") and founded in Traverse City in 2009 by another social worker, Pam Lynch.

It was Lynch Gamalski had been texting, to say the box was up and operational, when the man knocked on her driver's side window.

"I told him we are trying to make this like any other first-aid item," Gamalski said. "You have Band-Aids, you have antibiotic cream and you should have access to Narcan just as easily because, honestly, anyone can have an overdosage."

Gamalski previously worked as an addiction treatment therapist, and is a state-certified prevention specialist, which she said frequently exposed her to the casual cruelty leveled at the needs of clients and patients — a "people who use matches are going to get burned" kind of attitude.

That wasn't what the man knocking on her car window wanted to say, however.

"He started to tell me a little bit about his own personal history, and here he is, a grown man, a father, standing there with his daughter, talking to me, a stranger, and he started to cry," Gamalski recalled. "Then he thanked me."

The United States reported 107,622 overdose deaths in 2020, an increase of nearly 15 percent over the previous year, according to provisional data, released in May by the Centers for Disease Control and Prevention.

The harm-reduction philosophy of addressing opioid and other drug use is to help the user stay healthy until, or if, they decide to stop using.

Jerry Norris, who runs The Fledge Community Center in Lansing, said he welcomed Harm Reduction Michigan volunteers' offer to place a newspaper box stocked with Narcan on the sidewalk outside the organization's building.

The CDC's data can be read as impersonal, he said, but an untold number of grieving family members are contained in those dry-seeming statistics — an understanding Norris said he came by in the most difficult of ways.

"Most people's idea of harm reduction, of what it means, is very likely wrong," Norris said. "Older people who have surgery, are prescribed an opioid and have memory issues, can overdose. Little kids who get into an adult's prescription meds can overdose. And, now I'm going to tell you a story about me."

Norris said when his daughter was in high school, she got caught smoking cigarettes and was issued a citation. While on probation, she smoked cannabis, which showed up on a drug test, and contributed to her being court-ordered to attend Narcotics Anonymous meetings.

At the NA meetings, Norris said his daughter met other kids who suggested she use a prescription medication, Xanax, instead, for relaxation as it was less likely to be in her system when she next had to undergo a drug test.

Her Xanax use led to other drugs. Norris said his daughter later became addicted to opioids. At 29, she died of an overdose of fentanyl she'd used in a public bathroom at a local business and, when she died, she left behind four young children.

"I wish that business had Narcan available," Norris said. "Does my daughter deserve one more day? Ten more days? A thousand more days? When did she and all the others become disposable to our society?"

Lynch said public bathroom overdoses have resulted in deaths throughout Michigan, including in Traverse City, where some business owners who have so far chosen to remain anonymous, have still reached out to the organization for help training employees in how to respond, after experiencing customer overdoses and deaths from overdose on their properties.

Employee training is a service Harm Reduction Michigan provides, Lynch said, along with the newspaper boxes stocked with free Narcan, needle exchanges and disposal, fentanyl test strips, blood-borne disease testing and referrals to additional healthcare resources.

Stigma remains a part of overdose prevention work, as evidenced by a video Gamalski said she'd seen posted on social media and later removed. The video showed one of the newspaper boxes and included what Gamalski said was misinformation that stated making the reversal drug available for free was enabling drug users.

Lynch says this kind of attitude doesn't help the community, doesn't lessen drug use or provide solutions to the overdose epidemic.

"For those who think Narcan is enabling people, dead addicts do not have another chance to recover," Lynch said. "It is not like a person dies of an overdose and 'learns a lesson.' They know they are taking a chance, but they are too dependent at that point to do otherwise."

Lynch, too, said she's heard the "playing with matches" attitude, and says anyone with a shred of humanity would reach for a fire extinguisher if they saw someone on fire.

Narcan, for an opioid overdose, is that fire extinguisher, she said.

Narcan cannot be abused and cannot cause an overdose, according to the World Health Organization, which states the medication is contraindicated only for those with a known sensitivity, which is rare.

Peer-reviewed studies published in The Lancet in 2022 and the BMJ in 2013, show similar findings.

A "Good Samaritan law" in Michigan — Act 368 of the Public Health Code — protects anyone acting in good faith and administering an opioid antagonist like Narcan, to someone experiencing an overdose, from liability.

Sheriff's offices in some Michigan communities have, for several years, offered free Narcan from repurposed vending machines — an initiative that began as a partnership with researchers at Wayne State University and pre-dates Harm Reduction Michigan's use of newspaper boxes, Lynch said.

In northern Michigan, Harm Reduction Michigan has placed the refurbished newspaper boxes near Jubilee House in Traverse City, in front of the Foothills Café in Glen Arbor, Torch Cannabis Company in Central Lake, the Kalkushka Lounge in Kalkaska, the Golden Nugget in Ellsworth, Rapid City Marketplace in Rapid City, Terrain Restaurant in Bellaire and Shorts Brewing Company Pull Barn in Elk Rapids.

The boxes were previously used by the Manistee News Advocate, Lynch said, and the change mechanisms have been removed so Narcan is available without charge. The boxes have been cleaned and repainted. Other newspapers wishing to donate used boxes would be welcomed, Lynch said.

There also are boxes in other Michigan communities, including Manistee, Lansing, Cadillac and Baldwin, and on the sidewalk in front of Trixie's Bar in Hamtramck.

Trixie's co-owner, Ian Perrotta, said he supports Harm Reduction's mission, and has grown weary of hearing about what he called "untimely deaths" of people in his community, who he would later learn died of an opioid overdose.

The newspaper box is unassuming, doesn't require electricity, exists mostly in the background as part of the landscape, but people who need it know it's there, he said.

"For any business owner thinking about it, but worried they might take some flak, people are going to give you flak for any decision you make," Perrotta said. "Something that could save a life is probably something worth taking flak for."

Harm Reduction Michigan has so far placed 30 newspaper boxes stocked with Narcan around the state and re-stocks them regularly. Funding from the Michigan Department of Health and Human Services and a New York state-based grant-making organization, Vital Strategies, each paid for 20 boxes to get the project going, Lynch said.

The organization does accept private sponsorship for additional boxes, which Lynch said runs $500, and sponsored boxes can be customized to honor a particular person, she said.

Earlier this month, someone left an anonymous handwritten note inside the box outside Trixie's.

It simply said: "Thank you for doing this!"