Where the opioid crisis and homelessness meet, you'll find resilience and community care

In the opioid series that I reported for KPFA Radio and Street Spirit, there's one moment that will stick with me forever. A young man named Thad was speaking to me outside a medical van near his encampment in Oakland. Thad has overdosed three times from fentanyl since the pandemic began. He showed me that he carries the overdose reversal medication Narcan wherever he goes, and explained how he administers rescue breathing to people around him when they overdose.

"Luckily — thank god — I’ve not lost anybody. Because I’m just determined to breathe for them, if I have to breathe forever," Thad told me. 

What I learned during the process of reporting my series on the opioid crisis in unhoused communities in the East Bay was just how many lives are saved each day by the people at the center of the crisis — like Thad. 

My story started in early 2020 with a tip from a nurse practitioner in a neighboring county. She alerted me at the onset of the COVID-19 pandemic that the federal government was loosening its prescribing restrictions for the opioid treatment medication buprenorphine. I began interviewing and shadowing harm reduction outreach workers, and learned they were expecting a substantial increase in fatal overdoses because of the pandemic. Isolation, job loss, and an unstable supply chain were expected to cause people to use drugs alone, and in greater quantities. I thought the story would be about the ways that government and harm reduction organizations were preparing to prevent deaths.

I had to set aside the story for several months, and by the time I returned to it more data had been released by the CDC and California's Opioid Surveillance Dashboard — the situation was dire. The fatal overdose totals from opioids were steadily breaking records, from late 2019 through  late 2021, driven by the rising presence and use of fentanyl in the drug supply. As I reported the story, an emergency unfolded in real time. And the primary first responders were unhoused people who use drugs, and their advocates.

I ultimately spent 16 months speaking to over 24 unhoused people, overdose survivors, harm reduction advocates, medical workers, and county employees for the story. That reporting culminated in a 26-minute radio documentary I produced and two print pieces: the first reported on the conditions on the street (“Opioid overdoses are at record highs. It doesn’t have to be this way") and the second revealing the ways unhoused people who use drugs are reversing overdoses for each other (“‘Invisible’ overdoses are hiding the true scale of Alameda County’s opioid crisis").

Finding the data          

I made at least eight data requests for this series: I requested records of 911 calls for overdoses from the cities of Oakland and Berkeley, records of overdoses on station platforms and trains from Bay Area Rapid Transit, county coroners' office metadata of "accidents and suicides," county records of 911 calls and fatal overdoses, and detailed hospital admissions and opioid fatality data from the California Department of Public Health (which was denied). I also obtained data from a database run by the California DOJ called CURES, which documents each time a pharmacy dispenses an opioid medication (including treatment medications like methadone and buprenorphine).

Several times, county or state employees refused to furnish monthly data to me on fatal overdoses because it would violate privacy laws — while the coroner's office readily provided the names and personal information of everyone who had died.

The coroner's data, however, had incomplete information about the causes of overdose and a person's housing status at the time of their death. I learned that Alameda County, like many California counties, does not have a system in place to track the deaths of unhoused people. This became a central point of my series.   

Federal data about overdoses paints a clear picture of the trend of rising deaths from synthetic opioids like fentanyl. However, it's released on an eight-month delay. My reporting relied heavily on the CDC's provisional 12-month overdose counts. CDC overdose data, I learned, is not without irregularities: After my articles and radio story were published, it emerged that the CDC recently miscalculated fatality data from prescription opioids, which calls into question the stringent public policy measures and prescribing rules that have limited the availability of prescription pain medications for the general public and people with chronic pain.

All of this data resulted in some key numbers in the series, which ultimately supported one of the key revelations of my reporting: A single harm reduction group just in West Oakland confirmed that their participants reported reversing 670 overdoses in 2020, a more than 30 percent increase from the year before. In comparison, Alameda County reported that its EMS workers responded to 716 overdoses in the whole of Oakland in 2020. While it's extremely difficult to track the "invisible" overdoses and reversals occurring outside of hospitals and 911 calls, this partial data illustrated that the overdoses reversed by community members almost certainly exceed those reversed by medical responders. This is an analysis I have not seen before in the media.

Tips for homelessness reporting 

Unhoused people are among the most vulnerable in U.S. society. Many of my sources have experienced incarceration, targeting by police, misrepresentation by media, and violence and trauma on the street. Establishing trust, and avoiding doing further harm, is paramount.

With over two years of experience in homelessness reporting, and reporting in heavily criminalized communities, I have several suggestions of what not to do:

●  Do not take photos of unhoused people or their shelter without their consent

● Don't spread fear or hysteria about fentanyl, and always double check law enforcement's claims about incidents involving the drug.

●  Do not take a city or county official's word as truth if they tell you a homelessness intervention program is successful. Always ask people at the receiving end of programs how they are working — and try to back this up with data.

●  Don't compare the conditions of homelessness in the U.S. to the Global South in your story, it's racist.

●  Don't try to shock your audience with "poverty porn." Instead, be mindful of the imagery you use in your stories.

The phrase "poverty porn" refers to using written or visual imagery to provoke an emotional response among your audience. In this series, I asked myself while taking photographs: What's more important to highlight, the presence of used syringes at an encampment? Or photos that captured moments of solidarity, where my story subjects were living, surviving, or providing resources to each other and to the community?

A photograph of needles might provoke a strong emotional reaction — but could stigmatize and isolate people who use drugs, and perhaps even trigger more aggressive or violent policing in the area. In my series, I used photos of volunteers handing out burritos and safer drug using supplies, of candles along the tent of a community member who was murdered, of Narcan, and of supplies and fliers offering resources.

On the other hand, here are some things you should do:

●  Do ask everyone you speak with for permission to quote them before asking them a question, and for their consent before recording their voice.

●  Do tell everyone what outlet you work for.

●  Do focus on ways that unhoused people share resources and demonstrate resilience in the face of abandonment by the government.

● In your reporting, do mention concrete ways readers and listeners can support people to reverse overdoses and survive on the street.

●  Do consider the intersecting crises that your subjects may be experiencing, including racism, housing injustice, incarceration and policing, the War on Drugs, environmental injustice and climate change, and gender-based discrimination and violence.

●  Do ask for someone’s permission and consider the consequences before asking them to recount an extremely traumatic event.

●  Do ask for cell phone numbers and text people so that they can call or text you afterward if they change their mind about being quoted.

One of my sources texted me the day after we met and talked about his experience using fentanyl: He felt that his comments may have minimized the danger of an overdose, and wanted to warn other unhoused people who use drugs to avoid it if possible. I updated his quotes and ensured throughout the editing process that they were included. 

Do use people-first language, such as “someone who is unhoused,” “a person dealing with addiction,” or “someone who uses drugs,” rather than “homeless person,” “addict,” or “drug user.” Many advocates for unhoused people and harm reduction workers have experience with housing instability and drug use themselves. Be aware of this in your reporting.

And once the story is published, text your sources and let them know when it will ultimately air and run in the paper. If your sources do not have cell phones, find them in person. In my neighborhood Buy Nothing group, I found a free iPod to store my radio story, for one of my sources who didn't have a phone. For my print series, the stories ran in both the street paper Street Spirit and local newsroom The Oaklandside — in those cases I had print copies to hand out, which were circulating in unhoused communities in Berkeley and Oakland. The final print story in the series was accompanied by an instruction guide for how to reverse an overdose. 

The crisis continues

More empathetic reporting on the opioid crisis is desperately needed, as is urgent action to house people long-term. Provisional county data about homeless deaths show that most overdose deaths are occurring outdoors, unsheltered. If the government had been able to house people permanently during the pandemic, an unknown number of lives could have been saved.

But unhoused people who use drugs and their advocates aren't waiting for saviors: They're continuing to hand out warm food, Narcan, and safer drug using supplies, and to share resources and care with each other. It's important that journalists continue to report on this.    

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