JOHNSON CITY, Tenn. (WJHL) — Pastor Rayford Johnson was shaken enough when the first phone call came after Labor Day weekend: A young person well known to his congregation at Jubilee World Outreach Church had died of a drug overdose.
The one phone call and the one lost life wasn’t the end.
“Within 48 hours, it seemed like I got five more phone calls of the very same nature.”
The cluster of deaths, which appear at this point to have been caused by fentanyl that was laced into cocaine, shocked Johnson.
“It was people I know who are college-educated, who have families, who are responsible people when it comes to the community, and they evidently had some issues with drugs and they maintained their lifestyle,” Johnson said.
Until they died, that is — and those deaths and their aftermath have set Johnson on a mission. In the few months since, he has organized police-community meetings at his church, learned more about the region’s overdose problem and the concept of harm reduction, and embarked on an effort to get a Narcan “vending machine” placed in the city.
“Why can we not just pull the stigma out of this and let them know? Someone may have been using drugs, and if you see them passed out on the street, run over there and grab some Narcan and help them,” Johnson said inside Jubilee’s spacious sanctuary on Indian Ridge Road.
Narcan is a nasal spray version of Naloxone, an overdose reversal drug that’s saved countless lives and is becoming more available as society reckons with the havoc wreaked in particular by fentanyl, a synthetic opioid 50 times stronger than morphine.
Johnson has already enlisted the support of Johnson City Commissioner Aaron Murphy, who like Johnson is the minister of a predominantly Black church.
After hearing from Johnson, Murphy said, he researched Narcan and the concept of a vending machine to understand it might help people in need. What he learned about the limited number of cities, towns and counties that have installed the machines won him over.
“Those who don’t really understand would say there’s a better way to respond in those desperate times when someone has encountered fentanyl, but this is a great first step,” Murphy said.
“It may not be the ideal way, but it’s a great first step, and its success rate is well in the 90% in terms of those who have encountered fentanyl, hit with a can of Narcan, have a good chance of overcoming.”
A deep problem
According to the Centers for Disease Control, an average of 195 people a day nationwide died of an overdose involving fentanyl in 2021. That was a 23% increase from 2020, but in Northeast Tennessee, fentanyl-related overdose deaths rose much faster — more than doubling from 68 in 2020 to 139 in 2021.
As those numbers have risen, so have programs and opportunities to help people seek and maintain recovery. The increased opportunities haven’t slowed the pace of overdoses, and that’s largely down to fentanyl’s presence in numerous other drugs from opioids to stimulants like cocaine and methamphetamine.
Sheila Vakharia is the national Drug Policy Alliance’s deputy director for research and academic engagement. A former clinical social worker who’s worked in both abstinence-only and harm reduction settings, Vakharia said the United States is experiencing a “fourth wave” in an overdose crisis that’s lasted two decades now and killed more than one million people.
Prescription opioids drove the first wave, heroin the second and introduction of fentanyl the third.
“Now, this fourth wave where fentanyl is co-involved with stimulant drugs,” she said. “This tragic story in your community highlights this exact moment right now. It also adds the nuance of the fact that … our drug supply is becoming increasingly toxic and unpredictable.”
With so much adulteration of drugs (fentanyl purposefully cut into them to save money) and cross-contamination (inadvertent fentanyl contamination), Vakharia said, “the occasional recreation social user is being just as impacted as the more frequent regular user.”
Narcan, whose active agent is naloxone, has been used increasingly to help reduce the harm caused by opioid overdoses.
Vakharia said that type of harm reduction began taking the form of free Narcan dispensers just within the past decade and has been gaining in popularity.
“Put in the right community, people can get there whenever they need to, they can access the equipment whenever they need to and they know where they can go,” she said. Just as importantly, she added, “it’s not subject to certain hours or having to explain or defend or feel like you’re putting yourself out in the open.”
While research is just beginning to come in, Vakharia pointed to a study published in the Annals of Medicine in late September 2022. The study focused on three “public health vending machines” (PVHMs) in Clark County, Nev. (home of Las Vegas) that added “naloxone dispensation” (Narcan) in 2019.
The authors found that 41 fewer overdose fatalities than forecast were recorded in their study area during the first 12 months after the machines began dispensing Narcan. That was a reduction of more than 15% from the expected 270 fatalities to 229.
“Naloxone dispensation at PVHMs was associated with immediate reductions in opioid-involved overdose fatalities,” the study concluded. Among its “key messages” was that “communities should consider implementing public health vending machines in efforts to prevent opioid-involved overdose fatalities.”
‘I’m going to scream if I have to’
Back at World Jubilee Outreach, Johnson said he isn’t going to give up on spreading a message based on a concept he wasn’t even aware of (harm reduction) six months ago.
“I’m going to speak,” he said. “I’m going to reach out and I’m going to scream if I have to. Because this is … this involves people. People that you love. People that you know.”
Dealing with the aftermath of the overdoses and learning about Narcan and other methods for reducing the number of lives lost to drugs has been transformative for the former East Tennessee State University football player who’s in his early 50s.
“I believe we can make the difference,” he said. “If that person who has a drug addiction is struggling today and they die tomorrow, I can’t help them the next day.
“And let’s be honest. It’s a battle. Sometimes people relapse multiple times and you know what? It’s a part of the process.”
It’s also personal for Johnson, who said he has both a child and a sibling who struggle with addiction, or substance use disorder as it is now commonly called in recovery circles. It’s also affected some of his cousins.
“It’s in the human family tree. It’s all of us together.”
If the people partying that night had been carrying boxes of Narcan, Johnson might not have had to exercise his pastoral gifts with as many grieving moms and other relatives.
“I’m glad God has graced me with some kind of ability to come alongside people, but it is not the favorite part of my job,” he said. “This has driven me and forced me to action because that is not something I ever want to have to do again.”
Johnson said the last three-plus months have convinced him that pushing for a harm reduction approach that some might see as enabling is the right thing to do — and that it aligns with God’s will.
“In the society in which we live and in the culture in which we live I think 100 percent most definitely Jesus would have been carrying Narcan with him,” Johnson said.
“As the church and as people in the community who love one another, it’s time for us to put the rocks down and stop throwing stones and start really loving people. What does that look like? It looks like if you are struggling with a drug addiction, a brain disease, that we need to get you the help that is necessary just as if you had diabetes.”
Along with a regular line of communication with police, Johnson’s got Murphy in his corner. The city commissioner said police and first responders see carrying Narcan as just part of the job now, even if that change has occurred only within the past few years.
“The next step is ‘how do we equip our local community with Narcan?'” Murphy said. “Is that putting it in the hands of a local business downtown Johnson City, or a non-profit, or having dispensers that are available 24-7?”
Murphy said he believes his fellow commissioners and the Johnson City community as a whole “want to do what’s best for one another.”
“I think we’re all unified on that,” Murphy said. “I don’t see any division, and I believe that we just need to keep having conversations and come up with plans of action to take care of this matter at hand.”
Like Johnson, Murphy said as a pastor he’s had conversations with parents and other family members who’ve lost loved ones to fentanyl. He’s heard people talk of their personal experiences at community roundtables, and he’s led funerals of people who’ve died of fentanyl overdoses.
“Something has to be done, and it’s going to take leadership at all levels to respond and come together,” Murphy said. “That’s just where we are. Because we are losing lives, and that’s not okay.”