Nightlife Lifeguards: How Your Bartender Is Saving Lives in NYC
Thursday night, your bartender ejected a patron for uninvited face licking. Friday, an unconscious guest had to be hauled off the toilet, brought around, and crammed into a taxi. And the Saturday night fight was between brawling firemen. Who else was going to break it up?
Next weekend, it’s possible that what starts as an unmoving bathroom line will end with your bartender crouched on the wet tile floor over a barely conscious 20-something who, thinking a nice key bump would jumpstart the night, got a nostril full of fentanyl-laced cocaine, overdosed, and after two nasal-sprays of bartender-administered naloxone, returned from the brink of death.
“This one Friday night a gal runs in: ‘Got any napkins?’” says Eric -- mustachioed, tattooed, and friendly -- of the Lower East Side bar Antler, as he checks on customers. “This gal’s boyfriend is standing on the street, bleeding from his wrist. I tried to help but he was being... difficult. He wound up stumbling away.” Eric shrugs. “I had a full bar at the time. I called the cops, but I had to run back inside and, y’know, do my job. I checked the news the next couple of days. Nothin’. Hope he’s okay.”
Every night across the five boroughs, bartenders like Eric are relied upon as therapist, sage, clown, cheerleader, spiritual advisor, janitor, referee, party animal, cop. Forever caught between the demands of their trade and the desire to help strangers in need, bartenders are expected step into roles beyond their theoretical job description. Now, spurred by a growing number of overdoses attributed to cocaine laced with fentanyl, the New York City Department of Health has launched a pilot initiative to train bar staff on Manhattan’s Lower East Side in lifesaving measures, adding a new role to bartenders’ already expansive repertoire: first responder on the frontline of the American opioid crisis.
You don't get what you pay for: Your bag of cocaine is a guessing game
In 2016, the DOH and NYPD’s shared mortality data exposed something unusual and alarming: “There were people [dying of an opioid OD] with cocaine and fentanyl in their system, but no heroin,” says Dr. Denise Paone, the director of research and development in the DOH Bureau of Alcohol and Drug Use, Prevention, Care and Treatment. In 2016, fentanyl showed up in 37% of cocaine-involved overdose deaths -- up from 11% in 2015. Analysis of these OD victims, Dr. Paone says, indicated that they “had wanted to use cocaine. They did not set out to use an opioid. They were totally opioid naïve,” a term describing low tolerance for, and therefore high susceptibility to, opioids.
It was a pattern that, Khalid Islam, a paramedic and 13-year NYC/EMS veteran, had witnessed firsthand. “First time I ever saw fentanyl cut into cocaine was about six years ago,” he says. “Now it’s definitely a trend.”
Lives are being lost to opioids faster than car crashes, gun violence, and HIV at their peaks.
Here’s how it goes. On a Friday night, Joe Blow calls a guy whose number he got from a guy. He stashes a $50 bag of clumpy white powder in his wallet. The LES is packed with people spilling out of bars -- pulsing with light, energy, and music. He meets his buddies at a spot on Ludlow Street. Three shots later, Joe’s buzz turns to exhaustion. Crammed into a bathroom stall, Joe uses his house key to scoop out one bump, then another. He doesn’t remember the next few minutes, when euphoria turned into nausea like he’d leaned into a punch. He doesn’t remember holding himself upright with both hands on the sink, burning-up, sweating, vomiting, unable to catch a good breath. He doesn’t remember a stranger finding him snoring, lips blue from lack of oxygen, on the bathroom floor. He doesn’t remember the paramedics’ faces, the penlight in his pinpoint pupils, or the 6 milligrams naloxone titration and manual bag ventilation that saved his life without returning him to consciousness. What he remembers is confusion, waking up in the hospital, an IV in his arm. He’d heard of fentanyl, but all he’d done were a few bumps of coke.
Last year’s Presidential Commission report named the powerful synthetic opioid fentanyl and its analogues as the deadliest elements in America’s ongoing crisis. Every three weeks in 2016, opioids killed the same number of people as the 9/11 terrorist attacks. American lives are now being lost to opioids at a faster rate than car crashes, gun violence, and HIV at their respective peaks, and with no sign of slowing. In March, New York City Mayor Bill de Blasio announced $60 million for HealingNYC -- the Mayor and First Lady, Chirlane McCray’s wide-ranging initiative to combat opioids in the city -- a near-60% funding increase over last year.
"Fear City" flashbacks as ODs increase
Though its intensity and breadth has increased recently, New York’s opioid problem isn’t new. In 1980, the mysterious drug China White responsible for a rash of deaths in New York, was identified as fentanyl. “In New York, we’ve had [opioids] for a long time,” says Dr. Paone.
“I kind of have to laugh when people say, ‘Oh the opioid epidemic is here!’” says Khalid. “It's always been here! The difference is it’s in a lot of pharmaceuticals now. People have this false image [of opioid users] being wayward children or poor people. It’s not. It’s grandma, it’s the wealthy businessman -- everyone. And in all five boroughs.”
Fentanyl-cut cocaine was plaguing the DOH: how to address a population so diverse, made up of primarily casual users, who didn’t even know they were at risk? “We were thinking about where people were doing cocaine,” says Jackie Blachman-Forshay, the director of special projects at the DOH’s Mental Hygiene branch. “The idea actually came from one of my interns who’d spent many years working in bars.”
"Everyone does coke."
A longtime Lower East Side bartender named Paul tells me: “From my oldest regulars to my youngest drinkers, everyone does coke.” Data showing a recent spike in the drug’s supply and use support his claim. Cocaine’s relationship to New York City’s nightlife has been inextricable for a few decades now, and efforts to curb its use are quixotic.
“I’ve worked in bars where it’s understood: the guy hanging around has coke,” says Billy, another LES bartender. “He’s a friendly face, he can become a regular, a fixture.” Brad, a writer, bartender, and veteran of the LES scene remembers one such figure with affection: “He had this long, bleach-blond hair, and he wore white leather pants and a coke spoon around his neck. If you were making a movie about a coke-dealer and this guy showed up, you'd say, ‘Tone it down.’” He laughs. “He showed up with an eye-patch once.” But, Brad goes on, he wasn’t the only source. “I had like four or five guys I could call at any given time.”
"Coke hasn't been good in New York in 10 years."
How to detect fentanyl: You don't
While buying from a known and trusted dealer feels safer, the truth is that outside of carrying test strips, it’s impossible to tell if cocaine is really safe; fentanyl is odorless and colorless. “One guy wants to start the party early -- he's the canary in the mine,” Khalid says. “We show up, he’s on the bathroom floor, and his friends say ‘We just bought this bag! We don’t know what’s in it!’” Finding pure cocaine is nearly impossible, and it’s commonplace for dealers to cut the amphetamine with other substances -- like baking soda, baby laxatives, ephedrine, or Adderall -- to stretch profits while buoying potency. “I once watched a guy bag ‘pure’ cocaine,” says Brad, the writer. “It was like 5% coke per bag.” Brad goes on about a drug test: “They said, ‘You have 40 or 50 different drugs in your system.’ It was all the trash they were cutting coke with.”
Says Paul: “Coke hasn’t been good in New York in 10 years.”
Obviously, acknowledgement is not approval. “We don't allow people to go in the bathroom together. Nothing good comes of that. And open drug use gets you tossed,” says Ethan, a lifelong New Yorker and longtime LES bartender, echoing policies found across the board. But “there’s really only so much you can do. Especially if you’re working alone,” says Elizabeth, another LES bartender. For bar-staff who are, at a minimum, serving drinks, cleaning, listening to stories, and watching for signs of more overt trouble -- all for tips -- attempting to police cocaine use is a game of whack-a-mole played at 2am, blindfolded, with an upholstery hammer.
Attempting to police cocaine use is a game of whack-a-mole played at 2am, blindfolded, with an upholstery hammer.
“What’re you supposed to do -- search and drug-test everyone who walks in the door?” asks Max Bookman, an attorney specializing in New York State alcohol issues. “Someone on cocaine isn’t necessarily showing signs of inebriation that even a licensed security guard can identify.”
Can't stop the party drug
Considering cocaine’s seamy reputation and the known consequences of its use, who’s still using it and why? Raymond, 33, a professional stylist who is Hispanic, uses cocaine to stay up and out without feeling too drunk. “I do it four or five times a week lately,” he says. “I’m trying to fill myself up with experiences. Isn’t that what life is about?” Brad the writer, 32, white and affluent, cites similar reasons, saying he does it to “keep the fun going. You can drink WAY more if you’re running to the bathroom for bumps all night.”
“I’m out, y’know? And coke is a big part of the scene. It’s expected,” says Rachel, a middle-class, 26-year-old transplant from Canada who works in the service industry. “There’s a lot of nights where your friends are just talking-talking-talking, and you realize you’re the only one at the bar not coked-out, so you want to get on their level. One bump leads to another,” she says. FOMO and cascading use are familiar refrains. “You do some trash blow, it’s uppy, and it makes you kind of nauseous,” Brad says, “so you do another to get rid of the nausea, and another. You’re drinking, talking, dancing. You turn around, the bag’s gone and it’s five in the morning.” The line of logic seems to almost always terminate on chasing a late-night experience. “I don’t want to miss anything,” says Raymond. “And that’s hard if I’m passing out.”
With disparate potential users, the DOH’s next question was where to roll out the initiative. “The Lower East Side has some of the highest concentrations of liquor licenses in the state,” Bookman says. The 9-or-so square blocks stretching from the corners of Delancey and Essex to Bowery and Houston have been dubbed Hell’s Square by locals. “We wanted to go to a neighborhood with a high density of bars that’s a destination spot so we could reach a high number of people,” Dr. Paone says.
Flooding the streets of the LES with lifesaving naloxone
Speeded by purpose, DOH special projects director Jackie Blachman-Forshay beats the pavement bar to bar across Hell’s Square, a bag of lifesaving tools in tow. “It’s definitely been interesting,” she says. “Sometimes I’m trying to talk to people but it’s almost 9pm, and I’m having to shout over music... I’m motivated and inspired by the mission.”
Whiskey Ward is quiet before opening. There are no dollars in the jukebox, no quarters on the pool table. Light blooms from the big front windows, is caught and thrown by bottles behind the long bar onto the stamped sheet metal ceiling, and dissolves into the worn hardwood floor and red brick walls. Blachman-Forshay gathers staff around her -- two bartenders and a bartender/owner. Phase 1 is handing out patron-facing literature: stacks of school bus-yellow coasters and matching posters inform potential users of tainted cocaine and advise caution. USING COCAINE? The coasters read. USE WITH OTHERS. If you overdose, someone could be there to help.
"You can drink WAY more if you're running to the bathroom for bumps all night."
“Our message here is: If this already happening, we’re going to help you understand how to protect yourself,” Dr. Paone says. And aside from some minor concern about harshing buzzes, bartenders have responded positively. “The coasters are great!” says Paul. “It’s like when, instead of telling people not to have sex, they started giving out free condoms” -- a valid point best-taken in its full complexity: despite massive reductions in new infection rates due largely to information campaigns and the wide availability of prophylactics, over 75% of all new AIDS/HIV infections in NYC from 2011-2015 still came from sexual contact -- otherwise reasonable people miss or flat-out ignore good advice. The DOH knows this. Everyone knows this. Ask any smoker.
Responses to the potential danger of fentanyl-tainted cocaine are as varied as its users: “I won’t do it anymore, I guess,” says Rachel, the Canadian. “I’m definitely never gonna do a bump with a stranger again.” Writer Brad waves the danger off as one would sharks at the beach. “A bump’s not gonna kill me,” he says. “I told my girlfriend, ‘We have to get bad cocaine out of our lives,’ if not all cocaine.” But, Brad says, he just started working nights again. Stylist Raymond, a self-proclaimed libertarian, chooses to live with the risk. “It may add a little weight to the scale, but no, it’s not gonna be the reason I stop,” he says. “If there’s a serial killer on the loose, you’re still gonna go out to get your groceries. And I have so many beautiful thoughts and conversations on drugs. I believe there’s a place for them in this world.”
Commencing phase two of training, Blachman-Forshay pulls tidy, mailbox-blue zip-top pouches from her bag. Out of the pouches come hermetic blister packets, each about the size of a saltine. “This is naloxone,” Blachman-Forshay says holding up the packet, “and if a person is OD’ing, this will save their life.” There’s one for each staffer.
Naloxone (brand name Narcan or Evzio) works nearly instantly. “We use naloxone almost as a test for opioid OD,” says Khalid. “It’s so effective that if someone doesn’t respond to it, we begin to doubt that they’re ODing on an opioid at all.” You can pick up a dose yourself at most pharmacies without a prescription -- and for free from dozens of DOH affiliates around the city.
If grizzly Pulp Fiction flashbacks gives you pause, naloxone comes in EpiPen-like auto-injectors, and, as in the case of the DOH’s bar kit, single-use nasal sprays. “The person doesn’t even have to inhale,” Blachman-Forshay says. “The chemical will be absorbed into the mucous membrane. They may not feel great when they wake up, but they’ll be alive.” The bartenders around her nod solemnly.
A life or a liability: When to act
No good deed goes unpunished, goes the fear. So to be clear: In cases of possible drug OD, it is in everyone’s interest to act, even if that action ends with a 911 call. Existing Good Samaritan laws protect individuals acting in good faith to save a life. “Friends and bystanders being honest with us is incredibly helpful,” says Khalid.
New York State Public Health Law extends liability protection to people who respond to an opioid overdose. Bookman’s advice is clear: Get the training. “Bars and bartenders should be proactive in as many ways as they can.” Khalid agrees: “If bartenders are nervous about taking action, they can take classes or watch online tutorials. Know what an OD looks like, know the warning signs. We will work with you to save lives.”
In 15 minutes from start to finish, Blachman-Forshay explains how to recognize an OD (unresponsive, shallow or no breathing, blue lips or fingernails, pinpoint pupils) how to perform lifesaving interventions (call 911, check for consciousness via sternal rub, administer naloxone via spray up one nostril, wait three minutes, if the person is still not breathing or conscious, administer the other spray to the other nostril, and perform mouth-to-mouth until EMS arrives) briefs staff on how to further contact the DOH, and fields questions. She packs up, the bar’s doors swing wide, and as customers trickle in, Blachman-Forshay is on the street again, making her way to the next bar while her trainees work cutting fruit, serving drinks, smiling as they tend their flock.
"If a person is ODing, this will save their life."
Anyone can pour a beer or mix a drink. Adapting and rising to unfolding situations, staying engaged, and maintaining a safe space is what bartending truly requires, plus the nebulous extras. “You sign up to steer the ship,” says Jenny, a longtime LES bartender and nurse-in-training. “You take out the garbage, you break up fights, you make sure people don’t die,” then she shrugs. “Babysitting isn't the correct word,” says Ethan. “But you're taking care of a room full of intoxicated people who you helped intoxicate. It takes a certain type of person to handle situations like that correctly.”
“We know bartenders are busy,” says Blachman-Forshay. “We want them to be able to be fun -- not burden them beyond their job.” And helping others is as much a part of the trade as cracking open a beer -- always has been. “It’s usually bartenders who call us,” says Khalid. “They can tell the difference between someone just being drunk and something more serious. They want to help.” Eric of Antler is an exemplar. “You see people going through shit in this job,” he says. He leans forward onto his hands, smiles, shaking his head. “They drink when they’re celebrating, they drink when they’re upset. The bar is a social place. It’s way more fun to drink among friends than sit in your apartment alone with a sixer... I’d do anything in my power to help a person. It’s in my nature.”
So far, 18 out of 20 bars have welcomed the DOH’s program. If the trend continues, an expansion of the program seems likely. “People are really engaged with this,” says Dr. Paone. “We’re pleased with the way it’s going.”
As a professional medical first responder, Khalid emphatically endorses the initiative. “Bartenders having naloxone is an awesome, awesome thing,” he says. “I'm completely for it. If you can get the naloxone to someone early, that's so, so helpful to us.”
Most ODs, Khalid explains, die of a lack of oxygen. “They stop breathing,” he says. “They might be snoring, but that doesn’t mean they’re getting oxygen.” After about six minutes without oxygen to the brain or heart, permanent cell death can occur, and “our typical response time is about five minutes, so we’re really riding that line,” Khalid says. A bartender applying naloxone can start someone breathing again -- enough to keep a person alive until EMS arrives.
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