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SANTA CLARITA, Calif. – The group has 234,000 followers and 4.7 million likes on TikTok, a presence at many of Los Angeles’s biggest venues and nightlife events, and chapters at over two dozen college campuses in the United States. They have engaged with over 250,000 people in person. And they have saved lives through their work.
While any startup and its financiers would be thrilled with these figures, for End Overdose, the stakes are much higher.
“I can’t tell you how many times I’ve had to say, ‘Your brother is dead. Your mother is dead,” said Theo Krzywicki, founder of End Overdose. “All they had to do is put naloxone in the nose and rescue breathe.”
Last year, 109,360 people died from drug overdoses, according to provisional data from the CDC. Of these deaths, 79,770 were reported to be opioid-involved.
Unlike many better-funded programs working to address the nation’s opioid epidemic, End Overdose relies on a peer-to-peer model that seeks to prevent deaths from overdoses by distributing an opioid overdose reversal drug, naloxone, and test strips that reveal the presence of fentanyl, which can be present in other drugs. Naloxone can be injected or inhaled as a nasal spray and works by connecting to opioid receptors in the body, which can block the effect of opioid drugs. The nasal spray version, branded as Narcan, is now available over the counter.
End Overdose also gives quick, on-the-spot tutorials for how to respond to a potential drug overdose and how to administer naloxone as well as to use the test strips.
In line with other harm reduction initiatives, these trainings are judgment-free and solely focused on how a person should react when a person’s life is on the line due to an opioid overdose.
“This is a simple problem, but it affects everyone at every level. Everyone has caught on to naloxone saturation, but we still have significant problems with communication. You can give it out all over the place, but if it’s not going to the right people and it’s not the right message, they won’t use it,” said Krzywicki.
For Krzywicki, who works as a firefighter and paramedic in Los Angeles, the work is not abstract.
Krzywicki took his first opioid at 13 years old after being prescribed pain medication with unlimited refills after breaking his leg. Trekking the path of the opioid crisis in the United States since the mid-1990s, Krzywicki became addicted to synthetic opioids and eventually began using heroin at his Seattle high school.
During those years, he saw many friends die from drug overdoses. But then the scourge hit even close to home.
“My fiancée overdosed,” Krzywicki said to Direct Relief. “It was just so preventable, but at that time, no one was talking about what to do when someone overdoses.”
The tragedy set Krzywicki on a different path, and he began working in drug treatment centers and later as a paramedic. “I just wanted to do something about it,” he said.
While working as a paramedic in California, Krzywicki saw how easy it was to administer naloxone to reverse an overdose and thereby save a person’s life. He wanted to distribute it as widely as possible. In 2017, he started approaching treatment centers in California. However, Krzywicki said that most treatment centers require sobriety and will kick patients out if they relapse. He said the usual path for relapsed patients is to then seek out drugs with disastrous results. Out of treatment, they would no longer have access to the naloxone. Adding to his challenge, naloxone was “extraordinarily” difficult to source.
Thinking about how to meet the most at-risk people where they are, Krzywicki pivoted to the nightlife scene. He was able to link up with various harm reduction groups, which helped him gain access to naloxone.
“When we got embedded in the nightlife, that’s when things really changed,” he said.
Tragedy would catalyze more action. In 2017, Lil Peep, a young rapper, died from an opioid overdose. His death sparked a meeting of several prominent musicians and influencers at the Echoplex in L.A. to discuss how to make nightlife safer. Krzywicki was invited to give a training on naloxone use. Invitations for trainings followed from venues in the underground L.A. music scene and then, in 2019, from the L.A. Mayor’s Office for a citywide program, which was halted due to the Covid-19 pandemic.
No Marketing Budget
From these experiences, Krzywicki had some key learnings that he felt could be used to expand his outreach among young adults further.
“We wanted attraction rather than promotion. There is nothing more obnoxious than someone working in a healthcare space harping at you to stay safe. It’s not fun,” he said.
“We wanted to use a peer-to-peer model. Nothing is better than hearing it from someone your age, who looks like you and knows your experience,” he said. End Overdose, the name of the nonprofit Krzywicki created, decided to branch out to college campuses.
Giana Uy, 23, co-founded End Overdose’s first college chapter at UCLA last year.
“I wanted to make sure my friends around me were safe,” Uy said. “I had not heard of Narcan [before getting involved with End Overdose], and I wanted to make it accessible since there was nowhere to access it on campus,” she said. “People wanted to be able to test drugs and weren’t able to do it,” she said, referring to fentanyl test strips, which reveal the presence of fentanyl in other drugs. End Overdose also provides these test strips and related training for free.
After graduating last year, Uy decided to work for End Overdose full-time, working now as its director of external affairs and programs. Despite starting last year, the group now has 31 chapters nationally. They had to turn down about 50 applications from colleges due to a lack of resources.
“It’s all grassroots. A lot of people see the work being done on other campuses and want to bring it to their campuses. We have no marketing budget. It’s just social media, friends, and people seeing it firsthand,” she said. College chapters are all set up slightly differently depending on the specifics of the campus, but each has the goal of reaching as many people as possible.
Chapters are all given onboarding training, where they learn about different overdose responses and harm reduction in general. They are also trained on how to teach others effectively. End Overdose offers three types of trainings, based on the Substance Abuse and Mental Health Services Administration’s best practices and input from a range of medical professionals and people who have experience using drugs.
Students who lead these chapters distribute naloxone and fentanyl test strips to their peers, oftentimes by setting up tables in courtyards and routes to classes.
“Our goal is to have this on major campuses in America. We definitely want to have a chapter in every state,” Uy said.
Ready for Action
At an event for military veterans last month in the L.A. area, Anthony Banuelos, End Overdose’s director of operations, greeted passersby with a big smile and energetic greetings.
“Would you like some free naloxone?” he asked, rows of nasal spray versions of it in front of him on the table, which also had stickers, fentanyl test strips, and a life-size training mannequin.
Every person he asked said yes. Many said they knew someone who had died of an overdose. Banuelos said he survived an overdose as well.
After handing out a couple of packs of the spray, along with a QR code so the group could track usage, he launched into what he described as a “wham, bam, to the point” training process for how to identify if someone is overdosing, to call 911, how to administer naloxone, and how to do rescue breathing. He also noted that Good Samaritan Laws protect people who try to help in these situations and that naloxone has no negative effect if a person is experiencing a different medical emergency.
Banuelos then demonstrated how to use the spray on the mannequin and handed it to the trainee.
“It’s real life, unfortunately,” said MGySgt. Joe Gray, USMC. Gray received the training because he said he wanted to be able to “look after his Marines” in case the need arose. Asked if he felt ready to respond after the training, he quickly said yes.
SSgt. Jaime Serrano said he stopped by the table because of Banuelos’s friendly greeting.
“It’s the first time I heard about naloxone… I’m now prepared to respond,” he said.
Donna and Jeff Watkins, along with their friend Kim Miner, said they had several friends who lost their children to fentanyl.
“It’s the first time I have access to naloxone, and now I know how to react,” Donna Watkins said.
Jeff Watkins, who works as a key grip on Hollywood sets, said he received similar training on studio sets but not on location.
“We have AEDs (automated external defibrillators) on set; we should have this too,” he said.
Asked what drives him to do this work, Banuelos said, “We want everybody to be prepared to save someone’s life.”
Though the opioid crisis is “definitely getting worse,” according to Krzywicki, he is undeterred.
“I think we can fix this. Too often, people get lost in the tragedy… But we have medicine, training and the ability to get it out there. No one else has to die. If I don’t keep going… I’d feel like I’d be abandoning something,” he said.
End Overdose has given away over 130,000 naloxone doses to date.
Since 2017, Direct Relief has provided 2.6 million doses of naloxone to health centers, free clinics, community organizations and harm reduction groups, including End Overdose.