One LA Metro worker revived 21 riders overdosing on opioids. He's not alone

By Rachel Uranga | Los Angeles Times

LOS ANGELES — Walking along a rail platform, a veteran transit worker spotted a package of the opioid overdose-reversing drug naloxone, picked it up and slipped it in his vest. He couldn't imagine that he would use the medicine less than two hours later.

But looking back on that evening in February 2022, it shouldn't have been a surprise.

The synthetic opioid fentanyl was killing about four people a day in the county. Its reach stretched from high school classrooms to Beverly Hills homes; it plagued Skid Row and upended families across the region.

Inside train stations, one of the few free indoor spaces for those living on the margins, paramedics rush past commuters to platforms and train cabs to try to revive drug users who pushed too close to the edge or past it.

The transit worker saw so many overdoses he began going to a clinic on his way to work to get more doses of naloxone, commonly known by the brand Narcan. Metro had no clear policy on whether its workers can administer the drug, he said. But he couldn't bear to watch people die needlessly.

In 15 months, he has revived 21 people. The Times verified most of the claims through time-stamped photographs and witnesses.

"I'm tired of seeing people dying right in front of me," said the worker, who has been with Metro for more than a decade and asked not to be named because he was not authorized to speak with media.

Five months into the year, at least 35 people have died so far in the Metro system. The causes of deaths are under investigation, and most are suspected overdoses.

Metro policy prohibits workers from freely speaking with media or photographing conditions inside the trains. But half a dozen current and former workers, who include cleaning staff and security guards, spoke to The Times about the deaths and near deaths caused by drug use on the trains.

Some are angry about conditions; others feel resigned and numb. Their emotions are complicated by not only the brazen drug use, but also a rise in attacks on Metro personnel. Last year, 158 operators were assaulted.

"Unfortunately, when people with drug abuse issues come into our system from the communities we serve across L.A. County, our frontline employees bear the burden of discovering people who've overdosed, cleaning up after drug users or encountering their behavior while the drugs are in effect," Metro spokesperson Pamela Krebs said in an email. "The societal issues of drug abuse, crime, and homelessness across our county have made it much harder for them to do their jobs — and for Metro to provide the service it is intended to provide: safe, clean, efficient and reliable transportation."

A worker who was attacked a few years ago during her night shift said she was told not to record scenes she sees daily on her phone. Her photo feed is filled with pictures of men taking drugs, people half clothed, dead bodies, fights and blood-stained walls.

"I pray. I pray a lot because, Lord, only Jesus can change it," she said.

Complaints about drug use and sales reported on the Metro Transit Watch app soared nearly 100% last year, compared with the previous year. But the employee with Narcan in his pocket didn't need data to prove how bad things had gotten.

That night in February last year, he arrived to see a limp body sprawled out inside a rail car, according to his photos of the event. Metro transit officers were standing over a young man with tussled hair and skin-tight white pants.

"This guy was turning purple. Not breathing, vomiting on himself," the worker said. "From what I can tell, he was very, very close to death."

The worker pulled the packet from his Metro vest and offered up the Narcan to the officers. None wanted to administer a drug they had yet been trained to use, he said.

In the past, the worker would have felt the same. He had had little sympathy for the riders he saw daily, strung out in bench seats.

"They did this to themselves," he recalled thinking. "To be honest, I didn't really give a s—."

But the year before, he had befriended a 21-year-old struggling with fentanyl addiction. The young man was earnest, asking about how credit works and buying a home. He had a baby on the way, had gone through rehab and was seemingly starting a new chapter.

On Christmas Eve, just two months before, the friend died of an overdose.

"His baby was due like April," he said. "It was heart-wrenching."

The friendship gave him a new understanding.

"I had a different perspective on the overdoses that I would see" he said. "It was personal."

He clutched the tiny spray bottle and pumped a dose up the man's nose. Paramedics arrived. The man came to and walked off without acknowledgment. The worker was astonished at his recovery. That night, he searched online for training videos online.

"It was the push that I needed to look into it," he said. "To do something about it."

At that point, Metro employees had not been trained on how to use Narcan, although law enforcement officers who patrol the system carry the drug. Recently, transit safety officers and ambassadors have been trained.

CEO Stephanie Wiggins has said she hopes that training of its officers and 327 ambassadors — who are contracted to greet and help passengers — will have a "huge impact" on the system.

Fabian Bolanos, 52, says he has administered the drug four times since he started as an ambassador in fall.

"It's pretty intense," he said.

The first time, he spotted a man passed out on a bench at the Civic Center/Grand Park station with a needle in his arm, lips turning purple.

"I just immediately grabbed Narcan that I had, and I administered it," he said. "He wasn't coming back, and I started compressions. Then I gave him the second dose of Narcan, kept going on compressions, and finally he came back."

At the time, he had been on the job about two months, working for a Metro contractor, Strive Well-Being, Inc. The company "expressly prohibited" using the medicine, he said, but he wouldn't just watch people die.

Metro eventually changed the policy.

Bolanos, a former methamphetamine user and alcoholic who once overdosed, said the man fortified his own sobriety.

"It's a daily affirmation that I'm doing the right thing and that I need to maintain my sobriety," he said. "If I can hand it over and maybe give it to somebody else in need, maybe they go to a rehab, I'm doing my part."

When the revived man came to, Bolanos said, he got up and left on his scooter. He saw him later and asked, "You remember me?"

The man did. He appeared embarrassed.

"I told him try to get him to a rehab," Bolanos said. "I told him this is not going to end well. I have seen him around the train stations. He is still using."

Bolanos and the unidentified Metro worker have had days where they have to administer Narcan twice. Bolanos, who is leading a campaign to organize Strive Well-Being workers, said conditions have improved over recent months. In May, Metro reported a 17.8% reduction in complaints about drug use between Feb. 13 and May 8 as it cracked down on drug use on the system. It is still rampant.

Less than three months ago, he was exiting the platform at Westlake/MacArthur Park station when he saw a man in his 20s slumped over, lips turning blue. He had no pulse. Bolanos revived the man with Narcan and headed up the station's mezzanine to the break room when he saw a man in his 50s passed out near the ticket vending machine.

"This is unbelievable," he recalled thinking. "Another person right here right now."

"I was still trembling from giving compressions," he said. "I was still in this intense emotional feeling, and for me to look and see this other guy, I said, 'Nah, this can't be going back to back.'"

To stem the deaths, Los Angeles County helped distributed 112,000 boxes of Narcan last year as people left jail or through groups such as Community Health Project L.A.

The program is part of the county's expansion of what is known in treatment circles as harm-reduction services, strategies aimed at reducing the deadly effects of drug use. Since beginning in 2019, the program has reported 19,661 naloxone reversals, which is likely an undercount. Roughly half of those, or 9,790 reversals, were reported last year.

"It's everywhere in a way that it wasn't before," said Shoshanna Scholar, director of the county's Department of Health Services Harm Reduction Division. The agency helps train community workers, including staff at homeless shelters and other interim housing on how to use the medicine. "What we do know is without the naloxone on that and that trajectory of the overdose deaths would be much, much worse."

Ricky Blumenthal, the associate dean for social justice at the Keck School of Medicine at USC, sees the drug use on Metro against a wider backdrop of inequity in a region where homelessness has been growing as rents rise and there's few discrete spaces to use drugs on the streets. Many of those using drugs on the system don't have permanent homes, he said, but not all. Drug use can be a cause of homelessness or a symptom.

Whatever it is, overdoses take more homeless people than violence or car accidents.

In early 1990s, Blumenthal co-founded the Oakland California Syringe Exchange Program and was a founding board member of the national Harm Reduction Coalition, an advocacy and training organization devoted to improving the health of people who use drugs.

He started the program because he felt state, federal and local authorities weren't doing enough to stop the spread of HIV among drug users. People were left to die, much as they are now.

"Ultimately, we have to start caring for people who have become disadvantaged in our society," he said. "We're creating homelessness as a structural reality," he said. "We can make different choices. "

There's no one fix, he said, but providing better housing or providing overdose prevention sites, where people can safely use drugs.

Recently the Federal Drug Administration approved the use of Narcan for over-the-counter sales, a move that could allow for wider distribution of the drug and remove training barriers.

An overdose can happen in a few minutes of ingesting drugs, sometimes longer, depending the dose and whether it was smoked or injected, said Brian Hurley, the medical director for the Los Angeles County Department of Public Health's Substance Abuse Prevention and Control. Once breathing stops, death arrives in minutes.

It's not unusual for the nearly 2,600 maintenance workers at Metro to find people who are using drugs, passed out or unresponsive.

"It's taken a great mental toll on our membership," said Art Aguilar, former president of the Amalgamated Transit Union Local 1277, which represents those workers.

Maintenance staff regularly clean up needles, pipes and foil used to carry and cook drugs.

"We have seen an increase in usage of our therapy in our medical plan for our members," he said.

"I was hired in 33 years ago as a service attendant at RTD and you had issues with drugs then, but not to the level it is today," he said. "When I was hired in, I was brought to clean buses, not to find a body in it."

In one of the transit worker's videos, he is calling out to a thin man who is bent over, limbs tangled under a rail seat. He slowly pulls the unresponsive man out to the car floor. Three cigarettes and a piece of foil lie beside the seat where he passed out. The worker sprays the medicine in the man's nose and slaps his chest until he heaves a breath. Minutes later the man vomits and comes to. Dazed, he walks away.

"Do I think I'm saving their lives? Yes, absolutely," the worker said. "Do I think that's gonna help them in the long run? Probably not."

"I go home and I pray. I hope that this is like some sort of wake-up call for them or something," he said. "But I don't have my head in the sand thinking that it's going to be."

This story originally appeared in Los Angeles Times.

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