Aimee Dunkle explains a naloxone kit to Robert Salas, who is homeless and living in Santa Ana's Civic Center Plaza. In the background are volunteers Johnny Huynh and Tony Phan. (Photo by Spencer Grant)
Someone screamed for help when they saw him.
The man was lying on the ground — his blue complexion and pupil-less eyes signaling a pair of starving lungs.
He was stiff as a board. A body in the grip of an overdose.
Aimee Dunkle heard the call, rushed over to the man and had somebody start rescue breathing while she administered a nasal spray dose of Narcan, a brand name version of a lifesaving opioid reversal drug, naloxone.
More rescue breathing and a second Narcan dose and the color started to return to the man's face.
"He was still struggling to breathe so I grabbed him and sat him up," Dunkle said during a phone interview. "I really had to encourage him to take those breaths. It was hard for him to get his chest working again. But, he was breathing and I had him up on his feet within minutes.
"It was an incredible outcome. When somebody is blue and their eyes are in the back of their head, you have got their life in your hands."
Dunkle is no stranger to the lifesaving abilities of naloxone.
Since 2015, she's been handing out the medication at the Santa Ana Civic Center through her organization the Solace Foundation, with the hopes that arming drug users with it could save lives. The foundation sets up a booth from 1 to 3 p.m. every Saturday.
In the wake of the shuttering of the Orange County Needle Exchange Program, the county's only needle exchange, Dunkle's organization has become the only "access point" for harm reduction supplies for drug users, particularly homeless ones, in the county.
Aimee Dunkle and volunteer Johnny Huynh prepare kits in paper bags.
The needle exchange was denied a permit in mid-January by Santa Ana city officials because of excessive syringe litter concerns, causing it to close its doors after about two years of operation in the Civic Center.
The needle exchange was considered a vital access point into the communities of drug users, particularly the hundreds of homeless who have lived in encampments at the Civic Center.
Dunkle had been partnering with the needle exchange since its inception, taking advantage of its outreach capabilities. In the weeks following the needle exchange's closure, Dunkle said it "will be a public health catastrophe and people will absolutely die."
Kyle Barbour, co-founder and board member of the Orange County Needle Exchange Program, said through email that there are no updates to the exchange's predicament.
The Solace Foundation's permit recently was extended until near the end of April. Dunkle is hoping to combat the impact of the needle exchange loss until it can get back online, if it ever does.
The help the foundation provides has been stymied after losing the draw of the needle exchange.
Dunkle said she handed out just 17 Narcan kits during a recent Saturday. The last time she set up next to the needle exchange, she gave out 110 kits.
"People used to come from all over the county to get naloxone, now we are not seeing them," she said. "If they aren't getting naloxone, then people aren't surviving."
In 2015, the foundation recorded 12 overdose reversals, then in 2016 it tallied 420 reversals — the difference being the partnership with the needle exchange. The group reached more than 1,000 reversals last year.
So far this year, it has recorded 139 reversals. Dunkle said she'd be surprised if they came close to last year's reversal numbers.
The foundation was also distributing Narcan at the Santa Ana riverbed encampment before the homeless were cleared out for county maintenance.
Recently, Dunkle was permitted by the city to give out harm reduction supplies like sterile water, antibiotic ointment and alcohol wipes along with fentanyl test strips, which test urine for the presence of the drug.
Dunkle said fentanyl, an opiate that's up to 100 times stronger than morphine, has become an increasingly worrisome problem in the county.
Dunkle believes the man she recently saved was suffering from a fentanyl overdose due to his claim that he took "China White," which has been a common street term for heroin over the years but more recently has been the adopted moniker for fentanyl, according to Dunkle.
Dunkle does have some help in this fight.
The Solace Foundation recently reconvened its partnership with Radiant Health Centers after the group momentarily stopped its operations in the Civic Center after the needle exchange closed. Dunkle was able to persuade it to return.
Radiant Health hands out harm reduction supplies like condoms and provides HIV and hepatitis C testing. It works alongside Solace every Saturday.
"The supplies Solace is giving out are very important," said Tiffany Hendrix, Radiant Health director of health education and prevention. "Getting tested for HIV and hepatitis is also crucial."
Similar to Dunkle's analysis, Hendrix said the needle exchange's departure has resulted in declining weekly visitors, which means less lifesaving medicine gets into drug users' hands.
Dr. David Deyhimy, who works with Solace, said it's important that users are armed with Narcan because most addicts die using opiates around other addicts.
Deyhimy is an anesthesiologist at Saddleback Memorial Medical Center in Laguna Hills.
"So many lives are being saved because we are putting naloxone directly in the hands of the users," Deyhimy said. "Up until recently, their only recourse when somebody was overdosing was to leave the person or call 911 and run away."
Not everyone is happy about drug users receiving naloxone. Some believe it's further enabling their drug use by providing a safety net.
"In fact, the opposite is often the case because you are empowering them to save each other," Deyhimy said.
The Orange County Health Care Agency received 3,109 boxes of nasal Narcan in early December that are earmarked for The Solace Foundation. Dunkle said they received the drug through the California Department of Public Health Naloxone Grant Program.
Tammi McConnell, the agency's EMS administrator for regulatory and medical health services, wouldn't provide a comment through email about the foundation's work but said, "Narcan reverses an opioid overdose and saves lives."
For Dunkle, the work is personal.
Her son, Ben, died at age 20 of an overdose in 2012.
"While he overdosed, he was in the company of three people who failed to recognize the fact that he was dying," Dunkle said. "When they realized that he was dying, they didn't have the tools to save his life."
"They were frightened to call 911, they didn't know about naloxone and they didn't start rescue breathing. Naloxone would have saved Ben."
Dunkle tries to forge personal connections with the foundation's clients.
Eric, 30, of Laguna Niguel met Dunkle about 3½ years ago while she was training people on the administration of naloxone at a detox center where he worked.
Eric withheld his last name for fear of his story negatively affecting his career. He's been a "functioning addict" for many years.
He has been a client of the needle exchange and maintained a close friendship with Dunkle.
About a month ago, he was compelled to make a change in his life.
"I dug myself into a deep hole and didn't have an opportunity to get out of where I was," Eric said. "I was very depressed and felt trapped."
Out of desperation he called multiple resources like Drug Free Anaheim, but organizations were not willing to help him. So, he called Dunkle.
"I said, anything you can help me with, I would be so grateful," Eric said. "Within a matter of 15 minutes, she had somebody show up and pick me up. Fortunately, I was scholarshipped into a detox and today I am sober."
Dunkle said establishing these kinds of relationships with drug users is an essential part of her role in the Civic Center.
However, with the closing of the needle exchange and accompanying reduction of visitors, the Solace Foundation's impact has been minimized.
"People have stopped coming here without a doubt," Dunkle said. "We have to encourage them to come back so we can engage them. With fentanyl in the streets, it's more important than ever that they have naloxone and it's incredibly vital that they have access to HIV and hepatitis C testing."