Virginia Reilly is tricycling through Skid Row, in Los Angeles, wearing a shirt that says “NEVER USE ALONE,” nailing boxes of Narcan to trees with a staple gun.
Her dog, Ruby Reversal — as in “overdose reversal” — rides behind her in a wire basket; behind the dog, Reilly tows a wagon full of clean socks, cottons, sterilized needles, medicinal cannabis gummies and boxes and boxes of naloxone (Narcan is a brand of naloxone), a medicine that reverses nine out of 10 opioid overdoses.
“Hey sugar!” Reilly exclaims when her former neighbors emerge from their tents. She’s on Wall Street in Skid Row, a 4-square-mile area of downtown Los Angeles where about 2,700 people are estimated to live on the street.
Reilly says she uses drugs herself and lights up a pipe in the middle of her rounds, offering that she is best positioned to save the lives of her friends and former neighbors who are dying of drug overdoses at astonishing rates — largely because of fentanyl, a synthetic opioid 50 times stronger than heroin.
More than 2,200 unhoused people died in Los Angeles County in 2021 (the most recent year with complete data), and overdoses were responsible for more than a third of the deaths in 2020 and 2021. In ZIP codes encompassing Skid Row, fatal overdoses have increased by more than 1,000% since 2017 — with fentanyl involved in more than 70% of those deaths. Nationally, overdoses increased by roughly 53% during that same period, according to the Centers for Disease Control and Prevention.
“My friend was laying there on the asphalt with plastic over his face,” Reilly says when asked why she started nailing Narcan to trees. “We didn’t know where to get any Narcan. So we made a little memorial altar for him. And I made a little pink bag of Narcan and nailed it to [a nearby tree].”
“I thought that’s what I ought to do,” Reilly says, “make little bags and nail ‘em someplace people can get to it.”
Reilly and other staff and volunteers with a harm-reduction nonprofit called The Sidewalk Project have since nailed naloxone to trees every week in Skid Row. They call the program the Tree of Life. Executive director Soma Snakeoil says the practice helps ensure the lifesaving drug gets distributed well and is easily accessible to those who need it.
But there’s another crucial reason they say they nail naloxone to trees: It increases the chances that the medicine will not be destroyed or taken when crews clear (or sweep) encampments. Something that, according to interviews with unhoused residents and harm-reduction groups in Los Angeles, is apparently happening with alarming frequency.
“After sweeps, late at night when there’s no providers here, when there’s no one to give the Narcan to people, people are running up and down the street screaming, begging for Narcan,” Snakeoil says.
Amanda Cowan, executive director of the Los Angeles Community Health Project (CHPLA), says unhoused people complain to her staff that they lose naloxone in sweeps “every day, every day. Because we do routes every day.”
Dozens of encampments are swept every weekday in Los Angeles, according to records produced by the Bureau of Sanitation. Cowan says her staff reports that about 70% of the naloxone her group distributes is “trashed” in the relentless sweeps. That number is based on follow-up conversations they conduct with the unhoused people they give the overdose medicine to when they resupply their naloxone.
This underscores a profound contradiction in California’s response to its opioid and overdose crises. If the state is spending millions and millions of dollars to provide naloxone to residents who need it the most, then why is naloxone being pulled from those communities?
Meanwhile, the legality (and morality) of encampment sweeps has become a national issue as homelessness jumped across the United States by an estimated 18.8% between 2016 and 2023.
This year, the U.S. Supreme Court will rule on the constitutionality of encampment sweeps for the first time. The justices will review 9th Circuit Court of Appeals decisions that found sweeping encampments is cruel and unusual punishment if there is no shelter to take people to.
Democratic politicians in the Western United States, including California Gov. Gavin Newsom and LA City Attorney Hydee Feldstein Soto, had lobbied the conservative court to review those rulings. Newsom said the decisions had “tied the hands of state and local governments [trying] to address the issue.”
Unhoused residents and advocates in California say that the problem with sweeps is that they kill people, often by destroying property needed to survive. They point to the destruction of naloxone in the clean-ups as an urgent example.
“Advocates on the ground have been asking [why elected officials don’t end the sweeps] for many, many years,” Snakeoil says, “because we know that sweeps kill people.”
That the city of Los Angeles is taking naloxone from unhoused communities is not just anecdotal. New, still-unpublished research conducted by health behavior scholars at the University of Southern California finds, according to one of the lead researchers, that naloxone is frequently lost in sweeps in LA and Denver.
Between April 2020 and November 2022, health behavior researcher Jesse Goldshear and a team of academics surveyed 395 unhoused drug users in LA and Denver, 157 of whom (about 40%) said their encampments had both been swept in the prior three months and that they had property “taken or discarded by city, state, or county employees such as police or sanitation workers.”
Of the 157 people who endured sweeps in the prior three months and reported losing property, 95 people (or 60%) said they lost naloxone, meaning that about a quarter of all of the unhoused drug users surveyed by Goldshear and the researchers had lost the life-saving medicine.
The practice of removing the naloxone “puts people at a much more immediate risk of a fatal overdose,” says Goldshear, who also distributed naloxone as a harm-reduction volunteer in West Los Angeles.
He says he personally witnessed city and state crews taking naloxone from encampments. This is “directly contributing to potential deaths,” he says, adding that the practice is taking “away [unhoused people’s] only real defense against a fatal overdose.”
Paul Gomez, a spokesperson for LA’s Department of Public Works, says unopened and unattended naloxone is not thrown away during sweeps, but rather pulled and “bagged, tagged and stored” in another location where residents can retrieve it during specific hours.
“That’s bull,” says Ronald Hams, a resident of the Aetna Street encampment in the San Fernando Valley until its clearance in September 2023.
“That is not true,” Hams says. He reports that he watched city workers destroy some 100 units of Narcan in a surprise sweep of his encampment. The boxes were stored in a bin that Hams had labeled “NARCAN” in red sharpie, and that he and his neighbors kept on a rolling cart in a central area. They called it “The Medicine Cabinet.”
“I don’t understand how we can pick up our stuff when we’ve seen it go inside of a [garbage compactor] and be crushed,” says La Donna Harrell, another former resident of the Aetna Street encampment who witnessed city workers destroying Narcan.
Gomez says the city follows “established protocols for the removal and storage of items gathered during cleanups” and that crews store property collected during sweeps — including naloxone — at different sites across the city.
Signs posted prominently at the sites of many sweeps throughout Los Angeles say that “Items collected by the city may be retrieved from or by contacting the following location: The BIN” on Towne Avenue in Skid Row, a warehouse preceded by a tall black gate with razor wire.
But an employee working at the front desk of The BIN said he had “never” seen Narcan delivered or stored there.
“That kind of stuff, they wouldn’t bring here — they would just discard it,” said the employee, who declined to give his full name but noted he was familiar with naloxone. “They would trash it … they don’t bring it to us.”
The employee later reported that he had searched for records regarding several encampment sweeps where residents told harm-reduction volunteers that they had lost naloxone — and could not find any “paperwork on that whatsoever.”
“So they have to have trashed it, just want you to know,” the employee said.
Meanwhile, the city is still litigating the 2019 lawsuit, Garcia v. City of Los Angeles, that alleges city sanitation crews destroy property collected from sweeps instead of storing the property.
“In general, we almost never hear about anyone getting their property back,” says Mike Dickerson, policy and education co-chair for the homelessness outreach group KTown For All, which is a plaintiff in the Garcia case. In the fourth quarter of 2018 alone, the city swept more than 2,200 encampments, according to the lawsuit, and trashed three tons of debris for every bag of property collected.
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Jack Ross is a journalist in Los Angeles.
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