Cartoon by Sage Stossel

Alumni

Alum’s Overdose Prevention and Recovery Work Featured in Boston Globe Editorial Cartoon

Danielle McPeak (SPH’20) is an overdose prevention and recovery specialist with the Cambridge Public Health Department whose Narcan trainings were featured in a cartoon originally published in the Boston Globe.

In good weather, when the bustling streets in Cambridge’s Central Square are filled with noise, laughter, and life, Danielle McPeak (SPH’20) usually props up a table in Carl Barron Plaza, the red bricked triangle next to the Central Square T entrance that has been a neighborhood gathering place for decades. On the table: the opioid overdose reversal medication Narcan, test strips that indicate the presence of fentanyl in injectable drugs, and literature to support those seeking help beyond what’s available from McPeak and their colleagues.

Many of those clustering in the plaza are insecurely housed, says McPeak, an overdose prevention and recovery specialist with the Cambridge Public Health Department (CPHD) whose work distributing knowledge and Narcan was featured in an editorial cartoon in the Boston Globe. Tree-shaded granite benches in the plaza offer a safe and familiar place for those experiencing homelessness or struggling with substance use. “They hang out there with the people they know and feel safe with, so that’s usually a pretty good place for us to set up,” McPeak says.

In late December, McPeak held a session indoors and around the corner at the Central Square branch of the Cambridge Public Library that was observed by cartoonist Sage Stossel. In a few brief panels, Stossel distilled the broad scope of interactions McPeak has had since they began conducting the sessions every few months since starting at CPHD May 2022.

Did the cartoon portray a typical day for you?

That day in particular, I think we got a much more diverse audience than we usually do. It was a lot of people who saw it in the Cambridge city newsletter and maybe they knew a little bit about substance use and opioids, but not really a ton. Many of my interactions that day were a lot of providing a very condensed 5-minute training on what to look for if someone’s overdosing, how to use Narcan, what the right response should be, and answering some questions about substance use and potential issues with fentanyl exposure. For the most part, people were very curious and open to learning more.

Are there other community outreach events like the Narcan distribution?

I’ve done a lot more overdose prevention trainings. When we do these distribution events, I don’t want people to feel like I’m trying to keep them for too long, but still give them the important information. So it’s a very condensed—‘Here’s as much as I can tell you…’—in no more than five minutes.

But the full overdose prevention training is 45 minutes to an hour depending on participant questions. It’s a joint effort between myself and someone in a similar role at the Somerville Health and Human Services department. We were a recipient of the federal Overdose Data to Action (OD2A) grant and we initially provided this overdose prevention training as a part of that grant. It covers everything from just general opioid education to recognizing the signs of an overdose, how to respond properly, how to administer Narcan, what is Narcan, some special considerations around if people are overdosing in a publicly accessible space, some aspects of the Good Samaritan law and other kinds of legal considerations.

That’s really one of my favorite parts of the job. I got into public health originally through health education work, and it’s definitely a big part of where my heart lies in the field. We’ve continued doing that work since the grant ended, which I’m very happy about. In 2023, I think we trained over 300 people in overdose prevention.

What’s your mental preparation when you’re doing events like that? Do you have to consciously just remind yourself to stay in the moment?

In doing this work, I try to hold two separate but related mindsets in thinking about the feelings that people bring to talking about substance use. You have people who have dealt with it themselves and feel totally marginalized by the system that we live and operate in, which does not see people who use drugs as full human beings deserving of compassionate support and understanding. They’re navigating a system that only really gives them that support if they totally go cold turkey, and any deviation from that approach can be met with so much stigma and visceral hatred from some people.

So I try to hold space for that. I also try to hold space for the people who are just so scared of substance use and are so scared of the possibility that something like that could happen to someone they love, that someone they love could fall into the spiral of addiction and have their lives potentially fall apart because of it.

In one of the panels of the cartoon, there’s an encounter with someone who was apparently upset about the work you were doing.

I think a lot of the stigma and negative feelings towards people who use drugs comes from a place where people have this mindset that, if I do the right thing, if I make all the right choices, that’s not going to happen to me. That’s not going to happen to people I love. But for so many people, this is a fact of their life, and they didn’t do anything to deserve this—and even if they did mess up somewhere down the line, we should still have the systems in place to help them.

But I can know that and understand that while still maintaining some level of sympathy towards the people whose fear manifests in that way. I really have heard some crazy things doing this work, and I feel like I did not do as well of a job when I first started. I think my response in the past was sometimes, unfortunately, to shut down. Thankfully, I usually do this work in tandem with someone else, and they’ve been able to step up and be a support for me. I’ve learned a lot from those people and I think I’ve learned how to still interact in a way that I feel good about. I think I’ve grown a lot in this role in that regard.

Were there any aspects of SPH that prepared you for that level of interaction and that kind of understanding?

I think I was very much primed to be someone who tries to look at all sides of a situation and see public health as something that can help bring people together. I learned to advocate for what’s good for everybody, or good for as many people as possible in sometimes challenging situations. One course in particular that Candice Belanoff teaches [MC775: Social Justice and the Health of Populations: Racism and Other Systems of Oppression] was fabulous. I took that course with her in my studies and then I also was a teaching assistant for the subsequent secondary part of that course. I really learned a lot from her about looking at public health through a lens that considers the history of these systems in our country.

One other thing was my practicum experience. I was with an organization called Victory Programs, which is based out of Boston. They do a lot of great work with people who have HIV and AIDS, but I was actually with their hepatitis C team. They helped to run a coalition of providers, nonprofit organizations, people with lived experience, and people who work in hepatitis C care in some capacity. I did some work with them doing qualitative data, focus group interviews with people who either have hepatitis C or have had it in the past. And by the nature of the virus, many people who have hepatitis C are people who also use substances, especially injection drugs.

Doing those focus groups was a great experience for me and one where I was really able to talk to people very openly about what they’ve struggled with. Some of the feedback that I got in doing that was that I did a very good job of helping them feel heard and helping them feel like someone cares about them.

What were some of your takeaways from seeing the cartoon’s representation of public health in action?

It was a tremendous honor. Sage did a really good job of capturing a lot of different sides of how people approach things like opioids and substance use while still having a very clear viewpoint that this is something that’s important that should be happening and that this is a good thing.

And I really valued that she did it in that way. Something that I have talked about with some people at work is how exciting it is to have our work depicted in a way that’s so much more accessible to people who may not be excited, as some of us are, by data points and a long writeup about something. I’m always very excited when someone does cover my work in that way, but this sits in a very unique position of reaching people who otherwise would never hear about this work. I never would’ve guessed in a million years this would happen to me or come out of the work that I do. And I honestly really love how I was depicted in it as well.

It seemed to capture an important aspect of ground-level public health work that centers interacting with people and helping individuals, but in a way that is reflective of the wider aims of population health.

It’s something that I really love in my own public health career as well. Not to sound too pessimistic, but I’ve always kind of had this feeling of public health being sort of a double-edged sword. And that the more success and the further along you get in the job and climbing the ladder of public health, the further removed you often get from that boots-on-the-ground and face-to-face work, which for better or for worse, is what I really love about public health. As my public health career continues, I hope that I can find my own version of success that still has that aspect.