Alison Heller shows off fentanyl test strips before distributing them to various bars in the Castro in San Francisco.
Gabrielle Lurie/The Chronicle
It’s a busy Saturday night at Oasis, but drag queen Kochina Rude wants to make a public health announcement.
“How many of y’all have ever heard of harm reduction before?” she yells out to the crowd during intermission for her weekly drag show, “Princess.”
Then she begins distributing Narcan, the brand name of overdose reversal drug naloxone, from silver platters into the crowd. Using do-it-yourself diagrams she provides her audience with life-saving knowledge and materials — in less than five minutes.
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“Becky’s awake and she’s alive,” Rude says of her imaginary overdose victim at the end of her demonstration. “You saved her with Narcan and she’s ready to party another day!”
Drag queen Kochina Rude gives a Narcan demonstration during one of her shows at Oasis.
Dominic Saavedra
Rude is the drag alter ego of Oakland resident Cary Escovedo, a contractor at the California Department of Public Health by day. She’s been promoting drug harm reduction at her shows at the South of Market queer nightclub since 2021, and she estimates she’s distributed more than 3,500 doses of Narcan.
Rude’s independent naloxone work at Oasis has become one of many grassroots initiatives working to address the fentanyl crisis in San Francisco as overdose rates remain at an all-time high. In July alone, the San Francisco Office of the Chief Medical Examiner reported 39 accidental overdoses, 27 of which were caused by fentanyl. The synthetic opioid can be up to 50 times more potent than heroin and deadly even in small doses.
As fentanyl continues to make its way into club drugs — such as cocaine, ketamine and methamphetamine — both purposefully and through accidental cross-contamination, harm reduction advocates urge users to test their drugs and carry Narcan to reverse an accidental overdose.
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“As long as drugs, and thus drug users, are criminalized in this country, then we’re never going to know for sure how something like fentanyl is making its way into a bag of ketamine or cocaine. … There’s no health inspector for the trap house,” Rude told the Chronicle. “I would rather have my community focus on what we are able to control.”
While Rude already had several years of experience working in harm reduction, she said she was inspired to bring it into nightlife after reversing an overdose at a house party following the Folsom Street Fair in 2021.
“The experience was kind of a light bulb going off in my head where my community, I recognized, wasn’t getting the information that they needed to be prepared for situations like that,” Rude said.
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Within two weeks, Rude was handing out free Narcan from the San Francisco Drug Overdose Prevention and Education Project at her shows. She also raises funds to provide free fentanyl test strips to Oasis patrons, which are conveniently located outside the club’s bathroom.
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Though she began her work independently, Rude eventually caught the attention of the San Francisco Department of Public Health and the San Francisco Entertainment Commission. In 2023, they collaborated to produce an educational video on how to use fentanyl test strips and administer nasal naloxone.
More recently, both organizations tapped Rude and four-time Best Drag Queen of the Bay Area Nicki Jizz to spread overdose awareness throughout August. At select shows, the Department of Public Health and Entertainment Commission provide additional life-saving naloxone and educational materials on fentanyl overdose.
On Aug. 31, International Overdose Awareness Day, the commission and health department plan to join Nicki Jizz at Beaux in the Castro for a drag celebration of BIPOC excellence featuring stars from “RuPaul’s Drag Race.”
Drag queen Nicki Jizz gives a Narcan demonstration during her “Reparations” show.
Dylan Rice/San Francisco Entertainment Commission
This is not the first time drag queens have led the way in public health, noted Laura Thomas, the health representative for the Entertainment Commission. The Sisters of Perpetual Indulgence, for example, created one of the first safer sex guides during the AIDS crisis.
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“Drag queens are community members like everyone else is and are often able to use their soapbox, use their status as an entertainer, to also provide education as well as entertainment,” Thomas said.
But drag queens aren’t acting alone.
Alison Heller, co-founder of FentCheck, spends an afternoon each week on an atypical bar crawl through the Castro, distributing fentanyl test strips at eight different queer venues, including Moby Dick, Lobby Bar and the Mix. Heller said she places the materials in hand-decorated jars, bedazzled like disco balls, so they feel less “sterile and judgmental.” And since she knows her target audience may not be sober, she’s included illustrations on the packaging of her own hands using the test strips.
Heller admires Rude’s efforts at Oasis, where she has partnered with the drag queen as one of multiple test strip suppliers.
“I’m insanely in awe of the work she is doing,” Heller said. “It really takes a lot of bravery and guts to get out on stage like that.”
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Alison Heller refills a plastic container of fentanyl test strips at Moby Dick bar in the Castro in San Francisco.
Gabrielle Lurie/The Chronicle
Harm reduction has a long history in the queer community, notably during the AIDS epidemic in the 1980s. Organizations such as ACT UP organized needle exchange programs for intravenous drug users and distributed condoms to promote safer sex practices.
“We’re not inventing the wheel here,” Heller told the Chronicle during a recent stop at Midnight Sun, a popular gay bar on 18th Street. “What we’re doing is entirely inspired by the free condom initiative during the AIDS crisis. … It allows people to be anonymous and destigmatize access to what they need.”
FentCheck, which earned 501(c)(3) status in 2019, began in the East Bay before expanding its network of volunteers into Oregon, Philadelphia and New York. Beyond the Castro, Heller also works in select venues in the Mission, including the Sycamore and Hi Tops.
At first, some businesses were hesitant to work with FentCheck, largely because they didn’t want to seem like they were promoting drug use. But Heller has felt a shift over time.
“Sometimes it does take the worst-case scenario for people to call me back,” Heller said. “The list of venues that work with us after a tragedy does get longer.”
Rude has noticed a change in public readiness, too.
“When I do go out into (nightlife) settings on occasion when I’m not working, I do notice that people are more quick to jump to help when they think somebody is in trouble, or there’s always at least one person in the room that has Narcan in their purse or pocket,” Rude said. “I’ve seen this happen especially in the past six months. That was not the case when I started doing it three years ago.”
Alison Heller gestures to the bartender at 440 Castro Bar that she is refilling the container of fentanyl test strips.
Gabrielle Lurie/The Chronicle
Even the local live music scene is catching on. The nonprofit End Overdose is partnering with entertainment company Live Nation to supply naloxone at all its venues and has developed training for its staff, said End Overdose CEO Theo Kryzwicki. The organization also works with events like Breakaway Music Festival, scheduled for Oct. 25-26 at the Bill Graham Civic Auditorium, to distribute Narcan and educate concertgoers on the essentials of overdose prevention.
“We’re able to train more people in a few days than some health departments do for the entire year,” Kryzwicki said of End Overdose’s work at festivals like Electric Daisy Carnival. “It’s a great opportunity to engage people when they’re having fun.”
Still, harm reduction efforts have faced legal hurdles. Test strips were considered illicit drug paraphernalia in California until 2022, and it wasn’t until last year that the FDA approved over-the-counter purchase of naloxone.
In 2022, California Assembly Member Matt Haney proposed a bill that would require all bars in counties experiencing an “opioid overdose crisis” to carry nasal naloxone, but it was eventually killed in the Legislature.
So with 2024 on track to become one of the deadliest years for overdose deaths in San Francisco, it’s largely up to the community to fill in the resource gaps.
“This is not just for my benefit. This is for everyone,” Rude said of her work at Oasis. “I want to encourage other people to take what I’ve been able to do and turn around and train other people how to do it, too, because that’s how this is going to work. It’s how it’s going to reach the most people.”
Correction: An earlier version of this story misstated the nature of Kochina Rude’s employment. She is a contractor at the California Health Department.
Reach Lauren Harvey: [email protected]
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