San Francisco is fighting opioid overdoses by giving out Narcan at drag shows — and this queen started it

Drag queen Kochina Rude didn't go to the party intending to assist someone having an overdose — but she had come prepared.

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It was 2021, just past the height of the COVID-19 pandemic, when the performer encountered a person at a party who had passed out. Seeing that they were unresponsive, which was determined to be due to drug use, Rude administered them intranasal naloxone. Her quick thinking successfully prevented an overdose death, but only because she knew how to use it.

"I realized that my community was not getting the information they needed about how to reverse an overdose," Rude tells The Advocate. "As an adjunct trainer with the SF Drug Overdose Prevention and Education (D.O.P.E.) Project and a host of the biggest drag show in the Bay Area, I was in a unique position to engage queer audiences about practicing safer drug use."

The incident inspired Rude to begin distributing intranasal naloxone, brand name Narcan, at her performances. Naloxone is a medicine that quickly reverses overdoses from opioids by attaching to the body's receptors and blocking the effects, according to the National Institute on Drug Abuse. It's usually given as a nasal spray, but it can also be injected into the muscle, under the skin, or into the veins.

On top of distributing naloxone, Rude also uses her shows to give audiences a demonstration on how to administer it. While it was a challenge to figure out "how to effectively educate up to 500 people every weekend without killing the vibe," Rude was able to craft a show that's not only life-saving but also entertaining.

Rude says part of the trick is "to treat the audience like a kindergarten class." This means keeping information simple, avoiding big words, using call-and-response, and making sure the presentation is under five minutes. She also keeps it humorous and always tries to end on a positive note.

"As queer people, we are already used to facing stigma from the straight world, just by being our authentic selves," Rude says. "We are also accustomed to dealing with health crises that disproportionately affect us, such as HIV, AIDS, and [Mpox]. For this reason, I believe we are uniquely prepared to address the issue of overdoses in our community."

"We have an opportunity to save our own lives by doing what we’ve always done: sharing knowledge and educating each other about safer practices, breaking down stigma related to drug use, and caring for each other without judgment," she adds.

As Rude's shows gained traction, they ended up catching the attention of San Francisco city officials. To "support and elevate the work that drag queens were already doing," the San Francisco Entertainment Commission, in partnership with the city's Department of Public Health, launched the Overdose Prevention in Nightlife campaign in 2023, bringing on Rude as a drag ambassador.

Through the campaign, nearly 400 doses of naloxone have been distributed and over 1,200 attendees of queer nightlife events have been trained, according to Project and Communications Manager Dylan Rice, who says that there are also now "more and more venues are carrying naloxone and training their staff." Their efforts were even recognized by the Biden Administration in October at the White House Challenge to Save Lives from Overdose event.

"This campaign has helped promote the message that the city, the nightlife community, the LGBTQ+ community: We’ve got each other’s backs," Rice says. "We are stronger and more resilient when we are looking out for one another. It has also encouraged more conversations in the nightlife community about health and safety and ways people can protect themselves."

It's an initiative Rice encourages other cities to pursue. Even if not through drag shows, he says officials should feel emboldened to find creative solutions to the problems facing their communities, and as he learned, the best way is often listening to what community members are already saying.

"The campaign is a proof of concept of how government, artists, and nightlife spaces can work collaboratively to address a public health or public safety issue and to inspire action," Rice says. "San Francisco has deep roots in drag, but other cities can harness the power of their local artists in whatever genre or discipline that makes sense for them."

Beyond education, Rude hopes that the campaign will help erase the stigma around drug use. She notes that "most people in the world are drug users," citing caffeine, alcohol, nicotine, and cannabis as "drugs that people use daily that generally don’t carry the same stigma as illicit substances, despite the reality that more people struggle with alcohol than with opioids."

"It’s my belief that all drug users are deserving of dignity, respect, and autonomy to make informed choices about the substances they consume," Rude says. "I’ve found that queer people are more likely to grasp this concept since we’re constantly attacked for our choices to live as we are."

"I want to remind my community that there is no moral difference between a weekend warrior snorting bumps of cocaine on the dance floor versus a homeless person smoking fentanyl on a street corner," she continues. "When I say 'don't judge drug users,' I actually mean all drug users, not just people doing ketamine in the club bathroom on Saturday nights."