Second-chance metropolis: San Francisco’s plan to scale back overdose disaster
For bartenders and bouncers in San Francisco nightlife, keeping people safe often means more than just a quick check of ID and vaccination card. It can also mean saving someone from a fatal overdose.
“I was a bartender the other day and our bouncer came over and said he’d saved someone’s life,” said James Shane, who works at Emperor Norton’s BoozeLand in Tenderloin, pointing to a box of naloxone, a drug that prevents opioid overdoses turning back.
Shane was one of eight other bartenders and restaurant owners who recently attended a free naloxone administration training course, also known as narcan, while on the Mission. The 30-minute workshop was led by the Drug Overdose Prevention and Education (DOPE) Project, a program run by the Harm Reduction Coalition that distributes naloxone across the city and is funded by the Department of Public Health (SFDPH).
San Francisco has funded efforts to bring naloxone into the hands of drug users since 2003. However, as the number of overdose deaths has continued to rise since the pandemic, the city has also noted an increased need for life-saving drugs, according to Eileen Loughran, a health program coordinator for the SFDPH.
However, with overdose deaths still at historic highs, city guides are now pushing bold and controversial plans to crack down on drug trafficking and use outdoors. They hope to address parts of the opioid crisis that Narcan cannot alone, including behavioral therapy, housing, community, and more.
Kristen Marshall of Drug Overdose Prevention Education leads a class on how to use Narcan for bartenders and restaurant owners at Mission Bowling Club. (Craig Lee / The Examiner)
More than 6,000 overdoses were reversed in San Francisco in 2021 with naloxone alone, compared to 4,300 the previous year, according to data from the DOPE project and SFDPH. Both years mark a huge leap from 2019, when 2,605 reversals of overdose were reported.
At the same time, overdose deaths reached 545 between January and October, which is close to the 711 total overdose deaths reported in 2020, according to the chief coroner.
“Everything is increasing and it was all very predictable,” says Kristen Marshall, who oversees the DOPE project in San Francisco. “Stronger drugs only increase the existing risk. Add to this COVID and the isolation and chaos of a global pandemic, and it hits the same community that is experiencing these problems the hardest. “
In addition to bars and restaurants that choose to wear it, naloxone is also offered at places like the Community Behavioral Health Services Pharmacy at 1380 Howard St. It is also often worn by first responders in San Francisco, including some law enforcement officers.
Ali Heller (right) of FentCheck speaks to Wine Director Christopher Potter (left) and bartender Alex Duke at Patio Wine Bar in the Marina District about wearing Narcan in their bar. (Craig Lee / The Examiner)
Many places are plagued by the same challenges that San Francisco faces, contributing to addictions and overdose deaths, including unstable housing, food insecurity, and massive economic inequality. But few cities invest in overdose prevention and reversal as much as San Francisco, which operates the largest single-city naloxone distribution program in the country.
San Francisco harm reduction strategies go beyond overdose reversal kits and range from clean syringe access and disposal points to community behavioral health services pharmacy to the city’s newly formed Street Overdose Response Team.
Studies have shown that providing Narcan does not increase drug use or make drug use more risky, and it is not possible to overdose or overdose the drug on your own.
Rather, overdose reversals are often painful and traumatic for those affected. Individuals can wake up confused, disoriented, and angry. Withdrawal can also make you feel sick.
“Coming back from the brink of death isn’t a fun thing. The added stigma of an overdose compounded the negative impact of the experience, ”said Juliana DePietro, assistant program director for Glide, a nonprofit that offers a range of homeless services including harm control, mobile vaccination, medical care, food and social activities.
Still, from a public health perspective, flooding communities with the drug is a critical step simply to save lives. Given the right time and circumstances, it can be a step towards treatment. “A person can only change his life if he lives,” said Loughran.
Reversal to recovery
What happens to those who survive an overdose is now a real-time experiment by city guides who recently announced a plan to tackle drug trafficking and possibly also drug use.
“We are a city that is proud of its second chance,” said Mayor of London Breed at a recent press conference. But “our compassion should not be confused with weakness or indifference”.
On Friday, Breed declared a 90-day state of emergency in the Tenderloin and compared the crisis level with that of the COVID-19 pandemic. The move dispenses with contracting and planning rules so the city can launch a website that aims to connect people to behavioral health services and housing programs.
The announcement follows a plan released last week that will increase the police presence in the tenderloin, requiring users on the street to seek assistance or face jail terms.
“The situation at the tenderloin is an emergency and requires an emergency response,” said Breed. “We will use this focus and coordination to stop the illegal activities in the neighborhood, to give people the treatment and support they need, and to make the Tenderloin a safer and more livable place for families and children who call the neighborhood their home. “
The mayor’s more recent rhetoric contrasts with Breed’s stance in 2020. Last year, she redirected law enforcement funds to support the African American community and launched programs like the Street Crisis Response Team, which began in November 2020 as an alternative to police to respond to mental health and drug use crises on the streets.
It remains to be seen how the different approaches work together. Proponents of harm reduction warn that many struggling with addiction and homelessness have had negative and sometimes violent experiences with social services and hospitals.
But even those who disagree on solutions can often find common ground in the growing need to connect those struggling with addiction to treatment. DePietro says The City’s safe place of consumption can be critical at this point in providing a safe place for drug use as well as immediate connections to medical, social, and rehabilitation services. The idea is to create a controlled space where people can use drugs under the supervision of healthcare professionals, which can reverse overdoses, and connect people to other services that may need them.
“This (safe consumption site) could tackle so many stigma, criminalization and safety issues and just make sure people aren’t punished for their use so that they don’t have to consume in isolation, which is incredibly dangerous. Said DePietro.
Overdose deaths have tragically impacted communities across the city, but the majority in San Francisco are still extremely low-income and unhoused drug users. Poverty initiatives according to Marshall and DePietro.
“The work that is being done to address the overdose crisis is important on so many levels,” DePietro said. “A big part of this is reducing isolation and stigma around drug use, building a community with people who use drugs and providing a safe place to talk to vendors and case managers about anything they are concerned about, and Behavior changes.
Nevertheless, neither the mayor’s lightning bolt in the Tenderloin nor the safe place of consumption will be a panacea for the city’s longstanding tensions over police drug use and homelessness.
“Changes in behavior have to be driven by where a person is,” DePietro said. “This not only relates to the number of treatment beds available, but also to how they have experienced the treatment in the past.”
City of “second chance”
Meanwhile, more and more bars and venues are stocking their emergency kits and bathrooms with naloxone, especially before holidays like New Years Eve.
Mission Bowling Club owner Molly Bradshaw hosted the recent Narcan training workshop in her shop on Monday after someone recently walked in looking for Narcan during an overdose crisis. But the venue was running out of supplies it had before the pandemic.
“I want people to feel comfortable and safe here, or just feel good about asking for help when they need it. We have a wonderful community here and we want to be there for our uninhabited neighbors too, ”said Bradshaw, who has an academic background in public health. “We can’t do everything, but I wanted to know more about it and I feel empowered by it.”
Other efforts, such as a program called FentCheck, have sprung up to offer bars and venues free naloxone and fentanyl test strips that can be used to determine if the opioid is present in a drug supply. Oakland residents Alison Heller and Dean Shold founded the nonprofit after losing friends and loved ones to a drug overdose and are now distributing supplies to dozens of facilities in Oakland, San Francisco and New York City.
“Every day I go to venues and knock on doors and give them a chance to have Narcan,” Heller said recently while walking around the marina, where she asked bar workers if they wanted free supplies. “Bartenders tell me there’s no rule, rhyme or reason for who’s going to get this. Some venues that you might not suspect have that kind of engagement. “
sjohnson@sfexaminer.com
