San Francisco Chronicle - (Sunday)
BART’s cops save many who overdose
BART police Officer Eric Hofstein called out the young man’s name just before the man stumbled, passed out and fell facefirst into a metal gate before crumpling onto the ground outside the police station at Civic Center Station.
The man, whom he’d known for years, was still clutching a piece of tinfoil, lighter and a straw that he used to smoke fentanyl, an opioid up to 100 times more powerful than morphine. Hofstein scrambled to find the pulse of the man, who had already stopped breathing.
“I just remember thinking, ‘ He pushed too hard this time,’ ” Hofstein said, recalling the overdose that happened just after 3 p. m. on June 8.
Hofstein reached into his pocket, ripped open a package of the spray Narcan, a medication that reverses overdoses, and pumped a dose into the young man’s nose. The man revived, but when paramedics arrived, he fled.
Hofstein said the man has overdosed half a dozen times in the train system over the past few years. Across BART, similar close encounters with death have played out at least 58 times since the agency’s 275 police personnel started using Narcan in June 2019, according to police records obtained by The Chronicle in November.
“Every single one of which would have been a body in the morgue if Narcan wasn’t around,” said Jason Norelli, a harm reduction manager with nonprofit Glide. Norelli has seen this crisis up close: He was the case manager for a young man who died from an overdose in the
“We do our best to do any lifesaving measures. We also do our best to address the homeless crisis and the drug crisis.”
Lance Haight, BART deputy police chief
MacArthur Station bathroom half a year before BART police started carrying Narcan.
The Bay Area’s mental health, substance abuse and homelessness crises continue to bleed into BART’s train system, challenging its leaders to respond to these safety and public health plights. Drug use in public is a misdemeanor, but officers need to see someone doing drugs to arrest and charge them with the crime. BART’s board debates the best way to tackle the issue, trying to balance helping people in crisis while ensuring other riders remain safe. This year, the agency added ambassadors who can link people to social services and is trying to hire more officers, make fare gates more secure and beef up partnerships with county social services.
“We do our best to do any lifesaving measures,” BART Deputy Police Chief Lance Haight said. “We also do our best to address the homeless crisis and the drug crisis. It’s a complex societal issue and we’re not going to be able to solve it on our own, but we certainly are working hard to do our part.”
BART Director Bevan Dufty, who represents the area that includes Civic Center Station, said while conditions have improved, the agency isn’t immune from crises on the streets. San Francisco faces an unprecedented spike in overdose deaths this year: As of Nov. 1, 563 people had died of fatal overdoses, compared with 441 last year. The core of the crisis is the Tenderloin and SoMa, where nearly half of overdose deaths occurred.
On BART, the highest number of Narcan deployments — 20 out of 58 — were at Civic Center Station.
Of 36 instances for which a more detailed police report was available, Narcan was most commonly administered on a station platform — 14 times — but also used on trains, inside and outside fare gates and once in a parking lot.
In one case last December, a young man collapsed on the Civic Center Station platform, blood gushing from his mouth and nose. Hofstein spent 20 minutes giving him three doses of Narcan before the man was taken to the hospital. The man has been back buying drugs, Hofstein added. Before the pandemic, BART police officers deployed Narcan two to six times a month. Overdoses tended to spike in the winter. After the pandemic began, police kept using Narcan two or three times a month, even though BART ridership plunged 87%. There could be more: The overdose incident described by Hofstein was originally recorded as a sick person in the records system, not a Narcan deployment, which police confirmed raised the tally provided in the records request.
Sometimes it’s too late to save a life. Two recent Narcan deployments, one in September and another in November, were listed as coroner’s cases. BART doesn’t have comprehensive records of how many people died from overdoses, because the coroner determines the cause of death. In the records of 41 unattended deaths from January 2018 to Nov. 20, 2020, the case notes listed one as a confirmed overdose and two as possible overdoses.
Hofstein said more than 90% of police calls on a given morning at downtown San Francisco stations he patrols are medical or mental health crises. Over six years, he’s gotten to know drug addicts and tried to connect them with services. Three are now dead, he said. At the time one young man overdosed, Hofstein was trying to get a stroller for his child.
BART police saw the need for intervention as fentanyl use skyrocketed. Half a year after an elevator attendant saved a man’s life with Narcan, BART police started carrying the nose spray, which they get free from the California Department of Public Health. San Francisco police and health departments began carrying it years before.
“If you’re going to work with someone to make change, they have to be alive,” said Eileen Loughran, the city health department’s drug user health community programs coordinator.
BART police have pursued other solutions to respond to drug use. For the past three years, officers directed nonviolent people caught using drugs to treatment instead of jail under the city’s Law Enforcement Assisted Diversion program, a pilot program that ended in October. Currently, the department is trying to fill 23 vacant officer positions and will soon have 21 social worktrained ambassadors to respond to homelessness, mental health and substance abuse calls.
Not everyone agrees. Director Debora Allen said the agency has “no business hiring social workers,” and argued BART should instead partner with counties to provide social services and prioritize making fare gates more secure to reduce drug use in the system.
Hofstein stressed there’s no “cookiecutter” solution. Although ambassadors have helped him with cases, he doubted whether unarmed social workers without medical training could quell lifethreatening situations with verbal deescalation. And while new fare gates would keep out hardcore addicts and reduce filth, drug users might still need trains to get to rehab and a warm place “to keep from dying on the street,” he said.
A few years ago, he enrolled the young man he revived in June, whom he described as a sweet 24yearold kid then, in the diversion program. It didn’t last. Six months after saving his life, Hofstein found him back on the platform on a recent morning, another piece of burnt tinfoil in his hands.