San Francisco Chronicle - (Sunday)
With 2 dying a day from overdoses, S. F. must do more
At the San Francisco Medical Examiner’s Office, the bodies just keep coming. Roughly two every day. Each one requires yet another autopsy and yet another call to a devastated family with the same terrible message: Your loved one died of a drug overdose. Anybody who dies of a homicide, suicide, accident or alone with no doctor’s signoff on the cause of death winds up at the city morgue. Now, nearly half of those bodies are there because of an accidental drug overdose.
New numbers provided to The Chronicle
show 1,070 bodies were examined by the San Francisco Medical Examiner’s Office from Jan. 1 through Aug. 31. And 468 of them died of an overdose.
That puts San Francisco on track to lose more than 700 people to drugs in 2020 — or nearly two every day. That’s a shocking rise from the 441 people who died of drug overdoses in 2019 and the 259 who died the year before that.
“It’s exponentially growing. Every day — every day now — we’ve got deaths from overdoses,” said Dr. Luke Rodda, chief forensic toxicologist at the Medical Examiner’s Office, noting that the stunning rise has been a challenge for his team.
“It’s our work. It’s what we do,” he said. “We just have to think about how to keep up.”
Fentanyl, an incredibly dangerous and potent drug, is driving the rise in deaths. Of the 468 people who died of overdoses through August, 319 had fentanyl in their systems. Other drugs are often laced with it, and many of those who died probably didn’t even know they consumed it. Rodda said he finds cases in which someone thought they were buying Xanax, an antianxiety medication, on the street, but it’s laced with fentanyl.
Of those who died of overdoses in the first eight months of this year, 28% were homeless. Seventy percent died in the heart of the city — the Tenderloin, South of Market, Nob Hill and the Inner Mission. Older Black men living alone in residential hotels are dying at rates far higher than their portion of the city population.
And yet most of us will see these statistics, think they’re a shame, and quickly move on. It doesn’t really affect us, we think.
And for too long, City Hall has mostly agreed. Even as it devotes tremendous time and attention to quashing COVID19, another public health epidemic that has killed far fewer San Franciscans. As of Saturday, that tally was 123. We’re a city that freaks out about a jogger running past without a mask, but doesn’t blink at someone injecting themselves in the neck on a Tenderloin sidewalk.
Sure, we’re not going to “catch” a fentanyl addiction from somebody else, so it’s easy to think it’s not our problem. But those addictions are killing far too many of our fellow San Franciscans, devastating families and damaging neighborhoods in which the deadly wares are sold.
“I’m honestly floored,” said Supervisor Matt Haney, who pushed legislation requiring quicker, more frequent reporting of drug overdose deaths. “It’s already killed four times as many people as COVID. Where’s the urgency? I’m seeing far too much business as usual.”
It’s time for a fullfledged, multipronged, creative response. Like the one that’s been so successful keeping our COVID19 case rates and death tally low. We need the same kind of focused hard work across city departments and the same kind of intense education and public awareness campaigns.
I knew almost as soon as the COVID19 pandemic started to stand 6 feet away from others, wear a mask, use hand sanitizer, wash my hands for 20 seconds and stay home as much as possible. Signs are everywhere. The mayor and other officials talk about it constantly.
But until Friday morning, I had no idea, even after years of reporting at City Hall, how to access drug treatment in San Francisco if I or a loved one needed it. How would the guy sprawled out on a Hyde Street sidewalk, high out of his mind, have any clue?
Dr. Hali Hammer is the director of ambulatory care for the Department of Public Health and is overseeing an effort to make it easier to access treatment for substance use. Talking to her made it clear that a lot of good work is going into addressing this crisis, but there’s a lot of room for improvement.
“We have been very, very concerned about the increase in overdose deaths. We see firsthand the skyrocketing rates,” Hammer said. “We’re doing so many great things, but these numbers are unacceptable. We have to start thinking differently.”
For example, the place you’d go to find drug treatment — the Behavioral Health Access Center at 1380 Howard St. — is only open Monday through Friday from 8 a. m. to 5 p. m. As Hammer explained, people often need to hit their lowest — like getting kicked out by their spouse or being thrown in jail for a night — to realize they need help. And that doesn’t necessarily coincide with business hours.
The intention is to expand its hours and offerings with newly released Proposition C money and the adoption of the city’s Mental Health SF plan.
Accidental overdose deaths in San Francisco
Monthly average Demographic breakdown January to August 2020 overdose deaths
Gender
Male
Female
Hammer also wants to make it faster to get treatment once someone’s asked for it. It now takes a few days to enter outpatient treatment like a methadone clinic and close to a week to get a residential treatment slot — a lapse during which somebody can easily slip back into a drug habit.
“The truth is we lose a significant number of people when they have to wait at all,” Hammer said.
She also wants to make it easier to get a prescription for buprenorphine, a medicine to treat opioid addiction. It takes several trips to a doctor’s office to get the dosage right, she said. There are 12 people authorized to prescribe it on the department’s street medicine team, but they’re spending most of their time this year treating people in shelterinplace hotels and not walking the streets as much. She wants the team to be expanded. Hammer also wants a safe injection site where people can shoot up inside under supervision — and state Sen. Scott Wiener has said he’ll seek state permission to open one in the city again after several thwarted attempts. She also wants more drug sobering centers for people to ride out their highs safely. These places mean less of a chance of a deadly overdose and more opportunities for staff to offer treatment.
Though many progressive politicians dismiss any kind of law enforcement when it comes to our city’s drug crisis, Hammer said she supports arresting drug dealers. ( It’s odd that this is even controversial in San Francisco, but there you go!)
Race
Other/ Unknown
White
“I do think we need to crack down on that,” she said. “For those families living in the Tenderloin, we have to do something to make the streets safe for them.”
Though District Attorney Chesa Boudin has said repeatedly he won’t jail lowlevel drug dealers, City Attorney Dennis Herrera is seeking civil injunctions against 28 known offenders, trying to keep them out of the Tenderloin. The San Francisco Police Department stationed a huge mobile command van on Hyde Street last week to try to disrupt dealing.
If this was a multiplechoice test, I’d pick all of the above. Harm reduction, treatment and law enforcement are all worthwhile — and must continue.
That’s an idea pushed by Thomas Wolf, who was homeless in the Tenderloin and addicted to heroin before getting clean at the Salvation Army.
He’ll take anybody who’s interested on a stroll through the neighborhood. But notably, only those politicians and candidates on the more moderate end of the very narrow San Francisco political spectrum have asked to tag along.
Progressives tend to despise him for saying harm reduction needs to be paired with far more treatment opportunities and real punishment for dealers.
On his tour, he describes which dealers control which corners and where to go to buy which drugs. He shows where he slept on cardboard and where he held drugs for dealers.
He points out strange little facts — like that the safe
Asian
Age sleeping site at Turk and Jones streets has a box for depositing used needles, but no shower. Why not both? Or that there’s not a poster or billboard in sight telling people how to access treatment, but lots of little pieces of foil blowing in the wind, remnants of fentanyl use. Or that there’s a methadone clinic just steps from a major drug dealing corner, putting patients at risk every time they visit.
He’d like the city to offer major incentives — like two years of transitional housing for anybody who completes a sixmonth treatment program. On our walk, we saw people shooting up. We saw people sprawled on the sidewalk. We saw a man walking barefoot down Taylor Street carrying a meth pipe.
“That guy’s clearly spun out,” Wolf said. “He’s going to end up in the hospital, in jail or dead. Those are his three options.”
Wolf carries Narcan and has injected it into numerous people overdosing on drugs. But still, it can’t save everybody. Not even close. He saw three people overdose and die from fentanyl when he was living on the streets.
“That was in 2018,” he said. “Those deaths still haunt me to this day.”
And now there are hundreds more deaths to haunt us. Let’s wake up and address this crisis before even more bodies pile up.
San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: hknight@ sfchronicle. com Twitter: @ hknightsf Instagram: @ heatherknightsf
Location
Inner Mission
Other
Nob Hill
SOMA
Tenderloin