San Francisco Chronicle - (Sunday)
Overdose deaths soar in S.F.
San Francisco’s overdose deaths have sharply increased since the start of December, an alarming jump that comes amid the closure of the city’s Tenderloin Center — an informal place where people were able to use drugs under medical supervision.
An average of 58 people died each month in the three months before the center’s closing on Dec. 4, compared with an average of at least 68 in the three months following, The Chronicle’s analysis of new preliminary data from the medical examiner’s office shows.
New numbers released for January show it was the highest monthly total in three years.
It’s too early to know whether the closure is a factor in the increase. In a statement, the Department of Public Health said it is analyzing the latest overdose numbers to understand more about the deaths and “what trends may be present in the evolving overdose crisis.”
The health department did not respond to multiple emailed questions about whether the closure of the Tenderloin Center may have contributed to the rise. A spokesperson for Mayor London Breed said he could not comment on “what happened specifically and would rely on DPH experts.”
But Joshua Bamberger, a clinical professor of family and community medicine at UCSF, said there is nothing else he can attribute the deaths to other than the closing of the Tenderloin Center.
“The best treatment for fentanyl overdoses is a place where people can be observed using, such as what was being done informally with the Linkage Center,” he said, referring to the original name of the Tenderloin Center. “To see this very profound data hits home the importance of the site and how the mayor’s policy for closing the Linkage Center appears to result in an increase in deaths due to drug overdose.”
The new data released Friday shows at least 53 people died of overdoses in February, bringing the early running total for 2023 to 131 so far. That’s about the same as the average monthly deaths last year. But this tally will probably increase as medical examiners complete more death investigations in the coming months. January’s preliminary count was 62, compared with the updated count of 78.
The new total makes January 2023 the deadliest month so far for accidental drug overdose deaths in San Francisco since January 2020, the first month for which this data is available. Fentanyl, which became more common in the city in the late 2010s, has driven overdose mortality to unprecedented levels.
To address the rise, the health department is continuing to work on its Overdose Prevention Plan, which includes expanding access to the overdose reversal medication naloxone, and opening more residential care and treatment beds. The city has also increased access to buprenorphine, a medication for opioid use disorder treatment.
Jeff Cretan, a spokesperson for Breed, said the city is also working on “disrupting the fentanyl dealers that are preying on people through arrests and prosecutions.” He noted that the mayor and Board of Supervisors are working with nonprofit partners to open an overdose prevention site, “though we don’t have a proposal to do so yet.”
The Tenderloin Center at U.N. Plaza opened in January 2022 as the cornerstone of Breed’s Tenderloin emergency initiative announced in December 2021. Breed said the initiative would address overdose deaths and street conditions in the neighborhood, and also crack down on open-air drug use and dealing.
The center offered showers and food as well as connections to shelter, housing and addiction and mental health treatment. The site logged more than 100,000 visits, but critics pointed out that only 1,000 of those visits resulted in linkages to mental health or drug treatment despite the city spending millions on the center. While a relatively small portion of those who visited the center were connected to treatment, staff reversed more than 300 overdoses in the 11 months the site was operating.
When the center opened, officials didn’t share publicly that the facility would have a sanctioned outdoor area to use drugs under staff supervision. Critics said allowing drug use there enabled addiction.
But many supported the move and came to regard it as a de facto safe consumption site, a model that exists in cities around the world and in New York, where people can use drugs in a supervised setting. When Breed’s office closed the site, officials said it was always meant to be temporary. Officials also said it didn’t connect as many people to services as hoped.
Advocates predicted that the December closure of the center would lead to more overdoses and argued that an official supervised consumption site should replace it. After it closed, Breed’s health department pulled back on plans for smaller supervised consumption sites — which would operate within “wellness hubs” — to replace it.
The health department said in a statement that it is working closely with Breed, the Board of Supervisors and nonprofits to “look at options for opening wellness hubs that will provide health services for people who use drugs and are at risk for an overdose.”