S.F. team to offer care after overdoses
Reaching out within 72 hours seen as key
As San Francisco struggles with an exploding drug epidemic that killed more than 700 people last year, a new cityrun response team hit the streets Monday to try to help people who survive an overdose.
The hope is to prevent a future, potentially fatal overdose by directing people to resources and treatment. The influx of fentanyl, a powerful opioid, has exacerbated the city’s drug crisis over the past few years, with fatal overdoses rising from 441 in 2019 and 259 in 2018.
“We know that overdose deaths are preventable and every person who dies is someone’s son, daughter, friend, or neighbor. It is urgent that we save lives by doing what we know will work best,” Mayor London Breed said in a statement. “The Street Overdose Response Team is focused on helping people who are most at risk get the help they need to start their recovery.”
The new team comes as pressure increases on Breed and the Board of Supervisors to deal with the city’s drug crisis. Many advocates say that the city isn’t doing enough to directly address the tragedies on the streets, as well as systemic problems — like homelessness and mental health issues — that fuel the crisis.
While the SORT team did
its first run in the morning, by the afternoon, at least one person had died of an apparent overdose. Around 3 p.m., a yellow body bag flapped in the wind at the corner of Jones Street and Golden Gate Avenue with a vial of Narcan on the ground.
One man walking by said he called the paramedics when he saw someone laying motionless on the sidewalk, with drool coming down the side of his cheek. The paramedics were unable to save the man with more Narcan, he said. When they left, the police stood guard over the body for about an hour until the medical examiner finally came.
The Street Overdose Response Team (SORT) is one of several street crisis teams rolled out recently as officials try to address San Francisco’s twin behavioral health crises: addiction and mental illness. San Francisco also recently hired a new head of behavioral health, who will lead the city’s attempt to reform its system of care: Mental Health SF, a $100 millionayear initiative.
SORT — initially made up of a paramedic and public health specialist — will reach out within 72 hours of an overdose and can offer a range of services, including buprenorphine, which helps ease withdrawal; rescue kits that include the overdose reversal drug Narcan; and help getting into substance use treatment facilities or housing or shelter.
San Francisco has limited longterm care options — like residential treatment, housing and case managers — for those who want help. It’s unclear how the team will navigate the shortage. The city recently announced plans to add 400 mental health and addiction treatment beds, but the timeline to open some of the beds is uncertain.
Housing and shelter is particularly important because the unhoused are among those most at risk of an overdose. The rate of overdose deaths among homeless people doubled in San Francisco over the past year, accounting for at least onequarter of all overdose deaths, according to city data.
SORT will start by responding to calls 12 hours a day and ramp up to 24/7 by early 2022. The idea is to make sure patients — who are referred by hospitals, the 911 system and community partners — get followup care. The team hopes to be able to work with approximately 700 individuals within the first year. Once it’s up and fully running, SORT will cost about $5 million a year to operate, according to the health department.
At full expansion, SORT will consist of medical specialists such as doctors and nurses; behavioral health specialists including counselors and psychotherapists; and peer counselors with “related, lived experience.”
Peer counselors — who are “from the community, who have the same life experience as the people we’re outreaching to” — are crucial in helping those who might be resistant to treatment, said Dr. Barry Zevin, the medical director of street medicine at the health department.
SORT is a response to emergencyroom doctors and paramedics observing that people are more likely to accept treatment immediately after an overdose, Zevin said, although there’s no data to prove that. He added that there is data that show people with addiction disorders are responsive to lowbarrier treatment.
“Sometimes having a nearcatastrophic life event is a time when people reflect on what they’re doing,” said Kevin Lagor, a nurse practitioner with the health department’s street medicine team. “Ultimately all we’re trying to do is connect people to help if they’re ready for it. We can’t force anything on anyone.”
Officials said other efforts to stem fatal overdoses include opening a methamphetamine sobering center this fall with 20 temporary beds to connect to care, and expanding access to buprenorphine through telemedicine and by delivering it to “high risk” housing sites and other locations.
Those overdose interventions — including SORT — will cost around $13 million a year, a fraction of the city’s $13.2 billion budget. But the health department will spend a total of $606 million on all behavioral health initiatives this fiscal year, according to a spokesperson, up approximately $70 million from last year.
In addition, the city’s budget will add more than $1 billion to tackle homelessness over the next two years, on top of the $600 million existing twoyear spending.
Kristen Marshall, director of the Drug Overdose Prevention and Education Project, which manages the city’s overdose response, said that while she deeply respects the people who are part of the SORT team, officials are simply responding to pressure and the new initiative is not a longterm solution. Actual solutions would involve addressing systemic issues — including inadequate access to food, housing and water — that lead to people overdosing, Marshall said.
“I don’t care how many times you check on them after an overdose,” Marshall said. “They need dignified housing.”
Supervisor Matt Haney said SORT will bring overdose survivors into a larger system of care that may help them access basic needs including housing, food and water. Haney’s district includes the Tenderloin and SoMa, where 40% of all overdoses occurred in 2020.
“I mean this is not the whole solution. This is a part of the solution,” Haney said. “If someone has experienced an overdose, the right thing to do, including to address the broader needs that person has, is to have trained public health first responders.”
Haney added that funding for 400 new treatment beds, increased street outreach and more counseling services also made it into the budget.
The city is also ramping up the availability of Narcan, expanding to settings such as primary care clinics, housing sites, food pantries and dining halls. Already, the city is seeing a spike in the use of Narcan, which was administered more than 4,200 times in the first six months of 2021 versus 4,300 times in all of 2020.
That sharp rise in Narcan reversals is related to the rise of fentanyl, Zevin said.
“Two years ago, I saw virtually no one using fentanyl on purpose in San Francisco,” Zevin said. “Now, essentially all of my patients are using fentanyl.”
While the pace of overdose deaths dipped slightly this year, the share that involved fentanyl held steady at about 75%.
Activists have said one way to cut down on overdoses would be to open a safe drug use site where users are supervised and can access treatment. San Francisco officials have expressed support for such a site, but are waiting on state legislation to permit the sites, which has been delayed.
In the meantime, SORT will try to help save lives. The effort will complement the Street Crisis Response Teams, which began working last year. Those teams have mental health professionals who respond to some 911 calls in place of police, with the goal of helping those who are mentally ill, high on drugs, homeless or all three.