S.F. is investing millions in overdose response, but deaths keep coming

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Joshua Weens was walking toward his mother’s home in the Tenderloin on a warm August afternoon when he saw a man splayed out on the ground. His skin was slightly purple and drool dripped down his cheek.

A group of people hanging around the man near Golden Gate Avenue and Jones Street said he was just sleeping. But Weens was skeptical.

He called 911, and the dispatcher suggested Narcan. A woman nearby had the overdose antidote on her and sprayed it up the man’s nose, but it didn’t help. The paramedics arrived a few minutes later, tried Narcan again, and then declared the man dead.

“They said it was fena … fenta … fentanyl?” Weens said, struggling to pronounce the drug he had never heard of before.

That tragedy, which sometimes plays out multiple times a day in San Francisco, came just a few hours after the city’s new, $5 million Street Overdose Response Team launched. The team, which responds to 911 calls for overdoses and helps connect people to services and follow-up care — if they survive — is one of the city’s new initiatives this year to combat a dramatic surge in overdoses.

But even with $13.2 million for new and expanded overdose prevention programs this year, the death in the Tenderloin was a grim reminder of what the city is facing.

By the end of the month, 51 more people would die, the majority due to fentanyl, according to data released by the medical examiner’s office last week. That brings the yearly total to 457, which compares with 473 at this time last year. Last year hit a record 712 overdose deaths for all of 2020.

San Francisco has long grappled with an overdose epidemic, but the number of deaths soared after March 2020 when the first of the COVID-19 restrictions were put in place and fentanyl overtook the city’s drug supply. The peak came in January when 76 people died, 70% with fentanyl in their system.

While the monthly death toll has steadily declined since, it has begun to plateau at a concerning level: an average of 57 deaths a month. That compares to a monthly average of 59 in 2020, 37 in 2019 and 22 in 2018.

“The plateau is going to be higher than what we were used to before because of the risk of fentanyl,” said Dr. Phillip Coffin, director of substance use research for the health department. “It’s a new world.”

Such is the troubling reality in San Francisco, where fentanyl — an extremely powerful opioid that can be 50 to 100 times more potent than morphine — is deeply embedded in the drug supply. In the Tenderloin alone, the Police Department seized 19 kilograms, or 42 pounds, of fentanyl this year, compared with 5 kilograms in all of 2020.

The victims are disproportionately people of color, with Black people almost six times more likely to die of overdoses than the average resident.

City data provides a small window into the crisis: In just its first seven weeks of operation, SORT responded to 153 calls involving an overdose, or about three calls a day. That’s likely only a portion of the total number of overdoses in the city in a day, since people don’t always call 911 after they survive one.

Of the calls that SORT responded to, 87% of people were transported to the hospital; 31% had a follow-up consultation with the team in the emergency department; 12% did not accept any care; and 55% received harm reduction supplies, such as fentanyl test strips and Narcan. (Some people received more than one type of care.)

The team did not provide any data on how many people received long-term treatment or housing, or data on what happened to people after their initial interaction. Homeless people are among the most at risk for an overdose, city data shows. The city also has limited long-term care options and a dearth of residential treatment beds, housing and case managers.

SORT responds to calls 12 hours a day, and plans to ramp up to 24/7 by early 2022.

“We’re a really passionate group of people that are all just coming together to do this,” said Kevin Lagor, a nurse practitioner with the health department’s street medicine team.

The city also recently announced plans to add 400 mental health and addiction-treatment beds; however, the timeline to open some of the beds is uncertain. It also expanded hours at a drop-in center where people can get connected to treatment, and hired a new director of behavioral health services.

But it’s clear the city still has a long way to go to make a dent in a crisis that killed nearly three times more people than COVID-19 last year.

Kristen Marshall, project manager of the Drug Overdose Prevention and Education Project, said many of the city’s new initiatives — particularly SORT — duplicate what’s already being done by harm reduction groups around San Francisco: providing people with the supplies to stay as safe as possible until they’re ready for more care. The DOPE Project is funded by the Department of Public Health.

Marshall said City Hall is simply bowing to pressure to appear to be addressing the crisis, while ignoring the root causes of drug use and overdose: a lack of stable and affordable housing, a shortage of treatment beds, and systemic inequality.

“I respect the staff, and they are brilliant and wonderful, but it just sucks,” she said of SORT. “That kind of money could have gone to sustainable solutions.”

Meanwhile, as fentanyl continues to ravage communities, people like Weens are all the more crucial.

The 36-year-old was walking back from a job interview for a local homeless services nonprofit when he saw the man lying there. He was heartbroken when he realized the man was likely dead for a while before anyone stopped to see if he was OK.

“For me, it felt as if I failed. … Could I have helped him if I came by sooner?” he said in a recent interview. “I’m thinking this is someone’s dad, son, uncle.”

After Weens and the paramedics left the scene that early August afternoon, two policemen stood guard over the body in the sweltering sun until the medical examiner arrived about an hour later. Several people walked by, turning their eyes down to the body under the tarp.

“The community has become numb to it, and there needs to be more awareness,” Weens said.

While he was unfamiliar with fentanyl at the time, he said he has received a crash course in the six weeks since then: As a new outreach worker in the Tenderloin, he has helped reverse several overdoses in the past month alone.

“Walking and seeing that man, I knew that something wasn’t alright,” Weens said. “And I wouldn’t have been able to be all right with myself if I just kept going,” he said. “Take time to check. Take time to see. It doesn’t hurt to check, it doesn’t hurt to act.”

Editors note: A previous version of this story incorrectly said that SORT provides a type of harm reduction that it does not give out.

Trisha Thadani and Yoohyun Jung are San Francisco Chronicle staff writers. Email: tthadani@sfchronicle.com, yoohyun.jung@sfchronicle.com Twitter: @TrishaThadani, @yoohyun_jung

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