Drug-related deaths surged by 41% in San Francisco in the first quarter of this year – with one person dying of an accidental overdose every 10 hours, as the fentanyl crisis continues to ravage the US west coast.
San Francisco saw 200 people die of overdoses in the past three months compared with 142 in the same months a year ago, according to reports by the city’s medical examiner.
Those living on the streets were particularly hard hit – with twice as many unhoused people dying of overdoses between January and March compared with a year earlier.
Fentanyl was detected in most of the deaths. The city’s minority populations were particularly hard hit. A third of the overdose victims were Black, despite Black people making up only 5% of the city’s population.
“It’s a crying shame that a city as wealthy as San Francisco can’t get its act together to deal with overdose deaths,” said Dr Daniel Ciccarone, a professor of addiction medicine at the University of California San Francisco, who said the city’s increasingly punitive approach to handling drug users has only heightened their overdose risks.
“We’re a politically divided city between the people who have a lot of money and want the streets swept and those who think a compassionate, science-based, health approach is appropriate,” he said.
The spike in deaths began in December and was particularly apparent in January, when 82 deaths put the city’s overdose fatalities at an all-time high. This came just after the city government closed a key outreach center, where drug users were using with medical supervision, and increased policing in San Francisco’s drug-plagued Tenderloin district.
Last summer, voters recalled the city’s liberal district attorney and the San Francisco mayor, London Breed, appointed a new district attorney, Brooke Jenkins, who vowed to take a law-and-order approach to the problem and has since stepped up arrests of drug dealers.
Then in December, Breed closed the Tenderloin Center, a facility designed to provide daytime shelter for the unhoused, along with housing referrals, food, addiction treatment and health services. The center had unofficially allowed drug use in a supervised outside area. Attendants used Narcan to reverse more than 330 opiate overdoses in the 11 months the center was open, according to city data.
The center, which served more than 400 people daily, was opposed by some in the community, who said it was drawing drug users to the already-affected neighborhood.
Breed said in December she had been disappointed by the low number of visitors at the center who ultimately accepted help to get off of drugs. According to the San Francisco Chronicle, fewer than 1% of visits resulted in someone getting connected to addiction treatment services.
Since closing the center, Breed has sought $25m to increase police overtime with the priority of arresting drug dealers.
“We are dealing with multiple serious public safety challenges locally, from a fentanyl-driven overdose epidemic, open-air drug dealing, property crime in our residential and commercial neighborhoods, increasing gun violence and prejudice-fueled incidents,” she said in a March letter seeking more federal help in policing and prosecuting cases.
Last week, the California governor, Gavin Newsom, promised to send in resources and personnel from the national guard and the California highway patrol to bolster policing.
Gary McCoy of HealthRIGHT 360, the non-profit that ran the drug overdose prevention portion of the Tenderloin Center, said the government’s law-enforcement focused approach is backfiring and is instead pushing drug users into isolation, where they are more at risk of overdose deaths.
“Something that has been sold to folks as a strategy that is going to work and help tackle the overdose crisis is having the exact opposite effect,” said McCoy, adding that the police tactics create dangers that go beyond the fact that health officials no longer have the chance to witness and reverse overdoses at the Tenderloin Center.
“When people don’t have a safe place to go, when they’re using in doorways and public places and they’re afraid of getting caught and put in jail, they tend to rush and use more substance,” he said. “And when they rush, there’s a higher risk of overdose.”
Ciccarone said other safe use centers around the world, including one in Melbourne Australia that opened five years ago, have shown to reduce overdoses, bring drug use off the streets and help get addicts into treatment. But he cautioned it takes far longer than 11 months to see the results.
“People expected too much from it too soon,” he said of San Francisco’s center. “It gave the outward appearance that people were congregating to consume drugs. But here we have it closed for three months and the first three months show a tremendous rise in overdose deaths.”
The city’s supervisors have pushed to replace the Tenderloin Center, which was designed as a temporary measure, with 12 smaller “wellness hubs” around the city. These would provide health and shelter services, as well as allowing supervised drug use to prevent overdose deaths.
But last summer, Newsom vetoed legislation that would have allowed supervised drug use centers in three California cities, including San Francisco. And the plan for the wellness hubs stalled, after San Francisco’s city attorney raised the objection that the city could wind up bearing significant legal liability.
Breed has said she supports the wellness hubs.
“These are difficult situations because this involves legal advice, significant criminal liability which we cannot just ignore,” said the mayor, according to KTVU news. Non-profits are now seeking a way to fund the overdose prevention portions of their operations without city funding.
In a statement, the San Francisco department of health (SFDPH) said it has undertaken a host of measures to prevent overdoses, including adding hundreds of new beds for addiction recovery treatment, expanding neighborhood street care teams and making Narcan and medication-assisted addiction treatment options more available.
“SFDPH recognizes that any overdose death is one too many and mourns the loss of each of these lives,” the department said. It added the department was also looking for legal ways to open supervised use clinics. “These deaths drive us to find more ways to prevent overdoses and reduce the harms caused by fentanyl.”
Breed and the new district attorney have touted increased arrests and jail time for drug dealers. In a April blogpost, the mayor said police made 162 arrests for drug possession for sales in the last three months of 2022, an 80% increase, and are seizing dozens of kilograms of narcotics.
“These enforcement actions will continue, while our street outreach teams continue to go out and offer services and treatment,” wrote Breed.
But Alex Kral, an epidemiologist at the independent non-profit research institute RTI International, who led an evaluation of the Tenderloin Center, said the drug dealing arrests actually make the drug supply more dangerous by forcing users to go to people they don’t know for their drug supply and forcing users into hiding.
“You’re making an unpredictable drug market even more unpredictable,” he said.
“We’ve spent the last 50 years trying to arrest our way out of this and it’s clearly not working. The conditions on the streets are getting worse, the drugs are becoming more dangerous and the health of the community is much, much worse with increased policing.”
According to San Francisco supervisor Hillary Ronen, who has championed the idea of wellness hubs, the city has failed to come up with any new tactics to deal with a “horrific crisis”.
“We closed the Tenderloin Center with no plan in place to replace it,” she said. “Fentanyl is corrupting every part of the drug supply and all the social problems that underlie the drug addiction crisis continue – widespread poverty, trauma with no access to mental health care, inequality, and homelessness.
“What did we expect to happen?”
