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Fentanyl takes over the streets of San Francisco 

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Fentanyl takes over the streets of San Francisco 

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The main contributor to the rapid rise in drug overdoses and deaths in San Francisco is Fentanyl. Fentanyl is a synthetic opioid that is highly addictive, cheap, and 30-40x more potent than Heroin.

Between January and October 2021, Fentanyl was a factor in more than 70% of overdose deaths, which increased by 20% from the previous year.

An individual who has not yet built a tolerance for fentanyl could die just from two milligrams.

Thadani, T. (2022, February 3). Fentanyl is a public health crisis in San Francisco. These stories show why it’s so difficult for victims to escape their grip. The San Francisco Chronicle. https://www.sfchronicle.com/projects/2022/sf-fentanyl-opioid-epidemic/

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Mayor London Breed and city officals issued a "state of emergency" in the Tenderloin on December 17, 2021. Opioid overdoses had increased by 200 percent in San Francisco since 2018 (SF Mayor, 2021).
Overdose deaths topped COVID-19-related deaths in 2020
(SF Mayor, 2021).

Mayor London Breed Declares State of Emergency in the Tenderloin | Office of the Mayor. (2021, December 17). Sfmayor.Org. https://sfmayor.org/article/mayor-london-breed-declares-state-emergency-tenderloin

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In San Francisco, Black people are over two times more likely than White people to die from an overdose. Out of every 100,000 people, 277 Black people die from an overdose in comparison to White people which is 89 out of 100,000 (Appa et.  al, 2022). In San Francisco the Black male population is 5.6%, and 27% of that population have died due to opioid overdose (Kurtzman, 2022).

Another population that is disproportionately affected are people experiencing homelessness. The leading cause of death for individuals experiencing homelessness is drug overdose. Based on the autopsies of this population, 82% of deaths were caused by opioid overdoses from drugs such as fentanyl (Kurtzman, 2022).

Appa, A., Cawley, C., & Rodda, L. (2021, May 12). Drug overdose deaths during the COVID-19 pandemic in San Francisco. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779782

Kurtzman, L. (2022, March 10). Homeless deaths doubled in San Francisco during the pandemic's first year, mostly from drug overdoses. ucsf.edu. https://www.ucsf.edu/news/2022/03/422436/homeless-deaths-doubled-san-francisco-during-pandemics-first-year-mostly-drug

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In 2021, of the 650 overdose deaths, 73% involved fentanyl. Because of its low price and potency, tens of thousands of people are injecting and smoking fentanyl and dealing with addiction (Jung,2022). And, due to its high demand, there is an increase in the supply of fentanyl in the Tenderloin. In this same year, police captured 56 pounds of fentanyl in the Tenderloin neighborhood alone (Thadani et. al, 2022).

Jung, Y. (2022, February 23). Tracking San Francisco's drug overdose epidemic. The San Francisco Chronicle. https://www.sfchronicle.com/projects/2021/san-francisco-drug-overdoses-map/

Thadani, T. (2022, February 3). Fentanyl is a public health crisis in San Francisco. These stories show why it’s so difficult for victims to escape its grip. The San Francisco Chronicle.

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Devastating Rates of Open Drug Dealing in Tenderloin

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Devastating Rates of Open Drug Dealing in Tenderloin

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Tenderloin is home to the majority of open-air drug dealing. This makes a large number of illegal drugs available and easily accessible in Tenderloin. There are large drug consumers in Tenderloin which attracts many illegal drug dealers.  In fact, in San Francisco, 80 percent of drug-related arrests are made in Tenderloin (Miguel and Matier, 2022).

Miguel, K., & Matier, P. (2022). 85% of SF's drug arrests happen in the Tenderloin. police explain why. ABC7 San Francisco. https://abc7news.com/sf-tenderloin-drug-arrests-narcan-homeless/11535735/

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The Tenderloin is a vulnerable community filled with a high concentration of low-income families, homelessness, an open-air drug market, and overdoses. Making it difficult for families to raise their children in a safe environment away from crime and drug usage (Thandani, 2022).

Due to many people experiencing homelessness, most of these deaths occur outdoors and on sidewalks in front of buildings. Multiple deaths have been reported in various locations, particularly at Single Room Occupancy (SRO) establishments (Thandani, 2022).

Thadani, T. (2022). Fentanyl is a public health crisis in San Francisco. These stories show why it’s so difficult for victims to escape its grip. The San Francisco Chronicle. https://www.sfchronicle.com/projects/2022/sf-fentanyl-opioid-epidemic/

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The prevalence of the open-air drug market in the neighborhood was the top complaint among community members (Knight, 2020).

A resident in the Tenderloin, Karla Burgos, mentions how her 10-year-old son is aware of the drug transactions that occur in the area. And how she needs to plan different routes when they run errands so that her son does not have to see the burden of the open-air drug market (Knight, 2020).

Knight, H. (2020, September 5). Tenderloin tents are now rare. Open-air drug dealing is still all too common. San Francisco Chronicle. https://www.sfchronicle.com/bayarea/heatherknight/article/Tenderloin-tents-are-now-rare-Open-air-drug-15544410.php

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Drug Overdose Surging in the Tenderloin 

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Drug Overdose Surging in the Tenderloin 

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The opioid overdose deaths have increased by 478% from 2015 to 2020 in San Francisco. In 2015 there were 101 deaths in comparison to 2020 there were 584 deaths due to overdose (Coffin et. al, 2020).

There were around 1,310 deaths in 2020-2021 due to overdoses. Of those, 23% occurred in the Tenderloin (Jung, 2022).

Jung, Y. (2022). Tracking San Francisco’s drug overdose epidemic. The San Francisco Chronicle. https://www.sfchronicle.com/projects/2021/san-francisco-drug-overdoses-map/

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1. Decrease the number of deaths due to opioid overdoses in the Tenderloin community in 3 years.

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1. Increase in the number of individuals using opioids with others within 6 months in the Tenderloin community (not using drugs alone) (behavior).
2. Increase in the number of individuals using opioids seeking help within 8 months in the Tenderloin community (skill).
3. Increase in the number of individuals using opioids who have the skill to administer narcan in the Tenderloin community within 12 months (skill).
4. Increase in the number of peers administering narcan to opioid users when needed within 12 months in the Tenderloin community (behavior).

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1. Increase in the number of individuals using opioids that want to use narcan within 3 months in the Tenderloin community (attitude).
2. Increase in the number of individuals using opioids believing that it is okay to seek help/treatment within 3 months (attitude).
3. Increase in the number of individuals using opioids knowing where to seek help within 3 months (knowledge).
4. Increase in the number of individuals using opioids wanting to seek treatment within 3 months (attitude).
5. Increase in the number of individuals using opioids wanting to not be alone while doing drugs within 5 months (attitude).
6. Increase in the number of individuals using opioids knowing that doings drugs with a peer can save your life within 5 months (knowledge).
7. Increase in the number of individuals using opioids knowing that narcan reverses overdoses within 5 months (knowledge).
8. Increase in the number of people knowing how to administer  narcan within 5 months in the Tenderloin community (knowledge).

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NRTS: Narcan Reversal Training Survival

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People experiencing homelessness who are users of opioid drugs in the San Francisco Tenderloin district.

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Program Activities Phase 1: Program Development(1-3 Months):

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Program Activities Phase 1: Program Development(1-3 Months):

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Hire Staff - community outreach team

Recruit 15 peer educators that have experienced and/or have similar background

Purchase prescription narcan kits and demonstration kits

Rent a property that is located in the heart of the Tenderloin Community to train staff and storage for narcan kits

Develop a curriculum to provide training for Peer Educators. This training would focus on teaching staff on how to spot signs/symptoms of an overdose and how to administer narcan. This training would focus on teaching staff on how to effectively communicate with the participants, how to demonstrate the administration of narcan, and how to collect data (name of participants, how many kits received)

Develop a curriculum for Peer Educators to train the participants. This training would focus on the delivery component of talking to them about not using opioids alone, demonstrating the use of narcan, and disbursing aid kits.

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Program Activities Phase 2: Program Implementation (4-21 Months)

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Program Activities Phase 2: Program Implementation (4-21 Months)

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Part 1: Train Opioid Harm Reduction Peer Educators

15 Peer Educators meet for two sessions, 1 hour a day, once a week for 2 weeks for training to identify signs/symptoms of overdoses, how to administer Narcan on others to reverse overdoses, how to communicate with participants, and document the participant’s name and number of Narcan kits given(if given Narcan any).

Peer educators will have groups meetings once a week at the rental property with project coordinators to update one another and discuss the progress. Project coordinators can be reached on the phone if needed or have any questions.

Part 2: Peer Educators Conduct Narcan Reversal Training and Education

The total of 15 peer educators will alternate days/weeks depending on their availability to make sure 4 peer educators are available every week

4 peer educators will go to the tenderloin neighborhood to provide training on Narcan administration and education on opioid overdose and Narcan

4 Peer Educators will go 4 days a week for 3 hours a day, 1 session every 30 minute interactions, 24 total people a day for 15 months (6 people per each peer educator a day)

Training Approach

Peer educators will go and find our target population on the streets of Tenderloin neighborhood

Peer educators will go to the participant and start small talks then start a conversation on opioid by sharing about their own personal stories while they educate and introduce Narcan

The conversation should flow smoothly without making the participant feel attacked or judged

Training Topics

Peer educators will talk to our target population about not using opioids alone, Narcan will reverse opioid overdose

Peer educators will train our target population on how to administer narcan on others, and provide free narcan kits

Providing information about treatment options and where they can if it, if they are looking for it or ever get interested

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Program Activities Phase 3: Program Closing (22, 23, & 24 Months)

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Program Activities Phase 3: Program Closing (22, 23, & 24 Months)

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Set up an event celebrating the program accomplishments and raising more awareness to the situation.

During the events, there will be access to at least 5 peer educators for training and free Narcan kits

Award Peer Educators with certificates of recognition

Conduct evaluation on the data collected by the peer educators

Develop final report on the NRTS Program

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15 Trained Peer Educators

2 Curriculums: One to train the peer educators and one for peer educators to train the participants

Peer educations are trained for two session total

Peer educators will perform total of 6240 session over 15 months period

6240 interactions with people that are experiencing homelessness who are users of opioids (4 peer educators train/educate total of 96 people each week for 15 months)

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The city of San Francisco has an urgent need for large amounts of Narcan distribution on the streets. Narcan is a life-saving reversal drug that quickly treats drug overdoses. (Rinker, 2019).

The use of Narcan is helpful to the individuals who abuse opioids, the community, and first responders. At least 2,600 overdoses were reversed by community members using naloxone. San Francisco paramedics responded to over 2,000 overdose incidents with the use of naloxone (SFDPH,2020).  It often takes about 4-6 mg of Naloxone by injection to stop the effects of fentanyl.

“Facts on Fentanyl - Glide - San Francisco: Serving the People of the Tenderloin and San Francisco since 1963.” GLIDE, 11 Mar. 2021, https://www.glide.org/facts-on

fentanyl/.

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Project Director (part-time)

Project Coordinator (part-time)

A total of 15 Peer Educators (4 peer educators work per week)

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NRTS Program Budget -- Spreadsheet - Sheet1

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Between the years of 2017 to 2019, the city of San Francisco has spent around 10 million dollars to address the opioid abuse issue. ( Ohanian,2022). Now, the budget is far higher than before, being 71.4 million dollars in the past fiscal year. (Thadani, 2022). The San Francisco prevention program has used around 47,000 injectable doses of naloxone to help with the overdose crisis (SFDPH, 2020). The city has tried to provide free naloxone to reduce overdoses. And, the prevention and treatment programs have paid up to 30 times more for this life-saving medication in the past, however, the city is now struggling to pay for it.

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“The Economics of How San Francisco's Drug Policies Are Devastating the City.” Hoover Institution, https://www.hoover.org/research/economics-how-san-franciscos-drug-policies-are-devastating-city.
San Francisco Department of Public Health. https://www.sfdph.org/dph/alerts/files/PR-2020-Substance-Use-Trends-2019-Annual-Report.pdf.
Thadani, T. (2022, February 3). San Francisco's Fentanyl Crisis: A disaster in plain sight. The San Francisco Chronicle. Retrieved May 10, 2022, from https://www.sfchronicle.com/projects/2022/sf-fentanyl-opioid-epidemic/