(ScienceDirect, Fentanyl epidemic hits the U.S. West Coast: Opioid-related deaths in San Francisco from 2009–2019, August 2021)

• Deaths

  -52,404 deaths in the U.S. in 2015, 33,091 (63%) involving an opioid. Overdose rates by fentanyl increased by 72% from 2014 to 2015.

• Hospitalization rates

  -Increased overdose hospitalization rates through out the years.

• Access or availability of Naloxone/Narcan

  -Naloxone kits are provided to trained individuals by several organizations (DOPE project).

• Accessibility of safe sites to prevent overdose

  -DOPE Project sites, etc.

  
  

Rowe, C., Wheeler, E., Stephen Jones, T., Yeh, C., & Coffin, P. O. (2019). Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015. Journal of urban health : bulletin of the New York Academy of Medicine, 96(1), 6–11. https://doi.org/10.1007/s11524-018-0250-x

During the 1930s-1960s people of color lack home ownership. Many were at risk of being homeless due to high rent costs, then became homeless. Due to economic factors and not meeting basic needs to survive. The cost of living is too high and many are below median income. Chronic homeless are seeking remedies to forget the loss of assets by using substances to escape reality. There are 35% of shelters available but needs are higher and waitlists are 1,000 plus people trying to get housing. Lack of sufficient care is often not available to the homeless and puts them back on the streets when they need more support beyond housing.

Krivkovich A, Schiff R. The ongoing crisis of homelessness in the Bay Area: What’s working, what’s not. March 23, 2023. McKinsey & Company

Lane, J. (2020, August 31). Fentanyl drove steep increase in overdose deaths in San ... San Francisco Department of Public Health. https://www.sfdph.org/dph/alerts/files/PR-2020-Substance-Use-Trends-2019-Annual-Report.pdf

• Lack of awareness Fentanyl contamination in other drugs as just "white powder"

• Lack of knowledge of available resources for harm reduction such as opioid reversal Naloxone

• Underestimate potency of Fentanyl

https://rdcu.be/dHgQ4

Enforcement | State of California - Department of Justice - Office of the Attorney General

James, K., & Jordan, A. (2018). The Opioid Crisis in Black Communities. The Journal of Law, Medicine & Ethics, 46(2), 404–421. https://doi.org/10.1177/1073110518782949

In San Francisco County, opioid related deaths among African American significantly increased since 2011, the number is 426.2 per 100,000 while the nationally it is 51.8. Moreover, African Americans disproportionately affected compared to other races. For example, it is 4 times higher than second highest race which is Hispanics.

Drug overdose death rates for every US county (sfchronicle.com)

In the first year of the COVID-19 pandemic in San Francisco, there were 331 deaths among people experiencing homelessness. This number was more than double any number in previous years.

• Eighty one percent who died were male.

• Acute drug toxicity was the most common cause of death in each year, followed by traumatic injury.

• The proportion of deaths involving fentanyl increased each year (present in 52% of toxicology reports in 2019 and 68% during the pandemic).

Cawley, C., Kanzaria, H. K., Zevin, B., Doran, K. M., Kushel, M., & Raven, M. C. (2022). Mortality Among People Experiencing Homelessness in San Francisco During the COVID-19 Pandemic. JAMA network open, 5(3), e221870. https://doi.org/10.1001/jamanetworkopen.2022.1870

2. Increase the number of residents ability to recognize the signs of potential accidental Fentanyl overdose in the SOMA and Tenderloin neighborhood in San Francisco within 1 year. (skill)

3. Increase in the number of people who are experiencing homelessness and suffering from drug addiction in the SOMA and Tenderloin neighborhoods of San Francisco to test for fentanyl in order to safely use substances by 1 year. (skill)

   
   

• 10 New Life Mentors will meet 2 hours a day for 2 days a week for 6 weeks for training and to create prevention strategies and safe dosing materials. 

• Mentors (peer-to-peer program) will meet once a week on the field (more meetings by request if appropriate). 

• Red flag clients (suicidal ideation, mental health distress, physically unwell, etc.) will be sent to HSA for resources from social workers, case workers, and therapists (outside resources).

New Life staff conduct education

• New Life Mentors distribute flyers and conduct street outreach to individuals experiencing homelessness and drug addiction in the Tenderloin/SOMA to recruit them to attend prevention training (curriculum).

• New Life Staff to conduct a two-hour prevention strategy training twice a month, every month for 2 years (with incentives: food, hygiene packs, etc.).

  • Training Approach

    • Observation of situations that carry risk.

    • Demonstration of steps to prevent overdose risk.

    • Conduct part of the training on the street sidewalks for participants to practice.

    • Peers demonstrate preventative skills and knowledge.

  • Training Topics

    • Identify situations that carry higher risks of future overdoses.

    • Steps to control these situations as much as possible.

    • Overdosing prevention skills

New Life Safe Zone Site

• Provide drug testing kits, reversal kits, and educational resources.    

• CPR certification, offer AED services if needed.

• Access to healthcare professionals (medical assistants, EMTs, nurses, clinicians, etc.)