The Need For Narcan

San Francisco is currently heading for a record number of overdose deaths this year, with 268 deaths in the first four months of 2023. The main driver behind this increase is fentanyl, an incredibly potent and potentially deadly synthetic drug that’s found its way into many narcotics.

As overdoses have risen, so has the need for naloxone, or Narcan. This incredible, life-saving drug quickly reverses an overdose, blocking the effects of opiates on the brain and restoring breathing. It’s become a necessary tool for first responders throughout the city, along with many everyday San Franciscans. 

In one way, this is an important response to the increase in overdoses. The San Francisco Department of Public Health has done a good job of making naloxone available throughout the city, and SFDPH is committed to the distribution of naloxone as part of its 2022 Overdose Prevention Plan. 33,495 naloxone kits were distributed in 2021, and in the next few years, SFDPH is aiming to increase citywide naloxone distribution from 47,000 kits to 75,000 kits annually. 

But the fact that Narcan is so necessary, that SFDPH is planning on needing to distribute 75,000 naloxone kits in a single year—that is unsettling. Each year, the need for Narcan increases as the number of overdoses increases. Our That’s Fentalife! Campaign was created to push city officials to not only keep people alive, but ensure we have true treatment on demand to get people the services they need to recover from drug addiction.  

Some took offense at the That’s Fentalife! campaign. People were upset with the ironic tone, or misinterpreted our goals of the campaign, saying we wanted to limit Narcan use. 

The That’s Fentalife! campaign has never been about restricting naloxone use. It’s aimed squarely at City Hall, pushing our elected officials to do more to end the fentanyl epidemic. But this fight over Narcan gets to something deeper in San Francisco politics, where people endlessly debate about tactics or language while conditions in the city worsen. There’s almost universal agreement that San Francisco housing prices are too high, but we dither about in the margins of policy, while housing prices creep upwards and more people are forced to leave the city.

Our government can and should be an effective force for change, and we should demand more from our politicians. When there’s a clear crisis, like the fentanyl epidemic, our city officials need to treat it like a crisis. When we accept these worsening conditions as the new normal, when we stop trying to solve a problem and just try to mitigate the damage, we condemn ourselves to degraded lives.

San Francisco’s current response to the drug crisis has been to try to mitigate the damage from drug use by deploying street response teams. The Street Overdose Response Team (SORT) was established in August 2021 as a collaboration between the SFDPH and the SF Fire Department. The team consists of a community paramedic, street medicine clinician, and other specialists/peer counselors. SORT responds to 911 calls involving overdoses and applies naloxone to those who’ve overdosed, working 12 hours a day, seven days a week. From August 2021 to January 2023, SORT has responded to a total of 1,421 calls involving overdoses. 

The Post Overdose Engagement Team (POET) is a subsidiary of SORT that follows up within 72 hours via telephone or in-person visits with people who SORT had contact with. POET seeks to connect those individuals to case management, harm reduction supplies like naloxone, buprenorphine, peer support, and continued medical treatment.  

But the POET team’s success rate for follow-ups, and actually getting individuals into treatment services isn’t great. It’s critical that San Francisco address this gap between a person in crisis, and then getting them into treatment where they can recover. The cumulative followup rate of the POET team from August 2021 to January 2023 was 39 percent. As of January 2023, in the follow-ups that POET was able to make, only 5 percent of outcomes resulted in referral to a withdrawal management.

These low success rates aren’t the fault of the POET team. The people POET are trying to connect with can be very difficult to reach, and there is currently no way to compel someone to accept treatment who does not want it. With the way fentanyl rewires the brain, many people who are suffering from substance use disorder aren't able to accept treatment because of their disease. 

This disconnect between outreach and outcomes highlights one of the major problems with San Francisco’s response to the fentanyl epidemic. The city has developed a robust response to save lives through naloxone use and distribution, and SF must continue to make Narcan widely available—it’s an invaluable tool to keep people alive. But we cannot leave people on the street to deteriorate. San Francisco has a $14 billion budget and is home to some of the brightest minds in the country. If POET’s response is currently not effective at getting people the recovery treatment they need, we must explore better avenues to get people into recovery treatment.

An overdose should be an opportunity for a person with substance use disorder to realize they can get help. The city should add funding in the next budget to bolster intake center capacity and treatment beds, so that anyone who needs it can get treatment on demand. If the city is focusing more on treating the symptoms of the problem than the problem itself, the problem will never be solved. 

Likewise, if people who believe in the same goals continuously argue over language and tactics, we’ll never solve our most pressing problems. While people debate about the proper way to solve the drug crisis, thousands suffer and hundreds die. 

We don’t want the need for Narcan to become normalized. Right now, the need for naloxone is necessary and increasing in part because San Francisco hasn’t devoted enough funding to treatment on demand and programs that help move people towards treatment services for recovery. But that can change with the next budget. The Mayor and Board of Supervisors must prioritize funding for true treatment on demand for recovery in the final budget.

TogetherSF Action is making advocating for an end to the drug epidemic in San Francisco a top priority this year. Our first step? Flooding inboxes at City Hall. We need thousands of concerned San Franciscans to send letters to their leaders demanding they end open-air drug markets in 2023. Are you in?