San Francisco's fentanyl crisis strategies hotly debated ahead of mayoral election
KPIX has been marking Overdose Awareness Week by looking at a city that has shared a very similar experience as San Francisco. Fentanyl actually arrived in Vancouver before San Francisco. The results have been devastating for both cities. There are several different approaches British Columbia has tried to save lives, things like opening safe consumption sites and providing a regulated supply of drugs for some users.
The more permissive approach has stirred some opposition from Vancouver residents.
In San Francisco, there was an unofficial safe-use site in operation for a little while. The Tenderloin Linkage Center was opened in early 2022, operated by contractors for the city. It was originally announced as a connection point to services. It ultimately became a
defacto safe consumption site for users, generating some controversy and pushback from neighbors. Mayor London Breed decided to close it down at the end of that year.
That short-lived experiment raised some questions: Should safe-use sites be part of the city's portfolio? What other things is the city trying to get people linked up with help? And how might the upcoming election alter the city's approach?
"I did not see a way out until they showed up," said Michael in his Tenderloin hotel. "I didn't think I could do it by myself. I didn't care if I did it by myself."
He is talking about his help he has received from his psychiatric clinical pharmacist, Damian Peterson. He's making a house call to deliver this medically assisted drug treatment. Michael says this has been a key part of his journey off the street, into stability, and working towards recovery.
"They helped me taper that off," Michael says. "And then kind of balance me out. Suboxone, and whatnot. It's played a major major benefit to my life."
Tiki is another patient, and like many fentanyl users she says she can't imagine escaping that drug without something like methadone to reduce withdrawal symptoms.
"No way to do it on my own." she explained. "But also, the support is very important."
San Francisco has been increasing efforts to take this kind of help directly to people instead of expecting them to visit a clinic whenever it's time for their medication.
"I think it definitely makes sense. Like when somebody has so many other things going on in life that's making it chaotic and
unpredictable," Peterson explained between deliveries. "It's really hard to focus on this goal of making it to an appointment."
And after years of climbing overdose numbers, in a city desperate for some good news, some is finally emerging.
"Comparatively, we have 72 more people alive compared to last year," said San Francisco Public Health Director Dr. Grant Colfax. "So I think it's really important to put a human face on that."
City health officials say they're not sure why, but overdose numbers are falling. Deaths so far this year are down 15% from the same period last year.
"I think we can't point to any one specific thing. frankly, within the department, or in a broader sense that we can say, or pinpoint and say, 'This is the reason,'" Colfax said of the decline.
"Because I want to make it easier, just as easy to get treatment as it is to go out there and buy dope," Mayor London Breed recently said outside city hall.
What is San Francisco's plan going forward? Mayor Breed declined to be interviewed for this report. She has, in the past, supported some of what has been tried in Vancouver, namely safe-use sites.
"But we do have some concerns with state law that could lead to not only the arrest of people who are implementing safe consumption sites," Breed said at a recent debate. "But potentially the disbarment of lawyers in the city attorney's office."
"Harm reduction, which safe injection sites fall under, is a small part of the solution," Mark Farrell said at a recent campaign stop.
"But right now, it's the central part of what we do. Almost the only thing we do as a city government. And the answer is it's failing."
The drug crisis, and its intersection with homelessness, is a prominent topic in the race for mayor. There is one theme among
the challengers. Former Mayor Mark Farrell is suggesting one giant emergency center.
"Really massive additional shelter capacity," Farrell said. "One place where people can come, but have services connected with that."
"For me, a safe injection site, a safe consumption site, around fentanyl does not make sense at this point," Daniel Lurie told KPX.
Lurie has also stressed building out more shelter capacity.
"What is on the table is making sure that we get people off the streets that are using, into care on demand," he said. "Or, mandating treatment. Which we are able to do now with SB 43, but we need to build the beds."
"Look, there is no one right answer," said Supervisor Aaron Peskin. "Harm reduction is part of the answer. Abstinence is part of the answer. Treatment is part of the answer."
Peskin has suggested a regional approach with Santa Clara and Alameda Counties.
"And work jointly to stand up a facility, to repurpose under utilized, unutilized state buildings that have been sitting around for years," he said. "And stand those up as massive drug treatment centers."
"We want we want to stop the overdose crisis. We've got to get people off of the streets in independence where they can have a medically trained professional," said Supervisor Ahsha Safai.
Safai, an early advocate for sober housing, also points to the general need for more.
"We need sober living," he said. "We need to expand the number of mental health and drug treatment beds."
So it's a universal call for more treatment capacity. That will require resources. Then there are the questions about how to best connect people to help, and should more people be compelled into it.
"I wish I could sit down with them and say, 'Go here, go here, go here,'" Michael said of those on the streets.
He says the treatment he's receiving has changed his life. And as for how to get more people connected to that help, he says a lot of users just don't know where to start.
"I just wish they were educated more," he explained. "There are a lot of intelligent people out there, but they don't know what to do."
If you or anyone you know is struggling with addiction, call the national helpline at 1-800-662-4357.
