Overdose drug naloxone making an impact in SF as heroin use grows in visibility

It was an hour after midnight when two Mission District police officers arrived at Clinton Park and Guerrero Street. That’s where they found an unconscious 27-year-old man lying in his friend’s lap. He did not look well. His lips were blue, his breath shallow, his skin pale.

The friend said he’d just shot up heroin, and the pair of officers called an ambulance. But instead of waiting for the medical team to arrive, they retrieved a bag from their patrol car.

Officer Malek Jisrawi assembled a naloxone kit and administered the drug into the man’s nose. Almost immediately, the man woke.

The May 16 incident was one of 12 times officers with the San Francisco Police Department have used the drug, often known as Narcan, since they started carrying the kits in 2015. So far, the drug has been administered by officers from the Tenderloin, Mission, Northern and Southern stations.

“I think it’s a positive thing that law enforcement are doing this,” said Eliza Wheeler, project manager for the Drug Overdose Prevention and Education program, which works with the police to train and equip officers with the life-saving drug. “I think it maybe represents a shift in thinking about the relationship with drug-users as people worthy of intervention and care. It also gives law enforcement a tool where maybe they felt relatively helpless before.”

A majority of overdose victims that officers come into contact with have already been given the drug, according to police. Officer Cory Barone of Tenderloin Station said many in the department have been trained on how to use the kits, but that in most cases, the drug has already been administered by the time they arrive on the scene of an overdose.

That, according to Wheeler, is because of a long-standing effort to provide naloxone to the approximately 15,000 to 22,000 heroin users in San Francisco.

“In this city in particular, we have reached such a saturation in the drug-using community with naloxone,” Wheeler said. “If we hadn’t, we would see many many more deaths.”

Since 2003, the DOPE program has led efforts to distribute naloxone to groups dealing with heroin users. In 2014 alone, for instance, the DOPE program had handed out 2,200 kits.

And the program appears to be working.

In 2000, before widespread dissemination of the drug, 120 people died of overdoses related to heroin, according to the San Francisco Department of Health. In 2014, naloxone prevented 365 overdoses and the total dropped to 30, according to DOPE and DPH data.

In 2015, the DOPE program handed out 1,727 naloxone refills, and the number of prevented overdoses nearly doubled, with 640 reported reversals.

The data illustrates some of the impact of the DOPE program, but Wheeler cautioned that naloxone use and reported reversals are only part of the picture. The numbers don’t take into account hospitals, emergency medical use and use by police.

“People are overdosing on heroin, they just aren’t dying.” Wheeler said.

How it works

Naloxone is administered through the nose or injected with a needle, said Mary Howe, executive director of the Homeless Youth Alliance in the lower Haight.

The drug effectively blocks opiate receptors in the brain and halts the effect of heroin on the brain.

According to the San Francisco Drug Users Union website, naloxone is “a medication called an ‘opioid antagonist’ used to counter the effects of opioid overdose, for example morphine and heroin overdose. Specifically, naloxone is used in opioid overdoses to counteract life-threatening depression of the central nervous system and respiratory system, allowing an overdose victim to breathe normally.”

Howe, 34, says she’s given people naloxone at least six times and that it saved her own life when she first used heroin at age 14. She shot up with a couple other teenagers and almost immediately knew she’d taken too much.

“I remember feeling immediately really high and knowing that I had probably done too much,” she recalled. Howe said her friends were planning on abandoning her, but someone called 911 and that ultimately saved her life.

“I came to in front of the house in the grass,” she said, adding that paramedics were all around her. “Then I woke up handcuffed in the hospital.”

Increased visibility

There hasn’t been much of a change in the number of people using heroin and other drugs, according to Wheeler, but the public has become increasingly aware of drug users.

“I definitely see public injection more,” Howe said. “There’s more people living in the streets and more people [using] in public.”

Increased visibility of homeless people — drug users, specifically — can be attributed to San Francisco’s ongoing housing crisis and other affordability issues. But, ironically, Wheeler said that has resulted in more people having access to naloxone.

“Back when the DOPE project started using naloxone, almost half of overdose deaths were occurring in [single-room occupancy hotels] because people were living in hotels where they are likely to be alone,” she said. “There is a strong protective irony about the fact that people are outside.”

Another reason that more users are being seen in public is because there are so few drop-in centers for them to go to, according to Howe, who said there used to be six in The City and now only two remain. Those centers are usually places for drug users to get off the streets.

Howe said the public will continue to see people shooting up in parks and on sidewalks until safe drug use centers are opened, which, she admitted, is not a politically popular stance.

Overdose surges

The DOPE program and other outreach efforts can only do so much to address surges in overdoses and the rise of new heroin users, who often come to the drug after using prescription opiates, according to Wheeler. When new batches of especially strong heroin come arrive in San Francisco — like last summer, for example — more than 300 people overdosed in a three-month period.

A batch of fentanyl-laced heroin, which was much stronger than usual, was hitting folks hard, she recalled. So the DOPE program increased its outreach efforts to ensure naloxone was available in high volume.

But a much larger problem — one that has been less cyclical and has had nationwide impact — is the abuse of prescription opioids. In 2014, a majority of overdose deaths in San Francisco — 97 — were attributed to opioid prescriptions, according to DPH.

Many people who became addicted to prescription opioids, according to Wheeler, have begun using heroin because of a crackdown on the street drug. This segment of the drug-using population is less familiar with naloxone and heroin, which is worrying.

It also means there will, no doubt, be more overdose deaths to come.

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