by Jenna Lane
SAN FRANCISCO (KCBS) — Think of the opioid epidemic, and the U.S. Appalachia region may come to mind. At the same time, anyone in San Francisco walking from the Civic Center BART station to a theater or museum risks stepping on a needle.
Heroin use is so prevalent in San Francisco, city librarians may soon start carrying the drug that can reverse an overdose.
The widespread use of that drug, naloxone, is credited with saving lives at least 877 times in San Francisco last year. The number of fatal heroin overdoses fell from 120, before the city started distributing naloxone, to about 30 in 2014.
It’s part of a model called harm reduction, embraced by social service agencies as well as the Department of Public Health. Methadone and buprenorphine, medications that help people manage or end their opiate use, are readily available here. Needle exchange is common and has reduced the spread of viruses like HIV and Hepatitis C.
But San Francisco, like any city in America, is facing an uphill battle.
“The street is being flooded with synthetic opioids like fentanyl and carfentanyl,” said Dr. Andrew Desruisseau, medical director of Tenderloin Health Services. Fentanyl is becoming well-known as the drug that killed the artist Prince.
“Carfentanyl is actually an elephant-grade opioid that takes that up even to an another level, an astronomically powerful opioid,” said said Desruisseau. “Anybody who works in the addiction field knows if there is something stronger than street-level heroin, an addict will want that. Regardless of risk of overdose.”
That sense of accelerating deadliness and easier access is why so many health workers, IV drug users, and even some politicians are calling for — or at least considering — “safe injection.” It’s a controversial extension of the harm reduction model that would bring IV drug users in for medically supervised injection.
San Francisco Board of Supervisors President London Breed has introduced a bill that, if passed, would create a task force to study the idea. State lawmakers are trying to make it legal.
Mayor Ed Lee says he’s keeping an open mind about it. Many neighbors in the Tenderloin, where IV drug use is the most visible, support safe injection services. Others worry about enabling illegal drug use.
While harm reduction has proven helpful for many heroin users, the city still faces an increase in prescription opiate abuse. In 2014, 72 percent of the fatal opioid overdoses in 2014 were blamed on prescription drugs.
“It’s important to realize that the current opioid epidemic is first and foremost an epidemic of overprescribing,” said Dr. Anna Lembke, Stanford University Assistant Professor of Psychiatry and Behavioral Sciences.
Considering the Centers for Disease Control and Prevention finding, that three out of four new heroin users abused prescription opioids first, Lembke argues for broader insurance coverage of – and medical training in – addiction treatment.