OPIOID CRISIS DEATHS FINALLY DROP IN SAN FRANCISCO – WHY?
Answering that critically important question is relatively easy and straightforward – is high-risk opioid use decreasing? or has the “dramatic”, successful naloxone campaign been necessary to reduce otherwise fatal ODs due to mounting high risk use?
by Clark Miller
Published January 23, 2025
From the San Francisco Standard –
San Francisco has embraced Narcan as a tool to combat an overdose crisis that reached unprecedented levels in 2023. A record-breaking 752 people died of drug overdoses through the end of November. (City data for December is not yet available.)
Between January and September 2023, the Department of Public Health distributed 106,168 doses of Narcan, according to city data. …
Ordinary citizens who reverse an overdose are also not required to contact local health authorities.
The city’s Street Overdose Response Team—a program made up of a paramedic, a clinician and peer counselors tasked with connecting overdose survivors to medical care—followed up with survivors 36% of the time between October 2021 and June 2023, according to the most recent publicly available data.
Of 1,439 interactions the response team had with overdose survivors during that period, 5% of victims were referred to withdrawal management, 42% were “assisted with services” and 56% were provided harm reduction education. A total of 13% were prescribed buprenorphine, a withdrawal management drug, and 15% were already using the medication.
The figure of 13 percent of opioid overdosers consenting to be prescribed buprenorphine, the “proven” gold standard medical treatment that cures high risk opioid use, may seem quite small for users who had just come very close to death from high-risk opioid use, that future risk, per medical/media expert consensus, eliminated by simply taking the cure. And it was in any case nullified, the rationale and presumed benefit belied, in an important sense, by the 15 percent responding that they were using that “life-saving” cure when they narrowly escaped death by high-risk opioid use.
Observed by University of California San Francisco addiction expert Ayesha Appa,
Reversing overdoses is not what we want. Optimally, what we want is preventing the overdose in the first place,” Appa said. “The cumulative effects of [lack of oxygen] on the brain are obviously not great.”
Indeed. “Preventing the overdose in the first place” is the rationale for, only possible mode of action, and alleged benefit of America’s expert approach to the crisis, steadily increasing dispensed amounts of the substitute opioids buprenorphine and methadone in San Francisco and just about everywhere else, over decades of increasing overdose deaths.
And yet …
For some, the lack of successful interventions with overdose survivors points to a need for more coercive tactics. In October, Mayor London Breed issued an executive order to quickly implement new state legislation that broadens the use of conservatorship to include people with severe drug addiction.
Breed is also backing a March ballot measure to screen some welfare recipients for drug use before granting them cash payments.
Others say the overdose crisis points to a need for designated spaces, known as safe-consumption sites, where people can use drugs under the supervision of people trained to reverse overdoses and find other services when they are ready for treatment.
“One clear type of program that we’re missing, that seems obviously important and beneficial, would be a safe-consumption site,” Appa said.
And yet in San Francisco as elsewhere there is clearly a desperate casting about for something that works to prevent deaths, due to the “lack of successful interventions with overdose survivors”.
One approach, as reported here, is “The City’s drastic escalation in its distribution of naloxone, a drug that can reverse overdoses”.
Though it still fell short of its target for the year, the Department of Public Health reported giving out 157,528 doses of naloxone in fiscal year 2024, more than twice what it did just two years prior.
Per this news report in December 2024, that “drastic escalation” in community distribution of naloxone units, and presumably saves preventing fatal ODs as reported for such campaigns consistently, has corresponded with a 20 percent decrease in fatal opioid overdoses in the city for 2024 compared to 2023.
San Francisco public-health officials said they are cautiously optimistic about the progress made in 2024 in tackling the opioid crisis in The City.
Fatal overdoses through the first 11 months of the year, according to results published by the chief medical examiner, were down 20% from 2023. Last year, San Francisco recorded its largest number of drug-overdose deaths in a year since the medical examiner’s office started publishing monthly reports in 2020.
Per this report, safe consumption sites (SCS) can be ruled out as driving the decrease, because the city failed to support them, per Anna Berg, LCSW and programs director at the Harm Reduction Therapy Center in San Francisco.
“There’s been a lot of wonderful community work happening in the context of [the city’s] unfortunate political direction,” she said. “At our mobile sites, we have steadily increased the amount of naloxone we are distributing at every location
“There’s more naloxone out there, more people who know how to use it and are identifying emergencies in real time before they become fatal,” Berg said. “For our site alone, 63 percent of people who accessed our Narcan and overdose prevention services in February reported reversing an overdose. That’s an astounding number for one agency.”
And from a San Francisco Public Press report, legislative action and other initiatives in 2023 kickstarted multiple, intensive naloxone distribution campaigns that are targeted to high-risk areas.
Experts in overdose prevention say many teen and adult lives could be saved if more people know how to identify and respond to overdoses. In San Francisco, an array of programs are providing overdose response training to teenagers, college and graduate school students, and residents in neighborhoods that have a high rate of overdose deaths. …
This year, a new California state Senate bill required that all community colleges and universities provide opioid overdose education and distribute Naloxone. Maia Scarpetta and Rachel Murro, both PhD students at UCSF, organized drug reversal training for the UCSF community by enlisting the help of National Harm Reduction Coalition’s Drug Overdose Prevention and Education Project — aka the DOPE Project — a 20-year-old harm reduction organization that has been featured in CDC reports for its innovative research and practices in community-based naloxone distribution. …
The DOPE Project is also spearheading a groundbreaking initiative that trains permanent supportive housing residents as peer overdose responders. When shelter-in-place initiatives were enacted during the height of the COVID-19 pandemic, people experiencing homelessness were moved into hotels and supportive housing where the risk of overdose increased significantly for drug users due to the decreased likelihood that an acquaintance or bystander could respond.
But!
It turns out that’s all irrelevant, the Narcan campaigns that were, incontrovertibly, year-over-year, decreasing numbers of potentially fatal opioid overdoses by reversing them, by the hundreds, most likely thousands of additional saves per year.
Irrelevant because, explained in this San Francisco Examiner news piece by Dr. Grant Colfax, director of the San Francisco Department of Public Health, it has actually been the expansion of those gold standard treatments that accounts for the drops, including making it easer for opioid users to get methadone and the commonly used street currency for fentanyl, also known as buprenorphine.
Irrelevant, apparently, despite direct reports of annual increases of 10s of thousands of additional naloxone units distributed in San Francisco immediately prior to and over the period of OD death drops, the shift to targeting distribution to high-risk areas, and the report from one community organization of 63 percent of their Narcan services participants reporting having reversed a potentially fatal overdose. Those increases in naloxone-reduced opioid overdose deaths are more than enough to explain all of the reduced deaths.
To the extent that expert Dr. Grant Colfax is accurate, then for reality to remotely make sense, those large increases in fatal overdoses prevented by naloxone use over the period of reduced OD deaths would have to be disappeared, erased, magically somehow, perhaps by AI, by Expertspeak or similar dialect like the dialect of Fauci.
Another authoritative, expert understanding of the reasons for the sudden decrease
in OD deaths comes from top addiction expert Dr. Keith Humphreys, in this report, Dr. Humphreys explaining that,
“As there’s more death and destruction, people are losing people they know, seeing this incredible damage… It lowers people’s willingness to initiate drug use,” said one Stanford addiction researchers, Keith Humphreys, speaking to the Chronicle in November.
That phenomenon identified and discerned as causal by Dr. Humphreys – the awareness by high-risk users or potential users that many are dying of overdose and suffering leading to epiphany and choice to stop or not engage in high-risk use of addictive drugs – has very interestingly occurred at different times over widely different locations:
– in San Francisco just this past year, 2024 and not over the years and decades of “death and destruction” prior to that as in other locales
– In, for example, Ohio, dramatic, locale-specific decreases in 2018, over pandemic years, and in 2023
– Nationally, last year, in 2023, with sudden, significant drops in opioid overdose deaths.
Even more interesting? By freakish coincidence, the Humphreys effect, the transformative experiences of users or potential users leading to sharp drops, consistently including in SF, occurred just when intensive, targeted, naloxone campaigns were preventing opioid OD deaths – prevented deaths that were directly observed, not surmised, and in numbers more than enough to account for all of the decline in deaths. Consistently and as described in detail in the list of posts linked to here (scroll down).
But we’ve gotten off track and away from what we should know to be true as provided by America’s identified credible experts and the media reports identifying them as such.
It is, to say the least, difficult to imagine where we would be and the course the opioid crisis may have taken without the remarkable intellectual contributions of America’s medical experts.
But okay, let’s relax. There’s too much confusion here. The question is to be easily answered and in a straightforward way.
As posed in the subheadline to this post –
1) Is high-risk opioid use decreasing?
2) or has the desperate, successful naloxone campaign been necessary to reduce otherwise fatal ODs due to mounting high risk use?
For expert, gold standard treatments to have played a significant role, point 1 must be established by evidence. Alternatively, as in other locales consistently, it’s the Narcan, its use in desperate campaigns pointing to lethal failure of those treatments.
As the data emerge to settle the question – the mystery – there is a point of critical importance. It is established that as widespread, intensive naloxone campaigns successfully reduce fatal overdoses, by the thousands, due to layperson, community saves that are naturally unreported, increasingly traditional measures of nonfatal overdoses based on hospital and EMS records are significant to gross undercounts, and thereby without at least estimates of increasing community reversals by naloxone, trends in nonfatal opioid related overdoses (= trends in high-risk opioid use; = trends in expert treatment failure) are distorted, potentially tragically, lethally distorted.
So, that’s that. And, indeed, that is done.
Because it turns out that while the evaluation and data bearing on recent drops in OD deaths for San Francisco will be valuable, we already have the answer to our most important question – that of why, after years of trending increases in opioid related deaths in San Francisco and elsewhere, there have been sudden, unexpected, decreases nationally and in selected locales consistently.
That answer is established here and here. It is established by analyses of results and of secondary outcomes of the massive, $350 million National Institutes of Health (NIH) study that addressed the very question. We’ll get to that soon, below.
For San Francisco, the answer we have is established partly by this graphic and accompanying information from the news piece in the San Francisco Chronicle.
We know that it’s the naloxone campaigns reducing deaths
and not standard treatments by all of the congruent, consistently affirmed lines of evidence –
– Across many states and locales, consideration of related evidence consistently points to recent, dramatic year-by-year increases in opioid overdose deaths prevented by reversals as more than accounting for – many times more – any and all much smaller decreases in OD deaths by fatal overdose.
– Analysis of the original outcomes of the NIH study with two main interventions compared to control states, constituting an experiment evaluating effectiveness of expert gold standard treatments, established that reduced deaths were attributable to successful naloxone campaigns serving as harm reduction against gold standard opioid substitution therapy (OST aka MOUD, MAT) fueling increased high-risk use and deaths.
– Analysis, described in detail here, of secondary outcomes of the NIH study reaffirms the lethal failure of those treatments by considerations independent of those ruling out benefit from expert gold standard treatments for the original NIH reporting. Those considerations are especially important and relevant for San Francisco and the meaning of the graphic above.
To summarize that analysis, presented in detail in this recent post:
If, in the massive, multi-state NIH study, expert gold standard treatments had had any beneficial effect toward reducing high-risk opioid use and overdose deaths, the outcomes would have been least likely to provide statistically significant death reductions for users of opioid + stimulant combinations and most likely for other, opioid-only users. The outcomes, it turns out predictably, were the opposite of that.
Apart from those lines of evidence, as outlined here and detailed in multiple posts here, it has been established for years that there does not now exist nor has ever a body of evidence compellingly supporting or even pointing strongly to benefit for compulsive opioid users from being provided American experts’ gold standard medical or other treatments, that is, the treatments that have been increasingly provided over decades of increasingly lethal substance use epidemics.
There are no surprises here, and there will be more deaths
as San Francisco commits to attempts to coerce residents trapped in compulsive, high-risk drug use into lethal “treatments” to ‘get the help they need” from treatments that have never helped them. Because they do not help, they harm.
San Francisco, CA – Mayor London N. Breed, the San Francisco Human Services Agency (SFHSA), and Westside Community Services today announced the launch of the Treatment Pathway Initiative to support individuals with substance use disorder on their journey toward recovery.
In response to the opioid epidemic in San Francisco, Mayor Breed placed Proposition F onto the March 2024 ballot to require people with a substance use disorder who want to access county-funded cash assistance to participate in some form of treatment to maintain their CAAP benefits. Individuals who refuse to engage in treatment will be discontinued from receiving county-funded cash assistance. The Treatment Pathway Initiative is the program developed to implement Prop F, which now goes into effect in January of 2025.
“San Francisco is a city of compassion, but also a city that demands accountability,” said Mayor London Breed. “We fund a wide range of treatment and recovery services that are helping people every day, but it can be difficult to get everyone to accept the help they so badly need. The Treatment Pathway Initiative is a new tool that will get people to accept the treatment and services they need. The voters approved this new initiative and now we are putting it to work to make a difference in people’s lives and our city.”
There may well be, at some future time, accountability.
