SAN FRANCISCO -- It is a problem across the Bay Area, but the fentanyl crisis is hitting San Francisco especially hard, with the city reporting August was one of its deadliest months for overdoses.
According to San Francisco's drug overdose and treatment dashboard, 84 people died in August, up from 74 in July. At this pace, the total number will surpass the cities worst year for overdose deaths, which was 2020. City health officials themselves admit they are also fighting a sometimes overwhelming sense of despair in the fight to save lives.
"Like every five minutes," said a San Francisco drug user who identified himself as "J" of the noise on the street. "Every five minutes there is a siren, and I just assume that it is for an overdose."
On a South of Market alleyway with emergency responders working in multiple directions, J is living in the middle of San Francisco's drug crisis. Something he will tell you he's struggling to escape.
"I don't know anything else except do what I've got to do to hustle up cash," he said. "Get my hotel room, get some dope."
As for what type of help he thinks is needed for the city's very public drug crisis?
"The best thing to help me and every single junkie would be to get them off the street," he answered. "Get them housing, get them in residential treatment. I tried outpatient. It's not a 24-hour helpline. You need somewhere where you can go."
Officials with the San Francisco Department of Public Health are struggling to find answers for those looking for help.
"We are interested in showing that there are multiple pathways of treatment." Dr. Hillary Kunins with the SFDPH said Monday.
"We want people to not only understand that, but that there is hope," added Public Health Director Dr. Grant Colfax. "That recovery is possible."
With numbers on pace for the deadliest year on record, public health officials say they're going to be rolling out more information. Not just an accounting of the casualties, but a better look at what's being done to prevent them. For example, they are tracking how many people are showing up at the department's Behavioral Health Access Center at 1380 Howard Street.
If someone wants to enroll in some kind of treatment, this is one place where that journey can begin.
"We have counted 417 people who have entered residential substance use treatment through DPH from January through June of this year 2023," Kunins said of the early numbers.
"Me, personally, my main problem is the access," J said of the city's drug supply. "It's the availability. How cheap it is. This stuff right here is probably about $30 a gram. The cheaper s--t you can get for as low as five dollars or $10 a gram. That stuff is garbage."
When asked if there was a quality concern, J replied, "At least for the users. The drug dealers don't care if we die. They don't care if our legs fall off."
"I also think, candidly, that there is a sense of hopelessness," Colfax said of the scale of the challenge. "Despair with regard to the overdose epidemic we are seeing not only in San Francisco, but across the country."
The hope is that more information about who's getting help -- and how they're doing it -- can encourage more people to ask for help, and shed more light on what is working and what is not.
"Encouraging conversation about both what is happening in our city," Kunins said. "And what are the possible steps we can take to change that reality."
"Good luck to anybody using right now," J said. "You can get off of it. I believe in you. But the users have to make the call. It's on you."
A big part of the city's messaging effort is going to be the effectiveness of medically assisted treatment -- namely buprenorphine to manage withdrawal. They also say they'll eventually release even more data, like where people are from, how different people are finding their way into treatment and what's getting them there. All that, possibly in the information to come, as the city tells us a little more about the crisis that continues to unfold on city streets.
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