Skip to main content

Advertisement

Log in

Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

  • Brief Report
  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

This report documents a successful intervention by a community-based naloxone distribution program in San Francisco. The program and its partner organizations, working with participants who use drugs, first identified the appearance of illicitly made fentanyl and increased outreach and naloxone distribution. Distribution of naloxone and reported use of naloxone to reverse opioid-involved overdoses increased significantly while the number of opioid-involved and fentanyl-involved overdose deaths did not. Community-based programs that provide training and naloxone to people who use drugs can serve as an early warning system for overdose risk and adaptively respond to the rapidly changing overdose risk environment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. In 2014–15, the ten community partners of the DOPE project included five syringe service programs, San Francisco County Jail, three programs serving individuals who were homeless, and a local study that recruited and actively followed individuals who inject drugs.

  2. The community partners of the Dope Project provide “naloxone kits” to trained individuals. The kit includes educational materials on identifying and managing an opioid overdose, a prescription card, and two doses of naloxone. In 2014–2015, the DOPE Project provided three types of naloxone: 0.4 milligram (mg)/0.4 milliliter (ml) auto-injector, 0.4 mg/1-ml vials and syringes for intramuscular injection, and the off-label 2 mg/2 ml adapted for intranasal administration with mucosal atomizer devices.

  3. When previously trained participants return to a DOPE Project site for a refill of naloxone, staff conducted a brief interview. If naloxone was used in a suspected overdose, staff record information about where and when the overdose occurred, to whom naloxone was administered (e.g. “spouse”, “friend”, “stranger”), known drugs involved in the overdose, and whether participants used other response strategies covered in DOPE Project training (sternum rub, call 911, and rescue breathing).

  4. San Francisco Planning Department. Neighborhood Groups Map. 2017 [accessed 2017 July 15]; Available from: http://sf-planning.org/neighborhood-groups-map.

  5. Drug overdoses accounted for 52,404 deaths in the USA in 2015, 33,091 (63%) involving an opioid. The overdose death rate from synthetic opioids other than methadone, which includes fentanyl and its analogs, increased by 72% from 2014 to 2015 [2].

References

  1. National Center for Health Statistics. Provisional counts of drug overdose deaths, as of 8/6/2017. Atlanta, GA: Centers for Disease Control and Prevention; 2017.

    Google Scholar 

  2. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65.

  3. O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(34):897–903.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631–5.

    PubMed  PubMed Central  Google Scholar 

  5. Harm Reduction Coalition. Principles of Harm Reduction. 2018; http://harmreduction.org/about-us/principles-of-harm-reduction/. Accessed 5 Mar 2018.

  6. Treloar C, Rance J, Yates K, Trust ML. People who inject drugs: the perspectives of clients and staff of needle syringe programs. Int J Drug Policy. Jan 2016;27:138–45.

    Article  PubMed  Google Scholar 

  7. MacNeil J, Pauly B. Needle exchange as a safe haven in an unsafe world. Drug Alcohol Rev. Jan 2011;30(1):26–32.

    Article  PubMed  Google Scholar 

  8. Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. The textures of heroin: user perspectives on “black tar” and powder heroin in two U.S. cities. J Psychoactive Drugs. Sep-Oct 2016;48(4):270–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ciccarone D, Ondocsin J, Mars SG. Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’. Int J Drug Policy. 2017;46:146–55.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Somerville NJ, O’Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, et al. Characteristics of fentanyl overdose—Massachusetts, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382–6.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sporer KA, Kral AH. Prescription naloxone: a novel approach to heroin overdose prevention. Ann Emerg Med. Feb 2007;49(2):172–7.

    Article  PubMed  Google Scholar 

  12. Rowe C, Santos G-M, Vittinghoff E, Wheeler E, Davidson P, Coffin PO. Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program. Addiction. 2015;110(8):1301–10.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Siegler A, Huxley-Reicher Z, Maldjian L, Jordan R, Oliver C, Jakubowski A, et al. Naloxone use among overdose prevention trainees in New York City: a longitudinal cohort study. Drug Alcohol Depend. Jul 24 2017;179:124–30.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge and thank Michael Gilbert, Kara Lynch, Alex Kral, and Jon Zibbell for valuable suggestions during the preparation of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher Rowe.

Ethics declarations

Disclaimer

The authors are solely responsible for the content of this article, which does not necessarily represent the official views of the San Francisco Department of Public Health.

Electronic supplementary material

ESM 1

(DOCX 36 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rowe, C., Wheeler, E., Stephen Jones, T. et al. Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015. J Urban Health 96, 6–11 (2019). https://doi.org/10.1007/s11524-018-0250-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-018-0250-x

Keywords

Navigation