An academic study published today in the International Journal of Drug Policy noted a statistic one needn’t be a doctor nor a mathematician to grasp: 333 overdoses were recorded at the Tenderloin Center, and 333 of those overdoses were reversed.
The Tenderloin Center, a clandestine overdose-prevention site at which clients could use drugs overtly, was open from January to December, 2022, and recorded 124,100 visits. The perfect record on overdose prevention, wrote lead author Dr. Leslie Suen of the University of California, San Francisco, points to the site being “an effective harm-reduction strategy to save lives.”
With the Tenderloin Center shuttered after 11 months of operation, the city is presently on pace for perhaps its highest recorded number of overdoses yet. Citing a federal law actually known as “the Crack House Statute,” neither City Attorney David Chiu nor Mayor London Breed are game to continue operating such an overdose-prevention site in contravention of that law, despite the fact the city clearly did so for nearly all of 2022, and the statute of limitations for violating the Crack House Statute is five years.
But, while the Tenderloin Center’s record on reversing overdoses was perfect, the policies undergirding this hastily thrown together site were not. Staff here were mandated by the city to call 911 every time naloxone was administered to a person overdosing on drugs. This resulted in hundreds and hundreds of calls to 911 and the scrambling of emergency responders to visit the site. Far more often than not, by the time they arrived, the drug user had been revived and did not need or want to take an ambulance ride to the hospital, resulting in a waste of time and money and a diversion of emergency personnel.
Suen and her co-authors from the University of California, San Diego, and RTI International in Berkeley diplomatically note that this led to “strained relationships with city emergency response systems.” Mission Local is informed by others that this strain could be of the high-decibel variety.
There is another option to reverse many overdoses, however, that avoids the incessant 911 calls: Oxygen. This was used at the Tenderloin Center a few months into its operation, and is the subject of the academic paper, formally titled “Evaluating Oxygen Monitoring and Administration during Overdose Responses at a Sanctioned Overdose Prevention Site in San Francisco, California: A Mixed-Methods Study.”
In a nutshell, it analyzes the results of staff at the Tenderloin Center being given oxygen to treat overdoses 18 weeks into the site’s 46-week existence.
The outcomes, Suen and her nine co-authors find, were good. Overdoses requiring naloxone — and a mandatory 911 call, an ambulance dispatch and “tensions on-site” — reduced markedly, from 98 percent of all ODs to just 66 percent. What’s more, while naloxone can be traumatizing and unpleasant and induce withdrawal symptoms, oxygen does not.
The Tenderloin Center was formed in the wake of Mayor Breed’s December 2021 declaration of emergency regarding conditions in the Tenderloin. It was up and running only weeks later, and policies and procedures, if not improvised, were undertaken hastily.
“Even though they created these protocols very quickly, calling 911 every time — maybe that was not necessary,” said Suen, an assistant professor at UCSF and a researcher and primary care doctor specializing in substance-use disorder and treatment at Zuckerberg San Francisco General Hospital and its clinics.
“It does drain on resources and can create tensions on site and with emergency-response systems if services are repeatedly declined,” she said.
The 911 policy was described by the Department of Emergency Management as ensuring “additional life safety measures were in place to protect against the lethality of a fentanyl overdose. … Please keep in mind that when the Tenderloin Center was established, San Francisco was testing new approaches to address the overdose epidemic.”
It was, but other cities didn’t choose to initiate such a policy at their overdose prevention sites. In the first 15 months of operating two such sites in New York City, “staff reversed 730 overdoses,” notes the paper, “and only needed to call for 911 emergency services 11 times.”
“One of the things people often don’t understand is that overdoses are not an on-off switch. They don’t go from normal to completely overdosed,” says Suen. “You want to save someone’s life, but you don’t want to send them into severe withdrawal.”
With oxygen, a lot of the stress and indecision around whether to intervene or not is eliminated. “The threshold can be lower.”
As a result, while naloxone was administered less often, and 911 was called less often, there were actually more recorded overdoses on site after oxygen was introduced: They jumped from around five a week in the first 18 weeks to nine a week in the last 28 weeks. Suen says this could be due to staff not waiting for overdose symptoms to grow severe and intervening sooner with oxygen.
Another problem at the Tenderloin Center the researchers noted, however: Not enough oxygen.
“If something does go bad, how do I decide how to work this, because we only got enough oxygen for, like, two overdoses?” a staffer on-site told the paper’s authors. “Like, I hope nobody else overdoses, or you’re telling people, like, ‘Hey, don’t overdose today, because we ain’t got [oxygen].’ That’s a bad look, like, you can’t do that, like, ‘Hey, I just want to let you know, I don’t have enough oxygen for you to overdose today, so please keep it together.’ [laughter] That’s not good.”
Today’s paper is one of a planned trio of academic studies centered on the Tenderloin Center. The next two will examine the impact of the site on its neighborhood and on the people who worked there.
The Tenderloin Center was originally sold as a “linkage” center. But relatively little linkage — to jobs, housing, etc. — took place there. Critics have claimed that it did not accomplish any tangible goals and merely enabled drug-users.
Suen, clearly, sees things differently.
“As someone who works in the medical field, I view this as a public health intervention. Any time you deliver a medical intervention, you are thinking about saving lives,” she said.
“I know this as someone who offers treatment in this city: It takes time for someone to trust who they’re receiving treatment from. And it usually requires multiple times until someone achieves long-term recovery.”
And, more bluntly: “We cannot offer any interventions or other benefits if the person is dead.”
Thanks for this.
“Staff here were mandated by the city to call 911 every time naloxone was administered to a person overdosing on drugs. This resulted in hundreds and hundreds of calls to 911 and the scrambling of emergency responders to visit the site. ”
Do you know more specifically who mandated staff to call 911?
According to this article, “The 911 policy was described by the Department of Emergency Management..” you should look into that Department, not the Fire Department.
My money is on SFFD.
If anyone else revives someone with naloxone they typically don’t call 911. But here SFFD had the political clout to demand being called. Or losing some of their heroism claim that politically justify huge salaries for what amounts to a little club of City Family HS graduates. I’ll bet the Center staffers reviving overdoses were paid at least 30% less than SFFD. SFFD protects their expensive turf like every street protection gang.
Of the 333 reversed overdoses, how many were “frequent fliers?” In other words, did the center treat 33 people who overdosed 10 times or roughly 333 separate people? Also, what percentage of EMS calls are for overdoses? The city has not released this information despite repeated requests from various writers. Joe Eskanazi, if you know, would you mention it in one of your stories?
Breaking down these numbers are important. If the same people overdose repeatedly, those people should be targeted for careful and intensive intervention.
I would also like to see the harm reduction proponents come up with a plan to reduce harm for the neighborhoods where they want to install drug consumption sites. The OD prevention sites have brought crime and chaos to their surroundings in SF as well as in NYC and Vancouver. No one wants these sites in their vicinity when they bring more drug dealers and associated crime.
Thanks for your work on this important subject. The more facts we have the better we can solutions we can find to solve the problem.
This is ridiculous… I’ve been clean off herion for 8 yrs and I’m on methadone, my quality of life was wonderful because I was allowed my medical mj and methadone it was amazing I never felt so normal in my life. But then fentynl came around me and my fiance have been stuck literally stuck on this garbage chemical for around 4 and a half yrs and it’s destroying us and we’re very scared we won’t make it of this drug 😔 but we will not give up trying to kick, listen this city has failed us terribly the mayor is a joke and doesn’t care about people only money and everyone that’s complaining about open air drug markets and drug useser are living a lie and need to truly wake the fuck up overdoses arnt the problem guys I’ve saved prolly 200 people my self just being on the street and all the pro’s and emt’s and those urban alchemy waste of money perverts and undercover drug dealers and theirs don’t have a clue how to save some one from od nor do they care too but any way back to my point fentynl is gonna kill us cause of what it’s doing to are body’s people couldn’t overdose if they tried we need to legalize all drugs regulate them make them clean and safe in a lab keep and make different potency for different users some with big habits and some with none and also that would take out the open air drug markets take the power and money away from cartels and dirty cops and make drugs safe to use in a safe place to use them with people who really no how to save lives ok I’m gonna end my rant with this here is the correct way to reverse a od ok…. 1 say name try and get paid response and check for riged body and if breathing and blue lips 2. Immediately lay flat on back if not breathing and admister reduce breathing while admistering narcan and trying to get a pain response ITS FUCKING POINTLESS TO NARCAN SOMEONE AND JUST RUB YOUR NUCKLE ON THERE CHEST THERE NOT BREATHING FOR FUCK SAKE PEOPLE. Ok so u breath for them until the narcan kicks in after 2 min of breathing and narcan and they aren’t back give more narcan and this is the most important part never ever ever stop breathing for the person until they wake if u do this I promise you will have 100 percent success rate. Anyways…. me and my fiance have seriousness health issues now because of this crap drug and were stuck on it and were not gonna ever over dose we need help we need new kinds of clinics ones that use different methods so if drugs are legal and clean people have the choice to get off of them so far we have tried kicking 20 times we almost got the agolrithoum down hers is different than mine cause I’m already on methadone and she’s gonna microdose subutex but they both include lots of cbd thc flower and concentrate and edibles and tinctures and Xanax bars not off the street cause there’s fentynl in those but ones sealed from a pharmacy I won’t disclose were cause it’s if that get fucked off we have no chance of making it please for the love of God fire London breed she’s doesn’t have a clue how to help people like me nor does she want to all me And girl want is are life back are quality of life that this buetiful city used to offer before breed destroyed all the culture in every neighborhood fight for life for your city back and pray for the ones like me and my love cause we need it Thank you
Embarrassing to consider reversing individual overdoses on people chronically overdosing a success. These people while end up dying in the streets.
To say that there was no Linkage to the center is not accurate at all. I came to San Francisco in July the 2nd of last year for a fresh start. I was sleeping in a tent behind Costco and had my storage on the next block. I used the linkage for housing. With the housing coordinator through 123 10th street and the hot team I was placed at a hotel ran by the organization. I wasn’t on drugs. But I found my own my job and my own housing and with the resources to help with Rent I was able to move into my place in Oct. I think that people want a hand out like “here are keys and you can live rent free and we will do all the work for you.” Now at the hotel I didn’t really receive out and people did OD cause it was a sip hotel. But I made the best of the situation. People don’t put the forward themselves how can you say there’s no help.
A city championing marginal people will always fail. Labeling them as “marginalized”, only distorts the cause of the flourishing disfunction and decline.