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Mayor London Breed and Health Department Launch New Program to Fight Overdoses and Deaths

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Mayor London N. Breed and the Department of Public Health (DPH) announced on Sept. 30 a new overdose prevention program for single room occupancy hotels (SROs), to be carried out by DPH in partnership with the Harm Reduction Coalition and the Department of Homelessness and Supportive Housing.

The innovative program is in response to the rising number of overdose deaths in San Francisco, approximately 30 percent of which occur at SROs.

After years of keeping overdose deaths relatively flat, even in the face of a rising number of overdoses, San Francisco is seeing an increase in overdose deaths. This is largely the result of the introduction of fentanyl into the drug supply, which is a very potent opioid that carries a high risk of death by overdose.

“We must do more to fight the serious danger that fentanyl presents to our community, and this new program will help us meet people where they are and provide SRO residents with the training and medication to prevent overdose deaths,” said Mayor Breed. “This effort builds on San Francisco’s long history of implementing innovative solutions, working with the community, and emphasizing harm reduction to save lives.”

The number of fentanyl overdose deaths in San Francisco has increased each year since 2014. There were 36 fentanyl overdose deaths in 2017, 89 deaths in 2018, and in the first quarter of 2019 there were 39 fentanyl overdose deaths. Fentanyl has driven an overall 17 percent increase in all drug overdose deaths in San Francisco from 222 in 2017 to 259 in 2018. For the first time, fentanyl has surpassed heroin and prescription opioids as the leading cause of opioid overdose death.

“We knew fentanyl was coming and have been monitoring it closely,” said Dr. Grant Colfax, Director of Health. “Now it’s here. We will continue to expand our aggressive work to prevent overdoses and increase access to treatment.”

The Health Department supports the Harm Reduction Coalition’s Drug Overdose Prevention (DOPE) Project, which provided over 15,000 doses of naloxone to thousands of people at risk of experiencing or witnessing an overdose in 2018 alone.

DOPE recorded 1,658 overdose reversals in that year and is on track to nearly double that number in 2019. The DOPE Project continues to expand operations, with new sites and mobile activities in San Francisco. In addition, DPH provides low barrier access to buprenorphine to treat opioid use disorder and reduce overdose risk. DPH expanded the Street Medicine team, which is comprised of nurses, doctors, and social workers.
The Street Medicine team conducts outreach to homeless and marginally housed residents and clinicians provide prescriptions for the opioid treatment medication buprenorphine directly to people on the streets suffering from opioid addiction.

The new program will expand overdose prevention efforts even further. Based on the successful Tenant Overdose Response Organizers (TORO) program from Vancouver, the SRO project will work closely with SRO operators and tenants to develop on-site overdose prevention programs.

The project also will support the installation of naloxone-rescue boxes throughout the buildings to improve access to this critical life-saving medication. The SRO program will begin later this year and is supported by the California Department of Public Health, the California Department of Health Care Services and the federal Substance Abuse and Mental Health Services Administration.

“By deliberately expanding overdose prevention efforts to SROs, the residents, many of whom are formerly homeless and have struggled with mental health and substance use issues, will be empowered to save lives and support their community,” said Dr. Phillip Coffin, Director of Substance Use Research for the Department of Public Health.

The Department of Public Health reported an increase in overdose deaths in August, and earlier this month issued a health alert to San Francisco health providers when additional fentanyl overdoses occurred. Three men with no known history of opioid use required critical hospital care in San Francisco following fentanyl overdose, in three separate incidents. Two died from the overdoses and one recovered.

Office of Mayor London Breed

Office of Mayor London Breed

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Oakland Post: Week of November 20 – 26, 2024

The printed Weekly Edition of the Oakland Post: Week of November 20 – 26, 2024

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An Inside Look into How San Francisco Analyzes Homeless Encampments

Dozens of unhoused people are camped at Sixth and Jesse streets in San Francisco’s South of Market neighborhood. Tents made of tarps and blankets, piles of debris, and people lounging alongside the allies and walls of businesses are seen from all angles. These are some of the city’s hotspots. City crews have cleared encampments there over 30 times in the past year, but unhoused people always return.

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Since the ruling of Grants Pass by the US Supreme Court earlier this summer, which allows cities the authority to ban people from camping or sleeping on the streets, San Francisco has been at the head of the conversation to crack down on encampments.
Since the ruling of Grants Pass by the US Supreme Court earlier this summer, which allows cities the authority to ban people from camping or sleeping on the streets, San Francisco has been at the head of the conversation to crack down on encampments.

By Magaly Muñoz

Dozens of unhoused people are camped at Sixth and Jesse streets in San Francisco’s South of Market neighborhood. Tents made of tarps and blankets, piles of debris, and people lounging alongside the allies and walls of businesses are seen from all angles.

These are some of the city’s hotspots. City crews have cleared encampments there over 30 times in the past year, but unhoused people always return.

But it’s normal to have tents set up again within less than 24 hours after an encampment sweep, David Nakanishi, Healthy Streets Operation Center Manager at the Department of Emergency Management, says. Sometimes there’s less people than before but often there is also no change.

“Most of the people that were in the encampments that want to go inside, we’ve gotten the majority of those [into shelter],” Nakanishi says. “Many of the people we encounter now, are those who have various reasons to not accept shelter, and some are already in shelter/housing”.

Since the ruling of Grants Pass by the US Supreme Court earlier this summer, which allows cities the authority to ban people from camping or sleeping on the streets, San Francisco has been at the head of the conversation to crack down on encampments.

Where neighboring cities in the Bay Area are clearing encampments a few days a week, San Francisco is sweeping 10 times a week, two per weekday.

David Nakanishi, Healthy Streets Operation Center Manager at the San Francisco Department of Emergency Management, makes a 311 report on an encampment in the Mission District. These reports allow smaller city teams to tackle individual spots where unhoused people frequent. Photo by Magaly Muñoz.

David Nakanishi, Healthy Streets Operation Center Manager at the San Francisco Department of Emergency Management, makes a 311 report on an encampment in the Mission District. These reports allow smaller city teams to tackle individual spots where unhoused people frequent. Photo by Magaly Muñoz.

Considering the controversy that plagues the city around its harsh policies, the Post decided to tag along on a ride with Nakanishi to show us how he decides what encampments make it on the city’s sweep list.

Nakanishi, having over 20 years of experience in homelessness management, drives around the busiest parts of the city almost daily. He’s tasked with arranging a weekly sweeping operation schedule for city teams to engage with unhoused folks to help get them off the streets.

So what exactly is he looking out for when deciding what encampments get swept?

It depends, he says.

Locations like schools, recreational centers, senior centers, or businesses are places he tends to want to address quickly, especially schools. These are the places where the complaints are highest and access to facilities is important for residents.

He says he also takes into account 311 calls and reports made to him by city staff. On the date of publication, over 100 calls and reports were made about encampments around the city, according to San Francisco data.

Makeshift structures built from plywood and tarps are starting to pop up more throughout the city. Certain areas under freeways are not under direct authority from San Francisco, making it harder to sweep these encampments. Photo by Magaly Muñoz.

Makeshift structures built from plywood and tarps are starting to pop up more throughout the city. Certain areas under freeways are not under direct authority from San Francisco, making it harder to sweep these encampments. Photo by Magaly Muñoz.

Nakanishi made a few 311 reports himself on the ride along, pulling over to take photos and describe the encampments into his 311 app. He says it helps him remember where to possibly sweep next or allows smaller teams in the city to engage quicker with individuals on the streets.

Nakanishi also looks at the state of the encampments. Are there a lot of bulky items, such as furniture, or makeshift structures built out of tarps and plywood, blocking areas of traffic? Is trash beginning to pile up and spill into the streets or sidewalks? Sites that meet this criteria tend to be contenders for encampment sweeps, Nakanishi says.

Street by street, he points out individuals he’s interacted with, describing their conditions, habits, and reasons for denying assistance from the city.

One man on 2nd St and Mission, who rolls around a blue recycling bin and often yells at passing pedestrians, has refused shelter several times, Nakanishi says.

People deny shelter for all kinds of reasons, he says. There’s too many rules to follow, people feel unsafe in congregate or shared shelters, or their behavioral and mental health problems make it hard to get them into proper services.

Inside a tent left by an unhoused man on Stevenson and 14th Street in San Francisco. The area smelled of human waste and leftover alcohol. Photo by Magaly Muñoz.

Inside a tent left by an unhoused man on Stevenson and 14th Street in San Francisco. The area smelled of human waste and leftover alcohol. Photo by Magaly Muñoz.

Nakanishi references another man on South Van Ness under the freeway, who city outreach have attempted to get into shelter, but his screaming outbursts make it difficult to place him without disturbing other people in the same space. Nakanishi says it might be an issue of the man needing resources like medication to alleviate his distress that causes the screaming, but the city behavioral team is in the process of outreaching him to figure that out.

In October, city outreach teams engaged with 495 unhoused people. 377 of those engaged refused shelter and only 118 accepted placements, according to city data. That number of monthly referrals is consistent throughout the entirety of 2024 so far.

Nakanishi has long advocated for the well-being of unhoused people, he explains. In 2004, he was working with the Department of Public Health and told then-Mayor Gavin Newsom that there needed to be more housing for families. Nakinishi was told it was easier to deal with individuals first and the city “will get there eventually.” 20 years later, family housing is still not as extensive as it could be, and the waiting list to get placements for families is a mile long with over 500 names.

In 2020, he was a Senior Behavioral Health Clinician at a hotel in the city during the pandemic. He says in 2021 he collaborated with DPH to provide vaccines to those staying in the makeshift hotel shelters once those became available.

Nakanishi strips apart a solo tent on Stevenson and 14th Street in San Francisco. He discards items, like tarps and cardboard, so that people cannot reuse them to make another sleeping structure. Photo by Magaly Muñoz.

Nakanishi strips apart a solo tent on Stevenson and 14th Street in San Francisco. He discards items, like tarps and cardboard, so that people cannot reuse them to make another sleeping structure. Photo by Magaly Muñoz.

Despite the constant media attention that city outreach is inhumanely treating homeless people, so much so that it has led to lawsuits against San Francisco from advocates, Nakanishi says not a lot of people are seeing the true conditions of some encampments.

He describes soiled clothing and tents, drenched in urine, and oftentimes rodents or bug infestations in places where people are sleeping. He’s asked homeless advocates- often those who are the most critical about the city’s work- who have shown up to observe the sweeps if those are conditions the city should allow people to be subjected to, but not many have answers for him, Nakanishi says.

The city’s “bag and tag” policy allows city workers to throw away items that are “soiled by infectious materials” such as bodily fluids and waste.

Sweep operations are conducted at 8am and 1pm Monday through Friday. People at the encampments are given 72 hour notice to vacate, but some don’t leave the area until the day of the sweep.

City outreach workers come out the day before and day of to offer resources and shelter to those interested. The Department of Public Works discards any trash that is left over from the sweep and washes down the area.

Nakanishi told the Post that the only time the city takes tents or personal possessions from residents is when folks become physically violent towards workers and police take the items as evidence. Other items taken are bagged and tagged in accordance with city policy.

Stories from local newspapers such as the San Francisco Standard and the Chronicle show instances of SFPD handcuffing residents while their items are thrown in the trash or disposing of personal possessions without reason.

Advocates have long been pushing for a more competent and compassionate process if the city is going to choose to continue sweeping unhouse people.

No matter the lawsuits and constant criticisms from allies, the encampment sweeps are not slowing down, even with the cold weather quickly approaching the coastal city.

Nakanishi says there aren’t a lot of large encampments left in San Francisco so now they do runs of streets in order to stretch out the sweeps as much as possible.

It’s calculated strategies and years of first hand knowledge that make this job work, “It takes dedication to the work, caring for the people and the community, and persistence, patience and sometimes good luck to make the positive changes for the people on the street,” Nakanishi says.

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Oakland Post: Week of November 13 – 19, 2024

The printed Weekly Edition of the Oakland Post: Week of November 13 – 19, 2024

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