 | It has been suggested that Fentanyl crisis in San Francisco be merged into this article. (Discuss) Proposed since April 2024. |
Since 2017, the number of fatalities in California attributable to synthetic opioids has increased by 1,027%. Fentanyl has caused 20% of deaths among California's teenagers and young adults. California has made legal efforts to tackle the opioid issue, including patrols, assistance grants, and education.
In 2014, drug possession in California was reduced to a misdemeanor, rather than a felony, with the passing of Proposition 47. In response, San Francisco law enforcement reduced their efforts against drug possession and use. [1] San Francisco has not been able to develop a comprehensive and consistent approach to drug use and overdoses; the San Francisco Department of Public Health and local nonprofits tend to argue for harm reduction strategies, while law enforcement agencies have argued for increased penalties for drug possession, use, and dealing. [1]
Over 80,000 Americans may have fatally overdosed on opioids in 2021, with more than 11,200 of those fatalities occurring in California, as reported by the U.S. Centers for Disease Control and Prevention. [1] Fentanyl is responsible for the death of 20% of teens and young adults in California (15 - 24). According to California Health Policy Strategies statistics, drug overdoses are now two to three times more fatal than state car accidents. The number of California state fatalities linked to synthetic opioids has climbed by 1,027% since 2017. [3]
San Francisco has the highest per capita fatal OD rate compared to four neighboring counties. Synthetic opioids, most notably fentanyl and drugs laced with it have seen increasing usage in the American city of San Francisco, California since 2019. [4] Of the 1,510 overdose deaths occurring in the region, 57% belong to San Francisco. [5] According to a preliminary estimate from the San Francisco Medical Examiner office, there were 346 unintentional overdose fatalities in San Francisco throughout the initial five months of 2023, a rise of more than 40% over the identical period in 2018. According to the data, fentanyl is responsible for roughly 80% of all unintentional fatal overdoses in the city. [6] In the first four months of 2023, 268 people died from unintentional overdoses in San Francisco, according to an investigation by the medical examiner. All of the fentanyl was discovered in the Tenderloin region of San Francisco. [3] In 2023, 810 people died from accidental drug overdoses, a majority containing fentanyl, in San Francisco, [7] with overdoses per 100,000 people being more than double the national average. [8]
Deaths per year:
| Year | Deaths | Ref |
|---|---|---|
| 2017 | 222 | [9] |
| 2018 | 259 | [9] |
| 2019 | 441 | [9] |
| 2020 | 726 | [9] |
| 2021 | 642 | [9] |
| 2022 | 649 | [9] |
| 2023 | 810 | [3] [10] |
| 2024 (January to May) | 327 | [11] [12] |
According to the U.S. Drug Enforcement Administration, fentanyl is also substantially cheaper on average in San Francisco - around $100 cheaper per ounce - compared to cities like New York City and Philadelphia, and the California cities of Los Angeles and Sacramento. This cheaper pricing has been blamed for the higher overdose rate in San Francisco. As of January 2023, lower-grade fentanyl was being sold in the streets of San Francisco for $150 to $200 per ounce, while higher-grade fentanyl went for between $500 and $550 per ounce. Some fentanyl users reported that they obtained the drug for free by doing favors with fentanyl dealers. [13]
Members of the DEA have said they believe fentanyl's price is cheaper in the city due to "soft drug policies". Local users have reported they believe the price is cheaper because San Francisco fentanyl has been diluted with other substances, pointing to the more expensive price of fentanyl in previous years. The DEA has reported that "regular" fentanyl sold in the city ranges on average between 5% and 10% purity. Another theory, held by some of those involved with drug policy, is that the saturation of the market in the city has driven down prices. [13]
Authorities have reported that fentanyl from San Francisco is the source of fentanyl in Sacramento and that users and dealers from across California have traveled to San Francisco to purchase the drug more cheaply, although this latter assertion has been challenged by local nonprofits. [14]
In mid-2022, arrests of drug dealers and users increased again, with the appointment of a new district attorney. [15]
In December 2023, the city of San Francisco began testing wastewater for fentanyl, other drugs such as amphetamine, cocaine, methamphetamine, and xylazine, and naloxone. [16] [9] The testing was part of a larger study by the National Institute on Drug Abuse, which was also testing wastewater in 70 other U.S. cities, and is scheduled to continue until August 2024. [9]
Between May 2023 and January 2024, law enforcement in the city seized 145 pounds of fentanyl. [13] In early 2024, the California Highway Patrol recovered 42 pounds of fentanyl within a ten-mile radius of the Tenderloin neighborhood in San Francisco. In the same period, the CHP issued more than 6,000 drug-related citations, leading to nearly 500 arrests. [17]
Senate Bill 10, also known as "Melanie's Law", was a bill heard by the California Senate in 2023. The bill was named after 15-year-old Melanie Ramos, a student at Hollywood's Helen Bernstein High School who passed away at school in September 2022 from what was thought to be a fentanyl overdose. Her body was discovered in one of the campus bathrooms by her friend's stepfather after she had been reported missing for eight hours, according to a lawsuit filed by her family. By expanding resources, the bill attempts to prevent fentanyl overdoses on campuses across the state. [19] [14] As part of a school safety plan, the legislation would compel schools to devise an action plan for student opioid overdoses. This can entail educating staff on how to give medicines like Narcan to alleviate the symptoms of an opioid overdose. [14]
From the beginning of May through the middle of June, California Highway Patrol (CHP) officers seized in San Francisco as much fentanyl as it could be the direct cause of more than 2 million fatal overdoses. The governor's office stated that the quantity, being over 4 kilograms, was sufficient to kill the population of San Francisco three times over. The seizure was conducted as a part of Gavin Newsom's plan, which combats the spread of fentanyl and bright and tries to enhance public health and safety in San Francisco. [3] [20]
Attorney General Rob Bonta stated on 9 June 2023 that Walgreens, CVS, and two pharmaceutical companies would have to pay a total of $17.3 billion to the state of California as part of a settlement for their involvement in the opioid crisis. [1] Despite the drug issues in the San Francisco city, community-led harm-reduction initiatives have been stopped by Newsom and some local officials. Tenderloin Center, designed as a temporary harm-reduction measure, will be replaced by 12 smaller "wellness hubs" around the city. These hubs were designed to offer "health and shelter services", besides allowing "supervised drug use" so that overdose deaths are prevented. [3]
Legislation that would have permitted controlled drug-use facilities in three Californian cities, including San Francisco, was vetoed by Newsom in 2022 summer. Consequently, the plan for the wellness centers came to a standstill after San Francisco's city attorney objected that the city would end up being held heavily liable, a decision which made the non-profits seek a means to finance the overdose preventive components of their activities without receiving financing from the city. [3]
Licking County is a county located in the central portion of the U.S. state of Ohio. At the 2020 census, the population was 178,519. Its county seat is Newark. The county was formed on January 30, 1808, from portions of Fairfield County.
Fentanyl is a highly potent synthetic piperidine opioid primarily used as an analgesic. It is 30 to 50 times more potent than heroin and 100 times more potent than morphine; its primary clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic, and Sublimaze, among others.
A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.
Speedball, powerball, or over and under is the polydrug mixture of a stimulant with a depressant, usually an opioid. The most well-known mixture used for recreational drug use is that of cocaine and heroin; however, amphetamines can also be mixed with morphine and/or fentanyl. A speedball may be taken intravenously or by nasal insufflation.
Carfentanil or carfentanyl, sold under the brand name Wildnil, is an extremely potent opioid analgesic used in veterinary medicine to anesthetize large animals such as elephants and rhinoceroses. It is typically administered in this context by tranquilizer dart. Carfentanil has also been used in humans to image opioid receptors. It has additionally been used as a recreational drug, typically by injection, insufflation, or inhalation. Deaths have been reported in association with carfentanil.
Xylazine is a structural analog of clonidine and an α2-adrenergic receptor agonist, sold under many trade names worldwide, most notably the Bayer brand name Rompun, as well as Anased, Sedazine and Chanazine.
The Tenderloin is a neighborhood in downtown San Francisco, in the flatlands on the southern slope of Nob Hill, situated between the Union Square shopping district to the northeast and the Civic Center office district to the southwest. Encompassing about 50 square blocks, it is historically bounded on the north by Geary Street, on the east by Mason Street, on the south by Market Street and on the west by Van Ness Avenue. The northern boundary with Lower Nob Hill has historically been set at Geary Boulevard.
Medetomidine is a veterinary anesthetic drug with potent sedative effects and emerging illicit drug adulterant.
An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.
The US federal government is an opponent of the illegal drug trade; however, state laws vary greatly and in some cases contradict federal laws.
London Nicole Breed is an American politician who is the 45th and current mayor of San Francisco, serving since 2018. She was supervisor for District 5 and was president of the Board of Supervisors from 2015 to 2018.
Acetylfentanyl is an opioid analgesic drug that is an analog of fentanyl. Studies have estimated acetylfentanyl to be 15 times more potent than morphine, which would mean that despite being somewhat weaker than fentanyl, it is nevertheless still several times stronger than pure heroin. It has never been licensed for medical use and instead has only been sold on the illicit drug market. Acetylfentanyl was discovered at the same time as fentanyl itself and had only rarely been encountered on the illicit market in the late 1980s. However, in 2013, Canadian police seized 3 kilograms of acetylfentanyl. As a μ-opioid receptor agonist, acetylfentanyl may serve as a direct substitute for oxycodone, heroin or other opioids. Common side effects of fentanyl analogs are similar to those of fentanyl itself, which include itching, nausea, and potentially fatal respiratory depression. Fentanyl analogs have killed hundreds of people throughout Europe and the former Soviet republics since the most recent resurgence in use began in Estonia in the early 2000s, and novel derivatives continue to appear.
There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. It has been called "one of the most devastating public health catastrophes of our time". The opioid epidemic unfolded in three waves. The first wave of the epidemic in the United States began in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years. The second wave was from an expansion in the heroin market to supply already addicted people. The third wave starting in 2013 was marked by a steep 1,040% increase in the synthetic opioid-involved death rate as synthetic opioids flooded the US market.
The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.
The United States Centers for Disease Control and Prevention (CDC) has data on drug overdose death rates and totals. Around 1,106,900 US residents died from drug overdoses from 1968 to 2020. Around 932,400 died from 1999 through 2020. Around 93,700 died in 2020. Opioids were involved in around 80,400 of the around 109,200 deaths in 2021. Synthetic opioids other than methadone were involved with 70,601 deaths in 2021. Around 111,000 people died in 2022. Around 108,300 in 2023.
Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.
New Jersey's most recent revised policy was issued September 7, 2022 pursuant to P.L.2021, c.152 which authorized opioid antidotes to be dispensed without a prescription or fee. Its goal is to make opioid antidotes widely available, reducing mortality from overdose while decreasing morbidity in conjunction with sterile needle access, fentanyl test strips, and substance use treatment programs. A $67 million grant provided by the Department of Health and Human Services provides funding for naloxone as well as recovery services. This policy enables any person to distribute an opioid antidote to someone they deem at risk of an opioid overdose, alongside information regarding: opioid overdose prevention and recognition, the administration of naloxone, circumstances that warrant calling 911 for assistance with an opioid overdose, and contraindications of naloxone. Instructions on how to perform resuscitation and the appropriate care of an overdose victim after the administration of an opioid antidote should also be included. Community first aid squads, professional organizations, police departments, and emergency departments are required to "leave-behind" naloxone and information with every person who overdosed or is at risk of overdosing.
Beginning in 2022 and especially in 2023, the United States Congress has introduced and passed numerous pieces of legislation tackling opioids, fentanyl, and the opioid epidemic within America. Many of these bills have been introduced by different members of the Republican Party, and some pieces of legislation have attracted bipartisan support from members of the Democratic Party. Most legislative efforts have arisen during the 117th and 118th Congresses.
In response to the surging opioid prescription rates by health care providers that contributed to the opioid epidemic in the United States, US states began passing legislation to stifle high-risk prescribing practices. These new laws fell primarily into one of the following four categories:
Synthetic opioids, most notably fentanyl and drugs laced with it have seen increasing usage in the American city of San Francisco, California since 2019. In 2023, 810 people died from accidental drug overdoses, a majority containing fentanyl, in San Francisco, with overdoses per 100,000 people being more than double the national average. From January to July 2024, 412 people died from unintentional drug overdoses.