San Francisco has a new approach to the fentanyl crisis

Video transcript


[siren wailing]


We just heard an overdose go out.

Looks like somebody's at a bus stop.

Unknown male OD'ing -- that's all the information we have.

We have an engine with a paramedic,

as well as an ambulance with a paramedic on board, responding.


We're gonna be another additional layer to this response

and kind of try to begin care for this person at the scene.


[siren wailing]


Fentanyl's been a game-changer.

It's been a game-changer nationwide

and a game-changer here in San Francisco.

The vast majority of drug overdose deaths

here in San Francisco involve opioids,

and the vast majority of those involve fentanyl.


[indistinct conversations]


The first responders and paramedics in the San Francisco

Fire Department respond to literally dozens of overdoses every day.

Community paramedics have the ability to transport folks directly

from the street to a variety of non-emergency services

like shelters, mental health drop-ins, substance-use-disorder treatment,

or even bringing someone to a pharmacy or bringing someone to urgent care.


[siren wailing]


The fire department's seeing

over approximately a dozen overdoses a day. Those are just the overdoses that we know about

inside of the 911 system. We know that there are many, many more occurring that are never reported.

But the overdoses that this team focuses on

are the ones that are part of the 911 system

and folks that we know about

and can begin influencing their care right away.

30% of overdose deaths are unhoused individuals.

Approximately 5% of San Franciscans

are people of color,

but they represent 25% of overdose deaths

here in the city.


To see numbers like that

and to watch that just cut down people

was really hard.

And it was a little demoralizing after a while

when you realize there's very little --

We are the "come after the facts," not before.

[indistinct conversations]

[horn honks]

What was the call? Came in as an OD. Girl from across the street called.

Are you interested in a shelter bed today?

Not really -- I just want to recuperate and a lift...

Where would you like a taxi voucher to?

The streets -- Mission and 6th.

What do you -- What's down there for you?

-A friend's house. -A friend's house.

Well, I can't -- I can't do a transport or a taxi voucher

to a friend's house, but I can give you a taxi voucher

and get you into a shelter today.

I don't want to go to a shelter.

I could see about getting you a ride to the Lincoln Center.

Do you know the Lincoln Center at Market and 7th?

-Yeah, okay, okay.

-Would you like to go there? -Yeah.

-You would? -Yes.


This individual, we believe, was discharged from the hospital within the past 15 minutes.

She's here at a bus stop.

We can tell from our medical records

she's a high utilizer of 911 systems.

We could transport this person directly to shelter

from the street in the context of a 911 call.

But, for a variety of reasons, she's declining.

This initially came out as an overdose.

There might be an opioid component.

It's unclear at this time, but either way,

this is a very vulnerable, unhoused individual

who's essentially relying on the 911 system

for their primary care.

-Okay. 100%.

-Folks who survive overdoses

are at very, very high risk of future mortality.

So when this team -- this rapid response team --

has contact with an individual,

the data from that encounter is automatically transferred

to our Department of Public Health colleagues,

and their goal is to follow up with these folks

within 72 hours.


[siren wailing]

[indistinct conversations]


-We are on the outreach van.

We have a list of probably about nine people we're going to see

in the next two hours -- or at least try to find.

These are all people that have had a non-fatal overdose.

And what our job is, is to follow up with people

in that critical first 24 to 72 hours

after a non-fatal overdose,

when -- where someone's at an even higher risk

of overdosing again.

-How many overdoses has he had?

-So, he's had a couple, even in the past month.

-So we are basically going to see him

to kind of see what happened

and just kind of do a -- like, debrief about what happened,

to see what he's willing to do

to kind of reduce -- to reduce his risk.

[birds chirping]

-[speaking indistinctly]

-And where is our patient, he said?

-He said he hasn't been seen in three days.


[engine rumbling]


When our feet hit the ground,

we know exactly what we're meant to do that day,

and we're going to try to change someone's life.

And it could be one, and we could fail, right?

But we're just going to get up and try again.

Starting [buprenorphine] is a great start.

I just want to make sure that whatever you think you want

and whatever's going to work for you

that we're supporting you in any way we can.

So today it looks like we looked for six, five.

We were able to make contact with one in facility,

and we have a care plan for him.

Five we were unable to locate and can pick that up on Monday.

Does that sound about right, guys?

-Yes. -All right. Okay.

Everybody has a right to have someone care about them

or fight for them.

It's super personal. All of this is personal.

It's absolutely personal.