This article, written by Mark Hedin, was originally published in Central City Extra's September 2015 issue. You can find the paper distributed around area cafes, nonprofits, City Hall offices, SROs and other residences – and in the periodicals section on the fifth floor of the Main Library.



A powerful drug is crashing the party in San Francisco.

Fentanyl, a synthetically produced bluish-white, fine-powder opiate, is “the scariest one out there,” according to Dr. Phillip Coffin, Director of Substance Abuse Research at the Department of Public Health. “It’s the only one we measure in micrograms instead of milligrams,” Coffin said. “You just can’t titrate it (measure an appropriate dose) in the streets.”

Fentanyl is “up to 100 times more powerful than morphine and 30 to 50 times more than heroin,“ according to a March news release by the Drug Enforcement Administration.

"There is a white powder 'HEROIN’ going around that is causing a lot of folks to overdose,” reads a flyer distributed by the Homeless Youth Alliance and San Francisco Needle Exchange. “This heroin has been tested and is fentanyl, a really strong opiate. So if you are using it, please don’t use alone and remember you can always do more but never do less. You should all carry narcan (the familiar name for naloxone, an opiate antidote) on you because you never know when it will save someone’s life, be it a friend or a stranger. Please take care of each ￼other and be safe.”

“We documented 75 naloxone reversals of fentanyl” this July, Coffin said. Although some were initially reported as heroin overdoses, the Department of Public Health believes that the fast-acting, short-lived high of “fine white powder” described in reports by people renewing their narcan supplies sounds like fentanyl. That’s triple the ODs reversed with narcan in July a year ago.

“They were all heroin,” Coffin wrote in an email to the Extra. “There was no sign of fentanyl around at that time."

"On the street, people don’t necessarily know what it is," Eliza Wheeler, project manager for the Dope Project, told the Extra. "They were just calling it heroin or china white. We’ve been dealing with this spike since late June.”

The Department of Public Health contracts with the Dope Project to distribute naloxone citywide through needle exchange programs, the AIDS Foundation, Glide, the Drug Users Union, St. James Infirmary, Martin de Porres, Homeless Youth Alliance and to the jail, Wheeler said.

A sign on the Drug Users Union front door at 149 Turk St. warns: “super strong white powder heroin in SF. May need extra narcan/naloxone to stop overdose.”

Signs posted throughout the Vincent Hotel, where a memorial was held Aug. 21st for career addict Vera Pettway, contained similar warnings.

“All the needle exchanges have been mobilized about this for two months,” Wheeler said.

City Hall itself was the scene of an overdose rescue Aug. 18th, when a deputy there got word of “an unresponsive male” in a restroom. Sergeant J. Caramucci jimmied the bathroom stall open with a pocketknife, noticed a needle still sticking out of Richard Giles Bertram’s arm, and successfully oversaw his transport to San Francisco General Hospital by Fire Department medics, who arrived within four minutes.

Bertram survived. A Sheriff’s Department test of residue in a baby jar lid found at the scene determined that it was heroin.

Coffin says the scenario sounds much like a fentanyl overdose. Coffin said the SFPD is also being supplied with the antidote, though new Tenderloin Captain Teresa Ewins told the Extra that her officers have not yet been trained to administer naloxone.

Coffin, however, said that SFPD had, for the first time, used naloxone to reverse an overdose in recent weeks. Ewins told the Extra that Mission Station officers are now equipped with naloxone.

Wheeler says the Dope Project is phasing out distribution of Naloxone nasal kits, which cost $80 each. It assembles and distributes injectable kits that cost the program about $3 a piece, as well as FDA approved, prepackaged auto-injection kits worth $300 or more. The manufacturer Kaleo has donated 1,300 of those to the program since last fall.

The Department of Public Health recently obtained a sample of the dope someone had overdosed on, tested it, and found it to be fentanyl.“It was the first time we’ve suspected fentanyl and in fact found it,” Coffin said. So little is known about it, he added, that it's still unclear if what's on the street is pharmaceutically produced or black market.

Fentanyl, a synthetic, has been around for 25 years, Coffin said. Cancer patients may take the drug in skin patches or, as a faster-acting alternative, fentanyl lollipops.

Heroin and other opiates can kill by overdose when the drug gradually blocks receptors in the brain that tell the body to breathe, so the user doesn’t, and suffocates, Coffin said. Death from a heroin overdose usually takes more than an hour, but powerful fentanyl is much faster.

“It’s pretty darn dangerous,” Coffin said. He told the Extra that although there are no confirmed deaths due to fentanyl in the city so far, he was awaiting a medical examiner’s report on one recent fatal overdose.

The Department of Public Health estimates San Francisco has 15,000 to 20,000 intravenous drug users, with about ten heroin-related deaths a year. “We’re experiencing a far lower rate of fatal overdoses than we should,” Coffin said.

Wheeler credits the widespread availability of naloxone for the relatively low mortality rate among heroin users in San Francisco. The Dope Project, which got its start as a fiscally sponsored project of the Study Center (which publishes Central City Extra), has trained about 6,000 San Franciscans in naloxone’s use since 2003 and received “about 1,900” reports of people being rescued from an overdose by the administration of this quick and easy antidote, Wheeler said.

Deaths from prescription opiates such as oxycontin, percoset, codeine, oxymorphone, or hydromorphone, however, occur in San Francisco at about ten times the rate of heroin-related deaths, Coffin said. Although naloxone use could prevent some of these deaths, that population has proven harder to reach. Coffin said paramedics now also carry naloxone antidote kits for drug overdose emergencies.