Fentanyl afflicts San Diego’s homeless population



The fentanyl epidemic is devastating San Diego’s homeless community.

County data reveals that 203 homeless San Diegans died of overdoses involving fentanyl last year, more than double the already rising total the county medical examiner’s office tallied in 2020.

And in the first quarter of 2022 — the most comprehensive preliminary data available — fentanyl deaths among homeless residents increased 23% from the same time last year.

Soaring fentanyl deaths across the region among a much wider swath of the population prompted county supervisors to declare illicit fentanyl a public health crisis earlier this year.

The opioid painkiller that is 50 to 100 times stronger than morphine has been especially deadly for homeless people in San Diegans.

A homeless encampment on the outskirts of downtown on November 11, 2022. / Photo by Ariana Drehsler

Fentanyl deaths among San Diego’s homeless population accounted for a quarter of the 814 fentanyl deaths recorded in the county last year. Related deaths also accounted for more than a third of the 536 deaths of homeless residents investigated by county medical examiners.

Homeless residents staying on the outskirts of downtown and in the Midway district who spoke to Voice of San Diego say they have grown accustomed to fentanyl overdoses and deaths among them. Drugs are everywhere – and often mixed with other drugs. In recent months, some have been stockpiling naloxone, an opioid overdose reversal drug – better known as Narcan – so they can revive their neighbors.

“I see too many people falling,” said Greg Savas, who remains in the Midway District. “It kills a lot of people.”

Two different glass pipes used for smoking crystal meth and heroin. /Photo by Ariana Drehsler

The 45-year-old said around 20 people he knew had died of drug overdoses in recent years.

David Amrani, 36, estimated that he had resurrected around 30 people with Narcan. Amrani, who regularly uses fentanyl, said homeless people in the downtown area where he is staying are now better prepared.

Amrani and others say they have come to rely on Narcan and the test strips that detect fentanyl that the Harm Reduction Coalition of San Diego, a county contractor, provides to try to prevent deaths.

“I’ve never lost anyone because of me,” Amrani said.

David Amrani, 36, stands near homeless camps in downtown San Diego on November 11, 2022. / Photo by Ariana Drehsler

Data from the San Diego Fire Department shows that the city’s paramedics are also more regularly helping homeless patients with naloxone. In the past year, they have provided the drug 979 times, nearly double the number of administrations to homeless people in San Diegans two years ago.

The growing availability of Narcan is part of a larger county harm reduction strategy aimed at reducing the negative consequences of drug use by providing tools to reduce the risk of fatal overdoses and offering housing and support programs. treatment that does not oblige people who relapse. The county also recently approved a framework to spend a planned $100 million in settlement money associated with legal battles against opioid drugmakers to increase access to treatment, harm reduction tools and housing. .

Regional leaders are stepping up their response as the region’s fentanyl and homelessness crises explode. The growing problem of homelessness has made people living on the streets increasingly morose and skeptical about the arrival of solutions to meet their needs.

“People are consuming and they’re tired,” said Tara Stamos-Buesig of the Harm Reduction Coalition. “They don’t have the support they need or access to resources and they burn out. They live with a lot of trauma.

Tara Stamos-Buesig (right) of the Harm Reduction Coalition of San Diego hugs a homeless woman after giving her Narcan nasal spray, which can reverse opioid overdoses, downtown on November 11, 2022. /Photo by Ariana Drehsler

City and county officials say they are working to provide more low-barrier resources, including two shelters they opened last year to try to move more people with addictions and issues sanity inside. The county said it plans to open a smaller, city-focused shelter in the coming months and eventually take over and offer yet-to-be services at a former Volunteers addiction treatment center. of America in National City.

Nathan Fletcher, chairman of the County Board of Supervisors, called on the county to use opioid settlement funds to connect people with substance use problems with trained supporters immediately after overdoses and to step up efforts to move homeless people off the streets.

“The reality is that an individual who is suffering from addiction, if they are on our streets, is not going to improve if they are not housed,” Fletcher said.

Mayor Todd Gloria announced earlier this month that he will issue an executive order directing city staff to prioritize its response to the fentanyl crisis, including through increased street-level enforcement. He spoke of the toll fentanyl has taken on the city’s homeless population and criticized the pushers who prey on the homeless in San Diegans.

“We will not find or accept excuses to let this crisis continue to spin out of control,” Gloria said.

A letter from Gloria and 10 other California mayors sent Governor Gavin Newsom last week also highlighted the increase in fentanyl and methamphetamine overdose deaths among the state’s homeless population and urged the state to provide “additional education, treatment, and enforcement.”

Dr Jeffrey Norris, Father Joe’s chief medical officer, said his clinic had increased the number of slots in its medication-assisted treatment program by around 50% over the past year to try to meet demand. . So-called MAT programs provide prescriptions to minimize withdrawals and cravings.

Almost daily, Norris said patients notify program staff that another loved one has died.

Clothes can be seen in a puddle near a homeless encampment downtown on November 11, 2022. / Photo by Ariana Drehsler

“They see people dying left and right around them and they fear they’ll be next,” Norris said.

He said the fact that fentanyl is often mixed with other drugs has proven particularly terrifying – and deadly.

Data from the Office of the Medical Examiner shows that at least 80% of fentanyl-related deaths in the homeless population over the past three years have also involved methamphetamine.

Dr. Roneet Lev, who served as chief medical officer for the White House Office of National Drug Control Policy in the Trump administration before returning to the emergency department at Scripps Mercy Hospital, knows this all too well. deadly cocktail.

Lev said she’s encouraged by the increased access to Narcan, which can give patients a second — or fourth — chance at life, but worries users are playing Russian roulette.

“One of these times it may not work,” Lev said.

At the moment, Lev and Stamos-Buesig said, availability does not match need.

“Every emergency department in San Diego County is sending people out onto the streets needing help, crying and begging for help, and we have no place to put them,” Lev said.

Julie Tucker, 51, considers herself one of the lucky ones.

Julie Tucker, 51, walks to Father Joe’s Villages Health Center where she receives drug treatment. /Photo by Ariana Drehsler

A few months ago, Tucker said fentanyl was mixed with the meth she typically used to stay awake while hanging out along Harbor Drive downtown.

After two consecutive hospitalizations and side effects that made her fear she was dying, Tucker said she approached a street from Father Joe medical team who had previously visited his tent to see if they could test drugs.

A test showed he was contaminated with fentanyl, Tucker said.

Tucker said the team helped eliminate the drugs and enrolled her in their medication-assisted treatment program.

“I’ve been sober ever since,” Tucker said.

Tucker is now staying at a shelter and expects to move into a housing project in San Ysidro soon.

Many users are not yet ready to quit.

Amrani said he would take housing if offered, but can’t imagine giving up fentanyl — at least for now. He said it helped him deal with lingering injuries and the aches and pains that come with sleeping on the concrete. Going without fentanyl for a few days is a nightmare with severe side effects. The prospect of a crowded shelter also makes him anxious. Amrani said the arrests also did not change his reality, except that he lost property in the process.

“I wake up every day with the same thing,” Amrani said. “What’s the point of giving up something that makes me happy if there’s nothing else that makes me happy?”

Tara Stamos-Buesig (right) of San Diego’s Harm Reduction Coalition speaks with David Amrani (left) who is homeless downtown on November 11, 2022. / Photo by Ariana Drehsler