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Published in: Journal of Urban Health 1/2019

01-02-2019 | Brief Report

Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

Authors: Christopher Rowe, Eliza Wheeler, T. Stephen Jones, Clement Yeh, Phillip O. Coffin

Published in: Journal of Urban Health | Issue 1/2019

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Abstract

This report documents a successful intervention by a community-based naloxone distribution program in San Francisco. The program and its partner organizations, working with participants who use drugs, first identified the appearance of illicitly made fentanyl and increased outreach and naloxone distribution. Distribution of naloxone and reported use of naloxone to reverse opioid-involved overdoses increased significantly while the number of opioid-involved and fentanyl-involved overdose deaths did not. Community-based programs that provide training and naloxone to people who use drugs can serve as an early warning system for overdose risk and adaptively respond to the rapidly changing overdose risk environment.
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Footnotes
1
In 2014–15, the ten community partners of the DOPE project included five syringe service programs, San Francisco County Jail, three programs serving individuals who were homeless, and a local study that recruited and actively followed individuals who inject drugs.
 
2
The community partners of the Dope Project provide “naloxone kits” to trained individuals. The kit includes educational materials on identifying and managing an opioid overdose, a prescription card, and two doses of naloxone. In 2014–2015, the DOPE Project provided three types of naloxone: 0.4 milligram (mg)/0.4 milliliter (ml) auto-injector, 0.4 mg/1-ml vials and syringes for intramuscular injection, and the off-label 2 mg/2 ml adapted for intranasal administration with mucosal atomizer devices.
 
3
When previously trained participants return to a DOPE Project site for a refill of naloxone, staff conducted a brief interview. If naloxone was used in a suspected overdose, staff record information about where and when the overdose occurred, to whom naloxone was administered (e.g. “spouse”, “friend”, “stranger”), known drugs involved in the overdose, and whether participants used other response strategies covered in DOPE Project training (sternum rub, call 911, and rescue breathing).
 
4
San Francisco Planning Department. Neighborhood Groups Map. 2017 [accessed 2017 July 15]; Available from: http://​sf-planning.​org/​neighborhood-groups-map.
 
5
Drug overdoses accounted for 52,404 deaths in the USA in 2015, 33,091 (63%) involving an opioid. The overdose death rate from synthetic opioids other than methadone, which includes fentanyl and its analogs, increased by 72% from 2014 to 2015 [2].
 
Literature
1.
go back to reference National Center for Health Statistics. Provisional counts of drug overdose deaths, as of 8/6/2017. Atlanta, GA: Centers for Disease Control and Prevention; 2017. National Center for Health Statistics. Provisional counts of drug overdose deaths, as of 8/6/2017. Atlanta, GA: Centers for Disease Control and Prevention; 2017.
2.
go back to reference Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65.
3.
go back to reference O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(34):897–903.CrossRefPubMedPubMedCentral O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(34):897–903.CrossRefPubMedPubMedCentral
4.
go back to reference Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631–5.PubMedPubMedCentral Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631–5.PubMedPubMedCentral
6.
go back to reference Treloar C, Rance J, Yates K, Trust ML. People who inject drugs: the perspectives of clients and staff of needle syringe programs. Int J Drug Policy. Jan 2016;27:138–45.CrossRefPubMed Treloar C, Rance J, Yates K, Trust ML. People who inject drugs: the perspectives of clients and staff of needle syringe programs. Int J Drug Policy. Jan 2016;27:138–45.CrossRefPubMed
7.
go back to reference MacNeil J, Pauly B. Needle exchange as a safe haven in an unsafe world. Drug Alcohol Rev. Jan 2011;30(1):26–32.CrossRefPubMed MacNeil J, Pauly B. Needle exchange as a safe haven in an unsafe world. Drug Alcohol Rev. Jan 2011;30(1):26–32.CrossRefPubMed
8.
go back to reference Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. The textures of heroin: user perspectives on “black tar” and powder heroin in two U.S. cities. J Psychoactive Drugs. Sep-Oct 2016;48(4):270–8.CrossRefPubMedPubMedCentral Mars SG, Bourgois P, Karandinos G, Montero F, Ciccarone D. The textures of heroin: user perspectives on “black tar” and powder heroin in two U.S. cities. J Psychoactive Drugs. Sep-Oct 2016;48(4):270–8.CrossRefPubMedPubMedCentral
9.
go back to reference Ciccarone D, Ondocsin J, Mars SG. Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’. Int J Drug Policy. 2017;46:146–55.CrossRefPubMedPubMedCentral Ciccarone D, Ondocsin J, Mars SG. Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’. Int J Drug Policy. 2017;46:146–55.CrossRefPubMedPubMedCentral
10.
go back to reference Somerville NJ, O’Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, et al. Characteristics of fentanyl overdose—Massachusetts, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382–6.CrossRefPubMedPubMedCentral Somerville NJ, O’Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, et al. Characteristics of fentanyl overdose—Massachusetts, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382–6.CrossRefPubMedPubMedCentral
11.
go back to reference Sporer KA, Kral AH. Prescription naloxone: a novel approach to heroin overdose prevention. Ann Emerg Med. Feb 2007;49(2):172–7.CrossRefPubMed Sporer KA, Kral AH. Prescription naloxone: a novel approach to heroin overdose prevention. Ann Emerg Med. Feb 2007;49(2):172–7.CrossRefPubMed
12.
go back to reference Rowe C, Santos G-M, Vittinghoff E, Wheeler E, Davidson P, Coffin PO. Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program. Addiction. 2015;110(8):1301–10.CrossRefPubMedPubMedCentral Rowe C, Santos G-M, Vittinghoff E, Wheeler E, Davidson P, Coffin PO. Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program. Addiction. 2015;110(8):1301–10.CrossRefPubMedPubMedCentral
13.
go back to reference Siegler A, Huxley-Reicher Z, Maldjian L, Jordan R, Oliver C, Jakubowski A, et al. Naloxone use among overdose prevention trainees in New York City: a longitudinal cohort study. Drug Alcohol Depend. Jul 24 2017;179:124–30.CrossRefPubMed Siegler A, Huxley-Reicher Z, Maldjian L, Jordan R, Oliver C, Jakubowski A, et al. Naloxone use among overdose prevention trainees in New York City: a longitudinal cohort study. Drug Alcohol Depend. Jul 24 2017;179:124–30.CrossRefPubMed
Metadata
Title
Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015
Authors
Christopher Rowe
Eliza Wheeler
T. Stephen Jones
Clement Yeh
Phillip O. Coffin
Publication date
01-02-2019
Publisher
Springer US
Published in
Journal of Urban Health / Issue 1/2019
Print ISSN: 1099-3460
Electronic ISSN: 1468-2869
DOI
https://doi.org/10.1007/s11524-018-0250-x

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