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San Francisco pharmacies might have to carry overdose-reversal drugs

A box of Narcan is displayed in The Standard’s photo studio on Dec. 9, 2022. | Mike Kuba/The Standard

San Francisco Supervisor Matt Dorsey introduced legislation Tuesday that would require every retail pharmacy in the city to carry medication used to rapidly reverse overdoses of drugs like fentanyl.

In a statement, Dorsey acknowledged that a majority of San Francisco pharmacies already stock naloxone, but he asserted that a city requirement would “maximize its availability and help save lives.”

The city and country continue to suffer an extraordinary toll from fentanyl, with the U.S. logging a record 108,000 overdose fatalities—mainly from fentanyl—in 2021. In San Francisco, about 620 died from drug overdoses last year and the city is on pace to set a record for deadly overdoses this current year. Those numbers would likely be far higher without the widespread availability of naloxone, a medication commonly referred to as Narcan, which can reverse an overdose.

Nearly 60% of all drug overdose deaths in San Francisco and four neighboring counties involved fentanyl last year, new data shows. And while San Francisco has the highest per capita fatal overdose rate, 57% of the region’s 1,510 overdose deaths occurred outside the city.

City leaders and regional law enforcement agencies have recently taken steps to disrupt open-air drug markets and provide services to people with substance-use disorders who are willing to accept them.

Supervisor Matt Dorsey addresses a crowd on National Fentanyl Awareness Day in San Francisco on May 10, 2023. | Justin Katigbak for The Standard

The supervisor noted that, despite U.S. Food and Drug Administration approval in March for over-the-counter sale of naloxone without a prescription, random "secret shopper" surveys found some pharmacies short of the drug. One survey carried out by the San Francisco Department of Public Health found about 20% of local retail pharmacies did not have it in stock.

City legislation would require pharmacies in San Francisco to stock two boxes, with a three-day grace period for reorders, as well as penalties of $250 to $1,000 per violation.

Dorsey credited the city's Department of Public Health and City Attorney David Chiu for their help with introducing the legislation, and he called the ordinance “a blueprint” for other cities and states to similarly expand access.

Two prominent retail pharmacy outlets weighed in with support Tuesday.

“At Safeway, we already stock naloxone in our pharmacies,” said Wendy Gutshall, Safeway’s public and government affairs director. “We want to give our customers the choice to purchase this potentially life-saving drug.”

Perry Han, a regional vice president for Walgreens, said in a statement that naloxone is available in all of the chain’s San Francisco pharmacies. 

“We applaud Supervisor Dorsey for his work to increase access throughout San Francisco,” Han said.

Last August, the city won a judge’s ruling against Walgreens, the last of multiple defendants in a nationwide tangle of lawsuits involving companies that manufactured and distributed opioids. Walgreens agreed last month to pay San Francisco a $230 million settlement that can be used to address the city’s opioid epidemic.