Skip to main content

San Francisco health department changes its tune as overdoses surge

Department of Public Health Director Grant Colfax and Behavioral Health Director Hillary Kunins stood next to a picture of a penny dwarfing a potentially lethal dose of fentanyl. | Source: Courtesy Department of Public Health

As overdose deaths hit a record high in San Francisco, the city’s health department has a message: Stop or reduce drug use by seeking treatment. 

At a Friday press conference, Department of Public Health Director Grant Colfax and Behavioral Health Director Hillary Kunins stood next to a picture of a penny dwarfing a potentially lethal dose of fentanyl. The picture, which the department later posted to its Twitter account, is stamped in the bottom right corner with the letters “DEA,” an abbreviation for the Drug Enforcement Administration.

“A very, very small amount of fentanyl can kill someone,” Colfax said, holding up a penny to illustrate his point. 

The department reiterated the risks of drug use in a tweet referencing xylazine, or Tranq, an animal tranquilizer that has been linked to multiple deaths in San Francisco.

It’s a starker message for a health department that has long sought to reduce the stigma of drug use as a foundational part of its plan to fight overdoses.

Drug recovery advocates noted an apparent change in tone from top health officials, some calling it a welcome pivot from prior advertising around drug use. 

In 2020, the health department partnered with the Drug Overdose Prevention and Education Project, a harm-reduction nonprofit also known as DOPE Project, on an advertising campaign that drew backlash.

Some of the advertisements, which ran on billboards, bus stops and public transit vehicles, encouraged people to carry Narcan and not to use drugs alone. But the ads were also accused of normalizing or even glamorizing drug use.

Tom Wolf, a local recovery activist who was once addicted to drugs on the city’s streets, argued that the prior ads had given the impression that being homeless and addicted to drugs is fun.

“It actually created division between people who support recovery and those who support harm reduction,” Wolf said. 

Others questioned some of the messaging unveiled at the heath department's Friday press conference, calling it alarmist and counterproductive. 

Sara Shortt, director of policy at a homelessness nonprofit called HomeRise, said that she was pleased to see the department engaging in public education about the overdose crisis but was confused by the use of a narrative commonly employed by law enforcement. 

Shortt said the department’s assertion that a few grains of fentanyl can kill someone is misleading and that drumming up fear about fentanyl isn’t productive in reducing deaths. 

“It seems like a disconnect from all the work we’ve been doing with them,” Shortt said. “I just don’t want them to feed into any of the alarmism or hysteria that actually distracts from the real need.” 

An estimated 53 people died from overdoses in June, and the city is on pace to lose a record number of lives to narcotics in 2023.

City Hall’s inconsistent approach to the drug crisis has drawn criticism as officials attempt to reduce overdoses while dealing with poor street conditions and other ripple effects from the drug trade. 

Last year, the city quickly stood up a site called the Tenderloin Linkage Center where people used drugs under supervision, reversing over 300 overdoses but drawing criticism for failing to link many people to treatment. 

On May 30, the city launched a program to arrest people who are using drugs in public, intervening with dozens of drug users but prompting fears that the approach would force people into hiding and lead to more overdoses.

The department’s newest messaging comes as novel narcotics, such as Tranq, infiltrate the city’s drug supply. 

The health department announced on Friday that 2% of all people who died from overdoses in San Francisco this year had ingested Tranq.

The drug can cause symptoms that mimic the effects of a fentanyl overdose, but because it’s not an opioid, it’s immune to overdose reversal medications. Everyone who has died after ingesting the drug in San Francisco was also found with fentanyl in their system.  

The health department didn’t respond to questions about its messaging by publication time.

David Sjostedt can be reached at