Gabe Greschler

In perhaps her strongest rebuke yet of harm reduction, a strategy to combat drug addiction that critics say enables people to continue using, San Francisco Mayor London Breed said the policy has played a role in fueling the city&#8217;s fentanyl crisis.

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In perhaps her strongest rebuke yet of harm reduction, a strategy to combat drug addiction that critics say enables people to continue using, San Francisco Mayor London Breed said the policy has played a role in fueling the city's fentanyl crisis.

In perhaps her strongest rebuke yet of harm reduction, a strategy to combat drug addiction that critics say enables people to continue using, San Francisco Mayor London Breed said the policy has played a role in fueling the city&#8217;s fentanyl crisis.

&#8220;Harm reduction, from my perspective, is not reducing the harm,&#8221; said Breed during a rally in front of City Hall on Monday afternoon raising awareness about the city&#8217;s fentanyl deaths. &#8220;It is making things worse. I will not apologize for the stances I have taken that are controversial. For the people who are selling poison on the streets of San Francisco, that&#8217;s taken life.&#8221;

"Harm reduction, from my perspective, is not reducing the harm," said Breed during a rally in front of City Hall on Monday afternoon raising awareness about the city's fentanyl deaths. "It is making things worse. I will not apologize for the stances I have taken that are controversial. For the people who are selling poison on the streets of San Francisco, that's taken life."

&#8220;Harm reduction, from my perspective, is not reducing the harm,&#8221; said Breed during a rally in front of City Hall on Monday afternoon raising awareness about the city&#8217;s fentanyl deaths. &#8220;It is making things worse. I will not apologize for the stances I have taken that are controversial. For the people who are selling poison on the streets of San Francisco, that&#8217;s taken life.&#8221;

Breed&#8217;s comments on Monday are part of her increasingly zero-tolerance approach to drug use in the city during her nearly six-year tenure, a stance that comes as overdose deaths in San Francisco have exploded and led to a heated debate in recent years about what approach elected officials, social services and law enforcement should take when it comes to combating the issue.

Breed's comments on Monday are part of her increasingly zero-tolerance approach to drug use in the city during her nearly six-year tenure, a stance that comes as overdose deaths in San Francisco have exploded and led to a heated debate in recent years about what approach elected officials, social services and law enforcement should take when it comes to combating the issue.

Breed&#8217;s comments on Monday are part of her increasingly zero-tolerance approach to drug use in the city during her nearly six-year tenure, a stance that comes as overdose deaths in San Francisco have exploded and led to a heated debate in recent years about what approach elected officials, social services and law enforcement should take when it comes to combating the issue.

Ken Reigenborn uses drugs in the Tenderloin District of San Francisco on July 4, 2022. Homelessness and public drug use including the use of fentanyl continue to be major public health issues in the City.

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2024/01/2022_july_04_tenderloin_addiction-171.jpg?w=2500" alt="A man smokes drugs on tinfoil using a straw." class="wp-image-241309"/><figcaption class="wp-element-caption">Ken Reigenborn uses drugs in the Tenderloin District of San Francisco on July 4, 2022.</figcaption></figure>

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<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2024/01/2022_july_04_tenderloin_addiction-171.jpg?w=2500" alt="A man smokes drugs on tinfoil using a straw." class="wp-image-241309"/><figcaption class="wp-element-caption">Ken Reigenborn uses drugs in the Tenderloin District of San Francisco on July 4, 2022.</figcaption></figure>

The conversation has led some to question the policy of harm reduction, which aims to lessen the negative effects of drug use through a variety of public health interventions, some of which include <a href="https://www.sf.gov/information/syringe-access-collaborative">clean needle exchanges</a>, overdose prevention training or safe consumption sites.

The conversation has led some to question the policy of harm reduction, which aims to lessen the negative effects of drug use through a variety of public health interventions, some of which include <a href="https://www.sf.gov/information/syringe-access-collaborative">clean needle exchanges</a>, overdose prevention training or safe consumption sites.

While proponents of the strategy see it as the best chance to prevent users from overdosing on drugs or spreading blood-borne illnesses, critics have argued it doesn&#8217;t turn the tide on addiction or encourage sobriety.

While proponents of the strategy see it as the best chance to prevent users from overdosing on drugs or spreading blood-borne illnesses, critics have argued it doesn't turn the tide on addiction or encourage sobriety.

While proponents of the strategy see it as the best chance to prevent users from overdosing on drugs or spreading blood-borne illnesses, critics have argued it doesn&#8217;t turn the tide on addiction or encourage sobriety.

&#8220;We are drawing a line in the sand,&#8221; said Steve Adami, <a href="https://sfstandard.com/2023/07/16/former-city-workers-change-san-francisco-funds-drug-treatment/">executive director of the Salvation Army&#8217;s the Way Out program</a>, during Monday&#8217;s rally. &#8220;[And] standing up to the status quo. And challenging the city to enlarge the solutions base and start getting a grip in promoting recovery.&#8221;

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"We are drawing a line in the sand," said Steve Adami, <a href="https://sfstandard.com/2023/07/16/former-city-workers-change-san-francisco-funds-drug-treatment/">executive director of the Salvation Army's the Way Out program</a>, during Monday's rally. "[And] standing up to the status quo. And challenging the city to enlarge the solutions base and start getting a grip in promoting recovery."

&#8220;We are drawing a line in the sand,&#8221; said Steve Adami, <a href="https://sfstandard.com/2023/07/16/former-city-workers-change-san-francisco-funds-drug-treatment/">executive director of the Salvation Army&#8217;s the Way Out program</a>, during Monday&#8217;s rally. &#8220;[And] standing up to the status quo. And challenging the city to enlarge the solutions base and start getting a grip in promoting recovery.&#8221;

The change in tenor also comes as the mayor faces increasingly worrisome poll numbers from multiple moderate candidates, including Levi Strauss heir Daniel Lurie and former Supervisor Mark Farrell. Polling <a href="https://www.sfchronicle.com/sf/article/mayor-london-breed-election-18678601.php">released by the San Francisco Chronicle</a> on Feb. 22 shows Breed at risk of losing her reelection campaign, with voters preferring Farrell in a ranked-choice contest.

The change in tenor also comes as the mayor faces increasingly worrisome poll numbers from multiple moderate candidates, including Levi Strauss heir Daniel Lurie and former Supervisor Mark Farrell. Polling <a href="https://www.sfchronicle.com/sf/article/mayor-london-breed-election-18678601.php">released by the San Francisco Chronicle</a> on Feb. 22 shows Breed at risk of losing her reelection campaign, with voters preferring Farrell in a ranked-choice contest.

In response to the mayor&#8217;s comments on Monday, harm reduction advocates said Breed was shifting her position purely for political reasons and was &#8220;ignoring best practices.&#8221;

In response to the mayor's comments on Monday, harm reduction advocates said Breed was shifting her position purely for political reasons and was "ignoring best practices."

In response to the mayor&#8217;s comments on Monday, harm reduction advocates said Breed was shifting her position purely for political reasons and was &#8220;ignoring best practices.&#8221;

&#8220;We firmly believe harm reduction is public health and harm reduction is good for public safety,&#8221; said Laura Guzman, executive director of the National Harm Reduction Coalition. &#8220;It really helps keep people safe. Mayor Breed has shifted. And has really gone back and forth. There is nothing that indicates anything else other than political motivation.&#8221;

"We firmly believe harm reduction is public health and harm reduction is good for public safety," said Laura Guzman, executive director of the National Harm Reduction Coalition. "It really helps keep people safe. Mayor Breed has shifted. And has really gone back and forth. There is nothing that indicates anything else other than political motivation."

&#8220;We firmly believe harm reduction is public health and harm reduction is good for public safety,&#8221; said Laura Guzman, executive director of the National Harm Reduction Coalition. &#8220;It really helps keep people safe. Mayor Breed has shifted. And has really gone back and forth. There is nothing that indicates anything else other than political motivation.&#8221;

On Monday, the mayor had few words in response to the polling numbers.

On Monday, the mayor had few words in response to the polling numbers.

&#8220;Polls are gonna be what they be,&#8221; she said. &#8220;But the results will speak for themselves when I win in November.”

"Polls are gonna be what they be," she said. "But the results will speak for themselves when I win in November.”

&#8220;Polls are gonna be what they be,&#8221; she said. &#8220;But the results will speak for themselves when I win in November.”

For her part, the mayor&#8217;s posture on drug use seemed to shift with a now-famous December 2021 speech about public safety in which she called for for the city to be &#8220;<a href="https://www.youtube.com/watch?v=vRBe45y-834">less tolerant of all the bullshit</a>.&#8221;

For her part, the mayor's posture on drug use seemed to shift with a now-famous December 2021 speech about public safety in which she called for for the city to be "<a href="https://www.youtube.com/watch?v=vRBe45y-834">less tolerant of all the bullshit</a>."

For her part, the mayor&#8217;s posture on drug use seemed to shift with a now-famous December 2021 speech about public safety in which she called for for the city to be &#8220;<a href="https://www.youtube.com/watch?v=vRBe45y-834">less tolerant of all the bullshit</a>.&#8221;

At the time, the mayor helped usher in the opening of the now-defunct Tenderloin Center, <a href="https://sfstandard.com/2022/11/17/city-funded-survey-says-the-tenderloin-center-improved-the-neighborhood-others-arent-convinced/">a facility that aimed to help get addicts into treatment</a> but garnered intense criticism after effectively becoming a safe consumption site with visible public drug use.

City-funded survey says the Tenderloin Center improved the neighborhood. Many are unconvinced

At the time, the mayor helped usher in the opening of the now-defunct Tenderloin Center, <a href="https://sfstandard.com/2022/11/17/city-funded-survey-says-the-tenderloin-center-improved-the-neighborhood-others-arent-convinced/">a facility that aimed to help get addicts into treatment</a> but garnered intense criticism after effectively becoming a safe consumption site with visible public drug use.

Michael Ruiz, center,  holds a sign reading “Fetanyl? Not @ All” at the "March to Prevent Fentanyl Deaths" at City Hall in San Francisco on Monday, Feb. 26, 2024. Hundreds of people marched to raise awareness of the dangers of fentanyl and promote resources for those experiencing addiction.

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2024/02/20240227-fentanylmarch-01.jpg?w=2500" alt="A person is holding a sign reading &quot;Fentanyl? Not @ All&quot; in a crowd." class="wp-image-252852"/><figcaption class="wp-element-caption">Michael Ruiz, center, holds a sign reading, “Fentanyl? Not @ All,” at the &#8220;March to Prevent Fentanyl Deaths&#8221; at San Francisco City Hall on Monday.</figcaption></figure>

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2024/02/20240227-fentanylmarch-01.jpg?w=2500" alt="A person is holding a sign reading &quot;Fentanyl? Not @ All&quot; in a crowd." class="wp-image-252852"/><figcaption class="wp-element-caption">Michael Ruiz, center, holds a sign reading, “Fentanyl? Not @ All,” at the "March to Prevent Fentanyl Deaths" at San Francisco City Hall on Monday.</figcaption></figure>

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2024/02/20240227-fentanylmarch-01.jpg?w=2500" alt="A person is holding a sign reading &quot;Fentanyl? Not @ All&quot; in a crowd." class="wp-image-252852"/><figcaption class="wp-element-caption">Michael Ruiz, center, holds a sign reading, “Fentanyl? Not @ All,” at the &#8220;March to Prevent Fentanyl Deaths&#8221; at San Francisco City Hall on Monday.</figcaption></figure>

Last year, the mayor&#8217;s position budged further <a href="https://www.kqed.org/news/11950520/compassion-is-killing-people-london-breed-pushes-for-more-arrests-to-tackle-sfs-drug-crisis">during a press conference at United Nations Plaza</a>, when she said, in response to a question about the drug crisis, that &#8220;compassion is killing people. And we have to push forth some tough love to change what’s happening on the streets of San Francisco.”

Last year, the mayor's position budged further <a href="https://www.kqed.org/news/11950520/compassion-is-killing-people-london-breed-pushes-for-more-arrests-to-tackle-sfs-drug-crisis">during a press conference at United Nations Plaza</a>, when she said, in response to a question about the drug crisis, that "compassion is killing people. And we have to push forth some tough love to change what’s happening on the streets of San Francisco.”

Last year, the mayor&#8217;s position budged further <a href="https://www.kqed.org/news/11950520/compassion-is-killing-people-london-breed-pushes-for-more-arrests-to-tackle-sfs-drug-crisis">during a press conference at United Nations Plaza</a>, when she said, in response to a question about the drug crisis, that &#8220;compassion is killing people. And we have to push forth some tough love to change what’s happening on the streets of San Francisco.”

More recently, the mayor has placed on the ballot a <a href="https://sfstandard.com/2023/12/18/san-francisco-drugs-welfare-poll-march-2024-election/">controversial ballot measure, Prop. F,</a> which would mandate that some suspected illicit drug users undergo screening and treatment to continue receiving welfare benefits.

Controversial plan to screen welfare recipients for drugs is backed by voters, poll says

More recently, the mayor has placed on the ballot a <a href="https://sfstandard.com/2023/12/18/san-francisco-drugs-welfare-poll-march-2024-election/">controversial ballot measure, Prop. F,</a> which would mandate that some suspected illicit drug users undergo screening and treatment to continue receiving welfare benefits.

Last week, <a href="https://sfstandard.com/newsletters/preview/?title=Power%20Play">a union attorney</a> challenged the legality of the ballot measure in a letter addressed to the city. In response, the mayor on Monday said that &#8220;people&#8217;s lives should not be politicized.&#8221;

Last week, <a href="https://sfstandard.com/newsletters/preview/?title=Power%20Play">a union attorney</a> challenged the legality of the ballot measure in a letter addressed to the city. In response, the mayor on Monday said that "people's lives should not be politicized."

Last week, <a href="https://sfstandard.com/newsletters/preview/?title=Power%20Play">a union attorney</a> challenged the legality of the ballot measure in a letter addressed to the city. In response, the mayor on Monday said that &#8220;people&#8217;s lives should not be politicized.&#8221;

The pronouncements are a far cry from Breed&#8217;s homelessness strategy back when she was running for mayor in 2018. <a href="https://londonbreed.medium.com/a-bold-approach-to-homelessness-a42121dc586c">In a Medium post published at the time</a>, Breed called for safe injection sites and said she had visited such facilities abroad.

The pronouncements are a far cry from Breed's homelessness strategy back when she was running for mayor in 2018. <a href="https://londonbreed.medium.com/a-bold-approach-to-homelessness-a42121dc586c">In a Medium post published at the time</a>, Breed called for safe injection sites and said she had visited such facilities abroad.

The pronouncements are a far cry from Breed&#8217;s homelessness strategy back when she was running for mayor in 2018. <a href="https://londonbreed.medium.com/a-bold-approach-to-homelessness-a42121dc586c">In a Medium post published at the time</a>, Breed called for safe injection sites and said she had visited such facilities abroad.

Earlier this month, Breed also came out in support of what would have been the first long-term, city-funded <a href="https://sfstandard.com/2024/02/08/san-francisco-chinatown-sober-living-facility-london-breed/">sober living home in Chinatown</a>. <a href="https://sfstandard.com/2024/02/20/san-francisco-mayor-change-chinatown-sober-housing/">Opposition to its location</a>, however, has forced Breed to look elsewhere to open the facility.

Breed confronted over planned Chinatown sober living facility  

Mayor drops Chinatown ‘sober housing’ plan amid pushback

Earlier this month, Breed also came out in support of what would have been the first long-term, city-funded <a href="https://sfstandard.com/2024/02/08/san-francisco-chinatown-sober-living-facility-london-breed/">sober living home in Chinatown</a>. <a href="https://sfstandard.com/2024/02/20/san-francisco-mayor-change-chinatown-sober-housing/">Opposition to its location</a>, however, has forced Breed to look elsewhere to open the facility.

Breed blames harm reduction strategy for surging drug overdose deaths

Mike Stobbe

Smoking has surpassed injecting as the most common way of taking drugs in U.S. overdose deaths, a new government study suggests.

Smoking has surpassed injecting as the most common way of taking drugs in U.S. overdose deaths, a new government study suggests.

The Centers for Disease Control and Prevention called its study published Thursday the largest to look at how Americans took the drugs that killed them.

The Centers for Disease Control and Prevention called its study published Thursday the largest to look at how Americans took the drugs that killed them.

CDC officials decided to study the topic after seeing reports from California suggesting that smoking fentanyl was becoming more common than injecting it. Potent, illicit versions of the painkiller are involved in more U.S. overdose deaths than any other drug.

CDC officials decided to study the topic after seeing reports from California suggesting that smoking fentanyl was becoming more common than injecting it. Potent, illicit versions of the painkiller are involved in more U.S. overdose deaths than any other drug.

Some early research has suggested that smoking fentanyl is somewhat less deadly than injecting it, and any reduction in injection-related overdose deaths is a positive, said the study’s lead author, Lauren Tanz.

Some early research has suggested that smoking fentanyl is somewhat less deadly than injecting it, and any reduction in injection-related overdose deaths is a positive, said the study’s lead author, Lauren Tanz.

But “both injection and smoking carry a substantial overdose risk,” and it’s not yet clear if a shift toward smoking fentanyl reduces U.S. overdose deaths, said Tanz, a CDC scientist who studies overdoses.

But “both injection and smoking carry a substantial overdose risk,” and it’s not yet clear if a shift toward smoking fentanyl reduces U.S. overdose deaths, said Tanz, a CDC scientist who studies overdoses.

A person is loaded into an ambulance near UN Plaza in San Francisco on Wednesday, January 24, 2024. Cafe owner Penglorn Sam is happy with the addition of the skatepark to the plaza, which had been a magnet for drugs and illicit activity.

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2024/01/20240124_unplazaskateparksuccess_-0129.jpg?w=2357" alt="Paramedics load a person on a stretcher into an ambulance labeled &quot;San Francisco Fire Department.&quot;" class="wp-image-242920"/><figcaption class="wp-element-caption">A person is loaded into an ambulance near U.N. Plaza, the longtime epicenter of San Francisco’s drug and homelessness crises, in January.</figcaption></figure>

Illicit fentanyl is an infamously powerful drug that, in powder form, increasingly has been cut into heroin or other drugs. In recent years, it&#8217;s been a primary driver of the U.S. overdose epidemic. Drug overdose deaths in the U.S. went up slightly in 2022 after&nbsp;<a href="https://apnews.com/article/overdose-deaths-opioids-fentanyl-8cb302a70ddbb6a435f9e8fbb19f153b" target="_blank" rel="noreferrer noopener">two big leaps during the pandemic</a>, and provisional data for the first nine months of 2023 suggests it inched up last year.

Illicit fentanyl is an infamously powerful drug that, in powder form, increasingly has been cut into heroin or other drugs. In recent years, it's been a primary driver of the U.S. overdose epidemic. Drug overdose deaths in the U.S. went up slightly in 2022 after&nbsp;<a href="https://apnews.com/article/overdose-deaths-opioids-fentanyl-8cb302a70ddbb6a435f9e8fbb19f153b" target="_blank" rel="noreferrer noopener">two big leaps during the pandemic</a>, and provisional data for the first nine months of 2023 suggests it inched up last year.

Illicit fentanyl is an infamously powerful drug that, in powder form, increasingly has been cut into heroin or other drugs. In recent years, it&#8217;s been a primary driver of the U.S. overdose epidemic. Drug overdose deaths in the U.S. went up slightly in 2022 after&nbsp;<a href="https://apnews.com/article/overdose-deaths-opioids-fentanyl-8cb302a70ddbb6a435f9e8fbb19f153b" target="_blank" rel="noreferrer noopener">two big leaps during the pandemic</a>, and provisional data for the first nine months of 2023 suggests it inched up last year.

In San Francisco, at least 813 people died from overdoses last year—the worst year on record—according to revised data <a href="https://www.sf.gov/sites/default/files/2024-02/2024%2002_OCME%20Overdose%20Report.pdf" target="_blank" rel="noreferrer noopener">released by the city</a> on Wednesday. In January, the city recorded 66 overdose deaths, the majority of which were attributed to fentanyl, according to preliminary data.

In San Francisco, at least 813 people died from overdoses last year—the worst year on record—according to revised data <a href="https://www.sf.gov/sites/default/files/2024-02/2024%2002_OCME%20Overdose%20Report.pdf" target="_blank" rel="noreferrer noopener">released by the city</a> on Wednesday. In January, the city recorded 66 overdose deaths, the majority of which were attributed to fentanyl, according to preliminary data.

For years, fentanyl has mainly been injected, but drug users have increasingly smoked it. People put the powder on tin foil or in a glass pipe, heated from below, and inhale the vapor, explained Alex Kral, a RTI International researcher who studies drug users in San Francisco.

For years, fentanyl has mainly been injected, but drug users have increasingly smoked it. People put the powder on tin foil or in a glass pipe, heated from below, and inhale the vapor, explained Alex Kral, a RTI International researcher who studies drug users in San Francisco.

Smoked fentanyl is not as concentrated as fentanyl in a syringe, but some drug-takers see upsides to smoking, Kral said. Among them: People who inject often deal with pus-filled abscesses on their skin and risk infections with hepatitis and other diseases.

Smoked fentanyl is not as concentrated as fentanyl in a syringe, but some drug-takers see upsides to smoking, Kral said. Among them: People who inject often deal with pus-filled abscesses on their skin and risk infections with hepatitis and other diseases.

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“One person showed me his arms and said, ‘Hey, look at my arm! It looks beautiful! I can now wear T-shirts, and I can get a job because I don&#8217;t have these track marks,'&#8221; Kral said.

“One person showed me his arms and said, ‘Hey, look at my arm! It looks beautiful! I can now wear T-shirts, and I can get a job because I don't have these track marks,'" Kral said.

“One person showed me his arms and said, ‘Hey, look at my arm! It looks beautiful! I can now wear T-shirts, and I can get a job because I don&#8217;t have these track marks,'&#8221; Kral said.

CDC investigators studied the trend by using a national database built from death certificates, toxicology reports and reports from coroners and medical examiners.

CDC investigators studied the trend by using a national database built from death certificates, toxicology reports and reports from coroners and medical examiners.

They were able to get suitable data from the District of Columbia and 27 states for the years 2020 to 2022. From those places, they got information on how drugs were taken in about 71,000 of the more than 311,000 total U.S. overdose deaths over those three years—or about 23%.

They were able to get suitable data from the District of Columbia and 27 states for the years 2020 to 2022. From those places, they got information on how drugs were taken in about 71,000 of the more than 311,000 total U.S. overdose deaths over those three years—or about 23%.

The researchers found that between early 2020 and late 2022, the percentage of overdose deaths with evidence of smoking rose 74%, while the percentage of deaths with evidence of injection fell 29%. The number and percentage of deaths with evidence of snorting also increased, though not as dramatically as smoking-related deaths, the study found.

The researchers found that between early 2020 and late 2022, the percentage of overdose deaths with evidence of smoking rose 74%, while the percentage of deaths with evidence of injection fell 29%. The number and percentage of deaths with evidence of snorting also increased, though not as dramatically as smoking-related deaths, the study found.

People congregate near the intersection of Seventh and Market in Downtown San Francisco on Oct. 16, 2023. The intersection is known for its open-air drug trade, where fentanyl and other narcotics are bought and sold.

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/11/PHOTO01_7thMarketDrugs.jpg?w=2500" alt="People congregate near the intersection of 7th and Market in downtown San Francisco on Oct. 16, 2023." class="wp-image-216707"/><figcaption class="wp-element-caption">People congregate near the intersection of Seventh and Market in downtown San Francisco in October 2023. The intersection is known for its open-air drug trade, where fentanyl and other narcotics are bought and sold.</figcaption></figure>

It’s complicated to map out exact percentages of deaths that occurred after smoking, injecting, snorting or swallowing drugs, experts say. In some cases, a person may have used multiple drugs, taken different ways. In other cases, no drug-taking method was identified.

It’s complicated to map out exact percentages of deaths that occurred after smoking, injecting, snorting or swallowing drugs, experts say. In some cases, a person may have used multiple drugs, taken different ways. In other cases, no drug-taking method was identified.

The study found that in late 2022, of the deaths for which a method was identified, 23% of the deaths occurred after smoking, 16% after injections, 16% after snorting, and 14.5% after swallowing.

The study found that in late 2022, of the deaths for which a method was identified, 23% of the deaths occurred after smoking, 16% after injections, 16% after snorting, and 14.5% after swallowing.

Tanz said she feels the data is nationally representative. Data came from states from every region of the country, and all showed increases in smoking and decreases in injecting. Smoking was the most common route in the West and Midwest, and roughly tied with injecting in the Northeast and South, the report said.

Tanz said she feels the data is nationally representative. Data came from states from every region of the country, and all showed increases in smoking and decreases in injecting. Smoking was the most common route in the West and Midwest, and roughly tied with injecting in the Northeast and South, the report said.

Kral described the study as “mostly good” but said it has limitations.

Kral described the study as “mostly good” but said it has limitations.

It can be difficult to ascertain the how and why of an overdose death, especially if no witness was present. Injections might be more commonly reported because of injection marks on the body; to detect smoking, &#8220;they likely would need to find a pipe or foil on the scene and decide whether to write that down,” he said.

It can be difficult to ascertain the how and why of an overdose death, especially if no witness was present. Injections might be more commonly reported because of injection marks on the body; to detect smoking, "they likely would need to find a pipe or foil on the scene and decide whether to write that down,” he said.

It can be difficult to ascertain the how and why of an overdose death, especially if no witness was present. Injections might be more commonly reported because of injection marks on the body; to detect smoking, &#8220;they likely would need to find a pipe or foil on the scene and decide whether to write that down,” he said.

Kral also noted that many people who smoke fentanyl use a straw to inhale vapors from the burning powder, and it&#8217;s possible investigators saw a straw and assumed it was snorted.

Kral also noted that many people who smoke fentanyl use a straw to inhale vapors from the burning powder, and it's possible investigators saw a straw and assumed it was snorted.

Kral also noted that many people who smoke fentanyl use a straw to inhale vapors from the burning powder, and it&#8217;s possible investigators saw a straw and assumed it was snorted.

More people die after smoking drugs than injecting them, US study finds

The California Department of Public Health and multiple Bay Area counties are seeking to educate the public about the fentanyl crisis currently hitting the state and nation. The below explainer provides answers to some basic questions about the topic, which cost nearly 6,000 lives in California in 2021.

The California Department of Public Health and multiple Bay Area counties are seeking to educate the public about the fentanyl crisis currently hitting the state and nation. The below explainer provides answers to some basic questions about the topic, which cost nearly 6,000 lives in California in 2021.

<h2 class="wp-block-heading" id="h-what-is-fentanyl">What Is Fentanyl?</h2>

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<h2 class="wp-block-heading" id="h-what-is-fentanyl">What Is Fentanyl?</h2>

Fentanyl is a powerful synthetic opioid. It is 50-100 times more potent than morphine and can be fatal in amounts as small as a few grains of sand, according to the National Institute on Drug Abuse (NIDA).

Fentanyl is a powerful synthetic opioid. It is 50-100 times more potent than morphine and can be fatal in amounts as small as a few grains of sand, according to the National Institute on Drug Abuse (NIDA).

Opioids are a class of drugs that include forms that are non-synthetic, meaning they are naturally occurring, and synthetic, which means they are manufactured chemicals that act in the same way, according to Johns Hopkins Hospital.

Opioids are a class of drugs that include forms that are non-synthetic, meaning they are naturally occurring, and synthetic, which means they are manufactured chemicals that act in the same way, according to Johns Hopkins Hospital.

Examples of non-synthetic opioids, which are derived from the poppy plant, include heroin and morphine, according to the Mayo Clinic. Examples of synthetic opioids include fentanyl, OxyContin and Vicodin.

Examples of non-synthetic opioids, which are derived from the poppy plant, include heroin and morphine, according to the Mayo Clinic. Examples of synthetic opioids include fentanyl, OxyContin and Vicodin.

READ MORE: <a href="https://sfstandard.com/2023/08/03/this-san-francisco-block-had-the-most-overdose-calls-five-years-in-a-row/">This San Francisco Block Had the Most Drug Overdose Calls 5 Years in a Row</a>

This San Francisco block had the most drug overdose calls 5 years in a row

READ MORE: <a href="https://sfstandard.com/2023/08/03/this-san-francisco-block-had-the-most-overdose-calls-five-years-in-a-row/">This San Francisco Block Had the Most Drug Overdose Calls 5 Years in a Row</a>

Opioids are used to treat severe pain, by prescription. They block pain receptors in the brain. There is no medical use for heroin, which is an illegal narcotic. Other opioids, both synthetic and non-synthetic, are approved for use by the Food and Drug Administration to treat severe, acute pain, often following surgery, during cancer treatment or during end-of-life care, according to NIDA.

Opioids are used to treat severe pain, by prescription. They block pain receptors in the brain. There is no medical use for heroin, which is an illegal narcotic. Other opioids, both synthetic and non-synthetic, are approved for use by the Food and Drug Administration to treat severe, acute pain, often following surgery, during cancer treatment or during end-of-life care, according to NIDA.

Fentanyl is prescribed in the U.S. under brand names such as Duragesic and Actiq, according to the FDA.

Fentanyl is prescribed in the U.S. under brand names such as Duragesic and Actiq, according to the FDA.

Illicitly manufactured fentanyl can come in both liquid and powder form, according to the U.S. Drug Enforcement Administration.

Illicitly manufactured fentanyl can come in both liquid and powder form, according to the U.S. Drug Enforcement Administration.

<h2 class="wp-block-heading" id="h-what-is-rainbow-fentanyl">What Is &#8216;Rainbow Fentanyl&#8217;?</h2>

<h2 class="wp-block-heading" id="h-what-is-rainbow-fentanyl">What Is 'Rainbow Fentanyl'?</h2>

<h2 class="wp-block-heading" id="h-what-is-rainbow-fentanyl">What Is &#8216;Rainbow Fentanyl&#8217;?</h2>

Rainbow fentanyl is just dyed fentanyl.

It is increasingly found in pill or powder-brick form to which colorful dye has been added. The DEA believes the trend is an attempt by cartels to market the drug to children.

It is increasingly found in pill or powder-brick form to which colorful dye has been added. The DEA believes the trend is an attempt by cartels to market the drug to children.

On July 1, 2023, plainclothes officers from the San Francisco Police Department, Tenderloin Station conducted a narcotics surveillance operation on the 1100 block of Market St., which resulted in the arrest of 3 suspects. Officers seized 2,149 grams of fentanyl, 115.6 grams of meth, and $295 in alleged drug money.


<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/07/Untitled-1.jpg?w=767" alt="" class="wp-image-178553"/><figcaption class="wp-element-caption">On July 1, plainclothes officers from the San Francisco Police Department&#8217;s Tenderloin Station conducted a narcotics surveillance operation on Market Street, leading officers to seize 2,149 grams of fentanyl, 115.6 grams of meth and $295 in alleged drug money.</figcaption></figure>

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/07/Untitled-1.jpg?w=767" alt="" class="wp-image-178553"/><figcaption class="wp-element-caption">On July 1, plainclothes officers from the San Francisco Police Department's Tenderloin Station conducted a narcotics surveillance operation on Market Street, leading officers to seize 2,149 grams of fentanyl, 115.6 grams of meth and $295 in alleged drug money.</figcaption></figure>

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/07/Untitled-1.jpg?w=767" alt="" class="wp-image-178553"/><figcaption class="wp-element-caption">On July 1, plainclothes officers from the San Francisco Police Department&#8217;s Tenderloin Station conducted a narcotics surveillance operation on Market Street, leading officers to seize 2,149 grams of fentanyl, 115.6 grams of meth and $295 in alleged drug money.</figcaption></figure>

<h2 class="wp-block-heading" id="h-what-is-the-fentanyl-crisis">What Is the Fentanyl Crisis?</h2>

Cities and counties across the country are experiencing steady increases in fatal overdoses attributed to fentanyl, especially among young people, according to the U.S. Department of Health and Human Services and California Department of Public Health (CDPH).

Cities and counties across the country are experiencing steady increases in fatal overdoses attributed to fentanyl, especially among young people, according to the U.S. Department of Health and Human Services and California Department of Public Health (CDPH).

The federal government declared the crisis a public health emergency in 2017.

The federal government declared the crisis a public health emergency in 2017.

In the Bay Area, San Francisco reported a slight decline of fatal opioid overdoses in 2021 from the previous year, but still had far more deaths per 100,000 residents than any other Bay Area county, according to data from the the state public health department&#8217;s overdose dashboard.

In the Bay Area, San Francisco reported a slight decline of fatal opioid overdoses in 2021 from the previous year, but still had far more deaths per 100,000 residents than any other Bay Area county, according to data from the the state public health department's overdose dashboard.

In the Bay Area, San Francisco reported a slight decline of fatal opioid overdoses in 2021 from the previous year, but still had far more deaths per 100,000 residents than any other Bay Area county, according to data from the the state public health department&#8217;s overdose dashboard.

Age-adjusted rates are used in health data to equalize the age distribution in different populations to compare against a single standard. The health department uses the United States 2000 population figures. The adjusted number represents the death rate per 100,000 people in a population with an equalized age distribution.

Age-adjusted rates are used in health data to equalize the age distribution in different populations to compare against a single standard. The health department uses the United States 2000 population figures. The adjusted number represents the death rate per 100,000 people in a population with an equalized age distribution.

In 2021, the last full year for which data is available, San Francisco led all Bay Area counties in both total fatal overdoses and in the death rate using a standard, age-adjusted population, per 100,000 people. The city recorded 435 deaths from all opioid overdoses, with an age-adjusted death rate of 42 per 100,000 people.

In 2021, the last full year for which data is available, San Francisco led all Bay Area counties in both total fatal overdoses and in the death rate using a standard, age-adjusted population, per 100,000 people. The city recorded 435 deaths from all opioid overdoses, with an age-adjusted death rate of 42 per 100,000 people.

Sonoma County was second in the standardized death rate, at 25.6 per 100,000 people. The county recorded 122 total fatal opioid overdoses in 2021.

Sonoma County was second in the standardized death rate, at 25.6 per 100,000 people. The county recorded 122 total fatal opioid overdoses in 2021.

Third was San Joaquin County, with 143 total fatal overdoses, or an age-adjusted rate of 18.7 deaths per 100,000 people.

Third was San Joaquin County, with 143 total fatal overdoses, or an age-adjusted rate of 18.7 deaths per 100,000 people.

On the other end of the spectrum, with 27 total overdoses in 2021, Monterey County had the lowest death rate, at an age-adjusted rate of 5.6 deaths per 100,000 people. Santa Clara County had a rate of 7.7 deaths, with a total of 154 fatal overdoses in 2021.

On the other end of the spectrum, with 27 total overdoses in 2021, Monterey County had the lowest death rate, at an age-adjusted rate of 5.6 deaths per 100,000 people. Santa Clara County had a rate of 7.7 deaths, with a total of 154 fatal overdoses in 2021.

Overdoses are being driven both by people using fentanyl intentionally and people using other drugs that have been either combined with fentanyl or are counterfeit pills that include fentanyl. Counterfeit pills can appear to mimic well-known prescription drugs like Adderall and Valium, according to the DEA.

Overdoses are being driven both by people using fentanyl intentionally and people using other drugs that have been either combined with fentanyl or are counterfeit pills that include fentanyl. Counterfeit pills can appear to mimic well-known prescription drugs like Adderall and Valium, according to the DEA.

Epidemiologists have defined three prior waves of addiction that impacted the nation, according to the San Mateo County Health Department. The first was in 1996, as synthetic opioids became prevalent and over-prescriptions increased.

Epidemiologists have defined three prior waves of addiction that impacted the nation, according to the San Mateo County Health Department. The first was in 1996, as synthetic opioids became prevalent and over-prescriptions increased.

In 2010, users who had become addicted turned increasingly to heroin, fueling a second wave of addiction. The fentanyl crisis escalated in 2013 and 2014 as the drug became increasingly overprescribed and smuggled in from overseas.

In 2010, users who had become addicted turned increasingly to heroin, fueling a second wave of addiction. The fentanyl crisis escalated in 2013 and 2014 as the drug became increasingly overprescribed and smuggled in from overseas.

There is now a fourth crisis being defined, as fentanyl is increasingly being combined with stimulants and other drugs, including xylazine, a large-animal tranquilizer that is not approved for use in humans. The DEA and state health department both issued recent public health alerts warning of the use of xylazine.

There is now a fourth crisis being defined, as fentanyl is increasingly being combined with stimulants and other drugs, including xylazine, a large-animal tranquilizer that is not approved for use in humans. The DEA and state health department both issued recent public health alerts warning of the use of xylazine.

&#8220;Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,&#8221; DEA Administrator Anne Milgram said in a statement.

"Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier," DEA Administrator Anne Milgram said in a statement.

&#8220;Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,&#8221; DEA Administrator Anne Milgram said in a statement.

A needle on O'Farrell Street in the Tenderloin District of San Francisco, on Monday, July 4, 2022. 

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/06/1.jpg?w=1551" alt="" class="wp-image-176011"/><figcaption class="wp-element-caption">A needle lies on the ground on O&#8217;Farrell Street in the Tenderloin District of San Francisco on July 4, 2022. </figcaption></figure>

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/06/1.jpg?w=1551" alt="" class="wp-image-176011"/><figcaption class="wp-element-caption">A needle lies on the ground on O'Farrell Street in the Tenderloin District of San Francisco on July 4, 2022. </figcaption></figure>

<figure class="wp-block-image size-large"><img src="https://content.sfstandard.com/wp-content/uploads/2023/06/1.jpg?w=1551" alt="" class="wp-image-176011"/><figcaption class="wp-element-caption">A needle lies on the ground on O&#8217;Farrell Street in the Tenderloin District of San Francisco on July 4, 2022. </figcaption></figure>

<h2 class="wp-block-heading" id="h-what-caused-the-crisis">What Caused the Crisis?</h2>

In 1996, pain was redefined in the medical community as a fifth vital sign. This ushered in a huge change in the health care industry. Pharmaceutical companies became heavily invested in what was a growing sector of the health care system: pain management, including chronic pain management. That same year, OxyContin was introduced and marketed as a way to control chronic pain.

In 1996, pain was redefined in the medical community as a fifth vital sign. This ushered in a huge change in the health care industry. Pharmaceutical companies became heavily invested in what was a growing sector of the health care system: pain management, including chronic pain management. That same year, OxyContin was introduced and marketed as a way to control chronic pain.

Writing for the peer-reviewed medical journal Clinical Therapeutics in 2013, authors Dr. Natalia E. Morone and Dr. Debra K. Weiner said more basic pain-management education was needed by prescribing doctors.

Writing for the peer-reviewed medical journal Clinical Therapeutics in 2013, authors Dr. Natalia E. Morone and Dr. Debra K. Weiner said more basic pain-management education was needed by prescribing doctors.

&#8220;In clinical practice pain as the 5th vital sign has proven to be more complex to assess, evaluate, and manage than originally anticipated. It has also had some serious consequences which were never intended,” they said. “Associated with the national push to adequately manage patients in pain has been a rise in prescription opioids as well as a rise in opioid related death. Guided by pain as the 5th vital sign mandates, patients report pain and expect their providers to respond. Many clinicians do not know what the appropriate response is because they lack adequate education in the approach, examination, and management of patients in pain.&#8221;

"In clinical practice pain as the 5th vital sign has proven to be more complex to assess, evaluate, and manage than originally anticipated. It has also had some serious consequences which were never intended,” they said. “Associated with the national push to adequately manage patients in pain has been a rise in prescription opioids as well as a rise in opioid related death. Guided by pain as the 5th vital sign mandates, patients report pain and expect their providers to respond. Many clinicians do not know what the appropriate response is because they lack adequate education in the approach, examination, and management of patients in pain."

&#8220;In clinical practice pain as the 5th vital sign has proven to be more complex to assess, evaluate, and manage than originally anticipated. It has also had some serious consequences which were never intended,” they said. “Associated with the national push to adequately manage patients in pain has been a rise in prescription opioids as well as a rise in opioid related death. Guided by pain as the 5th vital sign mandates, patients report pain and expect their providers to respond. Many clinicians do not know what the appropriate response is because they lack adequate education in the approach, examination, and management of patients in pain.&#8221;

Pain management for even basic medical procedures was creating more and more addicts, who turned to other means to satisfy their addiction after their medical treatment ran its course. Fentanyl is the latest form of opioid being abused, but it is much more potent and deadly than other forms of the drug, bringing renewed urgency to the overall problem of opioid addiction.&nbsp;

Pain management for even basic medical procedures was creating more and more addicts, who turned to other means to satisfy their addiction after their medical treatment ran its course. Fentanyl is the latest form of opioid being abused, but it is much more potent and deadly than other forms of the drug, bringing renewed urgency to the overall problem of opioid addiction.&nbsp;

<h2 class="wp-block-heading" id="h-where-does-fentanyl-come-from">Where Does Fentanyl Come From?</h2>

Outside of abuse of prescription fentanyl, according to the DEA, illicit fentanyl mainly comes from China. Additionally, base chemical ingredients are shipped to Mexico and manufactured there by drug cartels, which then smuggle the drug into the United States, often compressed into counterfeit pills that mimic more well-known brands.

Outside of abuse of prescription fentanyl, according to the DEA, illicit fentanyl mainly comes from China. Additionally, base chemical ingredients are shipped to Mexico and manufactured there by drug cartels, which then smuggle the drug into the United States, often compressed into counterfeit pills that mimic more well-known brands.

<h2 class="wp-block-heading" id="h-who-is-dying-from-fentanyl">Who Is Dying From Fentanyl?</h2>

Breed blames harm reduction strategy for surging drug overdose deaths

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Fentanyl explainer: A breakdown of the drug crisis in the Bay Area

San Jose man accused of poisoning his mother with fentanyl

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Search Results for: fentanyl

Breed blames harm reduction strategy for surging drug overdose deaths

More people die after smoking drugs than injecting them, US study finds

Fentanyl explainer: A breakdown of the drug crisis in the Bay Area

San Jose man accused of poisoning his mother with fentanyl

Drug more powerful than fentanyl found in San Francisco