‘Fentanyl is where the devil dwells’: notes from 16th and Mission as overdose deaths spike

Patty, who sells clothing at the corner of 16th and Mission streets, and is known in the community as someone who will give away a jacket to a person who is cold or a pair of shoes to someone in need, says she has personally known 10 people who have died from an overdose in the last year. “A couple of them were really close and important to me,” she says.  

One asked her to shoot him up. Instead, she encouraged him not to do it. I told him, “he needs to find out how much to shoot up before he did it.”

That night, he died of an overdose at the Kailash Hotel at Julian and 16th streets, she says.  

Now, she tries to warn people by telling them, “if it’s too white, it’s not good; you have to get rock. If you get powder, you don’t know what it is.” 

Such is the advice at 16th and Mission, where Patty and others talked recently about the increase in drug overdoses. Just how many have happened at the BART Plaza is unclear but, since 2013, the number of overdose deaths in the Mission has increased sharply, skyrocketing more than 200 percent between 2019 and 2020 to 94 overdose deaths, according to data from the San Francisco Medical Examiner’s Office.

Just three years ago, only 10 people in the Mission died of an overdose. 

Citywide in 2020, 710 people died from an overdose. So far in 2021, 344 people have died from an overdose in San Francisco.

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During the pandemic, (between March 2020 until June 2021), 561 people have died from Covid in San Francisco. By contrast, in the same time frame, 973 people have died from an overdose. Of those deaths, 762 were from fentanyl.

Fentanyl has “changed the landscape” completely, said Laura Guzman, the senior director of capacity building and community mobilization at the National Harm Reduction Coalition. “It is much stronger and less expensive than other drugs, and has led to an “amount of overdoses which is unheard of,” she said.

Guzman said homeless residents often use drugs to cope with trauma from not having access to bathrooms and a safe place to sleep. Being in the midst of a pandemic only exacerbated existing traumas for many.

That was the case for Anthony, a 35-year old who hangs out at the 16th Street Plaza. He said it was living on the streets that made him start using in the first place. He was scared of being victimized during the night, and started taking crystal meth to keep him awake and ready to protect himself. 

In the mornings, he would sleep on BART. Now, after four overdoses, and a few months of being clean, he is back to using crystal meth and fentanyl. It helps him manage his pain from epididymitis, a condition in which the tube at the back of the testicles becomes inflamed. But, he add, there is also the pain that is “being felt in the world right now.” That, he says, is hard for people like him.

Anthony said overdose deaths happen either because someone is new to drugs and doesn’t know how much to take, or has been using it so long that they are trying to catch that old high.

Kristen Marshall, the associate director of San Francisco Programs for the DOPE Project, was hesitant to put all the blame on fentanyl. “When we focus on the drug, we lose track of the people, and we lose track of the root causes,” she said.

“People experiencing homelessness, people living in poverty, immigrant communities” are dying at the highest rate, “because they’re cut off from the majority of the … supportive resources in the city, and specifically the housing,” said Marshall. 

And Guzman, who knows the Mission well after working for 16 years as the director of the Mission Neighborhood Health Center, agreed.

“Folks don’t have IDs, folks don’t have housing, folks don’t have employment,” she said. And, for undocumented people in the Mission who are homeless and drug-addicted, not having an ID means not being able to receive a prescription for buprenorphine, a drug used to treat addiction to opioids.

For people dealing with addiction in San Francisco, there are public services such as short-term residential treatment programs, and withdrawal management programs that provide a space for safe detoxification. 

The website FindTreatmentSF.org, launched in 2019, allows the public and health care providers to see where residential substance use treatment beds are available citywide. The site was down for a couple of weeks this month, but is now up and running again. 

According to the site, beds are available. Yet admission to programs that treat substance use disorders has gone down since 2015, according to a report published by the Department of Public Health.

And Brian Edwards, a volunteer human rights organizer at the Coalition on Homelessness, said the issue is not bed availability, but outreach. “First of all, people don’t know the drop-ins are still open,” since the pandemic. 

“And there really isn’t anyone that’s going out and having conversations with folks, you know, in the street saying: Hey do you want treatment?” 

The city is about to debut the Street Overdose Response Team, which would connect to the 911 dispatch system, but Edwards is skeptical. 

When drug users get in a mind-frame that they are ready to make changes, there are often so many hoops to jump through to get the treatment that they say: “No, I’m probably just going to get high,” Edwards said.

A 42-year-old man who asked to be called JT “gifted” crack to a friend of his while sitting in a plastic chair at 16th Street near Mission on a Friday afternoon. One of his arms was broken (from punching someone, he says), and he was using the other to eat fried chicken from KFC that his friend had just brought over.

JT says he doesn’t want anyone to die, especially in his neighborhood.  “Because that brings the police,” he explains.

Just around the corner, the DOPE Project gave away harm reduction supplies including clean needles, Naloxone, or Narcan, which prevents opioid and fentanyl overdose, and hand sanitizer. The Dope project and the San Francisco AIDS Foundation estimate that in the past six months (from January to July),  4,235 potential overdose deaths in San Francisco were prevented by the Dope project and its partners. 

Every Friday for the past 30 years, there has been a syringe exchange and harm reduction supplies are given away at 16th and Mission from 7 to 9 p.m. On Tuesdays, nearby in Weiss Alley, supplies are also given away from 6 to 8 p.m. 

Laura Guzman said the Mission needs more educational materials created in Spanish about the safe use of drugs. “We need to focus more on the racial equity and community education piece,” she said.

Nearby, Pineapples, 38, listened to music and sat next to the toys and clothes she was selling on the street.

She knows all too well what it is like to lose someone to an overdose. Her ex-boyfriend, who was also her best friend, she says, died after taking drugs that, unbeknownst to him, contained fentanyl.

“We need to get this shit off the streets. Period. It’s the worst of the worst,” she says. “We are in a devil’s lair right now; fentanyl is where the devil dwells.”