View the San Francisco for Sunday, July 21, 2024
A study published last year found the share of overdose deaths nationwide in which fentanyl and stimulants were detected rose from 0.6% in 2010 to San Francisco health officials continue to grapple with an opioid crisis amid rising national concern about overdoses linked to a combination of fentanyl and stimulants.
Multiple published studies show that stimulants like cocaine and methamphetamine are increasingly being detected alongside opioids in fatal drug overdoses. “Stimulants make sense in the end cycle of the opioid problem,” said Dr. Daniel Ciccarone, an addiction-medicine professor at UCSF. “We have to remember that for the past 20 years, we’ve been in this three-wave problem with overdoses.” Ciccarone and his peers characterize the opioid epidemic’s “waves” as follows: The first began in the early 2000s with prescription opioids, followed by heroin during the second, in the 2010s. Around 2015, the third wave began with the rise of fentanyl, and the drug reached the West Coast in 2018. Public-health experts call this new cycle the crisis’ “fourth wave,” with stimulants increasingly used in tandem with fentanyl. A Millennium Health report published earlier this year found that 60% of fentanyl-positive urine samples collected across the country in 2023 also contained methamphetamine,. A study published in the journal Addiction last year found the share of overdose deaths nationwide in which fentanyl and stimulants were detected rose from 0.6% in 2010 to“Similar to national figures, most overdose deaths in San Francisco involve more than one substance,” said Dr. Hillary Kunins, the director of behavioral health services at the San Francisco Department of Public Health, told The Examiner. “What we know, and our colleagues at the Office of the Chief Medical Examiner know, is that both drugs are present in a person’s body.” The San Francisco Office of the Chief Medical Examiner did not respond to The Examiner’s request for comment at the time of publication. “What is not known is the extent to which that is from the mixing of two substances — meaning the person knew they were using an opioid, fentanyl, and knew they were using a stimulant — or whether the two drugs were present in the same sample specimen,” Kunins said. “It’s very hard to separate those two facts.”, down from the same time last year but higher than that period in 2020, ’21 and ’22. Of those 374 deaths, fentanyl was detected in 268, methamphetamine was detected in 175, and cocaine in 174. Although the drug detections add up to more than the total deaths, Kunins said it was unclear which deaths had multiple substances present.Dr. Alexander Bazazi, a UCSF epidemiologist and substance-use expert who also provides treatment in The City, said it’s rare to encounter patients on fentanyl who aren’t using stimulants. He said fentanyl acts as a sedative, and many users are looking to boost their highs. “The norm for people to use fentanyl daily in San Francisco is to also use methamphetamine,” Bazazi said. “That’s the norm, not the exception.” Other stimulant users might be consuming fentanyl without intending to, the experts who spoke with The Examiner said. They said, at least in San Francisco, it’s less likely they’re unknowingly consuming drugs with fentanyl mixed in than it is that they are “The same glass pipes the meth uses and the fentanyl uses will collect a resin of both drugs,” Ciccarone said. “You can’t tell from the resin — it’s just a brown, sticky substance — whether it’s a fentanyl resin or methamphetamine resin or both.” Some users will try to prevent this type of cross-contamination by differentiating pipes with colored rubber bands, said Bazazi, who said that a harm-reduction program similar to needle exchanges would also be helpful in addressing this issue by providing clean pipes. Bazazi said his main concern about fentanyl users also using stimulants is that consumption of the latter can be a “red herring,” as fentanyl is a more common cause of fatal overdoses. “Stimulants kill people on their own in a slow process by taxing the heart, the cardiovascular system — and then people end up having a stroke or a heart attack,” he explained. “There is a shift in the field to thinking about stimulant-toxicity deaths as being more like a chronic-disease death.”“It’s very hard to find out these things from looking at bodies, which is why we have to talk to living people,” Bazazi said. Students on their first day of school at Aptos Middle School in San Francisco on Wednesday, Aug. 16, 2023. The first-of-its-kind gender-identity law California Gov. Gavin Newsom signed earlier this month brings state policy in line with San Francisco’s — and The City’s school district had previously received flak from some of the new law’s most vocal critics. Newsom signed into law on July 15 Assembly Bill 1955 — aka the SAFETY Act — which bars public-school districts from requiring staff to notify parents if their children change their preferred pronouns or gender identities. California is the first state to pass such a law. Opponents of the law argue that Newsom’s annulment of school-board policies enacted a year ago infringe on parents’ rights to their children’s personal information, while supporters of the law say it will prevent “forced outing.”students’ “intersex, nonbinary, transgender or gender-nonconforming status” if it is disclosed to them and if students haven’t provided permission to share that information.“students have a right to be addressed by a name and pronoun corresponding to their gender identity,” as well as access to the restroom, locker room or other facilities consistent with their gender identity. Students can’t change their name or gender on their official record without “written authorization of a parent/guardian having legal custody of the student” under California law.The group’s political director, Alex Nester, told The Examiner that “parents are rightly appalled by this stab in the front from Governor Newsom, who is clearly more interested in bowing to the special interest groups that line his pockets than he is in protecting California families.” At least one school district has already sued Newsom over his signing of the SAFETY Act — Chino Valley Unified in San Bernardino County, one of several districts that passed policies in 2023 requiring teachers to notify parents if their child identifies as transgender — saying the law violates parents’ constitutional rights. “California law ensures minors can’t legally change their name or gender without parental consent, and parents continue to have guaranteed and full access to their student’s educational records consistent with federal law,” Gardon said. “We’re confident the state will swiftly prevail in this case.”In a statement, he said “our teachers can now focus on teaching the critical academic skills that our students need to succeed, not on policing the gender identities of children.” Danielle King, a senior youth policy counsel at National Center for Lesbian Rights, said the law also provides resources for parents and ensures retaliation protection for teachers who refuse to forcibly “out” students. The law is critical for transgender, gender-nonconforming and nonbinary students, King said, because of the rate of suicide ideation and attempts among transgender youth. According to the Trevor Project’s 2023 national survey on LGBTQ youth aged 13-24, 56% of transgender young men, 48% of transgender young women, 48% of nonbinary young people and 44% of gender-questioning youth contemplated suicide last year. King told The Examiner that “the criticisms of the SAFETY Act are based on misinformation about the new law.” “Its main purpose is to ensure that students are treated equally and that their privacy is respected so that they can thrive in school, just as their peers,” she said.Musk “doesn’t get to dictate to the state of California … and it’s outrageous that he’s saying that he’s moving because of the enactment of that law.”Click and hold your mouse button on the page to select the area you wish to save or print. 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