ROCK MED

[Drunk Monk]

RM director Gordon made a curt announcement on sitonmyfacebook, and I responded in turn because it's just my nature to chime in on fb - besides it needed a little spin-doctoring as the thread wasn't going well. Babs called me later and we chatted about it. She was the one that opened up the Warfield to RM back in 89, and built the small venue model for RM. I did a lot of Warfield shows back then for her in the early years as I was working at AFS and the Warfield was just a colorful stroll up Market. Plus they would feed me a really nice dinner and comp me drinks after the show. I could BART in and out. PPPFY will remember that period as it was some of the haziest years of my life, and the reason why if you ask me if I've seen bands from that time, I don't always remember.

Anyways, Babs was heartbroken, but I told her not to be all 'I told ya so' as this was Gordon's first big loss, and it was really more about crap that Wes left him than Gordon's own undoing. However, it could domino as there are grumblings in all the small venues that don't legally require RM. Frankly, I'm amazed they lasted so long as RM is a luxury and as I told Wes when he broke Bab's model, and have also told Gordon, you can't treat the small venues like the big ones if you want to sustain them. Those need a personal touch.

It hit me harder the other night when I was at my mom's as the ol' brain circus kept me awake with 3 rings and counting. I dug through my old posters, checking out the Warfield ones, and had several 'woah, i don't even remember this show' mmomments. I'm thinking of posting my old posters on facebook, the glorious final run posters from 2008 - 6 in total to form the fascade above the stage in dancing skeletons - and then to write some memories. I don't know why I didn't post about that run here - maybe because I was so burnt out after it happened. Maybe it was stolen by ninjas, just like my Mr. Banks post.

Anyway, I pulled out those posters to take to the bungalow, but we'll see if I really get around to posting them on fb. I only went back to the Warfield once after it changed hands and Babs left, and that was to deliver some dinner on NYE for some vols (I was working at BGC on the other side of Market st.) I just couldn't go back to the new management, knowing what I know about how sweet it was, back in the dayz.

[Drunk Monk]

Has it really been half a decade since I posted on this thread.  Wow.  Just wow.

Rock Med has let go of all of its camping shows.  I understand why.  It's an incredible liability and it provides little income, especially when compared to other events.  Cali Roots, which I've worked for so many years, is the same weekend as BottleRock, which I only worked when it started.  CR is tiny in comparison.  Kate Wolf, a longstanding festival that i've never worked because it's too close to SNWMF, is the same weekend as Pride in SF.  Those other shows are high profile big money events.  So no more campouts with RM.

But there's more to this story for DM....http://www.brotherhoodofdoom.com/doomFor...p?tid=4951

[Drunk Monk]

I had lunch at Levi's today. I had to pick up the jump bag & banner for TCEC from the full-time supe there. They eat really well at the Levi's cafeteria. I had an excellent piece of salmon, a lovely salad of mixed greens, some corn dish that was delish, and taco fixings.  I sat a table away from John Lynch, 49ers General Manager.  I only knew this because the RM supe told me who it was and was amused because I know someone named Lynch.

[Drunk Monk]

Haight Ashbury Free Clinic, Tenderloin Health Services to Close
HealthRIGHT 360, which operates both locations, cites a drop in patients and ongoing financial struggles as the cause.

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(Photo: Christopher Michel/Flickr)



It’s been 52 years since the Haight Ashbury Free Clinic launched in an old Victorian building on the corner of Haight and Clayton streets. The year was 1967, and a massive influx of young people had descended on the neighborhood — many of them sleeping on friends’ sofas, floors, or the street. As people did drugs, had sex, and lived outdoors, there was an immediate need for health services, and when Dr. David Smith opened the doors to the clinic at 558 Clayton St. it served 400 people in its first week.  
But this month its tenure as a fully-staffed, drop-in clinic for the neighborhood came to an end. In early July its medical team packed up their supplies and moved to HealthRIGHT 360’s new location on Van Ness Avenue and Mission Streets. 
Across town, another clinic is facing the same fate. Tenderloin Health Services, located on the top floor of the six-story social services provider Glide building in the Tenderloin, will close in October. 

The decision to shut two long-standing clinics that primarily serve unhoused and low-income populations didn’t come easily to the HealthRIGHT 360team. Lauren Kahn, managing director of policy and communications at the organization, tells SF Weekly that the organization “never make any decisions that don’t align with our values. But we have to keep the doors open and the lights on, and make decisions that are financially sound.”
Finances are at the heart of both closures, though the story goes deeper than that. In the case of Tenderloin Health Services, a steadily-reducing population of patients means that qualifying for funding has become more challenging.  
“There’s a lot of ways that the government supports and props up safety-net health centers like ours, but you have to operate with a certain number of patients to qualify,” Kahn explains. “You can’t always make everything work.”
Demand has dropped. The number of patients currently receiving care has dropped from a high of 4,000 several years ago, to a current average of around 1,500. 
Kahn has a few theories why. 
“There is competition for high-quality healthcare for low-income people in the Tenderloin. There is a bunch of clinics, and our census has gone down,” she says.
The clinic has also struggled to stay fully staffed. “There’s a real shortage of healthcare providers everywhere in California, and that extends to S.F. We were having trouble making sure we had enough nurse practitioners and physicians.” 
Most of the current staff — including the popular Dr. Andrew Desruisseau — will move over to the main HealthRIGHT 360 location at 1563 Mission St. by Oct. 4. The next few weeks will include transitioning clients, too. Some will move to the Mission Street campus. Others, who may want to continue their care in the Tenderloin, will receive a personal handoff from their current caregiver to someone at another nearby clinic. The goal is to make sure no one falls through the cracks.
“We have little concern that we will be able to transfer everyone to care that feels good and meaningful,” Kahn says. 
The closure of the Haight Ashbury Free Clinic has similar origins — their patient population has also dropped to around 1,000, half the number it served at its height.
Kahn credits this to a gentrifying neighborhood where low-income health services aren’t as needed as they once were in the 1960s. But there are also structural issues at play: the clinic is located up 26 stairs, with a heavy metal door halfway up. It’s not ADA accessible, and even once you’re inside, the tight doorways can make it difficult for patients to navigate. The building is aging, and the toilet frequently breaks. None of that mattered as much in the past when the population it served was younger, but unhoused seniors have become more prevalent in the Haight, and many can’t physically access the clinic. 
“We can’t grow, and we can’t afford to rejigger the space,” Kahn explains. “We couldn’t add a second doctor even if we wanted to. With the decreasing patient volume, and for reimbursement rates, it’s not financially viable.” 
But the Haight isn’t being totally left in the lurch: HealthRIGHT 360 was recently gifted a van, which they plan to use for mobile outreach. This way doctors can meet patients where they’re at — on street level. HealthRIGHT 360 is still trying to find a location to park it, but hopes to have it up and running by September.
As for the old clinic, it will still be used, for now. The Homeless Youth Alliance holds drop-in hours on Mondays, Wednesdays, and Fridays from 5:30 to 7:30 p.m. Many of their young people they serve can make it up the stairs easily to access snacks, medical care, and the needle exchange. 
A tentative plan is also in place to bring back daytime hours to Haight clinic, with HealthRIGHT 360’s guidance. If this moves forward, it will be run by volunteers — just like 1967. 
The closure of both clinics is a blow to the communities they serve, but Kahn hopes that with time they can fill the gaps. 
“When we take away one thing we’re always replacing it with others,” she says. “We take this seriously — that marginalized populations get access to care and are treated the way they deserve to be treated.”
But at the same time, keeping low-income clinics alive is hard. 
“You can’t take for granted that we’re always going to be here,” she adds. 

[Drunk Monk]

I had to recert today.  It occured to me that I've certed over 16 times now at least - every 2 years and in so many circumstances.  i recert at Defib This on the mall - great facility, very pro and efficient.  They meet AHA standards just enough and cut the BS.

AHA requires everyone have an up-to-date textbook (to make more money). I couldn't find mine from last time so I borrowed one from a RM instructor friend.  It was a pro teaching book.  Defib let me borrow one of theirs, just in case, but it was in espanol.  No matter, they don't use it. It's available for the open book exam, but I figured I could pass without it.  I did reference it on a few questions, just to be sure.

The instructor was very Cruz, a rescue swimmer who just got back from Tahoe and was clearly hungover.  That worked to our advantage because there was even less BS.  We just got it done.  And when it came to answering questions, he was totally on point.  Nice kid, much smarter than he looked, but hard to judge when he's all hungover.

The multi-choice 25 question exam was harder than I anticipated because I haven't taken an exam like that since...well since my last recert.  I studied psych of testing as an undergrad and started to overthink it.  Missed two questions, which I felt a tad ashamed by, but that's a pass and who cares really?

I strolled the mall after to shop for a CNY care package that I'm sending to Tara.  Has lunch at the new N'awlins place off Abbot Square, Roux Dat.  First time. So good! Highly recommended if you like creole cuisine.  I'm going to try everything I can eat on the menu.  Lots of shrimp & catfish.  

It's been a lovely Saturday today. 

[Drunk Monk]

Wow, seems like forever since my last post here. 

I hope I get to use that CPR recert this year.

From Concerts to COVID: Rock Med Volunteers Support San Fran Coronavirus Response


03/14/2021
Daniel Berger, BS, EMT
When the threat of COVID-19 became clear, mass gatherings across the country were quickly cancelled. However, for volunteers with Rock Medicine, the 47-year-old California-based event-medicine provider, the cessation of concerts did not mean the end of their volunteerism. Working with the San Francisco Department of Public Health, Rock Medicine mobilized its volunteers to help staff a field care clinic (FCC) at San Francisco’s Southeast Health Center. 
Run out of tents in the street alongside the center, the FCC was originally designed to act as an alternative destination for EMS, giving San Francisco ambulances a third option between leaving patients at scenes and transporting them to emergency departments. However, much of the site traffic has been from patients seeking urgent care, COVID-19 testing, or, recently, vaccinations. 
“Southeast Health Center is grateful for the supply of highly skilled and motivated volunteers to assist us as we run basic services and provide medical care, testing, and education for our community,” says Keith Seidel, MD, medical director of Southeast Health Center and deputy director of the FCC. “Rock Med has been invaluable in our unified response.”
Located in the Bayview-Hunters Point neighborhood of San Francisco, the Southeast Health Center is both a primary and urgent care clinic that also provides dental care and a variety of navigation services. This made it an ideal location to receive low-acuity ambulance traffic, giving patients the opportunity to be seen outside an emergency department and establish care with a primary care provider. 
“The Bayview area has been disproportionately affected by the pandemic, both with number of cases and social disparities,” says Seidel. 
According to the 2012 San Francisco Healthy Homes Project Community Health Status Assessment, residents of the Bayview-Hunters Point neighborhood face higher rates of hospitalization for diabetes, asthma, and heart failure, less access to parks and recreation, lower-performing schools, more violent crime, and higher rates of drug overdose deaths than in the rest of San Francisco.1 Compared to San Francisco as a whole, more Bayview-Hunters Point residents spend more than 50% of their income on housing and live in dense households. The neighborhood also has significant numbers of African-American and Latino residents, groups that have been disproportionately affected by COVID-19. Overall, the life expectancy for Bayview residents is 14 years lower than for those in San Francisco’s Russian Hill neighborhood. 
Since April 2020 Rock Medicine has provided volunteers to staff the site, donating more than 10,000 hours of service and helping conduct more than 16,500 COVID-19 tests. Additionally, volunteers have helped screen patients as they arrive at the clinic, provided food delivery to vulnerable patients, and moved between the brick-and-mortar clinic and field care tent to provide patient care. 
It has been quite a learning curve for Rock Medicine operations staff, who had to design new trainings, keep up with changing infection-control procedures, and are now preparing volunteers to help with vaccine distribution.
“One moment you’re front of stage at a music festival with the biggest artist of the year, and then suddenly you’re learning how to redeploy your volunteers during a global pandemic,” says Michelle Pimentel, Rock Medicine’s operation manager, who is overseeing the organization’s FCC deployment.
Although the organization was born from San Francisco’s Haight Ashbury Free Clinic, Rock Medicine had never operated a clinic on an indefinite basis. “We weren’t designed to respond to disasters, especially not one of this magnitude,” says Pimentel, “but our volunteers are prepared for anything, and all of us wanting to give back allowed us to overcome the challenges.” 
While 2020 was certainly not the way any of Rock Medicine’s volunteers expected to spend their year, their commitment to service, as well the passion of new volunteers who joined specifically to participate with COVID-19 response, has allowed the organization to uphold its founding principle that healthcare is a right, not a privilege, and continue its mission of providing nonjudgmental care to those who need it.
Rock Medicine is currently accepting EMTs, nurses, and unlicensed volunteers with approved BLS cards to join its pandemic response. For more see rockmed.org. 
Reference
1. San Francisco Healthy Homes Project. Community Health Status Assessment, https://sfenvironment.org/sites/www.emsw...ssment.pdf.
Daniel Berger, BS, EMT, is a third-year medical student at the Penn State College of Medicine and special projects manager for Rock Medicine. Contact him at dberger@rockmed.org.

As a side note, I'm still in good graces with the org, one of the last of my generation to be so. They sent me the 2020 RM shirt, which has our dove mascot in a mask (although the nose is peaking out so it's a chin mask...really?) and I've swapped a few texts with our director, mostly about Brit Box. I was talking to his wife about it over FB and he offered me his password, but we just went for it. But still, it was nice of him to offer. 

I've had no desire to volunteer for the Covid stuff. I think it's great but I'm not a medic anymore and high risk and I don't have as much spare time obvs. I had serious FOMO when they started vaxxin the vols who did vol for that (well deserved) but no regrets. 

I'm chomping at the bit to get back to a show...

[Drunk Monk]

Rock Med announced that it will be booking its first show soon. It's an SF opera performance in San Rafael - it's using something akin to the drive in movie model. 

We have been contracted by the San Francisco Opera to provide medical coverage at all of their drive-in opera shows at the Marin County Fairgrounds in San Rafael. Due to COVID restrictions, we’re only allowed to bring up to eight volunteers per show day(this may change in short notice & we may do less) All of these event dates will be put on Mainmed along with any pertinent information needed by the end of the weekend 4/5.

I'll be tempted is schedule allows and I have my vax on board.

[Drunk Monk]

Rock Med announced that it will be booking its first show soon. It's an SF opera performance in San Rafael - it's using something akin to the drive in movie model. 

I'll be tempted is schedule allows and I have my vax on board.

Booked. I'll have vax 2 on board in a few hours. My booking is a little early, not quite the 2 week full vax kick-in period, but I'll stay safe and bathe in sanitizer...

[King Bob]

Probably no trippers at that one, although you never can tell.

[Drunk Monk]

True. However if there is a tripper, no one is better suited to guide them through than ol’ DM.

There’s some chatter about how we proceed with psych in a post-covid world. I’m certainly not comfortable with physical restraint anymore. I don’t even want to talk to strangers that closely. I’m counting on this opera gig to be a softball. I suspect all we’ll see is geezer issues. It’s more of an excuse to get out and don my RM jacket again.

[Drunk Monk]

Although Rock Med is not mentioned in this article, our work helped raise funds for the rest of the clinic for years, and I'm very proud of that service.

From the Underground to Public Health Policy: A History of Harm Reduction in San Francisco

Holly McDede
Apr 20

Rachel McLean holds two pins on orange fabric hearts from the memorial for Pete Morse, at her home on March 10, 2022. (Beth LaBerge/KQED)

It was 1998, and San Francisco was in the midst of a heroin overdose crisis. Rachel McLean was an outreach worker in the Haight, and she says it felt like a war zone.
When youth in the neighborhood fatally overdosed, outreach workers would host memorials by a bench in Golden Gate Park's Panhandle.
They'd order pizza, tell stories, make zines and write poetry. But then came one three-week stretch with a new overdose death each week.
"And by the time we got to the third memorial, no one could even talk about what they loved and remembered about that person because it was just too much," McLean said. "And I remember a bunch of kids were like, 'You know, 'eff this, I'm just going to go and get high.'"
Heroin prices had dropped and the purity had doubled. From 1997 to 2000, 384 people died from heroin-related causes in San Francisco, making it the city’s single-largest cause of accidental death.
In 2000, the San Francisco Health Commission made harm reduction — a philosophy that advocates for making it safer to use drugs rather than criminalizing those who do — an official public health policy. It's an approach with roots spanning from the Summer of Love in 1967, to the beginning of the AIDS pandemic in the 1980s, to the present-day fight to open sites in San Francisco for people to use drugs safely.
Vitka Eisen, president and CEO of HealthRIGHT 360, poses for a portrait at the medical clinic in San Francisco on March 9, 2022. HealthRIGHT 360 is a health care provider for lower-income and otherwise marginalized Californians. (Beth LaBerge/KQED)
Inside a 'hippie' clinic, health care was a right
The Haight Ashbury Free Medical Clinic opened its doors in 1967, committed to an ethos where health care was a right, not a privilege. Tens of thousands of flower children and teenage runaways were flocking to San Francisco to “drop out” of everyday society and experiment with drugs, sex and rock 'n' roll.
The clinic offered people who used drugs health care at a time when the city’s health department worried compassion would encourage the hippies to stay. It provided a safe space for people dealing with bad trips and heroin withdrawal and, later, for veterans returning from Vietnam with post-traumatic stress disorder.
Founder Dr. David Smith said it was illegal for physicians to treat people with substance use disorder with prescription drugs in the 1960s. Clinic volunteers were so worried police would shut the clinic down if people used drugs inside that the door was painted to read: "No dealing!/No holding drugs/No using drugs/No alcohol/No pets/Any of these can close the clinic/We Love You."
When the Summer of Love ended, many people went home, but generations of people searching for meaning stayed behind in San Francisco, where the hard drugs moved in and people’s health care needs overwhelmed the clinic.
This painted door marked the entrance to the Haight Ashbury Free Medical Clinic. (Courtesy of David Smith archives)
“More than three years of life in the Haight, once the flower pot of America, now shattered into fragments of terror and despair, a ‘behavioral sink’ of pathologies feeding off the pill and the needle,” read a 1971 New York Times piece.
Still, the philosophy of the clinic — not only that health care is a right but also that addiction can be treated with medicine — persisted.
"It was harm reduction before there was such a term. It was never like, 'When are you going to get your shit together?' It was always, 'Hey, can I see what's going on?'" said Vitka Eisen, who was a patient at the Haight Ashbury Free Medical Clinic, as it was called in the 1980s.
The clinic smelled of patchouli, and a counselor walked around in a leather fringe jacket, Eisen recalled. She would go to the clinic before visiting her family in New York because she didn't want to be strung out on heroin when she went to see them. She’d pick up a “kick pack” of medicine to fight stomach cramping and nausea, and to help her sleep during withdrawal.
“After the seventh or eighth time, I was like, ‘I can’t do this anymore,’” she said.
She got treatment at Walden House, an addiction and mental health treatment program in San Francisco, and said she never used drugs again. Now she runs the treatment provider HealthRIGHT 360, the umbrella organization that includes what is known today as the Haight Ashbury Free Clinics.
'Carrying bleach was like having aspirin'
The philosophy of harm reduction spread internationally when activists and caregivers sought ways to reduce suffering and health risks during the AIDS crisis in the '80s. Volunteers handed out clean needles and encouraged cleaning needles with bleach.
Maia Szalavitz, the author of “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,” says she was addicted to cocaine and heroin at the time. She was unaware that sharing needles put her at risk of contracting HIV until 1986, when she met Maureen Gammon with the San Francisco-based group Mid-City Consortium to Combat AIDS.
Maia Szalavitz, author of 'Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,' in the 1980s. (Courtesy of Maia Szalavitz)
“She told me I shouldn’t share, but if you have to share, clean the needle with bleach and then with water,” Szalavitz said. “Shooting up is a pretty compulsive thing, so I immediately incorporated this into my compulsive routine and she probably saved my life.”
Gammon said carrying bleach was as common as having aspirin.
“People just had [bleach], and it was not unusual to go into a corner store or taqueria or bar and ask for a bottle of beach and be able to get it,” Gammon said.
Inside the Ambassador Hotel
The AIDS crisis also forged a new generation of physicians, said Joshua Bamberger, an associate clinical professor of family and community medicine at UCSF.
He began his residency at San Francisco General Hospital in 1989, and said all his energy and focus went into caring for men who were dying of AIDS.
“Much of my work was really holding men in my arms as they died,” he said. “And as awful as that was, it also created an era of physicians and other healers who bonded over the important things in medicine, which isn’t necessarily slinging medication but providing love and care for people who are really suffering.”
Some hospices refused to take in people who had a history of drug use, or had clauses saying they’d only accept people on the condition they’d been sober for six months before being referred. But the people who needed to be referred often had two or three months left to live.
So, many people found refuge at the Ambassador Hotel, an SRO in the Tenderloin run by gay rights activist Hank Wilson beginning in 1978. It became one of the few places where AIDS patients who used drugs could live without having to die on the streets. In the 1996 documentary "Life and Death at the Ambassador Hotel," the site is described as a model in harm-reduction housing.
“The Ambassador was sort of a de facto AIDS hospital,” said Bamberger, who did rounds there, providing care alongside community members and friends of those dying. “When treatment options were limited, and [people] didn’t have a home, the Ambassador was a place where they could land.”
Val Robb, a nurse at the Ambassador Hotel, said she had to learn the culture of the people who stayed there. Many people who used drugs were distrustful of a health care system that considered them not worth treating.
"I started speaking the language more, which is, 'Let me work out a deal. You need me to do this. I want you to do that,'" Robb said. "I need you to go to the doctor. If you go to the doctor, if you let them examine you, then let's get you some codeine. It wasn't like, 'I'm Nurse Nancy doing this thing for you.'"
There were times Robb had to go against what she knew about health, such as offering guests cigarettes if they would let her examine them. But she said she still had to draw the line.
"Another guy, he says, 'Val, I'm trying to get high, and my partner couldn't hit the vein. Can't you?' I said, 'No, I'm a nurse with kids and a license, I can't do that,'" she recalled.
It took years before the city approved or funded some of the harm-reduction practices happening underground. The AIDS crisis hit its peak in San Francisco in 1992, and the following year Mayor Frank Jordan declared a state of emergency and announced that San Francisco would back a program to give clean needles to people who used drugs.
'Call it Lazarus in a hypodermic'
Meanwhile, naloxone, the medication used to reverse overdoses, was still only widely available in medical settings. Rachel McLean, the outreach worker, said she and others attended a conference on drug policy reform in 1999 where an Italian man gave a presentation on naloxone.
“None of us could even understand what he was saying because his accent was so strong. But we understood that he said that in Italy, community health workers give out naloxone on the street,” she said. “And all of us, our minds were just blown by that.”
At the conference, Dan Bigg with the Chicago Recovery Alliance brought a duffle bag full of naloxone.
“And people would just come and take it, and that's how underground naloxone started in San Francisco,” McLean said.
Naloxone education material used in San Francisco from the Massachusetts Department of Public Health. (Courtesy of Joshua Bamberger)
"It's a mission that's part Che Guevara, part Mother Teresa. The guerrillas aren't doctors. Nonphysicians, obviously, are barred by law from handing out prescription drugs — it's a felony that can carry up to 10 years in federal prison,” reads a 2003 article from A.C. Thompson in The San Francisco Bay Guardian on a visit to a San Francisco needle exchange site where volunteers were distributing naloxone. 
Critics said providing people who used drugs with naloxone, more commonly known by the brand name Narcan, would encourage drug use. Clinicians worried about liability if people had an adverse reaction to the naloxone, or if they died even after naloxone was used.
While studying at San Francisco State University in the same year as the conference on drug policy reform, McLean was assigned to write a paper analyzing a public health problem. She drafted some ideas based on the knowledge she had absorbed from the community, and proposed opening safe injection rooms, testing drug supplies and training people who inject drugs in administering naloxone.
She presented the paper to members of a so-called “heroin subcommittee” created by the city to address overdose deaths, and members included the ideas in their final recommendations.
Rachel McLean looks through her archive of flyers, zines, educational information, and research on harm reduction at her home on March 10, 2022. A photo of friend and colleague Pete Morse can be seen, as can a zine about Matty Luv, singer of the San Francisco punk band Hickey, who passed away from a heroin overdose in 2002. (Beth LaBerge/KQED)
Soon after turning in her paper, McLean graduated from college, quit her job as an outreach worker and went to Mexico for three months, burned out by the trauma. But she would sometimes wake up at night to scribble notes about what an overdose prevention program would look like.
“The fire was still there,” she said.
Members of the heroin subcommittee ended up calling McLean. They remembered her recommendations from several years before and asked McLean if she would implement some of her ideas.
With a $30,000 annual budget, the Drug Overdose Prevention and Education (DOPE) Project began in a makeshift office in McLean’s kitchen in 2002. She started making phone calls to overdose prevention workers, and put together a curriculum to teach drug and alcohol treatment providers, sheriffs and deputies, the probation department, homeless shelter staff, and others how to reverse overdoses through rescue breathing. Without naloxone widely available, rescue breathing was something anyone could do to reverse overdoses, with some training.
Heroin overdose deaths plummet
Alex Kral, then a researcher with the Urban Health Study at UCSF, conducted a pilot study with other researchers in 2001 to 2002, training 24 people to use naloxone. There were 20 overdoses during the study. Trainees reversed all of them, 15 with naloxone, and most of those with an additional rescue method. The researchers presented the findings to the county’s public health director.
"We said, 'Look … you've got people dying of overdoses and you're not able to do anything about that,'" said Kral, who is now an epidemiologist with the nonprofit health research institute RTI International. "'Why don't you do something about it?' And [the director] said, 'Yeah, let's do it.'"
One year later, the San Francisco Department of Public Health partnered with the DOPE Project to distribute naloxone at syringe-exchange programs, SROs, reentry programs and other sites in the community.
Joshua Bamberger, who oversaw the program with San Francisco's DPH, said heroin overdose deaths dropped “unbelievably down,” plummeting from a peak of 155 in 1995 to 10 in 2010.
An altar includes a candle from a memorial for Pete Morse on the mantel of Rachel McLean's home on March 10, 2022. (Beth LaBerge/KQED)
“Nothing's gonna reduce death to the extent that getting 10,000 doses of naloxone out there in San Francisco in the early 2000s will ever do,” Bamberger said.
McLean, who now works for the state health department, still keeps a picture on her mantel of Pete Morse, who was at the forefront of bringing naloxone to the streets of San Francisco. He died of a drug overdose in 2007.
“I think about him all the time. I want to make sure that his contributions are remembered,” McLean said. “I don’t want to say that it broke my heart the most because I don’t want to compare it to all of the other deaths, but it’s still with me.”
The fentanyl overdose crisis
Naloxone has become a key tool in reducing overdose deaths nationwide. For years, it helped stave off the worst of the opioid crisis in San Francisco. But geography also helped for a time. On the West Coast, black tar heroin was the most common type of heroin, and that black color made it more difficult to hide white-powdered fentanyl inside.
Still, the number of people who injected drugs in San Francisco — mostly heroin — more than doubled early in this century, from 10,158 in 2005 to 22,000 in 2012.
By 2017, fentanyl had crept in to begin its rampage. That year, the city reported 36 deaths linked to fentanyl. That jumped to 90 in 2018. In 2020, the number of fentanyl-related deaths skyrocketed to 518.
An estimated 650 people overdosed and died in San Francisco last year, a spike driven by fentanyl, according to data from the San Francisco Medical Examiner’s Office.
Data on fentanyl-related and non-fentanyl-related overdose deaths from the San Francisco Department of Public Health and San Francisco Medical Examiner's Office. (Chart by Matthew Green/KQED)
“I lost so many people to just fentanyl,” said Joel Webber, who goes by Turtle. He sat on a curb recently near Hotel Whitcomb, a city-run hotel on Market Street. People regularly gather nearby to use or sell drugs.
Webber said he received methadone treatment for 22 years, then started using fentanyl when he stopped his methadone treatment.
“If I could, I would blow up every f---ing fentanyl lab up with a button and end it. I’d get sick, but I’ll take it,” Webber said. “I just want it gone.”
Drugs like fentanyl are unlikely to disappear, and that means the city will need to try new strategies to prevent overdoses. A river of naloxone is not enough to confront the crisis, said Keith Humphreys, an addiction researcher at Stanford University School of Medicine.
One dose of naloxone often is not enough to reverse a fentanyl overdose.
“Maybe we can’t make fentanyl use safe,” he said. “Let’s say you make it twice as safe. It’s still just so deadly it just overwhelms the capacity of what we know how to do.”
Community and trauma in harm-reduction work
In 2021, President Joe Biden became the first president to make expanding harm reduction one of his drug-policy priorities. But people still argue that harm reduction encourages drug use. Several city leaders in San Francisco have criticized an overreliance on harm-reduction services and a lack of abstinence-based treatment options.
Kristen Marshall and the Dope Project team pose for a portrait during Overdose Awareness Day in 2020. The event gathers providers and community members to hold space for those lost and celebrate people still with them. (Courtesy of Kristen Marshall)
Kristen Marshall was the program manager for the DOPE Project until last winter.
"When you do this work, it's your life, even if you try to fight it. It's a lot of grief, it's a lot of pain, it's a lot of trauma. And that breaks a person down," she said. "It feels really hard for me as someone who is in this position when suddenly people are like, 'Well, this is your job. If overdose prevention is your job, what do you do? Harm reduction must not work.'"
Still, because of the vast supply of naloxone in the community, people are reversing more drug overdoses, many fentanyl-related, in San Francisco than ever before. The DOPE Project reported 81 overdose reversals in 2006. In the year 2021 alone, the group reported 8,985 reversals. Many of those overdoses were reversed by people who use drugs. In comparison, San Francisco police, who by then were carrying naloxone, reversed 144 overdoses in 2021.
Reporting data from the Drug Overdose Prevention and Education Project, as documented in a San Francisco Department of Public Health report. (Chart by Matthew Green/KQED)
Marshall said the larger question she keeps asking herself is what happens after overdoses are reversed.
“So they go to treatment, then what? Where's their housing? So they go right back outside,” she said.
She believes overdose prevention efforts will inevitably fall short until root causes such as poverty, racism and isolation are addressed.
“We’re giving people Narcan and saying, ‘Live, live, live, live — you have to live,’” she said. “The question that I want to ask everyone is, ‘What are we living for? What is there for people to grasp?’”

This reporting was produced as a project for the USC Annenberg Center for Health Journalism's 2021 Data Fellowship. KQED's Kate Wolffe contributed to this story. 

[Drunk Monk]

RM sent me a form letter email asking if I’d like to register for their Show Lead / Dispatch program. Srsly?  Hard pass. 

Thinking a lot about my RM journey with Dov’s passing. Walstib.