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'There to Save a Life': San Francisco Bars Fight Fentanyl Overdoses With Narcan

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A wooden box hanging on a bar wall is open, with medication, cups, instructions inside.
A harm-reduction box created by Josh Yule hangs on the wall at Mothership bar in San Francisco on April 11, 2023. The boxes include Narcan and instructions on how to administer it, along with fentanyl test strips. (Beth LaBerge/KQED)

Tika Hall was at a music show in San Francisco’s Mission District in February when around 10 p.m. someone yelled out, “Does anyone have Narcan?”

Hall, who is an artist, a musician and a longtime San Francisco resident, understood this meant someone had overdosed, and that their survival could depend on finding Narcan, a naloxone nasal spray that reverses opioid overdoses.

Hall and a friend ran to the nearest bar, one of the few places still open that might carry it.

“When I go into crisis mode, I get a lizard brain, and I was like, ‘What we have to do is go get this thing,’” Hall said.

When the first bar did not have Narcan, they tried the next one, The Eagle, which did. The bartender gave them the medicine, no questions asked, and the Narcan was used to revive the person who had overdosed.

A closed white box with a pink asterisk logo hangs on a wall in a dimly lit bar with a bar counter further back and a bartender and two patrons.
A harm-reduction box created by Josh Yule hangs on the wall at Mothership bar in San Francisco on April 11, 2023. (Beth LaBerge/KQED)

“If this had happened somewhere there wasn’t a bar that had Narcan nearby, or if this had happened during the day when a bar wasn’t open, I don’t know what would have happened,” Hall said.

Now Hall carries Narcan with her everywhere, and the incident underscores the importance of making the antidote available for the public in places like bars. Two hundred people have fatally overdosed in San Francisco in the first three months of this year (PDF), and nationwide there has been a steep rise in accidental overdoses, as other illicit drugs — like cocaine and methamphetamines — have been increasingly laced with fentanyl.

Bay Area bar owners, staff and advocates are taking the initiative to keep patrons and the community safe. The nonprofit FentCheck brings Narcan and fentanyl test strips to bars and other community spaces, and bars are stocking the life-saving medication, as well as hosting trainings on how to administer it. Those promoting harm reduction in the nightlife community say the effort has also opened up a necessary conversation about the risks and realities of drug use.

Harm-reduction boxes offer ‘a beacon for conversation’

That push to reduce stigma and save lives is why Josh Yule has been building harm-reduction boxes and delivering them to bars since December. The bright, medical-white boxes contain Narcan; a neon pink, three-step guide to administering it; and fentanyl test strips.

Yule, a former bartender at The Knockout who still books shows there, makes the boxes at a friend’s woodshop in San Leandro. Nine San Francisco establishments house the boxes so far, including The Knockout, The Phone Booth, The Make Out Room and Mothership.

A white man with glasses looks at the camera as he gestures toward three white boxes with asterisk logos on them lined up next to each other in a bar.
Josh Yule shows a group of bar employees gathered for a Narcan training session the harm-reduction boxes he hopes to distribute to other Bay Area bars, at The Knockout in San Francisco on Dec. 15, 2022. (Beth LaBerge/KQED)

Each box is dedicated to Yule’s mother, Roberta Damron, who fatally overdosed on fentanyl in 2021. He signs the inside doors of the boxes “For Mom.”

“It is there to save a life. First and foremost, that’s what it does,” Yule said. “But it’s also there so people can talk to one another. People can feel safe that they know it’s there.”

Yule said his mother’s death, at age 66, was a shock. His mother was religious, straightlaced and hilarious.

“She was awesome,” Yule said.

He remembered how, when he was in middle school, his mom tore down a poster in his room of Sid Vicious, the bassist for The Sex Pistols who died of a drug overdose.

“She would be really embarrassed that this is how she passed away. I just know that. And I think about that often,” Yule said. “I never really understood what was going on. Maybe I didn’t really want to understand. I’m still figuring that one out.”

Yule had been studying graphic design at California College of the Arts, when he decided to pour his energy into work focused on destigmatizing opioid use disorders.

Two hands holding a few photos, with a mother and child in the topmost photo.
Josh Yule looks through the few photos he has of his mother, at his home in San Francisco on April 21, 2023. (Beth LaBerge/KQED)

He designed posters and stickers, but also wanted to create something physical that could become a “beacon for conversation.” The harm-reduction boxes became his thesis project.

Before his mother’s death, Yule had also lost two friends to fatal overdoses.

“We should be destigmatizing this disorder. It’s the only way to get anywhere. We’re just taking baby steps,” Yule said. “I wish that there was something that beckoned me to talk to my friend, or something I had seen. Maybe he would still be around. Maybe I would have put two and two together about my mom.”

Bar staff train and prepare for emergencies

Then, last winter, bar staff and community members were pushed to action after a string of near fatal overdoses in Mission District bars. Anita Ellis, a bartender at The Phone Booth and Pop’s Bar, organized a training for any interested bartenders in learning about Narcan as well as fentanyl test strips.

A white woman stands behind a dimly lit bar as an older white man with a white beard speaks smilingly to her
A harm reduction box made by Josh Yule and painted by artist Chelsea Wong hangs at the end of the bar at the Phone Booth while Anita Ellis bartends. (Beth LaBerge/KQED)

At least 50 people showed up at The Knockout for the December training, many more than a similar training Ellis had organized years before.

“I felt a lot of community spirit, this feeling of, ‘Let’s take care of one another.’” Ellis said. “The idea of somebody losing their life because they want to do a little blow in the bathroom because it’s their birthday or whatever occasion, or no occasion at all, I find that to be ludicrous. That shouldn’t be happening.”

Yule talked about the harm-reduction boxes during the event, and about 20 people signed up for them. He’s still working through that list, and more people have signed up since then. He’s also looking to expand to restaurants, and hopes to gain enough traction that the city or state takes over to continue the effort.

People stand and listen at a bar
A group of bar employees gathered for a Narcan training session listen to Josh Yule discuss harm reduction boxes he created to help prevent fentanyl overdoses in bars at The Knockout in San Francisco on Dec. 15, 2022. (Beth LaBerge/KQED)

Joanna Lioce, staff manager at Vesuvio Cafe in North Beach, picked up one of the harm-reduction boxes during that training. Years before, in response to overdoses in the alley outside the bar, Vesuvio staff were trained in administering Narcan. Lioce was able to reverse an overdose in the alleyway with Narcan.

“It’s like anything — if you see someone fall in a pool and you can get out and save them, you’re going to do it,” Lioce said.

She says Narcan is essential for bars in the age of fentanyl, like carrying a fire extinguisher.

Yule’s boxes alert patrons that Narcan is available in emergencies.

“We all kind of sound like grandmas now. Like, at least me and my friends are like, ‘Back in my day, you could buy cocaine in the Tenderloin and didn’t even have to worry about it.’ Now it’s like, ‘No, you can’t do anything like that,’” Lioce said.

A white man with glasses and a sweater opens a white wooden box with "How to Administer Naloxone" written in red on the inside of the box lid, as two women look on from the man's left.
Josh Yule shows local bar employee Joanna Lioce a harm-reduction box he created to help prevent fentanyl overdoses, after a Narcan training session at The Knockout in San Francisco on Dec. 15, 2022. (Beth LaBerge/KQED)

But there are still barriers to accessing Narcan for free, and Yule said one of the biggest challenges in completing his project was figuring out where to get Narcan. Now he goes to the city’s Community Behavioral Health Services pharmacy, where the public can get Narcan for free.

A potential policy solution, and barriers in supply

A bill from Assemblymember Matt Haney, Assembly Bill 24, could require libraries, gas stations, residential hotels and bars in areas hardest hit by drug overdoses to carry Narcan, or face $100 fines.

“There is enough Narcan to put in all of these establishments and also get into the hands of organizations who work directly with people who are using drugs. They really need to be in both places,” Haney said in an interview. “And we have to stop nickel-and-diming this if we are going to save lives.”

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In a statement, San Francisco Entertainment Commission Senior Analyst Dylan Rice said the commission is identifying policy, supply chain and consumer price considerations that would make it possible to achieve a vision for Narcan to be available behind every bar in San Francisco.

Some harm reduction advocates remain worried about resources. Laura Guzman, acting executive director of the National Harm Reduction Coalition, said their organization primarily distributes overdose reversal medication to syringe exchange programs that serve residents most vulnerable to overdoses.

“In San Francisco, we are still waiting to see if there will be additional allocation of naloxone that we could be distributing throughout all of the supportive housing, shelters, etcetera,” Guzman said. “There hasn’t been in San Francisco or in the state yet an amplification of naloxone access.”

Gov. Gavin Newsom has pledged $79 million to go toward distributing Narcan.

The medication could also become available over the counter later this year, though the manufacturer has said it could cost as much as $50 per kit, a price tag advocates say puts it out of reach for people who need it most.

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Laura Thomas, director of HIV and harm reduction policy at the San Francisco AIDS Foundation who also sits on the San Francisco Entertainment Commission, said she wants to see a day where all venues have Narcan, but is also concerned about diverting scarce resources. She said the AIDS Foundation uses its own organizational funds to buy Narcan because it does not get enough supplies from the state.

“And that is a huge problem because we are distributing Narcan to people who are the most likely to be at the scene of an overdose and the most likely to reverse an overdose,” Thomas said.

The community continues to educate each other

If you’re looking to access Narcan or learn how to use it, you could also try Princess, the weekly Saturday night dance party and drag spectacular at Oasis.

Virtually every weekend for about 18 months, Cary Escovedo has offered overdose prevention education during the show, usually for about five minutes after intermission. Escovedo, whose drag name is Kochina Rude and who co-hosts the event with Lisa Frankenstein, has partnered with the Drug Overdose Prevention and Education Project on the effort, and distributes about 24 doses of Narcan per show.

She starts off by asking the audience if they know what Narcan is, and then outlines a scenario that could happen in any club where a hypothetical person is found unresponsive.

In the scenario, friends call 911, administer Narcan and provide rescue breathing.

When the overdose is reversed, the audience cheers. Kochina Rude ends on a high note, focusing on how queer people are in a unique position to take care of each other.

“Because historically we have had to do so out of necessity,” she said.

Two white men with glasses talk over a white box in process of completion in a furniture store with carpentry equipment around them.
Josh Yule (left) and Jeremiah Nielsen work to make harm-reduction boxes at the Oakland handmade furniture manufacturing shop Jeremiah Collection, on Dec. 7, 2022. (Beth LaBerge/KQED)

Even if some bar owners may want to pretend drug use does not happen, bartenders can still come to Kochina Rude and access Narcan on their own, she said. During the weekly shows, she reminds the audience that they should not be scared to act.

“By taking this Narcan today, you now are serving as a community first responder in the event of an overdose, wherever you are,” she tells the audience. “And it can happen anytime and anywhere.”

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