San Francisco Attributes Lower Drug Deaths to 'Microdosing' Addiction Medication

Last month, 66 people died from an accidental drug overdose in San Francisco, and city health officials say that the majority of those deaths are from the potent opioid painkiller fentanyl.

The San Francisco Department of Public Health said 73 people died of an accidental overdose last May, so there’s about a 10% decrease in deaths. Drug overdoses in the city peaked in January at 71, followed by 63 in February, 68 in March and 56 in April.

The latest numbers (PDF) follow an overall trend in the city being able to help prevent unnecessary drug-related deaths.

“We want to be sure that the public knows that highly effective and lifesaving medications are available in San Francisco to treat people with addiction to fentanyl and other opioids,” said Dr. Hillary Kunins, director of behavioral health services and Mental Health SF. “At DPH, our priority is to increase the accessibility of substance use treatment services so that more people can enter treatment and regain their lives.”

Health officials attribute part of their lifesaving measures to a novel approach they’ve pioneered: microdosing buprenorphine, a medication proven to help people quit opioid painkillers, out of community hospitals.

Chief Medical Officer Dr. Joanna Eveland said patients addicted to opioids can begin microdosing buprenorphine with as little as one milligram a day to help them overcome the intense cravings and painful withdrawal symptoms that occur when somebody physically dependent on opioids stops using them suddenly.

“The challenge with buprenorphine is first getting started on the medication. If you start too early, while you still have another strong opioid in your system, like fentanyl, you can actually experience withdrawal symptoms,” Eveland said. “My patients who are taking buprenorphine report that they feel normal and stable. They can go back to work. They can take care of their families.”

San Francisco Department of Public Health researchers published their findings on custom-tailored microdosing buprenorphine treatments — which they call the “Howard Street Method” — last year in the journal of the American Society of Addiction Medicine.

Their research found that 27 people were treated with the Howard Street Method, all but one picked up their prescription for buprenorphine and 14 completed the program. Eighty percent of the people completing the program reported no symptoms of withdrawal and only three reported mild symptoms. A third ceased all opioid use.

Overall, researchers concluded the microdosing Howard Street Method was a “viable intervention for starting buprenorphine treatment and a promising alternative method for buprenorphine initiation in an under-resourced, safety-net population of people using fentanyl.”

Along with the Howard Street Method, the city has instituted several programs to help get drug users the help they need where they are. This includes the Night Navigation Team, which operates from 8 p.m. to midnight to help set up telehealth consultations with on-call doctors who can write prescriptions for drugs that can help reduce withdrawal symptoms that can be picked up at a 24-hour pharmacy.

“When they find somebody who’s ready and motivated to start treatment, start medication linked to other services, they’re able to get them on the phone with the doctor right in that moment, who does a visit with the person by phone again, can send a prescription that very night, if that’s what the person wants or talk about the plan for starting methadone the next day,” Eveland said.

Kunins said from March through May, city staff conducted approximately 440 in the field, nighttime telehealth visits for people who use fentanyl and other opioids.

The city also has programs to help the unhoused find hotel rooms or other safe places to stay so they can begin their treatment. City officials say 78% of those who are offered medication via telehealth meetings and given a place to stay end up filling their prescriptions.

Anyone in need of mental health or substance use services is encouraged to call San Francisco’s Behavior Health line at 888-246-3333.