Like many communities throughout the country, San Francisco has seen a rapid increase in drug overdoses in recent years due to the proliferation of the powerful, synthetic opioid fentanyl, which is 50 times stronger than heroin.

Among those most at risk are people experiencing homelessness, whose rate of overdose deaths has doubled in the past year and account for at least one-quarter of all overdose deaths in the City. Additionally, data shows that over 50% of people who die from a drug overdose had prior contact with Fire Department EMS personnel.

In response, the City is urgently rolling out new interventions. Chief among them is SORT, which will proactively identify, engage, and follow up with individuals who have survived an overdose in order to prevent another, possibly fatal one from occurring.

“We know that overdose deaths are preventable and every person who dies is someone’s son, daughter, friend, or neighbor. It is urgent that we save lives by doing what we know will work best,” said Breed.

“The Street Overdose Response Team is focused on helping people who are most at risk get the help they need to start their recovery. SORT is part of a package of new and expanded investments we are making this year to flatten the curve of the drug overdose epidemic and even lower the numbers of these tragic deaths.”

The City is investing $13.2 million this year in overdose prevention that in addition to SORT include:

• Opening the SOMA RISE Center this fall to provide 20 temporary beds for people who are intoxicated to come in safely off the streets and be connected to care and services, including housing.
• Expanded access to buprenorphine through telemedicine, increasing the hours at DPH’s Behavioral Health Pharmacy and delivery of buprenorphine to “high risk” housing sites and other locations.
• Round-the-clock hours at the Market Street Clinic, an opioid treatment clinic at Civic Center that provides on-demand services for methadone, buprenorphine, and counseling and primary medical care.
• Widespread distribution of naloxone to settings such as hospitals, primary care clinics, substance use treatment programs, housing sites, and public settings like food pantries and dining halls – anywhere substance users access services.
• Expansion of the evidence-based efforts to incentivize people to continue addiction treatments.

In 2018, DPH’s Street Medicine team was the first in the nation to bring opioid treatment directly to people experiencing homelessness with substance use disorders. The Street Overdose Response Team (SORT) builds on San Francisco’s successful street outreach model of care, which also includes the Street Crisis Response Team.

Specifically, SORT is tasked with connecting with people in the moment they are being resuscitated, and as they come out of hospitals, clinics or other settings from drug overdoses, and offering them services that address substance use disorders.

These include the opioid use disorder medicine buprenorphine, which not only helps wean people off opioids but can also directly prevent overdoses; rescue kits that include the opioid-blocker naloxone; educational materials; and support getting into substance use treatment facilities, housing or shelter as a safe exit from the streets.

The team launched on August 2 with an initial crew consisting of a street medicine specialist from the Department of Public Health and a community paramedic from the Fire Department who will provide immediate care and support within 72 hours of an overdose.

Later this fall, SORT will ramp up to include ongoing and regular care and case management for individuals experiencing homelessness who have survived an overdose with additional capacities such as ongoing medication treatment, primary care and mental health services, and referrals to residential care and other treatment programs.

At full expansion, SORT will consist of specialists with a range of expertise who can meet a patient’s unique needs, including medical specialists such as doctors and nurses; behavioral health specialists including counselors and psychotherapists, and peer counselors with related, lived experience.

“People who survive an overdose are at heightened risk for a subsequent overdose, including a fatal overdose,” said Dr. Grant Colfax, Director of Health. “With the Street Overdose Response Team, we can take a targeted and coordinated approach to reach people who need help the most and provide tailored information and care to save lives.”

SORT will respond citywide to overdose calls, initially 12 hours a day, and by early 2022 when fully deployed, will operate 24/7. Patients are identified by hospitals, the 911 system (such as dispatch, and fire or ambulance crews), through referrals from community partners, and other sources. The teams will make sure no one is lost follow up, and in collaboration with other street outreach teams and a network of providers, can find and maintain contact with patients over time. The team anticipates building its case list to approximately 700 individuals within the first year of operations.

“Every day our paramedics, EMTs, and fire fighters respond to dozens of overdose incidents, some of which end in tragedy despite our best efforts,” said San Francisco Fire Chief Jeanine Nicholson. “Because of this, the Fire Department is uniquely situated to lead the initial identification, engagement and outreach to individuals suffering from opioid use disorder. The Street Overdose Response Team builds on the City’s expanding efforts to actively engage our most vulnerable populations. Our Community Paramedics are impactful, street-level providers who will bring coordinated care directly to those in need.”

Previously, people experiencing homelessness with substance use disorders did not receive a proactive approach and depended on their actively seeking out care from the City’s behavioral health system. SORT is part of the approach directed by the Mental Health SF legislation, which passed in 2019, to guarantee mental health care to all San Franciscans who lack insurance and prioritize people who are experiencing homelessness.

The legislation provides services and coordinated support to people experiencing homelessness who have mental health and substance use disorders.

     The San Francisco Mayor’s Office of Communication is the source of this report.

Isabelle Price

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