First-of-a-kind drug program in San Francisco to treat opioid addicts on street

San Francisco’s mayor on Thursday announced he wants to create a special medical team — which would be the first of its kind in the nation — to give homeless people and opioid addicts a drug believed to stop heroin cravings, by finding them and spreading it on city streets.

Mayor Mark Farrell is proposing $6 million in his current budget proposal to boost the Department of Public Health's Street Medicine Team by adding 10 new clinicians and funding them over the next two years. Their aim is to prescribe the medication buprenorphine to at least 250 addicts, in a story first reported by the Chronicle.

"If we are really going to solve the problem we have to be creative," Farrell said at a news conference.

The money Farrell proposes to spend would come from the city’s general fund and would cost the city about $3 million year for access to the drug to treat addicts, but about $900,000 would be reimbursed each year to the city by Medi-Cal. 

Buprenorphine, known by its brand name Suboxone, works faster and causes fewer side effects than methadone, drug experts told the Chronicle. 

The team will take to the streets daily and provide the opioid treatment medicine directly to people suffering from heroin addiction. Buprenorphine is taken as a daily pill or strip that dissolves in the mouth. The treatment helps reduce cravings for opioids and can lessen withdrawal symptoms, 
reducing the risk of overdose.

"This program is a big step forward to saving lives lost to heroin, fentanyl and methamphetamine addiction and overdoses. Homeless people who use drugs are especially vulnerable and our health system is adapting by going directly to them with compassionate outreach and expertise," DPH 
Director Barbara Garcia said.

The health department implemented a one-year buprenorphine treatment pilot program in 2016, where the street team engaged opioid users and offered assessment, education and same-day prescriptions for buprenorphine. The team provided the services at a variety of locations, including Navigation Centers, syringe access sites, in parks and on the streets. Since then, nearly 60 percent of the approximately 200 people who began taking the drug are still working on being clean, officials told the Chronicle.

"When you think about it, we're doing a couple things, one saving lives with this program and second, the reduction of emergency costs for individuals who are in our ambulances, emergency rooms and hospitals," Farrell said. 

Additionally, the funding will allow for buprenorphine to be provided at Zuckerberg San Francisco General Hospital emergency rooms and for the implementation of an addiction consulting service within the hospital, so that doctors can have expertise on dealing with opioid addictions.

The Street Medicine Teams' medical director Dr. Barry Zevin, who's been working with the city's homeless population since 1991, said, "Many people have the preconception or stereotype that a person experiencing homelessness doesn't care about their health.

"What we see day after day, one person after another is that people are deeply concerned about their health. They may have more compelling concerns, like where are they going to get something to eat, where are they going to lay their head down and, if they're dependent on drugs, where are 
they going to be able to get drugs to prevent themselves from having severe and awful withdrawals," he said.

"If we're out there as a team, we're able to meet people where they are. We see and talk to people about the harm related to their substance abuse," Zevin said.

In addition to urging people on the streets to go into treatment for opioid addiction, Zevin said, his team is also recommending and assisting people, when needed, to go to methadone treatment centers.

Drug use has been front and center San Francisco news lately, with viral videos of people shooting up and leaving dirty needles on the floor of the BART Civic Center grabbing the attention of various stakeholders, including the mayor.

The department estimates there are 11,000 heroin addicts in San Francisco who use needles. 
Each month, the Department of Public Health and the San Francisco AIDS Foundation collect more than 275,000 used needles per month. And according to the San Francisco Department of Public Health, there are about 22,000 intravenous drug users in the city.

"I tried many times to shake my addiction of heroin for over 28 years and nothing worked. I tried everything," said Christopher Ruffino, a former heroin user who now works as a substance abuse counselor and credits Zevin with helping him change his life three years ago when they met near the 
Civic Center area.

"Dr. Zevin met me out in the rain, with my bicycle in my hand and the clothes on my back, and spoke to me for 25 maybe 30 minutes. He said, 'Look, I'm going to do this for you and do not let me down.' And I don't believe I have," Ruffino said.

"I owe my life to buprenorphine, without that it was over. I was losing hope and didn't think I was ever going to get it and I got it," he said.