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Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015

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This report documents a successful intervention by a community-based naloxone distribution program in San Francisco. The program and its partner organizations, working with participants who use drugs, first identified the appearance of illicitly made fentanyl and increased outreach and naloxone distribution. Distribution of naloxone and reported use of naloxone to reverse opioid-involved overdoses increased significantly while the number of opioid-involved and fentanyl-involved overdose deaths did not. Community-based programs that provide training and naloxone to people who use drugs can serve as an early warning system for overdose risk and adaptively respond to the rapidly changing overdose risk environment.

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  1. In 2014–15, the ten community partners of the DOPE project included five syringe service programs, San Francisco County Jail, three programs serving individuals who were homeless, and a local study that recruited and actively followed individuals who inject drugs.

  2. The community partners of the Dope Project provide “naloxone kits” to trained individuals. The kit includes educational materials on identifying and managing an opioid overdose, a prescription card, and two doses of naloxone. In 2014–2015, the DOPE Project provided three types of naloxone: 0.4 milligram (mg)/0.4 milliliter (ml) auto-injector, 0.4 mg/1-ml vials and syringes for intramuscular injection, and the off-label 2 mg/2 ml adapted for intranasal administration with mucosal atomizer devices.

  3. When previously trained participants return to a DOPE Project site for a refill of naloxone, staff conducted a brief interview. If naloxone was used in a suspected overdose, staff record information about where and when the overdose occurred, to whom naloxone was administered (e.g. “spouse”, “friend”, “stranger”), known drugs involved in the overdose, and whether participants used other response strategies covered in DOPE Project training (sternum rub, call 911, and rescue breathing).

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  5. Drug overdoses accounted for 52,404 deaths in the USA in 2015, 33,091 (63%) involving an opioid. The overdose death rate from synthetic opioids other than methadone, which includes fentanyl and its analogs, increased by 72% from 2014 to 2015 [2].


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The authors acknowledge and thank Michael Gilbert, Kara Lynch, Alex Kral, and Jon Zibbell for valuable suggestions during the preparation of the manuscript.

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Correspondence to Christopher Rowe.

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The authors are solely responsible for the content of this article, which does not necessarily represent the official views of the San Francisco Department of Public Health.

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Rowe, C., Wheeler, E., Stephen Jones, T. et al. Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015. J Urban Health 96, 6–11 (2019).

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