UCSF researchers dive into San Francisco fentanyl scene to find answers
SAN FRANCISCO (KRON) — Drug users are dying every day in San Francisco. Despite a year-long crackdown from law enforcement against street drug dealers, fentanyl suppliers, and users who consume illicit narcotics openly in public, the death toll has not significantly dropped.
Between January-April of 2024, 258 people died from accidental drug overdoses, according to the San Francisco Chief Medical Examiner’s Office. Between January-April of 2023, 275 people died from overdoses.
The University of California San Francisco launched a first-of-its-kind study to find out why overdoses are so rampant. The unique study focused on the users themselves and how they consume fentanyl. The synthetic opioid is cheap, highly addictive, and lethal in tiny amounts. When the city reached an all-time record of 806 deaths in 2023, 653 deaths were from fentanyl.
Researchers hit the streets to observe and talk to dozens of drug users. One factor stood out: The majority of users chose to smoke their drug of choice, instead of inject it, and they were sharing pipes.
The shift was driven by “difficulty injecting and fear of overdose,” researchers wrote.
Researchers wrote, “Now that smoking has replaced injecting as the most common way to consume fentanyl, UCSF researchers have uncovered an increased risk of fatal overdose from the residue that accumulates in smoking equipment. The researchers found that people both shared fentanyl resin and consumed it accidentally. This may be increasing the risk of overdose, especially among those who use the equipment to smoke other drugs, like methamphetamine, and have not developed tolerance to opioids like fentanyl.”
The research study, published Wednesday, is the first to explore fentanyl resin as a key contributor to overdose.
“The risk of overdose when sharing smoking devices with fentanyl resin could be seen as analogous to the risk of shared injection paraphernalia and HIV transmission,” said Daniel Ciccarone, professor of Addiction Medicine at UC San Francisco in the Department of Family & Community Medicine. “Harm reduction-based and culturally attuned education campaigns need to be rapidly advanced to address this new risk.”
To conduct the study, researchers observed drug users on the streets and conducted face-to-face interviews with 34 participants.
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The researchers observed that “fentanyl was extremely cheap, as low as $10 a gram; and most people used foil to smoke it, although glass bubbles, bongs, and dabbing devices also were popular. The quality of the fentanyl varied, and people had no apparent method to determine it. Several participants reported frequent use. Smoking was also more social, and people shared equipment, drugs, and information.”
While conducting fieldwork, researchers saw a “random person” try to borrow a glass pipe from a participant. The participant vehemently refused. The participant explained that the pipe had been used for fentanyl and did not want to share it with someone who only used methamphetamine and had zero tolerance to fentanyl.
While some participants took precautions to prevent others from using their smoking equipment and overdosing on the residues, San Francisco’s social smoking culture still increases fatality risks, particularly given high consumption rates, UCSF researchers said.
“This highlights the need for data that can inform harm reduction education,” Ciccarone said.
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