Health Advisory: Fentanyl Overdose from Suspected Counterfeit Oxycodone Tablet in San Francisco June 20, 2018 Public Health, SF Dept of Public Health fentanyl, naloxone, SFDPH 0 June 19, 2018 An individual experiencing a near-fatal overdose after consuming a pill stamped with “M30” was cared for at Zuckerberg San Francisco General Hospital on June 11, 2018. No pill was available for testing, however such tablets are reportedly readily available in San Francisco. Similar events have been reported in Arizona. Fentanyl has been increasingly present in street-purchased drugs in San Francisco (including as a white powder, and contaminating methamphetamine, cocaine, heroin, and counterfeit benzodiazepines and prescription opioids). Fentanyl test strips provided by syringe access programs have identified the presence of fentanyl in many street-purchased drugs (e.g. counterfeit “Xanax” tablets). In 2016, 22 of 105 opioid overdose deaths were caused by fentanyl, double the number from 2015. Of these 22 cases, 45% also involved methamphetamine, 27% cocaine, and 41% another opioid. Death from fentanyl toxicity can be more rapid than from other opioids, thus prompt peer response is essential. We recommend that anyone using street-purchased drugs carry naloxone, the short-acting opioid antagonist. Naloxone can be administered by witnesses as a first aid measure, is covered by MediCal, Healthy SF, and most health plans, and can be furnished without a prescription by pharmacists registered to do so. Naloxone can be obtained from the Community Behavioral Health Services (CBHS) Pharmacy at 1380 Howard Street on a walk-in basis (see below). Naloxone is also available at no cost from the DOPE Project for people who use drugs via syringe access sites and other community-based programs. Additional measures include advising anyone who uses street-purchased drugs to test their drugs for fentanyl (test strips available at syringe access sites), use “tester” doses to ensure there are no unexpected effects, and if using in a group, stagger drug use so that someone is alert to help others if needed. Actions requested of SF Clinicians: Refer patients with opioid use disorder to treatment. San Francisco has treatment available on demand, which can be accessed at methadone programs or through the triage center at 1380 Howard St. Ensure patients who access ANY street-purchased drugs have naloxone. Either prescribe naloxone directly or direct people to the pharmacy at 1380 Howard Street or to syringe access sites. Patients should be encouraged to keep the medication with them at all times. Advise patients who use drugs to test their drugs, use “tester” doses, and stagger drug use. Resources for Substance Use Treatment and Naloxone: Treatment Referrals: SFDPH triage center – Treatment Access Program (TAP) @ 1380 Howard Street, 8:00 a.m. – 4:30 p.m. weekdays BAART Clinic @ 433 Turk St, 7:30 a.m. - Noon for same day methadone; Call (415) 928 – 7800 and ask for intake counselor List of physicians who provide buprenorphine: http://buprenorphine.samhsa.gov/bwns_locator/ Naloxone from the CBHS Pharmacy at 1380 Howard Street, Monday-Friday walk-in 9:30 a.m. – 4:00 p.m. (no prescription required). Naloxone from the DOPE Project: Contact Kristen Marshall at marshall@harmreduction.org or call (919) 637–8632 for the distribution schedule Naloxone prescribing information (scroll down to Naloxone Prescribing, Education, and Awareness): http://www.sfhealthnetwork.org/employee-physicians/pain-management-resources/ Program Contact Information: Substance Use Research Unit Tel (415) 437–6204 nose.naloxone@sfdph.org View the SFDPH Health Advisory Comments are closed.
