San Francisco Marin Medical Society Blog

SFDPH Alert-- Health Update: Fentanyl Overdose

Health Update: Fentanyl Overdose

September 18, 2019

Fentanyl overdose deaths have increased in San Francisco, with several potential sources. There were fewer than 10 fentanyl overdose deaths through 2014, increasing each year since to 89 in 2018, and 39 in the first quarter of 2019. The increase in fentanyl overdose deaths has driven an overall 17% increase in drug overdose deaths from 222 in 2017 to 259 in 2018.

In San Francisco, fentanyl appears to be mostly sold as a powder (white or lavender), and not commonly mixed with heroin or other drugs. Fentanyl is commonly injected, but increasingly consumed through smoking. Most fentanyl overdoses in San Francisco occur among persons who are believed to be aware that they are using fentanyl or a related substance. However, there have been a number of cases of counterfeit pills, as well as cocaine and methamphetamine containing fentanyl, several of which have been reported in prior Health Alerts.

Most recently, in September 2019, three persons with no known history of opioid use required critical care in San Francisco following fentanyl overdose. One had sniffed a powder and was observed to immediately stop breathing and suffer a cardiac arrest; this person was toxicology positive primarily for fentanyl. The second reported sniffing cocaine while at a bar, but was toxicology positive for cocaine and fentanyl. The third was known to use cocaine, but was toxicology positive for fentanyl, cocaine, and methamphetamine; that individual is now deceased.

In addition, this month Santa Clara County reported increased law enforcement seizures of counterfeit 30-milligram “oxycodone” tablets consisting of only fentanyl, and associated fatal overdose events. The pills were stamped with an “M” inside a square on one side, and a “30” on the other side which is also scored. There have been no reports of this counterfeit pill in San Francisco to-date.

Actions requested of SF clinicians:

1. Initiate or refer patients with opioid use disorder to treatment. Treatment can be accessed at methadone programs or through the Treatment Access Program at Treatment Access Program at1380 Howard St.

2. Ensure patients who access ANY street-purchased drugs have naloxone and are aware of the risks of fentanyl. Either prescribe naloxone 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.

3. Advise patients who use drugs to test their drugs, use “tester” doses, and stagger drug use due to the rapidity of fentanyl overdose events.

Substance Use Disorder Treatment Referrals:

- SFDPH triage center – Treatment Access Program (TAP) @ 1380 Howard Street, 8 a.m.-4:30 p.m. weekdays 

BAART CLINIC @ 433 Turk St, 7:30am-12pm for same day methadone; Call (415) 928 – 7800; ask for intake counselor

List of physicians who provide buprenorphine: treatment/practitioner-program-data/treatment-practitioner-locator


-- CBHS Pharmacy at 1380 Howard Street, Monday-Friday walk-in 9:30 a.m.-4 p.m. (no prescription required).

-- Naloxone from the DOPE Project: Contact Kristen Marshall at or call (919) 637 – 8632 for the distribution schedule

--Naloxone Prescribing Information (scroll down to Naloxone Prescribing, Education, and Awareness):

Program Contact Information:

Substance Use and Health Tel: (415) 437 – 6282


To read the original Health Alert from The San Francisco Department of Public Health, please visit the following link:

Health Alert: Fentanyl Overdose

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