The opioid crisis rages on in San Francisco's Tenderloin District and elsewhere across the Bay Area, despite being overshadowed by the coronavirus pandemic in the last five months. And experts fear pandemic that sheltering orders are leading to bigger spikes in overdoses as addicts are using fentanyl more in solitude, without friends nearby in case of an OD.

Many addicts in San Francisco are now armed with Narcan — the life-saving drug naloxone hydrochloride that interrupts the body's response to opiates and reverses overdoses with a single injection — and they know when to jump in to save someone who is ODing. And overdoses are incredibly common with street-purchased fentanyl, the potency of which varies wildly. (And even low-potency fentanyl is many times more potent and deadly than heroin.)

As one addict, Carmen Sierra, tells KTVU, "I overdosed after taking two hits, two puffs off of tin foil and I was out." And as SFist reported in August 2019, a spike in fentanyl potency on SF's streets last June killed 10 people inside of a week.

The frequency of overdoses has led nonprofits like the city-funded Drug Overdose Prevention & Education (DOPE) Project to distribute free doses of Narcan as widely as possible, to prevent unnecessary deaths.

There were 89 overdose deaths connected to fentanyl in San Francisco in 2018, and that figure jumped to 234 in 2019. This year the number of fentanyl deaths is on track to go even higher, though the medical examiner's office still has hundreds of toxicology tests pending.

"We have seen an uptick in fatal overdoses, and that’s often caused by people using alone and no one being able to reverse that overdose,” says Paul Harkin, speaking to KTVU. Harkin works in harm reduction at local healthcare nonprofit HealthRIGHT 360.

The SFPD confirms the trend to KTVU, saying they have had to reverse more overdoses with Narcan so far this year than at the same point in previous years.

Drug use overall has likely spiked across the country, given the compounding of stressors and exacerbation of mental health issues brought on by the pandemic.

Santa Clara County reported seeing a tripling of fatal fentanyl overdoses back in May, with most of the cases being between the ages of 16 and 25. In many of the cases, pressed pills being passed off as Percocet or oxycodone, and sold on Snapchat and elsewhere on social media, were being blamed.

Federal and local law enforcement and health officials in San Diego County issued a broad warning two weeks ago about the spike they have been seeing in fentanyl-related deaths. There were a total of 152 fentanyl deaths in San Diego County in 2019, and so far this year the county has already recorded over 200 deaths likely connected to fentanyl.

"While buyers may think they’re getting cocaine, oxy or Xanax, in reality they’re playing a high stakes game of Russian roulette,” said U.S. Attorney Robert Brewer in a statement. "When it comes to fentanyl, there’s no truth in advertising and you can forget about quality control."

The fentanyl being found on American streets is often attributed to labs in China and Mexico that are getting the drug across the border. In some cases, as with heroin, counterfeit Xanax and other benzos and opioids, the drug supply is being purposely laced with cheap fentanyl. In the case of street-purchased stimulants like cocaine and methamphetamine — to which fentanyl would act as a counter-acting downer — experts have surmised that there is likely accidental contamination happening at the street-dealer level.

The deaths of two young men in Oakland late last year were connected to fentanyl-laced cocaine. Likewise, a counterfeit Percocet pill was blamed for the fentanyl-overdose death of a Stanford student in January.

"The DEA wants to remind the public that medications not obtained from legitimate pharmacists and illicit drugs like methamphetamine, can be laced with fentanyl and could result in your death," said San Diego-based DEA Special Agent in Charge John W. Callery in a statement.

Related: Spike In Fentanyl Potency In SF In June Led To 10 Deaths; Nonprofit Is Helping Reverse Overdoses

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