Fentanyl Plagues San Diego's Homeless Population

By Lisa Halverstadt, the Voice of San Diego

November 21, 2022

The fentanyl epidemic is devastating San Diego’s homeless community.

County data reveals 203 homeless San Diegans died of overdoses involving fentanyl last year, more than double the already surging total the County Medical Examiner’s Office tallied in 2020.

And in the first quarter of 2022 – the most complete preliminary data available – fentanyl deaths among unhoused residents were up 23 percent from the same period last year.

Skyrocketing fentanyl deaths throughout the region among a much broader swath of the population spurred county supervisors to declare illicit fentanyl a public health crisis earlier this year.

The opioid painkiller that is 50 to 100 times more powerful than morphine has been particularly deadly for homeless San Diegans.

Fentanyl deaths among San Diego’s unhoused population made up a quarter of the 814 fentanyl deaths the county recorded last year. Related deaths also made up more than a third of the 536 deaths of homeless residents investigated by county medical examiners.

Homeless residents staying on the edges of downtown and in the Midway District who spoke with Voice of San Diego say they have become accustomed to fentanyl overdoses and deaths in their midst. The drug is everywhere – and often laced into other drugs. In more recent months, some have stockpiled opioid overdose reversal drug naloxone – best known as Narcan – so they can revive their neighbors.

“I’m seeing too many people go down,” said Greg Savas, who stays in the Midway District. “It’s killing off a lot of people.”

The 45-year-old said about 20 people he knows have passed away during overdoses the past few years.

David Amrani, 36, estimated he’s revived about 30 people with Narcan. Amrani, who regularly uses fentanyl, said homeless residents in the downtown area where he stays are now more prepared.

Amrani and others say they have come to rely on Narcan and test strips that detect fentanyl that the Harm Reduction Coalition of San Diego, a county contractor, supplies to try to prevent fatalities.

“I’ve never lost anybody on my account,” Amrani said.

San Diego Fire-Rescue Department data shows city paramedics are also more regularly aiding homeless patients with naloxone. Over the past year, they have provided the drug 979 times – almost double the number of administrations to homeless San Diegans two years ago.

The increasing availability of Narcan is part of a larger county harm reduction strategy meant to reduce the negative consequences of drug use by providing tools to reduce the risk of deadly overdoses, and offering housing and treatment programs that don’t force out people who relapse. The county also recently approved a framework to spend an expected $100 million in settlement money associated with court battles against opioid drugmakers to increase access to treatment, harm reduction tools and housing.

Regional leaders are ramping up their response as both the region’s fentanyl and homelessness crises explode. The growing homelessness problem has left those living on the street increasingly morose and skeptical that solutions that meet their needs are coming.

“People are using and they’re tired,” said Tara Stamos-Buesig of the Harm Reduction Coalition. “They don’t have the support they need nor access to resources and they’re getting exhausted. They’re living with a lot of trauma.”

City and county officials say they are working to deliver more low-barrier resources including two shelters they opened in the past year to try to move more people with addiction and mental health challenges indoors. The county said it expects to open a smaller city-focused shelter in coming months and to eventually take over and offer yet-to-be detailed services at a former Volunteers of America drug treatment facility in National City.

Nathan Fletcher, chair of the County Board of Supervisors, has called for the county to use opioid settlement funds to connect those with substance use challenges with trained supporters immediately after overdoses and to redouble efforts to move those without homes off the street.

“The reality is an individual who’s suffering from addiction, if they’re on our streets, they’re not gonna get better if they’re not housed,” Fletcher said.

Mayor Todd Gloria earlier this month announced he will issue an executive order directing city staff to prioritize their response to the fentanyl crisis, including via increased street-level enforcement. He spoke out about the toll fentanyl has taken on the city’s homeless population and criticized dealers preying on homeless San Diegans.

“We will not make or accept excuses for letting this crisis continue to grow out of control,” Gloria said.

A letter Gloria and 10 other California mayors sent Gov. Gavin Newsom last week also highlighted rising fentanyl and methamphetamine overdose deaths among the state’s homeless population and urged state support to deliver “additional education, treatment and enforcement.”

Dr. Jeffrey Norris, Father Joe’s chief medical officer, said his clinic has increased its medication-assisted treatment program slots by about 50 percent over the last year to try to meet the demand. So-called MAT programs provide prescriptions to minimize withdrawals and cravings.

Almost daily, Norris said patients tell program staff about another loved one who died.

“They’re seeing people dying left and right around them and they’re worried they’re next,” Norris said.

He said the fact that fentanyl is often mixed into other drugs has proven particularly terrifying – and deadly.

Medical Examiner’s Office data shows at least 80 percent of fentanyl-related deaths in the unhoused population each of the last three years also involved meth.

Dr. Roneet Lev, who served as chief medical officer of the White House Office of National Drug Control Policy in the Trump administration before returning to Scripps Mercy Hospital’s emergency department, is all too familiar with that deadly cocktail.

Lev said she’s heartened by increasing access to Narcan that can give patients a second – or fourth – chance at life, but worries users are playing a game of Russian roulette.

“One of these times, it may not work,” Lev said.

For now, Lev and Stamos-Buesig said, the availability doesn’t match the need.

“Every single emergency department in San Diego County sends people out to the street who want help, who are crying and begging for help, and we have no place to put them,” Lev said.

Julie Tucker, 51, considers herself one of the lucky ones.

A couple months ago, Tucker said fentanyl was laced into the meth she typically used to stay awake while staying along Harbor Drive downtown.

After two back-to-back hospitalizations and side effects that left her fearing she was going to die, Tucker said she approached a Father Joe’s street medicine team that had previously visited her tent to see if they could test some drugs.

A test showed it was tainted with fentanyl, Tucker said.

Tucker said the team helped discard the drugs and enrolled her in its medication-assisted treatment program.

“I’ve been sober ever since,” Tucker said.

Tucker is now staying at a shelter and expects to soon move into a San Ysidro housing project.

Many users aren’t ready to quit yet.

Amrani said he’d accept housing if it was offered but can’t imagine giving up fentanyl – at least for now. He said it helps him cope with lingering injuries and the aches and pains that come with sleeping on the concrete. Going without fentanyl for a few days is a nightmare that comes with harsh side effects. The prospect of a packed shelter makes him anxious too. Amrani said arrests also haven’t changed his reality, except that he’s lost belongings in the process.

“I wake up to the same thing every day,” Amrani said. “What’s the point of quitting something that makes me happy if there is nothing else that makes me happy?”

Voice of San Diego is a nonprofit news organization supported by our members. We reveal why things are the way they are and expose facts that people in power might not want out there and explain complex local public policy issues so you can be engaged and make good decisions. Sign up for our newsletters at voiceofsandiego.org/newsletters/.