A community approach to ending overdose

With more than 100,000 people dying in the United States every year from unintentional drug overdose, cities are exploring ways to expand public access to naloxone, an easy-to-use spray or injectable medicine that can reverse opioid overdose in a matter of seconds.

Among the most active cities in this area is San Francisco, where the local health department is strengthening harm reduction efforts by soliciting direct input from those most impacted by the opioid crisis.

Overdoses occur across the city. The below graph, based on data from the Center on Substance Use and Health and published in the San Francisco Chronicle, visualizes overdose deaths in 2020 (pink) and in 2021 (blue).

Since distribution began in 2021, naloxone has reversed thousands of overdoses in San Francisco. To build on this, the local government, with support from the Partnership for Healthy Cities, is scaling up distribution efforts by installing Naloxone vending machines that anyone can access for free.

The project’s design was determined in part by a “needs assessment” conducted last year that involved speaking directly to drug users to gauge their interest in the machines and collect suggestions on where they should be placed.

To conduct the best possible survey, the team worked with local organizations and a team of “Community Navigators”—people with lived and living experience (PWLE) with Hepatitis C or substance use—who interviewed residents in neighborhoods with the highest rates of overdose. The idea was to foster a sense of trust that isn’t always possible when city officials are asking questions.

The surveys, which were conducted through a partnership between the San Francisco Department of Public Health and the community organization End Hep C SF, involved 15 community navigators from three local community-based organizations. They were dispatched to interview San Franciscans in priority areas identified by the city.

Seventy-six percent of survey respondents said they wanted naloxone vending machines in their neighborhoods and made specific recommendations about where to place them. Forty-six percent reported using naloxone in the past to reverse an overdose.

Project organizers said the survey’s design provided them with confidence about its results and emphasized the importance of involving PWLE from start to finish.

Eileen Loughran of the Department of Public Health said the approach recalled lessons learned from the city’s long history with harm reduction, including HIV: “You build better programming with partnerships that are informed by community,” she said. “We learned from syringe kiosks the importance of engaging with community in design, siting and placement of the machines.”

The San Francisco team is eager to share findings and tout this methodology with other cities strategizing about naloxone distribution—and not just in the U.S. Partnership-sponsored networking so far has included webinars with Athens, another city conducting overdose prevention, and national advocates in Portugal.