By Brian Rinker
The man was out of his wheelchair and lay flat on his back just off San Francisco’s Market Street, waiting for the hypodermic needle to pierce his skin and that familiar euphoric feeling to wash over him.
The old-timer, who appeared to be in his 60s, could not find a viable vein, so a 38-year-old man named Daniel Hogan helped him. Hogan, a longtime drug user originally from St. Louis, leaned over the older man, eyeing his neck as he readied a syringe loaded with the powerful synthetic opioid fentanyl.
Hogan called the man a “jellyfish” because most of his veins had collapsed from years of intravenous drug use and he rarely bled when pricked. But the older guy still had his jugular vein, and for Hogan that would work just fine.
Hogan’s hands were pink and swollen, bearing scars and scabs from years of daily drug use and the harshness of life on the streets. But those hands were skilled in the art of street phlebotomy. He slid the needle into the man’s neck and pushed the plunger.
Hogan, who said he had taken fentanyl every day for the past two months, explained that he’d developed a tolerance for the drug, and the dose he gave himself would kill a less experienced user. So, he gave the older man only a fraction of that amount.
In case it was too much, Hogan was ready with a vial of naloxone, the overdose-reversal drug.
Grim drug scenes like this play out every day on the streets surrounding San Francisco’s Civic Center — an area that spans the hard-luck sidewalks of the Tenderloin district and the transitional Mid-Market neighborhood, home to tech titans Twitter and Uber.
The area has become a beachhead for fentanyl, which has killed tens of thousands across the United States and is beginning to make itself felt in California.
The drug, which can shut down breathing in less than a minute, became the leading cause of opioid deaths in the United States in 2016. It is increasingly sought out by drug users, who crave its powerful high.
They feel a measure of security because many of their peers carry naloxone, which can quickly restore their breathing if they overdose.
Data suggests that in San Francisco the users may be reversing as many overdoses as paramedics — or more. In both cases, numbers have risen sharply in recent years.
In 2018, San Francisco paramedics administered naloxone to 1,647 people, up from 980 two years earlier, according to numbers from the city’s emergency response system.
That compares with 1,658 naloxone-induced overdose reversals last year by laypeople, most of them drug users, according to self-reported data from the DOPE Project, a Bay Area overdose prevention program run by the publicly funded Harm Reduction Coalition. That’s nearly double the 2016 figure.
“People who use drugs are the primary witnesses to overdose,” said Eliza Wheeler, the national overdose response strategist for the coalition. “So it would make sense that when they are equipped with naloxone, they are much more likely to reverse an overdose.”
The widespread availability of naloxone has radically changed the culture of opioid use on the streets, Hogan said. “In the past, if you OD’d, man, it was like you were really rolling the dice.” Now, he said, people take naloxone for granted.
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