38-year-old Pineapple lost her boyfriend to a fentanyl overdose
38-year-old Pineapple lost her boyfriend to overdose this year, and knows all too well how painful losing someone to drugs is. Photo by Clara-Sophia Daly.

Patty, who sells clothing at the corner of 16th and Mission streets, and is known in the community as someone who will give away a jacket to a person who is cold or a pair of shoes to someone in need, says she has personally known 10 people who have died from an overdose in the last year. “A couple of them were really close and important to me,” she says.  

One asked her to shoot him up. Instead, she encouraged him not to do it. I told him, “he needs to find out how much to shoot up before he did it.”

That night, he died of an overdose at the Kailash Hotel at Julian and 16th streets, she says.  

Now, she tries to warn people by telling them, “if it’s too white, it’s not good; you have to get rock. If you get powder, you don’t know what it is.” 

Such is the advice at 16th and Mission, where Patty and others talked recently about the increase in drug overdoses. Just how many have happened at the BART Plaza is unclear but, since 2013, the number of overdose deaths in the Mission has increased sharply, skyrocketing more than 200 percent between 2019 and 2020 to 94 overdose deaths, according to data from the San Francisco Medical Examiner’s Office.

Just three years ago, only 10 people in the Mission died of an overdose. 

Citywide in 2020, 710 people died from an overdose. So far in 2021, 344 people have died from an overdose in San Francisco.

During the pandemic, (between March 2020 until June 2021), 561 people have died from Covid in San Francisco. By contrast, in the same time frame, 973 people have died from an overdose. Of those deaths, 762 were from fentanyl.

Fentanyl has “changed the landscape” completely, said Laura Guzman, the senior director of capacity building and community mobilization at the National Harm Reduction Coalition. “It is much stronger and less expensive than other drugs, and has led to an “amount of overdoses which is unheard of,” she said.

Guzman said homeless residents often use drugs to cope with trauma from not having access to bathrooms and a safe place to sleep. Being in the midst of a pandemic only exacerbated existing traumas for many.

That was the case for Anthony, a 35-year old who hangs out at the 16th Street Plaza. He said it was living on the streets that made him start using in the first place. He was scared of being victimized during the night, and started taking crystal meth to keep him awake and ready to protect himself. 

In the mornings, he would sleep on BART. Now, after four overdoses, and a few months of being clean, he is back to using crystal meth and fentanyl. It helps him manage his pain from epididymitis, a condition in which the tube at the back of the testicles becomes inflamed. But, he add, there is also the pain that is “being felt in the world right now.” That, he says, is hard for people like him.

Anthony said overdose deaths happen either because someone is new to drugs and doesn’t know how much to take, or has been using it so long that they are trying to catch that old high.

Kristen Marshall, the associate director of San Francisco Programs for the DOPE Project, was hesitant to put all the blame on fentanyl. “When we focus on the drug, we lose track of the people, and we lose track of the root causes,” she said.

“People experiencing homelessness, people living in poverty, immigrant communities” are dying at the highest rate, “because they’re cut off from the majority of the … supportive resources in the city, and specifically the housing,” said Marshall. 

And Guzman, who knows the Mission well after working for 16 years as the director of the Mission Neighborhood Health Center, agreed.

“Folks don’t have IDs, folks don’t have housing, folks don’t have employment,” she said. And, for undocumented people in the Mission who are homeless and drug-addicted, not having an ID means not being able to receive a prescription for buprenorphine, a drug used to treat addiction to opioids.

For people dealing with addiction in San Francisco, there are public services such as short-term residential treatment programs, and withdrawal management programs that provide a space for safe detoxification. 

The website FindTreatmentSF.org, launched in 2019, allows the public and health care providers to see where residential substance use treatment beds are available citywide. The site was down for a couple of weeks this month, but is now up and running again. 

According to the site, beds are available. Yet admission to programs that treat substance use disorders has gone down since 2015, according to a report published by the Department of Public Health.

And Brian Edwards, a volunteer human rights organizer at the Coalition on Homelessness, said the issue is not bed availability, but outreach. “First of all, people don’t know the drop-ins are still open,” since the pandemic. 

“And there really isn’t anyone that’s going out and having conversations with folks, you know, in the street saying: Hey do you want treatment?” 

The city is about to debut the Street Overdose Response Team, which would connect to the 911 dispatch system, but Edwards is skeptical. 

When drug users get in a mind-frame that they are ready to make changes, there are often so many hoops to jump through to get the treatment that they say: “No, I’m probably just going to get high,” Edwards said.

A 42-year-old man who asked to be called JT “gifted” crack to a friend of his while sitting in a plastic chair at 16th Street near Mission on a Friday afternoon. One of his arms was broken (from punching someone, he says), and he was using the other to eat fried chicken from KFC that his friend had just brought over.

JT says he doesn’t want anyone to die, especially in his neighborhood.  “Because that brings the police,” he explains.

Just around the corner, the DOPE Project gave away harm reduction supplies including clean needles, Naloxone, or Narcan, which prevents opioid and fentanyl overdose, and hand sanitizer. The Dope project and the San Francisco AIDS Foundation estimate that in the past six months (from January to July),  4,235 potential overdose deaths in San Francisco were prevented by the Dope project and its partners. 

Every Friday for the past 30 years, there has been a syringe exchange and harm reduction supplies are given away at 16th and Mission from 7 to 9 p.m. On Tuesdays, nearby in Weiss Alley, supplies are also given away from 6 to 8 p.m. 

Laura Guzman said the Mission needs more educational materials created in Spanish about the safe use of drugs. “We need to focus more on the racial equity and community education piece,” she said.

Nearby, Pineapples, 38, listened to music and sat next to the toys and clothes she was selling on the street.

She knows all too well what it is like to lose someone to an overdose. Her ex-boyfriend, who was also her best friend, she says, died after taking drugs that, unbeknownst to him, contained fentanyl.

“We need to get this shit off the streets. Period. It’s the worst of the worst,” she says. “We are in a devil’s lair right now; fentanyl is where the devil dwells.”

A story that first ran in 2008 on the 16th Street BART Plaza

16th and Mission After Dark

This story originally ran in 2008. The violence on Friday left many questioning that intersection’s problems, and with how little has changed, this article still resonates. Tonight, the takeover of 16th and Mission happens at 3:13 a.m. Nothing marks its arrival. There’s no blaring siren or shouting crackhead to alert the corner regulars the time […]

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Clara-Sophia Daly

Clara-Sophia Daly is a multimedia storyteller and reporter who has worked both in print and audio. A graduate of Skidmore College where she studied International Affairs and Media/Film studies, she enjoys...

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11 Comments

  1. ” Harm reduction”. What a misnomer. Call it what it actually is ….Addict support and encouragement. The whole city is an open air drug market and flop house. Who could have NOT seen this brewing?

  2. Patty’s friend wasn’t suffering from the trauma of homelessness or needing to stay awake to not be victimized. He had housing in the Kailash Hotel. So let’s look at addiction and OD more honestly and acknowledge it’s not necessarily a result of being homeless. In fact there are many more SFsubstance abusers who have housing than those who don’t.

    1. I know, it’s a sad joke. Portland has a famous subsidized housing building that was built in 2011 and named for former Mayor Bud Clark. Bud Clark Commons cost 50 million dollars (for 130 units) and the residents die like flies there. In fact, it became the best place in the city to score drugs, indoors anyway. It was sold as as “a centerpiece of Portland’s Ten Year Plan to End Homelessness, Bud Clark Commons (BCC) represents a new approach to providing dignified housing and comprehensive services to help those experiencing homelessness”. Well 10 years have gone by and the “homeless” situation is FAR WORSE than 10 years ago….

  3. There are, what, $800m in Prop C proceeds sitting in a city account? 25% of Prop C was supposed to be for substance treatment. Have those dollars been converted into treatment on demand yet and if not, why not?

    We’re seeing the rise of a substance maintenance nonprofit ecosystem similar to housing and social services for whom the journey of mitigating that which they’ve abandoned efforts to solve is the destination rather than seeking radical solutions. Has it been 10 years now organizing to not win safe injection sites? Who decided that was worth such a dedication of scarce resources?

    With treatment on demand, odds of reaching anyone facing substance challenges are very low. Interventions do not generally work. People have to pull out of it themselves or suffer the often deadly consequences. Without treatment on demand, this is just a funding treadmill.

    And WTF, Yet Another East Bay Itinerant Nonprofiteer, moving from agency to agency? This is further colonization right here, housing, social services, substance maintenance. None of it is taking the slightest step towards alleviating the shit lives that drive people to destructive behaviors because that would put them out of jobs.

    How about we restore SSI for addicts, re–program Prop C moneys into substantial cash grants as reparations for the economic crimes of the market that imposed homelessness and see if that does better than the nonprofit patronage network that replaced it SSI in SROs for addicts? Instead of safe injection sites, how about City provided heroin, does and quality controlled? People like Haney will support this in 10 years time when the center has shifted. Why not start now and get it right earlier?

  4. Addicts don’t want treatment, they want to be addicts. 12 Step only works 5% of the time because that is the ratio of people who actually want treatment, and those are the only people for whom treatment is effective.

  5. “A 42-year-old man who asked to be called JT “gifted” crack to a friend of his while sitting in a plastic chair at 16th Street near Mission on a Friday afternoon. One of his arms was broken (from punching someone, he says), and he was using the other to eat fried chicken from KFC that his friend had just brought over.

    JT says he doesn’t want anyone to die, especially in his neighborhood. “Because that brings the police,” he explains.

    Just around the corner, the DOPE Project gave away harm reduction supplies including clean needles”

    Parasites and the people who enable them. A demon’s duo.

  6. Seems as though we should continue to head towards legalizing more drugs so they can at least be sold in regulated formulations less likely to kill you. Probably a Brave New World scenario with a percentage of people zoned out on legal narcotics (as many are already on legal alcohol), maybe less visible in their rooms or drug-taking facilities. Not inspiring, but less deadly than the present, so a higher percentage of lost souls may at least have a chance to escape from it.

    1. Great idea, as long as they are deployed in defined containment zones far from good citizens. Just like casinos are located now. They used to be illegal too.

  7. “senior director of capacity building and community mobilization at the National Harm Reduction Coalition”. No doubting this position comes with a nice salary and fringe benefits etc. Of course there need be harm in this world to justify its existence, the more the better. So they go out and scale things up through “harm reduction”. What a scam on the backs of addicts and this town.

  8. How can the reporter not see the dissonance in her own story? One source says addicts can’t get into treatment because of “hoops” and “lack of outreach.” The reporter then goes on to cite numerous sources at non-profits that do outreach to drug users all the time, including a needle distribution site where addicts come willingly! So where is the critical eye on whether all these non-profits are actually effective at harm reduction, and helping addicts get into treatment? Most of the sources are quick to blame the city or other people for what’s missing, without acknowledging that they are taking resources too. Where is their accountability?

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