At needle exchange sites around San Francisco, fliers are handed out to intravenous drug users warning them about a new and very potent form of heroin thought to be responsible for a dramatic increase in recent overdoses.
"Gunpowder heroin," as it's often called on the street, began infiltrating the city's illegal drug market back around February, according to widespread reports from various needle exchange participants. Yet public officials appear to be in the dark about the epidemic, partly because budget cuts have created long backlogs for toxicology tests and partly due to indifference about the safety of drug users.
The reports were gathered by the Drug Overdose Prevention and Education Project from their network of needle exchange programs and analyzed by Project Manager Eliza Wheeler. She noticed the trend in April, and a flood of reports followed through May. It soon became clear that she was witnessing a potentially deadly spike in heroin-related overdoses.
"The whole city is reporting strong stuff," Wheeler told us. "People are overdosing left and right."
From January through May, 99 heroin-related overdoses were reported. The largest number of overdoses occurred in May with a staggering 40 reports. Wheeler says that an average month has 12 overdoses.
While those directly involved with San Francisco's drug-using population seem to know all about the increase in overdoses, city and hospital officials seem to know nothing about it.
After checking with local police precincts in drug zones such as the Mission and Tenderloin, SFPD spokesman Sgt. Michael Andraychak told us officers haven't come in contact with a strong batch of heroin and they are unfamiliar with the term "gunpowder heroin."
According to Tenderloin Police Captain John Garrity, undercover and street officers only test controlled substances for positive or negative results. They do not test the drugs' potency or chemical make-up. Garrity told us that the cops haven't dealt much with opiate-related overdoses since the widespread availability of naxolone, an opiate overdose antidote commonly known by its brand name Narcan.
"We don't see the overdoses anymore," Garrity told us, "not for the last 20 years, not since Narcan came out."
SF General, St. Mary's, and St. Francis hospitals all say their emergency rooms haven't seen an increase in heroin overdoses either and are also unfamiliar with the term "gunpowder heroin."
It seems the city is content with letting nonprofit needle exchanges and programs like the DOPE Project deal with its opiate-using population. Although the DPH does fund and collaborate with many service providers, it rests the bulk of the responsibility on the drug users themselves.
While needle exchange programs combat blood borne diseases like hepatitis C and HIV, which can be contracted through sharing needles and other paraphernalia, DOPE attempts to educate users and prevent fatal opiate overdoses. The DOPE Project, funded through DPH, works with needle exchange programs to provide opiate users with a take home prescription of naloxone, which can be administered from a nasal spray or injected from a vial. At the exchange, if a returning drug user is re-supplying naxolone, he or she is asked "Did you lose it or use it?" If it was used, a report is made.
All the reports gathered by the DOPE Project are of overdose reversals, none of the reports are fatal, thanks to widespread availability of naxolone and the drug using population who use it. That doesn't mean people haven't died. In fact, a rash of fatal overdoses is rumored to have occurred. The suspected culprit: gunpowder heroin.