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How SF Hopes to Make This Critical Opioid Addiction Treatment More Available

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A bottle of the prescription pain medication buprenorphine. It is one drug used to treat people with opioid use disorder. (Joe Raedle/Getty Images)

View the full episode transcript.

Less than half of all San Francisco pharmacies carry buprenorphine, one of the most powerful medications used to treat opioid addiction, according to San Francisco’s Department of Public Health. The city hopes to change that. 


Episode Transcript

This is a computer-generated transcript. While our team has reviewed it, there may be errors.

Ericka Cruz Guevarra: I’m Ericka Cruz Guevarra, and welcome to the Bay. Local news to keep you rooted. There are lifesaving medications that can help people suffering from addiction, stay sober, but it can be hard for people to access them. And in- San Francisco, which experienced its deadliest year of drug overdoses in 2023, less than half of pharmacies in the city make a lifesaving drug called buprenorphine available.

Matt Dorsey: Anyone who makes the brave and difficult decision to seek recovery from opioid use disorder is really in a race against the clock, and if that drug is not available, we know that there are life threatening drugs that are abundant on San Francisco streets.

Ericka Cruz Guevarra: Federal and state officials have attempted to lower the barriers to critical opioid treatments like buprenorphine, but San Francisco hopes to take it a step further by requiring pharmacies to carry the drug. Today, how expanding access to buprenorphine can help the city’s drug overdose crisis.

Sydney Johnson: Last year was the worst year on record for overdose deaths in San Francisco.

Ericka Cruz Guevarra: Sydney Johnson is a reporter for KQED.

Sydney Johnson: There were 810 people who died of accidental overdose, according to data from the office of the Chief Medical Examiner. San Francisco has seen a higher rate of overdose deaths per capita compared to a lot of other places in the Bay.

Sydney Johnson: But really, the entire West Coast is experiencing a surge in overdose deaths right now. Oakland. Alameda, you know, certainly other parts of the Bay are experiencing this crisis, too. Most of the overdose deaths have been involving fentanyl, which is an opioid about 50 times stronger than heroin.

Sydney Johnson: It’s sometimes mixed intentionally with other drugs like methamphetamines and sometimes not intentionally. And we see the repercussions of that on both ends.

Ericka Cruz Guevarra: I mean, what do we know about what works when it comes to treating an opioid addiction? Like, what is that process look like for people?

Sydney Johnson: First of all, addiction is so personal to each individual and so is treatment. So I think when we’re talking about any kind of treatment or, you know, what works, it’s important to recognize that and also to recognize that relapse is such a common part of people’s recovery journey.

Sydney Johnson: So all that aside, there are a few different types of opiate addiction treatment. There’s residential treatment options counseling, peer to peer supports. But there’s also these proven treatments that are used to assist in recovery. And you know, these are just medications.

Ericka Cruz Guevarra: Yeah. What are those. What are these medications and drugs that we know really help people fight their opioid addiction.

Sydney Johnson: So the Food and Drug Administration has approved three different medications to treat opioid use disorder. It’s buprenorphine methadone and naltrexone. And all three of those have been found to reduce opioid cravings and withdrawal.

Sydney Johnson: And they’re widely considered to be powerful tools for recovery when combined with things like more counseling and social support, like housing and things that, can really influence someone’s ability to stay in recovery.

Ericka Cruz Guevarra: And I know your story focused specifically on buprenorphine. Why this drug?

Sydney Johnson: It’s been identified that buprenorphine is pretty underutilized under prescribed and under available. And that was something that now the city is trying to take some action in addressing.

Ericka Cruz Guevarra: So it’s what sounds like a really important drug for people suffering from opioid addiction and helping folks address their addiction. What does this drug look like exactly? How do you take it?

Sydney Johnson: Yeah. You can take it as a pill. It comes as a tablet. Or it can also come as a film, which is sort of like placed under the tongue for this quick absorption, you know, rapid response.

Sydney Johnson: There’s also an option to get slow release monthly injections. And, you know, this is a drug that is covered by insurance. You know, it’s very common. And people can sometimes stay on it for a very long time.

Ericka Cruz Guevarra: Let’s say you are someone living in San Francisco, and you decide that you are ready to seek treatment for an opiate addiction. How hard is it to access drugs like buprenorphine?

Sydney Johnson: A lot of pharmacies across the whole city, and really across the whole state, don’t carry enough buprenorphine to actually fill those prescriptions in a single day. If someone were to walk in and decide that they were ready to do that.

Sydney Johnson: So, for example, in San Francisco, where more than 3000 people have died of overdose since 2020, less than half of all the retail pharmacies carried buprenorphine and were able to fill a two week prescription within the same day within the years 2021 to 2022. And that was according to a survey by the city’s Department of Public Health.

Sydney Johnson: You can imagine if you have made it to this point where you’re going to get a prescription, go to get it filled, only to find out that the pharmacy that you’re at doesn’t even carry it, won’t be able to fill it. You know, that can be a really critical time period of trying to engage someone in this whole process. But fewer than half of the city’s pharmacies are able to meet that demand right when people need it.

Ericka Cruz Guevarra: Yeah. And it’s not just buprenorphine. I mean, some of these other drugs. So we’re talking about that really help people out of their addiction are also, in some cases, hard to get. Right.

Sydney Johnson: Right. And really, this is a very similar story here. There are barriers to accessing methadone, such as being required to go in person every day to take your dose. Maybe that’s helpful for some folks, but for people who maybe have been on methadone for several years, you know, they know their doctor well, they know the routine. Maybe it’s actually a huge hang up to have to go to a clinic every single day to do that.

Matt Dorsey: Anyone who makes the brave and difficult decision to seek recovery from opioid use disorder is really in a race against the clock.

Sydney Johnson: Supervisor Matt Dorsey and a handful of other San Francisco supervisors have noted that this particular issue, the lack of access to medication based treatments for opioid use disorder, is a real hang up for the city’s approach to actually trying to curb the rates of overdose that we’re seeing right now.

Matt Dorsey: And if that drug is not available at the pharmacy where you expect it to be. We know that there are life threatening drugs that are abundant on San Francisco streets. So it really is a life and death crisis. And I think ensuring the availability of buprenorphine at all of our retail pharmacies can go a long way to facilitating access.

Ericka Cruz Guevarra: Coming up. Why it’s so hard to get medication for addiction. Stay with us.

Ericka Cruz Guevarra: I mean, between buprenorphine and methadone and some of these barriers that we’re talking about. How would you maybe summarize why these barriers are there in the first place?

Sydney Johnson: Opioid addiction treatment medications have been around for a while, but for decades have been really, really highly regulated. There are reasons behind that. And one of them is that methadone and buprenorphine are technically opioids. They do not lead to overdose in the same way that other opioids have shown.

Sydney Johnson: However, that certainly carries a lot of concern and stigma. You know that this is a type of drug that you’re giving to someone who has problematic use with. And so historically, the federal government has kept these drugs, even ones that are meant to treat opioid use disorder, in really tight control.

Sydney Johnson: I actually met one woman who has been in recovery for several years now. And she takes buprenorphine. And the first time that she got it, she had tried to get it from her doctor, but wasn’t able to the first time and ended up getting it from an illicit market.

Ericka Cruz Guevarra: And what’s been done to lift some of the barriers to access for these lifesaving drugs nationally.

Sydney Johnson: So this year, the federal government agreed to remove a requirement for practitioners that required them to complete additional training that allowed them to obtain this special waiver before prescribing opioid addiction medications.

Sydney Johnson: And these regulations also allow for people to take home their medications rather than showing up daily when that’s appropriate. And for practitioners to be able to just prescribe larger doses and to be able to prescribe doses remotely via telehealth.

Sydney Johnson: So in response to these federal changes at the state level, Assemblymember Matt Haney, who represents San Francisco, has also proposed a bill that would align California law to these federal regulations to reduce those barriers to treatment. And this week, a handful of city leaders here in San Francisco said that they would go one step further and actually require pharmacies to stock the medication.

Ericka Cruz Guevarra: Is this normal to require pharmacies to stock a medication like buprenorphine?

Sydney Johnson: My understanding is that this is the first piece of legislation of its kind, where a city would require local retail pharmacies to stock any particular medication, at least coming from the metro level like this.

Ericka Cruz Guevarra: And this was done in San Francisco with naloxone last year as well. Right?

Sydney Johnson: That’s right. Last year, Supervisor Matt Dorsey proposed a similar piece of legislation to require pharmacies to carry naloxone, which is now actually over the counter. And that, he said, was very important also because naloxone is this really powerful medicine that can reverse an opioid overdose.

Ericka Cruz Guevarra: I mean, Sydney, what do we know about how much giving people access to these drugs actually increases their likelihood of surviving a drug addiction?

Sydney Johnson: So people who use medication assisted treatments, you know, like methadone or buprenorphine, were 80% less likely to die of an opioid overdose compared to people in treatment without the medications. That was according to a 2020 study in the medical journal addiction. These have a lot of potential to reduce the likelihood of overdose and really save lives.

Ericka Cruz Guevarra: I know so often, San Francisco becomes like a city that people are watching to see how we address homelessness, how we address the drug crisis. I mean, even though this is really being, I guess, led in San Francisco, what benefits or what impact could this have for the rest of the Bay area when it comes to how we address the drug crisis? Regionally.

Sydney Johnson: One thing San Francisco, I think is doing is at least trying to add more public health strategies to increase access to buprenorphine and methadone. And I think other cities and counties could learn from just San Francisco actually investing in this public health approach.

Sydney Johnson: There have been decades of underinvestment in this space in general. I think that other cities and counties can look at San Francisco and say, hey, this is a proven treatment. This is something that has a lot of evidence. What can we do to actually make it easier for people who want and can benefit from this?

Sydney Johnson: Because of course, this isn’t going to help everyone and, you know, fix everyone’s addiction. Who struggles with that? But how do we make sure that this is an option for the people who need it?

Ericka Cruz Guevarra: Sydney. Thank you so much.

Sydney Johnson: Of course. Thank you.

Ericka Cruz Guevarra: That was Sydney Johnson, a reporter for KQED. This 30 minute conversation with Sydney was cut down and edited by producer, Maria Esquinca. Ellie Prickett-Morgan is our intern. They scored this episode and added all the tape. Our senior editor is Alan Montecillo.

Ericka Cruz Guevarra: Additional production support from me music courtesy of the Audio Network. The Bay is a production of member supported KQED in San Francisco. I’m Ericka Cruz Guevarra, thanks for listening. Talk to you next time.

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