San Francisco, CA — Mayor London N. Breed today announced the proposal to fund a new Street Overdose Response Team (SORT) to help stem the rise of overdose deaths in San Francisco. SORT is an immediate, street-based response for people experiencing homelessness who have recently experienced a non-fatal overdose to be engaged in the behavioral health system of care. SORT is part of San Francisco’s system of Street Response Teams, including the Street Crisis Response Team and the newly proposed Street Wellness Response Team.

Early analysis of local data suggests more than 50% of individuals who died from an opioid overdose in 2020 had prior contact with San Francisco Fire Department EMS personnel in 2019 and 2020, which makes the Fire Department uniquely positioned to handle the immediate response. For follow-up care, a more specialized care team will be required. Clinical team members from the Department of Public Health (DPH), depending on the client’s needs, will include a mix of peer specialists, medical specialists such as nurses; and behavioral health specialists such as counselors and psychiatrists. This multi-disciplinary approach will address the client in a holistic way to allow for maximum success of the individual and their care coordination. SORT is for people who have experienced a non-fatal overdose. SFFD Emergency Medical Services will still be dispatched to intervene in calls for an overdose in progress. 

“The overdose crisis on our streets requires a wide range of approaches, including meeting people where they are in the moment when we can get them the help they need,” said Mayor Breed. “By getting to people immediately and then being consistent with our follow-up, we hopefully can get them on the path to stabilization and to recovery. This, of course, needs to be paired with broader efforts to prevent overdoses from happening in the first place, and that is why we are continuing to increase the number of treatment beds and outreach efforts for people in crisis.”

In 2020, exacerbated by the COVID-19 pandemic, the number of overdose fatalities on our streets reached a historic high of 699 accidental overdose deaths. Synthetic opioids, such as illicitly manufactured fentanyl, are a primary driver in overdose deaths both nationally and locally. According to new data published by the Centers for Disease Control and Prevention, more than 87,000 Americans died of drug overdoses between September 2019 and September 2020, the highest ever recorded since the opioid epidemic began in the 1990s. People who survive an opioid overdose are two to three times more likely to die from fatal overdose than people who use drugs who have never overdosed.

The SORT pilot is poised to successfully tackle overdoses; unlike most passive engagement models where clients are required to seek out care and self-present at a clinic or rehabilitation center, the SORT team will build on DPH’s proactive Street Medicine care model to actively identify, engage, and follow-up with people experiencing homelessness with substance use disorders. 

“DPH is pleased to further build on the innovative and successful model of the street response teams -- this time with a team targeting the unique needs of people on the streets who have survived a drug overdose,” said Director of Health, Dr. Grant Colfax. “This is a critical window of time when we can offer people life-saving medicine, show them that we care and have services on hand which they can access right then and there, and use it as an initial point of engagement in ongoing clinical services.”

“In 2020, the SFFD responded to thousands of opioid related encounters in which Narcan was administered. All too often these encounters ended in overdose death,” said San Francisco Fire Chief Jeanine Nicholson. “As SFFD members already provide life-saving treatment to those in acute overdose, it will be operationally seamless to have community paramedics of the Street Overdose Response Team outreach to and assist those struggling with addiction.”

The Street Overdose Response Team will require an investment of $11.4 million over two years, and will consist of: 

• Two Response Units: Provide real-time response to individuals who have experienced a recent non-fatal overdose and are identified to have an opioid use disorder. This will be an opportunity to provide initial treatment and prevention tools, including medication assisted treatment.
• Three Follow-Up Units: Engage clients within 72 hours of the initial contact from Response Units to provide continued care including withdrawal management, long-term treatment referral, physical and mental health services, as well as shelter and housing.
• Supervisory Team: Oversee field operations, provide clinical oversight, and maintain a centralized care center for engaged clients.

If this team is approved in the Budget when it is finalized at the end of July, they would begin the operational planning, developing protocols—including risk assessment and dispatch—and launch at least one team by August 1, 2021. 

San Francisco’s System of Street Response Teams

SORT will work alongside the Street Crisis Response Team, which is already operating, and the Street Wellness Response Team, which is also part of Mayor Breed’s proposed budget. The City is advancing a number of workforce training programs to create employment pipelines for these teams, with the goal of creating a diverse workforce and Street Response Teams that reflect the community they serve.

The Street Crisis Response Team launched in November 2020 to change the way San Francisco responds to non-violent, mental health crises on our streets. The SCRT pilot program offers a unique model for the nation with a behavioral health and harm reduction approach to people in distress. Each SCRT neighborhood team consists of a paramedic, a behavioral health clinician, and peer health worker.

The Street Wellness Response Team will consist of community paramedics and EMTs from the San Francisco Fire Department and Homeless Outreach Team members from the Department of Homelessness and Supportive Housing. They will be dispatched to well-being checks and situations that require immediate attention, but do not meet the threshold of an acute behavioral health crisis. This includes situations such as someone with obvious wounds, people who are lying down or sleeping, or someone inappropriately clothed for the weather.

Overdose Prevention Efforts

SORT will work in conjunction with other efforts to curb overdoses and prevent people dying from drug overdoses. San Francisco has already taken major steps towards enhancing overdose prevention programs, including the recently announced plans to open a drug sobering center in the South of Market neighborhood later this year. This center will enhance community safety by providing a place where people can recover off the street from methamphetamine, opiate and other drug intoxication and be connected to care. 

The City has been advocating for changes to the laws in order to implement Overdose Prevention Programs, which have shown promise in Europe and Canada in curbing overdose and improving treatment acceptance. Senate Bill 57 proposed by Senator Scott Wiener, which would bring life-saving overdose prevention programs to California by way of a 5-year pilot program that includes San Francisco, passed the Senate in late April and will be heard in the California State Assembly. 

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