(a) According to the U.S. Centers for Disease Control and Prevention, overdose deaths remain a leading cause of injury-related deaths in the United States, and the majority of overdose deaths involve opioids. From 2000 to 2015, more than half a million people died from drug overdoses across the United States. In 2021, more than 71,000 people died from synthetic opioid-related drug overdoses in the United States. On October 26, 2017, the U.S. Department of Health and Human Services declared the opioid crisis a national public health emergency and has renewed such declaration every 90 days since 2017.
(b) According to the California Department of Public Health, based on preliminary data, there were 6,843 opioid-related overdose deaths in California in 2021; 5,722 of these deaths were related to fentanyl, and 224 of the fentanyl-related overdose deaths were teens, ages 15–19 years old.
(c) According to the San Francisco Office of the Chief Medical Examiner, there were 647 accidental drug overdose deaths in San Francisco in 2022, and over 70% of those deaths were attributable to fentanyl. pPreliminary preliminary1
reports indicate there were 813 accidental drug overdose deaths in San Francisco in 2023, a 25% increase from 2022, with more than 80% of those deaths attributable to fentanyl.
(d) Naloxone and other opioid antagonists are life-saving medications that are used to reverse a drug overdose. They are safe to use, work almost immediately, and are not addictive. According to peer-reviewed articles published in the journals “Drug and Alcohol Dependence” and “JAMA Internal Medicine,” state laws allowing pharmacist dispensing of naloxone have been associated with a 53% increase in naloxone dispensing, and a significant reduction in overdose deaths. The California Public Health Officer has issued a standing order to allow pharmacies, community organizations, and other approved entities to distribute prescription naloxone and allow for the administration of prescription naloxone by a family member, friend, or other person, to a person experiencing an overdose.
(e) On March 29, 2023, the U.S. Food and Drug Administration announced that it approved NARCAN®, a four milligram (mg) naloxone hydrochloride nasal spray, for over-the-counter, nonprescription use. It is the first naloxone product approved for use without a prescription.
(f) Despite the efficacy of naloxone and other opioid antagonists, and the fact that pharmacy distribution of naloxone is the second-most effective way—after community distribution—to provide naloxone to people most likely to use it and reverse an overdose, naloxone remains largely inaccessible.
(g) Buprenorphine is a medication approved for the treatment of Opioid Use Disorder (“OUD”) and reduces the risk of dying from use of opioids by up to 50%. Buprenorphine can be prescribed by physicians, nurse practitioners, and physician assistants who have a Drug Enforcement Administration (“DEA”) license, as well as pharmacists with a DEA license (and who have state authority to prescribe controlled substances independent of a physician). The medication can be prescribed in an outpatient setting (in person or via telehealth) and dispensed at retail pharmacies. Recent federal legislation (Section 1262 of the 2023 Consolidated Appropriations Act) removed requirements for practitioners to obtain specific waivers to prescribe buprenorphine for the treatment of OUD. Despite these efforts toward accessibility, data show that retail pharmacy availability is a significant barrier to distributing buprenorphine to patients in the community.
(h) According to a peer-reviewed 2022 article published in the “Drug and Alcohol Dependence” journal, between May 2020 and April 2021, only 31% of California pharmacies stocked buprenorphine, limiting access for those who seek the medication for OUD treatment. To understand the impact on San Franciscans, in January 2024, the Department of Public Health’s Office of Overdose Prevention conducted a survey of all retail pharmacies in San Francisco. When surveyed, only 37 of 84 responding pharmacies (44%) were able to fill a day-of prescription for a 2-week supply of buprenorphine. Of the 47 pharmacies that did not have buprenorphine in stock at the time of the survey, just 17 (36%) indicated that they would be able to fill a prescription within one business day.
(i) Same-day access is particularly critical for Medication-Assisted Treatment (“MAT”) of OUD. Any delay is a missed opportunity to get someone started on this lifesaving treatment. Ensuring that individuals can immediately obtain buprenorphine at their local pharmacy will contribute to citywide goals of increasing the number of patients on MAT and reducing overdose fatalities.
(j) The Board of Supervisors hereby finds that the public interest is served by ensuring that retail pharmacies in San Francisco stock a minimum number of opioid antagonists for purchase and a minimum number of buprenorphine doses to fill new prescriptions.
CODIFICATION NOTE