By Dr. Susan Ehrlich, CEO, ZSFG

The title of the editorial in this month’s Scientific American said it all: “Drug Overdose Deaths in 2020 Were Horrifying: We need radical change in order to address the crisis.”

The statistic prompting that title and the thoughtful piece that followed was this: in 2020 drug overdose deaths in the US hit 93,000 – a 30% increase from the year prior. San Francisco has not been immune to this problem. In 2020 the S.F. medical examiner reported 697 accidental drug overdose deaths, more than twice the number of people who died from COVID-19 (257) during that same period. Thankfully the city has launched a major initiative to address this, Mental Health SF, led by our Department of Public Health. Here at ZSFG, we are an important part of that initiative and have multiple programs to address substance use disorders. This week I wanted to highlight our Opiate Treatment Outpatient Program (OTOP) team, acknowledging the challenges they’ve navigated during the pandemic, and in honor of the incredibly successful regulatory survey they just completed, while in full pandemic mode!

Since its inception almost 50 years ago, OTOP has used a combination of medication treatment, counseling services, harm reduction services, psychiatric care, specialty HIV care, and on-site hepatitis C treatment to address the many needs of our fellow S.F. residents. The program’s reach is stunning: in the fiscal year 2020-2021 OTOP dispensed over 165,000 doses of methadone or buprenorphine and provided 8,300 hours of substance use counseling. OTOP dispenses medication to about 300 people each day.

Like everything else on campus, COVID presented a dramatic challenge to this team’s operations, that pre-pandemic operated in a very crowded space in Building 90. In just a few weeks in March 2020, OTOP and the hospital set up a private and COVID-safe outdoor dispensing site in a small parking lot on the hospital campus which serves 250 patients/day, including weekends and holidays. This required huge changes in equipment, staffing, and clinical practices, but ultimately was well received by our patients who appreciated having a safe way to continue their treatment. OTOP set up indoor and outdoor specially designed telehealth booths to facilitate intake, medical visits, and counseling. Staff took on new roles, braved the outdoors in all kinds of weather, and made patients comfortable despite the new technology and less face-to-face contact.

And this team didn’t stop at our own site. OTOP doctors and nurses have made over 580 deliveries of methadone or buprenorphine to patients in COVID isolation or quarantine since the start of the pandemic. Medication was delivered to patients at their homes, in isolation and quarantine hotels, and on closed units like Medical Respite.

Along with the rest of our ambulatory sites, OTOP transitioned most counseling services to telephone and telehealth, and through help from a generous donor, was able to provide hundreds of cellular phones to patients who did not have them.

With all this change in practice, OTOP masterfully completed a very successful regulatory survey with the Drug Enforcement Agency. Please join me in congratulating the OTOP team for all that they do and have done to serve our patients and save lives.