And this hearing is really useful in that part. I hope this is one of many hearings that continue to ask the department for more, for working with other agencies and for doing the good work they are doing. Theyve done really good work. When you look at just c. I. T. In general, use of force, theyve done much, much better. I know there was a recent officerinvolved shooting, but its been a year and a half since the last one. And two and a half years since the last Mental Health officerinvolved shooting. Thats remarkable compared to the way it used to be. I think c. I. T. Works. And i applaud the work of the professional accountability and standards. Theyre doing really good work. [bell dings] and thank you for this hearing. Ill cede the rest of my time. Thanks. Clerk thank you. Next speaker. Hello. A number of years ago i saw an individual, a middle aged San Francisco homeowner, a brain cancer survivor being stopped, questioned, searched and arrested while he had been walking his bike to to gallonnen gate park. The officers claimed that they wanted to search for potential warrants across the bay. His drivers license lists his San Francisco address. There was actually no reason to associate him with the east bay. And the arrest was unwarranted, unjustified and unlawful in my opinion. And the officers were actually being you know, they were being immature, thats why i said that, they need better training sometimes. Clerk thank you. Are there any other members of the public who would like to speak on the item before i close Public Comment. Seeing none Public Comment is now closed. [gavel] supervisor walton, it is your unless you have any concluding remarks . Supervisor walton just briefly. Clerk yeah. Supervisor walton one, i definitely want to thank director henderson and his entire team for the presentation this morning. It really is evident in terms of the inequalities that exist across departments. And at least the feeling of Public Safety about how important d. P. A. s role is. Its a very Important Role and it needs to be recognized accordingly across the city, both in resources and in terms of how we treat the department of police accountability. So we will continue to be having those conversations. And i stated in Public Comment, there have been some shifts in terms of officerinvolved shootings in certain incidents. We still have a long way to go in terms of use of force. Use of force complaints. Of course, the disproportionately of people of color who are involved in those complaints and how we address those, as we move forward. So do want to thank you for the information provided, the quarterly reports, the annual reports. But i would like to continue this to the call of the chair, because we will bring d. P. A. Back, as well as Police Department and other Public Safety providers to have a more full conversation, as we continue to adjust the issues that exist around police accountability. Clerk so i hear a motion from supervisor walton to continue with the call of the chair. We can take that without objection. Mr. Clerk, please call our next item. Kick a resolution declaring a Public Health crisis on Drug Overdoses and drug use and urging the department of Public Health to present a comprehensive plan on how to address the crisis. Supervisor haney has joined us. Supervisor haney, this is your hearing. Supervisor haney thank you. Thank you, chair mandelman, and committee members. Im going to just provide some introductory remarks to open the hearing and ill pass it off to our friends from the department of Public Health. I want to also recognize and thank all of the folks in the room who are here for this hearing. And especially the people who are here from the organizations who are working on this issue every day and who are saving lives. I want to recognize the dope project, San Francisco aids foundation, glide, st. Anthonys, drug users union, the drug policy alliance, r. T. I. International and health right 360. I want to thank again them for their partnership and all of the work that they do. I also want to ha thank the many residents and neighbors in district 6, who have reached out with concern, urging my office and the city to take greater action. I think ive had over 20 meetings across the district where this was the main topic. And im glad that were here today to be able to talk about solutions. You know, i think theres a lot that we are proud of in our city. Theres a lot that i see in my district that inspires me and all of us around folks who are taking action for their neighbors who are in need. And relieving suffering. But theres also things that we need are serious challenges, that we need to respond to more urgently and more seriously. There are people in our neighborhoods that are suffering alone on the streets. There are Small Business people who are struggling to stay open. There are people who need treatment, health care and housing, who are unable to access it. And there are people that are dying nearly every day in our city from Drug Overdose. Its critical that when we have something that is of such a concern, especially in a city that is as caring and is as committed, we respond to it with the urgency and seriousness to save lives and make sure we are providing care for people who need it. So with this resolution is recognizing this crisis and taking a stand to be unified, committed to call our drug use and Drug Overdose crisis what it is, a Public Health crisis. And demand an Emergency Response. The Overdose Deaths in our city have increased this year and last year. And each loss of life is unacceptable and devastating. People in our city are dying from fentanyl, meth and heroin overdoses at the highest rates ever. This drug crisis is impacting all of us in our downtown neighborhoods in particular. And nearly every day i hear from constituents about how drug dealing, drug use and Drug Overdose are impacting their lives. I receive hundreds of constituent calls and emails on a weekly basis. And generally the sentiment is similar of concern. Some of the things, just quoting from things that i received, how can a wealthy firstclass city like San Francisco leave people to languish and suffer on the sidewalk. Why is it hard for people to get people the health they need. Can we ring the alarm to get more state funding. In 2018, Drug Overdose in San Francisco claimed the lives of 259 people. Fentanyl Overdose Deaths increased 150 in 2018. And Drug Overdose deaths accounted for five times as many deaths as either traffic deaths or homicides. This is despite the heroic work our advocates and outreach workers do every day. They save literally thousands of people on an on an annual basis, reversing overdose. This is a Public Health and Public Safety crisis. And we need to respond accordingly. The impact of these deaths and of drug use weighs heavily on my constituents, who want and deserve safe straight street. Those suffering from addiction are also persecuted by the stigma against the disease. As a community, we need to act boldly and compassionately in dealing with substanceuse disorder and Drug Overdose. What were going to hear today is what this Emergency Response will look like, both what were doing and what more we can do. We can no longer accept business as usual. We need comprehensive Actionable Solutions that address the core issues and change the status quo. There are a set of things that ive asked for the department of Public Health to respond to specifically, in terms of what we are doing and what we can do more of. What we know is that we that every day people are abandoned on our streets or cycle in and out of emergency rooms. We lack the intensive Case Management to ensure people dont fall through the cracks. And we need to support the folks who are doing the outreach on the streets every day, with what they need to respond to this crisis. So the seven things that the department of Public Health will be addressing today is how to improve the overall response in outreach to people who may be using drugs, in psychosis or potentially overdosing. Secondly, efforts that d. P. H. Has made access to narcan. One thing that we know is that an opioid overdose can almost universally be reversed by the administration of naloxone. And naloxone is are you teenlied a routinely administered by Emergency Services personnel, as well as outreach workers and providers, as i said, thousands of overdose reversals every year. Third, what efforts are we taking to expand street outreach and use data that we receive on a regular basis to respond more effectively. Fourth, provide regular reporting of overdose and Overdose Deaths and how this data that were collected is used in the responses that were taking as a city. Fifth, how does d. P. H. Plan to increase and support frontline Emergency Responders and Public Safety personnel. Sixth, what has and what is a d. P. H. Doing to identify and establish emergency, detox and dropin facilities. And, seventh, any potential support from state or federal resources. I also want to say that we recently passed Mental Health s. F. , which will transform the way that we are coordinating peoples care and treatment, as it relates to substanceuse disorder. And so we may want to hear some also about how some early steps that we might take will address that. I know folks have asked also about more issues related to streetlevel drug dealing. This hearing is specifically more on how we are addressing drug use and Drug Overdose. We created a streetlevel Drug Dealing Task force. Held a sixhour hearing around drug dealing and have a number of things that are happening around that. But this is specifically focused on department of Public Healths response, which has been meeting this effort and has been a National Leader in how weve responded currently and in the past. And specifically with the work of the dope project. And, you know, im excited to learn from what were doing. But also, you know, wanting to and weve spoken a lot about this to dr. Colfax, knowing what we can do as a board of supervisors, as the elected representatives to support the work and to ensure that were responding with the urgency and the breadth that we require to ensure that in the future were not that things dont continue to go in the direction they are. So with that ill turn it over to eileen from the department of Public Health. And again i just really want to thank you for your commitment and your work and your partnership, since ive been in office. Its really been a pleasure working with you and im grateful for the work that you do. Thank you before you start, we gave you ten minutes for this. Ill be talking really fast. So, good afternoon. And thank you so much for providing us the opportunity to come and speak about our efforts, that address the resolution. My name is eileen lockran. I work with the department of Public Health, in a branch called Community Health equity and promotion. I work directly with communitybased programs that work with people who use drugs and or are experiencing homelessness. So im here with my colleagues today, dr. Phillip coffin and dr. Judi martin. And we will be able to answer your questions at the end. But for the sake of time, were hoping that we can just go through the presentation, which will address the issues that are outlined in supervisor haneys resolution. So the overview, as i said, will just address the issues that are outlined in the resolution. So well just jump in right now with the data. So as supervisor haney nicely summarized, we had essentially a flat number of Drug Overdose deaths. If you look at the chart, the top of the lines is going to give you the total number of opioid, cocaine, methamphetamine deaths in San Francisco each year. Essentially flat through 2017 and increases in 2017 and 2018. If you look at the bottom line, that go up through the careen, those are opioid Overdose Deaths. In the purple, yellow, red is cocaine and methamphetamine deaths. Cocaine and methamphetamine deaths essentially have been stable as a combined entity. Theyve just shifted from cocaine to methamphetamine. These are cardiac or cerebral vascular events. The opioid deaths were also flat, i think in large part to the amazing work by our providers and teams in the community. And people who use drugs on the street, that have reversed so many overdose events. The increase is entirely attributed to fennels. As you can see on this slide, our prescription Overdose Deaths have declined, heroin Overdose Deaths have increased somewhat. The real increase, the jump is in fentanyl deaths over the last two years. There isnt you know, its remarkable that we made it through the Opioid Crisis without an overdose death. Theres no community that i know of, even with far more flexibility in services they can provide, like say vancouver, that survives the introduction of fentanyl unscathed. It is it is a challenging new drug on the street to manage. The project provides naloxone to lay people for overdose reversals. The number of reversals have gone up each year in a pretty remarkable fashion. Theyre on course for further increase this year. 30s are reversals done mostly by people who use drugs for because theyre the people most likely to be present in the event of an overdose. Weve see an increase in the amount of naloxone administered by emergency medical services. I do want to say about the mortality data, we obtain that from the drug reporting system. This comes from the medical examiners office. It takes the medical examiner generally three to six months to close a case. The other issue with the data is that we have relatively small number of Drug Overdose dates, because were not a large city. The variation in Overdose Deaths from month to month is tenfold. Theres a lot of instability in the numbers, which is why we report on an annual basis at this time. So San Francisco has a harmreduction policy. And its been in effect for over a decade. And thats the philosophy of really working with the individual to address their needs, to include them in their in any sort of service and care. One of the important things to recognize is that Harm Reduction is a continuum. And abstinence is a part of that continuum. And a lot of times people dont recognize that. Some of our very successful harmreduction programming is the syringe and disposal program, our naloxone distribution, medically assisted treatment, which is getting people started on often in the streets and the field in our Outreach Team and the sobering center. Syringe Access Programs are really a gateway to services, a way to engage people into care. Because we need to recognize that one type of service does not work for everyone. There needs to be different strategies to meet the needs of the individual. Next slide. So im going to share a slide that this slide shows the number of refills. And again this is because of the great work of our partner, the dope project, Drug Overdose project education program. What refills means is that they are coming back to a Distribution Site to get a replacement of narcan. It could mean that they did a reversal. It could mean that their narcan was lost or stolen. But you can see how that has steadily increased from 2003. And when i say Distribution Sites, its not only our syringes access sites, but its other programs that the dope project works really closely with to be Distribution Sites. For example, st. Johns church in the mission or Mission Neighborhood resource center. There are Access Points for this. Another thing is the jail prerelease, where individuals who are incarcerated are able to get narcan put on their property, prior to release, if they have a history of opiate use. Most recently there is project friends. And this is a program with First Responders, who are able to be a distribution and training opportunity. This is through ucsf and San Francisco general. Its federally funded. Next slide, please. So we have many mechanisms that meet the needs of people who u