Im chair of the committee and to my right and supervisor stephani and supervisor walton and were joined by supervisor hainey and i want to thank corwin coolee for staffing this meeting. Mr. Clerk, any announcements . Please make your you have silenced your stones and cell p. Items acted upon will appear on the march 10, 2020 agenda unless otherwise stated. Thank you, are clerk. Please all our first item. An ordinance to require the medical examiner to report information to the mayor, the board of supervisors and the director of health each month regarding deaths from Drug Overdoses. Thank you, supervisor hainey, this item is yours. Yes, thank you, chair. Im here, again, with you, committee to again discuss what we can t do to take action on te most deadly epidemic facing our city which is the Drug Overdose epidemic. Drug use and drug overuse deaths in San Francisco and across california, as we all know have been increasing at a terrifying rate and today, people in our cities are dying from methamphetamine and there were 222 fatal Drug Overdoses in 2017, 289 in 2018 and 330 in 2019 according to thelat the laf data health. Drug overdoses have reached at least 122 in 2018 and theres a 147 increase. The numbers released by the office of the chief medical examiner for the 2019 reveal revealed there were 234 deaths to have involved fentanyl compared to 90 in 2018. These numbers are shocking and they should, as weve discussed here, lead to urgent and immediate and swift action to prevent further loss of life and impact on our city. In San Francisco, Drug Overdose has accounted for five times as many deaths than traffic deaths and homicide. Outreach workers do everyday, such as the Drug Overdose prevention and education project, experts estimate the number of Drug Overdose deaths continue to rise significantly if drastic action is not immediately taken. Theres a lot that we need to do and we were here discussing the declaration of a Public Health crisis and had some plans presented to us from the department of Public Health. Were going to making an announcement today with the mayor about legislation to move forward with Overdose Prevention sites, but what is also clear from all of this is that we need to have the most uptodate information and numbers so that we can respond in realtime to the crisis that were facing, to prevent loss of life. And this data right now for Overdose Deaths is not required to be collected or presented to the public and its not regularly reported. The department of Public Health and the chief medical examiner have been reporting it and in some cases on a sixmonth or yearly basis and this is not some codified into law and what has been clear is that it is far too uncommon for us to know as a possible what were facing and for us to know, also, as policy makers so that we can respond appropriately. Of course, we know and should know in realtime the number of homicides and fatalities but for some reason, were not taking a similar approach to understanding and responding as a public and as city hall around Overdose Deaths. Mortality data can help support Public Health strategies in many ways, finding tools and methods to better collect that information and exchange it more easily as a priority, especially when it comes to the most urgent Public Health emergency. This drug crisis has farreaching impacts affecting families, our workforce, Small Businesses and visitors and i know that it is impacting all of our neighborhoods and were feeling it especially, acutely in district 6. Increasing the timelessness of the data will impact what were supposed to do from Public Health programmes to enforcement to make policy decisions and delivering the Vital Statistics in a more statistic way. I want to say one more thing about what this legislation will do. The current version of it, and well be putting forward some amendments, would require monthly reporting by the medical Examiners Office. After conversations with the medical Examiners Office, the medical examiner says it takes about 90 days to close out about 90 of their cases. So in light of that, well be amending our legislation to reflect reporting to occur every four months instead of monthly to give the medical Examiners Office an appropriate amount of time and we recognise that even after four months, there may be some adjusting thats needed after that. But it is critical that the public knows whats going on and we as policy makers can respond accordingly. I want to quote the chief forensic toxologist for the Examiners Office stating the reason for this legislation better than anyone could. He told the chronicle, we had a feeling throughout the year we were seeing more and more deaths and this is quite staggering and this was the reason why the numbers were released. He said, its important to be accurate and timely, but that the medical Examiners Office didnt want to wait six months. Thats good for reports. Thats not good for public awareness. So with that, we are going to be asking for much more regular reporting. I think this is the right way to do it. It gives enough time, but it does also recognise that there may be some small adjustments to the numbers, but this will give us Vital Statistics that we need. I lastly want to thank the medical Examiners Office, dr. Phil coffin here from the department of Public Health and the Safer Coalition driving this movement and leading this movement around, responding effectively to drug overdeuce anoverdose. Alexi want to thank l and we have amendments today i have highlighted and passed around and the amendments reflect the monthly reporting to every four months and also that reporting be done as an aggregate and we specify the drugs of interest when thele medical examiner provides the report and i believe we have a presentation from dr. Coffin who is here with us today. And i want to thank my cosponsors, as well, supervisor walton, ronen, brown and fewer. Well have a presentation from dr. Coffin. I sent it and it was uploaded. John carroll solving problems. So ill speak a little bit to what i can say is the department of Public Health and i cant say too much in terms of the medical examiner, but ill explain a little bit as to wha how we gatr the data and what were able to see in the mortality data. So when theres a death, it goes to the medical Examiners Office and the medical examiner has a lot of things that they do. One is toxicology and thats one of the key elements to determining an josep overdose dh but not the only element. If somebody a patient in methodone patients, they may have high levels of methodone but that may not be the cause of death. If somebody has prescribed patients, they may have levels of that that are not determined to be causal in their death. They look for signs it might be an overdose death or another cause. They have an autopsy and imaging they look for alternative causes of death and they look the the medical history they contact, for example, a methodone program or other clinics. So its not as simple as a Motor Vehicle fatality. Its a far more complex procedure that takes months to complete. Once they determine multiple things and one is the manner of death, which is suicide, homicide, unintentional or the major categories and we really limit our focus to the unintentional, acute poisoning deaths, because those warrant ae ones we consider, quote, unquote, Overdose Deaths. And they have to attribute the causal drugs. So attributing which drugs are causal in a death is really complicated and not as simple as looking at what drugs are positive for. A toxicology run may have 50 drugs that are positive and the medical examiner may determine one or two of them are actual causal drugs in the death. Over to this one here. And so once that happens, its sent to the Vital Records Office of the department of Public Health and the Vital Records Office, their job is to make sure everything is complete and theyre looking through and helping the medical examiner to help any errors in the report. And then they submit that to california electronic drug reporting system, edrs. And they take two weeks of processing to make it available and thats when we look at data ill show you. Once its in there in the electronic california drug reporting system, its comprehensive. Its comprehensive. And were able to look at things, demographics, able to geocode data and determine where deaths are occurring and things like that. So in terms of whats available at what time when were looking at the data and edrs, if we were to look at mortality in january, if we pulled the data today and looked at mortality in january, we would capture 4 of the Overdose Deaths that occurred in january. If we go back four months, were capturing 65 of Overdose Deaths that occurred at that point in time. Five months, we get 90 , so in general, we look at six months because then were getting somewheresomewhere close to 100t were getting complete data at the sixmonth time point. Thats the delay in reporting. It takes awhile to close the cases and confirm everything. The other issue in terms of reporting is, of course, frequency of reporting and, as you can see here, if we look at data by month, we have from seven to 31 deaths in any given month. If we looked by month, we see things doing terrible, great, terrible great and its hard to make sense of what the data means. Its useful as an electrocardio gram but for mortality tracking, its challenging. Quarterly data is challenging. We have reductions in the 20 , 30 range or increases. Whereas the overall numbers are fairly flat. So since ive been doing this, weve been doing annual reporting and we started doing sixmonth reporting as of this month and this is in part because the numbers are increasing and we dont have a small number now. As numbers get larger, its justified, i think, to do more frequent reporting. New york city, for example, they do quarterrerly reporting and they have about 1600 deaths per year and so they do quarterly reporting with 400 deaths because they feel thats stable enough numbers and they tried doing monthly reporting and because the numbers were too unstable. And so in terms of the sixmonth reporting, this is a report we released a couple of weeks ago. As you can see here, the black line is the total number of deaths and i specify, we near reirerow itnarrowit to opioids. And as you can see here, the numbers are essential, i would argue, flat, until you hit the second half of 2018, and there they jump to 144 deaths and in the first half of 2019, 182 deaths. Now we pulled these data in january of this year and so the second half of 2019 shows 148 deaths and that number will be much higher. I dont know exactly how much higher. Based on Prior Experience been , substantially higher. But what portion are complete, i cant say for sure because things vary based on the case closure time and processing time for cases at the medical Examiners Office, based on various things that may be going on in the given year. The next slide just drills down into opioid deaths. One of the important things when youre looking at Overdose Deaths is not just to look at one drug because theres often multiple drugs involved and, for example, if you just look at here, were looking at fentanyl, the bars you can see on top and that went up to 69 deaths in the first half of 2019. And then at least 93 in the second half of 2019. Heroin deaths are at about 27, which is somewhat of an increase over a couple of years prior but not a substantial increase. This is where fentanyl is not involved and thats the way with generally look at this, so if fentanyl is involved, thats going to kind of take priority, because if thats the one thats determined causal, thats more likely to actually be the cause of death than heroin or prescription opioids which would be the blue bars. So, for example, i exclude heroin and fentanyl and then, if theres only prescription opioids, thats the blue bar and heroin is the orange bar and any presence of fentanyl is the grey bar on top. Supervisor hainey . The first is that this legislation has instructed to provide the data so that i know on your first slide, theres a number of steps you take and go to the database. The chief medical examiner office, the chief toxicologist released this data on january 28th for the prior year and was confident about that data. That was 30 days after the fact, less than 30 days after the fact. So i understand the department of Public Health has a number of steps and what were asking for is the aggregated data which the chief medical Examiners Office seems very capable of being able to do. The other thing, if you go to the slide that shows the trend line, this one here, i think the reason why were doing this is because were in the midst of an epidemic. Over the last year and a half to two years, the numbers have beee completely changed and what we saw from 2014 to 2018 may have shown some sort of up and downs and some consistency and that completely changed in particular in the second half of 2018. And from there, weve seen it go up continuously since then. And the fact that we werent monitoring this and publically aware of this absolutely staggering increase in the number of people dying in our city, particularly in 2019, and the trend line in 2018, going up for the second half of 2018 was not just something that was a normal up and down but was the beginning of a very Straight Line up and this represents hundreds of people who are dying. I think this is what makes this so important, particularly during the time that we have a much deeper, immediate monitoring of the number of people who are being impacted, who are dying and that we have the information that is available to us and i do think the department of Public Health candies aggregate it and do analysis and really make sure its fully exact and then do it on a longer timeline. But i dont think we can afford to wait an entire year to have that information particularly when we are in the midst of such an epidemic. Vice chair stephani. Thank you. Im supportive of this legislation, but im hoping that we can take it one step further in the future and really, if were going to be reporting on Overdose Deaths in the city and county of San Francisco, and barring, of course, any privacy concerns around those that, unfortunately, succumb to their addiction, what actions were taken to help prevent that person from overdosing in the first place . I think we need to look at in a much broader way. We shouldnt just be requiring a report on how many deaths there are in San Francisco. But we should be looking at what did we do as a city and county to prevent that overdosing from occurring in the first place . Were there interventions that could have been done . Was there a criminal justice interintervention thajusticeintd have been done by the department of Public Health . When we offered needles to them, was recovery offered at that same time . Tom wolf who is on the Drug OverdoseTask Force Says never once was he offered treatment when he was offered needles. You know, i think ive shared, i have a brother who is a heroin addict and this is very personal to me. And i think that we need to have a focus on recovery, as well. And when i read things like departmentfunded Drug Overdose project, which is taxpayer dollars provides drug users with warnings about fentanyl, thats great and fine. But when i find out says further, so adjust your dose accordingly or you can still od by smoking or snorting, so start slow, i am actually dumbfounded that we are encouraging the use of fentanyl with taxpayer money, that we are actually not recognising that there really is no Harm Reduction when it comes to fentanyl. People die easily with just a little bit of fentanyl and theres no way to know with the drugs on the streets right now whether or not you could die. It is so prolific and so profound, what the drug cartels are doing with the drugs in our city that we would even say start slow. Im absolutely baffled by this. So for me, i think we need to be looking much deeper than requiring reports from the medical examiner every four months on how many Overdose Deaths we have in the city and county of San Francisco. We need to look at why, why are they overdoses . So i appreciate your legislation, supervisor hainey, but i dont think it goes far enough and i think we need to look at what are we doing about actually promoting recovery, actually people get clean and sober without the use of fentanyl and without the use of heroin . So those are my comments and i think that we need to do a lot more around this. Thank you. Supervisor walton . Thank you, chair. I guess my question really was the point of the presentation, to say you couldnt