San Francisco health officials reassess strategies as overdose deaths increase
The San Francisco Department of Public Health is planning to modify certain parts of its harm reduction strategies in tackling the city's drug overdose crisis, the department said Tuesday while announcing last month's number of drug overdose deaths.
A preliminary count revealed that 61 people died last month from accidental drug overdose, nearly the same amount as February 2024 when 63 people died from overdose. February's preliminary number of overdose deaths is slightly higher than January 2025, when 57 people died.
San Francisco Department of Public Health director Daniel Tsai made the announcement during a press conference on Tuesday, just three weeks into his new position after being appointed by Mayor Daniel Lurie.
"What this really underscores is how urgent and important this work is that we have at the department," Tsai said. "Every one of those 61 deaths is unacceptable. It's preventable, and we as a department are going to be doing everything possible to tackling this epidemic."
Tsai is attempting to navigate the city's response to preventing overdose deaths through reassessing strategies already in place, including aspects of harm reduction.
"When I'm in discussions with our providers, clinicians, and others, people affirm the work happening with many of our providers and partners across the city," Tsai said. "But almost everyone agrees that something has to change."
While he did not specify details of an exact plan, the department intends to alter its policy of handing out supplies like foil and straws in public areas used for smoking substances such as fentanyl. Fentanyl, a highly potent synthetic opioid, has contributed to the majority of overdose deaths in recent years.
"The policy that we will pivot on is distributing smoking supplies like foil, pipes, straws, particularly in public spaces," Tsai said.
Researchers at University of California, San Francisco have found that smoking fentanyl increases the risk of fatal overdose due to the resin that accumulates in smoking paraphernalia.
Sharing smoking devices that contain fentanyl residue could be just as if not more deadly than sharing needles, according to the 2024 paper authored by researchers at UCSF.
Tsai made it clear that the department will continue its practice of supplying clean syringes used for injecting drugs in order to help reduce the spread of illnesses like hepatitis C and HIV.
"San Francisco is not backing away in any way, shape or form from the tested, proven public health intervention of sterile syringe access, full stop," Tsai reaffirmed.
Tsai's announcement comes
one day after Lurie signed "Breaking the Cycle,"
a comprehensive strategy aimed at combating the overlapping issues of homelessness and drug addiction.
The executive directive calls for more coordinated services, better measurement of outcomes, and accountability for government. The idea is to get more people off the street and connected to services, keep public spaces clean and safe, and better manage taxpayer resources.
One aspect of the directive includes immediately modifying the city's policy of distributing clean smoking supplies, which garnered support from several supervisors.
"Mayor Lurie's directive is taking aim at some sacred cows here -- from harm reduction to homelessness spending -- that quite frankly deserve scrutiny for why they've failed to achieve better outcomes," Supervisor Matt Dorsey said in a statement.
"Reassessing fentanyl supply policies is a necessary step to prioritize treatment and recovery," said Supervisor Stephen Sherrill in the directive's press release.
Tsai said that the department will release more details on its changes to supplying equipment used for smoking drugs in the near future.
"My team will be meeting rapidly with a range of folks in the community over the coming week or week and a half before we roll out a more concrete policy pivot," Tsai said.
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Yahoo
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The science of sleep paralysis, a brain-body glitch making people see demons and witches
Sign up for CNN's Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep. Baland Jalal lay in bed terrified, experiencing his own real-life horror film. Newly awake, the 19-year-old could see his surroundings but couldn't move or speak, and he didn't know why. He thought, ''My God, what do I do?'' Jalal, now 39, said of that moment in 2005. 'I tried to call my mom (and) dad, but no words would emerge from my throat. … I had this ominous presence of a monster, and it lifted my legs up and down. 'It strangled me, trying to kill me. And I was 100% sure that I was going to die,' Jalal added. 'It literally feels like all the evil of the universe is condensed into a bubble, and it's in your bedroom.' This type of hallucination is a hallmark for many people with sleep paralysis. It occurs during transitions into or out of rapid eye movement, or REM, sleep, similar to a traffic jam at a busy intersection — your brain, awake and alert, and body, still asleep and immobilized, collide momentarily, said Dr. Matthew P. Walker, director of the Center for Human Sleep Science at the University of California, Berkeley, via email. Following deep sleep, REM sleep is the next critical phase of sleep cycles, characterized by more dreaming that's also extra vivid and lifelike, and by faster heart rate and breathing. It's essential for memory, concentration, mood regulation and immune function. Jalal's experiences propelled him to study this phenomenon around the world. He aimed to discover the cause of sleep paralysis, he said, and why some people with the diagnosis 'have these powerful encounters where it feels like evil of epic proportions.' He has since earned a doctorate in psychiatry and is now a researcher in Harvard University's psychology department and a leading expert on sleep paralysis. He also treats patients struggling with it. An estimated 30% of people worldwide experience at least one episode of sleep paralysis in their lifetime, according to the Cleveland Clinic. How many of those people have recurring and impairing sleep paralysis isn't clear, but the percentage is likely low, Jalal said. Here's what else you should know about sleep paralysis and how it can be managed. In REM sleep, our bodies are paralyzed so we don't act out our dreams and risk hurting ourselves or others, Jalal said. Sleep paralysis episodes are usually only a few minutes long but can last up to 20 minutes, according to the Cleveland Clinic. During sleep paralysis, however, 'we regain consciousness before the muscles regain their freedom from REM-induced paralysis,' said Walker, who is also a professor of neuroscience and psychology at the University of California, Berkeley About 40% of people with sleep paralysis have visual, auditory or tactile hallucinations, such as pressure on one's chest or feeling out of body, Jalal said. For about 90% of those individuals, the illusions are terrifying. They can include ghosts or cat- or alien-like creatures, and their actions can be as innocuous as simply approaching them or as nefarious as molesting or trying to kill them. In Jalal's academic travels, he discovered the contents and interpretations of hallucinations, views on what causes sleep paralysis, and episode frequency and duration can all also have a cultural basis. People living in Egypt and Italy, for example, would often see witches and evil genies, hold them responsible and think they could die from sleep paralysis, Jalal said. People in Denmark, Poland and parts of the United States, on the other hand, have less supernatural or exotic explanations and less fear. 'Why do we see these monsters? Is it the dreaming imagery … that's spilling over into conscious awareness?' Jalal said. 'My answer to that is, according to my research, no, not exactly. But it's part of it.' When you're aware yet paralyzed and confused, your natural reaction is to escape that situation. Your brain is bombarding your body with signals to move, but your body can't return any feedback. Jalal's theory, in short, is that your brain says, 'to hell with it' and concocts a story it thinks your body must be facing to be experiencing such bizarre symptoms. The reduced activity in your prefrontal cortex — responsible for reason and logic — also contributes to hallucinations becoming 'extremely realistic and emotionally charged, amplified by an overly active amygdala, the brain's emotional alarm center,' Walker said. Though scientists know that wake-sleep glitch is what's happening during a sleep paralysis episode, they're not entirely sure why. But there are several factors that can increase the risk of fragmented sleep and sleep paralysis. Those factors include stress and related conditions such as anxiety, post-traumatic stress disorder (PTSD), bipolar disorder and panic disorder, experts said. Much of Jalal's sleep paralysis occurred when he was in school. Now when he has an episode once or twice per year, it's usually during a high-stress period, he said. (Once you've experienced sleep paralysis, you can be conscious of that during an episode but still feel afraid.) Other common contributors are sleep deprivation, jet lag, an irregular sleep schedule, sleep disorders such as narcolepsy, and genetic factors, Walker and Jalal said. Obstructive sleep apnea, substance use disorder and some medications — such as those for attention deficit hyperactivity disorder — can also raise risk, according to the Cleveland Clinic. As scary as sleep paralysis may sound, it's not actually dangerous, experts said. But depending on how recurring it is, sleep paralysis can be a sign of an underlying sleep disorder, Jalal said. Regular episodes can also lead to anxiety around sleep and then avoidance of sleep, Jalal said. This pattern can interfere with your daily energy and ability to function. And if you often have frightening hallucinations, that can lead to anxiety or trauma-like symptoms. Sleep paralysis can be significantly alleviated with several practices or treatments, Walker said — starting with healthy sleep habits, for one. That includes seven to nine hours of restful sleep nightly. Maintaining a sleep schedule consistent in quality and quantity 'acts like tuning your internal clock, reducing the chance of disruptive wake-sleep overlaps — much like ensuring all parts of an orchestra are synchronized for perfect harmony,' Walker said. Also prioritize stress management, by using, for example, mindfulness and relaxation exercises, Walker said. Therapies can relieve certain underlying issues triggering sleep paralysis, including cognitive behavioral therapy, especially the version for people with insomnia. In more serious situations, medications are sometimes used, Walker said. Those include SSRI (selective serotonin reuptake inhibitor) or tricyclic antidepressants that can help manage a smooth flow between sleep stages or even reduce the REM phase of sleep. Generally, boosting the brain's serotonin levels somehow compensates for the loss of the REM phase, Jalal said. But rarely, long-term antidepressant use has been linked with REM sleep behavior disorder. While the aforementioned treatments can help reduce the frequency or length of sleep paralysis episodes, there isn't yet a gold-standard treatment that can stop an episode once it's happening. Jalal has been trying to officially create one over the past decade, though, and it's self-inspired. Called meditation relaxation therapy, the treatment reduced sleep paralysis by 50% after eight weeks for six people with narcolepsy, compared with a control group of four participants, found a small pilot study Jalal published in 2020. He currently has another study of the same treatment with more participants underway at Harvard. And the steps of Jalal's therapy are as follows: Cognitively reappraise the meaning of the attack. Close your eyes and remind yourself that your experience is common and you won't die from it. Emotionally distance yourself from it. Tell yourself that since your brain is just playing tricks on you, there's no reason for you to be scared or risk the situation getting worse because of your own negative expectations. Focus on something positive. Whether it's praying or imagining a loved one's face, this refocusing can make thoughts more pleasant rather than monstrous. Relax your muscles and don't move. Some experts say trying to slightly move your fingers or toes one by one may help you come out of an episode sooner. But Jalal's fourth step advises against this movement since you'd still be sending signals to paralyzed muscles and maybe triggering hallucinations. Viewing your own biology in a more objective way by learning more about the scientific basis of sleep paralysis is also helpful, Jalal said.
News24
3 hours ago
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Graphs that paint the picture of HIV in SA
Eight million people are living with HIV with more than six million being on treatment. Behind these big numbers lurk a universe of fascinating epidemiological dynamics. In this special briefing, Spotlight editor Marcus Low unpacks what we know about the state of HIV in South Africa. This is part 1 of 3. Four decades ago, hardly anyone in South Africa had HIV. Today, roughly one in eight people here are living with the virus. HIV has quite simply become a routine part of life in South Africa. But thanks to the fact that antiretroviral treatment is keeping several million people alive, HIV is no longer the crisis it was at the turn of the century. For many, the virus is still an all-too-real part of their lives. It still ranks among the country's top killers. As we will see in this Spotlight special briefing, there is good and bad news. We have made massive progress in our collective fight against HIV, especially since around 2008. But, as positive as the big picture may be, there are also reasons to be worried. In the 10 sections of this special briefing, we have used lots of graphs and an interactive table to liven things up. We have drawn almost entirely on estimates from Thembisa, the leading mathematical model of HIV in South Africa and also the basis for UNAIDS' country numbers. The big picture Total PLHIV in SA Graphic: Spotlight South Africa has the world's biggest HIV epidemic. Eight million people, or 12.8% of the population, lived with the virus in 2024. Despite the massive progress we've made in the last 20 years, this absolute number has kept increasing, and, at least by this measure, the epidemic has kept getting bigger. But while more people are living with HIV, dramatically fewer people are dying of HIV-related causes than two decades ago - we've gone from 281 000 HIV-related deaths in 2005/06 to 53 000 in 2023/24. 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Note: All of the above graphs are based on outputs from version 4.8 of the Thembisa model published in March 2025. We thank the Thembisa team for sharing their outputs so freely. Graphs were produced by Spotlight using the R package ggplot2. You are free to reuse and republish the graphs. For ease of use, you can download them as a Microsoft PowerPoint slide deck. Technical note: The Thembisa model outputs include both stock and flow variables. This is why we have at some places written 2024 (for stock variables) and 2023/2024 (for flow variables). 2024 should be read as mid-2024. 2023/2024 should be read as the period from mid-2023 to mid-2024.
Newsweek
10 hours ago
- Newsweek
Can Tackling Addictions Reduce Medicaid Costs?
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. Discussions around Medicaid costs have become more heated than ever in recent months as President Donald Trump's administration tries to push its budget bill through the legislative ranks. House Republicans have instructed the House Committee on Energy and Commerce to slash $880 billion in spending over the next decade, with Medicaid making up 93 percent of the committee's budget. As a result, the amount of money the federal Medicaid program needs to provide health care services for more than 70 million Americans has been under dispute, with some arguing there is significant waste and misuse of money in the system, while others have warned cuts would leave millions of vulnerable people without access to health care. While lawmakers continue debating the divisive legislation, experts have discussed with Newsweek whether there could be another way of reducing Medicaid costs—tackling substance use disorders. Medicaid enrollees with substance use disorders require significantly higher health costs than those without—around $1,200 per month on average compared to $550, according to KFF. Around 7.2 percent of Medicaid recipients age 12 to 64 have a diagnosed substance use disorder, and treatment is key to addressing overdoses, deaths and other health or social complications, KFF reported. So could tackling substance use disorders in turn reduce costs for the Medicaid program? Here's what experts told Newsweek. Photo-illustration by Newsweek/Getty/Canva Why Are Medicaid Costs Higher for Those With Substance Use Disorders? The reason Medicaid enrollees with substance use disorders have higher health costs is because they often also have additional health complications, Dr. Joshua Lynch, professor of emergency and addiction medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, New York, told Newsweek. This could be physical health conditions, such as hypertension, high cholesterol and diabetes, or mental health disorders, "which can lead to more complex health care needs," he added. Those with substance use disorders also may "experience more fragmented care and more challenging access to high quality, lower cost care and preventative services," Lynch said. They may also struggle to work, or stay in work, and this may "contribute to increased reliance on higher-cost healthcare services," he added. Many Americans with substance use disorders also go undiagnosed, Brendan Saloner, professor of health policy and management at the John Hopkins Bloomberg School of Public Health, Maryland, told Newsweek. He added that those with substance addiction can have a lot of problems, such as the risk of overdose, or contracting blood-borne diseases like HIV or hepatitis C, as well as other issues, so "it's much better to get people into care proactively then to wait for their problems to become a crisis." The higher costs for those with substance use disorders, therefore, could "reflect the devastating physical consequences of substance use itself," Heidi Allen, professor of social work at the Columbia University School of Social Work, New York, told Newsweek, pointing to overdoses, increased vulnerability for chronic illness and exposure to infectious diseases. It's also not just about health complications, John Kelly, professor of psychiatry at Harvard Medical School and director of the Recovery Research Institute at Massachusetts General Hospital, told Newsweek. "The nature of these disorders means also that, on average, in the Medicaid population, individuals suffering from substance use disorder tend to have more social instability in terms of secure housing, employment, and criminal justice complications. These all contribute to increased costs," he said. Could Tackling Substance Use Disorders Reduce Medicaid Costs? While tackling substance use disorders may not slash Medicaid costs in the short term, as it would require investment in prevention and treatment, it could have positive economic impacts in the long run. "Prioritizing substance use treatment for enrollees might not reduce Medicaid costs in the short term, since we would expect more Medicaid enrollees to engage with treatment, which itself costs money," Allen said. However, she added that "it could certainly improve the health of enrollees, which might result in Medicaid savings down the road." If patients also have access to high-quality treatment and are able to manage their condition, "they have a lower reliance on high-cost health care such as emergency visits and inpatient hospitalizations," Lynch said. He added that other comorbidities also become more manageable, while housing stability and employment turn more achievable. "All of these will lead to a decrease in overall Medicaid spending," he said. Kelly also said he thought that tackling substance use disorders could reduce costs for Medicaid, adding that "focus on earlier intervention, and better implementation of care coordination will result in reduced use of more expensive acute medical care services, as well as prevention of the contraction of more chronic disease such as alcohol-associated liver diseases, HIV and hepatitis infections." "I am very confident that it would help to prevent some long-term costs to the program and would have a huge impact on other non-health needs like employment and reduced incarceration," Saloner said. But he added that whether it fully pays for itself, or saves money, is a more difficult question to answer. "We have some older studies showing that substance use care can offset lots of costs to society, but purely from the perspective of the Medicaid budget it's hard to say. The quality of life gains make it very cost-effective, whether or not it's cost saving," he said. Carrie Fry, professor in the department of health policy at Vanderbilt University School of Medicine, Tennessee, told Newsweek: "Research shows that addressing substance use disorder with effective, evidence-based treatments reduces Medicaid costs." In order to cut Medicaid costs, Fry said, making it easier for people with substance use disorders "to start and remain on effective treatment" would be an important step in the process. "For opioid use disorder, this means expanding availability of medications for opioid use disorder including methadone, buprenorphine, and naltrexone," she said. She added that only about half of Medicaid enrollees with an opioid use disorder receive evidence-based treatment in a given year. "So, treatment is an important first step to addressing the burden of substance use disorders in Medicaid and can reduce or prevent additional downstream costs," Fry said. She added that reducing the prevalence of substance use disorder via prevention will "require a more comprehensive approach to addressing broader social conditions that lead to increased risk of developing a substance use disorder."
