Overdose prevention services at San Francisco AIDS Foundation

By Kristen Marshall, manager of overdose prevention and inventory services with Syringe Access Services

One of the things I’m struck by as a part of the Syringe Access Services team at San Francisco AIDS Foundation is how common it is for the people I serve to have saved somebody’s life. Or many times—multiple people’s lives. We provide Narcan, a medication that can be given to reverse an overdose to clients—and we train them to use it in emergency situations. The following story is about one of our clients at the 6th Street Harm Reduction Center—C* (not her real name)—a young woman who made her way to our services, received Narcan training, and was able to save her friend’s life as he overdosed in an abandoned squat.


When I first met C* over the summer, I was startled by how young she looked.

I met her at the 6th Street Harm Reduction Center. She came into the Center with older men, which isn’t unusual for women—especially young women—when they’re out on the streets. Regardless of my complicated feelings on the matter, I respect the survival mechanisms of the people I serve.

C was very quiet and shy as she made her way down the supply line, picking up safer injection supplies and syringes. I watched her, and as she finished up, I approached her and asked if she needed any Narcan. (Narcan is an opioid overdose reversal drug that can be given in emergency situations to prevent someone from overdosing.)

C didn’t know what Narcan was, seemed to be in a hurry, and not very willing to engage with me. I quickly explained what Narcan was, and although she hesitated, she agreed to be trained on how to administer it.

She didn’t say much during the training, but did follow what I said as I explained what an overdose looks like, and the correct steps to revive a person who is overdosing. During the course of her training, I found out that C was indeed very young—still in her teens. After we finished the training, she thanked me quietly—and then she left. 

After the training, C started coming in to the 6th Street Harm Reduction Center about once a week—always with the same men. One was her boyfriend, in his mid-twenties, and another was a good friend. She was always very quiet—getting the supplies she needed without speaking much to me or the other staff.

Last month, I was working the afternoon shift at 6th Street when C came in. She bee-lined right to me, her eyes big and alert. She told me she had to use her Narcan the night before.

I pulled her aside and asked if she was OK, and asked if the person was OK. She nodded, broke into a huge grin, and said excitedly, “I saved him. I didn’t think I could do it, and I thought I would be more scared, but I remembered everything you taught me. I did it and he lived.”

She was more animated and excited than I have ever seen her.

We sat down so I could get her more Narcan. Part of our refill process is for me to review and record the details of the overdose. Here’s what I learned.

She told me that she, her boyfriend, and her friend had been staying at a squat in Daly City. There was no electricity, and nobody knew they were there. Her boyfriend had gone out on an errand that night, and she was alone with her friend when he became unresponsive. She realized he was overdosing, and she hesitated. She didn’t have a phone so couldn’t call for help. The squat was completely dark, and she was worried about trying to revive her friend all alone. But she found the Narcan in her bag, and did everything right: the sternum rub, administering the first dose of Narcan, rescue breathing, and then a second dose followed by continued rescue breathing.

By the time her boyfriend returned to the squat, their friend was up and moving around. He was alive because of her.

I don’t know much about C’s past—why she was unhoused, why she uses, or what led her to us. But here was this teen girl, sitting in front of me, unhoused, a drug user, smiling, empowered, and proud of herself, because she had saved her friend’s life. But I do know this: She deserves to feel proud of herself. She deserves to look in the mirror and see someone special, because she is. And now she knows it.

Kristen Marshall is the manager of overdose prevention and inventory services with Syringe Access Services for San Francisco AIDS Foundation. Find out more about our Syringe Access Services


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