UCSC researcher explores drug use, harm reduction in San Francisco’s Latino/x community

Carlos Martinez
Carlos Martinez, professor in UC Santa Cruz’s Global and Community Health program 

It’s no secret that the opioid epidemic has devastated our country, especially within communities of color. Latino/xs have seen some of the highest drug addiction rates, which have only increased due to the rise of synthetic opioids like fentanyl and the COVID-19 pandemic. In 2019, San Francisco was the county with the third-highest opioid-related death rate among Latinos in California.

For these reasons, the San Francisco Department of Public Health funded a needs assessment published in November titled Unido/xs Contra La Sobredosis (United Against Overdose). The report is a joint effort between the San Francisco AIDS Foundation and the National Harm Reduction Coalition. (Harm-reduction efforts seek to reduce the negative consequences of substance use without requiring people to cease using drugs.) Under the Biden administration, harm-reduction efforts have received unprecedented support and funding. The lead author for the report is Carlos Martinez, a recent addition to UC Santa Cruz’s Global and Community Health faculty in the Latin American and Latino Studies Department.

“The report found that harm reduction isn’t a one-size-fits-all approach. It needs to be tailored to meet the needs of different communities, and we need to clearly communicate the necessity and effectiveness of harm reduction in the Latino/x community,” said Martinez. “Our goal is to get funding for capacity building for organizations already serving the Latino/x community and to provide trainings on harm reduction for those that have not focused on substance use.” 

The needs assessment explores drug use and the gaps and barriers to harm reduction services for the Latino/x community in San Francisco, a historically underserved population. It includes 105 quantitative respondent surveys and qualitative interviews of self-identified Latino/x drug users. 

Most participants (84.76%) identified as male, while 6.67% identified as female and 7.62% as transgender. Around 66.35% of respondents identified as heterosexual, while 15.38% identified as homosexual and another 15.38% as bisexual. Participants ranged in age from 23 to 74 years old, with a mean age of 46. More than a third of participants (37.38%) in the study reported living in single-room occupancy housing, and over a quarter (25.23%) were housing insecure.

Drug and alcohol use

Despite the rise in opioid use, the most consumed drug reported by participants was methamphetamine (27.90%). In comparison, 22.75% of participants reported regular alcohol use, 8.58% reported crack use, and 8.15% reported cocaine use. 

Three participants reported regular use of heroin, two reported regular use of fentanyl, and three reported regular use of prescription opioids. Over a quarter of participants (25.93%) also reported using fentanyl at least once.

Overdoses common

A quarter of participants reported experiencing an overdose at least once, and many of them overdosed more than two times. More than half (53.33%) said they didn’t know what Narcan or Naloxone is (highly effective medications that can reverse opioid overdoses) or how to obtain them (22.92%).

More than a third of participants (40.19%) felt either somewhat or very unfamiliar with the signs of an overdose. In comparison, 36.27% reported feeling either somewhat or very incapable of providing effective support for someone experiencing an overdose. 

Barriers to services

Perhaps, the most significant barrier is an awareness that these services exist. A large majority of participants (67.31%) did not know what harm reduction is.

Many of those who were aware felt uncomfortable accessing services for being seen by their peers (20%) or due to their immigration status (47.57% of respondents were undocumented). Approximately a third (32.69%) of respondents expressed feeling somewhat or very fearful of police, while 27.18% reported feeling somewhat or very fearful of being detained by immigration authorities.

Among service providers, 80% believe we do not have sufficient overdose prevention services for Latino communities in San Francisco. In comparison, 70% stated that they do not know of a treatment facility to assist Spanish and Mayan-speaking clients. 

Short and long-term actions

Martinez and his colleagues hope this work will impact San Francisco’s Overdose Prevention Plan, which aims to reduce fatal overdoses by 15% and reduce racial disparities among communities of color, including the Latino/x population, by 2025. Their report calls for an increase in hiring, retention, and training of Latino/x bilingual harm reduction workers, resources to support the sustainability of existing community-based harm reduction programs, tenant-led overdose prevention programming, supportive housing, and more.  

Early harm reduction work

Martinez began exploring harm reduction work in Tijuana, Mexico, as part of his doctoral degree program in medical anthropology at UC San Francisco and UC Berkeley. He examined the social and political conditions affecting the health of two communities, deportees from the United States and asylum seekers predominantly from Central America. He found abundant drug use among the community of homeless deportees in Tijuana, mainly opioids and meth. Through his research, he collaborated closely with two organizations in Tijuana: the Wound Clinic and the Refugee Health Alliance.

“I was working with organizations in Tijuana that offer free medical services and found that many deportees felt like they had lost their connection to Mexico and were suffering from social marginalization and a lack of employment and housing, which in many cases, led to drug use,” said Martinez. “They didn’t know where to seek help and were often being forced into jail or coercive drug rehabilitation centers by local police officers for their drug use.”

Now, as a faculty member at UC Santa Cruz, Martinez looks forward to expanding his harm reduction research and developing the Migration & Health focus area within the Global and Community Health program. In future research, Martinez is interested in examining how contemporary immigration and drug policies harm Latinos who use drugs and how harm reduction efforts can most effectively serve this community, particularly those undocumented and at risk of deportation.