The city's top addiction researchers believe it may be the next promising intervention for a portion of people languishing in San Francisco's streets.
Under a pilot program discreetly launched by the city more than two years ago, medical professionals at the Zuckerberg San Francisco General Hospital's Psychiatric Emergency Services are giving certain patients with methamphetamine use disorders "chill packs."
The "chill packs" consist of four doses of the antipsychotic medication Olanzapine, which is commonly used to treat schizophrenia and bipolar disorder. A study from 2021 found the drug helped to reduce the frequency and severity of methamphetamine-induced psychosis. Patients are instructed to take the tablets when they're experiencing psychiatric side effects that can also include excitability and irritability.
The Department of Public Health's communications team declined an interview request to discuss the program, without explanation.
While fentanyl accounted for four out of five accidental overdose deaths in San Francisco last year, city officials say methamphetamine contributes greatly to the city's homelessness crisis, the burden on San Francisco emergency rooms and neighbor complaints about street conditions — a hot-button issue in the upcoming mayoral election.
Methamphetamine-related hospital visits and deaths have reached record high levels in recent years. Nearly half of all patients who visited S.F. General's Psychiatric Emergency Services in 2017 and 2018 were related to methamphetamine use, according to a 2019 city report. From 2013 to 2017, people who were admitted into treatment programs and primarily used meth increased 30 percent, the report found.
Unlike opioids, there are no FDA-approved drugs to treat methamphetamine use or to prevent psychiatric symptoms associated with the substance.
"We're in a really bad spot for simple pharmacologic interventions for people who have stimulus-induced psychosis," said Michael Ostacher, a psychiatry professor at Stanford University who's not involved in San Francisco's program. "And there's a tremendous need for it."
Ostacher called the city's program a "really novel way to approach trying to help these patients and to mitigate some of the symptoms and suffering."
The most effective treatment currently available for stimulant use disorders is contingency management, an approach that uses incentives such as gift cards as positive reinforcement for people to reduce or stop their drug use. San Francisco has expanded its contingency management programs in recent years, but they require buy-in from participants.
San Francisco's "chill pack" program is not designed to treat methamphetamine addiction but rather provide short-term relief for side effects.
Brian Chan, an associate professor in addiction medicine at Oregon Health & Science University, said there are both pros and cons to such an approach. It doesn't necessarily ensure individualized or long-term care for someone's condition and it leaves it up to the patient to self-manage their symptoms. But it does allow healthcare providers to assist a difficult-to-reach, and sometimes leery, population.
"I see this more as a tool for engagement," Chan said. "We need new interventions and programs that can overcome barriers getting to people who do use stimulants — an often highly stigmatized population."
San Francisco Department of Public Health researchers recently analyzed the health records of 92 methamphetamine users who were given "chill packs" between January 2022 through May 2023 — the majority of whom were unhoused men. They found that the rate of psychiatric emergency service visits dropped 32 percent in the first two months after someone got a pack, as compared to the two months prior, and 13 percent after six months, according to a study recently published in the International Journal of Drug Policy.
The report concluded that the results indicated that the packs "represent a promising intervention," though it did note several glaring limitations. Those included the lack of a control group, interviews with patients to determine whether they were using the tablets and checking other hospitals to ensure the patients weren't seen outside of SF General during the time periods assessed.
In presentations posted online, Dr. Phillip Coffin, medical director for the city's Center on Substance Abuse and Health, described the "chill pack" program as potentially "the next Narcan," or overdose prevention kit, for treating the psychiatric side effects of stimulants.
Not only could it cut down on psychiatric emergency care use, Coffin said, but it may also help to curb other problems related to methamphetamine-induced psychosis, such as physical altercations, involuntary interventions with law enforcement and insomnia.
Coffin said at a recent public meeting that he was planning a clinical trial next year to better determine how the "chill packs" are being used and to further test his team's preliminary findings.
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