San Francisco reports vigilantes spraying Narcan into homeless, prompting health and safety concerns

Self-styled vigilantes in San Francisco have been filmed and accused of spraying the opioid antidote Narcan into the noses of homeless people who were not overdosing, prompting complaints from victims, condemnation from health officials and renewed debate over public safety in neighborhoods with open drug use.

Multiple accounts compiled by local outlets say strangers have walked up to people who appeared to be sleeping or slumped on sidewalks, administered a naloxone nasal spray and posted video of the encounters on social media. Victims describe immediate and violent opioid withdrawal after being dosed, while public-health officials emphasized that naloxone is intended for use only when someone is experiencing an overdose.

One man who identified himself as Nestor Garcia told the San Francisco Standard that a stranger shoved a plastic Narcan nozzle into his nostril this summer in UN Plaza as he dozed on his bicycle. Garcia said he was conscious and in a fentanyl-induced haze when the dose triggered violent sickness, leaving him vomiting and drenched in sweat.

"He knew I was still awake — he had bad intentions for sure," Garcia told the Standard. Other people interviewed by local outlets gave similar accounts of being startled awake by strangers pointing naloxone sprays at them or threatening to use them.

Narcan is the brand name for naloxone, a fast-acting medication that reverses life-threatening opioid overdoses by displacing opioids from brain receptors and restoring normal breathing. It is commonly distributed as a nasal spray and has been handed out widely by San Francisco public-health programs in recent years.

City data cited by local reporting show San Francisco recorded more than 3,500 fatal overdoses in the past four years, and the Department of Public Health said it has distributed more than 500,000 doses of naloxone since 2021 in an effort to curb overdose deaths. Public-health officials said naloxone is safe for people who do not have opioids in their system and usually has little to no effect on them. In people physically dependent on opioids, however, naloxone can precipitate sudden and severe withdrawal symptoms including vomiting, sweating, agitation and rapid heart rate.

Health experts contacted by local outlets called the street misuse of naloxone dangerous and suggested it could amount to assault. "Using Narcan this way is not just mean-spirited, it's cruel," said Dr. Ayesha Appa, an addiction specialist at the University of California, San Francisco. She urged bystanders to check for breathing before administering naloxone and warned that forcing someone into abrupt withdrawal could be life-threatening for people with underlying medical problems.

The San Francisco Department of Public Health told the Standard that naloxone should be used when a person is experiencing an overdose and that intentionally misusing the medication to cause pain or distress is inhumane. "Individuals should administer naloxone if they recognize that someone is experiencing an overdose," the agency said in a statement.

A viral social-media clip shared in July helped propel attention to the tactic. The video, viewed millions of times, shows a man brandishing a naloxone device to force a person to rise from a Tenderloin sidewalk; the clip drew thousands of comments, some praising the action as a way to clear public space. Local residents and business owners have repeatedly described frustration with open-air drug markets in parts of the city, including the Tenderloin, Sixth Street and around 16th and Mission, where dealers and people using drugs congregate despite daytime enforcement efforts.

City leaders have responded to the broader crisis with a mix of law enforcement, outreach and public-health measures, including mobile command units, increased patrols, community ambassadors, and plans for more treatment slots and interim housing. Advocates and neighbors say those efforts have had uneven results and that some residents are experiencing "compassion fatigue" amid persistent public health and safety challenges.

Advocates for people who use drugs and health-care providers warned that turning a life-saving medication into a tool of intimidation undermines trust and harms people who need emergency help. Kenneth Byrd, a person experiencing homelessness and fentanyl dependence, said, "They're using it like a weapon. People are going around doing it just for kicks." Another person, Henry Jones, who said he had been jolted awake by naloxone this year, described the experience as worse than being shot.

Medical professionals note that naloxone's effects typically last about an hour, during which a person dependent on opioids will be unable to feel the drug's effects and may experience an intense craving to avoid further withdrawal. Experts also warned that forcibly inducing withdrawal can lead to dangerous behaviors as people seek opioids to relieve symptoms.

Local authorities have not publicly announced arrests tied specifically to the reported incidents described in local reporting. The Department of Public Health reiterated that naloxone distribution programs are intended to reduce fatal overdoses and that community members who witness someone in distress should call emergency services or trained outreach teams.

The incidents underscore tensions in San Francisco as officials and residents confront overlapping crises of homelessness, stimulant and opioid use, and public safety. Health officials and medical experts say efforts to address the epidemic should prioritize evidence-based treatment, harm-reduction services and targeted outreach so that naloxone remains available to reverse overdoses rather than become a weapon in disputes over public space.

Police and city agencies did not immediately respond to requests for comment beyond public statements cited in local reporting. Local health officials and harm-reduction organizations continue to urge training on how and when to use naloxone and to discourage its use on people who are breathing and appear to be stable.