San Francisco could become the first city in the country to require every pharmacy within its boundaries to always carry naloxone, a drug that reverses overdoses caused by fentanyl and other opioids.

San Francisco Supervisor Matt Dorsey will introduce a bill Tuesday that, if approved, would require every pharmacy to always have in stock at least two nasal sprays containing the drug or face fines.

The city has struggled for years with rampant fentanyl use and fatal overdoses, and is on pace for its deadliest year yet.

There were 647 accidental drug overdose deaths in San Francisco in 2022, and over 70% of those deaths were attributable to fentanyl, according to the San Francisco Office of the Chief Medical Examiner.

In the first five months of 2023, preliminary reports show there were 346 overdose deaths in the city — an increase of more than 40% from the same period in 2022. More than 79% of those deaths were attributable to fentanyl, according to data from the medical examiner’s office.

Dorsey, a recovering meth addict, said he wants universal access to naloxone because the medication saves lives when it reaches an overdosing person in time.

“This is life and death, and this is a public health crisis that San Francisco has not experienced since the days of the AIDS crisis,” Dorsey said.

Making naloxone more widely available is seen as a key strategy in controlling the nationwide overdose crisis, which has been linked to more than 100,000 U.S. deaths annually.

Narcan, the leading brand of naloxone nasal spray, is already available without a prescription in all 50 states, where leaders have issued standing orders for pharmacists to sell the drug to anyone who asks for it. But not all pharmacies carry it.

Dorsey said a recent “secret shopper” survey conducted by the San Francisco Department of Public Health found that approximately 20% of San Francisco pharmacies did not have naloxone in stock, despite having legal authorization to provide it on request.

In San Francisco, police officers, firefighters, and paramedics are trained to identify an opioid overdose and carry Narcan. Many public libraries, public housing facilities and clinics are also stocked with the drug.

“We want all San Franciscans, no matter where they live, no matter where they work, to be able to go to their pharmacy and get it and so this measure, removes one more barrier to everyone having access to this lifesaving medication,” said Dr. Jeffrey Hom, director of population behavioral health at the San Francisco Department of Public Health.

Dorsey’s ordinance would allow a three-day grace period for pharmacies to reorder two boxes, and fine violators between $250 and $1,000 per violation.

In March, the Federal Drug Administration approved Narcan nasal spray to be sold over-the-counter. The medication will become available that way by late summer, according to Gaithersburg, Maryland-based Emergent BioSolutions, the maker of Narcan. Other brands of naloxone and injectable forms will not yet be available but could be soon.

Walgreens said naloxone is already carried in all of its San Francisco pharmacies.

“Walgreens believes that saving lives from deadly opioid overdoses is a shared responsibility amongst all public health stakeholders,” said Perry Han, Regional Vice President of Walgreens.

In May, Walgreens agreed to pay nearly $230 million to San Francisco to settle claims that the pharmacy giant helped fuel the opioid epidemic plaguing the city.