San Francisco Chronicle - (Sunday)
City seeks lifeline for meth users
Sobering center proposed to offer refuge, treatment
There’s a reason they call it “speed.”
It can be smoked, snorted, swallowed or pushed through a needle into a waiting vein. And as methamphetamine saws its way into the bloodstream, flooding the brain’s pleasure centers with dopamine, it induces a rush of euphoria, heightened energy and acute alertness.
The high can last for up to 16 hours and often comes with agitation, hallucinations and paranoia, sometimes causing users to become aggressive or violent. Then comes the crash as the sensation fades, leaving a hole that only more meth can fill. For people already suffering from mental illness, the effects can be all the more debilitating.
“In the beginning, everything seems super good. Things are falling apart, but you don’t see it right away. It’s a fantasy,” said Isaac Jackson, who struggled with meth for years before getting clean and is now president of the San
Francisco chapter of the Urban Survivors Union, which advocates for drug users. “When things start to fall apart really fast, it convinces you to use more drugs, to continue to feel that euphoria.”
People suffering from methinduced psychosis or who are boneweary after a dayslong run of using have few options in San Francisco, often languishing on the streets or ending up in an emergency room or jail. For some it’s worse: Methrelated deaths have increased 500% in the city from 2008 to 2018, according to recently released data from the Department of Public Health.
To try to curb a deepening crisis, city officials, public health experts and recovering users have proposed creating a sobering center to serve as a refuge for people crashing after a meth binge and for those in the grips of one. In addition to providing a place to rest and basic amenities, it will allow addiction specialists to try to coax meth users into treatment.
Ingesting meth inside the facility would be prohibited, but the task force did recommend building safe injection sites, where users would be given clean equipment and supervised while they shoot up to prevent overdoses.
The sobering center is a recommendation by a meth task force that spent months laying out a plan for tacking the city’s meth epidemic. Officials are scouting locations, and Mayor London Breed said she plans to have “at least one of these centers open within the next three to six months.”
The aggressive time
line reflects the urgency of the problem. On top of the spike in methrelated overdoses, which usually occur when the drug and whatever it might be mixed with cause heart failure or bleeding in the brain — the city’s emergency rooms are being inundated with meth patients.
From 2017 to 2018, 47% of all visits to the city’s psychiatric emergency room at San Francisco General Hospital were related to meth use. And among the nearly 4,000 homeless San Franciscans also suffering from psychosis and substance abuse, more than 54% have a history of using meth and similar stimulants. That makes meth the second most used substance among that population, after alcohol, at 95%, according to the city’s health department.
“Just at the level of managing our public health resources, doesn’t it make sense to have a place that is not psychiatric emergency services or an emergency room to take folks?” asked Supervisor Rafael Mandelman, who cochaired the meth task force.
Dr. Anton Nigusse Bland, San Francisco’s director of mental health reform, said the city envisions a facility large enough to accommodate both those ready to sleep and people who “might need space to walk around and pace a bit.” The task force’s report also suggested the sobering centers should be able to administer onsite “antipsychotics or sedatives if an individual presents with acute psychosis or agitation.”
Anyone staying in the center would also be screened for any other health issues. Nigusse Bland said. Clinical workers would pair with peer counselors who have firsthand experience in treating meth addiction. The sobering center would also be operational seven days a week, around the clock. Nigusse Bland estimates that most of the center’s patients would stay eight to 10 hours, but some people may need to sleep there for several days, depending on their condition, he said.
City health officials are under no illusions that one or even several stays at the sobering center would be enough to persuade people to accept treatment and other services. It will take time, Nigusse Bland said — months in most cases — to develop trust with patients.
“People might not be ready to go into treatment,” he said. “But if they’re ever in distress again, this is a place to come back to.”
Offering a less institutional space to crash could persuade more people to come to the center of their own accord, before their symptoms reach a crisis level, said Paul Harkin, program manager for harm reduction at Glide and a member of the task force.
“To go from being ignored on the street ... to psychiatric emergency services, it’s like using a Ferrari when you can use a pushcart,” he said. A sobering center “is much less extreme. It’ll have a much looser feel and feel less institutional than the psychiatric emergency center. You’ll see selfreferrals to that
“It’ll have a much looser feel and feel less institutional.” Paul Harkin, meth task force member
in greater numbers.”
San Francisco has operated a 12bed alcohol sobering center South of Market since 2003. Over the past 16 years, the facility has welcomed more than 13,000 people, many of them several times. City health officials hope to model the meth center on the alcohol facility to an extent.
“It makes sense, having a place for people who can access compassionate, directive care with a strategy to help people consider other options in their lives,” said Dr. Paul Earley, president of the American Society of Addiction Medicine.
“We’re hoping to all learn from this if it moves forward,” he said.
Dominic Fracassa is a San Francisco Chronicle staff writer. Email: dfracassa@ sfchronicle.com Twitter: @dominicfracassa