San Francisco Chronicle - (Sunday)
What S.F.’s drug crisis plan lacks
Last week, corporate pharmacy chains CVS and Walgreens reached tentative agreements to pay approximately $5 billion each to settle thousands of lawsuits filed over their role in the national opioid addiction crisis. If approved by all parties, it could be one of the last major settlements paid out by pharmaceutical companies for their role in peddling millions of opioid pills with little oversight.
That huge lawsuit won’t affect San Francisco. Our city attorney, David Chiu, is fighting a separate case surrounding Walgreens’ culpability in our current drug crisis. And it’s going well.
In August, a judge found Walgreens responsible for worsening conditions on the streets. Discussions are ongoing to determine exactly how much the pharmacy chain must pay.
The amount will no doubt be hefty; similar settlements have garnered San Francisco more than $100 million, including $54 million from opioid manufacturers Allergan and Teva earlier this year. That’s a lot of money falling into San Francisco’s lap. And conversations over how the city should spend it are already heating up.
It could get ugly.
Once the cases are finalized and the checks are written, the settlement money is set aside by the City Controller’s Office and earmarked for something vague like “opioid crisis abatement.” It’s meant to be an umbrella term; aside from $20 million specifically set aside for the overdose reversal drug Narcan, exactly how the money should be spent is up to the Board of Supervisors and the mayor.
That’s where things get tricky. Drug dealing and overdoses are hot topics these days and ensuring the funds are spent effectively, and not for self-serving political ends, could be a challenge. Do we invest in more policing? Mental health treatment beds? Health workers?
In September, Supervisors Matt Dorsey, Rafael Mandelman and Catherine Stefani held a news conference to
present “San Francisco Recovers,” a 33-page plan that ambitiously seeks to both arrest drug users and dealers and ramp up on-demand treatment. It’s a sweeping document that strives to make everyone happy, but its breadth seems to appease few. In response to the resolution, several health care and homelessness organizations that were not consulted before the plan’s release slammed many of its key proposals in a letter to Dorsey.
How do its backers intend to pay for San Francisco Recovers? Opioid settlement funds.
There is no doubt that the city needs a comprehensive, citywide plan to address the overdose crisis. Everyone can easily admit that we’re falling short. From January through September of this year, 451 people died of overdoses in San Francisco. A shortage of treatment beds, medical professionals
and housing continues to contribute to the crisis on our streets, and services for those with dual diagnoses, such as someone with schizophrenia and methamphetamine addiction, are nearly impossible to find.
But as the need ramps up, so has the discord. Arguments abound over whether abstinence-based programs, forced treatment or harm reduction is a more effective route. The results have been chaotic; earlier this year, in a bizarre waste of resources, police issued citations to people possessing drug paraphernalia that was handed out by syringe exchange programs funded by the Department of Public Health.
It’s clear there can’t be a comprehensive plan if each city department is left to proceed at its own discretion.
Luckily, San Francisco isn’t the first city handed an influx of money from an opioid abuse
settlement. Experts are on the case about how it should be spent.
Johns Hopkins University’s Bloomberg School of Public Health has developed guiding principles for jurisdictions that receive opioid litigation settlements. Among other things, it recommends one key aspect that is often left out of the discussion in San Francisco — including those with lived experience in decisions around where to spend the funds.
There will undoubtedly be resistance to this idea. Society tends to view people who use drugs, and often those who have a history of using drugs, as incapable of making decisions around their own care. But if San Francisco’s lawsuit is aimed at holding a corporation to account for its role in our overdose crisis, any settlement should be spent supporting the victims of that corporate malfeasance.
And, yes, many of the people
on our streets are victims, even if they aren’t spoken about that way. From 2006 through 2020, Walgreens filled prescriptions for nearly 6.4 million doses of opioids from doctors who were under investigation or had suspended licenses. When crackdowns on overprescribing were finally mandated by the government, many with opioid dependencies turned to the black market, and heroin use surged in San Francisco. That process played a clear role in where the city’s drug crisis stands today.
The people most impacted by these policies deserve to have a say in how this settlement money is spent. As a plan is formed, San Francisco needs to make room for them at the table.