San Francisco Chronicle - (Sunday)
U.N. Plaza center’s impact
A study commissioned by San Francisco suggests Mayor London Breed’s Tenderloin Center at U.N. Plaza was effective at preventing fatal overdoses and that public drug dealing, drug use and homelessness didn’t increase in the vicinity.
But the study didn’t look at how well the center, slated to close next month, connected people to services, one of the original stated goals.
Breed directed her staff to set up the center as part of her three
month emergency declaration to reduce drug deaths and improve street conditions after complaints, largely from immigrant families, in the Tenderloin.
Her news release at the time said the drop-in center would provide basics such as food and showers, connections to services including treatment and housing, and “overdose prevention.” News quickly emerged that meant allowing people to use drugs in an outdoor fenced-off area in the plaza. The decision ignited controversy, with supporters saying it acknowledged the reality of drug use and saved lives, and critics arguing it enabled addiction.
Breed has said the center didn’t connect as many people to services as hoped.
The analysis emerges as the city just rolled out a first-of-itskind overdose prevention plan and prepares to close the Tenderloin Center, which cost the city $22 million, by Dec. 5. The city promised in September to open a smaller, similar hub by the end of the year, but behavioral health director Dr. Hillary Kunins said Tuesday that the hub opening now has been pushed to early next year. Despite an urgent desire to open one, the city faces logistical challenges in finding a location and legal issues, she told the Chronicle.
The city paid a team of researchers led by Alex Kral, an epidemiologist from nonprofit health research institute RTI International, $500,000 to assess the center starting in April to find out challenges and successes. The study was commissioned before the city decided in June to close the center by year’s end.
The Chronicle reviewed a summary of the data before it is prepared for publication in a peer-reviewed journal, which will take months. The study’s methodology included having two research assistants walk the blocks and record drug activity and visible signs of homelessness roughly between 9 a.m. and 5 p.m. within a 500-meter radius of the center. The researchers also plan to include crime data, which was not available yet, in the final analysis.
Kral, who has expressed support for supervised drug consumption sites, said the center saved lives and didn’t worsen street conditions compared to before the pandemic, despite complaints from neighbors and some elected officials that it attracted crowds using drugs.
Researchers can’t directly attribute street conditions to the center — they could be the result of other factors, including community ambassadors added to the area to deter those behaviors — but Kral said other cities also haven’t tracked an increase in drug activity around similar centers.
Tom Wolf, who is in recovery and a frequent critic of the city’s approach to the drug crisis, tweeted in response to the study, “Anyone who’s spent time around the Tenderloin Center knows the street conditions are far worse than before. Drug deals happen through the fence into the Supervised Consumption Site that they refuse to call a Supervised Consumption Site.”
The analysis didn’t assess how well the center connected visitors to care, which Kral said was hard to track.
Critics pointed out that just a tiny fraction of those who visited got connected to mental health or addiction treatment.
Keith Humphreys, a professor of psychiatry and health policy at Stanford School of Medicine, questioned the legitimacy of the study and wondered why the center didn’t connect more people to treatment after the city spent $22 million on it.
“If that is success, what on Earth would constitute failure?” he asked.
A vast majority of guests’ requests were for basic services such as food and showers.
Breed’s office said in a statement Tuesday that the center was just part of a multipronged effort to address conditions.
“The Tenderloin Center has supported this work, and it has provided a respite from the street for many, helped prevent many overdoses, and connected people to services. We tried something new, knowing there will be successes and lessons learned, and an opportunity to build and grow from there,” the statement read.
The city will use data and lessons from the Tenderloin center to shape any future site.
As of Tuesday, staff at the center have tracked more than 115,000 visits, with 94% of guests from the Tenderloin.
Staff reversed 300 overdoses, almost all in the center’s courtyard. No one died. (While supervised drug consumption sites are illegal under federal law, the city argues that the center wasn’t an official site.)
Elsewhere in the city, roughly 7% of overdoses resulted in deaths from January through the end of September, according to estimates in the new data analysis. (That data was compiled using Medical Examiner death data and overdose reversal data from emergency medical technicians and a nonprofit that distributes Narcan.)
“If everybody goes to these centers, people will not die,” Kral said.
Guests spent an average of nearly 19,000 hours monthly inside the center — time not spent on the street “using drugs publicly or doing other potentially disrupting things,” Kunins said.
The analysis reported that public drug use and visible signs of homelessness in the surrounding area dropped since 2019, the most recent data before the pandemic, although they’re on par with 2018.
In 2019, there was a 65% chance of finding a drug-related issue on any given nearby block, the research found. In 2022, the chance dropped to 46%.
Kral said his analysis didn’t look at connections to services because the team didn’t have time and resources to follow where people ended up. He also said linkages alone weren’t a meaningful metric of success because not everyone might need or want those services.
Critics of the city’s emphasis on harm reduction have said the city doesn’t do enough to encourage recovery or abstinence for more people who need treatment.
City data shows the vast majority of requests were for basic services such as food and showers. The center linked 2,885 people to care, many to housing or shelter and others receiving medical care, mental health or drug treatment. Staff referred 5,843 more to similar services, and enrolled more than 600 in government benefits.
The health department didn’t set up the center, but the agency took over management halfway through the year. Kunins stressed that it was just one part of a larger system. She said she measured success by whether people got the services they wanted and needed, and pointed out that some outpatient opioid treatment has almost no wait, while the city has reduced wait times for residential substance use treatment to four days.
The city hasn’t had enough housing to meet demand, officials and staff said earlier this year.
Breed said during a news conference last month that the center was overwhelmed.
“There are a lot of folks who have gotten assistance, treatment, transition into housing, not as many as we would have hoped for, but a few … but they can only serve so many people at a time,” she said.
Kral said interviews and observations revealed the center needed more staff, leading to long lines that were bad for guests, neighbors and tourists alike, and at times ran low on supplies such as oxygen to give people after overdoses. Kunins said the city learned it would be better to have multiple, smaller sites instead.
Not everyone wants the exact model replicated, though.
Supervisor Ahsha Safaí said during a board meeting this month that the center has become “an embarrassment” and “was a linkage to nowhere.”
Safaí said he was “flabbergasted” when he visited and saw how many people were using drugs there, which he said “has to be triggering” for people trying to get sober.
While he didn’t want to see services disrupted when it closes, he said: “I don’t feel like we’re getting what was sold.”
But dozens of nonprofits have joined with Supervisor Dean Preston, who represents the area, to protest the closure. Preston authored a resolution, passed 6-5 by the Board of Supervisors two weeks ago, urging the city to keep the center open until a replacement is ready.
“We can’t in good conscience simply shutter the Tenderloin Center, leaving 400 people per day without the help that they need for an undetermined amount of time,” Preston said. “That’s not a plan for anything but increased suffering and death on our streets.”
The city contends that the center was always temporary and confirmed Tuesday that it will close in December. The health department detailed its plan to transition and refer guests to neighboring services and will post staff at the location on Dec. 5 to direct anyone who shows up elsewhere.
“We do not want care or that enrollment process to lapse,” Kunins said. “Our goal is to make sure they are carried through to another site with other providers.”