San Francisco Chronicle - (Sunday)
Drug screening plan has too many questions
Linger long enough in any online discussion about drugs, crime and homelessness in San Francisco, and you will inevitably see complaints about “the free $712” the city distributes to all comers, no questions asked. This cash bonanza allegedly invites drug tourists from across the nation to suck our coffers dry while feeding their habits and fouling our streets.
Like much of the public debate in San Francisco these days, there is a kernel of fact in this narrative — buried in a mound of rhetorical manure.
The County Adult Assistance Program does provide debit cards to extremely low-income or noincome residents with no dependent children. Benefits range from $109 per month for homeless individuals to $712 for people who are housed or agree to enter housing, 30% of which is then automatically deducted for rent. There are only around 5,200 single adults enrolled in the program, which is administered by the city’s Human Services Agency.
To receive benefits, recipients must navigate a set of rules that’s over 500 pages, starting with an employability screening, where they’re assessed on their work skills and if they’re eligible for Social Security, Medi-Cal and other programs. Those who are able are mandated to work 12 hours per month. Those who refuse to work or skip out lose their benefits, including housing stipends.
All applicants are questioned about drug use, and anyone unable to work or train due to mental health or addiction issues is referred to RAMS — a nonprofit that operates in the building where the County Adult Assistance program is based — where they are enrolled in a mandatory six-month counseling program. Currently, 118 county assistance clients are enrolled at RAMS. If they stop participating, they lose all benefits.
In short, yes, San Francisco does have a program that gives money to struggling individuals. But there are strings attached. The program’s relatively modest enrollment, in a city estimated to have 20,000 homeless people during a given year, suggests it isn’t a magnet for fraud and abuse.
Why does all this matter? Because the County Adult Assistance Program is at the center of San Francisco’s most controversial ballot measure in the March primary election: Proposition F.
Under Prop. F, Human Services Agency staff members would be trained to determine if there is “reasonable suspicion to believe an individual is dependent on illegal drugs.” They would then refer anyone flagged to professionals that the agency would hire, who would conduct a more thorough secondary screening and develop a mandatory treatment plan for anyone determined to be problematically using drugs. Treatment could include lowbarrier efforts such as taking prescription medication like buprenorphine to curb addiction, to months-long stays at a residential program. Sobriety is not required to receive benefits — there would be no drug testing — but participation in a treatment program would be.
The measure is sponsored by Mayor London Breed. In an interview with the editorial board, she passionately discussed losing her sister and a friend to drug overdoses and suggested that tough love like Prop. F has to be a more robust part of the solution to stemming the city’s record overdose deaths.
Her measure is certainly correct in its assessment that more needs to be done to help county assistance recipients. From Sept. 1, 2022, through Aug. 31, 2023, an estimated 13% of the city’s 700 drug overdose deaths were active or former clients of the program, according to the Human Services Agency. And more than 1,000 participants have told human services directly that they struggle with drug or alcohol addiction.
As we have written before, the moment when people show up, paperwork in hand, ready to participate in the bureaucracy to receive help, is a prime opportunity to connect them with treatment.
The question is if Prop. F will successfully do that, or simply create another layer of cumbersome and expensive San Francisco red tape.
Despite being under a voterbacked mandate to do so, San Francisco has for years failed to provide residents with treatmenton-demand levels of care. There are not enough treatment beds to meet the need, and insufficient staff to run the various treatment programs we do have.
There is no money in Prop. F to create new treatment options. In fact, the City Controller’s Office estimates it will cost as much as $1.4 million annually to run the enhanced screenings. There’s no new money for this, either. Disturbingly, the measure promises to pay for itself all or in part by using monies saved from disenrolling clients.
There are currently no dedicated city treatment slots for county assistance recipients, and the measure provides no guidance on how to improve access — it merely stipulates that no one will be punished if treatment isn’t available. The onus is on the Human Services Agency to figure things out.
Human services Executive Director Trent Rhorer told us his agency has “stayed in its lane” for long enough. If no local treatment options are available, his agency would seek slots for clients in other counties.
Of course, all of California is facing a drug treatment shortage. And San Francisco is limited in its ability to access out-of-county care, due to red tape it’s still trying to eliminate. Even if that path is cleared, the Human Services Agency will be up against other counties vying for any spot that opens.
Based on our conversations with sources, the Department of Public Health was largely kept out of Prop. F planning. The Human Service Agency’s expertise is helping people navigate the bureaucracy of obtaining insurance and benefits, and job training programs. Yes, city overdoses are an all-hands-on-deck crisis. But cutting out the department that handles drug treatment contracts was probably not a good idea. Problems with the Department of Public Health should be resolved, not passed off to another agency with no experience in treating addiction — and one that sources say is already struggling to get its clients into treatment.
According to two Human Services Agency workers, whom we’re not naming under the Chronicle’s anonymous sources policy over fear they could lose their jobs, the department is already too short-staffed to ensure all of its Medi-Cal-eligible clients are enrolled in the state insurance program. Clients can’t access drug treatment without Medi-Cal to pay for it.
These workers had no idea how the agency could add drug screenings to its already overtaxed workload.
“Making qualitative decisions about drug addiction is very different than making a qualitative decision if a person lives in San Francisco,” one worker said. “We have no expertise in that at all.”
So, what do we do to change conditions on our streets, if not Prop. F?
Mayor Breed could start by working with her departments to secure dedicated treatment-ondemand for county assistance recipients. If this succeeds, and treatment slots go unused, an ordinance similar to Prop. F can go through the legislative process, where expert testimony, science and public feedback can be woven into the plan to hammer out the kinks.
Prop. F didn’t need to go to voters. Given all the questions surrounding its implementation, it shouldn’t have.
There is no doubt that urgent action is needed to address the city’s addiction crisis. But if we’re going to enshrine something via the ballot, it should be a clear, thought-out solution. Prop. F is not that.