City’s drug treatment falling short, supervisors say
“We don’t make it easy to get treatment ... We should be using every point of contact to encourage people to seek treatment.”
Rafael Mandelman, San Francisco supervisor
San Francisco has suffered from a shortage of drug treatment beds for years, but the pandemic has made the problem more acute.
Just as overdose deaths skyrocketed in the city during the pandemic, fueled by the powerful drug fentanyl, COVID19 constrained capacity in treatment programs. One temporarily halted new patient intakes to quell an outbreak. Under shelterinplace, fewer people exited programs, lengthening wait times for some beds.
As of Monday afternoon on a dashboard updated daily, there were 30 drug treatment beds available out of a total of 481 funded by the city. An estimated 165 more are privately funded. Before the pandemic, there were about 24,500 injection drug users in the city, with an estimated 4,000 homeless, addicted and mentally ill.
Amid the escalating crisis, elected officials are trying to hold city health officials to a 2008 mandate to provide drug treatment on demand. With little recent data and challenges persisting, Supervisor Rafael Mandelman is calling for a future hearing to check the city’s progress at Tuesday's board meeting.
“We don’t make it easy to get treatment in the way that the folks who brought us the treatmentondemand legislation
were hoping that legislation would lead to,” Mandelman said. “We should be using every point of contact to encourage people to seek treatment.”
Proposition T, passed by voters in 2008, required that San Francisco provide and fund adequate free or lowcost drug treatment to meet demand, calculated by the total number of filled slots plus the number of individuals seeking those spots. It also mandated annual reporting, but the last city report was in 2019.
Officials, providers and advocates said adding beds is just a partial solution to a complicated problem that also includes the challenge of access. Some advocates also push for alternative treatment and harm reduction.
“The current treatment that’s available doesn’t work for everybody,” said Jason Norelli, a case manager with nonprofit Glide who has been in recovery for two decades. “We need to fund new ideas and different ways.”
Others agree more options are needed but criticize the city for policies they view as enabling drug use.
“It’s easier to get drugs on the corner than it is to get into a program,” said Richard Beal, who has been in recovery for three decades and is director of transitional housing at the Tenderloin Housing Clinic. “I believe in meeting clients where they are, but we do a disservice when we just leave them there.”
The Department of Public Health said its Prop. T report from last year will be ready before Mandelman’s hearing. Dr. Judith Martin, medical director of substance use services, said she thought the city met the mandate during the pandemic “by bending over backwards in pretzels.”
COVID19 “had a huge impact on services,” Martin said. “It’s a challenge for everybody.”
The pandemic made some potential participants reluctant to move into group settings and forced programs to set aside rooms for isolation or quarantine. Even with precautions, more than 1 in 3 participants tested positive for COVID19 in January at the Salvation Army’s Harbor Light residential program, Executive Director David Pierce said. The health department halted new intakes at Harbor Light until March 15.
The pandemic also slowed exits and slightly lengthened wait times for some beds. In the end, Martin said, there were only a few days when certain kinds of beds were not available and providers adjusted.
Kayla Crenshaw, lead navigator with Epiphany Center, which provides treatment to women, said there was a point over the winter for a few weeks she couldn’t find her clients treatment beds.
“The longer we wait, we might lose them . ... Sometimes for people it can be life or death,” said Crenshaw, a program graduate who spends her days on the streets and in the hospital trying to help pregnant women and mothers. She praised her city partners but said more beds and easier access are needed.
“No matter how hard I work, the need is just growing,” she said Friday as she stood outside the city’s shelterinplace hotel for families in the Tenderloin, her arms laden with bags full of donated baby clothes for residents.
One upside to the pandemic was that it increased access to telemedicine, Martin said. Other innovations have also helped. In 2019, the city created a dashboard of how many treatment beds are available and during the pandemic launched a crisis emergency response team.
Supervisor Matt Haney has been frustrated at the slow pace.
“The city is doing a terrible job,” Haney said. “Any resident can walk down the street and see people who are visibly in need of help and not getting it.”
Supervisors have also been skeptical of past Prop. T progress, evidenced at a 2019 hearing. The 1½page report that year said there was no wait for narcotic replacement treatment, intensive residential treatment and residential stepdown treatment. Usually available within a day was residential and outpatient detox and medication assisted treatment. The wait was a week for outpatient and case management.
“Currently the access to substance abuse treatment in San Francisco is better than at any time in the past,” the report said, noting that there were openings every day.
Sara Shortt, coordinator of the Treatment on Demand Coalition, called the report “disconnected from reality.”
Providers said drug users don’t always want treatment and some are jaded by past failed efforts to get help. When they’re ready, they can face an intake process that involves signing up for state medical insurance, screenings with long waits or multiple appointments, documentation that homeless individuals might not have, and authorization by the health department. The reality is that getting people in beds can take days or even weeks. By then, potential patients may be back on the streets.
Martin agreed the intake process presents hurdles. To streamline it, she said the city sometimes admits patients while their insurance is pending and foots the bill for months. The city is also running pilot programs that preauthorize patients for treatment, including a direct line from San Francisco General to Epiphany Center that fills beds the same day. The organization is pitching a similar pilot to reach women just before or after they’ve given birth. Nonprofit provider HealthRight360 plans to place intake staff in the hospital and jail, said CEO Vitka Eisen.