On Thursday, July 13, Mayor London Breed wrote that, of 115 people cited or arrested for public drug use in the previous two weeks, none accepted services, and the overwhelming majority were not San Francisco residents.
It’s a common refrain. Mission Local decided to find out: What does that offer of “services” look like? More than 30 people surveyed, all of whom were frequent drug users who have been cited or arrested by San Francisco police in the last two years, had little to no idea.
“They cram it in really fast when they’re discharging you [from jail], right in with all the other things they say,” said a woman named Sylvana, who was staying on Minna Street and grew up in the Fillmore. “You basically miss it.”
Of those interviewed, five were born-and-raised San Franciscans, and two more were born here, then displaced. Six were originally from Oakland, and three came from farther out in the East Bay. Others named hometowns all across Northern California. Two came from Virginia.
So, 23 percent were originally from San Francisco and 9 percent were from the Bay Area with about 66 percent from beyond the Bay, in line with city data: The city’s newly formed drug coordination center said 75 percent of recent arrestees were from outside San Francisco.
Gearing up for a sunny July day out in the community providing snacks, food and medical care, Khusar, 29, a program manager at Code Tenderloin, said: “I haven’t met a single person who doesn’t want ‘services.’”
“If it’s not food, it’s harm reduction. If it’s not harm reduction, it’s housing. If it’s not housing, it’s clothes. There’s always something that they want. It’s never nothing.”
In terms of users who get arrested, providers agreed that the confines of a cell were not the most encouraging environment to have an “aha” moment about sobering up.
Moreover, even if that moment comes, services out of jail won’t immediately follow. Jail Health Services, which provides addiction treatment and mental health services to those in jail, noted this month a deficit of 17 staffers, and a long wait for those referred out to treatment.
Kado
Earlier this month, a young man named Kado sat on a ledge at Seventh and Mission streets. “I’m high every day,” said the 24-year-old as he searched for a lighter to smoke fentanyl off some tin foil, scratched-up glasses falling down his nose.
On May 24, shortly before the May 30 crackdown on public opioid users, arrest logs confirm that police nabbed Kado for allegedly selling fentanyl and crack, which he says were for personal use and not sale. In less than 24 hours, he was released “on OR,” or on his own recognizance, with a written promise to appear in court the following week.
When asked about the offer of support through programs connected to jail on his release, Kado only laughed, looking confused. “Most people just want to get out of there,” he said.
Fentanyl is a short-acting opioid, meaning that without medication, withdrawal symptoms develop — nausea, shortness of breath, depression — within eight hours after someone’s last dose. Symptoms can last for weeks, according to the American Addiction Centers.
Kado said that while waiting out the day in jail, the only thing on his mind was getting his next dose. Withdrawal was already setting in.
Kado was born and raised in the Tenderloin. He went to Harvey Milk Elementary School and then a series of continuation and public schools in the city. He started using hard drugs when he was 13. Since then, Kado said, he’s stayed high.
Living on the streets with no working phone, there’s slim chance he’d stay in touch with a case manager.
A couple of years ago, Kado says he detoxed at Walden House on Hayes Street, but was kicked out when it was discovered he had used fentanyl again.
The stronger the drug, the harder the withdrawal, providers said. Fentanyl is considered around 50 times as powerful as heroin, making detox extraordinarily difficult, according to Gary McCoy, vice president of policy for HealthRight 360, which offers addiction and other health services.
Kado said that, ideally, he would like to get clean at a medicated service.
The week after his release, Kado missed court. The consequence of missing a court date is the issuance of an arrest warrant. And the cycle continues.
For homeless people and drug users, missing court is common. Others surveyed by Mission Local had the same story: a warrant for a missed court date, an outstanding citation (one owed $500 for smoking fentanyl in public), and no contact with a case worker.
A 2021 study that analyzed court appearances through the city’s main diversion program found someone without stable housing was nearly 1.5 times as likely to miss a court hearing as someone with a home.
Turning down service a ‘false narrative’
The Drug Market Agency Coordination Center — a collaborative of city agencies that includes the Department of Emergency Management, Department of Public Health, Police Department and Sheriff’s Office — on Thursday, July 20, gave its total arrests for intoxication: 170 people since May 30, when the city announced a ramping up of arrests for violating several drug codes.
Of those, reported Kristin Hogan, a spokesperson for the coordination center, “75 percent are not San Francisco residents.” Hogan added that in the past year-to-date, there have been “463 arrests for drug sales in Tenderloin/SOMA,” with 566 in all of 2022.
Most recently, she wrote, SFPD doubled the number of arrests from June 26 to July 9, when compared to the previous two-week period.
David Mauroff, chief executive officer of the San Francisco Pretrial Diversion Project, said the belief that people are turning down services is a false narrative, and largely anecdotal.
The most important part of treating someone, said Mauroff, whether it’s mental illness or drug addiction, is “meeting them where they are.”
“Addiction is a disease,” he said. “When someone gets their first cancer diagnosis, they’re not jumping right into chemotherapy. At that moment when you are wrestling with addiction and mental health issues, you’re not in a place to make that decision.”
SF Pretrial is a nonprofit funded in large part by the San Francisco Sheriff’s Office. They manage most of the programs for arrestees awaiting trial or in need of support.
In the past year, arrests have shot up, and jail populations are climbing. Anytime arrests are up, SF Pretrial’s client base increases. In early 2022, they averaged only around 500 cases at any given time. Right now, they’re down to 22 case managers, said Mauroff, spread thin across a growing list of 900 clients.
The biggest challenge, Mauroff said, has been connecting clients with treatment. “Agencies are telling us to stop sending people.” Depending on the program, most are full up.
The issue isn’t quite as simple as there being too few beds. As of today, Public Health’s online portal estimates 43 available beds of 563 designated for treatment. Many treatment options have qualifications based on gender, disability, sobriety, Medi-Cal enrollment or citizenship, however, and regardless of how many beds they have available, someone may not make the cut.
Staffing is a persistent issue at many of the city-contracted services. And, “if you can’t fully staff a program,” said McCoy of HealthRight360, “then a bed is just a bed — just a piece of furniture, nobody to fill it.”
Experts at programs across the spectrum of treatment, from abstinence-based to harm reduction, agree that the system of constant referrals, waitlists, appointments and follow-ups is extremely discouraging to someone suffering from depression related to drug addiction. And the cycle continues.
‘It’s about building trust’
Getting a clear answer on what exactly constitutes the “offer of services” to arrestees has been a challenge. Correspondence with the Police Department, Department of Public Health and Sheriff’s Office did not bring clarity about what services were offered.
Many providers in the city said they face the same issue from the city departments when asking for details about how treatment is offered in jail. They refer to it as a lack of transparency.
What remains in question is how people are evaluated for services, and if the right services for that person are even available. In any case, offering treatment straight from jail does not seem to work as well as a slower, more incremental approach, providers said.
On a recent weekend, UCSF nurses and Code Tenderloin volunteers conducted a walkabout through Downtown, administering Covid-19 vaccines to unhoused people in the area and lightly treating wounds.
The team’s first point of engaging someone to get vaccinated was offering an (underripe) banana.
“I have two warrants out, one for alleged battery,” said Nestor, cradling his fruit. He was sleeping off a fentanyl high in a doorway on Minna Street. After some coaxing, he was given a covid vaccine by a UCSF worker and a bag of snacks.
“I want to get clean,” said Nestor, his eyes closed and voice almost a whisper. “But I don’t think I’m ready.”
Nestor was recently cited by police for using drugs in public. Asked if he was planning to pay, he said no, that he doesn’t have the money and doesn’t want to go to his court date and risk jail time.
Sherri Borden, a nurse practitioner and roving clinic lead, said getting users into treatment requires building a relationship of trust — one that people don’t associate with a law enforcement setting.
“People want services,” she said. “But it’s how you talk to them. It’s about building trust. It’s about handing them a banana and a granola bar. If you say, ‘Hey, do you want services?’ people will just say ‘no,’” said Borden.
Then it’s an “OK, bye,’” she said, shaking her head. “You’ve missed the boat.”
‘I was born drunk’
“You have to understand the mind of an addict,” added Portery McFadden, 65, who was en route to the Tenderloin YMCA on a Tuesday in July. McFadden grew up in what was formerly called the Army Street Projects, now known as Bernal Dwellings, in the Mission. She lives in the Hotel Isabel, a single-room occupancy hotel at Mission and Seventh streets, where she says many of her neighbors use drugs.
“I was born drunk, myself,” she said. McFadden’s mother was a heavy drug user and alcoholic for much of her life. “A lot of these people, they were born drunk or high, and grew up like this.”
“Look around. The average person out here is depressed. Fentanyl’s a downer. You get out of jail, you’re sick. You don’t want help; you want to get high. You feel like you can’t get any lower.”
Seeking treatment, she said, is not one-size-fits-all.
“Everybody’s different. Some people, you have to walk them yourself to the corner and take them to the clinic; they can’t do it themselves. I walked two of my siblings to the clinic for treatment.”
At the Hotel Isabel a few years ago, McFadden remembered a social worker who, every week, made enough chicken soup for the whole building.
“She would put the soup in separate bowls. And she would knock on every door. But really, she did it to check in on people. That’s the way,” she said. “Nobody can turn down chicken soup, even if you don’t want anyone knocking.”
Just like McFadden described, another man buying fentanyl down the street said he spent much of his childhood on the streets in East Oakland, and started using early. He felt safer staying outside with his community, and didn’t feel the same about most residential programs.
Three women huddled together at the corner of Seventh and Natoma all agreed — they would be more inclined to get clean if they were given safe housing. “As long as I’m on the streets, I’m gonna stay high” said one woman, who grew up in Oakland.
She said she hadn’t heard anything about services, but that when police came up while she was smoking fentanyl, she was given a $500 citation. The officers then moved along.
As liberal as I consider myself, far to the left of Bernie Sanders, I confess it bothers me that there’s never even a hint of a suggestion that these people are at least partly responsible for their situations or that they’re doing any wrong.
Question to everyone…. Why dont they just hold drug users in jail for say, 2 weeks, until they are detoxed. I know it is unpleasant. Maybe the prospect of that happening will motivate them to go somewhere else. All good. Right?
It is cruel without proper medical setting and will not work to get them detoxed or off drugs, all it does is harm the addicted person.
I work with people with severe mental illness and criminal justice involvement, and the vast majority are active substance users. Many of them do detox in jail over and over, but for reasons I don’t want to spend the time writing about here, they don’t typically stay clean when they get out (long story short that’s not a very reasonable expectation for an addict who’s been in jail for less than a year+ and not receiving real drug treatment, and not having a place to go to that doesn’t surround them with drugs and funnel them into the same environmental, social and economic triggers).
Also, jail is not a therapeutic environment despite the good work done by the vastly understaffed Jail Behavioral Health team, so they’re often not really making much progress toward recovery.
Then there’s the frustrating fact that the jails are full of drugs and it’s often pretty easy for people to use in there. There are no easy or uncontroversial solutions to this complex problem. I wish there were.
“Then there’s the frustrating fact that the jails are full of drugs and it’s often pretty easy for people to use in there”
Proof that Drug Prohibition Doesn’t Work, cannot ever work, even in the literal police state of prison!
Prohibition only makes drugs and drug use more dangerous. Fentanyl is a drug used safely every day for pain relief in a medical setting.
Illicit Fentanyl is a product of prohibition, of the crack down on prescription opiates, of CDC abandoning science to publish politically inspired opioid dosage guidelines in 2015. It worked, prescriptions for safer opioids like oxycodone fell dramatically, and the black market stepped up to supply the demand with illicit fentanyl
Witness the results
Increased OD deaths
Chronic pain patients no unable to get relief
Physicians harassed by LE for legit practice of medicine
It really doesn’t matter who is responsible. Drugs are physically addicting. Until the medical profession comes up with medical alternatives, we aren’t going to get anywhere. They refuse “treatment” because it doesn’t work.
Okay, Robert. People are at least partly responsible for getting into this situation.
So what’s your point?
As someone to the left of Sanders, are you sure that applies to you? I confess it bothers me when people blame those on the streets, instead of neoliberal funding priorities. Sure, we can say they’re at least partly responsible. How is that a step in the right direction if we’re not funding more social workers and case managers?
1. The lower the number & quality of resources you have access to + the smaller/less resourced your personal support network is = the lower the quality & number of choices available to you.
2. As the resulting circumstances become more precarious, harm of the negative consequences accelerates exponentially.
3. Right or wrong is not the same thing as legal or illegal.
100 percent. This is the fatal flaw of today’s progressive movement; to paraphrase another, confusing permissiveness with compassion. This complete lack of personal accountability badly damages the movement’s credibility, as well as perpetuates the very problems it seeks to solve. This article is a prime example. Dont’ get me wrong -MissionLocal does so much great work uncovering the corruption in this great city, but it does seem to give a lot of other folks a pass.
“75 percent of recent arrestees were from outside San Francisco”
Sounds like ML’s anecdotal research is in line with the city’s findings. I’m a huge supporter of investing in services, housing, and other efforts to get people off drugs and off the streets. But SF can’t treat and house the world. Maybe we need a new approach: You have roots in SF, we’ll work hard to get you the help you need – only if you refuse real and reasonable efforts will we send you to prison. You came to SF from elsewhere to do drugs? You have two choices right now – you can either go to prison or get out of town and stay out, and if you come back you’re going to prison.
You’re suggesting a crystal clear 14th Amendment violation. Any judge worth their salt would laugh at your proposal.
The 14th Amendment as we knew it is on life support and is probably not much longer for this world.
You report on people walking around offering services, and of various groups reaching out, and then you write of people complaining that offering the services in jail is not sufficient and even that they always want some service. And you write of addicts telling you they just want to get out, get high, but oh yeah, sure, they would like services….
In the meantime, what I don’t find in the article is “what is actually being offered”
**SF says drug users turn down services. But what’s on offer?**
What IS being offered? And for how long? By whom?
> Many treatment options have qualifications based on gender, disability, sobriety, Medi-Cal enrollment or citizenship, however, and regardless of how many beds they have available, someone may not make the cut.
These requirements should be examined to see which are just keeping beds empty and what can be done to enable others to use those beds.
That’s what the article is about. It’s totally unclear what “services” (if any) are being offered, and the City wants to keep it that way.
They can be offered help in getting off drugs but the problem is there are not enough clinicians or beds to help all who want it, much less need it.
The biggest problem is like everything in life, there are rules and these addicts do not wish to follow program rules nor do they wish to pay for safe housing. I have seen many refuse to start in shelters and move on up. These people want the penthouse right away. Sorry but everyone needs somewhere to start and work your way up. Thrse addicts a lot of them not even from here want to just do as they please in our City. This is a shame.
Can we have some example, any example, of services that someone in the situations you describe, will accept, and how these services would be obtained—and when and where they may be obtained? All I saw was chicken soup.
Perhaps the less we know about the hundreds of millions of dollars squandered on nebulous Services, the less outraged the working populace would be? IDK, just spitballing.
The article mentions a shortage of case managers, so maybe instead of funding 220 more cops like Breed’s new budget does, we could hire 100 more cops and 120 more case managers and social workers. But maybe it’s just chicken soup after all. What do I know since I’m not an M.D?
Turning down treatment after arrest shouldn’t be optional…and for all the out of towners, the terms of release should be to never return.
Addiction is a form of mental illness. A symptom of that illness is that there’s no illness so no “solution” is really needed – maybe just immediate help like a blanket or some medical attention. That’s what “meeting people where they are” really means. So it’s enabling the illness. And it’s not tenable for the rest of us. Public drug use is illegal for a reason. The law isn’t there to be mean. It’s there because drugs are bad for the user and bad for the people around the user. That’s it. The consequences need to be to get off the streets and into mandatory rehab. It’s not a request. And please no whining from my fellow liberals. This is not harsh. Harsh is what’s going on now on our streets. There’s nothing compassionate about watching people kill themselves with drugs. Self-incarceration on public streets is not preferable to treatment incarceration. Ask the treatment specialists who see the same users nearly every day until that last time when the tragic circle is complete.
Besides lax enforcement and the weather – listen to out-of-towners you’ll find it is services that draws all these people here. Once here, turns out you can’t stay cushy maintaining your addiction? Something tells me if we ramped things down to the level of the rest of the country, we’d be facing only a fraction of the problem.
Why are addicts not able to afford even a simple burner phone? The city provides you with over $600 a month in assistance, and there are charities that help as well. You can get a monthly phone plan for like $20, and there’s free Wi-Fi all over the city. Can they really not set aside a small fraction of their welfare checks to maintain a phone? I don’t understand how you can manage in today’s world without internet access. Also, treatment needs to be mandatory – if addicts aren’t able to stay in voluntary programs, they need to be taken of the streets and put into involuntary detox programs, where they physically cannot leave until they have been sober for several months. It’s inhumane letting them be on the streets and slowly kill themselves.
You really don’t understand the mentality of Fentanyl addicts. The Drug requires that ALL FUNDS go to the drug. A phone will be traded for the drugs as soon as possible/necessary. Sadly, enabling addicts and prolonging the inevitable has a minuscule success rate. This is global chemical warfare.
If that’s the case, why would give them a choice when it comes to treatment? Clearly, almost 100 percent will refuse whatever services are offered, whether those services are effective or not. Better to make it mandatory and achieve what success you can. Seriously, anything has to be better than slow-motion suicide on the street.
What $600 are you referring to?
You think city workers walk up and down the street and hand out rolls of cash to people who look like they’re homeless?
What if you don’t have a mailing address? What if you have no ID?
What if you can’t show up for a sequence of appointments reliably? You think the city is going to track people down and hand them wads of cash?
The city doesn’t just give $600 to people in need.
Uh, let me see: no reliable source of income, no way to charge the phone, no money to buy more minutes, phones get stolen, phones get swept up in illegal DPW sweeps, phones get broken … shall I go on?
That sounds like a great idea, except for the fact that it doesn’t matter how long they are sober for. Once they leave any voluntary or mandated treatment they will get high. You leave somewhere sober with no house, no job, and nothing but being sober going for you and they will fall right back into it. There will be those few who make it, but not a lot of them. When 1st time patients go into a treatment facility, homeless or not, 97% won’t stay sober. As a former addict/alcoholic, none of my family, friends or my wife could keep me sober. They have to want it, and the ones that do will take the first opportunity.
They are addicts. When you are addicted every and I mean every waking moment of your life is focused on your next hit. They are not going to spend time and even a small amount of money getting phones any more then they are going into rehab voluntarily. You could offer them a new IPhone or a month in a swanky Malibu rehab and they wouldn’t care.
News flash: Care not Cash passed.
Yes, I know Care Not Cash program was supposedly reinstated, but this is where the Free Money in SF meme originated.
Thanks for the reporting Griffin. Breed’s drug theater is getting repetitive and tiresome. Poor London, she’s tried everything but these foreigners, these drug addict deadbeats just turn their back on the poor Mayor. Oh, boo hoo hoo. What are the services? The City doesn’t spell it out, but everybody knows these are the same “services” which have been offered since 1982 — fictional “services”, propaganda meant to service the political demands of the moment.
There are no treatments for crystal meth addiction. You’ve got to hit rock bottom where doing meth hurts more than the underlying pain to have a hope of pulling out.
Treatment for opiate/opioid addiction has a negligible success rate.
Government provided safe supply of pharmaceutical fentanyl is the only path forward to eliminate the open air drug markets and check overdoses with known OD-resistant dosing of slow dissolving oral tabs.
There is so much moral handwringing and wrong assumptions in the comments. In non-criminally justice involved people, getting into medically supported treatment can take more than a week, and there is only ONE facility in the city that can do this for people on Medi-Cal. For people on Medi-Cal, there is only one system of residential treatment that is open, and that, too, usually, is full. It is unethical to offer people services that do not exist. To the person who scoffed about people not affording phones — most cannot provide a mailing address, since they don’t have one, which is part of the criteria. To the person who suggested that it’s a good idea to let people in withdraw suffer without intervention, it worries me that you think this is acceptable. Fortunately, the jail has medically assisted treatment options such as methadone and bupe available, since they at least understand that withdrawal is not an ethical punishment but a physiological syndrome. Until we can support people with hope of a better life, of real offers of services (which begin with respect), we are all stuck with this paradigm.
We don’t need “new” approaches. How did SF go from the most beautiful city in the world to a complete sh**hole? Through many of the regressives who post on this site and vote for far left idealists with fantasy solutions. Return to “law and order” as a start – if a jail cell does not provide an “aha” moment, nothing will. SF, Chicago and NYC show the failures of regressives who have no idea what they’re doing. Go back to “old ideas” that worked and kept “the City” clean and safe. That makes too much sense, so it’ll never happen in the “new” and horrible SF.
The fact is that crimes against humanity are what is taking place, and just because the United States has failed on its own homeland to prevent this incomprehensible inhumane treatment of its own civilians/citizens international law, United nations, Interpol as well as more obscure sectors of military minded groups and others shall answer the call for dignity and relief while pinning down the obscene evil of so called relief programs ect…and the cruel greed of the non profits ,organized religion ,fund raisers, ect..