Desperate to battle a drug epidemic that’s cost more than 1,300 lives in the past 2 years, San Francisco authorities are pressing to get more people into treatment and costs millions on broadening existing programs and producing brand-new ones.
Now, some city leaders and nonprofits are restoring talk of a get-tough method of rehab that has been mainly declined throughout the U.S. considering that the 1990s– putting a primary focus on needing customers to shake their addictions without medication or regressions, loosely referred to as abstinence.
Presently, the city’s health department and its not-for-profit partners accept a “damage decrease” approach, letting people shed addictions mainly at their own speed with help from medication if asked for and without intensive judgment from therapists if theyrelapse Sometimes that indicates entering into residential rehab, however it likewise can merely be living inside far from the temptations of street dealerships.
The debate was restored last month as the city had a hard time to get more people help through its brand-new Tenderloin Linkage Center at U.N. Plaza, where those dealing with addiction can gain access to drug treatment and real estate. San Francisco has actually made national headings as Mayor London Type faces the outdoor drug use and dealing in the Tenderloin that citizens and merchants state has actually just worsened as the super-powerful opioid fentanyl has actually penetrated the drug supply.
The city dipped a toe into the abstinence strategy late in 2015 by financing a sober- just program for guys coming out of prison or as an option to being jailed. State law needs that any rehab program enable “medically assisted treatment” such as methadone or suboxone for opioids and not end treatment for regressions, however the 86-bed complex run by the Adult Probation Department navigates that by billing itself as cultivating way of life modifications, “not merely abstinence from drug use.” Individuals are prompted, nevertheless, to shake drugs with nomedication help And if they relapse, they are asked to go to a program to get drug- complimentary once again.
T.J. Johnson, a fentanyl addict who just recently got real estate through the city’s Tenderloin Linkage Center, trips a Muni bus to check out his sweetheart.
Stephen Lam/The ChronicleIn addition, a brand-new union of nonprofits and business called the Urban Vision Alliance is proposing a enormous growth of the abstinence- based approach utilizing transitional real estate and rehab to get people drug- complimentary prior to they get irreversible subsidized real estate. Through fundraising and preparation help, the group is supporting the production of 1,500 beds in complexes to be refurbished over the next numerous years in San Francisco by the Redemption Army, which provides programs shepherding people from the street into houses with heavy rehab along the method.
That infusion of treatment beds motivated by Urban Vision would be more than the number of treatment beds the city is presently including. San Francisco has plans to include about 400 mental health and addiction treatment beds, although the timeline for all of them isn’t yet clear.
Still, damage decrease has been the chosen strategy of most drug treatment providers throughout the country for years, and in San Francisco it’s rehab gospel for any program.
National research studies for years have actually revealed that abstinence techniques are less effective than the now-traditional medicated damage decrease approaches, with failure rates of at least 75% versus 40% to 60%. However the crisis has actually gotten so bad in San Francisco that abstinence fans state other options deserve a attempt.
That’s the argument made by Supervisors Ahsha Safaí and Catherine Stefani.
At a Feb. 8 managers conference, the 2 grilled the city’s director of behavioral health about why the city didn’t have more abstinence- basedprograms Safaí– stimulated by a union of those in recovery and supporters– assisted shepherd the probation department’s complex into presence, and stated at the hearing he ‘d like to see more like it moneyed by the city.
Hillary Kunins, the behavioral health director, reacted that the state law needing medication-assisted treatment forbids financing abstinence- just programs– however she included that she’s open to ideas.
” I desire to motivate us all to not fall under what I believe is a incorrect dichotomy of abstinence versus damage decrease, however actually see it for all of us together to enhance health results,” she stated throughout the conference.
Stefani, lining up with Safaí, appeared exasperated that there wasn’t more interest for abstinence methods.
” There are people who have substance use disorder that definitely can not use their drug of option,” she stated. “They can’t take a sip of white wine, they can’t do a line of coke, they can’t smoke fentanyl since they might pass away, and they do not desireto They are looking for abstinence in their life.
” We are not stating that you can’t have damage decrease either, however we are stating make a location for abstinence- based recovery for those addicts who are suffering and require it.”
Safaí informed The Chronicle he is simply attempting to broaden the combination of programs, considering that years of intensive efforts to help chronically homeless addicts have not cleared the streets of people shooting and cigarette smoking dope in public.
” We see such severe anguish on the streets, we need to be open to attempting brand-new things,” he stated. “Why not attempt something more requiring to see how effective that can be?”
The concern is urgent as the city prepares to launch brand-new rehab efforts with millions of dollars in brand-new state, federal and regional tax cash over the next couple of years. And Type is under extreme political pressure to offer with the crisis.
T.J. Johnson, who’s having a hard time to shake addictions to fentanyl and alcohol, understands the debate well. He’s attempted going cold turkey by himself and in tidy and sober centers.
T.J. Johnson accepts his sweetheart, Justine. Johnson, who is addicted to fentanyl, has been a regular visitor to the questionable Tenderloin Linkage Center and is helpful of its damage decrease approach versus abstinence- based programs.
Stephen Lam/The ChronicleHowever the just thing that makes good sense to this 41-year-old San Franciscan is what he’s doing today: taking methadone and drawing back gradually from drinking at his own speed. He’s doing it in his own location, a hotel space he landed just recently through a homeless-aid program– which indicates for the very first time in years, he’s housed and steady and able to commit himself to sobriety.
” I have actually attempted whatever else. This is the just thing that feels right,” Johnson stated the otherday “This talk of ‘abstinence’? It will not work. You simply can’t require people to kick drugs unexpectedly and remain tidy.”
More than a lots addiction professionals and hundreds of pages of research study documents evaluated by The Chronicle back up what Johnson is arguing. They preserve that medically assisted treatment, and keeping customers in a program regardless of regressions, are more effective than old-school abstinence techniques
A 2016 research study released by the National Library of Medicine revealed that rehab patients utilizing methadone were 4 times most likely to stay in treatment than those not utilizing medicine.
” We do desire to honor abstinence for people who are prepared and able to do so … however we understand abstinence- just programs just work for a little portion of the population,” stated Laura Guzman, a senior director at the National Damage Decrease Union.
Vitka Eisen, president and CEO of the city’s biggest drug treatment provider, HealthRight 360, stated going cold turkey, without medication, is not supported by the science, and is “thought about high danger and puts the customer at danger of death from overdose if they relapse.”
Nora Volkow, director of the National Institute on Substance abuse, stated the probation department program Safaí promoted is the initially of its particular kind she has actually heard of, and “I am seeing this program to see if we can gain from it.”
She included that the program’s production is part of a growing pattern around the country, not simply in San Francisco, of the endless drug epidemic requiring people to attempt any brand-new method they can believe of.
” The disaster of overdoses is requiring the discussion,” Volkow stated. “The numbers are worrying– you can not overlook the more than 100,000 people who passed away of overdoses in the previous year, the most ever.”
San Francisco’s damage decrease programs frequently move people into helpful or other types of real estate and let them continue to use drugs while case supervisors guide them towards sobrietyprograms However the disappointment Volkow speaks of is stimulating some to think about changing that policy, called “real estate initially,” which is providing those addicted to drugs real estate prior to they shake their addictions, acknowledging that getting sober is a lot easier if you’re steady under a roofing system.
One of the primary supporters for abstinence in San Francisco is Tom Wolf, who was homeless and gave up an opioid addiction in 2018 through abstinence in a Redemption Armyprogram Now working as a recovery supporter, he mentioned that a bulk of the 650 people who passed away of overdoses in San Francisco in 2015 were housed, according to city figures, and that lots of of those were previously homeless people living in “real estate very first” helpful real estate in the Tenderloin.
The helpful real estate citizens were being permitted to stay in their real estate while they used narcotics, and while case supervisors attempted to encourage them to getsober Wolf stated there requires to be a more assertive approach to getting those citizens tidy.
” The entire initial property of the damage decrease approach was to use options like medically assisted treatment to help you enter recovery and reach abstinence,” Wolf stated. “However what’s really going on now is they desire to simply keep you alive in locations like helpful real estate, which is great, however no one’s having the discussion about what to do next.
” We’re letting people continue to use their unlawful drugs too long. We need to work more difficult to get those people intorecovery I’m not opposed to utilizing things like methadone while you’re entering into recovery, however you’ll be far better off if you’re complimentaryof all medication and drugs Complete abstinence enhances your life.”
The union Urban Vision Alliance, which formally introduces in March, is proposing a higher focus on guiding unsheltered people with addiction into transitional real estate and getting firmer dedications from them to stop utilizing prior to they get irreversible houses– a kind of abstinence- based assistance.
The not-for-profit is loosely pattern its very first huge assistance task with the Redemption Army after the approach of Sanctuary for Hope, a street-to-recovery-to- real estate program in San Antonio, Texas, that declares to have been mainly accountable for a 77% decrease in the downtown homeless count considering that it was established in 2010.
Urban Vision’s focus will be on chronically homeless people– the 20% to 40% of the unhoused population who have actually lived outdoors for more than a year and extremely are the desperate ones seen getting high on the street.
” We require a much better exit to secure free of addictions,” stated Theo Ellington, director of homeless efforts at the Redemption Army. “Damage decrease hasn’t worked for somepeople Abstinence-based treatment has to be offered.”
Chronicle staff author J.D. Morris contributed to this report.
Kevin Fagan is a San Francisco Chronicle staff author. Email: kfagan@sfchronicle.com Twitter: @KevinChron