Raymond Llano carries a plastic bag with the whole lot he owns in a single hand, a cup of espresso within the different, and the flattened cardboard field he makes use of as a mattress underneath his arm as he waits in line for lunch at Glide Memorial Church in San Francisco. At 55, he hasn’t had a house for 15 years, since he misplaced a job at Goal.
Llano as soon as tried to get on public help however couldn’t — one thing, he mentioned, wanting perplexed, about owing the state cash — and he’d like to use once more.
However starting subsequent 12 months, if he does, he’ll face a brand new metropolis requirement that single adults with no dependents who obtain money advantages be screened for unlawful drug use and, if deemed needed, enter remedy. San Francisco’s voters accredited the brand new mandate in March.
Llano has no objection to being screened. He mentioned he makes use of hashish, which is authorized in California, although not federally, however doesn’t use different medicine. Nonetheless, he mentioned, “I suppose I would try recovery.”
One other man within the free-lunch line, Francis Farrell, 56, was far much less agreeable. “You can screen me,” he mentioned, elevating his voice, “but I don’t think you should force me into your idea of treatment.”
Nobody will probably be pressured to endure substance abuse remedy, nor will anybody be topic to drug testing, San Francisco officers insist. Moderately, beginning in January 2025, San Francisco’s public help recipients who display screen optimistic for habit on a 10-question drug abuse check will probably be referred to remedy. Those that refuse or fail to point out up for remedy will forfeit the $109 a month that the town grants to homeless adults who qualify for metropolis shelters or supportive housing, or the $712 a month it grants to adults with dwelling addresses.
Town well-known for its tolerance is resorting to robust love.
Trent Rhorer, govt director of the San Francisco Human Providers Company, cited three causes for the brand new measure, which was normal after comparable insurance policies in Los Angeles and New York: to incentivize individuals with a substance use dysfunction to enter remedy, to stop taxpayer cash from getting used to purchase unlawful medicine, and to dissuade drug seekers from transferring to San Francisco.
“We’re giving them the opportunity to engage in something, without requiring sobriety, to hopefully get on a path to recovery,” Rhorer informed KFF Well being Information.
When Mayor London Breed launched the poll initiative often known as Measure F in a information convention final 12 months, she referred to as it an incentive to encourage drug-addicted recipients of public help to enter “into a program that will help save their life.” Unintended overdoses killed greater than 800 individuals in San Francisco final 12 months.
However within the eyes of many well being care suppliers, researchers, and hurt discount advocates, the measure is neither an incentive nor a possibility.
The coverage was designed to have “a coercive, punitive effect” and will do extra hurt than good, mentioned Vitka Eisen, president and chief govt of HealthRIGHT 360, San Francisco’s largest drug remedy supplier.
“It would have been an interesting project, much more in the spirit of San Francisco as a hub of innovation, to figure out if we can identify people with substance use disorder. And if they go into treatment and stay for a period of time, they’ll get an increased benefit,” Eisen mentioned.
About 5,800 individuals within the metropolis at the moment obtain advantages from the County Grownup Help Applications, or CAAP. Underneath Measure F, those that acknowledge drug abuse on the screening check however refuse remedy and reside in city-provided shelter will lose their money advantages however can keep their shelter, Rhorer mentioned. Nevertheless, CAAP recipients who refuse remedy and rely upon public help to pay their hire in personal housing might lose their properties.
Town will give recipients three possibilities to point out up for remedy and pays hire on to a landlord for one month, Rhorer mentioned. Measure F got here in response to the grim situations on some San Francisco streets, the place women and men lie on sidewalks, typically blocking passersby with their legs and arms splayed, or stand bent over, frozen like statues. Many use fentanyl, an artificial opioid that has turned a long-standing homelessness drawback right into a public well being emergency.
About 12% of people that fatally overdosed in San Francisco final 12 months have been CAAP recipients, Rhorer mentioned.
Compassion fatigue appears to have settled over this metropolis identified for its kindheartedness. Measure F proponents raised $667,000 — greater than 17 instances as a lot as opponents — largely from enterprise executives and tech buyers, in line with the San Francisco Ethics Fee. Then in March, 58% of voters accredited the measure.
Since fentanyl started changing heroin round 2019, Rhorer mentioned, “drug tourists” have flocked to San Francisco, the place the opioid has been low cost and plentiful. Lenient legislation enforcement and comparatively beneficiant money public help grants even have drawn individuals with habit, he mentioned, though police exercise has elevated since final spring.
A current metropolis report discovered that solely 53% of the 718 individuals whom police cited for substance use over a 10-month interval that resulted in February mentioned they lived within the metropolis.
“People who live in San Francisco, who really need the most help, don’t get the help they need due to the influx of people coming from somewhere else,” mentioned Cedric Akbar, who runs restoration packages and co-founded Optimistic Instructions Equals Modifications. “And should our tax dollars go to the ones in San Francisco, or are we going to take care of the whole country?”
Akbar started utilizing heroin when he moved to San Francisco from Houston within the Nineteen Eighties and has been in restoration for 31 years. He mentioned he would have most popular even stricter necessities for eligibility for public help than these in Measure F however hopes the brand new mandate will no less than assist give individuals entry to remedy.
Town’s capability for remedy can be a priority. Eisen and others describe a dire scarcity of behavioral well being staff to employees remedy services and residential step-down models, that are essential for housing these in restoration from drug habit.
New packages funded by the just lately accredited Proposition 1 in California, which authorizes the state to spend $6.38 billion to construct psychological well being remedy services and supply housing for homeless individuals, are supposed to deal with the shortages.
Leslie Suen, an habit medication doctor and an assistant professor on the College of California-San Francisco, fears that pushing CAAP recipients into remedy might flip them off. When individuals “were stigmatized, or coerced, or told they would face consequences if they didn’t do a certain thing,” she mentioned, “that pushed them away from the health system even further.”
Although proof suggests obligatory remedy can present short-term advantages, it can also result in long-term hurt, the Nationwide Institute on Drug Abuse mentioned in an e-mail.
“To achieve the best outcomes,” the e-mail mentioned, remedy ought to be “delivered without stigma or penalty.”
Nearly everybody with a substance use dysfunction enters remedy underneath some type of strain, whether or not from a guardian, a partner, an employer, or the prison justice system, mentioned Keith Humphreys, a Stanford College psychiatry professor.
Nonetheless, he questioned the morality of requiring welfare recipients, versus criminals, to get drug remedy.
“I would never start with people who are poor but not committing crimes,” he mentioned. “I would start with people who are harming others.”
This text was produced by KFF Well being Information, which publishes California Healthline, an editorially unbiased service of the California Well being Care Basis.
