San Francisco Tries Tough Love by Tying Welfare to Drug Rehab

Raymond Llano carries a plastic bag with every part 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 below 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 Target.

Llano as soon as tried to get on public help however couldn’t — one thing, he mentioned, trying perplexed, about owing the state cash — and he’d like to use once more.

But 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 mandatory, 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 medication. Nonetheless, he mentioned, “I suppose I would try recovery.”

Another 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.”

No one will probably be pressured to bear substance abuse remedy, nor will anybody be topic to drug testing, San Francisco officers insist. Rather, beginning in January 2025, San Francisco’s public help recipients who display constructive for dependancy on a 10-question drug abuse test will probably be referred to remedy. Those who refuse or fail to indicate 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 house addresses.

The metropolis well-known for its tolerance is resorting to powerful love.

Trent Rhorer, govt director of the San Francisco Human Services Agency, cited three causes for the brand new measure, which was customary after comparable insurance policies in Los Angeles and New York: to incentivize folks with a substance use dysfunction to enter remedy, to forestall taxpayer cash from getting used to purchase unlawful medication, 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 instructed KFF Health News.

When Mayor London Breed launched the poll initiative often called Measure F in a news conference final 12 months, she known as it an incentive to encourage drug-addicted recipients of public help to enter “into a program that will help save their life.” Accidental overdoses killed more than 800 people in San Francisco final 12 months.

But within the eyes of many well being care suppliers, researchers, and hurt discount advocates, the measure is neither an incentive nor a chance.

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 people within the metropolis presently obtain advantages from the County Adult Assistance Programs, or CAAP. Under Measure F, those that acknowledge drug abuse on the screening check however refuse remedy and stay in city-provided shelter will lose their money advantages however can keep their shelter, Rhorer mentioned. However, CAAP recipients who refuse remedy and depend upon public help to pay their hire in personal housing may lose their houses.

The metropolis will give recipients three possibilities to indicate up for remedy and pays hire on to a landlord for one month, Rhorer mentioned. Measure F got here in response to the grim circumstances on some San Francisco streets, the place women and men lie on sidewalks, usually 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.

Paul Harkin, from the nonprofit Glide, arms out Narcan, fentanyl detection packets, and tinfoil in an alleyway in San Francisco on Feb. 3, 2020. (Nick Otto for the Washington Post through Getty Images)

Many homeless folks in San Francisco use fentanyl, an artificial opioid that has turned a long-standing homelessness drawback right into a public well being emergency. (Jessica Christian/San Francisco Chronicle through Getty Images)

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 traders, based on the San Francisco Ethics Commission. 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 folks with dependancy, he mentioned, though police exercise has elevated since final spring.

A latest metropolis report discovered that only 53% of the 718 folks whom police cited for substance use over a 10-month interval that led to 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 Positive Directions Equals Changes. “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 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 at the least assist give folks entry to remedy.

The metropolis’s capability for remedy can be a priority. Eisen and others describe a dire scarcity of behavioral well being staff to workers remedy services and residential step-down items, that are essential for housing these in restoration from drug dependancy.

New packages funded by the 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 folks, are supposed to handle the shortages.

Leslie Suen, an dependancy drugs doctor and an assistant professor on the University of California-San Francisco, fears that pushing CAAP recipients into remedy may flip them off. When folks “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.”

Though proof suggests obligatory remedy can present short-term advantages, it can also result in long-term hurt, the National Institute on Drug Abuse mentioned in an e mail.

“To achieve the best outcomes,” the e-mail mentioned, remedy needs to be “delivered without stigma or penalty.”

Almost everybody with a substance use dysfunction enters remedy below some form of strain, whether or not from a father or mother, a partner, an employer, or the felony justice system, mentioned Keith Humphreys, a Stanford University 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 article was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation. 

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