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 stated, trying perplexed, about owing the state cash — and he’d like to use once more.
However starting subsequent yr, 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 vital, enter remedy. San Francisco’s voters accredited the brand new mandate in March.
Llano has no objection to being screened. He stated he makes use of hashish, which is authorized in California, although not federally, however doesn’t use different medication. Nonetheless, he stated, “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 stated, elevating his voice, “but I don’t think you should force me into your idea of treatment.”
Nobody will probably be compelled to bear substance abuse remedy, nor will anybody be topic to drug testing, San Francisco officers insist. Relatively, beginning in January 2025, San Francisco’s public help recipients who display screen constructive for dependancy on a 10-question drug abuse check will probably be referred to remedy. Those that refuse or fail to indicate up for remedy will forfeit the $109 a month that 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.
The town well-known for its tolerance is resorting to powerful love.
Trent Rhorer, govt director of the San Francisco Human Providers Company, cited three causes for the brand new measure, which was usual 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 shifting 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 advised KFF Well being Information.
When Mayor London Breed launched the poll initiative referred to as Measure F in a information convention final yr, 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.” Unintentional overdoses killed greater than 800 folks in San Francisco final yr.
However 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, stated 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 stated.
About 5,800 folks 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 stay in city-provided shelter will lose their money advantages however can keep their shelter, Rhorer stated. Nevertheless, CAAP recipients who refuse remedy and rely upon public help to pay their hire in personal housing might lose their houses.
The town will give recipients three probabilities to indicate up for remedy and can pay hire on to a landlord for one month, Rhorer stated. 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 downside right into a public well being emergency.
About 12% of people that fatally overdosed in San Francisco final yr had been CAAP recipients, Rhorer stated.
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, in response to the San Francisco Ethics Fee. Then in March, 58% of voters accredited the measure.
Since fentanyl started changing heroin round 2019, Rhorer stated, “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 stated, though police exercise has elevated since final spring.
A latest metropolis report discovered that solely 53% of the 718 folks whom police cited for substance use over a 10-month interval that led to February stated 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,” stated Cedric Akbar, who runs restoration applications and co-founded Constructive 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 Eighties and has been in restoration for 31 years. He stated he would have most well-liked even stricter necessities for eligibility for public help than these in Measure F however hopes the brand new mandate will a minimum of assist give folks entry to remedy.
The town’s capability for remedy can be a priority. Eisen and others describe a dire scarcity of behavioral well being employees to workers remedy services and residential step-down models, that are essential for housing these in restoration from drug dependancy.
New applications 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 folks, are supposed to deal with the shortages.
Leslie Suen, an dependancy 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 folks “were stigmatized, or coerced, or told they would face consequences if they didn’t do a certain thing,” she stated, “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 stated in an electronic mail.
“To achieve the best outcomes,” the e-mail stated, remedy ought to be “delivered without stigma or penalty.”
Nearly everybody with a substance use dysfunction enters remedy underneath some form of stress, whether or not from a guardian, a partner, an employer, or the prison justice system, stated 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 stated. “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.
