San Francisco has an estimated 3,900 buildings that exhibit the same vulnerability as many of the buildings in Turkey and Syria that collapsed during the recent 7.8 magnitude earthquake.

The buildings, which will be predominantly commercial but also include residential buildings, are made of non-ductile concrete, said Brian Strong, who heads a city planning firm developing an ongoing retrofit program to make concrete buildings safer.

Neighborhoods with the greatest concentrations of non-ductile concrete buildings are downtown, South of Market and the Tenderloin, said Strong, who heads the Office of Resilience and Capital Planning.

“There shouldn’t be the kind of reaction that there was last week: ‘Well, (Turkey is) a developing country, we have better codes, we have better building practices, we could never get an earthquake that big.’ None of this is true. We all have the same problems we have there,” said David Friedman, a retired civil engineer who has worked in the Bay Area for decades.

In a multi-story building, non-ductile concrete structure can result in a phenomenon seen in the Turkey and Syria earthquakes, known as “pancakes,” where one floor falls in succession onto the next, Friedman said. A lack of enforcement of modern building codes contributed to the disaster, which has so far claimed nearly 42,000 lives and destroyed thousands of buildings.

Emergency teams are searching for people in the rubble of a destroyed building in Gaziantep, Turkey, this month.

Mustafa Karali/Associated Press

Buildings made of non-ductile concrete can be found throughout the Bay Area, said Sarah Atkinson, policy manager for seismic resilience at SPUR, of the San Francisco Bay Area Planning and Urban Research Association.

They were generally built decades ago, and many have not been retrofitted to be earthquake-proof without being required by law in a Bay Area city.

“These buildings keep collapsing in earthquakes around the world, and it’s very obvious to everyone that these are dangerous buildings,” Atkinson said. “Yet, not many cities have actually taken steps to move forward with retrofit orders for these buildings.”

In San Francisco, much of the city’s affordable housing stock is made of concrete — some of which may not be ductile, Strong said. In addition, some single rooms in the Tenderloin and Chinatown and some homeless shelters could be in the same situation, he said.

Non-ductile concrete buildings feature brittle concrete columns, beams, walls, and other connection points. They lack adequate steel reinforcement, making them more susceptible to buckling from rocking, said Megan Stringer, president of the Structural Engineers Association of Northern California.

“Imagine taking a straw and putting it between your fingers and squeezing it,” Stringer said. “Eventually the straw will bend in the middle.”

Some of the Bay Area’s most vulnerable non-ductile concrete buildings were constructed in the 1950s through the 1980s, although “as of the year 2000, aspects of concrete buildings were still underdesigned,” said Joe Maffei, a director at Maffei Structural Engineering and an adviser to the city .

Some Southern California cities have ordinances mandating the retrofitting of non-ductile concrete structures, including Los Angeles, Santa Monica, and West Hollywood.

San Francisco is currently developing a proposed regulation as part of the Strong-overseen concrete building safety program. The program began last October by convening meetings with a working group that includes the mayor’s office, civil engineers, commercial building owners, affordable housing operators and neighborhood groups.

The proposal would go to the Oversight Board for approval, Strong said, but there was no timeline for when it would be ready or when any proposed regulation would require retrofits to vulnerable concrete buildings to be completed, he said.

The concrete building program is also addressing the risks of about 700 tilt buildings, another type of vulnerable concrete building where concrete slabs are raised to form the exterior walls, Strong said. These buildings, which are commonly used to build supermarkets, warehouses and auto repair shops, are typically located in the South of Market and Bayview neighborhoods, and along the industrial areas of the east waterfront, according to Strong.

Any time frame for retrofits, both for non-ductile concrete buildings and for hinged buildings, is likely to be long. Santa Monica’s deadline is 10 years and West Hollywood’s is 20 years from the time building managers were notified, although both deadlines have been extended due to the COVID-19 pandemic. The Los Angeles deadline is 25 years.

The building at 2130 Post St. in San Francisco recently underwent seismic upgrades.

Adam Pardee/Special on The Chronicle

Will there be enough time for the Big One? It’s impossible to tell. According to the US Geological Survey, the Bay Area has a 72% chance of a magnitude 6.7 earthquake, a 51% chance of a magnitude 7.0 earthquake, and a 20% chance of a magnitude 1 earthquake over the next 30 years 7.5 magnitude earthquake.

The Hayward Fault in the East Bay, which is believed to be capable of producing an earthquake up to a magnitude of 7.0, has not produced a major quake since 1868 and is “due,” geologists say. The San Andreas Fault caused the 7.9 magnitude earthquake of 1906 and could shake San Francisco severely again.

San Francisco already has ordinances on the books mandating retrofits for two other types of structural defects, Strong said: unreinforced masonry buildings (including brick, stone and entirely unreinforced concrete buildings with little to no steel reinforcement) and soft-story buildings. Soft story buildings are those where the ground floor doesn’t have much reinforcement — where, say, a parking garage or a retail store is located.

Ninety percent of soft story buildings known to be vulnerable have been retrofitted, Strong said. After the 1989 magnitude 6.9 Loma Prieta earthquake, San Francisco enacted an ordinance mandating the retrofitting of all unreinforced masonry buildings — and by 2014, 95% had been retrofitted or demolished, according to the Structural Engineers Association of Northern California.

“Unlike LA, which pretty quickly created an ordinance for 25 years and threw everything in — they threw in their soft history, they threw in concrete — we’re going to take the approach where we’re targeting one building type at a time,” Stark said.

Non-ductile buildings are difficult to retrofit. For one, they’re difficult to identify: While you can look at a building and see that there’s a soft history, non-ductile concrete buildings require a structural engineer’s evaluation to verify them, Maffei said. Because of this, San Francisco only has an estimate of the number based on old insurance files and volunteers who walked around observing building types, and little confirmation on specific addresses affected, Strong said.

Non-ductile concrete buildings also require more invasive, complicated retrofits than soft dwellings, Maffei said. Multiple floors may need to be retrofitted, as opposed to a single floor for soft stories, and more people living in non-ductile buildings may need to move elsewhere when the retrofits are complete — a process that could take months, Atkinson added added by SPUR.

The building at 2 North Point St. in San Francisco recently underwent seismic upgrades.

Adam Pardee/Special on The Chronicle

Because concrete buildings vary so much in their design, costs also range from $40 per square foot to as much as $200 per square foot, Maffei said. According to Strong, the soft story retrofit program cost around $75,000 per building; The cost of the concrete retrofit program “is likely to be much higher,” Strong said.

When San Francisco’s soft-story multi-family home renovation program first took off in 2013, the economy was in a better position and building owners were better able to absorb additional costs, access affordable credit, or refinance, he said Atkinson. That’s less the case now, she noted.

“It is very likely that this time around, the city’s funding options will determine the potential for moving forward with this program,” Atkinson said.

The pace of retrofit programs in the Bay Area needs to be accelerated, Friedman said — and that requires political will to allocate resources to a problem that isn’t always front and center.

“I can understand stakeholders balking at the cost of retrofitting a non-ductile concrete building; It’s going to be expensive. But we’re dealing with buildings that (can) kill people, and at some point we have to get a sense of urgency,” Friedman said.

Reach out to Claire Hao: claire.hao@sfchronicle.com; Twitter: @clairehao_

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“Leaving people untreated is murder.” That’s how celebrity doctor and addiction expert Drew Pinksy talks about homelessness in California. If you turn in any direction on a Bay Area street, you’ll see what Pinsky sees — a human tragedy compounded by substance abuse and mental health issues.

Over the last few decades, a new treatment approach called harm reduction has gained popularity. Harm reduction emphasizes education and mitigation strategies, especially for substance abuse. But when harm reduction programs falter because of their poor mix with other government programs or are undermined by their very practitioners, they can hinder recovery efforts at the peril of the clients and the public.

The Drug Policy Alliance, which advocates harm reduction, describes several tenets of the approach, including improving access to drugs that reverse opioid overdoses, such as naloxone, protecting individuals who report drug use to emergency services, including self-reporting and expanding sterile-syringe access in order to lower transmission of infectious diseases.

What harm reduction broadly promises is better net public health outcomes at a lower cost. Harm reduction strategies have had many successes, which cannot be understated.

For example, San Francisco’s Drug Overdose Prevention and Education Project gave out more than 50,000 doses of the life-saving naloxone in 2020, reversing at least 4,300 drug overdoses.

A National Research Council and Institute of Medicine panel found that reported needle sharing among injection drug users declined sharply in a study of safe injection and needle exchange programs. A study of a San Francisco safe injection clinic reported that the clinic “resulted in a 47 percent decrease in surgical service admissions and an estimated savings of over $8 million for costs related to [injection-related infections].” The study also reported that an Oakland clinic “found that the average cost per individual treated … was $5, substantially lower than equivalent hospital costs of $185 and $360.”

Though harm reduction interventions can reduce the rate of adverse medical events, other problems can arise. Harm reduction needs to do what its name implies: reduce the long-term harm of substance abuse and enable recovery. Under the current approach, however, the onus rests largely on individuals to know that such services are available and to seek them out.

Housing First, the prevailing national model of addressing homelessness, incorporates a harm reduction approach that can range from no supportive services to the provision of paraphernalia but does not require clients to utilize recovery services, leaving many residents with unaddressed trauma. Because of the lack of recovery services, the evidence suggests that the combination of harm reduction and Housing First does not improve health outcomes or reduce health care costs.

What’s more, those in recovery or who have completed their recovery can be sent to a Housing First community with active drug users. This undermines their efforts to stay clean and contributes to a revolving door, whereby individuals cycle between the streets and programs. An American Psychiatric Association report found that “[The] majority of studies found no effect of permanent supportive housing (Housing First approach) on psychological symptoms or alcohol or drug use.”

Medical litter is also a quick mounting problem. In the 12 weeks following the opening of North America’s first safe injection site in Canada in 2003, public injection of drugs and biohazardous waste declined. But San Francisco distributes more needles than are turned in. Of the 5.8 million needles distributed in 2018, 2 million were unaccounted for. The program had no requirement to turn in used ones, so many of them ended up in the street.

To deal with the surge in waste, Mayor London Breed proposed spending an additional $13 million over two years on street-cleaning efforts! Clearly more is needed.

Instead of a fractured system of services splintered across the city, San Francisco should learn from places like San Antonio, Texas, which has shelters with short-term and transitional housing, recovery services, counseling, job training and mental and physical welfare services. A “one-stop shop” can assist in providing a tailored approach to each individual.

The city’s refusal to reform condemns the homeless to the status quo and leaves possible improvements on the table.

Jonathan Hofer is a research and marketing associate at the Independent Institute in Oakland, Calif., and co-author of the policy report “Beyond Homeless: Good Intentions, Bad Outcomes, Transformative Solutions.”

The post Lowering the hurt in San Francisco’s hurt discount program appeared first on DAILY SAN FRANCISCO BAY NEWS.

In 2000, the San Francisco Health Commission made harm reduction — a philosophy that advocates for making it safer to use drugs rather than criminalizing those who do — an official public health policy. It’s an approach with roots spanning from the Summer of Love in 1967, to the beginning of the AIDS pandemic in the 1980s, to the present-day fight to open sites in San Francisco for people to use drugs safely.

Vitka Eisen, president and CEO of HealthRIGHT 360, poses for a portrait at the medical clinic in San Francisco on March 9, 2022. HealthRIGHT 360 is a health care provider for lower-income and otherwise marginalized Californians. (Beth LaBerge/KQED)

Inside a ‘hippie’ clinic, health care was a right

The Haight Ashbury Free Medical Clinic opened its doors in 1967, committed to an ethos where health care was a right, not a privilege. Tens of thousands of flower children and teenage runaways were flocking to San Francisco to “drop out” of everyday society and experiment with drugs, sex and rock ‘n’ roll.

The clinic offered people who used drugs health care at a time when the city’s health department worried compassion would encourage the hippies to stay. It provided a safe space for people dealing with bad trips and heroin withdrawal and, later, for veterans returning from Vietnam with post-traumatic stress disorder.

Founder Dr. David Smith said it was illegal for physicians to treat people with substance use disorder with prescription drugs in the 1960s. Clinic volunteers were so worried police would shut the clinic down if people used drugs inside that the door was painted to read: “No dealing!/No holding drugs/No using drugs/No alcohol/No pets/Any of these can close the clinic/We Love You.”

When the Summer of Love ended, many people went home, but generations of people searching for meaning stayed behind in San Francisco, where the hard drugs moved in and people’s health care needs overwhelmed the clinic.

This painted door marked the entrance to the Haight Ashbury Free Medical Clinic. (Courtesy of David Smith archives)

“More than three years of life in the Haight, once the flower pot of America, now shattered into fragments of terror and despair, a ‘behavioral sink’ of pathologies feeding off the pill and the needle,” read a 1971 New York Times piece.

Still, the philosophy of the clinic — not only that health care is a right but also that addiction can be treated with medicine — persisted.

“It was harm reduction before there was such a term. It was never like, ‘When are you going to get your shit together?’ It was always, ‘Hey, can I see what’s going on?'” said Vitka Eisen, who was a patient at the Haight Ashbury Free Medical Clinic, as it was called in the 1980s.

The clinic smelled of patchouli, and a counselor walked around in a leather fringe jacket, Eisen recalled. She would go to the clinic before visiting her family in New York because she didn’t want to be strung out on heroin when she went to see them. She’d pick up a “kick pack” of medicine to fight stomach cramping and nausea, and to help her sleep during withdrawal.

“After the seventh or eighth time, I was like, ‘I can’t do this anymore,’” she said.

She got treatment at Walden House, an addiction and mental health treatment program in San Francisco, and said she never used drugs again. Now she runs the treatment provider HealthRIGHT 360, the umbrella organization that includes what is known today as the Haight Ashbury Free Clinics.

‘Carrying bleach was like having aspirin’

The philosophy of harm reduction spread internationally when activists and caregivers sought ways to reduce suffering and health risks during the AIDS crisis in the ’80s. Volunteers handed out clean needles and encouraged cleaning needles with bleach.

Maia Szalavitz, the author of “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,” says she was addicted to cocaine and heroin at the time. She was unaware that sharing needles put her at risk of contracting HIV until 1986, when she met Maureen Gammon, a volunteer with the San Francisco-based group Mid-City Consortium to Combat AIDS.

Maia Szalavitz, author of ‘Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction,’ in the 1980s. (Courtesy of Maia Szalavitz)

“She told me I shouldn’t share, but if you have to share, clean the needle with bleach and then with water,” Szalavitz said. “Shooting up is a pretty compulsive thing, so I immediately incorporated this into my compulsive routine and she probably saved my life.”

Gammon said carrying bleach was as common as having aspirin.

“People just had [bleach], and it was not unusual to go into a corner store or taqueria or bar and ask for a bottle of beach and be able to get it,” Gammon said.

Inside the Ambassador Hotel

The AIDS crisis also forged a new generation of physicians, said Joshua Bamberger, an associate clinical professor of family and community medicine at UCSF.

He began his residency at San Francisco General Hospital in 1989, and said all his energy and focus went into caring for men who were dying of AIDS.

“Much of my work was really holding men in my arms as they died,” he said. “And as awful as that was, it also created an era of physicians and other healers who bonded over the important things in medicine, which isn’t necessarily slinging medication but providing love and care for people who are really suffering.”

Some hospices refused to take in people who had a history of drug use, or had clauses saying they’d only accept people on the condition they’d been sober for six months before being referred. But the people who needed to be referred often had two or three months left to live.

So, many people found refuge at the Ambassador Hotel, an SRO in the Tenderloin run by gay rights activist Hank Wilson beginning in 1978. It became one of the few places where AIDS patients who used drugs could live without having to die on the streets. In the 1996 documentary “Life and Death at the Ambassador Hotel,” the site is described as a model in harm-reduction housing.

“The Ambassador was sort of a de facto AIDS hospital,” said Bamberger, who did rounds there, providing care alongside community members and friends of those dying. “When treatment options were limited, and [people] didn’t have a home, the Ambassador was a place where they could land.”

Val Robb, a nurse at the Ambassador Hotel, said she had to learn the culture of the people who stayed there. Many people who used drugs were distrustful of a health care system that considered them not worth treating.

“I started speaking the language more, which is, ‘Let me work out a deal. You need me to do this. I want you to do that,'” Robb said. “I need you to go to the doctor. If you go to the doctor, if you let them examine you, then let’s get you some codeine. It wasn’t like, ‘I’m Nurse Nancy doing this thing for you.'”

There were times Robb had to go against what she knew about health, such as offering guests cigarettes if they would let her examine them. But she said she still had to draw the line.

“Another guy, he says, ‘Val, I’m trying to get high, and my partner couldn’t hit the vein. Can’t you?’ I said, ‘No, I’m a nurse with kids and a license, I can’t do that,'” she recalled.

It took years before the city approved or funded some of the harm-reduction practices happening underground. The AIDS crisis hit its peak in San Francisco in 1992, and the following year Mayor Frank Jordan declared a state of emergency and announced that San Francisco would back a program to give clean needles to people who used drugs.

‘Call it Lazarus in a hypodermic’

Meanwhile, naloxone, the medication used to reverse overdoses, was still only widely available in medical settings. Rachel McLean, the outreach worker, said she and others attended a conference on drug policy reform in 1999 where an Italian man gave a presentation on naloxone.

“None of us could even understand what he was saying because his accent was so strong. But we understood that he said that in Italy, community health workers give out naloxone on the street,” she said. “And all of us, our minds were just blown by that.”

At the conference, Dan Bigg with the Chicago Recovery Alliance brought a duffle bag full of naloxone.

“And people would just come and take it, and that’s how underground naloxone started in San Francisco,” McLean said.

Naloxone education material used in San Francisco from the Massachusetts Department of Public Health. (Courtesy of Joshua Bamberger)

“It’s a mission that’s part Che Guevara, part Mother Teresa. The guerrillas aren’t doctors. Nonphysicians, obviously, are barred by law from handing out prescription drugs — it’s a felony that can carry up to 10 years in federal prison,” reads a 2003 article from A.C. Thompson in The San Francisco Bay Guardian on a visit to a San Francisco needle exchange site where volunteers were distributing naloxone. 

Critics said providing people who used drugs with naloxone, more commonly known by the brand name Narcan, would encourage drug use. Clinicians worried about liability if people had an adverse reaction to the naloxone, or if they died even after naloxone was used.

While studying at San Francisco State University in the same year as the conference on drug policy reform, McLean was assigned to write a paper analyzing a public health problem. She drafted some ideas based on the knowledge she had absorbed from the community, and proposed opening safe injection rooms, testing drug supplies and training people who inject drugs in administering naloxone.

Rachel McLean looks through her archive of flyers, zines, educational information, and research on harm reduction at her home on March 10, 2022. A photo of friend and colleague Pete Morse can be seen, as can a zine about Matty Luv, singer of the San Francisco punk band Hickey, who passed away from a heroin overdose in 2002. (Beth LaBerge/KQED)

Soon after turning in her paper, McLean graduated from college, quit her job as an outreach worker and went to Mexico for six months, burned out by the trauma. But she would sometimes wake up at night to scribble notes about what an overdose prevention program would look like.

“The fire was still there,” she said.

Members of a so-called “heroin subcommittee” created by the city to address overdose deaths ended up calling McLean. They had read her paper, and asked McLean if she would implement some of her ideas.

With a $30,000 annual budget, the Drug Overdose Prevention and Education (DOPE) Project began in a makeshift office in McLean’s kitchen in 2002. She started making phone calls to overdose prevention workers, and put together a curriculum to teach drug and alcohol treatment providers, sheriffs and deputies, the probation department, homeless shelter staff, and others how to reverse overdoses through rescue breathing. Without naloxone widely available, rescue breathing was something anyone could do to reverse overdoses, with some training.

Heroin overdose deaths plummet

Alex Kral, then a researcher with the Urban Health Study at UCSF, conducted a pilot study with other researchers in 2001 to 2002, training 24 people to use naloxone. There were 20 overdoses during the study. Trainees reversed all of them, 15 with naloxone, and most of those with an additional rescue method. The researchers presented the findings to the county’s public health director.

“We said, ‘Look … you’ve got people dying of overdoses and you’re not able to do anything about that,'” said Kral, who is now an epidemiologist with the nonprofit health research institute RTI International. “‘Why don’t you do something about it?’ And [the director] said, ‘Yeah, let’s do it.'”

One year later, the San Francisco Department of Public Health partnered with the DOPE Project to distribute naloxone at syringe-exchange programs, SROs, reentry programs and other sites in the community.

Joshua Bamberger, who oversaw the program with San Francisco’s DPH, said heroin overdose deaths dropped “unbelievably down,” plummeting from a peak of 155 in 1995 to 10 in 2010.

An altar includes a candle from a memorial for Pete Morse on the mantel of Rachel McLean’s home on March 10, 2022. (Beth LaBerge/KQED)

“Nothing’s gonna reduce death to the extent that getting 10,000 doses of naloxone out there in San Francisco in the early 2000s will ever do,” Bamberger said.

McLean, who now works for the state health department, still keeps a picture on her mantel of Pete Morse, who was at the forefront of bringing naloxone to the streets of San Francisco. He died of a drug overdose in 2007.

“I think about him all the time. I want to make sure that his contributions are remembered,” McLean said. “I don’t want to say that it broke my heart the most because I don’t want to compare it to all of the other deaths, but it’s still with me.”

The fentanyl overdose crisis

Naloxone has become a key tool in reducing overdose deaths nationwide. For years, it helped stave off the worst of the opioid crisis in San Francisco. But geography also helped for a time. On the West Coast, black tar heroin was the most common type of heroin, and that black color made it more difficult to hide white-powdered fentanyl inside.

Still, the number of people who injected drugs in San Francisco — mostly heroin — more than doubled early in this century, from 10,158 in 2005 to 22,000 in 2012.

By 2017, fentanyl had crept in to begin its rampage. That year, the city reported 36 deaths linked to fentanyl. That jumped to 90 in 2018. In 2020, the number of fentanyl-related deaths skyrocketed to 518.

An estimated 650 people overdosed and died in San Francisco last year, a spike driven by fentanyl, according to data from the San Francisco Medical Examiner’s Office.

Data on fentanyl-related and non-fentanyl-related overdose deaths from the San Francisco Department of Public Health and San Francisco Medical Examiner’s Office. (Chart by Matthew Green/KQED)

“I lost so many people to just fentanyl,” said Joel Webber, who goes by Turtle. He sat on a curb recently near Hotel Whitcomb, a city-run hotel on Market Street. People regularly gather nearby to use or sell drugs.

Webber said he received methadone treatment for 22 years, then started using fentanyl when he stopped his methadone treatment.

“If I could, I would blow up every f—ing fentanyl lab up with a button and end it. I’d get sick, but I’ll take it,” Webber said. “I just want it gone.”

Drugs like fentanyl are unlikely to disappear, and that means the city will need to try new strategies to prevent overdoses. A river of naloxone is not enough to confront the crisis, said Keith Humphreys, an addiction researcher at Stanford University School of Medicine.

One dose of naloxone often is not enough to reverse a fentanyl overdose.

“Maybe we can’t make fentanyl use safe,” he said. “Let’s say you make it twice as safe. It’s still just so deadly it just overwhelms the capacity of what we know how to do.”

Community and trauma in harm-reduction work

In 2021, President Joe Biden became the first president to make expanding harm reduction one of his drug-policy priorities. But people still argue that harm reduction encourages drug use. Several city leaders in San Francisco have criticized an overreliance on harm-reduction services and a lack of abstinence-based treatment options.

Kristen Marshall and the Dope Project team pose for a portrait during Overdose Awareness Day in 2020. The event gathers providers and community members to hold space for those lost and celebrate people still with them. (Courtesy of Kristen Marshall)

Kristen Marshall was the program manager for the DOPE Project until last winter.

“When you do this work, it’s your life, even if you try to fight it. It’s a lot of grief, it’s a lot of pain, it’s a lot of trauma. And that breaks a person down,” she said. “It feels really hard for me as someone who is in this position when suddenly people are like, ‘Well, this is your job. If overdose prevention is your job, what do you do? Harm reduction must not work.'”

Still, because of the vast supply of naloxone in the community, people are reversing more drug overdoses, many fentanyl-related, in San Francisco than ever before. The DOPE Project reported 81 overdose reversals in 2006. In the year 2021 alone, the group reported 8,985 reversals. Many of those overdoses were reversed by people who use drugs. In comparison, San Francisco police, who by then were carrying naloxone, reversed 144 overdoses in 2021.

Reporting data from the Drug Overdose Prevention and Education Project, as documented in a San Francisco Department of Public Health report. (Chart by Matthew Green/KQED)

Marshall said the larger question she keeps asking herself is what happens after overdoses are reversed.

“So they go to treatment, then what? Where’s their housing? So they go right back outside,” she said.

She believes overdose prevention efforts will inevitably fall short until root causes such as poverty, racism and isolation are addressed.

“We’re giving people Narcan and saying, ‘Live, live, live, live — you have to live,’” she said. “The question that I want to ask everyone is, ‘What are we living for? What is there for people to grasp?’”

The post From the Underground to Public Well being Coverage: A Historical past of Hurt Discount in San Francisco appeared first on DAILY SAN FRANCISCO BAY NEWS.

“Leaving people untreated is murder.” That’s how celebrity doctor and addiction expert Drew Pinksy talks about homelessness in California. If you turn in any direction on a Bay Area street, you’ll see what Pinsky sees — a human tragedy compounded by substance abuse and mental health issues.

Over the last few decades, a new treatment approach called harm reduction has gained popularity. Harm reduction emphasizes education and mitigation strategies, especially for substance abuse. But when harm reduction programs falter because of their poor mix with other government programs or are undermined by their very practitioners, they can hinder recovery efforts at the peril of the clients and the public.

The Drug Policy Alliance, which advocates harm reduction, describes several tenets of the approach, including improving access to drugs that reverse opioid overdoses, such as naloxone, protecting individuals who report drug use to emergency services, including self-reporting and expanding sterile-syringe access in order to lower transmission of infectious diseases.

What harm reduction broadly promises is better net public health outcomes at a lower cost. Harm reduction strategies have had many successes, which cannot be understated.

For example, San Francisco’s Drug Overdose Prevention and Education Project gave out more than 50,000 doses of the life-saving naloxone in 2020, reversing at least 4,300 drug overdoses.

A National Research Council and Institute of Medicine panel found that reported needle sharing among injection drug users declined sharply in a study of safe injection and needle exchange programs. A study of a San Francisco safe injection clinic reported that the clinic “resulted in a 47 percent decrease in surgical service admissions and an estimated savings of over $8 million for costs related to [injection-related infections].” The study also reported that an Oakland clinic “found that the average cost per individual treated … was $5, substantially lower than equivalent hospital costs of $185 and $360.”

Though harm reduction interventions can reduce the rate of adverse medical events, other problems can arise. Harm reduction needs to do what its name implies: reduce the long-term harm of substance abuse and enable recovery. Under the current approach, however, the onus rests largely on individuals to know that such services are available and to seek them out.

Housing First, the prevailing national model of addressing homelessness, incorporates a harm reduction approach that can range from no supportive services to the provision of paraphernalia but does not require clients to utilize recovery services, leaving many residents with unaddressed trauma. Because of the lack of recovery services, the evidence suggests that the combination of harm reduction and Housing First does not improve health outcomes or reduce health care costs.

What’s more, those in recovery or who have completed their recovery can be sent to a Housing First community with active drug users. This undermines their efforts to stay clean and contributes to a revolving door, whereby individuals cycle between the streets and programs. An American Psychiatric Association report found that “[The] Majority of studies found no effect of permanent supportive housing (Housing First approach) on psychological symptoms or alcohol or drug use.”

Medical litter is also a quick mounting problem. In the 12 weeks following the opening of North America’s first safe injection site in Canada in 2003, public injection of drugs and biohazardous waste declined. But San Francisco distributes more needles than are turned in. Of the 5.8 million needles distributed in 2018, 2 million were unaccounted for. The program had no requirement to turn in used ones, so many of them ended up in the street.

To deal with the surge in waste, Mayor London Breed proposed spending an additional $13 million over two years on street-cleaning efforts! Clearly more is needed.

Instead of a fractured system of services splintered across the city, San Francisco should learn from places like San Antonio, Texas, which has shelters with short-term and transitional housing, recovery services, counseling, job training and mental and physical welfare services. A “one-stop shop” can assist in providing a tailored approach to each individual.

The city’s refusal to reform condemns the homeless to the status quo and leaves possible improvements on the table.

Jonathan Hofer is a research and marketing associate at the Independent Institute in Oakland, Calif., and co-author of the policy report “Beyond Homeless: Good Intentions, Bad Outcomes, Transformative Solutions.”

The post Lowering the hurt in San Francisco’s hurt discount program appeared first on DAILY SAN FRANCISCO BAY NEWS.