San Francisco has seen a 15% reduction in drug overdose deaths this year with 462 people dying in the first eight months of 2024. That is still an “alarmingly high” mortality rate and it may increase again, said Dr. Grant Colfax, the city Department of Public Health director.

Nevertheless, when asked at an overdose awareness day event in August what happened to the department’s plan to open safe consumption sites, Colfax said: “What our focus is right now is continuing to make sure that people have access to treatment.”  That’s despite research showing such facilities — also known as overdose prevention centers — save lives, reduce drug use in public, increase access to life-saving treatment and care and reduce public spending on emergency services.

Instead, the Department of Public Health is relying on a new 24-hour-a-day outreach initiative that provides unhoused drug users with the opioid dependency medication buprenorphine.

This “Civic” episode goes inside an overdose prevention center run by OnPoint NYC to hear from staffers and people who have received help with treatment for substance use disorders and other challenges associated with addiction.

Meanwhile, more cities and states are embracing overdose prevention centers. Last February, the Providence City Council in Rhode Island approved a state-sanctioned overdose prevention center. In April, Minneapolis nonprofit Minnesota Overdose Awareness opened a safe injection site thanks to legislation signed in 2023 by Gov. Tim Walz, presidential candidate Kamala Harris’ running mate. And in June, the Vermont Legislature overrode the governor’s veto of a bill to sanction an overdose prevention center in Burlington, an addiction hot spot.

But San Francisco appears to have abandoned the strategy, despite previously having the support of Mayor London Breed and city supervisors. Talk of overdose prevention centers has not come up in any meaningful way during election campaigning. And elected officials did not reply to calls and emails in August requesting an update.

At a mayoral candidate debate in June, Breed suggested city attorneys could face disbarment for enabling the launch of an overdose prevention center because of prohibitions under state law. But in New York City, the nonprofit organization OnPoint NYC worked with the city to skirt legal liability and opened two centers in November 2021. Their efforts have cleaned up surrounding neighborhoods and reversed more than 1,500 overdoses in less than three years with no deaths, according to OnPoint.

[Read and listen to our previous reporting on San Francisco’s overdose crisis and ongoing prevention efforts.]

A study published in the New England Journal of Medicine in April found that the centers kept people alive and kept them from consuming drugs in public. And a 2022 study published in the Journal of the American Medical Association found that the centers did not increase crimes recorded by police or calls for emergency services in the surrounding neighborhoods.

OnPoint’s efforts are also improving lives, said Sam Rivera, the organization’s director.

“The anecdotal things around reunification with children and reunification with families and becoming employable again — these are things that would never have happened for these folks,” Rivera said.

The success is in large part due to OnPoint’s dedication to treating each client with dignity, said Susan Spratt, OnPoint’s associate director of clinical services.

“We’re seeing people who are often not seen, they’re stepped over, literally, in the streets,” Spratt said. “This has been said to me more than once, to me and to multiple staff members in our clinic: ‘I feel like you’re really listening to me. I haven’t been listened to in a long time. So, thank you.’”

The post Overdose Prevention Centers — Nonstarter in SF, Despite Success in NYC appeared first on San Francisco Public Press.

Todos los sábados, Aurelia Ramírez llena una bolsa con folletos sobre servicios locales de apoyo social, compra unas docenas de pan dulce y una caja de café, y camina por su vecindario del Distrito de la Misión, conectándose con personas que viven en la calle.

“Nuestro trabajo es verificar si las personas están bien,” dijo Ramírez, quien se mudó a San Francisco desde México hace 23 años.

Ramírez es embajadora comunitaria de la Oficina de Participación Cívica y Asuntos de Inmigrantes de San Francisco. Dijo que quería un trabajo que le permitiera ayudar a la comunidad Latina – especialmente gente de ascendencia maya de Yucatán, como ella.

“Es triste,” ella dijo. “No saben qué pueden hacer. Especialmente la gente de Yucatán.”

Mientras ofrece café y comida, ella comparte información sobre dónde va para recibir atención médica, servicios sociales, refugio, baños y lugares para lavar la ropa. Dijo que la pandemia causó un sufrimiento profundo en su comunidad y muchos nunca se recuperaron.

“Ellos perdieron un trabajo, perdieron la casa. No tienen dinero. ¿Qué pueden hacer?” dijo Ramírez. “Ya sabes, la gente que vende drogas te la dan gratis la primera vez, pero después tienes que pagar. Eso es el problema. Y ahora algunas personas, ya no están bien.”

De hecho, la tasa de muertes por sobredosis entre los mayas de Yucatán que viven en San Francisco ha aumentado lo suficiente desde la pandemia de COVID-19 como para alarmar a la Cónsul General de México en San Francisco, Remedios Gómez Arnau, quien procesa el certificado de la muerte de los ciudadanos mexicanos locales antes de su repatriación.

[ Leer también: “Proveedores de Servicios Exigen Acceso a Reclusos Latinos” ]

En un día inusualmente cálido y soleado de febrero, Ramírez despertó a la gente de sus casas de campaña y parecieron agradecidos por el café, la comida y la información sobre cuando estaría abierta una clínica dental gratuita.

Instó a los yucatecos a llamar a sus familias en Yucatán desde una oficina en Daly City llamada La Casa Del Yucateco que fue inaugurada por el gobernador de Yucatán, Mauricio Vila Dosal, en octubre pasado para brindar servicios gubernamentales a los yucatecos en San Francisco y sus alrededores.

Varias personas sin hogar le dijeron a Ramírez que lo que más necesitaban son viviendas e ir a un refugio estaba fuera de la discusión porque tenían miedo a la violencia y los robos. Ramírez explicó que cuando las personas que conocen están interesadas en recursos, ellos también enfrentan obstáculos.

“A veces, tienen listas de espera: listas de espera por refugio, listas de espera por ayuda,” dijo Ramirez. “Y ellos no quieren esperar. Quieren la ayuda al mismo tiempo.”

Buscando una vida mejor

En la Península de Yucatán, México, los indígenas mayas enfrentan discriminación sistémica, y acceso limitado a la educación, atención médica, oportunidades económicas, y representación política.

La situación lleva a muchos a buscar mejores oportunidades en otros lugares. Y durante generaciones, han estado emigrando a San Francisco y el Área de la Bahía, según Lydia Candila Chan, directora ejecutiva de la Asociación Mayab, una organización en San Francisco que ofrece recursos comunitarios esenciales, educativos y culturales.

Posiblemente, hasta 70,000 mayas yucatecos viven en la ciudad y sus alrededores, pero nunca ha habido un recuento oficial; es una estimación que Candila Chan obtuvo del Instituto para el Desarrollo de la Cultura maya con sede en la capital de Yucatán, Mérida.

Candila Chan dijo que los mayas yucatecos vienen a San Francisco en busca de oportunidades financieras “para darles a sus familias una vida mejor.” Pero la barrera del idioma puede ser un obstáculo grande para encontrar trabajo porque para muchos el español es una segunda lengua. Más de 500,000 mayas de Yucatán hablan la lengua indígena maya, según el último censo mexicano.

Algunos mayas alcanzaron el éxito y, para muchos, dijo Candila Chan, gracias a sus reconocidas habilidades culinarias.

“Son los mejores cocineros aquí en San Francisco,” ella dijo. “En cualquier restaurante al que vayas, verás a una persona de Yucatán.”

La representación de la población en los restaurantes la hizo excepcionalmente vulnerable durante la pandemia, cuando se cerró la industria.

“El sueño americano a veces les resulta muy triste,” dijo Candila Chan. “Están tan decepcionados entonces cuando sus amigos dicen ‘Vamos a tomar una cerveza y hablar,’ empiezan a empezar más y más. De repente, están viviendo en la calle. De repente mueren. Veo muchos.”

Candila Chan hace lo que puede para ayudar ofreciendo programas que brindan recursos esenciales, así como actividades culturales que unen a la comunidad de una manera saludable.

Más de 250 familias se benefician de la despensa semanal de alimentos de la Asociación Mayab. El centro también ofrece clases y presentaciones de jarana, el baile tradicional de Yucatán, artes y artesanías, capacitación en interpretación maya, y una liga de béisbol que ha crecido hasta incluir ocho equipos y 144 jugadores.

La población indígena no recibe advertencias sobre el fentanilo

Gómez Arnau, cónsul general de México en San Francisco, preguntó al socio comunitario Jorge Zepeda, director de salud latina de la Fundación Contra el SIDA de San Francisco, sobre la tasa elevada de muertes por sobredosis que estaba observando entre los indígenas mayas.

En ese momento, Zepeda estaba consultando con el Departamento de Salud Público de San Francisco para evaluar la salud de las poblaciones latinas en viviendas de un cuarto. Le dijo a Gómez Arnau que estaba viendo la misma tendencia y se dijo al departamento de salud.

“Le dije ‘¿Sabes cuántas personas que hablan español y maya han muerto por sobredosis?’ Dijeron ‘No estamos seguros,’” dijo Zepeda.

Desde enero de 2020 hasta diciembre de 2023, 2,955 personas murieron por sobredosis accidentales en San Francisco, según la Oficina del Médico Forense Principal. De ellos, 456 fueron categorizados como latinos. Pero es imposible obtener tasas de mortalidad de subgrupos de la población latina, ya que las autoridades de salud de las agencias municipales, estatales y federales agrupan a todos los latinoamericanos.

Eso no tiene en cuenta la diversidad de idiomas que existe dentro de sus subgrupos, lo que significa que es posible que información vital, como advertencias sobre los peligros del fentanilo y dónde obtener ayuda para los trastornos por uso de sustancias, no lleguen.

Categorizando a todos los latinoamericanos juntos también lleva otros problemas, según defensores como el Dr. Seciah Aquino, director ejecutivo de la Coalición Latina para una California Saludable. La organización fue parte de una campaña de años para intentar que los departamentos estatales recopilen y desagregaran datos más detallados para las comunidades latinas e indígenas.

“No somos un monolito,” dijo Aquino. “Necesitamos comprender y recibir datos que detallar más en esos subgrupos específicos. Si no lo hacemos, entonces estamos perdiendo datos de calidad que podrían llevarnos a tomar mejores decisiones en términos de los fondos que se asignan a la comunidad, a la región y cómo se distribuyen.”

La senadora estatal Lena González de Long Beach presentó el año pasado un proyecto de ley de equidad demográfica para fortalecer la colección de datos estatales. La Legislatura aprobó el proyecto de ley, pero el gobernador Gavin Newsom lo vetó en octubre pasado, diciendo que era inapropiado porque la Oficina de Administración y Presupuesto de los Estados Unidos estaba actualizando los estándares federales para recopilar información sobre raza y origen étnico.

El 28 de marzo se anunciaron estándares federales actualizados que no tenían en cuenta a las poblaciones indígenas latinas. González volvió a presentar su proyecto de ley el 27 de febrero y está avanzando en el Senado estatal.

Necesidad extrema de concienciación sobre las drogas y servicios de salud

Después de descubrir la brecha en la conciencia sobre el uso de drogas entre los latinos y los latinos indígenas, Zepeda se asoció con Laura Guzmán, directora ejecutiva de la Coalición Nacional para la Reducción de Daños, y el Dr. Carlos Martínez, investigador de antropología médica y salud pública de UC Santa Cruz, para realizar un estudio con financiación del Departamento de Salud Pública de San Francisco. El informe de su estudio, “Unido/xs Contra La Sobredosis,” se publicó en septiembre de 2022.

Descubrieron que la mayoría de los latinos e latinos indígenas de San Francisco que consumían sustancias intentaban llevar a cabo un objetivo específico y sabían muy poco de los riesgos asociados con esas sustancias.

“Sabían el efecto que quería, como seguir trabajando, relajarse o dormir,” dijo Zepeda. “Cuando les preguntamos: ‘¿Saben el nombre de la droga?’ ‘No. Pero puedo obtenerlo de una persona que conozco.’”

Concluyeron que para minimizar las sobredosis y los daños relacionados con las drogas en las comunidades latinas e indígenas, la ciudad debe educar a poblaciones específicas sobre los tipos de drogas, impactos del uso de drogas y conciencia de que las drogas a menudo están contaminadas con el opioide fentanilo, que puede causar una sobredosis letal.

El estudio también reveló una brecha evidente en la disponibilidad de servicios de tratamiento. Dijo que la mayoría de los proveedores comunitarios que prestan servicios a la comunidad latina “no se sentían cómodos” haciendo una derivación a un proveedor de servicios de salud por uso de sustancias en San Francisco porque no tenían la capacidad de interactuar con personas que hablan español o maya.

Zepeda dijo que ha visto un progreso desde que se publicó el informe, incluido que las solicitudes de propuestas para la salud conductual han incluido programas en español y maya recientemente.

Los funcionarios del Departamento de Salud Pública rechazaron las solicitudes de entrevista. En un correo electrónico, el departamento afirmó que ofrece 10 camas en el Managed Alcohol Program para pacientes latinos e indígenas. Y acaba de lanzar una iniciativa que se llama Health Access Point, que da servicios de reducción de daños a clientes latinos a través de un programa liderado por el Instituto Familiar de la Raza, el Mission Neighborhood Health Center y la Fundación Contra el SIDA de San Francisco.

Además, el departamento anticipa que una expansión planificada de 33 camas de un centro de tratamiento de salud mental y uso de sustancias para mujeres que han sido arrestadas, acusadas, condenadas o encarceladas será competente en español.

Necesitan programas culturalmente sensibles

Sin embargo, los proveedores de servicios dicen que la competencia lingüística no es lo mismo que los programas culturalmente sensibles y que son casi imposibles de encontrar para las comunidades latinas. The Latino Commission es la única organización que da ese tipo de tratamiento residencial en San Francisco y solo tiene 10 camas.

La directora ejecutiva de la Latino Commission, Debra Camarillo, dijo que conectarse con la propia cultura es fundamental para la sanación.

“Entramos en recuperación y podemos conectarnos y encontrar un sentido de nosotros mismos,” dijo Camarillo. “Y al encontrar ese sentido de uno mismo y desarrollar ese amor propio, surge un valor que al final entendemos que, como humanidad, como seres humanos, somos sagrados. En eso está lo sagrado.

“Si puedo entender ese lugar y puedo vivir en ese lugar, entonces mis acciones serán diferentes. No voy a tratarte como quizás te hubiera tratado en el pasado. No voy a tratarme a mí mismo y no voy a aceptar un tratamiento que quizás haya aceptado en el pasado.”

Para aumentar los programas sensibles lingüística y culturalmente para las poblaciones latinas necesitan a más médicos latinos, dijo la Dra. Marlene Martin, profesora asociada de UCSF y coautora de un estudio, publicado en el Journal of General Internal Medicine en enero de 2022, titulado “Falta de diversidad racial y étnica entre los médicos especializados en adicciones.”

Los autores del estudio concluyeron que diversificar la fuerza laboral médica requeriría una mayor financiación para las facultades de medicina en comunidades desatendidas, ayuda financiera para estudiantes sin acceso a la riqueza generacional, políticas de pago de préstamos más integrales y programas para exponer a los estudiantes a las carreras médicas.

Martin también es director de iniciativas de adicción en el Centro de Excelencia Latinx de UCSF, que está ayudando a satisfacer la necesidad de un tratamiento culturalmente sensible. Se han asociado con la Coalición Nacional para la Reducción de Daños en la educación sobre el uso de sustancias para organizaciones comunitarias latinas en San Francisco.

Sylvie Sturm informó esta historia mientras participaba en la beca de datos 2023 del Centro de Periodismo de Salud de la USC Annenberg, que brindó capacitación, tutoría y financiación para apoyar este proyecto.

Traducido al español por Cassandra Garibay.

The post Las Muertes por Sobredosis entre los Mayas en San Francisco Muestran la Necesidad Urgente de un Tratamiento Culturalmente Sensible appeared first on San Francisco Public Press.

Lee esta historia en español.

Every Saturday, Aurelia Ramirez fills a tote bag with pamphlets about local social support services, buys a few dozen slices of sweet bread and a box of brewed coffee, and walks through her Mission District neighborhood connecting with people living on the street.

“Our job is to check the people if they okay,” said Ramirez, who moved to San Francisco from Mexico 23 years ago.

Ramirez is a community ambassador for San Francisco’s Office of Civic Engagement and Immigrant Affairs. She said she wanted a job that allowed her to help the Latinx community — especially people of Maya descent from the Yucatán, like herself.

“It’s sad,” she said. “They don’t know what they can do. Especially Yucatán people.”

While offering coffee and snacks, she provides information about where to go for medical care, social services, shelter, showers and doing laundry. She said the pandemic caused deep suffering in her community and many never recovered.

“They lost a job, lost the house. They don’t have money. What they can do?” Ramirez said. “You know, people selling drugs — they give you free the first time but after, you need to pay. That’s the problem. And now some people, it’s not okay anymore.”

In fact, the rate of overdose deaths among Maya from the Yucatán living in San Francisco has risen enough since the COVID-19 pandemic to alarm San Francisco’s Mexican Consul General, Remedios Gomez Arnau, who processes death certificates of local Mexican nationals before they are repatriated.

[ Read also: “Service Providers Demand Access to Latinx Jail Inmates” ]

On an unseasonably warm and sunny day in February, Ramirez roused people from their tents, and they appeared grateful for the coffee, snacks and information about when a free dental clinic would be open.

She urged Yucatecans to call their families back home from an office in Daly City called La Casa Del Yucateco that was launched by Yucatán Governor Mauricio Vila Dosal last October to provide Yucatecans in and around San Francisco with government advice and services.

Several unhoused people told Ramirez that what they needed most was housing and going into a shelter was out of the question because they feared violence and theft. Ramirez explained that even when people she encounters are interested in accessing resources, they confront obstacles.

“Sometimes they have wait lists — wait lists for shelter, wait lists for help,” Ramirez said. “And they don’t want to wait. They want the help at the same time.”

Seeking a Better Life

In Mexico’s Yucatán Peninsula, Indigenous Maya face systemic discrimination, limited access to education, health care and economic opportunities, and limited political representation.

The situation leads many to seek better opportunities elsewhere. And for generations, they have been immigrating to San Francisco and the Bay Area, according to Lydia Candila Chan, executive director of Asociacion Mayab, a San Francisco-based organization that offers cultural, educational and essential community resources.

Possibly as many as 70,000 Yucatec Maya live in and around the city, but there has never been an official count — it’s an estimate that Candila Chan gleaned from the Institute for the Development of Maya Culture based in Yucatán’s capital city, Mérida.

Candila Chan said Yucatec Maya come to San Francisco seeking financial opportunities “to give their families a better life.” But the language barrier can be a major hurdle to finding a job, since many speak Spanish as a second language and are not fluent. More than 500,000 Maya from the Yucatán speak the indigenous Maya language, according to the latest Mexican census.

Some Maya do achieve success, and for many, Candila Chan said, that’s thanks to their renowned culinary skills.

“They are the best cooks here in San Francisco,” she said. “Any restaurant that you go, you will see one person from Yucatan.”

The population’s extraordinary representation in restaurants made it exceptionally vulnerable during the pandemic, when the industry was shut down.

“The American dream sometimes become very sad for them,” Candila Chan said. “They became so disappointed that when friends say, ‘Let’s go drink a beer and talk,’ from that, they start more and more and more. Suddenly, they living in the street. Suddenly they die. I see so many.”

Candila Chan does what she can to help by offering programs that provide essential resources as well as cultural activities that bring the community together in a healthy way.

More than 250 families benefit from the Asociacion Mayab’s weekly food pantry. The center also offers classes and performances of jarana, the traditional dance of Yucatán; arts and craft-making; Maya interpretation training; and an amateur baseball league that has grown to include eight teams and 144 players.

Indigenous Population Missing Fentanyl Warnings

Gomez Arnau, San Francisco’s Mexican Consul General, asked community partner Jorge Zepeda, director of Latinx health for the San Francisco AIDS Foundation, about the elevated rate of overdose deaths she was seeing among Indigenous Maya.

At the time, Zepeda was consulting with San Francisco’s Department of Public Health to assess the health of Latinx populations in single-room-occupancy buildings, commonly called SROs. He told Gomez Arnau he was seeing the same trend and he brought it up with the health department.

“I said, ‘Do you know how many people have died of overdose who are Spanish speaking and Maya speaking?’ They said, ‘Not sure,’” Zepeda said.

From January 2020 to last December, 2,955 people died of accidental overdose in San Francisco, according to the San Francisco Chief Medical Examiner’s Office. Of those, 456 were categorized as Latinx. But it’s impossible to get mortality rates of subgroups in the Latinx population since health authorities at city, state and federal agencies lump all Latin Americans together.

That neglects to account for the diversity of languages that exists within its subgroups, which means vital information, like warnings over the dangers of fentanyl and where to get help for substance use disorders, may not be reaching them.

Categorizing all Latin Americans together leads to other problems as well, according to advocates like Dr. Seciah Aquino, executive director of the Latino Coalition for a Healthy California, whose organization was part of a years-long campaign to get state departments to collect and disaggregate more detailed data for Latinx and Indigenous communities.

“We’re not a monolith,” Aquino said. “We need to understand and receive data back that drills down to those specific subgroups. If we don’t, then we’re losing quality data that could lead us to make better decisions in terms of funding that’s being allocated to the community, regionally, how it’s being spread out.”

State Sen. Lena Gonzalez (D- Long Beach) introduced a demographic equity bill to strengthen state data collection last year. The Legislature passed the bill but Gov. Gavin Newsom vetoed it last October, saying it was inappropriate because the U.S. Office of Management and Budget was updating federal standards for collecting race and ethnicity information.

Updated federal standards announced on March 28 did not account for Indigenous Latinx populations. Gonzalez reintroduced her demographic equity bill on Feb. 27, and it is making its way through the state Senate.

Dire Need for Drug Awareness and Health Services

After discovering the gap in knowledge over Latinx and Indigenous drug use, Zepeda partnered with Laura Guzman, executive director of the National Harm Reduction Coalition, and Dr. Carlos Martinez, a public health and medical anthropology researcher from UC Santa Cruz, to conduct a study with funding from San Francisco’s Department of Public Health. The report of their study, “Unido/xs Contra La Sobredosis (United Against Overdose),” was published in September 2022.

They discovered that most Latinx and Indigenous people in San Francisco who consumed substances were trying to achieve a specific goal and had very little knowledge of risks associated with those substances.

“They knew the effect that they wanted, whether it’s keeping working, or relax, or going to sleep,” Zepeda said. “When we ask them, ‘Do you know the name of the drug?’ ‘No. But I can get it from a person that I know.’”

They concluded that to minimize overdoses and drug-related harm in the Latinx and Indigenous communities, the city must educate target populations on types of drugs, drug use impacts and awareness that drugs are often tainted with the opioid fentanyl, which can cause lethal overdose.

The study also revealed a glaring gap in the availability of treatment services. Zepeda said the majority of community-based providers serving the Latinx community “didn’t feel comfortable making a referral to a current substance use or substance health service providers in San Francisco because they were not in the capacity to engage with the Spanish-speaking or Maya-speaking communities.”

Zepeda said he’s seen some progress since the report came out — namely the public health department’s requests for proposals for behavioral health have recently included Spanish-speaking and Maya-speaking programs.

Department of Public Health officials declined requests for an interview. In an email, the department stated that it offers 10 beds in the Managed Alcohol Program for Latinx and Indigenous patients. And it just launched an initiative called Health Access Point, which provides harm reduction services to Latinx clients through a program led by the Instituto Familiar de la Raza, the Mission Neighborhood Health Center and the San Francisco AIDS Foundation.

Also, the department anticipates that a planned, 33-bed expansion of a mental health and substance use treatment facility for women who have been arrested, charged, convicted or incarcerated will be Spanish-language competent.

Culturally Sensitive Programs Needed

Service providers say language competency is not the same as culturally sensitive programs, however, and those are nearly impossible to find for Latinx communities. The Latino Commission is the only organization providing that kind of residential treatment in San Francisco — and it only has 10 beds.

Latino Commission Executive Director Debra Camarillo said connecting with one’s own culture is fundamental to healing.

“We come into recovery, and we get to connect and find a sense of self,” Camarillo said. “And in finding that sense of self and building that self-esteem, then there becomes value that we understand at the end of the day, as humanity, as human beings we’re sacred. In that is sacredness.

“If I can understand that place, and I can live in that place, then my actions are going to be different. I’m not going to treat you like maybe I would treat you in the past. I’m not going to treat myself, and I’m not going to accept treatment that maybe I have done in the past.”

Increasing linguistically and culturally sensitive programs for Latinx populations will require more Latinx physicians, said Dr. Marlene Martin, a UCSF associate professor who co-authored a study, published in the Journal of General Internal Medicine in January 2022, titled “Lack of Racial and Ethnic Diversity Among Addiction Physicians.”

The study’s authors concluded that diversifying the physician workforce would require increased funding for medical schools in under-served communities, financial aid for students without access to generational wealth, more comprehensive loan repayment policies, and programs to expose students to medical careers.

Martin is also director of addiction initiatives at the UCSF Latinx Center of Excellence, which is helping to fill the need for culturally sensitive treatment by partnering with the National Harm Reduction Coalition on new substance use education for Latinx community-based organizations in San Francisco.

Sylvie Sturm reported this story while participating in the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship, which provided training, mentoring and funding to support this project.

The post Overdose Deaths Swell Among SF’s Maya Residents, Highlighting Urgent Need for Culturally Competent Drug Health Services appeared first on San Francisco Public Press.

Algunas personas recitan una oración de agradecimiento por el tiempo que pasaron en la cárcel del condado de San Francisco. Entre ellos está un hombre del Área de la Bahía al que llamaremos Carlos para respetar su solicitud de anonimato. 

“Gracias a Dios que yo me salí,” Carlos dijo, 29. “Busqué una mejor vida porque me acerqué a buenas personas, me acerqué a personas que me orientaron, me acerqué a personas que querían en realidad verme triunfar en la vida.”

Esas personas eran proveedoras de programas en español en las cárceles del condado. Carlos es de Honduras y llegó a San Francisco por un trabajo prometido que nunca se materializó. En cambio, vendió drogas.

Todo eso cambió cuando fue encarcelado en la cárcel del condado de San Francisco por cargos relacionados con drogas hace casi cuatro años. Cuando era encarcelado, conoció a un trabajador hispanohablante de ReSET Justice Collaborative – una de las organizaciones comunitarias que trabajan con el director de los programas de la cárcel para brindar capacitación vocacional, cursos educativos, tratamiento de trastornos por uso de sustancias, clases de manejo de la ira, actividades culturales, clases de inglés y observancias religiosas.

“Ellos fueron a visitarme a la cárcel. Y desde ahí ellos me suscribieron a lugares donde podían ayudarme,” Carlos dijo.“Luego de que salí me ayudaron a conseguir un trabajo que aún todavía lo tengo. Tengo dos años trabajando en este trabajo acá. No volví a regresar nunca más, nunca más a mezclarme con ventas de droga. … No me he vuelto a meter al Tenderloin y me ha servido mucho porque le he traído más tranquilidad a mi familia.”

Pero desde entonces, los programas ofrecidos en español en la cárcel del condado de San Francisco se han vuelto prácticamente inexistentes porque los cierres de rutina causados ​​por la escasez de personal han hecho prácticamente imposible impartir clases. Incluso con los diputados trabajando en turnos obligatorios de 16 horas, no hay suficientes para acompañar a las personas que administran sesiones de rehabilitación y otros programas de capacitación a las cárceles. El 2 de febrero, numerosos proveedores de servicios sociales para la población latina encarcelada imploraron a la Junta de Supervisión del Departamento del Sheriff en su reunión que los ayudará a obtener acceso a la cárcel.

Parecía que el liderazgo de la cárcel respondió al llamado público la semana siguiente anunciando un nuevo programa de recuperación del uso de sustancias y una clase de arte terapia ofrecida en español; sin embargo, un portavoz de la cárcel dijo que han estado planificando las clases desde octubre pasado. Sin embargo, algunos trabajadores carcelarios que llevan mucho tiempo expresaron dudas de que los programas durarían más de unas pocas semanas.

La falta de programación en español es un problema crecientemente grave ya que el encarcelamiento de latinos ha aumentado desde el lanzamiento el junio pasado de una ofensiva policial contra las drogas en los vecindarios de Tenderloin y sur de Market.

Según datos del Departamento del Sheriff, del 1 de junio al 10 de noviembre de 2023 (el más nuevo disponible), el 42% de las personas ingresadas en la cárcel del condado de San Francisco por cargos relacionados con drogas eran latinas, en comparación con el 30% que eran personas negras y el 28% que eran personas blancas. Y como Carlos vio hace años, algunas personas necesitan comunicar su necesidad de ayuda desesperadamente.

“Hay personas ahí que tienen hasta problemas mentales, problemas mentales que no pueden lidiar. ¿Y cómo se los van a contar a alguien que hable inglés y no entiende?” Carlos dijo. 

El año pasado, la policía también se dirigió a personas por simple consumo de drogas para motivarlos a recibir tratamiento para el trastorno por uso de sustancias, según funcionarios municipales y oficiales. Sin embargo, desde entonces, el programa de tratamiento de la cárcel, Road to Recovery, ha estado disponible sólo en inglés, a pesar del interés expresado por parte de la población latino.

Según datos del Departamento de Salud Pública de la ciudad, de septiembre de 2022 a septiembre de 2023, los Servicios de Salud Penitenciario evaluaron que 380 pacientes latinos encarcelados tenían un trastorno para consumir opioides. De ellos, 209 buscaron tratamientos a través de medicamentos como buprenorfina o metadona.

No está claro cuántos de ellos no recibieron programación de tratamiento porque eran monolingües de español, ya que no rastrean datos sobre preferencias de idioma.

Pero en un caso en octubre pasado, la proveedora de servicios Joanna Hernández del Latino Task Force, una asociación con sede en San Francisco de más de tres docenas de organizaciones comunitarias, dijo que fue testigo de un grupo de hombres en el programa del Road to Recovery en la cárcel del condado No. 3 en San Bruno. Hernández dijo que de los 46 hombres en el programa, 20 hablaban español y apenas podían entender la clase.

“A veces, simplemente se sientan y entienden algunas de las palabras, pero si no, simplemente van a sus celdas,” dijo Hernández en inglés. “Y luego me lo comprobé con el personal y me dijo: ‘No tengo personal que hable español y apesta porque siguen poniendo a personas que no hablan el idioma en este módulo del programa.’

“Es algo que pasa mucho dentro de las cárceles. Entonces, la gente está volviendo al mismo lío, volviendo al mismo comportamiento – si no volviendo peor, porque fueron confinados y arrancados de su familia, de sus hijos, de su religión, de todo.”

Ali Riker, directora de programas del Departamento del Sheriff, dijo que estaba consciente de que los hispanohablantes van a Road to Recovery, el programa en inglés. Dijo que cree que esto sucedió porque sabían suficiente inglés como para solicitar acceso al programa.

“No prohibimos la participación a las personas que lo solicitaron,” dijo Riker. “Sé que no es lo ideal. Estamos haciendo nuestro mejor esfuerzo. ¿Es suficiente? Ya sabes, necesitamos más. Definitivamente necesitamos más recursos.”

La Cárcel #3 del Condado de San Francisco en San Bruno es uno de los lugares donde los que son encarcelados pueden ir al programa Road to Recovery, un programa de rehabilitación para trastornos por uso de sustancias. El programa no se ofrece en español.

Read this story in English.

Hernández se unió a los otros proveedores de servicios sociales latinos en la Junta de Supervisión del Departamento del Sheriff el 2 de febrero. Dijo que ha experimentado el caos causado por la escasez de personal.

“Cuando llegas a facilitar tu clase, te dicen: ‘Lo siento, no llegamos al mínimo, el programa está cancelado’,” dijo Hernández. También dijo que descuidar las oportunidades vocacionales y de rehabilitación en la cárcel es contraproducente para los objetivos declarados de la ciudad.

“Sé que la gente quiere seguridad pública,” ella dijo. “Y sé que la gente quiere que cese la venta de drogas y que les roben o les golpeen los coches. ¿Pero qué hacemos encarcelando a la gente y no reciben ninguna rehabilitación?”

Los efectos negativos a largo plazo son especialmente tristes para los jóvenes encarcelados. Del 1 de junio al 10 de noviembre, hubo 10 veces más latinos de entre 18 y 24 años ingresados ​​en cárceles de San Francisco que las personas blancas o negras entre la misma edad. Y los defensores dicen que los más jóvenes necesitan especialmente programas de reinserción social, ya que los antecedentes penales les impiden adquirir habilidades laborales, avances profesionales y oportunidades económicas.

Los representantes del grupo comunitario dijeron a los comisionados de supervisión que ellos y otros proveedores de programas están en la mejor posición para ayudar a cambiar estas vidas.

“Somos culturalmente competentes,” dijo Bianca Sánchez, administradora de casos de Bay Area Community Resources. “Implementamos un enfoque centrado en la sanación y tenemos una perspectiva informada sobre el trauma, lo que nos hace más equipados para brindar servicios y apoyo dentro de las cárceles. Como profesionales capacitados, podemos brindar servicios efectivos de intervención, tratamiento y rehabilitación para romper los ciclos de encarcelamiento.”

Julie Soo, presidenta de la junta de supervisión, dijo que la solicitud estaba en consonancia con una legislación municipal de décadas de antigüedad, que ella ayudó a escribir,que garantiza el derecho a la igualdad de acceso a los servicios de la ciudad para todos los residentes de San Francisco, incluidos aquellos que saben poco el inglés. Sin embargo, dijo, un presupuesto “muy conservador” del Departamento del Sheriff requerirá “establecer prioridades.”

Llegan nuevos programas pero persisten las dudas

Menos de una semana después de la reunión de la junta de supervisión, se lanzó una nueva clase de recuperación del abuso de sustancias en español llamado Living in Balance; También se lanzó una clase de arte terapia en español.

Riker dijo que es optimista de que las clases programadas se mantendrán estables porque desde hace unos meses, el Departamento del Sheriff ha realizado programas ininterrumpidos de 9 a 11 a.m. en el anexo de la cárcel, donde recientemente han sido transferidos un gran número de reclusos que hablan español.

Otros no son tan optimistas como Riker. Hernández dijo que las dos horas para programas compiten con el tiempo al aire libre, llamadas y visitas a abogados, entre otras actividades, y está muy lejos de las seis a siete horas diarias de programación de tratamiento de adicciones que recibían los reclusos en el pasado. Y un trabajador que ha trabajado en la cárcel durante mucho tiempo, que habló bajo condición de anonimato, dijo que cree que el nuevo plan de estudios es para impresionar.

“Hacen cosas, ya sabes, para las cámaras, y luego, cuando termina, cuando nadie mira, todo vuelve a ser como era”, dijo el trabajador, y agregó: “Le doy dos semanas.”

Sylvie Pagan de NoVA, el No Violence Alliance Program, que atiende a personas que regresan a la comunidad después de estar en la cárcel por un delito violento o múltiples arrestos, dijo a la junta de supervisión el 2 de febrero que su organización también estaba lanzando un programa para latinos en la cárcel la semana que viene. Pero, dijo, “esto es sólo una semilla en un gran balde de muchas necesidades que necesitamos para la comunidad”.

Riker dijo que espera trabajar con más organizaciones comunitarias y, con los recursos escasos a su disposición, está implorando a grupos externos aun más ayuda.

Riker alentó a cualquier organización comunitaria enfocada en brindar servicios a hispanohablantes a enviar un correo electrónico a William Cooper, gerente de servicios de rehabilitación del Departamento del Sheriff, a william.cooper@sfgov.org.

Presupuesto de la alcaldesa da prioridad a la policía

La población carcelaria creció de 800 personas en junio a más de 1.100 hoy debido a la ofensiva policial contra las drogas. La situación exacerbó un nivel ya crítico de escasez de personal en la oficina del sheriff que, según los informes últimos, necesita contratar a 207 personas para dotar de personal a su contingente de 920 puestos. El año pasado, la abogada de derechos civiles Yolanda Huang demandó a San Francisco en nombre de personas encarceladas que afirmaban haber sufrido problemas de salud graves por la falta de luz solar después de años en confinamiento. Esa cuestión aún está en litigio, dijo Huang.

“La solución es que, si la alcaldesa quiere encarcelar a la gente, y no estoy hablando de si debería o no debería suceder, entonces tiene que pagar por ello,” dijo Huang. “Ella tiene que dotar de personal completo a la cárcel. Y si no va a dotar de personal completo a la cárcel, entonces no es necesario que encarcelen a estas personas. Es muy simple. Si los vas a alojar y controlarlos, entonces tienes que hacerlo bien. Y no lo son.”

Y no sólo las cárceles están sufriendo. La oficina del Defensor Público de San Francisco demandó al Tribunal Superior del Condado de San Francisco por retrasos en los juicios, alegando que infringía el derecho de sus clientes a un juicio rápido. El tribunal dijo que los retrasos en los juicios se deben a que la oficina del sheriff está extendida demasiado en las cárceles y el Salón de Justicia.

Sin embargo, la alcaldesa de San Francisco London Breed recortó el presupuesto del sheriff en $8 millones para 2023-24, dando al departamento un total anual de $292 millones. Pero sí aumentó el presupuesto del Departamento de Policía de San Francisco en $61 millones para 2023-24 y otros $11 millones el año siguiente fiscal para un total de $786 millones. Esos fondos se destinarán a la contratación de 500 funcionarios más, horas extras y salarios más altos negociados bajos un nuevo contrato sindical.

Además, en junio pasado, los supervisores de la ciudad respaldaron una resolución del supervisor Matt Dorsey solicitando que el Departamento de Recursos Humanos de la ciudad redactara una política de bonificaciones para los policías recién contratados que competiría con otras agencias policiales en el norte de California. El 16 de enero, Breed y el jefe de policía, Bill Scott, emitieron un comunicado de prensa conjunto promocionando sus éxitos. El comunicado anunció que en febrero y mayo se graduaron tres clases de la academia de policía con un total de 60 reclutas. El logro se debió a un salario inicial más alto y procesos de prueba y contratación simplificadas, según el comunicado. No se mencionó ninguna bonificación de contratación.

Mientras todo eso, supuestamente hay miedo en Departamento del Sheriff que las bonificaciones para firmar en otras agencias podrían atraer aun más diputados, incluyendo un bono de firma ampliamente publicitado de $75,000 del Departamento de Policía de Alameda para nuevos reclutas o contrataciones laterales de otros departamentos de policía.

Sylvie Sturm informó esta historia mientras participaba en la beca de datos 2023 del Centro Annenberg de Periodismo de Salud de la USC, que brindó capacitación, tutoría y financiación para apoyar este proyecto.

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Numerous drug policy experts and addictions specialists from across the country — as close as UCSF and as far away as Rhode Island — publicly oppose a San Francisco ballot measure that would compel adult welfare recipients to undergo drug screening before collecting cash benefits.

And efforts to publicize the measure have brought specialists who don’t always agree about addiction treatment practices to the same side of the debate.

Keith Humphreys, Stanford professor of psychiatry and behavioral sciences, has said San Francisco has been too permissive with people with substance use disorder. 

That led a local Proposition F campaigner to believe that he was an ally, Humphreys said.

“It was sent to me by someone in politics in San Francisco asking me, you know, do I want to endorse this?” he said. “And the answer is no.

“Being poor is not a crime. If this is something that is important to do, we should be doing it with people who threaten public safety, and not people who need this money to eat and pay their rent.”

Mayor London Breed’s Proposition F — Illegal Substance Dependence Screening and Treatment for Recipients of City Public Assistance would require single adults aged 65 and under who have no dependent children and receive County Adult Assistance Program benefits to participate in drug screening, evaluation and treatment to be eligible for cash benefits.

Recipients who decline screening or treatment would be ineligible for monthly cash benefits of $105 for people experiencing homelessness and $697 for housed residents. Benefit recipients who lack housing would receive 30 days of guaranteed shelter access. Those in housing would receive 30 days of rent paid directly to a landlord, with potential extensions for eviction prevention.

Proposition F has the backing of some wealthy donors in the tech sector, most notably Chris Larsen, a tech billionaire best known for co-founding Ripple and a major donor to political groups Neighbors for a Better San Francisco, Progress SF and GrowSF. 

Larsen has spent nearly $1 million on this election, including $250,000 on Proposition F, donations to various Democratic County Central Committee candidates running against incumbents, and $100,000 in one San Francisco Superior Court contest to unseat an incumbent judge.

Larsen is also a personal champion of Breed and her agenda.

“You’ve got a Board of Supervisors that doesn’t work with the mayor, that’s a huge problem,” Larsen said in an interview with Bloomberg News last fall. “And unfortunately, that can only be addressed in the ’24 election.”

A Failed Strategy

Breed said threatening to rescind cash benefits would compel low-income residents with substance use disorder into treatment. She announced the strategy last September after a plan to coerce people into treatment through arrests failed.

“The arrests that we’re making for public intoxication, people are not accepting help,” Breed said. “And so now it’s time to make sure that we are cutting off resources that continue to allow this behavior to occur without the accountability, without someone involved in a treatment program that could lead to a better life.”

According to retired Redondo Beach Police Lt. Diane Goldstein, the mistake San Francisco’s and other cities’ leaders make is that they don’t adequately fund programs that would effectively support public health, public safety and mental health.

Instead, she said, they “wait until things are so bad that they call the cops to fix the problem with the wrong set of tools.” 

Goldstein is now executive director of the Law Enforcement Action Partnership, a group of police, prosecutors, judges and other criminal justice professionals focusing on drug policy and criminal justice.

“Frankly, I just don’t know if the public is ever going to understand it,” Goldstein said. “Because they don’t understand that law enforcement should have never been tasked with enforcing a public health issue going back years. But the reason we do is, we’re the only people that answered the phone in the middle of the night.”

Goldstein said there are positive ways to involve police officers in helping more people access substance use disorder treatment programs. For example, the San Francisco Police Department was involved in a program in 2017 that brought law enforcement officers, street teams, case managers, public health clinicians and justice system professionals together to enroll repeat low-level drug offenders into community-based health and social services as an alternative to jail and prosecution. But that was short-lived.

The Law Enforcement Assisted Diversion — aka LEAD and now called Let Everyone Advance with Dignity — was launched in 2011 by Seattle-based Purpose Dignity Action, then called the Public Defender Association, which responds to public safety issues by facilitating inter-agency coordination. It has since expanded throughout the country.

In 2017, San Francisco received $6 million to implement LEAD from the Board of State and Community Corrections. But it stumbled after two years despite showing significantly lowered rates of misdemeanor and felony arrests, and felony cases among enrollees. 

One of the main problems was getting buy-in from law enforcement officers, according to an evaluation by the California State University, Long Beach, School of Criminology.

It was a major shift to go from arresting people to diverting them into social programs, according to interviews with officers and court personnel quoted in the report. As one officer said, “I’ve been around…cops for almost 30 years, and it’s not going to be like — it’s not going to be, push a button or snap your fingers and everybody is going to go, ‘Okay, we’ll do it different.’”

San Francisco Police Chief Bill Scott expressed willingness to revisit the program at a Police Commission meeting last June, but it’s unclear whether there have been efforts to revive it. The Police Department did not respond to inquiries about this subject.

Lisa Daugaard, co-executive director of Purpose Dignity Action, said leaders can no longer ignore the fact that coercing people into treatment for substance use disorders is counterproductive because it doesn’t address underlying circumstances.

“It comes from an understandable impulse to help people get better. That is not how people get better,” Daugaard said. “Imagine what happens if they don’t do that thing. So now you have people in an even more miserable situation than they are right now who definitely are going to be turning to the illicit economy to get their income. And that’s not good for anybody.”

She said she understands the pressures city leaders face regarding visible drug sales, use and addiction.

“The problem that we’ve got is that public officials under public pressure need something to point to that seems like action,” Daugaard said. “They don’t know how people get better, and that impulse to quick action can be very, very destructive.”

She said that’s why her organization “spends a ton of time” ensuring that their inter-agency approach visibly improves the situation on the streets for retail businesses and that police are satisfied with their recommendations.

Relapse Not Considered

San Francisco Human Services Agency Executive Director Trent Rhorer said last September that about 20% of the 5,200 people who collect County Adult Assistance Program benefits self-disclosed last year that they were suffering from substance use disorder. 

“It’s a population that has not availed themselves of treatment,” and this measure would lead to a “positive change” in their lives, Rhorer said.

Brandon del Pozo, an assistant professor of medicine and public health at Brown University, where he conducts research on the drug epidemic and its intersection with policing and criminal justice, said Proposition F does not account for the fact that addiction is an inherently relapsing disease, even among those who willingly enter medically assisted treatment. 

“The clinical odds of someone getting on the medication and staying on the medication are very low without repeated attempts,” del Pozo said.

He also applied his perspective as a 19-year veteran of the New York City Police Department and the former chief of police of Burlington, Vermont, where he organized the city’s response to the opioid crisis.

“The cop in me says that if you could get them to stay on for five years, and that’s the facts, try it. That is just not the world,” he said. “People will fail out of this and lose their assistance, lose what they need to survive.” 

Addiction specialists agree that the measure does not address the circumstances surrounding harmful substance use.

Dr. Marlene Martin, UCSF associate professor and founding director of the addiction care team at San Francisco General Hospital, was among four medical professionals who gathered for a Feb. 2 press conference to speak out against Proposition F.

She said her patients have told her they use substances because of housing instability, trauma, poverty, discrimination and untreated mental illness. She added that threatening to halt or cut city benefits will erode the trust it takes for recipients to disclose their substance use and seek addiction treatment.

“I have seen addiction and overdose worsen when people lose support systems, and that is what Proposition F threatens to do,” Martin said.

Laura Thomas, senior director of HIV and harm reduction policy at the San Francisco AIDS Foundation, said at the Feb. 2 press conference that Proposition F does not increase access to substance use disorder treatment. And while her organization provides a path to recovery for numerous clients every year, she said, the city is reducing its funding.

“If the Human Services Agency wants to connect people to treatment, I highly recommend that instead of putting this wasteful and cynical initiative on the ballot, that they add a couple of linkage counselors to connect people to medications for opioid use disorder including buprenorphine and methadone,” Thomas said.

Legal Troubles on the Horizon

The measure could bring the city legal troubles. Mission Local reported Feb. 20 that attorney Kerianne Steele representing Service Employees International Union Local 1021 sent a letter to the city attorney claiming that Proposition F violates the Meyers-Milias-Brown Act, which mandates that an employer confer with union employees on matters related to employment conditions.

Steele says Proposition F would adversely affect employees since it would lead to increased workloads at a time when the mayor is calling for budget cuts despite staff shortages across the Human Services Agency. The letter states also that there could be an increase to threats against staff as recipients are denied benefits, yet the measure includes no provisions for increased security.

And, while the measure anticipates enrolling an estimated 1,700 new clients into treatment, the SEIU letter states that, as of its writing, San Francisco had only 46 treatment beds available, according to the city’s tracking system. Meanwhile, the mayor’s budget proposes to cut city funding for drug treatment and mental health services.

The letter demands that the Proposition F be removed from the ballot. But the deadline to do that passed in November, according to the San Francisco Department of Elections.

The post Drug Policy, Addictions Specialists Oppose Prop F Tying Welfare to Drug Tests appeared first on San Francisco Public Press.

Some people recite a prayer of gratitude for the time they spent in San Francisco County Jail. Among them is a Bay Area resident we’ll call Carlos to respect his request for anonymity.

“Thank God,” said Carlos, 29. “I sought a better life because I got close to good people who guided me. I got close to people who really wanted to see me succeed in life.”

Those people were Spanish-language county jail reentry program providers. Carlos came to San Francisco from Honduras, pursuing promised work that never materialized. Instead, he sold drugs.

That all changed nearly four years ago when he was booked into San Francisco County Jail on drug violations. Once incarcerated, he met Spanish-speaking staff from the ReSET Justice Collaborative — one of myriad community organizations that work with the jail’s program director to provide vocational training, educational courses, substance use disorder treatment, anger management counseling, cultural activities, English classes and religious observances.

“They went to visit me in jail, and from there they signed me up to the places where they could help me,” Carlos said. “Because of how much they taught me, after I left, they helped me get a job that I still have. I have been working in this job here for two years. I never went back to being involved with drug dealing again. I have not gone into the Tenderloin again, and it has helped me a lot because it has brought more peace of mind to my family.”

But Spanish-language programming at San Francisco’s County Jail has since become virtually nonexistent as routine lockdowns caused by staff shortages have made it practically impossible to hold classes. Even while deputies work mandatory 16-hour shifts, there aren’t enough of them to escort people who administer rehabilitation sessions and other training programs into the jails. On Feb. 2, numerous social service providers for the Latinx incarcerated population implored the Sheriff’s Department Oversight Board at its monthly meeting to help them gain access to the jail.

It appeared that jail leadership responded to the public call-out the following week by announcing a new Spanish-language substance use recovery program and art therapy class, however a jail spokesperson said the classes had been in the works since last October. Nevertheless, some longtime jail workers expressed doubt that the programs would last for more than a few weeks.

The lack of Spanish-language programming is an increasingly dire problem since Latinx incarcerations have been on the rise since last June’s launch of a police crackdown on drugs in the Tenderloin and South of Market neighborhoods.

According to Sheriff’s Department data, from June 1 to Nov. 10, 2023 (the most recent available), 42% of people booked in San Francisco County Jail on drug-related charges were Latinx compared with 30% who were Black and 28% who were white. And as Carlos witnessed years ago, some people desperately need to communicate their need for help.

“There are people there who have mental problems, mental problems that they cannot deal with, and how are they going to tell that to someone who knows only English and doesn’t understand?” Carlos said.

Last year’s police crackdown also targeted people for simple drug use as a means of encouraging them into substance use disorder treatment, according to city and law enforcement officials. Yet since then the jail’s treatment program, Road to Recovery, has been available only in English, despite an expressed interest in treatment from the Latinx population.

According to city Department of Public Health data, during the 12 months that ended in September 2023, Jail Health Services assessed 380 incarcerated Latinx patients as having an opioid use disorder. Of them, 209 sought treatments through medications such as buprenorphine or methadone.

It’s unclear how many of them lost out on treatment programming because they were monolingual Spanish speakers, since the data don’t track language preference. But in one instance last October, service provider Joanna Hernandez of the Latino Task Force, a San Francisco-based association of more than three dozen community-based organizations, said she witnessed a “pod” — a group of men assigned to a small congregation of cells — attending Road to Recovery at County Jail No. 3 in San Bruno. Hernandez said of the 46 men attending, 20 were Spanish speakers and could barely understand the curriculum.

“Sometimes they just sit and kind of understand some of the words but if not, they’ll just go to their cells,” Hernandez said. “And then I checked in with the staff, and he told me, ‘I don’t have Spanish-speaking staff and it sucks because they keep putting people who don’t speak the language in this program pod.’

“It’s something that happens a lot inside the jails. So, people are coming back to the same mess, back to the same behavior — if not coming back even worse, because they were confined and ripped from their family, their children, their religion, like everything.”

Ali Riker, director of programs for the Sheriff’s Department, said she was aware that Spanish speakers attended the English-language Road to Recovery program. She said she speculated that this happened because they had enough English proficiency to request access.

“We weren’t, like, barring people from participating who requested it,” Riker said. “I know it’s not ideal. We’re doing our best. Is it enough? You know, we need more. We definitely need more resources.”

Hernandez joined the other Latinx social service providers at the Sheriff’s Department Oversight Board on Feb. 2. She said she’s experienced the chaos caused by short staffing.

“When you get there to facilitate your class, you’re told, ‘Sorry, we’re not at our minimum, program is cancelled,’” Hernandez said, adding that neglecting jail vocational and rehabilitation opportunities is counterproductive to the city’s stated goals. 

“I know that people want public safety,” she said. “And I know that people want drug sales to stop, their cars being robbed or bipped. But what are we doing locking people up and they’re not receiving any rehabilitation?”

Long-term negative effects are especially dismal for incarcerated youth. Latinx people aged 18 to 24 represented 10 times more drug-related bookings in San Francisco jail from June 1 to Nov. 10 than either their Black or white counterparts. And advocates say younger people especially need reentry programs since criminal records inhibit them from gaining work skills, career advancements and economic opportunities.

The community group representatives told the oversight commissioners that they and other program providers are best positioned to help turn these lives around.

“We are culturally competent,” said Bianca Sanchez, a case manager at Bay Area Community Resources. “We implement a healing-centered approach and have a trauma-informed lens, making us more equipped to provide services and support inside the jails. As trained professionals, we can provide the effective intervention, treatment and rehabilitation services to break the cycles of incarceration.”

Julie Soo, president of the oversight board, said the request was in keeping with decades-old city legislation enshrining the right to equal access to city services for all San Franciscans, including those with limited proficiency in English — legislation that she helped draft. But, she said, a “very conservative” Sheriff’s Department budget will require “setting up priorities.” 

New Programs Arriving but Doubts Remain

Less than a week after the oversight board meeting, a new Spanish-language version of a substance abuse recovery class called Living in Balance was launched as well as a Spanish-language art therapy class.

Riker said she’s optimistic that class scheduling will remain stable since the Sheriff’s Department has delivered programs uninterrupted from 9 to 11 a.m. in the jail annex — where a large number of Spanish-speaking inmates have recently been transferred — for a few months now.

Others are not as optimistic as Riker. Hernandez said the two hours a day compete with outdoor time, phone calls and lawyer visits, among other activities — and it’s a far cry from the six to seven hours a day of addiction treatment programming that inmates used to get. And a longtime jail worker speaking on condition of anonymity said they believe the new curriculum is just for show.

“They do stuff, you know, for the cameras, and then when it’s over with, when nobody’s looking, it goes back to how it was,” the worker said, adding, “I give it two weeks.”

Sylvie Pagan of NoVA, the No Violence Alliance Program, whose participants return to the community after serving time for a violent offense or multiple arrests, told the oversight board on Feb. 2 that her organization was also launching a Latino program in jail the next week. But, she said, “this is just a seed in a large bucket of many, many needs that we need for community.”

Riker said she’s eager to partner with more community organizations, and with the meager resources at her disposal, she’s imploring outside groups for even more help.

Riker encouraged any community-based organizations focused on providing volunteer services to the newcomer Spanish-speaking population to help by emailing William Cooper, rehabilitation services manager with the Sheriff’s Department, at william.cooper@sfgov.org.

Mayor’s Budget Prioritizes Police

Last year’s police crackdown on drugs caused the jail population to balloon from 800 people in June to more than 1,100 today. The situation exacerbated an already critical level of staff shortages at the sheriff’s office, which, according to the latest reports, needs to hire 207 people to fully staff its contingent of 920 positions.

Last year, civil rights attorney Yolanda Huang sued San Francisco on behalf of incarcerated people who claimed they suffered serious health problems from lack of sunlight after years of lockdowns. That issue is still being litigated, Huang said.

“The solution is, if the mayor wants to put people in jail — and I’m not talking about whether or not it should or should not happen — then she has to pay for it,” Huang said. “She has to fully staff the jail. And if she’s not going to fully staff the jail, then they need to not put these people in jail. It’s real simple. If you’re going to house them and control them, then you have to do it right. And they’re not.”

And it’s not just jails that are suffering. Gaps in duties normally assigned to sheriff’s deputies led the San Francisco Public Defender’s office to sue San Francisco County Superior Court over trial backlogs, claiming it infringed their clients’ right to a speedy trial. The court said trial delays were due to the sheriff’s office being overextended at the jails and the Hall of Justice.

Nevertheless, Mayor London Breed slashed the sheriff’s budget by $8 million for 2023-24 giving the department an annual total of $292 million. She did, however, increase the San Francisco Police Department’s budget by $61 million for 2023-24 and another $11 million the following fiscal year for a total of $786 million. That funding will go toward hiring 500 more officers, overtime and higher salaries negotiated under a new union contract.

Also, last June, city supervisors endorsed a resolution by Supervisor Matt Dorsey requesting that the city Human Resources Department draft a policy of hiring bonuses for police department recruits that would compete with other law enforcement agencies in Northern California.

On Jan. 16, Breed and Police Chief Bill Scott issued a joint press release touting their successes. The release announced that three police academy classes totaling 60 recruits were scheduled to graduate in February and May. The achievement was thanks to a higher starting pay and streamlined testing and hiring processes, the release stated. There was no mention of hiring bonuses.

Meanwhile, there are reportedly fears at the Sheriff’s Department that signing bonuses at other agencies could entice away even more deputies — like a widely publicized signing bonus of $75,000 from the Alameda Police Department for new recruits or lateral hires from other police departments.

UPDATED 2/14/2024: The story was updated with additional information from a jail spokesperson who said that jail leadership last October began organizing the Spanish-language programming that was recently announced.

Sylvie Sturm reported this story while participating in the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship, which provided training, mentoring and funding to support this project.

The post Service Providers Demand Access to Latinx Jail Inmates appeared first on San Francisco Public Press.

As fatal overdoses swelled, so did cases involving fentanyl, which was a factor in more than 81% of overdose deaths this year. That statistic is up from 70% in 2022, and 74% in 2021.

Nearly one-third of those people were listed as having no fixed address. Later that day, a crowd gathered at Civic Center Plaza to remember more than 420 who died in the city while experiencing homelessness this year.

At the vigil, some people held electric candles, while others raised some of the 40 banners displaying names of those who had died as participants took turns reading the names and ages of loved ones and friends, as young as 17, each accompanied by a chiming bell.

“There seems to be a fixation on the inconveniences and the material consequences of homelessness, and how it affects the housed rather than a centering of the human being, of the unhoused themselves,” said Benjamin DeShazo-Couchot, director of the San Francisco Night Ministry Care Line. “May we also remember them for living, learning, knowing, hoping, striving seeking, loving, surviving. This is also part of the story that must be known.”

The event, held annually over the past two decades, is organized by the Interfaith Council, the Coalition on Homelessness, the Night Ministry, the Faithful Fools and the arts nonprofit ABD/Skywatchers. Participants spent an hour reading all the names of those who had died, representing more than twice as many as there were last year.

“This gathering every year is a testimony to what is possible,” said Anne Bluethenthal, founder and artistic director of ABD/Skywatchers. “As we stand together this evening, we declare that we will not turn away — not locally, not globally. We will look, we will listen, to all the stories, to all the wailing. We will leave open our tender hearts. We will tell the truth of what we see, what we hear, what we feel.”

Last April, harm reduction advocates warned officials that a police crackdown to arrest people under the influence of drugs, against the advice of health experts, could lead to worse health outcomes. In its 2022 Overdose Prevention Plan, the San Francisco Department of Public Health argued that punitive policies “have not been shown to be effective at reducing overdose deaths, while incarceration is known to significantly increase risk of dying of drug overdose.”

Advocates have urged the city instead to open overdose prevention centers. These would allow drug users to consume under supervision, so they could get immediate help in case of overdose while also offering access to basic hygiene and medical services, food assistance and treatment referrals.

City officials have expressed reluctance to operate such a center, saying it would contravene federal and state laws that make it illegal to “knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.” But the city indicated willingness to support a facility if it were funded and operated by a nongovernmental entity.

Gary McCoy, vice president of policy and public affairs for HealthRight 360, a nonprofit contracted by San Francisco to provide treatment services, announced in October that his organization had raised the funds needed to run an overdose prevention center. He said the organization is still waiting on the Department of Public Health for the go-ahead to open a facility.

In a written response to a Public Press request for comment in October, the Department of Public Health suggested that despite the private funding, opening a center could be a long, arduous process, as “there are a number of complex legal, procurement, location, and community factors that need to be addressed.”

Worsening Trend for Black and Latinx Populations

This is also the deadliest year for overdoses among Black residents, who account for nearly one-third of all drug-related fatalities, despite representing only 6% of the city’s population.

The overdose mortality rate for Black residents is more than five times that of the overall population. In 2020, the previous record-setting year for overdose deaths when 726 people died, one-quarter were Black. In 2021, 642 people died of overdose, and 649 died in 2022.. In both of those years, Black residents accounted for 28% of all drug-related fatalities.

This chart breaks out the larger racial and ethnic groups in San Francisco. Additional residents whose races were categorized as “unknown” or “other” are included under “All Races.”

Last Wednesday, the Department of Public Health announced efforts to address these racial disparities with a $2.25 million grant over five years to the Homeless Children’s Network, which will direct funding “to prevent and lessen harmful health outcomes associated with substance use, and to reduce overdose death disparities through innovative, tailored approaches.” The financing came from opioid industry lawsuit settlement money and state Mental Health Services Act funds.

The chief medical examiner’s report for November also indicated a worsening trend for the city’s Latinx population. For the first time since record keeping began, Latinx residents made up a higher percentage of those who died of overdose in one month than Black residents — 28% for Latinx people versus 25% for Black people.

Among them was 24-year-old Aurelio Jimenez. His father, also named Aurelio Jimenez, attended the vigil to memorialize his son, even though the younger Jimenez had never been unhoused. Hanging around the father’s neck was a picture of his son as a child posing with a beaming smile in front of a fighter jet.

“It’s hard for us to take as a family because he went to college, he worked at St. Anthony’s, but still, living here, it took him,” Jimenez said, referring to fentanyl.

Jimenez said he had experienced his own struggles with addiction, and because of that, his son had been aware of the dangers of drug use. He added that the trauma of his son’s death caused him briefly to relapse. He is now in rehab.

The younger Jimenez was a health care financial analyst at the St. Anthony Foundation and a corporal in the Marine Corps Reserve. In the comments section of an online fundraiser to pay for funeral services, fellow Marine Manuel Porras, who worked with the younger Jimenez, praised his dedication to service.

“He did not gripe about his duties, but went about them with a smile, helping all who needed it,” Porras wrote. “He spent his life dedicated to the ideals of serving those in need and being a bright spot to his brothers on the hardest days.”

The city’s worsening trend in overdoses in the Latinx community is reflected in statewide statistics. A 2019 study revealed that San Francisco was in the top three counties for opioid-related death rates among Latinos in California. State data show Latinx Californians saw a 68.1% jump from 2020 to 2019, the biggest recent increase among all racial or ethnic groups.

Sylvie Sturm reported this story while participating in the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship, which provided training, mentoring and funding to support this project.

CLARIFICATION 12/21/2023: An earlier version of this story neglected to mention the Faithful Fools as co-organizers of the annual homeless vigil. 

The post 2023 Is San Francisco’s Deadliest Year on Record for Drug Overdoses appeared first on San Francisco Public Press.

Experts in overdose prevention say many teen and adult lives could be saved if more people know how to identify and respond to overdoses. In San Francisco, an array of programs are providing overdose response training to teenagers, college and graduate school students, and residents in neighborhoods that have a high rate of overdose deaths.

Fentanyl-related teen overdose deaths nearly tripled nationally from 2019 to 2021, according to the Centers for Disease Control and Prevention. And two-thirds of those who died had someone nearby who did not provide an overdose response.

In Episode 6 of the podcast series, “The Grassroots Effort to Save Lives: San Francisco and the Overdose Crisis,” we find out why students are choosing to learn how to reverse overdoses. And we drop in on a training session to find out how it’s done. Read our previous coverage on this storyline.

Now, some San Francisco high school students are trying to help by volunteering for a program that trains them to recognize drug abuse and reverse overdoses.

Among them is 17-year-old Burton High School student Jennifer Mendoza.

“I think it’s really important, especially in our school and at my age, that we should be teaching our students how this is performed,” Mendoza said.

The program, called Public Health Youth Corps, is run by FACES for the Future Coalition, which offers underprivileged youth a pathway toward a career in health care. It includes a healthcare innovation called mental health first aid, according to coalition Deputy Director Brooke Briggance.

“It’s in some ways kind of like CPR,” Briggance said.

Addressing psychological health is a key part of mitigating drug-related deaths among teenagers since more than 40% of teens who died of overdose from 2019 to 2021 had a history of mental health conditions, according to the CDC.

Through the program, students learn the early signs of various mental health challenges, how to approach conversations with individuals who may be suffering, and how to follow a trajectory of de-escalation in the event of worsening stages such as a panic attack, non-suicidal self-injury or thoughts of suicide.

Briggance said the students who volunteer for the training are passionate about mental health and substance use disorder because they routinely encounter these challenges in their personal lives.

“Many of them have seen overdose on the streets, in the neighborhoods in which they’re walking to school or hanging out with their friends,” she said. “Some of them have lost family members to overdose.”

Mendoza said if she had learned these skills earlier, she might have been able to help a friend whom she fears may have died of an overdose.

“We’re not really sure where they are right now but we have a feeling that they’re not here because they did a lot of drugs,” she said. “I feel like if I was more educated at that age, I could have helped him or found help.”

Some local university students are also getting involved in overdose reversal training. This year, a new California state Senate bill required that all community colleges and universities provide opioid overdose education and distribute Naloxone. Maia Scarpetta and Rachel Murro, both PhD students at UCSF, organized drug reversal training for the UCSF community by enlisting the help of National Harm Reduction Coalition’s Drug Overdose Prevention and Education Project — aka the DOPE Project — a 20-year-old harm reduction organization that has been featured in CDC reports for its innovative research and practices in community-based naloxone distribution.

“I don’t think that anybody living in SF is not in the presence of drug use, whether it’s your friends, your family, your neighbors, folks that you interact with on a daily basis,” Murro said.

“And I think a lot of us kind of intellectualize it and focus on it from a research perspective, or we’ll learn all the facts we can, but it’s like, what would we do if somebody was actually standing in front of us and needed our help? Which is not out of the realm of possibility at all.”

The UCSF training event drew more than 150 people who packed an auditorium.

[ Learn how to reverse an overdose by watching “How to Use Narcan with the DOPE Project.”]

The DOPE Project is also spearheading a groundbreaking initiative that trains permanent supportive housing residents as peer overdose responders. When shelter-in-place initiatives were enacted during the height of the COVID-19 pandemic, people experiencing homelessness were moved into hotels and supportive housing where the risk of overdose increased significantly for drug users due to the decreased likelihood that an acquaintance or bystander could respond.

A San Francisco Chronicle analysis found that of the approximately 650 people who died of accidental overdoses in the Tenderloin and nearby Sixth Street corridor between January 2019 and August 2022, more than 40% died inside single-room occupancy buildings, also called SROs.

In response, the DOPE Project collaborated with the San Francisco Department of Public Health on an overdose prevention training program designed for people living in permanent supportive housing. 

In February 2021, residents of two single-room occupancy buildings participated in the pilot — the Cadillac Hotel and The Minna Lee — in cooperation with buildings’ service provider, Delivering Innovation in Supportive Housing. The program installed inside the room of every resident an emergency button, which, when activated, sounded an alert on a peer responder’s phone so they could quickly respond and administer Narcan.

Responder Susan Lefever said the system works because residents tend to be distrustful of authority. So, if something goes wrong, they’re more likely to reach out to peers rather than building staff. She added that ever since she took on the role, she’s felt renewed pride.

“It feels like I’m useful, like I have a sense of purpose,” she said. “I’m not just one of the statistics in the SRO. I’m actually helping within the community.”

The post SF Students, SRO Residents Train to Reverse Drug Overdoses appeared first on San Francisco Public Press.

Several weeks after a crucial legal hurdle blocking safe consumption sites in San Francisco was seemingly resolved, proponents said they were dismayed that city leaders and public health officials were still not greenlighting centers that could reduce deaths related to drug use.

Overdose deaths have reached 620 this year — on track to have the highest annual tally since counting began, with fentanyl causing the vast majority of fatalities, according to the chief medical examiner’s latest report.

The Department of Public Health advocated for safe consumption sites — also known as overdose prevention centers or OPCs — in its 2022 Overdose Prevention Plan. These are places where people can consume drugs under supervision and get immediate help if they overdose, and where they can receive basic healthcare, hygiene services, food, and referrals to detox and treatment upon request.

But the department now appears to be hedging, said Supervisor Hillary Ronen.

“DPH gave us an initial timeline that had the first OPC opening in March of 2025,” she said. “Clearly, that’s not an urgent priority to deal with the fact that two to three people a day are dying of drug overdose.”

In Episode 5 of the podcast series, “The Fight for Safe Consumption Sites: San Francisco and the Overdose Crisis,” we investigate San Francisco’s long campaign for places where people could take drugs under supervision in case they overdose and how city leaders may be having a change of heart about supporting the sites, and we visit one such overdose prevention center in New York City. Read our previous coverage on this storyline.

Overdose prevention centers have operated in Canada and Europe for more than 20 years — and none of those centers has ever recorded a death, according to studies published in academic journals. Studies have shown that in communities where centers were located, their presence correlated with improved client health, reduced public nuisance, an increase in detox services, higher rates of long-term addiction treatment and, over time, reduced use of the sites for injecting drugs. And a cost-benefit analysis published in December 2016 in the Journal of Drug Issues showed that a single safe consumption site could save San Francisco’s public health system $3.5 million annually.

Mayor London Breed supported the 2022 plan and in the last two-year budget included $18.6 million for wellness hubs that would offer overdose prevention services. But City Attorney David Chiu warned that opening such sites could violate so-called “crackhouse” laws, federal statutes that, among other things, make it illegal to “knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.” Last April, Breed and Chiu agreed that to avoid breaking the law, the city could fund a wellness hub with wraparound services like healthcare if the safe consumption portion of the center was privately funded.

One local organization appears to have solved that part of the puzzle. On Oct. 5, Gary McCoy, vice president of policy and public affairs for HealthRight 360, a nonprofit contracted by San Francisco to provide treatment services, announced that his organization had raised the funds needed to operate an overdose prevention center.

The San Francisco Examiner on that day quoted a health department statement asserting that it was unaware that a nonprofit had succeeded in raising funds. Five days later, in an email to the Public Press, the department provided the same statement: “We have not been informed that any nonprofit has succeeded in raising funds. However, once the funds are raised, there are a number of complex legal, procurement, location, and community factors that need to be addressed.”

[Double your year-end gift to the Public Press during NewsMatch, a national campaign that supports nonprofit newsrooms by matching donations dollar for dollar.]

McCoy said he has noticed a lack of urgency regarding overdose prevention centers, adding that the city is now “barely discussing” implementing wellness hubs. He said he also noticed the increasing politicization of harm reduction strategies, a collection of practices that address health needs without requiring that those receiving help abstain from drugs or alcohol, or that they enter treatment for addiction.

“There’s been a very vocal, small group of people that have been really hammering this messaging — that they’re condemning San Francisco for progressive policies and talking about ‘this is why the city has failed,’” McCoy said.

Among those speaking against harm reduction is a new political lobbying group called TogetherSF Action, which is campaigning against overdose prevention centers, arguing that they are an ineffective way to connect people to treatment.

“These people are somehow getting the ear of our policymakers over the dedicated staff that have worked in these departments, that have the medical training, that have the lived experience,” McCoy said.

San Francisco pioneered the harm reduction philosophy in 1967 when the Haight Ashbury Free Medical Clinic provided healthcare to crowds of young people who heeded the call to “turn on, tune in and drop out.” It’s a healthcare approach that does not require people to stop taking drugs to get support. Instead, the goal is to help improve the health of people suffering from addiction by providing clean drug supplies, basic medical and hygiene care, some food and shelter.

But today, some local leaders, like Supervisor Matt Dorsey, are seeking to redefine those principles.

“We do have to take the principles of harm reduction seriously, in that part of it is reducing harms to the community,” Dorsey said.

Dorsey said the city’s permissiveness around drugs has resulted “in a level of drug tourism or San Francisco becoming a destination city for drug use.”He quoted a statistic from a report presented by Police Chief Bill Scott to the Police Commission last June indicating that 95% of people arrested for drug use that month were not from San Francisco.

Data from the chief medical examiner may challenge the drug tourism theory: A report released in October showed that 92% of people who died of overdose from January to September this year were from San Francisco.

Alex Kral, a San Francisco-based epidemiologist with expertise in substance use and overdose prevention centers, said the notion that harm reduction services encourage drug users to come to San Francisco “doesn’t really make any sense.”

“There’s no data showing this,” Kral said. “In general, the people who go to these types of services are people who’ve come to terms with the fact that they’ve been using drugs a long time, they’ve got a problem, and they need some help.”

Even though proponents fear that support for overdose prevention centers is waning among city leaders, they are not giving up. Activists have been running pop-up safe consumption sites in areas of the city where overdoses are most prevalent. 

Ronen participated in one such site on Aug. 31 — International Overdose Awareness Day. But she said that was an act of civil disobedience, not a replacement for the real overdose prevention model.

“Why the model is so wonderful is you can actually save people’s lives and do this really positive health intervention, and at the same time, address one of the worst things happening in San Francisco right now, which is the really chaotic streets conditions in certain neighborhoods,” she said.

Ronen said that when her office approached Breed’s office for a renewed commitment to overdose prevention sites, they were stalled yet again.

“I think there’s a good chance that HealthRight 360 is going to have to give back hundreds of thousands of dollars, and that we’re just going to see more and more people die of drug overdose in the city,” Ronen said.

Meanwhile, Breed and law enforcement officials have vigorously campaigned on a strategy involving arresting people under the influence of drugs, despite health department advice to the contrary. In its 2022 Overdose Prevention Plan, the Department of Public Health noted that punitive policies “have not been shown to be effective at reducing overdose deaths, while incarceration is known to significantly increase risk of dying of drug overdose.”

Ronen said the health department’s silence regarding the mayor’s approach is irresponsible.

“The Department of Public Health just does what she tells them to do, which is also a problem. Because in my opinion, they’re doctors, they have a duty to do everything in their power to save their patients’ lives,” Ronen said.

The mayor’s office did not respond to a request for comment.

The post City Officials Lack Urgency to Prevent Overdose Deaths, Say Safe Consumption Proponents appeared first on San Francisco Public Press.

San Francisco District Attorney Brooke Jenkins has frequently compared the sale of fentanyl to murder — most recently saying “the sale of fentanyl is equivalent to handing someone a loaded gun” during an Oct. 1 San Francisco Board of Supervisors hearing.

As such, she has criticized and diminished the use of diversion programs that offer criminal defendants accused of selling drugs rehabilitation, counseling and training rather than jail sentences. Since taking office 15 months ago, Jenkins has reduced the number of referrals to the San Francisco Pretrial Diversion Project by 70%, according to its CEO David Mauroff.

And as San Francisco’s rate of overdose fatalities reaches more than two deaths a day, Jenkins is pushing for defendants accused of selling drugs to remain in jail. But some legal advocates say that’s a bad strategy both for the defendants and for public safety.

“Who’s deciding our strategies and our next steps around all these people that are in jail?” Mauroff said. “They’re going to be released, you can’t hold them forever. So, what’s the plan for when they’re released?”

In Episode 4 of the podcast series, “The War on Drugs Revisited: San Francisco and the Overdose Crisis,” we take a historical look at the justice system’s approach to drugs, its racial inequities, what has changed over the years, and which older policies may be making a comeback. Read our previous coverage on this storyline.

Alexandra Pray, a San Francisco deputy public defender, said Jenkins’ heavy prosecutorial approach undermines the possibility of helping people develop skills to lead better lives without selling drugs.

“It’s maddening to have a district attorney’s office who says that their goal is to clean up the streets, but we have this proven way to actually make substantive changes and not just temporarily fix the problem, and the DAs office is willfully avoiding it,” Pray said.

The district attorney’s office did not respond to requests for comment.

Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University, told a California State Assembly committee dedicated to overdose prevention last May that arresting low-level drug dealers could undermine public safety by taking resources away from fighting violent crime.

“People at the bottom, you can punish them all day, and they’ll just be immediately replaced,” he said. “If you prioritize doing that, if we super criminalized low-level drug crimes, we effectively decriminalize going after rape, arson, murder, because there’s only so much resource in the criminal justice system. So, that I think was the big mistake of the 80s and early 90s that I would hope we would not repeat.”

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A Pew Research study from 2018 revealed that more imprisonment doesn’t reduce a state’s drug problems. The data showed no relationship between prison terms and drug misuse. 

The study’s authors concluded: “The evidence strongly suggests that policymakers should pursue alternative strategies that research shows work better and cost less.”

The San Francisco Pretrial Diversion Project was established as such an alternative strategy in 1976. The board and staff are composed of San Francisco residents, members of the San Francisco Bar Association, judges of the municipal courts, and a former client and current clinical social worker, Philip Jones. 

Jones, who said he was in and out of the criminal justice system from an early age, said it wasn’t until he was connected with the pretrial diversion program that he was able to turn his life around.

He said that his Latino-African American heritage influenced the way people in authority responded to his needs as a child.

“From a young age, I was told in school by teachers, by doctors that my behavior wasn’t normal,” Jones said. “I wasn’t able to sit in the classroom and go through eight hours of school every day without some kind of disturbance. I benefited more from physical play art, things that kind of excited a different dopamine response than just like normal completion of tasks or mathematics or science.”

Attempts to discipline Jones escalated from sending him to the principal’s office to after school detention to juvenile hall.

“That, in combination with exposure to trauma, some violence in the home, experimentation with substances, addiction, mental health, just kind of fueled my engagement with the criminal justice system,” he said. “I started to believe that I was this person that was destined to be incarcerated over and over again, this person that was incapable of holding a job, of getting higher education, and in this category where I felt really lost.”

For six years, he was routinely arrested for non-violent offences, at one point facing warrants every other month. Then, through the pretrial diversion program, he was assigned a case manager who helped him navigate social services, secure a long-term shelter bed, enter substance use treatment and anger management programs, and access mental health, where he found out about his bipolar disorder and learned about the importance of taking regular medication. The case manager’s office was open whenever Jones wanted to check in — it even had a cot in a secluded corner if he felt like taking a nap.

Jones said the San Francisco Pretrial Diversion Program helped his life “pivot from a cycle of arrest, jail, court into a cycle of healing.” Today, Jones has a master’s degree in social work and works as a therapist in a middle school and a high school.

“I see myself in the kids I work with every day, and literally in the neighborhood that I grew up in,” he said. “I love when clients feel that they can be comfortable with me when they feel they can talk to me, and they feel that I really see them on a level maybe others haven’t in the past.”

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