Supervisors Ross Mirkarimi, Aaron Peskin, Chris Daly, and Jake McGoldrick have submitted legislation and garnered enough votes to put a Treatment on Demand initiative on the November 2008 ballot. The initiative would do what many politicians have promised but have failed to deliver.
How Far We’ve Come
In 1996, the Coalition on Homelessness initiated a Treatment on Demand campaign in San Francisco. We interviewed over 700 individuals suffering from addictive disorders and found that most indeed wanted treatment, but that it was nowhere to be found. At that time, we had over 1,700 people on the waiting list for treatment, and we held the prized position of top state and national rankings in emergency room mentions for both methamphetamines and most dramatically, heroin. At that time, on average, a few fatal drug overdoses would occur in San Francisco each day.
With the passage of NAFTA and the loosening of the borders came an influx of black tar heroin to the West Coast of the United States. The prices of heroin plummeted on the streets while the purity skyrocketed. Even more-experienced addicts were overdosing.
The Coalition brought our findings to Dr. Sandra Hernández, Director of the Department of Public Health, and pitched the idea to move forward in an attempt to achieve treatment on demand in San Francisco. The idea behind the buzz phrase was to ensure availability of addiction treatment right when the window of recovery opened. Long wait lists and treatment unavailability would often cause those attempting to recover to go on another drug run. The danger, of course, was that that desperate run might be one’s very last, or that the window might close, and the patient would never return.
We brought the idea, along with a great deal of data, to every policy maker in the city. Dr. Hernández also pitched the idea to Mayor Willie Brown. Through a highly organized campaign, we were able to win the unanimous support of the Board of Supervisors and the Health Commission as well. Treatment on demand became official policy in 1997.
A Medical Issue
Addictive disorders are medical conditions recognized by the DSM IV, the manual that is used by professionals to define and categorize psychiatric conditions. Oftentimes, though not always, addictive disorders mask other psychiatric illnesses and patients self-medicate with street drugs. For example, if someone is manic depressive, they may find that speed evens out the radical ups and downs they are facing. While not the most effective medication for mania, it is often the only medication available in the post-Reagan United States. At the same time, untreated addiction is costly—in human terms to the individuals, families, and communities it impacts—but also in fiscal terms. Studies have shown that for every dollar invested in treatment, seven dollars in social, criminal, and health care are saved.
Individuals may have a genetic propensity for addictive disorders, and trauma can often bring that to the surface. For people without housing, trauma can be a daily occurrence. Healing from an addictive disorder while without housing may not be impossible, but is certainly markedly more difficult in a disease that requires prolonged struggle to overcome.
How Far We’ve Got to Go
While the Coalition on Homelessness had the support of policy makers, making it real, as they say, was a-whole-nother thing. The Coalition sustained a seven-year-long campaign that, while never completely reached the ultimate goal of treatment on demand, made some serious inroads. For example, treatment spending increased from just over $30 million in the city, most of which went to two large providers, to over $70 million, going to diverse treatment providers that targeted under-served communities and offered alternative modalities. We succeeded in increasing the number of treatment slots by 53%, and the wait list for treatment dropped to about 500 people on any given day. Most telling are the drug-related deaths: while still far too many, they’ve dropped down to an average of fewer than 100 a year in San Francisco.
These achievements are important and necessary, but we do not yet have treatment on demand: Those wait lists still exist, and overdose deaths resulting from a lack of access to treatment are still very much a reality in San Francisco.
The onset of this initiative puts much needed gas into an almost empty tank. Energies are now re-kindled and folks are getting exciting about truly achieving treatment on demand in San Francisco. The initiative if passed, would cost about $7-13 million, and would require the City to provide both residential and medical-based treatment on demand—the two modalities that have the longest wait lists.
If passed, the initiative would be a real response to a string of broken promises. We have countless mean-spirited initiatives that hide behind the promise of treatment—be it the aggressive panhandling ordinance or the latest incarnation of efforts to substitute criminal justice for community healthcare, the Community Justice Center. These initiatives have no treatment attached to them and frequently lead to increased jail time. However, the Treatment on Demand initiative is simple and has no hidden agenda—it’s just your plain ol’ basic ask: Shall we or shall we not have Treatment on Demand in San Francisco?
We believe that the people of San Francisco will answer yes.