City Hall Digest: Supervisors Demand Answers From Department of Public Health and Portland Deals With Drug Decriminalization

City Hall Digest is TogetherSF Action’s weekly dispatch from San Francisco’s City Hall, broken into bite-sized pieces—because understanding local government is your fundamental right.

Supervisors Demand Answers on Addiction Treatment Shortcomings

Recently, Supervisors Catherine Stefani and Rafael Mandelman sent a letter to Dr. Grant Colfax, the director of the San Francisco Department of Public Health, expressing their concerns over the availability of addiction treatment, and the ability of contracted service providers to deliver these crucial services.

Their letter was triggered by a San Francisco Chronicle article highlighting the story of a homeless veteran who had 26 separate contacts with emergency personnel in the month of June alone. He repeatedly asked to be taken to detox services—and on the two occasions EMS escorted him there and waited with him, he was turned away because services were not available. Intake coordinators blamed staff shortages on their inability to care for him. 

The Department of Public Health has long been telling the public that addiction treatment is readily and easily accessible. While anecdotal, this story not only provides a compelling counterargument to their claims but is also backed by facts. When you check the SFDPH’s website for finding treatment, admissions to withdrawal management programs are currently on hold. Furthermore, in FY2021-22, just 54% of people who asked to get into residential treatment were admitted within 10 days. 

The Supervisor’s questions in their letter focus on two main things: what accountability there is for the nonprofit organizations who receive tens of millions of dollars in city contracts to provide services, and the department that doles out these contracts.

For instance, the supervisors ask for copies of every contract between the department and substance use disorder service providers and their funding sources. They also requested information on how many people are seeking drug and alcohol addiction services on a weekly/monthly basis, how long the wait period is for treatment, and how many individuals who accessed withdrawal management services transitioned into outpatient treatment.

Articles recounting similar stories have been published previously, and the chronic inability of service providers to actually get people into services is well-known. Leaders at local service providers like HealthRight360 have stated that finding the right staff and being able to pay them a living wage is a challenge. But thanks in part to our advocacy, and thanks to Mayor Breed’s leadership, millions of dollars in funding to make service provider wages more competitive were included in the latest budget. Now, providers have no excuse. 

We’re thankful that Supervisors Stefani and Mandelman are asking tough questions that hold service providers accountable. Now, we need the Department of Public Health to provide honest answers about why their data does not match the experience of so many San Franciscans.

Portland Grapples with Negative Externalities of Drug Decriminalization

Last week, the New York Times published a piece examining the ongoing situation in Portland after the passage of a statewide measure in 2020 that decriminalized the possession of a “personal” supply of drugs (i.e. 1 gram of heroin, 2 grams of meth). Instead of criminal charges,  these offenses have become administrative citations. 

Three years later, it appears it isn’t going well. 

Oregon’s overdose death count nearly doubled in 2022 compared to 2019, and people are waiting months to enter treatment. A recent analysis by The Economist found, “from the 4,000 citations issued in Oregon in the first two years of the policy, fewer than 200 people called the hotline and fewer than 40 were interested in treatment.”

People in Portland are visibly suffering from their addictions on the street and are resistant to services, like many people with substance use disorder in San Francisco. Street conditions are further worsened by the same rampant open-air drug dealing that we see in the Tenderloin. Recent reporting from San Francisco also showed how drug dealers are taking advantage of Portland’s lax drug laws to peddle their product. 

The situation in Portland is serious, and it goes to show how important the cooperation among city departments and law enforcement is to ending the fentanyl epidemic. In Portland, law enforcement’s role has been reduced to issuing administrative citations that are essentially unenforceable fines. From arresting drug dealers to taking down larger networks, law enforcement has a clear role to play in tamping down the supply side of the drug crisis. 

Additionally, what should be a smooth funnel from the street to treatment is clogged by services with long waiting lists. For decriminalization to work, cities and states need to provide funding and staffing to ensure treatment on demand is accessible for everyone who needs it.

While no one on the liberal political spectrum is interested in repeating the past mistakes of the War on Drugs, it is also clear that politicians have a mandate to design a system that effectively employs tough love strategies to get users to accept the treatment they need, while also removing this deadly drug from our cities’ streets.