The City’s Plans for Wellness Hubs Is Halted. Now What?

A recent incident in which a 10-month-old child accidentally overdosed on fentanyl at a park in the Marina was an alarming wakeup call to the city about its mismanagement of the drug crisis. Fentanyl, an extremely potent and addictive opioid, is one of many illegal substances that have created cycles of abuse, addiction, and death in San Francisco. It has claimed the lives of more residents than COVID-19. 

This isn’t a new problem. In 2008, San Francisco voters passed Proposition T, which required DPH to maintain an adequate level of free and low-cost substance abuse treatment services, sufficient enough to meet demand. Fourteen years later, we are still seeing the Department of Public Health experiment with this, fail, and ultimately struggle to even begin to get their arms around the city’s drug problem. 

DPH’s latest experiment was a controversial facility originally called the “Tenderloin Linkage Center” (TLC) that ultimately closed. In its wake, residents are getting conflicting messages about the future of addiction treatment in San Francisco.

What was the Tenderloin Linkage Center?

The Tenderloin Center, formerly the Tenderloin Linkage Center, operated as a safe consumption site, a designated location where those struggling with addiction could use drugs they bring into the center on their own with the ultimate goal of linking people to the city’s continuum of care (mental health, addiction, housing, and vocational services). The center did show some promise by providing a space where overdose reversal was accessible—over the course of its operation, staff there reversed 300 overdoses on-site, plus 28 reversals in nearby streets. Every death that’s reversed is a victory. But users continue to overdose if they don’t get connected to recovery services.

And city data shows that the center fundamentally failed at connecting people to services. Between January 18, 2022 and the center’s closure in December 2022 a total of 124,100 people visited the site, but only 2,927 completed "linkages" (meaning the person was referred to and accepted housing, behavioral health, social services or drug treatment services). That is a 2.4 percent success rate. The success rate is even lower when we just look at how many people accepted just behavioral health or drug treatment services—less than 1 percent. While the site had amenities like access to meals, showers, and laundry services, its explicit purpose was to connect drug users with resources to break cycles of addiction and in this, it failed.

We need facilities that offer both harm reduction and recovery. In the end, the Tenderloin Center only offered harm reduction services. We need both if we’re going to make meaningful progress.

What’s the city’s plan now that the TLC has shuttered?

TLC, while temporary, served a few purposes: to gauge whether the city could replicate this model citywide; to test the legal waters (since safe consumption sites are technically illegal under federal and state law); to reduce overdoses; and to try a new approach to getting drug users in the city’s continuum of care. As of December 4, 2022 it has closed permanently, and the future of the city’s plan to tackle its drug problem has been cast into doubt.

Following the closure, the conversation pivoted to the Department of Public Health’s anticipated opening of 12 similar sites called “Wellness Hubs” across the city. These sites would have all functioned, at their most basic levels, as safe consumption sites, with more advanced options, like showers, laundry services, medical services, and behavioral health services, for the most impacted parts of the city. But it’s not clear whether they would be better than the TLC at getting users into long-term recovery.

In early December the Department of Public Health said it “is not planning to open 12 new drug consumption sites” and the Mayor’s office universally and quietly called off its plans to open the sites with the reason being “unforeseen legal problems.” However, the TLC operated without causing legal problems—so why isn’t the city moving forward with its plans?

It’s a combination of political, legal, and image problems. Despite the abrupt backpedaling from the DPH, this fight is still going on within the public discourse. The proposed plan met public backlash and skepticism within the recovery community. Supervisor Dean Preston criticized the Mayor for being “unwilling to lead.” Supervisor Hillary Ronen tweeted about the Mayor’s decision, calling for “courage.” A protest led by safe consumption site activists this past week demanded these centers move forward with development. 

What’s the solution?

Hubs for people suffering from addiction that offer a range of services from harm reduction to long-term recovery is a good plan—but the city should define success metrics and commit to more stringent data collection before they open. When the TLC was operating, DPH released a $500,000 “report” so dubious that Supervisor Raphael Mandelman called it "a very expensive advertisement for safer consumption facilities." In order to ensure these centers are actually working, the public needs transparency—and accountability.

Furthermore, there is an unseen cost to these facilities that goes beyond tax dollars. Tenderloin Housing Clinic CEO Randy Shaw critiqued TLC for saddling a low-income neighborhood with open-air drug markets, exposing the residents living in the area to negative externalities like encountering drugs, drug paraphernalia, and users displaying dangerous behavior. Tracking the impact these centers have on public safety is also essential to ensuring their success.  The open-air drug markets and usage in the neighborhood is so extreme that Tenderloin business owners are now circulating a petition to demand a full refund on their business taxes back from the city. 
The city needs a strategy that rolls harm reduction and rehabilitation into one and considers public safety at the same time—and it needs to communicate that strategy clearly to residents.