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How San Francisco can get extra individuals into drug restoration | Discussion board

Tue, 27 Dec 2022 16:45:13 +0000

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What San Francisco must get extra folks in drug restoration | Discussion board

Mon, 26 Dec 2022 18:29:20 +0000

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The truth of the drug commerce in San Francisco

Sun, 18 Dec 2022 20:29:19 +0000

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In the heart of San Francisco, in a neighborhood called The Tenderloin, an open-air drug market is thriving.

A block away, in City Hall, the mayor is demanding action.

But she and her city are up against a seemingly unstoppable force: fentanyl.

Today, On Point: How did San Francisco fall to the opioid epidemic? And what can it do to recover?

guests

Randy Shaw, director of the Tenderloin Housing Clinic, a non-profit supportive housing provider. (@beyondchron)

Leighton Woodhouse, Bay Area freelance journalist who has reported extensively on the drug trade in the Tenderloin. (@lwoodhouse)

Sam Quinones, journalist. Author of Dreamland and The Least of Us. (@samquinones7)

interview highlights

On the rise of drug use in the tenderloin

Leighton Woodhouse: “COVID-19 and the emptying of the streets downtown, which created this sort of vacuum that was filled by the open-air drug market, which already existed in the Tenderloin, but then spilled out into … other neighboring districts. So that’s “One big reason. The other big reason is fentanyl. Fentanyl has been on the East Coast for quite a few years, but it’s relatively new to the West Coast, and now it’s cut into everything.”

“So if you buy cocaine, if you buy heroin, if you buy methamphetamines on the street, the chances are it’s cut with fentanyl, which is a very deadly drug and highly, highly, highly addictive. And so fentanyl, it’s killing more people And it’s addicting people like crazy. And not just cocaine and methamphetamines and things like that. There’s children, teenagers who buy Xanax on Snapchat.

“And what they get is something that’s either cut with fentanyl or sometimes is pure fentanyl. And they end up getting hooked. And some of those people, kids, end up in the Tenderloin. So this plague of this new, highly potent, highly toxic opioid is another part of the reason.”

If you were to walk outside right now, a couple of blocks around the neighborhood, what would you see?

Randy Shaw: “Mayor Breed got more publicity for the Tenderloin than ever. And every national and even international media covered her Tenderloin emergency order from last December. And when you hear the words that you just ran, your listeners should know that it was not followed by any Increased police activity. No more police were given to the tenderloin after that emergency order than before.

“No actual actions were taken to respond to the mayor’s emergency order, even though they were promised. So, it became almost a cruel joke on the tenderloin that they were promised that all these things were going to change. If you walk out now, most of the tenderloin is fine.

“The problem is you have some blocks that are so out of control, dominated by open air drug markets, that people see those blocks and they are fearful for the neighborhood. And people who live in the neighborhood can’t walk through the neighborhood without hitting some of those blocks. The real question is how does a progressive city like San Francisco install a drug containment zone in the last remaining multiracial, low-income community in the city?”

On the drug containment zone

Randy Shaw: “If we look in practical terms, almost a year, about a few weeks before the mayor gave the emergency order, there was a high-profile viral video of thefts coming from the Louis Vuitton store, wealthy bags from Union Square. The mayor dispatched 80 police officers to Union Square, very upscale shopping district a few blocks from the Tenderloin. And they stayed there for a month. And if you go to Union Square now, you’ll still see police officers and police cars everywhere to protect the property at Union Square.

“We never got a similar response ever to the drug operations in the Tenderloin. So at some point, and I think we’ve reached that point, you have to conclude that this is what the city wants it to be. The mayor continually makes statements about how upset she is, but she’s the mayor and hasn’t allocated the resources to solve the problem.”

So, you say she’s not doing enough to allocate resources or even to encourage law enforcement to change how they’re operating in the Tenderloin.

Randy Shaw: “Exactly. If you talk to the police chief, he’ll agree with everything. Yes, it’s terrible what’s going on. It’s awful. But why don’t you solve it then? And if it happened in a more affluent neighborhood, we all know drug dealers would not be allowed to stay there for a day.So it isn’t that San Francisco’s incapable.

“At some point you have to decide. They’ve just decided to allow these drug activities in a low-income neighborhood, where people don’t have the political donations and the power. And this way they can identify it as, Well, we’re containing it in the Tenderloin so we don’t have it in more affluent neighborhoods.”

Tell me a little bit more about why you think the mayor… in your words, is allowing this to happen. Is it just simply because of the low income?

Randy Shaw: “The point in my book on the Tenderloin, I talk about the history and the Tenderloin was a very prosperous neighborhood for a long time until really the 1960s. And it started a 40-year decline. It started reviving under Mayor Lee in 2011. And had there not been COVID, none of this would have happened But I think what’s historically, there’s always been people who felt like, well, let it happen in the Tenderloin so it doesn’t happen in … the other upscale neighborhoods .

“And I think that, you know, we have district elections, so most of the supervisors don’t represent the tenderloin. So politically, it’s easier for them to not have to deal with it and just feel like it’s someone else’s problem. And then we have this whole crazy view that says that if you arrest drug dealers, you’re criminalizing poverty.

“But the people who are impacted by drug dealers are all poor. The tenderloin is all low income. We have no single-family homes. It’s the low-income areas, permanently affordable housing in most of the neighborhood. So there’s no risk of gentrification. So it’s really a hypocritical policy choice by a city that prides itself of being progressive.”

I’m looking at the overdose death rates for the city of San Francisco in 2021. 625 people died from drug overdoses. It was more than 700 in 2020. The city itself acknowledges that overdose death rate overdose rates are still 40% above pre-pandemic levels. Is that what you’re talking about?

Randy Shaw: “COVID closed down businesses, when it first started in March of 2020. And so it created empty spaces for drug dealers to proliferate. There were not this level of drug dealers prior to COVID, because businesses were thriving, and the city was operating and people were there. But once the city kind of emptied out after March 2020, when spots are empty, it invites opportunities for illegal activities.

“And it’s not just the Tenderloin, it’s nearby areas which are also taken over. And the city funds harm reduction programs that give out needles and encourage drug use. They’ve spent $30 million on a linkage center where the people can go to shoot up drugs and the drug dealers stood outside and sell them the drugs and they go in and shoot up in the city property. So there’s been a lot written about and talked about the nonsensical approach to safety in San Francisco. And it’s all true.”

What do you think the neighborhood needs right now to really get a handle on the situation?

Randy Shaw: “Last week, the mayor announced an $8.5 million investment in community ambassadors, unarmed ambassadors in various part, but they don’t deal with open drug markets. She could have taken that same 8.5 million and either have off duty police officers or armed security guards on the handful of blocks in the tenderloin where the dealers are operating and could have cleared that out.

“So when you see money being spent for things that don’t close open drug markets, it’s hard to understand how the mayor’s words are matched with actions, because they have not been.”

What needs to happen right now in San Francisco?

Leighton Woodhouse: “The first thing that needs to happen is, as we’ve remarked, you know, arresting the drug dealers, in my opinion. But there are, of course, many, many others that need to take place. Some of them already are being implemented in San Francisco. There’s much more treatment available than there used to be. I think the wrong mix of treatments, for example, you know, the harm reduction is sort of the prevailing philosophy in San Francisco. And harm reduction is basically premised on the idea that you need to keep people alive in order for them to be able to be steered to recovery.Obviously, nobody can recover if they’re dead.

“And so this is the philosophy around things like needle exchange, safe consumption sites passing out naloxone, which is an anti-opioid remedy and things like that. But in San Francisco, people aren’t pushed towards recovery. They’re given the implements and the oversight to stay alive, but then they’re just left where they are.I think there needs to be…much more aggressive towards opening beds in recovery centers where people can detox and rehabilitate with medically assisted treatment.

“They can go on Suboxone, they can go on methadone and things like that. But unfortunately, there’s no medication for meth. But where they can be treated and brought to point of functionality and ultimately sobriety. And that is not at all being pushed in San Francisco, it’s very much about just handing out needles, handing out foils, handing naloxone. And that’s it. That’s kind of where it ends in terms of treatment in San Francisco.”

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San Francisco can’t ban suspected drug sellers

Sat, 16 Jul 2022 08:01:45 +0000

SAN FRANCISCO — A California appeals court ruled against an effort by San Francisco to ban four suspected drug dealers from a 50-square-block area in a city neighborhood rife with drug dealing and drug use.

The ruling issued Friday is part of a case that started in 2020 when San Francisco south 28 alleged drug dealers who frequent the Tenderloin and South of Market neighborhoods to try and clean up the area that has seen the city’s largest number of overdose deaths. Then San Francisco City Attorney Dennis Herrera said the lawsuits, if approved in California Superior Court, would prevent the alleged dealers from entering that area of downtown.

The state’s First District Court of Appeal said a local government may be entitled to issue narrowly targeted stay-away orders to wrongdoers in some circumstances, but not one that is so broad, the San Francisco Chronicle reported Monday.

The city’s first attempt to enforce the ban against four of the 28 alleged drug dealers was blocked last May by a state judge in San Francisco who said state law did not appear to authorize a court to prohibit someone from entering a geographic area — but even if it did, the proposed order was so broad that it would violate the constitutional right to travel.

She said the San Francisco judge was entitled to believe the four people’s statements “that they were interested in taking advantage of the employment, treatment, housing, and health services available in the 50-square-block neighborhood.”

San Francisco City Attorney David Chiu’s spokesperson, Jen Kwart, said Monday the office was disappointed by the ruling and had not decided whether to appeal.

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San Francisco youngsters stroll previous open-air drug den on approach dwelling from college, stunning video reveals: report

Sun, 10 Jul 2022 14:54:23 +0000

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San Francisco children were recorded on video having to walk past what appeared to be one of the city’s open-air drug dens on their way home from school.

Ricci Wynne posted the video on Twitter last week, writing that the students were getting off the 14 transit line on 8th and Mission Streets when they encountered what appeared to be the homeless encampment sprawled across the sidewalk.

“This is no back ally [sic],” Wynne wrote. “This is a main artery in our city that has been hijacked bye [sic] drug dealers and now it is pure filth!”

The video shows a stream of children and other passengers getting off the public transit system before the camera cuts to the sidewalk, where a group of apparently homeless people was gathered.

SAN FRANCISCO BAY AREA MOTHER OF FENTANYL USER WARNS CITY IS ENABLING SON’S DRUG USE

Wynne added, “Now ask yourself this question would you want your children to walk through this squalor just to get home from school?”

WARNING: VIDEO CONTAINS EXPLICIT LANGUAGE

Wynne tagged a slew of politicians in the post including President Biden, Vice President Kamala Harris, House Speaker Nancy Pelosi, Democratic Sen. Dianne Feinstein and San Francisco Mayor London Breed.

Describing himself as a recovering drug addict, Wynne frequently posts videos showing drug addicts and drug paraphernalia on the city streets.

Homeless people are seen on streets of the Tenderloin District in San Francisco, California, on Oct. 30, 2021. -File
(Photo by Tayfun Coskun/Anadolu Agency via Getty Images)

The area where Wynne says the video was taken is nearby the Linkage Center in the city’s Tenderloin District, a neighborhood notorious for its rampant drug abuse.

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The Linkage Center was intended to connect homeless people and drug addicts with social services, but multiple accounts have claimed people were instead shooting up or smoking fentanyl inside.

San Francisco logged 650 overdose deaths last year and at least 700 in 2020. Recovery advocates have said that every one of those deaths was preventable.

Fox News’ Claudia Cowan contributed to this report.

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San Francisco to open drug sobering middle to handle meth and fentanyl epidemic and road disaster

Wed, 22 Jun 2022 00:38:50 +0000

San Francisco will open a drug sobering center on Monday where people on the streets can temporarily ride out highs and get connected to treatment, the latest initiative to address the overdose crisis and complaints about drug use on city streets.

The center, called SOMA RISE, will operate out of a former office building the city is leasing at 1076 Howard St. in the South of Market Neighborhood, one of the epicenters of the drug crisis, along with the Tenderloin.

It will have 20 beds where people from the Tenderloin and SoMa are expected to stay between four and 12 hours, longer if necessary. People can access beds and chairs, bathrooms and showers, food and water, clothes and connections to “services and housing support,” according to information online.

The city designed the center in 2019 to mainly serve users of methamphetamine, which can cause bad reactions including paranoia or hallucinations and can prompt aggressive behavior. The increase in meth use over the last decade contributed to skyrocketing overdose deaths and flooded San Francisco’s emergency rooms with people in a mental health crisis. The center will also help users of the powerful opioid fentanyl, a factor in a majority of the city’s more than 1,300 overdose deaths over the past two years, and other drugs.

The program will be voluntary. People can walk in or be transported by ambulance or city outreach teams that respond to people who are homeless or in mental health crises.

Staff on site will monitor participants’ vital signs, respond to and reverse overdoses and help them find and navigate services. Once people come down from their highs, staff can transport them to their next destination, such as a shelter, treatment program, medical clinic or “home location,” information said online. The site will be run by nonprofit drug treatment provider HealthRight360, but funded by the city.

The center will initially be open daily from 8 am to 8 pm and scale up to 24 hours a day.

Officials hope the opening of the long-awaited drug sobering center — after three years of planning — will provide long-term solutions to people suffering from addiction and reduce the number of people acting erratically or dangerously while high on the streets.

“The rise in drug use and overdoses in San Francisco shows that we have to take action and try new things to get people the help they need,” Breed said in a statement in June 2021. “Opening a sobering center provides our outreach teams with a place to take someone who shouldn’t be left alone on the street where they can sober up, settle down, and get connected to other services.”

The need is far greater than 20 beds: In the last comprehensive count in 2019, the city counted 4,000 people who struggled with substance use, mental illness and homelessness.

The 18-month pilot program finally comes to fruition as San Francisco continues to try to grapple with reducing public drug use and fatal overdoses. The center’s opening follows Mayor London Breed’s emergency declaration in the Tenderloin in December to address the overdose crisis. It also comes a week after the news that the centerpiece of the emergency – a drop-in center to connect people to services in UN Plaza – will close at the end of the year.

The Tenderloin center was meant to help people get off the streets, receive basic services and find long-term housing and treatment, but critics took issue with the city allowing drugs use in the outdoor area of the center, saying it enabled addiction. Supporters said it provided a low-barrier space for people to get help.

The debate could be reigned at the sobering center. Last year, the city said people would not be allowed to use drugs at the new sobering center, but would not be kicked out if they were caught using them.

Tom Wolf, a recovery advocate, said he wanted to reserve judgment on the sobering center to see how it goes. He supported the idea three years ago, but was more hesitant after the city allowed drug use at the Tenderloin center, which he opposed as counterproductive to recovery.

“I appreciate the fact that (the city) is trying to do something to address drugs and people in crisis,” he said. “I’m not 100% sold that this low-barrier approach where they give people a space to use dope, when it’s not a clinical setting like a drug consumption site, is really the best approach.”

He expects all the beds will be full, but said the key is to see what happens after visitors leave the center.

“What happens to that human being?” he asked.

The federal government prohibits supervised drug consumption sites staffed by medical professionals, but New York City has opened two. City officials, including Breed, have been talking for years about also opening a consumption site in San Francisco similar to New York’s, but the plan hasn’t moved forward, frustrating harm reduction advocates.

Her spokesman Jeff Cretan said Tuesday the city was still talking with the Department of Justice as they worked through “very real issues.” He said it was “an option” to have a nonprofit run the site, as New York does, to avoid liability, but the city was still “working with the federal government and finding a path forward.”

The city started planning the drug sobering center in 2019, but the pandemic delayed the planned opening in 2020. The city announced last June that the center would open in the fall. It wasn’t immediately clear why the opening was yet again delayed.

Supervisor Rafael Mandelman, who co-chaired the city’s meth task force, which recommended opening such a site in 2019, told the Chronicle in the spring of 2021 that while he was glad the site was in the works, he was concerned about delays and that this tiny pilot wouldn’t be enough to meet the needs.

“I’m sure we’re going to find that we need more than just one,” he said at the time.

Information online about the center said experts are developing criteria to evaluate the program’s effectiveness, which will guide improvements and “may support initiatives to create additional drug crisis response centers in other neighborhoods where we know the need exists.”

The program’s costs, what long-term services would be offered and other details weren’t immediately available Tuesday.

This is a developing story. Check back for updates.

Mallory Moench (she/her) is a San Francisco Chronicle staff writer. Email: mallory.moench@sfchronicle.com Twitter:@mallorymoench

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CA Appeals Courtroom Guidelines San Francisco Can’t Ban Tenderloin Drug Sellers

Thu, 05 May 2022 15:30:49 +0000

A California First District Court of Appeal decision released on Monday ruled that a ban against four drug dealers from a 50-block area of the Tenderloin and South of Market neighborhoods is illegal, upholding earlier rulings on the matter.

The case, The People v. Padilla-Martel, stemmed from an action by former San Francisco City Attorney Dennis Herrera and the City of San Francisco two years ago. In 2020, authorities had a hard time culling rampant drug use in the Tenderloin area of the city. Needing a new way to keep out a few dozen drug dealers who were responsible for a large percentage of drug dealing in the area, Herrera sued 28 of them that September from entering a 50-block area of the city. As most had several drug dealing priors, and all but one living outside the city, the city thought it had a strong case for public safety. The tenderloin still is an epicenter of drug dealing and overdose deaths in the city.

However, the matter was quickly challenged by the dealers as violating their constitutional right to travel and not having a local or state law to back the widespread ban. In May 2021, the San Francisco Superior Court ruled it unconstitutional. The city quickly appealed to the ruling, where it was soon heard again in the California First District Court of Appeal.

This led to a 3-0 ruling issued on Friday and released on Monday by the Court, in which it upheld the Superior Court ruling and said that while stay-away orders were usually legal in some circumstances in small areas, a broad 50-block ban for dozens of people was simply unconstitutional.

“We are mindful of, and sympathetic to, the challenges faced by the city in addressing the issues of illegal drug sales, drug use, and the drug-related health crisis and its effects on the people who live and work in the neighborhood,” Justice Marla Miller said in the court’s ruling. “Although the city contends these defendants have no reason to ever even be in the 50-square-block Tenderloin neighborhood except to sell drugs there was evidence that many community resources and government agencies are located in the Tenderloin.”

“The court finds it credible that the suspects were interested in taking advantage of the employment, treatment, housing, and health services available in the 50-square-block neighborhood. The SFPD declarations did not show that any of the defendants has been convicted of selling drugs, possessing drugs for sale, or violating any pretrial stay-away orders.”

Reaction to the ruling

The ruling led to a generally negative reaction in San Francisco on Monday and Tuesday. A spokesman for current San Francisco Attorney David Chiu said that the office was disappointed by the ruling. Others were worried what this would mean for crime in the city.

“Right now we’re still in [San Francisco District Attorney] Chesa Boudin’s San Francisco, where most of these guys get off anyway,” one San Francisco police officer said to the Globe on condition of anonymity on Tuesday. “Now we can’t even keep these guys away. Drug dealers certainly are taking advantage of the tenderloin, but you can bet it’s not for treatment or housing services or anything else the court listed. Well, except employment, but you have to sell drugs somewhere.”

“I’m not a lawyer, so maybe it did violate their right to travel or whatever, but these people are hurting people and making the lives of residents worse. We arrest them, they’re out soon enough. We try and force them out, court puts them back in. People try and clean up the area, and you have their cars and homes broken into. The judges obviously never had to respond to a call at 2 AM to find another person dead because of an overdose and then pass by on the way to the morgue a known dealer. We have to uphold the law, but let me tell you, it can be trying some days.”

“This is the San Francisco we have now in the Tenderloin. And these judges just stopped one of the few things left we can do to try and bring it back.”

As of Tuesday, the San Francisco City Attorney’s office is deciding whether or not to appeal the case to a higher court.

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San Francisco can’t ban suspected drug sellers from Tenderloin, court docket guidelines

Mon, 02 May 2022 22:56:10 +0000

The grim toll of drug dealing in San Francisco’s Tenderloin does not give the city legal authority to ban four suspected dealers from a 50-square-block area of the neighborhood, says a state appeals court.

Then-City Attorney Dennis Herrera filed suit in September 2020 seeking stay-away orders against 28 people from a large area of the Tenderloin, the center of the narcotics trade in San Francisco. Police said there were 600 drug-dealing arrests in the Tenderloin in 2020 and crime rates there were three times the city’s overall rate. Out of 699 drug overdose deaths in San Francisco in 2020, more than 40% were in the Tenderloin and South of Market, officials said.

The injunction would prohibit the named individuals from entering the area except while passing through by bus or subway, or walking a short distance to a court hearing. Violations would be punishable by fines of up to $8,500.

The city’s first attempt to enforce the ban, against four Oakland residents who had been separately arrested on suspicion of illegal possession and sale of drugs, was blocked last May by San Francisco Superior Court Judge Ethan Schulman. He said state law did not appear to authorize a court to prohibit someone from entering a geographic area — but even if it did, the proposed order was so broad that it would violate the constitutional right to travel.

On Friday, the state’s First District Court of Appeal said a local government may be entitled to issue narrowly targeted stay-away orders to wrongdoers in some circumstances, but not one that was this broad.

“We do not minimize the serious and pervasive harm caused by the flood of street-level drug sales in the Tenderloin,” Justice Marla Miller wrote in the 3-0 ruling. “We are mindful of, and sympathetic to, the challenges faced by the city in addressing the issues of illegal drug sales, drug use, and the drug-related health crisis and its effects on the people who live and work in the neighborhood.”

Miller said, however, that “although the city contends these defendants have no reason to ever even be in the 50-square-block Tenderloin neighborhood except to sell drugs there was evidence that many community resources and government agencies are located in the Tenderloin.” She said Schulman was entitled to believe the four people’s statements “that they were interested in taking advantage of the employment, treatment, housing, and health services available in the 50-square-block neighborhood.”

The city’s lawyers cited a ruling by the state Supreme Court in 2016 upholding a judge’s order requiring a defendant who had been convicted of robbing a Home Depot store to stay away from all of the appliance chain’s outlets in California. But Miller said the order did not interfere with the right to travel because the defendant was still allowed to go anywhere else in the area.

In this case, she said, each of the four defendants was accused of crimes in a relatively small area, and one has two daughters who live in the tenderloin.

Herrera left the city attorney’s office in November to become head of the San Francisco Public Utilities Commission and was succeeded by David Chiu, a former state assembly member. Chiu’s spokesperson, Jen Kwart, said Monday the office was disappointed by the ruling and had not decided whether to appeal.

Still, “we are pleased the Court of Appeal agreed that we can continue to pursue creative remedies in similar public nuisance cases,” Kwart said, referring to the state law against private actions that harm public health. “We are currently evaluating potential next steps, and we will continue to look for ways to use civil law to promote and increase public safety in the Tenderloin.”

But Chessie Thacher of the American Civil Liberties Union, a lawyer for the four defendants, noted the court’s observation that, under the law, “human beings do not constitute nuisances in themselves.”

“The city should pursue remedies, but not on the backs of these individuals,” Thacher said.

Bob Egelko is a San Francisco Chronicle staff writer. Email: begelko@sfchronicle.com Twitter: @BobEgelko

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92 Kilos of Fentanyl Seized in East Bay Drug Busts – CBS San Francisco

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Homeless Deaths Doubled in San Francisco Through the Pandemic’s First Yr, Principally from Drug Overdoses

Sun, 17 Apr 2022 13:10:20 +0000

COVID-19 Caused no Deaths Among People Experiencing Homelessness, but the Pandemic Reduced Contact With Substance Use Services

By Laura Kurtzman

More than twice as many people experiencing homelessness in San Francisco died during the first year of the COVID-19 pandemic compared to previous years, with the leading cause of death being drug overdose. No deaths were attributed to the virus itself.

The research, conducted by UC San Francisco in collaboration with the San Francisco Department of Public Health (SFDPH), demonstrates the urgent need to reach people who use drugs and are unhoused with substance use services. The research also shows that the City’s COVID-19 mitigation strategies to support this population, including placing people in shelters in Place hotel rooms, were largely protective and may have prevented additional deaths from occurring.

The study, which appears in JAMA Network Open, examined deaths of people characterized as homeless between March 17, 2020, when San Francisco’s shelter-in-place order was issued, until March 16, 2021, compared to the deaths each year from 2016 until 2019. It then linked them to the City’s data showing demographic characteristics and the services people had used before they died. Autopsy results were provided by the Office of the Chief Medical Examiner.

The overwhelming majority of the deaths, or 82%, were associated with drug overdose, mostly from synthetic opioids, such as fentanyl, often used with methamphetamine. Other causes of death were far less common: 6% died of traumatic injury, including homicide and suicide; 5% died of chronic conditions; 3% died of complications of chronic alcohol use; and 2% died of other causes. San Francisco’s data stands in contrast to other cities such as New York, in which COVID-19 was the leading cause of deaths among the homeless population, followed by drug overdoses.

Mitigating death among people experiencing homelessness will require a multi-faceted approach and a willingness to invest significant resources.

Maria Raven, MD, MPH

“Our findings highlight the severe vulnerabilities faced by individuals who do not have housing,” said Maria Raven, MD, MPH, Chief of Emergency Medicine at UCSF and a Vice Chair in the UCSF Department of Emergency Medicine. Raven also co-leads the program on adults with complex needs at the Benioff Homelessness and Housing Initiative.

“Death from the COVID-19 pandemic may have been avoided, but deaths from other factors known to impact this population disproportionately – drug use and violence – have increased,” she said. “Mitigating death among people experiencing homelessness will require a multi-faceted approach and a willingness to invest significant resources.”

About 80 percent of those who died were male, and as a clear sign of the racial disparity among those who died, a disproportionate number (27%) were Black, although the City’s Black population is just 5.6%.

The pandemic disrupted substance use services as fentanyl was driving a spike in overdoses in San Francisco. Since more than 90% of those who died were known to the City’s public health and social services, the researchers could track their use of services over time. Although fewer people generally used medical services during the pandemic, two-thirds of the people in the study were able to access care in the 12 months prior to their deaths. But contact with substance use services dropped from 20% in 2019-2020 to 13% during the 2020-2021 pandemic year.

“The pandemic has significantly impacted our delivery of care and services to people experiencing homelessness,” said Barry Zevin, MD, SFDPH’s Medical Director of Street Medicine, Shelter Health, and the Open Access Clinic. “We have been able to provide care and treatment to large numbers of people who were previously hidden and hopeless. The key is meeting people where they are at.”

UCSF and SFDPH researchers said it was important to track the cause of death among people experiencing homelessness during the pandemic, so as not to assume they all died of COVID-19. Linking mortality data with the uses of services could help identify places where services could be increased to prevent future deaths.

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